信諾集團 (CI) 2023 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by for the Cigna Group's Fourth Quarter 2023 Results Review. (Operator Instructions) As a reminder, ladies and gentlemen, this conference, including the Q&A session, is being recorded.

女士們、先生們，感謝你們耐心等待 Cigna 集團 2023 年第四季業績回顧。 （操作員說明）女士們先生們，請注意，本次會議，包括問答環節，正在錄製中。

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

我們先將會議交給 Ralph Giacobbe。請繼續。

Great. Thanks, operator. 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 of the Cigna Group and President and Chief Executive Officer of Cigna Healthcare; and Eric Palmer, President and Chief Executive Officer of Evernorth Health Services. In our remarks today, David and Brian will cover a number of topics, including our fourth quarter and full year 2023 financial results and our financial outlook for 2024. Following their prepared remarks, David, Brian and Eric will be available for Q&A.

偉大的。謝謝，接線生。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)，投資人關係資深副總裁。今天早上與我通話的是 Cigna 集團董事長兼執行長 David Cordani； Brian Evanko，Cigna 集團財務長兼 Cigna Healthcare 總裁兼執行長；埃里克·帕爾默 (Eric Palmer)，Evernorth Health Services 總裁兼執行長。在今天的演講中，David 和Brian 將討論許多主題，包括我們的2023 年第四季度和全年財務業績以及2024 年的財務前景。在他們準備好的演講之後，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 including 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 the cignagroup.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，在描述我們的財務表現時，我們使用了某些財務指標，包括調整後的營運收入和調整後的收入，這些指標並非根據美國普遍接受的會計原則（也稱為GAAP）確定。這些指標分別與最直接可比較的 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 Cignagroup.com 的投資者關係部分。我們使用「調整後營業收入」和「調整後每股盈餘」這個術語作為我們衡量財務表現的主要指標。

In our remarks today, we'll be making some forward-looking statements, including statements regarding our outlook for 2024 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.

在今天的演講中，我們將做出一些前瞻性聲明，包括有關 2024 年和未來業績展望的聲明。這些陳述存在風險和不確定性，可能導致實際結果與我們目前的預期有重大差異。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。

Pertaining to our financial results, in the fourth quarter, we recorded a net after-tax special item charge of $552 million or $1.88 per share. Details of the special items are included in our quarterly financial supplement. As described in today's 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 2024 outlook, we will do so on a basis that includes the potential impact of future share repurchases and anticipated 2024 dividends.

關於我們的財務業績，第四季度，我們記錄的稅後特殊項目費用淨額為 5.52 億美元，即每股 1.88 美元。特別項目的詳細資訊包含在我們的季度財務補充中。正如今天的新聞稿所述，在我們討論財務表現時，特殊項目不包括在調整後的營運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 2024 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 2024 年股息的潛在影響。

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

這樣，我就把電話轉給大衛。

Thanks, Ralph. Good morning, everyone, and thanks for joining our call today. 2023 was a very strong year for our company with consistent performance and sustained growth. We executed with discipline across our businesses. We delivered for our customers and patients, our employer clients, our health plan partners and the others we serve. And with our expertise and diverse breadth of capabilities, we continue to improve affordability and clinical outcomes as well as continuing our work to expand access and choice. As we look forward, we're carrying momentum into 2024 and we expect another strong year of performance in growth.

謝謝，拉爾夫。大家早安，感謝您今天加入我們的電話會議。 2023 年對我們公司來說是非常強勁的一年，業績穩定，持續成長。我們在各個業務領域都嚴格執行紀律。我們為我們的客戶和患者、我們的雇主客戶、我們的健康計劃合作夥伴以及我們服務的其他人提供服務。憑藉我們的專業知識和多元化的能力，我們將繼續提高負擔能力和臨床結果，並繼續努力擴大准入和選擇。展望未來，我們將繼續保持強勁勢頭進入 2024 年，並預計將迎來強勁的成長表現。

Now today, I'll focus my comments on key strategic drivers of our performance last year and how we continue to evolve and advance our business to sustain our impact on growth. Brian will then walk through additional details about our performance for 2023 as well as our outlook for 2024. Then we'll take your questions.

今天，我將集中評論我們去年業績的關鍵策略驅動因素，以及我們如何繼續發展和推進我們的業務，以維持我們對成長的影響。然後，Brian 將詳細介紹我們 2023 年的業績以及 2024 年的展望。然後我們將回答您的問題。

Now before I go into our results, I want to comment on the announcement we made earlier this week. We reached a definitive agreement to sell our Medicare businesses to HCSC. We expect this transaction to close in early 2025, following customary legal and regulatory approvals. And while we continue to see the seniors market as an attractive growth market, we concluded that our Medicare businesses, well large at about $12 billion in revenue, would require sustained investments and focus and capital as well as dedicated resources that were disproportionate with their size within the Cigna Group's portfolio.

現在，在討論我們的結果之前，我想對我們本週早些時候發布的公告發表評論。我們達成了最終協議，將我們的醫療保險業務出售給 HCSC。我們預計這筆交易將在獲得慣例法律和監管批准後於 2025 年初完成。雖然我們仍然認為老年人市場是一個有吸引力的成長市場，但我們得出的結論是，我們的醫療保險業務規模龐大，收入約為120 億美元，需要持續的投資、重點和資本以及與其規模不成比例的專用資源屬於 Cigna 集團的投資組合。

Additionally, with Evernorth's broad high-performing service portfolio, we will continue to serve the needs of seniors and grow our business. I would note that as part of our agreement, HCSC will be served by Evernorth for continued services for the customers we are selling. Additionally, we're expanding the reach of Evernorth's portfolio and see significant continued growth opportunities in Government services, including Medicare.

此外，憑藉 Evernorth 廣泛的高性能服務組合，我們將繼續滿足老年人的需求並發展我們的業務。我要指出的是，作為我們協議的一部分，HCSC 將由 Evernorth 提供服務，以便為我們銷售的客戶提供持續的服務。此外，我們正在擴大 Evernorth 的投資組合範圍，並看到政府服務（包括醫療保險）的持續成長機會。

Now as we consider the performance of our Medicare Advantage business in 2023, in the fourth quarter, results were in line with our expectations. And for the year, we balanced high-quality and competitive benefits offerings, continued target market expansion and disciplined pricing activity.

現在，當我們考慮 2023 年 Medicare Advantage 業務第四季度的業績時，結果符合我們的預期。今年，我們平衡了高品質和有競爭力的福利產品、持續的目標市場擴張和嚴格的定價活動。

Now with that, let's move into our 2023 headlines. Broadly for 2023, we exceeded our financial commitments: full year total revenue, we delivered $195.3 billion; full year adjusted earnings per share was $25.09; and cash flow from operations of $11.8 billion. This performance extends our track record of delivering consistent positive results in the face of dynamic market conditions. It speaks to the power of our franchise and the purposeful way we've constructed our company, continuing to build on the strength of Cigna Healthcare while also shaping and expanding our Evernorth Health Services platform to lead the way in addressing evolving needs in the marketplace.

現在，讓我們進入 2023 年的頭條新聞。整體而言，2023 年我們超越了財務承諾：全年總收入達 1,953 億美元；全年調整後每股收益為25.09美元；營運現金流為 118 億美元。這項績效延續了我們在面對動態市場條件時持續取得正面成果的記錄。它體現了我們特許經營權的力量以及我們建立公司的有目的的方式，繼續以 Cigna Healthcare 的實力為基礎，同時塑造和擴展我們的 Evernorth Health Services 平台，以引領滿足市場不斷變化的需求。

As a result of our focus, discipline and sustained execution, over the past decade, we've delivered adjusted EPS growth of more than 13% on an annualized basis. In the 5 years since our acquisition of Express Scripts, we've achieved or surpassed every goal we established for the combined company. Through 2023, we've grown revenue by over $50 billion and met or exceeded our adjusted EPS objectives each year, and we've returned $27 billion to shareholders through share repurchase as well as attractive dividend payments. In 2023, after increasing our outlook for adjusted EPS twice over the course of the year, we had a strong finish and delivered full year adjusted EPS that was better than expectations. In short, we've demonstrated the ability to profitably evolve our business and services that we provide over many years, which enable us to continue to deliver on our commitments and grow.

由於我們的專注、紀律和持續執行，在過去十年中，我們的調整後每股盈餘年化成長率超過 13%。自收購 Express Scripts 以來的 5 年裡，我們已經實現或超越了為合併後的公司設定的每一個目標。到 2023 年，我們的收入成長了超過 500 億美元，每年都達到或超過了調整後的每股收益目標，並且我們透過股票回購和有吸引力的股息支付向股東返還了 270 億美元。 2023 年，在全年兩次上調調整後每股收益預期後，我們取得了強勁的業績，全年調整後每股收益優於預期。簡而言之，我們已經證明了我們有能力在多年來提供的業務和服務中實現盈利，這使我們能夠繼續履行我們的承諾並不斷發展。

Now I'll discuss our performance in greater detail. I'll start with Evernorth. In our Express Scripts business, we successfully implemented the single largest contract ever in the pharmacy benefits industry. Throughout 2023, thousands of coworkers collaborated and worked with dedication so we'd be ready to begin fulfilling well over 400 million annual prescriptions for 20 million Centene customers starting at the beginning of this year. Additionally, Centene was amongst hundreds of additional clients that we're ready to serve in 2024, and our I'm proud to say we're off to a strong start. The good work of our team has helped us meet the needs of our customers and reinforce the trust that Centene and other clients place in our company.

現在我將更詳細地討論我們的表現。我將從永北開始。在 Express Scripts 業務中，我們成功實施了藥品福利產業有史以來最大的單一合約。在整個 2023 年，數千名同事齊心協力、奉獻精神，因此我們已做好準備，從今年年初開始，為 2000 萬 Centene 客戶提供超過 4 億張年度處方。此外，Centene 是我們準備在 2024 年服務的數百家其他客戶之一，我很自豪地說我們有了一個很好的開始。我們團隊的出色工作幫助我們滿足了客戶的需求，並增強了 Centene 和其他客戶對我們公司的信任。

Another Evernorth highlight for 2023 is that we once again advanced industry-leading innovation. Last spring, we launched a series of innovations, including ClearCareRx, to support affordability, additional transparency and broader choice, as well as IndependentRx, to partner and enable more closely with independent pharmacies. Then in November, we went further in expanding choice for clients, funding their pharmacy benefits with Express Scripts ClearNetwork. We were the first to launch a scaled pharmacy network model offering cost-based pricing.

2023年永北的另一個亮點是我們再次推動業界領先的創新。去年春天，我們推出了一系列創新，包括 ClearCareRx，以支持可負擔性、額外的透明度和更廣泛的選擇，以及 IndependentRx，以與獨立藥房更緊密地合作和支持。然後在 11 月，我們進一步擴大了客戶的選擇範圍，透過 Express Scripts ClearNetwork 為他們的藥品福利提供資金。我們是第一個推出規模化藥房網路模型並提供基於成本的定價的公司。

In addition, our accelerated growth businesses with Evernorth fueled our momentum as well. Accelerated growth in Accredo Specialty Pharmacy and CuraScript SD businesses and in our care services businesses contributed to Evernorth's strong top and bottom line results. With Accredo and CuraScript SD, we're supporting patients and providers with safe and effective use of the growing volume of high-cost clinically complex specialty drugs. We also continue building out our care service platforms to ensure patients can access care when and how they need it while also remaining connected with physical sense of care. Our MDLIVE virtual platform, for example, is now available to over 60 million individuals as part of their benefits offering and is supporting a growing volume of care, including over 2.2 million virtual visits in 2023. Our results clearly demonstrate that with Evernorth's leading capabilities, we have valued and flexible partner for health plans, employers, governmental organizations and health care providers.

此外，我們與 Evernorth 的業務加速成長也推動了我們的發展勢頭。 Accredo Specialty Pharmacy 和 CuraScript SD 業務以及我們的護理服務業務的加速成長為 Evernorth 強勁的營收和利潤做出了貢獻。透過 Accredo 和 CuraScript SD，我們支援患者和提供者安全有效地使用數量不斷增加的高成本臨床複雜特殊藥物。我們也繼續建立我們的護理服務平台，以確保患者能夠在需要時以所需的方式獲得護理，同時保持身體護理感的聯繫。例如，我們的MDLIVE 虛擬平台現已作為其福利服務的一部分向超過6000 萬人提供，並支持不斷增長的護理量，包括到2023 年超過220 萬次虛擬就診。我們的結果清楚地表明，憑藉Evernorth的領先能力，我們是健康計劃、雇主、政府組織和醫療保健提供者的寶貴且靈活的合作夥伴。

In Cigna Healthcare, we drove revenue and customer growth through disciplined pricing and medical cost management. We serve employers and individuals who trust us to guide them through the health care system. Our leading clinical care programs [could] use to support our customers and patients, equipping them with the right information and insights they need to make the best choices for their health and vitality. Our ongoing pricing and continued progress in affordability initiatives in 2023 resulted in a medical care ratio that was better than expectations.

在 Cigna Healthcare，我們透過嚴格的定價和醫療成本管理來推動收入和客戶成長。我們為信任我們指導他們使用醫療保健系統的雇主和個人提供服務。我們領先的臨床護理計劃可以用來支持我們的客戶和患者，為他們提供所需的正確資訊和見解，以便為他們的健康和活力做出最佳選擇。我們持續的定價和 2023 年可負擔性計畫的持續進展導致醫療保健比率優於預期。

Our U.S. Commercial Employer business had an outstanding year with continued strong growth. This was driven by our team's continued success in strengthening our competitive position through improved affordability and leveraging our high-performance networks and digitally enabled services as we expand care access, coordination of care and overall value. Our individual exchange business performed broadly in line with our expectations for the fourth quarter. And with the actions we've taken, we are on track to deliver improved profitability in 2024. And in international health, we achieved another positive top and bottom line results. Our high quality and localized health solutions, supported by our global provider network, continue to resonate very well with the globally mobile population and employees of multinational corporations as well as intergovernmental organizations.

我們的美國商業雇主業務今年表現出色，並持續強勁成長。這是由於我們的團隊在擴大護理服務、護理協調和整體價值的同時，透過提高負擔能力並利用我們的高效能網路和數位化服務，不斷成功地加強了我們的競爭地位，從而推動了這一趨勢。我們的個人交易所業務第四季的表現基本上符合我們的預期。透過我們採取的行動，我們預計在 2024 年實現更高的獲利能力。在國際健康領域，我們又取得了積極的營收和利潤成果。我們的高品質和在地化健康解決方案在我們的全球供應商網路的支持下，繼續與全球流動人口以及跨國公司和政府間組織的員工產生良好的共鳴。

Now turning to 2024. We will sustain our growth in high performance by sharply focusing on the greatest opportunities with a well-balanced portfolio of complementary businesses and a clear durable strategic growth framework. First, we will drive continued steady predictable growth from our high-performing foundational growth businesses: pharmacy benefit, U.S. Commercial Employer and our international health business.

現在展望 2024 年。我們將透過均衡的互補業務組合和明確的持久策略成長框架，敏銳地專注於最大的機遇，從而維持我們的高績效成長。首先，我們將推動我們的高效能基礎成長業務持續穩定、可預測的成長：藥品福利、美國商業雇主和我們的國際健康業務。

Our clients depend on our pharmacy services, for example, and our expertise as well as our leadership in lowering cost for prescription drugs and addressing growing needs such as the high demand for the GLP-1 class of drugs for weight loss in diabetes. We have a long history of guiding appropriate access to medications and providing specialized clinical support, and we will continue to build on these efforts with new programs, such as our EnCircleRx program. We're also supporting customers in additional ways, including by offering enhanced digital tools to help them better understand the value of their pharmacy benefits.

例如，我們的客戶依賴我們的藥局服務、我們的專業知識以及我們在降低處方藥成本和滿足不斷增長的需求（例如糖尿病減肥 GLP-1 類藥物的高需求）方面的領導力。我們在指導適當取得藥物和提供專業臨床支援方面有著悠久的歷史，我們將繼續在這些努力的基礎上推出新計劃，例如我們的 EnCircleRx 計劃。我們也以其他方式為客戶提供支持，包括提供增強的數位工具，幫助他們更好地了解藥品福利的價值。

We've been successful in growing our U.S. Commercial Employer business for more than a decade and continue to view this as a growth market for the Cigna Group. We continue to leverage the strength in coordinating a growing number of point solutions for our clients and improving clinical outcomes for our clients. Additionally, we continue to act as a disruptive innovator for small and middle-sized client needs.

十多年來，我們在美國商業雇主業務方面取得了成功，並繼續將其視為 Cigna 集團的成長市場。我們繼續利用優勢為客戶協調越來越多的單點解決方案並改善客戶的臨床結果。此外，我們繼續充當滿足中小型客戶需求的顛覆性創新者。

Second, we will build on further momentum for our accelerated growth portfolio, our fast-growing scaled Specialty Pharmacy business and our care service businesses. We have tremendous opportunities in these large and expanding markets with our differentiated specialty capabilities, supporting patients with high cost and clinically complex treatments. And within care services, we're advancing our capabilities in behavioral health, virtual and home care as well as coordinated care programs for specific conditions.

其次，我們將為加速成長的投資組合、快速成長的規模化專科藥局業務和護理服務業務奠定進一步的動力。憑藉我們差異化的專業能力，我們在這些龐大且不斷擴大的市場中擁有巨大的機會，為患者提供高成本和臨床複雜的治療支援。在護理服務方面，我們正在提高行為健康、虛擬和家庭護理以及針對特定情況的協調護理計劃的能力。

In summary, for 2024, we will grow our customer and revenue base again and our earnings and operating cash flow at the higher end of our long-term strategic targets. We've increased our expectations for full year 2024 adjusted EPS to at least $20.25. We expect our consolidated adjusted revenues to grow at least 20%, and we expect to generate at least $11 billion of operating cash flow. And we will continue to return capital to our shareholders, including a 14% increase in our quarterly dividend.

總之，到 2024 年，我們將再次擴大我們的客戶和收入基礎，並將我們的獲利和營運現金流保持在長期策略目標的高端。我們將 2024 年全年調整後每股盈餘的預期提高至至少 20.25 美元。我們預計合併調整後營收將成長至少 20%，並且預計將產生至少 110 億美元的營運現金流。我們將繼續向股東返還資本，包括將季度股利增加 14%。

Now before I wrap it up and turn it over to Brian, I also wanted to mention the announcements we made last month about expanding roles for Brian and Eric. Brian has been our Chief Financial Officer for the past 3 years and will continue in that role. He will also expand his responsibilities as President and CEO of Cigna Healthcare. Eric is expanding his responsibilities as Executive Vice President of Enterprise Strategy for the Cigna Group while also continuing as President and CEO of Evernorth Services. Brian and Eric's expanded positions, as well as other leadership changes we announced, provide further clarity of our priorities and strategy as well as the extent of reach and impact we're [bidding] to have. Importantly, it also reinforces the depth of our management bench.

現在，在我總結並將其交給布萊恩之前，我還想提一下我們上個月發布的有關擴大布萊恩和埃里克角色的公告。 Brian 在過去 3 年中一直擔任我們的財務官，並將繼續擔任該職位。他還將擴大作為 Cigna Healthcare 總裁兼執行長的職責。 Eric 正在擴大其作為 Cigna Group 企業策略執行副總裁的職責，同時繼續擔任 Evernorth Services 的總裁兼執行長。布萊恩和艾瑞克的職位擴大，以及我們宣布的其他領導層變動，進一步明確了我們的優先事項和策略，以及我們[競標]要達到的影響力和影響力。重要的是，它也加強了我們管理隊伍的深度。

At our Investor Day on March 7 in New York City, you'll hear more from me, Brian and Eric, as well as other key leaders from across our company. We look forward to sharing with you our views of the expanded addressable markets we see and how we've positioned the Cigna Group to advance our next chapters of attractive growth.

在 3 月 7 日於紐約市舉行的投資者日上，您將聽到我、Brian 和 Eric 以及我們公司其他主要領導人的更多資訊。我們期待與您分享我們對所看到的擴大的潛在市場的看法，以及我們如何定位 Cigna 集團以推進我們有吸引力的成長的下一個篇章。

Now I'll briefly summarize. With the momentum we carried out of 2023, we're raising our guidance for EPS in 2024. We're building on a strong year of disciplined execution, performance and growth across our company. We deliver for our customers and clients and partners. We kept our commitments to our shareholders, including delivering adjusted EPS for 2023 of $25.09, which was above our outlook, and we generated $11.8 billion of cash flow from operations. We've sharpened the focus of our portfolio further to ensure that we're positioned to drive another strong year for our company. We're building on a consistent track record of disciplined execution, innovation and differentiated partnerships. We've increased our outlook for 2024 and now expect EPS of at least $20.25, and we will continue to advance the strategic deployment of capital, including using the majority of our discretionary cash flow for share repurchase in 2024. We'll have another strong year of performance, continue our track record for more than a decade of delivering against our 10% to 13% long-term adjusted EPS growth target while maintaining an attractive dividend.

現在我簡單總結一下。憑藉 2023 年的勢頭，我們正在提高 2024 年每股收益的指引。我們正在為整個公司嚴格執行、業績和成長的強勁一年奠定基礎。我們為我們的客戶、客戶和合作夥伴提供服務。我們信守對股東的承諾，包括實現 2023 年調整後每股收益 25.09 美元，高於我們的預期，並且我們從營運中產生了 118 億美元的現金流。我們進一步強化了產品組合的重點，以確保我們能為公司帶來另一個強勁的一年。我們正在建立嚴格執行、創新和差異化合作夥伴關係的一貫記錄。我們上調了對2024年的展望，現在預計每股收益至少為20.25美元，我們將繼續推進資本的戰略部署，包括將大部分可自由支配現金流用於2024年的股票回購。我們將有另一個強勁的表現繼續我們十多年來的業績記錄，實現 10% 至 13% 的長期調整後每股收益成長目標，同時保持有吸引力的股息。

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

有了這個，我會把它交給布萊恩。

Thank you, David. Good morning, everyone. Today, I'll review the Cigna Group's fourth quarter and full year 2023 results and provide our outlook for full year 2024.

謝謝你，大衛。大家，早安。今天，我將回顧 Cigna Group 第四季和 2023 年全年業績，並提供我們對 2024 年全年的展望。

We're proud to deliver another strong year for the Cigna Group, reflecting focused execution and growth across Evernorth and Cigna Healthcare. Looking at full year 2023, some key consolidated financial highlights include revenue of $195.3 billion, adjusted earnings per share of $25.09 and cash flow from operations of $11.8 billion, all well exceeding our initial expectations for the year. Fourth quarter enterprise results were particularly strong with revenue growing 12% to $51.1 billion, after-tax adjusted earnings growing to $2 billion and adjusted earnings per share growing to $6.79. These results reflect broad-based strength across the company, and this momentum positions us well for growth in 2024.

我們很自豪能夠為 Cigna 集團帶來另一個強勁的一年，這反映了 Evernorth 和 Cigna Healthcare 的專注執行和成長。展望 2023 年全年，一些重要的綜合財務亮點包括 1,953 億美元的收入、25.09 美元的調整後每股收益以及 118 億美元的營運現金流，均遠遠超出了我們對該年度的最初預期。第四季企業業績尤其強勁，營收成長 12% 至 511 億美元，稅後調整後收益成長至 20 億美元，調整後每股盈餘成長至 6.79 美元。這些結果反映了整個公司的廣泛實力，這種勢頭為我們 2024 年的成長奠定了良好的基礎。

Regarding our growth platforms, I'll first comment on Evernorth. 2023 marked another year of sustained growth and profitability in Evernorth as our market-leading clinical capabilities and innovative solutions continue to create differentiated value for our health plan, employer and government, clients and customers. Fourth quarter 2023 Evernorth revenues grew 12% to $40.5 billion and pretax adjusted earnings grew 10% to $1.9 billion, both of which exceeded expectations. Evernorth's results in the quarter were driven by continued strong performance in our Specialty Pharmacy business, which saw a double-digit year-over-year revenue growth to reach $60 billion in revenues for full year 2023, and our unwavering focus on reducing net costs for our clients as new drug innovations come to market, including GLP-1 agonists, biosimilars, specialty generics and other emerging therapies for clinically complex conditions.

關於我們的成長平台，我先評論Evernorth。 2023 年是 Evernorth 持續成長和獲利的另一年，因為我們市場領先的臨床能力和創新解決方案繼續為我們的健康計劃、雇主和政府、客戶和消費者創造差異化價值。 2023 年第四季 Evernorth 營收成長 12% 至 405 億美元，稅前調整後收益成長 10% 至 19 億美元，均超出預期。 Evernorth 本季的業績得益於我們的專業藥房業務持續強勁的業績，該業務的收入同比增長兩位數，2023 年全年收入達到 600 億美元，以及我們堅定不移地致力於降低淨成本隨著新藥創新上市，我們的客戶不斷湧現，包括GLP-1 激動劑、生物相似藥、特種仿製藥和其他針對臨床複雜病症的新興療法。

The fourth quarter capped a strong 2023 for Evernorth with pretax adjusted earnings growing 5% for the year, above expectations. We achieved this even while incurring meaningful spending related to the implementation of our Centene relationship. Evernorth's favorable revenue and adjusted earnings growth in full year 2023 reflected strong execution and expansion across our foundational business, Express Scripts and our scaled accelerated growth business, Accredo Specialty Pharmacy.

第四季為 Evernorth 的 2023 年業績畫上圓滿句號，全年稅前調整後獲利成長 5%，高於預期。即使在與實施 Centene 關係相關的有意義的支出的同時，我們也實現了這一目標。 Evernorth 2023 年全年的良好收入和調整後獲利成長反映了我們的基礎業務 Express Scripts 和規模化加速成長業務 Accredo Specialty Pharmacy 的強勁執行力和擴張。

Now turning to Cigna Healthcare. We outperformed expectations with full year 2023 pretax adjusted earnings growing 9%, reflecting another year of highly effective execution. Fourth quarter 2023 adjusted revenues were $13 billion and pretax adjusted earnings were $969 million, representing strong year-over-year growth. The medical care ratio was 82.2%, favorable to expectations. Our medical care ratio favorability was primarily driven by our U.S. Commercial Employer business, particularly within our Stop Loss products, which outperformed expectations due to lower cost trends on high dollar claimants. Additionally, we saw lower-than-expected viral costs in the quarter with the combination of flu, COVID and RSV running below projections.

現在轉向 Cigna Healthcare。我們的表現超出預期，2023 年全年稅前調整後收益成長 9%，反映出另一年的高效執行。 2023 年第四季調整後營收為 130 億美元，稅前調整後收益為 9.69 億美元，較去年同期強勁成長。醫療就診率為82.2%，符合預期。我們的醫療保健比率受歡迎程度主要是由我們的美國商業雇主業務推動的，特別是我們的止損產品，由於高額索賠人的成本趨勢較低，該產品的表現超出了預期。此外，我們發現本季的病毒成本低於預期，流感、新冠肺炎和呼吸道合胞病毒的綜合成本低於預測。

As David noted in his comments, we have entered a definitive agreement with HCSC to sell our Medicare businesses. We expect to close this transaction in early 2025 following regulatory approvals, and our full year 2024 outlook assumes full year contributions from our Medicare businesses. For fourth quarter specifically, our Medicare Advantage business generated performance broadly in line with expectations.

正如 David 在評論中指出的那樣，我們已與 HCSC 達成最終協議，出售我們的醫療保險業務。我們預計在獲得監管部門批准後於 2025 年初完成此交易，我們的 2024 年全年展望假設我們的醫療保險業務全年做出貢獻。具體到第四季度，我們的醫療保險優勢業務的業績基本上符合預期。

Across Cigna Healthcare, our full year 2023 medical care ratio was 81.3%, better than expectations, benefiting from our disciplined pricing execution, continued affordability initiatives and the favorability in our Stop Loss products. The full year MCR of 81.3% was 70 basis points better than the midpoint of our initial 2023 guidance and is an improvement of 40 basis points from full year 2022.

在 Cigna Healthcare 中，我們 2023 年全年的醫療護理比率為 81.3%，好於預期，這得益於我們嚴格的定價執行、持續的負擔能力計劃以及我們對止損產品的青睞。全年 MCR 為 81.3%，比我們最初的 2023 年指導中位數高出 70 個基點，比 2022 年全年提高了 40 個基點。

Moving to Cigna Healthcare medical customers. We ended 2023 with 19.8 million total medical customers, growth of approximately 1.8 million or 10% from year-end 2022, ahead of our initial guidance. This growth was driven by U.S. healthcare, primarily from U.S. Commercial Employer fee-based customers, as well as growth in individual exchange and Medicare Advantage. Cigna Healthcare continues to perform well with strong underlying fundamentals. Our results reflect the strength of our differentiated value proposition and focused execution across the business as well as the stability and consistency of the U.S. Commercial Employer market. Overall, we're very proud of our strong 2023 results in a disruptive market environment, reflecting the intentional design of the company's growth platforms and our ongoing disciplined execution. This provides us with considerable momentum for 2024 and beyond.

轉向 Cigna Healthcare 醫療客戶。截至 2023 年底，我們的醫療客戶總數為 1,980 萬，較 2022 年底增長約 180 萬，即增長 10%，超出了我們的初步指導。這一增長是由美國醫療保健（主要來自美國商業雇主收費客戶）以及個人交換和醫療保險優勢的增長所推動的。 Cigna Healthcare 憑藉強勁的基本面繼續表現良好。我們的業績反映了我們差異化價值主張的優勢和整個業務的集中執行力以及美國商業雇主市場的穩定性和一致性。總體而言，我們對在顛覆性市場環境中 2023 年取得的強勁業績感到非常自豪，這反映了公司成長平台的有意設計和我們持續嚴格的執行。這為我們 2024 年及以後提供了巨大的動力。

Now turning to our outlook for full year 2024, specifically. We continue to expect strong underlying growth in Evernorth and Cigna Healthcare. We expect full year 2024 consolidated adjusted revenues of at least $235 billion, and we expect full year 2024 consolidated adjusted income from operations to be at least $8.025 billion or at least $28.25 per share, an increase from our prior outlook. When considering earnings seasonality, we would expect the adjusted earnings per share pattern to be similar to 2023.

現在具體談談我們對 2024 年全年的展望。我們繼續預期 Evernorth 和 Cigna Healthcare 的潛在成長強勁。我們預計 2024 年全年合併調整後收入至少為 2350 億美元，預計 2024 年全年合併調整後營運收入至少為 80.25 億美元或至少每股 28.25 美元，比我們之前的預期有所增加。考慮獲利季節性時，我們預期調整後每股盈餘模式將與 2023 年類似。

Now turning to our 2024 outlook for each of our growth platforms. At Evernorth, we expect full year 2024 adjusted earnings of at least $7 billion. We expect adjusted earnings within Evernorth to ramp as we move throughout the year with first quarter adjusted earnings contributing slightly below 20% of full year Evernorth adjusted earnings. The earnings ramp reflects the effect of early year client-specific onboarding spend. These investments are more concentrated in the first half of the year and taper off over the course of the year.

現在轉向我們對每個成長平台的 2024 年展望。 Evernorth 預計 2024 年全年調整後收益至少為 70 億美元。我們預計 Evernorth 的調整後獲利將隨著我們全年的發展而增加，第一季調整後獲利貢獻略低於 Evernorth 全年調整後獲利的 20%。獲利成長反映了年初針對特定客戶的入職支出的影響。這些投資更加集中在上半年，並在年內逐漸減少。

For Cigna Healthcare, we expect full year 2024 adjusted earnings of at least $4.75 billion. Assumptions in our Cigna Healthcare outlook for 2024 include approximately 19.3 million total medical customers at year-end, and we expect our medical care ratio to be in the range of 81.7% to 82.7% with the first quarter 2024 medical care ratio expected to be below the low end of the full year guidance range to reflect typical seasonal patterns.

對於 Cigna Healthcare，我們預計 2024 年全年調整後收益至少為 47.5 億美元。我們對 Cigna Healthcare 2024 年展望的假設包括年底醫療客戶總數約為 1,930 萬，我們預計我們的醫療保健比率將在 81.7% 至 82.7% 範圍內，2024 年第一季的醫療保健比率預計將低於全年指導範圍的低端，以反映典型的季節性模式。

Additionally, for the enterprise, we project an adjusted SG&A ratio of approximately 6.1% for 2024, reflecting a higher proportion of enterprise revenue from Evernorth, which carries a lower SG&A ratio. And we expect the consolidated adjusted tax rate to be in the range of 20.5% to 21%.

此外，對於企業而言，我們預計 2024 年調整後的 SG&A 比率約為 6.1%，反映出來自 Evernorth 的企業收入比例較高，而 Evernorth 的 SG&A 比率較低。我們預計綜合調整後稅率將在20.5%至21%之間。

Turning to our 2023 capital management position and 2024 capital outlook. We finished 2023 strong and delivered $11.8 billion of cash flow from operations. In 2023, we repurchased 7.8 million shares of common stock for approximately $2.3 billion, and we returned $1.5 billion to shareholders via dividends. Additionally, our debt-to-capital ratio finished the year at 40.1%, an improvement of approximately 100 basis points from year-end 2022.

談談我們2023年的資本管理狀況和2024年的資本展望。 2023 年我們表現強勁，營運現金流達 118 億美元。 2023年，我們以約23億美元的價格回購了780萬股普通股，並透過股利向股東返還了15億美元。此外，我們的負債資本比率全年達到 40.1%，比 2022 年底提高了約 100 個基點。

Now framing our 2024 capital outlook. We expect to deliver at least $11 billion of cash flow from operations through our efficient service-based business model. We expect to deploy approximately $1.5 billion to capital expenditures, and we expect to deploy approximately $1.6 billion to shareholder dividends, reflecting our quarterly dividend of $1.40 per share, a 14% increase on a per share basis. In 2024, we intend to use a majority of our discretionary cash flow for share repurchase. As we previously shared, we anticipate to repurchase at least $5 billion within the first half of 2024. Finally, we expect full year weighted average shares outstanding to be in the range of 282 million to 286 million shares.

現在製定我們 2024 年的資本展望。我們預計透過我們高效的基於服務的業務模式，將產生至少 110 億美元的營運現金流。我們預計將約 15 億美元用於資本支出，預計將約 16 億美元用於股東股息，反映出我們的季度股息為每股 1.40 美元，每股成長 14%。 2024年，我們打算將大部分可自由支配現金流量用於股票回購。正如我們先前所分享的，我們預計將在 2024 年上半年回購至少 50 億美元。最後，我們預計全年加權平均已發行股數將在 2.82 億至 2.86 億股之間。

Now to recap. Our full year 2023 consolidated results exceeded expectations, reflecting continued focused execution and discipline across Evernorth and Cigna Healthcare. And our 2024 outlook reflects continued strength and momentum across our 2 growth platforms, Evernorth and Cigna Healthcare. We are confident in our ability to deliver full year 2024 adjusted earnings of at least $28.25 per share.

現在回顧一下。我們 2023 年全年綜合業績超乎預期，反映出 Evernorth 和 Cigna Healthcare 持續專注的執行力和紀律。我們的 2024 年展望反映了我們的兩個成長平台 Evernorth 和 Cigna Healthcare 的持續實力和勢頭。我們有信心能夠實現 2024 年全年調整後每股收益至少 28.25 美元。

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

這樣，我們會將其轉交給接線員進行通話的問答部分。

(Operator Instructions) Our first question comes from A.J. Rice with UBS.

（操作員說明）我們的第一個問題來自 A.J.賴斯與瑞銀。

Obviously, we have the announcement on your sale of the Medicare Advantage business, and yet you're saying you still view the business as attractive. Obviously, there's been some volatility in some of the performance of some of the other players in this space already announced. Is this the time, in your mind, to sort of step back from the market and give some time for the dust to settle? Or how should we interpret the comments that you still think that segment is attractive?

顯然，我們已經宣布您出售 Medicare Advantage 業務，但您卻說您仍然認為該業務具有吸引力。顯然，已經宣布的該領域其他一些參與者的表現存在一些波動。在您看來，現在是時候退出市場並給塵埃一些時間了嗎？或者我們應該如何解讀您仍然認為該細分市場有吸引力的評論？

And then also on that, obviously, is there are speculation, at least in the press, about deal discussions. Your stock was quite volatile. I wonder if you could give us a little bit on how you approach large transactions, some of the financial parameters that people should keep in mind that would be hopefully reassuring for them.

顯然，至少在媒體上，也有關於交易討論的猜測。你的股票波動很大。我想知道您是否可以向我們介紹如何處理大型交易，以及人們應該牢記的一些財務參數，這些參數有望讓他們放心。

A.J., it's David. You have a lot in that question, and I appreciate it. Let me try to address some of the high points.

A.J.，我是大衛。你這個問題有很多內容，我很感激。讓我嘗試談談一些要點。

First and foremost, we are really pleased with the nature of the transaction we're able to structure with HCSC. We see it as a win-win, and it's a clarification to our strategy within our portfolio. As I noted in my prepared remarks, while we view the market as attractive growth market, the required capital investment, resources, focus relative to its size within our portfolio, coupled with the continued elevated regulatory environment, our decision was it was best to enter this transaction.

首先也是最重要的是，我們對能夠與 HCSC 進行交易的性質感到非常滿意。我們認為這是雙贏的，也是對我們投資組合中的策略的澄清。正如我在準備好的演講中指出的那樣，雖然我們認為市場是有吸引力的成長市場，但所需的資本投資、資源、相對於我們投資組合規模的重點，再加上持續加強的監管環境，我們的決定是最好進入本次交易。

Point two is, very importantly, we've been quite deliberate now for several years, working to expand the service portfolio and the value proposition within Evernorth for health plan partners as it relates to their government services, be it Medicare, be it duals, be it Medicaid, et cetera. And we're demonstrating a very attractive proven track record of growing our government reach but through the services franchise. And we will continue to fuel that on a go-forward basis and see that as an attractive trajectory for us.

第二點是，非常重要的是，我們多年來一直深思熟慮，致力於擴大 Evernorth 內健康計劃合作夥伴的服務組合和價值主張，因為這與他們的政府服務有關，無論是醫療保險，還是雙重保險，無論是醫療補助等等。我們正在展示一個非常有吸引力的、經過驗證的記錄，即透過服務特許經營來擴大我們的政府影響力。我們將繼續在前進的基礎上推動這一進程，並將其視為對我們有吸引力的發展軌跡。

As it relates to your latter part of your question, I'll reframe our M&A criteria. I want to make sure I put that in the context of our capital deployment criteria. We continue to view, first, capital deployment priorities, investing in our business. Brian referenced the CapEx deployment of about $1.5 billion. Second, we always evaluate M&A for its appropriate attributes, which I'll come back to in a moment. And then third, returning capital to shareholders. And as Brian noted, in 2024, in addition to raising our dividend by 14%, we expect to return the majority of our excess capital to shareholders through share repurchase with at least $5 billion in the first half of the year.

由於它與您問題的後半部分相關，我將重新制定我們的併購標準。我想確保將其納入我們的資本部署標準中。首先，我們繼續專注於資本部署優先事項，投資於我們的業務。 Brian 提到資本支出部署約為 15 億美元。其次，我們總是評估併購的適當屬性，我稍後會回到這一點。第三，向股東返還資本。正如布萊恩所指出的，2024年，除了將股利提高14%外，我們預計上半年將透過股票回購將大部分過剩資本返還給股東，金額至少為50億美元。

Lastly, in your action-packed question, as we think about the criteria for transactions, we think about 3 criteria: first, strategic attraction; second, financial attraction; and then third, overall path to clarity. So is it strategically aligned? Is it financially attractive? And as a final note, when we think about the financial piece of the equation, you evaluate each deal on its own respective merits, but seeking to get high visibility in terms of your value creation for your organization if you're going to enter into a transaction.

最後，在你提出的充滿行動的問題中，當我們考慮交易的標準時，我們會考慮三個標準：第一，策略吸引力；第二，策略吸引力；第三，策略吸引力。第二，資金吸引力；第三，通往清晰的整體路徑。那麼它在戰略上是否一致？它在經濟上有吸引力嗎？最後一點，當我們考慮等式的財務部分時，您會根據每筆交易各自的優點進行評估，但如果您要進入，則尋求在為您的組織創造價值方面獲得高度可見性一筆交易。

So to repeat, we're pleased with the decision and the transaction design. We will continue in a long-term service relationship with HCSC that further expands our proven track record within Evernorth. We see the Evernorth service portfolio as an attractive capital-light high visibility way to grow this portfolio. And as we have in the past, we will maintain very strong discipline for capital deployment, and our 2024 capital deployment priorities are quite clear.

重複一遍，我們對這個決定和交易設計感到滿意。我們將繼續與 HCSC 保持長期服務關係，進一步擴大我們在 Evernorth 的良好記錄。我們認為 Evernorth 服務組合是一種有吸引力的輕資本、高知名度的方式來發展這個組合。與過去一樣，我們將保持非常嚴格的資本部署紀律，並且我們 2024 年的資本部署優先事項非常明確。

Our next question comes from Stephen Baxter with Wells Fargo.

我們的下一個問題來自富國銀行的史蒂芬‧巴克斯特。

I just wanted to ask another kind of quick follow-up on the Medicare Advantage. So I would be curious if you'd be willing to share maybe your 5- or 10-year view of the market. So I totally appreciate that it's a small part of your business before the sale, but you are still the eighth largest plan in the country. Do you think market share and concentration is ultimately going to look much more like the commercial market than it does today? Would love any kind of medium-term thoughts you could offer in the market.

我只是想詢問有關 Medicare Advantage 的另一種快速跟進。所以我很好奇您是否願意分享您對市場 5 年或 10 年的看法。因此，我完全理解，這只是您出售前業務的一小部分，但您仍然是該國第八大計劃。您認為市佔率和集中度最終會比現在更像商業市場嗎？希望您能在市場上提供任何中期想法。

Stephen, it's David. You're asking for a 10-year crystal ball. I think in the dynamism of the marketplace, most people come back to in terms of rolling 3-year views of a given market.

史蒂芬，我是大衛。你要求的是一個 10 年的水晶球。我認為，在市場的活力中，大多數人都會回顧特定市場的三年滾動觀點。

But stepping back, first and foremost, the Medicare Advantage offering, broadly speaking, in the marketplace is a very attractive offering for seniors, and it has a long-term proven track record of delivering attractive benefits and, importantly, clinical coordination when you get to the Medicare beneficiaries, typically dealing with a higher level of clinical burden that's necessary for coordination. And the care outcomes, the quality outcomes, the overall value outcomes are positive. So broadly speaking, from a societal standpoint, we see MA as an important asset for the U.S. to continue to be served, supported financially and grow.

但退一步來說，首先也是最重要的是，從廣義上講，醫療保險優勢產品在市場上對老年人來說是一個非常有吸引力的產品，並且它擁有長期可靠的記錄，可以提供有吸引力的福利，而且重要的是，當您獲得醫療保險時，它可以提供臨床協調。對於醫療保險受益人來說，通常需要處理協調所需的更高水平的臨床負擔。護理結果、品質結果、整體價值結果都是正面的。因此，從廣義上講，從社會的角度來看，我們將 MA 視為美國繼續獲得服務、財政支持和成長的重要資產。

Secondly, the marketplace will see ebbs and flows in terms of the funding mechanism. We see the early look at the rate letter. That's a moment in time. That's a moment in time, either acceleration or potentially deceleration for that marketplace.

其次，市場在融資機制上也會出現潮起潮落。我們看到早期的費率信。那是一個時刻。這是一個及時的時刻，對於該市場來說，要么是加速，要么是潛在的減速。

Third is, if you look at the senior satisfaction level, NPS broadly -- Net Promoter Score, broadly, is attractive for Medicare Advantage. Therefore, as I noted previously to A.J.'s point, we worked really aggressively to ensure that we have a broad and we'll continue to broaden the portfolio of services in support of health plans and integrated value-based care providers to be in support of value-based care, be it for Medicare Advantage tools or the commercial population.

第三，如果你看看老年人的滿意度水平，NPS（廣義的淨推薦值）對 Medicare Advantage 很有吸引力。因此，正如我之前針對 A.J. 的觀點指出的那樣，我們非常積極地工作，以確保我們擁有廣泛的服務組合，並將繼續擴大支持健康計劃和基於價值的綜合護理提供者的服務組合，以支持基於價值的護理，無論是針對Medicare Advantage 工具還是針對商業人群。

So we see the marketplace as a growth market. Its respective growth will ebb and flow depending on reimbursement, to some level, from the government, lending toward benefit richness. And then ultimately, as you know, the last comment I would make is the primary wave of the baby boomer aging has reached a peak and is slowing. It's still attractive, but that primary wave has reached its peak and is slowing somewhat. Take it as a whole. We see this as an expansion opportunity for Evernorth.

因此，我們將市場視為一個成長市場。其各自的成長將在某種程度上取決於政府的補償，以及為福利豐富而提供的貸款。最後，如您所知，我要發表的最後評論是，嬰兒潮一代老化的第一波浪潮已經達到頂峰並且正在放緩。它仍然很有吸引力，但主波已經達到頂峰並且正在放緩。把它當作一個整體。我們認為這是 Evernorth 的擴張機會。

Our next question comes from Lisa Gill with JPMorgan.

我們的下一個問題來自摩根大通的麗莎吉爾。

I want to focus on Evernorth and maybe just understand some of the key drivers as you think about 2024. So first off, you talked about specialty in '23. Can you talk about what your expectations are about growth in specialty in '24, what you're doing around services? You touched a little bit on GLP-1. But you have a really big contract with CNC coming on board, but you also had an overall good 2024 selling season. So any of the key elements you can help us to understand as to what the drivers are for that strong AOI growth in Evernorth.

我想專注於 Evernorth，也許只是了解您對 2024 年的一些關鍵驅動因素。所以首先，您談到了 23 年的專業。您能否談談您對 24 年專業成長的期望以及您在服務方面所做的工作？您對 GLP-1 略有了解。但是，您與 CNC 簽訂了一份非常大的合同，而且 2024 年銷售季整體表現良好。因此，任何關鍵要素都可以幫助我們了解 Evernorth AOI 強勁成長的驅動因素。

Thanks, Lisa. It's Eric. A couple of different pieces in there. But first, let me just talk a bit about the portfolio of services that we're focused on in terms of Evernorth, and I'll transition that into some of the drivers of growth specifically for 2024.

謝謝，麗莎。是埃里克。裡面有幾件不同的作品。但首先，讓我簡單談談我們在 Evernorth 方面關注的服務組合，我將把它轉變為 2024 年專門的成長驅動力。

David noted in his prepared remarks a couple of highlights on capabilities we're growing. But I would call out, we are seeing significant interest from the market around themes helping to better coordinate individual point solutions and alleviate some of the burden that comes along with the fragmentation of how care is administered and how employers and plans are assembling care. So us working to improve navigation and reduce point solution fatigue is a key item.

大衛在他準備好的演講中指出了我們正在發展的能力的幾個亮點。但我要指出的是，我們看到市場對一些主題表現出濃厚的興趣，這些主題有助於更好地協調個人點解決方案，並減輕因護理管理方式以及雇主和計劃如何組合護理的分散而帶來的一些負擔。因此，我們努力改進導航並減少單點解決方案疲勞是一個關鍵項目。

Second of all, I would note, behavioral care continues to be an area of focus. And there's meaningful opportunity for behavioral care to be better coordinated as there's significant comorbidities with individuals with mental health care needs, along with other care needs. And we're in a position to help with -- address those challenges.

其次，我要指出的是，行為護理仍然是重點領域。由於有心理健康護理需求以及其他護理需求的個人存在嚴重的合併症，因此行為護理有更好的協調機會。我們有能力幫助應對這些挑戰。

The third item that I'd note would be around specialty and, in particular, the opportunity for us to continue to grow as there are more therapies, more choices in the specialty market as well as navigating through biosimilars. Overall, we're positioned really well to continue to drive affordability and choice in biosimilars. And as we've talked about previously, that's an important long-term multiyear tailwind in the economics and the growth of Evernorth overall. And then certainly, the continued growth in therapies like GLP-1s are -- is an area that's a factor in our proposition overall.

我要指出的第三個項目是關於專業產品，特別是，隨著專業市場上有更多的療法、更多的選擇以及生物相似藥的發展，我們有繼續發展的機會。總體而言，我們處於非常有利的位置，可以繼續推動生物相似藥的可負擔性和選擇。正如我們之前談到的，這是經濟和 Evernorth 整體成長的重要的長期多年推動力。當然，GLP-1 等療法的持續成長是我們整體主張中的一個因素。

So you put together that -- I've kind of touched on a number of the different capabilities. When you put together that suite of capabilities, that ends up being a really attractive portfolio, that we've had continued growth in the number of lives we're serving, growth in our clients' lives that enable us to deliver the numbers that we're talking about. Overall, really excited about the momentum we've got going into 2024 and see ourselves as well positioned to deliver there and continue the trajectory beyond.

所以你把它們放在一起——我已經觸及了許多不同的功能。當你把這套能力放在一起時，最終會成為一個非常有吸引力的產品組合，我們所服務的生活數量不斷增長，客戶生活的增長使我們能夠提供我們所期望的數字正在談論。總體而言，我們對進入 2024 年的勢頭感到非常興奮，並認為自己有能力實現這一目標並繼續未來的發展軌跡。

Our next question comes from George Hill with Deutsche Bank.

我們的下一個問題來自德意志銀行的喬治·希爾。

I guess just a couple of clarifying questions for me as it relates to MLR and the guide for '24. You guys have kind of bumped up the medical cost expectations. Can you kind of disaggregate what you're seeing by line of business there? And I just want to confirm that the MA business is still kind of included in the continuing ops in the MLR guidance for '24 because I saw in the footnotes it's kind of being carried as an asset held for sale. So just kind of like a disaggregation of kind of medical cost expectations and trends expectations for '24.

我想我需要澄清幾個與 MLR 和 24 指南相關的問題。你們提高了醫療費用預期。您能否依業務範圍對您所看到的內容進行分類？我只是想確認一下，MA 業務仍然包含在國土資源部 24 年指導中的持續運營中，因為我在腳註中看到它是作為待售資產進行的。這有點像是 24 世紀醫療成本預期和趨勢預期的分類。

George, it's Brian. So let me just take the MA question first, and then I'll get into the MCR.

喬治，是布萊恩。所以讓我先回答 MA 問題，然後再討論 MCR。

So as noted in my comments earlier, the Medicare Advantage business will continue to be reported through Cigna Healthcare through 2024. So all of our guidance, whether that be the revenue guidance, the customer volume guidance, the earnings guidance, all assumes that the Medicare business will continue to be reported through Cigna Healthcare on an asset held-for-sale basis. So just to clarify that. So all the metrics that you see line up with that basis.

因此，正如我先前的評論中所指出的，到 2024 年，Medicare Advantage 業務將繼續透過 Cigna Healthcare 進行報告。因此，我們所有的指導，無論是收入指導、客戶量指導、盈利指導，都假設 Medicare業務將繼續透過Cigna Healthcare 以持有待售資產的形式進行報告。所以只是為了澄清這一點。因此，您看到的所有指標都符合該基礎。

Within the MCR specifically, the midpoint of our guide obviously has a slight uptick from where we were in 2023. Now important to step back and thank the 2023 MCR performance was favorable to expectations and the primary driver of the Cigna Healthcare income outperformance. We're just really pleased with the -- both quarter and full year coming in favorable with expectations. And as I mentioned earlier, the 81.3% full year MCR was 70 basis points better than the midpoint of where we had started the guidance early in 2023.

具體而言，在MCR 範圍內，我們指南的中點顯然比2023 年的水平略有上升。現在重要的是退一步並感謝2023 年MCR 的表現有利於預期，也是Cigna Healthcare 收入優異的主要驅動力。我們對本季和全年的業績都符合預期感到非常滿意。正如我之前提到的，全年 MCR 為 81.3%，比我們在 2023 年初開始製定指導意見的中位數高出 70 個基點。

So you can think of the primary driver of the slightly higher projected 2024 MCR as being our Stop Loss products within the U.S. Commercial Employer business. As I mentioned earlier, these ran favorable to our target profit margins in 2023 due to lower-than-expected cost trends in high-dollar claimants. For 2024, our planning assumptions are for the Stop Loss products to normalize back into their typical target profit margin range.

因此，您可以將預計 2024 年 MCR 略高的主要驅動因素視為我們在美國商業雇主業務中的停損產品。正如我之前提到的，由於高額索賠人的成本趨勢低於預期，這些對我們 2023 年的目標利潤率有利。對於 2024 年，我們的規劃假設是停損產品正常化回其典型的目標利潤率範圍。

Secondarily, there's some product mix shift within the Cigna Healthcare portfolio between 2023 and 2024 that will impact the overall Cigna Healthcare MCR, although I would note that we expect the overall Cigna Healthcare profit margin percentage to be higher in 2024 compared to 2023. And we'd expect that to land near the low end of our targeted 9% to 10% range in 2024. And then finally, when you think about our MCR guidance, as always, our guidance does have an appropriate level of prudence to start off the year.

其次，2023 年至2024 年Cigna Healthcare 投資組合中存在一些產品組合變化，這將影響Cigna Healthcare 的整體MCR，儘管我要指出的是，我們預計2024 年Cigna Healthcare 的整體利潤率百分比將高於2023 年。預計到 2024 年，這一數字將接近我們目標 9% 至 10% 範圍的低端。最後，當你像往常一樣考慮我們的 MCR 指導時，我們的指導確實有適當的謹慎程度來開始年。

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。

I wanted to get back to the Health Care Services Corp. divestiture. Why was the PDP asset included in that sale? I would've thought that, that would have strategic value on the Evernorth side and that you'd have an advantage on the cost structure. And then similarly, including CareAllies as well, was that more a tie-in to the Medicare Advantage business? And what does that mean for broad sort of value-based care network development at Cigna?

我想回到醫療保健服務公司的剝離問題。為什麼 PDP 資產包含在該出售中？我以為，這對 Evernorth 方面具有戰略價值，並且您在成本結構上具有優勢。同樣，包括 CareAllies，這是否更多地與 Medicare Advantage 業務掛鉤？這對於 Cigna 廣泛的基於價值的護理網絡發展意味著什麼？

Josh, it's David. Let me take a portion of your question and then ask Eric to expand. And I'm going to come at the latter piece of it in terms of CareAllies and VBC, et cetera.

喬什，我是大衛。讓我回答你的部分問題，然後請艾瑞克進行擴充。我將從 CareAllies 和 VBC 等方面來討論後一部分。

First, your statement is correct. Think about the CareAllies as specifically focused on the MA portion of value-based care. So therefore, there's alignment there. Stepping back, on value-based care, we have a long history and, again, proven track record of delivering very strong positive results for the benefit of our clients and our customers and patients off of our value-based care orientation for Commercial, for individual exchange, as well as for Medicare Advantage. As you know from our prior conversations, that's been a partner and enabled model as opposed to an owned model, broadly speaking, in terms of owning the care delivery versus partnering enabling.

首先，你的說法是正確的。將 CareAllies 視為專門關注基於價值的護理的 MA 部分。因此，那裡存在對齊。退一步說，在基於價值的護理方面，我們擁有悠久的歷史，並且再次證明，我們在以價值為基礎的護理方向為商業、醫療、醫療等領域提供非常強勁的積極成果，為我們的客戶、我們的客戶和患者的利益提供非常強勁的積極成果。個人交換以及 Medicare Advantage。正如您從我們之前的對話中了解到的那樣，從廣義上講，就擁有護理服務與合作支援而言，這是一種合作夥伴和支持模式，而不是自有模式。

Additionally, I'd ask you to think about the commitment around that continuing. So our collaborative accountable care relationships for our Commercial business and our exchange business continues on. And our investment in and expansion of our Evernorth accountable care capabilities as we support health care delivery system partners around their value-based care, that continues, including our strategic partnership with Village. So on the value-based care side of the equation, no change in strategy for us. This specific subset of our assets was solely aligned to the Medicare Advantage business.

此外，我想請您考慮圍繞該持續進行的承諾。因此，我們在商業業務和交換業務方面的合作責任護理關係將繼續下去。我們對 Evernorth 負責任的醫療能力進行投資和擴展，因為我們支持醫療保健提供系統合作夥伴圍繞其基於價值的醫療服務，這一點仍在繼續，包括我們與 Village 的戰略合作夥伴關係。因此，在基於價值的護理方面，我們的策略沒有改變。我們資產的這一特定子集僅與 Medicare Advantage 業務保持一致。

I'll ask Eric to talk about the direction relative to PDP and our multidimensional services relationship there. Eric?

我會請 Eric 談談與 PDP 相關的方向以及我們在那裡的多維服務關係。艾瑞克？

Thanks, David. So 2 things I would note for you, Josh, here. First of all, as David and Brian had in their prepared remarks, we will have a multiyear services relationship between Evernorth and HCSC, building on a relationship that already exists there. So Evernorth will have the opportunity to continue to provide services associated not only with the prescription drug element of this business, but some of the other clinical coordination and related capabilities. So we're excited about that opportunity and working to grow together.

謝謝，大衛。喬希，我在這裡要為你指出兩件事。首先，正如 David 和 Brian 在他們準備好的演講中所說，我們將在 Evernorth 和 HCSC 之間建立多年的服務關係，建立在那裡已經存在的關係的基礎上。因此，Evernorth 將有機會繼續提供不僅與該業務的處方藥部分相關的服務，還提供與其他一些臨床協調和相關功能相關的服務。因此，我們對這個機會感到興奮，並努力共同成長。

Specifically to the employer PDP item, you should think of here Express Scripts continuing to be the face of the employer offerings, and this being seamless with the -- with all of our clients and services with the role that will be played here around the insurance dynamics going to HCSC. But again, this'll be a side of relationships that Express Scripts and Evernorth will continue to manage from a relationship and account management perspective, and we'll be -- continue to be very involved in an area of focus for us. So overall, I'm very excited about the opportunity to continue to grow with another partner here.

特別是對於雇主 PDP 項目，您應該認為 Express Scripts 仍然是雇主產品的代言人，這與我們所有的客戶和服務以及將在保險方面發揮的作用是無縫的。前往 HCSC 的動態。但同樣，這將是 Express Scripts 和 Evernorth 將繼續從關係和客戶管理角度進行管理的關係的一個方面，我們將繼續積極參與我們關注的一個領域。總的來說，我很高興有機會與這裡的另一位合作夥伴一起繼續成長。

Our next question comes from Scott Fidel with Stephens.

我們的下一個問題來自斯科特·菲德爾和史蒂芬斯。

Interested just now, with the sale of the MA business, how your priorities for investment and for growth in Cigna Healthcare may change from that. And obviously, you talked about how you've invested a lot in Medicare, so that should free up capital to invest in other businesses. So curious in terms of how you're thinking about where you can increase investment for growth in Cigna Healthcare. But also just how you're thinking about the exchange business now against the exit from MA just around your overall risk business in Cigna Healthcare will now be probably more weighted towards techs, which is a pretty volatile business. So curious just on your thinking about the exchange business and sort of how you -- how now you're going to sort of view that business post the sale of the MA.

剛才感興趣的是，隨著 MA 業務的出售，您在 Cigna Healthcare 的投資和成長優先事項可能會發生怎樣的變化。顯然，您談到瞭如何在醫療保險方面進行了大量投資，因此這應該可以釋放資金來投資其他業務。我很好奇您如何考慮在哪些方面可以增加投資以促進 Cigna Healthcare 的成長。而且，您現在如何考慮圍繞 Cigna Healthcare 的整體風險業務退出 MA 的交易所業務，現在可能會更偏重於科技股，這是一項相當不穩定的業務。我很好奇你對交易所業務的看法，以及你現在將如何看待出售 MA 後的業務。

Scott, it's David. I think your umbrella tenant is right. So as I noted in my prepared remarks, right, the decision allows for sharpening of focus as we lean into our portfolio going forward. As you think about the investments, though, we have a long track record of making multiyear investments within our portfolio. So think about investments in a digital-first orientation and data-led capabilities, continuing to invest in development of new programs and capabilities, be it what we talked about before with ClearCare or Pathwell capabilities; expanding the infrastructure and scale for a broader addressable market expansion; and our proven CuraScript SD expansion as we face off and support a broadening array of health care professionals and integrated delivery systems; and I mentioned to Josh, the Evernorth accountable care capability. So think about, broadly speaking, our investment strategy continuing to fuel a variety of items. And finally, sustained affordability, be it on the medical class pharmacy cost or administrative leverage that we get out of machine learning and AI through that lens.

斯科特，這是大衛。我認為你的雨傘租客是對的。因此，正如我在準備好的發言中指出的那樣，隨著我們向前推進投資組合，這一決定可以讓我們更加集中註意力。不過，當您考慮投資時，我們在投資組合中進行多年投資有著悠久的記錄。因此，請考慮對數位優先方向和數據主導的功能進行投資，繼續投資於新計劃和功能的開發，無論是我們之前討論的 ClearCare 或 Pathwell 功能；擴大基礎設施和規模，以擴大潛在市場；以及我們經過驗證的 CuraScript SD 擴展，因為我們面對並支援越來越多的醫療保健專業人員和綜合交付系統；我向喬許提到了 Evernorth 的責任醫療服務能力。因此，從廣義上講，我們的投資策略將繼續推動各種項目的發展。最後，持續的負擔能力，無論是醫療級藥房成本還是我們透過機器學習和人工智慧獲得的管理槓桿。

As it relates to the question around exchange or otherwise, we've always viewed the exchange business as sitting between Commercial as well as the Government. Obviously, the Government influences a meaningful portion of that through the benefit design and otherwise, yet we are able to successfully leverage our collaborative accountable care relationships. And as we've demonstrated now for about a decade, with the exchange business, by taking a very targeted focus within that market from its inception in 2014 to today, we continue to see that as a complementary aspects to our business. We will take very targeted positions, market by market, so long as we have the right collaborative accountable care relationships in place and have it be a complementary part of our portfolio.

由於它涉及交換或其他方面的問題，我們始終將交換業務視為商業和政府之間的事情。顯然，政府透過福利設計和其他方式影響了其中的重要部分，但我們能夠成功地利用我們的合作責任護理關係。正如我們在交易所業務上所展示的那樣，從 2014 年成立到今天，我們一直非常有針對性地關注該市場，我們繼續將其視為我們業務的補充。只要我們擁有正確的合作責任照護關係，並使其成為我們產品組合的補充部分，我們將針對每個市場採取非常有針對性的立場。

So I don't see the exchange posture is changing as a result of this. And broadly speaking, I don't think the investment strategy and the corporation changes as a result of it. It does create more capacity though, as you articulated, to accelerate some of the categories I made reference to. Hope that helps, Scott.

因此，我認為交易所的態度不會因此而改變。從廣義上講，我不認為投資策略和公司會因此而改變。不過，正如您所說，它確實創造了更多的能力，以加速我提到的一些類別。希望有幫助，斯科特。

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。

was wondering if you could just give a little more color about the membership guidance for 2024 by product. I know you're repricing exchanges. How is commercial going within Commercial, the subsegments? And then a little more color on the Medicare Advantage volume expectations as I guess that's in the guidance as well.

我想知道您是否可以對 2024 年按產品的會員指南提供更多資訊。我知道您正在重新定價交換。商業區隔領域的商業進展如何？然後對 Medicare Advantage 數量預期進行更多說明，我想這也在指南中。

Kevin, it's Brian. So as it relates to the net decline we've projected in the 2024 Cigna Healthcare customers, you can think of the primary driver of this being the individual exchange business. As we discussed late last year, we took some needed pricing actions in certain geographies in the individual exchange portfolio, and this will result in net customer declines for this business in 2024.

凱文，我是布萊恩。因此，由於它與我們預計的 2024 年 Cigna Healthcare 客戶的淨下降有關，您可以認為這是個人交換業務的主要驅動力。正如我們去年年底所討論的，我們在個別交易所投資組合的某些地區採取了一些必要的定價行動，這將導致該業務在 2024 年淨客戶數量下降。

Within the U.S. Commercial Employer business, we expect customer volumes to be up modestly. But you should think of this by subsegment being split a bit. So we expect to see a net decline in our National Accounts business, but this will be more than offset by the continued strong growth within our Select segment. And as a reminder, we continue to see opportunities for above-market growth in the Select segment, where our market share is still just 7%.

在美國商業雇主業務中，我們預期客戶數量將小幅成長。但你應該透過將子分段稍微拆分來考慮這一點。因此，我們預計國民帳戶業務將出現淨下降，但這將被我們精選業務的持續強勁成長所抵消。提醒一下，我們繼續在精選細分市場中看到高於市場成長的機會，而我們的市佔率仍僅為 7%。

When you think about the MA customer volume specifically, as we approach the 2024 bid cycle, as we always do, we apply local-market, county-level approach relative to how we price and set benefits. And so for most geographies, this resulted in stable benefits. A few areas, we had some targeted pullbacks, just in light of the funding environment 2024. And what we saw was in some of our local geographies, there was some very aggressive competitor behavior, which resulted in less net growth than what we had originally expected for the Medicare Advantage business.

當您具體考慮 MA 客戶量時，隨著我們一如既往地接近 2024 年投標週期，我們會採用與定價和設定收益相關的當地市場、縣級方法。因此，對於大多數地區來說，這帶來了穩定的效益。鑑於 2024 年的融資環境，我們在一些領域進行了一些有針對性的回調。我們看到，在我們的一些當地地區，存在一些非常激進的競爭對手行為，這導致淨增長低於我們最初的水平Medicare Advantage 業務的預期。

So taken all together, we would expect to see net customer volumes down slightly for year-end 2024 in comparison to year-end 2023 within the Medicare Advantage space, specifically. But when you put all these pieces together, we're pleased with the overall balance in the Cigna Healthcare business right now as we expect to see profit margins expand year-over-year, as I mentioned earlier, while we're serving a meaningful volume of customers that's grown markedly over the last 2 years.

綜上所述，我們預計 2024 年底的淨客戶數量將比 2023 年底略有下降，特別是在 Medicare Advantage 領域。但是，當你將所有這些部分放在一起時，我們對Cigna Healthcare 業務目前的整體平衡感到滿意，因為正如我之前提到的，我們預計利潤率將逐年擴大，同時我們正在為有意義的客戶提供服務過去兩年客戶數量顯著成長。

Our next question comes from Erin Wright with Morgan Stanley.

我們的下一個問題來自摩根士丹利的艾琳賴特。

On Evernorth, how are you thinking about the implications of cost-plus models and what that means at the PBM level and how does that influence your discussions with customers or just around your pharmacy network relationships? And just more broadly, just around transparency. And obviously, you talked about that in your prepared remarks in more transparent offerings at the PBM level. And how do you think those offerings are gaining or not gaining traction across your customer base?

在 Evernorth 上，您如何思考成本加成模型的影響以及這在 PBM 層面意味著什麼，以及這對您與客戶或圍繞藥房網絡關係的討論有何影響？更廣泛地說，就是圍繞著透明度。顯然，您在 PBM 層面上更透明的產品準備好的演講中談到了這一點。您認為這些產品在您的客戶群中是否獲得了關注？

Erin, it's Eric. First of all, just -- we would note fundamentally, we start with the portfolio and approach that's equipped to offer choice and flexibility in how we work to support our clients, and so that's the lens I ground back to.

艾琳，我是埃里克。首先，我們從根本上註意到，我們從投資組合和方法開始，這些投資組合和方法為我們支持客戶的工作方式提供了選擇和靈活性，這就是我所考慮的視角。

We're always open to looking at new ways and approaches and such that drive increased affordability and meets the needs of our buyers. And I'm really proud of the range of different financing solutions we offer and the number of innovations that we've delivered in 2023 and already in 2024 in terms of the types of options that we bring to our clients. And in fact, as David mentioned, in the fourth quarter, we launched our ClearNetwork solution, which was a first of its kind. It's comprehensive and simple solution to providing a cost index-based pharmacy network. That solution is unique in that it provides access to all the drugs in pricing that's based off of independent externally created cost on disease, kind of a simple margin that's shared between us and the dispensing pharmacy. So use that as an example. We had a lot of good conversations about that as a program and as an offering, but would note that the selling seasons for these types of things tend to be long in time. There's a long lead time in terms of implementation of such. So some good conversation with our clients on solutions like that.

我們始終樂於尋找新的方式和方法，以提高可負擔性並滿足買家的需求。我對我們提供的一系列不同的融資解決方案以及我們在 2023 年和 2024 年為客戶提供的選擇類型方面交付的大量創新感到非常自豪。事實上，正如 David 所提到的，我們在第四季度推出了 ClearNetwork 解決方案，這是同類中的第一個解決方案。它是提供基於成本指數的藥房網路的全面而簡單的解決方案。該解決方案的獨特之處在於，它提供了所有藥物的定價，這些定價基於獨立的外部創建的疾病成本，這是我們和配藥藥房之間共享的簡單利潤。因此，以此為例。我們對此作為一個計劃和一個產品進行了很多良好的對話，但我們注意到這些類型的東西的銷售季節往往很長。實施此類措施需要很長的準備時間。因此，與我們的客戶就此類解決方案進行了一些良好的對話。

Looking at other changes in the ecosystem. Overall, we'd note, our clients are demanding more for their health care dollars and are looking for ways to improve affordability overall and broadly are not interested in paying more for the same services that they receive today. We've got a wide variety of networks and solutions that exist already in the market and the flexibility to adapt and adjust the configuration of our networks to trade-off costs relative to the value and access profiles that exist. So overall, we've got good flexibility, good capabilities and modularity to be able to approach and line up our capabilities best with what our clients need.

看看生態系中的其他變化。總體而言，我們注意到，我們的客戶對醫療保健費用的要求更高，並且正在尋找提高整體負擔能力的方法，並且總體上對為他們今天獲得的相同服務支付更多費用不感興趣。我們擁有市場上現有的各種網路和解決方案，並且可以靈活地適應和調整我們的網路配置，以權衡相對於現有價值和存取配置檔案的成本。總的來說，我們擁有良好的靈活性、良好的能力和模組化能力，能夠將我們的能力與客戶的需求完美結合。

Our next question comes from Justin Lake with Wolfe Research.

我們的下一個問題來自沃爾夫研究中心的賈斯汀·萊克。

Wanted to ask a broader strategic question beyond MA. Most of your peers have set up their business models over the last 5 to 10 years to manage a significant amount of their internal healthcare spend, right, and drive additional profitability and revenue from those services businesses. So with the sale of MA, you're repricing your exchanges, which makes sense, but you risk membership and the amount of medical costs you control, right, and are able to run through your services business just declines. How do you think about the value there, those individual synergies of controlling medical costs and being able to provide services there, the natural growth it provides each and every year versus having to go out into the market and win each and every piece of business of growth, which obviously you've done pretty well over the last few years but just the stability of kind of having that internal membership? And how should investors expect this to impact your capital deployment strategy going forward?

想提出 MA 以外更廣泛的策略問題。大多數同行在過去 5 到 10 年裡都建立了自己的商業模式，以管理大量的內部醫療保健支出，並從這些服務業務中提高盈利能力和收入。因此，隨著MA 的出售，您將重新定價您的交易所，這是有道理的，但您會面臨會員資格和您控制的醫療費用金額的風險，對吧，並且能夠運行您的服務業務只會下降。您如何看待那裡的價值，控制醫療成本和能夠在那裡提供服務的個體協同作用，它每年提供的自然增長與必須進入市場並贏得每一項業務的情況增長，顯然你們在過去幾年裡做得很好，但只是擁有內部成員的穩定性？投資人應該如何預期這會影響您未來的資本部署策略？

Justin, it's David. There's a lot in your questions. Let me try to frame our thought process today and as we go forward.

賈斯汀，我是大衛。你的問題很多。讓我嘗試建構一下我們今天以及未來的思考過程。

First, to date, we have a very clear proven track record of delivering a total cost, total quality, including clinical quality and service quality solution, that resonates really well in the marketplace, whether it's in the benefit side of the equation or on the services side of the equation. And our results reinforce that.

首先，迄今為止，我們在提供總成本、總品質（包括臨床品質和服務品質）解決方案方面擁有非常清晰、經過驗證的記錄，無論是在效益方面還是在市場方面，這些解決方案在市場上都引起了很好的反響。等式的服務方面。我們的結果強化了這一點。

Point two is we've successfully executed an approach that is, on the delivery and fulfillment, a mix of partner and owned. We continue to evolve our portfolio. But philosophically, we do not believe, have not, do not and continue to not believe that you have to own everything to be able to fulfill. As you might recall, if you reflect back on prior conversations within our portfolio at Investor Days, we framed actually the amount of services that Evernorth, for example, was fulfilling at a point in time for the Cigna Healthcare portfolio. And we frame the expansion opportunity, to the point of your question, that existed in front of us, and we continue to expand those services. Our model though is also importantly not predicated on only having economic alignment for guaranteed cost. We're able to do it successfully for self-funded or shared-funding mechanism as well. So point two is we see the ability to continue to grow that over time with our Evernorth services portfolio.

第二點是我們成功地執行了一種方法，即在交付和履行方面，合作夥伴和自有的混合。我們不斷發展我們的產品組合。但從哲學上講，我們不相信、不相信、不相信、現在也不相信，你必須擁有一切才能實現目標。您可能還記得，如果您回想一下我們在投資者日投資組合中的先前對話，我們實際上會列出 Evernorth 在某個時間點為 Cigna Healthcare 投資組合提供的服務量。對於您提出的問題，我們建立了擺在我們面前的擴展機會，並且我們將繼續擴展這些服務。不過，重要的是，我們的模型不僅以保證成本的經濟協調為基礎。我們也能夠透過自籌資金或共享資金機製成功做到這一點。第二點是，我們看到隨著時間的推移，我們的 Evernorth 服務組合有能力繼續成長。

Point three is as it relates to services to continue to invest in, we've been very clear that certain services, we see additional step function opportunities to invest in and continue to grow. Most importantly, our proven scaled Specialty capabilities, the rate of spending growth and clinical complexity around that is off the charts. We have a leadership position there that will continue to grow, and we will continue to be the market leader in that space through our assets. Secondly, the need statements around behavioral health in the most comprehensive way, the market expects now much more coordination of behavioral and physical health, and we will continue to expand services that we have within our leading capabilities. And third, just to stop at 3 for illustration, is the breadth of virtual services, the ability to connect and coordinate and expand services as we go forward.

第三點是，由於它與繼續投資的服務有關，我們非常清楚，對於某些服務，我們看到了額外的投資和持續成長的階梯功能機會。最重要的是，我們經過驗證的專業能力規模、支出成長率和臨床複雜性都是空前的。我們在那裡的領導地位將繼續成長，並且我們將透過我們的資產繼續成為該領域的市場領導者。其次，以最全面的方式圍繞行為健康進行需求陳述，市場現在期望行為和身體健康更加協調，我們將繼續擴大我們在領先能力範圍內的服務。第三，僅以 3 為例進行說明，虛擬服務的廣度，以及隨著我們前進而連結、協調和擴展服務的能力。

So we agree with your point, I'll end with agreement with your point, of continuing to invest in our services capabilities to be able to support right services, but we do not believe you have to own all aspects of the care delivery equation to be able to deliver that on a go-forward basis. So hopefully, that gives you a framing. As you might expect, we'll spend time on this at our Investor Day on the seventh because it's an important part of our strategy today and important part of our growth strategy going forward.

因此，我們同意您的觀點，最後我同意您的觀點，即繼續投資我們的服務能力，以便能夠支持正確的服務，但我們不認為您必須擁有護理服務等式的所有方面才能能夠在前進的基礎上實現這一目標。希望這能給你一個框架。正如您所料，我們將在第七屆投資者日花時間討論這個問題，因為這是我們今天策略的重要組成部分，也是我們未來成長策略的重要組成部分。

Our next question comes from Lance Wilkes with Bernstein.

我們的下一個問題來自伯恩斯坦的蘭斯威爾克斯。

Could you talk a little bit about, over in the Cigna Healthcare side of the business employer, how penetration rates are going with the Specialty products in self-insured and if there are any interesting trends as you go into '24 here as you look at the selling season in '25 with respect to that? And then as you've gone through the selling season, any changes in employer priorities? And then also just a quick clarification on, if you could just explain, there's a little drop in fees in the PBM. So that was just clarification. The other one's a real question.

您能否談談在企業雇主的 Cigna Healthcare 方面，自保專業產品的滲透率如何，以及當您進入 24 世紀時是否有任何有趣的趨勢'25年的銷售季節又如何呢？然後，當你經歷銷售季節時，雇主的優先事項有什麼變化嗎？然後快速澄清一下，如果您能解釋一下的話，PBM 的費用略有下降。這只是澄清。另一個是一個真正的問題。

Lance, it's Brian. I'll take the majority of your question. I think there's a number of different pieces in there.

蘭斯，我是布萊恩。我會回答你的大部分問題。我認為裡面有很多不同的部分。

As it relates to the Specialty products and the attachment, if you will, to the medical in the Cigna Healthcare book of business, as you know, it's been a long-standing part of the company's strategy because we see the value of clinical integration being much greater when we have multiple components of relationship with an employer. So that's been, for many years, part of the company strategy.

如您所知，由於它與特種產品和配件（如果您願意的話）與 Cigna Healthcare 業務書中的醫療相關，因此它一直是公司策略的長期組成部分，因為我們看到臨床整合的價值當我們與雇主有多種關係時，效果會更大。因此，多年來，這一直是公司策略的一部分。

And important to bifurcate that by subsegment, certainly in the down market, we call the Select segment under 500. Most of those employers tend to buy the entirety of our offerings at once. So we have very high, to use your word, penetration rates in the under 500 and then comparatively lower when you get to the National Account space, where there tends to be a little bit more a la carte purchasing of the different services. So broadly speaking, I would say those patterns haven't changed too much over the last few years.

重要的是要按細分市場來劃分，當然在低端市場，我們將 500 名以下的精選細分市場稱為「精選細分市場」。大多數雇主傾向於立即購買我們的全部產品。所以，用你的話來說，我們在 500 人以下的滲透率非常高，而當你進入國民賬戶領域時，滲透率相對較低，那裡往往會更多地按菜單點菜購買不同的服務。從廣義上講，我想說這些模式在過去幾年裡沒有太大變化。

On your question on the selling season, in particular, and some of the employer preferences, the 2024 selling season is largely over with the exception of the Select segment. As I mentioned earlier, that's an area for us that continues to grow at above market rates and we're really pleased with. As we look forward to the '25 selling season, we do have some National Account RFPs in-house for both some existing clients and new business prospects. And directionally, RFP volumes are up a bit from prior years. Now each of these large clients, as you can appreciate, tend to have unique needs.

關於您關於銷售季節的問題，特別是關於一些雇主偏好的問題，2024 年的銷售季節基本上已經結束，但精選細分市場除外。正如我之前提到的，這對我們來說是一個繼續以高於市場水平成長的領域，我們對此感到非常滿意。當我們期待 25 年的銷售季節時，我們確實為一些現有客戶和新業務前景提供了一些內部國民帳戶 RFP。從方向上看，RFP 數量比前幾年有所增加。現在，正如您所知，這些大客戶中的每一個往往都有獨特的需求。

That said, there are a few areas that I would highlight for purposes of kind of themes. So one would be some of our larger employers are seeking to consolidate vendors or point solutions with those who can supply more integrated offerings. So we tend to call that point solution fatigue, you may hear Eric or I talk about. Secondly, a theme that's been around mental health and substance abuse benefits as these programs have become more and more important to employers from the standpoint of managing productivity, absences and overall health of their employee base. And thirdly, many of the larger employers are interested in digitally enabled care navigation capabilities to further power things like site of care optimization and consumer empowerment at the time that, that care is delivered.

也就是說，出於某種主題的目的，我要強調一些領域。因此，我們的一些較大的雇主正在尋求將供應商或單點解決方案與那些能夠提供更多整合產品的供應商進行整合。所以我們傾向於稱之為點解決疲勞，你可能聽到埃里克或我談論過。其次，主題圍繞著心理健康和藥物濫用福利，因為從管理員工生產力、缺勤和整體健康的角度來看，這些計畫對雇主來說變得越來越重要。第三，許多較大的雇主對數位化護理導航功能感興趣，以進一步推動護理網站優化和提供護理時的消費者賦權等工作。

So we continue to see interest in those areas as well as various provider network configurations that may optimize cost quality and/or incentive alignment between the provider and the financier. So our Cigna Healthcare offerings are really well positioned to address these themes and the demands from large employers while simultaneously continue to grow share in the under 500 Select segment.

因此，我們繼續看到人們對這些領域以及各種提供者網路配置的興趣，這些配置可能會優化提供者和金融家之間的成本品質和/或激勵協調。因此，我們的 Cigna Healthcare 產品確實能夠很好地滿足這些主題和大型雇主的需求，同時繼續增加在 500 強精選細分市場中的份額。

I think David wants to add a few comments here.

我想大衛想在這裡添加一些評論。

Sure. Lance, just to amplify and add one point. The amplification is that point solution fatigue, that plays through in terms of opportunities for our Evernorth team as well as our Cigna Healthcare team. So the -- around that, think about the ability to leverage solutions to get more value, better service, better clinical outcomes, overall value and affordability.

當然。蘭斯，只是為了放大加一分。放大是單點解決方案疲勞，這為我們的 Evernorth 團隊以及我們的 Cigna Healthcare 團隊帶來了機會。因此，圍繞這一點，考慮利用解決方案獲得更多價值、更好的服務、更好的臨床結果、整體價值和負擔能力的能力。

Secondly, I just wanted to reinforce a critical point. When we think about penetration or cross-selling, sometimes it's thought through -- and you didn't state this, but sometimes it's thought through under the notion of you're just cross-selling products. The integration of the products to deliver more value to the clients and customers is mission-critical. So that shows up in better service quality, better clinical quality, improved affordability. And I would highlight that our sustained differentiated MLR performance is, in many cases, aided by our proven ability to integrate certain services. They come together, would benefit the clients -- that enables us to generate a high level of cross-selling and a high level of penetration. Thanks, Lance.

其次，我只是想強調一個關鍵點。當我們考慮滲透或交叉銷售時，有時會經過深思熟慮 - 您沒有說明這一點，但有時會在您只是交叉銷售產品的概念下進行深思熟慮。整合產品以向客戶和客戶提供更多價值是至關重要的任務。這體現在更好的服務品質、更好的臨床品質和更高的負擔能力。我想強調的是，在許多情況下，我們持續的差異化 MLR 績效得益於我們經過驗證的整合某些服務的能力。它們結合在一起，將使客戶受益——這使我們能夠產生高水準的交叉銷售和高水準的滲透。謝謝，蘭斯。

Our next question comes from Gary Taylor with TD Cowen.

我們的下一個問題來自 Gary Taylor 和 TD Cowen。

David, I was hoping to ask an action-packed question like A.J. did, but I'm afraid I'm going to be to in the weeds for that. I just want to go back to Stop Loss because it looks like a pretty substantial benefit to the 4Q and headwind. When I just look at how much your fourth quarter MLR outperformed your typical seasonal pattern, particularly in a quarter where there was broad trend acceleration, and then I try to square how much AC enrollment and margin improvement should drive a tailwind, such that '24 MLRs should actually decline year-over-year, but you're guiding it up. I mean, it gets me to hundreds and hundreds of basis points of variance around Stop Loss. So could you quantify how much that helped 4Q and how much a headwind that is for '24? And then the second part would just be walk us through again why you had such favorable performance in that line.

大衛，我本來希望問一個像 A.J. 這樣充滿動感的問題。做到了，但恐怕我會為此陷入困境。我只想回到停損，因為它看起來對第四季和逆風來說是一個相當大的優點。當我只看一下您的第四季度MLR 的表現優於典型的季節性模式時，特別是在趨勢廣泛加速的季度，然後我嘗試計算AC 註冊人數和利潤率改善應該推動多少順風車，這樣' 24 MLR 實際上應該逐年下降，但你正在引導它上升。我的意思是，它讓我在停損周圍出現數百個基點的變異數。那麼您能否量化這對第四季度的幫助有多大以及對 24 年的不利影響有多大？然後第二部分將再次向我們介紹為什麼您在該領域表現如此出色。

Gary, it's Brian. So as it relates to the Stop Loss book, as you know, this is a really important part of the Cigna Healthcare portfolio. And we finished 2023 with $6 billion of premium in that product line, which, to the earlier question Lance asked, attaches itself to our self-funded offerings in many instances. This book will naturally have some variability to it. So I wouldn't get overly fixated on one quarter's performance. There tends to be a little bit more settlement activity that transpires in the fourth quarter. So we had a little bit more of the favorability work its way through in the quarter. Whereas if you smooth out over the course of the year, you don't have quite the same dynamic which is one of the reasons why when you do the bridge from '23 to '24, you shouldn't run rate the fourth quarter experience from that standpoint.

加里，是布萊恩。因此，如您所知，由於它與停損書相關，因此它是 Cigna Healthcare 投資組合中非常重要的一部分。到 2023 年，我們在該產品線中獲得了 60 億美元的溢價，對於蘭斯先前提出的問題，這在許多情況下都與我們自籌資金的產品相關。這本書自然會有一些變化。所以我不會過度關心一個季度的表現。第四季的結算活動往往會增加。因此，我們在本季獲得了更多的好感度。然而，如果你在這一年中保持平穩，你就不會擁有完全相同的動態，這就是為什麼當你從23 年過渡到24 年時，你不應該對第四季度的體驗進行評價的原因之一從這個角度來看。

So I mentioned earlier some of the moving pieces in the year-over-year MCR reconciliation, the 90 basis points increase from where we landed at the end of '23 to the midpoint of the '24 guide. A key component of that 90 basis points is an uptick that were anticipated in the Stop Loss product MCRs, which, to the point earlier, is a function of our assumption that, that will normalize back to more traditional levels of profitability on the Stop Loss products. So I think that's broadly the way I would encourage you to think about the dynamics at play here with that product line.

因此，我之前提到了同比 MCR 調節中的一些變化，即從 23 年底的水平到 24 年指南的中點增加了 90 個基點。 90 個基點的一個關鍵組成部分是止損產品 MCR 的預期上升，到目前為止，這是我們假設的函數，即止損將正常化回更傳統​​的盈利水平產品。因此，我認為這就是我鼓勵您思考該產品線的動態的大致方式。

Our last question comes from Dave Windley with Jefferies.

我們的最後一個問題來自傑弗里斯的戴夫·溫德利。

The premise of my question here is that your Evernorth profit guidance for '24 looks pretty highly visible to us. So my questions underneath that are, one, that you had guided '23 to include a ramping contribution from biosimilar. How should we expect that to continue? Should that continue to ramp in magnitude? And then the second part was the significant onboarding costs for the Centene contract in '23. Are you fully past those? Are those completely gone? Brian, you mentioned some Evernorth onboarding -- maybe unrelated, but Evernorth onboarding in your remarks. I just wanted to kind of understand the relative size of those. So those 2 things, please.

我在這裡提出問題的前提是，你們對 Evernorth '24 的利潤指導對我們來說看起來非常明顯。因此，我的問題是，第一，您在 23 年指導中納入了生物相似藥的不斷增加的貢獻。我們該如何期待這種情況會持續下去？這種情況是否應該繼續加劇？第二部分是 23 年 Centene 合約的巨額入職成本。你完全超越了這些嗎？那些完全消失了嗎？ Brian，你提到了 Evernorth 的一些入職——也許無關，但在你的言論中 Evernorth 的入職。我只是想了解它們的相對大小。那麼這兩件事，請。

It's David. Let me ask Brian to give you a framing in terms of -- because you have a question relative to the trajectory in the year-over-year and then ask Brian to hand it across to Eric to give you a little bit more color of your question, the onboarding costs that were really intense during 2023 and then some of what we're calling onboarding costs that bleeds into the early part of 2024, give you a little color of what those services look like. But I'll ask Brian to frame the financials first.

是大衛。讓我請布萊恩給你一個框架——因為你有一個與去年同期的軌跡相關的問題，然後請布萊恩把它交給埃里克，讓你對你的情況有更多的了解。問題是，2023 年的入職成本非常高，然後我們所說的入職成本會持續到2024 年初，讓您對這些服務的情況有一些了解。但我會請布萊恩先制定財務狀況。

Yes. Thanks, David. Dave, so overall, our AOI growth in Evernorth is expected to be about 9%, as implied by the $7 billion or more of income that we expect in the year. And you can think of that as having the benefit of Centene-related costs now essentially normalizing back to a point where the profitability of that relationship will be in the range of breakeven.

是的。謝謝，大衛。戴夫，總體而言，我們在 Evernorth 的 AOI 成長率預計約為 9%，正如我們預計今年收入 70 億美元或更多所暗示的那樣。你可以認為這是 Centene 相關成本的好處，現在基本上恢復正常，這種關係的盈利能力將處於盈虧平衡範圍內。

And then on top of that, we will have income performance. That's more in line with our traditional algorithm of 5% to 7% average annual income growth. And that reflects the benefit of all the multiyear trends that Eric talked about earlier, whether those be biosimilars, GLP-1 drugs, specialty generics, et cetera. So we certainly are seeing continued benefit from the biosimilar wave in 2024. But as I mentioned earlier, there's a bit of a specific and unique effect of the large amount of additional volume we're getting with the new client relationships in 2024.

除此之外，我們還會有收入表現。這更符合我們平均年收入成長 5% 至 7% 的傳統演算法。這反映了 Eric 之前談到的所有多年趨勢的好處，無論是生物相似藥、GLP-1 藥物、特種仿製藥等。因此，我們肯定會看到 2024 年生物相似藥浪潮的持續受益。但正如我之前提到的，我們在 2024 年透過新客戶關係獲得的大量額外銷售會產生一些特定且獨特的影響。

So Eric, maybe you can expand on that dynamic a bit.

埃里克，也許你可以稍微擴展一下這種動態。

Great. Thanks, Brian. So with Centene, first, I would just start by actually noting how proud I am of how our team has delivered here and how we worked collaboratively across and with the Centene team. It's really been a great effort and one that's come together really nicely for the benefit of our now shared customers. Implementation has gone really well, and our first month has been quite successful.

偉大的。謝謝，布萊恩。因此，對於 Centene，首先，我首先要指出的是，我對我們團隊在此交付的成果以及我們與 Centene 團隊的協作方式感到多麼自豪。這確實是一項巨大的努力，而且為了我們現在共同客戶的利益而完美地結合在一起。實施進展非常順利，我們的第一個月非常成功。

Now consistent with what we've said before, as Brian just noted, in 2023, we had meaningful implementation spending and no associated revenue generated loss 2024. We have results that will be approximately breakeven in 2025. We'd expect to achieve our run rate margin for this contract, which will be lower than the overall book of business.

現在與我們之前所說的一致，正如布萊恩剛剛指出的那樣，在2023 年，我們有有意義的實施支出，並且到2024 年沒有相關的收入產生損失。我們的結果將在2025 年大致實現盈虧平衡。我們預計將實現我們的目標該合約的利率差額將低於整體業務帳面。

With respect to the in-year 2024 timing that Brian alluded to before, you should just think about this, there's a lot more activity that has to happen at the beginning of a contract like this. There's more client outreach. There's work to get individuals into their therapies, et cetera. So there's normal effect here of just additional work and activity that has to take place in the first part of the year, and our expenses will reflect that. So that's a bit of that in-year shaping, but it's all consistent with what we had shared before.

關於 Brian 之前提到的 2024 年時間安排，您應該考慮一下，在這樣的合約開始時必須進行更多活動。有更多的客戶外展。有一些工作可以讓個人接受治療等等。因此，今年上半年必須進行的額外工作和活動會產生正常影響，我們的費用將反映這一點。這有點像是年內的情況，但與我們之前分享的內容是一致的。

The final thing I'd note is, consistent with our kind of normal practice now that Centene is a live client of ours, we won't be commenting going forward on specific profitability of a specific client or things along those lines, but know that the trajectory here start -- is off to the same start we expected and consistent with what we had talked about previously.

我要注意的最後一件事是，與我們的正常做法一致，既然 Centene 是我們的即時客戶，我們不會對特定客戶的具體盈利能力或類似的事情發表評論，但要知道這裡的軌跡開始— —與我們預期的開始相同，並且與我們之前討論的一致。

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

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

Thanks. Just a couple of messages to reiterate. First and foremost, 2023 was clearly a strong year of performance across our company as we executed quite well. And it's reinforced by more than a decade where we've executed consistently as we've evolved our company and continue to grow our business portfolio and those we serve. We have confidence that we're going to sustain that momentum and leverage our well-balanced portfolio across our franchise and continue to deliver within our 10% to 13% long-term EPS growth range as well as pay an attractive dividend.

謝謝。只需重申幾條訊息。首先也是最重要的是，2023 年顯然是我們公司業績強勁的一年，因為我們執行得相當好。十多年來，我們在公司發展過程中始終如一地執行，並不斷擴大我們的業務組合和我們所服務的對象，這一點得到了加強。我們有信心保持這一勢頭，並利用我們在整個特許經營範圍內均衡的投資組合，繼續實現 10% 至 13% 的長期 EPS 增長範圍，並支付有吸引力的股息。

Finally, I want to thank my coworkers around the world for their continued disciplined execution, their passion, importantly, in their caring orientation as well as dedication for those we serve. It shows up in our results. I'm really pleased and proud of what we delivered in 2023. And importantly, I'm even more excited for our expansion of our reach and impact in 2024.

最後，我要感謝世界各地的同事，感謝他們持續嚴格的執行力、他們的熱情，更重要的是，他們的關懷以及對我們所服務的人的奉獻。它顯示在我們的結果中。我對我們在 2023 年交付的成果感到非常高興和自豪。更重要的是，我對我們在 2024 年擴大影響力和影響力感到更加興奮。

As a final note for you all, we look forward to seeing many of you at our Investor Day, which is a month away. So in early March, we look forward to seeing you in New York City, and our team will be excited to talk about the market expansion we see in front of us, our capabilities and our opportunity to create additional value on a go-forward basis.

最後，我們期待在一個月後的投資者日見到你們。因此，三月初，我們期待在紐約見到您，我們的團隊將很高興地談論我們面前的市場擴張、我們的能力以及我們在前進的基礎上創造額外價值的機會。

Have a great day. Thanks.

祝你有美好的一天。謝謝。

Ladies and gentlemen, this concludes the Cigna Group's Fourth 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) 839-9317 or 203-369-3605. There is no passcode required for this replay.

女士們、先生們，信諾集團 2023 年第四季業績回顧到此結束。 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 個工作天內提供。您可以撥打 (800) 839-9317 或 203-369-3605 存取錄製的會議。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。