CVS Health Corp (CVS) 2021 Q4 法說會逐字稿

Ladies and gentlemen, good morning, and welcome to the CVS Health Fourth Quarter and Full Year 2021 Earnings Conference Call. (Operator Instructions) As a reminder, today's conference is being recorded.

女士們，先生們，早上好，歡迎來到 CVS Health 第四季度和 2021 年全年收益電話會議。 （操作員說明）提醒一下，今天的會議正在錄製中。

I would now like to turn the call over to Susie Lisa, Senior Vice President of Investor Relations for CVS Health. Please go ahead.

我現在想把電話轉給 CVS Health 投資者關係高級副總裁 Susie Lisa。請繼續。

Thank you, and good morning, everyone. Welcome to the CVS Health Fourth Quarter and Full Year 2021 Earnings Call. I'm Susie Lisa, Senior Vice President of Investor Relations for CVS Health. I'm joined this morning by Karen Lynch, President and Chief Executive Officer; and Shawn Guertin, Executive Vice President and Chief Financial Officer. Following our prepared remarks, we will host a question-and-answer session that will include Alan Lotvin, President, Pharmacy Services; Dan Finke, President, Health Care Benefits; Michelle Peluso, Chief Customer Officer; and Prem Shah, Chief Pharmacy Officer, both Co-Presidents of the Retail segment; and Jon Roberts, Chief Operating Officer.

謝謝大家，早上好。歡迎來到 CVS Health 第四季度和 2021 年全年收益電話會議。我是 CVS Health 投資者關係高級副總裁 Susie Lisa。今天早上，總裁兼首席執行官 Karen Lynch 加入了我的行列；執行副總裁兼首席財務官 Shawn Guertin。在我們準備好的發言之後，我們將舉辦問答環節，參與者包括藥房服務總裁 Alan Lotvin；醫療保健福利總裁 Dan Finke；首席客戶官 Michelle Peluso；和首席藥房官 Prem Shah，他們都是零售部門的聯席總裁；和首席運營官喬恩·羅伯茨 (Jon Roberts)。

Our press release and slide presentation have been posted to our website, along with our Form 10-K that we filed with the SEC this morning. During this call, we will make certain forward-looking statements reflecting our current views related to our future financial performance, future events, industry and market conditions as well as the expected consumer benefits of our products and services and our financial projections. Our forward-looking statements are subject to significant risks and uncertainties that could cause actual results to differ materially from what may be indicated in them.

我們的新聞稿和幻燈片演示以及我們今天早上向美國證券交易委員會提交的 10-K 表格已發佈到我們的網站上。在此次電話會議中，我們將做出某些前瞻性陳述，反映我們當前對未來財務業績、未來事件、行業和市場狀況的看法，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。我們的前瞻性陳述受重大風險和不確定性的影響，這些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 file with the SEC regarding these risks and uncertainties, in particular, those that are described in the cautionary statement concerning forward-looking statements and Risk Factors section in this morning's earnings press release and included in our Form 10-K.

我們強烈建議您查看我們向美國證券交易委員會提交的有關這些風險和不確定性的報告中的信息，特別是那些在今天上午的收益新聞稿中有關前瞻性陳述和風險因素部分的警告聲明中描述的信息，並包括在內在我們的 10-K 表格中。

During this call, we will use non-GAAP financial measures when talking about the company's performance and financial condition. 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. Today's call is being broadcast on our website, where it will be archived for 1 year.

在此次電話會議中，我們將在談論公司的業績和財務狀況時使用非公認會計原則財務指標。根據美國證券交易委員會的規定，您可以在今天上午的收益新聞稿和我們網站投資者關係部分發布的調節文件中找到這些非 GAAP 措施與可比的 GAAP 措施的調節。今天的電話會議正在我們的網站上播出，並將在網站上存檔 1 年。

Now I'd like to turn the call over to Karen.

現在我想把電話轉給 Karen。

Thank you, Susie. Good morning, everyone, and thank you for joining our call today. 2021 was an important year for CVS Health. We exceeded our financial goals, we advanced our strategy and we brought greater value to the people we serve, playing a critical role in the nation's pandemic response.

謝謝你，蘇西。大家早上好，感謝您今天加入我們的電話會議。 2021 年對 CVS Health 來說是重要的一年。我們超越了我們的財務目標，我們推進了我們的戰略，我們為我們所服務的人們帶來了更大的價值，在國家的大流行應對中發揮了關鍵作用。

We ended a strong 2021 with another strong quarter. We exceeded our adjusted EPS expectations for the fourth quarter in a row, delivering $1.98 adjusted EPS in the final quarter of 2021 and $8.40 adjusted EPS for the full year. We are entering 2022 with powerful momentum. We are delivering health care solutions that are personalized, connected and increasingly digital. We are engaging millions of consumers across our businesses and in our community health destinations across America. CVS Health is becoming a bigger part of their everyday health.

我們以另一個強勁的季度結束了強勁的 2021 年。我們連續第四個季度超出調整後每股收益預期，2021 年最後一個季度調整後每股收益為 1.98 美元，全年調整後每股收益為 8.40 美元。我們正以強勁的勢頭進入2022年。我們正在提供個性化、互聯且日益數字化的醫療保健解決方案。我們在全美各地的企業和我們的社區健康目的地吸引了數百萬消費者。 CVS Health 正在成為他們日常健康的重要組成部分。

Turning now to our performance. For the full year 2021, CVS Health grew adjusted revenue by 8.8% to $292 billion. We delivered adjusted operating income of $17.3 billion, up 8.1% year-over-year, and we increased adjusted earnings per share by 12%. We generated strong cash flow from operations of nearly $18.3 billion for the full year, exceeding our most recent guidance of at least $13.5 billion.

現在談談我們的表現。 2021 年全年，CVS Health 的調整後收入增長了 8.8%，達到 2920 億美元。我們實現了調整後營業收入 173 億美元，同比增長 8.1%，調整後每股收益增長了 12%。我們全年從運營中產生了近 183 億美元的強勁現金流，超過了我們最近至少 135 億美元的指導。

This strong performance positions us well for 2022. At this early stage of the year, we are maintaining our full year 2022 adjusted earnings per share guidance of $8.10 to $8.30. Our forecast reflects increased volume from COVID testing and front store sales in our retail business relative to our forecast at Investor Day, offset by the accelerated timing of vaccine boosters pulled into the fourth quarter of 2021. Shawn will provide more details on our results and guidance shortly.

這種強勁的表現使我們在 2022 年處於有利地位。在今年的這個早期階段，我們將 2022 年全年調整後的每股收益指引維持在 8.10 美元至 8.30 美元之間。我們的預測反映出與我們在投資者日的預測相比，我們零售業務的 COVID 測試和前台店面銷售量有所增加，但疫苗助推器的加速投放時間已提前到 2021 年第四季度，這抵消了這一影響。Shawn 將提供有關我們結果和指導的更多詳細信息不久。

Our 2021 performance demonstrates our ability to anticipate, deliver and exceed consumers' expectations for health care. Consumers are a major force driving change in health care, and we continue to engage successfully with individuals in more places and on their terms, virtually in the home and in their local community. Customers and clients continue to realize the superior value we are providing with our integrated health solutions, particularly those that address the most prevalent, costly and complex health conditions, such as diabetes, cancer and chronic kidney disease.

我們 2021 年的業績表明我們有能力預測、提供並超越消費者對醫療保健的期望。消費者是推動醫療保健變革的主要力量，我們將繼續在更多地方並根據他們的條件成功地與個人接觸，幾乎是在家中和當地社區。客戶和客戶繼續意識到我們通過綜合健康解決方案提供的卓越價值，特別是那些解決最普遍、成本最高和復雜的健康狀況的解決方案，例如糖尿病、癌症和慢性腎病。

Turning to the segment highlights. In Health Care Benefits, we delivered 9.4% adjusted revenue growth for the full year 2021, driven by our performance in Government Services. We had another strong year of Medicare growth with increases across all product lines. Total Medicare Advantage membership grew at 9.8% on a year-over-year basis, as we added over 265,000 new members in 2021 and exceeded our initial growth expectations. As a result of our strategic focus on dual-eligible special needs plans, enrollment nearly doubled in 2021.

轉向細分市場亮點。在醫療保健福利方面，我們在政府服務方面的表現推動了 2021 年全年的調整後收入增長 9.4%。我們又迎來了 Medicare 強勁增長的一年，所有產品線都實現了增長。 Medicare Advantage 會員總數同比增長 9.8%，因為我們在 2021 年增加了超過 265,000 名新會員，超出了我們最初的增長預期。由於我們將戰略重點放在雙重資格的特殊需求計劃上，2021 年的註冊人數幾乎翻了一番。

Our full year medical benefit ratio of 85% was in line with our guidance expectations. For the full year 2021, the utilization of total health care services in aggregate was in line with normalized historical baseline levels.

我們 85% 的全年醫療福利比率符合我們的指導預期。 2021 年全年，總體醫療保健服務的利用率與正常化的歷史基線水平一致。

Turning to 2022. We had an impressive annual enrollment period in our Medicare business. For the second consecutive year, we grew all Medicare product lines, and our growth rates this year exceed the industry averages in all categories. We grew total Medicare Advantage membership by 11.6% versus the prior year, reflecting increases in individual and group Medicare Advantage of over 15% and 6%, respectively, year-over-year. We also led the industry in absolute Medicare PDP net membership growth. This added nearly 295,000 net new members, while the overall PDP market continues to decline.

轉向 2022 年。我們的 Medicare 業務的年度註冊期令人印象深刻。我們連續第二年實現了所有醫療保險產品線的增長，今年我們在所有類別中的增長率都超過了行業平均水平。我們的 Medicare Advantage 會員總數比上一年增長了 11.6%，反映出個人和團體 Medicare Advantage 的同比增長分別超過 15% 和 6%。我們還在絕對 Medicare PDP 淨會員增長方面領先於行業。這增加了近 295,000 個淨新成員，而整個 PDP 市場繼續下滑。

We had a solid 2022 selling season in our national accounts commercial business. We expect to grow membership in the low single digits for the full year and maintain strong client retention of 96%. Our success is driven by the combination of our competitive cost structure, our integrated benefit designs, including medical and pharmacy, and products and services that utilize CVS Health capabilities such as transform care diabetes and virtual primary care programs.

我們的國民賬戶商業業務在 2022 年銷售旺季表現強勁。我們預計全年會員人數將以低個位數增長，並保持 96% 的強勁客戶保留率。我們的成功是由我們具有競爭力的成本結構、我們的綜合福利設計（包括醫療和藥房）以及利用 CVS Health 功能的產品和服務（如轉化護理糖尿病和虛擬初級保健計劃）相結合所推動的。

Membership enrollment was lower than expected in the 8 ACA individual exchanges we entered this year. We continue to build this business gradually with select geographic expansion, a focused price discipline and the appeal of co-branded Aetna-CVS Health offerings. Consistent with our prior guidance, we do not expect this offering to contribute materially to our financial results in 2022.

我們今年進入的 8 個 ACA 個人交易所的會員註冊人數低於預期。我們繼續通過選擇地理擴張、集中的價格紀律和聯合品牌 Aetna-CVS Health 產品的吸引力來逐步建立這項業務。與我們之前的指導一致，我們預計此次發行不會對我們 2022 年的財務業績做出重大貢獻。

Overall, our deep understanding of consumer needs, innovative product portfolio and our service excellence will drive growth in our Health Care Benefits segment. Our comprehensive range of products and benefit design that address consumers' whole health needs remains a key differentiator and fueled a strong selling season. For 2022, we forecast 7% to 9% revenue growth and 15% to 17% adjusted operating income growth.

總的來說，我們對消費者需求的深刻理解、創新的產品組合和卓越的服務將推動我們的醫療保健福利部門的增長。我們滿足消費者整體健康需求的全面產品和福利設計仍然是一個關鍵的差異化因素，並推動了強勁的銷售季節。到 2022 年，我們預測收入增長 7% 至 9%，調整後營業收入增長 15% 至 17%。

Turning to Pharmacy Services. We delivered 7.8% revenue and 20.6% adjusted operating income growth in 2021. We continue to be a consultative partner to our clients and members. We're delivering industry-leading cost trends and savings, service excellence and a broad product portfolio and a commitment to transparency. We consistently create value for our customers and clients with our better-than-market drug trend. We continue to enhance our utilization programs to ensure access to the therapeutics that are the most clinically appropriate.

轉向藥房服務。我們在 2021 年實現了 7.8% 的收入增長和 20.6% 的調整後營業收入增長。我們將繼續成為客戶和成員的諮詢合作夥伴。我們正在提供行業領先的成本趨勢和節約、卓越的服務和廣泛的產品組合以及對透明度的承諾。我們始終以優於市場的藥物趨勢為我們的客戶和客戶創造價值。我們繼續加強我們的利用計劃，以確保獲得最適合臨床的治療方法。

For 2022, we achieved a client retention rate of over 98% and drove $8.8 billion of net new business revenue. We are a leader in specialty pharmacy, delivering revenue growth of 12.3% for the fourth quarter and 9.3% for the full year versus prior period. Our specialty pharmacy programs drive value in the marketplace, and they differentiate us as we pair programs with digital capabilities to deliver a convenient and connected experience.

2022 年，我們實現了超過 98% 的客戶保留率，並推動了 88 億美元的新業務淨收入。我們是專業藥房的領導者，第四季度收入增長 12.3%，全年收入增長 9.3%。我們的專業藥房計劃推動了市場價值，它們使我們脫穎而出，因為我們將計劃與數字功能相結合，以提供方便和互聯的體驗。

For Pharmacy Services in 2022, we expect 6% to 8% revenue growth and 7% to 9% adjusted operating income growth as we create long-term value for our clients and our members. Our Retail segment plays a critical role as a community health destination for millions of Americans. This segment outperformed the industry and our expectations in 2021. We grew revenue 9.8% year-over-year to just over $100 billion, marking an important milestone in the history of this CVS Health business. We delivered an exceptional 24% adjusted operating income growth in 2021.

對於 2022 年的藥房服務，我們預計隨著我們為客戶和會員創造長期價值，收入將增長 6% 至 8%，調整後的營業收入將增長 7% 至 9%。我們的零售部門作為數百萬美國人的社區健康目的地發揮著至關重要的作用。該細分市場在 2021 年的表現超出了行業和我們的預期。我們的收入同比增長 9.8%，達到略高於 1000 億美元，這是 CVS Health 業務歷史上的一個重要里程碑。我們在 2021 年實現了 24% 的調整後營業收入增長。

Pharmacy sales and prescriptions filled both increased by nearly 9% year-over-year. This was notably driven by consumers who came to CVS Health for COVID-19 vaccine administration. For the full year 2021, CVS Health administered more than 32 million COVID-19 tests and more than 59 million vaccines. Over 35% of COVID-19 vaccines in 2021 were administered during the fourth quarter. Our work to test and vaccinate America for COVID is a powerful example of the relationships we are building with consumers, which leads to new customers seeking a range of other health services at CVS Health.

藥房銷售額和處方藥均同比增長近 9%。這主要是由前來 CVS Health 接種 COVID-19 疫苗的消費者推動的。在 2021 年全年，CVS Health 進行了超過 3200 萬次 COVID-19 檢測和超過 5900 萬次疫苗接種。 2021 年超過 35% 的 COVID-19 疫苗是在第四季度接種的。我們為美國進行 COVID 測試和疫苗接種的工作是我們與消費者建立關係的一個有力例子，這導致新客戶在 CVS Health 尋求一系列其他健康服務。

Front store sales growth was strong throughout 2021, up 8.4% versus the prior year. They were led by consumer demand for the over-the-counter COVID-19 tests as well as cough and cold, beauty and personal care products. We sold over 22 million OTC COVID-19 tests, with approximately 70% of sales in the fourth quarter.

整個 2021 年，門店銷售額增長強勁，比上年增長 8.4%。它們是由消費者對非處方 COVID-19 測試以及咳嗽和感冒、美容和個人護理產品的需求帶動的。我們在第四季度售出了超過 2200 萬份 OTC COVID-19 測試，約佔銷售額的 70%。

We are progressing on optimizing our retail portfolio and pivoting our stores into 3 formats: primary care clinics, enhanced health hubs and traditional CVS Pharmacy locations. We are executing our plan to de-densify stores based on consumer health and buying needs, omnichannel preferences and shifts in the U.S. population.

我們正在優化我們的零售組合併將我們的商店轉變為三種形式：初級保健診所、增強型健康中心和傳統 CVS 藥房地點。我們正在執行我們的計劃，根據消費者的健康和購買需求、全渠道偏好和美國人口的變化來降低商店的密度。

For 2022, as I mentioned, given the earnings outperformance and pull forward of vaccine boosters in 2021, we are maintaining our 2022 guidance. This now implies retail revenue to be plus or minus 1% versus prior year, and a low 20% decline in adjusted operating income growth. Shawn will provide more details.

對於 2022 年，正如我提到的，鑑於 2021 年疫苗助推器的盈利表現和推進，我們維持 2022 年的指導。這意味著零售收入與上一年相比將增長或下降 1%，調整後的營業收入增長將下降 20%。肖恩將提供更多細節。

Our digital approach is focused on delivering a superior experience for consumers by creating a more connected and seamless health journey. We are making progress towards setting a new standard for digital health care for consumers. cvs.com is one of the top health websites, with over 2 billion visits in 2021, up nearly 55% over the prior year. Our digital capabilities for health interactions, such as COVID testing and vaccines, prescription services and sales of health and wellness products have dramatically increased consumer engagement across all CVS Health businesses. We now serve 40 million customers digitally, up approximately 10% in the last 6 months alone.

我們的數字方法專注於通過創建更緊密、無縫的健康之旅，為消費者提供卓越的體驗。我們正在為消費者制定數字醫療保健新標準方面取得進展。 cvs.com 是頂級健康網站之一，2021 年的訪問量超過 20 億次，比上一年增長近 55%。我們用於健康互動的數字功能，例如 COVID 測試和疫苗、處方服務以及健康和保健產品的銷售，極大地提高了所有 CVS Health 業務的消費者參與度。我們現在以數字方式為 4000 萬客戶提供服務，僅在過去 6 個月內就增長了約 10%。

In 2021, we launched several new digital health services powered by advanced analytics to personalize the experience. We made it easier to join our CarePass program reaching 5.6 million subscribers in the quarter, up more than 40% year-over-year. We integrated CarePass for our Aetna commercial members and are excited about the adoption we are seeing. We also simplified the CarePass enrollment for all consumers, which is driving more growth in subscribers.

2021 年，我們推出了幾項由高級分析提供支持的新數字健康服務，以提供個性化體驗。我們讓加入 CarePass 計劃變得更加容易，該計劃在本季度達到 560 萬訂戶，同比增長超過 40%。我們為我們的 Aetna 商業會員集成了 CarePass，並對我們看到的採用感到興奮。我們還簡化了所有消費者的 CarePass 註冊，這推動了訂閱者的更多增長。

For our HealthHUB and MinuteClinic patients, we simplified and digitized the check-in process for patients. Our self-service digital tool enables individuals to complete traditional paperwork in advance of their appointment. Almost 80% of patients are already utilizing this capability.

對於我們的 HealthHUB 和 MinuteClinic 患者，我們簡化並數字化了患者的登記流程。我們的自助服務數字工具使個人能夠在預約前完成傳統的文書工作。幾乎 80% 的患者已經在使用此功能。

At our Investor Day, we promised a superior health care experience for consumers that will improve health outcomes, lower cost and provide broader access to care. We are making several moves to realize our vision for health care. We're advancing our care delivery capabilities, optimizing our retail portfolio and further diversifying the health products and services that we offer.

在我們的投資者日，我們承諾為消費者提供卓越的醫療保健體驗，這將改善健康結果、降低成本並提供更廣泛的醫療服務。我們正在採取多項措施來實現我們對醫療保健的願景。我們正在提高我們的護理服務能力，優化我們的零售組合，並進一步豐富我們提供的健康產品和服務。

We're driving this evolution both through internal initiatives and by seeking to execute capability-focused M&A for complementary health services. We will connect consumers in more places, in more ways and on their terms, with our digital-first, technology-forward approach as well as an enhanced omnichannel health experience. These strategic moves will accelerate the growth of our foundational businesses. In all this work, we will place the consumer at the center of all that we do.

我們正在通過內部舉措和尋求執行以能力為中心的補充醫療服務併購來推動這一演變。我們將通過我們的數字優先、技術先進的方法以及增強的全渠道健康體驗，在更多地方以更多方式並根據他們的條件連接消費者。這些戰略舉措將加速我們基礎業務的發展。在所有這些工作中，我們將把消費者置於我們所做一切的中心。

We remain focused on delivering on our commitment to sustainability for our shareholders, our customers and our communities. We recently launched CVS Health Zones aimed to advance health equity and to address social determinants of health in high-risk communities. We are collaborating with trusted national and local organizations to confront the 6 key social determinants of health through local investments. Our goal is to equip communities with the resources needed to close gaps in care for specific health conditions such as diabetes and heart disease. Health Zones is now active in 5 geographies with additional markets planned in 2022.

我們仍然專注於為我們的股東、我們的客戶和我們的社區履行我們對可持續發展的承諾。我們最近啟動了 CVS 健康區，旨在促進健康公平並解決高風險社區健康的社會決定因素。我們正在與值得信賴的國家和地方組織合作，通過地方投資應對健康問題的 6 個關鍵社會決定因素。我們的目標是為社區提供所需的資源，以縮小糖尿病和心髒病等特定健康狀況的護理差距。 Health Zones 目前活躍於 5 個地區，併計劃在 2022 年開闢更多市場。

We remain committed to the environment and have pledged to reduce our overall impact, cutting greenhouse gas emissions across our operations and supply chain and decreasing resource consumption, especially paper and plastics. In December, CVS Health was named to the 2021 S&P Dow Jones Sustainability North American Index for the 9th consecutive year and the Dow Jones Sustainability World Index for the 3rd consecutive year.

我們始終致力於保護環境，並承諾減少我們的整體影響，減少我們運營和供應鏈中的溫室氣體排放，並減少資源消耗，尤其是紙張和塑料。 12 月，CVS Health 連續第 9 年入選 2021 年標準普爾道瓊斯可持續發展北美指數，連續第 3 年入選道瓊斯可持續發展世界指數。

Our financial performance, execution, portfolio of assets and differentiated strategy all create strong momentum into 2022 and a clear pathway to achieve low double-digit adjusted EPS growth over time. I would also like to take a moment to recognize the continued contribution of our colleagues who have played a vital role in helping our nation prevail over the pandemic. I am proud of what we have done and are doing every day to make a difference.

我們的財務業績、執行、資產組合和差異化戰略都為 2022 年創造了強勁勢頭，並為隨著時間的推移實現低兩位數的調整後每股收益增長提供了明確的途徑。我還想花點時間感謝我們的同事們的持續貢獻，他們在幫助我們的國家戰勝大流行病方面發揮了重要作用。我為我們所做的和每天正在做的事情感到自豪，以有所作為。

With that, let me turn it over to Shawn.

有了這個，讓我把它交給肖恩。

Thank you, Karen, and good morning, everyone. Our fourth quarter results reflect the continuation of the strong performance delivered in the first 3 quarters of the year as we once again exceeded our expectations for revenue, cash flow and adjusted earnings per share. We maintained our focus on growth, operational execution and supporting the communities we serve as the effects of the pandemic persists.

謝謝你，凱倫，大家早上好。我們的第四季度業績反映了今年前 3 季度的強勁表現的延續，因為我們再次超出了我們對收入、現金流和調整後每股收益的預期。在大流行的影響持續存在的情況下，我們繼續關注增長、運營執行和支持我們所服務的社區。

Starting with the enterprise as a whole. Total fourth quarter adjusted revenues of $76.6 billion increased by 10.6% year-over-year. We reported adjusted operating income of $4.1 billion and adjusted EPS of $1.98, representing an increase of 40.8% and 52.3% versus prior year, respectively. For full year 2021, we reported total adjusted revenues of $292.1 billion, an increase of 8.8% versus prior year, reflecting robust growth across all business segments.

從企業整體做起。第四季度調整後總收入為 766 億美元，同比增長 10.6%。我們報告調整後營業收入為 41 億美元，調整後每股收益為 1.98 美元，分別比上年增長 40.8% 和 52.3%。 2021 年全年，我們公佈的調整後總收入為 2921 億美元，比上年增長 8.8%，反映了所有業務部門的強勁增長。

We delivered adjusted operating income of $17.3 billion and adjusted earnings per share of $8.40, up approximately 8.1% and 12% year-over-year, respectively. And we generated significant cash flow from operations of nearly $18.3 billion. This marks a record year of cash flow from operations for CVS Health and reflects the strength of our financial results, accelerated collections and focused improvements in our working capital position.

我們實現了 173 億美元的調整後營業收入和 8.40 美元的調整後每股收益，分別同比增長約 8.1% 和 12%。我們從近 183 億美元的運營中產生了大量現金流。這標誌著 CVS Health 運營現金流創紀錄的一年，反映了我們財務業績的實力、加速收款以及我們營運資金狀況的重點改善。

Turning to the Health Care Benefits segment. Fourth quarter adjusted revenue of $20.7 billion increased by 10.1% year-over-year, driven by membership growth in our Government Services business and lower COVID-19-related investments, slightly offset by the repeal of the health insurer fee. Adjusted operating income of $510 million grew by over 230% year-over-year driven by lower COVID-19-related investments and improved underlying performance, partially offset by higher COVID-related medical costs compared to prior year.

轉向醫療保健福利部分。第四季度調整後收入為 207 億美元，同比增長 10.1%，這得益於我們政府服務業務的會員增長和 COVID-19 相關投資的減少，但被健康保險公司費用的廢除略微抵消了。調整後的營業收入為 5.1 億美元，同比增長超過 230%，這得益於與 COVID-19 相關的投資減少和基礎績效的改善，但與上一年相比，與 COVID 相關的醫療費用增加部分抵消了。

Our adjusted medical benefit ratio of 87% improved 130 basis points year-over-year, driven by lower COVID-19-related investments, partially offset by the repeal of the health insurer fee. As a result of the Omicron variant, we experienced higher COVID testing and treatment costs in the fourth quarter, but this was largely offset by lower non-COVID costs, particularly in Medicare and Medicaid. Days claims payable at the end of the quarter was 49 and was, as expected, lower than the third quarter and consistent with normal seasonal trends and historic levels. Overall, we remain confident in the adequacy of our reserves.

我們調整後的醫療福利比率為 87%，同比提高 130 個基點，這主要是由於與 COVID-19 相關的投資減少，部分被健康保險公司費用的廢除所抵消。由於 Omicron 變體，我們在第四季度經歷了更高的 COVID 測試和治療成本，但這在很大程度上被較低的非 COVID 成本所抵消，特別是在醫療保險和醫療補助中。本季度末應付索賠天數為 49，如預期的那樣低於第三季度，符合正常的季節性趨勢和歷史水平。總體而言，我們對儲備的充足性仍然充滿信心。

In the Pharmacy Services segment, fourth quarter revenues of $39.3 billion increased by 8.2% year-over-year driven by increased pharmacy claims volume, growth in specialty pharmacy and brand inflation, partially offset by the impact of continued client price improvements. Total pharmacy membership increased by approximately 400,000 lives sequentially, reflecting sustained growth in government programs. Total pharmacy claims processed increased by 8.2%, above prior year. Approximately half of this growth was attributable to net new business in '21, with COVID-19 vaccine administration and new therapy prescriptions also contributing to the year-over-year growth.

在藥房服務部門，第四季度收入為 393 億美元，同比增長 8.2%，這主要受藥房索賠量增加、專業藥房增長和品牌通脹的推動，部分被客戶價格持續改善的影響所抵消。藥房會員總數按順序增加了約 400,000 人，反映出政府計劃的持續增長。處理的藥房索賠總額比上一年增加了 8.2%。這一增長的大約一半歸因於 21 年的淨新業務，COVID-19 疫苗管理和新治療處方也促進了同比增長。

Adjusted operating income of $1.8 billion grew 16.8% year-over-year, driven by improved purchasing economics, reflecting the products and services of our group purchasing organization and growth in specialty pharmacy. The quarter also reflected additional investments to support a successful welcome season.

調整後的營業收入為 18 億美元，同比增長 16.8%，這得益於採購經濟性的改善，反映了我們集團採購組織的產品和服務以及專業藥房的增長。該季度還反映了為支持成功的迎新季而進行的額外投資。

In our Retail/Long-Term Care segment, we delivered exceptional revenue and adjusted operating income growth versus prior year and once again exceeded our expectations. Fourth quarter revenue of $27.1 billion was up by 12.7% year-over-year, representing an increase of $3 billion. There are 2 main components to this increase: one, approximately 60% was driven by the administration of COVID-19 vaccines and testing, front store sales, including demand for over-the-counter COVID test kits and related treatment categories as well as strong COVID-related prescription volume.

在我們的零售/長期護理部門，與上一年相比，我們實現了出色的收入和調整後的營業收入增長，再次超出了我們的預期。第四季度收入為 271 億美元，同比增長 12.7%，增加了 30 億美元。這一增長有兩個主要組成部分：第一，約 60% 是由 COVID-19 疫苗和檢測的管理、店面銷售推動的，包括對非處方 COVID 檢測試劑盒和相關治療類別的需求以及強勁的需求與 COVID 相關的處方量。

The remaining 40% was attributable to a combination of underlying sustained pharmacy growth and broad strength in front store sales trends, partially offset by continued pharmacy reimbursement pressure. This strong revenue growth helped produce adjusted operating income of $2.5 billion. This quarterly result was 38% above prior year and significantly exceeded our forecasts.

其餘 40% 歸因於潛在的持續藥房增長和廣泛的門店銷售趨勢，部分被持續的藥房報銷壓力所抵消。這種強勁的收入增長幫助產生了 25 億美元的調整後營業收入。該季度業績比去年同期增長 38%，大大超出了我們的預期。

The increase in adjusted operating income was driven by a few key components: the administration of COVID-19 vaccines, underlying strength in pharmacy and front store sales and a $106 million gain from an antitrust legal settlement, which were partially offset by the combined impacts of ongoing but stable reimbursement pressure and business investments, including the minimum wage increase and store improvements.

調整後營業收入的增長是由幾個關鍵組成部分推動的：COVID-19 疫苗的管理、藥房和前店銷售的潛在實力以及反壟斷法律和解帶來的 1.06 億美元收益，這些收益部分被以下因素的綜合影響所抵消持續但穩定的報銷壓力和商業投資，包括最低工資增長和商店改善。

In terms of the improved performance in the quarter versus our expectations, there are 2 primary components. Approximately 75% was driven by vaccines, largely third dose boosters, which we previously expected to impact the first quarter of 2022. And the remaining 25% was driven by the nationwide surge in demand for over-the-counter and diagnostic COVID-19 testing, combined with stronger underlying front store sales performance.

就本季度業績與我們預期相比的改善而言，有兩個主要組成部分。大約 75% 是由疫苗推動的，主要是第三劑加強劑，我們之前預計這將影響 2022 年第一季度。剩下的 25% 是由全國范圍內對非處方和診斷性 COVID-19 測試的需求激增推動的，再加上更強勁的基礎店面銷售業績。

Looking at cash flow and the balance sheet. Our liquidity and capital position remained strong at the end of the fourth quarter, with full year cash flow from operations of nearly $18.3 billion and nonrestricted cash of over $3.8 billion. Through our proactive liability management transaction in December, we paid down $2.3 billion in long-term debt in the quarter, bringing the total long-term debt we have repaid since the close of the Aetna transaction to a net total of $21 billion.

查看現金流量和資產負債表。截至第四季度末，我們的流動性和資本狀況依然強勁，全年運營現金流接近 183 億美元，非限制性現金超過 38 億美元。通過我們 12 月份的主動負債管理交易，我們在本季度償還了 23 億美元的長期債務，使我們自 Aetna 交易結束以來已償還的長期債務總額淨額達到 210 億美元。

In addition, we returned over $2.6 billion to shareholders through our quarterly dividends in 2021.

此外，我們在 2021 年通過季度股息向股東返還了超過 26 億美元。

Our consistent outperformance during 2021 provides solid momentum as we head into this year, setting the stage for our continued strong outlook in 2022 despite multiple COVID unknowns that remain challenging to predict, such as additional variants, vaccine and testing protocols and government testing initiatives. As Karen noted earlier, we are maintaining our full year adjusted earnings per share guidance range of $8.10 to $8.30. We feel this is an appropriate stance at this early point in the year, especially given the earnings outperformance of retail in Q4 was due largely to the pull forward of third dose vaccine administration from 2022 into 2021. This represents 2% to 5% growth versus our revised 2021 adjusted earnings per share baseline of $7.92.

我們在 2021 年的持續優異表現為我們進入今年提供了堅實的動力，為我們在 2022 年的持續強勁前景奠定了基礎，儘管 COVID 的多個未知因素仍然難以預測，例如其他變體、疫苗和測試協議以及政府測試計劃。正如 Karen 之前指出的那樣，我們將全年調整後的每股收益指導範圍維持在 8.10 美元至 8.30 美元之間。我們認為在年初的這個時候這是一個合適的立場，特別是考慮到第四季度零售業的盈利表現主要是由於第三劑疫苗接種從 2022 年提前到 2021 年。這意味著 2% 至 5% 的增長與我們修訂後的 2021 年調整後每股收益基準為 7.92 美元。

As you think about the adjusted earnings per share baseline and year-over-year growth, I'd like to encourage you to keep a few things in mind. First, recall that our 2021 baseline of $7.92 removes items we do not forecast, prior year's development, net of profits returned to customers and net realized capital gains. It also includes the annualized impact of our investment in our colleagues through an increase in minimum wage. Second, it is also important to note that the baseline now includes a net favorable component attributable to COVID-19, driven by vaccines and testing of approximately $0.30 per share.

當你考慮調整後的每股收益基線和同比增長時，我想鼓勵你記住一些事情。首先，回想一下我們 2021 年 7.92 美元的基準去除了我們未預測的項目、前一年的發展、返還給客戶的利潤淨額和已實現資本利得淨額。它還包括我們通過提高最低工資對同事進行投資的年化影響。其次，同樣重要的是要注意，基線現在包括可歸因於 COVID-19 的淨有利部分，該部分由疫苗和測試驅動，約為每股 0.30 美元。

CVS Health continues to help lead the nation's COVID-19 pandemic response, clearly demonstrating the power of our integrated business model, consumer engagement and local community health destinations. While there is no change to our retail segment guidance, I would like to provide more detail on our COVID-19 retail volume assumptions for 2022.

CVS Health 繼續幫助領導國家應對 COVID-19大流行病，清楚地展示了我們綜合商業模式、消費者參與和當地社區健康目的地的力量。雖然我們的零售部門指南沒有變化，但我想提供更多關於 2022 年 COVID-19 零售量假設的詳細信息。

We expect that COVID-19 testing both in-store diagnostic and over-the-counter will continue at higher volumes than anticipated at Investor Day, offset by a reduced outlook on vaccines. In 2022, we expect vaccine volumes to decline approximately 70% to 80% and in-store diagnostic testing volumes to decline 40% to 50% compared to 2021. For over-the-counter test kits, we expect modest full year volume growth versus 2021.

我們預計，店內診斷和非處方 COVID-19 測試的數量將繼續高於投資者日的預期，但會被疫苗前景的下降所抵消。與 2021 年相比，我們預計 2022 年疫苗銷量將下降約 70% 至 80%，店內診斷檢測量將下降 40% 至 50%。對於非處方檢測試劑盒，我們預計全年銷量與 2021 年相比將適度增長2021.

Relative to vaccines, our outlook does not assume any impact from the administration of a fourth COVID-19 booster. As such, we expect the contribution of COVID-19 vaccines to be more heavily weighted to the first half of the year. As I mentioned, the impact of COVID-19 remains one of the most challenging aspects of developing our guidance due to many factors, including the risk of additional surges, potential new testing or vaccine protocols, legislative changes and OTC test kit dynamics such as supply challenges, coverage mandates and government initiatives. You will find additional details regarding our updated guidance in the slide presentation we posted to our website this morning.

相對於疫苗，我們的前景不假設第四次 COVID-19 助推器的管理會產生任何影響。因此，我們預計 COVID-19 疫苗的貢獻將在今年上半年佔據更大的權重。正如我所提到的，由於許多因素，COVID-19 的影響仍然是製定我們指南的最具挑戰性的方面之一，包括額外激增的風險、潛在的新測試或疫苗協議、立法變化和 OTC 測試套件動態，例如供應挑戰、覆蓋範圍任務和政府舉措。您可以在我們今天早上發佈到我們網站上的幻燈片演示中找到有關我們更新指南的更多詳細信息。

Turning to items that are below adjusted operating income on our income statement. We expect our interest expense for 2022 to be approximately $2.3 billion. We are purchasing shares to offset dilution. And as a result, we expect that diluted share count to be approximately flat versus 2021. Our expectation for the effective income tax rate is approximately 25.6%, consistent with 2021.

轉向我們損益表中低於調整後營業收入的項目。我們預計 2022 年的利息支出約為 23 億美元。我們正在購買股票以抵消稀釋。因此，我們預計攤薄後的股份數量將與 2021 年大致持平。我們對有效所得稅率的預期約為 25.6%，與 2021 年一致。

In terms of cash flow and capital deployment, we anticipate continued strong cash flow from operations in 2022, and we are updating our guidance range to $12 billion to $13 billion, reflecting the improved cash flow results for 2021. Capital expenditures are expected to be in the range of $2.8 billion to $3 billion as we invest in technology and digital enhancements to improve the consumer experience as well as our community locations. As we detailed in December, we remain committed to maintaining our investment-grade ratings, while also having the flexibility to deploy capital strategically for capability-focused M&A.

在現金流和資本配置方面，我們預計 2022 年運營現金流將持續強勁，我們將指導範圍更新為 120 億美元至 130 億美元，以反映 2021 年現金流結果的改善。資本支出預計將在28 億至 30 億美元的範圍，因為我們投資於技術和數字增強，以改善消費者體驗以及我們的社區位置。正如我們在 12 月詳述的那樣，我們仍然致力於維持我們的投資級評級，同時也可以靈活地戰略性地部署資本以進行以能力為中心的併購。

To conclude, the strong 2021 performance of CVS Health is expected to carry into 2022 as we continue to execute our strategy. We have solidified our leadership role in health care delivery as a trusted partner to our consumers and their communities. As we build upon this trust, we will continue to drive meaningful improvements that lower the cost of care, improve access and build engagement and convenience, ultimately enabling people to live healthier lives.

總而言之，隨著我們繼續執行我們的戰略，CVS Health 2021 年的強勁表現預計將延續到 2022 年。作為消費者及其社區值得信賴的合作夥伴，我們鞏固了我們在提供醫療服務方面的領導地位。在建立這種信任的同時，我們將繼續推動有意義的改進，以降低護理成本、改善可及性並建立參與度和便利性，最終使人們過上更健康的生活。

We will now open the call to your questions. Operator?

我們現在將打開您的問題的電話。操作員？

(Operator Instructions) We'll take our first question from Lisa Gill with JPMorgan.

（操作員說明）我們將從摩根大通的 Lisa Gill 那裡回答我們的第一個問題。

Karen, I just want to go back to the comment that you made about how to think about the stores in the future. Primary care, HealthHUB, enhanced and traditional, how do I think about the breakdown between each of those? And then secondly, you talked about making incremental acquisitions around health care services. Do you need to buy physicians to make the primary care clinics work? And how do I think about the other enhanced services that you'll bring to the overall CVS offering?

凱倫，我只想回到你關於如何考慮未來商店的評論。初級保健、HealthHUB、增強型和傳統型，我如何看待它們之間的細分？其次，你談到了圍繞醫療保健服務進行增量收購。您需要購買醫生才能使初級保健診所正常運轉嗎？我如何看待您將為整個 CVS 產品帶來的其他增強服務？

So let me just start with the 3 parts of the retail portfolio. As we said, we'll have primary care clinics, which would serve as a quarterback and serve as the patient's primary care medical home. And our HealthHUBs, the way you should think about HealthHUBs is they'll extend kind of the primary care for specific lower-risk use cases, which will allow us to expand the patient panel size with the primary care and obviously, lower cost. The HealthHUBs will also serve as that extender in virtual care.

因此，讓我從零售組合的 3 個部分開始。正如我們所說，我們將擁有初級保健診所，它們將充當四分衛並作為患者的初級保健醫療之家。而我們的 HealthHUBs，你應該考慮 HealthHUBs 的方式是它們將擴展針對特定低風險用例的初級保健，這將使我們能夠通過初級保健擴大患者小組的規模，顯然，成本更低。 HealthHUB 還將充當虛擬護理中的擴展器。

And our pharmacies will leverage kind of the existing touch points to provide the ancillary and complementary services like next best actions and medication adherence programs. And then you'd have the third ring, which would just be your typical CVS Pharmacy.

我們的藥房將利用現有的接觸點來提供輔助和補充服務，例如下一步最佳行動和藥物依從性計劃。然後你會有第三個戒指，這就是你典型的 CVS 藥房。

So if you think about -- we'll have a differentiated experience where we have the primary care clinics. We'll have coordinated assets. We'll bring the breadth of services. We'll connect through a single digital ecosystem. And then we'll have kind of -- and we'll invest in making sure that we're connecting the patient data, the provider workflows, that digital front end, so that we'll have a seamless patient and provider experience. That's the goal.

因此，如果您考慮一下 - 我們將在我們擁有初級保健診所的地方擁有與眾不同的體驗。我們將擁有協調的資產。我們將帶來廣泛的服務。我們將通過一個單一的數字生態系統進行連接。然後我們將有一種——我們將投資確保我們連接患者數據、提供者工作流程、數字前端，以便我們將擁有無縫的患者和提供者體驗。這就是目標。

Now you mentioned -- we mentioned at Investor Day, Lisa, that we would look at M&A activity to supplement our primary care services. We will -- we are continuing to evaluate our options there. And when we have more to talk about on that front, we'll be sure to share that with you.

現在你提到了——我們在投資者日提到過，麗莎，我們會考慮併購活動來補充我們的初級保健服務。我們將 - 我們將繼續在那裡評估我們的選擇。當我們在這方面有更多內容要討論時，我們一定會與您分享。

Karen, can you -- just when we think about the 3 and you think about the number of pharmacies, is there a way to put a number around them as far as like will 1/3 of them be primary care clinics, half of them? Is there any number that you've put around the number in each bucket?

凱倫，你能不能——當我們想到這 3 個，你想到藥房的數量時，有沒有辦法在它們周圍加上一個數字，比如其中 1/3 是初級保健診所，其中一半？每個桶中的數字周圍是否有任何數字？

Yes. I wouldn't specifically focus on a number. What we're really focusing in on is how do we have coverage. And if you think about our HealthHUBs and MinuteClinics today, we actually have coverage of 45% of the U.S. -- a little bit over 45% of the U.S. population. So we wouldn't -- and we'd want to have good, strong coverage for our Aetna and our Caremark health plan customers as well. So I look at it as coverage, not necessarily numbers.

是的。我不會特別關註一個數字。我們真正關注的是我們如何獲得報導。如果你想想我們今天的 HealthHUBs 和 MinuteClinics，我們實際上覆蓋了美國 45% 的人口——略高於美國人口的 45%。所以我們不會 - 我們希望為我們的 Aetna 和我們的 Caremark 健康計劃客戶提供良好、強大的覆蓋範圍。所以我將其視為覆蓋範圍，不一定是數字。

We'll take our next question from Lance Wilkes with Bernstein.

我們將與伯恩斯坦一起接受 Lance Wilkes 的下一個問題。

Kind of a related question on the primary care strategy and, overall, how you integrate that in with Aetna. I was interested in what sorts of patient types, and I'm thinking about like segments such as Medicare, Medicaid and employer you'd be more focused on for the primary care? And if that helps you to define what sorts of capabilities you're looking to add and/or targets?

這是一個關於初級保健策略的相關問題，總體而言，您如何將其與 Aetna 整合。我對什麼樣的患者類型感興趣，我在考慮像醫療保險、醫療補助和雇主這樣的細分市場，你會更關注初級保健？如果這有助於您定義您希望添加和/或定位的功能類型？

I'll start, and I'll ask Shawn to supplement here. What we said was we would look -- obviously, Medicare is our largest growth driver. We've been very successful, as I mentioned, to you with our growth. That is a growth engine for the company. So we would be focused on that. But not -- primarily, obviously, these clinics would serve a variety of different patients, and we would build them out. So we would have the opportunity to support other members with our -- with those primary care clinics. And let me ask Shawn to add here.

我先開始了，這裡請Shawn補充。我們說的是我們會看——顯然，醫療保險是我們最大的增長動力。正如我提到的，我們的成長對您來說非常成功。這是公司的增長引擎。所以我們會專注於此。但不是 - 主要是，很明顯，這些診所會為各種不同的患者提供服務，我們會建造它們。因此，我們將有機會通過我們的那些初級保健診所來支持其他成員。讓我請 Shawn 在此處添加。

Yes. No, Lance. I would agree with that. I mean I think that our long-term aspiration, especially given the size of the company, right, is to have sort of a broad cross-section of customer types. But clearly, Medicare is an important business for Aetna. Frankly, the preponderance of chronic conditions in that population, I think, make it a population that would benefit tremendously sort of from the strategy. And obviously, today, there's also an economic model that works there.

是的。不，蘭斯。我同意這一點。我的意思是我認為我們的長期願望，尤其是考慮到公司的規模，對的，是擁有廣泛的客戶類型。但顯然，Medicare 是 Aetna 的一項重要業務。坦率地說，我認為，該人群中慢性病佔優勢，使其成為將從該戰略中受益匪淺的人群。顯然，今天，還有一種經濟模式在那裡運作。

So Medicare is important for a variety of reasons. But ultimately, we would look to serve the local communities and the populations that exist. And I think the footprint and the nature of sort of our community assets will flex to serve the local populations. But Medicare is key, but the ultimate aspiration is a broad cross-section of customers.

因此，出於多種原因，Medicare 很重要。但最終，我們希望為當地社區和現有人口服務。而且我認為我們社區資產的足跡和性質將靈活地為當地居民服務。但醫療保險是關鍵，但最終的願望是擁有廣泛的客戶群。

Should we think of the additional health services that you'd be looking at as also being kind of focused maybe initially more on Medicare like home care and those sorts of areas as potential expansion targets?

我們是否應該將您正在考慮的其他醫療服務也考慮為可能最初更多地關注家庭護理等醫療保險，並將這些領域作為潛在的擴展目標？

Yes. It's hard to predict the exact order with which things will potentially show up if you're -- if this is something you decide that you'd rather acquire than build. But yes, absolutely, things that make sense to sort of extend sort of the care continuum, again, particularly to a Medicare population would make a lot of sense and they'd be high on the list.

是的。很難預測事物可能出現的確切順序，如果你是——如果這是你決定寧願獲得而不是建造的東西。但是，是的，絕對是，對延長某種程度的護理連續體有意義的事情，尤其是對醫療保險人群來說，會很有意義，而且它們會排在首位。

And our next question will come from Matthew Borsch with BMO Capital Markets.

我們的下一個問題將來自 BMO Capital Markets 的 Matthew Borsch。

Medicare Advantage, there's been a lot of chatter, as you well know about, increased competition being an issue for some of the other companies. Are you confident in your growth strategy coming into this year given all that sort of backlash from competitors and the very impressive growth numbers that you're pointing to that you achieved from the open enrollment?

Medicare Advantage，正如你所知，有很多人在談論，競爭加劇是其他一些公司的一個問題。鑑於競爭對手的強烈反對以及您指出的公開招生取得的令人印象深刻的增長數字，您對今年的增長戰略有信心嗎？

Matt, we've had a long-standing growth strategy for Medicare. And I'd just remind everyone that we have a broad portfolio of Medicare products that isn't just focused on individual. We have group Medicare, our PDP business and Med Sup. We had a very strong open enrollment period. We attribute that obviously to our strength in our product designs, our STARs performance, our products and services, our connections with the broader portfolio of assets that we have.

馬特，我們有一個長期的醫療保險增長戰略。我只想提醒大家，我們擁有廣泛的 Medicare 產品組合，不僅僅針對個人。我們有團體醫療保險、我們的 PDP 業務和 Med Sup。我們有一個非常強大的開放註冊期。我們顯然將這歸因於我們在產品設計、STAR 性能、產品和服務以及與我們擁有的更廣泛資產組合的聯繫方面的優勢。

As we look to 2023, clearly, the rate notice was positive. It looked like CMS was keeping with the stability that will allow us to have continued flexible benefit design. So we're confident in our strategy. Obviously there, it's a competitive marketplace, and we'll continue to play to our strengths. And let me ask Dan if he has anything he wants to add here.

展望 2023 年，利率通知顯然是積極的。看起來 CMS 保持了穩定性，這將使我們能夠繼續進行靈活的福利設計。所以我們對我們的戰略充滿信心。顯然，這是一個競爭激烈的市場，我們將繼續發揮我們的優勢。讓我問丹，他是否有什麼要補充的。

Thanks, Karen. I think you said it really well. Look, we've been really deliberate around our growth strategy here across the entire portfolio, making sure that we can provide really solid benefits to the senior population, really focused on our footprint coverage, inclusive of our D-SNP and that played out during AEP. And so like you said, we feel really confident in our growth expectations for 2022.

謝謝，凱倫。我覺得你說的真好。看，我們一直在認真考慮我們在整個投資組合中的增長戰略，確保我們能夠為老年人口提供真正可觀的福利，真正專注於我們的足跡覆蓋範圍，包括我們的 D-SNP 以及在AEP。所以就像你說的，我們對 2022 年的增長預期充滿信心。

And we'll take our next question from Steven Valiquette with Barclays.

我們將從巴克萊銀行的 Steven Valiquette 那裡回答我們的下一個問題。

I was also going to ask a question on Medicare, so part of it was answered. But I guess at an investor conference last month, you guys touched on your internal distribution capabilities for individual MA. So I'm curious if you're able just to provide more color on the mix of how much of your -- either the total MA book or just the membership growth in the MA book is driven by the internal sales distribution and marketing capabilities versus the external channels.

我也想問一個關於Medicare的問題，所以回答了一部分。但我想在上個月的一次投資者會議上，你們談到了你們個人 MA 的內部分配能力。所以我很好奇你是否能夠提供更多的顏色來說明你的 MA 書籍總數或只是 MA 書籍中的會員增長是由內部銷售分佈和營銷能力驅動的，而不是外部渠道。

Yes. So Steve, we have a number of distribution channels that we rely on for Medicare growth. Clearly, we have the national distribution, the tele service and our own internal proprietary channel. And we've had pretty good strength across all those channels. Obviously, we continue -- the other thing we did this year too is we added resource centers in the CVS Health locations so that people could get educated on Medicare more broadly.

是的。所以史蒂夫，我們有許多分銷渠道，我們依賴這些渠道來實現醫療保險的增長。顯然，我們擁有全國分銷、電話服務和我們自己的內部專有渠道。我們在所有這些渠道上都擁有相當不錯的實力。顯然，我們會繼續——我們今年做的另一件事也是在 CVS Health 地點增加了資源中心，以便人們可以更廣泛地接受 Medicare 方面的教育。

I think what's important to look at is the distribution of the book in Medicare, not necessarily where the current sales are going because that gives you a sense for kind of the future persistency. We had very strong retention across all of our distribution channels and feel good that we have the right focus on the distribution channels. Coupled with that is our marketing capabilities. And what we've done -- we continue to do is really gear our marketing capabilities towards growth areas in the market, and that has served us well; that generated solid growth for us. But let me see if Dan has anything to add here as well.

我認為重要的是要看這本書在 Medicare 中的分佈情況，不一定是當前的銷售情況，因為這會讓你對未來的持久性有所了解。我們在所有分銷渠道中都有很強的保留率，並且很高興我們對分銷渠道的關注是正確的。再加上我們的營銷能力。我們所做的——我們將繼續做的是真正將我們的營銷能力調整到市場的增長領域，這對我們很有幫助；這為我們帶來了穩健的增長。但是讓我看看 Dan 是否也有什麼要補充的。

Karen, I think you said it really well. Look, our strategy is to really use our diversified distribution channels for growth, digital, our personnel, our partners. We do have a robust internal sales force, and I think that the results really speak to our ability to optimize success across all of those channels.

凱倫，我覺得你說得很好。看，我們的戰略是真正利用我們多元化的分銷渠道來實現增長、數字化、我們的人員、我們的合作夥伴。我們確實擁有一支強大的內部銷售隊伍，我認為結果確實說明了我們在所有這些渠道中優化成功的能力。

And we'll take our next question from Michael Cherny with Bank of America.

我們將接受來自美國銀行的 Michael Cherny 的下一個問題。

Shawn, I think you said something I just want to clarify regarding the baseline, and that there's roughly $0.30 of COVID-related impact that's now in the baseline. A, I just want to make sure you got that right -- or I got that right.

肖恩，我想你說了一些我只想澄清的關於基線的事情，現在基線中與 COVID 相關的影響大約為 0.30 美元。答，我只是想確保你做對了——或者我做對了。

And then b, regarding that and how it factors into the store performance, clearly, II don't think anyone's expecting double-digit same-store growth for forever with this business. But as you get further towards what hopefully is the far side of the pandemic, what are the signs you're seeing relative to the new customers you brought into the stores and how you can continue to make them customers in a post-testing, post-vaccine world?

然後 b，關於這一點以及它如何影響商店業績，很明顯，我認為沒有人期望這項業務永遠保持兩位數的同店增長。但是，當你進一步接近大流行病的另一端時，你看到的與你帶入商店的新顧客相關的跡像是什麼，以及如何在後期測試中繼續讓他們成為顧客，發布-疫苗世界？

Yes. Yes. And let me start on the first, and I'll give you some insight, and I'll have Michelle or Karen talk a little bit about sort of the customer acquisition. But going back to the $0.30, you are correct. So for most of this year, when we've looked at the effect of COVID for the organization, it's been neutral, plus or minus, between the pressure in HCB and the revenue we're getting on the retail side. In the fourth quarter, one way to think about it is we had about a $0.40 fee and almost $0.30 of that was sort of sitting in the vaccine and testing, including the OTC line. And HCB came in relatively consistent with expectations.

是的。是的。讓我從頭開始，我會給你一些見解，我會讓 Michelle 或 Karen 談談一些關於客戶獲取的事情。但回到 0.30 美元，你是對的。因此，在今年的大部分時間裡，當我們研究 COVID 對組織的影響時，在 HCB 的壓力和我們在零售方面獲得的收入之間，它是中性的，正或負。在第四季度，一種思考方式是我們有大約 0.40 美元的費用，其中將近 0.30 美元用於疫苗和測試，包括 OTC 線。 HCB 的表現相對符合預期。

So we've gone from having this be a neutral item to being about a 30% contributor during the year, all really kind of manifesting itself in the fourth quarter. And you're right. I mean obviously, in 2022, the revenue from this stream of vaccine and diagnostic testing and OTC testing will decrease significantly. But we have seen kind of in what I call new customer acquisition, we have seen a lot more traffic in the stores, and that's manifesting itself in more prescriptions and increased basket sizes in some instances. So it's an excellent question that I think we're going to continue to work on, which is how do we maintain that momentum. But we definitely have built some momentum beyond sort of the direct COVID kind of product line here.

所以我們已經從一個中性項目變成了年內約 30% 的貢獻者，所有這些都在第四季度真正體現出來。你是對的。我的意思是，到 2022 年，疫苗和診斷測試以及 OTC 測試的收入將大幅減少。但我們已經看到了我所謂的新客戶獲取，我們看到商店的客流量增加了很多，這在某些情況下表現為更多的處方和增加的購物籃尺寸。所以這是一個很好的問題，我認為我們將繼續努力，這就是我們如何保持這種勢頭。但我們肯定已經建立了一些超越直接 COVID 產品線的勢頭。

And Shawn, I would just add from a loyalty perspective, 3 things. First, the most important thing we've been working on is making sure that everybody who comes through the door has a great experience. And we've seen overall satisfaction for vaccines and testing is extremely strong. Secondly, using this to drive digital adoption, we see many of these customers come back to get their QR code, their vaccine record and then do things like next best actions, potentially other vaccines that they need to take and the like. So we're seeing strong digital adoption from these customers.

肖恩，從忠誠度的角度來看，我只想補充三件事。首先，我們一直在做的最重要的事情是確保每個進來的人都有很好的體驗。我們已經看到對疫苗和測試的總體滿意度非常高。其次，利用它來推動數字化採用，我們看到許多這樣的客戶回來獲取他們的二維碼、他們的疫苗記錄，然後採取下一步最佳行動、他們可能需要接種的其他疫苗等。因此，我們看到這些客戶對數字技術的廣泛採用。

And finally, our loyalty programs are critical. You heard Karen mention CarePass is up over 40% year-over-year. When people become CarePass members, we see incremental engagement. And so it's critical as you build loyalty and retention amongst our many new customers.

最後，我們的忠誠度計劃至關重要。您聽說 Karen 提到 CarePass 同比增長超過 40%。當人們成為 CarePass 會員時，我們會看到越來越多的參與。因此，當您在我們眾多新客戶中建立忠誠度和保留率時，這一點至關重要。

Yes. And Michael, let me just clarify. I might have said 30% and I meant $0.30. I think that was clear, but just to be abundantly clear. It was $0.30 I was talking about.

是的。邁克爾，讓我澄清一下。我可能會說 30%，我的意思是 0.30 美元。我認為這很清楚，但只是非常清楚。我說的是 0.30 美元。

And we'll take our next question from Charles Rhyee with Cowen.

我們將與 Cowen 一起接受 Charles Rhyee 的下一個問題。

Just wanted to touch on in the 10-K it was disclosed about the CID. And I know you've been working with the DOJ. But maybe if you could just kind of give sort of your broad thoughts on opioids and sort of the company's stance here currently.

只是想談談在 10-K 中披露的關於 CID 的信息。我知道你一直在與司法部合作。但也許如果你能給出你對阿片類藥物的廣泛想法以及公司目前的立場。

Shawn, do you want to grab that one?

肖恩，你想抓住那個嗎？

Yes. Yes, of course. So I think our stance here is very similar to where it's been all along. Our fundamental position is that these prescriptions were written by doctors, not pharmacists. We did not manufacture or market these. And the health care system does rely on pharmacists to fill legitimate prescriptions that doctors are deeming necessary.

是的。是的當然。所以我認為我們在這裡的立場與一直以來的立場非常相似。我們的基本立場是，這些處方是醫生開的，不是藥師開的。我們沒有製造或銷售這些。醫療保健系統確實依賴藥劑師開出醫生認為必要的合法處方。

So based on that, we strongly disagree with the recent court decision in Ohio, and we look forward to the appellate court review of that case. And I'll remind you there that that was a ruling on liability only, not on damages. But -- and like any litigation, we will -- if we think it's in our interest, in the company's interest to sort of resolve matters, we will. But at this point, it's still very early and there's a lot to play out and we remain pretty firmly convicted in our position.

因此，基於此，我們強烈反對俄亥俄州最近的法院判決，我們期待上訴法院對該案進行複審。我會在那裡提醒你，那隻是關於責任的裁決，而不是關於損害賠償的裁決。但是——就像任何訴訟一樣，我們會——如果我們認為解決問題符合我們的利益，符合公司的利益，我們會的。但在這一點上，還為時過早，還有很多事情要做，我們仍然堅信自己的立場。

And we'll take our next question from Kevin Caliendo with UBS.

我們將從瑞銀的 Kevin Caliendo 那裡回答下一個問題。

You said earlier you weren't expecting -- your guidance doesn't assume a fourth booster shot, but are you contemplating another -- a different or later COVID surge this year? And how would that -- how do you think a new COVID surge might impact the cadence for the year or the Health Care Benefits business, given we have a potential drug that keeps people out of the hospital? And/or if there's no vaccine, how it would impact the retail part of the business?

你之前說過你沒有預料到——你的指導意見沒有假設第四次加強注射，但你是否在考慮另一個——今年不同的或更晚的 COVID 激增？鑑於我們有一種可以讓人們遠離醫院的潛在藥物，你認為新的 COVID 激增會如何影響今年的節奏或醫療保健福利業務？和/或如果沒有疫苗，它將如何影響業務的零售部分？

Yes. So we are not, Kevin, forecasting a surge later in the year, a la whether it be Delta or Omicron. And again, all of these have been a little bit different. But I'd remind everybody that we have had -- we have 2 business -- large businesses that have tended to move in opposite directions in these surges and which have largely allowed us to sort of navigate them successfully.

是的。因此，凱文，我們並沒有預測今年晚些時候會出現激增，無論是 Delta 還是 Omicron。再一次，所有這些都有點不同。但我要提醒大家，我們有 - 我們有 2 個業務 - 大型企業在這些浪潮中往往朝相反的方向發展，這在很大程度上使我們能夠成功地駕馭它們。

So I would say our overall cadence of earnings right now with that assumption is actually very similar to '21, a little bit more than half the earnings are in the front of the year. It's all hypothetical, but if we -- we don't have a lot of vaccine volume, for example, right now in the second half of the year. So if that did pick up or if there was a fourth booster or if there was even more testing activity, that would be certainly something that would sort of lift that on the retail side. But obviously, we'd have some of the offset on the HCB side.

所以我想說，我們現在的整體收益節奏實際上與'21非常相似，一半以上的收益是在今年的前面。這都是假設，但如果我們——例如，我們現在在今年下半年沒有大量的疫苗。因此，如果這種情況確實有所好轉，或者如果有第四個助推器，或者如果有更多的測試活動，那肯定會在某種程度上提振零售方面的情況。但顯然，我們在 HCB 方面會有一些抵消。

So there are a lot of moving parts, but we've been fortunate to sort of navigate, frankly, both the surges because of the kind of the opposite performances of these 2 businesses in the face of the surge.

所以有很多變動的部分，但坦率地說，我們很幸運能夠駕馭這兩次激增，因為這兩家企業在面對激增時表現相反。

We'll take our next question from A.J. Rice with Credit Suisse.

我們將接受 A.J. 的下一個問題。瑞士信貸的大米。

I thought I might ask about the at-home testing. Obviously, there's been a lot of discussion about the mandate for commercial insurers to cover that and so forth. You're saying in your guidance, I guess, you've got modest year-to-year growth. I'm assuming that a lot of that would be what you've seen in January.

我想我可能會問有關在家測試的問題。顯然，已經有很多關於商業保險公司承保的授權等問題的討論。你在你的指導中說，我猜，你有適度的年度增長。我假設其中很多是您在 1 月份看到的情況。

Can you comment on sort of beyond the first quarter? Do you really have much continued at-home testing? And maybe give a little bit of flavor for your strategy on the retail side as well as on the benefits side: network, out of network, how you're dealing with the different ways that you can potentially cover that on the benefit side and then participate on the retail side.

你能評論一下第一季度之後的情況嗎？您真的有很多持續的在家測試嗎？也許在零售方面和收益方面為您的策略提供一點風味：網絡，網絡外，您如何處理可能在收益方面涵蓋的不同方式，然後參與零售方面。

A.J., I'm happy to start on the forecast, and I can have Karen and/or Michelle sort of talk about the other side. But most of the OTC test volume is in the first quarter right now, in the first -- certainly the first half of the year in our forecast. The year-over-year comparisons are a little funny here because we really didn't have any meaningful volume until the third quarter and almost all the volume is in the fourth quarter. So that was pretty back-end loaded in '21. And conversely, our forecast, I think, is it's pretty front-end loaded right now.

A.J.，我很高興開始預測，我可以讓 Karen 和/或 Michelle 談談另一面。但大部分 OTC 測試量現在是在第一季度，在我們的預測中，當然是在今年上半年。同比比較在這裡有點有趣，因為直到第三季度我們才真正有任何有意義的交易量，而且幾乎所有交易量都在第四季度。所以這是在 21 年加載的漂亮後端。相反，我認為，我們的預測是它現在是前端加載的。

Obviously, there's a lot of dynamics here that are moving around, whether it be the insurance coverage of the benefit, the free test from the government, supply chain issues. This is a great example of an area where there's an awful lot of moving pieces that make the forecasting challenges. But I think this is also a good example of something that I think we will largely see play out in Q1 and hopefully have a more informed view on this for the full year.

顯然，這裡有很多動態變化，無論是福利的保險範圍、政府的免費測試、供應鏈問題。這是一個很好的例子，在這個領域中，有大量的變動因素給預測帶來了挑戰。但我認為這也是一個很好的例子，我認為我們將在第一季度看到它在很大程度上發揮作用，並希望在全年對此有更明智的看法。

And A.J., the kind of way we think about it is more testing could lead to earlier diagnosis. And when it's necessary, you could see COVID therapeutics and help minimize the spread of the disease and drive fewer hospitalizations. Relative to the benefits, let me ask Dan to just comment on how we're thinking about coverage and actually what we're doing today.

A.J.，我們認為更多的測試可以導致更早的診斷。在必要時，您可以看到 COVID 療法並幫助最大限度地減少疾病的傳播並減少住院治療。關於好處，讓我請 Dan 就我們如何考慮覆蓋範圍以及我們今天實際上在做什麼發表評論。

Yes. Thanks, Karen. I mean our top priority has really been to ensure that our members have access to the tests in a really convenient way. Obviously, supply plays into this. And so early on, as we're looking at making sure that our members have access, we're using our broad network opportunities. But we are working very closely with our retail partners to bring a more convenient digital solution into play that can be even more convenient for our members.

是的。謝謝，凱倫。我的意思是，我們的首要任務確實是確保我們的成員能夠以一種非常方便的方式進行測試。顯然，供應發揮了作用。所以在早期，當我們正在考慮確保我們的成員能夠訪問時，我們正在利用我們廣泛的網絡機會。但我們正在與我們的零售合作夥伴密切合作，以引入更方便的數字解決方案，為我們的會員帶來更多便利。

Yes. And maybe I'll have Michelle comment on. We are -- we have -- part of our strategy is to become digitally oriented, and we're working on a new digital strategy. So Michelle, maybe share what was in that.

是的。也許我會讓米歇爾發表評論。我們 - 我們已經 - 我們戰略的一部分是面向數字化，我們正在製定新的數字戰略。米歇爾，也許可以分享其中的內容。

Sure thing, Karen. Just like we did with vaccine and testing, our aim is to provide the best experience for consumers, and next week (inaudible) online, enter their information and immediately, be adjudicated and figure out the stores near them. Pick up the stores -- pick up the test kits in that store for free. So it will be an incredibly smooth digital experience for our customers. So we're excited to launch that next week.

當然可以，凱倫。就像我們在疫苗和測試方面所做的那樣，我們的目標是為消費者提供最佳體驗，下週（聽不清）在線輸入他們的信息，並立即進行裁決並找出他們附近的商店。去商店取貨——在那家商店免費取測試套件。因此，對於我們的客戶來說，這將是一種難以置信的流暢數字體驗。所以我們很高興下週推出它。

And we will take our next question from Stephen Baxter with Wells Fargo.

我們將接受來自富國銀行的斯蒂芬巴克斯特的下一個問題。

I wanted to ask about the labor market and your latest thinking there. Obviously, some headlines during the quarter for challenges on the staffing side. And in the release, you mentioned that you hired 45,000 associates through a virtual career day. That seems like a pretty big number relative to the size of your workforce. Hopefully, you can give us an update on where that puts you for staffing today, how many open positions you have, how turnover is trending and how you're thinking your strategy on labor play out from here.

我想問一下勞動力市場和你最近對那裡的看法。顯然，本季度的一些頭條新聞是關於人員配置方面的挑戰。在新聞稿中，您提到您通過虛擬職業日僱傭了 45,000 名員工。相對於您的勞動力規模，這似乎是一個相當大的數字。希望您能向我們提供最新信息，說明您今天的人員配備情況、您有多少空缺職位、人員流動趨勢如何以及您如何看待您的勞動力策略從這裡開始發揮作用。

As you know, talent is always our top priority. And as you mentioned, we have been strengthening our workforce despite a very tight labor market. We did have significant hiring throughout the year. And as you might imagine, we weren't immune to some of the Omicron issues. Some of our colleagues did get sick, but we were able to maintain strong stores -- store hours and pharmacy hours across the country.

如您所知，人才始終是我們的首要任務。正如你提到的，儘管勞動力市場非常緊張，但我們一直在加強我們的勞動力。全年我們確實有大量招聘。正如您可能想像的那樣，我們無法避免某些 Omicron 問題。我們的一些同事確實生病了，但我們能夠維持強大的商店——全國各地的商店營業時間和藥房營業時間。

This is a big focus. I think the minimum wage that we mentioned that we put in place has helped us. Keep in mind that I continue to evaluate that minimum wage to see if there's more that we could or should be doing as we continue to address labor shortages in the country.

這是一個很大的重點。我認為我們提到的最低工資對我們有所幫助。請記住，我將繼續評估最低工資，看看在我們繼續解決該國勞動力短缺問題時，我們是否可以或應該做更多的事情。

We'll take our next question from Justin Lake with Wolfe.

我們將與 Wolfe 一起接受 Justin Lake 的下一個問題。

Just wanted to see if I can follow up with a little bit more detail on the membership side. Hoping you can run us through maybe what you're expecting on the Commercial risk book, how you're thinking Medicaid redeterminations play out and how that impacts your Medicaid membership. And I'm not sure if you gave a specific Medicare Advantage membership number that I might have missed.

只是想看看我是否可以跟進更多關於會員方面的細節。希望你能告訴我們你對商業風險書的期望，你是如何看待醫療補助重新決定的，以及這對你的醫療補助會員資格有何影響。我不確定您是否提供了我可能錯過的特定 Medicare Advantage 會員編號。

Thanks. Dan, do you want to grab that?

謝謝。丹，你想抓住那個嗎？

Yes, sure. So let me take those in part. I mean first of all, as Karen mentioned, the Commercial book, we've seen some really strong retention in the fourth quarter certainly related to national accounts. In the fourth quarter, we also saw continuing strong retention and strong sales. We also saw a little bit of shift in that change in force dynamics due to the pandemic that we were expecting, which is good, and that's leading to our lower single-digit growth overall there.

是的，當然。所以讓我把這些部分。我的意思是，首先，正如凱倫提到的那樣，商業書籍，我們在第四季度看到了一些非常強勁的保留，這肯定與國民賬戶有關。在第四季度，我們還看到了持續強勁的保留率和強勁的銷售。我們還看到，由於我們預期的大流行，力量動態的變化發生了一點變化，這很好，這導致我們在那裡的整體增長率較低。

As far as Medicare, we had mentioned really strong AEP season. The team is really focused on OEP and making sure that we sustain that momentum. And so we're really confident in our ability to deliver on that double-digit individual growth in 2022.

至於醫療保險，我們提到了非常強勁的 AEP 季節。該團隊真正專注於 OEP 並確保我們保持這種勢頭。因此，我們對我們在 2022 年實現兩位數個人增長的能力充滿信心。

And then the last piece is the Medicaid piece. Look, we're following the PHE really, really closely. Redeterminations are obviously something that we're watching as it relates to that. I think it's reasonable to expect that the suspension of redeterminations will continue through the second quarter, and then we'll be monitoring it closely. And of course, working with our state partners to make sure that when that does occur, that's timely and appropriate. We don't consider that to be a sort of a day 1 event, it will be a gradual process, but we'll work closely with the states around that.

最後一塊是醫療補助計劃。看，我們非常非常密切地關注 PHE。重新確定顯然是我們正在關注的事情，因為它與此相關。我認為暫停重新確定將持續到第二季度是合理的，然後我們將密切關注它。當然，與我們的州合作夥伴合作以確保當這種情況發生時是及時和適當的。我們不認為這是第一天的活動，這將是一個漸進的過程，但我們將與各州密切合作。

But just to be clear, if your membership guidance, I think, is flat to up slightly for the year and Medicare Advantage is going to grow, give or take, maybe 300,000 members, is most of that decline going to be in Medicaid to kind of offset the growth in Medicare Advantage? Or is Commercial also going to decline year-over-year?

但需要明確的是，如果你的會員指南，我認為，在今年持平到略有上升，而 Medicare Advantage 將增長，給予或減少，可能有 300,000 名會員，那麼大部分下降將在 Medicaid 中實現抵消醫療保險優勢的增長？還是商業也將同比下降？

Yes. It will be mostly focused on Medicaid. That component of the redetermination is at play. But recall, we also had a large known group that's coming off the books in Medicaid as well.

是的。它將主要集中在醫療補助計劃上。重新確定的那個組成部分正在發揮作用。但回想一下，我們也有一個知名的大型團體，他們也在醫療補助計劃中脫穎而出。

We'll take our next question from Eric Percher with Nephron Research.

我們將接受 Nephron Research 的 Eric Percher 的下一個問題。

Eric Percher and Josh Raskin here. A question related to labor maybe in the back of the store. In 4Q, did Omicron require you to change either ramp to ramp up or stop a ramp down relative to what expectations of needs in the back of the store are? And how do you view the flexibility of labor in the back of the store as you see a decline in vaccine and tests? And is some of that offset by the desire to have the pharmacist providing more services from the store?

埃里克·珀徹 (Eric Percher) 和喬希·拉斯金 (Josh Raskin)。與勞動有關的問題可能在商店後面。在第 4 季度，Omicron 是否要求您根據商店後面的需求預期改變斜坡以增加或停止斜坡？當您看到疫苗和測試數量下降時，您如何看待商店後面勞動力的靈活性？希望藥劑師從商店提供更多服務的願望是否抵消了其中的一部分？

Go ahead, Prem.

來吧，普雷姆。

Yes. Thanks, Eric. This is Prem. It's a great question. So we are obviously doing 3 things. One is if you think about how we're thinking about our pharmacy assets and what I would say is consumer-led, digitally focused, really taking out a lot of work that would be duplicative or challenging, so creating efficiencies in the back of the store.

是的。謝謝，埃里克。這是普雷姆。這是一個很好的問題。所以我們顯然在做三件事。一是如果你考慮一下我們是如何考慮我們的藥房資產的，我想說的是以消費者為主導，以數字為中心，真正消除了大量重複或具有挑戰性的工作，從而在背後創造效率店鋪。

The part of your question around Omicron, it absolutely led to a little bit of what I would say is stress, right? We saw vaccination volumes grow very quickly and then come down. So that also -- we were able to absorb that and be able to deliver that care in a very, what I'd say, is high customer value way in the back of the store in December and in January.

你關於 Omicron 的問題部分，它絕對導致了一點我所說的壓力，對吧？我們看到疫苗接種量增長非常快，然後又下降了。因此，我們也能夠吸收這一點，並能夠在 12 月和 1 月以一種非常高的客戶價值方式在商店後面提供這種護理。

And we're definitely continuing to look at our back of the store and creating what I'd say is a digital-first experience for consumers, but also creating efficiencies across stores when you look at our pharmacy assets and how we can leverage those efficiencies across stores in the back of the store. So absolutely looking at that. There's more to come. And we see a tremendous opportunity there with our large fleet of stores to really maximize our efficiencies.

而且我們肯定會繼續關注我們的商店背面，並為消費者創造我所說的數字優先體驗，但當您查看我們的藥房資產以及我們如何利用這些效率時，也會提高整個商店的效率穿過商店後面的商店。所以絕對看那個。還有更多。我們在那裡看到了一個巨大的機會，我們的大型門店可以真正最大限度地提高我們的效率。

We'll take our final question from Nathan Rich with Goldman Sachs.

我們將與高盛一起接受 Nathan Rich 的最後一個問題。

Karen, if I could maybe go back to your comments on the primary care strategy. You talked about the need to have a digital platform to connect the physical assets that you have. Is that the starting point for this strategy as you think about kind of integrating primary care into the CVS Health business? And do you see this as something that you'd look to develop internally? Or could you look externally for these capabilities as we think about the best way to scale this strategy?

凱倫，如果我可以回到你對初級保健策略的評論。您談到需要有一個數字平台來連接您擁有的實物資產。當您考慮將初級保健整合到 CVS Health 業務中時，這是該戰略的起點嗎？您是否認為這是您希望在內部開發的東西？或者，在我們考慮擴展該戰略的最佳方式時，您是否可以從外部尋找這些能力？

Thanks for that question, Nathan. I think digital is a part of the strategy, it's not necessarily the driver. I think it's important when you think about the connectivity of care, the continuity of care, the seamless experience, you have to have those digital connections. So that will be part of our overall strategy. And we will continue to look at what we can do internally versus what opportunities there are externally as we think about tech stacks and things like that in target companies that we're looking at today.

謝謝你提出這個問題，內森。我認為數字化是戰略的一部分，不一定是驅動力。我認為重要的是，當您考慮護理的連通性、護理的連續性、無縫體驗時，您必須擁有這些數字連接。所以這將是我們整體戰略的一部分。我們將繼續研究我們在內部可以做什麼，而不是在我們考慮技術堆棧以及我們今天正在尋找的目標公司中的類似事物時，外部有哪些機會。

So I'm going to wrap up the call. So first of all, thank you all for joining us today. As we said, 2021 was really marked by strong financial performance across all of our businesses and very good progress on our strategy. And we are entering into 2022 with very powerful momentum and strong growth across all our businesses. So thank you for joining our call today.

所以我要結束通話。首先，感謝大家今天加入我們。正如我們所說，2021 年的真正標誌是我們所有業務的財務表現強勁，我們的戰略取得了非常好的進展。我們將以非常強勁的勢頭和所有業務的強勁增長進入 2022 年。感謝您今天加入我們的電話會議。

Thank you. And this does conclude today's CVS Health Fourth Quarter and Full Year 2021 Earnings Call and Webcast. You may disconnect your line at this time, and have a wonderful day.

謝謝。這確實結束了今天的 CVS Health 第四季度和 2021 年全年收益電話會議和網絡廣播。您可以在此時斷開您的線路，並度過美好的一天。