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    Lance Wilkes

    Senior Analyst specializing in U.S. Healthcare Services at Sanford C. Bernstein & Co., LLC

    Lance Wilkes is a Senior Analyst specializing in U.S. Healthcare Services at Sanford C. Bernstein & Co., LLC, renowned for his deep sector expertise and independent industry research. He actively covers major healthcare providers such as Agilon Health, Molina Healthcare, Cigna Group, and Express Scripts, with Institutional Investor recognizing his coverage since 2017 and naming him Runner-Up in Health Care Facilities & Managed Care in 2019. Lance joined Bernstein in June 2015 after key leadership roles in Cigna’s business development and venture capital arm, as well as senior positions at OptiCare Health and Aetna, and founding Columbia Street Advisors. He holds a Master’s degree in Economics & Corporate Finance from Trinity College and a BA in Economics from Brown University, and has held executive credentials relevant to healthcare finance and management.

    Lance Wilkes's questions to agilon health (AGL) leadership

    Lance Wilkes's questions to agilon health (AGL) leadership • Q2 2025

    Question

    Lance Wilkes from Bernstein inquired about agilon's strategies for maintaining stability with its physician partners, the variance in 'other medical expense,' and the management process for these crucial relationships.

    Answer

    Executive Chairman Ron Williams described the partnership model, which is built on long-term arrangements with large, established local PCP groups, supported by in-market presidents and medical directors. CFO Jeff Schwaneke added that the variance in 'other medical expense' is a direct function of the individual partner share calculations.

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    Lance Wilkes's questions to UNITEDHEALTH GROUP (UNH) leadership

    Lance Wilkes's questions to UNITEDHEALTH GROUP (UNH) leadership • Q2 2025

    Question

    Inquired about the management and strategic review process, asking for insight into what the process was previously, what changes have been made, and whether the strategic review is considered complete or is ongoing.

    Answer

    Stephen Hemsley described a return to 'very basic, fundamental, discipline' with much greater intensity in business reviews, focusing on core economic levers, operating metrics, and remediation progress. The process involves a more concentrated agenda, faster decision-making, and significant leadership changes. He characterized it as an ongoing process of drilling down on the businesses, particularly as they complete the 2026 planning process.

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    Lance Wilkes's questions to UNITEDHEALTH GROUP (UNH) leadership • Q1 2025

    Question

    Lance Wilkes asked for a breakdown of Q1 Medical Loss Ratio (MLR) impacts, including effects from premium changes, prior authorization shifts, and follow-up care from house calls, and whether any one-time positive factors were present.

    Answer

    John Rex, an executive, confirmed there were no one-time positive factors. He noted no impact from prior authorization changes but highlighted that a higher level of wellness visits drove follow-on specialty care. He also quantified impacts from IRA-driven Part D seasonality (approx. 90 bps) and the second year of V28 (approx. 60 bps), but stressed that increased utilization and member profile issues were by far the largest drivers of the quarterly performance.

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    Lance Wilkes's questions to UNITEDHEALTH GROUP (UNH) leadership • Q4 2024

    Question

    Lance Wilkes of Bernstein asked about customer satisfaction levels, the primary sources of dissatisfaction, and the company's strategies for improvement, including any impact on long-term financial algorithms.

    Answer

    CEO Andrew Witty acknowledged the need to reduce system complexity, highlighting claim processing as a key focus and advocating for industry-wide standardization. He pointed to major progress in digital consumer experience, noting UHC mobile app visits were up 66% year-over-year, overall digital engagement is up by a third, and call volumes are down 10% annually as consumers shift to more convenient digital channels.

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    Lance Wilkes's questions to UNITEDHEALTH GROUP (UNH) leadership • Q4 2024

    Question

    Lance Wilkes from Sanford C. Bernstein & Co. inquired about customer satisfaction levels, the primary sources of dissatisfaction, and the company's strategies to improve the member experience.

    Answer

    Executive Andrew Witty acknowledged the need to reduce complexity, highlighting claims processing as a key focus for improvement via technology and standardization. He emphasized strong progress in digital adoption, citing a 66% YoY increase in UHC mobile app visits and a one-third annual increase in overall digital engagement, which improves the consumer experience.

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    Lance Wilkes's questions to UNITEDHEALTH GROUP (UNH) leadership • Q3 2024

    Question

    Lance Wilkes inquired about the drivers of OptumHealth's margin improvement, the 2025 outlook for risk contracting adoption in various segments like employer, and other employer responses to high premium inflation.

    Answer

    John Rex, President and CFO, attributed OptumHealth's performance to portfolio refinement and strong execution in its care delivery model. Dr. Amar Desai, CEO of OptumHealth, noted increased outreach from payers for capitated arrangements and strong growth in services. CEO Andrew Witty and Heather Cianfrocco, President of Optum, both observed rising interest from commercial employers in exploring value-based care as an alternative to traditional models, driven by a need for predictability and better member experiences.

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    Lance Wilkes's questions to HCA Healthcare (HCA) leadership

    Lance Wilkes's questions to HCA Healthcare (HCA) leadership • Q2 2025

    Question

    Lance Wilkes of Bernstein asked about HCA's compensation ratio and labor supply, how the company is managing these factors, and the outlook for wage inflation for the remainder of the year.

    Answer

    CFO Mike Marks described the labor environment as 'pretty stable,' with wage inflation meeting expectations. He noted that contract labor has decreased to 4.3% of salaries, wages, and benefits, approaching pre-pandemic levels. The primary area of continued cost pressure is physician professional fees, which increased about 10% year-over-year, in line with projections.

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    Lance Wilkes's questions to HCA Healthcare (HCA) leadership • Q1 2025

    Question

    Lance Wilkes asked about the downstream effects of financial pressures on managed care organizations, such as changes in value-based care adoption or patient cost-sharing, and also inquired about the impact of the flu season.

    Answer

    CFO Mike Marks noted that Q1 respiratory volumes were in line with the prior year. On patient receivables, he stated that while average patient balances have increased slightly, collectability remains stable. CEO Sam Hazen added that from a broad perspective, HCA is not seeing evidence that value-based care models or changes in copays and deductibles are disrupting the overall demand for healthcare services.

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    Lance Wilkes's questions to HCA Healthcare (HCA) leadership • Q4 2024

    Question

    Lance Wilkes asked about the progress on labor, including the pace of hiring, wage inflation trends, and for background on the total exposure to supplemental payment programs and what Medicaid margins would be without them.

    Answer

    CFO Mike Marks reported that contract labor as a percentage of SWD was down to around 4.5% in the quarter, reflecting improved retention and workforce development. Wage inflation was stable and is expected to remain so in 2025. Regarding Medicaid, he stated that even with supplemental programs, total Medicaid reimbursement still falls short of covering the cost of care.

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    Lance Wilkes's questions to HCA Healthcare (HCA) leadership • Q3 2024

    Question

    Lance Wilkes of Bernstein asked about the drivers of improvement in the wage expense ratio, current wage inflation trends, and the impact of Medicaid redeterminations on bad debt.

    Answer

    CFO Mike Marks reported that wage rate inflation is stable in the 2.5% to 3.5% range and that this stability is factored into the 2025 outlook. Regarding bad debt, he noted that while uninsured volumes grew 7%, the overall cost of uninsured care is stable, and he does not anticipate significant changes going into next year.

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    Lance Wilkes's questions to CENTENE (CNC) leadership

    Lance Wilkes's questions to CENTENE (CNC) leadership • Q2 2025

    Question

    Lance Wilkes of Bernstein inquired about Centene's long-term strategy for its Marketplace risk adjustment payable, asking if the company plans to alter its product structure to reduce the payable or if it is comfortable maintaining its current position.

    Answer

    CEO Sarah London explained that for 2026, the immediate focus is on repricing to prioritize margin over membership, which could involve adjusting product tiers and networks. Looking ahead to 2027 and beyond, the strategy is to optimize the entire portfolio for sustainable profitability. She also mentioned leveraging Centene's scale to advocate for greater market transparency and policy stability, such as locking in rule changes before pricing is finalized.

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    Lance Wilkes's questions to CENTENE (CNC) leadership • Q2 2025

    Question

    Lance Wilkes of Bernstein inquired about Centene's long-term strategy regarding its Marketplace risk adjustment payable, asking whether the company plans to alter its product structure to reduce the payable or if it is comfortable maintaining a high-payable position.

    Answer

    CEO Sarah London explained that for 2026, the immediate focus is on repricing for 'margin over membership,' which may involve adjusting product tiers and networks. Longer-term, she noted Centene is advocating for greater market transparency and for policy changes to be finalized before pricing deadlines to create a more stable environment, rather than fundamentally changing its position on payables.

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    Lance Wilkes's questions to CENTENE (CNC) leadership • Q1 2025

    Question

    Lance Wilkes asked for more detail on specialty pharmacy trends, specifically the trend level and how it differs across PDP, MAPD, and Medicaid. He also asked if the Part D trend was from new prescriptions or higher costs, and requested a proportional breakdown of the drivers for the consolidated HBR guidance lift.

    Answer

    CEO Sarah London noted that in Medicaid, high-cost specialty drugs are a timing issue that will eventually be baked into state rates. EVP and CFO Andrew Asher specified the PDP trend is most prevalent in non-low-income members and is driven by higher utilization of drugs like Dupixent, as patients shift from assistance programs to PDP. He did not provide a specific breakdown of the HBR lift.

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    Lance Wilkes's questions to CENTENE (CNC) leadership • Q4 2024

    Question

    Lance Wilkes asked about the Medicaid RFP pipeline, the status of appeals in Texas and Georgia, and the company's strategic priorities for investments, capability enhancements, and M&A.

    Answer

    CEO Sarah London stated that the 2025 RFP pipeline is returning to a more normal pre-COVID cadence and provided updates on the Texas and Georgia protests, which are ongoing. On strategy, she highlighted continued evaluation of M&A opportunities and a particular interest in investing in capabilities for the ICRA market, while always weighing capital allocation against the value of share repurchases.

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    Lance Wilkes's questions to CENTENE (CNC) leadership • Q3 2024

    Question

    Lance Wilkes asked for more detail on Medicaid rates, specifically if they are set at a program or composite level, and whether the company sees utilization patterns normalizing for rejoiner cohorts.

    Answer

    CEO Sarah London clarified that while the final rate is a composite, it is built up from the underlying sub-programs. She also confirmed that run-out data shows rejoiners have high initial utilization that then normalizes, supporting the view that they create a temporary, artificial pressure on the MLR.

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    Lance Wilkes's questions to Elevance Health (ELV) leadership

    Lance Wilkes's questions to Elevance Health (ELV) leadership • Q2 2025

    Question

    Lance Wilkes asked for details on utilization trends by service category and business segment, and also inquired about prior period development and reserve levels.

    Answer

    CFO Mark Kaye focused his response on the ACA market, attributing pressure to a market-wide morbidity shift rather than company-specific issues. He identified emergency room and behavioral health services as primary utilization drivers, noting the new ACA cohort uses the ER at nearly twice the rate of commercial members. He stated prior period development was not significant, at approximately $40 million.

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    Lance Wilkes's questions to Elevance Health (ELV) leadership • Q1 2025

    Question

    Lance Wilkes asked for details on the strong growth in Carelon Services, seeking specifics on cross-sales into the Anthem book of business, sales to external health plans like the Blues, and the progress of migrating specialty pharmacy services into CarelonRx.

    Answer

    Peter Haytaian, President of Carelon, attributed the strong performance to balanced internal and external growth. Internally, he highlighted the expansion of total cost of care for oncology and behavioral health offerings. Externally, he noted that 2025 is expected to see the most significant external growth across the portfolio. Regarding CarelonRx, he confirmed the company is thoughtfully migrating specialty pharmacy scripts from acquisitions like BioPlus and Kroger, with the process expected to continue over the next year.

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    Lance Wilkes's questions to Elevance Health (ELV) leadership • Q4 2024

    Question

    Lance Wilkes from Bernstein asked for details on utilization trends across different product lines, such as Medicare Advantage and Commercial, and how these trends inform the company's assumptions for 2025. He also requested commentary on specific medical cost trend categories like inpatient and outpatient services.

    Answer

    CFO Mark Kaye reported that Q4 cost trends developed as anticipated. He noted that Medicaid trends remained elevated but stable, particularly in behavioral health and inpatient services. Medicare trends were also elevated but manageable, while Commercial performance was strong. Kaye stated that these elevated trends are expected to persist into the first half of 2025 and are factored into the company's guidance. CEO Gail Boudreaux reiterated the company's prudent approach to forecasting.

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    Lance Wilkes's questions to Elevance Health (ELV) leadership • Q3 2024

    Question

    Lance Wilkes of Bernstein asked for color on recent Medicaid rate increases compared to historical levels and questioned if the current pressures might prompt strategic changes, such as altering the PBM in-sourcing plan.

    Answer

    CEO Gail Boudreaux affirmed the company is staying its strategic course, citing the recent CareBridge acquisition as proof of executing its long-term plan for Carelon. Felicia Norwood, President of Government Health Benefits, added that rate negotiations are ongoing and that while states use lagging data, they are receptive to current trend information, with some providing midyear rate adjustments.

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    Lance Wilkes's questions to HUMANA (HUM) leadership

    Lance Wilkes's questions to HUMANA (HUM) leadership • Q1 2025

    Question

    Lance Wilkes inquired about the performance of individual businesses within CenterWell relative to targets, the drivers of external revenue growth in primary care, and the dynamics of internal versus external patient growth.

    Answer

    CFO Celeste Mellet reported that CenterWell's Home business was in line with expectations, while PCO and Pharmacy performed ahead of plan. She noted that durable factors like specialty mix and patient growth could lead to stronger full-year results. Revenue growth was driven by higher patient volumes and some favorable PPD, though the PPD benefit is not expected to recur.

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    Lance Wilkes's questions to MOLINA HEALTHCARE (MOH) leadership

    Lance Wilkes's questions to MOLINA HEALTHCARE (MOH) leadership • Q1 2025

    Question

    Lance Wilkes asked about network contracting, the impact of supplemental payments on hospitals, and the company's progress with value-based care (VBC) arrangements.

    Answer

    CEO Joseph Zubretsky explained that VBC is being adopted more slowly in Medicaid than in Medicare, but Molina is compliant with all state requirements and is actively working to increase penetration. CFO Mark Keim clarified that supplemental (directed) payments are typically pass-throughs that do not impact Molina's P&L, though Zubretsky noted potential cuts to them are a significant policy debate.

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    Lance Wilkes's questions to Cigna (CI) leadership

    Lance Wilkes's questions to Cigna (CI) leadership • Q3 2024

    Question

    Lance Wilkes asked about Cigna's strategic M&A criteria, particularly concerning management stability and business model volatility, and also inquired if high premium inflation is causing different behaviors from employers.

    Answer

    CEO David Cordani reiterated that Cigna's M&A criteria (strategic alignment, financial attractiveness, path to close) have not changed, but noted a more volatile asset would require a higher bar for durable synergies. CFO Brian Evanko observed that employers are adopting more precise affordability strategies, showing increased interest in specialty pharmacy programs like EnCircleRx, mental health capabilities, and precise provider networks.

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