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UnitedHealth Group, Inc. (NYSE:UNH)
Q2 2018 Earnings Conference Call
July 17, 2018, 8:45 a.m. ET

Contents:

  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:

Operator

Good morning. I will be your conference operator today. Welcome to the UnitedHealth Group's Second Quarter 2018 Earnings Conference Call. A question-and-answer session will follow UnitedHealth Group's prepared remarks. As a reminder, this call is being recorded. Here is some important introductory information.

This call contains forward-looking statements under U.S. Federal Securities laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the reports that we file with the Securities and Exchange Commission, including the cautionary statements included in our current and periodic filings. This call will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amounts is available on the financial reports and SEC filings section of the Company's investors page, at www.unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated July 17, 2018, which may be accessed from the investors page of the company's website.

I would now like to turn the conference over to the Chief Executive Officer of UnitedHealth Group, Mr. David Wichmann. Please go ahead.

David Wichmann -- Chief Executive Officer

Thank you, and good morning, everyone. Thanks for joining us for our second quarter report. We are encouraged by how our businesses are advancing in service to customers, consumers, physicians, and across the healthcare system at large. Encouraged, but far from satisfied. Continuous innovation and improvement in healthcare experience are critical to fulfilling our mission, helping people live healthier lives, and helping make the health system work better for everyone.

Consistency in high quality care, consumer experience, and value build trust and loyalty. These drive retention and growth and position us to deliver strong and reliable financial results in 2019, 2020, and beyond.

First half 2018 performance illustrates strong execution on this path. Compared to last year's first half, revenues of $111.3 billion increased 12.7%, or $12.5 billion. Adjusted cash flows from operations grew $7.2 billion, and adjusted net earnings grew 28.2% to $6.19 per share. For the full year, our outlook for adjusted net earnings per share is increasing to a new range of $12.50 to $12.75 per share. We expect cash flows from operations for 2018 to approach $15.5 billion, which the upper end of our previous guidance.

Importantly, our enterprise wide Net Promotor Score is tracking to advance meaningfully again in 2018 after increasing six points in 2017. Our NPS is particularly strong, or strongly improving across our government program customers and consumers, within our care delivery businesses, with network physicians and their practice managers, and with customers and consumers at United Healthcare Global and the pharmacy business at OptumRx. NPS across the employer health benefits base remains solid, with upside opportunities to distinguish our performance among commercial market consumers. We believe emerging innovations around a next generation of digitally enabled, higher personalized services combined with more evolved consumer centric benefit offerings will further advance our NPS performance.

Quality continues to be strong and rising. Approximately 80% of our Medicare Advantage seniors will be served by four-star rated plans in 2019. And, we are looking to improve on that strong base in 2020. For commercial benefits, we expect more than 40 local market health plans will be rated in the top HEDIS categories in 2018, up from just ten two years ago. We continue to help create a better future for healthcare through venture investments, building new businesses organically, ongoing investments in innovation throughout our enterprise, and open source innovation through partnerships and strategic acquisitions of businesses and capabilities. We look forward to sharing some of these and other innovations and developments with you at our annual investor conference.

As you know, we apply core competencies in clinical expertise, technology, and data analytics to serve people in differentiated ways across our operating platforms, focusing on our five long-term growth pillars. Transforming pharmacy care services is just one of those pillars. Applying our core competencies in the pharmacy arena yields a better service experience, transparency, simplicity, lower costs, higher value, and growth. We do so engaging proactively with customers, manufacturers, distributors, and retailers across the industry.

UnitedHealth Group now has more than five years' experience synchronizing medical care and pharmacy care for patients. Over those five years, we have continually applied learnings to refine our approach, while hardening, scaling, and expanding our services. Results in market share and NPS gain suggest we are the clear market leader in capability, experience, and value. We deliver integrated pharmacy care services to employers and health plans, on both a carve in and carve out basis. Health plans and employers continue to award OptumRx new business while existing customers are retained at a high-90s percentage rate year after year.

Here is how this integration of pharmacy and medical care actually works. Optum's analytic extension processes administrative, demographic, clinical, lab, pharmacy, and behavioral data to produce specific next best action information at the individual consumer level and identify the highest value actions an individual is most likely to take. That likelihood is a critical element because an action not taken produces no value.

We then deliver the insight to patients, consumers, and physicians on a multichannel basis. Perhaps they need help adhering to a medication regimen or digital coaching to better manage a chronic condition. Or, they would benefit from our digital weight loss and diabetes prevention program. This year, our customer advocates will help people, in real time, schedule hundreds of thousands of doctors' appointments to close specific gaps in care. Together, these services are helping clients advance quality, lower costs, and improve consumer satisfaction. This integrated approach improves pharmacy adherence by 12%, while helping reduce hospital admissions and ER use by 6%.

Our digital PreCheck MyScript service offers clarity, transparency, and simplicity to the prescribing physician through their electronic medical record, while helping patients at the point of care. Already today, PreCheck MyScript is integrated into the practice flow of physicians who treat as many as five million OptumRx consumers over the next year, and we will grow that figure aggressively over the course of the next 18 months.

These people have a simpler experience at the pharmacy counter as a direct result of the real-time preauthorization capacities and the formulary cost and coverage information delivered to their physician by PreCheck MyScript. OptumRx continues to emphasize timely, convenient prescription delivery for consumers. Our specialty pharmacies have long used local hubs to provide same day and next day delivery, with clinical support and counseling provided by pharmacists via modern telemedicine.

We provide infusion services, delivering specialty pharmaceuticals to patients in their homes over 350,000 times annually. We have begun to apply these services more broadly through our OptumCare sites. Patients using maintenance medicines receive refills in advance of their refill date, through our home delivery services, providing value and convenience for these prescription needs.

Finally, we are improving real consumer value as a leader in offering transparent point-of-sale discounts to consumers at the pharmacy counter. These meaningful discounts will be imbedded in the basic benefit design for more than seven million United Healthcare insured consumers. We are the only party incented to reduce both the next cost of drugs for people and the total medical costs for customers, giving us a unique value role in the pharmacy supply chain. All of these capabilities appropriately manage pharmacy and medical cost trends, ensure the highest levels of patient safety, simplify the consumer experience, and improve value.

Innovation, quality, service, and performance across all five growth pillars will be critical to helping us fulfill our mission and doing our part to help the markets we serve advance care access while reining in growth and healthcare spending.

Now, let me turn it to Andrew Witty for an update on our Optum business. Andrew, welcome to UnitedHealth Group.

Sir Andrew Witty -- Chief Executive Officer, Optum

Thank you, Dave. I'll start today by expressing my admiration and appreciation toward all of those whose work has created an extraordinary Optum platform, which is frankly unlike any other healthcare business in the world. As a member of the UnitedHealth Group Board of Directors, I had the opportunity to get to know the company and its people. And now, as Optum's CEO, I'm further impressed with the capabilities and talent we have at every level of this company, and the breadth of opportunity for Optum to serve and grow in pursuit of its mission.

Optum is vibrant and performing well. This young company will continue the nimble market responsive approach it has embraced since its inception, enabling Optum to serve more people in more ways and producing consistent strong growth in revenues and earnings.

In the second quarter 2018, OptumHealth increased the number of people it serves by 7%, and $92 million. And, revenue per person grew 12% over last year as OptumCare grows and diversifies its businesses. OptumInsight's backlog grew nearly 15% year-over-year on account of its technology data analytics, business process, and advisory services. OptumRx again filled over 3% more adjusted prescriptions as it continued to expand its market share.

Overall, Optum's second quarter revenue grew by more than $2 billion over last year, growth of about 9% to nearly $25 billion. Optum's earnings from operations rose 215%, driven by strong revenue growth and 80 basis points of margin expansion due to both operating advances and solid fundamental expense disciplines. Importantly, all three Optum segments expanded margins and grew operating and earnings strongly.

Now, looking ahead, the differentiated value we deliver to customers positions us to sustain growth into 2019 and beyond. Digital health is a UnitedHealth Group growth pillar, like pharmacy care services. Rally, part of Optum, has emerged as a market leading comprehensive consumer digital health platform. Fully implemented at operating at scale with multi-pay capabilities, Rally is our digital front door for the consumer. Rally helps people easily select the best health benefits plan for their families, assess their health, pursue wellness, and when care is needed engage effectively with the healthcare system.

Rally has now surpassed $1 billion in cumulative incentives paid to consumers, standing apart in an early stage digital health marketplace. Consumers earn these incentives for taking real actions to improve their health, like receiving biometric screenings, working to stop smoking, or selecting a primary care physician to just name three of many. By moving to digital coaching from legacy telephonic models, Rally triples the number of individuals engaging in our programs, while creating much higher consumer engagement intensity and loyalty. As a result, our customers are avoiding millions of dollars in downstream medical costs.

Already, one-third of our wellness coaching customers have moved to this new approach, and more than 90% of their coaching engagement are digital, compared to entirely analogue experience, only one year ago.

OptumInsight continues to grow steadily, working actively with payer customers, large and small, supporting our efforts to maintain and improve clinical quality, administrative accuracy, and payment integrity. Our artificial intelligence capabilities in areas like natural language processing for clinical information, are imbedded in our product sets and have proven valuable to both payers and care providers. Today, care providers who deliver care to nearly one-third of all Americans use Optum performance analytics, deepening and enriching the clinical datasets we use to improve performance of healthcare systems and the health of people.

At OptumCare, we are creating a structure to advance more modern and locally effective clinical and administrative models for the benefit of physicians, patients, and customers. OptumCare actively advances the practice of evidence-based medicine and meaningfully improves consistency in care quality while sustaining NPS scores in the range of 80 and offering more convenient site to service for applicable procedures and examinations at more than 500 community locations nationally.

Savings are more than 50% compared to less effective sites of care. This business is early in its growth curve and, like digital health, we see it as another important long-term growth pillar for the enterprise. Finally, as you heard Dave say, the value being delivered in pharmacy care services is translating into high NPS and continued client retention rates in the high 90s at OptumRx and new wins, including new health plans for 2019. We're already hard at work with prospects for 2020, even as we further strengthen capabilities for 2019.

In sum, our businesses are growing and performing well today and preparing for next year. We believe our investments in people, technologies, and processes position us to grow for years to come. I'm energized by the potential Optum has to make a meaningful difference in healthcare.

And now, I'd like to turn the call over to Steve Nelson, UnitedHealthcare CEO.

Steve Nelson -- Chief Executive Officer, UnitedHealthcare

Thank you, Andrew, and welcome. UnitedHealthcare grew to serve 2.2 million more people over the past 12 months. All in, our revenues advanced more than $5 billion over last year and nearly $46 billion in the quarter, growing at a 12% pace with Medicare and retirement revenues growing nearly 13% and community and state by more than 17%.

Our commercial business continues to serve nearly 27 million people with steady growth of 50,000 people and risk-based offerings this quarter, while the public and senior sector grew to serve 60,000 more people. We also experienced minor attrition in our fee-based products in the second quarter, similar to the second quarter of last year. The pricing we are receiving for risk-based products remains consistent with our expectations, and commercial medical cost trends remain steady, also in line with expectations. And, we're performing well on managing administrative costs across United Healthcare. In total, our second quarter earnings from operations of $2.4 billion grew 7% over second quarter of last year.

Looking forward, we are progressing well on two more enterprise growth pillars, consumer centric benefits and global, as we improve our total cost of the care position and simplify the consumer experience. In consumer centric benefits, we continue to align our approaches with value-based care delivery, supported by modern digital resources and data empowered human and digital advocates, who help people navigate the system and achieve their health and care objectives. This modern integrated approach increasingly enables greater personalization, better information flow, and improved consumer experience and value as measured by NPS.

For example, in our Medicare products, value-based care is driving 5% increases in key screenings, a 13% lower rate of emergency room use and a 3% increase in the number of seniors with regular doctor visits, all of which ultimately impact cost, satisfaction, consumer attention, and growth for our business. It's all about helping people at the moment they need it and then making it as simple as possible for them to make the best decisions to improve the effectiveness and quality of their care, affordability, and overall satisfaction.

These themes hold true, whether the person making that decision is a patient with a medical issue, a healthy consumer focused on prevention, a physician treating a patient, or a business executive understanding value drivers in their health benefit offerings. Looking ahead, we expect to continue to see strong growth in serving those with higher acuity needs, like seniors, people with special needs, long-term support services, and the chronically ill.

United Healthcare Global just completed the first full quarter with Benmedica, which is growing and performing well, serving the people of Chile, Columbia, and Peru. Strong year-over-year improvements in business performance were made in Brazil, as focused efforts over the past half-decade have strengthened Brazilian clinical integration and business alignment. These efforts have been instrumental in improving earnings in that region and will continue to gain momentum going forward.

Amil's recent recognition as the most innovative health insurance company in Brazil was informed by advances in technology, consumer experience, product design, and investments in primary care delivery and new models for paying for care. Our young South American business is well positions with strong assets, a stabilizing business environment, and a long runway for growth.

Now, I'll turn the call over to John Rex, UnitedHealth Group's Chief Financial Officer.

John Rex -- Executive Vice President and Chief Financial Officer

Thank you, Steve. The well-balanced quarter we reported this morning includes consolidated revenues growing 12% over last year to more than $56 billion. Our earnings from operations exceeded $4.2 billion, growing nearly 13% on steady operating margins. Adjusted earnings increased 28% to $3.14 per share, and our cash flow from operations grew to $4 billion.

Turning to details, we continue to expect our 2018 medical care ratio to run in the range of 81.5%, plus or minus 50 basis points, with commercial trends well within our expectations of 6%, plus or minus 50 basis points. In the quarter, our consolidated care ratio of 81.9% reflects the impact of the health insurance tax offset by changes in business mix and reserve development, both compared to last year. This quarter's favorable development was principally due to favorable costs up from the first quarter 2018 business.

Our second quarter operating cost ratio of 15% increased only 40 basis points over last year, despite including about one percentage point cost increase from the return of the health insurance tax and higher investments in innovation and business development. We offset that pressure with strong revenue growth in lower operating cost ratio business, like Medicare and Medicaid, and operating expense discipline across the board.

Turning to our balance sheet, we continue to maintain distinctive strength and flexibility. Return on equity for the second quarter exceeded 24% and our debt to total capital ratio was 40.8% at June 30. In June, the board of directors raised our shareholder dividend by 20% to an annual rate of $3.60 per share. We continue to deploy capital to further diversify our company through focused merger and acquisition activities, and for our long-standing share repurchase program.

We are optimistic as we look ahead to the second half of 2018 and into 2019, and strive for continued performance improvement while taking a realistic and prudent view of the future. As Dave mentioned, we now expect 2018 cash flows from operations to approach $15.5 billion and adjusted earnings in the range of $12.50-12.75 per share. Growth of 24% to nearly 27%.

David Wichmann -- Chief Executive Officer

Thank you, John. We think about the numbers shared with you today as the result of serving millions of people, one person at a time, one health system at a time. We continue to advance value, simplicity, affordability, and quality. Doing so in differentiated ways increases our value and sustains our growth. Growth provides even more opportunities to fulfill our mission and deliver long-term performance for the people we serve and our shareholders.

As we pass the midpoint of this year, we begin to shift focus to the year ahead, when we expect our enterprise to continue to innovate, grow, and perform strongly for society and for our investors. We expect to grow revenues, earnings, and cash flows broadly across the expanse of our uniquely diversified and increasingly global healthcare portfolio.

We won't get into specifics now, but at this distance we see more tailwinds than headwinds. As was the case heading into 2018, the tailwinds in our businesses are largely generated internally, coming from strong and diversified growth across our five distinct pillars, all aimed at achieving our long-standing mission. To achieve this growth, our businesses will continue to make deeper investments in quality improvements, technology deployment, delivery system optimization, consumer centric financing mechanisms, and other innovations to improve the value individuals receive from the health system. These investments will also serve to lower our cost structures, improve NPS, and enable sustained growth in differentiated value for years to come.

As to headwinds, we expect the policy debate surrounding coverage expansions and healthcare costs to continue into next year. Additionally, the return of the health insurance tax in 2020 will cause higher premiums and lower coverage levels for people, and we will be advocating on behalf of our customers and consumers for a delay or outright repeal of this tax.

As solid as our performance may seem, we are not satisfied given our organization's capabilities and capacities to serve. Despite strong topline growth and results, we are not performing at, nor consistently growing to, our full potential. This has, and will continue to be, an area of intense focus for our business leaders. Perhaps even more critical from my perspective, we must work enterprise wide to improve our speed and agility, so the pace of innovation and change better reflect our restless drive to deliver even more value to those we serve, and unleash the full transformative impact of this enterprise.

We'll provide some initial direction on 2019 in our third quarter earnings call, followed by a full review at our annual investors' conference on Tuesday, November 27th. We hope you can join us there.

...

Now, we will now open the call for your questions. One question per caller, please, so we can get to as many people as possible.

Questions and Answers:

Operator

[Operator Instructions] We'll take our first question from Justin Lake with Wolfe Research. Please go ahead. Your line is open.

Justin Lake -- Wolfe Research -- Analyst

Thanks. Good morning. On reserve development, given the relative lack of prior entry in development in the quarter, I was hoping you could give us some increased color on cost trend and reserve development across the commercial Medicaid and Medicare segments. And then, just to make sure we understand prior year development trends overall, can you tell us what percentage of claims, if any, you have? You said each quarter for adverse deviation for your reserves. I think most companies talk about mid-single digit, but just wanted to confirm yours. Thanks.

David Wichmann -- Chief Executive Officer

That's Jeff Putnam.

Jeff Putnam -- Chief Financial Officer, UnitedHealthcare

Good morning. Thanks for your questions, Justin. Starting with development, we maintain a reserving process, as you know, that's tightly controlled and consistent over time. We're very comfortable with our reserve position at the end of the quarter and really pleased with the overall accuracy of our reserving over time. When you look at our year-to-date development, because the second quarter was fairly modest -- but, when you look year-to-date, as a percentage of our prior year medical expense, it's right in line where we are historically. As that works into trends, we are always very respectful of trend. But, as we stand right now, we've not seen anything to date that would inform or change our view on commercial medical trends for the year, by cost category or in total.

We don't get into details on trends in Medicare and Medicaid businesses, but I could offer a couple of comments. Medicare trends are generally stable with last year and we are seeing some elevated consumption over time, similar to last year, related to the market leading growth that we've had. Medicaid trends also really need to be looked at state-by-state as there are some areas with increased trend and we're working to manage those down. But, nothing really notable to call out on those.

Justin Lake -- Wolfe Research -- Analyst

The Medicare trend you mentioned -- can you just expand on that? What drives that in terms of your market leading growth? I apologize.

David Wichmann -- Chief Executive Officer

Maybe I could ask Brian Thompson to speak to that.

Brian Thompson -- Chief Financial Officer, UnitedHealthcare Medicare & Retirement

Sure. Again, we're really not seeing any trend emergence in 2018. I want to make that clear. What we're seeing is very consistent with what we saw in '17. The point is, given our market leading growth, we do prepare for and have seen a utilization uptick as we grow meaningfully compared to the rest of the market. We see that both in the form of new enrollees as well as our improved retention, holding onto folks later in life. What we're seeing in '18 looks a lot like what we saw in '17 and '16 -- this being the fourth year now for strong market share gains. It provides a very credible, good baseline for us as we look forward to 2019.

David Wichmann -- Chief Executive Officer

Thank you, Justin. Next question, please.

Operator

We'll go next to Sarah James with Piper Jaffray. Please go ahead. Your line is open.

Sarah James -- Piper Jaffray -- Analyst

Thank you. My question is on the 2019 commercial environment. On the last call, you had mentioned that the national account RFP pipeline was larger than normal. There have been some concerns in pricing. Could you walk us through how your national accounts model in middle market develop?

David Wichmann -- Chief Executive Officer

Sure. I think the question relates to national accounts pipeline and development. Dan?

Dan Schumacher -- Chief Financial Officer, UnitedHealthcare

Sure. Thanks. Good morning. On the national accounts front, as we continue to progress through the selling season, I think I shared last quarter and would likewise amplify this quarter -- it's really a theme around incumbency that continues to be it as we progress through the selling season. At this point, I would tell you that we've had some nice new client wins as well as expansions in existing clients, but we've also had some clients leave us as well. There is still more to be resolved in the selling season.

We are doing well, again, to convert retirees to group Medicare offerings. Likewise, we continue to do very well in the middle market segment as we work through the year. So, that's the self-funded national account profile. I think you also were asking a bit about the pricing environment and as it relates to commercial risk-based offerings. From our perspective, we were happy to see, as we had told you last quarter, we had expected to return to growth in the commercial risk-based group offerings as we progress through the year. We did that in the second quarter and had nice contributions across all market segments, from individual small group through to middle market as well.

As we look at that environment, it is competitive. It has been competitive. We always have pockets of competition that we're responding to, but we find ourselves well positioned and well served by our broad footprint, both geographically as well as by market segment and funding status. As we talked about in this forum for some time, we've done well to expand our product portfolio along that value and price continuum, and increasingly align that to care providers that are high performing. Hopefully, that gives you some color on what's happening, both in the self-funded and the fully insured segments in the commercial market.

David Wichmann -- Chief Executive Officer

Thank you, Sarah. Next question, please.

Operator

We'll go next to Dave Windley with Jefferies. Please go ahead. Your line is open.

Dave Windley -- Jefferies -- Analyst

Good morning. Thanks for taking my question. I want to flip over to Optum. The first part, OptumInsight margin has performed very well year-to-date. I wondered if you could talk about either pricing or mix of business drivers of that? Secondly, and more broadly, as Andrew talked about Rally and the uptake of different technologies, how do you think about broadening the uptake, or the adoption rate, of your technologies in an environment where we might see competition directly from a technology company?

David Wichmann -- Chief Executive Officer

Great. We'll take both of those questions. Tim, do you want to take the first one?

Timothy A. Wicks -- President, OptumRx, Inc.

Sure. Happy to do that. On OptumInsight, as we think about the quarter and about the margin growth, it really is two items. One, you referenced pricing and mix and there is a significant amount of mix opportunity that is occurring in terms of growth of business around the risk and quality businesses as well as payment integrity. And then, the secondary area of that is also important. You heard us talk a significant amount in 2017 about the discipline that we drove -- financial discipline and overall cost management. That's really coming through the business, frankly all across Optum, but specifically in OptumInsight in the quarter as well.

David Wichmann -- Chief Executive Officer

Great. And I'll just make a few remarks on Rally as well. Rally is something we're very proud of having developed in the course of the last four years. Obviously, there was a lot of work that went into it in advance of our alignment with them. But, they've done a very nice job of taking a single product company and making it multidimensional along the lines that Andrew has described. We are seeing probably a very fast uptake. In fact, accelerating uptake, of that business, as we expand our offerings to respond to greater levels of consumer need.

As an example, when we gave Rally the responsibility for our premium designation program, which is effectively the way in which consumers search for and find a physician and/or other care services, we all of a sudden started to appeal to a broader group of consumers, which dramatically increased the registration rate across that platform. We're now sitting at, I believe, 18 million people registered with Rally.

So, we believe that the expansion of the value that is offered on the Rally chassis is the single best way to get there. And that really requires that we continue to provide significant value to consumers, both in terms of cost containment, but also in terms of the improved health that they each receive. We'll continue to expand and diversify that offering, keeping it simple for people, and we look forward to the developments that we'll see with the individual health record and how that drives next best action and to the consumers we serve and expect to see increased utilization as a result as well.

Dave Windley -- Jefferies -- Analyst

Great. Thank you.

David Wichmann -- Chief Executive Officer

Thank you, David. Next question, please.

Operator

Our next question comes from Peter Costa with Wells Fargo. Please go ahead.

Peter Costa -- Wells Fargo Securities -- Analyst

Good morning. Thank you. Regarding Optum -- Andrew, welcome aboard in your first quarter in the hot seat. I want to understand what you expect to be different about growing Optum going forward under you relative to how it's grown in the past. And then, if you could, in the quarter itself, the growth in revenues at Optum slowed down from the first quarter. Can you spike out how much of that was related to M&A?

Sir Andrew Witty -- Chief Executive Officer, Optum

Sure, Peter. Thanks for the question. I'll ask Tim in a second to address your second part of the question. In terms of the first, obviously very early days for me here at Optum. I think terrific foundations have been laid over the last seven or eight years in terms of the asset base that this company has. It's really unparalleled in terms of the portfolio of assets that we have. As we look forward, the opportunities are going to be very much centered around how we start to drive the gearing between all of these assets, to really bring to life the full potential of this portfolio. What we see at a very high level is significant at direct local interface as care provider and touch points with patients and consumers.

So, a business with a real face backed up with an extraordinary evolving digital capability, which then allows us to drive high frequency contact, really all underpinned by tremendous commitment to care and delivering quality of care. Commitment to bringing down total cost of care and ensuring all of that is done in an extraordinary high-quality way. So, I think all of those tenants of the business, which have got us thus far, are going to be absolutely the characteristics going forward. What I'm focusing on now is really making sure I understand all of the various parts of this business, working with the team to figure out the next steps. But, it's going to be characterized very much in the way I just described. I'll pass it to Tim to answer the more specific question on the quarter.

Timothy A. Wicks -- President, OptumRx, Inc.

Sure. First, as we look at the growth rate of revenue at Optum, both year-over-year and sequentially, it is in line with our plan in both of those ways of looking at it. The revenues of $24.7 billion were up 9%, or up $2.1 billion, compared to a year ago, with both OptumHealth and OptumInsight posting double-digit growth rates, with OptumRx posting a 7% growth rate year-over-year. In each of those businesses, organic growth was very strong, both in OptumHealth in terms of care delivery with market expansion as well as OptumServe volume growth and behavioral health. And then, in OptumInsight, strong growth with the addition of the advisory board

But also, pretty significant volume growth in terms of our risk and quality business, and then also volume growth in payment integrity. Also, when I mentioned OptumRx earlier, and the overall revenue growth there, it's important to understand that that's driven by new sales growth in terms of new clients that have come on as well as very strong expansion in terms of specialty. So, really solid growth across the businesses and in line with our expectations.

Peter Costa -- Wells Fargo Securities -- Analyst

I was hoping you'd spike out quantitatively exactly what the growth was from M&A this quarter versus the growth last quarter.

Timothy A. Wicks -- President, OptumRx, Inc.

We don't spike that out specifically, Peter, but I would tell you it's not an appreciable difference.

Peter Costa -- Wells Fargo Securities -- Analyst

Thank you.

David Wichmann -- Chief Executive Officer

Okay, thank you, Peter. Next question, please.

Operator

We'll go next to Steve Cano with Goldman Sachs. Please go ahead.

Steven Cano -- Goldman Sachs -- Analyst

Morning, guys. Thanks for the question. I wanted to follow up on the decline in ASO coupled with another strong quarter of growth in the group risk business. Can you give us a sense for what you're seeing out there? Has that decades long shift to ASO stalled or slowed? Are you seeing a greater demand for group risk products now? If so, why do you think that is? And in this context, if you could comment on NexusACO, I'd be curious to hear what's happening there. Thanks.

David Wichmann -- Chief Executive Officer

Dan?

Dan Schumacher -- Chief Financial Officer, UnitedHealthcare

Sure. Thanks. You had a few things tucked in there, but first, just on the quarter and the decline, with regard to self funded enrollment. The reality is it's the normal season pattern, particularly in our national accounts and employer-based attrition. If you look at that outcome in comparison to the average of the last five or ten years it's very much in keeping with that. So, really just the normal seasonal pattern we see on the ASO front.

I think you had asked about an acceleration or change in the migration from fully insured to self-funded. That continues to be a recurring theme. I would say it's at a comparable pace to what we've seen over the last several years. I wouldn't spike out any acceleration or deceleration in that. We don't believe, on the fully insured side, to see greater take-up rates. We're actually taking market share and I think a large contributor to that is the work that we've done around expanding our product portfolio around that value continuum, and then making sure we pair it with really high performing care delivery partners -- both OptumCare as well as externally. And then, improving the consumer experience and making it simple and personal for them.

You had asked also about NexusACO. We continue to build that product and are excited for the prospects. As a reminder for those on the phone, the NexusACO offering is really a national accountable care offering. So, we string together our best solutions locally into a national solution. Today, we have about 75,000 enrollees on that. We'll double that as we turn into the year, and we'll look to double it again by the time we get to the end of 2019. Thanks, Steve.

David Wichmann -- Chief Executive Officer

What you've hit on is this category of growth for us -- a pillar of growth around consumer centric benefits and NexusACO would be one example. But, if you look to the distinguished group ensure growth over the course of the last three years or so, and why we're bullish on growth going forward, it's because of these new designs that we're progressively putting into the marketplace. To maybe tie it to the question before that, our ability then to use digital assets in other ways to engage consumers around lifestyle behavior modifications creates a great attraction to these products as well. Thank you. Next question, please.

Steven Cano -- Goldman Sachs -- Analyst

Thanks.

Operator

We'll go next to Michael Baker with Raymond James. Please go ahead. Your line is open.

Michael Baker -- Raymond James -- Analyst

Thank you. Could you outline some of your promising venture investments in light of your drive to reshape the future of healthcare?

David Wichmann -- Chief Executive Officer

We'll start with Dirk McMahon.

Dirk McMahon -- President and Chief Operating Officer, Optum

Yeah, sure. Optum Ventures generally invests in digital health companies that use data and analytics to improve consumers' access to health and healthcare services -- and healthcare across the board. Also, Ventures invests in things that make the healthcare system more reliable and easier to navigate. The Ventures investments are focused on four main areas -- health analytics, digital on demand, consumer focused health, and healthcare system management. I would also conclude that there's a lot of synergies between Optum and Optum Ventures. Optum provides a good scalable platform to test Optum Ventures. And Optum Ventures is being able to give us shots in the arm with respect to our digital agenda.

Michael Baker -- Raymond James -- Analyst

Thanks, Dirk.

David Wichmann -- Chief Executive Officer

I'll just add a little bit to that. We also build businesses organically inside our company. One would be a business called Renai. We're advancing new platforms for dialysis and trying to promote home-based dialysis and use, as well as trying to drive greater value to consumers in that whole category. And then, one we announced in the last couple of weeks. Along with our venture partner Alumni, we created a company called Vine, which is an on-demand healthcare insurance platform, which I would characterize as being pretty revolutionary in terms of the potential it holds to fit a particular market segment in the group insured marketplace, as well as the self-funded market.

Those are a couple of additional examples. These are the things that we hope to profile for you to a greater extent when we get together in November. Next question, please.

Operator

The next question's from Kevin Fischbeck with Bank of America/Merrill Lynch. Please go ahead.

Kevin Fischbeck -- Bank of America/Merrill Lynch -- Analyst

Great. Thanks. I want to ask you about the guidance. I struggled a little bit with the guidance that's happened so far year-to-date. Q1, you raised guidance by less than a beat and in Q2, you basically raised guidance with the beat, even though announcing a few pretty big deals during the year -- Benmedica and a few other things -- that are probably at least a third of what the total guidance range has been. Could you rectify why the guidance hasn't been raised by more, given the tailwind from M&A and what appear to be solid trends so far in the first half of the year? Is there anything you would highlight as either one time in the first half or a headwind for the second half?

David Wichmann -- Chief Executive Officer

I think we've actually raised expectations pretty strongly over the course of this year -- twice by a total of about 17.5 cents at the midpoint, and that's despite some pretty substantive FLU pressure and a new HIF effect we've identified in the first quarter of around $0.22 or so. So, the way we look at it, at least from my vantage point, we've raised it by about $0.40 or so, so far this year.

But, as we look to the balance of 2018, we're focused on growth. We're continuing focus on cost containment and achieving the full potential of its enterprise capacities. You can see that we are deeply investing in innovation to drive constructive measure change and improve healthcare economics in both North and South America. Also, we're focused on these five areas of growth, advancing quality measured by NPS, and continuing to invest and diversify our businesses so that we can achieve a long-term sustainable growth rate that we've outlined for you in the past, of which we remain deeply committed to.

We did by Benmedica in the first quarter. Benmedica is interesting for us. Right now, it's in winter, so not particularly accretive in the second and third quarter of the year. It happens to bear the same characteristics as our UnitedHealth Brazil businesses as well. So, we don't see a lot of material improvements in our results as it relates to that. Maybe we'll start to see that closer to the fourth quarter or so.

But, the company has so much potential, given its assets. Just performing to its full potential is our ambition and that's what this team is aiming to achieve. So, we'll continue to get after costs, after growth, and diversifying and growing our business, and investing in it for the long-term so we can serve more people and more health systems better. Thanks for your question. Next question, please.

Operator

We'll go next to Lance Wilkes with Sanford Bernstein. Please go ahead.

Lance Wilkes -- Sanford C. Bernstein -- Analyst

Good morning. I have a question on the PVM in particular. I'm interested in understanding, for margin in OptumRx -- it looked like margin was up for the quarter although cost of product was also up. What are some of the drivers of that? And related to the long-term view, how are you looking at the online pharmacy strategy of United overall, and with the entrance of Pill Pack and Amazon? What is your view as far as adding them in network, partnering with them, etc.? Thanks.

David Wichmann -- Chief Executive Officer

John Prince, do you want to take that?

John Prince -- Chief Executive Officer, OptumRx

Sure. Let's just talk about the margin in general. We're comfortable with our long-term outlook of 3-5%. I think we see -- in different quarters, you see a variation with mix over time. The product is the driver of our specialty home infusion -- those drive our business in terms of the product mix. I think it will fluctuate over time, but ultimately we're comfortable with our long-term outlook. Also, we're comfortable with how we're executing in the market from an overall perspective.

In terms of online pharmacy, we work with various partners across the healthcare system. We've been very focused on our consumer experience in our home delivery, our specialty, and our infusion business. That has been the key driver of our growth over the last year and a half. We've done an exceptionally good job of improving our NPS in those areas. We've become hyperlocal. Those are businesses where we are in the market. So, you look at our strategy between home delivery and specialty infusion, we're in 35 markets being hyperlocal. We've added six this year. We're going to add six more this year.

We see the market pivoting to being both same day and next day service. We've been investing heavily in that, and we're flexible based on how a consumer wants to work with us in terms of whether they want to be online, digital, in the market, etc. I think we have a good strategy to execute against that. Thanks.

David Wichmann -- Chief Executive Officer

Thank you. Next question, please.

Operator

Next question is from AJ Rice with Credit Suisse. Please go ahead.

AJ Rice -- Credit Suisse -- Analyst

I thought at this point, maybe just ask about the comment you made toward the end of your prepared remarks, Dave, where you talked about the restless drive. I think the comment was not satisfied with performance, a few areas where we could do better. I think also maximizing performance consistently. You've done 28% EPS growth in the first half -- pretty good by most standards for this industry. What are the areas where you think you're still underperforming? What are you referring to with those comments?

David Wichmann -- Chief Executive Officer

I think we highlighted some of those today. We didn't talk about them in terms of levels of disappointment, but it's fair to say that we're not particularly pleased with how we've done the large case ASO marketplace overall. If you look at our performance over the course of the past years, it's not reflective of the winning capabilities of this company. So, that is a good example of a place that I think we need to improve. I'm very satisfied with our NPS performance, but extremely anxious to get that moved up. At the same time, to manage the interchange of that with the evolutions that are required in order to respond to consumer demands.

So, figuring that out is one of our challenges. Another one is the pace at which we are driving adoption of the use of technology and digital broadly. There's nothing wrong here. I don't want to leave you with that point of view. By most measures, with a company with the capacity that this one has, I believe we should be able to move faster, with greater speed and agility, to respond to emerging market demand for these kinds of services. We are well out front with all of them, but my view is we need to get these into the hands of consumers faster and make a bigger difference on the effectiveness of health systems and the health of people

So, maybe just chalk it up a little bit to having higher expectations than what we're currently achieving, largely because we have a good inside view of what the internal capacities are of this enterprise overall. So, expect us to step it up.

AJ Rice -- Credit Suisse -- Analyst

Okay. Thanks a lot.

David Wichmann -- Chief Executive Officer

Next question, please.

Operator

We'll go next to Josh Raskin with Nephron Research. Please go ahead. Your line is open.

Joshua Raskin -- Nephron Research LLC -- Analyst

Thanks. Good morning. On two specific growth opportunities in 2019, the first on Medicare Advantage. Now that you guys have submitted your bids, I'm curious if there's a thought around relatively generous reimbursement -- especially relative to what we've seen over the last decade or so -- and how you think about the Medicare Advantage market overall, and then United within that. And then the second area, just individual public exchanges. Do you guys are getting more interested -- or any interested -- in potential expansions there and how you're thinking about that market over the next couple of years.

David Wichmann -- Chief Executive Officer

Brian Thompson will take your first question.

Brian Thompson -- Chief Financial Officer, UnitedHealthcare Medicare & Retirement

Thanks. We're certainly encouraged by the direction of the 2019 rate. It's up nearly three points versus last year, and then compliment that with some policy changes around the framework that provides greater flexibility around how we can define benefits -- all good for seniors. As you mentioned, I do think that ushers in an opportunity in 2019 for an environment that will provide stronger coverages, innovations, and benefit enhancements for the seniors served. It should be great for MA. As I think about our position in it, we will approach 2019 with an expectation of continuing the momentum that we've demonstrated over the last four years with share gains in '19 as well.

David Wichmann -- Chief Executive Officer

As it relates to exchanges, I'll just take that one. Our decisions are made state-by-state. As you know, we have a very modest presence overall. I'll reaffirm that nothing has fundamentally changed since we made our decision several years back now, which has absolutely turned out to be the right one for us. As always, we'll evaluate for future participation on a market-by-market basis. One thing you may read is there was some noise out there about us joining in the Massachusetts exchange. That was largely due to our small group penetration having grown to a point where we were required to participate in that exchange. It wasn't necessarily a voluntary decision on our part. Thanks for the question. Next question, please.

Operator

We'll go next to Ralph Giacobbe with Citi. Please go ahead.

Ralph Giacobbe -- Citigroup -- Analyst

Thanks. Good morning. To go back to MLR, a little bit higher than we expected. Lots of moving parts. Can you talk about whether you've seen a bit of an uptick in cost per claim or acuity? It would be helpful to break out the 6% trend between what you're seeing in terms of utilization versus unit cost. And then, the last piece, if you can give us a sense of how much Benmedica and seasonality there maybe impacted MLR in the quarter. Thanks.

Unidentified Speaker

There are a few questions inside that, Ralph. First, on MLR, I'll say that that was right in line with our expectations. As we noted earlier, we're not changing our outlook for the full year at all -- and the year-over-year change is an element we described -- the insurers tax and tax favorable and then business mix and the less favorable development going the other direction. As far as acuity, overall acuity in aggregate is in line with our expectations there as well. What you'll see over time, as we work hard to keep moving lower acuity in each category to its appropriate place of service, what remains in each category will naturally have a little bit of upward pressure on acuity inside those categories.

No change in our view on unit cost versus utilization still at 4%, primary driver being the unit cost and 2% of utilization. And then, I think the last piece was Benmedica. I think Dave touched a little bit on that earlier, given the size of Benmedica against our total medical expense base. It's really not a material factor at this point.

David Wichmann -- Chief Executive Officer

You should conclude from this that the trends are very much in line with our expectations for the year. Our teams are performing very well containing healthcare costs and they are pricing to a forward view of trends. Very consistent with the actions that we've taken in the past. As it relates to that comment around international, our international businesses in South America are performing very well. Very nice growth year-over-year off of strong baselines. Good start for Benmedica, as well. Next question, please.

Operator

We'll go next to Gary Taylor with JP Morgan. Please go ahead.

Gary Taylor -- JP Morgan -- Analyst

Good morning. Any specific comment on days claims payable being down just a touch? We've tiptoed around talking about trend and I've heard and appreciate all of your comments. But, I wanted to specifically ask on hospital trend, given the for-profit hospital is such a marked acceleration of same store revenue in the first quarter, if with a little more visibility at this point, if you have seen, in fact, just in the hospital piece, any pickup in trend?

David Wichmann -- Chief Executive Officer

Gary, I'll take that last one first. We really haven't. Things are aligned and consistent with what our expectations were coming into the year and as we move throughout the year as well. The first part of our question, with respect to the days -- Jeff, do you want to take that?

Jeff Alter -- Chief Executive Officer, UnitedHealthcare Employer & Individual

Sure. We're comfortable with our level of reserves here as of June 30th, and with 48.3 days, that's well within our expected range that you've seen us at historically, which has typically been 47-49 days, other than the period where we had the individual ACA effect that elevated it up to closer to 50. It's down year-over-year, about a day, when you bring it out to the decimal point there. And there is a couple of things contributing to that. One is we continue to see a little modest reduction in provider claim submission timing. Also, there was a timing impact from when we released capitated payments that are directly linked to risk and quality revenue receipts that just changed from third quarter to second quarter relative to last year.

David Wichmann -- Chief Executive Officer

Thank you, Gary. Next question, please.

Operator

We'll go next to Gary Taylor with JP Morgan. Please go ahead.

Steven Valiquette -- Barclays -- Analyst

Great. Good morning. This is a little bit granular, but we are getting a few calls around the new expansion in 2018 of total knee replacement from just the inpatient to now the outpatient setting. I think, at a high level, there should be some cost savings around this, but there also could be an increase in utilization, just because of the availability and the lower cost setting. I'm just curious at a high level what you're seeing around this phenomenon so far this year. Thanks.

David Wichmann -- Chief Executive Officer

Maybe Andrew Hayek, who came to us from STA, can respond.

Andrew Hayek -- Chief Executive Officer, OptumHealth

I'll offer some general commentary. I do think the CMS policy announcement is consistent with our overall view, that more surgery, including higher acuity surgery, will shift to the outpatient setting and ultimately to a surgery center setting. That's based on improvements in technology and surgical technique and aesthetic technique. All of that improves the quality experience and cost of care. From that standpoint, we have been seeing continued growth in total joint replacement procedures in the commercial space. We are beginning to see that happen with knees from a Medicare standpoint, in terms of physicians preparing to shift those cases. We believe that's really good for the patient in terms of quality and experience -- very high NPS, fantastic quality outcomes, and substantial cost savings.

We've been seeing that on a commercial basis for a number of years and are working very collaboratively with leading health plans. We think that will be a great benefit to Medicare over the coming years. And we expect them to continue to widen the range of procedures that are eligible for outpatient. It's all the right thing for the patient and for the healthcare system.

David Wichmann -- Chief Executive Officer

Which is one of the reasons why invested in SCA, which we viewed as the right ambulatory surgical platform, properly positioned in the higher acuity surgeries that were offered in those settings, with great ambition for its ability to expand and meet the needs of more people with higher quality and greater levels of consumer satisfaction -- just as a reminder, SCA operates in a 91 NPS zone. So, very progressive and doing so while saving consumers about 50%. Next question, please.

Operator

Our next question is from Ana Gupte with Leerink Partners. Please go ahead.

Ana Gupte -- Leerink Partners -- Analyst

Good morning. On drug pricing reform, do you have any change in your plans or actions to aid the administration's agenda -- overall spending, specialty RX, transparency, and out of pocket for seniors? You have the largest set of capabilities at scale with Medicare Advantage bundled with Part D -- the largest big three integrated PBM and -- I was just curious.

David Wichmann -- Chief Executive Officer

John Prince?

John Prince -- Chief Executive Officer, OptumRx

Thanks, Ana. In terms of overall drug pricing, we are very focused on lowering drugs costs for consumers. As you know, our strategy is focused on the net cost of drugs, decrease in total cost in healthcare, and creating a transformative consumer experience. That's very aligned with what is happening in the broader market. So, in terms of what we're focused on, we're very focused on initiatives that bring that down the list price of drugs. But, more importantly, the net cost of drugs. A lot of things that we focused on have been providing ideas around what we're doing exactly. As you know, in the second quarter and late in the first quarter, we started direct to consumer pharmacy discounts for United Healthcare. That impacted seven million people and their out of pocket costs.

We've been very focused on investments in PreCheck MyScript. That now is being used by almost 100,000 physicians in the market that directly links into the electronic medical record. That is helping in transparency. It gives the doctor an idea of what is the formulary, how much does it cost, are there lower cost alternatives. We're very focused on value payments. We have 15 of those in the market right now and we continue to expand on that.

Lastly, we're very focused on our drug negotiations and encouraging our pharmaceutical partners to lower the list price. We've been working with people as they come to market with products to have a lower list price. And, when people have done that, we've put them preferred on the formulary. So, it gives you a series of examples that we're very focused on lowest net cost, improving total cost of care, and we've been doing very practical things in the market to make that a reality.

Ana Gupte -- Leerink Partners -- Analyst

Thanks, John.

David Wichmann -- Chief Executive Officer

Thank you. Next question, please.

Operator

We'll go next to David MacDonald with SunTrust. Please go ahead.

David MacDonald -- SunTrust Bank -- Analyst

Good morning. Just one quick question on global. I was wondering if you guys could spend a minute on what you're trying to do at the local level to increase the penetration of private insurance, and also what you're doing more at the national level to try and drive increased public/private collaboration with these governments. Thanks.

David Wichmann -- Chief Executive Officer

We'll have Molly Joseph, our Chief Executive of UnitedHealthcare Global respond.

Molly Joseph -- Chief Executive Officer, UnitedHealthcare Global

Our focus is around our Latin America platform. There, we really see a very strong demand for access to private healthcare and a limited supply of affordable private healthcare. Our core capabilities create tremendous value across affordability, access, and outcomes for those that we serve. Our businesses in these markets are broad. They are diversified. They are scaled. That is both from a health benefits perspective and from a medical delivery perspective. We work to use these platforms in combination with our enterprise core capabilities to advance healthcare modernization, make care more affordable, and make it more effective for those that we serve.

In doing that, we open up access to serve broader segments of the private healthcare market. And, over time, we earn trust to serve these markets more holistically by partnering with governments.

David Wichmann -- Chief Executive Officer

I think one of the strongest examples of that is our public/private partnership in our hospital in Portugal. We're leading on quality and provide a very cost-effective solution working with government to serve the needs of the people of Portugal. Molly and her team has really done a nice job, particularly around innovation and bringing new innovations to the market. What you're starting to feel is the introduction of information analytics, use of digital capacities, increased product modernization, and designs in countries that have historically not had a great deal of diversity of offering.

That helps to create demand for all folks. That access to private health systems serves the needs of multiple different price point expectations that those consumers have. We're very pleased with the work that they've done. Next question, please.

Operator

We'll go next to Matt Borsch with BMO Capital Markets. Please go ahead.

Matthew Borsch -- BMO Capital Markets -- Analyst

Thank you. In response to the first question you had on reserving, I'm trying to understand -- clearly there's a positive bias to your reserve development. But, is there a specific margin for adverse deviation, if that's the correct term, that you target -- or should we expect that zero is the best result as we move ahead?

David Wichmann -- Chief Executive Officer

Jeff?

Jeff Alter -- Chief Executive Officer, UnitedHealthcare Employer & Individual

Yeah. That's not something we disclose publicly. That said, it is not zero. We do have a target and it's been very stable over the years, built up by business for adverse deviation.

David Wichmann -- Chief Executive Officer

Yeah, and the way that shows itself is when you carry over from over a year. It doesn't really show up quarter to quarter. It shows up going from Q4 to Q1 and less dramatic when you get into Q2. Our development really relates to Q1 this year, and it's not really all that different from the development that we experienced in Q2 2017 related to the first quarter of '17 as well.

Thank you, Matt. Next question, please.

Operator

We'll go next to Michael Newshel with Evercore ISI. Please go ahead.

Michael Newshel -- Evercore ISI -- Analyst

Thanks. I wanted to ask how much headway from the health insurer fee moratorium you're expecting in the back half of the year from major commercial renewals? David, I think you mentioned a $0.22 impact earlier? Is that right? And, was any of that absorbed in the first half of the year?

David Wichmann -- Chief Executive Officer

The $0.22 -- I'm sorry to confuse you -- related to the impact of FLU combined with that. I think specifically the HIF component was six or seven cents -- something in that zone, if I recall correctly. Okay?

Michael Newshel -- Evercore ISI -- Analyst

Got it. And then most of that falling in the second half of the year, but small.

David Wichmann -- Chief Executive Officer

That's right. Yes. Thank you. I believe that concludes the questions for the day. We accomplished one of our performance metrics, and that was to make sure that we were able to answer all of your questions. I appreciate them. They were all very good.

To sum up our report for the second quarter, the people of UnitedHealth Group, Optum, and United Healthcare executed well on our strategic path, improving quality, affordability, and consumer satisfaction for the people we serve, resulting in growth and reliable returns for our shareholders. Revenue, cash flow, earnings, and importantly NPS scores continue to advance.

While we recognize there is much more to be done to reach the full transformative potential of our enterprise, we are committed to help positively reshape healthcare to be higher quality, more affordable, simpler, and of higher value to people. We are confident that we will continue this strong performance in the second half of this year, in 2019, 2020, and for many years to come.

...

Thank you again for joining us today. This concludes our call.

Operator

And this will conclude today's program. Thanks for your participation. You may now disconnect.

Duration: 71 minutes

Call participants:

David Wichmann -- Chief Executive Officer

Sir Andrew Witty -- Chief Executive Officer, Optum

Steve Nelson -- Chief Executive Officer, UnitedHealthcare

John Rex -- Executive Vice President and Chief Financial Officer

Brian Thompson -- Chief Financial Officer, UnitedHealthcare Medicare & Retirement

Jeff Putnam -- Chief Financial Officer, UnitedHealthcare

Jeff Alter -- Chief Executive Officer, UnitedHealthcare Employer & Individual

John Prince -- Chief Executive Officer, OptumRx

Dan Schumacher -- Chief Financial Officer, UnitedHealthcare

Andrew Hayek -- Chief Executive Officer, OptumHealth

Molly Joseph -- Chief Executive Officer, UnitedHealthcare Global

Timothy A. Wicks -- President, OptumRx, Inc.

Dirk McMahon -- President and Chief Operating Officer, Optum

Peter Costa -- Wells Fargo Securities -- Analyst

Justin Lake -- Wolfe Research -- Analyst

Dave Windley -- Jefferies -- Analyst

Kevin Fischbeck -- Bank of America/Merrill Lynch -- Analyst

Matthew Borsch -- BMO Capital Markets -- Analyst

Michael Baker -- Raymond James -- Analyst

Gary Taylor -- JP Morgan -- Analyst

Sarah James -- Piper Jaffray -- Analyst

Ana Gupte -- Leerink Partners -- Analyst

Ralph Giacobbe -- Citigroup -- Analyst

AJ Rice -- Credit Suisse -- Analyst

Steven Cano -- Goldman Sachs -- Analyst

David MacDonald -- SunTrust Bank -- Analyst

Lance Wilkes -- Sanford C. Bernstein -- Analyst

Joshua Raskin -- Nephron Research LLC -- Analyst

Steven Valiquette -- Barclays -- Analyst

Michael Newshel -- Evercore ISI -- Analyst

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