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Dave’s Daily English Transcript

4.17.2020 Dave Wichmann: Good morning and welcome to Dave’s Daily, it’s wonderful to have you here again today. It’s a week, as we look back, it's a week of gratitude. We just had a very, very busy week and there's so many things that have been accomplished this past week, some much more important than others, but the opportunity on Tuesday to talk about you as our team and all the great things that you've done to address COVID-19 and to publicize that was through our earnings conversation were just terrific. We’ve had a lot of innovations as well and in fact today, I didn't plan on talking about these but a lot of things accelerated pretty quickly. So, we're going to take a little bit of a pivot today and talk about some of those things as well. And then we've seen a lot of evolution, you know, broadly in the market with respect to, you know testing and also surges and leveling off on the other side of the curve, those kinds of activities which show some hope and promise. But the thing I'm most grateful for is the things that are kind of left unsaid; the things that people don't see each day every day, and that's the great work of our health care workforce who’s out there every day battling COVID-19, and your work each and every day supporting them as well, making sure that we are keeping the health system working effectively, funded well and all those things as well. What I find is that we see a lot of elation around certain specific things, but there's not enough stories about the great work that you're doing. So, I want you to know that I see it every day and I can't be more grateful to each and every one of you for what you're doing. Just keep it steady, keep it strong, keep being united in your response. Today, I'd like to thank the UHG Talent Acquisition team for my swag. It happens to now match my chair, so that it works well. There’s something you've indicated that you'd like to see me in pink or yellow or something bright, and I want you to know I have a wide array of color palette that I choose; it’s black, blue, gray and white or some derivative thereof and those are the things that you know I appreciate most. So, I want you to know that I have a wide variety and a wide color palette that I pursue each and every day and if it’s just the same with you I’ll stay away from Hawaiian shirts and otherwise and stick to what I'm comfortable wearing. But anyway, I appreciate all the wonderful suggestions, that makes me laugh every day and you know it's hard to find opportunities to laugh in this environment. So anyway, we got a lot of questions we are going to answer today, but I do want to talk about innovations and I know one of your very favorite people that you enjoyed was Dr. Deneen Vojta and she's the one remember, she gave you the demonstration of the swab. We had a new innovation the FDA approved around advancing swabbing even further to make those tests even more effective. And we’ve asked Deneen to come here and demonstrate for you what those evolutions have been. So, Deneen how are you? Dr. Deneen Vojta: Good, thanks for having me back. As you know, I've worked here for about 14 years and one of the things I'm grateful for about UnitedHealth Group of many things, is our willingness to see things through. So, you know, not a one-and-done, and then you know we move on. We actually will see things, and this is an example of that.

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So, as you know, one of the first studies that the Everett Clinic and Po Tu conducted with us was the idea to, so can we de-risk the testing process. So, can I do it myself as a patient versus a doctor? The answer was yes. And do I have to go all the way back? The answer is no. You can just go you know midway up your nose. But you probably have seen in the paper, etc., that supplies are still a big problem and so specifically as we talked about last time, when you do take this swab regardless of what kind it is, you have to put it in this viral transport medium, and this actually is even running out too. So, this is what I call bug juice. You know, keeps the theoretically keeps the virus alive long enough so when it actually gets to the machine that runs the test, then you know, it's still alive and can be picked up. So, but again they are running out of the viral transport medium. So, one of the tests further de-risking the process was, well do you really need this viral transport medium or could you use normal saline, salt water, if you will? Well, it turns out and here we have it, good old normal saline, salt water, the answer is yes. So, you can actually transport the product in this in this part is limitless, so that's really good news. The second question that we de-risked during the last week was even though we talked about nasal swabs and nasal swabs actually believe or not, that's a foam tip and these, while turned out to be just as effective in and picking up the virus or transporting the virus for detection, these are in short supply as well. So, the next question was, what about good old spun polyester swabs. So, what does it look like to you? It's a Q-tip, looks like a Q-tip. And fun fact is that Q-tips actually, while originally were made of cotton are actually spun polyester. Now this is a medical grade spun polyester, but as you saw yesterday, the FDA, because of the good work of Po and others with us in R&D and UnitedHealth Group as a whole, now the FDA has added this to the list of acceptable swabs. Which is terrific, because while both the foam swab and the NP swabs are in short supply, these are almost limitless which is really great news. Dave Wichmann: Those are still pretty intimidating, why are they so big? Dr. Deneen Vojta: They’re used for lots of different places. I’ll just leave it as that. Dave Wichmann: Okay, got it, got it. Still you're going into the frontal part of your naval cavity. It's still going up in the front part of your naval cavity, your nasal cavity to collect the sample. And then you put it in regular saline? Dr. Deneen Vojta: Regular saline. Dave Wichmann: And ship it. And you were very careful to point out last time that this is not a home test, but it can be self-collected in the presence of a clinical setting.

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Dr. Deneen Vojta: That's right in the spirit of scientific inquiry, you don't always get the answer you want. So, I'll tell you something else we did that actually did not work out. We tried to actually transport it in dry, so no liquid, and that didn't work. In addition, now we did two things with that study: a) there was no liquid, so it was a dry transfer and it was at room temperature and that didn’t we quickly realized that was not going to work. So, a future one we could separate those two. Was one worse than the other? Was it the dry or the room temperature? So, that’s another de-risking process. Dave Wichmann: Cool. That’s great. One other thing I have before I turn to folks’ questions, actually want to go through some innovations as well. But Gilead, yesterday, put out some additional encouraging news about their drug, Remdesivir, which is a treatment for COVID-19, and they conducted, not a study, but rather they administered it to 250 patients in Chicago and had some promising results. What I want to encourage people is there are hundreds of things going on right now and there is a lot of hope and promise. But these aren’t necessarily subjected to clinical trials, nor are they necessarily approved at this stage. Not to take anything away from it, but what I want folks to realize is that now as you look forward, you’re going to read a lot of things and it’s important to be properly informed by those. I just want you to tell the folks what a controlled clinical trial is and why it’s so important that we pursue those. Dr. Deneen Vojta: First of all, I agree with you. Kudos to all the physicians and the frontline workers who are trying their best, using their years of experience because there’s no road map here to figure out what might work. So, they might try certain drugs. You hear in ICUs, people are putting people in the prone position, believe it or not. And there’s some anecdotal evidence to suggest that might be helpful, et cetera. But at the end of the day, we have to figure out how much of that was just chance. So, it goes back to good old stats. If I flip a coin and three times I get heads, you can make an assumption about that. But in reality, as you and I know, if I do it 1,000 times, it’s going to be about 500 and 500 over time. So, it’s a statistical modeling problem. So, what you want to do, particularly drug trials and other kind of human intervention, is that you give the drug to half the people, or other intervention like the prone positioning. And then the other half, you don’t. But you don’t tell either the investigator or the patient which one they have, because otherwise, we can be biased in our findings. At the end, you use a statistician to help you decide how many people will you need in this trial to get either the drug or the placebo, to actually see a true statistically significant effect. So, that’s what hasn’t happened yet in a lot of those trials. That’s what we call an observational trial, they’re just watching what happens. But we don’t know how much of that was actually chance. So, you want to take that out. I’ll tell you, a number of the studies we’re participating in, we are focusing on that randomization.

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Dave Wichmann: That’s great. I’m glad you explained that to folks. We’re again not taking anything away from it because based upon the results of 250 patients, it looks great. And it clearly seems to have broken the trend. But this is a treatment option and hopefully it works among the number of other things people are trying today. So, anyway, thank you for being here. I may come back to you, we’ll see how it goes. A couple of other things that have happened, Sanvello, I asked you a couple of weeks ago to download that application. It was really designed for consumers to address stress and anxieties. And by the way, in just a very short period of time, it’s become the number one stress and anxiety behavioral health application in the country. So, that’s great to see that that innovation, brought on by UnitedHealth Group Ventures, has taken off the way that it has. But now they’ve come up with a Sanvello for clinicians, which is basically extending that application to clinicians again for free during this time, for the purpose of being able to have a telehealth visit with a clinician. There’s a number of other therapies that can be administered through that, as well as several observations the clinician can make while you’re not in a clinical setting with that clinician. So, a number of really nice advances. We’re operating at the speed of light. It’s amazing to see how fast and how effective this team is really around innovation, one of our core values, during these times. So, just super excited about that as well. You also probably saw this morning, both the Sanvello and the swab and the saline solutions were announced last evening, or yesterday afternoon and last evening. Today, we announced a $5 million grant that’s part of the $60 million that we've allocated so far. This is just getting specific around where those grants go. As you know, the health care workforce and its safety is an important part of what we're doing broadly across the organization. In this case, this morning, is a $5 million grant that was offered off to three third parties to continue to enable health care workforce safety across the United States. So, that was good to see as well. Two other things I’d like to touch on was the Administration rolled out some guidelines for reopening. As you know, we're an essential service so we’ve been open the whole time. A lot of what they’re talking about is how to reopen the businesses. Ours has never closed. So, we are open. For us, it’s more about how do we work and where do we work and those kinds of things as well. We’re working with our epidemiologists, our clinicians, your business leaders to sort through all that. I may have something on that about this time next week and then give you some further instruction. Rest assured, what’s most important to us is to make sure this remains a very safe work environment for you, for your family. It's not going to be a one-size-fits-all type of an answer because of the diversity of our workforce, the locations, all those kinds of things. We’ll give you some good guidance on it. Rest assured, we’re going to take the professionals’ points of view. We’re going to evaluate our own standards in the way in which we maintain our facilities and make sure that we keep you safe. The other thing is that you’ve probably noticed that there are these wild swings in data and it all started on Tuesday this week. Unfortunately, what we’ve seen is what I’ll call retroactive catch up in terms of designation of the cause of death in particular. So, you saw a very severe rise yesterday. You saw actually an increase over Tuesday and Wednesday as well.

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Those are more about counting as opposed to that there's actually a rise in the incidence rates. They’re just catching up in terms of the way they count things. So, what’s specifically happening here is that these are individuals who were either not tested and/or tested negative for COVID-19, but yet they passed away due to symptoms of it and as a result are being included now. Also, now that the rate of, you know we’re still in the back end of flu and pneumonia season as well, and what you have seen is actually the pneumonia diagnosis and death rates have fallen off completely, which may be that because folks are confusing these two situations. I don’t like talking with you about death and of those kinds of things, but I know you're watching and I just want to make sure that you know that that these are just statistics and how they're being accounted for, as opposed to actual trends. We have seen what I've characterized as a peak in many markets, some people believe we are on the downslope, that the actual incident rates are dropping off and I'd like to believe those to be the case. I'd like to see those trends stay-in-place. What's most important making sure that they do is just that we each and every one of us take individual responsibility for maintaining the proper physical distancing standards, proper hygiene and make sure that if we are symptomatic and we have known symptoms, that we make sure that we shelter and make sure we isolate ourselves, particularly if those symptoms are fever, shortness of breath, body aches and pain, maybe a loss of taste, smell, things that you know are COVID-19 symptoms. So just be careful about that and again seek help and assistance to the extent that your symptoms accelerate to a place where you're uncomfortable. A couple of questions. So, one of them was about N95 masks, and when more would be made available, more widely. I wasn't sure if this was as it relates to our employee population or if it was more broadly be. One area that has improved for us in terms of our overall procurement is the ability to buy N95 masks, and I think 3M and others have done a nice job making these available. 3M, meaning they have the N95 masks, but others who build comparable products, but there still a shortage of these and our prioritization of these are for our clinical workforce broadly. So, we're not using them in non-clinical settings, we are encouraging people to either utilize more of a surgical mask, or make your own protective mask. What you're really trying to do is make sure you're providing a safe environment for others, and there's been a lot of encouragement to make sure that we do so. Second question was around how we are leveraging business intelligence and predictive analytics to get in front of the virus. We’ve done a lot of things, you know Deneen and team, over at what we call 5995, which is UHG R&D had built an analytical model which basically, it’s a Strain Space Model. They looked at the potential demand for services against the supply, respirators things like that that you probably have seen, as well as evaluated against PPE and others and try to predict when surges might occur and to see whether or not health systems and we were ready for those surges and that's been very instructive for us. We've utilized it for internal purposes, which is to really manage our own business we need to be there as a workforce, ready to be responsive to surges when they occur. So, we've done that, we've also used Symmetry, Impact Pro and Impact Intelligence tools to identify individuals. So, when B.T. was here yesterday, Brian Thompson, he talked about identifying high-risk members and we utilize our own tools to determine who those are before we make those 7.7 million outreach calls and ensure that consumers have the right supply to shelter-in-place. Another one that was asked is about that we would not accept CARES Act relief, this $100 billion or so, and the reason we're not accepting it is because we're confident in our financial position and liquidity, as we had with John Rex here some time ago. We showed how strong this organization is and how properly managed it is for the long haul, and because of that, we are very strong balance sheet and we can take care of our own affairs. Others have greater needs so, by us

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taking something it would actually detract from others’ ability to get disproportionately, particularly surge areas of that nature. So, anything that we receive it's received in, because we were directed to receive it and we turn around and we send it right back. And it's because we're in a good position as a company. There is really no need for us to do so. Those of you who read the paper about the tough economic times, you see more and more layoffs occur and a lot more unemployment that’s occurring across the nation. And there's a question about whether or not we're going to see the same thing in our business as well. We have retained everybody, and I mean everybody, through the furlough, which means that we have not let anybody go due to COVID-19. We are an essential business and we provide an essential service to America and to other places across the world, particularly in South America, and because of that, we need to stay intact and operationally ready to serve now, while we’re in the middle of COVID-19, but also on the other side of it, so that we have available capacity to deal with things like elective procedures and stuff like that when it comes back online. So, we have made a policy to basically stay online and to not furlough due to COVID-19. I can’t guarantee that will be the case forever, meaning who knows, there could be some kind of circumstance that arises where the company might be at risk or something, but I just don't foresee that happening. So, I'm very proud to say that that we have no furloughs due to COVID-19 and I appreciate the amazing work that each and every one of you have done. There's one last one that I'll take and then I'll close and I'll save some of the content we have for this session for later, and it’s really around getting back to work. There's been a lot of questions about that, and I already said that your health and safety is our top priority. We are looking at when to bring our workforce back to work, meaning into the office-based setting. And as you know, we have an initial idea that we send our non-clinical workforce to home through April 30. So, like I said, I will assess that, along with the experts across our company: clinicians, epidemiologists and your business leadership team, over the course of the next week or so and get back to you. It will be very well organized. It will be very data-driven. It'll be very well supported and I can assure you that not everybody will agree, and I expect that. And you may not agree and I understand that as well, but we're just trying to make the best decisions for this company to ensure that it is here to serve people in the most constructive way possible. You'll just have to trust me a bit that we’ll try to make the best decisions that we can. With that, I’ll close. It’s Friday. So, that means tomorrow is Saturday and Sunday and as you know, Dave’s Daily doesn't work on weekends. I hope that you get a chance to recharge this weekend as well. Just remember, despite the fact that there's a lot of good news out there, it doesn't mean that our standards of how we take personal accountability for COVID-19. Those things do not change. So, please exercise the restraints that you've seen to date. Make sure that you get time to get away from work and connect with your families. Again, I know that work just plows into every moment of every day when your work setting isn't defined. So, please make sure to take the time consciously to recharge your batteries, connect with your family and friends and do so in the proper socially-distanced way. I'm sure we’ll all be safe through the weekend.

Alright, take care. I'll see you Monday.