信諾集團 (CI) 2023 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by for the Cigna Group's Second Quarter 2023 Results Review.

女士們、先生們，感謝你們耐心等待 Cigna 集團 2023 年第二季度業績回顧。

(Operator Instructions)

（操作員說明）

We'll begin by turning the conference over to Ralph Giacobbe. Please go ahead.

我們首先將會議交給 Ralph Giacobbe。請繼續。

Thank you. Good morning, everyone. 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, The Cigna Group's Chairman and Chief Executive Officer; Brian Evanko, Chief Financial Officer; and Eric Palmer, President and Chief Executive Officer of Evernorth Health Services.

謝謝。大家，早安。感謝您參加今天的電話會議。我是拉爾夫·賈科布 (Ralph Giacobbe)，投資者關係高級副總裁。今天早上與我通話的是 Cigna 集團董事長兼首席執行官 David Cordani；布萊恩·埃万科 (Brian Evanko)，首席財務官；埃里克·帕爾默 (Eric Palmer)，Evernorth Health Services 總裁兼首席執行官。

In our remarks today, David and Brian will cover a number of topics, including our second quarter financial results and our updated financial outlook for 2023. Following their prepared remarks, David, Brian and Eric will be available for Q&A.

在今天的講話中，David 和 Brian 將討論許多主題，包括我們第二季度的財務業績和 2023 年最新的財務展望。在他們準備好的講話之後，David、Brian 和 Eric 將接受問答。

As noted in our earnings release, when describing our financial results, we use 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 thecignagroup.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.

正如我們在財報中所指出的，在描述我們的財務業績時，我們使用了某些財務指標、調整後的運營收入和調整後的收入，這些指標並不是根據美國普遍接受的會計原則（也稱為GAAP）確定的。這些指標分別與最直接可比的 GAAP 指標、股東淨收入和總收入進行了調節，分別包含在今天的收益報告中，該報告發佈在 thecignagroup.com 的投資者關係部分。我們使用“調整後營業收入”和“調整後每股收益”這一術語作為我們衡量財務業績的主要指標。

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 the cautionary note to today's earnings release and in our most recent reports filed with the SEC.

在今天的講話中，我們將做出一些前瞻性聲明，包括有關我們對 2023 年和未來業績的展望的聲明。這些陳述存在風險和不確定性，可能導致實際結果與我們當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今天的收益發布的警示說明以及我們向美國證券交易委員會提交的最新報告中。

Regarding our results, in the second quarter, we recorded after-tax special item charges of $5 million or $0.01 per share for the integration and transaction-related cost. 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. With that, I will turn the call over to David.

關於我們的業績，在第二季度，我們記錄了 500 萬美元的稅後特殊項目費用，即每股 0.01 美元的整合和交易相關成本。此外，請注意，當我們對財務業績（包括 2023 年全年展望）做出前瞻性評論時，我們將基於未來股票回購和預期 2023 年股息的潛在影響。這樣，我就把電話轉給大衛。

Thanks, Ralph. Good morning, everyone, and thanks for joining our call today. For the second quarter, again, we delivered a strong performance, fueled by continued growth across our diverse portfolio of businesses. Today, I'll review key strategic drivers contributing to our momentum and while we believe we're well positioned to sustain our growth as we continue to support the health and vitality of those we serve with our differentiated solutions and capabilities.

謝謝，拉爾夫。大家早上好，感謝您今天加入我們的電話會議。在我們多元化業務組合持續增長的推動下，第二季度我們再次取得了強勁的業績。今天，我將回顧有助於我們發展勢頭的關鍵戰略驅動因素，同時我們相信，隨著我們繼續以差異化的解決方案和能力支持我們所服務的人們的健康和活力，我們有能力維持我們的增長。

Brian will cover additional details about our financial performance in the quarter and our 2023 outlook. As part of our ongoing effort for you to hear more from members of our leadership team, Eric Palmer, President and Chief Executive Officer of Evernorth Health Services, will be joining our call and is available to take your questions.

Brian 將介紹有關我們本季度財務業績和 2023 年展望的更多詳細信息。作為我們不斷努力讓您聽到我們領導團隊成員更多信息的一部分，Evernorth Health Services 總裁兼首席執行官埃里克·帕爾默 (Eric Palmer) 將加入我們的電話會議並回答您的問題。

With that, let's get started. In the second quarter, we delivered total revenues of $48.6 billion, adjusted earnings per share of $6.13 and cash flow from operations of $2.5 billion. We're pleased with our performance overall during the quarter and through the first half of the year. With focus on affordability and innovation, we are continuing to strengthen our competitive position and grow our businesses.

就這樣，我們開始吧。第二季度，我們的總收入為 486 億美元，調整後每股收益為 6.13 美元，運營現金流為 25 億美元。我們對本季度和上半年的整體表現感到滿意。我們專注於負擔能力和創新，不斷增強我們的競爭地位並發展我們的業務。

In Evernorth Health Services, we saw another strong quarter of our market-leading pharmacy, care and benefits portfolio. Express Scripts, our pharmacy benefits business harnesses our deep relationships, extensive clinical expertise and is delivering innovations and innovative solutions for those we serve. We've long been a leader in supporting access to prescription drugs and to further enhance our efforts, we took a series of actions in the quarter including launching co-pay assurance to support further affordability for patients and ClearCareRx to provide our clients with broader choice.

在 Evernorth Health Services，我們看到市場領先的藥品、護理和福利產品組合又一個強勁的季度。我們的藥房福利業務 Express Scripts 利用我們深厚的關係和廣泛的臨床專業知識，為我們服務的客戶提供創新和創新解決方案。長期以來，我們一直是支持獲得處方藥的領導者，為了進一步加強我們的努力，我們在本季度採取了一系列行動，包括推出自付保證以支持患者進一步負擔得起，以及ClearCareRx 為我們的客戶提供更廣泛的選擇。

We also introduced independent Rx, which is a first of its kind support program for rural pharmacists that recognizes the critical role they play in improving access for millions of Americans. We will continue to lead the way to the current environment of elevated legislative and regulatory activity, and we're encouraged by the positive recognition of our work to make safe, effective and affordable access of prescription drugs within reach for millions of people who need them.

我們還推出了獨立 Rx，這是針對農村藥劑師的首個此類支持計劃，該計劃認識到他們在改善數百萬美國人的用藥機會方面發揮的關鍵作用。我們將繼續引領當前立法和監管活動加強的環境，我們的工作得到了積極認可，我們感到鼓舞，我們的工作是為數百萬有需要的人提供安全、有效和負擔得起的處方藥。

Our client retention is also strong, and we are continuing to build and expand new relationships. For example, we're making good progress for our implementation with Centene, which begins on January 2024. Our teams are working collaboratively, and we are on track as we prepare to further improve affordability in serving 20 million Centene customers.

我們的客戶保留率也很高，並且我們正在繼續建立和擴展新的關係。例如，我們與Centene 的實施工作正在取得良好進展，該計劃將於2024 年1 月開始。我們的團隊正在協同工作，並且我們正步入正軌，準備進一步提高為2000 萬Centene 客戶提供服務的負擔能力。

In the quarter, we had strong growth in Accredo, our specialty pharmacy business. In a moment, I'll profile the deep clinical expertise and capabilities that make Accredo a differentiated leader in the space.

本季度，我們的專業製藥業務 Accredo 實現了強勁增長。稍後，我將介紹使 Accredo 成為該領域差異化領導者的深厚臨床專業知識和能力。

Turning to Cigna Healthcare. We delivered another quarter of organic customer growth, reinforcing how well our consultative approach and capabilities continue to resonate in the market. Our U.S. commercial business continues to build momentum. We've had sustained success with commercial customer growth outpacing the overall market, and 2023 is shaping up to be another very strong year for this business. With our affordability initiatives and deep consultative sales approach, we're delivering highly competitive total cost of care for employer clients as well as providing programs supporting healthy engaged workforces that they need.

轉向 Cigna 醫療保健。我們實現了又一個季度的有機客戶增長，增強了我們的諮詢方法和能力繼續在市場中引起共鳴的程度。我們的美國商業業務繼續發展勢頭。我們取得了持續的成功，商業客戶增長速度超過了整體市場，2023 年將成為該業務又一個非常強勁的一年。憑藉我們的負擔能力計劃和深入的諮詢銷售方法，我們為雇主客戶提供極具競爭力的總護理成本，並提供支持他們所需的健康敬業的勞動力的計劃。

In U.S. government, our Medicare Advantage business is achieving above-market customer growth with high-quality affordable pains and targeted investments that we continue to make to further strengthen our network and offerings.

在美國政府，我們的醫療保險優勢業務正在通過高質量、負擔得起的痛苦和有針對性的投資實現高於市場的客戶增長，我們將繼續進行這些投資，以進一步加強我們的網絡和產品。

In our individual exchange business, we will continue taking a focused approach by engaging customers to improve health outcomes and managing risks in the expanding population we serve. In the quarter, while our medical care ratio is generally in line with expectations, we did have an increase to our 2023 risk adjustment payable. Relative to the risk adjuster impact, we expect this to be a 2023 event, and we've already taken actions for 2024.

在我們的個人兌換業務中，我們將繼續採取有針對性的方法，通過吸引客戶來改善健康結果並管理我們所服務的不斷擴大的人群的風險。本季度，雖然我們的醫療保健比率總體符合預期，但我們的 2023 年應付風險調整確實有所增加。相對於風險調整器的影響，我們預計這將是 2023 年的事件，並且我們已經為 2024 年採取了行動。

In our international health business, we drove continued innovation and growth in target markets with solutions for the globally mobile population and employees of multinational corporations as well as into governmental organizations. Overall, our second quarter results show that the Cigna group is performing well with underlying strength in our complementary businesses.

在我們的國際健康業務中，我們通過為全球流動人口和跨國公司員工以及政府組織提供解決方案，推動目標市場的持續創新和增長。總體而言，我們第二季度的業績表明，Cigna 集團表現良好，我們的互補業務具有潛在優勢。

We believe we're well positioned to continue growing our company and deliver on our commitments. With the strength of our results, we are increasing our outlook for full year revenue and customer growth as well as cash flow from operations, and we are reaffirming that we are on track to deliver adjusted EPS of at least $24.70 for full year 2023.

我們相信我們有能力繼續發展我們的公司並兌現我們的承諾。憑藉我們強勁的業績，我們正在提高對全年收入、客戶增長以及運營現金流的預期，並重申我們有望在 2023 年全年實現至少 24.70 美元的調整後每股收益。

Now I'll talk about how we are working to sustain our momentum with our differentiated and diversified capabilities and our durable strategic growth framework. Our framework guides us in continuing to respond to customer, patient and client needs as well as capturing growth opportunities within our foundational businesses and our accelerated growth businesses.

現在我將談談我們如何通過差異化和多元化的能力以及持久的戰略增長框架來維持我們的勢頭。我們的框架指導我們繼續響應客戶、患者和客戶的需求，並在我們的基礎業務和加速增長業務中抓住增長機會。

Additionally, we harness the power of our talent, client relationships and partnerships as well as an expanding technology portfolio for cross enterprise leverage. Technology increasingly provides us with opportunities to accelerate innovation and growth. Artificial intelligence and machine learning, for example, capabilities further enhancing ways for us to support patients in their clinical care teams as well as drive additional efficiency initiatives.

此外，我們利用人才、客戶關係和合作夥伴關係以及不斷擴大的技術組合的力量來實現跨企業的槓桿作用。技術越來越多地為我們提供加速創新和增長的機會。例如，人工智能和機器學習的能力進一步增強了我們在臨床護理團隊中支持患者的方式，並推動了額外的效率舉措。

Today, I'll talk more about one of our accelerated growth businesses, Accredo, our flagship specialty pharmacy, where we have a competitive advantage in an area of growing need and opportunity. Earlier this summer, we welcomed a group of investors to Warrendale, Pennsylvania at one of our Accredo clinical care sites. The visit provided an opportunity to see the breadth of our specialty capabilities and the depth of our clinical expertise, a critical driver for the positive outcomes and impact we achieved for patients requiring complex and high-cost treatments for chronic conditions.

今天，我將更多地談論我們加速增長的業務之一 Accredo，我們的旗艦專業藥房，我們在需求和機會不斷增長的領域擁有競爭優勢。今年夏天早些時候，我們在賓夕法尼亞州沃倫代爾的 Accredo 臨床護理中心之一迎來了一批投資者。這次訪問提供了一個機會來了解我們專業能力的廣度和臨床專業知識的深度，這是我們為需要復雜且高成本的慢性病治療的患者取得積極成果和影響的關鍵驅動力。

Here are a few headlines from the day at Warrendale. First, Accredo has a proven track record of growth. Only 5 years ago, when Express Scripts combined with Cigna, Here are a few headlines from the day Warrendale. First, Accredo has a proven track record of growth. Only 5 years ago, when Express Scripts combined with Cigna, Accredo was approximately a $30 billion business. Today, Accredo has grown to approximately $60 billion.

以下是沃倫代爾當天的一些頭條新聞。首先，Accredo 擁有良好的增長記錄。僅在 5 年前，當 Express Scripts 與 Cigna 合併時，以下是 Warrendale 當天的一些頭條新聞。首先，Accredo 擁有良好的增長記錄。僅在 5 年前，當 Express Scripts 與 Cigna 合併時，Accredo 的業務規模約為 300 億美元。如今，Accredo 的市值已增至約 600 億美元。

In 2023, serves approximately 900,000 patients with some of the most complex conditions and needs. Accredo now represents about 40% of Evernorth's total revenue and because of its unique strengths, Accredo has grown faster than the overall marketplace. Second is secular tailwinds in the market creates significant growth opportunities as we look to the future. Those who need specialty drugs make up about 5% of the population and they drive more than 40% of total health care costs across medical, behavioral and pharmacy services. This is fueling expected mid- to high single-digit annual growth in what is already a specialty pharmaceutical market of approximately $380 billion.

到 2023 年，將為大約 900,000 名病情和需求最複雜的患者提供服務。 Accredo 目前約佔 Evernorth 總收入的 40%，並且由於其獨特的優勢，Accredo 的增長速度快於整個市場。其次，當我們展望未來時，市場的長期順風創造了巨大的增長機會。需要特殊藥物的人約佔總人口的 5%，他們在醫療、行為和藥房服務方面佔醫療保健總成本的 40% 以上。這將推動已經約 3800 億美元的專業藥品市場實現中高個位數的年增長。

Biosimilars represent a force of change and a substantial opportunity for further growth and impact, and we will leverage them for greater affordability for clients and patients. We've long been a leader in supporting greater adoption of biosimilars as we did with the wave of generic medications when they became available decades ago. And like generics, we believe biosimilars will drive much needed affordability improvements for those we serve and thereby, create more financial capacity to pay for new pharmaceutical innovations today and as we look to the future.

生物仿製藥代表著變革的力量以及進一步增長和影響的巨大機會，我們將利用它們來提高客戶和患者的負擔能力。長期以來，我們一直是支持更多地採用生物仿製藥的領導者，就像幾十年前仿製藥上市時我們對仿製藥浪潮所做的那樣。與仿製藥一樣，我們相信生物仿製藥將推動我們所服務的人們急需的負擔能力改善，從而創造更多的財務能力來支付今天和未來的新製藥創新。

Third is the breadth of our clinical capabilities and use of data that further fuels precision and impact. We've built and strengthened our clinical capabilities and far-reaching operating model over decades. Within Accredo, we have therapeutic resource centers with clinical teams of pharmacists, nurse, dietitians and social workers, specializing in different disease states such as blood and neurological disorders and multiple types of cancers.

第三是我們臨床能力和數據使用的廣度，進一步提高了準確性和影響力。幾十年來，我們建立並加強了我們的臨床能力和影響深遠的運營模式。在 Accredo 內，我們設有治療資源中心，擁有由藥劑師、護士、營養師和社會工作者組成的臨床團隊，專門治療不同的疾病狀態，例如血液和神經系統疾病以及多種類型的癌症。

Unlike many of our competitors, we directly employ hundreds of field-based infusion nurses. Today, they are located within 75 miles of approximately 90% of the U.S. population. And as they care for patients inside their homes, they provide better, more coordinated and personalized experiences, including addressing social determinants of health.

與我們的許多競爭對手不同，我們直接僱用了數百名現場輸液護士。如今，它們位於大約 90% 的美國人口的 75 英里範圍內。當他們在家中照顧患者時，他們提供更好、更協調和個性化的體驗，包括解決健康的社會決定因素。

With the clinical care models focused on each individual patient, we're able to provide a level of personalized clinical support that is vital in specialty pharmacy. Many new high-cost drugs for oncology, gene therapies and reconditions are coming to market, further pressuring affordability for clients and requiring greater support for patients that take these complex medications safely and effectively. I would note drug manufacturers also recognize our expertise and capabilities as well as our superior outcomes that we produce with our unique coordinated clinical model.

通過專注於每位患者的臨床護理模式，我們能夠提供對專業藥學至關重要的個性化臨床支持。許多用於腫瘤、基因治療和修復的新的高成本藥物即將上市，這進一步給客戶的負擔能力帶來壓力，並需要為安全有效地服用這些複雜藥物的患者提供更多支持。我要指出的是，藥品製造商也認可我們的專業知識和能力，以及我們通過獨特的協調臨床模型產生的卓越成果。

Putting all this together, we're excited about the accelerated growth opportunities we have with Accredo's differentiated specialty pharmacy and view it as a powerful growth engine for our company today and into the future.

總而言之，我們對 Accredo 的差異化專業藥房所擁有的加速增長機會感到興奮，並將其視為我們公司今天和未來的強大增長引擎。

Now stepping back to the enterprise level, I'll briefly recap. We drove strong earnings that built on our momentum from the first quarter and last year. We delivered adjusted EPS of $6.13, strong customer, revenue and cash flow growth. Our progress gives us confidence to reaffirm our guidance of adjusted EPS of at least $24.70 for full year 2023, and we also remain on track for adjusted EPS of at least $28 in 2024. This reinforces how we are creating value for our customers and clients and leveraging differentiated capabilities to give us flexibility to continue performing well in a dynamic environment.

現在回到企業層面，我將簡要回顧一下。我們在第一季度和去年的勢頭基礎上實現了強勁的盈利。我們的調整後每股收益為 6.13 美元，客戶、收入和現金流增長強勁。我們的進展使我們有信心重申2023 年全年調整後每股收益至少24.70 美元的指導，並且我們也仍有望在2024 年實現調整後每股收益至少28 美元。這強化了我們為客戶和客戶創造價值的方式利用差異化的能力使我們能夠靈活地在動態環境中繼續保持良好的表現。

Now Brian will share additional perspective about our performance in the quarter and our outlook for the rest of the year. Brian?

現在，布萊恩將分享有關我們本季度業績和今年剩餘時間前景的更多觀點。布萊恩？

Thank you, David. Good morning, everyone. Today, I'll review Cigna's second quarter 2023 results and discuss our updated outlook for the full year. Second quarter results were strong, reflecting continued execution across the enterprise. Looking at the quarter specifically, some key consolidated financial highlights include revenue growth of 7% to $48.6 billion, after-tax adjusted earnings of $1.8 billion, adjusted earnings per share of $6.13 and cash flow from operations of $2.5 billion.

謝謝你，大衛。大家，早安。今天，我將回顧 Cigna 2023 年第二季度的業績，並討論我們更新後的全年展望。第二季度業績強勁，反映出整個企業的持續執行力。具體來看本季度，一些重要的綜合財務亮點包括收入增長 7% 至 486 億美元、稅後調整後收益 18 億美元、調整後每股收益 6.13 美元以及運營現金流 25 億美元。

Revenue and cash flow both exceeded expectations, while adjusted earnings per share were slightly ahead of expectations. Our 2 platforms continue to perform well, with Evernorth posting solid top and bottom-line growth, while Cigna Healthcare delivered results in line with expectations despite an unfavorable risk adjustment impact in our individual exchange business, which I will discuss shortly.

收入和現金流均超出預期，調整後每股收益略超預期。我們的兩個平台繼續表現良好，Evernorth 實現了穩健的營收和利潤增長，而 Cigna Healthcare 的業績符合預期，儘管我們的個人交易業務受到了不利的風險調整影響，我將很快討論這一點。

First, turning to Evernorth results. Evernorth continues to deliver strong performance, with second quarter 2023 revenues growing 10% to $38.2 billion, and pretax adjusted earnings were $1.5 billion. Evernorth's results in the quarter were driven by continued strong performance in our differentiated specialty pharmacy business, which had year-over-year revenue growth in the mid-teens, and our focus on providing a variety of solutions that drive affordability and lowest net cost for our customers and clients.

首先，轉向永北的結果。 Evernorth 繼續表現強勁，2023 年第二季度收入增長 10%，達到 382 億美元，稅前調整後收益為 15 億美元。 Evernorth 本季度業績的推動因素是我們差異化專業製藥業務的持續強勁表現，該業務的收入同比增長了十幾歲，以及我們專注於提供各種解決方案，以提高人們的負擔能力和最低的淨成本。我們的客戶和客戶。

Additionally, we continue to build out our cross-enterprise leverage capabilities harnessing data and technology to accelerate innovation for customers and clients. And we also continue to make strategic investments to further enhance and expand our client relationships, diversify our portfolio of products and services, prepare for new clients in 2024 and advance our technology capabilities.

此外，我們繼續構建跨企業槓桿能力，利用數據和技術來加速客戶和客戶的創新。我們還繼續進行戰略投資，以進一步加強和擴大我們的客戶關係，使我們的產品和服務組合多樣化，為 2024 年的新客戶做好準備，並提高我們的技術能力。

Overall, Evernorth has delivered strong first half results and we are well positioned as we look to the back half of the year. Our diversified solutions allow us to sustain momentum by delivering differentiated value to our customers and clients, helping them overcome key healthcare challenges.

總體而言，Evernorth 上半年業績強勁，展望下半年，我們處於有利地位。我們的多元化解決方案使我們能夠通過為客戶和客戶提供差異化​​價值來保持發展勢頭，幫助他們克服關鍵的醫療保健挑戰。

Turning to Cigna Healthcare. Second quarter 2023 adjusted revenues grew 12% to $12.7 billion. Pretax adjusted earnings were $1.2 billion, and the medical care ratio was 81.2%. The medical care ratio reflects some items specific to our individual exchange business that largely offset one another in the quarter.

轉向 Cigna 醫療保健。 2023 年第二季度調整後收入增長 12%，達到 127 億美元。稅前調整後收益為12億美元，醫療保健比例為81.2%。醫療保健比率反映了我們個人兌換業務特有的一些項目，這些項目在本季度基本上相互抵消。

After receiving our first view of industry-wide risk adjustment data in early July, we increased our full year 2023 estimated individual exchange risk adjustment payable. It's important to note, this was primarily driven by 2 states. Within those 2 states, the unfavorable impact from the first half of 2023 was about $80 million and was recognized in the second quarter. We expect a similar magnitude of impact in the back half of the year. Additionally, this impact is isolated to the 2023 calendar year as we have taken corrective pricing actions in the impacted geographies in our 2024 REIT filings.

在 7 月初收到第一批全行業風險調整數據後，我們上調了 2023 年全年預計應付的個別匯率風險調整。值得注意的是，這主要是由兩個州推動的。在這兩個州中，2023 年上半年的不利影響約為 8000 萬美元，並在第二季度得到了確認。我們預計今年下半年也會產生類似程度的影響。此外，這種影響僅限於 2023 日曆年，因為我們已在 2024 年房地產投資信託基金備案中對受影響地區採取了糾正定價措施。

Specific to the second quarter, the unfavorable risk adjustment payable impact was largely offset by a favorable update to our 2022 risk adjustment receivable within the individual exchange business. Underlying fundamentals across the Cigna Healthcare segment continued to perform well as we further expanded our relationships and delivered affordability for our customers and clients. As we have mentioned on prior calls, we planned and priced for more normalized levels of utilization this year.

具體到第二季度，不利的應付風險調整影響在很大程度上被我們個人交易所業務中 2022 年風險調整應收賬款的有利更新所抵消。隨著我們進一步擴大我們的關係並為我們的客戶和客戶提供負擔能力，整個 Cigna Healthcare 部門的基本面繼續表現良好。正如我們在之前的電話會議中提到的，我們為今年更加標準化的利用率水平進行了計劃和定價。

Our year-to-date claims experience has been broadly in line with this expectation, across both commercial and Medicare Advantage.

我們今年迄今為止的理賠經驗在商業和 Medicare Advantage 方面基本符合這一預期。

Turning to Cigna Healthcare Medical customers. We ended the quarter with 19.5 million total medical customers, growth of approximately 1.5 million customers year-to-date across all businesses. Within our government business, medical customers grew sequentially and year-to-date Medicare Advantage has grown 12%.

轉向 Cigna Healthcare 醫療客戶。截至本季度末，我們的醫療客戶總數為 1,950 萬，今年迄今為止所有業務的客戶數量增長了約 150 萬。在我們的政府業務中，醫療客戶連續增長，年初至今 Medicare Advantage 增長了 12%。

Overall, Cigna Healthcare's results in the quarter were solid as we demonstrated strong underlying fundamentals despite the increased 2023 individual exchange risk adjustment payable previously mentioned. And we continue to grow our customer and client relationships, providing differentiated value and driving affordability.

總體而言，儘管前面提到的 2023 年應付個人外匯風險調整有所增加，但 Cigna Healthcare 本季度的業績依然穩健，因為我們展現了強勁的基本面。我們繼續發展我們的客戶和客戶關係，提供差異化​​的價值並提高可負擔性。

Now turning to our outlook for full year 2023. We have increased our expectations for full year 2023, consolidated adjusted revenues to at least $190 billion, driven by continued strength in our businesses as we continue to deliver innovative services and solutions for the benefit of our customers, patients and clients. We are reaffirming our adjusted earnings per share outlook of at least $24.70 per share. And we expect adjusted EPS to be split approximately evenly between the third and fourth quarters.

現在轉向我們對2023 年全年的展望。我們提高了對2023 年全年的預期，在我們業務持續強勁的推動下，我們繼續提供創新服務和解決方案，以造福我們的客戶，綜合調整後收入至少達到1,900 億美元。顧客、患者和客戶。我們重申調整後每股收益前景至少為 24.70 美元。我們預計調整後的每股收益將在第三季度和第四季度之間大致平均分配。

In Evernorth, we continue to expect full year 2023 adjusted earnings of at least $6.4 billion. With respect to Evernorth earnings' cadence, we expect mid-single-digit year-over-year adjusted earnings' growth in the third quarter and mid- to high single-digit adjusted earnings' growth in the fourth quarter.

我們繼續預計 Evernorth 2023 年全年調整後收益至少為 64 億美元。就Evernorth的盈利節奏而言，我們預計第三季度調整後盈利同比增長為中個位數，第四季度調整後盈利增長為中個位數至高。

In Cigna Healthcare, we continue to expect full year 2023 adjusted earnings of at least $4.425 billion. We expect third quarter Cigna Healthcare adjusted earnings to be slightly below 55% of second half adjusted earnings to reflect seasonal patterns as well as the rate and pace of investments. This incorporates the impact from the estimated individual exchange risk adjustment payable in the second half of the year, which is offset by other items in Cigna Healthcare, including expense efficiencies. Additionally, we continue to expect our 2023 medical care ratio to be within the range of 81.5% to 82.3%.

對於 Cigna Healthcare，我們繼續預計 2023 年全年調整後收益至少為 44.25 億美元。我們預計 Cigna Healthcare 第三季度調整後收益將略低於下半年調整後收益的 55%，以反映季節性模式以及投資率和步伐。這包括下半年應付的估計個人匯率風險調整的影響，該影響被 Cigna Healthcare 的其他項目（包括費用效率）所抵消。此外，我們繼續預計 2023 年醫療保健比率將在 81.5% 至 82.3% 的範圍內。

Switching gears, let's move to our 2023 capital management position and outlook. Year-to-date through August 2, 2023, we have repurchased approximately 3.8 million shares of common stock for approximately $1.1 billion. The continued strength of our cash generation gives us the confidence to increase our full year 2023 expected cash flow from operations by $500 million to at least $9.5 billion for the full year. Our balance sheet and cash flow outlook remains strong, benefiting from our highly efficient service-based model that drives strategic flexibility, strong margins and attractive returns on capital.

換個話題，讓我們談談 2023 年的資本管理立場和展望。年初至今，截至 2023 年 8 月 2 日，我們已回購約 380 萬股普通股，價值約 11 億美元。我們現金流的持續強勁使我們有信心將 2023 年全年預期運營現金流增加 5 億美元，達到全年至少 95 億美元。我們的資產負債表和現金流前景依然強勁，這得益於我們基於服務的高效模式，該模式推動了戰略靈活性、強勁的利潤率和有吸引力的資本回報。

Now to recap. Second quarter results were strong, reflecting high-quality underlying fundamentals in our foundational and accelerated businesses, giving us confidence to deliver on our 2023 adjusted EPS guidance of at least $24.70. And we continue to expect 2024 adjusted EPS of at least $28 consistent with our prior commentary. And with that, we'll turn it over to the operator for the Q&A portion of the call.

現在回顧一下。第二季度業績強勁，反映出我們基礎業務和加速業務的高質量基本面，使我們有信心實現 2023 年調整後每股收益至少 24.70 美元的目標。我們繼續預計 2024 年調整後每股收益至少為 28 美元，與我們之前的評論一致。這樣，我們會將其轉交給接線員進行通話的問答部分。

(Operator Instructions)

（操作員說明）

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

我們的第一個問題來自斯科特·菲德爾先生和斯蒂芬斯。

Appreciate the color on the risk adjustment dynamics. I think that helps also explain some of the rate increases that we've seen you filing in some of those pertinent states like Georgia for 2024.

欣賞風險調整動態的色彩。我認為這也有助於解釋我們看到你們在佐治亞州等一些相關州提交的 2024 年加息申請。

My question is if we back out the risk adjustment impacts from both '22 and '23, can you give us an update on how you view sort of underlying utilization and cost trends in the marketplace and the individual business for 2023?

我的問題是，如果我們取消“22”和“23”的風險調整影響，您能否向我們介紹您如何看待 2023 年市場和個體業務的基本利用率和成本趨勢？

And how you'd say sort of core, I guess, its exchange margins are tracking towards your longer-term view in '23. And as you put these price increases in for '24, how that will sync up relative to the long-term sort of 4% to 6% pretax margins that you've historically sort of manage the individual business for?

我想，你會說，它的核心匯率正在朝著你 23 年的長期觀點發展。當您將這些價格上漲計入 24 年時，相對於您歷來管理個人業務的 4% 至 6% 的長期稅前利潤率，這將如何同步？

Scott, it's Brian. I'll try to take each of those bites kind of one at a time. So as I mentioned in my comments, in the quarter, we had an $80 million impact from the risk adjustment payable matter in 2023, which reflects essentially a true-up for the first 2 quarters of the year. But that was largely offset in the quarter by the favorable true-up we had on the 2022 risk adjustment settlement.

斯科特，這是布萊恩。我會嘗試一次只咬一口。正如我在評論中提到的，在本季度，我們因 2023 年應付風險調整事項而產生了 8000 萬美元的影響，這基本上反映了今年前兩個季度的情況。但這在本季度很大程度上被我們對 2022 年風險調整和解協議的有利調整所抵消。

The other residual piece within the individual exchange business is we had some favorable claim cost experience in the first half of the year. So the $80 million was offset largely by the 2022 risk adjustment settlement, but also, to a lesser degree, by favorable cost trend within our individual exchange business, which reflects a younger, healthier population than what we had in 2022. So claim costs there, certainly within check, but we had the larger payable, which creates the pressure point for the year.

個人兌換業務中的另一個剩餘部分是我們在上半年獲得了一些有利的索賠成本經驗。因此，這8000 萬美元在很大程度上被2022 年風險調整和解協議所抵消，但在較小程度上也被我們個人兌換業務中有利的成本趨勢所抵消，這反映出比2022 年我們的人口更年輕、更健康。因此，那裡的索賠成本，當然在控制範圍內，但我們的應付賬款較大，這造成了今年的壓力點。

As it relates to the profit margins and how to think about where we are in '23 and the rate increase impact on '24. Just for some context here, you can think of this business being approximately a $5 billion block for us in 2023 in terms of premium revenue. And we had shared on a prior call that we were anticipating the individual exchange book to run below our target margins within 2023. As you noted, our long-term target for this business is 4% to 6%.

因為它關係到利潤率以及如何思考我們在 23 年的處境以及加息對 24 年的影響。就這裡的一些背景而言，您可以認為，就保費收入而言，到 2023 年，這項業務對我們來說約為 50 億美元。我們在之前的電話會議上表示，我們預計 2023 年個人交換賬簿的利潤率將低於我們的目標利潤率。正如您所指出的，我們對該業務的長期目標是 4% 至 6%。

For the remainder of this year, we're expecting another $80 million of risk adjustment payable impact across the second half, which, as I mentioned, will be offset by the strength across the broader Cigna Healthcare portfolio including expense efficiencies.

在今年剩餘時間裡，我們預計下半年將產生 8000 萬美元的應付風險調整影響，正如我所提到的，這將被更廣泛的 Cigna Healthcare 投資組合（包括費用效率）的實力所抵消。

When you put all this together, the individual exchange margins in 2023 will be below our prior estimates. And for 2024, we have taken sizable price increases in our 2 largest states. So we would expect some degree of margin expansion in the individual exchange book overall in '24 relative to '23. The exact amount of that margin improvement will end up being a function of our geographic and customer mix in 2024 as we are likely to have fewer customers in the individual exchange business in 2024 relative to where we are in 2023.

當你把所有這些放在一起時，2023 年各個交易所的利潤率將低於我們之前的估計。到 2024 年，我們在兩個最大的州大幅提價。因此，我們預計 24 年個人交易簿總體利潤率相對於 23 年將出現一定程度的擴張。利潤率改善的具體金額最終將取決於 2024 年我們的地理和客戶組合，因為相對於 2023 年，我們在 2024 年個人交易所業務中的客戶可能會減少。

So thanks for the question. Hopefully, you can follow all those moving pieces.

謝謝你的提問。希望您能跟隨所有這些動人的片段。

Our next question comes from Mr. A.J. Rice with Crédit Suisse.

我們的下一個問題來自 A.J. 先生。瑞士信貸的米飯。

I know at this point in the year, large employers are well on their way to thinking about their '24 outlook both from health benefits and also on the pharmacy benefit side. I wondered if given you've got a great window on all of that, anything interesting to call out in terms of priorities for employers around benefit design, focus on particular categories of healthcare, whether -- I know sometimes it's diabetes, sometimes payment planning

我知道今年這個時候，大型雇主正在從健康福利和藥品福利方面考慮他們的“24”前景。我想知道您是否對所有這些都有一個很好的了解，在福利設計方面雇主優先考慮的任何有趣的事情，重點關注特定類別的醫療保健，我知道有時是糖尿病，有時是付款計劃

Anything on the cost management focus? I know there's a lot of discussion about GLP-1s and wonder whether they're focused on trying to manage that more effectively. And then just overall expectations in those customers around cost trends and -- are they assuming it's sort of a more normalized outlook going into '24? Or are they making any assumptions about pent-up demand or anything?

有什麼關於成本管理的重點嗎？我知道有很多關於 GLP-1 的討論，並且想知道他們是否專注於嘗試更有效地管理它。然後，這些客戶對成本趨勢的總體期望——他們是否認為進入 24 年後前景會更加正常化？或者他們是否對被壓抑的需求或其他什麼做出了任何假設？

It's David. Let me describe a little bit of the -- we'll say the buying characteristics and areas of focus in the market more broadly, and then I'll ask Eric to give you a little bit more color in terms of the pharmacy-specific space and using your GLP-1 as an example.

是大衛。讓我描述一下——我們會更廣泛地描述市場的購買特徵和關注領域，然後我會請埃里克在藥房特定領域為您提供更多信息並以您的 GLP-1 為例。

So stepping back, and it's for the latter part of your comment to reinforce it. The buying behaviors continue to have an intense focus on what I will call base-buying needs focus on affordability, coupled with consistent high-quality service levels.

因此，退後一步，您的評論的後半部分將強化這一點。購買行為繼續高度關注我所說的基礎購買需求，即關注可負擔性以及始終如一的高質量服務水平。

There's 2 additional dimensions, I would say, that have intensified recently relative to need state. One, as employers, because you're coming at through the employer lens continue to intensify their focus on having healthy, engaged, highly productive workforce. They're intensifying their focus and need and awareness of the complex behavioral health needs from their population, inclusive of, but also beyond the more intense behavioral health dimensions. This includes anxiety, stress, depression and complexity to come along with that.

我想說，最近相對於需求狀態而言，還有兩個額外的維度有所加強。第一，作為雇主，因為你從雇主的角度來看，他們會繼續加強對擁有健康、敬業、高生產力的員工隊伍的關注。他們正在加強對人口復雜行為健康需求的關注、需求和認識，包括但也超出了更強烈的行為健康維度。這包括焦慮、壓力、抑鬱和隨之而來的複雜性。

Here, I would note that within our Cigna Group, portfolio of solutions, we're well positioned to meet the needs because there's a lot of coordination that's necessary to advance there.

在這裡，我要指出的是，在我們的 Cigna 集團解決方案組合中，我們能夠很好地滿足需求，因為需要進行大量協調才能實現這一目標。

The second trend I'd highlight is what the marketplace is sometimes calling point solution fatigue, where over time, employers have aggregated many individual point solutions that made sense at a given moment in time, but they find themselves stepping back and looking at that inventory questioning whether or not either, a, they're getting all the value out of each individual solution; or b, the friction and/or abrasion for their coworkers or medical professionals is worth the value of the fractured point solutions, and therefore, are challenging more opportunities to coordinate or integrate solutions to get more value, leverage and better service from that standpoint.

我要強調的第二個趨勢是市場有時稱之為點解決方案疲勞，隨著時間的推移，雇主聚集了許多在特定時刻有意義的單獨的點解決方案，但他們發現自己退後一步並查看該庫存質疑是否，a，他們是否從每個單獨的解決方案中獲得了所有價值； b，其同事或醫療專業人員的摩擦和/或磨損值得破碎點解決方案的價值，因此，他們正在挑戰更多協調或集成解決方案的機會，以便從這個角度獲得更多價值、影響力和更好的服務。

And again, our portfolio is really well positioned there and continues to resonate in the market as evidenced by our growth. I'll ask Eric to provide a little bit of color of areas of focus for buyers more broadly in pharmacy, including the GLP-1.

再說一次，我們的投資組合在那裡確實處於有利位置，並繼續在市場中引起共鳴，我們的增長就證明了這一點。我將請 Eric 為更廣泛的藥房買家提供一些關注領域的顏色，包括 GLP-1。

Great. Thanks, David. I'll start with the GLP-1. GLP-1s are definitely top of mind for many of our clients. There's been a meaningful uptick in utilization here. And as I think you know, we have coverage for these medications on our formularies from early on for value-based arrangements with pharma manufacturers, we've seen contributions for the benefit of patients and our clients by result of the structures. We have recently launched a program called InCircleRx, which brings together management of the GLP-1 cardiac, diabetic conditions, obesity. So these conditions often tend to be interrelated, to bring together a benefit plan design, the clinical support as necessary and the overall resources we can bring to help these patients, better manage their health and ultimately get to a better plan costs.

偉大的。謝謝，大衛。我將從 GLP-1 開始。 GLP-1 絕對是我們許多客戶最關心的問題。這裡的利用率顯著上升。我想你知道，我們從一開始就在我們的處方集中涵蓋了這些藥物，與製藥商進行了基於價值的安排，我們已經看到這些結構為患者和客戶的利益做出了貢獻。我們最近啟動了一個名為 InCircleRx 的項目，該項目匯集了 GLP-1 心臟、糖尿病和肥胖的管理。因此，這些條件往往是相互關聯的，將福利計劃設計、必要的臨床支持以及我們可以提供的總體資源結合在一起，以幫助這些患者，更好地管理他們的健康並最終獲得更好的計劃成本。

So at GLP-1 and the broader cardiac, obesity, diabetes space is a real area of focus. I would also note as David touched on in his comments, continued interest in behavioral solutions. That's an area that we've got strong expertise within Evernorth, and we're excited about the opportunities in that market and the need to help manage behavioral care more effectively.

因此，在 GLP-1 和更廣泛的心臟領域，肥胖、糖尿病領域是一個真正的重點領域。我還想指出，正如大衛在評論中談到的那樣，人們對行為解決方案持續感興趣。這是我們 Evernorth 擁有豐富專業知識的領域，我們對該市場的機會以及幫助更有效地管理行為護理的需求感到興奮。

Those will probably be the top couple of specific themes I would call out at this point, A.J.

這些可能是我此時要指出的最重要的幾個具體主題，A.J.

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。

A couple of quick questions. One, just so I appreciate your comments on cost trend, but did see a pretty big pickup in medical costs payable in the quarter relative to reserve growth. Just curious what drove that.

幾個簡單的問題。一，我很欣賞您對成本趨勢的評論，但確實看到本季度應付醫療費用相對於準備金增長有相當大的上升。只是好奇是什麼推動了這一點。

And then, just stepping back, the Stop Loss business has seen a nice acceleration this year up in the teens. Just curious what you're seeing there? And do you expect that to be the kind of the trajectory after we've seen a bit of a slowdown over the last few years?

然後，退一步來說，止損業務今年已經看到了十幾歲的良好加速。只是好奇你在那裡看到了什麼？在我們看到過去幾年的放緩之後，您是否認為這會是這種軌跡？

Justin, it's Brian. I'll start, and I think David will pile on in terms of the Stop Loss component. So as it relates to our medical cost payables or reserves, nothing particular I flag here. We continue to employ a consistent methodology as it relates to how we set our reserves. There'll be some natural variability in this metric as product mix shift tends to occur from quarter-to-quarter. And I know the days claims payable metric is one that's commonly looked at.

賈斯汀，我是布萊恩。我將開始，我認為大衛將在止損部分方面進行補充。因此，由於它與我們的應付醫療費用或準備金有關，我在這裡沒有什麼特別要指出的。我們繼續採用一致的方法，因為它與我們如何設定儲備金有關。由於產品組合往往每個季度都會發生變化，因此該指標會存在一些自然變化。我知道應付索賠天數指標是人們普遍關注的指標。

We don't target or forecast any specific level of DCP rather this is more the output of our detailed assumption setting that's been aggregated up to the enterprise level. So we remain comfortable with our reserving methodology and confidence in the adequacy of the balance sheet.

我們不針對或預測任何特定的 DCP 水平，而這更多的是我們匯總到企業級別的詳細假設設置的輸出。因此，我們對我們的準備金方法仍然感到滿意，並對資產負債表的充足性充滿信心。

As it relates to Stop Loss, you're right. We're seeing nice growth in that product line. We've got 13% year-on-year premium growth. We're on track to achieve our target profitability in that business this year. So nice performance, and it continues to resonate with our clients. David, anything you want to add in that regard?

由於它與止損有關，你是對的。我們看到該產品線的良好增長。我們的保費同比增長 13%。我們今年有望實現該業務的盈利目標。如此出色的表現，並持續引起我們客戶的共鳴。大衛，在這方面你有什麼要補充的嗎？

Yes. Thanks, Brian. The item I amplify is just a recall from prior conversations, part of our consultative approach and go-to-market approach is when you work with clients of a variety of sizes around the benefit design that matches their strategy, the clinical programs in support of that, the master strategy, the service support program for the master strategy. The final thing we work on is the funding mechanism. And as the market conditions change, we have the ability to flex between risk or guarantee cost, shared returns and/or self-funded with Stop Loss and our stop-loss program, as you call out, continues to perform well, grow well and resonate in the marketplace because it provides that peace of mind and predictability for employers around their cash flow and any dislocation that may happen in a given year.

是的。謝謝，布萊恩。我強調的內容只是對之前對話的回憶，我們的諮詢方法和進入市場方法的一部分是，當您與各種規模的客戶合作時，圍繞與他們的戰略相匹配的福利設計、支持的臨床計劃即總戰略、總戰略的服務支持計劃。我們要做的最後一件事是融資機制。隨著市場狀況的變化，我們有能力在風險或擔保成本、共享回報和/或通過止損自籌資金之間進行調整，正如您所說，我們的止損計劃繼續表現良好，增長良好，並且之所以能在市場上引起共鳴，是因為它讓雇主能夠安心並可預測其現金流以及特定年份可能發生的任何混亂。

So our specialists in that space have a high-performing book. It continues to resonate well. And you'll see ebb and flow over time based on market buying conditions, but continued growth.

因此，我們該領域的專家擁有一本表現出色的書。它繼續引起良好的共鳴。隨著時間的推移，您會看到根據市場購買條件的變化，但會持續增長。

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 want to come back to the pharmacy side of the business for a minute and ask a couple of questions. When I think about the quarter, can you talk about the margin impact from, one, GLP-1s, I know you talked about strength there; two, the shift to biosimilars; and three, the Centene implementation costs. Can you just talk about how each of those had an impact on the margin in the quarter?

我只想回到藥房業務方面，問幾個問題。當我想到本季度時，您能否談談 GLP-1 對利潤率的影響，我知道您談到了那裡的實力；二、轉向生物仿製藥；第三，Centene 的實施成本。您能否談談其中每一項對本季度利潤率的影響？

And then just as a follow-up, when you talked about the 2024 selling season, more specific on the PBM side. Can you maybe just give a little more detail as to how renewals went and what your retention rates are expected to be for '24?

作為後續行動，當您談到 2024 年銷售季節時，更具體地說是 PBM 方面。您能否更詳細地說明續訂的進展情況以及 24 年的預期保留率是多少？

Lisa, it's Brian. I'll start. I think that's a multiparter, and then Eric is going to chime in with some comments on the sales season. But as it relates to the quarter, overall, Evernorth continues to perform really well. So I'd start there and largely in line with our expectations when you put all the different moving pieces together.

麗莎，是布萊恩。我開始吧。我認為這是一個多方合作，然後埃里克將對銷售季節發表一些評論。但就本季度而言，總體而言，Evernorth 的表現仍然非常出色。因此，當您將所有不同的移動部件組合在一起時，我將從這裡開始，並且很大程度上符合我們的期望。

The individual components you kind of called out there, Eric referenced earlier, GLP-1 utilization does continue to build, which in the Evernorth business is a positive contributor to our earnings at this point in time, whether that be for diabetic indications or nondiabetic indications. So that's certainly a net positive relative to the Evernorth business in 2023.

Eric 之前提到過，您提到的各個組成部分，GLP-1 的利用率確實在繼續增加，這在Evernorth 業務中對我們目前的收入做出了積極貢獻，無論是針對糖尿病適應症還是非糖尿病適應症。因此，相對於 2023 年 Evernorth 業務來說，這無疑是一個淨利好消息。

On the biosimilar side of the house, you should think of, thus far, relatively low adoption of AMJEVITA in the first half of the year. On the second half of the year, we obviously added 2 additional biosimilars into the National Preferred Formulary. And one of the reasons we expect acceleration in income growth in the third and fourth quarter is the impact of greater biosimilar adoption as well as improved overall positioning relative to the dynamics of competitiveness across the 4 drugs that will be on the National Preferred Formulary.

在生物仿製藥方面，您應該想到，到目前為止，今年上半年 AMJEVITA 的採用率相對較低。今年下半年，我們顯然在國家優先處方中添加了 2 個生物類似藥。我們預計第三季度和第四季度收入增長加速的原因之一是生物仿製藥採用率的提高以及相對於將列入國家首選處方集的 4 種藥物的競爭力動態而言整體定位改善的影響。

But in the second quarter, I wouldn't characterize biosimilars as a particular driver of the margin profile. On the Centene impact, we remain very much on track relative to the implementation against our commitments as we mentioned before, we expect to spend about $200 million over the course of 2023. You should think of that as gradually building quarter-to-quarter over the course of the year. And so the money is being spent as we speak. And all those factors did impact the second quarter. But again, nothing in particular I would call out being significantly deviating from our expectations compared to what we expected 3 months ago. Eric, maybe you can pick up both on Centene and the selling season.

但在第二季度，我不會將生物仿製藥視為利潤狀況的特定驅動因素。關於 Centene 的影響，正如我們之前提到的，我們在兌現承諾方面仍處於正軌，我們預計在 2023 年期間將花費約 2 億美元。您應該將其視為逐季度逐步建設這一年的歷程。所以，就在我們說話的時候，錢已經被花掉了。所有這些因素確實影響了第二季度。但同樣，與 3 個月前的預期相比，我不會特別指出與我們的預期有顯著偏差。 Eric，也許你可以同時了解 Centene 和銷售季節。

Great. Thanks, Brian. So just a couple of other comments on Centene. I'm really pleased with how we are working together to deliver an implementation program to serve Centene's customers. We are on track, and there's good momentum in the readiness for our January '24 implementation. So continue to be excited about that opportunity.

偉大的。謝謝，布萊恩。關於 Centene 的其他一些評論。我對我們如何共同努力交付實施計劃來服務 Centene 的客戶感到非常滿意。我們已步入正軌，並且為 24 月 1 月的實施做好了良好的準備。因此，請繼續對這個機會感到興奮。

With respect to the selling season more broadly, we operate in a competitive market, and the strength of our solutions really continues to resonate. We will deliver another strong retention rate. As we look to the 2024, I think mid-90s are higher and consistent with our prior commentary around what a strong retention rate looks like, we'll have additional new growth, new client wins on top of the large Centene wins as well. So feeling good as we kind of wind down the 2024 selling season at this point, and we'll provide more detail on that when we provide our 2024 guidance later on.

就更廣泛的銷售季節而言，我們在競爭激烈的市場中運營，我們的解決方案的實力確實繼續引起共鳴。我們將提供另一個強勁的保留率。當我們展望2024 年時，我認為90 年代中期會更高，這與我們之前關於強勁保留率的評論一致，我們將有更多的新增長，除了Centene 的巨大勝利之外，還會贏得新客戶。因此，隨著 2024 年銷售季節的結束，我們感覺很好，稍後我們將在提供 2024 年指導時提供更多詳細信息。

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

我們的下一個問題來自美國銀行的 Kevin Fischbeck。

I wanted to get a little more color on the increased enrollment outlook. I guess you've indicated in the past that you're being a little bit conservative about the session and determinations. Were those -- anything changed there to drive that? Or was it new customer growth? Just a little color.

我想對入學人數增加的前景有更多的了解。我想您過去曾表示您對會議和決定有點保守。那些——有什麼改變來推動這一點嗎？或者是新客戶的增長？只是一點點顏色。

Kevin, it's Brian. So I'll start, and I think your question is specific to Cigna Healthcare, which is where I'll go. So first off, we're really pleased with the strong growth momentum across the Cigna Healthcare book. If you look at our year-to-date customer growth, it's running ahead of expectations at $1.5 million net growth, and that builds off of a strong performance we had in 2022, where we added nearly 1 million customers across the Cigna Healthcare platform.

凱文，我是布萊恩。那麼我就開始吧，我認為你的問題是針對 Cigna Healthcare 的，我將去那裡。首先，我們對 Cigna Healthcare 的強勁增長勢頭感到非常滿意。如果你看看我們今年迄今為止的客戶增長，就會發現淨增長150 萬美元，超出了預期，這是建立在我們2022 年強勁業績的基礎上的，當時我們在Cigna Healthcare 平台上增加了近100萬客戶。

As it relates to our refreshed membership outlook for the year, you can think of the primary driver of that being an elevated expectation for individual exchange customers by year-end 2023. The other components of the Cigna Healthcare customer outlook are broadly unchanged from our prior projections. We're not yet seeing meaningful signs of any economic pressure within our commercial book of business. But that said, we have assumed some elevated disenrollment in the U.S. commercial business in the second half of 2023 in order to be prudent.

由於它與我們今年更新的會員前景相關，您可以認為其主要驅動因素是到 2023 年底對個人交易所客戶的期望提高。Cigna Healthcare 客戶前景的其他組成部分與我們之前的預期基本沒有變化。預測。我們尚未在我們的商業業務中看到任何經濟壓力的有意義的跡象。但話雖如此，為了謹慎起見，我們假設 2023 年下半年美國商業業務的退出人數會有所增加。

We continue to exclude any potential Medicaid redetermination lives from our commercial forecast for the balance of the year. And taken all together, again, pleased to see a full year outlook of 8% growth in total medical customers across Cigna Healthcare. One minor refinement we made this year or this quarter relative to the individual exchange businesses, we are now forecasting some level of Medicaid redeterminations coming in through the balance of the year. So you should think of the commercial business, excluding Medicaid redetermination of the individual forecast now including some level of redeterminations for the balance of the year.

我們繼續將任何潛在的醫療補助重新確定壽命排除在今年剩餘時間的商業預測之外。總而言之，我們再次高興地看到 Cigna Healthcare 的醫療客戶總數預計全年增長 8%。我們在今年或本季度對個人交換業務進行了一項細微的改進，我們現在預測今年剩餘時間將進行一定程度的醫療補助重新確定。因此，您應該考慮商業業務，不包括現在對個人預測的醫療補助重新確定，包括對今年剩餘時間的某種程度的重新確定。

Our next question comes from Josh Raskin with Nephron Research.

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

Just clarification on the exchange true-ups and the impact there. I just want to make sure I get this right. I assume you've got a bigger payable, but that probably means that your claims costs are coming in a little bit better. So I just want to see if there's actually any offset from the receivable from last year. So I just want to see if there's actually an EPS impact expected for this year.

只是澄清交易所的真實情況及其影響。我只是想確保我做對了。我假設您的應付金額更大，但這可能意味著您的索賠費用會好一點。所以我只是想看看去年的應收賬款是否真的有任何抵消。所以我只是想看看今年的每股收益是否真的會受到影響。

And then my real question is just could you speak to your MA bid strategy for 2024? I'm specifically interested in how you're thinking about benefit design in light of rates and the risk model changes? And then if there's anything to talk about the VillageMD partnership, if that impacts any way you're bidding in certain markets?

然後我真正的問題是，您能談談您 2024 年的 MA 出價策略嗎？我特別感興趣的是，您如何根據利率和風險模型的變化來考慮福利設計？那麼，如果有什麼關於 VillageMD 合作夥伴關係的話題，這是否會影響您在某些市場的競價方式？

Josh, it's Brian. So I'll take the first one, and then David will pick up on the Medicare Advantage question. So as it relates to the different payable dynamics, let me try to give you the full picture here. So just for some context, we ended the quarter with about 820,000 customers in the individual exchange business. That was up significantly from where we were at the end of 2022.

喬什，這是布萊恩。我將回答第一個問題，然後 David 將討論 Medicare Advantage 問題。因此，由於它涉及不同的應付動態，讓我嘗試在這裡向您提供完整的情況。因此，僅就某些背景而言，本季度末我們的個人交易所業務客戶數量約為 820,000 名。這比 2022 年底的水平顯著上升。

And during the 2022 year, we were in a risk adjustment receivable position on this business. So when we stepped into '23, we had been anticipating that, that would switch over and that will -- we'd be in a payable position for 2023. The first look we got at the industry-wide risk adjustment data that we received in early July indicated that will be in an even greater payable position for the 2023 plan year, and that was driven by 2 large states. Those 2 large states represent about half of the individual exchange premium base.

2022 年，我們對該業務處於應收賬款風險調整狀態。因此，當我們進入 23 年時，我們一直預計，情況會發生轉變，我們將在 2023 年處於應付狀態。我們首先看到的是我們收到的全行業風險調整數據7 月初表示，2023 計劃年的應付款狀況將更高，這是由兩個大州推動的。這兩個大州約佔個人外匯溢價基數的一半。

And the adjustment in the first half of the year that came through the second quarter was an $80 million increase in the payable. That was offset largely by a favorable true-up on the 2022 receivable, you can think of that in the range of about $50 million, and then the residual is primarily driven by favorable claim costs in 2023 relative to our expectations.

上半年的調整是從第二季度開始的，應付賬款增加了 8000 萬美元。這在很大程度上被 2022 年應收賬款的有利調整所抵消，您可以認為其範圍約為 5000 萬美元，然後剩餘部分主要由 2023 年相對於我們的預期有利的索賠成本驅動。

So that favorability in the 2023 claim costs partially offset the increased payable that we have, that ran through the second quarter. So hopefully, that helps to square the picture a little bit on the individual exchange business. David, do you want to pick up on that?

因此，2023 年索賠成本的優惠部分抵消了我們第二季度增加的應付款項。因此，希望這有助於使個人交易業務的情況有所改善。大衛，你想了解一下嗎？

Sure, Brian. So you had 2 questions. Specific to MA and our bid strategy, I'll just speak more broadly. I'm not going to go into detail specifically, Josh, just to manage expectations given the time cycle and the competitive nature. First and foremost, as I noted, we're pleased with our growth in 2023, point one; two, as we look to 2024 to some of the points you made reference to, we expect to see larger-than-average local market variability in terms of offering and positioning by competitors.

當然，布萊恩。所以你有兩個問題。具體到 MA 和我們的出價策略，我只會更廣泛地談論。喬什，我不會具體討論細節，只是為了管理考慮到時間週期和競爭性質的期望。首先，正如我所指出的，我們對 2023 年的增長感到滿意，第一點；第二，正如我們展望 2024 年您提到的一些觀點一樣，我們預計競爭對手的產品和定位方面的本地市場變化將大於平均水平。

And at this point, I would highlight and reinforce that we remain convicted to and comfortable with our bid assumptions relative to underlying medical costs based upon what we've seen through the first 2 quarters of the year and our outlook for the year. I'd also note that our starts position coming into the cycle is consistent and strong and our early look at the starts on a go-forward basis remains consistent and strong from that standpoint.

在這一點上，我要強調並強調，根據我們今年前兩個季度的情況和對今年的展望，我們仍然對相對於基本醫療成本的出價假設深信不疑並感到滿意。我還要指出的是，我們進入周期的開局位置是一致和強勁的，從這個角度來看，我們對未來開局的早期看法仍然是一致和強勁的。

Specifically to your last point around Village, first and foremost, I'd ask you to think about initiating the relationship with Village, we seek to have a long-term strategic positive impact. I would note that day 1 for the benefit of our customers who are experiencing Village and Summit relationships, they began to see benefits immediately by the nature of the structure of our relationship and then we continue to collaborate, innovate on value-based care, whether it's leveraging some Evernorth capabilities like behavioral, virtual or other services, and/or go more deeply into individual markets around more precisely leveraging data and insights to curate subspecialty networks to get the best possible quality and cost and affordability.

具體到您關於 Village 的最後一點，首先也是最重要的是，我請您考慮啟動與 Village 的關係，我們尋求產生長期的戰略積極影響。我要指出的是，第一天，為了體驗Village 和Summit 關係的客戶的利益，他們開始立即看到我們關係結構的本質所帶來的好處，然後我們繼續合作，在基於價值的護理方面進行創新，無論是它正在利用Evernorth 的一些功能，如行為、虛擬或其他服務，和/或更深入地進入各個市場，更精確地利用數據和見解來策劃子專業網絡，以獲得盡可能最好的質量、成本和可承受性。

That benefit will continue to mount as we go forward. And to the core of your question, contribute to market by market, our posture in MA. But specifically, we're driving this initiative with Village and with our Evernorth team to benefit our commercial space as well. So we're pleased with the early traction, a lot of work to do, and it will continue to yield dividends both today and into the future. Thanks, Josh.

隨著我們的前進，這種好處將繼續增加。至於你問題的核心，請逐個市場地做出貢獻，即我們在 MA 中的立場。但具體來說，我們正在與 Village 和 Evernorth 團隊一起推動這一舉措，以使我們的商業空間也受益。因此，我們對早期的牽引力感到滿意，還有很多工作要做，它將在今天和未來繼續產生紅利。謝謝，喬什。

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

我們的下一個問題來自高盛的內森·里奇先生。

I wanted to go back to biosimilars. How has the pricing of biosimilar HUMIRA compared to expectations as more competition come to market?

我想回到生物仿製藥。隨著市場競爭加劇，生物仿製藥 HUMIRA 的定價與預期相比如何？

And given what appears to be a very significant reduction in pricing, does that pull forward the benefit from the HUMIRA biosimilar at all? And for the different options that you added to the formulary, should we think of the economics of each of those as being similar to Evernorth?

鑑於價格似乎大幅下降，這是否會帶來 HUMIRA 生物仿製藥的益處？對於您添加到處方中的不同選項，我們是否應該認為每個選項的經濟學都與 Evernorth 類似？

And then just a quick follow-up on the Cigna Healthcare segment. Brian, could you maybe help us think through the seasonality this year and maybe why that's different than a typical year? And as we think about the 2024 and going forward, do you go back to more normal seasonality in that business?

然後是 Cigna Healthcare 部門的快速跟進。 Brian，您能否幫助我們思考一下今年的季節性以及為什麼與往常不同？當我們考慮 2024 年和未來時，該業務是否會回到更正常的季節性？

It's Eric. I'll start. So as you noted and implied in your question, biosimilars are a really important opportunity to drive competition and for us to then help to make the competition efficient to drive improvements to the affordability of these high-cost specialty medicines. Now in 2023, we've continued to co-prefer HUMIRA on the formulary towards the beginning of the year, we added AMJEVITA to our National Preferred Formulary and recently added Cyltezo and Sandoz's products, both the low and high anti-wax versions onto the NPF. So that's the activity that's gotten us to this point to date.

是埃里克。我開始吧。因此，正如您在問題中指出和暗示的那樣，生物仿製藥是推動競爭的一個非常重要的機會，對我們來說，我們可以幫助提高競爭效率，從而提高這些高成本特種藥物的可負擔性。現在到了2023 年，我們在年初的處方集中繼續共同青睞HUMIRA，我們將AMJEVITA 添加到我們的國家首選處方中，並且最近將Cyltezo 和Sandoz 的產品（低抗蠟版本和高抗蠟版本）添加到了處方中國家基金。這就是我們迄今為止所開展的活動。

I would note, we work through with the manufacturers on the terms of those to drive to the best available cost, the best available expense for our clients. And we have visibility into that pretty early on. So we've navigated and made our arrangements in constructing the placement such as we came into this year, and so I wouldn't want you to think about there being dynamics kind of playing out simultaneously. These are things we have negotiated in advance. We have visibility into as the products come into the market and we work to leverage the competition to continue to improve affordability for the benefit of the clients we serve.

我要指出的是，我們與製造商就這些條款進行合作，以期為我們的客戶提供最佳的可用成本和最佳的可用費用。我們很早就了解這一點。因此，我們已經在構建佈局方面進行了導航和安排，就像我們今年進入的那樣，所以我不希望你考慮同時發生的動態。這些都是我們事先商定好的。我們了解產品進入市場的情況，並努力利用競爭來繼續提高負擔能力，以造福我們所服務的客戶。

Over time, as we drive even more products, more competition, we'll work to continue to bring improved levels of affordability to our clients and continue to construct our offerings in a way that best meet their needs. I hand it over to Brian on the second part of your question.

隨著時間的推移，隨著我們推出更多產品，競爭更加激烈，我們將努力繼續提高客戶的承受能力，並繼續以最能滿足他們需求的方式構建我們的產品。我將你問題的第二部分交給布萊恩。

It's Brian. So as it relates to the Cigna Healthcare seasonality, I'd start to remind you, we expect the second half earnings to be a little bit less than 55% in the third quarter. Relative to the MCR component of that, our prior expectations on the MCR seasonality have not changed. So what I mean by that is the directional pattern we saw, for example, in 2022 on MCR is a reasonable proxy for we'd expect the 2023 quarterly pattern to be, and as a result, the fourth quarter MCR is likely to be the highest quarter of the year as we see more customers meet their deductible and out-of-pocket maximum obligations.

是布萊恩。因此，由於與 Cigna Healthcare 的季節性相關，我開始提醒您，我們預計下半年收益將略低於第三季度的 55%。相對於 MCR 部分，我們之前對 MCR 季節性的預期沒有改變。所以我的意思是我們看到的方向模式，例如，2022 年 MCR 是我們預期 2023 年季度模式的合理代理，因此，第四季度 MCR 很可能是這是今年最高的季度，因為我們看到更多的客戶履行了他們的免賠額和自付費用最高義務。

However, we do expect the pace of SG&A spending to look different than it did last year. For example, we had a step-up in SG&A in the fourth quarter of 2022 that we would not expect to recur in the fourth quarter of '23. The other item that I call your attention to is our net investment income in the fourth quarter of '22 was considerably weaker than what we're expecting to see in the fourth quarter of '23. So those are the primary things to think through as it relates to the seasonality pattern.

然而，我們確實預計 SG&A 支出的步伐將與去年有所不同。例如，我們在 2022 年第四季度提高了 SG&A，但我們預計不會在 23 年第四季度再次出現這種情況。我提請您注意的另一件事是我們 22 年第四季度的淨投資收入比我們預期的 23 年第四季度要弱得多。因此，這些是需要考慮的主要問題，因為它與季節性模式相關。

As it relates to '24, at this point in time, there's nothing I'd call your attention to that will lead us to think there's any abnormal pattern.

由於它與“24”有關，在這個時間點上，我沒有提請您注意任何會讓我們認為存在任何異常模式的事情。

Our next question comes from Mr. Steven Valiquette.

我們的下一個問題來自 Steven Valiquette 先生。

So I guess to the extent that your Medicare Advantage book is seeing a more normalized utilization trend this year that you baked into your pricing and guidance. Just curious if you have any additional color just for the second quarter and whether it normalized more in the outpatient setting versus inpatient. I just want to hear a little more color on some of the trends by cost category, just given the topic of this is for the industry this quarter?

因此，我認為您的 Medicare Advantage 手冊今年看到了更加規範化的使用趨勢，您已將其納入定價和指導中。只是好奇第二季度是否有任何額外的顏色，以及門診患者與住院患者相比是否更加正常化。我只是想听聽按成本類別劃分的一些趨勢的更多信息，只是考慮到本季度的行業主題？

Steve, it's Brian. So as you noted, we planned and price for more normalized utilization levels in 2023, and our claims experience is largely consistent with that expectation. So within the MA book specifically to the core of your question, we have seen elevated utilization of both outpatient and professional services all year. But important, this should be viewed in the context of what we had forecasted and priced for. So the overall cost trends are largely in line with our expectations in both our second half 2023 guidance and our 2024 bids anticipate that, that dynamic will continue as it relates to specifically within outpatient and professional, surgeries are the area that I'd call your attention to, in particular, orthopedic and cardiovascular.

史蒂夫，我是布萊恩。正如您所指出的，我們計劃在 2023 年實現更加標準化的利用率水平並定價，我們的索賠經驗與這一預期基本一致。因此，在 MA 書中，特別針對您問題的核心，我們發現全年門診和專業服務的利用率都有所提高。但重要的是，這應該在我們的預測和定價的背景下看待。因此，總體成本趨勢在很大程度上符合我們在 2023 年下半年指導和 2024 年投標中的預期，這種動態將持續下去，因為它特別涉及門診和專業手術，我稱之為您的領域特別關注骨科和心血管科。

We did see some level of favorability in inpatients. So those are a few of the subcategories that I'd call your attention to, but all in line with what we had anticipated coming into the year.

我們確實看到住院患者有一定程度的好感。這些是我提請您注意的一些子類別，但都符合我們對今年的預期。

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

我們的下一個問題來自富國銀行的斯蒂芬·巴克斯特先生。

I wanted to ask about some of the moving parts in the P&L this year for Evernorth. In the first half, there's a pretty notable divergence in the growth of revenue and gross profit. And then what you're seeing drop through to earnings? I know that Centene is a big part of that and the investments you're making there. But the trend underneath that still feels like it's pretty notable. Any additional color on what's going on within Evernorth SG&A would be helpful, whether that's investments or mix or anything else that we should be keeping in mind?

我想詢問 Evernorth 今年損益表中的一些變動因素。上半年，收入和毛利的增長出現了相當明顯的分化。那麼你看到收入下降了什麼？我知道 Centene 是其中的重要組成部分以及你們在那裡進行的投資。但其背後的趨勢仍然讓人感覺相當引人注目。任何有關 Evernorth SG&A 內部發生的事情的額外信息都會有所幫助，無論是投資、混合還是我們應該記住的其他任何事情？

Steve, it's Brian. So a few things I'd call your attention to in regards to the profitability margins relative to revenue. We had an expansion of our relationship with the Department of Defense that was effective on January 1, and we had some additional spending that we're kind of working our way into in terms of growing into that. So that certainly weighed down the income growth a bit in the first half of the year.

史蒂夫，我是布萊恩。因此，我想提請您注意有關相對於收入的利潤率的一些事情。我們擴大了與國防部的關係，該關係於 1 月 1 日生效，並且我們正在努力增加一些額外支出，以實現這一目標。因此，這無疑對上半年的收入增長造成了一定程度的拖累。

To your point, the rate pace of investments, particularly around the accelerated growth businesses in Evernorth, both the healthcare services as well as the Accredo specialty pharmacy also impacted the income growth. And then for the back half of the year, we expect accelerated income growth, again, mid-single digits in the third quarter, mid- to high single digits in the fourth quarter, largely driven by the increased ramp for biosimilars. And I would note that, that's not predicated on any meaningful share shift. We have strong visibility to that income emerging in the back half of the year.

就您而言，投資速度，特別是圍繞 Evernorth 加速增長的業務、醫療保健服務以及 Accredo 專業藥房也影響了收入增長。然後，在今年下半年，我們預計收入將再次加速增長，第三季度將實現中個位數增長，第四季度將實現中個位數至高個位數增長，這主要是由生物仿製藥的增長所推動。我要指出的是，這並不以任何有意義的份額轉移為基礎。我們對下半年出現的收入有很強的預見性。

We'll go ahead to Mr. George Hill with Deutsche Bank.

我們將請來德意志銀行的喬治·希爾先生。

I know it's a small piece of the business, but the other revenue inside of Evernorth grew 35% this quarter, accelerating actually versus the prior quarter. I guess it's becoming to some degree, a meaningful portion of the segment. I guess, could you talk about what's driving that growth? And how should we think about the margin profile that's attached to that business?

我知道這只是業務的一小部分，但 Evernorth 內部的其他收入本季度增長了 35%，實際上比上一季度有所增長。我想它在某種程度上正在成為該細分市場的一個有意義的部分。我想，您能談談是什麼推動了這種增長嗎？我們應該如何考慮該業務的利潤狀況？

George, it's Brian. I'll start and then Eric can pick up a bit. So yes, the fees and other revenue in Evernorth is a strong driver of growth granted off of a low base. So important to keep that in mind as you think about the overall P&L. Multiple areas of growth underneath this line. One I'd call out is we're seeing increased demand for PBM service-based solutions, meaning more fee-oriented relationships as we have more and more clients looking for those types of mechanisms.

喬治，是布萊恩。我先開始，然後埃里克可以接一下。所以，是的，Evernorth 的費用和其他收入是低基數增長的強大推動力。當您考慮整體損益時，記住這一點非常重要。這條線下方有多個增長領域。我要指出的是，我們看到對基於 PBM 服務的解決方案的需求不斷增加，這意味著隨著越來越多的客戶尋求此類機制，更多以費用為導向的關係。

We also have contributions from our Evernorth Care businesses reflected here. So for example, MD Live and Evercore are both contributing to that. And then if you're looking at pharmacy other revenue, the CuraScript specialty distribution business has been a strong grower year-on-year. You also recall from some of our prior conversations that we're very focused on driving cross-enterprise leverage between the Cigna Healthcare business and Evernorth. So as Cigna Healthcare procures more and more services from Evernorth, we have some benefit that comes through the fees and the other revenue lines in Evernorth from that as well.

這裡還體現了 Evernorth Care 業務的貢獻。例如，MD Live 和 Evercore 都為此做出了貢獻。然後，如果您關注藥房其他收入，CuraScript 專業分銷業務同比增長強勁。您還記得我們之前的一些談話，我們非常注重推動 Cigna Healthcare 業務和 Evernorth 之間的跨企業槓桿作用。因此，隨著 Cigna Healthcare 從 Evernorth 採購越來越多的服務，我們也可以通過費用和 Evernorth 的其他收入來源獲得一些好處。

So Eric, anything you want to add in terms of further color?

埃里克，你想在進一步的色彩方面添加什麼嗎？

Brian, thanks. You hit the headlines in terms of the main drivers here financially. We'd just note on the fee-based portion of the PBM in particular. This is an area that we've continued to accelerate, David made reference in his prepared remarks around our ClearCareRx program. This builds off of a couple of years of experience that we've got in providing fee-based fully aligned mechanisms in terms of providing the pharmacy benefit and so those fee types of arrangements will come through there.

布萊恩，謝謝。您在財務方面的主要驅動力方面成為了頭條新聞。我們只想特別注意 PBM 的收費部分。這是我們持續加速的一個領域，David 在他針對我們的 ClearCareRx 計劃準備的評論中提到了這一點。這是建立在我們在提供藥房福利方面提供基於費用的完全一致機制方面所獲得的幾年經驗的基礎上的，因此這些費用類型的安排將在那裡實現。

I would say, have you think about the margin profile for that business is very consistent with the other businesses in Express Scripts and the like and then likewise, the growth in our MD Live and behavioral platforms, continue to be an area of real focus for us and continued momentum and into that a driver as well.

我想說，您是否考慮過該業務的利潤狀況與 Express Scripts 等其他業務非常一致，同樣，我們的 MD Live 和行為平台的增長仍然是真正關注的領域我們和持續的動力，也是一個驅動力。

And I would have you think about those margins is also generally in line with the Evernorth segment overall. So we continue to be excited about the opportunity and the momentum that we're building in all of the different lines across the Evernorth portfolio, and you're seeing the growth there come through that line.

我希望您考慮一下這些利潤率總體上也與 Evernorth 細分市場一致。因此，我們繼續對我們在 Evernorth 投資組合的所有不同產品線中建立的機會和勢頭感到興奮，並且您會看到通過該產品線實現的增長。

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

我們的最後一個問題來自伯恩斯坦的蘭斯·威爾克斯先生。

A question on the specialty products in the Healthcare segment. And just had kind of 3 elements to it. One was what sort of utilization trends you were seeing in behavioral, dental and some of the other areas where you're taking some risk? And then a broader question, just understanding how much specialty is contributing to the earnings' power of the business versus just the core medical? And what do you think the cross-sell opportunities might still remain for that business?

關於醫療保健領域的特色產品的問題。並且只有 3 個元素。一是您在行為、牙科和其他一些您冒險的領域看到了什麼樣的利用趨勢？然後是一個更廣泛的問題，只是了解與核心醫療相比，專業對企業盈利能力的貢獻有多大？您認為該業務可能仍然存在哪些交叉銷售機會？

It's Brian. I'll start, and then David, if you want to chime in with anything, feel free. So for a long period of time, as I think you know, our specialty products within Cigna Healthcare has been a really core part of the value proposition as we seek to expand client relationships. So we have few clients that only purchase medical services from us more and more, purchase a full suite because we've demonstrated over time our clinical models perform best when we have a fuller suite of services.

是布萊恩。我先開始，然後大衛，如果你想插話，請隨意。因此，在很長一段時間內，正如我想您知道的那樣，當我們尋求擴大客戶關係時，我們 Cigna Healthcare 的特色產品一直是價值主張的真正核心部分。因此，我們很少有客戶越來越多地從我們這裡購買醫療服務，購買全套服務，因為隨著時間的推移，我們已經證明，當我們擁有更全套的服務時，我們的臨床模型表現最佳。

As it relates to what we're seeing in terms of trends in terms of utilization, behavioral health has certainly been growing at a strong clip, not just this year, but for the past few years. Part of that is by design as we engage with our customers. And over time, that's a good thing because the more utilization we see in behavioral health services, it helps to defray core medical costs over time.

由於它與我們所看到的利用趨勢有關，行為健康無疑一直在強勁增長，不僅是今年，而且在過去幾年也是如此。其中一部分是我們與客戶互動時設計的。隨著時間的推移，這是一件好事，因為我們看到行為健康服務的利用率越高，隨著時間的推移，它有助於支付核心醫療費用。

We've also seen an uptick in dental utilization this year as well, but all of these things are within, again, the boundaries of what we had forecasted and planned for and priced for within our Cigna Healthcare book of business, which is why you're seeing our commercial employer business continue to perform so well financially. And again, that line is on track to achieve target margins here in 2023. And David, anything you want to pick up on here?

今年我們也看到牙科利用率有所上升，但所有這些都在我們 Cigna Healthcare 業務手冊中預測、計劃和定價的範圍內，這就是為什麼您我們看到我們的商業雇主業務在財務上繼續表現良好。再說一遍，該生產線有望在 2023 年實現目標利潤率。大衛，您有什麼想要了解的嗎？

Sure, Brian. A few items to highlight, specifically, just clicked on one more notch in behavioral, as Brian noted, elevated trend and as you would expect, and over a prolonged period of time, I think the last 3 to 5 years, as you click down in it, think about the professional services as such, we continue to innovate new products, new programs, expansion of network, both physical network. We operate the largest virtual behavioral network in America today and then expanding behavioral services even further in our value-based care programs to help medical professionals be a first line of screening and support from that standpoint.

當然，布萊恩。需要強調的一些項目，特別是，正如布萊恩指出的那樣，在行為上又點擊了一個檔次，趨勢上升，正如你所期望的，在很長一段時間內，我認為在過去的3 到5 年裡，當你點擊向下時在其中，思考專業服務本身，我們不斷創新新產品、新方案、擴展網絡、物理網絡。我們今天運營著美國最大的虛擬行為網絡，然後在我們基於價值的護理計劃中進一步擴展行為服務，從這個角度幫助醫療專業人員成為第一線的篩查和支持。

To the last part of your question around the expansion opportunities within our portfolio, you know our portfolio well in terms of the healthcare side of the equation. If you think about the old monitors of Select, I think under 500 employees, middle market, 500 to 5,000 old monitors and Nashville above 5,000 multi-geographic Select to still think about that as totally cross-sold and penetrated. We go to market with bundled solutions. It's a big part of our value proposition, helps us generate a predictable high quality, low trend and outcome.

對於您關於我們投資組合中的擴張機會的問題的最後一部分，您在醫療保健方面非常了解我們的投資組合。如果你考慮 Select 的舊顯示器，我認為在 500 名員工以下、中端市場、500 至 5,000 台舊顯示器以及納什維爾 5,000 台以上的多地域 Select 仍然認為這是完全交叉銷售和滲透。我們以捆綁解決方案進入市場。這是我們價值主張的重要組成部分，幫助我們產生可預測的高質量、低趨勢和結果。

Middle market remains and has a high level of penetration yet there are cross-sell opportunities and national accounts, a lower level of penetration versus the other segments. However, as I noted to A.J.'s question, the point solution fatigue in the marketplace present at even further opportunity as you coordinate those services.

中間市場仍然存在，並且具有較高的滲透率，但存在交叉銷售機會和國民賬戶，與其他細分市場相比，滲透率較低。然而，正如我在回答 A.J. 的問題時指出的那樣，當您協調這些服務時，市場上的單點解決方案疲勞會帶來更多機會。

The last note I would make is as we leverage the breadth of the Evernorth capabilities today and into the future, we're innovating new solutions. So you'll hear us talk more about Pathwell programs to take specific diagnoses and look at reengineering those episodes of care end-to-end. And in cases, to your phraseology, we take risk based on the performance, we hold ourselves accountable based upon the clinical service and financial outcomes.

我要說的最後一點是，當我們利用 Evernorth 今天和未來的廣泛功能時，我們正在創新新的解決方案。因此，您將聽到我們更多地談論 Pathwell 計劃，以進行特定的診斷，並考慮對這些端到端的護理進行重新設計。在某些情況下，用您的措辭來說，我們根據績效承擔風險，根據臨床服務和財務結果對自己負責。

So strong penetration down market, opportunities upmarket, market buying behavior is evolving because of point solution fatigue and importantly, continued innovation will continue to drive growth for us there. Thanks, Lance.

由於單點解決方案疲勞，市場的強勁滲透、高端市場的機會、市場購買行為正在不斷演變，重要的是，持續的創新將繼續推動我們在那裡的增長。謝謝，蘭斯。

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

現在，我將把電話轉回給大衛·科達尼 (David Cordani)，他將發表結束語。

Thank you for your engagement and questions today. I just want to highlight a few items. We stepped into 2023 with strong growth and have been successful in building beyond that momentum throughout the first half of the year. We remain confident that we'll deliver on our commitments, including our adjusted EPS outlook for 2023 of at least $24.70 and our commitment for at least $28 of EPS in 2024.

感謝您今天的參與和提問。我只想強調幾項。我們以強勁的增長勢頭邁入 2023 年，並在今年上半年成功超越了這一勢頭。我們仍然有信心兌現我們的承諾，包括調整後的 2023 年每股收益展望至少為 24.70 美元，以及我們對 2024 年每股收益至少 28 美元的承諾。

I'd also note how proud and appreciative I am of our colleagues around the world who continue to be dedicated to driving innovation and delivering on the programs and solutions as well as partnerships that support every day in the health and vitality of our customers, our patients and our clients.

我還要指出的是，我對我們世界各地的同事感到多麼自豪和感激，他們繼續致力於推動創新、提供計劃和解決方案以及合作夥伴關係，為我們的客戶、我們的客戶和我們的每一天的健康和活力提供支持。患者和我們的客戶。

As always, we look forward to talking to you again soon about how we're working to sustain the growth of our company and capture more opportunities to serve more lives and achieve a greater impact and we continue to invest in our future every day to drive further innovation. Have a great day.

一如既往，我們期待很快再次與您討論我們如何努力維持公司的增長，並抓住更多機會來服務更多的生活並實現更大的影響，我們每天都會繼續投資於我們的未來，以推動進一步創新。祝你有美好的一天。

Ladies and gentlemen, this concludes Cigna Group's Second Quarter 2023 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) 839-1335 or (203) 369-3357. There is no passcode required for this replay.

女士們、先生們，信諾集團 2023 年第二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 10 個工作日內提供。您可以撥打 (800) 839-1335 或 (203) 369-3357 訪問錄製的會議。此重播不需要密碼。

Thank you for participating. We will now disconnect.

感謝您的參與。我們現在將斷開連接。