COVID-19 FAQs to help you answer client questions

[Text on Screen: COVID-19 Webinar. January 27, 2021. UnitedHealthcare]

[Text on Screen: Opening Remarks]

Alison Richards: Good afternoon everyone, and welcome to our call today. I'm Alison Richards, the Chief Operating Officer for UnitedHealthcare's national account business.

[Text on Screen: Opening Remarks. UnitedHealthcare COVID-9 Briefing. UnitedHealthcare]

And I couldn't start this call in the new year without first saying, thank you. And extending our sincere gratitude and appreciation for your partnership and your business. Each and every day we are all working together with you to serve the millions of people who choose UnitedHealthcare. And I know this continues to be extremely challenging times, and we thank you for the trust you have placed in us, and continue to place in us.

So let's get started with what we're going to do today. We're going to show the agenda. And I have two colleagues that are just awesome that you've heard from before, Craig Kurtzweil, our Vice President for the Center of Advanced Analytics, and Dr. Rhonda Randall, our Chief Medical Officer.

I'm also going to provide a few updates along the way. So let's get started with some of the logistics. The call is being recorded, and we will share the replay through our normal channels. We are combining our commercial audiences today, including brokers, consultants, fully insured employers, and self-funded employers.

With these different audiences there may be different consideration, different protocols, and different guidelines regarding the content that we share. So as always, if you need more information, your UnitedHealthcare or UMR account representative, is the best resource to support you.

We're going to have a Q&A answer time at the end of the call, and all participants are encouraged to enter questions in the Q&A box at the bottom of the screen. We will do our best to cover the themes that are coming in and that we are seeing, throughout all the questions.

So again, your UnitedHealthcare or UMR account representative will be the best person to get to if you have really specific questions after this call.

Now, of course, we can't have a call without the disclaimer that's out there. So our legal disclaimer is on the screen. A couple of highlights. This call is intended to provide general information and does not constitute formal advice. So please contact your medical, legal, and tax advisor on how to respond to the specific situation.

So with that we're going to get right into our content today. You've all heard over the last couple of calls, Craig Kurtzweil talking about what's going on nationally as well as what's going on locally with the data. So I'm going to turn the call over to Craig. Craig?

[Text on Screen: Understanding the Data]

Craig Kurtzweil: Thank you, Alison, and good to be back with you all. We always think it's a good idea to start with the data to get us all grounded with where we've been with the pandemic, and potentially where are we headed with the pandemic.

So I'll start with a quick overview of what's happening across the country. We'll look at a couple of the individual states that are of interest. And well talk a little bit about vaccine reporting and abatement as well.

But let's start with a look at what's happening across the United States. A chart that's familiar to most of you, again, we're looking at what's happening across the total of the United States. The bars are the cases that are coming through per 100,000 citizens. The orange line is the positivity rate and the black line is the mortality rate.

A couple things since we've talked last, just to kind of take note of, did we see an impact when it came to the holiday season? You can see there is a dip in both of the holidays, whether it's the Thanksgiving holiday or the end of the holidays. You can see the dip in the cases, and then the rebound that we do see with the spread of the disease post-holiday. So you can see a couple of those spikes in the trend in the late winter season.

But we're in an interesting point in time when it comes to the pandemic, mathematically, analytically. If you look at those last couple weeks, we're now starting to see 11% decline two weeks ago, and over a 20% decline in the number of cases in the last week. So much so that if you look at across the United States, 48 out of the 50 states saw a decline in cases over the last week. I'll talk about what that means as we talk about vaccinations and things like that, but a really interesting spot as I've been studying this for the past now almost a year, we're at an interesting spot where the declines that we're seeing now is something we haven't really experienced, and especially haven’t experienced especially over the past six months or so. So more to come on that, but really optimistic as far as where the trend lines are looking at this time.

On the next page we thought it would be good to give you an update on some benchmarks. I know you're all in different industries, and obviously the COVID spread and severity of COVID is very different based on the industries that you serve.

So for example, on the far left hand side we that our clients that are in the university space, the nursing, nursing homes space, as well as airlines and so on, we are seeing a higher rate of COVID. That's the blue bar. And the red bar, beginning to look at the admissions that are coming through as well. So a look at severity.

Especially within the nursing industry as well as the nursing home industry, we're seeing higher rates of COVID and higher rates of admissions that are happening within that block of business in particular.

And then as you go to the far right, as you get into high tech, obviously very different geographics. But from a workforce perspective a very different experience when it comes to COVID spread and severity.

On the next page we take a unique look. We haven’t shown you this chart before, but I think it's really interesting but I love the numbers behind this.

As we start to look at the known prevalence of COVID, the partially vaccinated portion of the US population, as well in green, the completely or fully vaccinated portion of the population, we start to get to some interesting math here.

So let's start with the US total population. In total, and this is as of Sunday night, 7.6% of the United States' population had a known case of COVID. Now, we know that – and I stress the word known. That's just the number of COVID cases that have come through and been tested and been reported.

Based on some Jama research that was published a couple weeks ago, actual COVID in a population is likely, and no one knows for sure, but likely around four times that. So across the US population, if we do that quick math, that's over 30% potentially of the US population has actually had COVID in one form or another, during the pandemic.

If we look at partially vaccinated, so those are the folks that have gotten one shot and just one shot at this time, about 5% of the population has had one shot, and almost a full percent have had two shots or have been fully vaccinated. Now, some of those folks might take a little bit more time two more weeks after vaccination to get really complete efficacy of those medications, but are fully vaccinated at this time.

So as you do some math and start to combine those, you add those together and get to 13.5% of the US population has had either known COVID, partially vaccinated, or fully vaccinated.

Now, I have to stress and note for the analytic folks that are on the phone, there are people that could have known COVID and receive a vaccination. So there could be a little be a little bit of double counting there, but it should be pretty close to what things look like. But then again, if you do the math and you take four times the known prevalence, call it 30%, plus another 5, 6% being vaccinated, we start to get to some interesting numbers, where we're approaching upper 30s, even low 40s as far as what portion of the population has at least some protective capability around the virus.

It gets even more interesting when you look at some of the individual states. On the far left if you look at what's happening in North Dakota, South Dakota, Alaska and so on, those are the states, especially the Dakotas, that if you remember last time we talked, I was stressing they were the ones that were really having large problems. They saw a dramatic spike, some of the highest rates of COVID that any states have seen at any time during the pandemic. Their known prevalence is in the 12, 13, 14% range. But at the same time, they're also some of the states that are leading the way when it comes to the percent of their population that is getting partially and fully vaccinated.

So the combination of that, again, if you do the math and take the known prevalence, multiply it by 4, and then add in the vaccination rates that we see in those states, North Dakota and South Dakota get to 50%, 60% of the population meeting one of those criteria. Now, not all the way to where we're talking about herd immunity and those types of things, but getting to a portion of a mass number that starts to dramatically change the spread of the disease mathematically in a population. You look at their specific charts, dramatic decreases in cases that we've seen over the past month plus in the Dakotas.

So it's early, they're smaller states, but an interesting study on potentially what these numbers could start to look like across the States and across the country. Next page.

We are going to be bringing and not only reporting at a state level, at a United States level, but we're going to be bringing that vaccine reporting to you.

So in the same way that we've produced the COVID report that allows you to look at the confirmed and possible and probable cases that have come through, we are in the lower left going to bring in vaccine data. So looking to see the number in the population that has been partially vaccinated, fully vaccinated, and then have the ability to look at that by week, by age bracket, by relationship, employee versus spouse, and by geography.

Where the numbers make sense, where we're not identifying individual people from a PHI perspective, we'll be rolling this reporting out to you in the near future, so you will have that at your fingertips as well.

And then finally, on the last page, we can't talk about COVID without also talking about the impact that COVID has.

Just to kind of round out what happened in 2020 from the data perspective, we see that there have been again, significant reductions in preventive care. In the April, May time period we saw 30, 40, 50, 80% reductions in some of these services.

What I would note is there were a few months when we started to get back to that zero percent line where things got to be more normal, we never had a real substantial catch up period. But then again, when you look at November and December, some of those lines start to come back down. You are seeing a little bit more wellness abatement in the population at the end of 2020.

So I can't stress enough, we're all dealing and working through COVID and vaccinations and things like that, but getting back to a return to care around wellness is still a high priority for the country and for our employer clients.

With that, I'll pass the ball back to you, Alison.

[Text on Screen: National Policy Updates]

Alison Richards: Thank you, Craig. Thanks, Craig. Great data, and at the end, just listening to that wellness update and all the things that we need to be doing just to continue to reminder. So thank you for that update.

[Text on Screen: National Policy Updates. UnitedHealthcare COVID-19 Briefing. UnitedHealthcare]

I'm going to spend just a few minutes on some of the national policy updates just that have happened in the last couple of months since we were together in December. And talk a little bit about what the new administration has placed and some of the updates that we've heard.

So first 100 days. Well, maybe let's just talk about his first three days in office. President Biden issued over 30 executive orders, presidential memorandums and agency directives, primarily focused on addressing COVID-19. As well as him doing and reversing many of former President Trump's actions.

So for employers and insurers, there are no directives that change our current approach to covering individuals with COVID-19 or with any other health concern.

One area we're monitoring is the discussion of protection for worker's health and safety. The gist of it for us is that the federal government really wants to reduce the risk of worker's contracting COVID-19 in the workplace setting. So the Occupational Safety and Health Administration we all know as OSHA, is working on revised guidance for employers regarding workplace safety during the pandemic.

OSHA is also determining whether any temporary emergency standards such as wearing masks in the workplace, are necessary. OSHA is also going to identify potential short, medium, and long term changes that could protect workers and ensure equity and enforcement. These revised guidances are expected to come in sometime around March 15^th, probably around the timing when we're going to be scheduling another call on a variety of the topics I'm highlighting today.

Just a quick hit on the Trump administration regulations. We're continuing to expect that Biden administration to review the Trump administration regulations on guidelines. And we're going to continue to update you as appropriate in that section.

Skipping into some coverage and expansion opportunities, one area we expect Biden administration to strengthen is around the individual exchanges and expanding opportunities for coverage. We're going to also continue to monitor and update you as we learn more on both of these areas in future calls.

I want to spend just a few minutes talking on Transparency Coverage and Surprise Billing.

Now, these are two hot topics that are out there currently. And a couple items that we're working on just to update you on the dates of some of the things that are happening, and what we can expect to hear from us partnering with you on future calls.

In the near term, the transparency and coverage rule imposes two requirements on group health plans and insurance companies. Beginning in January 1^st, 2022 every health insurance company will need to do two things. Disclose its in network negotiated rates for all covered items, and secondly, disclose negotiated rates for all covered prescription drugs.

Skipping into the next year on January 1^st, 2023 plans must provide members with cost estimator tools that allow consumers to understand their out of pocket costs, or in network or out of network services. And in the following year on this three year journey, the tools must provide estimates for all covered items and services.

There's a lot to unpack there. There's a lot of information that we're going to be working on alongside with you as we bring this over future calls, and showing you some of the tools that we're bringing to the table.

I do think it's important to point out that all these requirements apply to fully insured, are all favors level funded and self-funded employers. Overall, I believe the price transparency, and we believe, is a really good thing. However, there are a few implications that we're going to need to consider.

A couple of examples may be, what is the member experience for finding and understanding prices? How we will design and need to change some of the future incentives that we have in plan design? What is the potential for more capitated or bundled arrangements with providers? And what are evolving dynamics between providers and insurers in terms of how rates may be negotiated?

Those are just a few items worth thinking about. And as these continue to go we're going to have a lot of conversations and partnership as we build out some of these solutions.

Moving into the content of No Surprise Bill Act, of course they're closely aligned with the concept of price transparency. And the idea really is that the consumer should be protected for egregious or surprised billing practices.

The No Surprise Bill Act was embedded in COVID-19 legislation that passed in December. It is designed to protect people from unexpected medical bills and from getting stuck in the middle of the insurance company and the provider. In essence, after January 1^st, 2022 insurers and providers must hold consumers harmless from medical bills in hospitals, emergency rooms, and air ambulances, to name a few, when services are rendered by an out of network provider.

Again, this requirement applies to all fully insured, all favors, level funded, self-funded employers. And it would not preempt any state level rules.

We understand that there could be many implications from this legislation in terms of plan design. So we know that there are people on this call today who will need a lot more information than we have right now. So as we continue to unpack everything that's within this bill, as well as in the transparency, stay tuned. We're going to have more information on a separate call coming up in March, to go a lot deeper on these topics. Specifically on the No Surprise Bill.

I hope I'm giving you at least a high level and a good perspective on some of the things that we're monitoring on a national basis and policy level today, and how we can all partner together on some of these topics.

Now, what I'd like to do is turn the call over to Dr. Rhonda Randall, our colleague who is our Chief Medical Officer. She will be updating us on a lot of things from vaccination and updates.

[Text on Screen: Vaccination and Virus Insights. UnitedHealthcare COVID-19 Briefing. UnitedHealthcare]

This is a very hot topic that's out there. Lots of questions and answers we're receiving from the field on a daily basis. And I'm sure Rhonda as she goes through this, will answer quite a few of them. So Rhonda?

[Text on Screen: Vaccination and Virus Insights. UnitedHealthcare COVID-19 Briefing. UnitedHealthcare]

Dr. Rhonda Randall: Thanks, Alison. I want to also thank Craig for giving us that good foundation of data.

I want to go through a few updates with you today. I'm going to talk a little bit about some changes you're hearing to the virus in the news. We'll spend a good amount of time on vaccines, and touch on monoclonal antibodies a little bit. And then close out with pieces of about what we're seeing in the future, particularly as it pertains to returning to health.

Let's first start with, you're likely hearing that there have been some new variance discovered with the SARS COV-2 virus.

[Text on Screen: COVID-19 Virus Updates]

And remember, this is an RNA virus and they do change their sequence over time. It's not uncommon for other RNA viruses to do this. And it's one of the reasons that it's really important that we continue not only the work that we're going to talk about with vaccine, but all the public health measures. With physical distancing, with handwashing, with staying home if you don’t feel well. Quarantining if you've been exposed, staying isolated if you're infected. And wearing masks when you are in periods of time where you're closer than six feet to people, particularly who are not in your own household.

Because the more that a virus transmits from one person to the next, the more opportunity it has to have that variation and change its sequence. This virus has 20 different epitopes, so opportunities to change.

For the most part up until this point, the variance that we've seen and the changes that we've seen have been fairly minor. The one that was first discovered in the UK, that variant is called – all of these variants are named by letters and numbers. This variant is called B.1.1.7 if you want to get scientific about it. It was first discovered in the UK. And it's the variant that's given a lot of concern because it has a significant number of mutations.

Another variant was first discovered in South Africa. That variant is called 1.351. And another one recently discovered in Brazil. That variant is variant P.1. Each of these have different changes in the proteins of the virus. Where we sit to date on understanding what's different about them, particularly the variant discovered in the UK, looks to be more highly transmissible. That is fairly common for RNA viruses, as they mutate over time, to become more transmissible. But the thing that's concerning us now is that we're seeing a small, small increase in mortality rate. Moving from a mortality of about 1% with prior strains, to now about 1.3% with this strain. So 30% more deadly. So I just wanted to give you a sense of what that means at 30% more deadly. It's going from a 1% mortality to a 1.3% mortality rate. And that is concerning.

Now let's maybe move to the next slide and talk a little bit about vaccine and then we'll bring these both back together.

[Text on Screen: COVID-19 Vaccine]

So the two vaccines that are available today, both Pfizer and Moderna, those are messenger RNA vaccines. They both require two doses to be fully effective. And they both require storage at ultra low temperatures, making some supply chain challenges.

To give us a sense of where we are from public health standpoint today, nearly 20 million Americans have been vaccinated with at least one dose of either Pfizer or Moderna. And about 3.5 million United States citizens have received two shots.

Of those 20 million individuals who have been vaccinated, 2.7 million of them are long term care residents. They really bore the greatest burden of risk of hospitalization and mortality of the individuals who have died in the United States to date. About 40% of them have been individuals who reside in long term care and are more frail. So getting that population and the healthcare workforce that cares for them vaccinated, has been our top priority as the vaccine rolls out when it's in short supply.

A couple of things to look forward to here. As far as the effectiveness of the two dose vaccines, the first shot seems to have protection upwards of 50%. But I can't underscore enough how important it is to follow up and get that second shot. The only people who shouldn't get the second shot are somebody who's had an allergic reaction to the first one. And although we hear about those cases in the news, it is pretty rare, and it seems to be one of the additives in the vaccine, not the mRNA vaccine itself.

As far as what's on the horizon, I was actually hoping that I would have even greater detailed news for you today from Johnson & Johnson. But I do expect them to release their data, either late this week or early next week, so that we can – scientists can begin to take a look at their phase three trial.

A couple things that I really like about what they've done in their trial. First of all, they over sampled populations that are often underrepresented in clinical trials. They over sampled older persons. They over sampled minority populations. And they also did a significant amount of this trial internationally.

So we except to get their data within the next few days. And once their data is released, expect to see them apply for EUA and have that sitting in front of the FDA's vaccine advisory committee like their two predecessors did.

A couple things that give everyone a lot of hope around the J&J vaccine, it's an adenovirus vaccine, so it's different technology than the messenger RNA vaccine. It does not require ultra low temperatures. It requires regular refrigeration like other vaccines that are housed at your doctor's office. And it's one shot.

The United States government has purchased 100 million doses. But I think as we tie it back to the mutations we've talked about earlier, with all of these vaccines, it's really important that we see global uptake, not just domestic uptake, to prevent that additional changes [PH 00:07:18] go forward.

One to watch, after J&J releases their data, the next one I'm going to be watching for is Novavax. That has a different technology than the other three. It's a protein based vaccine.

So you can get information. Where can your employees get vaccine? We have links to all of the health department information on UHC.com. So you can go on our website, pick your state, and it'll take you directly to that information.

I also want to remind folks that if people have been infected, it is recommended that they get the vaccine. And I would refer them to their personal physician on how long to wait. Some studies are saying 90 days, and other scientists are saying we don’t need to wait that long. We just need to wait until you feel recovered and back to baseline.

So a couple things that we'll talk about the next time we get back together. We'll talk about some challenges around vaccine hesitancy. But I think it would be premature to talk about that today while we're just really focused on those initial rollouts.

One other thing I wanted to mention as far as treatment is concerned, we have the monoclonal antibodies, and your partners at UnitedHealthcare are ensuring that the individuals who can benefit from those, who are at high risk of hospitalization, have access. And of note, people over the age of 65 have a 10% risk of hospitalization, so that's really the population that we're focused on. In addition to younger persons who have chronic conditions and multiple chronic conditions.

And the good news is, is that we have several monoclonal antibody choices out there. So if we lose one of them because of these mutations, there are others out there. The downside to some of these cocktails is supply chain. Production. So we have today, Lily and Regeneron, but there are several others in trial.

And the timing of when you give these is really what matters. You want to give it while the person really has the virus circulating in their bloodstream. That's when they make the difference.

My last slide here, I'll spend a quick minute talking about return to health. I can't continue to underscore enough the importance of those public health and safety practices that we've all been doing now for almost a year. It's just really impressive to see how much we've done from a year ago when we didn’t even yet have the sequence of this virus, to where we've come now with treatments and vaccines.

A couple things that Craig and I see in our data, screenings.

[Text on Screen: Return to Health]

Cancer screenings, immunizations, continue to be depressed. We did start to see them come back late last year, but not to the levels that they were pre pandemic. So there's still a lot of opportunity and partnership with you there.

A couple things that I'm really concerned about right now from a behavioral health standpoint, we are seeing increases in the number of individuals who say that they have poor mental health days. We're seeing increases in the number of individuals who are self-reporting depression. We're seeing nationally in US data, increases in drug overdoses and suicide rates, particularly in individuals under the age of 25. All of these things around return to health can have lasting implications to the health of our nations and our communities.

More to come on that, but continue to appreciate your partnership as we communicate with people the importance of getting back to care. And we're making it easy for them to get into their primary care physician, also using telehealth.

I'll be back with you when it's time for Q&A, and I'm going to turn the call back to Alison. 

[Text on Screen: Operational Updates. UnitedHealthcare COVID-19 Briefing. UnitedHealthcare]

Alison Richards: Thank you, Rhonda. As always, great updates and so directional with all the questions. I do believe I'm hearing and seeing that our Q&A has lit up with all of the questions related to vaccines. So I'm sure at the end of this call you're going to have quite a few to answer and come back to. So as always, awesome.

I just wanted to hit a few other things on operational updates as we continue to go through. And knowing that the health of our members is our top priority, as you heard Rhonda as well as Craig talk to, and we're committed really to helping contain the pandemic and helping keep members informed on the latest FDA authorized COVID-19 vaccine information.

Taking a look at a few key ways we are helping to support you and your employees on this slide, just from left to right if you take a look at it. For example, on pre vaccination. We're encouraging members to get the COVID-19 vaccine when it is their turn, your turn.

We're also using information from trusted public sources. We are also sharing reliable up to date information about vaccine cost, access, and more, via our UHC.com, our myUHC.com, and through our customer service agents and our concierge. We are aware that some people may be hesitant about vaccines, so we're creating additional content really to address and ease those concerns.

What happens when it's time for the vaccine? We will be here to help notify eligible members and help direct them to appropriate resources and vaccination providers.

In February, we're going to be launching a zip code based vaccine resource locator. It's going to be a tool that members can enter their zip code to be connected to the state and local department of health website, along with scheduling websites in their area.

Second dose. We will also reinforce the importance of vaccine. You heard Rhonda talking a little bit about that in the vaccine. You saw some of the statistics already from Craig on the prevalence of those that have already received it. And we're going to be using these tools to reinforce the importance of the vaccine and adherence, and help remind members when to get their second vaccine dose.

And finally, on post vaccinations. Completed vaccinations will be celebrated and confirmed through our myUHC dot website.

I just want to spend a few minutes on ProtectWell. We have talked about ProtectWell on previous calls. And ProtectWell is on our phone or app. It's a topic that addresses and helps us reduce the risk of our employees to return to the workplace.

The ProtectWell solution is here to help increase trust, that propels both prevention and progress. We have now nearly 600 employer organizations using ProtectWell as a great resource to help you manage bringing employees back to work.

In the near future, ProtectWell will expand its capabilities to track the vaccination status of employees. This feature will give employers two paths for facilitating employee return to the office. Either through daily symptoms screening or through confirmed vaccination status.

The vaccine tracking feature will enable a person to take a picture of the card they received from the CDC, enter the vaccination date, type the vaccine, lot number, and physician and clinic site.

Users can also enable reminders to get their second vaccine dose, and more. So a very versatile tool coming your way.

As a UHC employee I wanted to tell you, I look at – I use ProtectWell every day to check in. It allows me to check my symptoms and if I do have one, it tells me to stay home. It's very easy to use, and with this enhancement it's adding into the vaccine information, it will improve the overall experience for employees and employers.

As a reminder, ProtectWell is free in 2021, and carrier agonistic. So it can be offered to all of your employees.

All right. Last but not least, I have a few administrative reminders to share with this group. We've talked about this over the journey of our calls.

[Text on Screen: UHC Policy Reminder]

When dates are coming and off related to how treatment is being paid for cost sharer. So I just want to highlight a couple of dates that are coming off as a reminder, to keep us all aligned for future calls.

The best source of this information are some of the policy information we have our websites today, or checking in with your account teams, your UMR or your UnitedHealthcare account team members. They're great. They have all of this information at their fingertips when needed.

So a few administration reminders. For individual and group market, and individual exchange plans, the cost share waivers for inpatient COVID treatment at in network facilities will end January 31^st, 2021. And beginning February 1^st, 2021 cost sharing will be adjudicated in accordance with the members' benefit plan.

For inpatient admissions that begin on January 1^st through January 31^st, 2021, UnitedHealthcare will waive cost share for COVID-19 treatment until the patient is discharged. Implementation for some of these self-funded customers may vary depending upon the decisions you've made, and some states may have additional or different requirements.

As we take a look at individual and group market, and individual exchange health plans, UnitedHealthcare will waive cost sharing as well for the administration of emergency use authorization for monoclonal antibody treatments for in network providers, in outpatient settings, through February 28^th, 2021. The cost share waiver was previously set to expire on January 31^st, 2021 and implementation for self-funded customers may vary again.

I'd like to say if there's a decision or a different decision anybody on this call wants to make regarding to some of these things I've just mentioned, please talk to your UnitedHealthcare or UMR representative.

All right. We've given you a lot of updates over the last 40 minutes or so. Great content, very dense, very quick. And I know there's going to be a ton of follow ups as we talk about some of the national policy things coming up in the future.

So what I'd like to do is get to some of our questions and answers. And as we start looking at that in the queue, I'd first like to do a sincere thank you to my colleagues and speakers on the call today, Craig Kurtzweil and Rhonda Randall. Just amazing job as usual with their content, and all the information that they're able to impact.

And I'd also like to say a huge thank you to all of you on this call today. Taking the time to listen in, ask your questions, as well as give us feedback. 

[Text on Screen: Poll. Visit www.menti.com Enter code: 96 30 714]

Alison Richards: I'm going to look at some of the questions starting to pop in. And Dr. Randall, I know you're not surprised, but you're going to be getting quite a few questions today on this.

And I think the first one was around really, frequently around the timeframe in getting the first shot and the second shot, and whether that impacts the efficacy if you don’t get it within the recommended 28 or 21 day timeframe.

Dr. Rhonda Randall: The studies that have been done that were submitted to the FDA for EUA, recommended depending on whether it's Pfizer or Moderna, a 21 to 28 day interval between the shots.

[Text on Screen: Q&A]

More recently with logistics, some of the scientists at the CDC have said, if you just can't get back, if there is a legitimate good reason that you can't get it within that three to four time period, you can extend it by a couple days or a couple weeks if it's needed. But we really don’t want to encourage people to do that. I think what that really is meant to do is not discourage somebody who had a good reason that they couldn't get back in within that four week time period.

Another related question that I often get to this Alison, so maybe I'll anticipate it, is when does your immunity kick in? And I mentioned earlier with the two messenger RNA vaccines, you get about 50% protection with the first shot, and 90 to 95 after the second shot. It usually takes about two weeks after that first shot until you're at about 50% immunity. And with that booster shot, an additional two weeks until you're at full 90 to 95% protection.

Alison Richards: Great. Thank you for that. Well, we're just going to keep going with you, Rhonda. There's another one that is here.

[Text on Screen: Poll. Visit www.menti.com Enter code: 96 30 714]

You might have answered this a little bit. But what happens if a person gets the first shot from, let's say Pfizer, and the second round from Moderna. Is there anything related or safe – what would you say about that?

Dr. Rhonda Randall: Nobody's really studied it. But here's what we do know. Because of Operation Warp Speed and the way the vaccines have been distributed, the states have gotten either Moderna or Pfizer. So if you live in Florida, you get your first shot in Florida, you go back somewhere else in Florida, you're going to get the same manufacturer. But for some reason if somebody is a snowbird and they have changed states and the state that they are now in has a different vaccine, again, they recommend that you get the advice of your personal physician. But the scientific though is it is better to get the booster of the other manufacturer than to forego getting a booster at all.

Alison Richards: All right. Thanks for that. Craig, I'm going to just quickly talk to you just a little bit. There was a question in here related to – not to give a crystal ball. We don’t like crystal ball answers. But what is the data telling us as we look at it, in what's next? I mean, would you like to talk a little bit about that?

Craig Kurtzweil: That's the question on everybody's mind. It's on my mind. So first of all, as you all know, I'm not a clinician. I'm not an epidemiologist. I'm a data guy. So I'm looking at the data and analyzing this every day. What I would say is everything that Dr. Randall said is obviously, accurate. There's new variance, there's lots of variables that come into play here. We've been through a rollercoaster analytically on this one. We've seen ups and we've seen downs.

I would say I'm looking at the data and things look like the arrows are pointed in the right direction for the first time in a while. The combination of the case rates are starting to come down, mortality rate is starting to come down. And now, hopefully vaccination rates starts to uptick as we've seen. The combination of all that coming together mathematically, analytically, points me in the direction that things should be starting to get better rather than worse. Again, hopefully some of the variables that are coming to play with new variance and things like that don’t impact that. But what I'm looking at today, I'm optimistic at this point.

Alison Richards: Great. Thank you so much for that, Craig. Rhonda, I have another one for you. When is it appropriate to receive the monoclonal antibody therapy? That is a mouthful by the way, trying to say that antibody therapy a couple of times. So I'll leave it to you to say it correctly.

Dr. Rhonda Randall: We first of all want the population to get that to the individuals who are high risk. So the people who are at greatest risk of ending up seriously ill, requiring hospitalization, and high risk for mortality. It is best for those individuals to receive that monoclonal antibody, it's antibodies that are fighting the virus, early in the course of the illness.

These are generally approved for people who are not yet hospitalized. They're done in the outpatient setting. And it is an infusion that occurs. So what we hope is that it is soon after you test positive and that you're not sick enough to be hospitalized but you're in a high risk population. Certainly want you to partner with not only your own physician, but it's often the local health departments who have access to where those infusions are being given and where you can go.

Alison Richards: Thanks for that. The other thing I was going to – there's another question on here along the lines of talking about vaccinations, around vaccine safety. And I know you kind of highlighted it a little bit as you talked through. But it's just a general comment related to – on the chat there were quite a few comments related getting one versus the other. What about waiting for the new technology? So would you just want to talk a little bit about some of those comments?

Dr. Rhonda Randall: These vaccines, along with the other vaccines that are available for a variety of different diseases – flu shot, measles, et cetera – the vaccine safety compared to the risk of getting the disease, just no comparison.

The risks with many vaccines, the greatest risk is an allergic reaction. So if somebody who carries an EpiPen for example, that's something you want to have counsel with your physician about. When you get the vaccine, where you get the vaccine, if a different formula is maybe a better option for you, for example.

My family and I will be getting the vaccine when it's our turn. I feel comfortable about the safety and efficacy. The number of individuals that were studied in these trials is enormous, and the safety and efficacy data really is there.

Johnson & Johnson for example, the one that we expect to come out next, they have 45,000 people in their phase three clinical trial. But internationally, nearly 200,000 people have participated in that trial. And the safety and efficacy data has a lot of predictive value in it.

So I feel from a population standpoint, comfortable to recommend the two vaccines that are out there to the general population now. And any individual who has a particular concern, you can never go wrong with counseling your own primary care doctor. And again, we made it easy to do that. You can do a telephone call or you can do telemedicine. That's always a good place to start. Not only do they know and study the science really well, they know you. And we're happy to take those questions as well. Thanks for that.

Alison Richards: Thank you, Rhonda. I'm getting a few questions on ProtectWell, so let me just reiterate a couple of points I made on ProtectWell. It is free and it is available for all UHC as well as non UHC members. So when we say it could be for anybody, it is. It's app based, and it will be app based that you'll be able to download this from the app store.

It's for any size employer, any funding level, any size when we think about the number of employees. That was a question around size, funding mechanism, and with UHC or non UHC. So it is out there, and your account teams will definitely have a tremendous amount of information on that if you're interested in the ProtectWell app.

There was another question here on cost of the vaccine. And I think it was related to the cost and who – I think that's maybe a two part question. I'll just reiterate, and I'd like Rhonda maybe you to add on to it.

There's two things to the cost of the vaccine. The first vaccine and the administration of the vaccine. The highlight, the government pays for the vaccine and the plan sponsor pays for the cost of the administration. So I wanted to separate those two because we do get a tremendous amount of questions related to the cost.

So again, the vaccine is paid by the government, the administration is really paid by the plan sponsor. And there is no employee, if you think about it, or cost to the member.

Rhonda, do you want to talk a little bit about why sometimes the compensation on the administration is provided to get that second shot – they get more for it in the arm? Do you want to add just a little bit there?

Dr. Rhonda Randall: It's really meant to be an incentive to do the extra work of the care coordination. Making those phone calls, come back in, scheduling those appointments the same time you're getting your first shot, for example. There was a recognition that there was some extra manpower in doing that. And that cost is not being passed along to the individual or the plan sponsor. That's being born by us and the federal government.

So it's really not meant to make it harder for individuals to have a higher copay, for example. It's meant to pay equitably the vaccine providers for the additional work of ensuring everyone gets back in. Because there's a significant difference between the immunity you get from one shot versus two, nearly double.

Alison Richards: Great. All right. Well, with that, I know we had a few more things and questions that were out there. But with our United culture we like to finish in five, to get people on to their next meeting and event that they need to attend.

So first of all, I need to say thank you again to everybody on the phone for taking the time to listen and be with us, give us the feedback, as well as some of those questions so we're ready for our next call and our time together.

I'd like to thank my co-presenters, Dr. Randall and Craig Kurtzweil as well. And I'd like to thank our entire UnitedHealthcare team as well, who helped put this together.

[Text on Screen: Thank you.]

We're here for you anytime for your convenience, to provide guidance and support in any way that's helpful. So please, check in with your account teams if you have any questions.

We're hoping you and your families are safe and healthy, and that you all have a great 2021 together. Thank you very much.