Centene Corp (CNC) 2024 Q2 法說會逐字稿

Good morning everyone and welcome to the Centene Corporation 2024 second quarter financial results conference call. All participants will be in a listen-only mode. (Operator Instructions) Please note, today's event is being recorded.

大家早安，歡迎參加 Centene Corporation 2024 年第二季財務業績電話會議。所有參與者將處於僅聽模式。 （操作員說明）請注意，今天的活動正在錄製中。

This time, I’d like to turn the floor over to Jen Gilligan, Head of Investor Relations. Ma’am, please go ahead. Jennifer Gilligan.

這次，我想請投資者關係主管 Jen Gilligan 發言。女士，請繼續。珍妮佛·吉利根。

Thank you, Jamie and good morning everyone. Thank you for joining us on our second quarter 2024 earnings release conference call. Sarah London, Chief Executive Officer, Andrew 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 centence.com. Ken Fasola, Centene's President and Jon Dinesman our Head of External Affairs will also be available as participants during Q&A.

謝謝傑米，大家早安。感謝您參加我們的 2024 年第二季財報發布電話會議。 Centene 執行長 Sarah London 和執行副總裁兼財務長 Andrew Asher 將主持今天早上的電話會議，您也可以透過我們的網站 centence.com 存取該電話會議。 Centene 總裁 Ken Fasola 和我們的外部事務主管 Jon Dinesman 也將參與問答環節。

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.

Centene 可能對未來預期、計畫和前景發表的任何言論均構成前瞻性陳述，符合 1995 年《私人證券訴訟改革法案》中的安全港條款。

Actual results may differ materially from those indicated by those forward-looking statements as a result of various important factors, including those discussed in our second quarter 2024 press release, which is available on the company's website under the Investor section. Centene anticipates that subsequent events and developments may cause its estimates to change.

由於各種重要因素，包括我們在 2024 年第二季新聞稿中討論的因素（可在公司網站的「投資者」部分查看），實際結果可能與這些前瞻性陳述所示的結果存在重大差異。 Centene 預計後續事件和事態發展可能會導致其估計發生變化。

While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so. The call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our second quarter 2024 press release.

雖然公司可能選擇在未來某個時候更新這些前瞻性陳述，但我們明確表示不承擔任何這樣做的義務。此次電話會議也將提及某些非公認會計準則措施。這些指標與最直接可比較的 GAAP 指標的調整可以在我們的 2024 年第二季新聞稿中找到。

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

現在，我想將電話轉給我們的執行長莎拉倫敦 (Sarah London)。莎拉？

Thank you, Jen. And thanks everyone for joining us as we review our second quarter 2024 financial results. This morning, we reported second quarter adjusted diluted EPS of $2.42, a stronger than previously anticipated result. Our earnings power in the period was supported by mixed results in our core business line with strong execution in marketplace, partially offset by pressure in Medicaid resulting from redeterminations.

謝謝你，珍。感謝大家與我們一起回顧 2024 年第二季的財務表現。今天早上，我們報告第二季調整後稀釋後每股收益為 2.42 美元，強於先前的預期。我們在此期間的獲利能力得到了核心業務線好壞參半的結果以及強大的市場執行力的支持，部分被重新決定帶來的醫療補助壓力所抵消。

Medicaid continues to perform in line with our expectations. Taking a step back from the moving pieces of the quarter, our diversified platform continues to enable us to deliver earnings power consistent with our previous expectations as we navigate a dynamic healthcare landscape. Given the importance of redeterminations to the Q2 results, let's start there.

醫療補助繼續符合我們的預期。回顧本季的動態，我們的多元化平台繼續使我們能夠在動態的醫療保健環境中提供與先前預期一致的獲利能力。鑑於重新確定對第二季結果的重要性，讓我們從這裡開始。

As many of you know, and as we have been reporting on for well over a year now, this process has played out at an unprecedented scale and has driven a similarly unprecedented membership shift that we knew would require the rebalancing of rates to account for the acuity of the members we continue to serve on behalf of our state partners.

正如你們許多人所知，正如我們一年多以來一直在報道的那樣，這一過程已經以前所未有的規模展開，並推動了同樣前所未有的會員資格轉變，我們知道這需要重新平衡費率以考慮到我們繼續代表我們的國家合作夥伴服務的成員的敏銳度。

While we are disappointed with the magnitude of the disconnect between Medicaid rate and acuity that we saw materialize in the quarter, our underlying analysis continues to suggest this is largely due to the mixed shift of the population and is therefore a temporary and addressable dynamic, and one that we are already actively addressing. The dialogue we established with each state's regulatory and actuarial counterparts early on in the lead-up to redeterminations have in this phase allowed us to profile the shifts we are seeing as they emerge and resulted in rates for the second half of the year that are very much a step in the right direction.

雖然我們對本季度醫療補助率與視力之間的脫節程度感到失望，但我們的基礎分析仍然表明，這主要是由於人口的混合變化造成的，因此是一種暫時且可解決的動態，並且我們已經在積極解決這一問題。我們在重新確定之前與每個州的監管和精算同行建立的對話使我們能夠在這一階段描述我們所看到的變化，並導致下半年的費率非常高。一大步。

As you'll hear from Drew, this momentum is evidenced by an uptick in our expectation for the annualized composite rate adjustment. Ultimately, we still anticipate the Medicaid business will return to a steady state pre pandemic HBR range once we are fully beyond the redeterminations impact. And each month and each rate cycle gets us closer to more normalized operating dynamics.

正如您將從德魯那裡聽到的那樣，我們對年化綜合利率調整的預期上升證明了這一勢頭。最終，我們仍然預計，一旦我們完全擺脫重新確定的影響，醫療補助業務將恢復到大流行前 HBR 的穩定狀態。每個月和每個費率週期都讓我們更接近更規範的營運動態。

In addition to right sizing rates, we continue to improve on the underlying Medicaid operations and to innovate as we look to drive health outcomes. One example of this is our new HALO program, which leverages peer-to-peer counseling to support recovery for members diagnosed with a substance use disorder. Innovations like this are well within our span of control and can help reduce medical costs for our state partners while driving improved outcomes for our members.

除了正確的規模調整率之外，我們還繼續改進基礎醫療補助營運並在尋求推動健康成果的過程中進行創新。這方面的一個例子是我們新的 HALO 計劃，該計劃利用同儕諮詢來支持被診斷患有藥物濫用障礙的會員的康復。此類創新完全在我們的控制範圍之內，可以幫助降低我們的州合作夥伴的醫療成本，同時改善我們會員的成果。

As we work through an historic redeterminations process, we have not lost sight of the opportunities for long-term growth in Medicaid, which is dependent on our ability to successfully procure and re-procure contracts at a state level. On this front, our business development team and local state teams continue to deliver, with previously discussed wins in critical geographies like Florida, Kansas, and Michigan. We have reviewed the recently announced actions taken by the state to finalize our new Florida contract and feel good about the outcome. We look forward to implementing that contract and to launching our new Arizona LTSS business with a targeted start date in Q4 this year.

當我們進行歷史性的重新確定過程時，我們並沒有忽視醫療補助長期增長的機會，這取決於我們在州一級成功獲得和重新獲得合約的能力。在這方面，我們的業務開發團隊和當地州團隊繼續交付成果，並在佛羅裡達州、堪薩斯州和密西根州等關鍵地區取得了先前討論的勝利。我們回顧了該州最近宣布的為敲定我們佛羅裡達州新合約而採取的行動，並對結果感到滿意。我們期待執行該合約並啟動我們新的亞利桑那州 LTSS 業務，目標啟動日期為今年第四季。

The strength of our local markets has been a key priority under the leadership of Dave Thomas, our CEO of Markets and Medicaid, who will be leaving Centene later this year after 25 years with the organization. Throughout that time, Dave has been influential in the company's success and has helped to build and support a team of exceptional mission-driven market leaders.

在我們的市場和醫療補助首席執行官 Dave Thomas 的領導下，我們當地市場的實力一直是我們的首要任務。在此期間，戴夫對公司的成功發揮了重要影響，並幫助建立和支持了一支由使命驅動的卓越市場領導者組成的團隊。

As we position the organization for our next chapter of growth and innovation in Medicaid, we will leverage one of those leaders, as Nathan Landsbaum, who many of you now know from his role in Florida, prepares to take a leadership role across the markets later this year. Nate has been with the organization for more than 18 years and brings extensive experience ranging from corporate positions to health plan leadership roles in multiple markets.

當我們將組織定位為醫療補助增長和創新的下一個篇章時，我們將利用其中一位領導者，正如你們許多人現在從他在佛羅裡達州的角色中認識的內森·蘭茲鮑姆（Nathan Landsbaum）一樣，他準備好稍後在整個市場中發揮領導作用今年。 Nate 在該組織工作超過 18 年，帶來了從企業職位到多個市場的健康計劃領導角色的豐富經驗。

I want to thank Dave for the significant contribution he has made to our organization, and we look forward to working with Nate and our market CEOs to harness the power of incumbency and serve more members in more programs.

我要感謝 Dave 對我們組織的重大貢獻，我們期待與 Nate 和我們的市場執行長合作，利用現任者的力量，在更多計劃中為更多會員提供服務。

Turning to marketplace, Centene's Ambetter Health demonstrated once again demonstrated once again it is not only the undisputed leader in the individual market, but also serves as a strategic complement to our Medicaid business, providing coverage continuity for members, and a natural hedge as we navigate mix and acuity shifts from redeterminations.

轉向市場，Centene 的 Ambetter Health 再次證明，它不僅是個人市場無可爭議的領導者，而且還是我們醫療補助業務的戰略補充，為會員提供承保連續性，並在我們導航時提供自然對沖混合和敏銳度因重新確定而改變。

Ambetter is delivering strong performance in the core business and delivering on margin expansion in 2024. At the same time, the business has been able to capture in-year membership growth, contributing to this morning's increase in our full-year premium and service revenue expectations. And to date, through the redeterminations process, has exceeded expectations for serving members transitioning for Medicaid. From a macro perspective, the marketplace landscape continues to shift positively in our direction.

Ambetter 在核心業務中取得了強勁的業績，並在2024 年實現了利潤率擴張。貢獻。迄今為止，透過重新確定流程，已經超越了在職會員過渡到醫療補助的預期。從宏觀角度來看，市場格局持續朝著我們的方向積極轉變。

With heightened awareness among consumers and the migration of micro and small commercial groups to the individual market, we see an increasing and increasingly accessible addressable market, giving us exciting room to run in this business.

隨著消費者意識的提高以及微型和小型商業集團向個體市場的遷移，我們看到了越來越多且越來越容易進入的潛在市場，這為我們在這項業務中提供了令人興奮的經營空間。

By executing well in the first half of 2024, we are harnessing the positive momentum we continue to gain with our members, providers, and distribution partners. As we look to 2025 and scenarios around the enhanced advanced premium tax credits, we believe the benefits of enabling access to affordable healthcare for more than 20 million Americans are clear.

透過 2024 年上半年的良好執行，我們正在利用我們與會員、提供者和分銷合作夥伴持續獲得的積極勢頭。當我們展望 2025 年以及圍繞增強的高級保費稅收抵免的情景時，我們相信讓超過 2000 萬美國人獲得負擔得起的醫療保健的好處是顯而易見的。

Coverage has been a critical driver of economic stability for rural communities across the country, particularly in states like Texas, Florida, and Georgia. And mass adoption has finally made a long-envisioned, robust individual marketplace a reality. Rhetoric aside, we believe there is bipartisan alignment around the promise of this chassis and that Centene is well positioned to build on this foundation to drive growth in 2025 and beyond.

覆蓋範圍一直是全國農村社區經濟穩定的關鍵驅動力，特別是在德克薩斯州、佛羅裡達州和喬治亞州等州。大規模採用最終使長期設想的、強大的個人市場成為現實。撇開言辭不談，我們相信兩黨圍繞這一底盤的承諾達成一致，並且 Centene 處於有利位置，可以在此基礎上繼續發展，推動 2025 年及以後的增長。

To this end, we continue to track momentum around affordable, customized, and portable coverage for individuals in the form of ICRAs. While this market is still very early, we believe it represents a compelling alternative to employer sponsored coverage. And as the thought leader in this space, with the number one brand in the individual market and without a commercial group business to protect, we see this as fertile, organic hunting ground that can create upside to our story.

為此，我們繼續追蹤以 ICRA 形式為個人提供負擔得起的、客製化的和便攜式保險的勢頭。雖然這個市場還處於早期階段，但我們相信它代表了雇主贊助保險的一個令人信服的替代方案。作為這個領域的思想領袖，擁有個人市場的第一個品牌，並且沒有商業集團業務需要保護，我們認為這是肥沃的、有機的狩獵場，可以為我們的故事創造積極的一面。

Meanwhile, Centene's Medicaid platform delivered an on-plan financial performance in the quarter and continues to make significant operational progress. We are, as many of you know, approaching an important milestone for this business as we prepare for new Medicare Advantage star ratings to be unveiled in October. The pending star's announcement represents a critical step towards our previously established three-year goal of achieving 85% of our Medicaid Advantage membership enrolled in plans rated three and a half stars or better as published in the fall of 2025. We are pleased with the operational progress that we have made year-to-date and remain on track to deliver steady progress compared to the 19% achieved by last year's efforts, recently updated to 23% by CMS.

同時，Centene 的醫療補助平台在本季度實現了按計劃的財務業績，並繼續取得重大營運進展。正如你們許多人所知，隨著我們為 10 月公佈的新 Medicare Advantage 星級評級做準備，我們正在接近這項業務的一個重要里程碑。待定星級的宣布是朝著我們之前製定的三年目標邁出的關鍵一步，即實現2025 年秋季發布的85% 的Medicaid Advantage 會員註冊了三星級半或以上的計劃。滿意我們今年迄今的進展，與去年的 19% 相比，仍有望取得穩定進展，CMS 最近更新為 23%。

Let me give you a sense for what has tangibly improved. At this time, we have good visibility into results related to admin and ups. Consistent with prior updates, in this cycle, we were able to hold on to the gains we achieved last year and build upon them. Our performance continues to improve with the processing of appeals, CTMs, and health risk assessments, and focus work by our call center and claims teams has driven improvements we would expect to see as part of scoring in October.

讓我讓您了解一下有哪些明顯的改進。此時，我們可以很好地了解與 admin 和 ups 相關的結果。與先前的更新一致，在這個週期中，我們能夠保持去年的成果並在此基礎上再接再厲。隨著上訴、CTM 和健康風險評估的處理，我們的績效不斷提高，我們的呼叫中心和理賠團隊的重點工作推動了我們預計在 10 月的評分中看到的改進。

On the HEDIS front, the significant increase in member outreach that you heard about in Q3 and Q4 drove improved physician access and successfully closed gaps in care for many of our members. These are important lead indicators for improvement in our HEDIS scores. We continue to invest in and strengthen these programs as we move through 2024 consistent with our commitment to and focus on quality enterprise-wide. We do not yet have final caps results or cut points, but as we sit here today, we are pleased with the progress against our internal expectations and expect this October 2024 milestone to be a meaningful step to our ultimate goal.

在 HEDIS 方面，您在第三季和第四季聽說的會員外展活動顯著增加，改善了醫生的獲取機會，並成功縮小了許多會員的護理差距。這些都是提高 HEDIS 分數的重要先行指標。到 2024 年，我們將繼續投資並加強這些計劃，這與我們對全企業品質的承諾和關注保持一致。我們還沒有最終的上限結果或削減點，但當我們今天坐在這裡時，我們對超出我們內部預期的進展感到高興，並預計2024 年10 月的這一里程碑將成為實現我們最終目標的有意義的一步。

Relative to 2025 Medicaid bids, we remain focused on our product strategy of serving lower income complex seniors and despite a challenging rate environment, I'm proud of the work our team did to integrate a data-driven health equity lens into our supplemental benefits design. We also took the opportunity in this bid cycle to simplify our contractual footprint, all part of a multi-year strategy to build back to a high-quality, high-performing and profitable Medicare business aligned for growth. As we approach November, we are certainly keeping a close eye on election dynamics at every level and scenario planning for key policy themes across our states and lines of business.

相對於2025 年醫療補助投標，我們仍然專注於為低收入複雜老年人提供服務的產品策略，儘管費率環境充滿挑戰，但我為我們的團隊將數據驅動的健康公平視角融入我們的補充福利設計中所做的工作感到自豪。我們也利用這個投標週期的機會簡化了我們的合約範圍，所有這些都是多年策略的一部分，旨在重建高品質、高性能和盈利的醫療保險業務，以實現成長。隨著 11 月的臨近，我們當然會密切關注各層面的選舉動態，以及各州和各產業關鍵政策主題的情境規劃。

As we have said before, at Centene, we focus on policy, not politics, and we operate day in and day out in a politically diverse ecosystem. We have demonstrated success over the past 25 years across multiple Republican and Democratic administrations. This is because we focus on our mission first and thoughtfully partner at both the state and federal level on solutions that work best for each community we serve.

正如我們之前所說，在 Centene，我們關注的是政策，而不是政治，並且我們日復一日地在一個政治多元化的生態系統中運作。過去 25 年來，我們在歷屆共和黨和民主黨政府中都取得了成功。這是因為我們首先關注我們的使命，並在州和聯邦層面深思熟慮地合作，開發最適合我們服務的每個社區的解決方案。

In this role, I've had the honor of meeting with lawmakers across the country, including governors, senators, congressmen and women, state legislators and regulators, and leaders of major federal policy committees. And while they have different views on many topics, there is one thing they all want to improve the health of the communities they serve.

在此職位上，我有幸會見了全國各地的立法者，包括州長、參議員、眾議員、州立法者和監管者以及主要聯邦政策委員會的領導人。儘管他們對許多主題有不同的看法，但他們都希望改善他們所服務的社區的健康。

This is Centene's mission, and it is a vision we firmly believe has bipartisan support regardless of the electoral outcome in November. We are now more than halfway through 2024, and we are making good progress moving the organization beyond real but temporary headwinds, including Medicaid redeterminations and a well-documented Medicare Advantage ARS revenue challenge.

這是 Centene 的使命，我們堅信，無論 11 月的選舉結果如何，這一願景都會得到兩黨的支持。現在 2024 年已過半，我們正在取得良好進展，使組織擺脫真正但暫時的不利因素，包括醫療補助重新確定和有據可查的 Medicare Advantage ARS 收入挑戰。

At the same time, we are still hard at work strengthening the underlying business, modernizing our processes and infrastructure, adding exceptional talent, and investing in innovation. We believe Centene's focus on government-sponsored health care positions us very well for profitable growth as we go forward, and we remain confident that we can deliver value to our shareholders by delivering value to our members and keeping them at the center of all that we do. We are pleased to reiterate our outlook for adjusted diluted EPS of greater than $6.80 a dynamic year and look forward to furthering our progress in 2025 and beyond.

同時，我們仍在努力加強基礎業務，實現流程和基礎設施現代化，增加優秀人才，並投資創新。我們相信，Centene 對政府資助的醫療保健的關注使我們在未來的盈利增長中處於有利地位，並且我們仍然相信，我們可以通過為我們的會員提供價值並將他們置於我們所有業務的中心，從而為我們的股東提供價值。我們很高興重申我們對動態年度調整後攤薄每股收益超過 6.80 美元的展望，並期待在 2025 年及以後進一步取得進展。

With that, I'll turn it over to Drew.

有了這個，我會把它交給德魯。

Thank you, Sarah. Today we reported second quarter 2024 results including $36 billion in premium and service revenue and adjusted diluted earnings per share of $2.42, up 15% from Q2 of 2023. Results in the quarter, as previewed earlier in the week, were consistent with the dynamics we described intra-quarter in the May 29th 8-K. The quarter serves as yet another example of the benefits of a diversified enterprise allowing for varying degrees of performance among the many parts of our business. This Q2 result keeps us on track to deliver adjusted diluted earnings per share in excess of $6.80 in 2024.

謝謝你，莎拉。今天，我們公佈了2024 年第二季度業績，包括360 億美元的保費和服務收入，調整後攤薄每股收益為2.42 美元，比2023 年第二季度增長15%。那樣，本季的業績與我們的動態一致。本季是多元化企業好處的又一個例子，讓我們業務的許多部分可以實現不同程度的績效。第二季的業績使我們預計在 2024 年實現超過 6.80 美元的調整後稀釋每股收益。

Our consolidated HBR was 87.6% for Q2 and 87.3% year-to-date. This positions us to achieve the high end of our previous full year guidance range around 87.9%. As previewed in the May 8-K, Medicaid medical expense was higher in Q2 largely due to the acuity of membership that remains as redeterminations wrap up.

我們第二季的綜合 HBR 為 87.6%，今年迄今為 87.3%。這使我們能夠實現先前全年指導範圍的上限，即 87.9% 左右。正如 5 月 8-K 期預測的那樣，第二季醫療補助醫療費用較高，主要是由於重新決定結束後會員資格仍然存在敏銳性。

You may recall about a year ago we talked about needing from our state partners, one acknowledgement, two action, and three sufficiency regarding matching rates with acuity. All states have acknowledged the need and intent to match rates and acuity. All but one have taken action. We are still working on the sufficiency with more visibility now that we're largely through redeterminations. The acuity of the population that remains, the stayers plus the rejoiners, is now more clear to us and our state partners than when we were working through large membership shifts of Q4 2023 and Q1 2024.

您可能還記得大約一年前，我們討論過需要我們的國家合作夥伴，一個確認，兩個行動，以及三個充分性，以將比率與敏銳度相匹配。所有州都承認匹配率和敏銳度的必要性和意圖。除一國外，所有國家都已採取行動。由於我們主要是透過重新確定，我們仍在努力提高可見性的充分性。與我們在2023 年第四季和2024 年第一季進行大規模會員變動時相比，我們和我們的國家合作夥伴現在更加清楚留下來的人口（留下來的人和重新加入的人）的敏銳度。

We continue to have constructive conversations with our state partners on the sufficiency and the timing of rates as we present them with updated data from the latter part of the redetermination process. Pursuant to these efforts, we now expect the back half of 2024 Medicaid composite rates to be 4% plus relative to our original forecast of 2% to 2.5%. This 7/1 to 10/1 rate cycle will impact about half of our Medicaid premium. So this will help the trajectory of the HBR in the back half of the year compared to Q2's 92.8%.

我們繼續與我們的國家合作夥伴就費率的充足性和時間安排進行建設性對話，同時向他們提供重新確定過程後期的最新數據。根據這些努力，我們現在預計 2024 年下半年的醫療補助綜合費率為 4% 以上，而我們最初的預測為 2% 至 2.5%。這個 7/1 到 10/1 的利率週期將影響我們大約一半的醫療補助保費。因此，與第二季的 92.8% 相比，這將有助於 HBR 在今年下半年的發展軌跡。

While we certainly have more work to do on rates in 2024 and 2025, we have no change in our long-term view of the ultimate proper matching of rates and acuity in our Medicaid business. Meanwhile, our marketplace business continues to perform well, not just as we wrapped up 2023 risk adjustment with great execution, but also in our 2024 positioning and performance, including a little more growth in 2024 with 4.4 million members at quarter in. Let me hit the highlights of Tuesday's 8-K.

雖然我們在 2024 年和 2025 年的費率方面肯定還有更多工作要做，但我們對醫療補助業務中費率和敏銳度最終適當匹配的長期看法沒有改變。同時，我們的市場業務繼續表現良好，不僅是因為我們以出色的執行力結束了2023 年的風險調整，而且還因為我們2024 年的定位和業績，包括2024 年的增長略有增加，本季度會員數達到440 萬。

In the past decade, we've gotten pretty good at operating the marketplace business, including accumulation and submission of data to get paid the right revenue to match the acuity of our marketplace population.

在過去的十年中，我們已經非常擅長經營市場業務，包括累積和提交數據，以獲得適當的收入，以匹配我們市場人群的敏銳度。

The result of that execution, which improved year-over-year, was a better-than-expected result as we wrapped up the Edge server process in May and estimated the value of our submissions as we referenced in the May 8-K. This was subsequently corroborated by weekly data, then ultimately CMS's final notice published this past Monday. The result was a net favorable pickup expected in our 2024 P&L of approximately $600 million as outlined in Tuesday's filing. Again, great execution in Marketplace.

該執行結果逐年改善，好於預期，因為我們在 5 月結束了邊緣伺服器流程，並估計了我們在 5 月 8-K 中引用的提交內容的價值。隨後每週數據證實了這一點，最終 CMS 在上週一發布了最終通知。正如週二提交的文件中所述，我們預計 2024 年損益淨值將實現約 6 億美元的有利成長。再次強調 Marketplace 的出色執行力。

Our Medicaid segment continues to be on track with our expectations for 2024, and we look forward to continue to improve that business over the next few years as Star scores improve and we get the requisite revenue to drive better performance. And despite redeterminations and divestitures, this company continues to outperform in premium revenue. You can see that in the year-to-date reported revenue. Accordingly, we increased the 2024 full-year premium and service revenue guidance by $5 billion compared to our April 2024 earnings release.

我們的醫療補助部門繼續符合我們對 2024 年的預期，我們期待在未來幾年中繼續改善該業務，因為星級評分提高，並且我們獲得了推動更好業績所需的收入。儘管進行了重新決定和資產剝離，該公司的溢價收入仍然表現出色。您可以在年初至今的報告收入中看到這一點。因此，與 2024 年 4 月發布的財報相比，我們將 2024 年全年保費和服務收入指引增加了 50 億美元。

Approximately $1 billion in Medicaid, $2 billion in commercial, and $2 billion in Medicare segment revenue to a range of $141 billion to $143 billion. That bodes well for the future, exiting 2024 with a higher revenue base upon which to drive EPS growth in 2025 and beyond. One other guidance update, we now expect over $1.55 billion of investment income in 2024, excluding gains on divestitures.

醫療補助收入約 10 億美元，商業收入約 20 億美元，醫療保險部門收入約 20 億美元，介於 1,410 億美元至 1,430 億美元之間。這對未來來說是個好兆頭，到 2024 年結束時，收入基礎將提高，從而推動 2025 年及以後的每股收益成長。另一項指導更新顯示，我們現在預計 2024 年投資收入將超過 15.5 億美元，不包括資產剝離收益。

Our adjusted SG&A expense ratio is 8.0% in the second quarter on track with our full-year guidance. Cash flow provided by operations was $2.2 billion in Q2. Unregulated cash on hand a quarter end was $217 million. Consistent with previous comments, we expect the majority of deployable cash to be available during the second half of the year. The first half of the year, we deployed $851 million on Centene shares.

第二季調整後的 SG&A 費用率為 8.0%，符合我們的全年指引。第二季營運提供的現金流為 22 億美元。季度末手頭上不受監管的現金為 2.17 億美元。與先前的評論一致，我們預計大部分可部署現金將在今年下半年到位。今年上半年，我們投資了 8.51 億美元購買 Centene 股票。

Our debt to adjusted EBITDA was 2.8 times at quarter end. Our medical claims liability at quarter end represented 54 days in claims payable up one day sequentially and up two days compared to Q2 of 2023. The diversified portfolio of Centene performed well as a whole in the first half of 2024. And while we expect some continued pressure on our Medicaid HBR in the second half of the year compared to our original goal, we expect Medicaid HBR improvement relative to Q2 given the second half rate action. Further rate action into 2025 would continue the improvement.

截至季末，我們的調整後 EBITDA 債務為 2.8 倍。我們季度末的醫療索賠負債為 54 天，應付索賠比 2023 年第二季度增加了一天，增加了兩天。 ，下半年我們的醫療補助HBR 面臨壓力，考慮到下半年的利率行動，我們預期醫療補助HBR 相對於第二季有所改善。 2025 年的進一步利率行動將持續改善。

On the topic of 2025, it's much too early to give 2025 guidance, but we can walk you through the tailwinds and headwinds that we believe today relative to 2024. In the category of 2025 tailwinds, we currently forecast, one, HBR improvement in Medicaid as we expect to make continued progress on rates throughout 2025. Two, a return to Medicaid growth post-redeterminations. Three, growth in the overall marketplace market and in our membership. Four, the absence of a Medicare PDR in 2025.

關於2025 年的話題，現在給出2025 年的指導還為時過早，但我們可以帶您了解我們今天認為相對於2024 年的順風和逆風。是醫療補助方面的HBR 改善我們預計 2025 年費率將持續取得進展。第三，整個市場和我們的會員數量的增長。第四，2025 年缺乏 Medicare PDR。

Recall we have a $125 million PDR P&L hit embedded in our current 2024 guidance. Five, revenue growth in PDP. Six, capital deployment in 2024 annualizing into 2025 and capital deployment in 2025. Seven, continued progress on improving operational efficiency and SG&A execution. 2025 headwinds would include, one, the annualization of the first half of 2024 final redetermination impact on 2025 premium revenue. Two, we wouldn't expect to repeat the $600 million prior year marketplace risk adjustment benefit. And three, Federal Reserve rate actions gradually impacting investment income. We will provide more insight as we get through 2024, and we expect to provide formal 2025 guidance at our investor day in December.

回想一下，我們目前的 2024 年指引中包含了 1.25 億美元的 PDR 損益。五、PDP收入成長。六是2024年的資本部署，年化至2025年以及2025年的資本部署。 2025 年的不利因素包括，一是 2024 年上半年最終重新確定對 2025 年保費收入的年化影響。第二，我們預期不會重複去年 6 億美元的市場風險調整收益。第三，聯準會的利率行動逐漸影響投資收益。我們將在 2024 年提供更多見解，並預計在 12 月的投資者日提供正式的 2025 年指引。

Looking ahead, we are clearly focused on influencing our state partners to match rates with acuity, improving Stars, continuing to position our marketplace products to produce strong margins, improving Stars, continuing to position our marketplace products to produce strong margins, and we are planning to deliver on our 2024 adjusted diluted EPS guidance of greater than $6.80 and grow adjusted EPS thereafter.

展望未來，我們顯然致力於影響我們的州合作夥伴將費率與敏銳度相匹配，提高星級，繼續定位我們的市場產品以產生強勁的利潤，提高星級，繼續定位我們的市場產品以產生強勁的利潤，我們正在計劃實現我們 2024 年調整後稀釋後每股收益超過 6.80 美元的指導，並在此後增長調整後每股收益。

Thank you for your interest in Centene, and we can open it up for questions.

感謝您對 Centene 的興趣，我們可以打開它來提問。

(Operator Instructions) Stephen Baxter from Wells Fargo.

（操作員說明）來自富國銀行的 Stephen Baxter。

Yes, hi. Thanks for all the color. I was hoping that you could tell us what you're expecting for Medicaid MLR in the back half of the year and any kind of bridging assumptions we should use to get there. And I guess as we're thinking about the magnitude of MLR improvement that you get on a 4% plus composite rate, that would also be something that's helpful to know. And then if you could give us a sense of, for the states that have updated your rates inside that composite rate, where does this leave you in terms of normalized profitability? Is there still more work to do on the second half rate states? Or do you think this brings you back basically closer to in line with your targeted level of profitability? Thanks.

是的，嗨。感謝所有的顏色。我希望您能告訴我們您對下半年醫療補助 MLR 的期望，以及我們應該用來實現這一目標的任何橋接假設。我想，當我們考慮 4% 以上的綜合利率所帶來的 MLR 改善幅度時，了解這一點也是很有幫助的。然後，如果您能讓我們了解一下，對於在該綜合利率內更新了利率的州，這在標準化盈利能力方面會給您帶來什麼影響？下半年利率狀態還有更多工作要做嗎？或者您認為這會讓您基本上更接近目標盈利水平嗎？謝謝。

Yes, thanks, Stephen. So, I think you could take the, we guided to effectively the top end, around the top end of our HBR, consolidate a range of 87.9% and come up with some estimates. I think you actually did in a report last Tuesday to come up with some estimates on where that Medicaid HBR might land. Certainly we expect improvement relative to what we printed in Q2. And if you think about 4% plus in the back half of the year, and we do have half, just about half of our premium revenue in the back half of the year, you can sort of figure out the math of what in isolation that would benefit us from.

是的，謝謝，史蒂芬。因此，我認為您可以採取我們有效指導的上限，圍繞我們的 HBR 的上限，鞏固 87.9% 的範圍並提出一些估計。我認為您實際上在上週二的一份報告中對醫療補助 HBR 可能落地的地方做出了一些估計。當然，我們預計相對於第二季的印刷結果將有改善。如果你考慮下半年的 4% 以上，而我們下半年的保費收入確實有一半，大約一半，你可以算出孤立的數學結果將使我們受益。

And of course, we've got trend built in, we've got seasonality depending on, month-to-month. So, those are other factors to consider. But, as we've said before, we think this will take into 2025 for sure to sort of get back to equilibrium. We've got 1/1 rates, which we don't currently have visibility on, but that's about 35%. 4/1 is in the zone of 15%. And then another bite at the 7/1 to 10/1 apple in 2025. So, we've got multiple rate cycles to continue to influence here to get back which we fully expect to sort of get back to that equilibrium of rates and acuity.

當然，我們有內建的趨勢，我們有每月的季節性。所以，這些都是需要考慮的其他因素。但是，正如我們之前所說，我們認為到 2025 年肯定會恢復平衡。我們有 1/1 的比率，目前還看不到，但大約是 35%。 4/1 位於 15% 區域。然後在 2025 年再咬一口 7/1 到 10/1 的蘋果。

Sarah James

莎拉詹姆斯

Thank you. Can you help us get a sense of what your like core stayer book MLR looks like for Medicaid so far this year? So, it's the full uptick in the first half, 2024 versus 2023. Just related to what's going on with redetermination and rates, are there other factors in there?

謝謝。您能否幫助我們了解今年到目前為止您喜歡的 MLR 核心保留書對於醫療補助的情況？所以，2024 年與 2023 年上半年相比，這是全面上升的。

Yes, let me hit this at a high level and then I think it'd be good for Drew to walk through some of the data that underpins our viewpoint on this. But the bottom line, as we both said in our remarks, is that the primary driver of the HBR pressure is the increased acuity of the membership post-redeterminations and that mismatch between rates and acuity, which is, we're confident is a temporary and fixable dynamic. As we've said before, there are always pockets of trend that we watch. We called out behavioral health. Obviously, you heard from my remarks that we're very active in terms of developing programs to manage outcomes for that population. And then here and there, state by state dynamics, if there's a change to the preferred drug list or something like that.

是的，讓我從高層次談一下這個問題，然後我認為德魯最好介紹一下支持我們對此觀點的一些數據。但正如我們在演講中所說，底線是，《哈佛商業評論》壓力的主要驅動因素是重新確定後會員資格的敏銳度增加，以及費率和敏銳度之間的不匹配，也就是說，我們相信這是暫時的。正如我們之前所說，我們總是專注於一些趨勢。我們呼籲行為健康。顯然，您從我的演講中了解到，我們在製定管理該人群結果的計劃方面非常積極。然後到處根據州動態說明首選藥物清單是否有變化或類似情況。

Yes, Sarah, you're right. And Sarah James, you're right. Stayers, we can isolate stayers, leavers, rejoiners, and then the new members. And we can go one step deeper on stayers as we look for, is there a trend here or is this really the remaining mix of business that we're left with post-redeterminations? We can actually go into the continuous members. And so, when we go into continuous members, which is a subset of the stayers, trend looks pretty stable. And so, when we go into continuous members, which is a subset of the stayers, trend looks pretty stable. And so lifting back up to stayers versus leavers and rejoiners, the spread between stayers and leavers, that has widened largely, we believe, due to a handful of states that went deeper. You can see that in our membership. We're a little bit lower than we expected, around 13.1 million members.

是的，莎拉，你說得對。莎拉詹姆斯，你是對的。留宿者，我們可以隔離留宿者、離開者、重新加入者，然後是新成員。當我們尋找留存者時，我們可以更深入地了解這裡是否存在趨勢，或者這真的是我們在重新確定後留下的剩餘業務組合嗎？我們實際上可以進入連續成員。因此，當我們研究連續會員（即常駐會員的子集）時，趨勢看起來相當穩定。因此，當我們研究連續會員（即常駐會員的子集）時，趨勢看起來相當穩定。因此，我們認為，由於少數州採取了更深入的措施，因此，回到留下來者與離開者和重新加入者之間，留下者和離開者之間的差距在很大程度上擴大了。您可以在我們的會員資格中看到這一點。我們的會員數約為 1310 萬，略低於我們的預期。

Therefore, they were pushing out more lower utilizers out of Medicaid, and you saw that in the administrative terminations. Then the other dynamic in one of those cohorts, the rejoiners, that's a growing population force, which is good ultimately, but obviously that's tilting towards those that are seeking care. So that's contributing to the higher HBR as well, including, and this is an interesting dynamic, a widening eligibility gap in coverage where we're not getting premium for a number of months. And that's widening. It used to be 70% plus had no break in coverage. Now we're under 50% with no break in coverage. And the number of months we're not getting premium for those ultimate rejoiners is impacting the results as well. And that'll wash out, over the next year, but that's another dynamic that's, pushing on the reported HBR.

因此，他們將更多較低利用率的人排除在醫療補助之外，您可以在行政終止中看到這一點。然後，這些群體中的另一個動力，即重新加入者，是人口不斷增長的力量，這最終是好的，但顯然這傾向於那些正在尋求治療的人。因此，這也導致了更高的 HBR，包括，這是一個有趣的動態，承保資格差距不斷擴大，我們有幾個月沒有獲得保費。而且這種情況正在擴大。以前是 70% 以上，覆蓋範圍沒有中斷。現在我們的覆蓋率還不到 50%，而且覆蓋範圍沒有中斷。我們沒有為這些最終重新加入者獲得溢價的月份數也會影響結果。明年，這種情況就會消失，但這是推動《哈佛商業評論》報道的另一種動力。

Well, and I would just add, it's a dynamic that we can include in the data that we're sharing with states. And so, again, this was a dynamic we've anticipated all along, which is precisely why we took an early and often approach to data sharing. And I think that has served us well throughout the process, but particularly in this quarter as we're able to bring forward the data on these different dynamics. And obviously that has favorably influenced the second half rates.

好吧，我想補充一點，這是一種動態，我們可以將其包含在我們與各州共享的數據中。因此，這也是我們一直以來所預期的動態，這正是我們早期且經常採取資料共享方法的原因。我認為這在整個過程中對我們很有幫助，特別是在本季度，因為我們能夠提供有關這些不同動態的數據。顯然這對下半年的利率產生了有利的影響。

Justin Lake from Wolfe Research.

沃爾夫研究中心的賈斯汀·萊克。

Thanks. Good morning. A couple of questions. First on MLRs, I'm just wondering if you might update us on your MLRs by segment versus the original guidance that's going to get you to the 87.9, maybe even throughout some second half MLR seasonality between 3Q and 4Q. And then on Part D, there's a lot of changes going on here. This has been a pretty big part of your book. I'm curious if you could help us understand how you think we should look at this year-over-year. It looks like it should be a big increase in premium given the federal subsidy is going to increase significantly. Is this profitable for you in 2024? How do you think about the risk reward of how investors should approach it in 2025 given all the changes there? Thanks.

謝謝。早安.有幾個問題。首先關於MLR，我只是想知道您是否可以按細分市場向我們更新您的MLR 與最初的指導，這將使您達到87.9，甚至可能在第三季度和第四季度之間的下半年MLR 季節性期間。然後在 D 部分，這裡發生了很多變化。這是你書中相當大的一部分。我很好奇您是否可以幫助我們了解您認為我們應該如何看待今年的情況。鑑於聯邦補貼將大幅增加，保費似乎應該會大幅增加。 2024 年這對你來說有利可圖嗎？考慮到 2025 年發生的所有變化，您如何看待投資者應如何應對這項風險回報？謝謝。

Yes, maybe let me hit PDP and then Drew can talk about seasonality of HBR. Obviously not at a stage where we can give specific 2025 guidance, but as you heard from Drew, the PDP revenue is a 2025 tailwind. I think the team has taken a really thoughtful approach to the bid process, leveraging frankly decades of experience and data that we have and expect to see a first set of data from CMS next week. But whether, volume is static or down, premium will increase, as you said, Justin, with the changes from the IRA. And as we've said before, we view this as a product line that has to be able to stand alone from a profitability standpoint.

是的，也許讓我先談談 PDP，然後德魯可以談談《哈佛商業評論》的季節性。顯然，我們還沒有到可以給出具體 2025 年指導的階段，但正如您從德魯那裡聽到的那樣，PDP 收入是 2025 年的推動力。我認為團隊在投標過程中採取了非常深思熟慮的方法，坦率地利用了我們數十年的經驗和數據，並期望下週看到來自 CMS 的第一組數據。但無論交易量是靜態還是下降，正如賈斯汀您所說，隨著 IRA 的變化，保費都會增加。正如我們之前所說，我們認為這是一條必須能夠從獲利角度獨立的產品線。

Yes. So on the MLR by segment, I think we do, we're pretty disclosive. We give you guys a lot of disclosure, including the actual by segment. Not all our large peers do that. Hopefully you enjoy seeing that detail. But we're not going to give detailed guidance by segment. Though the 87/9, I think you could probably do some math and piece together what we've told you historically to figure out the zone of each of those. And once again, it's a diversified portfolio. That's how we manage the business.

是的。因此，對於按細分市場劃分的國土資源部，我認為我們確實這樣做，我們非常公開。我們向你們提供了很多信息，包括實際的細分信息。並非我們所有的大型同行都會這樣做。希望您喜歡看到這個細節。但我們不會按細分市場提供詳細指導。雖然是 87/9，但我認為您可能可以做一些數學計算，並將我們歷史上告訴您的內容拼湊起來，找出每個區域的區域。再次強調，這是一個多元化的投資組合。這就是我們管理業務的方式。

The seasonality is such that typically commercial, you'd see tick up throughout the year. Obviously, we had the benefit in Q2 that kept it sort of flat to Q1. And then, deductible wear off in the commercial business, you'd see that tick up. So that's one thing to take into account.

季節性是典型的商業性，你會看到全年都會增加。顯然，我們在第二季度獲得了好處，使其與第一季持平。然後，商業業務的免賠額逐漸減少，你會看到這種情況增加。所以這是需要考慮的一件事。

And then just one more follow-up comment on Part D or PDP. I said multiple times, Q1 at the conference in March, just trying to explain the fact that we expected the direct subsidy to go up over $100 on top of the $29 direct subsidy this year. So obviously, that goes into the yield, largely goes into the yield. So as Sarah said, that'll be a pretty big step up in premium yield. We'll have to see where the membership shakes out. We'll know a little bit more next Monday about where we stand. But we won't know competitive positioning until the landscape files come out in September.

然後是關於 D 部分或 PDP 的另一項後續評論。我在3月份的會議上多次說過，第一季度，只是想解釋一個事實，即我們預計直接補貼將在今年29美元的直接補貼基礎上增加100美元以上。顯然，這會影響產量，很大程度會影響產量。正如莎拉所說，這將是保費收益率的一個相當大的進步。我們必須看看會員資格的變化。下週一我們會更了解我們的立場。但要等到 9 月的景觀文件出來後我們才能知道競爭定位。

Josh Raskin from Nefron Research

Nefron Research 的 Josh Raskin

Hi, thanks. Good morning. Why do you think the risk adjuster on the exchange has developed so much better than you expected? The payable was $1.3 billion less than you thought. And what are the changing dynamics there? And I guess more importantly, Drew, I appreciate the headwinds, tailwinds for 2025. But, if you think about sort of the $0.80 hurdles that you've got to get over and I know you get back some from the PDR. But, if you think about the consensus sitting at $7.53, I'd just be curious to get your perspectives on, is that directionally in the right spot or, should we be thinking about something different?

你好謝謝。早安.為什麼您認為交易所風險調節器的發展比您預期的要好得多？應付金額比您想像的少 13 億美元。那裡的變化動態是什麼？我想更重要的是，德魯，我很欣賞 2025 年的逆風和順風。但是，如果您考慮 7.53 美元的共識，我只是想知道您的觀點，這在方向上是否正確，或者我們是否應該考慮一些不同的東西？

Yeah, on the risk adjustment. So at year end, we're sitting there every year trying to estimate not just where we sit for the current, let's say 2023 at [12.31 '23] not just what we believe the acuity of the population is in marketplace at that point in time. We also have to estimate what we're going to get done over the next four months and then get submitted into the edge server. And that's all the data, acuity data, claims run out, encounter data from sometimes providers, sometimes vendors. And so a lot of data that we've got to accumulate and execute on and get that into the edge server.

是的，關於風險調整。因此，到了年底，我們每年都會坐在那裡，試圖估計的不僅僅是當前的情況，比如說 2023 年 [12.31 '23]，而不僅僅是我們認為當時人們對市場的敏銳度。我們還必須估計我們將在接下來的四個月內完成的工作，然後提交到邊緣伺服器。這就是所有的數據，敏銳度數據，索賠用完，遇到的數據有時來自提供商，有時來自供應商。我們必須累積和執行大量數據，並將其輸入邊緣伺服器。

So there are estimates that go into that year end reserve. We've got to estimate the risk and we've got some data from Wakely throughout the year to know at least at that point the relativity. But I'd say we just executed really strong. We get better every year at that. We have to estimate the relativity. It's a zero sum game in the industry. So you're estimating what other people are going to do as well. We try to be conservative but realistic with assumptions since it is a zero sum game. And while I would expect maybe a little bit of favorability because we don't always book to a 50-50 proposition, this was good news. And I would thank our teams here for really strong execution.

因此，有一些估計會進入年底儲備金。我們必須估計風險，並且我們從韋克利全年獲得了一些數據，以便至少在那時了解相對論。但我想說我們的執行力非常強大。我們在這方面每年都變得更好。我們必須估計相對性。這是業界的零和遊戲。所以你也在估計其他人會做什麼。我們嘗試保持保守但現實的假設，因為這是一個零和遊戲。雖然我預計可能會有一點好感，因為我們並不總是以 50-50 的比例預訂，但這是個好消息。我要感謝我們的團隊非常強大的執行力。

On consensus yes, we're not going to opine on consensus or give guidance this early. Hopefully, the headwinds and tailwinds helped. You could sort of take some of that color on the execution part of risk adjustment and getting paid the appropriate amounts for the acuity of our population and marketplace as you think through rolling from year-to-year. And hopefully, that's pretty good color for now.

關於共識，是的，我們不會這麼早就就共識發表意見或提供指導。希望逆風和順風能有所幫助。你可以在風險調整的執行部分採取一些這種顏色，並在你逐年思考時根據我們人口和市場的敏銳度獲得適當的金額。希望現在的顏色非常好。

A.J. Rice from UBS

A.J.瑞銀的米

Hi, everybody. I guess I have two questions. One, on the public exchange trends. I think if you ex-out -- tells a little bit on what your assumptions are in the back half of the year. But if you ex-out the risk adjustment true-up, I know your official guidance was for MLR to be in the 78.5 to 79.5 range this year on the public exchanges. It sounds like maybe you're pretty close to that. I want to just confirm that. And you didn't call that out as any headwind or tailwind. So whatever you're at on public exchange margin this year, you seem to think you can carry that ex the risk adjustor true-up difference for next year. Is that the way to think about it?

大家好。我想我有兩個問題。一、關於公共交流趨勢。我認為，如果你退出的話，請說明你對下半年的假設。但如果你排除風險調整的真實性，我知道你的官方指導是今年公開交易所的 MLR 處於 78.5 至 79.5 的範圍內。聽起來也許你已經很接近了。我想確認一下。你並沒有稱之為任何逆風或順風。因此，無論你今年的公共交易保證金處於什麼水平，你似乎都認為你可以將風險調整器的真實差異轉移到明年。是這樣思考的嗎？

And then maybe just on Medicaid real quick. The rate updates you're seeing, there's been some discussion about how long state actuaries have to look back, and they look back to full 12 months? Or do they make adjustments based on a shorter period of time? Are you assuming that the July 1 update this year, then the October, then the January and then next year's July that things get progressively better each one of those updates on average as they get the information? Or are you assuming they have enough information? Those rate adjustments are all about the same?

然後也許很快就可以享受醫療補助了。您看到的利率更新，有一些關於國家精算師必須回顧多長時間的討論，他們回顧了整整 12 個月？還是根據更短的時間進行調整？您是否假設今年 7 月 1 日更新，然後是 10 月，然後是 1 月，然後是明年 7 月，當他們獲得資訊時，平均每一次更新的情況都會逐漸好轉？還是你假設他們有足夠的資訊？這些費率調整都差不多嗎？

Yes, thanks, A.J. You're right. There's sort of a natural look back in the process on Medicaid rates. But I think if you look at what we've seen, frankly, in the rate updates that we've had starting from the beginning of redeterminations, it would have been easy in a normal course for us to have a full normal complement of data. And so we saw early moves. I think we're seeing a continuation of that trend with maybe even a little bit more favorability relative to the speed of reaction to what we saw in Q2 materializing in the back half rates.

是的，謝謝，A.J.你說得對。在醫療補助費率的過程中，有一種自然的回顧。但我認為，如果你看看我們所看到的，坦白說，在我們從重新確定開始以來的費率更新中，在正常過程中我們很容易獲得完整的正常數據補充。所以我們看到了早期的舉動。我認為我們看到這種趨勢的延續，相對於我們在第二季度看到的後半利率實現的反應速度，甚至可能有更多的好感。

And so from here, really what we're saying is that we have even more supporting data as we go forward. And so the active dialogue with the states and I think our positioning relative to making sure that we have full sufficiency in terms of matching rate and acuity gets better and better each bite at the apple as we go through. So I think that accelerating momentum is something we feel. I think you're seeing it in the rates, and we would expect and hope to continue that as we get through 1/1. And then if there's additional work we need to do for second half next year. And then, Drew, do you maybe want to talk about exchange performance?

因此，從這裡開始，我們真正想說的是，隨著我們的前進，我們擁有更多的支援數據。因此，與各州的積極對話以及我認為我們的定位相對於確保我們在匹配率和敏銳度方面擁有充分的充足性，在我們經歷的每一口蘋果中都變得越來越好。所以我認為我們感受到了加速的勢頭。我認為您已經在費率中看到了這一點，我們預計並希望在 1 月 1 日之後能夠繼續這樣做。如果明年下半年我們還需要做更多的工作。然後，德魯，你想談談交換性能嗎？

Andrew Asher

安德魯·阿舍爾

Yes. So A.J., you're right. We originally guided to midpoint of 79%. On the full commercial book, that's now $32.5 billion of revenue with the updated guidance. So despite sort of growing -- yes, we're generally on track, excluding the $600 million benefit. So that's good.

是的。所以A.J.，你是對的。我們最初的指導值為 79% 的中點。在完整的商業帳面上，根據更新後的指引，目前的收入為 325 億美元。因此，儘管有所增長——是的，我們總體上步入正軌，不包括 6 億美元的福利。所以這樣很好。

And as we think about 2024 risk adjustment, I mean we're always trying to be prudent with how we approach that. So that's also something to think about. But really pleased with the execution marketplace team, not just the 2023 benefit sitting in Q2, but the 2024 year as well, and that incurred year is tracking nicely.

當我們考慮 2024 年的風險調整時，我的意思是我們始終努力謹慎地對待這個問題。所以這也是值得思考的事情。但對執行市場團隊非常滿意，不僅是第二季的 2023 年收益，還有 2024 年的收益，而且該年的進展情況良好。

Kevin Fischbeck from Bank of America.

美國銀行的凱文‧菲施貝克 (Kevin Fischbeck)。

Hey, thanks for the question. This is Adam Ron. I'm for Kevin. One of your peers appears to be saying they're insulated from some of these Medicaid pressures due to having been pretty deep into risk corridors. And I believe that's something you've also called out as a benefit at some point. So could you help size what the gross amount before these corridors in trend that you're seeing that's higher versus what you thought and how it compares to the 4% composite rate you mentioned?

嘿，謝謝你的提問。這是亞當羅恩。我是為了凱文。您的一位同事似乎表示，由於已經深入風險走廊，他們免受部分醫療補助壓力的影響。我相信這也是您在某些時候也稱之為好處的東西。那麼，您能否幫忙估算一下您所看到的這些走廊之前的總金額與您的想法相比是否較高，以及與您提到的 4% 綜合率相比如何？

And then if I could also ask one quick clarification, you mentioned in Medicare now that business submitted, you'd be optimizing your footprint. So wondering if that includes market exits and if you could help size the membership in those markets. Thanks.

然後，如果我還可以要求一個快速澄清，您在醫療保險中提到，現在業務已提交，您將優化您的足跡。因此，想知道這是否包括市場退出，以及您是否可以幫助擴大這些市場的會員規模。謝謝。

Yes. So relative to Medicare, we I think the team has done a really good job in terms of thoughtfully defining the 25 bids consistent with the long-term strategy, even in a challenging rate year. But also, as I as I mentioned, we've been thinking about how to streamline that book and further align it with our Medicaid footprint, because that's where the puck is going. And so as a result of that, you will see us exit a handful of states with that longer term strategy in mind.

是的。因此，相對於 Medicare，我認為該團隊在深思熟慮地定義與長期戰略一致的 25 個投標方面做得非常好，即使是在充滿挑戰的費率年份。而且，正如我所提到的，我們一直在考慮如何簡化這本書並進一步使其與我們的醫療補助足跡保持一致，因為這就是冰球的發展方向。因此，你會看到我們帶著長期策略退出了少數州。

Yes. And risk corridors, that's sort of a part of our business. They come in a few different forms, whether it's a true risk corridor, a minimum MLR, profit sharing, depending on the state. I would say those peak during COVID, the COVID era, and now are more in a steady state. And just to give you a number, if you look on our balance sheet, you wouldn't be able to pick it out of the balance sheet necessarily. But for Medicaid specifically, we've got $2.3 billion as a payable on our balance sheet at Q2. That's split between the line items, return to premium payable and current liabilities and part of it is in other long-term liabilities, but that spans multiple years as work for, there’s runout, there’s years, sometimes it takes years for states to ultimately go through the imaginations to collect and retrieve that.

是的。風險走廊，這是我們業務的一部分。它們有幾種不同的形式，無論是真正的風險走廊、最低 MLR、利潤分享，這取決於各州。我想說的是，這些在新冠疫情期間達到頂峰，現在處於穩定狀態。只是為了給你一個數字，如果你查看我們的資產負債表，你不一定能夠從資產負債表中選出它。但具體而言，對於醫療補助，我們第二季的資產負債表上有 23 億美元的應付款項。這是在行項目、應付保費回報和流動負債之間分配的，其中一部分是其他長期負債，但它跨越多年的工作時間，有耗盡，有多年，有時需要各國最終需要花費數年時間才能通過想像力來收集和檢索這些資訊。

Scott Fidel from Stephens

史蒂芬斯的斯科特·菲德爾

Hi, thanks, good morning. Just wanted to first just ask on the exchange margins. Obviously, given a few different moving pieces here with the risk adjuster, how would you just sort of suggest that we think about sort of what's embedded in guidance now for your pretax margin for the marketplace when thinking against that 5% to 7.5% long-term target?

嗨，謝謝，早安。只是想先詢問一下外匯保證金。顯然，鑑於風險調整器存在一些不同的變化因素，在考慮 5% 至 7.5% 的長期投資時，您會如何建議我們考慮現在市場稅前利潤率指導中包含的內容？

And then just separately, it would be helpful if -- obviously, there's been a lot of moving pieces to operating cash flow year-to-date across the industry and for Centene as well. I know there's been a lot of sort of timing dynamics with certain states with Medicaid. So Drew, maybe if you had sort of some visibility that you could give us into your expectations for full year operating cash flow that would be helpful as well. Thanks.

然後，單獨來看，如果——顯然，今年迄今為止，整個行業和 Centene 的營運現金流都發生了很多變化，那將會很有幫助。我知道某些州的醫療補助計劃存在許多時間動態。因此，德魯，也許如果您有一定的了解，可以向我們提供您對全年營運現金流的預期，這也會有所幫助。謝謝。

Yes. On cash flows, it's not really one of our guidance elements because, to your point, exactly in this business, they can swing from the last day of the quarter to the first day of the next quarter based upon when states want to pay us. But I think you can look at the first half of the year, and we were negative $400 million or so in Q1. We've got $2.2 billion positive in Q2. The first half of the year, you can look at that. That's a reasonable depiction. But you're right, it's sort of a fool's errand to predict cash flow quarter-to-quarter because of the government programs dynamic.

是的。關於現金流，這實際上並不是我們的指導要素之一，因為就您而言，正是在這項業務中，它們可以根據各州希望向我們付款的時間從本季度的最後一天到下季度的第一天。但我認為你可以看看今年上半年，我們第一季的虧損約為 4 億美元。第二季我們的獲利為 22 億美元。上半年，你可以看看。這是一個合理的描述。但你是對的，由於政府計劃的動態性，逐季度預測現金流量有點愚蠢。

What's important, though, is getting cash out of the subsidiaries and dividends up to the subs and then capital deployment. So we're excited about capital deployment in the back half of the year. That's consistent with what we've said here before. And even in the first half of the year, we're able to do $850 million of share repurchase.

不過，重要的是從子公司中獲取現金，並向子公司發放股息，然後進行資本部署。因此，我們對今年下半年的資本部署感到興奮。這與我們之前所說的一致。即使在今年上半年，我們也能夠進行 8.5 億美元的股票回購。

On the margins on marketplace, or let's stick to commercial segment. I think going back to the discussion that we just had with A.J., sort of the -- excluding the $600 million being on track for what we said originally well into that 5% to 7.5% pretax margin. And then obviously, the $600 million would be on top of that. So just good sound performance and excited about our product positioning for next year. We'll learn more and more as we get further into 2024 about our positioning, and expect that the market to grow. And the 10 years of experience of the marketplace team and all their supporting shared service partners across this entire company, we expect to have another good year in marketplace in 2025.

在市場邊緣，或讓我們堅持商業領域。我想回到我們剛剛與 A.J. 進行的討論，不包括我們最初所說的 5% 至 7.5% 稅前利潤率的 6 億美元。顯然，6 億美元將是最重要的。因此，良好的聲音表現並對我們明年的產品定位感到興奮。隨著 2024 年的深入，我們將越來越多地了解我們的定位，並預計市場將會成長。憑藉 Marketplace 團隊及其整個公司所有支援共享服務合作夥伴 10 年的經驗，我們預計 2025 年 Marketplace 將迎來美好的一年。

David Windley from Jefferies

傑富瑞 (Jefferies) 的大衛溫德利 (David Windley)

Hi, good morning. Thank you. Your G&A ratio was favorable in the quarter, some benefit from the exchange risk adjustment that you called out, but even with that would have been below your full year range. Wondering what other benefits you might have seen if those are sustainable? And if you might direct us to a subrange in the range for the full year.

早安.謝謝。本季的一般管理費用比率是有利的，部分受益於您提出的匯率風險調整，但即使如此，仍將低於全年範圍。想知道如果這些好處是可持續的，您可能還會看到哪些其他好處？如果您可以引導我們了解全年範圍內的子範圍。

Yes, David, we're -- it was right on track in the quarter, the SG&A ratio. And I'd say we're still right on track for that 8.4 to 9.0 range that we previously provided. So that midpoint being 8.7. So it typically ramps up during the year. Q4 is always the highest with all the open enrollment cost. You're right, we were aided a little bit in the quarter by having more revenue in the denominator because of the settlement from 2023 risk adjustment in marketplace. So I'd say we're right on track and pleased with the execution. And, but there's more to come. There's more we can do.

是的，大衛，我們——本季的 SG&A 比率處於正確的軌道上。我想說，我們仍然在我們之前提供的 8.4 到 9.0 範圍內走上正軌。所以中點是 8.7。因此，它通常會在一年中增加。在所有公開招生費用中，第四季始終是最高的。你是對的，由於 2023 年市場風險調整的結算，我們在本季度得到了一些幫助，因為分母中的收入有所增加。所以我想說我們正步入正軌並對執行感到滿意。而且，還有更多的事情要做。我們還能做更多事。

I've said before, we got to take a couple of hundred basis points of SG&A out of our Medicare business. And our leadership in Medicare is working on that, in conjunction with the rest of the company. And just multiyear initiatives that we set out to achieve when we launched the original value creation plan, and now that's sort of part of the fiber of the company. So we're not satisfied with that -- with what we're expecting to achieve this year in SG&A, but we're on track. So that's good. We need to do more, and we will over the next few years.

我之前說過，我們必須從醫療保險業務中扣除幾百個基點的SG&A。我們在醫療保險領域的領導層正在與公司其他部門合作致力於實現這一目標。這只是我們在啟動最初的價值創造計劃時所要實現的多年計劃，現在這已成為公司結構的一部分。因此，我們對此並不滿意——對我們今年在銷售、管理和管理方面實現的預期目標並不滿意，但我們正在走上正軌。所以這樣很好。我們需要做更多的事情，而且我們會在未來幾年內做更多的事情。

Okay. Thank you.

好的。謝謝。

Lance Wilkes from Bernstein

伯恩斯坦的蘭斯威爾克斯

Great. I wanted to ask about the outlook for Medicaid growth. And in particular, I wanted to get kind of an update on pipeline. What you're seeing as far as where you're being more successful and less successful RFP scoring? And what your rejoiner outlook is?

偉大的。我想問一下醫療補助成長的前景。特別是，我想了解管道的最新情況。您認為 RFP 評分在哪些方面比較成功，哪些方面不太成功？您的重新加入前景如何？

And maybe as just a little clarification. Over in the Part D book, can you also just give us a little background and description of the demographics of that book? Kind of what's the age cohorts you've got going through there? And how much is LIS, which I imagine is most? But if you could describe that as well, that would be helpful.

也許只是一點點澄清。在 D 部分的書中，您能否為我們介紹一下該書的背景和人口統計？您在那裡經歷的年齡層是多少？還有我想像中最多的LIS多少錢？但如果你也能描述這一點，那就會很有幫助。

Yes. Thanks, Lance. Let me hit RFPs. I can give you a little bit of an update on the rejoiners, maybe some of the numbers that are underneath what Drew was talking about in terms of trend. But obviously, RFP results, we put some great results on the board in the last quarter, including Florida, where we're very pleased to maintain our statewide presence and expect enrollment changes to the new contract to be very stable as well as Michigan and Kansas.

是的。謝謝，蘭斯。讓我來提交 RFP。我可以給你一些關於重新加入的最新情況，也許是德魯在趨勢方面所談論的一些數字。但顯然，就RFP 結果而言，我們在上個季度在董事會上取得了一些出色的成果，其中包括佛羅裡達州，我們非常高興能夠維持全州範圍內的業務，並預計新合約的註冊變更將非常穩定，密西根州和堪薩斯州。

I think this performance really bodes well as we look ahead to what we think are really exciting organic growth opportunities for Medicaid. And we've talked about these cohorts before, but think about new states, new markets, new programs and then various expansion opportunities. And I think we've also demonstrated ability in the last 24 months to capture these opportunities. Oklahoma is a new state. Delaware was a new market for Centene. Arizona, a new long-term care opportunity for us, and then recent expansion opportunities in North Carolina, both Medicaid expansion and the tailored plan.

我認為這種表現確實是個好兆頭，因為我們期待著醫療補助的真正令人興奮的有機成長機會。我們之前已經討論過這些群體，但想想新的州、新的市場、新的計劃以及各種擴張機會。我認為我們在過去 24 個月中也展現了抓住這些機會的能力。俄克拉荷馬州是一個新州。特拉華州是 Centene 的一個新市場。亞利桑那州對我們來說是一個新的長期照護機會，然後是北卡羅來納州最近的擴張機會，包括醫療補助擴張和量身定制的計劃。

So I think we're really confident in our ability to leverage that local approach as a differentiator, the power of the experience that this organization has and our local teams have and the access that we have by virtue of our incumbency to really understand the direction that the states want to take the program's priorities of the state leaders. And again I think a unique ability to work with each community to design solutions that work for the health of those members. And I think we see that time and time again comes out in the RFP results.

因此，我認為我們對利用本地方法作為差異化優勢的能力、該組織和本地團隊所擁有的經驗的力量以及我們憑藉我們的職責所擁有的真正了解方向的能力充滿信心各州希望採取該計劃的國家領導人的優先事項。我再次認為與每個社區合作設計有利於這些成員健康的解決方案的獨特能力。我認為我們一次又一次地看到 RFP 結果中出現了這一點。

So feeling really good about the pipeline. We think the pipeline is active and continues to activate as we get through, obviously, the pandemic and now through redeterminations, there's even more bandwidth for the state Medicaid offices. So a lot of interesting opportunities there.

所以對管道的感覺非常好。我們認為，顯然，隨著我們度過大流行病，這條管道是活躍的，並且繼續激活，現在透過重新確定，州醫療補助辦公室有更多的頻寬。所以那裡有很多有趣的機會。

Relative to rejoiners, again, Drew touched on this dynamic and how that's sort of playing through all of the numbers. But the rejoiner rate continues to tick up. It's now, for most mature states, in the low 30%. And again, he shared that, that started with the vast majority of those members having no gap in coverage. We're now down to less than 50% of those having continuous coverage, which is creating that premium spread.

相對於重新加入的人，德魯再次談到了這種動態以及它是如何影響所有數字的。但重新加入率持續上升。現在，對於大多數成熟的州來說，這一比例處於 30% 的低水平。他再次表示，這始於絕大多數成員的覆蓋範圍沒有差距。現在，持續承保的人數已降至不到 50%，這造成了溢價差。

And then, Drew, do you want to talk about demographics for PDP?

然後，德魯，你想談談 PDP 的人口統計嗎？

Yes. PDP, we're number one position in 2024. That's a strategic business for us. I think we've said this before, but we've got about $50 billion of pharmacy spend across the company that we control. And about half of that is driven by the PDP business, and we'll see how that shifts in 2025 and beyond.

是的。 PDP，到 2024 年我們將排名第一。我想我們之前已經說過這​​一點，但我們控制的整個公司的藥品支出約為 500 億美元。其中大約一半是由 PDP 業務驅動的，我們將看到 2025 年及以後這種情況將如何變化。

But that means we've got a leading position in auto-assigns. So we've got three products, a low premium product and then a higher premium product. And we've been thoughtful about, as I mentioned in the Q1 call, all of the changes that are coming for the IRA, the second year of the inflation Reduction Act for next year. And to the extent if you want, we can slice and dice data a number of ways. We can get with you afterwards for any of that demographic or the buckets of the actual membership data.

但這意味著我們在自動分配方面處於領先地位。所以我們有三種產品，一種是低溢價產品，然後是高溢價產品。正如我在第一季電話會議中提到的，我們一直在深思熟慮 IRA 即將到來的所有變化，即明年《通膨削減法案》的第二年。如果您願意，我們可以透過多種方式對資料進行切片和切塊。之後我們可以與您聯繫，以了解任何此類人口統計或實際會員資料。

Andrew Mok from Barclays

巴克萊銀行的安德魯·莫克

Hi, good morning. Just wanted to make sure I follow the Medicaid margin progression from here. It sounds like you're saying this is peak Medicaid pressure this quarter with the 92.8% MLR. And when I pair that with an SG&A of, say, 7% or so, that suggests Medicaid is running close to 0% margin right now. Then you're getting 4% rate on half of your book in the second half. So that should put you closer to 2% margin at year-end, with the balance recovered in 2025. Is that the right way to think about the margin path on the Medicaid business?

早安.只是想確保我從這裡遵循醫療補助利潤的進展。聽起來您好像在說這是本季醫療補助壓力的峰值，MLR 為 92.8%。當我將其與 SG&A（例如 7% 左右）配對時，這表明醫療補助目前的利潤率接近 0%。那麼，您的後半部分圖書將獲得 4% 的折扣。因此，年底時的利潤率應該接近 2%，並在 2025 年恢復平衡。

I think, certainly, we expect the peak at 92.8% to be Q2. And then you'd have to allocate our SG&A out, which is probably lower than that on Medicaid. It's lower, we've got you have to remember our commercial business is pretty heavy with distribution and broker costs. I mean that's embedded in the cost of goods sold of the products that we price. So you have to think about the distribution of our business. Medicare is well above Medicaid as well because there's distribution costs there as well.

我認為，當然，我們預計第二季將達到 92.8% 的峰值。然後你必須分配我們的SG&A，這可能低於醫療補助。它更低，我們必須記住，我們的商業業務的分銷和經紀人成本相當高。我的意思是，這已包含在我們定價的產品的銷售成本中。所以你要考慮我們業務的分佈。醫療保險也遠高於醫療補助，因為那裡也有分配成本。

So think about that when you look at our aggregate SG&A in the high 7s. So yes, we expect to do better in the back half of the year as we continue to execute in Medicaid and get that 4%-plus rate impact on about half of our revenue and then carry that into 2025 with more work to do.

因此，當您查看我們高達 7 的 SG&A 總額時，請考慮這一點。所以，是的，我們預計下半年會做得更好，因為我們繼續執行醫療補助計劃，並對我們約一半的收入產生4% 以上的影響，然後將其延續到2025 年，還有更多工作要做。

Michael Ha from Baird

邁克爾·哈（Baird）

Thank you. Just a quick one, and then a real question. So one of your peers called out negative retro rate adjustment from California. Just curious how much does that impact your second quarter Medicaid MLR? And then the real question on MAA star ratings, it sounds like you have more complete program data and a stronger sense on how you're progressing. So with all the information you have an admin, ops and QT, those items sound strong. But how much of a swing factor do you expect to have some tough points from now to October? And how much actual visibility right now do you actually have on the cash results and any early thoughts on potential cut point updates? No surprises expected there. Thank you.

謝謝。只是一個簡短的問題，然後是一個真正的問題。因此，您的一位同行呼籲加州進行負面的復古利率調整。只是好奇這對您第二季的醫療補助 MLR 有多大影響？然後是關於 MAA 星級評級的真正問題，聽起來您擁有更完整的計劃數據，並且對自己的進展有更強烈的認識。因此，有了管理員、操作員和 QT 的所有信息，這些項目聽起來很強大。但從現在到 10 月，您預計會遇到一些困難點，搖擺因素有多大？您現在對現金結果和對潛在截止點更新的任何早期想法實際上有多少實際了解？預計不會有任何意外。謝謝。

Yes, thanks for the question. So on Stars, as you heard, bottom line is we're very pleased with the progress and the momentum we're seeing internally. We are tracking year-over-year improvements in each of the key chapters. Relative to the results in October, we don't yet have those final cap scores and obviously don't have cut points yet. So there's a range in our projection. But we feel good about that entire range and are tracking very nicely with internal expectations. And as I said, expect a meaningful step up in the results in October.

是的，謝謝你的提問。因此，在 Stars 上，正如您所聽到的，底線是我們對內部看到的進展和勢頭感到非常滿意。我們正在追蹤每個關鍵章節的逐年改進。相對於 10 月的結果，我們還沒有最終的上限分數，顯然還沒有削減分數。所以我們的預測有一個範圍。但我們對整個範圍感覺良好，並且非常符合內部期望。正如我所說，預計 10 月的結果將取得有意義的進步。

And all of this is really the result of the continued work by the team, our enterprise-wide governance process, awareness and activation across the organization, more different line alignment, the quality is a top priority, and all of the investments that you've heard us talk about along the way and things like member outreach call centers. We've organized differently around provider partnerships. We've done a lot of work under the hood relative to digital data and efforts to make our member onboarding experience best-in-class.

所有這一切實際上都是團隊持續工作的結果，我們的企業範圍的治理流程，整個組織的意識和激活，更多不同的生產線對齊，質量是重中之重，以及您的所有投資我們聽過我們談論一路走來以及諸如會員外展呼叫中心之類的事情。我們圍繞著供應商合作夥伴關係進行了不同的組織。我們在數位數據方面做了很多工作，並努力使我們的會員入職體驗達到一流。

And so that also then accrues to visibility in terms of momentum in 2024. So think about the fact we're halfway through 2024 dates of service that will drive the 2025 results and feel good about what we're seeing there. It's important to note as well that this work is accruing not just to Stars improvement but the quality score improvement in our other lines of business and in Medicaid in particular quality scores are really important factors. We think about RFP success and how we are viewed by the state in terms of being able to deliver value to them and to members. So all in, feel really good about the fact that we will be able to deliver sustainable programmatic improvement not just in Stars but in quality overall as we go forward.

因此，這也會在 2024 年的勢頭方面產生可見性。還需要注意的是，這項工作不僅有助於星級的提高，而且還提高了我們其他業務部門的品質分數，特別是醫療補助，品質分數是非常重要的因素。我們考慮 RFP 的成功以及國家如何看待我們能夠為他們和會員提供價值。總而言之，隨著我們的前進，我們將能夠不僅在星級方面而且在整體品質方面實現可持續的計劃改進，這一事實讓我們感到非常高興。

And then on your question, first let me make sure I was crystal clear on SG&A in the last question, our current guidance is 8.4% to 9% so call that the high 8s. And then once again Medicare and marketplace or commercial as a whole are sort of into the double digits in terms of think about that as in terms of the real activity of SG&A as you think about Medicaid. And then yes, we operate in the same state as what was referred to yesterday. At our size there is pluses and minuses in every quarter so we didn't feel the need to call that out.

關於你的問題，首先讓我確保我在上一個問題中對SG&A 非常清楚，我們目前的指導是8.4% 到9%，所以稱之為高8。然後，醫療保險和市場或商業作為一個整體再次進入兩位數，就像考慮醫療補助一樣，考慮到 SG&A 的實際活動。是的，我們的營運狀態與昨天提到的相同。按照我們的規模，每個季度都有優點和缺點，所以我們覺得沒有必要指出這一點。

Ryan Langston from Cowen

來自考恩的瑞安·蘭斯頓

Hi, good morning everybody. Appreciate the headwinds and tailwinds for 2025. I don't think I heard anything on Medicare advantage unless I missed it. I would assume the priority would be to have some margin improvement year-on-year but can you maybe just refresh us on your view on that versus say growth of enrollment into 2025 even if it's just broadly or directionally. Thanks.

嗨，大家早安。欣賞 2025 年的逆風和順風。我認為首要任務是利潤率同比有所提高，但您能否向我們介紹一下您對此的看法，以及 2025 年入學人數增長的情況，即使只是廣泛或定向增長。謝謝。

Thanks. Yes. We've said before we expect to shrink in 2025 as we think about what business is going to serve this company. Well on the long run, we think about the convergence of Medicaid and Medicare with the duals, Heidi and find the opportunities. So said, a couple of times publicly $14 billion, $15 billion, $16 billion, somewhere in that zone of revenue for 2025. Then I did mention in the tailwinds, the fact that the PDR that we're booking this year is actually a half of the PDR we booked last year. And then we don't expect to have a PDR booked into the 2025 P and L for 26.

謝謝。是的。我們之前說過，我們預計 2025 年會縮減規模，因為我們會考慮哪些業務將為該公司提供服務。從長遠來看，我們會考慮醫療補助和醫療保險與海蒂的雙重融合，並尋找機會。也就是說，有幾次公開表示 140 億美元、150 億美元、160 億美元，處於 2025 年收入區域。 然後我確實在順風中提到，事實上我們今年預訂的 PDR 實際上是一半我們去年預訂的PDR。然後我們預計 2025 年 P 和 L 中不會有 26 個 PDR。

So I would first week got to chip away at the degree of run-rate negative margin and push towards break-even. And then we can talk about what the margin opportunity is in Medicare or So mathematically, it is a tailwind expected to be a tailwind and excited about the stars progress as they're referred to. And we're going to lead us over a multiyear view.

因此，我將在第一週減少運行率的負利潤程度，並努力實現收支平衡。然後我們可以討論醫療保險或醫療保險的利潤機會是什麼，所以從數學上講，這是一種順風，預計會是順風，並對所提到的明星進步感到興奮。我們將引導我們進行多年的展望。

Yes, we've said before we expect to shrink in 2025 as we think about what business is going to serve this company well in the long run. We think about the convergence of Medicaid and Medicare with the duals and Heidi and Fidei opportunities, so said a couple of times publicly, $14 billion, $15 billion, $16 billion, somewhere in that zone of revenue for 2025. And then I did mention in the tailwinds the fact that the PDR that we're booking this year is actually half of the PDR we booked last year and then we don't expect to have a PDR booked into the 2025 PNL for 26.

是的，我們之前說過，我們預計 2025 年會收縮，因為我們考慮從長遠來看哪些業務將為該公司提供良好服務。我們考慮了醫療補助和醫療保險與雙重以及海蒂和菲迪機會的融合，正如多次公開說過的那樣，2025 年收入在該區域的某個地方，140 億美元、150 億美元、160 億美元。

So, first we've got to chip away at the degree of run rate negative margin and push towards break even and then we can talk about what the margin opportunity is in Medicare. So mathematically it is a tailwind or expected to be a tailwind and excited about the Stars progress that Sarah referred to and where that's going to go to lead us over a multiyear view.

因此，首先我們必須消除運行率的負利潤程度並努力實現收支平衡，然後我們可以討論醫療保險的利潤機會。因此，從數學上來說，這是一個順風，或者預計會是一個順風，並且對莎拉提到的星星進展以及這將引導我們進行多年的展望感到興奮。

George Hill from Deutsche Bank

德意志銀行的喬治·希爾

Yes. Good morning, guys. Two quick ones for me if you don't mind. I guess Drew on the exchange business you mentioned the well into 7.5% long-term margin. I guess is that the sustainable run rate or is it prudent to kind of price for the midpoint in 2025? And then my follow-up would be is there's a lot of changes in Part D for 2025. Are you guys making any significant changes to the Part D product and really what I’m most focused on is how you guys are thinking about pharmacy networks?

是的。早上好傢伙。如果你不介意的話，給我兩個快點。我猜德魯在交易所業務中提到了 7.5% 的長期保證金。我想這是可持續運行率還是對 2025 年中點的價格是否謹慎？然後我的後續行動是 2025 年 D 部分有很多變化。

On the marketplace side maybe I'll jump in. I think what we've said is we're well into the 5 to 7.5 range. And as we think about positioning for 2025 we do expect to grow. We expect the overall market to grow but we have positioned for margin in 2025 and a view that the marketplace product can continue to deliver strong profitable growth.

在市場方面，也許我會介入。當我們考慮 2025 年的定位時，我們確實預期會成長。我們預計整體市場將會成長，但我們已對 2025 年的利潤率進行了定位，並認為市場產品可以繼續帶來強勁的利潤成長。

Yes. Then on PDP, you can go pull the Q1 transcript went really deep there but let me hit the highlights. Obviously we as payers are thinking about the underwriting of the catastrophic phase going from 20% to 60%. These are all IRA changes. The member out of pocket going down and therefore it's hit earlier. Thinking about manufacturer behavior, thinking about the MPPP, effectively the member smooth and cost share program and we're always thinking about how to optimize network and balance access and cost of goods sold. So that continues as we prepare for 2025.

是的。然後在 PDP 上，您可以將第一季的成績單拉到那裡，非常深入，但讓我重點介紹一下。顯然，作為付款人，我們正在考慮將災難性階段的承保比例從 20% 提高到 60%。這些都是 IRA 的變化。自掏腰包的成員會下降，因此會更早受到打擊。考慮製造商的行為，考慮 MPPP，有效地實現成員平滑和成本分攤計劃，我們一直在思考如何優化網路並平衡存取和銷售商品的成本。在我們為 2025 年做準備時，這種情況仍在繼續。

And ladies and gentlemen at this time we'll conclude our question-and-answer session. I'd like to turn the floor back over to Sarah London for closing

女士們、先生們，我們的問答環節現在就結束了。我想把發言權交還給莎拉倫敦 (Sarah London) 結束

Thank you. Thanks everyone for the interest this morning and the great questions. As we wrap up the call, I really just want to emphasize our excitement around the opportunities that lay ahead for this business. We are as an organization making significant progress, strengthening and modernizing the enterprise. We feel really good about the performance of the core business. As a leadership team we're also really energized by the markets we serve and the room we have to grow profitably as we go forward. So appreciate again the time this morning and your interest in Centene and look forward to future updates.

謝謝。感謝大家今天早上的興趣和提出的好問題。在我們結束電話會議時，我真的只想強調我們對這項業務面臨的機會感到興奮。我們作為一個組織取得了重大進展，加強了企業並實現了現代化。我們對核心業務的表現感覺非常好。作為一個領導團隊，我們所服務的市場以及我們在前進過程中必須實現獲利成長的空間也讓我們充滿活力。再次感謝今天早上的時間以及您對 Centene 的興趣，並期待未來的更新。

Ladies and gentlemen, with that will conclude today's conference call and presentation. We do thank you for joining. You may now disconnect your lines.

女士們先生們，今天的電話會議和演講到此結束。我們非常感謝您的加入。現在您可以斷開線路。