Just your sense, again, we'll have plenty of AI people on here, but your sense as with the data that you have, where is it really working spectacularly well?

Yeah, look, I'll give you the areas.

It is funny because I do use AI at a personal level.

So we have Agent PC, which is an agent that mimics me that gets better and better that we worked on.

We had at our executive meeting, you were supposed to build an agent.

I think they were surprised I actually showed up and built agents.

And then apparently I built the most agents.

As you prepare for 2027, what are you paying attention to? And more specifically, what's keeping you up at night?

Mm-hmm

... you need predictability, you need incentives aligned with total cost of care, quality, and experience, and you need the ability to innovate and drive care at the front line on behalf of patients.

So then let me take you through the stages that you alluded to and reflect on them.

I started in CMS.

I was in government twice, the second time through, uh, twenty eleven, and then ran the CMS Innovation Center after serving as chief medical officer.

As you remember, we had almost zero percent of payments really in value-based care models tied to total cost of care, quality, and experience.

At that time, you're launching the ACO program, you're launching these new CMMI models.

[laughs]

What's the job been like for you for the first few months? And I would also add, how is Optum changing?

Thanks for the question.

You know, very busy the first few months.

We have a great team, but lots of work to do.

You know, I always like to center us on the mission.

So the mission of Optum is to help people live healthier lives and to help make the health system better for everyone.

You know, we serve north of 125 million people in various ways across the country.

What is Optimum's stance right now? Are you diving in, say, with ambient listening for clinical notes, or is it more of wait and see?

What type of impact will it have? How big will it be? What areas will go into? What can people not imagine today that will become standard over the next five to 10 years?

Look, I'm not an expert.

You're probably more of an expert than me.

And Sandeep Dettalani leads this AI technology work for us.

But I think it's going to be like the internet.

I think it'll change everything.

So then let me... give us some potential examples.

How are you approaching it today? What type of databases are you looking at? What kind of problems are you trying to clinically improve? Where are you taking the company right now?

when we talk about value-based care or you talk about value-based care how do you define it right because there's you know i hear you say 50 and 80 and 100 but like is that like what do you mean by that

Here's what I mean by value-based care.

So that the buyer of care, the payer, and the provider of care, the physician group, the health system, it's focused on total cost of care, quality, so health outcomes, and experience, and it's a longitudinal model, so at least a year or longer, and it has some component of two-sided risk.

We have learned, and we saw this at the Innovation Center, and it's true in the private market as well, when there's only one-sided sort of upside, people don't do the investments and do the change at the level they need to.

When you're taking a fully capitated rate or two-sided risk, all your incentives are aligned on how do I keep that patient healthy, out of the hospital, provide the best care possible.

And sorry, just Medicare Advantage, I can't help myself because...

There's a lot of rhetoric around Medicare Advantage these days.

And yet it feels like people feel like the whole system screwed up for people who don't understand the supply chain from how do you explain the American drug system to them?