Centene Corp (CNC) 2022 Q3 法說會逐字稿

Good morning, everyone, and welcome to the Centene Corporation Third Quarter 2022 Earnings Results Conference Call. (Operator Instructions) Please also note, today's event is being recorded.

大家早上好，歡迎參加 Centene Corporation 2022 年第三季度收益結果電話會議。 （操作員說明）另請注意，今天的活動正在錄製中。

At this time, I would like to turn the conference call over to Jennifer Gilligan, Senior Vice President of Finance and Investor Relations. Ma'am, please go ahead.

在這個時候，我想把電話會議轉給財務和投資者關係高級副總裁詹妮弗·吉利根。女士，請繼續。

Thank you, Jamie, and good morning, everyone. Thank you for joining us on our third quarter 2022 earnings results conference call. Sarah London, Chief Executive Officer; Brent Layton, President and Chief Operating Officer; and Drew Asher, Executive Vice President and Chief Financial Officer of Centene, will host this morning's call, which also can be accessed through our website at centene.com.

謝謝你，傑米，大家早上好。感謝您參加我們的 2022 年第三季度收益結果電話會議。莎拉倫敦，首席執行官； Brent Layton，總裁兼首席運營官； Centene 執行副總裁兼首席財務官 Drew Asher 將主持今天上午的電話會議，也可以通過我們的網站 centene.com 訪問該電話會議。

Any remarks that Centene may make about future expectations, plans and prospects constitute forward-looking statements for the purpose of safe harbor provision under the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by those forward-looking statements as a result of various important factors, including those discussed in Centene's most recent Form 10-K filed February 22, 2022, and other public SEC filings.

Centene 可能對未來的預期、計劃和前景發表的任何評論都構成前瞻性陳述，目的是根據 1995 年《私人證券訴訟改革法案》提供安全港條款。實際結果可能與這些前瞻性陳述所表明的結果大不相同，因為各種重要因素的結果，包括 Centene 於 2022 年 2 月 22 日提交的最新 10-K 表格和其他公開的 SEC 文件中討論的因素。

Centene anticipates that subsequent events and developments may cause its estimates to change. While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so. The call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our third quarter 2022 press release, which is available on the company's website under the Investors section.

Centene 預計後續事件和發展可能會導致其估計發生變化。雖然公司可能會選擇在未來某個時候更新這些前瞻性陳述，但我們明確表示不承擔任何這樣做的義務。電話會議還將提及某些非公認會計原則措施。這些措施與最直接可比的 GAAP 措施的對賬可以在我們的 2022 年第三季度新聞稿中找到，該新聞稿可在公司網站的“投資者”部分下找到。

Company is unable to provide a reconciliation of its 2023 and 2024 adjusted diluted EPS targets to corresponding GAAP measures without unreasonable efforts due to the difficulty of predicting the timing and amounts of various items within a reasonable range.

由於難以在合理範圍內預測各種項目的時間和數量，公司無法在不做出不合理努力的情況下將其 2023 年和 2024 年調整後的稀釋後每股收益目標與相應的 GAAP 措施進行對賬。

Finally, please mark your calendars for our upcoming Investor Day on December 16 in New York City. Invitations and necessary registration information will be sent out shortly.

最後，請在日曆上標記我們即將於 12 月 16 日在紐約市舉行的投資者日。邀請和必要的註冊信息將很快發出。

With that, I'd like to turn the call over to our CEO, Sarah London. Sarah?

有了這個，我想把電話轉給我們的首席執行官 Sarah London。莎拉？

Thank you, Jen, and thanks, everyone, for joining us this morning as we discuss our third quarter results.

感謝 Jen，感謝大家今天早上加入我們，討論我們的第三季度業績。

During our time today, I'll review the highlights of our financial and operational performance for Q3 and address some of the more recent developments shaping our view of 2023 and beyond. Then Brent will offer comments around the core businesses and share updates on our strong positioning relative to 2023 Medicare and Marketplace enrollment. Finally, Drew will provide details of our overall financial performance and update our full year 2022 outlook.

在我們今天的時間裡，我將回顧我們第三季度財務和運營業績的亮點，並討論一些影響我們對 2023 年及以後的看法的最新發展。然後，布倫特將圍繞核心業務發表評論，並分享我們相對於 2023 年醫療保險和市場註冊的強勢定位的最新情況。最後，德魯將提供我們整體財務業績的詳細信息，並更新我們的 2022 年全年展望。

First, the quarter. We reported third quarter adjusted EPS of $1.30, slightly ahead of our expectations. Our strong results were driven by continued organic growth in Medicaid and Medicare, the continued impact of Marketplace bid discipline, as well as strategic capital deployment in the form of share and bond repurchases.

首先，季度。我們報告第三季度調整後每股收益為 1.30 美元，略高於我們的預期。醫療補助和醫療保險的持續有機增長、市場競標紀律的持續影響以及股票和債券回購形式的戰略資本部署推動了我們強勁的業績。

We now expect Centene's full year 2022 adjusted EPS to be within a range of $5.65 to $5.75, as we've raised the bottom end of the guidance range by $0.05 to reflect strong third quarter results and taking into account continued investments to yield future returns.

我們現在預計 Centene 的 2022 年全年調整後每股收益將在 5.65 美元至 5.75 美元之間，因為我們已將指導範圍的下限提高了 0.05 美元，以反映強勁的第三季度業績，並考慮到持續投資以產生未來回報。

Since our initial issuance of the 2022 adjusted EPS guidance, we have now raised the midpoint 5.5% or $0.30, driven by government program growth and the successful execution of several key value creation initiatives. Drew will cover the quarter and our financial outlook in more detail shortly.

自我們首次發布 2022 年調整後每股收益指引以來，在政府項目增長和幾項關鍵價值創造計劃的成功執行的推動下，我們現已將中點提高了 5.5% 或 0.30 美元。 Drew 很快將更詳細地介紹本季度和我們的財務展望。

Our strong year-to-date performance provides positive momentum as we prepare the organization for 2023 and beyond. With successful Medicaid reprocurements in Mississippi, Nebraska and Texas this quarter, our business development team continues to execute well, demonstrating their powerful market knowledge and delivering solid results. While we were disappointed with the results in the California RFP process, we remain confident in the quality of our RFP response, and in the merits of our protest there, which we'll talk more about shortly.

我們年初至今的強勁表現為我們為 2023 年及以後的組織做好準備提供了積極的動力。由於本季度在密西西比州、內布拉斯加州和德克薩斯州成功進行了醫療補助計劃，我們的業務開發團隊繼續執行良好，展示了他們強大的市場知識並取得了可靠的成果。雖然我們對加利福尼亞 RFP 流程的結果感到失望，但我們仍然對我們的 RFP 響應的質量以及我們在那裡抗議的優點充滿信心，我們稍後將對此進行更多討論。

In our other core business lines, we are enthusiastic about the opportunities we see to strategically balance growth with margin expansion. In Marketplace, we have demonstrated strong margin improvement this year and see the recent developments in the marketplace competitive landscape as an opportunity for new organic growth in 2023 and beyond.

在我們的其他核心業務線中，我們對我們看到的在戰略上平衡增長與利潤率擴張的機會充滿熱情。在 Marketplace 中，我們今年表現出強勁的利潤率提升，並將市場競爭格局的最新發展視為 2023 年及以後新的有機增長的機會。

In Medicare, we are confident we have positioned our bids to achieve expanded margin performance next year, while still delivering low to mid-single-digit growth. Together, Medicare and Marketplace are well positioned to offer tailwinds in support of our 2023 earnings goals.

在醫療保險方面，我們有信心我們已經將我們的出價定位為明年實現擴大的利潤率表現，同時仍實現中低個位數的增長。 Medicare 和 Marketplace 共同處於有利地位，可以為我們 2023 年的盈利目標提供支持。

Behind the scenes, our transformation work continues with a number of value creation initiatives achieving key milestones during the quarter. As you know, we are redesigning key shared service functions to reflect the size and scale of the organization, and we're supporting these teams with modern, flexible technology that will streamline workflows and make it easier to serve both members and providers.

在幕後，我們的轉型工作繼續進行，多項價值創造計劃在本季度實現了關鍵里程碑。如您所知，我們正在重新設計關鍵的共享服務功能，以反映組織的規模和規模，我們正在用現代、靈活的技術支持這些團隊，這些技術將簡化工作流程，更容易為成員和提供者提供服務。

This quarter, we completed the first wave of call center regionalization and successfully installed new call center technology to support the Marketplace team in the upcoming open enrollment period.

本季度，我們完成了呼叫中心區域化的第一波浪潮，並成功安裝了新的呼叫中心技術，以在即將到來的開放註冊期間支持 Marketplace 團隊。

We also launched our Provider 360 application that will allow us to more seamlessly manage our provider relationships across the country. Each of these enhancements position Centene for improvement in both quality and efficiency as we move into 2023.

我們還推出了我們的 Provider 360 應用程序，這將使我們能夠更無縫地管理我們在全國范圍內的供應商關係。隨著我們進入 2023 年，這些增強功能中的每一項都使 Centene 能夠提高質量和效率。

At the same time, we continue to advance our portfolio review work. We closed PANTHER (sic) [PANTHERx] this quarter and are in the closing process on both MagellanRx and Ribera. We will share additional updates as we position our non-health plan assets for maximum strategic value.

與此同時，我們繼續推進我們的投資組合審查工作。我們本季度關閉了 PANTHER (sic) [PANTHERx]，並且正在關閉 MagellanRx 和 Ribera。當我們定位我們的非健康計劃資產以獲得最大戰略價值時，我們將分享更多更新。

Finally and importantly, we are pleased to share that a major cornerstone of our Value Creation Plan was achieved this month when we concluded our PBM RFP process ahead of schedule. As many of you know, we expected the RFP process to drive significant value for Centene, our members and our state and federal partners.

最後也是重要的一點，我們很高興地分享，我們的價值創造計劃的一個主要基石已經在本月完成，我們提前完成了 PBM RFP 流程。眾所周知，我們希望 RFP 流程能夠為 Centene、我們的成員以及我們的州和聯邦合作夥伴帶來巨大的價值。

Beginning January 1, 2024, Evernorth Express Scripts will provide Centene's pharmacy benefit management services. This new partnership will allow us to innovate and redesign the way our pharmacy benefits are administered, as we deliver improved value to our customers and shareholders. As a result of this new contract, we anticipate delivering savings that exceed our previous expectations in 2024 and throughout the duration of the multiyear agreement.

從 2024 年 1 月 1 日開始，Evernorth Express Scripts 將提供 Centene 的藥房福利管理服務。這種新的合作夥伴關係將使我們能夠創新和重新設計我們的藥房福利管理方式，因為我們為客戶和股東提供了更高的價值。由於這份新合同，我們預計在 2024 年和整個多年協議期間所節省的費用將超出我們之前的預期。

Now turning to 2 recent challenges. Given the development around both STARS and our California contract, I'd like to spend a few minutes providing additional perspective on each of these issues.

現在轉向最近的兩個挑戰。鑑於圍繞 STARS 和我們的加州合同的發展，我想花幾分鐘就這些問題中的每一個提供額外的視角。

As we've shared before, the year-over-year deterioration of our Medicare Advantage Star Ratings was driven in part by the sunsetting of disaster relief provisions related to COVID. We were additionally impacted by a decline in specific metrics related to ops and admin, a result of our own operational challenges during late 2020 and 2021.

正如我們之前所分享的，我們的 Medicare Advantage 星級評級逐年下降的部分原因是與 COVID 相關的救災條款的取消。由於我們在 2020 年末和 2021 年的運營挑戰，我們還受到與運營和管理相關的特定指標下降的影響。

While the final results were slightly worse than our internal expectations, the vast majority of the revenue headwind was known to us months in advance, as we shared transparently with the investment community. This knowledge allowed us to position 2023 products with an emphasis on benefit stability and create a glide path to better mitigate the member impact from the STARS revenue headwind in 2024.

雖然最終結果略低於我們的內部預期，但絕大多數收入逆風是我們提前幾個月知道的，因為我們與投資界透明地分享了這一點。這些知識使我們能夠定位 2023 年產品，重點是福利穩定性，並創造一條下滑路徑，以更好地減輕 2024 年 STARS 收入逆風對會員的影響。

As we called out during our June Investor Day, since learning of the magnitude of the STARS impact, we've taken aggressive action to change our approach to the STARS program. From an organizational perspective, we hired an experienced Chief Quality Officer and assigned strong operational leaders to manage key ops and admin programs beginning in Q1.

正如我們在 6 月的投資者日期間所呼籲的那樣，自從了解到 STARS 影響的嚴重性後，我們已採取積極行動來改變我們對 STARS 計劃的態度。從組織的角度來看，我們聘請了一位經驗豐富的首席質量官，並指派了強大的運營領導者從第一季度開始管理關鍵的運營和管理計劃。

We centralized oversight of the quality program and moved the entire organization under Jim Murray, our Chief Transformation Officer, to directly connect quality to our value creation office and take advantage of Jim's long experience driving Medicare quality outcomes.

我們集中監督質量計劃，並將整個組織轉移到我們的首席轉型官 Jim Murray 的領導下，直接將質量與我們的價值創造辦公室聯繫起來，並利用 Jim 在推動醫療保險質量成果方面的長期經驗。

In addition, we launched a focused effort to standardize and streamline our quality processes, and we implemented real-time operational dashboards to track key performance metrics.

此外，我們集中精力標準化和簡化我們的質量流程，並實施了實時運營儀表板來跟踪關鍵績效指標。

Earlier this year, we invested in new technology to enhance our access to clinical data around gaps in care, and we committed to integrating the company's numerous quality platforms into a single unified workflow.

今年早些時候，我們投資了新技術以增強我們對圍繞護理差距的臨床數據的訪問，我們致力於將公司的眾多質量平台整合到一個統一的工作流程中。

Finally, we made significant investments to improve our Medicare members onboarding journey, including the redesign of our approach to those mission-critical survey questions that impact caps and other metrics.

最後，我們進行了大量投資以改善我們的醫療保險會員入職旅程，包括重新設計我們對影響上限和其他指標的關鍵任務調查問題的方法。

But addressing the STARS challenge didn't stop with operational transformations. In late Q1, this newly installed management team cracked open our 2022 performance plan, and added quality improvement as a key compensation metric for every single employee at Centene across the enterprise.

但解決 STARS 挑戰並沒有停止運營轉型。在第一季度末，這個新成立的管理團隊破解了我們的 2022 年績效計劃，並將質量改進作為 Centene 整個企業每位員工的關鍵薪酬指標。

When I say quality is a priority, I mean it. Over the next 3 cycles, our goal is to achieve at least 60% of members in 4-star plans. And I promise you, this senior management team is aggressively tracking STARS improvement towards that goal on a real-time basis.

當我說質量是重中之重時，我是認真的。在接下來的 3 個週期中，我們的目標是在 4 星級計劃中實現至少 60% 的會員。我向你保證，這個高級管理團隊正在積極地實時跟踪 STARS 朝著該目標的改進。

Now turning to California. The California RFP also carries implications for earnings power in 2024. Shortly after the August Medical award announcement and after closely reviewing the results, Centene, along with many other RFP participants filed protests with the State of California.

現在轉向加利福尼亞。加州 RFP 還對 2024 年的盈利能力產生了影響。在 8 月醫學獎宣布後不久，在仔細審查了結果後，Centene 與許多其他 RFP 參與者一起向加利福尼亞州提出了抗議。

As this audience will appreciate, we are limited in our ability to comment too much during an active protest, but I will say this, Centene takes a matter of filing protests seriously. When we do so, it is not a matter of reflex, but done only when we see serious errors in a decision-making process, resulting in negative impacts on our beneficiaries.

正如這些觀眾所理解的那樣，我們在積極抗議期間發表過多評論的能力有限，但我要說的是，Centene 認真對待提出抗議的問題。當我們這樣做時，這不是條件反射的問題，而是只有在我們看到決策過程中出現嚴重錯誤時才會這樣做，從而對我們的受益人造成負面影響。

Because of our historic discipline around these decisions, Centene has a proven track record of success in the protests we have undertaken. And given our strong view of the merits of our California protest, we intend to exhaust all available avenues of appeal.

由於我們圍繞這些決定的歷史性紀律，Centene 在我們所進行的抗議活動中有著良好的成功記錄。鑑於我們對加州抗議的優點的強烈看法，我們打算用盡所有可用的上訴途徑。

Drew will talk more specifically about the financial impact of the STARS issue and the California results in a moment, but it is important to note that we are actively managing both situations and feel confident in our current strategies.

Drew 稍後將更具體地討論 STARS 問題和加利福尼亞結果的財務影響，但重要的是要注意，我們正在積極管理這兩種情況，並對我們當前的策略充滿信心。

As a reminder, Centene is on a journey of transformation in service of value creation. Between now and 2024, our work is to focus and fortify the organization, creating a strong foundation from which to drive profitable growth over the long-term.

提醒一下，Centene 正在為價值創造服務的轉型之旅。從現在到 2024 年，我們的工作是集中精力並加強組織，為長期推動盈利增長奠定堅實的基礎。

From the time our value creation plans were initially late in June of 2021, this team went in eyes wide open to the level of change we were determined to enact. As we reflect on 2022, and the 2 full quarters since this management team has taken the helm, I am pleased with the amount of progress we have made and confident in our delivery of future milestones.

從 2021 年 6 月下旬我們的價值創造計劃最初開始，這個團隊就對我們決心實施的變革水平睜大眼睛。當我們回顧 2022 年以及自該管理團隊掌舵以來的兩個完整季度時，我對我們取得的進展感到高興，並對我們實現未來里程碑充滿信心。

We've assembled the right talent with proven executive leadership skills, created a sharpened focus through our value creation office and made deliberate investments to accelerate change. There is a lot more work ahead, but delivering this year's foundational milestones creates important momentum that will carry us into 2023 and 2024.

我們已經聚集了具有成熟執行領導技能的合適人才，通過我們的價值創造辦公室創造了更加突出的重點，並進行了深思熟慮的投資以加速變革。未來還有很多工作要做，但實現今年的基本里程碑會創造重要的動力，將我們帶入 2023 年和 2024 年。

The upcoming December Investor Day presents us with an important opportunity to give investors clarity around the long-term strategy that will underpin the trajectory of Centene's business. We'll use Investor Day as a platform to share important areas of operational focus, as well as to lay out the market opportunities upon which we'll build our future growth. And importantly, we'll commit to long-term growth targets, so that our investors are clear on management's expectations for our enterprise.

即將到來的 12 月投資者日為我們提供了一個重要機會，讓投資者清楚地了解支撐 Centene 業務發展軌蹟的長期戰略。我們將利用投資者日作為一個平台，分享運營重點的重要領域，並展示我們將建立未來增長的市場機會。重要的是，我們將致力於實現長期增長目標，以便我們的投資者清楚管理層對我們企業的期望。

Before I turn it over to Brent, I'd like to take a brief moment to express my gratitude to our Centene team members in Florida for their efforts in the face of the destruction brought by Hurricane Ian last month. Once again, our local teams activated quickly, harnessing the power of our local partnerships to support our members and employees and their communities in a time of need.

在我把它交給布倫特之前，我想花一點時間對佛羅里達州的 Centene 團隊成員表示感謝，感謝他們在上個月伊恩颶風帶來的破壞中所做的努力。再次，我們的當地團隊迅速啟動，利用我們當地合作夥伴的力量，在需要時支持我們的成員和員工及其社區。

Sunshine employees contacted more than 22,000 high-risk members ahead of the storm to ensure they had a plan, and in the storm's wake to confirm their safety and assess their needs. We partnered with state and local government entities to strategically deploy resources, provide community support and offer distribution and staging sites for relief efforts.

Sunshine 員工在風暴前聯繫了 22,000 多名高風險成員，以確保他們有計劃，並在風暴過後確認他們的安全並評估他們的需求。我們與州和地方政府實體合作，戰略性地部署資源，提供社區支持，並為救災工作提供分發和集結地點。

More than 500 Sunshine Health employees, some of whom were impacted themselves. Nonetheless, volunteered their time at disaster relief sites, including those sites we set up inside our health plan community centers.

超過 500 名 Sunshine Health 員工，其中一些人自己受到了影響。儘管如此，他們還是自願在救災地點，包括我們在健康計劃社區中心內設立的那些地點。

At the height of operations, our community center in Fort Myers was serving more than 2,100 families each day, providing needed items like food, water, diapers, baby formula and basic hygiene products. Mission-driven employees are Centene's most powerful asset. Thank you to Sunshine Health employees and employees nationwide for your steadfast support of the communities impacted by Hurricane Ian.

在運營高峰期，我們位於邁爾斯堡的社區中心每天為 2,100 多個家庭提供服務，提供食物、水、尿布、嬰兒配方奶粉和基本衛生用品等所需物品。以使命為導向的員工是 Centene 最強大的資產。感謝 Sunshine Health 員工和全國員工對受颶風伊恩影響的社區的堅定支持。

Throughout 2022 from Buffalo to (inaudible) to Fort Myers, your acts of selflessness and service demonstrate the extraordinary impact of our mission-driven workforce. I cannot express to you how proud I am to call you colleagues and friends.

從布法羅到（聽不清）再到邁爾斯堡，整個 2022 年，您的無私和服務行為展示了我們以使命為導向的員工隊伍的非凡影響。我無法向你表達我多麼自豪能稱你為同事和朋友。

With that, I'll turn it over to Brent for an update on the business.

有了這個，我將把它交給布倫特以獲取有關業務的最新信息。

Thank you, Sarah, and good morning. We are pleased to have made so much progress in 2022, both organizationally and operationally. While some of the benefits will take time to materialize externally, the internal advancements are tangible.

謝謝你，莎拉，早上好。我們很高興在 2022 年在組織和運營方面都取得瞭如此大的進步。雖然一些好處需要時間才能在外部實現，但內部進步是有形的。

During the third quarter, we received results from several RFPs. In August, we received mixed results in California, as we were awarded contracts in 9 counties, including San Diego. We have also been awarded a sole-source contract in Imperial County. As Sarah mentioned, we have appealed the state's notice of awards and we'll provide updates on the process as appropriate.

在第三季度，我們收到了幾個 RFP 的結果。 8 月，我們在加利福尼亞獲得了喜憂參半的結果，因為我們在包括聖地亞哥在內的 9 個縣獲得了合同。我們還獲得了帝王縣的獨家合同。正如莎拉所提到的，我們已對州政府的裁決通知提出上訴，我們將酌情提供有關流程的最新信息。

in August, we were also informed of our successful bid to continue to serve the State of Mississippi's Medicaid managed care program, including entry into the CHIP program. We've been a part of the Medicaid program since its exception and are pleased to continue our relationship with the state.

8 月，我們還獲悉我們成功申請繼續為密西西比州的 Medicaid 管理式醫療計劃服務，包括加入 CHIP 計劃。自醫療補助計劃例外以來，我們一直是該計劃的一部分，並且很高興繼續與該州保持關係。

In another of our long-standing markets, we reprocured the STAR Health Medicaid program in Texas. We've held this contract since 2008 when in collaboration with the Texas Health and Human Services Commission and the Department of Family and Protective Services. Our health plan, Superior became the first managed care organization in the country to provide statewide sole source Medicaid coverage to children in foster care.

在我們的另一個長期市場中，我們重新採購了德克薩斯州的 STAR Health Medicaid 計劃。自 2008 年以來，我們與德克薩斯州衛生與公眾服務委員會和家庭與保護服務部合作，簽訂了這份合同。我們的健康計劃Superior 成為該國第一個為寄養兒童提供全州唯一來源醫療補助保險的管理式護理組織。

To round out the quarter, we were fortunate to win the reprocurement of our statewide managed care contract in Nebraska. We look forward to continuing to serve our membership in the Heritage Health program.

為了完成本季度，我們很幸運地贏得了內布拉斯加州全州管理式醫療合同的重新採購。我們期待繼續為我們的遺產健康計劃的會員服務。

In our existing Medicaid business, membership has increased to 15.7 million members at the end of third quarter, and we continue to see an uptick in RFP activity. As the PHE has been extended to February, our Medicaid growth continues to be aided by the ongoing suspension of eligibility redeterminations.

在我們現有的醫療補助業務中，截至第三季度末，會員人數已增加到 1570 萬，我們繼續看到 RFP 活動有所增加。由於 PHE 已延長至 2 月，我們的 Medicaid 增長繼續得益於資格重新確定的持續暫停。

As you've heard me say before, whenever the PHE comes to close, we'll continue to work with our state partners to support member transition and believe we are well positioned to attract membership to our Marketplace products.

正如您之前聽到我所說的那樣，每當 PHE 結束時，我們將繼續與我們的州合作夥伴合作，支持會員過渡，並相信我們已經做好了吸引會員加入我們的 Marketplace 產品的準備。

Our Ambetter product ended the quarter with 2.1 million members and remains on track to meet its margin goal for 2022. As the marketplace leader, we continue to ensure that Americans have financially affordable options for coverage, especially there in times of disruption, such as the recent announcement of market exits by some of our competitors.

我們的 Ambetter 產品在本季度結束時擁有 210 萬會員，並有望實現 2022 年的利潤目標。作為市場領導者，我們繼續確保美國人擁有經濟上負擔得起的保險選擇，尤其是在中斷時期，例如我們的一些競爭對手最近宣布退出市場。

We are working closely with our state partners to ensure these members have access to affordable coverage. We also see the extension of the enhanced advance premium tax credits as fuel for additional growth during 2023 open enrollment period, which will begin in a few days.

我們正在與我們的州合作夥伴密切合作，以確保這些成員能夠獲得負擔得起的保險。我們還認為，在 2023 年開放招生期間，擴大預付保費稅收抵免是推動額外增長的動力，這將在幾天后開始。

Consistent with our strategy, Ambetter Health will continue to pursue margin expansion through strategic membership growth and thoughtful pricing discipline.

根據我們的戰略，Ambetter Health 將繼續通過戰略性會員增長和周到的定價紀律來擴大利潤。

As we look to 2023, we've expanded our Marketplace offerings to the State of Alabama, bringing this to 28 states. Additionally, we've added more than 60 new counties, bringing us to over 1,500, which is over half the counties in the United States.

展望 2023 年，我們已將 Marketplace 產品擴展到阿拉巴馬州，將其擴展到 28 個州。此外，我們增加了 60 多個新縣，使我們達到 1,500 多個，超過美國縣的一半。

We're also looking forward to the expansion of our Ambetter Health Virtual Access product, which we first launched during 2022 open enrollment. This product supports affordable and convenient access to licensed virtual primary care providers, as well as access to specialists and other support services.

我們還期待擴大我們在 2022 年公開招生期間首次推出的 Ambetter Health Virtual Access 產品。該產品支持以負擔得起且方便的方式獲得許可的虛擬初級保健提供者，以及獲得專家和其他支持服務。

We will offer Virtual Access in 9 new states for the upcoming open enrollment period, bringing the product to 13 states in total. Our geographic and product expansion, sales strategy, stable pricing, product offerings and operational strengths allow us to be optimistic about our positioning for 2023 open enrollment.

我們將在即將到來的開放註冊期間在 9 個新州提供虛擬訪問，將產品總共帶到 13 個州。我們的地域和產品擴張、銷售策略、穩定的定價、產品供應和運營優勢使我們對 2023 年公開招生的定位感到樂觀。

In Medicare, we ended the quarter with over 1.5 million members. We have strong geographic growth for 2023 with WellCare product offerings of about 80% of the eligible Medicare population. We feel our 2023 products are in line with the expectations to support our low to mid-single-digit growth expectations and continue to focus on member retention.

在 Medicare，我們在本季度結束時擁有超過 150 萬會員。我們在 2023 年實現了強勁的地域增長，WellCare 產品覆蓋了大約 80% 的合格醫療保險人口。我們認為我們的 2023 年產品符合支持我們中低個位數增長預期並繼續關注會員保留的預期。

Look forward to telling you more about our '23 outlook in December. In short, our core products continue to perform well.

期待在 12 月告訴您更多關於我們 '23 展望的信息。總之，我們的核心產品繼續表現良好。

With that, let me turn the call over to Drew.

有了這個，讓我把電話轉給德魯。

Thank you, Brent. Today, we reported third quarter 2022 results of $35.9 billion in total revenue, an increase of 11% compared to the third quarter of 2021, and adjusted diluted earnings per share of $1.30. Based upon performance in the quarter, we're raising our 2022 adjusted earnings guidance to a range of $5.65 to $5.75 by lifting the bottom of the range $0.05.

謝謝你，布倫特。今天，我們報告了 2022 年第三季度的總收入為 359 億美元，與 2021 年第三季度相比增長了 11%，調整後的攤薄每股收益為 1.30 美元。根據本季度的表現，我們將 2022 年調整後的收益指引提高至 5.65 美元至 5.75 美元的範圍，將區間的底部提高到 0.05 美元。

Year-to-date, our guidance midpoint is up $0.30 or 5.5% since our original 2022 guidance provided in December of 2021. Total revenue grew by $3.5 billion compared to the third quarter of 2021, driven by: one, strong organic growth throughout the last year in Medicaid, primarily due to the ongoing suspension of eligibility redeterminations and Missouri Foster Care that commenced [71, 22%].

年初至今，我們的指導中點比我們在 2021 年 12 月提供的 2022 年指導中值增加了 0.30 美元或 5.5%。與 2021 年第三季度相比，總收入增長了 35 億美元，其驅動因素是：一、整個經濟增長強勁的有機增長去年在 Medicaid 中，主要是由於資格重新確定的持續暫停和密蘇里州寄養照護開始 [71, 22%]。

Number two, the January 2022 acquisition of Magellan and 3 strong Medicare membership growth. This was partially offset by the July 2022 PANTHERx divestiture. Our Q3 consolidated HBR was 88.3%, Medicaid at 90.2% was right on track in the quarter, consistent with normal seasonality and back-to-school encounters. 48% of our Medicaid members are under 18 years old.

第二，2022 年 1 月收購 Magellan 和 3 強勁的醫療保險會員增長。這部分被 2022 年 7 月的 PANTHERx 剝離所抵消。我們第三季度的綜合 HBR 為 88.3%，醫療補助為 90.2%，在本季度處於正軌，與正常的季節性和返校遭遇一致。我們 48% 的 Medicaid 會員未滿 18 歲。

Medicare at 83.9% was better than expectations in the quarter, driven by favorable health care affordability initiatives consistent with our efforts to improve execution.

本季度的醫療保險比例為 83.9%，好於預期，這得益於有利的醫療保健負擔能力計劃，這與我們改善執行的努力相一致。

Year-to-date, the Medicare HBR is trending better than our original expectation, which we assumed would be roughly flat to 2021. That should bode well for our baseline as we look ahead to 2023 and 2024.

年初至今，Medicare HBR 的趨勢好於我們最初的預期，我們假設到 2021 年將大致持平。這對於我們展望 2023 年和 2024 年的基線來說應該是個好兆頭。

The commercial HBR of 84.2% improved 450 basis points quarter over prior year quarter, consistent with our original full year goal of an approximate 500 basis point HBR improvement in 2022 compared to 2021.

84.2% 的商業 HBR 比去年同期提高了 450 個基點，這與我們最初的全年目標一致，即 2022 年與 2021 年相比 HBR 提高約 500 個基點。

Commercial performance in 2022 has been driven by disciplined pricing actions initiatives executed in 2022, and as expected, a reduction in COVID and pent-up demand costs compared to 2021.

2022 年的商業表現受到 2022 年執行的有紀律的定價行動計劃的推動，並且正如預期的那樣，與 2021 年相比，COVID 和被壓抑的需求成本有所減少。

Our Marketplace businesses in 2022 is a good example of execution of margin expansion balanced with growth, which will enable us to take advantage of membership opportunities in 2023 and beyond.

我們在 2022 年的市場業務是執行利潤擴張與增長平衡的一個很好的例子，這將使我們能夠在 2023 年及以後利用會員機會。

Moving to other P&L and balance sheet items. Our adjusted SG&A expense ratio was 8.3% in the third quarter compared to 8.1% last year. The inclusion of Magellan and the sale of PANTHERx increased the ratio by approximately 20 basis points compared to the year ago quarter.

轉到其他損益表和資產負債表項目。第三季度調整後的 SG&A 費用率為 8.3%，而去年為 8.1%。與去年同期相比，麥哲倫的加入和 PANTHERx 的出售使該比率增加了約 20 個基點。

Additionally, we increased Medicare marketing and value creation investment spending in the quarter. This was partially offset by real estate optimization savings based upon efforts that we began in Q2.

此外，我們在本季度增加了醫療保險營銷和價值創造投資支出。基於我們在第二季度開始的努力，這部分被房地產優化節省所抵消。

Since the start of the third quarter, we have repurchased 15.3 million shares of our common stock for $1.3 billion. Year-to-date, we have repurchased 19.5 million shares for $1.7 billion. Also, since the start of the third quarter, we have repurchased approximately 317 million of our senior notes for $300 million to balance the capital structure and take advantage of market conditions.

自第三季度開始以來，我們以 13 億美元的價格回購了 1530 萬股普通股。年初至今，我們以 17 億美元回購了 1950 萬股股票。此外，自第三季度開始以來，我們以 3 億美元回購了約 3.17 億份優先票據，以平衡資本結構並利用市場條件。

We are working to close the MagellanRx divestiture by the end of the year. Estimated net deployable proceeds on that transaction would be in the zone of $1.1 billion. A few weeks ago, we were very pleased to receive an upgrade for our senior notes to investment grade by Fitch. The company has been working on that goal for a couple of years. Our senior notes are now rated investment grade by 2 of the 3 major rating agencies.

我們正在努力在今年年底前完成 MagellanRx 的剝離。該交易的估計可部署淨收益將在 11 億美元左右。幾週前，我們很高興收到惠譽將我們的優先票據升級為投資級的消息。該公司多年來一直致力於實現這一目標。我們的優先票據現在被 3 家主要評級機構中的 2 家評為投資級。

Cash flow provided by operations was $3.3 billion in the third quarter, primarily driven by earnings and the receipt of approximately $2.9 billion in CMS payments for October on the last day of September. This temporarily drives up unearned revenue and accounts payable on our balance sheet.

第三季度運營提供的現金流為 33 億美元，主要受收益和 9 月最後一天 10 月收到約 29 億美元 CMS 付款的推動。這暫時推高了我們資產負債表上的未實現收入和應付賬款。

Our year-to-date operating cash flow was $7.8 billion or $4.9 billion, excluding the early receipt of payments from CMS, representing 3.5x net earnings or 1.7x adjusted net earnings.

我們年初至今的經營現金流為 78 億美元或 49 億美元，不包括提前收到 CMS 的付款，相當於 3.5 倍淨收益或 1.7 倍調整後淨收益。

Our domestic unregulated and unrestricted cash on hand at quarter end was $387 million, a portion of which was spent in October to finish up the capital deployment I just referenced.

季度末，我們手頭的國內不受監管和不受限制的現金為 3.87 億美元，其中一部分在 10 月份用於完成我剛才提到的資本部署。

Debt at quarter end was $18 billion. Our debt to adjusted EBITDA came in at 3.0x. Our medical claims liability totaled $16 billion at quarter end, and represents 54 days in claims payable compared to 55 days in Q2 2022 and 51 days in Q3 of 2021. The sequential decrease was largely driven by the timing of pharmacy claims payments.

季度末的債務為 180 億美元。我們對調整後 EBITDA 的債務是 3.0 倍。截至季度末，我們的醫療索賠負債總額為 160 億美元，與 2022 年第二季度的 55 天和 2021 年第三季度的 51 天相比，應付索賠的時間為 54 天。環比下降主要是由於藥房索賠支付的時間。

Outside of adjusted earnings during the quarter, we recorded a $0.65 gain on the sale of PANTHERx, partially offset by a $0.23 loss on the impairment of Ribera Salud, and a $0.16 real estate impairment, consistent with what we discussed last quarter.

除本季度調整後的收益外，我們記錄了出售 PANTHERx 的 0.65 美元收益，部分被 Ribera Salud 減值損失 0.23 美元和房地產減值損失 0.16 美元所抵消，這與我們上個季度討論的情況一致。

We expect another $0.15 or so of real estate impairment outside of adjusted earnings over the next couple of quarters as we complete the value creation real estate optimization. These items are reflected in updated GAAP guidance.

隨著我們完成價值創造房地產優化，我們預計在接下來的幾個季度中，除了調整後的收益之外，房地產減值還會增加 0.15 美元左右。這些項目反映在更新的 GAAP 指南中。

Quickly on 2022 adjusted earnings guidance, since we only have 1 quarter left in the year. As mentioned, we are lifting the bottom of the adjusted EPS range by nickel. Underneath that, premium and service revenue is up approximately $700 million. There is no change to HBR from the previous range.

快速了解 2022 年調整後的收益指引，因為我們今年只剩下 1 個季度了。如前所述，我們將調整後每股收益範圍的底部抬高了鎳。在此之下，保費和服務收入增加了約 7 億美元。與之前的範圍相比，HBR 沒有變化。

In the back half of 2022 investment income outperformance has largely been offset by SG&A investments to yield future returns. Suffice to say 2022 has been a very good year on of executing on the Value Creation Plan as a new leadership team.

在 2022 年下半年，投資收益的優異表現在很大程度上被 SG&A 投資所抵消，以產生未來的回報。可以說，2022 年是作為新領導團隊執行價值創造計劃的非常好的一年。

Many of you have asked about 2023 and 2024 in the context of recent business developments like the California RFP, Florida Medicaid rates and STARS, so let me give you some more color.

在加州 RFP、佛羅里達州醫療補助費率和 STARS 等近期業務發展的背景下，你們中的許多人都詢問了 2023 年和 2024 年的情況，所以讓我再給你們一些色彩。

We are in the middle of building up our detailed 2023 annual operating plan that we will complete by the beginning of December, seek our Board approval, and then share formal 2023 guidance with you at our December 16 Investor Day. Based upon good execution on our value creation plan and anticipated 2023 tailwinds and headwinds, we are still targeting low-6s consistent with what we have relayed to you previously.

我們正在製定詳細的 2023 年度運營計劃，該計劃將於 12 月初完成，尋求董事會批准，然後在 12 月 16 日的投資者日與您分享正式的 2023 年指導。基於我們價值創造計劃的良好執行以及預期的 2023 年順風和逆風，我們仍然以與我們之前傳達給您的內容一致的低 6 為目標。

While we so-called blessed consensus last December when it was at $6.20, today's consensus would still be in an expected 2023 guidance range. And that includes the worse-than-expected 4% to 4.5% rate decrease effective 10/01/22. We will run through all of the tailwinds and headwinds at the Investor Day and provide you bridges such that you can have confidence in our 2023 gain plan.

雖然去年 12 月我們所謂的祝福共識為 6.20 美元，但今天的共識仍將在預期的 2023 年指導範圍內。其中包括自 22 年 10 月 1 日起降幅低於預期的 4% 至 4.5%。我們將在投資者日經歷所有順風和逆風，並為您提供橋樑，讓您對我們的 2023 年收益計劃充滿信心。

As we look ahead to 2024, we know a fair amount more than we first -- when we first laid out a long-term target at our June 2021 Investor Day. Let me provide more insight into a few of the components that are different than our original construction of 2024, starting with STARS.

當我們展望 2024 年時，我們比第一次知道的要多得多——當我們在 2021 年 6 月的投資者日首次製定長期目標時。讓我更深入地了解一些與我們最初構建的 2024 年不同的組件，從 STARS 開始。

In 2021, we knew we would have a step back in STARS revenue for 2024, due to not only the inevitable sunsetting of COVID disaster relief provisions, but also underperformance in the area of Medicare ops and admin in the back half of 2020 and in the first half of 2021 prior to this management team taking the helm.

到 2021 年，我們知道 STARS 的收入將在 2024 年有所回落，這不僅是因為 COVID 救災條款不可避免地取消，而且在 2020 年下半年以及醫療保險運營和管理領域的表現不佳。在該管理團隊掌舵之前的 2021 年上半年。

Sarah provided you color on more of the background. But yes, it was a little worse than we originally expected as the final STAR results became visible during 2022.

莎拉為您提供了更多背景的顏色。但是，是的，這比我們最初預期的要差一些，因為最終的 STAR 結果在 2022 年變得可見。

Moving now to California. Our 2024 forecast construction anticipated and continues to anticipate retaining our major state Medicaid contracts, including California. We are confident in the basis for our protest, but if we are unsuccessful, that could be a pressure point relative to the $7.50-plus target.

現在搬到加利福尼亞。我們的 2024 年預測建設預計並將繼續預計保留我們的主要州醫療補助合同，包括加利福尼亞州。我們對我們抗議的基礎充滿信心，但如果我們不成功，這可能是相對於 7.50 美元以上目標的壓力點。

On the positive side, we are very pleased with the economics to be realized as a result of the PBM RFP process. Investment income is stronger today and expected to be stronger in 2024 than we originally had built into the 2024 modeling. And we are pulling Value Creation Plan levers and buying shares with 2024 in mind.

從積極的方面來說，我們對 PBM RFP 流程所帶來的經濟效益感到非常滿意。今天的投資收入更強，預計 2024 年的投資收入將比我們最初在 2024 年模型中建立的更強。我們正在拉動價值創造計劃的槓桿，並考慮到 2024 年購買股票。

A number of you have asked for the impact of STARS in California. But let me boil it down into a macro view of 2024, including the items, I just mentioned. There is approximately $0.20 to -- $0.25 to $0.50 of potential EPS pressure in 2024 in relation to our original goal of $7.50-plus.

你們中的一些人詢問了 STARS 在加利福尼亞的影響。但讓我把它歸結為 2024 年的宏觀視圖，包括我剛才提到的項目。與我們最初的 7.50 美元以上目標相比，2024 年的潛在每股收益壓力約為 0.20 美元至 0.25 美元至 0.50 美元。

Until we know more on the outcome of California, we are still committed to driving to at least $7.50. I hope that gives you adequate scenario-based color for 2024, as we sit here in 2022.

在我們對加州的結果有更多了解之前，我們仍然致力於將價格提高到至少 7.50 美元。我希望這能為您在 2024 年提供足夠的基於場景的顏色，因為我們在 2022 年坐在這裡。

And I'm sure you've thought through if we can achieve our 2024 goals. That means we have pulled levers that both annualize and carry into 2025 when our STARS headwind turns into a sequential tailwind.

我相信您已經考慮過我們是否能夠實現 2024 年的目標。這意味著當我們的 STARS 逆風變成連續順風時，我們已經拉動了年化和持續到 2025 年的槓桿。

We are pleased with the third quarter and the progress demonstrated in 2022 as well as the prospect for our business in 2023 and beyond. And we look forward to sharing with you our long-term strategy and long-term growth algorithm for both revenue and earnings growth at Investor Day in December. Thank you for being part of our journey.

我們對第三季度和 2022 年取得的進展以及我們在 2023 年及以後的業務前景感到滿意。我們期待在 12 月的投資者日與您分享我們針對收入和收益增長的長期戰略和長期增長算法。感謝您參與我們的旅程。

Operator, you may now open the lineup for questions.

接線員，您現在可以打開隊列提問了。

(Operator Instructions) And our first question today comes from Josh Raskin from Nephron Research.

（操作員說明）我們今天的第一個問題來自 Nephron Research 的 Josh Raskin。

I was wondering, if you could talk a little bit more about the key factors and the decision to move the PBM to Express Scripts, sort of what got you over the hurdle of moving? And I was curious, if you were attracted by any of the other services that are offered by [Appernorth], that's part of it. I'm specifically interested in specialty as well.

我想知道，如果您能多談談關鍵因素以及將 PBM 遷移到 Express Scripts 的決定，是什麼讓您克服了遷移的障礙？我很好奇，如果您被 [Appernorth] 提供的任何其他服務所吸引，那也是其中的一部分。我對專業也特別感興趣。

And then I know part 3 of 1 question, but any way to size the relative outperformance versus previous expectations just on the economics of the deal?

然後我知道 1 個問題的第 3 部分，但是有什麼方法可以僅根據交易的經濟性來衡量相對錶現與先前預期的對比？

Yes. Thanks, Josh. So first, I would say that we were very pleased how competitive the process turned out to be and the fact that we had multiple very good options. As we said, we were able to achieve savings that exceeded expectations without feeling like we were sacrificing quality and execution. And we carried forward into the process, all of the criteria that we talked about in earlier calls in terms of operational execution, level of partnership, a sense of quality performance innovation.

是的。謝謝，喬希。所以首先，我想說我們非常高興這個過程的競爭性以及我們有多個非常好的選擇這一事實。正如我們所說，我們能夠在不犧牲質量和執行力的情況下實現超出預期的節省。我們將我們在之前的電話會議中談到的運營執行、合作水平、質量績效創新意識等所有標準都推進到了流程中。

We have ahead of us a significant operational undertaking, but I have to give major credit to our team for spending a lot of the time during the RFP process doing preparation work in order to give us maximum optionality in the consideration.

我們面前有一項重大的運營任務，但我必須對我們的團隊表示高度讚揚，因為他們在 RFP 過程中花費了大量時間進行準備工作，以便在考慮中給予我們最大的選擇權。

So we're feeling good about moving forward with core services and the ability to continue to expand the relationship, if that makes sense.

因此，如果有意義的話，我們對推進核心服務和繼續擴大關係的能力感到滿意。

Yes. And Josh, on the economics, as I'm sure you can appreciate, we don't like disclosing sort of proprietary cost structure elements, but it did exceed our expectations, which I think you can surmise by our willingness to take on the operational challenge of moving. And that was sort of baked into the macro view I provided on 2024.

是的。喬希，在經濟學方面，我相信你會理解，我們不喜歡披露專有成本結構元素，但它確實超出了我們的預期，我認為你可以推測出我們願意承擔運營移動的挑戰。這在某種程度上融入了我在 2024 年提供的宏觀視圖中。

And our next question comes from Stephen Baxter from Wells Fargo.

我們的下一個問題來自富國銀行的斯蒂芬巴克斯特。

I think you said you'll be targeting 60% of your Medicare Advantage membership in 4 star or Ambetter contracts. I apologize if I missed it, but what was the time frame you think it will realistically take to get there, and assuming that it is a multiyear process, do you think it's reasonable to expect most of the improvement to be concentrated in the next cycle and some of those metrics are still in front of you be measured? Or do you think we should think about maybe a more even pacing on that?

我想你說過你將把 60% 的 Medicare Advantage 會員定位在 4 星或 Ambetter 合同中。如果我錯過了，我深表歉意，但是您認為實際需要多長時間才能到達那裡，並且假設這是一個多年的過程，您認為期望大部分改進集中在下一個週期是否合理而其中一些指標還在你面前被衡量？或者你認為我們應該考慮一個更均勻的節奏嗎？

Yes. Thanks, Stephen, for the question. So it is -- we do see that goal of the 60% in 4 star, or at least 60% in 4 star over the next 3 cycles. So keeping in mind the fact that STARS results are released in October.

是的。謝謝，斯蒂芬，這個問題。所以它是 - 我們確實看到了 60% 的 4 星目標，或者在接下來的 3 個週期中至少 60% 的 4 星。因此，請記住 STARS 結果於 10 月發布的事實。

And I think we see the progress over that time period to be sort of fairly equal steps and are, again, like I said, pleased with what we're seeing in terms of the real-time data that we're tracking and meaningful operational improvement over the course of 2022 so far.

而且我認為我們認為在這段時間內取得的進展是相當平等的，並且再次，就像我說的，我們對我們正在跟踪的實時數據和有意義的運營方面所看到的感到滿意到目前為止，在 2022 年期間有所改善。

And our next question comes from Justin Lake from Wolfe Research.

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

Just a couple of things here. First, I appreciate your comments on 2024. Can you be -- just give us a little bit more color in terms of when you say the $0.20 to $0.25 to $0.50 of headwinds potentially. Does that assume -- is that net of everything, meaning, like, for instance, if I were to think about your guidance in 2024, there's some -- looked like there was some conservatism just in terms of the buildup when you gave it initially, plus the tailwinds minus the headwinds. Are you saying when you add all of that together, if everything happens the way it looks today, meaning the appeal is not successful, for instance, that number would be $0.25 to $0.50 too high? First.

這裡只有幾件事。首先，我感謝您對 2024 年的評論。您能不能 - 就您所說的 0.20 美元至 0.25 美元至 0.50 美元的潛在逆風而言，給我們更多的色彩。這是否假設 - 是一切的網絡，意思是，例如，如果我要考慮你在 2024 年的指導，有一些 - 看起來只是在你最初給出它時的積累方面存在一些保守主義，加上順風減去逆風。你是說當你把所有這些加在一起時，如果一切都像今天這樣發生，這意味著上訴不成功，例如，這個數字會太高 0.25 到 0.50 美元？第一的。

And then secondly, can you just give us an update on California in terms of the timing? My understanding is the state has to make a decision or the arbiter has to make a decision on the appeal. And then there's also a lawsuit that are in place that a judge would need to roll on. So maybe you can give us a color on that timing?

其次，您能否就時間方面向我們介紹一下加利福尼亞的最新情況？我的理解是國家必須做出決定，或者仲裁人必須對上訴做出決定。然後還有一場訴訟需要法官繼續審理。所以也許你可以給我們一個關於那個時間的顏色？

Yes, I'll take part one, Justin. As we sit here, 16 months removed from that first look into 2024 back in June of 2021. We obviously know a fair amount more than we did then. And so yes, what I covered was meant to capture everything we know now.

是的，賈斯汀，我會參與其中。當我們坐在這裡時，距離 2021 年 6 月對 2024 年的第一次展望已經過去了 16 個月。我們顯然比當時知道的要多得多。所以是的，我所涵蓋的內容是為了捕捉我們現在所知道的一切。

And I think you pointed out the biggest swing factor, obviously, is California, a pretty sizable piece of business for us in L.A. and Sacramento and current counties. So that would be the swing factor of that $0.25 to $0.50. It's a net view, but that's the biggest swing factor that would get us back into that $7.50-plus.

而且我認為你指出了最大的搖擺因素，顯然，加州是我們在洛杉磯、薩克拉門托和當前縣的一個相當大的業務。所以這將是 0.25 美元到 0.50 美元的波動因子。這是一個淨觀點，但這是讓我們回到 7.50 美元以上的最大波動因素。

And then in terms of timing on the appeal, the department is currently considering all of the appeals that have been submitted across RFP respondents. And the next step is what we consider to be a fairly procedural ruling. And then from there, we would move into the courts with a lawsuit.

然後就上訴的時間安排而言，該部門目前正在考慮已在 RFP 受訪者中提交的所有上訴。下一步是我們認為是相當程序性的裁決。然後從那裡，我們會帶著訴訟進入法庭。

And our next question comes from Lance Wilkes from Bernstein.

我們的下一個問題來自 Bernstein 的 Lance Wilkes。

See, I just wanted to get a clarification on the PBM, the kind of expected timing of the savings, if they're all hitting in '24 if you're getting a portion of that in '24 and more in '25. And then just understanding the length of contracts on that?

看，我只是想澄清一下 PBM，節省的預期時間，如果它們都在 24 年達到，如果你在 24 年和 25 年獲得更多。然後只是了解合同的長度？

And then if there's anything to tell us about mitigation strategies on the STAR ratings, like any opportunity to shift people to other if you have dual plans in the state or anything like that, that would be helpful, too.

然後，如果有什麼可以告訴我們關於 STAR 評級的緩解策略的信息，比如如果您在該州有雙重計劃或類似的任何事情，任何將人們轉移到其他人的機會，那也會有所幫助。

Yes. On the PBM contract, it's a multiyear contract. And so you're right, we get the stair step benefit. Quite frankly, that we'd always anticipated. The concept of a stair step effective 1/1/24 with either a renewal or a new PBM contract.

是的。在 PBM 合同中，這是一份多年期合同。所以你是對的，我們得到了階梯式的好處。坦率地說，這是我們一直預料到的。樓梯步驟的概念於 24 年 1 月 1 日生效，可續籤或簽訂新的 PBM 合同。

And then we negotiate multiyear guarantees and inflators. And so think of it as sort of a gradual improvement thereafter. So over the next, call it, few years after the commencement of the contract.

然後我們協商多年擔保和充氣機。因此，可以將其視為此後的逐步改進。所以接下來，在合同開始幾年後，打電話給它。

And then on STARS, I would say, there are probably 3 ways to think about mitigation. The first and most important is making sure that we position 2023 bids in order to maximize benefit stability across 2023 and 2024. And given that we had early visibility into headwind, we were able to do that.

然後在 STARS 上，我想說，可能有 3 種方法來考慮緩解。首先也是最重要的是確保我們定位 2023 年的投標，以最大限度地提高 2023 年和 2024 年的利益穩定性。鑑於我們對逆風有早期了解，我們能夠做到這一點。

The second, of course, is creating the important tailwinds in 2024 in order to make up for the revenue hit. And then the most important one is making sure that our performance in STARS through dates of service of 2022 as strong as possible, so that we're creating maximum tailwinds for the STARS revenue as we head into 2025, as Drew referenced.

第二，當然是在 2024 年創造重要的順風，以彌補收入損失。然後最重要的是確保我們在 2022 年服務日期之前在 STARS 中的表現盡可能強勁，以便我們在進入 2025 年時為 STARS 收入創造最大的順風，正如 Drew 所引用的那樣。

And again, on that latter point, having the strong predictive data that allowed us to see the impending impact of the 2021 issue is equally giving us visibility to meaningful improvement in our operational performance on STARS in 2022 so far.

同樣，在後一點上，擁有強大的預測數據使我們能夠看到 2021 年問題即將產生的影響，這同樣使我們能夠看到 2022 年迄今為止我們在 STARS 上的運營績效的有意義的改進。

And our next question comes from A.J. Rice from Credit Suisse.

我們的下一個問題來自 A.J.瑞士信貸大米。

Just first one cleanup on the PBM contract. I know this is one of the biggest contracts, it's changed hands in a while. And sometimes, historically, when there's been a big contract change, the customer gets some help on the transition period. Is there any support that you're going to get from your new PBM on next year that impacts the results as you make the transition?

只是對 PBM 合同的第一次清理。我知道這是最大的合同之一，它在一段時間內易手。有時，從歷史上看，當合同發生重大變化時，客戶會在過渡期得到一些幫助。明年您將從新 PBM 獲得的任何支持是否會影響您進行過渡時的結果？

And then my more meaningful long-term question is on the reverifications. Obviously, there's been another delay in the -- or extension of the PHE since I think you last time updated your thoughts on reverifications. There's also the chatter about the economy slowing down. Maybe give us your updated thoughts about how much of the reverifications you might absorb next year versus slipping into '24, if you have any updated thoughts?

然後我更有意義的長期問題是關於重新驗證。顯然，自從我認為您上次更新了您對重新驗證的想法以來，PHE 的延期或延期又出現了延遲。還有關於經濟放緩的傳言。如果您有任何更新的想法，也許給我們您關於明年可能吸收多少重新驗證而不是滑入 24 年的最新想法？

Okay. Yes, 2 good questions. On the first one, yes, it's very customary, as you pointed out, A.J., that the winning RFP PBM covers the transition costs. So there's a negotiated pool of cost coverage for the actual sort of operating and consulting cost and execution costs that will take during 2023 to convert as of 1/1/24. Quite frankly, similar concept we had back in 2015.

好的。是的，2 個好問題。在第一個問題上，是的，正如您所指出的，A.J. 非常習慣，獲勝的 RFP PBM 涵蓋了過渡成本。因此，對於實際類型的運營和諮詢成本以及執行成本，將在 2023 年至 24 年 1 月 1 日轉換為實際類型的成本覆蓋範圍。坦率地說，我們在 2015 年就有類似的概念。

And your second question, so yes, another 3 months go by, and we're targeting our construction of our forecast on our 2023 operating plan is assuming a ['21] commencement of redeterminations, but that has moved since last quarter. So right now, if you look back at right before the pandemic, we've grown about 3 million members in Medicaid, a little over 3 million, so call it about $12.5 billion of revenue.

你的第二個問題，所以是的，又過了 3 個月，我們的目標是構建我們對 2023 年運營計劃的預測，假設 ['21] 開始重新確定，但自上個季度以來已經發生了變化。所以現在，如果你回顧一下大流行之前的情況，我們在 Medicaid 中增加了大約 300 萬成員，略高於 300 萬，因此可以稱其為大約 125 億美元的收入。

And so the last time we talked, we were estimating $7 billion to $7.5 billion would be the amount that would be sort of given back due to redeterminations, bumped that up a little bit now to $7.5 billion to $8 billion. So it's about 62% of that revenue that we've gained.

所以我們上次談話時，我們估計 70 億到 75 億美元將是由於重新確定而返還的金額，現在稍微提高到 75 億到 80 億美元。所以這大約是我們獲得的收入的 62%。

But as each quarter goes by, I think the long-term prognosis of the company, we benefit because we don't give back 100% of that incremental revenue we've grown, at least in our estimates. So the time has been really good to be able to work with the states to plan for not just ensuring that there's continuity of coverage for Medicaid recipients, but also to make sure our marketplace business, which is well positioned in '25 of our Medicaid markets to be the recipient of some of those members.

但隨著每個季度的過去，我認為公司的長期預測，我們會受益，因為我們不會 100% 返還我們已經增長的增量收入，至少在我們的估計中是這樣。因此，能夠與各州合作制定計劃的時機非常好，不僅要確保 Medicaid 接受者的保險範圍的連續性，還要確保我們的市場業務在 25 年的 Medicaid 市場中處於有利地位成為其中一些成員的接收者。

Your question about '23 versus '24, based upon a '21 commencement date, the midpoint of that revenue is $7.75 billion, probably $4 billion to $4.5 billion of that would hit in '23, and then the balance largely in '24, but let's see what happens with the PHE date, and we'll have to update you if that moves.

您關於 23 年與 24 年的問題，基於 21 年的開始日期，該收入的中點是 77.5 億美元，其中可能會在 23 年達到 40 億至 45 億美元，然後大部分是在 24 年，但是讓我們看看 PHE 日期會發生什麼，如果發生變化，我們將不得不更新您。

Sorry, I was just going to add quickly on the recession point. It's hard to estimate exactly what the impact of that will be partly because we're still watching that trend, but in general, during a recession, more folks rely on the health safety net and managed care growth. And so that may be an input as we see what the overall impact of redeterminations is as they unfold.

抱歉，我只是想快速補充一下衰退點。很難準確估計這將產生什麼影響，部分原因是我們仍在關注這一趨勢，但總的來說，在經濟衰退期間，更多的人依賴健康安全網和管理式醫療增長。因此，當我們看到重新決定展開時的整體影響時，這可能是一種投入。

And our next question comes from Kevin Fischbeck from Bank of America.

我們的下一個問題來自美國銀行的 Kevin Fischbeck。

I wanted to go into, I guess, the state rate update on backdrop. You guys for a while, talked about redeterminations and kind of the confidence that states will give you appropriate rates if the risk pool does get worse.

我想，我想了解一下背景下的州費率更新。有一段時間，你們談到了重新確定以及如果風險池確實變得更糟，各州會給你適當的利率的信心。

I'd just like to hear kind of what you think happened in Florida and whether any other states are talking about rate cuts in front of that? Because that one to me kind of bothered me a little bit heading into next year, making me wonder, if we're about to see additional states come in with rates. So any color on how you're thinking about that?

我只是想听聽你認為佛羅里達發生了什麼，以及其他州是否在談論降息？因為那對我來說有點困擾我進入明年，這讓我想知道，如果我們即將看到更多的州加入費率。那麼，您對此有何看法？

Yes. In Florida, they never put in a COVID Era risk corridor. And so I'm sure that was a consideration for them. But believe me, we pushed back on that. We didn't think that the minus 4.5% on behalf of the participants, the industry in Florida was appropriate. And the good news with Florida is historically they're very good listeners, and it's our job to show data.

是的。在佛羅里達州，他們從未設置過 COVID 時代的風險走廊。所以我確信這是他們的考慮因素。但請相信我，我們對此進行了反擊。我們不認為代表參與者的負 4.5%，該行業在佛羅里達州是合適的。佛羅里達州的好消息是，從歷史上看，他們是非常好的聽眾，展示數據是我們的工作。

And if we can show the data mid-cycle or certainly by 10/1/23, we get another buy at the Apple, and Florida has been a great partner for us and really expect to have a continuing strong and economically viable arrangement in Florida in the long run.

如果我們能在周期中期或肯定在 23 年 10 月 1 日之前顯示數據，我們將再次購買 Apple，佛羅里達州一直是我們的絕佳合作夥伴，並且真的希望在佛羅里達州擁有持續強大且經濟上可行的安排從長遠來看。

Other states looking to for a cut?

其他州尋求削減？

Yes. If you go back, let me frame the answer in terms of what we shared with you at Investor Day, the 1.3% is what we had built in is our composite rate into the 2022 plan that we shared with you in December of 2021. That's closer to 0.9% to 1%, and most of that difference is Florida. So the rest of the portfolio is sort of in the zone of right on track.

是的。如果您回頭，讓我根據我們在投資者日與您分享的內容來構建答案，我們在 2021 年 12 月與您分享的 2022 年計劃中內置的 1.3% 是我們的綜合費率。那是接近 0.9% 到 1%，大部分差異是佛羅里達州。因此，投資組合的其餘部分在某種程度上處於正確的軌道上。

Our next question comes from Scott Fidel from Stephens.

我們的下一個問題來自斯蒂芬斯的 Scott Fidel。

Wanted to just maybe flesh out the exchange Marketplace a bit more for 2023. As you mentioned, obviously, some pretty major competitive changes in the Marketplace, particularly with Bright exiting and looks like Friday is exiting at least Texas as well. So maybe walk us through how meaningful you think, I guess, the jump ball on membership could be?

想要在 2023 年更加充實交易所市場。正如你所提到的，顯然，市場中有一些相當大的競爭變化，特別是隨著 Bright 的退出，看起來週五至少也退出了德克薩斯。所以也許讓我們了解一下您認為會員資格的跳球可能有多有意義？

And then also, your comfort just with your pricing, if you do end up getting a big all listed of members from some of these other carriers, whether you're confident that your pricing is positioned to still achieve your targeted exchange margins?

此外，您對定價感到滿意，如果您最終從其他一些運營商那裡獲得了大量的成員名單，您是否有信心您的定價仍然能夠實現您的目標兌換利潤？

Yes. Thanks for the question. In general, we see the Marketplace exit as an overall positive, but I'll let Brent walk through the why, and how we're feeling about pricing and positioning.

是的。謝謝你的問題。總的來說，我們認為市場退出總體上是積極的，但我會讓布倫特了解原因，以及我們對定價和定位的感受。

There is no doubt that there is a great opportunity for us here. We've been in the exchange program from day 1. We've never exited. We've continued to provide strong provider networks, good customer service and very stable pricing with good distribution. So we do see this as an opportunity from the standpoint.

毫無疑問，這裡對我們來說是一個很好的機會。我們從第一天起就參加了交流計劃。我們從未退出過。我們繼續提供強大的供應商網絡、良好的客戶服務和非常穩定的定價和良好的分銷。因此，從角度來看，我們確實認為這是一個機會。

At the same time, we think that there's one, the membership that would potentially come over from some of our competitors were exiting, but also just overall growth as we head into the upcoming open enrollment. So we feel positive about the opportunities.

與此同時，我們認為有一個，可能來自我們的一些競爭對手的會員資格正在退出，但隨著我們進入即將到來的公開招生，整體增長也是如此。因此，我們對機會感到樂觀。

We've spent many, many years working very closely with our state regulators, which have given us an opportunity to work through this challenge that they face as people have exited, but that partnership allows us also to continue to work on a daily basis of getting strong customer service.

我們花了很多很多年與我們的州監管機構密切合作，這讓我們有機會應對他們在人們退出時面臨的挑戰，但這種夥伴關係也讓我們能夠繼續每天獲得強大的客戶服務。

And our next question comes from Calvin Sternick from JPMorgan.

我們的下一個問題來自摩根大通的 Calvin Sternick。

Maybe ask one just on utilization. Can you give us a little color on utilization trends in the quarter by product line and how those sort of compared to pre-pandemic levels? I guess whether you've seen any notable shifts quarter-over-quarter?

也許只問一個關於利用率的問題。您能否就本季度按產品線劃分的使用趨勢以及與大流行前水平相比如何？我猜你是否看到任何顯著的季度變化？

Good question. So let me hit COVID first, then I'll get to your non-COVID, which I think is more of the line of your questioning.

好問題。所以讓我先打COVID，然後我會談到你的非COVID，我認為這更像是你的提問。

So COVID was slightly higher than Q2, which was, as you may recall, down from Q1. So -- and there was a very shallow peak in August. So really sort of consistent, slightly higher than Q2.

因此，COVID 略高於第二季度，您可能還記得，第二季度低於第一季度。所以 - 八月有一個非常淺的高峰。所以真的有點一致，略高於第二季度。

The non-COVID, which is what you're asking about is really in line with normal seasonality and pre-covid movements, like from Q2 to Q3. We don't see any signs of pent-up demand at the magnitude that we saw in 2021. And we also track a basket of potentially deferrable services, and that's flat to Q2. So pretty stable macro.

您所問的非 COVID 確實符合正常的季節性和疫情前的變動，例如從第二季度到第三季度。我們沒有看到任何與 2021 年一樣大的需求被壓抑的跡象。我們還跟踪了一籃子可能推遲的服務，這與第二季度持平。所以相當穩定的宏。

And yes, there's a couple of pockets of continued, call it, minor suppression. I'd point to nonemergent ER still a little suppressed, which is good news, obviously. And then while we had a really good quarter in Medicare underneath that, I'd say, ER and urgent care are a little high, offset by a little bit favorable inpatient in Medicare. So just something we're watching in Medicare, but obviously, it didn't affect the aggregate results, which were really strong in Medicare in the quarter.

是的，有幾個口袋繼續，稱之為輕微壓制。我會指出非緊急急診室仍然有點壓抑，這顯然是個好消息。然後，雖然我們在醫療保險中有一個非常好的季度，但我想說，急診室和緊急護理有點高，被醫療保險中一些有利的住院病人所抵消。所以這只是我們在醫療保險中觀察到的東西，但很明顯，它並沒有影響總體結果，這在本季度醫療保險中非常強勁。

Can I just ask on the Medicare and commercial side? Are you seeing any change from inflation on consumers' willingness to sort of access care?

我可以只問醫療保險和商業方面嗎？您是否看到通貨膨脹對消費者獲得某種護理的意願有任何變化？

With the subsidies, think about our government programs business and the cost sharing that most of our members avail themselves of. I think it's probably a different population than if we had a national account business. So no -- yes, no signs of that yet.

有了補貼，想想我們的政府項目業務和我們大多數成員利用的成本分攤。我認為這可能與我們擁有國民賬戶業務的人口不同。所以沒有——是的，還沒有跡象。

And our next question comes from Michael Ha from Morgan Stanley.

我們的下一個問題來自摩根士丹利的 Michael Ha。

Just on MLR real quickly. It looks like the Street might have been a little bit too low in Medicaid MLR for the quarter, but it sounds like it was directly in line with your internal expectations. Is that right?

就在 MLR 上真的很快。看起來華爾街在本季度的 Medicaid MLR 中可能有點太低了，但聽起來它直接符合您的內部預期。那正確嗎？

And on MA, very strong performance sequentially improving 170 bps, you mentioned some favorable affordability initiatives, but it just seems unusually strong for third quarter. I was wondering, if you could help trail down a bit on that.

在 MA 上，表現非常強勁，連續提高了 170 個基點，您提到了一些有利的可負擔性舉措，但第三季度似乎異常強勁。我想知道，如果你能幫助追踪一下。

And then one last one on the PBM contract. Of your $35 billion in drug spend, how much of that is currently sitting with CVS Caremark?

然後是 PBM 合同的最後一項。在您 350 億美元的藥物支出中，CVS Caremark 目前有多少？

All right. Let me see if I remember all 3 questions. Almost all of it is the answer to your last question. We have about $40 billion plus, or minus of gross spend and almost all of that is with Caremark.

好的。讓我看看我是否記得所有 3 個問題。幾乎所有這些都是您最後一個問題的答案。我們有大約 400 億美元的總支出，幾乎所有這些都來自 Caremark。

On Medicaid, yes, we are right on the nose. We are right at our expectation, both in our plan as well as our 6 -- plus 6 forecast, which is that midyear reforecast. So right on track on Medicaid.

在醫療補助上，是的，我們就在眼前。我們的預期是正確的，無論是在我們的計劃中，還是在我們的 6 加 6 預測中，即年中的重新預測。所以在 Medicaid 上走上了正軌。

And in Medicare, pleased with the performance. There's a whole slate of clinical initiatives and call them sort of initiatives to help improve quality and the affordability of health care. And so it could be anything from clinical initiatives or provider contracting or execution on chart chase for risk adjustment.

在醫療保險中，對錶現感到滿意。有一整套臨床舉措，並稱它們為有助於提高醫療保健質量和可負擔性的舉措。因此，它可以是臨床計劃或供應商合同或執行圖表追逐風險調整的任何內容。

So it's sort of like the nuts-and-bolts execution that we've got a whole slate of initiatives that will continue to drive into all of our businesses. We just happen to do really well in Medicare so far this year.

所以這有點像具體的執行，我們有一系列的舉措將繼續推動我們所有的業務。今年到目前為止，我們碰巧在醫療保險方面做得很好。

And our next question comes from Nathan Rich from Goldman Sachs.

我們的下一個問題來自高盛的 Nathan Rich。

First, if I could just ask a quick clarification on the $0.25 to $0.50 potential headwind. Does it include incremental capital deployment benefits from buybacks and debt repayment? And could you maybe just talk about generally how you're thinking about the capital deployment piece of the long-range plan?

首先，如果我能快速澄清一下 0.25 美元到 0.50 美元的潛在逆風。它是否包括回購和償還債務帶來的增量資本部署收益？您能否大致談談您如何看待長期計劃的資本部署部分？

And then as a follow-up on the MA business, I think you had previously talked about margin improvement in 2023. And I think, highlighted some of the investments you're making in light of the recent STAR scores. So does that change the margin trajectory for that business over the next few years?

然後作為 MA 業務的後續行動，我認為您之前曾談到 2023 年的利潤率提高。我認為，根據最近的 STAR 分數，強調了您正在進行的一些投資。那麼，這是否會改變該業務在未來幾年的利潤率軌跡？

Yes. We'll talk a lot more at Investor Day about capital deployment. But yes, the third bucket of our value creation plan is always contemplated heavy deployment of share buyback, but debt management as well, as you saw this quarter, we bought back 317 million of face of our bonds for $300 million and cut out some future interest expense along the way. But we'll cover more of capital deployment at Investor Day. So the answer to your first question is yes, it's contemplated in that -- in the 2024 macro view, I provided.

是的。我們將在投資者日更多地討論資本配置。但是，是的，我們價值創造計劃的第三部分總是考慮大量回購股票，但債務管理也是如此，正如你在本季度看到的那樣，我們以 3 億美元回購了 3.17 億面的債券，並削減了一些未來一路上的利息支出。但我們將在投資者日介紹更多的資本配置。所以你的第一個問題的答案是肯定的，這是我提供的——在 2024 年宏觀視圖中。

And then, I guess, since we've already sort of bless the current consensus. The answer to your second question, which is we've contemplated investments necessary to drive performance in our 2023 buildup, and we still expect margin expansion in Medicare for 2023.

然後，我想，因為我們已經在某種程度上祝福當前的共識。你的第二個問題的答案是，我們已經考慮了必要的投資來推動我們 2023 年的業績增長，我們仍然預計 2023 年醫療保險的利潤率會擴大。

Yes. And again, I think we've pointed in the past to the fact that the Marketplace progression is a good proof point of our ability to expand margin and still grow and innovate in a product line as well as being positioned to take advantage of market opportunities like we are in Marketplace. So that is still the plan for 2023, and we feel good about how our bids are positioned for that.

是的。再一次，我認為我們過去已經指出，市場的發展很好地證明了我們有能力擴大利潤、仍然在產品線中增長和創新，以及能夠利用市場機會就像我們在 Marketplace 中一樣。所以這仍然是 2023 年的計劃，我們對我們的出價如何定位感到滿意。

And then as we go through 2024, we're going to want to make sure that we reduce member abrasion that was part of how we designed the bids. And then as we look to 2025 and pick up the tailwinds of STARS, the ability to revisit sort of the margin and growth balance on a go-forward basis.

然後當我們進入 2024 年時，我們將要確保減少成員磨損，這是我們設計標書的一部分。然後，當我們展望 2025 年並順應 STARS 的順風時，能夠在前進的基礎上重新審視利潤率和增長平衡。

Our next question comes from Gary Taylor from Cowen.

我們的下一個問題來自 Cowen 的 Gary Taylor。

I just had a quick question, and I wanted to pass on a clinic question. I still get a lot including this morning. My quick one was just on the Florida rate cut, which you said was, I think, worse than you had thought, yet you maintained. Actually raised the low end of this year and blessed and maintain what you had said about 2023.

我只是有一個簡短的問題，我想傳遞一個臨床問題。我仍然得到很多，包括今天早上。我的快速反應是佛羅里達降息，我認為你說的情況比你想像的要糟糕，但你堅持了下來。實際上提高了今年的低端，並祝福並保持您所說的關於 2023 年的內容。

So my question was just other operational offsets anything specific that allows you to uphold the guidance despite that cut?

所以我的問題只是其他運營抵消任何具體的東西可以讓你在削減的情況下堅持指導嗎？

And then the client question, I still get all the time is really around redetermination, adverse selection risk. I know, Drew, you've talked a lot about that low utilizer bucket and keeping an eye on that, et cetera. But anything sort of updated there that is underpinning that the confidence on the Medicaid MLR on margin for '23 would be helpful, I think.

然後是客戶的問題，我一直得到的仍然是圍繞重新確定、逆向選擇的風險。我知道，Drew，你已經談論了很多關於低利用率的桶並密切關注它，等等。但我認為，那裡的任何更新都支持對 23 年邊緣醫療補助 MLR 的信心會有所幫助。

The answer to your first question, it's really the beauty of having a very broad portfolio of multiple lines of business, being in 30 states now for Medicaid. I mean that helps a lot. So you're not ultra, ultra-dependent on any single state, although Florida is a pretty big one for us.

您的第一個問題的答案是，擁有多個業務線的非常廣泛的投資組合真的很美妙，現在在 30 個州獲得醫療補助。我的意思是這很有幫助。因此，儘管佛羅里達州對我們來說是一個相當大的州，但您並沒有過度、過度依賴任何一個州。

So I think it's the execution of the Value Creation Plan and the levers that the team is pulling that has enabled us to power through that isolated item. And in the portfolio, there's things that are going to be better than you expected and things that won't come in exactly where you had expected. So we're pretty pleased to be able to still be targeting that low 6s zone for 2023.

所以我認為是價值創造計劃的執行和團隊正在拉動的槓桿使我們能夠通過這個孤立的項目。在投資組合中，有些事情會比你預期的要好，有些事情不會完全符合你的預期。因此，我們很高興能夠在 2023 年仍然瞄準低 6s 區域。

On redeterminations, we continue to look at the data, sort of nothing different than what we've said in past earnings calls or at our June Investor Day. I don't want to minimize that as an important lever that we will be tracking. It's our job to educate states and provide data to the extent that a rate modification would be necessary in a post redetermination world.

在重新確定時，我們繼續查看數據，這與我們在過去的財報電話會議或 6 月投資者日所說的沒有什麼不同。我不想將其作為我們將跟踪的重要槓桿最小化。我們的工作是教育各州並提供數據，以便在重新確定後的世界中需要修改利率。

So there's work to do in there, but we're ready to do so. I think I described on the prior call; we've got -- we've actually developed a common template across all of our health plans. We've got the data sources available and we're ready to go in and make the arguments and we've warmed up our state partners to acknowledge that it's going to be something that they are going to track also.

所以那裡有工作要做，但我們已經準備好了。我想我在之前的電話中描述過；我們已經——我們實際上已經為我們所有的健康計劃開發了一個通用模板。我們已經獲得了可用的數據源，我們已經準備好進入並提出論點，我們已經讓我們的州合作夥伴熱身，以承認這將成為他們也將追踪的東西。

So I don't want to minimize that as either a risk or something that we really have to work hard to execute on, but we're ready, and our state partners are generally good listeners.

因此，我不想將其最小化為風險或我們確實必須努力執行的事情，但我們已經準備好了，我們的州合作夥伴通常都是很好的傾聽者。

Our next question comes from Steven Valiquette from Barclays.

我們的下一個問題來自巴克萊銀行的 Steven Valiquette。

So just a follow-up on the utilization trends. I think if I heard you right, you mentioned that you're not really seeing any notable pent-up demand of traditional non-COVID utilization in '22 versus what you saw in '21. So I guess as we just sort of think about the puts and takes for utilization for '23, do you still factor in the possibility of pent-up demand utilization in any cost categories for next year, whether it's led to procedures or other areas? Or do you just think the canopy, this is just not going to happen now, and it's all in the rearview mirror as far as the whole notion of pent-up demand?

所以只是對利用率趨勢的跟進。我想如果我沒聽錯的話，您提到與您在 21 年看到的相比，您在 22 年並沒有真正看到對傳統非 COVID 使用的任何顯著被壓抑的需求。所以我想，當我們只是考慮一下 23 年的投入使用時，你是否仍然考慮到明年任何成本類別中被壓抑的需求使用的可能性，無論是導致程序還是其他領域？或者你只是認為天篷，這只是現在不會發生，就被壓抑的需求的整個概念而言，這一切都在後視鏡中？

Yes, I think we're going to assume it's going to be a blend. I mean, there are some pockets where we do expect some normalization. But when I say pent-up demand, it's really the sort of the flood that we saw in Q2 of 2021, especially in the Marketplace. And we don't expect something like that to occur again.

是的，我想我們會假設它會是一個混合體。我的意思是，有些地方我們確實期望一些正常化。但是當我說被壓抑的需求時，這確實是我們在 2021 年第二季度看到的那種洪水，尤其是在市場上。我們不希望類似的事情再次發生。

Providers have become very resilient of managing through and we saw that in Omicron. They were able to manage through that very well without any residual meaningful pent-up demand coming out of that Q1, early Q1 Omicron variants.

供應商在管理方面變得非常有彈性，我們在 Omicron 看到了這一點。他們能夠很好地管理這一點，而不會從第一季度早期的第一季度 Omicron 變體中產生任何有意義的被壓抑的需求。

So we're going to make forward trend assumptions that we think about not just future COVID costs, future COVID vaccine costs, but also sort of flu normal trend, a normal flu season meaning sort of a pre-COVID Era flu season. So all of that is fungible and our forward estimates of trend. But yes, we're thinking about sort of all of those legs of the stool.

因此，我們將做出前瞻性趨勢假設，我們不僅要考慮未來的 COVID 成本、未來的 COVID 疫苗成本，還要考慮流感的正常趨勢，一個正常的流感季節意味著某種 COVID 時代之前的流感季節。所以所有這些都是可替代的，也是我們對趨勢的前瞻性估計。但是，是的，我們正在考慮所有這些凳子的腿。

And our next question comes from George Hill from Deutsche Bank.

我們的下一個問題來自德意志銀行的 George Hill。

Drew, just 2 things I wasn't clear on is, number one, is there any recourse left for the Florida rate cut? Or is that decision final? I was just a little confused by the commentary as to whether or not we're done there, or something goes forward.

德魯，我不清楚的兩件事是，第一，佛羅里達降息還有什麼追索權嗎？還是該決定是最終決定？關於我們是否已經完成，或者有什麼進展，我對評論感到有點困惑。

And maybe just I had a quick -- I'll do PBM for 1,000 here well I'll ask. Can you provide any color on kind of what was kind of the incremental thing that drove the decision change from CVS to ESI? And I typically shorter length quarter these things like price, service, access, formulary? Just would love to know kind of what was the needle mover in the RFP?

也許只是我有一個快速 - 我會在這里為 1,000 做 PBM 我會問的。您能否就推動決策從 CVS 更改為 ESI 的增量事物提供任何顏色？我通常會在價格、服務、訪問、處方等這些方面縮短四分之一？只是想知道 RFP 中的動針者是什麼？

Yes, I can take the PBM question first and then kick it over to Drew on Florida. I think like I said, we were really happy with how competitive the process was. We thought everybody showed up with really strong bids. Obviously, economics matter a lot, but we look across the whole slate of criteria. And it was really sort of the aggregate calculus that made the decision, not any one individual thing.

是的，我可以先回答 PBM 問題，然後將其轉給佛羅里達州的 Drew。我想就像我說的那樣，我們對這個過程的競爭程度感到非常滿意。我們認為每個人的出價都非常高。顯然，經濟學很重要，但我們會審視整個標準。真正做出決定的是某種綜合計算，而不是任何一個單獨的事情。

Again, I think the market has good strong competition. We feel good about the go-forward partnership and the ability to sort of innovate how our PBM functions are administered.

再次，我認為市場有很好的競爭。我們對前進的伙伴關係以及創新 PBM 職能管理方式的能力感到滿意。

And then on Florida, yes, the cake is baked for the 10/1 sort of rate change. But my reference was we're constantly reviewing data with not just the state representatives, but also their actuaries and we'll continue to do so over the next year. And then we expect the renewal of that rate no later than 10/1/23.

然後在佛羅里達州，是的，蛋糕是為 10/1 的利率變化而烤的。但我的參考是，我們不僅與州代表，還與他們的精算師一起不斷審查數據，我們將在明年繼續這樣做。然後我們預計該利率的更新不遲於 23 年 10 月 1 日。

One question you didn't ask, but we've got a couple of notes coming in and just to be clear on the $0.25 to $0.50 is net of the tailwinds that I laid out. So that was a macro-overall view of 2024, where this team, we are committed to driving to the $7.50-plus, but we also have -- we don't have perfect information, including California. And that view is net of tailwinds, but it includes headwinds such as STAR.

一個你沒有問的問題，但我們收到了幾張紙條，只是為了弄清楚 0.25 美元到 0.50 美元之間的價格是不是我提出的順風。所以這是對 2024 年的宏觀整體看法，在這個團隊中，我們致力於推動 7.50 美元以上，但我們也有——我們沒有完美的信息，包括加利福尼亞。這種觀點不包括順風，但它包括諸如 STAR 之類的逆風。

And ladies and gentlemen, that will conclude our question-and-answer session.

女士們先生們，我們的問答環節到此結束。

At this time, I'd like to turn the floor back over to Sarah London for any closing remarks.

在這個時候，我想把發言權轉回 Sarah London 來做任何結束語。

Thanks so much. Thanks, everyone, for your time this morning. Great questions. We look forward to seeing many of you at our December Investor Day, and look forward to the opportunity to share more about Centene's strategy for long-term profitable growth. Have a great day.

非常感謝。謝謝大家，今天早上的時間。好問題。我們期待在 12 月的投資者日見到你們中的許多人，並期待有機會分享更多關於 Centene 長期盈利增長戰略的信息。祝你有美好的一天。

And ladies and gentlemen, the conference has now concluded. We do thank you for joining today's presentation. You may now disconnect your lines.

女士們，先生們，會議現已結束。我們非常感謝您參加今天的演講。您現在可以斷開線路。