Andrew Witty : Josh, listen — thanks so much for the question. It’s a really — that’s a big question. Let me just give a few thoughts toward that. So one of the key capabilities you need to be in value-based care at scale is patients. Patients because it takes three or five years of getting to know medical practices before they become part of our network and as we go through our expansion. Patient then in terms of how you go through the process of building the capabilities and skills within the clinical practices to move from fee-for-service to value-based care. And of course, that patient size is reflected in how long it takes to go through this from an economic and financial perspective. And that’s why as we see this rapid development now, it’s kind of — OptumCare, value-based care is kind of an overnight success that took 15 years to build.
And that’s — it’s really a truth. And we’re seeing that scale now come to life and all credit to the teams who are doing that. In terms of what helps here, I think it’s really building a muscle within your organization to continuously test, learn, correct, test, learn, correct in terms of how we work. This is a very — so very — it’s a somewhat delicate system because what you’re dealing with, obviously, highly professional clinical decision makers on the front line who are absolutely, ultimately responsible for every decision they make in front of every patient. But you’re also trying to make sure they have the right information to be able to learn from the whole system, the information we know about those folks and what’s likely to happen, what could happen, what might be the best practice.
And how can we get the whole of the system to operate at a higher level. Those sorts of pieces of progress, those areas where we relentlessly invested, give us opportunities to improve the clinical care. If we can improve the clinical care, the economics follow. So within this whole model, getting the clinical care right, getting people in the right facilities, making sure people don’t spend too long in care facilities when it’s unnecessary, making sure that illness is delayed, deferred because they’re treated well that prevention is the priority, that’s what drives all of the economics. What we’re seeing, Josh, is that over the last three or four years, we are indeed being able to bring our more recent cohorts to a better economic position more quickly.
That’s allowing us then to continue to invest more aggressively in bringing new patients into the system. And that — it’s really that mechanism, which you’re seeing come to life at the moment. Hopefully, that helps a little bit. And next question please.
Operator: We’ll take the next question from the line of Justin Lake with Wolfe Research.
Justin Lake : Wanted to touch on cost trend. MLR was in line with your expectations for the quarter. But wanted to hear — there’s been questions about the impact of respiratory in the quarter. There’s even been some discussion around a pickup in just overall utilization in December. So would love some comments on those to it, maybe just a little on how trend looked between the different businesses, commercial, Medicare and Medicaid?
Andrew Witty : Yes. Justin, thanks so much. I’m going to ask Brian Thompson to respond to that, please.
