CVS Health Corp (CVS) 2022 Q4 法說會逐字稿

Ladies and gentlemen, good morning, and welcome to the CVS Health Fourth Quarter and Full Year 2022 Earnings Conference Call. (Operator Instructions) As a reminder, today's conference is being recorded.

女士們，先生們，早上好，歡迎參加 CVS Health 第四季度和 2022 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 Thomas Cowhey, Senior Vice President of Capital Markets for CVS Health. Please go ahead.

我現在想把電話轉給 CVS Health 資本市場高級副總裁 Thomas Cowhey。請繼續。

Good morning. And welcome to the CVS Health Fourth Quarter and Full Year 2022 Earnings Call and Webcast. I'm Tom Cowhey, Senior Vice President of Capital Markets for CVS Health. I'm joined this morning by Karen Lynch, President and Chief Executive Officer of CVS; Shawn Guertin, Executive Vice President and Chief Financial Officer of CVS; and Mike Pykosz, Chairman, CEO and Co-Founder of Oak Street Health.

早上好。歡迎來到 CVS Health 第四季度和 2022 年全年收益電話會議和網絡廣播。我是 CVS Health 資本市場高級副總裁 Tom Cowhey。今天上午，CVS 總裁兼首席執行官 Karen Lynch 加入了我的行列； CVS 執行副總裁兼首席財務官 Shawn Guertin； Oak Street Health 董事長、首席執行官兼聯合創始人 Mike Pykosz。

Following our prepared remarks, we will host a question-and-answer session that will include additional members of the CVS management team: Daniel Finke, President, Healthcare Benefits; Michelle Peluso, Chief Customer Officer and Retail Co-President; Prem Shah, Chief Pharmacy Officer and Retail Co-President; David Joyner, New President, Pharmacy Services; and Dr. Alan Lotvin, outgoing President Pharmacy Services.

在我們準備好的發言之後，我們將舉辦一個問答環節，屆時將包括 CVS 管理團隊的其他成員：醫療保健福利總裁 Daniel Finke；首席客戶官兼零售聯席總裁 Michelle Peluso； Prem Shah，首席藥房官兼零售聯席總裁；藥房服務部新總裁 David Joyner；和即將卸任的藥房服務總裁 Alan Lotvin 博士。

Our earnings and Oak Street acquisition press releases and slide presentations have been posted to our website along with our Form 10-K and our Form 8-K that we filed this morning with the SEC. Today's call is also being broadcast on our website, where it will be archived for 1 year.

我們的收益和 Oak Street 收購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 表格和 8-K 表格已發佈到我們的網站上。今天的電話會議也在我們的網站上播出，並將在那裡存檔 1 年。

During this call, we will make certain forward-looking statements reflecting current views related to our future financial performance, future events, industry and market conditions, including impacts related to the ongoing COVID-19 pandemic as well as the expected consumer benefits of our products and services and our financial projections and the benefits of the pending acquisitions of Signify Health and Oak Street Health, and the associated integration plans, expected synergies and revenue opportunities. All forward-looking statements are subject to significant risks and uncertainties that could cause actual results to differ materially from currently projected results, including with respect to the ongoing COVID-19 pandemic and the pending acquisition and integration of Signify Health. We strongly encourage you to review 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 the Risk Factors section in this morning's earnings press release, Oak Street Health acquisition press release and included in our Form 10-K and the Form 8-K we filed this morning.

在此電話會議期間，我們將做出某些前瞻性陳述，反映與我們未來財務業績、未來事件、行業和市場狀況相關的當前觀點，包括與持續的 COVID-19 大流行相關的影響以及我們產品的預期消費者利益和服務以及我們的財務預測和即將收購 Signify Health 和 Oak Street Health 的好處，以及相關的整合計劃、預期的協同效應和收入機會。所有前瞻性陳述都受到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當前預測結果存在重大差異，包括持續的 COVID-19 大流行和即將收購和整合 Signify Health。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，特別是那些在關於前瞻性陳述的警告聲明和今天上午的收益新聞稿中的風險因素部分中描述的風險和不確定性，Oak Street Health收購新聞稿，並包含在我們今天早上提交的 10-K 表格和 8-K 表格中。

During this call, we will use non-GAAP measures when talking about the company's performance and financial condition, and you can find a reconciliation of these non-GAAP measures in this morning's press release and the reconciliation document posted to the Investor Relations portion of our website.

在這次電話會議中，我們將在談論公司的業績和財務狀況時使用非 GAAP 衡量標準，您可以在今天上午的新聞稿中找到這些非 GAAP 衡量標準的對賬以及發佈在我們投資者關係部分的對賬文件網站。

With that, I'd like to turn the call over to Karen. Karen?

有了這個，我想把電話轉給凱倫。卡倫？

Thank you, Tom, and good morning, everyone, and thanks for joining our call today. This morning, we are going to discuss our 2022 results, our 2023 guidance and our announcement that we entered into a definitive agreement to acquire Oak Street Health. Mike Pykosz, Chairman, CEO and Co-Founder of Oak Street Health, will join Shawn and me during the call to discuss this important transaction.

謝謝湯姆，大家早上好，感謝您今天加入我們的電話會議。今天早上，我們將討論我們的 2022 年業績、2023 年的指導方針以及我們宣布達成收購 Oak Street Health 的最終協議。 Oak Street Health 董事長、首席執行官兼聯合創始人 Mike Pykosz 將在電話會議期間與 Shawn 和我一起討論這一重要交易。

But first, 2022 was a year of progress for CVS Health. We delivered strong financial results, we made meaningful progress on our strategy and we brought a greater value to the people that we serve. This morning, we announced that we exceeded our adjusted EPS expectations for the fourth quarter in a row, delivering fourth quarter 2022 adjusted EPS of $1.99 and full year 2022 adjusted EPS of $8.69. This result represents nearly 10% growth over our 2021 baseline. For 2023, we continue to expect adjusted EPS in the range of $8.70 to $8.90, which at the midpoint, represents high single-digit growth off of our 2022 baseline of approximately $8.25.

但首先，2022 年是 CVS Health 取得進步的一年。我們取得了強勁的財務業績，我們在戰略上取得了有意義的進展，並為我們所服務的人們帶來了更大的價值。今天早上，我們宣布我們連續第四季度超出調整後每股收益預期，2022 年第四季度調整後每股收益為 1.99 美元，2022 年全年調整後每股收益為 8.69 美元。這一結果比我們 2021 年的基準增長了近 10%。對於 2023 年，我們繼續預計調整後的每股收益將在 8.70 美元至 8.90 美元之間，這在中點處代表了我們 2022 年基線約 8.25 美元的高個位數增長。

In 2022, CVS Health surpassed the $300 billion mark in total revenue, growing full year revenues by more than 10% to $322 billion. We delivered adjusted operating income of $17.5 billion and generated adjusted EPS of $8.69. Our ability to generate cash flow from operations was robust at nearly $16.2 billion for the full year.

2022 年，CVS Health 的總收入突破 3000 億美元大關，全年收入增長超過 10%，達到 3220 億美元。我們實現了 175 億美元的調整後營業收入和 8.69 美元的調整後每股收益。我們從運營中產生現金流的能力非常強勁，全年達到近 162 億美元。

Each of our foundational businesses generated excellent results. Starting with the Health Care Benefits segment. We grew revenues by more than 11% for the year and delivered adjusted operating income of $6 billion. Our medical benefit ratio of 84% improved by 100 basis points versus the prior year and was consistent with our full year expectations after adjusting for the impact of elevated flu in the fourth quarter.

我們的每一項基礎業務都取得了優異的成績。從醫療保健福利部分開始。我們全年的收入增長了 11% 以上，調整後的營業收入達到 60 億美元。我們 84% 的醫療福利比率比上一年提高了 100 個基點，並且在針對第四季度流感升高的影響進行調整後與我們的全年預期一致。

I want to highlight a few areas within the HCB segment. Although our individual Medicare Advantage growth was below our expectations, Medicare Advantage remains a key strategic growth area for CVS Health. We remain focused on delivering superior service to our Medicare Advantage members while advancing our efforts to improve our Star ratings. We are executing on the actions we identified to address our CAHPS survey scores and are making the necessary investments to drive our Stars Improvement initiative.

我想強調 HCB 細分市場中的幾個領域。儘管我們個人的 Medicare Advantage 增長低於我們的預期，但 Medicare Advantage 仍然是 CVS Health 的一個關鍵戰略增長領域。我們仍然專注於為我們的 Medicare Advantage 會員提供優質服務，同時努力提高我們的星級評級。我們正在執行我們確定的行動來解決我們的 CAHPS 調查分數，並正在進行必要的投資來推動我們的 Stars 改進計劃。

We also made progress in the last 90 days in advancing our efforts to diversify our national PPO contract and have obtained the necessary regulatory approvals to move forward. This will enable us to more effectively manage our Medicare business in the future. As we will discuss shortly, adding both Signify Health and Oak Street Health to our value-based care delivery platform will deepen our focus on this important business.

在過去的 90 天裡，我們在推進國家 PPO 合同多元化方面也取得了進展，並獲得了向前推進所需的監管批准。這將使我們能夠在未來更有效地管理我們的醫療保險業務。正如我們稍後將討論的那樣，將 Signify Health 和 Oak Street Health 添加到我們基於價值的醫療服務平台將加深我們對這一重要業務的關注。

In our individual exchange business, we now expect to end 2023 with between 900,000 and 1 million individual members. This significant growth in membership is driven by our provider network, market growth, marketplace disruptions and our co-branded integrated benefit offerings. We anticipate a positive, sustainable contribution from this membership in future years.

在我們的個人交易業務中，我們現在預計到 2023 年底個人會員將達到 90 萬至 100 萬。會員人數的顯著增長是由我們的供應商網絡、市場增長、市場顛覆和我們的聯合品牌綜合福利產品推動的。我們預計未來幾年該成員將做出積極、可持續的貢獻。

Our Pharmacy Services segment grew full year revenues by 11% with adjusted operating income of $7.4 billion. Performance in our specialty pharmacy was again outstanding. Revenue grew more than 19% year-over-year, driven by our industry-leading digital and specialty pharmacy capabilities.

我們的藥房服務部門全年收入增長了 11%，調整後的營業收入為 74 億美元。我們專業藥房的表現再次出色。在我們行業領先的數字和專業藥房能力的推動下，收入同比增長超過 19%。

As we enter 2023, the first wave of new biosimilars will be coming to market, starting with competitors for HUMIRA. We recently announced that AMJEVITA will be added to coverage within our commercial formularies alongside HUMIRA and other branded products. Our approach to biosimilars reflects our commitment to drive the lowest net cost for our clients while providing members coverage of clinically safe, effective medications and ensuring continuity of care.

隨著我們進入 2023 年，第一波新的生物仿製藥將進入市場，首先是 HUMIRA 的競爭對手。我們最近宣布，AMJEVITA 將與 HUMIRA 和其他品牌產品一起納入我們的商業處方集的覆蓋範圍。我們對生物仿製藥的方法反映了我們致力於為我們的客戶帶來最低的淨成本，同時為會員提供臨床安全、有效的藥物並確保護理的連續性。

Retail delivered another strong year, outperforming our initial guidance and long-term targets. Revenues for the year grew by more than 6% versus the prior year, and we generated $6.7 billion of adjusted operating income. We finished 2022 with another quarter of strong performance in both the pharmacy and the front store. Pharmacy revenue increased by nearly 8% versus the prior year and delivered another quarter of year-over-year market share gains. Front store revenues grew by nearly 7%, driven by demand for consumer health and cough, cold and flu products.

零售業又迎來了強勁的一年，超過了我們最初的指導和長期目標。這一年的收入比上一年增長了 6% 以上，我們產生了 67 億美元的調整後營業收入。我們在 2022 年結束時在藥房和前店都取得了又一個季度的強勁表現。藥房收入比上年增長近 8%，市場份額同比增長四分之一。受消費者健康和咳嗽、感冒和流感產品需求的推動，前店收入增長了近 7%。

We are making significant progress advancing our strategy, which includes expanding our care delivery and health services capabilities in primary care, home health and provider enablement. Last year, we announced the pending acquisition of Signify Health, which represented an important step forward in our value-based care strategy. Signify will strengthen our presence in the home and enhance our provider enablement capabilities. We now project that this transaction will close in the second quarter of 2023.

我們在推進我們的戰略方面取得了重大進展，其中包括擴大我們在初級保健、家庭保健和提供者支持方面的保健提供和保健服務能力。去年，我們宣布即將收購 Signify Health，這是我們在基於價值的醫療戰略方面向前邁出的重要一步。 Signify 將加強我們在家庭中的存在並增強我們的供應商支持能力。我們現在預計該交易將於 2023 年第二季度完成。

At our Investor Day in 2021, we shared our vision to deliver a superior health experience for consumers. Central to our strategy is advancing our value-based care platform of capabilities that drive consumer engagement. This morning, we announced that we have entered into a definitive agreement to acquire Oak Street Health's outstanding shares for $39 per share in cash, representing a total transaction value of approximately $10.6 billion. The acquisition of Oak Street Health will broaden our value-based care platform into primary care and accelerate our long-term growth.

在 2021 年的投資者日，我們分享了為消費者提供卓越健康體驗的願景。我們戰略的核心是推進我們基於價值的護理能力平台，以推動消費者參與。今天上午，我們宣布我們已達成最終協議，以每股 39 美元的現金收購 Oak Street Health 的流通股，總交易價值約為 106 億美元。收購 Oak Street Health 將把我們基於價值的護理平台擴展到初級保健領域，並加速我們的長期增長。

Primary care drives patient engagement and positive clinical outcomes. Although it is a very small proportion of total health spend, just about 10% nationally, it wields significant influence over health care utilization. Individuals who seek routine primary care services report fewer serious medical diagnoses, lower mortality rates and a 33% lower annual health care expense.

初級保健推動患者參與和積極的臨床結果。儘管它在醫療總支出中所佔的比例很小，在全國范圍內僅為 10% 左右，但它對醫療保健的利用具有重大影響。尋求常規初級保健服務的個人報告的嚴重醫療診斷較少，死亡率較低，年度醫療保健費用降低 33%。

Oak Street Health has a proven senior-focused primary care model that is scalable at a national level. Their innovative care model goes beyond typical primary care to provide patients with comprehensive preventative care to support overall health and well-being. With 169 medical centers across 21 states today, we see a significant opportunity to expand in the next few years and provide superior care to many more patients.

Oak Street Health 擁有經過驗證的以老年人為中心的初級保健模式，該模式可在全國范圍內擴展。他們的創新護理模式超越了典型的初級護理，為患者提供全面的預防性護理，以支持整體健康和福祉。如今，我們在 21 個州擁有 169 個醫療中心，我們看到了在未來幾年擴大規模並為更多患者提供優質護理的重要機會。

Oak Street has a committed and experienced leadership team with extensive care delivery expertise and a best-in-class fully integrated technology solution.

Oak Street 擁有一支敬業且經驗豐富的領導團隊，擁有豐富的護理服務專業知識和一流的完全集成技術解決方案。

Oak Street's model focuses on providing more coordinated, holistic and connected care. Oak Street physicians spend 3x longer on average with their 159,000 at-risk patients and drive markedly better outcomes. Their approximately 600 providers and 6,000 team members have a proven ability to improve patient outcomes and experiences.

Oak Street 的模式側重於提供更加協調、全面和關聯的護理。 Oak Street 的醫生在 159,000 名高危患者身上花費的時間平均延長了 3 倍，並且取得了明顯更好的結果。他們的大約 600 名提供者和 6,000 名團隊成員已證明有能力改善患者的治療效果和體驗。

At a time when consumers are increasingly frustrated with their experience in the health care system, Oak Street's approach delivers a truly specialized care experience that drives a Net Promoter Score of 90. The quality of this experience is evidenced by the fact that Oak Street was selected to be the trusted primary care partner of AARP and is the only primary care provider to carry the AARP name across all their sites.

在消費者對他們在醫療保健系統中的體驗越來越失望的時候，Oak Street 的方法提供了真正專業的護理體驗，推動淨推薦值達到 90。Oak Street 被選中這一事實證明了這種體驗的質量成為 AARP 值得信賴的初級保健合作夥伴，並且是唯一一家在其所有站點都使用 AARP 名稱的初級保健提供者。

As part of CVS Health, we believe Oak Street's value-based care model will have a far greater impact on patients. Our unparalleled consumer touch points will expand Oak Street's reach and will allow them to engage with more consumers more frequently and more conveniently. The combination of CVS Health's foundational businesses with Oak Street and Signify Health creates one of the premier multi-payer Medicare value-based care platforms in the marketplace today.

作為 CVS Health 的一部分，我們相信 Oak Street 基於價值的護理模式將對患者產生更大的影響。我們無與倫比的消費者接觸點將擴大 Oak Street 的影響範圍，並使他們能夠更頻繁、更方便地與更多消費者互動。 CVS Health 的基礎業務與 Oak Street 和 Signify Health 的結合創造了當今市場上首屈一指的多付款人 Medicare 基於價值的護理平台之一。

But our ambition does not stop there. These Medicare-focused assets complement our established care delivery assets, including our over 1,100 retail health MinuteClinics in a number of ways: Creating convenient access and additional clinical capacity for Oak Street with preventive care and chronic care services for seniors; enhancing access to our broad nurse practitioner workforce; and providing wraparound services tailored to seniors and those with complex conditions, such as medication reconciliation and post-discharge follow-ups. The potential across CVS Health's base of assets is powerful. Together, we will transform the experience for consumers across the country.

但我們的雄心不止於此。這些以 Medicare 為重點的資產以多種方式補充了我們現有的醫療服務資產，包括我們的 1,100 多家零售健康 MinuteClinics：加強接觸我們廣泛的執業護士隊伍的機會；並為老年人和病情複雜的人提供量身定制的全方位服務，例如藥物調整和出院後隨訪。 CVS Health 資產基礎的潛力是強大的。我們將共同改變全國消費者的體驗。

The Oak Street transaction is financially attractive and enhances our ability to accelerate our sustainable long-term growth. Shawn will provide more details on the financials of the transaction and will discuss the growth and profitability prospects of the Oak Street assets.

橡樹街交易在財務上具有吸引力，並增強了我們加速可持續長期增長的能力。 Shawn 將提供有關交易財務的更多詳細信息，並將討論 Oak Street 資產的增長和盈利前景。

At the close of the transaction, Mike Pykosz will continue to lead Oak Street within CVS Health. Mike, we're so excited to welcome you and your team to CVS Health at the close of this transaction.

在交易結束時，Mike Pykosz 將繼續領導 CVS Health 內的 Oak Street。邁克，我們非常高興地歡迎您和您的團隊在本次交易結束時加入 CVS Health。

Mike, would you like to say a few words?

邁克，你想說幾句話嗎？

Thank you, Karen, and good morning, everyone. Our mission at Oak Street Health is to rebuild health care as it should be. When we started Oak Street, we set out to address the root causes of high-cost, low-quality care and poor experiences for Medicare patients. 10 years into that journey, as we continue to drive our national expansion and look to impact more patients and communities, we could not have found a partner more aligned to our mission than CVS Health.

謝謝你，凱倫，大家早上好。我們 Oak Street Health 的使命是重建醫療保健。當我們開始 Oak Street 時，我們著手解決醫療保險患者高成本、低質量護理和糟糕體驗的根本原因。 10 年過去了，隨著我們繼續推動我們的全國擴張並希望影響更多的患者和社區，我們找不到比 CVS Health 更符合我們使命的合作夥伴。

At Oak Street Health, we operated a network of primary care centers who specialized in care for older adults. We focus on areas with large concentrations of medical-eligible patients with incomes below 300% of the federal poverty line, areas where we can make the biggest impact.

在 Oak Street Health，我們運營著一個專門為老年人提供護理的初級保健中心網絡。我們專注於收入低於聯邦貧困線 300% 且符合醫療條件的患者大量集中的地區，這些地區是我們可以發揮最大影響的地區。

We created our innovative models from the ground up and focus on ensuring our patients receive the right care upfront, improving their experiences and keeping them healthy and out of the hospital. This proven and naturally scalable model benefits patients, providers and payers while improving health outcomes, lowering medical costs and delivering a better patient experience.

我們從頭開始創建我們的創新模型，並專注於確保我們的患者預先得到正確的護理，改善他們的體驗並讓他們保持健康並遠離醫院。這種經過驗證且自然可擴展的模型使患者、提供者和付款人受益，同時改善健康結果、降低醫療成本並提供更好的患者體驗。

This focus has generated meaningful results for our patients, including reducing hospital admissions by over 50% and lowering 30-day readmissions by 42%. By providing coordinated holistic care, we can close care gaps and address social determinants of health, delivering 5-star HEDIS performance.

這種關注為我們的患者帶來了有意義的結果，包括將住院率降低了 50% 以上，並將 30 天再入院率降低了 42%。通過提供協調的整體護理，我們可以縮小護理差距並解決健康的社會決定因素，提供五星級的 HEDIS 績效。

Our track record shows that we've been able to deliver consistent performance across different populations and geographies. And while our primary focus is Medicare managed at-risk patients, we've also demonstrated our care model can work outside MA.

我們的業績記錄表明，我們能夠在不同人群和地區提供一致的績效。雖然我們的主要關注點是 Medicare 管理的高危患者，但我們也證明了我們的護理模式可以在 MA 之外發揮作用。

For example, in 2021, we participated in the Medicare direct contracting program, where we took on full risk on traditional Medicare patients. Among all the participants in the program, we generated savings that were 2x higher than any other multistage direct contract center, and we were ranked #1 in net dollars saved. These results show that, even amongst the most innovative groups of this new program, our capabilities and results stood out.

例如，在 2021 年，我們參與了 Medicare 直接承包計劃，我們承擔了傳統 Medicare 患者的全部風險。在該計劃的所有參與者中，我們產生的節省比任何其他多級直接合同中心高出 2 倍，並且我們在節省的淨美元方面排名第一。這些結果表明，即使在這個新項目中最具創新性的群體中，我們的能力和成果也很突出。

By joining CVS Health's ecosystem, we will accelerate our journey to improve patient outcomes and experiences while largely continuing to invest in both our innovative care model and invest in what we believe is the best team in health care. The expansive consumer touch points of CVS Health virtually and in the community, including the trusted CVS pharmacists, will broaden and deepen our connections with the patients under our care.

通過加入 CVS Health 的生態系統，我們將加快改善患者治療效果和體驗的進程，同時在很大程度上繼續投資於我們的創新護理模式，並投資於我們認為是醫療保健領域最好的團隊。 CVS Health 在虛擬和社區中廣泛的消費者接觸點，包括值得信賴的 CVS 藥劑師，將擴大和加深我們與接受我們護理的患者的聯繫。

At Oak Street, we have talked about the massive market opportunity for companies that can address the huge challenges in health care. CVS Health is in a unique position to deliver market-leading health solutions. The breadth of their offerings and proven the ability to scale assets will significantly enhance our ability to tackle these challenges. We believe this transaction is a great outcome for all of our stakeholders, including our patients, all of our payer partners, our team of Oakies and our shareholders.

在 Oak Street，我們談到了能夠應對醫療保健領域巨大挑戰的公司所面臨的巨大市場機遇。 CVS Health 在提供市場領先的健康解決方案方面處於獨特的地位。他們產品的廣度和經過驗證的擴展資產的能力將顯著增強我們應對這些挑戰的能力。我們相信這項交易對我們所有的利益相關者來說都是一個很好的結果，包括我們的患者、我們所有的付款合作夥伴、我們的 Oakies 團隊和我們的股東。

With that, let me turn it back to Karen.

有了這個，讓我把它轉回凱倫。

Thank you, Mike. CVS Health delivered strong financial results in 2022, and we are entering 2023 with tremendous momentum. We continue to make progress on our strategy and will enhance the capabilities of our value-based care platform through the Oak Street Health and Signify Health acquisitions. We are excited about the opportunities ahead of us.

謝謝你，邁克。 CVS Health 在 2022 年取得了強勁的財務業績，我們正以巨大的勢頭進入 2023 年。我們繼續在我們的戰略上取得進展，並將通過收購 Oak Street Health 和 Signify Health 來增強我們基於價值的護理平台的能力。我們對擺在我們面前的機會感到興奮。

I'll now turn it over to Shawn for a deeper look into our results, our 2023 outlook and the Oak Street transaction. Shawn?

我現在將其轉交給肖恩，以更深入地了解我們的結果、我們的 2023 年展望和橡樹街交易。肖恩？

Thank you, Karen, and good morning, everyone. I will first take some time to detail our results and 2023 guidance before discussing this morning's announcement of the Oak Street transaction.

謝謝你，凱倫，大家早上好。在討論今天上午宣布的橡樹街交易之前，我將首先花一些時間詳細介紹我們的業績和 2023 年的指導方針。

Our fourth quarter results reflect the continuation of our excellent performance from each of our core business segments as we exceeded our expectations for revenue, cash flow generation and adjusted earnings per share.

我們的第四季度業績反映了我們每個核心業務部門的出色表現的延續，因為我們超出了我們對收入、現金流產生和調整後每股收益的預期。

A few highlights regarding total company performance. Total fourth quarter revenues of $83.8 billion increased by 9.5% year-over-year, reflecting growth at or above internal expectations for each of our foundational businesses. We reported fourth quarter adjusted operating income of $4 billion and adjusted EPS of $1.99.

關於公司總體業績的一些亮點。第四季度總收入為 838 億美元，同比增長 9.5%，反映出我們每項基礎業務的增長達到或高於內部預期。我們報告第四季度調整後營業收入為 40 億美元，調整後每股收益為 1.99 美元。

For full year 2022, we reported total revenue of $322.5 billion, an increase of 10.4%, with solid growth across each of our foundational businesses. This led to a full year adjusted EPS of $8.69, representing an increase of 9.7% off our 2021 adjusted EPS baseline of $7.92. And importantly, CVS Health's ability to generate cash remains strong. For full year 2022, we generated $16.2 billion in cash flow from operations.

2022 年全年，我們報告的總收入為 3225 億美元，增長 10.4%，我們的每項基礎業務都實現了穩健增長。這導致全年調整後每股收益為 8.69 美元，比我們 2021 年調整後每股收益基準 7.92 美元增長 9.7%。重要的是， CVS Health 產生現金的能力仍然很強。 2022 年全年，我們從運營中產生了 162 億美元的現金流。

Looking at performance by business segment. Health Care Benefits delivered strong revenue and adjusted operating income growth versus the prior year. Fourth quarter revenue of $23 billion increased by 11.3% year-over-year. We grew membership by 548,000 lives in 2022, driven by strong growth in our commercial and Medicare businesses, offsetting the divestiture of a portion of our Aetna International business earlier this year and a decline in Medicaid membership due to a previously disclosed contract loss.

按業務部門查看績效。與上一年相比，醫療保健福利帶來了強勁的收入和調整後的營業收入增長。第四季度收入為 230 億美元，同比增長 11.3%。在我們的商業和醫療保險業務強勁增長的推動下，我們在 2022 年增加了 548,000 名會員，抵消了今年早些時候剝離我們 Aetna International 業務的一部分以及由於先前披露的合同損失導致的醫療補助會員人數下降。

Our medical benefit ratio of 86% improved 100 basis points year-over-year. Adjusted operating income of $858 million grew 68.2% year-over-year. Both of these measures were driven by the net favorable impact of COVID-19 compared to the prior year and strong underlying performance, partially offset by the unfavorable impact of the flu. Outside of an elevated flu season, medical costs remain in line with expectations, as has been the case throughout 2022. Consolidated days claims payable at the end of the quarter was 52.5, up 3.4 days versus the prior year. Overall, we remain confident in the adequacy of our reserves.

我們 86% 的醫療受益率同比提高了 100 個基點。調整後的營業收入為 8.58 億美元，同比增長 68.2%。與上一年相比，這兩項措施均受到 COVID-19 的淨有利影響和強勁的基礎業績的推動，部分被流感的不利影響所抵消。在流感高發季節之外，醫療費用仍符合預期，整個 2022 年都是如此。本季度末綜合應付索賠天數為 52.5，比去年同期增加 3.4 天。總體而言，我們對儲備的充足性仍然充滿信心。

In the Pharmacy Services business, our ability to deliver industry-leading drug trend for our clients, our specialty management capabilities and excellent customer service levels continue to drive growth. During the fourth quarter, revenue of $43.7 billion increased by 11.2% year-over-year, driven by increased pharmacy claims volume, growth in specialty pharmacy and brand inflation, partially offset by continued client price improvements.

在藥房服務業務中，我們為客戶提供行業領先藥物趨勢的能力、我們的專業管理能力和卓越的客戶服務水平繼續推動增長。第四季度，受藥房索賠量增加、專業藥房增長和品牌通脹的推動，收入為 437 億美元，同比增長 11.2%，但部分被客戶價格的持續改善所抵消。

Total pharmacy claims processed increased by 3.1% above the prior year and 4.6% when excluding COVID-19 vaccinations, primarily attributable to net new business; increased utilization; and the impact of an elevated cough, cold and flu season. Adjusted operating income of $2 billion grew 9% year-over-year, driven by improved purchasing economics, including increased contributions from the products and services of the company's group purchasing organization, partially offset by continued client price improvements.

處理的藥房索賠總額比上年增長 3.1%，如果不包括 COVID-19 疫苗接種，則增長 4.6%，這主要歸因於淨新業務；提高利用率；以及咳嗽、感冒和流感季節加劇的影響。調整後的營業收入為 20 億美元，同比增長 9%，這得益於採購經濟性的改善，包括公司團購組織的產品和服務的貢獻增加，部分被持續的客戶價格改善所抵消。

In our Retail/Long-Term Care segment, we delivered strong revenue growth despite mixed COVID-related trends and continued economic uncertainty. Specifically, during the fourth quarter, revenue of $28.2 billion grew 4%, reflecting increased prescription and front store volume; including the impact of an elevated cough, cold and flu season; pharmacy drug mix; and brand inflation. These items were partially offset by decreased COVID-19 vaccinations and diagnostic testing, the impact of recent generic introductions and continued pharmacy reimbursement pressure.

在我們的零售/長期護理部門，儘管 COVID 相關趨勢喜憂參半且經濟持續存在不確定性，但我們實現了強勁的收入增長。具體而言，第四季度收入為 282 億美元，增長 4%，反映了處方藥和店面銷量的增加；包括咳嗽、感冒和流感季節加劇的影響；藥房藥物組合；和品牌膨脹。這些項目被 COVID-19 疫苗接種和診斷測試的減少、最近仿製藥的影響以及持續的藥房報銷壓力部分抵消。

Adjusted operating income of $1.8 billion declined 25.1% versus prior year, but was largely in line with internal expectations, driven by decreased COVID-19 vaccinations and diagnostic testing, continued pharmacy reimbursement pressure and increased investments in the segment's operations and capabilities, including the vast majority of a discretionary bonus payment to frontline colleagues. These decreases were partially offset by increased prescription volume and improved generic drug purchasing.

調整後營業收入為 18 億美元，較上年下降 25.1%，但在很大程度上符合內部預期，原因是 COVID-19 疫苗接種和診斷測試減少、藥房報銷壓力持續存在以及對該部門運營和能力的投資增加，包括龐大的大部分酌情支付給前線同事的獎金。這些減少部分被處方量的增加和仿製藥採購的改善所抵消。

Pharmacy prescription volume grew 0.8% year-over-year, reflecting increased utilization and the impact of an elevated cough, cold and flu season, partially offset by decreases in COVID-19 vaccinations. Excluding the impact of COVID-19 vaccinations, pharmacy prescription volume increased by 4% year-over-year.

藥房處方量同比增長 0.8%，反映出利用率增加以及咳嗽、感冒和流感季節增加的影響，部分被 COVID-19 疫苗接種減少所抵消。排除 COVID-19 疫苗接種的影響，藥房處方量同比增長 4%。

Turning to the balance sheet. Our liquidity and capital position remain excellent. We ended the year with approximately $5.4 billion of cash at the parent or unrestricted subsidiaries and an adjusted net debt to EBITDA of about 2.9x. Excluding the adjustment for cash at the parent or unrestricted subsidiaries, our adjusted debt-to-EBITDA is approximately 3.1x.

轉向資產負債表。我們的流動性和資本狀況仍然良好。年底，我們在母公司或不受限制的子公司擁有約 54 億美元的現金，調整後的淨債務與 EBITDA 之比約為 2.9 倍。不包括母公司或非受限子公司的現金調整，我們調整後的債務與 EBITDA 之比約為 3.1 倍。

Through our quarterly dividend, we returned $719 million to shareholders and repurchased $1.5 billion of our common stock in the fourth quarter. We also entered into a $2 billion fixed-dollar accelerated share repurchase transaction which became effective on January 3, 2023.

通過我們的季度股息，我們在第四季度向股東返還了 7.19 億美元，並回購了 15 億美元的普通股。我們還進行了一項 20 億美元的固定美元加速股票回購交易，該交易於 2023 年 1 月 3 日生效。

A few other items worth highlighting for investors. We continue to experience the impact of market volatility on our investment portfolio and recorded net realized capital losses of approximately $37 million in the quarter. We recorded $117 million of office real estate optimization charges in the quarter related to the reduction of corporate office real estate space in response to our new flexible work arrangement. We also recognized a $250 million gain related to the sale of our bswift business in November. And we recorded $99 million of incremental charges related to opioid litigation to address the final terms and other implications of the global settlement executed in December.

其他一些值得投資者強調的項目。我們繼續經歷市場波動對我們投資組合的影響，本季度實現的淨資本損失約為 3700 萬美元。我們在本季度記錄了 1.17 億美元的辦公室房地產優化費用，這些費用與為響應我們新的靈活工作安排而減少的公司辦公室房地產空間有關。我們還確認了與 11 月份出售 bswift 業務相關的 2.5 億美元收益。我們記錄了 9900 萬美元與阿片類藥物訴訟相關的增量費用，以解決 12 月執行的全球和解的最終條款和其他影響。

Shifting to our outlook for 2023. We expect revenue growth of 3% to 5%, and we are reaffirming our full year adjusted earnings per share guidance range of $8.70 to $8.90. We believe this range is prudent at this stage in the year and reflects approximately 5% to 8% growth versus our 2022 adjusted EPS baseline of $8.25. We detailed the adjustments reflected in our 2022 baseline in the earnings materials posted on our IR website.

轉向我們對 2023 年的展望。我們預計收入增長 3% 至 5%，我們重申我們的全年調整後每股收益指導範圍為 8.70 美元至 8.90 美元。我們認為，這一範圍在今年這個階段是謹慎的，與我們 2022 年調整後的 EPS 基線 8.25 美元相比，增長了約 5% 至 8%。我們在 IR 網站上發布的收益材料中詳細介紹了我們 2022 年基準中反映的調整。

I want to point out 3 things on our 2023 adjusted EPS guidance. First, consistent with past practice, our projections do not assume the recurrence of prior year reserve development. Second, these projections do not include a specific provision for our pending Signify transaction, which is expected to close in the second quarter of this year, but which we project will have a small impact on 2023 adjusted EPS. And third, I want to remind everyone that, beginning this year, we are shifting to a reporting convention that excludes net realized capital gains and losses from adjusted operating income.

我想在我們 2023 年調整後的 EPS 指南中指出三件事。首先，與過去的做法一致，我們的預測不假設上一年儲備開發的重複發生。其次，這些預測不包括針對我們未決的 Signify 交易的具體準備金，該交易預計將在今年第二季度完成，但我們預計這將對 2023 年調整後的每股收益產生很小的影響。第三，我想提醒大家，從今年開始，我們將轉向一種報告慣例，將已實現資本淨損益從調整後的營業收入中剔除。

Now let's turn to some of the segment details. In our Health Care Benefits segment, we expect to see membership growth of 2% to 4% with increased membership in both Medicare and Commercial, partially offset by declines in Medicaid due to the impact of redeterminations in 2023. Overall, we expect to generate revenue growth of 11% to 13%. Our projected medical benefit ratio for 2023 is 84.7%, plus or minus 50 basis points. As I just noted, we do not assume prior year reserve development in our projections. We are providing a cautious outlook for HCB adjusted operating income, expecting growth in a range of about 2% to 4% and reflecting a prudent assumption regarding the performance of our individual exchange business, lower individual MA enrollment and investments in our Stars Improvement initiatives.

現在讓我們轉向一些細分細節。在我們的醫療保健福利部分，我們預計隨著 Medicare 和 Commercial 會員人數的增加，會員人數將增長 2% 至 4%，部分被 2023 年重新確定的影響導致的 Medicaid 下降所抵消。總體而言，我們預計將產生收入增長11%至13%。我們預計 2023 年的醫療受益率為 84.7%，上下浮動 50 個基點。正如我剛才指出的，我們在預測中不假設上一年的儲備開發。我們對 HCB 調整後的營業收入持謹慎展望，預計增長約 2% 至 4%，並反映了對我們個人交易所業務表現的審慎假設、個人 MA 註冊人數減少以及對 Stars 改善計劃的投資。

Moving to our Pharmacy Services segment. We expect revenue in a range from 1% to 2% growth, driven by a successful 2023 selling season and strong retention, partially offset by lower Medicaid volume. For the full year 2023, we expect pharmacy claims to range from flat to growth of 1%. Overall, we expect these results to generate adjusted operating income growth of 4% to 5%.

轉到我們的藥房服務部門。我們預計收入將增長 1% 至 2%，這得益於成功的 2023 年銷售季和強勁的保留率，部分被較低的醫療補助計劃所抵消。對於 2023 年全年，我們預計藥房索賠將從持平到增長 1%。總體而言，我們預計這些結果將帶來 4% 至 5% 的調整後營業收入增長。

Finally, shifting to our Retail/LTC segment. As we discussed previously, this segment will be burdened by the lower contribution from COVID as we transition into the endemic stage as well as continued reimbursement pressure in the pharmacy. We expect revenue growth of 1% to 3% and prescription growth of 2% to 4% despite continuing decreases of COVID-19 vaccines. Overall, for the Retail/LTC segment, we expect 2023 adjusted operating income to decline from 2022 to between $5.95 billion and $6.05 billion.

最後，轉向我們的零售/LTC 部門。正如我們之前討論的那樣，隨著我們過渡到流行階段以及藥房持續的報銷壓力，這部分將受到 COVID 貢獻較低的負擔。儘管 COVID-19 疫苗持續減少，我們預計收入增長 1% 至 3%，處方藥增長 2% 至 4%。總體而言，對於零售/LTC 部門，我們預計 2023 年調整後的營業收入將從 2022 年下降至 59.5 億美元至 60.5 億美元之間。

For items below adjusted operating income, we expect our interest expense for 2023 to be approximately $2.23 billion. Our tax rate is expected to be approximately 25.5%.

對於低於調整後營業收入的項目，我們預計 2023 年的利息支出約為 22.3 億美元。我們的稅率預計約為 25.5%。

I want to make a few comments as you think about the cadence of our earnings throughout the year as Retail returns to earnings seasonality more aligned to pre-pandemic patterns. We are currently projecting the lowest contribution to earnings in the first quarter of the year. The remaining 3 quarters will be relatively consistent with slightly more than half of our earnings coming in the second half of the year.

當您考慮我們全年收益的節奏時，我想發表一些評論，因為零售業收益的季節性回歸更符合大流行前的模式。我們目前預計今年第一季度對收益的貢獻最低。剩下的 3 個季度將與我們今年下半年收入的一半以上相對一致。

Shifting to shares. We expect our diluted weighted average share count to be approximately 1.298 billion, reflecting the impact of both our fourth quarter 2022 repurchase activity as well as the accelerated share repurchase that is currently underway.

轉向股票。我們預計我們的攤薄加權平均股數約為 12.98 億，反映了我們 2022 年第四季度回購活動以及目前正在進行的加速股票回購的影響。

We anticipate another strong year of cash generation. We expect cash flow from operations of $12.5 billion to $13.5 billion. Capital expenditures are expected to be in the range of $2.8 billion to $3 billion.

我們預計又一個強勁的現金產生年。我們預計運營現金流為 125 億美元至 135 億美元。資本支出預計在 28 億美元至 30 億美元之間。

Turning to the Oak Street transaction. We committed to investors that we would be diligent when deploying our capital, seeking assets with the best technology, capabilities and cultural alignment to our vision. After a thorough and robust review of the market, Oak Street was the primary care asset that proved to be the most strategically and financially compelling. Oak Street will operate as a payer-agnostic business within CVS Health, focused on improving outcomes and experiences for the Medicare populations it serves. CVS Health has a strong and proven track record of helping its payer clients succeed, and we will continue to prioritize that success after this transaction.

轉向橡樹街交易。我們向投資者承諾，我們將在部署資本時勤勉盡責，尋求具有最佳技術、能力和文化契合我們願景的資產。在對市場進行全面而有力的審查後，Oak Street 成為被證明在戰略和財務上最具吸引力的初級保健資產。 Oak Street 將在 CVS Health 內作為與付款人無關的業務運營，專注於改善其服務的 Medicare 人群的結果和體驗。 CVS Health 在幫助其付款客戶取得成功方面擁有良好而可靠的記錄，我們將在此次交易後繼續優先考慮這一成功。

What we saw when we looked into Oak Street's portfolio of clinics was a remarkably consistent path to clinic profitability. This trend was true across diverse geographies, populations and payers. As Oak Street drives strong patient experiences and engagement, their patient panels grow. And as Oak Street's providers engage with those patients, they improve outcomes and increase patient contributions over time. These 2 factors combine to drive clinics to maturity, achieving profitability within the first 3 years and unlocking annual adjusted EBITDA potential of approximately $7 million per clinic using Oak Street's definition of adjusted EBITDA. Within the 169 clinics Oak Street has today, we have high visibility into embedded adjusted EBITDA of over $1 billion.

當我們調查橡樹街的診所組合時，我們看到的是一條非常一致的診所盈利之路。這種趨勢在不同的地區、人口和支付者中都是真實的。隨著橡樹街推動強大的患者體驗和參與，他們的患者小組也在增長。隨著 Oak Street 的提供者與這些患者接觸，他們會隨著時間的推移改善結果並增加患者的貢獻。這兩個因素共同推動診所走向成熟，在頭 3 年內實現盈利，並使用 Oak Street 對調整後 EBITDA 的定義釋放每個診所每年調整後 EBITDA 潛力約 700 萬美元。在 Oak Street 今天擁有的 169 家診所中，我們對超過 10 億美元的嵌入式調整後 EBITDA 有很高的了解。

We also recognize the tremendous opportunity to scale Oak Street's clinics to reach more seniors across the nation. At their current rate of expansion, we expect Oak Street to have over 300 clinics by 2026, at which point, we project they will have more than $2 billion of embedded Oak Street adjusted EBITDA.

我們還認識到擴大橡樹街診所以覆蓋全國更多老年人的巨大機會。按照他們目前的擴張速度，我們預計到 2026 年 Oak Street 將擁有 300 多家診所，屆時，我們預計他們將擁有超過 20 億美元的嵌入式 Oak Street 調整後 EBITDA。

Shifting to synergies. We envisioned 5 main opportunities to realize more than $500 million of value over time: One, accelerating Oak Street patient growth through CVS Health channels; two, improving Oak Street's economics through integration with our broad portfolio of assets; three, improving the retention of our Aetna MA members through the improved outcomes and experience provided at Oak Street clinics; four, driving greater utilization of CVS Pharmacy and Caremark capabilities; and five, capturing modest savings from external public company and lease costs.

轉向協同效應。我們設想了 5 個主要機會，隨著時間的推移實現超過 5 億美元的價值：第一，通過 CVS Health 渠道加速 Oak Street 患者的增長；第二，通過整合我們廣泛的資產組合來改善橡樹街的經濟狀況；第三，通過改善橡樹街診所提供的結果和經驗，提高我們 Aetna MA 會員的保留率；四、推動 CVS Pharmacy 和 Caremark 能力的更大利用；第五，從外部上市公司和租賃成本中獲得適度的節省。

We project that our investment in Oak Street will drive double-digit returns on invested capital over time as clinics mature and synergies are realized. We are committed to exploring additional avenues to further accelerate growth, synergy realization and returns from this transaction while balancing further near-term dilution to our EPS trajectory.

我們預計，隨著診所的成熟和協同效應的實現，我們對 Oak Street 的投資將隨著時間的推移推動兩位數的投資回報。我們致力於探索其他途徑，以進一步加速增長、協同效應實現和此次交易的回報，同時平衡對我們 EPS 軌蹟的進一步近期稀釋。

As stated in our press release, this transaction will be funded with available resources and existing financing capacity, and we remain committed to maintaining our current investment-grade rating. The transaction is subject to approval by Oak Street's shareholders, regulatory approvals and other customary closing conditions. We expect this transaction to close in 2023.

正如我們在新聞稿中所述，此次交易將由可用資源和現有融資能力提供資金，我們將繼續致力於維持目前的投資級評級。該交易須經 Oak Street 股東批准、監管批准和其他慣例成交條件。我們預計該交易將於 2023 年完成。

We are now targeting 2024 adjusted EPS of approximately $9, growing to approximately $10 in 2025 with the potential for upside in 2025 based on the successful resolution of our Medicare Star ratings mitigation efforts. The 2024 and 2025 adjusted EPS trajectories reflect the impact of the previously disclosed 2024 Medicare Star ratings headwind and Centene contract loss, closing of the Oak Street Health transaction in 2023, as well as projected contributions from the Signify Health transaction in 2024 and beyond. Consistent with past practice, CVS Health expects to exclude integration and transaction costs from its adjusted EPS presentation.

我們現在的目標是 2024 年調整後每股收益約為 9 美元，到 2025 年增長到約 10 美元，並且基於我們成功解決 Medicare Star 評級緩解措施，2025 年有可能上漲。 2024 年和 2025 年調整後的每股收益軌跡反映了先前披露的 2024 年醫療保險星級評級逆風和 Centene 合同損失、2023 年 Oak Street Health 交易結束以及 Signify Health 交易在 2024 年及以後的預計貢獻的影響。與過去的做法一致， CVS Health 預計將從其調整後的 EPS 列報中排除整合和交易成本。

With the close of these transactions, we expect that our adjusted debt-to-EBITDA will peak in the mid-3x level in 2024, well within leverage ranges aligned to our current investment-grade rating. Our current projections assume modest discretionary repurchase activity in 2024. This is consistent with our 2021 Investor Day projections, which contemplated 1% to 2% adjusted EPS growth from repurchases in addition to offsetting dilution. As leverage begins to subside in 2025, we will have potential for additional repurchases.

隨著這些交易的結束，我們預計我們調整後的債務與 EBITDA 比率將在 2024 年達到 3 倍中期的峰值，完全處於與我們當前投資級別評級一致的槓桿範圍內。我們目前的預測假設 2024 年將有適度的酌情回購活動。這與我們對 2021 年投資者日的預測一致，該預測除了抵消攤薄效應外，還預計通過回購實現 1% 至 2% 的調整後每股收益增長。隨著槓桿在 2025 年開始消退，我們將有可能進行額外的回購。

In summary, we are excited to announce the acquisition of Oak Street and to incorporate them into our expanding portfolio of capabilities. Oak Street's best-in-class clinics will serve as the focal point of high-quality care for seniors across America. The strategic rationale for this combination is sound and the growth opportunity is vast.

總而言之，我們很高興地宣布收購 Oak Street 並將其納入我們不斷擴展的能力組合。橡樹街一流的診所將成為全美老年人優質護理的焦點。這種合併的戰略依據是合理的，增長機會是巨大的。

Together, CVS Health's foundational businesses, Signify's home assessment and provider enablement capabilities and Oak Street's clinics and care model, create the premier multipayer Medicare value-based care platform. We could not be more pleased to join with Oak Street as we take the next step in our journey to build a differentiated health services organization and transform how care is delivered.

CVS Health 的基礎業務、Signify 的家庭評估和提供商支持能力以及 Oak Street 的診所和護理模式共同創建了首屈一指的多付款人 Medicare 基於價值的護理平台。我們很高興加入 Oak Street，因為我們正在邁出下一步，建立一個差異化的醫療服務組織並改變醫療服務的提供方式。

To conclude, we delivered excellent performance in 2022, creating strong momentum as we continue to execute our strategy in 2023. We are building on our achievements, expanding our portfolio of capabilities and continuing on our path to become the leading health care solution company.

總而言之，我們在 2022 年取得了出色的業績，為我們在 2023 年繼續執行戰略創造了強勁勢頭。我們正在取得成就的基礎上，擴大我們的能力組合，並繼續朝著成為領先的醫療保健解決方案公司的方向前進。

With that, we will now open the line for your questions. Operator?

有了這個，我們現在將打開您的問題熱線。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。

Congratulations on the transaction, and congratulations on the strategy overall. I know every quarter, I've asked about this, this strategy around value-based care and what you're going to do in this area. So I'm happy that you finally have done this.

祝賀交易，並祝賀整體戰略。我知道每個季度，我都問過這個問題，這個圍繞基於價值的護理的策略以及你將在這個領域做什麼。所以我很高興你終於做到了。

So really just 2 things I want to better understand. One, following Oak Street, they did slow the growth of the number of centers they were opening last year due to cash constraints. Shawn, it sounds like you're laying out that you're going to keep that strategy the same at roughly 35 centers per year.

所以真的只有兩件事我想更好地理解。第一，在橡樹街之後，由於現金緊張，他們去年確實放慢了他們開設的中心數量的增長。肖恩，聽起來你打算在每年大約 35 個中心保持同樣的策略。

One, is there a reason why you wouldn't reaccelerate that growth when we think about Oak Street? And then secondly, as we think about some of the changes that have come with RADV, the MA rates that have come out, can you maybe just talk about the impact, not just on the MA side, but also on the provider side? And did you take that into account when you were thinking about buying a primary care asset?

第一，當我們想到橡樹街時，您是否有理由不重新加速這種增長？其次，當我們考慮 RADV 帶來的一些變化時，已經出現的 MA 費率，你能不能談談影響，不僅僅是在 MA 方面，還有在供應商方面？當您考慮購買初級保健資產時，您是否考慮到了這一點？

Lisa, I'll turn it to Shawn in a second, but I just wanted to acknowledge your point about we did lay out a variable vision at December 2021 to really expand into health services. And I really believe this transaction is a clear win for both patients and providers. And as we said in our prepared remarks, this really does create the premier multipayer Medicare value-based platform.

麗莎，我馬上轉給肖恩，但我只想承認你的觀點，即我們確實在 2021 年 12 月制定了一個可變願景，以真正擴展到醫療服務領域。我真的相信這筆交易對患者和提供者來說都是一個明顯的勝利。正如我們在準備好的評論中所說，這確實創建了首屈一指的基於多付款人醫療保險價值的平台。

And you and I have talked a lot about value-based care not just being a contract, but being a platform where we really drive engagement and connect patients to care. And this transaction, combined with Signify Health, really does demonstrate that we are executing on our long-term strategy to drive long-term growth for the company.

你和我已經談了很多關於基於價值的護理，它不僅僅是一份合同，而且是一個我們真正推動參與並將患者與護理聯繫起來的平台。此次交易與 Signify Health 相結合，確實表明我們正在執行我們的長期戰略，以推動公司的長期增長。

Let me turn it over to Shawn to answer your specific questions.

讓我把它交給肖恩來回答你的具體問題。

Lisa. So on the first one about kind of clinic expansion. To be clear, the numbers we cited today in our model are premised on maintaining a trajectory of 35 to 40 clinics a year expansion.

麗莎。所以在第一個關於診所擴張的問題上。需要明確的是，我們今天在模型中引用的數字的前提是保持每年 35 到 40 家診所的擴張軌跡。

As I mentioned in my prepared remarks, one of the things that we will be doing over the coming months is exploring alternative avenues of accelerating synergy realization, but potentially looking at the growth aspect of that, and in particular, avenues that would help us manage sort of greater clinic growth but also sort of manage kind of inside the dilution framework that we've talked about with this transaction.

正如我在準備好的發言中提到的，我們將在未來幾個月做的事情之一是探索加速實現協同效應的替代途徑，但可能會著眼於增長方面，特別是有助於我們管理的途徑某種程度上更大的診所增長，但也某種程度上管理我們在此次交易中談到的稀釋框架內。

And we will be looking at those avenues because it's a very important point because, when you look at the long-term returns of this model, that accelerated growth has some real long-term kind of return benefits to doing that. So again, that will be something that we continue to work on, and explore the best way to do that, within the framework that we've discussed with you today.

我們將研究這些途徑，因為這是非常重要的一點，因為當你觀察這種模式的長期回報時，加速增長對這樣做有一些真正的長期回報好處。同樣，這將是我們繼續努力的事情，並在我們今天與您討論的框架內探索實現這一目標的最佳方式。

On your second question, it was important to us to both understand the positioning on RADV and at least be able to see the MA advance rate notice for '24 and, frankly, work in conjunction with Oak on what we thought that meant to them. And we've had the ability to do that. And obviously, as you all know, much of that still leaves many questions to be answered in the future. It does provide a little bit more clarity than we had in the past. But I think we do understand the dynamics and some of the mitigation efforts that we could put in place if certain things stand or certain things get modified.

關於你的第二個問題，重要的是我們既要了解 RADV 的定位，又要至少能夠看到 24 年的 MA 提前利率通知，並且坦率地說，與 Oak 一起研究我們認為對他們意味著什麼。我們有能力做到這一點。顯然，正如你們所知，其中大部分仍有許多問題需要在未來得到解答。它確實比我們過去提供了更多的清晰度。但我認為我們確實了解動態和一些我們可以在某些事情發生或某些事情被修改時可以採取的緩解措施。

In many ways, though, what I would say is what we saw come out of those notices, I think, is exactly why you want high-quality Medicare Advantage value-based care assets. In its most simplest sense, when you have a year, for example, when reimbursements get squeezed, what's one of the things you want to do? You want to look at your cost control levers. And certainly, Oak is a demonstrable asset that has proven to improve outcomes and reduce costs.

不過，在很多方面，我想說的是我們從這些通知中看到的，我認為，這正是您想要高質量的基於 Medicare Advantage 價值的護理資產的原因。在最簡單的意義上，當你有一年的時間，例如，當報銷被壓縮時，你想做的事情之一是什麼？你想看看你的成本控制槓桿。當然，Oak 是一項可證明的資產，已被證明可以改善結果並降低成本。

And so I think as we think about navigating the future of Medicare Advantage and maybe even a broader opportunity in Medicare value-based care in the fee-for-service population, I think both Signify and Oak are exactly the kind of assets that you would like to have at your side as you do that.

因此，我認為，當我們考慮駕馭 Medicare Advantage 的未來，甚至可能在按服務付費人群中獲得更廣泛的基於 Medicare 價值的護理機會時，我認為 Signify 和 Oak 正是您想要的資產喜歡在你這樣做的時候在你身邊。

And Lisa, just adding to that point. I think we all recognize the importance of Medicare Advantage and the popularity. And we are very encouraged by the political statements that were made last night to support Medicare. And this fits really nicely into that picture as well.

麗莎，只是補充一點。我想我們都認識到 Medicare Advantage 的重要性和受歡迎程度。我們對昨晚為支持醫療保險而發表的政治聲明感到非常鼓舞。這也非常適合那張照片。

Our next question will come from Michael Cherny with Bank of America.

我們的下一個問題將來自美國銀行的 Michael Cherny。

Congratulations on the deal. I'm sure there are going to be a number of other questions there, so I want to hone in on Health Care Benefits and particularly the work you're doing around Stars. I know last month, Karen, you outlined the waiver and the requirements to push forward on the '24 mitigation plans. Can you just give us a sense of where you stand on the various different work streams tied to achieving the '25 mitigation and the planned throughput you have in order to get there and reestablish your Stars presence?

祝賀這筆交易。我敢肯定那裡還會有許多其他問題，所以我想深入了解醫療保健福利，尤其是您圍繞 Stars 所做的工作。我知道上個月，凱倫，你概述了豁免和推進 '24 緩解計劃的要求。您能否讓我們了解一下您在與實現 25 年緩解措施相關的各種不同工作流程中所處的位置，以及您為到達那裡並重新建立 Stars 存在而擁有的計劃吞吐量？

Yes, Mike, thanks for the question. And you're right. We did make progress on our regulatory approvals to move our contracts forward. And we are continuing to make investments in Stars so that we can mitigate the risk. As you might remember, we narrowly missed in our CAHPS scores, and the team has been working very diligently over the course of the last few -- couple of months to make sure that we are improving our results.

是的，邁克，謝謝你的提問。你是對的。我們確實在監管批准方面取得了進展，以推進我們的合同。我們將繼續對 Stars 進行投資，以降低風險。您可能還記得，我們在 CAHPS 分數上差一點，團隊在過去幾個月中一直非常勤奮地工作，以確保我們正在改進我們的結果。

I'm going to ask Dan to talk about the specifics.

我要請 Dan 談談具體情況。

Yes. Thanks, Karen. So in 2022, we really took a look at the opportunity around CAHPS and member experience, and we launched some additional campaigns related to that, that frankly are still ongoing. Things like assisting our members to understand their benefits, expanding our concierge services to really maximize the member experience overall.

是的。謝謝，凱倫。因此，在 2022 年，我們真正審視了 CAHPS 和會員體驗方面的機會，並發起了一些與之相關的額外活動，坦率地說，這些活動仍在進行中。諸如幫助我們的會員了解他們的利益、擴展我們的禮賓服務以真正最大化會員整體體驗等事情。

We also have the opportunity to impact other domains as well, our patient safety domain, that worked really hard with our retail colleagues on in the fourth quarter related to patient medication adherence. And then of course on the HEDIS front, closing as many gaps in care as possible in the fourth quarter, and now currently focused on really optimizing our record collection during the hybrid season.

我們也有機會影響其他領域，即我們的患者安全領域，該領域在第四季度與我們的零售同事一起努力工作，與患者服藥依從性有關。然後當然是在 HEDIS 方面，在第四季度盡可能多地縮小護理方面的差距，現在目前專注於在混合季節真正優化我們的記錄收集。

So we're committed to improve our Stars ratings. We believe we have the right actions and the right team to really improve the ratings overall.

因此，我們致力於提高我們的星級評分。我們相信我們有正確的行動和正確的團隊來真正提高整體收視率。

Our next question will come from A.J. Rice with Credit Suisse.

我們的下一個問題將來自 A.J.瑞士信貸的大米。

Congratulations on the transaction as well. I wondered, since we had Mike on the call, the -- obviously, this has played out a little bit in the public domain. So there's been speculation that someone might be up with Oak Street for a while. I wonder if he could comment on what kind of feedback he's gotten from his doctors. How do they -- how are they reacting to this? And I wonder, do they have to approve, in any way, this transaction? Is there anything in their agreements that require approval?

也祝賀交易成功。我想知道，自從我們讓 Mike 接聽電話以來，很明顯，這在公共領域已經發揮了一些作用。所以有人猜測有人可能會在橡樹街待上一段時間。我想知道他是否可以評論他從醫生那裡得到的什麼樣的反饋。他們如何 - 他們對此有何反應？我想知道，他們是否必須以任何方式批准這筆交易？他們的協議中有什麼需要批准的嗎？

And then lots of questions around the deal, but I might just ask, Shawn, Karen, you're thinking you're going to close this at the end of the year or some time this year. I know the regulatory process is a little less certain than it was a few years ago, I guess, the way to describe it. If it were to slip into some point in '24, would you -- would that materially change your $9 and $10 target? Or are you -- does that have some flexibility around the timing of the deal in it?

然後圍繞這筆交易提出了很多問題，但我可能會問，肖恩，凱倫，你認為你會在今年年底或今年某個時候完成這項交易。我知道監管過程比幾年前更不確定，我想，描述它的方式。如果它在 24 年滑入某個點，你會 - 這會實質性地改變你的 9 美元和 10 美元的目標嗎？或者你 - 在交易時間方面是否有一些靈活性？

A.J., we do -- we're -- we do expect to have this transaction close, I'll let Shawn comment on the financials, but I don't think that we have material changes in those numbers.

A.J.，我們確實 - 我們 - 我們確實希望完成這筆交易，我會讓肖恩對財務狀況發表評論，但我認為這些數字不會發生重大變化。

I want to turn it over to Mike. Mike, can you just respond to A.J.'s question around the clinicians?

我想把它交給邁克。邁克，你能回答 A.J. 關於臨床醫生的問題嗎？

Yes, happy to. So on the second point, no, we don't require any separate approvals. We just need more the standard shareholder approvals.

是的，很高興。所以關於第二點，不，我們不需要任何單獨的批准。我們只需要更多標準的股東批准。

On the first question you asked, I think, is the most important one. At Oak Street Health, our mission is to rebuild health care as it should be. And I think the physicians I've talked to and leaders and team members across Oak Street that I've had the chance to talk to so far, I think there's a huge amount of excitement that this is kind of the next stage of our journey.

關於你問的第一個問題，我認為是最重要的一個。在 Oak Street Health，我們的使命是重建醫療保健。而且我認為到目前為止，我已經與我交談過的醫生以及我有機會與之交談的橡樹街的領導和團隊成員，我認為這是我們旅程的下一階段，我感到非常興奮.

And we're really proud of what we've built over the first 10 years of Oak Street, but we really believe there's an order of magnitude of more growth out there for us. We can go to more communities and impact more older adults. And I think that CVS Health brings just a huge amount of resources that we can partner with and leverage to help us provide higher quality of care for patients, to help us provide a better patient experience and to help continue to make Oak Street the best place to work in health care.

我們為 Oak Street 前 10 年的建設感到非常自豪，但我們真的相信我們還有一個數量級的增長空間。我們可以去更多的社區，影響更多的老年人。而且我認為 CVS Health 帶來了大量的資源，我們可以與之合作並利用這些資源來幫助我們為患者提供更高質量的護理，幫助我們提供更好的患者體驗並幫助繼續使 Oak Street 成為最佳場所從事衛生保健工作。

So I think from our physicians and the rest of our team members' perspective, I think this is a huge positive to continue to help us execute on our mission.

所以我認為從我們的醫生和我們團隊其他成員的角度來看，我認為這是一個巨大的積極因素，可以繼續幫助我們執行我們的使命。

And A.J., I'm not sure if you had a question about more global kind of deal returns, but specifically to your question about the timing of close, the answer is no, it would not change those.

A.J.，我不確定你是否有關於更多全球交易回報的問題，但特別是關於你關於關閉時間的問題，答案是否定的，它不會改變那些。

And arguably, it actually adds a little bit of lift because, if you remember, there's an operating loss that's going on for a little bit of time, and you're picking that up a little bit deeper into the cycle of moving from kind of loss to breakeven to gain. So it actually would not kind of change the $9 to $10 at all, certainly not in a negative way.

可以說，它實際上增加了一點提升，因為，如果你還記得的話，運營虧損會持續一段時間，而且你正在從某種程度上更深入地了解這一點虧損到盈虧平衡。所以它實際上根本不會將 9 美元改變為 10 美元，當然不會以負面的方式改變。

Our next question will come from Justin Lake with Wolfe Research.

我們的下一個問題將來自 Justin Lake 和 Wolfe Research。

Wanted to shift back to Health Benefits for a minute. I wanted to ask if you can walk us through your expectations on membership growth across the businesses in detail. So where do you expect to grow in MA? [So we can say] commercial MA exchanges?

想轉回健康福利一分鐘。我想問您是否可以詳細介紹您對各業務會員增長的期望。那麼您希望在馬薩諸塞州的哪些地方成長？ [所以我們可以說] 商業 MA 交易所？

And then your MLR looks like it's up about 100 basis points year-over-year, maybe a little less. Just hopeful you could frame how much of that comes from the PYD roll off that you're not assuming and what other drivers might be impacting that. Appreciate it.

然後你的 MLR 看起來同比上升了大約 100 個基點，也許少一點。只是希望你能構想出你沒有假設的 PYD 退出有多少，以及其他哪些驅動因素可能會影響它。欣賞它。

Justin, it's Karen. Please let me just comment on the growth. So first of all, in our commercial book, we do expect to grow in our commercial book. And our value proposition is truly resonating in the marketplace. We announced last month that we closed the State of North Carolina, which will bring us about 570,000 members on 1/1/25. So I think that's a good demonstration of the strong value proposition that we have in our commercial business.

賈斯汀，是凱倫。請讓我對增長發表評論。因此，首先，在我們的商業賬簿中，我們確實希望在我們的商業賬簿中有所增長。我們的價值主張在市場上真正引起了共鳴。我們上個月宣布關閉北卡羅來納州，這將在 25 年 1 月 1 日為我們帶來約 570,000 名會員。所以我認為這很好地證明了我們在商業業務中的強大價值主張。

I mentioned our significant growth in individual exchanges, 900,000 to 1 million members next year. And then in Medicare, as you know, Justin, we are disappointed in our individual Medicare Advantage growth, but we are growing our D-SNP business and our group MA business.

我提到了我們個人交流的顯著增長，明年將有 90 萬到 100 萬會員。然後在醫療保險方面，正如你所知，賈斯汀，我們對個人醫療保險優勢的增長感到失望，但我們正在發展我們的 D-SNP 業務和我們的集團 MA 業務。

So I'll let Dan specifically give you a little bit more details on growth, but I'm going to turn it to Shawn to answer your MBR question.

因此，我會讓 Dan 專門為您提供更多有關增長的詳細信息，但我會將其轉交給 Shawn 來回答您的 MBR 問題。

Yes. So Justin, the MBR, I think the guidance midpoint is up about 70 basis points year-over-year. There's a number of pieces that are leading to that. The first, to the point of your question, is the removal of prior year favorable reserve development, is about 20 basis points there.

是的。所以賈斯汀，MBR，我認為指導中點同比上升了大約 70 個基點。有許多部分導致了這一點。首先，就你的問題而言，是去除前一年的有利儲備開發，大約有 20 個基點。

Second, the provision we are making for the exchange business and the provision for any adverse deviation there is also worth about 20 basis points. About 10 basis points is driven by Medicaid redeterminations and what we think the MBR impact will be there. The divestiture of our international business in 2022, that was lower-MBR, so that's adding about 10.

其次，我們為交易所業務所做的準備金和任何不利偏差的準備金也價值約 20 個基點。大約 10 個基點是由醫療補助計劃的重新確定以及我們認為 MBR 的影響所推動的。我們在 2022 年剝離了我們的國際業務，這是較低的 MBR，因此增加了大約 10 個。

So it's 3 or 4 items that are building that up. I would say more broadly behind this, that when you looked at the fourth quarter and you looked behind the impacts of flu and respiratory illness, utilization continued to perform very consistent with what we expected to see. And we still feel the pricing environment is very sound and rational going into 2023.

所以它是建立它的 3 或 4 個項目。我想更廣泛地說，當你回顧第四季度並回顧流感和呼吸道疾病的影響時，利用率繼續表現與我們預期的非常一致。進入 2023 年，我們仍然認為定價環境非常合理。

And Karen, I would just add 2 comments to your remarks. I mean, first on the Medicare front, a couple of bright spots during AEP, where our growth in the duals population as well as our group MA products, and so we expect continued growth in those products through the remainder of the year. And clearly, the team is also focused on our individual MA enrollment as it relates to OEP and our lock-in period. Some of the investments we made at the end of AEP showed some signs of growth that we're looking forward to for the remainder of the year.

Karen，我只想在您的評論中添加 2 條評論。我的意思是，首先在 Medicare 方面，AEP 期間有幾個亮點，我們的雙胞胎人口和我們的 MA 產品都在增長，因此我們預計這些產品將在今年剩餘時間繼續增長。顯然，該團隊還關注我們的個人 MA 註冊，因為它與 OEP 和我們的鎖定期有關。我們在 AEP 結束時進行的一些投資顯示出一些增長跡象，我們期待在今年餘下時間看到這些跡象。

And then the last comment would just be on Medicaid. We do expect some modest growth in that book of business through the first quarter. But as anticipated, at the end of the first quarter, we do expect some of the redetermined members to fall off the roster. And so we're working closely with the states around our opportunities to regain that membership.

然後最後一條評論將只針對醫療補助計劃。我們確實預計第一季度該業務將出現適度增長。但正如預期的那樣，在第一季度末，我們確實預計一些重新確定的成員會從名冊上消失。因此，我們正在與各州密切合作，圍繞我們重新獲得會員資格的機會。

Our next question will come from Eric Percher with Nephron Research.

我們的下一個問題將來自 Nephron Research 的 Eric Percher。

Eric Percher and Josh Raskin here at Nephron. A question with respect to the approach to M&A. How important was geographic diversification in your process or as you're examining assets and making this decision? And then conversely, how important was homogeneity of the model that Oak Street has built? And maybe lastly, how do you think about how this and Signify come together with respect to physician enablement?

Nephron 的 Eric Percher 和 Josh Raskin。關於併購方法的問題。地域多元化在您的流程中或在您檢查資產並做出此決定時有多重要？然後反過來，橡樹街建立的模型的同質性有多重要？也許最後，您如何看待這和 Signify 如何在醫生支持方面走到一起？

I can have Karen talk about that as well at the end, but what I would say is, as we talked about our factors here, Eric, we've conducted a very thorough evaluation over the last 15 months and are confident this is the best asset in the space.

最後我也可以讓 Karen 談談這個，但我想說的是，當我們在這裡討論我們的因素時，Eric，我們在過去 15 個月裡進行了非常徹底的評估，並且相信這是最好的空間中的資產。

It really satisfied all of our criteria: Talented and capable leadership; a leading integrated technology platform; a clear ability, to the point of your question, to scale and reproduce the model and the results across both geography and for different payers. It also has, as Mike mentioned, the demonstrable capability to improve clinical outcomes and lower costs, and I think a very clear path around the unit economics required for profitability. I'd be remiss if I didn't also mention that it has a fundamentally differentiated patient experience, as evidenced by their 90 NPS and their exclusive AARP endorsement. So this asset, really, we've talked about the list of criteria, we really hit it.

它確實滿足了我們所有的標準：有才華和能力的領導；領先的綜合技術平台；就您的問題而言，具有明確的能力，可以跨地域並針對不同的付款人擴展和重現模型和結果。正如 Mike 提到的那樣，它還具有改善臨床結果和降低成本的可證明的能力，而且我認為圍繞盈利所需的單位經濟學有一條非常清晰的路徑。如果我不也提到它具有根本不同的患者體驗，那我就失職了，正如他們的 90 NPS 和他們獨家的 AARP 認可所證明的那樣。所以這個資產，真的，我們已經討論過標準列表，我們真的達到了它。

And I think to your point, the geography was important. We're a big company, we're going to need a big footprint over time, and being in 21 states was important in and of itself. But it's actually, in my mind, the scalability element was the ability to demonstrate the model worked in different geographies. And to the point of your second question about having, I'll call it, the homogeneity of the model, it was the ability to reproduce it and then make changes to it. I think that was very, very important, and frankly, very distinct in what we looked at in the market.

我認為就您而言，地理位置很重要。我們是一家大公司，隨著時間的推移，我們將需要更大的足跡，而在 21 個州開展業務本身就很重要。但實際上，在我看來，可擴展性元素是證明模型在不同地區工作的能力。關於你的第二個問題，我稱之為模型的同質性，這是複制它然後對其進行更改的能力。我認為這非常非常重要，而且坦率地說，與我們在市場上看到的情況非常不同。

I think the second part of your question, I think, is important, too, because there is a lot of interplay potentially down the road between these 2 assets. One of, I think, the benefits that we have, and I think we've built in a modest synergy when we talk about the ability to accelerate growth, is the ability of Signify, when they're doing a home visit, to recognize that here is a member that needs to be returned or connected to care. And that doesn't have to be, obviously, through Oak, but it can be now. And it can be our MinuteClinics as well.

我認為你問題的第二部分也很重要，因為這兩種資產之間可能存在很多相互作用。我認為，當我們談論加速增長的能力時，我們擁有的好處之一是 Signify 的能力，而且我認為我們已經建立了適度的協同作用，當他們進行家訪時，認識到這是一個需要返回或連接到護理的成員。顯然，這不一定要通過 Oak，但現在可以。它也可以是我們的 MinuteClinics。

So the interconnectivity of actually getting these members the care they need, when they need it and where they need it, and to Mike's point, the way it should be provided, I think these 2 things over time will be able to work powerfully together.

因此，實際上讓這些成員在他們需要的時間和地點獲得他們需要的護理的相互聯繫，以及 Mike 的觀點，應該提供的方式，我認為隨著時間的推移，這兩件事將能夠強有力地協同工作。

Yes. And Eric, just to add to that. I think it's really important to think about community and community-based care as we've talked a lot strategically being in a community and really having kind of all these assets work together. Shawn made a good example of Signify and Oak, but then you think about our MinuteClinics, and we can kind of leverage those MinuteClinics for additional capacity. We can leverage our nurse practitioners as well, and then we can have wraparound services. So we can have a very much of a holistic approach to care in the community.

是的。埃里克，只是為了補充這一點。我認為考慮社區和基於社區的護理非常重要，因為我們已經在戰略上討論了很多在社區中的問題，並且真正讓所有這些資產一起工作。 Shawn 是 Signify 和 Oak 的一個很好的例子，但是你想想我們的 MinuteClinics，我們可以利用這些 MinuteClinics 來增加容量。我們也可以利用我們的執業護士，然後我們可以提供全方位服務。因此，我們可以採用非常全面的方法來提供社區護理。

I'd also add that it is really critically important for us to be a multi-payer-agnostic provider and make sure that we're connecting care for all the patients that we're interacting with in the community.

我還要補充一點，對於我們來說，成為一個與多付款人無關的提供者並確保我們為我們在社區中與之互動的所有患者提供護理是非常重要的。

Our next question will come from Stephen Baxter with Wells Fargo.

我們的下一個問題將來自富國銀行的斯蒂芬巴克斯特。

I appreciate all the color on the Oak Street acquisition. I was hoping you could help us think a little bit about the timing you'd expect to be required to realize both the greater than $2 billion of earnings power itself and also the $500 million of synergies. And also maybe any insight into where both those figures might be on a reported basis over the next couple of years would be great.

我欣賞橡樹街收購的所有顏色。我希望你能幫助我們考慮一下你預計需要實現超過 20 億美元的盈利能力本身以及 5 億美元的協同效應的時間。而且，也許對這兩個數字在未來幾年的報告基礎上的位置有任何了解都會很棒。

Yes. So let me talk kind of about this in sort of a financial terms and try to get at some of those points. As I mentioned, right, this is a -- we do think this is a deal that has an attractive long-term return on capital. And -- but it also has the potential to move the needle from an earnings perspective in a company of this size and scale.

是的。因此，讓我以某種財務術語來談談這個問題，並嘗試了解其中的一些要點。正如我提到的，對，這是一個——我們確實認為這是一項具有有吸引力的長期資本回報的交易。而且 - 但它也有可能從這種規模和規模的公司的盈利角度來看。

Our strategy has been and will continue to be to deploy capital to improve the sustainable earnings growth rate of this company as a whole. When you look at this asset in concert with Signify, we project this could improve our overall long-term earnings company growth rate by at least 100 basis points a year as these investments mature. It's important as you think about this, that the dilution, especially the dilution from financing, is temporal and short term, but these sustainable improvements in growth rate are not.

我們的戰略一直並將繼續是部署資本以提高該公司整體的可持續盈利增長率。當您與 Signify 一起查看此資產時，我們預計隨著這些投資的成熟，這可以使我們的整體長期收益公司增長率每年至少提高 100 個基點。考慮到這一點很重要，稀釋，尤其是融資稀釋，是暫時的和短期的，但這些可持續的增長率改善不是。

From a return on capital standpoint, we think it earns double-digit returns on capital in year 7. And very importantly, because of the embedded value in that clinic infrastructure, that return on capital continues to grow on the order of 200 basis points a year thereafter.

從資本回報率的角度來看，我們認為它在第 7 年獲得了兩位數的資本回報率。而且非常重要的是，由於診所基礎設施的內在價值，資本回報率繼續以每年 200 個基點的速度增長此後一年。

And I mentioned in my remarks that, at the current rate of expansion, we would expect to have 300 clinics by -- in 2026 or by the end of 2026. And using the Oak Street convention around adjusted EBITDA at $7 million per clinic, we think the embedded EBITDA could cross the $2 billion threshold in the 2026 year. So that's an important sort of data point. But I think it's important to recognize that the way that embedded EBITDA really manifests itself can be in these ongoing returns on capital.

我在發言中提到，按照目前的擴張速度，我們預計到 2026 年或 2026 年底將擁有 300 家診所。並使用圍繞調整後 EBITDA 的橡樹街公約，每家診所 700 萬美元，我們認為嵌入式 EBITDA 可能會在 2026 年突破 20 億美元的門檻。所以這是一種重要的數據點。但我認為重要的是要認識到嵌入式 EBITDA 真正體現自己的方式可能是這些持續的資本回報。

I'd comment that, while the return profile might be longer than other deals you've seen in the past, I don't think it's atypical of deals that meaningfully improve your strategic positioning as a company. And I do think it's important -- in fact, I think being overly slavish to deals that only satisfy short-term returns are exactly what can lead to long-term growth problems. And I think we're -- this is something that has a lot of long-term growth to earnings power.

我要評論的是，雖然回報率可能比你過去看到的其他交易更長，但我認為這不是典型的交易，可以有意義地改善你作為公司的戰略定位。我確實認為這很重要——事實上，我認為對只滿足短期回報的交易過於盲從正是導致長期增長問題的原因。而且我認為我們 - 這是對盈利能力有很多長期增長的東西。

And finally, you had asked about the synergies and some of the kind of accretion dilution. The synergies are powerful here, and I think it's one of the things that we're uniquely positioned to deliver on. I've often -- when I've talked to all of these companies, they've often said to me like, if I say, "What do you need to grow faster?" And they say, "Members and capital," well, that's something we can bring to bear here.

最後，您詢問了協同效應和某種增生稀釋。這裡的協同作用很強大，我認為這是我們處於獨特位置可以實現的事情之一。我經常 - 當我與所有這些公司交談時，他們經常對我說，如果我說，“你需要什麼才能更快地增長？”他們說，“成員和資本”，嗯，這是我們可以在這裡承擔的事情。

But most of the synergies, probably about 70% of what we talked about, are tied up really in that accelerated growth and the improved retention of MA members. And so when you think about the model here, the J curve, if you will, this is about moving them along that curve faster. And in that trajectory, that generally gets closer to breakeven and positive in that year 2 to 3 time frame. So that it's after that, that a lot of these synergies mature.

但大多數協同效應，可能占我們所討論內容的 70%，都與加速增長和提高 MA 成員保留率密切相關。所以當你考慮這裡的模型時，J 曲線，如果你願意的話，這是關於讓他們更快地沿著這條曲線移動。在那個軌跡中，通常在 2 到 3 年的時間範圍內接近盈虧平衡和積極。因此，在那之後，許多協同作用才成熟。

The way we see that playing out is, I think this would be roughly EPS-neutral probably in like year 4 of our ownership or thereabouts, and begin to be accretive on an EPS line for year 5. But make no mistake, it is improving each year, which is going to help our growth rate between then and now, and you're building substantial embedded long-term value in that footprint.

我們看到結果的方式是，我認為這可能在我們擁有所有權的第 4 年左右大致保持 EPS 中性，並在第 5 年的 EPS 線上開始增加。但不要誤會，它正在改善每年，這將有助於我們從那時到現在的增長率，並且您正在該足跡中建立可觀的嵌入式長期價值。

Our next question will come from Ann Hynes with Mizuho Securities.

我們的下一個問題將來自瑞穗證券的 Ann Hynes。

Maybe we can shift to Retail, your guidance for OP of $5.95 billion to $6 billion. Can you just let us know how much endemic COVID you have in that guidance? And for 2024 and 2025 expectations, are you assuming that stays flat? Or is there any growth in that base business?

也許我們可以轉向零售，您對 OP 的指導為 59.5 億美元至 60 億美元。你能告訴我們你在該指南中有多少地方性 COVID 嗎？對於 2024 年和 2025 年的預期，您是否假設保持不變？還是該基礎業務有任何增長？

No. So Ann, for 2023, we have about $500 million to $600 million of what I'll call the endemic COVID contribution from the 3 categories we've been talking about: Vaccines, diagnostic testing and over-the-counter testing. It's important to recognize that, that is significantly down from the contribution that we experienced in 2022, nearly $1 billion down from that. So we're targeting producing the $6 billion, again, despite kind of that headwind.

不，所以安，到 2023 年，我們將有大約 5 億至 6 億美元來自我們一直在談論的 3 個類別的地方性 COVID 貢獻：疫苗、診斷測試和非處方測試。重要的是要認識到，這大大低於我們在 2022 年的貢獻，比那低了近 10 億美元。所以我們的目標是生產 60 億美元，儘管有一些逆風。

In our forecasting, the general -- I would tell you, the general targeting is we continue to expect retail to be able to maintain flat. And it's -- we have a declining COVID contribution in our thinking behind that, that obviously, there's other initiatives.

在我們的預測中，一般 - 我會告訴你，一般目標是我們繼續期望零售能夠保持平穩。它是——我們在這背後的想法中對 COVID 的貢獻正在下降，顯然，還有其他舉措。

And I'm going to let Michelle and Prem maybe talk about some of the other things that are going on in both the front of the store and the back of the store that are helping the business broadly, but also helping us sort of manage through the decline in COVID contribution.

我要讓 Michelle 和 Prem 談談商店前面和後面發生的其他一些事情，這些事情正在廣泛幫助業務，但也幫助我們進行管理COVID貢獻的下降。

Ann, it's Michelle. So while it's easy to see we had a really strong financial year and gaining share in both front store and pharmacy, there's a lot of underlying trends that I think are driving the momentum even if COVID slows. So if you think about 2022, we grew consumers, we experienced stronger household penetration, and we actually grew service levels and Net Promoter Scores to historically high levels. And so the foundation and momentum has been strong in the front store.

安，是米歇爾。因此，雖然很容易看出我們有一個非常強勁的財政年度，並且在前店和藥店都獲得了份額，但我認為即使 COVID 放緩，也有許多潛在趨勢正在推動這一勢頭。因此，如果你想想 2022 年，我們增加了消費者，我們的家庭滲透率更高，我們實際上將服務水平和淨推薦值提高到歷史最高水平。因此，前店的基礎和勢頭一直很強勁。

This is coming about because of things like our investments in omnichannel, modernizing our store fleet, improving our merch mix, improving service and even our pricing and promotional strategy. So this is a kind of underlying momentum and foundation that we think will help us continue our growth trajectory.

這是因為我們對全渠道的投資、現代化我們的商店車隊、改善我們的商品組合、改善服務，甚至我們的定價和促銷策略。所以這是一種潛在的動力和基礎，我們認為這將幫助我們繼續我們的增長軌跡。

But at the same time, we absolutely recognize there's also opportunity to invest in cost structure and productivity improvements. So we're investing in supply chain, for instance, to optimize, modernize and selectively automate. We believe that will bear a significant return. We're also finding lots of other opportunities to improve inventory turns and reduce overall product loss. So it's this combination of growth on site productivity improvements that we think will continue to fuel our performance, not just in 2023, but beyond.

但與此同時，我們絕對認識到也有機會投資於成本結構和生產力改進。因此，我們正在投資供應鏈，例如，以優化、現代化和有選擇地自動化。我們相信這將帶來可觀的回報。我們還發現了許多其他機會來提高庫存周轉率並減少整體產品損失。因此，我們認為正是這種現場生產力提高的增長組合將繼續推動我們的業績，不僅在 2023 年，而且在以後。

So let me turn it over to Prem.

所以讓我把它交給 Prem。

Yes. Just a couple of other points. Our Q4 market share in pharmacy is now approximately 27%. We grew share another 12 basis points, and we're about 117 basis points higher than the pre-pandemic share.

是的。只是其他幾點。我們第四季度在藥房的市場份額現在約為 27%。我們的份額又增長了 12 個基點，比大流行前的份額高出約 117 個基點。

And then secondly, I'd say there's 2 areas we're really focused. One is on our digital approach in our pharmacies and how we continue to be the most convenient retail destinations for our patients and consumers and really connecting that with our digital strategies. And the second is really around our clinical programs. We're seeing continued strong adoption of those clinical programs that drive further adherence and retention for our patients. And we're starting to see new therapies also rise.

其次，我想說我們真正關注的有兩個領域。一是關於我們藥房的數字方法，以及我們如何繼續成為患者和消費者最方便的零售目的地，並將其與我們的數字戰略真正聯繫起來。第二個是圍繞我們的臨床項目。我們看到這些臨床項目繼續得到廣泛採用，這些項目進一步推動了我們患者的依從性和保留率。我們開始看到新療法也在興起。

So continued strong momentum in Retail from a pharmacy perspective. We continue to have extremely strong service levels in our business as well to drive the business forward.

因此，從藥房的角度來看，零售業的勢頭持續強勁。我們繼續在我們的業務中擁有極其強大的服務水平，並推動業務向前發展。

Our next question will come from Nathan Rich with Goldman Sachs.

我們的下一個問題將來自高盛的 Nathan Rich。

Oak Street's cohort data paints a pretty compelling path just in terms of the embedded EBITDA that is in the centers. I guess, what do you see as the key variables to kind of achieving that kind of J curve that they've laid out? And you've talked about some of this, but what can CVS do to potentially accelerate that?

Oak Street 的同類數據就中心的嵌入式 EBITDA 而言描繪了一條非常引人注目的路徑。我想，您認為實現他們所設計的那種 J 曲線的關鍵變量是什麼？你已經談到了其中的一些，但 CVS 可以做些什麼來潛在地加速呢？

And then just as a quick follow-up, Shawn, I was wondering if you could just talk a little bit more -- in more detail about capital deployment plans in '24 and '25. I think you said some modest level of share repurchases in '24 and more in '25. Can you also talk about maybe what you see as sort of deleveraging our debt paydown across those years as well?

然後作為快速跟進，肖恩，我想知道你是否可以多談一點——更詳細地談談 24 年和 25 年的資本部署計劃。我認為你在 24 年和 25 年說過一些適度的股票回購。你能不能也談談你認為那些年我們的債務償還的去槓桿化？

Yes. So as you mentioned, I think, and I can certainly -- I think Mike can comment as well, right? Really, the variable, and it's remarkably consistent, right, over time, is the ability to drive membership growth sort of along, to your point, along that sort of J curve of cohort financials. And today, I think Oak has done a great job being successful as that. And what this deal really opens up is a lot of new potential pools for members.

是的。所以正如你提到的，我想，我當然可以——我認為邁克也可以發表評論，對吧？真的，變量，而且它非常一致，正確的，隨著時間的推移，是沿著隊列財務的那種 J 曲線推動會員增長的能力。而今天，我認為 Oak 在這方面取得了成功。這筆交易真正打開的是許多新的會員潛力池。

And I think that will take a lot of different forms, right? There are certainly -- well, it's very much going to be a multi-payer asset. There's obviously things we can do for plan design offerings to highlight the Oak network or the Oak clinics. We can do that with the Aetna members. I mentioned Signify before as a potential sort of source of members. But when you just think about the vast array of members that we interact with and the vast array of seniors that we interact with every year across this company, this is a much wider catch basin, if you will, for potential growth.

而且我認為這將採取很多不同的形式，對嗎？當然有——好吧，它很可能是一種多付款人資產。顯然，我們可以為計劃設計產品做一些事情來突出 Oak 網絡或 Oak 診所。我們可以與 Aetna 成員一起做到這一點。我之前提到 Signify 是一種潛在的會員來源。但是，當你只考慮我們每年與我們互動的大量成員以及我們每年與我們互動的大量老年人時，如果你願意的話，這是一個更廣泛的潛在增長集水區。

I also think we can strengthen the value of the offering with our other fulfillment assets around pharmacy and MinuteClinics. And frankly, I think that will make that offering not only more attractive benefits, but all of the payers who contract with Oak, they will all benefit from what we bring to bear with our retail health strategy and our pharmacy strategy. And I think that is sort of -- that is an opportunity there.

我還認為我們可以通過圍繞藥房和 MinuteClinics 的其他履行資產來加強產品的價值。坦率地說，我認為這不僅會使該產品更具吸引力，而且會使所有與 Oak 簽約的付款人受益，他們都將從我們的零售健康戰略和藥房戰略中受益。我認為那有點——那是一個機會。

On capital deployment, I think, as I mentioned, what we expect for this to play out is that, over the next couple of years, we will likely be in the mid-3s from a debt-to-EBITDA ratio, and that's obviously a range that is consistent with our current investment-grade ratings. And that is important to us, to maintain that rating profile.

關於資本配置，我認為，正如我所提到的，我們希望這能發揮作用的是，在接下來的幾年裡，我們的債務與 EBITDA 比率可能會處於 3s 左右，這顯然是與我們當前的投資級評級一致的範圍。這對我們來說很重要，以保持評級狀況。

Having said that, I still think we have an ample amount of financial flexibility over the next 2 to 3 years after this transaction. We would -- our current projections are -- or let me step back.

話雖如此，我仍然認為我們在此次交易後的未來 2 到 3 年內擁有充足的財務靈活性。我們會——我們目前的預測是——或者讓我退後一步。

As you mentioned, we have a modest amount of share repurchase in the '24, '25. Think about that as maybe 1 point or 2 above dilution. That's very consistent with what we told you on Investor Day. So when we think about the flexibility we have, I would say that we would have probably between $4 billion and $8 billion of flexibility over the '23, '24 window, and then that grows more to like the $10 billion to $15 billion of flexibility in the '24, '25 window. Timing obviously still to be determined.

正如你提到的，我們在 24 和 25 年進行了少量的股票回購。將其視為稀釋以上 1 點或 2 點。這與我們在投資者日告訴你的非常一致。因此，當我們考慮我們擁有的靈活性時，我想說我們在 23、24 窗口期間可能會有 40 億美元到 80 億美元的靈活性，然後會增長到 100 億美元到 150 億美元的靈活性在 '24, '25 窗口中。時間顯然還有待確定。

But I think that gives us ample flexibility because this is the capital that we could continue to use to return value to shareholders via the dividend, obviously, incremental share repurchases, deleveraging, to your point. Or it could be used for other corporate purposes.

但我認為這給了我們足夠的靈活性，因為這是我們可以繼續使用的資本，通過股息，顯然，增量股票回購，去槓桿化，向股東回報價值。或者它可以用於其他公司目的。

So before we conclude, I want to take this opportunity to thank our CVS Health colleagues for their extraordinary work bringing our vision to life, improving the health of our customers and delivering on our financial objectives. .

因此，在我們結束之前，我想藉此機會感謝我們的 CVS Health 同事所做的非凡工作，使我們的願景變為現實，改善了客戶的健康並實現了我們的財務目標。 .

As you heard today, CVS Health delivered strong results, and we're advancing our strategic initiatives. We entered 2023 with great momentum, and we are well positioned for growth in our foundational businesses, and we're making continued progress against our strategy. We are so excited about the opportunities ahead of us, including both the Signify and Oak Street Health acquisitions, and we look forward to keeping you updated throughout the year.

正如您今天所聽到的那樣，CVS Health 取得了強勁的成果，我們正在推進我們的戰略舉措。我們以強勁的勢頭進入 2023 年，我們為基礎業務的增長做好了充分準備，並且我們正在根據我們的戰略不斷取得進展。我們對擺在我們面前的機會感到非常興奮，包括 Signify 和 Oak Street Health 的收購，我們期待著全年為您提供最新信息。

Thank you.

謝謝。

Ladies and gentlemen, this does conclude today's CVS Health Fourth Quarter and Full Year 2022 Earnings Call and Webcast. You may disconnect your line at this time, and have a wonderful day.

女士們，先生們，今天的 CVS Health 第四季度和 2022 年全年收益電話會議和網絡廣播到此結束。您可以在此時斷開您的線路，並度過美好的一天。