Centene Corp (CNC) 2021 Q4 法說會逐字稿

Good day, and welcome to the Centene Fourth Quarter and Fiscal Year 2021 Earnings Conference Call. (Operator Instructions) Please note, today's event is being recorded. I would now like to turn the conference over to Jennifer Gilligan, Senior Vice President, Investor Relations. Please go ahead, ma'am.

美好的一天，歡迎參加 Centene 第四季度和 2021 財年收益電話會議。 （操作員說明）請注意，今天的活動正在錄製中。我現在想將會議轉交給投資者關係高級副總裁 Jennifer Gilligan。請繼續，女士。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our Fourth Quarter 2021 Earnings Results Conference Call. Michael Neidorff, Chairman and Chief Executive Officer; Sarah London, Vice Chairman; 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 2021 年第四季度收益結果電話會議。 Michael Neidorff，董事長兼首席執行官；莎拉倫敦，副主席； 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 those forward-looking statements as a result of various important factors, including those discussed in Centene's most recent Form 10-Q filed on October 26, 2021, and other public SEC filings, including the risks and uncertainties described with respect to the potential impacts of COVID-19 on our business and results of operations. 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 1995 年《私人證券訴訟改革法案》下的安全港條款的前瞻性陳述。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 2021 年 10 月 26 日提交的最新表格 10-Q 和其他公開的 SEC 文件中討論的因素，包括有關 COVID-19 對我們的潛在影響所描述的風險和不確定性業務和經營成果。 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 fourth quarter 2021 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 2021 年第四季度新聞稿中找到，該新聞稿可在公司網站的“投資者”部分下找到。

With that, I would like to turn the call over to our Chairman and CEO, Michael Neidorff. Michael?

有了這個，我想把電話轉給我們的董事長兼首席執行官 Michael Neidorff。邁克爾?

Can you hear me now?

你能聽到我嗎？

Yes, sir.

是的先生。

Can you hear me now?

你能聽到我嗎？

Loud and clear, sir.

響亮而清晰，先生。

Okay. I'll start over. Good morning, and welcome to our Fourth Quarter 2021 Earnings Call. I'm joined today by Sarah London, Brent Layton and Drew Asher. We had a strong ending through 2021. Our portfolio is performing well as we executed across our 3 major product lines during the fourth quarter, building on our strong foundation and extending our market-leading position in government-sponsored health care. Our membership grew 4% to 26.6 million individuals, driven by increases in Medicaid, strong growth in Medicare and good performance in our Marketplace business. We also welcome the Magellan team to Centene earlier last month, with the acquisition successfully closing exactly 1 year after we announced the transaction. We are pleased to welcome the Magellan team led by Ken Fasola and Jim Murray.

好的。我會重新開始。早上好，歡迎參加我們的 2021 年第四季度財報電話會議。 Sarah London、Brent Layton 和 Drew Asher 今天也加入了我的行列。到 2021 年，我們的業績表現強勁。我們的產品組合在第四季度的 3 個主要產品線中表現良好，建立在我們堅實的基礎之上，並擴大了我們在政府資助的醫療保健領域的市場領先地位。在 Medicaid 的增長、Medicare 的強勁增長以及我們的 Marketplace 業務的良好表現的推動下，我們的會員人數增長了 4%，達到 2660 萬人。我們還歡迎 Magellan 團隊上個月早些時候加入 Centene，此次收購在我們宣布交易整整一年後成功完成。我們很高興歡迎由 Ken Fasola 和 Jim Murray 領導的麥哲倫團隊。

There is a dire need for mental health care in this country. 2 years into it, this pandemic and the acquisition of Magellan will allow us to expand our reach to provide increased access to behavioral health. In addition, Magellan will give us the capabilities to innovate and reimagine behavioral health, significantly enhancing our ability to provide integrated physical and mental health care to all our members.

這個國家迫切需要精神衛生保健。 2 年後，這種流行病和對麥哲倫的收購將使我們能夠擴大我們的影響力，以提供更多獲得行為健康的機會。此外，麥哲倫將賦予我們創新和重新構想行為健康的能力，顯著提高我們為所有成員提供綜合身心保健的能力。

Also, in January, we welcomed 5 new Board members to our Board as part of our Board reflection process, who bring significant industry and various leadership experience. Bob Ditmore, John Roberts and Tommy Thompson have retired from the Board. And I want to thank them for their many years of service and contributions to Centene. As I look back on the onset of the pandemic, I am pleased with how we navigated the uncertainty, served our members and we grow -- and grew the business as a diversified health care enterprise. Just this year, we have added $14 billion. We have accelerated our plans for our value creation and have a clear pathway ahead to expand our margins and deliver strong multiyear earnings growth. We have the right team and the right strategy with significant opportunities ahead.

此外，在 1 月份，我們歡迎 5 位新的董事會成員加入我們的董事會，作為我們董事會反思過程的一部分，他們帶來了重要的行業和各種領導經驗。 Bob Ditmore、John Roberts 和 Tommy Thompson 已從董事會退休。我要感謝他們多年來對 Centene 的服務和貢獻。當我回顧大流行的爆發時，我很高興我們如何駕馭不確定性，為我們的會員服務並成長——並將業務發展為一家多元化的醫療保健企業。就在今年，我們增加了 140 億美元。我們加快了我們的價值創造計劃，並為擴大利潤率和實現強勁的多年盈利增長制定了明確的道路。我們擁有合適的團隊和正確的戰略，並擁有重大機遇。

Finally, I want to thank all our employees who continue to step up and serve our members during the surge of the Omicron. I couldn't be prouder of a good role that we have played in ensuring that our -- stay strong and healthy with the highest quality care, particularly during the pandemic.

最後，我要感謝我們所有的員工，他們在 Omicron 激增的過程中繼續挺身而出，為我們的會員服務。我為我們在確保我們的 - 以最優質的護理保持強壯和健康方面所發揮的良好作用感到無比自豪，尤其是在大流行期間。

And you'll probably hear, I have a little frog in my throat, so I'm going to turn this over to Sarah London, who will help manage us through the question-and-answer period and I'll participate as I want to. Sarah?

你可能會聽到，我的喉嚨裡有一隻小青蛙，所以我將把它交給 Sarah London，她將在問答期間幫助管理我們，我會隨心所欲地參與至。莎拉？

Great. Thank you, Michael, and good morning, everyone. As Michael noted, we delivered a strong fourth quarter performance creating positive momentum as we start the new year and successfully executed on key operational objectives, including the introduction of new Marketplace products for the 2022 open enrollment period, repositioning that business for success in a constantly evolving landscape, the delivery of another strong annual enrollment period in Medicare Advantage, as the value we provide for beneficiaries continues to resonate in the market and continued progress on our value creation plan, including refining margin expansion opportunities and advancing the execution of our highest priority initiatives.

偉大的。謝謝你，邁克爾，大家早上好。正如邁克爾所說，我們在新的一年開始時創造了強勁的第四季度業績，並成功執行了關鍵運營目標，包括在 2022 年開放註冊期間推出新的 Marketplace 產品，不斷重新定位該業務以取得成功隨著我們為受益人提供的價值繼續在市場上引起共鳴，我們的價值創造計劃不斷取得進展，包括改善利潤率擴張機會和推進我們最優先事項的執行倡議。

On today's call, Brent will comment on our core businesses, including how we are carrying our Q4 momentum forward into 2022. Then Drew will provide details on our fourth quarter performance and financial outlook.

在今天的電話會議上，布倫特將評論我們的核心業務，包括我們如何將第四季度的勢頭推進到 2022 年。然後，德魯將提供有關我們第四季度業績和財務前景的詳細信息。

Before I turn it over to them, let me provide a brief update on the value creation progress. From a structural perspective, we have added important talent and leadership to our value creation office. As we announced in early January, Jim Murray, who served as Magellan's President and COO, has transitioned to take on the new role of Chief Transformation Officer, leading the day-to-day management of the VCO. Jim brings experience in operating discipline and a track record for successful execution, adding another important layer of accountability to our value creation program. We are thrilled to have him on board.

在我把它交給他們之前，讓我簡要介紹一下價值創造的進展。從結構的角度來看，我們為我們的價值創造辦公室增加了重要的人才和領導力。正如我們在 1 月初宣布的那樣，曾擔任 Magellan 總裁兼首席運營官的 Jim Murray 已過渡到擔任首席轉型官的新角色，領導 VCO 的日常管理。 Jim 帶來了運營紀律方面的經驗和成功執行的記錄，為我們的價值創造計劃增加了另一個重要的責任層。我們很高興他能加入。

Now to the details. As we mentioned at our December Investor Day, 2022 is largely a year of foundational execution, and we plan to provide guideposts on our operational progress, incremental though some may seem, as a way of bringing you on the journey with us and offering a view into the work underway. And while we are only 1 month into Q1, we have already made progress on some of those key guideposts.

現在到細節。正如我們在 12 月的投資者日中提到的那樣，2022 年在很大程度上是基礎執行的一年，我們計劃為我們的運營進度提供指導，儘管有些似乎是漸進的，以此作為讓您與我們一起踏上旅程並提供觀點的一種方式進入正在進行的工作。雖然我們進入第一季度只有 1 個月，但我們已經在其中一些關鍵指南上取得了進展。

First, our pharmacy platform consolidation project. As a reminder, the strategy here is to outsource administrative PBM functions to an external partner, thereby allowing us to reduce our 3 PBM platforms down to 1 and to focus that technology on the clinical, member and provider engagement capabilities that are most important to differentiating the overall member experience. This will drive SG&A savings across the technology footprint and allow for more efficient investment in process automation.

首先，我們的藥房平台整合項目。提醒一下，這裡的策略是將管理 PBM 功能外包給外部合作夥伴，從而使我們能夠將我們的 3 個 PBM 平台減少到 1 個，並將該技術集中在對差異化最重要的臨床、成員和提供者參與能力上整體會員體驗。這將推動整個技術足蹟的 SG&A 節省，並允許對流程自動化進行更有效的投資。

Coming into 2022, we had 8 remaining state-specific programs that had not yet been consolidated on our external PBM platform. We successfully migrated 3 of these on January 1 and another on February 1 as planned. We are targeting the fourth migration for March 1 and the remaining 3 are scheduled for later in Q2. Overall, we are on track to be fully consolidated in time to issue our planned PBM RFP against our full $38 billion of pharmacy spend. I am pleased to say that work is well underway to prepare for the RFP release this summer, and we look forward to maximizing value for the enterprise through that process.

進入 2022 年，我們還有 8 個州特定計劃尚未整合到我們的外部 PBM 平台上。我們在 1 月 1 日成功遷移了其中 3 個，並在 2 月 1 日按計劃成功遷移了另一個。我們的目標是在 3 月 1 日進行第四次遷移，其餘 3 次計劃在第二季度晚些時候進行。總體而言，我們有望及時全面整合，以針對我們全部 380 億美元的藥房支出發布計劃中的 PBM RFP。我很高興地說，今年夏天發布 RFP 的準備工作正在順利進行，我們期待通過該過程為企業實現價值最大化。

Since December, we have also made good progress on the efforts we outlined around standardizing and rationalizing core operations. We initiated Phase 1 of our call center standardization, including process mapping as well as beginning the formal enterprise transition of our telephony infrastructure to the cloud. As we mentioned before, this will offer more convenient ways for our members to interact with us and get the information they need. We are starting with our Medicare and Marketplace products and expect this work to be completed in early Q3.

自 12 月以來，我們在圍繞核心業務標準化和合理化概述的努力方面也取得了良好進展。我們啟動了呼叫中心標準化的第一階段，包括流程映射以及開始將我們的電話基礎設施正式企業過渡到雲。正如我們之前提到的，這將為我們的會員提供更便捷的方式與我們互動並獲取他們需要的信息。我們從我們的醫療保險和市場產品開始，預計這項工作將在第三季度初完成。

We also kicked off Phase 2 of our utilization management work, which involves building an enterprise shared services function to serve all 3 major product lines with a primary focus on enhancing quality and productivity. We completed the Medicare transition and now have the Marketplace transition in motion.

我們還啟動了利用率管理工作的第二階段，其中包括建立企業共享服務功能，以服務於所有 3 條主要產品線，主要關注提高質量和生產力。我們完成了 Medicare 的過渡，現在正在啟動 Marketplace 的過渡。

Lastly, back in October, we formally updated our work-at-home policies, as we have learned how to deliver the same level of productivity and service to our members in a more flexible workplace environment. The shift to work at home and enhanced flexibility will have a meaningful impact on our ability to recruit and retain talent, but it also means we need to reevaluate our real estate footprint, something Drew mentioned during the December Investor Day. We have already evaluated approximately 25% of our facility locations and see opportunities for material downsizing of our footprint, expect updates on that work as we get through the full real estate portfolio.

最後，早在 10 月，我們就正式更新了在家工作的政策，因為我們已經學會瞭如何在更靈活的工作環境中為我們的會員提供相同水平的生產力和服務。在家工作的轉變和增強的靈活性將對我們招聘和留住人才的能力產生重大影響，但這也意味著我們需要重新評估我們的房地產足跡，德魯在 12 月的投資者日期間提到了這一點。我們已經評估了大約 25% 的設施位置，並看到了大幅縮減我們足蹟的機會，期待在我們完成完整的房地產投資組合時更新這項工作。

Finally, I want to touch on the capital allocation pillar of our value creation plan and particularly the portfolio review process. Closing out the story on USMM, we used the proceeds from that majority divestiture to execute $200 million in share repurchases in December. We are aggressively working our way through the noncore portfolio with a consistent, rigorous and strategic evaluation process. We will continue to provide updates on this work as it progresses.

最後，我想談談我們價值創造計劃的資本配置支柱，尤其是投資組合審查流程。結束有關 USMM 的故事後，我們在 12 月利用剝離多數股權的收益執行了 2 億美元的股票回購。我們正在通過一致、嚴格和戰略性的評估流程積極推進非核心產品組合。隨著這項工作的進展，我們將繼續提供更新。

While the value creation work is critically important, it is also complex. Let me assure you that we have full organizational commitment to our value creation objectives and are laser-focused on leveraging Centene's size and scale to unlock significant value for our stakeholders. But let me also take this opportunity to thank our leaders and our teams throughout the organization from our local market CEOs and operational leaders to frontline staff and clinical experts for their enthusiasm, agility and willingness to think differently and work differently in service of our members.

雖然價值創造工作至關重要，但也很複雜。讓我向您保證，我們對我們的價值創造目標有充分的組織承諾，並專注於利用 Centene 的規模和規模為我們的利益相關者釋放重大價值。但讓我也藉此機會感謝我們的領導和整個組織的團隊，從當地市場首席執行官和運營領導到一線員工和臨床專家，感謝他們的熱情、敏捷性和願意以不同的方式思考和以不同的方式為我們的會員服務。

Overall, our businesses are performing well. We are building on the strength of our core business lines, and we are making meaningful progress on our commitment to margin expansion, all while delivering for our members, state partners, employees and shareholders.

總體而言，我們的業務表現良好。我們正在鞏固我們核心業務線的實力，並且在我們對擴大利潤的承諾方面取得了有意義的進展，同時為我們的會員、州合作夥伴、員工和股東提供服務。

I'd now like to turn the call over to Brent for some insights on our core business line performance during Q4.

我現在想把電話轉給布倫特，以了解我們在第四季度的核心業務線表現。

Thank you, Sarah. Good morning, everyone. I'm happy to be here today to talk about our performance of our core business lines. Over the past 2 years, we've discussed how Centene's size and scale and our ability to be nimble has allowed us to manage through this pandemic. We remain well positioned to provide quality services in a pandemic environment or a return to more normalized utilization. Government-sponsored health care continues to grow in the U.S., and Centene continues to gain momentum across all of our product lines.

謝謝你，莎拉。大家，早安。我很高興今天能在這裡談論我們核心業務線的表現。在過去的 2 年中，我們討論了 Centene 的規模和規模以及我們靈活的能力如何使我們能夠應對這一流行病。我們仍然有能力在大流行環境中提供優質服務或恢復更正常的使用。政府資助的醫療保健在美國繼續增長，Centene 在我們所有的產品線中繼續獲得動力。

Our Medicaid business is still growing with membership increasing to $15 million as we closed out 2021. This growth was aided by the ongoing suspension of redeterminations, which I will talk about more in a moment. We continue to see success in our Medicaid business, such as our new contract in Nevada. In Medicare, we ended the year with more than 1.2 million members across 33 states. As we mentioned last month, we experienced strong growth during the open enrollment period and remain on track to meet our 2022 expectations. We benefited from the combination of WellCare's product expertise and Centene's strong provider network and geographic footprint. In 2022, Centene offers plans in 327 new counties as well as 3 new states. We continue to see significant opportunity within Medicare as our expanding footprint makes Centene's product offering available to more than 75% of the country's eligible beneficiaries.

到 2021 年結束時，我們的 Medicaid 業務仍在增長，會員人數增加到 1500 萬美元。這種增長得益於持續暫停的重新裁決，我稍後將對此進行更多討論。我們繼續看到我們的醫療補助業務取得成功，例如我們在內華達州的新合同。在 Medicare，我們在 33 個州擁有超過 120 萬會員。正如我們上個月提到的，我們在公開招生期間經歷了強勁的增長，並有望實現我們對 2022 年的預期。我們受益於 WellCare 的產品專業知識和 Centene 強大的供應商網絡和地理足蹟的結合。 2022 年，Centene 在 327 個新縣和 3 個新州提供計劃。隨著我們不斷擴大的足跡使 Centene 的產品可供該國 75% 以上的合格受益人使用，我們繼續在醫療保險中看到重大機遇。

Finally, in Marketplace, membership was more than 2.1 million at the end of the year, and we are pleased with our open enrollment results. For 2022, we are excited about our product offerings, which have evolved to meet the demands of our members with greater flexibility, accessibility and affordability. At the same time, we're further expanding our reach, offering Marketplace product in 5 new states. This year, Ambetter is in 49% of all counties in the U.S. This product and geographic expansion translated to solid growth during the open enrollment period. And what makes the sustained momentum in Marketplace more impactful is the fact that we never participated in a race to the bottom with our rates. We remain committed to returning Ambetter margins back to their long-term pretax target of 5% to 7.5%. And I think the initiatives we undertook in Marketplace in 2021 and the pricing discipline showed clear evidence of our ability to execute on our margin goals across all of our business lines.

最後，在 Marketplace 中，截至年底，會員人數超過 210 萬，我們對我們的公開招生結果感到滿意。對於 2022 年，我們對我們的產品感到興奮，這些產品已經發展到能夠以更大的靈活性、可訪問性和可負擔性來滿足我們會員的需求。與此同時，我們正在進一步擴大我們的影響力，在 5 個新州提供 Marketplace 產品。今年，Ambetter 覆蓋了美國 49% 的縣。這種產品和地域擴張轉化為開放招生期間的穩健增長。使 Marketplace 的持續發展勢頭更具影響力的原因在於，我們從未參與過以我們的費率進行的逐底競賽。我們仍然致力於將 Ambetter 的利潤率恢復到 5% 至 7.5% 的長期稅前目標。而且我認為我們在 2021 年在 Marketplace 採取的舉措和定價紀律清楚地證明了我們有能力在所有業務線中執行我們的利潤目標。

Before handing the call over to Drew, I want to provide a quick update on our thinking of redeterminations. We continue to work closely with our state partners to understand the timing and how to best support the transition. Our current outlook continues to reflect a return of redeterminations in May. But again, this will not be universal and the timing will vary state-by-state. The continuity of care by members that roll off Medicaid remains a top priority. Our breadth of products and services provide Centene a great opportunity to deliver this continuity of care at a low cost through our Marketplace capabilities. We currently offer exchange products in 25 of our 29 Medicaid states. Overall, we are pleased with our competitive position of our portfolio heading into 2022.

在將電話轉交給 Drew 之前，我想簡要介紹一下我們對重新裁決的看法。我們將繼續與我們的州合作夥伴密切合作，以了解時機以及如何最好地支持過渡。我們目前的展望繼續反映 5 月份重新確定的回歸。但同樣，這不會是普遍的，時間會因州而異。退出 Medicaid 的成員的護理連續性仍然是重中之重。我們廣泛的產品和服務為 Centene 提供了一個絕佳的機會，可以通過我們的 Marketplace 功能以低成本提供這種連續性護理。目前，我們在 29 個 Medicaid 州中的 25 個州提供交換產品。總體而言，我們對進入 2022 年的投資組合的競爭地位感到滿意。

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 reported fourth quarter 2021 results, including $32.6 billion in revenue, an increase of 15% compared to the fourth quarter of 2020 and adjusted diluted earnings per share of $1.01 in the quarter and $5.15 for the full year. These results are at the top end of our 2021 adjusted earnings guidance provided at our December Investor Day.

謝謝你，布倫特。今天上午，我們公佈了 2021 年第四季度的業績，包括 326 億美元的收入，與 2020 年第四季度相比增長 15%，本季度調整後的攤薄每股收益為 1.01 美元，全年為 5.15 美元。這些結果是我們在 12 月投資者日提供的 2021 年調整後收益指導的最高端。

Let's start with revenue for the quarter. Total revenue grew by $4.3 billion compared to the fourth quarter of 2020, primarily due to strong organic Medicaid and Medicare membership growth during 2021. Total membership increased to $26.6 million, up 4% compared to a year ago. Our Q4 consolidated HBR was 87.9%, consistent with our expectations. As promised, beginning with today's earnings release and each quarter going forward, you will be able to see the HBR components that drive the overall consolidated HBR, commercial, Medicaid and Medicare HBRs.

讓我們從本季度的收入開始。與 2020 年第四季度相比，總收入增長了 43 億美元，這主要是由於 2021 年強勁的有機醫療補助和醫療保險會員增長。會員總數增加到 2660 萬美元，比一年前增長 4%。我們第四季度的綜合 HBR 為 87.9%，符合我們的預期。正如所承諾的那樣，從今天的收益發布和未來的每個季度開始，您將能夠看到推動整體合併 HBR、商業、醫療補助和醫療保險 HBR 的 HBR 組件。

In commercial, you can see the high HBRs in the Q2 and Q3 time frame, driven by the risk adjustment items we covered at our June Investor Day and the Delta variant in the third quarter, as we discussed on the Q3 call. Structurally, Medicaid in the high 80s has the highest absolute HBR of the 3 business lines. And Medicare, inclusive of our Medicare Advantage and PDP businesses, posted the 2021 HBR in the mid- to high 80s. As we've said before, we believe there's an opportunity to lower the Medicare HBR as we look to 2023 and beyond.

在商業方面，您可以看到第二季度和第三季度的高 HBR，這是由我們在 6 月投資者日和第三季度討論的風險調整項目和第三季度的 Delta 變量驅動的，正如我們在第三季度電話會議上討論的那樣。從結構上看，80 年代高的 Medicaid 在 3 條業務線中擁有最高的絕對 HBR。包括我們的 Medicare Advantage 和 PDP 業務在內的 Medicare 在 80 年代中期至高位發布了 2021 年 HBR。正如我們之前所說，我們相信在 2023 年及以後有機會降低 Medicare HBR。

At an investor conference on January 10 this year, we provided insights about the Omicron variant and related COVID inpatient authorizations rising in the back half of December. As an update for January, COVID inpatient authorizations continue to climb and peaked, at least for now, in mid-January. Interestingly, with the Delta variant, Marketplace was the highest peak of our 3 business lines and Medicare was the lowest. With Omicron, Medicare was the highest peak and Marketplace was the lowest. But fortunately, the acuity, and therefore, severity we are seeing with Omicron is lower than the Delta variant, and measures like average length of stay and resulting cost per admit are lower than during prior variants. This seems consistent with the lower acuity seen in the national data. One more item on trend, influenza cases, so far, continue to be very low compared to a typical year.

在今年 1 月 10 日的投資者會議上，我們提供了有關 Omicron 變體和相關 COVID 住院授權在 12 月下半月上升的見解。作為 1 月份的更新，COVID 住院授權繼續攀升並達到頂峰，至少目前是在 1 月中旬。有趣的是，對於 Delta 變體，Marketplace 是我們 3 條業務線中的最高峰，而 Medicare 是最低的。對於 Omicron，Medicare 是最高峰，而 Marketplace 是最低的。但幸運的是，我們看到的 Omicron 的敏銳度和嚴重程度低於 Delta 變體，平均住院時間和每次入院成本等指標也低於之前的變體。這似乎與國家數據中的較低敏銳度一致。另一個趨勢項目是，到目前為止，與典型年份相比，流感病例仍然非常低。

Moving to other P&L and balance sheet items. Our adjusted SG&A expense ratio was 9.2% in the fourth quarter compared to 9.7% last year. This was in line with our expectation that our SG&A rate would be the highest in the fourth quarter of the year because of open enrollment spending in both Medicare and Marketplace. Year-over-year improvement reflects leveraged expenses over higher revenues.

轉到其他損益表和資產負債表項目。第四季度調整後的 SG&A 費用率為 9.2%，而去年為 9.7%。這符合我們的預期，即我們的 SG&A 率將在今年第四季度達到最高水平，因為 Medicare 和 Marketplace 的公開招生支出。同比改善反映了槓桿費用高於收入。

Some of you have asked about our SG&A rate and our mix of businesses. So let me give you some perspective relative to the midpoint of adjusted 2022 SG&A guidance of 8.05%. First of all, it's important to remember that we have and will continue to calculate our SG&A rate and margin metrics off of premium and service revenue, which excludes the forecasted $6 billion of pass-through revenue. And as we covered at our Investor Day, we're breaking out depreciation from SG&A in 2022 and reporting it on a separate income statement line. We expect depreciation to run a little under $700 million for 2022.

你們中的一些人詢問了我們的 SG&A 費率和我們的業務組合。因此，讓我給你一些關於調整後的 2022 年 SG&A 指導中點 8.05% 的觀點。首先，重要的是要記住，我們已經並將繼續根據保費和服務收入來計算我們的 SG&A 費率和利潤率指標，其中不包括預計的 60 億美元的傳遞收入。正如我們在投資者日所報導的那樣，我們將在 2022 年打破 SG&A 的折舊，並將其報告在單獨的損益表行中。我們預計 2022 年的折舊將略低於 7 億美元。

On an absolute basis, Magellan increases our SG&A rate by approximately 20 basis points. Our international businesses increased by a little over 30 basis points and our other health care enterprise businesses increased it by about 10 basis points, meaning the midpoint of our adjusted SG&A rate for 2022, excluding those businesses would be in the mid-7s, and our value creation plan is focused on driving that lower over time.

在絕對基礎上，麥哲倫將我們的 SG&A 利率提高了大約 20 個基點。我們的國際業務增長了 30 多個基點，我們的其他醫療保健企業業務增長了約 10 個基點，這意味著我們 2022 年調整後的 SG&A 利率的中點，不包括這些業務將在 7 年代中期，我們的價值創造計劃的重點是隨著時間的推移將其降低。

Cash flow provided by operations was $675 million in the quarter, primarily driven by net earnings. We continue to maintain a strong liquidity position of $2.3 billion of domestic unregulated cash on our balance sheet at quarter end. Furthermore, we closed our $2.6 billion Magellan transaction right after year-end, which used our available unregulated cash. Our goal continues to be to build cash at parent beginning in the back half of 2022 for additional share buybacks and debt paydown.

本季度運營提供的現金流為 6.75 億美元，主要受淨收益的推動。我們在季度末的資產負債表上繼續保持強勁的流動性頭寸，即 23 億美元的國內不受監管的現金。此外，我們在年底後立即完成了 26 億美元的麥哲倫交易，這筆交易使用了我們可用的不受監管的現金。我們的目標仍然是從 2022 年下半年開始在母公司積累現金，以進行額外的股票回購和債務償還。

On that topic, as Sarah mentioned, during the fourth quarter, we repurchased approximately $200 million of our stock using proceeds from the sale of our majority stake in U.S. Medical Management. Debt at quarter end was $18.8 billion. Our debt-to-cap ratio was 40.9%, excluding our nonrecourse debt. Our medical claims liability totaled $14.2 billion at quarter end and represents 52 days in claims payable compared to 51 in Q3. Our balance sheet remains strong, and we expect it to strengthen even further as we improve margins and generate cash flow.

關於這個話題，正如莎拉所提到的，在第四季度，我們使用出售我們在美國醫療管理公司的多數股權的收益回購了大約 2 億美元的股票。季度末的債務為 188 億美元。我們的債務與上限比率為 40.9%，不包括我們的無追索權債務。截至季度末，我們的醫療索賠負債總額為 142 億美元，應付索賠的天數為 52 天，而第三季度為 51 天。我們的資產負債表仍然強勁，隨著我們提高利潤率和產生現金流，我們預計它會進一步加強。

As we begin 2022, we're building on the positive momentum from our fourth quarter results as well as our organizational commitment to the value creation plan. We are reiterating our full year 2022 financial guidance, including expectations for adjusted earnings per share of $5.30 to $5.50.

在 2022 年開始之際，我們將在第四季度業績的積極勢頭以及我們對價值創造計劃的組織承諾的基礎上再接再厲。我們重申我們的 2022 年全年財務指導，包括調整後每股收益 5.30 美元至 5.50 美元的預期。

As you think about the seasonality of 2022 earnings, it looks like consensus is about 58% of adjusted EPS in the first half of the year and 42% in the back half, and that's a pretty good proxy for our estimates. And as you heard from Brent, we are pleased with our execution in the annual enrollment periods for Medicare and Marketplace and are well positioned to achieve our 2022 membership expectations.

當您考慮 2022 年收益的季節性時，似乎共識是上半年調整後每股收益的 58% 左右，下半年調整後每股收益的 42%，這是我們估計的一個很好的代表。正如您從布倫特那裡聽到的那樣，我們對我們在醫療保險和市場的年度註冊期間的執行感到滿意，並且有能力實現我們對 2022 年會員的期望。

Overall, our 2021 performance demonstrates the strength and agility of our organization. As Sarah touched on, we have a lot of work in motion to drive our multiyear financial commitments in the value creation plan. We look forward to updating you on our progress as we move through the year.

總體而言，我們 2021 年的表現展示了我們組織的實力和敏捷性。正如莎拉所說，我們有很多工作要做，以推動我們在價值創造計劃中的多年財務承諾。我們期待著在我們度過這一年的過程中向您更新我們的進展。

Thank you for your interest. Operator, Rocco, can you please open the line for questions?

感謝您的關注。接線員，Rocco，你能打開電話提問嗎？

(Operator Instructions) Today's first question comes from Josh Raskin at Nephron Research.

（操作員說明）今天的第一個問題來自 Nephron Research 的 Josh Raskin。

I just wanted to follow up on the process around potential divestitures and noncore assets, and I understand the complexities, Sarah, that you mentioned. I think I'm specifically interested if there's an opportunity to include certain PBM assets as part of this RFP process that you're starting, and then if you could just remind us on thoughts on international as well?

我只是想跟進有關潛在剝離和非核心資產的流程，我理解你提到的複雜性，莎拉。我想我特別感興趣是否有機會將某些 PBM 資產作為您開始的這個 RFP 流程的一部分，然後您是否可以提醒我們關於國際的想法？

Yes, absolutely. So as we've said, there are no exceptions to the portfolio review process. We're being very clear-eyed about all of those noncore assets. We really used USMM to codify that process. And then we've been prioritizing sort of the largest and most independent of assets, which is why you heard an update on international. And as I'm sure you can appreciate for specific updates on execution phase are not always going to be able to be shared incrementally. So we'll definitely share updates with you that we can as we have them.

是的，一點沒錯。正如我們所說，投資組合審查流程沒有例外。我們對所有這些非核心資產非常清楚。我們確實使用 USMM 來編碼該過程。然後我們一直在優先考慮最大和最獨立的資產，這就是你聽到國際更新的原因。而且我確信您會欣賞執行階段的特定更新並不總是能夠以增量方式共享。因此，我們一定會與您分享我們擁有的更新。

On the PBM front, our strategy there overall has not changed. And so the various PBM assets, including the inbound Magellan assets, are going through that portfolio review process and I think will be subject to the same criteria as all the other assets. So stay tuned for more updates on that.

在 PBM 方面，我們的戰略總體上沒有改變。因此，包括入境麥哲倫資產在內的各種 PBM 資產正在經歷投資組合審查過程，我認為將受到與所有其他資產相同的標準。因此，請繼續關注這方面的更多更新。

Great. And just a quick follow-up. Can you just remind us any RFPs that are coming up in the next year or 2 where Centene is the incumbent?

偉大的。只是一個快速的跟進。您能否提醒我們明年或 2 年 Centene 將在任的任何 RFP？

Well, first of all, we're waiting to hear our award in Louisiana. So still we don't have no timetable or update but waiting on Louisiana's award. We are anticipating the California RFP to be released this month, and we've been preparing for that.

好吧，首先，我們正在等待在路易斯安那州聽到我們的獎項。所以我們仍然沒有時間表或更新，只能等待路易斯安那州的獎項。我們預計加州 RFP 將於本月發布，我們一直在為此做準備。

And our next question today comes from Stephen Baxter at Wells Fargo.

我們今天的下一個問題來自富國銀行的斯蒂芬巴克斯特。

So the commercial MLR and the new disclosures improved quite meaningfully versus Q3. So obviously, that runs against the typical seasonality here. I appreciate in the commentary on Omicron. I was hoping you could talk a little bit about how utilization versus baseline levels trended from Q3 into Q4? And then I guess also, whether there's any kind of revenue impact to consider since it looks like PMPMs were up a little bit? And then any impact from stuff like favorable development you flagged. Just trying to understand the moving parts first quarter utilization in the quarter.

因此，與第三季度相比，商業 MLR 和新披露的改進相當顯著。很明顯，這違背了這裡的典型季節性。我很欣賞關於 Omicron 的評論。我希望您能談談從第三季度到第四季度的利用率與基線水平的趨勢如何？然後我想，是否有任何收入影響需要考慮，因為看起來 PMPM 有點上升？然後是您標記的有利發展之類的任何影響。只是想了解該季度第一季度的活動部件利用率。

Yes, sure. Thanks. Q3, as I said in my remarks, that's when we got hit with the Delta variant largely, sort of, peaking in August. And Marketplace, which is the vast majority of that commercial line item, sort of took at the hardest in terms of the relative peaks compared to prior variants. And it was the opposite of that with the Omicron variant, which started in the back half of December. So I think that's the -- largely the Q3 to Q4 progression that you're observing in that table, nothing else notable in terms of prior period development. We seek to reestablish at similar levels based upon consistent reserve methodology. So I think that was the driver that caused that.

是的，當然。謝謝。第三季度，正如我在講話中所說，那是我們在很大程度上受到 Delta 變體的影響的時候，在某種程度上，在 8 月達到頂峰。與之前的變體相比，作為該商業項目的絕大多數的 Marketplace 在相對峰值方面處於最艱難的狀態。與 12 月下半月開始的 Omicron 變體相反。因此，我認為這主要是您在該表中觀察到的第三季度到第四季度的進展，就前期發展而言，沒有其他值得注意的地方。我們尋求根據一致的儲備方法在相似的水平上重建。所以我認為這是造成這種情況的驅動因素。

Sir, our next question today comes from Kevin Fischbeck of Bank of America.

先生，我們今天的下一個問題來自美國銀行的 Kevin Fischbeck。

Just wondering if you could talk a little bit about the exchange environment of one of your competitors, scaling back pretty significantly kind of highlighting irrational pricing on the exchanges. So I think you talked about being able to improve margins this year. Can you just kind of help us -- remind us where your margin target is for this year versus that long-term target? And how much of getting to that long-term target is based upon what you have in control or whether some of that is based upon -- if you agree that some people are rational, that pricing, broadly speaking, kind of returning to a normalized rate?

只是想知道你是否可以談談你的一個競爭對手的交易環境，縮減相當大的規模，突出了交易所的非理性定價。所以我認為你談到了今年能夠提高利潤率。你能幫我們一下嗎——提醒我們今年的利潤目標與長期目標相比在哪裡？達到這個長期目標的程度取決於你所控制的東西，或者其中一些是否基於——如果你同意有些人是理性的，那麼從廣義上講，定價有點回歸正常化速度？

Yes. Good questions and they're all around Marketplace. As we sat here over the summer of 2021, with new product development, we're thinking about how to respond to competition and continuing to hone our portfolio for marketplace. Coupling that with a more disciplined financial bid approach, at least for those bids that were still open in that time frame, we expect meaningful movement in that HBR going from 2021 to 2022. I'll sort of walk you back to our Investor Day and the conference that we were at on January 10. We expect about 500 basis point improvement year-to-year in our commercial.

是的。好問題，他們都在 Marketplace 周圍。當我們在 2021 年夏天坐在這裡時，隨著新產品的開發，我們正在考慮如何應對競爭並繼續磨練我們的市場組合。再加上更嚴格的財務投標方法，至少對於那些在那個時間範圍內仍然開放的投標，我們預計 HBR 從 2021 年到 2022 年會有有意義的運動。我會帶你回到我們的投資者日和我們在 1 月 10 日參加的會議。我們預計我們的商業廣告將同比提高約 500 個基點。

So that commercial line, that's -- we price for and expect to execute on a pretty meaningful improvement, which still won't get us to our final destination, that 5% to 7.5% pretax zone for Marketplace. So it's -- it will be a meaningful movement. And of course, there were some things that we got hit with in 2021 that won't reoccur. That will be part of it, but we make conscious decisions on pricing, which is why we're so pleased to be 2 million-plus in terms of membership coming out of the open enrollment period.

因此，那條商業線，就是 - 我們為一個非常有意義的改進定價並期望執行，這仍然不會讓我們到達我們的最終目的地，即 Marketplace 的 5% 到 7.5% 的稅前區域。所以它 - 這將是一個有意義的運動。當然，我們在 2021 年遇到的一些事情不會再發生。這將是其中的一部分，但我們會在定價方面做出有意識的決定，這就是為什麼我們很高興在開放註冊期結束後會員人數超過 200 萬。

Our next question today comes from A.J. Rice at Crédit Suisse.

我們今天的下一個問題來自 A.J.瑞士信貸的大米。

Yes. I think in the prepared remarks, it was mentioned that Medicare margins, HBR, you think, will improve in '23 and beyond. I guess I would just wonder if you could flesh out more what are the levers to allow that to happen. Is it an expectation about improvement in STARS ratings? Is it expectation of some of the rapid growth you've seen recently, some of those members maturing? Give us a little flavor for how you have the visibility in '23 and beyond by improving it.

是的。我認為在準備好的評論中提到，您認為醫療保險利潤率、HBR 將在 23 年及以後有所改善。我想我只是想知道您是否可以充實更多允許這種情況發生的槓桿。是對 STARS 評級提高的預期嗎？是對你最近看到的一些快速增長的期望，其中一些成員正在成熟嗎？通過改進它，讓我們了解一下您如何在 23 年及以後獲得知名度。

And maybe my follow-up would be just to flesh out, I know Brent mentioned the California RFP, there's been some discussion in the press about potentially a preemptive deal with Kaiser. And just any assessment of the RFP process? Anything different about that, that you'd like to call out or highlight or give us perspective on?

也許我的後續行動只是充實，我知道布倫特提到了加利福尼亞的 RFP，媒體上已經討論過可能與 Kaiser 達成先發製人的協議。以及對 RFP 流程的任何評估？對此有什麼不同之處，您想提出或強調或給我們一些看法嗎？

A.J., I'll start, and then I'll kick it over to Drew. In regards to, I think, the announcement you're talking about is Kaiser Permanente, we do not subcontract with Kaiser Permanente in California. So it does not change our RP strategy or any of our approach in the procurement that will be forthcoming. I'll turn it over to you, Drew.

A.J.，我會開始，然後我會把它踢給德魯。關於，我認為，您所說的公告是 Kaiser Permanente，我們不與加利福尼亞州的 Kaiser Permanente 分包。因此，它不會改變我們的 RP 戰略或我們即將推出的任何採購方法。我會把它交給你的，德魯。

Yes. Then on Medicare, yes, A.J., it's sort of a comprehensive project plan, which touches a number of the areas you mentioned. So it's not just pulling clinical initiatives, and we've got a slate of dozens of those initiatives that we brought from other experiences, and we've seen work in other places. It's also the bid process, and quite frankly, having a little bit more of a discipline and a trade-off between growth and margin. And what I'm pleased at is our base of business is 50, 5-0 -- will be 50% higher coming off of the 2021 and 2022 open enrollment period. So expect growth to slow considerably in Medicare, but that's a heck of a base to then approach the margin expansion opportunity.

是的。然後是醫療保險，是的，A.J.，這是一個全面的項目計劃，涉及您提到的許多領域。因此，這不僅僅是拉動臨床計劃，我們還從其他經驗中獲得了數十項此類計劃，並且我們已經在其他地方看到了工作。這也是投標過程，坦率地說，在增長和利潤之間有更多的紀律和權衡。我很高興的是，我們的業務基礎是 50、5-0——從 2021 年和 2022 年的開放招生期開始，將增加 50%。因此，預計醫療保險的增長將大幅放緩，但這是接近利潤率擴張機會的基礎。

And so the bid process, pushing towards margin will be a multiyear effort. We're not going to try to go get it all in 1 year because we've got to balance the attractiveness of our products. You're right to mention STARS. s will be a little bit more volatility over the next few years. The STARS scores that were released in '21 called the rating year '22, which result in 2023 revenue, looked good. Now we were aided by the disaster relief provisions. And between that and some other operational challenges, the STAR scores that are released in October of 2022, called the rating year '23 STARS scores, which resulted in 2024 revenue, we expect, as I mentioned on the third quarter call, those are to drop. And we've got a lot of work to do to improve our execution around STARS as we look at what we can impact today are essentially the rating year 24 stars for revenue in '25. So we'll have to manage through that -- those cycles, but there are a number of levers to pull in clinical initiatives and just, as Brent mentioned earlier, harnessing the assets of the combined company and continue to push for excellent operational execution.

因此，爭取利潤的投標過程將是一項多年的努力。我們不會試圖在 1 年內全部完成，因為我們必須平衡產品的吸引力。你說得對 STARS。在接下來的幾年裡，s 的波動性會更大一些。 21 年發布的 STARS 分數稱為 22 年評級年，這導致了 2023 年的收入，看起來不錯。現在我們得到了救災規定的幫助。在這與其他一些運營挑戰之間，2022 年 10 月發布的 STAR 分數，稱為評級年 '23 STARS 分數，這導致了 2024 年的收入，正如我在第三季度電話會議上提到的那樣，我們預計，這些將降低。我們還有很多工作要做，以提高我們圍繞 STARS 的執行力，因為我們看看我們今天可以影響的基本上是 25 年收入的 24 星評級年。因此，我們必須通過這些週期進行管理，但有許多槓桿可以拉動臨床計劃，正如布倫特之前提到的，利用合併後公司的資產並繼續推動出色的運營執行。

And our next question today comes from Scott Fidel with Stephens.

我們今天的下一個問題來自 Scott Fidel 和 Stephens。

Actually, just quickly wanted to tack on to A.J.'s question. Just on the Medicare margin side. Just wanted to get your initial thoughts on the advanced notice that just came out for 2023, seemed pretty solid from my perspective. But just interested in how that reinforces your confidence on sort of getting that margin improvement in MA? And then just as a follow-up, just appreciate the color that you've given us on the year-over-year expected change in MLR for commercial. Just interested if there's anything you'd want to call out for us in thinking about Medicare and Medicaid MLRs in 2022 versus 2021. Obviously, now we're all going to be tracking those metrics closely now that you're providing them. So just -- that you want to call out ahead of time, that would be helpful as well.

實際上，只是很快就想回答 A.J. 的問題。就在醫療保險邊際。只是想了解您對 2023 年剛剛發布的提前通知的初步想法，從我的角度來看，這似乎非常可靠。但只是對這如何增強您在 MA 中提高利潤率的信心感興趣？然後，作為後續行動，請欣賞您為我們提供的關於 MLR 商業預期年同比變化的顏色。只是有興趣在 2022 年與 2021 年考慮醫療保險和醫療補助 MLR 時是否有什麼想呼籲我們。顯然，現在我們都將密切跟踪這些指標，因為您正在提供這些指標。所以只是- 你想提前打電話，這也會有幫助。

Yes, absolutely. In fact, pointing you back to the Investor Day slide where we gave a specific bridge by major line of business of HBR progression from 2021 to 2022. And so if you do the math, that shows the impact on the entire HBR. So if you sort of divide that by the percentage that, that business represents, you get to the 500 basis points in commercial. Medicare, we expect around flat. Once again, we didn't price to improve nor do we think it will degradate in 2022, and that creates an opportunity for '23 and beyond in Medicare.

是的，一點沒錯。事實上，讓您回到投資者日幻燈片，我們在其中給出了 HBR 從 2021 年到 2022 年進展的主要業務線的具體橋樑。因此，如果您進行數學計算，就會發現對整個 HBR 的影響。因此，如果您將其除以該業務所代表的百分比，您將獲得 500 個商業基點。醫療保險，我們預計持平。再一次，我們沒有為改進付出代價，我們也不認為它會在 2022 年退化，這為 23 年及以後的醫療保險創造了機會。

And then in Medicaid, we talked about the last few times, we were in public forums talking about a reversion to the mean and utilization returning to a more normalized HBR in Medicaid, which would be up about 130 basis points year-to-year. You see that represented in that waterfall from our Investor Day slides at 90 basis points, but that applies to the entire HBR. It's 130 if you just isolate Medicaid itself. And then with the advanced notice, I think what it does demonstrate is bipartisan support for the Medicare program and agree those rates and elements so far we expect to be workable for next year.

然後在 Medicaid 中，我們談到了最近幾次，我們在公共論壇上討論了回歸均值和利用率回歸到 Medicaid 中更加正常化的 HBR，這將同比上升約 130 個基點。您可以從我們的投資者日幻燈片中看到 90 個基點的瀑布圖，但這適用於整個 HBR。如果您只是隔離醫療補助本身，則為 130。然後通過提前通知，我認為它確實證明了兩黨對醫療保險計劃的支持，並同意到目前為止我們預計明年可以使用的這些費率和要素。

And our next question today comes from Justin Lee at Wolfe Research.

我們今天的下一個問題來自 Wolfe Research 的 Justin Lee。

I actually want to follow up through on your comments around Medicaid specifically. When you talked about margin normalization, 130 basis point move is pretty significant in Medicaid. Can you give us an idea where those margins were in '21 and where you expect them to kind of normalize in '22 to start off?

我實際上想具體跟進您對 Medicaid 的評論。當您談到保證金正常化時，130 個基點的變動在 Medicaid 中非常重要。你能給我們一個想法，這些利潤在 21 年在哪裡，你希望它們在 22 年開始正常化嗎？

I think you'll have to orient yourself to the HBRs and sort of track in that manner. And don't forget, we also had pharmacy carve-outs in a couple of our states. So that was not insignificant. The impact of that, especially in California, so that was sort of a progression, a mathematical progression right off the top. And then, yes, we're making forward estimates of -- we see returning at least like emergency room access for Medicaid on the emergent side, so things that are truly emerging, that has returned.

我認為你必須讓自己適應 HBR 並以這種方式進行跟踪。別忘了，我們在幾個州也有藥房分拆。所以這不是微不足道的。其影響，尤其是在加利福尼亞，所以這是一種進步，一種數學進步。然後，是的，我們正在提前估計——我們看到至少像緊急情況下醫療補助的急診室通道一樣，真正出現的事情已經回來了。

The non-emergent, we think there's still an opportunity to keep some of that suppressed and redirect members to their PCPs and physicians. So it's a culmination of forward estimates and a view into the right sort of rate environment for Medicaid.

對於非緊急情況，我們認為仍有機會保留其中的一些壓制並將成員重定向到他們的 PCP 和醫生。因此，這是前瞻性估計的高潮，也是對 Medicaid 正確費率環境的看法。

Okay. Maybe -- again, I don't want to pin you down on the 10 basis points. But for instance, one of your peers talked about making margin target closer to 4%. Most of the others talk about kind of a midpoint closer to 3%. Maybe you can help us just kind of orient to that in terms of what you think normal is.

好的。也許——再一次，我不想把你固定在 10 個基點上。但例如，您的一位同行談到讓保證金目標接近 4%。其他大多數人都在談論接近 3% 的中點。也許您可以幫助我們了解您認為正常的情況。

Yes. Going back to our June Investor Day, where we first laid out our North Star margin goal of 3.3% after tax and sort of explained that 4.4% pretax. Medicaid is going to be a little bit below that, but it can't be too far below that because it's over 60% of our business. So maybe that helps you frame in your models the different businesses. Medicare would be above the average. And then Marketplace, the highest of the 3 at the 5% to 7.5% pretax as far as long-term targets.

是的。回到我們 6 月的投資者日，我們首先制定了稅後 3.3% 的北極星利潤率目標，並在某種程度上解釋了 4.4% 的稅前利潤率。醫療補助計劃會略低於這個數字，但不能低於這個數字太遠，因為它占我們業務的 60% 以上。因此，也許這可以幫助您在模型中構建不同的業務。醫療保險將高於平均水平。然後是市場，就長期目標而言，稅前 5% 至 7.5% 是三個中最高的。

And our next question today comes from Matt Borsch of BMO.

我們今天的下一個問題來自 BMO 的 Matt Borsch。

Yes. Maybe if I could just continue on the Medicare Advantage product. Should we take as -- from what you're saying that you're going to be more conservative or you plan to be in your approach on bidding Medicare Advantage for 2023? And then associated with that, as a follow-up, if you could just talk about the level and intensity of competition that you're seeing in Medicare Advantage today.

是的。也許如果我可以繼續使用 Medicare Advantage 產品。我們應該從你所說的——你會更加保守，或者你計劃在 2023 年競標 Medicare Advantage 時採用你的方法嗎？然後與此相關，作為後續行動，如果您可以談談您今天在 Medicare Advantage 中看到的競爭水平和強度。

I'll tackle the first piece, and then Brent is really close to this on a daily basis, and competition can follow up. I think, Matt, by definition, if we're going to be seeking to expand margin, obviously, there's a trade-off there. You shouldn't expect this to grow 30% like we did last year in terms of membership, which was just a phenomenal, top line result. But now we've got to convert some of that to deliver on margins. So yes, by definition, we will be pushing margin harder in '23, '24 and '25 bids than we did in the '21 and '22 bids, and that's just sort of the opportunity that stands in front of us.

我會處理第一塊，然後布倫特每天都非常接近這個，競爭可以跟進。我認為，馬特，根據定義，如果我們要尋求擴大利潤，顯然，那裡有一個權衡。你不應該期望這會像我們去年在會員方面那樣增長 30%，這只是一個驚人的頂線結果。但現在我們必須將其中的一些轉換為利潤。因此，是的，根據定義，我們將在 '23、'24 和 '25 投標中比在 '21 和 '22 投標中更努力地推動保證金，這只是擺在我們面前的機會。

There's always going to be competition, whether it's Medicare Advantage or whether it's Marketplace. I would say, though, that the smaller players in Medicare Advantage really did not have a meaningful impact in regards to our results and our growth. But we feel good about our positioning and -- over '22 and ongoing.

總是會有競爭，無論是醫療保險優勢還是市場。不過，我想說的是，Medicare Advantage 中較小的參與者對我們的業績和增長確實沒有產生有意義的影響。但我們對我們的定位感覺很好，而且 - 超過 22 歲並且還在繼續。

Our next question today comes from Ricky Goldwasser with Morgan Stanley.

我們今天的下一個問題來自摩根士丹利的 Ricky Goldwasser。

So as we think about MA in 2022, from what we saw, you meaningfully invested into very rich benefits. So how should we think about sort of Medicare margins in 2022? Maybe you can give us some baseline that we can think of as we're thinking of that margin expansion opportunity in '23 and beyond? And then if you can comment on just what you're seeing for core utilization versus baseline and how is that factored into '22 guidance in terms of just use of ER acuity -- and acuity levels?

因此，當我們考慮 2022 年的 MA 時，從我們所看到的情況來看，您有意義地投資於非常豐厚的福利。那麼我們應該如何考慮 2022 年的醫療保險利潤率呢？也許你可以給我們一些我們可以想到的基線，因為我們正在考慮 23 年及以後的利潤率擴張機會？然後，如果您可以評論一下您所看到的核心利用率與基線的對比，以及如何將其納入 22 年指南中關於 ER 敏銳度和敏銳度水平的使用？

Yes, Ricky, I think I'd ask you to orient to the Medicare HBR that we disclosed for 2021, and our expectation of that being sort of in the zone of flat, consistent '21 to '22. That's -- as we explained at Investor Day, it's one of the pieces that our guidance is predicated on. And then, yes, every -- on utilization, every wave, Omicron or every COVID wave since the beginning, there's a -- the deferrable services are less and less impacted. It doesn't mean we don't think there are channel checks tell us that there are surgeries that are being rescheduled for February that would have otherwise been done in January, but the providers are getting more and more resilient in terms of being able to manage both.

是的，Ricky，我想我想請您關注我們在 2021 年披露的醫療保險 HBR，以及我們對 21 年至 22 年持平、一致的預期。那是 - 正如我們在投資者日解釋的那樣，這是我們的指導所依據的部分之一。然後，是的，從一開始，每一次——關於利用率、每一波、Omicron 或每一次 COVID 浪潮，都有一個——可延期服務受到的影響越來越小。這並不意味著我們不認為有渠道檢查告訴我們有一些手術正在重新安排在 2 月份進行，否則這些手術本來可以在 1 月份完成，但提供者在能夠做到的方面變得越來越有彈性管理兩者。

So there's been a continuing return to, call it, normal utilization over the past 6 to 9 months. Some areas aren't fully there. Like I mentioned, the nonemergent emergency room, which is good, and hopefully, that's a structural change for the industry. We're certainly working with our members and our physicians to try to get members to engage directly with their physicians for nonemergent services. But all of that's factored into the progressions of our HBRs that we laid out at Investor Day.

因此，在過去的 6 到 9 個月內，它一直在持續恢復到正常使用。有些領域並不完全存在。就像我提到的那樣，非急診室，這很好，並且希望這是行業的結構性變化。我們當然正在與我們的會員和我們的醫生合作，試圖讓會員直接與他們的醫生接觸以獲得非緊急服務。但所有這些都被納入了我們在投資者日制定的 HBR 進展中。

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. So question around Medicare Advantage. Obviously, the early CMS data looks promising for Centene, the MA membership growth for '22. But just given the greater than average industry volatility in this year's Medicare, AEP. Just curious if you can remind us just on Centene's profile on how much of your typical MA membership growth is maybe driven by internal sales efforts versus reliance on external channels. And do you expect any notable changes in that mix going forward, just given some of the volatility that we're seeing and other trends across the MA marketing efforts.

偉大的。所以關於醫療保險優勢的問題。顯然，早期的 CMS 數據對 Centene 來說是有希望的，即 22 年的 MA 成員增長。但只是考慮到今年醫療保險 AEP 的行業波動性高於平均水平。只是好奇您是否可以僅在 Centene 的個人資料中提醒我們，您的典型 MA 會員增長有多少可能是由內部銷售努力而不是依賴外部渠道推動的。鑑於我們看到的一些波動性以及 MA 營銷工作中的其他趨勢，您是否期望這種組合在未來有任何顯著變化。

Yes. We're not really seeing that volatility you're referring to. I mean we've got multiple channels. The Medicare team over the past 4 or 5 years has developed multiple channels, the W2 workforce are going back a long ways back. And then more recently, next -- in the last 3 or 4 years, Teledigital. We've got -- we actually created our own direct-to-consumer proprietary internal capability. That's another channel. We've got the brokerage channel, which we honed probably a few years ago after the Universal American acquisition. So we've been working on this for a number of years. And then the merger with Centene gave us, as Brent mentioned, access to a much broader footprint, and quite frankly, network just to complement what WellCare had built along the way.

是的。我們並沒有真正看到你所指的那種波動性。我的意思是我們有多個渠道。過去 4 或 5 年，Medicare 團隊開發了多種渠道，W2 員工隊伍正在回溯很長一段時間。然後最近，下一個 - 在過去的 3 或 4 年，Teledigital。我們已經——我們實際上創建了我們自己的直接面向消費者的專有內部能力。那是另一個渠道。我們有經紀渠道，我們可能在幾年前收購環球美國公司後對其進行了磨練。所以我們多年來一直在努力。正如布倫特所說，與 Centene 的合併讓我們獲得了更廣泛的足跡，坦率地說，網絡只是為了補充 WellCare 在此過程中建立的網絡。

So just to give you one data point, our -- I think what you're getting at is sort of that distribution channel of Teledigital and telemarketing. It's about half of our sales, but it was about half of our sales last year, too. So not a real change in the distribution of where we're getting our growth from.

所以只是給你一個數據點，我們的 - 我認為你得到的是一種電話數字和電話營銷的分銷渠道。這大約是我們銷售額的一半，但也大約是我們去年銷售額的一半。因此，我們的增長來源分佈並沒有真正的變化。

And our next question today comes from Dave Windley at Jefferies.

我們今天的下一個問題來自 Jefferies 的 Dave Windley。

I was wondering in Medicaid, if you're able to do analytics that would either tell you explicitly or give you hints as to which members were likely to be redetermined off when that turns back on, and if you can see that what are the relative claims patterns of those people or the HBR on that subgroup versus the whole?

我想知道在醫療補助計劃中，您是否能夠進行分析，明確地告訴您或提示您在重新啟用時可能會重新確定哪些成員，以及您是否可以看到哪些是相對的這些人的索賠模式或該亞組的 HBR 與整體的索賠模式？

Yes. No, obviously, we've been thinking about that. And while there are some characteristics, we don't have good employment data on those that may have gotten employment since they originally qualified for Medicaid. There's some cohorts such as moms post delivery in some states depending on state eligibility rules that they might have otherwise rolled off at a certain point postpartum. So we can look at some of that, but there's not -- it's not like you've got a cohort that we're getting with a rate sell that says, "to be redetermined in the future", so we can make estimates of that. And we've seen, over time, the impact of eligibility going up and down the FPL scale. But we think we're well prepared for that time when it comes. We'll see if it pushes out past our May 1 assumption, which our guidance is built on. And the teams are really focused on 25 out of 29 states being prepared. And I think Brent can probably add some color, some interesting color, for you guys on our engagement with states on that topic.

是的。不，顯然，我們一直在考慮這個問題。雖然有一些特徵，但我們沒有關於那些自最初有資格獲得醫療補助以來可能已經就業的人的良好就業數據。根據州的資格規則，有些州的媽媽們在分娩後可能會在產後的某個時候退出。所以我們可以看看其中的一些，但沒有——這不像你有一個我們正在通過利率出售獲得的隊列，上面寫著“未來將重新確定”，所以我們可以估計那。我們已經看到，隨著時間的推移，資格在 FPL 規模上上下波動的影響。但我們認為我們已經為那個時候做好了充分的準備。我們將看看它是否超出了我們 5 月 1 日的假設，我們的指導是建立在該假設之上的。團隊真正專注於正在準備的 29 個州中的 25 個。而且我認為布倫特可能會為你們在該主題上與各州的接觸添加一些顏色，一些有趣的顏色。

Yes. I mean we have been in constant contact well starting last year with both the federal government, and obviously, our state partners. And as Drew said, we've really built a platform between our exchange through to Medicaid. And from that standpoint, whether it's network and communication and planning, we're preparing for this. So wherever that date is, we believe that we have the ability to really be a solution as people want to -- obviously, states want to make sure their citizens have health insurance coverage, and we've been working with them and we're preparing for it.

是的。我的意思是，從去年開始，我們一直與聯邦政府保持良好的聯繫，顯然還有我們的州合作夥伴。正如 Drew 所說，我們真的在我們的交流和醫療補助之間建立了一個平台。從這個角度來看，無論是網絡、溝通和規劃，我們都在為此做準備。所以無論那個日期是什麼，我們相信我們有能力真正成為人們想要的解決方案——顯然，各州希望確保他們的公民有健康保險，我們一直在與他們合作，我們正在為它做準備。

On our next question today comes from Nathan Rich of Goldman Sachs.

今天我們的下一個問題來自高盛的 Nathan Rich。

Drew, could you maybe just remind us whether the '22 guidance includes any expected savings from the value creation plan? I think going back to the December Analyst Day, the SG&A bridge had 15 basis points of leverage on the core business, but I wasn't sure if that included anything specifically from the program. And then it sounds like the company is tracking well against the early guideposts that you laid out, especially around pharmacy. I guess I'd just be curious, is there a potential to see savings from some of those actions this year as we think about progression over the balance of the year.

Drew，您能否提醒我們 22 年的指導是否包括價值創造計劃的任何預期節省？我想回到 12 月的分析師日，SG&A 橋對核心業務有 15 個基點的槓桿作用，但我不確定這是否包括該計劃的任何具體內容。然後聽起來該公司正在很好地跟踪您制定的早期指南，尤其是在藥房方面。我想我只是好奇，當我們考慮今年餘下時間的進展時，是否有可能從今年的一些行動中節省開支。

Yes, it's a really good question on sort of the jump-off point because we're crystal clear internally also the midpoint of $5.40 for 2022 is a jump-off point, upon which we will pull levers to get the $2 of opportunity, including the SG&A bucket, that $700 million of SG&A bucket that we laid out at Investor Day. So those should be incremental largely showing up in '23 and '24, but incremental to the jump-off point of the $5.30 to $5.50 guidance. And Sarah can give you an update on some of those activities.

是的，這是一個關於起點的非常好的問題，因為我們內部也很清楚，2022 年 5.40 美元的中點是一個起點，我們將在此基礎上拉動槓桿以獲得 2 美元的機會，包括SG&A 桶，我們在投資者日佈置的 7 億美元的 SG&A 桶。因此，這些應該是增量的，主要出現在 '23 和 '24 中，但增量到 5.30 美元至 5.50 美元指導的起點。莎拉可以為您提供其中一些活動的最新信息。

Yes. As you noted, we are making good progress. We are very focused on hitting those EPS targets for '22, '23 and '24. And we'll always look for upside. But I think the way we look at it, you don't get to kick the extra point if you don't score the touchdown first. So we're staying really focused on our goals, first and foremost, in year.

是的。正如你所指出的，我們正在取得良好進展。我們非常專注於實現 '22、'23 和 '24 的 EPS 目標。我們將始終尋找上行空間。但我認為我們看待它的方式，如果你沒有先達陣得分，你就不能踢加分。因此，我們將真正專注於我們的目標，首先是這一年。

And 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。

Well, first, I just want to say hello to Michael and wish him well, but I did want to see if there was any updates you can provide. Wondering if there's any update on CEO search and process timing you can provide another 5 new Board members in January. But is that likely a first half or second half announcement? And is there any visibility for investors outside of -- we'll just wake up 1 day and we'll see who the CEO is?

好吧，首先，我只想向邁克爾打個招呼並祝他一切順利，但我確實想看看您是否可以提供任何更新。想知道 CEO 搜索和流程時間是否有任何更新，您可以在 1 月份再提供 5 名新的董事會成員。但這可能是上半年或下半年的公告嗎？是否對投資者以外的投資者有任何可見性 - 我們只需醒來 1 天，我們就會看到 CEO 是誰？

Let me start that. There's a process we're going through. We're following good governance. We're looking at various candidates, and they recognize that some time ago, earlier when this was publicized, I'd talked about them. I spoke to the Board of my desire to step down as CEO, and the process is in place. And I think -- there's too much more than that. We're beginning over our SKUs. So it's a clear process. And I hope to see results over -- between now and midyear at the latest.

讓我開始吧。我們正在經歷一個過程。我們遵循良好的治理。我們正在研究各種候選人，他們認識到前段時間，在這被公開的早些時候，我談到了他們。我向董事會表達了我辭去首席執行官一職的願望，並且流程已經到位。而且我認為 - 不止於此。我們從 SKU 開始。所以這是一個清晰的過程。我希望看到結果——最遲從現在到年中。

Ladies and gentlemen, our next question today comes from Calvin Sternick with JPMorgan.

女士們先生們，我們今天的下一個問題來自摩根大通的 Calvin Sternick。

Just wanted to ask on the exchanges and the enhanced subsidies and any update on legislation and timing for something to get done there and just any sense for the likelihood that something will get done there in 2022.

只是想詢問交易所和增加的補貼以及有關立法和時間的任何更新，以便在那裡完成某事，以及對 2022 年在那裡完成某事的可能性有任何意義。

Jon, do you want start with that, and then let Brent pick up?

喬恩，你想從那個開始，然後讓布倫特接手嗎？

Michael, I'll start that and then I'll let Jon Dinesman speak from there. I mean it's clearly a priority of the Biden administration. This has clearly had an impact. It's clearly led to large enrollments from that standpoint. We do anticipate that there will be many efforts, and we anticipate future legislation. But Jon, I'll let you add to that, sir.

邁克爾，我會開始，然後讓 Jon Dinesman 從那裡發言。我的意思是，這顯然是拜登政府的優先事項。這顯然產生了影響。從這個角度來看，這顯然導致了大量的招生。我們確實預計會有很多努力，我們預計未來的立法。但是喬恩，我會讓你補充一下，先生。

Yes. The one thing that's important is it had strong support to coming out of the house, also maintain that strong support in the Senate. So there's a clear recognition, especially by the Democrats that this was critical to strengthening the ACA and even the mansion proposal included this. So anybody who guesses on timing is really doing a guess, but we still feel like confident that if there is a bill that passes that this will be included.

是的。重要的一件事是它得到了眾議院的大力支持，也保持了參議院的大力支持。所以有一個明確的認識，尤其是民主黨人認為這對加強 ACA 至關重要，甚至豪宅提案也包括了這一點。因此，任何猜測時間的人都在猜測，但我們仍然有信心，如果有一項法案通過，這將被包括在內。

And our next question today comes from George Hill at Deutsche Bank.

我們今天的下一個問題來自德意志銀行的喬治希爾。

Yes. Just on the PBM project, I guess, as the project continues to press along, are you able to give us any more color maybe on which parts do you feel like you want to in-source versus feel like outsourced? Do you feel like this is a complete outsourcing project? Or you guys hold on the higher-value projects like formulary network management? Just kind of as we think about the scope of the RFP and the outsourcing project, just kind of what stays and what goes?

是的。就 PBM 項目而言，我想，隨著項目的繼續推進，你能否給我們更多的顏色，也許你覺得哪些部分你想內購而不是外包？你覺得這是一個完整的外包項目嗎？還是你們持有像處方網絡管理這樣的高價值項目？就像我們考慮 RFP 和外包項目的範圍一樣，什麼會留下，什麼會繼續？

Yes, it's a great question. I would say we have a pretty strong operating hypothesis going into the RFP about what pieces we want to partner for and what we want to keep in-house, but we're also doing a pass at that work through the lens of value creation to make sure that we still feel like that hypothesis holds. And I think some of that will also be informed, quite frankly, by the conversations that we have with potential partners through the RFP process. But I would say, on balance, keeping those capabilities that allow us to create a differentiated experience for our members and providers, is always going to be the priority.

是的，這是一個很好的問題。我想說，我們在 RFP 中有一個非常強大的運營假設，關於我們想要合作的部分以及我們想要內部保留的部分，但我們也在通過價值創造的鏡頭來完成這項工作確保我們仍然覺得這個假設成立。坦率地說，我認為其中一些也將通過我們通過 RFP 流程與潛在合作夥伴進行的對話得到通知。但我想說，總而言之，保持那些使我們能夠為我們的會員和提供商創造差異化體驗的能力始終是首要任務。

Thank you. 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.

謝謝你。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。

Thank you, all. I want to thank everybody for joining us today. And we really look forward over the course of the year to continue to report our results. Clearly, I believe we have the right product mix, the right strategy for those products. The margin expansion program is clear, and everybody in the organization knows what has to be done. And most importantly, we have the right team working on these things to bring you good health. So it's a -- I'm really looking forward to the results about the year. Thank you for participating.

謝謝你們。我要感謝大家今天加入我們。我們真的很期待在這一年裡繼續報告我們的結果。顯然，我相信我們擁有正確的產品組合和針對這些產品的正確策略。利潤擴張計劃很明確，組織中的每個人都知道必須做什麼。最重要的是，我們有合適的團隊致力於這些事情，為您帶來健康。所以這是一個 - 我真的很期待今年的結果。感謝您的參與。

Thank you, sir, and thank you all for your participation on today's conference. Today's call has now concluded. You may disconnect your lines, and have a wonderful day.

謝謝你，先生，謝謝大家參加今天的會議。今天的電話會議現已結束。你可以斷開你的線路，並有一個美好的一天。