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President and COO of Optum at UnitedHealth Group John Prince on reshaping healthcare for the good of all

Healthcare is undergoing a substantial transformation, and there's an air of collective optimism as leaders and organizations seek ways to elevate and advance the industry. What will it take to get there, and where can you have the biggest impact on your organization?

We all want to believe we're working towards something meaningful and that our actions have a lasting impact on helping redefine healthcare. And while it's easy to feel that the industry may be stuck in its ways, together, we are positioned to drive change, and anyone in healthcare has that power within them.

John Prince has been in healthcare his entire career and brings 25+ years of experience building new and transforming organizations. For the last 17 years, he's held diverse executive roles, and today as the President and COO of Optum at UnitedHealth Group, the organization's mission drives his commitment to create real change.

We sat with John to chat about what it takes to reshape healthcare for the benefit of all involved and to create a lasting impact. The conversation is below, and if you're short on time, here are a few quick takeaways: 

  • We're embarking on a consumer-first journey in healthcare, with all aspects from operational, clinical, or financial coming together to redefine healthcare from a people perspective.
  • Developing deeper organizational relationships between government agencies and private sectors matters to enrich operations, analytics, technology, and care coordination is key to this move forward.
  • Aligning distinct client needs in the market with the services offered by an organization will lead to progressive outcomes. It will be what enables a business to execute the change-making initiatives necessary to move into this new chapter in healthcare.

What follows is a lightly edited transcript of the session with John.

Derek Lo: John, welcome. We're thrilled to have you here.

John Prince: Hey, Derek, good to see you.

Derek: John, it's a huge honor to have you join us today to kick this off. But before we dive into what it means to reshape healthcare, it'll be great if you could give us a bit of background on yourself and share with our attendees what got you into healthcare in the first place.

John: Great. Thank you, and it's great to be here and in your inaugural event. I've been in healthcare my entire career, so I've spent 25+ years building new and transforming businesses in healthcare. In the last 17 years, I've been at Optum in different executive roles for us, and today, I am the President and COO of the company. I think when you get into healthcare, it's because of the mission. And what got me into healthcare originally was my brother. 

"My older brother was hit by a drunk driver in college. He suffered a traumatic brain injury. He had many fundamental issues regarding his health and well-being and has suffered in the healthcare system for the last couple of decades. And so he is my guiding light in terms of how I think about why the healthcare system needs to transform."

Derek: A very touching story. Thank you for sharing that with us all, and we appreciate you being so open and honest with us. 

The rise of consumerism in healthcare

Derek Lo: Transitioning a bit into your tenure at Optum, you've been with the company for nearly 17 years. What's changed or surprised you the most, would you say, during your tenure?

John Prince: Well, it's a lot. I think the biggest thing that's transformed in the last few years is the rapid rise of consumerism in healthcare. If I glanced back 17 years ago, we looked at consumer-directed health care plans and thought, "the change is going to come from the plan design benefit." I'd say now, "it is the role of the consumer and an incredible opportunity to redefine healthcare from a people perspective." 

And I see a great trend around the integration of all aspects of health care, whether it's operational, clinical, consumer experience, or financial, all coming together. 

"It's a unique time where data and insights and the opportunity to personalize healthcare has come to the forefront. And so I see an incredible opportunity there in terms of change." 

If I had to put two on the list, the other biggest change would probably be the acceleration of value-based care. That's an area that we've spent a lot of time at Optum thinking about, but it's also more broadly in the industry, and I think if you see the adoption of value-based care in the last two years, it's exponentially increased in the market.

Derek: What do you think has led to that rapid growth in adopting value-based care?

John: I think the concept has been around for two decades, and probably what's different now is that we have the backbone to do it. Many times before, people said, "well, how do you deliver value-based care when you are connecting multiple parties of the healthcare system that were fragmented?" 

Now we and others are building backbones that enable that. We now have the technology to build the operations. 

"We've created the incentive systems to help align people and have gathered the assets and put them all into one organization. So I think that's what's different now, accelerating it." 

Also, the results. 

You can't accelerate something if you don't have the proof points around how it improves the cost-quality experience and [whether] you can create a better experience for doctors and people operating in that system. So, I think that is what's different now and what's making that [type of] environment.

Defining transformation

Derek Lo: Based on what you said, you're currently accountable for all of R&D across Optum. I think folks would be especially curious to hear your view on how technology impacts value-based care and how it generally shapes Optum and, ultimately, U.S. healthcare. And what do you think is going to be the biggest impact of technology over the next five to ten years?

John Prince: That's a really good question. At the core, Optum is a tech company. We're tech-driven. We have 32,000 technologists as part of our team, so many people are coding and building new technology. 

We just finished our most recent strategy as an organization that was approved by the board and are operating and executing against it. They are excited about the opportunity. 

I'd say that the first key transformation around technology is designing with the consumer lens in mind. And that sounds simple, Derek, but you've been in the tech space in healthcare for the last couple of years and know that the technology available at that time was not designed in that way. It was designed for the provider or the person processing a claim. It was not designed to think about a consumer or their health needs. 

From an experience standpoint, I'd say the second thing that I'm most focused on is [answering] "how do we create a system that's openly architected that allows the whole healthcare system to work together."

"A huge focus for us is "how do you create a platform?" and I think that's the keyword of the future. Platforms in healthcare that everybody can operate in because you need to connect the payers, the providers, pharmaceutical companies, the other key providers, and the consumer in a healthcare system that is open architecture. That's a key focus for Optum."

Better than that is asking, "where are we spending money around digital-first and making sure we're designing a thing from a digital-first perspective?" or "how are we moving everything to the cloud now?" and "how do we build all the new transformative stuff and fix the old systems that are still operating in our doctor groups or our health plans and get them to work with the government agencies and actually modernize those?"

I think the huge opportunity is around technology, which is exciting. The attack agenda is going to transform healthcare in the next few years.

Derek: That's super fascinating and makes a ton of sense, and it's what we see as well. 

Partnerships matter more than ever

Derek Lo: How do you think we can urge stakeholders in commercial state governments and agencies that use technology that's probably even more outdated than most to start moving into the 21st century?

John Prince: I think that's where the private sector partnership is so important. The government is a really important partner. 

"You cannot be in healthcare and not think about the government as a key partner. They set the framework. They create a lot of and sponsor research with involvement. I think treating them as a partner is critical." 

They also need partners and don't have the largest technology staff. So I think coming to them with ideas is key because innovation in the private sector is critical. They help sponsor initiatives when we're building new systems; they're a key sponsor to ensure they support and are aligned with it. There's a lot of opportunity with that kind of partnership.

Rethinking our approach to healthcare 

Derek Lo: Amazing. Let's zoom out a bit further beyond just technology. What are some of the changes you're most excited about, either with Optum or otherwise, that you believe will ultimately have the biggest positive impact on reshaping health care for the better?

John Prince: I'm pretty excited about some of the things that we're doing in the healthcare system. 

What I'm excited about is our partnership with clients. Our clients have a lot of competing initiatives right now, and we are trying to work with them around how they modernize what their people are doing, how their operations are set up, and how they do it all at the same time. One of the unique things we've been doing is making these market performance partnerships in the last few years, and we've announced a few of them: John Muir, Boulder Community, SSM, and Facet are examples.  

With these health systems, we're thinking a lot about how they modernize their operations, analytics, technology, and care coordination. And I'm pretty excited about the opportunity there and the results we achieved in the market. 

So, that's probably first and foremost around the opportunity. 

I think the second is a lot of the work that has been done around really connecting all the pieces of the healthcare system. 

"We have a bias that virtual healthcare is not something that sits over here. It's actually integrated, and how do you have that as an extension of a doctor? Not that you go see a unique doctor, but that your existing doctor can be reached and you can engage with them across multiple modalities." 

You can interact with them virtually or come to the office, so creating a healthcare system that connects all of those things is exciting and becoming more mainstream.

Derek: Yes, and on that note, especially with telehealth, will we see more traditional health systems and hospitals go national or broaden their geographic reach?

John: The need is there to have that capability. At the broadest level, I absolutely would say that. I'll give you an example. 

"Say you're in your 20s and are fresh out of college looking for a healthcare system. Your first thought at 10 pm is not to go to Urgent Care. If there's technology, you can pull up on your phone and look up something like "do I have this condition?" and if you can get care at your fingertips, you're going to do that." 

I think the role of the consumer will drive the need to expand in the market. 

A provider then has to have the technology, but I think the capability doesn't need to be known by the consumer. They know it works. Behind the scenes, that technology links with the provider, who is accredited in their state. And they have all the characteristics they need to match with that individual.

So I actually approach it, Derek, not from the provider's perspective, but I'd look at it from the consumer perspective and ask, "what do they need?" 

Because the magic, if you're running that business, is how you set it up where you have a system that tells you someone comes online, you know where that person is located, what this person's needs are, and you can match them with that ideal physician. 

That's where the magic happens. Behind the scenes, but I don't think the consumer should ever think about that.

‍Moving into action

Derek Lo: That makes a ton of sense. On the topic of what you mentioned earlier around technology and some of the next solutions being more platform-based, with some of these change-making initiatives within Optum, how have you thought about moving the company into action from concept to ultimately execution and then implementation?

John Prince: That's a great question. It all starts with your clients. We're a very client-market-focused organization. 100% of what we do starts with our clients in the market and pulls us forward. 

"We spend a lot of time thinking about what health plans want, how they need to meet the markets, what a health system needs, what a provider needs, what the government needs, what the employers need, what are life sciences companies need, and so they shape what we do and how we set it up."

Then we think about our business and set up different growth platforms, so we have various growth platforms aligned to those market needs. 

We have a growth platform focused on value-based care and one on transforming how you manage ambulatory care and that whole ecosystem from primary care, home community, behavioral health, and financial services. 

We think about transforming around financial technology and trying to modernize it. We think about health technology, and we think about pharmacy care services and transformative. So we think about the market and platform and then being responsive.

The magic happens when you link the services across your organization to meet a specific need. That's how we think about the market and how we're organized as a company.

Derek: Amazing. Well, John, thank you so much for spending time with us today. Truly incredible to have you and your perspective from one of health care's most impactful companies. Thanks again, John.

John: Thanks. Great to see you. Appreciate it, Derek. Thank you.

About Medallion Elevate: The Future of Healthcare Operations

At Medallion's inaugural debut, Elevate: The Future of Healthcare Operations, healthcare executives, founders and leaders came together and highlighted the collective optimism of an industry that's ready to elevate and advance the industry. 

It represented actionable insights, disruptive ideas, and ground-breaking insights from some of the best healthcare leaders, visionaries, investors, and founders.

If you enjoy this material, check out more sessions from the Medallion Elevate event.

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