We see health care. differently. Comprehensive data Novel insights Transformative actions Lasting value

We see health care differently Comprehensive data Novel insights Transformative actions Lasting value

24 Hours of Optum data: Creating a more complete health picture We capture: Largest EHR dataset 90 million lives Largest eligibilitycontrolled claims dataset 160 million lives $749M Health care costs 4.8M Diagnoses 8.3M Signs, diseases, symptoms (provider notes) 4.0M Procedures 2.8M Measurements (provider notes) 1.9M Medications prescribed, administered and filled 4.9M Vital signs and observations 3.2M Lab results More than 150,000 providers 2,000 hospitals 7,000 clinics Only person-linked, integrated dataset 30 million EHR linked Rx claims 2

The funnel challenge: What business questions do you need to answer? Quality data manufacturing leads to more useable, research-ready patients Competitor data Optum data Data usability is a function of patients meeting research requirements such as clinical markers of interest and tenure Usable patients Usable patients 3

How did we get here? 4

Dyslipidemia Case Study

Quantifying Statin Intolerance A common reason for statin-related sides effects is Statin Associated Muscle Symptoms (SAMS). In our study, these qualitative symptoms were limited to: muscle aches, muscle weakness, muscle stiffness, muscle cramps, myalgias, and myositis. Approximately 90% of all statin-related side effects occur within the 1 st 6 months after initiation of therapy. We define statin intolerance as a patient reporting these symptoms within 1 year after initiation of a statin therapy. Description Patients # Patients Taking a Statin 6,929,680 # Patients Experiencing SAMS 1,951,936 % Patients Experiencing SAMS 28.2% # Patients Experiencing SAMS with No Preexisting History 924,519 Estimated % With Statin Intolerance 13.3% Patients Receive PCSK9 2,111 Patients Receiving PCSK9 After Statin Intolerance 900 American Heart Association s Estimate = 10-15% Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6

Quantifying Statin Intolerance A common reason for statin-related sides effects is Statin Associated Muscle Symptoms (SAMS). In our study, these qualitative symptoms were limited to: muscle aches, muscle weakness, muscle stiffness, muscle cramps, myalgias, and myositis. Approximately 90% of all statin-related side effects occur within the 1 st 6 months after initiation of therapy. We define statin intolerance as a patient reporting these symptoms within 1 year after initiation of a statin therapy. Description Patients # Patients Taking a Statin 6,929,680 # Patients Experiencing SAMS 1,951,936 % Patients Experiencing SAMS 28.2% # Patients Experiencing SAMS with No Preexisting History 924,519 Estimated % With Statin Intolerance 13.3% Patients Receive PCSK9 2,111 Patients Receiving PCSK9 After Statin Intolerance 900 American Heart Association s Estimate = 10-15% Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7

Statin Intolerance Symptoms by Number of Statins For patients who did not have symptoms within 1 year before starting a statin, the graph below shows the number of patients with statin intolerance symptoms looking 1 year after being prescribed/administered the medication ~1/5 of patients already complain of symptoms despite being on only 1 statin, and these symptoms increase as the patient is prescribed different statins By the time patients try 3 or more statins, almost 40% of the patients show statin intolerance symptoms within 1 year 1 Statin 2 Statins 3+ Statins Patients with Statin Intolerance Symptoms from Physician Notes 1M 2M 3M 4M 5M Only a small proportion (<1%) of patients with symptoms are then prescribed a PCSK9 850 (0.1%) 705 (0.2%) 555 (0.5%) Patients without Symptom Mentions Patients with Statin Intolerance Symptom Mentions Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8

Days Between Statin Intolerance and PCKS9 Prescription Days Between Statin Intolerance and Prescription for a PCSK9 It takes > 180 days for many patients to receive a PCSK9 after they are defined as statin intolerant. Using the integrated data, one could calculate the cardiovascular related costs for the long and short patients, and if the long patients incur greater costs, an argument could be made that PCSK9s should be prescribed earlier in the treatment pathway. 500 450 400 350 300 250 200 150 100 50 0 Early Patients Late Patients Patients With a PSCK9 Prescription After Statin Intolerance Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9

Optum solved one of the biggest problems in health care: Multiple EMR systems that do not communicate with one another Multi-specialty practices EMR1 Rx platform Billing system Small group practices EMR2 Rx platform Billing system Medical groups Physician offices EMR 3 Rx platform Billing system Integrated delivery networks EMR1 EMR2 Rx platform Billing system Hospitals EMR3 Staging area Provider notes Demographics Lab results Procedures (NLP) Diagnosis Medications Outpatient visits Vital signs Hospitalizations Observations Processing: Validation, normalization, standardization, mapping Analytics for providers Longitudinal comprehensive clinical dataset Data and analytics for life sciences 10

Optum s Cohort Builder quickly defines and profiles study populations, simplifying and speeding time to analysis, insight and evidence generation 11

The Cost of Hypoglycemia 12

Understanding Impact of Hypoglycemia WITHOUT Hypoglycemic Events COST WITH Hypoglycemic Events COST Pharmacy (AWP) $27.77 PMPM Medical (Std. Cost) $1,019.62 PMPM Pharmacy (AWP) $9.17 PMPM Medical (Std. Cost) $4,158.73 PMPM Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.

DIABETES WITHOUT HYPOGLYCEMIC EVENT DIABETES WITH HYPOGLYCEMIC EVENT Event of Interest: Diabetes diagnosis Event of Interest: Hypoglycemic event Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.

Comprehensive data leads to novel insights for brand marketing, value-based contracting, comparative effectives and evidence generation Provider notes Treatment rationale, lifestyle observations, signs and symptoms, biomarkers Medications Therapeutic-area-specific market baskets Vital signs BMI, blood pressure, pain scores Cost Disease burden for pharmacy, provider, and facility spend Claims 120M+ Linked EHR/ claims: 15M+ EHR 80M+ Lab values More than 260 different labs (e.g., A1C, egfr, FEV, values) Medical procedures and conditions Indications, treatments and comorbidities Patient and provider details Physician speciality, age, gender, smoking status, race geography 15

Holistic view, informed by data and illuminated by tools, guides actions and creates common understanding of value Holistic view of patient journey Not just what, but why: Detailed understanding of drivers of treatment choice at critical care-milestones Enables more precise understanding: who, what, when Who Patient, provider, payer What Tailored interventions: messaging, support programs and tools When At critical junctures in the patient journey Optum Patient Journey application Optimization of interventional, promotional, educational spends for patients, providers, payers 16

Primary Adherence 17

Breast Cancer Oral Medication Overview Between 2015 2016, the overall patients represented in the EHR linked all payor data who have a prescription for one of the medications of interest is ~33K Just over 1K patients have a prescription for Ibrance Patient Count by Medication (2015-2016) 25,000 20,000 19,441 n = 33,120 patients 15,000 11,848 10,000 5,000 0 4,006 1,163 Arimidex Aromasin Femara Ibrance Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 18

% of Written Prescriptions Primary Adherence by Brand Looking at primary adherence differences between the 4 brands shows that Ibrance only has half the fill rate compared to Aromatase Inhibitors Majority of Ibrance prescriptions are not filled, whereas <40% of Aromatase Inhibitors are not filled Primary Adherence by Brand 68.0% 65.1% 60.4% 66.0% 33.6% 39.4% 34.8% 31.9% Legend Arimidex Aromasin Femara Ibrance Filled as Written 0.0% 0.1% 0.0% 0.3% 0.0% 0.1% 0.1% 0.0% Filled Another Brand Filled Another Brand (Different Class) (Same Class) Primary Adherence No Fills Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 19

% of Rx Claims Payment Type by Brand For medications that were filled as written, the addition of the all payor data shows variation in the type of payment Patients adhering to Ibrance are more likely to use commercial insurance and cash compared to the other payment methods for the Aromatase Inhibitors 46.9% 44.9% 40.8% 41.5% Payment Type by Product 37.7% 36.4% 16.0% 1.3% 2.4% 0.9% 0.0% 0.0% 0.1% 0.0% 6.0% 2.8% 2.8% 2.8% 27.0% 22.1% Legend Arimidex Aromasin Femara Ibrance Cash Commercial Manufacturer Medicaid Payment program Type for Pharmacy Claim Medicare Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 20

% of Written Prescriptions Biomarker Status and Primary Adherence Out of patients with medications of interest and eligible for primary adherence: Prescriptions for Patients with Biomarker Status HR Positive HER2 Negative HR+/HER2-7,840 7,407 10,388 For patients with an indicated biomarker status of HR+/HER2-, the filled as written rate is increased for Ibrance, but slightly decreased for aromatase inhibitors Filled as Written vs. No Fill Rate for HR+/HER2- Patients n = 7,407 66.0% 34.0% 55.5% 44.5% 62.7% 37.1% 36.1% 63.5% Filled as Written No Fills Filled as Written No Fills Filled as Written No Fills Filled as Written No Fills Arimidex Aromasin Femara Ibrance Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 21

Claims + EHR data expansion One of the largest and most complete claims data assets in the United States Optum insurance claims Linked EHR/ claims Optum EHR One of the largest and broadest EHR data assets in the United States More than 1 billion prescriptions per year from 76 million patients per year: 25 30% is eligibility controlled (30 million lives) Includes data from 90%+ of HCPs 90%+ of pharmacies All payers, including cash All-payer Rx claims Adding one of the largest aggregators of pharmacy claims Adding Rx claims for: 1. Individuals with EHR capture and Optum insurance claims 2. Individuals with EHR capture alone 22

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> NEAR Expanded Offerings for Enterprise- Wide Enablement 2017-2018

A New World of Use Cases Robust and Precise Medical & Scientific Audiences Fast, Representative and Actionable Commercial and Sales Audiences P r o d u c t s Panther Smart Files CDMs Clinformatics Provider RWE Patient Journey Cohort Builder Comparative Analytics Integrated All-Payer Panther (with weekly updates) North Star Commercial Analytics F e a t u r e s Evidence Generation Data Patient-Centric Quarterly updates Full history of information: Visits Labs Meds Dx s Insight Expansion Data Moment-of-Truth based Weekly updates Most recent information: Written Filled prescription tracking Most recent lab value Dx indication for prescription Admissions & Re-admissions 26

The Objective of Our Data and Tools To Illuminate Three Pillars There are three main pillars of insights needed to tell the full story of which care works best and why. 1 2 3 $ $ $ $ $ SOCIAL, ENVIRONMENTAL AND BEHAVIORAL HEALTHCARE DELIVERY PAYMENT & ACCESS We combine these three perspectives to provide the most complete view of patient perspective, cost and outcomes available in the market today. 27

Healthcare Requires a Centralized View of the Patient, and Optum is Positioned to Construct that View Eligibility Cost PATIENT Rx fills Labs Financial strain Physician notes Devices Media exposure Vitals Diagnoses Payment and access Consumer behavior Clinical severity Procedures CPG Diagnoses Procedures Reported outcomes Written Rx User-generated information 28

Optum integrates data from across the health care ecosystem, enlarging and enriching our view of the patient, provider and payer Social, Environmental & Behavioral Data Socio-Demographic Health Risk Assessment Media & Digital Exposure Wearable / Device Data Patient Engagement Data Promotional Exposure Purchasing Patterns Loyalty / Membership Survey Responses SEB DATA Reported Outcomes $ CLINICAL DATA CLAIMS DATA Healthcare Delivery Data Electronic Health Records Electronic Medical Records Clinical Notes Genomic Data Registry Data Care Management Program Data Payment & Access Data Medical & Pharmacy Insurance Claims Eligibility & Enrollment Data All-Payer Pharmacy Claims Point of Sale Data Orange: In production: The largest deterministically linked Claims Electronic Health Record data asset on the market; additional data assets listed are part of Optum s expanding data eco-system 29

Near Term Focus 2017-2018 $ C o n t i n u e t o b u i l d E H R - b a s e d p o p u l a t i o n E x p a n d a l l - p a y e r m e d i c a l a n d p h a r m a c y p o p u l a t i o n s D e e p e n g e n o m i c i n s i g h t s : B i o m a r k e r s T u m o r t y p i n g I n c o r p o r a t e n o v e l d a t a : C o n s u m e r D a t a W e a r a b l e D a t a P a t i e n t R e p o r t e d O u t c o m e s ( P R O ) Boost denominator and scope of insights Organic growth of EHR patients Multi-sourced EMR patients Integrated (claims + EHR) patients Increased speed at the time of prescriptions (Dx, Labs, NLPderived) Diversify payer representation Boost integrated patient counts Improve cost / utilization perspective for research Provide broad market representation of brand share / formulary choice for commercial audiences Demonstrate pharmaco-genomic interactions Oncology Auto-immune disorders Rare diseases Incorporate patient s perspective and behavior outside of the health system Front Store Pharmacy PRO s Media 30

Steve Davis SVP, Data and Advanced Analytic Tools 31