CVS Health Corp (CVS) 2023 Q1 法說會逐字稿

Ladies and gentlemen, good morning, and welcome to the CVS Health First Quarter 2023 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 2023 年第一季度收益電話會議。 （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 Larry McGrath, Senior Vice President of Business Development and Investor Relations for CVS Health. Please go ahead.

我現在想把電話轉給 CVS Health 業務發展和投資者關係高級副總裁 Larry McGrath。請繼續。

Good morning, and welcome to the CVS Health First Quarter 2023 Earnings Call and Webcast. I'm Larry McGrath, Senior Vice President of Business Development and 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.

早上好，歡迎來到 CVS Health 2023 年第一季度收益電話會議和網絡廣播。我是 CVS Health 業務發展和投資者關係高級副總裁 Larry McGrath。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。

Following our prepared remarks, we'll host a question-and-answer session that will include additional members of our leadership team: Daniel Finke, President of our Health Care Benefits segment; Michelle Peluso, Chief Customer Officer and Co-President of our Pharmacy & Consumer Wealth segment; Prem Shah, Chief Pharmacy Officer and Co-President of our Pharmacy & Consumer Wellness segment; David Joyner, President of the Pharmacy Services business within our Health Services segment; Kyle Armbrester, Chief Executive Officer of Signify Health; and Mike Pykosz, Chief Executive Officer of Oak Street Health.

在我們準備好的發言之後，我們將舉辦問答環節，屆時將包括我們領導團隊的其他成員：醫療保健福利部門總裁 Daniel Finke；我們藥房和消費者財富部門的首席客戶官兼聯席總裁 Michelle Peluso； Prem Shah，首席藥房官兼我們藥房和消費者健康部門的聯席總裁；健康服務部門藥房服務業務總裁 David Joyner；昕諾飛健康首席執行官 Kyle Armbrester； Oak Street Health 首席執行官 Mike Pykosz。

Our press release and slide presentation has been posted to our website along with our Form 10-Q that we filed this morning with the SEC. Today's call is also being broadcast on our website, where we archive for 1 year.

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-Q 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，我們在網站上存檔了 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 COVID-19 as well as the expected consumer benefits of our products and services and our financial projections and the benefits of the Signify Health and Oak Street Health acquisition and the associated integration plans, expected synergies and revenue opportunities. Our 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 COVID-19 and the integration of both the Signify Health and Oak Street Health acquisition.

在此次電話會議中，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 COVID-19 相關的影響以及我們產品和服務的預期消費者利益我們的財務預測以及 Signify Health 和 Oak Street Health 收購的好處以及相關的整合計劃、預期的協同效應和收入機會。我們的前瞻性陳述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 COVID-19 以及 Signify Health 和 Oak Street Health 收購的整合。

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 risk factors in our most recent annual report filed on Form 10-K, our quarterly report on Form 10-Q filed this morning and our recent filings on Form 8-K including this morning's earnings press release.

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，特別是那些在我們以 10-K 表格提交的最新年度報告中關於前瞻性陳述和風險因素的警告聲明中描述的那些，我們今天早上提交的 10-Q 表格季度報告和我們最近提交的 8-K 表格文件，包括今天早上的收益新聞稿。

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 in 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 指標。您可以在今天上午的新聞稿和發佈到我們網站投資者關係部分的調節文件中找到這些非 GAAP 措施的調節。

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, Larry. Good morning, everyone, and thanks for joining our call today. This morning, we reported strong first quarter results that demonstrate excellent performance across CVS Health. We successfully closed the acquisitions of Signify Health and Oak Street Health and are updating our projections to include the financial impact of both transactions.

謝謝你，拉里。大家早上好，感謝您今天加入我們的電話會議。今天早上，我們報告了強勁的第一季度業績，證明了 CVS Health 的出色表現。我們成功完成了對 Signify Health 和 Oak Street Health 的收購，並正在更新我們的預測以包括這兩項交易的財務影響。

We are revising our full year 2023 adjusted EPS guidance to a range of $8.50 to $8.70, reflecting the positive contribution of our strong underlying results and the impact of the Signify Health transaction, which enabled us to partially offset the dilution from the early close of Oak Street and the financing costs for both transactions. Shawn will discuss the details of our updated outlook for the year shortly.

我們將 2023 年全年調整後的每股收益指引修改為 8.50 美元至 8.70 美元，反映出我們強勁的基礎業績的積極貢獻以及 Signify Health 交易的影響，這使我們能夠部分抵消 Oak 提前關閉帶來的稀釋Street 和這兩種交易的融資成本。 Shawn 將很快討論我們更新後的年度展望的細節。

We are purposely executing on our strategy as we continue to expand our health platform of capabilities to serve a broader customer and consumer base. We are addressing the total cost of care, improving health and expanding access to affordable quality care. Today, we are announcing changes to our operating model and financial reporting that more accurately reflect how our businesses are managed. These changes allow us to be more nimble in our execution and more innovative when expanding our products and services. We are excited about accelerating our momentum by unlocking long-term value across our businesses and the broader health care marketplace.

我們正在有目的地執行我們的戰略，因為我們繼續擴大我們的健康平台的能力，以服務更廣泛的客戶和消費者群。我們正在解決護理總成本問題，改善健康狀況並擴大獲得負擔得起的優質護理的機會。今天，我們宣布改變我們的運營模式和財務報告，以更準確地反映我們的業務管理方式。這些變化使我們能夠在擴展產品和服務時更加靈活地執行和更具創新性。我們很高興通過釋放我們業務和更廣泛的醫療保健市場的長期價值來加速我們的發展勢頭。

Beginning this quarter, we will report our results as follows. First, our new Health Services segment unifies most of the former operations of our Pharmacy Services segment as well as our health care delivery operations, including primary care, retail health clinics, home-based care services and provider enablement capabilities. This structure will simplify access to our multi-payer capabilities, better align the way we serve clients and create superior health experiences for consumers. Together, these businesses are positioned to more effectively address the total cost of care, implement new care models and deliver connected solutions that build sustainable health communities. These combined businesses serve more than 110 million people, have more than 20,000 colleagues and, in 2022, reported combined revenues of nearly $170 billion.

從本季度開始，我們將報告如下結果。首先，我們新的健康服務部門統一了我們藥房服務部門以前的大部分業務以及我們的醫療保健交付業務，包括初級保健、零售健康診所、家庭護理服務和供應商支持能力。這種結構將簡化對我們的多付款人功能的訪問，更好地調整我們為客戶提供服務的方式，並為消費者創造卓越的健康體驗。這些企業共同定位於更有效地解決醫療總成本問題，實施新的醫療模式並提供建立可持續健康社區的互聯解決方案。這些合併後的企業為超過 1.1 億人提供服務，擁有超過 20,000 名同事，並且在 2022 年報告的合併收入接近 1,700 億美元。

We also created a new Pharmacy & Consumer Wellness segment that integrates all of our omnichannel pharmacy capabilities, traditional retail pharmacy, specialty and mail order pharmacy fulfillment and infusion services, along with our front store offerings. We are making the pharmacy experience as easy for consumers as possible while ensuring that we are creating better outcomes, lowering costs and increasing convenience. These combined businesses serve more than 120 million people, deliver more than 1.6 billion scripts annually, have more than 220,000 colleagues and, in 2022, reported combined revenues of nearly $109 billion.

我們還創建了一個新的藥房和消費者健康部門，整合了我們所有的全渠道藥房能力、傳統零售藥房、專業和郵購藥房履行和輸液服務，以及我們的前台產品。我們正在使消費者的藥房體驗盡可能輕鬆，同時確保我們創造更好的結果、降低成本和增加便利性。這些合併後的企業為超過 1.2 億人提供服務，每年交付超過 16 億份劇本，擁有超過 220,000 名同事，2022 年報告的合併收入接近 1090 億美元。

The Health Care Benefits segment remains largely unchanged and will continue to offer a full range of insured and self-insured medical, pharmacy, dental and behavioral health products and services. This business serves more than 25 million medical members, has more than 40,000 colleagues and, in 2022, reported revenues of more than $91 billion.

醫療保健福利部門基本保持不變，並將繼續提供全方位的保險和自保醫療、藥房、牙科和行為健康產品和服務。該業務為超過 2500 萬醫療會員提供服務，擁有超過 40,000 名同事，2022 年報告的收入超過 910 億美元。

Turning to our performance in the quarter. We grew total revenue to more than $85 billion, an increase of 11% versus the prior year, and delivered adjusted operating income of $4.4 billion. Adjusted EPS was $2.20. We had another quarter of robust cash flow from operations, generating $7.4 billion.

談談我們在本季度的表現。我們的總收入增長到超過 850 億美元，比上一年增長 11%，調整後的營業收入為 44 億美元。調整後每股收益為 2.20 美元。我們還有四分之一來自運營的強勁現金流，產生了 74 億美元。

Each of our businesses delivered strong performance in the quarter. Starting with the Health Care Benefits segment, we grew revenues to nearly $26 billion, an increase of more than 12%, and delivered adjusted operating income of $1.8 billion. Overall medical costs were well controlled and in line with expectations. Membership in the first quarter increased by 1 million members versus the prior year. This growth was primarily driven by the significant increase in our individual exchange business.

我們的每項業務在本季度都取得了強勁的業績。從醫療保健福利部門開始，我們的收入增長到近 260 億美元，增幅超過 12%，調整後的營業收入達到 18 億美元。整體醫療費用控制良好，符合預期。第一季度的會員人數比上年增加了 100 萬。這一增長主要是由我們個人外匯業務的顯著增長推動的。

Our Medicare business remains one of our strongest growth segments. We recently announced that the City of New York awarded us its group Medicare Advantage plan contract that begins in September 2023. The City of New York is one of the largest client wins in Aetna's history. We look forward to providing access to high-quality, affordable and convenient health care to the city's more than 200,000 retirees and their eligible dependents. We now expect approximately 12% membership growth in our Medicare Advantage business for the full year 2023 and are diligently working to improve our competitive position in individual MA to return to market growth in 2024. The recent award of 2 additional marquee group Medicare Advantage contracts, serving approximately 45,000 retirees and their eligible dependents, will supplement that growth beginning in January of 2024.

我們的醫療保險業務仍然是我們最強勁的增長領域之一。我們最近宣布，紐約市授予我們其於 2023 年 9 月開始的團體 Medicare Advantage 計劃合同。紐約市是 Aetna 歷史上贏得的最大客戶之一。我們期待為該市超過 200,000 名退休人員及其符合條件的家屬提供優質、負擔得起且方便的醫療保健服務。我們現在預計，到 2023 年全年，我們的 Medicare Advantage 業務的會員人數將增長約 12%，並且正在努力提高我們在個人 MA 中的競爭地位，以在 2024 年恢復市場增長。最近授予了 2 個額外的大型集團 Medicare Advantage 合同，為大約 45,000 名退休人員及其符合條件的家屬提供服務，將從 2024 年 1 月開始補充這一增長。

Turning to our Commercial business. We ended the quarter with approximately 18 million members, a nearly 6% increase sequentially. In addition to the significant growth in our individual exchange members, this increase was also driven by growth in key accounts, public and labor and small group membership. These results reflect our strong value proposition, innovative solutions and service excellence.

轉向我們的商業業務。本季度結束時，我們擁有約 1800 萬會員，環比增長近 6%。除了我們個人交易所會員的顯著增長外，這一增長還受到大客戶、公眾和勞工以及小團體會員人數增長的推動。這些結果反映了我們強大的價值主張、創新的解決方案和卓越的服務。

In our Medicaid business, we increased membership in the quarter but expect declines for the rest of the year following the expiration of the public health emergency. As Medicaid members face potential disruptions in their health benefits, we are using the full breadth of our portfolio of assets to help them avoid coverage losses and maintain positive health outcomes.

在我們的醫療補助業務中，我們在本季度增加了會員人數，但預計在公共衛生緊急事件結束後今年剩餘時間裡會員人數會下降。由於 Medicaid 成員的健康福利可能受到干擾，我們正在利用我們的全部資產組合來幫助他們避免承保損失並保持積極的健康結果。

In our Health Services segment, revenues grew to nearly $45 billion, an increase of more than 12%. Adjusted operating income increased more than 14% to $1.7 billion. Our total pharmacy claims process in the quarter grew 3.7% versus the prior year and 4.8% excluding COVID vaccinations. We continued to deliver strong results in our specialty business, with revenue growth of more than 10%.

在我們的健康服務部門，收入增長到近 450 億美元，增幅超過 12%。調整後營業收入增長 14% 以上，達到 17 億美元。我們本季度的總藥房索賠流程比去年同期增長了 3.7%，不包括 COVID 疫苗接種在內增長了 4.8%。我們的專業業務繼續取得強勁業績，收入增長超過 10%。

Our Pharmacy & Consumer Wellness segment delivered a strong quarter, successfully navigating challenging market conditions and normalizing COVID trends. Revenue grew to approximately $28 billion, an increase of nearly 8% versus the prior year. We generated $1.1 billion of adjusted operating income in the quarter, a decrease of approximately 28% from the prior year, largely due to lower COVID-related contribution.

我們的藥房和消費者健康部門在本季度表現強勁，成功應對了充滿挑戰的市場環境並使 COVID 趨勢正常化。收入增長至約 280 億美元，比上年增長近 8%。我們在本季度產生了 11 億美元的調整後營業收入，比上年下降約 28%，這主要是由於與 COVID 相關的貢獻減少。

Performance was strong in both the pharmacy and the front store. Pharmacy revenue increased by 10% versus the prior year, driven by product mix and prescription growth of 2.5%. Our growth in the retail pharmacy is notable and has resulted in significant market share gains over time. This is a testament to the value we provide our pharmacy patients and the investments we have made to improve their experiences. Front store revenues grew by 5% or nearly 8% on a same-store basis, driven by the strength across a variety of categories, including beauty and personal care as well as consumer health products. We continued to successfully execute on our retail footprint optimization strategy, closing more than 100 locations year-to-date, while exceeding our retention goals for colleagues and scripts. We remain on track to close 300 stores in 2023 and a cumulative total of 900 stores by 2024.

藥房和前店的表現都很強勁。受產品組合和處方藥增長 2.5% 的推動，藥房收入較上年增長 10%。我們在零售藥店的增長是顯著的，並且隨著時間的推移導致了顯著的市場份額增長。這證明了我們為藥房患者提供的價值以及我們為改善他們的體驗所做的投資。受包括美容和個人護理以及消費者健康產品在內的各種類別的實力推動，前台店收入在同店基礎上增長了 5% 或近 8%。我們繼續成功執行我們的零售足跡優化戰略，今年迄今關閉了 100 多個地點，同時超過了我們保留同事和腳本的目標。我們仍有望在 2023 年關閉 300 家門店，到 2024 年累計關閉 900 家門店。

Turning to our progress on our strategy. Nearly 18 months ago, we outlined the bold shift in our strategy and shared our vision to become the leading health solutions company for consumers. Our goal is to redefine health care by creating a model that is convenient, affordable, connects care and puts the patient at the center. Achieving this vision requires the right set of capabilities to serve a broader patient, customer and community base. At the center of our vision is a value-based platform that is multi-payer, multichannel and successful at driving consumer engagement, all leading to improved health outcomes.

轉向我們的戰略進展。將近 18 個月前，我們概述了我們戰略的大膽轉變，並分享了我們成為領先的消費者健康解決方案公司的願景。我們的目標是通過創建一種方便、負擔得起、連接護理並以患者為中心的模式來重新定義醫療保健。實現這一願景需要具備一系列正確的能力來為更廣泛的患者、客戶和社區群體提供服務。我們願景的核心是一個基於價值的平台，該平台是多付款人、多渠道並成功推動消費者參與，所有這些都將改善健康結果。

Importantly, as I highlighted earlier, we have completed the acquisitions of Signify Health and Oak Street Health. These acquisitions significantly advance our value-based strategy by adding primary care, home-based care and provider enablement capabilities to our platform. They also bring cutting-edge technology and talent that will accelerate innovation in areas such as automation, analytics and technology-enabled data-driven product development. These premier growth businesses strongly enhance our ability to execute our care delivery strategy.

重要的是，正如我之前強調的那樣，我們已經完成了對 Signify Health 和 Oak Street Health 的收購。這些收購通過在我們的平台上增加初級保健、家庭護理和供應商支持能力，顯著推進了我們基於價值的戰略。他們還帶來了尖端技術和人才，將加速自動化、分析和技術支持的數據驅動產品開發等領域的創新。這些首要的增長業務極大地增強了我們執行醫療服務戰略的能力。

Signify Health has a proven track record of identifying gaps in care and returning patients to care in close collaboration with their payer partners. They have demonstrated their ability to continuously innovate and evolve, further enhancing their value to their payer partners. Signify has a substantial pipeline of opportunities to enhance their position. This includes updating their in-home evaluations to continue to accurately document conditions and diseases while adapting to CMS risk model changes. We will also introduce a Stars enablement offering that will provide meaningful benefits for all payers.

Signify Health 在與付款合作夥伴密切合作下，在發現護理差距和讓患者重返護理方面擁有良好的記錄。他們展示了不斷創新和發展的能力，進一步提升了他們對付款合作夥伴的價值。 Signify 有大量的機會來提升他們的地位。這包括更新他們的家庭評估，以繼續準確記錄病情和疾病，同時適應 CMS 風險模型的變化。我們還將推出 Stars 支持產品，為所有付款人提供有意義的好處。

Oak Street Health has a powerful combination of strong patient engagement, high-quality care and integrated technology that connects care experiences. These capabilities make Oak Street Health the premier clinic-based provider in the ecosystem today and uniquely positions them to manage the risk adjustment changes recently implemented by CMS. The early close of the acquisition will be a short-term headwind to our 2023 adjusted EPS but will enable us to unlock synergies earlier and evaluate all options to accelerate growth at Oak Street and CVS Health.

Oak Street Health 擁有強大的患者參與度、高質量護理和連接護理體驗的集成技術。這些能力使 Oak Street Health 成為當今生態系統中首屈一指的基於診所的提供商，並使他們在管理 CMS 最近實施的風險調整變化方面處於獨特的地位。收購的提前結束將對我們 2023 年調整後的每股收益構成短期不利因素，但將使我們能夠更早地釋放協同效應，並評估加速 Oak Street 和 CVS Health 增長的所有選擇。

More importantly, the combination of Signify, Oak Street and CVS Health creates a value-based, person-centered care platform propelled by the powerful connections between our unique capabilities and assets. This will enable us to drive better patient experience and health outcomes while delivering on our long-term financial goals.

更重要的是，昕諾飛、Oak Street 和 CVS Health 的結合創造了一個基於價值、以人為本的護理平台，由我們獨特的能力和資產之間的強大聯繫推動。這將使我們能夠在實現長期財務目標的同時推動更好的患者體驗和健康結果。

We are also making progress on driving integrated value across our foundational businesses. We serve 2.9 million members who are enrolled in our integrated medical and pharmacy plans. For members that utilize our integrated offerings, we are driving higher rates of medication adherence, up to 15% lower hospital admissions and readmission rate, up to 19% reductions in ER visits and 25% greater utilization of critical mental health care.

我們還在推動基礎業務的綜合價值方面取得進展。我們為 290 萬加入我們綜合醫療和藥房計劃的會員提供服務。對於使用我們綜合產品的會員，我們正在推動更高的服藥依從率、最多可降低 15% 的住院率和再入院率、最多可減少 19% 的急診就診次數以及提高 25% 的重要心理健康護理利用率。

Overall, these integrated plans offer members access to quality, better coordinated care and improved health outcomes. As we continue to expand our capabilities, we will develop more powerful connections that drive superior patient experiences, better outcomes and lower costs.

總的來說，這些綜合計劃為會員提供了獲得優質、更協調的護理和改善健康結果的途徑。隨著我們繼續擴展我們的能力，我們將開發更強大的連接，以推動卓越的患者體驗、更好的結果和更低的成本。

We remain critically focused on digital engagement and achieved a significant milestone this quarter, exceeding 50 million unique digital customers. These customers are driving meaningful results, with digital sales in the quarter up more than 30% versus the prior year. Engagement levels are strong as these customers spend 2.4x more than our nondigitally engaged customers and at higher margins. We continue to drive innovation and expand our digital offerings to meet customers' needs.

我們仍然專注於數字參與，並在本季度實現了一個重要的里程碑，超過 5000 萬獨特的數字客戶。這些客戶正在推動取得有意義的成果，本季度的數字銷售額比去年同期增長了 30% 以上。參與度很高，因為這些客戶的支出是我們非數字化參與客戶的 2.4 倍，而且利潤率更高。我們繼續推動創新並擴展我們的數字產品以滿足客戶的需求。

Last month, we released our 2022 ESG Report, highlighting the progress we are making towards our ambitious goals. We continue to build on our achievements, including signing 2 additional renewable energy purchases that meaningfully advance our transition to 50% renewable energy by 2040.

上個月，我們發布了 2022 年 ESG 報告，強調了我們在實現宏偉目標方面取得的進展。我們繼續鞏固我們的成就，包括簽署 2 項額外的可再生能源採購協議，這將有意義地推動我們到 2040 年向 50% 的可再生能源過渡。

Before I turn the call over to Shawn, I'd like to talk about recent regulatory actions and how our businesses are positioned to successfully navigate through the impact in the months and years to come. We have a long history of successfully working within Medicare Advantage funding levels to support program stability for our members. We're building on that experience to drive more care to value-based arrangements and to clinical care programs that deliver better outcomes and improve member experiences. Our strong capabilities enable us to navigate the current environment and deliver offerings that our customers value.

在我把電話轉給肖恩之前，我想談談最近的監管行動，以及我們的企業如何在未來幾個月和幾年內成功應對影響。我們在 Medicare Advantage 資金水平內成功開展工作以支持我們會員的計劃穩定性方面有著悠久的歷史。我們正在以這種經驗為基礎，推動更多關注基於價值的安排和臨床護理計劃，以提供更好的結果和改善會員體驗。我們強大的能力使我們能夠駕馭當前環境並提供客戶看重的產品。

We appreciate CMS' approach to provide a 3-year phase-in for the risk adjustment model changes. This will allow the industry to work within the guidelines and to reduce disruptions faced by members. We support CMS' goal to increase the value of risk coding and believe coding should capture the true picture of a patient's health, including risk factors, identifying care gaps and patient needs and ultimately driving better outcomes.

我們讚賞康哲藥業為風險調整模型變更提供 3 年逐步實施的方法。這將使該行業能夠在準則範圍內開展工作，並減少成員面臨的干擾。我們支持 CMS 提高風險編碼價值的目標，並相信編碼應該捕捉患者健康的真實情況，包括風險因素、識別護理差距和患者需求並最終推動更好的結果。

Aetna, Signify Health and Oak Street are the right combination of assets to successfully manage through these changes. Each have robust processes and infrastructure to handle the increasing complexities in patient care and reimbursement. They also bring an incredible expertise that allows us to quickly evaluate the impact from these changes and rapidly implement the necessary operational updates to excel in this dynamic environment.

Aetna、Signify Health 和 Oak Street 是成功管理這些變化的正確資產組合。每個都有強大的流程和基礎設施來處理患者護理和報銷中日益複雜的問題。他們還帶來了令人難以置信的專業知識，使我們能夠快速評估這些變化的影響，並迅速實施必要的運營更新，以在這個動態環境中脫穎而出。

I also want to address the recent regulatory focus on the PBM industry. PBMs have consistently been found to operate in a highly efficient market and drive real savings to health care customers and members. Every day, we deliver product choices for our clients and their members that help make care more affordable, accessible and simple. Our business is centered on transparency, innovation and simplicity, which strengthens our ability to meet customers and health plan client needs and, most importantly, drive towards the lowest net cost.

我還想談談最近對 PBM 行業的監管重點。 PBM 一直被發現在一個高效的市場中運作，並為醫療保健客戶和成員帶來真正的節省。每天，我們都為我們的客戶及其成員提供產品選擇，幫助他們使護理變得更實惠、更容易獲得和更簡單。我們的業務以透明、創新和簡單為中心，這增強了我們滿足客戶和健康計劃客戶需求的能力，最重要的是，推動實現最低的淨成本。

Finally, I want to thank our dedicated CVS Health colleagues for their commitment and extraordinary work driving our vision forward.

最後，我要感謝我們敬業的 CVS Health 同事，感謝他們的承諾和非凡的工作推動我們的願景向前發展。

I'll now turn the call over to Shawn for a deeper look into our financial results and outlook for the year.

我現在將電話轉給肖恩，以更深入地了解我們今年的財務業績和前景。

Thank you, Karen, and good morning, everyone. Our first quarter results reflect the continuation of outstanding performance from each of our business segments as we delivered strong revenue growth, cash flow from operations and adjusted earnings per share. These results are driven by our steadfast focus on growth, operational execution and supporting the communities we serve.

謝謝你，凱倫，大家早上好。我們的第一季度業績反映了我們每個業務部門繼續保持出色的業績，因為我們實現了強勁的收入增長、運營現金流和調整後的每股收益。這些結果是由我們堅定不移地關注增長、運營執行和支持我們所服務的社區所推動的。

A few highlights regarding total company performance. First quarter revenues of $85.3 billion increased by 11% year-over-year, reflecting strong growth across each of our businesses. We delivered adjusted operating income of $4.4 billion and adjusted EPS of $2.20, representing decreases of 5.1% and 4.3% versus prior year, respectively, primarily due to lower COVID-19 contributions in the current year. Our ability to generate cash remains outstanding, with cash flow from operations in the quarter of $7.4 billion. Cash flows in the quarter benefited from the timing of CMS payments that are expected to normalize by the end of the year.

關於公司總體業績的一些亮點。第一季度收入 853 億美元，同比增長 11%，反映出我們每項業務的強勁增長。我們實現了 44 億美元的調整後營業收入和 2.20 美元的調整後每股收益，分別比上年下降 5.1% 和 4.3%，這主要是由於本年度 COVID-19 貢獻減少。我們產生現金的能力依然出色，本季度的運營現金流為 74 億美元。本季度的現金流受益於 CMS 付款的時間安排，預計到年底將正常化。

As Karen mentioned in her prepared remarks, beginning this quarter, we have resegmented our businesses and our financial reporting to more closely align with how they are managed. I will discuss our first quarter 2023 results and provide comparisons against the prior year based on our new structure. After reviewing the results, I will update our 2023 guidance under the new segmentation.

正如 Karen 在她準備好的發言中提到的那樣，從本季度開始，我們對我們的業務和財務報告進行了重新細分，以更緊密地與它們的管理方式保持一致。我將討論我們 2023 年第一季度的業績，並根據我們的新結構與上一年進行比較。在審查結果後，我將根據新的細分更新我們的 2023 年指南。

Starting with Health Care Benefits. We delivered strong revenue growth versus the prior year. First quarter revenue of $25.9 billion increased by 12.1% year-over-year. Membership grew over 4% on a sequential basis, reflecting significant growth in individual exchange members as well as increases across all other product lines.

從醫療保健福利開始。與上一年相比，我們實現了強勁的收入增長。第一季度收入為 259 億美元，同比增長 12.1%。會員數量環比增長超過 4%，反映出單個交易所會員的顯著增長以及所有其他產品線的增長。

Adjusted operating income of $1.8 billion in the quarter declined slightly versus the prior year. This was driven by the expected return to more normalized utilization as the effect of COVID waned and by the lower impact from prior year reserve development. These decreases were largely offset by higher net investment income and membership growth across all product lines during the quarter.

本季度調整後營業收入為 18 億美元，與去年同期相比略有下降。這是由於隨著 COVID 的影響減弱以及上一年儲備開發的影響較小，預期恢復到更正常的利用。這些下降在很大程度上被本季度所有產品線的更高淨投資收入和會員增長所抵消。

Our medical benefit ratio of 84.6% increased 120 basis points year-over-year, reflecting more normalized utilization including the impact of higher flu as compared to last year and modestly lower impact from favorable prior year development. Our assumption was always that our 2023 medical cost seasonality by business would look more like prepandemic patterns. We believe that the consensus estimates for quarterly MBR may have relied too heavily on recent experience that was impacted by COVID-19. Overall, utilization trends remain in line with expectations.

我們的醫療福利比率為 84.6%，同比增長 120 個基點，反映了更加正常化的利用率，包括與去年相比更高的流感影響以及去年有利發展的影響略有下降。我們的假設始終是，我們 2023 年按業務劃分的醫療成本季節性看起來更像是大流行前的模式。我們認為，對季度 MBR 的共識估計可能過於依賴受 COVID-19 影響的近期經驗。總體而言，利用率趨勢仍符合預期。

Consolidated days claims payable at the end of the quarter was 48.1, down 3.2 days sequentially. This is more in line with historical levels of days claims payable for the first quarter in prepandemic periods. Overall, we remain confident in the adequacy of our reserves.

本季度末綜合應付索賠天數為 48.1，環比下降 3.2 天。這更符合大流行前第一季度應付索賠天數的歷史水平。總體而言，我們對儲備的充足性仍然充滿信心。

Our Health Services business, which includes most of the operations of our legacy Pharmacy Services segment as well as our health care delivery operations, generated revenue of approximately $45 billion, an increase of 12.6% year-over-year. This increase was driven by pharmacy claims growth, specialty pharmacy and brand inflation, partially offset by continued client price improvements. While results from both Signify, which closed in March, and Oak Street, which closed yesterday, will be included in this segment going forward, the timing of the close of Signify resulted in an immaterial impact to first quarter 2023 results.

我們的健康服務業務，包括我們遺留的藥房服務部門的大部分業務以及我們的醫療保健交付業務，創造了約 450 億美元的收入，同比增長 12.6%。這一增長是由藥房索賠增長、專業藥房和品牌通脹推動的，部分被持續的客戶價格上漲所抵消。雖然 3 月關閉的 Signify 和昨天關閉的 Oak Street 的業績將被計入這一細分市場，但 Signify 關閉的時間對 2023 年第一季度的業績影響不大。

Adjusted operating income of nearly $1.7 billion grew over 14% year-over-year, driven by improved purchasing economics and increased pharmacy claims volume. This was partially tempered by ongoing client price improvements and lower COVID-19 testing. Total pharmacy claims processed in the quarter increased by 3.7% above the prior year and 4.8% when excluding COVID-19 vaccinations. This increase was primarily attributable to net new business in 2023, increased utilization and the impact of an elevated cough, cold and flu season. Total pharmacy membership remained steady, exceeding 110 million members.

受采購經濟改善和藥房索賠量增加的推動，調整後營業收入接近 17 億美元，同比增長超過 14%。持續的客戶價格改善和較低的 COVID-19 測試在一定程度上緩和了這種情況。本季度處理的藥房索賠總額比去年同期增長 3.7%，如果不包括 COVID-19 疫苗接種，則增長 4.8%。這一增長主要歸因於 2023 年的淨新業務、利用率提高以及咳嗽、感冒和流感季節增加的影響。藥房會員總數保持穩定，超過 1.1 億會員。

In our Pharmacy & Consumer Wellness segment, we delivered strong revenue growth despite continued economic uncertainty and lower COVID-19 contributions. During the first quarter, revenue of $27.9 billion grew nearly 8%, reflecting increased prescription and front store volume, pharmacy drug mix and brand inflation. These increases were partially offset by continued reimbursement pressure, decreased COVID-19 vaccinations and diagnostic testing and the impact of recent generic introductions.

在我們的藥房和消費者健康部門，儘管經濟持續存在不確定性和 COVID-19 貢獻較低，但我們實現了強勁的收入增長。第一季度，279 億美元的收入增長了近 8%，反映了處方藥和店面銷量的增加、藥房藥品組合和品牌通脹。這些增長部分被持續的報銷壓力、COVID-19疫苗接種和診斷測試的減少以及最近仿製藥引入的影響所抵消。

Adjusted operating income of $1.1 billion declined 27.9% versus the prior year, driven by reimbursement pressure and decreased COVID-19 vaccinations and testing as well as increased investments in operations and capabilities. These decreases were partially offset by increased prescription volume and improved generic drug purchasing. Pharmacy prescription volume grew 2.5% year-over-year, reflecting increased utilization and elevated cough, cold and flu volume compared to the prior year. Excluding the impact of COVID-19 vaccinations, prescription volume increased by 4.5%.

調整後營業收入為 11 億美元，較上年下降 27.9%，這是受報銷壓力、COVID-19 疫苗接種和檢測減少以及運營和能力投資增加的推動。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。藥房處方量同比增長 2.5%，反映出與上一年相比使用率增加以及咳嗽、感冒和流感量增加。排除 COVID-19 疫苗接種的影響，處方量增加了 4.5%。

Turning to the balance sheet. Our liquidity and capital position remained excellent. Through the first quarter, we generated cash flow from operations of $7.4 billion, bolstered by the CMS prepayment I discussed earlier, and ended the quarter with approximately $2.7 billion of cash at the parent in unrestricted subsidiaries. During the quarter, we issued approximately $6 billion of long-term debt for general corporate purposes including funding the Signify transaction. The Oak Street transaction was funded with available resources, including proceeds of $5 billion from a term loan that closed earlier this week.

轉向資產負債表。我們的流動性和資本狀況保持良好。整個第一季度，在我之前討論的 CMS 預付款的支持下，我們從運營中產生了 74 億美元的現金流，並且在本季度結束時母公司在不受限制的子公司中擁有約 27 億美元的現金。本季度，我們發行了約 60 億美元的長期債務用於一般企業用途，包括為 Signify 交易提供資金。橡樹街交易的資金來自可用資源，包括本週早些時候關閉的一筆定期貸款的 50 億美元收益。

We repurchased approximately 22.8 million shares in the quarter, and through our quarterly dividend, we returned $779 million to shareholders. We remain committed to maintaining our current investment-grade ratings while preserving flexibility to deploy capital strategically.

我們在本季度回購了大約 2280 萬股股票，並通過季度股息向股東返還了 7.79 億美元。我們仍然致力於維持我們目前的投資級評級，同時保持戰略性部署資本的靈活性。

A few other items worth highlighting for investors. First, as previously noted, beginning this year, the impact of net realized capital gains or losses will be excluded from adjusted operating income. Net realized capital losses in the 3 months ended March 31, 2023 and 2022 were $105 million and $75 million, respectively. Second, we recorded an additional loss on assets held for sale associated with our Omnicare long-term care business of $349 million. We also recognized acquisition-related transaction and integration costs associated with the Signify and Oak Street transactions as well as additional office real estate optimization charges in the quarter for a total of $68 million.

其他一些值得投資者強調的項目。首先，如前所述，從今年開始，已實現淨資本收益或損失的影響將被排除在調整後的營業收入之外。截至 2023 年 3 月 31 日和 2022 年 3 月 31 日止的三個月內，已實現的淨資本損失分別為 1.05 億美元和 7500 萬美元。其次，我們記錄了與我們的 Omnicare 長期護理業務相關的持有待售資產的額外損失 3.49 億美元。我們還確認了與 Signify 和 Oak Street 交易相關的收購相關交易和整合成本，以及本季度額外的辦公室房地產優化費用，總計 6800 萬美元。

Finally, effective January 1 of this year, we adopted a new standard related to the accounting for long-duration insurance contracts. Our results will reflect this change going forward. The retrospective adoption of the new accounting standard also required us to revise our net income for 2022. This change positively impacted our first quarter 2022 results by $42 million and our full year 2022 results by $162 million.

最後，自今年 1 月 1 日起，我們採用了與長期保險合同會計相關的新準則。我們的結果將反映這一變化。追溯採用新會計準則還要求我們修改 2022 年的淨收入。這一變化對我們 2022 年第一季度的業績產生了 4200 萬美元的積極影響，對 2022 年全年的業績產生了 1.62 億美元的積極影響。

Before we provide our updated expectations for 2023, I want to discuss the impact of our business resegmentation had on our financials. The primary impact of resegmentation that I want to highlight is the revised treatment of our Maintenance Choice product. Previously, the economics of Maintenance Choice were reflected in both our Pharmacy Services and Retail segments regardless of where the drugs were dispensed and drove a large intersegment elimination. After resegmentation, the economics of Maintenance Choice will only be reflected in our Pharmacy & Consumer Wellness segment, which now includes all pharmacy, mail and specialty fulfillment operations. This change correspondingly results in the discontinuation of adjusted operating income eliminations and provides greater simplicity for investors.

在我們提供 2023 年的最新預期之前，我想討論一下我們的業務重組對我們財務狀況的影響。我想強調的重新細分的主要影響是我們維護選擇產品的修訂處理。以前，維護選擇的經濟性反映在我們的藥房服務和零售部門中，無論藥物在哪里分配，並推動了大量的部門間淘汰。重新細分後，Maintenance Choice 的經濟效益將僅反映在我們的藥房和消費者健康部門，該部門現在包括所有藥房、郵件和專業履行業務。這一變化相應地導致調整後營業收入抵銷的終止，並為投資者提供了更大的簡單性。

In addition to the changes related to our treatment of Maintenance Choice, we shifted our legacy care delivery operations, including MinuteClinic, from Retail into our Health Services segment. This is also where our recently acquired Signify and Oak Street businesses will be reported.

除了與我們對 Maintenance Choice 的處理相關的變化外，我們還將我們的傳統護理交付業務（包括 MinuteClinic）從零售轉移到我們的健康服務部門。這也是我們最近收購的 Signify 和 Oak Street 業務的報告地點。

Turning now to updated guidance based on our new segments. Beginning with the Health Services segment. Our new adjusted operating income guidance is a range of $6.61 billion to $6.73 billion. This estimate reflects the resegmentation changes previously described, the impact of emerging risks to the 340B program and the inclusion of Signify Health and Oak Street Health acquisitions, partially offset by underlying strength in our Pharmacy Services business.

現在轉向基於我們新細分市場的更新指南。從健康服務部門開始。我們新調整後的營業收入指導範圍為 66.1 億美元至 67.3 億美元。這一估計反映了先前描述的重新細分變化、新出現的風險對 340B 計劃的影響以及收購 Signify Health 和 Oak Street Health 的影響，部分被我們藥房服務業務的潛在實力所抵消。

For the Health Care Benefits segment, we now expect adjusted operating income of $6.39 billion to $6.52 billion, benefiting from higher net investment income in the first quarter of 2023 and prior period development. We continue to take a prudent and cautious stance with respect to our individual exchange business inside our full year outlook.

對於醫療保健福利部門，我們現在預計調整後的營業收入為 63.9 億美元至 65.2 億美元，這得益於 2023 年第一季度和前期發展的更高淨投資收入。在我們的全年展望中，我們繼續對我們的個人外匯業務採取審慎和謹慎的態度。

In the Pharmacy & Consumer Wellness segment, our new adjusted operating income guidance is a range of $5.73 billion to $5.83 billion, reflecting lower-than-expected COVID volumes as well as the impact of resegmentation. We are also updating our guidance for additional net investment income generated in our Corporate segment due to higher yields and higher average parent cash balances in the first quarter of 2023. We do not expect these higher corporate cash balances to persist in 2023 following the recent closure of both the Signify and Oak Street acquisitions.

在藥房和消費者健康領域，我們新調整後的營業收入指引範圍為 57.3 億美元至 58.3 億美元，反映出低於預期的 COVID 銷量以及重新細分的影響。由於 2023 年第一季度更高的收益率和更高的平均母公司現金餘額，我們還更新了我們對公司部門產生的額外淨投資收入的指導。我們預計這些較高的公司現金餘額在最近關閉後不會持續到 2023 年Signify 和 Oak Street 的收購。

Finally, our new projection for interest expense is $2.7 billion, reflecting the incremental financing costs for Signify and Oak Street. We are also updating our share count guidance to approximately 1.293 billion shares as our previously announced accelerated share repurchase transaction yielded more shares than initially projected. In aggregate, the headwind of approximately $0.35 resulting from the impact of the Signify and Oak Street acquisitions and their associated financing, partially offset by underlying strength across the enterprise, result in a net headwind of $0.20. This brings our 2023 adjusted EPS guidance range to $8.50 to $8.70.

最後，我們對利息支出的新預測為 27 億美元，反映了 Signify 和 Oak Street 的增量融資成本。我們還將我們的股票數量指引更新為約 12.93 億股，因為我們之前宣布的加速股票回購交易產生的股票數量超過了最初的預期。總的來說，Signify 和 Oak Street 的收購及其相關融資的影響造成約 0.35 美元的逆風，部分被整個企業的潛在實力所抵消，導致淨逆風 0.20 美元。這使我們 2023 年調整後的每股收益指導範圍達到 8.50 美元至 8.70 美元。

Shifting to our cash flow. We continue to anticipate strong cash flow from operations in 2023 and are maintaining our guidance range of $12.5 billion to $13.5 billion. Capital expenditures are unchanged at a range of $2.8 billion to $3 billion, and we continue to project an adjusted effective tax rate of 25.5%.

轉向我們的現金流。我們繼續預計 2023 年的運營現金流將強勁，並將我們的指導範圍維持在 125 億美元至 135 億美元之間。資本支出保持在 28 億美元至 30 億美元的範圍內不變，我們繼續預計調整後的有效稅率為 25.5%。

I also want to provide an update on the progression of earnings for the year. Due to the strength of our results in the first quarter, the incorporation of Signify and Oak Street and the 340B headwind, we now expect second half 2023 earnings to be slightly more than 50% of the full year results, with the third quarter modestly higher than the fourth quarter.

我還想提供有關本年度收入進展的最新信息。由於我們第一季度的強勁業績、Signify 和 Oak Street 的合併以及 340B 的逆風，我們現在預計 2023 年下半年的收益將略高於全年業績的 50%，第三季度略高比第四季度。

We also want to highlight our expectations for quarterly MBRs. We continue to expect the year-on-year increases in MBR to be higher in the first half than the second half. This dynamic is due to COVID-driven lower utilization trends in the first half of 2022. We expect the MBR progression in the second quarter of this year to look similar to the trend in the first quarter.

我們還想強調我們對季度 MBR 的期望。我們繼續預計上半年 MBR 的同比增幅將高於下半年。這種動態是由於 2022 年上半年 COVID 驅動的較低利用率趨勢。我們預計今年第二季度的 MBR 進展看起來與第一季度的趨勢相似。

Shifting now to our multiyear outlook. We remain committed to achieving the $9 and $10 targets for 2024 and 2025 that we shared during our earnings call in February. We take these commitments seriously and have aligned the organization and our operations to achieve these goals. As with any multiyear plan, new headwinds and tailwinds can emerge. Recently, there have been significant developments in the 340B program that create challenges for our pharmacy benefits business. And based on our most recent experience, COVID contributions may dissipate more rapidly than previously anticipated.

現在轉向我們的多年展望。我們仍然致力於實現我們在 2 月份的財報電話會議上分享的 2024 年和 2025 年 9 美元和 10 美元的目標。我們認真對待這些承諾，並調整組織和我們的運營以實現這些目標。與任何多年計劃一樣，可能會出現新的逆風和順風。最近，340B 計劃取得了重大進展，這給我們的藥房福利業務帶來了挑戰。根據我們最近的經驗，COVID 貢獻的消散速度可能比之前預期的要快。

The early close of the Signify and Oak Street transactions improve our ability to accelerate synergy realization. In addition, our business resegmentation presents the opportunity to reduce duplicative efforts and enhance focus on rationalizing our core operations. We believe these opportunities, combined with the underlying strength of our business and our commitment to evaluate all alternatives to accelerate growth and synergies from our new acquisitions, will enable us to mitigate the new headwinds I just discussed.

Signify 和 Oak Street 交易的提前結束提高了我們加速實現協同效應的能力。此外，我們的業務重組為減少重複工作和加強對核心業務合理化的關注提供了機會。我們相信，這些機會，加上我們業務的潛在實力，以及我們評估所有替代方案以加速增長和新收購的協同效應的承諾，將使我們能夠減輕我剛才討論的新逆風。

To conclude, our first quarter results reflect continued strength from all of our core business segments. We are excited to begin the work of integrating Signify and Oak Street into our operations and are pleased with the positive contribution of our foundational businesses on our 2023 adjusted EPS guidance. We will maintain our focus on growth and operational execution and look forward to keeping you updated as we continue to progress on our long-term strategy.

總而言之，我們第一季度的業績反映了我們所有核心業務部門的持續實力。我們很高興開始將 Signify 和 Oak Street 整合到我們的運營中，並對我們的基礎業務對我們 2023 年調整後的 EPS 指南做出的積極貢獻感到高興。我們將繼續專注於增長和運營執行，並期待在我們繼續推進我們的長期戰略時為您提供最新信息。

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 A.J. Rice with Credit Suisse.

（操作員說明）我們將從 A.J. 那裡回答我們的第一個問題。瑞士信貸的大米。

Maybe just on the focus on MA for 2024. Karen, in your remarks, you mentioned that you feel like Oak Street is particularly well positioned to absorb the pending changes around the risk adjustment and so forth. I wonder if I could get you to flesh that out a little more of what you all see in Oak Street relative to some of the other things perhaps you've looked at or whatever that makes you confident of their ability to make the adjustments or if they've already got things in place to do that.

也許只是關注 2024 年的 MA。凱倫，在你的評論中，你提到你覺得橡樹街特別適合吸收圍繞風險調整等未決的變化。我想知道我是否可以讓你更充實一點你在橡樹街看到的相對於你可能看過的其他一些東西，或者任何讓你相信他們有能力做出調整的東西，或者如果他們已經做好了準備。

And then maybe the follow-up I'll ask now, too. Shawn, you guys have laid out the mitigation steps that you are taking to offset the Star Rating headwind for next year. I wonder if you've got the update on what you're doing with respect to the one plan that got hit, with respect to some of the cost reduction programs that you talked about implementing and other things. Any update on that would be great.

然後也許我現在也會問後續問題。肖恩，你們已經制定了為抵消明年星級評級逆風而採取的緩解措施。我想知道您是否了解您在執行的一項計劃、您談到實施的一些成本削減計劃以及其他方面所做的最新進展。任何更新都會很棒。

Yes, let me take a couple of those things. First of all, as I said in my prepared remarks, we do plan to get back to market growth in our individual MA product for a number of reasons. I'll start with the work that we've been doing on our -- kind of in our Medicare product, making sure that we have strong benefits and strong service capabilities. We believe that Oak Street and Signify also give us credibility in the Medicare Advantage space.

是的，讓我拿一些東西。首先，正如我在準備好的發言中所說，出於多種原因，我們確實計劃讓我們的個別 MA 產品恢復市場增長。我將從我們在我們的 Medicare 產品中所做的工作開始，確保我們擁有強大的福利和強大的服務能力。我們相信 Oak Street 和 Signify 也給了我們在 Medicare Advantage 領域的信譽。

We took a long hard look at Oak Street and their ability to adapt to the Medicare rate advantage. The one thing that we were most impressed by was the level of commitment that they have relative to their patient care and, secondly, the technology platform that they have. And I'm going to ask Mike to actually talk a little bit more about that, but I would say that very, very strong performing business. We are excited about what their capabilities will bring to our Medicare and also other payers, Medicare, because as you know, it's a payer-agnostic business. So a lot of the work that they're doing not only benefits us, it benefits their broader customer base as well.

我們仔細研究了 Oak Street 及其適應 Medicare 費率優勢的能力。我們印象最深的一件事是他們對患者護理的承諾水平，其次是他們擁有的技術平台。而且我要請邁克實際上多談一點，但我會說非常非常強大的表現業務。我們對他們的能力將為我們的 Medicare 以及其他付款人 Medicare 帶來什麼感到興奮，因為如您所知，這是一項與付款人無關的業務。因此，他們所做的很多工作不僅讓我們受益，也讓他們更廣泛的客戶群受益。

Mike?

麥克風？

Thank you, Karen. To build on that, I think most importantly, the results we're driving the economic from with our patients is really driven by the strength of our care model. And we've been incredibly successful across programs, across different risk adjustment methodologies. For example, we were in the top 1% of the Medicare Shared Savings Program. We're in that program. We were the top-performing direct contract in our ACO REACH entity. We obviously achieved phenomenal results on Medicare Advantage.

謝謝你，凱倫。在此基礎上，我認為最重要的是，我們推動患者經濟發展的結果實際上是由我們的護理模式的力量驅動的。我們在不同的項目、不同的風險調整方法中取得了令人難以置信的成功。例如，我們在 Medicare Shared Savings Program 中名列前 1%。我們在那個項目中。我們是 ACO REACH 實體中表現最好的直接合同。我們顯然在 Medicare Advantage 上取得了驚人的成果。

And so what underlies that is a robustness in the clinical model, an incredible medical leadership team and, as Karen noted, a really strong technology platform. So when there are changes, we can adapt to those and implement them. And the consistency of our approach, the fact that we operate our centers in a consistent manner across the country really enables us to rapidly change as we need to. But most importantly, fundamentally, what is driving the economics of Oak Street is great patient care and keeping people healthy in and out the hospital, and that's going to be durable regardless of how risk adjustment is done.

因此，支撐這一點的是臨床模型的穩健性、令人難以置信的醫療領導團隊，以及 Karen 指出的真正強大的技術平台。因此，當有變化時，我們可以適應並實施它們。我們方法的一致性，我們在全國以一致的方式運營我們的中心這一事實確實使我們能夠根據需要迅速改變。但最重要的是，從根本上說，推動橡樹街經濟發展的是出色的患者護理和讓人們在醫院內外保持健康，無論如何進行風險調整，這都將是持久的。

And let me ask Dan to talk a little bit about our recontracting efforts and what we're doing on Stars.

讓我請 Dan 談談我們的重新簽約工作以及我們在 Stars 上所做的事情。

So a couple of updates on the Stars program. First of all, on the contract diversification process that is ongoing and as expected, we're beginning the operationalization of that as we speak. And then Shawn has talked in the past about the investments that we've made from an enterprise perspective with the enterprise focus to improve the clinical experience and the member experience for our members. We continue to believe we have the right actions and the team in place.

因此，對 Stars 計劃進行了一些更新。首先，正如預期的那樣，在正在進行的合同多元化過程中，我們正在開始對其進行操作。然後 Shawn 過去談到了我們從企業角度進行的投資，以企業為重點，以改善我們會員的臨床體驗和會員體驗。我們仍然相信我們有正確的行動和適當的團隊。

We have some positive momentum there. As you know, we're between 2 important times in the rating cycle. The CAPS survey is currently underway. The investments we've made in customer satisfactions are showing some internal measurement improvement in the member experience measurements. We're also wrapping up the HEDIS season, and the team has been very focused on chart collection, and we're seeing some year-over-year improvement there. And all of these actions are added to our robust Stars program, and we look forward to this being reflected in our Stars outcomes going forward.

我們在那裡有一些積極的勢頭。如您所知，我們處於評級週期的兩個重要時期之間。 CAPS 調查目前正在進行中。我們在客戶滿意度方面所做的投資顯示出在會員體驗衡量方面的一些內部衡量改進。我們也結束了 HEDIS 賽季，團隊一直非常專注於圖表收集，我們在那裡看到了一些同比改進。所有這些行動都被添加到我們強大的 Stars 計劃中，我們期待這能反映在我們未來的 Stars 成果中。

So A.J., on that point, I would just say I'm encouraged by what we're seeing on the internal metrics relative to our Stars performance.

所以 A.J.，在這一點上，我只想說我對我們在與我們的明星表現相關的內部指標上看到的感到鼓舞。

Our next question comes from Lisa Gill with JPMorgan.

我們的下一個問題來自摩根大通的 Lisa Gill。

Karen, I guess I just want to shift gears a little bit and go back to your PBM comment around transparency, lowest net price. Now we continue to see a lot of chatter in D.C. around potential PBM legislation around both changes to rebates, changes to spread pricing. Shawn called out changes to 340B and having a headwind. There's the net to gross bubble-popping when we think about insulin, I think about these new drugs, GLP-1 coming to the market.

凱倫，我想我只是想稍微換檔，回到你關於透明度、最低淨價的 PBM 評論。現在，我們繼續在華盛頓看到很多關於潛在 PBM 立法的討論，這些立法涉及回扣的變化和價差定價的變化。 Shawn 要求對 340B 進行更改並遇到逆風。當我們想到胰島素時，我想到了這些新藥 GLP-1 上市時的淨泡沫。

When we put all of this together, can you or -- welcome back to David Joyner, talk about your outlook for the PBM, how you're thinking of this and any potential changes that you think will come about on the PBM side? And what are you hearing more importantly from your clients as we think about these areas?

當我們將所有這些放在一起時，您能否或 - 歡迎回到 David Joyner，談談您對 PBM 的展望，您如何看待這一點以及您認為 PBM 方面會發生的任何潛在變化？當我們考慮這些領域時，您從客戶那裡聽到的更重要的是什麼？

Lisa, first of all, I thought your report on the PBM industry was fantastic. And let me -- I'll just make a few comments on the PBM industry at large, and I'll ask David to answer your specific questions.

麗莎，首先，我認為你關於 PBM 行業的報告非常棒。讓我——我將對整個 PBM 行業發表一些評論，我會請大衛回答你的具體問題。

I think it's really important that we all recognize that the PBMs play an essential role in lowering drug costs. And I think we all would agree that in fact, the PBM is the only player in the supply chain whose specific role it is to lower drug costs for our customers.

我認為我們都認識到 PBM 在降低藥物成本方面發揮著重要作用，這一點非常重要。我想我們都會同意，事實上，PBM 是供應鏈中唯一的參與者，其特定作用是為我們的客戶降低藥品成本。

And I think we've had a number of investigations. They've consistently concluded that the PBMs operate in a highly efficient and effective manner to really deliver real savings. And I think you mentioned the customers, our clients hire us to manage their pharmacy benefit, which includes both the administration and the management of overall drug costs. And almost every case, they bring in sophisticated consultants to help them look at that broader service offering, which includes looking at rebates, looking at spread pricing. And our clients have a choice and decide how they want to contract for rebates and spread pricing.

我認為我們已經進行了大量調查。他們一致得出結論，PBM 以高效且有效的方式運作，可以真正實現真正的節省。我想你提到了客戶，我們的客戶僱用我們來管理他們的藥房福利，包括管理和整體藥物成本的管理。幾乎在每個案例中，他們都會聘請經驗豐富的顧問來幫助他們審視更廣泛的服務，包括審視回扣、審視價差。我們的客戶可以選擇並決定他們希望如何簽訂回扣和差價合同。

And in fact, today, we're passing through over 98% of rebates on behalf of our clients, which obviously have full audit rights. And our scorecard is really how we're effectively and successfully managing the client spend, which we have consistently demonstrated and low to single -- low to mid-single-digit growth in overall pharmacy spend. So I think that we've seen a high level of member and client satisfaction. And I think that the government -- we've answered the government's questions on transparency and innovation, and our clients are making those choices. And I think that we have consistently demonstrated that the PBMs play a critical role in the health care ecosystem.

事實上，今天，我們代表我們的客戶處理了超過 98% 的回扣，這些客戶顯然擁有完全的審計權。我們的記分卡實際上是我們如何有效和成功地管理客戶支出，我們一直在證明這一點，並且整體藥房支出的低到中個位數增長。所以我認為我們已經看到了高水平的會員和客戶滿意度。我認為政府——我們已經回答了政府關於透明度和創新的問題，我們的客戶正在做出這些選擇。我認為我們一直在證明 PBM 在醫療保健生態系統中發揮著關鍵作用。

Now your specific questions, let me ask David to talk about the customers.

現在你的具體問題，讓我請大衛談談客戶。

Thanks, Karen, and Lisa, thanks for the question. So as you know, I've been in this industry for a long time and maybe have become too accustomed to the scrutiny in the marketplace, but it also has allowed us, I think, to validate the value that we bring to our customers. So as I kind of answer more broadly kind of the customer question and kind of where the focus is, as you know, 9 out of every 10 prescriptions are generic drugs today. So if you look at it from a member affordability, this is a very affordable benefit and, I think, the value that the PBM has been able to accelerate and deliver to our customers.

謝謝 Karen 和 Lisa，謝謝你提出這個問題。所以正如你所知，我在這個行業工作了很長時間，可能已經習慣了市場的審查，但我認為，它也讓我們能夠驗證我們為客戶帶來的價值。因此，當我更廣泛地回答客戶問題和焦點所在時，如你所知，今天每 10 個處方中有 9 個是仿製藥。因此，如果你從會員的承受能力來看，這是一個非常實惠的好處，我認為，PBM 已經能夠加速並為我們的客戶提供價值。

So the focus now is really on that last 10% and the 10% both in terms of the high list prices and areas in which we have been able to deliver competition and actually create discounts for our customers. So I would say there's a couple of different areas that we're focusing on. One is to make sure that we preserve and protect the transparency that we're delivering to our customers today. As Karen said, we passed through, obviously, 98-plus percent of the rebates, and the customers choose how they want to contract with us with full audit rights.

因此，現在的重點實際上是最後 10% 和 10%，無論是在高標價方面，還是在我們能夠提供競爭並實際為我們的客戶創造折扣的領域。所以我想說我們關注的是幾個不同的領域。一是確保我們保持和保護我們今天向客戶提供的透明度。正如 Karen 所說，我們顯然通過了 98% 以上的回扣，客戶可以選擇他們希望如何與我們簽訂合同，並擁有完全的審計權。

So I think our customers feel very strongly about the value that we're delivering, but there is obviously an area around the member affordability. So we're focusing specifically in the area of insulins. We have in -- today, 65% of all of our plan sponsors actually offer a $35 or less co-pay for the members that have insulin. So when you look at it from a member affordability and areas where we want to protect the preventative drug classes, our customers are actually moving down this path and making sure that they're both focusing on transparency for themselves and also making sure that they're focusing on transparency for the members.

所以我認為我們的客戶對我們提供的價值有非常強烈的感覺，但顯然在會員負擔能力方面存在一個領域。所以我們特別關注胰島素領域。我們 - 今天，我們所有計劃贊助商中有 65% 實際上為使用胰島素的會員提供 35 美元或更少的共同支付。因此，當您從會員的負擔能力和我們希望保護預防性藥物類別的領域來看時，我們的客戶實際上正在沿著這條道路前進，並確保他們既關注自己的透明度，又確保他們“重新關注成員的透明度。

And the last piece I'll say just in terms of kind of the client reaction and/or kind of where they're positioned today, we did have a large client forum upon my return. And there's a big focus on kind of the advocacy, both in the states and at the federal level, and they're very focused on making sure that they both educate and preserve the tools that we have available to us to manage the spend. So whether you mentioned biosimilars or the high cost of GLP-1s is making sure that we continue to actually have the tools in place to drive competition that allows us to reduce cost for our customers.

最後一篇我要說的只是關於客戶反應的種類和/或他們今天所處位置的種類，我回來後我們確實有一個大型客戶論壇。在州和聯邦一級，人們非常關注某種宣傳，他們非常專注於確保他們既教育又保留我們可以用來管理支出的工具。因此，無論您提到生物仿製藥還是 GLP-1 的高成本，都確保我們繼續實際擁有推動競爭的工具，使我們能夠為客戶降低成本。

So I'd say it has been somewhat of a wake-up call. And I would expect that you'll see more kind of advocacy not just within the PBM but, obviously, the payers that actually have to fund the other benefit.

所以我想說這有點像警鐘。我希望您不僅會在 PBM 內看到更多類型的倡導，而且顯然，實際上必須為其他利益提供資金的付款人。

Our next question comes from Justin Lake with Wolfe Research.

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

Appreciate the reiteration of '24 and '25 EPS target. Given you've updated '23 and there's a ton of moving parts for '24, I wanted to focus here and ask a question for an update on areas like the Star Rating, Centene loss headwind next year. I know that number has moved obviously. How should we think about the deals year-over-year versus the $0.35 dilution that you've offered for this year? And any other areas of potential offset or growth beyond typical core growth and capital deployment as we think about kind of the moving parts to kind of bridge us to that $9 would be really helpful.

感謝重申 '24 和 '25 EPS 目標。鑑於您已經更新了 23 年並且 24 年有大量活動部件，我想集中在這裡並提出一個問題，以了解明年星級評級、Centene 損失逆風等領域的更新。我知道這個數字已經明顯移動了。我們應該如何考慮同比交易與您今年提供的 0.35 美元稀釋？除了典型的核心增長和資本部署之外，任何其他潛在的抵消或增長領域都會非常有幫助，因為我們考慮了某種移動部件來將我們連接到那 9 美元。

Yes. I will start on that, and Karen or anybody else can sort of comment on this. So I think in terms of thinking about the existing headwinds that you mentioned, Stars and Centene, I think we look at those as largely the same. And as I mentioned in my remarks, we're driving the organization to achieve the $9 per share for 2023 and approximately $10 for 2024 on an adjusted EPS basis. But as we mentioned, over the quarter, there has been a couple of things, I think, that have sort of popped up.

是的。我將從這個開始，Karen 或其他任何人都可以對此發表評論。因此，我認為就您提到的現有不利因素 Stars 和 Centene 而言，我認為我們對這些因素的看法大致相同。正如我在發言中提到的那樣，我們正在推動該組織在調整後的每股收益基礎上實現 2023 年每股 9 美元和 2024 年每股約 10 美元的目標。但正如我們所提到的，在本季度，我認為有幾件事突然出現了。

Having said that, we do believe we have 2 very impactful levers, 1 of which you mentioned, that can help us mitigate these potential headwinds. The first is to explore all the alternatives to accelerate growth and synergy realization in Signify and Oak Street. For Signify, that will be driven by continued strong multi-payer growth and using our combined assets to expand product and capabilities for all payers. For Oak Street, the early closing will allow us to explore alternative growth vehicles that allow us to accelerate clinic growth and mitigate dilution and, very importantly, begin this work well in advance of 2024.

話雖如此，我們確實相信我們有 2 個非常有影響力的槓桿，您提到了其中 1 個，可以幫助我們減輕這些潛在的不利因素。首先是探索所有替代方案，以加速 Signify 和 Oak Street 的增長和協同效應的實現。對於 Signify 而言，這將受到持續強勁的多付款人增長以及利用我們的合併資產為所有付款人擴展產品和能力的推動。對於 Oak Street，提前關閉將使我們能夠探索替代增長工具，使我們能夠加速診所增長並減輕稀釋，並且非常重要的是，在 2024 年之前就開始這項工作。

The second item is that the closing of these 2 strategic transactions and the resegmenting of our operation provides us with a timely opportunity to both improve focus and reduce administrative and operational costs by streamlining, eliminating duplicative efforts and achieving greater organizational operational efficiency. We believe both areas represent sizable opportunities that have the potential to serve as mitigating tailwinds for '24 and '25.

第二項是，這兩項戰略交易的完成和我們業務的重新劃分為我們提供了一個及時的機會，可以通過精簡、消除重複工作和實現更高的組織運營效率來提高重點並降低行政和運營成本。我們相信這兩個領域都代表著巨大的機會，有可能成為 24 和 25 年的緩和順風。

So I'd say, in summary, while there's still a lot to play out here on both the headwinds and tailwinds side, we still believe these are goals that are within an attainable range of outcomes.

所以我想說，總而言之，雖然在逆風和順風方面還有很多事情要做，但我們仍然相信這些目標在可實現的結果範圍內。

And Shawn, when do you think you'll be able to share with us or put some numbers around the benefits you'll see to those deals versus kind of what consensus numbers maybe assumed for '24 and the efficiency cost cutting that you think you might be able to achieve for next year? Any idea in terms of magnitude or timing?

肖恩，你認為你什麼時候可以與我們分享或圍繞你將看到的這些交易的好處給出一些數字，而不是 24 年可能假設的共識數字以及你認為的效率成本削減明年能否實現？在幅度或時間方面有什麼想法嗎？

Yes. I think this is really at the top of the priority list for the next really quarter or 2. And I think we'll have greater clarity on both headwinds and tailwinds sort of over that time period. And I just want to be clear, I might have said $9 and $10 for '23 and '24. That's for '24 and '25. Just to be clear. But Justin, this is really at sort of the top of the performance agenda for the next couple of quarters for us.

是的。我認為這確實是下一個真正的季度或 2 的優先列表的首位。而且我認為我們將在那個時期內對逆風和順風都有更清晰的認識。我只想說清楚，我可能會說 23 年和 24 年分別為 9 美元和 10 美元。那是 24 和 25 年的。只是為了清楚。但是賈斯汀，這確實是我們未來幾個季度績效議程的首要任務。

Our next question comes from Michael Cherny with Bank of America.

我們的下一個問題來自美國銀行的 Michael Cherny。

I think this is a quasi 2-parter: 1 technical and 1 more type of the numbers. But just first, on the segmentation change, I just want to confirm, especially based on the press release that the specialty and mail revenue and EBIT moved from Health Services, the former Pharmacy Services to Pharmacy & Consumer Wellness just because I'm trying to make sure I understand the full footing of where the guidance changed.

我認為這是一個準 2 部分：1 個技術和 1 個更多類型的數字。但首先，關於細分變化，我只想確認，特別是根據新聞稿，專業和郵件收入以及息稅前利潤從健康服務（以前的藥房服務）轉移到藥房和消費者健康，只是因為我試圖確保我了解指南變更的全部內容。

And I guess the real question along those lines is, can we dive a little bit more into what goes into 340B in terms of the changes that you've seen? And you called it out specifically for Health Services. Is there any impact that you can bridge in terms of the total number, both for Health Services as well as if there is any that impacts Pharmacy & Consumer Wellness?

我想沿著這些思路真正的問題是，我們能否根據您所看到的變化更深入地研究 340B 中的內容？而且您專門為衛生服務提出了要求。就總數而言，您是否可以彌合對健康服務以及是否有任何影響藥房和消費者健康的影響？

Michael, I'll jump in on this one. So I want to be clear that the economic benefit really of specialty and mail is still in HSS. What we've done here is consolidate the fulfillment functions in the PCW organization, and there's no meaningful sort of transfer of profit around sort of the fulfillment angle of that. So when you look at the guidance change on HSS, it looks like a big number. The biggest component of that is really the elimination of the dual credit of Maintenance Choice being in both. When you take that out, you will see the guidance has come down about $300 million for HSS.

邁克爾，我會加入這個。所以我想明確一點，專業和郵件真正的經濟效益仍在 HSS 中。我們在這裡所做的是鞏固 PCW 組織中的履行職能，並且圍繞履行的角度沒有有意義的利潤轉移。因此，當您查看 HSS 的指導變化時，它看起來是一個很大的數字。其中最大的組成部分實際上是消除了維護選擇的雙重信用。當你把它拿出來時，你會看到 HSS 的指導已經減少了大約 3 億美元。

That's basically 2 main pieces. One you saw in our earnings slides, there's about a $0.07 decrement or about $130 million. That's sort of the core performance of the pharmacy business, which I'll come back to vis-à-vis 340B. The other is we're now including the adjusted operating income for Oak and Signify in there, and that is the other piece that would get you to about a $300 -- or $300 million change in the guidance. But the thing to keep in mind is the elimination and then also the elimination then of the elimination entry that we had around maintenance choice, that's going to look a lot bigger.

這基本上是 2 個主要部分。您在我們的收益幻燈片中看到的一張，減少了大約 0.07 美元或大約 1.3 億美元。這是藥房業務的核心績效，我將在 340B 中回過頭來討論。另一個是我們現在將 Oak 和 Signify 的調整後營業收入包括在內，這是另一個可以讓你獲得大約 300 美元或 3 億美元的指導變化的部分。但要記住的是消除，然後是我們圍繞維護選擇的消除條目的消除，這看起來要大得多。

The 340B impact, as I mentioned, it's a very fluid situation. We're reacting to sort of what the actions that various manufacturers are taking. What I'd say is, as I mentioned, there's about a $0.07 decrease in our guidance related to pharmacy performance. That actually is an underlying positive strength in the non-340B elements of our pharmacy business. And then we've put in sort of a best estimate at this point. So that 340B impact is a little bigger than the $0.07. I think there are various -- there's been a note or 2 published about this, and I'd say those aren't unreasonable proxies for sort of what we've incorporated into our guidance on this topic. But again, I can't stress enough, it's still a -- it's sort of a dynamic process that's moving around.

正如我提到的，340B 的影響是一個非常不穩定的情況。我們正在對各種製造商正在採取的行動做出反應。正如我所提到的，我要說的是，我們與藥房績效相關的指導減少了大約 0.07 美元。這實際上是我們製藥業務非 340B 元素的潛在積極力量。然後我們在這一點上進行了某種最佳估計。所以 340B 的影響略大於 0.07 美元。我認為有各種各樣的 - 已經發布了一兩篇關於這個的說明，我想說這些並不是我們已經納入我們關於這個主題的指南的某種不合理的代理。但是，我再次強調，它仍然是一個 - 它是一個不斷變化的動態過程。

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。

Appreciate the incremental detail on Signify and Oak's impact on the guidance. My question would be, how are you prioritizing the development of Oak? Are you focusing on getting existing membership into existing clinics near term? It sounds like there is new clinic build that may be accelerated by the early close. What can you tell us there?

欣賞有關 Signify 和 Oak 對指南的影響的增量細節。我的問題是，您如何確定 Oak 開發的優先級？您是否專注於在短期內讓現有會員加入現有診所？聽起來好像有新的診所建設可能會因提前關閉而加速。你能告訴我們什麼？

Yes. I'll turn it to Mike, but it's really both, right? We're considering, obviously, the key financial levers, getting membership into the clinics. That's always been -- it's one of the synergy values we discussed when we announced the deal. And then as I mentioned, one of the opportunities we've had once we've closed is to explore solutions to accelerate that growth.

是的。我會把它轉給邁克，但實際上兩者都是，對吧？顯然，我們正在考慮關鍵的財務槓桿，讓會員進入診所。這一直是——這是我們在宣布交易時討論的協同價值之一。然後正如我提到的，一旦我們關閉，我們所擁有的機會之一就是探索加速增長的解決方案。

But I'll let Mike comment as well.

但我也會讓 Mike 發表評論。

Yes. From an Oak Street perspective, we couldn't be more excited getting to work with CVS. The breadth and the number of older adults that CVS is interacting with across all the different business units is really unprecedented in the U.S., and that creates an incredible opportunity for us to meet more people, introduce to them what we do at Oak Street Health, which we think is highly differentiated from a care model perspective and a patient experience perspective. That can allow us to bring more and more patients in, which can really move up the profitability timing in our J-curve.

是的。從 Oak Street 的角度來看，我們對與 CVS 合作感到非常興奮。 CVS 在所有不同業務部門與老年人互動的廣度和數量在美國確實是前所未有的，這為我們創造了一個難得的機會來結識更多人，向他們介紹我們在 Oak Street Health 所做的事情，我們認為，從護理模式的角度和患者體驗的角度來看，這是高度不同的。這可以讓我們帶來越來越多的患者，這可以真正提高我們 J 曲線的盈利時間。

And so that is an incredible excitement point. And I think even thinking more broadly than just the kind of traditional CVS Health, we're really excited to work with Signify, which is a huge opportunity there as well. So that's just on the filling a clinic perspective. And obviously, we are always excited. We think there's a huge market opportunity to put more clinics up. And so that combination, I think, is really powerful.

所以這是一個令人難以置信的興奮點。而且我認為甚至比傳統的 CVS Health 更廣泛地思考，我們真的很高興與 Signify 合作，這也是一個巨大的機會。所以這只是填補了診所的觀點。顯然，我們總是很興奮。我們認為建立更多診所存在巨大的市場機會。因此，我認為這種組合非常強大。

Yes, this is Kyle. Just from me briefly, too. When we go into the almost 3 million homes we go into this year, so many of them don't have a primary care physician or are completely isolated from a care team. And so we're very excited to have an option for those folks and to be able to drive them back to a model that we know is going to drive better outcomes and to connect them into Oak Street.

是的，這是凱爾。也只是簡單地從我這裡說起。當我們進入今年進入的近 300 萬戶家庭時，他們中的許多人沒有初級保健醫生，或者完全與護理團隊隔離。因此，我們很高興能為這些人提供選擇，並能夠將他們帶回到我們知道會帶來更好結果並將他們連接到 Oak Street 的模式。

So there's a tremendous amount of synergies, I think, bringing all of these 3 assets together, CVS with the brand and the reach, Oak with their differentiated model and now our presence in the home. And when we pull all 3 of those together, I think we're going to have a really unique experience that drives better patient outcomes across the country.

因此，我認為，將所有這三種資產結合在一起，CVS 與品牌和影響力，Oak 及其差異化模型以及現在我們在家中的存在，將產生巨大的協同效應。當我們將這三者結合在一起時，我認為我們將擁有真正獨特的體驗，從而在全國范圍內推動更好的患者治療。

Yes. And Eric, I wouldn't lose sight of the fact that there are a lot of other assets that we can connect the dots for these members, including kind of our retail health clinics, including our pharmacy. You can think about Medicare -- pharmacy adherence, pharmacy reconciliation. So there's lots of touch points that will create additional value for us across the entire enterprise as we connect all these assets together.

是的。埃里克，我不會忽視這樣一個事實，即我們可以為這些成員連接很多其他資產，包括我們的零售健康診所，包括我們的藥房。您可以考慮 Medicare——藥房依從性、藥房協調。因此，當我們將所有這些資產連接在一起時，有很多接觸點將為我們在整個企業中創造額外價值。

And Karen, do you believe you have all the assets you need now? Or could we see more inorganic addition to Health Care Services?

凱倫，你相信你現在擁有你需要的所有資產嗎？或者我們能否在醫療保健服務中看到更多的無機添加劑？

Yes. I think over time, we'll look at what other assets, but right now, we need to focus on execution of the assets that we just acquired. And then as you think longer term around the corner, there might be additional opportunities in the home or health services, tech kinds of things. But right now, for the near term, it is important for us to execute on these important assets and bring our products and services to bear for our customers.

是的。我認為隨著時間的推移，我們會研究其他資產，但現在，我們需要專注於執行我們剛剛收購的資產。然後，當你認為從長遠來看，在家庭或健康服務、技術類的事情上可能會有更多的機會。但是現在，就近期而言，重要的是我們要執行這些重要資產並為我們的客戶提供我們的產品和服務。

Our next question comes from Kevin Caliendo with UBS. And Kevin, your line is open, please unmute.

我們的下一個問題來自瑞銀的 Kevin Caliendo。凱文，你的線路是開放的，請取消靜音。

Sorry about that. Just looking at the MBR guide. I just want to make sure I got this right. So your -- Shawn, you said second quarter MBR would be flat, right, with first quarter MBR and that utilization expectations were in line with your expectations. I guess just can you remind us what the utilization expectations were or are and any way to segment out what you're seeing? You mentioned higher flu but maybe across the different business lines, just to get a better understanding of sort of what the assumption is for 2Q as well in terms of utilization and how to think about that going forward.

對於那個很抱歉。只看 MBR 指南。我只是想確保我做對了。所以你的 - 肖恩，你說第二季度的 MBR 將與第一季度的 MBR 持平，並且利用率預期符合你的預期。我想您能否提醒我們過去或現在的利用率預期是多少，以及是否可以通過任何方式來劃分您所看到的內容？您提到了更高的流感，但可能涉及不同的業務線，只是為了更好地了解第二季度的假設以及利用率以及如何考慮未來的假設。

Yes. I'll have Dan talk a little bit more about the specifics on utilization. But specific to the MBR discussion, just to be clear, it may mathematically work out to be what you said, but we expect a similar kind of year-over-year increase in Q2 MBR and then sort of a leveling out for kind of Q3, Q4. And I think this has more to do, I think, with how '22 manifested itself in terms of how COVID was playing out.

是的。我會讓 Dan 多談談利用率的具體細節。但具體到 MBR 的討論，需要明確的是，從數學上講，它可能會像你所說的那樣，但我們預計第二季度 MBR 會出現類似的同比增長，然後在第三季度趨於平穩, Q4.我認為這與 22 年如何在 COVID 的表現方面表現出來有更多關係。

And I think that's why that's going to sort of drive that pattern. We have been pricing all along for a return to normal utilization across the portfolio. I think we're getting closer and closer to that all the time, certainly with some of what we've seen in first quarter. But I can have Dan comment a little bit more. But as you mentioned, overall, we thought it was in line with our expectations and our pricing.

我認為這就是為什麼這會推動這種模式。我們一直在定價以恢復整個投資組合的正常利用率。我認為我們一直在越來越接近這一目標，當然還有我們在第一季度看到的一些情況。但我可以請 Dan 發表更多評論。但正如您提到的，總體而言，我們認為這符合我們的預期和我們的定價。

So Dan?

那麼丹？

Yes. Thanks, Shawn. As Shawn said, we've been expecting the quarter-over-quarter increases towards a normalized level of utilization, and we certainly continue to see that in the first quarter. Inpatient volume has continued to be slightly below normalized levels. We also saw some transitions of care to some alternative sites of care, outpatient/ambulatory. And obviously, we think that's a good thing, offering alternative sites of care with lower overall costs. So we see that trend continue.

是的。謝謝，肖恩。正如肖恩所說，我們一直預計利用率會環比增長，達到正常水平，我們肯定會在第一季度繼續看到這種情況。住院人數繼續略低於正常水平。我們還看到了一些護理轉移到一些替代護理地點，門診/門診。顯然，我們認為這是一件好事，以較低的總體成本提供替代護理場所。所以我們看到這種趨勢仍在繼續。

Mental health remains above prepandemic levels. We also think that's a good thing because demand is being met. And then general services, like physician services, ambulatory ER and specialists are all generally at normalized levels. And all of that, like Shawn said, is priced within expectations. When you think about the lines of business, the way I think about it is Commercial and Medicare, in line with expectations, generally at normalized levels and Medicaid is still being somewhat favorable.

心理健康狀況仍高於大流行前水平。我們也認為這是一件好事，因為需求得到了滿足。然後是一般服務，如醫生服務、門診急診室和專家，一般都處於正常水平。所有這一切，正如肖恩所說，都在預期之內。當你考慮業務線時，我的想法是商業和醫療保險，符合預期，一般處於正常水平，醫療補助計劃仍然有些有利。

Our next question will come from Brian Tanquilut with Jefferies.

我們的下一個問題將來自 Jefferies 的 Brian Tanquilut。

As I think about the Oak Street acquisition and the guidance that you had given at the time of the deal being announced, $2 billion EBITDA target for 2026, I think I've heard Shawn talk about driving accelerated growth there. How do we reconcile -- first, do you still believe that that's the goal? And then how do you reconcile the J-curve with the increase or the acceleration in growth in units that you're contemplating?

當我想到 Oak Street 的收購以及您在宣布交易時給出的指導，即 2026 年 20 億美元的 EBITDA 目標時，我想我聽 Shawn 談論推動那裡的加速增長。我們如何調和——首先，你仍然相信那是目標嗎？然後，您如何協調 J 曲線與您正在考慮的單位增長或加速增長？

Yes. Just to be clear, I think, I'm not sure, but the EBITDA number you're referencing was sort of the embedded EBITDA kind of concept. And I think that's again, when we talk a lot about sort of accretion dilution, we're in the GAAP world. And what that does is it leaves out sort of the embedded EBITDA that's building. But as I mentioned, there's significant long-term value because of that embedded EBITDA and accelerating clinic growth.

是的。需要明確的是，我想，我不確定，但你引用的 EBITDA 數字是一種嵌入式 EBITDA 的概念。而且我認為，當我們談論很多關於某種吸積稀釋時，我們又在 GAAP 世界中。這樣做的目的是排除正在構建的嵌入式 EBITDA。但正如我所提到的，由於嵌入的 EBITDA 和加速的診所增長，因此具有重要的長期價值。

And as we've discussed, though, there are vehicles and models where we could see kind of both accelerating the clinic growth and better managing the dilutive impact of that clinic growth. And now that we're closed, and we're closed well in advance of '24, I think one of the opportunities we have is to explore and potentially execute on those in time to have an impact on 2024.

正如我們所討論的那樣，儘管如此，我們可以看到一些車輛和模型既可以加速診所的增長，又可以更好地管理診所增長的稀釋影響。現在我們已經關閉，而且我們在 24 年之前就關閉了，我認為我們擁有的機會之一是探索並可能及時執行那些對 2024 年產生影響的機會。

But I'll let Mike, as the expert here, talk more about this.

但我會讓邁克作為這裡的專家更多地談談這個問題。

Yes. What I would add to that is if you look at the economics of the Oak Street J-curve, which we've shared a lot publicly, on the Oak Street level, the biggest driver of that is both the quality of care for patients and how fast you can fill up centers. And we're -- we think there's still opportunities to continue to improve the quality of care of patients as we have year-over-year. There's a lot of capabilities at CVS that can accelerate that.

是的。我要補充的是，如果你看看橡樹街 J 曲線的經濟學，我們已經公開分享了很多，在橡樹街層面，最大的驅動因素是患者的護理質量和你能以多快的速度填滿中心。而且我們 - 我們認為仍有機會繼續提高患者的護理質量，就像我們每年所做的那樣。 CVS 有很多功能可以加速這一過程。

But even more importantly, if we can just pull up the time it takes to fill up a center, we will pull off those extremely profitable years at the back-end J-curve, which right now are taking 6, 7 years to get to. You can pull that up faster. Obviously, now that number that Shawn referenced that embedded EBITDA number becomes reality much faster. And I think that's the biggest opportunity from an economic perspective.

但更重要的是，如果我們能夠縮短填滿一個中心所需的時間，我們將在後端 J 曲線上實現那些極其有利可圖的年份，現在需要 6、7 年才能達到.你可以把它拉得更快。顯然，現在 Shawn 引用的那個嵌入式 EBITDA 數字更快地成為現實。我認為從經濟角度來看，這是最大的機會。

And while we are so excited to see part of CVS is then as we're doing that, we can reinvest even more in more centers, more capabilities to create an incredibly powerful flywheel. And obviously, interacting with a broader CVS ecosystem will both help Oak Street, and then we can actually do a lot to help different parts within CVS as well. So again, we couldn't be more excited about that, but the opportunities are huge.

雖然我們很高興看到 CVS 的一部分在我們這樣做的同時，但我們可以在更多的中心、更多的能力上進行更多的再投資，以創造一個非常強大的飛輪。顯然，與更廣泛的 CVS 生態系統進行交互都會對 Oak Street 有所幫助，然後我們實際上也可以做很多事情來幫助 CVS 中的不同部分。因此，我們對此再一次感到非常興奮，但機會是巨大的。

I want to thank you all for joining our call today. We obviously entered 2023 with really strong execution, and we are committed to achieving our goals. So thank you.

我要感謝大家今天加入我們的電話會議。我們顯然以非常強大的執行力進入了 2023 年，我們致力於實現我們的目標。所以謝謝。

This concludes today's CVS Health First Quarter 2023 Earnings Call and Webcast. You may disconnect your line at this time, and have a wonderful day.

今天的 CVS Health 2023 年第一季度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。