Elevance Health Inc (ELV) 2024 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by and welcome to the Elevance Health third-quarter earnings conference call. (Operator Instructions) As a reminder, today's conference is being recorded.

女士們、先生們，感謝你們的支持並歡迎參加 Elevance Health 第三季財報電話會議。 （操作員指示）提醒一下，今天的會議正在錄製中。

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 third quarter 2024 earnings call. This is Stephen Tanal, Vice President of Investor Relations. And with us this morning on the earnings call are Gail Boudreaux, President and CEO; 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 2024 年第三季財報電話會議。我是史蒂芬‧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)；馬克‧凱 (Mark Kaye)，我們的財務長； Peter Haytaian，Carelon 總裁； Morgan Kendrick，我們的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 our revised outlook for the 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.

蓋爾將在電話會議開始時簡要討論本季度、我們修訂後的今年展望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。

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 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.

在電話會議期間，我們將參考某些非 GAAP 衡量標準，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。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。

I will now turn the call over to Gail.

我現在將把電話轉給蓋爾。

Thank you, Steve and good morning everyone. We appreciate you joining our earnings call. Today, we will review our third quarter financial results, discuss our outlook for 2024 and provide an update on the operating environment.

謝謝你，史蒂夫，大家早安。我們感謝您參加我們的財報電話會議。今天，我們將回顧第三季的財務業績，討論 2024 年的前景，並提供有關營運環境的最新資訊。

During the call, we will also highlight fundamental drivers of long term growth for van health which remains strong. For the third quarter adjusted diluted earnings per share were $8.37 which was below our expectations. Primarily due to elevated medical costs in our Medicaid business.

在電話會議中，我們還將強調貨車健康長期成長的基本驅動力，該驅動力仍然強勁。第三季調整後攤薄每股收益為 8.37 美元，低於我們的預期。主要是由於我們的醫療補助業務的醫療費用增加。

The impact on the third quarter and our full year outlook are being partially offset by focused medical management. The work we are doing with States to reflect the acuity of our members in rates and proactive actions we are taking to enhance operating efficiency which will strengthen our business for the long term.

對第三季和全年前景的影響被重點醫療管理所部分抵消。我們正在與各國開展的工作，旨在反映會員對費率的敏銳度，以及我們為提高營運效率而採取的積極行動，這將長期加強我們的業務。

We are navigating a challenging and dynamic operating environment and have reduced our full year outlook to prudently reflect these challenges. Given third quarter results and our expectation that timing disconnects between Medicaid rates and acuity currently facing the industry will continue.

我們正在應對充滿挑戰和充滿活力的營運環境，並降低了全年展望，以審慎地反映這些挑戰。鑑於第三季度的業績以及我們的預期，醫療補助費率與該行業目前面臨的敏銳度之間的時間脫節將繼續存在。

We have reduced our outlook for adjusted diluted earnings per share to approximately $33. Importantly, we are not leveraging the future to achieve short term gains. We are investing to position Elevance Health for strong growth over the long term.

我們將調整後稀釋每股盈餘的預期下調至約 33 美元。重要的是，我們不會利用未來來實現短期收益。我們正在投資，以使 Elevance Health 實現長期強勁成長。

The issues impacting the Medicaid business are time bound and our State partners are working constructively with us on rate renewals. We're confident that rates will ultimately reflect the underlying acuity of our members, albeit on a lag as States often use data that is more than a year old in setting rates. The short term headwinds are a byproduct of the large scale and unprecedented mix shifts associated with the end of the public health emergency.

影響醫療補助業務的問題是有時間限制的，我們的州合作夥伴正在與我們就費率續約進行建設性合作。我們相信，利率最終將反映我們成員的潛在敏銳度，儘管由於各國在設定利率時經常使用一年多前的數據而存在滯後。短期阻力是公共衛生緊急事件結束後發生的大規模、前所未有的組合變化的副產品。

Over the long term Medicaid managed care is an attractive business that is integral and complementary to our other health benefits and Carelon businesses and offers significant growth opportunities notably serving specialized populations where we provide distinct value with our unique capabilities.

從長遠來看，醫療補助管理式醫療是一項有吸引力的業務，它與我們的其他健康福利和Carelon 業務是不可或缺的和互補的，並提供顯著的成長機會，特別是為特殊人群提供服務，我們在這些人群中透過我們獨特的能力提供獨特的價值。

Across our health benefits business, we are diligently executing on our growth strategy. Our Medicaid team is working tirelessly with our State partners and we appreciate the collaboration. While the rate increases we've received are the highest in the past decade. They're still inadequate to cover 2024 cost trends that we now expect to be 3 times to 5 times historical averages.

在我們的健康福利業務中，我們正在努力執行我們的成長策略。我們的醫療補助團隊正在與我們的州合作夥伴不懈地合作，我們感謝這種合作。雖然我們收到的利率增幅是過去十年來最高的。它們仍然不足以涵蓋 2024 年的成本趨勢，我們現在預計該成本將是歷史平均值的 3 到 5 倍。

We're confident that rates will reflect the acuity of our members as enrollment continues to stabilize. And we're acting with urgency to deliver significant operational efficiencies and appropriately manage the cost of care.

我們相信，隨著註冊人數持續穩定，費率將反映我們會員的敏銳度。我們正在緊急採取行動，以顯著提高營運效率並適當管理護理成本。

Partnering with States as they expand managed care to beneficiaries with chronic or complex conditions aligns well with our specialized whole health solutions. And is an important part of our growth strategy. In partnership with e Blue Cross Blue Shield of North Carolina. We're pleased to be expanding our service to North Carolinians through the recent award of a sole source foster care contract covering nearly 60,000 new members. This marks the second sole source foster care win in 2024.

與各國合作，將管理式醫療服務擴展到患有慢性或複雜疾病的受益人，這與我們專業的整體健康解決方案非常吻合。這是我們成長策略的重要組成部分。與北卡羅來納州的 e Blue Cross Blue Shield 合作。我們很高興透過最近授予涵蓋近 60,000 名新會員的獨家寄養合同，將我們的服務擴展到北卡羅來納州。這標誌著 2024 年第二次獲得寄養唯一來源。

In Medicare, we're taking deliberate steps to ensure the long term sustainability of our business. We are now two days into the 2025 annual election period and are pleased with our positioning overall. We remain disciplined in our approach to 2025 bids. Building on the actions we took to position our Medicare advantage business for sustainable performance heading into 2024.

在醫療保險方面，我們正在採取審慎的措施來確保我們業務的長期可持續性。現在距離 2025 年年度選舉期還有兩天，我們對我們的整體定位感到滿意。我們在 2025 年投標中仍然保持嚴格的紀律。在此基礎上，我們採取了一系列行動，使我們的醫療保險優勢業務在 2024 年實現永續績效。

For 2025, we took a balanced approach to margin and membership, prioritizing the benefits seniors value most to mitigate the impact of [CMS] rate cuts on beneficiaries and promote access to high quality, comprehensive and coordinated care for our members.

到2025 年，我們對利潤和會員資格採取平衡的方法，優先考慮老年人最重視的福利，以減輕[CMS] 費率削減對受益人的影響，並促進我們的會員獲得高品質、全面和協調的護理。

Given the benefit reductions and meaningful market exits we made heading into 2024. We maintain greater stability in our offerings for 2025. And as a result, we expect to grow individual Medicare advantage membership in line or slightly better than the broader market in 2025 led by products where we have strong sustainable market positions.

鑑於我們在2024 年之前進行了福利削減和有意義的市場退出。持平或略好於我們擁有強大的永續市場地位的產品。

Medicare advantage star quality ratings remain a key enterprise priority. And we're committed to our long term goal of achieving and maintaining star ratings at the high end of all plans in our markets. For payment year 2026 we improved our own performance across nearly 60% of star measures and are pleased to be the only large payer to offer multiple five star plans. Unfortunately, we will see the percentage of our members and plans rated four stars or higher decline due to significantly higher cut points.

醫療保險優勢星級品質評級仍然是企業的關鍵優先事項。我們致力於實現並維持我們市場上所有計劃高端的星級評級的長期目標。在 2026 年付款年，我們在近 60% 的星級措施中提高了自己的績效，並很高興成為唯一提供多個五星級計劃的大型付款人。不幸的是，我們將看到我們的會員和計劃被評為四星或更高的百分比由於明顯更高的削減點而下降。

The entire decline in our four star member mix was due to one of our larger age contracts narrowly missing a four star rating by [410,000] of a point. We have challenged our initial scoring with CNS and are considering all of our options.

我們四星會員組合的整體下降是由於我們的一份較大年齡的合約與四星級評級相差 [410,000] 個點。我們已經對 CNS 的初始評分提出了質疑，並正在考慮我們所有的選擇。

Our commercial businesses are performing well and are on track to achieve their financial targets. We anticipate further growth in 2025 to be driven by increased penetration of our best in class products and services given momentum in both of our individual exchange and national account businesses.

我們的商業業務表現良好，並有望實現其財務目標。鑑於我們個人交易所和國民帳戶業務的發展勢頭，我們預計 2025 年的進一步成長將由我們一流產品和服務滲透率的提高所推動。

For the largest employers, we offer differentiated value in innovative and attractive solutions. And our focus on whole health in partnership with Carelon is resonating. In our individual exchange business we're delivering particularly strong growth with membership up more than 30% year-to-date as we look to 2025 we're expanding our individual and family ACA plans in three states, Florida, Maryland, and Texas under the Wellpoint brand, which will complement our existing presence in these states while driving growth for our health benefits and Carelon segments.

對於最大的雇主，我們透過創新和有吸引力的解決方案提供差異化價值。我們與 Carelon 合作對整體健康的關注引起了共鳴。在我們的個人交換業務中，我們實現了特別強勁的成長，今年迄今為止，會員數量增長了30% 以上，預計到2025 年，我們將在佛羅裡達州、馬裡蘭州和德克薩斯州這三個州擴大我們的個人和家庭ACA 計劃Wellpoint 品牌將補充我們在這些州的現有業務，同時推動我們的健康福利和 Carelon 細分市場的成長。

Focus geographic expansion enhances our ability to serve as a lifetime, trusted health partner to consumers in our communities.

重點地域擴張增強了我們作為社區消費者值得信賴的終身健康合作夥伴的能力。

Turning to Carelon, we're making significant progress in scaling our enterprise flywheel for growth. CarelonRx continues to expand its customer base while diversifying its value proposition. Earlier this month, we closed the acquisition of Kroger Specialty Pharmacy, which is aligned with our strategy of controlling the levers that matter and delivering whole health affordably.

至於 Carelon，我們在擴展企業飛輪以實現成長方面取得了重大進展。 CarelonRx 持續擴大其客戶群，同時實現價值主張多元化。本月早些時候，我們完成了對克羅格專業藥房的收購，這符合我們控制重要槓桿並以經濟實惠的方式提供整體健康的策略。

Meanwhile, innovative solutions such as our SpecialtyRx, Savings Navigator Weight Management Solutions and EnsureRx continue to gain traction and drive savings for our clients. Growth in Carelon services remain strong and we are on track to exceed the upper end of our initial outlook for low 20s percentage revenue growth. This includes external growth above our initial targets for 2024.

同時，我們的 SpecialtyRx、Savings Navigator 體重管理解決方案和 EnsureRx 等創新解決方案繼續獲得關注並為我們的客戶節省開支。 Carelon 服務的成長仍然強勁，我們預計將超過我們最初預期的 20 % 收入成長百分比的上限。這包括超出我們 2024 年初始目標的外部成長。

A proofpoint in first demonstrating our value proposition internally before driving growth externally. Carelon also recently entered into an agreement to acquire CareBridge, a value based manager of home and community based services for chronic and complex members that will serve as the foundation for Carelon's Home Health Business. And we're excited to continue to serve all its customers and members.

這是在外部推動成長之前首先在內部展示我們的價值主張的證據。 Carelon 最近還簽署了一項收購 CareBridge 的協議，CareBridge 是一家為慢性和複雜會員提供家庭和社區服務的價值管理公司，該公司將作為 Carelon 家庭健康業務的基礎。我們很高興繼續為所有客戶和會員提供服務。

Carelon Services is expanding its capabilities to manage a growing proportion of health care spending supporting the long term growth of the business. And by extension, the value it creates for health plan customers.

Carelon Services 正在擴大其能力，以管理日益增長的醫療保健支出比例，支持業務的長期成長。進而推而廣之，它為健康規劃客戶創造的價值。

Despite the challenges of the current environment, we're investing to position Elevance Health for sustained growth over the long term including through the application of AI Driven solutions that are enhancing member and provider experiences reducing costs and driving more efficient processes.

儘管當前環境面臨挑戰，我們仍在投資，以使 Elevance Health 實現長期持續成長，包括透過應用人工智慧驅動的解決方案來增強會員和提供者的體驗，降低成本並推動更有效率的流程。

We expect to realize operational and financial benefits in 2024 and greater impact in 2025 and beyond. For our members, we're integrating AI across touch points to provide personalized digital service, improve access to care and further increase satisfaction.

我們預計在 2024 年實現營運和財務效益，並在 2025 年及以後產生更大的影響。對於我們的會員，我們正在跨接觸點整合人工智慧，以提供個人化的數位服務，改善獲得護理的機會並進一步提高滿意度。

We're also improving provider interactions and reducing costs by streamlining administrative tasks, automating onboarding and enhancing contract administration. And for our associates, we're investing in tools that increase productivity, reduce manual tasks and enhance efficiency across the organization.

我們還透過簡化管理任務、自動化入職和加強合約管理來改善提供者互動並降低成本。對於我們的員工，我們正在投資於提高生產力、減少手動任務並提高整個組織效率的工具。

These are just a few of the AI applications we anticipate in the coming years. As we focus on programs that can have the greatest impact guided by a mission to provide unmatched value to our members, providers and associates.

這些只是我們預計未來幾年人工智慧應用的一小部分。我們專注於能夠產生最大影響的計劃，其使命是為我們的會員、提供者和員工提供無與倫比的價值。

In summary, our businesses remain fundamentally strong and we remain confident in the flywheel for long term growth we're building with our complementary businesses. The issues impacting Medicaid are time bound and we're acting with urgency to improve performance and ensure adequate rates that reflect the acuity of our members.

總而言之，我們的業務從根本上仍然強勁，我們對我們與互補業務建立的飛輪的長期成長仍然充滿信心。影響醫療補助的問題是有時間限制的，我們正在緊急採取行動，以提高績效並確保足夠的費率來反映我們會員的敏銳度。

We are confident that we're making the right investments to position Elevance Health for strong and sustainable growth over the long term in service of consumers across all age and income levels. And that we will emerge from this period of unprecedented change, stronger and even better position to serve the growing need for care management and cost containment in our health care system.

我們相信，我們正在做出正確的投資，以使 Elevance Health 實現長期強勁和可持續增長，為所有年齡和收入水平的消費者提供服務。我們將從這個前所未有的變革時期中脫穎而出，以更強大、甚至更好的地位來滿足我們的醫療保健系統對護理管理和成本控制日益增長的需求。

Before closing, I would also like to thank our dedicated associates for their tireless commitment to our mission and for the work they do each and every day to deliver for all of our stakeholders. It is their dedication and passion for those that we're privileged to serve that is reflected in our ongoing recognition as a great place to work for the fifth consecutive year.

在結束之前，我還要感謝我們敬業的員工對我們使命的不懈承諾，以及他們每天為我們所有利害關係人所做的工作。他們對我們有幸服務的人們的奉獻和熱情體現在我們連續第五年被認可為一個優秀的工作場所。

With that, I'd like to turn the call over to Mark K, our CFO to provide more details on our operating results and outlook. Mark.

因此，我想將電話轉給我們的財務長 Mark K，以提供有關我們的營運業績和前景的更多詳細資訊。標記。

Thank you, Gail and good morning to everyone on the line.

謝謝你，蓋爾，祝在線的每個人早安。

As Gail shared, we reported third quarter results including GAAP diluted earnings per share of $4.36 and adjusted diluted earnings per share of $8.37 which came in below our expectations.

正如蓋爾分享的那樣，我們報告了第三季度業績，其中 GAAP 攤薄每股收益為 4.36 美元，調整後攤薄每股收益為 8.37 美元，低於我們的預期。

We ended the third quarter with 45.8 million members flat sequentially, growth in commercial was largely offset by the loss of approximately 85,000 Medicaid members due to a specific footprint change that took effect at the beginning of September. Year-over-year, commercial membership has grown by nearly 600,000, driven by strong fee based and individual ACA health plan growth on the distinct value we deliver to large employers and the targeted local positioning of our products.

截至第三季末，我們的會員數量為 4,580 萬，與上一季持平，商業成長在很大程度上被 9 月初生效的特定覆蓋範圍變化導致約 85,000 名醫療補助會員的流失所抵消。與去年同期相比，商業會員數量增長了近 600,000 名，這得益於我們為大型雇主提供的獨特價值以及我們產品的本地目標定位，收費和個人 ACA 健康計劃的強勁增長。

Total operating revenue for the quarter was $44.7 billion, up over 5% year-over-year reflecting strong re acceleration in growth from the low point last quarter. The consolidated benefit expense ratio was 89.5% for the third quarter. An increase of 270 basis points year-over-year, principally due to Medicaid cost trend developing worse than expected. While Medicaid rate increases will reach record levels this year, they remain inadequate to cover cost trend that is in the range of 3 times to 5 times historical averages.

該季度總營業收入為 447 億美元，年成長超過 5%，反映出成長較上季低點強勁加速。第三季綜合福利費用率為89.5%。年比成長 270 個基點，主要是由於醫療補助成本趨勢發展差於預期。儘管今年醫療補助費率上漲將達到創紀錄水平，但仍不足以涵蓋歷史平均 3 至 5 倍的成本趨勢。

We are working closely with our state partners to ensure they fully capture the acuity of our Medicaid membership in future rates. During the quarter, we mitigated the impact through disciplined medical management and took further proactive actions to enhance operating efficiency across the enterprise.

我們正在與我們的州合作夥伴密切合作，以確保他們在未來的費率中充分體現我們醫療補助會員資格的敏銳度。本季度，我們透過嚴格的醫療管理減輕了影響，並採取了進一步的積極行動來提高整個企業的營運效率。

As a result, Elevance Health adjusted operating expense ratio was 9.6%. An improvement of 150 basis points. Adjusted operating gain for the quarter was $2.4 billion and $8.3 billion for the year-to-date period. Primarily reflecting declines in our Medicaid business.

結果，Elevance Health 調整後的營運費用率為 9.6%。提高了150個基點。本季調整後營業利潤為 24 億美元，年初至今調整後營業利潤為 83 億美元。主要反映了我們的醫療補助業務的下降。

We maintained a consistent and prudent posture with respect to reserves days in claims payable at the end of the third quarter, stood at 42.8 days which remains slightly above our targeted range in the low 40s. Given third quarter results and our expectation that cost trend in our Medicaid business will remain elevated through at least the fourth quarter. We have reduced our full year outlook for adjusted diluted earnings per share to approximately $33.

我們對第三季末應付理賠準備金天數保持一致和審慎的態度，為 42.8 天，略高於我們 40 多天的目標範圍。鑑於第三季的業績以及我們的預期，我們的醫療補助業務的成本趨勢至少在第四季將保持在高水準。我們將調整後稀釋每股盈餘的全年預期下調至約 33 美元。

We now expect our 2024 benefit expense ratio will be more than 100 basis points higher than we anticipated last quarter. Bringing the full year to approximately 88.5%. Full year operating cash flow is now expected to be approximately $4.5 billion.

我們現在預計 2024 年的福利費用率將比我們上季度的預期高出 100 個基點以上。使全年利用率達到約88.5%。目前預計全年營運現金流約 45 億美元。

It's important to keep in mind that the issues impacting the Medicaid managed care industry are time bound and we are confident that rates will ultimately reflect the underlying acuity of our Medicaid membership.

重要的是要記住，影響醫療補助管理式醫療行業的問題是有時限的，我們相信費率最終將反映我們醫療補助會員資格的潛在敏銳度。

It's also notable that in 2024 businesses representing more than half of our revenues will be operating at margins below their long run potential. We expect margins will return to appropriate and sustainable levels over time.

另外值得注意的是，到 2024 年，占我們收入一半以上的企業的營運利潤率將低於其長期潛力。我們預計隨著時間的推移，利潤率將恢復到適當且可持續的水平。

Turning to 2025, we expect continued momentum in our commercial business bolstered by the expansion of our exchange offerings into three new states. In the alignment of our value proposition in national and large group markets, we will deliver balanced growth in our Medicare advantage, business and stability in Medicaid as redeterminations return to a normal cadence.

展望 2025 年，我們預計，由於我們的交易所產品擴展到三個新州，我們的商業業務將繼續保持成長勢頭。在調整我們在全國和大型集團市場的價值主張時，隨著重新確定恢復到正常節奏，我們將在醫療保險優勢、業務和醫療補助穩定性方面實現平衡增長。

And we will further scale Carelon, our enterprise flywheel for growth with notable contributions from the expansion of specialty pharmacy dispensing capabilities in CarelonRx and continued momentum in CarelonRx services as we drive greater product adoption internally and externally and build out our home and community based business.

我們將進一步擴大我們的企業飛輪Carelon 的規模，以透過CarelonRx 專業藥房配藥能力的擴展以及CarelonRx 服務的持續發展勢頭做出顯著貢獻，因為我們在內部和外部推動了更多的產品採用，並建立了我們的家庭和社區業務。

Finally, we are undertaking bold actions to modernize and transform many of our core processes through the application of new technologies that will create structural efficiencies and long term value. There is much to be excited about in 2025 and we expect strong acceleration in revenue growth at least in line with our long term growth algorithm in the high single digit percent range.

最後，我們正在採取大膽行動，透過應用新技術來實現許多核心流程的現代化和轉型，從而創造結構效率和長期價值。 2025 年有很多令人興奮的事情，我們預計營收成長將強勁加速，至少符合我們在高個位數百分比範圍內的長期成長演算法。

While we are confident that the issues impacting the Medicaid managed care industry are time bound at this point in time. Our outlook for 2025 adjusted EPS growth is at least in the mid-single digit percent range.

雖然我們相信影響醫療補助管理式醫療產業的問題目前是有時間限制的。我們對 2025 年調整後每股盈餘成長的預期至少在中位數百分比範圍內。

This reflects our assumption that the timing disconnect between Medicaid rates and acuity will continue. We will navigate this backdrop with the same focus and discipline that has been central to the long term success of Elevance Health.

這反映了我們的假設，即醫療補助費率和視力之間的時間脫節將繼續存在。我們將以同樣的重點和紀律來應對這一背景，這對 Elevance Health 的長期成功至關重要。

Importantly, the earnings power of our diverse and complementary businesses remain strong and we are confident in our ability to deliver at least 12% growth in adjusted diluted earnings per share annually on average over time.

重要的是，我們多元化和互補業務的盈利能力仍然強勁，我們有信心隨著時間的推移，我們有能力實現調整後攤薄每股收益平均每年至少增長 12%。

And with that operator, please open the call for questions.

請透過該接線生撥打電話詢問問題。

(Operator Instructions)

（操作員說明）

AJ Rice, UBS.

AJ 賴斯，瑞銀集團。

Hi, everybody. Thanks for the question. So in the slide deck, you're reiterating your expectation of 12% earnings growth from '22 to '27, which off that '22 base would suggest you get something like $51.27. But you're also saying off the new base this year, you'll grow 5% next year, which would give you something like [$34.65], something in a high $34.

大家好。謝謝你的提問。因此，在幻燈片中，您重申了從 22 年到 27 年盈利增長 12% 的預期，以 22 年為基礎，您將獲得 51.27 美元左右的收入。但你也說，在今年的新基數基礎上，明年你將增長 5%，這會給你帶來類似 [34.65 美元] 的東西，最高 34 美元。

I guess the question is and it sounds like all of the short term issues are around Medicaid, is the getting the right rate is going to be sufficient to get you the kind of accelerated earnings growth in '26 and '27. That would get you back on track to hit that multiyear 12% CAGR target or should we rebate that given what we're looking at 2024 and 2025?

我想問題是，聽起來所有短期問題都圍繞著醫療補助，獲得正確的利率是否足以讓你在 26 和 27 年內實現收入加速成長。這將使您重回正軌，實現 12% 的多年複合年增長率目標，或者考慮到 2024 年和 2025 年的情況，我們是否應該回扣這一目標？

Thank you for the question, AJ. Let me provide a little bit of high level perspective around that because I think there's, you have a lot of math in that question, but I think it's important, certainly appreciate the dynamic environment that we're currently operating in.

謝謝你的提問，AJ。讓我圍繞這個問題提供一些高層次的觀點，因為我認為這個問題涉及很多數學知識，但我認為這很重要，當然要欣賞我們目前所處的動態環境。

I think to really start that. First, we believe that the earnings power of our diverse and complementary businesses remain strong. So feel good about thinking about at least 12% over the long term and adjusted EPS over time. So I think that's important.

我想真正開始吧。首先，我們相信我們多元化且互補的業務的盈利能力仍然強勁。因此，考慮長期至少 12% 並隨著時間的推移調整每股收益，這會是一件好事。所以我認為這很重要。

As you heard, and we're thinking about what's happening in our business right now. I'd like to sort of reiterate some of the things that Mark shared in his opening comments. First, strong acceleration in revenue growth, at least, in line with our long term algorithm in the high single digit percentage. So there's a lot I think to be excited about in our business momentum in our commercial business going strong.

正如您所聽到的，我們正在考慮我們的業務目前正在發生的事情。我想重申馬克在開場白中分享的一些內容。首先，營收成長強勁加速，至少與我們高個位數百分比的長期演算法一致。因此，我認為我們的商業業務勢頭強勁，有很多值得興奮的地方。

We're entering several additional expanded ACA footprints next year, we feel good about the Medicare Advantage business, which we focus to be sustainable long term growth and Carelon is going to deliver even greater value as we look at the internal and external growth we're seeing in services and the robust pipeline in CarelonRx.

明年我們將進入幾個額外的擴展 ACA 業務，我們對 Medicare Advantage 業務感覺良好，我們專注於可持續的長期增長，而當我們考慮內部和外部增長時，Cararelon 將提供更大的價值。 CarelonRx 中的服務和強大的管道。

And then the last piece of that is continuing to realize substantial operational efficiencies. However, given, the dynamics that we spoke about in the environment that we're in, we anticipate that Medicaid margins in '25 are going to remain below our long term target. But again, this is a timing disconnect between rates and acuity, which we do believe is time bound, but think that can persist through 2025.

最後一部分是繼續實現顯著的營運效率。然而，考慮到我們所討論的當前環境的動態，我們預計 25 年的醫療補助利潤率將繼續低於我們的長期目標。但同樣，這是利率和敏銳度之間的時間脫節，我們確實認為這是有時間限制的，但認為這種情況可能會持續到 2025 年。

And also it's really important that we are going to continue to make ongoing investments in '25 because we think that there's a powerful opportunity across our business. So taken together, we think that we're being prudent in how we think about '25 and our expectations at this pace and timing. And that our guidance will give you a lot more detail in the fourth quarter. But I think you can rest assured we're going to continue to navigate '25 with the same focus and discipline that has been central to our long term success.

此外，我們將繼續在 25 年進行持續投資也非常重要，因為我們認為我們的業務存在巨大的機會。綜上所述，我們認為我們對 25 年的看法以及我們對這個速度和時間的期望是謹慎的。我們的指導將在第四季度為您提供更多詳細資訊。但我認為您可以放心，我們將繼續以同樣的重點和紀律度過 25 年，這對我們的長期成功至關重要。

Next question. Thank you.

下一個問題。謝謝。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Hi, thanks for the question. Just wanted to come back to the Medicaid discussion. Obviously the magnitude of the revision that's implied there is alarming, particularly given that we're at the end of the membership impacts from re-determination, just trying to understand better how things got so much worse, so quickly.

你好，謝謝你的提問。只是想回到醫療補助討論。顯然，這意味著修訂的幅度令人震驚，特別是考慮到我們正處於重新決定對會員資格的影響的末尾，只是試圖更好地理解事情如何變得如此之快、如此糟糕。

I guess how much of this is actually new to the third quarter versus not having a good reading on where things were last quarter. And to the extent there are new developments in the third quarter. Can you better help us understand? You know, perhaps what some of those are? Thank you.

我猜想其中有多少實際上是第三季的新內容，而不是沒有很好地了解上季度的情況。從某種程度上來說，第三季有新的進展。你能更好地幫助我們理解嗎？你知道，也許其中一些是什麼？謝謝。

Thank you. Let me ask Mark Kaye, our CFO to address your question. Thank you,

謝謝。讓我請我們的財務長 Mark Kaye 來解答您的問題。謝謝你，

Stephen, good morning. Let me start off by noting that we experienced accelerated cost trends in Medicaid throughout the third quarter. And additionally, we saw unfavorable prior period development related to the current year, specifically in our Medicaid business.

史蒂芬，早安。首先我要指出的是，整個第三季我們都經歷了醫療補助成本加速趨勢。此外，我們看到與今年相關的前期發展不利，特別是在我們的醫療補助業務方面。

If I sit back for a moment, the Medicaid cost trends accelerated in the quarter. They restated negatively for the current year. And as such, we're tracking in the range of around --, 3 times to 5 times the historical average depending on the state. The elevated level of cost trend is driven. And you heard us address this in our prepared remarks primarily by the higher overall membership acuity, given the redetermination cycle is now substantially complete.

如果我稍微坐下來，醫療補助成本趨勢在本季加速。他們重申了對今年的負面看法。因此，我們追蹤的範圍是歷史平均值的 3 倍到 5 倍，具體取決於各州。成本水準的上升趨勢是驅動的。鑑於重新決定週期現已基本完成，您在準備好的發言中聽到我們主要透過更高的整體會員敏銳度來解決這個問題。

And we are continuing to work with the States. We very much appreciate the collaboration. And while rate increases to date have also been higher than the historical average, they remain insufficient to fully cover the claims trends that we're seeing. And so it's important to keep in mind that the state processes themselves typically rely on reference periods that lag current experience by as much as one to two years. And while we are sharing more recent experience and trained information real time with the state, it's going to take time before that's fully reflected in their rate schedules.

我們正在繼續與各國​​合作。我們非常感謝這次合作。儘管迄今為止的升息幅度也高於歷史平均水平，但仍不足以完全覆蓋我們所看到的索賠趨勢。因此，重要的是要記住，國家流程本身通常依賴於滯後當前經驗一到兩年的參考期。雖然我們正在與州政府即時分享最新的經驗和訓練有素的信息，但要完全反映在他們的費率表中還需要時間。

Thank you. Next question, please.

謝謝。請下一個問題。

Ben Hendrix, RBC Capital Markets.

本‧亨德里克斯，加拿大皇家銀行資本市場部。

Okay, thank you very much. Just wanted to kind of drill in a little bit more on the pacing of the catch up and of rates to acuity that you may expect over the coming year. You probably don't have perfect visibility into it. But are there any pockets, I think Mark mentioned a big bowl of members that kind of came off.

好的，非常感謝。只是想更多地了解您在來年可能期望的追趕節奏和敏銳度。您可能對它沒有完美的了解。但是有沒有口袋，我想馬克提到了一大碗這樣的會員。

Recently, it just are there any pockets of areas where you see a large bullet of members come off acuity increase and then have a state renegotiation that could be kind of a catalyst for creating some accelerated recovery or how do you think about pacing of the recovery throughout next year? Thanks.

最近，在某些領域，您會看到大量成員的敏銳度增加，然後進行狀態重新談判，這可能會成為加速復甦的催化劑，或者您如何看待復甦的節奏整個明年？謝謝。

Thanks for the question. Then, I'll ask Mark to comment on this as well. But I remember, you know, this is one of the largest and unprecedented mix shifts we've seen in Medicaid as the PHE has unwound over the course of the year. And again, as Mark said, what we saw was this acceleration through the third quarter. So I think putting that in perspective is really important. We have not had an environment like this before in Medicaid. So it's a very unusual time frame for us. But let me have Mark, give a little bit more color on that.

謝謝你的提問。然後，我也會請馬克對此發表評論。但我記得，你知道，這是我們在醫療補助中看到的最大且前所未有的混合轉變之一，因為英國公共衛生局在這一年中已經放鬆。正如馬克所說，我們看到的是第三季的加速成長。所以我認為正確看待這一點非常重要。我們以前在醫療補助中從未有過這樣的環境。所以這對我們來說是一個非常不尋常的時間框架。但是讓我請馬克來對此進行更多說明。

I think the only thing I'll add to a Gail's remarks is that as we think about 2025, we do expect that mismatch between rates and acuity to narrow, especially as the state rate updates increasingly reflect the underlying member acuity.

我認為我要在蓋爾的言論中補充的唯一一點是，當我們考慮2025 年時，我們確實預計利率和敏銳度之間的不匹配會縮小，特別是當州利率更新越來越多地反映潛在成員的敏銳度時。

Thank you. Next question, please.

謝謝。請下一個問題。

Ann Hynes, Mizuho.

安海因斯，瑞穗。

Great. Thank you. Can you just give us a little bit more detail on the utilization trends? Like what is increasing more than your expectations? Is it inpatient outpatient pharmacy? Any color you could provide would be helpful. Thanks.

偉大的。謝謝。您能否為我們提供更多有關使用趨勢的詳細資訊？例如什麼成長超出了你的預期？是住院門診藥局嗎？您可以提供的任何顏色都會有幫助。謝謝。

I may have Mark address that please. Thanks.

請給我馬克地址。謝謝。

Maybe let me take this briefly from two perspectives. I'll do a little bit of Medicare. Then I'll do a Medicaid. So Medicare in the quarter, you know what's likely elevated, it was manageable overall reflected some incremental pressure related to the two midnight rule. We also saw a late summer surge in COVID.

也許讓我從兩個角度來簡單介紹一下這一點。我會做一點醫療保險。然後我會做醫療補助。因此，本季的醫療保險，你知道可能會增加什麼，總體上是可控的，反映出與午夜兩點規則相關的一些增量壓力。我們也看到夏末新冠疫情激增。

On Medicaid as I spoke about trends a minute ago, we are seeing some ongoing pockets of that elevated trend. They're most notable in the behavioral health area overall that we do expect margins to continue to remain pressured through the rest of the year. And certainly for those two businesses will remain below our long term average in 2025.

關於醫療補助，正如我一分鐘前談到的趨勢一樣，我們看到了這種上升趨勢的一些持續存在的部分。總體而言，最引人注目的是行為健康領域，我們預計今年剩餘時間利潤率將繼續面臨壓力。當然，到 2025 年，這兩項業務仍將低於我們的長期平均值。

Thanks. And again, our results were predominantly driven by Medicaid and as Mark said, we did see some slight pressure in Medicare but feel very comfortable about where we positioned our bids for 2025.

謝謝。再說一次，我們的結果主要是由醫療補助推動的，正如馬克所說，我們確實看到醫療保險方面有一些輕微的壓力，但我們對 2025 年的出價定位感到非常滿意。

So, thank you. Next question, please.

所以，謝謝你。請下一個問題。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Hi, this is Tiffany on for Andrew. It looks like the 200 basis points of 3Q Enterprise MLR miss like translates to about 500 basis points of Medicaid pressure in the quarter. One, is that the right ballpark to think about and two, like just given the apparent like hundreds of basis points of incremental pressure is the Medicaid book profitable today?

大家好，我是安德魯的蒂芬妮。看起來第三季企業 MLR 未達 200 個基點相當於本季醫療補助壓力約 500 個基點。第一，這是值得思考的正確方向；第二，就像剛剛考慮到的數百個基點的增量壓力一樣，醫療補助計劃今天是否有利可圖？

Thank you. I'll ask Mark to respond to that as well.

謝謝。我也會請馬克對此做出回應。

Thank you very much for the question. The ballpark is about right for 2024. And as I think about the Medicaid business it is expected to be profitable this year. I'll be below our target margin range for the year itself.

非常感謝你的提問。預計 2024 年是正確的。我將低於我們今年的目標利潤範圍。

And it's important to know that you really can't look at the Medicaid marginal business in any particular single quarter. You know, they are normal quarter-to-quarter dynamics of the business. But importantly, over the long term, we do expect the Medicaid Managed Care business to be a profitable and an attractive one for us and it's integral and it is complementary to other health benefits and Carelon businesses.

重要的是要知道，您確實無法查看任何特定單一季度的醫療補助邊際業務。您知道，它們是業務的正常季度動態。但重要的是，從長遠來看，我們確實預計醫療補助管理式醫療業務對我們來說是一項有利可圖且有吸引力的業務，它是其他健康福利和 Carelon 業務不可或缺的補充。

Thanks for that mark. And again, just want to reiterate that, we do believe this is time bound. And we also believe that Medicaid is a very good business, particularly the specialized populations where we have unique capabilities.

謝謝你的那個標記。再次，我想重申一下，我們確實相信這是有時間限制的。我們也相信醫療補助是一項非常好的業務，尤其是我們擁有獨特能力的特殊人群。

But again, thank you for the question and next question please.

但再次感謝您提出問題，請下一個問題。

Erin Wright, Morgan Stanley.

艾琳·賴特，摩根士丹利。

And I wanted to ask on Medicare advantage, just based on the analysis of sort of the MA landscape now. And the latest kind of benefit design details is there is the competitive environment playing out as you would expect in terms of being fairly rational with the focus on kind of profit versus growth. Is it playing out according to plan there? And in driving some of that assumption in terms of your at or above market growth in M&A next year. Thanks.

我想問一下醫療保險的優勢，只是基於現在對 MA 情況的分析。最新的福利設計細節是，競爭環境正如你所期望的那樣，相當理性地關注利潤與成長。事情照計劃進行嗎？並推動明年的併購成長達到或高於市場水準的假設。謝謝。

Thanks for the question, Erin. You know, first, I think it's really important to realize we feel well positioned in MA. And we took a number of actions, prudent actions last year at the beginning of the year to position the business for long term.

謝謝你的提問，艾琳。你知道，首先，我認為認識到我們在馬薩諸塞州的定位非常重要。去年年初，我們採取了一系列謹慎的行動來為業務進行長期定位。

Importantly, we had a number of market exits of markets, we didn't think we saw long term sustainability. And this year, we continue to look for stability and make sure that we're in this business for the long term.

重要的是，我們有很多市場退出，我們認為我們沒有看到長期的可持續性。今年，我們繼續尋求穩定性並確保我們長期從事這項業務。

So I'm going to ask Felicia to comment now that we're a few days into a AEP and give you a perspective of our thoughts on the market.

因此，我將請 Felicia 發表評論，因為我們已經制定了 AEP 幾天，並向您介紹我們對市場的看法。

Thank you, Gail and, thank you Erin for the question. You know, our strategy as we look at Medicare Advantage really didn't start this year around our approach to balancing membership and margin. We started last year to really take strategic actions in order to create a sustainable foundation for growth in our Medicare Advantage business. And that included exiting several underperforming markets and that represented about 85,000 members.

謝謝蓋爾，謝謝艾琳提出的問題。您知道，我們在考慮 Medicare Advantage 時的策略實際上並不是從今年開始圍繞平衡會員資格和利潤的方法展開的。我們從去年開始真正採取策略行動，為我們的 Medicare Advantage 業務的成長奠定可持續的基礎。其中包括退出幾個表現不佳的市場，該市場約有 85,000 名會員。

In addition to that, we made significant reductions in our supplemental benefits in Puerto Rico on the heel of some losses in 2023. So if we put together our bid for 2025 we started the work with the foundation and wanted to make sure that we maintain stability where we need it to. But we wanted to be very focused on a balance between growth and margin, particularly in attractive and sustainable products and performance for us as we went forward.

除此之外，在 2023 年出現一些損失之後，我們大幅減少了波多黎各的補充福利。需要它的地方。但我們希望非常關注成長和利潤之間的平衡，特別是在我們前進的過程中有吸引力且可持續的產品和業績。

Specifically, we focus very much on our [D] step business in our high priority markets where we have the assets and the cost structure to really support leading market share. Additionally, I want to note that our products are predominantly HMO, not PPO and we were very prudent in our positioning, overlaying our local market dynamics and consumer preferences with our own market prioritization framework.

具體來說，我們非常關注我們高優先市場中的 [D] 步驟業務，我們擁有真正支持領先市場份額的資產和成本結構。此外，我想指出的是，我們的產品主要是 HMO，而不是 PPO，我們的定位非常謹慎，將我們當地的市場動態和消費者偏好與我們自己的市場優先順序框架相結合。

So when we look at where we are now, only two days into AEP, we feel very good about how we're position in terms of our key products and our target market. We prudently navigated the environment. And as we sit here today, as you said, we really expect to grow in line or slightly better than the market, but competitively feel, we're very positioned well as we head into this AEP. Thank you.

因此，當我們看看我們現在的處境時，AEP 啟動僅兩天，我們對我們在關鍵產品和目標市場方面的定位感到非常滿意。我們謹慎地應對環境。正如您所說，我們今天坐在這裡，我們確實期望成長與市場一致或略好於市場，但從競爭角度來看，我們在進入 AEP 時處於非常有利的位置。謝謝。

Thank you. Next question, please.

謝謝。請下一個問題。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

Thanks. Good morning. I wanted to follow up on your comments around Medicaid trend accelerating through the quarter and being 3 times to 5 times typical to your point. I don't think anyone on this call has ever heard of trend being discussed in terms of multiples of typical. And given it got worse through the quarter.

謝謝。早安.我想跟進您對本季度醫療補助趨勢加速的評論，並且是您觀點的典型趨勢的 3 到 5 倍。我認為這次電話會議中沒有人聽說過以典型倍數來討論趨勢。鑑於整個季度情況變得更糟。

Just curious if you could give us some color on what's going on through the quarter. Is it that you're seeing people come back on the rolls that are sicker, given the redeterminations themselves should have been, you know, give or take, run out at this point.

只是好奇您是否能給我們一些有關本季發生情況的資訊。是不是你看到人們回來時病情更重了，因為重新決定本身應該在這一點上用完。

And then, you know, given that it looks like the exit rate in the quarter is the lowest margin, the highest cost sounds like. Can you tell us where you were ending the quarter and where you expect to be for the fourth quarter versus that 3% to 4% margin target that we all think about. Thanks.

然後，你知道，鑑於本季的退出率看起來是最低的利潤，聽起來成本最高。您能否告訴我們本季結束時的情況以及第四季度的預期情況與我們都考慮的 3% 至 4% 的利潤率目標相比。謝謝。

Thanks for the question. Just a couple of thoughts. And I'll ask Mark to provide a little bit more perspective. Remember again, this was the most significant change we've seen in membership in Medicaid probably as long as I've been in this business coming off of the PHE and again, the driver was this acceleration that we saw through the third quarter. And we did plan for accelerated acuity in our business, which I think is important.

謝謝你的提問。只是幾個想法。我會請馬克提供更多的觀點。再次記住，這是我們在醫療補助會員資格方面看到的最重大的變化，可能是我從PHE 從事這項業務以來所看到的最重大的變化，而且驅動因素是我們在第三季度看到的這種加速。我們確實計劃加快業務敏銳度，我認為這很重要。

But again, none of us when you're planning for 3 times to 5 times the cost structure, we've been working very diligently with our state partners in terms of understanding those rates and where we need to be. And again, they are looking at data often times a year in arrears and have been responsive to changing their process. But it has not kept pace yet and we think it will take them some time.

但同樣，當你計劃 3 到 5 倍的成本結構時，我們一直在與我們的州合作夥伴非常努力地合作，以了解這些費率以及我們需要達到的目標。再說一次，他們每年都會經常查看拖欠的數據，並且對流程的改變做出了積極的回應。但它還沒有跟上步伐，我們認為這需要一些時間。

With that, let me ask Mark to give a little bit more perspective on some of the other questions that you had embedded.

接下來，讓我請馬克對您提出的其他一些問題提供更多的看法。

Just to add additional color here, as you heard from Gail. We definitely plan for an elevated level of trend in 2024 relative to the historic average Medicaid trend, which is running in the low single digit percent range. And to the point we made earlier, that trend is now running around 3 to 5 times historic average levels of course, depending on the states and meaningfully above our expectations.

正如您從蓋爾那裡聽到的那樣，只是為了在這裡添加額外的色彩。我們絕對計劃在 2024 年相對於歷史平均醫療補助趨勢（目前處於低個位數百分比範圍內）提高趨勢水準。正如我們之前指出的那樣，這一趨勢現在約為歷史平均水平的 3 到 5 倍，當然，具體取決於各州，並且明顯高於我們的預期。

And that's really driven by this unprecedented redetermination related activity, which has resulted in several downstream changes in membership, mix membership count security program adjustments, et cetera. I'd also like just to reiterate sort of that long term target for Medicaid is in that 2% to 4% range.

這實際上是由這種前所未有的重新確定相關活動所推動的，這導致了會員資格、混合會員數量安全計畫調整等方面的一些下游變化。我還想重申醫療補助的長期目標是在 2% 到 4% 的範圍內。

And finally, just to your point, we've also not been standing still. Obviously, we've been very active in managing the things that we can control around cost structure and acceleration of initiatives that we had in place around AI and making our business sustainable for the long term.

最後，就你的觀點而言，我們也沒有停滯不前。顯然，我們一直非常積極地管理我們可以控制的成本結構和加速我們圍繞人工智慧制定的舉措，並使我們的業務長期可持續發展。

And again, very active with our state partners, proud of our teams for the work that they've done to bring this forward. But again, we do think this will take time to work with our state partners to get the match at the appropriate level.

再次，我們與我們的州合作夥伴非常積極地合作，為我們的團隊為推動這一目標所做的工作感到自豪。但同樣，我們確實認為這需要時間與我們的州合作夥伴合作，以使比賽達到適當的水平。

So thanks for the question and next question, please.

謝謝你提出這個問題，還有下一個問題。

Lisa Gill, JPMorgan.

麗莎·吉爾，摩根大通。

Thanks very much and good morning. Gail, one of your peers talked about accelerating Rx trends, and specialty. You know, we've seen changes to IRA around catastrophic coverage, the one you haven't called out anything around Rx as far as cost trend goes. Are you seeing that? How did you price for that going into 2025? And then just on the flip side, CarelonRx had very strong results is that a key driver of what we're seeing, especially on the specialty side and growth and specialty.

非常感謝，早安。蓋爾，你的一位同行談到了加速 Rx 趨勢和專業。你知道，我們已經看到 IRA 圍繞災難性保險發生了變化，就成本趨勢而言，你還沒有在 Rx 方面提出任何變化。你看到了嗎？到 2025 年，您是如何定價的？另一方面，CarelonRx 取得了非常強勁的業績，這是我們所看到的關鍵驅動因素，特別是在專業方面以及成長和專業方面。

So, thanks for the question, Lisa. Let me get a little perspective directly on your question and I'll ask Peter Haytaian, who leads our pharmacy business to provide some more contacts. So year-to-date, we have seen an increase in Medicare advantage, [part D] especially drug utilization. But the trends in unit cost have been in line with our assumptions. So we don't see it as a significant impact to what we've been talking about.

所以，謝謝你的提問，麗莎。讓我直接回答您的問題，然後我會請領導我們藥局業務的 Peter Haytaian 提供更多聯絡資訊。今年迄今為止，我們看到醫療保險優勢增加，[D 部分] 特別是藥物利用率。但單位成本的趨勢符合我們的假設。因此，我們認為這不會對我們一直在談論的內容產生重大影響。

Let me ask Pete to give you a little more perspective on what's happening in terms of overall pharmacy.

讓我請皮特給您更多關於整體藥房正在發生的事情的看法。

Yeah. Thanks Lisa for the question. As you said, we were very pleased with what we're seeing, you know, in terms of our CarelonRx strategy and growth. We can send you down our path of insourcing the strategic levers that matter down our path of specialty pharmacy and infusion. We're making really good progress there.

是的。謝謝麗莎的提問。正如您所說，我們對我們所看到的 CarelonRx 策略和成長感到非常滿意。我們可以引導您內包我們在專業製藥和輸液領域至關重要的策略槓桿。我們在那裡取得了非常好的進展。

And as it relates to growth, our story is resonating in the marketplace. We're beginning to see a lot of pull through in that regard and we've had some nice wins going into 2025 upmarket as well. So that is all proceeding as planned.

由於與成長相關，我們的故事在市場上引起了共鳴。我們開始看到這方面取得了很大進展，並且在進入 2025 年高端市場時我們也取得了一些不錯的勝利。所以一切都按計劃進行。

In terms of our overall, performance from an operating margin perspective though, as Gail said, we did expect what we saw in the specialty pharmacy trends, we did see that increase, but it was really as expected when you look at our overall margins, the out performance in the quarter was largely due to a one time favorable revenue adjustment that was in a year. And when you, even that out or spread that out through the year the full year still remains on track in terms of our initial guidance around the 6%, 6.5% margin profile. So we feel overall very good about where we are and where we expected to be.

就我們的整體業績而言，從營業利潤率的角度來看，正如蓋爾所說，我們確實預計到我們在專業藥房趨勢中看到的情況，我們確實看到了這種增長，但當你看在看我們的整體利潤率時，這確實符合預期，本季的出色表現主要歸功於一年內一次有利的收入調整。即使是這樣，或將其分散到全年，根據我們圍繞 6%、6.5% 利潤率的初步指導，全年仍然保持在正軌上。因此，整體而言，我們對自己所處的位置和預期的位置感到非常滿意。

Thanks Pete. Next question, please.

謝謝皮特。請下一個問題。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Quick follow up on the rate outlook for Medicaid, if you could just give some color on what you observed as far as rate increases, maybe historically or in the first half of the year and then what you're seeing in the second half of the year and what your outlook is based on how far you are along in early '25.

快速跟進醫療補助的費率前景，如果您能就您觀察到的費率上漲情況提供一些顏色，可能是歷史上的或上半年的情況，然後是您在下半年看到的情況25 年初，您的展望取決於您的進展。

And then the broader question was just, are you, are you anticipating making any strategic moves as a result of these pressures that again are time bounded? And as part of that, does this make any change in how you might insource all of the functions of your PB ? Thanks.

然後更廣泛的問題是，您是否預計由於這些同樣有時間限制的壓力而採取任何策略行動？作為其中的一部分，這是否會改變您將 PB 的所有職能內包的方式？謝謝。

So a lot of questions here, Lance. Thank you. Let me, let me just address your question on strategic. Then I'll ask Felicia specifically talk about Medicaid. You know, we feel we've laid out a very comprehensive strategy around the growth drivers and the opportunities as I shared in the first question, really, how we see acceleration in revenue and strong commercial business. We believe that time bound issues around Medicaid. And we think we will work through those with the assets we have.

這裡有很多問題，蘭斯。謝謝。讓我來回答你關於戰略的問題。然後我會請費莉西亞具體談談醫療補助。你知道，我們認為我們已經圍繞著成長動力和機會制定了非常全面的策略，正如我在第一個問題中所分享的那樣，實際上，我們如何看待收入的加速和強大的商業業務。我們認為醫療補助存在時間限制問題。我們認為我們將利用我們擁有的資產來解決這些問題。

And then Medicare being well positioned and Carelon is a real accelerator for us. And as you saw, we announced an additional acquisition this morning as part of care bridge that gives us home based care and another pillar inside of our growth strategy for Carelon services where we can take significantly more pass through of the type of medical expense we're managing inside of Carelon.

然後，醫療保險處於有利位置，而 Carelon 是我們真正的加速器。正如您所看到的，我們今天早上宣布了一項額外收購，作為護理橋樑的一部分，該橋樑為我們提供了家庭護理，也是我們Carelon 服務增長戰略的另一個支柱，我們可以通過這種方式獲得更多的醫療費用類型的轉嫁。

So I would say, we're very focused on the long term growth drivers and our flywheel for growth inside of Elevance Health and feel very positive about the fundamentals of our business. So strategically, I think we're moving forward in the exact same path that we've laid out and in the pharmacy side taking more control of the levers that matter for us.

所以我想說，我們非常關注長期成長動力和 Elevance Health 內部成長的飛輪，並對我們業務的基本面感到非常積極。因此，從戰略上講，我認為我們正在沿著我們所製定的完全相同的道路前進，並在藥房方面更多地控制對我們重要的槓桿。

And you've continued to see us integrate the Kroger specialty pharmacy acquisition, our advanced home delivery. So feel very good about that progress and we're dealing with the time based issues in Medicaid right now. But let me ask Felicia to address the Medicaid specifically.

您不斷看到我們整合了克羅格專業藥局收購和先進的送貨上門服務。因此，對這一進展感到非常滿意，我們現在正在處理醫療補助中基於時間的問題。但讓我請費莉西亞具體談談醫療補助。

Good morning and thanks for the question. You know, if you can imagine the rate negotiations with our state partners are ongoing. And when you take a look at how our portfolio of business is spread out across the year, we have about half of our states that are January States and the other half that are July States. And in the back half of the year, the work that we started with our state, certainly around the July States and rates certainly took a look at the '25 rates that they were working with us on.

早安，謝謝你的提問。你知道，如果你能想像與我們的國家合作夥伴的費率談判正在進行中。當你看看我們的業務組合在一年中的分佈時，你會發現我們大約一半的州是一月的州，另一半是七月的州。在今年下半年，我們在我們的州（當然在 7 月各州）開始的工作，當然也考慮了他們與我們合作的 25 年利率。

But we also put a lot of work to work with our states on understanding the trends that we're seeing in the first half of the year. As you heard earlier, the reference period for most of our states are 2023 when you think about the '25 rate setting process. So there will certainly be that missile assignment and that timing mismatches, we talk about.

但我們也投入了大量工作與各州合作，以了解我們在今年上半年看到的趨勢。正如您之前所聽到的，當您考慮「25」利率設定流程時，我們大多數州的參考期是 2023 年。因此，我們談論的導彈任務和時間安排肯定會不匹配。

When we look at the work that we're seeing with our state partners. Some states have certainly been more receptive to going back and taking a look at those and addressing those rates. Now, we've had certain states that have given us mid-year rate adjustments and more of those will happen as we go through the back half of the year and early next year as well.

當我們看到我們與國家合作夥伴所做的工作時。一些州肯定更願意回頭看看這些問題並解決這些問題。現在，我們已經有某些州對我們進行了年中利率調整，而在今年下半年和明年初，更多的調整將會發生。

But as you heard earlier, this is a process which you clearly understand that will take some time to actually get total alignment between our rates and the security of the membership that we're seeing on the heels of an unprecedented change and mix with respect to this business.

但正如您之前所聽到的，這是一個您清楚了解的過程，需要一些時間才能在我們的費率和會員安全之間真正實現完全一致，這是我們在前所未有的變化和組合之後看到的這項業務。

But I will tell you, we are going to continue our strong advocacy working with our state partners, sharing up to date information around the changes that we're seeing and we have full confidence that we will ultimately have rates that are aligned with the acuity of the membership in our population. So thank you for the question.

但我會告訴你，我們將繼續與我們的國家合作夥伴合作，大力倡導，分享有關我們所看到的變化的最新信息，我們完全有信心，我們最終將獲得與敏銳度相一致的費率我們人口中的成員。謝謝你的提問。

Thank you. Next question, please.

謝謝。請下一個問題。

Joshua Raskin, Nephron.

約書亞·拉斯金，尼弗龍。

Hi, saying sorry to stay on the topic, but I'm still struggling with why the security rate mismatches accelerating now or why this cost trend is accelerating now. My understanding is that most of the redeterminations, you know, have been done, right? This started over a year ago. So felt like there was less redetermination activity in the most recent quarter than previously.

你好，很抱歉繼續談論這個主題，但我仍然在努力思考為什麼安全率不匹配現在正在加速，或者為什麼這種成本趨勢現在正在加速。我的理解是，大部分重新決定已經完成，對嗎？這件事從一年多前就開始了。所以感覺最近一個季度的重新確定活動比以前少了。

And I think, last quarter, there was this conversation around higher utilization for members that were about to lose coverage. And so you would have expected that to slow. So I guess I'm still confused as to what's causing this big acceleration in this trend. Why is that happening so late in the process?

我認為，上個季度，圍繞著提高即將失去保險的會員的利用率進行了討論。所以你會預期這一速度會放緩。所以我想我仍然對是什麼導致了這一趨勢的大幅加速感到困惑。為什麼這個過程發生得這麼晚？

Josh, good morning and thanks very much for the question. Two key points. I'd like you to keep in mind here.

喬希，早安，非常感謝你的提問。兩個關鍵點。我希望你記住這裡。

First, we've modeled a prudent view of costs for the fourth quarter and you could think about that as us holding Medicaid trend, approximately flat relative to where we were in September.

首先，我們對第四季度的成本進行了謹慎的建模，您可以認為我們持有醫療補助趨勢，與 9 月的水平大致持平。

And the second key point to keep in mind here is that we had unfavorable development related to the current year in the quarter.

這裡要記住的第二個關鍵點是，本季我們的發展與今年相關。

Next question, please.

請下一個問題。

Michael Halloran, Baird.

麥可·哈洛倫，貝爾德。

So, just to add on the Medicaid topic. So based on your '24 guide, if I'm not mistaken, implied, 4Q impact actually seems to be larger than your third quarter, MLR Pressure. So it sounds like this is the case. But is this basically assuming the security rate mismatch worsen in the next quarter even though you have all your September October rate increases.

所以，只是補充一下醫療補助主題。因此，根據您的 24 年指南，如果我沒有記錯的話，第四季度的影響實際上似乎比第三季的 MLR 壓力更大。所以聽起來好像是這樣的。但這基本上是假設安全利率錯配在下個季度惡化，即使你的 9 月 10 月利率都上漲了。

And at this point, I guess in mid-October, do you think you now have enough data and visibility into your own acuity mix that you can pass along to these states in time for Jan one renewals or just, you know, I presume draft rates are pretty already there. So could they open that back up and adjust or is it too late -- you?

在這一點上，我想在十月中旬，你認為你現在有足夠的數據和對你自己的敏銳度組合的可見性，你可以及時傳遞到這些州以進行一月的續約，或者只是，你知道，我想選秀利率已經差不多了。那麼他們可以打開備份並進行調整嗎？

Yeah, a couple of things, just high level one, you also have to factor in a seasonality into the fourth quarter. So make sure you're doing that and I'll ask Felicia to talk a bit about Medicaid and the process that just goes on a rate setting.

是的，有幾件事，只是高水準的一件事，你還必須考慮到第四季的季節性因素。因此，請確保您正在這樣做，我將請 Felicia 談談醫療補助以及費率設定的流程。

Yeah. So, you know, thank you so much for the question again. You know, at this point, we have about 55% of our rate visibility for premium for January. However, those are draft rates. So we spend a lot of time with our states right now making sure that they understand the experience that we were seeing in the second and third quarters as we head into the rate setting process.

是的。所以，你知道，非常感謝你再次提出這個問題。您知道，目前我們的 1 月份保費費率可見度約為 55%。然而，這些都是草稿費率。因此，我們現在花了很多時間與各州溝通，以確保他們了解我們在進入利率制定過程時在第二季和第三季所看到的經驗。

So yes, when we have draft rates, the process is still iterative and ongoing and we are continuing to make sure that the states have visibility around that information. So we have 55% as I said, of visibility into the January renewals, but those are early discussions, Michael and expect a lot of work to happen between now and the end of the year in terms of the work between us and our state partners.

所以，是的，當我們有了草案費率時，這個過程仍然是迭代和持續的，我們將繼續確保各州能夠了解這些資訊。因此，正如我所說，我們對 1 月份續約的可見度為 55%，但這些只是早期討論，邁克爾，預計從現在到今年年底，我們和我們的州合作夥伴之間將開展大量工作。

Maybe one to comment just to add on to Felicia's remarks. Just to reaffirm, Medicaid trend is not expected to accelerate in the fourth quarter. It's primarily seasonality that's resulting in these numbers.

也許有人想發表評論只是為了補充費利西亞的言論。只是重申，醫療補助趨勢預計不會在第四季加速。這些數字主要是季節性造成的。

Next question, please.

請下一個問題。

Ryan Langston, Cowen.

瑞安·蘭斯頓，考恩。

Hi, good morning. It sounds like you expect growth on the exchange side into 2025. So I guess in that context, how should we think about the margin profile for maybe just the exchanges in the overall commercial business? I think you can.

嗨，早安。聽起來您預計交易所方面的成長將持續到 2025 年。我想你可以。

Thank you very much for the question. We have Morgan Kendrick, who leads our commercial business. Respond to that,

非常感謝你的提問。我們有摩根肯德里克 (Morgan Kendrick)，他負責領導我們的商業業務。對此作出回應，

Ryan, thank you for the question. We act, we feel really good about our commercial business in aggregate and certainly the individual ACA is a big piece of that. We've taken a very disciplined approach over the last 36 months in gradually expanding our footprint and our competitiveness in our 14 geographies, as Gail mentioned in the prepared Marks up front, we're expanding that in other markets.

瑞安，謝謝你的提問。我們採取行動，我們對我們的商業業務總體感覺非常好，當然個人 ACA 是其中的重要組成部分。在過去36 個月裡，我們採取了非常嚴格的方法，逐步擴大我們在14 個地區的足跡和競爭力，正如蓋爾在前面準備好的標記中提到的那樣，我們正在其他市場中擴大這一範圍。

So this year, we're expecting to have nice growth in our markets, probably improving share in the markets that we served by about two points moving forward. That said when I think about next year, we're positioned really well and in the geographies where we've already served, We're in the process of sort of determining the positioning in the markets that we're moving into, but are really excited about that business. And it also being in line with our expectations on the economics.

因此，今年，我們預計我們的市場將實現良好成長，未來我們所服務的市場份額可能會提高約兩個百分點。也就是說，當我想到明年時，我們的定位非常好，並且在我們已經服務的地區，我們正在確定我們正在進入的市場的定位，但是對這項業務真的很興奮。這也符合我們對經濟的預期。

Thank you. And, just another thing to remember, those are states where we also have Medicaid and Medicare business. So it aligns with us knowing those states.

謝謝。而且，需要記住的另一件事是，我們在這些州也有醫療補助和醫療保險業務。所以它與我們了解這些狀態是一致的。

Well, thank you. Next question.

嗯，謝謝。下一個問題。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

Hi. Thanks. Just interested if you could maybe dimension for us and discuss some of the downstream impacts from the Medicaid environment to the Carelon health businesses. Do you know that there's quite a bit of leverage or exposure in those businesses to Medicaid? So curious , on how those businesses are performing and how you're positioning them around some of these dynamics, we're seeing a Medicaid. Thanks.

你好。謝謝。只是有興趣，您是否可以為我們討論一下醫療補助環境對 Carelon 健康業務的一些下游影響。您是否知道這些企業對醫療補助有相當大的槓桿或曝險？非常好奇這些企業的表現如何以及如何圍繞其中一些動態對它們進行定位，我們看到了醫療補助。謝謝。

Yeah, thanks for the question, Scott. I'll ask Pete to address your questions.

是的，謝謝你的提問，斯科特。我會請皮特回答你的問題。

I think it's a great question. I appreciate it. First, just stepping back and thinking about Carelon overall and as you heard in the prepared remarks. Overall, very pleased with the growth trajectory of Carelon Services exceeding 30% growth in the quarter, a quarter year-over-year, not on a path to exceed initial guidance of the high teen low '20. So we feel very good about that.

我認為這是一個很好的問題。我很感激。首先，退一步思考卡倫的整體情況，正如您在準備好的演講中聽到的那樣。總體而言，我們對 Carelon Services 本季成長超過 30%（年成長 30%）的成長軌跡感到非常滿意，但並未超過 20 年高青少年低點的初步指導。所以我們對此感覺非常好。

And as it relates to growing internally and externally, I'll say that we're, we're continuing down the path that we've been in with regard to proving out our solutions internally and then growing externally, I did want to point out that and as Gail mentioned in the prepared remarks, seeing really nice traction externally, I'd say 4 times improvement in terms of growth in 2024 and good visibility on 2025.

由於它涉及內部和外部的增長，我想說的是，我們正在繼續沿著我們一直在內部證明我們的解決方案然後外部增長的道路前進，我確實想指出正如蓋爾在準備好的發言中提到的那樣，看到外部的巨大吸引力，我想說2024 年的成長將提高4 倍，2025 年的能見度也將提高。

As it relates to your question. Specifically, yes, we do have products oriented to Medicaid, Medicare, we are taking full risk and as it relates to our performance overall, we are seeing some of those behavioral health trends play through. So when you look at the margin profile in the short term, we are being impacted by the behavioral health trends, we are also being impacted by the acceleration some of the risk arrangements that we're deploying.

因為它與你的問題有關。具體來說，是的，我們確實有醫療補助、醫療保險的產品，我們正在承擔全部風險，因為它與我們的整體績效相關，我們正在看到一些行為健康趨勢正在發揮作用。因此，當你觀察短期的利潤狀況時，我們會受到行為健康趨勢的影響，我們也會受到我們正在部署的一些風險安排的加速的影響。

And as you recall, I think I've said it in the past early on when we launch these risk arrangements, the margin profile is a bit more compressed and then as it evolves, it improves. So the combination of those two factors is what's been affecting us in the short term. We feel very good about the long term and continuing to grow within the government program business as well as in the commercial business. We are pursuing a diversified approach just like the rest of Elevance Health.

正如您所記得的那樣，我想我在過去很早就說過，當我們推出這些風險安排時，保證金狀況會更加壓縮，然後隨著它的發展，它會有所改善。因此，這兩個因素的結合在短期內影響了我們。我們對政府專案業務和商業業務的長期發展和持續成長感到非常滿意。就像 Elevance Health 的其他部門一樣，我們正在追求多元化的方法。

Next question, please.

請下一個問題。

Whitman Mayo, Leerink Partners.

惠特曼·梅奧，Leerink 合夥人。

Hey. Thanks. I just wanted to go back and follow up. I think it was Justin's question, not sure I actually heard the answer.

嘿。謝謝。我只是想回去跟進。我認為這是賈斯汀的問題，不確定我是否真的聽到了答案。

Are the rejoiners coming back negatively impacting cost, like are they increasingly gaining access through the point of care through presumptive eligibility in the hospital or something like what does the actual care activity look like on the joiner population?

重新加入者的回歸是否會對成本產生負面影響，例如他們是否越來越多地透過醫院的推定資格透過護理點獲得服務，或者加入者群體的實際護理活動是什麼樣子？

It's Mark here. Thank you very much for the follow-up here. There are a number of train factors that are remaining to various degrees. And certainly, some have improved over the past quarters, think about like the pull forward effect to think about member mischaracterization and certainly some that are ongoing.

我是馬克。在此非常感謝您的關注。有許多列車因素在不同程度上仍然存在。當然，有些在過去幾季有所改善，例如考慮成員錯誤描述的拉動效應，當然還有一些持續發生的問題。

Really important here is that the state actuarial rate process and our ongoing discussions with them really aim to capture the overall cost of the members in ensuring the adequacy operates over time. On your question specifically, you could think about a portion of trained is being attributed primarily to the acuity mix shift versus, I think we spoke about last quarter, so that same-store type trade utilization.

這裡真正重要的是，國家精算率流程以及我們與他們正在進行的討論的真正目的是捕獲成員的整體成本，以確保隨著時間的推移充分運作。具體就你的問題而言，你可以認為一部分受過訓練的人主要歸因於敏銳度組合的轉變，我想我們上個季度談到過，所以同店類型的交易利用率。

And you could think about approximately 60% of the trend as being related to acuity mix. And the key point, as I'm going to sort of end here is that our embedded Medicaid outlook really does include prudent assumptions for cost trend in the fourth quarter, inclusive of all the underlying factors.

您可以認為大約 60% 的趨勢與敏銳度組合有關。我要在這裡結束的關鍵點是，我們的嵌入式醫療補助前景確實包括對第四季度成本趨勢的審慎假設，包括所有潛在因素。

Sarah James, Cantor Fitzgerald

莎拉詹姆斯，康托費茲傑拉

Thank you. Mark, when you said Medicaid is profitable in '24, is that across all states? Or is it a mix of some profitable and some not. And then can you just help us understand the actual actuarial soundness protection? Is that a two-year or a three-year period? If we look at '24 and '25 as below target margins. But I think '23 was a good year for you guys on Medicaid. Does that still give you a position to pursue retroactive rate increases on top of the midyear rate updates you're targeting?

謝謝。馬克，當你說醫療補助在 24 年獲利時，所有州都是如此嗎？或者是有些有利可圖，有些則無利可圖的混合體。那麼您能幫助我們了解實際的精算穩健性保護嗎？這個期限是兩年還是三年？如果我們將「24」和「25」視為低於目標利潤。但我認為 23 年對你們享有醫療補助的人來說是美好的一年。除了您目標的年中利率更新之外，這是否仍然可以讓您追求追溯升息？

Sarah, thank you very much for the question here. I'm not going to talk about states specifically. But simply just to note, Medicaid margins on the whole are expected to compress significantly this year. And we started out this extensively.

莎拉，非常感謝你在這裡提出問題。我不會具體談論州。但要注意的是，今年醫療補助的利潤率預計總體上將大幅壓縮。我們開始廣泛地進行這項工作。

This is the industrywide timing disconnect between rates and acuity. Our long-term expectations are unchanged. And that's because we are continuing to proactively collaborate with our state partners on integrating acuity into the rates that we're seeing. We know that's going to take time based on the state processes, the collection of data etc.

這是整個產業範圍內速率和敏銳度之間的時間脫節。我們的長期預期沒有改變。這是因為我們正在繼續積極與我們的州合作夥伴合作，將敏銳度納入我們所看到的利率中。我們知道，根據狀態流程、資料收集等，這將需要時間。

And so, we're very confident that over time, rates will certainly appropriately on an actuarial and otherwise basis reflect the underlying acuity that we're experiencing. And so, I would certainly say that we are confident in our long-term targets that we have set out and we're committed to achieving them.

因此，我們非常有信心，隨著時間的推移，利率肯定會在精算和其他基礎上適當地反映我們正在經歷的潛在敏銳度。因此，我肯定會說，我們對我們制定的長期目標充滿信心，並且致力於實現這些目標。

Thank you. And just reiterating, I think we do believe Medicaid is a long-term very good business for us. It's complementary to our other health benefits business and particularly around other specific populations that we think we have very unique skills to serve those. So again, thank you very much for your questions. We see Medicaid as a long term in this being an industry time-bound issue.

謝謝。重申一下，我認為我們確實相信醫療補助對我們來說是一項長期非常好的業務。它是我們其他健康福利業務的補充，特別是針對其他特定人群，我們認為我們擁有非常獨特的技能來為這些人群提供服務。再次非常感謝您的提問。我們認為醫療補助是長期的問題，因為這是一個產業有時限的問題。

Next question please.

請下一個問題。

Dave Windle, Jefferies.

戴夫·溫德爾，杰弗里斯。

Hi. Good morning. Thank you for taking my questions. I wanted to try to understand, respectively, the comments about kind of the cadence of rate recovery or achievement in Medicaid and then the confidence in MA bids for Medicare and with the question being in your mid-single-digit EPS growth for next year, do you expect margins in caid and care, respectively, to be up, flat or down?

你好。早安.感謝您回答我的問題。我想分別嘗試了解有關醫療補助費率恢復或成就的評論，以及對醫療保險投標的信心，以及明年的中個位數每股收益增長的問題，您預計caid 和care 的利潤率分別會上升、持平還是下降？

So thank you very much for the question. Let me ask Mark, first to address your questions on margins. And then, obviously, at this pace, we'll give you some directional commentary because it's still early in the year for '25 but we'll give you at least a sense of how we're thinking, Mark.

非常感謝你提出這個問題。讓我先問馬克，回答你關於利潤的問題。然後，顯然，按照這個節奏，我們會給你一些方向性的評論，因為現在還處於 25 年初，但我們至少會讓你了解我們的想法，馬克。

Overall, we expect for 2025 margins to continue to remain strong in commercial. Let me start there. On the Medicaid side, here, margins will remain below our long-term margin range and that's really predominantly related to the timing match that we've spoken about. You could think about them as effectively being stable year-over-year.

整體而言，我們預計 2025 年商業利潤率將持續保持強勁。讓我從這裡開始。在醫療補助方面，利潤率將保持在我們的長期利潤範圍以下，這實際上主要與我們談到的時間匹配有關。您可以認為它們實際上逐年穩定。

And then, on Medicare, because of the sustainability around our 2025 product positioning, we actually expect margins to improve in 2025 compared to 2024.

然後，在醫療保險方面，由於我們 2025 年產品定位的可持續性，我們實際上預計 2025 年的利潤率將比 2024 年有所改善。

Thanks for the question. Next question, please.

謝謝你的提問。請下一個問題。

Joanna Gajuk, Bank of America.

喬安娜·加尤克，美國銀行。

Hi. Good morning. Thanks so much for taking the question. So just last question, I guess, on this Medicaid commentary, and I guess the margin commentary you just made in terms of margins being stable to be in next year. Is that I guess, confirmation that you assume that by the end of '25, the Medicaid rate mismatch will be fully restored? Is that the way to read by the end of the year, it's going to be restored?

你好。早安.非常感謝您提出問題。我想，最後一個問題是關於醫療補助的評論，我想你剛剛就利潤率在明年保持穩定所做的利潤率評論。我猜這是確認您認為到 25 年底，醫療補助費率不匹配將完全恢復嗎？難道就這樣讀到年底，就要恢復了嗎？

Thanks for the question. Let me actually step back for a second and think about MLR guidance for 2025, and we're not looking to provide that necessarily today, but let me share a few modeling considerations that might help you. First, again, with respect to the third quarter, we had some out-of-period items, including unfavorable entry or development for the Medicaid business, and we do not expect that.

謝謝你的提問。實際上，讓我退一步思考 2025 年 MLR 指導意見，我們今天並不打算提供這一指導意見，但讓我分享一些可能對您有所幫助的建模注意事項。首先，再說一遍，關於第三季度，我們有一些過時的項目，包括醫療補助業務的不利進入或發展，我們預計不會發生這種情況。

As we progress toward and through 2025, you could think about that as a first half, second half story, where we expect the rate versus acuity mismatching Medicaid to narrow as the year progresses and as rates continue to improve.

隨著我們向2025 年邁進並直至2025 年，您可以將其視為上半部分和下半部分的故事，我們預計隨著時間的推移以及比率的持續改善，醫療補助的比率與視力不匹配的情況將會縮小。

It's also important when you think about the modeling for the business to remember that January 1 is a major renewal base in our commercial business, right. And that marks the beginning of an end, we also marked the beginning of a new plan year for Medicare. So we're remaining intensely focused on the appropriate medical management, and that's going to continue through 2025. I would say otherwise, it's too early to provide specific individual line of business guidance as we head into next year.

當您考慮業務建模時，請記住 1 月 1 日是我們商業業務的主要更新基礎，這一點也很重要，對吧。這標誌著結束的開始，我們也標誌著醫療保險新計劃年的開始。因此，我們仍然高度關注適當的醫療管理，並將持續到 2025 年。

Right. And thanks, Mark. And just to reiterate that, we're taking a prudent view of the timing on the mismatch in Medicaid and want to be respectful of the safe process and the work we're doing, we feel that it has been a very good process with the states. But again, they have to get their data from prior periods.

正確的。謝謝，馬克。只是重申一下，我們對醫療補助不匹配的時機持謹慎態度，並希望尊重安全流程和我們正在做的工作，我們認為這是一個非常好的流程州。但同樣，他們必須從之前的時期取得數據。

And so, we're trying to update them on what we're seeing. So again, it's early in the timing, but we wanted to give some our confidence in the long term of our business and the fundamentals. But again, I want to take a prudent view of what's happening in Medicaid, particularly on the state rate. We'll have one more question, please.

因此，我們正在嘗試向他們通報我們所看到的最新情況。再說一次，現在還為時過早，但我們希望讓一些人對我們業務的長期發展和基本面充滿信心。但我想再次謹慎地看待醫療補助的情況，特別是州費率。請再問我們一個問題。

George Hill, Deutsche Bank.

喬治·希爾，德意志銀行。

Hey. Good morning, guys. And just kind of a couple of quick follow-ups here on the Medicaid again. I guess number one, -- , could you provide more color on what drove the PYD in the quarter? And then, I guess from a state concentration perspective is kind of -- is the discrepancy between rates and acuity broad-based? Or is -- are there state concentrations here that we should be concerned about, like that could speed the resolution of the issue?

嘿。早安，夥計們。再次對醫療補助進行一些快速跟進。我想第一，您能否提供更多有關本季 PYD 推動因素的資訊？然後，我想從國家集中度的角度來看，利率和敏銳度之間的差異是否具有廣泛的基礎？或者是──我們是否應該擔心國家的集中，這樣可以加快問題的解決？

So in terms of your overall question, clearly, we manage a portfolio of states, and we don't get into specific states. But every state is a little bit different based on the population we serve and the programs that are in place. So I wouldn't make it generalized across all states. I know that we are working very diligently with each of the states to make sure -- and again, this is industrywide, not just unique to Elevance Health, and we see this across everything.

因此，就您的整體問題而言，顯然，我們管理一系列州，我們不會進入特定州。但根據我們服務的人口和實施的計劃，每個州都略有不同。所以我不會將其推廣到所有州。我知道我們正在與每個州非常努力地合作，以確保這是整個行業的，而不僅僅是 Elevance Health 獨有的，我們在所有方面都看到了這一點。

So thank you very much for the question. And now we'll turn, I think, to, first of all, say thank you, operator, and thank you for all the interest and support of everyone who has been on the line. I just want to reiterate, we're confident that we're making the right investments position Elevance Health for strong and sustainable growth over the long term and that we are confident we're going to emerge from this period of unprecedented to change even stronger. Thank you, everyone, for your interest in Elevance Health, and thank you for joining us on this call.

非常感謝你提出這個問題。我想，現在我們首先要對接線員表示感謝，並感謝所有線上用戶的興趣和支持。我只是想重申，我們有信心我們對 Elevance Health 進行了正確的投資，以實現長期的強勁和可持續增長，並且我們有信心我們將擺脫這個前所未有的時期，變得更加強大。感謝大家對 Elevance Health 的關注，也感謝您參加我們的這次電話會議。

Ladies and gentlemen, a recording of this conference will be available for replay after 11:00 AM today through November 16, 2024. You may access the replay system at any time by dialing (866) 510-4837, and international participants can dial (203) 369-1943.

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11 月16 日期間進行重播。 ( 203）369-1943。

This concludes our conference for today. Thank you for your participation and for using Verizon conferencing. You may now disconnect.

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。