Centene Corp (CNC) 2023 Q1 法說會逐字稿

Good day, and welcome to the Centene Corporation First Quarter 2023 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, Finance and Investor Relations. Please go ahead.

美好的一天，歡迎來到 Centene Corporation 2023 年第一季度收益電話會議。 （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財務和投資者關係高級副總裁 Jennifer Gilligan。請繼續。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our first quarter 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 also can 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一季度收益結果電話會議。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 21, 2023, 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 於 2023 年 2 月 21 日提交的最新 10-K 表格以及美國證券交易委員會的其他公開文件中討論的因素。

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.

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 first quarter 2023 press release, which is available on the company's website under the Investors section.

該電話還將提及某些非 GAAP 措施。在我們 2023 年第一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”部分下找到。

The company is unable to provide a reconciliation of certain 2024 measures to the corresponding GAAP measures without unreasonable effort due to the difficulty of predicting the timing and amounts of various items within a reasonable range. With that, I would like to turn the call over to our CEO, Sarah London. Sarah?

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 2024 措施與相應 GAAP 措施的對賬。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 thank you all for joining us this morning as we review our first quarter 2023 results and update both our 2023 guidance and 2024 EPS floor. Centene's first quarter results were strong, reflecting continued positive momentum operationally and the beginning of another year of disciplined execution against our strategic framework. We reported $2.11 of adjusted diluted EPS for the quarter and lifted our premium and service revenue forecast by another $3.7 billion.

謝謝 Jen，也感謝大家今天早上加入我們，因為我們回顧了 2023 年第一季度的業績並更新了我們的 2023 年指導和 2024 年 EPS 下限。 Centene 的第一季度業績強勁，反映了運營方面持續的積極勢頭，以及對我們戰略框架嚴格執行的又一年的開始。我們報告本季度調整後攤薄每股收益為 2.11 美元，並將我們的保費和服務收入預測再上調 37 億美元。

We also moved our full year 2023 adjusted EPS guidance to at least $6.40, the top of our original range. At the same time, as you saw from the press release, we have updated our 2024 adjusted EPS floor to greater than $6.60. Given the focus on 2024, let me start there by providing more detailed commentary on our insights and current thinking. Then, I'll come back to 2023 and our recent progress.

我們還將 2023 年全年調整後的每股收益指引上調至至少 6.40 美元，這是我們最初範圍的上限。同時，正如您在新聞稿中看到的那樣，我們已將 2024 年調整後的 EPS 下限更新為超過 6.60 美元。鑑於對 2024 年的關注，讓我從對我們的見解和當前想法提供更詳細的評論開始。然後，我將回到 2023 年和我們最近的進展。

A year ago, when I stepped into this role, we were in the early stages of executing against a 3-year value creation plan. We saw no reason to change that plan as its basic pillars were rock-solid, streamline the company by focusing on our core businesses, price our products for profitable growth, modernize our business processes and tools and deploy capital in a disciplined manner to create enterprise and shareholder value.

一年前，當我擔任這個職位時，我們正處於執行 3 年價值創造計劃的早期階段。我們認為沒有理由改變該計劃，因為它的基本支柱堅如磐石，通過專注於我們的核心業務來精簡公司，為我們的產品定價以實現盈利增長，使我們的業務流程和工具現代化，並以有紀律的方式部署資本以創建企業和股東價值。

After 13 months in this role, I am even more convinced that this organization has the capacity to deliver substantially more value to our customers and shareholders. This team has a clear vision for how we intend to execute and transform in a sustainable way as we set ourselves up for the long term, and we are confident in our long-term growth algorithm.

在擔任這個職位 13 個月後，我更加相信這個組織有能力為我們的客戶和股東提供更多的價值。這個團隊對於我們打算如何以可持續的方式執行和轉型有著清晰的願景，因為我們為自己的長期發展做好了準備，並且我們對我們的長期增長算法充滿信心。

We also have the benefit of a far more complete view of the near-term dynamics we will need to navigate and the investments required to ensure Centene is positioned for market leadership. That combined insight is the underpinning of our revised 2024 earnings floor. I'll outline the major drivers of our decision, and Drew will walk through the numbers and mechanics in more detail.

我們還受益於更全面地了解我們需要應對的近期動態以及確保 Centene 處於市場領導地位所需的投資。這種綜合洞察力是我們修訂後的 2024 年盈利底線的基礎。我將概述我們決定的主要驅動因素，德魯將更詳細地介紹數字和機制。

The first and most significant driver is Medicaid redeterminations. Over the last 1.5 months, with the benefit of finalized implementation plans and early data feeds from our state partners, we have refreshed our state-level models and projections to inform an updated view of the potential impact to membership and acuity of the redeterminations process across our 31 health plans.

第一個也是最重要的驅動因素是醫療補助的重新確定。在過去的 1.5 個月裡，得益於最終確定的實施計劃和來自我們州合作夥伴的早期數據饋送，我們更新了我們的州級模型和預測，以提供有關重新確定過程對成員資格和敏銳度的潛在影響的更新視圖我們的 31 項健康計劃。

Based on that analysis, 2023 progression looks slightly better, but we now believe it is prudent to build in a more conservative view of the potential disconnect between rates and acuity that could manifest in some of our states in 2024.

根據該分析，2023 年的進展看起來略好一些，但我們現在認為，對 2024 年我們一些州可能出現的利率和敏銳度之間的潛在脫節建立更保守的觀點是謹慎的。

As a reminder, we view any disconnect as a temporary one. We fully expect that states will ultimately provide sufficient rate adjustments to reflect any changes in acuity of the Medicaid population, but we are building a provision in our 2024 target in case there is a gap in timing in some of our states.

提醒一下，我們將任何斷開連接視為暫時斷開連接。我們完全預計各州最終將提供足夠的費率調整以反映醫療補助人口敏銳度的任何變化，但我們正在我們的 2024 年目標中製定一項規定，以防我們的一些州在時間上存在差距。

We remain committed to ensuring that the most vulnerable members of our communities have ongoing access to high-quality health care, and we are empowering our local teams to navigate the redeterminations process in a way that strengthens the partnership with our state customers given their critical importance to our long-term success in Medicaid.

我們仍然致力於確保我們社區中最脆弱的成員能夠持續獲得高質量的醫療保健，並且我們正在授權我們的本地團隊以一種加強與我們州客戶的伙伴關係的方式來引導重新確定過程，因為他們至關重要到我們在醫療補助計劃中的長期成功。

The second major driver of our revised '24 outlook is based on our 2024 Medicare bid strategy. As we evaluated the final 2024 CMS rates, our view of potential 2025 program dynamics and the strength we saw in 2023 performance, we decided to use 2024 as an opportunity to more aggressively rightsize our membership and focus on our core member base.

我們修訂後的 24 年展望的第二個主要驅動因素是基於我們的 2024 年醫療保險投標策略。當我們評估 2024 年的最終 CMS 費率、我們對 2025 年計劃動態的看法以及我們在 2023 年的表現中看到的實力時，我們決定以 2024 年為契機，更積極地調整我們的會員規模，並專注於我們的核心會員群。

This will move us away from some of the membership that resulted from a growth at all cost pricing mentality during the '21 and '22 annual enrollment periods and create a solid foundation from which to drive earnings power in the back half of the decade.

這將使我們擺脫一些因在 21 年和 22 年年度註冊期間不惜一切代價定價心態增長而產生的會員資格，並為在本世紀後半期推動盈利能力奠定堅實的基礎。

At the same time, we see an opportunity to make targeted investments in Medicare that enhance our ability to reach and serve these members. These include own distribution capacity, provider enablement tools to support value-based care and the acceleration of digital capabilities that will truly differentiate the WellCare member and provider experiences going forward.

與此同時，我們看到了對 Medicare 進行有針對性投資的機會，以增強我們接觸和服務這些成員的能力。其中包括自己的分銷能力、支持基於價值的護理的供應商支持工具以及數字功能的加速，這將真正區分未來的 WellCare 成員和供應商體驗。

Given the fundamental impact this strategy will have on member months, as well as the changes CMS recently announced to the STARS program, we are also resetting our multiyear quality target given that we will be managing members who are naturally more complex from a quality standpoint. Our focus over the next few years will be to maximize contracts that reach the 3.5 star threshold and to begin laying the groundwork for the Health Equity index adjustment that CMS will measure starting in 2024 and 2025.

鑑於該策略將對會員月產生的根本影響，以及 CMS 最近宣布對 STARS 計劃的更改，我們還重新設置了多年質量目標，因為我們將管理從質量角度來看自然更複雜的會員。我們未來幾年的重點將是最大限度地增加達到 3.5 星門檻的合同，並開始為 CMS 將於 2024 年和 2025 年開始衡量的健康公平指數調整奠定基礎。

Drew will walk through the mechanics, but given our target populations, we believe of near-term focus on maximizing 3.5 star plus results when combined with an adjustment from the Health Equity Index when implemented, will most efficiently provide both the long-term quality profile and the economics necessary for WellCare to be competitive in our segment.

Drew 將詳細介紹這些機制，但考慮到我們的目標人群，我們認為，在實施時結合健康公平指數的調整，將近期重點放在最大化 3.5 星以上的結果上，將最有效地提供長期質量概況以及 WellCare 在我們的細分市場中具有競爭力所必需的經濟效益。

For the upcoming October results, we are trending precaps between 14% and 18% membership in 4-star plans. But we have 1 large contract on the bubble that represents 10% of our members. For those still watching that metric, we are conservatively assuming the downside scenario and therefore, expect minimal 4-star progression year-over-year but we expect to see solid overall contract improvement reflecting the operational progress we have made, and we have baked a conservative view of these results into our overall assumptions.

對於即將到來的 10 月結果，我們預測 4 星計劃的會員比例在 14% 到 18% 之間。但是我們有一份關於泡沫的大合同，代表我們 10% 的成員。對於那些仍在關注該指標的人，我們保守地假設下行情況，因此，預計同比增長最少的 4 星，但我們預計整體合同將得到穩固的改善，反映出我們取得的運營進展，我們已經制定了保守觀點將這些結果納入我們的總體假設。

Ultimately, we believe that returning to WellCare's roots in serving lower income, diverse and complex seniors is an anchoring position in what will be the fastest-growing subsegment of the Medicare Advantage market and one that aligns perfectly with our local community integrated model and our Medicaid footprint. We are investing today to protect and enhance this business because we firmly believe it will be a powerful earnings and growth engine for Centene in the long term.

最終，我們相信，回歸 WellCare 為低收入、多元化和復雜的老年人提供服務的根源是 Medicare Advantage 市場增長最快的細分市場的一個錨點，並且與我們的當地社區綜合模型和我們的 Medicaid 完美契合腳印。我們今天正在投資以保護和加強這項業務，因為我們堅信從長遠來看，它將成為 Centene 強大的收益和增長引擎。

The final major driver of our revised 2024 outlook is the recognition that we need to invest in specific infrastructure that will allow us to innovate at scale. As we work to consolidate systems and simplify our technology ecosystem, we see an opportunity to future-proof our target architecture, expand and modernize our data layer and build a digital operating structure centered around our customer relationships.

我們修訂後的 2024 年展望的最後一個主要驅動力是認識到我們需要投資特定的基礎設施，使我們能夠大規模創新。在我們努力整合系統和簡化我們的技術生態系統時，我們看到了一個機會，可以讓我們的目標架構面向未來，擴展和現代化我們的數據層，並建立一個以客戶關係為中心的數字運營結構。

Done correctly, this work will accelerate our transformation, allowing us to tap into the power of Centene's unique local data footprint, automate more of our core functions, drive innovative clinical models and deliver market-leading customer experiences across all 3 of our businesses. We recognize the significance of increasing near-term investments at the expense of adjusted earnings per share.

如果做得好，這項工作將加速我們的轉型，使我們能夠利用 Centene 獨特的本地數據足蹟的力量，使我們更多的核心功能自動化，推動創新的臨床模型，並在我們所有 3 項業務中提供市場領先的客戶體驗。我們認識到以調整後每股收益為代價增加近期投資的重要性。

Ultimately, we are confident these investments will fortify the foundation of the enterprise and accelerate capabilities that will position us well against our long-term growth thesis.

最終，我們相信這些投資將鞏固企業的基礎並加速能力建設，使我們能夠很好地應對我們的長期增長主題。

Let me close out this portion of the 2024 discussion by emphasizing a few final points. One, we do not intend to update this number between now and our annual Investor Day in December. Two, our goal is to provide you with as much detail and transparency as we possibly can about our assumptions without compromising our competitive strategy during the bid cycle. This includes the improved segment reporting you can find beginning this quarter in our 10-Q.

讓我通過強調最後幾點來結束 2024 年討論的這一部分。第一，我們不打算從現在到 12 月的年度投資者日更新此數字。第二，我們的目標是在不影響我們在投標週期中的競爭策略的情況下，盡可能多地向您提供有關我們假設的細節和透明度。這包括您可以在本季度開始的 10-Q 中找到改進的細分報告。

And three, this is a number we are confident in. As some of you have been correct to point out, a floor is not a finish line, and $6.60 for 2024 is not our finish line. This is a number that we intend to meet and beat.

第三，這是一個我們有信心的數字。正如你們中的一些人指出的那樣是正確的，下限不是終點線，2024 年的 6.60 美元也不是我們的終點線。這是我們打算達到並擊敗的數字。

Before I turn it over to Drew, I want to comment briefly on progress in 2023, because performance this year presents an opportunity to strengthen the position from which we navigate through 2024, and we are executing well in 2023 thus far.

在我把它交給德魯之前，我想簡要評論一下 2023 年的進展，因為今年的表現提供了一個機會來加強我們在 2024 年的導航位置，到目前為止我們在 2023 年的表現很好。

Our local teams were fully mobilized to support the beginning of redeterminations on April 1. Although by the time planning was complete, only 2 of our states chose this as their start date. The remaining 28 states are evenly distributed across May, June and July start dates. In general, states are pursuing a balanced mix of population-based and time-based approaches.

我們的當地團隊已全面動員起來支持 4 月 1 日開始重新確定。儘管到計劃完成時，我們只有 2 個州選擇了這一天作為他們的開始日期。其餘 28 個州平均分佈在 5 月、6 月和 7 月的開學日期。總的來說，各州正在尋求基於人口和基於時間的方法的平衡組合。

Recent changes to implementation plans have biased to later start dates, reflecting the unprecedented scale of the undertaking for many states. Our focus from the beginning has been maximizing coverage continuity, both for Medicaid eligible and for marketplace potential members, and we are executing well against that goal.

最近對實施計劃的更改偏向於推遲開始日期，反映出許多州的承諾規模空前。我們從一開始就專注於最大限度地提高覆蓋範圍的連續性，無論是對符合醫療補助計劃的成員還是對市場潛在的成員，我們都在朝著這個目標努力。

We have robust multichannel communications in place for every state. In states where we have already commenced with early member communications, we are seeing positive early indicators, including low opt-out rates for text messages and higher engagement than normal in outbound live call campaigns.

我們為每個州都建立了強大的多渠道通信。在我們已經開始與早期會員溝通的州，我們看到了積極的早期指標，包括短信的低選擇退出率和出站實時電話活動中比正常情況更高的參與度。

In all but 5 of our states, we have either already received membership files or have a clear model established for data exchange with the state once their process begins. Where we have already received member files, we are using them to refine the analytics driving our outreach campaigns and to inform productive discussions with state actuaries and our regulator partners.

在除 5 個州之外的所有州中，我們要么已經收到會員文件，要么已經建立了一個清晰的模型，以便在流程開始後與州進行數據交換。在我們已經收到會員文件的地方，我們正在使用它們來完善推動我們的外展活動的分析，並為與州精算師和我們的監管合作夥伴的富有成效的討論提供信息。

Leveraging Centene's local approach, we have deployed community-based provider education and engagement campaigns with a focus on educating our FQHC partners as well as key provider partners in every region. So our members have the benefit of multiple trusted sources of information as they navigate this process.

利用 Centene 的本地方法，我們部署了基於社區的提供商教育和參與活動，重點是教育我們的 FQHC 合作夥伴以及每個地區的主要提供商合作夥伴。因此，我們的成員在瀏覽此過程時可以受益於多個可信賴的信息來源。

For members losing eligibility, we have launched both direct and indirect outreach campaigns to educate them about their marketplace options. Across all 25 states where we have an overlap between our Medicaid and Ambetter footprints, we have activated our unique and comprehensive Ambetter broker network, so they are prepared to support members transitioning to the Marketplace.

對於失去資格的會員，我們發起了直接和間接的外展活動，以教育他們了解他們的市場選擇。在我們的 Medicaid 和 Ambetter 足跡重疊的所有 25 個州，我們已經激活了我們獨特而全面的 Ambetter 經紀人網絡，因此他們準備好支持會員過渡到 Marketplace。

And we are working closely with states where we are able to do direct outreach to members to facilitate warm handoffs in the enrollment process. In short, our teams are hard at work supporting members and continuing to build positive momentum with our state partners.

我們正在與我們能夠直接與會員進行外展的州密切合作，以促進註冊過程中的熱情交接。簡而言之，我們的團隊正在努力支持成員，並繼續與我們的州合作夥伴建立積極的勢頭。

Turning to Marketplace. As we've discussed, Centene's Ambetter product line experienced incredible growth during the 2023 open enrollment. This positive momentum continued during the first quarter, and we closed the quarter with more than 3 million Marketplace members. As we move through 2023, we continue to monitor new member demographics and overall claims data consistent with the rigorous tracking that occurred during the first quarter.

轉向市場。正如我們所討論的，Centene 的 Ambetter 產品線在 2023 年公開註冊期間經歷了令人難以置信的增長。這一積極勢頭在第一季度持續存在，我們在本季度結束時擁有超過 300 萬的 Marketplace 會員。隨著 2023 年的到來，我們將繼續監控新會員的人口統計數據和總體索賠數據，這與第一季度進行的嚴格跟踪保持一致。

As I mentioned earlier, the proven breadth and depth of Ambetter's broker network, a clear driver of OEP success, will also be a key differentiator as we look to maximize the Catcher's Mitt opportunity. Overall, we continue to view the marketplace as a durable coverage vehicle and Ambetter as the market leader in this space continues to represent a powerful organic growth opportunity for Centene.

正如我之前提到的，Ambetter 經紀人網絡經過驗證的廣度和深度是 OEP 成功的明顯驅動因素，也將成為我們尋求最大限度地利用 Catcher's Mitt 機會的關鍵差異化因素。總體而言，我們繼續將市場視為持久的覆蓋工具，而作為該領域市場領導者的 Ambetter 繼續為 Centene 提供強大的有機增長機會。

From a Medicare standpoint, while we are working through a strategic rebuild, it is important to note the strong underlying operational improvements we are seeing that align with our 5-point plan. Examples include a new center of excellence for Medicare calls that has reduced per member per month calls by almost 25%. The implementation of new AI-based call sentiment technology, resulting in real-time performance improvement, a 20% reduction in voluntary disenrollment and a 47% reduction in CTMs year-over-year.

從 Medicare 的角度來看，在我們進行戰略重建的同時，重要的是要注意我們看到的與我們的 5 點計劃相一致的強大的潛在運營改進。例子包括一個新的 Medicare 呼叫卓越中心，該中心將每個成員每月的呼叫減少了近 25%。實施新的基於 AI 的呼叫情緒技術，從而提高了實時性能，自願退出減少了 20%，CTM 同比減少了 47%。

We have added almost 1,400 new clinics under value-based contracts, and most importantly, we are seeing member, provider and broker satisfaction scores in the mid-90s year-to-date. We are on a journey, but there is tangible improvement, and we continue to build operating momentum as we progress through 2023.

我們根據基於價值的合同增加了近 1,400 家新診所，最重要的是，我們看到會員、提供者和經紀人的滿意度得分在 90 年代中期至今。我們正在旅途中，但有明顯的改善，並且隨著我們在 2023 年的進步，我們將繼續建立運營勢頭。

Finally, a quick update on our value creation initiatives, which remains front and center as we work to fortify the foundation of the business. Overall, we are tracking ahead of our SG&A goals, excluding the additional investments I mentioned earlier, and our slate of SG&A initiatives is progressing well against key milestones. We continue to streamline the organization through portfolio rationalization, closing 3 transactions in January and more work is underway. And finally, importantly, our PBM implementation is on track across all work streams.

最後，快速更新我們的價值創造計劃，在我們努力鞏固業務基礎的過程中，它仍然是重中之重。總體而言，我們正在跟踪我們的 SG&A 目標，不包括我之前提到的額外投資，我們的一系列 SG&A 計劃在關鍵里程碑方面進展順利。我們繼續通過投資組合合理化精簡組織，在 1 月份完成了 3 筆交易，更多工作正在進行中。最後，重要的是，我們的 PBM 實施在所有工作流中都步入正軌。

In short, 2023 is shaping up to be another strong year of execution and earnings performance, and we expect to gather further momentum as we progress through the year that will help us to power through our updated 2024 floor. And while we are changing our earnings past 2 and through 2024, something we certainly don't take lightly, we have not changed our focus, our strategy or our confidence in the ultimate earnings power of this organization and its long-term growth potential.

簡而言之，2023 年將成為執行力和收益表現強勁的又一年，我們預計隨著這一年的進展，我們將獲得更多動力，這將幫助我們在更新的 2024 年地板上獲得動力。雖然我們正在改變我們過去 2 年和 2024 年的收益，但我們當然不會掉以輕心，我們沒有改變我們的重點、我們的戰略或我們對該組織的最終盈利能力及其長期增長潛力的信心。

We are not just building a company for 2024. We are making the decisions today that will enable us to deliver 12% to 15% adjusted EPS growth in the back half of the decade and ensure Centene is the market leader in government-sponsored programs for years to come.

我們不僅僅是為 2024 年建立一家公司。我們今天做出的決定將使我們能夠在本世紀後半葉實現 12% 至 15% 的調整後每股收益增長，並確保 Centene 成為政府資助計劃的市場領導者未來幾年。

With that, I'll hand it over to Drew to walk through the details of Q1 and the interplay between 2023 and a new prudent floor for 2024 that we will work to beat. Drew?

有了這個，我將把它交給 Drew 來詳細介紹第一季度的細節以及 2023 年與我們將努力克服的 2024 年新的審慎下限之間的相互作用。德魯？

Thank you, Sarah. This was a very good quarter, as you can see in the press release. Adjusted EPS of $2.11 was ahead of our expectations and a good start to the year. Let me hit a few key items for Q1 and then spend most of my time on the remainder of 2023 and 2024. Premium and Service revenue at $35 billion was strong in Q1. The HBR was on track at 87% and adjusted SG&A at 8.5% was consistent with our updated mix of business. DCP was 54 days, consistent with Q4 and up 1 day from Q1 last year.

謝謝你，莎拉。正如您在新聞稿中看到的那樣，這是一個非常好的季度。 2.11 美元的調整後每股收益超出了我們的預期，是今年的一個良好開端。讓我先談談第一季度的幾個關鍵項目，然後將大部分時間花在 2023 年和 2024 年的剩餘時間上。第一季度保費和服務收入高達 350 億美元，表現強勁。 HBR 在 87% 的軌道上，調整後的 SG&A 為 8.5%，與我們更新的業務組合一致。 DCP 為 54 天，與第四季度一致，比去年第一季度增加了 1 天。

During the quarter, the Medicaid HBR of 90.0% was on track as well and reflects 2 items: one, a delay in a 2022 rate increase from one of our largest states, which we expect to favorably impact our Q2 2023 Medicaid HBR; and two, Senate Bill 510 in California, dealing with prior period COVID claims. Those 2 items pushed up the Medicaid HBR over 40 basis points in the quarter.

在本季度，90.0% 的 Medicaid HBR 也步入正軌，反映了 2 個項目：一是我們最大的州之一推遲了 2022 年的加息，我們預計這將對我們 2023 年第二季度的 Medicaid HBR 產生有利影響；第二，加利福尼亞州參議院第 510 號法案，處理前期 COVID 索賠。這兩個項目在本季度將 Medicaid HBR 推高了 40 個基點以上。

The Medicare HBR at 85.2% was a little better than expectations. Marketplace revenue was stronger than expected, while the commercial HBR at 76.3% was in line with our internal forecast. Q1 cash flow from operations was strong, even when excluding a few out-of-period items such as early Medicare premiums. Overall, this was another good quarter with sound fundamentals.

85.2% 的 Medicare HBR 略好於預期。市場收入強於預期，而商業 HBR 為 76.3%，符合我們的內部預測。第一季度的運營現金流強勁，即使剔除早期醫療保險保費等一些過期項目也是如此。總的來說，這是另一個基本面良好的好季度。

In the last 1.5 months, we've gone through a rigorous process, not just to refine the forecast for the remainder of 2023 in our typical three plus nine process but we also accelerated what we could to develop a more detailed forecast for 2024. Let's tackle 2023 and then get to 2024. For the full year of 2023, premium and service revenue is coming in stronger than our last midpoint of $132.5 billion driven by Medicaid and Marketplace.

在過去的 1.5 個月裡，我們經歷了一個嚴格的過程，不僅在我們典型的三加九過程中完善了對 2023 年剩餘時間的預測，而且我們還加快了我們可以為 2024 年制定更詳細預測的速度。讓我們從 2023 年開始，然後到 2024 年。到 2023 年全年，保費和服務收入將超過我們上一個由醫療補助和市場推動的 1325 億美元的中點。

Medicaid revenue improvement is largely due to the refinement of timing of redeterminations in 2023 versus 2024. As an example, as we entered April, one of our largest states provided updated clarity around Foster Care redeterminations, moving the start date from April 1 to September 1. And they also clarified the timing of other populations, resulting in the start date 1 month later than we had planned, resulting in more Medicaid member months in 2023.

醫療補助收入的改善主要是由於 2023 年與 2024 年重新確定時間的改進。例如，當我們進入 4 月時，我們最大的州之一提供了有關 Foster Care 重新確定的更新清晰度，將開始日期從 4 月 1 日移至 9 月 1 日.而且他們還明確了其他人群的時間安排，導致開始日期比我們計劃的晚了1個月，導致2023年的Medicaid會員月數增加了。

In Marketplace, we are very pleased to be leveraging our #1 market position to not only seize market growth but also increase market share. We finished the open enrollment period strong and that carried into the special enrollment period, or SEP, with 3.1 million members at quarter end. We expect to continue to grow the rest of the year. To draw a distinction, the 2021 SEP during COVID was wide open for all eligibles and had pent-up demand with a different acuity profile than the SEP enrollees in 2022 or today.

在 Marketplace 中，我們很高興能夠利用我們排名第一的市場地位來抓住市場增長，同時增加市場份額。我們以強勁的勢頭結束了開放註冊期，並進入了特殊註冊期 (SEP)，在本季度末擁有 310 萬會員。我們預計今年剩餘時間將繼續增長。為了區分，COVID 期間的 2021 SEP 對所有符合條件的人開放，並且與 2022 年或今天的 SEP 登記者相比，具有不同敏銳度的被壓抑的需求。

Though we have found that partial year SEP members profitability is below that of open enrollment members, largely due to risk adjustment mechanics, the ability to renew those same members on 1/1/24 will set us up well for 2024.

儘管我們發現部分年度 SEP 會員的盈利能力低於公開註冊會員，這主要是由於風險調整機制，但在 24 年 1 月 1 日續訂這些相同會員的能力將為我們在 2024 年做好準備。

Consistent with what we shared on the Q4 earnings call, the demographic data including subsidy eligibility and product mix continues to look encouraging. Product positioning and distribution execution are also strong. The overall individual market has grown more than expected this year, and this macro growth is a positive factor when considering risk pools.

與我們在第四季度財報電話會議上分享的內容一致，包括補貼資格和產品組合在內的人口統計數據看起來繼續令人鼓舞。產品定位和分銷執行力也很強。今年整體個人市場增長超過預期，在考慮風險池時，這種宏觀增長是一個積極因素。

Overall, we are able to absorb this additional growth in 2023 and this should provide an earnings tailwind for 2024 to help offset other areas of headwind. We are lifting the 2023 consolidated premium and service revenue, another $3.7 billion to a midpoint of approximately $136 billion driven by Medicaid and Marketplace.

總體而言，我們能夠在 2023 年吸收這一額外增長，這應該會為 2024 年帶來盈利增長，以幫助抵消其他領域的不利因素。我們正在將 2023 年的綜合保費和服務收入提高 37 億美元，達到約 1360 億美元的中點，這是由 Medicaid 和 Marketplace 推動的。

Our revised 2023 HBR reflects an overall 10 basis point improvement to a range of 87.1% to 87.7%. This is driven by a few net items. First of all, there's a slight shift in mix due to growth in Marketplace, which has a structurally lower HBR. And as we'll talk about in a minute, we now expect a 10 basis point improvement in Medicaid in 2023 versus previous guidance. A revised HBR also reflects a specific nuance for Medicare.

我們修訂後的 2023 年《哈佛商業評論》反映總體改善 10 個基點，達到 87.1% 至 87.7% 的範圍。這是由一些淨項目驅動的。首先，由於 Marketplace 的增長，結構上 HBR 較低，因此組合略有變化。正如我們將在一分鐘內討論的那樣，我們現在預計 2023 年醫療補助計劃將比之前的指導提高 10 個基點。修訂後的 HBR 也反映了醫療保險的特定細微差別。

I mentioned on the February earnings call that we expect to lose money in Medicare Advantage in 2024. Based upon our latest underwriting estimates, we have reflected in 2023 guidance an approximate $200 million premium deficiency reserve or PDR, which we would expect to record in the fourth quarter of 2023. Other than that, our fundamental HBR is good in Q1 and on track for 2023. This PDR will be refined as we finalize bids and get further into 2023.

我在 2 月的財報電話會議上提到，我們預計 2024 年 Medicare Advantage 會虧損。根據我們最新的承保估計，我們在 2023 年的指導中反映了大約 2 億美元的保費不足準備金或 PDR，我們希望將其記錄在2023 年第四季度。除此之外，我們的 HBR 基本面在第一季度良好，並有望在 2023 年實現。隨著我們最終確定投標並進一步進入 2023 年，將對該 PDR 進行完善。

To be clear, we are absorbing this premium -- this Medicare premium deficiency reserve into our revised 2023 HBR and adjusted EPS guidance, demonstrating the current strength of the business.

需要明確的是，我們正在將這筆保費——這筆醫療保險保費不足準備金吸收到我們修訂後的 2023 年 HBR 和調整後的 EPS 指導中，以證明該業務目前的實力。

On the flip side, growth in Marketplace with more than 2.5x the SG&A rate of Medicaid due in part to distribution costs and exchange fees, changes the mix for SG&A. When coupled with investments in quality and other key areas Sarah mentioned, our adjusted SG&A guidance for 2023 is up to a midpoint of 8.9%.

另一方面，部分由於分銷成本和交換費用，市場的 SG&A 比率增長超過 Medicaid 的 2.5 倍，改變了 SG&A 的組合。再加上 Sarah 提到的質量和其他關鍵領域的投資，我們調整後的 2023 年 SG&A 指導高達 8.9% 的中點。

Let me demonstrate the impact to mix. Someone recently asked why our SG&A rate is in the low 7s. Actually, if you pro forma our 2023 revenue mix as if we were 80% Medicaid, we wouldn't be in the low 7s. Of course, in addition to our #1 position in Medicaid, we like having the #1 marketplace franchise, the #2 PDP franchise and the Medicare Advantage business with over 1 million members across 36 states.

讓我演示一下混合的影響。最近有人問為什麼我們的 SG&A 率處於 7 的低位。實際上，如果你對我們 2023 年的收入組合進行預估，就好像我們是 80% 的醫療補助計劃一樣，我們就不會處於低位 7。當然，除了我們在 Medicaid 中排名第一之外，我們還喜歡擁有排名第一的市場特許經營權、排名第二的 PDP 特許經營權和在 36 個州擁有超過 100 萬會員的 Medicare Advantage 業務。

Investment in other income was strong in Q1, and we expect that to continue for the remainder of the year at a midpoint of $975 million. We have bought back $577 million of shares since the beginning of the year, including $300 million post the Q4 call toward our approximate $1.5 billion goal for 2023. We expect to continue the majority of our health plan dividends to come late in the year.

第一季度對其他收入的投資強勁，我們預計今年剩餘時間將繼續保持在 9.75 億美元的中點水平。自今年年初以來，我們已經回購了 5.77 億美元的股票，其中包括第四季度電話會議後的 3 億美元，以實現我們 2023 年約 15 億美元的目標。我們預計將在今年晚些時候繼續發放我們的大部分健康計劃股息。

As of today, we have an approximate diluted share count of 550 million shares. As we generate cash at the parent, we plan to deploy it to buy back our shares. For instance, in April, we were able to monetize the stock consideration we received at the closing of our sale of Magellan Specialty, we seized this opportunity so that we could deploy to share buyback.

截至今天，我們的稀釋股數約為 5.5 億股。當我們在母公司產生現金時，我們計劃將其用於回購我們的股票。例如，在 4 月，我們能夠將我們在 Magellan Specialty 出售結束時收到的股票對價貨幣化，我們抓住了這個機會，以便我們可以部署股票回購。

Overall, for 2023, inclusive of the items we just covered, we are lifting our 2023 adjusted EPS guidance to at least $6.40 the top of our original guidance range.

總體而言，對於 2023 年，包括我們剛剛涵蓋的項目在內，我們將 2023 年調整後的 EPS 指導提升至至少 6.40 美元，比我們最初的指導範圍高出 6.40 美元。

Let's move to 2024. In 2024, while we were previously targeting $7.15 of adjusted EPS, we are reducing that to greater than $6.60 based upon more visibility on key 2024 drivers. While we are determined to do better than $6.60, based upon what we know today, we believe this is a prudent target for our 2024 earnings. And we believe this is the right jump-off point to apply our long-term growth algorithm, CAGR of 12% to 15% for the back half of the decade, consistent with what we shared with you at December Investor Day.

讓我們轉到 2024 年。在 2024 年，雖然我們之前的目標是調整後每股收益為 7.15 美元，但基於對 2024 年關鍵驅動因素的更多可見性，我們將其降低到 6.60 美元以上。雖然我們決心要做得比 6.60 美元更好，但根據我們今天所知，我們認為這是我們 2024 年收益的審慎目標。我們相信這是應用我們的長期增長算法的正確起點，十年後半期的複合年增長率為 12% 至 15%，這與我們在 12 月投資者日分享的內容一致。

Let me outline our approach and key assumptions to this revised 2024 target. Starting with Medicaid. The first redeterminations just started April 1, but what has transpired over the past 1.5 months has enabled us to gain more clarity on each state's process in terms of timing and approach to the sequencing of populations.

讓我概述一下我們對這個修訂後的 2024 年目標的方法和主要假設。從醫療補助計劃開始。第一次重新確定剛剛於 4 月 1 日開始，但過去 1.5 個月發生的事情使我們能夠更清楚地了解每個州在人口排序的時間和方法方面的進程。

As Sarah mentioned, we have also been able to refine acuity projections, state-by-state, subpopulation by subpopulation as well as the anticipated degree and timing of projected rate actions. Acuity projections, in many cases, are based upon specific data from the state and their actuaries. For instance, a number of our states shared files with us for those they expect to redetermine in April, May and/or June. And we are using this information to calculate the acuity of stayers versus leavers.

正如 Sarah 提到的，我們還能夠改進敏銳度預測、逐個州、逐個子群體以及預計利率行動的預期程度和時間。在許多情況下，敏銳度預測是基於來自州及其精算師的特定數據。例如，我們的一些州與我們共享了他們希望在 4 月、5 月和/或 6 月重新確定的人的文件。我們正在使用這些信息來計算留守者與離開者的敏銳度。

On the other side of acuity, the rate change projections are state-by-state, subpopulation by subpopulation, and they are often based upon direct conversations with the Medicaid departments and their actuaries, including many verbal acknowledgments of the potential need for rate actions as redeterminations unfold.

在敏銳度的另一面，利率變化預測是各州、各子人群的，它們通常基於與醫療補助部門及其精算師的直接對話，包括許多口頭承認利率行動的潛在需要，因為重新決定展開。

We've had very constructive discussions with our state partners about redeterminations, not just in terms of process, but also the rate implications. We have also thought about the RFP cycle as we forecast the timing of future rate actions. While we are still early in the redetermination cycle, which we expect will last into Q2 of 2024, we have developed more confidence in our estimates of the net impact on 2023 and 2024 with the benefit of the (inaudible).

我們與我們的州合作夥伴就重新確定進行了非常有建設性的討論，不僅在流程方面，而且在利率影響方面。我們在預測未來利率行動的時間時也考慮了 RFP 週期。雖然我們仍處於重新確定週期的早期階段，我們預計該週期將持續到 2024 年第二季度，但由於（聽不清）的好處，我們對我們對 2023 年和 2024 年淨影響的估計更有信心。

One more relevant fact for 2022, we were approximately $2 billion in payback -- payable back to certain states for risk corridors or minimum MBR profit-sharing mechanisms. That's important to factor in relative to any expected acuity shifts in those specific states. Finally, with each state putting a stake in the ground with respect to timing and approach, we are better able to refine our forecasted premium revenue for both 2023 and 2024.

另一個與 2022 年相關的事實是，我們的投資回報約為 20 億美元——應償還給某些州的風險走廊或最低 MBR 利潤分享機制。考慮到這些特定狀態下任何預期的敏銳度變化，這一點很重要。最後，由於每個州都在時間和方法方面投入了資金，我們能夠更好地完善我們對 2023 年和 2024 年的保費收入預測。

Ultimately, we expect the rates provided by our states to match the acuity of the population as has historically been the case, though this is expected to ebb and flow through the redetermination process. In other words, if there's a mismatch between acuity and rates, we expect it to be temporary.

最終，我們希望我們各州提供的利率與歷史上的人口敏銳度相匹配，儘管這預計會在重新確定過程中起伏不定。換句話說，如果敏銳度和利率之間存在不匹配，我們預計這只是暫時的。

Now let's get to some numbers. To provide some of our assumptions embedded in our updated 2024 target, we expect approximately $77 billion of Medicaid premium revenue in 2024 relative to approximately $84 billion in 2023. The premium revenue drop in 2024 is largely driven by redeterminations continuing and annualizing into 2024.

現在讓我們來看看一些數字。為了提供我們更新後的 2024 年目標中嵌入的一些假設，我們預計 2024 年醫療補助保費收入約為 770 億美元，而 2023 年約為 840 億美元。2024 年保費收入下降主要是由於重新確定持續到 2024 年並按年計算。

There are also some other puts and takes in the revenue, including market share shifts, as we have previously discussed, the California contract renewal and the projected potential county shifts in Texas Star Plus as well as the added North Carolina expansion population.

收入中還有一些其他的投入和收入，包括市場份額轉移，正如我們之前討論的那樣，加利福尼亞州的合同續籤和德州之星 Plus 的預計潛在縣轉移以及北卡羅來納州人口的增加。

With respect to the Medicaid HBR, as you will recall, we were originally expecting to be around 89.9% in 2023. Our latest forecast is slightly better than that at approximately 89.8%. For 2024, based upon the process I just described, we have now built in 50 basis points of HBR increase to be prudent for redeterminations and the potential temporary mismatch of timing between acuity change and rate.

關於 Medicaid HBR，您會記得，我們最初預計 2023 年將達到 89.9% 左右。我們的最新預測略好於 89.8% 左右。對於 2024 年，根據我剛才描述的過程，我們現在已經將 HBR 提高了 50 個基點，以謹慎對待重新確定以及敏銳度變化和利率之間潛在的暫時時間不匹配。

That would put us at approximately 90.3%. Then we expect approximately 20 basis points of benefit from a new PBM contract and other initiatives to yield an estimated 2024 Medicaid HBR of approximately 90.1%.

這將使我們達到大約 90.3%。然後，我們預計新的 PBM 合同和其他舉措將帶來大約 20 個基點的收益，從而產生大約 90.1% 的 2024 年醫療補助 HBR。

In Medicare and Marketplace, we are still refining our bids that are due this summer. So we're going to be a little guarded with getting too granular with bid assumptions for each of those lines of business. In Marketplace, our first quarter results were on track. And while one quarter doesn't make the year, we are so far pleased with the marketplace positioning not just for 2023 but also the longer-term benefit from strengthening our #1 market position.

在 Medicare 和 Marketplace 中，我們仍在完善今年夏天到期的投標。因此，我們將對每個業務線的出價假設過於細化保持謹慎。在 Marketplace，我們第一季度的業績步入正軌。雖然四分之一沒有成為年度，但到目前為止，我們不僅對 2023 年的市場定位感到滿意，而且對加強我們排名第一的市場地位所帶來的長期利益也感到滿意。

We look forward to getting more insight into 2023 marketplace performance as the year unfolds, including when we get the first view of the Wakely risk adjustment data in late June, early July. Suffice to say, we are bullish about growth and margin potential in our marketplace positioning and business for 2023, 2024 and beyond, and more importantly, the chassis for seizing individual market opportunities ahead.

隨著時間的推移，我們期待更深入地了解 2023 年的市場表現，包括我們在 6 月底、7 月初首次看到 Wakely 風險調整數據時。可以說，我們看好 2023 年、2024 年及以後市場定位和業務的增長和利潤潛力，更重要的是，看好未來抓住個別市場機會的底盤。

In Medicare, we received the final 2024 rates and risk model clarity on March 31. The 2024 final rate was less negative for us by approximately 1.25% relative to the advanced notice but still an inadequate rate relative to trend. Some of the final rate change will accrue to our provider partners and some we will work into our bids. We continue to forecast a pretax loss in 2024, which is embedded in our revised 2024 target inclusive of the 2024 amortization of the PDR we expect to record in 2023.

在 Medicare 中，我們於 3 月 31 日收到了 2024 年最終利率和風險模型清晰度。相對於提前通知，2024 年最終利率對我們的負面影響較小約 1.25%，但相對於趨勢而言仍然不足。一些最終的費率變化將歸於我們的供應商合作夥伴，一些我們將參與我們的投標。我們繼續預測 2024 年會出現稅前虧損，這包含在我們修訂後的 2024 年目標中，包括我們預計在 2023 年記錄的 PDR 的 2024 年攤銷。

As we indicated on the Q4 2022 call, underperformance in Medicare growth and earnings is a temporary dynamic, which we will -- while we balance the preservation of a base of membership with trough 2024 STARS revenue and expectations of improvement in STAR scores now geared towards our low income and dual strategy Sarah described.

正如我們在 2022 年第四季度電話會議上指出的那樣，Medicare 增長和收益表現不佳是一種暫時的動態，我們將在保持會員基礎與 2024 年 STARS 收入低谷以及對 STAR 評分改善的預期之間取得平衡我們的低收入和莎拉描述的雙重策略。

While it's widely known that moving from 3.5 to 4 stars comes with, on average, 5% more revenue. There's also a meaningful economic benefit of moving from 3 to 3.5 stars that averages the equivalent of 3% to 6% depending on the contract. Given we have approximately 80% of our current membership and contracts below 3.5 stars from last October scoring, our focus now is to first maximize 3.5, especially as our membership will be shifting and tilting more towards low income and D-SNP in 2024 and beyond.

雖然眾所周知，從 3.5 星升級到 4 星平均會增加 5% 的收入。從 3 星升至 3.5 星還有一個有意義的經濟效益，平均相當於 3% 至 6%，具體取決於合同。鑑於我們目前大約 80% 的會員和合同在去年 10 月的評分中低於 3.5 星，我們現在的重點是首先最大化 3.5，特別是因為我們的會員將在 2024 年及以後更多地轉向低收入和 D-SNP .

So while you might consider our Medicare business as temporarily under construction for 2024, we believe Medicare Advantage will be a margin expansion and growth driver for the back half of the decade. Once again, we haven't yet submitted bids for these products. So for external consumption, we're going to combine the Medicare and commercial 2024 forecasted revenue for this discussion. Together, we expect approximately $46 billion of premium revenue from Medicare and commercial segments in 2023 and $45 billion in 2024. Directionally, we expect to grow Marketplace throughout the rest of '23 and into 2024.

因此，儘管您可能認為我們的 Medicare 業務在 2024 年暫時處於建設中，但我們相信 Medicare Advantage 將成為本世紀後半葉的利潤擴張和增長動力。再說一遍，我們還沒有為這些產品提交投標。因此，對於外部消費，我們將結合 Medicare 和商業 2024 年的預測收入進行討論。我們預計，到 2023 年，醫療保險和商業部門的保費收入將達到約 460 億美元，2024 年將達到 450 億美元。從方向上講，我們預計 Marketplace 將在 23 世紀剩餘時間和 2024 年實現增長。

On the other hand, we expect to rationalize certain Medicare plan benefit packages, or PBPs, in 2024, which will result in lower Medicare membership, but membership composition will be more consistent with the strategy Sarah outlined. When we add our other businesses, which represent approximately $6 billion in premium and service revenue, subject to additional divestitures, we expect total premium and service revenue midpoints of approximately $128 billion in 2024 compared to about $136 billion in 2023.

另一方面，我們預計在 2024 年對某些 Medicare 計劃福利包 (PBP) 進行合理化處理，這將導致 Medicare 會員人數減少，但會員構成將與 Sarah 概述的戰略更加一致。當我們將代表約 60 億美元保費和服務收入的其他業務加入額外資產剝離時，我們預計 2024 年保費和服務總收入中點約為 1,280 億美元，而 2023 年約為 1,360 億美元。

We will issue formal 2024 guidance with a full table of details later in the year, but we thought it would be helpful to review some of the underlying assumptions that we believe support an adjusted EPS target of greater than $6.60. By powering through 2024, Medicare challenges and getting to the other side of redeterminations, this company will be stronger to seize the opportunities in the back half of the decade.

我們將在今年晚些時候發布包含完整詳細信息表的正式 2024 年指南，但我們認為回顧一些我們認為支持調整後 EPS 目標超過 6.60 美元的基本假設會有所幫助。通過 2024 年的發展，醫療保險挑戰和重新決定的另一面，這家公司將更強大地抓住這個十年後半期的機遇。

Finally, while we are disappointed that we are lowering our outlook, this revised 2024 target reflects our updated view informed by an accelerated 2024 forecast, process and recent insights in Medicaid, Marketplace and Medicare. And it is a target we have confidence in delivering. This perspective also gives us the flexibility to make the right decisions for 2025 and beyond. We will do our best to exceed $6.60 in 2024 without sacrificing anything for 2025 and beyond.

最後，雖然我們對下調前景感到失望，但這一修訂後的 2024 年目標反映了我們根據 2024 年加速預測、流程以及最近對醫療補助計劃、市場和醫療保險的見解得出的最新觀點。這是我們有信心實現的目標。這種觀點還使我們能夠靈活地為 2025 年及以後做出正確的決定。我們將盡最大努力在 2024 年超過 6.60 美元，而不會為 2025 年及以後做出任何犧牲。

Operator, let's go to Q&A.

接線員，我們進入問答環節。

(Operator Instructions) Today's first question comes from AJ Rice with Credit Suisse.

（操作員說明）今天的第一個問題來自瑞士信貸的 AJ Rice。

Just maybe to drill down a little further on what you're thinking with respect to Medicaid redeterminations. I guess it sounds like you're reflecting in your outlook for '24 a little more caution on acuity and potentially how quick that gets picked up in rate adjustment. I wonder if you could give us a sense, are you falling more on just thinking there is a little bit of lag in the period in which the rate adjustments get updated? Or are you seeing anything that's indicating to you that the acuity itself will be worse than what you were thinking 3 or 6 months ago?

也許只是進一步深入了解您對醫療補助重新確定的想法。我想這聽起來像是您在對 24 年的展望中反映出對敏銳度的謹慎程度以及利率調整的速度有多快。我想知道您是否可以給我們一個感覺，您是否更多地認為利率調整更新的時間有一點滯後？或者您是否看到任何跡象表明視力本身會比您 3 或 6 個月前的想法更差？

And I wonder just granular as we start to get into this, as you're talking to somebody that's getting a redetermination, do you give them the notification? Does the state give them the notification? And as you talk to them about their options to sign up on the public exchanges, are they -- do you have a sense of whether they're going to do that immediately? Is there going to be a lag in the way they think about that before they immediately go and sign up. Any updated color on that as well.

我想知道，當我們開始討論這個問題時，當您與正在重新確定的人交談時，您會向他們發出通知嗎？國家給他們通知了嗎？當你和他們談論他們在公共交易所註冊的選擇時，他們 - 你是否知道他們是否會立即這樣做？在他們立即去註冊之前，他們的思考方式是否會有滯後。任何更新的顏色也是如此。

Thanks, A.J. It's a great question. So relative to redeterminations, we've, over the last couple of weeks of states have been approaching the April 1 start date. We've gotten a lot of good information. Some of it is from them finalizing their implementation plans. And as we noted, some of those have shifted in the final hours as they contemplate sort of the scope of this work. And some of it is states who have actually given us data files that allow us to update our models more formally.

謝謝，A.J.這是一個很好的問題。因此，相對於重新確定，我們在過去幾週內已經接近 4 月 1 日的開始日期。我們得到了很多有用的信息。其中一些來自他們最終確定的實施計劃。正如我們所指出的，其中一些人在最後幾個小時內發生了變化，因為他們考慮了這項工作的範圍。其中一些州實際上向我們提供了數據文件，使我們能夠更正式地更新我們的模型。

We have used that to refresh a really comprehensive multivariate model that we have across 31 states that takes into account all of the different dimensions that Drew talked about and allows us to project where membership shifts may happen and where acuity shifts may disconnect and then how all of that plays out over time, with things like the risk quarters with things like rate mechanisms, rate calendars and then really an overarching view of what is the agenda of the state and are there other things going on like procurement and things like that.

我們已經用它來刷新我們在 31 個州擁有的真正全面的多變量模型，該模型考慮了 Drew 談到的所有不同維度，並允許我們預測成員轉移可能發生的位置以及敏銳度轉移可能斷開的位置以及所有這些變化的方式隨著時間的推移，它會隨著時間的推移而發揮作用，比如風險季度、利率機制、利率日曆，然後是對國家議程的總體看法，還有其他事情正在發生，比如採購等等。

And so as a result of that, what we're really trying to do is build in a little bit more conservatism in '24, where we see the potential in some states for a temporary disconnect between rate and acuity. And again, we see this as temporary. In the long term, rate has always equaled acuity in Medicaid.

因此，我們真正想做的是在 24 年建立更多的保守主義，我們看到某些州有可能在利率和敏銳度之間暫時脫節。同樣，我們認為這是暫時的。從長遠來看，在醫療補助計劃中，利率始終等於敏銳度。

But it allows our local teams to have the flexibility to navigate not just the redeterminations process but those conversations with the states in a way that really prioritizes our customer relationship because of how critical we know those relationships are to our long-term success in Medicaid.

但它使我們的本地團隊不僅可以靈活地處理重新確定過程，還可以以真正優先考慮我們的客戶關係的方式來處理與各州的對話，因為我們知道這些關係對我們在醫療補助計劃中的長期成功至關重要。

So that's really sort of the driving factor behind additional conservatism in '24. And then to your question about how the tactical rollout is going. The answer really depends state by state. There's obviously official notification in every state that goes out from the state to the members who they need to take through the redetermination process and then time lines in terms of those members being able to respond.

所以這確實是 24 世紀額外保守主義背後的驅動因素。然後是關於戰術部署進展情況的問題。答案確實取決於各州。顯然每個州都有官方通知，從該州發出給需要通過重新確定流程的成員，然後是這些成員能夠做出回應的時間表。

CMS has done a really nice job of making sure states are following the guidelines in terms of multiple outreaches to members and the time lines in order to ensure that we don't have folks dropping through the cracks because of process.

CMS 在確保各州在對成員的多次外展和時間線方面遵循指導方針方面做得非常好，以確保我們不會讓人們因為流程而掉線。

And then we have lined up, as I mentioned, those sort of multichannel communication plans as well as activating local providers and our broker networks where we're allowed to so that we have direct conversations either -- with members either through their providers where they can get more information or in those states where we can direct, educate and outreach to members who are qualified for exchange products. We actually have marketing campaigns specifically around that.

然後，正如我提到的，我們已經排好隊，這些類型的多渠道溝通計劃以及激活本地供應商和我們被允許的經紀人網絡，以便我們可以直接對話 - 通過他們的供應商與會員進行直接對話可以獲得更多信息，或者在我們可以指導、教育和推廣有資格獲得交換產品的會員的那些州。我們實際上有專門圍繞這一點的營銷活動。

And finally, your point about sort of the speed with which members are being responsive. Again, I think it's going to depend. But one of the dynamics that we're seeing in Marketplace special enrollment period and actually overall Marketplace growth is a result of the combined awareness and affordability that has come from investments in broker marketing as well as, obviously, the enhanced APTCs, -- and so we think that in particular, the broker community is really well mobilized against moving those members over to marketplace as quickly as possible.

最後，您關於成員響應速度的觀點。同樣，我認為這將取決於。但我們在 Marketplace 特殊註冊期看到的動態之一以及實際上整個 Marketplace 的增長是來自對經紀人營銷的投資以及顯然增強的 APTC 的綜合意識和負擔能力的結果， - 和所以我們認為，特別是，經紀人社區真的很好地動員起來反對盡快將這些成員轉移到市場上。

And our next question today comes from Josh Raskin at Nephron Research.

我們今天的下一個問題來自 Nephron Research 的 Josh Raskin。

Just a quick clarification and then my question. But did I hear the PDR is expected to amortize partially in 2024, meaning MA profitability is supposed to be -- expected to be negative in 2025 as well?

只是一個快速的澄清，然後是我的問題。但我是否聽說 PDR 預計將在 2024 年部分攤銷，這意味著 MA 的盈利能力應該是——預計到 2025 年也將是負數？

And then my question is maybe could you provide a little more color on your thoughts around statutory capital especially as you see some of these revenue headwinds? You seem to screen this holding a little bit more capital than the peers. And I guess, sort of how you think about that relative to debt to cap and share buybacks would be a strategic enough reason to maybe increase your leverage above your debt-to-cap targets.

然後我的問題是，也許您能否就您對法定資本的看法提供更多色彩，尤其是當您看到其中一些收入逆風時？您似乎比同行持有更多的資金。我想，你如何看待與債務上限和股票回購相關的問題，這將是一個足夠戰略性的理由，可以將你的槓桿率提高到債務上限目標之上。

Good questions, Josh. The PDR, no, we expect to fully amortize that in 2024. It's a 1-year contract for Medicare members, as you know. And so we don't expect that to bleed into 2025. And so if that number is 200, that's what we've built into our guidance for 2023. But we will refine that as we get the bids finaled, see the rollout of the annual enrollment period beginning in December, and that will dictate the specific amount that we record from accounting rules, and then that would be reevaluated at the end of each quarter of 2024 and adjust it accordingly. So that's how the PDR would work mechanically.

好問題，喬什。 PDR，不，我們希望在 2024 年完全攤銷。如您所知，這是一份針對 Medicare 成員的為期 1 年的合同。因此，我們不希望這種情況會持續到 2025 年。因此，如果這個數字是 200，這就是我們在 2023 年的指導方針中所設定的內容。但是我們會在最終確定出價時對其進行完善，請參閱從 12 月開始的年度註冊期，這將決定我們從會計規則中記錄的具體金額，然後將在 2024 年每個季度末重新評估並相應調整。這就是 PDR 的機械工作方式。

On statutory capital, it's a good question. We modified the management fees. We think we improved the management fee structure this year with more precision, and that has the result of trapping more capital into our regulated subs, which is why we expect to only do $1.5 billion share buyback this year, which will be largely late in the year. We've got $300 million under our belt already. And then we expect that to step up to about $3 billion, which we mentioned on the last earnings call for 2024.

關於法定資本，這是一個很好的問題。我們修改了管理費。我們認為我們今年更精確地改進了管理費結構，其結果是將更多資金投入了我們受監管的子公司，這就是為什麼我們預計今年只會進行 15 億美元的股票回購，這將在很大程度上晚於年。我們已經有 3 億美元了。然後我們預計這一數字將增加到約 30 億美元，我們在上一次 2024 年財報電話會議上提到了這一點。

So we've got a certain level we like to maintain, but we certainly don't need to have excess capital sitting in our subs. And we'll go after that through the dividend process back half of this year and into 2024. Our debt to EBITDA is right around 3x. We're content with that. It will probably move up or down a little bit around that 3x, but that's our target. We love the fact that we're investment grade now. And I think as we look at our debt stack over the next decade, that will serve the company well.

所以我們有一定的水平，我們希望保持，但我們當然不需要在我們的潛艇上投入過多的資金。我們將在今年下半年和 2024 年完成股息流程。我們對 EBITDA 的債務約為 3 倍。我們對此感到滿意。它可能會在 3 倍左右上下移動一點點，但這是我們的目標。我們喜歡我們現在是投資級的事實。而且我認為，當我們審視未來十年的債務堆棧時，這將對公司有好處。

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

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

First, a quick follow-up on A.J.'s question. Drew, is there any way you can delineate for us the impact of redeterminations on the risk pool versus what you expect to make up on pricing? Meaning maybe you could tell us -- if states kind of pushed off pricing completely for a year, how much of a negative impact do you now think just changes in the risk pool would have on your MLR for 2024?

首先，快速跟進 A.J. 的問題。德魯，你有什麼方法可以為我們描述重新確定對風險池的影響與你期望對定價進行彌補的影響嗎？這意味著也許你可以告訴我們——如果各州將定價完全推遲一年，你現在認為風險池的變化會對 2024 年的 MLR 產生多大的負面影響？

And then my question is on Medicare Advantage. One, do you still expect to lose money in Medicare Advantage despite the $200 million PDR? Meaning ex the PDR, are you still losing money in 2024? And if so, maybe how much? And then I appreciate the color on the STARS at 4 stars for 2024. But as you said, 3.5 stars is really important as a first step. Any color on how you expect to improve 3.5 stars in 2020 -- for 2025, I should say, versus the 20% you're at today?

然後我的問題是關於 Medicare Advantage 的。第一，儘管有 2 億美元的 PDR，您是否仍然希望在 Medicare Advantage 中賠錢？意思是前 PDR，你在 2024 年還在虧錢嗎？如果是這樣，也許是多少？然後我很欣賞 2024 年 4 星的 STARS 顏色。但正如你所說，作為第一步，3.5 星真的很重要。關於您期望如何在 2020 年提高 3.5 星的任何顏色——我應該說，到 2025 年，與您今天的 20% 相比？

All right, a multi-3-part question there. On redeterminations, some of the mechanics on that. So when we went through that process, as Sarah described, of really looking at subpopulation by subpopulation, looking at the data that we had, what was shared by the state actuaries, you're triangulating a bunch of data points. And now we're starting to get data, which is great. We concluded that it would be prudent to have a provision of 50 basis points for the timing mismatch. And we do believe it's just -- it's merely a timing mismatch in 2024.

好吧，這是一個由 3 部分組成的多問題。關於重新確定，一些機制。因此，當我們經歷這個過程時，正如莎拉所描述的那樣，真正地逐個子人口查看子人口，查看我們擁有的數據，以及州精算師共享的數據，你正在對一堆數據點進行三角測量。現在我們開始獲取數據，這很棒。我們的結論是，為時間錯配提供 50 個基點是明智的。我們確實相信這只是 - 這只是 2024 年的時間不匹配。

And so as you heard on -- in my script, we're doing about 10 basis points better than we expected to for 2023. And we previously had 10 basis points of degradation built into our modeling. So we needed an additional 30. And so that's what's embedded. That's part of the driver of the $0.55 drop for 2024 earnings -- adjusted earnings target.

正如你所聽到的——在我的腳本中，我們在 2023 年的表現比我們預期的要好大約 10 個基點。我們之前在模型中內置了 10 個基點的退化。所以我們需要額外的 30 個。這就是嵌入的內容。這是 2024 年收益下降 0.55 美元的部分驅動因素——調整後的收益目標。

The second question you had was on Medicare. I'll answer the financial question and then pass it to Sarah and Jim Murray here on more color on Medicare and STARS and whatnot. But yes, we expect to lose money despite the amortization of the $200 million into 2024. So we're looking at -- and we were able to look at a number of things, including how we were performing in 2023 as we're thinking about setting the bids and, obviously, getting the final rates was a pretty important factor in that equation. But yes, the Medicare business, we expect to lose more than that amortization of PDR.

你的第二個問題是關於醫療保險的。我將回答財務問題，然後將其傳遞給 Sarah 和 Jim Murray，了解有關 Medicare 和 STARS 等的更多信息。但是，是的，儘管將 2 億美元攤銷到 2024 年，我們預計仍會虧損。所以我們正在研究——我們能夠研究很多事情，包括我們在 2023 年的表現，正如我們所想的那樣關於設置出價，顯然，獲得最終費率是該等式中非常重要的因素。但是，是的，我們預計醫療保險業務的損失將超過 PDR 的攤銷。

And then on the STARS piece, I do want to be clear that we're obviously not taking our eye off the goal of maximizing 4-star membership, but the previous target of 60% in 4 star or 3 cycles is really no longer relevant for 2 reasons. One is our adjusted 2024 bid strategy and the intentional decision to double down on our core membership, which is inherently more complex from a quality standpoint.

然後在 STARS 部分，我想明確一點，我們顯然並沒有把目光從最大化 4 星會員的目標上移開，但之前 4 星或 3 週期 60% 的目標確實不再相關有兩個原因。一個是我們調整後的 2024 年競標策略和有意決定加倍吸引我們的核心會員，從質量的角度來看，這本質上更加複雜。

And then the second is CMS changed the rules. And so introducing the Health Equity Index adjustment, which we are very supportive of, will actually help account for the management of that complexity over time. But we need to make sure that we invest in the short term around the health equity program in those contracts where that's going to matter in order to have that lift take those contracts to 4 star in the long term.

其次是CMS改變了規則。因此，引入我們非常支持的 Health Equity Index 調整，實際上將有助於解決隨著時間的推移管理這種複雜性的問題。但我們需要確保我們在短期內圍繞健康公平計劃投資於那些重要的合同，以便從長遠來看將這些合同提升到 4 星。

And so in some ways, we're sort of slowing down speed up and the near-term objective of getting more of those contracts into 3.5 star is really based primarily on operational execution and some of the investments that we talked about around not just HEDIS but also the customer experience, which will influence caps. But let me let Jim Murray talk a little bit more because he is watching this day to day.

因此，在某些方面，我們正在放慢速度，近期目標是讓更多這些合同進入 3.5 星級，這實際上主要基於運營執行和我們談到的一些投資，而不僅僅是 HEDIS還有客戶體驗，這將影響上限。但是讓我讓 Jim Murray 多說一點，因為他每天都在看。

What we've talked about in the past is we've been a very transactional company as it respects some of what we do in Medicare. And Sarah has pointed out, a number of times around 5 strategic areas of focus in Medicare. And I'll reference some of those as I go through that. The end goal is to try to create relationships with our members and with our providers and where we're able to do that, I think it's going to have some positive impact on STARS, and I'll try to introduce that to you here.

我們過去談到的是，我們一直是一家非常注重交易的公司，因為它尊重我們在 Medicare 中所做的一些事情。 Sarah 曾多次指出，Medicare 圍繞 5 個戰略重點領域。我會在討論過程中參考其中的一些內容。最終目標是嘗試與我們的成員和我們的提供商建立關係，以及我們能夠做到這一點的地方，我認為這會對 STARS 產生一些積極影響，我將在這裡向您介紹。

There's a lot of things that are going on, and I'm going to be agnostic as it relates to either revenue year '24 or '25 or '26. But Sarah talked earlier about some of what we're doing around the improvement in CTMs. Obviously, we're doing a lot of work here to reach out to our members and try to create a better relationship with them.

有很多事情正在發生，我將成為不可知論者，因為它與 24 年或 25 年或 26 年的收入有關。但 Sarah 早些時候談到了我們圍繞 CTM 的改進所做的一些工作。顯然，我們在這裡做了大量工作來接觸我們的會員並努力與他們建立更好的關係。

But one of the 5 areas of focus is rebalancing our distribution channels. There was a significant movement this past year where more of our members came to us with our W-2 and our direct-to-consumer and broker on the street selling channels, which is significantly stronger for us from a lifetime value than some of the other channels we had used in the past, and that's having a significantly positive lift on CTMs.

但 5 個重點領域之一是重新平衡我們的分銷渠道。過去一年發生了重大變化，我們有更多的會員帶著我們的 W-2 以及我們直接面向消費者和經紀人的街頭銷售渠道來到我們這裡，從終身價值來看，這對我們來說比一些我們過去使用過的其他渠道，這對 CTM 有顯著的積極提升。

Sarah also mentioned, we've really focused on service. We're starting to get back some of the cap survey early returns, and we're seeing that there was a nice lift in the cap question related to service. And so that ultimately will help us with caps, and we're happy about that. Appeals is another admin measure. We're seeing some good results in 2023 relative to appeals. And HEDIS scores this year were in the final week of chart chase.

Sarah 還提到，我們非常注重服務。我們開始收回一些上限調查的早期回報，我們看到與服務相關的上限問題有了很好的提升。因此，這最終將幫助我們解決問題，我們對此感到高興。上訴是另一項管理措施。我們在 2023 年看到了一些與上訴相關的好結果。今年的 HEDIS 分數處於圖表追逐的最後一周。

We are improving year-over-year. If I were being brutally honest, I would say it was done more with blunt force trauma as opposed to having an elegant infrastructure in place, and that's where Sarah talked earlier about needing to be in more value-based contracts, and we have a team of people who's focused on that, and then creating value-based enablement tools.

我們逐年改進。如果我非常誠實，我會說更多的是用鈍力創傷來完成，而不是有一個優雅的基礎設施，這就是 Sarah 早些時候談到需要簽訂更多基於價值的合同的地方，我們有一個團隊專注於此的人，然後創建基於價值的支持工具。

We need to do a better job with our providers in showing them where we are and where they are relative to the risk-based contracts and the quality that they're delivering so that they can take proactive action to help us with HEDIS scores. And we're in the process of building those tools, and I expect some really good results from that.

我們需要與我們的提供商更好地合作，向他們展示我們所處的位置以及他們相對於基於風險的合同以及他們提供的質量的位置，以便他們能夠採取積極行動來幫助我們獲得 HEDIS 分數。我們正在構建這些工具，我希望從中得到一些非常好的結果。

So I think we're making some nice progress. I think you'll see a nice lift in our 3.5 in October. But I'd like to say around we're miles to go before we sleep.

所以我認為我們正在取得一些不錯的進展。我想您會在 10 月份看到我們的 3.5 有很好的提升。但我想說，在我們入睡之前，我們還有很長的路要走。

And ladies and gentlemen, our next question comes from Stephen Baxter of Wells Fargo.

女士們，先生們，我們的下一個問題來自富國銀行的斯蒂芬巴克斯特。

So when we look at Medicaid margins either industry-wide or state by state, we see margins that are fairly elevated relative to historical norms and by an amount that would exceed, I think, what you're talking about around the 50 basis points cumulative impact you assume, which I think is at least in part thought to be temporary. How you respond to that, for example, if industry-level margins went from, say, 3% to 2.5%, and that's still above target margins or what the industry has historically earned. I guess why do you think states would respond to that?

因此，當我們查看全行業或各州的醫療補助利潤率時，我們看到利潤率相對於歷史規範而言相當高，而且我認為這個數額將超過您所說的累計 50 個基點您假設的影響，我認為這至少在一定程度上被認為是暫時的。例如，如果行業層面的利潤率從 3% 上升到 2.5%，並且仍然高於目標利潤率或該行業的歷史盈利水平，您將如何應對。我想你為什麼認為各州會對此做出回應？

Well, states, they want a successful program, and they want payers such as Centene to deliver quality and savings, quite frankly, help them manage their budgets as well, especially with the complex populations. And so I wouldn't dug out going back in time, to get to the essence of your question, what was the HBR for both WellCare and Centene over an extended time period, meaning you don't sort of -- any year, you can have a little bit of a mismatch in trend and rate. But over an extended time, and let me just read you how consistent this has been.

嗯，各州，他們想要一個成功的計劃，他們希望像 Centene 這樣的付款人能夠提供質量和節省，坦率地說，幫助他們管理他們的預算，特別是對於復雜的人群。因此，我不會回到過去，去了解你問題的本質，WellCare 和 Centene 在很長一段時間內的 HBR 是多少，這意味著你不會 - 任何一年，你趨勢和匯率可能會有一點不匹配。但是在很長一段時間內，讓我告訴你這是多麼一致。

WellCare 2015, 89.8%; '16, 89.5%; '17, 88.8%; '18, 88.9%. Centene, 2015, 89.5%; '16, 89.8%, '17, 89.3%, '18, 89.5%, really consistent. And so we expect -- if we tick up into the, let's say, low 90s, we would expect to get that mismatch that we're building into guidance for 2024 sort of back into that high 89s. Obviously, mix of business will adjust that to some degree with complex populations having a little bit higher HBRs and lower SG&A. But we think that's the sweet spot, and that's what we expect to be able to achieve as we look out over the back half of the decade.

WellCare 2015，89.8%； '16, 89.5%; '17, 88.8%; '18, 88.9%。 Centene，2015 年，89.5%； '16, 89.8%, '17, 89.3%, '18, 89.5%, 非常一致。因此，我們預計 - 如果我們進入 90 年代的低位，我們預計我們正在構建的 2024 年指導中的不匹配會回到 89 年代的高位。顯然，業務組合將在一定程度上調整這一點，複雜的人群具有更高的 HBR 和更低的 SG&A。但我們認為這是最佳點，也是我們期待在這十年的後半期能夠實現的目標。

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。

Going back to the Medicare business Sarah, you had talked about following membership growth to focus on your core members. I'm curious how that will impact your view of Medicare revenue growth longer term relative to the high single-digit to 10% revenue growth guidance you laid out at the Analyst Day. And on margins for that business, can you maybe talk about the investments that you're making in 2024 and how significant those are? And is there any change to the way you're thinking about the longer-term margins for that business?

回到 Medicare 業務 Sarah，你談到了關注會員增長以關注你的核心會員。我很好奇這將如何影響你對醫療保險收入長期增長的看法，相對於你在分析師日提出的高個位數到 10% 的收入增長指導。關於該業務的利潤率，您能否談談您在 2024 年進行的投資以及這些投資的重要性？您考慮該業務的長期利潤率的方式是否有任何變化？

Yes. Thanks, Nathan, for the question. So in some ways, I think, to your question in terms of rate and pace of revenue growth, it's not dissimilar to how we're thinking about the rate and pace of STARS, which is going a little bit slower in the short term in order to ramp up in the long term. And so as we looked at all of the moving parts relative to the starts headwind we have in '24. And obviously, the work we're doing to sort of rebuild the business given the decentralization of the WellCare operations in '21 and '22 AEP bid strategy as well as the rates from CMS, we looked at '24 as an opportunity to kind of do a hard reset on that membership and that to create a pretty solid foundation for us to grow earnings off of -- over the long term.

是的。謝謝，內森，提出這個問題。所以在某些方面，我認為，對於你關於收入增長速度和速度的問題，這與我們對 STARS 的速度和速度的思考方式沒有什麼不同，後者在短期內會稍微慢一些以便長期提升。因此，當我們查看與 24 年開始逆風相關的所有移動部件時。顯然，考慮到 21 年和 22 年 AEP 投標策略中 WellCare 業務的分散化以及 CMS 的費率，我們正在做的重建業務的工作，我們將 24 年視為一個機會對該會員資格進行硬重置，並為我們創造一個非常堅實的基礎，以便從長遠來看增加收入。

And obviously, the shorter-term view of that would be more around margin and then driving membership growth in the long term as we start to feather in the tailwind from the STARS. And again, the revenue from getting to 3.5% and then that health equity adjustment and then normal course program investments that we'll get more of those contracts and that membership up into 4 stars.

顯然，短期來看，這將更多地圍繞利潤率，然後隨著我們開始從 STARS 中受益，從長遠來看推動會員增長。再一次，從達到 3.5% 的收入，然後是健康公平調整，然後是正常的課程計劃投資，我們將獲得更多的合同和會員資格，達到 4 星。

And then relative to investments, let me talk about some of the investments that are more specific to Medicare. But again, they really do fit into the broader category of investments around customer experience, quality and then sort of underlying infrastructure, particularly around data. The idea of -- Jim talked about leveraging an own distribution channel to maximize the acquisition and onboarding experience for our members making sure that we have the right provider enablement tools so that we can expand and optimize our value-based relationships and then increasing our self-service tools for members as well as the quality investments around HEDIS and Health Equity.

然後相對於投資，讓我談談一些更具體到醫療保險的投資。但同樣，它們確實適合圍繞客戶體驗、質量以及底層基礎設施（尤其是數據）進行更廣泛的投資類別。這個想法——Jim 談到了利用自己的分銷渠道來最大化我們會員的獲取和入職體驗，確保我們擁有正確的提供商支持工具，以便我們可以擴展和優化我們基於價值的關係，然後提高我們的自我-面向會員的服務工具以及圍繞 HEDIS 和 Health Equity 的優質投資。

We think those are -- there's going to be some upfront investment, obviously, to set up those capabilities, but I think those will also layer into the overall P&L for Medicare. But because each one of those investments is high impact in terms of driving long-term value of customer, driving down the cost to manage a member that we ultimately think that they won't have an impact on long-term margins -- long-term target margins in Medicare.

我們認為這些 - 顯然會有一些前期投資來建立這些能力，但我認為這些也將融入醫療保險的整體損益表中。但由於這些投資中的每一項都在推動客戶的長期價值方面產生了重大影響，降低了管理會員的成本，我們最終認為它們不會對長期利潤產生影響 - 長期 - Medicare 中的長期目標利潤率。

And our question today comes from Scott Fidel at Stephens.

我們今天的問題來自 Stephens 的 Scott Fidel。

Interested just to get your input into the debate that's going on right now just around core health care utilization trends and how those are tracking, excluding COVID just looking at sort of non-COVID, how those are tracking relative to pricing expectations. And maybe you could give us some input into certain areas there you may see utilization running a bit higher and what some of those offsets may be in terms of what seems to be trying to get a bit better than expected.

有興趣讓您參與目前正在進行的圍繞核心醫療保健利用趨勢以及這些趨勢如何跟踪的辯論，不包括 COVID 只是看看某種非 COVID，這些趨勢如何相對於定價預期進行跟踪。也許你可以給我們一些關於某些領域的投入，在那裡你可能會看到利用率有點高，而這些抵消中的一些可能是在試圖比預期好一點的方面。

Thanks, Scott. Trends look stable in the quarter. We sort of look back to pre-COVID time periods largely back to normalized utilization. For instance, screenings are fully back or a little bit soft on cervical, but they changed the -- I think it changed the guidance on that in 2020. We keep on looking for signs of acuity increase and aren't finding any. Looking at the first few months after initial cancer diagnosis or the cost per cancer diagnosis, those are all in check. So pretty stable.

謝謝，斯科特。本季度的趨勢看起來很穩定。我們有點回顧 COVID 之前的時間段，主要是回到正常化的利用率。例如，宮頸篩查完全恢復或有點軟，但他們改變了——我認為它改變了 2020 年的指導。我們一直在尋找敏銳度增加的跡象，但沒有找到任何跡象。查看初次癌症診斷後的前幾個月或每次癌症診斷的費用，這些都在檢查中。非常穩定。

I mean there's always watch items. When you are specialty pharmacy, obviously, is always a watch item. It has been for probably the last decade. We're watching behavioral health costs. They're up a little bit year-over-year with some substance abuse and some of that's the waivers or the -- some of the prior auth rules that were -- curbs were put in during the COVID era. But really, really pretty stable trend as we look at the quarter. And a little bit positive, as I mentioned in my script in Medicare. Some of that was the flu was more heavily weighted Q4 versus Q1 and inpatient is slightly better, probably a Venn diagram with the flu, less inpatient flu, but as a whole is a little bit better than Q1 of last year.

我的意思是總是有手錶項目。當你在專業藥房時，很明顯，永遠是一個值得關注的項目。大概在過去的十年裡。我們正在關注行為健康成本。他們在一些藥物濫用方面比去年同期有所上升，其中一些是豁免，或者——一些先前的授權規則——在 COVID 時代實施了限制。但是，從本季度來看，趨勢確實非常穩定。正如我在 Medicare 的腳本中提到的那樣，有點積極。其中一些是流感在第四季度比第一季度更重，住院病人略好，可能是流感的維恩圖，住院流感較少，但總體上比去年第一季度好一點。

And ladies and gentlemen, our next question comes from Sarah James at Cantor Fitzgerald.

女士們，先生們，我們的下一個問題來自 Cantor Fitzgerald 的 Sarah James。

I wanted to understand your updated marketplace assumptions for '24. So you're assuming some of the low acuity falls off on the Medicaid, I'm wondering if you're assuming any of that risk profile evolved in the Marketplace as a whole in '24? And then based on some of the recent implementation changes by the states that seem to increasingly favor keeping people insured in some form. What do you have built into your new 2024 revenue guide for the overall Marketplace market size?

我想了解您對 24 年更新後的市場假設。所以你假設一些低敏銳度在醫療補助計劃上下降了，我想知道你是否假設任何風險狀況在 24 年整個市場中演變？然後根據各州最近的一些實施變化，這些變化似乎越來越傾向於以某種形式為人們提供保險。對於整個市場市場規模，您在新的 2024 年收入指南中建立了什麼？

Sarah, thanks for the question. We are still assuming about 200,000 to 300,000 members in that Catcher's Mitt opportunity. And as we've rerun all of the assumptions across that multivariate model I mentioned, that hasn't really changed. And again, it's really a result of the waterfall and assumptions about where those members go -- with large chunks of those members going to employer-sponsored insurance or into the coverage gap. But I'll let Drew talk a little bit more about what we're building into our assumptions in terms of the acuity impact of those members.

莎拉，謝謝你的提問。我們仍然假設 Catcher's Mitt 機會中有大約 200,000 到 300,000 名成員。當我們在我提到的那個多變量模型中重新運行所有假設時，這並沒有真正改變。再一次，這實際上是瀑布和關於這些成員去向的假設的結果——這些成員中的很大一部分去雇主贊助的保險或進入覆蓋缺口。但我會讓德魯多談談我們在這些成員的敏銳度影響方面的假設。

Yes. So really pleased with the growth in the overall market. And as we've looked at data historically, as the market grows, the risk pool improves as well. I think the fortification of the enhanced APTCs, the advanced premium tax credits, was really helpful in solidifying this as sort of a market that's going to be strong for many years. So I think that's helped the risk pool.

是的。對整體市場的增長非常滿意。正如我們從歷史上看數據一樣，隨著市場的增長，風險池也會有所改善。我認為增強型 APTC 的強化，先進的保費稅收抵免，真的有助於鞏固這個市場，這個市場將持續多年。所以我認為這有助於風險池。

For us specifically, we're growing well beyond the market. Obviously, there was a couple of competitor exits. Those members it got first in the free market, and we picked up a fair amount of those, but those came in at our pricing, our clinical programs, our network construct, our products as if they were new members sort of off the street. And then we're also gaining market share.

具體來說，我們的增長遠遠超出了市場。顯然，有幾個競爭對手退出了。它首先在自由市場上獲得的那些成員，我們獲得了相當數量的成員，但這些成員是按照我們的定價、我們的臨床計劃、我們的網絡結構、我們的產品進來的，就好像它們是街邊的新成員一樣。然後我們也在獲得市場份額。

So we expect actually to be in a pretty large payable position for risk adjustment, and we're accruing accordingly. And obviously, we will true that up once we get the first look of Wakely data in late June, early July.

因此，我們預計實際上將處於一個相當大的風險調整應付頭寸，我們正在相應地累積。顯然，一旦我們在 6 月下旬、7 月初首次看到 Wakely 數據，我們就會證實這一點。

But pleased with some of the elements you look for. When you're growing a lot, you look for signals and through the data. The percentage of subsidized population is up 3% year-over-year to 95%. That's a good sign, we believe, for risk pools. And we can look at stayers versus leavers. We had a 75% renewal rate into '23. The stayers are equaling the leavers.

但對您尋找的某些元素感到滿意。當你成長很多時，你會尋找信號並通過數據。受補貼人口比例同比增長3%，達到95%。我們認為，對於風險池來說，這是一個好兆頭。我們可以看看留下來的人和離開的人。到 23 年，我們的續訂率為 75%。留下來的人等於離開的人。

So we're cautiously optimistic on that business and the risk pool for 2023. And as Sarah mentioned, we did layer in a couple of hundred thousand of redetermined members coming into the Marketplace later in the year. And so the member months aren't that significant of a driver. And we factored in some variance around that into our revenue guidance already.

因此，我們對該業務和 2023 年的風險池持謹慎樂觀態度。正如 Sarah 所提到的，我們確實在今年晚些時候將數十萬重新確定的成員加入了市場。因此，會員月份並不是那麼重要的驅動因素。我們已經在我們的收入指導中考慮了一些差異。

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。

I wanted to understand the long-term EPS guidance a little bit because it was just a little bit confusing to me because you're taking down this year's or say, next year's EPS number, still talking about 12% to 15%. But I think, Sarah, you said that your view about the earnings power hasn't changed. Does that mean that you think you'd be growing more like 15% off of this lower base? Or is 12% to 15% the right way to be thinking about it?

我想稍微了解一下長期 EPS 指導，因為它讓我有點困惑，因為你要記下今年或明年的 EPS 數字，仍然在談論 12% 到 15%。但我認為，莎拉，你說過你對盈利能力的看法沒有改變。這是否意味著您認為您的增長會比這個較低的基數低 15%？或者 12% 到 15% 是正確的思考方式嗎？

And then just to put a point on this PDR because the PDR is essentially taking whatever it is $0.25, $0.30 of losses from next year and booking it this year. So your $6.60 guidance, is it right to think that that's more like a fixed whatever that is $6.35 kind of real earnings base that you have to then overcome to grow 12% to 15% off of $6.60.

然後只是在這個 PDR 上強調一點，因為 PDR 基本上是從明年開始承擔 0.25 美元、0.30 美元的損失，並在今年入賬。所以你的 6.60 美元的指導，認為這更像是一個固定的 6.35 美元的實際收入基礎，然後你必須克服它才能從 6.60 美元增長 12% 到 15% 是正確的。

So just trying to reconcile how you're thinking about long-term earnings power, in particular the PDR and how that affects growth into 2025. Thanks.

所以只是想調和你對長期盈利能力的看法，特別是 PDR 以及它如何影響到 2025 年的增長。謝謝。

Yes, your math on the PDR is not wrong. And you're right, you've got to step over that as you go into '25, and we've thought about that. But I'd think of it more as not that linear because we're making bid decisions strategically and deciding where to invest and where it will let go, certain pockets or PBPs, as I mentioned in the script. And so it's helpful to know and to have the meaningful outperformance in '23 as yet another lever.

是的，您在 PDR 上的數學沒有錯。你是對的，當你進入 25 歲時，你必須超越它，我們已經考慮過了。但我更認為它不是線性的，因為我們正在戰略性地做出投標決策，並決定投資哪里以及放手哪裡，某些口袋或 PBP，正如我在腳本中提到的那樣。因此，了解並在 23 年取得有意義的出色表現作為另一個槓桿是有幫助的。

So I wouldn't completely disconnect the PDR from us knowing that we're doing well in 2023 as you think about what '24 would have been absent the PDR. And then I'll let Sarah sort of weigh in on the 12% to 15%.

因此，我不會完全斷開 PDR 與我們的聯繫，因為您知道我們在 2023 年表現良好，因為您會想到沒有 PDR 會發生什麼 '24。然後我會讓 Sarah 權衡 12% 到 15%。

Yes. Thanks for the question. And totally appreciated. When we think about the long term, and I'll roll back to even in the beginning value creation plan, we had a lot of confidence that there was more earnings power in this organization than we were delivering back to shareholders then. I think that confidence a year ago had only grown.

是的。謝謝你的問題。並完全讚賞。當我們考慮長期時，我會回滾到甚至在開始的價值創造計劃中，我們非常有信心這個組織的盈利能力比我們當時回饋給股東的能力更強。我認為一年前的信心只會增強。

The difference between then and now, I think, is a really more complete understanding of what it's going to take to fully unlock that value. And so we still have total confidence in that 12% to 15% long-term CAGR.

我認為，過去和現在的區別在於對完全釋放該價值所需要的條件有更全面的了解。因此，我們仍然對 12% 至 15% 的長期復合年增長率充滿信心。

I think our view is that we need to make some of these short-term both explicit and implicit investments in our business in order to make sure that we are set up with the most strength against that long-term algorithm. And as Drew said, we see the $6.60 or greater than $6.60 floor as the right jump-off point for that 12% to 15% adjusted EPS in the long term.

我認為我們的觀點是，我們需要對我們的業務進行一些短期的顯性和隱性投資，以確保我們在長期算法方面擁有最大的優勢。正如德魯所說，我們認為 6.60 美元或高於 6.60 美元的底價是長期調整後每股收益 12% 至 15% 的正確起點。

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。

Two quick questions. The first is I appreciate your commentary about receiving new data state files from the states to update your margin assumptions around Medicaid. So the question is, is that largely complete? Have you received updated stayer or leaver files from all your states? Or is it really more from the states that are very imminently beginning the redeterminations and we should maybe expect more material updates on that state information to come over the course of the year?

兩個快速問題。首先，我感謝您關於從各州接收新數據狀態文件以更新您對醫療補助計劃的保證金假設的評論。所以問題是，這基本上完成了嗎？您是否收到了來自所有州的更新的留校或離校文件？或者它真的更多來自那些迫在眉睫的重新確定的州，我們應該期待在這一年中對該州信息進行更多的材料更新？

The second is just on the IBNR days and dollars down a bit sequentially. I know there's some other items in that line. Just wondering if there's anything else through the call-out impacting that line on the balance sheet.

第二個是 IBNR 天數和美元連續下跌一點。我知道該行中還有其他一些項目。只是想知道通過標註是否還有其他任何影響資產負債表上的那條線。

Yes. Let me -- I'll hit the state files conversation and turn over to Drew. So we have -- as I mentioned, we're in all but 5 of our states. We either have received files or we have a process in place. The files that we've gotten have certainly been tilted towards the states that are already underway with their process or where their start dates are more imminent. And this actually rolls back to a conversation that we've had over the last 1.5 years in this forum about how we were preparing for this process and the idea that as we got data, our ability to drop that into our model and then extrapolate from that where there were common themes. And whether we were seeing in those files, stayer and leaver analysis that was sort of in line with the macro analysis we did without the benefit of the actual files.

是的。讓我——我將開始國家文件對話，然後交給德魯。所以我們有——正如我提到的，我們在除 5 個州之外的所有州。我們要么已經收到文件，要么已經制定了流程。我們收到的文件肯定傾向於已經在進行流程的狀態，或者它們的開始日期更迫在眉睫。這實際上可以追溯到過去 1.5 年我們在這個論壇上進行的一次對話，內容涉及我們如何為這個過程做準備，以及當我們獲得數據時，我們有能力將其放入我們的模型中，然後從中進行推斷那裡有共同的主題。以及我們是否在這些文件中看到，停留者和離開者分析是否與我們在沒有實際文件的情況下所做的宏觀分析一致。

And so getting those files is obviously helpful in order to give us a view of those specific states, but we've also been seeing trends in those files, again, largely in line with our expectations but allowed us to update our extrapolations in the larger model. So that's a long-winded way of saying that we feel like the data that we've received so far is what has allowed us to update our view and conservatism in '24. But then we also think that it has given us a pretty solid view of '24 and what will come in from other states. Now obviously, we need to some of that, but there's been enough consistency to give us the confidence to share what we did today. And then I'll turn it over to Drew on IBNR.

因此，獲取這些文件顯然有助於我們了解這些特定狀態，但我們也一直在這些文件中看到趨勢，同樣，這在很大程度上符合我們的預期，但允許我們在更大範圍內更新我們的推斷模型。因此，這是一種冗長的說法，我們覺得到目前為止收到的數據使我們能夠在 24 年更新我們的觀點和保守主義。但我們也認為它讓我們對 24 年以及其他州會發生什麼有了一個非常可靠的看法。現在很明顯，我們需要其中的一些，但已經有足夠的一致性讓我們有信心分享我們今天所做的事情。然後我會把它交給 IBNR 上的德魯。

Yes. On the balance sheet, liabilities are up a fair amount from year-end, 12/31/22. The accounts payable and accrued expenses are up, but that's $1.3 billion of state pass-throughs. So our pass-throughs -- the pure pass-throughs actually don't go through medical claims liability. They go through premium revenue and -- or sorry, premium tax revenue and premium tax expense sort of outside the IBNR process. So they don't really impact DCP.

是的。在資產負債表上，負債較年末 22 年 12 月 31 日增加了相當數量。應付賬款和應計費用有所增加，但這是 13 億美元的州轉嫁費用。所以我們的傳遞——純粹的傳遞實際上不經歷醫療索賠責任。他們通過 IBNR 流程之外的保費收入和 - 或者抱歉，保費稅收和保費稅收支出。所以他們並沒有真正影響 DCP。

Now there are state-directed payments embedded within medical claims liability, and we define those terms in our press release and we've had for a while. But IBNR is $17.5 billion or medical claims liability up from $16.7 million. You saw the DCP relatively flat. So feel good about the consistency of our reserving process.

現在醫療索賠責任中嵌入了國家指導的支付，我們在新聞稿中定義了這些術語，我們已經有一段時間了。但 IBNR 是 175 億美元或醫療索賠責任，高於 1670 萬美元。你看到 DCP 相對平坦。因此，對我們預訂過程的一致性感到滿意。

And our next question today comes from Lance Wilkes with Bernstein.

我們今天的下一個問題來自 Lance Wilkes 和 Bernstein。

Yes. With the $0.55 decline in 2024, I think you've kind of sketched out how much of that is due to the conservatism and redetermination. Could you talk a little bit about how much is from the targeted investments in MA bids or MA in your bid strategy there? And how much is investment in infrastructure and of the investments in infrastructure, could you talk a little more about the components of that? And how much of that is necessary for the Medicaid business and the core businesses as contrasted with Medicare Advantage.

是的。隨著 2024 年 0.55 美元的下跌，我想你已經大致勾勒出其中有多少是由於保守主義和重新決定造成的。您能否談談那裡的出價策略中有多少來自 MA 出價或 MA 的目標投資？基礎設施投資和基礎設施投資有多少，你能多談談其中的組成部分嗎？與 Medicare Advantage 相比，其中有多少是 Medicaid 業務和核心業務所必需的。

Yes. Thanks, Lance. Great question. I was hoping you would ask that. Let me talk through sort of the core buckets of investment, and then I'll hand it over to Drew to delineate the bridge a little bit more precisely. So as we've gone through the transformation work, the value creation work, particularly the platform consolidation work that we launched last quarter and then, obviously, the sort of updated analysis of product strategy, we see an opportunity in 3 main buckets for investments.

是的。謝謝，蘭斯。很好的問題。我希望你會問那個。讓我談談投資的核心部分，然後我會把它交給德魯來更準確地描述這座橋。因此，當我們完成轉型工作、價值創造工作，特別是我們上個季度啟動的平台整合工作，然後顯然是對產品戰略的更新分析時，我們看到了 3 個主要投資領域的機會.

And it's important to note, and I'll call out where some of them are specific to Medicare and other product lines, as you asked but it's important to note that part of the reasons we're making to make these investments now is because they will accrue to multiple lines of business. So these are really enterprise-wide synergistic investments.

重要的是要注意，我會指出其中一些特定於醫療保險和其他產品線的地方，正如你所問的，但重要的是要注意，我們現在進行這些投資的部分原因是因為它們將累積到多個業務線。因此，這些實際上是企業範圍內的協同投資。

The first is under the umbrella of customer experience. And so this is where in Medicare thinking about own distribution channels, which actually can accrue over the long term, we believe, to our Marketplace business as well, really our business is becoming a sold business rather than one that is just purchased and influenced through brokers in a different way.

首先是在客戶體驗的保護傘下。因此，這就是 Medicare 考慮自己的分銷渠道的地方，我們相信，從長遠來看，這實際上可以積累到我們的市場業務中，實際上我們的業務正在成為一種銷售業務，而不是剛剛購買和影響的業務經紀人以不同的方式。

Provider enablement tools, which again, will help with VBC expansion in Medicare, but also will support the VBC expansion work that we're doing in Medicaid and then those self-service tools which we see an opportunity across lines of business to sort of enhance our digital interaction with our members.

提供者支持工具，這將再次幫助醫療保險中的 VBC 擴展，但也將支持我們在醫療補助中進行的 VBC 擴展工作，然後是我們認為跨業務線有機會增強的自助服務工具我們與會員的數字互動。

The second major bucket is quality. And again, this is one where STARS is a piece of this, but the underlying components are really around HEDIS and HealthEquity, which are major components of the quality programs for all 3 lines of business.

第二大桶是質量。再一次，這是 STARS 的一部分，但底層組件實際上圍繞 HEDIS 和 HealthEquity，它們是所有 3 個業務線的質量計劃的主要組成部分。

So HEDIS is going to become an increasingly important part of STARS based on the new CMS guidance as are the HealthEquity investments. HEDIS is a huge part of proving the quality outcomes to our state partners for Medicaid, and it will put us ahead of the curve for what we see coming in marketplace from a QRS standpoint.

因此，根據新的 CMS 指南，HEDIS 將成為 STARS 越來越重要的一部分，HealthEquity 投資也是如此。 HEDIS 是向我們的醫療補助州合作夥伴證明質量結果的重要組成部分，它將使我們領先於我們從 QRS 的角度看到的市場曲線。

And then the last piece is infrastructure. And so a piece of that is really fortifying those target systems. So as we've been thinking about the platform consolidation, what are those platforms that are going to be the targets and carry the scale of the organization in the back half of the decade and making sure that we fortify those for scale.

然後最後一部分是基礎設施。因此，其中一部分確實在強化這些目標系統。因此，當我們一直在考慮平台整合時，哪些平台將成為目標並在本世紀後半段承載組織的規模，並確保我們強化這些平台以實現規模化。

And then, of course, my favorite topic, which is data and really accelerating the work that we're doing around data liquidity across the organization, our agility and ability to invest and use that data to power the business, but also to drive innovation. So those are sort of the 3 major investment buckets. And again, some of those accrue to the Medicare business, but they all accrue to multiple business lines, and then I'll turn it over to Drew to give you the bridge.

然後，當然是我最喜歡的話題，那就是數據，真正加速我們圍繞整個組織的數據流動性所做的工作，我們投資和使用數據來推動業務的敏捷性和能力，同時也推動創新.所以這些是 3 個主要的投資桶。再一次，其中一些歸於醫療保險業務，但它們都歸於多個業務線，然後我會把它交給德魯給你橋樑。

Yes. On the numbers, we've talked about the $200 million PDR. I know that hits 2023, so it's not part of the $0.55, but you really need to think about that as a conscious investment. We don't take lightly spending shareholder money, but we think it's the right investments, targeting the right members, thinking about the long-term attractiveness of the Medicare market, especially in the populations that we will emphasize going forward. And then getting to the $0.55, which is in 2024, 60% of that is the 30 basis points in Medicaid and the remaining 40%, about $150 million, plus or minus, is the investments that Sarah just covered.

是的。關於數字，我們已經討論了 2 億美元的 PDR。我知道它會在 2023 年到期，因此它不屬於 0.55 美元的一部分，但您確實需要將其視為一項有意識的投資。我們不會輕易花股東的錢，但我們認為這是正確的投資，針對正確的成員，考慮到醫療保險市場的長期吸引力，特別是在我們未來將強調的人群中。然後到 2024 年的 0.55 美元，其中 60% 是醫療補助計劃的 30 個基點，其餘 40%，大約 1.5 億美元，正負是莎拉剛剛涵蓋的投資。

And ladies and gentlemen, our final question today comes from Calvin Sternick with JPMorgan.

女士們，先生們，我們今天的最後一個問題來自摩根大通的 Calvin Sternick。

Just a couple of clarifications. I know you're being conservative on the STARS assumption for next year. And you do get minimal improvement for '25? Is the expectation that, that comes back to you in '26 such that you kind of keep it that 20/20/20 ramp that you talked about over the next 3 years?

只是一些澄清。我知道你對明年的 STARS 假設持保守態度。而你在 25 年的進步微乎其微？是否期望在 26 年回到你身邊，這樣你就可以在接下來的 3 年裡保持你談到的 20/20/20 斜坡？

And then on Medicaid, I know you mentioned having more member months this year and a little more visibility into the timing of when members could roll off. Just wondering if there's anything you're anticipating in terms of HBR or earnings seasonality?

然後在醫療補助計劃上，我知道你提到今年有更多的會員月，並且對會員何時可以退出的時間有了更多的了解。只是想知道您是否對《哈佛商業評論》或收益季節性有什麼預期？

Yes. Thanks, Cal. Let me hit the STARS question. So if we -- as I said, we are sort of assuming a downside scenario out of conservatism, partly because cap tends to be the longest pole in the tent to recover in STARS. And so if we see minimal improvement year-over-year, the important thing to look at will be the progression into 3.5 stars of our membership because, again, that's as Drew talked about, where we get the economic benefit and the ability to continue to invest as we move through the progression.

是的。謝謝，卡爾。讓我來回答 STARS 問題。因此，如果我們——正如我所說的那樣，出於保守主義的考慮，我們有點假設出現下行情況，部分原因是上限往往是 STARS 中恢復的最長桿。因此，如果我們看到同比增長微乎其微，那麼重要的是要關注我們的會員是否升級到 3.5 星，因為正如 Drew 所說的那樣，我們可以從中獲得經濟利益和繼續發展的能力在我們前進的過程中進行投資。

Again, we will look at the 3.5 star threshold and movement of membership across that threshold as the definition of success as we move through the next couple of years. But the 20/20/20 is not really a relevant guide post anymore because of those changes I described in the bid strategy, which is intentionally going to make the mix more complicated and shift the denominator and the fact that the CMS program rules really suggest a different, more methodical approach contract by contract to the levers that we use to get to 4 star. And then I'll turn it over to Drew for the second part.

同樣，在接下來的幾年中，我們將把 3.5 星門檻和會員跨越該門檻的移動視為成功的定義。但是 20/20/20 不再是一個真正相關的指南帖子，因為我在出價策略中描述了這些變化，有意使組合更加複雜並改變分母，而且 CMS 程序規則確實表明一種不同的、更有條理的方法，一個接一個地收縮我們用來達到 4 星的槓桿。然後我會把它交給 Drew 做第二部分。

Yes. On earnings seasonality, where we expect to be pushing about 65% of adjusted EPS for 2023 in the first half of the year, so maybe 35% or slightly under 35% for the back half of the year. That back half does include the fourth quarter assumption around the PDR. And I think you're also referring to HBR seasonality in Medicaid. Think of it as like a check mark. So we expect to be down a little bit in Q2 relative to the 90.0% and then rising in the back half of the year.

是的。關於收益季節性，我們預計上半年將推動 2023 年調整後每股收益的 65% 左右，因此下半年可能達到 35% 或略低於 35%。後半部分確實包括圍繞 PDR 的第四季度假設。而且我認為您還指的是醫療補助計劃中的 HBR 季節性。把它想像成一個複選標記。因此，我們預計第二季度相對於 90.0% 會略有下降，然後在下半年上升。

Thank you. Ladies and gentlemen, that's all the time we have for questions today. So I'd like to turn the conference back over to Sarah London for closing remarks.

謝謝。女士們，先生們，這就是我們今天所有的提問時間。因此，我想將會議轉回 Sarah London 的閉幕詞。

I just want to close out by reiterating Drew's comments and my own that we don't take the change in the 2024 lightly, but it's not something that we would be doing if we didn't firmly believe that it was the right thing for Centene in the long term. So I appreciate the great questions, appreciate everyone joining us today and look forward to updating you as we continue to execute in 2023 and build momentum for 2024 in the long term.

我只想重申 Drew 的評論和我自己的評論，即我們不會輕視 2024 年的變化，但如果我們不堅信這對 Centene 來說是正確的事情，我們就不會這樣做在長期。因此，我感謝大家提出很好的問題，感謝今天加入我們的每一個人，並期待在我們繼續執行 2023 年並為 2024 年長期建立勢頭的過程中為您提供最新信息。

Thank you, ma'am. 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.

謝謝你，女士。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。