Centene Corp (CNC) 2023 Q3 法說會逐字稿

Welcome to the Centene Corporation Third Quarter Earnings Release. (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.

歡迎閱讀 Centene Corporation 第三季財報發布。 （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 third 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.

謝謝你，羅科。大家早安。感謝您參加我們的第三季財報電話會議。莎拉·倫敦，首席執行官； Centene 執行副總裁兼財務長 Drew Asher 將主持今天早上的電話會議，也可以透過我們的網站 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 anticipates that subsequent events and developments may cause its estimates to change.

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 預計後續事件和事態發展可能會導致其估計發生變化。

While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so. The call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our third quarter 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.

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。此次電話會議也將提及某些非公認會計準則措施。這些指標與最直接可比較的 GAAP 指標的調節可以在我們的 2023 年第三季新聞稿中找到，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 措施的對帳。

Finally, we'd like to highlight our upcoming Investor Day scheduled for December 12 in New York City. This event will also be available via webcast. With that, I would like to turn the call over to our CEO, Sarah London. Sarah?

最後，我們想強調一下即將於 12 月 12 日在紐約市舉行的投資者日。活動也將透過網路直播進行。說到這裡，我想將電話轉給我們的執行長莎拉倫敦 (Sarah London)。莎拉？

Thank you, Jen. And thanks, everyone, for joining us. This morning, we reported very strong third quarter 2023 results, including adjusted EPS of $2, outperforming our internal expectations by approximately $0.20. Strong fundamentals and excellent marketplace growth and performance contributed to the strength in the quarter as well as our improved outlook for 2023. We now expect full year 2023 adjusted earnings per share of at least $6.60, representing over 14% year-over-year growth.

謝謝你，珍。感謝大家加入我們。今天早上，我們報告了非常強勁的 2023 年第三季業績，其中調整後每股收益為 2 美元，比我們的內部預期高出約 0.20 美元。強勁的基本面以及出色的市場成長和業績促成了本季的強勁成長以及我們對 2023 年前景的改善。我們現在預計 2023 年全年調整後每股收益至少為 6.60 美元，年成長超過 14%。

With my time this morning, I'll hit on key focus areas, including Medicaid redeterminations, upcoming RFPs, marketplace performance and recent Medicare Advantage Stars results and then provide a brief update on the operational progress we have made over the last few months. Then I'll turn it over to Drew to provide details on the quarter and additional commentary relative to our increased financial guidance for 2023. Let's start with Medicaid. We are now over 40% or approximately 1 million members through redeterminations, and we continue to track in line with our expectations for membership and acuity changes as well as our assumed sloping of overall timing.

今天早上，我將重點討論關鍵的重點領域，包括醫療補助重新確定、即將發布的 RFP、市場表現和最近的 Medicare Advantage Stars 結果，然後簡要介紹我們在過去幾個月中取得的營運進展。然後我將把它交給 Drew，提供有關本季度的詳細資訊以及與我們增加的 2023 年財務指導相關的附加評論。讓我們從醫療補助開始。透過重新確定，我們現在超過 40% 或大約 100 萬會員，並且我們將繼續按照我們對會員和敏銳度變化的預期以及我們假設的總體時間傾斜進行追蹤。

As we closely monitor Medicaid membership transitions, rejoin our data remains instructive as we think about the net membership impact of redeterminations and coverage continuity. We are now seeing April through August cohorts consistently experiencing rejoining rates in the mid-20% range. Importantly, the 90-day grace period in most states means that the majority of these members have no break in coverage as they return to the Medicaid program. CMS has obviously been playing an important role with respect to the oversight of the Medicaid redeterminations process, including recent intervention to pause redeterminations in certain states as well as the effort to reinstate children and individuals who are incorrectly dropped from coverage due to system issues. We are seeing some of the impact of these reinstatements come through in our rejoiner data and continue to monitor the impact these changes will have on the timing of expected membership shifts over the coming months.

當我們密切關注醫療補助會員資格的轉變時，重新加入我們的數據仍然具有指導意義，因為我們考慮重新確定和涵蓋連續性對會員資格的淨影響。我們現在看到 4 月到 8 月的隊列重新加入率一直在 20% 左右。重要的是，大多數州的 90 天寬限期意味著大多數會員在返回醫療補助計劃後，保險範圍不會中斷。 CMS 顯然在監督醫療補助重新確定過程方面發揮了重要作用，包括最近在某些州暫停重新確定的干預措施，以及努力恢復因係統問題而被錯誤地從保險範圍中剔除的兒童和個人。我們在重新加入者資料中看到了這些恢復的一些影響，並繼續監測這些變化對未來幾個月預期成員轉變時間的影響。

That said, we have not changed our view that the ultimate impact of redeterminations would be 2.3 million to 2.4 million members. And based on our view of recent CMS actions and our ongoing conversations with state partners, we still expect the overwhelming majority of redeterminations to be completed by May of 2024. We continue to track in line with our expected 200,000 to 300,000 members moving from Medicaid into marketplace as a result of the redetermination process. We have partnered with an increasing number of states to make auto enrollment a more seamless path for Medicaid members losing eligibility and are pleased to be able to leverage our market-leading and better platform to maximize coverage continuity for members of the communities we serve.

儘管如此，我們並沒有改變我們的觀點，即重新決定的最終影響將是 230 萬至 240 萬成員。根據我們對最近CMS 行動的看法以及我們與州合作夥伴正在進行的對話，我們仍然預計絕大多數重新決定將在2024 年5 月之前完成。我們將繼續跟踪我們預計的200,000 至300,000 名會員從醫療補助轉入醫療補助的情況。市場是重新確定過程的結果。我們與越來越多的州合作，為失去資格的醫療補助成員提供更無縫的自動註冊途徑，並且很高興能夠利用我們市場領先的更好平台，最大限度地提高我們所服務社區成員的覆蓋連續性。

Our rate discussions continue to be constructive as well. The consistent trend we saw in 7/1 and 10/1 rate cohorts has continued so far as the first wave of 1124 draft rates have been released. We are working through an incomplete 4:1 retro rate as Drew will discuss further, but continue to have constructive discussions there as well. We appreciate the thoughtful and database collaboration with our state partners as they acknowledge the importance of matching rates with acuity in order to maintain the strength and effectiveness of each Medicaid program.

我們的利率討論也仍然具有建設性。到目前為止，我們在 7/1 和 10/1 利率組中看到的一致趨勢一直持續到第一波 1124 草案利率發佈為止。我們正在研究不完整的 4:1 恢復率，德魯將進一步討論，但也將繼續進行建設性討論。我們感謝與我們的州合作夥伴進行深思熟慮的資料庫合作，因為他們認識到將費率與敏銳度相匹配的重要性，以保持每個醫療補助計劃的強度和有效性。

Overall, we are encouraged by the progress that states are making with respect to Medicaid redeterminations. I'm pleased to be moving through the process with operational stability and results that are consistent with our modeling. Turning to growth. In North Carolina, we are preparing for Medicaid expansion that will go live in December. North Carolina is the 41st state to expand Medicaid. And by passing this legislation with the joint leadership of a democratic governor and a Republican supermajority legislature, they demonstrate the increasing bipartisan support for this program.

總體而言，我們對各州在醫療補助重新確定方面取得的進展感到鼓舞。我很高興能夠以穩定的運行和與我們的建模一致的結果完成整個過程。轉向增長。在北卡羅來納州，我們正在準備擴大醫療補助計劃，該計劃將於 12 月實施。北卡羅來納州是第 41 個擴大醫療補助範圍的州。透過在民主黨州長和共和黨絕對多數立法機構的共同領導下通過這項立法，他們表明了兩黨對該計劃日益增長的支持。

We expect this trend to continue as states look to provide improved access to quality care for their citizens. In RFP news, our Sunshine Health team officially submits our response to the Florida ITM this week. I want to give a nod to the Sunshine Health team to our exceptional business development team and the many Cen teamers who contributed to this effort. I'm proud of the work they did to prepare this response and proud of the long-standing partnership we have established in serving the communities of Florida. In general, we are seeing an increase in RFP activity and momentum around states considering the addition of new populations into a managed care model.

我們預計這種趨勢將持續下去，因為各州希望為其公民提供更好的優質照護服務。在 RFP 訊息中，我們的 Sunshine Health 團隊本周正式向佛羅裡達州 ITM 提交了我們的回應。我想向 Sunshine Health 團隊、我們傑出的業務開發團隊以及為這項工作做出貢獻的許多 Cen 團隊成員表示敬意。我為他們為準備這項應對措施所做的工作感到自豪，並為我們在服務佛羅裡達州社區方面建立的長期合作夥伴關係感到自豪。總的來說，我們看到考慮將新人口添加到管理式醫療模式中的各州的 RFP 活動和勢頭增加。

Notably, the recently released Georgia RFP includes, for the first time, the state's aged, blind and disabled population. As we look ahead to our procurement pipeline, we feel good about the opportunity to leverage our incumbent position and our differentiated depth of expertise in managing complex populations to defend and grow our Medicaid footprint. In support of this work, I'm happy to share that we have officially appointed Wade Rakes as Centene's Chief Growth Officer. Wade will take on this responsibility in addition to continuing to serve as the CEO of our Peach State Health Plan as he leads our incredibly strong Georgia team through their procurement remaining at the helm through the conclusion of that process.

值得注意的是，最近發布的喬治亞州徵求建議書首次納入了該州的老年人、盲人和殘疾人人口。當我們展望我們的採購管道時，我們很高興有機會利用我們現有的地位和我們在管理複雜人群方面的差異化專業知識來捍衛和擴大我們的醫療補助足跡。為了支持這項工作，我很高興地告訴大家，我們已正式任命 Wade Rakes 為 Centene 的首席成長長。韋德除了繼續擔任我們桃州健康計劃的首席執行官之外，還將承擔這一責任，因為他領導著我們極其強大的佐治亞州團隊，透過他們的採購，在整個過程結束時繼續掌舵。

Wade will bring valuable experience as both a local and enterprise leader for Centene as he helps to drive execution around our growth strategy. Turning to Marketplace. Our Ambetter franchise continues to outperform this year, outpacing our growth expectations in the quarter and reaching just under 3.7 million members as of September 30. This means added earnings power for the remainder of 2023 as well as a potential earnings tailwind for 2024 as our retained special enrollment period or SEP members become more profitable in their soft more year with Ambetter.

Wade 將為 Centene 帶來作為本地和企業領導者的寶貴經驗，幫助推動我們成長策略的執行。轉向市場。我們的Ambetter 特許經營權今年繼續表現出色，超出了我們在本季度的增長預期，截至9 月30 日，會員數量略低於370 萬名。這意味著2023 年剩餘時間的盈利能力增加，並為2024 年帶來潛在的獲利推動力，因為我們保留了特殊註冊期或 SEP 會員在 Ambetter 的軟年中變得更有利可圖。

Ambetter's unique individual market density, consistent performance and market-leading brand recognition have enabled us to build attractive and efficient networks and to foster productive relationships with a vast array of distribution partners. This has driven our impressive growth in 2023 and positions us well to continue to serve this large and expanding addressable market. We'll have an opportunity to dive more deeply into the future growth drivers of this business during our Investor Day in December and remain excited by the growth and earnings potential of the individual market in both the short-term and the long-term.

Ambetter 獨特的個人市場密度、一致的性能和市場領先的品牌認知度使我們能夠建立有吸引力且高效的網絡，並與眾多分銷合作夥伴建立富有成效的關係。這推動了我們在 2023 年實現令人印象深刻的成長，並使我們能夠繼續為這個龐大且不斷擴大的目標市場提供服務。我們將有機會在 12 月的投資者日期間更深入地探討該業務的未來成長動力，並對單一市場的短期和長期成長和獲利潛力保持興奮。

Finally, Medicare. This is an important time of year for our Medicare Advantage business as 2024 enrollment begins to take shape through the annual enrollment period, which kicked off on October 15. As you'll recall, the 2024 bid cycle represents a pivot point for our Medicare Advantage products as we reposition our offerings to better serve low-income and complex lives. Touching on the important topic of Stars, we received the final Star rating results along with the rest of the industry 2 weeks ago. The final Stars results for this cycle were consistent with our July and September commentary, where we expected 2/3 of our membership associated with contracts showing year-over-year raw score improvement.

最後是醫療保險。對於我們的Medicare Advantage 業務來說，這是一年中的一個重要時刻，因為2024 年的投保在10 月15 日開始的年度投保期中開始形成。您可能還記得，2024 年投標週期代表了我們Medicare Advantage 的一個關鍵點我們重新定位我們的產品，以便更好地服務低收入和複雜的生活。談到星級這個重要話題，兩週前我們和業界其他人一起收到了最終的星級評級結果。本週期的最終 Stars 結果與我們 7 月和 9 月的評論一致，我們預計 2/3 的會員與顯示原始分數同比改善的合約相關。

That result was approximately 73%. We also said we are expecting roughly 90% of our membership to be associated with contracts rated 3 stars or higher, and that final result was 87%. While we delivered Stars results in line with our Q2 expectations, these results certainly do not reflect the ambition of this organization. They do, however, represent an important step on our journey to improve quality scores and restored Medicare Advantage earnings power. Relative to our ongoing work to strengthen Medicare execution overall, we continue to see improvement in our operating metrics, which are important indicators for member experience and ultimately, Star scores.

結果約為 73%。我們還表示，我們預計大約 90% 的會員會與 3 星或更高級別的合約相關，最終結果是 87%。雖然我們提供的星級結果符合我們第二季的預期，但這些結果肯定沒有反映組織的雄心。然而，它們確實代表了我們在提高品質分數和恢復 Medicare Advantage 盈利能力的道路上邁出的重要一步。相對於我們正在進行的整體加強醫療保險執行的工作，我們繼續看到我們的營運指標有所改善，這些指標是會員體驗以及最終星級評分的重要指標。

Our first call resolution has improved year-over-year and quarter-over-quarter as have our customer satisfaction scores. We are still tracking a roughly 40% reduction in member complaints year-over-year and consistently delivering service levels in the high 90% and we continue to build out our network, including adding 6,100 new providers in the quarter and moving more than 12,000 members into new value-based agreements.

我們的首次呼叫解決率逐年和逐季度都有所提高，我們的客戶滿意度得分也是如此。我們仍然發現會員投訴同比減少了約 40%，並始終提供高達 90% 的服務水平，並且我們繼續建設我們的網絡，包括在本季度增加 6,100 家新提供商並轉移超過 12,000 名會員納入新的基於價值的協議。

Medicare Advantage remains an integral part of our portfolio of businesses, strategically aligned with our Medicaid and Marketplace platforms and a long-term driver of both earnings and growth. We remain committed to and focused on the work necessary to improve overall performance and quality on behalf of our Medicare members. Before I turn it over to Drew, let me touch briefly on our value creation work. We continue to make progress against the many initiatives that will focus and fortify our enterprise to support robust long-term growth.

Medicare Advantage 仍然是我們業務組合中不可或缺的一部分，與我們的 Medicaid 和 Marketplace 平台在策略上保持一致，並且是獲利和成長的長期驅動力。我們仍然致力於並專注於代表我們的 Medicare 會員提高整體績效和品質所需的工作。在將其交給德魯之前，讓我先簡單介紹一下我們的價值創造工作。我們繼續在許多舉措上取得進展，這些舉措將集​​中和加強我們的企業，以支持強勁的長期成長。

As our first wave of operational redesign work matures, we are evolving our focus for those initiatives to optimizing and automating workflows as we look to support more efficient and effective service for our members and providers. For the initial installations of our new telephony system, we are now layering on additional features that are driving month-over-month improvement in self-service. And over the last few months, within our now centralized utilization management teams, we have been focused on reducing provider abrasion by expanding the use of our proprietary tool, [CATA], which automates the approval of authorizations for clinically appropriate procedures using AI technology we developed in collaboration with Apixio. Speaking of technology, I'm particularly excited about the data work we have accelerated over the last few quarters as we look to aggressively build out an integrated data fabric across Centene to support our long-term technology strategy.

隨著我們第一波營運重新設計工作的成熟，我們正在將這些措施的重點轉向優化和自動化工作流程，因為我們希望為我們的會員和提供者提供更有效率、更有效的服務。對於新電話系統的初始安裝，我們現在正在分層添加其他功能，這些功能正在推動自助服務逐月改進。在過去的幾個月裡，在我們現在集中的利用管理團隊中，我們一直致力於透過擴大我們的專有工具[CATA] 的使用來減少提供者的磨損，該工具使用我們的人工智慧技術自動批准臨床適當程序的授權。與 Apixio 合作開發。說到技術，我對過去幾季加速的數據工作感到特別興奮，因為我們希望在 Centene 上積極建立整合資料結構，以支援我們的長期技術策略。

One of the benefits of taking this work on now is that we can leverage the most modern technology and design our infrastructure to account for the ways in which we foresee both traditional AI and generative AI being deployed in our environments to automate administration, support more seamless provider collaboration and optimize clinical insights that will transform our members' health journeys across lines of business.

現在進行這項工作的好處之一是，我們可以利用最現代的技術並設計我們的基礎設施，以考慮我們預見傳統人工智慧和生成式人工智慧在我們的環境中部署的方式，以實現管理自動化、支援更無縫的服務。提供者協作並優化臨床見解，這將改變我們會員跨業務線的健康之旅。

One quick milestone from this work. Over the last 3 quarters, we have significantly increased the number of digital clinical sources flowing into our clinical data hub, where we hold a longitudinal health record for our members. The expansion of clinical data from digital sources is expected to reduce the overall cost and improve the accuracy and timeliness of information we can use to solve for gaps in care, understand member risk and acuity and support predictive modeling for care management interventions.

這項工作的一個快速里程碑。在過去的三個季度中，我們顯著增加了流入臨床資料中心的數位臨床來源的數量，我們在這裡為會員保存縱向健康記錄。來自數位來源的臨床數據的擴展預計將降低總體成本並提高資訊的準確性和及時性，我們可以使用這些資訊來解決護理方面的差距，了解會員風險和敏銳度並支持護理管理幹預措施的預測模型。

There are a number of other operational and digital initiatives in flight across our value creation portfolio, and we look forward to providing updates and proof points for those as we move into and through 2024. But it is important to note that increasingly, this work is carrying momentum not because of the value creation scorecard. But because it is simply part of the disciplined operating DNA we are building across the company.

我們的價值創造組合中還有許多其他營運和數位措施正在實施，我們期待在進入2024 年及整個2024 年時為這些舉措提供更新和證據。但值得注意的是，這項工作越來越多地帶來動力並不是因為價值創造記分卡。但因為它只是我們在整個公司建立的紀律運作 DNA 的一部分。

From a portfolio review standpoint, we were pleased to reach a definitive agreement to divest Circle Health earlier this quarter. Circle is an excellent asset with a strong management team, and we took our time to find the right partner who will continue to support the good work Circle is doing to serve communities in the U.K. We continue to expect this deal to close in Q1 of next year and to be $0.03 to $0.04 accretive to 2024.

從投資組合審查的角度來看，我們很高興在本季早些時候達成剝離 Circle Health 的最終協議。 Circle 是一項優秀的資產，擁有強大的管理團隊，我們花了很多時間尋找合適的合作夥伴，他們將繼續支持Circle 為服務英國社區所做的良好工作。我們仍然預計這筆交易將在明年第第一季完成到 2024 年將增加 0.03 至 0.04 美元。

There are a few remaining assets we continue to evaluate and reposition, but we are now in the final innings of this work and expect that as we get to mid-2024, we will be focused on building around our solid strategic and streamlined core business.

我們將繼續評估和重新定位一些剩餘資產，但我們現在正處於這項工作的最後階段，預計到 2024 年中期，我們將專注於圍繞我們堅實的策略和精簡的核心業務進行建設。

Finally, I want to touch on our PBM migration. Given its importance to our 2024 financial targets, but more importantly, given the value we expect it will drive for our customers and members. The teams have put in an enormous amount of work over the last few months and continue to make great progress against our key milestones. In fact, earlier this month, we got to see an early but important proof point of how well these teams are working together on behalf of our customers due to a 10/1 migration of one of our health plans from a legacy platform over to ESI. Thanks to thoughtful planning and testing ahead of time and strong collaboration and communication during the cutover, this was a very successful transition, and we believe it sends a great signal about the health of this project as we move into Q4.

最後，我想談談我們的 PBM 遷移。鑑於它對我們 2024 年財務目標的重要性，但更重要的是，考慮到我們期望它將為我們的客戶和會員帶來的價值。在過去的幾個月裡，這些團隊投入了大量的工作，並繼續在我們的關鍵里程碑方面取得巨大進展。事實上，本月早些時候，由於我們的一項健康計劃從舊平台 10/1 遷移到 ESI，我們看到了一個早期但重要的證據，表明這些團隊代表我們的客戶合作得有多好。 。由於提前深思熟慮的規劃和測試以及切換期間的強有力的協作和溝通，這是一次非常成功的過渡，我們相信，當我們進入第四季度時，它發出了關於該項目健康狀況的重要信號。

Overall, Centene continues to generate positive momentum. We are making important strides operationally, fortifying the foundation of the business and increasingly leveraging our size and scale to better serve our customers.

總體而言，Centene 繼續產生積極的勢頭。我們在營運方面取得了重要進展，鞏固了業務基礎，並越來越多地利用我們的規模和規模來更好地為客戶服務。

Strategically, as you've seen through our divestitures, we have sharpened the focus of the enterprise on our 3 core business lines and continue to work hard to preserve the unique innovation engine of our local health plans. These advancements, along with our 2023 outperformance give us confidence that we will exceed our 2024 earnings floor of $6.60 and continued to demonstrate improved member and provider experiences. With that, I'll turn it over to Drew.

從策略上講，正如您透過我們的資產剝離所看到的那樣，我們將企業的重點集中在我們的 3 個核心業務線上，並繼續努力保持我們當地健康計劃的獨特創新引擎。這些進步加上我們 2023 年的優異表現，讓我們有信心超過 2024 年 6.60 美元的盈利下限，並繼續展示改進的會員和提供者體驗。有了這個，我會把它交給德魯。

Thank you, Sarah. Today, we reported third quarter 2023 results of $35 billion in premium and service revenue and adjusted diluted earnings per share of $2 up over 50% from $1.30 in Q3 of 2022. This represents a $0.20 beat to our internal forecast that we tried to recalibrate you to in early September. Our Q3 consolidated HBR was 87%, a little bit better than our expectation, driven by the commercial segment. This keeps us right on track with our full year HBR guidance range.

謝謝你，莎拉。今天，我們公佈了2023 年第三季的業績，保費和服務收入為350 億美元，調整後攤薄每股收益為2 美元，較2022 年第三季的1.30 美元增長超過50%。這比我們試圖重新調整的內部預測高出0.20 美元。到九月初。在商業部門的推動下，我們第三季的綜合 HBR 為 87%，略優於我們的預期。這使我們能夠正確履行《哈佛商業評論》全年指導範圍。

Medicaid at 90.7% was fundamentally on track other than one of our states providing a draft and incomplete rate update retroactive to 4/1/'23. This was worth about 40 basis points in the quarter relative to our expectations. Other than that unique item, which we would expect to be a timing matter with a favorable future resolution. We continue to be on track in Medicaid including relative to our acuity estimates that we've been tracking since the recommencement of redeterminations on April 1, 2023.

除了我們的一個州提供了一份草案和不​​完整的費率更新（追溯至 2023 年 4 月 1 日）之外，醫療補助費率為 90.7%，基本上步入正軌。相對於我們的預期，該季度的價值約為 40 個基點。除了那個獨特的項目之外，我們預計這是一個時間問題，未來會有有利的解決方案。我們在醫療補助方面繼續走上正軌，包括相對於我們自 2023 年 4 月 1 日重新開始重新確定以來一直在追蹤的敏銳度估計。

As you can see in the membership tables, we are down 1.1 million Medicaid members since 3/31/'23, right on track with our forecast that include redetermination estimates. That $1.1 million includes Iowa reshuffling of about 83,000 members effective July 1 as expected. To update a statistic we previously provided, 13 of our 14 states in the 7/1 to 10/1 cohort have included acuity adjustments in our rates. One is still outstanding. And so far, 7 of our 1124 cohort states have provided draft rates that include acuity adjustments overall, consistent with our estimates.

正如您在會員表格中看到的，自 2023 年 3 月 31 日以來，我們的醫療補助會員人數減少了 110 萬，與我們的預測（包括重新確定估計）完全一致。這 110 萬美元包括愛荷華州約 83,000 名成員的改組，如預期，將於 7 月 1 日生效。為了更新我們先前提供的統計數據，在 7/1 至 10/1 隊列中的 14 個州中，有 13 個州在我們的費率中納入了敏銳度調整。有一個仍然很出色。到目前為止，我們的 1124 個隊列州中有 7 個州提供了包括總體敏銳度調整在內的草案費率，這與我們的估計一致。

Our view of 2024 Medicaid performance is unchanged, other than revenue looks to be a little stronger than the $77 billion we outlined on our Q1 call. At Investor Day, we'll provide more detail on 2024 guidance. Medicare was on track at 82.2%, an improvement of 170 basis points from Q3 of 2022. Similarly, our view of Medicare 2024 performance is consistent with what we shared previously. And as you finish modeling 2023, make sure you factor in the Q4 2023 Medicare HBR step-up, including the previously discussed premium deficiency reserve.

我們對 2024 年醫療補助業績的看法沒有變化，只是收入看起來比我們在第一季電話會議中概述的 770 億美元略強一些。在投資者日，我們將提供有關 2024 年指導的更多詳細資訊。 Medicare 的成長率為 82.2%，比 2022 年第三季提高了 170 個基點。同樣，我們對 Medicare 2024 年表現的看法與我們先前分享的一致。當您完成 2023 年建模時，請確保考慮 2023 年第四季度 Medicare HBR 的升級，包括先前討論的保費不足準備金。

The commercial HBR at 78.9% in Q3 continues to be strong and better than expected. Simultaneously, we are also capturing growth from both redeterminations and the special enrollment period. We said on the Q2 call that we expected to hit 3.6 million members this year, and we accomplished that as of the end of Q3. You may recall that last quarter, we grew 200,000 members. This quarter, we grew 386,000 members. This continued growth and HBR performance in 2023 sets us up well to achieve our previously stated goal of growing marketplace, at least $3 billion of revenue in 2024 while also expanding margin.

第三季商業 HBR 為 78.9%，持續強勁且優於預期。同時，我們也從重新確定和特殊招生時期獲得成長。我們在第二季電話會議上表示，預計今年會員數將達到 360 萬，並在第三季末實現了這一目標。您可能還記得，上個季度，我們增加了 20 萬名會員。本季度，我們增加了 386,000 名會員。這種持續成長和 2023 年《哈佛商業評論》的表現使我們能夠很好地實現先前提出的市場成長目標，即到 2024 年實現至少 30 億美元的收入，同時擴大利潤率。

Moving to other P&L and balance sheet items. Our adjusted SG&A expense ratio was 8.6% in the third quarter compared to 8.3% last year, consistent with our mix of business. Cash flow provided by operations was $1 billion in the third quarter, primarily driven by net earnings. Our domestic unregulated and unrestricted cash on hand at quarter end was $231 million. During the third quarter, we repurchased 11.6 million shares of our common stock for $773 million. Year-to-date, we have repurchased 22.9 million shares for $1.58 billion, a little over our goal of $1.5 billion for 2023.

轉向其他損益表和資產負債表項目。第三季調整後的 SG&A 費用率為 8.6%，而去年為 8.3%，與我們的業務結構一致。第三季營運產生的現金流為 10 億美元，主要由淨利推動。截至季末，我們國內手頭上不受監管和不受限制的現金為 2.31 億美元。第三季度，我們以 7.73 億美元回購了 1,160 萬股普通股。今年迄今，我們已回購 2,290 萬股股票，耗資 15.8 億美元，略高於 2023 年 15 億美元的目標。

Our debt to adjusted EBITDA ticked down to 2.8x. Our medical claims liability totaled $17.1 billion at quarter end and represents 53 days in claims payable up 1 day from Q2 of 2023. Outside of adjusted earnings, during the third quarter, we announced the divestiture of Circle, our U.K. hospital company, which triggers a noncash write-down of goodwill. We also adjusted the carrying value of our U.K. physician business. You can see these and other items in the table in our press release.

我們的債務與調整後 EBITDA 比率下降至 2.8 倍。截至季度末，我們的醫療索賠負債總額為171 億美元，相當於53 天的應付索賠，比2023 年第二季度增加了1 天。除了調整後的收益之外，在第三季度，我們宣布剝離我們的英國醫院公司Circle，引發了商譽的非現金減記。我們也調整了英國醫生業務的帳面價值。您可以在我們新聞稿的表格中看到這些內容和其他內容。

We are pleased with the performance of the company in the first 3 quarters of the year and are increasing our outlook to at least $6.60 of adjusted EPS for 2023. As Sarah mentioned, this puts us at greater than 14% adjusted EPS growth in 2023 after posting 12% in 2022, 2 pretty good years. The press release table has other 2023 guidance elements, including no change in HBR or SG&A ranges and $0.5 billion more in premium revenue. We also still forecast investment in other income, a little over $1 billion, excluding divestiture gains and losses. As we are almost at 2024, which we will go into more detail at our Investor Day in a little over 6 weeks, we continue to have confidence in our 2024 adjusted EPS floor of greater than $6.60. In fact, the strength of this quarter is another data point that increases our confidence.

我們對公司今年前3 季的業績感到滿意，並將2023 年調整後每股收益的預期提高到至少6.60 美元。正如莎拉所提到的，這使我們在2023 年調整後每股收益增長超過14 % 2022 年將成長 12%，這是相當不錯的兩年。新聞稿表還包含其他 2023 年指導要素，包括 HBR 或 SG&A 範圍不變以及保費收入增加 5 億美元。我們也預期其他收入投資略高於 10 億美元，不包括資產剝離損益。由於我們即將到 2024 年，我們將在 6 週多一點的投資者日上詳細介紹這一點，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。事實上，本季的強勁表現是另一個增強我們信心的數據點。

While I do spend a lot of my time talking about and driving margin, let me close by talking about growth because Centene is a combination, margin expansion and growth investment opportunity. On growth, Medicaid expansion is coming to North Carolina late this year. Our Oklahoma win in both broad Medicaid and sole source foster care is on track to commence 4/1/'24 and there's a pipeline of complex populations expected to come into managed care over the next few years. One example being the recent Georgia RFP as Sarah referenced. Marketplace has proven to be an excellent franchise and asset for this company. This business today produces more revenue than our Medicare Advantage business, and that will widen in 2024. And even our PDP business, which may be small in relative revenue should grow meaningfully in 2024, these members produce pharmacy spend and our potential MAPD candidates down the road.

雖然我確實花了很多時間談論和提高利潤率，但讓我最後談談成長，因為 Centene 是利潤率擴張和成長投資機會的組合。在成長方面，醫療補助計劃將於今年年底擴展到北卡羅來納州。我們俄克拉荷馬州在廣泛的醫療補助和唯一來源寄養方面的勝利預計將於 2024 年 4 月 1 日開始，預計未來幾年將有大量複雜人群進入管理式護理。薩拉提到的最近的喬治亞州徵求建議書就是一個例子。事實證明，Marketplace 是該公司的一項出色的特許經營權和資產。如今，該業務產生的收入比我們的Medicare Advantage 業務更多，而這一收入將在2024 年擴大。即使我們的PDP 業務（相對收入可能較小）也應該在2024 年大幅增長，這些成員會產生藥房支出，而我們潛在的MAPD 候選者將在2024 年實現顯著增長。路。

We're excited about the future and our ability to power through 2024 and come out the other side post divestitures, post redeterminations and on our way to fixing Medicare a better company than in 2021. On the other side of 2024, we look forward to driving a 12% to 15% long-term adjusted EPS CAGR. Thank you for your interest in Centene. Rocco will take questions now.

我們對未來以及我們在 2024 年保持動力的能力感到興奮，並在資產剝離、重新確定後走出困境，並將 Medicare 打造成比 2021 年更好的公司。在 2024 年的另一邊，我們期待著推動12% 至15% 的長期調整後EPS 複合年增長率。感謝您對 Centene 的興趣。羅科現在將接受提問。

(Operator Instructions) Today's first question comes from Kevin Fischbeck with BofA.

（操作員說明）今天的第一個問題來自美國銀行的 Kevin Fischbeck。

(Operator Instructions) Today's first question comes from Kevin Fischbeck with BofA.

（操作員說明）今天的第一個問題來自美國銀行的 Kevin Fischbeck。

Great. Just wanted to maybe dig into the exchange performance in the quarter because obviously, whenever you have 75% membership growth in your being MOR. It's always a little bit unusual, particularly because in the past, we've seen SEP enrollment come in with MLR pressure. So can you just talk a little bit more about what's driving that outperformance? And as you grow membership faster than you were thinking, what gives you comfort around the MLR coming in better than people have been forecasting?

偉大的。只是想深入了解本季的交易所表現，因為顯然，每當您的 MOR 會員數量增長 75% 時。這總是有點不尋常，特別是因為在過去，我們看到 SEP 註冊是在國土資源部的壓力下進行的。那麼您能多談談是什麼推動了這種出色的表現嗎？當您的會員成長速度比您想像的要快時，是什麼讓您對國土資源部的進展比人們預測的更好感到放心？

Yes. Thanks, Kevin. Thanks for the question. As I talked about in my script, so let me hit on sort of the growth, which I think has a lot to do with the fact that we have an established franchise have #1 for brand recognition in the market, a differentiated distribution network and there's a lot of experience executing and we sort of foresaw the growth that was going to come because the additional awareness and affordability that was created not just through CMS spend on marketing and navigators, but really the sentinel effect of the extension of the enhanced APTCs.

是的。謝謝，凱文。謝謝你的提問。正如我在劇本中談到的那樣，讓我談談某種成長，我認為這與以下事實有很大關係：我們擁有成熟的特許經營權，在市場上擁有排名第一的品牌認知度、差異化的分銷網絡以及我們有很多執行經驗，而且我們在某種程度上預見了即將到來的增長，因為額外的意識和負擔能力不僅是透過CMS 在行銷和導航方面的支出而創造的，而且實際上是增強的APTC 擴充的哨兵效應。

Turning to performance. We're obviously pleased not only with the growth but the fact that we sustained performance of that business in 2023 and done so exactly as you say, despite having significant SEP membership growth, which in past years has created pressure, not just because of the risk adjustment effect but also like we saw in 2021 through pent-up demand. So when we think about the factors that are contributing to overall performance and what's giving us comfort, the first is just what we're seeing in terms of underlying growth and performance of the core business that came in, in OEP. The second is the fact that we are not seeing the pent-up demand in the SEP membership like we saw in 2021, partly due to the fact that those members -- some of those members are coming in for Medicaid, where they had coverage and others would have been eligible for coverage in previous years.

轉向性能。顯然，我們不僅對成長感到滿意，而且對我們在2023 年維持該業務的業績這一事實感到滿意，並且完全按照您所說的去做，儘管SEP 會員數量大幅增長，這在過去幾年中造成了壓力，而不僅僅是因為風險調整效應，但也像我們在 2021 年透過被壓抑的需求看到的那樣。因此，當我們考慮影響整體業績的因素以及讓我們感到安心的因素時，首先是我們在 OEP 核心業務的潛在成長和業績方面看到的情況。第二個事實是，我們沒有看到像 2021 年那樣對 SEP 會員的被壓抑的需求，部分原因是這些會員——其中一些會員正在加入醫療補助，他們在醫療補助中擁有保險和其他人在前幾年才有資格獲得保險。

So the belief is that they weren't carrying a lot of unaddressed acuity into the market. The other factor is, and we pointed to this in the past, but in general, when we see this level of market growth, it drives a healthier overall risk pool, and we're seeing some of that in the performance. But I think the bigger piece is probably just execution from the team, really solid pricing discipline coming into the year as we've been on a margin progression with this product, execution on clinical initiatives, really thoughtful risk adjustment calculations. And again, just the expertise of having a team that's been doing this for a decade, I think, is really showing in what you're seeing in terms of performance this year.

因此我們相信他們並沒有將太多未解決的敏銳度帶入市場。另一個因素是，我們過去曾指出過這一點，但總的來說，當我們看到這種水平的市場成長時，它會推動更健康的整體風險池，我們在業績中看到了其中的一些因素。但我認為更重要的部分可能只是團隊的執行力，今年我們的定價紀律非常可靠，因為我們在該產品上取得了利潤增長，臨床計劃的執行力，真正深思熟慮的風險調整計算。再說一遍，我認為，擁有一支十年來一直從事這方面工作的團隊的專業知識，在今年的表現中確實體現了出來。

The only thing I would add numerically is just we've been through 2 rounds of Wakely data. So you have to think about the claims cost matched against the risk profile of the population. And so we've adjusted our risk adjustment payable actually up to $1.8 billion from $1.5 billion from Q2 to Q3, consistent with the feedback in the data from Wakely, and we're still holding the allowance on the insolvent peers or those that were waiting to get paid from through CMS. And so that $314 million that actually went up by $9 million in the quarter because one of those peers is still operating at least for the first half of this year. So it wasn't the bring down of that reserve that helped the quarter.

我唯一要補充的數字是我們已經完成了兩輪 Wakely 數據。因此，您必須考慮與人群風險狀況相符的索賠成本。因此，我們將第二季到第三季的應付風險調整實際上從15 億美元調整到了18 億美元，這與Wakely 的數據反饋一致，並且我們仍然對無力償債的同行或正在等待的同行持有準備金透過 CMS 獲得報酬。因此，本季的 3.14 億美元實際上增加了 900 萬美元，因為其中一家同業至少在今年上半年仍在運作。因此，並不是儲備金的下降對本季有所幫助。

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

今天我們的下一個問題來自富國銀行的史蒂芬‧巴克斯特。

I appreciate the commentary you made on acuity running in line with your expectations so far. I guess how do you think the higher level of procedural disenrollment that we're seeing across the industry have impacted that? Are you able to comment yet on what you're seeing in terms of utilization on the rejoiner population, especially maybe in the earlier cohorts. And then I appreciate you flagging kind of this unusual item on the rate side. I guess how should we think about the path to the Medicaid MLR that you just reported this quarter to what you're targeting for 2024, that 90.1%.

我很欣賞您對跑步敏銳度所做的評論，到目前為止符合您的期望。我想您認為我們在整個行業中看到的更高水平的程序退出對此有何影響？您能否對您所看到的重新加入人群的利用率發表評論，尤其是在早期人群中。然後，我很感謝您在費率方面標記了這種不尋常的項目。我想我們應該如何考慮您本季剛剛報告的醫療補助 MLR 到 2024 年目標 90.1% 的路徑。

Thanks, Stephen. Yes. So let me hit on the first part of the question relative to what we're seeing in levers and stayers, obviously, overall, we're seeing our levers HBR less than stayers as we had expected. What's interesting about the rejoiner rate, the last time that we updated on this, we were looking at April rates in that sort of mid 20% range and then sort of reasonable Pareto as you move through the ensuing months. What we've seen in the last month or 6 weeks or so is really that April to August cohort all filling up into what averages out at about 25%, which tells me that rate of rejoining that has picked up a little bit again, we think part of that is being driven by the CMS interventions.

謝謝，史蒂芬。是的。因此，讓我來談談與我們在槓桿和保持器中看到的問題相關的第一部分，顯然，總體而言，我們看到我們的槓桿 HBR 低於我們預期的保持器。重新加入率的有趣之處在於，我們上次對此進行更新時，我們觀察的是4 月份的比率在20% 左右的範圍內，然後在接下來的幾個月中，您會看到合理的帕累托曲線。我們在過去一個月或 6 週左右的時間裡看到的是，4 月至 8 月的隊列平均填充率約為 25%，這告訴我，重新加入率再次有所回升，我們我認為部分原因是CMS 幹預措施所推動的。

And given the fact that 75% -- sorry, 70% of those members have no gap in coverage and 95% of them have less than 2 months gap in coverage. We feel good about the fact that there aren't significant laggard impacts to acuity in terms of what we're seeing in those rejoiner cohorts. And then maybe, Drew, do you want to talk about the underlying Medicaid MLR.

考慮到 75% 的成員——抱歉，70% 的成員在保險範圍內沒有差距，而其中 95% 的成員在覆蓋範圍內的差距不到 2 個月。我們對這樣一個事實感到滿意：就我們在這些重新加入者群體中看到的情況而言，敏銳度沒有顯著的滯後影響。德魯，也許您想談談基本的醫療補助 MLR。

Yes, right. And as Sarah said, the levers have a lower HBR than the stayers consistent with our expectations. But actually, the rejoiners are right around the same HBR as the stayers. So that's looking good as well relative to our forecast. And then, yes, we're on track for the metrics we gave out, including the 90.1% target for 2024. As we get 1/1 rates, and I mentioned that we've gotten 7 that include acuity adjustments so far for 1/1 in the form of draft rates. That's just another positive weight on the scale of giving us confidence as we turn the page into 2024.

是的，沒錯。正如莎拉所說，槓桿的 HBR 低於維持器，符合我們的預期。但實際上，重新加入者與留下者的 HBR 大致相同。因此，相對於我們的預測，這看起來也不錯。然後，是的，我們正在實現我們給出的指標，包括2024 年90.1% 的目標。當我們得到1/1 的比率時，我提到我們已經得到了7 個，其中包括迄今為止1 的敏銳度調整/1 以匯票費率的形式表示。當我們邁入 2024 年時，這只是給我們信心的另一個正面因素。

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

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

Just a clarification first. I think I heard 20% now maybe going to 25% of redeterminations are coming back. I'm assuming those were Centene lives coming back to Centene plans. And I think you said 10%-ish or so are moving to exchanges. I'm curious about are you taking share from other plans when they're seeing redeterminations and you're getting their members into your exchanges? And then you mentioned through the big growth in PDP. I guess just a question on sort of strategy. It seems like a little deemphasis in terms of network or catchment points to the Medicare Advantage program, switching the PBM already.

首先澄清一下。我想我聽說現在 20% 到 25% 的重新決定會回來。我假設這些是 Centene 的生活，回到 Centene 的計劃。我想你說過大約 10% 左右正在轉向交易所。我很好奇，當其他計劃看到重新決定並且您讓他們的成員加入您的交流時，您是否會從其他計劃中獲取份額？然後你提到了 PDP 的大幅成長。我想這只是一個關於策略的問題。就人脈或服務點而言，似乎有點不再強調 Medicare Advantage 計劃，已經切換了 PBM。

So I'm just curious on what the idea is around the low-priced products for the PDP next year?

所以我只是好奇明年 PDP 的低價產品有什麼想法？

Yes. So thanks, Josh. Let me hit those clarification points, and then I'll turn it over to Drew. So what we are seeing on average across the April to August cohort is a 25% rejoiner rate on average. So those again have sort of filled up from what had been a Pareto -- decreasing Pareto to a pretty consistent 25% rejoining rate. And then our expectations, again, just mathematically, we're about that 10% to 15% recapture, which leaves the 200,000 to 300,000 member expectation that we're still tracking in line with.

是的。所以謝謝，喬許。讓我澄清一下這些要點，然後我會將其交給德魯。因此，我們在 4 月至 8 月的隊列中看到的平均重新加入率是 25%。因此，這些再次從帕累托圖上填滿了——將帕累托圖降低到相當一致的 25% 重新加入率。然後，我們的預期，再次，從數學上來說，我們大約會重新獲得 10% 到 15% 的會員數量，這使得我們仍在跟踪的 200,000 到 300,000 名會員的預期保持一致。

We are pulling share from other players and trying to track pretty closely, obviously, members that are coming from our plans. And then to the extent we can identify specifically those members that are coming from other Medicaid programs.

我們正在從其他參與者那裡獲取份額，並試圖非常密切地追蹤來自我們計劃的成員。然後我們可以具體識別出來自其他醫療補助計劃的成員。

Yes, Josh. And then on PDP, and you'll remember this business going back 10 years, which was a legacy WellCare asset and business. The strategy there is as much about corralling and managing pharmacy spend and having a future feeder for MAPD than it is about generating earnings on what's this year, $2.5 billion of revenue. So I think it was fortuitous that our change and improvement in cost structure or change to a new PBM and a meaningful improvement in cost structure occurred right when there are a number of rule changes impacting PDP like no pharmacy DIR elimination of the member cost share in the catastrophic phase, the cap on insulin and so we were able to leverage that cost structure and make it affordable for our members while the direct subsidy went up meaningfully.

是的，喬許。然後在 PDP 上，您會記得這項業務可以追溯到 10 年前，它是 WellCare 的遺產資產和業務。該策略的重點是集中和管理藥房支出以及為 MAPD 提供未來的支線，而不是利用今年 25 億美元的收入創造收入。因此，我認為，當有許多影響PDP 的規則變化（例如沒有藥房DIR 取消會員成本份額）時，我們對成本結構的改變和改進或對新的PBM 的改變以及成本結構的有意義的改進發生是偶然的。在災難性階段，胰島素上限，因此我們能夠利用這種成本結構，使我們的會員能夠負擔得起，同時直接補貼大幅增加。

And so we'll be getting paid that direct subsidy by the government. So it was actually a good alignment of opportunities for us to continue to leverage that business to actually help our other businesses in the terms of pharmacy cost structure.

因此，我們將獲得政府的直接補貼。因此，這實際上是一個很好的機會，讓我們能夠繼續利用該業務在藥品成本結構方面真正幫助我們的其他業務。

And our next question today comes from Justin Lake with 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。

A quick question and a follow-up. So the questions on the exchange business. Just can you give us some color in terms of how that membership growth was pretty exceptional in the third quarter. How did that look versus your expectations? And how does that kind of educate '24. And then specifically on '24 with the margins there, my kind of back of the envelope, Drew, is that your kind of guidance for next year assumes margins towards the higher end of that 5% to 7.5% target range.

一個簡短的問題和後續行動。那麼關於兌換業務的問題。您能否給我們一些關於第三季會員成長非常出色的資訊？與您的預期相比，情況如何？這如何教育'24。然後，特別是在 24 年的利潤率方面，德魯，我的底線是，你對明年的指導假設利潤率接近 5% 至 7.5% 目標範圍的高端。

Is that right? And then just a follow-up on the retro. Can you give us any more color in terms of the -- why you think that was incomplete that just sounds something -- I've never heard the word incomplete on a rate update and what gives you the confidence that they're going to reverse that? Is there any kind of color from the state that you could share with us on the confidence and the timing.

是對的嗎？然後只是復古的後續。你能否給我們更多的資訊——為什麼你認為這聽起來不完整——我從來沒有在利率更新中聽過「不完整」這個詞，是什麼讓你有信心他們會逆轉那？是否有來自該州的任何顏色，您可以與我們分享信心和時機。

All right. First on the growth in the quarter and marketplace, you're right, that was outstanding growth. Now you may remember, we said that we expected to get to 3.6 million members this year, and we're just above 3.6 million this quarter. So most of that was sort of embedded in our forecast as we saw the momentum from Q2. But you're right, it is a good indicator and sort of momentum builder for 2024. On margin, we are still just this year. We are in marketplace. We're still just below our target range of 5% to 7.5% and that's not because of HBR.

好的。首先，關於本季和市場的成長，你是對的，這是出色的成長。現在您可能還記得，我們​​說過我們預計今年的會員數量將達到 360 萬，而本季度我們的會員數量剛剛超過 360 萬。因此，當我們看到第二季度的勢頭時，其中大部分內容都已包含在我們的預測中。但你是對的，這是一個很好的指標，也是 2024 年的動力建構者。就保證金而言，我們今年仍然處於這種狀態。我們在市場上。我們仍略低於 5% 至 7.5% 的目標範圍，這並不是因為《哈佛商業評論》。

It's actually because of all the growth and the year one commission that comes along with that. So it's a real good reason to be just below your target range, which means there is capacity as expected and as we have forecasted into 2024 to expand margin into that 5% to 7.5% zone. And so I'll just leave it at that. We expect to pierce zone and be well into that range for 2024 and we -- our forecasts are on track for that. We price for that, and that's what we expect.

這實際上是因為所有的增長和隨之而來的第一年佣金。因此，這是一個略低於目標範圍的真正充分理由，這意味著產能符合預期，正如我們預測的那樣，到 2024 年，利潤率將擴大到 5% 至 7.5% 的區域。所以我就這樣吧。我們預計到 2024 年將突破該區域並進入該範圍，我們的預測正在實現這一目標。我們為此定價，這就是我們所期望的。

Regarding -- probably not going to get too much into a single state call it, negotiation. But yes, that was a 40 basis point push in the quarter that pushed our HBR up a little bit higher in Medicaid. And just based upon the back and forth and the construction of that incomplete and maybe rushed retro rate, we expect a favorable future outcome maybe in Q4, but it could drag into 2024.

關於——可能不會對單一國家進行過多的討論，稱之為談判。但是，是的，本季上漲了 40 個基點，推動我們的《哈佛商業評論》在醫療補助中的表現略高。僅基於來回的情況以及不完整且可能倉促的復古利率的構建，我們預計未來的結果可能會在第四季度出現，但可能會拖到 2024 年。

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

今天我們的下一個問題來自 A.J.瑞銀的賴斯。

Two quick areas of question. On the marketplace comments, I know traditionally that product, you hit a deductible potentially in the fourth quarter and your utilization rate upticks. Are you expecting that? Do you think you have a good visibility on all these new members and how they might act in the fourth quarter? And maybe to what degree have you reflected that and then as you think about that population, we sort of talked around it with a couple of the other questions, moving into next year. You mentioned the commission dynamic, potentially better risk scoring and so forth.

兩個快速提問領域。根據市場評論，我傳統上知道該產品可能會在第四季度達到免賠額，並且利用率會上升。你期待嗎？您認為您對所有這些新成員以及他們在第四季度的表現有很好的了解嗎？也許你在多大程度上反映了這一點，然後當你考慮這個人口時，我們圍繞這個問題討論了一些其他問題，進入明年。您提到了佣金動態、可能更好的風險評分等等。

How much of a margin tailwind this population represent for you as you look into next year. I know the churn rates in that population were high by historically, but I think they've come down. And I don't know if that's the same for you, but maybe any comment along those lines as well.

當你展望明年時，這個人口對你來說意味著多少利潤順風。我知道從歷史上看，該人群的流失率很高，但我認為它們已經下降了。我不知道這對你來說是否相同，但也許也有類似的評論。

Yes, A.J., you're right that particularly in that SEP membership, we're seeing more retention industry-wide, which is, I think, logical just given the insulation and the extension of the enhanced APTCs and the increased affordability of the product. And as you said, the soft more effect of that membership, in particular, the fact that we'll have a full year of risk adjustment, and we'll have moved through any sort of early utilization, we think, provides a tailwind for the retained part of that SEP population.

是的，A.J.，你說得對，特別是在SEP 會員方面，我們看到整個行業的保留率越來越高，我認為，考慮到增強型APTC 的隔離和擴展以及產品的可承受性的提高，這是合乎邏輯的。正如您所說，該成員資格的軟影響，特別是我們將進行一整年的風險調整，並且我們將通過任何形式的早期利用，我們認為，這為我們提供了推動力該SEP 群體的保留部分。

And as Drew said, our focus going into 2024 is really retaining the tremendous growth that we've had in 2023 and then continuing our progress on pricing discipline in order to expand margin and pierce into that 5 -- sorry, 5% to 7.5% range.

正如德魯所說，我們進入2024 年的重點實際上是保持2023 年的巨大增長，然後繼續在定價紀律方面取得進展，以擴大利潤率並滲透到這5 個國家——抱歉，5% 到7.5 %範圍。

Yes. And on your Q4 comment, you're absolutely right, sort of -- if you look at the slope lines of the deductible wear off throughout the year, we do expect a healthy tick up in HBR. We planned for that in our commercial, including marketplace businesses and also in Medicare, normally a step-up in HBR, but then you had the PDR on top of that. So those are some of the things to think about for Q4 as well as heavy SG&A as expected, as typical in Q4, which is as you're calibrating your models for 2023 to finish out the year.

是的。關於您對第四季度的評論，您絕對是正確的，如果您查看全年免賠額磨損的斜率線，我們確實預計 HBR 會健康上升。我們在我們的廣告中規劃了這一點，包括市場業務和醫療保險，通常是《哈佛商業評論》的升級版，但除此之外還有 PDR。因此，這些是第四季度需要考慮的一些事情，以及預期的大量 SG&A，就像第四季度的典型情況一樣，即您正在校準 2023 年的模型以結束這一年。

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。

Great. I wanted to ask on the Medicare business. I guess -- is there any change to how you're thinking about MA enrollment and revenue kind of relative to the initial expectations now that you have a fuller view of the competitive environment? And just for clarification, are you still planning the $200 million PDR in 4Q?

偉大的。我想問一下醫療保險業務。我想，既然您對競爭環境有了更全面的了解，您對碩士招生和收入的看法是否與最初的預期相比有任何變化？澄清一下，您是否仍計劃在第四季度支付 2 億美元的 PDR？

And then kind of bigger picture, could you talk about the path to getting the 85% of members into 3.5 Star plans by October of 2025. And the areas that you're investing in and kind of any incremental investments that you're maybe planning for '24 in that respect?

然後從更大的角度來看，您能否談談到 2025 年 10 月讓 85% 的會員加入 3.5 星計劃的途徑。以及您正在投資的領域以及您可能計劃的任何增量投資'24 在這方面？

Yes. Thanks, Nathan. So with the competitive landscape and additional information we have not changed our view that we would be down $4 billion in 2024 in the Medicare business. Again, our focus is really on narrowing to that lower income complex population. That was part of how we constructed the bids and certainly how we crafted our strategy going into AEP.

是的。謝謝，內森。因此，考慮到競爭格局和更多信息，我們並沒有改變我們的觀點，即 2024 年我們的醫療保險業務將減少 40 億美元。再次強調，我們的重點其實是縮小到低收入複雜人口。這是我們如何建立投標的一部分，當然也是我們如何制定 AEP 策略的一部分。

And then relative to Stars, we're obviously pleased to have delivered results in line with our expectations beginning in Q2, but there's obviously still work to do. And so this next cycle will be an important additional step to that ultimate goal of 85% of members in 3.5 Stars. And our focus really continues to be on rebuilding the operational capacity and the infrastructure to support sustainable programmatic improvement, and that was really demonstrated by moving again 53% of our membership from sub 3 to 87% of our membership at or above 3 in this first step. So we'll need to continue to pull up underperforming contracts. We'll need to move contracts and members from the 3 across that 3.5 Star threshold.

相對於 Stars，我們顯然很高興從第二季開始就取得了符合我們預期的結果，但顯然仍有工作要做。因此，下一個週期將是實現 85% 的會員獲得 3.5 顆星的最終目標的重要一步。我們的重點實際上仍然是重建營運能力和基礎設施，以支持可持續的計劃改進，這一點透過在第一屆會議中再次將53% 的會員從3 級以下提升到87% 的3 級或以上會員來證明。步。因此，我們需要繼續收回表現不佳的合約。我們需要將團結和成員從 3 級移至 3.5 星門檻。

And a lot of that is again, why we've tried to create visibility into some of the underlying operational metrics that we're tracking internally around our overall CTM and around call center metrics and our ability to answer questions for members and provide them a good member experience getting them connected to physicians, getting them aligned to value-based providers so that those incentives are aligned to close gaps in care, which ultimately accrues not just to HEDIS but to cap.

其中許多又是為什麼我們試圖創建一些底層營運指標的可見性，這些指標是我們在內部圍繞整體 CTM 和呼叫中心指標進行追蹤的，以及我們為會員回答問題並為他們提供幫助的能力。良好的會員體驗讓他們與醫生建立聯繫，讓他們與基於價值的提供者保持一致，以便這些激勵措施能夠縮小護理差距，最終不僅會增加HEDIS 的收益，還會增加上限。

So those are all the things that we're really focused on. We've got a very robust governance structure in place. As we've said before, we've got incentives aligned top to bottom in the organization. There is no confusion that this is a priority, and we continue to be focused on making incremental improvements and holding steady on those improvements that we've made to date.

這些都是我們真正關注的事情。我們已經建立了非常健全的治理結構。正如我們之前所說，我們的激勵措施在組織中自上而下一致。毫無疑問，這是一個優先事項，我們將繼續專注於進行漸進式改進，並保持我們迄今為止所做的那些改進。

And you asked about the -- our view on the PDR has that changed? Our current guidance gives us capacity for PDR in the mid-200s. But the accounting calculations in December will dictate that precise number.

你問我們對 PDR 的看法有改變嗎？我們目前的指導使我們有能力在 200 年代中期進行 PDR。但 12 月的會計計算將決定這個精確數字。

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。

I just wanted to do a quick deeper dive on a couple of the items that you've talked to. One would be on Medicaid redetermination. If you can just talk a little bit about for levers, any sort of double coverage analysis you've done to see like what percentage of those were maybe 0% MLR. And then for this more complex population focus and MA going forward, do you know what the kind of percentage target margin would be for that as you think about that as a sustainable business going forward.

我只是想快速深入地探討一下您談到的幾個項目。其中之一是醫療補助重新確定。如果你能簡單談談槓桿，你所做的任何類型的雙重覆蓋分析，看看其中有多少百分比可能是 0% MLR。然後，對於這個更複雜的人口焦點和未來的 MA，當你將其視為未來的可持續業務時，你知道目標利潤率是多少嗎？

And if you wanted to give any update on your PBM cost save, obviously, $500 million, I think, was the category cost, say, for gross margin improvements. It seems like you may have upside to that. So I would love to hear any further color.

如果您想提供有關 PBM 成本節省的任何最新信息，顯然，我認為 5 億美元是類別成本，例如毛利率提高。看來你可能有這樣做的好處。所以我很想聽到更多的顏色。

Yes, back at -- I think in the January conference we outlined, as we talked about a number of the factors before we had any real data on redeterminations and now we've actually got real data, which sort of trumps all the hypotheses that we were going through leading up to April of 2023. We had indicated that as we look through our data, we could see through COB claims, the other insurance coverage where members had duplicative coverage had gone from 2.7% of the Medicaid population in 2019 to 3.4%.

是的，回到- 我想在一月份的會議上我們概述了，因為我們在獲得有關重新確定的任何真實數據之前討論了許多因素，現在我們實際上已經獲得了真實數據，這勝過了所有假設我們正在經歷截至 2023 年 4 月的情況。我們曾表示，當我們查看數據時，我們可以透過 COB 索賠看到，成員重複承保的其他保險範圍已從 2019 年醫療補助人口的 2.7% 增加到3.4 %。

So made sense at the time, we sort of triangulated that with a bunch of other things to come up with our forecast that we outlined on the Q1 call. And the good news is we're right on track with those forecasts. Now that we've got -- we're well into redeterminations and over 40% according to our estimates through redeterminations. On the PBM that's right on track, as Sarah mentioned, and the economics as well that we're expecting. And as you would expect from us, many of those are in the form of guarantees that our PBM underwrote. So we're on track for the contribution to the greater than 660 from the PBM economics.

所以當時是有道理的，我們將其與其他一些事情進行了三角測量，以得​​出我們在第一季電話會議中概述的預測。好消息是我們的預測完全正確。現在我們已經開始重新確定，根據我們的估計，重新確定的比例超過 40%。正如 Sarah 所提到的，PBM 正步入正軌，而且經濟方面也符合我們的預期。正如您對我們的期望，其中許多都是由我們的 PBM 承保的擔保形式。因此，我們有望透過 PBM 經濟學為超過 660 個國家做出貢獻。

And then just relative to Lance, to your question on the complex populations. Obviously, the reimbursement for those populations can be higher, but you're dealing with a higher acuity and more complex care within that cohort. And so our view is that because that aligns with our expertise in managing Medicaid members that we have the opportunity through value-based arrangements for that to be a profitable cohort but also to drive differential outcomes for that population.

然後就蘭斯而言，關於你關於複雜人口的問題。顯然，這些人群的報銷可能會更高，但您在該人群中面臨更高的敏銳度和更複雜的護理。因此，我們的觀點是，因為這與我們管理醫療補助成員的專業知識相一致，所以我們有機會透過基於價值的安排，使他們成為一個有利可圖的群體，同時也為該人群帶來不同的結果。

And if you take a step back and look at segments of the Medicare population, the lower income complex members are the fastest-growing segment. And that is part of why we have focused on that membership not just for this cycle, but as part of our long-term fundamental strategy.

如果你退後一步看看醫療保險人口的各個部分，你會發現低收入群體成員是成長最快的部分。這就是為什麼我們不僅在本週期關注會員資格，而且將其作為我們長期基本策略的一部分。

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。

Two quick ones on Medicare. The first is, as we're thinking about Medicare enrollment in 2024 and looking at some of the reductions across OTC and Flex Benefits and SSBCI, it looks like those hit pretty evenly across both individual MA and D-SNP. And I know you're talking about focusing on more complex care next year, and I think D-SNP's actually been growing this year. So just wondering how we should think about individual retail MA versus D-SNP if we should see similar trends? And then just my second question on MA is I still get a lot of questions from folks trying to do the EPS bridge. I know you said $0.80 loss from Medicare next year. I'm just wondering if you could give us just an updated figure for Medicare this year, including the PDR.

醫療保險上有兩個快速的。首先，當我們考慮 2024 年 Medicare 投保人數並考慮 OTC 和 Flex Benefits 以及 SSBCI 的一些減少時，看起來個人 MA 和 D-SNP 受到的影響相當均勻。我知道您正在談論明年重點關注更複雜的護理，而且我認為 D-SNP 今年實際上一直在增長。所以只是想知道如果我們看到類似的趨勢，我們應該如何看待個人零售 MA 與 D-SNP？關於 MA 的第二個問題是，我仍然收到嘗試做 EPS 橋的人們提出的許多問題。我知道您說過明年 Medicare 損失 0.80 美元。我只是想知道您能否給我們今年 Medicare 的最新數據，包括 PDR。

Yes. So sometimes, it is tough to glean from public data exactly what we did with benefits or what any payer do with benefits. You can get directional. But if you sort of got into our bids and now our product set that's being sold out there in the market today, you'd see that we heavily trimmed our Part B giveback and PPO plans, but we invested in D-SNP and with the supplemental benefits, we actually combined a number of supplemental benefits into a simple spendables card.

是的。因此，有時，很難從公共資料中準確收集我們對福利的處理方式或任何付款人對福利的處理方式。你可以得到方向。但是，如果您參與我們的投標，現在我們的產品組合已在市場上出售，您會發現我們大幅削減了 B 部分回饋和 PPO 計劃，但我們投資了 D-SNP 並補充福利，我們實際上將許多補充福利合併到一張簡單的消費卡。

Think Flex, OTC, grocery. And so that simplifies it for the member. And you may not actually be able to define that from some of the landscape files. But yes, as we said earlier, we haven't changed our view on sort of our forecast for 2024 in terms of about $16 billion of Medicare Advantage revenue down about $4 billion.

想想 Flex、OTC、雜貨店。這樣對於會員來說就簡化了。您實際上可能無法從某些景觀文件定義它。但是，正如我們之前所說，我們並沒有改變對 2024 年 Medicare Advantage 收入約 160 億美元的預測的看法，減少了約 40 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·菲德爾和史蒂芬斯。

Wanted to just ask about 2 salient points relative to medical costs. And first, just maybe an update on the behavioral utilization that you've been seeing earlier in the year and how that's been getting factored into the rates and sort of comfort with that in '24, I guess, particularly for the big Magellan behavioral book? And then second would just be definitely curious in your thinking just around the new California minimum wage law for health care workers and similar types of legislation and how you sort of are thinking about that factoring into unit costs and into your pricing looking out over the next several years?

想問一下與醫療費用相關的兩個要點。首先，也許是您今年早些時候看到的行為利用率的更新，以及如何將其納入 24 年的比率和舒適度中，我猜，特別是對於麥哲倫行為大書？其次，你肯定會好奇你對加州新的醫療保健人員最低工資法和類似立法的看法，以及你如何考慮將其納入單位成本和定價中，展望未來幾年？

Yes. So relative to California, that does not apply to MCOs, but we're obviously tracking that for potential pass-through costs from providers. So again, keeping an eye on that. Relative to behavioral, that's still a component of underlying utilization. It's not creating quite as much pressure as we were seeing before. But certainly, within the marketplace population in general, is sort of an industry-wide trend substance used in opioid use disorder continues to be something that the whole industry is focused on.

是的。因此，相對於加州，這不適用於 MCO，但我們顯然正在追蹤供應商潛在的轉嫁成本。所以，再次關注這一點。相對於行為，這仍然是基礎利用率的一個組成部分。它並沒有像我們之前看到的那樣產生那麼大的壓力。但可以肯定的是，在整個市場人群中，用於阿片類藥物使用障礙的全行業趨勢物質仍然是整個行業的焦點。

And to your point about Magellan, the increased focus on integrating medical care with behavioral and one of the things that we hear very consistently when we are out with our state partners. Almost every single governor that we have talked to this year, rates behavioral health and mental health as a #1 issue in their state and whether that's staffing shortages, access, thinking about broadband in order to increase telehealth, they are all focused on ways that they can support providing additional behavioral health to their membership, and it has actually created really nice tailwinds relative to our Magellan business.

至於你關於麥哲倫的觀點，人們越來越關注將醫療保健與行為結合，這是我們與國家合作夥伴外出時經常聽到的事情之一。今年我們採訪過的幾乎每一位州長都將行為健康和心理健康列為他們所在州的第一大問題，無論是人員短缺、接入、考慮寬頻以增加遠距醫療，他們都專注於以下方式：他們可以支持為其會員提供額外的行為健康，這實際上為我們的麥哲倫業務創造了非常好的順風。

So maybe, Ken, if you want to talk about some of the recent wins that Magellan has experienced as a result of this focus.

肯，如果您想談談麥哲倫最近因這種關注而取得的一些勝利。

Yes. Thanks, Sarah, Scott. We realized success in the state of Idaho, which I think is a forbear to opportunities to work with other states as they think about the point that Sarah made. I think she and I met over 30 governors in the last 6 months. Every one of them mentioned behavioral health is top 3. So we're working with a number of states. I won't mention them specifically, but behind the scenes to cultivate opportunities to capitalize on this growing interest among governors and supporting the needs of their Medicaid members with behavioral health. And then the point about the integrated offerings, our public sector, Magellan business, as this is a long-standing distinctive competency.

是的。謝謝莎拉、史考特。我們在愛達荷州取得了成功，我認為這是對與其他州合作的機會的克制，因為他們考慮了莎拉提出的觀點。我想她和我在過去 6 個月裡會見了 30 多位州長。他們每個人都提到行為健康是前三名。所以我們正在與許多州合作。我不會具體提及它們，但在幕後尋找機會，利用州長們日益增長的興趣，並支持其醫療補助成員的行為健康需求。然後是關於綜合產品、我們的公共部門、麥哲倫業務的問題，因為這是一項長期存在的獨特能力。

It's a business that will power and leverage as we think about combined offerings in a really excited about our prospects. And with Wade's appointment, Zane and the team that business development here, leveraging the Magellan asset, a lot to like about the future.

當我們考慮組合產品時，我們對前景感到非常興奮，這是一項將提供動力和槓桿作用的業務。隨著韋德的任命，贊恩和團隊利用麥哲倫資產在這裡開展業務，對未來有很多看好。

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。

So circling back to your comments on the levers having higher HBR than the stayers and 7 out of 21 states adjusting for acuity. Is there any way to give us more color on that sizing the range of the lever versus stayer HBR differential or how influential -- how meaningful the acuity adjustments are to rates overall?

因此，回到您對槓桿的 HBR 高於固定器的評論，以及 21 個州中有 7 個州調整了敏銳度。有沒有什麼方法可以讓我們更了解槓桿範圍與固定 HBR 差異的大小，或影響力——敏銳度調整對整體利率有多大意義？

Yes, it's consistent with our expectations. And as you might imagine, it really varies by state to state subpopulation to subpopulation. And you're right, with the 1/1 rates, 7 of them in, all including acuity adjustments, feel pretty good about the matching of rates so far with a couple of exceptions, but in the aggregate, matching of the rates with our acuity forward estimates.

是的，這符合我們的預期。正如您可能想像的那樣，不同州的子群體之間的情況確實有所不同。你是對的，對於1/1 的比率，其中7 個，都包括敏銳度調整，到目前為止，除了幾個例外之外，對比率的匹配感覺非常好，但總的來說，比率與我們的匹配敏銳度前瞻性估計。

I just want to add one clarification, (inaudible) I know this is what you meant, but I just want to be sure that what we're tracking is that the levers HBR is less than the stayers. And that is what was expected. And so one of the things that we've talked about in that we did leading into the redeterminations process was identifying those members that we would have predicted would roll off as we look forward into the redeterminations process, and then we could subset those populations and run the differential HBR and those are the inputs that went into our model that we talked about on the Q1 call as we build up what rate and acuity, we would want across each state and then rolled up to the portfolio in order to be tracking as we are in line with expectation going into 2024.

我只想補充一點說明，（聽不清楚）我知道這就是您的意思，但我只是想確定我們正在追蹤的是槓桿 HBR 小於保持器。這正是我們所期望的。因此，我們在重新確定過程中所做的事情之一就是確定那些我們預計在重新確定過程中將會消失的成員，然後我們可以對這些群體進行子集化，運行差分HBR，這些是我們在第在第一季電話會議上討論的模型中的輸入，因為我們建立了每個州想要的利率和敏銳度，然後匯總到投資組合中，以便進行追蹤我們對 2024 年的預期是一致的。

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

謝謝。今天我們的下一個問題來自摩根士丹利的 Michael Ha。

Just first quickly, regarding exchange sequential membership growth, the 386,000, how much of that 386,000 purely best recapture Medicaid redetermination live. Number two, regarding MA, I'm curious to hear your thoughts on what transpired in California. The Star ratings decline disruption there across a number of market-leading plans, whether that might positively impact your MA growth assumptions in California?

首先，關於交易所連續會員成長，386,000 名，這 386,000 名中的多少人最好重新獲得醫療補助重新確定。第二，關於馬薩諸塞州，我很想聽聽你對加州發生的事情的看法。星級評級的下降擾亂了許多市場領先的計劃，這是否會對您在加州的 MA 成長假設產生積極影響？

And then lastly, on Star ratings improvement. I understand in 2Q, you had about 47% of your MA lives in value-based care arrangements. It grew about 3% year-to-year, what was the percentage change of lives and downside arrangements? I'm curious because I understand if this metric improves, so does the overall consumer experience, which could help organically generate improvement in quality, consumer experience metrics. So I'm trying to understand how much tailwind that could be for next year.

最後，關於星級評定的提升。據我所知，在第二季度，您大約 47% 的 MA 生活在基於價值的護理安排中。年成長約3%，生活和不利安排的變化百分比是多少？我很好奇，因為我知道如果這個指標得到改善，整體消費者體驗也會改善，這可以幫助有機地提高品質和消費者體驗指標。所以我試著去了解明年可能會有多大的推動力。

Yes. Thanks, Michael. So of the 386,000 in the quarter, it's not a perfect science to figure out exactly which are coming through pure enrollment growth versus those coming over from redeterminations. We're obviously able to track those who are moving from a Centene plan to a Centene plan. And then we extrapolate based on the data that we are seeing based on the data that CMS is publishing and then in cases where we can specifically identify which of those members are coming over from a competitor.

是的。謝謝，麥可。因此，在本季度的 386,000 名學生中，要準確地弄清楚哪些是透過純粹的入學成長而產生的，哪些是透過重新確定產生的，並不是一個完美的科學。顯然，我們能夠追蹤那些從 Centene 計劃轉向 Centene 計劃的人。然後，我們根據 CMS 發布的數據所看到的數據進行推斷，然後在我們可以具體識別哪些成員來自競爭對手的情況下進行推斷。

So not entirely clear that we can, again, sort of dissect that membership as you talked about in California, I think what we're seeing in California is actually consistent with what you see across the entire country, if you take a step back and the fact that the 2 key cut points that were put in place this year were tougher in those middle ranges of Star ratings and particularly trimmed the outliers as we all know. And so that was part of what happened in California.

因此，並不完全清楚我們是否可以再次剖析您在加利福尼亞州談到的會員資格，我認為我們在加利福尼亞州看到的情況實際上與您在整個國家看到的情況是一致的，如果您退後一步，事實上，今年實施的兩個關鍵削減點在中等星級評級範圍內更加嚴格，並且特別削減了眾所周知的異常值。這就是加州發生的事情的一部分。

But I think it's too early what impact that will have in terms of overall competitive outcomes through the AEP process because we're only about 10 days into that, but certainly look forward to updating everybody on that at Investor Day. And then relative to Stars and value-based arrangements. Again, we're still in that high 40% range from a value-based care standpoint, and it is a mix of upside only and upside downside risk. And you're right, as we move members into more downside risk arrangements, we get tighter alignment between us and the providers.

但我認為，現在就透過 AEP 流程對整體競爭結果產生什麼影響還為時過早，因為我們才開始大約 10 天，但我們當然期待在投資者日向大家通報最新情況。然後相對於星級和價值的安排。同樣，從基於價值的照護角度來看，我們仍然處於 40% 的高區間內，而且它是單一上行風險和上行下行風險的混合體。你是對的，當我們讓會員承擔更多的下行風險安排時，我們和提供者之間的協調會更加緊密。

We lead to better HEDIS outcomes in terms of getting members in addressing gaps in care. And we know that there's a direct correlation between members who access care and their ultimate CaP scores. And so that has been a huge focus for us. in general, but obviously, a leverage point where we can use our provider partnerships to help accelerate that work, particularly on our Stars improvement journey.

我們透過讓會員解決護理方面的差距來取得更好的 HEDIS 成果。我們知道，獲得護理的會員與他們的最終 Cap 分數之間存在直接相關性。所以這一直是我們的一個重點。總的來說，但顯然，這是一個槓桿點，我們可以利用我們的供應商合作夥伴關係來幫助加速這項工作，特別是在我們的星星改進之旅中。

And today's final question comes from Calvin Sternick with JPMorgan.

今天的最後一個問題來自摩根大通的卡爾文·斯特尼克。

A couple of clarifications. So first, on the 1/1 '24 rate update, I think you said so far, some of the states are including acuity adjusters. Just to be clear, is the expectation of the rest of that 1/1 cohort will also provide acuity adjusters? And then second, I think in the past, you've talked about the percent of 0 and low utilizers being up only marginally. Does that fully normalize back to the historical range? Or is there still some room for that to work its way down?

一些澄清。首先，關於 24 年 1 月 1 日的費率更新，我想您到目前為止已經說過，一些州包括敏銳度調節器。需要澄清的是，該 1/1 隊列中的其餘人是否也期望提供敏銳度調節器？其次，我想在過去，您談到 0 和低利用率用戶的百分比僅略有上升。這是否完全正常化回到歷史範圍？或者說還有下降的空間嗎？

Yes. We do expect. Other than one state where we're only LTSS which is an exception, obviously, relative to redeterminations. The answer is yes to your first question. And then you're right, we're still shifting during this intermediate time period of getting to a post redetermination environment from the pre and the pre-redetermination environment, the 0 utilizers were up for the expansion population. They're actually down and chip and tan, as you're recalling correctly, was flat. So we're moving through that process, refreshing data.

是的。我們確實期待。除了我們只有 LTSS 的一個州之外，這顯然是一個例外，相對於重新確定。你的第一個問題的答案是肯定的。然後你是對的，在這個中間時間段內，我們仍在從重新確定前和重新確定前環境進入重新確定後環境，0 個用戶正在準備擴展人口。正如你所記得的那樣，它們實際上是羽絨、碎裂和曬黑的，是平坦的。所以我們正在完成這個過程，刷新資料。

But that's sort of -- we're in between the pre- and the post redetermination phase, so that will shift throughout that time period.

但這是一種 - 我們正處於重新確定前和重新確定後階段之間，因此在整個時期內情況都會發生變化。

Thank you. 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.

謝謝。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. As we close out this morning, I'd just like to thank our more than 66,000 employees for delivering excellent results this quarter and year-to-date. As a company, we remain focused on our mission and on creating value for our members, our stakeholders and our shareholders. We appreciate the time and interest this morning and look forward to continuing this discussion at our upcoming Investor Day in December. Thanks, everybody.

謝謝，羅科。在今天早上結束時，我要感謝我們超過 66,000 名員工在本季度和年初至今取得的出色業績。作為一家公司，我們始終專注於我們的使命，為我們的成員、利害關係人和股東創造價值。我們感謝今天早上的時間和興趣，並期待在即將到來的 12 月投資者日繼續討論。謝謝大家。

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。