Centene Corp (CNC) 2025 Q1 法說會逐字稿

Good day, and welcome to the Centene Corporation first quarter 2025 conference call. (Operator Instructions). Please note today's event is being recorded.

大家好，歡迎參加 Centene Corporation 2025 年第一季電話會議。（操作員指令）。請注意，今天的活動正在記錄。

I would now like to turn the conference over to Jennifer Gilligan, Investor Relations. Please go ahead.

現在我想將會議交給投資者關係部的 Jennifer Gilligan。請繼續。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our first-quarter 2025 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.

謝謝你，羅科，大家早安。感謝您參加我們的 2025 年第一季財報業績電話會議。莎拉倫敦 (Sarah London)，執行長； Centene 執行副總裁兼財務長 Drew Asher 將主持今天上午的電話會議，您也可以透過我們的網站 centene.com 存取。

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 對未來預期、計畫和前景所作的任何評論均構成 1995 年《私人證券訴訟改革法案》安全港條款規定的前瞻性陳述。

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 first-quarter 2025 press release, Centene's most recent Form 10-K filed on February 18, 2025, and other public SEC filings, which are available on the company's website under the Investors section.

由於各種重要因素，實際結果可能與這些前瞻性陳述所示的結果有重大差異，包括我們在 2025 年第一季度新聞稿中討論的因素、Centene 於 2025 年 2 月 18 日提交的最新 10-K 表格以及其他公開的 SEC 文件，這些文件可在公司網站的「投資者」部分查閱。

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. While we also refer to certain non-GAAP measures, a reconciliation of these measures with the most directly comparable GAAP measures can be found in our first-quarter 2025 press release.

Centene 預計後續事件和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間點更新這些前瞻性聲明，但我們明確表示不承擔任何這樣做的義務。雖然我們也參考了某些非 GAAP 指標，但您可以在我們的 2025 年第一季新聞稿中找到這些指標與最直接可比較的 GAAP 指標的對帳。

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

說完這些，我想把電話轉給我們的執行長莎拉倫敦 (Sarah London)。莎拉？

Thanks, Jen, and thanks, everyone, for joining us as we review our first-quarter results and updated full year 2025 outlook. This morning, we reported first quarter adjusted diluted EPS of $2.90, consistent with the expectations we shared with investors last month. Our full year 2025 adjusted EPS expectations remain unchanged at greater than $7.25. We have increased clarity on the components of our $7.25 floor and have moved some of the underlying metrics as a result. Drew will cover these and other details of the quarter in a moment.

謝謝 Jen，也謝謝大家加入我們，一起回顧我們的第一季業績並更新 2025 年全年展望。今天上午，我們報告第一季調整後稀釋每股收益為 2.90 美元，與我們上個月與投資者分享的預期一致。我們對 2025 年全年調整後每股盈餘的預期保持不變，仍為 7.25 美元以上。我們進一步明確了 7.25 美元底線的組成要素，並因此調整了一些基礎指標。德魯稍後將介紹這些內容以及本季的其他細節。

Uncertainty and change are not new to Centene, and we are managing the business well while navigating a dynamic policy landscape. Relative to the active national dialogue around healthcare policy reform, we believe a few things are important to note.

不確定性和變化對 Centene 來說並不陌生，我們在應對動態政策環境的同時，也很好地管理業務。相對於圍繞醫療政策改革的積極的全國性對話，我們認為有幾點值得注意。

First, we do not see broad support for benefit cuts in Medicaid from either the White House or from Congress. In fact, over the last few months, we have witnessed an increase in bicameral Republican members objecting to major Medicaid reforms.

首先，我們沒有看到白宮和國會廣泛支持削減醫療補助福利。事實上，在過去的幾個月裡，我們看到越來越多的共和黨兩院議員反對重大醫療補助改革。

While there is building momentum around work requirements within the expansion population and opportunities to drive better efficiency in the system for beneficiaries and the states, we believe that large-scale benefit cuts and significant policy changes will present challenges for the reconciliation process.

儘管擴大人口的工作要求勢頭強勁，並且有機會提高受益者和各州的系統效率，但我們認為大規模的福利削減和重大的政策變化將對協調進程構成挑戰。

Second, there is growing bipartisan recognition in Congress that the expiration of the enhanced premium tax credits must be addressed before they expire at the end of the year. Recent survey conducted by leading Republican pollsters found that 78% of swing voters support extending healthcare premium tax credits for working families.

其次，國會兩黨日益認識到，必須在年底增強保費稅收抵免到期之前解決其到期問題。共和黨主要民調機構最近進行的一項調查發現，78% 的搖擺選民支持延長工薪家庭的醫療保險費稅收抵免。

The criticality of these tax credits for Republican voters, small business owners, and our existing rural healthcare infrastructure as well as the potential of the even individual marketplace to serve as a platform for ICHRA growth has taken root for many Republican congressional leaders.

許多共和黨國會領導人已經認識到這些稅收抵免對共和黨選民、小企業主和我們現有的農村醫療保健基礎設施的重要性，以及個人市場作為 ICHRA 發展平台的潛力。

Congress is scheduled to return from recess next week, and we expect activity focused on driving the contours of a reconciliation bill as the first order of business. Public and lawmakers are targeting Memorial Day for a reconciliation bill, but much will depend on the consensus building process.

國會定於下週休會，我們預計會議的首要任務是推動和解法案的發展。公眾和立法者計劃在陣亡將士紀念日當天達成和解法案，但這在很大程度上取決於達成共識的過程。

Beyond reconciliation, the next big order of business will be government funding due to expire at the end of Q3. We anticipate this could be another vehicle where healthcare issues are addressed. Amid this backdrop, we continue to execute on our strategic initiatives while advocating for sound healthcare policy. We have demonstrated the ability to be successful under multiple administrations and expect nothing less as we navigate the next four years. Turning to the core business.

除了和解之外，下一個重要任務是解決第三季末到期的政府資金問題。我們預計這可能成為解決醫療保健問題的另一種途徑。在此背景下，我們繼續執行我們的策略舉措，同時倡導健全的醫療保健政策。我們已經證明了在多屆政府領導下取得成功的能力，並且對未來四年的發展抱有更高的期望。轉向核心業務。

Medicaid took important steps forward in the quarter as we continue on our path of margin recovery, including better alignment of rates and member acuity in more geographies. As we noted back in February, approximately 40% of our Medicaid revenue received refreshed rates at the start of the quarter with an average increase of 4.5%. These rates contributed to underlying improvement in the performance of the book.

隨著我們繼續在利潤率復甦的道路上前進，醫療補助在本季度取得了重要進展，包括在更多地區更好地協調費率和會員敏銳度。正如我們在二月指出的那樣，本季度初，我們約 40% 的醫療補助收入獲得了更新，平均增幅為 4.5%。這些比率有助於根本改善該書的表現。

However, the full impact of this improvement was masked in the quarter by a more active flu season than we anticipated. In Medicaid, flu, and ILI drove $130 million of incremental medical expense in the quarter beyond our initial expectations, largely offsetting the underlying MLR improvement we experienced.

然而，由於本季流感季節比我們預期的更為活躍，因此這項改善的全部影響被掩蓋了。在醫療補助方面，流感和流感樣疾病導致本季度醫療費用增加 1.3 億美元，超出了我們最初的預期，在很大程度上抵消了我們經歷的潛在 MLR 改善。

On the rate front, our discussions with state partners continue to be constructive and to benefit from increasingly complete data, demonstrating the acuity shift the industry has seen over the last year as a result of the tailing redetermination process.

在費率方面，我們與國家合作夥伴的討論繼續富有建設性，並受益於日益完整的數據，表明由於尾礦重新確定過程，該行業在過去一年中已經看到了敏銳度的轉變。

We continue to believe that Medicaid will ultimately return to pre-pandemic margin levels as we work through the coming rate cycles and engage with our members to deliver high-quality, low-cost outcomes.

我們仍然相信，隨著我們努力度過即將到來的費率週期並與我們的會員合作提供高品質、低成本的結果，醫療補助最終將恢復到疫情前的利潤水平。

On the business development front, we delivered several key Medicaid contract wins since the start of the year, underscoring the strength and competitiveness of our unique service model. Centene was selected by the State of Illinois to continue providing Medicare and Medicaid services for duly eligible members through a fully integrated D-SNP. The D-SNP program will provide services and support statewide for members who qualify for both Medicare and Medicaid as well as duly eligible MLTSS members.

在業務發展方面，自今年年初以來，我們已贏得多項重要的醫療補助合同，凸顯了我們獨特服務模式的優勢和競爭力。Centene 被伊利諾伊州選中，透過完全整合的 D-SNP 繼續為符合條件的成員提供醫療保險和醫療補助服務。D-SNP 計劃將為全州範圍內符合 Medicare 和 Medicaid 資格的會員以及符合資格的 MLTSS 會員提供服務和支援。

The state of Nevada, our Silver Summit Health Plan has once again been selected by the Nevada Department of Health and Human Services to serve its Medicaid managed care program. For the first time, the program will include expansion of Medicaid managed care into rural and frontier service areas, allowing us to grow our footprint across the state. These wins are testimony to Centene's expertise in both high and low acuity populations, making us a partner of choice in states across the nation.

內華達州，我們的 Silver Summit Health Plan 再次被內華達州衛生與公眾服務部選中，為其醫療補助管理式醫療計劃提供服務。該計劃將首次將醫療補助管理式醫療擴展到農村和邊境服務區，使我們能夠擴大在全州的覆蓋範圍。這些勝利證明了 Centene 在高敏銳度和低敏銳度人群方面的專業知識，使我們成為全國各州的首選合作夥伴。

Our Medicare segment performed in line with expectations during the quarter, as we advance our Medicare Advantage business on a path toward breakeven in 2027 and manage the evolution of Medicare Part D amidst significant program changes due to the Inflation Reduction Act.

我們的醫療保險部門在本季度的表現符合預期，我們推動醫療保險優勢業務在 2027 年實現收支平衡，並在通貨膨脹削減法案導致的重大計劃變化中管理醫療保險 D 部分的演變。

As you saw from this morning's press release, we have added $1 billion of annual revenue to our outlook for 2025 as Medicare Advantage membership is shaping up to be a little stronger than we previously anticipated.

正如您從今天早上的新聞稿中看到的那樣，由於醫療保險優勢計劃 (Medicare Advantage) 的會員資格比我們之前預期的要強勁一些，我們在 2025 年的展望中增加了 10 億美元的年收入。

This better-than-expected membership is being driven by improved retention, and we are pleased to be able to attract and retain lives through our strengthening Medicare value proposition. As we plan for 2026, we were pleased to see the inclusion of more recent claims data in the final 2026 Medicare Advantage rate calculation, resulting in rates that better reflect the medical cost trend we've seen in MA over the last two years.

會員人數優於預期是由於保留率的提高，我們很高興能夠透過加強醫療保險價值主張來吸引和留住會員。在我們規劃 2026 年時，我們很高興看到在最終的 2026 年醫療保險優勢費率計算中納入了更多最新索賠數據，從而使費率更好地反映了我們在過去兩年中在馬薩諸塞州看到的醫療成本趨勢。

There will still be gaps to close between rate and cost across certain geographies, but this step forward was important as we look to deliver valuable benefits to seniors and return our business to breakeven in 2027.

某些地區的費率和成本之間仍存在差距，但這一進步至關重要，因為我們希望為老年人提供有價值的福利，並在 2027 年實現業務收支平衡。

In addition to rate, the critical levers we are pulling to drive to breakeven in Medicare Advantage are Stars results, value-based clinical initiatives and operational efficiency through SG&A reductions. On the Stars front, we continue to see momentum.

除了費率之外，我們為實現醫療保險優勢計劃的收支平衡而採取的關鍵槓桿是星級結果、基於價值的臨床計劃以及透過降低銷售、一般和行政費用而實現的營運效率。在星光方面，我們繼續看到強勁勢頭。

And while a number of components remain outstanding, we are projecting underlying improvement across chapters. That said, we are conscious of the fact that cut points, or the relationship between absolute scores and corresponding star ratings have become more difficult due to recent methodology changes and variability in competitor performance.

儘管許多部分仍未解決，但我們預計各個章節都會出現根本性的改善。話雖如此，我們意識到，由於最近方法的變化和競爭對手錶現的變化，分數線或絕對分數與相應星級之間的關係變得更加困難。

With that in mind, we took on the challenge to derisk our Stars outcomes for 2027 and to build a plan that supports our 2027 breakeven trajectory across the range of projected outcomes expected this October.

考慮到這一點，我們接受了挑戰，降低 2027 年 Stars 結果的風險，並製定了一項計劃，以支持我們 2027 年在 10 月預計的一系列預測結果中實現收支平衡軌跡。

Through the identification of cost-saving opportunities and operational levers, we have increased confidence in our ability to generate breakeven results in 2027 with our current Star ratings where 55% of members in 3.5-star plans, with improvements on those results giving us increased flexibility and potential upside in our breakeven path.

透過識別成本節約機會和營運槓桿，我們對自己在 2027 年實現收支平衡的能力更加有信心，我們目前的星級評定為 55% 的會員採用 3.5 星計劃，這些結果的改善為我們在收支平衡道路上提供了更大的靈活性和潛在的上升空間。

As always, rates for 2027 will be an important input, and we will continue to advocate for program funding that supports the critical healthcare needs of Medicare Advantage beneficiaries across the country.

與往常一樣，2027 年的費率將是一個重要輸入，我們將繼續倡導支持全國醫療保險優勢計劃受益人的關鍵醫療保健需求的計劃資金。

Finally, our Commercial segment, which includes our Marketplace business, grew nicely during the first quarter as new enrollment and retention were both stronger than previously anticipated. The impact we experienced relative to the reintroduction of integrity programs like failure to reconcile, or STR, was more muted in the period than we originally forecasted, contributing to better-than-expected member retention.

最後，我們的商業部門（包括我們的市場業務）在第一季實現了良好的成長，因為新註冊量和保留量都高於先前的預期。相對於重新引入誠信計劃（如未能協調或 STR），我們在此期間所經歷的影響比我們最初預測的要小，這導致會員保留率比預期好。

This membership strength is reflected in the full-year revenue increase we issued earlier this morning. Recent CMS guidance suggests that ultimate STR notifications and actions won't be taken until this summer, suggesting we won't see the full impact of this member shift until Q3. As a reminder, we have these, and other seasonal member attritions already baked into our full-year forecast.

我們今天早上發布的全年收入成長反映了會員人數的強勁成長。最近的 CMS 指南表明，最終的 STR 通知和行動要到今年夏天才會採取，這意味著我們要到第三季才能看到這一成員轉變的全部影響。提醒一下，這些以及其他季節性會員流失情況已納入我們的全年預測。

The other policy news, CMS issued the marketplace integrity and affordability proposed rule last month, including standards for the health insurance marketplaces as well as for health insurers, brokers, and agents who connect millions of consumers to affordable individual coverage. We are engaging with CMS on these policy proposals and working to model the potential impact of each component.

另一項政策新聞是，CMS 上個月發布了市場誠信和可負擔性建議規​​則，其中包括針對健康保險市場以及為數百萬消費者提供可負擔個人保險的健康保險公司、經紀人和代理人的標準。我們正在與 CMS 就這些政策提案進行合作，並努力模擬每個組成部分的潛在影響。

The only major provision that would impact 2025 would be the discontinuation of the continuous SAP for members below 150% of the FPL. The rest, depending on what gets finalized, would influence market and membership dynamics beginning in 2026. With respect to enhanced ABTCs, we remain optimistic that legislators will act to preserve these tax credits given the value they create in health outcomes and market stability.

唯一會對 2025 年產生影響的主要條款是停止對收入低於聯邦貧窮線 150% 的成員實施持續性退休金計畫 (SAP)。其餘內容取決於最終確定的內容，將從 2026 年開始影響市場和會員動態。關於增強型 ABTC，我們仍然樂觀地認為，立法者將採取行動保留這些稅收抵免，因為它們在健康結果和市場穩定方面創造了價值。

But we are preparing for a range of potential outcomes as we establish plans for marketplace pricing and product positioning in 2026. While there are a number of factors that could impact the marketplace operating landscape over the next year, as a category leader in this business, we look forward to navigating the near-term dynamics from a position of strength and recalibrating our book with a focus on margin and long-term profitable growth.

但在製定 2026 年市場定價和產品定位計畫時，我們正在為一系列可能的結果做好準備。雖然有許多因素可能會影響未來一年的市場營運格局，但作為該行業的領導者，我們期待從優勢地位出發，把握短期動態，並重新調整我們的帳簿，重點關注利潤率和長期盈利增長。

Stepping back, as we survey the performance of our diversified portfolio, we are pleased to reiterate our full year 2025 adjusted EPS outlook of greater than $7.25 and a mid-sector volatility that is unmatched in recent history. With three months under our belt, we are prudently guiding with an element of conservatism to acknowledge at this early stage in the year, the many moving parts we are managing.

回顧一下，當我們調查多元化投資組合的表現時，我們很高興地重申我們對 2025 年全年調整後每股收益的預期，即每股收益超過 7.25 美元，並且中期行業波動性在近代歷史上是無與倫比的。經過三個月的努力，我們以謹慎和保守的態度對待今年年初面臨的諸多問題。

We remain excited by our long-term trajectory, including the attractiveness of our end markets, our positioning to capture meaningful market share and the associated earnings power and the exceptional Cent team that is mobilized and executing against these opportunities, committed to delivering value to our shareholders and transforming the health of the communities we serve one person at a time.

我們對我們的長期發展軌跡感到興奮，包括我們終端市場的吸引力、我們佔據有意義的市場份額的定位和相關的盈利能力，以及為抓住這些機會而動員和執行的卓越 Cent 團隊，致力於為我們的股東創造價值並改變我們所服務的社區的健康狀況。

With that, I'll turn it over to Drew to cover the quarter and full year view in more detail.

接下來，我將把主題交給 Drew，讓他更詳細地介紹本季和全年的情況。

Thank you, Sarah. Today, we reported first-quarter 2025 results, including strong premium and service revenue of $42.5 billion and adjusted diluted earnings per share of $2.90 in the quarter, a good start to 2025.

謝謝你，莎拉。今天，我們公佈了 2025 年第一季的業績，包括強勁的 425 億美元保費和服務收入以及本季 2.90 美元的調整後稀釋每股收益，為 2025 年開了個好頭。

While we manage the company as a diversified portfolio, let's go segment by segment for some insights of how we've been able to manage various tailwinds and headwinds to yield a strong aggregate result so far in 2025. Medicaid membership was stable and right in line with our expectation of 12.9 million to 13 million members. The Medicaid HBR, excluding excess influenza related costs, was approximately 93%, showing some progress compared to 93.4% in Q4 of 2024.

雖然我們將公司作為多元化投資組合進行管理，但讓我們逐一細分，了解我們如何能夠管理各種順風和逆風，從而在 2025 年迄今為止取得強勁的整體業績。醫療補助會員人數保持穩定，符合我們預期的 1,290 萬至 1,300 萬名會員人數。不包括超額流感相關費用的醫療補助 HBR 約為 93%，與 2024 年第四季的 93.4% 相比有所進步。

You'll see the print at 93.6%, including about $130 million of Q1 influenza-related cost above our expectations. At a conference in March, we had also cited $130 million of excess influenza costs through February, and consistent with CDC data, influenza settled down as we got into March.

您將看到列印率為 93.6%，其中包括第一季流感相關成本約 1.3 億美元，超出我們的預期。在 3 月的一次會議上，我們還提到了 2 月份流感超額成本為 1.3 億美元，與 CDC 數據一致，進入 3 月份，流感疫情穩定下來。

Fundamentally, we continue to make progress matching rates and acuity. The key word being progress, not completion. For instance, a 4:1 rate cycle representing about 11% of Medicaid revenue yielded an approximate 5% rate increase, those still inadequate for that 4-1 cohort in areas such as an LTC, home and community-based services, and emerging high-cost drugs.

從根本上來說，我們在匹配率和敏銳度方面繼續取得進展。關鍵字是進步，而不是完成。例如，4:1 的費率週期約佔醫療補助收入的 11%，其費率成長了約 5%，但對於長期照護、家庭和社區服務以及新興高成本藥物等領域的 4-1 群體來說，這些成長仍然不足。

So progress, but more work to do as we get through 2025 and into 2026. On our entire Medicaid book, we are projecting a full year composite rate increase at 4%-plus. Medicare Advantage and PDP both outperformed on membership. We retained more membership than expected during the Medicare Advantage open enrollment period, which bodes well for long-term earnings power. This is contributing $1 billion to our 2025 premium and service revenue guidance increase.

所以，我們取得了進步，但在 2025 年和 2026 年，我們還有很多工作要做。就我們的整個醫療補助計劃而言，我們預計全年綜合費率將增加 4% 以上。Medicare Advantage 和 PDP 在會員數方面均表現出色。在醫療保險優勢計劃開放註冊期間，我們保留的會員人數超出預期，這對長期盈利能力來說是個好兆頭。這將為我們 2025 年保費和服務收入預期成長貢獻 10 億美元。

PDP ended the quarter at 7.9 million members, strong growth from 2024. Medicare segment HBR was 86.3% in the quarter, which, as we covered in past discussions, is expected to follow an inverted slope line compared to 2024 due to the Inflation Reduction Act program changes. So a lower Medicare segment HBR and higher earnings early in the year and a higher HBR and lower earnings later in the year.

本季末，PDP 會員數達 790 萬，較 2024 年強勁成長。本季度醫療保險部門的 HBR 為 86.3%，正如我們在過去的討論中所述，由於《通膨削減法案》計劃的變化，預計與 2024 年相比，該比例將呈現倒斜率線。因此，年初醫療保險部門的 HBR 較低，收益較高，而年末的 HBR 較高，收益較低。

Within the Medicare segment, both Medicare Advantage and PDP businesses were on track in the quarter. And you'll see an intra-year increase in the Medicare Advantage PDR, premium deficiency reserve, that was planned for and is solely related to the sloping of earnings during 2025.

在醫療保險領域，醫療保險優勢計劃和 PDP 業務在本季均進展順利。您將看到醫療保險優勢計劃 PDR（保費缺口準備金）在年內有所增加，這是計劃中的，並且僅與 2025 年的收入傾斜有關。

So no change in our view of Medicare Advantage earnings for 2025. Commercial membership was very strong in the quarter, not just during open enrollment for 1/1, but also in February and March. Q1 Commercial segment HBR at 75.0% was a little higher than last year's 73.3%, driven by 1.9 million new marketplace members in Q1.

因此，我們對 2025 年醫療保險優勢計劃收益的看法並沒有改變。本季度商業會員數量非常強勁，不僅在 1/1 開放註冊期間，而且在 2 月和 3 月也是如此。第一季商業部門的 HBR 為 75.0%，略高於去年的 73.3%，這得益於第一季 190 萬名新市場成員。

These members are utilizing a little more than last year's new members. But because it's so early in the year, we are not yet recognizing a matching offset for risk adjustment. We'll know more when we get the first Wakely file in late June, early July.

這些成員的利用率比去年的新成員略高一些。但由於今年還處於初期階段，我們尚未確認風險調整的匹配抵銷。當我們在六月底七月初收到第一個 Wakely 文件時，我們就會知道更多。

Given top-line performance in Q1, and even as we forecast net membership attrition throughout the rest of the year, we are adding $5 billion of premium revenue to 2025 guidance related to marketplace.

鑑於第一季的營收表現，即使我們預測今年剩餘時間的會員淨流失率會有所上升，我們也將在 2025 年市場相關指引中增加 50 億美元的保費收入。

Moving to other consolidated P&L and balance sheet items. Our adjusted SG&A expense ratio was 7.9% in the first quarter compared to 8.7% last year, which decreased due to continued leveraging of expenses over higher revenues and good discipline. Cash flow provided by operations was $1.5 billion for Q1, primarily driven by net earnings.

轉向其他合併損益表和資產負債表項目。我們在第一季度調整後的銷售、一般及行政費用率為 7.9%，而去年同期為 8.7%，由於繼續利用費用來抵消更高的收入和良好的紀律，費用率有所下降。第一季經營活動產生的現金流為 15 億美元，主要由淨收益推動。

Our debt-to-adjusted EBITDA was 2.8 times at quarter end. Our medical claims liability totaled $19.9 billion for Q1 and represents 49 days in claims payable; a decrease of four days as compared to the fourth and first quarters of 2024, driven by significant revenue growth in the PDP business.

季度末我們的債務與調整後 EBITDA 比率為 2.8 倍。我們第一季的醫療索賠責任總額為 199 億美元，相當於 49 天的索賠應付；與 2024 年第四季和第一季相比減少了四天，這得益於 PDP 業務收入的大幅成長。

The decrease in days was expected given the mix impact of our PDP business, which will be a $16 billion-plus business in 2025 versus $5.2 billion last year. As I'm sure you know, pharmacy claims complete much faster than medical claims, causing the mix-related mathematical reduction to DCP. Looking at the full year, we are pleased to reiterate greater than $7.25 of adjusted diluted EPS.

考慮到我們的 PDP 業務的混合影響，預計天數將減少，到 2025 年，該業務的規模將超過 160 億美元，而去年為 52 億美元。我相信您知道，藥房索賠的完成速度比醫療索賠快得多，從而導致與混合相關的 DCP 數學減少。縱觀全年，我們很高興重申調整後的稀釋每股收益超過 7.25 美元。

As you've heard, the theme of the quarter was strong premium revenue growth and stronger-than-expected membership. Accordingly, we are increasing premium and service revenue guidance to a midpoint of $165 billion, up from $159 billion.

正如您所聽到的，本季的主題是強勁的保費收入增長和超出預期的會員數量。因此，我們將保費和服務收入預期從 1,590 億美元上調至 1,650 億美元的中點。

We are also recalibrating the consolidated HBR to reflect this growth and a couple of other items. 50 basis points is driven by: one, incremental Q1 growth in marketplace, with that growth assumed for now to be at a lower-than-average margin level; two, a full-year Medicaid HBR in the mid- to high 91s, inclusive of flu from Q1; and three, very high utilization of specialty drugs in non-low-income PDP members. While most of this is covered by the PDP demo risk corridor, some of it makes it to our P&L.

我們也正在重新調整合併的 HBR，以反映這一增長和其他一些項目。 50 個基點的成長動力來自以下因素：一是第一季市場增量成長，目前假設該成長處於低於平均水準的利潤率；二、全年醫療補助 HBR 在 91 年代中後期，包括第一季度的流感；三是非低收入 PDP 成員的特藥利用率非常高。雖然其中大部分都包含在 PDP 演示風險走廊中，但其中一部分還是計入了我們的損益表。

When coupled with SG&A outperformance in PDP, we are still on track for a PDP pretax margin in the 1%.

再加上 PDP 的銷售、一般及行政開支表現優異，我們仍有望達到 1% 的 PDP 稅前利潤率。

We are also lowering the consolidated adjusted SG&A ratio midpoint by 45 basis points given strong performance in Q1 and based upon our 2025 growth and mix of business. And we lowered investment income by $100 million as we re-forecasted cash balances and calibrated potential rate cuts.

鑑於第一季的強勁表現以及基於我們 2025 年的成長和業務組合，我們還將合併調整後的銷售、一般和行政費用比率中點降低 45 個基點。由於我們重新預測了現金餘額並調整了潛在的降息幅度，因此投資收入降低了 1 億美元。

So on track for 2025 at this early point in the year, with a very strong top line creating attractive long-term earnings power. Now a few educational comments on 2026, since much of what we do in 2025 sets us up for success in 2026.

因此，從今年年初開始，我們就已經步入了 2025 年的軌道，擁有非常強勁的營收，創造了具有吸引力的長期盈利能力。現在針對 2026 年提出一些有教育意義的評論，因為我們在 2025 年所做的許多事情都為我們在 2026 年取得成功奠定了基礎。

On Marketplace, there are two items that, if finalized, would impact the 2026 market size and risk pool that need to be reflected in 2026 pricing. Potential expiration of the eAPTCs is one that we've discussed heretofore. The second item, as Sarah mentioned, is the new Marketplace integrity and affordability proposed rule released in March with provisions that would impact 2026.

在市場上，有兩項內容如果最終確定，將影響 2026 年的市場規模和風險池，需要反映在 2026 年的定價中。我們之前已經討論過 eAPTC 可能到期的問題。第二項，正如莎拉所提到的，是 3 月發布的新的市場誠信和可負擔性擬議規則，其中的條款將影響 2026 年。

Looking at actuarial studies, these two items combined may cause high single-digit price increases, and that's before, before any baseline trend adjustments, pricing forward trend for 2026 and potential tariffs. While the proposed rule changes seem likely to get implemented, we are still optimistic about lawmakers seeing the merits of continuing eAPTCs, and over half of our states have agreed to accept two sets of rates, one with enhanced APTCs and one without, in case there's clarity by July.

從精算研究來看，這兩項加起來可能會導致價格出現高個位數上漲，而且這還是在任何基線趨勢調整、2026 年定價趨勢和潛在關稅之前。雖然擬議的規則變更似乎有可能得到實施，但我們仍然對立法者看到繼續實行 eAPTC 的優點持樂觀態度，並且我們超過一半的州已經同意接受兩套稅率，一套是增強型 APTC，一套沒有，以防 7 月份情況明朗。

So rest assured, we are on top of adequately pricing for these matters. PDP, the high specialty drug trend, being partly driven by pharmacy industry behavior will need to be reflected in 2026 bids, along with the assumption that the demo risk corridor, will not be repeated at the same protective level. And we'll also be thinking about potential tariff impacts when making bid decisions.

所以請放心，我們能夠為這些問題提供合理的定價。PDP，即高度專業化藥物趨勢，部分受製藥業行為驅動，需要在 2026 年的競標中得到體現，同時假設演示風險走廊不會在相同的保護水平上重複。在做出投標決定時，我們也會考慮潛在的關稅影響。

Remember, our discussions last year about the PDP direct subsidy substantially rising in 2025 due to forecasted IRA dynamics, that landed right where we thought it would. No, we expect another year of a large direct subsidy increase maybe to over $200 compared to this year's $142 because of the intentional and maybe unintentional cost consequences of the IRA.

請記住，我們去年討論過，由於預測的 IRA 動態，PDP 直接補貼將在 2025 年大幅增加，而這一結果與我們預想的完全一致。不，我們預計，由於 IRA 有意或無意造成的成本後果，直接補貼明年將大幅增加，可能超過 200 美元，而今年為 142 美元。

So again, we are focused on making adequate pricing moves, coupled with a higher PMPM yield as we think about being responsible in our 2026 decisions being made in the next month or two. We are very pleased to deliver a strong Q1 and more earnings power for the future.

因此，我們再次專注於做出適當的定價舉措，同時提高 PMPM 收益率，因為我們考慮在未來一兩個月內對 2026 年的決策負責。我們非常高興看到第一季業績表現強勁，並且未來獲利能力將進一步增強。

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

感謝您對 Centene 的關注。羅科，請開始提問。

(Operator Instructions) Josh Raskin, Nephron Research.

（操作員指示）Josh Raskin，Nephron Research。

I was wondering if you could just give some more details about the flu-related costs that you cited specifically if you're seeing more physician visits, I'm assuming primary care and maybe even a specialty. And how confident are you that these are flu related and not related to some uptick in trend that could lead to downstream utilization. And I want to make sure all of that was contained in Medicaid, you're not seeing any of that in the Medicare book, correct?

我想知道您是否可以提供一些有關流感相關費用的更多細節，特別是如果您看到更多的醫生就診，我假設是初級保健，甚至是專科醫療。您有多大信心認為這些與流感有關，而與可能導致下游利用的某些趨勢上升無關。我想確保所有這些都包含在醫療補助計劃中，你在醫療保險手冊中沒有看到任何這些內容，對嗎？

Thanks for the question. So the $130 million that we saw above expectations in Q1 in Medicaid is a result of very closely tracking. So we have a clear and consistent definition for flu and what we call ILI or influenza-like illnesses and that is what drove the $130 million. Again, it's a consistent code set that we've used over the last eight years. We also look at sort of flu-related illnesses.

謝謝你的提問。因此，我們看到第一季醫療補助支出超出預期 1.3 億美元，這是密切追蹤的結果。因此，我們對流感以及所謂的 ILI 或流感樣疾病有一個明確一致的定義，這也是我們投入 1.3 億美元的原因。再次強調，這是我們過去八年來一直使用的一致代碼集。我們也研究與流感相關的疾病。

We don't include that in the calculation, but it does support the view that obviously CDC reported this was the most acute flu season the country seen in the last 15 years, and we saw both in sort of core flu utilization and then sort of knock-on effect.

我們沒有將其納入計算，但它確實支持了這樣的觀點：顯然，疾病預防控制中心報告稱，這是該國過去 15 年來最嚴重的流感季節，我們看到了核心流感利用率和連鎖反應。

But again, that $130 million is isolated to our standard flu definition. We did see some flu in Marketplace and in Medicare, but not the same as the $130 million that we saw in Medicaid and then obviously saw that trail consistent with the national trajectory pretty hard down in March. And so, we think that is isolated to a Q1 item.

但同樣，這 1.3 億美元與我們的標準流感定義無關。我們確實在市場和醫療保險方面看到了一些波動，但與我們在醫療補助中看到的 1.3 億美元不同，顯然看到這一軌跡與 3 月的國家軌跡一致。因此，我們認為這與 Q1 項目無關。

Got it. If I could just sneak in. I didn't hear a commentary around the long-term embedded earnings. I think you've talked about $3 to $4 in the past. I just wanted to make sure that was consistent, especially in light of your comments around MA getting to breakeven even without the Stars improvement.

知道了。如果我能偷偷溜進去就好了。我沒有聽到有關長期內含收益的評論。我認為您過去曾談論過 3 到 4 美元。我只是想確保這是一致的，特別是考慮到您關於 MA 即使沒有 Stars 改進也能實現收支平衡的評論。

Yeah. No. Clearly, there's still opportunity to expand Medicaid margins. That's clear based upon the current HBR and what we're forecasting for this year. Still excited about, and even actually probably more optimistic about the ability to get to breakeven.

是的。不。顯然，仍有機會擴大醫療補助的利潤。根據目前的 HBR 和我們對今年的預測，這一點很明顯。仍然對實現收支平衡的能力感到興奮，甚至實際上可能更加樂觀。

And depending on the levers we can pull, the Stars results and then the 2027 Medicare revenue maybe even beyond that. So that still holds. And then PDP, we're still on that 1%-ish area in pretax for this year. Even with a little bit of pressure or a fair amount of pressure in non-low-income specialty costs, we're making that up in SG&A. So that still presents an opportunity for margin expansion.

並且，根據我們可以採取的措施，Stars 的結果以及 2027 年醫療保險收入甚至可能超越這一水準。所以這仍然成立。然後是 PDP，今年我們的稅前利潤仍處於 1% 左右的範圍內。即使在非低收入專業成本方面面臨一點壓力或相當大的壓力，我們也會在銷售、一般及行政費用方面彌補這一壓力。因此這仍然為利潤率的擴大提供了機會。

On top of that, we just added $6 billion more in revenue, which is exciting to think about the earnings power of that over the next few years.

除此之外，我們的收入剛剛增加了 60 億美元，想想未來幾年的獲利能力就令人興奮。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Maybe just to ask a couple of the Washington related questions. I know at the Investor Day, you guys had sized your estimate of what the headwind would be if the public exchange subsidies -- enhanced subsidies were to go away at about $1 a share. You've mentioned some new things today, and I really wasn't clear whether the tariff comment was related to public exchanges somehow. But is that dollar still a good number? Or how has your thinking evolved on that if it has at all?

也許只是想問幾個與華盛頓有關的問題。我知道在投資者日，你們已經估計瞭如果公共交易所補貼——增強補貼以每股 1 美元左右的價格取消，將會帶來什麼樣的不利影響。您今天提到了一些新的事情，我真的不清楚關稅評論是否與公開交流有關。但這美元還是一個好數字嗎？或者，如果有的話，您對此的想法是如何演變的？

And then you also mentioned the work rules, which do seem to be something that a lot of these guys are talking about. I wondered just conceptually how to think about that? If plans are asked to be the ones that sort of get the asset stations about whether people are adhering to the work rules, et cetera -- work rule requirements, et cetera, how much of a burden would that be? And how impactful would something like that be on the business, you think?

然後你也提到了工作規則，這似乎是很多人在談論的事情。我只是從概念上想知道該如何思考這個問題？如果要求計劃成為獲取資產站的計劃，了解人們是否遵守工作規則等 - 工作規則要求等，那將是多麼大的負擔？您認為這樣的事情會對業務產生多大影響？

Yeah. Thanks, A.J. Great questions. So the dollar is still good relative to the view of enhanced eAPTCs. We're working through the process of sizing the elements that came out in the proposed rule for marketplace and obviously interfacing with CMS and providing feedback.

是的。謝謝，A.J.很好的問題。因此，從增強型 eAPTC 的角度來看，美元仍然表現良好。我們正在對市場擬議規則中提出的要素進行規模調整，顯然要與 CMS 互動並提供回饋。

So as we see what gets finalized and for what period of time, I think we can provide an update on the interplay of those provisions with the enhanced eAPTCs. Obviously, we'll have hopefully increased visibility on what's going to happen with the enhanced eAPTCs as we get into Q2 and the Q3 time frame based on belief that either through reconciliation or through the government funding vehicles that Congress will act on the extension of those.

因此，當我們了解最終確定的內容和期限時，我認為我們可以提供有關這些條款與增強型 eAPTC 相互作用的最新資訊。顯然，隨著我們進入第二季度和第三季度，我們希望能夠更清楚地了解增強型 eAPTC 的進展情況，因為我們相信，無論是透過和解還是透過政府資助工具，國會都會採取行動延長這些計劃。

So more to come, but we're obviously watching that closely and sizing both the potential impact and the interplay. Relative to work requirements, these, as you know, are not new. We have work requirements in some of our states today.

未來還會有更多，但我們顯然正在密切關注並評估其潛在影響和交互作用。相對於工作要求，這些，正如你所知，並不是什麼新鮮事。今天，我們的一些州有工作要求。

We've also seen them come and, frankly, go in our states over the years. And based on that experience, really, a lot depends on what the ultimate framework is and the definition of able-bodied adults and what the carve-outs are. And so we really would expect a high degree of variability in how they -- and if they settle out at the state level, which again is not new for us, right?

坦白說，這些年來，我們也看到他們在我們的州來來去去。根據這項經驗，實際上，很多事情取決於最終的框架是什麼、健全成年人的定義是什麼以及有哪些豁免。因此，我們確實預計，他們的解決方式和在州一級的解決方式將有很大的差異，這對我們來說也不是什麼新鮮事，對吧？

We operate in 31 states for Medicaid, which means the programs are all different. We're very used to sort of tracking these changes on the horizon and then working closely with our state partners to understand how they would implement them.

我們在 31 個州開展醫療補助計劃，這意味著每個州的計劃都不同。我們非常習慣追蹤這些即將發生的變化，然後與我們的州合作夥伴密切合作，了解他們將如何實施這些變化。

And we've seen different levels of dependency or expectation relative to MCOs involvement in that process. We think there's a great opportunity to lean in there and map out state-by-state ways that we can ensure that members continue to have access to critical healthcare resources. So our teams are already at work on that process in anticipation of what may or may not come on the work requirements front.

我們已經看到了對於 MCO 參與該過程的不同程度的依賴性或期望。我們認為，這是一個很好的機會，我們可以利用這一點，並制定各州各自的方案，確保會員能夠繼續獲得關鍵的醫療保健資源。因此，我們的團隊已開始著手進行此流程，以預測工作需求方面可能出現或可能不出現的情況。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Just talking on the exchanges. The risk adjustment numbers have been bouncing around for a lot of your peers. I believe Wakely just gave an update there. Curious what -- how Wakely's numbers kind of look versus yours? Were you able -- did you move your risk adjustment around much in the quarter versus year-end for 2024?

只是在交流中談論。對於許多同行來說，風險調整數字一直在波動。我相信韋克利剛剛在那裡提供了最新消息。好奇的是——Wakely 的數字與你的數字相比如何？您是否能夠—您是否在 2024 年季度與年底之間大幅調整了風險調整？

And then that number does look kind of different than what it did in the end of '23 versus '24. Just curious how you see your risk pool changing? It looks like your payable was down pretty meaningfully.

這個數字看起來與 23 年底和 24 年底的數字確實有些不同。只是好奇您如何看待您的風險池變化？看起來您的應付款項下降得相當明顯。

Yeah. Actually, if you -- I know it's early. If you pull out the 10-Q we just filed, there's very good consistency, almost exact consistency when you look at Q4 '24 versus where we ended up in Q1, and the Wakely data that we get continual updates on relative to the 2024 year was very consistent with our estimates. So good -- nothing sort of out of line in the quarter relative to our estimates at year-end for where we think we're going to end up for 2024. So pleased with that.

是的。實際上，如果你——我知道現在還早。如果你拿出我們剛提交的 10-Q 報表，你會發現一致性非常好，當你查看 2024 年第四季度與第一季的最終結果時，幾乎完全一致，而且我們不斷更新的相對於 2024 年的 Wakely 數據與我們的估計非常一致。非常好——相對於我們在年底對 2024 年的預測，本季沒有任何異常。我對此非常滿意。

The real question is going to be the utilization we're seeing in our new business, our 1.9 million members, some of that does look consistent with what should show up in 2025 risk adjustment. We think we're being prudent, sort of waiting to see if that's going to be the case when we get our first review of 2025 risk adjustment data, which comes at the end of June, early July for that first Wakely data dump for the industry.

真正的問題是我們在新業務中看到的利用率，我們的 190 萬會員，其中一些確實與 2025 年風險調整中出現的情況一致。我們認為我們很謹慎，正在等待看當我們第一次審查 2025 年風險調整數據時是否會出現這種情況，該數據將於 6 月底或 7 月初發布，屆時將首次向該行業提供 Wakely 數據。

Ann Hynes, Mizuho Securities.

瑞穗證券的安‧海因斯 (Ann Hynes)。

I know you gave original guidance from Medicaid rates in the second half. You assumed, I believe, around the 2.5% rate increase. Is that still the case? And do you have increased visibility on how those negotiations are going for the second half? That would be my first question.

我知道您在下半年給出了醫療補助費率的原始指引。我相信，您假設利率會上漲 2.5% 左右。現在還是這樣嗎？您對下半年談判的進度是否有了更清楚的了解？這是我的第一個問題。

And then maybe secondly, with Medicaid besides the flu, is anything running harder than you expected when you -- versus when you gave original guidance?

其次，除了流感之外，醫療補助計劃是否還有比您最初給予指導時預期的更難的事情？

Thanks, Ann, for the question. So composite rate for the full year, we're now seeing at mid-4s, and the rate negotiations relative to upcoming, so think about the 7/1 cohort, which is the next cycle, we will start to get visibility into that as we get in later into Q2.

謝謝安提出這個問題。因此，我們現在看到的全年綜合利率為 4% 左右，而且利率談判即將到來，因此考慮一下 7/1 群體，也就是下一個週期，隨著進入第二季度後期，我們將開始了解這一點。

So more to come on that front. But as you heard me say, I think we're seeing good, continued momentum in our discussions with state partners. And the fact that as we roll forward, we have further completion data behind us in terms of the acuity patterns that started to emerge in Q2 right around this time last year.

關於這方面還有更多內容。但正如您所聽到的，我認為我們在與國家合作夥伴的討論中看到了良好且持續的勢頭。事實上，隨著我們不斷前進，我們獲得了進一步的完成數據，這些數據反映了去年第二季左右開始出現的敏銳度模式。

So that helps bolster the conversation in terms of supporting the actuarial calculus, and I think helps in conversations with the state. So obviously, looking to that 7/1, 9/1, and 10/1 cohort to contribute to the back half of the year. And then I think you asked about Medicaid utilization beyond flu. And so we continue to see largely the same themes. But Drew, maybe you want to click into a few of those.

因此，這有助於加強在支持精算計算方面的對話，我認為這有助於與國家的對話。因此，顯然，我們希望 7/1、9/1 和 10/1 群體能夠為下半年做出貢獻。然後我想您問的是流感以外的醫療補助利用。因此，我們繼續看到大致相同的主題。但是德魯，也許你想點擊其中的幾個。

Yeah. No, clearly, we had the flow of $130 million in Q1. That's transitory. Behavioral health continues to be a trend item. We've mentioned that probably for the last six quarters.

是的。不，顯然，我們在第一季的流量為 1.3 億美元。這只是暫時的。行為健康仍然是一個趨勢。我們可能在過去六個季度中提到過這一點。

We've got initiatives to tackle that and working with our state partners, things like applied behavioral analysis. I guess, no surprise coming out of the pandemic era. There's pockets of home health. We've mentioned that before, things like attended services that where we can tighten UM, do some audits. And then probably the area of uptick is high-cost drugs.

我們已採取措施解決這個問題，並與我們的國家合作夥伴合作，進行應用行為分析等工作。我想，疫情時代結束也就不足為奇了。有一些家庭保健措施。我們之前提到過，例如我們可以加強 UM 的服務，做一些審計。那麼可能上漲的領域是高成本藥品。

An example might be Elevidys, which curiously is a $3.2 million single treatment drug that -- if you read the GAMA articles, it's questionable in terms of the efficacy. And looking at -- we're all trying to keep healthcare affordable. That seems quite extreme for a cost of a single treatment for a newly approved drug last year. So that's an area of uptick that effectively is on the back of the federal and state governments and us as a payer. So that's one thing we're watching, and we thought about that as we lifted the Medicaid HBR into the mid- to high 91s from our previous guidance.

一個例子可能是 Elevidys，奇怪的是，它是一種價值 320 萬美元的單一治療藥物——如果你讀過 GAMA 文章，你會發現它的療效值得懷疑。看看吧——我們都在努力讓醫療費用保持可負擔的水平。對於去年新批准的藥物的單一治療費用來說，這似乎相當高昂。因此，這一成長領域實際上得益於聯邦政府、州政府以及我們作為付款人的努力。這是我們正在關注的一件事，我們在將醫療補助 HBR 從先前的指導中提升到 91% 左右時也考慮到了這一點。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

I was just hoping if you could help us understand a little bit better how you're thinking about the progression of Medicaid MLR throughout the balance of the year. I know you mentioned that I think you had 11% of your rates in the second quarter, and I know you some rate updates there. But it looks like you have a lot of work to do to get even the exit rate MLR down to the level that you've now guided to for the full year.

我只是希望您能幫助我們更了解您對全年 Medicaid MLR 進展的看法。我知道您提到過，我認為您的第二季度利率為 11%，而且我知道您在那裡進行了一些利率更新。但看起來，要將退出率 MLR 降至您目前指導的全年水平，您還有很多工作要做。

So just trying to understand the progression and why we should be able to think about getting from 93% on the core in the first quarter to something probably in the 90% to 91% range for the fourth quarter to kind of make this all fit together? Thank you.

因此，只是想了解進展情況，以及為什麼我們應該能夠考慮從第一季的核心 93% 提高到第四季度的 90% 到 91% 左右，以使這一切融為一體？謝謝。

Yeah. Thanks, Stephen. Obviously, there are two key levers to the progression of the Medicaid MLR. The first is rates. And so I'll let Drew talk a little bit about the assumptions, both, again, sort of composite and then how that plays out in the back half.

是的。謝謝，史蒂芬。顯然，醫療補助 MLR 的進展有兩個關鍵槓桿。首先是利率。因此，我將讓德魯稍微談談這些假設，它們都是綜合的，然後談談它們在後半部分如何發揮作用。

But to my comments earlier, a lot of it has to do with the tenor of the conversations that we're having with the states, and the fact that we have sort of empirical evidence of the acuity shift. And we continue to have momentum if you look quarter over quarter over quarter in terms of those rates coming in to start to address the acuity dislocation.

但就我先前的評論而言，這在很大程度上與我們與各州對話的基調有關，而且我們掌握了敏銳度轉變的經驗證據。如果你看一下每季的利率變化，你會發現我們繼續保持勢頭，開始解決敏銳度錯位問題。

The other lever is obviously what we can do internally relative to clinical initiatives and thinking about the right network partners and ways to ensure that we are consistently interrogating our operating model to ensure that we're delivering high quality, but we're doing so at low cost.

另一個槓桿顯然是我們內部可以採取的與臨床計劃相關的措施，以及思考合適的網路合作夥伴和方法，以確保我們不斷審視我們的營運模式，以確保我們提供高品質的服務，但我們是以低成本做到這一點的。

And so we have maximum effort on that, that is always in place, but I think picked up through the course of last year, making sure that we are on top of all of those levers that we can pull internally and the coordination of that is really what drives the ultimate outcome.

因此，我們為此付出了最大的努力，而且始終如此，但我認為，我們在去年的努力有所提升，確保我們能夠掌握內部可以發揮的所有槓桿，而這些槓桿的協調才是真正推動最終結果的因素。

But Drew, do you want to talk more specifically about rates and progression?

但是德魯，你想更具體地談談費率和進展嗎？

Yeah, sure. And I'm sure you know this, but we've sort of managed the company as a diversified portfolio. So our goal is to hit the 88.9% to 89.5% consolidated HBR. Yes, we provide details underneath that, and we are driving to a mid- to high 91s for full year. And you're right, that takes some improvement progression.

是的，當然。我相信您知道這一點，但我們已經將公司作為多元化投資組合進行管理。因此我們的目標是達到 88.9% 到 89.5% 的合併 HBR。是的，我們提供了詳細信息，並且我們預計全年業績將達到 91% 左右。你說得對，這需要一些改進的進程。

The first half of this year being better than the second half of last year, and then the second half of this year being better than the first half of this year, partly driven by rates. If you do the math, our full year is actually 4%-plus. That's our full year goal for rates. That would -- you could do the algebra and figure out, we're betting on mid-3s. We'd probably be disappointed in the mid-3s in the back half of the year, but that's what we're betting on.

今年上半年的表現優於去年下半年，下半年的表現又優於上半年，部分原因是受到利率的推動。如果你算一下，我們全年的成長率其實是 4% 以上。這就是我們全年的利率目標。那－你可以做一下代數運算，算出來，我們押注 3 中段。我們可能會對下半年的中期表現感到失望，但這就是我們所押注的。

And then there's a number of levers where we're working with our state partners to not just for rates, but program changes. Actually, there's one state where it's likely we're going to get pharmacy management back after the state tried an experiment, and it didn't work. And there's other levers where we're working on behavioral health and home health and things I mentioned for the 4/1 cohort. So that together should give good lift in the back half of the year in Medicaid, and you'll be able to see that given the detail that we report.

然後，我們正在與州合作夥伴合作，不僅針對利率，還針對計畫變更，採取多種措施。實際上，有一個州嘗試過一項實驗，但沒有成功，我們很可能會重新獲得藥房管理權。我們也利用其他手段來改善行為健康和家庭健康，以及我之前提到的針對 4/1 群體的事情。因此，這些因素加在一起應該會為下半年的醫療補助帶來良好的提振，從我們報告的細節中您就能看到這一點。

Dave Windley, Jefferies.

戴夫·溫德利（Dave Windley），傑富瑞集團（Jefferies）。

I wanted to ask just a clarification to Justin's question. Drew in your answer, you talked about risk adjustment and where you think it would go. I think I know what you mean, but I just wanted to -- I don't want to assume. So do you think it should go risk -- in the risk pool should go up? Is that what you were implying?

我只是想澄清一下賈斯汀的問題。在您的回答中，您談到了風險調整以及您認為它會走向何方。我想我知道你的意思，但我只是想——我不想假設。那麼，您認為風險池中的風險應該上升嗎？這就是你所暗示的嗎？

And then the second question I had was around your membership growth, which looks very attractive. Could you talk about what percentage of your exchange book is fully subsidized. And if that was different during this first quarter SEP lift, if you could comment on that, too, please?

我的第二個問題是關於你們的會員成長情況，這看起來非常有吸引力。您能否談談您的兌換帳簿中有多少比例是完全補貼的？如果第一季 SEP 提升期間情況有所不同，您是否也可以對此發表評論？

Yeah. On the risk adjustment, yes, thanks for asking the clarification. I always welcome that. The -- if you look at our Q, we didn't really book -- our net payable or receivable didn't change from year-end. So in other words, we're not booking a big receivable on 2025 risk adjustment in the first quarter, even though we see diagnosis codes and utilization on that new membership that should yield some risk adjustment offset.

是的。關於風險調整，是的，感謝您的澄清。我對此始終表示歡迎。如果你看一下我們的 Q，我們並沒有真正入帳——我們的淨應付款項或應收款項與年底相比沒有變化。換句話說，儘管我們看到新會員的診斷代碼和利用率應該會產生一些風險調整抵消，但我們不會在第一季就 2025 年風險調整記入大筆應收帳款。

So we'll get more information on that. And hopefully, there's that opportunity, but we're not sort of betting on that with what we booked in Q1, given it's so early in the year. And then no issues with 2024 risk adjustment coming into this year.

因此我們將獲得更多有關此的資訊。希望有這樣的機會，但考慮到現在還處於年初階段，我們不會根據第一季的預訂情況來押注這個機會。那麼 2024 年風險調整在今年就不會出問題了。

And relative to membership, the vast majority of our membership is subsidized, which is consistent, always has been consistent with our focus on really serving the lowest income. Marketplace members seen as a sister population to Medicaid and sort of the natural hedge and synergistic services that is serving those two populations affords us. We do not see any major shift in the percentage of subsidized population coming into this OE and what we saw in Q1 in terms of strong growth.

就會員資格而言，我們的絕大多數會員都是補貼的，這與我們真正服務最低收入者的重點是一致的。市場成員被視為醫療補助的姊妹人群，為我們提供了為這兩個人群服務的自然對沖和協同服務。我們沒有看到進入該 OE 的補貼人口比例發生任何重大變化，並且我們在第一季看到了強勁的成長。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，費茲傑拉領唱者。

I wanted to clarify, when you talked about the new exchange lives coming on at a higher MLR. Are you talking about the dynamic of just new members not having trended to normal margins yet? Or is there something in the acuity or claims data that makes you think these new lives might be a higher MLR, lower margin outside of the traditional ramp? And how are you thinking about effectuation rate and where enrollment could end at the end of the year for exchanges?

當您談到新的交換生命將在更高的 MLR 下出現時，我想澄清一下。您說的是新成員的動態尚未趨向正常利潤嗎？或者敏銳度或索賠數據中是否存在某些內容讓您認為這些新生命可能會有更高的 MLR，傳統坡道之外的更低利潤率？您如何看待實施率以及交換生招生在年底何時結束？

Yeah, sure. So let me start with -- so effectuation rate in this -- in Q1 came in strong, sort of at the higher end of our expected range, but generally in the same neighborhood as we normally see. We actually saw meaningfully higher renewal rates this year, which is awesome. That's a result of focused effort from our Ambetter team. And so really pleased to see those results.

是的，當然。首先，第一季的實現率表現強勁，處於我們預期範圍的高端，但總體上與我們通常看到的水平大致相同。事實上，我們今年的續約率明顯提高，這真是太棒了。這是我們 Ambetter 團隊專注努力的成果。看到這些結果真的很高興。

We are still projecting the same trajectory of membership. So strong Q1 growth means a slightly higher jump-off point, but still expecting, as Drew talked about, that attrition through the year, which incorporates all the assumptions around FTR and a return to more normal seasonality. But it means at the end of the year, we're projecting high 4s versus that mid-4s that we were talking about on the Q4 call. So nothing changed there, just a slightly higher jump off point and everything is sort of baked into the outlook.

我們仍在預測相同的會員軌跡。因此，強勁的第一季成長意味著起點會略高一些，但正如 Drew 談到的，預計全年的人員流失率仍將持續，這包含了圍繞 FTR 的所有假設以及回歸更正常的季節性。但這意味著，到年底，我們預計銷售額將達到 4% 左右，而不是我們在第四季度電話會議上討論的 4% 左右。所以那裡什麼都沒改變，只是起點稍微高了一點，一切都融入了前景。

As Drew said, we are seeing utilization in that new member cohort. Our renewal members are -- the experience there as expected. And that utilization is really consistent with care that informs acuity and typically flows through to risk adjustment. So think about PCP and chronic care visits. And given that we won't see the Wakely data until late Q2, we're taking a prudent posture on that population. But we have accounted for that level of utilization in our full-year outlook.

正如德魯所說，我們看到了新成員群體的使用率。我們的續約成員——在那裡的經歷正如預期的那樣。這種利用率實際上與敏銳度護理一致，通常流向風險調整。因此，請考慮 PCP 和慢性病護理就診。鑑於我們要到第二季末才能看到 Wakely 數據，我們對該族群採取了謹慎的態度。但我們已在全年展望中考慮到了這一利用率水準。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

I wanted to follow up on the Part D commentary. You called out that you're still targeting Part D pretax margins of 1%, but you referenced that you might be in the risk corridor, which suggests a lower margin. Can you help us understand how the risk corridor actually works? Is that applied at the contract level or plan level such that we might see a wide range of underlying performance, some of which will be in the risk corridor, but you still net out to 1% pretax margins?

我想跟進 D 部分的評論。您說您仍然以 1% 的 D 部分稅前利潤為目標，但您提到您可能處於風險區間，這意味著利潤率較低。您能幫助我們了解風險走廊實際上是如何運作的嗎？這是否適用於合約層面或計劃層面，以至於我們可能會看到廣泛的潛在表現，其中一些將處於風險區間，但您仍然可以獲得 1% 的稅前利潤率？

Yes. Good question, Andrew. Part of it, we're making up in SG&A, but there is a -- it's a nice protective mechanism that CMS, I think, was smart to put in place given the IRA changes. So when you get to 2.5% -- and this is important, relative to the bid assumption, of pharmacy cost, which is not relative to guidance, but relative to the bid assumption in the mechanics of the bids, then there's a 50-50 split if you're off to the bad more than 2.5%.

是的。問得好，安德魯。其中一部分，我們在銷售、一般和行政費用中彌補了，但考慮到 IRA 的變化，我認為 CMS 採取的是一個很好的保護機制，這是明智之舉。因此，當達到 2.5% 時——這很重要，相對於藥房成本的投標假設，這不是相對於指導，而是相對於投標機制中的投標假設，那麼如果虧損超過 2.5%，就會有 50-50 的分成。

So yes, we're into that risk corridor because of the very high specialty utilization, like I said in my script, some of which is driven by pharma behavior, pushing cost to the federal government and into the PDP program from what would have otherwise been pharmacy assistant and patient assistant programs.

所以是的，我們進入了那個風險走廊，因為專業利用率非常高，就像我在腳本中所說的那樣，其中一些是由製藥行為驅動的，將成本轉嫁給聯邦政府並轉入 PDP 計劃，而這些成本原本是藥房助理和患者助理計劃。

But nonetheless, we've got cover because of that risk corridor. And that's what we're thinking about for 2026. As a payer, we can't assume that, that risk corridor will get reinstated at that same level unless CMS clarifies that in advance, and so that will be reflected in our bids.

但儘管如此，由於有該風險走廊，我們還是得到了保障。這就是我們對 2026 年的思考。作為付款人，我們不能假設風險走廊會恢復到同一水平，除非 CMS 事先澄清這一點，因此這將反映在我們的出價中。

So yeah, that all adds up to still being on track for a pretax margin, the ones -- one because of the SG&A help, but then also the protective mechanism, which was good to have in a year where the maximum amount of pocket went down to $2,000.

所以，是的，所有這些加起來仍然處於稅前利潤的軌道上，一方面是因為銷售、一般和行政費用的幫助，另一方面也是因為保護機制，這在最高預算下降到 2,000 美元的一年裡是件好事。

Lance Wilkes, Bernstein.

蘭斯威爾克斯、伯恩斯坦。

I want to focus in a little more on the specialty pharmacy trends. Can you talk a little bit about what trend level you're seeing for specialty and how it differentiates between maybe PDP, MAPD, and Medicaid? And then more -- just to better understand it over in the Part D area, could you talk about are you seeing new prescriptions being written? Or is this just a higher -- like same number of unit and unit assumptions, but a higher like dollar value of that?

我想多關註一下專業藥局的趨勢。您能否稍微談談您所看到的專業趨勢水平以及它如何區分 PDP、MAPD 和 Medicaid？然後更多——只是為了更好地理解 D 部分領域，您能否談談您是否看到了新開的處方？或者這只是更高——就像相同數量的單位和單位假設，但美元價值更高？

And maybe just a clarification on that three items for the HBR guide lift, if you could just give us like a proportion of each of those too?

也許您只是想澄清一下 HBR 導引升降機的這三個項目，能否也給我們每個項目的比例？

Thanks, Lance. Let me hit the Medicaid piece, and then I'll turn it over to Drew for PDP. So one of the things that's important to note, and Drew touched on this, but just so to sort of firm in everyone's mind that ultimately, the Medicaid specialty drug utilization ends up getting baked into the state rates.

謝謝，蘭斯。讓我來談談醫療補助部分，然後我會把它交給 Drew 進行 PDP。因此，需要注意的一件重要的事情，德魯也提到了這一點，但只是為了讓每個人都牢記，最終，醫療補助特種藥物的使用將被納入州費率。

It is a process for that to happen. And so one of the things that we're seeing is that states that are still trying to figure out how to put programs in place around some of these specialty drugs that are particularly high cost. That can take some time for them to figure out whether they're going to do that as a carve-out or how they're going to manage through it.

實現這一目標需要一個過程。因此，我們看到的情況之一是，各州仍在試圖弄清楚如何針對一些成本特別高的特殊藥物實施計劃。他們可能需要一些時間來弄清楚是否要將其作為一項豁免條款來實施，或者如何應對。

One of the things that we can uniquely do, and this actually goes back to Stephen's question about sort of why you can have confidence in the progression of the MLR is that we are able to bring to our state solutions for how to think about dealing with those high-cost drugs. So a big piece in Medicaid is just a timing. Again, that will get baked into the rates through a couple of different potential program changes.

我們能夠獨特地做到的一件事，實際上可以追溯到史蒂芬為什麼你可以對 MLR 的進展充滿信心的問題，那就是我們能夠為我們的州帶來如何處理這些高成本藥物的解決方案。因此，醫療補助計劃中的很大一部分只是時間問題。再次，這將透過幾個不同的潛在計劃變更納入到費率中。

And then, Drew, if you want to talk about the PDP specialty drug dynamics.

然後，德魯，如果你想談談 PDP 特種藥物動態。

Yeah, Lance. It's most prevalent in the non-low-income PDP members. So not as prevalent in low income because they've always been cost share protected. And it does relate to the change in the maximum amount of pocket going down to $2,000. We thought about that.

是的，蘭斯。這種現像在非低收入的人民民主黨成員中最為普遍。因此，低收入群體中這種情況並不普遍，因為他們一直受到成本分攤保護。這確實與最高賠償額降至 2,000 美元有關。我們考慮過這個問題。

In fact, we thought about pharma behavior. We thought about member behavior as we priced our PDP business, but we didn't expect things like patient assistant programs barriers to be put up for patients to push them over to the PDP program as severe as what's happening.

事實上，我們曾考慮過製藥公司的行為。我們在為 PDP 業務定價時考慮了會員的行為，但我們沒有想到患者助理計劃會給患者設置障礙，迫使他們轉向 PDP 計劃，這種情況會如此嚴重。

So it's a pretty high trend in areas. I'll give you some categories, asthma, eczema, inflammatories, where we see same members all of a sudden having, for instance, a DUPIXENT script on 1/1 and figuring out that, that member used to be in a patient assistant program. So the good news is we can absorb that.

因此，這在各個地區都是一個相當高的趨勢。我會給你一些類別，哮喘、濕疹、炎症，我們會看到相同的成員突然在 1/1 上擁有例如 DUPIXENT 腳本，並發現該成員曾經參加過患者助理計劃。所以好消息是我們可以吸收這一點。

We can think about that in our '26 bids. The backstop of the federal government, which effectively is shifting pharma cost over to the federal government because of the risk corridor, that's in place this year. So we're on track, and we expect to be on track in PDP, just sharing some observations that need to make it into the 2026 bids and why we think that direct subsidy is going to be lifted again, which increased the cost of the program. So we're good at predicting that stuff and getting that into the bids, and we'll do that for 2026.

我們可以在 26 年競標中考慮這個問題。聯邦政府的支持措施今年已經到位，透過風險走廊，實際上將製藥成本轉移到了聯邦政府身上。因此，我們正按計劃進行，並且我們預計 PDP 也將按計劃進行，只是分享一些需要納入 2026 年競標的觀察結果，以及為什麼我們認為直接補貼將再次取消，這增加了該計劃的成本。因此，我們擅長預測這些事情並將其納入競標中，我們將在 2026 年做到這一點。

John Stansel, JPMorgan.

摩根大通的約翰·斯坦塞爾。

To kind of follow up on the Part D side, growth has been very strong this year. Have the new members behaved kind of consistent with your overall pool? And then following up on the '26 theme here, it sounds like based on the kind of the wording and the final rate notice and what you're alluding to here that you think that the demo risk corridors might be dialed back in 2016.

從 D 部分的後續情況來看，今年的成長非常強勁。新成員的行為是否與你們的整體成員行為一致？然後繼續討論這裡的 26 個主題，聽起來根據措辭和最終利率通知的類型以及您在這裡暗示的內容，您認為演示風險走廊可能會在 2016 年回撥。

Do you think that's an industry consensus that everyone expects and will design their bids in that way? Or is there a concern that, that might not necessarily be the way that people approach this -- the '26 bid cycle, given all the moving parts?

您是否認為這是業界共識，即每個人都期待並會以這種方式設計他們的出價？或者有人擔心，考慮到所有變動因素，這可能不一定是人們處理 26 年競標週期的方式？

For PDP, I think it would be foolish not to assume that because obviously, there'd be a lot more pressure in that specialty trend if that demo had not been in place. So we can tell you what we're going to do and buyer be aware for the rest of the industry.

對於 PDP，我認為不這樣做是愚蠢的，因為顯然，如果沒有這個演示，這種專業趨勢就會面臨更大的壓力。因此我們可以告訴您我們將要做什麼，並讓買家了解整個行業的情況。

But the industry has usually been pretty good about thinking through the elements of what impacts PDP. So look, that's a great business for us, $16 billion-plus of revenue. We've been able to manage that well through the years and through the changes, including the IRA.

但業界通常已經很好地思考了影響 PDP 的因素。所以，這對我們來說是一筆很棒的生意，收入超過 160 億美元。多年來，我們透過包括愛爾蘭共和軍 (IRA) 在內的一系列變革，成功地管理了這個問題。

And so the point is to just to showcase what's going on underneath the covers, even though we still believe we're going to hit that 1%-plus margin this year and we'll be pricing prudently for next year as well.

因此，重點只是展示幕後發生的事情，儘管我們仍然相信今年的利潤率將達到 1% 以上，而且明年我們也會謹慎定價。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

This is Joaquin Arriagada on for Joanna. Could you talk about any changes to your trend outlook within MA? And there have been discussions around group MA. So have you been seeing anything unusual in your group business in terms of utilization?

我是 Joaquin Arriagada，代替 Joanna 發言。能談談您對 MA 內部趨勢展望有何變化嗎？並且圍繞 MA 組已經有討論。那麼，就利用率而言，您是否發現集團業務中存在任何異常情況？

We were, as Drew said, pleased with the membership outperformance. The overall segment is on track. and in MA, we are right in line with expectations. So I don't know if there's anything, Drew, you want to add or any that?

正如德魯所說，我們對會員的出色表現感到滿意。整體業務進展順利。在 MA 方面，我們完全符合預期。所以我不知道德魯，您是否還有什麼要補充的嗎？

No, really pleased with the performance of Medicare stability. I mean, obviously, we saw the uptick in outpatient in Q2 of 2023. And we've been planning accordingly for, let's say, outsized trend in that area for the last couple of years. So really consistent good performance as we progress our way to breakeven in Medicare Advantage.

不，我對醫療保險穩定性的表現非常滿意。我的意思是，顯然，我們看到 2023 年第二季門診人數上升。過去幾年來，我們一直在針對該地區的超大趨勢進行相應的規劃。因此，隨著我們在醫療保險優勢計劃中逐步實現收支平衡，我們確實取得了持續良好的表現。

George Hill, Deutsche Bank.

德意志銀行的喬治·希爾。

Drew, I want another clarifying question. I think I know what you mean, but I want to double check. You said that you guys were seeing pharmacy pricing pressure as it related to PDP looking at the 26%. I want to make sure that you meant pharma pricing pressure versus pharmacy pricing pressure? And then, I guess, should we think of the PDP target margins looking up to the '26 bid process as flat?

德魯，我想再問一個澄清問題。我想我知道你的意思，但我想再確認一下。您說你們看到了與 PDP 相關的藥局定價壓力，佔 26%。我想確認一下您指的是藥品定價壓力還是藥局定價壓力？那麼，我想，我們是否應該認為 PDP 目標利潤率在 26 年競標過程中是持平的？

And maybe could you talk about what initiatives do you guys feel like you can take outside of the bid process to expand margins in that space?

也許您能談談您認為在投標過程之外可以採取哪些措施來擴大該領域的利潤率？

Certainly, one of the elements of earnings power that we laid out at Investor Day is to take that PDP margin from the 1% zone to 3%-plus, and we'll seek to do that over the next few years. Too early to specify exactly what we think for 2026.

當然，我們在投資者日提出的獲利能力要素之一是將 PDP 利潤率從 1% 區間提升至 3% 以上，我們將力爭在未來幾年內實現這一目標。現在就具體說明我們對 2026 年的看法還為時過早。

And you're right. We're actually seeing pressure in, once again, non-low-income members, utilization of specialty drugs that are now showing up in PDP, some of which were previously in pharmacy assistance program. So not pharmacy cost pressures, utilization of specialty drugs and largely in the asthma, eczema, and inflammatory areas.

你是對的。實際上，我們再次看到非低收入成員在使用現在出現在 PDP 中的特種藥物方面面臨壓力，其中一些藥物以前包含在藥房援助計劃中。因此，藥房成本壓力、專科藥物的利用率以及主要在氣喘、濕疹和發炎領域。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Maybe just a bigger picture question. I know you mentioned you're seeing some progress on the Medicaid rate side. But how do we think about state's ability to actually fund the necessary improvements that the industry seems like it needs just given where state budgets are and obviously, with the backdrop of these potential funding cuts. I guess what are the conversations like with those -- with your states? And where are they at and being able to fund those improvements?

也許只是一個更大的問題。我知道您曾提到您在醫療補助費率方面看到了一些進展。但是，考慮到州政府的預算，以及顯然在這些潛在的資金削減的背景下，我們如何看待州政府是否有能力為該行業所需的必要改進提供資金。我猜想與你們各州的對話是什麼樣的？他們現在在哪裡，能夠資助這些改進嗎？

Yeah. Thanks for the question. So I think one of the things -- you're raising a good point. I think it's important to keep in mind that through the redetermination process, the states shed a significant number of members, which means they were coming into rating with overall budget savings. And I think that, that has helped the conversations in these early cycles.

是的。謝謝你的提問。所以我認為其中一件事——你提出了一個很好的觀點。我認為需要記住的是，透過重新確定程序，各州減少了大量議員，這意味著他們在進入評級時總體預算有所節省。我認為這有助於早期週期的對話。

The other piece of it is obviously that the states legally need to have actuarially sound rates. So while there are always budget constraints that states think about ultimately sort of the math drives the day. The other thing I would say is that historically, when we've seen state budget pressure, it's actually been a tailwind relative to states starting to think about moving additional populations that may not be in a managed care model into managed care because of the predictability of the budget and the savings opportunities that are there.

另一點顯然是各州在法律上需要有精算合理的稅率。因此，儘管各州總是考慮預算限制，但最終還是由數學來決定。我想說的另一件事是，從歷史上看，當我們看到州預算壓力時，這實際上是一個順風，因為各州開始考慮將可能不在管理式醫療模式中的更多人口轉移到管理式醫療中，因為預算的可預測性和存在的節約機會。

And we hear that time and time again, if you think about the states that have recently moved to managed care, they can actually quantify significant savings that they have seen. And that then sort of catalyzes the conversation about some of those more complex specialty populations, which is obviously the group that we have circled relative to driving long-term growth for us as well as margin expansion in Medicaid.

我們一次又一次地聽到，如果你想想最近轉向管理式醫療的州，他們實際上可以量化他們所看到的顯著節省。這在某種程度上催化了關於一些更複雜的專業人群的討論，這顯然是我們所關注的群體，旨在推動我們的長期成長以及醫療補助的利潤擴張。

So we are very experienced at navigating these conversations. I think we have the benefit now of years of data relative to moving through the redetermination process, a full year of data relative to the acuity shift, and I think can help states think about where to find savings if and as they feel budget pressure.

因此，我們在引導這些對話方面非常有經驗。我認為，我們現在擁有相對於重新確定過程的多年數據，相對於敏銳度轉變的全年數據，我認為這可以幫助各州思考在感到預算壓力時如何節省開支。

Michael Ha, Baird.

麥可·哈，貝爾德。

Regarding the exchanges. So firstly, I'm having a little bit of trouble bridging to your expected $5 billion of additional revenue. If I take your roughly 0.5 million more lives, [550] revenue PMPM, I'm still getting to only about $3 billion to $4 billion. And I know you're still assuming the same in your attrition cadence. So I was wondering if you could help me bridge that gap in case I'm missing something?

關於交流。首先，我對實現您預期的 50 億美元額外收入遇到了一些困難。如果我再奪走你們大約 50 萬人的生命，[550] 每月收入，我仍然只能獲得大約 30 億到 40 億美元。並且我知道您在消耗節奏中仍然假設相同的事情。所以我想知道如果我遺漏了什麼，您是否可以幫助我彌補這個差距？

And then I understand you're treating incremental exchange growth in 1Q to be lower margins. It sounds like you could be conservatism, but wondering what exact margin level you're assuming on those lives?

然後我了解到您將第一季的增量匯率成長視為較低的利潤率。聽起來你可能是保守派，但想知道你對這些生命的假設的具體利潤水平是多少？

And lastly, very quickly, when you hear the most bearish concerns about the magnitude of potentially millions of fraudulent lives and the exchanges and the risk that might pose to you next year. I'm just curious to hear your general thoughts overall level of confidence that this most bear-case scenario that's rolling around won't actually happen.

最後，當您聽到最悲觀的擔憂時，您很快就會意識到，潛在的數百萬欺詐性生命以及交易所的規模以及明年可能給您帶來的風險。我只是好奇地想聽聽你們對這種最糟糕的情況實際上不會發生的整體信心水平。

Yeah. Thanks for the question. So let me start with the last piece of that and we can sort of work our way backwards. There's obviously been a lot of concern about the idea that there is sort of ramp in broker fraud or got members in the population.

是的。謝謝你的提問。因此，讓我從最後一部分開始，然後我們可以按逆向思路進行。顯然，人們非常擔心經紀人詐欺行為或人口詐欺現象會增加。

I think it's important to note that the movement to drive additional program integrity, which was understandably loosened during the pandemic, started more than a year ago and a lot of the program integrity measures that are being put in place are things that we've operated with in the past, which means we have baseline and benchmark data around what some of these rates should be.

我認為值得注意的是，推動額外項目完整性的運動在疫情期間可以理解地有所放鬆，這一運動始於一年多前，正在實施的許多項目完整性措施都是我們過去一直在實施的，這意味著我們擁有關於這些比率應該是多少的基線和基準數據。

We were a pioneer in terms of implementing the agent of record lock. Back in January of last year we introduced that. We were the first to put it in place. and we're seeing the benefit of that. And we track very closely the levels of complaints that come in from members or where there are broker issues throughout the year and can understand whether we're seeing upticks in that and anything different than what we would expect.

我們是實施記錄鎖代理的先驅。我們在去年一月就推出了這個功能。我們是第一個實施這項措施的人。我們也看到了它帶來的好處。我們密切追蹤來自會員的投訴水平或全年經紀人的問題，並了解我們是否看到此類問題增加以及是否與我們的預期有任何不同。

So I think we have accounted for things like the failure to reconcile in our full year outlook. Again, the timing of that has shifted. But the team is pretty experienced at understanding the dynamics in the membership. Obviously, the new utilizers that we have where we're seeing utilization is frankly a good sign because it's hard for ghosts to utilize the system. And we feel like we have all the data we need to account for what -- how this will play out both through the remainder of this year and in 2026.

所以我認為我們已經將諸如未能協調之類的因素納入了全年展望中。再次，時機已經改變。但該團隊在了解會員動態方面非常有經驗。顯然，我們看到的新利用者的利用率坦率地說是一個好兆頭，因為鬼魂很難利用這個系統。我們覺得我們已經掌握了所有需要的數據，可以預測今年剩餘時間和 2026 年的情況。

I think you asked about sort of the level of margin for the new member cohort. Overall, we still expect to be in the 5% to 7.5% margin range for marketplace. And as I said, we've encountered for a continuation of the level of utilization we're seeing in that new member base. In the full year outlook, our renewal members are as expected. And then --

我認為您詢問的是新成員群體的利潤水平。總體而言，我們仍然預期市場利潤率將在 5% 至 7.5% 之間。正如我所說的，我們在新的會員群體中看到了持續的利用率。展望全年，我們的續約成員符合預期。進而--

Yeah, on your first question, the -- so we put up $10.1 billion of commercial premium in Q1. And if you do the math on our guidance, it's $39 billion for the full year. So we are accounting for attrition throughout the rest of the year to end up in the high 4s. So that sort of hangs together.

是的，關於您的第一個問題，我們在第一季投入了 101 億美元的商業保費。如果你按照我們的指導來計算，全年將是 390 億美元。因此，我們將今年剩餘時間的人員流失率計算在內，最終達到 4% 左右。所以這一切都是連在一起的。

Thank you. And ladies and gentlemen, this concludes our question-and-answer session. I'd like to turn the conference back over to Sara London for losing remarks.

謝謝。女士們、先生們，我們的問答環節到此結束。我想將會議交還給 Sara London 發表失敗言論。

Thanks, Rocco, and thanks, everyone, for your time this morning and for your interest. We look forward to continued updates as we move forward and as we manage the business from a position of strength.

謝謝，羅科，也謝謝大家今天早上抽出時間和關注。我們期待在前進的過程中以及在以實力優勢管理業務的過程中不斷獲得更新。

Thank you. This concludes today's conference call. We thank you all for attending today's presentation. You may disconnect your lines, and have a wonderful day.

謝謝。今天的電話會議到此結束。感謝大家參加今天的演講。您可以斷開線路，享受美好的一天。