Elevance Health Inc (ELV) 2023 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).

女士們、先生們，感謝大家的支持，並歡迎參加 Elevance Health 第四季財報電話會議。 （操作員說明）。

I would now like to turn the conference over to the company's management. Please go ahead.

我現在想將會議轉交給公司管理階層。請繼續。

Good morning, and welcome to Elevance Health's Fourth Quarter 2023 Earnings Call. This is Steve Tanal, Vice President of Investor Relations. And with us this morning on the earnings call are Gail Boudreaux, President and CEO; and Mark Kaye, our CFO; Peter Haytaian, President of Carelon, Morgan Kendrick, President of our Commercial Health Benefits business; and Felicia Norwood, President of our Government Health Benefits business.

早安，歡迎參加 Elevance Health 2023 年第四季財報電話會議。我是史蒂夫‧塔納爾，投資人關係副總裁。今天早上與我們一起參加財報電話會議的是總裁兼執行長蓋爾‧布德羅 (Gail Boudreaux)；和我們的財務長馬克‧凱 (Mark Kaye)； Peter Haytaian，Carelon 總裁，Morgan Kendrick，我們商業健康福利業務總裁；以及我們政府健康福利業務總裁 Felicia Norwood。

Gail will begin the call with a brief discussion of the quarter and year and recent progress against our strategic initiatives. Mark will then discuss our financial results and outlook in greater detail. 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.

蓋爾將在電話會議開始時簡要討論本季度和年度以及我們戰略舉措的最新進展。然後馬克將更詳細地討論我們的財務表現和前景。在我們準備好發言後，團隊將可以進行問答。在電話會議期間，我們將參考某些非公認會計原則措施。這些非 GAAP 衡量標準與最直接可比較的 GAAP 衡量標準的對帳可在我們的網站 elevancehealth.com 上找到。

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 Elevance 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.

我們也將在這次電話會議上發表一些前瞻性聲明。請聽眾注意，這些陳述存在一定的風險和不確定性，其中許多風險和不確定性難以預測，並且通常超出 Elevance 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有重大差異。我們建議聽眾仔細審查今天的新聞稿以及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 a strong end to 2023. Demonstrating our ability to execute with agility and the balance and resilience of our enterprise. In the fourth quarter, Elevance Health delivered GAAP diluted earnings per share of $3.63 and adjusted diluted earnings per share of $5.62.

謝謝史蒂夫，大家早安。今天，我們很高興與大家分享，Elevance Health 為 2023 年畫上了圓滿的句號。這展示了我們敏捷執行的能力以及我們企業的平衡性和彈性。第四季度，Elevance Health 的 GAAP 攤薄每股收益為 3.63 美元，調整後攤薄每股收益為 5.62 美元。

For the full year, we reported GAAP diluted earnings per share of $25.22 and adjusted diluted earnings per share of $33.14. 2023 marks the sixth consecutive year in which we grew adjusted diluted earnings per share within or above our 12% to 15% long-term target growth rate with a compound annual growth rate exceeding the high end of the range. This reflects the ongoing execution of our strategy to accelerate capabilities and services, invest in high-growth opportunities and optimize our health benefits business.

對於全年，我們公佈的 GAAP 攤薄每股收益為 25.22 美元，調整後稀釋每股收益為 33.14 美元。 2023 年是我們調整後稀釋每股盈餘連續第六年成長在 12% 至 15% 的長期目標成長率之內或以上，複合年增長率超過該範圍的高端。這反映出我們正在持續執行策略，以加速能力和服務、投資高成長機會並優化我們的健康福利業務。

In 2023, we made significant strides building upon our flywheel for growth. Carelon has and will continue to add attractive capabilities that we can scale rapidly and sustainably over the long term. For example, just a few weeks ago, we announced the acquisition of Paragon Healthcare, a company specializing in infusible and injectable therapies. The acquisition expands our capabilities catering to consumers with complex and chronic needs, who can benefit the most from our approach to whole person health.

2023 年，我們在飛輪的基礎上取得了重大進展，實現了成長。 Carelon 已經並將繼續增加有吸引力的功能，我們可以長期快速、可持續地擴展這些功能。例如，就在幾週前，我們宣布收購 Paragon Healthcare，這是一家專門從事輸液和注射療法的公司。此次收購擴大了我們滿足具有複雜和長期需求的消費者的能力，他們可以從我們的整體健康方法中受益最多。

Infusion Services will complement our suite of pharmacy services which today include a fast-growing specialty pharmacy business and our advanced home delivery service, which launched at the beginning of this year. Carelon Services is poised for strong growth in 2024 with the onboarding of new clients and continued expansion of services provided to Elevance Health medical members, including the rollout of risk-based oncology products and Carelon Insights as well as the launch of comprehensive Carelon Behavioral Health management services to address the whole health needs of Medicaid beneficiaries living with serious mental illness.

輸液服務將補充我們的藥房服務套件，其中包括快速成長的專業藥房業務和今年年初推出的先進的送貨上門服務。隨著新客戶的加入以及向 Elevance Health 醫療會員提供的服務的持續擴展，Cararelon Services 預計在 2024 年實現強勁增長，包括推出基於風險的腫瘤產品和 Carelon Insights 以及推出全面的 Carelon 行為健康管理滿足患有嚴重精神疾病的醫療補助受益人的整體健康需求的服務。

Turning to our health benefits business. 2023 marked another strong year despite a dynamic operating environment. Performance was led by the optimization of our commercial business, where our operating margins continue to recover from pandemic [Aero lows], which will continue into 2025. Commercial customers prioritize affordability, experience and simplicity, and we're delivering on all fronts.

轉向我們的健康福利業務。儘管營運環境充滿活力，2023 年仍然是強勁的一年。業績是由我們商業業務的優化帶動的，我們的營運利潤率繼續從流行病[航空低點] 中恢復，這種情況將持續到2025 年。商業客戶優先考慮負擔能力、體驗和簡單性，我們正在各方面提供服務。

In 2023, we launched a series of initiatives designed to improve and simplify the customer experience, including our associates' ability to better serve our members through the integration of AI support and natural language processing, which has significantly improved first call resolution, in addition to enhancing our claims auto-adjudication rate. We're also broadening the use of AI to automate certain aspects of our provider directory and other administrative processes, which have improved data accuracy in consumer and provider experiences.

2023 年，我們推出了一系列旨在改善和簡化客戶體驗的舉措，包括我們的員工透過人工智慧支援和自然語言處理的整合更好地為會員提供服務的能力，這顯著提高了首次呼叫解決率，此外提高我們的索賠自動裁決率。我們還擴大了人工智慧的使用，使我們的提供者目錄和其他管理流程的某些方面實現自動化，這提高了消費者和提供者體驗的數據準確性。

Momentum in our national accounts business is a direct result of the unique and differentiated value we offer to large employers. We continue to consolidate business with existing clients, achieving excellent retention and winning over 75% of employers, who ultimately switch carriers despite a smaller pipeline of new accounts for 2024.

我們國民帳戶業務的發展動能是我們為大型雇主提供獨特且差異化價值的直接結果。我們繼續鞏固與現有客戶的業務，實現了出色的保留並贏得了超過 75% 的雇主，儘管 2024 年新客戶數量較少，但他們最終還是更換了運營商。

In our individual business, we positioned our products thoughtfully to drive profitable and sustainable growth, and we're pleased with our performance in 2023. We're looking forward to even stronger membership growth this year as we focus on maximizing access to care for redetermined Medicaid beneficiaries. Our relentless focus on affordable products, superior customer experiences and simplicity is yielding strong results.

在我們的個人業務中，我們對產品進行了深思熟慮的定位，以推動盈利和可持續增長，我們對2023 年的業績感到滿意。我們期待今年的會員增長更加強勁，因為我們專注於最大限度地提高重新確定的患者獲得照護的機會醫療補助受益人。我們對價格實惠的產品、卓越的客戶體驗和簡單性的不懈關注正在產生強勁的成果。

After growing commercial membership by over 400,000 members last year, we are poised to grow by another 750,000 in 2024. Medicaid eligibility redeterminations remain ongoing, and in many states have accelerated their redetermination processes. To date, over 70% of our members, who lost Medicaid coverage were unenrolled for administrative reasons. This is a challenging reality for many families, but we're encouraged that we are nearly 2/3 of the way through the process. With close to 30% of those unenrolled before September 1, having reenrolled in an Elevance Health product. Our research indicates that many unenrolled members are facing barriers to reenrollment including awareness of the process and required actions to maintain coverage.

去年，我們的商業會員數量增加了 40 萬多名，預計到 2024 年將再增加 75 萬名。醫療補助資格重新確定仍在進行中，並且在許多州已經加快了重新確定流程。迄今為止，超過 70% 失去醫療補助覆蓋的會員因行政原因而取消註冊。對許多家庭來說，這是一個充滿挑戰的現實，但我們感到鼓舞的是，我們已經完成了近 2/3 的過程。近 30% 的人在 9 月 1 日之前取消註冊，但重新註冊了 Elevance Health 產品。我們的研究表明，許多未註冊的會員在重新註冊方面面臨障礙，包括對流程的認識和維持覆蓋範圍所需的行動。

To address this, we're executing an extensive renewal campaign and have reached over 3 million people with our omnichannel approach as we remain committed to supporting them as their trusted health partner. Despite accelerated membership attrition from redeterminations to date, our Medicaid business is performing well. Grades remain actuarially sound for the members we are privileged to serve, and we are innovating to meet their needs. For example, in 2024, we will expand our community connected care model into 8 additional states. This program assists Medicaid members with their health-related social needs by identifying gaps and connecting members to support services in their communities.

為了解決這個問題，我們正在進行廣泛的更新活動，並透過我們的全通路方法覆蓋了超過 300 萬人，我們仍然致力於支持他們作為他們值得信賴的健康合作夥伴。儘管迄今為止重新確定導致會員流失加速，但我們的醫療補助業務仍表現良好。對於我們有幸服務的會員來說，精算等級保持良好，我們正在創新以滿足他們的需求。例如，到 2024 年，我們將把我們的社區互聯護理模式擴展到另外 8 個州。該計劃透過找出差距並將成員與其社區中的支持服務聯繫起來，幫助醫療補助成員滿足與健康相關的社會需求。

We will also launch a program in alliance with the affordable connectivity program, major wireless carriers and Samsung that will help increase equitable access to digital and virtual health tools. The program will provide eligible Medicaid members with a curated selection of digital and virtual health tools via smartphone with no data cap at no cost along with training materials and ongoing guidance on how to use these tools.

我們還將與負擔得起的連接計劃、主要無線營運商和三星合作推出一項計劃，這將有助於增加對數位和虛擬健康工具的公平存取。該計劃將透過智慧型手機為符合條件的醫療補助成員提供精選的數位和虛擬健康工具，無數據上限，免費，以及培訓材料和有關如何使用這些工具的持續指導。

Strong performance in 2023 allowed us to invest for the long term. In the fourth quarter, these investments were concentrated in Medicare, where we remain intensely focused on building a strong foundation for sustainable long-term growth. This includes improving our star quality ratings and driving profitable growth in markets, where we know we can win over the long term. Unfortunately, pockets of the Medicare Advantage market have remained hyper competitive despite a more challenging funding environment. While our plans continue to offer attractive and valuable benefits, we took intentional actions as part of our 2024 bid strategy to address product sustainability, and as such, we experienced greater-than-expected attrition in certain markets.

2023 年的強勁表現使我們能夠進行長期投資。第四季度，這些投資集中在醫療保險領域，我們仍然高度重視為可持續長期成長奠定堅實的基礎。這包括提高我們的星級品質評級並推動市場的獲利成長，我們知道我們可以在這些市場取得長期勝利。不幸的是，儘管融資環境更具挑戰性，但醫療保險優勢市場的部分地區仍然競爭激烈。雖然我們的計劃繼續提供有吸引力和有價值的好處，但作為2024 年投標策略的一部分，我們採取了有意的行動來解決產品可持續性問題，因此，我們在某些​​市場的流失超出了預期。

As a result, we expect our Medicare Advantage membership to be roughly flat in 2024 on an organic basis, but earnings to improve. Importantly, cost trends in our Medicare Advantage business continued to develop as we expected, and we are confident that the assumptions underlying our bids for 2024 are appropriate.

因此，我們預計 2024 年我們的 Medicare Advantage 會員人數將基本持平，但收入將有所改善。重要的是，我們的 Medicare Advantage 業務的成本趨勢繼續按照我們的預期發展，我們相信我們 2024 年投標的假設是適當的。

With respect to [Stars], we have now fully implemented -- my Health Advocate our comprehensive personalized customer service model for Medicare. This has improved the experiences for our members, helping them to easily navigate the health care system and their plan benefits. Early proof points reflect an improvement in first call resolution, a key indicator of future quality performance for our Medicare Advantage plans. We are confident that we have a solid foundation in our health benefits business, from which we will grow Carelon for the long term with many of the building blocks in place to accelerate our enterprise flywheel for growth.

關於 [Stars]，我們現已全面實施 — my Health Advocate 我們的 Medicare 全面個人化客戶服務模式。這改善了我們會員的體驗，幫助他們輕鬆了解醫療保健系統及其計劃福利。早期證據顯示首次呼叫解決率有所提高，這是我們 Medicare Advantage 計劃未來品質績效的關鍵指標。我們相信，我們在健康福利業務方面擁有堅實的基礎，我們將以此為基礎實現 Carelon 的長期發展，並為加速我們的企業飛輪成長提供許多基礎。

We are positioned to deliver another year of strong earnings growth in line with our long-term target in 2024, while continuing to invest in our future. We expect adjusted diluted earnings per share to be greater than $37.10 this year, reflecting growth of at least 12% over 2023. Finally, advancing Health Equity is foundational to our efforts to improve the health and lives of the individuals and communities we are privileged to serve.

我們準備在 2024 年實現另一個強勁的獲利成長，符合我們的長期目標，同時繼續投資於我們的未來。我們預計今年調整後的稀釋每股收益將超過 37.10 美元，比 2023 年至少增長 12%。最後，推進健康公平是我們努力改善個人和社區健康和生活的基礎。服務。

Our industry-leading approach received renewed recognition when the National Committee for Quality Assurance awarded its newly established health equity accreditation plus to 20 of Elevance Health affiliated Medicaid health plans covering over 90% of our Medicaid members and making us the only national plan to have received this distinction to date. We also saw excellent progress on our ambitious goal to improve maternal health equity by reducing the disparity in preterm birth rates between black and non-Black communities, improving the disparity gap by 5.2% relative to our 2022 baseline.

當國家品質保證委員會向20 個Elevance Health 附屬Medicaid 健康計劃授予新成立的健康公平認證plus 時，我們行業領先的方法得到了重新認可，覆蓋了我們超過90% 的Medicaid 會員，這使我們成為唯一獲得該認證的國家計劃迄今為止這種區別。我們也看到，透過縮小黑人和非黑人社區之間的早產率差異，改善孕產婦健康公平這一雄心勃勃的目標取得了巨大進展，相對於我們的 2022 年基線，差距縮小了 5.2%。

In closing, I want to express my gratitude to our extraordinary team of over 100,000 associates. It is their collective passion and hard work that enables us to deliver on our commitments to all of our stakeholders. This past year alone, our associates logged over 225,000 volunteer hours in our communities, a record high for ElevanceHealth. This remarkable achievement reflects our deep dedication to making a tangible positive impact on the lives of the people we are privileged to serve and for the communities we call home.

最後，我要向我們超過 10 萬名員工組成的卓越團隊表示感謝。正是他們的集體熱情和辛勤工作使我們能夠兌現對所有利益相關者的承諾。光是去年，我們的員工就在社區參與了超過 225,000 小時的志工服務，創下了 ElevanceHealth 的歷史新高。這項非凡成就反映了我們致力於為我們有幸服務的人們的生活以及我們稱之為家園的社區產生切實的積極影響。

As we move forward, we will remain focused on serving our members as their lifetime trusted health partner. With that, I'd like to turn the call over to our new Chief Financial Officer, Mark Kaye. Mark?

隨著我們的前進，我們將繼續專注於為我們的會員提供服務，成為他們終生值得信賴的健康合作夥伴。說到這裡，我想將電話轉給我們新任財務長馬克凱 (Mark Kaye)。標記？

Thank you, Gail, and good morning. I am pleased to join you for my first earnings call as CFO of Elevance Health. As Gail shared, we delivered strong results every quarter of 2023, including in the fourth quarter, which was marked by solid top and bottom line growth and significant progress in the execution of our enterprise strategy to accelerate capabilities and services, invest in high-growth opportunities and optimize our businesses.

謝謝你，蓋爾，早安。我很高興與大家一起參加我作為 Elevance Health 財務長的第一次財報電話會議。正如蓋爾分享的那樣，我們在2023 年每個季度（包括第四季度）都取得了強勁的業績，其特點是營收和利潤的穩健增長，以及在執行企業戰略方面取得的重大進展，以加速能力和服務、投資高成長機會並優化我們的業務。

Fourth quarter adjusted diluted earnings per share of $5.62 and full year adjusted diluted earnings per share of $33.14 were ahead of expectations. Since 2018, Elevance Health has achieved a compound annual growth rate of nearly 16%, surpassing our long-term target range of 12% to 15%. Operating revenue exceeded a $170 billion in 2023, up 9.3% year-over-year driven by growth in both our health benefits and Carelon businesses.

第四季調整後稀釋每股收益為 5.62 美元，全年調整後稀釋每股收益為 33.14 美元，皆超乎預期。自2018年以來，Elevance Health實現了近16%的複合年增長率，超過了我們12%至15%的長期目標範圍。在我們的健康福利和 Carelon 業務成長的推動下，2023 年營業收入將超過 1,700 億美元，較去年同期成長 9.3%。

The benefit expense ratio was 89.2% for the fourth quarter and 87% for the full year, representing an improvement of 50 basis points and 60 basis points respectively, compared to the prior year periods. This was primarily driven by premium rate adjustments in recognition of medical cost trend, most notably in our commercial health benefits business.

第四季福利費用率為89.2%，全年福利費用率為87%，較去年同期分別提升50個基點及60個基點。這主要是由於認識到醫療成本趨勢而調整保費率所致，尤其是在我們的商業健康福利業務中。

The adjusted operating expense ratio was 11.6% for the fourth quarter, up 20 basis points compared to the prior year period, driven by accelerated investments made in the quarter, notably in network quality, value-based care and customer experience initiatives designed to address key priority areas for Medicare Advantage stars. For the full year, the adjusted operating expense ratio was 11.3% flat year-over-year. Operating cash flow was $8.1 billion in 2023 or 1.3x GAAP net income. This includes the benefit of approximately $300 million of state-based payments for 2024 dates of service that we received in the fourth quarter and which will correspondingly impact operating cash flow in 2024. We ended the year with a debt-to-capital ratio of 38.9% in line with our targeted range.

第四季調整後的營運費用率為11.6%，較上年同期上升20 個基點，這得益於本季加速投資，特別是在網路品質、基於價值的護理和旨在解決關鍵問題的客戶體驗計劃方面。 Medicare Advantage 星級的優先領域。全年調整後營業費用率為11.3%，較去年同期持平。 2023 年營運現金流為 81 億美元，是 GAAP 淨利的 1.3 倍。這包括我們在第四季度收到的 2024 年服務日期約 3 億美元的國家付款的好處，這將相應地影響 2024 年的營運現金流。我們年底的債務與資本比率為 38.9 % 符合我們的目標範圍。

Giving confidence in our outlook, we took advantage of market volatility during the fourth quarter to accelerate share repurchases, specifically, we repurchased 2 million shares of our common stock for $929 million, bringing total share repurchases for the year to 5.8 million shares at a total cost of $2.7 billion. Our health benefits business ended the year with approximately 47 million members, a decrease of around 570,000 year-over-year driven by attrition in Medicaid associated with eligibility redeterminations, partially offset by growth in our commercial fee-based membership.

為了增強對前景的信心，我們利用第四季度的市場波動加速了股票回購，具體來說，我們以9.29 億美元回購了200 萬股普通股，使全年股票回購總數達到580 萬股。成本27億美元。截至今年年底，我們的健康福利業務擁有約 4,700 萬會員，年減約 57 萬，原因是與資格重新確定相關的醫療補助計劃減少，但部分被我們的商業收費會員的增長所抵消。

Today, we are 7 to 8 months into the Medicaid redetermination process. And while there is significant variability by state, we believe that nearly 2/3 of our members have had their eligibility evaluated. Of those unenrolled, approximately 70% have lost coverage due to administrative reasons. And we have also seen an elongation in the time some beneficiaries have taken to reenroll into Medicaid, while others have transitioned on to an ACA exchange plan.

如今，醫療補助重新確定流程已進入 7 至 8 個月。儘管各州之間存在顯著差異，但我們相信近 2/3 的會員已經接受了資格評估。在未投保的人中，大約 70% 由於行政原因失去了保險。我們也看到一些受益人重新加入醫療補助計劃的時間延長，而其他受益人則轉向 ACA 交換計劃。

As Gail noted, we are executing an extensive renewal campaign to maximize continuity of coverage. Accordingly, we expect reenrollment into Medicaid continue through at least 2024 and for growth in ACA exchange plans to accelerate. This has been incorporated into our membership guidance ranges for 2024. Turning to our financial outlook for 2024. We are pleased to provide initial guidance for adjusted diluted earnings per share of greater than $37.10, reflecting growth of at least 12% year-over-year. We are focused on optimizing our health benefits business, including through the ongoing margin recovery of our commercial risk-based business, the strategic repositioning of our Medicare Advantage plan offerings in certain markets and the transformation of our cost structure.

正如蓋爾所指出的那樣，我們正在進行廣泛的更新活動，以最大限度地提高覆蓋範圍的連續性。因此，我們預計重新加入醫療補助至少會持續到 2024 年，並且 ACA 交換計劃的成長將加速。這已納入我們 2024 年的會員指導範圍。談到我們 2024 年的財務展望。我們很高興為調整後的稀釋每股收益超過 37.10 美元提供初步指導，反映同比增長至少 12% 。我們專注於優化我們的健康福利業務，包括透過我們基於商業風險的業務的持續利潤恢復、我們的醫療保險優勢計劃產品在某些市場的策略重新定位以及我們的成本結構的轉型。

Further, we are investing in high-growth opportunities with a focus on establishing a foundation for sustained long-term growth. We will scale Carelon's existing capabilities and add new ones in 2024 driving incremental earnings growth and accelerating our enterprise flywheel for growth.

此外，我們正在投資高成長機會，重點是為持續的長期成長奠定基礎。我們將在 2024 年擴大 Carelon 的現有能力並增加新的能力，從而推動收益增量成長並加速我們的企業飛輪的成長。

The momentum in our commercial health benefits in Carelon businesses is partially offset by the Medicaid membership headwinds included in our guidance. We anticipate total medical membership to end 2024 in the range of $45.8 million to $46.6 million down approximately $750,000 year-over-year at the midpoint. Medicaid membership is expected to end the year in the range of 8.8 million to 9.2 million members, with attrition driven by the net loss of approximately 930,000 members associated with changes in our footprint discussed on our third quarter earnings call and ongoing eligibility redeterminations.

我們在 Carelon 業務中的商業健康福利的勢頭被我們的指導中包含的醫療補助會員資格不利因素所部分抵消。我們預計到 2024 年底，醫療會員總數將在 4,580 萬美元至 4,660 萬美元之間，年比中點減少約 75 萬美元。預計今年年底醫療補助會員數量將達到880 萬至920 萬，其中約93 萬會員的淨流失將導致會員流失，這與我們在第三季度財報電話會議上討論的足跡變化以及正在進行的資格重新確定有關。

Commercial membership is expected to grow by over $750,000 at the midpoint, ending the year in the range of 32.4 million to 32.8 million members. This includes over 300,000 net new risk-based members and approximately 400,000 net new fee-based members collectively driven by new business wins and strong client retention reflecting our resolute focus on customer affordability, experience and simplicity. Medicare Advantage membership is expected to end the year approximately flat.

預計商業會員數中點將增加超過 75 萬美元，到年底會員數將達到 3,240 萬至 3,280 萬。其中包括超過30 萬名基於風險的淨新會員和約40 萬名基於新業務的淨新會員，這些會員都是由新業務獲勝和強大的客戶保留率推動的，這反映了我們對客戶負擔能力、體驗和簡單性的堅定關注。預計 Medicare Advantage 會員資格到年底將大致持平。

As a reminder, we took intentional actions as part of our 2024 bid strategy to improve the sustainability of our product offerings. And given unexpected competitive dynamics in certain markets experienced greater-than-expected attrition. Nonetheless, these actions will help establish a strong foundation for profitable and sustainable growth over the long term.

謹此提醒，作為 2024 年競標策略的一部分，我們採取了有意識的行動，以提高我們產品的可持續性。由於某些市場出現了意想不到的競爭動態，因此出現了超出預期的損耗。儘管如此，這些行動將有助於為長期獲利和永續成長奠定堅實的基礎。

And we remain confident in the outlook for utilization and medical cost trends embedded in our 2024 bids. Finally, we expect our Medicare supplement and federal employees' health benefits membership to remain relatively stable year-over-year. On a consolidated basis, operating revenue for 2024 is expected to be flat to up low-single digits. We project operating earnings for the year to be at least $10.3 billion, reflecting 9% growth with contributions from both our health benefits and Carelon businesses, disciplined benefit management and the successful execution of our 2023 business optimization initiatives.

我們對 2024 年投標中包含的利用率和醫療成本趨勢的前景仍然充滿信心。最後，我們預計我們的醫療保險補助和聯邦員工的健康福利會員資格將比去年同期保持相對穩定。綜合來看，2024 年營業收入預計將持平或出現低個位數成長。我們預計今年的營業利潤將至少達到 103 億美元，成長 9%，這得益於我們的健康福利和 Carelon 業務、嚴格的福利管理以及 2023 年業務優化計劃的成功執行。

Please note that our guidance metrics do not include the impact of pending M&A, even though we have several transactions we expect to close at this year. Earnings seasonality is expected to be relatively consistent year-over-year with slightly more than 55% of our full year adjusted diluted earnings per share in the first half of the year and more than half of that expected in the first quarter.

請注意，我們的指導指標不包括待決併購的影響，儘管我們預計今年將完成幾筆交易。預計獲利季節性將與去年同期相對一致，上半年略高於全年調整後稀釋每股收益的 55%，第一季則超過預期的一半。

Finally, I'm pleased to announce that our Board of Directors recently approved a 10.1% increase in our regular quarterly dividend, raising it to $1.63 per share. This marks our 13th consecutive annual dividend increase, underscoring our commitment to delivering strong results for our shareholders and the value of our balanced and resilient business model.

最後，我很高興地宣布，我們的董事會最近批准將定期季度股息增加 10.1%，達到每股 1.63 美元。這標誌著我們連續第 13 次增加年度股息，突顯了我們為股東提供強勁業績的承諾以及我們平衡和有彈性的業務模式的價值。

In closing, 2023 was a strong year for the company, and I'm looking forward to working alongside the talented and dedicated team at Elevance Health to deliver on our financial targets. I look forward to meeting all of you in 2024. And with that, operator, please open the line for questions.

最後，2023 年對公司來說是強勁的一年，我期待與 Elevance Health 才華橫溢、敬業的團隊一起工作，以實現我們的財務目標。我期待在 2024 年與大家見面。接線生，請撥打電話提問。

(Operator Instructions) For our first question, we'll go to the line of A.J. Rice from UBS.

（操作員說明）對於我們的第一個問題，我們將轉到 A.J. 的線路。瑞銀的米。

Welcome on board, Mark. Congratulations to the company for another year of meeting the growth targets, and I know it's early to talk about this, but maybe you'd have to take some steps today to ensure your positioning. With 2025, you'll have the Star ratings impact to overcome.

歡迎加入，馬克。恭喜公司又一年實現了成長目標，我知道現在談論這個還為時過早，但也許您今天必須採取一些措施來確保您的定位。到 2025 年，您將需要克服星級評級的影響。

Or when you think about that, will the company do anything differently? How do you think about the levers you have to push to offset what appears at least on the surface to be a couple percentage points of headwind from that Star ratings impact. We step up share repurchases, accelerate investments in Carelon -- how do you think about that at this early date and the ability to sustain that 12% to 15% even into next year?

或者當你考慮這一點時，公司會採取不同的做法嗎？您如何看待必須採取哪些措施來抵消至少表面上看來與星級影響有幾個百分點的逆風。我們加大了股票回購力度，加快了對 Carelon 的投資——您如何看待目前的情況以及將 12% 至 15% 維持到明年的能力？

Well, thanks for the question, A.J. There's a lot in there. And as you know, '25, it's a little early to point on '25, but I'd like to give you at least a little bit of color on how we're thinking about some of the things that you mentioned. Let me start first with Star Ratings. Because as we shared on the last we are intensely working.

嗯，謝謝你的提問，A.J.裡面有很多東西。正如你所知，25 年，現在談論 25 年還為時過早，但我想至少向你提供一些關於我們如何思考你提到的一些事情的資訊。讓我先從星級開始。因為正如我們最後分享的那樣，我們正在緊張地工作。

Medicare Advantage is a very important business for us, and we're strategically committed to the long term. And I will reiterate this year, we felt we took very prudent actions for a long-term sustainable business and feel good about our bid. So that positions us well for 2025 in particular. In terms of the star ratings, again, a few things going on there. We shared on our last call that on the group business, we have a number of levers at our disposal that we are able to pull, and we're still moving forward with that.

Medicare Advantage 對我們來說是一項非常重要的業務，我們在策略上致力於長期發展。今年我要重申，我們認為我們為長期可持續業務採取了非常謹慎的行動，並對我們的出價感到滿意。因此，這對我們在 2025 年的發展尤其有利。就星級評定而言，再次發生了一些事情。我們在上次電話會議上表示，在集團業務方面，我們擁有許多可以使用的槓桿，並且我們仍在繼續前進。

And then in terms of overall Star ratings, we do think that, that's going to be a multiyear initiative. But I wanted to share, as I shared on my early remarks that we have invested at the last part of the year, and we were investing actually prior to even the announcement. We have been hit success with moving all of our business into our Health Advocate model, and we do know that we're seeing some early signs -- we don't know where the points are going to come out, but we do feel good about the investments we're making.

然後就整體星級評分而言，我們確實認為這將是一項多年的舉措。但我想分享，正如我在早期言論中分享的那樣，我們在今年下半年進行了投資，而且我們實際上在宣布之前就已經進行了投資。我們已經成功地將所有業務轉移到我們的健康倡導者模式中，我們確實知道我們看到了一些早期跡象 - 我們不知道要點會出現在哪裡，但我們確實感覺良好關於我們正在進行的投資。

And again, feel really good about where our bids have come out. Broader, let me take a little bit step further back because I think your question around 25% is broader than just Medicare Advantage and Stars. As I think about '25 again, not giving guidance on '25, but we do expect to accelerate growth in 2025 and we've talked quite a bit in recent calls about our flywheel for growth, which is in our improvement in both the health benefits business and our Carelon segment. We anticipate that our health benefits business is going to continue to grow in '25 after a reset year in '24.

再說一次，我們對我們的出價結果感到非常滿意。更廣泛地說，讓我退後一步，因為我認為您關於 25% 的問題比 Medicare Advantage 和 Stars 更廣泛。當我再次考慮「25」時，不會對「25」給予指導，但我們確實預計到2025 年將加速成長，並且我們在最近的電話會議中多次談到了我們的成長飛輪，這體現在我們在健康和健康方面的改善惠及業務和我們的 Carelon 部門。我們預計，在 24 年重置後，我們的健康福利業務將在 25 年繼續成長。

And then we should see an accelerated impact to that growth, which will drive revenue for Carelon. And then Carelon also has been independently scaling its multiple new capabilities, and we'll share, I assume even more of those on the call today. And then finally, as you know, we took some actions at the end of last year around our disciplined operating cost efficiencies, and we expect to see even greater benefits from those as we digitize and use AI in our investments.

然後我們應該會看到這種成長的加速影響，這將推動 Carelon 的收入。然後 Carelon 也一直在獨立擴展其多項新功能，我們將分享，我想今天的電話會議上會分享更多的功能。最後，如您所知，我們在去年底圍繞嚴格的營運成本效率採取了一些行動，隨著我們在投資中進行數位化和使用人工智慧，我們預計會從中看到更大的收益。

So honestly, I think we feel that we've positioned our business very prudently and that the balance and resilience of our enterprise and our earnings power of our health benefits in Carelon together gives us a lot of confidence in our ability to achieve our long-term targets. So just a little bit more color on where we are. Next question please.

老實說，我認為我們認為我們對業務的定位非常謹慎，我們企業的平衡性和彈性以及我們在 Carelon 的健康福利的盈利能力一起讓我們對實現長期目標的能力充滿信心。術語目標。因此，只需對我們所處的位置多一點顏色即可。請下一個問題。

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

接下來，我們將邀請美國銀行的 Kevin Fischbeck。

Great. I guess I wanted to ask about the MLR guidance for 2024. It sounds like you guys are expecting margin improvement in MA, your repositioning commercial and Medicaid is dropping pretty meaningfully. But why is MLR only flat? I would think that we'd be seeing MLR improvement? Is there some offset in there?

偉大的。我想我想問一下 MLR 2024 年的指導。聽起來你們預計 MA 的利潤率會提高，你們的重新定位廣告和醫療補助正在大幅下降。但為什麼MLR只是平坦的呢？我認為我們會看到 MLR 的改進？裡面有偏移嗎？

Maybe let me start with the 2023, just to set the context here. So our 2023 benefit expense ratio end of the year is slightly better than our initial expectations at that 87%. And just to remind you, that represented the 60 basis point improvement year-over-year as well as falling in the lower half of our initial 2023 guidance range.

也許讓我從 2023 年開始，只是為了設定背景。因此，我們 2023 年底的福利費用率略優於我們最初預期的 87%。只是提醒您，這代表同比改善 60 ​​個基點，但下降到我們最初 2023 年指導範圍的下半部分。

As it relates to 2024, we are guiding to a flat benefit expense ratio of 87%, plus/minus 50 basis points. And our outlook here reflects a consistent approach to reserves and a prudent thought process around utilization, given the dynamic operating environment, especially for our government businesses. If I take a deeper look at the underlying businesses themselves, the health benefit expense ratio reflects that intentional management action we're taking in commercial. It will continue on through into 2024 around the disciplined underwriting practices, I mean, part of our margin recovery efforts. And then certainly, on the Medicare advantage side, continued appropriate expectations around utilization and Medicare -- medical cost trends.

就 2024 年而言，我們指導福利費用率固定為 87%，加/減 50 個基點。考慮到動態的營運環境，尤其是我們的政府業務，我們的展望反映了對儲備的一貫態度和圍繞利用的審慎思維過程。如果我更深入研究基礎業務本身，健康福利費用比率反映了我們在商業領域採取的有意管理行動。它將圍繞嚴格的承保實踐持續到 2024 年，我的意思是，這是我們利潤恢復努力的一部分。當然，在醫療保險優勢方面，繼續對利用率和醫療保險——醫療成本趨勢進行適當的預期。

Thank you, Mark, and thanks, Kevin, for the question. Next, question please.

謝謝馬克，也謝謝凱文提出的問題。接下來請提問。

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

接下來，我們將討論 Nephron Research 的 Josh Raskin 的系列。

I was wondering, if you could speak a little bit more specifically around the growth in Medicare Advantage to start this year. It sounds like a little bit lower than expectations. And I'm curious specifically in the commentary you made around pockets of competition, maybe where you're seeing that, what you think is driving that? And then any specific comments on retention relative to expectations for this year.

我想知道您是否可以更具體地談談今年開始的 Medicare Advantage 的成長。聽起來比預期低一些。我特別好奇你對一些競爭的評論，也許你在哪裡看到了這一點，你認為是什麼推動了這一點？然後是關於與今年預期相關的保留率的具體評論。

And just maybe a couple of overarching comments because I think it's important that I'm going ask solution Norwood, who leads our government business to comment more specifically. And I think it's important to frame that we made some very specific discipline decisions and feel really good about our bids entering into this.

也許只是一些總體性的評論，因為我認為重要的是我要向解決方案諾伍德提出更具體的評論，他領導我們的政府業務。我認為重要的是我們做出了一些非常具體的紀律決定，並對我們的投標進入此感到非常滿意。

And Felicia, we actually exited some markets very specifically that were underperforming. So I think you have to take that into account. But she'll just provide a lot more detail on kind of where we landed this year and the perspective on the market. So Felicia, please?

費利西亞，我們實際上非常明確地退出了一些表現不佳的市場。所以我認為你必須考慮到這一點。但她只會提供更多關於我們今年的進展以及對市場的看法的細節。那麼費利西亞，好嗎？

As we headed into 2024, we made some very disciplined decisions that we were going to enhance the financial performance for our Medicaid Advantage business. In the Mainland, we exited as Gail noted specifically certain markets that have been underperforming for 3 years. And with the impending risk model revisions, we really saw no path to long-term attractive sustainable economics in those markets. And that really represented a decline of about 84,000 members.

在邁入 2024 年之際，我們做出了一些非常嚴格的決定，就是我們將提高醫療補助優勢業務的財務表現。在內地，我們退出了，因為蓋爾特別指出了某些市場已經連續三年表現不佳。隨著風險模型即將修訂，我們確實看不到在這些市場上實現長期有吸引力的永續經濟的途徑。這實際上意味著大約 84,000 名會員的減少。

I also want to note that we've reduced supplemental benefits in Puerto Rico both to turn around their performance after a very challenging 2023 and to position us for the 3-year phase-in of the risk model revisions, which will have a material adverse impact on Medicare Advantage on the island, in part due to the higher mix of duals that we have in Puerto Rico. So we've reset our supplemental benefits there and in the midst of a very highly competitive bid environment, we will see membership declines in somewhere in the neighborhood of about 90,000 in 2024 in Puerto Rico.

我還想指出的是，我們減少了波多黎各的補充福利，既是為了在充滿挑戰的2023 年之後扭轉其業績，也是為了讓我們能夠在3 年的時間內逐步實施風險模型修訂，這將對我們產生重大不利影響。對島上醫療保險優勢的影響，部分原因是波多黎各的雙元組合較多。因此，我們重新設定了那裡的補充福利，在競爭非常激烈的申辦環境中，我們將看到 2024 年波多黎各的會員人數將減少約 9 萬人。

Now while the decline is larger than we expected, it certainly has bolstered our confidence in the anticipated improvement in our benefit expense ratio in Puerto Rico. At the end of the day, what we wanted to do was to establish a very strong foundation from which we can grow in Puerto Rico long term, sustainably and profitably.

現在，雖然下降幅度超出了我們的預期，但這無疑增強了我們對波多黎各福利費用率預期改善的信心。歸根結底，我們想要做的是建立一個非常堅實的基礎，以便我們能夠在波多黎各長期、可持續和盈利地發展。

Back to the mainland. Selling activity for AEP was actually very strong for us as we expected. When we exclude the planned attrition on the island that we mentioned in -- on the mainland that I mentioned earlier, our net Mainland Medicare Advantage membership would be on track to grow by high single digits this year, despite encountering greater disenrollment in certain markets due to very aggressive offerings by select competitors.

回到大陸。正如我們預期的那樣，AEP 的銷售活動實際上非常強勁。當我們排除我之前提到的大陸地區的計劃減員後，我們的大陸醫療保險優惠會員淨額今年將有望實現高個位數增長，儘管在某些市場中由於退出人數較多，某些競爭對手提供的非常激進的產品。

At the end of the day, I think that we've made very thoughtful decisions around how we're going to position our business for long-term sustainable growth going forward. And we've done the things that we've always committed to do. We expect to do very well in our blue markets. We are performing better in our Blue markets than the overall growth rates, and we're very much focused on a combination of balancing that perspective between margin and membership growth. So we feel good about how we're positioning our business going forward.

歸根結底，我認為我們已經就如何定位我們的業務以實現未來的長期可持續成長做出了非常深思熟慮的決定。我們已經做了我們一直致力於做的事情。我們期望在我們的藍色市場中表現出色。我們在藍色市場的表現比整體成長率好，而且我們非常注重在利潤率和會員成長之間實現平衡。因此，我們對未來業務的定位感到滿意。

And as we said earlier, in light of all of these dynamics, we'd expect to have flat membership in 2024.

正如我們之前所說，鑑於所有這些動態，我們預計 2024 年會員數將持平。

Next, we'll go to the line of Sarah James from Cancer Fitzgerald.

接下來，我們將回顧《巨蟹座菲茨傑拉德》中的莎拉詹姆斯。

Do you guys have some really nice margin expansion guided to for Carelon in 2024. I was wondering if you could unpack it a little bit for us as we think through the major buckets that are causing the expansion and then also the pacing, if it's ratable as we think about the margin expansion through 2024 and then I guess, further out as we get to 2027?

你們是否有一些關於 2024 年 Carelon 利潤率擴張的非常好的指導。我想知道你們是否可以為我們解開一些內容，因為我們會考慮導致擴張的主要因素以及節奏（如果可評級）當我們考慮到2024 年利潤率擴張時，我想，當我們到達2027 年時，還會進一步擴大嗎？

I'm going to ask Pete Haytaian, who leads Carelon to comment on that. And as you know, we're excited about the real flywheel opportunity that we're seeing in Carelon. So Pete?

我將請 Carelon 的領導者 Pete Haytaian 對此發表評論。如您所知，我們對在卡雷隆看到的真正的飛輪機會感到興奮。那麼皮特？

Yes. Let me talk about Carelon Services growth. And we are very excited about the opportunity and the progress that we're making with respect to services growth. I think you saw that play through in 2023. We committed to double-digit increase on revenue, which we achieved. And as it relates to our 2024 guide, you saw that we're talking about high-teens, low-20s growth. And it's really playing through our strategy that we talked about focusing in on complexities in health care, high-cost spend areas. And really driving capitated risk in key areas to support our health plans.

是的。讓我談談 Carelon Services 的成長。我們對服務成長的機會和所取得的進展感到非常興奮。我想您在 2023 年就看到了這一點。我們致力於實現兩位數的收入成長，我們也做到了。由於它與我們的 2024 年指南相關，您看到我們正在談論高 10 歲、低 20 歲的增長。我們談到的重點是醫療保健和高成本支出領域的複雜性，這確實是發揮我們的策略性作用。並真正推動關鍵領域的人均風險，以支持我們的健康計劃。

In '23, we did that with our post-acute care initiative, DME, Wound Care. And as we move forward into 2024, I mean Gail mentioned this in the prepared remarks, we have new offerings that are whole health full risk opportunities. Like oncology, assuming full risk in oncology as well as in Medicaid with behavioral health with the seriously mentally ill population.

23 年，我們透過急性後護理計劃 DME（傷口護理）做到了這一點。當我們邁入 2024 年時，我的意思是蓋爾在準備好的發言中提到了這一點，我們提供了新的產品，這些產品是完全健康的全風險機會。與腫瘤學一樣，承擔腫瘤學以及醫療補助中的全部風險，以及嚴重精神疾病族群的行為健康。

So these are significant initiatives that are really propelling the trajectory of our business. I would also say that -- as it relates to external growth, we're also seeing really nice improvements from that perspective and really nice momentum. Our pipeline in '23 for '24 growth was much more significant. In terms of our sales this time versus last year, we've seen a real nice trajectory in our growth. And we've had a couple of really nice notable wins with the Blues.

因此，這些都是真正推動我們業務發展軌跡的重大舉措。我還想說，因為它與外部成長有關，從這個角度來看，我們也看到了非常好的改進和非常好的動力。我們在 23 年為 24 年的成長所做的準備要重要得多。就我們這次的銷售情況而言，與去年相比，我們看到了真正良好的成長軌跡。我們與藍軍取得了幾場非常精彩的勝利。

I would say that as it relates to that and the opportunity with the Blues, they are doing exactly what we just talked about in the past and looking closely at some of these full risk comprehensive offerings that we're delivering in Elevance Health. And then very interested in that in terms of the opportunities to create predictable stable cost of care for them. So very pleased with where we are in the trajectory of growth in Carelon.

我想說，因為這與 Blues 的機會有關，他們正在做我們剛才談到的事情，並仔細研究我們在 Elevance Health 中提供的一些全面風險綜合產品。然後對為他們創造可預測的穩定護理成本的機會非常感興趣。我們對卡倫的發展軌跡感到非常滿意。

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

接下來，我們將前往富國銀行的史蒂芬‧巴克斯特（Stephen Baxter）。

I just want to come back to the Medicaid redetermination process. So entering 2023, we're expecting some normalization of the Medicaid outperformance that you saw in years prior. Can you give us an update on where that landed in 2023 compared to your initial thinking? And then just a little bit more color on what your guidance assumes for Medicaid in 2024. Does that put you back at historical norms for margins? Or should we think -- should we be thinking about something else there?

我只想回到醫療補助重新確定過程。因此，進入 2023 年，我們預計您幾年前看到的醫療補助表現將趨於正常化。與您最初的想法相比，您能否向我們介紹 2023 年的最新情況？然後對您對 2024 年醫療補助的指導假設進行更多說明。這會讓您的利潤率回到歷史標準嗎？或者我們應該思考──我們應該考慮其他事情嗎？

Stephen, thanks very much for the question. On Medicaid membership, our outlook reflects the footprint adjustments we spoke about on our third quarter earnings call and the continued attrition due to redetermination. We believe Medicaid redeterminations are approximately 2/3 complete across our Medicaid markets. And in general, we've seen more front-loaded disenrollment, notably in a few large states that have elected to adopt accelerated processes. And then based on the trends that we've observed relative -- or related to these market-wide coverage shifts, we have adjusted our Medicaid retention assumption to be approximately 30% of our PHE related growth.

史蒂芬，非常感謝你的提問。關於醫療補助會員資格，我們的前景反映了我們在第三季財報電話會議上談到的足跡調整以及由於重新確定而導致的持續流失。我們相信醫療補助重新確定在我們的醫療補助市場中已完成約 2/3。總的來說，我們看到了更多提前退出的情況，特別是在一些選擇採取加速流程的大州。然後，根據我們觀察到的相對或與這些市場範圍的覆蓋範圍變化相關的趨勢，我們將醫療補助保留假設調整為約佔 PHE 相關增長的 30%。

We're not planning to provide point to estimates for coverage transitions generally. We do, however, believe that ACA will pick up more than initially expected. While employer group coverage will gain a little bit less than initially expected. But most importantly, these updated projections are factored into our membership guidance that we provided this morning.

我們一般不打算提供覆蓋範圍轉變的估計值。然而，我們確實相信 ACA 的成長將超過最初的預期。雖然雇主群體的覆蓋範圍將略低於最初預期。但最重要的是，這些更新的預測已納入我們今天早上提供的會員指南中。

Next, we'll go to the line of Lance Wilkes from Bernstein.

接下來，我們將轉到伯恩斯坦的蘭斯威爾克斯（Lance Wilkes）系列。

Could you talk a little bit about your value-based care strategies. And what I would be interested in is from a contracting standpoint, how are you approaching that for '24 and like MA? Are you doing any sort of renegotiation to kind of hold those value-based care providers -- more stable in that year given the risk adjustment changes? And then how is the priority for owning those sorts of assets in Carelon change? And what's your current outlook there?

您能談談您的基於價值的照護策略嗎？我感興趣的是從合約的角度來看，你們是如何處理 '24 以及像 MA 那樣的問題的？鑑於風險調整的變化，您是否正在進行任何形式的重新談判，以保持那些基於價值的護理提供者在當年更加穩定？那麼卡雷隆擁有此類資產的優先順序有何變化呢？您目前的前景如何？

Well, thanks for the question, Lance. There's quite a bit there. But I think let me start with our value-based strategy, we've talked about on this call a number of times, and I think I would say it's remained really consistent, but we're making a lot of very good progress on that. Overall, more than 60% are in value-based care. And in Medicare, it's even more. Specific to your question on renegotiation, we have multiple-year arrangements with our value-based providers, and we're always looking at a couple of things. One, quite frankly, to make sure that it's a win-win and we're aligned, both on cost, quality outcomes and Stars.

嗯，謝謝你的提問，蘭斯。那裡有相當多的東西。但我想讓我從我們基於價值的策略開始，我們已經多次在這次電話會議上討論過，我想我會說它仍然非常一致，但我們在這方面取得了很多非常好的進展。總體而言，超過 60% 的人接受基於價值的護理。在醫療保險方面，情況甚至更多。針對您關於重新談判的問題，我們與基於價值的提供者達成了多年的安排，並且我們一直在關註一些事情。一，坦白說，是為了確保這是雙贏的，並且我們在成本、品質結果和星級方面保持一致。

So we spend a lot of time focusing on some of the ways that we can get data back and forth more simply. We use our -- we've integrated the way we share data back and forth, and that's really around closing gaps in care and quite frankly, simplifying the process under which we work with those providers. Our goal is to make that ubiquitous across all of our value-based providers. And so we made a lot of progress there and dramatically improve sort of the time to action with those providers. And I think that's important because, honestly, that gives them data to act and that improves their outcomes. We have seen our value-based providers perform better in the circumstance, and we think that, that's going to remain important.

因此，我們花了很多時間專注於一些可以更簡單地來回獲取數據的方法。我們使用我們的——我們已經整合了我們來回共享數據的方式，這實際上是為了縮小護理方面的差距，坦率地說，簡化我們與這些提供者合作的流程。我們的目標是讓這一點在我們所有基於價值的提供者中無處不在。因此，我們在這方面取得了很大進展，並大大縮短了與這些提供者合作的時間。我認為這很重要，因為說實話，這為他們提供了採取行動的數據，並改善了他們的結果。我們已經看到基於價值的提供者在這種情況下表現得更好，我們認為這仍然很重要。

In terms of our strategy around ownership. We've talked about that. We -- as you know, we do have assets inside of Carelon. I guess where I would focus you more is around the specialty high-cost complex areas of specialty because that's where we think that there's a huge differentiated focus between our technology, our clinical domain expertise and our ability to drive trend.

就我們圍繞所有權的戰略而言。我們已經討論過了。如您所知，我們確實在 Carelon 內部擁有資產。我想我會更關注專業高成本複雜的專業領域，因為我們認為我們的技術、臨床領域專業知識和推動趨勢的能力之間存在著巨大差異化的重點。

Again, we don't need to own the providers, but we do need to have a significant role in the enablement of those care providers, and we have spent time doing that. We launched a number of new products this year with oncology, serious mental illness and we're getting into other areas like musculoskeletal, renal and more. And I think -- that's where you see the significant spend areas accelerating and Carelon with its assets has a great opportunity.

同樣，我們不需要擁有這些提供者，但我們確實需要在支持這些護理提供者方面發揮重要作用，並且我們已經花了時間這樣做。今年我們推出了許多涉及腫瘤、嚴重精神疾病的新產品，我們正在進入肌肉骨骼、腎臟等其他領域。我認為，這就是您看到重要支出領域加速成長的地方，而 Carelon 及其資產擁有巨大的機會。

So we expect Carelon's care provider enablement platforms continue to contribute pretty significantly Carelon's revenue meaningfully over the longer term, and we're building those assets. And again, I'll keep going back to my flywheel, where we think that will improve the performance of our health benefit plans. There's a lot of interest in externally in these. And Pete mentioned, we saw some nice traction in a few of these offerings this year. So overall, I'd say very consistent focus around our value-based care enablement, and we feel like we're getting a lot of traction. And I would focus you a lot on the specialized care Specialty Care, particularly on the Carelon growth opportunity.

因此，我們預計 Carelon 的護理提供者支援平台將在長期內繼續為 Carelon 的收入做出顯著貢獻，並且我們正在建立這些資產。再次，我將繼續回到我的飛輪，我們認為這將提高我們健康福利計劃的績效。外部對這些有很多興趣。皮特提到，今年我們在其中一些產品中看到了一些不錯的吸引力。總的來說，我想說，我們非常一致地關注基於價值的護理支持，我們覺得我們得到了極大的關注。我會專注於特殊護理專業護理，特別是 Carelon 的成長機會。

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

接下來，我們將邀請高盛 (Goldman Sachs) 的內森·里奇 (Nathan Rich)。

Two on the Medicare business. First, you talked about Medicare cost trend developing as expected in the fourth quarter. I guess I'd be curious if there are any areas that came in higher or lower than expected and what the benefit expense guidance for 2024 assumes for Medicare cost trend? And then I guess, higher level, as you reposition the Medicare business, and I understand there's several moving pieces over the next couple of years.

其中兩個涉及醫療保險業務。首先，您談到了第四季度醫療保險成本趨勢的發展符合預期。我想我很好奇是否有任何領域的收入高於或低於預期，以及 2024 年福利支出指南對醫療保險成本趨勢的假設是什麼？然後我想，更高的層面，當你重新定位醫療保險業務時，我知道在接下來的幾年裡會有一些變化。

What's the company's current view, I guess, first of the Medicare Advantage market longer term? But then second, the membership growth and margin potential for Elevance, specifically within that market context.

我想，公司目前對醫療保險優勢市場的長期看法是什麼？其次，Elevance 的會員成長和利潤潛力，特別是在該市場背景下。

I'm going to ask Mark to address your first question, and then I'll come back and share our long-term views on Medicare.

我將請馬克回答你的第一個問題，然後我會回來分享我們對醫療保險的長期看法。

Nathan, overall utilization in the fourth quarter developed largely in line with our expectations. And that's evidenced by our reported benefit expense ratio, which came in favorable, as you know, to consensus and really to the midpoint of our initial full year 2023 guidance range. We did see pockets of high utilization, specifically in Medicare related to orthopedics such as knee and hip replacements and other outpatient procedures. But this is broadly planned for as part of our underlying cost trained assumptions.

Nathan，第四季的整體利用率發展基本上符合我們的預期。我們報告的福利費用比率證明了這一點，如您所知，該比率符合共識，實際上達到了我們最初的 2023 年全年指導範圍的中點。我們確實看到了高利用率的領域，特別是與骨科相關的醫療保險，例如膝關節和髖關節置換術以及其他門診手術。但這是我們基本成本訓練假設的一部分的廣泛計劃。

Similarly, we saw a seasonal uptick in respiratory elements, including the flu and COVID as well as increased RC vaccinations. But again, utilizations were aligned with what we planned. We'll continue to monitor our claims trends closely, including prior authorization data. We remain confident that our Medicare Advantage bids for 2024 and our pricing commercial do reflect appropriate projections for utilization and medical cost trends.

同樣，我們看到呼吸道疾病的季節性上升，包括流感和新冠肺炎，以及 RC 疫苗接種的增加。但同樣，利用率與我們的計劃一致。我們將繼續密切監控我們的索賠趨勢，包括事先授權數據。我們仍然相信，我們的 2024 年 Medicare Advantage 投標和我們的定價廣告確實反映了對利用率和醫療成本趨勢的適當預測。

Nathan, in terms of your broader question, let me just provide a little bit of perspective. as I think about the market, we still think Medicare Advantage is a very good long-term market. And as I said, we're committed to driving sustainable performance for the long term. Medicare Advantage delivers really strong differentiated value for seniors. I think you have to start there. And as you look at the aligned incentives across the system to deliver better outcomes and better care -- it is very -- it's a very strong marketplace, and it continues to grow.

內森，就你更廣泛的問題而言，讓我提供一點觀點。當我考慮市場時，我們仍然認為 Medicare Advantage 是一個非常好的長期市場。正如我所說，我們致力於推動長期永續績效。 Medicare Advantage 為老年人提供了真正強大的差異化價值。我認為你必須從那裡開始。當你看到整個系統中一致的激勵措施，以提供更好的結果和更好的護理時，這是一個非常強大的市場，並且還在繼續增長。

And importantly, it's incredibly popular with seniors with greater than 50% of seniors selecting Medicare Advantage today. So that's against that backdrop, we know seniors value stability in their benefits year-over-year and the items that are most important to them. And so we have, as you heard from us earlier, look to make sure that we are in this market for the long term balancing that stability. So with what we know is happening in this market, we can make the right benefit decisions and again, feel that we positioned ourselves and are making the right strategic investments to improve our performance.

重要的是，它在老年人中非常受歡迎，目前有超過 50% 的老年人選擇 Medicare Advantage。因此，在這種背景下，我們知道老年人重視福利的穩定性以及對他們來說最重要的項目。因此，正如您之前從我們那裡聽到的那樣，我們希望確保我們在這個市場上的長期平衡是穩定的。因此，根據我們所知道的這個市場正在發生的情況，我們可以做出正確的利益決策，並再次感覺到我們已經定位自己並正在做出正確的策略投資來提高我們的績效。

We see this business maturing, as Mark shared in his comments as well. And again, been very intentional about our desire or decision to exit certain programs or markets and plans where we didn't think we had a long-term sustainable path to performance. And that combined with the risk models, made that choice and then again, reposition Puerto Rico, which we believe is still a very good market, but there were some actions that we knew we had to take.

正如馬克在評論中所分享的那樣，我們看到這項業務正在日趨成熟。再說一遍，我們非常有意地希望或決定退出某些我們認為沒有長期可持續績效道路的專案或市場和計劃。結合風險模型，做出了選擇，然後再次重新定位波多黎各，我們認為這仍然是一個非常好的市場，但我們知道必須採取一些行動。

So as we look at those decisions for the long term, as Felicia shared, our business performed when you look at the mainland and take out those exits. We had very strong selling season. Again, I think that's a testament to the value of the benefits and our position. And importantly, we do believe we can grow this business profitably even in a year with hypercompetitive markets in certain cases, where we outperformed the growth in our blue markets, which, again, has always been a strategy we've had is to go deeper in our blue markets and to gain more share with the value of our brand as well as in other places.

因此，當我們從長遠角度看待這些決定時，正如費利西亞分享的那樣，當你著眼於大陸並取消這些退出時，我們的業務表現出色。我們的銷售旺季非常強勁。我再次認為，這證明了我們的優勢和地位的價值。重要的是，我們確實相信，即使在某些情況下，即使在市場競爭異常激烈的一年中，我們也可以實現這項業務的盈利增長，在這些情況下，我們的表現優於藍色市場的成長，而這又是我們一直採取的策略，即深入發展在我們的藍色市場中，並透過我們的品牌價值以及其他地方獲得更多份額。

So again, we think it's a good market. We know we have some work to do in that market, but we feel we're positioning for the long term and think that we can add distinctive value for seniors as part of our focus on whole health and continuation of coverage to stay Blue for life and all of their coverage.

所以，我們再次認為這是一個很好的市場。我們知道我們在這個市場上還有一些工作要做，但我們認為我們的定位是長期的，並認為我們可以為老年人增加獨特的價值，作為我們關注整體健康和持續承保以保持終身藍色的一部分以及他們所有的報道。

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

接下來，我們將轉到摩根大通的麗莎吉爾 (Lisa Gill) 的線路。

I want to focus on margin drivers. Can you maybe just spend a little time talking about the progression in 2024, getting to those targets that you have in '25 and then secondly, when I think about the margins in CarelonRx, you talked about them improving by 40 to 60 basis points. Can you talk about what the drivers are there as well? Is that Paragon Health and BioPlus, which I would assume carry better margins? Or is there something else that's really driving that improvement as we move into '24?

我想關注利潤驅動因素。您能否花一點時間談論 2024 年的進展，實現 25 年的目標，其次，當我想到 CarelonRx 的利潤率時，您談到它們提高了 40 到 60 個基點。您能談談那裡的驅動程式是什麼嗎？我認為 Paragon Health 和 BioPlus 的利潤率會更高嗎？或者，當我們進入 24 世紀時，是否有其他因素真正推動了這種改進？

I'll talk about health benefits, and I'll pass it over to Pete in a couple of minutes to talk about Carelon. On the health benefits side, we are seeing operating margins expands or expect to expand by 25 to 50 basis points in 2024. And I think about this as really being driven by 3 primary categories.

我將談論健康益處，幾分鐘後我將把它交給皮特來談論卡雷隆。在健康福利方面，我們看到營業利潤率擴大或預計在 2024 年擴大 25 至 50 個基點。我認為這實際上是由 3 個主要類別驅動的。

First is the continued underwriting discipline and the pricing actions that we're taking in commercial, 2023 really marks the end of the first full year of our efforts to recover margins from the pandemic Aero lows and we expect those supporting initiatives really to continue through 2024 and then possibly into 2025.

首先是持續的承保紀律和我們在商業領域採取的定價行動，2023 年確實標誌著我們從大流行航空低點中恢復利潤率的努力的第一個全年的結束，我們預計這些支持舉措將真正持續到2024 年然後可能到 2025 年。

Second one, I'd call your attention to here really relates to the Medicare margin expansion. And here, as you've heard us talk about, this is about building that strong foundation for sustainable long-term growth in 2024 and striking that balance between growth and margin. And in 2024, we leaned a little bit more towards the margin and the growth and you see that come through in some of our outlook projections this morning.

第二個問題，我想提請您注意，這裡確實與醫療保險利潤率擴張有關。正如您所聽到的，我們的目標是為 2024 年可持續長期成長奠定堅實的基礎，並在成長和利潤之間實現平衡。到 2024 年，我們更傾向於利潤率和成長，您會在今天早上的一些展望預測中看到這一點。

And then the third one, I'd call your attention to is really the operating expense leverage -- you see that we are gaining additional incremental leverage in 2024 with our guide down to 11.1% for the operating expense ratio.

然後，我想提請您注意的第三個因素實際上是營運費用槓桿——您會看到，我們將在 2024 年獲得額外的增量槓桿，我們的營運費用比率指南降至 11.1%。

And Lisa, your question was on the trajectory of the margins in pharmacy. So you'll recall that this year, in 2023, we made pretty significant investments as it relates to the acceleration of BioPlus and advanced home delivery, and that puts some pressure on our margins in 2023. That will not repeat itself in 2024. We did go live with BioPlus on January 1 as well as with respect to advanced 1 delivery. We're really excited about that, and it's moving in the right direction.

麗莎，你的問題是關於藥局利潤的軌跡。所以你會記得，今年，也就是2023 年，我們進行了相當大的投資，因為這與BioPlus 和先進的送貨上門服務的加速有關，這給我們2023 年的利潤率帶來了一些壓力。這種情況在2024 年不會重演。我們確實於 1 月 1 日與 BioPlus 一起上線，以及高級 1 交付。我們對此感到非常興奮，而且它正在朝著正確的方向發展。

And over time, we've built those products for scale. And as that business builds and progresses, we will continue to see margin improvement. So that is what is delivering an improvement in margin in '24.

隨著時間的推移，我們已經規模化地建立了這些產品。隨著業務的建立和發展，我們將繼續看到利潤率的提高。這就是 24 年利潤率改善的原因。

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

接下來，我們將轉到史蒂芬斯的斯科特·菲德爾的路線。

I was hoping you could -- just on the commercial risk enrollment guidance, if you can break that down for us between group and individual? And then on the individual piece, I'm curious in terms of what you're thinking in terms of how much of that growth comes from the catchers med -- for Medicaid and then how you're thinking about the acuity of those lives that are coming into the exchanges from Medicaid?

我希望您能—就商業風險註冊指南而言，您能否為我們在團體和個人之間進行細分？然後就我個人而言，我很好奇您對增長有多少來自於醫療補助的捕手的想法，然後您如何考慮那些生活的敏銳度正在從醫療補助進入交流？

We know that in Medicaid, that acuity is generally rising as the redeterminations continue. So I'm curious, though, in terms of those lives that are transitioning into the exchanges, how are you thinking about those as being sort of higher or lower or in line acuity with the legacy population in the exchange market?

我們知道，在醫療補助中，隨著重新確定的持續，這種敏銳度普遍上升。所以我很好奇，對於那些正在過渡到交易所的人來說，您如何看待這些人與交易所市場中的遺留人口的敏銳度較高或較低？

Well, thanks for the question, Scott. I think we've got about 4 or 5 in there. So we'll try to hit the high points of your question. Let me ask Morgan and then Mark to comment on your question. Morgan?

嗯，謝謝你的提問，斯科特。我想我們那裡大約有四、五個人。因此，我們將盡力抓住您問題的要點。讓我請摩根和馬克對你的問題發表評論。摩根？

Yes, Scott, thanks for the question. As we think about the ACA business, we've talked about it for a while now. We're quite bullish on that segment. And as we've remarked in other quarterly reports, we operate in all rating areas in our 14 geographies, where we can. And certainly, we've seen an expansion in the actual market share and the market growth actually in these geographies.

是的，斯科特，謝謝你的提問。當我們思考 ACA 業務時，我們已經討論了一段時間了。我們非常看好這一領域。正如我們在其他季度報告中指出的那樣，我們在 14 個地區的所有評級區域中盡可能開展業務。當然，我們已經看到這些地區的實際市場份額和市場實際成長。

In fact, it's certainly a big driver is Medicaid redetermination. As we've indicated earlier on the call today, we've concluded about 2/3 of those. We expect that to continue in 2024. And also, as we've noted in the past, we've seen an elongated period of time from when someone is redetermined and when they actually join Medicare or come on an ACA product moving along. That said, quite pleased that our growth this year is outpacing our market growth. So clearly, we're picking up our fair share and more, quite honestly, of the Medicaid redetermined members.

事實上，醫療補助的重新確定無疑是一個重要的推動因素。正如我們在今天早些時候的電話會議中所指出的，我們已經完成了其中大約 2/3 的工作。我們預計這種情況將在 2024 年持續下去。而且，正如我們過去指出的那樣，從某人被重新確定到他們真正加入 Medicare 或繼續使用 ACA 產品，我們已經看到了很長一段時間。也就是說，我們今年的成長速度超過了市場成長速度，對此我感到非常高興。很明顯，我們正在獲得公平的份額，老實說，我們正在獲得醫療補助重新確定的成員的份額。

So at the end of the day, this will continue. We've had a very steadfast and steady approach around the right economics and the right network strategies. -- to draw in these members. It's very important for the business to continue. And I'm going to turn that over to Mark to speak a little bit about the margins and the separation of the various pieces that you asked the questions on...

所以最終，這種情況將會持續下去。我們圍繞著正確的經濟和正確的網路策略採取了非常堅定和穩定的方法。 ——吸引這些成員。這對於業務的持續發展非常重要。我將把這個問題交給馬克，讓他談談您提出問題的各個部分的邊距和分離…

Yes. If I think about Medicaid rates and acuity, the conversations with the states are ongoing. We'll continue to work with them and their consultants really to ensure that all adjustments are reasonable and reflect the risk associated with ongoing redeterminations in 2024.

是的。如果我考慮醫療補助費率和敏銳度，與各州的對話正在進行中。我們將繼續與他們及其顧問合作，真正確保所有調整都是合理的，並反映與 2024 年正在進行的重新確定相關的風險。

Our outlook for 2024 does assume a normalization of Medicaid margins -- we already have line of sight into about 70% of Medicaid premiums for 2024. And we are comfortable with the actuarial soundness of the underlying rates, especially understanding the acuity for leaders versus [stayers].

我們對 2024 年的展望確實假設醫療補助利潤率正常化——我們已經看到了 2024 年約 70% 的醫療補助保費。我們對基本費率的精算穩健性感到滿意，特別是了解領導者與[住宿者]。

Yes. And thanks, Scott. And I think you also asked about the acuity in the individual exchange marketplace. So I wanted to just put a fine point on that. Our risk profile of the members we're picking up certainly in '23, obviously, early in '24 very much aligns with the expectation of what we've historically had. So we feel it's actually rolling out to our expectations.

是的。謝謝，斯科特。我認為您也詢問了個人交易市場的敏銳度。所以我想強調一點。顯然，我們在 23 年、24 年初招募的成員的風險狀況與我們歷史上的預期非常一致。所以我們覺得它實際上正在達到我們的期望。

Next, we'll go to the line of Ben Hendrix from RBC Capital Markets.

接下來，我們將聽聽加拿大皇家銀行資本市場公司 (RBC Capital Markets) 的 Ben Hendrix 的演講。

I just wanted to follow-up on the Carelon margin question. On Carelon Services, slightly down margins in the guidance. Just wanted to see if that -- the degree to which that is associated with new risk-based arrangements or membership or to the perhaps to the new behavioral benefits and kind of what are the prospects for that kind of ramping up beyond 2024?

我只是想跟進卡雷隆保證金問題。 Carelon Services 的指導利潤率略有下降。只是想看看這是否與新的基於風險的安排或會員資格相關，或者與新的行為效益相關的程度，以及 2024 年之後這種增長的前景如何？

No. First of all, we're very pleased with the operating performance of Carelon. You saw that play through in 2023. I think we committed to 25 to 50 basis points of improvement. You saw 70 basis points of improvement year-over-year. So that it's performing really well.

不會。首先，我們對 Carelon 的經營業績感到非常滿意。您在 2023 年看到了這一情況。我認為我們致力於改進 25 到 50 個基點。您看到年比改善了 70 個基點。所以它的表現非常好。

You answered the question already as it relates to 2024, quite frankly, we are, as Gail talked about, and as I talked about earlier, launching some very significant at-risk product offerings, both oncology, seriously incrementally ill population as well as others, and that comes with a lower margin in the earlier years, but that improves over time. So that is precisely what was creating the pressure on the margin in '24.

您已經回答了與 2024 年相關的問題，坦白說，正如蓋爾所說，正如我之前所說，我們正在推出一些非常重要的高風險產品，包括腫瘤學、嚴重漸進性疾病人群以及其他產品，前幾年的利潤率較低，但隨著時間的推移，情況會有所改善。這正是 24 年利潤率面臨壓力的原因。

Yes. And just to sort of put a finer point on it, we do remain confident in our long-term guidance that we gave in mid- to upper single-digit operating margin. So as Pete said, we think the business we're bringing on is really good. We're committed to bringing in more risk business. But in the early years, that does have a little bit lower profile. But overall, we feel very good about the long term.

是的。為了更準確地說明這一點，我們確實對我們給出的中上個位數營業利潤率的長期指導充滿信心。正如皮特所說，我們認為我們帶來的業務非常好。我們致力於引進更多風險業務。但在早年，這確實有點低調。但總體而言，從長遠來看，我們感覺非常好。

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

接下來，我們將前往沃爾夫研究中心的賈斯汀·萊克（Justin Lake）系列。

Most of my questions have been answered, but a couple of numbers here. First, you reported $200 million plus of positive prior year development a quarter, materially more than I think the company has ever seen in Q4. Just curious, given the MLR was generally in line. Can you tell us whether there were any pressure areas that work to offset the benefit of the PYD in the quarter? And then with the benefits repositioning of Medicare Advantage, which we've clearly done, do you expect to be within your 3% to 5% target margin here for Medicare Advantage in '24?

我的大部分問題都已得到解答，但這裡有幾個問題。首先，您報告了上年一個季度的積極發展超過 2 億美元，這比我認為該公司在第四季度所看到的要多得多。只是好奇，考慮到 MLR 總體上是一致的。您能否告訴我們是否存在任何壓力領域可以抵銷本季 PYD 的收益？然後，隨著我們已經明確完成的 Medicare Advantage 福利重新定位，您是否期望 24 年 Medicare Advantage 的目標利潤率能夠達到 3% 至 5% 的範圍內？

We are confident that our year-end reserves are prudent and have been set consistent with historical practice. In the quarter, you are correct that we saw positive prior year development on a gross basis, and that was indeed favorable. It's worth pointing out here that, that was largely offset through premium rebates and colors as well as the reestablishment of reserves for the current year. An alternative way to think about this is that our full year days in claims payable decreased just 0.2 days year-over-year.

我們相信，我們的年末準備金是審慎的，並且是符合歷史慣例的。在本季度，您是正確的，我們看到了去年總體上的積極發展，這確實是有利的。值得指出的是，這在很大程度上被溢價回扣和顏色以及本年度儲備金的重建所抵消。另一種思考方式是，我們全年的應付理賠天數比去年同期僅減少了 0.2 天。

And that's noteworthy in the context of the fact that we have observed cycle times to have actually decreased more than 3 days, since the end of December 2022. And that should give you a feel for our comfort level around reserves.

值得注意的是，自 2022 年 12 月底以來，我們觀察到週期時間實際上減少了​​ 3 天以上。這應該會讓您感受到我們在儲備方面的舒適程度。

On your second question, just relative to the long-term target margin ranges, commercial is on track to achieve our long-term goals. Let's say, Medicaid is normalizing, but continues to perform well. And then Medicare Advantage for now is below our long-term target margin range.

關於你的第二個問題，相對於長期目標利潤範圍，商業正在實現我們的長期目標。假設醫療補助正在正常化，但仍表現良好。然後，醫療保險優勢目前低於我們的長期目標利潤範圍。

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

接下來，我們將前往 TD Cowen 的 Gary Taylor 線路。

I just wanted to follow-up on enrollment. I kind of thought the story for '23 was that with the intentional commercial repricing, which has been pretty successful this year, you lost some commercial risk enrollment because of that? And I'm just trying to figure out on the 1 million plus decline in risk enrollment for '24, how much of that is commercial risk versus the expected Medicaid redeterminations?

我只是想跟進註冊情況。我認為 23 年的故事是，今年非常成功的有意商業重新定價，你因此失去了一些商業風險註冊？我只是想弄清楚 24 年風險登記人數下降了 100 萬以上，其中商業風險與預期的醫療補助重新確定相比有多少？

We're all pleased with the performance of our commercial business in the fourth quarter and in 2023. We did make meaningful progress towards our margin recovery goals in the year. I'd say January renewals have gone well. We certainly experienced to date higher retention than we did at the same period last year. Repricing actions, as you would expect, do continue to impact membership growth, but this is expected. And so we're really continuing to expect approximately flat membership growth overall in our group risk business this year, while continuing to improve margins in line with our stated goals.

我們對第四季度和 2023 年商業業務的表現感到滿意。今年我們在實現利潤率恢復目標方面確實取得了有意義的進展。我想說一月的續約進展順利。迄今為止，我們的留存率確實比去年同期更高。正如您所期望的那樣，重新定價行為確實會繼續影響會員成長，但這是預期的。因此，我們確實繼續預期今年集團風險業務的整體會員成長大致持平，同時繼續根據我們既定的目標提高利潤率。

And just again, to put a fine point, most of the losses in risk membership is driven by both the Medicaid redeterminations and the adjustment in the footprints that we've shared with you in the past. So that really is the key driver.

再次強調一點，風險會員資格的大部分損失是由醫療補助重新確定和我們過去與您分享的足跡調整造成的。所以這確實是關鍵驅動因素。

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

接下來，我們將請聽來自傑富瑞 (Jefferies) 的大衛溫德利 (David Windley)。

Squeezing in here. I wanted to go to CarelonRx on the revenue growth side. High growth in '23 low single digits, I think you're expecting in '24. I suspect the BioPlus acquisition inorganically would have contributed to some of that growth in '23, but I don't think it bridges the full change. So maybe you could add some color around the slowdown in growth, the lower growth expectations for CarelonRx in '24?

擠在這裡。我想在收入成長方面去 CarelonRx。我認為您預計 24 年會出現 23 年低個位數的高成長。我懷疑 BioPlus 的收購會在一定程度上促進 23 年的成長，但我不認為它能彌合全面的變化。因此，也許您可以在增長放緩以及 CarelonRx 24 年增長預期較低的情況下添加一些色彩？

As it relates to 2023 and the growth of around 18.6% that did exceed our initial guidance -- and as you alluded to, that was driven primarily by the BioPlus acquisition and including BioPlus and our results to a lesser extent, drug mix and trends -- but I would say as it relates to 2024, I would say we have tremendous momentum in the business. And we're really excited about how our strategy is playing through.

因為它與2023 年有關，約18.6% 的成長確實超出了我們最初的指導——正如您所提到的，這主要是由BioPlus 收購推動的，包括BioPlus 和我們的結果（在較小程度上）、藥物組合和趨勢—— - 但我想說，與 2024 年相關，我想說我們的業務發展勢頭強勁。我們對我們的策略的實施感到非常興奮。

We've talked about assuming the strategic levers that really matter in our business. We've done that with Specialty Pharmacy and BioPlus. We've done that with advanced home delivery. You heard about the recent announcement of Paragon and infusion, which we're really excited about. And then there are several new product launches that are resonating in the marketplace that we've talked about previously, like insurer as one of the examples.

我們已經討論過如何採用對我們的業務真正重要的策略槓桿。我們已經透過 Specialty Pharmacy 和 BioPlus 做到了這一點。我們已經透過先進的送貨上門服務做到了這一點。您聽說了最近發布的 Paragon 和 Infusion，我們對此感到非常興奮。然後，我們之前討論過的一些新產品的發佈在市場上引起了共鳴，例如保險公司就是例子之一。

And this momentum is playing through in our sales in 2024. We are having a good season. Obviously, that activity occurred in 2023. Our retention remains strong. Our sweet spot does remain in that 3,000 to 10,000 range in terms of the business that we're attracting. And as you know, there's a little more reticence in terms of the larger jumbo accounts moving. But I would say that a couple of notable wins there. We saw a couple of wins in the 20,000 to 50,000 range. So we're really excited about the momentum in Carelon and what we're doing strategically and how that's playing through in the marketplace.

這種勢頭正在我們 2024 年的銷售中體現出來。我們正在經歷一個不錯的銷售季。顯然，該活動發生在 2023 年。我們的保留率仍然很高。就我們吸引的業務而言，我們的最佳點確實仍然在 3,000 到 10,000 的範圍內。如您所知，對於大型帳戶的轉移，人們更加謹慎。但我想說的是，那裡有一些值得注意的勝利。我們在 20,000 到 50,000 範圍內看到了一些勝利。因此，我們對 Carelon 的發展勢頭、我們正在採取的策略以及其在市場上的表現感到非常興奮。

Our next question will be our last question.

我們的下一個問題將是最後一個問題。

For our final question, we'll go to the line of George Hill from Deutsche Bank.

對於我們的最後一個問題，我們將聯繫德意志銀行的喬治希爾。

I'm going to come back to M&A margins 1 more time. And I'm going to ask you, if you could expand a little bit, if there is a way to disaggregate kind of the MA margin expansion thinking about your pricing initiatives versus utilization expectation versus mix and kind of the market exits that you guys have targeted just trying to figure, if you can kind of maybe rank order the contribution on margin expansion in MA from each of those 4 initiatives?

我還要再談一次併購利潤。我要問你們，你們是否可以擴大一點，是否有辦法分解 MA 利潤擴張的類型，考慮你們的定價舉措、利用率預期、組合以及你們所擁有的市場退出類型目標只是想弄清楚，您是否可以對這4 項舉措中每項舉措對MA 利潤率擴張的貢獻進行排序？

We are not looking to necessarily provide individual margin guidance within the Health Benefit segment. Certainly, we feel comfortable with where we're guiding to in aggregate for 2024 and the 25 to 50 basis point range -- and we think that the qualitative commentary that we provided in the call today should give you enough to get a feel for how the management team is thinking about this.

我們不希望在健康福利領域提供個人利潤指導。當然，我們對 2024 年的總體指導目標以及 25 至 50 個基點範圍感到滿意——我們認為，我們今天在電話會議中提供的定性評論應該足以讓您了解如何實現這一目標。管理團隊正在考慮這個問題。

Given this is my first earnings call, I just want to spend a minute on capital deployment before we close out here. And I just wanted to make the point that I expect to continue with Elevance Health's existing strategic policy around capital deployment, as I believe it really strikes the right balance between growth and the return of capital to our stockholders.

鑑於這是我的第一次財報電話會議，我只想在結束之前花一點時間討論資本部署。我只是想指出，我希望繼續執行 Elevance Health 圍繞資本部署的現有策略政策，因為我相信它確實在成長和股東資本回報之間取得了適當的平衡。

And just as a reminder, we are going to target 50% of our free cash flow towards M&A or organic reinvestment and approximately 50% is a return of capital to our stockholders, either via the 30% for share repurchases -- or the 20% for dividends. And each year may differ. But over the years, we expect to allocate capital consistent with this framework.

提醒一下，我們將把 50% 的自由現金流用於併購或有機再投資，大約 50% 是透過 30% 的股票回購或 20% 的方式向股東返還資本。為了股息。而且每年可能會有所不同。但多年來，我們期望能依照這個框架來分配資本。

Thank you, Mark, and thank you to everyone who joined us. In closing, we're pleased to have delivered another strong year in 2023, and we're confident that the ongoing execution of our strategy and the balance and resilience of our diverse set of businesses positions us well for 2024 and beyond.

謝謝你，馬克，也謝謝所有加入我們的人。最後，我們很高興在 2023 年又取得了強勁的業績，我們相信，我們策略的持續執行以及我們多元化業務的平衡和彈性將使我們在 2024 年及以後保持良好的地位。

We're very excited about our future, and we look forward to sharing more on our progress with you in the coming year. Thank you again for your interest in Elevance Health, and have a great rest of your week.

我們對未來感到非常興奮，並期待在未來一年與您分享更多我們的進展。再次感謝您對 Elevance Health 的關注，並祝您本週休息愉快。

Ladies and gentlemen, a recording of this conference will be available for replay after 11:00 a.m. today through February 23, 2024. You may access the replay system at any time by dialing (800) 568-3942. International participants can dial ( 203 ) 369-3812. 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，本次會議的錄音將於今天上午 11:00 後至 2024 年 2 月 23 日期間進行重播。您可以隨時撥打 (800) 568-3942 訪問重播系統。國際參與者可撥打 (203) 369-3812。我們今天的會議到此結束。感謝您的參與和使用 Verizon 會議。您現在可以斷開連線。