CVS Health Corp (CVS) 2019 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the CVS Health Q4 2019 Earnings Call.

女士們、先生們，感謝大家的支持，歡迎參加 CVS Health 2019 年第四季度財報電話會議。

(Operator Instructions) Please be advised that today's conference is being recorded.

（操作員指示）請注意，今天的會議正在錄製中。

(Operator Instructions)

（操作員說明）

I would now like to hand the conference over to your speaker today, Valerie Haertel, Senior Vice President of Investor Relations for CVS Health.

我現在想將會議交給今天的發言人，CVS Health 投資者關係高級副總裁 Valerie Haertel。

Thank you.

謝謝。

Please go ahead, madam.

請繼續，女士。

Thank you, and good morning, everyone.

謝謝大家，大家早上好。

Welcome to the CVS Health Fourth Quarter and Full Year 2019 Earnings Call.

歡迎參加 CVS Health 2019 年第四季度和全年收益電話會議。

As a reminder, this call is being recorded.

提醒一下，此通話正在錄音。

I'm Valerie Haertel, Senior Vice President of Investor Relations for CVS Health.

我是 Valerie Haertel，CVS Health 投資者關係高級副總裁。

I am joined this morning by Larry Merlo, President and CEO; Eva Boratto, Executive Vice President and CFO.

今天上午，總裁兼首席執行官拉里·梅洛 (Larry Merlo) 也加入了我的行列。伊娃·博拉托 (Eva Boratto)，執行副總裁兼首席財務官。

Following our prepared remarks, we'll host a question-and-answer session that will include Jon Roberts, Chief Operating Officer; Karen Lynch, President of Aetna; and Derica Rice, President of Caremark.

在我們準備好的發言之後，我們將舉辦問答環節，首席運營官喬恩·羅伯茨 (Jon Roberts) 出席；凱倫·林奇 (Karen Lynch)，Aetna 總裁；以及 Caremark 總裁 Derica Rice。

(Operator Instructions)

（操作員說明）

Consistent with our practice, in addition to this call and our press release, we have posted a slide presentation on our website.

根據我們的做法，除了本次電話會議和新聞稿之外，我們還在我們的網站上發布了幻燈片演示。

Our Form 10-K will be filed next week and will be available on our website at that time.

我們的 10-K 表格將於下週提交，屆時將在我們的網站上提供。

Please note that during this call we will make certain forward-looking statements that reflect our current views related to our future financial performance, future events and industry and market conditions as well as expected consumer benefits of our products and services and our financial projections, including synergies from the Aetna acquisition.

請注意，在本次電話會議中，我們將做出某些前瞻性聲明，反映我們對未來財務業績、未來事件、行業和市場狀況以及我們產品和服務的預期消費者利益以及我們的財務預測的當前看法，包括收購 Aetna 帶來的協同效應。

These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from what may be indicated in them.

這些前瞻性陳述存在風險和不確定性，可能導致實際結果與其中可能表明的結果存在重大差異。

We strongly encourage you to review the information in the reports we filed with the SEC regarding these risks and uncertainties, in particular, those that are described in the Risk Factors section of our annual report on Form 10-K and the cautionary statement concerning forward-looking statements disclosures in our quarterly reports on Form 10-Q.

我們強烈建議您查看我們向 SEC 提交的報告中有關這些風險和不確定性的信息，特別是我們 10-K 表格年度報告的風險因素部分中描述的信息以及有關前瞻性聲明的警示性聲明。查看表10-Q 季度報告中的報表披露。

You should also review the section entitled Cautionary Statement Concerning Forward-looking Statements in this morning's earnings press release.

您還應該查看今天上午的收益新聞稿中標題為“有關前瞻性陳述的警示聲明”的部分。

During this call, we will use non-GAAP financial measures when talking about the company's performance and financial condition.

在本次電話會議中，我們在談論公司的業績和財務狀況時將使用非公認會計準則財務指標。

In accordance with SEC regulations, you can find a reconciliation of these non-GAAP measures to the comparable GAAP measures in this morning's earnings press release and the reconciliation document posted on the Investor Relations portion of our website.

根據 SEC 的規定，您可以在今天上午的收益新聞稿以及我們網站投資者關係部分發布的對賬文件中找到這些非 GAAP 衡量標準與可比 GAAP 衡量標準的對賬。

And as always, today's call is being broadcast on our website, where it will be archived for 1 year.

與往常一樣，今天的電話會議將在我們的網站上播出，並將存檔一年。

Now I'll turn the call over to Larry.

現在我將把電話轉給拉里。

Well, thanks, Valerie.

嗯，謝謝，瓦萊麗。

And good morning, everyone, and thanks for joining us.

大家早上好，感謝您加入我們。

2019 was a transformational year for CVS Health, and we have made significant progress in our first full year after acquiring Aetna.

2019 年是 CVS Health 轉型的一年，我們在收購 Aetna 後的第一個全年取得了重大進展。

We've been executing against our plan, which has been delivering substantial value above our initial expectations, and this value is driven by growth across our businesses as well as contributions from our integration synergies.

我們一直在執行我們的計劃，該計劃所帶來的巨大價值超出了我們最初的預期，而這一價值是由我們業務的增長以及我們的整合協同效應的貢獻所驅動的。

Eva will provide the details on our '19 performance, along with our improved outlook for 2020, and I'll provide a few financial highlights and discuss our operational execution.

Eva 將提供有關我們 19 年業績的詳細信息，以及我們對 2020 年改善的展望，我將提供一些財務亮點並討論我們的運營執行情況。

For the full year 2019, we delivered adjusted earnings per share of $7.08, with total revenues of nearly $257 billion, up 32%, reflecting a full year of Aetna's operations and positive momentum across our enterprise.

2019 年全年，我們實現調整後每股收益 7.08 美元，總收入近 2570 億美元，增長 32%，反映了 Aetna 全年的運營情況和整個企業的積極勢頭。

We generated strong cash flows from operations of $12.8 billion, enabling us to repay $4.7 billion of net long-term debt, return $2.6 billion to shareholders in the form of cash dividends and continue to invest to accelerate future growth of our enterprise.

我們從運營中產生了 128 億美元的強勁現金流，使我們能夠償還 47 億美元的長期淨債務，以現金股息的形式向股東返還 26 億美元，並繼續投資以加速企業的未來增長。

Moving to 2020, we expect continued progress with adjusted earnings per share in the range of $7.04 to $7.17, representing growth of approximately 3% to 5% over our 2019 baseline of $6.83, which excludes net realized capital gains and prior years' development.

到2020 年，我們預計調整後每股收益將繼續取得進展，在7.04 美元至7.17 美元之間，較2019 年6.83 美元的基準增長約3% 至5%，其中不包括已實現的淨資本收益和前幾年的發展。

This growth is ahead of what we outlined at our June Investor Day last year.

這一增長超過了我們去年六月投資者日所概述的增長。

Now our strong performance as a combined company, along with positive feedback from our key stakeholders, gives us even greater confidence in our ability to accelerate growth in 2020 and beyond.

現在，我們作為合併後的公司的強勁業績，加上主要利益相關者的積極反饋，讓我們對 2020 年及以後加速增長的能力更加充滿信心。

We have set a clear and bold path for CVS Health to be the most consumer-centric health company, transforming the way care is delivered in the U.S. And a significant part of that is delivering an expanded suite of integrated health services, across our businesses.

我們為 CVS Health 成為最以消費者為中心的健康公司設定了一條清晰而大膽的道路，改變美國提供護理的方式，其中一個重要部分是在我們的業務中提供一套擴展的綜合健康服務。

And with over a year of successful integration, we have laid a strong foundation for growth.

經過一年多的成功整合，我們為增長奠定了堅實的基礎。

We remain focused on making health care more local across the country, making health care simpler to help consumers better navigate their health and make informed decisions, and helping people achieve their best health outcome, particularly when it comes to managing chronic disease.

我們仍然致力於使醫療保健在全國范圍內更加本地化，​​使醫療保健更加簡單，以幫助消費者更好地了解自己的健康狀況並做出明智的決定，並幫助人們實現最佳的健康結果，特別是在管理慢性病方面。

We have 4 priorities that guide our transformation as we outlined at our June Investor Day, and they are: grow and differentiate our businesses; deliver transformational products and services; create a consumer-centric technology infrastructure; and modernize enterprise functions and capabilities.

正如我們在 6 月投資者日所概述的，我們有 4 個優先事項來指導我們的轉型，它們是： 發展我們的業務並使其脫穎而出；提供變革性產品和服務；創建以消費者為中心的技術基礎設施；實現企業職能和能力現代化。

And we have advanced all 4 of these priorities in the past year, and I'll briefly touch on a few recent highlights to demonstrate areas where we have momentum and are driving innovation.

在過去的一年裡，我們已經推進了所有四個優先事項，我將簡要介紹最近的一些亮點，以展示我們有動力並正在推動創新的領域。

In Health Care Benefits, we have grown our membership to 22.9 million, up nearly 4% over last year, driven by strong growth in our government services businesses.

在醫療保健福利方面，在政府服務業務強勁增長的推動下，我們的會員人數已增至 2,290 萬人，比去年增長近 4%。

In particular, our Medicare Advantage business grew by over 3x the industry average in 2019, generating outstanding membership growth of over 30% in both our individual and group Medicare products.

特別是，我們的 Medicare Advantage 業務在 2019 年增長超過行業平均水平 3 倍，個人和團體 Medicare 產品的會員人數增長超過 30%。

Last year, in our commercial book, we implemented $0 or low copay options for members at our MinuteClinics, with 3 million members enrolled for January 2020.

去年，在我們的商業書中，我們為 MinuteClinics 的會員實施了 0 美元或低自付費用選項，截至 2020 年 1 月，註冊會員人數為 300 萬。

At Caremark, we recently announced a new $0 out-of-pocket program for diabetes care.

在 Caremark，我們最近宣布了一項新的糖尿病護理 0 美元自付費用計劃。

We expect enrolled members on average to save an estimated $467 per year in out-of-pocket expenses.

我們預計註冊會員平均每年可節省約 467 美元的自付費用。

In the area of chronic disease management, we have developed a number of innovative pilot programs and service offerings.

在慢性病管理領域，我們開發了許多創新試點項目和服務產品。

As an example, Transform Oncology Care is a new program that pulls together our integrated assets and capabilities and includes a precision medicine program that uses the latest genomic science and technology to help patients receive the most effective cancer treatments.

例如，轉變腫瘤護理是一項新計劃，匯集了我們的綜合資產和能力，其中包括一個精準醫療計劃，該計劃利用最新的基因組科學和技術來幫助患者接受最有效的癌症治療。

We are also bringing innovation to the point of care at our retail pharmacies, which are at the forefront of our effort to make quality health care more accessible, simple, seamless and affordable.

我們還在零售藥店的護理點引入創新，這些藥店處於我們努力使優質醫療保健變得更容易、簡單、無縫和負擔得起的最前沿。

And our HealthHUBs are the most visible aspect of our integrated offerings and an important component of our comprehensive strategy to fundamentally transform the way we deliver care to millions of Americans locally.

我們的 HealthHUB 是我們綜合產品中最明顯的方面，也是我們全面戰略的重要組成部分，該戰略旨在從根本上改變我們向當地數百萬美國人提供醫療服務的方式。

Now as we expand our MinuteClinics and HealthHUBs, where our practitioners can treat about 80% of what a primary care physician can treat, we expect to help patients avoid more costly or unnecessary care.

現在，隨著我們擴大 MinuteClinics 和 HealthHUB，我們的醫生可以治療初級保健醫生可治療的大約 80% 的疾病，我們希望幫助患者避免更昂貴或不必要的護理。

We also began rolling out pharmacist panels at our HealthHUBS, which we will expand to other retail locations.

我們還開始在 HealthHUBS 推出藥劑師小組，並將其擴展到其他零售地點。

And these panels provide a holistic, 360-degree view of the patient by combining pharmacy and medical data.

這些面板結合藥房和醫療數據，提供患者的 360 度整體視圖。

And having integrated data at their fingertips, our pharmacists can improve medication adherence, optimize medication regimens, close gaps in care, and connect patients to their health plan, a MinuteClinic or other appropriate resources.

通過觸手可及的整合數據，我們的藥劑師可以提高用藥依從性，優化用藥方案，縮小護理差距，並將患者與其健康計劃、MinuteClinic 或其他適當的資源聯繫起來。

Now our hubs continued to outperform their control group with higher script volume and increased MinuteClinic visits.

現在，我們的中心繼續優於對照組，腳本量更高，MinuteClinic 就診次數也有所增加。

And our front store sales are in line with expectations, and we continued to see increased utilization of health-related services.

我們的前店銷售符合預期，並且我們繼續看到健康相關服務的利用率有所增加。

Now a key part of our consumer-centric care strategy is meeting people where they are, including in the palm of their hand.

現在，我們以消費者為中心的護理策略的一個關鍵部分是在人們所在的地方（包括在他們的手掌中）與他們見面。

And we're seeing positive uptake of our digital strategy as consumers increasingly engage with us through our apps, online, and via text messaging.

隨著消費者越來越多地通過我們的應用程序、在線和短信與我們互動，我們看到我們的數字戰略得到了積極的採用。

And we are seeing higher rates of satisfaction and loyalty from our digitally engaged consumers.

我們看到數字化消費者的滿意度和忠誠度更高。

So those are just a few of our accomplishments with several more listed in our slide presentation.

這些只是我們取得的一些成就，我們的幻燈片演示中還列出了更多成就。

And they are the validation points that the Aetna integration activities over the past year have established a solid foundation to accelerate the pace of innovation, bring our unique offerings to more and more people and drive profitable growth.

它們證明安泰過去一年的整合活動為加快創新步伐、為越來越多的人帶來我們獨特的產品並推動盈利增長奠定了堅實的基礎。

As we continue to innovate and execute, we will stay close to the markets we serve and respond to the needs of our clients.

隨著我們不斷創新和執行，我們將貼近我們所服務的市場並響應客戶的需求。

What this means for our 4 key priorities is the following: Within the health plan landscape, our clients, they're looking to us for solutions and innovation.

這對我們的 4 個關鍵優先事項意味著如下： 在健康計劃領域，我們的客戶正在向我們尋求解決方案和創新。

In particular, the expansion of government programs creates a need for our services to manage complex, high-acuity and chronic condition consumers.

特別是，政府項目的擴展需要我們的服務來管理複雜、高度敏感和慢性病的消費者。

And with our convenient and local touch points in place and with our advanced data and analytics, we have the ability to creatively and efficiently deliver local, personal, high-touch care with new products and service offerings coming to market.

憑藉我們便捷的本地接觸點以及先進的數據和分析，我們有能力通過上市的新產品和服務，創造性地、高效地提供本地、個人、高接觸度的護理。

Second, the importance of specialty medicine and gene therapy benefit management solutions and services, it continues to grow.

其次，專科醫學和基因治療效益管理解決方案和服務的重要性不斷增長。

This year, we estimate about 60% of pharmacy spend is specialty, and that includes that paid under the medical benefit, and it could reach 25% of total health care costs over the next several years.

今年，我們估計大約 60% 的藥房支出是專業支出，其中包括根據醫療福利支付的支出，並且在未來幾年內可能達到醫療保健總成本的 25%。

And we are continuously innovating and bringing new programs and solutions to our clients.

我們不斷創新，為客戶帶來新的計劃和解決方案。

And further innovation in this area is imperative to delivering a better patient experience and lowering costs.

為了提供更好的患者體驗和降低成本，這一領域的進一步創新勢在必行。

Third is the importance of our open platform approach, and we are committed to extending to our many health plan clients the technology offerings and health care services that we develop in-house.

第三是我們開放平台方法的重要性，我們致力於將我們內部開發的技術產品和醫療保健服務擴展到我們的許多健康計劃客戶。

We have about 350 health plan relationships and over 100 health system alliances across the enterprise.

我們在整個企業內擁有約 350 個健康計劃關係和 100 多個健康系統聯盟。

And it's vital that we continue to grow these relationships and help these clients solve the issues they are managing.

我們繼續發展這些關係並幫助這些客戶解決他們正在管理的問題至關重要。

And our integrated model will benefit us as we not only transform our business, but also lead the transformation of the greater health care landscape.

我們的一體化模式將使我們受益，因為我們不僅改變我們的業務，而且引領更大的醫療保健格局的轉變。

And finally, as discussed earlier, we are continuing to enhance our local offerings through our HealthHUBs and our MinuteClinics, working to not leave any white space for disruption.

最後，如前所述，我們將繼續通過 HealthHUB 和 MinuteClinics 增強我們的本地服務，努力不留下任何干擾的空白。

For us, the value within the 4 walls of our retail locations is only growing in the form of higher-margin products and services, increased traffic and medical cost savings.

對我們來說，零售店四牆內的價值只會以更高利潤的產品和服務、增加客流量和節省醫療成本的形式增長。

So with the substantial progress that we have made executing our plan, today's leadership announcement positions our company to further accelerate growth.

因此，隨著我們在執行計劃方面取得的實質性進展，今天的領導層聲明使我們公司能夠進一步加速增長。

These changes will enable us to more rapidly bring our innovations to market by placing our experienced leaders in areas where their immediate past experience and deep relationships in the businesses will enhance execution of both our core growth initiatives and our transformation strategies.

這些變化將使我們能夠更快地將我們的創新推向市場，將我們經驗豐富的領導者安置在他們過去的經驗和深厚的業務關係將增強我們核心增長計劃和轉型戰略執行力的領域。

This announcement also reflects our deep and talented bench, along with the opportunities our business model creates for personal growth.

這一公告也反映了我們深厚而才華橫溢的團隊，以及我們的商業模式為個人成長創造的機會。

So let me take a moment to congratulate Alan, Jonathan and Alec on their new roles, and I also want to thank Derica for his leadership and contributions.

因此，請允許我花點時間祝賀艾倫、喬納森和亞歷克擔任新職務，我還要感謝德麗卡的領導和貢獻。

And Derica and Alan will work together to ensure a smooth transition.

德麗卡和艾倫將共同努力確保平穩過渡。

So I am confident that we have the right leadership team in place, and we are at the forefront of driving a sea change in how our key stakeholders think about us, and how consumers work with us to take control of their health.

因此，我相信我們擁有合適的領導團隊，並且我們處於推動關鍵利益相關者如何看待我們以及消費者如何與我們合作來控制自己健康的巨大變化的最前沿。

And with that, let me turn it over to Eva.

接下來，讓我把它交給伊娃。

Thanks, Larry, and good morning, everyone.

謝謝拉里，大家早上好。

As Larry stated, our strong performance across the enterprise continued in the fourth quarter, capping off a successful year across all of our businesses.

正如拉里所說，我們整個企業的強勁表現在第四季度繼續，為我們所有業務的成功的一年畫上了圓滿的句號。

In the fourth quarter, we delivered adjusted EPS of $1.73, and our consolidated adjusted revenues grew 23.1% year-over-year.

第四季度，我們的調整後每股收益為 1.73 美元，調整後綜合收入同比增長 23.1%。

The increase in revenue was primarily driven by the addition of Aetna in the Health Care Benefits segment, followed by higher volume in both the Pharmacy Services and Retail/Long-Term Care segments.

收入的增長主要是由於安泰保險在醫療保健福利領域的增加，以及藥房服務和零售/長期護理領域銷量的增加。

The fourth quarter also benefited from a lower-than-anticipated tax rate.

第四季度還受益於低於預期的稅率。

Looking at our fourth quarter results by segment.

按部門查看我們第四季度的業績。

Within Pharmacy Services, total revenues increased 6.2% year-over-year, exceeding our expectations.

藥房服務領域的總收入同比增長 6.2%，超出了我們的預期。

Our growth was driven by increased volume, specialty, including the onboarding of IngenioRx and brand inflation.

我們的增長是由銷量和專業性的增加推動的，包括 IngenioRx 的加入和品牌擴張。

Pharmacy Services adjusted operating income increased 1.5% versus last year, in line with expectations, primarily due to increased claims volume, the shift of Aetna's mail order and specialty operations into our Pharmacy Services segment and improved purchasing economics, including the benefit from synergies.

藥房服務調整後的營業收入比去年增長了1.5%，符合預期，這主要是由於索賠量增加、Aetna 的郵購和專業業務轉移到我們的藥房服務部門以及採購經濟性的改善（包括協同效應的好處）。

This was partially offset by continued price compression.

這被持續的價格壓縮部分抵消。

Moving to our Retail/Long-Term Care segment.

轉向我們的零售/長期護理部門。

Performance was in line with our expectations, with total revenues up 2.5% year-over-year.

業績符合我們的預期，總收入同比增長 2.5%。

We delivered strong adjusted script growth of 5.6%, with comp scripts up 6.9%, primarily driven by the continued adoption of our patient care programs.

我們的調整後腳本增長了 5.6%，補償腳本增長了 6.9%，這主要是由於我們的患者護理計劃的持續採用。

Our fourth quarter share of retail scripts was 26.8%, up 80 basis points.

我們第四季度的零售腳本份額為 26.8%，增長了 80 個基點。

Front store sales and operating income continued to be a positive driver in the fourth quarter.

前店銷售和營業收入繼續成為第四季度的積極推動因素。

Same-store front store sales increased 0.7%, primarily driven by increases in health and beauty, including strength in cough and cold sales.

同店前店銷售額增長 0.7%，主要受到健康和美容產品增長的推動，包括咳嗽和感冒產品的銷售強勁。

Adjusted operating income for Retail/Long-Term Care declined 4.4% as expected, primarily due to the continued reimbursement pressure.

零售/長期護理的調整後營業收入如預期下降 4.4%，主要是由於持續的報銷壓力。

Throughout the year, Retail/Long-Term Care adjusted operating income benefited from increased volume and higher generic dispensing rate.

全年，零售/長期護理調整後的營業收入受益於銷量的增加和普通配藥率的提高。

Turning to Health Care Benefits.

轉向醫療保健福利。

The segment delivered results that were in line with our expectations.

該部門的業績符合我們的預期。

Total revenues continue to benefit from strong membership growth in our government products.

總收入繼續受益於我們政府產品會員的強勁增長。

Total health MBR was 85.7% for the quarter and 84.2% for the year, in line with our expectations.

本季度總健康 MBR 為 85.7%，全年為 84.2%，符合我們的預期。

Health Care Benefit expenses were higher in the fourth quarter, related to our readiness investments for 1/1 plan starts.

第四季度醫療保健福利支出較高，這與我們為 1/1 計劃啟動做好準備的投資有關。

Next, I'll briefly touch on our strong cash generation and disciplined capital allocation strategy.

接下來，我將簡要介紹一下我們強大的現金生成能力和嚴格的資本配置策略。

In 2019, we generated significant cash from operations of $12.8 billion, coming in materially above our expectations.

2019 年，我們從運營中產生了 128 億美元的大量現金，大大超出了我們的預期。

Cash flow was primarily driven by improvements in working capital, including the timing of certain payables and receivables, which will partially impact our 2020 guidance.

現金流主要是由營運資本的改善推動的，包括某些應付賬款和應收賬款的時間安排，這將部分影響我們 2020 年的指導。

We used approximately $4.7 billion of cash to repay net long-term debt in 2019.

2019 年，我們使用了約 47 億美元的現金來償還長期淨債務。

And since the close of the Aetna transaction, we have repaid approximately $8 billion of net long-term debt.

自 Aetna 交易完成以來，我們已經償還了約 80 億美元的淨長期債務。

As Larry mentioned, we also returned $2.6 billion to shareholders through cash dividends during the year.

正如 Larry 提到的，我們年內還通過現金股息向股東返還了 26 億美元。

Transitioning to our 2020 guidance, full year adjusted earnings per share is expected to be in the range of $7.04 to $7.17, reflecting an increase of 3% to 5% from our 2019 baseline of $6.83.

過渡到我們的 2020 年指引，全年調整後每股收益預計在 7.04 美元至 7.17 美元之間，較 2019 年 6.83 美元的基準增長 3% 至 5%。

Given our successful integration activity and execution of our strategic priorities, our outlook is more favorable with growth projections improving to low to mid-single-digit growth versus our previous expectation for low single-digit growth.

鑑於我們成功的整合活動和戰略重點的執行，我們的前景更加樂觀，增長預測將改善至低至中個位數增長，而我們之前的預期為低個位數增長。

As a reminder, our 2020 financial projections exclude net realized capital gains and prior year's development, which contributed about $0.25 to the full year 2019 results.

提醒一下，我們 2020 年的財務預測不包括已實現的淨資本收益和上一年的發展，這對 2019 年全年業績貢獻了約 0.25 美元。

We expect consolidated full year 2020 adjusted operating income to be in the range of $15.5 billion to $15.8 billion, up 1.25% to 2.75%, with consolidated total revenues in the range of $262 billion to $265.5 billion, up 2% to 3.5%.

我們預計2020年全年調整後合併營業收入將在155億美元至158億美元之間，增長1.25%至2.75%，合併總收入將在2620億美元至2655億美元之間，增長2%至3.5 %。

We expect integration synergies in the range of $800 million to $900 million in 2020, up from our previous expectation of about $800 million.

我們預計 2020 年整合協同效應將達到 8 億至 9 億美元，高於我們之前約 8 億美元的預期。

Integration synergies in 2020 will continue to come from the integration of our operations, streamlining of functions, contracting efficiencies and medical cost savings, as we've discussed in the past.

正如我們過去所討論的那樣，2020 年的整合協同效應將繼續來自我們的運營整合、職能精簡、合同效率提高和醫療成本節省。

Projected integration costs of approximately $450 million are excluded from our non-GAAP results.

我們的非 GAAP 業績不包括預計的約 4.5 億美元的整合成本。

We expect to deliver between $10.5 billion and $11 billion of cash flow from operations in 2020.

我們預計 2020 年將產生 105 億至 110 億美元的運營現金流。

As I previously stated, this includes the timing impact of certain payables and receivables that contributed to our 2019 outperformance.

正如我之前所說，這包括導致我們 2019 年業績優異的某些應付賬款和應收賬款的時間影響。

After the payment of our shareholder dividend, capital retention to support projected growth in our insurance operations and gross capital expenditures of $2.3 billion to $2.6 billion.

支付股東股息後，我們將保留資本以支持保險業務的預計增長，資本支出總額將達到 23 億至 26 億美元。

We plan to use the remaining $4.2 billion to $4.6 billion of cash available to continue to pay down debt.

我們計劃使用剩餘的 42 億至 46 億美元可用現金繼續償還債務。

We remain on track to reach our goal of low 3x leverage in 2022.

我們仍有望在 2022 年實現 3 倍低杠桿率的目標。

We continue to expect to generate between $10 billion to $12 billion in cash annually to enhance shareholder value in the long term.

我們仍然期望每年產生 100 億至 120 億美元的現金，以長期提高股東價值。

As previously stated, we will maintain our dividend of $2 per share, demonstrating our commitment to return capital to our shareholders.

如前所述，我們將維持每股 2 美元的股息，以體現我們向股東返還資本的承諾。

Keep in mind that because we are not repurchasing shares, the weighted average shares outstanding continues to increase with compensation-related share issuance, including option exercises.

請記住，由於我們不回購股票，因此隨著與薪酬相關的股票發行（包括期權行使），已發行加權平均股票繼續增加。

Our 2020 adjusted earnings per share guidance reflects approximately $0.08 of dilution from those incremental shares.

我們的 2020 年調整後每股收益指引反映了這些增量股票帶來的約 0.08 美元的稀釋。

Moving to our segments.

轉向我們的細分市場。

For the full year 2020, we expect Pharmacy Services revenues to be in the range of $137.5 billion to $139.5 billion with adjusted operating income of $5.2 billion to $5.3 billion, representing projected growth of 2.25% to 3.75%.

2020 年全年，我們預計藥房服務收入將在 1,375 億美元至 1,395 億美元之間，調整後營業收入將在 52 億美元至 53 億美元之間，預計增長 2.25% 至 3.75%。

This improvement relative to our Investor Day outlook is due to improved business retention and stronger purchasing economics.

相對於我們的投資者日展望的改善是由於業務保留率的提高和購買經濟的增強。

Since our Q3 earnings call, net new business improved by $2.8 billion, reflecting our business momentum.

自第三季度財報電話會議以來，淨新業務增長了 28 億美元，反映了我們的業務勢頭。

Included in our net new business is the retention of a larger portion of the Centene contract as well as additional client wins.

我們的淨新業務包括保留大部分 Centene 合同以及贏得更多客戶。

We're pleased to report that we have extended our contract with Centene through 2022.

我們很高興地報告，我們已將與 Centene 的合同延長至 2022 年。

Year-over-year adjusted operating income growth is attributable to specialty performance, continued improvement in purchasing economics and enterprise modernization.

調整後營業收入的同比增長歸功於專業業績、採購經濟的持續改善和企業現代化。

Offsetting these positive factors is continued industry-wide price compression and the net losses in the selling season.

全行業持續的價格壓縮和銷售季節的淨虧損抵消了這些積極因素。

We continue to cycle through our rebate guarantee challenges, resulting from lower brand inflation, which we have discussed on previous calls.

我們繼續應對因品牌通脹較低而帶來的回扣保證挑戰，我們在之前的電話會議中已經討論過這一點。

Additionally, looking ahead to the 2021 selling season, we are pleased to report that, to date, we have completed approximately 65% of renewals with strong retention, including the extension of the FEP contract through 2021 and the renewal of the WellCare contract through 2023.

此外，展望2021 年銷售季，我們很高興地報告，迄今為止，我們已完成約65% 的續約，且保留率很高，包括將FEP 合同延長至2021 年，以及將WellCare 合同續約至2023年。

Our PBM model continues to be vital in managing drug costs.

我們的 PBM 模型對於管理藥品成本仍然至關重要。

The importance of scale, expertise and customer relationships will continue to be paramount, and we remain focused on delivering the value that our clients expect.

規模、專業知識和客戶關係的重要性將繼續至關重要，我們將繼續專注於提供客戶期望的價值。

Now let me turn to Retail/Long-Term Care.

現在讓我談談零售/長期護理。

We expect full year 2020 Retail/Long-Term Care total revenues to be between $87.5 billion and $88.8 billion with adjusted operating income of $6.7 billion to $6.8 billion, representing projected growth of 0.25% to 1.75%.

我們預計 2020 年全年零售/長期護理總收入將在 875 億美元至 888 億美元之間，調整後營業收入為 67 億美元至 68 億美元，預計增長 0.25% 至 1.75%。

Retail is expected to continue to deliver strong adjusted script growth of 4.5% to 6.5% due to the continued successful execution of our patient care programs, including pharmacy clinical care, that improve both medication adherence and patient retention.

由於我們的患者護理計劃（包括藥房臨床護理）的持續成功執行，提高了用藥依從性和患者保留率，預計零售業將繼續實現 4.5% 至 6.5% 的強勁調整後腳本增長。

We expect our pharmacy growth to be partially offset by continued reimbursement pressure.

我們預計我們的藥房增長將被持續的報銷壓力部分抵消。

Front store operations are expected to drive increased bottom line growth with a focus on our health and beauty business and improved personalization and customer engagement.

預計前店業務將推動利潤增長，重點關注我們的健康和美容業務，並提高個性化和客戶參與度。

Finally, we expect Retail/Long-Term Care to benefit from operating productivity enhancements delivered by our enterprise modernization.

最後，我們預計零售/長期護理將從我們企業現代化帶來的運營生產力提高中受益。

Within the Health Care Benefits segment, we expect total revenues to be in the range of $74.1 billion to $74.8 billion, with adjusted operating income of $5.5 billion to $5.6 billion in 2020, representing projected growth of 5% to 6.75%.

在醫療保健福利領域，我們預計 2020 年總收入將在 741 億美元至 748 億美元之間，調整後營業收入將在 55 億美元至 56 億美元之間，預計增長 5% 至 6.75%。

Growth is off reported 2019 results.

增長低於報告的 2019 年業績。

We expect continued strength in our government products, driving top line growth.

我們預計政府產品將繼續走強，推動收入增長。

We expect to end 2020 with between 23.1 million and 23.4 million medical members, fueled by Medicare Advantage and Medicaid growth, including the acquisition of IlliniCare from Centene.

在 Medicare Advantage 和 Medicaid 增長（包括從 Centene 收購 IlliniCare 的推動下），我們預計到 2020 年底，醫療會員數量將達到 2,310 萬至 2,340 萬。

There are a few items to consider for Health Care Benefits.

醫療保健福利有幾個項目需要考慮。

First, integration synergies will continue to disproportionately benefit the Health Care Benefits segment.

首先，整合協同效應將繼續使醫療保健福利領域受益匪淺。

Our full year MBR is expected to be approximately 83%, plus or minus 50 basis points.

我們全年的 MBR 預計約為 83%，上下浮動 50 個基點。

Compared to 2019, there is an approximate 160 basis point benefit from the inclusion of the HIF in 2020.

與 2019 年相比，2020 年納入 HIF 帶來約 160 個基點的收益。

From an adjusted EPS perspective, the effect of the HIF is a drag of approximately $0.13 year-over-year.

從調整後每股收益的角度來看，HIF 的影響同比下降約 0.13 美元。

Our core commercial medical cost trend is expected to be approximately 6%, plus or minus 50 basis points, even with the effect of leap day.

即使考慮到閏日的影響，我們的核心商業醫療成本趨勢預計約為 6%，正負 50 個基點。

Adjusted operating income will be impacted by the divestiture of WellCare, and partially offsetting that is the acquisition of IlliniCare.

調整後的營業收入將受到 WellCare 剝離的影響，而收購 IlliniCare 則部分抵消了這一影響。

Starting in 2020, we will no longer provide quarterly earnings per share guidance.

從 2020 年開始，我們將不再提供季度每股收益指引。

We will continue to provide directional color and insights on our expected performance drivers that may impact the quarterly progression of earnings relative to historical results to provide transparency.

我們將繼續提供有關預期業績驅動因素的方向性色彩和見解，這些驅動因素可能會影響相對於歷史業績的季度收益進展，以提供透明度。

As we transform our business, we're highly focused on the enterprise as a whole and achieving our goals.

在我們進行業務轉型時，我們高度關注整個企業並實現我們的目標。

We are managing our integrated business with the goal of driving long-term shareholder value.

我們管理綜合業務的目標是推動長期股東價值。

And our internal compensation metrics are also based on our annual performance.

我們的內部薪酬指標也是基於我們的年度績效。

With that introduction, let me provide some color about the quarterly progression of earnings we expect in 2020.

通過上述介紹，讓我對我們預期的 2020 年季度盈利進展提供一些說明。

Q1 is expected to be the lowest earnings quarter for the year due to the seasonality in both the Pharmacy Services and Retail/Long-Term Care segments.

由於藥房服務和零售/長期護理領域的季節性，預計第一季度將是全年盈利最低的季度。

Similar to 2019, Health Care Benefits lowest earnings quarter will be the fourth quarter due to the earnings progression for that segment, including spending to support January readiness.

與 2019 年類似，醫療保健福利收入最低的季度將是第四季度，因為該部門的盈利進展，包括支持 1 月份準備的支出。

We also expect that benefit from enterprise modernization to ramp over the course of the year, while integration synergies will be more ratable throughout the year.

我們還預計，企業現代化帶來的效益將在年內逐步增加，而整合協同效應將在年內更加顯著。

In summary, we are very pleased with the progress we have made since the close of the Aetna acquisition and have strong confidence in our outlook for 2020 as well as the long-term trajectory of our enterprise.

總而言之，我們對自 Aetna 收購完成以來所取得的進展感到非常滿意，並對 2020 年的前景以及企業的長期發展軌跡充滿信心。

Over the course of the year, we'll provide you with additional updates on our progress related to our transformation efforts and the status of our HealthHUB rollout.

在這一年中，我們將向您提供有關我們轉型工作的進展以及 HealthHUB 推出狀態的更多最新信息。

With that, let's open the line for questions.

接下來，讓我們打開提問熱線。

(Operator Instructions) The first question comes from George Hill of Deutsche Bank.

（操作員說明）第一個問題來自德意志銀行的喬治·希爾。

I think I want to start in the PBM segment, Larry and Eva.

我想我想從 PBM 部分開始，Larry 和 Eva。

And I guess, if we look at the 2020 guide versus 2019, the revenue numbers are very close.

我想，如果我們將 2020 年的指南與 2019 年的指南進行比較，就會發現收入數字非常接近。

The claims number is very close, but profitability seems markedly improved.

索賠數量非常接近，但盈利能力似乎明顯改善。

So I guess could you talk about the dynamic of what's going on in that segment, where kind of a similar claims number and a similar revenue number is driving kind of better-than-expected profitability?

所以我想你能談談該領域正在發生的動態嗎？類似的索賠數量和類似的收入數字正在推動優於預期的盈利能力？

Yes, George.

是的，喬治。

This is Eva.

這是伊娃。

I'll start, and then if Larry or Derica want to jump in.

我先開始，然後如果拉里或德麗卡想加入的話。

Overall, we're quite pleased with the expectations for the PBM segment that we laid out today.

總的來說，我們對今天提出的 PBM 部分的期望感到非常滿意。

Clearly, it's a significant improvement from what we gave at our Investor Day.

顯然，這比我們在投資者日上提供的內容有了顯著的改進。

And as you look at that business, there are 2 key drivers from the improvement that we provided -- from results we provided previously: a, improvement in the selling season that we outlined; and b, what I'll call continued purchasing economics.

當你審視該業務時，我們提供的改進有兩個關鍵驅動因素 - 從我們之前提供的結果來看：a，我們概述的銷售季節的改善； b，我稱之為持續購買經濟學。

So we've worked hard in improving our underlying cost of goods, thinking about our rebates, working through our rebate challenges, improvements in the network generics.

因此，我們努力改善我們的基本商品成本，考慮我們的回扣，解決我們的回扣挑戰，改進網絡仿製藥。

And as we look at all of those factors, it's yielding the results.

當我們考慮所有這些因素時，它正在產生結果。

Additionally, I don't want to lose -- our modernization effort is also contributing to the expectations for the PBM.

此外，我不想失敗——我們的現代化努力也有助於提高對 PBM 的期望。

And George, this is Derica.

喬治，這是德麗卡。

I would also say you also recall that 2019 was an investment year for us in terms of the Anthem or IngenioRx implementation.

我還想說，您還記得，2019 年對我們來說是 Anthem 或 IngenioRx 實施方面的投資年。

And we've stated that in 2020, that becomes a profitable proposition for us.

我們已經說過，到 2020 年，這將成為我們有利可圖的主張。

And we've -- as Eva said, we've obviously been working hard to reverse our rebate exposure, and we've seen that, that exposure has lessened in our outlook for 2020 versus the peak that we realized in 2019.

正如伊娃所說，我們顯然一直在努力扭轉我們的回扣風險，而且我們已經看到，與我們在 2019 年實現的峰值相比，我們對 2020 年的展望中的回扣風險有所減少。

So we're on track, in fact, ahead of where we thought we'd be in terms of bringing that and reducing that exposure and mitigating that over time.

因此，事實上，我們正走在正軌上，在實現這一目標、減少風險並隨著時間的推移緩解風險方面，我們已經領先於我們的預期。

And recall, as you think about our claims and year-over-year, in the claims, you'll see the benefit of the wrap of the onboarding the Anthem contract on the network perspective, and that does not flow through to revenue as that account is on a net basis.

回想一下，當您考慮我們的索賠和逐年索賠時，您會看到從網絡角度來看，加入 Anthem 合同的好處，並且這不會轉化為收入，因為賬戶是按淨額計算的。

Okay.

好的。

That's helpful.

這很有幫助。

And then maybe just a quick follow-up is, you brought up enterprise modernization.

然後也許只是一個快速的後續行動，你提到了企業現代化。

It seems like you guys narrowed the range on that a little bit.

看來你們把範圍縮小了一點。

I guess I would just ask kind of what drove the narrowing versus the top end.

我想我只想問是什麼推動了相對於高端的縮小。

And I guess, did you feel like there were any opportunities that you saw before that you're not able to capitalize on?

我想，您是否覺得以前看到過但無法利用的機會？

Or just any comments on there, I think, that would be helpful.

或者我認為任何評論都會有幫助。

No, George, from an overall financial perspective, we're really confident in that program.

不，喬治，從整體財務角度來看，我們對該計劃非常有信心。

As we got closer, we just wanted to tighten the range a bit as we look out in 2020, and Jon can provide some color on some of the initiatives.

隨著我們越來越接近，我們只是想在展望 2020 年時稍微收緊範圍，喬恩可以為一些舉措提供一些見解。

Yes, George.

是的，喬治。

So we're well underway with our modernization effort and very happy with where we are.

因此，我們的現代化工作正在順利進行，並且對我們的現狀感到非常滿意。

And as you recall, we're focused on working smarter to deliver substantial cost benefits while at the same time delivering an unmatched consumer experience.

正如您所記得的，我們專注於更智能地工作，以提供可觀的成本效益，同時提供無與倫比的消費者體驗。

So some key focus areas are technology modernization, so rationalizing the number of applications that we use across our enterprise, developing centers of excellence that will deliver higher levels of service at lower cost, examples, data and robotics are centers of excellence for us.

因此，一些關鍵的重點領域是技術現代化，因此合理化我們在整個企業中使用的應用程序數量，開發卓越中心以更低的成本提供更高水平的服務，示例、數據和機器人技術是我們的卓越中心。

We're also moving to a hybrid cloud environment that will not only lower cost, but significantly reduce the time to build and deploy new capabilities.

我們還正在轉向混合雲環境，這不僅可以降低成本，而且可以顯著減少構建和部署新功能的時間。

We're also working on productivity improvements, optimizing our call centers by taking calls out by leveraging artificial intelligence, natural language processing and robotics, along with other technologies.

我們還致力於提高生產力，通過利用人工智能、自然語言處理和機器人技術以及其他技術接聽電話來優化我們的呼叫中心。

We're rationalizing the vendors and optimizing those.

我們正在合理化供應商並優化它們。

And then there are business initiatives that will focus on the digitization of manual processes across our company.

然後還有一些業務計劃將重點關注整個公司手動流程的數字化。

And finally, we're leveraging and advancing our integrated data and analytics capabilities.

最後，我們正在利用和推進我們的集成數據和分析能力。

And as an example, that will allow us to implement enhanced workforce management tools, that allows us to schedule to better serve our customers.

舉例來說，這將使我們能夠實施增強的勞動力管理工具，使我們能夠安排時間更好地為客戶服務。

So those are some examples.

這些是一些例子。

I think we actually see the opportunity we originally envisioned, and this is a multiyear effort that will deliver substantial savings, while at the same time improving service to both our customers and our own employees.

我認為我們確實看到了我們最初設想的機會，這是一項多年的努力，將帶來大量節省，同時改善對我們的客戶和我們自己的員工的服務。

Your next question comes from Justin Lake of Wolfe Research.

您的下一個問題來自沃爾夫研究中心的賈斯汀·萊克。

Justin?

賈斯汀？

You got me okay?

你讓我還好嗎？

Yes, we can hear you, Justin.

是的，我們能聽到你的聲音，賈斯汀。

Sorry about that.

對於那個很抱歉。

We wanted to first follow-up on the question and Derica's comments on rebate guarantees.

我們想首先跟進這個問題以及 Derica 對回扣保證的評論。

Just quickly, have we kind of seen the bottom there?

很快，我們看到底部了嗎？

Or I know you were expecting another level of improvement into 2021.

或者我知道您期待 2021 年會有更高水平的改進​​。

Had that kind of recapture happened faster?

這種重新捕獲發生得更快嗎？

Or should we still see a meaningful change in 2021 on rebate guarantees in terms of improvement?

或者我們是否應該在 2021 年看到回扣保證在改進方面出現有意義的變化？

Yes.

是的。

I think, Justin, on the rebate guarantee, as we said, the impact was greatest in 2019.

Justin，我認為，關於回扣保證，正如我們所說，2019 年的影響最大。

It is still a headwind through 2020, albeit less of a headwind.

到2020年，這仍然是一個逆風，儘管逆風有所減弱。

And we do see the issue essentially immaterial as you head into 2021.

我們確實認為，隨著 2021 年的到來，這個問題基本上變得無關緊要。

And Justin, keep in mind, as you heard us talk throughout 2019, we were able to mitigate a portion of those headwinds with working with clients and clients adopting a more complete formulary, which created a win-win.

賈斯汀，請記住，正如您在 2019 年聽到我們談論的那樣，我們能夠通過與客戶合作以及客戶採用更完整的處方集來減輕部分不利因素，從而創造了雙贏。

There was value for them, and that helped us offset some of the potential headwind associated with that.

它們是有價值的，這有助於我們抵消一些與之相關的潛在阻力。

And then my core question was just around the intercompany numbers.

然後我的核心問題就是圍繞公司間的數據。

Your intercompany number, if I'm backing into it correctly, looks like it's down a few billion dollars year-over-year on revenue, which makes sense, I think, given the divestiture of those Aetna PDP lives.

如果我沒記錯的話，你們公司間的數據看起來收入同比下降了幾十億美元，我認為，考慮到 Aetna PDP 生命線的剝離，這是有道理的。

But the intercompany actual profitability, which I thought also might have went down, instead, it got worse instead of getting better.

但公司間的實際盈利能力，我認為也可能下降了，相反，它變得更糟而不是變得更好。

So the drag on intercompany, looks like it's actually a bigger negative EBIT year-over-year, which I found a little bit strange.

因此，對公司間的拖累，看起來實際上是同比更大的負息稅前利潤，我覺得這有點奇怪。

So I was wondering if you could flesh out what happened with intercompany, especially the increased drag on intercompany corporate from an EBIT perspective.

因此，我想知道您是否可以詳細說明公司間發生的情況，特別是從息稅前利潤的角度來看，公司間公司受到的拖累增加。

Yes.

是的。

I think, Justin, as you look at the intercompany, clearly, with the net new business, selling season being down that, that can affect that elimination of those clients that had Maintenance Choice and what have you.

我認為，賈斯汀，當你看看公司間的情況時，很明顯，隨著淨新業務的增加，銷售季節的下降，這可能會影響那些擁有維護選擇和你擁有的客戶的消除。

And as you look at the margin that we record there, right, that reflects the underlying margin of our -- of that business for which that has adopted Maintenance Choice.

當您查看我們在那裡記錄的利潤時，這反映了我們已採用維護選擇的業務的基本利潤。

So there's an aspect of price compression that flows through there.

因此，這裡存在著價格壓縮的一個方面。

Your next question comes from Robert Jones of Goldman Sachs.

你的下一個問題來自高盛的羅伯特·瓊斯。

Great.

偉大的。

I guess maybe over on the retail guidance, we have the specific guidance now, which seems largely in line with your previous communications for low single-digit growth.

我想也許在零售指導上，我們現在有了具體的指導，這似乎與您之前關於低個位數增長的溝通基本一致。

But now we're a quarter closer, I'm wondering if maybe you could just walk through the major building blocks coming off a year.

但現在我們已經接近四分之一了，我想知道您是否可以瀏覽一下一年後的主要構建模塊。

Clearly, that you saw high single-digit declines in EBIT growth in '19.

顯然，19 年息稅前利潤增長出現了個位數的大幅下降。

So just wondering if you could give us the major blocks, again, now probably having a little bit more clarity than you did at the time of the last communication, that helps get us from the down high single to the up low single would be really helpful.

所以只是想知道你是否可以再次給我們主要的塊，現在可能比上次溝通時更清晰一點，這有助於我們從下高單曲到上低單曲有幫助。

Yes.

是的。

This is Eva.

這是伊娃。

I'll take that.

我會接受的。

So as you look at returning to low single-digit growth, I think there are 4 things that I'll highlight, right: It's the result of continued solid script growth, improvements from generics and the meaningful impact from modernization.

因此，當您考慮恢復低個位數增長時，我認為有四件事需要強調，對吧：這是持續穩定的腳本增長、仿製藥的改進以及現代化的有意義影響的結果。

And as we've said, the modernization initiative, I think, disproportionately benefit the retail segment versus our other segments as we look at 2020.

正如我們所說，我認為，展望 2020 年，現代化舉措將使零售部門與其他部門相比受益匪淺。

I'll remind you that we no longer have the headwind of the tax reform investment that we were wrapping through in the first half of 2019.

我要提醒您的是，我們不再面臨 2019 年上半年完成的稅制改革投資的阻力。

And this is Jon Robert.

這是喬恩·羅伯特。

The only other thing I would say is we're also working to reposition the front store with a focus on health and beauty.

我唯一要說的是，我們也在努力重新定位前店，重點關注健康和美麗。

We're pivoting to the HealthHUBs.

我們正在轉向 HealthHUB。

And then we're growing in the front -- growing margin in the front, growing the top line a little bit through our focus and execution around personalization.

然後我們在前面不斷增長——前面的利潤不斷增加，通過我們對個性化的關注和執行，收入有所增長。

No, that's helpful.

不，這很有幫助。

And then I guess the follow-up to that would be something as you guys are now closer to transitioning a lot of these stores.

然後我想後續行動將會是，因為你們現在已經接近轉變許多這樣的商店了。

Is there any contemplation around what the drag or setback could be on comps?

是否有考慮過比賽中可能出現的阻力或挫折？

I know when you go through these transitions, obviously, there's usually a bit of a 1 step backwards before 2 steps forward.

我知道，當你經歷這些轉變時，顯然，在前進 2 步之前通常會先倒退 1 步。

Is that contemplated as you think about the growth in the retail segment overall in 2020?

當您考慮 2020 年零售業的整體增長時，是否考慮過這一點？

Yes, Bob, it's Larry.

是的，鮑勃，是拉里。

It is.

這是。

And as you've heard us talk late last year, as we get a bigger critical mass of the hubs operational, we'll provide more quantitative guidance.

正如您去年年底所聽到的那樣，隨著我們讓更多的樞紐投入運營，我們將提供更多的定量指導。

And you can expect that will be in the spring, midyear time frame.

您可以預計這將是在春季、年中的時間範圍內。

Your next question comes from Ricky Goldwasser of Morgan Stanley.

您的下一個問題來自摩根士丹利的瑞奇·戈德瓦瑟。

So one follow-up and then another question.

因此，一個後續行動，然後是另一個問題。

On the follow-up, you highlighted the HIF headwind is $0.13.

在後續行動中，您強調了 HIF 的逆風為 0.13 美元。

When we think about what's changed in terms of HIF impact, what would be the impact from midyear renewals on the commercial side due to the HIF repeal?

當我們思考 HIF 影響方面發生了什麼變化時，由於 HIF 廢除，年中續訂會對商業方面產生什麼影響？

Ricky, it's Karen.

瑞奇，是凱倫。

Obviously, we would factor that into our overall pricing as we move forward in our renewals, with the commercial business, that would be factored in.

顯然，當我們推進續約時，我們會將其納入我們的整體定價中，商業業務也會考慮在內。

And it should be overall -- we'll balance the reduction with our margin expectations.

總體而言，我們將在減少額與利潤率預期之間取得平衡。

And Ricky, this is Eva.

瑞奇，這是伊娃。

So as we spoke about the HIF back in June, really, that's the only change, the repeal for 2021 relative to what we discussed back in June.

因此，當我們在 6 月份討論 HIF 時，確實，這是唯一的變化，即相對於我們 6 月份討論的內容而言，2021 年廢除。

And Ricky, just to make sure we're all on the same page, the $0.13 comprehends the question that you're asking.

Ricky，為了確保我們意見一致，0.13 美元可以理解您所問的問題。

No, understood.

不，明白了。

My question was, was it $0.10 before?

我的問題是，之前是 0.10 美元嗎？

Now there's an incremental $0.03.

現在增加了 0.03 美元。

So we just get a sense of how much you're ahead versus your original guide.

因此，我們只是了解您與原始指南相比領先了多少。

That was the purpose of the question.

這就是問題的目的。

Yes.

是的。

I think, Ricky, the repeal, we haven't broken that out, but it was a pretty modest change to us, adding a couple of pennies.

我認為，瑞奇，廢除，我們還沒有打破這一點，但這對我們來說是一個相當溫和的改變，增加了幾分錢。

Okay.

好的。

Understood.

明白了。

And then for my primary question, Larry, obviously, you are expanding on the HealthHUBs.

對於我的主要問題，拉里，顯然，您正在擴展 HealthHUB。

And one of the key questions that we're getting from investors is whether, at some point, we're going to see you adding a primary care function to the HealthHUB strategy?

我們從投資者那裡得到的關鍵問題之一是，在某個時候，我們是否會看到你們在 HealthHUB 戰略中添加初級保健功能？

Obviously, primary care is becoming an important part of a vertical strategy for others in the industry.

顯然，初級保健正在成為業內其他公司垂直戰略的重要組成部分。

I wanted to get kind of like your view on whether this is something that you're considering in the future.

我想了解一下您對這是否是您將來會考慮的事情的看法。

I know that you have the relationship with Teladoc.

我知道你和 Teladoc 有關係。

But Teladoc assumes to address kind of like the acute needs of the population versus primary care that is -- could create just greater stickiness over time.

但 Teladoc 認為，解決人口的迫切需求與初級保健之間的關係，隨著時間的推移，可能會產生更大的粘性。

Yes, Ricky.

是的，瑞奇。

It's a great question.

這是一個很好的問題。

And as we sit today, we've talked a lot about utilization of Teladoc, okay, where -- our technology capabilities there as well as the opportunities that we have across the Aetna provider network.

今天，我們就 Teladoc 的利用進行了很多討論，好吧，我們的技術能力以及我們在 Aetna 提供商網絡中擁有的機會。

And Ricky, you heard in our prepared comments that, today, our nurse practitioners can treat about 80% of what is treated in a PCP office.

Ricky，您在我們準備好的評論中聽說，今天，我們的執業護士可以治療 PCP 辦公室治療的大約 80%。

The one element that I want to emphasize that I want to make sure doesn't get lost in all of this, because we talk about being a complement to the role of the primary care physician, and as we talk to our Aetna members, our consumers, they do talk about the value that they have and the relationship with the PCP.

我想強調的一個要素是，我想確保不會在所有這一切中迷失，因為我們談論的是對初級保健醫生角色的補充，並且當我們與 Aetna 成員交談時，我們的對於消費者來說，他們確實談論自己擁有的價值以及與PCP 的關係。

And at the same time, they also talk about the need for -- they use words like navigator.

與此同時，他們也談到了需要——他們使用了“導航”這樣的詞。

We call it concierge.

我們稱之為禮賓服務。

And the fact that it gets back to one of the imperatives in terms of the ability to be local and the fact that people are looking, how can you help me access, how can you help me use my benefits, how can you help me navigate through this complex maze called health care.

事實上，它又回到了本地化能力和人們正在尋找的事實這一當務之急，你如何幫助我訪問，你如何幫助我利用我的福利，你如何幫助我導航穿過這個稱為醫療保健的複雜迷宮。

Our HealthHUBs are playing that role.

我們的 HealthHUB 正在發揮這一作用。

So I don't want that to get lost in this overall equation.

所以我不希望這一點在這個整體方程式中迷失。

Your next question comes from Lisa Gill of JPMorgan.

您的下一個問題來自摩根大通的麗莎·吉爾。

Great.

偉大的。

I just want to start with the 2021 selling season and kind of compare it to 2020.

我只想從 2021 年的銷售季節開始，並將其與 2020 年進行比較。

So Larry, I heard you talk about in your prepared remarks the $0 to low copay plan options for commercial members.

拉里，我聽到您在準備好的發言中談到了針對商業會員的 0 美元至低共付額計劃選項。

One, is that just really in your Aetna book of business?

第一，這確實在您的 Aetna 業務手冊中嗎？

Or are you selling that within the Caremark component?

或者您是否在 Caremark 組件中出售該產品？

And then as we think about some of the plan designs that drove 2020 and you talked about the better profitability and aligning formularies, et cetera, how do we compare what you're selling for 2021 versus 2020?

然後，當我們思考推動 2020 年發展的一些計劃設計時，您談到了更好的盈利能力和調整處方等，我們如何比較您 2021 年與 2020 年的銷售情況？

Yes.

是的。

Lisa, maybe I'll ask Derica to start and just -- start with the selling season broadly, and then we'll dig into the questions there.

麗莎，也許我會請德麗卡從廣泛的銷售季節開始，然後我們將深入探討那裡的問題。

Lisa, if you think about it, when we came into the selling season, our book of business that was up for renewal was around $50 billion.

麗莎，如果你想一想，當我們進入銷售季節時，我們需要更新的業務賬簿約為 500 億美元。

And today, we've completed about 65% of that with a very high retention rate.

今天，我們已經完成了大約 65%，並且保留率非常高。

So we're off to a very strong start.

所以我們有了一個非常好的開始。

And as you heard from Eva's opening comments, that included the retention of FEP, which we've signed through 2021 as well as we were also able to renew the WellCare book of business as well.

正如您從 Eva 的開場白中聽到的，其中包括保留 FEP，我們已簽署該協議直至 2021 年，並且我們還能夠續簽 WellCare 業務手冊。

When you think about the economics of this, this is what's helping to drive our outlook for not only 2020, but our outlook for '21 as well.

當你思考這一點的經濟學時，你會發現這不僅有助於推動我們對 2020 年的展望，也有助於推動我們對 21 年的展望。

So we don't have -- we don't anticipate having the net new business loss to overcome in '21 that obviously we're overcoming in our guidance for 2020.

因此，我們預計 21 年不會克服新業務淨損失，而我們在 2020 年的指導中顯然正在克服這一問題。

So that bodes very well.

所以這是一個很好的預兆。

And then obviously, when we -- when Larry talked about the formulary management, that really related to our efforts to mitigate our rebate exposure.

顯然，當拉里談到處方管理時，這確實與我們減輕回扣風險的努力有關。

And again, as I've stated previously, it was expected to peak in 2019.

正如我之前所說，預計 2019 年將達到頂峰。

That began to mitigate in 2020, and we expect it to be de minimis by the time we get to '21.

這種情況在 2020 年開始有所緩解，我們預計到 21 世紀，這種情況將降至最低限度。

And then in terms of the $0 copay, recall that we just launched a program here recently, RxZERO, for our diabetes patients, where, essentially, we've removed the out-of-pocket burden.

然後就 0 美元共付額而言，回想一下，我們最近剛剛在這里為我們的糖尿病患者推出了一個項目 RxZERO，從本質上講，我們已經消除了自付費用。

We think that, that will not only improve access, but adherence, but it will translate into improved health outcomes when we think about the medical claims that we expect to see downstream.

我們認為，這不僅會改善可及性，而且會改善依從性，而且當我們考慮我們期望在下游看到的醫療聲明時，它將轉化為改善的健康結果。

So -- and we are selling that to all our clients as well as our $0 copay.

因此，我們將其出售給所有客戶以及我們的 0 美元共付額。

Yes.

是的。

And Lisa, to that point -- and then I'll flip it over to Karen.

麗莎，到此為止——然後我將把它轉給凱倫。

Because to Derica's point, that $0 copay of the diabetes care category is both for Aetna members as well as Caremark members.

因為對於 Derica 來說，糖尿病護理類別的 0 美元自付費用既適用於 Aetna 會員，也適用於 Caremark 會員。

And the excitement around that is -- today, as you know, the rebates get passed back to the plan sponsor.

令人興奮的是——今天，如您所知，回扣將返還給計劃發起人。

And they have that tug and pull in terms of, do I apply those discounts at the pharmacy counter?

他們有這樣的拉力，我是否可以在藥房櫃檯應用這些折扣？

Or do I apply those discounts in buying down the monthly premium?

或者我是否可以使用這些折扣來購買每月保費？

And this takes that off the table.

這就把這個問題排除在外了。

And by clients adopting the Value Formulary, okay, and the benefits of improved adherence, reducing medical costs, they no longer have to make that decision.

通過客戶採用價值處方集，好吧，以及提高依從性、降低醫療成本的好處，他們不再需要做出這樣的決定。

And that is the beauty of that program.

這就是該計劃的美妙之處。

So Karen, maybe I'll flip it over to you.

凱倫，也許我會把它交給你。

And Lisa, just to give you some color on the 2020 enrollment, we have seen strong interest in the integrated pharmacy medical.

麗莎，我想給大家介紹一下 2020 年招生情況，我們看到了人們對綜合藥房醫療的濃厚興趣。

We actually sold more integrated pharmacy members in January of 2020 than we did all of 2019.

實際上，我們在 2020 年 1 月銷售的綜合藥房會員數量比 2019 年全年還要多。

So obviously, a significant interest in the integration value and about 40% of our -- had about 40% increase in new business was also sold with pharmacy.

顯然，我們對整合價值非常感興趣，我們的新業務增長了約 40%，其中約 40% 也與藥房一起出售。

So really strong results relative to the integrated stores.

相對於綜合商店來說，業績確實強勁。

And how do I think about the profitability of things like the RxZERO diabetes program?

我如何看待 RxZERO 糖尿病計劃等項目的盈利能力？

Is pharma, in some way, helping to fund that in the way that you contracted for that?

製藥公司是否以某種方式以您簽訂合同的方式提供資金？

Is it that you're making it up with incremental scripts because people are going to be more adherent to the program?

您是否用增量腳本來彌補這一點，因為人們會更加遵守該計劃？

Just how do we think about those kind of programs and the profitability as we think about these going forward?

當我們考慮這些計劃的未來時，我們如何看待這些計劃和盈利能力？

Lisa, this is Derica.

麗莎，這是德麗卡。

No, pharma is not funding this.

不，製藥公司不會為此提供資金。

In fact, if you think about the way we've constructed it, it's pretty much self-funding.

事實上，如果你考慮一下我們建造它的方式，你會發現它幾乎是自籌資金的。

So one, through the client adopting our Value Formulary, they're able to create offsets in terms of their cost structure.

因此，通過客戶採用我們的價值公式，他們能夠在成本結構方面創造抵消。

And then, obviously, they get the second offset with the improved medical outcomes downstream by having improved adherence and compliance with the meds on the part of the diabetes patients.

然後，顯然，通過提高糖尿病患者對藥物的依從性和依從性，他們獲得了下游醫療結果改善的第二個抵消。

So again, it's a win-win for both, both the out-of-pocket burden for the member as well as the cost control in terms of downstream medical claim costs for the client themselves or the plan sponsor.

因此，這對雙方來說都是雙贏，既減輕了會員的自付費用，也減輕了客戶本身或計劃發起人下游醫療索賠成本的成本控制。

Your next question comes from Kevin Caliendo of UBS.

你的下一個問題來自瑞銀集團的凱文·卡里恩多。

I want to go through some of the comments around the stronger purchasing economics.

我想回顧一下有關更強勁的購買經濟的一些評論。

You mentioned both generics.

您提到了兩個泛型。

And in the PBM, I'm guessing, there's also better purchasing on specialty as well.

我猜想，在 PBM 中，也有更好的專業採購。

What's the dynamic?

動態如何？

Like what's changing that's making your purchasing better incrementally?

比如是什麼變化讓您的採購逐漸變得更好？

Just love to understand what's sort of changing over the last 6 months there.

只是想了解過去 6 個月裡發生了什麼變化。

Listen, I'll start, right?

聽著，我要開始了，對嗎？

Overall, with our Red Oak venture as well as our internal teams, right, where we work to improve our cost structure each and every day.

總的來說，通過我們的紅橡樹企業以及我們的內部團隊，我們每天都在努力改善我們的成本結構。

And we look for opportunities.

我們尋找機會。

You're right.

你說得對。

There's specialty opportunities, there's generics.

有特殊機會，也有通用機會。

Our rebate negotiations, our network negotiations are all part of -- a contributor.

我們的回扣談判、我們的網絡談判都是貢獻者的一部分。

Yes.

是的。

And this is Jon, Kevin.

這是喬恩，凱文。

So I mean, as you look out over the next couple of years, there's going to be significant launches of generics and biosimilars.

所以我的意思是，當你展望未來幾年時，仿製藥和生物仿製藥將會大量推出。

As a matter of fact, between 2020 and 2023, there's going to be $41 billion of these launches.

事實上，2020 年至 2023 年間，此類產品的發射金額將達到 410 億美元。

And as Eva says, we're very happy with Red Oak.

正如伊娃所說，我們對紅橡木非常滿意。

And we see an opportunity, not only with new launches, but also, we also see opportunities in how we purchase existing complex generics, single-source generics and existing biosimilars.

我們不僅看到了新產品上市的機會，而且還看到瞭如何購買現有復雜仿製藥、單一來源仿製藥和現有生物仿製藥的機會。

And just don't underestimate also the comments that Larry made earlier around having better formulary compliance on the part of our clients as well, which also improves the yield in terms of the utilization.

不要低估拉里早些時候關於我們的客戶也有更好的處方合規性的評論，這也提高了利用率方面的收益。

Okay.

好的。

And one -- just one quick follow-up.

還有一——只是一個快速跟進。

I was a little confused about the CNC, the Centene renewal and the -- in the past, it was a $3.6 billion headwind.

我對 CNC、Centene 更新以及過去的 36 億美元逆風有點困惑。

Now it's $900 million or so with the WellCare renewal.

現在，加上 WellCare 續約，費用約為 9 億美元。

Can you just help me understand sort of what happened there in terms of the headwind from that contract?

您能幫我了解一下該合同帶來的不利影響嗎？

Am I thinking about that right?

我這樣想對嗎？

Or just more detail around that would be really helpful.

或者只是提供更多詳細信息會非常有幫助。

Yes, Kevin.

是的，凱文。

The -- and keep in mind that with WellCare -- with the WellCare-Centene transaction just closing, these were 2 separate events.

請記住，對於 WellCare，WellCare-Centene 交易剛剛結束，這是兩個獨立的事件。

So the WellCare contract was extended.

因此，WellCare 合同得以延長。

As you'll recall, that contract went through 2020 and has been extended for another 3-year period effective 1/1/21.

您可能還記得，該合同有效期至 2020 年，並已從 2021 年 1 月 1 日起再延長 3 年。

And the dynamic around Centene is that contract was renewed, again a 3-year period starting 1/1/24, a larger portion of the Centene business than what was originally planned.

Centene 周圍的動態是合同續簽，再次從 2024 年 1 月 1 日開始為期 3 年，佔 Centene 業務的比例比最初計劃的更大。

So some of the business rolled off, okay, to RxAdvance, largely the exchange business and some Medicaid programs, and we're retaining the balance of that business.

因此，一些業務轉移到了 RxAdvance，主要是交換業務和一些醫療補助計劃，我們保留了該業務的平衡。

And we expect in both cases to operate that business for the value of that contract over the 3-year contractual periods.

我們希望在這兩種情況下，在 3 年合同期內按照合同價值運營該業務。

Your next question comes from Michael Cherny of Bank of America.

您的下一個問題來自美國銀行的邁克爾·切爾尼。

I guess I just want to circle back.

我想我只是想繞回來。

I know Lisa had asked some questions about the selling season.

我知道麗莎問了一些有關銷售季節的問題。

When you think about the selling season, and this is thematic relative to the overall enterprise, how do you feel about where you need to be, from a tipping point perspective, when all of the pieces you're putting together within the integrated pharmacy medical offering are fully resonating in the market?

當您考慮銷售季節時，這是相對於整個企業的主題，從轉折點的角度來看，當您在綜合製藥醫療中整合的所有部分都在哪裡時，您對自己需要達到的位置有何感受？產品在市場上引起充分共鳴嗎？

And I guess, along those lines, what else are the consultants or plan sponsors asking you to do that you're not already doing?

我想，沿著這些思路，顧問或計劃發起人還要求您做哪些您尚未做的事情？

Or that you have planned in the hopper, but maybe trying to accelerate, to make sure that they can maximize the value they have of working with you?

或者您已經在料斗中計劃好了，但可能試圖加速，以確保他們能夠最大限度地發揮與您合作的價值？

Michael, this is Derica.

邁克爾，這是德麗卡。

I'll kick it off for the PBM and, Karen, if you have anything you want to add in terms of the Aetna book of business.

我將開始 PBM，凱倫，如果您對 Aetna 業務手冊有什麼想要補充的。

But as it relates to the PBM, I'll say that we've had really good feedback from both the client base, when we talk to our health plan and employer clients as well as the benefit consultants when we hold our advisory meetings.

但由於它與 PBM 相關，我想說，當我們與我們的健康計劃和雇主客戶交談時，我們從客戶群以及當我們舉行諮詢會議時的福利顧問那裡得到了非常好的反饋。

And we'd actually just held one here recently at the beginning of January.

事實上，我們最近在一月初剛剛在這裡舉辦了一次。

They're extremely excited about the opportunities with the HealthHUB and our ability to integrate our pharmacy and medical claims and use that for points of intervention on behalf of the member in order for them to invite them to take their next best action from their own personal health.

他們對 HealthHUB 的機會以及我們整合我們的藥房和醫療索賠的能力感到非常興奮，並代表會員將其用於乾預點，以便他們邀請他們從自己的個人角度採取下一個最佳行動健康。

That is resonating very well, Michael.

這引起了很好的共鳴，邁克爾。

And what we've seen is that -- there was some question around how would health plans take on to this new integrated model.

我們所看到的是——健康計劃如何適應這種新的綜合模式存在一些問題。

We've now had a number of health plans that have come and chosen to pilot with us on some of our care management programs that we have in development.

我們現在已經制定了許多健康計劃，並選擇與我們一起在我們正在開發的一些護理管理計劃中進行試點。

So again, consistent with our open platform concept, we're bringing some of those new inventions and insights to them that we're developing alongside with our Aetna colleagues.

因此，根據我們的開放平台概念，我們將與 Aetna 同事一起開發的一些新發明和見解帶給他們。

And that is actually playing out very well in the marketplace.

這實際上在市場上表現得很好。

So I do think that, that is contributing to our successful start to the 2021 selling season.

因此，我確實認為，這有助於我們在 2021 年銷售季取得成功。

And I would expect that to continue as we think about the remainder of the selling season as we move into 2022 as well.

當我們進入 2022 年時，我預計這種情況將持續下去，因為我們會考慮銷售季節的剩餘時間。

Yes, Michael, very similar responses from our customers.

是的，邁克爾，我們的客戶的反應非常相似。

We've recently met with our customers and our brokers.

我們最近會見了我們的客戶和經紀人。

They're very excited about the opportunities from the HealthHUB, increasingly excited about the connectivity of the data and the analytics and really connecting the members throughout their personal health journey.

他們對 HealthHUB 提供的機會感到非常興奮，對數據和分析的連接性以及在整個個人健康旅程中真正連接會員的興趣越來越興奮。

So that's where they are really excited about our care management programs, how we're connecting their employees into the communities.

因此，這就是他們對我們的護理管理計劃以及我們如何將他們的員工與社區聯繫起來真正感到興奮的地方。

So it's been resonating quite well.

所以它引起了很好的共鳴。

I think that's why we've seen the increase in the integrated pharmacy medical sales that we have with this open enrollment season.

我認為這就是為什麼我們在這個開放招生季節看到綜合藥房醫療銷售增長的原因。

But as we look to 2021, we'll continue to develop new capabilities.

但展望 2021 年，我們將繼續開發新功能。

We'll be advancing our behavior change programs, like our Aetna adviser or Next Best Action.

我們將推進我們的行為改變計劃，例如我們的 Aetna 顧問或 Next Best Action。

We'll continue to drive that local sites of care using the HealthHUB and MinuteClinics as a primary place for those sites of care.

我們將繼續使用 HealthHUB 和 MinuteClinics 作為這些護理站點的主要場所來推動當地護理站點的發展。

We'll continue to drive new benefit designs, like our low-cost, no copay MinuteClinic, but also looking at additional plan designs for first-dollar coverage.

我們將繼續推動新的福利設計，例如我們的低成本、無自付費用的 MinuteClinic，但也會考慮針對第一美元承保範圍的其他計劃設計。

And then we'll be continuing to round out our new clinical programs like our RxZERO program and our Transform Oncology and our kidney care program, all of which have been resonating with the customers and the brokers.

然後我們將繼續完善我們的新臨床項目，例如我們的 RxZERO 項目、我們的 Transform Oncology 項目以及我們的腎臟護理項目，所有這些項目都引起了客戶和經紀人的共鳴。

So Michael, what's really getting traction is our ability to solve for both the client and the member.

所以邁克爾，真正吸引人的是我們為客戶和會員解決問題的能力。

It's not either/or.

這不是非此即彼。

It's an and.

這是一個和。

And I think that's where the power in this really lies.

我認為這才是真正的力量所在。

Your next question comes from Lance Wilkes of Bernstein.

您的下一個問題來自伯恩斯坦的蘭斯·威爾克斯。

I wanted to take a step back and let you address a little bit the management changes that have been taking place and some of the new appointments you've gotten.

我想退後一步，讓您談談正在發生的管理層變動以及您獲得的一些新任命。

Maybe to put that in context with kind of your overall strategic vision and how you're looking at the company going forward and how you see the organization supporting that, if there are different roles and different sorts of talents you're looking for.

如果您正在尋找不同的角色和不同類型的人才，也許可以將其與您的整體戰略願景、您如何看待公司的未來以及您如何看待支持該目標的組織聯繫起來。

Yes, Lance, it's Larry.

是的，蘭斯，是拉里。

Look, I think as everybody on this call is aware, organization structures evolve over time depending on the needs of the business.

看，我認為參加這次電話會議的每個人都知道，組織結構隨著時間的推移而發展，具體取決於業務的需求。

And we've always had a very robust management planning and development program across the organization, and we're pretty proud of the results that we've seen with that.

我們在整個組織中一直擁有非常強大的管理規劃和發展計劃，我們對所看到的結果感到非常自豪。

So we have results in a very deep and talented bench.

所以我們在板凳深度和才華橫溢方面取得了成果。

And as you heard in my prepared remarks, these changes really reflect the priorities that we have today, the opportunity to -- and the excitement around these products and services coming to market and the opportunity to get them into the hands of more and more people as quick as we possibly can.

正如您在我準備好的發言中聽到的那樣，這些變化確實反映了我們今天的優先事項、機會以及對這些產品和服務進入市場的興奮，以及將它們交到越來越多的人手中的機會盡可能快。

So we're very pleased with where we're at today and excited about what's in front of us.

因此，我們對今天的處境非常滿意，並對我們面前的事情感到興奮。

Great.

偉大的。

I appreciate that.

我很感激。

And if you could -- maybe just on a smaller point, talk a little bit about the fourth quarter commercial medical cost, your experience relative to your projections.

如果可以的話，也許只是在一個較小的問題上，談談第四季度的商業醫療成本，以及相對於您的預測的經驗。

And if there was anything else, from a medical cost standpoint, maybe amongst the businesses, that impacted fourth quarter positively or negatively?

從醫療成本的角度來看，是否還有其他因素對第四季度產生了積極或消極的影響？

Yes, Lance.

是的，蘭斯。

This is Eva.

這是伊娃。

As we look at our fourth quarter medical cost trend, it was in line with our guidance.

當我們審視第四季度的醫療成本趨勢時，它與我們的指導一致。

I'd say it was at the lower end of our guidance range of 6% plus or minus 50 basis points as you look at 2019.

我想說的是，從 2019 年的情況來看，這是我們指導範圍 6% 正負 50 個基點的下限。

The year played out largely as we expected, and there's really no changes to call out.

這一年的表現基本上符合我們的預期，並且確實沒有什麼值得指出的變化。

Lance, the only thing I would add is we heard -- we saw an earlier flu season in December.

Lance，我唯一要補充的是，我們聽說——我們在 12 月看到了較早的流感季節。

As you likely know, it's -- we've seen it happened in December, coming down in January, but nothing out of the ordinary.

正如您可能知道的那樣，我們已經看到它在 12 月發生，在 1 月下降，但沒有什麼異常。

It is the influenza B. The incidences are a little bit higher in outpatient, but we aren't seeing the severity that we've seen in past years relative to the flu season, and we feel like we've adequately covered it in our reserves.

是乙型流感。門診的發病率稍高一些，但我們沒有看到過去幾年相對於流感季節所看到的嚴重程度，我們覺得我們已經在我們的保險中充分涵蓋了它。儲備。

Your next question comes from Ralph Giacobbe of Citi.

您的下一個問題來自花旗銀行的拉爾夫·賈科布。

Can you just give us a little bit better idea on the enrollment trends by end market in the health benefits segment and specifically the commercial market and the split between ASO and commercial as we think about 2020?

您能否讓我們更好地了解一下健康福利領域終端市場（特別是商業市場）的註冊趨勢以及我們對 2020 年的看法，以及 ASO 和商業之間的劃分？

Relative to the commercial business, as you know, we continue to offer choice to our commercial business.

如您所知，相對於商業業務，我們繼續為我們的商業業務提供選擇。

We have seen a transition from risk to ASO, particularly in the lower end of the small segment.

我們已經看到了從風險到 ASO 的轉變，特別是在小型細分市場的低端領域。

We've been offering a self-insured product at the smaller end of the segment to combat what we've seen relative to those changes.

我們一直在該細分市場的較小端提供自我保險產品，以應對我們所看到的與這些變化相關的情況。

Relative to ASC business and our national accounts business, as we came into the year, we expect to see kind of flat to down in January, but we are well aware of some national accounts that we'll see coming towards -- to us in latter half of the year.

相對於 ASC 業務和我們的國民賬戶業務，隨著我們進入今年，我們預計 1 月份會出現持平甚至下降的情況，但我們很清楚我們將在 2019 年看到一些國民賬戶業務的發展。下半年。

So we expect to increase that number in the latter half of the year.

因此我們預計下半年會增加這個數字。

And then in small group, we continue to be pressured in our -- in that business, and we are contracting in that business.

然後，在小團體中，我們繼續在該業務中面臨壓力，並且我們正在該業務中收縮。

Okay.

好的。

So is it fair to say commercial business down year-over-year in '20?

那麼，說 20 世紀商業業務同比下降是否公平？

And then, I guess, we've talked a lot about sort of the selling season, specifically sort of on the pharmacy side.

然後，我想，我們已經討論了很多關於銷售季節的問題，特別是在藥房方面。

Just as we think about sort of the medical selling season, if you will, as we move through the year with sort of the integrated pitch, is it more selective to sort of match with the HealthHUB rollout that's going to be more expansive going into 2022?

正如我們思考某種醫療銷售季節一樣，如果您願意的話，當我們以某種綜合宣傳方式度過這一年時，是否更有選擇性地與HealthHUB 的推出相匹配，HealthHUB 的推出將在2022 年更加廣泛？

Or is this something that we should see resonating and start to see commercial growth in '21, given sort of the integration of the Aetna and CVS pieces?

或者考慮到 Aetna 和 CVS 的整合，我們應該在 21 年看到這種共鳴並開始看到商業增長？

Yes, given the integration of the pieces, we should expect to see better commercial growth in 2021.

是的，考慮到各個部分的整合，我們預計 2021 年會看到更好的商業增長。

And Ralph, keep in mind that it's -- our plan for the hubs, we'll be between 600 and 650 by year-end.

拉爾夫，請記住，我們的樞紐計劃是，到年底我們的樞紐數量將達到 600 到 650 個。

So we do need to build those critical masses.

所以我們確實需要建立這些臨界群體。

It's not going to surprise you that as we prioritize markets, we have worked to match concentration of Aetna members for these first phases.

您不會感到驚訝的是，當我們優先考慮市場時，我們已努力在第一階段匹配 Aetna 成員的集中度。

Your next question comes from Charles Rhyee of Cowen.

您的下一個問題來自 Cowen 的 Charles Rhyee。

Larry, maybe just going back, as you're talking about the HealthHUB there.

Larry，也許只是回去，因為你正在談論那裡的 HealthHUB。

When you look at these new HealthHUBs formats, I think, along with adding all the health services aspects of it, there's also been sort of a remodeling of how you're looking at remodeling the front end and how you're kind of shelving the products in maybe a more intuitive way there.

當你看到這些新的 HealthHUB 格式時，我認為，除了添加它的所有健康服務方面之外，還對你如何看待重塑前端以及如何擱置產品可能以更直觀的方式存在。

Do you see that being extended out just beyond the HealthHUBs?

您是否認為它已經擴展到 HealthHUB 之外？

And can that be applied across all your stores?

這可以應用於您所有的商店嗎？

And I ask that because when we think back historically, when retailers have gone into a phase of trying to refresh stores, that's kind of come with an uplift in same-store sales.

我之所以這麼問，是因為當我們回顧歷史時，當零售商進入嘗試更新商店的階段時，這會帶來同店銷售額的提升。

And is that something that you've seen so far in the HealthHUBs against the control group?

到目前為止，您在 HealthHUB 中看到過與對照組相反的情況嗎？

And is that something we could expect as you kind of go forward and as we think beyond just the 1,500 HealthHUBs.

隨著您的前進以及我們對 1,500 個 HealthHUB 之外的思考，這是我們可以期待的事情。

Yes, Charles, this is Jon.

是的，查爾斯，這是喬恩。

So remember, in the HealthHUBs, we're taking probably 20% of the sales floor, converting it to the hub services.

因此請記住，在 HealthHUB 中，我們大約佔據了 20% 的銷售面積，將其轉換為中心服務。

And at the same time, we're shrinking the general merchandise and adding a lot of health and wellness items.

與此同時，我們正在縮減一般商品的規模，並增加大量的健康和保健商品。

And when we look at our 2019 HealthHUB stores, we're actually seeing positive growth in the front store sales and margin because health and wellness are actually carrying higher margin.

當我們查看 2019 年 HealthHUB 商店時，我們實際上看到了前店銷售額和利潤率的正增長，因為健康和保健實際上帶來了更高的利潤率。

And we are taking components of what we're learning in the HealthHUBs, and we're deploying those products and categories across our fleet.

我們正在利用我們在 HealthHUB 中學到的知識，並在我們的車隊中部署這些產品和類別。

So yes, there is an opportunity to expand that to all stores.

所以，是的，有機會將其擴展到所有商店。

And we have different formats depending upon volumes and geographies that stores are in.

根據商店的數量和地理位置，我們有不同的格式。

And also recall, over the last several years, we've remodeled just about the majority of our fleet.

還請記住，在過去幾年中，我們幾乎改造了大部分機隊。

So we're feeling really good about the shape that these stores are in and our ability to continue to grow.

因此，我們對這些商店的現狀以及我們持續增長的能力感到非常滿意。

And a follow-up, maybe partly related.

還有一個後續行動，可能部分相關。

When we're looking at the synergy guidance, looks like in 2019, you outperformed that fairly nicely about $100 million or so.

當我們查看協同效應指導時，看起來在 2019 年，您的表現相當好，約為 1 億美元左右。

When you look at the 2020 guidance, you kind of bumped it up a little bit, taking up the range, $800 million to $900 million from, call it, roughly $800 million.

當你查看 2020 年的指導時，你會發現它有點上調，範圍從 8 億美元到 9 億美元，可以稱之為大約 8 億美元。

Anything to think in that?

這裡面有什麼值得思考的嗎？

Is that more of a pacing and timing of like how quickly you can realize synergies?

這是否更像是一種節奏和時機，比如你能多快實現協同效應？

Or is there an opportunity that we can, again, exceed probably better given where our end target out in 2021 is?

或者考慮到我們 2021 年的最終目標，我們是否有機會再次超越？

Yes, Charles, it really reflects on the quality of the integration work in terms of the fact that it was done extremely well, and we were able to accomplish many of those activities ahead of schedule.

是的，查爾斯，這確實反映了集成工作的質量，因為它做得非常好，而且我們能夠提前完成其中許多活動。

So it's really a great job by the team.

所以這對團隊來說確實是一項偉大的工作。

Your final question comes from Steven Valiquette of Barclays.

你的最後一個問題來自巴克萊銀行的史蒂文·瓦利奎特。

Great.

偉大的。

So you touched on this topic a little bit, but just a question around the commercial medical cost trend for 2020 in particular.

您稍微談到了這個話題，但只是一個關於 2020 年商業醫療費用趨勢的問題。

We have seen some other managed care companies talk about lower trends in 2020 due to better pharmacy integration.

我們看到其他一些管理式醫療公司談論 2020 年由於更好的藥房整合而出現的較低趨勢。

So with your 6% expected commercial trend for '20 you mentioned on Page 23 in the slide deck, I'm curious are there any elevated cost areas, maybe either in inpatient or outpatient, that might be offsetting some pharmacy savings?

因此，根據您在幻燈片第 23 頁上提到的 20 世紀 6% 的預期商業趨勢，我很好奇是否有任何成本上升的領域，可能是住院或門診，這可能會抵消一些藥房節省？

Maybe more importantly, is there any bias for the 6% trend to improve over time as you get further along in the overall CVS-Aetna merger integration.

也許更重要的是，隨著整個 CVS-Aetna 合併整合的進一步推進，6% 的趨勢是否會隨著時間的推移而改善。

Relative to our trend, we don't know what our competitors include in sort of their trend expectations.

相對於我們的趨勢，我們不知道我們的競爭對手在他們的趨勢預期中包含了什麼。

But we obviously factor in a variety of things like the economy, provider consolidation, use of technology, continued emergence of specialty drugs, but there's nothing included in our trend that is out of the ordinary.

但我們顯然考慮了各種因素，如經濟、供應商整合、技術的使用、特種藥物的持續出現，但我們的趨勢中沒有任何不尋常的因素。

We've factored in what we typically factored in, accounting for where we think savings will occur as well.

我們已經考慮了我們通常考慮的因素，也考慮到了我們認為會發生節省的地方。

And we're quite confident in how we're projecting our trend at 6%, plus or minus 50 basis points.

我們對如何預測 6%（正負 50 個基點）的趨勢非常有信心。

From the merger overall, though, shouldn't this trend come down over time?

不過，從合併整體來看，這種趨勢難道不應該隨著時間的推移而減弱嗎？

I mean should commercial cost trend be a beneficiary of the overall merger?

我的意思是商業成本趨勢應該成為整體合併的受益者嗎？

Yes.

是的。

So Steve, we haven't provided longer-term trend projections, right?

那麼史蒂夫，我們還沒有提供長期趨勢預測，對吧？

But as you saw back at Investor Day, right, we are driving towards meaningful medical cost savings through the integration, and we'll have more to say about that as time progresses.

但正如您在投資者日所看到的那樣，我們正在通過整合推動有意義的醫療成本節省，隨著時間的推移，我們將對此有更多的說法。

So with that, let me just thank everybody for their time.

因此，讓我感謝大家抽出時間。

Because just summarizing quickly here, I hope you agree with us that today's results really reflect the importance of our strategy in making health care more simple, local and affordable.

因為只是在這裡快速總結一下，我希望您同意我們的觀點，即今天的結果確實反映了我們使醫療保健變得更加簡單、本地化和負擔得起的戰略的重要性。

And we're really pleased with the progress that we have made in executing our plan.

我們對執行計劃所取得的進展感到非常滿意。

And a lot of the credit for that goes to our nearly 300,000 colleagues for all of their hard work and commitment to our purpose.

這在很大程度上要歸功於我們近 300,000 名同事的辛勤工作和對我們目標的承諾。

And all of us here are confident in our ability to meet the needs of the diverse markets that we serve while continuing to accelerate growth.

我們所有人都對我們有能力滿足我們所服務的多元化市場的需求，同時繼續加速增長充滿信心。

So with that, I'm sure we'll talk to many of you soon.

因此，我相信我們很快就會與你們中的許多人交談。

Ladies and gentlemen, this concludes today's conference call.

女士們、先生們，今天的電話會議到此結束。

Thank you for participating.

感謝您的參與。

You may now disconnect.

您現在可以斷開連接。