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.