UnitedHealth Group - Earnings Call - Q1 2025

Executive Summary

• Q1 2025 delivered revenue of $109.6B (+9.8B YoY) and adjusted EPS of $7.20; results missed S&P Global consensus as utilization in Medicare Advantage ran materially above plan and Optum Health revenue mix pressured reimbursement. EPS est: $7.29*, revenue est: $111.60B*.
• Management cut FY2025 guidance: net EPS to $24.65–$25.15 (from $28.15–$28.65) and adjusted EPS to $26.00–$26.50 (from $29.50–$30.00), while affirming revenue of $450–$455B; full-year MCR now expected at 87.5% ±50 bps.
• Drivers: MA care activity doubled vs 2024 assumptions (physician/outpatient-centric); Optum Health’s new member profile post plan exits and V28 risk model transition reduced 2025 reimbursement vs expectation.
• Stock narrative hinges on the guidance reset, magnitude/duration of senior utilization, and execution on Optum Health member engagement; Optum Rx momentum and AI-enabled productivity are offsets.

What Went Well and What Went Wrong

What Went Well

• Optum Rx growth and client wins; quarterly Optum Rx revenue $35.1B (+y/y) with adjusted scripts 408M; management highlighted strong selling season and retention.
• Digital engagement and care access: senior digital engagement +40% in Q1; earlier/higher wellness visits expected to improve detection and management; “HouseCalls” program closes care gaps in-home.
• AI/productivity: Optum Insight launched AI-powered claims tools boosting RCM productivity >20% for customers.

Quote: “UnitedHealth Group grew to serve more people more comprehensively but did not perform up to our expectations, and we are aggressively addressing those challenges…” — Andrew Witty, CEO.

What Went Wrong

• Medicare Advantage utilization spike: care activity indications rose at 2x 2024’s increase, particularly in physician/outpatient; group MA elective care also elevated amid higher member premiums.
• Optum Health reimbursement headwinds: new members from plan exits showed low prior engagement, depressing 2025 risk scores; V28 model transition more complex than anticipated, impacting high-acuity patients.
• Margin pressure: MCR rose to 84.8% (vs 84.3% LY); consolidated operating margin 8.3% (down vs Q3), net margin 5.7%; management now guides FY MCR to 87.5% ±50 bps.

Transcript

Operator (participant)

Ladies and gentlemen, please stand by. Good morning and welcome to the UnitedHealth Group First Quarter 2025 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 and Earnings Reports section of the company's Investor Relations page at www.unitedhealthgroup.com.

Information presented on this call is contained in the earnings release we issued this morning and in our Form 8K dated April 17, 2025, which may be accessed from the Investor Relations page of the company's website. I will now turn the conference over to the Chief Executive Officer of UnitedHealth Group, Andrew Witty.

Andrew Witty (CEO)

Good morning, everyone. Thank you for joining us today. UnitedHealth Group started 2025 in two seemingly disparate ways. One: continued strong growth across our businesses. Our people are providing more health benefits and services to more members and patients as the market responds to our distinct offerings. The other way, however, was an overall performance that was frankly unusual and unacceptable. As you saw in our release, we're revising our adjusted earnings per share outlook for the year to $26-$26.50. This morning, we'll detail for you the factors driving our revised outlook and how we plan to address them. I'll start with performance, which was impacted by two broad factors in our Medicare businesses: care activity and member profiles. It's important to recognize UnitedHealthcare and Optum are distinct businesses with different models, markets, and products.

In addition, Optum's Medicare business is multi-payer and not limited to just UnitedHealthcare members. Given these differences, changes in care activity and member profiles do not always follow the same patterns and can result in different impacts to each business. The respective teams are urgently responding to our performance challenges. Starting with care activity, in UnitedHealthcare's Medicare Advantage business, we had planned for 2025 care activity to increase at a rate consistent with the utilization trend we saw in 2024. Instead, though, first quarter 2025 indications suggest care activity increased at twice that rate. Increases in physician and outpatient services were most notable and inpatient to a lesser extent. This increase in care activity was limited to our MA business and was not a factor in our commercial or Medicaid businesses. Care activity trends in those areas were as expected.

Turning to member profile, unanticipated changes in our Optum Medicare membership is impacting 2025 revenue. We added more new Medicare patients to Optum Health, a portion of whom were covered by plans that were exiting markets. They experienced a surprising lack of engagement last year, which led to 2025 reimbursement levels well below what we would expect and likely not reflective of their actual health status. Additionally, many of the current and new complex patients we serve are more affected by the CMS risk model changes that we are in the process of implementing. To be sure, it is complicated, but we're not executing on the model transition as well as we should. We must and will work to better anticipate and address these factors. Here, still early in 2025, we believe they are highly addressable as we look ahead to 2026.

Let me now talk specifically about what we're doing. First, we're ensuring the complex patients most impacted by the previous administration's Medicare funding cuts engage in clinical and value-based programs. Second, we're consistently engaging with members in their homes and in post-discharge settings. Engagement remains the key. Third, we're appropriately assessing and updating the health status of new patients, especially those at high risk levels. Fourth, to more effectively transition to the new CMS risk model, we're investing significantly in improving physician-clinical workflow to help ensure better care and timely insights on when and where care is most efficient and effective. Finally, our Medicare Advantage plan designs and pricing for 2026 will be fully informed by these trends. While we are decidedly unsatisfied with these results, our growth and foundation for improvement remain solid. UnitedHealthcare's Medicare Advantage business is on pace to serve an additional 800,000 people this year.

Optum Health is on track to add 650,000 net new patients to value-based care arrangements. In Medicaid, we are growing and continue to see positive momentum in closing the gap between people's health status and state rates, and we are very appreciative of our state customers for the ongoing productive discussions. Within Optum, so far this year, Optum Rx is off to a strong selling season, characterized by new wins as well as high retention of long-term customers. The growth of Optum Rx underscores the vital role that PBMs play in helping to reduce the price of drugs for consumers and the value that sophisticated purchasers of healthcare, the employers, unions, and governments see in our efforts to counter the high prices set by drug manufacturers and to ensure that people have convenient access to high-quality, affordable drugs.

That's more important than ever as drug manufacturers continue to increase what they charge Americans, in some cases ten times what they charge people in Europe. The growth at UnitedHealthcare and Optum reflects the efforts of our 400,000 colleagues who come to work every day, thinking differently about what is possible, advancing new products and ideas while constantly refining existing programs, working to make things better for the people we are privileged to serve. Our team continues to innovate to make accessing care easier. For example, our newest tools have sparked a more than 40% increase in digital engagement among our senior members through the first quarter. We see evidence of this in sharply higher and earlier wellness visits to their primary care physicians, with total visits in the first quarter running far above the year-ago period.

This will help members better manage their health and promote early detection of emerging issues. Further, Medicare Advantage also costs taxpayers less and delivers more to seniors than fee-for-service Medicare, especially in value-based care arrangements. An essential approach in achieving both health outcomes and lowered costs is ensuring people get the care they need when and where they need it. A good place to understand those needs better is in a senior's home. Our House Calls program does just that. House Calls, which is only available in Medicare Advantage, provides a thorough in-home clinical visit at no cost to seniors. Following CMS's best practices for such care, our clinicians review a patient's medical history and current medications, conduct comprehensive physical exams, provide lab tests and screenings, and coordinate necessary follow-on care.

House Calls clinicians closed millions of care gaps last year, helping people stay out of the hospital and the emergency department and referring those in need to appropriate social services to help them live healthier at home. This is Medicare Advantage innovation and value in action, helping drive proactive, preventive engagement with the health system rather than more expensive, reactive acute care. These benefits and innovations and their value to seniors and taxpayers were put at unnecessary risk by funding cuts in recent years to the Medicare Advantage program. While we continue to navigate those funding cuts to seniors' benefits, it is significant that the recently released 2026 rate notice begins to reflect the accelerating care cost trends we have experienced for some time. This will provide much-needed relief to seniors and reflects policymakers' understanding of the importance and the popularity of Medicare Advantage.

Our work to deliver a better experience for people and lower costs spans our enterprise, as it always has. Just within the last few weeks, we have introduced several initiatives that will help people in their healthcare journeys. Optum Rx will remove prior authorizations on 80 drugs accounting for more than 10% of our pharmaceutical prior authorizations. Optum Rx has aligned payment models to pharmacies more closely to their cost for drugs. This helps pharmacies manage the ever-increasing prices charged by drug manufacturers, enabling pharmacies to stock more medicines and ensuring more consistent pricing and access to medicine for consumers. 26 million consumer calls were more accurately directed to the right advocate by an AI agent, improving the consumer experience and reducing wait times. We expect AI will direct over half of our calls to the best resource during 2025.

All of these efforts are making things simpler and easier for consumers and providers, a goal we share with all healthcare stakeholders. Yet, we all have to contend with the stubborn fact that healthcare costs more in the U.S. than it should, even beyond the widely recognized disparities in drug prices. Common procedures such as heart bypass surgery, spinal fusions, and heart stents are four times as expensive in the U.S. as they are in Germany, Australia, and the U.K. Total hip replacements are twice as much. It's simply not sustainable. As we have made clear, we are as committed as ever to continuing down the path of transparency and affordability, ensuring that Americans get the health system they deserve. With that, I'll turn it over to John, who will discuss first quarter performance and full-year outlook in more detail. John?

John Rex (CFO)

Thank you, Andrew. I'll start by walking through several updates to our 2025 outlook and then elaborate on the reasons for them. As Andrew said, we now expect adjusted earnings of $26-$26.50 per share. It's an outlook that I'm extremely disappointed to share with you. This reflects the profile of patients served at Optum Health. It also reflects significantly increased care activity across the UnitedHealthcare Medicare Advantage plans. Within that outlook, we expect about 50% to come in the first half of the year. We're affirming the consolidated revenue outlook of $450-$455 billion we shared with you in December. Within this, we expect revenues for both UnitedHealthcare and Optum Rx to be better than our initial view. I'll set a reduced outlook at Optum Health.

The full-year medical care ratio is now expected to be 87.5% plus or minus 50 basis points, reflecting higher utilization across senior populations and the patient mix and revenue profile of Optum Health. Within this range, we expect the first half of the year to be below the midpoint and the second half to be above. At Optum Health, our revenue outlook is $106 billion-$107 billion, and operating earnings is $6.2 billion-$6.4 billion, based on the factors discussed, and which I'll get into more deeply in a moment. Over half of the $10 billion revenue change is the result of transitioning some legacy risk-based arrangements to fee-based and is neutral to earnings. We expect about half of Optum Health's operating earnings to be in the first half. At UnitedHealthcare, the operating earnings outlook is updated to $16 billion-$16.5 billion and reflects the higher care activity we're seeing.

Within UnitedHealthcare, pressure was largely contained within the senior business, where we saw a sharp increase in care activities that became apparent as we closed out the quarter. As noted, this was most significant for both physician and outpatient care, and to a lesser extent, inpatient care. In years past, this is an insight we may not have picked up until the second quarter, so it is useful to have the information with ample time to incorporate into our 2026 planning. In the quarter, we experienced percentage increases in care activity about double last year's level. Unit prices behaved as expected. Let me start with the obvious fact that it is early in the year, and we do not know everything that might be driving our experience or how long the increase in care activity might last. Care activity was broad-based across our senior individual and group populations.

One example, in Group MA, member retention was about 98%, and as a result, serves well as a same-member metric. Here, we observed significant increases in elective care activity in the first quarter. Of note, in this population, we believe the behavior may have been impacted by the meaningfully higher member premiums, which were driven by the Medicare funding cuts. Another example across senior populations was the earlier and higher wellness visit activity we saw, which, of course, drives specialty and outpatient utilization. Some of this may be a seasonal shift in consumption patterns as wellness visits happen once a year. Turning to Optum Health, as it relates to the patient profile, we experienced a couple of key elements here. First, growth in certain markets where there were meaningful plan exits.

These new patients had not been engaged by their prior plans for most of last year, and we're seeing revenues associated with the patient profiles meaningfully below expected and normal levels. This is very addressable. Second, the ongoing execution to the new CMS risk model, while complicated given the multi-year phase-in, has not been to our operational standards. Transitioning to a new model and concurrently running two distinct versions has been more operationally complex than anticipated. No question, we need to execute better, and we will. Across the enterprise, we continue to focus on operating costs to help mitigate external pressures while ensuring our workforce aligns to the areas of greatest opportunities and customer needs.

Looking ahead, we see a long runway for further technology advances that will translate to more and sustained operating efficiency, which in turn drives opportunity for further innovation and advancements in the company and across the industry. Before we get to Q&A, I want to provide a few business highlights. At UnitedHealthcare, we still expect to serve up to 800,000 more people in Medicare Advantage this year across our individual, group, and dual special needs offerings. This underscores our long-standing commitment to stability and differentiated value. Our growth demonstrates UHC's deep relationship with our members. People served by our community and state business increased to 7.6 million. We continue to have growth momentum with recent service expansions in Kentucky, New York, and Florida.

We're also encouraged by the updated Medicaid rates so far in 2025 that more closely align with underlying member acuity, but funding remains insufficient to meet the health needs of patients. Commercial self-funded membership increased by approximately 700,000 in the first quarter, a result of our continued strong product innovation. Commercial insured membership was impacted by the individual exchange products. Our disciplined pricing approach remains consistent, and as a result, we experience some member attrition. Overall, in our commercial book, we are encouraged by the early 2026 selling season indications, which are showing strong retention rates. Turning to Optum. At Optum Health, we continue to expect to add 650,000 new value-based care patients this year. We're working to engage with these new members ever more rapidly. By the end of 2025, we expect to have about 5.4 million value-based care patients.

At Optum Insight, we have a pipeline of new products coming to market this year with exceptional customer interest. For example, in the first quarter, we launched AI-powered claims efficiency tools that increased productivity by over 20% for our revenue cycle management customers. Lastly, Optum Rx revenues grew 14%, exceeding $35 billion for the quarter. Both customer retention and new customer wins contributed to script growth of 3%. As Andrew noted, performance in the quarter was below the standards we expect. With disciplined and urgent execution and attention to detail, we expect a return to form in the quarters ahead. With that, I'll hand it back to Andrew.

Andrew Witty (CEO)

Thanks, John. Even with the growth our people generated this quarter, this was far from the performance we expect of ourselves. We're acutely aware it's a privilege to be a part of an organization with the capabilities to make a meaningful contribution to modernizing and simplifying the health system. We're committed to improving our performance in the rest of 2025 and into 2026, and in doing so, to delivering consistent positive results for you and returning to our long-term earnings per share growth target of 13-16%. With that, we can now turn to your questions, operator.

Operator (participant)

Thank you. The floor is now open for questions. At this time, if you have a question or comment, please press Star one on your touch-tone phone. You may remove yourself from the queue by pressing Star two on your touch-tone phone. We ask that you limit yourself to one question. If you ask multiple questions, we will only be answering the first question so we can respond to everyone in the queue this morning. We'll take our first question from Justin Lake with Wolfe Research.

Justin Lake (Analyst)

Thanks. Good morning. My question's on Medicare Advantage cost trend. You said that you came into the year assuming trend at similar levels to 2024. Can you share with us precisely what that trend estimate was, meaning what did you expect for this year, and what are you expecting now? Can you tell us how much of that you actually saw in the first quarter? For instance, how much did you miss your MLR by, your own estimate of MLR, and how much you're expecting that to accelerate or how different the back three quarters is versus what you saw in the first quarter? Thanks. Even if this is emerging the way it is.

Andrew Witty (CEO)

Yeah. Justin, thanks so much for the question. I'm going to ask Tim Knowles to respond just in a second in detail to your question. I mean, obviously, it's still very early in the year, but we have clearly seen a pickup in trend in a specific part of the UHC business, particularly in the senior business. Tim will talk a little more about that to you in a second. It's still early. Even our first quarter is only partially complete. Unusually, we've seen this pickup, which is what's obviously influencing our position here. Let me ask Tim to give you a little bit more detail on that.

Tim Noel (CEO)

Morning, Justin. Thanks for the question. Yeah, I'll attempt to break it all down for you here. As was mentioned in the opening remarks, in 2025, we anticipated care levels consistent with what we observed in 2024, which felt appropriate as we stepped into the year. What we were assuming, and if you think about this as units consumed, we were assuming that in 2025, we'd see a similar increase by that metric that we observed in 2024. If you break that down in the Medicare book, you can think that in total, in terms of total trend drivers, about one-third of that is related to increase in care activity or units consumed. What we are seeing, and again, that's focused on physician and outpatient, but driving an overall two-times increase in that level of units consumed in Q1 of 2025.

That metric is about one-third of the total trend drivers in the Medicare book. We are seeing that inside of the first quarter of this year, but we are making the assumption right now that that trend will persist throughout 2025, and then also making the same assumption that it will persist into 2026, and that will shape our overall pricing assumptions. Now, some of the drivers that John mentioned behind what we are seeing, you might presume that some of those would result in a change in our seasonal consumption patterns. At this distance, we feel like we need to make the assumption that that activity will persist throughout the year and into 2026.

Andrew Witty (CEO)

All right. Tim, thanks so much. Next question, please.

Operator (participant)

We'll take our next question from Josh Raskin with Nephron Research.

Josh Raskin (CFA)

Hi, thanks. Good morning. Can you help us connect the higher incidence of primary care visits and the Optum Health pressure? I assume you don't have that primary care issue in Optum Health, which should also mitigate the downstream impact. Why are you expecting the higher follow-through if you control primary care? Based on the fact that you're seeing worse performance in Optum Health or value-based care, could you remind us why you think you can control costs better in that environment? It's probably a good time to get the refresher on why the strategy to allocate a lot more capital to VBC in the ecosystem totally is best for the long term.

Andrew Witty (CEO)

Yeah. Josh, thanks so much for the question. I'm going to ask Tim just to address the first part of your question, then Amar to talk a little, Dr. Desai to talk a little bit around the Optum Health experience during the quarter and the differences of what we're seeing there and the like. As I said in my commentary at the beginning, the businesses do operate very different kind of models, and it's not completely surprising to see somewhat different experiences. I'm going to ask Heather to just do, as you kindly requested, a kind of refresher on the value-based care position. We'll do that also for you. Bear with us. This answer's probably going to take a few minutes. Tim, if I could ask you to start, and then we'll pass over to Dr. Amar Desai.

Tim Knowles (CEO)

Yeah. Thanks, Josh, for the question. Yeah, let me just dive in a little bit with a little bit more detail into some of what we're seeing that's driving the increase in care activity. Let me start with our fee-for-service, so kind of our non-capitated community MA members. We have seen an increase in physician and outpatient care activity in that population. One of the dynamics that we're seeing is they are generally seeking more preventative care, which is a good thing. That also includes more in-home visits, more in-home clinical assessments. That in and of itself, really not the trend driver, but it's the follow-on care that is more than what we have anticipated, and that constitutes specialist visits, physician specialist visits, as well as some other outpatient services.

A dynamic at play in our group Medicare Advantage business is we're seeing a significant and disproportionate increase in utilization, largely within our public sector group retiree business. This is a population that experienced the greatest year-over-year premium increases. While we've seen a similar dynamic play out historically in our individual Medicare Advantage business when premium increases have been in play, we've really never seen this dynamic before in the group MA business. We're seeing it because of the pressures related to the Medicare funding cuts that are really driving up premiums in the group retiree business like they really never had before. Kind of think groups with premiums going from $50 to $200. We did assume that we would see some care activity level increases in this population, but what we're seeing far surpasses what we would have reasonably anticipated.

In that population as well, we are seeing more preventive care, more annual wellness visits, more in-home clinical assessments. Again, the driver there also being really the follow-on care that results from that.

Amar Desai (CEO)

Hey, thanks for the question, Josh. The results for Optum Health, to be clear, were impacted by the profile of new value-based patients in Optum Health and the second year of the V28 phase. We are taking actions to proactively address these issues. Our patient profile post-AEP included many new to Medicare as well as new to Optum Health who were meaningfully less engaged by their prior health plans and providers. We believe that market-specific plan exits driven by V28 caused this dynamic. Because of the strength and stability of our provider network, those patients chose Optum Health. Member profile challenges were not specific to any single Medicare Advantage carrier and occurred in multi-payer geographies like Texas and Washington.

Additionally, we underestimated the impact of V28, in particular as it relates to the higher acuity structure of our patient population, which is more impacted by the risk model change. Our planned actions around operating cost containment and medical expense management were not able to offset the cumulative impacts of V28 and the new member profiles. As it relates to care patterns for Optum Health, in general, in Q1, we see as a busier time for our physicians as we are engaging our patients. We've already engaged over 50% of all members and 75% of our complex members. This year, it's particularly important given the member profile of new Medicare and new Optum Health patients. Also within Optum Health, we're seeing some elevation in outpatient behavioral utilizations. Again, we're taking incremental actions above and beyond what we've planned for any year to improve performance.

First, enhancing access for employee-to-network PCPs, especially around new patients to diagnose, document, and treat conditions. We are expanding home-based visits and wraparound services, particularly as it relates to post-discharge visits after inpatient care. As Andrew alluded to, we have accelerated EMR unification, deploying smarter clinical workflows and point-of-care tools to better adapt to the V28-related changes. Thanks for the question.

Andrew Witty (CEO)

Great, Amar. Thanks so much. Let me ask Heather to maybe just take an overview of the value-based care proposition and why we continue to believe so strongly in it.

Heather Cianfrocco (CEO)

Sure. I think what you're seeing here is, as Andrew said, you've got two different business models here, and it's important to keep that in mind. A couple of things I'll just point out. Again, in Optum Health, capitated experience, this is specific to senior populations in our experience, in a unique environment, mindful of, again, what's a new risk model, a year-two risk model. Keeping in mind what Dr. Desai said, we assume and anticipate certain physician activity in the first part of the year. That's part of our model because it drives not only that diagnosis, but the treatment so we can understand the gaps in care. That's part of the plan, and I think that's why you don't—it's a little different story in Optum Health. As Dr.

Desai said, we need to be mindful of that, particularly based on two years of elevated care activity coming into this year. Now, to your point, the outcomes-based model, or what we call the value-based care model, should naturally offset some of that for a few reasons, as Dr. Desai mentioned. Number one, engagement is key. That early engagement by a network that's aligned and activated can better identify gaps in care, manage them, and support higher preventive healthcare and reduced emergency visits and hospital visits.

In addition to that, what's unique about Optum Health's model is the wraparound services and the in-home services, which not only help assess our members in the home, but they're able to then kick off things like post-discharge visits, the more acute condition management programs that are critical to those transitions of care and help reduce total cost of care and naturally offset some of trend. In addition to that, result in a better health outcome for our patients and a better experience and help them with a healthier life. Those are kind of the bases of our model. You then wrap the integration of our behavioral health into our model, which is increasingly more an integrated part of our care delivery systems. That's what I think is differentiated about the model.

Even though, to be incredibly direct and respectful, of this year, we will see the impact of the revenue through the year. The differentiated value-based care model has meant growth for Optum Health above industry in the past, and we believe you'll continue to see that. Why is that? Because, again, a better care delivery model, a better experience for our patients. In addition to that, we see very high retention. These members that need the services, that have higher acuity, that need a more intensive care model, they stay with us. The work we do today will support the growth in 2026. That is why we're confident in not only the growth in 2026 from a membership perspective, but because there's more members to serve out there.

In many cases, we're serving few of the seniors in any respective geography, and we have more capacity in our networks. In addition to that, it supports our performance. Now, I'll just note one last thing, and that is, I think through the year, you're going to watch us pace that. While we're still committed to our membership growth, we're going to be looking at particular geographies, pacing through that to ensure that we're focusing on the new membership with our PCP network and with our in-home services.

Andrew Witty (CEO)

Thanks, Heather. I think, Josh, I really appreciate the question, and thanks, everybody, for allowing us to respond to that sort of as fully as we can. I mean, just maybe add a couple of comments to that. To that last set of comments from Heather, when we look into, and you have often heard us talk previously about cohorts of members who choose to join Optum Health value-based care, what we're seeing in those earlier cohorts, going back to, say, 2023, for example, those folks who first came in and started to benefit from our value-based care approach, we're seeing on basically all metrics outperformance in terms of the way in which that cohort and cohorts before them have performed. What we're seeing here is not really a challenge to the underlying principle of value-based care.

What we're seeing is how to adjust to a very dramatic price cutting regime that's been implemented over the last couple of years by the administration. It's important to recognize that that was, across the average of the industry, independent analysis would say that was about a 9% price cut across the industry. Now, that's a significant downdraft in terms of pressure. Obviously, that affects participants, whether you're a payer or a provider in the marketplace. You've seen that effect over the last first year. We're now well into the second year of all of this. What we're seeing during this second year is some of the, I would call them, second-order derivative effects. I'll give you just a couple of examples of that. You've heard one very explicitly, and we've mentioned the other already on the call.

Second-order effect would be, for example, as this pricing pressure has continued to press down alongside a series of underfunded rate increases, you've seen premiums and benefits start to be affected in the marketplace. Group premiums have gone up because of these price cuts. That is now driving a different behavior from group members. That's what we've picked up in this area. We need to do a better job of being able to predict and anticipate these second and third-order effects when they come, but they are direct consequences of this transition. A second one, which we referred to and is really important within the Optum Health story for 2025, is plan exits.

We saw a very significant increase in the number of plan exits across the country last year as plans chose to respond to the price cutting pressure by essentially withdrawing their offer in multiple geographies across the country. What we've seen is an unusually complete vacation of offers by certain plans. To put it a different way, 100% of participants in a particular payer's plan had to find a new home. They had no way of staying in their old home. They had to find a new home. What we saw when they came to us, where we were still offering a plan option, we saw those members had not had the level of engagement in the prior six, eight months before they vacated that plan at the level you would have expected.

That has a direct consequence on how they are understood in terms of the reimbursement model of the system. That is what's driving a lot of our issues in Optum Health this year. Again, that is a temporary phenomenon which gets fixed during 2025. It is simply an example of one of these second-order derivative effects of the transition of absorbing this 9% or more decrease in pricing. None of that really speaks to the value of value-based care. Value-based care delivers a completely different approach of trying to ensure people have more years of health and less years of healthcare acute treatment, trying to get ahead of the illness, trying to avoid the high-cost consequences of late diagnosis, and tries to make sure that we are encouraging people to think about healthy lifestyle, early engagement, making sure that we're heading off problems before they arrive.

We know that works based on multiple cohorts of patients that we've been privileged to have the right to manage. What we're going through, like the rest of the industry, is a dramatic, really never seen before adjustment in pricing for this marketplace. What we're seeing this year is two or three areas where the pressure that that has created across the market is creating new dynamics we haven't seen. That's exactly what we're responding to here. We believe that they are largely addressable as we go through the rest of this year and in no way undermine our confidence in the value-based care strategy of the company. Josh, thanks so much for the question, and I'll move on to the next question.

Operator (participant)

Our next question comes from AJ Rice with UBS.

A.J. Rice (MD, Equity Research)

Thanks. Hi, everybody. Just to put a finer point on some of this discussion around especially what's happening at the MA side, it sounds like you're saying most of the elevated care that you're seeing is on the group side. It sounds like you're putting more of that on the benefit and premium changes that have occurred rather than just an underlying uptake and utilization. I want to make sure I understood that. Also on the competitive exits and the impact of that, it doesn't sound like you're calling that out on the insurance side. You're just calling that out on the Optum side. Finally, on part D, you had been cautious about that coming into the year, but you're not mentioning that at all. Is that playing out about as expected?

Andrew Witty (CEO)

AJ, excuse me. Thank you so much for the question. Let me ask Tim to respond.

Tim Noel (CEO)

Yes. Good morning, AJ. Thanks for the question. Yeah. I'll hit those last two pieces first. Yeah, you're correct. We are really seeing this focused on our community Medicare Advantage and group Medicare Advantage book. We're not seeing it on our chronic special needs population or our dually eligible population. Also, I'm not seeing this care activity pattern in our newer members, either new to Medicare or new to United. The care activity items that we talked about last year, provider upcoding, and some of the pressures on specialty drugs, I'm not seeing that play into this either. Those elements are both tracking very much in line with how we've planned. When you think about the split, it is slightly more pronounced on our group business.

If you think about our overall fee-for-service business, it's just, I would say, just slightly more than the contribution that you'd expect on the group side. While we certainly do see trends that suggest that where the premiums have increased and members are paying a high portion of that, that is where we're seeing this pointed pressure on care activity on the group business. However, it's very likely that some of the same underlying trends that are generating higher care activity patterns in individual community MA are also at play in the group business.

Andrew Witty (CEO)

Great. Thanks so much. Next question, please.

Operator (participant)

Our next question comes from Lisa Gill with JPMorgan.

Lisa Gill (MD)

Very much and good morning. Andrew, I just want to go back to the path to the long-term growth rate. You reiterated that you feel confident you can get back there. With the 2026 rates looking better, we're going to move into the final year of V28. How do I think about what the key elements are to get back to that long-term growth rate?

Andrew Witty (CEO)

Yeah. Lisa, thanks so much for the question. Yeah, clearly, we were pleased to see the beginning of recognition of rate increases, which actually reflect reality, which we haven't seen for the last couple of years. Hopefully, that will continue to be the stance, and the data will drive that in the way we saw this year. Very, very pleased to see that. Also pleased to see in the Medicaid books of business, continue to see great engagement with states as they also adjust to make sure that those rates are appropriate for what we're seeing. Those are important. Obviously, next year, there will be a further step down in terms of pricing from the V28 model. We can't ignore that. That's clearly a reality.

The way we'd look at this, Lisa, is that we are very, very much we see very much the end of this transition period in terms of having to absorb the amount of pressure. I mean, clearly, we're a leader in all of this marketplace. We're taking almost certainly a bigger fraction, if you will, of the pressure because of our market leadership position here. We feel like we're very much getting through this. We, obviously, this year have picked up these two or three second-order derivative effects, which we're going to do a much better job of anticipating and managing for as we go into 2026. We think that an awful lot of the issue that we're seeing early in 2025, we can fix in 2025 and help us deliver stronger performance for 2026.

We expect that to then be a kind of ramp into reacquiring our target growth rate momentum that we aspire to as an organization. Thank you very much. Next question.

Operator (participant)

We will move to our next question from Stephen Baxter with Wells Fargo.

Stephen Baxter (Stock Analyst)

Yeah. Hi, thanks. Just to follow up on the trend discussion, could you talk about where MA margins are now expected to shake out inside your 2025 guidance and what you think is a reasonable timeline for recovering the target margins and whether there's any change to what you're thinking is as a reasonable long-term margin target in this business post V28 and some of the issues you've had adapting to it? Again, confidence level you can improve MA margins in 2026 if trend stays at this level. Thank you.

Andrew Witty (CEO)

Steven, thanks so much. I'll ask Tim to respond to that.

Tim Noel (CEO)

Thanks, Steven, for the question. The margins that we're anticipating consistent with the changes we've announced today are still within our targeted margin range for Medicare Advantage for 2025. As we look forward to 2026, and we include the increases in care activity that we're seeing both in the 2025 portion of our bid and also pricing for 2026, at this distance, we can accommodate those care activity levels and return to the historical planning target levels that we've always historically assumed.

Andrew Witty (CEO)

Great. Thanks so much, Tim. Next question.

Operator (participant)

Our next question comes from Aaron Wright with Morgan Stanley.

Erin Wright (Analyst)

Great. Thanks for taking my question. On the policy front, I guess, what is your latest thinking in terms of just PBM reform? Your model has obviously evolved on that front, but also Medicaid funding cuts and what sort of permutations you could anticipate there and your ability to navigate that. Thanks.

Andrew Witty (CEO)

Yeah, Aaron, thanks so much. Let me ask Patrick Conway to respond to you on the PBM side, and then Chris can maybe make a couple of comments on Medicaid, if that's okay. Patrick?

Patrick Conway (CEO)

Yeah. Thanks, Aaron, for the question. First, in terms of policy, we're leading in the marketplace with transparency, choice, and affordability. We've had three major announcements that I think both help drive the policy environment, but also are a reason we've had significant market growth. One, 100% commercial rebate pass-through. First large PBM to do that. You're seeing that drive positive reaction in the marketplace. It's removing any lingering doubt about our incentives. We want lower list prices and lower net prices, as Andrew said. Second, removing 25% of prior authorizations, over 10% of reauthorizations, over 10% of prior authorizations, making the system simpler, better, easier for consumers and clinicians. Third, cost-based reimbursement for pharmacies. It's really important to know this is for all pharmacies, all drugs, all clients rolling out. Already started and rolling out and put across the entire book.

You heard from independent and community pharmacies, their support of these changes. The last thing I just call out, just because it's new and it concerns us significantly, is the Arkansas legislation that the governor signed yesterday around PBM and pharmacy ownership. We're honestly not sure what problem they're trying to solve, but let me be clear on the impact on patients. When you do that, we have Genoa Pharmacies in the state providing integrated mental and behavioral healthcare. This could cut off access for those patients with things like schizophrenia, severe depression. You have specialty medicine, where we may have been serving a patient with cancer for years, and imagine that patient now not getting their medicine in their home. You have home infusions for elderly Americans, where they may not be able to get out of their home, and we're providing their medication.

You have home delivery for people in rural parts of Arkansas. We are significantly concerned about this. We will work with the state in the regulatory process post-legislation to try to address those populations and maintain access. We want you to hear clearly from us that our concern is about patients and maintaining access to patients across the nation to these medicines.

Andrew Witty (CEO)

All right. Patrick, thank you. Christa?

Christa Sodano (CEO, Government Programs)

Yeah. Thanks for the question. On the Medicaid side, I think we won't speculate on any really specifics. What I do want to emphasize is just regardless of any changes, our priority remains the health of our members and ensuring that they have access to high-quality coverage. As it relates to our business, we have a really broad footprint across 32 states. We have a variety of programs and products and really decades of experience. We remain confident in the value that managed care can provide to our state partners and our ability to support our states as they really navigate through any changes. Thanks for the question.

Andrew Witty (CEO)

Christa, thanks so much. Just looping back to the pharmacy section, I think Patrick laid things out very well there, Aaron, for you. I also would just say I was encouraged to see in the president's executive order earlier in the week a kind of an interest in really looking at multiple elements of the pharmacy value chain. I think one of the things that has been honestly most disappointing over the last year or two is the obsession with the role of the PBM versus everybody else in the system. If you read the EO carefully, what you'll see in there are quite good, sensible questions to explore what's going on either side of the PBM in terms of the manufacturers and also ultimately many of the providers in the network.

I think what you'll see from that is the PBM plays a unique role in trying to bring down drug prices for Americans. It does that at very, very narrow margins, oftentimes taking very significant risk in the process, and is really the only participant in the system that has that. The way a PBM wins more business is by successfully bringing down drug costs for its clients, and that's how it wins more accounts. That is not how the rest of the system operates. I'm hopeful as the administration explores the questions that the EO raises, that this will become a much more thoughtful review of how to reform the whole value chain and not simply one component where I think you can make very, very serious mistakes which could really damage patient access. I was encouraged to see that from the administration.

Aaron, thanks so much for the question. Next question.

Operator (participant)

Our next question comes from Andrew Mak with Barclays.

Andrew Mak (VP)

Hi, good morning. I was hoping to get your thoughts on the risks and implications of tariffs, particularly around the impact of pharmaceutical tariffs that are currently being contemplated by the administration. Thanks.

Andrew Witty (CEO)

Yeah, Andrew, thanks so much for the question. Obviously, it's a dynamic situation in terms of what may happen around pharmaceutical tariffs. It's going to be a process now where the administration goes through its analysis and investigation. We obviously don't know what may or may not come from that. When we look at our potential exposure to that, we feel pretty good. In fact, I'd say better than pretty good in terms of the degrees of price protection mechanisms we have in pre-existing contracts and also various pieces of legislation which also limit the ability of manufacturers to pass price increases down through the system. At this point, and again, given that we don't know what any tariff may or may not be, when you look at the structure of the marketplace, we feel pretty well positioned for that, Andrew. Next question.

Operator (participant)

Our next question comes from Dave Windley with Jefferies.

Dave Windley (MD)

Hi, good morning. Thanks for taking my question, Andrew. I appreciate your comments about kind of the macro cost of healthcare in the United States. We have an administration that seems more focused on budget deficit reduction, which entails cutting to healthcare. I guess my philosophical question here is, why isn't modest, persistent underfunding of the system the right way to get those costs more in balance and to force innovation in the system? How does United operate in an environment that might bring that without having the snafus or whatever that a V28 model brings?

Andrew Witty (CEO)

David, thanks so much for the question. I think it's a good and deep question, actually. There's no question that what I think we need is continued strong innovation in new approaches of how to bring together different elements of the system to have a more patient-centered impact on healthcare. One of the characteristics, I think, of all healthcare marketplaces, but perhaps particularly the U.S., is there is no shortage of innovation, but it tends to be point solutions, whether it's a new device or a new drug or a new model of care. These things tend to show up in very isolated ways. We spend a lot of money on innovation in America, but we don't see the yield of that innovation. I would argue that's because it's not brought together. We don't align incentives. We don't really rethink workflows.

We do not try and center everything around what gives you the best outcome for the patient over the lifetime of the patient, not just this encounter or even this year. How do you make that patient or how do you give that patient the opportunity for maximum numbers of great health years? That, for me, should be the guiding principle. That is what Value-Based Care is about, and it is what UnitedHealth Group is committed to innovate and drive behind. I think we have made extraordinary progress in that. Now, unfortunately, what we have seen through V28 is almost focus the price cut where the most innovation is going on.

You've seen this pressure come exactly into the program where historically the government has funded Medicare Advantage and created a very thoughtful system which incentivizes participants to the only way a participant can win in Medicare Advantage is to incentivize, be able to deliver a great care experience and access experience for the member, release enough costs through efficiencies to provide benefits to members, and then pay a rebate back to the government, right? Everybody wins in that system. That was a very cleverly designed system by the government many years ago. It's been supported by multiple administrations of both directions since then. What we saw through V28 was really a kind of blunt instrument approach to just take money out of that system. That's what's causing the disruption here.

I don't think anybody, we would never have any anxiety about saying, "Look, we want to see the healthcare budget grow by less each year." We should look at the whole budget. We should look at the whole system, and we should look at how we can use tools to do that. What we know is that Medicare Advantage costs less than traditional Medicare. We know that when a Medicare Advantage patient is in a fully delegated value-based care managed clinic like Optum Health, they will save even more money for the system, and they will have better personal experience, they have better clinical outcomes, and the government spends less money. It's those sorts of integrated approaches which we think are the response. I made that comment about the president's executive order on pharmacy, and I kind of invite the same.

We should be thinking about the whole system and how we align the whole system, not simply looking at these kind of individual component approaches which we've seen over the last few years. I hope very much that just like the pharmacy agenda that the president is laying out for understanding, that we might have a similar one here. That would be very positive because the answer to your question is yes. We should be able to deliver great healthcare at lower cost with better experience, better clinical outcome for people and for the government. That is what the mission of UnitedHealth Group is, and that is what the goal of value-based care and Optum Care is also. Next question.

Dave Windley (MD)

Thank you very much.

Operator (participant)

Our next question comes from Ben Hendrix with RBC Capital Markets.

Ben Hendrix (Equity Research Analyst)

Hi, thank you very much. I wonder if we could touch briefly on Medicaid. Just wanted to get an update on what you're seeing from state renewals through April and if we're still on track to close that rate acuity gap by the end of the year. Thanks.

Andrew Witty (CEO)

Ben, thanks so much for the question. I'm going to ask Christa to answer that for you.

Christa Sodano (CEO, Government Programs)

Yeah, thanks for the question. We were encouraged with the progress that we made on rates in the second half of 2024, which really continued into our one-to-one rate cycle. As John and Andrew both mentioned, overall, the gap between acuity of the population and the rate funding is really narrowing with each cycle, as well as through some off-cycle adjustments that we have seen. It's really too early to call the rates on 7/1, but about 35% of our revenue renews in that 7/1 cycle. With each cycle, that base data continues to reflect more recent experience. We remain optimistic with the collaborative relationships we have with our states that over the course of the year, this gap will continue to narrow.

Andrew Witty (CEO)

Great. Christa, thanks so much. Next question, please.

Operator (participant)

Our next question comes from Lance Wilkes with Bernstein.

Lance Wilkes (MD)

Great. Thanks. Could you talk a little bit about the first quarter MLR impacts and maybe breaking out the impacts that were driven by the premium increase that you described and maybe any sort of deductible increases? Also, were there impacts as a result of the way in which you're approaching prior authorization, any changes in that? Do you have a sense as to maybe increased follow-through from your House Calls and primary care actions as far as getting follow-up visits tied to risk-adjusted activity? Lastly, were there any one-time good guys in the first quarter which perhaps supported medical loss ratio and caused the distinction between one Q versus guidance? Thanks.

Andrew Witty (CEO)

Thanks so much, Lance. John Rex.

John Rex (CFO)

Good morning, Lance. Just to your last part, no, there were no one-time good guys in the quarter that would have supported that. A few things just to point out of it. To your first point on any shifts on pre-authorization procedures or any element like that impacting, no, nothing from that element there. Tim noted that certainly we had a much higher in addition to the group, which was a big factor, we had a much higher level of wellness visits in the quarter. Those are not the factor, though. They are super effective. They are not costly. They do drive specialty care, however, a lot of follow-on specialty care. What we do not know is, was that something seasonal then? Is it a slightly altered seasonal pattern that we saw so much activity in wellness visits?

In some populations, frankly, certain populations just had 2x the year-ago levels of wellness visits. Others stopped 50%. It was broad-based in terms of that activity. That was certainly an element in there, an element well known to all of you. Also, just the change in seasonality due to the IRA-driven Part D changes. Think of that as about roughly 90 basis points of impact or so in the quarter also. That would have been an element versus kind of what you would have typically seen. I think I know you were well aware that was kind of be a factor as we moved into this. I'm not sure that was a factor that was well anticipated in kind of all the analyst models out there for a lot of good reasons, but those IRA impacts in that zone.

Certainly, kind of the Medicare funding reductions, you go into that second year of V28, also impactful of that. Think of that as roughly in the 60 basis point zone. Just so I can go through a lot of elements here, those are kind of the key factors. Far and away, the increased utilization and the member profile elements that we've highlighted throughout the course of this call being by far the most impactful things in the quarter.

Andrew Witty (CEO)

Thanks, John. Thanks so much. Next question.

Operator (participant)

Our next question comes from Sarah James with Cantor Fitzgerald.

Sarah James (MD, Equity Analyst)

Thank you. I just want to circle back to the tariff question quickly. Are the penalties under the IRA for pharma manufacturers who raise price above inflation enough to protect you from tariffs passed through on Medicare? I am not sure if that implies to exchanges as well, but with those bids due earlier, like April to June, do you have to assume that tariffs are in place, or do you think the states will give you some flexibility to submit two versions of bids with and without tariffs?

Andrew Witty (CEO)

Listen, Sarah, thanks so much for the question. As I said earlier, obviously, like you, we do not know yet what, if, when might happen in this territory. Like you, we are watchfully waiting. As you allude to, there are many kind of layers of government protection, if you will, within the regulations that sit over the drug companies in terms of their ability to increase price above inflation. There are things like Medicaid best price protections, specifically in the Medicaid area, which would also have potential applications here. Of course, we have our various Optum Rx, where relevant in this conversation, have their own contractual price protections. There are multiple layers of that.

Obviously, we're going to be very carefully making sure that we bid in the context of that kind of mesh of protection and make sure that we do that as thoughtfully as we possibly can. I just also just want to reiterate, like everybody else, we don't know yet what the reality of this is, but we're very attuned to it. I think I've tried to share with you our sense that it should not be a significant exposure for us, certainly not this year. We'll be working very thoughtfully about bids and the rest, as you suggest, for next year. We have time for just one last question.

Operator (participant)

Our last question comes from Jessica Tassan with Piper Sandler.

Jessica Tassan (Analyst)

Hi guys. Thank you so much for the question. I wanted to ask about, UHC has achieved really phenomenal growth in MA year to date, up 521,000 members through April. Almost half of that growth has come from CSNP plans. Just wondering if you all can elaborate on UHC's dominance in the CSNP market. What do these plans offer the beneficiary? Why has UHC been so successful in this segment? What does CSNP enrollment mean from an economic perspective for UHC in 2025 and then over the long term? Thanks.

Andrew Witty (CEO)

Yeah, Jessica, thanks so much. I'll ask Bobby Hunter, who looks after our M&R business, to respond to that, Bobby.

Bobby Hunter (CEO of Government Programs)

Yeah, thanks, Jessica, for the question. I would say really just overall, we're very pleased with our year-to-date growth in Medicare Advantage. As you know, we continue to be on track to deliver on the full-year growth target of up to 800,000 members. The momentum we had in AEP carried over really nicely into OEP, including notably strong retention of our existing members, and then really diversified growth across our community HMO plans, full dual plans, and the plans you mentioned that are designed for members with chronic conditions. Really, both from a mixed volume standpoint, we feel really good about where we sit in 2025 and the outlook that that gives us around the membership growth.

I would just note really that the Medicare Advantage plans that we offer, the great work that we do from a value-based care integration standpoint with a collection of our providers, both internal and external, really position us well to manage these members with chronic complex conditions. We are very proud to continue to get to serve more of those members as we progress throughout the year. Thanks so much for the question.

Andrew Witty (CEO)

Bobby, thanks so much. I would like to thank everybody for all of your questions. We appreciate your engagement very much today. While we are not satisfied with our performance to the start of 2025, I hope you have heard today our determination to improve and our enthusiasm about the path forward. We remain deeply committed to the value-based care strategy of the company, and we believe that that is the way to solve many of America's healthcare problems, both from a cost, but most importantly, from a patient experience and outcome perspective. I think many of you who know UnitedHealth Group well will also know and recognize that when we encounter an issue, we figure out how to work it and how to deal with it.

Rest assured, we all at United are going to work our issues that we've encountered in the first quarter, solve them, and you should count on us to continue to strive towards delivering for everybody we serve and to make sure that the growth of this company returns to the kind of ranges that you would expect of us. With that, I'd like to thank everybody for your time today, and we appreciate it.

Operator (participant)

Ladies and gentlemen, this concludes today's call. Thank you for your participation. You may now disconnect and have a great day.