Centene Corp (CNC) 2022 Q1 法說會逐字稿

Good day, and welcome to the Centene Corporation First Quarter 2022 Earnings Results Conference Call. (Operator Instructions) Please note, today's event is being recorded.

美好的一天，歡迎參加 Centene Corporation 2022 年第一季度收益結果電話會議。 （操作員說明）請注意，今天的活動正在錄製中。

I would now like to turn the conference over to Jennifer Gilligan. Please go ahead, ma'am. Ms. Gilligan, your line is live.

我現在想把會議交給 Jennifer Gilligan。請繼續，女士。 Gilligan 女士，您的電話已上線。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our First Quarter 2022 Earnings Results Conference Call. Sarah London, Chief Executive Officer; Brent Layton, President and Chief Operating 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，大家早上好。感謝您參加我們的 2022 年第一季度收益結果電話會議。莎拉倫敦，首席執行官； Brent Layton，總裁兼首席運營官； Centene 執行副總裁兼首席財務官 Drew Asher 將主持今天上午的電話會議，也可以通過我們的網站 centene.com 訪問該電話會議。

Any remarks that Centene may make about future expectations, plans and prospects constitute forward-looking statements for the purpose of the safe harbor provision under the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by these forward-looking statements as a result of various important factors, including those discussed in Centene's most recent Form 10-K filed on February 22, and other public SEC filings. Centene anticipates that subsequent events and developments may cause its estimates to change. While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so.

Centene 可能對未來的預期、計劃和前景發表的任何評論均構成前瞻性陳述，以符合 1995 年《私人證券訴訟改革法案》下的安全港條款。實際結果可能與這些前瞻性陳述所表明的結果存在重大差異由於各種重要因素，包括 Centene 於 2 月 22 日提交的最新 10-K 表格中討論的因素，以及其他公開的 SEC 文件。 Centene 預計後續事件和發展可能會導致其估計發生變化。雖然公司可能會選擇在未來某個時候更新這些前瞻性陳述，但我們明確表示不承擔任何這樣做的義務。

The call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures, can be found in our first quarter 2022 press release, which is available on the company's website under the Investors section.

電話會議還將提及某些非公認會計原則措施。這些措施與最直接可比的 GAAP 措施的對賬可以在我們的 2022 年第一季度新聞稿中找到，該新聞稿可在公司網站的“投資者”部分下找到。

Additionally, please mark your calendars for our upcoming Investor Day scheduled for June 17. This meeting will be hosted in a virtual format available via webcast.

此外，請在您的日曆上標記我們即將於 6 月 17 日舉行的投資者日。本次會議將以網絡直播的虛擬形式舉行。

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

有了這個，我想把電話轉給我們的首席執行官 Sarah London。莎拉？

Thank you, Jen. Good morning, everyone, and thank you for joining us as we review our first quarter 2022 results. I want to begin by acknowledging the passing of a great man, Michael Neidorff, whose leadership and passion built Centene into the purpose-driven market leader that it is today. Michael infused our entire organization with the belief that high-quality affordable health care should be within reach of every American, especially our nation's most vulnerable.

謝謝你，珍。大家早上好，感謝您在我們回顧 2022 年第一季度業績時加入我們。首先，我要感謝一位偉人 Michael Neidorff 的逝世，他的領導和熱情將 Centene 打造成了今天的目標驅動型市場領導者。邁克爾向我們整個組織灌輸了這樣一種信念，即每個美國人，尤其是我們國家最脆弱的人，都應該能夠獲得高質量的負擔得起的醫療保健。

On behalf of the entire Centene team, I want to send our thoughts and prayers to Michael's family. We will miss him dearly, but I can assure you that Michael's legacy lives on in the men and women of this company, and our commitment to his vision has never been stronger.

我代表整個 Centene 團隊，向邁克爾的家人表達我們的想法和祈禱。我們會非常想念他，但我可以向您保證，邁克爾的遺產在這家公司的男女員工身上永存，我們對他的願景的承諾從未如此強烈。

On our call today, I'll begin with an update regarding the company's leadership structure, touch on first quarter highlights and then provide you an update on strategy and our value creation initiatives. Brent will speak to our performance in our core business lines. And finally, Drew will review our financial results and full year 2022 outlook in more detail.

在我們今天的電話會議上，我將首先介紹公司領導結構的最新情況，介紹第一季度的亮點，然後為您提供有關戰略和我們的價值創造計劃的最新信息。布倫特將談論我們在核心業務領域的表現。最後，德魯將更詳細地審查我們的財務業績和 2022 年全年展望。

First, the company's core leadership structure. We are updating this morning the construct of the office of the CEO. This group of individuals represents the most experienced, strategic and senior leaders of the organization, who will assist me in setting policy and driving forward Centene's enterprise agenda. The office of the CEO includes myself, Brent Layton, our President and Chief Operating Officer; Drew Asher, our Chief Financial Officer; Jim Murray, our Chief Transformation Officer, who will take on expanded responsibilities in addition to our value creation office; and Ken Fasola, who, in addition to leading Magellan, will assume oversight of our portfolio of strategic non-health plan assets.

一是公司核心領導結構。今天早上我們正在更新首席執行官辦公室的結構。這群人代表了該組織最有經驗、最具戰略意義和最高級的領導者，他們將協助我制定政策並推動 Centene 的企業議程。首席執行官的辦公室包括我自己、我們的總裁兼首席運營官布倫特·雷頓（Brent Layton）；我們的首席財務官 Drew Asher； Jim Murray，我們的首席轉型官，除了我們的價值創造辦公室外，他還將承擔更多職責；和 Ken Fasola，除了領導 Magellan 之外，他還將負責監督我們的戰略非健康計劃資產組合。

This construct with key support from our Chief Administrative Officer and General Counsel, formalizes the manner in which we've been operating for the last several months and represents the agenda setting nucleus of the organization as we enter the next stage of transformation and growth.

在我們的首席行政官和總法律顧問的關鍵支持下，這一架構正式確定了我們過去幾個月的運營方式，並代表了我們進入下一階段轉型和增長時組織的議程設置核心。

Now let's discuss our first quarter results. Centene delivered a strong first quarter performance, including adjusted diluted EPS of $1.83 up 12% compared to the year ago quarter. We closed the quarter with 26.2 million members, up 8% compared to the year ago quarter, demonstrating the strength and value of our products in the market and the success of our enrollment periods. As a result, we are raising our full year 2022 outlook from our previously provided range. We now expect our full year 2022 adjusted EPS to be within a range of $5.40 to $5.55. Drew will provide more details on the quarter and outlook in a few moments.

現在讓我們討論一下我們的第一季度業績。 Centene 第一季度表現強勁，調整後的攤薄後每股收益為 1.83 美元，與去年同期相比增長 12%。我們在本季度結束時擁有 2620 萬會員，比去年同期增長 8%，證明了我們產品在市場上的實力和價值以及我們註冊期的成功。因此，我們將 2022 年全年展望從之前提供的範圍上調。我們現在預計我們 2022 年全年調整後的每股收益將在 5.40 美元至 5.55 美元之間。 Drew 將在稍後提供有關本季度和展望的更多詳細信息。

Now to strategy. Over the last few months, the opportunities to optimize and strengthen our business have become even clearer. We remain hyper focused on executing our Value Creation Plan with many work streams well underway and clear milestones ahead. At the same time, we are refreshing our long-term strategy in order to pave the way for growth beyond our 2024 horizon. As we have said before, focusing on our core business and prioritizing value creation are not just short-term ideas. They are pillars of, and critical inputs to, a long-term strategic vision for the company.

現在來戰略。在過去的幾個月裡，優化和加強我們業務的機會變得更加清晰。我們仍然高度專注於執行我們的價值創造計劃，許多工作流程正在進行中，並且未來的里程碑很明確。與此同時，我們正在更新我們的長期戰略，以便為 2024 年之後的增長鋪平道路。正如我們之前所說，專注於我們的核心業務並優先考慮價值創造不僅僅是短期的想法。它們是公司長期戰略願景的支柱和關鍵投入。

Let me give you an example. Over the last 9 months, you have heard us repeatedly talk about operating excellence as a focus of our value creation work. It includes streamlining platforms, standardizing processes, modernizing systems and using data everywhere to be as smart as possible about how we do our work. It means fewer calls, fewer clicks and faster answers. Will it create SG&A savings? Absolutely. Is that our measure of success? No.

讓我給你舉個例子。在過去的 9 個月中，您多次聽到我們將卓越運營作為我們價值創造工作的重點。它包括簡化平台、標準化流程、現代化系統以及使用無處不在的數據來盡可能智能地了解我們的工作方式。這意味著更少的呼叫、更少的點擊和更快的答复。它會節省 SG&A 嗎？絕對地。這是我們衡量成功的標準嗎？不。

The real goal of operating excellence is to fundamentally improve the experience that members, providers, community and state partners have with Centene. Success, put simply, is making it easier to do business with us. For our members, we believe we can deliver more seamless and efficient ways to give the information, access and care they need when and where they need it most.

卓越運營的真正目標是從根本上改善會員、供應商、社區和州合作夥伴對 Centene 的體驗。簡單地說，成功就是讓我們更容易做生意。對於我們的會員，我們相信我們可以提供更無縫和更有效的方式，在他們最需要的時間和地點提供他們需要的信息、訪問和護理。

Our goal is to increasingly empower our members and their caregivers as agents and advocates in the care journey. For our provider partners, we believe there is a significant opportunity to align more closely in value-based partnerships, and we are committed to delivering the data and tools that will help them drive better health outcomes.

我們的目標是讓我們的會員和他們的護理人員在護理過程中成為代理人和倡導者。對於我們的供應商合作夥伴，我們相信有一個重要的機會可以更緊密地建立基於價值的合作夥伴關係，我們致力於提供有助於他們推動更好的健康結果的數據和工具。

For our state partners, we believe in being excellent at the basics, but we also intend to leverage our uniquely local approach to deliver innovative solutions that are infused with an understanding of the communities we serve and designed to help them succeed. The goal across all stakeholders is the same: to build lasting trusted relationships. This has been a differentiator for Centene from the beginning, and we intend to build on this strength as we grow and innovate. More to come on this during our June Investor Day. In the meantime, you should feel confident the work we do over the next 3 years will not only align with but naturally fuel our next phase of innovation and growth, and we are designing and executing with that end in mind.

對於我們的州合作夥伴，我們相信在基礎方面表現出色，但我們也打算利用我們獨特的本地方法來提供創新的解決方案，這些解決方案融入了對我們服務的社區的理解，旨在幫助他們取得成功。所有利益相關者的目標是相同的：建立持久的信任關係。這從一開始就是 Centene 的一個差異化因素，我們打算在我們成長和創新的過程中利用這種優勢。在我們 6 月的投資者日期間會有更多關於這方面的內容。同時，您應該對我們在未來 3 年所做的工作充滿信心，這不僅會與我們下一階段的創新和增長保持一致，而且會自然而然地推動我們下一階段的創新和增長，我們在設計和執行時都考慮到了這一目標。

Now turning to specific updates on the value creation work. We remain on track to achieve our previously stated goals. Jim Murray and his team are moving at a rapid but thoughtful pace to execute on these initiatives with tremendous support and partnership from both our corporate business leaders and our local team leaders. While we are excited about our progress, we also ask you to recognize that some of these initiatives are complex and will take years to fully complete.

現在轉向價值創造工作的具體更新。我們仍有望實現我們先前提出的目標。吉姆默里和他的團隊正在以快速但周到的速度執行這些舉措，並得到了我們企業業務負責人和當地團隊負責人的大力支持和合作。雖然我們對我們的進展感到興奮，但我們也要求您認識到其中一些舉措很複雜，需要數年時間才能完全完成。

We are being deliberate using a step-by-step approach to ensure that standardization and operational enhancements are taking place in the right way across the organization. This means that as we enhance certain enterprise-wide best practices, we will also preserve the local feel and approach that has served as this company's hallmark for 2 decades.

我們正在慎重地使用循序漸進的方法來確保標準化和運營增強在整個組織中以正確的方式進行。這意味著，在我們加強某些企業範圍內的最佳實踐的同時，我們還將保留作為該公司 2 年標誌的本地感覺和方法。

I'll give you a few examples of the progress the team has achieved in the quarter. First, we successfully hit our pharmacy platform migration milestones and are already engaged in strategic discussions with our potential PBM partners about how to drive additional quality and value in delivering pharmacy benefits to our members. Last week, slightly ahead of schedule, we released the RFP that will cover our more than $40 billion of pharmacy spend in 2022.

我將舉幾個例子說明團隊在本季度取得的進展。首先，我們成功實現了藥房平台遷移里程碑，並且已經與我們潛在的 PBM 合作夥伴進行了戰略討論，討論如何在為我們的會員提供藥房福利時提高質量和價值。上週，我們提前發布了 RFP，該 RFP 將涵蓋我們在 2022 年超過 400 億美元的藥房支出。

We have made meaningful progress this quarter in evaluating our existing portfolio of real estate assets, given our commitment to increased work from home and flexible work models. We are in the process of determining the necessary square footage to support our employees moving forward and anticipate a significant downsizing of our current leased space.

鑑於我們致力於增加在家工作和靈活的工作模式，本季度我們在評估我們現有的房地產資產組合方面取得了有意義的進展。我們正在確定必要的面積，以支持我們的員工向前發展，並預計我們目前的租賃空間將大幅縮小。

We have also advanced our efforts to centralize key functions such as utilization management and call centers to enterprise shared services organizations. To that end, we performed a lift and shift of reporting responsibilities for both these functions earlier this month. For the remainder of the year, we will be focusing on standardizing best practices and optimizing these operating models. In addition to the savings opportunity, we believe these organizational shifts will create a better experience for our members and providers as well as our employees.

我們還努力將利用率管理和呼叫中心等關鍵功能集中到企業共享服務組織。為此，我們在本月初對這兩個職能部門的報告職責進行了提升和轉移。在今年剩下的時間裡，我們將專注於標準化最佳實踐和優化這些運營模式。除了節省機會外，我們相信這些組織轉變將為我們的會員和供應商以及我們的員工創造更好的體驗。

Lastly and importantly, we've kicked off our efforts around large-scale IT platform consolidation. As you know, Centene has grown tremendously through acquisition over the last several years. And as we have mentioned before, the resulting technology footprint includes multiple core platforms and over 500 support applications. The conversion process will require a multiyear staged approach to derisk the effort, but the opportunity for increased efficiencies is significant. And while this will be hard work, consolidation is necessary to enable the stakeholder experience we intend to deliver. These are just a few examples of the nearly 15 work streams in the process of being activated. As I stated earlier, we are very pleased by our progress but recognize that we still have miles to go before we sleep.

最後也是重要的一點，我們已經開始圍繞大規模 IT 平台整合開展工作。如您所知，Centene 在過去幾年中通過收購取得了巨大的發展。正如我們之前提到的，由此產生的技術足跡包括多個核心平台和 500 多個支持應用程序。轉換過程將需要多年分階段的方法來消除努力，但提高效率的機會是巨大的。雖然這將是一項艱鉅的工作，但整合對於實現我們打算提供的利益相關者體驗是必要的。這些只是正在激活的近 15 個工作流中的幾個例子。正如我之前所說，我們對自己的進步感到非常高興，但也認識到我們還有很長的路要走才能入睡。

Before I wrap up, I would like to highlight a recent example of the work we are doing to improve health equity through data-driven innovation. In March, Centene was 1 of 3 organizations who received the Innovation Award by the National Committee for Quality Assurance, or NCQA, for our focus on health equity. The award recognizes Centene's data-driven health equity improvement model for being a leading-edge strategy for improving health equity and health care quality. The effectiveness of our health equity improvement model represents success on many levels.

在結束之前，我想強調一個最近的例子，說明我們正在通過數據驅動的創新改善健康公平。 3 月，Centene 是 3 個獲得美國質量保證委員會 (NCQA) 創新獎的組織之一，以表彰我們對健康公平的關注。該獎項認可 Centene 的數據驅動的健康公平改進模型是提高健康公平和醫療保健質量的前沿戰略。我們的健康公平改善模型的有效性代表了許多層面的成功。

By using a data-driven process, we are identifying opportunities to reduce health care disparities, designing initiatives across community member and provider levels and tracking our impact. These efforts can produce higher quality outcomes for our members and, in turn, improvement to important metrics such as HEDIS scores.

通過使用數據驅動的流程，我們正在尋找減少醫療保健差距的機會，設計跨社區成員和提供者級別的計劃並跟踪我們的影響。這些努力可以為我們的會員帶來更高質量的成果，進而改善 HEDIS 分數等重要指標。

To highlight some examples, Centene's health equity model was able to improve rates of immunizations for Latino children with our SilverSummit Healthplan in Nevada, colorectal cancer screening rates for American Indian and Alaska native members in our Arizona complete health plan and maternal health outcomes among African-American and Black members with our Health Net plan in California.

為了突出一些例子，Centene 的健康公平模型能夠通過我們在內華達州的 SilverSummit Healthplan 提高拉丁裔兒童的免疫接種率，在我們的亞利桑那州完整健康計劃中為美洲印第安人和阿拉斯加原住民成員提高結腸直腸癌篩查率，並在非洲-擁有我們在加利福尼亞州的 Health Net 計劃的美國和黑人會員。

Health Net has also been chosen to participate in NCQA's Health Equity Accreditation plus pilot program. Addressing health equity in new and innovative ways is very much aligned with our purpose and will be an important part of our work going forward. Further, applying big data to drive local outcomes will be a critical and sustaining differentiating strategy for the enterprise.

Health Net 還被選中參與 NCQA 的健康公平認證和試點計劃。以新的和創新的方式解決健康公平問題非常符合我們的目標，並將成為我們未來工作的重要組成部分。此外，應用大數據來推動本地成果將是企業的一項關鍵和持續的差異化戰略。

In closing, I'm humbled by the opportunity to lead this exceptional team and company. We have significant runway ahead to deliver for our members, enhance our operations, achieve our financial commitments and create value for our shareholders.

最後，我很榮幸有機會領導這個傑出的團隊和公司。我們在為我們的會員提供服務、增強我們的運營、實現我們的財務承諾並為我們的股東創造價值方面有很大的發展空間。

With that, I will turn it over to Brent, who will provide an update on our core business lines. Brent?

有了這個，我將把它交給布倫特，他將提供我們核心業務線的更新。布倫特？

Thank you, Sarah. Good morning, everyone. Before I jump in, I'd like to build on Sarah's remarks. I had the pleasure of working with Michael Neidorff for 21 years. His impact on this company is undeniable, and I will continue to be thankful for the opportunity he gave me. I'd also like to take a moment to recognize this is Sarah's first earnings call as our CEO. And Sarah, I couldn't be more pleased to continue to work with you in your new role. And I think I speak for the entire team here at Centene when I say we're excited about what the future holds for us as an organization under your leadership.

謝謝你，莎拉。大家，早安。在我開始之前，我想以莎拉的言論為基礎。我有幸與 Michael Neidorff 一起工作了 21 年。他對這家公司的影響是不可否認的，我將繼續感謝他給我的機會。我還想花點時間承認這是莎拉作為我們的首席執行官的第一次財報電話會議。莎拉，我非常高興能在你的新角色中繼續與你合作。當我說我們對作為一個在您領導下的組織的未來前景感到興奮時，我想我代表了 Centene 的整個團隊。

Now back to the business of the day. I'm happy to talk about the performance of our core business lines during the first quarter. In the first quarter, we have seen HBR in line with expectations across each of our core products. Our Medicaid business remains strong, with membership increasing to nearly 15.3 million members at the end of the first quarter and contract reprocurement wins in Louisiana and Indiana. As I'm sure you've all gotten -- got used to me saying, our Medicaid growth continues to be aided by the ongoing suspension of redeterminations.

現在回到今天的業務。我很高興談論我們核心業務線在第一季度的表現。在第一季度，我們看到 HBR 符合我們每個核心產品的預期。我們的醫療補助業務依然強勁，第一季度末會員人數增加到近 1530 萬，並在路易斯安那州和印第安納州贏得了合同再採購。我相信你們都已經習慣了我所說的，我們的醫療補助增長繼續受到持續暫停重新裁決的幫助。

As Drew will explain further, we anticipate the return of redeterminations in August. We continue to work with our state partners to better understand how we can support this transition and are confident in our ability to retain and attract membership to our exchange products in the 25 states where we have both Medicaid and Marketplace.

正如 Drew 將進一步解釋的那樣，我們預計 8 月將恢復重新裁決。我們將繼續與我們的州合作夥伴合作，以更好地了解我們如何支持這一過渡，並對我們在擁有醫療補助和市場的 25 個州保留和吸引我們的交換產品會員的能力充滿信心。

As states begin to transition back to redeterminations, I believe we will begin to see new opportunities for Medicaid managed care programs as we move past the pandemic, and states look to improve health outcomes and make Medicaid programs more efficient.

隨著各州開始過渡到重新決定，我相信隨著我們度過大流行病，我們將開始看到醫療補助管理式醫療計劃的新機會，並且各州希望改善健康結果並提高醫療補助計劃的效率。

In our exchange product, following a strong open enrollment, we ended the quarter at over 2 million members. We are pleased with both our member retention and our new member enrollments. As I discussed at the fourth quarter call, we introduced 3 new product offerings for the exchange in 2022. These products designed to meet the evolving needs of our members, have performed in line with our expectations, serving as both the tool for our member retention and attraction as a means to provide member engagement and manage utilization. While we're pleased with the performance of these products, our core and better product offerings remain the foundation of our exchange offerings.

在我們的交換產品中，經過強大的開放註冊，我們在本季度結束時擁有超過 200 萬會員。我們對我們的會員保留和新會員註冊感到滿意。正如我在第四季度電話會議上所討論的，我們在 2022 年為交易所推出了 3 種新產品。這些產品旨在滿足我們會員不斷變化的需求，其表現符合我們的預期，既是我們保留會員的工具和吸引力作為提供會員參與和管理利用率的一種手段。雖然我們對這些產品的性能感到滿意，但我們的核心和更好的產品仍然是我們交換產品的基礎。

We continue to monitor the administration's adjustment to the exchange market, including efforts to close the family glitch, which could allow an additional 5 million people to use tax credits to purchase Marketplace plans. In Medicare, we ended the quarter following annual enrollment with more than 1.4 million members across 36 states. Overall, we are very pleased with our strong growth of Medicare, yielding 200,000 net new members and 16% membership growth year-over-year 2021. We've managed well through another COVID variant at the top of the year as well.

我們繼續關注政府對外匯市場的調整，包括努力解決家庭故障，這可能使另外 500 萬人能夠使用稅收抵免購買 Marketplace 計劃。在 Medicare，我們在 36 個州擁有超過 140 萬會員的年度註冊後結束了本季度。總體而言，我們對 Medicare 的強勁增長感到非常滿意，2021 年淨新會員人數達到 200,000 名，會員人數同比增長 16%。我們在今年年初也通過另一個 COVID 變體管理得很好。

As we continue into 2022 and beyond, we see significant opportunity in Medicare. Our focus continue to be margin enhancement through clinical initiatives, network expansion and value-based contracting. Overall, 2022 is off to a solid start across all 3 core products.

隨著我們持續到 2022 年及以後，我們看到了醫療保險的重大機遇。我們的重點仍然是通過臨床計劃、網絡擴展和基於價值的合同來提高利潤率。總體而言，2022 年所有 3 種核心產品的開局良好。

With that, let me turn the call over to Drew.

有了這個，讓我把電話轉給德魯。

Thank you, Brent. This morning, we kicked off 2022 with first quarter results of $37.2 billion in revenue and adjusted diluted earnings per share of $1.83 in the quarter up 12% from $1.63 in Q1 2021.

謝謝你，布倫特。今天早上，我們以 372 億美元的收入和 1.83 美元的調整後攤薄每股收益從 2021 年第一季度的 1.63 美元增長 12%，從而開啟了 2022 年第一季度的業績。

Let's start with revenue for the quarter. Total revenue grew by $7.2 billion compared to the first quarter of 2021 primarily due to strong organic growth throughout the last year in Medicaid and strong Medicare membership growth during the annual enrollment period. Total membership increased to 26.2 million, up 8% compared to a year ago.

讓我們從本季度的收入開始。與 2021 年第一季度相比，總收入增長了 72 億美元，這主要是由於去年醫療補助的強勁有機增長以及年度註冊期間醫療保險會員的強勁增長。會員總數增至 2620 萬，比一年前增長 8%。

It's important to note a couple of revenue drivers that were unplanned in the quarter. First of all, you will see that our premium tax revenue was $3 billion in the quarter. That's about $1.5 billion more than we had estimated. This was largely due to 4 states providing lump sums for us to pass-through to providers. And remember, this revenue item is interesting but not relevant since it's 100% pass-through. That's why we are constantly orienting you to the premium and service revenue, which drives important metrics like net income margin and SG&A percentage.

重要的是要注意本季度計劃外的幾個收入驅動因素。首先，您會看到本季度我們的保費稅收收入為 30 億美元。這比我們估計的多出約 15 億美元。這主要是因為有 4 個州為我們提供了一次性支付給供應商的費用。請記住，這個收入項目很有趣但不相關，因為它是 100% 傳遞的。這就是為什麼我們不斷將您導向保費和服務收入，這推動了淨利潤率和 SG&A 百分比等重要指標。

Premium and Service revenue of $34.2 billion in the quarter was about $1 billion higher than our expectation with approximately half of it due to a Texas retroactive hospital pass-through that CMS recently restored. Because there's a small administrative provision on this retro item, it's included in premium revenue, not premium tax revenue. The remainder of Premium and Service revenue outperformance was strong continued Medicare and Medicaid growth.

本季度的保費和服務收入為 342 億美元，比我們的預期高出約 10 億美元，其中大約一半是由於 CMS 最近恢復的德克薩斯州追溯醫院轉達。因為這個複古項目有一個小的行政規定，它包含在保費收入中，而不是保費稅收收入中。保費和服務收入表現優異的其餘部分是醫療保險和醫療補助的強勁持續增長。

Our Q1 consolidated HBR was 87.3% consistent with our expectation, leaning slightly positive. Since you now have visibility and comparability into quarterly HBR components, let's talk about each. Medicaid at 88.9% was right on track in the quarter. Our Medicare HBR was slightly better than our expectation driven by a good quarter for our Medicare PDP business. The PDP business may only be $2 billion in annual revenue, but it's a great asset. That's the largest contributor to our over $40 billion of 2022 pharmacy spend, and it's a good captive audience for our Medicare Advantage business.

我們的第一季度綜合 HBR 為 87.3%，與我們的預期一致，略微正面。由於您現在對季度 HBR 組件具有可見性和可比性，讓我們來討論每個。本季度 88.9% 的醫療補助計劃步入正軌。我們的 Medicare HBR 略好於我們的預期，這是由於我們的 Medicare PDP 業務季度表現良好。 PDP 業務的年收入可能只有 20 億美元，但它是一筆巨大的資產。這是我們 2022 年超過 400 億美元藥房支出的最大貢獻者，也是我們 Medicare Advantage 業務的良好俘虜受眾。

All right, back to the Q1 HBR. Our commercial business improved 420 basis points year-over-year reflecting pricing discipline and making progress towards the annual goal we laid out at Investor Day.

好吧，回到 Q1 HBR。我們的商業業務同比增長 420 個基點，反映了定價紀律並朝著我們在投資者日制定的年度目標取得了進展。

Moving to other P&L and balance sheet items. Our adjusted SG&A expense ratio was 7.7% in the quarter, consistent with our expectations compared to 7.6% last year. The inclusion of Magellan and Circle each increased the year-over-year ratio by approximately 20 and 15 basis points, respectively. We expect our Value Creation Plan to drive SG&A lower over the next few years.

轉到其他損益表和資產負債表項目。本季度調整後的 SG&A 費用率為 7.7%，與去年的 7.6% 相比符合我們的預期。 Magellan 和 Circle 的加入分別使同比增長約 20 個基點和 15 個基點。我們預計我們的價值創造計劃將在未來幾年降低 SG&A。

Cash flow provided by operations was $1.2 billion in the first quarter primarily driven by net earnings. Our domestic unregulated and unrestricted cash on hand at quarter end was $68 million as expected after closing the Magellan transaction in early Q1. Our goal continues to be to build cash at parent beginning in the back half of 2022 for share buybacks and debt paydown. This corresponds with the timing of the majority of our health plan dividends.

第一季度運營提供的現金流為 12 億美元，主要受淨收益的推動。在第一季度初完成麥哲倫交易後，我們在季度末手頭的國內不受監管和不受限制的現金為 6800 萬美元。我們的目標仍然是從 2022 年下半年開始在母公司積累現金，用於股票回購和債務償還。這與我們大部分健康計劃紅利的時間一致。

Debt at quarter end was relatively flat at $18.9 billion. Our debt-to-cap ratio was down slightly at 40.7%, excluding our nonrecourse debt. Our medical claims liability totaled $16.3 billion at quarter end up $2 billion and represents 53 days in claims payable compared to 52 in Q4 2021.

季度末的債務相對持平，為 189 億美元。不包括我們的無追索權債務，我們的債務與上限比率小幅下降至 40.7%。本季度我們的醫療索賠負債總額為 163 億美元，最終達到 20 億美元，應付索賠的天數為 53 天，而 2021 年第四季度為 52 天。

As we begin 2022, we're building momentum both in our businesses and our Value Creation Plan. And as you've heard me say many times, one quarter doesn't make the year. However, we do have a quarter of actuals under our belt, and we all know that the PHE has been pushed out to July and therefore, redeterminations would start after that. So let's go through some changes we made in full year 2022 guidance metrics.

在我們開始 2022 年之際，我們正在為我們的業務和我們的價值創造計劃建立動力。正如你多次聽到我所說的那樣，四分之一不是一年。但是，我們確實有四分之一的實際情況，而且我們都知道 PHE 已被推遲到 7 月，因此之後將開始重新確定。因此，讓我們回顧一下我們對 2022 年全年指導指標所做的一些更改。

Premium and Service revenue was up $2.5 billion, including the first quarter results, the Texas item we discussed earlier and an assumption that redeterminations commence August 1, 3 months later than our prior assumption. Since we continue to grow due to the pushback of the PHE end date, we also expect the ultimate run rate revenue reduction to be higher at around $6 billion, up from our previous estimate of $5 billion. That will largely impact 2023.

保費和服務收入增加了 25 億美元，其中包括第一季度業績、我們之前討論的德克薩斯項目以及重新確定從 8 月 1 日開始的假設，比我們之前的假設晚了 3 個月。由於 PHE 結束日期的推遲，我們繼續增長，我們還預計最終運行率收入減少將更高，約為 60 億美元，高於我們之前估計的 50 億美元。這將在很大程度上影響到 2023 年。

Continuing on with 2022 guidance, premium tax revenue, once again, with no impact on bottom line, is up $1.5 billion for 2022. And our HBR and SG&A ranges are reconfirmed and unchanged. Overall, given the results in the quarter and pushing back the commencement of redeterminations, we are raising our adjusted EPS guidance range to $5.40 to $5.55 with a little over 60% in the first half of the year.

繼續遵循 2022 年的指導方針，2022 年的保費稅收收入在不影響利潤的情況下再次增加了 15 億美元。我們的 HBR 和 SG&A 範圍再次得到確認並保持不變。總體而言，鑑於本季度的結果並推遲重新確定的開始，我們將調整後的每股收益指導範圍提高到 5.40 美元至 5.55 美元，上半年略高於 60%。

As we look ahead, I'm pleased with the value creation work so far. And as Sarah said, this goes well beyond cost-cutting. Jim Murray and the team are making operational decisions and changes that are focused on long-term durability of operating excellence.

展望未來，我對迄今為止的價值創造工作感到滿意。正如莎拉所說，這遠遠超出了削減成本的範圍。 Jim Murray 和他的團隊正在製定專注於卓越運營的長期持久性的運營決策和變革。

You've heard this company talk for years about quality and STARS, and now better late than never, STARS is a tier 1 initiative of the value creation office with new investments being made in member engagement, value-based contracting, operational functions and clinical initiatives. Given the Star calendar, it will take a couple of years for our investments to show up in Star scores that come out in late 2023, which will drive 2025 revenue. In the meantime, as we said in multiple venues, the Star scores that come out in late 2022 that drive 2024 revenue will show a meaningful drop due to the sunsetting of the COVID era disaster relief provisions and our immature operations during these past measurement periods.

您已經聽說這家公司多年來一直在談論質量和 STARS，現在總比沒有好，STARS 是價值創造辦公室的一級倡議，在成員參與、基於價值的合同、運營職能和臨床方面進行了新的投資倡議。鑑於 Star 日曆，我們的投資需要幾年時間才能顯示在 2023 年底出現的 Star 分數中，這將推動 2025 年的收入。與此同時，正如我們在多個場所所說的那樣，由於 COVID 時代救災規定的落伍以及我們在過去這些測量期間的不成熟運營，2022 年末出現的推動 2024 年收入的星級評分將顯著下降。

On other value creation initiatives, we look forward to giving you more details at the June Investor Day, but let me give you a teaser on one that Sarah mentioned. While we are still finalizing the details, we expect to reduce over half of our domestic leased real estate footprint. Though there will be a onetime cost to this, which we will frame for you in Q2, the run rate benefit will be a nice contributor to our value creation goals. More to come in June.

關於其他價值創造計劃，我們期待在 6 月的投資者日為您提供更多詳細信息，但讓我先為您介紹一下 Sarah 提到的一項。雖然我們仍在敲定細節，但我們預計將減少一半以上的國內租賃房地產足跡。儘管這將產生一次性成本，我們將在第二季度為您制定，但運行率收益將是我們價值創造目標的一個很好的貢獻者。更多內容將在 6 月發布。

In summary, the business is performing well while we are focused on, enthusiastic about and investing in the future. Thanks for your support.

總而言之，在我們專注、熱衷和投資未來的同時，業務表現良好。謝謝你的支持。

Operator, you may now open the line for questions.

接線員，您現在可以打開線路提問。

(Operator Instructions) Today's first question comes from Justin Lake at Wolfe Research.

（操作員說明）今天的第一個問題來自 Wolfe Research 的 Justin Lake。

Sarah, congrats on the new role. I wanted to ask a couple of things. One, on the MLR. Drew, you're giving us MLR by segment, which is incredibly helpful. Can you tell us how those numbers kind of shake out versus your expectations? I know you expected the exchanges to get 500 basis points better. I think you talked about Medicaid being -- at least year-over-year, Medicaid, probably up more than 100 basis points year-over-year. So just kind of curious how those came out versus your expectations.

莎拉，恭喜獲得新角色。我想問幾件事。一，在 MLR 上。 Drew，您按段向我們提供 MLR，這非常有幫助。你能告訴我們這些數字與你的預期相比是如何變化的嗎？我知道你預計交易所會提高 500 個基點。我想你談到了醫療補助——至少同比，醫療補助可能同比增長超過 100 個基點。所以只是有點好奇這些結果是如何與你的期望相比的。

And then secondly, on the Medicaid side, how are the discussions going with states on the resetting process for next year? Do you still expect them to kind of let these MLR floors absorb whatever upside there might be? Or do you think the states are looking to come after the lower utilization potentially be at lower rates?

其次，在醫療補助方面，與各州就明年的重置過程進行的討論如何？您是否仍然期望他們讓這些 MLR 地板吸收可能存在的任何好處？還是您認為各州希望在較低的利用率可能以較低的利率之後出現？

Okay. Thanks, Justin. Yes. So ripping through the HBRs by our lines of business, Medicaid was right on track in the quarter. And we sort of expect that to tick up during the year and then the fourth quarter would come down a little bit. That's the progression throughout the year.

好的。謝謝，賈斯汀。是的。因此，通過我們的業務線撕毀 HBR，醫療補助計劃在本季度步入正軌。我們有點預計這一年會有所上升，然後第四季度會有所下降。這就是全年的進展。

You're right. On our commercial business, we expect about 500 basis points year-over-year improvement. We got 420 in the first quarter. That's right on track with our expectation. Last Q2 was pretty ugly for commercial. So you'll see a wider gap there or improvement there, and we expect that to continue on for the rest of the year. So we're right on track.

你是對的。在我們的商業業務方面，我們預計同比增長約 500 個基點。我們在第一季度獲得了 420 個。這符合我們的預期。上個 Q2 對於商業廣告來說非常難看。因此，您會看到那裡的差距更大或有所改善，我們預計這將在今年餘下的時間裡繼續下去。所以我們走上了正軌。

Commercial and Medicare was a little bit better than expectation due to the PDP business not only in HBR, but I'm actually pleased with that business. We had to collapse 6 of our products down to 3. Remember, we acquired Aetna's business a few years ago, and after a few years, you have to get down to the 3 products, and we had great retention based on some programs that were implemented so not just an HBR benefit, but also really good retention performance on that business.

由於 PDP 業務不僅在 HBR，商業和醫療保險比預期好一點，而且我實際上對這項業務感到滿意。我們不得不將我們的 6 種產品縮減為 3 種。請記住，幾年前我們收購了 Aetna 的業務，幾年後，您必須減少 3 種產品，並且基於某些計劃，我們保留了很多實施不僅是 HBR 的好處，而且該業務的保留性能也非常好。

And then the sunsetting of the risk corridors, that continues. We're still down to about half a dozen COVID era risk corridors, and therefore, the paybacks we're seeing have diminished quite a bit from last year, and those discussions continue to be constructive.

然後是風險走廊的日落，這種情況仍在繼續。我們仍然下降到大約六個 COVID 時代的風險走廊，因此，我們看到的回報比去年減少了很多，這些討論仍然具有建設性。

And ladies and gentlemen, our next question today comes from Josh Raskin at Nephron Research.

女士們先生們，我們今天的下一個問題來自 Nephron Research 的 Josh Raskin。

So I just wanted to draw on Sarah's comments earlier about the provider network. And how are you thinking about sort of network development? And specifically curious about potential impacts from providers that are seeing pressure on labor cost inflation. And then maybe any specifics around the changes with respect to value-based care in 2023 and beyond?

所以我只是想藉鑑 Sarah 之前關於提供商網絡的評論。您如何看待網絡開發？尤其是對那些看到勞動力成本通脹壓力的供應商的潛在影響感到好奇。然後，關於 2023 年及以後基於價值的護理的變化，也許有任何細節？

Yes. I can take that, and then we'll probably ask Brent to comment on it as well. So first, relative to inflation impacts, we haven't really seen anything so far this year. The fact that our rates are contracted creates a buffer on that but obviously aware of the potential future impact. And it's yet another reason why the move more aggressively to align with providers in value-based contracting is a major priority as we go forward. We've made really good progress on that and I think probably relative to peers are further along on the Medicaid side. But I'll let Brent talk about kind of where we are today and then how we're looking about at that going forward.

是的。我可以接受，然後我們可能也會請布倫特對此發表評論。首先，相對於通脹影響，今年到目前為止我們還沒有真正看到任何東西。我們的費率已簽約這一事實為此提供了緩衝，但顯然意識到了潛在的未來影響。這也是為什麼在基於價值的合同中更積極地與供應商保持一致是我們前進的主要優先事項的另一個原因。我們在這方面取得了非常好的進展，我認為與同行相比，醫療補助方面可能更進一步。但我會讓布倫特談談我們今天的情況，然後我們如何看待未來的發展。

We're spending a great deal of time working with providers on value based. And when I talk about value-based, I'm talking about risk both up and downside. And I would say that, in Medicare, we've continued a very strong effort. So we've always been very focused on value-based true risk in Medicare, and we're continuing that and accelerating that.

我們花費大量時間與基於價值的供應商合作。當我談論基於價值的時候，我指的是上行和下行風險。我想說的是，在醫療保險中，我們繼續做出非常強大的努力。因此，我們一直非常關注醫療保險中基於價值的真實風險，我們正在繼續這一點並加速這一點。

Medicaid, though, is really discussions as we moved into the pandemic and now coming out of the pandemic, have allowed us to really be a very high percentage for the Medicaid product. And I think you'll continue to see tremendous growth for risk within Medicaid. And right now, we're looking for the best approach within the exchange.

但是，隨著我們進入大流行病和現在走出大流行病，醫療補助計劃確實是在討論，這使我們能夠真正成為醫療補助計劃產品的一個非常高的比例。而且我認為您將繼續看到醫療補助內部風險的巨大增長。現在，我們正在尋找交易所內的最佳方法。

So we're very focused in value-based and there's a tremendous amount of effort. I'm very excited where, ultimately, our conversations, relationships with providers are going and where they're at today.

所以我們非常專注於基於價值的工作，並且付出了巨大的努力。我對我們的對話、與供應商的關係最終走向何方以及他們今天所處的位置感到非常興奮。

And ladies and gentlemen, our next question today comes from Scott Fidel with Stephens.

女士們先生們，我們今天的下一個問題來自 Scott Fidel 和 Stephens。

And first of all, I just wanted to send my condolences on Michael's passing to the Centene team. And then on the question, I was hoping maybe you can give us a little more insight just to some of the policy dynamics that are playing out here around the exchange market. And Brent, I know that you had touched on one of those with the administration looking to try to address the family glitch. We've also obviously got the temporary subsidies that were in place from the ARPA bill, and those may or may not expire.

首先，我只想對邁克爾的傳球向 Centene 團隊表示哀悼。然後關於這個問題，我希望你能給我們更多的見解，只是關於外匯市場上的一些政策動態。還有布倫特，我知道你已經觸及了其中一位政府希望試圖解決家庭故障的人。我們顯然也從 ARPA 法案中獲得了臨時補貼，這些補貼可能會或可能不會到期。

So just interested on how you're thinking about some of these policy sort of developments playing out and how much flexibility the administration will have to implement these just through executive actions? Or will there need to be a legislative vehicle to address some of these? And do you see one of those actually emerging here at this point in time?

因此，只是對您如何考慮其中一些政策發展感興趣，以及政府僅通過行政行動來實施這些政策的靈活性有多大？或者是否需要立法工具來解決其中的一些問題？您是否看到其中一個實際出現在這裡？

Yes. Scott, thanks for your comments and for the question. So I'll touch on the enhanced APTCs relative to marketplace, and then we can talk about the family glitch as well. So the enhanced APTCs are currently scheduled to expire at the end of this year. And if those are allowed to expire, we estimate that it would impact around 10% to 15% of our Marketplace membership.

是的。斯科特，感謝您的評論和問題。因此，我將討論相對於市場的增強型 APTC，然後我們也可以討論家庭故障。因此，增強型 APTC 目前計劃在今年年底到期。如果允許這些過期，我們估計它將影響大約 10% 到 15% 的 Marketplace 會員。

That said, there is broad Democratic support for the program. And so as you pointed out, over the next couple of months, we're watching very closely to see if they can identify an actionable legislative vehicle. And so one example of that would be a slim down build back better. And the prevailing view is that the enhanced APTC is being extended out to 2025 as well as drug pricing reform will be the most likely health care candidates for inclusion in a bill like that. So watching that certainly very closely over the coming months here.

也就是說，該計劃得到了民主黨的廣泛支持。正如你所指出的，在接下來的幾個月裡，我們正在密切關注他們是否能夠確定一個可行的立法工具。因此，其中一個例子就是瘦身後更好地重建。普遍的觀點是，增強的 APTC 將延長至 2025 年，藥品定價改革將是最有可能納入此類法案的醫療保健候選人。因此，在接下來的幾個月裡，肯定會非常密切地關注這一點。

But I would also say that we don't see it as a binary endpoint. There are other legislative and policy options that are available to mitigate the impact. So we're talking to our state and federal partners actively about those in parallel. And so as you would expect, overall, planning for both best and worst-case scenario and proactively working to support and shape policy that's not just good for Centene, but policy, we think, is good for the entire industry.

但我還要說，我們不將其視為二進制端點。還有其他立法和政策選擇可以減輕影響。因此，我們正在與我們的州和聯邦合作夥伴積極討論這些問題。因此，正如您所期望的那樣，總體而言，規劃最好和最壞的情況，並積極努力支持和製定不僅對 Centene 有利的政策，而且我們認為政策對整個行業都有好處。

I will turn it over to Kevin Counihan, who is on the phone, to talk a little bit more about the family glitch and how we see that as an opportunity for Ambetter product but also some of the hurdles that we would need to overcome in order to make that as actionable as possible.

我將把它交給電話中的凱文·庫尼漢（Kevin Counihan），更多地談談家庭故障以及我們如何將其視為 Ambetter 產品的機會，以及我們需要克服的一些障礙使其盡可能可行。

Thanks. We're very pleased with the administration's policy decision on the family glitch. As you folks probably know, we've been advocating for this for quite some time, and it's really a long overdue. So it's a very welcome change.

謝謝。我們對政府關於家庭故障的政策決定感到非常滿意。正如你們可能知道的那樣，我們已經提倡這一點已經有一段時間了，而這確實是姍姍來遲。所以這是一個非常受歡迎的變化。

As mentioned, there clearly are some issues related in the draft final rule that we're working very collaboratively with CMS in terms of addressing. So much of health care policy is about -- should be about simplicity and making things easier and simpler for individuals and families to access affordable coverage. We believe the spirit of the family glitch provision attempts to do that, but also believe that there's opportunities for refinement. And as I said, we're working very aggressively with CMS and constructively to address those.

如前所述，最終規則草案中顯然存在一些問題，我們正在與 CMS 密切合作以解決這些問題。如此多的醫療保健政策是關於 - 應該是關於簡單性，讓個人和家庭更容易和更簡單地獲得負擔得起的保險。我們相信家庭故障條款的精神試圖做到這一點，但也相信存在改進的機會。正如我所說，我們正在非常積極地與 CMS 合作，並建設性地解決這些問題。

And ladies and gentlemen, our next question today comes from Matt Borsch of BMO Capital Markets.

女士們先生們，我們今天的下一個問題來自 BMO Capital Markets 的 Matt Borsch。

I was hoping you could help us think about the headwinds from the drop -- expected drop in Star revenues going into 2023 and how you may have anticipated and incorporated that into your bid for 2023. I know that's confidential, but maybe just some sense directionally you can give us on that.

我希望你能幫助我們思考下降帶來的不利因素——預計到 2023 年 Star 收入將下降，以及你可能如何預期並將其納入你對 2023 年的競標。我知道這是保密的，但也許只是一些方向性的意義你可以給我們。

Yes, it's a really good question. Actually, it's a 2024 question. 2023, so the Star scores that came out in October of 2021, they're called the rating year 2022 Star scores, which is revenue '23. Those were in good shape, obviously, aided with a tailwind from the disaster relief provisions. So those sunset as we go into 2024. And some of the measures where, quite frankly, we just weren't operating at the level we need to operate back in the back half of 2020 for ops and admin measures and then 2021 dates of service, which fuel the rating year '23 Star scores, which is revenue year '24.

是的，這是一個非常好的問題。實際上，這是一個 2024 年的問題。 2023 年，因此 2021 年 10 月出現的星級分數，稱為評級年 2022 年星級分數，即收入 '23。顯然，在救災規定的幫助下，這些狀況良好。因此，我們進入 2024 年的那些日落。坦率地說，我們只是沒有達到我們需要在 2020 年下半年運營和管理措施以及 2021 年服務日期的運營水平，這推動了評級年 '23 星級評分，即收入年 '24。

So we're enthusiastic about margin expansion opportunity for 2023, and that's sort of -- we're trying to balance that with a little bit of growth in Medicare Advantage for '23. And then we've got a hurdle for 2024. And our jobs as managers, not victims, is to execute and pull levers, and the Value Creation Plan is designed just to do that.

因此，我們對 2023 年的利潤率擴張機會充滿熱情，這在某種程度上——我們正試圖在 23 年 Medicare Advantage 的一點點增長之間取得平衡。然後我們遇到了 2024 年的障礙。作為管理者而不是受害者，我們的工作是執行和拉動槓桿，而價值創造計劃就是為此而設計的。

Matt, I was just going to add a little bit more detail, and Drew touched on this in his comments, but sort of as we look forward, right, because it is a multiyear effort, our ability to focus on it and make it a tier 1 initiative right now is very important to making that sort of meaningful rebound.

馬特，我只是想補充一點細節，德魯在他的評論中談到了這一點，但有點像我們期待的那樣，對，因為這是一項多年的努力，我們有能力專注於它並使其成為現在的一級主動性對於實現這種有意義的反彈非常重要。

So we think we've talked about this before, but we hired a Chief Quality Officer in Q4 of last year and are making real investment in processes and systems with a focus on the member experience. But I would also highlight this is another great motivator for alignment in value-based contracts with providers because that's the best way to improve member experience, make sure we're closing those gaps in care.

所以我們認為我們之前已經討論過這個問題，但我們在去年第四季度聘請了一名首席質量官，並且正在對流程和系統進行真正的投資，重點是會員體驗。但我還要強調，這是與供應商達成基於價值的合同的另一個重要動力，因為這是改善會員體驗的最佳方式，確保我們縮小護理方面的差距。

And our next question today comes from Kevin Fischbeck at Bank of America.

我們今天的下一個問題來自美國銀行的 Kevin Fischbeck。

This is Adam Ron on for Kevin. It seems like you were largely able to improve your exchange margins and hit the enrollment targets that you outlined. So I'm wondering after the open enrollment experience that you had, if you noticed any increased price competition and if you would expect that to continue and how you think about growing off the space setting aside expiration of subsidies.

這是凱文的亞當羅恩。看起來您在很大程度上能夠提高您的外匯利潤並達到您概述的註冊目標。因此，我想知道在您的公開招生經歷之後，您是否注意到價格競爭加劇，您是否希望這種競爭持續下去，以及您如何考慮在補貼到期的情況下擴大空間。

Yes. So there's certainly competition. You've seen that increase in some markets exponentially in the last couple of years. I think some companies are figuring out this -- at the core is an insurance business. And so you've actually got to get to an earnings standpoint to have a viable business. And I think that's going to help the market sort of balance out a little bit better as we look ahead. But you're absolutely right. We powered through that competition. We welcome competition. And Brent, maybe a couple of new products that helped us diversify our portfolio.

是的。所以肯定有競爭。在過去幾年中，您已經看到某些市場呈指數級增長。我認為有些公司正在弄清楚這一點——其核心是保險業務。因此，您實際上必須從盈利角度出發才能擁有可行的業務。而且我認為這將有助於市場在我們展望未來時更好地平衡。但你是絕對正確的。我們通過那場比賽提供了動力。我們歡迎競爭。還有布倫特原油，也許是一些幫助我們多樣化投資組合的新產品。

Yes. I mean, we actually raised our premium. We increased it, but yet we were still able to grow and be successful in our markets from the standpoint. And some of that has to do with the new products that we developed. One of the products was more of a clinic focused in South Florida and in Texas and also more of a tailored network approach we used, and that help us retain members. We've been also not only grew, we retained a great deal of our members year-over-year, which we're excited about.

是的。我的意思是，我們實際上提高了保費。我們增加了它，但從這個角度來看，我們仍然能夠在我們的市場上成長並取得成功。其中一些與我們開發的新產品有關。其中一個產品更像是一家專注於南佛羅里達州和德克薩斯州的診所，也更像是我們使用的定製網絡方法，這有助於我們留住會員。我們不僅在成長，而且每年都保留了大量的會員，這讓我們感到很興奮。

In fact, last year, we grew a great deal through the Biden itself and we've actually been able to retain 69% of those from '21 into '22. So retain growth and being able to very much bring new product it really helped us retain and keep our membership and actually grow even if we raise premiums.

事實上，去年，我們通過拜登本身增長了很多，我們實際上已經能夠保留 69% 的人，從 21 年到 22 年。因此，保持增長並能夠帶來非常多的新產品，這確實幫助我們保留並保持我們的會員資格，並且即使我們提高保費也實際增長。

And I've pointed this out before, but I'll do so again because I think it's an important bellwether that the work that the Marketplace team did to really understand the competitive dynamics on a county-by-county level and then to build that up to the portfolio performance that we were aiming for, I think, is not only tremendously impressive work, but is also a good indicator of how we think about going into the calibration of margin and growth in Medicare in the upcoming bid cycle.

我之前已經指出了這一點，但我會再次這樣做，因為我認為 Marketplace 團隊所做的工作是一個重要的風向標，它真正了解了一個縣級的競爭動態，然後建立它我認為，達到我們目標的投資組合業績不僅是令人印象深刻的工作，而且也是我們如何考慮在即將到來的投標週期中校準醫療保險的利潤率和增長的一個很好的指標。

Our next question today comes from Gary Taylor at Cowen.

我們今天的下一個問題來自 Cowen 的 Gary Taylor。

I know Michael will be missed, so I'll share my condolences as well. Just a 2-part question. First, Drew, I appreciate the comment on the Medicaid HBR seasonality. The commercial HBR seasonality was so unusual last year. I just wondered if you could comment on expectations for that line of business specifically, if we'll see a more typical seasonality where it's far lower in the first quarter, first half and higher in the second half?

我知道邁克爾會被想念，所以我也會表達我的哀悼。只是一個兩部分的問題。首先，德魯，我很欣賞關於醫療補助 HBR 季節性的評論。去年的商業 HBR 季節性是如此不同尋常。我只是想知道您是否可以具體評論對該業務線的預期，如果我們會看到一個更典型的季節性，即第一季度遠低於上半年，下半年則更高？

Second part of the question was just we read so much noise about the California PBM implementation with Magellan having gone poorly initially. And just wondered if you could comment on what you're doing to mitigate that. And can you provide any comfort that it won't have impact on the August Medical award?

問題的第二部分只是我們讀到了太多關於加州 PBM 實施的噪音，而麥哲倫最初表現不佳。只是想知道您是否可以評論您正在採取哪些措施來緩解這種情況。你能不能安慰一下它不會對八月醫學獎產生影響？

Let me hit the mechanical question first. You're right. Last year, we sort of whipsawed quarter-to-quarter in our commercial performance. Now part of that is COVID variants coming at us. And so I'll say everything else equal, Gary, we expect a steady tick-up based upon the benefit plan designs in the commercial business, as you would expect throughout the year, so a steady rise to get to our goals.

讓我先回答機械問題。你是對的。去年，我們的商業業績按季度大幅下滑。現在，其中一部分是 COVID 變種向我們襲來。所以我會說其他一切都一樣，加里，我們希望根據商業業務中的福利計劃設計穩步上升，正如您全年所期望的那樣，穩步上升以實現我們的目標。

Yes. And then on the Magellan front, I would say the team out there worked very, very closely with the state in those early days of go-live and has been performing very, very well since mid- to late February. There are 0 backlog in authorizations and I think has built a really positive relationship with the state through that collaboration.

是的。然後在麥哲倫戰線上，我想說那裡的團隊在上線初期與該州非常非常密切地合作，並且自 2 月中下旬以來一直表現非常非常好。授權積壓為 0，我認為通過這種合作與國家建立了非常積極的關係。

Relative to the RFP, California is a very important state for us, and we have -- throughout the Magellan acquisition process throughout the Rx go-live and throughout our bid process have been very focused on making sure that we are aligned with the state and meeting their expectations and looking to exceed their expectations.

相對於 RFP，加利福尼亞州對我們來說是一個非常重要的州，我們在 Magellan 收購過程中，在整個 Rx 上線和整個投標過程中都非常專注於確保我們與州和滿足他們的期望並尋求超越他們的期望。

So there were challenges out of the gate, but I think the team recovered incredibly well. You'd have to ask California, but at least the signals we're getting from them is that they're very happy with the collaboration and the partnership.

所以有很多挑戰，但我認為球隊恢復得非常好。你得問問加利福尼亞，但至少我們從他們那裡得到的信號是他們對合作和夥伴關係非常滿意。

I'll add one thing. Obviously, California is a very important state to Centene, but we are very fortunate to have many years of experience in California, and we're honored to be in California. And we have a lot of preparation for this RFP. We've been preparing for a very long time, and we strive every day to be the best health plan in California. And that is our goal, and that's what we want to attain and will be.

我要補充一件事。顯然，加州對 Centene 來說是一個非常重要的州，但我們很幸運能在加州擁有多年的經驗，也很榮幸來到加州。我們為此 RFP 做了很多準備。我們已經準備了很長時間，我們每天都在努力成為加州最好的健康計劃。這就是我們的目標，這就是我們想要達到和將要達到的目標。

And our next question today comes from Nathan Rich at Goldman Sachs. .

我們今天的下一個問題來自高盛的 Nathan Rich。 .

Sarah, I wanted to follow up on some of your comments on the Value Creation Plan to start. You mentioned putting the pharmacy RFP out. I guess could you maybe at a high level talk about the key elements of that RFP and what you're looking for in a partner and kind of where you see the biggest opportunities for cost improvement in your pharmacy book?

莎拉，我想跟進您對開始價值創造計劃的一些評論。你提到了把藥房 RFP 拿出來。我想您能否在高層談談該 RFP 的關鍵要素以及您在合作夥伴中尋找的內容以及您在藥房書中看到的最大的成本改進機會？

And then maybe a bit longer term, but you talked about refreshing the long-term strategy to drive growth. I know you'll get into more detail in June, but could you maybe just talk about some of the key areas that you're looking at when you look at the business in terms of where you see the opportunity?

然後可能有點長期，但你談到了更新長期戰略以推動增長。我知道您將在 6 月份詳細介紹，但您能否談談您在從哪裡看到機會來看待業務時所關注的一些關鍵領域？

Sure. Thanks for the question. So I'll hit on the PBM front and invite Drew to weigh in as well because we've been having these conversations with potential partners together. We're -- we issued the RFP early. We're still on track for the year-end award, but part of the logic of getting the RFP out there earlier was to allow for the more strategic conversation about what the scope would be with that partner.

當然。謝謝你的問題。所以我會談到 PBM 方面，並邀請 Drew 參與進來，因為我們一直在與潛在的合作夥伴進行這些對話。我們 - 我們提前發布了 RFP。我們仍有望獲得年終獎，但提早發布 RFP 的部分邏輯是允許就與該合作夥伴的範圍進行更具戰略性的對話。

The key criteria are obviously going to be quality and performance. Transparency is incredibly important and then also feeling that like we have a very close partner. And so economics are incredibly important, probably first, second and third, but then also making sure that as we deliver a member and provider experience, that we have a very responsive partner that is as focused on quality as we are. I don't know, Drew, if you want to add anything.

關鍵標準顯然是質量和性能。透明度非常重要，而且感覺就像我們有一個非常親密的合作夥伴。因此，經濟學非常重要，可能是第一、第二和第三，但同時也要確保在我們提供會員和提供商體驗時，我們有一個反應迅速的合作夥伴，與我們一樣專注於質量。我不知道，德魯，如果你想添加任何東西。

No, I think you hit on the keyword, which is partner. I don't want to have to arm wrestle every other month on issues and really want someone in tandem thinking about how we can deliver the most value to our state and federal customers and our members. So pretty pleased with the level of engagement so far.

不，我認為您點擊了關鍵字，即合作夥伴。我不想每隔一個月就問題進行一次武裝角力，我真的希望有人一起思考我們如何為我們的州和聯邦客戶以及我們的成員提供最大的價值。到目前為止，對參與度非常滿意。

And then on the strategy front, obviously, we'll get more into this in June and I think more over the back half of the year. But you've heard us lay out some of the principles. And so making sure that we are growing from the strength of the core business lines and looking at obvious adjacencies and then making sure that we are operating at a high level of excellence on an ongoing basis because we believe that will build the trusted relationships and, through that local approach, can give us a differentiated strategy for growth. So more to come in June on that.

然後在戰略方面，顯然，我們將在 6 月份對此進行更多討論，我認為在今年下半年會有更多。但是你聽說我們列出了一些原則。因此，確保我們從核心業務線的實力中成長，並著眼於明顯的鄰接關係，然後確保我們在持續的基礎上以高水平的卓越運營，因為我們相信這將建立值得信賴的關係，並且，通過這種本地化方法，可以為我們提供差異化的增長戰略。所以在六月會有更多關於這方面的內容。

And ladies and gentlemen, our next question comes from A.J. Rice at Crédit Suisse.

女士們先生們，我們的下一個問題來自 A.J.瑞士信貸的大米。

Just wanted to follow up. First, a clarification on comments Sarah made about the Medicare bid strategy. I think previously, you guys have said that your focus in '23 will be on pricing for margin. I wonder if you would still say that, that would be the case.

只是想跟進。首先，澄清莎拉對醫療保險出價策略的評論。我認為，你們之前曾說過，你們在 23 年的重點將放在保證金定價上。我不知道你是否仍然會這麼說，會是這樣。

And then a more broad question, you referenced in the release that Medicaid utilization seems to be returning to somewhat normalcy. I wonder where you at relative to a pre-pandemic level or a baseline level on Medicaid at this point. Do you think you're fully sort of where you would be? Or is there still some utilization that has not come back? And if you want to make any comments on Medicare and the Marketplace as well on that, that would be great.

然後是一個更廣泛的問題，您在新聞稿中提到，醫療補助計劃的使用似乎正在恢復正常。我想知道此時您相對於大流行前水平或醫療補助的基線水平處於什麼位置。你認為你完全符合你的預期嗎？還是還有一些沒有恢復的利用率？如果您想對 Medicare 和 Marketplace 發表任何評論，那就太好了。

Sure. Thanks, A.J. I will just clarify relative to Medicare, the focus is absolutely on margins, still preserving slight growth but really starting to turn the dial on margin expansion. And it's -- as Drew has said before, it's a multiyear journey, but it starts in 2023. Drew, do you want to talk about utilization?

當然。謝謝，A.J.我將相對於醫療保險澄清一下，重點絕對是利潤率，仍然保持小幅增長，但真正開始轉向利潤率擴張。而且——正如 Drew 之前所說，這是一個多年的旅程，但從 2023 年開始。Drew，你想談談利用率嗎？

Yes, sure. Yes, we're pretty close back to sort of the pre-pandemic levels on Medicaid. Let me give you a couple of examples. Like pediatric, physicals and preventative, that snapped back pretty quickly, which is a good thing in 2020. But the adult visits are still lagging a little bit, and then ER has come back for all business lines, except for non-emergent in ER visits in Medicaid. So there's a couple of pockets where there's still a little bit of slight suppression, but we're largely back to pre-pandemic levels as we look at utilization metrics.

是的，當然。是的，我們非常接近醫療補助計劃大流行前的水平。讓我舉幾個例子。像兒科、體檢和預防一樣，很快就恢復了，這在 2020 年是一件好事。但是成人就診仍然有點滯後，然後 ER 已經恢復到所有業務線，除了急診室中的非急診醫療補助計劃的訪問。所以有幾個口袋仍然有一些輕微的抑制，但是當我們查看利用率指標時，我們在很大程度上回到了大流行前的水平。

And our next question today comes from Michael Hua with Morgan Stanley.

我們今天的下一個問題來自摩根士丹利的 Michael Hua。

And my condolences as well to Michael and the Centene team. So my question -- a 2-part question on Medicaid pipeline. First, with the number of upcoming RFPs, I was wondering if you could highlight which near-term opportunities are top of mind of Centene. To us, it looks like they're mainly reprocurements, but are there any specific upcoming greenfield opportunities you've your eye on?

我也向邁克爾和 Centene 團隊表示哀悼。所以我的問題——關於醫療補助計劃的兩部分問題。首先，隨著即將到來的 RFP 的數量，我想知道您是否可以強調哪些近期機會是 Centene 的首要考慮因素。對我們來說，它們看起來主要是再採購，但是您是否關注任何即將到來的特定綠地機會？

And then second part a question to Sarah. And firstly, congrats on the appointment. I know Michael has been speaking about Centene as more than just a health plan for still a moment with your extensive background in health care tech really looking forward to you ushering the company forward. But yes, looking at Medicaid specifically and continuity of ops. Could you talk about how you can help continue the company's RFP run rate that has been around 80% for the better part of the past decade?

然後第二部分向莎拉提問。首先，祝賀您的任命。我知道邁克爾一直在談論 Centene 不僅僅是一項健康計劃，因為您在醫療保健技術方面的廣泛背景非常期待您帶領公司向前發展。但是，是的，特別關注醫療補助和運營的連續性。您能否談談如何幫助公司在過去十年的大部分時間裡保持 80% 左右的 RFP 運行率？

So the best person to answer that question and the answer to your second question is Brent.

所以回答這個問題和第二個問題的最佳人選是布倫特。

There's no doubt the Medicaid RFP pipeline is reopening. It's much more like a 2017, '18 and '19. Clearly, the pandemic slowed down reprocurements in '20 and '21. And with that, we're seeing both, yes, reprocurements and we have prepared for these, we try to run the very best health plans each and every day and respond to win these RFPs. But we also see a lot of new opportunities. We see new opportunities in states that have managed care for Medicaid that we're not in. And yes, we're beginning many, many discussions with states talking about enhancing their Medicaid program.

毫無疑問，醫療補助 RFP 管道正在重新開放。它更像是 2017 年、18 年和 19 年。顯然，大流行減緩了 20 和 21 年的再採購。有了這個，我們看到了，是的，重新採購，我們已經為此做好了準備，我們每天都嘗試運行最好的健康計劃，並做出回應以贏得這些 RFP。但我們也看到了很多新的機會。我們在那些管理醫療補助計劃的州看到了新的機會，而我們不在。是的，我們正在開始與各州進行許多討論，討論加強他們的醫療補助計劃。

So I think you'll see a great deal of RFPs, where it gives us new opportunity to grow and new opportunity really to have a positive impact. We're actually very excited about it, seeing that really normal course is reappearing.

所以我認為你會看到大量的 RFP，它為我們提供了新的發展機會和真正產生積極影響的新機會。我們實際上對此感到非常興奮，看到真正正常的課程正在重新出現。

And ladies and gentlemen, our next question today comes from George Hill with Deutsche Bank.

女士們先生們，我們今天的下一個問題來自德意志銀行的喬治希爾。

Yes. Just a quick follow-up on the PBM RFP. Can you talk about how broad the PBM RFP is going -- like is it going to what I would call the usual suspects? And maybe can you talk about how you think about an early renewal for '23, given that you've got a pretty good partner at CVS and they've got the ability to pull some of the cost savings forward.

是的。只是對 PBM RFP 的快速跟進。你能談談 PBM RFP 的範圍有多大嗎——就像我所說的通常的嫌疑人一樣？鑑於您在 CVS 有一個非常好的合作夥伴，並且他們有能力將部分成本節省向前推進，也許您能談談您對 23 年提前續訂的看法。

Yes. We need a partner that can handle the size and scale of $40 billion of spend and the complexity of a multiline business. So that does limit the field to some degree, but there's still adequate competition out there. And I mean each of the parties has their own unique opportunities to impress us.

是的。我們需要一個能夠處理 400 億美元支出的規模和規模以及多線業務的複雜性的合作夥伴。所以這確實在一定程度上限制了這個領域，但仍然有足夠的競爭。我的意思是每一方都有自己獨特的機會給我們留下深刻印象。

And I would just reiterate relative to the timing that, again, we released RFP early in order to give time for those fulsome conversations, but we're still on track for year-end award. And as Drew has said and we have said multiple times that there's nothing like a good old-fashioned RFP to make sure that we're getting the best economics.

我只想重申一下時間，我們再次提前發布了 RFP，以便為那些令人愉快的對話留出時間，但我們仍有望獲得年終獎。正如 Drew 所說，我們已經多次說過，沒有什麼能比得上一個好的老式 RFP 來確保我們獲得最好的經濟效益。

And our next question today comes from Stephen Valiquette with Barclays.

我們今天的下一個問題來自巴克萊銀行的 Stephen Valiquette。

Great. Let me also offer my condolences to everyone who is close to Michael. Just a quick question here. In relation to your comment that you now expect the $6 billion revenue loss from the redeterminations from the $5 billion previously. Was there any change to your internal projection on where you think you'll end the 2023 in relation to the Medicaid membership numbers? Or is that $1 billion additional revenue falloff just purely related to the extra revenue that you'll book for the additional months in '22 that would still fall off in '23? I just want to better understand the mechanics around that. But more importantly, just where you think your membership numbers will end '23. Any change there or not?

偉大的。讓我也向所有與邁克爾關係密切的人表示哀悼。這裡只是一個簡單的問題。關於您的評論，您現在預計重新確定會導致 60 億美元的收入損失，而不是之前的 50 億美元。您認為與 Medicaid 會員人數相關的 2023 年結束時間的內部預測是否有任何變化？或者，這 10 億美元的額外收入下降僅與您在 22 年額外幾個月預訂的額外收入有關，而這些額外收入在 23 年仍會下降？我只是想更好地了解這方面的機制。但更重要的是，您認為您的會員編號將在 23 年結束。有沒有變化？

Yes. Let me answer it this way. We've grown -- if you go back to March of 2020, the inception, the onset of the pandemic, we've grown 2.8 million members since then in Medicaid, excluding as like North Carolina or Missouri expansion business, which was sort of an organic wins.

是的。讓我這樣回答。我們已經成長了——如果你回到 2020 年 3 月，即大流行的開始和開始，自那時以來，我們在 Medicaid 中已經增加了 280 萬會員，不包括北卡羅來納州或密蘇里州的擴張業務，這有點像有機勝。

So we expect a little over half of those members to attrit through the redetermination process, granted, it's an estimate. But it's a very -- it's a very complex estimate that we've assessed 29x over picking slope lines based upon direct conversations with the state. And Brent and Dave Thomas' team have done a really good job engaging with states and actually preparing for the [Catchersmed] opportunity in marketplace.

因此，我們預計這些成員中有超過一半會在重新確定過程中流失，當然，這是一個估計值。但這是一個非常 - 這是一個非常複雜的估計，根據與州的直接對話，我們已經評估了 29 倍於選擇坡度線。 Brent 和 Dave Thomas 的團隊在與各州的接觸方面做得非常好，並為市場上的 [Catchersmed] 機會做準備。

But sticking with your question in Medicaid, so yes, we expect a little over half of that 2.8 million members, which gets you to the $6 billion of revenue to attrit largely by the end of '23. I guess some of it could go into '24, depending on the states that really want to stretch out redeterminations, but I'd say largely by the end of 2023.

但是堅持你在 Medicaid 中的問題，所以是的，我們預計這 280 萬會員中的一半多一點，這將使你在 23 年底之前獲得 60 億美元的收入。我想其中一些可能會進入 24 年，這取決於真正想要延長重新裁決的州，但我會說主要是到 2023 年底。

And our next question today comes from Calvin Sternick with JPMorgan.

我們今天的下一個問題來自摩根大通的 Calvin Sternick。

Yes. A couple of related questions here on the redeterminations and the exchanges. I guess, first, with so many members coming to market, either late this year or even into the first half of next year, do you anticipate any meaningful uptick in marketing spend to try to capture these members and just sort of how you think that would compare to historical spending levels?

是的。這裡有幾個關於重新裁決和交流的相關問題。我想，首先，有這麼多會員進入市場，無論是今年年底還是明年上半年，您是否預計營銷支出會出現任何有意義的增加以試圖吸引這些會員，以及您的看法與歷史支出水平相比？

And then second, can you just remind us what programs or initiatives you have in place to try to capture Medicaid members as their income moves up and down to sort of retain the (inaudible) team products?

其次，您能否提醒我們您有哪些計劃或舉措來嘗試在醫療補助成員的收入上下波動以保留（聽不清）團隊產品時吸引他們？

Yes, like I mentioned in my last response, the team has really put a lot of thought into making sure we've got the processes in place to be able to, in some cases, market to, in some cases work directly with the state in terms of making those redetermined members aware of the opportunity to move in a Marketplace. And I think, Brent, you probably got some insights into how that process has gone with the assistance from the CMS letter that was put out in early March.

是的，就像我在上次回復中提到的那樣，團隊確實花了很多心思來確保我們已經制定了適當的流程，以便能夠在某些情況下進行市場營銷，在某些情況下直接與州合作讓那些重新確定的成員意識到進入市場的機會。我認為，布倫特，在 3 月初發出的 CMS 信函的幫助下，您可能對這個過程的進展有了一些了解。

So the 29 states where we have Medicaid health plans, we have the exchange or our Ambetter product in 25 of them. So we're able to overlap the counties and in a lot of ways, overlap the provider network, first and foremost.

因此，我們有 Medicaid 健康計劃的 29 個州，其中 25 個有交換或 Ambetter 產品。因此，我們能夠重疊縣，並在很多方面重疊供應商網絡，首先也是最重要的。

Second, we spent a great deal of time with the states. And absolutely both the federal level and the state level absolutely want people to have coverage. And both government entities are working very closely with us. In regards to the states, it's about communication. How can we actually communicate with our members in what way through texting and so forth to let them know what their options and opportunities are to work with them and the exact same on the federal level from that standpoint.

其次，我們花了很多時間與各州打交道。聯邦一級和州一級都絕對希望人們有報導。兩個政府實體都與我們密切合作。就國家而言，它是關於溝通的。我們如何才能通過發短信等方式與我們的成員進行實際溝通，讓他們知道他們有哪些選擇和機會與他們合作，從這個角度來看，在聯邦層面上也是如此。

In regards to your question about marketing spend and so forth, another component is exactly when does the PHE in, number one. And number two, every state will work at a different time. Some will want to move fast, some not so fast, and that will impact it. But no matter what it is, we will absolutely focus on distribution. We've gotten very good at distribution for the exchange, and we'll continue to do that.

關於您關於營銷支出等的問題，另一個組成部分是 PHE 的確切時間，第一。第二，每個州將在不同的時間工作。有些人想要快速行動，有些人不想那麼快，這會影響它。但不管是什麼，我們絕對會專注於分銷。我們已經非常擅長分發交易所，我們將繼續這樣做。

And our next question today comes from Benjamin Flox with Jefferies.

我們今天的下一個問題來自 Benjamin Flox 和 Jefferies。

Just wanted to follow up on redeterminations, specifically on the impact of the Medicaid risk pool. We've heard some state program leaders indicate they're going to make an effort to keep the 6 members on the roles as long as possible, which seems like it could front-end load some of the margin risk. Can you just provide an update on your thinking about managing through redetermination if and when those 2 begin?

只是想跟進重新確定，特別是醫療補助風險池的影響。我們聽說一些州項目負責人表示，他們將努力讓 6 名成員盡可能長時間地擔任該職位，這似乎可能會在前端加載一些保證金風險。如果這兩個開始以及何時開始，您能否提供有關通過重新確定進行管理的想法的最新信息？

Yes. I think the longer the Medicaid members are on the roles, sort of the better for the member, obviously, and the more stable sort of the overall aggregate population. But look, it's our job to get out in front of our state customers with data. We've already started doing that. We've had conversations with CMS to prepare for any necessary moves in rates.

是的。我認為醫療補助成員擔任角色的時間越長，顯然對成員來說就越好，而且總人口越穩定。但是看，我們的工作是在我們的州客戶面前展示數據。我們已經開始這樣做了。我們已經與 CMS 進行了對話，以準備任何必要的費率變動。

Right now, we're focused on the sunsetting of the risk corridors. And as soon as we get some additional data as redeterminations start presumably in August, but I guess we'll see if that sticks. Then to ensure that rates are actuarial sound, and that's sort of what we do for a living around here regardless of what changes there are in Medicaid programs. Also, you'll note that we've lifted the HBR this year in Medicaid into the 89s. And so it's our job to sort of keep it there regardless of what's thrown at us.

目前，我們專注於風險走廊的日落。一旦我們得到一些額外的數據，重新確定大概會在 8 月開始，但我想我們會看看這是否會持續下去。然後確保費率是精算的，這就是我們在這裡謀生的方式，不管醫療補助計劃有什麼變化。此外，您會注意到我們今年在 Medicaid 中將 HBR 提升到了 89 年代。所以我們的工作就是不管有什麼東西都要把它留在那裡。

And I would just touch back on Brent's comments as well that the benefit of being so conversant with our states and helping them to even think about what the right strategy is going into redeterminations and what the impacts might be is that we have line of sight to how each one of the states is thinking, and some of that thinking is shifting. So we have states that started off thinking that they could through the roles in 3 months and I think then better digested the fact that it was probably if coverage continuity and [voter abrasion] was important that, that's more like a 12-month plan, but we're seeing states everywhere from 5 months, which I think is probably the most aggressive all the way to 17 months.

我也想回顧一下布倫特的評論，即與我們的州如此熟悉並幫助他們思考重新決定的正確策略是什麼以及可能產生的影響是我們有視線每個州的想法如何，其中一些想法正在發生變化。所以我們有一些州開始認為他們可以在 3 個月內完成這些角色，我認為然後更好地消化這樣一個事實，即如果覆蓋連續性和 [選民磨損] 很重要，那更像是一個 12 個月的計劃，但是我們看到從 5 個月到 17 個月的所有狀態，我認為這可能是最激進的。

And again, just the fact that we're in those conversations gives us line of sight to plan and then, as Drew said, also be able to bring forward data that make sure that the rates are actuarially sound based on the impact we think we'll incur.

再說一次，我們在這些對話中的事實使我們能夠規劃視線，然後，正如 Drew 所說，還能夠提出數據，確保根據我們認為的影響，利率在精算上是合理的。會招致。

And ladies and gentlemen, this concludes our question-and-answer session. I'd like to turn the conference back over to the management team for any final remarks.

女士們，先生們，我們的問答環節到此結束。我想將會議轉回給管理團隊，以進行最後的評論。

Thanks, Rocco, and thanks, everyone, for joining us this morning. Please feel free to reach out to Investor Relations with any follow-up calls, and we'll talk to you soon.

謝謝，Rocco，謝謝大家今天早上加入我們。請隨時通過任何後續電話聯繫投資者關係部，我們會盡快與您聯繫。

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

謝謝你，女士。今天的電話會議到此結束。我們感謝大家出席今天的演講。您現在可以斷開線路，度過美好的一天。