- Thank you . I am joined by Dr. Sumit Dutta, chief medical officer for OptumRx. We're here to talk about medications and healthcare in general today and in the future. So Sumit, thanks very much for joining us.

- Thank you, and thanks for having me today.

- I'd like to begin with the current state, COVID-19. With vaccinations now increasing, will everything go back to normal?

- Well, certainly a new normal. And I'm happy to say I'm back in the office in Chicago that you can see. And there will be things that are different. And I'm certainly in a Zoom call now with lights on me and that didn't occur before the pandemic, but I think there are things that will be positive because of the pandemic and as we move forward. One example is a focus on health inequity. I think we really came to understand during the pandemic how unequal healthcare can be in the United States. And there feels to me, certainly at Optum, at the company I work for, a true focus on resolving that. And I think the second thing is around how healthcare is delivered. And that's a broad question, I'm sure we'll be talking about it in greater depth, but I think the vaccines were developed, they're effective and they're safe. And that is bringing us to a place where we can hope for a better tomorrow.

- So, telehealth and remote monitoring certainly took off during the pandemic. What do you foresee for usage declining, increasing between now and 2030?

- Oh, I think telehealth will be a part of healthcare delivery as we move forward. I know at Optum, at our company, we've had nearly 300,000 telehealth consultations. We performed pharmacist consultations through the phone and through video and I myself had a dermatology visit during the pandemic virtually. And I'll have to tell you, I liked it. I didn't have to pay for parking, it was very efficient. We agreed upon the time and I found the technology worked very well in terms of establishing the diagnosis. Patients are happy when the system works in their life. And so I expect to see even more of these types of technologies to make the consumer experience better.

- Very good. What is your forecast for home delivery and things like home infusion?

- I think they mimic the overall trends towards home delivery of other goods and services. We have gotten used to providers being able to deliver many of our goods and services to our home, again, in a way that's efficient and good for people. And there's no question to me that the increases that we've seen in home delivery because of social isolation and pandemic and being at home will continue because it's just, it's convenient.

- And you are talking about that convenience of what patients want. Talk about what healthcare would look like if it were designed for the consumer and the consumer journey.

- Well, I'll paint a vision for the future where I think there's a home that's designed for good health, and you can imagine for example, floors with scales and so providers can understand, wait, we already today at Optum have glucose monitors that provide through the cloud, our clinicians, blood glucose levels. I can imagine even more of that data coming from patients in the home to the provider who can then provide services through telehealth and then receive their medicines as you previously asked in the mail. Much more convenient for those patients who would like to receive their healthcare that way.

- So, our event today is titled, Patients and Consumers in 2030. And when we spoke earlier, you were making a distinction between the consumer perspective and the patient perspective. Please say more about that.

- That's a great question, Ed. I think what we've seen over the course of the last 20 years is more of a convergence of the patient and the consumer together and I think for the better. So as a physician, and I know there are many physicians on the call, this is a, maybe it's a touchy or an interesting subject, but I think it doesn't have to be. Clearly there are aspects of being a patient that I think do not contradict with being a consumer of healthcare. So that's 0.1 from the physician's perspective. I think the idea of providing a quality service and having the patient be satisfied with the care that they receive is an example of where patient and consumer converge. And I think those are the areas where we're clearly, it's a good thing. I think the second thing I just say is, as affordability challenges become more pressing, then patients have to become consumers so that they can achieve the best value for limited resources. We all have limited resources and patients thinking like consumers in that context, leads to better value in healthcare.

- Well, let's talk about affordability specifically around medications. It's already a big concern for many patients. But what do you foresee with things like new precision medicine drugs that are definitely going to become available over the next few years?

- Affordability is the number one concern and shaped how I think about the delivery of pharmaceutical care in terms of overall health care. And obviously that's as chief medical officer of OptumRx, that's my primary concern. So let me go back in time 20 plus years ago, when I first started in this industry. At that time you had novel drugs that were expensive, maybe not as expensive as today. And then you had a period of competition where there were alternatives to those drugs and OptumRx and companies like us would negotiate for the best value. And then there would be generic introductions and we would move people and guide them to generics as quickly as possible. That balance really led to an affordable healthcare situation 20 years ago. What we've seen since is we've seen very novel precision and to your point, drugs come out at very high prices and less ability for generics and competition to be able to lower prices and create affordability for patients. And so there's a balance of these very novel drugs and their costs. Ultimately I think if you have therapy that patients can't afford, then what good is it?

- Indeed. This is something that NEJM Catalyst published about. How would these payment questions be mediated?

- Well, I think clearly it is really considering the value that these drugs provide. And there's potentially a misperception that when FDA approves the drug, it must be valuable and that value is let's say maximum. But the reality is drugs vary in value. They come out with studies that are sometimes contradictory, relative to that value and their price may not correlate to the value that those drugs give. So I think increasingly, the ability for society, for companies like us, for pharmaceutical companies, for physicians to understand truly the value of that drug and whether it makes sense relative to the other choices, becomes the way that we think about drugs in the future.

- Well, it'll be interesting to see among patients, patients acting as consumers among PBMs like OptumRx, among hospitals, how that's societal value in the end is judged. One aspect of this is transparency and recent transparency efforts, I would say, have bogged down. How can misinformation problem be solved?

- So transparency is an important issue. And, let me tie it back to your last point about judging the value of a drug. I think ultimately judging the value of a drug is going to be two things, a patients getting better and can they afford the therapies that make them better. Now, how does that tie to transparency? Transparency becomes the way that providers and patients, have a much better understanding of the value that a drug so that they can make the best choices. I know when I went to medical school and when I was practicing medicine, I hardly knew what the price of a drug was. That was not the way that I could make the best decision for my patients. And today OptumRx, we've invested in tools, technology, such that physicians and patients can have an understanding at the point of that prescription being written. If someone knows that amongst the alternatives, that the efficacy is best for a drug that is significantly cheaper than another, then that allows that decision to be made. And I think going forward again, that'll be increasingly the way that decisions are made.

- Well on the point of consumerism is consumer shopping for medications and in general for healthcare, is that really realistic? And is it desirable?

- Again, some really great questions, I think that, I love that question about, is it desirable? So let's start with what's happening today. Consumers are making more and more choices about medicines today and I'll tie it back. I had the opportunity a number of years back to work for another company where I worked in Asia, in New Delhi. And in New Delhi, there was a lot of self-pay for healthcare. I saw that firsthand. And what I'm seeing here now is that there are times when patients choose to purchase their healthcare or their drugs, specifically the work that I do off of a benefit. That might be because of convenience, it might be because of privacy, disclosure issues. It may be because that's the most affordable way to manage that. So there is a consumerism that exists today in the United States healthcare that didn't exist in the past. And I see that increasing, particularly as you get these drugs that are so expensive, that consumers will not have the ability to pay for them, generally speaking. And then other drugs where it really is possible for consumers to shop and compare and get the best price. Again, we foresee those trends, they've started already. And so have built consumer shopping tools, if you will, so that consumers can understand the difference between price and get the best value for their healthcare dollar.

- Enormous ramifications there. Final topic, at the outset you mentioned inequity, that's been highlighted by the COVID-19 pandemic. What would an equitable care delivery look like? Especially for medications.

- Equitable healthcare, I'll give some examples, 'cause they'll take many forms. Let's start with the studies that support FDA approval for drugs. Those studies would include sufficient numbers of people, of different backgrounds so that the healthcare provider and the system can confidently say that a drug will add value to a person regardless of their background. So that's one example of equity. Another example of equity will be that drugs are available in the communities for all different kinds of people. I'm sure many of the folks who are watching this know about food deserts or have heard that term before, they may be aware or may not have heard that pharmacy deserts exist as well, where there are not the ability for certain groups of people in communities to be able to easily get their drugs, again, a place where home delivery has value, but also an opportunity to create those services and ensure that they're equitable. There are a number of other examples that I can give, but equitable care to your question, looks like everyone, regardless of their background, the color of their skin, their gender, they all have the same high or highest quality care that they should get and they deserve to get.

- Excellent. Sumit, thank you so much. This has been such an interesting conversation.