Centene Corp (CNC) 2026 Q2 法說會逐字稿

Good day and welcome to the Centene Corporation 2026 second-quarter conference call. (Operator Instructions) Please note, today's event is being recorded.

大家好，歡迎參加 Centene Corporation 2026 年第二季財報電話會議。(接線員指示) 請注意，今天的活動將被錄音。

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

現在我想把會議交給投資人關係資深副總裁 Jennifer Gilligan。請開始。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our second-quarter 2026 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，Rocco，大家早安。感謝各位參加我們 2026 年第二季財報結果電話會議。Centene 執行長 Sarah London 與執行副總裁兼財務長 Drew Asher 將主持今天上午的電話會議；各位也可透過我們的網站 centene.com 收聽。

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. Specifically, our commentary on our full year 2026 outlook, including the drivers of such outlook, are forward-looking statements.

Centene 可能就未來預期、計畫與前景所作的任何評論，均構成《1995 年私人證券訴訟改革法》安全港條款所稱之「前瞻性陳述」。具體而言，我們對 2026 全年展望（包括該展望的驅動因素）的評論，均屬前瞻性陳述。

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 second quarter 2026 press release and other public SEC filings which are available on the company's website under the investors section.

由於多項重要因素，實際結果可能與這些前瞻性陳述所示存在重大差異。其中包括我們 2026 年第二季新聞稿及其他公開的 SEC 申報文件中所討論者；相關文件可於公司網站「投資人」專區查閱。

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. The call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our second quarter 2026 press release.

Centene 預期後續事件與發展可能導致其估計發生變化；雖然公司可能在未來某個時間點選擇更新這些前瞻性陳述，但我們明確聲明不承擔任何更新義務。本次電話會議亦將提及若干非 GAAP 指標。這些指標與最直接可比的 GAAP 指標之調節表，可見於我們 2026 年第二季新聞稿。

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

接下來，我想把電話會議交給我們的執行長 Sarah London。Sarah？

Thanks, Jen, and thanks, everyone, for joining us on the call. This morning, we will review our second quarter results and provide details around our improved full-year 2026 financial guidance. Q2 adjusted diluted earnings per share of $2.51 exceeded our previous expectations, with outperformance driven by underlying business strengths and a more fully informed view of our marketplace risk adjustment positioning.

謝謝 Jen，也謝謝各位參加本次電話會議。今天上午，我們將回顧第二季業績，並說明我們上調後的 2026 全年財務指引。第二季調整後稀釋每股盈餘（EPS）為 2.51 美元，超出我們先前預期；優於預期主要來自核心業務的強勁表現，以及我們對 Marketplace 風險調整（risk adjustment）定位更充分且更完整的掌握。

Thanks to strong first-half results, we now expect full-year 2026 adjusted diluted earnings per share of greater than $4.80, up from our prior outlook of greater than $3.40 provided during our April update. We are excited by the positive momentum we have built and remain focused on our goal of delivering industry-leading health outcomes with an industry-leading cost structure.

受惠於上半年強勁表現，我們目前預期 2026 全年調整後稀釋每股盈餘將高於 4.80 美元，較我們在 4 月更新時提供的先前展望（高於 3.40 美元）上調。我們對已建立的正向動能感到振奮，並將持續聚焦於以業界領先的成本結構，交付業界領先的健康成果之目標。

Now let's talk about the business. Starting with Medicaid. Medicaid results were in line with our expectations for the quarter, driven by disciplined execution against our operational and financial goals. We ended the quarter with just over 12 million members, a slightly larger step down in membership than anticipated. While some of this was driven by state-specific program changes, we also saw an uptick in activity around enrollment and eligibility in certain states.

接下來談談業務。先從 Medicaid 開始。本季 Medicaid 業績符合我們預期，主要來自我們在營運與財務目標上的紀律性執行。季末會員數略高於 1,200 萬人，會員數下滑幅度略大於預期。其中一部分原因來自各州特定的計畫變更；此外，我們也看到部分州在投保（enrollment）與資格審核（eligibility）方面的活動有所增加。

As we look at core medical cost drivers in the quarter, the big rocks remain consistent with past quarters, with behavioral health, home health, and high-cost drugs among the top contributors. We did see a slight uptick in acuity from the expansion population, directly consistent with the increased attrition in the quarter, but we were able to absorb that given the strength of our execution across quality and affordability initiatives.

就本季核心醫療成本驅動因素而言，主要項目與過去幾季一致，行為健康（behavioral health）、居家照護（home health）與高成本藥物仍是主要貢獻來源。我們確實看到擴張族群（expansion population）的病情嚴重度（acuity）略有上升，這與本季更高的流失率（attrition）直接一致；但憑藉我們在品質與可負擔性（affordability）倡議上的執行力，我們得以吸收該影響。

Rates remain a critical lever and continue to develop positively, with 7/1 rates coming in better than expected. This improves our full-year 2026 composite rate forecast from roughly 4.5% to roughly 5%. The tone and tenor of our state rate conversations remains constructive and rate development continues to be supported by the incorporation of more current data. As you think about our guidance, we are now expecting lower year-end membership than our previous outlook with the increased enrollment and eligibility activity as we move through the back half of the year.

費率仍是關鍵槓桿，且持續朝正向發展，7/1 生效的費率優於預期。這使我們對 2026 全年綜合費率（composite rate）的預測，從約 4.5% 上調至約 5%。我們與各州就費率的溝通氛圍與基調仍具建設性，而費率制定也持續受益於納入更即時的數據。就指引而言，隨著我們進入下半年、投保與資格審核活動增加，我們目前預期年末會員數將低於先前展望。

As is typical, we assume that additional attrition will impact acuity and have set guidance to account for that possibility in the second-half of 2026. As you would imagine, we are heavily engaged with our state partners as they prepare for OB3 implementation, and we are working hard to minimize unnecessary membership disruption. This includes investing in near real-time data exchange with states to inform ex parte member eligibility, exemption validation, and member outreach.

如同慣例，我們假設進一步的流失將影響病情嚴重度，並已在 2026 年下半年的指引中納入此一可能性。如各位所料，隨著各州準備推動 OB3 上線（implementation），我們正與州政府夥伴密切合作，並努力將不必要的會員中斷降至最低。這包括投資於與各州近乎即時的資料交換，以支援 ex parte 會員資格判定、豁免（exemption）驗證，以及會員外展（outreach）。

We are also activating a nationwide playbook, building on the work programs we already have in place across our states to help members identify community engagement, education, and workforce opportunities. And we are engaging with state actuaries about the best approach to OB3-related rate adjustments.

我們也正在啟動全國性的作戰手冊（playbook），在既有各州工作計畫的基礎上，協助會員辨識社區參與、教育與就業機會。同時，我們也正與各州精算師就 OB3 相關的費率調整，討論最佳作法。

Given recent cost pressures in the business, we haven't talked as much about quality, but it is worth sharing that behind the scenes, we have been systematically driving improved quality performance across our Medicaid markets. Over the last three cycles, through expanded data capture, scalable member engagement programs, and targeted provider incentives, we have delivered improvement in more than 90% of our core clinical measures, ensuring Centene members receive more complete and better quality care each year. And in this cycle, we are targeting more than 75% of our Medicaid health plan's NCQA quality ratings to be at or better than 3.5 stars.

鑑於近期業務面臨的成本壓力，我們較少談及品質；但值得分享的是，在幕後我們一直在 Medicaid 市場中系統性地推動品質表現提升。過去三個週期中，透過擴大資料擷取、可規模化的會員互動計畫，以及針對性的提供者獎勵，我們在超過 90% 的核心臨床指標上實現改善，確保 Centene 會員每年都能獲得更完整且更高品質的照護。而在本週期中，我們的目標是讓超過 75% 的 Medicaid 健康計畫之 NCQA 品質評等達到或優於 3.5 星。

Ultimately, the value of Medicaid managed care is ensuring high-quality outcomes at lower costs, and we are building tangible momentum around those.

歸根結底，Medicaid 管理式照護的價值在於以更低成本確保高品質成果，而我們正在此方面建立具體且可見的動能。

Turning to Medicare, our Medicare segment once again delivered outperformance in Q2 with continued strength in both our PDP and our Medicare Advantage businesses. PDP benefited in the quarter from the true-up of certain prior period items, but the results also reflect fundamental favorability. While we continue to see elevated levels of specialty drug trend, they remain lower than our original expectations through the first half of the year.

接著談 Medicare，我們的 Medicare 事業群在第二季再次交出優於預期的表現，PDP 與 Medicare Advantage 業務皆持續強勁。PDP 本季受惠於部分前期項目的追溯調整（true-up），但結果也反映出基本面上的有利因素。雖然我們仍看到專科藥物趨勢（specialty drug trend）維持在較高水準，但在上半年期間仍低於我們最初的預期。

As a result, we now expect PDP to deliver a pre-tax margin greater than 3% in 2026 versus the 2% we guided to at the beginning of the year. Our PDP team once again took a thoughtful approach to the 2027 bid process, prioritizing sustainable profitability. As this business hits post-IRA stability, we look forward to delivering consistent margin on what is now roughly $25 billion of premium revenue and successfully leveraging our greater than $60 billion in pharmacy spend through our partnership with ESI to deliver industry-leading cost structure to our state customers and members across lines of business.

因此，我們目前預期 PDP 在 2026 年的稅前利潤率將高於 3%，相較於年初指引的 2% 有所上調。我們的 PDP 團隊在 2027 年投標（bid）流程中再次採取審慎作法，優先考量可持續的獲利能力。隨著該業務在 IRA 後進入穩定期，我們期待在目前約 250 億美元的保費收入規模上，交付一致的利潤率，並透過與 ESI 的合作，成功運用我們超過 600 億美元的藥局支出（pharmacy spend），為各州客戶與跨業務線的會員提供業界領先的成本結構。

Solid execution from the Medicare Advantage team led to outperformance once again this quarter. Medical costs remain elevated when compared to historical averages, but year-to-date trend is running modestly favorable to expectations. Key medical cost drivers were stable quarter over quarter. D-SNP members now represent approximately 40% of our Medicare Advantage portfolio, and that cohort continues to perform favorably.

Medicare Advantage 團隊的穩健執行，使我們本季再次表現優於預期。相較於歷史平均，醫療成本仍偏高，但年初至今的趨勢略優於預期。主要醫療成本驅動因素較上一季維持穩定。D-SNP 會員目前約占我們 Medicare Advantage 組合的 40%，而該族群的表現仍持續良好。

Looking ahead to 2027, we plan to further simplify our Medicare Advantage footprint, focusing our benefits increasingly on the duals population, where our deep expertise in Medicaid allows us to deliver a local, integrated, and differentiated experience to these members. On the Stars front, we are once again seeing year-over-year improvement in raw performance, supported by the full range of quality initiatives we've deployed over the last three years.

展望 2027 年，我們計畫進一步簡化 Medicare Advantage 的布局，並將福利更聚焦於雙重資格（duals）族群；憑藉我們在 Medicaid 的深厚專業，我們能為這些會員提供在地化、整合式且具差異化的體驗。在星級評等（Stars）方面，我們再次看到原始表現逐年改善，這得益於過去三年所部署的全方位品質倡議。

That said, we along with the industry, are facing headwinds from artificial cut point increases and overall Stars program methodology changes, not to mention uncertainty around the future of the program overall. As you'll recall, the company took steps coming into 2025 to de-risk Stars results more broadly as we considered our Medicare Advantage strategy of focusing on lower-income complex populations in the face of a Stars program that fails to effectively risk adjust for these members.

話雖如此，我們與整個產業一樣，正面臨因人工調高 cut point（門檻分數）以及整體星級（Stars）計畫方法論變更所帶來的逆風，更不用說對該計畫整體未來走向的不確定性。如各位所記得，公司在邁入 2025 年之際採取了若干措施，以更廣泛地降低星級結果的風險；當時我們在評估 Medicare Advantage 策略時，選擇聚焦於低收入且病況複雜的人群，因為現行星級計畫未能有效針對這些會員進行風險調整。

Thanks to these actions, including portfolio optimization, strong operational execution and SG&A management, and strategic duals growth, we are seeing accelerated margin improvement, and we are confident in our plan to deliver breakeven or better results in 2027 and margin improvement thereafter. Overall, we are pleased with the momentum building in our Medicare segment thus far in 2026 and look forward to leveraging that strength as we prepare for 2027.

受惠於這些行動（包括投資組合最佳化、強勁的營運執行與 SG&A 管控，以及策略性雙重資格（duals）成長），我們看到利潤率改善加速，並對我們在 2027 年達成損益兩平或更佳表現、以及其後利潤率持續改善的計畫充滿信心。整體而言，我們對 2026 年迄今 Medicare 事業部所累積的動能感到滿意，並期待在準備迎接 2027 年之際，進一步運用這股優勢。

Last but certainly not least, Marketplace delivered excellent Q2 results after more than a year's worth of focused execution to achieve meaningful margin recovery in that business. Recall that we moderated our pre-tax margin expectations for the marketplace at the end of Q1. Our 3% pre-tax guidance at the time accounted for elevated utilization patterns we observed in Q1, largely driven by our silver tier members and did not fully reflect the corresponding risk adjustment offset we anticipated given the level of observed membership acuity, a posture that we felt was prudent in advance of receiving the first full Wakely report, which includes the first view of overall market acuity.

最後但同樣重要的是，Marketplace 在經過一年多聚焦執行、以實現該業務顯著的利潤率修復之後，交出了優異的第二季（Q2）成果。請回想，我們在第一季（Q1）結束時下調了對 Marketplace 稅前利潤率的預期。當時我們給出的 3% 稅前指引，已納入我們在 Q1 觀察到的偏高使用率型態（主要由白銀級（silver tier）會員所驅動），但並未完全反映我們基於已觀察到的會員病況嚴重度（acuity）水準所預期的相對應風險調整（risk adjustment）抵銷效果；在收到第一份完整的 Wakely 報告（其中包含對整體市場病況嚴重度的首次觀察）之前，我們認為採取較為審慎的立場是合理的。

Rolling those assumptions forward to Q2. First, we continued to see higher utilization patterns among our Silver Tier members, but these moderated over the quarter compared to what we assumed in our guidance. At the same time, a thorough analysis of the highly anticipated June Wakely report not only confirmed our hypothesis about the relative acuity of our population but has also allowed us to revise our view of full year performance for the marketplace business.

將上述假設延續至第二季（Q2）。首先，我們仍持續看到白銀級會員的使用率偏高，但相較於我們在指引中所假設的水準，該情況在本季期間有所緩和。同時，對備受期待的 6 月 Wakely 報告進行深入分析後，不僅證實了我們對於自家人群相對病況嚴重度的假設，也使我們得以修正對 Marketplace 業務全年表現的看法。

And finally, we received favorable development on our final 2025 CMS risk adjustment reconciliation to the tune of $180 million in the quarter. In light of the aggregate first half results, we now expect to deliver a pre-tax margin between 4.5% and 5% for the marketplace business for the full year, an improvement compared to our previous guidance as well as our initial guidance issued in February.

最後，我們在本季收到 2025 年 CMS 風險調整最終對帳（reconciliation）的有利進展，金額約為 1.8 億美元。綜合上半年整體結果，我們目前預期 Marketplace 業務全年稅前利潤率可達 4.5% 至 5%，較我們先前指引以及 2 月發布的初始指引皆有所提升。

While the year is not finished, it feels important to pause and reflect on the strength of these results, and I would be remiss if I did not take this opportunity to very publicly acknowledge and thank our marketplace team for the exceptional leadership and discipline they demonstrated over the last year to get us to this point. They saw and called a market-wide issue first. They leveraged more than a decade of experience and the breadth and depth of data that comes with operating in 29 markets to comprehensively diagnose the issue at hand, quickly translate that into actionable insight, execute in a very tight window to appropriately reprice our business for 2026 while correctly and conservatively planning for how 2025 would ultimately unfold.

雖然年度尚未結束，但此刻停下來回顧這些成果的強勁表現很重要；若不藉此機會公開肯定並感謝我們的 Marketplace 團隊在過去一年所展現的卓越領導力與紀律，我將深感不妥。他們率先看見並指出這是一個全市場層面的問題。他們運用十餘年的經驗，以及在 29 個市場營運所累積的廣度與深度數據，全面診斷眼前問題，迅速將其轉化為可執行的洞見，並在非常緊迫的時間窗口內完成執行，為 2026 年適當地重新定價我們的業務，同時以正確且保守的方式規劃 2025 年最終可能的走勢。

I am humbled by their expertise and grateful to have them guiding this business through an unprecedented year of turbulence and uncertainty.

他們的專業令我深感敬佩，也很感謝有他們在這個前所未有、充滿動盪與不確定的一年中引領這項業務前行。

Looking to the rest of 2026, we are jumping off a Q2 membership of roughly 3.5 million members, slightly better than previous expectations, with metal-tier distribution, age, and other key demographics largely unchanged from our Q1 results. We continue to expect membership to decline as we move through the rest of the year, consistent with the return to more regular seasonality, and our guidance has accounted for membership impacts related to various ongoing CMS program integrity efforts.

展望 2026 年剩餘期間，我們以第二季約 350 萬名會員作為起點，略優於先前預期；金屬層級（metal-tier）分布、年齡及其他關鍵人口統計特徵，與第一季結果大致不變。我們仍預期會員數將在今年剩餘時間逐步下降，符合回歸較正常季節性的趨勢；而我們的指引亦已納入 CMS 各項持續進行的計畫完整性（program integrity）措施對會員數的影響。

As a leader in this market, we will continue to push for and promote transparency and policy stability as we believe that regardless of the origin story you give it, the individual market is a compelling, future-proof platform that can deliver access to high-quality healthcare for hardworking Americans and small business owners and increasingly serve as a flexible, affordable, and affordable alternative to employer-provided insurance options.

作為此市場的領導者，我們將持續推動並倡議透明度與政策穩定性；我們相信，不論你如何描述其起源故事，個人保險市場都是一個具吸引力、面向未來且經得起考驗的平台，能為辛勤工作的美國人與小企業主提供高品質醫療照護的可近性，並且日益成為雇主提供之保險選項之外，一種更具彈性、可負擔且具成本效益的替代方案。

Overall, we are very pleased to deliver a quarter of solid performance and year-over-year progress in each of our business lines. While this dynamic healthcare operating landscape has presented challenges, it has also provided important opportunities at the enterprise level to enhance the way we do business. And we are taking advantage of this moment to lean in and transform our organization to better serve the needs of our members, state partners, and stakeholders. This includes thoughtfully reviewing our portfolio to position each business for long-term earnings growth, maximizing our talent bench, organizing our teams in a way that even more fully leverages our scale, and of course, deploying data, technology, and AI to streamline our service delivery and improve our member experience.

整體而言，我們很高興在各條業務線都交出穩健表現，並實現年對年進步的一季。雖然這個充滿變動的醫療照護營運環境帶來挑戰，但也在企業層面提供了重要機會，讓我們強化經營方式。我們正把握此刻，積極投入並推動組織轉型，以更好地滿足會員、州政府合作夥伴與利害關係人的需求。這包括審慎檢視我們的投資組合，使各項業務具備長期獲利成長的定位；最大化我們的人才梯隊；以更能充分發揮規模優勢的方式來組織團隊；當然也包括部署數據、科技與 AI，以精簡服務交付並改善會員體驗。

While we have made progress across all of these categories, I'd like to touch briefly on our AI strategy. You've heard us reference examples over the last few quarters of high-value AI-enabled use cases, including integrating AI into our forecasting processes to improve precision and the always-on suite of fraud, waste, and abuse algorithms that learn from our inbound claims data every day. And there are others.

雖然我們在上述各項領域皆已有所進展，但我想簡要談談我們的 AI 策略。過去幾季你們聽到我們提到一些高價值、由 AI 賦能的應用案例，例如將 AI 整合進我們的預測流程以提升精準度，以及一套「永遠在線」的詐欺、浪費與濫用（fraud, waste, and abuse）演算法組合，每天都會從我們流入的理賠（claims）數據中學習。此外還有其他案例。

Even our legal department has several high ROI-agentic use cases in production, including one agent that reviews invoices from outside counsel firms and now saves us a point and a half in our legal bills every month. We view these early successes as proof points for a much larger opportunities ahead. As we look to the next phase of our AI strategy, our focus is increasingly shifting from individual use cases to the underlying capabilities that make AI scalable across the enterprise.

甚至我們的法務部門也已有多個高投資報酬（ROI）的代理式（agentic）用例投入生產環境，其中包括一個代理會審閱外部法律顧問事務所的發票，現在每月可為我們節省約 1.5 個百分點的法律費用。我們將這些早期成功視為未來更大機會的驗證。展望 AI 策略的下一階段，我們的重心正日益從單一用例，轉向能讓 AI 在全企業範圍可規模化的底層能力。

As a Medicaid-first company operating in a margin-conscious environment, we take a deliberate approach to where we invest. That means prioritizing investments in foundational capabilities such as trusted data products, dynamic context management and open standards that keep business knowledge reusable and portable as the technology evolves. We believe long-term differentiation will increasingly come from proprietary data and context as model technology becomes more commoditized.

作為一家以 Medicaid 為先（Medicaid-first）的公司，且在重視利潤率的環境中營運，我們對投資方向採取審慎、深思熟慮的做法。這意味著優先投資於基礎能力，例如可信賴的數據產品、動態情境管理（dynamic context management），以及能在技術演進過程中讓業務知識可重用且可攜的開放標準。我們相信，隨著模型技術日益商品化，長期差異化將愈來愈來自專有數據與情境（context）。

This disciplined approach positions us to unlock the full potential of AI while maintaining a relentless focus on ROI. It also provides a governed, predictable foundation for AI, which is critical in a regulated environment where consistency, auditability, and compliance are non-negotiable. This work, like all of our transformation efforts, is designed in service of delivering industry-leading outcomes with an industry-leading cost structure, fulfilling our mission, and ultimately supporting our ambition to not just manage care but to power health for the communities we serve.

這種自律的做法，使我們能在保持對 ROI 不懈聚焦的同時，釋放 AI 的全部潛力。它也為 AI 提供一個受治理、可預期的基礎，這在受監管的環境中至關重要，因為一致性、可稽核性與合規性都是不可妥協的要求。這項工作與我們所有轉型努力一樣，旨在以業界領先的成本結構交付業界領先的成果，實現我們的使命，並最終支持我們的抱負：不僅是管理照護（manage care），更要為我們所服務的社區賦能健康（power health）。

In closing, we are making meaningful progress on our path to margin restoration while advancing the platform and processes that will modernize and improve the way we do business. This momentum is visible in our strong second quarter results and our increased earnings outlook for 2026. With our members at the center of every strategic decision we make, we see significant opportunity to reshape the healthcare experience for millions of Americans.

總結來說，我們在利潤率修復的道路上取得了實質進展，同時推進平台與流程，讓我們的經營方式得以現代化並持續改善。這股動能反映在我們強勁的第二季業績，以及我們對 2026 年獲利展望的上修。在我們所做的每一項策略決策中都以會員為核心，我們看見重塑數百萬美國人醫療照護體驗的重大機會。

With that, I'll turn it over to Drew to provide more details on the quarter and our updated full-year outlook.

接下來，我把時間交給 Drew，請他就本季表現與我們更新後的全年展望提供更多細節。

Thank you, Sarah. Today, we reported very strong second quarter 2026 results, including $44.4 billion in premium and service revenue and adjusted diluted earnings per share of $2.51. As you evaluate Q2 in the context of a baseline for 2027, we had approximately $0.50 of earnings in the quarter relating to settlements of 2025 items in amounts that we wouldn't expect to recur in 2027. About $180 million related to marketplace final 2025 risk adjustment, net favorability relative to our prior guidance and about $160 million in our Medicare segment, largely favorable PDP 2025 risk adjustment and quality settlements.

謝謝你，Sarah。今天，我們公布了 2026 年第二季非常強勁的業績，包括保費與服務收入 444 億美元，以及調整後稀釋每股盈餘（adjusted diluted EPS）2.51 美元。當你們在評估第二季、並將其作為 2027 年基準的一部分時，本季約有 0.50 美元的盈餘與 2025 年項目的結算（settlements）相關，這些金額我們預期在 2027 年不會再度發生。其中約 1.8 億美元與 Marketplace 2025 年最終風險調整相關，屬於相對於我們先前指引的淨有利；另約 1.6 億美元來自我們的 Medicare 事業部，主要是 PDP 2025 年風險調整與品質結算的有利影響。

These items took strong execution by the team, but we wanted you to understand these drivers since the $0.50 will be a reconciling item when we provide a bridge from 2026 to 2027 in a couple of quarters. That aside, any way you slice it, this was a fantastic quarter. Our consolidated HBR was 89.6% for Q2, down from 93% in Q2 of 2025. Let's dig into each segment.

這些項目需要團隊強而有力的執行，但我們希望你們了解這些驅動因素，因為在幾個季度後我們提供從2026年到2027年的調節橋接時，這0.50美元將會是一個調節項目。除此之外，無論你怎麼看，這都是一個非常出色的季度。我們第二季的合併HBR為89.6%，低於2025年第二季的93%。讓我們深入探討各個業務分部。

In Medicaid, at a 93.9% HBR, we are right on track with our prior forecast and are still expecting a full-year HBR around 93.5%. This is down from our original expectation of 93.7% as we covered on the Q1 call. Consistent with our prior commentary, we expect Q2 and Q3 Medicaid HBRs to be higher than Q1 and Q4. As we look ahead to Q3, our 7/1 rate cohort, which represents about 20% of our membership, came in strong. This 7/1 cohort provides a nice sequential benefit from Q2 to Q3 to make progress toward matching rate and cost.

在Medicaid方面，HBR為93.9%，我們與先前的預測完全一致，並且仍預期全年HBR約為93.5%。這低於我們最初預期的93.7%，正如我們在第一季電話會議中所提到的。與我們先前的評論一致，我們預期第二季與第三季的Medicaid HBR將高於第一季與第四季。展望第三季，我們7/1生效的費率群組（約占我們會員的20%）表現強勁。這個7/1群組為第二季到第三季帶來良好的連續性效益，有助於朝費率與成本匹配的方向取得進展。

Overall, we now expect the full-year 2026 rate impact to be approximately 5%, up from 4.5%, with no change in our view of fundamental trend of mid-4s for the year. As some of you have written about, we did continue to see attrition in our Medicaid membership ending Q2 with 12.1 million members and we expect some states to continue to trim Medicaid rolls leading up to any OB3 implementation in 2027.

整體而言，我們目前預期2026年全年費率影響約為5%，高於先前的4.5%；同時，我們對於全年基本趨勢為4%中段（mid-4s）的看法不變。正如部分人士所撰文指出的，我們確實持續看到Medicaid會員數流失，第二季末會員數為1,210萬人；我們也預期在2027年任何OB3實施之前，部分州將持續縮減Medicaid名冊。

So for now, we are holding the incremental 50 basis points benefit of the rate improvement to account for a little higher membership attrition in the back half of the year, including the associated acuity impact. To be more specific. We expect full-year Medicaid membership to be down 8% to 9% compared to 12/31/25 versus our prior view of being down 6%. Overall, Medicaid was right on track in Q2 with good signs of medical expense execution coupled with progress on rates, and there's more work to do over the next couple of years to restore margin.

因此，目前我們保留費率改善所帶來的額外50個基點效益，以反映下半年可能較高的會員流失（以及相關的病況嚴重度影響）。更具體地說：我們預期全年Medicaid會員數相較於2025/12/31將下降8%至9%，而先前我們的看法是下降6%。整體而言，Medicaid在第二季完全符合預期，醫療費用執行良好並且費率也有所進展；未來幾年仍需持續努力以恢復利潤率。

Medicare segment results were strong in the quarter, including an HBR at 89.5%, inclusive of the 2025 item discussed a minute ago. PDP with good visibility once you get through two quarters, is having another strong year, and we now expect a full year pre-tax margin of greater than 3% compared to original guidance of 2%. Strong execution by the team, coupled with very good product positioning and being another year removed from the inception of the Inflation Reduction Act have all contributed to the improvement in our 2026 PDP forecast.

Medicare分部本季表現強勁，HBR為89.5%，其中包含我們剛才提到的2025年項目。PDP在度過前兩個季度後能見度良好，今年再度表現強勁；我們目前預期全年稅前利潤率將高於3%，相較於原先指引的2%。團隊的強力執行、非常良好的產品定位，以及距離《降低通膨法案》（Inflation Reduction Act）生效又過了一年，皆促成我們2026年PDP預測的改善。

Medicare Advantage, representing a little over 40% of segment revenue, continued to perform well, getting closer to breakeven for full year 2026 performance. The commercial segment, led by marketplace, had a very strong quarter with an HBR of 79.2% compared to prior year 90.6%, driven by the convergence of three positive factors.

Medicare Advantage約占分部營收的40%多一些，持續表現良好，使2026年全年表現更接近損益兩平。商業保險分部在市集（marketplace）的帶動下，本季表現非常強勁，HBR為79.2%，相較去年同期的90.6%，主要由三項正面因素匯聚所驅動。

One, a strong end to 2025 as discussed a minute ago. Two, confirmation of 2026 market acuity and particularly our relative risk adjustment position being better than reflected in our prior guidance. And three, tapering medical trend driving better than expected Q2 medical costs.

第一，如同剛才所述，2025年年底表現強勁。第二，確認2026年市場病況嚴重度（acuity），尤其是我們相對風險調整（risk adjustment）地位優於先前指引所反映的水準。第三，醫療趨勢（medical trend）趨緩，使第二季醫療成本優於預期。

While we were optimistic after seeing the New Wakely March demographic report that we helped initiate as discussed on the Q1 call, as we are waiting to see corroboration from the first Wakely claims reports received in late June. This data helps us understand our acuity relative to the market. Essentially, the data confirmed we took the correct swift actions in the summer of 2025 when we refiled 2026 rates with the visibility we had at the time of last year's major market shift.

雖然在看到我們協助促成、並於第一季電話會議中提到的Wakely 3月人口統計報告後，我們已感到樂觀，但我們仍在等待6月底收到的第一批Wakely理賠報告的佐證。這些資料有助於我們了解自身病況嚴重度相對於市場的情況。基本上，資料確認我們在2025年夏季所採取的迅速且正確的行動：在去年市場重大變動後，基於當時可見度重新提交（refile）2026年費率。

Accordingly, we now expect a Marketplace pre-tax margin of 4.5% to 5% in 2026 back on track after a temporary industry detour in 2025. As you can see, marketplace membership was reasonably stable compared to Q1 at 3.5 million members and we continue to expect a little more attrition as eligibility verifications may step up in the back half of the year.

因此，我們目前預期2026年Marketplace稅前利潤率為4.5%至5%，在2025年產業短暫偏離後重回正軌。如你所見，市集會員數相較第一季相當穩定，為350萬人；我們仍預期下半年因資格驗證可能加強而出現些許流失。

While we are still vigilant about pricing for risk shifts due to program integrity measures and changes affecting eligibility prospectively, we would expect the marketplace to be a more stable business for Centene as we look out over the next couple of years compared to the prior periods of abrupt program changes and the expiration of eAPTCs.

儘管我們仍對因計畫完整性措施（program integrity measures）以及影響未來資格的變更所造成的風險結構轉移之定價保持警覺，但展望未來幾年，相較於過去計畫突發變更以及eAPTCs到期的時期，我們預期Marketplace對Centene而言將是更穩定的業務。

Our adjusted SG&A expense ratio was 6.9% in the second quarter, compared to 7.1% last year, reflecting continued discipline in scale as well as product mix. As Sarah referenced, we are taking actions as part of an enterprise optimization to drive efficiencies and support the affordability of healthcare in 2027 and beyond.

我們第二季調整後SG&A費用率為6.9%，去年同期為7.1%，反映我們在規模化與產品組合方面持續保持紀律。如Sarah所提到，我們正採取企業優化（enterprise optimization）相關行動，以提升效率並支持2027年及以後醫療照護的可負擔性。

These actions, including further digitization, more ubiquitous use of technology and AI, and improvements in the customer experience alongside operational efficiencies should help us not just adapt to volume changes in our business but also drive margin restoration over the next few years. Q2 is initial evidence of that momentum.

這些行動包括進一步數位化、更普遍地運用科技與AI、在提升客戶體驗的同時推動營運效率，應可協助我們不僅因應業務量變動，也在未來幾年推動利潤率修復。第二季是這股動能的初步證據。

We ended the quarter with $715 million of cash available for general corporate use. During the second quarter of 2026, we repurchased $260 million of senior notes in our continued effort to delever to create capacity to seize future opportunities. Accordingly, we ended the quarter with a debt-to-cap ratio of 41.6%, down from 46.5% at year end. Our medical claims liability totaled $20.3 billion and represents 47 days in claims payable, a decrease of one day as compared to the first quarter of 2026, driven by timing of state-directed payments.

本季末，我們可供一般公司用途的現金為7.15億美元。在2026年第二季，我們回購了2.60億美元的高級票據（senior notes），持續致力於去槓桿（delever），以創造把握未來機會的能力。因此，本季末我們的負債對資本比率（debt-to-cap ratio）為41.6%，低於年末的46.5%。我們的醫療理賠負債合計203億美元，相當於47天的應付理賠天數，較2026年第一季減少1天，主要受州政府指示付款（state-directed payments）時點影響。

Cash flow provided by operations was $8 billion year-to-date and $3.6 billion for Q2, primarily driven by net earnings and the net impact of temporary pass-through payment receipts, state premium payments, and marketplace-related payments to CMS. As a heads up, in Q3, we expect to pay out over $3 billion of Medicaid pass-through payments that are sitting on our balance sheet at the end of Q2. As you've seen in our disclosure definitions, pass-through payments merely go through premium tax revenue and premium tax expense on our P&L and do not impact any key operating metrics like HBR, SG&A rate or DCP.

年初至今營運活動提供的現金流為80億美元，第二季為36億美元，主要由淨利以及臨時通道式（pass-through）付款收款、州保費付款與與Marketplace相關支付給CMS的款項之淨影響所驅動。先提醒一下，第三季我們預期將支付超過30億美元的Medicaid通道式付款，這些款項在第二季末仍列在我們的資產負債表上。如你們在我們的揭露定義中所見，通道式付款僅在損益表上流經保費稅收入與保費稅費用，並不影響任何關鍵營運指標，例如HBR、SG&A費用率或DCP。

Overall, given the strength of the quarter, we now expect greater than $4.80 of adjusted EPS in 2026, inclusive of the $0.50 that we wouldn't expect to recur in 2027. This increase from prior guidance of greater than $3.40 is primarily driven by an improved marketplace pre-tax margin of 4.5% to 5% and PDP margin of greater than 3%. Our Medicaid HBR forecast is consistent with prior guidance and the forecasted enterprise adjusted SG&A rate for 2026 is better by 10 basis points.

整體而言，鑑於本季表現強勁，我們目前預期2026年調整後EPS將高於4.80美元，其中包含我們預期不會在2027年重複出現的0.50美元。相較於先前「高於3.40美元」的指引，此次上調主要由Marketplace稅前利潤率改善至4.5%至5%以及PDP利潤率高於3%所驅動。我們對Medicaid HBR的預測與先前指引一致，而2026年企業層級調整後SG&A費用率預測則改善10個基點。

Total revenue is up $6 billion from prior guidance, but only $2 billion of that is actually premium and service revenue, with $1.5 billion attributable to Marketplace and $1.5 billion for Medicaid. The remaining $4 billion is merely premium tax pass-through revenue. While we have reported year-to-date adjusted EPS of $5.88, we expect a little above breakeven in Q3 and a loss in Q4 due to the seasonal sloping of our Medicare Part D and commercial products. This second-half trajectory is consistent with the prior year and commentary we provided on the Q1 call.

總營收較先前指引增加60億美元，但其中實際只有20億美元來自保費與服務營收，其中15億美元歸因於Marketplace，另15億美元來自Medicaid。其餘40億美元僅為保費稅的轉付（pass-through）營收。雖然我們年初至今已公布的調整後EPS為5.88美元，但由於我們的Medicare Part D與商業產品具有季節性走勢，我們預期第三季將略高於損益兩平，第四季則將出現虧損。這一下半年走勢與前一年一致，也符合我們在第一季電話會議中提供的評論。

You can see other guidance elements that were modified in our guidance table. Our workforce and enterprise optimization is expected to drive an estimated $480 million midpoint of SG&A costs in 2026 that are part of GAAP guidance and highlighted in the reconciliation table in the press release. We look forward to showing continued progress toward restoration of earnings as we look ahead.

您可以在我們的指引表中看到其他已調整的指引要素。我們的人力與企業優化預期將在2026年帶來約4.8億美元（以中位數估計）的SG&A成本，該項已納入GAAP指引，並在新聞稿中的調節表內重點揭露。展望未來，我們期待在邁向獲利恢復的道路上持續展現進展。

For those of you who hung in with us through 2025 industry turbulence, joined us since, or are thinking about jumping in, we thank you for your interest in Centene.

對於在2025年產業動盪期間仍與我們同行的各位、此後加入我們的各位，或正在考慮加入的各位，我們感謝您對Centene的關注。

Rocco, let's open it up for questions.

Rocco，我們開放提問吧。

Yes, sir. We will now begin the question-and-answer session. (Operator Instructions)

是的，先生。我們現在開始問答環節。(接線員指示)

John Stansel, JP Morgan.

John Stansel，JP Morgan。

Great. Thanks for taking the question. I want to ask about Medicaid enrollment. Just firstly, as you think about the high-acuity population stepping down, any particular areas that are driving that? And then just as we think about overall acuity shifting in the population within 2026, how you view that with a bridge to next year? Are you seeing this as pull forward or is this kind of incremental to anything we think about for OB3 impacts next year?

很好。謝謝讓我提問。我想問關於Medicaid投保人數（enrollment）。首先，當您思考高病情嚴重度（high-acuity）族群回落（stepping down）時，有哪些特定領域在推動這個變化？另外，當我們思考到2026年整體族群的病情嚴重度（acuity）變化時，您如何看待這點作為銜接到明年的橋樑？您看到這是提前反映（pull forward），還是相對於我們對明年OB3影響的預期屬於額外增量（incremental）？

Yeah, thanks, John, for the question. So, as we said, we did see slight incremental attrition compared to expectation in queue. Mostly that was in the expansion population. Some of it was driven by state-specific changes, but more of the uptick, as you pointed out, in terms of the enrollment and eligibility activity in certain states that are starting to tighten in general, consistent with what we've seen over the last year or so, but also starting to think about and prepare for OB3.

是的，John，謝謝你的問題。如同我們所說，我們確實看到相較於預期略高的額外流失（attrition）。主要發生在擴張族群（expansion population）。其中一部分是由各州特定變更所驅動，但更多的上升，如你所指出的，是某些州在投保與資格認定活動上開始整體收緊，這與我們過去一年左右所見一致，同時也開始思考並為OB3做準備。

So we saw a slight uptick in acuity in Q2 around that attrition. Obviously, we're able to absorb that given the strength of execution on initiatives. And as Drew talked about, as we think about guidance for the back half of the year, we're for now holding back that 50 basis points of favorability in the rate, in order to see how the additional membership attrition sort of move from 6% to 8% to 9% impacts acuity in the back half of the year.

因此，我們在第二季看到與該流失相關的病情嚴重度略有上升。顯然，憑藉各項措施執行力的強勁，我們能夠吸收這些影響。正如Drew所談到的，當我們思考下半年指引時，我們目前先保留費率中50個基點的有利因素（favorability），以觀察額外的會員流失從6%走向8%到9%時，對下半年病情嚴重度的影響。

If we take a big step back, I think your question is exactly right, which is, to what extent is this sort of not just a preparation, potentially a pull forward of some of the activity. Again, obviously not formal implementation of OB3, but states starting to tighten those criteria and starting to prepare and sort of categorize populations, and in some ways, I think probably prevent enrollment that would otherwise have had to go through a work requirements process.

如果我們退一步從更宏觀的角度看，我認為你的問題完全切中要點：這在多大程度上不只是準備工作，而可能是部分活動的提前反映（pull forward）。再次強調，這顯然不是OB3的正式實施，但各州開始收緊相關標準、開始準備並對族群進行分類；在某些方面，我認為也可能是在避免原本必須經過工作要求（work requirements）流程的投保。

So I think it's possible that that will end up being some of pull forward -- Again, we're accounting for that as we think about guidance for the back half of the year. And then, as I mentioned, we are very very deep in the planning process with all of our states and thinking about how they're going to go through, not just the ex parte process, trying to maximize the data they have for that. So that we ensure that folks who are eligible today and have clear data behind that don't face any coverage disruption, and then where there's opportunity for us to lean in and leverage all of the work we've done in terms of building out networks of community engagement, job programs for our members. We already had those in 17 states coming into this year, and so that's given us a fantastic blueprint to build out and obviously have the latitude from CMS guidance to really help members through that process.

因此我認為，這最後可能會有一部分屬於提前反映——同樣地，我們在思考下半年指引時已將此納入考量。另外，如我提到的，我們正與所有合作州非常深入地進行規劃，思考他們將如何推進，不僅是ex parte流程，也在努力最大化他們可用的資料。如此一來，我們能確保目前符合資格且有明確資料佐證的人，不會面臨任何保障中斷；同時，在我們可以加大投入之處，運用我們在建立社區參與網絡、為會員提供就業計畫等方面所做的所有工作。我們在今年開始前就已在17個州具備這些資源，因此這為我們擴展提供了極佳藍圖，並且在CMS指引所賦予的彈性下，能真正協助會員完成該流程。

And so as we think about this process compared to the broader redeterminations process, it's obviously very different in terms of scope and scale. It's a much more targeted population. We have a much higher degree of impactability than we had during that process in terms of being able to support members who want to be eligible and who need avenues for engagement and then continue to have very constructive conversations with our state partners about the right way to implement rates that will account for the acuity shift that we would expect as part of the Medicaid expansion population moves.

因此，當我們將此流程與更廣泛的重新認定（redeterminations）流程相比時，其範圍與規模顯然非常不同。這是一個更具針對性的族群。相較於當時的流程，我們在支持想要符合資格、且需要參與途徑的會員方面，具有更高程度的可影響性（impactability）；同時也能與各州合作夥伴持續進行非常具建設性的對話，討論如何以正確方式制定費率，以反映我們預期Medicaid擴張族群變動所帶來的病情嚴重度轉移。

Ann Hynes, Mizuho.

Ann Hynes，Mizuho。

Great. Thank you. I got a lot of questions just on the Medicaid margin progression given all the OBBB changes. And I know it's a little too early to provide 2027 guidance, but would you expect margins and Medicaid to expand just given the dynamic environment with all the regulatory changes? Thanks.

很好。謝謝。我有很多問題，主要是關於在所有OBBB變更之下，Medicaid利潤率（margin）走勢的演進。我知道現在提供2027年指引還太早，但在所有監管變動造成的動態環境下，您是否預期Medicaid的利潤率會擴張？謝謝。

Yeah, and thanks for the question. I'll go back to sort of where I just landed in John's question and expand that a little bit as we think about our -- first of all, overarching commitment to continued margin progression in Medicaid, and that includes, this year and moving from the 93.7% and 93.5% and continuing to hold ourselves to a high standard of execution and certainly going to try to improve that the rest of this year.

是的，謝謝你的問題。我會回到我剛才在回答John問題時的落點，並在此基礎上再延伸一些，來談我們——首先——對Medicaid利潤率持續改善（margin progression）的整體承諾；這也包括今年，從93.7%與93.5%（的水準）往前推進，並持續以高標準要求我們的執行力，當然也會努力在今年剩餘期間進一步改善。

But if we think about the number of different policy changes that are going to collide for states next year, it is certainly impactful. And so it is not something that we can or should hand wave. But again, I'll sort of kick through a couple of things that I think are helpful to think about and the things that we're thinking about as we approach kind of planning for '27, guiding for '27, that give us a sense of confidence in terms of, again, that goal of continued margin progression through the headwinds of OB3.

但如果我們思考明年各州將同時面臨多項不同政策變更的交疊，這確實影響重大。因此，這不是我們可以或應該輕描淡寫帶過的。不過，我會再快速帶過幾點我認為有助於思考的面向，以及我們在規劃2027年、提供2027年指引時所思考的事項，這些讓我們對於——再次強調——在OB3逆風下仍能達成利潤率持續改善的目標，抱持一定信心。

So first is that point about scope and scale. Obviously, a very different population than what we went through with the broader redeterminations PHE unwind. Some data points for context -- We came into the year with our expansion population as 25% -- 20% of the Medicaid portfolio. We will end the year with that being roughly 18%. And so if you just take some of the rough estimates that have been put out there, whether it's RWJ or CBO of, call it, 25% to 40% of that may roll off, you're talking either way, sort of mid-single-digit attrition. And that would be over 27%, 28%, possibly 29% if some states delay. So think about that number in the context of the fact that we just said we anticipate an 8% to 9% membership drop this year and are still committed to margin progression.

首先是關於範圍與規模的那個重點。顯然，這次的族群與我們在更廣泛的重新認定、PHE結束（unwind）期間所經歷的族群非常不同。提供一些背景數據——我們在今年開始時，擴張族群約占Medicaid組合的25%——20%。我們將在年底時使其約為18%。因此，如果你採用外界提出的一些粗略估計，不論是RWJ或CBO所估的約25%到40%可能會退出（roll off），不管怎麼算，你談的都是中個位數百分比的流失。而這會發生在2027年、2028年，若部分州延後，可能到2029年。把這個數字放在我們剛才所說的背景下思考：我們預期今年會員數將下降8%到9%，但我們仍然承諾利潤率持續改善。

The second piece is this point about impactability. And so as you think about the cohorts that the expansion members are going to fall in, one is going to be that ex parte eligible where there's very clear data, whether they (technical difficulty) off of claims data, run through the frailty algorithm, their automatically eligible. You have a bigger cohort that is what I would sort of describe as practically eligible, right? So they are engaged in community activities. They are going to school. They are serving as a caregiver. And all that needs to happen is they need to appropriately document that. And so that's a cohort that, again we can support and make and we're trying to maximize all the sources of data around that. But that's a population that we would want to see maintain their eligibility because they're doing all the right things relative to the legislative guidance.

第二點是關於可影響性（impactability）。因此，當你思考擴張成員將落入哪些族群時，其中一類會是依法（ex parte）符合資格的族群，因為有非常明確的資料——不論他們（技術困難）基於理賠資料，跑過衰弱度（frailty）演算法後，就會自動符合資格。你還有一個更大的族群，我會把它描述為在實務上符合資格（practically eligible），對吧？他們參與社區活動。他們在上學。他們擔任照護者。而所需要做的就是把這些情況適當地文件化。因此這也是一個族群——同樣地，我們可以支援、協助推動，而且我們正試圖把所有相關的資料來源都最大化。但這是一個我們希望能維持其資格的人口，因為相對於立法指引，他們都在做正確的事情。

And then the third cohort are folks who are not currently eligible, but again, they can become eligible. And so that's part of the playbook to offer them opportunities to engage in the community, workforce opportunities, job training. And if you separate for just a second kind of the perspective on the legislation as being sort of a pay for, when you get down to the state level, even in some of the more ambitious [red] states, the goal is really for people to be engaged in their own care and their own, sort of forward-looking trajectory, not necessarily to keep people from getting healthcare coverage.

第三個族群則是目前尚不符合資格的人，但同樣地，他們可以變得符合資格。因此，這也是作戰手冊的一部分：提供他們參與社區的機會、就業機會、職訓。如果你先把立法的觀點（把它視為某種「財源」安排）暫時放一邊，當你落到州層級，即便是在一些更積極的[red]州，目標其實是讓人們參與自己的照護，以及他們自身、偏向前瞻性的發展軌跡，而不一定是要阻止人們取得醫療保險保障。

And so I think we're talking about a very different kind of impactability to this overall program than we saw with the PHE.

因此，我認為我們談的是這個整體計畫在「可影響性」上非常不同的一種情況，和我們在 PHE 期間看到的不一樣。

And then the last thing quickly is just rate. And the fact that coming out of the PHE, we did not have -- I don't know if you should ever call trend or tailwind, but we did not have the tailwind of having heavy trend in that look-back base period like we do if you think about the trend that we've been managing in '24 and '25 and '26 as we roll into '27. So that's a little bit of a difference in terms of air cover to the degree there is a dislocation between rate and acuity.

最後一點很快提一下，就是費率（rate）。而且，從 PHE 出來之後，我們並沒有——我不知道你是否應該把它稱作趨勢或順風（tailwind），但我們並沒有在回溯基期（look-back base period）裡出現像現在這樣的強勁趨勢順風；如果你想想我們在 '24、'25、'26 所管理的趨勢，並且一路滾動進到 '27。所以就「空中掩護」（air cover）而言，若費率與病情嚴重度（acuity）之間出現錯位（dislocation），這會是一個小小的差異。

But we also didn't have the explicit guidance that CMS has given in terms of mid-cycle and retro rate adjustments, we didn't have the need for states to document the OB3 rate consideration as they sent rates up to certification. And so we just have a different set of tools at our disposal as we think about managing this over the next couple of years. All of which is to say, again, you cannot hand wave it but we do think it is a more manageable effort than what we went through with redeterminations, and our goal remains margin recovery for the Medicaid business, even through the OB3 headwinds over the next year or two.

但我們也沒有 CMS 明確給出的指引——例如期中（mid-cycle）與追溯（retro）的費率調整；我們也沒有要求各州在把費率送交認證（certification）時，必須文件化 OB3 的費率考量。因此，當我們思考在未來幾年如何管理這件事時，我們手上可用的工具組合就是不同的。總之，再次強調，你不能輕描淡寫帶過，但我們確實認為，這比我們在重新認定（redeterminations）期間所經歷的更可控；而我們的目標仍然是讓 Medicaid 業務的利潤率回復，即便在未來一到兩年面對 OB3 的逆風也是如此。

Justin Lake, Wolfe Research.

Justin Lake，Wolfe Research。

Thanks. I have a few questions on the exchanges quickly. First, your 10-Q indicates the 2025 risk adjustment settlement benefited the company by $481 million for the year. You talked about $180 million in the quarter, just wanted to get the delta there, what's driving that? And how we should think about that versus that nonrecurring benefit you talked about in the -- for the year. And then what are you assuming for the full year '26 risk adjustment in the exchanges? And lastly, maybe just a quick comment on the lower cost trend in 2Q and what's driving that?

謝謝。我想快速問幾個關於交易所（exchanges）的问题。首先，你們的 10-Q 顯示 2025 年風險調整（risk adjustment）結算讓公司全年受益 4.81 億美元。你們提到本季是 1.8 億美元，我想了解兩者之間的差額（delta）是什麼、是什麼在驅動？以及我們應該如何看待這個，對比你們提到的那個年度一次性（nonrecurring）受益。另外，你們對交易所 2026 全年風險調整的假設是什麼？最後，能否簡短評論一下第二季（2Q）較低的成本趨勢，以及背後的驅動因素？

Sure. I'll hit those in reverse order and let Drew walk through sort of the mechanics of the '25 risk adjustment. So first, in terms of overall utilization, we did see that moderate in Q2 from Q1 expectations. And again, if you think about how we set guidance on the Q1 call, we saw that uptick in utilization in Q1, initially called it out around specialty drugs, and our hypothesis at the time was that we had retained and attracted a higher acuity silver membership and the utilization was consistent with that hypothesis, but we didn't yet have the full view of the market acuity from the weekly data.

當然。我會倒著回答，然後讓 Drew 說明一下 '25 風險調整的運作機制。首先，就整體醫療使用量（utilization）而言，我們確實看到第二季相較於第一季的預期有所緩和。同樣地，如果你回想我們在第一季電話會議上如何設定指引，我們在第一季看到使用量上升，起初特別點出是在專科藥（specialty drugs）上；當時我們的假設是，我們留住並吸引了病情更嚴重度（acuity）較高的白銀（silver）會員，而使用量與這個假設一致，但我們當時還沒有從每週資料中完整掌握市場的嚴重度全貌。

And so what we essentially assumed in guidance was a continuation of that step-up and did not sort of give full credit for the risk adjustment offset. So what we saw in Q2 was a moderation from Q1 expectations. And utilization patterns that are very consistent with the higher Acuity Silver membership that we do, in fact have as confirmed by the weekly data. And if you just look at some of the disease states and the drug categories, again, consistent with what we called out in March around chronic conditions, anti-inflammatory oncology, these are conditions and drugs that have high HCC coding and therefore have pretty robust risk adjustment associated with them.

因此，我們在指引中基本上假設那個躍升會延續，且並未完全把風險調整的抵銷效果（offset）納入。所以我們在第二季看到的是，相較於第一季的預期有所緩和。而使用量型態也與我們確實擁有的高嚴重度白銀會員非常一致，這點已由每週資料所確認。如果你看一些疾病狀態與藥物類別，同樣地，與我們在三月提到的慢性病、抗發炎、腫瘤等一致；這些疾病與藥物具有較高的 HCC 編碼，因此也對應相當可觀的風險調整。

So all of that really came together essentially as we expected it to, maybe even a little bit better than expected in Q2. And then for full year 2026, we are now assuming a meaningful receivable in our 2026 risk adjustment position.

所以整體而言，這些因素基本上如我們所預期地整合到一起，第二季甚至可能比預期還要好一些。至於 2026 全年，我們現在假設在 2026 的風險調整部位上會有一筆顯著的應收款（receivable）。

And then I'll turn it over to Drew to walk through the mechanics of the 2025 reconciliation.

接著我把時間交給 Drew，請他說明 2025 年對帳（reconciliation）的運作機制。

Yes, Justin, so you're right. The $481 million is in the Q. That's an absolute number. And then you may recall every year, we have explicit margin on these estimates that gets released and then reestablished largely the same amount. So that's about $250 million. That doesn't benefit the P&L relative to our prior guidance because that's expected to roll each year. And so that gets you down to about $230 million, and then there's about $50 million of other deducts VBC. We had a little bit of refinement in Q1, which leaves $180 million better than our previous guidance.

是的，Justin，你說得沒錯。4.81 億美元是在 Q（季報）裡的數字，這是一個絕對金額。然後你可能記得，每一年我們在這些估計上都有明確的利潤率緩衝（explicit margin），會先釋放（released）再重新建立（reestablished），而金額大致相同。那大約是 2.5 億美元。相對於我們先前的指引，這部分不會讓損益表（P&L）受益，因為它預期每年都會滾動。所以扣掉後大約剩 2.3 億美元，另外還有大約 5,000 萬美元的其他扣減項（deducts），與 VBC 有關。我們在第一季做了一點精煉調整，最後就形成比我們先前指引好 1.8 億美元。

Andrew Mok, Barclays.

Andrew Mok，Barclays。

Hi, good morning. Given the increased visibility into this year's ACA acuity and higher full-year margin outlook, can you share how you're thinking about pricing for 2027 and the balance between further margin recovery versus membership growth next year? And at this point, do you expect the ACA market as a whole to grow? Thanks.

嗨，早安。鑑於今年 ACA 嚴重度（acuity）的能見度提高，以及全年利潤率展望上修，你能否分享一下你們如何思考 2027 年的定價，以及在明年進一步修復利潤率與會員成長之間的取捨？另外，就目前來看，你們是否預期整體 ACA 市場會成長？謝謝。

Yeah, thanks, Andrew, for the question. So as usual, we are taking a state-by-state approach to pricing. And the goal is a competitive and balanced portfolio. There has obviously been some movement in the market in terms of market exits, sort of the competitive landscape has changed slightly. Our bronze strategy has not changed as we think about 2027. And so it's a little bit too early to say as we're still sort of in the pricing process. And we'll get visibility into our competitive positioning as we get into Q3. But you can imagine our goal has been margin restoration for that business and that will continue to be our focus and has underpinned the strategy relative to 2027 pricing.

好的，謝謝 Andrew 的提問。如同以往，我們採取逐州（state-by-state）的定價方式。目標是打造具競爭力且均衡的產品組合。市場顯然有一些變動，例如有業者退出市場，競爭版圖也略有改變。我們在思考 2027 年時，青銅（bronze）策略並沒有改變。因此現在還稍微早了一點，因為我們仍在定價流程中。等到進入第三季（Q3），我們會更清楚看到自身的競爭定位。但你可以想像，我們的目標一直是讓該業務的利潤率回復，這也將持續是我們的重點，並且一直是 2027 年定價策略的基礎。

Relative to overall market growth, I think our view is that once we got through the implementation of various policy changes that this market would return to normalized growth. It continues to be a popular product and in many geographies is increasingly sort of the only point of access for folks to affordable healthcare. We do -- we are watching some of the lawsuits that are out there and the different rules that may impact membership right now. All of those have either been vacated and on appeal or have been stayed. And so that would probably mute some of the membership impacts that those would otherwise have, but we need to see how those are going to play out as we step into open enrollment. We'll obviously be able to give you a better viewpoint on that on the Q3 call.

相較於整體市場成長，我認為我們的看法是，一旦我們度過各項政策變更的落實期，這個市場就會回到常態化成長。它仍然是一個受歡迎的產品，而且在許多地區，愈來愈成為民眾取得可負擔醫療保健的唯一入口。我們確實——正在關注目前一些訴訟，以及可能影響當前會員數的不同規則。這些案件要嘛已被撤銷並進入上訴，要嘛已被暫緩執行。因此，這可能會削弱原本可能造成的部分會員數影響，但我們仍需觀察在進入公開投保期時，這些事情將如何發展。我們當然會在第三季電話會議上，給你更好的觀點。

Kevin Fischbeck, BoA.

Kevin Fischbeck，美國銀行（BoA）。

Great, thanks. I want to follow-up on some of the other conversations about Medicaid rates and acuity. Because I think that is a concern that people have is that rates will catch up, but then the acuity keeps shifting, making it hard to fully recapture the margin. I would have thought that we would start to see a little bit more progress in 2026 relative to that. Is there a time period where you feel like the data really does inflect and that we should be seeing it in the whatever it is, the Jan 1 rates next year? In the mid-year rate next year?

很好，謝謝。我想就其他關於 Medicaid（醫療補助）費率與病情嚴重度（acuity）的討論再追問一下。因為我認為大家擔心的是：費率會追上來，但病情嚴重度卻持續變化，使得很難把利潤率完全收回。我原本以為在 2026 年相較之下，我們會開始看到更多進展。你們是否有一個時間點，覺得數據真的會出現拐點，讓我們應該在明年 1 月 1 日的費率中看到反映？或是在明年年中的調整費率中看到？

Is there a time period where you kind of say, mathematically, this is the time we should be expecting it? And then is there anything that you think about as far as the risk -- the data points you gave about the risk rolling off was very helpful. But is there anything that you think about as far as like MLR impact of that risk pool relative to the MLR impact of the membership that has already dropped, is there a reason to believe that work requirements will be better, worse, neutral relative to the overall risk pool? Thanks.

是否有一個時間點，你們會說，從數學上來看，這就是我們應該預期看到的時間？另外，關於風險方面——你提供的關於風險族群逐步退出（risk rolling off）的數據點非常有幫助。但就 MLR（醫療損失率）的影響而言，相較於已經流失的會員所帶來的 MLR 影響，這個風險池的 MLR 影響你們還會怎麼看？是否有理由相信工作要求（work requirements）對整體風險池而言會更好、更差，或是中性？謝謝。

Thank you, Kevin. On your last point, do you mean relative to those who dropped during redeterminations or those who have already rolled off in some of this sort of early attrition, if you will?

謝謝你，Kevin。關於你最後一點，你是指相較於在重新認定（redeterminations）期間流失的人，還是指在某種「早期流失」（early attrition）中已經退出的人？

Well, yeah, I guess versus the comparison period that we're looking at, because I guess if you have 1 million people drop off. In each period, is the 1 million dropping off now sicker/healthier than the 1 million you dropped off a year or two ago and is now in the base data?

嗯，對，我想是相對於我們正在看的比較期間。因為如果有 100 萬人退出。

Got it. Okay. So let me talk a little bit about sort of overarching arc. As we come into 2026, obviously, we've been very focused in the last year on sort of the multi-tenant program in terms of execution and discipline on cost trend. As everyone knows, we have incrementally every quarter, we have more and more of the trend that we've seen in that base period, and that's why I think we continue to see strength in the development of the rates.

了解。好。那我先談一下整體的大方向。進入 2026 年時，顯然我們在過去一年非常聚焦於多承租戶（multi-tenant）計畫的執行，以及在成本趨勢上的紀律。如大家所知，每一季我們都逐步納入更多在基期所看到的趨勢，因此我認為我們持續看到費率制定的發展力道很強。

And I think what we are seeing a little bit now and what we're at least accounting for in the back half of '26, and frankly, to some degree what we've seen in that kind of point to point and a half of membership attrition that we originally accounted for, obviously it's a little bit higher now. I do think is some degree of pull forward of the OB3 impact. And so those things are sort of colliding, if you will in the back half of this year, and we're able to demonstrate that we're still powering through that. Again, with some degree of benefit from the tailwind of the rates.

而我認為我們現在看到的一些情況——至少我們在 2026 年下半年已將其納入考量——坦白說，在我們原先納入的那種點到點約 1.5 個百分點的會員流失中也有反映，當然現在略高一些。我確實認為其中有一定程度是 OB3 影響的提前發生（pull forward）。因此，這些因素在今年下半年某種程度上「碰撞」在一起，而我們也能證明我們仍能挺過去。同樣地，部分得益於費率帶來的順風（tailwind）。

And not necessarily with the explicit input into the rates of the OB3 impact that we believe are to come. And so if you think about the 7/1 rate cohort, a few of those states did put in explicit factors for the OB3 implementation, but all of them have committed to looking at rates 1/1/27 and thinking about mid-cycle adjustments as we step into the year when those impacts are going to come. So, again, in terms of that delta between when do we see the impact, when do we get rates for it, it continues to feel as we look at OB3 that there's going to be a tighter coordination between states knowing that these impacts are going to come, actually being able to better calculate what those will be and then accounting for those in the rates ahead of time.

而且費率中未必已明確納入我們認為即將到來的 OB3 影響。因此，如果你看 7/1 的費率批次（rate cohort），有少數州確實針對 OB3 的實施加入了明確因子，但所有州都承諾會在 1/1/27 檢視費率，並在進入那些影響將發生的年度時，考慮年中調整。所以，再次回到「何時看到影響、何時拿到對應費率」的差距，從我們對 OB3 的觀察來看，州政府會更緊密協調：既然知道這些影響將到來，就能更好地計算其幅度，並提前在費率中反映。

Again, to the extent that there's the dislocation, I think we have the tailwind of strength in rates from trend. All of that said, and I think this is exactly what you're getting at in your point, I do think that that will mute the full potential of margin recovery that we would want to see from our efforts as we think of back half of '26 and part of '27. And once we get to back half of '27, I think what we will start to see is the ability to impact underlying trend have the benefit of the tailwind of rates from the base period and then the benefit of explicit adjustments in the forward-looking rates relative to OB3. And that's when I think we start to get acceleration on margin recovery.

同樣地，就算存在錯位（dislocation），我認為我們仍有來自趨勢所帶動的費率強勁作為順風。但即便如此——我想這正是你問題的重點——我確實認為，當我們看 2026 年下半年與 2027 年部分期間時，這會抑制我們希望從各項努力中看到的利潤率回升的全部潛力。而一旦到了 2027 年下半年，我認為我們將開始看到：影響底層趨勢的能力，能同時享有基期帶來的費率順風，以及在前瞻性費率中針對 OB3 的明確調整所帶來的好處。那時我認為利潤率回升會開始加速。

But again, our goal is to continue to drive margin improvement regardless. And then maybe, Drew, do you want to talk just a little bit about sort of the relative acuity of the populations that have been rolling off sort of quarter over quarter, if we see any changes there?

但再次強調，我們的目標是不論如何都要持續推動利潤率改善。另外，Drew，你要不要稍微談一下，這些逐季退出的人口在相對病情嚴重度上如何？我們是否看到任何變化？

Yeah, I think to reinforce something Sarah said earlier, really important to understand this in the context. I know, Kevin, you do, but for the broad audience, the expansion population historically about 20% of our membership as of June 30, 19%, we expect within our guidance and our forecast down to 18%. So it is an isolated population that we can track the beta on, which gives us comfort with what we've seen so far in terms of acuity moves as that population is slowly shrinking with the pull forward that we've got that covered in our guidance inclusive of the benefit that Sarah covered on the 7/1 rates.

好的。我想強化 Sarah 先前提到的一點：把這件事放在脈絡中理解非常重要。Kevin，我知道你理解，但為了更廣泛的聽眾：擴張族群（expansion population）歷來約占我們會員的 20%；截至 6 月 30 日是 19%，我們預期在指引與預測中會降到 18%。因此這是一個我們可以追蹤其 beta（敏感度/變動特性）的獨立族群，這讓我們對目前看到的病情嚴重度變化感到安心；隨著該族群因提前發生而緩慢縮小，我們的指引已涵蓋這部分，並包含 Sarah 提到的 7/1 費率所帶來的好處。

Pleased with the discussions with our state partners, as she said, in terms of the acknowledgement -- explicit acknowledgement in terms of adding into the rates for a few of the states, but the acknowledgement that once those states decide how they're going to implement OB3 or any pull forward of expansion membership verifications that the rates would be reconsidered at that interim point in 1/1 really before much of the impact were to occur. So there's a lot to execute on, but we're sort of all over it with that isolated population really focused in the expansion population.

我們對與州政府夥伴的討論感到滿意；如她所說，部分州在費率中加入了明確的認列——但更重要的是，州方也明確認知：一旦這些州決定要如何實施 OB3，或任何擴張會員資格驗證的提前推進，費率會在 1/1 的那個中期點重新檢視，而且是在大部分影響發生之前。所以還有很多需要執行，但我們已全面投入，並且針對這個可隔離的族群——也就是擴張族群——高度聚焦。

Stephen Baxter, Wells Fargo.

Stephen Baxter，富國銀行（Wells Fargo）。

Just a couple of more clarifications on the improvement in the exchange outlook. Is the added period 180 basis points included in the margin revision that you gave? If so, I think it's worth about 50 basis points of the improvement. And then if we think about the other improvement that you're seeing, I think you're saying both that risk adjustment is improving versus the -- I think it was a slight receivable before, now a meaningful receivable, and cost trend is a little bit favorable to what you previously assumed.

我再釐清幾點關於交易所（exchange）展望改善的部分。新增的 180 個基點期間是否已包含在你們所提供的利潤率修正中？如果是的話，我認為它大約貢獻了 50 個基點的改善。另外，如果我們思考你們看到的其他改善，我理解你們的意思是：風險調整（risk adjustment）相較之前有所改善——之前我記得是小幅應收款（receivable），現在變成顯著的應收款——而成本趨勢也比你們先前假設的略為有利。

So as we think about the remaining 125 basis points of improvement, I guess how should we think about the relative contribution of those two factors? Thank you.

因此，當我們思考剩餘的125個基點改善時，我想我們應該如何看待這兩個因素各自的相對貢獻？謝謝。

Yeah, you're right. We're going from a 3% pre-tax margin in prior guidance to 4.5% to 5%, mid-point 4.75%.

是的，你說得對。我們是從先前指引的3%稅前利潤率，提升到4.5%到5%，中位數是4.75%。

And yeah, I think you got the math right. $180 million is about 60 basis points on the full year, but there's some additional improvement in there, both from -- and you sort of have to look at these in tandem, both from the improvement relative to prior guidance in our relative risk position. I mean, we had the hypothesis, as you may remember from the Q1 call, with the early Wakely demographic data, that report that we helped drive for the first time this year.

是的，我想你的計算沒錯。1.8億美元大約相當於全年約60個基點，但其中還有一些額外的改善，來源包括——而且你必須把這些因素一起看——相較於先前指引，我們相對風險部位的改善。我的意思是，我們有一個假設，如你可能還記得在第一季電話會議上，基於Wakely早期的人口統計資料，那份報告是我們今年首次協助推動產出的。

And we got the corroboration and the actual claims data -- four months of claims data in the June Wakely. So you have to look at that in the context of cost trend, but both of those things were positive drivers in the quarter and for the full year. And we're also being thoughtful in our guidance about we increased the sloping of the HBR in terms of thinking through the benefit plan rollout, especially with a higher bronze population for us and we were thoughtful about any potential revenue reconciliations relative to eligibility verifications as we thought about making sure we're covered for in that 4.5% to 5% for any potential aberrations in the back half of the year, though Q2 looked pretty good in terms of a jumping-off point for Q3.

而我們在6月的Wakely報告中得到了佐證以及實際的理賠資料——四個月的理賠資料。所以你必須在成本趨勢的脈絡下來看，但這兩件事在本季以及全年都是正向驅動因素。此外，我們在指引上也很審慎：我們提高了HBR的斜率，因為我們在推演福利方案推出時的影響，特別是我們的青銅級（bronze）族群占比更高；同時，當我們思考如何確保在4.5%到5%區間內有足夠緩衝時，也審慎納入了相對於資格驗證（eligibility verifications）可能出現的任何收入對帳（reconciliations）影響，以因應下半年可能的異常情況，儘管第二季作為第三季的起點看起來相當不錯。

AJ Rice, UBS. Please go ahead.

UBS的AJ Rice。請繼續。

Hi, everybody. I know you're undertaking some initiatives to just impact the overall company cost structure. I think you instituted some employee buyouts in the quarter. And Drew is also talking about the technology and AI investments you're making.

大家好。我知道你們正在推動一些措施，以影響公司整體的成本結構。我想你們在本季實施了一些員工自願離職補償方案（buyouts）。而Drew也在談你們正在進行的科技與AI投資。

Can you just comment on how that in and of itself, regardless of what's happening with the cost trend, impact your cost structure, maybe your G&A ratio, and how you think about how that may improve going forward?

你們能否評論一下，這些措施本身——不論成本趨勢如何——會如何影響你們的成本結構，例如你們的G&A比率，以及你們如何看待未來可能的改善？

Thanks, AJ. So coming out of sort of back half of '25 and coming into '26, you heard us talk a lot about our focus on multi-year margin restoration for the business and also a view that there is an opportunity in this moment for a lot of different reasons to really optimize the enterprise for what we see in the future. And that has taken a number of different shapes and forms, including simplifying the organization, simplifying our operating model ways of working, really thinking about how to even further leverage the size and scale of the organization for the benefit of member experience and obviously being sort of good stewards of taxpayer dollars. Really simplifying our interaction with members and providers and then again leveraging data and AI to modernize our operations.

謝謝你，AJ。所以從大約25年下半年到進入26年，你聽到我們多次談到，我們聚焦於這項業務的多年期利潤率修復，同時也認為在此刻、基於許多不同原因，確實有機會把企業針對我們所看到的未來進一步最佳化。而這已經以多種不同的形態呈現，包括簡化組織、簡化我們的營運模式與工作方式，並真正思考如何進一步運用組織的規模與量體，來提升會員體驗，當然也要善盡納稅人資金的管理責任。也包括大幅簡化我們與會員及醫療提供者的互動，並再次運用資料與AI來現代化我們的營運。

Overall. So we touched on a couple of those. I think we'll continue to share the impacts of those and the different opportunities. But it really is in service, as I've said a couple of times, of delivering industry-leading health outcomes. So really thinking about the quality impact to our members, making sure they have access to high-quality care, that they are actually sort of seeing improvements overall, which impact the HBR, but also doing that with an industry-leading cost structure. And so that's something that we're focused on. I think you see good SG&A results this year. We're going to continue to focus on that as we go forward because we believe that there is opportunity in that area and that's part of the goal that we've set for ourselves over the long-term.

整體而言。所以我們提到了其中幾項。我想我們會持續分享這些措施的影響以及不同的機會。但正如我已經說過幾次，這一切都是為了提供業界領先的健康成果。因此，我們真正思考的是對會員的品質影響，確保他們能取得高品質照護，並且整體上確實看到改善；這會影響HBR，但同時也要以業界領先的成本結構來做到。這就是我們的重點。我想你今年看到不錯的SG&A結果。我們未來也會持續聚焦，因為我們相信這個領域仍有機會，而這也是我們為自己設定的長期目標之一。

Lance Wilkes, Bernstein.

Bernstein的Lance Wilkes。

Great, thanks. Could you talk a little bit about your ICHRA business and in particular kind of size of membership, sales outlook, margin performance and the types of clients that are interested in that thus far?

很好，謝謝。能否談談你們的ICHRA業務，特別是會員規模、銷售展望、利潤率表現，以及目前對此感興趣的客戶類型？

And maybe just two quick cleanup clarifications. One would be, what are you seeing as far as low utilizers over in Medicaid? I think you've commented on that previously. Maybe you could just update us on how that is looking. In the note or in the press release, you talked about particular areas of medical cost management that you were performing well and maybe you could just highlight what those were within Medicaid. Thanks.

另外兩個快速的釐清問題。第一個是，你們在Medicaid那邊看到的低使用者（low utilizers）情況如何？我記得你們之前有評論過。也許你們可以更新一下目前的狀況。在備註或新聞稿中，你們提到在某些醫療成本管理領域表現良好，能否特別指出在Medicaid裡面是哪些領域？謝謝。

Yeah, sure. So Medicaid, in terms of medical costs, fundamental trend drivers were consistent with past quarters. So we've talked about behavioral health, home health, high-cost drugs. We did see a second quarter of year-over-year moderation in behavioral health, particularly in ABA, and I think that's a direct result of our focus in the space and the work that we've talked about and done really over the last 12 to 18 months in terms of everything from member outreach, educating providers on standards of care, influencing state policy, and then aggressive fraud, waste, and abuse in such a fragmented provider network.

好的，當然。就Medicaid而言，在醫療成本方面，基本的趨勢驅動因素與過去幾季一致。所以我們談過行為健康、居家照護、高成本藥物。我們確實看到行為健康在第二季出現年對年趨緩，特別是在ABA方面；我認為這是我們聚焦該領域以及我們在過去12到18個月所談到並完成的工作所直接帶來的結果，包括從會員外展、教育醫療提供者照護標準、影響州政府政策，到在如此分散的提供者網絡中積極打擊詐欺、浪費與濫用。

So that is a space that we really are seeing the impact of our efforts. There are other places that we made progress in the quarter. One example, around payment integrity is really in those areas that are susceptible to more of the AI upcoding. We've talked a bit about sepsis and the fact that we started to see an uptick on that as well as it showing up on lower duration stays. And showing up as a diagnosis code without the underlying clinical documentation to support the level of acuity that diagnosis would suggest.

所以這確實是我們看到努力成效的領域。本季我們在其他方面也取得進展。其中一個例子是在支付完整性（payment integrity）方面，特別是那些更容易受到AI「向上編碼」（upcoding）影響的領域。我們談過敗血症（sepsis），以及我們開始看到其增加，同時也出現在住院天數較短的案例中。而且它以診斷碼的形式出現，但缺乏底層臨床文件來支持該診斷所暗示的嚴重程度（acuity）。

And so, we made great progress in the quarter in terms of implementing algorithms, and some of that is, that the AI talked about, but also kind of clinical conversations and making sure that we're actually paying correctly for the care that's delivered. So, those are the two areas. And then, as we talked about, we have a pretty robust.

因此，我們在本季在導入演算法方面取得很大進展，其中一部分就是前面提到的AI，但也包括臨床端的溝通，並確保我們確實是針對所提供的照護正確支付。所以，這就是兩個領域。然後，如同我們談到的，我們也有相當健全的。

Let me just talk quickly about ICHRA and then I'll turn it over to Drew to talk about the low utilizers in Medicaid. Our ICHRA business is roughly 50,000 members today. That's a 2.5 times growth since last year. So great growth rate, small numbers. But I would say that there is no shortage or abatement in the interest and energy around ICHRA as an alternative. Some of that is driven by the fact that employers, and we're among those are seeing the pressures of cost drivers going up and those getting passed through to us. But it's also the fact that in the number of geographies, the options for small group are deteriorating.

我先快速談一下ICHRA，然後我會交給Drew來談Medicaid中的低使用者。我們的ICHRA業務目前大約有5萬名會員。這比去年成長了2.5倍。所以成長率很不錯，基數仍小。但我會說，市場對ICHRA作為替代方案的興趣與動能並沒有減弱或消退。其中一部分原因是雇主——我們也在其中——正感受到成本驅動因素上升的壓力，而這些成本也被轉嫁到我們身上。但另一個原因是，在許多地區，小型團體（small group）的選項正在惡化。

So we think there is -- continue to believe that there is a great opportunity there. As I think many know, we offered ICHRA as a benefit to some of our employees and have used that to get a really good sense of the benefits that can give employees as an alternative in terms of choice and portability and frankly greater affordability. So we continue to be bullish about that. It's obviously a much smaller portion of our portfolio, but we think it's a great option for the future.

所以我們認為——也持續相信——那裡有很大的機會。如同許多人所知，我們也把ICHRA作為部分員工的福利，並藉此更清楚了解它作為替代方案能帶給員工的好處，包括選擇性與可攜性（portability），坦白說也更具可負擔性。因此我們仍然相當看好。它顯然在我們的投資組合中占比小得多，但我們認為它是未來很好的選項。

And then over to Drew on low utilizers.

接著把時間交給 Drew，談談低使用者。

Yeah. So, Lance, yeah, we track low zero utilizers in all of our lines of business. And as you understand, in an insurance business, you have sort of this gamut of high utilizers, and you always have a cohort of low and zero utilizers. When you look at that for Medicaid specifically, you're right, we've seen a drop in those low utilizers -- zero utilizers from the PHE, public health emergency period, as you would expect, making our way towards pre-PHE.

是的。所以，Lance，是的，我們在所有業務線都會追蹤低使用者與零使用者。如你所知，在保險業務中，你會看到一個從高使用者到低與零使用者的光譜。就 Medicaid 而言，你說得沒錯，我們確實看到從 PHE（公共衛生緊急狀態）期間的低使用者／零使用者比例下降，這也符合預期，因為我們正逐步回到 PHE 之前的狀態。

And interestingly, which ties back to our discussion about the expansion population and the slight acuity shift that we're noticing and we're planning for, it's the most pronounced -- the drop is most pronounced in the Medicaid expansion population as a subset of our overall Medicaid portfolio.

而且很有意思的是，這也呼應我們先前談到的擴張人口，以及我們正在觀察並納入規劃的輕微病情嚴重度（acuity）變化：在我們整體 Medicaid 組合中，下降最明顯的是 Medicaid 擴張人口這個子群。

George Hill, Deutsche Bank.

George Hill，德意志銀行。

Hey, good morning, guys. And I'm going to ask Steve's question, but from the PDP perspective. If we back out the PDP adjustment, it looks like that's about 60 basis points of doing the math right and the margin expansion is going from -- expectations going from 3 versus 2. So I guess I would ask, like, is that like 50 basis points of like real margin expansion versus a prior expectation and kind of how do you think about the risk in the balance of the year as those beneficiaries hit their moves and do we see like a step up in utilization in the back half of the year? So just how we're thinking about this to the organic margin expansion. Thanks.

嗨，早安，各位。我想從 PDP 的角度來問 Steve 的那個問題。如果把 PDP 調整扣除掉，看起來大約是 60 個基點（如果我算得沒錯），而利潤率擴張的預期是從 3 變成 2。所以我想問的是：這裡面大概有 50 個基點是真正相較先前預期的利潤率擴張嗎？以及你們怎麼看今年剩餘期間的風險——當這些受益人達到他們的變動點時，我們會不會在下半年看到使用量上升、出現一個台階式的增加？也就是說，我們該如何看待這個有機的利潤率擴張。謝謝。

Yeah, good questions around PDP and a business that's performing well, once you get through the second quarter, George, you have a pretty good. Since it's a pharmacy benefit only, while it's complex, it's a pharmacy benefit only, you've got a pretty good read on the year, but you're absolutely right, tracking through the maximum out-of-pocket, MOOPS through the year and then having visibility of the prior years that were impacted by the Inflation Reduction Act, and quite frankly, triggering some additional utilization in specialty as we covered about a year ago. So, that's performing well.

是的，關於 PDP 的好問題。George，這個業務表現得很好，通常過了第二季之後，你對全年就會有相當清楚的掌握。因為它只是一個藥局福利（pharmacy benefit only），雖然很複雜，但畢竟是藥局福利，你對全年會有不錯的判讀。不過你說得完全正確：我們會追蹤全年累積到最高自付額（maximum out-of-pocket，MOOPS）的進程，並且也能看到前幾年受到《降低通膨法案》（Inflation Reduction Act）影響的情況；坦白說，正如我們大約一年前提到的，那也引發了專科藥（specialty）額外的一些使用量。所以，這塊表現得很好。

You may have noticed we said greater than three, not just three. And so we're bullish about sort of our positioning for this year. We're sitting on greater than three right now. And you're right on your math in terms of the benefit that we had in the quarter for the settlement of prior year risk adjustment and quality items that we wanted to make sure you understood as you think about rolling this year into 2027.

你可能也注意到我們說的是「大於 3」，而不只是 3。因此，我們對今年的整體態勢相當樂觀。我們目前就在 3 以上。而且你在數學計算上是對的：本季我們因為前一年度風險調整與品質項目的結算而獲得的效益，我們希望你在思考把今年延伸到 2027 年時能把這點納入理解。

Sarah James, Cantor Fitzgerald.

Sarah James，Cantor Fitzgerald。

Thank you. I wanted to drill a little bit into the AI investments and G&A. So in AI, your shift in focus to platform related items, trusted data products, dynamic context management. Can you help us understand on a more practical level what that means and is it a platform build or a vendor relationship?

謝謝。我想更深入問一下 AI 投資與 G&A。在 AI 方面，你們把重點轉向平台相關項目、可信任的資料產品、動態情境管理（dynamic context management）。能否從更實務的層面幫我們理解這代表什麼？這是自建平台，還是與供應商的合作關係？

And then second, in the queue, you guys mentioned that you're considering early adoption of ASU 2025-06. So if you do that, how meaningful of a tailwind could it be to G&A and is any of that overlapping with the $480 million enterprise optimization of G&A or is it a separate lever? Thanks.

第二個問題，你們提到正在考慮提前採用 ASU 2025-06。如果你們這麼做，對 G&A 可能帶來多大程度的順風？其中是否有任何部分與 4.8 億美元的企業層級 G&A 優化重疊，還是這是一個獨立的槓桿？謝謝。

Yeah, thanks, Sarah. My comments were to go a little bit deeper on strategy, less so a shift, but more to point out that we've made good progress in terms of high ROI use cases and deployment of AI. It is still early, and it's a little bit more of a philosophy, which is I think it's easy to get on an earnings call and say we're doing AI everywhere and we've got all these great partnerships, but our view is that for -- there's also a risk of spending a lot of money on AI and getting no return for it. And that's not something that we can afford to do as a Medicaid-first company in a margin-compressed environment.

是的，謝謝你，Sarah。我的評論是想在策略上再深入一點，與其說是重點轉移，不如說是要指出：我們在高投資報酬（ROI）的使用情境與 AI 部署方面已取得不錯進展。目前仍在早期階段，這更像是一種理念：我認為在法說會上很容易說我們到處都在做 AI、也有很多很棒的合作夥伴，但我們的看法是——同時也存在一個風險：在 AI 上花了很多錢卻沒有任何回報。在利潤率受壓縮的環境下，作為一家以 Medicaid 為優先的公司，我們承擔不起這種情況。

And so we are really strategically thinking about this around first, the greatest value that will come from all of this and sort of the ability to maximize AI is really predicated on the command you have of your data, the ability build differentiated data products and to maintain and own the context layer. And if you think about being the largest Medicaid managed care, the largest government-sponsored programs company in the market with 25 years of history and context, that's really where we are focusing in terms of the foundational work.

因此，我們在策略上非常聚焦於：首先，這一切能帶來的最大價值，以及最大化 AI 的能力，真正取決於你對資料的掌握程度、打造差異化資料產品的能力，以及維持並擁有情境層（context layer）的能力。如果你想到我們是市場上最大的 Medicaid 管理式照護、最大的政府資助計畫公司，擁有 25 年的歷史與情境脈絡，這正是我們在基礎性工作上所聚焦的地方。

And so while we'll continue to highlight places where we're then leveraging that to deploy use cases, we are also holding ourselves to an extraordinarily high bar in terms of the ROI. We aren't just going to deploy ROI to talk about AI, we're going to deploy it where there is very clear tangible return on that investment. And we think that the way to do that is by this foundational focus on data and context in the short-term. So more to come on that, but it was really just trying to sort of click down and give folks a sense of our philosophy and how we're being prudent about investments in that space.

所以，雖然我們會持續強調我們如何運用這些基礎來部署各種使用情境，但我們也對 ROI 設定了極高的門檻。我們不會只是為了談 AI 而部署 AI；我們會在投資回報非常清楚、可衡量且具體的地方才部署。而我們認為，要做到這點，短期內就必須以資料與情境為核心打好基礎。所以後續還會有更多分享，但我主要是想再往下講一層，讓大家理解我們的理念，以及我們如何在這個領域審慎投資。

Yeah, and as far as the early adoption of that, internally developed software pronouncement, that's not going to be material to the company. What you're seeing in SG&A is sort of real true substantive execution and action. And as you heard from Sarah and as we look ahead, we're very optimistic about our ability to deliver an industry-leading cost structure, including the SG&A element on behalf of state and federal customers and ultimately taxpayers.

是的，至於提前採用那項「內部開發軟體」的會計準則公告，對公司而言不會是重大影響。你在 SG&A 看到的，是實打實、具體且有實質內容的執行與行動。而且如同你從 Sarah 那裡聽到的，以及我們往前看，我們對於交付業界領先的成本結構非常樂觀，其中也包括代表州與聯邦客戶、最終也代表納稅人的 SG&A 構成。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛。

Hi, thanks. Good morning. I wanted to just tack on -- I know there's been already a couple of questions about the out-year dynamics of Medicaid with OBBBA. I feel like one area that the work requirements get a lot of attention and widely so, but the other regs seem to get a lot less attention in the discussion in terms of the Medicaid SDPs and the provider tax reform and then the budget neutrality of the 1115 waivers and just effectively around how much more limitation on the states that's going to create on their funding.

嗨，謝謝。早安。我想再追問一下——我知道已經有幾個問題談到 OBBBA 下 Medicaid 的跨年度動態。我覺得外界對工作要求（work requirements）關注度很高，這也合理，但在討論中，其他規範似乎受到的關注少很多，例如 Medicaid 的 SDP、提供者稅（provider tax）改革，以及 1115 豁免的預算中立（budget neutrality），本質上就是這些會在資金上對各州造成多大的限制。

As the Feds look to sort of bring the sort of the mapping back down and balance to where it used to be more traditionally. So just be interested in your thoughts there in terms of ultimately, how you think the funding environment may evolve with the states and how that sort of intersects with your efforts to get rates back up above cost trends and then continue with marginal recovery, more looking out sort of into FY28, '29, and '30? Thanks.

因為聯邦政府似乎想把整體的「對應／配比」（mapping）拉回到更傳統的水準並重新取得平衡。所以我想聽聽你們的看法：最終你們認為各州的資金環境會如何演變？這又如何與你們把費率拉回到高於成本趨勢、並持續進行利潤率修復的努力交會——更著眼於 FY28、'29、'30 的展望？謝謝。

Yeah, thanks, Scott, for the question. And you're right to point out sort of what I referenced before, that there are kind of multiple components of this that are colliding that aren't just work requirements. What's interesting is -- and it goes back to kind of what is the value of managed care. One of the biggest values that we deliver to the states is being able to help them contain their budget and have budget predictability.

是的，謝謝你的問題，Scott。你指出得很對，正如我先前提到的，這裡有多個面向同時碰撞，並不只是工作要求而已。有趣的是——這也回到「管理式照護的價值是什麼」。我們為各州提供的最大價值之一，就是能協助他們控制預算並提升預算可預測性。

And so what we have found is that when states go through periods of budget pressure, it actually creates strength in the partnership. And it's part of why we've talked -- you've seen over the last year, a different level of engagement and movement in terms of program changes and benefit changes. And a lot of that is because states look to us for ideas and for opportunities to maintain the fidelity of the benefits that they want to offer to the Medicaid population, but doing so within a more budget-constrained environment, it's also a time where we've seen much more movement of specialty populations into managed care.

因此，我們發現的是，當各州經歷預算壓力期間時，實際上會強化彼此的合作夥伴關係。這也是我們一直在談的原因之一——你們在過去一年看到，在方案變更與福利變更方面，有不同層級的參與度與推進。其中很大一部分原因在於，各州會向我們尋求想法與機會，以在更受預算限制的環境下，仍能維持他們希望提供給醫療補助（Medicaid）族群之福利的完整性；同時，我們也看到更多專科族群被納入管理式照護。

And so, the states are absolutely sort of wrangling all of those pieces at the same time, but we actually think it's an opportunity to have productive conversations about where they can get savings without further cutting into the Medicaid program. Think about carving in more populations, so it actually could be a period of potential further growth. You're seeing a little bit of that come through in the RFP cycle.

因此，各州確實是在同一時間把所有這些拼圖都整合處理，但我們其實認為，這是一個機會，可以就他們如何在不進一步削減醫療補助計畫的情況下取得節省，進行具建設性的對話。想想把更多族群納入（carve in），所以這其實可能是一段具有進一步成長潛力的期間。你會在RFP循環中看到一些這樣的跡象。

And so, again, it's certainly going to be a number of things that we've got to work with them on over the next couple of years, but I think it's a much more balanced view than just feeling like all of these policy changes are going to create pressures ultimately on rates. I think they need to fund the programs, and I think we've got great ideas about how they can do that and have the opportunity to, and are engaging with them on that front already.

所以，再次強調，未來幾年我們確實會有不少事情需要與他們一起合作處理，但我認為這是一個更為平衡的觀點，而不只是覺得所有這些政策變動最終都會對費率造成壓力。我認為他們需要為這些計畫提供資金，而我們也有很好的想法，能協助他們做到這點並把握機會，而且我們在這方面已經開始與他們互動。

Michael Ha, Baird. Please go ahead.

Michael Ha，Baird。請繼續。

Thank you. Just wanted to follow-up on Kevin and Lance's question. I guess asking it in a different way, looking for more granularity since it's such an important topic. So I understand, Drew, as you said, the remaining low, no utilizer of Medicaid members, much lower now than the last few years. And you only expect a very modest acuity shift into next year.

謝謝。我想跟進Kevin和Lance的問題。我想用不同方式問，因為這是非常重要的議題，所以希望能更細緻一些。所以我理解，Drew，如你所說，剩餘的低使用者或零使用者的醫療補助會員，現在比過去幾年低很多。而你們也只預期到明年會有非常溫和的病情嚴重度（acuity）轉移。

That said, I know this year a bit higher member attrition, you're leaving some rate cushion on the table for back half acuity shifts potentially. I was wondering if you could provide just more granularity around what you mean by low utilizers today, specifically, and what MLR range would you even consider low utilizer? And how has the distribution of members across these buckets changed in your expansion book since redetermination first began in 2023? Thank you.

話雖如此，我知道今年會員流失率（attrition）稍高一些，你們也在費率上保留了一些緩衝，以因應下半年可能出現的病情嚴重度變動。我想請你更具體說明一下，你們今天所指的低使用者究竟是什麼，特別是，以及你們會把哪一個醫療損失率（MLR）區間視為低使用者？另外，自從2023年重新資格審查（redetermination）開始以來，在你們的擴張（expansion）業務中，會員在這些分組（bucket）之間的分布如何改變？謝謝。

Yes, so we take a look, we can slice the data so many different ways and then you also have to think about we're only six months into the year and factor that into the cohort you're looking at because -- obviously, you have to compare that to like periods. But like if you step up and look at fundamentally, as you would expect, the, let's say, zero utilizing population is down from that PHE time period, as I said before, and the med expansion population where we are seeing slight -- I mean, I'm talking slight acuity in terms of what we expect this year, which the 50 basis points should more than cover in terms of the back half of the year.

是的，所以我們會檢視資料，我們可以用很多不同方式切分資料；同時你也必須考量我們今年才過了六個月，並把這點納入你所看的同一群組（cohort），因為——顯然你必須拿相同期間來比較。但如果你拉高一點、從根本來看，如你所預期的，譬如說，零使用族群相較於PHE那段期間已經下降了，正如我先前所說；而在醫療補助擴張族群方面，我們看到的病情嚴重度只有些微——我是說非常些微——就我們對今年的預期而言，而這50個基點應該足以涵蓋今年下半年的影響。

But we're being thoughtful about there is an impact when you shed lower utilizing members when states may not adopt OB3 early, but some states are explicitly taking action, effectively pulling forward some of that impact and that actually gives us really good data to be able to share with other states. I mean, there's one state, as that adopted the OB3 provisions early, so we're getting early data on that state is pretty immaterial, but it's data nonetheless.

但我們也審慎看待：當各州可能未及早採用OB3時，若你流失的是較低使用的會員，確實會有影響；但有些州正在明確採取行動，等於把部分影響提前反映，而這也讓我們取得非常好的資料，能與其他州分享。我的意思是，有一個州提前採用了OB3條款，所以我們正在取得該州的早期資料；這影響相當不重大，但畢竟仍是資料。

So we're confident we can manage through this, but it's good to be able to have these discussions with our state partners to acknowledge that when actions are taken on the expansion population, which is not in all of our states. But those actions will have rate consequences and we're already seeing traction, not just in discussions, but in actual rates being provided in advance in 7/1 in a few states. So we're optimistic we can roll through this, and it's really good to have the muscles that have been built both on the payer side, but also on the state side in terms of the acknowledgment of what acuity shifts mean in Medicaid.

因此，我們有信心可以把這件事管理過去，但能與我們的州政府合作夥伴進行這些討論也很重要，並承認當針對擴張族群採取行動時——而這並非發生在我們所有州——但這些行動會對費率產生後果，而我們已經看到進展，不僅是在討論上，也包括在少數州於7/1提前提供實際費率。所以我們對於能順利度過這段期間感到樂觀；而且，無論是在付款方端，或是在州政府端，對於醫療補助中病情嚴重度轉移意味著什麼的認知與能力都已建立起來，這真的很好。

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

謝謝。以上為我們的問答環節。我想把會議交回給Sarah London，請她做結語。

Thanks, Rocco. Just to wrap up, obviously feel great about the progress so far this year on our margin restoration agenda. I feel like we have a prudent posture as we look at the back half of the year. Just want to thank everyone for joining us this morning, for your interest in Centene, and a big thank you as always to the Centene team. It is an honor to be on this mission with you. Have a great day.

謝謝，Rocco。最後做個總結，顯然我們對今年迄今在利潤率修復（margin restoration）議程上的進展感到非常振奮。在展望下半年時，我覺得我們採取了審慎的立場。也想感謝今天早上各位的參與、對Centene的關注，並一如既往地非常感謝Centene團隊。能與各位一同投入這項使命，我深感榮幸。祝大家有美好的一天。

Thank you, ma'am. This does conclude our conference call for today. We thank you all for attending today's presentation. You may now disconnect your lines and have a wonderful day.

謝謝您，女士。今天的電話會議到此結束。感謝各位參加今天的簡報。您現在可以掛斷電話線，祝您有美好的一天。