CVS Health Corp (CVS) 2023 Q2 法說會逐字稿

Good morning, everyone. My name is Bruno and I'll be your conference operator for today. At this time, I would like to welcome everyone to the CVS Health Second Quarter 2023 Earnings Conference Call. (Operator Instructions) I will now hand over to your host, Larry McGrath, you may begin your conference.

大家，早安。我叫布魯諾，我將擔任今天的會議操作員。此時，我歡迎大家參加 CVS Health 2023 年第二季度收益電話會議。 （操作員指示）我現在將會議交給主持人 Larry McGrath，您可以開始會議了。

Good morning, and welcome to the CVS Health Second 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. Following our prepared remarks, we'll host a question-and-answer session that will include additional members of our leadership team.

早上好，歡迎參加 CVS Health 2023 年第二季度收益電話會議和網絡廣播。我是 CVS Health 業務開發和投資者關係高級副總裁 Larry McGrath。今天早上凱倫·林奇也加入了我的行列。總裁兼首席執行官；執行副總裁兼首席財務官肖恩·格廷 (Shawn Guertin)。在我們準備好的發言之後，我們將舉辦問答會議，其中包括我們領導團隊的其他成員。

Our press release and slide presentation have 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 it will be archived for 1 year.

我們的新聞稿和幻燈片演示以及今天早上向 SEC 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，並將存檔一年。

During this call, we'll make certain forward-looking statements. Our forward-looking statements are subject to significant risks and uncertainties that could cause actual results to differ materially from currently projected results. 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 reports on Form 10-Q, the most recent of which was filed this morning, and our recent filings on Form 8-K, including this morning's earnings press release.

在這次電話會議中，我們將做出某些前瞻性陳述。我們的前瞻性陳述面臨重大風險和不確定性，可能導致實際結果與當前預測結果存在重大差異。我們強烈建議您查看我們向 SEC 提交的有關這些風險和不確定性的報告，特別是我們在 10-K 表格上提交的最新年度報告中有關前瞻性陳述和風險因素的警告聲明中描述的報告、我們的10-Q 表格季度報告（最新的一份於今天早上提交）以及我們最近提交的8-K 表格（包括今天早上的收益新聞稿）。

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

在本次電話會議中，我們將在談論公司的財務業績和財務狀況時使用非公認會計準則衡量標準。您可以在今天上午的新聞稿以及我們網站投資者關係部分發布的對賬文件中找到這些非公認會計原則措施的對賬。

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

說到這裡，我想把電話轉給凱倫。凱倫？

Thank you, Larry. Good morning, everyone, and thanks for joining our call today. CVS Health closed another successful quarter, delivering on our financial commitment through the power of our diversified business model and focused execution of our strategy. We have been relentless in the pursuit of our goal to deliver superior health experiences by improving outcomes, lowering costs, driving higher levels of engagement and broadening access to high-quality care.

謝謝你，拉里。大家早上好，感謝您今天加入我們的電話會議。 CVS Health 又一個成功的季度結束了，通過我們多元化的業務模式和集中執行戰略的力量，兌現了我們的財務承諾。我們一直不懈地追求我們的目標，即通過改善結果、降低成本、推動更高水平的參與和擴大獲得高質量護理的機會來提供卓越的健康體驗。

So far in 2023, we have achieved several key accomplishments. First, we acquired Signify Health and Oak Street Health, 2 best-in-class value-based care assets. We are making progress integrating these multipayer companies to create meaningful value. We are unlocking opportunities by connecting Signify and Oak Street to CVS Health assets, such as Aetna, MinuteClinic and CVS Pharmacy, and driving patient engagement and growth. As we scale our health care delivery assets and realize synergy opportunities, we will accelerate our long-term growth trajectory.

2023年到目前為止，我們已經取得了幾項關鍵成就。首先，我們收購了 Signify Health 和 Oak Street Health，這是兩個一流的基於價值的護理資產。我們正在整合這些多支付公司以創造有意義的價值。我們通過將 Signify 和 Oak Street 與 Aetna、MinuteClinic 和 CVS Pharmacy 等 CVS Health 資產連接起來，釋放機遇，並推動患者參與和增長。隨著我們擴大醫療保健服務資產並實現協同機會，我們將加速我們的長期增長軌跡。

Second, we expanded our individual exchange offerings to 12 states, and successfully onboarded more than 1 million new members. Strategically, this is an important marketplace that grew to approximately 15 million enrollees in 2022. Our success with this population lays the foundation for future earnings growth at Aetna and creates connections for these members across all our integrated assets.

其次，我們將個人交易所產品擴展到 12 個州，並成功吸引了超過 100 萬新會員。從戰略上講，這是一個重要的市場，到2022 年，註冊人數將增長到約1500 萬。我們在這一群體中的成功為Aetna 未來的收入增長奠定了基礎，並為這些會員在我們所有的綜合資產中建立了聯繫。

And finally, our ability to generate strong cash flow enables us to invest in our long-term strategy and return value to shareholders. Through June 30, we generated more than $13 billion of operating cash flow and returned more than $3.5 billion to our shareholders. We expect to continue to return cash to our shareholders and deploy capital to enhance shareholder value.

最後，我們產生強勁現金流的能力使我們能夠投資於我們的長期戰略並為股東回報價值。截至 6 月 30 日，我們產生了超過 130 億美元的運營現金流，並向股東返還了超過 35 億美元。我們期望繼續向股東返還現金，並部署資本以提升股東價值。

Today, we reported second quarter adjusted EPS of $2.21 and adjusted operating income of $4.5 billion. Our diversified business, strengthened by our exceptional execution, positions us to navigate emerging headwinds in Medicare Advantage and a changing consumer environment. We are reaffirming our full year 2023 adjusted EPS guidance range of $8.50 to $8.70. Shawn will provide more details on our updated outlook for the year shortly.

今天，我們報告第二季度調整後每股收益為 2.21 美元，調整後營業收入為 45 億美元。我們卓越的執行力增強了我們的多元化業務，使我們能夠應對醫療保險優勢和不斷變化的消費者環境中出現的逆風。我們重申 2023 年全年調整後每股收益指導範圍為 8.50 美元至 8.70 美元。肖恩將很快提供有關我們今年最新展望的更多詳細信息。

Turning to our performance highlights for the quarter. In our Health Care Benefits segment, we grew revenues to $26.7 billion, an increase of nearly 18%, and delivered adjusted operating income of $1.5 billion. Medical membership in the second quarter was $25.6 million, an increase of 1.2 million members versus the prior year, reflecting broad-based growth, including individual exchange, Medicare and Commercial membership. For our core commercial membership, this quarter marks the eighth consecutive quarter of membership gains. This growth reflects our differentiated product offerings that address the total cost of care and the whole health of a member through our integrated solutions.

轉向我們本季度的業績亮點。在醫療保健福利部門，我們的收入增至 267 億美元，增長近 18%，調整後營業收入為 15 億美元。第二季度的醫療會員資格為 2,560 萬美元，比上一年增加了 120 萬會員，反映了廣泛的增長，包括個人交換、醫療保險和商業會員資格。對於我們的核心商業會員資格而言，本季度標誌著會員資格連續第八個季度增長。這種增長反映了我們提供的差異化產品，通過我們的集成解決方案解決了總護理成本和會員的整體健康問題。

Medical cost trends were well controlled in our Commercial and Medicaid books of business. Consistent with the broader industry, elevated medical costs emerged in our Medicare Advantage business, which became apparent in the latter part of the quarter. The primary driver of these elevated medical costs with greater-than-expected utilization in outpatient settings. Shawn will discuss these trends in more detail.

我們的商業和醫療補助業務賬簿中很好地控制了醫療成本趨勢。與更廣泛的行業一致，我們的醫療保險優勢業務中出現了醫療成本上升，這一點在本季度後半段變得明顯。醫療成本上升的主要原因是門診設施的利用率高於預期。肖恩將更詳細地討論這些趨勢。

In Medicaid, the state of Oklahoma awarded us a new statewide Medicaid contract beginning in April 2024. That will add approximately 200,000 members. This win demonstrates our market-leading ability to comprehensively support Medicaid populations through our deep local relationship, investment in clinical programs and integrated well-being solutions.

在醫療補助方面，俄克拉荷馬州向我們授予了一份新的全州醫療補助合同，從 2024 年 4 月開始。這將增加大約 200,000 名會員。這一勝利證明了我們通過深厚的當地關係、對臨床項目的投資和綜合福祉解決方案全面支持醫療補助人群的市場領先能力。

This quarter, we were able to offset the pressures in our Health Care Benefits segment with continued strong execution in our Health Services segment. Revenues grew to $46.2 billion, an increase of nearly 8%. Adjusted operating income grew 3.5% to $1.9 billion. These results were driven by our Pharmacy Services business. We consistently demonstrate value to consumers and our clients by successfully managing drug cost trends and bringing innovative clinical solutions to the market.

本季度，我們通過健康服務部門持續強勁的執行力，抵消了醫療保健福利部門的壓力。收入增至 462 億美元，增長近 8%。調整後營業收入增長 3.5%，達到 19 億美元。這些結果是由我們的藥房服務業務推動的。我們通過成功管理藥品成本趨勢並將創新的臨床解決方案推向市場，始終如一地向消費者和客戶展示價值。

In the second quarter, branded drug revenue increased, in part driven by the GLP-1 category. This expensive and fast-growing category presents new choices for the over 70 million adults in the U.S. who are living with obesity and the nearly 37 million people, who have type 2 diabetes. We are well positioned to deliver value to customers in this category with our weight loss programs and utilization management tools that drive the lowest net cost for our clients.

第二季度，品牌藥收入增長，部分原因是 GLP-1 類別。這一昂貴且增長迅速的類別為美國超過 7000 萬肥胖成年人和近 3700 萬 2 型糖尿病患者提供了新的選擇。我們有能力通過我們的減肥計劃和利用率管理工具為此類客戶提供價值，從而為客戶帶來最低的淨成本。

Every day, we create competition, drive the lowest net cost and deliver transparency, value and choice to our customers. This is the foundation of our continued success and our market-leading position.

我們每天都在創造競爭，推動最低的淨成本，並為客戶提供透明度、價值和選擇。這是我們持續成功和市場領先地位的基礎。

Turning to health care delivery. Both Signify Health and Oak Street Health had strong quarters, delivering business performance consistent with our expectations. These assets bring core capabilities to our multi-payer value-based care platform that drive optimal patient engagement with health services across multiple channels. In the short time since we closed these transactions, we've launched efforts to drive high patient engagement by leveraging our CVS Health assets.

轉向醫療保健服務。 Signify Health 和 Oak Street Health 都有強勁的季度表現，其業務表現符合我們的預期。這些資產為我們基於價值的多支付者護理平台帶來了核心功能，可推動患者跨多個渠道更好地參與健康服務。自從我們完成這些交易後的短時間內，我們就開始努力利用我們的 CVS Health 資產來提高患者參與度。

Signify Health is core to our home health services strategy. Signify enables better health in the home and has an unmatched ability to build trust and connect with 3 million patients in their home annually. We capture valuable insights into a patient's broader care needs during in-home evaluation and are able to create engagement points across other health services for our health plan partners. These engagement points ultimately drive better care, lower the total cost of care, such as reducing hospital readmissions, and improving health outcomes.

Signify Health 是我們家庭健康服務戰略的核心。 Signify 能夠幫助改善家庭健康狀況，並且具有無與倫比的能力，能夠每年與 300 萬患者的家中建立信任和聯繫。我們在家庭評估過程中獲取有關患者更廣泛護理需求的寶貴見解，並能夠為我們的健康計劃合作夥伴在其他健康服務中創建參與點。這些參與點最終會推動更好的護理，降低護理總成本，例如減少再入院率和改善健康結果。

Survey results show that members who are highly satisfied with their Signify in-home evaluations are 26x more likely to recommend their health plan and 74% more likely to consider additional health services. Signify's customers recognize the power of this trusted relationship and the value of these home services.

調查結果顯示，對 Signify 家庭評估高度滿意的會員推薦其健康計劃的可能性高出 26 倍，考慮額外健康服務的可能性高出 74%。 Signify 的客戶認識到這種信任關係的力量以及這些家庭服務的價值。

Since the close of the acquisition, Signify has demonstrated exceptional retention of its health plan and health system customers. We've added new relationships, expanding the opportunity to bring Signify's services to more Medicare member. CVS Health's trusted brands and our broad customer touch points further increased opportunities for Signify to engage with patients and expand the services they deliver. This quarter, there is a strong demand for both in-home evaluation and additional Signify services in the home.

自收購完成以來，Signify 展示了其健康計劃和醫療系統客戶的出色保留。我們增加了新的關係，擴大了將 Signify 的服務帶給更多 Medicare 會員的機會。 CVS Health 值得信賴的品牌和廣泛的客戶接觸點進一步增加了 Signify 與患者互動並擴展他們提供的服務的機會。本季度，對家庭評估和額外 Signify 服務的需求強勁。

We launched new member engagement initiatives at select CVS pharmacies to drive [IHE] conversion of Aetna Medicare members and CVS Pharmacy customers to Signify. Early results are promising with higher engagement across the CVS Health channels utilized.

我們在選定的 CVS 藥房推出了新的會員參與計劃，以推動 [IHE] Aetna Medicare 會員和 CVS 藥房客戶轉變為 Signify。早期結果令人鼓舞，所使用的 CVS Health 渠道的參與度更高。

Turning to Oak Street Health. We are accelerating patient growth through our broad community presence and ability to engage consumers across multiple channels. Today, there are approximately 1 million Medicare eligible seniors, who visit CVS pharmacies each week that are located near an Oak Street Clinic. We launched new member engagement initiatives focused on creating connections between Medicare-eligible CVS customers, both in-store and digitally, and Oak Street Health provider. We are also connecting Aetna Medicare members who are currently without a primary care physician with their local Oak Street provider to reengage them in their care.

轉向橡樹街健康。我們通過廣泛的社區影響力和跨多種渠道吸引消費者的能力，加速患者的增長。如今，大約有 100 萬符合醫療保險資格的老年人每週都會前往橡樹街診所附近的 CVS 藥房。我們推出了新的會員參與計劃，重點是在符合 Medicare 資格的 CVS 客戶（店內和數字方式）與 Oak Street Health 提供商之間建立聯繫。我們還將目前沒有初級保健醫生的 Aetna Medicare 會員與當地的 Oak Street 醫療服務提供者聯繫起來，讓他們重新獲得護理。

These initiatives will drive Oak Street patient growth and accelerate the path to mature clinic profitability, while broadly serving the needs of Medicare members. As Oaktree expands to additional geographies, these opportunities to drive higher patient growth will continue to increase. By the end of 2023, we expect to have Oak Street clinics in 25 states, up from 21 at the close of the transaction. We will also open new Oak Street clinics co-located with CVS pharmacies this year, and have already identified additional locations for 2024. We now expect to build 50 to 60 clinics next year.

這些舉措將推動橡樹街患者的增長，並加速診所實現成熟盈利的道路，同時廣泛滿足醫療保險會員的需求。隨著橡樹資本擴展到更多地區，推動患者增長的機會將繼續增加。到 2023 年底，我們預計將在 25 個州開設橡樹街診所，而交易結束時該診所的數量為 21 個。今年，我們還將在與 CVS 藥房合用的橡樹街診所開設新診所，並已確定 2024 年的其他地點。我們現在預計明年將開設 50 至 60 家診所。

Turning to our Pharmacy & Consumer Wellness segment. We grew revenue to $28.8 billion, an increase of nearly 8% versus the prior year. We generated $1.4 billion of adjusted operating income in the quarter, a decrease of 17% from the prior year. largely due to lower COVID-related volumes. Our pharmacy business delivered another quarter of strong performance. Same-store pharmacy sales increased by more than 14% versus the prior year, primarily driven by pharmacy drug mix and brand inflation.

轉向我們的藥房和消費者健康部門。我們的收入增至 288 億美元，比上年增長近 8%。本季度我們產生了 14 億美元的調整後營業收入，比上年下降 17%。很大程度上是由於與新冠病毒相關的交易量減少。我們的製藥業務又一個季度表現強勁。同店藥房銷售額較上年增長超過 14%，主要受到藥房藥品組合和品牌通脹的推動。

Same-store prescription growth when excluding the impact of COVID, grew by nearly 5%. This growth is fueled by our efforts to provide a differentiated omnichannel pharmacy experience that meets customers where they are. In our front store, we've grown market share, increased household penetration and delivered historically high service levels. This positions us well to manage through economic volatility. In the quarter, our same-store sales, excluding OTC test kits, grew by more than 1%, demonstrating the resiliency of our front store offering in a more challenging consumer environment.

排除新冠疫情的影響，同店處方增長近 5%。這一增長得益於我們努力提供差異化​​的全渠道藥房體驗，以滿足客戶的需求。在我們的前店，我們擴大了市場份額，提高了家庭滲透率，並提供了歷史上最高的服務水平。這使我們能夠很好地應對經濟波動。本季度，我們的同店銷售額（不包括 OTC 測試套件）增長了 1% 以上，這證明了我們的前店產品在更具挑戰性的消費者環境中的彈性。

We also continue to make progress growing our digital members and sales. This quarter, we exceeded 53 million unique digital customers, up over 2 million from last quarter. Our digital sales increased 24% versus the prior year, including a meaningful increase of 65% in our over-the-counter health solution offerings. This offering is highly valued by our health plans members, allowing them to conveniently access their important OTC benefit.

我們還繼續在增加數字會員和銷售額方面取得進展。本季度，我們的獨立數字客戶數量超過 5300 萬，比上季度增加超過 200 萬。我們的數字銷售額比上年增長了 24%，其中非處方健康解決方案產品顯著增長了 65%。這項服務受到我們的健康計劃會員的高度重視，使他們能夠方便地獲得重要的非處方藥福利。

Last quarter, we discussed optimizing our cost structure. This morning, we announced a restructuring charge of nearly $500 million associated with the elimination of approximately 5,000 noncustomer-facing positions, as well as the impairment of noncore assets. These efforts are expected to generate over $600 million of run rate savings beginning in 2024.

上季度，我們討論了優化成本結構。今天早上，我們宣布了一項近 5 億美元的重組費用，涉及消除約 5,000 個非面向客戶的頭寸以及非核心資產的減值。從 2024 年開始，這些努力預計將節省超過 6 億美元的運行費用。

Our optimization efforts have also focused on identifying additional opportunities to drive efficiency and operational excellence using technology. For example, we've been selectively using artificial intelligence for some time and are increasingly finding opportunities to improve the efficiency of our operations, enhance our customer experience and increase our competitiveness. When combining all of our productivity initiatives, we are confident we will achieve the $700 million to $800 million of cost savings that we are targeting in 2024.

我們的優化工作還側重於尋找利用技術提高效率和卓越運營的額外機會。例如，我們有選擇地使用人工智能已經有一段時間了，並且越來越多地尋找機會來提高我們的運營效率、增強我們的客戶體驗並提高我們的競爭力。當結合我們所有的生產力計劃時，我們有信心在 2024 年實現節省 7 億至 8 億美元成本的目標。

These actions enable us to reallocate resources and invest in critical growth areas, such as health services and technology, which are the biggest enabler of our strategy. We've taken meaningful steps executing on our long-term strategy with tangible proof of the value of our unique integrated offering. We look forward to providing more details at our Investor Day on December 5 in Boston. I'll now turn the call over to Shawn to provide a deeper look into our results and our guidance. Shawn?

這些行動使我們能夠重新分配資源並投資於關鍵增長領域，例如衛生服務和技術，這是我們戰略的最大推動者。我們已經採取了有意義的步驟來執行我們的長期戰略，並切實證明了我們獨特的集成產品的價值。我們期待在 12 月 5 日於波士頓舉行的投資者日上提供更多詳細信息。我現在將把電話轉給肖恩，以更深入地了解我們的結果和指導。肖恩？

Thank you, Karen, and good morning, everyone. Our second quarter results continue to demonstrate the strength of our execution and the power of our diversified enterprise. We delivered strong revenue growth, adjusted earnings per share and cash flow from operations. A few highlights regarding total company performance. Second quarter revenues of nearly $90 billion increased by more than 10% year-over-year, reflecting strong growth across each of our businesses.

謝謝你，凱倫，大家早上好。我們第二季度的業績繼續證明了我們的執行力和多元化企業的力量。我們實現了強勁的收入增長、調整後每股收益和運營現金流。有關公司整體業績的一些亮點。第二季度收入近 900 億美元，同比增長超過 10%，反映出我們各項業務的強勁增長。

We delivered adjusted operating income of nearly $4.5 billion and adjusted EPS of $2.21, representing decreases of approximately 10% and 13% versus prior year, respectively. These decreases were primarily due to declines in our health care benefits in Pharmacy & Consumer Wellness segments, partially offset by strong execution in our pharmacy services operations.

我們實現調整後營業收入近 45 億美元，調整後每股收益為 2.21 美元，分別比上年下降約 10% 和 13%。這些下降主要是由於我們在藥房和消費者健康領域的醫療保健福利下降，但部分被我們藥房服務業務的強勁執行力所抵消。

Our ability to generate cash remains outstanding, with year-to-date cash flow from operations of $13.3 billion. These cash flows were impacted by the timing of CMS payments that are expected to normalize in the fourth quarter. Excluding this impact, our cash flows from operations remained strong at $8 billion.

我們產生現金的能力依然出色，今年迄今為止的運營現金流量為 133 億美元。這些現金流受到 CMS 付款時間的影響，預計第四季度將正常化。排除這一影響，我們的運營現金流仍保持在 80 億美元的強勁水平。

Shifting to the details for our Health Care Benefits segment. We delivered strong revenue growth versus the prior year. Second quarter revenue of $26.7 billion increased by 17.6% year-over-year, reflecting growth across all product lines. Membership grew to 25.6 million, an increase of 121,000 members sequentially, reflecting increases in our individual exchanged and commercial businesses, partially offset by the impact of Medicaid redeterminations.

轉向我們的醫療保健福利部分的詳細信息。與上一年相比，我們實現了強勁的收入增長。第二季度收入為 267 億美元，同比增長 17.6%，反映了所有產品線的增長。會員人數增至 2,560 萬，比上一季度增加 121,000 名，反映出我們個人交換和商業業務的增長，但部分被醫療補助重新確定的影響所抵消。

Adjusted operating income of $1.5 billion in the quarter declined approximately 20% versus the prior year. This decline was driven by a higher-than-expected medical benefit ratio, partially offset by higher net investment income and strong execution on operating cost management. Our medical benefit ratio of 86.2% increased 350 basis points year-over-year, reflecting higher-than-expected Medicare Advantage utilization in the second quarter. These trends were primarily driven by higher utilization in the outpatient setting as well as dental and behavioral health. We also recognized higher utilization levels in the first quarter and prior year, resulting in lower year-over-year prior period development in the quarter.

本季度調整後營業收入為 15 億美元，較上年同期下降約 20%。這一下降是由高於預期的醫療福利比率推動的，但部分被較高的淨投資收入和運營成本管理的強勁執行力所抵消。我們的醫療福利比率為 86.2%，同比增長 350 個基點，反映出第二季度 Medicare Advantage 利用率高於預期。這些趨勢主要是由門診環境以及牙科和行為健康的更高利用率推動的。我們還認識到第一季度和去年同期的利用率較高，導致本季度同比前期發展較低。

It is important to note that utilization in our other lines of business, including individual exchange, commercial and Medicaid remain generally in line with our pricing expectations. Days claims payable at the end of the quarter was 46.9, down 1.2 days sequentially. This decline was almost entirely driven by the impact of increased Medicaid pass-through payments in the quarter. Excluding this impact, DCP was stable, and overall, we remain confident in the adequacy of our reserves.

值得注意的是，我們其他業務領域（包括個人交易所、商業和醫療補助）的利用率總體上仍符合我們的定價預期。本季度末應付索賠天數為 46.9 天，環比下降 1.2 天。這一下降幾乎完全是由於本季度醫療補助轉嫁付款增加的影響所致。排除這一影響，DCP 保持穩定，總體而言，我們對儲備充足性仍然充滿信心。

Our Health Services segment, which includes our pharmacy services business and our health care delivery operations, generated revenue of approximately $46.2 billion, an increase of 7.6% year-over-year. This increase was driven by pharmacy drug mix, growth in specialty pharmacy, brand inflation and the addition of Signify and Oak Street. These increases were partially offset by the impact of continued client price improvements.

我們的健康服務部門，包括我們的藥房服務業務和我們的醫療保健服務業務，產生了約 462 億美元的收入，同比增長 7.6%。這一增長是由藥房藥物組合、專業藥房的增長、品牌擴張以及 Signify 和 Oak Street 的增加推動的。這些增長被客戶價格持續上漲的影響部分抵消。

Adjusted operating income of nearly $1.9 billion grew 3.5% year-over-year, primarily driven by strong execution and improved purchasing economics, partially offset by ongoing client price improvements and lower MinuteClinic COVID-19 testing. Total pharmacy claims process in the quarter declined by approximately 1% versus the prior year and down 50 basis points when excluding COVID-19 vaccinations. This decline was primarily attributable to the New York Medicaid carve-out, largely offset by net new business. Total pharmacy membership was approximately 110 million members.

調整後營業收入接近 19 億美元，同比增長 3.5%，這主要是由強勁的執行力和採購經濟性的改善推動的，但部分被持續的客戶價格改善和 MinuteClinic COVID-19 測試減少所抵消。本季度的藥品索賠流程總額比去年同期下降了約 1%，如果不包括 COVID-19 疫苗接種，則下降了 50 個基點。這一下降主要歸因於紐約醫療補助計劃的剝離，但在很大程度上被淨新業務所抵消。藥房會員總數約為 1.1 億。

Within our Health Services segment, we are very encouraged by the performance and growth of our health care delivery assets. Signify completed 673,000 in-home evaluations in the quarter, an increase of 16% versus the same period last year and generated revenue growth of 19%. Oak Street ended the quarter with 177 centers and 181,000 at-risk lives. Increases over the same period last year of approximately 23% and 35%, respectively. Oak Street also significantly increased revenue in the quarter, growing 43% compared to the same quarter last year.

在我們的醫療服務部門，我們對醫療保健服務資產的表現和增長感到非常鼓舞。 Signify 在本季度完成了 673,000 次家庭評估，與去年同期相比增長了 16%，收入增長了 19%。截至本季度末，Oak Street 共有 177 個中心和 181,000 人處於危險之中。較去年同期分別增長約23%和35%。 Oak Street 本季度的收入也大幅增長，與去年同期相比增長了 43%。

Moving to our Pharmacy & Consumer Wellness segment. We generated revenue of $28.8 billion, up nearly 8% versus the prior year and nearly 11% on a same-store basis, reflecting the impact of pharmacy drug mix, increased prescriptions and brand inflation. These increases were partially offset by the impact of recent generic introductions, decreased COVID-19-related volume and continued reimbursement pressure.

轉向我們的藥房和消費者健康部門。我們的收入為 288 億美元，比上年增長近 8%，同店收入增長近 11%，反映了藥房藥品組合、處方增加和品牌膨脹的影響。這些增長被最近推出的仿製藥的影響、與 COVID-19 相關的數量減少和持續的報銷壓力所部分抵消。

Adjusted operating income of $1.4 billion declined approximately 17% versus the prior year, driven by reimbursement pressure, lower COVID-19 vaccine and testing and lower front store volumes. These decreases were partially offset by increased prescription volume and improved generic drug purchasing.

受報銷壓力、COVID-19 疫苗和測試減少以及前置店銷量減少的推動，調整後營業收入為 14 億美元，較上年下降約 17%。這些下降被處方量的增加和仿製藥採購的改善部分抵消。

Same-store Pharmacy sales were up more than 14% driven by drug mix, a 3.6% increase in same-store prescription volumes and brand inflation. The increase in same-store prescription volumes, excluding the impact of COVID-19 vaccinations, was 4.9%.

受藥物組合、同店處方量增長 3.6% 和品牌膨脹的推動，同店藥房銷售額增長了 14% 以上。排除 COVID-19 疫苗接種的影響，同店處方量增長了 4.9%。

As Karen mentioned, our front store business is not immune to rends in the broader economy, but we have shown resiliency in the face of these challenges and continue to demonstrate the value we offer consumers. Same-store sales for the front store were down 30 basis points, primarily due to declines in cough, cold and flu and OTC test kits. Excluding the impact of OTC test kits, same-store front store sales were up by more than 1%.

正如凱倫提到的，我們的前店業務並不能免受更廣泛經濟的影響，但我們在面對這些挑戰時表現出了彈性，並繼續展示我們為消費者提供的價值。前店同店銷售額下降 30 個基點，主要是由於咳嗽、感冒和流感以及 OTC 檢測試劑盒的下降。剔除OTC檢測試劑盒的影響，同店前店銷售額增長超過1%。

Turning to the balance sheet. Our liquidity and capital position remained excellent. Our ability to generate cash flow has always been a strength of our organization and the enterprise continues to identify new opportunities to optimize our balance sheet. Through the second quarter, we generated cash flow from operations of $13.3 billion, bolstered by the CMS prepayment I discussed earlier, and ended the quarter with approximately $3.3 billion of cash at the parent and unrestricted subsidiaries.

轉向資產負債表。我們的流動性和資本狀況仍然良好。我們產生現金流的能力一直是我們組織的優勢，並且企業不斷尋找新的機會來優化我們的資產負債表。在我之前討論的CMS 預付款的支持下，整個第二季度我們從運營中產生了133 億美元的現金流，並在本季度結束時母公司和不受限制的子公司擁有約33 億美元的現金。

During the quarter, we issued approximately $5 billion of long-term debt and repaid our outstanding $5 billion term loan that was used to fund a portion of the Oak Street transaction. Through our quarterly dividend, we returned $795 million to shareholders. We remain committed to maintaining our current investment-grade ratings, while preserving flexibility to deploy capital strategically.

本季度，我們發行了約 50 億美元的長期債務，並償還了未償還的 50 億美元定期貸款，該貸款用於為橡樹街交易的一部分提供資金。通過季度股息，我們向股東返還了 7.95 億美元。我們仍然致力於維持當前的投資級評級，同時保持戰略性部署資本的靈活性。

A few other items worth highlighting for investors. We 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 $168 million. As Karen mentioned in her prepared remarks, we also took a restructuring charge of nearly $500 million associated with our cost optimization efforts and the impairment of noncore assets.

其他一些值得投資者重點關注的項目。我們確認了與 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 1.68 億美元。正如凱倫在她準備好的發言中提到的，我們還承擔了近 5 億美元的重組費用，這些費用與我們的成本優化工作和非核心資產減值相關。

Turning now to our outlook for 2023. We are reaffirming our adjusted earnings per share guidance of $8.50 to $8.70. This guidance reflects our performance through the second quarter as well as a higher-than-expected Medicare Advantage medical cost trend for the remainder of 2023, offset by strength in our Pharmacy Services business within our Health Service segment.

現在轉向我們對 2023 年的展望。我們重申調整後每股收益指導為 8.50 美元至 8.70 美元。該指引反映了我們第二季度的業績以及 2023 年剩餘時間內高於預期的 Medicare Advantage 醫療成本趨勢，但被我們健康服務部門內的藥房服務業務的實力所抵消。

In the Health Care Benefits segment, we now expect our 2023 medical benefit ratio to fall at the high end of our previous range of 84.7% plus or minus 50 basis points, reflecting the impact of higher Medicare Advantage utilization. While there is uncertainty surrounding the duration of this utilization spike, our 2023 guidance now prudently assumes that these medical cost trends will remain elevated for the rest of 2023. This update also results in a change to our guidance for adjusted operating income, which we now expect to fall in a range of $5.99 billion to $6.12 billion.

在醫療保健福利領域，我們現在預計 2023 年的醫療福利比率將降至之前 84.7% 範圍的高端，上下浮動 50 個基點，反映了 Medicare Advantage 使用率提高的影響。雖然這一利用率峰值的持續時間存在不確定性，但我們的2023 年指導現在謹慎地假設這些醫療成本趨勢在2023 年剩餘時間內將保持較高水平。此更新還導致我們對調整後營業收入的指導發生變化，我們現在預計下降幅度為 59.9 億美元至 61.2 億美元。

While we are encouraged by trends in our individual exchange business, this guidance continues to reflect a prudent and cautious stance for that business. In our Health Services segment, our updated adjusted operating income guidance is a range of $7.11 billion to $7.23 billion, reflecting the strong execution year-to-date in our Pharmacy Services business and our expectation of continued strength for the remainder of the year.

儘管我們對個人交易所業務的趨勢感到鼓舞，但該指引繼續反映了對該業務的審慎和謹慎的立場。在我們的健康服務部門，我們更新後的調整後營業收入指導範圍為 71.1 億美元至 72.3 億美元，反映了我們的藥房服務業務今年迄今的強勁執行力以及我們對今年剩餘時間持續強勁的預期。

Developments in our 340B business continue to align with the guidance we provided on our first quarter call. In our Pharmacy & Consumer Wellness segment, we now expect adjusted operating income in the range of $5.63 billion to $5.73 billion. This updated guidance reflects strong fundamental execution year-to-date, while recognizing the potential for a weakening consumer environment.

我們 340B 業務的發展繼續與我們在第一季度電話會議上提供的指導保持一致。在我們的製藥和消費者健康部門，我們現在預計調整後的營業收入在 56.3 億美元至 57.3 億美元之間。這一更新後的指引反映了今年迄今為止強勁的基本面執行力，同時認識到消費環境可能疲軟。

Shifting to our cash flow. We continue to anticipate strong full year 2023 cash flow from operations in a range of $12.5 billion to $13.5 billion. As a result of prioritization of our portfolio to optimize our cost structure, we now expect capital expenditures in a range of $2.6 billion to $2.8 billion. We continue to maintain our projections for interest expense and share count. And finally, we now project our adjusted effective tax rate at 25.3%. You can find additional details on the components of our updated 2023 guidance on our Investor Relations web page.

轉向我們的現金流。我們繼續預計 2023 年全年運營現金流強勁，將在 125 億美元至 135 億美元之間。由於我們對投資組合進行了優先排序以優化成本結構，我們現在預計資本支出在 26 億至 28 億美元之間。我們繼續維持對利息支出和股票數量的預測。最後，我們現在預計調整後的有效稅率為 25.3%。您可以在我們的投資者關係網頁上找到有關我們更新的 2023 年指南組成部分的更多詳細信息。

Before concluding my prepared remarks, I would like to address our medium-term growth projections and targets. As Karen touched on in her remarks, CVS Health benefits from the diversity of our operations, and this positions us well to be resilient in the face of adversity. We take our commitment seriously, as evidenced by the announcement this morning of our cost-cutting initiative, which will meaningfully improve our positioning for 2024.

在結束我準備好的發言之前，我想談談我們的中期增長預測和目標。正如 Karen 在發言中談到的那樣，CVS Health 受益於我們業務的多樣性，這使我們能夠在逆境中保持彈性。我們認真對待我們的承諾，今天上午宣布的成本削減計劃就證明了這一點，這將有意義地改善我們 2024 年的定位。

However, given the emergence of multiple potential headwinds across our diverse set of assets, including uncertainty in Medicare Advantage, the potential for a weakening consumer environment and reduced retail contributions from COVID, combined with our plans to accelerate Oak Street clinic growth, our 2024 adjusted EPS target of $9 is no longer a reasonable starting point for our guidance range. Given the more challenging outlook for 2024 and our desire to set guidance that is achievable with opportunities to outperform, we now believe investors should anchor their initial expectations for our 2024 adjusted EPS to $8.50 to $8.70, essentially flat to our existing 2023 guidance range.

然而，考慮到我們多元化資產中出現的多種潛在不利因素，包括醫療保險優勢的不確定性、消費者環境的潛在疲軟以及新冠疫情帶來的零售貢獻減少，再加上我們加速橡樹街診所增長的計劃，我們的2024 年調整後的9 美元的 EPS 目標不再是我們指導範圍的合理起點。鑑於2024 年前景更具挑戰性，並且我們希望設定可實現的指導，並有機會跑贏大市，我們現在認為，投資者應將其對2024 年調整後每股收益的初步預期固定在8.50至8.70 美元，基本與我們現有的2023 年指導範圍持平。

As is our convention, this guidance does not assume any prior year reserve development. Given the level of uncertainty for 2024, we also believe investors should no longer rely on our 2025 adjusted EPS target of $10. We will provide more clarity on our longer-term earnings growth outlook at our Investor Day in December.

按照我們的慣例，本指南不假設任何前一年的儲備開發。鑑於 2024 年的不確定性程度，我們還認為投資者不應再依賴我們 2025 年調整後每股收益 10 美元的目標。我們將在 12 月的投資者日上更明確地闡述我們的長期盈利增長前景。

While emerging headwinds have created uncertainty for our 2024 and 2025 outlook, make no mistake, we are more convinced than ever in our long-term strategy. The power of our integrated model and care delivery assets will change how consumers and patients engage with the health system and how they receive care. We believe this will benefit customers, patients, payers and ultimately, our shareholders.

儘管新出現的不利因素給我們 2024 年和 2025 年的前景帶來了不確定性，但毫無疑問，我們比以往任何時候都對我們的長期戰略更有信心。我們的綜合模型和護理服務資產的力量將改變消費者和患者與衛生系統的互動方式以及他們接受護理的方式。我們相信這將使客戶、患者、付款人受益，並最終使我們的股東受益。

To conclude, our second quarter results continue to demonstrate the power of our diversified enterprise and the resiliency of our businesses. We continue to maintain our focus on growth and operational execution as we work to become the leading health solutions company for consumers.

總而言之，我們第二季度的業績繼續證明了我們多元化企業的力量和業務的彈性。我們繼續關注增長和運營執行，努力成為消費者領先的健康解決方案公司。

With that, we will now open the call to your questions. Operator?

現在，我們將開始回答您的問題。操作員？

(Operator Instructions) Our first question comes from A.J. Rice from Credit Suisse.

（操作員說明）我們的第一個問題來自 A.J.瑞士信貸的大米。

I know Karen teed it up and you mentioned a couple of times, Shawn, taking into account changing consumer backdrop and then the MA uncertainty. Just on that, it sounds like on the consumer changing, you're signaling about the cough, cold and flu being somewhat soft, but I wouldn't necessarily think that's related to the economy.

我知道凱倫已經做好了準備，肖恩，你提到過幾次，考慮到不斷變化的消費者背景以及 MA 的不確定性。就這一點而言，聽起來消費者正在發生變化，你發出的信號是咳嗽、感冒和流感有所緩解，但我不一定認為這與經濟有關。

What are you specifically seeing something that's impacting your business from a consumer at this point in the retail side? Or are you just anticipating that? And then on the MA, obviously, you gave guidance on the benefits in the back half of the year MLR. But what is your thinking about how some of the things you're seeing might have impact Oak Street? And can you comment on your 24 bids and whether they incorporate some caution around utilization?

目前，在零售方面，您從消費者那裡看到的具體影響您業務的因素是什麼？或者你只是期待這一點？然後，在 MA 方面，顯然，您對國土資源部下半年的效益給出了指導。但是您對您所看到的一些事情可能會對橡樹街產生什麼影響有何看法？您能否評論一下您的 24 個出價以及它們是否在利用率方面採取了一些謹慎措施？

A.J., a couple of things on consumer, and then I'll ask Michelle talk a little bit. But as we saw June kind of emerge and kind of predicting sort of this economic volatility and a potential recession, we saw a little bit of pullback in consumer behavior in June. So we are reflecting that in kind of our forward-looking approach. So I can have Michelle talk a little bit about what we saw, and then I'll turn it back to Shawn to talk about the numbers.

A.J.，關於消費者的一些事情，然後我會請米歇爾談談。但當我們看到 6 月份出現並預測這種經濟波動和潛在衰退時，我們看到 6 月份消費者行為略有回落。因此，我們以前瞻性的方式反映了這一點。所以我可以讓米歇爾談談我們所看到的，然後我會把它轉回給肖恩談論這些數字。

Yes. And just above on Karen's point, we had another solid quarter. It was a market share gain quarter again for the front store, we saw stronger household penetration and historically high net promoter scores. They think out of an abundance of caution, we're just looking at slightly softening consumer demand in the back part of the quarter, along with comping historically high cough, cold and flu.

是的。就在凱倫的觀點之上，我們又度過了一個堅實的季度。對於前店來說，這個季度的市場份額再次獲得增長，我們看到了更強的家庭滲透率和歷史最高的淨推薦分數。他們出於高度謹慎的考慮，我們只是看到本季度後半段消費者需求略有疲軟，以及咳嗽、感冒和流感的歷史高位。

I will say though, of course, the strength is coming from the investments we're making in omnichannel and our merch mix and service and simplifying pricing and promotion. We're rightsizing our cost structure with our store footprint, our distribution footprint, improving inventory turns. And we're really excited and convictious about what we're doing with Oak Street Health and Signify to introduce more seniors and more Medicare eligible customers to the great offerings that Signify and Oak Street Health have in the community.

當然，我要說的是，我們的優勢來自於我們在全渠道、商品組合和服務以及簡化定價和促銷方面的投資。我們正在通過商店足跡、分銷足跡來調整我們的成本結構，提高庫存周轉率。我們對與 Oak Street Health 和 Signify 合作向更多老年人和更多符合 Medicare 資格的客戶介紹 Signify 和 Oak Street Health 在社區中提供的優質服務感到非常興奮和堅定。

So there's a lot there, A.J., in your question. So let me try to kind of cover the ground as thoroughly as I can, and I will have both Dan and Mike actually talk about, respectively, what we saw in Aetna and HCB. As I mentioned in the prepared remarks, our MBR was up 350 basis points year-over-year. It's really important to look at and recall that last quarter, we said we expected Q2 MBR to be up year-over-year. One of the main drivers in that is we printed 82.7% last year in the second quarter. So there's a lot to do here with the starting point.

A.J.，你的問題涉及很多內容。因此，讓我嘗試盡可能徹底地介紹基礎知識，我將讓 Dan 和 Mike 分別談論我們在 Aetna 和 HCB 中看到的情況。正如我在準備好的發言中提到的，我們的 MBR 同比增長了 350 個基點。回顧並回顧上個季度非常重要，我們表示預計第二季度 MBR 將同比增長。其中主要推動因素之一是我們去年第二季度的印刷率為 82.7%。因此，這裡有很多工作要做。

Having said that and allowing for that, Q2 did end up coming in higher than we expected. And the real driver here is Medicare Advantage. And it's also important to keep in mind that Medicare is more than 50% of our premium revenue now. As I stated, I want to be clear that commercial, Medicaid and exchange all performed consistent or even slightly better than our expectations in the quarter. But as we closed the month of May and mid-June, it became apparent that the Medicare costs were higher than we had anticipated in Q1, and that pressure was continuing into the second quarter. And the real driver remains the outpatient categories that we and others have been discussing.

話雖如此，考慮到這一點，第二季度的業績確實高於我們的預期。真正的驅動力是醫療保險優勢。同樣重要的是要記住，醫療保險目前占我們保費收入的 50% 以上。正如我所說，我想澄清的是，商業、醫療補助和交易所在本季度的表現均一致甚至略好於我們的預期。但當我們結束 5 月和 6 月中旬時，很明顯醫療保險成本高於我們在第一季度的預期，並且這種壓力持續到第二季度。真正的驅動因素仍然是我們和其他人一直在討論的門診類別。

So let me have Dan talk a little bit about what we saw in Aetna and have Michael follow that up with what we saw in Oak Street, and I'll come back and talk a little bit about -- how we've prepared our guidance for '23 and '24 in light of this.

因此，讓我讓 Dan 談談我們在 Aetna 看到的情況，並讓 Michael 跟進我們在橡樹街看到的情況，然後我會回來談談我們如何準備我們的指導鑑於此，'23 和'24 。

Yes. Thanks, Shawn. So I think it's important to note that our Commercial and Medicaid lines of business were largely in line with expectations. And as reported more broadly in the industry, we did experience higher-than-anticipated outpatient utilization in Medicare. This is likely due to some of these services that have been postponed by our seniors not feeling comfortable accessing the health care system during the pandemic.

是的。謝謝，肖恩。因此，我認為值得注意的是，我們的商業和醫療補助業務範圍在很大程度上符合預期。正如業內更廣泛報導的那樣，我們的醫療保險門診利用率確實高於預期。這可能是由於我們的老年人在大流行期間不願意使用醫療保健系統而推遲了其中一些服務。

You can think about this as outpatient orthopedic procedures, hips and knees, some cardiac procedures, a little bit of increase in dental, and we're still seeing some continued levels of elevated mental health use. Again, specific to Medicare and outpatient services, our inpatient volumes remain lower than our normalized levels, and that's the same across all lines of business. So it's something we're closely watching.

您可以將其視為門診骨科手術、臀部和膝蓋手術、一些心臟手術、牙科手術的少量增加，而且我們仍然看到心理健康使用量持續上升。同樣，就醫療保險和門診服務而言，我們的住院人數仍然低於正常水平，所有業務領域都是如此。所以這是我們正在密切關注的事情。

From an Oak Street perspective, we've seen similar trends on medical costs with outpatient and being up across our payer partners. Specifically though, we've had a really strong start to the year on Caremark execution at Oak Street. And so we've been able to largely offset the increased outpatient costs through a roughly 4% reduction year-over-year in admissions per thousand. So we're able to offset the increase in outpatient with continued strong performance in keeping our patients out of the hospital and decreasing inpatients.

從橡樹街的角度來看，我們在門診醫療費用上看到了類似的趨勢，並且在我們的付款合作夥伴中也有所上升。但具體來說，今年我們在 Oak Street 的 Caremark 執行方面取得了非常強勁的開局。因此，我們通過將每千人入院人數同比減少約 4%，在很大程度上抵消了門診費用的增加。因此，我們能夠通過持續強勁的表現來抵消門診患者的增加，使我們的患者不再住院並減少住院患者。

Great. So turning back to '23. First, as I mentioned, Medicare did come in probably about 220 basis points worse than expected for the quarter. Given the way costs have emerged, it's more instructive to look, I think, at the first half of the year, which is off 100, 110 basis points versus our guidance expectation. As Dan mentioned, there are aspects of this that make -- some of this could be from a pent-up demand bubble involving discretionary and deferrable services, which, if true, would potentially run its course and lesson over time. And some preliminary July data does show some of that improvement.

偉大的。所以回到'23。首先，正如我所提到的，本季度醫療保險的業績確實比預期差了約 220 個基點。考慮到成本的出現方式，我認為，看看今年上半年的情況更具啟發性，因為今年上半年的成本比我們的指導預期低了 100、110 個基點。正如丹所提到的，這有一些方面的原因——其中一些可能來自於涉及可自由支配和可延期服務的被壓抑的需求泡沫，如果屬實，可能會隨著時間的推移而結束其進程和教訓。 7 月份的一些初步數據確實顯示了一些改善。

However, at this stage in the absence of any compelling evidence to the contrary, we think it's appropriate to be cautious in our outlook and have assumed that the 100 basis points of pressure observed in the first half of '23 persist through the second half of the year. The result of this is what I mentioned in my prepared remarks, that the HCB MBR would be up about 50 basis points at the high end of our guidance range.

然而，現階段，在沒有任何令人信服的相反證據的情況下，我們認為對我們的前景持謹慎態度是適當的，並假設 23 年上半年觀察到的 100 個基點的壓力持續到下半年。那一年。其結果就是我在準備好的發言中提到的，HCB MBR 將在我們指導範圍的高端上漲約 50 個基點。

In terms of 2024, 2024 will come down to 2 things: where does the 2023 year settle out, which serves as the baseline to go into 2024; and then what level of trend do we experience off that baseline. Our 2024 MA bid did contemplate a degree of higher utilization. But if trends persist at the levels we've experienced in the first half, as contemplated in our current guidance, we will have already consumed that higher utilization assumption. If a higher level of medical cost trend then persist again in '24 or, said differently, if we don't see an abatement in medical cost trend, we would then be pressured on our bid assumptions.

就2024年而言，2024年將歸結為兩件事：2023年在哪裡確定，作為進入2024年的基準；然後我們會在基線之外經歷什麼水平的趨勢。我們的 2024 年 MA 投標確實考慮了一定程度的更高利用率。但如果趨勢持續在我們上半年經歷的水平，正如我們當前指導中所設想的那樣，我們將已經消耗了更高的利用率假設。如果較高水平的醫療成本趨勢在 24 年再次持續存在，或者換句話說，如果我們沒有看到醫療成本趨勢的下降，那麼我們的出價假設就會受到壓力。

In the absence of the clear indicators that utilization is abating and out of an abundance of caution, our revised 2024 guidance assumes that we have an incremental headwind in 2024 over our revised 2023 guidance baseline. To the extent utilization does abate and costs developed more favorably in 2023 than we project, that could serve as upside to our outlook for both 2023 and 2024.

由於缺乏明確的指標表明利用率正在減弱，並且出於高度謹慎，我們修訂後的 2024 年指導假設我們在 2024 年將比修訂後的 2023 年指導基線面臨增量逆風。如果 2023 年利用率確實有所下降，且成本發展比我們的預期更為有利，那麼這可能會成為我們對 2023 年和 2024 年前景的上行展望。

Our next question comes from Lisa Gill from JPMorgan.

我們的下一個問題來自摩根大通的麗莎·吉爾。

Great. First, Shawn, I want to say thank you for revising 2024. I think that, that's a very realistic expectation, and I like the word of potential upside. So with that said, let me move to my question, and that's really around GLP-1s. As I think about the different components of the business, I heard you and Dan both talk about the fact that Commercial was in line. But just given the strength of what you're seeing on your Pharmacy side of your business, is there not any impact on the medical side of your business due to GLP-1s?

偉大的。首先，Shawn，我想說謝謝你對 2024 年的修訂。我認為，這是一個非常現實的期望，我喜歡潛在上升這個詞。話雖如此，讓我談談我的問題，這實際上是圍繞 GLP-1 的。當我思考業務的不同組成部分時，我聽到你和丹都談到商業是一致的事實。但考慮到您在藥房業務方面所看到的實力，GLP-1 是否不會對您業務的醫療方面產生任何影響？

And then secondly, as we think about both GLP-1s biosimilars, the strength in the [Rx services] component of the business, can you maybe just walk through what some of those components are? Are we starting to see more rebating activity around GLP-1s? I know Karen had made a comment around programs, around obesity and diabetes, if you can talk anything around that as to how we think about that going forward in the Pharmacy services business. And then just lastly, on the Pharmacy Services business, any incremental comments on how to think about the '24 selling season, how that went?

其次，當我們考慮這兩種 GLP-1 生物仿製藥時，以及業務的 [Rx 服務] 部分的優勢，您能否簡單介紹一下其中一些部分是什麼？我們是否開始看到更多圍繞 GLP-1 的折扣活動？我知道凱倫曾圍繞肥胖和糖尿病等項目發表過評論，如果你能談談我們如何看待藥房服務業務的未來。最後，關於藥房服務業務，有任何關於如何思考 24 年銷售季節的增量評論嗎？進展如何？

Lisa, it's Karen, and I'll start and hand it over to David Joyner and the rest of the team here. But as you mentioned, we have seen, consistent with the industry, higher levels of utilization in GLP-1 drugs across each of our businesses. And in HCB, what we saw was that we have seen increased utilization, but we feel like we have priced appropriately for it, and so we feel that the risk is manageable in that business.

麗莎，我是凱倫，我將開始並將其交給大衛·喬伊納和團隊的其他成員。但正如您提到的，我們已經看到，與行業一致，我們每項業務中 GLP-1 藥物的利用率都較高。在 HCB 中，我們看到利用率有所提高，但我們覺得我們已經對其進行了適當的定價，因此我們認為該業務的風險是可控的。

As you look at the Pharmacy Services business, that is -- we believe this is going to be a competitive category for us over time. And quite frankly, is the reason why, as you know, PBMs exist. We have the opportunity to create competitiveness, provide lowest net cost, give additional programs, like the programs I mentioned in my prepared remarks.

當你審視藥房服務業務時，我們相信，隨著時間的推移，這將成為我們的一個競爭類別。坦率地說，正如您所知，這就是 PBM 存在的原因。我們有機會創造競爭力，提供最低的淨成本，提供額外的計劃，就像我在準備好的發言中提到的計劃一樣。

And also what we're seeing in the PCW business is it is generating very strong revenue there. But as you know with branded drugs, there is there's not a lot of margin with those kinds of drugs. So kind of overall, each of the businesses kind of have GLP-1 in them and they are impacting them in a variety of different ways. But I would just reemphasize the importance of the PBM and how we will continue to drive lowest net cost, and this is a perfect category to do that in. Let me turn it over to David to talk about what he's seeing on growth and -- in this Pharmacy Services business and the selling season, yes.

我們在 PCW 業務中看到的是，它正在創造非常強勁的收入。但正如你所知，對於品牌藥物來說，這類藥物的利潤並不多。總的來說，每個企業都包含 GLP-1，並且它們以各種不同的方式影響著它們。但我想再次強調 PBM 的重要性以及我們將如何繼續推動最低淨成本，這是一個完美的類別。讓我把它交給 David 來談談他對增長的看法，以及——在這個藥房服務業務和銷售季節，是的。

Sure. So Lisa, this is David, and thanks for the question. As we look forward into 2024, we obviously have the headwinds of the partial termination of Centene. And obviously, we're working close with the orderly transition of both the Medicare and Medicaid lines of business.

當然。麗莎，我是大衛，謝謝你的提問。當我們展望 2024 年時，我們顯然面臨 Centene 部分終止的不利因素。顯然，我們正在密切合作，推動醫療保險和醫療補助業務線的有序過渡。

So as a result of Centene, our health plan business will be down year-over-year as we continue to focus on pricing discipline for both prospective customers and renewing our in-force customers. So as I look at 2024, net new business and the pipeline is definitely weighted more towards the employer business this year. And we've had a particularly strong year in the national employer accounts as we won close to 60% of the clients that have changed PBMs for '24.

因此，由於 Centene 的影響，我們的健康計劃業務將同比下降，因為我們繼續關注潛在客戶的定價紀律並更新我們的有效客戶。因此，當我展望 2024 年時，今年的淨新業務和管道肯定更偏重於雇主業務。我們在全國雇主賬戶方面度過了特別強勁的一年，因為我們贏得了近 60% 的已在 24 年更改 PBM 的客戶。

We've seen the success with enterprise accounts as well, where we share common customers with Aetna. We continue to believe we offer the best PBM operating model in both cost of goods and service levels in the industry, and are confident in our long-range growth outlook as we wrap up the 2024 selling season and turn our focus towards growing in 2025 and beyond. And finally, I would just suggest we continue to focusing on leveraging our full suite of CVS Health assets, including the most recent value-based care acquisitions of both Signify and Oak Street, as we continue to offer a differentiated value prop in the multipayer marketplace.

我們也看到了企業客戶的成功，我們與 Aetna 擁有共同的客戶。我們仍然相信，我們在產品成本和服務水平方面提供了業內最佳的 PBM 運營模式，並對我們的長期增長前景充滿信心，因為我們即將結束 2024 年銷售季，並將重點轉向 2025 年的增長，超過。最後，我只是建議我們繼續專注於利用我們的全套 CVS Health 資產，包括最近對 Signify 和 Oak Street 的基於價值的護理收購，因為我們繼續在多支付市場提供差異化​​的價值支撐。

Talk about the biosimilars so another one of her questions.

談論生物仿製藥，這是她的另一個問題。

Sure. So it was a multifaceted question. So let me just add on the biosimilars, because we obviously have not announced our position for the coming year. But that said, we've had a very thoughtful and planned approach to the Humira biosimilar launch, and it's been planned for several years now. So as a result, our customers have already benefited from the competition with a much lower spend in the category. So as we prepare for the formulary launch, we're committed to the same lowest net cost strategy that we employ across our formulary and we'll be using the additional competition to create even more value for our customers and members.

當然。所以這是一個多方面的問題。因此，讓我補充一下生物仿製藥，因為我們顯然還沒有宣布來年的立場。但話雖如此，我們對 Humira 生物仿製藥的推出採取了非常周到和有計劃的方法，而且已經計劃了好幾年了。因此，我們的客戶已經從競爭中受益，並且在該類別中的支出要低得多。因此，當我們準備推出處方藥時，我們致力於在整個處方藥中採用相同的最低淨成本策略，並且我們將利用額外的競爭為我們的客戶和會員創造更多價值。

So I'd like to offer 2 additional points. The first is we have a unique track record in the biosimilar-like market. So as you recall, several years ago, we removed Lantus from our formulary and added a low-list price biosimilar-like product called Basaglar. We were able to convert 97% of the volume and delivered more than 21% savings to our customers. So while we haven't announced our formulary strategy yet, we took a similar approach in the hep C category by announcing last, and was also able to deliver the lowest net cost and the most innovative solution for our customers.

所以我想補充兩點。首先，我們在生物仿製藥市場擁有獨特的記錄。正如您所記得的，幾年前，我們將來得時從我們的處方集中刪除，並添加了一種名為 Basaglar 的低價生物仿製藥產品。我們成功實現了 97% 的轉化，並為客戶節省了 21% 以上的成本。因此，雖然我們尚未宣布我們的處方策略，但我們在丙型肝炎類別中採取了類似的方法，最後宣布，並且也能夠為我們的客戶提供最低的淨成本和最具創新性的解決方案。

So as we -- so not only will we continue to provide our clients and members optionality, we're also ensuring that we're providing the lowest net cost options, and that our selective strategy helps our clients truly realize the savings. So bottom line, and this speaks to the broader biosimilar marketplace, we're committed to establishing a viable and durable biosimilar market and believe we're well positioned to deliver innovation in the AI class. And we look forward to providing more clarity around Humira in the coming weeks.

因此，我們不僅將繼續為我們的客戶和會員提供選擇，我們還將確保我們提供最低的淨成本選擇，並且我們的選擇性策略可以幫助我們的客戶真正實現節省。因此，最重要的是，這涉及更廣泛的生物仿製藥市場，我們致力於建立一個可行且持久的生物仿製藥市場，並相信我們有能力在人工智能領域提供創新。我們期待在未來幾週內提供有關 Humira 的更多信息。

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

我們的下一個問題來自美國銀行的邁克爾·切爾尼。

Maybe if I can just dive in a little bit more on Medicare Advantage and the exchange business relative to the long-term outlook. Shawn, I'm obviously not looking for anything beyond what you gave on the color, but the build includes clearly your work and your investments in Stars, your work and your investments in the exchange business. Can you just give us a broad-based update on those 2 sides on where things are progressing, and especially as we head into the fall, how you think about that push-pull dynamic relative to positioning for Stars for fiscal '25?

也許我可以稍微深入了解一下相對於長期前景的 Medicare Advantage 和交換業務。肖恩，顯然我並不是在尋找除了您在顏色上給出的內容之外的任何東西，但構建顯然包括您的工作和您對星星的投資，您的工作和您對交易所業務的投資。您能否向我們介紹一下這兩個方面的進展情況，特別是當我們進入秋季時，您如何看待與 25 財年明星定位相關的推拉動態？

Yes, Michael, let me start on Stars, and Shawn can fill in the details on the numbers. But as you know, we had made significant progress -- efforts and had made significant investments in making progress in our Stars performance. We've been very focused on our remediation efforts. Our contract diversification strategy is well underway.

是的，邁克爾，讓我從星星開始，肖恩可以填寫數字的詳細信息。但如您所知，我們已經取得了重大進展——努力並進行了大量投資，以提高我們的星級績效。我們一直非常專注於我們的補救工作。我們的合同多元化戰略正在順利進行。

And all of our internal indicators are positive and show progress. But having said that, having missed by such a narrow margin last year, I think we all recognize that it all comes down to the CMS cut point. So we'll know better in October, but our internal measures are positive from how we measure it.

我們所有的內部指標都是積極的並顯示出進展。但話雖如此，去年以如此微弱的差距落敗，我想我們都認識到這一切都歸結於 CMS 的削減點。所以我們會在十月份知道得更多，但從我們衡量的方式來看，我們的內部措施是積極的。

And Michael on exchanges, we're another quarter in and things are still looking positive. And as I mentioned, we've been -- we continue to be cautious in our outlook in terms of what we're planning on that from this year. But both the revenue and the utilization side have been in line with our expectations.

邁克爾談到交易所，我們又過了一個季度，情況仍然看起來很積極。正如我所提到的，我們一直對今年的計劃持謹慎態度。但無論是收入還是利用率方面都符合我們的預期。

And so I think that, that really is something to think about as an opportunity for the future. We have a 1 million member book now, probably something like $5 billion in revenue potentially this year, and it's not making a meaningful contribution. And one of the benefits of getting to scale so quickly is I think we can now turn towards at least getting some contribution of profitability from that business, and that would be our plan for 2024 and beyond that, that would begin to be a profit contributor for us. So I do think it's one of the growth levers that we have.

所以我認為，這確實是值得考慮的未來機會。我們現在有 100 萬會員，今年的收入可能約為 50 億美元，但它並沒有做出有意義的貢獻。如此迅速擴大規模的好處之一是，我認為我們現在至少可以從該業務中獲得一些盈利貢獻，這將是我們 2024 年及以後的計劃，這將開始成為利潤貢獻者為了我們。所以我確實認為這是我們擁有的增長槓桿之一。

Our next question comes from Justin Lake from Wolfe Research.

我們的下一個問題來自沃爾夫研究中心的賈斯汀·萊克。

A couple of questions. So first, just on the MLR, Shawn, maybe you could give us a little more color in terms of at least relative to our estimates and consensus. It looked like you missed the quarter by 150, 175 basis points, yet you're raising guidance by 50. It might have been some intra-year development. I know the quarter had some prior year in it as well. So just trying to kind of isolate what's going on there. If you can help us with some of that bridge, I'd appreciate it.

有幾個問題。首先，關於國土資源部，肖恩，也許你可以給我們更多的信息，至少是相對於我們的估計和共識而言。看起來您錯過了本季度 150、175 個基點，但您卻將指引提高了 50 個基點。這可能是年內的一些發展。我知道這個季度也有前一年的情況。所以只是試圖隔離那裡發生的事情。如果您能幫助我們完成這座橋樑，我將不勝感激。

And then on the guidance change, your, by my math, $500 million to $800 million of OI, can you give us some increased clarity on where you're seeing that? For instance, how much of that is tied to MA assumption versus where you would typically be, et cetera? So if you can break that apart for us as well, that would be helpful.

然後，關於指導意見的變化，根據我的計算，您的 OI 為 5 億至 8 億美元，您能否更清楚地說明您在哪裡看到的？例如，其中有多少與 MA 假設以及您通常所處的位置相關，等等？因此，如果您也能為我們將其分解，那將會很有幫助。

Yes, there's a few pieces going on in the quarter that are worth calling out. I did mention one, obviously, we had Medicaid pass-throughs that sort of has pushed on the MBR a bit in the quarter. We actually did have unfavorable PYD this quarter. So we recognize that in the quarter, that's sort of pushing the number. But the biggest thing that's driving our guidance increase for the year is the change in outlook on our Medicare MBR. And that, like I said, for the quarter, it's probably off a little more than 200 basis points. And I think it's more instructive, as I mentioned, to look at that for the first half, and that's largely what we've assumed.

是的，本季度發生的一些事情值得一提。我確實提到過一個，顯然，我們有醫療補助傳遞，這在本季度推動了 MBR 的發展。事實上，本季度我們的 PYD 確實不利。因此，我們認識到，在本季度，這一數字有所增加。但推動我們今年指導增長的最大因素是我們的醫療保險 MBR 前景的變化。正如我所說，本季度的漲幅可能略高於 200 個基點。正如我所提到的，我認為回顧上半年的情況更具啟發性，而這在很大程度上是我們的假設。

So if you look at HCB going down about $400 million of adjusted operating income, obviously, there's other moving parts under the surface. But most of that's the 50 basis points on the overall HCB MBR. Again, the other lines of business are largely in line, if not even a little better than our expectations on HCB. Offsetting that, obviously, was our increase in the Health Services segment driven by Pharmacy Services. That is about $500 million better. And again, that is driven by sound fundamental -- sound fundamental performance that Karen and David discussed.

因此，如果你看看 HCB 調整後營業收入下降了約 4 億美元，顯然，表面之下還存在其他變動因素。但其中大部分是整體 HCB MBR 的 50 個基點。同樣，其他業務也基本上符合我們對 HCB 的預期，甚至好一點。顯然，藥房服務推動的健康服務領域的增長抵消了這一影響。大約多出 5 億美元。再說一次，這是由凱倫和大衛討論過的良好基本面驅動的。

And you'll recall that we did talk about the underlying Pharmacy Services performance in Q1 was strong, and we've now carried that strong first half performance for the full year. And as was mentioned earlier in response to the question, we have decreased our outlook on PCW by about $100 million considering the impacts we observed towards the end of the second quarter, softening consumer demand in particular, we talked about. So those are the moving pieces inside. Overall, AOI is pretty much flat to where we were, but those are the moving pieces under the covers.

您會記得，我們確實談到過第一季度的基本藥房服務業績強勁，現在我們已經在全年實現了上半年的強勁業績。正如前面在回答問題時提到的，考慮到我們在第二季度末觀察到的影響，特別是我們談到的消費者需求疲軟，我們將 PCW 的前景下調了約 1 億美元。這些就是裡面的移動部件。總體而言，AOI 與我們之前的水平基本持平，但這些都是幕後的變化因素。

Our next question comes from Kevin Caliendo from UBS.

我們的下一個問題來自瑞銀集團的 Kevin Caliendo。

Well, Shawn, I think you mentioned that you planned on opening more Oak Street clinics than originally planned. But I got a sense that, that was also an incremental headwind. Does that mean that you'll be using less off balance sheet? Or you had talked about potentially if you increase using off-balance sheet metrics to do so, is that still the case or has that changed?

嗯，肖恩，我想你提到你計劃開設比原計劃更多的橡樹街診所。但我有一種感覺，這也是一個漸進的逆風。這是否意味著您將減少資產負債表外的使用？或者您曾經討論過，如果您增加使用表外指標來實現這一目標，情況仍然如此還是已經改變？

Yes. So I do want to talk about that. You're correct in your assessment. Obviously, this is a very important and strategic investment in our future that we're making, and we continue to believe that there's high demand for more access to the differentiated Oak Street care model. Our analysis has consistently shown that accelerated clinic growth is the right thing to do in terms of optimizing the long-term returns on this investment and expanding access for at-risk populations. And as Karen mentioned, we're going to do so in 2024, targeting 50 to 60 clinics. And Oak Street will and already is working closely with their payer partners and identifying the key geographies.

是的。所以我確實想談談這個。你的評估是正確的。顯然，這是我們對未來進行的一項非常重要的戰略投資，我們仍然相信，人們對更多地獲得差異化的橡樹街護理模式有很高的需求。我們的分析一致表明，就優化這項投資的長期回報和擴大高危人群的就診機會而言，加速診所的增長是正確的做法。正如 Karen 提到的，我們將在 2024 年這樣做，目標是 50 到 60 家診所。橡樹街將並且已經在與其付款合作夥伴密切合作並確定關鍵地區。

As you mentioned, our updated outlook for 2024 includes the full impact of this accelerated expansion without the benefit of any structured transaction. We are still evaluating the details and the merits of such a transaction, and we'll update you if anything definitive and material develops on that front.

正如您所提到的，我們對 2024 年的最新展望包括這種加速擴張的全面影響，而沒有任何結構性交易的好處。我們仍在評估此類交易的細節和優點，如果這方面有任何明確的進展和材料，我們將向您通報最新情況。

Kevin, I just want to make a couple of comments on Oak Street. We've made significant progress already having closed not that long ago on driving patient growth and really leveraging the overall assets of the entire enterprise. We're using Signify to use the -- recommend if people don't have a primary care to Oak Street.

凱文，我只想對橡樹街發表一些評論。不久前，我們在推動患者增長和真正利用整個企業的整體資產方面已經取得了重大進展。如果人們沒有橡樹街的初級護理服務，我們將使用 Signify 來使用——推薦。

We're helping Aetna Medicare members that don't have a primary care and recommending them to Oak Street. We're using connections in our pharmacies as well. So I'm really encouraged by the opportunity and the growth, and really excited about what we've seen. And more -- we have more conviction now that the meaningful value that we thought we could unlock will surface over the course of the next couple of years.

我們正在幫助沒有初級保健服務的 Aetna Medicare 會員，並將他們推薦給 Oak Street。我們也在藥房使用連接。因此，我對這個機會和成長感到非常鼓舞，並對我們所看到的感到非常興奮。而且，我們現在更有信心，我們認為可以釋放的有意義的價值將在未來幾年內浮出水面。

Our next question is from Nathan Rich from Goldman Sachs.

我們的下一個問題來自高盛的內森·里奇。

Shawn, could you -- on the restructuring program, could you maybe talk about how much of the savings are in the '23 guidance? And do you see the full run rate for 2024? And then on the new 2024 guidance, you mentioned a number of buckets that drove the guidance revision, the higher utilization, reduced outlook for retail given the macro environment. I think COVID and Oak Street were the other 2. Could you maybe just help us think about the magnitude across each of those major buckets in terms of what drove the guidance revision?

Shawn，關於重組計劃，您能否談談 23 年指導方針中節省了多少資金？您是否看到 2024 年的全部運行率？然後，在新的 2024 年指導意見中，您提到了推動指導意見修訂的一些因素，例如更高的利用率、考慮到宏觀環境的零售前景的降低。我認為新冠疫情和橡樹街是另外兩個。您能否幫助我們思考一下推動指導修訂的因素對每個主要類別的影響程度？

Yes, sure. So on the restructuring charge, there's the timing of all of this, it will have minimal impact the actions we take on 2023. To the extent there is any impact, we've thought that through in our reaffirmation of guidance. But really, this was a major step forward in delivering the $700 million to $800 million of G&A savings that we talked about in May. And the job [OEMs] alone, as we mentioned, contributed probably close to $600 million of that benefit. But there's other things we've done in terms of shutting down projects. Obviously, there's been open positions we're not going to hire for as well. And so we have a high degree of visibility into getting the effect that we committed to for 2024.

是的，當然。因此，就重組費用而言，所有這一切的時間安排對我們在 2023 年採取的行動的影響微乎其微。就影響而言，我們在重申指導意見時已經考慮到了這一點。但實際上，這是我們在 5 月份談到的 7 億至 8 億美元一般管理費用節省方面向前邁出的重要一步。正如我們所提到的，僅 [OEM] 一項工作就可能貢獻了近 6 億美元的收益。但在關閉項目方面我們還做了其他一些事情。顯然，我們也不會招聘一些空缺職位。因此，我們對於實現 2024 年承諾的效果具有高度的可見性。

On 2024 guidance, you're correct. There are -- there are really, I would say, 3 kind of performance items, some of which will have a lot to do with the external environment and then obviously the one decision. The positive item, obviously, is we do expect some of the outperformance in pharmacy services that we're experiencing in 2023 will pull through favorably into our 2024 performance. I would note that not all this favorability will pull through as it will naturally work its way into client pricing as contracts reset in 2024. So you can see the magnitude of our increase for this year. It's obviously not that much because we're not going to pull all that through, but it's a meaningful positive item for next year.

關於 2024 年指導，你是對的。我想說，確實有 3 種績效項目，其中一些與外部環境有很大關係，然後顯然是一個決定。顯然，積極的一面是，我們確實預計 2023 年我們在藥房服務方面的一些出色表現將有利地影響我們 2024 年的業績。我要指出的是，並非所有這些優惠都會持續下去，因為隨著 2024 年合同重置，它自然會影響到客戶定價。因此，您可以看到我們今年增長的幅度。顯然不是那麼多，因為我們不會完成所有這些，但它對明年來說是一個有意義的積極項目。

Similarly, I think on the headwind side, the largest provision we've made in our guidance has to do with the Medicare Advantage performance. We've sort of sized the impact of that for this year and sort of have made provision for a potential headwind on that. So I think you can kind of get in the neighborhood there, that would be the biggest other one. And then the other one is the -- in PCW, we've made some provision for the softening consumer demand to persist into next year, as well as potentially more decline in COVID for next year. We have factored that into our guidance. And as I was mentioning on the previous question, we've built in the full effect of the Oak Street acceleration as well. Obviously, that's a choice we're making in an investment in the future.

同樣，我認為在逆風方面，我們在指導中做出的最大規定與醫療保險優勢績效有關。我們已經對今年的影響進行了評估，並為潛在的不利因素做好了準備。所以我認為你可以去那裡的附近，那將是最大的另一個。另一個是——在 PCW 中，我們已經制定了一些準備金，以應對消費者需求疲軟持續到明年的情況，以及明年新冠肺炎疫情可能進一步下降的情況。我們已將這一點納入我們的指導中。正如我在上一個問題中提到的，我們也建立了橡樹街加速的全部效果。顯然，這是我們在未來投資中做出的選擇。

And Nathan, just to comment, I want to be very clear that we took a very thoughtful and careful approach to this restructuring. We are very deliberate in making sure that we had non-customer-facing roles and that we weren't taking any action that would risk the execution of our long-term strategy.

內森，我想明確表示，我們對這次重組採取了非常深思熟慮和謹慎的方法。我們非常謹慎地確保我們擁有非面向客戶的角色，並且我們不會採取任何可能危及我們長期戰略執行的行動。

Yes. And just one kind of housekeeping thing in that. Again, as always, we've removed the PYD that's close to $0.05 probably where we are on a year-to-date basis, and so we've taken that out as well for 2024.

是的。這只是其中的一種家務事。與往常一樣，我們再次取消了年初至今接近 0.05 美元的 PYD，因此我們在 2024 年也取消了這一金額。

Our next question comes from Josh Raskin from Nephron Research.

我們的下一個問題來自 Nephron Research 的 Josh Raskin。

Great. How are you thinking about the operating income contributions from Oak Street and Signify? I assume those are different directions in 2024. And specifically in light of the risk change -- risk model changes, I would assume there could be some benefit in Signify, some headwind for Oak Street. And if you could also maybe size the impact of the risk model changes on the MA segment in the Aetna business on reimbursement, that would be helpful, too.

偉大的。您如何看待 Oak Street 和 Signify 的營業收入貢獻？我認為 2024 年這些是不同的方向。特別是考慮到風險變化——風險模型的變化，我認為 Signify 可能會帶來一些好處，而 Oak Street 可能會遇到一些阻力。如果您還可以衡量風險模型變化對 Aetna 業務 MA 部門報銷的影響，那也會很有幫助。

Yes. I can talk a little bit about the segment, and then I can have Mike talk a little bit and Dan talk a little bit about the changes for 2024. It's an important question because as part of our strategy that we've talked about, the growth in the earnings from these 2 assets is an important part of sort of increasing our long-term earnings growth rate.

是的。我可以談談這個部分，然後我可以讓 Mike 談談，Dan 談談 2024 年的變化。這是一個重要的問題，因為作為我們已經討論過的戰略的一部分，這兩項資產的收益增長是提高我們長期收益增長率的重要組成部分。

And we do expect to having meaningful contribution of earnings improvement from these 2 assets from their base in 2023 into 2024. And everything we've seen in our first quarter of ownership, I think, has been consistent with that, and I think we're even more -- have stronger conviction about sort of the value that we can bring. So they will be a positive contributor in our estimation of earnings growth in 2024. And I'll turn it to Mike and Dan to talk a little bit about sort of the risk model and the changes for 2024.

我們確實期望這兩項資產從 2023 年到 2024 年的基礎上對盈利改善做出有意義的貢獻。我認為，我們在第一季度所有權中看到的一切都與此一致，我認為我們'更重要的是——對我們可以帶來的價值有更堅定的信念。因此，他們將對我們對 2024 年盈利增長的估計做出積極貢獻。我將請 Mike 和 Dan 談談 2024 年的風險模型和變化。

Yes. On the HCB side, I would think about it in this way. First of all, the model is being phased, and over time, we are pleased with that decision. Our modeling overall was very similar in the aggregate to the modeling of CMS. And frankly, with our size of book, it allows us to really manage the impact over time. So minimal impact to HCB.

是的。在HCB方面，我會這樣考慮。首先，該模型正在分階段進行，隨著時間的推移，我們對這一決定感到滿意。我們的建模總體上與 CMS 的建模非常相似。坦率地說，憑藉我們的規模，它使我們能夠真正管理隨著時間的推移所產生的影響。因此對 HCB 的影響很小。

Yes. From an Oak Street's perspective, I think the thing to remember is a lot of the changes in -- the risk remodel changes were driven by less specific codes being replaced by more specific codes. So you'll have less documentation codes with a lower coefficient on a high number of patients, and higher coefficient codes on a lower number of patients.

是的。從橡樹街的角度來看，我認為要記住的很多變化是——風險重塑變化是由不太具體的代碼被更具體的代碼取代所驅動的。因此，對於大量患者，您將擁有較少的文檔代碼和較低的係數，而對於較少數量的患者，您將擁有較高的係數代碼。

And so the impact is going to be net of those changes, right, not the gross impact of that. And one of the advantages of Oak Street is we have the same operating model and the same technology in all of our centers. So it allows us to react faster to those types of changes, and we are already implementing new protocols, new clinical guidelines, et cetera, to be aware of that.

因此，影響將扣除這些變化，對吧，而不是總體影響。橡樹街的優勢之一是我們所有中心都擁有相同的運營模式和相同的技術。因此，它使我們能夠更快地對這些類型的變化做出反應，並且我們已經在實施新的協議、新的臨床指南等，以意識到這一點。

And I'd really like to point out, Oak Street has been very successful across programs with different risk-adjusted methodologies. We were part of the Medicare Shared Savings program, and we were a top 1% performer in that. We are the top performer in the ACO REACH program. And those have different risk-adjusted methodologies, cash, et cetera, et cetera. So I think it just goes to the fact that if you're doing a great job taking care of people,and keeping them out of the hospital, lowering medical cost, that will be durable across any risk adjust methodology. So we're pretty confident in our ability to keep generating great results going forward.

我真的很想指出，橡樹街在採用不同風險調整方法的項目中都取得了非常成功。我們是 Medicare 共享儲蓄計劃的一部分，並且是該計劃中表現最好的 1%。我們是 ACO REACH 計劃中的佼佼者。這些都有不同的風險調整方法、現金等等。因此，我認為事實是，如果你在照顧人們方面做得很好，讓他們遠離醫院，降低醫療成本，那麼這在任何風險調整方法中都是持久的。因此，我們對未來繼續取得出色成果的能力充滿信心。

Yes. And just from a Signify standpoint, it's absolutely been a tailwind for us. Our clients and partners team up with us because we help manage this industry change for them. We stay ahead of the risk model changes. We help build new things into the Signify in-home business. We've seen a surge in demand for additional diagnostic and preventative testing work. It's an opportunity for us to expand into more follow-on care. So we're actually very excited about it. It's also been a nice touch point for us as we've integrated into the retail and pharmacy businesses at CVS.

是的。僅從 Signify 的角度來看，這對我們來說絕對是順風順水。我們的客戶和合作夥伴與我們合作，因為我們幫助他們管理這一行業變革。我們始終領先於風險模型的變化。我們幫助 Signify 家居業務打造新事物。我們看到對額外診斷和預防性測試工作的需求激增。這是我們擴展到更多後續護理的機會。所以我們實際上對此非常興奮。這對我們來說也是一個很好的接觸點，因為我們已經融入了 CVS 的零售和製藥業務。

Managing medications inside the home is a huge unlock for us. And so we've been bringing in a deeper consumer engagement model with our partners inside the retail space in Pharmacy, and we've seen really great results with the kickoff there with the Aetna membership.

在家中管理藥物對我們來說是一個巨大的挑戰。因此，我們一直在與藥房零售領域的合作夥伴引入更深入的消費者參與模式，並且隨著 Aetna 會員資格的啟動，我們看到了非常好的成果。

I would just quickly reemphasize 1 thing Mike said in his ability to have a common care model on a common technology platform and the ability to operationalize this should not be underestimated. And in our view, that was a differentiating characteristic about their model. But that is a very important point that, in my opinion, that Mike made there.

我想再次強調邁克所說的一件事，即他在通用技術平台上擁有通用護理模式的能力以及實施該模式的能力不應被低估。我們認為，這是他們模型的一個與眾不同的特徵。但在我看來，邁克在那裡提出了一個非常重要的觀點。

Our next question comes from Elizabeth Anderson from Evercore.

我們的下一個問題來自 Evercore 的 Elizabeth Anderson。

Bruno, she might have dropped. So let me just wrap it up here by thanking our colleagues for their commitment and dedication that they show every single day, supporting our customer, our clients and our patients. As we demonstrated today, we continue to execute on our bold goals and deliver outstanding performance despite the challenging environment that we're in. And I really believe and I know the team believes that this is a testament to our consistently strong execution and our resilient business model, and gives us the confidence that we can continue our momentum throughout 2023 and 2024. Thanks for joining the call today.

布魯諾，她可能已經掉下去了。因此，讓我在此總結一下，感謝我們的同事每天所表現出的承諾和奉獻精神，為我們的客戶、客戶和患者提供支持。正如我們今天所展示的那樣，儘管我們所處的環境充滿挑戰，但我們仍繼續執行我們的大膽目標並提供出色的業績。我真的相信並且我知道團隊相信這證明了我們始終如一的強大執行力和我們的韌性商業模式，並讓我們有信心在 2023 年和 2024 年繼續保持這一勢頭。感謝您今天加入電話會議。

Ladies and gentlemen, this concludes today's call. Thank you for joining. You may now disconnect your lines. Thank you.

女士們、先生們，今天的電話會議到此結束。感謝您的加入。您現在可以斷開線路。謝謝。