Centene Corp (CNC) 2022 Q4 法說會逐字稿

Good day, and welcome to the Centene Fourth Quarter Earnings Conference Call. (Operator Instructions) Please note, today's event is being recorded. I would now like to turn the conference over to Jennifer Gilligan, Senior Vice President of Investor Relations. Please go ahead, ma'am.

美好的一天，歡迎來到 Centene 第四季度收益電話會議。 （操作員說明）請注意，今天的活動正在錄製中。我現在想將會議轉交給投資者關係高級副總裁 Jennifer Gilligan。請繼續，女士。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our fourth quarter and full year 2022 earnings results conference call. Sarah London, Chief Executive Officer; and Drew Asher, Executive Vice President and Chief Financial Officer of Centene, will host this morning's call, which can also be accessed through our website at centene.com. Ken Fasola, Centene's President; and Jim Murray, our Chief Operating Officer, will also be available as participants during Q&A.

謝謝你，Rocco，大家早上好。感謝您加入我們的第四季度和 2022 年全年收益結果電話會議。莎拉·倫敦，首席執行官； 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。 Centene 總裁 Ken Fasola；我們的首席運營官 Jim Murray 也將作為參與者參加問答環節。

Any remarks that Centene may make about future expectations, plans and prospects constitute forward-looking statements for the purpose of the 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 on February 22, 2022; and other public SEC filings.

Centene 可能就未來預期、計劃和前景發表的任何評論構成根據 1995 年《私人證券訴訟改革法》規定的安全港條款的前瞻性陳述。實際結果可能與這些前瞻性陳述所表明的結果存在重大差異由於各種重要因素，包括 Centene 在 2022 年 2 月 22 日提交的最新 10-K 表格中討論的那些因素；和其他公開的 SEC 文件。

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.

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。

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 fourth quarter 2022 press release, which is available on the company's website under the Investors section. The company is unable to provide a reconciliation of certain 2023 and 2024 measures to the corresponding GAAP measures without unreasonable efforts due to the difficulty of predicting the timing and amounts of various items within a reasonable range.

該電話還將提及某些非 GAAP 措施。在我們 2022 年第四季度的新聞稿中可以找到這些措施與最直接可比的 GAAP 措施的對賬，該新聞稿可在公司網站的“投資者”部分下獲取。由於難以在合理範圍內預測各種項目的時間和金額，公司無法在沒有不合理努力的情況下提供某些 2023 年和 2024 年措施與相應 GAAP 措施的調節。

With that, I would 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 review our fourth quarter and full year 2022 results and provide our updated outlook for 2023. First, let's close out the year.

感謝 Jen，也感謝大家今天早上加入我們，回顧我們的第四季度和 2022 年全年業績，並提供我們對 2023 年的最新展望。首先，讓我們結束這一年。

2022 was a dynamic and productive year for Centene. We took on many challenges, including a leadership transition, transforming our organizational structure, modernizing our approach to corporate governance, focusing on our core business, improving operations and quality and delivering on our financial commitments along the way.

2022 年對 Centene 來說是充滿活力和富有成效的一年。我們接受了許多挑戰，包括領導層交接、轉變我們的組織結構、使我們的公司治理方法現代化、專注於我們的核心業務、改善運營和質量以及在此過程中兌現我們的財務承諾。

This morning, we reported fourth quarter adjusted EPS of $0.86 and full year 2022 adjusted EPS of $5.78. These strong results came in above the top end of our most recently issued 2022 guidance and were 7% higher than the midpoint of our initial outlook for the year. Looking back over 2022, our 3 core business lines performed well.

今天早上，我們報告第四季度調整後每股收益為 0.86 美元，2022 年全年調整後每股收益為 5.78 美元。這些強勁的業績高於我們最近發布的 2022 年指引的上限，比我們今年初步展望的中點高出 7%。回顧 2022 年，我們的 3 大核心業務線表現良好。

In Marketplace, we materially improved the profitability of our Ambetter product line through advancements in our clinical programs and strategic product positioning, delivering more than the 500 basis points in margin improvement we promised while continuing to show solid growth and market expansion. This provided Ambetter with a strong jumping off point to achieve our long-term target margin and profitable growth goals in 2023.

在 Marketplace 方面，我們通過臨床項目和戰略產品定位的進步，顯著提高了 Ambetter 產品線的盈利能力，實現了我們承諾的超過 500 個基點的利潤率提高，同時繼續顯示出穩健的增長和市場擴張。這為 Ambetter 提供了一個強有力的起點，可以在 2023 年實現我們的長期目標利潤率和盈利增長目標。

In our Medicare Advantage business, Centene generated outsized growth in 2022, ending the year with 21% more members compared to year-end 2021. Our focus throughout the year was on strong clinical program performance, quality improvement, which you've heard a lot about; expanded value-based care relationships; and providing enrollees with a more seamless member experience.

在我們的 Medicare Advantage 業務中，Centene 在 2022 年取得了巨大的增長，與 2021 年底相比，到年底的成員增加了 21%。我們全年的重點是強大的臨床項目績效、質量改進，您已經聽到了很多關於;擴大基於價值的護理關係；並為登記者提供更加無縫的會員體驗。

In 2022, the strength of WellCare's underlying performance was demonstrated through year-over-year HBR improvement. And we're confident in our increasingly disciplined approach to quality operations will provide an important lever as we move through 2023 and work to improve WellCare's profitability on its expanded scale.

2022 年，WellCare 基礎業績的實力通過《哈佛商業評論》同比改善得到證明。我們相信，我們越來越嚴格的質量運營方法將在我們邁向 2023 年並努力提高 WellCare 擴大規模的盈利能力時提供一個重要的槓桿。

Our local markets also performed well throughout the year, serving more Medicaid members in more geographies than ever before. Our Delaware go-live, as well as a significant number of successful reprocurements and program expansions, including in Louisiana, Nebraska, Texas and Missouri, to name just a few, bolstered our market presence and leadership position in Medicaid managed care.

我們的本地市場全年也表現良好，為更多地區的更多 Medicaid 會員提供比以往任何時候都多的服務。我們在特拉華州的上線，以及包括路易斯安那州、內布拉斯加州、得克薩斯州和密蘇里州在內的大量成功的再採購和計劃擴展，鞏固了我們在醫療補助管理式醫療領域的市場地位和領導地位。

In California, Centene was ultimately selected to serve the state through direct contracts in 10 key markets, including Los Angeles and Sacramento Counties. We are working towards readiness for the 1/1/24 start date of the new California contracts, and we look forward to our continued partnership with the state to improve the medical health care delivery system and advance the state's innovative [Calian] programming.

在加利福尼亞州，Centene 最終被選中通過在 10 個主要市場（包括洛杉磯和薩克拉門託縣）的直接合同為該州服務。我們正在努力為 24 年 1 月 1 日新加州合同的開始日期做好準備，我們期待與該州繼續合作，以改善醫療保健提供系統並推進該州的創新 [Calian] 計劃。

2022 also marked the first full year of execution on our value-creation plan, and it was by every measure of success. We hit all major milestones, including redesigning our UM function across the enterprise; successfully negotiating a new PBM partnership, reducing our real estate footprint by 70% to accommodate new workforce flexibility, itself an important cultural evolution for the company; and making important investments in data and digital tools that will make it easier for our members, our providers and our employees to work with us.

2022 年也是我們執行價值創造計劃的第一個完整年，從各方面來看都是成功的。我們達到了所有重要的里程碑，包括重新設計我們在整個企業中的 UM 功能；成功談判新的 PBM 合作夥伴關係，將我們的房地產足跡減少 70% 以適應新的勞動力靈活性，這本身就是公司的重要文化變革；對數據和數字工具進行重要投資，使我們的會員、供應商和員工更容易與我們合作。

We exit 2022 not only well positioned to achieve our $400 million in targeted SG&A savings in 2023, but also having added $300 million in new SG&A opportunities to our longer-term backlog. In addition to achieving these value-creation milestones, we made meaningful progress on our portfolio review process.

我們在 2022 年退出，不僅有能力在 2023 年實現 4 億美元的 SG&A 目標節省，而且還為我們的長期積壓訂單增加了 3 億美元的新 SG&A 機會。除了實現這些創造價值的里程碑外，我們還在投資組合審查過程中取得了有意義的進展。

We closed 3 divestitures in 2022 and announced a fourth. Notably, in the first weeks of 2023, we closed the previously announced sale of Magellan Specialty as well as the sales of Centurion and HealthSmart, bringing our total number of divestitures since Q4 of 2021 to 7. This disciplined execution has streamlined our enterprise, reduced distraction and allowed us to increase our focus on our core business lines. It has also powered significant and timely share repurchases during 2022 and year-to-date in 2023.

我們在 2022 年完成了 3 項資產剝離，並宣布了第四項資產剝離。值得注意的是，在 2023 年的前幾週，我們完成了先前宣布的 Magellan Specialty 出售以及 Centurion 和 HealthSmart 的出售，使我們自 2021 年第四季度以來的資產剝離總數達到 7 個。這種嚴格的執行簡化了我們的企業，減少了分心，讓我們更加關注我們的核心業務線。它還推動了 2022 年和 2023 年年初至今的重大和及時的股票回購。

Finally, in December, we aligned the enterprise around a long-term strategic plan, inclusive of a commitment to 12% to 15% long-term adjusted EPS growth. With our senior leadership team in place and the company's demonstrated progress against our strategic and financial goals in 2022, we are well positioned to capitalize on the momentum of the past year and successfully continue our value-creation journey for shareholders and members in 2023. With that, let's talk about 2023 so far.

最後，在 12 月，我們圍繞一項長期戰略計劃調整了企業，包括承諾 12% 至 15% 的長期調整後每股收益增長。憑藉我們的高級領導團隊到位以及公司在實現 2022 年戰略和財務目標方面取得的進展，我們有能力利用過去一年的勢頭，並在 2023 年成功地繼續為股東和成員創造價值的旅程。隨著那，讓我們談談到目前為止的2023年。

Centene's Marketplace products yielded exceptional growth during this year's open enrollment, outpacing even the robust growth of the total market itself. This year's OEP performance only reinforces our view of the increasing durability of the Marketplace as a coverage vehicle and Ambetter's leadership position within this market.

Centene 的 Marketplace 產品在今年的公開註冊期間取得了非凡的增長，甚至超過了整個市場本身的強勁增長。今年的 OEP 表現進一步鞏固了我們的觀點，即 Marketplace 作為覆蓋工具的耐用性不斷提高，以及 Ambetter 在該市場中的領導地位。

To harness this growth opportunity, our Ambetter team applied a portfolio approach to pricing and product positioning, decisively leveraging our local expertise and strong broker relationships on a market-by-market basis to attract and retain membership across our Marketplace footprint. While it is still early days with respect to claims experience, we want to share a few observations about Ambetter's strong OEP growth and provide some performance expectations given the team's outperformance on membership.

為利用這一增長機會，我們的 Ambetter 團隊採用組合方法進行定價和產品定位，果斷地利用我們在逐個市場的本地專業知識和強大的經紀人關係來吸引和保留我們市場足跡中的會員。雖然在理賠經驗方面還處於早期階段，但我們想分享一些關於 Ambetter 強勁的 OEP 增長的觀察結果，並提供一些鑑於團隊在會員方面表現出色的業績預期。

Approximately 70% of our 2023 membership is enrolled in a Silver Plan compared to approximately 72% in 2022. Silver plans have consistently represented the majority of our membership year after year, and 2023 is no different. Similar to previous plan years, the majority of our 2023 membership selected our core product. At the same time, we are pleased with the continued uptake we are seeing in our newer products, demonstrating the value of flexibility and plan design for our members.

我們 2023 年的會員中約有 70% 加入了銀牌計劃，而 2022 年這一比例約為 72%。銀牌計劃年復一年地代表我們會員的大部分，2023 年也不例外。與之前的計劃年度類似，我們 2023 年的大多數會員選擇了我們的核心產品。與此同時，我們很高興看到我們的新產品得到持續採用，展示了靈活性和計劃設計對我們會員的價值。

Key membership demographics like gender, age, geography and subsidy levels are consistent with what we experienced last year. Most importantly, these factors are also consistent with the pricing assumptions we used for 2023 product positioning. We continue to expect our Marketplace business to achieve margins within the long-term targeted range of 5% to 7.5% during 2023. And we are pleased to have the opportunity to serve so many Marketplace members as the reach of that product continues to expand.

性別、年齡、地域和補貼水平等主要會員人口統計數據與我們去年的情況一致。最重要的是，這些因素也與我們用於 2023 年產品定位的定價假設一致。我們繼續期望我們的 Marketplace 業務在 2023 年實現 5% 至 7.5% 的長期目標範圍內的利潤率。隨著該產品的影響範圍不斷擴大，我們很高興有機會為如此多的 Marketplace 成員提供服務。

As we highlighted for investors last month, Medicare Advantage enrollment results for 2023 developed softer than expectations we provided at Investor Day in December. Our goal for the 2023 AEP was to foundationally align our Medicare offerings for long-term margin recovery, product stability and overall quality, capitalizing on the scale we achieved through outsized growth in 2021 and 2022.

正如我們上個月向投資者強調的那樣，2023 年的 Medicare Advantage 註冊結果比我們在 12 月投資者日提供的預期要疲軟。我們 2023 年 AEP 的目標是從根本上調整我們的 Medicare 產品，以實現長期利潤率恢復、產品穩定性和整體質量，利用我們在 2021 年和 2022 年通過超額增長實現的規模。

In our effort to better control the overall member experience, which requires operational stability and contributes directly to quality results, we made the decision to change our distribution strategy and focus more on proprietary channels.

為了更好地控制整體會員體驗，這需要運營穩定性並直接影響質量結果，我們決定改變我們的分銷策略，更多地關注專有渠道。

Near-term sales and retention were more significantly impacted by our distribution strategy than expected, particularly in light of competitor investment in channels we deprioritized. That said, several of the channels we prioritize performed better than expected, reinforcing our long-term view of an optimal go-to-market strategy for Medicare Advantage and dual eligible members.

我們的分銷策略對近期銷售和保留的影響比預期的要大，特別是考慮到競爭對手對我們取消優先級的渠道的投資。也就是說，我們優先考慮的幾個渠道的表現好於預期，強化了我們對 Medicare Advantage 和雙重合格會員的最佳上市戰略的長期看法。

Despite the soft membership results relative to expectations, we continue to expect 100 basis points of Medicare HBR improvement in 2023. Importantly, we are already seeing positive operational impact for members and brokers, with strong service levels, improved customer satisfaction and a 30% reduction in overall calls compared to this time last year.

儘管會員業績低於預期，但我們繼續預計 2023 年 Medicare HBR 改善 100 個基點。重要的是，我們已經看到會員和經紀人的積極運營影響，服務水平高，客戶滿意度提高，減少 30%與去年同期相比，總通話量。

Turning to more recent Medicare news. Regarding the finalization of the RADV rule, we are supportive of CMS' decision to limit the scope of historical audits. CMS' decision in this regard avoids significant cost and abrasion for our provider partners. That said, the lack of fee-for-service adjustment and the as-yet undefined sampling and extrapolation methodology leaves a number of open questions as to the viability of the final approach. We are working in collaboration with our industry partners to determine the best path forward.

轉向最近的醫療保險新聞。關於 RADV 規則的最終確定，我們支持 CMS 限制歷史審計範圍的決定。 CMS 在這方面的決定避免了我們的供應商合作夥伴的重大成本和磨損。也就是說，缺乏按服務收費的調整以及尚未定義的抽樣和外推方法為最終方法的可行性留下了許多懸而未決的問題。我們正在與我們的行業合作夥伴合作，以確定最佳的前進道路。

Regarding last week's preliminary rate notice, 2024 initial rates are less favorable than recent years and below our internal expectation for funding. We will fully exercise our ability to provide feedback to CMS during the comment period and look forward to collaborating with the agency as we work towards rate finalization in April. That said, we see a path to achieving Medicare Advantage results that meet member needs and support our 2024 financial goals.

關於上週的初步利率通知，2024 年的初始利率不如近幾年有利，也低於我們對資金的內部預期。我們將在評論期間充分發揮我們向 CMS 提供反饋的能力，並期待與該機構合作，努力在 4 月份最終確定利率。也就是說，我們看到了實現滿足會員需求並支持我們 2024 年財務目標的 Medicare Advantage 結果的途徑。

Finally, as we all know, 2023 will be an important year for the Medicaid business. In December, Congress passed the Federal Consolidated Appropriations Act for 2023, which ends a continuous coverage provision on March 31. This tees up redeterminations to begin this spring, an event we have been working to prepare for throughout 2022.

最後，眾所周知，2023 年將是醫療補助業務的重要一年。 12 月，國會通過了 2023 年聯邦綜合撥款法案，該法案於 3 月 31 日結束了連續覆蓋條款。這為今年春天開始的重新決定做好了準備，我們一直在努力為整個 2022 年做準備。

As we approach the redetermination process, we are focused on 3 things: first, optimizing the verification process for members. We are working closely with our state partners and our network of community partners in each market to facilitate member transition and coverage continuity. In the last month, we've deployed internal and external training designed to maximize each member touch point and our ability to support beneficiaries as their eligibility is reviewed.

當我們接近重新確定過程時，我們專注於三件事：首先，優化成員的驗證過程。我們正在與每個市場的州合作夥伴和我們的社區合作夥伴網絡密切合作，以促進成員過渡和覆蓋範圍的連續性。在上個月，我們部署了內部和外部培訓，旨在最大限度地提高每個成員的接觸點，以及我們在審查資格時支持受益人的能力。

Leveraging Centene's unique and powerful data, we've launched eligibility likelihood modeling across our Medicaid footprint in order to prioritize and customize member outreach. And we've launched enhanced reporting and membership dashboards for clear tracking of redeterminations-related activities across the enterprise.

利用 Centene 獨特而強大的數據，我們已經在我們的 Medicaid 足跡中啟動了資格可能性建模，以便優先考慮和定制會員外展。我們還推出了增強型報告和會員儀表板，以便清楚地跟踪整個企業中與重新確定相關的活動。

Second, we are focused on ensuring that state program rates reflect any shifting of the risk pool created by membership changes. We recognize the dynamics in each market are different, so we are leveraging our data to support early collaborative discussions with our state partners.

其次，我們專注於確保州計劃利率反映由成員變更產生的風險池的任何變化。我們認識到每個市場的動態都不同，因此我們正在利用我們的數據來支持與州合作夥伴的早期協作討論。

And third, we are focused on maximizing the opportunity to provide coverage continuity to members who are no longer eligible for Medicaid, but who are eligible for subsidized coverage on the Marketplace. Given the strong overlap of our Medicaid and Marketplace footprint in 25 states, we continue to size the opportunity for our Marketplace products at 200,000 to 300,000 lives throughout the duration of redeterminations.

第三，我們專注於最大限度地為不再有資格享受醫療補助但有資格在市場上獲得補貼保險的會員提供連續性保險的機會。鑑於我們的 Medicaid 和 Marketplace 足跡在 25 個州的強烈重疊，我們將繼續在重新確定期間將我們的 Marketplace 產品的機會調整為 200,000 至 300,000 人的生命。

In 15 of the 25 states, where we have both Medicaid and Marketplace products, we will reach out to our current members directly with educational information regarding the enrollment process as well as with Marketplace plan options. We expect that state count to grow as we advance through the redeterminations process, and we have a robust, scalable plan in place to support this communication and education effort.

在我們同時擁有 Medicaid 和 Marketplace 產品的 25 個州中的 15 個，我們將直接聯繫我們現有的成員，提供有關註冊過程的教育信息以及 Marketplace 計劃選項。我們希望隨著我們通過重新決定過程的推進，狀態計數會增加，並且我們有一個強大的、可擴展的計劃來支持這種溝通和教育工作。

Finally, I'd like to highlight some important news that came just a few weeks ago. In late January, the FCC issued guidance to improve member communication opportunities related to maintaining Medicaid and other governmental health care coverage. We view this as an incredibly important step, not only relative to supporting a seamless verification process, but also a meaningful step forward in modernizing the industry's overall approach to Medicaid member engagement. We are working closely with states to integrate this guidance into our redetermination strategy and to prove the value of digital engagement in reducing cost and improving member outcomes.

最後，我想強調幾週前發布的一些重要消息。 1 月下旬，FCC 發布了指南，以改善與維持醫療補助和其他政府醫療保健覆蓋範圍相關的成員溝通機會。我們認為這是非常重要的一步，不僅與支持無縫驗證流程有關，而且在使行業整體方法現代化以實現 Medicaid 成員參與方面也邁出了有意義的一步。我們正在與各州密切合作，將此指南整合到我們的重新確定戰略中，並證明數字參與在降低成本和改善成員成果方面的價值。

On balance, when you take into account our more informed view of open enrollment for 2023, the updated timing of redeterminations and recently closed divestitures, we are well positioned to achieve the top half of our full year 2023 adjusted EPS guidance. Drew will provide greater detail on our outlook in just a moment.

總的來說，當你考慮到我們對 2023 年公開招生的更明智的看法、重新確定的更新時間和最近關閉的資產剝離時，我們完全有能力實現 2023 年全年調整後 EPS 指導的上半部分。德魯稍後將提供有關我們前景的更多細節。

As we look ahead, 2023 promises to be another transformative year for the enterprise and one in which we will need to navigate notable market dynamics across our product lines from redeterminations to Medicare positioning to fast-growing Marketplace products. This is not new for Centene, and we are better equipped to manage through this change than we ever have been before, thanks to the work we have done over the last 18 months to focus and fortify our operations and to align the organization around value-creation principles.

展望未來，2023 年有望成為企業又一個變革的一年，我們將需要在我們的產品線中駕馭顯著的市場動態，從重新確定到 Medicare 定位，再到快速增長的 Marketplace 產品。這對 Centene 來說並不是什麼新鮮事，我們比以往任何時候都更有能力應對這一變化，這要歸功於我們在過去 18 個月中所做的工作，以專注和加強我們的運營，並使組織圍繞價值-創作原則。

As we look downfield, we continue to see tremendous opportunity for all 3 of our core businesses, including complex Medicaid populations and dual eligibles, Marketplace adjacencies and STAR score improvement. We continue to track well against our long-term goals and look forward to executing against our strategic plan, driving strong results and delivering value to members and shareholders.

當我們展望未來時，我們繼續看到我們所有 3 項核心業務的巨大機遇，包括複雜的醫療補助人口和雙重資格、市場鄰接和 STAR 評分改進。我們繼續很好地跟踪我們的長期目標，並期待執行我們的戰略計劃，推動強勁的業績並為會員和股東創造價值。

With that, I will turn it over to Drew to review our results and outlook in more detail.

有了這個，我將把它交給德魯來更詳細地審查我們的結果和前景。

Thank you, Sarah. Today, we reported fourth quarter 2022 results, including $35.6 billion in total revenue, an increase of 9% compared to the fourth quarter of 2021, and adjusted diluted earnings per share of $0.86 in the quarter. For the full year, we reported $5.78 of adjusted EPS, a 7% beat over our original 2022 guidance and growth of over 12% compared to 2021.

謝謝你，莎拉。今天，我們公佈了 2022 年第四季度的業績，其中總收入為 356 億美元，比 2021 年第四季度增長 9%，該季度調整後的攤薄每股收益為 0.86 美元。全年，我們報告的調整後每股收益為 5.78 美元，比我們最初的 2022 年指導高出 7%，與 2021 年相比增長了 12% 以上。

Let's start with revenue details for the quarter. Total revenue grew by $3 billion compared to the fourth quarter of 2021, driven by strong organic growth throughout the year in Medicaid, primarily due to the ongoing suspension of eligibility redeterminations; strong Medicare membership growth; and the January 2022 acquisition of Magellan, partially offset by divestitures.

讓我們從本季度的收入細節開始。與 2021 年第四季度相比，總收入增長了 30 億美元，這主要得益於醫療補助計劃全年強勁的有機增長，這主要是由於資格重新確定的持續暫停；強勁的醫療保險會員增長；以及 2022 年 1 月對 Magellan 的收購，部分被資產剝離所抵消。

Our Q4 consolidated HBR was 88.7%, a little bit better than our expectations, and 87.7% for the full year. Medicaid at 89.6% for the full year was right in line with our expectation of an HBR in the 89s for 2022. Medicare at 86.2% for the full year was 90 basis points better than 2021, driven by execution of clinical initiatives.

我們第四季度的綜合 HBR 為 88.7%，略好於我們的預期，全年為 87.7%。全年 89.6% 的 Medicaid 符合我們對 2022 年 89 年代 HBR 的預期。由於臨床計劃的執行，全年 86.2% 的 Medicare 比 2021 年高 90 個基點。

And on commercial, recall, we originally promised a 500 basis point reduction in the HBR in 2022. How did we do? We were down 550 basis points for the full year. This was driven by disciplined pricing actions, initiatives executed in 2022, and as expected, a reduction in COVID and pent-up demand costs compared to 2021.

在商業方面，回想一下，我們最初承諾在 2022 年將哈佛商業評論降低 500 個基點。我們做得如何？我們全年下跌了 550 個基點。這是由嚴格的定價行動和 2022 年執行的舉措推動的，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。

Moving to other P&L and balance sheet items. Our adjusted SG&A expense ratio was 9.3% in the fourth quarter compared to 8.7% last year, driven by the inclusion of Magellan and the sale of PANTHER as well as increased Medicare marketing and value-creation investment spending in the quarter, given the overall company outperformance.

轉到其他損益表和資產負債表項目。我們調整後的 SG&A 費用比率在第四季度為 9.3%，而去年同期為 8.7%，這是由於考慮到整個公司表現出色。

Cash flow used in operations was minus $1.6 billion in the fourth quarter. You may recall, in the third quarter, we had an early receipt of $2.9 billion of CMS payments pertaining to the fourth quarter, which is driving down our reported Q4 operating cash flow. Cash flow provided by operations was $6.3 billion for the full year, representing 5.2x net earnings or 1.9x adjusted net earnings. This was driven by earnings before charges, including real estate and divestiture-related impairments and an increase in medical claims liabilities.

第四季度用於運營的現金流為負 16 億美元。您可能還記得，在第三季度，我們提前收到了與第四季度相關的 29 億美元 CMS 付款，這降低了我們報告的第四季度運營現金流。全年運營產生的現金流量為 63 億美元，相當於淨收益的 5.2 倍或調整後淨收益的 1.9 倍。這是由費用前收益推動的，包括房地產和剝離相關的減值以及醫療索賠負債的增加。

Our domestic unregulated and unrestricted cash on hand was $793 million at year-end, though after making some planned pass-through payments in early January, that amount is closer to 0.

截至年底，我們國內不受監管和不受限制的手頭現金為 7.93 億美元，儘管在 1 月初進行了一些計劃的轉嫁付款後，這一數額接近於 0。

From January of 2022 through today, we repurchased 39.1 million shares of our common stock for $3.3 billion. Debt at quarter end was $18 billion, down approximately $800 million from prior year-end, driven by senior note repurchases of $318 million, a repayment of our $180 million construction loan and repayments of over $100 million in revolver and term loan borrowings. Our debt-to-adjusted EBITDA came in right at 3.0x, down from 3.5x a year ago. Days in claims payable was 54 in Q4 of 2022 compared to 54 in Q3 of 2022 and 52 in Q4 of 2021.

從 2022 年 1 月到今天，我們以 33 億美元回購了 3910 萬股普通股。季度末的債務為 180 億美元，比上年末減少約 8 億美元，這是由於優先票據回購 3.18 億美元、償還我們 1.8 億美元的建築貸款以及償還超過 1 億美元的循環貸款和定期貸款借款。我們的債務調整後 EBITDA 正好是 3.0 倍，低於一年前的 3.5 倍。 2022 年第四季度的應付索賠天數為 54 天，而 2022 年第三季度為 54 天，2021 年第四季度為 52 天。

GAAP earnings during the quarter include impairments related to several divestitures that were completed or pending as of December 31, as well as an impairment of our federal services business, partially offset by a gain on the sale of MagellanRx.

本季度的 GAAP 收益包括與截至 12 月 31 日已完成或未決的多項資產剝離相關的減值，以及我們聯邦服務業務的減值，部分被出售 MagellanRx 的收益所抵消。

Looking back at 2022, it was a very good year of execution during some notable changes for Centene. Sarah hit on some of the highlights, but let me remind you of a few. We beat original adjusted EPS guidance by 7%. We bought back almost 7% of the company's shares, including January 2023 repurchases. We reduced debt-to-adjusted EBITDA to 3x and got upgraded to investment grade by Fitch. We continue to execute on divestitures. Since Q4 of 2021, we've completed 7 divestitures for gross proceeds of over $3.5 billion. We improved the discipline of the company in many areas while strengthening DCP by a couple of days, and we picked up 2 very strong operators, Fasola and Murray, along the way.

回顧 2022 年，在 Centene 的一些顯著變化中，這是執行力非常好的一年。 Sarah 提到了一些要點，但讓我提醒您一些。我們超出了最初調整後的 EPS 指導 7%。我們回購了公司近 7% 的股份，包括 2023 年 1 月的回購。我們將債務調整後 EBITDA 比率降至 3 倍，並被惠譽升級為投資級別。我們繼續執行資產剝離。自 2021 年第四季度以來，我們已經完成了 7 項資產剝離，總收益超過 35 億美元。在加強 DCP 幾天的同時，我們在許多領域改善了公司的紀律，並在此過程中挑選了 2 名非常強大的運營商，Fasola 和 Murray。

All right, enough on the rearview mirror. Let's talk about what really matters today and tomorrow, starting with 2023. We gave detailed guidance elements at Investor Day, but a few things have happened since then, including more clarity of the timing of the restart of redeterminations, a couple more Centene divestitures, a very strong Marketplace annual enrollment period and softer Medicare Advantage enrollment as we mentioned at the recent investor conference in San Francisco.

好吧，在後視鏡上就足夠了。讓我們談談今天和明天真正重要的事情，從 2023 年開始。我們在投資者日提供了詳細的指導要素，但此後發生了一些事情，包括重新確定重新確定的時間更加明確，更多的 Centene 資產剝離，正如我們最近在舊金山舉行的投資者會議上提到的那樣，市場年度註冊期非常強勁，而 Medicare Advantage 註冊率較低。

My bias when we haven't yet closed the first month of 2023 is not to touch 2023 guidance until we have some actual results, but there are a few things that will help you understand how we are starting out of the gates compared to what we outlined at December Investor Day. Our 2023 premium and service revenue should be approximately $2 billion higher than the range provided at Investor Day.

當我們還沒有關閉 2023 年的第一個月時，我的偏見是在我們得到一些實際結果之前不要觸及 2023 年的指導，但是有一些事情可以幫助您了解我們是如何開始的，而不是我們的在 12 月投資者日概述。我們 2023 年的保費和服務收入應比投資者日提供的範圍高出約 20 億美元。

Let me bridge that for you: $1.5 billion more of Medicaid premium revenue from a higher starting point in 2023 and an additional 2 months until redeterminations recommence April 1; plus an additional $3 billion of commercial premium revenue from an outstanding marketplace open enrollment period; minus $0.5 billion of Medicare revenue as we were off in the annual enrollment period, down high single digits versus down mid-single digits; and minus approximately $2 billion of divested revenue previously in guidance, Magellan Specialty, Centurion and HealthSmart.

讓我為您總結一下：2023 年從更高的起點開始增加 15 億美元的 Medicaid 保費收入，並在 4 月 1 日重新開始重新確定之前增加 2 個月；加上來自傑出市場開放註冊期的額外 30 億美元商業保費收入；減去 5 億美元的 Medicare 收入，因為我們在年度註冊期結束時，下降了高個位數，而下降了中個位數；減去之前在指導、Magellan Specialty、Centurion 和 HealthSmart 中剝離的約 20 億美元收入。

Let me go a little deeper on 2 2023 topics. On the additional Medicaid broad growth of $1.5 billion, we expect to give about 2/3 of that back in the redetermination process. So our previous estimate of $8 billion of ultimate run rate revenue give back goes up to $9 billion. By April 1, we expect to have grown by 3.4 million Medicaid members since the onset of the pandemic, excluding new markets and we expect to lose approximately 2.2 million of those members in the redetermination process over the next 1.5 years. In other words, about 65% of that growth.

讓我更深入地討論 2 個 2023 主題。在 15 億美元的額外醫療補助廣泛增長中，我們預計將在重新確定過程中回饋其中的約 2/3。因此，我們先前估計的 80 億美元最終運行率收入回饋高達 90 億美元。到 4 月 1 日，我們預計自大流行開始以來，醫療補助成員將增加 340 萬，不包括新市場，我們預計在未來 1.5 年的重新確定過程中將失去大約 220 萬這些成員。換句話說，大約是增長的 65%。

The 2023 portion is baked into the new revenue guidance. The remaining 2024 portion would be about $6 billion of the $9 billion. And I know a number of you have asked about our early read of attributes related to our growth in Marketplace. As Sarah outlined, based upon a review of the demographics, metal tiers, product types, subsidy eligibility and distribution sources of our new membership, we don't see any signs of alarm. The proof will ultimately being the claims data, but all of this Marketplace growth, even membership from carriers who have exited, comes in at our product design, our network construct, our pricing and into our clinical models.

2023 年的部分被納入新的收入指南。剩餘的 2024 年部分將是 90 億美元中的約 60 億美元。我知道你們中的許多人都問過我們早期閱讀的與我們在 Marketplace 中的增長相關的屬性。正如 Sarah 概述的那樣，根據對我們新會員的人口統計數據、金屬等級、產品類型、補貼資格和分配來源的審查，我們沒有看到任何警報跡象。證據最終將是索賠數據，但所有這些市場增長，甚至來自已經退出的運營商的會員資格，都來自我們的產品設計、我們的網絡構建、我們的定價和我們的臨床模型。

While we aren't changing our adjusted EPS guidance range at this very early stage for 2023, all of this recent insight, including the higher revenue base, biases us to the top half of our adjusted EPS range of $6.25 to $6.40. And of course, once we see from data -- once we see some data from Q1, we will refine all the underlying elements for you no later than our Q1 earnings call, suffice to say that we ended 2022 strong, and that looks to be continuing into 2023.

雖然我們不會在 2023 年的早期階段改變調整後的每股收益指導範圍，但所有這些最近的見解，包括更高的收入基礎，都使我們偏向於調整後每股收益範圍 6.25 美元至 6.40 美元的上半部分。當然，一旦我們從數據中看到——一旦我們看到第一季度的一些數據，我們將在第一季度財報電話會議之前為您完善所有基本要素，足以說明我們在 2022 年結束時表現強勁，看起來持續到 2023 年。

As we look out to 2024, we remain committed to our previously provided adjusted EPS floor of at least $7.15. While we're 10 months away from giving formal 2024 guidance, let me give you some updated color on recent events that are included in this assessment.

展望 2024 年，我們仍然致力於實現之前提供的至少 7.15 美元的調整後每股收益下限。雖然我們距離提供正式的 2024 年指導還有 10 個月的時間，但讓我為您提供一些有關此評估中包含的近期事件的最新信息。

First of all, on the positive side, 2023 looks to be a little stronger out of the gate as we just discussed. Second, we completed California renegotiations in late January and are pleased with the outcome. Third, our Marketplace business is $3 billion larger than we had previously assumed, and we expect performance in the target margin zone in both 2023 and 2024. Four, investment income continues to grow, including the recent 25 basis point Fed rate increase in early February. Five, share count is down further, and with the stock price lower, we will strive to accelerate planned share repurchases earlier in the year. That's a pretty good collection of tailwinds.

首先，從積極的方面來看，正如我們剛剛討論的那樣，2023 年看起來會更強大一些。其次，我們在 1 月下旬完成了加州的重新談判，並對結果感到滿意。第三，我們的 Marketplace 業務比我們之前假設的多了 30 億美元，我們預計 2023 年和 2024 年的業績都在目標利潤率區域。第四，投資收益持續增長，包括近期美聯儲在 2 月初加息 25 個基點.五、股份數量進一步減少，隨著股價走低，我們將爭取在今年早些時候加快計劃的股份回購。這是一個很好的順風集合。

On the headwind side, though, Medicare is going to be challenging for us in 2024. We knew it was going to be tough given the cards we were dealt in STAR scores, stemming from poor decisions in 2020. And the impact of a disappointing advanced notice on 2024 rates does not help. We will most certainly be pricing for a negative margin in Medicare Advantage in 2024 temporarily. And we don't expect to grow Medicare Advantage in 2024 and likely will shrink a little.

不過，不利的一面是，Medicare 將在 2024 年對我們構成挑戰。鑑於 2020 年的錯誤決定導致我們在 STAR 分數中處理的牌，我們知道這將是艱難的。以及令人失望的先進的影響關於 2024 年費率的通知無濟於事。我們肯定會在 2024 年暫時為 Medicare Advantage 的負利潤率定價。而且我們預計 Medicare Advantage 不會在 2024 年增長，而且可能會略有縮減。

We have a lot of work between now and the first Monday in June when the bids are due to refine our estimates and products further. And obviously, the industry will be asking a lot of questions about the components of the advanced notice in anticipation of final rates in a couple of months.

從現在到 6 月的第一個星期一，我們有很多工作要做，屆時投標將進一步完善我們的估計和產品。很明顯，在幾個月後預期最終利率的情況下，該行業將對預先通知的組成部分提出很多問題。

But here is the silver lining. If we can achieve at least $7.15 of adjusted EPS in 2024, with a meaningfully underperforming Medicare business embedded in that result, that becomes a margin expansion and growth opportunity in the back half of the decade as we improve STARS and pull other levers over the next few years. We know what needs to be done. It just takes time, especially in STARS.

但這是一線希望。如果我們能夠在 2024 年實現至少 7.15 美元的調整後每股收益，並且該結果中嵌入了明顯表現不佳的醫療保險業務，那麼隨著我們改善 STARS 並在下一個時期拉動其他槓桿，這將成為本十年後半期的利潤擴張和增長機會幾年。我們知道需要做什麼。這只是需要時間，尤其是在 STARS 中。

We can now turn the page from a very good 2022, the first year of execution from this management team and an important foundational year for multiyear improvement as we look ahead and ultimately getting to our long-term growth and earnings algorithm we shared with you at Investor Day.

我們現在可以從非常好的 2022 年翻開新的一頁，這是該管理團隊執行的第一年，也是多年改進的重要基礎年，因為我們展望未來並最終實現我們與您分享的長期增長和收益算法投資者日。

Thanks for being part of our journey. Operator, Rocco, you may now open the line for questions.

感謝您參與我們的旅程。接線員 Rocco，您現在可以打開問題熱線。

(Operator Instructions) Today's first question comes from Josh Raskin at Nephron Research.

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

I wanted to start on the weaker MA start in the selling season. And maybe you could talk a little bit about was that due to changes by competitors? I heard something -- I heard a lot about the distribution channel changes that you made, but any specifics would be helpful. And then any benefit design changes that you made that you think contribute to some of that lost membership would be helpful as well.

我想從銷售季節較弱的 MA 開始。也許你可以談談這是由於競爭對手的變化嗎？我聽到了一些消息——我聽說了很多關於你所做的分銷渠道變化的事情，但任何細節都會有所幫助。然後，您所做的任何您認為會導致部分會員流失的福利設計變更也會有所幫助。

Yes. Thanks, Josh. Happy to hit that at a high level and then have Ken weigh in as well. So as I mentioned in my remarks, our major focus in the selling season was on operational stability, and on the fundamental underpinnings, that would contribute to quality results because we continue to take long-term view in Medicare. And so in order to achieve those results, we started rebalancing our distribution channels with a bias towards more proprietary channels where we feel we could control the member experience better.

是的。謝謝，喬希。很高興能達到高水平，然後讓肯也參與進來。因此，正如我在發言中提到的那樣，我們在銷售季節的主要重點是運營穩定性和基本面支撐，這將有助於實現高質量的結果，因為我們繼續對 Medicare 持長期觀點。因此，為了實現這些結果，我們開始重新平衡我們的分銷渠道，偏向於我們認為我們可以更好地控制會員體驗的更多專有渠道。

And so that was part of what impacted the softer results because, as you pointed out, we also had the competitive dynamics, investments from competition, not just in the market, but in those -- some of those channels that we deprioritized. But Ken, if you want to weigh in a little bit on benefits as well.

因此，這是影響較軟結果的部分原因，因為正如你所指出的，我們也有競爭動力，來自競爭的投資，不僅在市場上，而且在那些我們取消優先級的渠道中。但是肯，如果你也想權衡一下好處。

Yes. Thanks, Josh. The CMS data, which is readily available, demonstrates. So I think you've seen where members have moved. For our part, we rotated towards margin improvement, recognizing going in that, that would probably be at the expense of some member gains in very targeted markets.

是的。謝謝，喬希。很容易獲得的 CMS 數據證明了這一點。所以我想你已經看到了成員移動的地方。就我們而言，我們轉向提高利潤率，認識到這樣做可能會以犧牲一些非常有針對性的市場的會員收益為代價。

But I think the insight that we've gained this past year, both with respect to the comments Sarah made about the distribution mix and the really overperformance from owned and more captive channels, along with, I think, a greater insight with respect to the characteristics of the kind of members that are likely more responsive to both our product and network mix, I think, gives us really the opportunity to be vastly more precise as we move into the new year.

但我認為我們在過去一年中獲得的洞察力，包括 Sarah 對分銷組合的評論以及自有和更多專屬渠道的真正超額表現，以及我認為對我認為，可能對我們的產品和網絡組合更敏感的那種成員的特徵，讓我們真正有機會在進入新的一年時更加精確。

And I think you'll see that as we move, not just through our product design positioning for the coming year, but the way we allocate and optimize distribution, resources and the marketing, now that we've all -- and we've moved marketing internally. We had some of that subcontracted, I think, is going to create a strong platform for the achievement of the guidance we've provided.

而且我認為隨著我們的發展，您會看到這一點，不僅是通過我們來年的產品設計定位，還有我們分配和優化分銷、資源和營銷的方式，現在我們已經——而且我們已經將營銷轉移到內部。我認為，我們將其中的一些分包出去，將為實現我們提供的指導創建一個強大的平台。

And just a quick follow-up. Do you have visibility or any insights into the changes in membership, whether that's helpful from a quality improvement, STARS improvement perspective? Do you know the members that have lapsed relative to the members that you've retained? Does that feel like you're moving more towards the right direction on STAR improvement?

并快速跟進。您是否了解或了解會員的變化，從質量改進、STARS 改進的角度來看，這是否有幫助？您知道相對於您保留的成員而言已經失效的成員嗎？這是否感覺您正在朝著 STAR 改進的正確方向前進？

This is Jim. Absolutely. Sarah and Ken both reference the focus on proprietary distribution channels. In past lives, I've seen that creating a relationship -- and we talked a little bit about in New York, creating a relationship with those members goes a long way towards some of the things that are measured in STARS. For example, complaints. If you have a relationship and you bring the member in and explain to the member the benefits that they are going to get and how to use the system, obviously the complaints to CMS are significantly reduced. We're beginning to see that, frankly, in 2023 in the first 1.5 months of results. Disenrollments are much lower as a result of using proprietary channels.

這是吉姆。絕對地。 Sarah 和 Ken 都提到了對專有分銷渠道的關注。在過去的生活中，我已經看到建立關係——我們在紐約談過一點，與這些成員建立關係對 STARS 衡量的一些事情有很大幫助。比如投訴。如果你有關係並且你把會員帶進來並向會員解釋他們將獲得的好處以及如何使用該系統，顯然對 CMS 的投訴會大大減少。坦率地說，我們在 2023 年的頭 1.5 個月的結果中開始看到這一點。由於使用專有渠道，退出率要低得多。

The other thing is that because of the stability of the existing membership, we expect that we're going to see some improvement in STAR scores as well as RAF scores going forward, which will help our overall margin profile going forward. So we feel really good about that. So focusing on relationships and how long we keep a member used to more of a 7- to 8-year member retention, and we need to begin to build that kind of stability going forward. And a lot of steps that we've taken around STARS are starting to see some favorable results. So feeling good about that.

另一件事是，由於現有會員資格的穩定性，我們預計未來 STAR 分數和 RAF 分數會有所改善，這將有助於我們的整體利潤率狀況向前發展。所以我們對此感覺非常好。因此，關注關係以及我們讓會員習慣於 7 到 8 年的會員保留多長時間，我們需要開始建立這種穩定性。我們圍繞 STARS 採取的許多步驟開始看到一些有利的結果。所以感覺很好。

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

我們今天的下一個問題來自 Wolfe Research 的 Justin Lake。

First, I want to appreciate the color on '23 and '24. Just wanted to get a little bit more detail, of course. So it looks like you're at 2.7% net income margins for 2023, give or take. From there, Drew, you mentioned Medicare Advantage margins go lower, it sounds like, year-over-year. I think the market certainly expects pressure on the risk pool in Medicaid year-over-year. So curious in terms of what gets better in 2024. I know one of the big buckets is Jim is working on those cost-cutting. Maybe you can share, for instance, how much cost-cutting benefit you expect to get from '23 to '24 as well as kind of your thoughts on that Medicaid margin in general and any other moving parts we might have missed.

首先，我想欣賞 '23 和 '24 的顏色。當然，只是想了解更多細節。所以看起來你在 2023 年的淨收入利潤率是 2.7%，或多或少。從那裡開始，德魯，你提到 Medicare Advantage 的利潤率下降，聽起來像是同比下降。我認為市場肯定預計醫療補助計劃的風險池將逐年承受壓力。很好奇 2024 年會發生什麼變化。我知道吉姆正在努力削減成本，其中一個重要因素是。例如，也許您可以分享您期望從 23 歲到 24 歲期間獲得多少成本削減收益，以及您對醫療補助計劃的總體利潤率和我們可能錯過的任何其他變動部分的看法。

Yes, sure. Thanks, Justin. Yes, some of the tailwinds for 2024 that are sort of baked into our forecast, obviously, a really meaningful tailwind from the PBM RFP as sort of a stair-step benefit, as we've talked about, that commences 1/1/24. And we're well in the integration period and the transition period, working well with ESI and CVS as both good partners. So we expect to yield that benefit across our entire book of business.

是的，當然。謝謝，賈斯汀。是的，我們的預測中包含了 2024 年的一些順風，顯然，PBM RFP 的真正有意義的順風是一種階梯式收益，正如我們所討論的那樣，從 24 年 1 月 1 日開始.而且我們在整合期和過渡期都很好，與ESI和CVS都是很好的合作夥伴。因此，我們希望在整個業務範圍內產生這種收益。

Investment income continues to be strong. We expect that to continue into 2024 share buyback. You see our share count, as we disclosed in our Investor Day deck, ended the year lower than we had anticipated. So we're able to bake that into our 2023 guidance. And at these prices, we'll be buying. That's for sure.

投資收益持續強勁。我們預計這種情況將持續到 2024 年的股票回購。正如我們在投資者日平台上披露的那樣，您會看到我們的股票數量在年底低於我們的預期。因此，我們能夠將其納入我們的 2023 年指南。以這些價格，我們將購買。這是肯定的。

Marketplace will be a few billion larger than we originally anticipated in 2024. And we like our margin position there, and we can probably make another step or we will make another step in 2024. And then as you mentioned, the overarching value-creation plan, including a lot of the work that Jim and a lot of other people around the company are executing on pulling levers, we expect momentum as we get into really the third year of that value-creation plan. So those are all the tailwinds. But as I mentioned, Medicare is going to be a pretty significant headwind given STARS as well as the lackluster and advanced notice.

到 2024 年，市場規模將比我們最初預期的大幾十億美元。我們喜歡我們在那裡的利潤率，我們可能會再邁出一步，或者我們將在 2024 年再邁出一步。然後正如你提到的，總體價值創造計劃，包括 Jim 和公司其他許多人正在執行的許多工作，以拉動槓桿，我們預計在進入該價值創造計劃的第三年時會有動力。所以這些都是順風。但正如我所提到的，鑑於 STARS 以及乏善可陳的提前通知，醫療保險將成為一個相當大的逆風。

You also asked about Medicaid. So as I think about Medicaid, and I know you've asked this a number of times, but now we're on the conference call, that's FD compliant, so I can answer some of those questions. So as we think about the progression going from 2022 to 2023, we ended the year at 89.6% in 2022. And we've got about 30 basis points of pressure built into 2023 up to the very high 89s. But as we dissect the 2022 actuals and we look at things that we had to fortify or are unlikely to recur. That's another 10 to 20 basis points of nonrecurring, call it, items embedded in the 2022 Medicaid HBR.

您還詢問了醫療補助計劃。所以當我想到醫療補助時，我知道你已經問過很多次了，但現在我們正在進行電話會議，這是符合 FD 的，所以我可以回答其中的一些問題。因此，當我們考慮從 2022 年到 2023 年的進展時，我們在 2022 年以 89.6% 結束了這一年。到 2023 年，我們已經承受了大約 30 個基點的壓力，直到非常高的 89s。但是，當我們剖析 2022 年的實際情況時，我們會看到我們必須加強或不太可能再次發生的事情。這是 2022 年醫療補助 HBR 中嵌入的非經常性項目的另外 10 到 20 個基點。

So we think that gives us adequate room for a little bit of pressure from redeterminations as we are working hard with our associations, with the actuaries that represent our associations, the actuaries that represent the states, our state regulators, departments, and really sort of warming them up for what may or may not be necessary. But to the extent that there is a risk pool shift, we expect action probably not as fast, but hopefully close to as fast as the action that was put in, in the other direction with acuity changes during the COVID era.

因此，我們認為這給了我們足夠的空間來承受重新確定的一點壓力，因為我們正在努力與我們的協會、代表我們協會的精算師、代表各州的精算師、我們的州監管機構、部門，以及真正的某種為可能需要或不需要的事情讓他們熱身。但就存在風險池轉移的程度而言，我們預計行動可能不會像 COVID 時代敏銳度變化的另一個方向那樣快，但希望接近與所採取的行動一樣快。

So we're prepared for that. We've had a lot of time to prepare. And this, the elongated process of redetermination and the sloping, will help us gather data and be able to manage that HBR in the high 89s.

所以我們為此做好了準備。我們有很多時間準備。而這個，重新確定和傾斜的延長過程，將幫助我們收集數據並能夠在 89 分的高位管理 HBR。

And just to put a bow on it, anything on update on the 3.3% net income margin target at North Star for 2024, how you view that?

順便說一句，北極星 2024 年 3.3% 的淨利潤率目標的最新進展，您如何看待？

Yes. Well, our target is at least $7.15 of EPS. The interplay between operating income and share buyback will sort of affect whether or not that 3.3% is the absolute number that we hit for 2024. But that is our North Star, and we're going to keep on pushing for that. And obviously, the divestitures, as we've talked about, have some impact on the denominator there in terms of both the margin and the dollars. But we're going to fight hard to deliver that, at least $7.15, even though we've got a pretty meaningful Medicare headwind in 2024.

是的。那麼，我們的目標是每股收益至少為 7.15 美元。營業收入和股票回購之間的相互作用將在某種程度上影響 3.3% 是否是我們在 2024 年達到的絕對數字。但這是我們的北極星，我們將繼續推動這一目標。顯然，正如我們所討論的那樣，資產剝離對利潤率和美元方面的分母都有一些影響。但我們將努力實現這一目標，至少達到 7.15 美元，即使我們在 2024 年遇到了相當有意義的醫療保險逆風。

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

我們今天的下一個問題來自富國銀行的斯蒂芬巴克斯特。

A couple of questions on the quarter. I wanted to ask about reserves in PYD. I think that the DCPs look good, but trying to understand the magnitude of PYD you experienced in the quarter better. For a lot of other companies, by the time we get to the fourth quarter, PYD is pretty minimal. It doesn't seem like that was necessarily the case here. I would love to understand what drove this quarter and what business was impacted. And this might be the same answer, but wondering why we didn't necessarily see the same typical Q4 MLR seasonality in commercial. Any color there would also be appreciated.

關於本季度的幾個問題。我想問一下 PYD 的儲備。我認為 DCP 看起來不錯，但試圖更好地了解您在本季度經歷的 PYD 的規模。對於很多其他公司來說，到第四季度時，PYD 已經非常少了。這裡似乎不一定是這種情況。我很想了解是什麼推動了本季度的發展以及哪些業務受到了影響。這可能是相同的答案，但想知道為什麼我們不一定會在商業廣告中看到相同的典型 Q4 MLR 季節性。那裡的任何顏色也會受到讚賞。

No, you're right. We outperformed. That was probably the biggest contributor to our sort of overall slight outperformance on HBR, but commercial continues to be strong. And I'd chalk that up more to execution and the momentum that we've gained over the last, call it, 5 quarters in that Marketplace business, implementing clinical initiatives, the interplay with the value-creation office, not just for SG&A, but also for trend vendors and HBR initiatives that drive both quality and the affordability of health care. So those are some of the drivers that helped the commercial business, and we feel pretty good about that heading into 2023.

不，你是對的。我們表現出色。這可能是我們在《哈佛商業評論》上整體表現略勝一籌的最大貢獻者，但商業仍然強勁。我會把這更多地歸功於執行力和我們在過去的 5 個季度中獲得的勢頭，市場業務，實施臨床計劃，與價值創造辦公室的相互作用，而不僅僅是 SG&A，也適用於推動醫療保健質量和可負擔性的趨勢供應商和哈佛商業評論倡議。因此，這些是幫助商業業務的一些驅動因素，我們對進入 2023 年感到非常滿意。

We do disclose that the roll-forward tables, I think one of them is in the press release, the rest will be in the 10-K, last year. So 2021 saw a higher favorable development of the 12/31/2020 reserves. That's understandable with sort of the chaos of practice patterns and claims patterns during the 2020 year of COVID, but still consistent reserve methodologies and a pretty strong showing of development during 2022 off of the 12/31/2021 reserves.

我們確實披露了前滾表，我認為其中一個在新聞稿中，其餘的將在去年的 10-K 中。因此，2021 年 12/31/2020 儲備的發展更為有利。在 2020 年 COVID 期間，實踐模式和索賠模式有些混亂，這是可以理解的，但儲備方法仍然一致，2021 年 12 月 31 日儲備在 2022 年的發展表現相當強勁。

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

我們今天的下一個問題來自 A.J.瑞士信貸的賴斯。

A couple of things, if I could. First, on the Marketplace. I know -- I appreciate the comments about the demographics of the people you've seen through the open enrollment period. There's also been some questions about what are the demographics going to be of people that reverified off of Medicaid and go on the exchanges. I know the current exchange population has very diverse health needs. Do you think those redetermined Medicaid people that end up on the exchanges will pull up the risk pool? Pull down the risk pool? How are you thinking about that, first off?

如果可以的話，有幾件事。首先，在市場上。我知道——我很欣賞您在公開註冊期間看到的有關人員人口統計數據的評論。還有一些問題是關於從醫療補助計劃中重新驗證並繼續交換的人的人口統計數據是什麼。我知道目前的交換人口有非常多樣化的健康需求。你認為那些最終進入交易所的重新確定醫療補助計劃的人會拉高風險池嗎？拉低風險池？首先，你是怎麼想的？

Yes. Thanks, A.J., for the question. So if we think about the members who are redetermining off, we do think that those numbers are probably carrying a slightly higher acuity, but then you have to balance that with a view that with the growth that we've seen in the Marketplace product. And if you look back to historic periods of growth of this magnitude, it tends to bring many more healthy members into the pool. So the net effect of those 2 dynamics, it's hard to say exactly where that equals out, but our Marketplace team is watching both of those cohorts pretty carefully and I think has obviously had visibility into the fact that redeterminations were going to factor into 2023 and took that into account in pricing.

是的。謝謝，A.J.，提出這個問題。因此，如果我們考慮重新確定的成員，我們確實認為這些數字的敏銳度可能略高，但你必須將其與我們在 Marketplace 產品中看到的增長相平衡。如果你回顧歷史上這種規模的增長時期，它往往會將更多健康的成員帶入池中。所以這兩種動態的淨效應，很難說到底在哪里相等，但我們的市場團隊正在非常仔細地觀察這兩個群體，我認為顯然已經看到重新確定將影響到 2023 年和在定價時考慮到了這一點。

Okay. if I could slip in another one on your Medicare comments for next year. I know on the RADV, you said, "This is what we like. This is what we don't like." When you think about the rate notice, it sounds like there's places where you think the industry can comment to CMS and potentially ask, maybe look at it in a different way or something. Could -- are you willing to talk about where some of those points of discussion, at least between the industry at large and CMS might be?

好的。如果我可以在你明年的醫療保險評論中加入另一個。我知道在 RADV 上，你說，“這是我們喜歡的。這是我們不喜歡的。”當您考慮費率通知時，聽起來您認為行業可以在某些地方向 CMS 發表評論並可能詢問，也許以不同的方式或其他方式看待它。您是否願意談談其中一些討論點，至少是在整個行業和 CMS 之間？

And in terms of your strategy, it sounds like you're talking about a potential negative margin. So that must mean you're going to try to stabilize benefits year-to-year in a growing market. I'm wondering, is it conservative to say we're going to have stable benefits, but not have growth on the enrollment side?

就您的策略而言，聽起來您在談論潛在的負利潤率。因此，這一定意味著您將嘗試在不斷增長的市場中逐年穩定收益。我想知道，說我們將有穩定的福利，但在入學方面沒有增長，這是否保守？

Yes. On the Medicare side, we've said this coming into even this year is we try to design benefits in order to maximize stability as we move through '23 and '24. And I think we will continue to do our best to keep benefits as stable as possible, taking that long-term view that, that stable operations, optimizing for member experience, improving quality is the right thing to do, and weathering the '24 headwind may have an impact on margin as a result. But the goal would be to keep benefits as stable as possible. So we're not [whip signing] members, and we are focused on building those longer-term relationships, as Jim talked about.

是的。在 Medicare 方面，我們已經說過，即使在今年，我們也會嘗試設計福利，以便在我們度過 23 年和 24 年時最大限度地提高穩定性。而且我認為我們將繼續盡最大努力使收益盡可能穩定，從長遠來看，穩定運營、優化會員體驗、提高質量是正確的做法，並經受住 24 世紀的逆風可能因此對保證金產生影響。但目標是盡可能保持福利穩定。所以我們不是 [鞭子簽名] 成員，我們專注於建立那些長期關係，正如 Jim 所說的那樣。

Relative to your first question, the RADV rule is sort of in the final state. And so there, it's really about talking to our industry partners about how we feel about the impact of the as yet undefined methodology and what impact we think that may have and how comfortable we are with that. And then the 2024 rate notice is a regular cycle of conversations that we have with the agency in order to communicate what we believe the impact of the somewhat lackluster rates might be on the overall industry and the benefits to seniors.

相對於您的第一個問題，RADV 規則有點處於最終狀態。因此，這實際上是與我們的行業合作夥伴討論我們對尚未定義的方法的影響的看法以及我們認為可能產生的影響以及我們對此的接受程度。然後，2024 年費率通知是我們與該機構進行的定期對話週期，目的是傳達我們認為有些低迷的費率可能對整個行業產生的影響以及對老年人的好處。

And our next question today comes from Gary Taylor at Cowen.

我們今天的下一個問題來自 Cowen 的 Gary Taylor。

(inaudible)

（聽不清）

Pardon for the interruption, everybody. This is the operator. Mr. Taylor, your line is breaking up very badly. It looks like we have a bad connection. I would ask that you please disconnect and dial back in or pick up your speaker phone, if that's the case.

請原諒我的打擾，大家。這是運營商。泰勒先生，您的線路斷線很嚴重。看來我們關係不好。如果是這樣的話，我會請您斷開連接並重新撥入或拿起您的免提電話。

Is that better or not?

那好還是不好？

That's much better. Thank you, sir.

這樣好多了。謝謝你，先生。

Okay. I apologize. I just wanted to ask about expectations for ACA risk adjustment given the enrollment growth for '23, when we've seen companies with really large enrollment growth in the ACA. Sometimes, they've been surprised to end up being increasing payable on the ACA front. So it looks sort of like in this case, you guys have generally been a receiver and now you're going to have a much larger population. Is your expectation that's fairly even? Or is there any material additional payable you're contemplating for '23?

好的。我道歉。我只是想問一下，鑑於 23 年的入學人數增長，當我們看到 ACA 入學人數增長非常大的公司時，對 ACA 風險調整的預期。有時，他們驚訝地發現 ACA 方面的應付款項最終增加了。所以它看起來有點像在這種情況下，你們通常是接收者，現在你們將擁有更多的人口。您的期望值相當嗎？或者您是否正在考慮為 23 年支付任何額外的材料？

Yes. So it's a good question. The demographics of what's coming in looks very similar to -- and actually, the subsidy eligibility has gone up a little. So nothing really alarming in all the attributes we can look at what we know today. Obviously, the proof is going to be in the med cost. And you're right, in Marketplace, it's a zero-sum game concurrent risk adjustment process for 2023. So that's something we'll be watching.

是的。所以這是個好問題。即將到來的人口統計數據看起來非常相似——實際上，補貼資格有所提高。因此，在我們今天所知道的所有屬性中，沒有什麼是真正令人擔憂的。顯然，證據將包含在醫療費用中。你是對的，在 Marketplace 中，這是 2023 年的零和遊戲並發風險調整過程。所以這是我們將要關注的事情。

There's also 2 less competitors out there. And so we thought about that as we not only booked our 2022 risk adjustment receivables, but also as we forecast into 2023, we'll get the first Wakely data in June this year, and we'll have to take a look at that. But we've thought about that as we forecasted and as we closed out 2022.

那裡的競爭對手也少了 2 個。因此我們考慮了這一點，因為我們不僅預訂了 2022 年的風險調整應收賬款，而且正如我們預測到 2023 年一樣，我們將在今年 6 月獲得第一個 Wakely 數據，我們將不得不看一下。但我們已經按照我們的預測和 2022 年結束時考慮了這一點。

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

我們今天的下一個問題來自高盛的 Nathan Rich。

I wanted to follow up on the Medicare business. Drew, could you help us think about the magnitude of the step down that you are thinking for Medicare margins in 2024, just given the comments that you made about pricing for a negative margin and trying to keep benefit stable maybe relative to the margin that you're targeting for 2023? And then I guess outside of plan design, are there any offsets that you think you can leverage to try to mitigate some of this impact in 2024?

我想跟進醫療保險業務。德魯，你能否幫助我們考慮一下你正在考慮的 2024 年醫療保險利潤率下降的幅度，只是考慮到你對負利潤率定價的評論，並試圖保持福利穩定可能相對於你的利潤率目標是 2023 年？然後我想在計劃設計之外，您認為您是否可以利用任何抵消措施來嘗試減輕 2024 年的部分影響？

We're always looking for whether it's -- Jim and the team, the Medicare team are focused on SG&A. I think there's opportunity there. There's continuing maturity in trend vendors. So yes, we're going to look for any possible offset other than benefits. And as Sarah said, we'll try our best to keep stability for our members, but we do expect at least at this early point to shrink a little bit in 2024. But the swing is pretty meaningful, both in terms of STARS and the very disappointing advanced notice with rates. I mean, that advanced notice for us, call it, minus 1%, excluding STARS because we made our own bed in STARS, but we are expecting a positive low single digit. So it's a pretty meaningful swing. Every point is a couple of hundred million dollars on a $20 billion business.

我們一直在尋找——吉姆和團隊，醫療保險團隊是否專注於 SG&A。我認為那裡有機會。趨勢供應商不斷成熟。所以是的，我們將尋找除收益之外的任何可能的補償。正如 Sarah 所說，我們將盡最大努力為我們的成員保持穩定，但我們確實預計至少在這個早期點會在 2024 年有所縮減。但無論是在 STARS 還是在非常令人失望的利率提前通知。我的意思是，我們的提前通知，稱之為負 1%，不包括 STARS，因為我們在 STARS 中製作了自己的床，但我們期待一個正的低個位數。所以這是一個非常有意義的搖擺。在 200 億美元的業務中，每一點都是幾億美元。

So we've got to manage through that, and it will be a pretty sizable drop. I can't give you an exact number yet. We'll definitely give you that in 10 months after we've gone through the bids, we've got the final rates, and we've developed sort of that balance between margin degradation and stability in the product. But it will be tough. We'll power through it. And '25 and beyond will be margin expansion and growth as well ramp up over the next few cycles of STAR results. And it's good to hear, Jim conveyed to you guys, that we're already seeing some elements of optimism that we're going to be able to achieve that multiyear improvement that we're seeking.

所以我們必須解決這個問題，這將是一個相當大的下降。我還不能給你一個確切的數字。在我們完成投標後的 10 個月內，我們肯定會告訴你，我們已經獲得了最終利率，並且我們已經在利潤率下降和產品穩定性之間取得了某種平衡。但這會很艱難。我們會全力以赴。而'25及以後將是利潤率的擴張和增長，以及在接下來幾個STAR結果週期中的增長。很高興聽到，吉姆向你們傳達，我們已經看到了一些樂觀的因素，我們將能夠實現我們正在尋求的多年改進。

One other thing I would add when we think about levers in 2024 is the breadth and depths of our value-based care relationships, which is something that I think we are -- we're already planning on, but have the runway to accelerate in 2023 in order to be in an even stronger position. And as many of you know that, that was -- we have a good set of relationships with a number of the sort of leading value-based care providers, but I think we have been not as aggressive in that in the past, and so in 2022 started to turn our focus there. Our organizing around that internally brought in some great talent to help accelerate. So that will be a focus in 2023 that I think will give us some benefit in 2024 and then obviously beyond that as well.

當我們考慮 2024 年的槓桿時，我要補充的另一件事是我們基於價值的護理關係的廣度和深度，我認為這是我們已經在計劃的事情，但有加速的跑道2023 年才能處於更強大的位置。正如你們中的許多人所知，那是——我們與許多領先的基於價值的護理提供者建立了良好的關係，但我認為我們過去在這方面沒有那麼積極，所以2022 年開始將我們的注意力轉移到那裡。我們圍繞這個組織內部引進了一些優秀的人才來幫助加速。因此，這將成為 2023 年的重點，我認為這將在 2024 年給我們帶來一些好處，然後顯然也會在這之後帶來好處。

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

我們今天的下一個問題來自摩根士丹利的 Michael Ha。

I just wanted to ask a bit more about redeterminations and expectations. Appreciate all the color on the 30 bps of Medicaid MLR pressure in '23. I recall hearing at your Investor Day that your state composite rate increase, improved about 50 bps. So I'm just curious, how did that compare to your original expectations? I think there's originally been some concern that state rate increases may not go into effect until a couple of quarters after redeterminations were underway, but 50 bps improvement feels pretty strong, pretty positive, quite high.

我只是想多問一些關於重新確定和期望的問題。欣賞 23 年 30 個基點的 Medicaid MLR 壓力的所有顏色。我記得在你的投資者日聽到你的州綜合利率增加了大約 50 個基點。所以我很好奇，這與您最初的期望相比如何？我認為最初有人擔心州利率上調可能要到重新確定後的幾個季度才會生效，但 50 個基點的改善感覺非常強勁，非常積極，相當高。

And I think -- and if I think about the messaging around just most states expecting to complete redeterminations likely later in '23, then in that scenario, you're entering '23 strong rate increase, couple that with a very slow rollout of redetermination. It seems like a recipe that could present some earnings upside this year. Is that a fair way to think about how redeterminations might develop?

而且我認為 - 如果我考慮圍繞大多數州期望可能在 23 世紀晚些時候完成重新確定的信息，那麼在那種情況下，你將進入 23 年強勁的加息，再加上重新確定的非常緩慢的推出.這似乎是一個可以在今年帶來一些收益增長的秘訣。這是考慮重新確定可能如何發展的公平方法嗎？

Yes. So the composite rate that is embedded in our guidance as we -- as you properly pointed out we disclosed at Investor Day is 1.4%. So I guess, yes, compared to a meager 0.9%, that is a big jump, but it's still on an absolute basis, 1.4%. So think about that in context. But the reason why we are 0.9% relative to the 1.3% that we had baked into our 2022 guidance, Florida was a pretty big piece of that. We expect the recovery there this year as we demonstrate the need for rates. So that will be an ongoing process as we go through the rate cycles. Luckily, they're distributed across the year. They're not all stacked on 1/1, like the commercial business or the Medicare business. They do -- we have slugs that renew throughout the year, which will help with the sloping of redeterminations as well.

是的。因此，正如我們在投資者日披露的那樣，我們的指導中包含的綜合利率是 1.4%。所以我想，是的，與微不足道的 0.9% 相比，這是一個很大的飛躍，但它仍然是絕對基礎上的 1.4%。因此，請結合上下文考慮這一點。但是，相對於我們納入 2022 年指導方針的 1.3%，我們只有 0.9%，佛羅里達州佔了很大一部分。我們預計今年會出現復甦，因為我們證明了對利率的需求。因此，隨著我們經歷利率週期，這將是一個持續的過程。幸運的是，它們全年分佈。它們並不像商業業務或醫療保險業務那樣全部按 1/1 堆疊。他們有——我們有全年更新的鼻涕蟲，這也將有助於重新確定的傾斜。

Maybe just to add a little bit of color on the process. To your point about sort of the methodical approach that we were expecting, with the certainty of the year-end bill, we started to get updated information obviously from each 1 of our states and are -- continue to be in regular contact with them. And I would say that in general, we are seeing that methodical approach hold with the vast majority of our states sitting in a 9- to 14-month bucket in terms of the time frame that they expect redetermine redeterminations to play out under, and some of them indicating that they won't start April 1, they'll start closer to summer time.

也許只是為了在過程中添加一點顏色。關於我們期望的某種有條不紊的方法，在年終賬單確定的情況下，我們開始顯然從我們每個州獲得更新信息，並且 - 繼續與他們保持定期聯繫。我要說的是，總的來說，我們看到這種有條不紊的方法適用於我們絕大多數州，就他們期望重新確定重新確定的時間框架而言，他們坐在 9 到 14 個月的時間段內，有些他們中的一些人表示他們不會在 4 月 1 日開始，他們會在臨近夏令時開始。

So as you think about sort of the start date shift, overall, nothing that suggests overall slope line will shift materially. And we are seeing continued positive momentum from our states and being open to and encouraging our support in outreach and communication education efforts to members. So in general, I feel like the industry is aligning and organizing around an approach that will minimize or seek to minimize member abrasion in the process and are allowing us to run alongside our state partners, all of which is positive from our perspective.

因此，當您考慮某種開始日期變化時，總的來說，沒有任何跡象表明整體斜率線會發生重大變化。我們看到來自我們各州的持續積極勢頭，並開放並鼓勵我們支持對會員的外展和溝通教育工作。因此，總的來說，我覺得該行業正在圍繞一種方法進行調整和組織，這種方法將最大限度地減少或尋求最大限度地減少流程中的成員磨損，並允許我們與我們的州合作夥伴一起運行，從我們的角度來看，所有這些都是積極的。

And our next question today comes from Scott Fidel with Stephens.

我們今天的下一個問題來自斯科特菲德爾和斯蒂芬斯。

Wanted to just drill in a little bit more, especially given possibly the importance of the buybacks. Just if you can walk us through your updated sources and uses of cash for 2023 and how much you think you can have for deployable excess capital for buybacks. And then, Drew, I'm not sure if you've given us 2023 operating cash flow guidance yet. So if you do have that, I would appreciate that, too.

只想多鑽一點，特別是考慮到回購的重要性。只要您能向我們介紹您 2023 年的最新現金來源和用途，以及您認為您可以擁有多少可部署的過剩資本用於回購。然後，德魯，我不確定你是否給了我們 2023 年的運營現金流指導。因此，如果您確實擁有它，我也將不勝感激。

Yes. So as you've seen, we did quite a bit of buyback in 2022. And even as we were in the 70s in January, we were able to execute on a few hundred million more. That was largely driven by divestiture proceeds. So we're continuing the portfolio review process. So the timing of buyback associated with divestitures will vary based upon sort of that M&A process. But in the normal course, yes, we expect late in the year a few billion of share buyback. We're going to see what we can pull forward, but we also have improved the allocation process and therefore, the management fee process, and that will trap a little bit of cash in the first half, maybe the first 3 quarters of 2023. So that's why we are back-weighted.

是的。因此，正如您所見，我們在 2022 年進行了大量回購。即使我們在 1 月份處於 70 年代，我們也能夠執行數億美元。這主要是由剝離收益推動的。因此，我們將繼續投資組合審查流程。因此，與資產剝離相關的回購時間將根據併購過程的種類而有所不同。但在正常情況下，是的，我們預計在今年年底回購數十億美元的股票。我們將看看我們能向前推進什麼，但我們也改進了分配流程，因此改進了管理費流程，這將在上半年，也許是 2023 年前三個季度收集一些現金。所以這就是我們反向加權的原因。

As you look at our guidance for share buyback, we've sort of back weighted that share repurchase. So it won't have a meaningful impact on '23, but it will roll into '24. So we're going to do our best. We'll probably pay down a little bit of debt as well as we're -- if we sell off an asset that had EBITDA, we'll pay off some debt as well to manage that. And now when you actually -- you pay off debt, you get a benefit with the interest rates higher. So we're going to do our best to take advantage of where we're trading, but we also need to do that with a balanced view of the capital structure.

當您查看我們的股票回購指南時，我們已經對股票回購進行了某種程度的加權。所以它不會對 23 年產生有意義的影響，但它會進入 24 年。所以我們會盡力而為。我們可能會像現在這樣償還一些債務——如果我們出售一項有 EBITDA 的資產，我們也會償還一些債務來管理它。現在當你實際上——你還清債務時，你會從更高的利率中獲益。因此，我們將盡最大努力利用我們的交易地點，但我們也需要以平衡的資本結構觀點來做到這一點。

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

我們今天的下一個問題來自美國銀行的 Kevin Fischbeck。

Just wanted to make sure I understood. I think you guys said that you expected to add 200,000 to 300,000 lives on the exchanges from redeterminations. I just want to make sure that, that was now, I guess, in your guidance. And then you talked a little bit about the risk pool on the exchanges, really interested in that concept about the people who come on from redeterminations because that's where I would guess, it would look more like the SEP from prior years, where you only have them for 6 months. You don't have time to risk score. And in theory, they're sicker than ever. So I would love to kind of hear how you're thinking about the risk pool of those members.

只是想確保我理解。我想你們說過，你們希望通過重新確定在交易所增加 200,000 到 300,000 條生命。我只是想確保，我想，那是在你的指導下。然後你談到了交易所的風險池，對重新確定的人的概念非常感興趣，因為我猜這就是它，它看起來更像是前幾年的 SEP，在那裡你只有他們 6 個月。您沒有時間去冒險評分。從理論上講，他們比以往任何時候都病得更重。所以我很想听聽你是如何看待這些成員的風險池的。

Yes. So relative to the redetermining members into Marketplace, we do -- again, as I said earlier, we do expect that on balance, they probably have slightly higher acuity. But at a minimum, pardon me, your point about the fact that we don't have them for the full year means that they turn to profitability as we move into 2024. And again, this is something that the team had visibility to throughout 2022 and coming into the year and baked into our guidance, and I think will be -- have the offset of our expectation that a number of those members who are coming into the pool will be healthier to offset that overall and are coming in with a 1/1 start date. So we have the full benefit of their 2023 risk adjustment.

是的。因此，相對於重新確定進入 Marketplace 的成員，我們再次重申，正如我之前所說，我們確實預計總的來說，他們的敏銳度可能略高。但至少，請原諒，您關於我們全年都沒有它們這一事實的觀點意味著，隨著我們進入 2024 年，它們將轉為盈利。再一次，這是團隊在整個 2022 年都可以看到的事情並進入這一年並納入我們的指導，我認為將 - 抵消我們的期望，即進入池中的一些成員將更健康以抵消整體並以 1 /1 開始日期。因此，我們充分受益於他們 2023 年的風險調整。

And then relative to the 200,000 to 300,000, that continues to be our estimate that is baked into guidance. And a lot of that is of a belief that the vast majority of members who redetermine off will first go to the commercial book. And again, we just need to see how the data starts to play out and whether there are any adjustments to that as we see folks coming over on to the marketplace products.

然後相對於 200,000 到 300,000，這仍然是我們納入指導的估計。其中很多是相信絕大多數重新決定離開的成員將首先進入商業書籍。再一次，我們只需要看看數據是如何開始發揮作用的，以及當我們看到人們轉向市場產品時是否有任何調整。

And our next question comes from Steven Valiquette with Barclays.

我們的下一個問題來自巴克萊銀行的 Steven Valiquette。

Really just a quick confirmation questions around potential impact (inaudible) for the changes (inaudible) for '23. (inaudible) feel like they should be an as higher or greater to be offset by (inaudible).

真的只是關於 23 年變更（聽不清）的潛在影響（聽不清）的快速確認問題。 （聽不清）感覺它們應該更高或更大以被（聽不清）抵消。

Pardon me, Mr. Valiquette, sir, I apologize. Your line is very bad, the connection. Can you pick up your handset if you're using a speaker phone, sir?

請原諒我，Valiquette 先生，我向您道歉。你的線路很差，連線。先生，如果您使用免提電話，您可以拿起聽筒嗎？

Is that better?

那個更好嗎？

Actually, no. It's not coming through well at all, sir. We're not able to understand what you're asking. Would you be able to reconnect or possibly reach out off-line. I apologize, we have to move on. We're not able to hear what you're saying. Our next question today comes from Calvin Sternick with JPMorgan.

實際上，不。一點都不順利，長官。我們無法理解您的要求。您是否能夠重新連接或可能離線聯繫。抱歉，我們必須繼續前進。我們聽不到你在說什麼。我們今天的下一個問題來自摩根大通的 Calvin Sternick。

First, a quick clarification on MA. I think I heard a comment about lower disenrollment. Was that for this AEP? Or is that more of a go-forward comment? And then second, it sounds like MA has got a margin expansion beyond 2025. Just curious how you're thinking about the overall level of membership growth once you start getting -- you get past the STARS (inaudible).

首先，快速澄清一下 MA。我想我聽到了關於較低退學率的評論。是為了這個 AEP 嗎？或者這更像是一個前瞻性的評論？其次，聽起來 MA 的利潤率在 2025 年之後有所擴大。只是好奇一旦你開始獲得會員增長的整體水平 - 你就超過了 STARS（聽不清）。

This is Jim. I'll take the first part of your question. We've been doing a lot during 2022 to address some of the issues that we've had with STARS. A big driver of some of our poor STARS results had been the customer complaints called CTMs and disenrollment. And we're obviously -- I like to look at things every day. We're watching our CTMs and disenrollments for this past year, and the amount that we're seeing is favorable to what we've seen in the past. And so a lot of the steps that we've taken during the course of '22 seem to be bearing some fruit. Those results will -- as Drew mentioned, STARS takes time, will favorably impact our 2026 revenue.

這是吉姆。我會回答你問題的第一部分。我們在 2022 年做了很多工作來解決我們在 STARS 上遇到的一些問題。我們一些糟糕的 STARS 結果的一個重要驅動因素是稱為 CTM 和退出的客戶投訴。而且我們顯然 - 我喜歡每天看東西。我們正在觀察過去一年的 CTM 和退出人數，我們看到的數量有利於我們過去看到的情況。因此，我們在 22 年期間採取的許多步驟似乎都取得了一些成果。這些結果將——正如德魯提到的，STARS 需要時間，將對我們 2026 年的收入產生有利影響。

We're also in the process right now. CMS comes out with CAP surveys from March to May. We're in the process of doing a number of procedures that have never been done here before as a consolidated Centene to enhance our CAP scores as CMS does that survey. So there's a lot of good things that are going on to positively impact where we think STARS will be in the future. I think when we were in New York together. We talked about 20% for 2025 being in 4-plus STAR plans, 20% of our membership. We want that to be at least 40% in '26, and then we're targeting 60% in '27.

我們現在也在這個過程中。 CMS 從 3 月到 5 月發布了 CAP 調查。我們正在做一些以前從未在這裡做過的程序，作為一個綜合的 Centene，以提高我們的 CAP 分數，因為 CMS 正在進行這項調查。因此，有很多好事正在對我們認為 STARS 未來的發展方向產生積極影響。我想我們一起在紐約的時候。我們談到 2025 年有 20% 的會員參與 4+ STAR 計劃，占我們會員的 20%。我們希望在 26 年至少達到 40%，然後我們的目標是在 27 年達到 60%。

And ladies and gentlemen, our next question today comes from George Hill at Deutsche Bank.

女士們，先生們，我們今天的下一個問題來自德意志銀行的喬治希爾。

Drew, I just wanted to circle back on the idea that you sounded pretty bullish on the opportunity on the PBM transition. Just wanted to see if there were any changes to expectations or synergy targets as it relates to that.

德魯，我只是想回顧一下你聽起來非常看好 PBM 過渡的機會的想法。只是想看看與此相關的預期或協同目標是否有任何變化。

No. My bullishness is ESI and Centene working together to deliver what we anticipated when we inked the deal a couple of months ago or a month or so ago.

不，我看好 ESI 和 Centene 共同努力，以實現我們在幾個月前或一個月前簽署協議時的預期。

One more thing. Let me -- on share buyback, let me clarify something that I said earlier. I was answering a 2024 question. The $3 billion is our placeholder for 2024. The 2023 back half of the year share buyback is about $1.5 billion. And that's because we've got a little bit of trapped capital that we'll have to get out over the following year or so. So the $3 billion I mentioned is the forecast for 2024, absent any acquisitions.

還有一件事。讓我——關於股票回購，讓我澄清一下我之前說過的話。我在回答一個 2024 年的問題。 30 億美元是我們 2024 年的佔位符。2023 年下半年的股票回購約為 15 億美元。那是因為我們有一些被困的資本，我們將不得不在接下來的一年左右的時間裡擺脫困境。所以我提到的 30 億美元是對 2024 年的預測，沒有任何收購。

Thank you. And ladies and gentlemen, this does conclude today's question-and-answer session. I'd like to turn the conference over to Sarah London for any closing remarks.

謝謝。女士們，先生們，今天的問答環節到此結束。我想將會議轉交給 Sarah London 作閉幕詞。

Thanks, Rocco, and thanks, everyone, for your time this morning. Please reach out to Jen with any follow-up questions, and we look forward to talking to you throughout the rest of the quarter.

謝謝 Rocco，也謝謝大家今天早上的時間。如有任何後續問題，請聯繫 Jen，我們期待在本季度的剩餘時間內與您交談。

Thank you. This concludes today's conference call. We thank you all for attending today's presentation. You may now disconnect your lines, and have a wonderful day.

謝謝。今天的電話會議到此結束。感謝大家出席今天的演講。您現在可以斷開線路，度過美好的一天。