Centene Corp (CNC) 2024 Q3 法說會逐字稿

Good day, and welcome to the Centene Corporation third-quarter results conference call. (Operator Instructions) Please note, this event is being recorded.

美好的一天，歡迎參加 Centene 公司第三季業績電話會議。 （操作員說明）請注意，正在記錄此事件。

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

現在我想將會議交給投資者關係主管 Jennifer Gilligan。請繼續，女士。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our third 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 年第三季財報電話會議。莎拉·倫敦，首席執行官； Centene 執行副總裁兼財務長 Drew Asher 將主持今天早上的電話會議，也可以透過我們的網站 centene.com 訪問該電話會議。 Centene 總裁 Ken Fasola 也將參加問答環節。

Any remarks that Centene may make about future expectations, plans and prospects constitute forward-looking statements for the purpose of the Safe Harbor provision under the Private Securities Litigation Reform Act of 1995.

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 third quarter 2024 press release, which is available on the company's website under the Investors section.

由於各種重要因素，包括我們在2024 年第三季新聞稿中討論的因素，實際結果可能與這些前瞻性陳述所示的結果有重大差異，該新聞稿可在公司網站的「投資者」部分下找到。

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

Centene 預計後續事件和事態發展可能會導致其估計發生變化。雖然公司可能選擇在未來某個時候更新這些前瞻性陳述，但我們明確表示不承擔任何這樣做的義務。

We will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our third quarter 2024 press release. Please mark your calendars for our upcoming Investor Day being held on December 12 in New York City.

我們也將參考某些非公認會計原則措施。這些指標與最直接可比較的 GAAP 指標的調整可以在我們的 2024 年第三季新聞稿中找到。請在您的日曆上標記我們即將於 12 月 12 日在紐約舉行的投資者日。

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？

Thank you, Jen, and thanks, everyone, for joining us as we review our third quarter 2024 financial results.

謝謝 Jen，也謝謝大家加入我們，共同回顧 2024 年第三季的財務表現。

Given the recent market volatility impacting managed care, let's start with the bottom line upfront. The overall outlook for our business remains consistent with our updates in the quarter. We remain confident in our full year 2024 adjusted diluted EPS guidance of greater than $6.80, and our view of headwinds and tailwinds as we look to 2025 are largely unchanged from what we have previously shared.

鑑於最近的市場波動影響了管理式醫療，讓我們先從底線開始。我們業務的整體前景與本季的最新情況保持一致。我們對 2024 年全年調整後稀釋後每股收益超過 6.80 美元的指導仍然充滿信心，並且我們對 2025 年逆風和順風的看法與我們之前分享的基本沒有變化。

We still believe that we will grow adjusted EPS next year, and we still believe that we have a unique and powerful platform from which to drive long-term EPS growth of 12% to 15% in a normalized environment.

我們仍然相信明年調整後每股收益將會成長，我們仍然相信我們擁有一個獨特而強大的平台，可以在正常化環境下推動長期每股收益成長 12% 至 15%。

Specific to the quarter, we are reporting third quarter adjusted diluted EPS of $1.62, a stronger result than our most recent expectation for the period, with the upside driven in part by anticipated tax items shifting forward into the third quarter.

具體到本季度，我們報告的第三季度調整後攤薄每股收益為 1.62 美元，強於我們對該時期的最新預期，部分上行是由預期稅項轉移到第三季度推動的。

Within our core business lines, Medicare and Marketplace performance was consistent with expectations in the quarter, and Medicaid performance ended up a little better than our mid-quarter commentary, aided by movement in rates we saw as a result of refreshed data and effective advocacy.

在我們的核心業務範圍內，醫療保險和市場的表現與本季度的預期一致，而醫療補助的表現最終比我們的季度中期評論要好一些，這得益於我們看到的因更新數據和有效宣傳而產生的費率變動。

In general, we are encouraged by progress we saw throughout the quarter relative to our ongoing dialogue with state partners to align Medicaid rates with the acuity of our post redeterminations book of business. We have spent the better part of 2024, offering a significant level of transparency into our business during a year of unprecedented change. We are pleased that this transparency positions us today with a stable outlook for 2024.

總的來說，我們對整個季度所取得的進展感到鼓舞，我們與州合作夥伴正在進行對話，以使醫療補助費率與我們重新確定後業務簿的敏銳度保持一致。 2024 年的大部分時間裡，我們都在經歷前所未有的變革，為我們的業務提供了極高的透明度。我們很高興這種透明度使我們對 2024 年的前景保持穩定。

With that, let's get into the details, starting with Medicaid. As you know, our largest business has undergone significant transformation over the last 18 months as a result of the nationwide return of eligibility determinations. Since the start of this process, millions of Americans have been transitioned out of managed Medicaid across the country, materially shifting the Medicaid risk pool in a way that requires action by our state partners to rightsize program rates to reflect the post redeterminations member base.

接下來，讓我們從醫療補助開始詳細了解。如您所知，由於全國範圍內重新進行資格認定，我們最大的業務在過去 18 個月中經歷了重大轉變。自從這一進程開始以來，全國範圍內數百萬美國人已經脫離了受管理的醫療補助，這極大地改變了醫療補助風險池，這需要我們的州合作夥伴採取行動，調整計劃費率，以反映重新確定後的會員基礎。

During the third quarter, our state partners continued to work through the tail of their respective redetermination processes. And as we sit here today, the vast majority of the 30 states in which we operate are now through their respective backlogs. We closed the period with roughly 13 million members and are seeing evidence of membership leveling as we move into the fourth quarter.

在第三季度，我們的國家合作夥伴繼續完成各自重新確定過程的尾部工作。當我們今天坐在這裡時，我們開展業務的 30 個州中的絕大多數現在都已處理完各自的積壓訂單。在此期間，我們擁有大約 1300 萬會員，隨著進入第四季度，我們看到了會員資格等級的證據。

Since this process began, you have heard a consistent message from us in terms of our boots-on-the-ground support for our members and, equally, our proactive data-driven dialogue with our state partners to ensure rate discussions throughout this period are fully informed and benefit from the most current data. As we sit here today, all of our states have acknowledged the need to match rates with acuity, and all of our states have now taken action with respect to acuity adjustments in some form.

自從這一流程開始以來，您已經聽到了我們向會員提供實地支持的一致信息，同樣，我們與州合作夥伴進行積極的數據驅動對話，以確保整個期間的費率討論得到落實。並從中受益。當我們今天坐在這裡時，我們所有的州都承認有必要將費率與敏銳度相匹配，並且我們所有的州現在都已採取某種形式的敏銳度調整行動。

While there is still work to do with respect to the sufficiency of rate adjustments, our conversations continue to be productive, and we are encouraged by the engagement and the incremental movement we saw as the quarter unfolded. We now expect our back half composite adjustment rate to be in the 4.5% to 5% range. As state-by-state experience matures, we are still seeing just over 30% of members who were initially dropped from Medicaid eligibility ultimately returned to us.

儘管在利率調整的充分性方面仍有工作要做，但我們的對話仍然富有成效，並且我們對本季度所看到的參與度和增量變化感到鼓舞。我們現在預計後半段綜合調整率將在 4.5% 至 5% 的範圍內。隨著各州經驗的成熟，我們仍然看到超過 30% 的最初被取消醫療補助資格的會員最終回到了我們的身邊。

Less than half these rejoiners are reinstated with retroactive coverage. The majority experienced a coverage gap, which means we experience a corresponding premium gap. As we have discussed previously, this creates temporary pressure on the Medicaid MLR.

這些重新加入者中只有不到一半透過追溯保險恢復。大多數人都經歷了承保缺口，這意味著我們也經歷了相應的保費缺口。正如我們之前討論的，這對醫療補助 MLR 造成了暫時的壓力。

However, a close look at the rejoiner trend suggests that is starting to slow. This incremental lessening of pressure as we move through Q4 and evidence of a return to a more normal churn rate across the Medicaid book offers a natural tailwind as we move into 2025.

然而，仔細觀察重新加入的趨勢表明，這一趨勢正在開始放緩。隨著我們進入第四季度，壓力逐漸減輕，並且有證據表明整個醫療補助計劃的流失率恢復到更正常的水平，這為我們進入 2025 年提供了自然的順風車。

We continue to track the data closely and provide regular and detailed updates to our state counterparts. We believe the solid foundation of data-driven advocacy we have built over the last six quarters has served us well and will continue to do so as we advocate for appropriate 2025 rates and mid-cycle acuity adjustments.

我們將繼續密切追蹤數據，並定期向州同行提供詳細的更新資訊。我們相信，我們在過去六個季度建立的數據驅動倡議的堅實基礎為我們提供了良好的服務，並且在我們倡導適當的 2025 年利率和週期中期敏銳度調整時，我們將繼續這樣做。

Overall, the movement we have seen in rates over the course of 2024 reinforces our view that what we are experiencing is a temporary dynamic and that state Medicaid programs will ultimately return to actuarially sound rates that match acuity.

總體而言，我們在 2024 年期間看到的費率變動強化了我們的觀點，即我們正在經歷的只是暫時的動態，各州醫療補助計劃最終將恢復到與敏銳程度相匹配的精算合理費率。

While redeterminations have captured much of the attention over the last few quarters, it should not go unnoticed that Centene has been equally busy delivering strong RFP results and positioning our Medicaid business for long-term growth. In August, the team at Pennsylvania Health and Wellness reprocured our long-term support services business in that state, reinforcing the strength of this organization in serving low-income members with complex support needs.

雖然重新決定在過去幾個季度引起了廣泛關注，但不應忽視 Centene 同樣忙於提供強勁的 RFP 結果並定位我們的醫療補助業務以實現長期成長。八月，賓州健康與保健團隊重新採購了我們在該州的長期支援服務業務，增強了該組織為具有複雜支援需求的低收入成員提供服務的實力。

In September, we successfully reprocured our statewide presence in Iowa in a highly competitive process. And then earlier this month, Centene's Meridian Health Plan in Michigan won yet another 2024 RFP, this time providing integrated Medicare and Medicaid services for dual-eligible members as Michigan transitions their statewide program to a HIDE SNP. In short, we are making progress against rate and acuity alignment and our best-in-class business development team continues to effectively articulate our value proposition.

9 月，我們在激烈的競爭中成功地重新獲得了愛荷華州的全州業務。本月早些時候，Centene 位於密西根州的Meridian Health Plan 再次贏得了2024 年RFP，這次為具有雙重資格的會員提供綜合醫療保險和醫療補助服務，因為密西根州將其全州計劃過渡到HIDE SNP 。簡而言之，我們在速度和敏銳度方面取得了進展，我們一流的業務開發團隊繼續有效地闡明我們的價值主張。

Throughout it all, our teams have worked tirelessly to advance our Medicaid quality results, deliver operational and compliance improvements, and innovate through local partnerships as we serve the most underserved communities across the country. And so while the redetermination process has been challenging, it is nonetheless mobilized us toward an operating discipline that is creating a stronger, healthier platform from which to grow.

在整個過程中，我們的團隊孜孜不倦地努力提高我們的醫療補助品質結果，實現營運和合規性改進，並透過當地合作夥伴關係進行創新，為全國服務最匱乏的社區提供服務。因此，儘管重新決定的過程充滿挑戰，但它仍然動員我們走向一種營運紀律，從而創造一個更強大、更健康的成長平台。

Turning to the rest of the business. Our Medicare segment continued to perform in line with expectations during the quarter. As we look ahead, Medicare Advantage remains a strategically important pillar of our platform and represents significant opportunity for margin expansion as we continue to improve Stars, reduce SG&A, and advance our clinical programs.

轉向其餘業務。我們的醫療保險部門在本季的表現持續符合預期。展望未來，Medicare Advantage 仍然是我們平台的重要策略支柱，隨著我們不斷提高星級、減少 SG&A 並推動我們的臨床項目，它代表了利潤擴張的重大機會。

To this end, our 2025 Star ratings released earlier this month with financial implication for 2026 represent a meaningful step forward on the journey to margin recovery.

為此，我們在本月稍早發布了 2025 年星級評級以及 2026 年的財務影響，這代表著我們在利潤恢復之路上邁出了有意義的一步。

These results demonstrate our ability to effectively identify areas of potential improvement and methodically execute on delivering those enhancements. During the cycle, we elevated our performance with 46% of members in plans at or above 3.5 stars versus 23% from the prior year despite higher-than-industry anticipated cut point changes. Our Star results represent strong overall improvement in our core operations and continued focus on quality for our members.

這些結果表明我們有能力有效地識別潛在改進的領域，並有條不紊地執行這些改進。在此週期內，儘管切點變化高於行業預期，但我們的績效有所提高，有 46% 的會員參與了 3.5 星或以上的計劃，而去年這一比例為 23%。我們的星級結果代表了我們核心業務的整體強勁改善以及對會員品質的持續關注。

Consistent with what we previewed on the Q2 call, we used 2025 bids as an opportunity to further focus our franchise on lower income seniors and tighten the alignment between our Medicare Advantage business and our Medicaid footprint. We exited six states while strengthening our offerings in key counties and regions within our existing footprint.

與我們在第二季度電話會議中預覽的一致，我們以2025 年投標為契機，進一步將我們的特許經營權集中在低收入老年人身上，並加強我們的Medicare Advantage 業務和Medicaid 業務之間的一致性。我們退出了六個州，同時在現有業務範圍內加強了在重點縣和地區的服務。

As a planned byproduct of this work, we were able to streamline our contract portfolio creating more balanced membership across our contracts and enabling greater focus and impact in our program investments going forward.

作為這項工作的計劃副產品，我們能夠簡化我們的合約組合，在我們的合約中創建更平衡的成員資格，並在我們未來的專案投資中實現更大的關注和影響。

These adjustments position us for a preliminary view of 2025 Medicare Advantage revenue in the range of $14 billion to $16 billion. As we have shared previously, this implies down membership year over year but represents progress on our path to breakeven in this business.

這些調整使我們初步預計 2025 年 Medicare Advantage 收入將在 140 億至 160 億美元之間。正如我們之前所分享的，這意味著會員數量逐年下降，但代表著我們在該業務實現盈虧平衡的道路上取得了進展。

Within our Medicare portfolio, our Part D business will generate a more sizable revenue contribution in 2025, owing in part to significant changes adopted as a result of the Inflation Reduction Act. Though it is early, we are pleased with our preliminary view of product positioning, and we expect Part D revenue to grow significantly next year with potential for membership growth as well.

在我們的醫療保險組合中，我們的 D 部分業務將在 2025 年產生更可觀的收入貢獻，部分原因是《通貨膨脹減少法案》帶來的重大變化。儘管現在還為時過早，但我們對產品定位的初步看法感到滿意，我們預計明年 D 部分的收入將大幅增長，會員也有增長的潛力。

In light of recent policy changes that make Centene's industry-leading Medicaid footprint a competitive advantage as we look to serve more dual-eligible Medicare members, we remain focused on the compelling opportunity our Medicare platform provides for both margin expansion and growth long term as we turn around and stabilize this business.

鑑於最近的政策變化使Centene 行業領先的醫療補助足跡成為競爭優勢，因為我們希望為更多符合雙重資格的醫療保險會員提供服務，我們仍然專注於我們的醫療保險平台為利潤擴張和長期增長提供的令人信服的機會，因為我們扭虧為盈並穩定這項業務。

Finally, our marketplace business continues to perform well in 2024. Our results in the quarter were in line with our most recent expectations as we capitalize on more than a decade of experience to effectively serve now 4.5 million members.

最後，我們的市場業務在 2024 年繼續表現良好。

Looking to 2025, we believe our marketplace products are well positioned relative to our strategy. Open enrollment will not begin for another week, but our early expectation is that we will be able to achieve pretax margins well within our targeted range of 5% to 7.5%.

展望 2025 年，我們相信我們的市場產品相對於我們的策略定位良好。公開招生還要一週後才能開始，但我們的早期預期是，我們將能夠實現稅前利潤率遠在 5% 至 7.5% 的目標範圍內。

Centene demonstrated our thought leadership in Marketplace earlier this year by implementing an agent of record lock policy, which was subsequently implemented market-wide by CMS in July. In addition, CMS has introduced program integrity processes in line with both Centene advocacy and pre-pandemic era policy that will further improve controls on exchange enrollment during this open enrollment cycle.

今年早些時候，Centene 透過實施記錄代理鎖定政策展示了我們在 Marketplace 中的思想領導力，隨後 CMS 於 7 月在整個市場實施了該政策。此外，CMS 還引入了符合 Centene 倡導和大流行前時代政策的計劃完整性流程，這將進一步改善開放註冊週期內對交易所註冊的控制。

These types of policies improve the member experience as well as the quality of our book, but we do expect they will create a moderating effect on overall market growth in 2025. As a result, our membership growth expectation for this year's marketplace open enrollment remains modest.

此類政策改善了會員體驗以及我們圖書的質量，但我們確實預計它們將對 2025 年的整體市場成長產生調節作用。

Continued migration of commercial small group enrollment into the exchanges, expanding access and affordability initiatives as well as the program integrity enhancements net out to a view of mid-single-digit macro market growth in 2025.

商業小團體註冊持續遷移到交易所、擴大准入和可負擔性舉措以及項目完整性的增強，預計 2025 年宏觀市場將實現中個位數增長。

Ultimately, we are pleased with the performance of our Marketplace business and believe this market that now serves a strong bipartisan base of more than 20 million Americans can be a powerful platform to expand affordable healthcare coverage and access for individuals across the country.

最終，我們對Marketplace 業務的表現感到滿意，並相信這個目前服務於超過2000 萬美國人的強大兩黨基礎的市場可以成為一個強大的平台，擴大全國各地個人負擔得起的醫療保健覆蓋範圍和獲取機會。

As we close out year three of our value creation plan, we're pleased with the progress we have made but even more pleased with the second order opportunities we see ahead as we continue to drive operational improvements and mine efficiencies in our business model. This quarter, we advanced work on a project some of you have heard me speak about, namely the use of AI to automate and optimize our management of provider contracts.

當我們結束價值創造計畫的第三年時，我們對所取得的進展感到滿意，但更對我們在繼續推動業務模式中的營運改善和採礦效率時看到的二階機會感到更加滿意。本季度，我們推進了一個專案的工作，你們中的一些人聽過我談論過，即使用人工智慧來自動化和優化我們對供應商合約的管理。

By deploying AI within our provider operations, we can reduce the amount of manual labor associated with the installation of new contracts as well as the significant maintenance required for the tens of thousands of existing provider agreements within our portfolio. Additionally, AI will allow us to produce considerably stronger analytics on provider performance, an important lever for advancing initiatives such as value-based care across our business.

透過在我們的供應商營運中部署人工智慧，我們可以減少與安裝新合約相關的體力勞動量，以及我們產品組合中數以萬計的現有提供者協議所需的大量維護。此外，人工智慧將使我們能夠對提供者的績效進行更強大的分析，這是在我們的業務中推進基於價值的護理等舉措的重要槓桿。

Centene's diversified portfolio continues to allow us to navigate unprecedented landscape challenges and build for the future. Our quality team kept the gains from last year's Medicare Advantage Star scores and built on them, strengthening our Medicare platform.

Centene 的多元化投資組合繼續使我們能夠應對前所未有的景觀挑戰並建立未來。我們的品質團隊維持了去年 Medicare Advantage Star 評分的成果，並以此為基礎，加強了我們的 Medicare 平台。

Our health plan and business development teams defended existing contracts and won new ones, expanding the reach of our leading Medicaid franchise. Marketplace continues to deliver value for our members and earnings power for our enterprise, generating important returns and creating a compelling platform to support growth in the individual market. And we continue to find opportunities to get better at the basics and innovate in how we show up to support our members, providers, and regulators.

我們的健康計劃和業務開發團隊捍衛了現有合約並贏得了新合同，擴大了我們領先的醫療補助特許經營範圍。 Marketplace 繼續為我們的會員創造價值，為我們的企業創造獲利能力，產生重要的回報，並創建一個引人注目的平台來支持個別市場的成長。我們繼續尋找機會，在基礎知識方面做得更好，並在支持我們的會員、提供者和監管機構的方式上進行創新。

With the election now 10 days away, I'll highlight again that our product and government relations teams have been preparing for months for the many post-election scenarios that may emerge. No matter the results on November 5, Centene is well positioned as an industry thought leader for maintaining coverage and affordability for Americans across each of our product lines.

距離選舉還有 10 天，我要再次強調，我們的產品和政府關係團隊已經為可能出現的許多選舉後情況做好了數月的準備。無論 11 月 5 日的結果如何，Centene 都處於行業思想領袖的有利地位，可以確保我們每個產品線的覆蓋範圍和美國人的負擔能力。

The momentum across this enterprise is palpable, and it is a direct result of the efforts of our more than 60,000 CenTeamers, committing their time and energy and talent to improving the health of the communities we serve. To this end, I want to recognize those who showed up to support our members and fellow employees who were impacted by Hurricanes Helene and Milton.

這項企業的發展勢頭是顯而易見的，這是我們 60,000 多名 CenTeamers 努力的直接結果，他們投入時間、精力和才能來改善我們所服務社區的健康。為此，我要向那些前來支持受颶風海倫和米爾頓影響的會員和同事的人們表示認可。

The CenTeamers took immediate and urgent action, including Centene Foundation efforts to deploy much needed financial support to key nonprofit partners in impacted states, headquarters teams coordinating the shipments of over-the-counter medicine and other hard-to-find supplies to our communities in North Carolina and Florida and colleagues opening their homes to fellow employees impacted by the storm. You went above and beyond for our members and each other and showed what it means to be part of the CenTeam. Thank you.

CenTeamers 立即採取了緊急行動，包括 Centene 基金會努力向受影響州的主要非營利合作夥伴提供急需的財政支持，總部團隊協調向我們的社區運送非處方藥和其他難以找到的物資北卡羅來納州和佛羅裡達州及其同事向受風暴影響的同事開放家園。你們為我們的成員和彼此做出了超越，並展示了成為 CenTeam 的一員意味著什麼。謝謝。

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 third quarter 2024 results including $36.9 billion in premium and service revenue and adjusted diluted earnings per share of $1.62. Q3 performance was ahead of our previous expectations and 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 年第三季業績，包括 369 億美元的保費和服務收入以及 1.62 美元的調整後稀釋每股收益。第三季的業績超出了我們先前的預期，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。

As you saw in our press release this morning, the adjusted diluted EPS for the third quarter includes $0.10 associated with a marketplace premium tax benefit that we previously expected in the fourth quarter of 2024, so merely a timing shift. The quarter also includes about $0.04 of accelerated income tax benefit. Even without those two favorable timing items, we were still a little ahead for the quarter. Our consolidated HBR was 89.2% for Q3, which brings us to 87.9% year-to-date.

正如您在今天早上的新聞稿中看到的那樣，第三季度調整後的稀釋每股收益包括0.10 美元，與我們之前預計在2024 年第四季度發生的市場溢價稅收優惠相關，因此這只是時間上的轉變。該季度還包括約 0.04 美元的加速所得稅優惠。即使沒有這兩個有利的時機項目，我們在本季度仍然領先一些。第三季的綜合 HBR 為 89.2%，今年迄今為 87.9%。

Consistent with our previous public commentary, our Medicaid membership was just over 13 million and our Q3 Medicaid HBR at 93.1% was a little above Q2. While there are still very small pockets of redetermination activity occurring, we largely expect stability in our Medicaid membership around that 12.9 million to 13 million mark as we close out 2024.

與我們先前的公開評論一致，我們的醫療補助會員人數略高於 1300 萬，第三季醫療補助 HBR 為 93.1%，略高於第二季。儘管仍有極少數重新確定活動發生，但我們很大程度上預計，到 2024 年結束時，我們的醫療補助會員人數將穩定在 1,290 萬至 1,300 萬大關左右。

With every month that goes by, we continue to make progress with our state partners and their actuaries in our efforts to match rates with acuity. As Sarah mentioned, now 100% of our states have acknowledged and acted. So it's just a matter of sufficiency of rates, state by state, program by program.

每個月過去，我們都在與我們的國家合作夥伴及其精算師一起不斷取得進展，努力將費率與敏銳度相匹配。正如莎拉所提到的，現在我們 100% 的州已經承認並採取行動。因此，這只是各州、各項目的費率充足性問題。

We remain confident that this is not a matter of if, but when we get back to equilibrium between rates and acuity. We are pleased and encouraged by the progress since our last call, but there's more wood to chop with our state partners, supported by the irrefutable data we provide.

我們仍然相信，這不是是否會發生的問題，而是我們何時恢復利率和敏銳度之間的平衡的問題。自從上次通話以來所取得的進展讓我們感到高興和鼓舞，但在我們提供的無可辯駁的數據的支持下，我們還有更多的工作要做。

The commercial HBR of 80% was right on track for Q3, and we showed a little bit more growth with 4.5 million Marketplace members at quarter end, 22% growth from a year ago. We continue to be pleased with the execution in our Marketplace business. And while the open enrollment period hasn't yet started, we believe we can grow during open enrollment and achieve our margin goals in 2025.

第三季度，80% 的商業 HBR 正處於正軌，並且我們顯示了更多的增長，截至季度末，市場會員數量為 450 萬，比一年前增長了 22%。我們仍然對市場業務的執行感到滿意。儘管開放註冊期尚未開始，但我們相信我們可以在開放註冊期間實現成長，並在 2025 年實現利潤率目標。

Medicare results in the quarter were consistent with our expectations, including a segment HBR of 88.0%. Good execution in 2024 in both our Medicare Advantage and PDP businesses enables us to enter 2025 right on track.

本季的醫療保險表現與我們的預期一致，其中 HBR 部分為 88.0%。 2024 年我們的 Medicare Advantage 和 PDP 業務的良好執行使我們能夠正確進入 2025 年。

As you saw with the landscape file, we continue to take Medicare Advantage actions designed for the long run, consistent with our strategy focused on low income and dual-eligibles. We exited six of our smaller states that didn't quite match our Medicaid footprint, and we administratively reduced our number of H contracts by about 30%.

正如您在景觀文件中看到的那樣，我們繼續採取專為長期而設計的 Medicare Advantage 行動，這與我們專注於低收入和雙重資格的策略是一致的。我們退出了六個與我們的醫療補助計劃不太相符的較小州，並且我們在行政上將 H 合約數量減少了約 30%。

While we have much of the annual and open enrollment periods yet to play out, as Sarah covered, we are still targeting $14 billion to $16 billion of Medicare Advantage revenue in 2025. And we are still targeting the same 2025 result that would be consistent with an approximate $125 million of premium deficiency related expense that would be recorded in Q4 of 2024. So overall, no major changes to our Medicare Advantage game plan. Similarly, our Stars game plan is on track at 46% and 3.5 stars for the 2026 payment year, as we covered in our October 11 8-K.

正如Sarah 所言，雖然我們還有很多年度和開放註冊期尚未結束，但我們仍將2025 年Medicare Advantage 收入的目標定為140 億至160 億美元。 而且我們仍以2025 年的目標為目標，該結果將與約 1.25 億美元的保費不足相關費用將記錄在 2024 年第四季。同樣，正如我們在 10 月 11 日的 8-K 中所述，我們的 Stars 遊戲計劃在 2026 年付款年將達到 46% 和 3.5 顆星。

As we've talked about for the last couple of quarters, we expect meaningful revenue growth in our PDP business in 2025, largely driven by the Inflation Reduction Act mechanics. Furthermore, our bids positioned us well, anchored by our outstanding pharmacy cost structure that, when coupled with the CMS demo, facilitates very low cost and attractive products for seniors.

正如我們在過去幾季所討論的那樣，我們預計 2025 年 PDP 業務的收入將出現有意義的成長，這主要是受到《通貨膨脹削減法案》機制的推動。此外，我們的投標使我們處於有利地位，以我們出色的藥房成本結構為基礎，與 CMS 演示相結合，可以為老年人提供成本非常低且有吸引力的產品。

For 2025, we are pleased to again be below the auto-assign benchmark in 33 out of 34 regions; and our zero premium product, inclusive of the federal demo subsidy is available to seniors in 43 out of 50 states.

到 2025 年，我們很高興在 34 個地區中的 33 個地區再次低於自動分配基準；我們的零保費產品（包括聯邦演示補助）可供 50 個州中 43 個州的老年人使用。

So we think our reported premium yield will more than double in 2025 compared to 2024 due to the IRA, and we should be able to grow membership as well subject to the annual enrollment period that just started. We are targeting a 2025 PDP margin of 1% or so that we will look to edge up over time, and that is on a much higher revenue base for 2025.

因此，我們認為，由於 IRA，我們報告的保費收益率在 2025 年將比 2024 年增加一倍以上，而且我們也應該能夠在剛開始的年度註冊期內增加會員數量。我們的目標是 2025 年 PDP 利潤率達到 1% 左右，隨著時間的推移，我們將逐步實現這一目標，而這是建立在 2025 年更高的收入基礎上的。

Our adjusted SG&A expense ratio was 8.3% in the quarter, a good result contributing to a slightly better view for 2024. Cash flow used in operations was $1 billion for Q3, driven by a few normal course balance sheet items: one, the settlement of marketplace risk adjustment payables for the 2023 benefit year with a corresponding collection of over $800 million of 2023 receivables expected in Q4; two, Medicaid rate increases not yet collected; and three, an increase in Part D receivables.

本季調整後的SG&A 費用率為8.3%，這一良好結果有助於2024 年的前景略有改善。表項目推動的：一是結算2023 年受益年度的市場風險調整應付款項，預計第四季相應收回的 2023 年應收帳款將超過 8 億美元；二、醫療補助費率上調尚未徵收；第三，D部分應收帳款的增加。

Unregulated cash on hand at quarter end was $266 million. During the third quarter plus October, we deployed approximately $1.6 billion on Centene shares for a year-to-date total of $2.4 billion. Our debt to adjusted EBITDA was 2.9 times at quarter end.

截至季末，手頭上不受監管的現金為 2.66 億美元。在第三季和 10 月期間，我們投資了約 16 億美元購買 Centene 股票，今年迄今的投資總額為 24 億美元。截至季末，我們的調整後 EBITDA 債務為 2.9 倍。

Our medical claims liability at quarter end represented 51 days in claims payable, down 3 days sequentially and down 2 days compared to Q3 of 2023. If it weren't for a higher level of state-directed payments in Q3, we would have been at 53 days.

季度末我們的醫療索賠負債相當於應付索賠51 天，比上一季減少了3 天，與2023 年第三季度相比減少了2 天。本來會處於53天。

We have updated our 2024 guidance elements to help with your modeling as we look towards wrapping up 2024. Our full-year premium and service revenue was $2 billion higher than previous guidance, which gives us more earnings power for the future.

我們更新了 2024 年指導要素，以幫助您在 2024 年結束之際進行建模。

Our consolidated 2024 HBR guidance of 88.3% to 88.5% reflects the Medicaid insights and updates we have provided you at the last couple of investor conferences. We continue to expect Q3 2024 to be the high watermark for our Medicaid HBR.

我們的 2024 年 HBR 綜合指導為 88.3% 至 88.5%，反映了我們在過去幾次投資者會議上為您提供的醫療補助見解和更新。我們仍然預計 2024 年第三季將成為我們的醫療補助 HBR 的高水位線。

2024 SG&A guidance midpoint of 8.6% is slightly down due to cost management and revenue growth. And to round out a couple of other metrics, we expect investment income of over $1.7 billion, excluding gains and losses on divestitures, and depreciation expense in the zone of $550 million. Importantly, we are still on track for greater than $6.80 of adjusted diluted EPS in 2024.

由於成本管理和收入成長，2024 年 SG&A 指導中點 8.6% 略有下降。為了完善其他幾個指標，我們預計投資收入將超過 17 億美元，不包括資產剝離的損益以及約 5.5 億美元的折舊費用。重要的是，我們仍有望在 2024 年實現超過 6.80 美元的調整後攤薄每股收益。

Q3 represents another quarter of good progress, from another divestiture to cost management to revenue growth to Stars and wins in Iowa Medicaid, Pennsylvania LTSS, and Michigan HIDE to boot. Execution in our diversified portfolio enables us to reaffirm our 2024 adjusted diluted EPS guidance of greater than $6.80 despite the temporary Medicaid rate acuity mismatch that we've been briefing you on since May.

第三季代表著另一個季度的良好進展，從另一項資產剝離到成本管理，再到收入增長到星級，並在愛荷華州醫療補助、賓夕法尼亞州 LTSS 和密西根州 HIDE 中獲勝。儘管我們自 5 月以來一直向您通報了暫時的醫療補助費率不匹配的情況，但我們多元化投資組合的執行使我們能夠重申 2024 年調整後攤薄每股收益高於 6.80 美元的指導。

As we make forward progress quarter after quarter, we still expect to grow adjusted diluted EPS in 2025 and beyond.

隨著我們逐季取得進展，我們仍預計 2025 年及以後調整後的稀釋每股盈餘將實現成長。

Thank you for your interest in Centene. Rocco, let's open it up for questions.

感謝您對 Centene 的興趣。羅科，讓我們開始提問吧。

(Operator Instructions) Stephen Baxter, Wells Fargo.

（操作員說明）Stephen Baxter，富國銀行。

I was hoping for the Medicaid MLR, you could potentially provide a little bit of commentary about where you're expecting the fourth quarter to land and any bridging items maybe we should consider, including maybe whether there is any retroactivity in the third quarter, either positive or negative.

我希望醫療補助 MLR，您可能會就您預計第四季度的情況以及我們可能應該考慮的任何過渡項目提供一些評論，包括第三季度是否有任何追溯性積極或消極。

And then I guess just a follow-up would be, I'd love to hear you talk about the total level of cost growth that you're seeing in the Medicaid business and where that sits in the second half, trying to understand how much margin impact we should think about the composite rate update you discussed producing. Thank you.

然後我想後續行動是，我很想聽您談論您在醫療補助業務中看到的成本增長的總體水平以及下半年的情況，試圖了解有多少我們應該考慮您討論的綜合利率更新對利潤率的影響。謝謝。

Sure. Thanks, Stephen. So let me tell you a little bit about what we saw in the quarter and what that means for us as we sort of look into Q4 and '25. And really, it is result of the groundwork that we laid out over the last 18 months and what we've shared with you in terms of the proactive dialogue with the states. And I think also a result of being the largest Medicaid provider and being maniacal about data.

當然。謝謝，史蒂芬。因此，讓我告訴您一些我們在本季看到的情況，以及在我們研究第四季和 25 年時這對我們意味著什麼。事實上，這是我們在過去 18 個月所做的基礎工作以及我們在與各州積極對話方面與大家分享的結果。我認為這也是最大的醫療補助提供者和對數據狂熱的結果。

And so, as we saw the inflection around the dislocation between rate and acuity start to pick up in Q2, we were very early to call that out. We were very early to bring that to our state partners to show the data and then to continue to refresh that data on an ongoing basis.

因此，當我們看到速率和敏銳度之間的錯位在第二季度開始出現變化時，我們很早就指出了這一點。我們很早就將其提供給我們的州合作夥伴以顯示數據，然後繼續不斷刷新該數據。

And that then became an important input if you think about the 14 states that have rate updates between 7/1 and 10/1. You also heard from both my and Andrew's commentary that one state that we've been waiting for to get an adjustment back to 2023, one of our smaller states.

如果你考慮利率更新在 7/1 到 10/1 之間的 14 個州，那麼這就成為一個重要的輸入。您也從我和安德魯的評論中聽說，我們一直在等待調整回到 2023 年，這是我們較小的州之一。

But that did come through, and therefore, have universality in terms of states acknowledging that there's a need to get rates and acuity together and also demonstrating their willingness to do so. So all of that nets out to the commentary around the composite rate adjustment being in the high 4s to 5% as we think about the year. Also informs the fact that we're encouraged by the momentum that we saw in the quarter and how we think about that influencing the conversations around not just 2025 rates but continuing to push for mid-cycle acuity adjustments.

但這確實實現了，因此，各國都承認有必要將利率和敏銳度結合在一起，並表明它們願意這樣做，因此具有普遍性。因此，當我們考慮今年時，所有這些都導致​​了圍繞綜合利率調整在 4% 至 5% 左右的評論。也告訴我們一個事實，即我們對本季看到的勢頭感到鼓舞，以及我們如何看待這不僅會影響圍繞 2025 年利率的對話，還會繼續推動週期中期敏銳度調整。

As you heard from Drew, there's still work to do. But again, the fact that bringing that data forward, leveraging the strong relationships that we have at the state level and being able to push those productive conversations to drive results I think, is sort of what we stand on. I don't know if there's anything you want to add in terms of cost trend or anything.

正如您從德魯那裡聽到的那樣，仍有工作要做。但同樣，我認為，提供這些數據，利用我們在州一級擁有的牢固關係，並能夠推動這些富有成效的對話來推動結果，這就是我們的立場。我不知道您在成本趨勢或其他方面是否有什麼要補充的。

Yeah, Stephen, as you think about the progression from Q3 to Q4, just think about Q3 in Medicaid HBR being the high watermark, as I said in my remarks. And then we've got one pretty big state with a 9/1 renewal and three states with 10/1 renewals and rate updates that obviously will impact Q4 more so than Q3. And then you didn't ask about other lines of business.

是的，史蒂芬，當您考慮從第三季度到第四季度的進展時，只需考慮醫療補助 HBR 中的第三季度是高水位線，正如我在發言中所說的那樣。然後我們有一個相當大的州以 9/1 的續訂率和三個州以 10/1 的續訂率和費率更新，顯然對第四季度的影響比第三季度更大。然後你也沒有問其他業務。

But if you step back and think about the HBR in the aggregate, setting aside Medicaid, Q4 seasonally is higher in the Medicare and commercial segments, commercial, typically, because of deductibility and seasonality sort of ticks up during the year. And then in Medicare, usually Q1 and Q4 are a little bit higher than Q2 and Q3. So that rounds out as you think about your modeling from Q3 to Q4 in the context of the aggregate guidance that we provided.

但如果你退後一步，從總體上考慮HBR，拋開醫療補助，第四季度醫療保險和商業領域的季節性較高，通常是商業領域，因為一年中的免賠額和季節性有所上升。然後在醫療保險中，通常 Q1 和 Q4 比 Q2 和 Q3 高一點。因此，當您在我們提供的整體指導的背景下思考從第三季度到第四季度的建模時，這一點就結束了。

Josh Raskin, Nephron Research.

喬許·拉斯金，腎單位研究。

Just a follow-up on that. Could you speak to core Medicaid utilization trends sort of outside of the acuity shifts, what you're seeing in terms of sort of same-store utilization trends? Maybe specifically comment on behavioral health and maybe the areas you talked about in early September.

只是對此的後續行動。您能否談談在敏銳度轉變之外的核心醫療補助利用趨勢，即您在同店利用趨勢方面所看到的情況？也許會具體評論行為健康以及您在九月初談到的領域。

And then separately, you said sort of the reverification process is sort of complete in your state. I mean, you're kind of back to the normal procedures around reverifications, how does that change the conversation with the states? Does that have any impact on sort of how you're advocating for rates?

然後，您說，您所在的州的重新驗證過程已經完成。我的意思是，你有點回到了有關重新驗證的正常程序，這如何改變與各州的對話？這對您倡導利率的方式有任何影響嗎？

Yeah. Thanks, Josh. There's nothing really new to add relative to the trend conversation from the updates we gave in Q2 and then throughout Q3. So obviously, the major driver of HBR in Medicaid is the mismatch of rate and acuity. And we called out before we have the ability to isolate sort of underlying continuous member cohorts to validate the fact that there is no sort of massive trends sitting in that continuous member book.

是的。謝謝，喬許。相對於我們在第二季和整個第三季提供的更新中的趨勢對話，沒有什麼真正新的內容需要添加。顯然，醫療補助中 HBR 的主要驅動因素是比率和敏銳度的不匹配。在我們有能力隔離潛在的連續會員群體之前，我們就提出了這樣的要求，以驗證連續會員簿中不存在任何大規模趨勢的事實。

There are pockets of trend that are exactly the same as we've been calling out previously, so behavioral health, home health. And then obviously, at a state level, there are those program-specific issues where a state may have changed to the program and needs to give us rate to account for that, which is really normal course blocking and tackling. But in an environment where you have redetermination sort of pressing down on the whole book, those issues become a little bit more visible.

有些趨勢與我們先前呼籲的完全相同，例如行為健康、家庭健康。顯然，在州一級，存在一些特定於計劃的問題，州可能已經改變了計劃，需要給我們費率來解釋這一點，這確實是正常的路線阻塞和解決。但在你對整本書重新決定的環境中，這些問題變得更加明顯。

But think about things like adding GLP-1s to the preferred drug list, changing rules around behavioral health access, and changes to prior off ability on our side and sort of cost management techniques. So those are again very consistent with what we've been saying throughout the quarter. We didn't see any new changes as we came out of the quarter.

但想想諸如將 GLP-1 添加到首選藥物清單、改變有關行為健康獲取的規則、改變我們的優先權能力以及某種成本管理技術之類的事情。因此，這些再次與我們在整個季度中所說的非常一致。本季結束後，我們沒有看到任何新的變化。

And then relative to your other comment, we are again seeing states kind of get through the tail of the administrative process. But relative to the rate conversations, those really are sort of aggregate data based.

然後，相對於您的其他評論，我們再次看到各州完成了行政程序的尾部。但相對於利率對話，這些確實是基於聚合數據的。

And so, understanding the impact of what those administrative changes do in terms of the remaining population and then what the resulting acuity is, all of that is -- there's a willingness and appetite by the state to look at that. And it's pretty consistent with the actuarial process because there is a normal look back.

因此，了解這些行政變革對剩餘人口的影響，以及由此產生的敏銳度，所有這些都是——國家有意願和興趣來關注這一點。這與精算過程非常一致，因為有正常的回顧。

And so, the fact that we're through, again, largely through that tail is not prohibitive relative to the advocacy work that we need to do to make sure that rates are matching what the acuity is netting out to.

因此，我們再次主要透過這條尾巴的事實相對於我們需要做的宣傳工作來說並不令人望而卻步，以確保利率與敏銳度相符。

AJ Rice, UBS.

AJ 賴斯，瑞銀集團。

Just trying to drill down to put perspective on what you guys are saying versus what some of the peers have said. So if your composite rate increases are in the 4.5% to 5% range, and this is the worst for medical loss ratio and you can get better from here, it sounds like, with rate updates similar to that.

只是想深入了解你們所說的話和一些同行所說的觀點。因此，如果您的綜合費率增幅在 4.5% 至 5% 範圍內，這是醫療損失率最差的情況，您可以從這裡得到更好的結果，聽起來，費率更新與此類似。

Can you sort of parse out -- obviously, that's a blend of the states that didn't update as well as the states that have updated presumably at higher rates. What types of rate updates do you think you need? I mean, we've had others say they need high single-digit updates. One even said maybe low double digit updates. What -- how much do you need to meet your goal of showing consistent MLR improvement going forward?

您能解析一下嗎？您認為您需要什麼類型的費率更新？我的意思是，我們已經聽到其他人說他們需要高個位數的更新。有人甚至表示更新可能會低至兩位數。什麼——您需要多少才能實現顯示 MLR 持續改進的目標？

Yeah. Thanks, AJ. I mean, the answer is obviously different state by state. And as we've said, there's still work to do relative to efficiency. I think the fact -- and we've called this out before about we are in sort of an unprecedented time.

是的。謝謝，阿傑。我的意思是，答案顯然因州而異。正如我們所說，在效率方面仍有許多工作要做。我認為事實是——我們之前已經指出過，我們正處於一個前所未有的時代。

And so, where we have seen the rate adjustments that are outsized relative to what would be normal course all lends itself to the sort of encouraging view that we have that states understand that they need to make up the difference between where the rates may stand for a specific date or specific program and then what we're seeing in terms of the actual experience.

因此，我們看到的利率調整幅度相對於正常情況而言過大，這一切都令人鼓舞，我們認為各州明白他們需要彌補利率可能代表的水平之間的差異特定的日期或特定的計劃，然後是我們在實際體驗方面所看到的。

I don't know, Drew, if there's anything you want to add?

不知道德魯，你還有什麼要補充的嗎？

Yeah. No, we'll just keep forging ahead. I mean, we've gotten rates in the high single-digit range in the very, very small states. So don't get too excited, we got a 10%. But that just gives you the indication of states are looking at the data that we're providing and looking at recent data as well and trying to balance that into their actuarial process.

是的。不，我們只會繼續前進。我的意思是，我們在非常非常小的州獲得了高個位數的利率。所以不要太興奮，我們得到了 10%。但這只是表明各州正在查看我們提供的數據並查看最近的數據，並試圖將其平衡到他們的精算過程中。

We're making progress here. We still have wood to chop. We'll be working on that throughout 2025 when we have the 1/1 cohort that we're starting to get visibility on recently, and then moving to 4/1, where we have one big state; and then almost half of our states, 7/1 to 10/1.

我們正在這裡取得進展。我們還有木頭要砍。我們將在整個 2025 年致力於這項工作，屆時我們將開始獲得最近可見的 1/1 隊列，然後轉向 4/1，其中我們有一個大狀態；然後是我們幾乎一半的州，7月1日到10月1日。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

I'll just follow up on some of the questions. First of all, on rates, just a clarification. Can you tell us specifically what period we should be thinking about, that 4% to 5% composite covering? Is that the year? Is that second half? And maybe you could share with us just because some of your peers have so we can get a kind of baseline, what's the cost spread that compares to that 4% to 5% that you're seeing now?

我將跟進一些問題。首先，關於費率，只是澄清一下。您能具體告訴我們我們應該考慮哪個時期的 4% 到 5% 的複合覆蓋嗎？是那一年嗎？這是後半段嗎？也許您可以與我們分享，因為您的一些同行已經這樣做了，這樣我們就可以獲得一種基準，與您現在看到的 4% 到 5% 相比，成本價差是多少？

And lastly, you've seen a significant pickup in Medicaid pass-through payments. Just want to make sure, is that 4% to 5% you're talking about, including pass-through payments? Or does it net those pass-throughs out? Thanks.

最後，您看到醫療補助轉嫁付款顯著增加。只是想確定一下，您所說的是 4% 到 5% 嗎，包括轉手付款？或者它會排除這些傳遞嗎？謝謝。

Yes. Thanks, Justin, for the questions. So the 4.5% or the high 4s to 5% is the back half rate, so more recent time period. And then we look at that as net rates. And so, pass-throughs would be excluded from that as would programmatic changes to the extent that benefits were adjusted. So we're looking at that as sort of a net fundamental rate even though the gross rates are often a little bit higher depending on the unique state program.

是的。謝謝賈斯汀提出的問題。所以 4.5% 或高 4s 到 5% 是後半率，所以是最近的時間段。然後我們將其視為淨利率。因此，轉嫁將被排除在外，而福利調整的程序性變更也將被排除在外。因此，我們將其視為一種淨基本利率，儘管根據獨特的州計劃，毛利率通常會稍高一些。

And I would think a bit less as cost trend and more about trying to peg that exit [net] expense PMPM as we exit the redetermination time period and then matching the rates against that exit rate. As Sarah indicated, when we look down into our book of business and look at continuous members, and these are pretty big cohorts that have been with us, I mean, millions and millions of members, so statistically sound, that have been with us for two years. There's not a whole lot of trends.

我認為，當我們退出重新確定時間段時，我會少考慮一些成本趨勢，而更多地考慮嘗試將退出[淨]費用 PMPM 掛鉤，然後將費率與退出率進行匹配。正如莎拉指出的那樣，當我們查看我們的業務記錄並查看連續會員時，這些都是與我們在一起的相當大的群體，我的意思是，數以百萬計的會員，從統計上來說是合理的，他們已經與我們在一起兩年了。沒有太多的趨勢。

There's some typical trend in the high acuity populations, reasonable levels of trend and pretty flat in tandem. So I would think of it more as like pegging that exit run rate PMPM, matching rates against it that we'll be working on over the next couple of cycles.

高敏銳度人群有一些典型的趨勢，合理的趨勢水平並且相當平坦。因此，我認為它更像是掛鉤退出運行率 PMPM，將其與我們將在接下來的幾個週期中研究的速率進行匹配。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，康托費茲傑拉。

Is there a way to size up the pent-up demand portion of trend that would slow as rejoiners flow versus the acuity mix that would continue? And on the GLP-1 flag, can you size how much pressure to trend that is for states that cover it and whether there is a corresponding adjustment in rates or there's a lag there for catching up?

有沒有一種方法可以衡量趨勢中被壓抑的需求部分，隨著重新加入者的流動而放緩，與將持續的敏銳度組合相比？在 GLP-1 標誌上，您能否估算涵蓋該標誌的各州的趨勢壓力有多大，以及利率是否有相應的調整，或者是否存在追趕的滯後？

Yeah. So relative to rejoiners, I think as we called out that dynamic and that cohort in particular where, again, in immature months, we're seeing 30% of members who are coming back and as this process has unfolded, an increasing gap in terms of how long it takes for them to come back, which then puts them out of that retroactive reinstatement window is part of what's been contributing to the HBR pressure and delta that you've seen in the last two quarters.

是的。因此，相對於重新加入者，我認為，當我們呼籲這種動態和群體時，特別是在不成熟的幾個月裡，我們看到30% 的成員回來了，隨著這個過程的展開，在條款上的差距越來越大他們需要多長時間才能回來，然後將他們排除在追溯恢復窗口之外，這是導致哈佛商業評論壓力和三角洲的部分因素，正如你在過去兩個季度看到的那樣。

And my commentary about the fact that, that dynamic is slowing, I think, is important. Because those -- the rejoiners tend to come back and find their way back because they are in need of health care. And so again, they create sort of this artificial pressure where they're using the system, and we haven't received premiums for the time period that they weren't enrolled even though they were eligible.

我認為，我對這一動態正在放緩這一事實的評論很重要。因為那些重新加入的人往往會回來並找到回來的路，因為他們需要醫療保健。同樣，他們在使用該系統時製造了某種人為壓力，即使他們符合資格，我們也沒有在他們未註冊的時間內收到保費。

So the more of that we work through and have now worked through over the last couple of quarters means that, that should create a natural tailwind as we turn into 2025.

因此，我們在過去幾個季度所做的工作以及現在所做的工作越多，這意味著，當我們進入 2025 年時，這應該會產生自然的推動力。

And then GLP-1s, Drew, maybe you want to talk about the states that have put those on formulary and the data that we can present to them as they think about making sure we get paid for it.

然後，德魯，GLP-1，也許您想談談將這些藥物納入處方集的州，以及當他們考慮確保我們為此獲得報酬時我們可以向他們提供的數據。

Actually, we've had a couple of states that have had GLP-1s available for the [weight] loss indication for a while. So we've got good data. Then we take to other states that are maybe contemplating, should they put it on their formulary, should they not and share that data with them. It also helps shape the rate discussion of -- the ramping of that we saw in those states that have been on it for over a year.

事實上，我們已經有幾個州將 GLP-1 用於[體重]減輕指示已有一段時間了。所以我們有很好的數據。然後我們會聯繫其他可能正在考慮的州，看看他們是否應該將其納入處方集，並與他們分享這些數據。它還有助於塑造利率討論——我們在那些已經進行了一年多的州看到了利率的上升。

So there's a handful of states. The states can make those decisions, and we administer and then we share data. There's one state that recently added GLP-1s, I believe, as of August. And we're sharing data monthly with them to make sure that the rate that they loaded in, the PMPM rate, their estimate upon the commencement is consistent with the uptake that is being seen in that specific state.

所以有幾個州。各州可以做出這些決定，我們進行管理，然後分享數據。我相信，截至 8 月份，有一個州最近增加了 GLP-1。我們每月與他們共享數據，以確保他們的加載率、PMPM 率、他們在開始時的估計與該特定州的吸收率一致。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Last quarter, you categorized Medicaid HBR improvement as a tailwind for 2025. With a modest setback in Medicaid MLR in the quarter, is it still fair to characterize Medicaid MLR as a tailwind for next year? And what visibility do you have into 1/1 rate updates at this point? Thanks.

上個季度，您將醫療補助 HBR 的改善視為 2025 年的順風車。此時您對 1/1 利率更新有什麼了解？謝謝。

Yeah. I would say, yes. Medicaid HBR improvement is definitely a tailwind for 2025. As you heard Drew say, we've started to get some of those 1/1 rates, and we'll have a lot more visibility and obviously be able to update you on 2025 overall at our Investor Day in December. But I still believe we'll be able to grow adjusted EPS, and those headwinds and tailwinds in the aggregate that we've shared previously remain the same

是的。我會說，是的。醫療補助HBR 的改進絕對是2025 年的順風車。年整體最新情況：我們十二月的投資者日。但我仍然相信我們將能夠增長調整後的每股收益，並且我們之前分享的總體上的逆風和順風保持不變

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Great. I was hoping you could give a little more detail to help our understanding on some of the rates and rejoiner aspects. In particular, with rate increases, as you're doing those, are states doing that by program or at a composite level across programs?

偉大的。我希望您能提供更多詳細信息，以幫助我們了解一些費率和重新加入方面的信息。特別是，隨著利率的提高，正如你們所做的那樣，各州是按計劃還是在跨計劃的綜合層面上這樣做？

And then when you're thinking about rejoiners and maybe any comments on levers would also be interesting, but rejoiners. Do you have cohorts that are there long enough that you can see a normalization in utilization patterns? Thanks.

然後，當您考慮重新加入者時，也許任何有關槓桿的評論也會很有趣，但是重新加入者。您是否有足夠長的群組，可以看到利用率模式的正常化？謝謝。

Yes. On the -- so first of all, relative to rates, states do -- we get sort of a composite rate, but it's a reflection of a buildup of the underlying sub-programs that are in there. And so they take into account the sort of variety of programs that any of us individually are managing.

是的。首先，相對於各州的利率，我們得到了某種綜合利率，但它反映了其中基礎子計畫的累積。因此，他們考慮了我們每個人單獨管理的各種項目。

And then relative to payers and levers and rejoiners, we do now have, to your point, Lance, rejoined our data -- rejoined our run-out data. and being able to look at and confirm the view that, again, those rejoiners are coming back because they are in need of services.

然後，相對於付款人、槓桿和重新加入者，蘭斯，按照您的觀點，我們現在確實重新加入了我們的數據——重新加入了我們的耗盡數據。並且能夠再次審視並確認這些重新加入者回來是因為他們需要服務的觀點。

And then we see the normalization of their utilization patterns thereafter. And in fact, the idea that had we been receiving premiums for those members during the time that we had the gap, it would have normalized their HBR more than what we're seeing.

然後我們看到他們的利用模式此後正常化。事實上，如果我們在缺口期間為這些會員收取保費，那麼他們的 HBR 就會比我們現在看到的更正常。

So that -- all of that, again, continues to confirm the view that it's sort of this artificial pressure that's creating MLR uptick. And then I don't know, anything else on stairs and levers as those continue to run out? No? Yes. So still the same differences that we've been seeing and all of that data gets put into the mix in our advocacy with state partners.

因此，所有這些再次證實了這樣一種觀點，即正是這種人為壓力導致了 MLR 的上升。然後我不知道，隨著樓梯和槓桿的不斷耗盡，還有其他嗎？不？是的。因此，我們所看到的差異仍然存在，所有這些數據都被納入我們與國家合作夥伴的倡議中。

Adam Ron, Bank of America.

亞當‧羅恩，美國銀行。

I appreciate the question. I was wondering if we could get a little more color on the Part D business. You mentioned you expect 1% margin next year. Wondering how that compares to this year.

我很欣賞這個問題。我想知道我們是否可以在 D 部分業務上獲得更多的色彩。您提到預計明年的利潤率為 1%。想知道與今年相比如何。

And then also, one of your peers mentioned that due to the IRA changes that partially took effect this year, they saw a greater utilization shift in some specialty drugs this year because the member cost sharing went down, and that happened after they priced 2025.

另外，您的一位同行提到，由於IRA 的變化今年部分生效，他們今年看到一些特殊藥物的利用率發生了更大的變化，因為會員分攤費用下降了，而這種情況發生在他們定價2025 年之後。

And so wondering if you were seeing that and if that had any risk for 2025 or if the voluntary program helps minimize some downside. Any color around all that would be helpful. Thanks.

因此，想知道您是否看到了這種情況，以及這對 2025 年是否有任何風險，或者自願計畫是否有助於最大程度地減少一些負面影響。周圍的任何顏色都會有幫助。謝謝。

Yeah. Thanks, Adam. No, we're really pleased with our positioning in PDP. So starting with 2024, we're right on track. I mean, we sort of knew the rules of the IRA. We thought about the member change in behavior, which will be different in '25 than '24, but we thought about it for '24 as well and any sort of manufacture behavior changes that might be induced by the changing of the mechanics of the IRA.

是的。謝謝，亞當。不，我們對我們在 PDP 中的定位非常滿意。因此，從 2024 年開始，我們正步入正軌。我的意思是，我們有點了解愛爾蘭共和軍的規則。我們考慮了成員行為的變化，這在 25 年與 24 年會有所不同，但我們也考慮了 24 年的情況，以及 IRA 機制的變化可能引起的任何類型的製造行為變化。

So we're right on track, as you can see in our aggregate Medicare segment. But underneath that, PDP is on track and in that same zone of margin for '24. So sort of we expect a degree of consistency between '24 and '25 in the margin, although the revenue will be a lot higher in '25 than '24. So pleased with the positioning. The team did a really good job estimating the direct subsidy.

因此，正如您在我們的綜合醫療保險細分市場中看到的那樣，我們正走在正軌上。但在此之下，PDP 已步入正軌，並處於 24 年的相同邊緣區域。因此，我們預計 24 年和 25 年的利潤率將保持一定程度的一致性，儘管 25 年的收入將比 24 年高得多。對這個定位非常滿意。團隊在估算直接補貼方面做得非常好。

Obviously, that was a big risk that we talked about going back to Q1 at a conference in March and then on the Q1 call, trying to make sure, quite frankly, that the industry was thinking through all of the elements that needed to be reflected in the bid and therefore driving the direct subsidies. So we would expect to grow in the open enrollment period, the annual enrollment period.

顯然，這是一個很大的風險，我們在三月份的一次會議上討論了回到第一季度，然後在第一季度的電話會議上，坦率地說，試圖確保該行業正在考慮所有需要反映的要素參與競標，從而推動直接補貼。因此，我們預計開放招生期（年度招生期）會有所增長。

Given our positioning, we're below the benchmark in 33 out of the 34 regions, which is a really good result but consistent with where we've been in the past. And we continue to have zero premium products in the majority of states, in part, thanks to the CMS demo, which brought down that premium by $15.

鑑於我們的定位，我們在 34 個地區中的 33 個地區低於基準，這是一個非常好的結果，但與我們過去的情況一致。我們在大多數州繼續擁有零溢價產品，部分歸功於 CMS 演示，該演示將溢價降低了 15 美元。

So pleased with the positioning. Not satisfied with the 1% margin, give or take. But I think that's the right area to a target for '25. And then we'll look to edge that up over the following couple of years.

對這個定位非常滿意。對 1% 的利潤不滿意，給予或接受。但我認為這是實現 25 年目標的正確領域。然後我們將在接下來的幾年裡努力提高這一點。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

First question, just I was hoping to circle back on Sarah's comment around the expected exchange market growth for next year at the mid-single digits. One of your large sort of ex market-focused peers talked more about a mid-teens growth expectation for next year. And I know you did sort of call out a few sort of regulatory changes for next year.

第一個問題，我只是希望回顧一下莎拉關於明年外匯市場預期成長中個位數的評論。一位關注市場的前同行更多地談到了明年的中位數成長預期。我知道你確實呼籲明年進行一些監管改革。

So it would be helpful maybe if you could maybe walk us through sort of how you would be thinking about like sort of, I guess, the gross marketplace growth and then how some of these regulatory changes may sort of bring that down to the mid-single digits.

因此，如果您能向我們介紹您將如何考慮市場總成長，以及其中一些監管變化如何將其降至中期，也許會有所幫助。

Then just my follow-up question would just be around California. One of your peers has commented the last couple of quarters on a retroactive rate adjustment in Medicaid, that's been pretty significant. I know you guys haven't really called that out to nearly the same degree, but just curious on sort of what you've been seeing on that front as well. Thanks.

那麼我的後續問題就只是關於加州。您的一位同行在過去幾季對醫療補助的追溯費率調整發表了評論，這是相當重要的。我知道你們並沒有真正以幾乎相同的程度來呼籲這一點，但只是對你們在這方面所看到的東西感到好奇。謝謝。

Yeah. Thanks, Scott, for the question. So long term, we're still very bullish on our view of growth in marketplace, and we called out all of the drivers of that, that sort of increased stability and broker infrastructure, affordability awareness.

是的。謝謝斯科特提出這個問題。從長遠來看，我們仍然非常看好我們對市場成長的看法，並且我們指出了所有的驅動因素，例如穩定性和經紀商基礎設施的增強以及可負擔性意識。

As we think about this year, think about the fact that we're coming off of the tailwinds from redetermination. So that creates sort of a natural step down to a more moderated growth rate just to begin with.

當我們思考今年時，請考慮一下這樣一個事實：我們正在擺脫重新決定的順風車。因此，這在一開始就自然地降低了成長率。

And then as you said exactly, the program integrity policies that are being layered in, and really, most of these are just policies that are being reintroduced that were sort of put on pause during the COVID era. One of the new ones is this agent of record lock policy, which requires a member to have a single broker throughout the enrollment period, which again we think creates a more stable enrollment experience. It's something that we put in place starting back in January. So that's not really new for us but maybe new for some folks in the industry.

正如您所說，正在分層的計劃完整性政策，實際上，其中大部分只是重新引入的政策，這些政策在新冠病毒時代有點暫停。其中一項新政策是記錄鎖定代理策略，它要求會員在整個註冊期間必須有一個經紀人，我們認為這再次創造了更穩定的註冊體驗。這是我們從一月開始實施的。所以這對我們來說並不是什麼新鮮事，但對業內的一些人來說可能是新鮮事。

And then two additional policies that are sort of reinstatement, which is failure to report, which is sort of the IRS policy, making sure that the income level is correct relative to enrollment and the subsidies; and then the flag for overlap between marketplace and Medicaid eligibility. And so, those -- the introduction of those or reintroduction of those relative to this open enrollment is part of what creates sort of that downward pressure in this cycle.

然後還有兩項額外的政策，即恢復政策，即未報告，這是國稅局的政策，確保收入水平相對於入學和補貼是正確的；然後是市場和醫療補助資格之間重疊的標誌。因此，這些——引入這些或重新引入與公開招生相關的那些是在這個週期中造成某種下行壓力的部分原因。

The other thing that I think is important to note is that as we come through the redetermination process, we also anticipate less growth than we've seen in the past couple of years relative to the SEP period.

我認為值得注意的另一件事是，當我們完成重新確定過程時，我們也預計相對於 SEP 期間的成長將低於過去幾年的成長。

And so, think about returning to more normal marketplace membership seasonality, which means growth during open enrollment, a peak sometime in Q1 and then sort of natural trailing of membership as you move through the rest of the year. And so, all of that nets out to our view of mid-single-digit growth for the market, our view of sort of more modest this year growth in open enrollment.

因此，考慮恢復更正常的市場會員季節性，這意味著開放註冊期間的成長，在第一季的某個時間達到峰值，然後在今年剩餘時間裡會員資格自然落後。因此，所有這些都證明了我們對市場中個位數成長的看法，以及我們對今年公開招生成長較為溫和的看法。

But still believe that we will grow in open enrollment. And based on what we've seen -- obviously open enrollment doesn't start for another week, but what we've seen in terms of the competitive landscape, still feel very good about being able to execute our strategy relative to delivering well within our target margins of 5% to 7.5%.

但仍然相信我們會在公開招生方面有所成長。根據我們所看到的情況 - 顯然公開招生還要一周才能開始，但我們在競爭格局方面看到的情況，仍然對能夠執行我們的戰略以及在內部交付良好方面感到非常滿意我們的目標利潤率為5% 至7.5%。

And then, Drew, do you want to comment on the California dynamic?

然後，德魯，你想對加州的動態發表評論嗎？

Yeah. Never a 100% sure exactly we're talking about the same thing. But similar to what you described, we were able to get adequate information to get a negative retro into our Q2 results.

是的。永遠不能百分百確定我們正在談論同一件事。但與您所描述的類似，我們能夠獲得足夠的資訊來對第二季的結果進行負面回顧。

Michael Ha, Baird.

麥可·哈，貝爾德。

Just wanted to quickly confirm, on your modest exchange growth expectations, does that imply Centene can grow higher than market to higher than sort of mid-single digit for next year?

只是想快速確認一下，根據您適度的交易所成長預期，這是否意味著 Centene 明年的成長速度可以高於市場，達到中個位數以上？

And then I know there's been a few questions on Medicaid cost trend already. But just curious, what level of cost trend are you assuming for fourth quarter? Directionally, is it fair to assume your guide sort of implies the 4Q Medicaid trend is higher sequentially? Thanks.

然後我知道已經有人對醫療補助成本趨勢提出了一些問題。但只是好奇，您假設第四季度的成本趨勢是什麼水平？從方向上看，假設您的指南暗示第四季度醫療補助趨勢依次走高是否公平？謝謝。

Yeah. So I think, Drew, you covered the seasonality of HBR, but maybe just hit that again in Medicaid.

是的。所以我認為，德魯，你涵蓋了《哈佛商業評論》的季節性，但也許只是在醫療補助中再次提到了這一點。

Yeah, Medicaid cost. I think the way to think about that, Michael, is that we expect Q3 to be the high watermark for Medicaid HBR. And yes, every quarter, we assume that there's typical trend in our books of business across all the businesses.

是的，醫療補助費用。邁克爾，我認為思考這個問題的方法是，我們預計第三季將成為醫療補助 HBR 的高水位線。是的，每個季度，我們都假設我們所有業務的業務帳簿中都有典型的趨勢。

But essentially, what we're doing is exiting the redetermination era at elevated medical expense PMPM relative to a year ago, obviously, and then trending on that going forward, which we expect to have those Q4 -- the benefit in Q4 of the 9/1 and the 10/1 rates. The benefit obviously is much greater in Q4 than Q3.

但從本質上講，我們正在做的是以相對於一年前更高的醫療費用PMPM 退出重新確定時代，顯然，然後朝著未來的趨勢發展，我們預計第四季度將獲得9 季度第四季度的收益/1 和 10/1 比率。第四季的收益顯然比第三季大得多。

And then just relative to marketplace growth, so we haven't quantified the target growth, but do believe that we will grow in marketplace. Our strategy really for 2025 has been more about delivering margins well within that pretax range. And so, I wanted to give some color on what we see as overall market growth, and then look forward to providing a more detailed update at our December Investor Day on that front.

然後只是相對於市場成長，所以我們沒有量化目標成長，但相信我們會在市場上成長。我們 2025 年的策略其實更多的是讓利潤率維持在稅前範圍內。因此，我想對我們所看到的整體市場成長進行一些說明，然後期待在 12 月投資者日提供這方面更詳細的更新。

Dave Windley, Jefferies.

戴夫·溫德利，杰弗里斯。

I was going to switch topics to G&A. Sarah, you mentioned AI. And I wondered, I guess, one, if you would be in a position to quantify any of the AI benefits that you might expect to see; and two, are any of those projects shovel-ready at this point?

我本來打算把話題轉到 G&A 上。莎拉，你提到了人工智慧。我想知道，我想，第一，你是否能夠量化你可能期望看到的任何人工智慧好處；第二，這些項目目前是否已準備就緒？

And then three, on G&A. Are there any timing-related spending items that we should be thinking about on G&A, thinking like offsets to the higher Medicaid MLR, things like that, that we should think '24 versus '25 on G&A? Thanks.

然後是三個，關於一般行政費用。我們是否應該在 G&A 上考慮任何與時間相關的支出項目，例如對更高的醫療補助 MLR 的抵消，諸如此類的事情，我們應該在 G&A 上考慮「24 與 25」？謝謝。

Yeah. I'll let Drew cover timing more broadly relative to year-over-year. The one thing I will call out which you all know is that SG&A naturally goes up in Q4 because we get into our selling periods for Marketplace and Medicare, So just something to keep in mind, but consistent with what you see every year.

是的。我將讓德魯更廣泛地介紹與去年同期相比的時間安排。我要指出的一件事是，你們都知道，SG&A 在第四季度自然會上升，因為我們進入了 Marketplace 和 Medicare 的銷售期，所以需要記住這一點，但與您每年看到的情況一致。

Broadly relative to operational efficiency, I think we've delivered great results and created momentum as we think about kind of closing out year three. And as you heard me say, I'm sort of even more excited about the fact that we didn't just deliver on the low-hanging fruit, but really starting to get to the second and third order opportunities, which I think reflects the fact that operational excellence is sort of increasingly baked into the DNA of the organization.

總體而言，相對於營運效率，我認為在我們考慮結束第三年時，我們已經取得了巨大的成果並創造了動力。正如你聽到我說的，我更興奮的是，我們不僅實現了唾手可得的成果，而且真正開始獲得第二和第三階機會，我認為這反映了事實上，卓越運營已經越來越融入到組織的DNA 中。

The AI product I mentioned in particular is shovel-ready. But it's -- this is not the beginning. We've actually been layering in the use of AI across different parts of the business as we've come through the value creation work.

我特別提到的人工智慧產品已經準備就緒。但這不是開始。實際上，在完成價值創造工作時，我們一直在業務的不同部分分層使用人工智慧。

And the benefit of doing so much work in terms of standardizing processes means that you can then flip over to automating process, and then you have access to the data allows you to layer in AI and really think about a different way to leverage the size and scale and the data of this organization to drive standardization and administrative processes that aren't necessarily differentiating, and then really focus the talent of the organization on those parts of the process that are differentiating.

在標準化流程方面做這麼多工作的好處意味著你可以轉向自動化流程，然後你可以存取數據，讓你可以在人工智慧中分層，並真正考慮一種不同的方式來利用規模和規模。的規模和數據來推動不一定具有差異化的標準化和管理流程，然後真正將組織的人才集中在流程中具有差異化的部分。

So lots of additional non-AI SG&A opportunities. You obviously heard us talk about that relative Medicare. That's going to be another great lever to derisk Stars and drive the path to profitability in that business. But thinking about things like digital payments to providers, vendor consolidation, portal consolidation.

還有很多額外的非 AI SG&A 機會。你顯然聽到我們談論那個親戚的醫療保險。這將成為消除明星風險並推動該業務獲利的另一個重要槓桿。但要考慮向提供者進行數位支付、供應商整合、入口網站整合等問題。

All of these are things that are still ahead of us, and so feel good about the ability to continue to extract EPS improvement, frankly, from that 1% to 2% that comes from margin improvement over time.

所有這些都是擺在我們面前的事情，因此坦白說，隨著時間的推移，利潤率改善所帶來的 1% 到 2% 的 EPS 改善的能力讓我們感到很高興。

Yeah. Then we'll bridge you off of the midpoint of 2024 is 8.6% at Investor Day, and it will be somewhat dependent on the mix of business. Obviously, Marketplace and Medicare carry a much higher SG&A load than Medicaid. And then we'll have to weave in the impact of the PDP revenue growth as well. So we'll be sure to do that at Investor Day.

是的。然後我們將在投資者日為您提供 2024 年中點 8.6% 的信息，這在一定程度上取決於業務組合。顯然，Marketplace 和 Medicare 的 SG&A 負擔比 Medicaid 高得多。然後我們還必須考慮 PDP 收入成長的影響。因此，我們一定會在投資者日這樣做。

George Hill, Deutsche Bank.

喬治·希爾，德意志銀行。

This is Maxi on for George. The Medicaid PMPM seems to have grown much faster than your peers this quarter. How much of it is driven by rate adjustment? And any other main drivers beyond rate adjustments? And how sustainable is the PMPM growth at this rate going forward? Thank you.

這是喬治的馬克西。本季醫療補助 PMPM 的成長速度似乎比同業快得多。其中有多少是由利率調整所推動的？除了費率調整之外，還有其他主要驅動因素嗎？ PMPM 以這樣的速度成長的可持續性如何？謝謝。

Yeah. Thanks for the question. As you heard us talking about cash flow, it's not what you asked about but it's -- there's an interplay here with the cash flows being impacted and the DCP being impacted by state-directed payments that works its way into the yield that you're probably calculating off the face of the disclosures that we have. So there's a fair amount of increase in state-directed payments in the quarter.

是的。謝謝你的提問。當你聽到我們談論現金流時，這不是你問的問題，而是——現金流受到影響，DCP 受到國家指導支付的影響，這兩者之間存在相互作用，這會影響到你所期望的收益率。因此，本季國家指導的付款有相當多的增加。

And -- but you're right that the high 4s to 5% composite back half rate is helping that as well.

而且——但你說得對，4% 到 5% 的複合後半率也對此有所幫助。

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

謝謝。我們的問答環節到此結束。我想把會議轉回莎拉·倫敦做閉幕詞。

Thanks, Rocco. I'll just close out by emphasizing what I think you've heard this morning, which is our business objectives and expected 2024 earnings power remain unchanged. We are pleased to be making progress matching Medicaid rates with acuity and generating positive momentum on RFP wins in the meantime.

謝謝，羅科。最後，我想強調一下您今天早上聽到的內容，即我們的業務目標和 2024 年預期盈利能力保持不變。我們很高興在醫療補助費率與敏銳度匹配方面取得進展，同時為 RFP 獲勝產生積極勢頭。

Relative to Medicare, we are marking gains on important strategic initiatives there, and we continue to lead in our marketplace business, which is a product where I think our depth of experience and execution is unparalleled.

相對於醫療保險，我們在重要的策略性舉措上取得了進展，並且我們繼續在市場業務中處於領先地位，我認為我們的經驗和執行深度是無與倫比的。

So we still have work to do. We still have a lot of opportunity ahead and look forward to updating you again at our upcoming Investor Day in December. But in the meantime, thank you for your interest in Centene, and I hope you have a great weekend.

所以我們還有工作要做。我們仍然有很多機會，並期待在即將到來的 12 月投資者日再次向您通報最新情況。但同時，感謝您對 Centene 的興趣，希望您週末愉快。

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 weekend.

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並度過一個愉快的周末。