Against a backdrop of rising costs, workforce shortages and fragmented care, the Oracle Health and Life Sciences Summit convened leaders who are tackling these challenges head-on.
Among the most anticipated conversations was a fireside chat between Seema Verma, executive vice president and general manager of Oracle Health, and Patrick Conway, MD, CEO of Optum. Both are veterans of CMS and now lead influential healthcare organizations shaping the future of care delivery.
They took a candid, strategic look at how healthcare leaders can accelerate value-based care, reduce administrative waste, and harness emerging technologies like artificial intelligence — not just to cut costs, but to improve access, equity and outcomes. Dr. Conway’s urgent optimism is leading the charge.
“The scale of the opportunity is incredibly exciting, and I can see pockets of significant positive impact,” he said.
Clinicians at one of Optum’s Massachusetts clinics are already modeling what the future could look like with advanced tools and focus on population health.
“Care teams just saying, ‘I’m testing this. I’m learning this. I’m taking care of this population this way.’ It’s amazing.”
But he acknowledged most organizations aren’t truly optimizing the potential of value-based care, especially as they continue to pay their physicians based on the fee-for-service model. He issued a call to action: “We’ve talked about it long enough. It’s time to deliver.”
Ms. Verma echoed that sentiment, pointing out that newer tools and infrastructure, especially AI, now offer a path forward.
“There are different tools now that we didn’t have,” she said. “We can do this.”
Here are five key takeaways from their discussion:
- Healthcare affordability is reaching a breaking point
The financial pressure on healthcare stakeholders — from patients to payers — has reached critical levels.
“We are in an era right now of medical costs that are higher in Medicare, commercial and Medicaid than we’ve seen in a very long time,” Dr. Conway said. “They are desperate for solutions to help manage the cost of their benefits.”
Drug pricing continues to be a major pain point. Dr. Conway contrasted U.S. drug costs with those in other countries, noting that domestic list prices are often 5x to 10x higher.
“There’s policy solutions there. But also, how do we work across the system to try to get drugs and access to drugs that are affordable?” he said. “If you look at the U.S. versus other countries, the largest cost disparities in drug costs for hospitals and health systems right now. Interestingly, it’s not the utilization as much as it is the price.”
The average admissions aren’t going up substantially but the treatment patterns are changing. There are more specialist visits and inpatient stays instead of observations. The price difference between observation stays compared to inpatient stays is thousands of dollars for the same services.
“There’s a lot of incentive to move to that higher price tag,” said Dr. Conway. “If it’s clinically warranted, and you can prove that with the data, great. Put your paperwork in. If it’s not clinically warranted and people are using tools just to get higher payment through the system, that’s waste.”
- Value-based care has proven outcomes but still hasn’t reached scale
Optum’s value-based care infrastructure covers over 5 million patients under full-risk models and another 7 million in two-sided risk arrangements. These models are not theoretical and the hospitals they’re working with see real results.
“[Hospitals’] avoidable ER visits go down double digit-plus quality and outcomes and experience improves in this peer reviewed literature we publish, so it can be successful,” Dr. Conway said. “It is successful, proven data and now we’re scaling that across the country.”
But despite clear successes, adoption remains limited. “We’re not going fast enough,” he said, pointing out that while about 50% of Medicare payments are now in value-based arrangements, commercial and Medicaid adoption lags. “The total addressable market is every American.”
One underlying issue is that providers often lack the tools to effectively deliver value-based care. Ms. Verma added that many clinicians don’t have access to complete patient data or interoperable systems.
“Without interoperability, how do you expect them to manage care? They don’t have a complete medical record,” she said.
- AI is a generational opportunity if deployed thoughtfully
Dr. Conway sees AI as a transformative force akin to the internet.
“We have over 1,000 use cases, but now we’re really scaling some of the key ones,” he said. “We’re willing to partner, which I think is a little different than Optum or UnitedHealth Group historically.”
The company is looking for partners across the board, including clinical care providers. Dr. Conway shared one of his earliest experiences as an attending physician to illustrate how collaborations can make a difference.During his first week as an attending physician at Children’s Hospital of Philadelphia, he met a patient who had been referred to specialists around the country for and nobody had given them a diagnosis.
“The child had about a 500-page chart. It takes me until about page 283 where I’m like, ‘Oh my gosh, this kid has a metabolic disorder.’ In today’s world, no human should have to read 500 pages. Use AI,” said Dr. Conway. “It makes the clinical system much faster.”
- Fixing fragmentation is essential and possible
System inefficiencies driven by poor data exchange and redundant processes are well-known — and fixable.
“We’ve got thousands of people in the provider’s back office, payer’s back office, literally fighting via fax and other methods about what’s covered and what’s not,” Dr. Conway said.
One solution Optum is scaling is real-time benefit verification.
“It’s real-time benefit tech — literally just confirming in real time with technology: Is this covered? Therefore, what is the payment? You connect that financial support to consumers with that payment,” he said.
The patient perspective, Ms. Verma noted, reveals how these inefficiencies manifest in real life.
“They can be navigating five or six portals on their phone with all these different people trying to manage their care,” she said. Her vision is a unified portal that consolidates medication, appointment, and benefit data across systems.
Dr. Conway illustrated the value of coordinated care with a personal anecdote. A dual-eligible patient in South Boston with 12 chronic conditions was hospitalized more than 10 times a year. After enrolling in an integrated care model with wraparound services, she had no hospitalizations the following year.
“That’s what we want for our own health,” he said.
- Primary care and mental health need investment
Dr. Conway made it clear that primary care and behavioral health access are not just clinical priorities — they are system imperatives.
“We try to ensure our clinicians are not only paid fairly but supported with the tools they need,” he said. “That’s how you reduce unnecessary ER visits and hospitalizations.”
Tackling these issues provides better patient care, and improves clinician well-being. Optum’s clinician burnout rate is 36% lower than the national average, which he attributes to a combination of technology support and value-based incentives.
“The financial model is actually value-based,” he said. “You have a lot of systems that are like, ‘I do value-based care.’ And they pay their doctors RVU — it doesn’t really work.”
Behavioral health workforce shortages are also top of mind.
“We have a lot of need, not enough clinicians, certainly not enough psychiatrists,” Dr. Conway said. “We need to maximally use that workforce — right people, right level of care. Huge opportunity for technology.”
