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UnitedHealth Group (NYSE:UNH)
Q1 2021 Earnings Call
Apr 15, 2021, 8:45 a.m. ET

Contents:

  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:


Operator

Ladies and gentlemen, thank you for standing by and welcome to the UnitedHealth Group first-quarter 2021 earnings conference call. At this time, all participants are on a listen-only mode. After the speakers' presentation, there will be a question-and-answer session. [Operator instructions] And now I'd like to introduce your host for today's program, Andrew Witty.

Please go ahead, sir.

Andrew Witty -- Chief Executive Officer

Good morning, and thank you for joining us to discuss our first-quarter results and positive outlook as we continue to execute on UnitedHealth Group's long-standing mission and strategies. The exceptional dedication of the people of Optum and UnitedHealthcare again defined this period. They've adapted swiftly and creatively to demand in unrapidly changing circumstances, implemented new ideas, and importantly remain focused on serving people exceptionally well. As a result, adjusted earnings per share were $5.31, reflecting strong execution at both UnitedHealthcare and Optum.

In light of our strong start to the year, balanced with continued respect for the potential pandemic-related effects we have previously described, we are increasing our full-year adjusted earnings outlook to a range of $18.10 to $18.60 per share. I'll touch briefly on two highlights among many in the quarter that illustrate the increased momentum our colleagues at UnitedHealth Group are driving. People served with our employer and individual offerings grew nearly 100,000 in the quarter. Even within the context of a challenged U.S.

employment environment. And this underscores the growing consumer orientation affordability and breadth of our products. Optum inside revenues increased 14% and operating income increased 45% compared to the year-ago period, as more normal activity levels among healthcare system customers returned, leading to expansion in how we help them advance clinical and operational excellence. Significant innovation and automation in the Optum in-site businesses drove strong productivity gains.

We have the right capabilities assets and strategies in place and we remain restless to innovate, evolve, and further integrate our offerings to serve more people more effectively both directly and with our many external partners throughout the healthcare environment. To achieve this, we've been sharply in our focus in three key areas. First, delivering even greater value to those we serve throughout the healthcare system by better harnessing the collaborative capabilities of Optum and UnitedHealthcare. We believe we can develop new products and services which support people more effectively by bringing to bear greater application and adoption of the combined offerings of these two distinct and complementary organizations.

OptumCare's work supporting Medicare Advantage patients illustrates this well and I'll speak more to this shortly. The second area of focus increase in the application of our technology and related resources to improve care for people and the operational health systems. There are benefits for everyone in helping to make the healthcare system work more like an actual system. Improving the natural flow accessibility and use of information is essential to that goal, all within a secure and protected framework.

We can help care -- we can help care providers and payers better serve patients by more effectively simplifying key administrative processes and by providing timely access to relevant information. The third focus is making healthcare work better for consumers. We're ambitious to meet the rising expectations of healthcare consumers and we will continue to improve our offerings include and in such critical zones as greatly simplified intuitive and satisfying consumer digital experiences and advanced healthcare bank and payment services that enable people to fund, price, and pay for care digitally. You'll hear more -- more from us about these approaches in the months ahead.

But today, I'd like to focus on the first unlocking greater value for customers at the intersection of Optum and UnitedHealthcare including through our ability to develop new useful service offerings. One of the most effective ways of doing so is through stronger alignment of the high-quality clinical services of OptumCare to address the needs of patients we serve for our nearly 90 health plan customers. A key foundation is increasing the clinical outcome accountability of our OptumCare practices. Of the 4 million patients who OptumCare serves in some form of accountable arrangement today, 2 million are being served under fully capitated arrangements.

And this demonstrates strong growth and progress. But OptumCare served 20 million patients in total, which is one reason why we view the potential of OptumCare as only beginning to be harnessed. These accountable arrangements drive measurably better patient outcomes and experiences all at a lower cost. For example, seniors served by OptumCare physicians under such arrangements spend on average one-third fewer days in the hospital and have 40% fewer days in skilled nursing facilities than seniors in traditional Medicare.

We expect the growth in the number of OptumCare patients served under accountable arrangements to accelerate. A further example of using our combined expertise to advance more beneficial service offerings is the recent opening of a first-of-its-kind Optum-integrated care facility in Riverside County, California. While we have long offered and continue to actively develop our senior-focused clinics, this new clinic and community center offers a comprehensive range of primary care-led services including a pharmacy all under a single roof, and importantly it is especially orientated around supporting Medicaid, Medicare, commercial and individual members of all ages. This comprehensive health center provides improved care access with modern onsite services including annual wellness visits, chronic disease management support, coordinated care with trusted specialists, and laboratory imaging and pharmacy services.

The adjacent community center includes a full-service gym and meeting rooms for health education. We see Optum and our payor partners as uniquely positioned to be able to offer these types of impactful venues and look forward to learning from the community and expand in these services. To sum up, we continue to organize and apply the unique capabilities of this organization in ways that enable us to execute on the goals we established for 2021 and beyond and to continue to deliver on our 13% to 16% long-term earnings growth objective. Now, I'll turn it over to our president and chief operating officer, Dirk McMahon, to give more color on initiatives to drive greater performance across the organization.

Dirk McMahon -- President and Chief Operating Officer

Thanks, Andrew. As Andrew noted, we continue to drive growth by supporting more affordable, simpler quality care across Optum and UnitedHealthcare. These are themes you've heard us cover before and we continue to see the benefits of this approach for people -- for the people we serve. Let me turn those themes into some specific examples across Optum and UnitedHealthcare that illustrate how our approach is working.

The first is health. We've been simplifying the consumer experience over the past year. We've driven greater engagement with seniors by increasing the adoption of digital tools. Monthly active users of our digital offerings have risen double digits with similar increases in online transactions.

This has led to greater adoption of our digital therapeutic offerings. In the first quarter, high-risk chronic disease patients in our home monitoring program logged over 1.5 million biometric measurements such as glucose level, enabling 99% medication compliance and an NPS of 84%. We've also made it easier for people to get and maintain behavioral health support by expanding traditional and virtual provider networks and combine them with modern digital therapeutic services. Behavioral health needs have increased significantly during the pandemic and as a result, we've seen substantial adoption in our digital behavioral platform that provides on-demand emotional support, logging a rise of over 100% and utilization.

Always accompanying our work to simplify healthcare is Optum and UnitedHealthcare's sharp focus on delivering high-quality care. We've talked to you before about the advances we are making to integrate patient-specific health data and plan information directly into the physician's workflow. Clinicians can seek gaps in care and act to close them during the patient's visit and in addition -- during the patient's visit -- in addition to other steps that facilitate more efficient care and better outcomes. We now support over 8 million of these insight-enabled digital interactions each month with rapidly expanding physician adoption.

Delivering high-quality care has been central to our response to the COVID pandemic. Our most recent effort to help members access vaccines is a prime example. We launched a vaccine locator tool helping people find and sign up for vaccination. And we've made millions of outbound contact to engage members and help them get the information they need.

Lastly, making care more affordable remain central for the people we serve and the health system overall and is essential for increasing access. For instance, through our medication sourcing program, high-cost providers now source drugs at a network specialty pharmacy including OptumRX, or charge market rates only for the drug. Early work on this has generated substantial savings for our customers. Our work to make healthcare simpler higher quality and more affordable drive strong growth for our business.

At the end of January for example, UnitedHealthcare was awarded an Oklahoma Soonercare Medicaid contract to serve nearly 200,000 people. Oklahoma previously operated under a fee-for-service program. The award affirms the value we bring the state partners and consumers and reflects our commitment to expand access to care for all Americans. We look forward to working with our new partners in Oklahoma and sharing with you on future calls new examples as our work on simplicity, quality, and affordability continues to create improvements and new growth opportunities.

With that, now I'll turn it over to our chief financial officer, John Rex.

John Rex -- Executive Vice President and Chief Financial Officer

Thank you, Dirk. Before I review the performance of our businesses, as in recent quarters, I'd like to provide an update on the care patterns we're seeing as the pandemic continues to evolve. Over the course of the first quarter, total care activity, including COVID-19-related care, ran marginally below seasonal baseline. Pacing of elective care activity through the quarter generally trapped and in opposite directions with the rise in decline of COVID incidence rates, which were much higher in the early part of the quarter than in the latter part.

To put this in perspective, February and March showed COVID-related care at about half the level experienced in January. Since the quarter's end, we have again begun to see a rise in COVID-related care, while at this time, not approaching the January level. Outpatient care activity was moderately below seasonal baseline for the full quarter, running in counterpoint to the COVID incidence patterns over the three months and reflecting a well-below average influenza, and respiratory illness season. And total in-patient activity was modestly above seasonal baseline, with over 55,000 COVID-19-related admissions during the quarter compared to 65,000 in the fourth-quarter 2020.

Moving to business unit performance. OptumHealth's first-quarter revenue and earnings increased 35% year over year. Revenue per consumer served grew 31% over the year-ago quarter. The growth in this metric continues to reflect the expanding number of people served under value-based care arrangements and the increasing acuity of the care services we offer.

OptumInsight's revenue grew 14% in the quarter and earnings 45%, due to growth in our services and technology offerings and improved productivity. The revenue backlog at $20.8 billion grew $1.6 billion over the first quarter 2020, as more normalized business activity started to return among our provider and payer customers. OptumRx revenue and earnings were relatively consistent year over year and in line with our expectations. Adjusted scripts declined modestly from the year-ago quarter, a period during which we provided advanced medications to the people we serve as the pandemic began.

Pharmacy care and specialty services continue to grow strongly, in particular, home infusion, and our community behavioral health pharmacies. Turning to UnitedHealthcare. First-quarter operating results reflected strong execution and continued membership growth. In addition to the growth in commercial and Medicare Advantage offerings noted earlier, people served in managed Medicaid programs grew by nearly 1.1 million over the year-ago quarter.

Of the 900,000 new seniors we expect to serve within Medicare Advantage this year, about 775,000 are in individual and group, and 125,000 in dual special needs offering. Of importance to the senior customers we serve, our house calls clinicians have been considerably more able compared to this time last year to provide their vital services. We conducted nearly 600,000 home visits in the quarter as more seniors and caregivers were vaccinated and comfortable having in-person visit. That's up by a third compared to first-quarter 2020 and about four times higher than what was achieved in the second-quarter 2020.

Our liquidity and capital positions remain strong, with first-quarter cash flows from operations at $6 billion or 1.2 times net income. As we look forward toward the combination with Change Healthcare, we intend to maintain our long-standing capital policy. These include our approach to returning capital to shareholders via share repurchase and an advancing dividend, with ample capacity to continue building upon our strategic growth platform. We now expect adjusted earnings per share in the range of $18.10 to $18.60, an increase of $0.35 from the outlook we offered at our investor conference.

This outlook continues to include an estimated $1.80 per share of unfavorable COVID-19-related effects. The substantial majority of which we still expect to occur in the latter part of the year, largely as carriers more freely able to be delivered to people. Now I'll turn it back to Andrew.

Andrew Witty -- Chief Executive Officer

Thanks, John. The story you heard about this quarter is the story you've heard for many years, and will continue to do so about UnitedHealth Group, a focus on better serving people and organizations in healthcare, using the combined capabilities of Optum and UnitedHealthcare to improve care, cost, and experience, and an unwavering attention to executional excellence in all that we do. Operator, let's open it up for questions. One per caller, please.

Questions & Answers:


Operator

Certainly. Our first question comes from the line of Matt Borsch from BMO Capital Markets. Your question, please.

Matt Borsch -- BMO Capital Markets -- Analyst

Hi, yes. Good morning. Congratulations on the quarter. I have a question for you on the prior-year reserve development, which is obviously a very large number.

Can you just talk to where that emanated from in terms of components, whether by program or by quarter in 2020? And how that may be influencing your posture on forward reserving?

Andrew Witty -- Chief Executive Officer

Great. Thanks for the -- I'm glad you asked that. I know a lot of people probably have that in mind. John, you should answer that, I think.

John Rex -- Executive Vice President and Chief Financial Officer

Sure. Matt, good morning. It's John Rex.

Matt Borsch -- BMO Capital Markets -- Analyst

Good morning.

John Rex -- Executive Vice President and Chief Financial Officer

Let me give a little color on that. So, yes, the prior-year development, $1 billion favorable versus $850 million in the 4Q. As I'm sure you expect, you know, that emanates heavily from the second half of 2020 and a lot from the fourth quarter. It was favorable really across the businesses.

The elements there that would be driving that would be largely along care deferral activity that would have occurred in the quarter. I think when you think about kind of impact to the company and P&L impact, certainly, there are, you know, significant mitigating factors, as I know you're well aware, MLR -- MLR rebates, risk order arrangements, reserve reestablishment that occurs. When I look at it and take it all together with those mitigating factors, P&L impact would have been in a similar zone to last year's first quarter with those elements coming in. Thank you.

Matt Borsch -- BMO Capital Markets -- Analyst

Thank you.

Andrew Witty -- Chief Executive Officer

Thanks, John. Thanks, Matt. Next question, please.

Operator

Certainly. Our next question comes from the line of Kevin Fischbeck from Bank of America. Your question [Inaudible]. I'm sorry.

Our next question comes from the line of Robert Jones from Goldman Sachs.

Robert Jones -- Goldman Sachs -- Analyst

Great. Good morning. Thanks for the question, and congrats to Andrew and Brian one the -- on the new roles. I actually just wanted to ask one on OptumHealth.

I think you said 35% of the growth there was driven by global cap. You also shared 2 million risk patients in OptumCare are now in global cap. You know, just curious if you could give a little bit more on kind of where you think this number could get to, you know, the number of patients in global cap arrangements within OptumCare this year and then maybe over time. And then it'd be helpful to understand a little bit just how many of the 20 million patients you highlighted are actually in MA today? Thanks so much.

Andrew Witty -- Chief Executive Officer

Great. Listen, Robert, thanks so much for the question. Before I ask Wyatt Decker to add, you know, you put your finger on a really key part of the growth strategy going forward. Clearly, you know, you're going to see over this year and next year, an accelerating move toward more capitated patients within the OptumCare universe.

As I mentioned in my prepared comments, there's a tremendous opportunity as we look at those 20 million and growing number of patients who we look after migrating toward what we believe to be a better mechanism to help them manage both their care outcome and also the cost implications. So you -- you'll see that continue to accelerate. As we expand our OptumCare networks, we are rapidly transitioning our capabilities clinic by clinic to be able to do this. And it's one of the areas I think we feel extremely optimistic about future momentum.

But to give you a little bit more detail, Dr. Decker, who leads Optum Health, please.

Wyatt Decker -- Chief Executive Officer, OptumHealth

Yeah. Thank you, Robert, for the question. And Andrew, I think you set it up nicely. OptumCare has become the nation's preeminent ambulatory delivery of value-based care.

It is physician-led. And increasingly, you'll see us bringing comprehensive services to bear to meet the needs of all of our patients, but a particular focus on value-based and a particular focus on the fully capitated individual. We will continue to grow over 250,000 lives this year, and you can expect that to accelerate in the years to come as we continue to attract individuals through organic growth, as well as, through our partnership with UHC, and as Andrew mentioned, nearly 90 other providers. Thank you.

Andrew Witty -- Chief Executive Officer

Thanks, Wyatt, and thanks, Robert, for the question. Next question, please.

Operator

Certainly. [Operator instructions] Our next question comes from the line of Lisa Gill from JPMorgan.

Andrew Witty -- Chief Executive Officer

Hi, Lisa. Go ahead.

Lisa Gill -- J.P. Morgan -- Analyst

Good morning, and thank you for taking the question. I'm just curious how we think about digital and telehealth impacting medical costs. What you've seen thus far? And what's the future role post the pandemic when we think about helping to control costs from a telehealth perspective?

Andrew Witty -- Chief Executive Officer

Lisa, that's a great question. I'm going to ask, in a second, Dr. Decker. And also, I think I'll ask Dirk McMahon to make a couple of comments, but let me just preface that.

So, you know, we've -- we've obviously seen telehealth develop as a set of capabilities over the last several years. We've been a very extensive user of those capabilities. But I think one of the things we've seen from 2020 and the pandemic is really a kind of shift in terms of people's thinking and -- and willingness to utilize telehealth. We also think that the way in which they're being utilized are -- is evolving.

And so what you're going to see from us, and it's one of the examples I might cite in terms of the opportunity for new product development between Optum and United Healthcare, is you're -- you're going to see UnitedHealth Group lean forward into much more integrated telehealth capabilities. We've got a number of new initiatives in deployment as we speak, operating between the two companies. And with that introduction, let me pass it over to Wyatt to maybe give you a little bit more detail on that. And then I think would be good to hear from Dirk the perspective he has on this.

So Wyatt first.

Wyatt Decker -- Chief Executive Officer, OptumHealth

Yeah. Well, thanks for the question. And -- and as you heard us mentioned before, we were very proud of how quickly we stood up over 17,000 providers during the pandemic on telehealth solutions, but that really is just is the beginning. And of course, across the country, we've seen a massive shift in consumer adoption and willingness to engage in virtual health solutions, as well as with our providers more broadly.

So -- so our philosophy is that not all telehealth is created equally. And as -- as we continue to develop our new products, you'll see us integrating physical care, virtual care, home care, and behavioral care in a way that is innovative and differentiated. And in fact, we've already launched a -- a -- a product we call Optum virtual care that is live in all 50 states and is doing just that. And -- and what will really differentiate our -- our product to those that we serve is the ability to offer virtual solutions.

But then, if necessary, immediately connect them to a live bricks-and-mortar solution form for a more complex or thorough care, as well as identifying and triaging both physical and behavioral healthcare needs and offering a comprehensive behavioral healthcare. We're seeing continued sustainability of virtual care solutions which, as you may know, peaked during the height of the pandemic, have declined some, but are still probably 10x where they were pre-pandemic. And certain conditions or behavior or -- or areas like behavioral healthcare are now seeing about 50% utilization through virtual services. So we're very excited about where we can take this off.

I'll turn it over to you, Dirk.

Dirk McMahon -- President and Chief Operating Officer

Yeah. Thanks, Wyatt. I think Andrew and -- and Wyatt pretty well drilled it. But let me say a couple of things.

First, we know that people want to meet with their doctor and we've been focused on facilitating that with Optum care. And, you know, with people, basically as you look at how things evolved, you know, the brick-and-mortar position that the vast majority of the telebusiness today. I -- I would also say that I -- I do see a tremendous opportunity for new models and new product strategies with -- with Optum care and others where, you know, we -- we lean toward those providers who have, again, the best outcomes and provide the most efficient care. So like any other doctors in our network, we at UnitedHealthcare, are going to be looking for that.

Strongly, we think Optum care can provide that very well. That's it. Thanks, Lisa.

Andrew Witty -- Chief Executive Officer

Thanks, Dirk. Thanks -- thanks, Wyatt. I got to say, Lisa, you know, I've been keeping an eye on the pa -- patient verbatims as we've been deploying the Optum virtual platform that Wyatt referred to. And -- and really, the feedback is really extraordinary in terms of -- of how patients are -- are seeing this, the benefit they feel from it, and the ease with which they're able to engage with it so.

So -- so this is exactly the kind of thing you're going to see going forward. I think Optum in an extremely advantaged position being able to bring together this notion of integrated telehealth with physical and behavioral health, and that's going to be the path we go. And I think we're on the verge of kind of next generation of what this looks like versus what we've seen previously. So, Lisa, thanks so much for raising the question.

And next question, please.

Operator

Certainly, our next question comes from the line Kevin Fischbeck from Bank of America. Your question, please.

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

Great. Thanks. I guess one verification. Just, first I guess, is your guidance assume anything for sequestrations delay but then I guess the -- the real question is that the $1.80 that you guys are -- those including in your guidance, that sounds like things are starting off the year relatively well with overall utilization coming in better and membership growing and some of the Optum insight, things kind of normalizing I guess.

How do you think about that $1.80? How is that progressing and to what kind of signpost do you need to kind of see before you -- you feel like that number might come in and -- and lower than that?

Andrew Witty -- Chief Executive Officer

Yeah, no, listen. Kevin, thanks for the question. I'll let -- I'm going to ask John in a second to refer to the dollar rate the -- the math I guess behind that and the -- and the underlying trends. As far as sequestrations are concerned, obviously, we, you know, we're keeping a close eye on the guidance from the administration.

We -- you know, we've clearly seen the extensions. But the guidance range we've given today is not caveated by that in any way. So, you know, we -- we -- we have our assumptions on that, but the guidance stands notwithstanding any outcome there. John, on the $1.80.

John Rex -- Executive Vice President and Chief Financial Officer

Yeah, Kevin. John Rex. Good morning. Let me talk a little bit about that and how we think about that progressing throughout the -- the course of the year.

So, you know, just a few impacts here. I -- I think the first -- the important impact I suggest is that if a significant majority, I'd call it 70% of our projected COVID impact is -- is really occurs in the second half of the year. And, you know, just to be frank, we -- we just don't know enough now about what is going to happen later in the year, kind of have a very meaningfully different projection of what our full-year results will be in terms of will they be better in terms of better than the original projections, except for what we've experienced thus far which we've expect -- expected some stronger underlying business performance growth across a number of businesses. We've executed well on productivity measures.

And maybe just very modestly less impact in the 1Q unfavorable impact than we would have anticipated. But the -- the important component there being that is really much more a -- a back half weighted view in terms of COVID-19 impact. You know, that's really premised upon our expectation that as we get later in the year, people are going to be more able to access previously deferred care and higher acuity levels as a result of missed their postponed treatments, and that's what we're, you know, that's what we built -- that's what we build into that -- that view in terms of an expectation. But that's -- that's really, you know, in an unusual time still.

No question. And we, therefore, increased our full-year estimate but -- by what we know today.

Andrew Witty -- Chief Executive Officer

Thanks, John, and, Kevin, thanks so much for -- for asking the question. I mean I think -- I think John really summarized it super well. You know, we -- we've raised our expectations for the year based on our experience so far this year with -- and we've retained that -- that $1.80 assumption if you will in terms of what could happen. But we just -- we obviously don't have the detailed visibility of that yet.

But we feel that's the right balance stands to take in terms of -- in terms of this -- of rest of this year. So I hope that's clear and thanks so much for the question, Kevin. Next question.

Operator

Certainly, our next question comes from the line of Josh Raskin from Nephron Research. Your question, please.

Josh Raskin -- Nephron Research -- Analyst

Hi, thanks. Good morning. Here with Eric Percher as well. So our question this quarter again on OptumHealth and appreciate the comments in the prepared remarks and the Q&A.

But want to I speak to the ultimate strategy around the accumulation of employed physicians and if this is all about a move to global capitation, and we're really more interested in the how, right? Is this more standard based like what you're talking about in Riverside, California? Is this more of a technology overlay that enables the physicians to do this? And then I would just ask again how many of those $20 million, I understand $250,000 will move this year. But how many those $20 million ultimately end up in global cap in your mind?

Andrew Witty -- Chief Executive Officer

Josh, thanks for the question. And -- and before I pass it to Wyatt again to -- to respond to the specifics. Let me just give you a sense of how we see this play now, and I -- I think the answer to your question is really both. So, you know, we absolutely see tremendous opportunity to continue to develop a variety of different clinic types.

And if you look at the -- the -- I -- I cited one particular example but we've been open -- open in a wide number of different type of clinic, depending on the environment that -- or the locality that we're operating in. And -- and you should -- you should continue to expect to see that degree of customization according to the need of the geography. It's not a one size fits all model by any -- any means. So you'll continue to see that.

But at the same time, we strongly believe there is opportunity over the next few years, and this is where I focused in my kind of second area of going deeper around technology. How we can then help those clinics operate more efficiently? How we can ensure they are better connected both locally with other clinics that we may own or to a higher level of information support? So we see this has been a highly activated network of -- of clinics and centers. The center -- the network itself will have a high degree of diversity in it because it needs to be responsive to the needs of the -- the locality, the communities that we're operating in. And of course, as, you know, sensitive to the previous comments, it will have a very significant telehealth capability deployed alongside it.

Wyatt, maybe you could talk a little bit to how you see the progression and within the $20 million?

Wyatt Decker -- Chief Executive Officer, OptumHealth

Yup. Thank you, Andrew, and thanks, Josh. Great question. We will continue to evolve, and -- and one of the pieces that will differentiate us as comprehensive care providers is just that being comprehensive.

And so you'll see us continuing to weave together products and services that meet people's needs in new and innovative ways, and -- and telehealth and digital solutions are -- are big piece but not the only piece. The other -- the other part that I'd call out is we're in -- we're increasingly leveraging technology to bring advanced decision support to our physicians and providers. And you may have heard previously about optimal care. This is a value-based care delivery of set of decision tools that are yielding real results, giving people the best highest quality care that eliminates what we tend to call low-value care, and is the differentiator.

So -- so, we'll continue to deploy those technologies. As -- as you know, we are on track to grow by over 10,000 physicians. We're now at 56,000 doctors, both affiliated, contracted, and employed. And we'll leverage all of those models as we go forward.

And we continue to evolve and employ doctors who are really actually quite attracted to our model of value-based primary care. We eliminate much of the clerical burden in our physicians' and advanced practitioners' practice and let them focus on the work they love. So, this is really gaining traction among our physician workforce. And then to your point around how much of the 20 million lives that we serve today will ultimately be capitated, we anticipate that not only will a -- a significant portion -- you heard the number, 2 million today and a quarter million as we mentioned growing.

So -- so, as we continue to grow, we also expect that we'll always offer a -- a host of modalities including fee-for-service. And that actually is a feeder system as we -- as we think about value-based care being kind of the core of what we offer and fully capitated the core of the core if you will. Thank you.

Andrew Witty -- Chief Executive Officer

Thanks, Brian. And maybe -- maybe I'll just ask Dan Schumacher to briefly add to -- to the comments and talk a little bit about Optum Home which is a further dimension of this. So, go ahead.

Dan Schumacher -- Chief Strategy and Growth Officer

Thanks, Andrew, and great question, Josh. To the question around sort of center base, tech base, data-enabled, and -- and different versions of that that Brian was talking about. Optima Home is a -- is a great example of a collaboration between UnitedHealthcare and Optum that's in, you know, relatively early stages. But we focused on Medicare Advantage members that are in Dual Special Needs Plans initially and that's a full risk offering.

And we're doing it in markets where we don't currently have local Optum care practices. So, what we're doing in the program is really both providing care, but also arranging and coordinating care. We're trying to address medical, behavioral, and social need. And, you know, the results initially have been great.

We've improved access to people with more than 80% having in-home visits and -- and more than half of them getting connected back into office-based care, social services referrals, and so forth, as well as great health quality and outcome. So, today, we've got a little under 100,000 lines across six markets. We're looking to expand that price that across the Medicare Advantage Duals stint, but also into the individual MA we're doing with United Healthcare. And ultimately, we look to do that with other health plans.

So, another growth factor for us as we look at building out our -- our value base in UNH.

Andrew Witty -- Chief Executive Officer

So, Josh, I mean, I know that was a -- a little bit of a long answer from the three of us. But you asked a really important question, and this is really one of the core elements of the future of the company and it's why you've heard us talk so much about Optum Health, Optum Care. And you can see the -- the growth potential. You know, we're at that 2 million life level now, we clearly see the capitation strategy as a highly effective strategy to deliver both quality and cost management for patients.

That movement is really significant and it's really moving strongly. And with the development of the diverse sets of clinics and skills -- the development of the technology support that you've just heard referred to, we believe we're in a very strong position to be able to be the leader in the ability to manage those patients in the best possible way and ensure that they -- they get the kind of healthcare they deserve. So, Josh, thanks so much for asking the question. Next question, please.

Operator

Certainly. [Operator instructions] Our next question comes from the line of Ricky Goldwasser from Morgan Stanley. Your question, please.

Ricky Goldwasser -- Morgan Stanley -- Analyst

Yeah. Hi, good morning. If I think about your de-utilization, I mean, you -- you gave us an update on how utilization is tracking. But can you give us a little bit more details on how it's tracking across the different patient populations? And also, we talked about acuity levels, your expectations for acuity level to step up the second half of the year.

But from the experience to date as you're starting to see individuals are coming back, what type of acuity you're seeing for those that haven't received care for the last year? And I think the final one there, could you just remind us as you think about that guidance for the full year, are you assuming digitalization by year-end it's going to be above the 2019 baseline?

Andrew Witty -- Chief Executive Officer

So, great question, Ricky. I'm going to ask Brian Thompson who has recently been appointed as the chief executive officer of United Healthcare to respond to that. So, BT?

Brian Thompson -- Chief Executive Officer, UnitedHealthcare

Hey, thanks for the question there. When I think about baseline, what I can say right now is what we're seeing is largely tracking to our expectations. And as we have signaled, where we see an abatement in services, it's largely offset by the increase in COVID-related costs. And that's tracked as we had expected.

When you back out the impact of the suppressed utilization, the underlying factors associated with the medical cost trend largely looked like they did. We aren't seeing significant upticks in services in specific areas out of the norm. So, I would say it looks a lot like utilization prior to the COVID implications. And when I think by line of business, I would say generally tracking a little below baseline in both our government program, closer to baseline inside our commercial business but largely in track with what we had expected.

And where it's a little out of line, again, where perhaps infection rates were higher, we saw that naturally offset with greater utilization. So, first quarter -- quarter, I would say largely as expected.

Andrew Witty -- Chief Executive Officer

John, do you want to add?

John Rex -- Executive Vice President and Chief Financial Officer

Yeah, Ricky, good morning. John right here. So, as Brian noted, one of the aspects we look for is the rising acuity from patients that have deferred or error mistreatments. And at this, you know, at this point, we don't have evidence of that occurring and it could be just that it's still too early on to have enough evidence to see it.

But we have not yet seen that rising acuity in the -- in the populations that -- that we serve. And your point in terms of how we think about as we get later into the year and why that -- why that moves like it does, and you heard my commentary that a, you know, significant majority of the Dollar 80 we have layered into the second half of the year, that is largely because of the assumptions around those elements. That we see -- that people are increasingly able to get the care they need, the amount of care deferral declined meaningfully as you get in that latter part of the year. They're accessing the system and -- and we do get into these elements where we see rising acuity come again.

So, those are the elements that have -- that are premised in terms of that -- that expectation at this point. So, hope -- but -- but really, you know. And the other element that Brian touched on also just in terms of your population, you have commercial, a little more access to the system versus the public program members. Thank you.

Andrew Witty -- Chief Executive Officer

Thanks, John, and thanks, Ricky, for the question. Next question, please.

Operator

Certainly, our next question comes from the line of Dave Windley from Jefferies. Your question, please.

Dave Windley -- Jefferies -- Analyst

Thank you. Good morning. Thanks for taking my question. I want to ask a question about integration and -- and long -- longitudinal care and data versus fragmentation.

And the question is this. So, Andrew, over many years, Optum has really invested a lot of money in -- in kind of aggregating data about -- about the patient status, care -- care and services delivered so that touchpoints with United or Optum could -- could have all that information at hand. I -- I guess what I'm interested in around kind of your -- your build-out. But specifically, the comments you've made about telemedicine is how important is it for telemedicine to enhance and augment the longitudinal and integrated nature of care versus fragmenting that by having it kind of siloed as a separate benefit.

Thanks.

Andrew Witty -- Chief Executive Officer

Right. It's a great question. So, I think -- I think our bias is -- is increasingly, and I think rightly toward driving a more and more seamless, simple, easy-to-access care environment both for the patient and the provider, actually. So, what that speaks to is trying to avoid the fragmentation of the interface and definitely trying to avoid the fragmentation of the information that then sits behind it.

So, we -- we want to really try and create a much more seamless opportunity. And so, for example, to give you a real example, in Optum Virtual, which is -- you've heard a little bit about on the call already today. So, of course, you know, patients are looking for a way to engage with a physician. They actually want to talk to their physician.

So, one of the things that we're doing is building that platform. But then there might be situations where the physician wants to bring in a specialist into that conversation. Now, in a multi-disciplinary clinic, they might be in a position in normal times to go down the hall, get somebody to come down and visit. Now, in Optum Virtual, we're able to do that kind of thing.

So, that's an example of trying to bring that integration even within the virtual space, so it kind of replicates a little bit more what you might expect in a physical environment. And so, we definitely see the need to -- to try and drive toward that and we definitely want to try and create the fluidity of the information to ensure that physicians have what they need when they're in front of the patient when they're talking to the patient they can make the best possible choices. So, we want them to be as highly educated as possible in that context. So, we're -- we're leaning much -- we're leaning very much toward the idea of integrated, seamless, and that's true whether you're in the physical or the virtual space.

And we want the two to sit together. Thanks for the question. Next question?

Dave Windley -- Jefferies -- Analyst

Thank you.

Andrew Witty -- Chief Executive Officer

Thank you.

Operator

Certainly, our next question comes from the line of Justin Lake from Wolfe Research. Your question, please.

Justin Lake -- Wolfe Research -- Analyst

Thanks. Good morning. A lot of good topics already covered here, so I just have a few quick follow-ups. First, the detail on Optum Care is very, very helpful.

I -- I was hoping I could ask for one more piece of information here which is, you know, the -- so, it's not like you're going to have 18 million people out of 20 million that are still not capitated. I'm wondering how many of these are sitting in -- in Medicare Advantage plans that are in capitated, given this is where most of the capitation happened. Just trying to think about the potential kind of pent-up growth there. And then on Medicare Advantage, it sounded like your health assessments are going better in 2021.

Should we expect that you should get a significant amount of that risk score headwind that everybody saw for 2021 to reverse next year and get those revenues back? And then lastly, could you give us an update on earnings seasonality for the year versus the 50-50 split you talked about on the last update? Thanks.

Andrew Witty -- Chief Executive Officer

Hey, Justin, thanks so much for the questions. I'm going to ask, in a second, John, to talk to the earnings seasonality and for Wyatt to address the degree to -- the population we have within the MA plan. Let me just touch on the health assessment. You heard in the prepared comments the very strong performance of the house calls program, actually, higher than last year, record quarter, actually, in terms of performance of house calls.

And you're quite right. That makes us feel pretty optimistic that that headwind that we saw is going to dissipate pretty rapidly as we rotate into 2022. And that gives us kind of a rising optimism that much of the -- much of that kind of the negative headwind that characterized the emergence of the pandemic starts to mitigate, at least on that dimension. You know, obviously, we don't know what's going to happen in the next few months with this disease.

But as we sit here today, that would be the right kind of expectation to look at. Let me go to Wyatt first. And then, John, if you pick up from Wyatt on the seasonality. So, Wyatt?

Wyatt Decker -- Chief Executive Officer, OptumHealth

Yeah, Justin, thanks for the question. And of the individuals that we serve that are not in fully capitated programs, about a third of them are seniors. And so you can think of that as the Medicare population that we serve through a variety of touchpoints in our care delivery assets. And then you -- as you'd expect, a subset of those are already in MA plan, which is to your question.

And so we see, again, a great potential to continue to capture, enroll, and care for MA patients through OptumCare's delivery capabilities. And you'll also see us going deeper in the markets that we're in and bringing our very mature risk-based platform in established markets to new markets where, today, we are primarily fee-for-service. So expect both geographic growth and increasing depth and penetration in the markets we serve today. Thank you.

John Rex -- Executive Vice President and Chief Financial Officer

Justin, good morning. It's John. In terms of the seasonality, so historically, we've been at, what I'd call, a kind of 48-52 split in terms of first half-second half. I put that probably more in the zone of first half being in the 52, 53 zone this year.

That is really due to the -- how we're tracking in the $1.80 per share and impact on us. The majority of that is occurring in the second half of the year. So that would be, really, the reason for the seasonality looking different this year than it has looked in other years. Thanks.

Andrew Witty -- Chief Executive Officer

Thanks, John. And thanks, Justin, for the questions. Appreciate it. We've got time for two more questions, operator, so let's go to the next one.

Operator

Certainly. Our next question comes from the line of A.J. Rice from Credit Suisse. Your question, please.

A.J. Rice -- Credit Suisse -- Analyst

Hi, everybody. Maybe drill down a little bit on OptumInsight. Obviously, you had a really good margin trend this quarter. I wondered -- because I know there was a discussion last year during the pandemic that some of the John Muir type of deals were somewhat on hold as it was tough to sell a health system on that given social distancing and so forth.

Does the fact that you don't have investments for those, is that helping you on the margin right now? And are those now basically reopened now that you can go out and bid? And maybe another aspect of the OptumInsight story, as you think ahead now with Change Health coming on board, should we assume that there's a pause in selling activity of some sort while you integrate that and position the company to be even stronger -- that business to be even stronger? I know there's a lot of synergy assumed to be coming online with that one. So how should we think about how Change Health coming online affects the trajectory of that business?

Andrew Witty -- Chief Executive Officer

Hi, A.J. Thanks so much for the question. I'm going to ask Robert Musslewhite to make some comments in a second around the progression of the margin in the quarter, which obviously, we're very, very pleased to see that. And it was due to a ton of hard work on a number of different dimensions that Robert can describe to you.

Just on those large contract agreements like the one we have with John Muir, yeah, there was a bit of disruption last year, but I would say that is absolutely back on stream now in terms of a line of business for us. And we have some -- a very, very exciting pipeline, and that pipeline exists both in the short, medium, and longer term. So that's an area you're going to hear more from us on and is absolutely back in full swing. In terms of Change, obviously, we are very keen to continue to work through the regulatory process.

We expect this to close in the second half, as we've previously indicated. And you should not expect any disruption from us bringing Change on board to really anything that we're doing and especially not in terms of our selling activity. So we absolutely continue to operate OptumInsight fully as if we were not in a transaction. And even post-transaction, I would fully expect the ongoing sales energy of the company to be not disrupted.

So nothing -- I really would not lead you to expect anything on that front. With that, Robert, would you go into a bit more detail, please, around the evolution of the margin during the last quarter?

Robert Musslewhite -- Chief Executive Officer, OptumInsight

Sure. And, hey, A.J. Listen, we were pleased with the quarter. It was a really good quarter on the top line, and that, of course, drove profitable growth that contributed to margin.

But specifically on margin, we also are really seeing the results of a lot of the modernization work we did across 2020. So last year, we undertook a significant review of the business across the operations and drove -- find some multiple ways to drive stronger and more efficient performance and help find -- ensure that the investments we are making were invested appropriately against our key growth opportunities. And so if you look at those initiatives, multiple automation initiatives using advanced techniques in AI, NLP, machine learning, it really drove a lot of short-term productivity. But it also drives a situation where we feel like we've made sustainable margin improvements for the long term.

And that puts us in a position to be more competitive. And that actually rolls over to exactly what you were mentioning, being more competitive on the large engagements. And as Andrew said, we feel really optimistic about that pipeline and where it's headed. The disruption was more in timing and not really in interest during the pandemic.

In fact, during the pandemic, I think there was growing recognition among our health system relationships that this was a very productive way to work with Optum and a really important need for them as they face some disruption, even coming out of the pandemic, to their finances in ways that we can sustainably support them in a really holistic way. So we feel like that's a great path forward. We're excited about the business and feel like we've made some important changes that put us on a really good track going forward.

Andrew Witty -- Chief Executive Officer

Thanks, Robert.

A.J. Rice -- Credit Suisse -- Analyst

OK. Great.

Andrew Witty -- Chief Executive Officer

And, A.J., thanks for asking the question. Insight, I think, is really on the cusp of a very exciting few years. Thanks to the significant work that was done last year, the increase in rate of opportunity that we see to bring in new significant contracts. And then obviously, the pending Change acquisition creates some really exciting momentum for this business.

So this is an area I fully anticipate us looking to for material growth going forward. Operator, last question, please.

Operator

Certainly. Our final question comes from the line of George Hill from Deutsche. Your question, please.

George Hill -- Deutsche Bank -- Analyst

Hey, good morning, guys, and thanks for squeezing me in at the end. Andrew, I'd just be interested to hear your commentary about the outlook for commercial bundles. I know we're all talking a lot about risk sharing, what I call risk syndication in the Medicare Advantage space, and the bundling of risk in the Medicare Advantage space. But I'd be interested in the company's outlook for the commercial business and if you're seeing increased uptake of kind of more risk-sharing tools in that market.

Thank you.

Andrew Witty -- Chief Executive Officer

Yeah. No, great. So, listen, I think in the commercial -- and I'm going to ask Bill Golden to come in here real quick. But I think in the commercial space, just as possible for us to start to design innovative products, and we've already begun to do that between Optum and UHC.

Let me ask Bill to dive into that in a little bit more detail. Bill?

Bill Golden -- Chief Executive Officer, UnitedHealthcare Employer & Individual

Yeah. Thank you, and thanks for the question. Yeah, I would say we're in the early stages of provider-aligned products, where we're taking advantage of that risk-based. As an example, in our Southern California OptumCare partnership, Harmony really continues to be a cornerstone over those offerings.

We're learning a lot with that product, not only regarding how it's priced but, more importantly, the actually experience for the members. And so we're using that as a cornerstone and as a program to continue to roll out throughout the country with other areas. So we're very optimistic about the opportunities that that will show in the future but still in the very early stages of our global cap with the commercial business. Thank you.

Andrew Witty -- Chief Executive Officer

Thanks, Bill. And, George, thanks so much for the question. That's clearly an area we expect to see more in the future. But as Bill said, it's early days, and we'll see how that progresses.

With that, everybody, thank you so much for spending the time with us this morning. As we move through what we all hope are the latter stages of this pandemic, you can expect us to continue to focus on the areas where UnitedHealth Group can do the most to improve healthcare, including adding even greater value at the intersection of Optum and UnitedHealthcare; applying our technology and expertise to create a better-functioning, more responsive, and cost-efficient healthcare system; and making healthcare work better for consumers. We look forward to connecting with you again on these priorities in the weeks and months ahead. And once again, thank you for your attention this morning.

Bye-bye.

Operator

[Operator signoff]

Duration: 1 minutes

Call participants:

Andrew Witty -- Chief Executive Officer

Dirk McMahon -- President and Chief Operating Officer

John Rex -- Executive Vice President and Chief Financial Officer

Matt Borsch -- BMO Capital Markets -- Analyst

Robert Jones -- Goldman Sachs -- Analyst

Wyatt Decker -- Chief Executive Officer, OptumHealth

Lisa Gill -- J.P. Morgan -- Analyst

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

Josh Raskin -- Nephron Research -- Analyst

Dan Schumacher -- Chief Strategy and Growth Officer

Ricky Goldwasser -- Morgan Stanley -- Analyst

Brian Thompson -- Chief Executive Officer, UnitedHealthcare

Dave Windley -- Jefferies -- Analyst

Justin Lake -- Wolfe Research -- Analyst

A.J. Rice -- Credit Suisse -- Analyst

Robert Musslewhite -- Chief Executive Officer, OptumInsight

George Hill -- Deutsche Bank -- Analyst

Bill Golden -- Chief Executive Officer, UnitedHealthcare Employer & Individual

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