Elevance Health Inc (ELV) 2022 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Elevance Health Fourth Quarter Earnings Conference Call. (Operator Instructions) As a reminder, today's conference is being recorded. I would now like to turn the conference over to the company's management. Please go ahead.

女士們，先生們，感謝你們的支持，歡迎來到 Elevance Health 第四季度收益電話會議。 （操作員說明）提醒一下，今天的會議正在錄製中。我現在想把會議轉交給公司管理層。請繼續。

Good morning, and welcome to Elevance Health's Fourth Quarter 2022 Earnings Call. This is Steve Tanal, Vice President of Investor Relations, and I'm joined this morning on our earnings call by Gail Boudreaux, President and CEO; John Gallina, our CFO; Peter Haytaian, President of Carelon; Morgan Kendrick, President of our Commercial and Specialty Business Division; and Felicia Norwood, President of our Government Business division. Gail will begin the call with a brief discussion of some of the highlights of the quarter and year before turning to our recent announcement of the acquisition of Blue Cross and Blue Shield of Louisiana and a number of other updates on key strategic initiatives. John will then discuss our financial results and outlook for 2023 in greater detail.

早上好，歡迎來到 Elevance Health 的 2022 年第四季度財報電話會議。我是投資者關係副總裁 Steve Tanal，今天早上我和總裁兼首席執行官 Gail Boudreaux 一起參加了我們的財報電話會議；我們的首席財務官 John Gallina； Carelon總裁Peter Haytaian；我們的商業和專業業務部總裁 Morgan Kendrick；以及政府業務部門總裁 Felicia Norwood。蓋爾將首先簡要討論本季度和本年度的一些亮點，然後轉向我們最近宣布收購路易斯安那州的 Blue Cross 和 Blue Shield 以及其他一些關鍵戰略計劃的最新消息。然後，約翰將更詳細地討論我們的財務業績和 2023 年展望。

After our prepared remarks, the team will be available for Q&A. During the call, we will reference certain non-GAAP measures. Reconciliations of these non-GAAP measures to the most directly comparable GAAP measures are available on our website, elevancehealth.com. We will also be making some forward-looking statements on this call. Listeners are cautioned that these statements are subject to certain risks and uncertainties, many of which are difficult to predict and generally beyond the control of Elevate Health. These risks and uncertainties can cause actual results to differ materially from our current expectations. We advise listeners to carefully review the risk factors discussed in today's press release and in our quarterly filings with the SEC. I will now turn the call over to Gail.

在我們準備好的評論之後，團隊將可以進行問答。在電話會議期間，我們將參考某些非 GAAP 措施。我們的網站 elevancehealth.com 提供了這些非 GAAP 措施與最直接可比的 GAAP 措施的調節。我們還將就此次電話會議發表一些前瞻性聲明。聽眾被警告說，這些陳述受到某些風險和不確定性的影響，其中許多是難以預測的，而且通常超出了 Elevate Health 的控制範圍。這些風險和不確定性可能導致實際結果與我們目前的預期大不相同。我們建議聽眾仔細閱讀今天的新聞稿和我們向美國證券交易委員會提交的季度文件中討論的風險因素。我現在將把電話轉給蓋爾。

Thanks, Steve, and good morning, everyone. Today, we're pleased to share that Elevance Health delivered strong fourth quarter results, closing out another year of growth, consistent with our long-term targets and considerable progress in our transformation to become a lifetime trusted health partner.

謝謝，史蒂夫，大家早上好。今天，我們很高興地與大家分享，Elevance Health 第四季度取得了強勁的業績，結束了又一年的增長，這與我們的長期目標一致，並且在我們轉型為終身值得信賴的健康合作夥伴方面取得了長足進步。

In the fourth quarter, Elevance Health delivered GAAP earnings per share of $3.93, and adjusted earnings per share of $5.23. For the full year, we reported GAAP earnings per share of $24.81 and adjusted earnings per share of $29.7 reflecting growth of 15% year-over-year from our adjusted baseline of $25.20 in 2022.

第四季度，Elevance Health 公佈的 GAAP 每股收益為 3.93 美元，調整後每股收益為 5.23 美元。全年，我們報告的 GAAP 每股收益為 24.81 美元，調整後每股收益為 29.7 美元，反映了我們在 2022 年調整後的基線 25.20 美元同比增長 15%。

2022 marks the fifth consecutive year in which we grew adjusted earnings per share within or above our 12% to 15% long-term target growth rate. This reflects the focused and sustained execution of our strategy to optimize our health benefits businesses, invest in high-growth opportunities and accelerate capabilities and services. Elevance Health ended 2022, serving more than 47.5 million medical members, up nearly 2.2 million members year-over-year, including more than 1 million new Commercial and over 1 million new Government members.

2022 年是我們調整後每股收益連續第五年增長在 12% 至 15% 的長期目標增長率以內或之上。這反映了我們戰略的集中和持續執行，以優化我們的健康福利業務，投資於高增長機會並加速能力和服務。截至 2022 年，Elevance Health 為超過 4750 萬名醫療會員提供服務，同比增長近 220 萬名，其中包括超過 100 萬名新商業會員和超過 100 萬名新政府會員。

Investments in enhancing the customer experience, delivering innovative, customized whole health solutions, deepening digital engagement, and prioritizing HealthEquity, all helped to deliver strong growth across customer segments. Membership growth, coupled with expansion in both the scope and scale of Carelon's business with our health plans helped to propel double-digit growth in CarelonRx and Carelon services. In total, for the year, Elevance Health produced nearly 14% growth in operating revenue and double-digit growth in adjusted operating earnings.

在增強客戶體驗、提供創新、定制的整體健康解決方案、深化數字參與以及優先考慮 HealthEquity 方面的投資，都有助於實現跨客戶群的強勁增長。會員人數的增長，加上 Carelon 業務範圍和規模的擴大以及我們的健康計劃，幫助推動了 CarelonRx 和 Carelon 服務的兩位數增長。總體而言，Elevance Health 全年營業收入增長近 14%，調整後營業收入實現兩位數增長。

Now I'd like to discuss a number of recent developments, including the acquisition of Blue Cross and Blue Shield of Louisiana that we just announced on Monday. Like our Anthem Blue Cross, Blue Shield family of plans, Blue Cross and Blue Shield of Louisiana is deeply rooted in its local community, serving Louisianans for almost 90 years. And like our health plans, Blue Cross and Blue Shield of Louisiana is committed to improving the health and lives of the people of Louisiana.

現在我想討論一些最近的發展，包括我們剛剛在周一宣布的對路易斯安那州 Blue Cross 和 Blue Shield 的收購。就像我們的 Anthem Blue Cross、Blue Shield 計劃系列一樣，路易斯安那州的 Blue Cross 和 Blue Shield 深深植根於當地社區，為路易斯安那人服務了近 90 年。與我們的健康計劃一樣，路易斯安那州的 Blue Cross 和 Blue Shield 致力於改善路易斯安那州人民的健康和生活。

Our organizations are well aligned in our mission and purpose and have worked together in partnership through our Healthy Blue Alliance, serving Medicaid and dual special needs plans in Louisiana for a number of years now. Upon closing, Blue Cross and Blue Shield of Louisiana will be our 15th Blue state, providing us with deep local roots in a new market, while we bring national scale and access to our portfolio of innovative solutions and capabilities to support the community.

我們的組織在我們的使命和宗旨上非常一致，並且通過我們的健康藍色聯盟合作夥伴合作，多年來在路易斯安那州為醫療補助和雙重特殊需求計劃提供服務。關閉後，路易斯安那州的 Blue Cross 和 Blue Shield 將成為我們的第 15 個藍色州，為我們在新市場提供深厚的本地根基，同時我們將在全國范圍內擴大我們的創新解決方案和能力組合，以支持社區。

We're looking forward to accelerating Blue Cross and Blue Shield of Louisiana strategy to make an even greater difference in the health and lives of the 1.9 million individuals they serve. Blue Cross and Blue Shield plans are at our best when we collaborate. Together, the Blue system provides health benefits to nearly 115 million consumers across all 50 states. There are many untapped opportunities to leverage our unique scale.

我們期待著加快路易斯安那州的 Blue Cross 和 Blue Shield 戰略，以進一步改善他們所服務的 190 萬人的健康和生活。當我們合作時，Blue Cross 和 Blue Shield 計劃將發揮最佳作用。 Blue 系統共同為所有 50 個州的近 1.15 億消費者提供健康福利。有許多未開發的機會可以利用我們獨特的規模。

One recent example is Synergie Medication Collective. Earlier this year, we became a founding investor in this new contracting organization founded by a group of Blue Cross and Blue Shield affiliated companies. The collective focuses on improving affordability and access to medical specialty drugs that are injected or infused in a clinical setting.

最近的一個例子是 Synergie Medication Collective。今年早些時候，我們成為了這個由 Blue Cross 和 Blue Shield 附屬公司組成的新承包組織的創始投資者。該集體專注於提高在臨床環境中註射或輸注的醫療專業藥物的可負擔性和可及性。

Synergie will seek best-in-class medical drug pricing, leveraging our collective industry-leading specialty drug spend to enhance affordability and drive toward value-based care representing another example of Blue's partnering for progress.

Synergie 將尋求一流的醫療藥品定價，利用我們行業領先的集體藥品支出來提高負擔能力並推動基於價值的護理，這是 Blue 合作取得進步的另一個例子。

Inside Elevance Health, we are also directly addressing fast-growing areas of cost trend. In November, we announced the acquisition of BioPlus, the largest independent specialty pharmacy provider offering a complete range of specialty pharmacy services for patients living with complex and chronic conditions.

在 Elevance Health 內部，我們還直接解決成本趨勢快速增長的領域。 11 月，我們宣布收購 BioPlus，這是最大的獨立專業藥房供應商，為患有復雜和慢性疾病的患者提供全方位的專業藥房服務。

BioPlus will enhance our ability to deliver on our whole health promise and enable us to leverage our resources in scale to deliver greater affordability and access to critical medications. Over time, it will allow us to bring specialty pharmacy fulfillment for our members in-house, what is a dynamic time in the field, given the anticipated growth of biosimilars.

BioPlus 將增強我們實現整體健康承諾的能力，並使我們能夠大規模利用我們的資源，以提供更大的可負擔性和獲得關鍵藥物的機會。隨著時間的推移，考慮到生物仿製藥的預期增長，這將使我們能夠在內部為我們的成員帶來專業藥房服務，這是該領域充滿活力的時期。

Upon closing, BioPlus will become part of CarelonRx, our pharmacy services business that we rebranded at the beginning of this year. With the addition of specialty pharmacy, we will expand the scope of the services and capabilities inside of Carelon and by extension, the proportion of overall health care spending that we manage or address.

關閉後，BioPlus 將成為我們在今年年初更名的藥房服務業務 CarelonRx 的一部分。隨著專業藥房的加入，我們將擴大 Carelon 內部的服務範圍和能力，進而擴大我們管理或處理的整體醫療保健支出的比例。

The acquisition of BioPlus furthers our commitment to scaling health care services to address the needs of health plans beginning with our own. Of Carelon's nearly $41 billion of revenue in 2022, approximately 60% came from partnering with our health plans. Meanwhile, in 2022, Carelon achieved the goal we set at our March 2021 Investor Conference of managing at least 20% of our consolidated benefit expense by 2025.

收購 BioPlus 進一步推動了我們擴大醫療保健服務規模的承諾，以滿足從我們自己的健康計劃開始的需求。在 Carelon 2022 年近 410 億美元的收入中，約 60% 來自與我們的健康計劃的合作。與此同時，Carelon 在 2022 年實現了我們在 2021 年 3 月投資者大會上設定的目標，即到 2025 年管理至少 20% 的綜合福利支出。

This is 3 years ahead of schedule, a testament to the growing suite of capabilities within Carelon. Carelon has made significant progress since our last investor conference. And we look forward to providing shareholders an update on our long-range planning at our next investor conference, which will be held on Thursday, March 23, 2023 in New York City.

這比計劃提前了 3 年，證明了 Carelon 內部不斷增長的能力套件。自上次投資者會議以來，Carelon 取得了重大進展。我們期待在將於 2023 年 3 月 23 日星期四在紐約市舉行的下一次投資者會議上向股東提供有關我們長期計劃的最新信息。

Increasingly, we are evaluating and growing our enterprise through 2 primary businesses: health benefits and health care services. And we're continuing down the path of scaling Carelon by addressing the needs of our Commercial, Medicare and Medicaid health benefits businesses. Beginning with the first quarter of 2023, we will evolve our external reporting to better align with this approach and begin to report Carelon split between CarelonRx and Carelon services, while we combine our Commercial and Government health benefits operations for reporting purposes into a single health benefit segment.

我們越來越多地通過 2 個主要業務來評估和發展我們的企業：健康福利和醫療保健服務。我們正在通過滿足我們的商業、醫療保險和醫療補助健康福利業務的需求，繼續擴大 Carelon 的規模。從 2023 年第一季度開始，我們將改進我們的外部報告，以更好地與這種方法保持一致，並開始報告 Carelon Rx 和 Carelon 服務之間的拆分，同時我們將我們的商業和政府健康福利業務合併為報告目的，形成單一的健康福利部分。

Our new reporting structure will allow stakeholders to more clearly track the progress we are making against our enterprise strategy and better reflects how we evaluate our business results against our enterprise strategy today. John will discuss this more in his remarks, and you can also find a pro forma view of quarterly and full year 2022 results, the new reporting structure as a supplemental table in this morning's press release.

我們新的報告結構將使利益相關者能夠更清楚地跟踪我們在企業戰略方面取得的進展，並更好地反映我們如何根據當今的企業戰略評估我們的業務成果。約翰將在他的發言中更多地討論這個問題，你還可以在今天上午的新聞稿中找到 2022 年季度和全年業績的預估視圖，新的報告結構作為補充表。

Now I'd like to touch on a few recent highlights before discussing our outlook for 2023. During the fourth quarter, we were pleased to become the first managed care organization in the nation to earn the full 3-year health equity accreditation from the National Committee for Quality Assurance for all of our own Medicaid health plans covering nearly 90% of our Medicaid membership.

現在，在討論我們對 2023 年的展望之前，我想先談談最近的一些亮點。在第四季度，我們很高興成為美國第一家獲得國家衛生公平 3 年期完整認證的管理式醫療組織我們自己的所有 Medicaid 健康計劃的質量保證委員會涵蓋了我們近 90% 的 Medicaid 會員。

This recognition demonstrates that focus and resolve yield results. We have long been dedicated to countering health and equities across our enterprise and through partnerships with care providers. We continue to work toward health equity through policy and practice in pursuit of better outcomes and experiences for all and ultimately, to improve the health of humanity.

這種認可表明專注和解決會產生結果。長期以來，我們一直致力於通過與護理提供者的合作來應對整個企業的健康和公平問題。我們繼續通過政策和實踐努力實現健康公平，為所有人追求更好的結果和體驗，並最終改善人類的健康。

Our Medicaid team is prepared to uphold that commitment by ensuring access to care for underprivileged populations through continuity of coverage for all beneficiaries eligible for Medicaid, who will be subject to the eligibility redeterminations this year. We look forward to working alongside state partners to help minimize loss of coverage due to administrative challenges and to ensure beneficiaries no longer eligible for Medicaid understand their coverage options.

我們的 Medicaid 團隊準備通過為所有符合 Medicaid 資格的受益人提供連續性保險來確保弱勢群體獲得醫療服務，他們將在今年接受資格重新確定，從而履行這一承諾。我們期待與州合作夥伴合作，以幫助最大程度地減少因行政挑戰而導致的保險損失，並確保不再符合醫療補助資格的受益人了解他們的保險選項。

Our ACA exchange plans are now being offered in almost every county in our 14 Blue states. We remain committed and prepared to ensure seamless transitions of those Medicaid members as they move into exchange plans or employer-based coverage.

現在我們 14 個藍色州的幾乎每個縣都提供我們的 ACA 交換計劃。我們仍然致力於並準備確保這些 Medicaid 成員在進入交換計劃或基於雇主的保險時無縫過渡。

Across our health plans, we are optimizing our businesses. The pandemic brought with it substantial uncertainties and that resulted in margin compression in our Commercial and Medicare health plans in 2021 that we didn't recover in 2022. It has since become apparent that COVID costs are not going to zero. And as we discussed last year, we've been repricing our risk in our Commercial business, and we are enjoying improved reimbursement rates, risk adjustment revenue and star quality bonus payments in our Medicare Advantage business in 2023.

在我們的健康計劃中，我們正在優化我們的業務。大流行帶來了巨大的不確定性，並導致我們 2021 年的商業和醫療保險健康計劃的利潤率壓縮，而我們在 2022 年沒有恢復。從那以後，很明顯 COVID 成本不會為零。正如我們去年討論的那樣，我們一直在重新定價我們商業業務的風險，我們在 2023 年的 Medicare Advantage 業務中享受改進的報銷率、風險調整收入和星級質量獎金支付。

With January 1 renewals behind us in Commercial, and the 2023 Medicare Advantage plan year underway, we remain confident in the margin recovery previously discussed and for the improvement in our Commercial and Medicare businesses to more than offset anticipated member attrition in our Medicaid business when redeterminations begin on April 1.

隨著 1 月 1 日我們在商業領域的續約以及 2023 年 Medicare Advantage 計劃年度的進行，我們仍然對之前討論的利潤率恢復充滿信心，並對我們的商業和 Medicare 業務的改善充滿信心，以抵消重新確定時我們 Medicaid 業務的預期成員流失4月1日開始。

Our confidence in operating our Medicare Advantage business solidly inside our long-term 3% to 5% target margin range has been underpinned by our bid strategy, in which we took a balanced approach. While the AEP proved to be somewhat more competitive than we expected, we still expect to grow Medicare Advantage membership relatively close to our prior targeted growth rate in 2023.

我們對在 3% 至 5% 的長期目標利潤率範圍內穩固地運營我們的 Medicare Advantage 業務的信心得到了我們採取平衡方法的出價策略的支持。雖然事實證明 AEP 比我們預期的更具競爭力，但我們仍然預計 Medicare Advantage 會員的增長將相對接近我們之前在 2023 年設定的目標增長率。

Turning now to our outlook for 2023. We expect adjusted earnings of greater than $32.60 per share, reflecting growth of over 12%. Our guidance reflects double-digit growth in operating earnings in each of our health benefits and Carelon businesses that will be driven by the focused execution of our enterprise strategy, to optimize our health benefits business, invest in high-growth opportunities and accelerate capabilities and services.

現在談談我們對 2023 年的展望。我們預計調整後的每股收益將超過 32.60 美元，增長超過 12%。我們的指引反映了我們每項健康福利和 Carelon 業務的營業收入實現兩位數增長，這將受到我們企業戰略重點執行的推動，以優化我們的健康福利業務，投資於高增長機會並加速能力和服務.

Our outlook contemplates a range of outcomes on Medicaid redeterminations, coverage shifts and retention and our expectation for Commercial and Medicare margin recovery from pandemic-era lows. John will discuss our assumptions in greater detail. The strong growth we achieved in 2022 would not have been possible without the hard work and dedication of our more than 100,000 associates. Our collective determination to improve lives and communities is unwavering, and we look forward to making a meaningful difference as Elevance Health.

我們的展望考慮了醫療補助重新確定、覆蓋範圍轉移和保留的一系列結果，以及我們對商業和醫療保險利潤率從大流行時代低點回升的預期。約翰將更詳細地討論我們的假設。如果沒有我們超過 100,000 名員工的辛勤工作和奉獻精神，我們不可能在 2022 年實現強勁增長。我們改善生活和社區的集體決心是堅定不移的，我們期待著作為 Elevance Health 做出有意義的改變。

I would like to thank them for the important work they do and the impact they make every day. Now I'd like to turn the call over to John for more on our operating results. John?

我要感謝他們所做的重要工作以及他們每天產生的影響。現在我想把電話轉給約翰，了解更多關於我們的經營業績。約翰？

Thank you, Gail, and good morning to everyone on the line. We are pleased to have delivered solid fourth quarter financial results, closing out another strong year of growth for Elevance Health. The focused execution on our enterprise strategy continues to drive progress against our stated long-term targets. Fourth quarter adjusted earnings per share of $5.23 was ahead of our expectations and drove full year adjusted earnings per share to $29.7, reflecting growth of over 15% year-over-year off of our adjusted 2021 baseline of $25.20 and above our long-term 12% to 15% annual earnings per share growth target.

謝謝你，蓋爾，早上好在線的每個人。我們很高興在第四季度取得了穩健的財務業績，結束了 Elevance Health 又一個強勁增長的一年。集中執行我們的企業戰略繼續推動我們實現既定的長期目標。第四季度調整後每股收益為 5.23 美元，超出了我們的預期，並將全年調整後每股收益推高至 29.7 美元，反映出比我們調整後的 2021 年基線 25.20 美元同比增長超過 15%，高於我們的長期 12 %至15%的年度每股收益增長目標。

We ended the year with 47.5 million members, up $2.2 million or nearly 5% year-over-year, with organic growth having comprised more than 85% of our overall increase. In the fourth quarter, medical membership grew by 248,000 members, led by growth in Medicaid, driven in large part by the ongoing suspension of eligibility redeterminations and the acquisition of Vivida Health, which added 29,000 Medicaid members.

到年底，我們擁有 4750 萬會員，同比增長 220 萬美元或近 5%，有機增長占我們整體增長的 85% 以上。在第四季度，醫療會員人數增加了 248,000 人，這主要是由於醫療補助計劃的增長，這在很大程度上是由於資格重新確定的持續暫停和對 Vivida Health 的收購，增加了 29,000 名醫療補助計劃會員。

For the full year, we added 1.1 million net new Commercial members and 1.1 million net new Government members. Total operating revenue for the year was nearly $156 billion, an increase of approximately 14% over the prior year, reflecting solid growth in our health benefits businesses and continued momentum in Carelon. We are pleased with the progress made to accelerate our service capabilities during the year as CarelonRx and Carelon services grew revenue by 12% and 27% over 2021, respectively.

全年，我們淨增加了 110 萬名新商業會員和 110 萬名淨新政府會員。全年營業總收入接近 1560 億美元，比上年增長約 14%，反映出我們健康福利業務的穩健增長以及 Carelon 的持續發展勢頭。我們對這一年在加速我們的服務能力方面取得的進展感到高興，因為 CarelonRx 和 Carelon 服務的收入分別比 2021 年增長了 12% 和 27%。

The consolidated benefit expense ratio for the fourth quarter was 89.4%, a decrease of 10 basis points over the fourth quarter of 2021. This strong performance includes an improvement in Commercial underwriting margin and also benefited from the reclassification of certain quality improvement expenses. These improvements were partially offset by the Medicaid business, which carries a higher benefit expense ratio than our Commercial and Medicare health plans.

第四季度的綜合福利費用率為 89.4%，比 2021 年第四季度下降 10 個基點。這一強勁表現包括商業承保利潤率的提高以及某些質量改進費用的重新分類。這些改進部分被 Medicaid 業務所抵消，該業務的福利支出比率高於我們的商業和 Medicare 健康計劃。

Elevance Health's SG&A expense ratio in the fourth quarter was 11.5% and 11.4% for the full year reflecting an improvement of 20 basis points in the fourth quarter and full year. These positive results include the negative impact on the SG&A ratio related to aligning certain quality improvement expenses with CMS guidelines. The overall improvement was driven primarily by expense leverage associated with strong growth in operating revenue.

Elevance Health 第四季度的 SG&A 費用比率為 11.5%，全年為 11.4%，反映出第四季度和全年提高了 20 個基點。這些積極的結果包括與使某些質量改進費用與 CMS 指南保持一致相關的對 SG&A 比率的負面影響。整體改善主要是由與營業收入強勁增長相關的費用槓桿推動的。

In 2022, we produced another year of strong operating cash flow of $8.4 billion, representing 1.4x net income, which was significantly better than our outlook to start the year and was driven by stronger risk-based membership growth and maintaining a prudent balance sheet.

2022 年，我們又實現了 84 億美元的強勁運營現金流，相當於淨收入的 1.4 倍，這明顯好於我們年初的預期，這得益於基於風險的會員增長強勁和保持審慎的資產負債表。

Additionally, relative to our initial guidance, a shift in the timing of certain payments to state-based partners added over $500 million to the fourth quarter operating cash flow that we now expect that we will pay in the first quarter of 2023. We ended 2022 with a debt-to-cap ratio of 39.9%, in line with our expectations and within our targeted range.

此外，相對於我們最初的指導，向州合作夥伴支付某些款項的時間發生了變化，使我們現在預計將在 2023 年第一季度支付的第四季度運營現金流增加了 5 億多美元。我們在 2022 年結束了負債率 39.9%，符合我們的預期並在我們的目標範圍內。

During the fourth quarter, we repurchased 1.1 million shares of our stock for $567 million. For the year, we repurchased 4.8 million shares for $2.3 billion, exceeding our initial outlook for 2022 as we took advantage of the volatile periods in the market and opportunistically repurchase shares.

第四季度，我們以 5.67 億美元回購了 110 萬股股票。今年，我們以 23 億美元的價格回購了 480 萬股股票，超過了我們對 2022 年的初步預期，因為我們利用了市場動盪時期併機會主義地回購了股票。

Consistent with our approach throughout the pandemic, we maintained a prudent posture with respect to reserves. Days in Claims Payable ended the year at 47.7 days, an increase of 2.5 days year-over-year and stable with the third quarter. Medical Claims Payable grew over 15% year-over-year compared to premium revenue growth of 13.5%.

與我們在整個大流行期間的做法一致，我們在儲備方面保持審慎態度。應付索賠天數年末為 47.7 天，同比增加 2.5 天，與第三季度持平。與保費收入增長 13.5% 相比，應付醫療索賠同比增長超過 15%。

In summary, 2022 was a very strong year. We grew adjusted earnings per share by over 15%. We grew operating gain by nearly 13%. We grew membership by 2.2 million, and we grew revenue by nearly 14%, all with a stable medical loss ratio, a 2.5-day increase in Days in Claims Payable and operating cash flow of $8.4 billion or 1.4x net income.

總之，2022 年是非常強勁的一年。我們將調整後的每股收益增長了 15% 以上。我們的營業收益增長了近 13%。我們的會員增加了 220 萬，收入增長了近 14%，醫療損失率保持穩定，應付索賠天數增加了 2.5 天，運營現金流為 84 億美元或淨收入的 1.4 倍。

Before turning to our 2023 outlook, I would like to provide more detail on our decision to adapt our external segment reporting to better align with our enterprise strategy. Beginning with the first quarter of 2023, we will begin to disclose Carelon as a separate business division and provide operating revenue, operating gain and operating margin information separately for Carelon Services and CarelonRx.

在談到我們的 2023 年展望之前，我想詳細說明我們調整外部分部報告以更好地與我們的企業戰略保持一致的決定。從 2023 年第一季度開始，我們將開始將 Carelon 作為一個單獨的業務部門進行披露，並分別提供 Carelon Services 和 CarelonRx 的營業收入、營業收益和營業利潤率信息。

Carelon offers a diverse suite of services across behavioral health, advanced analytics and services, complex care, pharmacy services and digital assets, and we remain committed to expanding the scale and scope of services Carelon provides to our own and third-party health plans.

Carelon 提供涵蓋行為健康、高級分析和服務、複雜護理、藥房服務和數字資產的多元化服務，我們仍然致力於擴大 Carelon 為我們自己和第三方健康計劃提供的服務的規模和範圍。

As we've continued down the path of scaling Carelon by addressing the needs of our Commercial, Medicare and Medicaid health benefits businesses, it's become increasingly apparent that the similarities between our health plans have evolved to outnumber the differences. And we have also decided to combine our employer, individual, Medicare, Medicaid health plans and products into a single health benefits division.

隨著我們通過滿足我們的商業、醫療保險和醫療補助健康福利業務的需求繼續擴大 Carelon 的規模，越來越明顯的是，我們的健康計劃之間的相似之處已經發展到超過差異。我們還決定將我們的雇主、個人、醫療保險、醫療補助健康計劃和產品合併為一個健康福利部門。

The remaining segment, Corporate and Other will include a small amount of revenue and earnings from non-Carelon, non-health benefits businesses as well as our corporate unallocated expenses. The new health benefits segment will combine the same group of businesses that currently comprises the Commercial and specialty and Government business divisions. And the Carelon Services segment, reflects the same group of businesses that comprised the diversified business group, now Carelon Services, which has historically been included as part of our old other segment.

其餘部分，企業和其他將包括來自非 Carelon、非健康福利業務的少量收入和收益以及我們的企業未分配費用。新的健康福利部門將合併目前由商業和專業以及政府業務部門組成的同一組業務。 Carelon Services 部門反映了構成多元化業務集團的同一組業務，即現在的 Carelon Services，它在歷史上一直被列為我們舊的其他部門的一部分。

We are excited to begin disclosing the performance of our 2 primary and distinct businesses in a manner more consistent with how we will grow our enterprise for years to come and to be doing so at the time of strength for our organization. As you can see, our Commercial health plan margin recovery is well underway and will extend into 2023, which is reflected in our Health Benefits segment margin guidance provided in our press release this morning.

我們很高興開始披露我們 2 個主要和不同業務的績效，其方式更符合我們未來幾年發展企業的方式，並在我們組織實力強大的時候這樣做。如您所見，我們的商業健康計劃利潤率恢復正在順利進行，並將延續到 2023 年，這反映在我們今天上午發布的新聞稿中提供的健康福利部門利潤率指南中。

To ensure a smooth transition to our new reporting structure, we have also included a supplemental table in this morning's press release showing our quarterly and full year 2022 results pro forma for the new reporting structure alongside new supplemental performance metrics for CarelonRx and Carelon services that can be used to model revenue for each business.

為了確保順利過渡到我們的新報告結構，我們還在今天上午的新聞稿中包含了一個補充表格，顯示了我們對新報告結構的季度和 2022 年全年預估結果，以及 CarelonRx 和 Carelon 服務的新補充績效指標，這些指標可以用於為每項業務建模收入。

Our commitment to elevating whole health and advancing health beyond health care is unwavering, and our new segment reporting structure will allow our stakeholders to more clearly track the progress we're making against our enterprise strategy.

我們堅定不移地致力於提升整體健康和促進超越醫療保健的健康，我們新的分部報告結構將使我們的利益相關者能夠更清楚地跟踪我們在企業戰略方面取得的進展。

Now I'd like to discuss our outlook for 2023 in greater detail. We are pleased to have provided initial earnings per share guidance of greater than $32.60 reflecting growth of over 12% year-over-year putting us on track to produce a sixth consecutive year of growth in adjusted earnings per share, consistent with our long-term 12% to 15% compound annual growth rate target.

現在我想更詳細地討論我們對 2023 年的展望。我們很高興提供了超過 32.60 美元的初始每股收益指引，反映了超過 12% 的同比增長，使我們有望連續第六年實現調整後每股收益的增長，這與我們的長期目標一致12%至15%的複合年增長率目標。

2023 will be a year of optimization, but we will also demonstrate the balance and resilience of our health benefits businesses as we execute the planned recovery of our Commercial and Medicare health plan margins from pandemic-era lows which we expect will more than offset the impact of membership attrition and margin normalization in our Medicaid business when eligibility redeterminations resume.

2023 年將是優化的一年，但我們也將展示我們的健康福利業務的平衡和彈性，因為我們執行計劃從大流行時代的低點恢復我們的商業和醫療保險健康計劃利潤率，我們預計這將抵消影響當資格重新確定恢復時，我們的醫療補助業務中的會員流失和利潤率正常化。

For 2023, we anticipate growth in medical membership despite Commercial repricing and Medicaid redeterminations. Commercial risk-based membership is expected in 2023, up over 200,000 at the midpoint, ending the year in the range of 4.9 million to 5.1 million members. Growth will be driven by individual and small group risk-based membership, partially offset by attrition in our large group risk business, driven by the repricing discussed earlier.

到 2023 年，儘管商業重新定價和醫療補助重新確定，但我們預計醫療會員人數會增加。預計到 2023 年，基於商業風險的會員人數將增加 200,000 人，到年底將達到 490 萬至 510 萬會員。增長將由個人和小型團體基於風險的會員資格推動，部分被我們大型團體風險業務的減員所抵消，這是由前面討論的重新定價驅動的。

Note that we expect Commercial risk-based membership to decline by approximately 60,000 in the first quarter with individual up approximately 100,000 and group risk-based membership down approximately 160,000. We anticipate growth in individual and group risk-based membership over the balance of the year concentrated in the second half as consumers transition from Medicaid to Commercial coverage.

請注意，我們預計第一季度基於商業風險的會員將減少約 60,000 人，其中個人將增加約 100,000 人，而基於團體風險的會員將減少約 160,000 人。我們預計，隨著消費者從醫療補助計劃轉向商業保險，個人和團體基於風險的會員在今年餘下時間的增長集中在下半年。

Fee-based membership is expected to grow by approximately 600,000 members at the midpoint to 27.1 million to 27.4 million at year-end 2023. The wider-than-normal range contemplates a variety of scenarios related to coverage shifts out of Medicaid and into employer-sponsored plans and the relatively uncertain macroeconomic backdrop.

到 2023 年底，收費會員人數預計將在中點增加約 600,000 人，達到 2710 萬至 2740 萬。超出正常範圍的範圍考慮了與承保範圍從醫療補助計劃轉移到雇主-贊助計劃和相對不確定的宏觀經濟背景。

We expect approximately 1/3 of this growth to occur in the first quarter with the balance more heavily concentrated in the back half of the year as consumers transition from Medicaid to Commercial coverage. Total Commercial membership will end the year in the range of 32 million to 32.5 million members, up over 800,000 members at the midpoint.

我們預計這一增長的大約 1/3 將出現在第一季度，隨著消費者從醫療補助計劃轉向商業保險，其餘部分將更多地集中在今年下半年。到年底，商業會員總數將在 3200 萬至 3250 萬之間，中間超過 800,000 名會員。

Medicare Advantage membership is expected to grow by approximately 75,000 to 125,000 members with growth in both individual and group pushing our membership over the 2 million member mark. Medicaid membership is expected to end the year in the range of 10.8 million to 11.3 million, driven by the attrition associated with eligibility redeterminations beginning on April 1 of this year.

Medicare Advantage 會員預計將增加約 75,000 至 125,000 名會員，個人和團體的增長將推動我們的會員超過 200 萬大關。受今年 4 月 1 日開始的資格重新確定相關的人員流失的推動，預計 Medicaid 成員到年底將在 1080 萬至 1130 萬之間。

This wider-than-normal range contemplates a range of scenarios on the pace of redeterminations and the prospect of macroeconomic headwinds developing over the course of 2023. And finally, we expect our Medicare supplement and federal employees' health benefits memberships will be relatively stable year-over-year.

這個比正常範圍更寬的範圍考慮了一系列關於重新確定速度的情景以及 2023 年宏觀經濟逆風發展的前景。最後，我們預計我們的 Medicare 補充和聯邦僱員的健康福利會員資格將在今年相對穩定-超過一年。

In total, medical membership is expected to end 2023 in the range of 47.4 million to 48.5 million, reflecting growth of over 400,000 members at the midpoint. The consolidated medical loss ratio is expected to be 87.2% in 2023, plus or minus 50 basis points, an improvement of approximately 20 basis points compared with 2022, primarily driven by the repricing of Commercial risk-based business and margin expansion in Medicare Advantage, related to the improved reimbursement levels across rates, risk adjustment and star quality performance.

總體而言，到 2023 年底，醫療會員人數預計將在 4740 萬至 4850 萬之間，反映出中點會員人數增長超過 400,000 人。預計 2023 年綜合醫療損失率為 87.2%，上下浮動 50 個基點，較 2022 年提高約 20 個基點，主要受商業風險業務的重新定價和 Medicare Advantage 的利潤率擴張推動，與提高費率、風險調整和星級質量績效的報銷水平有關。

The SG&A expense ratio is expected to be 11.2%, plus or minus 50 basis points, a reduction of 20 basis points at the midpoint driven by expense leverage associated with growth in operating revenue, partially offset by continued growth in our Carelon businesses, which carry higher SG&A ratio than our health benefits business.

SG&A 費用比率預計為 11.2%，上下浮動 50 個基點，中點減少 20 個基點，原因是與營業收入增長相關的費用槓桿，部分被我們 Carelon 業務的持續增長所抵消，其中包括SG&A 比率高於我們的健康福利業務。

We expect operating gain for the year to be greater than $9.35 billion, reflecting growth of at least 10% over 2022, again, being the primary driver of growth in adjusted earnings per share. Below the line, we expect investment income to be approximately $1.6 billion and the interest expense to be approximately $1 billion, both reflecting the impact of higher interest rates.

我們預計今年的營業收益將超過 93.5 億美元，反映出比 2022 年至少增長 10%，再次成為調整後每股收益增長的主要驅動力。在此線之下，我們預計投資收入約為 16 億美元，利息支出約為 10 億美元，均反映了較高利率的影響。

And our effective tax rate is expected to be in the range of 22% to 24%. Our full-year operating cash flow is expected to be greater than $7.6 billion, including the unfavorable impact of a timing delay on the payment of approximately $500 million to certain Medicaid state partners that we previously believed we would pay in the fourth quarter of 2022. Adjusting for timing, our 2023 cash flow outlook will be greater than $8.1 billion or approximately 1.1x our expected GAAP net income.

我們的實際稅率預計在 22% 到 24% 之間。我們的全年運營現金流預計將超過 76 億美元，其中包括時間延遲對我們之前認為我們將在 2022 年第四季度支付的某些醫療補助州合作夥伴支付約 5 億美元的不利影響。根據時間調整，我們 2023 年的現金流量前景將超過 81 億美元，大約是我們預期的 GAAP 淨收入的 1.1 倍。

We expect full year share repurchases of approximately $2 billion, and our weighted average fully diluted share count for the year is expected to be in the range of 239 million to 240 million shares outstanding.

我們預計全年股票回購額約為 20 億美元，我們今年的加權平均完全攤薄股票數量預計在 2.39 億至 2.4 億股流通股之間。

Our 2023 guidance does not include the pending acquisition of BioPlus or Blue Cross and Blue Shield of Louisiana, which we expect will close later in the year. Importantly, neither is expected to have a material impact on earnings in 2023.

我們的 2023 年指引不包括待定收購路易斯安那州的 BioPlus 或 Blue Cross 和 Blue Shield，我們預計這些收購將在今年晚些時候完成。重要的是，預計兩者都不會對 2023 年的收益產生實質性影響。

At the segment level, we expect the Health Benefit segment operating revenue to grow in the mid- to upper single-digit percentage range year-over-year in 2023, with segment operating margin up 25 to 50 basis points year-over-year. We expect CarelonRx revenue to grow in the upper single-digit percentage range with low single-digit growth in adjusted scripts and mid-single-digit growth in revenue per adjusted script.

在細分層面，我們預計 2023 年健康福利細分市場營業收入將同比增長中上個位數百分比，細分市場營業利潤率同比增長 25 至 50 個基點。我們預計 CarelonRx 的收入將在較高的個位數百分比範圍內增長，調整腳本的個位數增長率較低，每個調整腳本的收入增長率為中個位數。

And we expect Carelon Services to grow revenue in the low double-digit range organically, excluding all pending or unannounced M&A, driven by growth in revenue per consumer served, as we expect consumer serve to grow in the low single-digit range from 105 million at year-end 2022.

我們預計 Carelon Services 的收入將在較低的兩位數範圍內有機增長，不包括所有未決或未宣布的併購，這是受服務於每個消費者的收入增長的推動，因為我們預計消費者服務將在較低的個位數範圍內增長，從 1.05 億在 2022 年底。

Carelon Services operating margin is expected to expand by 25 to 50 basis points year-over-year in 2023. With respect to our earnings seasonality, we are projecting similar profitability patterns to historical ranges and expect to earn slightly more than 55% of our full year adjusted earnings per share in the first half of the year with slightly more than half of that in the first quarter, consistent with current consensus modeling of seasonality.

到 2023 年，Carelon Services 的營業利潤率預計將同比增長 25 至 50 個基點。關於我們的盈利季節性，我們預計盈利模式將與歷史範圍類似，並預計將略高於我們全部收入的 55%上半年調整後每股收益略高於第一季度的一半，與當前的季節性共識模型一致。

Finally, we remain committed to enhancing shareholder returns through capital deployment including share repurchases and dividends and are pleased to announce that our Board of Directors recently approved a 16% increase in our regular quarterly dividend to $1.48 per share, our 12th consecutive annual increase, which will be paid on March 24 to shareholders of record at the close of business on March 10.

最後，我們仍然致力於通過包括股票回購和股息在內的資本配置來提高股東回報，並高興地宣布，我們的董事會最近批准將我們的定期季度股息增加 16% 至每股 1.48 美元，這是我們連續第 12 年增加股息，這將於 3 月 24 日支付給 3 月 10 日營業結束時登記在冊的股東。

In closing, 2022 was another year of strong growth for Elevance Health as we continue down the path of transforming from a traditional health insurance company to a lifetime trusted health partner, and we are well positioned to deliver another year of strong growth in line with our long-term targets in 2023.

最後，2022 年對 Elevance Health 來說又是強勁增長的一年，因為我們繼續沿著從傳統健康保險公司轉型為終生值得信賴的健康合作夥伴的道路前進，我們有能力根據我們的目標實現又一年的強勁增長2023年的長期目標。

We look forward to discussing our enterprise strategy and long-term financial targets at our upcoming investor conference, which we will host in New York City on Thursday, March 23, 2023. And with that, operator, please open the line for questions.

我們期待在即將於 2023 年 3 月 23 日星期四在紐約市舉辦的投資者會議上討論我們的企業戰略和長期財務目標。因此，運營商，請打開問題熱線。

(Operator Instructions) Our first question will go to the line of Lance Wilkes from Bernstein.

（操作員說明）我們的第一個問題將來自伯恩斯坦的蘭斯威爾克斯。

Yes. And can you talk a little bit about the growth in the services business, which is really interesting. Both org changes that you're intending to put in place to kind of support the new segment reporting, if any? And then in the Care delivery aspect of that, can you just talk a little bit about what you've been doing to date with some of your partnerships with Aledade and Privia and how that's kind of being deployed in the market and what your expectations are for Care delivery long term?

是的。你能談談服務業務的增長嗎，這真的很有趣。您打算實施的兩項組織更改都支持新的細分報告，如果有的話？然後在護理交付方面，您能否談談您迄今為止與 Aledade 和 Privia 的一些合作夥伴關係所做的事情，以及它在市場上的部署情況以及您的期望是什麼長期護理？

Well, thanks for the question, Lance. Let me frame a little bit of what you asked, and then I'll ask Pete Haytaian, who leads Carelon to give you a little bit more color on that. First, in terms of org structure, we've actually been building our team over the last 18 months, and Pete's done a really strong job of both bringing individuals who are in the services industry to Carelon, but also taking individuals from our health benefits business, who have a deep understanding of that business and having them lead.

好吧，謝謝你的問題，蘭斯。讓我對您提出的問題進行一些概括，然後我會請 Carelon 的負責人 Pete Haytaian 為您提供更多信息。首先，在組織結構方面，我們實際上在過去 18 個月裡一直在建設我們的團隊，Pete 在將服務行業的人員帶到 Carelon 以及從我們的健康福利中獲取人員方面做得非常出色業務，他們對該業務有深刻的了解並讓他們領導。

So we feel we've got a really good mix of talent and have been building our bench strength pretty effectively. So we don't envision any structural changes, obviously, as acquisitions come in, they fit into the verticals that we've shared as part of our strategy. So let me just have Pete comment a little bit about -- a little bit more about Carelon and our growth there.

所以我們覺得我們擁有非常好的人才組合，並且一直在非常有效地增強我們的替補實力。因此，我們不設想任何結構性變化，顯然，隨著收購的進行，它們適合我們作為戰略一部分共享的垂直領域。因此，讓我讓 Pete 稍微評論一下——更多關於 Carelon 和我們在那裡的成長。

Yes. No, thanks a lot Gail. Thanks a lot, Lance, for the question. Overall, as Gail said, we're really pleased with the momentum and performance that we saw in 2022. And as Gail noted, in the year, we did do a lot around restructuring. We obviously went through rebranding, which there was a lot of excitement around. And as she said, we infused a lot of new talent across the organization. And then in terms of the infrastructure we built internally, we're very focused.

是的。不，非常感謝蓋爾。非常感謝蘭斯提出的問題。總體而言，正如蓋爾所說，我們對我們在 2022 年看到的勢頭和表現感到非常滿意。正如蓋爾指出的那樣，在這一年中，我們確實圍繞重組做了很多工作。我們顯然經歷了品牌重塑，周圍有很多令人興奮的事情。正如她所說，我們為整個組織注入了許多新人才。然後就我們內部構建的基礎設施而言，我們非常專注。

As you know, a core part of our strategy is focused on internal growth and serving Elevance affiliated health plans. And so we built the infrastructure to engage to a much better degree with our associates and partners internally. And we're seeing really good progress there. I hope you can see that through the numbers and the improvement in the year.

如您所知，我們戰略的核心部分是專注於內部增長和服務 Elevance 附屬健康計劃。因此，我們構建了基礎架構，以便更好地與內部員工和合作夥伴進行互動。我們在那裡看到了非常好的進展。我希望您可以通過數字和這一年的改進看到這一點。

We remain keenly focused on whole health and improving the patient experience. That's something else that we're very focused on looking from the outside in, in terms of the patient experience.

我們仍然密切關注整體健康和改善患者體驗。就患者體驗而言，這是我們非常關注從外到內看的另一件事。

And then I'd say the other thing that we've been really focused on internally, where we're trying to change the culture, and it's working, is driving more risk and capitation through the portfolio. And that has really helped in terms of the acceleration of our growth and the innovation that we're seeing going forward.

然後我要說的是我們一直在內部真正關注的另一件事，我們正在努力改變文化，並且它正在發揮作用，正在通過投資組合推動更多的風險和人頭。這確實有助於加速我們的增長和我們正在看到的創新。

As it relates to your question on some of the Care delivery partnerships, we're seeing really good progress there. Again, when you look at the assets within Carelon, it can add a lot of value to our partners. And so we continue to look to wrap around those services and create incremental value. And as we look forward, we have that in mind as well. We talk to our provider base partners, where are they feeling stressed, where can we support them. So there's a lot of opportunity that we got going forward.

由於它與您關於某些護理交付合作夥伴關係的問題有關，我們在那裡看到了非常好的進展。同樣，當您查看 Carelon 內部的資產時，它可以為我們的合作夥伴增加很多價值。因此，我們繼續尋求圍繞這些服務並創造增量價值。在我們展望未來的同時，我們也牢記這一點。我們與我們的供應商基地合作夥伴交談，他們在哪裡感到壓力，我們可以在哪裡支持他們。所以我們有很多前進的機會。

Yes. Thanks, Pete. And Lance, specifically, in terms of how we're deploying, we see those partnerships and some of the investments we've made as part of our overall value-based care strategy. Our penetration has been strong, we're around 63% driven by purposeful collaboration. Those are 2 really good examples.

是的。謝謝，皮特。蘭斯，具體來說，就我們的部署方式而言，我們將這些合作夥伴關係和我們所做的一些投資視為我們基於價值的整體護理戰略的一部分。我們的滲透率一直很高，我們約有 63% 是由有目的的合作驅動的。這是兩個非常好的例子。

We continue to learn and improve that approach, and part of that is how we work closely with Carelon to capitate services and actually, I think, impact more of the health care dollar and impact more of overall services. But we feel really confident about the strategy that we've deployed. And as I've shared before on these calls, we know that sharing -- the downside risk is really the most important part of where we need to achieve better outcomes.

我們繼續學習和改進這種方法，其中一部分是我們如何與 Carelon 密切合作以提供服務，實際上，我認為，影響更多的醫療保健美元和整體服務。但我們對我們已經部署的戰略非常有信心。正如我之前在這些電話會議上分享的那樣，我們知道分擔下行風險確實是我們需要取得更好成果的最重要部分。

And so we're continuing to grow those arrangements, early days still, but we feel good about the partnerships that we have, and we continue to expand them, and we feel on track to deliver on the goals that we've shared previously at our Investor Day, but also in these calls. So thanks very much for the question and next question please.

因此，我們將繼續擴大這些安排，雖然還處於早期階段，但我們對我們擁有的合作夥伴關係感到滿意，並且我們將繼續擴大它們，並且我們感到有望實現我們之前在我們的投資者日，也在這些電話中。非常感謝這個問題，請問下一個問題。

Next, we'll go to the line of A.J. Rice from Credit Suisse.

接下來，我們將轉到 A.J.來自瑞士信貸的大米。

Congratulations on the Blue Cross and Blue Shield of Louisiana deal. It's been quite a while since we've seen one of those. My big recollection is the approval process and navigating the regulatory side of things can be a little tricky. Can you give us a sense of any discussions you have with the states at this point and your confidence level? I know you're saying by year-end close.

祝賀路易斯安那州的 Blue Cross 和 Blue Shield 交易。自從我們看到其中一個以來已經有一段時間了。我最大的回憶是審批流程和監管方面的導航可能有點棘手。您能否告訴我們您此時與各州進行的任何討論以及您的信心水平？我知道你說的是年底前。

And John, you mentioned that it wouldn't be meaningful to this year's numbers. I'm assuming that's partly due to late closure. But is it -- can we say that it would be accretive? Is there anything you can say financially about it? And then the last aspect of this is, obviously, there's a lot of changing things related to the Blues generally with the antitrust settlement, et cetera. Are you seeing more discussions, Gail, as you're out there? Or is there more interest in collaboration, maybe we could see a broader upswing in activity?

約翰，你提到這對今年的數字沒有意義。我假設這部分是由於延遲關閉。但它 - 我們可以說它會增加嗎？在經濟上你有什麼可以說的嗎？然後，最後一個方面是，顯然，與藍軍相關的很多變化通常與反托拉斯和解等有關。蓋爾，你在外面時是否看到更多討論？還是對合作更感興趣，也許我們可以看到更廣泛的活動上升？

Well, thank you, A.J. That was a very comprehensive set of questions, and let me try to kind of go through them. First, we really are excited about the acquisition of Blue Cross and Blue Shield of Louisiana, as you said, it's been some time since one of these has occurred. But I think as you think about like the driver for this, this is very much a strategic acquisition.

嗯，謝謝你，A.J.這是一組非常全面的問題，讓我嘗試過一遍。首先，正如您所說，我們對收購路易斯安那州的 Blue Cross 和 Blue Shield 感到非常興奮，其中一個發生已經有一段時間了。但我認為，正如你所想的那樣，這在很大程度上是一項戰略收購。

The Board of Blue Cross and Blue Shield of Louisiana, really wanted to have a greater impact and accelerate the strategy that they put in place. This is a solidly run plan, 4.5-star Medicare plan. And I think those are really important things as you think about this acquisition.

路易斯安那州的 Blue Cross 和 Blue Shield 董事會真的希望產生更大的影響並加快他們實施的戰略。這是一個穩健運行的計劃，4.5 星 Medicare 計劃。當你考慮這次收購時，我認為這些都是非常重要的事情。

The other thing that I think is really important for us is Blue Cross and Blue Shield of Louisiana very much aligns with our strategy. They're deeply rooted in their local communities. They -- as we shared, they've served Louisianans for more than 90 years. Our mission and purpose is well aligned. And we've had a healthy Blue Alliance partnership with them that serves our Medicaid and dual special needs plans for a number of years now. So we've worked together culturally, I think there's a great alignment there.

我認為對我們來說真正重要的另一件事是路易斯安那州的 Blue Cross 和 Blue Shield 非常符合我們的戰略。他們深深植根於當地社區。他們——正如我們分享的那樣，他們為路易斯安那人服務了 90 多年。我們的使命和宗旨是一致的。多年來，我們與他們建立了健康的藍色聯盟合作夥伴關係，為我們的醫療補助計劃和雙重特殊需求計劃提供服務。所以我們在文化上一起工作，我認為那裡有很好的一致性。

And the other thing is we're excited because this brings the 15th Blue state. So we can -- just as we have in our other 14, we've kept our deep local roots in a new market, but we also can bring our national scale and access to our portfolio of innovative solutions and capabilities, again, accelerating what the Blue Cross and Blue Shield strategic focus has been, and that supports the community, and I think accelerates their strategy and making an even greater difference in impact on the 1.9 million lives.

另一件事是我們很興奮，因為這帶來了第 15 個藍色州。所以我們可以——就像我們在其他 14 個市場所做的那樣，我們在一個新市場中保持了深厚的本地根基，但我們也可以將我們的全國規模和對我們創新解決方案和能力組合的訪問，再次加速Blue Cross 和 Blue Shield 的戰略重點一直是支持社區，我認為這會加速他們的戰略，並對 190 萬人的生活產生更大的影響。

In terms of closing, this will be subject to the normal closing conditions. And as we shared, we believe that we expect the deal to close in the second half of 2023. So again, not much more there. We do feel the impact that we can have on the community and the citizen in Louisiana with the foundation, Accelerate Louisiana really is a strong component of this and helps accelerate health care status, accessibility, affordability as well as health equity, and those are areas that we've been deeply investing and committed to as well.

在交割方面，這將取決於正常的交割條件。正如我們所分享的那樣，我們相信我們預計該交易將在 2023 年下半年完成。因此，不會再多了。我們確實感受到我們可以通過基金會對路易斯安那州的社區和公民產生影響，Accelerate Louisiana 確實是其中的重要組成部分，有助於加快醫療保健狀況、可及性、可負擔性和健康公平，這些都是領域我們一直在深入投資並致力於此。

In terms of collaborations, you heard that we've done a number of collaborations and feel good about the Synergie Medical Collective, which is a great example of all of us coming together around medical specialty and again, with an alignment and focus around fundamentally improving affordability. We have 150 million Americans that we serve across this country. And we feel that ability for us to work together to have an even greater impact again on access and affordability is really important.

在合作方面，您聽說我們已經進行了多次合作，並且對 Synergie Medical Collective 感覺良好，這是我們所有人圍繞醫學專業聚集在一起的一個很好的例子，並且再次調整併專注於從根本上改善負擔能力。我們在這個國家服務了 1.5 億美國人。我們認為，我們能夠共同努力，再次對可及性和可負擔性產生更大的影響，這一點非常重要。

And I would just point to that as an example. So thank you very much for the question. I think we, again, are excited about this. We think it's a great collaboration for us and feel that there's an opportunity for us to work together and for us to obviously use Carelon to help support the advancement of all Blues. So thanks very much.

我只是舉個例子。非常感謝你提出這個問題。我想我們再次對此感到興奮。我們認為這對我們來說是一次很棒的合作，我們覺得我們有機會一起工作，顯然我們可以利用 Carelon 來幫助支持所有藍軍的進步。非常感謝。

Next, we'll go to the line of Justin Lake from Wolfe Research.

接下來，我們將轉到 Wolfe Research 的 Justin Lake 線。

Just wanted to check in. In 2022, you did about 7% margin in that Commercial business. I know you're not reporting it specifically anymore. But you had 11% target out there for 2025. I wanted to check in on that target and just find out if that is still what you're expecting to do by 2025. Maybe you could share with us how much progress you're making towards that in 2023?

只是想登記一下。2022 年，您在該商業業務中的利潤率約為 7%。我知道你不再專門報告它了。但是你有 11% 的目標到 2025 年。我想檢查一下這個目標，看看這是否仍然是你期望到 2025 年做的事情。也許你可以與我們分享你取得的進展到 2023 年？

And then give us -- I'm sure there's an offset there in terms of mortgage services on the Medicaid side from a margin perspective. Can you share where you expect your Medicaid margins to be versus the 2% to 4% target you have out there long term?

然後給我們——我敢肯定，從利潤率的角度來看，醫療補助計劃方面的抵押貸款服務會有所抵消。您能否分享您期望醫療補助計劃的利潤率與您長期設定的 2% 至 4% 的目標相比？

Thank you, Justin. And we do appreciate the questions. In terms of Commercial, we're actually doing very, very well. We have a repricing effort going on that began on July 1, 2022. And what we had seen was the overall cost structure of the Commercial market was higher than we had assumed. And so this repricing was about 25% of the large group block in July. And then we repriced about 50% of the block here on January 1, 2023, and it was really to ensure that the premiums more accurately reflect the underlying cost structure of the book.

謝謝你，賈斯汀。我們非常感謝這些問題。在商業方面，我們實際上做得非常非常好。我們從 2022 年 7 月 1 日開始進行重新定價工作。我們看到的是商業市場的整體成本結構高於我們的假設。所以這個重新定價大約是 7 月份大集團塊的 25%。然後我們在 2023 年 1 月 1 日對大約 50% 的區塊重新定價，這確實是為了確保保費更準確地反映這本書的基本成本結構。

The result of that would be margin recovery associated with that. We feel very good about the progress that we're making, and we still stand by the commitments that were made in our prior Investor Day to get the Commercial margins up to the level that we had estimated by 2025.

其結果將是與之相關的保證金恢復。我們對我們正在取得的進展感到非常滿意，我們仍然信守在之前的投資者日做出的承諾，即到 2025 年將商業利潤率提高到我們估計的水平。

You have to look at now the health services segment in total. And as you had asked, we have the Commercial margin improvement ongoing. We will have Medicare margin improvement as our risk adjusters are really recovering -- risk-adjusted revenue really recovering from pandemic-era lows Also, we do have 74% of our MA membership in 4-star plans or above for the 2023 payment year. And we believe our Medicare Advantage business will be solidly within the target margin range of 3% to 5%.

您現在必須全面了解醫療服務領域。正如您所問，我們正在進行商業利潤率的改善。我們的醫療保險利潤率將有所提高，因為我們的風險調整器正在真正復甦——風險調整後的收入確實從大流行時代的低點中復蘇。此外，在 2023 年的付款年度，我們確實有 74% 的 MA 會員參與四星級或以上計劃。我們相信我們的 Medicare Advantage 業務將穩固地處於 3% 至 5% 的目標利潤率範圍內。

And then on Medicaid, which was your final question, we've been working very closely with our state partners on Medicaid and feel very good about the rating actions. And that the rates are actuarially sound rates and feel very good about that. However, we were making either at or above the high end of our range here in the last couple of years which obviously resulted in MLR collars and various other rebates being paid back to the states.

然後關於醫療補助，這是你的最後一個問題，我們一直在與我們的州合作夥伴在醫療補助方面密切合作，並對評級行動感到非常滿意。而且這些利率在精算上是合理的，並且對此感覺非常好。然而，在過去的幾年裡，我們在這裡的生產範圍處於或高於我們範圍的高端，這顯然導致 MLR 項圈和其他各種回扣被返還給各州。

We expect that the Medicaid business will be solidly within the 2% to 4% range, closer to the high end, but still with actuarial equivalent rates. So hopefully, that helps clarify all that.

我們預計醫療補助業務將穩定在 2% 至 4% 的範圍內，接近高端，但仍具有精算等值率。希望這有助於澄清所有這些。

Next, we'll go to the line of Nathan Rich from Goldman Sachs.

接下來，我們將轉到 Goldman Sachs 的 Nathan Rich 的路線。

On Carelon, you mentioned that you hit the target for 20% of benefit expense through Carelon ahead of schedule. Could you talk about how much higher this percentage can go from here with your current capabilities? And then specifically on the outlook for 2023. The revenue guidance for Carelon Services came in a bit below your long-term target. How are you thinking about growth from here just given the progress that you've made? And will more growth come from external customers going forward?

關於 Carelon，您提到您通過 Carelon 提前實現了 20% 的福利支出目標。您能否談談以您目前的能力，這個百分比可以提高多少？然後特別是 2023 年的前景。Carelon Services 的收入指導略低於您的長期目標。鑑於您已經取得的進展，您如何看待從這裡開始的增長？未來更多的增長會來自外部客戶嗎？

Yes. Thanks, Nathan. I'm going to have Pete Haytaian provide a little perspective. And as we shared earlier, we are going to be updating our long-term planning at our Investor Day in March. So we probably won't go into like where we think our updated guidance is on that, but we can certainly give you some color on how each of the components are playing and feel very good about the progress that Carelon overall is making. So Pete?

是的。謝謝，內森。我要請 Pete Haytaian 提供一些觀點。正如我們之前分享的那樣，我們將在三月份的投資者日更新我們的長期計劃。因此，我們可能不會像我們認為我們更新的指南那樣深入，但我們當然可以為您提供一些關於每個組件如何發揮作用的顏色，並對 Carelon 整體取得的進展感到非常滿意。那麼皮特？

Yes. No, thanks for the question, Nathan. As it relates to '23, just to be clear, and John noted this in the prepared remarks, the low double-digit range growth in '23 is really organic growth. It does not include M&A. I think if you look at our recent history, there's been a lot of M&A that's contributed meaningfully to us. And we're being very intentional about that. We're very focused on it. It's something that we'll continue to do. And I think it's an important part of our growth strategy going forward.

是的。不，謝謝你的問題，內森。由於它與 23 年相關，需要明確的是，約翰在準備好的發言中指出了這一點，23 年的兩位數低增長實際上是有機增長。它不包括併購。我想如果你看看我們最近的歷史，就會發現很多併購對我們做出了有意義的貢獻。我們對此非常有意識。我們非常專注於此。這是我們將繼續做的事情。我認為這是我們未來增長戰略的重要組成部分。

As Gail said, in terms of the amount of medical spend that we penetrate, we'll talk more about that at Investor Day, but we're really encouraged with our trajectory right now. We feel like we can continue to grow pretty significantly. There's a lot of white space internally. So a lot of opportunity there. But to your point about external growth, we did establish some new leadership. We've got a new infrastructure in terms of external growth. We're very focused, as Gail said, you've heard a lot about the Blues and Blue partnerships, and we're very encouraged of what we're seeing in terms of the blue opportunity.

正如蓋爾所說，就我們滲透的醫療支出金額而言，我們將在投資者日討論更多，但我們現在對我們的軌跡感到非常鼓舞。我們覺得我們可以繼續顯著增長。內部有很多空白區域。那裡有很多機會。但就你關於外部增長的觀點而言，我們確實建立了一些新的領導層。我們在外部增長方面擁有新的基礎設施。正如蓋爾所說，我們非常專注，您已經聽說過很多關於 Blues 和 Blue 合作夥伴關係的信息，我們對我們在藍色機會方面看到的情況感到非常鼓舞。

So we do think we can see nice growth externally as well. But again, our first focus is on the affiliated health plans and creating value there first.

因此，我們確實認為我們也可以在外部看到良好的增長。但同樣，我們的首要重點是附屬健康計劃並首先在那裡創造價值。

Next, we'll go to the line of Scott Fidel from Stephens.

接下來，我們將轉到 Stephens 的 Scott Fidel 的台詞。

Just 2 follow-ups on the Blues topic. The first is if you can maybe give us some color on the incremental revenue you expect to drive from the BCBSLA Louisiana acquisition because obviously, you already have some revenues that you're generating off of Healthy Blue. Then also maybe just an update on the Blue Cross and Blue Shield of Minnesota situation. I think that, that relationship on the Medicaid side will term at the beginning of 2024. Just any update on membership or financial impact that you expect from that situation as well?

只有 2 個關於 Blues 主題的跟進。首先是，如果你能給我們一些關於你希望從 BCBSLA 路易斯安那州收購中獲得的增量收入的顏色，因為很明顯，你已經從 Healthy Blue 中獲得了一些收入。然後也可能只是明尼蘇達州藍十字和藍盾的最新情況。我認為，醫療補助方面的這種關係將在 2024 年初終止。您是否也希望從這種情況中獲得有關會員資格或財務影響的任何更新？

Yes, sure. Thank you, Scott, for the question. So associated with Blue Cross and Blue Shield of Louisiana. As we had stated, we're not expecting that to close until later in (technical difficulty) 2023 will not be material, really than the line items. However, assuming it does close in '23, in 2024, what we should see is an incremental 1.6 million members after you eliminate the various double counts and you referenced the significant partnership we have with them already.

是的，當然。斯科特，謝謝你提出這個問題。因此與路易斯安那州的藍十字和藍盾有關。正如我們所說，我們預計要到 2023 年晚些時候（技術難度）才會關閉，這並不重要，實際上比訂單項更重要。但是，假設它確實在 23 年關閉，到 2024 年，我們應該看到在您消除各種重複計算並引用我們已經與他們建立的重要合作夥伴關係之後增加 160 萬會員。

So it's an incremental 1.6 million members. And it's really -- it's an incremental $4.5 billion in revenue on top of what we have now. So that's really about the high-level economics that we would expect to endure in 2024.

所以它增加了 160 萬會員。而且它真的 - 在我們現在擁有的基礎上增加了 45 億美元的收入。所以這真的是關於我們預計在 2024 年會持續的高水平經濟。

I'm going to ask Felicia Norwood to comment on Minnesota.

我要請 Felicia Norwood 對明尼蘇達發表評論。

Yes. Scott, thank you for the question on Minnesota. We operate over 27 Medicaid plans across the country with over 11.5 million members. And when you think about what we do, we bring very deep expertise in this business and a relentless focus on our whole health strategy, health equity and improving health outcomes. The expertise we bring to the table has been recognized by our external partners, and we really look forward to continuing to bring that experience to other Blue partners and alliances not only in Medicaid, but in Medicare as well.

是的。斯科特，謝謝你提出關於明尼蘇達州的問題。我們在全國運營超過 27 個醫療補助計劃，擁有超過 1150 萬會員。當你想到我們所做的事情時，我們會在這項業務中帶來非常深厚的專業知識，並堅持不懈地關注我們的整體健康戰略、健康公平和改善健康結果。我們帶來的專業知識得到了外部合作夥伴的認可，我們真的很期待繼續將這種經驗帶給其他 Blue 合作夥伴和聯盟，不僅在 Medicaid 領域，而且在 Medicare 領域。

When I think about our alliance relationships, each of them is very different. And Blue Cross and Blue Shield of Minnesota decided to end our administrative services relationship, which supported about 330,000 Medicaid members and provide back-office services in-house. We're going to work with them to make sure that there's a seamless transition because at the core of what we do, we want to make sure our members are taken care of, and that's our highest priority.

當我想到我們的聯盟關係時，他們每個人都是非常不同的。明尼蘇達州的 Blue Cross 和 Blue Shield 決定終止我們的行政服務關係，該關係為大約 330,000 名醫療補助成員提供支持並提供內部後台服務。我們將與他們合作以確保無縫過渡，因為我們所做工作的核心是確保我們的會員得到照顧，這是我們的首要任務。

So we continue to value alliance relationships and really look forward to continued growth in this segment with partners who value the deep expertise that we bring to the table for serving vulnerable and complex populations.

因此，我們繼續重視聯盟關係，並真誠期待與重視我們為弱勢和復雜人群提供服務的深厚專業知識的合作夥伴在這一領域的持續發展。

Yes. Thanks, Felicia. And Scott, that will be in January '24, just from a timing perspective.

是的。謝謝，費利西亞。斯科特，從時間的角度來看，那將是 24 年 1 月。

Next, we'll go to the line of Lisa Gill from JPMorgan.

接下來，我們將轉到來自摩根大通的 Lisa Gill 的台詞。

I just wanted to follow up on utilization expectations for 2023. John, you made the comment that COVID is not going away, I agree that, that should be in the baseline. But as we think about this, do you feel like there's any level of pent-up demand or potentially higher acuity levels as we move into 2023? And would you call out any specific line of business?

我只是想跟進 2023 年的利用率預期。約翰，你發表了 COVID 不會消失的評論，我同意，這應該在基線中。但是當我們考慮這個問題時，您是否覺得在我們進入 2023 年時有任何水平的被壓抑的需求或可能更高的敏銳度水平？你會說出任何特定的業務範圍嗎？

Thank you for the question, Lisa. And we're not discussing specific trend assumptions for 2023. But really when you look at some of the cost drivers, that we have relative to expectations, emergency room has been favorable. Inpatient has been favorable. Pharmacy costs actually are running a little bit higher than expected and outpatient is running a little bit higher than expected.

謝謝你的問題，麗莎。我們不是在討論 2023 年的具體趨勢假設。但實際上，當您查看一些成本驅動因素時，我們相對於預期而言，急診室一直很受歡迎。住院一直有利。藥房成本實際上比預期高一點，門診費用比預期高一點。

I don't know that we really see any pent-up demand as much as we see being as much as the new normal. But just to reiterate, the overall cost structure of the business is higher than if COVID had never occurred. COVID is here and it continues to be a cost driver. What I think is probably most important in all of this is that our pricing now reflects the underlying cost structure and our MLR guidance also reflects this higher cost structure. So we actually feel very well positioned going into 2023.

我不知道我們是否真的看到任何被壓抑的需求，就像我們看到的新常態一樣多。但重申一下，企業的整體成本結構高於從未發生過 COVID 的情況。 COVID 就在這裡，它仍然是一個成本驅動因素。我認為在所有這一切中最重要的可能是我們的定價現在反映了潛在的成本結構，而我們的 MLR 指南也反映了這種更高的成本結構。所以我們實際上感覺非常適合進入 2023 年。

Next, we'll go to the line of Kevin Fischbeck from Bank of America.

接下來，我們將轉到來自美國銀行的 Kevin Fischbeck 的台詞。

Great. I guess my question is going to be really on 2024. So if you can make a direct comment on that, that would be great. But if not, at least comment on the 2023 trajectory to give us a little bit of a sense. Because it seems like the story here for 2023 is balanced portfolio improvements in Commercial and Medicare are offsetting Medicaid. But obviously, the Medicaid pressure is one that builds throughout the year, both from a revenue and I would think from an MLR pressure perspective, which pegs the question about whether it's a bigger headwind in 2024 than it is in 2023 and whether there are similar opportunities in 2024 to kind of to offset that?

偉大的。我想我的問題實際上是在 2024 年。所以如果你能對此發表直接評論，那就太好了。但如果沒有，至少評論一下 2023 年的軌跡，讓我們有點感覺。因為 2023 年的故事似乎是商業和醫療保險的平衡投資組合改進正在抵消醫療補助。但顯然，醫療補助壓力是全年都會增加的壓力，無論是從收入還是從 MLR 壓力的角度來看，這都提出了一個問題，即 2024 年的逆風是否比 2023 年更大，以及是否有類似的情況2024 年的機會可以抵消這種影響嗎？

Yes. Thank you for the question, Kevin. And as you indicated in your question, we're not going to provide any specific details we did on 2024. Obviously, at our Investor Day coming up here in a few months, we'll provide a lot more long-term aspirations. But I think the way you've characterized 2023 is correct. It's really -- it's a year of optimizing our health benefits business, while we continue to grow and expand the capabilities within Carelon.

是的。謝謝你的問題，凱文。正如你在問題中指出的那樣，我們不會提供我們在 2024 年所做的任何具體細節。顯然，在幾個月後即將到來的投資者日，我們將提供更多的長期願景。但我認為你描述 2023 年的方式是正確的。這真的是 - 這是優化我們的健康福利業務的一年，同時我們繼續發展和擴展 Carelon 的能力。

And then you talk about, well, gee, could the headwind be greater. As you look at the Medicaid redeterminations, there's certainly a lot of variables associated with the pace and timing, on a state-by-state basis, where they go, which lines of business they ultimately reside in. I think one of the great things about the balance and resilience of our membership base is that we end up with the members somewhere.

然後你說，哎呀，逆風會更大嗎？當你看醫療補助計劃的重新決定時，肯定有很多與速度和時間相關的變量，在一個州一個州的基礎上，他們去了哪裡，他們最終居住在哪些業務領域。我認為其中一件很棒的事情關於我們會員基礎的平衡和彈性，我們最終會在某個地方找到會員。

We have a product offering for every member regardless of age, regardless of employment status, regardless of health condition and I feel very, very good. So we do expect approximately about half of the Medicaid members to be reverified here in this calendar year and the other half next year. So there is some balance there. But at the end of the day, we are very well positioned to retain much of that membership.

我們為每個成員提供產品，無論年齡、就業狀況、健康狀況如何，我感覺非常非常好。因此，我們確實預計大約一半的醫療補助成員將在本日曆年和明年的另一半在這裡重新驗證。所以那裡有一些平衡。但歸根結底，我們完全有能力保留大部分成員。

Yes, thanks, John. And Kevin, I think it's an insightful question because as you've heard us talk about, I think there's 3 core pillars of how we see our business evolving. Optimizing our health benefits business. It's highly scaled. We're very diversified in that business. And again, as you think about 2023, we have an opportunity for margin recovery, which is really we've been intensely focused on.

是的，謝謝，約翰。凱文，我認為這是一個很有見地的問題，因為正如你聽到我們談論的那樣，我認為我們如何看待我們的業務發展有 3 個核心支柱。優化我們的健康福利業務。它的規模很大。我們在該業務中非常多元化。再一次，當你想到 2023 年時，我們有機會恢復利潤率，這實際上是我們一直非常關注的。

But the other 2 pillars, I think, are really important about our future growth, which is investing in growth opportunities. And then third, accelerating services and capabilities, particularly through Carelon. And remember, as we think about Carelon, a lot of that is synergistic with our health plan business. We've continued to grow this and that allows the Synergie to also occur with Carelon services as well as expanding capabilities that you've seen us both through organically and inorganically.

但我認為，其他兩大支柱對我們未來的增長非常重要，即投資於增長機會。第三，加速服務和能力，特別是通過 Carelon。請記住，當我們考慮 Carelon 時，其中很多與我們的健康計劃業務具有協同作用。我們一直在不斷發展，這使得協同效應也可以與 Carelon 服務一起發生，並擴展您通過有機和無機看到我們的能力。

So overall, I think we've got more levers than we've ever had historically, and those position us well for the balance that John just shared.

所以總的來說，我認為我們擁有比以往任何時候都多的槓桿，這些槓桿使我們能夠很好地實現約翰剛剛分享的平衡。

Next, we'll go to the line of Stephen Baxter from Wells Fargo.

接下來，我們將轉到 Wells Fargo 的 Stephen Baxter 的台詞。

It'd be great if you could expand a little bit on the dynamics you saw in Medicare Advantage open enrollment this year, and how you think those trends might play out over the next couple? And then specifically, hoping to clarify the enrollment expectations there. I think you said 75,000 to 100,000 membership growth. Is that a sequential Q1 figure or year-end figure just trying to realign versus some of the previous expectations you've shared here?

如果你能稍微擴展一下今年在 Medicare Advantage 公開註冊中看到的動態，以及你認為這些趨勢在接下來的幾對中會如何發揮作用，那就太好了？然後具體來說，希望澄清那裡的招生期望。我想你說的是 75,000 到 100,000 的會員增長。這是一個連續的第一季度數字或年終數字，只是試圖重新調整與您在這里分享的一些先前的預期嗎？

Sure, I'll have Felicia Norwood, who leads that business, to share her comments.

當然，我會請負責該業務的 Felicia Norwood 分享她的意見。

Thanks for that question. When we think about Medicare Advantage, as Gail mentioned in her early remarks, we took a very strategic approach as we thought about our bids for '23, and we expect to deliver good performance in terms of growth, not just in individual but also in group. As John referenced, we plan to grow between 75,000 and 125,000. But we did end up encountering a very competitive AEP.

謝謝你的問題。當我們考慮 Medicare Advantage 時，正如蓋爾在她早期的評論中提到的那樣，我們在考慮 23 年的出價時採取了非常戰略性的方法，我們希望在增長方面取得良好的表現，不僅在個人方面，而且在團體。正如約翰所提到的，我們計劃在 75,000 到 125,000 之間增長。但我們最終確實遇到了一個非常有競爭力的 AEP。

On the other hand, we had very solid growth in our D-SNP business, which is where we've had a focus for some period of time. And I think that positions us well for the rest of OEP in the remainder of 2023. As we think about our competitiveness, we have a very strong benefit portfolio, and we believe that we're positioned well in order to continue to grow this business.

另一方面，我們的 D-SNP 業務增長非常穩健，這是我們一段時間以來一直關注的領域。而且我認為這使我們在 2023 年剩餘時間里為 OEP 的其餘部分做好準備。當我們考慮我們的競爭力時，我們擁有非常強大的福利組合，我們相信我們處於有利地位以繼續發展這項業務.

So at the end of the day, a competitive environment, which it always will be in Medicare Advantage, but still an opportunity to grow and a business that we feel very good about. And most importantly, the opportunity is we are in 2023 to deliver very strong margin recovery and operates squarely within our 3% to 5% pretax target margin range in this business. So solid growth and solid margins in 2023.

因此，歸根結底，這是一個競爭激烈的環境，它始終存在於 Medicare Advantage 中，但仍然是一個成長的機會，也是一個我們感覺非常好的企業。最重要的是，我們有機會在 2023 年實現非常強勁的利潤率回升，並在我們該業務的 3% 至 5% 的稅前目標利潤率範圍內運營。 2023 年將實現穩健的增長和可觀的利潤率。

Next, we'll go to the line of Josh Raskin from Nephron Research.

接下來，我們將轉到 Nephron Research 的 Josh Raskin 的產品線。

I was wondering if you could provide an update on some of the trends you're seeing in value-based care. I heard some of the comments earlier. But as you go into 2023, are there any changes in the dynamics of the industry? Any changes specify in contracting terms that either the providers are looking for or that you're trying to push. And then maybe any updated views on the employment or ownership of physicians or physician groups.

我想知道您是否可以提供有關您在基於價值的護理中看到的一些趨勢的最新信息。我早些時候聽到了一些評論。但是當你進入 2023 年時，這個行業的動態有什麼變化嗎？供應商正在尋找或您試圖推動的合同條款中指定的任何更改。然後可能有任何關於醫生或醫生團體的就業或所有權的最新觀點。

Well, thanks for the question, Josh. In terms of -- a little bit consistent, I guess, with what I shared before on value-based care, I mean we've been -- we continue, quite frankly, to refine and improve our strategy. We feel we're making really good progress on it. What we're seeing is a lot more interest in sharing up and downside risk. Historically, value-based care was more upside risk and we've gotten about 63%. We've gone -- we've continued to refine that to now include much more downside risk.

好吧，喬希，謝謝你的提問。就——有點一致，我想，與我之前分享的基於價值的護理，我的意思是我們一直在——坦率地說，我們繼續完善和改進我們的戰略。我們覺得我們在這方面取得了非常好的進展。我們看到的是，人們對分擔上行和下行風險的興趣要大得多。從歷史上看，基於價值的護理具有更大的上行風險，我們得到了大約 63%。我們已經走了——我們繼續完善它，現在包括更多的下行風險。

And also I think one of the biggest differences is the sharing of data bilaterally and much more timely so that action can be taken in, I think, in a much more integrated way. And we're doing a lot of work with that with our care providers, it's embedded. And also what happens like post primary care. So how do we manage all the specialty services. That's a big part of the Carelon strategy in terms of what Pete is doing in his business.

而且我認為最大的區別之一是雙邊和更及時地共享數據，這樣我認為可以以更加綜合的方式採取行動。我們正在與我們的護理提供者一起做很多工作，它是嵌入式的。還有初級保健後會發生什麼。那麼我們如何管理所有的專業服務。就皮特在他的業務中所做的事情而言，這是 Carelon 戰略的重要組成部分。

So as I think about that, I would say structurally, we're seeing a lot more interest and a lot more conversation as this takes several years for, I think, physician practices to get comfortable with value-based care. And so we're building credibility with that. We're getting better at our reporting and our engagement. And we're not only doing it across Medicare Advantage, and I think that is one of the changes. Some of our relationships are specific to Commercial, for example, and that's a very different approach, including with some fee-based customers.

因此，當我考慮這一點時，我會從結構上說，我們看到了更多的興趣和更多的對話，因為我認為這需要幾年的時間，因為醫生實踐才能適應基於價值的護理。因此，我們正在以此建立信譽。我們在報告和參與方面做得越來越好。我們不僅在整個 Medicare Advantage 中這樣做，而且我認為這是變化之一。例如，我們的一些關係是特定於商業的，這是一種非常不同的方法，包括與一些收費客戶的關係。

So that would be a trend. In terms of the ownership of physicians, I think we've been very consistent about that. We do own physicians in terms of our integrated health plans, and those have performed very well in MMM and health fund in Florida. I think CareMore is beginning to become even more integrated with the work we're doing. So I think our strategy has stayed very consistent there.

所以這將是一種趨勢。就醫生的所有權而言，我認為我們對此非常一致。就我們的綜合健康計劃而言，我們擁有自己的醫生，這些醫生在佛羅里達州的 MMM 和健康基金中表現非常出色。我認為 CareMore 開始與我們正在做的工作更加融合。所以我認為我們的戰略在那裡一直保持一致。

So I don't really have any significant updates other than I think it's all embedded in our ability to drive more downside risk to integrate data in a much more real-time basis. And then really become true partners and train each other and how do we work in a value-based care environment. As I think you know well, this doesn't happen overnight, and it takes quite a bit of work for us on both sides to be committed to the long-term partnership. But we feel good, and we're seeing more enrollment in those partnerships. And the results have been good. We see differentiated quality and cost outcomes. So thank you very much for the question.

所以我真的沒有任何重大更新，除了我認為這一切都嵌入在我們的能力中，以更實時地整合數據來推動更多的下行風險。然後真正成為真正的合作夥伴並互相培訓，以及我們如何在基於價值的護理環境中工作。我想你很清楚，這不會在一夜之間發生，我們雙方都需要付出大量努力才能致力於長期合作夥伴關係。但我們感覺很好，我們看到更多的人加入了這些合作夥伴關係。結果很好。我們看到了差異化的質量和成本結果。非常感謝你提出這個問題。

Next, we'll go to the line of Rob Cottrell from Cleveland Research.

接下來，我們將轉到 Cleveland Research 的 Rob Cottrell 的路線。

Just on the CarelonRX or PBM, how should we square the high single-digit outlook for 2023 relative to your long-term 2025 low double-digit outlook? And then also, can you provide a bit more color on what Carelon's role will be within the Synergie Collective.

就 CarelonRX 或 PBM 而言，我們應該如何將 2023 年的高個位數前景與您 2025 年的長期低兩位數前景相比較？然後，您能否提供更多關於 Carelon 將在 Synergie Collective 中扮演的角色的顏色。

I'm going to ask Pete Haytaian to address that, please.

請Pete Haytaian 解決這個問題。

Yes. Thanks. In terms of the short term, if you're referencing the script growth. Overall, we're going to see nice script growth in Medicare and Commercial. In terms of the headwind to that, really, that's due to the Medicaid dynamic around reverifications or redeterminations. And then overall, we're going to see lower COVID vaccination. So that doesn't impact operating gain, but that is really the reason for the difference in the numbers in terms of what you're seeing short term, long term.

是的。謝謝。就短期而言，如果您指的是腳本增長。總體而言，我們將在醫療保險和商業領域看到不錯的腳本增長。就逆風而言，實際上，這是由於圍繞重新驗證或重新確定的醫療補助動態。然後總體而言，我們將看到較低的 COVID 疫苗接種率。所以這不會影響運營收益，但這確實是你所看到的短期和長期數字差異的原因。

In terms of overall growth, though, we feel really good about how we're doing in the pharmacy business. There continues to be a lot of interest in our integrated value proposition. In 2022, we're coming off a good year. We saw a 300% improvement in net membership growth. So that was good in terms of penetrating our self-funded business. And we're seeing that continue to play through into 2023. We're obviously through a lot of the selling for the beginning of the year. What we did see is we saw a lot more activity and penetration in the [10,000] or less business.

不過，就整體增長而言，我們對我們在藥房業務中的表現感到非常滿意。人們對我們的綜合價值主張仍然很感興趣。 2022 年，我們將迎來豐收的一年。我們看到淨會員增長提高了 300%。因此，就滲透我們的自籌資金業務而言，這很好。我們看到這種情況將持續到 2023 年。顯然，我們在年初經歷了很多拋售。我們確實看到的是，我們在 [10,000] 或更少的業務中看到了更多的活動和滲透。

We saw RFPs up by about 6% year-over-year. And again, I'll reiterate that this is a segment and area that we perform really, really well in. I think you referenced Synergie at the end of your question. And again, to Gail's point in our commentary, our focus, a big part of our strategy is overall affordability and choice and this creates an opportunity for us in the context of medical specialty to create more affordability for our members.

我們看到 RFP 同比增長約 6%。再一次，我要重申，這是一個我們表現非常非常好的細分市場和領域。我認為你在問題的末尾提到了 Synergie。再一次，對於蓋爾在我們的評論中的觀點，我們的重點，我們戰略的很大一部分是整體負擔能力和選擇，這為我們在醫學專業的背景下創造了一個機會，為我們的會員創造更多的負擔能力。

Again, by working in conjunction with the Blues across 100 million Americans, those that are utilizing specialty on the medical side, we have an opportunity to create much greater affordability. So we look forward to that. That work is in earnest right now in '23 with value potentially playing through into 2024.

同樣，通過與 1 億美國人的 Blues 合作，那些在醫療方面利用專業知識的人，我們有機會創造更大的負擔能力。所以我們對此充滿期待。這項工作現在正在 23 年認真進行，其價值可能會持續到 2024 年。

Next, we'll go to the line of Whit Mayo from SVB Securities.

接下來，我們將轉到 SVB Securities 的 Whit Mayo 線。

Just on the topic of health plan optimization and Commercial repricing initiatives. Can you comment maybe more specifically on stop loss. I think you guys are beginning to anniversary some of the challenges in the creep and high-cost claims last year, just how you feel about trends in the business margins, just maybe broadly, any comments about the overall stop-loss market?

只是關於健康計劃優化和商業重新定價計劃的主題。你能否更具體地評論一下止損。我認為你們開始紀念去年的蠕變和高成本索賠中的一些挑戰，您對業務利潤率趨勢的看法，也許從廣義上講，對整體止損市場有何評論？

Sure, Whit. I'm going to have Morgan Kendrick, who leads our commercial business, give you some perspective there.

當然，惠特。我將請領導我們商業業務的摩根·肯德里克 (Morgan Kendrick) 為您提供一些觀點。

Thank you for the question. Regarding the stop-loss business, that's certainly an area that was underperforming priorly and we began that journey to recover the margins in that business back in January of last year. It started with some of our integrated -- our external business rather. And then as the year progressed further, we had our July cohort, which John mentioned earlier, which was about 25% of our integrated business, both stop loss and risk-based business.

感謝你的提問。關於止損業務，這肯定是之前表現不佳的領域，我們從去年 1 月就開始了恢復該業務利潤率的旅程。它始於我們的一些綜合業務——我們的外部業務。然後隨著這一年的進一步發展，我們有了 7 月份的隊列，約翰之前提到過，這大約占我們綜合業務的 25%，包括止損和基於風險的業務。

Both of those went through a repricing exercise midyear, and then that concluded with January. So regarding the stop-loss market, we feel very good about it. We've got continued strong penetration but opportunity to continue to grow that, both on our internal integrated business as well as our external. And we feel at this point in time, we have right-priced our business based on risk and we'll continue doing that so very fastidiously as we move through in 2023.

這兩項都在年中進行了重新定價，然後在 1 月份結束。所以關於止損行情，我們感覺非常好。我們的滲透率持續強勁，但有機會在我們的內部整合業務和外部業務中繼續發展。我們覺得在這個時候，我們已經根據風險對我們的業務進行了正確定價，並且在 2023 年我們將繼續非常嚴格地這樣做。

Next, we'll go to the line of Dave Windley from Jefferies.

接下來，我們將轉到 Jefferies 的 Dave Windley 系列。

You called out a headwind to the MLR this year from the growth, the outsized growth in Medicaid did not call out a benefit to the SG&A ratio in '22 from that. I'm wondering if there was one. And then more importantly, as that -- as the direction of those books reverses and Medicaid shrinks in '23 from redetermination, does that create a headwind? And what levers are you pulling to offset that headwind for SG&A ratio?

你從今年的增長中指出了 MLR 的逆風，醫療補助的超額增長並沒有說明 22 年的 SG&A 比率從中受益。我想知道是否有一個。然後更重要的是，隨著這些書籍的方向逆轉，醫療補助計劃在 23 年因重新確定而縮減，這是否會造成逆風？您正在拉動什麼槓桿來抵消 SG&A 比率的不利因素？

Thank you for the question, Dave. As you can imagine, there's a lot of puts and takes associated with SG&A ratios and the ability to invest and the fact that we have been investing quite heavily and in various digital capabilities, things that are member facing and can actually improve the member experience. The other aspect is, is that we've really enjoyed a lot of fixed cost leveraging.

謝謝你的問題，戴夫。你可以想像，有很多與 SG&A 比率和投資能力相關的投入和投入，以及我們一直在大量投資和各種數字能力的事實，這些都是會員面臨的，實際上可以改善會員體驗。另一方面是，我們真的很享受很多固定成本槓桿。

Our premiums grew at 13.5% year-over-year, which obviously allowed the SG&A ratio to decline from that aspect as well. So we do expect a reduction in our operating expense ratio in 2023, driven by the leverage of top line growth as well as improved operating efficiency partially offset by the reinvestment and strategic initiatives in support of our growth.

我們的保費同比增長 13.5%，這顯然也讓 SG&A 比率從這方面下降。因此，我們確實預計 2023 年我們的運營費用率會下降，這是由於收入增長的槓桿作用以及運營效率的提高，部分被支持我們增長的再投資和戰略舉措所抵消。

So while certainly, the mix of business does matter, and as we said in the guidance, Carelon services carries a higher SG&A ratio than the rest of the company in general and we expect Carelon Services to grow faster, a lot of puts and takes. But fixed cost leveraging and investment in capabilities are probably 2 of the most significant drivers year-over-year.

因此，當然，業務組合確實很重要，正如我們在指南中所說，Carelon 服務的 SG&A 比率總體上高於公司其他部門，我們預計 Carelon Services 的增長速度更快，有很多投入和需求。但固定成本槓桿和能力投資可能是同比增長最重要的兩個驅動因素。

Next, we'll go to the line of Steven Valiquette from Barclays.

接下來，我們將轉到 Barclays 的 Steven Valiquette 系列。

Appreciate the color on the '23 membership guidance, particularly in the Commercial with the repricing strategy. You may have touched on this a little bit, but I guess, you previously talked about your goal of narrowing the profitability gap between the fee-based and risk-based commercial customers. So I'm just curious if you can just provide a little more color on your expected progress on that profit gap in calendar '23 in particular, just in light of all the pricing and growth trends you talked about for the risk and fee-based books of business in Commercial?

欣賞 '23 會員指南上的顏色，特別是在具有重新定價策略的商業中。您可能已經稍微談到了這一點，但我想，您之前談到了縮小收費商業客戶和風險商業客戶之間盈利能力差距的目標。所以我很好奇你是否可以根據你談到的基於風險和費用的所有定價和增長趨勢，特別是在 23 年日曆中的利潤差距方面提供更多顏色商業書籍？

Great. I'll have Morgan share his thoughts.

偉大的。我會讓摩根分享他的想法。

Stephen, thank you for the question. And we had a very successful selling season with CarelonRx, as Pete indicated, and we grew our specialty lines of business rather materially, and we continue to make steady progress towards our goal of improving that revenue gap between risk and fee-based business. One thing of note, when you think about in '22, retrospectively looking back, which will take (inaudible) forward as well, admin fee revenue grew nearly 8% compared with 4% in our fee-based membership growth.

斯蒂芬，謝謝你的提問。正如皮特所指出的那樣，我們在 CarelonRx 的銷售季非常成功，我們的專業業務線得到了實質性的發展，並且我們繼續朝著我們的目標穩步前進，以改善風險業務和收費業務之間的收入差距。需要注意的一件事是，當您回顧 22 年時，回顧一下，這也將（聽不清）向前推進，管理費收入增長了近 8%，而我們的收費會員增長為 4%。

So this alone is certainly clearly indicating that we've got an expansion in revenue and product per sold member. I would say this is driven by not only our Carelon assets, but it's also driven by strong growth in our clinical buy-ups. Again, those noted specialty products and our aligned incentives Carelon services products. And again, so we feel good about that trajectory. We feel good about that gap continuing to close. And as John had indicated earlier, this isn't about any one segment. This is around actually growing that fee-based business. Many -- much of that business is moving to the fee-based schedules, but also the pull-through of the Carelon assets that we're working jointly with Pete and his team on. Thank you for the question.

因此，僅此一項肯定清楚地表明我們已經擴大了每位銷售會員的收入和產品。我想說這不僅是由我們的 Carelon 資產推動的，而且還受到我們臨床收購強勁增長的推動。同樣，那些著名的特色產品和我們一致的獎勵 Carelon 服務產品。再一次，我們對這條軌跡感覺良好。我們對這種差距繼續縮小感到高興。正如約翰之前指出的那樣，這與任何一個細分市場無關。這是圍繞實際發展收費業務。許多 - 大部分業務正在轉向基於費用的時間表，但我們正在與皮特和他的團隊合作的 Carelon 資產也是如此。感謝你的提問。

Yes. Thanks for the question. I think as Morgan just shared, we're making really nice progress on really improving the -- both the revenue per member and the profitability per member in our fee-based business. And the example he gave, I think, helps demonstrate that. And so overall, we feel it's been strong and we have a lot of confidence in that. So thanks again for the question. And it's, again, part of optimizing our health benefits business that we've talked about.

是的。謝謝你的問題。我認為正如 Morgan 剛剛分享的那樣，我們在真正改善收費業務的每位會員收入和每位會員的盈利能力方面取得了非常好的進展。我認為，他舉的例子有助於證明這一點。總的來說，我們覺得它很強大，我們對此很有信心。再次感謝您的提問。這又是優化我們已經討論過的健康福利業務的一部分。

Next, we'll go to the line of George Hill from Deutsche Bank.

接下來，我們將前往德意志銀行的 George Hill 路線。

I ask kind of a question on the future state of the CarelonRx business. because you guys announced the BioPlus acquisition, you've got the Synergie initiatives. You've got the JV with SS&C on DomaniRx. So I guess it's probably a question for '24 or beyond. But I guess can you talk about how much of the vertical integration of the PBM business that you think that you need to do, given the outsourced relationship with CVS and the other initiatives that you have going on?

我問了一個關於 CarelonRx 業務未來狀態的問題。因為你們宣布了對 BioPlus 的收購，所以你們有了 Synergie 計劃。您在 DomaniRx 上與 SS&C 建立了合資企業。所以我想這可能是 24 歲或以後的問題。但我想你能談談你認為你需要做多少 PBM 業務的垂直整合，考慮到與 CVS 的外包關係以及你正在進行的其他計劃？

Yes, George. Thanks a lot for that question. And I think it's helpful to sort of step back and think about our overall strategy and where we started in this regard. When we started a few years ago, we always talked about being a different kind of PBM and our strategy has been keenly focused on whole health and integration of medical, pharmacy, behavioral and social. And that's been core to what we've been doing.

是的，喬治。非常感謝這個問題。我認為退一步思考我們的總體戰略以及我們在這方面的起點是有幫助的。當我們幾年前開始時，我們總是談論成為一種不同的 PBM，我們的戰略一直敏銳地關注整體健康以及醫療、藥學、行為和社會的整合。這是我們一直在做的事情的核心。

And we've also said, and we've been very deliberate about this, that we want to own the strategic levers that matter. Those that, quite frankly, drive the greatest affordability choice and, of course, superior patient experience. And that's the journey we're going on. I think what you're seeing in BioPlus and what you're seeing in Synergie are really good examples of that and what we prioritized.

我們還說過，我們對此非常慎重，我們希望擁有重要的戰略槓桿。坦率地說，那些推動了最大的負擔能力選擇，當然還有卓越的患者體驗。這就是我們正在進行的旅程。我認為你在 BioPlus 中看到的和你在 Synergie 中看到的都是很好的例子，也是我們優先考慮的事情。

If you look at specialty pharmacy, it's 40% to 50% of the overall drug spend right now. And it's a critical driver of value for patients, and so that's where we started. And we'll continue on this journey, again, through the lens of greater affordability and superior patient experience. So over time, you will continue to see us take ownership of the strategic levers that really matter.

如果你看看專科藥房，它現在佔藥品總支出的 40% 到 50%。它是患者價值的關鍵驅動因素，這就是我們的起點。我們將再次通過更高的負擔能力和卓越的患者體驗繼續這一旅程。因此，隨著時間的推移，您將繼續看到我們掌握真正重要的戰略槓桿。

Next, we'll go to the line of Gary Taylor from Cowen.

接下來，我們將轉到 Cowen 的 Gary Taylor 系列。

Actually I had a quick question about BioPlus as well. I was just wondering a couple of things. If you could give us a sense of annual revenue there, geographic reach and someone I think Pete earlier said in the future would bring specialty fulfillment in-house. And I thought that's what BioPlus was. So I just want to make sure I understand the business model there?

事實上，我也有一個關於 BioPlus 的快速問題。我只是想知道幾件事。如果你能讓我們了解那裡的年收入、地理覆蓋範圍和我認為皮特早些時候說過的某個人會在內部帶來專業實現。我認為這就是 BioPlus。所以我只是想確保我了解那裡的商業模式？

Yes. Thanks for the question, Gary. We feel really good about adding BioPlus to the family. It hasn't obviously closed yet. We think it will likely close in the first quarter. And in terms of their breadth, I won't get into all the specifics about it, but they are the largest independent specialty pharmacy out there that remains with a broad range of services. They cover over 100 of the limited distribution drugs. So we feel really good about that.

是的。謝謝你的問題，加里。我們對將 BioPlus 添加到這個家庭感到非常高興。它顯然還沒有關閉。我們認為它可能會在第一季度關閉。就它們的廣度而言，我不會詳細介紹它的所有細節，但它們是最大的獨立專業藥房，仍然提供廣泛的服務。它們涵蓋了超過 100 種限售藥物。所以我們對此感覺非常好。

And their footprint is covering all 50 states. So we believe it's a really great platform. The other thing I would say that we're really impressed by 2 things, quite frankly. One is really great talent over there with a lot of experience, long-standing experience. And then the other real differentiating factor around BioPlus is their differentiated service model.

他們的足跡覆蓋了所有 50 個州。所以我們相信這是一個非常棒的平台。另一件事我要說的是，坦率地說，我們對兩件事印象深刻。那裡有一個非常棒的人才，擁有豐富的經驗，長期的經驗。然後，圍繞 BioPlus 的另一個真正的差異化因素是他們差異化的服務模型。

Time to therapy, the speed to which they're providing services is really differentiating and we'd like to build upon that. So we're excited about this. And when it closes, we're obviously going to be very focused on building the scale to be able to take on all our specialty pharmacy.

治療時間，他們提供服務的速度確實與眾不同，我們希望以此為基礎。所以我們對此感到興奮。當它關閉時，我們顯然將非常專注於建立能夠承擔我們所有專業藥房的規模。

Thank you, we have one last question.

謝謝，我們還有最後一個問題。

And for our final question, we'll go to the line of (inaudible) from Morgan Stanley.

對於我們的最後一個問題，我們將轉到摩根士丹利的（聽不清）。

Just wanted to dig a little deeper on Commercial margins. I know you mentioned you're still targeting 10.5% to 11.5% by '25. And I think John might have mentioned 125 bps better commercial margin in '23. Was that right? And if so, that would be slightly more than 8% for '23, which means there's still a considerable gap to your '25 target. And I was expecting a majority of that improvement might happen this year just given your repricing efforts, but if you're seeing 125 bps in '23 and the following 2 years, would need at least 225 bps of improvement.

只是想更深入地了解商業利潤率。我知道你提到過到 25 年你的目標仍然是 10.5% 到 11.5%。而且我認為約翰可能在 23 年提到了 125 個基點的商業利潤率。是這樣嗎？如果是這樣，'23 將略高於 8%，這意味著與'25 目標仍有相當大的差距。鑑於你的重新定價努力，我預計今年大部分改進可能會發生，但如果你在 23 年和接下來的 2 年看到 125 個基點，則至少需要 225 個基點的改進。

So I was wondering if you could just talk a little bit more about the path and progression of that improvement in '24 and '25. If you could help us break down the drivers, we can better envision that path? Like what percent of that improvement is coming from upselling your fee-based business or the shift to higher-margin small group or just any other contributors, maybe potentially more of a pricing efforts beyond '23?

所以我想知道你是否可以多談談 24 年和 25 年改進的路徑和進展。如果你能幫助我們分解驅動因素，我們能更好地設想那條路嗎？比如這種改進中有多少百分比來自你的收費業務的追加銷售或轉向利潤率更高的小團體或任何其他貢獻者，也許更多的是 23 年後的定價努力？

Yes. Thank you for the question, Michael. I'm not sure where your 125 basis point comment came from. But that was not part of our prepared remarks. What I can share is that if you look at the press release and you can see on a reported basis, the third quarter of '22 versus the third quarter '21, commercial margins increased by 120 basis points. And then in the fourth quarter of '22 versus fourth quarter of '21 on that reported basis, the commercial margins increased by 180 basis points.

是的。謝謝你的問題，邁克爾。我不確定您的 125 個基點評論來自何處。但這不是我們準備好的評論的一部分。我可以分享的是，如果你看一下新聞稿，你可以在報告的基礎上看到，22 年第三季度與 21 年第三季度相比，商業利潤率增加了 120 個基點。然後在報告的基礎上，22 年第四季度與 21 年第四季度相比，商業利潤率增加了 180 個基點。

In terms of the margin improvement, as we have said historically, it is not going to be pro rata. We've got 3 more years, '23 through '25 to get to those lavish target margins, that it will -- there will be far more of the improvement here in '23 for the reason that you noted. And then there will be continued improvement in '24 and '25.

就利潤率改善而言，正如我們過去所說的那樣，它不會按比例增加。我們還有 3 年的時間，從 23 年到 25 年才能達到那些奢侈的目標利潤率，因為你提到的原因，23 年會有更多的改進。然後將在 24 和 25 年繼續改進。

Obviously, we're going to continue to optimize our fully insured block together with the fee-based selling strategies that Morgan talked about. Overall, we're still standing behind that margin target through 2025. Thank you.

顯然，我們將繼續優化我們的完全保險塊以及摩根談到的基於費用的銷售策略。總體而言，到 2025 年，我們仍將落後於該利潤率目標。謝謝。

Thank you, John, and thank you for everyone for joining us. In closing, we're pleased to have delivered another strong year in 2022 and are confident that the ongoing execution of our strategy positions us well for 2023. We look forward to discussing our long-term strategy in greater detail at our 2023 investor conference which we said we plan to host in New York City on March 23, 2023.

謝謝你，約翰，感謝大家加入我們。最後，我們很高興在 2022 年取得了又一個強勁的一年，並相信我們戰略的持續執行將使我們在 2023 年處於有利地位。我們期待在我們的 2023 年投資者會議上更詳細地討論我們的長期戰略我們說我們計劃於 2023 年 3 月 23 日在紐約市舉辦。

Thank you for your interest in Elevance Health , and have a great rest of week. Thank you.

感謝您對 Elevance Health 的關注，祝您度過愉快的一周。謝謝你。

Ladies and gentlemen, a recording of this conference will be available for replay after 11:00 a.m. today through February 24, 2023. You may access the replay system at any time by dialing (800)-396-1242 and international participants can dial (203)-369-3272. This concludes our conference for today. Thank you for your participation and for using Verizon conferencing. You may now disconnect.

女士們，先生們，今天上午11:00後至2023年2月24日，本次會議的錄音將可供回放。您可以隨時撥打（800）-396-1242進入回放系統，國際與會者可以撥打（ 203)-369-3272。我們今天的會議到此結束。感謝您的參與和使用 Verizon 會議。您現在可以斷開連接。