信諾集團 (CI) 2022 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by for Cigna's Fourth Quarter 2022 Results Review. (Operator Instructions) As a reminder, ladies and gentlemen, this conference, including the Q&A session, is being recorded. We'll begin by turning the call over to Ralph Giacobbe. Please go ahead.

女士們，先生們，感謝您支持 Cigna 的 2022 年第四季度業績審查。 （操作員說明）女士們先生們，本次會議（包括問答環節）正在錄製中。我們首先將電話轉給 Ralph Giacobbe。請繼續。

Great. Thanks. Good morning, everyone, and thank you for joining today's call. I'm Ralph Giacobbe, Senior Vice President of Investor Relations. With me on the line this morning are David Cordani, Cigna's Chairman and Chief Executive Officer; and Brian Evanko, Cigna's Chief Financial Officer. In our remarks today, David and Brian will cover a number of topics, including Cigna's fourth quarter and full year 2022 financial results as well as our financial outlook for 2023.

偉大的。謝謝。大家早上好，感謝您參加今天的電話會議。我是投資者關係高級副總裁 Ralph Giacobbe。今天早上和我一起在線的是 Cigna 的董事長兼首席執行官 David Cordani；和 Cigna 的首席財務官 Brian Evanko。在我們今天的講話中，David 和 Brian 將涵蓋多個主題，包括 Cigna 的第四季度和 2022 年全年財務業績以及我們 2023 年的財務展望。

As noted in our earnings release, when describing our financial results, Cigna uses certain financial measures, adjusted income from operations and adjusted revenues, which are not determined in accordance with accounting principles generally accepted in the United States, otherwise known as GAAP. A reconciliation of these measures to the most directly comparable GAAP measures shareholders net income and total revenues, respectively, is contained in today's earnings release, which is posted in the Investor Relations section of cigna.com. We use the term labeled adjusted income from operations and adjusted earnings per share on the same basis as our principal measures of financial performance. In our remarks today, we will be making some forward-looking statements, including statements regarding our outlook for 2023 and future performance. These statements are subject to risks and uncertainties that could cause actual results to differ materially from our current expectations. A description of these risks and uncertainties is contained in our cautionary note in today's earnings release and in our most recent reports filed with the SEC.

正如我們在收益發布中指出的那樣，在描述我們的財務業績時，Cigna 使用了某些財務措施、調整後的運營收入和調整後的收入，這些措施不是根據美國普遍接受的會計原則（也稱為 GAAP）確定的。這些措施與最直接可比的 GAAP 措施股東淨收入和總收入的調節分別包含在今天的收益報告中，該報告發佈在 cigna.com 的投資者關係部分。我們在與我們衡量財務業績的主要指標相同的基礎上使用標記為調整後運營收入和調整後每股收益的術語。在我們今天的發言中，我們將做出一些前瞻性陳述，包括關於我們 2023 年展望和未來業績的陳述。這些陳述受風險和不確定因素的影響，可能導致實際結果與我們目前的預期存在重大差異。對這些風險和不確定性的描述包含在我們今天發布的收益報告和我們最近提交給美國證券交易委員會的報告中的警示性說明中。

Before turning the call over to David, I will cover a few items pertaining to our financial results and disclosures. Regarding our results in the fourth quarter, we recorded after-tax special item charges of $17 million or $0.06 per share for integration and transaction-related costs. We also recorded an after-tax special item charge of $56 million or $0.18 per share for costs associated with the sale of businesses. As described in today's earnings release, special items are excluded from adjusted income from operations and adjusted revenues in our discussion of financial results. Additionally, please note that when we make prospective comments regarding financial performance, including our full year 2023 outlook, we will do so on a basis that includes the potential impact of future share repurchases and anticipated 2023 dividends.

在將電話轉給大衛之前，我將介紹一些與我們的財務業績和披露有關的項目。關於我們第四季度的業績，我們記錄了 1700 萬美元或每股 0.06 美元的稅後特殊項目費用，用於整合和交易相關成本。我們還記錄了 5600 萬美元或每股 0.18 美元的稅後特殊項目費用，用於與業務出售相關的成本。正如今天的收益報告所述，在我們討論財務結果時，特殊項目不包括在調整後的運營收入和調整後的收入中。此外，請注意，當我們對財務業績（包括我們的 2023 年全年展望）做出前瞻性評論時，我們將在包括未來股票回購和預期 2023 年股息的潛在影響的基礎上這樣做。

With that, I'll turn the call over to David.

有了這個，我會把電話轉給大衛。

Thank you, Ralph. Good morning, everyone, and thanks for joining today's call. 2022 was a pivotal year of performance and growth for our company. Evernorth further expanded its health service reach and impact, and Cigna Healthcare demonstrated tremendous resilience in the dynamic market. Together, the breadth and complementary nature of our portfolio enabled us to exceed our revenue and earnings outlook and return meaningful capital to our shareholders. This provides us with momentum as we begin 2023 and we expect another year of customer and earnings growth as we innovate and expand our broad portfolio of services and capabilities.

謝謝你，拉爾夫。大家早上好，感謝您參加今天的電話會議。 2022 年是我們公司業績和增長的關鍵一年。 Evernorth 進一步擴大了其醫療服務範圍和影響，Cigna Healthcare 在充滿活力的市場中展現出巨大的彈性。總之，我們投資組合的廣度和互補性使我們能夠超越我們的收入和盈利前景，並向我們的股東回報有意義的資本。這為我們從 2023 年開始提供了動力，我們預計隨著我們創新和擴展我們廣泛的服務和能力組合，客戶和收入將再增長一年。

Today, I'll provide perspective about our key drivers for our 2022 performance and how we're positioned for sustained growth going forward. Then Brian will walk through additional details about our 2022 financial results and discuss our '23 outlook. Then we'll take your questions. So let's jump in.

今天，我將提供有關我們 2022 年業績的主要驅動因素的觀點，以及我們如何為未來的持續增長做好準備。然後布賴恩將詳細介紹我們 2022 年財務業績的更多細節，並討論我們的 23 年展望。然後我們會回答你的問題。讓我們開始吧。

As we reflect on our performance for 2022, I'm proud of what the company and Cigna team delivered overall. We grew full year revenues to approximately $181 billion. We delivered full year adjusted earnings per share of $23.27 reflecting a 14% rate of growth. We returned $9 billion to shareholders through a combination of share repurchase and dividends, and we sharpened the health service focus of our international business through the divestiture of our life accident and supplemental benefits businesses across 7 markets. This performance demonstrates how well our Evernorth and Cigna Healthcare platforms are strategically positioned for sustained attractive growth. In 2022, Evernorth delivered strong top and bottom-line growth and also on renewed and expanded several large multiyear client relationships for 2023 and beyond. The depth of Evernorth's capabilities and expertise is highly valued by our clients and partners and enables us to deepen existing relationships across our entire portfolio of businesses. Cigna Healthcare, our health benefits platform also had a strong year, delivering customer growth along with differentiated medical cost performance for the benefit of our customers and clients. Our U.S. commercial business had a standout performance achieving outsized customer growth while maintaining pricing discipline and driving margin improvement. This reflects our ability of our commercial team to work consultatively to help employers of all sizes manage affordability, all while we support healthy, highly engaged employees for the benefit of their businesses. Overall, we're pleased with the strength of our 2022 performance across our enterprise.

當我們回顧 2022 年的業績時，我為公司和 Cigna 團隊的整體表現感到自豪。我們全年收入增長至約 1810 億美元。我們全年調整後每股收益為 23.27 美元，增長率為 14%。我們通過股票回購和股息相結合的方式向股東返還了 90 億美元，並且通過剝離我們在 7 個市場的人身意外和補充福利業務，加強了我們國際業務的健康服務重點。這一業績證明了我們的 Evernorth 和 Cigna Healthcare 平台在戰略定位方面的優勢，以實現持續的有吸引力的增長。 2022 年，Evernorth 實現了強勁的收入和利潤增長，並在 2023 年及以後更新和擴展了幾個大型多年期客戶關係。 Evernorth 的能力和專業知識的深度受到我們的客戶和合作夥伴的高度重視，並使我們能夠加深整個業務組合中的現有關係。我們的健康福利平台 Cigna Healthcare 在這一年也表現強勁，為我們的客戶和客戶帶來了差異化的醫療成本績效和客戶增長。我們的美國商業業務表現出色，實現了客戶的大幅增長，同時保持了定價紀律並推動了利潤率的提高。這反映了我們的商業團隊有能力以協商方式幫助各種規模的雇主管理負擔能力，同時我們支持健康、高度敬業的員工以造福於他們的企業。總體而言，我們對整個企業 2022 年的業績表現感到滿意。

As we look to 2023, we continue to deliver and capture meaningful value in multiple ways. First, we expect sustained growth through our foundational businesses, pharmacy benefit services, U.S. commercial and international health. These are mature scaled businesses that have established core relationships with corporate clients, health plans and governmental agencies. The value proposition for these businesses continues to resonate very well in the marketplace. In Pharmacy Benefit Services, we expect continued contributions in 2023 through the strength of our unique solutions and partnership orientation. With the strong selling season across our employer, health plan and governmental agency portfolio, we will continue delivering greater affordability to more customers and patients. Additionally, we are investing meaningfully to put in place the teams and resources to make prescriptions more accessible and affordable for approximately [20 million seventeen] customers starting in 2024.

展望 2023 年，我們將繼續以多種方式交付和獲取有意義的價值。首先，我們預計通過我們的基礎業務、藥房福利服務、美國商業和國際健康實現持續增長。這些是成熟的規模化企業，與企業客戶、健康計劃和政府機構建立了核心關係。這些企業的價值主張繼續在市場上產生很好的共鳴。在藥房福利服務方面，我們預計通過我們獨特的解決方案和合作方向的優勢，在 2023 年繼續做出貢獻。隨著我們的雇主、健康計劃和政府機構組合的銷售旺季，我們將繼續為更多的客戶和患者提供更大的負擔能力。此外，我們正在進行有意義的投資以建立團隊和資源，以便從 2024 年開始讓大約 [2000 萬十七] 客戶更容易獲得和負擔得起處方藥。

In the U.S. commercial business, we also had a strong 2023 selling season across all our market segments and across all funding types, self-funded risk and shared return arrangements. As a result, we anticipate driving another year of earnings, customer and revenue growth. And in International Health, we expect continued revenue and earnings contributions through our leadership in meeting the health and moving needs in attractive growth markets and for the globally mobile.

在美國商業業務中，我們在所有細分市場和所有融資類型、自籌風險和共享回報安排方面也有一個強勁的 2023 年銷售季。因此，我們預計將推動又一年的收益、客戶和收入增長。在國際健康領域，我們希望通過我們在滿足有吸引力的增長市場和全球移動市場的健康和移動需求方面的領導地位，繼續為收入和收益做出貢獻。

Second, we expect outsized growth from our accelerated businesses, Accredo Specialty Pharmacy, Evernorth Care Services and U.S. government. These businesses have differentiated capabilities and platforms addressing accelerated secular growth trends.

其次，我們預計我們的加速業務、Accredo Specialty Pharmacy、Evernorth Care Services 和美國政府將實現超額增長。這些企業擁有差異化的能力和平台來應對加速的長期增長趨勢。

With Accredo, we were able to lower cost for patients and plans while preserving choice and flexibility for those who could benefit from new drugs. This includes our work to increase the availability of biosimilars. We've seen a handful of these lower-cost alternatives for biologic drugs launched in the past few years. and understand the exceptional value they deliver for the benefit of clients and customers. 2023 will mark the start of a growing market opportunity for biosimilars, a trend that we expect to continue ramping up in 2024 and beyond. This includes HUMIRA, a treatment for a range of inflammatory conditions and one of the top-selling drugs globally over the past decade. Now there's a biosimilar alternative that we've co-preferred on a national preferred formulary creating significant savings opportunities for clients and customers. We will continue our leadership in advocating for greater availability of biosimilars, which over time, we expect to drive even more savings and benefit for patients and clients.

借助 Accredo，我們能夠降低患者和計劃的成本，同時為那些可以從新藥中受益的人保留選擇和靈活性。這包括我們提高生物仿製藥可用性的工作。我們已經看到在過去幾年中推出的一些低成本的生物藥物替代品。並了解他們為客戶和客戶的利益提供的非凡價值。 2023 年將標誌著生物仿製藥市場機會不斷增長的開始，我們預計這一趨勢將在 2024 年及以後繼續增長。這包括修美樂 (HUMIRA)，它是一種治療一系列炎症的藥物，也是過去十年全球最暢銷的藥物之一。現在有一種生物仿製藥替代品，我們在國家首選處方集上共同首選，為客戶和消費者創造了顯著的節省機會。我們將繼續發揮領導作用，倡導提高生物仿製藥的可用性，隨著時間的推移，我們希望為患者和客戶帶來更多的節省和利益。

In Evernorth Care Services, we are continuing to enhance and expand our portfolio of capabilities in care management and care delivery. Last year, MDLIVE virtual patient visits grew meaningfully, including a substantial increase in primary care visits. Demand and satisfaction with virtual care is rising and we will continue expanding our MDLIVE platform to provide even more of these options for the benefit of our customers. Evernorth Care Services is also accelerating our value-based care capabilities through our recently announced partnership with VillageMD. Our wrapping Evernorth health service capabilities with VillageMD's network of physicians, we will help guide more patients to high-quality care experiences at lower overall total costs. We expect this partnership to begin rolling out over the course of this year.

在 Evernorth Care Services，我們將繼續增強和擴展我們在護理管理和護理交付方面的能力組合。去年，MDLIVE 虛擬患者訪問量顯著增長，包括初級保健訪問量的大幅增加。對虛擬護理的需求和滿意度正在上升，我們將繼續擴展我們的 MDLIVE 平台，為我們的客戶提供更多這樣的選擇。 Evernorth Care Services 還通過我們最近宣布的與 VillageMD 的合作夥伴關係來加速我們基於價值的護理能力。我們將 Evernorth 健康服務能力與 VillageMD 的醫生網絡相結合，我們將幫助引導更多患者以更低的總成本獲得高質量的護理體驗。我們預計這種夥伴關係將在今年開始展開。

In the U.S. government, another accelerated business, we expect strong growth in 2023 as we expand services and our geographic presence across a large and growing addressable market. This includes Medicare Advantage, where we will introduce enhanced services and benefits, and we nearly doubled the size of our provider network over the last 2 years as we expand into new geographies. Additionally, as we have demonstrated continued consistent commitment to participating in the ACA exchange marketplace, in a dynamic environment, our Individual & Family Plan business, we will see outsized customer growth in 2023.

在美國政府，另一項加速發展的業務，我們預計 2023 年將實現強勁增長，因為我們將在一個龐大且不斷增長的潛在市場中擴展服務和地域影響力。這包括 Medicare Advantage，我們將在其中引入增強的服務和福利，並且隨著我們擴展到新的地區，我們在過去兩年中將供應商網絡的規模擴大了近一倍。此外，由於我們一直致力於參與 ACA 交易市場，在充滿活力的環境中，我們的個人和家庭計劃業務將在 2023 年看到巨大的客戶增長。

The third growth driver for us in 2023 and beyond is enterprise leverage. This is where our businesses work together to create or capture more value than anyone could achieve on their own. Here, think about our ability to look across our enterprise and client relationships to broaden and deepen them by leveraging our entire suite of capabilities. A great example is a new large service-based relationships for Cigna Healthcare where we were able to expand our support for a long-served Evernorth client. Additionally, the depth of clinical expertise success in advancing innovation and breadth of solutions within Evernorth, all combined to help further improve Cigna Healthcare's value proposition. For example, in 2022, by harnessing Evernorth's capabilities and programs, Cigna Healthcare delivered exceptional affordability, a key reason it continues to be competitively attractive option for employers of all sizes. This ability to deliver meaningful value is what makes Evernorth a partner of choice to a wide range of health plans, large employers and other clients.

我們在 2023 年及以後的第三個增長動力是企業槓桿。在這裡，我們的企業攜手合作，創造或獲取比任何人單打獨鬥都無法實現的更多價值。在這裡，考慮一下我們審視我們的企業和客戶關係的能力，以通過利用我們的整套能力來擴大和深化它們。一個很好的例子是 Cigna Healthcare 新的基於服務的大型關係，我們能夠擴大對長期服務的 Evernorth 客戶的支持。此外，Evernorth 在推動創新方面取得成功的臨床專業知識的深度和解決方案的廣度，所有這些都有助於進一步提高 Cigna Healthcare 的價值主張。例如，在 2022 年，通過利用 Evernorth 的能力和計劃，Cigna Healthcare 提供了卓越的負擔能力，這是它繼續成為各種規模雇主具有競爭力的吸引力選擇的一個關鍵原因。這種提供有意義價值的能力使 Evernorth 成為各種健康計劃、大型雇主和其他客戶的首選合作夥伴。

Another way we generate enterprise leverage is with our longitudinal portfolio data, which enables us to accelerate innovation and create new solutions for our clients and customers. This is specifically how we developed our pathway programs we're able to integrate Cigna Healthcare's high-performing provider networks and benefits management with Evernorth's analytical and clinical expertise as well as personalized digital support. This equips path well to lower cost while connecting patients with the right care, anticipating their future needs and helping them recover more quickly. [Path] of focus in 2023 includes musculoskeletal conditions and patients who take injectable or infusible biologic drugs. Early feedback here has been very positive, and we expect to support millions of patients throughout these programs with better experience, clinical quality, costs, resulting in improved overall value. These examples illustrate just some of the impact we've already achieved with our cross-enterprise leverage, and we'll continue acting on additional opportunities in the years ahead to expand relationships, accelerate innovation for the benefit of our customers patients and clients.

我們產生企業影響力的另一種方式是使用我們的縱向投資組合數據，這使我們能夠加速創新並為我們的客戶和客戶創建新的解決方案。這就是我們開發通路計劃的具體方式，我們能夠將 Cigna Healthcare 的高性能供應商網絡和福利管理與 Evernorth 的分析和臨床專業知識以及個性化數字支持相結合。這為降低成本提供了很好的途徑，同時將患者與正確的護理聯繫起來，預測他們未來的需求並幫助他們更快地康復。 2023 年的重點 [路徑] 包括肌肉骨骼疾病和服用可注射或輸註生物藥物的患者。這裡的早期反饋非常積極，我們希望在這些項目中以更好的體驗、臨床質量和成本為數百萬患者提供支持，從而提高整體價值。這些示例僅說明了我們已經通過跨企業槓桿作用取得的一些影響，我們將在未來幾年繼續利用更多機會擴大關係，加速創新，造福於我們的客戶患者和客戶。

Now I'll briefly summarize. 2022 was a strong year of performance and growth for our company. With our Evernorth and Cigna Healthcare platforms, and our durable growth framework, we are well positioned to meet the needs of our customers, clients and partners as we look to the future. We are delivering on our commitments to our shareholders with our 2022 adjusted EPS of $23.27 and returning $9 billion in share repurchase and dividends. And we are also responding to evolving needs of those we serve in the coming years in the Healthcare environment of accelerated change. We have a differentiated innovation pipeline that will allow us to build on our momentum and create value, continue to advance our growth strategy. We are confident 2023 will be another year of strong performance for our company as we expect to deliver customer and earnings growth. Our EPS outlook of at least $24.60 and the 10% increase of our quarterly dividend reinforced our commitment to sustained impact and growth for the benefit of all of our stakeholders.

現在我簡單總結一下。 2022 年是我們公司業績和增長強勁的一年。憑藉我們的 Evernorth 和 Cigna Healthcare 平台，以及我們持久的增長框架，我們在展望未來時能夠很好地滿足我們的客戶、客戶和合作夥伴的需求。我們正在兌現對股東的承諾，2022 年調整後每股收益為 23.27 美元，並通過股票回購和股息返還 90 億美元。在未來幾年加速變化的醫療保健環境中，我們還在響應我們所服務的人們不斷變化的需求。我們擁有差異化的創新渠道，這將使我們能夠在我們的動力和創造價值的基礎上繼續推進我們的增長戰略。我們相信 2023 年將是我們公司業績強勁的又一年，因為我們希望實現客戶和收益增長。我們至少 24.60 美元的每股收益預期和季度股息增加 10% 加強了我們為所有利益相關者的利益而持續影響和增長的承諾。

And with that, I'll turn the call over to Brian.

有了這個，我會把電話轉給布賴恩。

Thanks, David. Good morning, everyone. Today, I'll review key aspects of Cigna's fourth quarter and full year 2022 results, and I'll provide our outlook for 2023. We're very pleased with our strong performance in 2022. We reflecting focused execution and growth across both Evernorth and Cigna Healthcare, with each segment achieving pretax adjusted earnings growth in line or above our long-term targets. This positions us well for continued growth in 2023. Looking at full year 2022 specifically, key consolidated financial highlights include total revenues of approximately $181 billion, and adjusted earnings of $7.3 billion after tax or $23.27 per share, reflecting 14% growth from 2021. This is above the high end of our 10% to 13% and long-term average adjusted EPS growth target.

謝謝，大衛。大家，早安。今天，我將回顧 Cigna 2022 年第四季度和全年業績的主要方面，並提供我們對 2023 年的展望。我們對 2022 年的強勁表現感到非常滿意。我們反映了 Evernorth 和 Evernorth 的專注執行和增長Cigna Healthcare，每個部門都實現了符合或高於我們長期目標的稅前調整後收益增長。這為我們在 2023 年的持續增長奠定了良好的基礎。具體來看 2022 年全年，主要合併財務亮點包括總收入約為 1810 億美元，調整後稅後收益為 73 億美元或每股 23.27 美元，較 2021 年增長 14%。這高於我們 10% 至 13% 和長期平均調整後每股收益增長目標的上限。

Regarding our segments, I'll first comment on Evernorth. 2022 marked another year of sustained growth and profitability in Evernorth, is our innovation, market-leading clinical capabilities and proven track record of delivering for clients and customers continue to resonate in the market. Turning specifically to fourth quarter results for Evernorth, revenues grew to $36.2 billion, while pretax adjusted earnings grew 6% over fourth quarter 2021 to $1.7 billion. Similar to the first 3 quarters of 2022, Evernorth's strong results in the fourth quarter were driven by continued expansion of our accelerated growth businesses, led by our specialty pharmacy as well as our focus on affordability and delivering lowest net cost solutions for our clients and customers. We also continued to make meaningful strategic investments, which serve to strengthen our client relationships, expand our services portfolio and advance our digital capabilities. Overall, Evernorth delivered another strong year, focusing on driving value for clients and customers and expanding our partnerships and relationships, all while achieving strong revenue and pretax adjusted earnings growth in line with our long-term growth targets.

關於我們的細分市場，我將首先評論 Evernorth。 2022 年是 Evernorth 持續增長和盈利的又一年，我們的創新、市場領先的臨床能力和為客戶提供服務的可靠記錄將繼續在市場上引起共鳴。具體來看 Evernorth 第四季度的業績，收入增長至 362 億美元，而稅前調整後收益比 2021 年第四季度增長 6% 至 17 億美元。與 2022 年前三個季度類似，Evernorth 第四季度的強勁業績是由我們的專業藥房引領的加速增長業務的持續擴張以及我們對負擔能力的關注以及為我們的客戶和客戶提供最低淨成本解決方案所推動的.我們還繼續進行有意義的戰略投資，以加強我們的客戶關係、擴展我們的服務組合併提升我們的數字能力。總體而言，Evernorth 又迎來了一個強勁的一年，專注於為客戶和顧客創造價值並擴大我們的合作夥伴關係，同時實現強勁的收入和稅前調整後收益增長，符合我們的長期增長目標。

Our recently announced collaboration with Centene that begins in 2024 as well as other large multiyear contracts we renewed for 2023 and further demonstrate the strength of our value proposition and proven partnership orientation in the market, providing long-term opportunities to grow while driving lower cost for our clients.

我們最近宣布與 Centene 的合作始於 2024 年，以及我們續簽到 2023 年的其他大型多年期合同，進一步證明了我們的價值主張的實力和在市場上經過驗證的合作夥伴關係導向，提供了長期增長機會，同時推動降低成本我們的客戶。

Turning to Cigna Healthcare. As we enter 2022, we shared with all of you our goals of both growing our customer base and expanding margins. I'm pleased to report we ended the year accomplishing both of these goals, as we grew our medical customer base by 5% or 923,000 lives to 18 million total customers, while improving full year pretax adjusted margins to 9%. A year-over-year improvement of 90 basis points. Fourth quarter 2022 performance contributed to full year results with adjusted revenues of $11.1 billion, pretax adjusted earnings of $500 million and a medical care ratio of 84%. Despite an elevated flu and RSV season, our medical care ratio was slightly better than our expectations, particularly within our stop-loss products. Our medical care ratio for full year 2022 of 81.7% improved 230 basis points compared to the prior year. Both full year and fourth quarter results benefited from pricing discipline and affordability initiatives, including our clinical programs. Overall, Cigna Healthcare delivered for our customers, clients and partners, all while driving a strong year of customer growth and margin expansion with full year pretax adjusted earnings growth of 13%, which is above the high end of our long-term target range of 8% to 10%.

求助於 Cigna Healthcare。在我們進入 2022 年之際，我們與大家分享了我們擴大客戶群和擴大利潤的目標。我很高興地報告，我們在年底實現了這兩個目標，因為我們的醫療客戶群增加了 5% 或 923,000 人，達到 1800 萬客戶總數，同時將全年稅前調整後利潤率提高到 9%。同比提高 90 個基點。 2022 年第四季度的業績對全年業績做出了貢獻，調整後收入為 111 億美元，稅前調整後收益為 5 億美元，醫療保健率為 84%。儘管流感和 RSV 季節有所增加，但我們的醫療保健比率略好於我們的預期，尤其是在我們的止損產品中。我們 2022 年全年的醫療保健比率為 81.7%，與上一年相比提高了 230 個基點。全年和第四季度的業績都受益於定價紀律和可負擔性舉措，包括我們的臨床項目。總體而言，Cigna Healthcare 為我們的客戶、客戶和合作夥伴提供了服務，同時推動了強勁的客戶增長和利潤增長，全年稅前調整後收益增長 13%，高於我們長期目標範圍的高端8% 到 10%。

Turning to Corporate and other operations. The fourth quarter 2022 pretax adjusted loss was $382 million. As a reminder, this segment previously included earnings contributions from the International Life, accident and supplemental benefits businesses that we divested to Chubb on July 1, 2022. Overall, Cigna's 2022 results were strong, reflecting focused execution for the benefit of our clients and customers. As we turn to 2023, we continue to expect underlying growth in both Evernorth and Cigna Healthcare, while continuing to make strategic investments to drive future growth.

轉向公司和其他業務。 2022 年第四季度稅前調整後虧損為 3.82 億美元。提醒一下，該部分之前包括我們於 2022 年 7 月 1 日剝離給 Chubb 的國際人壽、意外和補充福利業務的收益貢獻。總體而言，Cigna 的 2022 年業績強勁，反映了為我們的客戶和客戶的利益而集中執行.展望 2023 年，我們繼續預計 Evernorth 和 Cigna Healthcare 的潛在增長，同時繼續進行戰略投資以推動未來增長。

For the full year 2023 outlook, we expect consolidated adjusted revenues of at least $187 billion. We expect full year consolidated adjusted income from operations to be at least $7.33 billion or at least $24.60 per share, consistent with our prior EPS commentary on our third quarter earnings call. I'd like to remind you this outlook includes a headwind from costs we will incur in 2023 to prepare for serving Centene's customers. This contract starts on January 1, 2024, and we look forward to many years of partnership and collaboration as we drive affordability for their customers. Additionally, with regards to earnings seasonality we would expect a different cadence this year when compared to historical patterns, with earnings more back half weighted. In first quarter, representing slightly above 20% of the full year EPS. For full year 2023, we project an adjusted SG&A expense ratio of approximately 7.3%. And we expect a consolidated adjusted tax rate in the range of 21% to 21.5%.

對於 2023 年全年展望，我們預計綜合調整後收入至少為 1870 億美元。我們預計全年綜合調整後運營收入至少為 73.3 億美元或每股至少 24.60 美元，這與我們之前對第三季度財報電話會議的每股收益評論一致。我想提醒您，這一前景包括我們將在 2023 年為為 Centene 的客戶提供服務而產生的成本帶來的不利影響。該合同於 2024 年 1 月 1 日開始，我們期待著多年的合作夥伴關係和協作，以提高他們的客戶的負擔能力。此外，關於收益的季節性，我們預計今年的節奏與歷史模式不同，收益的權重會增加一半。第一季度，略高於全年每股收益的 20%。對於 2023 年全年，我們預計調整後的 SG&A 費用比率約為 7.3%。我們預計綜合調整後的稅率在 21% 至 21.5% 之間。

I'll now discuss our 2023 outlook for our segments. For Evernorth, we expect full year 2023 adjusted earnings of at least $6.4 billion. Tailwinds and headwinds are largely consistent with the points we highlighted on our third quarter earnings call. These include tailwinds from a strong selling season and value creation from the increased availability of biosimilars, building in the second half of 2023 and ramping in 2024 and beyond. These are partly offset by headwinds from additional costs to support future growth, including implementation costs associated with onboarding Centene prior to receiving revenue, strategic investments in our accelerated growth businesses and the expansion of our relationships with the Department of Defense in Prime Therapeutics.

我現在將討論我們細分市場的 2023 年展望。對於 Evernorth，我們預計 2023 年全年調整後收益至少為 64 億美元。順風和逆風與我們在第三季度財報電話會議上強調的要點基本一致。其中包括強勁的銷售季節帶來的順風，以及生物仿製藥可用性增加帶來的價值創造，在 2023 年下半年建立並在 2024 年及以後增加。這些部分被支持未來增長的額外成本的不利因素所抵消，這些成本包括與在獲得收入之前加入 Centene 相關的實施成本、對我們加速增長業務的戰略投資以及我們與國防部在 Prime Therapeutics 方面的關係的擴展。

In consideration of these tailwinds and headwinds, we expect adjusted earnings within Evernorth to be weighted more towards the back half of the year, with low single-digit year-over-year earnings growth in the first half, followed by mid-to-high single-digit year-over-year earnings growth in the second half. For Cigna Healthcare, we expect full year 2023 adjusted earnings of at least $4.4 billion, representing growth of at least 8% year-over-year. We expect 2023 Cigna Healthcare earnings to be split closer to 50-50 between the first half and second half of the year. This outlook reflects the strength of our value proposition and focused execution in our business driven by organic customer growth and disciplined pricing. Key assumptions reflected in our Cigna Healthcare earnings outlook for 2023 include the following: regarding total medical customers, we expect 2023 growth of at least 1.2 million customers, with growth across each of our U.S. commercial, Medicare Advantage and individual businesses. Within U.S. commercial, we expect organic customer growth across each of our national middle market and select market segments. And similar to 2022, the growth will primarily reflect fee-based customers.

考慮到這些順風和逆風，我們預計 Evernorth 調整後的收益將更多地集中在今年下半年，上半年收益同比增長較低，隨後是中高下半年盈利同比增長個位數。對於 Cigna Healthcare，我們預計 2023 年全年調整後收益至少為 44 億美元，同比增長至少 8%。我們預計 2023 年上半年和下半年 Cigna Healthcare 的收益分配將接近 50-50。這一前景反映了我們在客戶有機增長和嚴格定價驅動下的價值主張和集中執行業務的實力。我們的 Cigna Healthcare 2023 年盈利展望中反映的主要假設包括：關於醫療客戶總數，我們預計 2023 年至少有 120 萬客戶增長，我們的美國商業、Medicare Advantage 和個人業務均有增長。在美國商業領域，我們預計我們每個國家中間市場和特定細分市場的客戶都會有機增長。與 2022 年類似，增長將主要反映收費客戶。

We expect Medicare Advantage customer growth of at least high single digits, and we expect growth in our U.S. individual business of at least 300,000 customers, driven by geographic expansion, strong industry growth and the exit of competitors from certain geographies. We expect the 2023 medical care ratio to be in the range of 81.5% to 82.5% and in part reflecting an increased mix of government business, which tends to have a higher medical care ratio compared to U.S. commercial and international health. Additionally, we would expect the first quarter 2023 medical care ratio to be within the full year guidance range. As it relates to corporate and other operations, this segment has evolved given the divestiture of a portion of our international business last year that had been a positive earnings contributor in the first half of 2022. As a result, we expect the full year 2023 pretax adjusted loss to more closely reflect annualized fourth quarter 2022 results.

我們預計 Medicare Advantage 客戶的增長至少將達到高個位數，我們預計在地域擴張、強勁的行業增長和競爭對手退出某些地區的推動下，我們的美國個人業務將至少增長 300,000 名客戶。我們預計 2023 年的醫療保健比率將在 81.5% 至 82.5% 之間，這在一定程度上反映了政府業務組合的增加，與美國商業和國際醫療保健相比，政府業務的醫療保健比率往往更高。此外，我們預計 2023 年第一季度的醫療保健比率將在全年指導範圍內。由於與企業和其他業務相關，鑑於我們去年剝離了部分國際業務，這部分業務在 2022 年上半年對收益做出了積極貢獻，因此該部門已經發展。因此，我們預計 2023 年全年稅前調整後的虧損，以更準確地反映 2022 年第四季度的年化業績。

Now moving to our capital management position and outlook. In 2022, we finished the year strong and delivered $8.7 billion of cash flow from operations. We returned $9 billion to shareholders via share repurchases and dividends in 2022. Specific to share buyback, we repurchased 27.4 million shares for $7.6 billion. Additionally, our debt-to-cap ratio finished the year at 40.9%, an improvement of 80 basis points from year-end 2021. Now framing our capital outlook for 2023. We expect at least $9 billion of cash flow from operations, reflecting the strong capital efficiency of our enterprise. This positions us well to continue creating value through accretive capital deployment in line with our strategy and priorities. We expect to deploy approximately $1.4 billion to capital expenditures. These investments will include substantial commitments to our accelerated growth platforms of specialty pharmacy, Evernorth Care, and U.S. government. We expect to deploy approximately $1.45 billion to shareholder dividends, reflecting our increased quarterly dividend of $1.23 per share, up 10% from 2022 on a per share basis. Year-to-date, as of February 2, 2023, we have repurchased 1.6 million shares for $510 million. And our guidance assumes full year 2023 weighted average shares to be in the range of 296 million to 300 million shares.

現在轉向我們的資本管理立場和展望。 2022 年，我們以強勁的表現結束了這一年，並交付了 87 億美元的運營現金流。我們在 2022 年通過股票回購和派息向股東返還了 90 億美元。具體到股票回購，我們以 76 億美元回購了 2740 萬股股票。此外，我們的債務與資本比率在今年結束時為 40.9%，比 2021 年底提高了 80 個基點。現在正在製定 2023 年的資本展望。我們預計運營現金流至少為 90 億美元，反映了我們企業的資本效率高。這使我們能夠根據我們的戰略和優先事項通過增值資本部署繼續創造價值。我們預計將部署約 14 億美元用於資本支出。這些投資將包括對我們的專業藥房、 Evernorth Care 和美國政府加速增長平台的重大承諾。我們預計將向股東派發約 14.5 億美元的股息，反映出我們增加的每股 1.23 美元的季度股息，比 2022 年每股增長 10%。年初至今，截至 2023 年 2 月 2 日，我們已經以 5.1 億美元回購了 160 萬股股票。我們的指引假設 2023 年全年加權平均股數在 2.96 億至 3 億股之間。

Our balance sheet and cash flow outlook remains strong, benefiting from our asset-light framework that drives strategic flexibility, strong margins and attractive returns on capital. And now to recap. Our full year 2022 consolidated results reflect strong contributions and execution from both Evernorth and Cigna Healthcare. Our 2023 outlook reflects continued momentum across our segments as we invest to support long-term attractive growth. We are confident in our ability to deliver our 2023 full year adjusted earnings of at least $24.60 per share. And we continue to expect to deliver 2024 adjusted EPS of at least $28 consistent with our prior EPS commentary.

我們的資產負債表和現金流前景依然強勁，這得益於我們的輕資產框架推動了戰略靈活性、強勁的利潤率和有吸引力的資本回報。現在回顧一下。我們 2022 年全年的綜合業績反映了 Evernorth 和 Cigna Healthcare 的強大貢獻和執行力。我們的 2023 年展望反映了我們各細分市場的持續發展勢頭，因為我們投資支持長期有吸引力的增長。我們有信心實現 2023 年全年調整後每股至少 24.60 美元的收益。我們繼續預計 2024 年調整後每股收益至少為 28 美元，與我們之前的每股收益評論一致。

With that, we'll turn it over to the operator for the Q&A portion of the call.

有了這個，我們將把它交給接線員進行電話的問答部分。

(Operator Instructions) Our first question comes from Mr. A.J. Rice with Credit Suisse.

（操作員說明）我們的第一個問題來自 A.J. 先生。瑞士信貸的大米。

I might ask a little bit more about where you're at in the rollout of the VillageMD value-based contracting arrangements. I know when the deal was signed, contracts had to be signed in the various markets with the VillageMD folks. Have you largely been able to do that? Maybe give us anything you can about how you see that business ramping up in terms of contribution to Evernorth revenue and operating income over time. I assume it will be not particularly material this year, but as you look out over the next few years.

我可能會問更多關於您在推出基於價值的 VillageMD 合同安排方面的進展情況。我知道當交易簽署時，必須在各個市場與 VillageMD 人員簽署合同。你基本上能夠做到這一點嗎？也許可以告訴我們您如何看待該業務隨著時間的推移在對 Evernorth 收入和營業收入的貢獻方面的增長。我認為今年它不會特別重要，但正如你在未來幾年所看到的那樣。

A.J., it's David. So first and foremost, stepping back, we're pleased with the relationship and the ability to partner with a proven organization that has a nice growth track record. Two, you think about the work taking place collaboratively in phases, with the first phase of well underway working through and successfully securing approvals and contracts with building momentum, whereby we will put in place with Village capabilities such that we could enable more targeted access to preferred or higher-performing specialists within the Cigna Healthcare Life portfolio and the direct serve portfolio of our relationships as Phase 1 and expand some of the capabilities to coordinate care, whether it's expansion of virtual capabilities, expansion of behavioral capabilities or otherwise. There's a second phase of work, so the innovation will continue, whereby we work with Village to codify and build some new products that have exclusivity relative to their proven physician leadership and physician-directed programs that have even a more targeted value proposition not just for the benefit of Cigna Healthcare on the benefit side, but offered for the benefit of health plans we serve in a broader sense and for Village.

A.J.，是大衛。因此，首先，退一步說，我們對與擁有良好增長記錄的成熟組織的關係和合作能力感到滿意。第二，你認為工作是分階段協作進行的，第一階段的工作進展順利，並成功獲得批准和合同，勢頭強勁，我們將利用村莊的能力，使我們能夠更有針對性地訪問Cigna Healthcare Life 投資組合中的首選或更高績效的專家以及我們關係的直接服務組合作為第一階段，並擴展一些能力來協調護理，無論是虛擬能力的擴展、行為能力的擴展還是其他。這是第二階段的工作，因此創新將繼續，我們將與 Village 合作編寫和構建一些新產品，這些產品相對於他們經過驗證的醫師領導和醫師指導的計劃具有排他性，這些計劃具有更具針對性的價值主張，而不僅僅是為了Cigna Healthcare 在利益方面的利益，但提供了我們在更廣泛意義上和為村莊服務的健康計劃的利益。

One of the wonderful parts of the way the relationship is built through leveraging the Evernorth capabilities, we'll be building a lot of the shared savings together with Village. And as such, be able to benefit from those shared savings through our Evernorth program. So to recap, good momentum already, good collaboration already, good progress already. You're right, we don't market as a significant revenue or earnings driver in 2023 for us, but we will see progress in 2023, especially through the second half of the year and a building contributor in 2024, and we look forward to providing you more of an update as we look to 2024.

通過利用 Evernorth 的能力建立這種關係的方式的精彩部分之一是，我們將與 Village 一起建立大量的共享儲蓄。因此，能夠通過我們的 Evernorth 計劃從共享的儲蓄中受益。回顧一下，勢頭已經很好，合作已經很好，進展已經很好。你是對的，我們不會在 2023 年將其作為重要的收入或盈利驅動因素進行營銷，但我們將在 2023 年看到進展，尤其是在今年下半年，並在 2024 年成為建築貢獻者，我們期待在我們展望 2024 年時，為您提供更多更新。

Our next question comes from Mr. Gary Taylor with Cowen.

我們的下一個問題來自 Gary Taylor 先生和 Cowen。

I also wanted to ask about VillageMD. So David, we'll keep you on that track just a little bit longer. My question -- I guess I have a couple of questions about it. One is, I know historically, your inclination was Cigna didn't need to own delivery assets even though your peers are increasingly moving in that direction, and this investment does obviously give you some ownership of a delivery asset. So just wanting to understand how much your thinking has evolved along those lines? And then secondly, I just kind of want to understand a little better long term -- Village obviously has a large growth national expansion plan. How do you -- but payer agnostic -- so does it really just become a important partner and a part of a preferred primary care network? Or how do we think about the next several years, like what that relationship means to the Cigna Healthcare and to Evernorth?

我也想問一下VillageMD。所以大衛，我們會讓你在這條軌道上停留更長的時間。我的問題——我想我有幾個問題。一是，我從歷史上知道，你的傾向是 Cigna 不需要擁有交付資產，即使你的同行越來越多地朝著那個方向發展，而且這項投資顯然讓你擁有交付資產的一些所有權。所以只是想了解您的想法沿著這些方向發展了多少？其次，我只是想從長遠來看更好地理解——Village 顯然有一個巨大的增長全國擴張計劃。你如何 - 但付款人不可知 - 所以它真的只是成為一個重要的合作夥伴和首選初級保健網絡的一部分嗎？或者我們如何看待未來幾年，比如這種關係對 Cigna Healthcare 和 Evernorth 意味著什麼？

Sure, Gary. A lot in there. Let me try to address the points, all important points, and I appreciate your question. First and foremost, to be clear, our strategy remains consistent. Our preferred approach on the core medical fulfillment of care is to partner and enable. I'll come back to that. As we've discussed before, there are parts of the health care delivery or service fulfillment equation that we seek to own, and we're very clear relative to that. Examples include virtual, behavioral, specialty pharmaceutical fulfillment and select aspects of home care, we deem them to be unique, highly differentiated and an ability to leverage over multiple geographies in an efficient way. Our notion of partnering continues through, we'll call it, core value-based care, where today, about 75% of our MA customers have a value-based care relationship. About 50% of our exchange customers have a value-based care relationship. And about 40% of our commercial employer business has a value-based care relationship.

當然，加里。裡面有很多。讓我嘗試解決這些要點，所有重要的要點，我很欣賞你的問題。首先要明確的是，我們的戰略始終如一。我們在核心醫療護理方面的首選方法是合作和支持。我會回到那個。正如我們之前所討論的，我們尋求擁有醫療保健提供或服務履行等式的某些部分，我們對此非常清楚。示例包括虛擬的、行為的、專業的藥品履行和家庭護理的特定方面，我們認為它們是獨一無二的、高度差異化的，並且能夠以有效的方式利用多個地區。我們的合作理念貫穿始終，我們稱之為基於核心價值的護理，今天，我們大約 75% 的 MA 客戶擁有基於價值的護理關係。我們大約 50% 的交換客戶擁有基於價值的護理關係。我們大約 40% 的商業雇主業務具有基於價值的護理關係。

Now to the Village relationship. First and foremost, it's also a clear depiction as we discussed at our Investor Day, that we see the health care delivery system community as an addressable market for us. We see it as an addressable market to bring additional services to help to extend their reach, their care coordination, [care equation] of high-performing specialty networks and overall continuity of care, including digital aspects of the care equation. So the Village relationship, we see as an extension of partnering we see that payer agnostic orientation that you articulated as a positive because Evernorth serves a broad portfolio of clients including most of the large health plans in America today in some way, shape or form. And we see the ability to grow collectively and collaboratively with Village as a positive, but through partnering set of relationships. So to reiterate, there are aspects that we'll seek to own. We will continue to use our current process of incentive alignment and care coordination to extend our core value-based care offerings. And now with Evernorth, we will seek to deepen those services with select provider partners for the benefit of the totality of the panel, not just for the Cigna Health care lives that go through. However, there may be some unique programs that are designed from a Cigna health care standpoint. So we see this as a great win-win and an additional growth opportunity for Evernorth. Gary, I hope that helps.

現在到Village 關係。首先，正如我們在投資者日討論的那樣，這也是一個清晰的描述，我們將醫療保健提供系統社區視為我們的目標市場。我們認為這是一個可尋址的市場，可以提供額外的服務，以幫助擴大他們的覆蓋範圍、他們的護理協調、高性能專業網絡的[護理方程式]和護理的整體連續性，包括護理方程式的數字方面。因此，Village 關係，我們將其視為合作夥伴關係的延伸，我們認為您所表達的付款人不可知論方向是積極的，因為 Evernorth 以某種方式、形式或形式為廣泛的客戶組合提供服務，包括當今美國的大多數大型健康計劃。我們認為與 Village 共同成長和協作的能力是積極的，但要通過一系列合作關係。因此，重申一下，我們將尋求擁有某些方面。我們將繼續使用我們目前的激勵調整和護理協調流程來擴展我們基於核心價值的護理產品。現在與 Evernorth 一起，我們將尋求與精選的供應商合作夥伴一起深化這些服務，以造福於整個小組，而不僅僅是為了經歷的 Cigna Health 護理生活。但是，可能有一些獨特的計劃是從 Cigna 醫療保健的角度設計的。因此，我們認為這是一個偉大的雙贏和 Evernorth 的額外增長機會。加里，我希望這有幫助。

Our next question comes from Ms. Erin Wright with Morgan Stanley.

我們的下一個問題來自摩根士丹利的 Erin Wright 女士。

You mentioned some of the headwinds and tailwinds for Evernorth into 2023. And obviously, there's the Centene implementation cost. But you also mentioned some other strategic investments. And can you quantify those? Or what is that exactly? And in the back-end weighting across the segment, is that largely attributable to those associated costs? Or is that a little bit of the HUMIRA benefit has been or changeable comes available midyear?

你提到了 Evernorth 到 2023 年的一些逆風和順風。顯然，還有 Centene 的實施成本。但你也提到了其他一些戰略投資。你能量化這些嗎？或者那到底是什麼？在整個細分市場的後端權重中，這主要歸因於這些相關成本嗎？或者 HUMIRA 的一些好處已經或有變化在年中可用？

Erin, it's Brian. So as it relates to the headwinds and tailwinds you're right to call out the strategic investments. So we continue to invest an outsized amount of money in areas such as our Evernorth care services platform to enable things like VillageMD that David just discussed alongside our specialty pharmacy business, which continues to grow at very attractive rates. And so that's all been factored in alongside the Centene related implementation costs. But importantly, we have tailwinds that allow us to introduce our guide today with at least 4.5% income growth for the Evernorth segment, inclusive of those pressure points on the spending side. As it relates to the cadence of Evernorth earnings, you should think of the back half weighting that I referenced is primarily driven by the biosimilar ramp effect that I described, but not entirely, there's also some effect of the cadence of operating expense spending over the course of the year that also impacts the timing. But the biosimilar contributions, we do expect to be more back-half weighted, which is a key driver of the difference in the cadence.

艾琳，是布萊恩。因此，由於它與逆風和順風有關，你呼籲戰略投資是正確的。因此，我們繼續在我們的 Evernorth 護理服務平台等領域投入大量資金，以實現像 David 剛剛討論的 VillageMD 以及我們的專業藥房業務，該業務繼續以極具吸引力的速度增長。因此，這一切都與 Centene 相關的實施成本一起考慮在內。但重要的是，我們有順風使我們能夠在今天推出我們的指南，Evernorth 部分的收入至少增長 4.5%，包括支出方面的那些壓力點。由於它與 Evernorth 收益的節奏有關，你應該想到我提到的後半部分權重主要是由我描述的生物仿製藥斜坡效應驅動的，但不完全是，運營費用支出的節奏對一年中的進程也會影響時間安排。但是生物仿製藥的貢獻，我們確實期望更多的後半部分加權，這是節奏差異的關鍵驅動因素。

Our next question comes from Mr. Kevin Fischbeck with Bank of America.

我們的下一個問題來自美國銀行的 Kevin Fischbeck 先生。

I wanted to ask a little bit about the customer growth, that's a pretty strong number there. And so when you think about the enrollment growth, I guess, first on the ACA side how comfortable are you about the risk profile and the pricing on that type of growth? And then as far as the commercial growth, is there -- I know it's ASOs so it's less risk -- worried about risk there, but just want to understand your thought process around how redeterminations impacted your growth expectations there? Maybe how much of that growth you expect there is in group versus kind of new customer wins?

我想問一些關於客戶增長的問題，這是一個非常強勁的數字。因此，當您考慮入學人數增長時，我想，首先在 ACA 方面，您對這種增長的風險狀況和定價有多滿意？然後就商業增長而言，是否存在——我知道這是 ASO，所以風險較小——擔心那裡的風險，但只想了解你對重新確定如何影響你在那裡的增長預期的思考過程？也許您預計這種增長中有多少來自團隊與新客戶的贏得？

Kevin, it's David. Let me start just frame it a bit more broadly and then ask Brian to peel back your question a little bit. First, we're pleased with the strong performance we delivered in 2022 and now being able to step into 2023 with a very attractive outlook. And it continues to reinforce that our Cigna Health care platform, including our commercial employer portfolio continues to perform very well. I'd just highlight 3 areas quickly in terms of the underlying drivers or enablers of the continued growth for us. One, especially in the commercial employer portfolio is a consistent intense focus. We have, we are, we will continue to have a consistent intense focus on this segment as we see it as a growth segment. Hence, we focus and innovate for as befit. Second is a track record of excellent total cost or total medical costs. That is resulting from very good work from our network management team our clinical programs and the returns [to] deliver and our growing suite of site of care optimization programs that all contribute to good clinical quality service and overall affordability. And then finally, what we've talked about before, but maybe it's sometimes forgotten our orientation around consultation and putting solutions in place. So whether it's an employer, of 100 or an employer of 10,000, we take an orientation of consultatively working to put the right solution suite in place for them. I'm going to have Brian peel back the drivers of our outlook, (inaudible). We have not factored in an uptake relative to redeterminations as a contributor in our outlook for the year. We recognize that redeterminations present an opportunity for us, not a risk for us because we don't have that business to protect currently. But given it's still uncertain in terms of the rate and pace of state activity to adjudicate their redeterminations, we don't have that factored into this very attractive outlook. Of course, we'll present updates to you as the year unfolds as states go through the redetermination process.

凱文，是大衛。讓我開始更廣泛地構建它，然後請 Brian 稍微回顧一下你的問題。首先，我們對我們在 2022 年取得的強勁表現感到滿意，現在我們能夠以非常有吸引力的前景進入 2023 年。它繼續加強我們的 Cigna 醫療保健平台，包括我們的商業雇主組合繼續表現良好。我只想快速強調 3 個領域，這些領域是我們持續增長的潛在驅動因素或推動因素。一，尤其是在商業雇主組合中，是一貫的強烈關注。我們已經，我們將繼續高度關注這一領域，因為我們將其視為一個增長領域。因此，我們專注並不斷創新。其次是出色的總成本或總醫療成本的記錄。這是由於我們的網絡管理團隊非常出色的工作，我們的臨床計劃和交付的回報以及我們不斷增長的護理現場優化計劃套件都有助於提供良好的臨床質量服務和整體負擔能力。最後，我們之前討論過的內容，但有時可能會忘記我們圍繞協商和製定解決方案的方向。因此，無論是擁有 100 人的雇主還是擁有 10,000 人的雇主，我們都以協商工作為導向，為他們制定正確的解決方案套件。我要讓 Brian 揭開我們前景的驅動因素，（聽不清）。我們沒有將與重新確定相關的接受度作為我們今年展望的貢獻者考慮在內。我們認識到，重新確定為我們提供了機會，而不是風險，因為我們目前沒有要保護的業務。但考慮到各州活動的速度和步伐仍然不確定，以裁定他們的重新決定，我們沒有將其納入這一非常有吸引力的前景。當然，隨著各州經歷重新確定過程，我們會隨著時間的推移向您展示最新情況。

I'll ask Brian to unpack the drivers of our membership growth a little further.

我將請 Brian 進一步解釋我們會員增長的驅動因素。

Sure, David. Kevin. So maybe just a little bit more detail here in terms of how to think about the 1.2 million plus net customer growth. And then I'll hit your question on the ACA exchange profitability as well. So first off, I'd be remiss if I didn't say we're really pleased with another year of strong growth that we expect here in 2023 and following growing almost 1 million net customers or 5% in 2022. And as we mentioned earlier, we expect net growth in 2023 across all of our major U.S. business segments with the individual exchange business expecting at least 300,000 net customer growth. Our MA net growth has started strong. We expect at least a high single-digit percentage growth rate for 2023, in line or better than industry growth rates. And we expect at least 250,000 net new customers generated by core growth across our U.S. commercial portfolio. So if you take those 3 components together, they represent about half of our expected full year net growth of 1.2 million plus customers. And then the balance of the 2023 customer growth, you can think of as the net effect of some moving pieces, including the larger client relationship expansion that David mentioned in his prepared remarks, and we have good line of sight into this 1.2 million plus to David's point, we are not banking on any meaningful amount of volume for Medicaid redeterminations.

當然，大衛。凱文。因此，就如何考慮 120 萬以上的淨客戶增長而言，這裡可能會提供更多細節。然後我也會問你關於 ACA 交易所盈利能力的問題。因此，首先，如果我不說我們對我們預計在 2023 年以及在 2022 年增加近 100 萬淨客戶或 5% 的又一年強勁增長感到非常滿意，那我就失職了。正如我們提到的早些時候，我們預計 2023 年我們所有主要美國業務部門都將實現淨增長，其中個人交易所業務預計至少有 300,000 名客戶淨增長。我們的 MA 淨增長開始強勁。我們預計 2023 年至少會有個位數的高增長率，與行業增長率持平或更好。我們預計美國商業組合的核心增長將至少帶來 250,000 名淨新客戶。因此，如果將這 3 個組成部分放在一起，它們約占我們預期的全年淨增長 120 萬以上客戶的一半。然後是 2023 年客戶增長的平衡，您可以將其視為一些移動部分的淨效應，包括大衛在準備好的發言中提到的更大的客戶關係擴展，我們對這 120 萬以上的客戶有很好的看法大衛的觀點，我們沒有指望任何有意義的數量來重新確定醫療補助計劃。

As it relates to the morbidity and/or risk pool of the IFP business or individual business that we're adding, our 2023 customer growth outlook reflects a combination of a few things being industry growth our own new market entry as well as competitors exiting certain geographies that we participate in. As you think about where our margin profile stands, in 2022, the margins on this book are below our long-term goal. Our long-term goal just to remind you is 4% to 6%. We took a step forward in '22 from where we were in '21, given that '21 was a depressed margin year. But we're still below our long-term goal. And for purposes of '23, we continue to expect the margins on this book will run below our 4% to 6% long-term goal in our Cigna Healthcare income and MCR guidance reflects this. Just given the substantial amount of new customers we've added, we thought it was prudent to assume margins will be below our long-term target for this calendar year. But this is a book of business that does represent a source of future embedded earnings power that will help to contribute toward the long-term growth in the Cigna Healthcare segment income

由於它與我們正在添加的 IFP 業務或個體業務的發病率和/或風險池有關，我們 2023 年的客戶增長前景反映了行業增長、我們自己的新市場進入以及競爭對手退出某些行業等因素的結合我們參與的地區。當你考慮我們的利潤率狀況時，到 2022 年，這本書的利潤率低於我們的長期目標。我們提醒您的長期目標是 4% 到 6%。鑑於 21 年利潤率低迷，我們在 22 年比 21 年向前邁進了一步。但我們仍低於我們的長期目標。出於 23 年的目的，我們繼續預計這本書的利潤率將低於我們 Cigna Healthcare 收入的 4% 至 6% 的長期目標，而 MCR 指南反映了這一點。考慮到我們增加的大量新客戶，我們認為假設利潤率將低於我們本日曆年的長期目標是謹慎的。但這是一本業務簿，它確實代表了未來嵌入式盈利能力的來源，這將有助於為 Cigna Healthcare 部門收入的長期增長做出貢獻

Our next question comes from Mr. Scott Fidel with Stephens.

我們的下一個問題來自斯科特菲德爾先生和斯蒂芬斯。

I guess you guys get the first crack to comment on the preliminary 2024 M&A rates and just interested in your initial observations on those. Obviously, we sell the final rates ahead and whether that influences your thoughts on your 10% to 15% long-term Medicare Advantage enrollment growth target at all, max.

我想你們是第一個對 2024 年初步併購率發表評論的人，並且只對你們對這些的初步觀察感興趣。顯然，我們提前出售最終利率，以及這是否會影響您對 10% 至 15% 的長期 Medicare Advantage 註冊增長目標的想法，最多。

Clearly, the initial or preliminary rate letter came out. But before I comment on that, just stepping back for a moment, it's clear that Medicare Advantage has represented and continues to represent a significant both market opportunity as well as a growth opportunity for the U.S. today serving about 30 million seniors continued growth and seniors reinforce the value, the clinical quality and the service quality they receive by continuing to renew and/or expand relationships in MA. The initial rate letter that came out does have lower or somewhat anemic revenue, we'll await the final rate letter that comes forward relative to that. Having said that, I think it's a little bit early to presuppose what 2024 growth outlook may look like because you compete on a relative basis. Having said that, this will create, if it stays in the range of what the rate letter looks like. It will create some revenue dislocation. So the sophistication of benefit management that's going to be necessary market by market. The leverage of value-based care relationships, which, as I noted earlier, about 75% of our MA lives are in a value-based care relationship will all come into play. I reinforce the fact that the 10% to 15% is our objective to have 10% to 15% customer growth over time on average. We're stepping into this year with a very good customer growth outlook already that we feel good about. And as a final note, I would remind you that while an attractive long-term growth opportunity for us, today, this represents or MA represents less than 5% of the enterprise portfolio. So any dislocation in 2024, we deem to be manageable with the strong performing portfolio that we have in front of us.

顯然，初始或初步費率信已經出來了。但在我對此發表評論之前，先退後一步，很明顯，Medicare Advantage 已經代表並將繼續代表重要的市場機會以及美國今天為約 3000 萬老年人提供服務的增長機會持續增長和老年人加強他們通過繼續更新和/或擴展 MA 中的關係而獲得的價值、臨床質量和服務質量。最初的費率信確實有較低或有些貧血的收入，我們將等待與此相關的最終費率信。話雖如此，我認為現在預設 2024 年的增長前景可能有點早，因為你是在相對基礎上競爭的。話雖如此，如果它保持在費率字母的範圍內，這將創建。它將造成一些收入錯位。因此，收益管理的複雜性將成為逐個市場所必需的。基於價值的護理關係的槓桿作用，正如我之前提到的，我們 MA 大約 75% 的生活處於基於價值的護理關係中，這一切都將發揮作用。我要強調的是，10% 到 15% 是我們的目標，隨著時間的推移，客戶平均增長 10% 到 15%。我們帶著非常好的客戶增長前景進入今年，我們對此感到滿意。最後一點，我想提醒你，雖然對我們來說這是一個有吸引力的長期增長機會，但今天，這代表或 MA 代表不到企業投資組合的 5%。因此，我們認為 2024 年的任何混亂都是可以控制的，因為我們擁有我們面前的強大表現組合。

Our next question comes from Mr. Justin Lake with Wolfe Research.

我們的下一個問題來自 Wolfe Research 的 Justin Lake 先生。

Just want to follow up first on the membership guide. Just any color on the pricing of that membership, how much comes in Q1 versus the rest of the year? And then Healthcare margins -- certainly been a lot better there in 2022. Just wondering what ballpark you're expecting to be in 2023 there relative to your long-term guidance?

只想先跟進會員指南。該會員定價的任何顏色，第一季度與今年剩餘時間相比有多少？然後是醫療保健的利潤率——到 2022 年肯定會好得多。只是想知道相對於你的長期指導，你預計 2023 年會有什麼樣的大概水平？

Justin, a little color relative to pacing and then I'll ask Brian to talk about more to your second question. As Brian noted, we have good visibility into the membership volume. And when you think about the -- outside of the individual exchange business, what we've seen growth across all of our funding types. Still the lion's share of it is ASO including the service-based relationship with a large customer. So in essence, a meaningful portion of that volume will be realized in the first quarter of 2023, and then they'll be puts and takes throughout the course of the year. We'll look forward to providing you updates on. Now individual lines of business will move throughout the course of the year. But by and large, if you think about -- our expectation is that we'll have good performance relative to that on the first quarter of the year and then some puts and takes throughout the course of the year with some additional growth and maybe some additional disenrollment as we factored in some impact in our outlook for a bit of an uptick in disenrollment as we look at the current fragility of the U.S. economy. So good visibility for Q1. I'll ask Brian to talk a bit more around the margin.

賈斯汀，關於節奏的一些顏色，然後我會請布賴恩談談你的第二個問題。正如 Brian 指出的那樣，我們對會員數量有很好的了解。當你想到——在個人交易業務之外時，我們看到了我們所有融資類型的增長。其中最大的份額仍然是 ASO，包括與大客戶的基於服務的關係。因此，從本質上講，該交易量的很大一部分將在 2023 年第一季度實現，然後它們將在全年進行投放和獲取。我們期待為您提供更新。現在，個別業務線將在全年移動。但總的來說，如果你想一想——我們的預期是，相對於今年第一季度的表現，我們將有良好的表現，然後在整個一年中進行一些看跌期權，並有一些額外的增長，也許還有一些考慮到當前美國經濟的脆弱性，我們考慮了一些影響，認為退學率會略有上升。第一季度的知名度非常好。我會請 Brian 多談談邊緣問題。

Justin. So as it relates to the Cigna Healthcare margin profile, we're first off, really pleased to have finished 2022 with the 9% Cigna Healthcare margin, which is 90 basis points of year-over-year expansion which allowed us to return to the low end of our target margin range of 9% to 10%. So this stronger-than-expected 2022 performance certainly increases our confidence in executing against our '23 margin goals. As I noted in my prepared comments earlier, we will see some product mix shift in 2023, specifically with the government lines becoming a slightly larger percent of premium within Cigna Healthcare, and these products tend to carry a lower profit margin profile than the U.S. commercial and international health products. So when you consider all of this and our continued investments in our accelerated growth platforms such as MA, we'd expect our 2023 Cigna Health care margins to land within our target 9% to 10% range, but at the low end.

賈斯汀。因此，就 Cigna Healthcare 的利潤率狀況而言，我們首先非常高興以 9% 的 Cigna Healthcare 利潤率結束 2022 年，這是同比增長 90 個基點，這使我們能夠回到我們目標利潤率範圍的低端為 9% 至 10%。因此，這種強於預期的 2022 年業績無疑增強了我們執行“23 年利潤率目標”的信心。正如我之前在準備好的評論中指出的那樣，我們將在 2023 年看到一些產品組合發生變化，特別是政府產品線在 Cigna Healthcare 中的保費佔比略高，而且這些產品的利潤率往往低於美國商業產品和國際健康產品。因此，當您考慮所有這些以及我們對 MA 等加速增長平台的持續投資時，我們預計 2023 年 Cigna Health 的利潤率將落在我們的目標 9% 至 10% 的範圍內，但處於低端。

Our next question comes from Ms. Lisa Gill with JPMorgan.

我們的下一個問題來自摩根大通的 Lisa Gill 女士。

I just wanted to come back to the PBM. David, you made a comment that HUMIRA would be on the formulary and parity with the biosimilar. Just curious as we think about AbbVie potentially increasing the rebates around that product? Is it better for the PBM if it shifts to the biosimilar? Or are contracts now set up in a way that you're going to share in the overall cost savings where it doesn't really matter. And then secondly, when we think about plan design, anything of note when we think about pharmacy benefit for 2023?

我只是想回到 PBM。大衛，你評論說 HUMIRA 將出現在處方集上並與生物仿製藥持平。只是好奇，當我們想到 AbbVie 可能會增加圍繞該產品的回扣時？如果轉向生物類似藥，對 PBM 是否更好？或者現在是否以一種您將在無關緊要的情況下分享總體成本節省的方式建立合同。其次，當我們考慮計劃設計時，當我們考慮 2023 年的藥房福利時有什麼值得注意的嗎？

So to your first question, the co-preferred position that we have taken on our national preferred formulary is a mechanism to aid the transition, preserve and expand choice with aligned economics back to our clients and for the benefit of our customers and patients. I'd also note that that's our National Preferred Formulary, which is our largest single formulary. We support and administer multiple formularies that are customized for individual clients from that standpoint and avail choice. I'd also suggest that this will be fluid. It will flex over time. Third, as we've demonstrated within our PBM and our broad pharmacy portfolio services, we have the tools to align the incentives whereby when we enable choice and create value. Meaningful portion of that value are passed back to clients, customers and patients and a sustainable portion of the value is retained by us and the current position that we have taken aligns in that way. So it's not -- we have to have a reason of our brand drug versus the biosimilar. We have the mechanisms to afford additional choice, additional flexibility and to align the incentives.

因此，對於您的第一個問題，我們對我們的國家首選處方集採取的共同首選立場是一種機制，以幫助過渡、保留和擴大選擇，將經濟調整回饋給我們的客戶，並造福於我們的客戶和患者。我還要指出，那是我們的國家首選處方集，這是我們最大的單一處方集。我們支持和管理多個處方集，這些處方集是從這個角度和可用性選擇為個人客戶定制的。我還建議這將是流動的。它會隨著時間的推移而彎曲。第三，正如我們在 PBM 和廣泛的藥房組合服務中所展示的那樣，當我們提供選擇和創造價值時，我們擁有調整激勵措施的工具。該價值的重要部分被回饋給客戶、客戶和患者，而價值的可持續部分由我們保留，我們目前採取的立場與此保持一致。所以它不是 - 我們必須有我們的品牌藥物與生物仿製藥的理由。我們擁有提供額外選擇、額外靈活性和調整激勵措施的機制。

As it relates to the second part of your question, I would just give you by way of trend as opposed to an individual benefit design configuration or change, buyers in the space, be they corporate buyers, health plan buyers, et cetera, are seeking to push for more what we talk about internally all the time, coordination of services and continue to challenge point solutions. That plays very well for us. So when you think about an illustration of that, the path well program around biosimilars, the Pathwell programs are on biologics, the Pathwell programs around injectables is a way to further coordinate services with precision or a subset of patients and deliver more value from that standpoint, you have to harness data, you have to harness clinical capabilities, you have to harness digital capabilities. You have to harness network and benefit management capabilities. And again, the combined organization is well positioned for that. So I would say more precision in benefit programs on a go-forward basis that bring more targeted coordination, harnessing data and harnessing specific subsegments. And again, we are well positioned for that in Pathwell an illustration of that direction.

由於它與你問題的第二部分有關，我只想通過趨勢而不是個人利益設計配置或變化的方式給你，這個領域的買家，無論是公司買家、健康計劃買家等，都在尋求推動更多我們一直在內部討論的內容，協調服務並繼續挑戰單點解決方案。這對我們來說非常好。因此，當您考慮一個例子時，圍繞生物仿製藥的 Pathwell 計劃，Pathwell 計劃是關於生物製劑的，圍繞注射劑的 Pathwell 計劃是一種進一步協調精確服務或部分患者並從該角度提供更多價值的方法，你必須利用數據，你必須利用臨床能力，你必須利用數字能力。您必須利用網絡和利益管理能力。再一次，合併後的組織為此做好了充分準備。因此，我會說在前進的基礎上更精確地制定福利計劃，帶來更有針對性的協調、利用數據和利用特定的細分市場。再一次，我們在 Pathwell 中很好地說明了這個方向。

Our next question comes from Mr. Josh Raskin with Nephron Research.

我們的下一個問題來自 Nephron Research 的 Josh Raskin 先生。

I want to go back to Village in the partnership there. And I'm just trying to think about how Village and Cigna Healthcare work together and sort of how you have impact on their strategy? And are there targeted growth strategies in markets that may be stronger than, say, your MA book? And then, Dave, I think you said 75% of the Medicare Advantage business is in some sort of value-based care. How much of that is actually full risk or full capitation relationships?

我想回到那裡的合作夥伴關係中。我只是想想想 Village 和 Cigna Healthcare 如何合作，以及你如何影響他們的戰略？市場中是否有可能比您的 MA 書更強大的目標增長策略？然後，戴夫，我想你說過 75% 的 Medicare Advantage 業務是在某種基於價值的護理中。其中有多少實際上是完全風險或完全按人頭計算的關係？

Josh, good to chat with you this morning. So let me take your second question first. In aggregate, a small proportion is in full cap. As we've discussed before, our preferred approach typically has a shared risk relationship. Some of it is in global cap for sure, but a minority of it is in global cap, a majority of it is in a shared risk -- long-standing shared risk program. And then another minority would be an upside only pay for pay in terms of new relationship pay for performance. So if you think about it in terms of a suite of capabilities, our sweet spot and our preferred approach is a shared alignment program, not a global cap program, but we have some global cap.

喬希，很高興今天早上和你聊天。那麼讓我先回答你的第二個問題。總的來說，一小部分是完全上限。正如我們之前所討論的，我們首選的方法通常具有共享風險關係。其中一些肯定在全球上限，但其中一小部分在全球上限，其中大部分在共同風險 - 長期共同風險計劃中。然後另一個少數人將是一個好處，只支付新的關係薪酬方面的薪酬。所以如果你從一套能力的角度來考慮它，我們的最佳點和我們首選的方法是一個共享的對齊程序，而不是一個全球上限計劃，但我們有一些全球上限。

To the first part of your question, you came back to the village and CHE side of the equation. So I'd ask you to think about, first and foremost, the relationship with Village that was built out and expanded is an Evernorth relationship. That's not to take away from CHE, I'll come to the core of your question in a moment. And that relationship, as I discussed with a previous question, is around helping to broaden and target the reach, broaden the reach and then target with precision around subspecialty and then coordinate services in an even more precise way off of their already highly performing value proposition. Now that will be benefit to Cigna Healthcare, but also other health lands and broadly speaking, Village's patient panel over time.

對於問題的第一部分，您回到了等式的村莊和 CHE 一側。所以我想請你首先考慮一下，與 Village 建立和擴展的關係是 Evernorth 關係。這並不是要從 CHE 那裡拿走，我馬上就會談到你問題的核心。正如我在上一個問題中所討論的那樣，這種關係是圍繞幫助擴大和瞄準範圍，擴大範圍，然後圍繞子專業精確定位，然後以更精確的方式協調服務，使其已經表現出色的價值主張.現在，隨著時間的推移，這將有利於 Cigna Healthcare，但也有利於其他健康領域，從廣義上講，Village 的患者小組。

Now specific to Cigna Healthcare, this relationship presents the opportunity to design certain benefit alternatives or unique product alternatives in collaboration with Village because of our closer relationship. That will evolve over time, and those conversations are manifesting themselves already. And the positive there is that that's building off of an already positive relationship. So back to the main course here is an Evernorth relationship and further evolving their already strong performance in terms of reach. precision for the breadth of the panel. Cigna Healthcare will benefit from that. It presents the opportunity in targeted geographies and to bring specific benefit alternatives forward for the benefit of Cigna Health care and all that is on the market relative to co-collaboration right now. That's why we're so excited about the partnership with Village.

現在具體到 Cigna Healthcare，由於我們的關係更密切，這種關係提供了與 Village 合作設計某些福利替代方案或獨特產品替代方案的機會。這將隨著時間的推移而演變，而這些對話已經開始顯現。積極的一面是，這是在已經積極的關係基礎上建立起來的。所以回到這裡的主要課程是 Evernorth 的關係，並進一步發展他們在影響力方面已經很強大的表現。面板寬度的精度。 Cigna Healthcare 將從中受益。它在目標地區提供了機會，並為信諾醫療保健和目前市場上與合作相關的所有產品帶來了特定的利益替代方案。這就是我們對與 Village 的合作感到如此興奮的原因。

Our next question comes from Mr. Stephen Baxter with Wells Fargo.

我們的下一個問題來自 Wells Fargo 的 Stephen Baxter 先生。

This is Nick on for Steve. I wanted to ask about the in-group trends you're seeing in commercial, given the number of different data points we're getting on the labor market. I know the last time you guys spoke about it, you said that while you were starting to feel some of the headlines manifest employers were generally still in net hiring mode. I wanted to see if that was still the case and if there was anything to call out between select, middle market and international.

這是史蒂夫的尼克。考慮到我們在勞動力市場上獲得的不同數據點的數量，我想問一下您在商業廣告中看到的內部趨勢。我知道你們上次談到這個問題時說，雖然您開始感覺到一些頭條新聞表明雇主通常仍處於淨招聘模式。我想看看情況是否仍然如此，以及在精選市場、中間市場和國際市場之間是否有什麼需要指出的。

Nick, it's David. I'll just give you a little directional indicator here. So throughout 2022, broadly speaking, we saw the kind of net effect of hiring still the lead dimension in terms of playing through. Although as we've talked quarter-to-quarter throughout the course of 2022, we recognized there was a softening in the economy. As we get through the latter part of the year and the end of the year, that pretty much muted down and approximates canceling itself off. So the net hiring versus the net disenrollment moved to a slight negative. As I mentioned in a prior comment, our projection for 2023 assumes a further uptick or a further softening of disenrollment as we look at the economy, we don't -- within our book as we go case by case and relationship by relationship, we don't see large dislocations, but we think it's prudent to plan for some further softening throughout the course of the year, and that's fully factored in to our projection. I wouldn't call out 1 individual subsegment. The National Press would say that small employers are continuing to hire in terms of fight to get to full levels of employment. So we can see some indicators relative to that. But broadly speaking, I would suggest you to think about -- we believe we've taken a prudent outlook in our full year membership outlook by further dampening the additional enrollment throughout the course of the year, and we think that's an appropriate approach.

尼克，是大衛。我只是在這裡給你一個方向性的指標。因此，在整個 2022 年，從廣義上講，我們看到招聘的那種淨效應仍然是發揮作用的主要維度。儘管我們在整個 2022 年期間都按季度進行了討論，但我們認識到經濟正在走軟。當我們度過今年下半年和年底時，這種情況幾乎減弱並接近於自我取消。因此，淨招聘與淨退學率略有負數。正如我在之前的評論中提到的那樣，我們對 2023 年的預測假設在我們觀察經濟時退學率會進一步上升或進一步走軟，但我們並沒有——在我們的書中，我們逐個分析，逐個分析，我們沒有看到大的錯位，但我們認為計劃在全年進一步軟化是謹慎的，我們的預測已充分考慮到這一點。我不會說出 1 個單獨的細分市場。國家媒體會說，小雇主正在繼續招聘，以爭取實現全面就業。所以我們可以看到一些與此相關的指標。但從廣義上講，我建議你考慮一下——我們認為，我們通過進一步抑制全年的額外註冊，對我們的全年會員前景持謹慎態度，我們認為這是一種適當的方法。

Our next question comes from Mr. Steven Valiquette with Barclays.

我們的下一個問題來自巴克萊銀行的 Steven Valiquette 先生。

So just back on Evernorth again, within that context of the earnings growth being more back half weighted and faster growth in the back half. Just if you can remind us again how you're thinking about the cadence of recognition of the Centene PBM onboarding costs between the first half versus the second half? I'm wondering if that's still kind of fluid for you guys is how that might flow during the year? Or is that kind of set in stone as far as the weighting of that expense in the first half versus the second half?

所以再次回到 Evernorth，在盈利增長的背景下，後半部分加權更多，後半部分增長更快。只是如果你能再次提醒我們你是如何考慮上半年和下半年之間 Centene PBM 入職成本的認可節奏的？我想知道這對你們來說是否仍然是一種流動性，在這一年中它會如何流動？或者就上半年與下半年的支出權重而言，這種情況是一成不變的嗎？

Steve, it's Brian. So as it relates to the Centene related implementation costs in 2023, we do expect there to be an uptick over the course of the year in that spending. So you can think of it as growing from the first quarter through the fourth quarter modestly. So as you think about the total spend. So we've incurred a small fraction of the total we expect to spend over the course of the full year. But importantly, which if you think about that mathematically, it goes against the concept of back half income weighting. The magnitude of that is far outweighed by the other factors that I referenced earlier in terms of the contribution from biosimilars ramping in the back half as well as the other SG&A patterns that will emerge over the course of the year. But you should think of the Centene related costs for the course of the year and a small fraction of that already spent.

史蒂夫，是布萊恩。因此，由於它涉及到 2023 年與 Centene 相關的實施成本，我們確實預計該支出在這一年中會有所增加。所以你可以認為它從第一季度到第四季度適度增長。因此，當您考慮總支出時。因此，我們的支出只佔全年預計支出總額的一小部分。但重要的是，如果你從數學上考慮這一點，它就違背了後半收入加權的概念。就下半年生物仿製藥的貢獻以及今年將出現的其他 SG&A 模式而言，我之前提到的其他因素遠遠超過了它的重要性。但是你應該考慮一年中與 Centene 相關的成本以及已經花費的一小部分。

Our next question comes from Mr. Nathan Rich with Goldman Sachs.

我們的下一個問題來自高盛的 Nathan Rich 先生。

I wanted to follow up on the biosimilar ramp and how you're approaching formulary changes this year and going forward. I guess specifically to the negotiations manufacturers. Is that something that we should think about happening once per year on an annual basis does the entry of additional biosimilars give you the opportunity to go back to all manufacturers and negotiate additional savings? And then could you also talk about how you and your clients are thinking about the extent you want to drive patients to the lowest-cost product versus kind of maintaining choice and kind of access to different therapies.

我想跟進生物仿製藥的增長，以及你們今年和未來如何應對處方集的變化。我猜是專門去談判廠家的。這是我們每年應該考慮每年發生一次的事情嗎，額外的生物仿製藥的進入是否讓你有機會回到所有製造商並協商額外的節省？然後，您能否也談談您和您的客戶如何考慮您希望將患者推向成本最低的產品的程度，而不是保持選擇和獲得不同療法的種類。

Nate, it's David. You should think about, broadly speaking, the formulated decisions are made in the latter part of the calendar year, so deep into Q4 of a given year for the next year with the best insights; two, there's always some fluidity relative to drug launches that manifest themselves throughout the course of the year. In the case of biosimilars, we know there are drug launches expected in the Q3 time frame of this year of 2023, that we've fully contemplated and factored in. And we have the ability to flex formularies in the course of the year with individual clients, individual health plans, et cetera, obviously, on a consultative fashion. So view the decisions are largely made in advance of the year. However, you have the flexibility to go back and make adjustments my comments are not specific to your specific question around manufacturer-specific contracts through that lens.

內特，是大衛。你應該想想，從廣義上講，制定的決定是在日曆年的下半年做出的，所以深入到給定年份的第四季度，對下一年有最好的洞察力；第二，在一年中，與藥物發布相關的總是存在一些流動性。就生物仿製藥而言，我們知道預計將在 2023 年的今年第三季度推出藥物，我們已經充分考慮並考慮到了這一點。而且我們有能力在一年中根據個人情況調整處方集客戶、個人健康計劃等，顯然是以諮詢方式進行的。因此，看來這些決定主要是在今年之前做出的。但是，您可以靈活地返回並進行調整，我的評論並不針對您通過該鏡頭對製造商特定合同的具體問題。

To the latter part of your question, by and large, employers, health plans, et cetera, are focused on clinical efficacy and comparative effectiveness. So the fixation relative to first and foremost as it should be clinical efficacy, making sure when there's any alternative that's available in turning the best external validation of the clinical equivalent of the impact of a pharmaceutical is evaluated properly and then comparative effectiveness, looking at the economics and then getting to a total low cost of care or best value equation. And then the employer or health line may make some trade-offs in terms of which levers they want to use to achieve that, but ultimately, it comes down to the best total cost equation once the clinical efficacy hurdle is crossed.

對於你問題的後半部分，總的來說，雇主、健康計劃等都關注臨床療效和比較效果。因此，與臨床療效相關的固定因素首先應該是臨床療效，確保在有任何替代方案時，可以正確評估藥物影響的臨床等效性的最佳外部驗證，然後比較療效，看看經濟學，然後得出總的低成本護理或最佳價值等式。然後，雇主或健康線可能會根據他們想要使用哪些槓桿來實現這一目標做出一些權衡，但最終，一旦跨越臨床療效障礙，它就會歸結為最佳總成本方程式。

And as I mentioned in the prior question, we have the tools, we have the services, we have the flexibility to avail employer by employer, health fund by health plan to be able to get them to the right balance that they want. But ultimately, it's the low total cost equation with the clinical outcomes that are preferred from that standpoint that drive the net conversations and the net decisions by employers and by health plans.

正如我在上一個問題中提到的，我們有工具，我們有服務，我們可以靈活地利用每個雇主、每個健康計劃的健康基金，以使他們達到他們想要的正確平衡。但最終，從推動雇主和健康計劃進行淨對話和淨決策的角度來看，具有臨床結果的低總成本方程式是首選。

Our next question comes from Mr. Lance Wilkes with Bernstein.

我們的下一個問題來自伯恩斯坦的 Lance Wilkes 先生。

Just wanted to follow up, David, on the comments you made on the VillageMD relationship, which was really helpful to kind of frame that. And what I was trying to understand is from the Evernorth side, it would seem that Evernorth could be a distribution partner wherever Evernorth could be helping Village to enable itself to better manage costs, either through providing MD live or networks or Evernorth PBM services, et cetera. So maybe a little more color on sort of what is the primary role that Evernorth is playing there? And then just secondarily, for the MCO, how important and what is the opportunity for in addition to new product design for you to cross-sell in your ASO block, the VillageMD sort of value-based care source of services.

大衛，只是想跟進你對 VillageMD 關係所做的評論，這對構建框架非常有幫助。我試圖從 Evernorth 方面了解，Evernorth 似乎可以成為分銷合作夥伴，只要 Evernorth 可以通過提供 MD 現場或網絡或 Evernorth PBM 服務等方式幫助 Village 更好地管理成本，等等等等。那麼也許更多關於 Evernorth 在那裡扮演的主要角色的顏色？其次，對於 MCO，除了新產品設計之外，還有什麼機會可以在您的 ASO 區塊中進行交叉銷售，VillageMD 是一種基於價值的護理服務來源。

Lance. So I think your framework is quite helpful. If you think about the building blocks you articulated, you laid them out quite nicely. I just would play with the order a little bit. Job 1 for us with Village is to work in partnership, right? It's not to push a product. It's a work in partnership to avail additional capabilities off their already strong performing platforms. to further improve affordability or clinical quality. So let's take an example. Take the opportunity to curate in an individual market or submarket for larger markets, the highest-performing oncology providers for certain tumor types or certain diagnoses. Our longitudinal data sets enable that in a very differentiated way, [deal] to bring a bit more precision. The net result of that is, therefore, for a village patient, a higher probability of getting the best possible evidence-based care and coordinated care and therefore, best overall value. of which then Village benefits from that. The patient obviously benefits from that. And what we've designed is the Evernorth enablement benefits from that.

槊。所以我認為你的框架很有幫助。如果你考慮一下你所表達的構建基塊，你會把它們佈置得非常好。我只是會玩一下訂單。我們與 Village 的工作 1 是合作，對吧？這不是推產品。這是一項合作工作，可以利用他們已經強大的性能平台的額外功能。進一步提高負擔能力或臨床質量。那麼讓我們舉個例子。藉此機會在單個市場或子市場中策劃更大的市場，為某些腫瘤類型或某些診斷提供最高績效的腫瘤學供應商。我們的縱向數據集以一種非常差異化的方式實現了這一點，[交易]帶來了更多的精確度。因此，最終結果是，對於鄉村患者而言，獲得最佳循證護理和協調護理的可能性更高，因此獲得最佳整體價值。然後村莊從中受益。患者顯然從中受益。我們設計的是 Evernorth 支持從中受益。

Point 2 is you want to distribution. We could bring more access in volume flow through the high-performing opportunities that exist here. There's no doubt around that, and we will seek to do so. And then third, where you came back to, we will absolutely help to enable these capabilities back, which is a subset of your distribution in a way, back to our large well-performing portfolio of ASO clients by bringing yet even more precision of care coordination for their benefit. But in this case, we have through the Evernorth services and through the collaboration with Village, the ability to be rewarded in addition to the value we would be creating for their benefit. So there's multiple building blocks here, which is why we're quite excited.

第 2 點是你要分配。我們可以通過這裡存在的高性能機會帶來更多的流量訪問。毫無疑問，我們將尋求這樣做。然後第三，在您返回的地方，我們絕對會幫助您重新啟用這些功能，這在某種程度上是您分發的一個子集，通過帶來更精確的護理，回到我們大量表現良好的 ASO 客戶組合為他們的利益而協調。但在這種情況下，我們通過 Evernorth 服務並通過與 Village 的合作，除了為他們的利益創造價值之外，還有能力獲得獎勵。所以這裡有多個構建塊，這就是我們非常興奮的原因。

At the end of the day, if you put a big circle around it, Lance, it all comes down to how do we harness more data how do we harness more clinical coordination to bring even greater clinical quality and overall affordability, 1 patient at a time with a platform that is performing well, that is village and then creating extenders and some care coordination that comes along with it. And through Evernorth, we have both the service mechanism and then the sharing mechanism built that will work in conjunction with Village for.

歸根結底，如果你把它畫一個大圈，蘭斯，這一切都歸結為我們如何利用更多的數據，我們如何利用更多的臨床協調來帶來更高的臨床質量和整體負擔能力，一個病人花時間在一個表現良好的平台上，那就是 village，然後創建擴展器和一些隨之而來的護理協調。通過 Evernorth，我們既有服務機制，又有共享機制，可以與 Village for 一起工作。

Our last question comes from Dave Windley with Jefferies.

我們的最後一個問題來自 Jefferies 的 Dave Windley。

Scott asked rates question. It's been a couple of more days since the RADV rule. I thought I'd ask you, David, to provide your thoughts on RADV and navigating through that in addition to a tighter rate environment for next year?

斯科特問費率問題。 RADV 規則已經過去了幾天。我想我會請你，大衛，提供你對 RADV 的看法，並在明年收緊利率環境的情況下駕馭它？

Sure. Dave. So relative to RADV and the new information that came out, first and foremost, we deem that risk adjusters are and remain an important tool for the program. And as I noted before, a program that has worked obviously for quite some time for the benefit of seniors and delivering excellent clinical quality, value and service. Additionally, from a Cigna perspective, we remain committed to executing, obviously, this program in a highly compliant fashion. Now specific to the RADV actions, we're pleased, the CMS concluded that they're not going to extrapolate their actions prior to 2018. We're concerned that we continue to question a couple of decisions. For example, the elimination of the fee-for-service adjuster that we deemed to be foundational to the program. And we await specifics relative to the methodology that is going to be used in some aspects of the extrapolation and work as we have in the past and as we always will, we will work closely with CMS to seek to get further clarity relative to the open items that are here. So a bit of a fluid environment but we see progress relative to the lack of extrapolation beyond 2018, and we see some open questions for the industry at large. So remain, and we will collaborate with CMS to get more visibility on that over the near term.

當然。戴夫。因此，相對於 RADV 和出現的新信息，首先，我們認為風險調節器現在是並且仍然是該計劃的重要工具。正如我之前指出的那樣，該計劃顯然在很長一段時間內為老年人的利益發揮了作用，並提供了卓越的臨床質量、價值和服務。此外，從 Cigna 的角度來看，我們仍然致力於以高度合規的方式執行該計劃。現在具體到 RADV 行動，我們很高興，CMS 得出結論，他們不會在 2018 年之前推斷他們的行動。我們擔心我們會繼續質疑一些決定。例如，取消我們認為是該計劃基礎的按服務收費調節器。我們等待與將在推斷的某些方面使用的方法相關的具體細節，並且像我們過去所做的那樣工作，我們將一如既往地與 CMS 密切合作，以尋求相對於公開的進一步清晰度這裡的項目。因此，環境有點不穩定，但我們看到了相對於 2018 年以後缺乏推斷的進展，我們看到了整個行業的一些懸而未決的問題。所以留下來，我們將與 CMS 合作，以在短期內獲得更多的可見性。

I will now turn the call back to David Cordani for closing remarks.

我現在將把電話轉回給 David Cordani 作結束語。

Thank you. Just to briefly recap, 2022 was a strong year of performance, growth and positive impact that our company brought forward. With Evernorth and Cigna Healthcare, we demonstrated that we are serving the current needs of our customers, clients and partners, and we expect to deliver another year of customer and earnings growth in 2023. I want to recognize and more importantly, thank and more than 70,000 coworkers around the world. It's ultimately their continued dedication and leadership that allows us to make a defining difference in health care and their demonstrated commitment to building on the momentum we've delivered to have a larger impact as we look to the future as we strive to improve the health and vitality that of those we're privileged to serve. With that, we thank you for joining our call today, and we look forward to our continued conversations as we go forward. Have a good day.

謝謝。簡單回顧一下，2022 年是我們公司業績、增長和積極影響強勁的一年。通過 Evernorth 和 Cigna Healthcare，我們證明了我們正在滿足我們的客戶、客戶和合作夥伴的當前需求，我們希望在 2023 年實現又一年的客戶和收入增長。我想認識到，更重要的是，感謝並不僅僅是全球 70,000 名同事。歸根結底，正是他們的持續奉獻和領導才能使我們能夠在醫療保健領域做出決定性的改變，以及他們明確承諾在我們已經提供的勢頭的基礎上再接再厲，在我們努力改善健康和健康的過程中展望未來產生更大的影響。那些我們有幸服務的人的活力。有了這個，我們感謝您今天加入我們的電話會議，我們期待著我們繼續進行對話。祝你有美好的一天。

Ladies and gentlemen, this concludes Cigna's Fourth Quarter 2022 Results Review. Cigna Investor Relations will be available to respond to additional questions shortly. A recording of this conference will be available for 10 business days following this call. You may access the recorded conference by dialing (800 -- 839-2290 or (203)-369-3607. There is no passcode required for this replay. Thank you for participating. We will now disconnect.

女士們，先生們，信諾 2022 年第四季度業績回顧到此結束。 Cigna 投資者關係部將很快回答其他問題。本次會議的錄音將在本次電話會議後的 10 個工作日內提供。您可以通過撥打 (800 -- 839-2290 或 (203)-369-3607) 訪問錄製的會議。此重播不需要密碼。感謝您的參與。我們現在將斷開連接。