(CNC) 2024 Q1 法說會逐字稿

Good day, and welcome to the Centene First Quarter 2024 Financial Results Conference Call. (Operator Instructions) Please note, today's event is being recorded.

美好的一天，歡迎參加 Centene 2024 年第一季財務業績電話會議。 （操作員說明）請注意，今天的活動正在錄製中。

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

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 first quarter 2024 earnings results conference call. Sarah London, Chief Executive Officer; and Drew Asher, Executive Vice President and Chief Financial Officer of Centene, will host this morning's call, which also can be accessed through our website at centene.com. Ken Fasola, Centene's President, will also be available as a participant during Q&A.

謝謝羅科，大家早安。感謝您參加我們的 2024 年第一季財報電話會議。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 20, 2024 and other public SEC filings. 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 可能就未來預期、計畫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。差異這是由於各種重要因素造成的，包括 Centene 於 2024 年 2 月 20 日提交的最新 10-K 表格和其他公開的 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。雖然公司可能選擇在未來某個時候更新這些前瞻性陳述，但我們明確表示不承擔任何這樣做的義務。

The call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our first quarter 2024 press release, which is available on the company's website under the Investors section.

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 2024 年第一季新聞稿中找到，該新聞稿可在公司網站的「投資者」部分下找到。

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 thanks, everyone, for joining us as we discuss our first quarter 2024 results.

感謝 Jen，感謝大家加入我們，討論 2024 年第一季的業績。

This morning, we reported first quarter adjusted EPS of $2.26, ahead of our previous expectations for the period. As a result of this strong start to the year, we are increasing our full year 2024 adjusted EPS guidance to greater than $6.80. Drew will cover the quarter and our updated financial outlook in further detail in a few moments. While there is still more work to do, we are pleased with the first quarter results, and we'll look to harness the positive momentum we are generating in our core businesses as we move through the balance of the year.

今天早上，我們報告第一季調整後每股收益為 2.26 美元，超出了我們先前的預期。由於今年開局強勁，我們將 2024 年全年調整後每股盈餘指引提高至 6.80 美元以上。德魯將稍後詳細介紹本季和我們最新的財務前景。儘管還有更多工作要做，但我們對第一季的業績感到滿意，並且我們將在今年餘下的時間裡利用我們在核心業務中產生的積極勢頭。

In 2024, Centene's focus remains on our work to streamline and modernize the underlying infrastructure of our company and to assemble the people, processes and tools necessary to deliver best-in-class experiences to our members, providers, regulators and state partners. Let me share a couple of examples of progress here.

2024 年，Centene 的重點仍然是我們的工作，以簡化和現代化公司的底層基礎設施，並整合必要的人員、流程和工具，為我們的會員、提供者、監管機構和國家合作夥伴提供一流的體驗。讓我在這裡分享幾個進展的例子。

During the first quarter, we completed an important initiative to simplify our prior authorization process by automating our real-time source data. This simplification improves the timeliness of authorization decisions, ensuring our members get the care they need quickly and removing friction from the process overall for both members and providers.

在第一季度，我們完成了一項重要舉措，透過自動化即時來源資料來簡化我們的事先授權流程。這種簡化提高了授權決策的及時性，確保我們的會員快速獲得所需的護理，並消除會員和提供者在整個流程中的摩擦。

Q1 also saw the accumulation of months of thoughtful and thorough go-live preparation in Oklahoma. Our team obtained perfect scores in our readiness review from the state, and we are thrilled to be serving Oklahomans statewide as of April 1.

第一季也見證了俄克拉荷馬州經過數月深思熟慮和徹底的上線準備工作的累積。我們的團隊在該州的準備審查中獲得了滿分，我們很高興能夠從 4 月 1 日起為俄克拉荷馬州全州提供服務。

Finally, our improved operational agility also allowed Centene to mobilize quickly in support of our members and provider partners in the wake of the Change Healthcare cybersecurity incident. This included launching a national provider outreach campaign that spans Centene's provider network across all products, Medicaid, Medicare and Marketplace, and has included targeted efforts to support those disproportionately impacted by the outage, including FQHCs, safety net hospitals, rural health clinics and behavioral health providers. We appreciate the focus on and support for last-mile providers from HHS and CMS throughout this process as these clinicians represent a critical component of the infrastructure through which our members access high-quality health care.

最後，我們改進的營運敏捷性也使 Centene 能夠在 Change Healthcare 網路安全事件發生後迅速動員起來支援我們的會員和提供者合作夥伴。這包括發起一項全國性的提供者外展活動，涵蓋Centene 的所有產品、醫療補助、醫療保險和市場的提供者網絡，並包括有針對性地努力支持那些受停電影響尤為嚴重的群體，包括FQHC、安全網醫院、農村健康診所和行為健康提供者。我們感謝 HHS 和 CMS 在整個過程中對最後一英里提供者的關注和支持，因為這些臨床醫生是我們的會員獲得高品質醫療保健的基礎設施的重要組成部分。

Now on to our business lines. We are roughly 90% of the way through redeterminations, and our Medicaid franchise continues to demonstrate resilience as we navigate the complexities of this unprecedented process. As you can see from today's release, our first quarter membership tracked slightly higher than our expectation at Investor Day in December. Overall, we continue to be well guided with respect to membership and rate by the projection model we built state by state more than a year ago and that we continue to refine as we move through the redeterminations process.

現在談談我們的業務線。我們已完成約 90% 的重新決定，在應對這一前所未有的複雜過程時，我們的醫療補助特許經營權繼續展現出韌性。正如您從今天的發布中看到的，我們第一季的會員人數略高於我們在 12 月投資者日的預期。總體而言，我們在會員資格和費率方面繼續受到我們一年多前逐州建立的預測模型的良好指導，並且在重新確定過程中我們繼續完善該模型。

As we've noted before, 2024 represents an important year for blocking and tackling through acuity shifts and corresponding rate discussions with our state partners to ensure we are positioned to provide high-quality services for our members. We are actively engaged in that process and are seeing solid results thus far with opportunities still ahead. As we move through the remainder of the year, we expect these discussions to increasingly represent the regular back-and-forth dialogue we maintain with our state partners in the normal course of managing the dynamics around each individual Medicaid program we serve.

正如我們之前指出的，2024 年是透過敏銳度轉變以及與我們的州合作夥伴進行相應費率討論來阻止和解決問題的重要一年，以確保我們能夠為我們的會員提供高品質的服務。我們正在積極參與這項進程，到目前為止，我們已經看到了紮實的成果，而且機會仍然存在。隨著今年剩餘時間的推移，我們預計這些討論將越來越多地代表我們在管理我們所服務的每個醫療補助計劃動態的正常過程中與州合作夥伴保持的定期來回對話。

At the same time, we have been executing on important reprocurements, and the early months of 2024 delivered notable data points. Most of the key RFP results are now public, positioning us well to generate continued Medicaid growth in a post-redeterminations world. Centene reprocured one of our largest contracts with the recent announcement of intended awards by the state of Florida. Although the protest period is ongoing, Centene is well positioned based on Florida's determination that Sunshine Health is among those that will provide best value to the state.

同時，我們一直在執行重要的重新採購，並在 2024 年初交付了值得注意的數據點。大多數關鍵的 RFP 結果現已公開，這使我們能夠在重新確定後的世界中實現醫療補助的持續成長。佛羅裡達州最近宣布了擬授予的合同，Centene 重新獲得了我們最大的合約之一。儘管抗議期仍在繼續，但 Centene 處於有利地位，因為佛羅裡達州確定 Sunshine Health 是將為該州提供最大價值的機構之一。

In Michigan, we were thrilled to be selected to continue serving the vast majority of our existing membership with some opportunity to grow. And we look forward to our continued collaboration with the state.

在密西根州，我們很高興被選中繼續為絕大多數現有會員提供服務，並提供一些成長的機會。我們期待與國家繼續合作。

In Texas, our protest remains ongoing. We are honored to have served Texans for 25 years and intend to defend Superior Health's ability to provide access to affordable and high-quality health care for our members in the Lone Star state.

在德州，我們的抗議活動仍在繼續。我們很榮幸為德州人民服務了 25 年，並​​打算捍衛 Superior Health 為孤星州會員提供負擔得起的高品質醫療保健的能力。

We are proud of the way our health plans and business development team have delivered so far during this critical cycle of reprocurements. The Centene value proposition remains a powerful one, built on more than 4 decades of experience serving Medicaid communities, an unwavering local approach and a commitment to innovation in the services and support we bring to our members. We are honored to provide access to care as well as community-based support to improve the lives of those we serve in 31 states across the country.

我們對我們的健康計劃和業務開發團隊迄今為止在這一關鍵的重新採購週期中所交付的方式感到自豪。 Centene 的價值主張仍然是一個強大的價值主張，它建立在 4 多年服務醫療補助社區的經驗、堅定不移的在地方法以及我們為會員提供的服務和支持創新的承諾之上。我們很榮幸能夠為全國 31 個州的服務對象提供護理服務以及社區支持，以改善他們的生活。

Moving to Medicare. The Medicare Advantage macro landscape remains challenging. Consistent with our prior view, we see final 2025 funding levels as insufficient with respect to general medical cost trend expectations. Drew will provide some early commentary around our strategy to navigate Medicare in 2025 as a result.

轉向醫療保險。醫療保險優勢的宏觀情勢仍充滿挑戰。與我們先前的觀點一致，我們認為 2025 年最終資金水準不足以滿足整體醫療費用趨勢預期。因此，德魯將圍繞我們 2025 年醫療保險的策略提供一些早期評論。

Medicare Advantage STAR ratings remain the single most powerful lever to drive performance in this vital business and continue to represent a top priority across the organization. As we drive to our goal of 85% of members in 3.5 STAR contracts by October of 2025, we continue to see improved progress and stability in our performance and expect those to be reflected in our results come October.

Medicare Advantage STAR 評級仍然是推動這一重要業務績效的最有力槓桿，並繼續代表整個組織的首要任務。隨著我們努力實現到 2025 年 10 月 85% 的會員獲得 3.5 個 STAR 合約的目標，我們繼續看到我們業績的進步和穩定性的改善，並預計這些將反映在我們 10 月份的業績中。

We are tracking year-over-year improvements in our core operations as well as in the ways we support our members as they receive care. And we are carrying forward this positive momentum into 2024 as our teams are clearly focused and aligned on quality.

我們正在追蹤我們的核心運營以及我們在會員接受護理時支持他們的方式的逐年改進。我們正在將這一積極勢頭延續到 2024 年，因為我們的團隊明確關注品質並保持一致。

Longer term, Medicare Advantage remains an important business for Centene. The strategic link between Medicare and Medicaid has only become more explicit since our last earnings call. Recent CMS rule-making included final requirements to better coordinate dual special needs plans, or D-SNP, participation with important milestones beginning in 2027. By the end of the decade, a Medicaid footprint will be a prerequisite to D-SNP growth. Centene is perfectly positioned to gain positive momentum from this growing bond between Medicare and Medicaid.

從長遠來看，Medicare Advantage 仍然是 Centene 的一項重要業務。自從我們上次財報電話會議以來，醫療保險和醫療補助之間的策略連結變得更加明確。最近的CMS 規則制定包括更好地協調雙重特殊需求計劃(D-SNP) 的最終要求，以及從2027 年開始的重要里程碑的參與。 。 Centene 完全有能力從 Medicare 和 Medicaid 之間不斷增長的聯繫中獲得積極的動力。

Finally, Marketplace. This business continues to represent a unique and powerful growth segment for Centene, and our teams are executing well against the opportunity. With approximately 4.3 million Marketplace lives at the end of the first quarter, Centene's Marketplace membership has more than doubled in size compared to just 2 short years ago. This exceptional growth has been accompanied by consistent margin expansion as our deep product knowledge and staying power in the market enable us to forecast pretax margins well within our targeted range of 5% to 7.5% for 2024.

最後，市場。該業務繼續代表 Centene 獨特且強大的成長領域，我們的團隊在這一機會中表現出色。截至第一季末，Centene 的 Marketplace 會員數量約為 430 萬，與短短兩年前相比，其會員規模增加了一倍多。這一非凡的成長伴隨著持續的利潤率擴張，因為我們深厚的產品知識和市場持久力使我們能夠預測 2024 年稅前利潤率遠在 5% 至 7.5% 的目標範圍內。

We are pleased with the traction our Ambetter health products are generating and see additional room to expand the reach of Health Insurance Marketplace offerings overall. In 2024, the source of our membership growth is widely diversified. Based on a survey we conducted following open enrollment, nearly 40% of new members identify as previously uninsured. Approximately 25% joined us from another Marketplace carrier, and approximately 10% chose Ambetter after losing access to an employer-sponsored plan. This is in addition to those members who selected Ambetter after losing Medicaid coverage.

我們對 Ambetter 健康產品產生的吸引力感到高興，並看到擴大健康保險市場產品整體覆蓋範圍的更大空間。 2024年，我們的會員成長來源將會更加多元化。根據我們在公開註冊後進行的一項調查，近 40% 的新會員認為以前沒有保險。大約 25% 的人從另一家 Marketplace 業者加入我們，大約 10% 的人在失去雇主資助計畫的訪問權後選擇了 Ambetter。這還不包括在失去醫療補助覆蓋範圍後選擇 Ambetter 的會員。

As we look to the future of Marketplace, we expect new member growth to be driven by an increasingly addressable and accessible uninsured population and the evolution occurring as employers consider alternative options for providing employer-sponsored insurance.

當我們展望 Marketplace 的未來時，我們預計新會員的成長將由越來越多的可尋址和可訪問的未投保人群以及雇主考慮提供雇主贊助的保險的替代方案時發生的演變所推動。

Centene has been rapidly evolving as an organization over the last 2 years. We have been resolute in creating focus, trimming the organization down to the core strategic assets that give us the strongest platform for future growth. We are executing against our strategic plans, fortifying and modernizing our infrastructure and successfully delivering access to affordable, high-quality health care for millions of Americans. Our strong first quarter results demonstrate the power of our diversified earnings drivers as we deliver on our financial commitments, maintain our posture of disciplined capital deployment and continue to invest to support long-term growth.

Centene 作為一個組織在過去兩年中一直在快速發展。我們一直堅定地打造重點，將組織精簡為核心策略資產，為我們未來的成長提供最強大的平台。我們正在執行我們的策略計劃，加強和現代化我們的基礎設施，並成功地為數百萬美國人提供負擔得起的高品質醫療保健。我們強勁的第一季業績證明了我們多元化獲利驅動因素的力量，因為我們兌現了我們的財務承諾，保持了嚴格的資本部署態勢，並繼續投資以支持長期成長。

As always, we want to thank our nationwide workforce of nearly 60,000 for showing up every day committed to improving the lives of our members and transforming the health of the communities we serve. This CenTeam is the engine that ultimately powers our results and amplifies our impact.

一如既往，我們要感謝全國近 60,000 名員工每天都在致力於改善我們會員的生活並改變我們所服務社區的健康狀況。這個 CenTeam 是最終推動我們取得成果並擴大我們影響力的引擎。

With that, let's turn the call over to Drew for more details around our performance in the first quarter and our updated financial outlook for 2024. Drew?

接下來，讓我們將電話轉給德魯，以了解有關我們第一季業績和 2024 年最新財務展望的更多詳細資訊。

Thank you, Sarah. Today, we reported first quarter 2024 results, including $36.3 billion in premium and service revenue and adjusted diluted earnings per share of $2.26 in the quarter, 7% higher than Q1 of 2023. This result was better than our expectations, and we are increasing full year 2024 adjusted EPS guidance by $0.10 to greater than $6.80. This quarter is a good example of the benefit of a diversified business with multiple levers to drive results.

謝謝你，莎拉。今天，我們公佈了2024 年第一季業績，其中保費和服務收入為363 億美元，該季度調整後攤薄每股收益為2.26 美元，比2023 年第一季高出7%。的預期，我們正在全面增加2024 年每股收益指引調整了 0.10 美元，達到 6.80 美元以上。本季是多元化業務透過多種槓桿推動績效的好處的一個很好的例子。

Our Q1 consolidated HBR was 87.1%, which is right on track for our full year guidance. Here's an example of the benefit of that diversification since we provide you with transparency into the line of business components. Medicaid at 90.9% was a little higher in the quarter than we expected as we continue to work through the appropriate matching of rates and acuity in the short term. Redeterminations are certainly front and center in the acuity rate match process, but getting the right match for other circumstances such as states changing pharmacy programs or behavioral health practices are also important initiatives in a handful of states.

我們第一季的綜合 HBR 為 87.1%，這完全符合我們的全年指引。這是多元化的好處的一個例子，因為我們為您提供了業務組件線的透明度。本季的醫療補助率為 90.9%，略高於我們的預期，因為我們將繼續在短期內實現費率和敏銳度的適當匹配。重新確定無疑是敏銳度匹配過程的前沿和中心，但針對其他情況（例如州改變藥房計劃或行為健康實踐）進行正確匹配也是少數州的重要舉措。

On the other hand, our commercial HBR at 73.3% was a little better than we had planned in the quarter driven by the continued strength of our Marketplace business. And our Medicare segment at 90.8% was right on track in the quarter. All of this netting out to 87.1%, a good result.

另一方面，由於我們的 Marketplace 業務持續強勁，我們的商業 HBR 達到 73.3%，略好於我們本季的計劃。我們的醫療保險部門本季的使用率為 90.8%，一切正常。所有這些淨值達到 87.1%，一個不錯的結果。

Going a little bit deeper into each of our business lines. Medicaid membership at 13.3 million members was slightly better than the 13.2 million members we forecasted as of Q1 -- for Q1 as of our Investor Day. Drivers of membership for the remainder of the year include, one, new wins such as Oklahoma and Arizona LTSS; two, the return of slight growth in markets once redeterminations are complete, plus the rejoiners dynamic; net of, three, the substantial wind-down of redeterminations over the next 3 to 4 months. Upon reforecasting the sloping of membership and revenue for 2024, including Q1 membership being a little bit higher than planned, we added $1 billion of Medicaid premium revenue to our 2024 guidance. The overall composite rate is running a little above the 2.5% we last referenced, and we have over 75% member month rate visibility into the 2024 calendar year.

更深入地了解我們的每個業務線。截至第一季投資人日，醫療補助計劃會員人數為 1,330 萬，略優於我們預測的 1,320 萬會員。今年剩餘時間會員資格的推動因素包括：一是俄克拉荷馬州和亞利桑那州 LTSS 等新勝利；第二，重新決定完成後市場將恢復小幅成長，加上重新加入者的動態；扣除三項因素後，未來 3 至 4 個月內重新決定將大幅減少。在重新預測 2024 年會員資格和收入的傾斜情況（包括第一季會員資格略高於計畫）後，我們在 2024 年指引中增加了 10 億美元的醫療補助保費收入。整體綜合費率略高於我們上次提到的 2.5%，我們對 2024 日曆年的會員月費率可見度超過 75%。

Regardless of the temporary work to match rates and acuity, our long-term goal remains to return to the high 89s HBR as we look out over the 2025, 2026 time frame. All things considered, we are pretty pleased with the performance of our Medicaid business 1 year into a very complex redetermination process. And as Sarah covered, we cannot be more pleased with our performance in recent Florida and Michigan Medicaid RFPs. The Texas protest process still needs to play out.

無論為匹配率和敏銳度而進行的臨時工作如何，我們的長期目標仍然是在 2025 年和 2026 年的時間範圍內恢復到 HBR 89 的高水準。考慮到所有因素，我們對醫療補助業務在非常複雜的重新確定流程一年後的表現非常滿意。正如莎拉所說，我們對最近佛羅裡達州和密西根州醫療補助徵求建議書中的表現感到非常滿意。德州的抗議進程仍需持續。

Our commercial business performed very well in the quarter in terms of both growth and HBR. Consistent with previous comments, we grew from 3.9 million Marketplace members at year-end to 4.3 million at the end of Q1. For the past 2 years, we have consistently delivered a combination of growth, coupled with improving margin. Our guidance assumes that we stay at 4.3 million Marketplace members for the rest of 2024. If we can grow during the special enrollment period, which we've been able to do in the past 2 years, there would be upside to our premium and service revenue guidance. So stay tuned.

我們的商業業務本季在成長和 HBR 方面都表現出色。與先前的評論一致，我們的 Marketplace 會員數量從年底的 390 萬增加到第一季末的 430 萬。在過去的兩年裡，我們持續實現了成長和利潤率的提高。我們的指導假設我們在 2024 年剩餘時間內保持 430 萬市場會員數量。收入指導。所以請繼續關注。

Our current 2024 guidance assumes about $16 billion of Medicare Advantage revenue, representing 12% of total premium and service revenue guidance, and approximately $4 billion of PDP revenue. I previously mentioned at a conference that Medicare inpatient authorizations were higher than expected in January and February. March authorizations ended up being lower than February, though still elevated from Q4. And Medicare outpatient trend continues at the elevated level we first saw in Q2 of 2023, though reasonably steady.

我們目前 2024 年的指引假設 Medicare Advantage 收入約為 160 億美元，佔總保費和服務收入指引的 12%，PDP 收入約為 40 億美元。我之前在一次會議上提到，一月和二月的醫療保險住院授權高於預期。 3 月份的授權最終低於 2 月份，但仍較第四季有所上升。醫療保險門診趨勢持續保持在 2023 年第二季首次看到的較高水平，但相當穩定。

Nonetheless, the performance in the quarter for the Medicare segment was in line with our expectations, and our full year view has not changed. We had good performance with our new pharmacy cost structure and executed well on other operating levers.

儘管如此，醫療保險部門本季的表現符合我們的預期，我們對全年的看法並沒有改變。我們的新藥房成本結構表現良好，並且在其他操作槓桿上執行良好。

As we look ahead, I feel like we are making 2025 decisions with our eyes wide open: inpatient and outpatient trends, complex pharmacy changes from the Inflation Reduction Act, an insufficient 2025 rate environment based upon the final rate notice and a risk model being phased in beginning in 2024 that is punitive to partial and full duals. It also seems like many of our peers should have more religion in setting benefits at sustainable levels given these headwinds.

展望未來，我覺得我們正在睜大眼睛做出2025 年決策：住院和門診趨勢、《通貨膨脹削減法案》帶來的複雜藥房變化、基於最終費率通知的2025 年費率環境不足以及分階段的風險模型從 2024 年開始，這對部分和完全雙打是懲罰性的。考慮到這些不利因素，我們的許多同行似乎應該更加堅定地把福利設定在可持續的水平上。

I'll repeat what I said on the mic at a conference in March. To accomplish our strategic goals with our Medicare Advantage business, it doesn't matter if we ultimately level off at $14 billion, $15 billion or $16 billion of Medicare Advantage revenue. What is strategically important is the alignment with Medicaid and those complex populations we want to serve, especially given where the puck is heading with regulations pulling duals and Medicaid closer together. We're still in the process of making 2025 county-by-county decisions, and we'll finalize and submit Medicare bids in early June. So we'll provide you with more 2025 Medicare commentary on our Q2 call.

我將重複我在三月的一次會議上透過麥克風所說的話。為了透過 Medicare Advantage 業務實現我們的策略目標，我們最終將 Medicare Advantage 收入穩定在 140 億美元、150 億美元或 160 億美元並不重要。策略上重要的是與醫療補助和我們想要服務的那些複雜人群保持一致，特別是考慮到冰球的發展方向與法規將雙重和醫療補助更加緊密地聯繫在一起。我們仍在逐個縣做出 2025 年決策，我們將在 6 月初完成並提交 Medicare 投標。因此，我們將在第二季電話會議上為您提供更多 2025 年醫療保險評論。

We expect Medicare to be a good business for us in the long run, and it's an important part of our overall portfolio. We need to deliver on STARS improvements, clinical levers and SG&A actions over the next few years, and those efforts remain on track.

我們預計醫療保險從長遠來看對我們來說是一項良好的業務，它是我們整體投資組合的重要組成部分。我們需要在未來幾年內實現 STARS 改進、臨床槓桿和 SG&A 行動，而這些努力仍在按計劃進行。

Going to other P&L and balance sheet items. Our adjusted SG&A expense ratio was 8.7% in the first quarter, consistent with our updated mix of business, including growth in Marketplace. Cash flow used in operations was $456 million for Q1, primarily driven by net earnings, more than offset by the timing of risk corridor payments, a delay in March's premium payment from one of our large state partners subsequently received in early April and slower receipt of pharmacy rebates as we transitioned to a new third-party PBM in January of 2024.

轉到其他損益表和資產負債表項目。第一季調整後的 SG&A 費用率為 8.7%，與我們更新的業務組合（包括 Marketplace 的成長）一致。第一季營運中使用的現金流量為4.56 億美元，主要由淨利推動，但被風險走廊支付的時間、我們的一個大型州合作夥伴隨後於4 月初收到的3 月份保費支付的延遲以及收到的付款速度放緩所抵消。

From January 1 through mid-April, we repurchased 3.4 million shares of our common stock for $251 million. Our share repurchase goal for 2024 is unchanged at $3 billion to $3.5 billion. Our debt to adjusted EBITDA was 2.9x at quarter end, consistent with year-end. And during Q1, we were pleased to maintain our S&P BBB- rating under the updated S&P rating model.

從 1 月 1 日到 4 月中旬，我們以 2.51 億美元的價格回購了 340 萬股普通股。我們 2024 年的股票回購目標維持在 30 億至 35 億美元不變。截至季末，我們的調整後 EBITDA 債務為 2.9 倍，與年末一致。在第一季度，我們很高興在更新的標準普爾評級模型下維持我們的標準普爾 BBB- 評級。

Our medical claims liability at quarter end represented 53 days in claims payable, down 1 day from Q1 and Q4 of 2023. DCP was actually up due to Change Healthcare claims receipt delays, then back down due to an acceleration of state-directed payments to providers and lower pharmacy invoices outstanding at quarter end. You'll see in the reserve table that our 2024 Medicare Advantage PDR is up $50 million in the quarter. This progression in the 2024 PDR was expected and planned for due to quarterly seasonality in Medicare Advantage.

截至季末，我們的醫療索賠負債佔應付索賠的天數為53 天，比2023 年第一季度和第四季度減少了1 天。指導向提供者付款的加速而有所下降季度末未清的藥房發票減少。您將在準備金表中看到我們的 2024 年 Medicare Advantage PDR 在本季度增加了 5000 萬美元。由於 Medicare Advantage 的季度季節性，2024 年 PDR 的這項進展是預期和計劃的。

Though it's early in the year, we are comfortable adding $1 billion of premium and service revenue and $0.10 of adjusted EPS to our 2024 guidance. You'll also see some mechanical changes to total revenue driven by pass-through premium taxes and the GAAP effective tax rate due to the Circle divestiture. We also expect investment income to be a little bit above our previous forecast of $1.4 billion while still providing for a few rate cuts in 2024.

儘管現在還為時過早，但我們很樂意在 2024 年指引中增加 10 億美元的保費和服務收入以及 0.10 美元的調整後每股收益。您還將看到因轉嫁溢價稅和因 Circle 剝離而導致的 GAAP 有效稅率推動的總收入發生一些機械變化。我們也預計投資收入將略高於我們先前預測的 14 億美元，同時仍會在 2024 年進行一些降息。

Q1 was a quarter of momentum. We put another quarter of redeterminations behind us. We reprocured one of our largest contracts and are well positioned in Florida. We executed well in the Marketplace annual enrollment period and put up a strong quarter of both growth and margin. We delivered on the January 1 PBM conversion, and our businesses and customers are benefiting from an improved cost structure. We continue to advance our multiyear operational improvements, and Centene continues to attract talent. And all of this resulted in strong Q1 results and increased 2024 guidance.

第一季是一個季度的勢頭。我們又把四分之一的重新決定拋在腦後。我們重新獲得了最大的合約之一，並且在佛羅裡達州處於有利地位。我們在市場年度註冊期間表現良好，並實現了強勁的季度成長和利潤。我們於 1 月 1 日實現了 PBM 轉換，我們的企業和客戶都受益於成本結構的改善。我們繼續推動多年來的營運改進，Centene 繼續吸引人才。所有這些都帶來了強勁的第一季業績並提高了 2024 年指引。

While there is plenty more to achieve, we are off to a good start in 2024.

儘管還有很多工作要做，但我們在 2024 年有了一個好的開始。

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

感謝您對 Centene 的興趣。 Rocco，請開啟提問佇列。

(Operator Instructions) Today's first question comes from Kevin Fischbeck with Bank of America.

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

I just wanted to go into your margin commentary on the exchanges because, I guess, from our expectations too, it came in a little bit better. I guess that's the fastest-growing part of your business, which always potentially lowered the visibility into claims receipts. And obviously, you had a change going on at the same time. So I mean, I guess, how comfortable are you -- or what points do you look at to give you comfort that, that MLR outperformance is true and durable rather than potentially some issue around rapid membership growth or change disruption?

我只是想談談你們對交易所的保證金評論，因為我想，從我們的預期來看，它的表現要好一些。我想這是您業務中成長最快的部分，這總是有可能降低索賠收據的可見性。顯然，你同時也在改變。所以我的意思是，我想，您是否感到放心，或者您認為哪些點可以讓您感到安心，MLR 的優異表現是真實且持久的，而不是圍繞會員快速增長或變革中斷的潛在問題？

Yes. Thanks, Kevin. I think 2 important points there. One is just the confidence in the overall HBR. And I think as we look back over the last 2 cycles, we have seen rapid growth in the market overall and, obviously, growth in our book. It's more than doubled in the last 2 years. And I think we've tracked very well to the HBR implications of that. So understanding where SEP growth may have pressured margins in year, but then the fact that the sophomore effect of that growth that we accumulated last year starts to play out this year is consistent with our expectations.

是的。謝謝，凱文。我認為有兩點很重要。一是對《哈佛商業評論》整體的信心。我認為，當我們回顧過去兩個週期時，我們看到了整個市場的快速成長，顯然，我們的帳簿也出現了成長。過去 2 年增加了一倍以上。我認為我們已經很好地追蹤了《哈佛商業評論》對此的影響。因此，了解 SEP 的成長可能會對今年的利潤率造成壓力，但事實上，我們去年累積的成長的第二年效應今年開始發揮作用，這與我們的預期一致。

So again, I think the team has demonstrated a really solid ability to track the moving parts, which gives us confidence in the performance of that book. We've also, as we've talked about in the past, implemented a really strong program around clinical initiatives. And so that has continued to mature, which I think also helps overall management of the book.

再說一次，我認為團隊已經展示了追蹤活動部件的真正紮實的能力，這讓我們對這本書的表現充滿信心。正如我們過去談到的那樣，我們還圍繞臨床計劃實施了一項非常強大的計劃。因此它不斷成熟，我認為這也有助於本書的整體管理。

And then relative to the visibility on change, maybe I'll just hit that sort of broadly because I think that question probably applies across lines of business, and as I said in my remarks, just incredibly proud of how the teams mobilized here in our response, demonstrating operational agility prioritizing member access to care and then a huge push around getting out to providers and finding every way possible to get them reconnected as fast as possible so that they could get paid and they can support our members, which is priority #1. And then, of course, we can have the visibility that we need.

然後，相對於變革的可見性，也許我會廣泛地討論這個問題，因為我認為這個問題可能適用於各個業務線，正如我在講話中所說，我們對團隊在我們這裡的動員方式感到非常自豪。當務之急 # 1.然後，當然，我們可以獲得我們需要的可見性。

And on that point, throughout that process, we had very solid visibility from an inpatient perspective because [OPPS] were not disturbed at any point during that process. Centene also has a long-standing practice of using received claims, not paid, which Drew has talked about before. And so outpatient visibility was good coming into that incident on a relative basis and then being able to catch up quickly as a result of providers reconnected. So the highest point, we were missing mid-teens percentage of our claims. So by the time we closed the quarter, the impact was very modest, and we accounted for that in our financial processes.

在這一點上，在整個過程中，我們從住院患者的角度擁有非常可靠的可見性，因為 [OPPS] 在過程中的任何時候都沒有受到干擾。 Centene 也有使用收到的索賠而不是付款的長期做法，德魯之前曾談到這一點。因此，相對而言，門診患者對該事件的可見性很好，然後由於提供者重新連接而能夠快速趕上。因此，最高點是，我們的索賠中漏掉了百分之十幾的百分比。因此，到本季結束時，影響非常小，我們已在財務流程中考慮到了這一點。

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

我們的下一個問題來自富國銀行的史蒂芬‧巴克斯特。

I wanted to ask about the revised premium and service revenue guidance first. It seems like based on what you saw in the first quarter that you'd annualize to something closer to around $145 billion versus the revised guidance of $137 billion. So wondering if there's anything we should be keeping in mind. Just as another kind of call out, the Medicaid premiums in the quarter were well above our model. So I don't know if there's anything there that's influencing it.

我想先詢問修訂後的保費和服務收入指引。根據您在第一季看到的情況，您的年化收入似乎接近 1,450 億美元左右，而修訂後的指引為 1,370 億美元。所以想知道是否有什麼我們應該記住的。正如另一種呼籲一樣，本季的醫療補助保費遠高於我們的模型。所以我不知道是否有任何因素在影響它。

And then from the Medicaid MLR perspective, how are you thinking about Medicaid MLR progression through the year from the starting point and the factors that are influencing that?

然後從醫療補助 MLR 的角度來看，您如何看待醫療補助 MLR 從起點到全年的進展以及影響因素？

Yes, Stephen, in Q1, we did have a fair amount of state-directed payments. In fact, some states, we believe, in response to the Change incident, accelerated a number of those. That actually also had about a 20-basis-point impact on our Q1 Medicaid HBR relative to our expectations of a normal level of state-directed payments. So that also showed up in our premium revenue. So you can't quite annualize Q1.

是的，史蒂芬，在第一季度，我們確實有相當數量的國家指導付款。事實上，我們認為，有些州為了因應變革事件，加速了其中的一些進程。相對於我們對國家指導支付正常水準的預期，這實際上也對我們第一季醫療補助 HBR 產生了約 20 個基點的影響。這也體現在我們的保費收入中。所以你不能完全將第一季年化。

And there could be a little bit more -- we expect a little bit more redetermination attrition through Q2, maybe a little bit into Q3. But then on the flip side, we've got some growth coming in as well. So that would be the progression of Medicaid revenue throughout the rest of the year.

而且可能還會有更多——我們預計第二季會有更多的重新確定人員流失，也許第三季會有更多。但另一方面，我們也取得了一些成長。這將是今年剩餘時間醫療補助收入的成長。

Medicare, probably a little bit more attrition throughout the year as we prepare for our 2025 bids and the bid decisions we're going to make in terms of where we want to emphasize, where we want to deemphasize products, PBPs, states, age contracts for '25. So we will probably have a little bit more attrition in Medicare Advantage as planned throughout the year. So those are some of the things to think through.

醫療保險，在我們為2025 年投標做準備時，全年可能會有更多的人員流失，我們將根據我們想要強調的地方、我們想要淡化的產品、PBP、州、年齡合約來做出投標決定'25。因此，按照全年規劃，我們的 Medicare Advantage 可能會出現更多的人員流失。這些是需要考慮的一些事情。

Marketplace, we're assuming flat at 4.3 million members. Hopefully, there is some upside there, to your point, in premium and service revenue if we can grow during the SEP. But we just didn't want to bet on that in guidance.

Marketplace，我們假設會員數持平於 430 萬。希望按照您的觀點，如果我們能夠在 SEP 期間實現成長，保費和服務收入會有一些上升空間。但我們只是不想把賭注押在這一點上。

You also asked about Medicaid HBR. Yes, so we came in at 90.9% for the quarter. We definitely expect 20 of that sort of being pressed on by the state-directed payments above our expectations. But we've got some work to do. We've got initiatives to drive down the HBR from the Q1 level. Remember that half of our rates -- about half of our rates show up in that 7/1 to 10/1 time frame. I think that's a little bit higher distribution than the industry broadly in Medicaid. But so far, so good there in a number of cases.

您也詢問了 HBR 醫療補助計劃。是的，所以本季我們的完成率為 90.9%。我們肯定預計會有 20 家此類企業受到超出我們預期的國家指導付款的壓力。但我們還有一些工作要做。我們已採取措施將《哈佛商業評論》從第一季的水平拉低。請記住，我們一半的費率——大約一半的費率出現在 7/1 到 10/1 的時間範圍內。我認為這比醫療補助行業的整體分佈要高一些。但到目前為止，在很多情況下都表現良好。

And there's always states where we've got to make sure that we're presenting the data, whether it's a PBM carve-out or behavior health costs and changes in state practices that we're getting paid for that, but that's more normal course stuff. So we do expect to drive down that 90.9% throughout the rest of the year.

And there's always states where we've got to make sure that we're presenting the data, whether it's a PBM carve-out or behavior health costs and changes in state practices that we're getting paid for that, but that's more normal course東西.因此，我們確實預計今年剩餘時間內將下降 90.9%。

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。

First, I just wanted to ask given your update here, where do you expect your exchange margins to come in this year relative to your 5% to 7.5% target? And then more broadly, on your PDP strategy, right, they're getting a lot of questions here. There's a ton of changes coming in 2025.

首先，我只是想問一下，根據您的最新情況，相對於 5% 至 7.5% 的目標，您預計今年的匯率利潤率會是多少？更廣泛地說，關於您的 PDP 策略，對吧，他們在這裡收到了很多問題。 2025 年將會發生大量變化。

Drew, would love to understand kind of how you see the moving parts for 2025. And maybe you could just tell us if you're going to take on a lot more liability, you're going to have to price up for things like bad debt. Can you tell us if -- even if your membership didn't change, how much more premium would you have? Like, how much premium do you have in '24? And then how much would you have in 2025 in terms of Part D premium? Just so we could think about the order of magnitude at flat membership.

德魯， 也許了解您如何看待 2025 年的變化。您能否告訴我們，即使您的會員資格沒有改變，您的保費會增加多少？例如，24 年你有多少保費？那麼 2025 年 D 部分保費是多少呢？這樣我們就可以考慮固定會員資格的數量級。

Thanks, Justin. Yes, as we said before, our expectation for Marketplace is that we will be well within our target 5% to 7.5% range in 2024. That has not changed.

謝謝，賈斯汀。是的，正如我們之前所說，我們對 Marketplace 的預期是，到 2024 年，我們將完全處於 5% 至 7.5% 的目標範圍內。

And then I'll let Drew get into the details on PDP.

然後我會讓 Drew 詳細介紹 PDP。

Yes. So PDP, and I hit this at the Barclays conference, which -- for which the replay is available. But let me go over more of this because it's a really good question. And you're right, the impact of the Inflation Reduction Act, we had some of that this year in '24 -- 2024. But the real larger change is coming '25, to your point, Justin. So for '24, the direct subsidy went up for the first time since 2010, and it went from $2 to $29. And to your point, that drives revenue yield because the direct subsidy is what the federal government pays to the payer based upon all the payers' bids.

是的。 PDP 和我在巴克萊銀行會議上談到了這一點，該會議的重播是可用的。但讓我再詳細討論這個問題，因為這是一個非常好的問題。你是對的，《通貨膨脹削減法案》的影響，我們今年在 24 年到 2024 年就受到了一些影響。因此，24 世紀，直接補貼自 2010 年以來首次上漲，從 2 美元上漲到 29 美元。就您而言，這會提高收入，因為直接補貼是聯邦政府根據所有付款人的出價向付款人支付的費用。

And so for '25, we actually think, now that we've gotten risk scores by member since that March conference, we can rip through the mechanics of cost share and the changes around how quickly the members can get to the maximum amount of pocket, it's likely more than $100 increase to that $29. And that's driven by, to your point, the catastrophic phase going from 20% to 60%. So we're underwriting that now. And the good news is we've been in this business since 2006. We've got all the data. So we're just taking a slice of risk that we've been administering anyhow.

因此，對於 25 年，我們實際上認為，自 3 月的會議以來，我們已經獲得了會員的風險評分，我們可以徹底了解成本分攤機制以及會員如何快速獲得最大口袋金額的變化，到29 美元可能會增加100 多美元。就您而言，這是由從 20% 上升到 60% 的災難性階段推動的。所以我們現在正在承保。好消息是我們自 2006 年就開始從事這項業務。因此，我們只是承擔了我們一直在管理的部分風險。

I mentioned the member out of pocket. You had to think through that and any behavior changes in the members. Very good point on the bad debt. Hopefully, people are thinking about that, the MPPP program, where the members can essentially smooth out the cost share. You do have to assume, yes, some bad debt. We've got data from our Marketplace business that we're using to triangulate where we think that should be bid. And then manufacturer behavior with all the changes to the IRA impacting manufacturers, thinking about what they might do with some of their behaviors.

我提到了自掏腰包的會員。你必須仔細考慮這一點以及成員的任何行為變化。關於壞帳的觀點非常好。希望人們能夠考慮 MPPP 計劃，成員可以基本上消除成本分攤。是的，你確實必須承擔一些壞帳。我們從市場業務中獲得了數據，我們用這些數據來三角測量我們認為應該出價的位置。然後是製造商的行為，IRA 的所有變化都會影響製造商，思考他們可能會如何處理他們的一些行為。

So you're right, all of that goes into the bid process, and it should drive the direct subsidy up significantly, which will drive the yield up. And we will think about the balance between membership retention in PDP because you're right. Naturally, that business is going to grow a fair amount from a revenue standpoint based upon the direct subsidy going up. So thanks for asking about that.

所以你是對的，所有這些都進入了投標過程，它應該會顯著推動直接補貼，從而提高收益率。我們會考慮 PDP 成員保留之間的平衡，因為你是對的。當然，從收入的角度來看，隨著直接補貼的增加，該業務將會大幅成長。謝謝你詢問這個問題。

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

今天我們的下一個問題來自 Josh Raskin 和 Nephron。

I wanted to go back to Medicare Advantage and 2025 bid strategy with an understanding you're not going to submit your bids for another couple of months here. But would that allusion to $14 billion, $15 billion or $16 billion a suggestion that you would expect membership to be sort of flat to down based on what you know today? And then do you expect to book another PDR in terms of where you think margins would be for next year?

我想回到 Medicare Advantage 和 2025 年出價策略，並了解您在接下來的幾個月內不會在這裡提交出價。但是，根據您今天所了解的情況，140 億美元、150 億美元或 160 億美元的暗示是否表明您預計會員資格會持平甚至下降？然後，根據您認為明年的利潤率，您是否預計會再次預訂 PDR？

And then lastly, I heard some commentary. I don't think we've heard this before, sort of depending the idea that Medicare Advantage is still an important segment. But is there a scenario where MA is not a core operating business for Centene? I understand the advantage with the Medicaid footprint becoming more important. But is there a scenario where just contribution to earnings and even revenues is not large enough to justify the infrastructure?

最後，我聽到了一些評論。我認為我們以前沒有聽說過這個，這有點取決於醫療保險優勢仍然是一個重要部分的想法。但是否有一種情況，MA 不是 Centene 的核心營運業務？我了解醫療補助足跡變得越來越重要的優勢。但是否存在一種情況，即僅對獲利甚至收入的貢獻不足以證明基礎設施的合理性？

Yes. Thanks, Josh. Maybe I'll take the last question first and say that as we look at the landscape today the -- again, the tie between Medicare and Medicaid and what that produces in terms of long-term growth opportunity, we see as very compelling. And so we're always evaluating how the landscape changes, but we're very committed to rebuilding our Medicare franchise focused on the low-income complex members and using that to drive growth across both lines of business. Obviously see opportunity for earnings contribution and then longer-term growth in that business.

是的。謝謝，喬許。也許我會先回答最後一個問題，並說，當我​​們審視今天的情況時，醫療保險和醫療補助之間的聯繫以及它在長期增長機會方面所產生的聯繫，我們認為非常引人注目。因此，我們一直在評估情況的變化，但我們非常致力於重建我們的醫療保險特許經營權，重點關注低收入複雜的成員，並利用它來推動兩個業務線的成長。顯然，我們看到了獲利貢獻的機會以及該業務的長期成長。

Relative to 2025, certainly a more challenging rate environment than I think most might have expected. But again, we're really focused on building a high-quality sort of durable franchise that will allow us to remain agile as the landscape shifts. What hasn't changed for us is -- and the things that we can control are STARS, as Drew said, the biggest lever being 2/3 of performance improvement for Medicare and then SG&A and clinical initiatives, which we remain focused on and are on track.

相對於 2025 年，利率環境肯定比我認為大多數人預期的更具挑戰性。但同樣，我們真正專注於建立一種高品質的持久特許經營權，這將使我們能夠隨著環境的變化保持敏捷。對我們來說沒有改變的是——正如 Drew 所說，我們可以控制的是 STARS，最大的槓桿是 Medicare 績效改進的 2/3，然後是 SG&A 和臨床計劃，我們仍然關注並正在實施這些計劃。步入正軌。

Obviously, too early, as you said, to discuss bid strategy. But we do continue to see volume as the lever as we sharpen the focus of the book, position to support those quality improvement efforts and make county-by-county decisions to improve profitability. I think it's also too early to weigh in on a PDR, but we're obviously taking into account all of the factors as we think about the guidance that we set and sort of the balance of the year as we come through finalizing those decisions over the next 6 to 8 weeks.

顯然，正如您所說，討論出價策略還為時過早。但我們確實繼續將數量視為槓桿，因為我們強化了本書的重點，定位於支持這些品質改進工作並做出逐個縣的決策以提高盈利能力。我認為現在權衡 PDR 還為時過早，但我們顯然會考慮所有因素，因為我們會考慮制定的指導方針，並在最終確定這些決定時對今年的餘額進行排序。

And our next question today comes from Andrew Mok with Barclays.

今天我們的下一個問題來自巴克萊銀行的安德魯·莫克。

Just wanted to follow up on the Medicare MLR. And just given the strong growth in PDP combined with the strong MLR seasonality of that business, can you give us a sense for underlying trends there and how that's supposed to impact the balance of the year on the Medicare MLR?

只是想跟進 Medicare MLR。鑑於 PDP 的強勁成長以及該業務 MLR 的強勁季節性，您能否讓我們了解那裡的潛在趨勢以及這將如何影響 Medicare MLR 的年度平衡？

Yes. You're right on seasonality of the PDP business in our Medicare segment. So unlike a commercial business where you got deductibles in the beginning of the year and your HBR goes up through the year, it's the opposite in PDP. So we still feel good about the range around 90% for our Medicare segment HBR for the full year.

是的。您對我們 Medicare 部門 PDP 業務的季節性的看法是正確的。因此，與商業企業不同的是，商業企業在年初就有免賠額，而你的 HBR 全年都會上漲，而 PDP 則相反。因此，我們仍然對全年 Medicare 部門 HBR 的 90% 左右的範圍感到滿意。

Underneath that trend, outpatient still elevated but consistent with that higher level since Q2 of '23. And we've got assumptions of that perpetuating throughout '24 embedded in our forecast. Inpatient, as I said earlier, a little bit of a tick-up in authorizations in January, February. It's good to see a little bit of relief in March relative to February, but still elevated relative to Q1. So we've thought about that going forward as well.

在這一趨勢之下，門診量仍然有所增加，但與 23 年第二季以來的較高水準一致。我們的預測中包含了這種情況在整個 24 年持續存在的假設。正如我之前所說，住院病人在一月和二月的授權略有增加。很高興看到 3 月相對於 2 月有所緩解，但相對於第一季仍有所上升。所以我們也考慮了這一點。

And then we've got good performance in Medicare. There's other clinical initiatives that we've been able to execute on and getting paid the right amount of revenue as well that have helped sort of curtail some of that inpatient authorization. So I feel pretty good about Q1 and expect that to sort of carry on through the year.

然後我們在醫療保險方面也取得了良好的表現。我們還能夠執行其他臨床計劃並獲得適量的收入，這有助於減少部分住院授權。因此，我對第一季的感覺非常好，並希望這種情況能持續一整年。

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。

I wanted to stick on Medicare Advantage. I guess, I think duals are about 1/3 of your membership right now, and obviously, you highlighted the opportunity there. I guess could you give us a sense of maybe where margins are currently on that population relative to nonduals and when -- if you're thinking about changes that need to be made in terms of bid design for 2025, how you're approaching that population given the prioritizing and serving this population longer term?

我想堅持使用 Medicare Advantage。我想，我認為雙打現在大約佔您會員的 1/3，顯然，您強調了那裡的機會。我想您能否讓我們了解目前該人群相對於非雙重人群的利潤率以及何時 - 如果您正在考慮 2025 年投標設計方面需要進行的更改，您將如何實現這一目標考慮到優先考慮並長期服務該族群？

Yes, Nathan, thanks for the question. So we -- and we talked about this a little bit earlier this year, but we intentionally came into the 2024 cycle redesigning our product offerings with the duals population, again, low-income complex population more broadly in mind. And we're really pleased with how the team executed during AEP. And that is inclusive of product design, but it's also being really thoughtful about what distribution channels best reach those members and the experience that really drives loyalty among that population.

是的，內森，謝謝你的提問。所以我們——我們今年早些時候討論過這個問題，但我們有意進入 2024 年周期，重新設計我們的產品，以適應雙性戀人群，同樣，更廣泛地考慮低收入複雜人群。我們對團隊在 AEP 期間的執行情況感到非常滿意。這包括產品設計，但也需要真正考慮哪些分銷管道最能接觸到這些會員，以及真正提高該族群忠誠度的體驗。

And so saw an uptick in the concentration of duals in our overall population in this AEP, consistent with what we were looking for. And I think that bodes well in terms of our team's ability to really understand that population to leverage the local knowledge that we have and that synergy across the Medicaid and Medicare population in serving these members, those local community resources that matter in terms of driving health outcomes.

因此，在本 AEP 中，我們整體人口中的雙重集中度有所上升，這與我們的預期一致。我認為，這預示著我們的團隊有能力真正了解該人群，利用我們擁有的當地知識，以及醫療補助和醫療保險人群之間的協同作用，為這些成員、那些對推動健康至關重要的當地社區資源提供服務結果。

So all that is to say, I think it bodes well in terms of being able to design products as we go into the 2025 cycle and drive further focus in the book on that population to continue to yield those members to whom we feel like we're going to deliver the best value over the long term.

因此，我認為這預示著我們能夠在進入 2025 年周期時設計產品，並進一步推動書中對這一人群的關注，以繼續產生我們認為屬於我們的成員。價值。

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

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

I wanted to go back to Medicare. So given where rates came out and your evolving strategy around overlapping footprint, do you still think the couple of hundred basis points of SG&A leverage on Medicare is the goal point? I think you guys rolled that out at I-Day. And then how do you think about the SG&A framework for your Medicare business overall? Because typically, I think about it being a couple of percent higher than Medicaid would run. But given the scale that you're targeting, is that still a fair ballpark for where the overhead costs would run for that business unit?

我想回到醫療保險。因此，考慮到利率的變化以及您圍繞重疊足跡不斷發展的策略，您是否仍然認為醫療保險的 SG&A 槓桿的幾百個基點是目標點？我想你們在 I-Day 上就推出了這一點。那麼您如何看待整個醫療保險業務的 SG&A 架構？因為通常情況下，我認為它比醫療補助的運作高幾個百分點。但考慮到您的目標規模，對於該業務部門的管理費用來說，這仍然是一個公平的大概嗎？

Yes. So you're right. We need to take out, I said, at least 200 basis points of SG&A over the next few years to be -- to get to sort of where we want to get to in Medicare Advantage. And the plans are on track to do that. Think about -- WellCare had well below 1 million members, well below 1 million members when WellCare came into the Centene combination. And WellCare was at scale and operating effectively and efficiently. So the scale -- we're not really concerned about scale issues with Medicare even as we expect a little bit more attrition as we prioritize the strategic goals of being in Medicare and the tie-in to Medicaid, to your point, the footprint matching up as well as prioritizing margin recovery over the next few years, driven predominantly by STARS but other levers like SG&A that we're talking about here and clinical initiatives.

是的。所以你是對的。我說，我們需要在未來幾年內將 SG&A 至少削減 200 個基點，以達到我們想要達到的 Medicare Advantage 目標。並且計劃正在按計劃實現這一目標。想想看—WellCare 的會員數遠低於 100 萬，當 WellCare 加入 Centene 組合時，遠低於 100 萬會員。 WellCare 規模宏大，營運高效。因此，規模——我們並不真正擔心醫療保險的規模問題，儘管我們預計會出現更多的人員流失，因為我們優先考慮加入醫療保險和與醫療補助的結合的戰略目標，就你的觀點而言，足跡匹配並優先考慮未來幾年的利潤恢復，這主要由 STARS 驅動，但也有其他槓桿，例如我們在這裡討論的 SG&A 和臨床計劃。

So it's certainly a much higher SG&A ratio than Medicaid because you've got distribution costs and open enrollment costs and things like that. And Marketplace is actually a little bit higher than Medicare itself. So that does mechanically work its way into our SG&A rate. So we're not concerned about being subscale in Medicare Advantage. We want that business to sit side by side with our Medicaid business to seize the opportunities of the future later on in the decade, and we'll power through 2025, even if that means some attrition.

因此，它的 SG&A 比率肯定比醫療補助高得多，因為你有分銷成本和公開註冊成本等等。而 Marketplace 實際上比 Medicare 本身要高一點。因此，這確實會機械地影響到我們的 SG&A 費率。因此，我們並不擔心 Medicare Advantage 規模較小。我們希望該業務能夠與我們的醫療補助業務並駕齊驅，在十年後抓住未來的機遇，我們將持續到 2025 年，即使這意味著一些消耗。

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。

Actually, I just kind of wanted to follow up, I guess, on that last comment for just a second. We're just looking at total employees down 12% sequentially, 8,000 sequentially. I was just trying to think through what the implications are sequentially into 2Q, 3Q in terms of G&A or even some of those employees might be medical support in the [MedEx] line.

事實上，我想我只是想跟進最後一條評論。我們只看到員工總數比上一季減少 12%，即 8,000 人。我只是想思考一下對第二季、第三季的一般管理費用（G&A）的影響，甚至其中一些員工可能是 [MedEx] 系列的醫療支援。

And then just my second question would be just to clarify on the -- when we see the $50 million additional PDR for Medicare in the 10-Q, is that an additional $50 million that ran through the P&L this quarter and impacted the reported EPS and weighed on the reported Medicare MLR this quarter?

然後我的第二個問題只是澄清一下——當我們看到10-Q 中醫療保險的PDR 增加了5000 萬美元時，本季度的損益表上又增加了5000 萬美元，影響了報告的每股收益和對本季度報告的醫療保險 MLR 造成壓力？

Yes. Good questions. Most of the change in the employee base is the divestiture of Circle. That was pretty employee-intensive in Great Britain. So that was a result of divestiture. Although we are constantly managing the right amount of resources, it's our job to, on behalf of taxpayers, on behalf of the federal and state governments, managing efficiently, matching resources with the business that we have and trying to do that efficiently and effectively. But that big move was due to divestiture.

是的。好問題。員工基礎的大部分變化是 Circle 的剝離。這在英國是相當僱員密集的。這就是資產剝離的結果。儘管我們不斷管理適量的資源，但我們的工作是代表納稅人、代表聯邦和州政府進行有效管理，將資源與我們擁有的業務相匹配，並努力高效、有效地做到這一點。但這項重大舉措是由於資產剝離所致。

And you're right, the $50 million, while we expected it as we mapped out the seasonality of Medicare during the year, and that has the PDR sort of pushing up a little bit in Q2, maybe a little bit more in Q3 and then being relieved completely relative to the 2024 policy year in Q4, that $50 million did hit the P&L. It did make its way into the loss ratio for the Medicare segment. But it was exactly as -- it was as planned, so it wasn't a surprise to us.

你是對的，5000 萬美元，雖然我們在製定今年 Medicare 的季節性時對此有所預期，但 PDR 在第二季度有所上升，也許在第三季度會上升一點，然後相對於第四季度的2024 年保單年度，損益表中確實有5,000 萬美元，這讓我們完全鬆了一口氣。它確實影響了醫療保險部門的損失率。但這完全按照計劃進行，所以我們並不感到驚訝。

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 had a couple of clarifications. First, on Medicaid, did you see fewer disenrolled members than you anticipated in the quarter? Or was there a higher reconnect rate? Just curious if you could give a little more color on what the drivers of the higher membership were in the quarter and how do you see those developing over the rest of the year relative to that 13.6 million membership number you previously guided to.

我有幾點需要澄清。首先，在醫療補助方面，您發現本季退出的會員數量是否比您預期的要少？或重連率是否更高？只是好奇您是否可以更詳細地說明本季度較高會員數量的驅動因素，以及相對於您之前指導的 1360 萬會員數量，您如何看待今年剩餘時間的發展。

And then second, on the Medicare -- on the Medicaid composite rate, the 2.5%, just want to clarify, is that the core is running a little bit better than you expected? Or is that 2.5% inclusive of the accelerated state payments?

其次，關於醫療保險－關於醫療補助綜合費率，2.5%，只是想澄清一下，核心的運作情況是否比你預期的要好一點？或者這 2.5% 是否包含國家加速付款？

Yes. On membership, we still expect to be in that mid-13s by year-end. And so I think 100,000-member difference on 13 point -- to 13.3 million, some may call rounding, but luckily, it's rounding in the right direction, right? But it's probably more timing of precision around redeterminations, and some of that will carry into Q2. And there's even a few states that will tail off into Q3 as they've stretched out the redetermination process. But all of that is in the mid-13s estimate of membership by year-end, which includes a couple of nice growth opportunities too that we seized, Oklahoma, which commenced 4/1. And as you heard in Sarah's remarks, that went really well operationally. And then subject to protest, the Arizona LTSS win, low membership but high revenue.

是的。在會員資格方面，我們預計到年底仍將達到 13 歲左右。所以我認為 100,000 名成員的差異在 13 個點上——到 1330 萬，有些人可能會稱之為四捨五入，但幸運的是，它的四捨五入方向是正確的，對嗎？但重新確定的時間可能更加精確，其中一些將延續到第二季​​。甚至有一些州將推遲到第三季度，因為它們已經延長了重新確定過程。但這一切都是到年底的 13 年代中期的會員人數估計，其中也包括我們抓住的幾個很好的成長機會，俄克拉荷馬州，從 4 月 1 日開始。正如您在莎拉的演講中所聽到的，操作起來非常順利。然後，由於抗議，亞利桑那州 LTSS 獲勝，會員人數少，但收入高。

And then your question on composite rate, the 2.5%, yes, we're a little bit above that. And that's sort of an all-in view of a composite rate, whether the rate relates to acuity, whether the rate relates to redeterminations or just general trend.

然後是關於綜合利率的問題，2.5%，是的，我們的利率略高於這個數字。這是對綜合比率的全面看法，無論該比率與敏銳度有關，無論該比率與重新確定有關還是僅與整體趨勢有關。

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。

Just had a couple of modeling questions that would be helpful. One, just on investment income, if you can sort of walk us towards what you view as sort of the run rate for the second quarter and for the balance of the year. I know there were a few gains included in the first quarter investment income. And then also on operating cash flow, obviously that was noisy in the first quarter for the reasons you mentioned. If you wouldn't mind just giving us an update on the full year CFFO expectation and then how you're thinking maybe about the second quarter given that you did get that state payment came in, in April.

只是有幾個建模問題會有所幫助。第一，僅就投資收入而言，您是否可以引導我們了解您所認為的第二季和今年剩餘時間的運行率。我知道第一季的投資收益包含了一些收益。然後還有經營現金流，顯然，由於您提到的原因，第一季的情況很吵。如果您不介意向我們提供有關全年 CFFO 預期的最新信息，以及您對第二季度的看法，因為您確實收到了 4 月份的州付款。

Yes. Investment income, if you peel away gains, we disclosed those throughout the Q, which we just filed. So understandably, you haven't ripped through that yet. You get a little bit over $400 million in the quarter. But you can't just multiply that by 4. We expect the full year to be above -- a little bit above the $1.4 billion that we guided to at Investor Day. But the difference between that and just annualizing is we've got multiple rate cut scenarios built into our forecast. Maybe those play out to be conservative, but the Federal Reserve will decide that.

是的。投資收入，如果你剝離收益，我們在我們剛剛提交的整個季度中都披露了這些收入。所以可以理解的是，你還沒有突破這一點。本季您的營收略高於 4 億美元。但你不能僅僅將其乘以 4。但這與僅按年計算的差異在於，我們的預測中內建了多種降息情境。也許這些結果會顯得保守，但聯準會將做出決定。

You also saw that we had a lot of payables. Look at our balance sheet, we relieved a lot of payables in the quarter. We accelerated state-directed payments on behalf of our providers. So obviously, when you relieve payables and you're building up pharmacy rebate receivables, that has an impact on investment income as well. But pleased that we're going to come in -- we expect to come in a little bit above that $1.4 billion.

您還看到我們有很多應付帳款。看看我們的資產負債表，我們在本季減輕了很多應付帳款。我們代表我們的提供者加速了國家指導的付款。顯然，當您減少應付帳款並增加藥品回扣應收帳款時，這也會對投資收入產生影響。但很高興我們能夠進入——我們預計收入將略高於 14 億美元。

On the operating cash flow, as you know, in this business that bounces around quite a bit. A large state decides pay us on 4/2 versus 3/31, and you have a big flip between quarters. Just mentioned some things that impact cash flow as well, the timing of pharmacy rebate receivables or payable invoices. So it's sort of maybe a fool's errand to try to predict that quarter-to-quarter in terms of how that will play out. What really matters in this business is the dividends from subs, the cash flow, not only GAAP cash flow statement but the cash that comes from subsidiaries to parent such that we can deploy capital. And we expect that to pick up, as you'll see in the Q, over the next few quarters. And that will drive our capital deployment later in the year for share buyback and some debt -- a little bit of debt reduction as well. So that's what we're looking forward to.

如您所知，該業務的營運現金流量波動很大。一個大州決定以 4/2 與 3/31 向我們付款，並且季度之間會有很大的轉變。剛才提到了一些也會影響現金流的事情，也就是藥局回扣應收帳款或應付發票的時間。因此，試圖逐季度預測結果可能是愚蠢的。在這項業務中真正重要的是來自子公司的股利、現金流，不僅是公認會計原則現金流量表，還有從子公司到母公司的現金，以便我們可以部署資本。我們預計這一趨勢將在接下來的幾個季度內有所回升，正如您將在問題中看到的那樣。這將推動我們在今年稍後進行資本部署，用於股票回購和一些債務——以及一點債務削減。這就是我們所期待的。

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。

A couple of quick things here. Appreciate the reiteration of the long-term target of the high 89s for your Medicaid HBR. I wondered, if you think you're finishing up on redeterminations largely in the second quarter, the disenrollments and maybe a little spills in the third quarter, when do you think you get visibility once and for all on how that whole process has impacted the risk pool? And are you still thinking -- I think at Investor Day, you said that you could get 30 basis points of margin improvement '24 and '25 in Medicaid. Is that still your thought at this point?

這裡有幾件事。感謝重申您的 Medicaid HBR 高 89 的長期目標。我想知道，如果您認為您將在第二季度完成大部分重新確定工作，在第三季度完成取消註冊和可能的一些溢出，那麼您認為您什麼時候才能徹底了解整個過程如何影響了風險池？您是否還在想——我想在投資者日，您說過您可以在 24 年和 25 年獲得醫療補助 30 個基點的利潤率改善。此時此刻您仍有這樣的想法嗎？

Yes. Thanks, A.J. You're right. So we're 9 -- roughly 90% of the way through redeterminations from a membership standpoint. Obviously, the cumulative member months impact sort of trails that a little bit. And we do think that the tail of membership will run through Q2 and Q3 and sort of largely be complete by that point.

是的。謝謝，A.J.你說得對。因此，從會員資格的角度來看，我們已經完成了 9 項重新決定，大約完成了 90%。顯然，累積會員月數對軌跡的影響有點大。我們確實認為會員資格的尾部將貫穿第二季度和第三季度，到那時基本上已經完成。

I would say the nice thing is that I don't think that we have seen -- we've not had to wait to see sort of the shifting risk pool. We've been watching that really closely, and that's part of the preparation of the team did leading into this process over a year ago, which allowed us to have those proactive modeling conversations with our state partners through the rate cycles in the last year. And we're mirroring that same process as we move through the rate updates that Drew talked about between 7/1 and 10/1.

我想說，好的一點是，我認為我們還沒有看到——我們不必等待看到風險池的變化。我們一直在密切關注這一點，這是一年多前團隊為這一過程所做的準備工作的一部分，這使我們能夠在去年的利率週期中與我們的州合作夥伴進行主動建模對話。當我們瀏覽德魯在 7 月 1 日至 10 月 1 之間談論的費率更新時，我們正在鏡像相同的過程。

And so really sort of trying to address the bolus of any dislocation between rate and acuity in that cycle, but obviously leaving open, as we said before, the idea that some of that tailwind of margin will get picked back up in '25 and possibly trailing a little bit into '26. And that's where we see the recovery in terms of that basis point on the margin.

因此，我們確實在嘗試解決該週期中利率和敏銳度之間任何錯位的問題，但顯然，正如我們之前所說，利潤率的一些順風將在 25 年甚至可能會恢復的想法仍然存在。年後有點落後。這就是我們看到邊際基點復甦的地方。

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 just maybe a brief one on that last comment, last point. On the rate visibility, I think you called out 75%. You talked about matching acuity which, Sarah, you just commented on. Is the matching of acuity and getting those payments squared up, is -- should we think about that being in the remaining 25% that you don't have rate visibility on yet? Or are you expecting some amount of kind of retro catch-up from states where you actually have already had rate discussions? And just kind of understanding the mix of that is what I'm hoping to do.

所以也許只是對最後一個評論、最後一點進行簡短的介紹。關於可見度，我想你說的是 75%。你談到了匹配敏銳度，莎拉，你剛剛對此發表了評論。敏銳度的匹配和這些付款的平方是否是——我們是否應該考慮一下，在剩下的 25% 中，您還沒有利率可見度？或者您是否期望實際上已經進行過利率討論的州能夠進行某種程度的追趕？我希望能夠理解其中的混合。

Yes -- okay.

是的——好吧。

Okay. Sorry. The 75% is a member month view of what we know for the 2024 calendar year member months, and the 25% would be there's 7/1 rates we don't know. We certainly don't know 9/1 or 10/1 rates, but they have a limited impact on the 2024 calendar year. To the macro point, we need -- ultimately, we're going to need to have rates match acuity, and that -- we expect that to shake out. It may not be perfect in this rate cycle, which means sort of the 2025, 2026 time period is when we would expect to get back into the high 89s based upon today's mix of business.

好的。對不起。 75% 是我們所知道的 2024 日曆年會員月的會員月視圖，25% 是我們不知道的 7/1 費率。我們當然不知道 9/1 或 10/1 利率，但它們對 2024 年的影響有限。從宏觀角度來看，我們需要——最終，我們需要讓利率與敏銳度相匹配，並且——我們預計這種情況將會發生。在這個利率週期中它可能並不完美，這意味著根據今天的業務組合，我們預計在 2025 年、2026 年期間將回到 89 的高點。

So there might be a couple of retros. It seems like different companies have different definitions of retro. We're only waiting on a couple of retros. There might be adjustments going forward where the state realizes and their actuaries, "Hey, we missed the mark last time. Let me fix this going forward." But we are still expecting a couple of retros as we talked about at Investor Day and on the Q1 call.

所以可能會有一些復古。看來不同的公司對復古有不同的定義。我們只等待一些復古。州政府及其精算師意識到，未來可能會進行調整，“嘿，我們上次沒有達到目標。讓我來解決這個問題。”但我們仍然期待一些回顧，正如我們在投資者日和第一季電話會議上談到的那樣。

But it's largely getting the rates correct and matching acuity going forward. And that's why we're not expecting to move into the -- back into the high 89s immediately. It may take a rate cycle or so. But that does remain a margin expansion opportunity. On a company that's performing well on a consolidated basis, actually that creates some capacity for margin expansion in Medicaid as we look at '25, '26.

但它主要是讓利率正確並匹配未來的敏銳度。這就是為什麼我們不希望立即回到 89 的高位。這可能需要一個費率週期左右。但這確實仍然是一個擴大利潤率的機會。對於一家在綜合基礎上表現良好的公司來說，實際上，正如我們在 25 年和 26 年所看到的那樣，這實際上為醫療補助的利潤率擴張創造了一定的能力。

Yes. And the only thing I would add, which is just that as we've watched the team sort of work through the complexity of this process where we have encountered those targeted dislocations, I've just been really impressed with how our teams have stepped up to that dialogue. There is clarity on the drivers. It's a very data-driven approach. They've clearly built really solid collaborative dialogue with our state partners and are really solutions-oriented in how they step into those conversations. And so I think building credibility with our state partners as we work through this process has been consistent throughout and, I think, again sort of creates the framework to get back to a matching state and get that tailwind opportunity.

是的。我唯一要補充的是，當我們看到團隊在這個過程的複雜性中遇到了那些有針對性的錯位時，我們團隊的進步給我留下了深刻的印像到那次對話。司機的情況很清楚。這是一種非常數據驅動的方法。顯然，他們與我們的國家合作夥伴建立了真正堅實的合作對話，並且在如何介入這些對話方面真正以解決方案為導向。因此，我認為，在我們整個過程中，在整個過程中與我們的國家合作夥伴建立信譽是一致的，而且我認為，這再次創建了一個框架，以回到匹配的狀態並獲得順風的機會。

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

今天我們的下一個問題來自德意志銀行的喬治·希爾。

Just 2 quick ones for me. I guess as you talked about the progress and the STARS goals for 2025, I would just love, at a high level, if you could talk about kind of the strategy and the progress towards achieving that goal. And Drew, as you were talking about kind of all the changes to Part D for 2025, I didn't hear you talk about the new Part D risk model. I would just be interested if you could make quick comments on how you think the new risk model in Part D kind of impacts the ability to drive revenue in that part of the business.

對我來說只有 2 個快速的。我想，當您談到 2025 年的進展和 STARS 目標時，我希望您能在較高層面上談談策略的類型以及實現該目標的進展。 Drew，當您談論 2025 年 D 部分的所有變化時，我沒有聽到您談論新的 D 部分風險模型。我只是感興趣，如果您能快速評論一下您認為 D 部分中的新風險模型如何影響該部分業務的收入成長能力。

Sure. Thanks, George. So quality, obviously a top priority for the organization regardless of line of business. But we remain very focused on STARS because of the impact it has for the Medicare trajectory. Very pleased with the work underway, engagement across the organization. We're leveraging a comprehensive governance process, and that has given us great visibility in terms of progress on initiatives at a detailed level.

當然。謝謝，喬治。因此，無論業務線如何，品質顯然是組織的首要任務。但我們仍然非常關注 STARS，因為它對醫療保險軌跡有影響。對正在進行的工作以及整個組織的參與非常滿意。我們正在利用全面的治理流程，這使我們能夠在詳細層面上清楚地了解舉措的進展。

Based on what we know today, we believe that we have maintained last year's progress and made additional advancements on admin and ops programs and metrics, which, you'll remember, was sort of the focus in the first cycle. And then in this past cycle, HEDIS and CAHPS were most in focus for us. We're in the middle of those processes. Those will wrap up in the next 30 to 60 days. We also have TTY that's still in flight.

根據我們今天所了解的情況，我們相信我們保持了去年的進展，並在管理和營運計劃和指標方面取得了額外的進步，您會記得，這是第一個週期的重點。在過去的這個週期中，HEDIS 和 CAHPS 是我們最關注的焦點。我們正處於這些過程的中間。這些將在接下來的 30 到 60 天內完成。我們還有仍在飛行中的 TTY。

So those are the last pieces that will land here towards the end of Q2 and then allow us to sort of rerun projections with a high degree of -- higher degree of confidence as we look to October. And so expect more detail in terms of what we're looking for in October on the Q2 call. But overall, just really pleased with how the team continues to show up, and again, alignment across the organization that this is a critical priority.

因此，這些是最後的部分，將在第二季末落地，然後讓我們在展望 10 月時，以高度的信心重新進行預測。因此，我們希望在 10 月的第二季電話會議上獲得更多有關我們正在尋找的內容的詳細資訊。但總的來說，我對團隊的持續表現感到非常滿意，並且在整個組織內保持一致，這是一個關鍵的優先事項。

Yes. And you're absolutely right. The risk model bifurcation between PDP and MAPD, that's a factor as well that needs to be worked into the bid cycle. And I think I did mention that we were able to run risk scores by member and the mechanics and how that rips through the -- not just the risk scores but also the timing of members with cost share and getting to the maximum out of pocket, or the MOOP. Those are all important things to think about. And really, the message is -- that's why there's reason for cautiousness for the industry in bidding PDP for 2025.

是的。你是完全正確的。 PDP 和 MAPD 之間的風險模型分歧，這也是投標週期中需要考慮的因素。我想我確實提到過，我們能夠按會員和機制進行風險評分，以及如何進行風險評分——不僅是風險評分，還包括會員分攤成本和最大限度自掏腰包的時機，或MOOP。這些都是需要考慮的重要事情。實際上，要傳達的訊息是——這就是為什麼業界在投標 2025 年 PDP 時持謹慎態度的原因。

And our next question comes from Lance Wilkes with Bernstein.

我們的下一個問題來自伯恩斯坦的蘭斯威爾克斯。

Can you talk a little bit about the PBM migration? And in particular, I was interested in if all the savings levers turned on, on January 1, if there should be a ramp of that over the course of the year with things like formulary alignment, et cetera, and if any of that might spill into '25. And maybe then as a broader question, just on your ongoing dialogues with states, how are they looking at GLP-1s and kind of adding coverage to that?

能談談 PBM 遷移嗎？我特別感興趣的是，所有儲蓄槓桿是否會在 1 月 1 日啟動，在這一年中是否會出現諸如處方調整等方面的傾斜，以及是否有任何可能溢出進入'25。也許作為一個更廣泛的問題，就您與各國正在進行的對話而言，他們如何看待 GLP-1 並增加覆蓋範圍？

Thanks, Lance, for the question, mostly because I don't think I can brag enough about our pharmacy team and the phenomenal job they did in such a massive undertaking. We've talked before about how well that went, January 1. But I think everybody who's been through something that significant knows that you don't just drop the mic the next day. And so these folks have continued to work tirelessly over the last couple of months to make sure that, that process just gets smoother and smoother for our members. We've had great collaboration with ESI. And so trajectory on that front just continues to be really positive.

謝謝蘭斯提出這個問題，主要是因為我認為我無法充分誇耀我們的藥局團隊以及他們在如此龐大的事業中所做的出色工作。我們之前已經討論過 1 月 1 日的進展如何。因此，這些人在過去的幾個月中繼續不懈地工作，以確保我們的會員的這一過程變得越來越順利。我們與 ESI 有著良好的合作。因此，這方面的發展軌跡仍然非常積極。

And then I'll let Drew talk a little bit about the step-up in the economics and some of the GLP-1 activity.

然後我會請 Drew 談談經濟學的進步和一些 GLP-1 活動。

Yes. So we didn't want to wait for economics. So we do have a stairstep benefit on behalf of our state and federal customers and our members as of 1/1/24. But we're constantly working with our partner at ESI to figure out ways to deliver value to our customers and manage costs. So we expect sort of normal course improvements from that point forward, and we'll continue to try to drive efficiencies in the pharmacy ecosystem.

是的。所以我們不想等待經濟學。因此，自 2024 年 1 月 1 日起，我們確實為我們的州和聯邦客戶以及我們的會員提供階梯式福利。但我們不斷與 ESI 合作夥伴合作，找出為客戶提供價值和管理成本的方法。因此，我們預計從那時起會出現正常的改進，並且我們將繼續努力提高製藥生態系統的效率。

On GLP-1s, not a lot of uptake yet by states. There's a couple of states where -- have decided to allow GLP-1s for the weight loss indication. Obviously, GLP-1s for the diabetes indication, we could see the volume coming through there. But for the weight loss indication, there's only a couple, and we're quick to go share the data with them to show them what it's costing them, but it's not that material to the company as a whole. And that's where the states control the formulary, the preferred drug list and make the decisions that we then administer and take risk for. And we just need to make sure that the states have the data so they can match rates with the cost that they choose to allow in their benefit plans.

對於 GLP-1，各州還沒有大量採用。有幾個州已決定允許 GLP-1 用於減肥指示。顯然，GLP-1 用於糖尿病適應症，我們可以看到那裡的體積。但對於減肥指標，只有幾個，我們很快就會與他們分享數據，向他們展示這給他們帶來了什麼損失，但這對整個公司來說並不是那麼重要。這就是各州控制處方集、首選藥物清單並做出決定的地方，然後我們進行管理並承擔風險。我們只需要確保各州擁有數據，以便他們可以將費率與他們選擇在福利計劃中允許的成本相匹配。

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

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

Thanks, Rocco, and thanks, everyone. Appreciate the time and interest this morning. Overall, we are pleased with how we're powering through a dynamic landscape and with the progress that we've demonstrated so far. So appreciate you joining us, and we'll see you next quarter.

謝謝羅科，謝謝大家。感謝今天早上的時間和興趣。總的來說，我們對我們在動態環境中的表現以及迄今為止的進展感到滿意。感謝您加入我們，我們下季再見。

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。