Centene Corp (CNC) 2023 Q2 法說會逐字稿

Good day, and welcome to the Centene Second Quarter 2023 Earnings Conference Call. (Operator Instructions) Please note, today's event is being recorded.

美好的一天，歡迎參加 Centene 2023 年第二季度收益電話會議。 （操作員說明）請注意，今天的活動正在錄製中。

I would now like to turn the conference over to Jennifer Gilligan, Senior Vice President, Investor Relations. Please go ahead, ma'am.

我現在想將會議交給投資者關係高級副總裁詹妮弗·吉利根 (Jennifer Gilligan)。請繼續，女士。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our second 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, will also be available as a participant during Q&A.

謝謝羅科，大家早上好。感謝您參加我們的第二季度收益電話會議。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 訪問該電話會議。 Centene 總裁 Ken Fasola 也將參加問答環節。

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言論均構成前瞻性陳述，以符合 1995 年《私人證券訴訟改革法案》中的安全港條款。實際結果可能與這些前瞻性陳述所表明的結果存在重大差異這是由於各種重要因素造成的，包括 Centene 於 2023 年 2 月 21 日提交的最新 10-K 表格以及其他公開的 SEC 文件中討論的因素。

Centene anticipates that subsequent events and developments may cause its estimates to change. While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so.

Centene 預計後續事件和事態發展可能會導致其估計發生變化。雖然公司可能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 second quarter 2023 press release, which is available on the company's website under the Investors section. The company is unable to provide a reconciliation of certain 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.

此次電話會議還將提及某些非公認會計準則措施。這些指標與最直接可比的 GAAP 指標的調節可以在我們的 2023 年第二季度新聞稿中找到，該新聞稿可在公司網站的“投資者”部分下找到。由於難以在合理範圍內預測各種項目的時間和金額，如果不付出不合理的努力，公司就無法提供某些 2024 年措施與相應 GAAP 措施的對賬。

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

說到這裡，我想將電話轉給我們的首席執行官莎拉·倫敦 (Sarah London)。莎拉？

Thank you, Jen, and good morning. Thank you for joining us for Centene's Q2 earnings call.

謝謝你，珍，早上好。感謝您參加 Centene 第二季度財報電話會議。

Our second quarter performance demonstrated Centene's ability to deliver solid results amid a dynamic health care landscape. We reported $2.10 of adjusted diluted EPS for the quarter and lifted our 2023 premium and service revenue forecast by another $1.8 billion. We now expect to deliver at least $6.45 of adjusted EPS for full year 2023, a $0.05 increase compared to April guidance.

我們第二季度的業績證明了 Centene 有能力在動態的醫療保健環境中提供堅實的業績。我們公佈的本季度調整後攤薄每股收益為 2.10 美元，並將 2023 年保費和服務收入預測再上調 18 億美元。我們現在預計 2023 年全年調整後每股收益至少為 6.45 美元，比 4 月份的指導增加 0.05 美元。

We are proud of the progress we are making with respect to the execution of our strategy, achieving operational milestones, while delivering on the financial commitments we've made to our shareholders. Importantly, our balanced portfolio of core businesses delivered strong second quarter financials, with marketplace growth and Medicaid performance both running slightly ahead of expectation.

我們為我們在執行戰略、實現運營里程碑以及履行對股東做出的財務承諾方面所取得的進展感到自豪。重要的是，我們均衡的核心業務組合帶來了強勁的第二季度財務業績，市場增長和醫療補助業績均略高於預期。

Let me provide a few updates related to our progress in each business line, and then share the latest on our value creation work. Let's start with Medicaid.

讓我提供一些與我們每個業務線的進展相關的最新信息，然後分享我們價值創造工作的最新進展。讓我們從醫療補助開始。

Since our Q1 call, Medicaid redeterminations have formally kicked off in every one of our 30 active states. The time our team spent over the last 18 months preparing for redeterminations has positioned us well to support our state partners, establishing timely information exchange and shared workflow as well as reaching out directly to members to provide education around process and enrollment options.

自第一季度電話會議以來，醫療補助重新確定已在我們 30 個活躍州中的每一個州正式啟動。我們的團隊在過去 18 個月中花費了時間準備重新確定，這使我們能夠很好地支持我們的州合作夥伴，建立及時的信息交換和共享工作流程，並直接與會員聯繫以提供有關流程和註冊選項的教育。

Year-to-date, we have made 9 million outreach attempts, with early indications of higher-than-normal member engagement. These outreach efforts, inclusive of more than 15,000 community events, also contribute to our ability to recapture members, even if initially disenrolled as part of redeterminations. We are actively tracking the number of members that we are recapturing post-procedural disenrollment and expect the percentage to meaningfully advance as this process unfolds.

今年迄今為止，我們已進行了 900 萬次外展嘗試，早期跡象表明會員參與度高於正常水平。這些外展工作，包括超過 15,000 場社區活動，也有助於我們重新吸引成員，即使最初是作為重新決定的一部分而被取消的。我們正在積極跟踪程序後重新註冊的會員數量，並預計隨著這一過程的展開，該比例將顯著提高。

At an enterprise level, net Medicaid membership is consistent with expectations. We have seen ebbs and flows from month to month as states continue to evolve and refine their processes. Given the recent news that CMS is requiring states -- certain states to pause redeterminations and reinstate members who were dropped for procedural reasons, we will be closely tracking any impact this may have on the membership slope over the next few months.

在企業層面，醫療補助淨會員資格符合預期。隨著各州不斷發展和完善其流程，我們每個月都會看到潮起潮落。鑑於最近有消息稱 CMS 要求各州（某些州）暫停重新決定並恢復因程序原因被剔除的成員，我們將密切跟踪這可能對未來幾個月的成員傾斜產生的任何影響。

Much of the redeterminations' journey remains ahead, and we continue to monitor the major levers, including rate, acuity and membership. Based on our most recent analysis and informed by member lists and acuity projections from our state partners, our expectation around member acuity for 2023 remains unchanged.

大部分重新決定的旅程仍在前方，我們將繼續監控主要槓桿，包括比率、敏銳度和會員資格。根據我們最新的分析以及會員名單和州合作夥伴的敏銳度預測，我們對 2023 年會員敏銳度的預期保持不變。

As we assess who is staying versus leaving, we are tracking consistent with the acuity modeling we discussed on our first quarter call in April. Medicaid rate conversations continue to be constructive. We are consistently seeing states take acuity adjustments into consideration in their rate updates. And at an enterprise level, we remain on track with our expectations for 2023.

當我們評估誰留下來還是離開時，我們正在跟踪與我們在四月份第一季度電話會議上討論的敏銳度模型一致的情況。醫療補助費率對話仍然具有建設性。我們不斷看到各州在利率更新中考慮到敏銳度調整。在企業層面，我們仍符合 2023 年的預期。

Overall, we are grateful for the partnership and trust placed with us by the states we serve and for the leadership CMS has shown in helping us to ensure that eligible Medicaid members do not experience unnecessary coverage gaps as states work through the unprecedented scale of this redetermination process.

總體而言，我們感謝我們所服務的各州給予我們的合作夥伴關係和信任，也感謝 CMS 在幫助我們確保符合資格的醫療補助成員在各州努力完成這一前所未有的規模的重新確定過程中不會遇到不必要的承保缺口方面所表現出的領導力。過程。

From a Medicaid business development standpoint, we chalked an exciting new business win in June, as our team in Oklahoma was selected by the Oklahoma Healthcare Authority for statewide contracts to provide managed care for the SoonerSelect and SoonerSelect Children's Specialty Plan programs. The team delivered a strong RFP response and was the sole source winner for the Children's Specialty program, designed to serve children and families involved in the child welfare and juvenile systems, including foster care. This represents Centene's 31st state and our sixth Sole Source Foster Care contract.

從醫療補助業務發展的角度來看，我們在 6 月份取得了令人興奮的新業務勝利，因為我們在俄克拉荷馬州的團隊被俄克拉荷馬州醫療保健管理局選為全州範圍內的合同，為 SoonerSelect 和 SoonerSelect 兒童專業計劃項目提供管理式護理。該團隊對 RFP 做出了強烈的回應，並成為兒童專業項目的唯一獲獎者，該項目旨在為參與兒童福利和青少年系統（包括寄養）的兒童和家庭提供服務。這是 Centene 的第 31 個州，也是我們的第六份 Sole Source Foster Care 合同。

Overall, Medicaid, our largest and longest-running business, delivered strong results in the second quarter, and our market teams continue to prove the value of the local approach, demonstrating innovative and comprehensive support for our members and state partners as we continue to execute against redeterminations in the coming months and quarters.

總體而言，我們規模最大、運行時間最長的業務醫療補助在第二季度取得了強勁的業績，我們的市場團隊繼續證明本地方法的價值，在我們繼續執行的過程中，向我們的會員和州合作夥伴展示創新和全面的支持反對在未來幾個月和幾個季度重新做出決定。

Turning to Medicare. Our quarter-end membership was 1.3 million, with approximately 47% of Medicare Advantage lives associated with value-based care arrangements, a 300-basis-point increase from Investor Day as we've added key VBC partners to our network. Second quarter results reflect some slightly higher outpatient claims experience within Medicare during the month of May. Drew will provide more detail on this as well as our bid posture for 2024, but it is worth noting that our increased 2023 adjusted EPS guidance incorporates our latest view of trend and pockets of slightly higher Medicare utilization in the back half of the year should that occur.

轉向醫療保險。我們的季度末會員人數為 130 萬，大約 47% 的 Medicare Advantage 生活與基於價值的護理安排相關，比投資者日增加了 300 個基點，因為我們將主要 VBC 合作夥伴添加到了我們的網絡中。第二季度的結果反映出 5 月份 Medicare 內的門診索賠經歷略有增加。德魯將提供有關此問題的更多詳細信息以及我們對 2024 年的投標姿態，但值得注意的是，我們增加的 2023 年調整後每股收益指導包含了我們對趨勢的最新看法以及今年下半年醫療保險利用率略高的情況，如果這樣的話發生。

Given our discussion in Q1 around Star, I'd like to provide an update on what we expect to see in October and what we are seeing year-to-date around Star's improvement efforts that will inform future results. As a reminder, on our Q1 call in April, I shared that we expected minimal progress in 4-star plans, but that we anticipated solid overall contract improvement, reflecting the operational investments we have made. With more complete program data, our projection show some more pressure on 4-star results, but we are still expecting solid overall contract progression, thanks to strong improvements in admin and ops and pharmacy measures, which have been our focus in this first cycle.

鑑於我們在第一季度圍繞 Star 進行的討論，我想提供有關我們在 10 月份預計會看到的情況以及我們今年迄今為止所看到的圍繞 Star 改進工作的最新信息，這些改進工作將為未來的結果提供信息。提醒一下，在四月份的第一季度電話會議上，我表示我們預計四星級計劃的進展微乎其微，但我們預計整體合同將得到穩健改善，這反映了我們所做的運營投資。有了更完整的計劃數據，我們的預測顯示四星級結果面臨更大的壓力，但我們仍然期望整體合同進展穩健，這要歸功於管理、運營和藥學措施的大力改進，這一直是我們第一個週期的重點。

With several contracts close to the bubble, variability in cut points means we could end the cycle with no 4-star contracts compared to our current single contract representing 2.7% of members. While this is disappointing, we do expect to see meaningful movement in our 3- and 3.5-star bands in October, and roughly 2/3 of our members are in plans showing year-over-year improvement. Pulling up these underperforming contracts represents tangible progress in delivering economic value to Medicare as we look to 2025 and beyond.

由於幾份合同接近泡沫，切割點的變化意味著我們可以在沒有四星級合同的情況下結束週期，而我們目前的單一合同佔會員的 2.7%。雖然這令人失望，但我們確實預計 10 月份我們的 3 星和 3.5 星樂隊會出現有意義的變化，並且大約 2/3 的會員計劃顯示出同比改善。展望 2025 年及以後，取消這些表現不佳的合同代表著在為 Medicare 創造經濟價值方面取得了切實進展。

As a reminder, in Q1, we reset our quality strategy to maximize contracts that reach the 3.5-star threshold, consistent with our renewed focus on serving complex and dual-eligible members beginning with our 2024 bids. Put simply, Star strategy is different when you're managing complex and duals populations. Strong performance at 3.5 stars with Centene's target member mix will give our Medicare business the economics necessary to serve these populations well and support our multiyear performance goals.

提醒一下，在第一季度，我們重新調整了質量策略，以最大限度地提高達到 3.5 星門檻的合同，這與我們從 2024 年投標開始重新關注為複雜和雙重資格會員提供服務的重點是一致的。簡而言之，當您管理複雜和雙重群體時，明星策略是不同的。 Centene 目標會員組合的 3.5 星強勁表現將為我們的醫療保險業務提供良好的服務所需的經濟性並支持我們的多年績效目標。

With this in mind, we have set a revised target of reaching 85% of members in 3.5 star plans by October of 2025. We are closely monitoring in-year Star metrics and continue to see important markers of sustained improvement, consistent with our remarks on the Q1 call. A few examples include: a 27% reduction in year-over-year call volumes resulting from a redesigned member onboarding process that features digital outreach and member self-service; consistent 4-star performance in our core admin and ops metrics; call center service levels for members, providers and brokers at or above target with first call resolution in the mid-80s; year-to-date, member provider and broker satisfaction scores in the mid-90s and the addition of 24,000 new physicians across our Medicare network year-to-date as we look to ensure robust access options for our members.

考慮到這一點，我們制定了修訂後的目標，即到 2025 年 10 月讓 85% 的會員參與 3.5 星級計劃。我們正在密切關注年內的星級指標，並繼續看到持續改進的重要標誌，這與我們在Q1 通話。一些例子包括：由於重新設計的會員入職流程（以數字化推廣和會員自助服務為特色），通話量同比減少了 27%；我們的核心管理和運營指標始終保持四星級績效；會員、提供商和經紀人的呼叫中心服務水平達到或高於目標，首次呼叫解決率在 80 年代中期；今年迄今為止，會員提供者和經紀人的滿意度得分在 90 年代中期，並且我們的 Medicare 網絡今年迄今增加了 24,000 名新醫生，因為我們希望確保為我們的會員提供強大的訪問選擇。

Medicare Advantage provides Centene with an important opportunity to serve low-income and medically complex seniors. It also represents a significant long-term earnings opportunity as we strengthen the overall performance and trajectory of our program.

Medicare Advantage 為 Centene 提供了為低收入和病情複雜的老年人提供服務的重要機會。隨著我們加強計劃的整體績效和發展軌跡，它也代表了一個重要的長期盈利機會。

Moving to marketplace. Our Ambetter Health franchise continues to outperform. This truly differentiated asset creates a unique growth opportunity for Centene, both near and long term. We ended the quarter with 3.3 million marketplace lives exceeding our previous projections.

轉移到市場。我們的 Ambetter Health 特許經營業務繼續表現出色。這種真正差異化的資產為 Centene 創造了獨特的近期和長期增長機會。本季度末，我們的市場壽命達到 330 萬，超出了我們之前的預測。

Our strong membership results were driven by strategic product design, long-standing and differentiated broker relationships and overall market growth. Our large and growing marketplace platform is well positioned to provide coverage to beneficiaries losing Medicaid eligibility from redeterminations, and we are leveraging our networks and engagement tools to support members during this transition.

我們強勁的會員業績是由戰略產品設計、長期且差異化的經紀商關係以及整體市場增長推動的。我們龐大且不斷增長的市場平台處於有利地位，可以為因重新確定而失去醫療補助資格的受益人提供保險，並且我們正在利用我們的網絡和參與工具在這一過渡期間為會員提供支持。

Where states allow, we are educating our Medicaid members about marketplace options and are working to proactively communicate with members who we predict will likely be eligible for marketplace in order to preserve continuity of coverage.

在各州允許的情況下，我們正在向醫療補助會員介紹市場選擇，並努力主動與我們預測可能有資格加入市場的會員進行溝通，以保持承保的連續性。

During just May and June, Ambetter Health successfully outreached to potential members with more than 160,000 digital touch points via e-mail or SMS as part of our redetermination efforts. We expect this dynamic will continue to fuel growth in marketplace throughout the remainder of the year and into 2024.

僅在 5 月和 6 月期間，作為我們重新確定工作的一部分，Ambetter Health 通過電子郵件或短信成功接觸了超過 160,000 個數字接觸點的潛在會員。我們預計這一動態將在今年剩餘時間和 2024 年繼續推動市場增長。

Finally, our value-creation initiatives are advancing well. We continue to take a rigorous approach to streamlining core SG&A as we focus and fortify the organization for the future. This includes additional work to standardize our operating model, while maintaining the hyper local care that differentiates Centene in the market.

最後，我們的價值創造計劃進展順利。我們將繼續採取嚴格的方法來精簡核心銷售、管理和行政費用（SG&A），以聚焦和強化組織的未來發展。這包括標準化我們的運營模式的額外工作，同時保持 Centene 在市場上脫穎而出的超本地化服務。

The implementation of our new PBM contract remains on track, as we've achieved all first half 2023 milestones and look forward to our first go-live dates in early 2024. Our portfolio review work also continues. And in June, we closed the divestiture of Apixio to New Mountain Capital. We structured the transaction to maintain an ownership position as well as a long-term contract because of our view that Apixio's proven artificial intelligence tools are uniquely positioned for this moment in health care technology. We believe that partnering with New Mountain will allow Apixio to innovate rapidly through continued investment, while we continue as an influential customer and minority owner. This is a great example of our thoughtful efforts to maximize long-term value as we reposition noncore assets.

我們新的 PBM 合同的實施仍在按計劃進行，因為我們已經實現了 2023 年上半年的所有里程碑，並期待著 2024 年初的首次上線。我們的投資組合審查工作也在繼續。 6 月，我們完成了將 Apixio 剝離給 New Mountain Capital 的交易。我們設計此次交易是為了維持所有權地位和長期合同，因為我們認為 Apixio 成熟的人工智能工具在目前的醫療保健技術領域具有獨特的地位。我們相信，與 New Mountain 的合作將使 Apixio 通過持續投資快速創新，同時我們將繼續作為有影響力的客戶和少數股東。這是我們在重新定位非核心資產時為實現長期價值最大化而深思熟慮的一個很好的例子。

In parallel, as our value-creation efforts create operating bandwidths, we continue to build our M&A pipeline and look forward to diversifying our capital deployment as strategic opportunities for inorganic growth emerge.

與此同時，隨著我們的價值創造努力創造運營帶寬，我們將繼續建立併購渠道，並期待隨著無機增長戰略機遇的出現而實現資本配置多元化。

Overall, Centene delivered another quarter of solid financial results, while executing against a robust list of transformative initiatives to move our company forward. With half of 2023 in the books, we are excited to leverage our positive momentum as we work to support our state partners throughout the duration of redeterminations, maintain our leadership position in marketplace, and strategically realign our Medicare Advantage business, building momentum around Stars and positioning our products for long-term growth and profitability.

總體而言，Centene 又一個季度實現了穩健的財務業績，同時執行了一系列強有力的變革舉措，推動公司向前發展。 2023 年即將過去一半，我們很高興能夠利用我們的積極勢頭，在重新確定期間努力支持我們的州合作夥伴，保持我們在市場上的領導地位，並戰略性地重新調整我們的 Medicare Advantage 業務，圍繞星級和定位我們的產品以實現長期增長和盈利。

Centene's improved earnings power in 2023 is a direct result of the focus and hard work that our organization is demonstrating every single day across our markets. We remain confident in our ability to achieve greater than $6.60 of adjusted earnings per share in 2024 as we continue to execute against our strategic framework, creating value for members, customers and shareholders alike.

Centene 在 2023 年盈利能力的提高是我們組織每天在市場上表現出的專注和辛勤工作的直接結果。我們仍然有信心在 2024 年實現超過 6.60 美元的調整後每股收益，因為我們將繼續執行我們的戰略框架，為會員、客戶和股東創造價值。

With that, I'd like to turn the call over to Drew to review the quarter and our financial outlook in more detail. Drew?

因此，我想將電話轉給德魯，以更詳細地審查本季度和我們的財務前景。德魯？

Thank you, Sarah. Today, we reported second quarter 2023 results of $35 billion in premium and service revenue and adjusted diluted earnings per share of $2.10, up over 18% from $1.77 in Q2 of 2022. Our Q2 consolidated HBR was 87.0%, consistent with our expectation and on track with our full year guidance range. Medicaid at 88.9% was a little favorable from the item that we mentioned on the first quarter call, and so far so good on matching rates with acuity, though it is still early in the redetermination process.

謝謝你，莎拉。今天，我們公佈了 2023 年第二季度的業績，保費和服務收入為 350 億美元，調整後攤薄每股收益為 2.10 美元，比 2022 年第二季度的 1.77 美元增長超過 18%。我們第二季度的合併 HBR 為 87.0%，與我們的預期一致，並且跟踪我們的全年指導範圍。醫療補助的 88.9% 與我們在第一季度電話會議中提到的項目相比有點有利，到目前為止，在匹配率與敏銳度方面表現良好，儘管現在仍處於重新確定過程的早期階段。

Medicare at 86.2% was a little higher in the quarter than planned as we also saw May outpatient incurred claims higher than the January through April period, largely in outpatient surgery. With respect to progression, May outpatient trend was higher than April, then it came down in June. July so far is steady with June. Inpatient was on track, and our previous guidance already assumed the Q1 Medicare HBR favorability would not continue.

本季度的醫療保險覆蓋率為 86.2%，略高於計劃，因為我們還看到 5 月份門診索賠高於 1 月至 4 月期間，主要是門診手術。從進展情況來看，5月份門診量趨勢高於4月份，6月份則有所下降。到目前為止，7 月與 6 月持平。住院病人正步入正軌，我們之前的指導已經假設第一季度醫療保險 HBR 的優惠不會繼續下去。

The commercial HBR of 81% was consistent with our expectations, inclusive of continued strong marketplace growth of 200,000 members in the quarter. Recall that special enrollment period members start with a lower margin profile and therefore, higher HBR than full year members, due in part to risk adjustment mechanics, where the shorter duration doesn't get full credit for health conditions. Though if retained for the following year, the SEP cohort has proven to be attractive. Our guidance contemplates growth to a peak of approximately 3.6 million members in Q4.

81% 的商業 HBR 符合我們的預期，包括本季度 200,000 名會員的市場持續強勁增長。回想一下，特殊註冊期會員一開始的利潤率較低，因此，HBR 高於全年會員，部分原因是風險調整機制，較短的註冊期不能充分考慮健康狀況。儘管如果保留到下一年，SEP 群體已被證明具有吸引力。我們的指導預計第四季度會員人數將增長至約 360 萬的峰值。

On the topic of marketplace risk adjustment, 2022 was recently finalized by CMS, and we received our first view of the 2023 risk adjustment from the Wakely data in June and July. Overall, no surprises in marketplace risk adjustment. And as of June 30, we have lowered our booked risk adjustment revenue estimates by a cumulative $314 million given the financial condition of a couple of marketplace competitors.

關於市場風險調整的話題，CMS 最近敲定了 2022 年的風險調整，我們從 6 月和 7 月的 Wakely 數據中首次看到了 2023 年風險調整的情況。總體而言，市場風險調整併不意外。考慮到幾個市場競爭對手的財務狀況，截至 6 月 30 日，我們已將預定風險調整收入預估累計下調了 3.14 億美元。

Though we have made this prudent adjustment to our revenue over each of the past 5 quarters, we plan on fully asserting our rights to collect what we are owed for risk adjustment. To be clear, we have already absorbed this $314 million hit, and this was the biggest reconciling item between the CMS published amount owed to us for 2022 and what was on our books prior to June of 2023.

儘管我們在過去 5 個季度的每個季度都對收入進行了謹慎的調整，但我們計劃充分維護我們的權利，收取我們因風險調整而欠下的款項。需要明確的是，我們已經吸收了這 3.14 億美元的損失，這是 2022 年 CMS 公佈的欠我們的金額與 2023 年 6 月之前賬面上的金額之間最大的調節項目。

Moving to other P&L and balance sheet items. Our adjusted SG&A expense ratio was 8.6% in the second quarter compared to 8.2% last year, consistent with our updated mix of business. Cash flow provided by operations was $2.5 billion in the second quarter, primarily driven by net earnings and the timing of premium payments from our state partners. Our domestic unregulated and unrestricted cash on hand at quarter end was $200 million.

轉向其他損益表和資產負債表項目。第二季度調整後的 SG&A 費用率為 8.6%，而去年為 8.2%，與我們更新的業務組合一致。第二季度運營提供的現金流為 25 億美元，主要是由淨利潤和我們的州合作夥伴支付保費的時間推動的。截至季度末，我們國內手頭不受監管和不受限制的現金為 2 億美元。

During the second quarter and through July, we repurchased 10.5 million shares of our common stock for $700 million. Year-to-date, we have repurchased 15.4 million shares for $1.08 billion. We also reduced debt by $300 million in the quarter and achieved debt to adjusted EBITDA of 2.9x. Our medical claims liability totaled $17 billion at quarter end and represents 52 days in claims payable compared to 54 in Q1 of '23 and 55 in Q2 of '22. The decrease was driven by state-directed payments that we collected over prior quarters and paid out in a lump sum in Q2, the largest related to California Hospital and Prop 56 payments, representing $713 million or 2.2 days sequentially.

從第二季度到 7 月份，我們以 7 億美元的價格回購了 1050 萬股普通股。年初至今，我們已回購 1540 萬股股票，價值 10.8 億美元。本季度我們還減少了 3 億美元的債務，債務調整後 EBITDA 達到了 2.9 倍。截至季度末，我們的醫療索賠負債總額為 170 億美元，應付索賠天數為 52 天，而 23 年第一季度為 54 天，22 年第二季度為 55 天。這一下降是由我們在前幾個季度收取並在第二季度一次性支付的國家指導付款推動的，其中最大一筆與加州醫院和第 56 號提案相關的付款，相當於 7.13 億美元或連續 2.2 天。

Outside of adjusted earnings during the second quarter, divestiture activity produced a net $0.11 gain in the quarter, and we also recognized additional real estate impairments of $0.02, consistent with our ongoing real estate optimization initiatives.

除了第二季度調整後的收益之外，剝離活動在本季度產生了 0.11 美元的淨收益，我們還確認了 0.02 美元的額外房地產減值，這與我們正在進行的房地產優化舉措一致。

Now let's turn to the full year of 2023. We are pleased with the performance of the company in the first half of the year and are increasing our outlook to at least $6.45 of adjusted EPS for 2023. We are increasing 2023 premium and service revenue by $1.8 billion to reflect an additional $800 million of state-directed payments as well as refinement in Medicaid and Marketplace premium revenue progression throughout the year.

現在讓我們轉向 2023 年全年。我們對公司上半年的業績感到滿意，並將 2023 年調整後每股收益的預期上調至至少 6.45 美元。我們將 2023 年保費和服務收入增加18 億美元用於反映額外 8 億美元的國家指導付款以及全年醫療補助和市場保費收入進展的完善。

Our 2023 guidance continues to include an approximate $200 million premium deficiency reserve for Medicare, as we discussed on the Q1 call. The PDR would be recorded in Q4 of 2023. 2023 guidance also includes a little over $1 billion in investment income, excluding divestiture gain and losses.

正如我們在第一季度電話會議中討論的那樣，我們的 2023 年指導繼續包括約 2 億美元的醫療保險保費缺口準備金。 PDR 將在 2023 年第四季度記錄。2023 年指導還包括略高於 10 億美元的投資收入，不包括剝離收益和損失。

To go a little bit deeper in Medicaid for 2023, during our first quarter call, we discussed many of our assumptions related to redeterminations that supported our forward projections. We have continued to monitor the actual member data against our projections by state and subpopulation. And as of July, we are tracking consistent with that updated forecast that we provided in April.

為了更深入地了解 2023 年的醫療補助，在第一季度電話會議中，我們討論了許多與支持我們的前瞻性預測的重新確定相關的假設。我們繼續根據州和亞人群的預測來監測實際會員數據。截至 7 月，我們的追踪與我們 4 月提供的更新預測一致。

The matching of rates to acuity continues to be a very important lever for the company as we navigate the redeterminations process. Fourteen of our 30 states provide rate updates between 7 1 and 10 1 each year. Twelve of those have provided us rates, all of which include acuity adjustments. The other two are still working on rate updates. And based upon discussions, we expect those also to include acuity adjustments.

在我們進行重新確定過程時，費率與敏銳度的匹配仍然是公司非常重要的槓桿。我們 30 個州中有 14 個州每年提供 7 1 到 10 1 之間的費率更新。其中十二個已向我們提供了費率，所有這些都包括敏銳度調整。另外兩個仍在進行費率更新。根據討論，我們預計這些還包括敏銳度調整。

Beyond 2023, we are continually assessing our positioning for 2024, whether analyzing redetermination data and rate actions, assessing our 2024 bid assumptions in Medicare against current data, or examining our continued growth and performance of marketplace. Accordingly, we continue to have confidence in our 2024 adjusted EPS floor of greater than $6.60.

2023 年之後，我們將不斷評估 2024 年的定位，無論是分析重新確定數據和費率行動，根據當前數據評估 2024 年 Medicare 的出價假設，還是檢查我們的持續增長和市場表現。因此，我們仍然對 2024 年調整後每股收益下限超過 6.60 美元充滿信心。

To give you a little bit more color on 2024, that $6.60 has an embedded forecasted ballpark $0.80 loss from Medicare Advantage. In other words, if we were merely breakeven in Medicare Advantage in 2024, that $6.60 would be approximately $7.40.

為了讓您對 2024 年有更多的了解，這 6.60 美元包含了 Medicare Advantage 的預計損失 0.80 美元。換句話說，如果我們在 2024 年僅實現 Medicare Advantage 盈虧平衡，則 6.60 美元約為 7.40 美元。

Let me close by addressing some of the concerns I've heard over the past few months. Number one, redeterminations. Our early results are playing out well compared to our assumptions, and states understand that in order to have actuarial soundness, acuity adjustments are necessary. Still plenty of execution ahead, but being on track is a good start.

最後，讓我談談我在過去幾個月中聽到的一些擔憂。第一，重新決定。與我們的假設相比，我們的早期結果表現良好，各州都明白，為了保證精算的合理性，有必要進行敏銳度調整。前面還有很多執行任務，但走上正軌是一個好的開始。

Number two, Medicare trend. We came into the year assuming double-digit outpatient trend, and did so again for 2024. And as you know, our Medicare business is under construction for 2024, as we are investing in certain products and pulling back in others. Based upon current forecasts, we expect our Medicare segment to produce approximately 14% of our premium and service revenue in 2024 compared to 16% in the current quarter. And any change in our view of 2024 margin in Medicare, better or worse by the time we get to the fourth quarter of 2023, merely flexes the PDR we book in 2023 up or down.

第二，醫療保險趨勢。我們在今年假設了兩位數的門診量趨勢，並在 2024 年再次這樣做。如您所知，我們的醫療保險業務正在 2024 年建設中，因為我們正在投資某些產品並縮減其他產品。根據目前的預測，我們預計 2024 年醫療保險部門將占我們保費和服務收入的約 14%，而本季度為 16%。當我們到達 2023 年第四季度時，我們對 2024 年醫療保險利潤率的看法發生任何變化，無論好壞，都只會使我們在 2023 年預訂的 PDR 向上或向下彎曲。

Number three, growth. We couldn't be more pleased with our performance in the Oklahoma RFP for both broad Medicaid and foster care, and we look forward to the State of North Carolina implementing Medicaid expansion. We continue to execute well in marketplace, where our industry-best overall position has enabled us to grow marketplace membership 62% year-over-year.

第三，成長。我們對俄克拉荷馬州廣泛醫療補助和寄養徵求建議書中的表現感到非常滿意，我們期待北卡羅來納州實施醫療補助擴展。我們繼續在市場上表現出色，我們行業最佳的整體地位使我們的市場會員數量同比增長 62%。

And while yes, we have to get through the rest of redeterminations, we still have value creation initiatives to execute upon and we have years of work ahead on Stars, there's a lot to like here. So while the market trades us at 10 to 11x earnings, we'll keep on executing, buying Centene shares and building up our M&A pipeline to acquire as we create operational capacity.

是的，雖然我們必須完成其餘的重新決定，但我們仍然有價值創造計劃需要執行，而且我們在星星方面還有多年的工作要做，這裡有很多值得喜歡的地方。因此，儘管市場以 10 至 11 倍的市盈率交易我們，但我們將繼續執行，購買 Centene 股票並建立我們的併購渠道，以便在我們創造運營能力時進行收購。

Thank you for your interest in Centene. Operator, Rocco, you can open the line up for questions.

感謝您對 Centene 的興趣。接線員，Rocco，您可以打開隊列提問。

(Operator Instructions) Today's first question comes from Stephen Baxter at Wells Fargo.

（操作員說明）今天的第一個問題來自富國銀行的史蒂芬·巴克斯特（Stephen Baxter）。

I still think there's maybe a little bit of confusion out there about the adjustments you're talking about on the exchanges in the quarter. Maybe you could break down those adjustments a little bit further, just so we can really assess core performance.

我仍然認為，對於您所談論的本季度交易所的調整，可能存在一些混亂。也許您可以進一步分解這些調整，以便我們能夠真正評估核心性能。

I guess potentially, what was the benefit related to the 2022 plan year that you saw in the quarter? And then you're also talking about lowering booked revenue, I think, related to the financial conditions of some of the potential payers in the market. Is that related to 2022 or 2023, or some combination of both? I guess just trying to understand the underlying components of that $350 million figure you cited a little bit better?

我想您在本季度看到的與 2022 年計劃年相關的潛在收益是什麼？然後，您還談到了降低預訂收入，我認為這與市場上一些潛在付款人的財務狀況有關。這與 2022 年或 2023 年有關，還是兩者的某種組合有關？我想只是想更好地理解您引用的 3.5 億美元數字的基本組成部分？

Stephen, thanks for the question. I appreciate it. This is obviously an important dynamic to understand. I'll let Drew walk through the mechanics and address your question, but there's one important point and takeaway that I do want to make sure we don't lose, which is that it is a testament to strength and experience of our Ambetter team, that were not only demonstrating tremendous growth, but ensuring that growth is profitable through prudent risk adjustment planning. And I think that's sort of the overlay to all of this, but let me make sure that Drew walks through all of the mechanics.

斯蒂芬，謝謝你的提問。我很感激。這顯然是一個需要理解的重要動態。我會讓 Drew 介紹一下機制並回答你的問題，但有一個重要的點和要點我確實想確保我們不會輸，那就是它證明了我們 Ambetter 團隊的實力和經驗，這不僅展示了巨大的增長，而且通過審慎的風險調整計劃確保增長是有利可圖的。我認為這有點像所有這些的疊加，但讓我確保德魯遍歷所有的機制。

Yes, Stephen. And understandably, it's a little complicated. And it's difficult to define some of these numbers with public information heretofore. So let me try to make it clear. So let's start with 2022 risk adjustment. The CMS final announcement was that we were owed $648 million. And as you did and others, you could look back at our 10-K and see that we had $58 million on our books at year-end. So it's a $590 million difference.

是的，斯蒂芬。可以理解的是，這有點複雜。迄今為止，很難用公開信息來定義其中一些數字。那麼讓我試著說清楚。那麼我們就從2022年的風險調整開始吧。 CMS 最終宣布欠我們 6.48 億美元。正如您和其他人所做的那樣，您可以回顧一下我們的 10-K，發現年底我們的賬簿上有 5800 萬美元。因此，存在 5.9 億美元的差異。

You heard the $300 million-plus item, that's almost completely related to the 2022 year. We have a little bit of that for '23 as one of those competitors was in the exchanges in certain markets for about half a year this year and appeared to be out now. So 300 -- over 300 is the largest reconciling item. And then similar to what you heard yesterday from one of my peers, there was margin on estimates. Just like in IBNR, you put margin on estimates because you never want to book to an exact 50-50 outcome. And so that margin rolls every year. That's about $100 million. So that doesn't drop to the bottom line. It gets reestablished. And then breakage for minimum MLRs where we're really performing well in some of our contracts. We have RADV accruals. And so you get through all of that, you get down to $39 million would have been the P&L benefit for -- recognized in '23 for the final issuance of what we are owed by CMS, and that was recognized over first and second quarter.

你聽說過這個價值3億多美元的項目，它幾乎完全與2022年有關。我們在 23 年有一些這樣的情況，因為其中一個競爭對手今年在某些市場的交易所呆了大約半年，現在似乎已經退出了。所以 300——超過 300 是最大的調節項。然後，與您昨天從我的一位同行那裡聽到的情況類似，估計存在裕度。就像在 IBNR 中一樣，您在估算上留有餘量，因為您永遠不想預訂精確的 50-50 結果。因此，利潤率每年都會滾動。這大約是1億美元。所以這不會落到底線。它被重新建立。然後是最低 MLR 的破壞，我們在一些合同中確實表現良好。我們有 RADV 應計費用。所以你完成了所有這些，你得到的損益收益將減少到 3900 萬美元——在 23 年我們對 CMS 所欠款項的最終發行中得到了確認，並且在第一季度和第二季度得到了確認。

Now let me jump to 2023. 2023, you can see we've shifted -- we've got about $300 million on our books for 2022 receivable. We've shifted to about $1.5 billion net payable for 2023, which demonstrates the strength of the acuity of the population and our estimates, partially informed by the Wakely data we got in June and July of where we expect to be relative to our peers. And we also booked that with some margin consistently year-to-year, and we'll see how that shakes out. But we see that as a good sign. And you always have to look at that in tandem with the acuity of the population, including our excellent growth this year.

現在讓我跳到 2023 年。2023 年，你可以看到我們已經發生了轉變——我們的賬簿上有大約 3 億美元的 2022 年應收賬款。我們已將 2023 年的應付淨額調整為約 15 億美元，這表明了人們的敏銳度和我們的估計，部分是根據我們在 6 月和 7 月獲得的 Wakely 數據得出的，我們預計相對於同行的情況。我們還每年都以一定的利潤預訂，我們將看看情況如何。但我們認為這是一個好兆頭。你必須始終結合人們的敏銳度來看待這一點，包括我們今年的出色增長。

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

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

Just looking at 2024 and adjusting for the PDR, EPS next year would be -- if you sort of moved it from this year to next year, EPS would be down, call it, mid-single digits. Can you just help us bucket broad strokes? How much is Medicaid headwind from redeterminations? How much is MA? I think you sized the loss there. How much is earnings from exchanges? Is that going to rise? I'm sure there's a benefit from lower G&A dollars. There's a share buyback.

只要看看 2024 年並根據 PDR 進行調整，明年的每股收益就會是——如果你把它從今年移到明年，每股收益將會下降，可以稱之為中個位數。你能幫我們概括一下嗎？重新確定對醫療補助計劃有何不利影響？ MA 多少錢？我認為你衡量了那裡的損失。交易所的收入有多少？那會上漲嗎？我確信較低的管理費用會帶來好處。有股票回購。

Just any directional commentary to help us understand sort of the puts and takes? And then, just lastly, help us understand the PDR and why that doesn't cover the entirety of the loss for Medicare Advantage next year?

只是有任何方向性評論來幫助我們理解看跌期權和看跌期權嗎？最後，請幫助我們了解 PDR 以及為什麼它不能彌補明年 Medicare Advantage 的全部損失？

Yes, let me start. Thanks, Josh. Let me start with your last question. Yes, it's the accounting rules around PDRs, you really only pick up -- think of it as like the marginal loss and direct cost necessary to administer the contract, including distribution costs, but there's a lot you can't pull into a PDR in that SG&A. So that's why we still have an $0.80 loss -- the ballpark of $0.80 loss embedded in that $6.60 in 2024, despite the fact we're rolling a projected $200 million or, call it, $0.27 or so PDR into '24.

是的，讓我開始吧。謝謝，喬什。讓我從你的最後一個問題開始。是的，這是圍繞 PDR 的會計規則，您實際上只能將其視為管理合同所需的邊際損失和直接成本，包括分銷成本，但有很多東西您無法納入 PDR SG&A。因此，這就是為什麼我們仍然有 0.80 美元的損失——2024 年 6.60 美元中嵌入了 0.80 美元的損失，儘管事實上我們將預計的 2 億美元，或者稱之為 0.27 美元左右的 PDR 滾動到 24 年。

If you step back and think about, and we've given a number of these elements of '24, even though, typically, we give '24 guidance at Investor Day in December of '23. But we've given a lot of information, so let me try to summarize some of that. Medicaid about a $7 billion incremental revenue headwind. We've all known that for a while, and that's built into the figures we gave out in Q1. About a $77 billion Medicare revenue premium stream in 2024. So a little bit of a headwind there in terms of volume.

如果你退後一步想一想，我們已經給出了 24 年的一些要素，儘管通常我們會在 23 年 12 月的投資者日給出 24 日的指導。但我們已經提供了很多信息，所以讓我嘗試總結其中的一些信息。醫療補助計劃將帶來約 70 億美元的增量收入逆風。我們都知道這一點有一段時間了，這已納入我們在第一季度給出的數據中。 2024 年，醫療保險收入保費流約為 770 億美元。因此，就數量而言，存在一些阻力。

And then if you'll recall the bridge that we walked through in Q1 of HBR, going from a projected 89.8% in '23 to 90.1%, inclusive of an allowance for some potential pressure and a mismatch between acuity and rates as well as some benefit from our PBM arrangement. So there's a couple of headwinds in Medicaid.

然後，如果您還記得我們在《哈佛商業評論》第一季度走過的那座橋樑，從 23 年預計的 89.8% 上升到 90.1%，其中包括一些潛在壓力以及敏銳度和比率之間的不匹配以及一些受益於我們的 PBM 安排。因此，醫療補助計劃存在一些阻力。

Obviously, we talked about the $0.80 headwind, which is not just the $0.80, but it's -- we're making a little bit Medicare this year, we expect to. So it's that swing. Marketplace, you're absolutely right. Not just the continued push on margin in marketplace, but the growth this year and how that matures into next year, the sophomore year of special enrollment period members is attractive, as I mentioned in the script.

顯然，我們談到了 0.80 美元的逆風，這不僅僅是 0.80 美元，而是——我們今年預計會做一些醫療保險。這就是那個鞦韆。市場，你說得完全正確。正如我在劇本中提到的，不僅是市場利潤率的持續推動，而且今年的增長以及如何成熟到明年，特別註冊期會員的第二年都很有吸引力。

And then you're right, we've got other elements like the annualization of this year's share buybacks. So those are the pieces that get you to the $6.60, inclusive of the $0.80 headwind that's embedded in that, which we expect to recover over the next couple few years.

然後你是對的，我們還有其他因素，例如今年股票回購的年化率。因此，這些都是讓你達到 6.60 美元的部分，包括其中嵌入的 0.80 美元的逆風，我們預計在未來幾年內會恢復。

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

今天我們的下一個問題來自沃爾夫研究中心的賈斯汀·萊克。

I've got a few, hopefully, simple number of questions. I'll rattle off to you here, and we'll see what you can answer. The first one is, I've got you at about 3 -- or I should say, 20% of your Medicare Advantage members right now in 3.5 star plans, Sarah, I appreciate you've given the 85% for '26. I was hoping you might be able to give us up to '25 ballpark there where you expect to be in October for 3.5 star plans?

我有幾個問題，希望是簡單的。我會在這裡向你滔滔不絕地講，我們看看你能回答什麼。第一個是，我已經為您提供了大約 3 個——或者我應該說，您現在有 20% 的 Medicare Advantage 會員享受 3.5 星級計劃，莎拉，我很感激您為 26 年提供了 85%。我希望您能給我們 25 月份的大概情況，您預計 10 月份的 3.5 星級計劃是多少？

Then Drew, you said 14% of Medicare revenue -- 40% of revenue in Medicare. What does that imply for MA membership next year? And then just lastly, on the rate increases you're getting in the third quarter, how are the overall rates coming in versus typical 1% to 2% that I think you guys talked about?

然後德魯，你說 14% 的醫療保險收入——40% 的醫療保險收入。這對明年的 MA 會員資格意味著什麼？最後，關於第三季度的利率上漲，與我認為你們談論的典型的 1% 到 2% 相比，總體利率如何？

Thanks for the question, Justin. I'll take the first one, and then turn it over to Drew. We're still a little bit early relative to cut points. So again, that 85% target for October of 25%, then to your point, revenue year '26, we're seeing really solid improvement as I pointed to in terms of 2/3 of our membership moving in contract improvement year-over-year.

謝謝你的提問，賈斯汀。我會拿第一個，然後把它交給德魯。相對於切入點，我們還有點早。再說一次，10 月份的 85% 目標是 25%，那麼就你的觀點而言，26 年的收入，我們看到了真正堅實的改善，正如我所指出的，我們 2/3 的會員在合同改善方面逐年增加-年。

Directionally and again, it's still -- the numbers are not final, but just to give you a sense, if we -- this year, we're sitting in about 50% of plans that are in 3 star or above. We expect that to be around 90% of members in 3 star or better come October. And so the exact numbers that fall in 3 or 3.5 really depends on those cut points that we don't have yet, but just so you understand sort of the magnitude of directional improvement that we're tracking.

再說一次，方向性的數字仍然不是最終的，但只是為了讓您感覺到，如果我們今年，我們大約有 50% 的計劃處於 3 星級或以上。我們預計到 10 月份，大約 90% 的會員將達到 3 星或更高級別。因此，3 或 3.5 的確切數字實際上取決於我們尚未掌握的那些切入點，但這只是為了讓您了解我們正在跟踪的方向性改進的程度。

Justin, I tried to give you all the inputs, but let me do some math to you -- for you. So last quarter, we said $128 billion for next year's revenue. Obviously, we'll refine that as we get through the year. So if you multiply that by 14%, that's $18 billion.

賈斯汀，我試圖向您提供所有信息，但讓我為您做一些數學計算。上個季度，我們表示明年的收入為 1280 億美元。顯然，我們將在這一年中對其進行完善。如果乘以 14%，那就是 180 億美元。

Our Medicare segment includes MA and PDP, PDPs in the zone of a couple of billion. So you can get down to about $16 billion of MA revenue. And if you did the same exercise for this year, we'd be in the zone of $20 billion in MA revenue.

我們的醫療保險部分包括 MA 和 PDP，PDP 的規模約為數十億。因此，MA 收入可減少至約 160 億美元。如果今年也進行同樣的計算，我們的 MA 收入將達到 200 億美元。

And then part 3 was the third quarter rates. Yes, they're sort of -- they're consistent with our expectation. They're all over the board because when we're -- if you're deep into a payable risk corridor in a state, then ultimately, they're going to recalibrate the rates to that. Although there's no net impact to the company if we're in the corridor.

第三部分是第三季度的利率。是的，它們在某種程度上與我們的期望一致。他們都是全面的，因為當我們——如果你深入一個州的應付風險走廊，那麼最終，他們將重新調整利率。不過，如果我們在走廊裡，對公司不會產生任何淨影響。

So it's not that instructive to go through, and we never go state by state. But let me just step up to a higher level and say we've been working well with our states. And the typical back and forth with states on the nonacuity parts of rates and call that normal course.

因此，這並沒有什麼指導意義，而且我們也不會一個州一個州地去了解。但讓我更進一步地說，我們與各州合作得很好。典型的來回陳述利率的非敏銳部分，並將其稱為正常過程。

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

今天我們的下一個問題來自伯恩斯坦的蘭斯·威爾克斯。

Great. Just a couple of questions on kind of capital deployment and raising capital. As far as the MA business, could you talk a little bit about variability of profitability by geography? And obviously, part of that would be, are there opportunities to maybe sell off portions of that business, lower performing portions or whatnot? And I guess related in the other direction is, you mentioned M&A pipeline. Just interested in what the priorities are as you're looking at deploying capital?

偉大的。只是關於資本部署和籌集資金的幾個問題。就 MA 業務而言，您能否談談不同地區盈利能力的差異？顯然，其中一部分是，是否有機會出售該業務的部分、業績較低的部分或諸如此類的東西？我想另一個方向相關的是，你提到了併購管道。只是對您考慮部署資本時的優先事項感興趣嗎？

Yes. Thanks, Lance, for the question. So relative to Medicare Advantage, I think our view is, to your point, we take geography-by-geography approach to looking at that portfolio. Our lens is through big construction as we look at '24 and '25 and where there are less profitable products that we've put out there. And we talked about this on the Q1 call, but we've been very focused as we constructed '24 bids on this idea that there are less profitable or less aligned products, and that's where we are sort of aggressively pruning.

是的。謝謝蘭斯提出這個問題。因此，相對於醫療保險優勢，我認為我們的觀點是，就您的觀點而言，我們採用逐個地理位置的方法來研究該投資組合。我們的鏡頭是通過大型建設來實現的，因為我們著眼於 24 世紀和 25 世紀，以及我們在那裡推出的利潤較低的產品。我們在第一季度的電話會議上討論了這一點，但我們一直非常專注，因為我們根據這樣的想法構建了 24 個出價，即利潤較低或不太一致的產品，這就是我們正在積極修剪的地方。

So directionally aligned, but not through the lens of divestiture, more through the lens of rightsizing and realigning the MA book overall to create that solid platform for growth and the synergy that it provides with the focus on lower income and complex members to our Medicaid footprint.

方向如此一致，但不是通過剝離的鏡頭，更多的是通過整體調整和重新調整 MA 書籍的鏡頭，以創建堅實的增長平台及其提供的協同作用，重點關注我們醫療補助足跡中的低收入和復雜成員。

And then for the M&A pipeline, again, we continue to be focused on opportunities that are -- we consider sort of right down the fairway, relative to our three core business lines, that being our primary focus, but also acknowledging that we have two strong and important retail businesses, which is how we think about Marketplace and Medicare and the platform that we think marketplace provides in terms of long-term growth relative to what we're seeing from gig workers, contract workers, ICRA and sort of burdening individual marketplace, what are some of the capabilities that we think are going to be important to own those distinctive competencies. And so those are also part of the consideration in the overall M&A pipeline.

然後，對於併購渠道，我們繼續關注機會，我們認為相對於我們的三個核心業務線，這是我們的主要關注點，但也承認我們有兩個機會強大而重要的零售業務，這就是我們對市場和醫療保險的看法，以及我們認為市場提供的平台相對於我們從零工、合同工、ICRA 和個人負擔中看到的長期增長而言市場，我們認為哪些能力對於擁有這些獨特的能力非常重要。因此，這些也是整個併購流程中考慮的一部分。

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

今天我們的下一個問題來自 A.J.瑞信的賴斯。

Just to circle back to couple of things on the Medicaid reverifications. Obviously, it's sort of a herculean task for the states to go through this process. It seems like everyone involved. Is it having any impact? It doesn't seem like it, but I'll ask the question on either RFPs working through the system or RFPs that are being awarded, be it stood up? Have you seen any spillover impact on any of that?

只是回到有關醫療補助重新驗證的幾件事。顯然，對於各州來說，完成這個過程是一項艱鉅的任務。看來每個人都參與其中。有影響嗎？看起來並非如此，但我會問有關通過系統工作的 RFP 或正在授予的 RFP 的問題，它是否成立？您是否看到了其中的任何溢出影響？

And then just a follow-up on first comment on the acuity adjustments. Just give us the latest thinking on how quickly those acuity adjustments may happen as data rolls in? And are there any states that are saying, "Hey, we'll help you out prospectively anticipating some change."

然後只是對敏銳度調整的第一次評論的後續行動。請給我們最新的想法，即隨著數據的湧入，這些敏銳度調整可能會以多快的速度發生？是否有任何州說：“嘿，我們將幫助您前瞻性地預測一些變化。”

Yes. Thanks, A.J. I'll let Drew talk about the rates, but it is important just to -- as a reminder, that we saw -- we have a number of states that had a 7 1 renewal and had very constructive conversations. All of those states have included acuity adjustments. And we're seeing that trend carry forward, but I'll let Ken get specific on that.

是的。謝謝，A.J.我會讓德魯談談費率，但重要的是——作為提醒，我們看到——我們有許多州進行了 7 1 續約，並進行了非常有建設性的對話。所有這些狀態都包括敏銳度調整。我們看到這種趨勢不斷發展，但我會讓肯具體說明這一點。

Relative to the overall Medicaid redeterminations landscape, you are right that this is sort of an unprecedented scale of effort. And we've been really pleased with the level of partnership that we've seen the states and in general, a trend that states are leaning in to the value of public-private partnership that we offer.

相對於整個醫療補助重新確定的情況，你是對的，這是一種前所未有的努力規模。我們對各州的合作水平感到非常滿意，總的來說，各州正在傾向於我們提供的公私合作夥伴關係的價值。

But Ken has been out talking with our Medicaid directors and our governors very closely over the last weeks and months. So I'll let him provide a little bit more color on that, and then kick it over to Drew to just talk a bit about the rate discussions.

但在過去的幾周和幾個月裡，肯一直在與我們的醫療補助董事和州長進行密切交談。因此，我會讓他對此提供更多信息，然後將其交給 Drew，讓他談談費率討論。

Yes. Thanks, A.J. In fact, we were with nearly 14 governors last week, had an opportunity to spin through the Republican Governors Association. And in every conversation we had, redeterminations came up with an eye towards, one, what are we seeing by virtue of the view we have across multiple markets, best methods and genuine appreciation for opportunity that's available to provide more informed counsel to members through outreach.

是的。謝謝，A.J.事實上，上週我們與近 14 名州長一起，有機會通過共和黨州長協會進行旋轉。在我們進行的每一次對話中，重新決定的著眼點是，第一，憑藉我們對多個市場的看法、最佳方法以及對機會的真正欣賞，我們看到了什麼，這些機會可以通過外展為會員提供更明智的建議。

Sarah mentioned the millions of interactions that we've had, the collaboration with the departments, clearly an eye towards doing the best to give members a chance to make an informed decision. And when there's procedural disenrollments to move quickly to provide the opportunity to get those folks either into the right spot, whether it's in Medicaid or we're seeing opportunities in the marketplace.

莎拉提到我們已經進行了數百萬次互動，與各部門進行了合作，顯然是為了盡最大努力讓會員有機會做出明智的決定。當程序退出時，要迅速採取行動，為這些人提供機會，讓他們進入正確的位置，無論是在醫療補助中，還是我們在市場上看到的機會。

Finally, to your point about whether it's going to slow the pipeline, there's no indication of that with respect to procurements and reprocurements. Drew?

最後，就您關於是否會減慢管道速度的觀點而言，在採購和重新採購方面沒有任何跡象表明這一點。德魯？

Yes, A.J., on acuity, over the -- really, over the past year, we've been putting data in front of our state partners and working collaboratively with them and their actuaries in anticipation of the commencement of redeterminations. So often, really on behalf of all the payers in the marketplace in Medicaid, we're working with the state and the associations to influence for what we think is appropriate in terms of not just rates, but the acuity component within rates.

是的，A.J.，關於敏銳度，實際上，在過去的一年裡，我們一直在向我們的國家合作夥伴提供數據，並與他們及其精算師合作，以期開始重新確定。通常，我們真正代表醫療補助市場上的所有付款人，與州和協會合作，不僅在費率方面，而且在費率中的敏銳度方面，影響我們認為合適的內容。

And then by definition, the 7 1 rate increases, and we saw two outstanding between 7 1 and 10 1, but the 12 that we've gotten so far, all of which have had acuity adjustments with a focus on the redetermination impact. By definition, those are prospective, except for maybe the couple of months that we have under our belt so far in redeterminations. So pretty pleased with the partnership with our state partners and plenty of work to do, A.J., but it's a good start.

然後根據定義，7 1 率增加，我們在 7 1 和 10 1 之間看到了兩個突出的值，但到目前為止我們已經得到了 12 個，所有這些都進行了敏銳度調整，重點關注重新確定的影響。根據定義，這些都是前瞻性的，除了我們迄今為止重新確定的幾個月之外。 A.J.，我對與我們的州合作夥伴的合作關係非常滿意，而且還有很多工作要做，但這是一個好的開始。

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

今天我們的下一個問題來自美國銀行的 Kevin Fischbeck。

I want to follow up on the comment that redetermination is going as expected. It seems like when you read some of the news articles that things are going -- you did kick off faster. Obviously, the administration is stepping in, which implies that things are going maybe a little bit faster.

我想跟進有關重新確定正在按預期進行的評論。看起來，當你讀到一些新聞文章時，事情正在發生——你確實開始得更快了。顯然，政府正在介入，這意味著事情進展可能會更快一些。

We'd love just to kind of hear how you're thinking about it? What it exactly means to have this delay? Would you expect the pace to change dramatically? Or have you changed your view about the pace of enrollment losses through the year? And is this slowdown of the administration is pushing? Is it more about the timing of how things go the rest of this year? Or do you think that ultimately, it will change that the number of people who get redetermined off of the enrollment?

我們很想听聽您對此有何看法？這種延遲究竟意味著什麼？您預計步伐會發生巨大變化嗎？或者您是否改變了對今年入學人數流失速度的看法？政府的放緩是不是在推動？更多的是關於今年剩餘時間事情進展的時間安排嗎？或者您認為最終會改變重新確定入學人數？

Thanks, Kevin. Yes, we had always anticipated upfront bolus of redeterminations just because of the fact that there were certain states that were moving faster than others and others that had taken a more ratable approach. So I think the idea that there is a big amount of upfront data is helpful, but not unexpected.

謝謝，凱文。是的，我們一直預期會預先進行重新決定，因為某些州的行動速度比其他州快，而其他州則採取了更值得評估的方法。因此，我認為存在大量前期數據的想法是有幫助的，但並不意外。

And then that has also given us some visibility into where there may be data issues that are causing -- or sort of the procedural disenrollments are higher than the states might have originally been expecting. In aggregate, though, as we said, our membership is on track with our expectations.

這也讓我們對可能導致數據問題的地方有了一定的了解，或者程序上的退出人數比各州最初預期的要高。但總的來說，正如我們所說，我們的會員資格符合我們的期望。

We are recapturing members who fell off, but still have eligibility. And because of all of the outreach efforts we're making, we're able to bring those members back on and track the fact that we're able to successfully reenroll them. And again, we do expect that number to grow over the course of the program.

我們正在重新招募那些掉隊但仍然有資格的會員。由於我們所做的所有外展努力，我們能夠讓這些成員重新加入並跟踪我們能夠成功重新註冊他們的事實。再次強調，我們確實預計這個數字會在該計劃的過程中不斷增長。

Relative to the CMS intervention, our view is that CMS has provided great flexibility for the states to go a little bit slower. Obviously, in recent weeks, they've taken a bit of a stronger stance relative to a certain cohort of states, but it's still too early to see whether that will have a major impact on the slope.

相對於 CMS 干預，我們認為 CMS 為各州提供了很大的靈活性，可以放慢一些速度。顯然，最近幾週，他們相對於某些州採取了更強硬的立場，但現在判斷這是否會對斜率產生重大影響還為時過早。

Obviously, they've asked certain states to pause for a month, in other states they're looking to extend the grace period relative to members replying to enrollment requests. And so again, hard to say whether that's a slowdown to make sure that states are getting the process right, so that they can continue at pace or whether for those states that were quick out of the gate, it slows them down overall and what that does to the slope line, but that's something we're obviously going to be tracking very closely over the next couple of months.

顯然，他們已經要求某些州暫停一個月，在其他州，他們希望延長相對於會員回复註冊請求的寬限期。再說一遍，很難說這是否是為了確保各州正確推進進程而放慢速度，以便他們能夠繼續按部就班地進行，或者對於那些快速走出大門的州來說，這是否會減慢他們的整體速度，以及這會帶來什麼影響。坡線確實如此，但這顯然是我們在接下來的幾個月中將密切跟踪的事情。

Yes. And then just one last data point. The ultimate sort of roll-off of redeterminations, our view hasn't changed. Still about 65% of what we grew since the onset of the pandemic. 3.6 million members would have been the growth. So 65% of that rolling off would be 2.3 million to 2.4 million members, about $9.5 billion to $10 billion of cumulative revenue. So that's already factored into the numbers we gave in Q1, the $77 billion, for instance, of forecasted Medicaid premium.

是的。然後是最後一個數據點。最終的重新決定的滾動，我們的觀點沒有改變。仍然是自大流行爆發以來我們增長的 65% 左右。 360萬會員將會增長。因此，其中 65% 的會員數量將達到 230 萬至 240 萬，累計收入約為 95 億至 100 億美元。因此，這已經計入我們在第一季度給出的數字中，例如，預計醫療補助保費為 770 億美元。

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

今天我們的下一個問題來自斯科特·菲德爾和斯蒂芬斯。

I appreciate all the details that you gave us on some of the dynamics in the marketplace. May be helpful to just to bring it up to sort of the high level if you wanted to share, what type of commercial MLR you're now sort of embedding in the 2023 guide and then in the 2024 floor of at least $6.60?

我感謝您向我們提供的有關市場動態的所有詳細信息。如果您想分享一下，您現在在 2023 年指南中嵌入哪種類型的商業 MLR，然後在 2024 年至少 6.60 美元的地板中嵌入什麼類型的商業 MLR，可能會對將其提升到較高水平有所幫助？

And then inside of that, definitely appreciate the conservatism around some of these receivables from some of these plans out there that are in a tough condition. Would you be willing to maybe just give us a little insight into how you sort of develop that $350 million reduction in terms of sort of, I guess, how that breaks down between Friday and Bright? Or just how your methodology works maybe just sort of a general level of conservatism that you're building in there?

然後，在其中，肯定要欣賞一些狀況艱難的計劃中的一些應收賬款的保守態度。您是否願意向我們介紹一下您如何實現 3.5 億美元的削減，我想，從周五到布萊特期間如何分解？或者你的方法論的運作方式可能只是你在那裡建立的保守主義的一般水平？

Yes, the team -- thanks, Scott. The team does a lot of work to mine out balance sheet positioning and statutory capital of our peers that are in potential financial difficulty, looking at what assets are backing reserves on their balance sheets.

是的，團隊——謝謝，斯科特。該團隊做了大量工作來挖掘處於潛在財務困難的同行的資產負債表定位和法定資本，查看哪些資產支持其資產負債表上的準備金。

And then you're right, hopefully taking a conservative approach on that and doing that different depending on the carrier situation. So we'll see how that plays out. I hope to get every nickel of that $314 million, but trying to be realistic and prudent, but we will fight for it because that's shareholder money.

那麼你是對的，希望對此採取保守的方法，並根據運營商的情況採取不同的做法。所以我們將看看結果如何。我希望能拿到這 3.14 億美元中的每一分錢，但要盡量現實和謹慎，但我們會為之奮鬥，因為那是股東的錢。

On the HBR for commercial. Commercial includes both marketplace, and we've got about $3 billion of commercial group business, which runs sort of meaningfully higher structurally than our marketplace business. And we still expect to do a little bit better than last year. Last year, commercial, we posted an 81.1%. But thinking about the SEP membership rolling in, with a little bit higher HBR, now that's not for a full year. So you have to sort of slope that through. But from a progression standpoint because the deductible natures of the commercial business, you should expect like an ongoing tick up of that total commercial HBR, but it's sort of on track to what we expect.

在《哈佛商業評論》上刊登商業廣告。商業包括兩個市場，我們擁有大約 30 億美元的商業集團業務，其結構比我們的市場業務要高得多。我們仍然預計會比去年做得更好一些。去年，我們的商業廣告佔有率為 81.1%。但考慮到 SEP 會員資格的不斷增加以及《哈佛商業評論》的更高一點，現在這還不是一整年。所以你必須讓它通過。但從進展的角度來看，由於商業業務的可扣除性質，您應該預期商業 HBR 總額會持續上升，但它在某種程度上符合我們的預期。

And again, just important to remember that the performance of the core business and marketplace is allowing us to absorb that SEP growth. And those members tend to become more profitable in their sophomore year. So assuming good retention, the book that we're building this year will have incremental contribution next year.

再次強調，重要的是要記住，核心業務和市場的表現使我們能夠吸收 SEP 的增長。這些會員在大二的時候往往會變得更賺錢。因此，假設保留率很高，我們今年編寫的書明年將會有增量貢獻。

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

今天我們的下一個問題來自摩根士丹利的 Michael Ha。

Maybe just quickly first on Medicaid acuity adjustments. Wondering where these adjustments assumed are embedded in your 1.4% composite rate increase guide for '23? Or are you now tracking better than that for '23? Trying to understand if these mid-year renewals actually represent upside to your guide? And then on Star, I believe you're originally targeting 20% of members in 4-STAR+PLUS plans at your Investor Day?

也許首先要快速調整醫療補助敏銳度。想知道這些假設的調整是在 23 年 1.4% 綜合利率增長指南中嵌入的嗎？或者你現在的追踪情況比 23 年更好嗎？試圖了解這些年中更新是否真的代表了您的指南的好處？然後在 Star 上，我相信您最初的目標是在投資者日將 20% 的會員納入 4-STAR+PLUS 計劃？

Now that came down to about 14% to 18% last quarter, and now 0%. I'm trying to understand what exactly changed since last quarter? It sounds like you might not have received cut points yet, or maybe I'm wrong, you did, and they're far more difficult. Was it driven by the two key outlier deletion? I'm just trying to get some more insight on what changed from last quarter to now? And does that even influence your '24 MA growth assumptions?

現在上個季度下降到 14% 到 18% 左右，現在為 0%。我想了解自上季度以來究竟發生了什麼變化？聽起來你可能還沒有收到切分，或者也許我錯了，你已經收到了，而且它們要困難得多。是由兩個關鍵異常值刪除驅動的嗎？我只是想更深入地了解從上個季度到現在發生了什麼變化？這是否會影響您對 '24 MA 增長的假設？

Yes. So let me hit Stars and sort of rebate. So we did -- at Investor Day, we were looking at 20% in 4 stars. On the Q1 call, because of what we saw in terms of the overall Medicare rate environment, some of the changes that we had made coming into the year, relative to a focus on duals and what we were planning to do for 2024 bid construction and going forward, we walked through the fact that for our target population, right, which is increasingly going to be low-income complex and duals members, that 3.5 stars is the more appropriate focal point for our Star strategy.

是的。所以讓我打星星並獲得一些回扣。所以我們做到了——在投資者日，我們將 20% 的評級定為 4 星。在第一季度的電話會議上，由於我們在整體醫療保險費率環境方面看到的情況，我們在今年做出的一些變化，相對於對雙元的關注以及我們計劃為 2024 年投標建設和展望未來，我們經歷了這樣一個事實：對於我們的目標人群（右），即越來越多的低收入群體和雙打會員，3.5 顆星是我們星級戰略更合適的焦點。

And so that is really how, over the next 3 to 4 cycles, we're looking at success in Stars. And so I also on that call, pointed out that we were seeing 4-star progress in the measures that we had visibility into at that point, which were those core admin and ops and pharmacy measures, which is our focus in this first cycle, but that we had a number of contracts that were on the bubble and that we were taking a conservative approach and actually assuming minimal progress.

因此，在接下來的 3 到 4 個週期中，我們實際上就是這樣看待 Stars 的成功的。因此，我也在這次電話會議上指出，我們當時看到的措施取得了四星級的進展，這些措施是核心管理、運營和藥房措施，這是我們第一個週期的重點，但我們有許多合同處於泡沫狀態，我們採取了保守的方法，實際上假設進展甚微。

So the takeaway from the Q1 call was minimal progress in 4-star off that 2.7% baseline. What we're saying today is with additional view of HEDIS and CAHPS and some degree of sort of case mix, that there's a little bit more pressure in that 4-star. Again, it's too early to say because we don't have cut points, but we want to be very transparent, and we used very conservative assumptions.

因此，第一季度電話會議得出的結論是，在 2.7% 的基線基礎上，四星級的進展微乎其微。我們今天要說的是，從 HEDIS 和 CAHPS 的額外角度以及某種程度的案例組合來看，四星級酒店的壓力更大一些。同樣，現在說還為時過早，因為我們沒有切入點，但我們希望非常透明，並且我們使用了非常保守的假設。

This does not impact 2024, right, because we already know the revenue for 2024, but it certainly was an input as we looked at 2024 bid construction, relative to what we thought about in terms of 2025 to 2026 and sort of the multiyear performance targets for the Medicare book.

這不會影響 2024 年，對吧，因為我們已經知道 2024 年的收入，但相對於我們對 2025 年至 2026 年的考慮以及多年績效目標，這肯定是我們考慮 2024 年投標建設時的一個輸入為醫療保險書。

And again, important to note that we are seeing really solid underlying improvement in the program and really taking a chapter by chapter approach to moving up all of our underperforming contracts into that 3.5 star band, which is where we start to get important economics. Drew pointed this out on the Q1 call as well that there's -- folks know the economics associated with the 4-star, but there's a 3% to 6% economic lift that comes with moving into that 3.5 star band. And when you combine that with the profile of largely or heavily dual-based population, those economics actually work very well relative to the performance we're looking for.

再次強調的是，我們看到該計劃確實取得了實質性的根本性改進，並且確實採取了逐章的方法，將我們所有表現不佳的合同提升到 3.5 星等級，這就是我們開始獲得重要經濟效益的地方。德魯在第一季度電話會議上也指出了這一點，人們知道與 4 星級相關的經濟效益，但進入 3.5 星級會帶來 3% 到 6% 的經濟提升。當你將其與大部分或大量雙基人口的概況結合起來時，這些經濟學實際上相對於我們正在尋找的表現非常有效。

And Michael, on the 1.4% composite forecasted rate that we laid out at Investor Day in December of '22, that would have partially reflected our view at the time of what we thought might be necessary for acuity adjustments. But the reason I say partially is because you'll remember, we basically pulled forward sort of a lot of the forecasting for the next couple of years of acuity as we got into the first quarter of 2023.

邁克爾，我們在 2022 年 12 月的投資者日上提出的 1.4% 綜合預測利率，這部分反映了我們當時認為可能需要進行敏銳度調整的觀點。但我之所以說部分原因是因為你會記得，當我們進入 2023 年第一季度時，我們基本上提前了對未來幾年敏銳度的預測。

So what we know now would push that number up, but there's also a counterbalance to that as we continue to perform well, especially in states with paybacks, where we're forecasting for 2023 -- sort of the calendar year of 2023 to be in paybacks to the tune of about $1.3 billion in Medicaid.

因此，我們現在所知道的情況會推高這個數字，但隨著我們繼續表現良好，特別是在有回報的州，我們預測 2023 年（有點像 2023 年日曆年）會產生抵消作用。醫療補助的回報約為 13 億美元。

That would be a counterbalance to that because states ultimately adjust the rates by looking at the pool of participants in Medicaid and their positioning in risk corridor payback. So it's sort of a stale number at this point, but those are two factors that would push and pull up that number.

這將是一種平衡，因為各州最終會根據醫療補助的參與者群體及其在風險走廊回報中的定位來調整費率。因此，目前這個數字有點陳舊，但有兩個因素會推高和拉高該數字。

And our next question today comes from Sarah James at Cantor Fitzgerald.

今天我們的下一個問題來自 Cantor Fitzgerald 的 Sarah James。

I was wondering if you could quantify what the redetermination impact was in the quarter? And then if we're thinking about the sort of April and May cohort, especially April is coming up towards the end of their 90- to 120-day response period. And I know you guys only have a couple of states in that cohort.

我想知道您是否可以量化本季度重新確定的影響？然後，如果我們考慮 4 月和 5 月的隊列，尤其是 4 月，他們的 90 至 120 天響應期即將結束。我知道你們這個群體中只有幾個州。

But could you talk a little bit about what sort of information you get? Do you know who is responding of your members? And have you gotten any information on what a success rate looks like for that April cohort?

但您能談談您獲得了哪些類型的信息嗎？你知道你的成員誰在回應嗎？您是否獲得有關四月份隊列成功率的任何信息？

Yes, Sarah, on the question about the impact, you can look at the sort of the membership progression. We're down 263,000 members from 3/31/23 in Medicaid, and that's sort of right on track with what we expected in terms of the impact.

是的，莎拉，關於影響的問題，你可以看看會員資格的進展情況。與 2023 年 3 月 31 日相比，我們的醫療補助成員減少了 263,000 名，就影響而言，這與我們的預期相符。

And then on what we can look at -- so it's a good question. I'm looking at each of those monthly cohorts independently, but we could actually see sort of the members boomeranging back at a much higher rate with April because, to your point, we're a few months out from that incurred month as opposed to July, which would be a lower number because there's still some runway there for members to boomerang back.

然後我們可以看到什麼——這是一個很好的問題。我正在獨立地查看每個月的群組，但我們實際上可以看到一些成員在 4 月份以更高的速度回歸，因為就你而言，我們距離發生的月份還有幾個月，而不是 4 月份。七月，這個數字會較低，因為仍有一些跑道供會員迴旋。

But so far, that month is in the 20s in terms of percentage of members who lost eligibility that have now regained it without, importantly, 85% of which without any break in coverage period. There are some members, the other 15% of what we're seeing are being reinstated back to maybe a month or 2 after they lost eligibility. But it's very early. There's not a lot of redetermination activity in April. So it will be interesting over the next few months to see that dynamic of members getting reinstated.

但到目前為止，該月失去資格的會員比例在 20 多歲左右，但現在又重新獲得資格，重要的是，其中 85% 的會員在承保期間沒有任何中斷。有一些會員，我們看到的另外 15% 的會員在失去資格後可能會恢復一兩個月。但現在還很早。四月份沒有太多重新確定的活動。因此，在接下來的幾個月裡，看到會員恢復活力將會很有趣。

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

今天我們的下一個問題來自加里·泰勒和考恩。

I have two questions for you. One, a couple of your competitors mentioned that the second quarter results bore -- are not immaterial MLR headwind from the California court settlement related to COVID costs out of period. So just wondering if your quarter did -- this quarter did reflect that or if you had already booked that?

我有兩個問題要問你。一，你們的幾個競爭對手提到，第二季度的業績令人擔憂——加州法院和解協議與期外新冠疫情相關的和解對國土資源部來說並不是不重要的阻力。所以只是想知道您的季度是否反映了這一點，或者您是否已經預訂了？

And then secondly, just sort of coming back to Scott's question, I just want to ask about commercial MLR again. And looking at this year-over-year, just to exclude sort of the deductibility seasonality. But in the first quarter, your commercial MLR was down 290. This quarter, it's up 350. A small portion of that is SEP. A small portion of that, I think, is the smaller year-to-year RAF accrual true-up. So it really did seem to deteriorate, but I know you're saying, I think you felt it was in line, and you think the year is still going to come where you expect to land on commercial MLR. So I just wanted to understand that movement between 1Q and 2Q a little better from your view?

其次，回到 Scott 的問題，我只想再次詢問商業 MLR 的問題。逐年觀察，只是為了排除某種免賠額季節性。但在第一季度，商業 MLR 下降了 290。本季度上升了 350。其中一小部分是 SEP。我認為，其中一小部分是英國皇家空軍每年較小的應計調整。所以它看起來確實在惡化，但我知道你是在說，我認為你覺得它是符合要求的，並且你認為今年仍然會達到你期望登陸商業 MLR 的程度。所以我只是想從您的角度更好地理解第一季度和第二季度之間的走勢？

Yes, on SB 510 in California, we booked that in Q1 when we got that information, which is -- I think we explained this on the Q1 call also is why we were a little bit high at 90.0, and then we had a really good quarter in Q2. So year-to-date, we're looking good in Medicaid.

是的，在加利福尼亞州的 SB 510 上，當我們獲得該信息時，我們在第一季度預訂了該信息，這就是——我認為我們在第一季度電話會議上解釋了這一點，這也是我們在 90.0 有點高的原因，然後我們真的有一個第二季度表現良好。今年迄今為止，我們的醫療補助計劃看起來不錯。

And then you're right on commercial. You've got the dynamic of Q2 '22, having a really sort of a good guy. We didn't have any insolvency issues from the '21 calendar year. And so that wasn't chipping away at the final settlement from CMS like it is over the last 5 quarters, including this quarter as well.

然後你就可以做商業廣告了。你有 22 年第二季度的活力，有一個真正的好人。自 21 日曆年以來，我們沒有出現任何破產問題。因此，這並沒有像過去 5 個季度（包括本季度）那樣影響 CMS 的最終和解結果。

So that's sort of the swing item and our growth was excellent last year. It is tremendous this year. And while that puts a little bit of pressure on the near term, we're thrilled that with our #1 market position, leveraging the Ambetter brand, we're able to grow a lot this year, which will give us earnings power for 2024 and beyond. But that does show up in the current period, HBR a little bit.

所以這是一個搖擺項目，去年我們的增長非常出色。今年真是太棒了。雖然這會給短期帶來一些壓力，但我們很高興憑藉我們排名第一的市場地位，利用 Ambetter 品牌，我們今年能夠實現大幅增長，這將為我們帶來 2024 年的盈利能力超越。但這確實在當前時期有所體現，哈佛商業評論有一點。

And our next question today comes from Calvin Sternick with JPMorgan.

今天我們的下一個問題來自摩根大通的卡爾文·斯特尼克。

Just a clarification. In terms of the Medicaid retention rate, I know it's about 1/3 you expect to end up with. But in terms of timing, just given that we have these 90-, 120-day sort of reenrollment windows, do you expect to land at that 1/3 number, I guess, second quarter of '24? Or is there going to be sort of a couple of month lag where maybe it will take another quarter before you end up planning that 1/3?

只是一個澄清。就醫療補助保留率而言，我知道這大約是您預期最終的 1/3。但就時間而言，考慮到我們有 90 天、120 天的重新註冊窗口，您是否預計會在 24 年第二季度達到 1/3 的數字？或者是否會有幾個月的滯後，也許還需要一個季度才能最終計劃那 1/3？

Well, part of that depends on whether or not people finish in that 14-month time period. And who knows what might be going on by the time we get to Q1 or Q2 of 2024. So tough to predict exactly when each state will end. But we think that's -- the numbers we gave, without trying to predict exactly the month we hit that, we think that's the ultimate outcome and that hasn't changed.

嗯，部分取決於人們是否能在 14 個月的時間內完成任務。誰知道到 2024 年第一季度或第二季度時會發生什麼。很難準確預測每個州何時結束。但我們認為，我們給出的數字，沒有試圖準確預測我們達到這個數字的月份，我們認為這是最終的結果，並且沒有改變。

And again, all those outreach efforts that I mentioned are designed to try to minimize the span between someone who's dropped eligibility, but is still eligible and the recapture. And that includes, obviously, the direct outreach, but also relying on primary care physicians and providers in general, so that we're not recapturing folks when they're showing up at an emergency department. And so I think that outreach has also proven to be successful, at least in these early months.

再說一次，我提到的所有這些外展工作都是為了盡量縮短那些被取消資格但仍然符合資格的人與重新獲得資格之間的時間跨度。顯然，這包括直接外展，但也依賴初級保健醫生和一般提供者，這樣我們就不會在人們出現在急診室時重新抓到他們。因此，我認為外展活動也被證明是成功的，至少在最初幾個月是這樣。

And our next question today comes from Steven Valiquette with Barclays.

今天我們的下一個問題來自巴克萊銀行的 Steven Valiquette。

Maybe just to shift gears on the Medicare side for a moment, and your comments around the cost trends were definitely helpful. There's still a lot of different theories out there as to why Medicare is seeing elevated cost trend in '23 specifically, particularly in outpatient, while Medicaid and commercial are not really seeing the same elevated trends. So I was just curious to get your thoughts and any additional color on why you think this is happening in Medicare specifically this year?

也許只是暫時改變醫療保險方面的方向，您對成本趨勢的評論絕對有幫助。關於為什麼醫療保險在 23 年看到成本上升的趨勢，特別是在門診，仍然有很多不同的理論，而醫療補助和商業並沒有真正看到同樣的上升趨勢。所以我只是想知道您的想法以及您認為為什麼今年特別是在醫療保險中會發生這種情況的任何其他信息？

Yes, I mean it's tough to speculate here and don't plan on it, but you could probably think about the composition of our members. 49% of our members in Medicaid are under 19 years old. So there's probably not a lot of cardiac, or ortho, or cataract, which is what we're seeing on the Medicare side.

是的，我的意思是很難在這裡進行推測並且不進行計劃，但您可能會考慮一下我們成員的構成。我們 49% 的 Medicaid 會員年齡在 19 歲以下。因此，可能沒有太多的心臟、矯形或白內障，這正是我們在醫療保險方面看到的。

Other than that, I can't really explain other than saying what we're seeing in Medicaid and marketplace is pretty stable relative to the pop we saw in May, which is not alarming, but figured it would be a helpful commentary for you guys, given some of the noise around the industry and the fact that our Medicare HBR was a little bit higher than we expected in the second quarter.

除此之外，我無法真正解釋，只能說我們在醫療補助和市場中看到的情況相對於我們五月份看到的流行趨勢相當穩定，這並不令人擔憂，但我認為這對你們來說是一個有用的評論考慮到行業內的一些噪音以及我們的醫療保險 HBR 略高於我們第二季度預期的事實。

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

今天我們的下一個問題來自高盛的內森·里奇。

Just a couple of clarifications. Maybe just sticking on that last question. Drew, I'd be curious if you could maybe frame the magnitude of this kind of step down that you saw in June when you're thinking about kind of monthly cadence? And how you're expecting that to play out over the back half of the year?

只是一些澄清。也許只是堅持最後一個問題。德魯，我很好奇，當你考慮每月的節奏時，你能否描述一下你在 6 月份看到的這種下降的幅度？您預計下半年情況如何？

And then a quick follow-up on the marketplace margins and expectations for next year. Given both the growth you're seeing, the SEP enrollment, as well as kind of pricing plans for '24, what type of margin improvement you'd expect to see in the commercial business next year just as we think about progression into '24?

然後快速跟進明年的市場利潤和預期。考慮到您所看到的增長、SEP 註冊人數以及 '24 的定價計劃，正如我們考慮進入 '24 那樣，您預計明年商業業務會出現什麼樣的利潤率改善？

Well, we definitely have priced for and expect margin progression as we get into 2024. We'll have to give you more of an update as we get towards the end of the year at Investor Day for more specific '24 guidance elements that detailed.

好吧，隨著進入 2024 年，我們肯定已經定價並預計利潤率會增長。當我們接近年底的投資者日時，我們必須向您提供更多更新，以了解更具體的 24 年指導元素。

And then on your '23 question related to trend, as Sarah said in her script, we've got accommodation in our at least $6.45 adjusted EPS guidance for some continuation of this. Although to your point, we did see a step down, not all the way back to April, but a step down in June and sort of that holding in July with respect to the relativity from what we saw with May incurred through their second month of development.

然後，關於您與趨勢相關的 23 個問題，正如莎拉在她的腳本中所說，我們已經在至少 6.45 美元的調整後每股收益指導中進行了調整，以便繼續保持這一趨勢。儘管就您的觀點而言，我們確實看到了下跌，不是一路回到四月，而是在六月下跌，並且在七月保持了這種狀態，與我們看到的五月第二個月的相對性有關。發展。

And ladies and gentlemen, this concludes our question-and-answer session. I'd like to turn the conference back over to Sarah London for any closing remarks.

女士們、先生們，我們的問答環節到此結束。我想將會議轉回莎拉·倫敦（Sarah London）發表閉幕詞。

Thanks, Rocco, and thanks, everyone. We appreciate the interest and all the great questions. We look forward to providing additional updates on our progress as we move through the back half of '23. I hope you all have a great day.

謝謝羅科，謝謝大家。我們感謝您的興趣和所有重要的問題。我們期待在 23 年下半年提供有關我們進展的更多最新信息。我希望你們都有美好的一天。

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。我們感謝大家參加今天的演講。您現在可以斷開線路，度過美好的一天。