Reinventing Pharmacy (Part 3): Optum Rx CEO, Dr. Patrick Conway, Brings the PBM, Provider and Payer POV

Optum Rx serves more than 62 million people, processes 1.6 billion prescriptions and generates more than $110 billion of revenue annually. Dr. Patrick Conway, CEO of Optum Rx, is the third and final guest in a series of Healthcare is Hard episodes exploring the transformation of the pharmacy business – following conversations with Mark Cuban and Dr. Troyen Brennan.

Dr. Conway brings an expansive view of the healthcare system to this discussion and his role leading one of the most influential organizations in the pharmacy space. He became CEO of Optum Rx in August 2023 and before that, served as CEO of Care Solutions at Optum for more than three years. He was president and CEO of Blue Cross and Blue Shield of North Carolina for two years and spent more than six years at the Centers for Medicare and Medicaid Services where he held several positions including Chief Medical Officer, Director of CMMI, and Deputy Administrator for Innovation and Quality. Before joining CMS, he oversaw clinical operations and quality improvement at Cincinnati Children’s Hospital Medical Center, and he is still a practicing pediatrician in Boston where he occasionally works at an area medical center on weekends.

Some of the topics Dr. Conway discussed with Keith Figlioli in this episode of Healthcare is Hard include:

• VBC – A way or THE way. As someone who has spent a significant portion of his career focused on improving cost and quality in the U.S. healthcare system, Keith starts the interview asking Dr. Conway for his perspective on value-based care. Dr. Conway says we can either figure out VBC, or raise taxes and reduce benefits, noting that the American public would not be happy about the latter. He firmly believes that VBC is THE way through. He discussed the positive impacts he's witnessed from VBC, and how he believes it’s been a major contributor to slowing the growth of healthcare costs over a significant period of time. However, he’s concerned about how the transition to VBC has slowed.
• Affordable innovation. When discussing the extremely high cost of new specialty drugs, Dr. Conway points out that innovation is useless if it’s unaffordable and inaccessible to people. He shared personal stories contrasting very difficult conversations he’s had with parents in the past about the failing health of their children, and a more recent experience where Optum Rx delivered a new gene therapy to a child with a rare disease who will now live a full life. With therapies like that one costing $3 million, Dr. Conway discussed his views on some of the public and private financing options that could help improve access to life-changing therapies while still rewarding the innovators.
• Choice and transparency. Dr. Conway explains some of the solutions Optum Rx has brought to market to serve its customers, and areas where the company is exploring new solutions to keep customer satisfaction high. While customers are happy with Optum Rx, he makes it clear that continuously developing new solutions to stay ahead of a fast-evolving market is essential. During this discussion, customer choice – for both patients and the employers who fund their benefits – is a recurring theme and a major focus.

To hear Dr. Conway and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.