Centene Corp (CNC) 2023 Q4 法說會逐字稿

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

美好的一天，歡迎參加 Centene 第四季和 2023 年全年獲利結果電話會議。 （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 Jen Gilligan, Head of Investor Relations. Please go ahead, madam.

我現在想將會議交給投資者關係主管 Jen Gilligan。請繼續，女士。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our fourth quarter and full year 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 conference 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，大家早安。感謝您參加我們的第四季和全年財報電話會議。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，您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. Our Form 10-K for 2023 will be filed in coming weeks.

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。我們的 2023 年 10-K 表格將在未來幾週內提交。

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。

While we'll also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our fourth quarter 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.

同時我們也將參考某些非公認會計原則措施。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 年第四季新聞稿中找到，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。

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執行長莎拉倫敦 (Sarah London)。莎拉？

Thanks, Jen, and good morning, everyone. Today, we reported a strong finish to a very productive 2023. Fourth quarter results include adjusted earnings per share of $0.45, generating full year 2023 adjusted EPS of $6.68. The quarterly and full year EPS results were slightly ahead of internal expectations and provide the organization with positive momentum as we head into 2024.

謝謝，珍，大家早安。今天，我們報告了 2023 年的豐碩成果。第四季業績包括調整後每股收益 0.45 美元，2023 年全年調整後每股收益為 6.68 美元。季度和全年每股收益結果略高於內部預期，為我們進入 2024 年提供了積極的動力。

We've been planning for and talking about 2024 for a while. And now that we're here, we're focused on positioning each of our lines of business for long-term growth, while continuing the important work to fortify our platform as we prepare for 2025 and beyond. Specifically, we are working through the tail of the redeterminations process, positioning Centene to resume organic enrollment growth in Medicaid and to pursue new program opportunities from a position of strength.

我們為 2024 年進行規劃和討論已經有一段時間了。現在我們來到這裡，我們專注於為每個業務線定位以實現長期成長，同時繼續進行重要工作來強化我們的平台，為 2025 年及以後做好準備。具體來說，我們正在完成重新確定過程的尾部，使 Centene 能夠恢復醫療補助的有機註冊人數增長，並以優勢地位尋求新的計劃機會。

We are solidifying our Medicare Advantage footprint, thanks to an annual enrollment period that largely hit the mark with respect to our target membership, including sales, retention and disenrollment. And we are capturing a powerful growth opportunity in marketplace, demonstrated by the increased revenue guidance we issued this morning.

我們正在鞏固我們的 Medicare Advantage 足跡，這要歸功於年度註冊期在很大程度上達到了我們的目標會員資格（包括銷售、保留和退出）的目標。我們正在抓住市場中強大的成長機會，我們今天早上發布的收入指引增加證明了這一點。

We recognize that amid these opportunities, we still have valuable bottom line work to do. And we are approaching that work with the same focus and disciplined execution that has defined the first 2 years of this management team's tenure. In fact, the Centeam wasted no time setting the tone for 2024 by successfully delivering what we believe to be the largest ever PBM platform migration and improving our pharmacy cost structure on behalf of our customers and members. We have processed more than 40 million scripts so far through ESI and are pleased with the way this massive undertaking has rolled out.

我們認識到，在這些機會中，我們仍然有寶貴的底線工作要做。我們正在以與該管理團隊任期前兩年相同的專注和嚴格的執行力來開展這項工作。事實上，Centteam 不失時機地為 2024 年定下了基調，成功地完成了我們認為是有史以來最大的 PBM 平台遷移，並代表我們的客戶和會員改善了我們的藥房成本結構。到目前為止，我們已經透過 ESI 處理了超過 4000 萬個腳本，並對這項大規模工作的進行方式感到滿意。

There is always a period of issue management after a change of this magnitude and the teams have worked tirelessly and collaboratively to prioritize member access to care during this transition. We will continue to closely monitor end-to-end processing and customer service as we move through the year.

在如此大規模的變化之後，總會有一段時間的問題管理期，並且團隊不知疲倦地協作，在這一過渡期間優先考慮會員獲得護理的機會。在這一年中，我們將繼續密切監控端到端處理和客戶服務。

Additionally, in January, Centene closed the divestiture of Circle Health, the last of our international assets, and the company can now focus solely on our domestic core businesses. Circle marks the tenth divestiture since we began the portfolio review process in late 2021, and we are pleased to have purposefully streamlined our enterprise while keeping the portfolio of divestitures net accretive to earnings and generating cash for deployment.

此外，一月份，Centene 完成了對 Circle Health 的剝離，這是我們最後的國際資產，公司現在可以專注於我們的國內核心業務。 Circle 是我們自 2021 年底開始投資組合審查流程以來的第十次剝離，我們很高興有目的地精簡我們的企業，同時保持剝離投資組合對收益的淨增值並產生用於部署的現金。

In the broader context of value creation, our SG&A initiatives remain on track to exceed our original savings goals, and we continue to identify opportunities to drive operating efficiency through modernization and process improvement. Annual enrollment periods for both Marketplace and Medicare also contribute to our confidence in Centene's 2024 positioning. Continued pricing discipline in Marketplace and the deliberate actions we took to align our 2024 Medicare bids with our strategic focus on lower income and complex members yielded the intended results on both fronts. Marketplace growth was more robust than anticipated, fueled by better-than-anticipated overall market growth as individual commercial offerings continue to gain traction with an expanding consumer set. As such, we expect to deliver both growth and our planned margin expansion in marketplace in 2024. Together, these dynamics position us well to achieve our 2024 adjusted earnings per share guidance of greater than $6.70.

在更廣泛的價值創造背景下，我們的 SG&A 計畫仍有望超越我們最初的節約目標，並且我們繼續尋找機會，透過現代化和流程改進來提高營運效率。 Marketplace 和 Medicare 的年度註冊期也增強了我們對 Centene 2024 年定位的信心。 Marketplace 中持續的定價紀律以及我們為將 2024 年醫療保險投標與我們對低收入和複雜會員的戰略重點保持一致而採取的深思熟慮的行動，在這兩方面都取得了預期的結果。市場成長比預期更加強勁，這是由於個人商業產品繼續受到不斷擴大的消費者群體的歡迎，整體市場成長優於預期，這推動了市場成長。因此，我們預計將在 2024 年實現成長並計劃實現市場利潤率擴張。總而言之，這些動態使我們能夠很好地實現 2024 年調整後每股收益超過 6.70 美元的目標。

With that, let's click deeper into each of our core business lines. Within Medicaid, we have delivered important proof points around the power of incumbency while navigating the unprecedented dynamics of redeterminations. In December, we were awarded the Arizona LTSS contract that will expand our footprint in serving complex populations in that state. That same month, we added approximately 90,000 members to our care and coverage through the successful go-live of Medicaid expansion in North Carolina. And in early January, we successfully reprocured our New Hampshire contract, earning the top score in the Granite State among competitors.

接下來，讓我們更深入地了解我們的每個核心業務線。在醫療補助計劃中，我們在應對前所未有的重新決定動態的同時，就現任的權力提供了重要的證據。 12 月，我們獲得了亞利桑那州 LTSS 合同，該合約將擴大我們為該州複雜人群提供服務的足跡。同月，透過在北卡羅來納州成功實施醫療補助擴展，我們的護理和承保範圍增加了約 90,000 名會員。 1月初，我們成功重新獲得了新罕布什爾州的合同，在花崗岩州的競爭對手中獲得了最高分。

Our uniquely local footprint fosters important and trusted relationships with the communities and state partners we serve and continues to differentiate us as we retain and grow our largest business.

我們獨特的本地足跡與我們所服務的社區和州合作夥伴建立了重要且值得信賴的關係，並在我們保留和發展我們最大的業務時繼續使我們脫穎而出。

Turning to redeterminations. The process continues to track largely in line with our expectations. As of year-end, we were approximately 80% of the way through the projected member transitions, and consistent with our modeling, we ended 2023 right around 14.4 million Medicaid members. Our health plan presidents, along with our Medicaid actuarial teams, continue to work in concert with our state partners to monitor the risk pool impact of membership changes and calibrate rates to match acuity in the near term. To that end, we received some, but not all, of the outstanding 2023 retrospective rate adjustments we mentioned during our December Investor Day before year-end, and we still feel good about our 2024 Medicaid guidance as we sit here in early February.

轉向重新決定。這個過程繼續基本上符合我們的預期。截至年底，我們已完成預計會員過渡的大約 80%，並且與我們的模型一致，到 2023 年年底，我們的醫療補助會員人數約為 1,440 萬。我們的健康計劃主席以及我們的醫療補助精算團隊繼續與我們的州合作夥伴合作，監測會員資格變化對風險池的影響，並調整利率以匹配近期的敏銳度。為此，我們收到了我們在年底前12 月投資者日期間提到的部分（但不是全部）2023 年回顧性利率調整，而且當我們2 月初坐在這裡時，我們仍然對2024 年醫療補助指導感到滿意。

While Medicare has been a hot topic for the industry of late, we are pleased that the annual enrollment period played out largely as expected for Centene. And our 2024 financial projections for Medicare remain unchanged from Investor Day.

雖然醫療保險最近一直是該行業的熱門話題，但我們很高興 Centene 的年度投保期基本上符合預期。我們對 Medicare 的 2024 年財務預測與投資者日相比保持不變。

Duals or D-SNP members have grown as a percentage of our Medicare enrollment as thoughtful benefit design changes allowed us to invest in and effectively refocus our book on members to whom we have the strongest ability to provide long-term value. We expect D-SNP members to represent more than 35% of our Medicare Advantage membership by year-end, an important step relative to our strategic plan.

Duals 或D-SNP 會員在我們的Medicare 註冊人數中所佔的比例有所增長，因為深思熟慮的福利設計變化使我們能夠投資於我們最有能力為其提供長期價值的會員，並有效地重新關注我們的會員。我們預計到年底，D-SNP 會員將占我們 Medicare Advantage 會員的 35% 以上，這是相對於我們的策略計劃而言的重要一步。

As an organization, we remain laser-focused on advancing our Medicare quality agenda. We made progress on a number of initiatives in 2023 that create positive momentum as we continue to execute in 2024. This includes expanding our member outreach capacity, which ultimately allows us to conduct over 1.1 million preventive service outreach calls, reach 80% more members and schedule 62 more appointments year-over-year. At the same time, we invested in digital data and provider connectivity, successfully deploying direct EMR connectivity to over 640,000 provider practices.

作為一個組織，我們仍然專注於推進我們的醫療保險品質議程。 2023 年，我們在多項舉措上取得了進展，這些舉措為我們在2024 年繼續執行創造了積極勢頭。這包括擴大我們的會員外展能力，最終使我們能夠進行超過110 萬次預防性服務外展電話，覆蓋80% 以上的會員，較去年同期增加 62 次預約。同時，我們投資於數位數據和提供者連接，成功為超過 640,000 個提供者實踐部署了直接 EMR 連接。

And finally, we continue to drive core administrative and customer experience performance with service levels remaining in the high 90s through Q4. All of these efforts are important contributors to our long-term STARS performance goals. In 2024, as planned, we will continue to invest in this space with an obvious focus on Medicare Advantage Star Ratings, but with an approach that will drive benefit across lines of business.

最後，我們繼續推動核心管理和客戶體驗績效，服務水準在第四季度保持在 90 左右。所有這些努力都是我們長期 STARS 績效目標的重要貢獻者。按照計劃，到 2024 年，我們將繼續投資這一領域，重點關注 Medicare Advantage 星級評級，但採取的方法將推動跨業務線的效益。

With respect to Medicare utilization, as you heard from us in December, our 2024 bids incorporate a level of elevated medical trend related to non-inpatient services. To date, based on our full year and fourth quarter claims experience, we continue to view our pricing posture is adequate to support our 2024 Medicare outlook.

關於醫療保險的利用，正如您在 12 月從我們那裡聽到的那樣，我們的 2024 年投標納入了與非住院服務相關的醫療趨勢水平的提高。迄今為止，根據我們全年和第四季的理賠經驗，我們仍然認為我們的定價態勢足以支持我們的 2024 年醫療保險前景。

Preliminary Medicare Advantage rates for 2025 were released last week. Bearing in mind the continued expectation for the multiyear phase-in of the risk adjustment model change that was finalized in 2023, we view the preliminary rates as insufficient with respect to general medical cost trend expectations. Drew will provide some additional thoughts on the preliminary rate in a moment.

2025 年 Medicare Advantage 初步費率於上週發布。考慮到 2023 年最終確定的風險調整模型變革將在多年內逐步實施的持續預期，我們認為初步費率不足以滿足整體醫療費用趨勢預期。德魯稍後將提供一些關於初步費率的額外想法。

As this audience is well aware, we will receive final Medicare Advantage rates for 2025 in early April. And at the time of our first quarter call, we will have a better directional sense for bid strategy related to next year.

正如聽眾所熟知的那樣，我們將於 4 月初收到 2025 年最終的 Medicare Advantage 費率。在我們第一季電話會議時，我們將對明年的出價策略有更好的方向感。

Finally, Marketplace. As you've heard from us with increasing enthusiasm in recent months, Marketplace presents Centene with a unique opportunity for simultaneous revenue growth and margin expansion in 2024. Overall, market growth was stronger than expected during this open enrollment period, and we successfully captured our target market share of the expanded pie, netting to stronger-than-expected OEP results for the company.

最後，市場。正如您最近幾個月從我們那裡聽到的那樣，Marketplace 為Centene 提供了一個獨特的機會，可以在2024 年實現收入同步增長和利潤率擴張。總體而言，在開放註冊期間，市場增長強於預期，我們成功抓住了我們的機會擴大蛋糕的目標市場份額，為公司帶來強於預期的 OEP 業績。

Within our 4.3 million member footprint as of January, our market share increased to roughly 26%, up from 23% previously, serving as another proof point of our leadership in the space. This strong enrollment result is driving the $2.5 billion increase to our full year 2024 premium and service revenue guidance.

截至 1 月份，在我們的 430 萬會員中，我們的市佔率從先前的 23% 增加到約 26%，這再次證明了我們在該領域的領導地位。這項強勁的註冊結果推動我們的 2024 年全年保費和服務收入指引增加了 25 億美元。

Membership mix continues to skew slightly younger, consistent with the year-over-year trend we saw last year. And distribution across metal tiers is consistent with our expectation, with Silver plans representing the majority of our enrollment. One driver of overall marketplace growth has been members impacted by Medicaid redeterminations. On that front, we continue to track towards the top half of our previously provided guidance range of 200,000 to 300,000 redetermined lives captured by Ambetter.

會員結構繼續略微年輕化，這與我們去年看到的同比趨勢一致。金屬等級的分佈與我們的預期一致，白銀計劃代表了我們的大部分註冊人數。整體市場成長的驅動因素之一是受醫療補助重新確定影響的會員。在這方面，我們繼續追蹤先前提供的 Ambetter 捕獲的 200,000 至 300,000 條重新確定生命指導範圍的上半部分。

Ultimately, the individual commercial market represents a strategic opportunity for Centene, and we are excited to enable the expanding reach of these offerings as the demands of the market evolve.

最終，個人商業市場代表了 Centene 的策略機遇，我們很高興能夠隨著市場需求的發展擴大這些產品的覆蓋範圍。

While the dynamic businesses Centene operates in continue to ebb and flow, the strength and diversification of our government-sponsored health care platform creates resiliency. We see tremendous opportunity for our core products both near and long term. We will continue to execute against these opportunities to improve health outcomes for our members, generate profitable growth and drive shareholder return.

雖然 Centene 經營的充滿活力的業務不斷潮起潮落，但我們政府資助的醫療保健平台的實力和多元化創造了彈性。我們看到了我們的核心產品近期和長期的巨大機會。我們將繼續抓住這些機會，改善會員的健康狀況，實現獲利成長並推動股東回報。

Before I turn it over to Drew, I want to take just a moment to thank the entire Centeam for how you showed up in 2023 on behalf of our members and our partners. I am honored to work alongside you in 2024 as we make this company stronger every day and transform the health of the communities we serve one person at a time.

在將其交給 Drew 之前，我想花一點時間感謝整個中心團隊代表我們的成員和合作夥伴在 2023 年的表現。我很榮幸能在 2024 年與您並肩工作，讓我們的公司一天比一天強大，並改變我們所服務的社區的健康狀況。

With that, I will hand the call over to Drew for more details around our financial performance and 2024 outlook.

接下來，我會將電話轉交給 Drew，以了解有關我們財務業績和 2024 年前景的更多詳細資訊。

Thank you, Sarah. Today, we reported fourth quarter 2023 results, including $35.3 billion in premium and service revenue and adjusted diluted earnings per share of $0.45 in the quarter. For the full year, we reported $6.68 of adjusted EPS, growth of over 15% compared to 2022, including a 5.5% beat to our original 2023 guidance. And that's on the heels of growing adjusted EPS 12% in 2022 compared to 2021.

謝謝你，莎拉。今天，我們公佈了 2023 年第四季業績，其中包括 353 億美元的保費和服務收入，以及該季度調整後的稀釋每股收益 0.45 美元。我們公佈的全年調整後每股收益為 6.68 美元，與 2022 年相比增長超過 15%，其中比我們最初的 2023 年指引高出 5.5%。與 2021 年相比，2022 年調整後每股盈餘成長 12%。

Our Q4 consolidated HBR was 89.5%, while our full year consolidated HBR was 87.7%, both in the range of our expectations. Medicaid at 90.0% for the full year was slightly higher than our expectations. As of Q3, we were 89.9% year-to-date and we posted 90.6% in the fourth quarter.

我們第四季的綜合 HBR 為 89.5%，全年綜合 HBR 為 87.7%，皆在我們的預期範圍內。全年醫療補助率為 90.0%，略高於我們的預期。截至第三季度，年初至今比率為 89.9%，第四季為 90.6%。

As we mentioned at our Investor Day in December, there were some open Medicaid retro rate adjustments. At year-end, had we received those adjustments, our full year 2023 Medicaid HBR would have been about 10 basis points better. All things considered, over 9 months into redeterminations, our original forecast for membership, acuity and rates were very close. As you can see in the membership tables, we were at 14.47 million Medicaid members at year-end, consistent with the 14.4 million we were forecasting as shared in the Investor Day appendix. That reflects an approximate 1.9 million Medicaid member reduction since 3/31/23 due to redeterminations as expected.

正如我們在 12 月的投資者日所提到的，有一些公開的醫療補助復古利率調整。如果我們在年底收到這些調整，我們 2023 年全年醫療補助 HBR 將會提高約 10 個基點。考慮到所有因素，經過 9 個多月的重新確定，我們對會員資格、敏銳度和費率的初步預測非常接近。正如您在會員表格中看到的那樣，截至年底，我們的醫療補助會員人數為 1,447 萬，與我們在投資者日附錄中預測的 1,440 萬一致。這反映出自 2023 年 3 月 31 日以來，由於如預期重新確定，醫療補助成員人數減少了約 190 萬人。

To reiterate what we laid out at Investor Day, our 2024 guidance reflects a low point of 13.2 million Medicaid members at 3/31/24 and year-end 2024 membership of approximately 13.6 million. That all ties to our 2024 midpoint of $80.5 billion of Medicaid premium revenue. So no changes to our 2024 view of Medicaid revenue, membership or HBR.

重申我們在投資者日所闡述的內容，我們的 2024 年指引反映了 2024 年 3 月 31 日醫療補助會員人數的低點為 1,320 萬，而 2024 年年底會員人數約為 1,360 萬。這一切都與我們 2024 年醫療補助保費收入中點 805 億美元有關。因此，我們對 2024 年醫療補助收入、會員資格或《哈佛商業評論》的看法沒有改變。

Medicare full year HBR was 87.1%, which includes the $250 million premium deficiency reserve recorded in the fourth quarter that we first discussed with you back in April of 2023. On Medicare trend, we continue to see steady but elevated levels of outpatient trend, consistent with what we began to see in Q2 and consistent with our forecast. We also saw a pickup of COVID costs in December, as we mentioned in early January, though not alarming compared to prior COVID cycles.

醫療保險全年HBR 為87.1%，其中包括我們在2023 年4 月首次與您討論的第四季度記錄的2.5 億美元保費不足準備金。在醫療保險趨勢上，我們繼續看到門診趨勢穩定但水平上升，與我們在第二季度開始看到的情況並與我們的預測一致。正如我們在 1 月初提到的，我們也看到 12 月新冠疫情成本上升，儘管與先前的新冠疫情週期相比並不令人擔憂。

We thought about the current level of trend when we booked the 2024 PDR and continue to believe our forecasts are consistent with delivering our 2024 Medicare segment guidance elements outlined at Investor Day.

當我們預訂 2024 年 PDR 時，我們考慮了當前的趨勢水平，並仍然相信我們的預測與投資者日概述的 2024 年醫療保險部門指導要素一致。

To help you with some math, the $250 million premium deficiency reserve lifted the fourth quarter Medicare segment HBR by approximately 475 basis points, and the full year Medicare HBR by approximately 110 basis points.

為了幫助您進行數學計算，2.5 億美元的保費不足準備金將第四季度 Medicare 部分 HBR 提高了約 475 個基點，將全年 Medicare HBR 提高了約 110 個基點。

The commercial HBR at 79.8% for the full year continues to be strong. Simultaneously in Q4, we were also capturing growth from both redeterminations and the special enrollment period, and we were up to 3.9 million Marketplace members as of year-end. That is the source of the strong premium growth in the fourth quarter. And as you heard from Sarah, we couldn't be more pleased with the growth that continued into January 2024, up to approximately 4.3 million members. This continued growth in HBR performance in 2023 sets us up very well to achieve our 2024 Marketplace goals.

全年商業 HBR 為 79.8%，並持續保持強勁勢頭。同時，在第四季度，我們也從重新確定和特殊註冊期中獲得了成長，截至年底，我們的市場會員數量達到了 390 萬。這就是第四季保費強勁成長的根源。正如您從 Sarah 那裡聽到的那樣，我們對一直持續到 2024 年 1 月的會員數量增長感到非常滿意，達到約 430 萬。 2023 年 HBR 業績的持續成長使我們能夠很好地實現 2024 年市場目標。

Moving to other P&L and balance sheet items. Our adjusted SG&A expense ratio was 9.7% in the fourth quarter, compared to 9.3% last year consistent with our updated mix of business along with Medicare distribution costs. Cash flow provided by operations was $8.1 billion for the full year, representing 2.2x adjusted net earnings. This was primarily driven by net earnings, an increase in risk adjustment payable for Marketplace, and the timing of pass-through payments.

轉向其他損益表和資產負債表項目。第四季調整後的 SG&A 費用率為 9.7%，去年為 9.3%，這與我們更新的業務組合以及醫療保險分銷成本一致。全年營運提供的現金流為 81 億美元，相當於調整後淨利的 2.2 倍。這主要是由淨利潤、市場應付風險調整的增加以及轉嫁付款的時間所推動的。

Our unregulated and unrestricted cash on hand at year-end was approximately $200 million.

截至年底，我們手頭上不受監管和不受限制的現金約為 2 億美元。

During the fourth quarter, we repurchased 397,000 shares of our common stock for $27 million. For the full year 2023, we repurchased 22.9 million shares for $1.58 billion, a little over our goal of $1.5 billion.

第四季度，我們以 2,700 萬美元回購了 397,000 股普通股。 2023 年全年，我們以 15.8 億美元回購了 2,290 萬股股票，略高於我們 15 億美元的目標。

Our debt to adjusted EBITDA was 2.9x at year-end. Our medical claims liability totaled $18.0 billion at year-end and represents 54 days in claims payable, compared to 53 in Q3 of 2023 and 54 in Q4 of 2022.

截至年底，我們的調整後 EBITDA 債務為 2.9 倍。截至年底，我們的醫療索賠責任總額為 180 億美元，應付索賠天數為 54 天，而 2023 年第三季為 53 天，2022 年第四季為 54 天。

Looking back at 2023, it was a very good year of execution. We beat original adjusted EPS by 5.5%. We bought back 4% of the company's shares for a cumulative total of over 10% since Q1 of 2022.

回顧2023年，是執行力非常好的一年。我們比最初調整後的每股收益高出 5.5%。我們回購了公司4%的股份，自2022年第一季以來累計回購超過10%。

We continue to execute on divestitures. We completed 5 divestitures in 2023, closed the divestiture of Circle in January of 2024, and received approximately $850 million in net proceeds in January. In total, we have completed 10 divestitures and are close to wrapping up that successful phase of value creation.

我們繼續執行資產剝離。我們在 2023 年完成了 5 項資產剝離，並於 2024 年 1 月完成了 Circle 的資產剝離，並在 1 月獲得了約 8.5 億美元的淨收益。我們總共完成了 10 項資產剝離，即將結束價值創造的成功階段。

On January 1, 2024, as Sarah mentioned, we successfully executed on our PBM conversion. RFPing and moving PBMs has become one of our core competencies. And as a result of that, we have improved our pharmacy cost structure on behalf of our members and customers.

正如 Sarah 所提到的，2024 年 1 月 1 日，我們成功執行了 PBM 轉換。 RFP 和移動 PBM 已成為我們的核心能力之一。因此，我們代表我們的會員和客戶改善了我們的藥房成本結構。

And we doubled Marketplace membership since year-end 2022 and fortified Ambetter's #1 position. 2023, a pretty good year.

自 2022 年底以來，我們將 Marketplace 會員數量增加了一倍，並鞏固了 Ambetter 的第一名地位。 2023年，真是美好的一年。

We have provided detailed 2024 financial guidance elements at our December Investor Day. Since then, we've gained some additional clarity around the AEP and OEP results in Medicare and Marketplace. Medicare enrollment is tracking right in line with our expectations relative to both volume and product mix. I give the Medicare team credit for precision in sales, disenrollment and membership products mix forecast, as well as execution in a challenging year.

我們在 12 月投資者日提供了詳細的 2024 年財務指導要素。從那時起，我們對 Medicare 和 Marketplace 中的 AEP 和 OEP 結果有了更多的了解。醫療保險登記數量和產品組合的進度完全符合我們的預期。我讚揚醫療保險團隊在銷售、退出和會員產品組合預測方面的精確性，以及在充滿挑戰的一年中的執行力。

While Medicare Advantage is only a $16 billion revenue stream for us, it represents a meaningful margin expansion opportunity as we improve STARS over the next few years and begin to have that reflected in revenue in 2026 and beyond.

雖然 Medicare Advantage 對我們來說只是 160 億美元的收入來源，但隨著我們在未來幾年改進 STARS 並開始將其反映在 2026 年及以後的收入中，它代表了一個有意義的利潤擴張機會。

To reinforce Sarah's comments on the 2025 advanced notice, we're in the process of preparing our feedback with questions so far around the adequacy of fee-for-service trend and a new method for normalization that further reduced the rate. For us, the rate change as it sits today is approximately minus 1.3% before risk coding trend. And the new risk model introduced last year, and that's being phased in, still has a disproportionate negative effect on partial and full duals, the most vulnerable populations in Medicare.

為了強化 Sarah 對 2025 年提前通知的評論，我們正在準備反饋，其中包含迄今為止圍繞按服務收費趨勢是否充分的問題以及進一步降低費率的新的正常化方法的問題。對我們來說，在風險編碼趨勢之前，目前的利率變化約為 -1.3%。去年推出的新風險模型（目前正在逐步實施）仍然對部分和完全雙重醫療保險中最脆弱的人產生不成比例的負面影響。

Our Marketplace chassis continues to be well positioned for both growth and margin. Marketplace growth is running ahead of our previous expectations, allowing us to raise our full year 2024 consolidated premium and service revenue guidance by $2.5 billion, which takes our guidance to a midpoint of $136 billion. Appetite for Marketplace products continues to be strong as these offerings successfully provide both health care access and affordability for millions of beneficiaries.

我們的市場框架繼續在成長和利潤方面處於有利地位。市場成長超出了我們先前的預期，使我們能夠將 2024 年全年綜合保費和服務收入指引提高 25 億美元，這使我們的指導中位數達到 1,360 億美元。對市場產品的需求持續強勁，因為這些產品成功地為數百萬受益人提供了醫療保健服務和負擔能力。

At this very early point in the year, we are reiterating our 2024 adjusted EPS guidance of greater than $6.70.

在今年早些時候，我們重申 2024 年調整後每股盈餘指引值高於 6.70 美元。

As we turn the page from 2023, we can quickly reflect back on our second strong year of execution from this management team and positive progression of the company. I couldn't be more excited to drive success with this team and provide affordable access to health care for our members in 2024 and beyond.

當我們翻過 2023 年這一頁時，我們可以很快回顧一下管理團隊的第二個強勁執行力以及公司的積極進展。我非常高興能夠與這個團隊一起推動成功，並在 2024 年及以後為我們的會員提供負擔得起的醫療保健服務。

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

感謝您對 Centene 的興趣。羅科，請您先開始排隊吧。

(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 was hoping you could expand a little bit on the Medicare outlook embedded in your guidance. Certainly concerned that cost in the fourth quarter could be coming in higher than expected, and you certainly reported an MLR that was a bit above consensus even ex the PDR. That would seem to suggest to, I think, most that your Medicare assumptions for 2024 would be pressured, but you're saying that's not the case. So hoping you can expand on why that wouldn't be and maybe some of the underlying trend assumptions that you factored into your guidance here.

我希望您能對指南中包含的醫療保險前景進行一些擴展。當然擔心第四季度的成本可能會高於預期，而且您報告的 MLR 甚至略高於共識，甚至不包括 PDR。我認為，這似乎表明大多數人對 2024 年醫療保險的假設將面臨壓力，但你說事實並非如此。因此，希望您能夠詳細說明為什麼不會發生這種情況，以及您在此處納入指導的一些基本趨勢假設。

Sure, Stephen. Thanks for the question. Yes, we still feel comfortable with how we've accounted for trend in the 2024 bids. And as you heard earlier, no change to 2024 Medicare guidance elements. But let me talk a little bit about what we saw throughout 2023 and underlying trends. Let's talk macro first and then we can talk Q4.

當然，史蒂芬。謝謝你的提問。是的，我們仍然對 2024 年投標趨勢的解釋感到滿意。正如您之前所聽到的，2024 年醫療保險指導要素沒有改變。但讓我談談我們在 2023 年所看到的情況和基本趨勢。我們先談宏觀，然後再談第四季。

From an inpatient utilization standpoint, that was pretty consistent throughout 2023, very little variation quarter-over-quarter. Where we did see a step-up, as we pointed to multiple times throughout the back half of the year, was in Q2 in outpatient. And underneath that, the drivers were fairly consistent through the last 3 quarters of the year. So orthopedics with DME on either side of that, cardiac and cardiovascular as a subclinical category.

從住院患者利用率的角度來看，整個 2023 年這一情況相當一致，季度與季度之間的變化很小。正如我們在今年下半年多次指出的那樣，我們確實看到了第二季門診量的成長。除此之外，車手在今年最後三個季度的表現相當穩定。因此，骨科與 DME 處於其兩側，心臟和心血管作為亞臨床類別。

So those are pretty consistent full year. What was incremental in Q4, obviously, the biggest item was taking a $250 million PDR. We also saw a COVID step-up between Q3 and Q4, and then sequentially month-over-month in the quarter. We also saw in Medicare-only ILI step-up late in Q4. Both of those have come back down as we're seeing in January runout data. We saw some RSV vaccine utilization in Q4, partly a function of our continued efforts to get seniors in for their preventive services visits. You heard me talk about that in my prepared remarks. That was also part of intentional investments we made in quality in Q4 as we prepared and positioned for 2024, which, as you know, is that critical third year in our cycle and our effort to get to 85% of members and 3.5 stars by October of 2025.

所以全年這些數據相當一致。顯然，第四季增量最大的項目是 2.5 億美元的 PDR。我們也看到第三季和第四季之間新冠病毒感染人數增加，然後在本季逐月逐月增加。我們也在第四季末看到僅限醫療保險的 ILI 有所增加。正如我們在一月份的運行數據中看到的那樣，這兩個指標都已回落。我們在第四季度看到了一些 RSV 疫苗的使用，部分原因是我們不斷努力讓老年人參與預防性服務訪問。你在我準備好的發言中聽到了我談到這一點。這也是我們在第四季度為2024 年做準備和定位時在品質方面進行的有意投資的一部分，如您所知，這是我們週期中關鍵的第三年，我們努力在10 月之前獲得85%的會員和3.5 顆星2025 年。

So those are really the elements of both full year '23 and then in Q4. And again, still feel comfortable with how we've accounted for overall trend in the '24 bids, and no change to '24 guidance for Medicare.

所以這些確實是 23 年全年和第四季的要素。再說一次，我們仍然對我們如何解釋 24 年投標的總體趨勢感到滿意，並且 24 年醫療保險指導沒有變化。

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。

I was wondering if you could give us some color on the Medicare Advantage membership losses coming into the year. I'm looking specifically at geographic mix relative to expectations, meaning did you lose the members where you expected? And then also, were the balance of new sales and sort of gross losses consistent with expectations, retention? Was that in line? Just any color there would be helpful.

我想知道您是否能給我們一些有關今年 Medicare Advantage 會員流失情況的資訊。我正在特別關注相對於預期的地理組合，這意味著您是否失去了預期的成員？另外，新銷售和總損失的餘額是否與預期一致，保留率是否一致？那是在排隊嗎？任何顏色都會有幫助。

Yes. Thanks, Josh. We were, as Drew said, very pleased with the way the Medicare team executed in AEP and precision across all of the dimensions that you talked about, again, largely in line with expectations. We took an intentional refocus in the '24 bid strategy to try to align to those lower income, more complex members, as well as to the duals and the D-SNP population, and successful in terms of what we're seeing relative to the concentration of duals coming out of AEP.

是的。謝謝，喬許。正如德魯所說，我們對 Medicare 團隊在 AEP 中執行的方式以及您談到的所有維度的精確度非常滿意，基本上符合預期。我們在 24 世紀申辦策略中有意重新調整重點，試圖與那些收入較低、更複雜的成員以及雙重身份和 D-SNP 人群保持一致，就我們所看到的相對於來自 AEP 的對偶濃度。

So pretty pleased with where we intentionally focus what the impact looks like. And again, that was really a function of the team going PBP by PBP and building up a strategy, where we could invest in those members that we wanted to retain and in those members that we feel like we're going to provide the greatest long-term value to. Ken, I don't know if you want to talk a little bit about some of the calibration we did on distribution as part of that effort overall.

我們對我們有意關注其影響的地方感到非常滿意。再說一遍，這確實是團隊逐個進行 PBP 並製定策略的職能，我們可以投資於那些我們想要保留的成員以及我們認為我們將提供最長期服務的成員。- 期限價值。肯，我不知道你是否想談談我們在分發方面所做的一些校準，作為整體工作的一部分。

Yes. It's a really important add to Sarah and Drew's comments. If you recall, in prior quarters, we talked about the prior penetration with Teledigital brokers, and we made a conscious effort both in terms of owned assets and discipline with preferred partners. That move to mix to a balance that we're really, really comfortable with. And our owned assets performed historically far better with respect both to retention and overall quality.

是的。這是對莎拉和德魯評論的非常重要的補充。如果你還記得，在前幾個季度，我們談到了與 Teledigital 經紀商的先前滲透，並且我們在自有資產和與首選合作夥伴的紀律方面做出了有意識的努力。混合到我們非常非常滿意的平衡的舉動。從歷史上看，我們的自有資產在保留率和整體品質方面表現都要好得多。

And we're seeing that now in preferred partners. I think the distribution system has responded to obvious opportunities to improve quality, persistency and product mix, as Sarah said, is directly in line with what we were targeting. So the level of precision is both impressive, important and directionally where we're going to go.

我們現在在首選合作夥伴身上看到了這一點。我認為分銷系統已經對提高品質、持久性和產品組合的明顯機會做出了反應，正如莎拉所說，這與我們的目標直接一致。因此，精度水準既令人印象深刻、也很重要，而且對我們的發展方向具有指導意義。

And our next question today comes from Kevin Fischbeck with BofA.

今天我們的下一個問題來自美國銀行的 Kevin Fischbeck。

Great. Just want to see, you raised the revenue guidance by $2.5 billion, but didn't change the EPS guidance. Is there anything that you would highlight there as an offset on the EPS line? Or is that just conservatism?

偉大的。只是想看看，您將收入指引提高了 25 億美元，但沒有改變每股收益指引。您有什麼要強調的地方作為 EPS 線的抵消嗎？或者這只是保守主義？

And then just to make sure I understand the PDR, you're saying that the rate is not sufficient to cover trend. Is your PDR reflect the current rate update? Or does it assume something better? And if the rate update would be reaffirmed, then the PDR might change?

然後為了確保我理解 PDR，您說該匯率不足以涵蓋趨勢。您的 PDR 是否反映了目前的費率更新？或者它假設了更好的東西？如果匯率更新得到重申，那麼 PDR 可能會改變？

Yes. Thanks, Kevin. Great question. So on the Marketplace front, it's really just acknowledging that we're very early in the year. And then I think you point out a really important point relative to the mechanics of the PDR and how that positioned us with the ability to look at full year trend in '23. So I'll let Drew talk a little bit more about those mechanics.

是的。謝謝，凱文。很好的問題。因此，在市場方面，我們實際上只是承認我們還處於今年的早期階段。然後我認為您指出了與 PDR 機制相關的非常重要的一點，以及這如何使我們有能力審視 23 年全年趨勢。所以我會讓德魯多談談這些機制。

Yes. So the PDR that we booked in the fourth quarter, that's for the 2024 calendar year. And so you evaluate -- in Medicare, you evaluate on an annual basis, and so '25 really doesn't come into play there because we still have the opportunity to adapt our bids accordingly. And obviously, we don't have a final rate notice yet. We just have the advanced notice that we've got some work to do on.

是的。我們在第四季預訂的 PDR 是 2024 日曆年的。所以你要評估——在醫療保險中，你每年進行評估，所以「25」確實不會發揮作用，因為我們仍然有機會相應地調整我們的出價。顯然，我們還沒有最終的費率通知。我們剛剛收到提前通知，表示我們還有一些工作要做。

On the PDR, think back to even Stephen's question, we sort of get another bite at the apple of evaluating forward trend because we set the PDR and the accounting rules are such you're setting the PDR based upon forward view of how you think '24 to play out. So that was -- any trend considerations that we had were embedded in that PDR we booked in the fourth quarter.

關於 PDR，回想一下史蒂芬的問題，我們在評估未來趨勢方面又遇到了麻煩，因為我們設定了 PDR，而會計規則是這樣的，你是根據你的想法的前瞻性觀點來設定 PDR 的。 24號打完。所以，我們所考慮的任何趨勢都包含在我們在第四季度預訂的 PDR 中。

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。

Drew, I appreciate all the color on Medicare Advantage rates. You mentioned that your rate is minus 1.3%. Given trends in the mid-2s, and you didn't really have much star impact year-over-year. It sounds like the combination of the V28 model and the fee-for-service normalization is somewhere in the negative 3.5% range. So first, is that math right? And then second, if so, can you compare the negative 3.5% that you're seeing for 2025, at least in the advanced notice, versus how big a negative that was in 2024, so we can understand the year-over-year kind of impact?

德魯，我很欣賞 Medicare Advantage 費率上的所有色彩。您提到您的利率是-1.3%。考慮到 2 年代中期的趨勢，你並沒有真正產生太大的明星影響力。聽起來 V28 模型和按服務收費標準化的組合處於負 3.5% 的範圍內。首先，這個數學正確嗎？其次，如果是這樣，您能否將 2025 年（至少在提前通知中）看到的 3.5% 的負增長與 2024 年的負增長進行比較，以便我們了解同比情況的影響？

And then can you -- if you can break up the impact between V28 and the fee-for-service normalization on both a 2025 and a year-over-year basis, it would be incredibly helpful to kind of understand what's going on there. Appreciate it.

如果你能在 2025 年和逐年基礎上分解 V28 和按服務收費正常化之間的影響，那麼了解那裡發生的情況將會非常有幫助。欣賞它。

Yes. Let me try to parse that out. So the line item of HCC model changes, which includes the risk score normalization that you pointed out, was about 1 point -- in our evaluation of the advanced notice, is about 1 point worse than last year. And part of that is the normalization change in calculation and going to like a regression model versus the omission of a base period. So that's probably as deep as we want to go on an earnings call. But if you foot up all of the elements, it's about 1.3% on an absolute basis, current as we stand today, impact on rates.

是的。讓我試著解析一下。因此，HCC 模型變化的行項目（包括您指出的風險評分標準化）大約為 1 分——在我們對提前通知的評估中，比去年差了大約 1 分。其中一部分是計算的標準化變化，以及迴歸模型與基期省略的比較。因此，這可能是我們想要參加財報電話會議的深度。但如果你考慮到所有因素，按照我們目前的情況，絕對值約為 1.3%，對利率的影響。

Now that's before risk score trend. Obviously, that would push it into the positive zone. And we're going to push on some of the mechanics, and then we will -- we're in the position of not trying to grow Medicare Advantage. We're trying to ultimately recover margin back half of the decade. And so we'll just adjust the bids accordingly. And the products may be a little bit less attractive for seniors from an industry standpoint if we don't make a lot of progress on the final rates.

現在這是風險評分趨勢之前的情況。顯然，這會將其推入正值區域。我們將推動一些機制，然後我們將不會試圖擴大醫療保險優勢。我們正在努力最終恢復五年前的利潤。因此我們將相應地調整出價。從行業的角度來看，如果我們在最終費率上沒有取得重大進展，這些產品對老年人的吸引力可能會降低一些。

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。

Just want to pivot over to Medicaid for a minute. Obviously, you mentioned the retro adjustments, you didn't get marginal headwind, I guess. You've also talked about some states being proactive and giving you the acuity adjustments ahead of time, and then you've got your normal rate cycle with the state. I wonder if there's any updated thoughts on where you land for '24 in terms of your Medicaid margin. And I think you had talked about the fact that, coming out of redeterminations, you saw a potential for improvement in Medicaid margins going into '25. Just wondered if there was any updated thoughts on any of that.

只是想轉向醫療補助一分鐘。顯然，你提到了復古調整，我想你並沒有受到邊際阻力。您還談到了一些州採取了積極主動的態度，並提前為您提供了敏銳度調整，然後您就得到了該州的正常利率週期。我想知道您在 24 年的醫療補助利潤方面是否有任何最新想法。我認為您已經談到了這樣一個事實：經過重新確定，您看到了 25 年醫療補助利潤率有改善的潛力。只是想知道是否有任何更新的想法。

Yes. Thanks, A.J. Let me talk a little bit about the dynamic we saw in Q4 and then how we feel as we sit here in early February. So full year HBR for Medicaid in '23 was really a function of Q4. And what we saw in Q4 was some of that timing dynamic that we've called out since the beginning of redeterminations is a dynamic that we were fully expecting to be managing through, the timing of matching rate with acuity as the risk pool shift. So Q4 was a heavy member roll-off quarter as we talked about. And later in the quarter, we saw some acuity -- pressure in the portfolio ahead of those 1/1 rates that have been designed to address that acuity clicking in.

是的。謝謝，A.J.讓我談談我們在第四季看到的動態，以及我們在二月初坐在這裡的感受。因此，23 年醫療補助的全年 HBR 實際上是第四季度的函數。我們在第四季度看到的是自重新確定開始以來我們一直呼籲的一些時機動態，我們完全希望能夠透過這種動態來管理，即隨著風險池的變化，將利率與敏銳度相匹配的時機。因此，正如我們所說，第四季是會員滾滾的重要季度。在本季度晚些時候，我們看到了一些敏銳度——在 1/1 利率之前，投資組合面臨壓力，而這些利率正是為了解決這種敏銳度而設計的。

We also had some of those retro rates also designed to address the acuity coming in late in the year. And like we said, we got some of those before year-end, but not all, so continue to work on those. That's really what drove that lingering pressure in Q4. And as we sit here today, we've got really solid visibility into the rate for our 2024 member months, 63% of the book we've got visibility for. We've got those 1/1 rates now in place, and they are, in general, coming in towards the higher end of that composite range that Drew mentioned at Investor Day of 2% to 2.5%. And then we're still working on that handful of 2023 retro rates that would then come in, in '24.

我們還制定了一些復古利率，旨在解決今年稍後出現的尖銳問題。正如我們所說，我們在年底前得到了其中一些，但不是全部，所以請繼續努力。這確實是第四季度揮之不去的壓力的原因。當我們今天坐在這裡時，我們對 2024 年會員月的費率有了非常可靠的了解，我們已經了解了 63% 的書籍。我們現在已經制定了 1/1 的利率，總體而言，它們正接近德魯在投資者日提到的 2% 至 2.5% 綜合區間的高端。然後我們仍在研究少數 2023 年的復古利率，這些利率將在 24 年實施。

So you take that all together, acknowledge it's still early in the year, and that's -- that's what makes us feel good about our 90.1% midpoint for the '24 Medicaid HBR. And then to your point, as any of those timing dislocations shake out in '24, and we continue to calibrate and match those up, then as we move into kind of the roll-off of redeterminations in '25 and beyond, that becomes a tailwind for the book overall.

所以你把所有這些放在一起，承認現在還處於今年年初，這就是讓我們對 24 年醫療補助 HBR 的 90.1% 中點感到滿意的原因。然後就你的觀點而言，當任何這些時間錯位在 24 年出現時，我們將繼續校準和匹配它們，然後當我們進入 25 年及以後的重新決定的滾動時，這將成為一個本書整體的順風車。

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。

I just wanted to pivot back to Medicare. And just interested if you can sort of talk through for us just on the inpatient side. It doesn't seem like you saw anything unusual in the fourth quarter, but do want to confirm whether or not you did see any type of mix shift towards more short-stay inpatient visits and reduction in observation visits as mentioned by a large peer in Medicare. And then just sort of sticking on this potential theme, would love just your feedback and sort of thoughts around the implementation of the 2 midnight rule for MA and how you're factoring that into your 2024 outlook?

我只是想回到醫療保險。如果您能在住院方面為我們談談的話，我很感興趣。您似乎在第四季度沒有看到任何異常情況，但確實想確認您是否確實看到任何類型的混合轉向更多短期住院就診和減少觀察就診，正如一位大同行所提到的那樣醫療保險。然後，只是堅持這個潛在的主題，希望您能就 MA 2 午夜規則的實施提供反饋和想法，以及您如何將其納入您的 2024 年展望中？

Yes. Thanks, Scott. As Sarah said, at the high level, inpatient was pretty steady throughout 2023. And you go a couple of clicks below that, we looked at case mix, admits per 1,000, alts per 1,000, we didn't see a Q4 uptick in inpatient. If you look at observation days, we saw no meaningful shift in observation days. We all know the 2 midnight rule doesn't start till 1/1/24, but we've been on top of that, preparing for that, thinking through that as we formulated our forecast for 2024, and we think we've got that captured.

是的。謝謝，斯科特。正如莎拉所說，在高水準上，住院病人在2023 年相當穩定。你在下面點擊幾下，我們查看了病例組合，每1,000 人的入院人數，每1,000 人的替代人數，我們沒有看到第四季住院病人數量的上升。如果你看看觀察天數，我們發現觀察天數沒有有意義的變化。我們都知道午夜 2 點規則要到 2024 年 1 月 1 日才會開始，但我們一直在為此做好準備，在製定 2024 年預測時深思熟慮，我們認為我們已經做到了捕獲的。

And obviously, the industry, we can still do medical necessity on that. But yes, we'll be observing that 2 midnight rule beginning in January.

顯然，在這個行業，我們仍然可以在這方面做醫療必需品。但是，是的，我們將從一月份開始遵守午夜 2 點規則。

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. Could you talk a little bit about the pipeline and some of the upcoming bids with respect to Medicaid or in some of the upcoming RFP rewards? And then more broadly, Sarah, if you could talk a little bit to as you've gone through some of the recent wins and as you're looking at satisfaction scores within states, what are areas of strength that are helping you with either retention or new wins? And are there particular areas of opportunity? And what are some of the plans to address some of those areas?

偉大的。您能否談談有關醫療補助或即將到來的一些 RFP 獎勵的管道和一些即將進行的投標？更廣泛地說，莎拉，如果您能談談您最近的一些勝利以及您在查看各州內的滿意度得分時，哪些優勢領域可以幫助您保留還是新的勝利？是否有特定的機會領域？針對其中一些領域有哪些計劃？

Yes. Thanks, Lance, for the question. So as you pointed out, we've had some great positive momentum of late with New Hampshire, Arizona, North Carolina expansion, as well as Oklahoma. And that makes us feel good as we roll into what's an active RFP season. We obviously have Florida in flight and really proud of the Sunshine team and the work they're doing, as well as Georgia and then Texas for later this year and 2025 go-live.

是的。謝謝蘭斯提出這個問題。正如您所指出的，我們最近在新罕布夏州、亞利桑那州、北卡羅來納州以及俄克拉荷馬州的擴張中取得了一些巨大的積極勢頭。當我們進入活躍的 RFP 季節時，這讓我們感覺良好。顯然，佛羅裡達州正在飛行中，我們對 Sunshine 團隊和他們所做的工作感到非常自豪，還有喬治亞州和德克薩斯州，將於今年晚些時候和 2025 年上線。

So we continue to track that. We continue to have, I believe, the best BD team in the business, incredibly strong local teams that are being really thoughtful and incrementally forward-looking in terms of, as we said at Investor Day, making sure that we're competing on promises kept, not just promises made.

所以我們繼續追蹤這一情況。我相信，我們仍然擁有業內最好的 BD 團隊，非常強大的本地團隊，正如我們在投資者日所說，他們非常周到且具有漸進的前瞻性，確保我們兌現承諾進行競爭遵守，而不僅僅是做出的承諾。

And so that, I think, goes to the second part of your question, which is really what are we seeing in the market in terms of the investments we've made over the last 2 years around customer satisfaction, and that local community partnership. And we're really starting to see improvement in terms of partner satisfaction, provider relationships, as well as quality. So if you look at our Medicaid quality scores year-over-year, you're seeing really nice improvement there.

因此，我認為，這是您問題的第二部分，這就是我們在過去兩年中圍繞客戶滿意度和當地社區合作夥伴關係所做的投資方面在市場上看到的情況。我們確實開始看到合作夥伴滿意度、供應商關係以及品質方面的改善。因此，如果您逐年查看我們的醫療補助品質得分，您會發現那裡確實有了很大的進步。

Those have been things at the top of our list in terms of focus over the last 2 years, and I think starting to see those bear fruit. Those are really important drivers as states think about who they want as partners relative to the managed Medicaid business.

這些是過去兩年我們重點關注的事情，我認為這些事情已經開始結出碩果。當各州考慮他們想要誰作為與管理的醫療補助業務相關的合作夥伴時，這些都是非常重要的驅動因素。

I would say the other major theme that we continue to hear and we continue to be focused on, pretty organically, frankly, is health equity. And so the emergence of the 1115 waivers and thinking about how to put dollars into things like housing, food, jobs, childcare that ultimately drive pretty significant health care outcomes. And that's something that states are increasingly interested in partnering over. Again, something that Centene has been naturally focused on as a byproduct of being local in our approach and having the strength of those long-standing incumbent relationships.

我想說，坦白說，我們繼續聽到和繼續關注的另一個主要主題是健康公平。因此，1115 豁免的出現，以及如何將資金投入到住房、食品、工作、兒童保育等方面，最終推動相當顯著的醫療保健成果。這也是各國對合作越來越感興趣的事。同樣，Centene 自然而然地關注這一點，作為我們在地化方法和擁有長期現有關係優勢的副產品。

So I think really good improvement in the places that we focused and really good core strength in the areas that are going to matter going forward.

所以我認為我們在重點領域取得了很好的進步，在未來重要的領域也取得了非常好的核心力量。

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

今天我們的下一個問題來自摩根大通的卡爾·斯特尼克。

I wanted to ask two in the Marketplace. So first, can you talk about the demographic trends of the incremental membership you got? So any insight on the acuity and metal mix of the extra members you added compared to what you initially anticipated?

我想在市場上問兩個。首先，可以談談您新增會員的人口統計趨勢嗎？那麼，與您最初預期的相比，您添加的額外成員的敏銳度和金屬組合有什麼見解嗎？

And then on ICRA and the Indiana pilot, how many members did you enroll in that product? And what are some of the key milestones you're looking to evaluate the pilots move through this year?

然後，在 ICRA 和印第安納試點計畫中，您註冊了多少會員？您希望評估今年試點工作的一些關鍵里程碑是什麼？

Thanks, Cal, for the question. So as you've heard, the demographics for the population that came in during OEP for us were pretty consistent with our expectations, and the distribution of tiers between silver, gold and bronze also pretty consistent. We still have the majority of our members in those -- in that silver tier. So the demographics have not shifted materially.

謝謝卡爾提出的問題。正如您所聽到的，我們在 OEP 期間進入的人口統計數據與我們的預期非常一致，白銀、黃金和銅牌之間的等級分佈也非常一致。我們的大多數成員仍然處於白銀級別。因此，人口結構並沒有發生重大變化。

One of the things that I think is interesting, is may just be the DataGeek in May. But if you look at what we're seeing, not just in our book, but overall in the market, there's some interesting small shifts in the demographics overall that I think tell us a lot about what's actually driving the underlying growth above and beyond just what we know in terms of affordability and awareness from the enhanced APTCs and the additional marketing dollars going into navigators and the broker channel.

我認為有趣的事情之一可能就是五月的 DataGeek。但如果你看看我們所看到的，不僅僅是在我們的書中，而是在整個市場上，總體人口統計數據中存在一些有趣的小變化，我認為這些變化告訴我們很多關於真正推動潛在成長的因素我們從增強的 APTC 以及進入導航器和經紀商管道的額外行銷資金中了解到的負擔能力和認知度。

So we're seeing year-over-year-over-year age coming down slightly, which I think supports our view that we're seeing a younger pool, we're seeing a healthier pool, and we're seeing some of those gig workers coming into the market. We're seeing the distribution between -- in gender, between male and female shift a little bit. So more men coming into the Marketplace, which we see as a signal of digging deeper into that uninsured population because women tend to move sooner out of that population.

因此，我們看到年齡逐年略有下降，我認為這支持了我們的觀點，即我們正在看到一個更年輕的泳池，我們正在看到一個更健康的泳池，我們正在看到其中的一些零工工人進入市場。我們看到性別之間、男性和女性之間的分佈發生了一些變化。因此，越來越多的男性進入市場，我們認為這是深入挖掘未投保人群的訊號，因為女性往往會更快離開該群體。

And then we're also seeing the gold tier as an industry tick up a little bit, which we see as supporting our view that small group migration coming into the market. Obviously, we've got anecdotal evidence around that. But that's true in our book, that's true in the overall industry, and again, I think very consistent with what we think is driving sort of 31% overall market growth. But pleased as well with the fact that, within that growth, we were able to grow our market share within footprint.

然後，我們也看到黃金層作為一個產業的小幅上漲，我們認為這支持了我們對小群體移民進入市場的觀點。顯然，我們有相關的軼事證據。但我們的書中確實如此，整個產業也是如此，我認為這與我們認為推動 31% 整體市場成長的因素非常一致。但令我們感到高興的是，在這種成長的過程中，我們能夠在足跡範圍內擴大我們的市場份額。

And then relative to ICRA, obviously, that's still very much a nascent market. The Indiana pilot is very new. I'm happy to say that we sold our first customer in January. So good early proof point. But the goal there for us is really to test and learn and gather data. And we're pretty confident that we're going to be incrementally smarter about how that market is evolving as we go throughout the year.

顯然，相對於 ICRA，這仍然是一個新興市場。印第安納州的飛行員非常新。我很高興地說我們在一月份出售了第一位客戶。很好的早期證據。但我們的目標實際上是測試、學習和收集數據。我們非常有信心，隨著全年的發展，我們將越來越清楚地了解該市場的發展。

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

今天我們的下一個問題來自 TD Cowen 的 Gary Taylor。

One clarification, one question. I just want to clarify, Drew, on the negative 1.3% '25 advanced notice for Centene. Is that exclude STARS or basically assumes for Centene no different STARS impact on the negative 15 basis points that CMS sized for the industry.

一項澄清，一個問題。德魯，我只是想澄清一下 Centene 的 25 年 1.3% 負利率提前通知。是排除 STARS 還是基本上假設 Centene 的 STARS 對 CMS 為該行業確定的 15 個基點負值沒有不同的影響。

And then my question is, I just wanted to see if you could just balance these very diverse views on MA. Your MA MLR first 9 months was down 110 basis points year-over-year. Fourth quarter was up 310 excluding the entire PDR, and you only boosted the PDR by $50 million or 30 basis points on '24. You said your MA outlook looks unchanged. So there's 2 camps this quarter. There's Centene and United saying the sharp fourth quarter MA MLR spike means nothing for '24. And then there's Humana who said the sharp spike in the quarter is the new baseline heading into '24. So it's been a while since I've seen such divergent views across the industry that all had sort of the same cost acceleration. So can you just explain again why you're landing where you're landing on 2024 MA?

然後我的問題是，我只是想看看你是否可以平衡這些對 MA 的不同觀點。前 9 個月的 MA MLR 年減 110 個基點。不包括整個 PDR，第四季度增長了 310，而您僅將 PDR 增加了 5000 萬美元，即 24 年增長了 30 個基點。您說您的 MA 前景看起來沒有變化。所以本季有 2 個營地。 Centene 和曼聯表示，第四季 MA MLR 的急劇上升對於 24 年來毫無意義。 Humana 表示，本季的大幅成長是進入 24 年的新基線。因此，我已經有一段時間沒有看到整個行業如此不同的觀點了，而且所有觀點都具有相同的成本加速。那麼你能再解釋為什麼你會落在 2024 年移動平均線的位置嗎？

All right. So let me take the first one first. So of the 1.3 -- of the minus 1.3%, our STAR rating change is minus 0.5%, so absent that, we'd be at minus 0.8%. So it's a little bit heavier than the industry as a whole, which I believe CMS was at minus 0.2%. So hopefully, that helps with the math there.

好的。所以讓我先講第一個。因此，在 1.3 的負 1.3% 中，我們的 STAR 評級變化為負 0.5%，因此如果沒有這一點，我們的變化將為負 0.8%。所以它比整個產業重一點，我相信 CMS 的水平是負 0.2%。希望這對數學有幫助。

On Medicare, Sarah said, look, we're looking hard at our outpatient trend, which we're not happy with, but it's steady at that elevated level relative to May, June time frame, and that's sort of what we've built in the forecast. So that would be a change year-over-year. Inpatient, we talked about that. I mean no uptick, as we've noted -- as we said earlier.

關於醫療保險，莎拉說，看，我們正在認真研究門診趨勢，我們對此並不滿意，但相對於五月、六月的時間框架，它穩定在較高的水平，這就是我們所建立的在預測中。所以這將是逐年變化。住院病人，我們討論過這個。我的意思是沒有上升，正如我們之前所說的。

Maybe one of the elements that may be a little bit unique with us is that, as we see the year developing, and there's a dial we have on quality spend and initiatives, and there's a lot of quality initiatives that we're going to do regardless of what our aggregate EPS result is, but we really stepped that up in Q4, and that triggered a heavier level of office visits, which is a good thing, getting our members in to see their physicians. It triggered RSV vaccines, which is a good thing, and we saw that coming through in December. And as Sarah mentioned, we did have ILI.

也許對我們來說有點獨特的元素之一是，隨著我們看到這一年的發展，我們在質量支出和舉措方面有一個調整，並且我們將要做很多質量舉措不管我們的EPS 總結果是多少，但我們確實在第四季度加大了力度，這引發了更頻繁的就診，這是一件好事，讓我們的會員去看醫生。它觸發了 RSV 疫苗，這是一件好事，我們在 12 月就看到了這一點。正如莎拉所提到的，我們確實患有流感樣疾病。

The only area of the business where ILI influenza-like illness was heavier year-over-year was in Medicare. And obviously, that's transitory. It's already come down in January.

ILI 流感樣疾病逐年加重的唯一業務領域是醫療保險。顯然，這是暫時的。一月就已經下來了。

So those are the other elements that you should think about when evaluating Q4. But we feel good about our forecast. We had another buy at the apple on the PDR, Gary. If we thought trend was going to be $50 million higher than the $250 million in next year, the PDR would have been $300 million, and -- we reported $6.61 or something like that. So we feel good about our forecast. We've got work to do in Medicare to improve the macro, but we're ready to tackle 2024.

因此，這些是您在評估第四季度時應該考慮的其他因素。但我們對我們的預測感覺良好。加里，我們在 PDR 上又買了蘋果。如果我們認為趨勢將比明年的 2.5 億美元高出 5000 萬美元，那麼 PDR 將是 3 億美元，並且 - 我們報告了 6.61 美元或類似的數字。所以我們對我們的預測感覺良好。我們在醫療保險方面還有很多工作要做，以改善宏觀狀況，但我們已準備好迎接 2024 年。

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

我們的下一個問題來自德意志銀行的喬治·希爾。

I actually want to ask Gary's question kind of in a slightly different way. I'm kind of focusing on what seems to be kind of 2 different narratives as it relates to the utilization trend. I guess, more broadly.

實際上我想以稍微不同的方式問加里的問題。我有點關注似乎與使用趨勢相關的兩種不同的敘述。我想，更廣泛地說。

And one is kind of the -- it's like there is this seasonal utilization of this (inaudible) has come through that now needs to be -- that now we're returning to a baseline trend that is normal ex the seasonality or the bolus. And there's another narrative that is trend is running below baseline (inaudible) adjusted basis because of the impact of COVID and now we have kind of a 3-year heightened utilization trend to get back to baseline.

其中之一是 - 就好像這種（聽不清楚）的季節性利用已經完成，現在需要 - 現在我們正在返回到季節性或推注之外的正常基線趨勢。還有另一種說法是，由於新冠疫情的影響，趨勢正在低於基線（聽不清楚）調整後的基礎，現在我們有一種 3 年利用率提高的趨勢，以回到基線。

Sarah, I guess I'd ask you if you kind of have a preferred utilization narrative that you guys are seeing. Is that -- like are we kind of working through this short-term backlog as it relates to utilization that should normalize? Or are we running below a longer-term trend that we need to return back to likely over multiyear basis?

莎拉，我想我會問你們是否有你們所看到的首選使用敘述。是不是——就像我們正在解決這種短期積壓的問題一樣，因為它與應該正常化的利用率有關？或者我們的運作是否低於長期趨勢，我們需要在多年的基礎上恢復到這一趨勢？

Yes. I mean I certainly prefer our narrative, and I think about it really specific to Centene. So I appreciate the need to try to harmonize what different companies are seeing, but we remain focused on what we're seeing in our population. The idea that we saw some of this trend in Q2, that we accounted for it in our 2024 bids, we feel sufficiently -- we had a second bite at the apple at the end of the year with the benefit of the full year's visibility of utilization, the assumptions that we've made in 2024, how we feel about our ability to apply clinical initiatives, leverage our value-based relationships and manage through the trend that we're seeing. That's really our focus, less so worrying about what others are saying.

是的。我的意思是，我當然更喜歡我們的敘述，而且我認為它確實針對 Centene。因此，我意識到有必要嘗試協調不同公司所看到的情況，但我們仍然專注於我們在人群中所看到的情況。我們在第二季度看到了這種趨勢的一些想法，我們在 2024 年的投標中考慮到了這一點，我們感覺足夠了——我們在年底第二次咬了蘋果，受益於全年的可見性利用率、我們在2024 年所做的假設、我們對應用臨床計劃、利用我們基於價值的關係以及管理我們所看到的趨勢的能力的看法。這才是我們真正關注的焦點，而不是擔心別人的言論。

And our next question today comes from Dave Windley with Jefferies.

今天我們的下一個問題來自傑弗里斯的戴夫溫德利。

So I wanted to clarify and then ask a question. So Drew, you mentioned -- you've actually both mentioned second bite at the apple a couple of times. I wanted to make sure I understood that, that was a second bite opportunity kind of up to the end of the year. Or does that mean if things develop in a way that causes you to have a different view of 2024 kind of currently, that you could go back and revise your estimate for PDR? So I wanted to clarify that.

所以我想澄清一下然後提出一個問題。德魯，你提到過──其實你們都多次提到第二口蘋果。我想確保我明白這一點，這是直到今年年底的第二次機會。或者這是否意味著，如果事情的發展導致您對 2024 年有不同的看法，您可以回去修改您對 PDR 的估計？所以我想澄清這一點。

And then my question, rotating over to SG&A, is where are you related to head count rationalization, real estate rationalization, other things kind of on the basic cost-cutting, value creation plan list to take out SG&A? Where do you stand in that evolution?

然後我的問題是，轉向 SG&A，你們在哪些方面與人員合理化、房地產合理化以及基本成本削減、價值創造計劃清單上的其他事項有關，以剔除 SG&A？在這場演變中你處於什麼位置？

Yes. So good questions around the PDR. And look, we don't love being in the PDR position, but we've got work to do on Medicare, but it did give us an opportunity to reevaluate the '24 forecast as we got into January and closed the December books. And what will happen mechanically throughout 2024 is that PDR will largely be released in -- forecasted to be released in Q4, because of sort of the mechanics of the seasonality of earnings in Medicare throughout the year. But every quarter, we reevaluate the sufficiency of that PDR relative to the '24 policy and calendar year. And if we have to tweak it, we will. But that would be within the confines of 2024.

是的。關於 PDR 的問題非常好。看，我們不喜歡處於 PDR 位置，但我們在醫療保險方面還有工作要做，但這確實給了我們一個機會，在我們進入 1 月並關閉 12 月賬簿時重新評估 24 年的預測。整個 2024 年將發生的事情是，PDR 將主要在 - 預計將在第四季度發布，因為全年醫療保險收入的季節性機制。但每個季度，我們都會重新評估該 PDR 相對於 '24 政策和日曆年的充足性。如果我們必須調整它，我們會的。但這是在 2024 年的範圍內。

On SG&A, still plenty of opportunity ahead. I mentioned at Investor Day that we've got at least a couple of hundred basis points more in Medicare we've got to go after over the next few years. On real estate, largely through that, probably some tweaks here and there, but largely through. For instance, the charges around real estate, we're through the bolus of that. And then we've got our slate of initiatives that we continue to tackle, and plenty of efficiency opportunities.

SG&A 方面，未來仍有大量機會。我在投資者日提到，我們在未來幾年必須追求的醫療保險至少增加了幾百個基點。在房地產方面，主要是透過這一點，可能會在這裡或那裡進行一些調整，但主要是透過。例如，圍繞房地產的費用，我們已經解決了。然後我們就有了一系列需要持續解決的舉措，以及大量提高效率的機會。

Yes. I would echo that and just say that a lot of great execution in the first 2 years, we're going to realize that in 2024. But we haven't stopped. And you've heard us talk about building the pipeline for 2025 and beyond in terms of additional opportunities. Obviously, our long-term algorithm has 1% to 2% of margin expansion built in. And we do see additional opportunities to drive efficiency in the business as we standardize our workflows, the ability to then automate that with technology.

是的。我對此表示贊同，只是說前兩年我們取得了很多出色的執行力，我們將在 2024 年意識到這一點。但我們並沒有停止。您已經聽過我們談論為 2025 年及以後建立更多機會的管道。顯然，我們的長期演算法內建了 1% 到 2% 的利潤擴張。隨著我們標準化工作流程，以及透過科技實現自動化的能力，我們確實看到了提高業務效率的更多機會。

So really pleased, not just with the execution thus far and the discipline to get us here. We're really thinking about how we do work going forward. We do see opportunity for continued efficiency in the future.

非常高興，不僅僅是迄今為止的執行力和讓我們走到這一步的紀律。我們確實在考慮未來如何開展工作。我們確實看到了未來持續提高效率的機會。

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

今天我們的下一個問題來自 Cantor 的 Sarah James。

Could you remind us what the margin progression looks like on exchanges? Like how many quarters it takes for you to get to run rate?

您能否提醒我們交易所的保證金進度如何？例如你需要多少季度才能達到運作率？

And then just a mechanics clarification on the PDR. Are you guys booking that as the delta between where you view costs and target margin, where it would roll over kind of flat at target margin from '24 to '25? Or is it that you're booking it as the view of cost to breakeven? If you can give us the context of that.

然後是對 PDR 的機械說明。你們是否將其視為成本與目標利潤之間的增量，從 24 年到 25 年，它會以目標利潤持平？還是您出於盈虧平衡成本的考慮而預訂它？如果您能給我們相關背景的話。

Yes. On your second question, it's really neither of those as sort of the accounting principle on the marginal loss. So it excludes things like marketing costs and certain investments. So it's -- think of it as the marginal loss that we're pulling into the year in which we set the bids. So certainly, it's not booked -- nowhere near target margins. We've got a lot of work to do to go from essentially a minus 3.5% expected reported margin in 2024 to that 4% to 5% pretax zone as we look at later in the decade. So STARS will probably be 2/3 of that progression and, like I said, we still have SG&A and clinical initiatives.

是的。關於你的第二個問題，這其實不是邊際損失的會計原則。因此它不包括行銷成本和某些投資等費用。因此，可以將其視為我們設定出價當年的邊際損失。所以當然，它沒有被預訂——遠未達到目標利潤。我們還有很多工作要做，才能從 2024 年的預期報告利潤率基本上為負 3.5% 降至我們在本十年後期所看到的 4% 至 5% 的稅前區域。因此，STARS 可能佔該進展的 2/3，正如我所說，我們仍然有 SG&A 和臨床計劃。

And isn't it interesting, we're spending so much time on 12% of our revenue, $16 billion. Important lever, but we actually have some pretty other good businesses like Marketplace that you just asked about. The margin progression we expect -- it's the sophomore year in which we pick up the benefit of the SEP, special enrollment period, members that come in, for a couple of reasons. One is they're typically utilizing some degree of services and they get out of the way and then become more normalized in the following calendar year. And then also the risk adjustment. The mechanics are punitive to some degree, if you're only picking up a partial year, and then when you get a full calendar year, you have sort of the numerator and denominator sort of matching up.

有趣的是，我們在 12% 的收入（160 億美元）上花費瞭如此多的時間。重要的槓桿，但實際上我們還有一些其他不錯的業務，例如您剛剛詢問的 Marketplace。我們預期的利潤成長——在第二年，我們獲得了 SEP 的好處、特殊註冊期、加入的會員，原因有幾個。一是他們通常會使用某種程度的服務，然後他們會避開，然後在下一個日曆年變得更加正常化。然後還有風險調整。如果您只選擇了部分年份，那麼當您獲得完整的日曆年時，該機制在某種程度上是懲罰性的，分子和分母就會匹配。

So we expect the benefit of last year's SEP members, if we continue to grow SEP, which -- that's not baked into our guidance yet. We're just at 4.3 million members. But if we continue to grow during 2024, that will be an expected tailwind for 2025.

因此，如果我們繼續發展 SEP，我們預計去年的 SEP 成員會受益，但這尚未納入我們的指導。我們只有 430 萬會員。但如果我們在 2024 年繼續成長，那麼這將是 2025 年的預期順風車。

And on that point, I would just note that we're seeing increase year-over-year in retention of SEP members, which means that we're poised to capture the benefit of that sophomore effect from that heavy growth we had in SEP last year. So that's a really nice trend that we've been watching and seeing that retention grow year-over-year.

在這一點上，我只想指出，我們看到 SEP 成員的保留率逐年增加，這意味著我們準備好從去年 SEP 的大幅成長中獲得二年級效應的好處年。所以這是一個非常好的趨勢，我們一直在觀察並看到保留率逐年增長。

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。

So I'll ask one on the Medicaid business. I wanted to -- it sounds like the HBR so far as the redeterminations have played out has been in line with expectations. The '24 guidance has that 50 basis point headwind that was, I think, put in place for any sort of timing mismatch as it relates to acuity. I just wanted to clarify if that's something that you're seeing currently and so reiterating your expectations for '24, you feel like what you've seen play out so far requires that 50 basis points, or if the timing between the rate updates and the costs you're seeing in the underlying book, if that timing has actually been matched up better than you had anticipated?

所以我會詢問一位有關醫療補助業務的問題。我想——聽起來《哈佛商業評論》的重新決定已經符合預期。我認為，24 年的指導意見存在 50 個基點的逆風，這是為了應對與敏銳度相關的任何類型的時機不匹配。我只是想澄清一下這是否是您目前看到的情況，因此重申您對 24 年的預期，您覺得到目前為止所看到的情況需要 50 個基點，或者利率更新和您在基礎書中看到的成本，如果時間安排實際上比您預期的更匹配？

I would say at a high level, we're pretty pleased just given the complexity of the portfolio and all the state-by-state dynamics with the degree to which acuity and rate have matched up relative to timing. Obviously, not perfect. We talk about what we saw in Q4. But across the entire portfolio, feeling pretty good about that, which is, again, part of why we're still confident in that 90.1% midpoint. But maybe, Drew, you can talk a little bit about sort of risk corridors and other dynamics that we're tracking relative to that 50 basis point buffer.

我想說，在高水準上，考慮到投資組合的複雜性以及所有州與州之間的動態以及敏銳度和利率相對於時間的匹配程度，我們感到非常高興。顯然，並不完美。我們談論我們在第四季度看到的情況。但在整個投資組合中，感覺相當不錯，這也是我們仍然對 90.1% 的中點充滿信心的部分原因。但德魯，也許你可以談談我們正在追蹤的相對於 50 個基點緩衝的風險走廊和其他動態。

Yes. So you also have to remember, we've got PBM savings rolling into that. We targeted that at 20 basis points. So that's sort of a nice lever that we factored into sort of getting down to the 90.1%. And then as we think about a question from earlier, '25, 2026, we would expect to get back into the high 89s on a same mix basis.

是的。因此，您還必須記住，我們已將 PBM 節省的資金投入其中。我們的目標是 20 個基點。因此，這是一個很好的槓桿，我們將其考慮在內，以降低到 90.1%。然後，當我們思考 2026 年 25 日早些時候的問題時，我們預計會在相同的混合基礎上回到 89 的高點。

From a risk corridor standpoint, while it's imperfect in terms of a buffer, depending on where you have sort of trend or rate pressure, we're still at -- we're about $1.8 billion in payback for the 2023 year. So we're still in a pretty heavy payback position for our Medicaid risk corridors and minimum MLRs. It's not across every state, but it's spread across a number of states. And that is something else to think through as we think about the future and rate action and matching acuity with rates.

從風險走廊的角度來看，雖然它在緩衝方面並不完美，但根據趨勢或利率壓力的情況，我們仍然在 2023 年獲得約 18 億美元的回報。因此，我們的醫療補助風險走廊和最低 MLR 仍處於相當沉重的回報狀態。它並不遍及每個州，但它分佈在多個州。當我們思考未來和利率行動以及將敏銳度與利率相匹配時，這是需要考慮的其他事情。

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

謝謝。女士們、先生們，我們的問答環節到此結束。我想將會議轉回給管理團隊進行總結發言。

Great. Thanks, Rocco, and thanks, everyone, for your time and interest this morning. We look forward to providing updates as we move deeper into 2024.

偉大的。謝謝羅科，謝謝大家今天早上的時間和興趣。隨著 2024 年的深入，我們期待提供更新。

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。