Optum CEO Matt Wolfe on technology, talent and mission

Dan Reynolds: Thanks for meeting with us, Matt. Where are data and technology gaining traction and creating productivity gains in workers’ comp and auto no-fault insurance within your practice?

Matt Wolfe: I’m excited about what our team is doing by leveraging artificial intelligence (AI). We’ve found some very material use cases that will allow us to see real success from these tools and bring more value to our clients and ultimately their claimants, which aligns with our mission. For example, we are soon going to deploy a new capability within our redesigned VitalPoint® platform that uses AI to help claims professionals understand more about a claim and how to keep it progressing, synthesizing clinical and state guidelines to help claims professionals make decisions more quickly without sacrificing quality.

But if I take a step back from AI and the specifics around its impact on technology, I’m also excited about the process of transformation here within Optum. We’ve had a lot of really good solutions brought forward, and we have some older processes that are ripe for transformation using technology. In 2026, we’ll digitize major aspects of our ancillary services business, which will lead to faster turnaround times and improved experiences for all stakeholders.

Seeing that work start to play out, and witnessing the results, goes beyond simply doing more with less from a cost perspective. By being able to turn data around more quickly and leverage that data for information, trend reporting, and analysis beyond the transactional processes, we have really started to unlock new capabilities and value.

For injured people, our technology and process enhancements mean they’re getting their prescriptions filled and supplies delivered faster. For our clients, we’re becoming more responsive and adding value. There are many areas where we can continue to innovate by using technology broadly, and our teams are rapidly integrating new tools and approaches.

Dan: Where does Optum currently stand in its journey to transform manual processes, and how much work remains across different sectors of the business?

Matt: I really think of our business in terms of three distinct sectors. We have our pharmacy business. We have what we refer to as ancillary services — durable medical equipment, home health visits, supplies, and similar items. The third portion of our business focuses on helping manage medical spend, which comes to market in a couple different ways: our PPO network offering and our engagement with providers, as well as solutions that help our clients understand and verify they’re paying for the right services and that billed items are clinically appropriate.

Each of these three areas is at a slightly different stage of transformation. Our pharmacy business probably has the most technology in play from a process perspective. Some of that’s been aided by regulatory changes requiring the use of clearinghouses and e-billing, which has forced the whole industry in that direction.

I would say we’re probably 90% of the way there with our pharmacy business, but we have plenty of improvements underway that will enhance the experience for multiple stakeholders. Examples include improving how we deliver pharmacy cards to injured parties, how we make the claims professional’s job of reviewing and decisioning claims easier through faster access to information, and even how we can improve the experience of our network pharmacy partners through faster reimbursement.

For our ancillary business, I’d say we’re probably about halfway there. This business still involves a lot of manual touchpoints — referrals come in from claims professionals and then our team shepherds those through to find the right supplies and pricing. There’s some back-and-forth and it’s still heavy on manual processes, with many inputs and pathways that add time to the process. As mentioned, I’m very excited about our roadmap for the ancillary sector. New streamlined ancillary processes will make everybody’s job easier and allow us to deliver more value by ultimately shortening turnaround times and greatly improving the experience of the injured party.

On the medical cost management front, we have opportunities to implement improved capabilities to drive more value. For example, we’re building an improved PPO solution that will help stakeholders find the right provider quickly, not just based on location or negotiated rates, but also leveraging outcomes data.

Dan: How does AI’s summarization capability serve as a foundation for your internal operations?

Matt: We’re using AI broadly within our internal operations. One example is how our teams leverage AI tools to help accelerate work in software development. There’s significant complexity in transforming client portals or developing new tools that process cases and transactions behind the scenes. The development process involves analysis, requirements gathering, and testing — all areas where we’re leveraging AI capabilities to improve turnaround time and ensure quality. We’re also seeing success using AI to help analyze legacy systems and convert programming languages to modern code. This has been very helpful as teams work to modernize platforms and transition tools to the cloud.

Dan: What improvements have you made to the VitalPoint client portal?

Matt: VitalPoint has always been a key element of our pharmacy program. Over the last few years, our company has done some really great things with this technology, and we recently introduced a new version full of significant enhancements. We rolled out the updated version to our clients in waves this year and we’ve received a lot of positive feedback.

This was a material shift in usability and design, focusing on making it easier for claims professionals to use the system, whether they’re clinicians or adjusters. We took a forward-thinking approach with the design, creating an interface that’s more in line with modern expectations. The new interface has an “app” look and feel — resembling what you see when opening your smart phone. We’ve brought information forward without cluttering the experience, reducing clicks and page scrolling. Our VitalPoint improvements allow users to move more quickly and make decisions faster without sacrificing the information they need to do their job effectively.

Dan: How is technology helping to alleviate the heavy workload of adjusters in the industry to prevent burnout?

Matt: I’ve heard consistently from clients that they need to make claims professionals’ jobs much easier, for various reasons. The industry has a talent shortage, which makes these roles increasingly difficult to fill, and many companies are also facing cost pressures. Often, busy employees are asked to do even more.

For us, making our clients’ jobs easier is an important way we provide value. The updates to VitalPoint are a great example. Improvements don’t always have to be big, flashy changes. They might be as simple as reducing the number of clicks from 10 to 4, which helps adjusters process more during the day or feel less burnt out.

We will continue to focus on driving value in this space. I’m excited about the work we’ve planned here.

Dan: How is the complexity of the DME process affected by the need to interact with other systems in the healthcare ecosystem?

Matt: I don’t think it has to be as complex as it is today. That’s one of the things I’m most excited about in regard to our roadmap for ancillary services and DME. When we talk about making a claims professional’s job easier, we’re focusing on how to limit the “back and forth.” For example, how do we put information in front of that claims professional so they don’t even need to send a referral? They can point and click and say, “I need this for this person on this date,” and technology helps us take care of the rest. We’re looking at making bigger impacts there.

There’s also some direct-to-provider interaction where, with the right approvals and processes, we can let the doctor order the supply, confirm the fitment, confirm the need, and confirm with the injured person right there where it needs to be delivered and when they need it.

As long as we get that information quickly to a claims professional for approval, it cuts out a lot of unnecessary steps. The process doesn’t need to be what it is today — it’s just what we’ve grown accustomed to. I’m excited about streamlining and improving it.

Dan: What are the primary bottlenecks in the referral process, and how does digitization address the goal of delivering services more efficiently?

Matt: Over the last few years, it has been fascinating for me to learn more about these processes. When I first joined Optum Workers’ Comp and Auto No-Fault, I thought DME and ancillary services were similar to pharmacy transactions. The reality is there’s so much more complexity to them.

The core process is very transactional, but at the client contract level, it differs significantly. On the pharmacy side, we have exclusive contracts or we’re a majority supplier for a client. In the ancillary space, it’s more typical for a payer to use a panel of providers.

The way panels work is interesting. A claims professional can work with any of multiple service providers, send out a referral, and whoever provides the best price and quickest delivery to the injured person gets the business. Speed and the ability to react to that referral is paramount because we might not get the business otherwise.

Being able to provide information to the claims professional to ensure they’re getting the right solution at the right time and right price is important and aligns with our mission. As we introduce technology and digitize that process, it reduces risk and the amount of potential non-value-added work where we’re chasing down a supply only to realize we won’t fulfill it. Digitization allows us to put our best foot forward quickly and help the claims professional make a decision.

As we reduce costs, it helps us become more competitive, potentially moving some of the panel business to more exclusive arrangements. The transactional nature of it is very different from other areas, and there’s significant opportunity there.

Dan: What strategies do you implement to identify and overcome organizational silos within Optum?

Matt: Optum Workers’ Comp and Auto No-Fault came together as a result of different companies focused on various specialties — pharmacy, ancillary, medical bill review, and others. With any acquisition or merger, breaking down existing walls between entities is difficult. Even though several companies have worked to become one, a few barriers have persisted.

Since joining, one of my primary areas of focus has been to make this company operate more like a small business by breaking down these barriers. We’re making roles, responsibilities, and organizational lines fuzzier with the intent of improving how we take care of our clients and injured persons.

Everything we do must tie back to our mission of helping injured individuals recover, regain function, or return to work as quickly as possible. And this connects directly with our priority to ensure clients receive proper value — avoiding frivolous charges and unnecessary expenses. These are values all of our employees align on, whether they originally worked in ancillary or pharmacy benefits.

We’re implementing purposeful talent mobility to ensure cross-pollination of experience. People who have run operations focused on DME are being immersed in pharmacy to learn that aspect of the business. We’re doing the same with account teams to help everyone think big picture and realize we’re not just a pharmacy benefits provider but much more.

This approach allows employees to bring successful practices from one area to another, helping standardize and normalize best practices across the company. It also helps people feel invigorated in their roles. When you’re doing the same thing continuously, work can become stale. Moving people around and presenting them with new challenges has really benefited us, and our clients would agree.

Dan: How is your company addressing the misalignment between business models and mission in the pharmacy sector?

Matt: One of the first things I realized was that our models on the pharmacy side were actually contrary to our mission. We want somebody to get healthy and return to work, but our financial models were set up to generate revenue from prescription fills. This meant our clinical success in helping someone recover actually reduced our revenue.

We’re not just a PBM — in fact, I don’t think that term applies to our industry the same way it does on the group health side. I think of what we do more as a pharmacy solutions provider and I am focused on ensuring our models and incentives align with our mission. Processing transactions is necessary, but I want to shift to where we’re rewarded for outcomes, not volume. We are actively moving to a model where we’re incentivized to get someone back to work more quickly, achieve better outcomes, and save our clients’ money. This shift to a performance-driven model can help change the narrative about companies like ours.

We are here to do good, and we do some really good things. I want to make sure we eliminate any components that might be misunderstood along the way. That’s an example of how we’re shifting to ensure that people see our true mission.

Dan: What aspects of the business energize you most as you look towards the future?

Matt: We work hard to keep people at the center of everything we do. This extends to our internal staff. I’m focused on finding ways to celebrate their work and make sure they truly understand the impact they make. This has never been more important.

We’re working to ensure that people within our division understand our mission and how they’re contributing to it. We want our employees to recognize and embrace the wonderful moments, for example, “Today, I helped get somebody what they needed really quickly, and they’re feeling much better because of it.”

We highlight and celebrate those positive interactions — good in action — whether they happen with an injured person, a claims professional, or someone else. This celebration is crucial because work can get bogged down by external factors that aren’t necessarily attributed to us but feel close by. We’ve implemented some innovative approaches to enhance our working culture, energize our employees, and maintain this positive focus.

Dan: How is your organization balancing human talent with AI technology in your industry space?

Matt: We’re part of a larger enterprise that has really leaned into the responsible use of AI. They’ve done a great job of investing in knowledge, tools, and resources, while also setting the guardrails for what’s expected as part of Optum and UnitedHealth Group. I’m really excited about what our team is doing. Our activities mesh with our goals of accelerating processes, finding information more quickly, and elevating people to perform more value-added tasks. AI tools and agents can handle certain administrative tasks to allow our team to focus on more complex responsibilities. We’re launching a pilot soon that exemplifies this approach.

As I mentioned earlier, we are deploying AI capabilities to help claims professionals who are using the new version of VitalPoint understand why a prescription needed additional input to process at the point of sale,  and what needs to be changed to allow it to process. The technology explains the reason the medication failed a point-of-sale edit, all the clinical and formulary factors involved, and what steps they need to take to move it forward. Sometimes it’s as simple as a days supply or quantity adjustment, while other times specific documentation is needed.

It’s challenging to navigate through various state guidelines and regulatory information. Another example of how we’re using AI is to turn that complex information into plain language in real time, helping our professionals understand not just that a medication was held from processing, but how to resolve it. This helps accelerate their process while still ensuring humans make the final decisions.

This approach is all about finding information, synthesizing it, and delivering it in a much faster way. Ultimately, it means someone gets approval for their medication, equipment, or supplies that much faster.

Dan: How is Optum addressing employee concerns about AI potentially replacing jobs?

Matt: At Optum Workers’ Comp and Auto No-Fault, we will never solely lean on AI to make decisions. We will also not be using AI to fully replace employees or specific roles. For us, it’s all about ensuring we’re using AI and technology to make our jobs better, easier, and more productive — not to make people obsolete.

We’re helping employees shift toward more valuable work because we can use AI tools to handle some routine tasks. It’s not much different than moving from pens, papers, and typewriters to computers. It’s simply a change that requires learning new tools to use the technology.

Employees are learning how to write prompts, understand what they’re seeing, and set up agents to help them process repetitive tasks. This is really an upskilling process. We are implementing AI in an accountable way, ensuring we’re not adding risk. We want to make sure people understand there’s always a human in the loop and human interaction throughout the process.

In the end, the goal is to empower our people through technology so they can focus on what matters most: compassionately delivering value to injured persons and our client partners.