Elevance Health Inc (ELV) 2025 Q2 法說會逐字稿

Thanks, ladies and gentlemen. Thank you for standing by and welcome to the Elevance Health second-quarter earnings conference call. Later we will conduct a question-and-answer session. (Operator Instructions) As a reminder, today's conference is being recorded.

謝謝各位，女士們、先生們。感謝您的支持，歡迎參加 Elevance Health 第二季財報電話會議。稍後我們將進行問答環節。（操作員指示）提醒一下，今天的會議正在被錄音。

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

現在我想將會議交給公司管理階層。請繼續。

Good morning, and welcome to Elevance Health’s second-quarter 2025 earnings conference call. My name is Nathan Rich, Vice President of Investor Relations.

早安，歡迎參加 Elevance Health 2025 年第二季財報電話會議。我叫 Nathan Rich，是投資人關係副總裁。

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.

今天早上參加收益電話會議的有總裁兼首席執行官蓋爾·布德羅 (Gail Boudreaux)、首席財務官馬克·凱伊 (Mark Kaye)、Carelon 總裁彼得·海泰安 (Peter Haytaian)、商業健康福利業務總裁摩根·肯德里克 (Morgan Kendrick) 和政府健康福利業務總裁費利西亞·諾伍德 (Felicia Norwood)。

Gail will begin the call with a discussion of our second quarter performance and revised outlook as well as the progress we've made 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討論我們第二季度的業績和修訂後的展望以及我們在戰略舉措方面取得的進展。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 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 may cause actual results to differ materially from our current expectations.

在通話過程中，我們將參考某些非公認會計準則指標。這些非公認會計準則 (non-GAAP) 指標與最直接可比較的公認會計準則 (GAAP) 指標的對帳表可在我們的網站 elevancehealth.com 上查閱。我們也將在本次電話會議上做出前瞻性陳述。請聽眾注意，這些聲明存在一定的風險和不確定性，其中許多難以預測且通常超出 Elevance Health 的控制範圍。這些風險和不確定性可能會導致實際結果與我們目前的預期有重大差異。

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.

我們建議聽眾仔細閱讀今天的新聞稿和我們向美國證券交易委員會提交的季度文件中討論的風險因素。現在我將電話轉給蓋爾。

Good morning, and thank you for joining us.

早安，感謝您加入我們。

Let me start by directly addressing our revised full-year outlook. We know this adjustment is disappointing, and we're taking concrete actions to address it. Our focus is on execution, making the right decisions now to strengthen the business and position Elevnace Health for long-term sustainable performance.

首先，我直接談談我們修改後的全年展望。我們知道這種調整令人失望，我們正在採取具體行動來解決它。我們的重點是執行，現在做出正確的決策來加強業務並使 Elevnace Health 實現長期可持續的績效。

Our strategy remains grounded in delivering whole health solutions that are simple, affordable and personalized. While the external environment continues to evolve, we are focused on the areas within our control, managing cost, deploying targeted investments and reinforcing the operational foundation that supports long-term value creation.

我們的策略始終立足於提供簡單、實惠且個人化的整體健康解決方案。在外部環境不斷變化的同時，我們專注於我們能控制的領域，管理成本，部署有針對性的投資，並加強支持長期價值創造的營運基礎。

In the second quarter, we delivered adjusted EPS consistent with our expectations. These results reflect continued strength in our Medicare Advantage portfolio and disciplined cost management across key parts of the business as we navigate evolving dynamics in the ACA and Medicaid markets. Our Carelon platform continues to drive growth.

在第二季度，我們實現了與預期一致的調整後每股盈餘。這些結果反映了我們在應對 ACA 和醫療補助市場不斷變化的動態過程中，醫療保險優勢產品組合的持續強勁表現以及關鍵業務部分的嚴格成本管理。我們的 Carelon 平台持續推動成長。

CarelonRx is gaining traction in the market with its integrated medical pharmacy offering. And Carelon services delivered strong results with CareBridge scaling rapidly across dual eligible and high acuity Medicaid populations. As I mentioned at the start of the call, we are revising our full year 2025 adjusted EPS guidance to approximately $30. This reset reflects the same pressures that others in the sector have now confirmed, particularly elevated medical cost trends across ACA and slower than expected Medicaid rate alignment.

CarelonRx 憑藉其綜合醫藥藥房服務在市場上獲得了越來越多的關注。Carelon 服務取得了顯著成果，CareBridge 在雙重合格和高敏感度醫療補助人口中迅速擴展。正如我在電話會議開始時提到的，我們正在將 2025 年全年調整後每股盈餘預期修改為約 30 美元。此次重置反映了該行業其他公司已經確認的相同壓力，特別是整個 ACA 的醫療成本趨勢上升以及醫療補助費率調整速度低於預期。

Importantly, this decision is anchored in our view that the elevated trends we are now observing will persist and reflects our updated visibility into the second half of the year. It is not based on assumptions of a near-term recovery.

重要的是，這項決定基於我們的觀點，即我們目前觀察到的上升趨勢將持續下去，並反映了我們對下半年的最新預測。它並非基於近期復甦的假設。

We are choosing to act now, not later, to ensure our outlook reflects prevailing conditions and to give investors a clearer visibility. We believe this step positions us to execute with discipline and begin rebuilding long-term margin stability that will empower our future growth. Looking ahead, we're executing against a clear strategy focused on strengthening structural performance across the enterprise.

我們選擇立即採取行動，而不是推遲，以確保我們的前景反映當前情況，並讓投資者有更清晰的認識。我們相信，這項措施使我們能夠嚴格執行並開始重建長期利潤穩定性，從而增強我們未來的成長。展望未來，我們正在執行一項明確的策略，重點是加強整個企業的結構績效。

We're advancing our efforts to stabilize trends, particularly in high-cost areas like specialty services, post-acute care and certain outpatient settings. Our programs focus on ensuring the right care in the rate setting, grounded in safety, quality and outcomes.

我們正在加強努力穩定趨勢，特別是在專科服務、急性後期護理和某些門診環境等高成本領域。我們的專案重點是確保在費率設定中提供正確的護理，以安全、品質和結果為基礎。

In support of our commitment to simplify care delivery, we have significantly streamlined our prior authorization processes with over half of electronic requests now processed in real time, and fewer requirements for high-performing providers. Our AI-enabled tools such as Health OS and Intelligent Clinical Assist, help streamline clinical workflows and accelerate routine approvals by surfacing relevant data.

為了履行簡化醫療服務的承諾，我們大大簡化了事先授權流程，現在超過一半的電子請求都可以即時處理，並且對高績效提供者的要求也減少了。我們的人工智慧工具，例如 Health OS 和 Intelligent Clinical Assist，可透過顯示相關數據來幫助簡化臨床工作流程並加快常規審批。

All medical decisions requiring clinical judgment are reviewed by licensed professionals with independent oversight to ensure [care is] appropriate, consistent and aligned with our commitment to quality. We're also using advanced analytics to identify fraud, waste and abuse, enabling us to intervene where patterns deviate from clinical and billing standards, reinforcing system integrity while protecting appropriate access to care.

所有需要臨床判斷的醫療決定均由有執照的專業人員在獨立監督下審查，以確保[護理]適當、一致且符合我們對品質的承諾。我們還使用先進的分析技術來識別詐欺、浪費和濫用行為，使我們能夠在模式偏離臨床和計費標準時進行幹預，加強系統完整性，同時保護適當的護理機會。

Our value-based care portfolio continues to expand, particularly in behavioral health and oncology. More than one-third of our benefit expense is now in downside risk arrangements, supporting improved care coordination and cost predictability. Through Carelon, we're scaling these capabilities across Elevance Health and with external clients helping to drive better outcomes for complex and chronic populations.

我們基於價值的護理組合不斷擴大，特別是在行為健康和腫瘤學領域。目前，我們的福利支出中有超過三分之一用於下行風險安排，以支持改善照護協調和成本可預測性。透過 Carelon，我們正在 Elevance Health 和外部客戶範圍內擴展這些功能，幫助為複雜和慢性人群帶來更好的結果。

Importantly, these are not future state aspirations. They are embedded in our operations today and form the core of our multiyear plan to stabilize margins and build sustainable earnings power. While it is still early to provide an initial outlook for 2026. The actions we're taking are designed to stabilize trend, improve pricing alignment and restore operating leverage over time.

重要的是，這些不是未來國家的願望。它們已融入我們今天的營運之中，並構成了我們穩定利潤率和建立可持續盈利能力的多年計劃的核心。雖然現在對 2026 年做出初步展望還為時過早。我們正在採取的行動旨在穩定趨勢、改善定價協調並隨著時間的推移恢復營運槓桿。

In ACA, we've already repriced products for rising cost intensity. We also expect a broader market reset in 2026 as the scheduled expiration of enhanced subsidies drives further risk pool changes and our position reflects early disciplined action. In Medicaid, we're proactively engaged with state partners to ensure that upcoming cycles continue to reflect the developing acuity environment. While rate recovery has lagged current cost levels, we expect a meaningful catch-up as utilization data becomes more actionable.

在ACA中，我們已經根據不斷上升的成本強度重新對產品進行了定價。我們也預計 2026 年市場將出現更廣泛的重置，因為增加補貼的預定到期將推動風險池的進一步變化，而我們的立場反映了早期的紀律行動。在醫療補助方面，我們積極與州合作夥伴合作，以確保即將到來的周期繼續反映不斷發展的敏銳度環境。儘管費率恢復落後於當前成本水平，但隨著利用率數據變得更具可操作性，我們預計會出現有意義的追趕。

In commercial, we're maintaining a disciplined approach to pricing, ensuring our renewals and network contracts are aligned to the trend environment. And in Medicare Advantage, we bid with discipline for the focus on margin normalization, supported by stable utilization and Carelon-led clinical programs.

在商業領域，我們保持嚴謹的定價方式，確保我們的續約和網路合約與趨勢環境保持一致。在醫療保險優勢計劃 (Medicare Advantage) 中，我們嚴格按照競標程序進行競標，重點關注利潤率正常化，並透過穩定的利用率和 Carelon 主導的臨床項目提供支援。

These steps, combined with our structural cost levers and care management, payment integrity and value-based care delivery are designed to improve visibility and consistency as we move through 2025 and into the next phase of growth. We recognize that revising guidance for the second consecutive year is disappointing, and we remain committed to transparency and strong execution as we continue to navigate unprecedented cost trend affecting multiple lines of business.

這些步驟與我們的結構性成本槓桿和護理管理、支付完整性和基於價值的護理服務相結合，旨在提高我們在 2025 年進入下一增長階段時的可見性和一致性。我們意識到連續第二年修改指導方針令人失望，我們將繼續致力於透明度和強有力的執行，因為我們將繼續應對影響多個業務線的前所未有的成本趨勢。

We're taking this step to reflect what we can control, sharpening our execution, focusing our investments and strengthening the core drivers that will support a more durable and sustainable future. And this would not be possible without the dedication of our nearly 100,000 associates that amplify our impact every day.

我們採取這項措施是為了反映我們能夠控制的事情，加強我們的執行力，集中我們的投資，並加強支持更持久和可持續的未來的核心驅動力。如果沒有我們近 10 萬名員工的奉獻，這一切都不可能實現，正是他們每天努力擴大我們的影響力。

We remain confident in the strength of our enterprise, the impact of our investments and our ability to create long-term value through operational discipline, innovation, and our commitment to Whole Health Transformation.

我們對我們的企業實力、我們的投資影響以及我們透過營運紀律、創新和對整體健康轉型的承諾創造長期價值的能力充滿信心。

With that, I'll turn it over to Mark to walk through the financials. Mark?

說完這些，我會把責任交給馬克介紹財務狀況。標記？

Thank you and good morning, everyone.

謝謝大家，早安。

Elevance Health reported second quarter GAAP diluted earnings per share of $7.72 and adjusted diluted earnings per share of $8.84. As Gail discussed, we have updated our full year 2025 adjusted earnings per share to be approximately $30, reflecting both an industry-wide increase in morbidity impacting our ACA business and a slower deceleration in Medicaid cost trend, pressures we expect to continue in the second half.

Elevance Health 公佈第二季 GAAP 稀釋每股收益為 7.72 美元，並在調整後稀釋每股收益為 8.84 美元。正如 Gail 所述，我們已將 2025 年全年調整後每股收益更新至約 30 美元，這不僅反映了全行業發病率的上升對我們 ACA 業務的影響，也反映了醫療補助成本下降趨勢的放緩，我們預計這些壓力將在下半年持續存在。

Although external conditions remain dynamic, we are prioritizing factors we can directly influence and which are within our control, including taking decisive actions to stabilize trend and align pricing for long-term sustainability. We ended the second quarter with 45.6 million medical members, down approximately 200,000 sequentially, driven by a reduction in Medicaid membership and lower effectuation rates in our ACA business, a dynamic we first highlighted on last quarter's earnings call.

儘管外部條件仍在變化，但我們優先考慮能夠直接影響且在我們控制範圍內的因素，包括採取果斷行動穩定趨勢並調整價格以實現長期可持續性。截至第二季度，我們的醫療會員人數為 4,560 萬，比上一季度減少約 20 萬，這主要是由於醫療補助會員人數減少以及 ACA 業務的實施率下降，我們在上個季度的收益電話會議上首次強調了這一動態。

Operating revenue was $49.4 billion, an increase of 14% year-over-year, principally reflecting higher premium yields in recognition of elevated cost trend and recently completed acquisitions in home health and specialty pharmacy. The consolidated benefit expense ratio was 88.9%, an increase of 260 basis points year-over-year, driven by our ACA and Medicaid businesses, partially offset by a favorable out-of-period settlement with the value-based care provider.

營業收入為 494 億美元，年增 14%，主要反映了成本上升趨勢帶來的保費收益率上升以及最近完成的家庭保健和專科藥房收購。綜合福利費用率為 88.9%，年成長 260 個基點，這主要得益於我們的 ACA 和醫療補助業務，但與基於價值的護理提供者達成的有利的期外和解協議部分抵消了這一影響。

In the ACA market, membership shifts from Medicaid into ACA following the redetermination process, together with lower effectuation rates have driven a market wide increase in morbidity resulting in elevated medical cost trends. We have also reviewed the latest data from the Wakely Consulting Group, and our expectation for risk adjustment remains unchanged.

在 ACA 市場中，會員資格在重新確定過程之後從 Medicaid 轉移到 ACA，再加上較低的生效率導致整個市場發病率上升，從而導致醫療成本趨勢上升。我們也審查了Wakely Consulting Group的最新數據，我們對風險調整的預期保持不變。

Importantly, our 2026 rate filings capture both the current increase in market wide morbidity and further risk pool deterioration resulting from the anticipated expiration of the enhanced subsidies. Medicaid cost trend decelerated in the second quarter, though at a more modest pace than initially expected. We are experiencing higher acuity resulting from ongoing disenrollments as well as an overall increase in member utilization.

重要的是，我們 2026 年的費率申報既反映了當前市場範圍內發病率的上升，也反映了由於預計增強補貼到期而導致的風險池進一步惡化。第二季醫療補助成本趨勢放緩，但速度比最初預期的要慢。由於會員不斷取消註冊以及會員利用率整體上升，我們的敏感度正在上升。

The rate updates we received for the July cohort aligned with our initial assumptions but lagged current trend levels. As a result, we now anticipate a prolonged Medicaid margin recovery period as it will take time for states to incorporate the latest experience into rates. Medicare Advantage cost trends remain in line with our expectations with Part D seasonality progressing as anticipated, and we continue to target stable margins for the year.

我們收到的七月利率更新與我們最初的假設一致，但落後於當前趨勢水準。因此，我們預計醫療補助利潤恢復期將會延長，因為各州需要時間將最新的經驗納入費率。醫療保險優勢計畫的成本趨勢與我們的預期一致，D 部分的季節性發展符合預期，我們將繼續以今年穩定的利潤率為目標。

Our adjusted operating expense ratio of 10.0% improved 140 basis points year-over-year. We are prioritizing strategic investments in innovative care models, artificial intelligence and pharmacy services to support long-term success.

我們的調整後營業費用率為 10.0%，年比改善了 140 個基點。我們優先對創新護理模式、人工智慧和藥房服務進行策略性投資，以支持長期成功。

Carelon's strong performance in the second quarter underscores our steadfast commitment to expanding its capabilities as we power our enterprise flywheel for growth. CarelonRx grew operating revenue by over 20% as we gained traction with larger clients and scaled our specialty pharmacy assets. Profitability in the quarter was impacted by ongoing initiatives around accelerating growth as we expand upmarket. Carelon Services delivered greater than 50% growth in revenue and operating gain through its expansion of risk-based relationships and the integration of CareBridge.

Carelon 在第二季度的強勁表現凸顯了我們堅定不移地致力於擴大其能力，為企業飛輪提供成長動力。隨著我們獲得更大客戶的青睞並擴大我們的專業藥房資產，CarelonRx 的營業收入增加了 20% 以上。隨著我們不斷拓展高端市場，本季的獲利能力受到了持續加速成長措施的影響。Carelon Services 透過擴大基於風險的關係和整合 CareBridge 實現了超過 50% 的收入和營業收益成長。

Turning to the balance sheet. We ended the quarter with a debt-to-capital ratio of 40.8%, preserving flexibility for strategic investments and opportunistic capital deployment. Year to date, we've returned approximately $2 billion to investors. Operating cash flow totaled $2.1 billion in the quarter, and we now expect approximately $6 billion for the full year, reflecting our revised earnings outlook and discrete working capital items.

轉向資產負債表。本季末，我們的債務資本比率為 40.8%，為策略性投資和機會性資本部署保留了靈活性。今年迄今為止，我們已向投資者返還了約 20 億美元。本季營運現金流總計 21 億美元，我們目前預計全年營運現金流約為 60 億美元，這反映了我們修正後的獲利預期和單獨的營運資本項目。

Turning to our revised guidance for 2025, we forecast our benefit expense ratio to be approximately 90% for the full year as elevated trend levels persist in our ACA and Medicaid businesses. In a dynamic operating environment, this outlook is a prudent foundation for execution during the second half of the year. With respect to seasonality, we contemplate slightly more earnings to be realized in the third quarter relative to the fourth quarter.

談到我們對 2025 年的修訂指南，我們預測全年福利費用率將達到約 90%，因為我們的 ACA 和醫療補助業務持續保持高趨勢水準。在動態的營運環境中，這種前景為下半年的執行奠定了審慎的基礎。就季節性而言，我們預計第三季的獲利將比第四季略高。

And looking ahead, we're also assessing the implications of the recently passed budget reconciliation bill, particularly Medicaid work requirements and more frequent eligibility reviews as well as the scheduled expiration of the enhanced marketplace subsidies. These changes could present near-term enrollment pressures and further shifts in the risk pool.

展望未來，我們也正在評估最近通過的預算協調法案的影響，特別是醫療補助工作要求和更頻繁的資格審查以及增強市場補貼的預定到期日期。這些變化可能會帶來短期入學壓力和風險池的進一步轉變。

Finally, we are focused on restoring margin stability and building long-term earnings power through disciplined pricing, growth in Carelon and investments in technology to deliver value for our members and shareholders over time.

最後，我們致力於透過嚴格的定價、Carelon 的成長和技術投資來恢復利潤率穩定性和建立長期盈利能力，以便長期為我們的會員和股東創造價值。

With that operator, please open the lines for questions.

請與該接線員聯繫，以便解答疑問。

(Operator Instructions)

（操作員指示）

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning. Question on the ACA. Can you help delineate the pressure you're seeing in that business between unit cost trends and shifts in the risk pool? And in the prepared remarks, I think you said your expectation for risk adjustment this year remains unchanged for the current year. So can you explain how that's possible given the higher morbidity that we're seeing? Thanks.

嗨，早安。關於 ACA 的問題。您能否幫助您描述您在該業務中看到的單位成本趨勢和風險池變化之間的壓力？在準備好的評論中，我認為您說過您對今年風險調整的預期保持不變。那麼，考慮到我們所看到的較高的發病率，您能解釋一下這是如何可能的嗎？謝謝。

Andrew, thank you very much for the question and good morning. There are three principal factors that we are monitoring, and which are behind the sharper uptick on medical trend in our ACA book. The first is the risk pool acuity and morbidity, which has risen materially as a result of the higher proportion of relatively healthier members, especially in states with a larger portion of fully subsidized individuals.

安德魯，非常感謝您的提問，早安。我們正在監測三個主要因素，這些因素導致了我們的 ACA 書中醫療趨勢的急劇上升。首先是風險池的敏銳度和發病率，由於相對健康的成員比例較高，這一數字大幅上升，特別是在全額補貼個人比例較大的州。

And we've seen that occur because of the exit from the market. And that's concurrent with higher acuity members from Medicaid moving into ACA following the redetermination process. And you could think about that as being about 70% of the total impact.

我們已經看到，由於退出市場而出現這種情況。同時，醫療補助計劃中較高敏銳度的成員在重新確定程序後轉入 ACA。你可以認為這佔了總影響的 70% 左右。

Second and third impacts related to utilization. Utilization is running higher in several cost categories in ACA, notably emergency room visits, behavioral health services, some prescription drugs in specialty pharmacy, very consistent with the claims pattern that we have previously called out.

第二和第三個影響與利用率有關。ACA 中幾個成本類別的使用率都在上升，特別是急診室就診、行為健康服務、專科藥房的一些處方藥，這與我們之前提到的索賠模式非常一致。

And on utilization here, we also do see a subset of providers employing more aggressive coating tactics and, in some ways, inappropriately leveraging what we think of as the independent dispute resolution process and that obviously inflates allowed amounts. I just wanted to make a comment here that, that inappropriate use of IDR is about -- is contributing to higher costs for the entire health care system without necessarily improving patient care. And you can think about that as being about 30% of the total.

就利用率而言，我們也確實看到一部分供應商採用了更激進的塗層策略，並且在某種程度上不恰當地利用了我們所認為的獨立爭議解決程序，這顯然誇大了允許的金額。我只是想在這裡評論一下，IDR 的不當使用會導致整個醫療保健系統的成本增加，而不一定能改善病患照護。你可以認為這大約佔總數的 30%。

On risk adjustment, the key point here is that the uptick in member acuity we are observing is driven by a broader market-wide morbidity trend, not by shift in our membership mix versus the market or a risk adjustment profile.

關於風險調整，這裡的關鍵點是，我們觀察到的會員敏銳度的上升是由更廣泛的市場發病率趨勢驅動的，而不是由我們的會員結構相對於市場或風險調整概況的變化所驅動的。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Thanks. Hi, everybody. I might just ask you, if possible, when we think about the revision you're making here, obviously, you're calling out the two areas, the public exchanges, the ACA marketplace, and Medicaid. Can you size a little bit for us? Or give us a sense about how much the relative impact of each of those is in the guidance revision. And I would guess on Medicaid, it sounds like it's a matter of just pushing out 6 to 12 months having the data to get the updated rates?

謝謝。大家好。如果可能的話，我可能會問您，當我們考慮您在這裡所做的修改時，顯然您會提到兩個領域，即公共交易所、ACA 市場和醫療補助。可以給我們稍微調整一下尺寸嗎？或者讓我們了解這些因素在指導修訂中的相對影響有多大。我猜對於醫療補助來說，聽起來好像只需要推遲 6 到 12 個月就可以獲得更新的費率？

Is that the way to think about it? And then on the public exchanges, though, it sounds like you've got to reprice, you've got to take into account everything you're seeing this year plus the loss of the enhanced subsidies next year potentially. How challenging is that, if possible, to comment on at this point? And is margin recovery on the exchanges next year even practical to think about?

是這樣思考的嗎？然而，在公開交易所，聽起來你必須重新定價，你必須考慮今年看到的所有情況以及明年可能失去的增強補貼。如果可能的話，現在要評論這件事有多困難？明年交易所的保證金恢復是否值得考慮？

Well, thanks for that question, AJ. There's a whole number of parts. Let me take a step back and sort of reframe for you the sort of outlook that we've given. I think, first and foremost, as you heard in our prepared remarks, we took a prudent view of the full year, and we look to really incorporate those elevated trends that we experienced in the second quarter. I think importantly, we're not betting on new initiatives to bend the trend or cost curve. So we didn't assume any improvements in trends for the remainder of the year.

好吧，謝謝你的提問，AJ。有很多部分。讓我退一步思考一下，重新為您闡述我們給予的觀點。我認為，首先，正如您在我們準備好的演講中所聽到的，我們對全年持審慎態度，並且我們希望真正融入我們在第二季度經歷的那些上升趨勢。我認為重要的是，我們不會指望新的措施來扭轉趨勢或成本曲線。因此，我們並不認為今年剩餘時間的趨勢會有任何改善。

If you think about ACA, I'll touch on that, we have embedded a more elevated morbidity profile into our forecast. We think that the morbidity has stabilized, given what we've seen but we're also allowing for potential for a more significant pull-through at the end of the year as we expect -- unless something happens with those subsidies that we'll expect people to be using more services.

如果您考慮 ACA，我會談到這一點，我們已經將更高的發病率概況嵌入到我們的預測中。我們認為，根據目前的情況，發病率已經穩定下來，但正如我們預期的那樣，我們也考慮到年底出現更顯著的拉升的可能性——除非這些補貼出現問題，否則我們預計人們會使用更多的服務。

So that's embedded as people will seek treatment before coverage could potentially lapse, and I think that's an important assumption. Secondarily, on Medicaid, we're also planning for elevated morbidity due to the ongoing enrollment losses. You saw that in the second quarter in some states that have already begun more aggressive redetermination processes.

因此，這是根深蒂固的，因為人們會在保險可能失效之前尋求治療，我認為這是一個重要的假設。其次，在醫療補助方面，我們也計劃應對因持續的入學人數流失而導致的發病率上升。您會看到，第二季度一些州已經開始了更積極的重新確定進程。

So we're seeing that. We do expect a more gradual alignment to rates, if you noticed. We have been pleased. It's been a very constructive discussion, and rates came in line with our original expectations, what changed is that morbidity increase because of the enrollment losses that increase that profile. So those rate discussions remain constructive in our states. So we're not, again, forecasting anything new in terms of what's happening there. We have made progress, and we continue to expect it to be a step down.

所以我們看到了這一點。如果你注意到的話，我們確實預期利率會更漸進地調整。我們非常高興。這是一次非常有建設性的討論，發病率符合我們最初的預期，變化的是，由於入學人數的減少，發病率也隨之增加。因此，在我們各州，這些利率討論仍然具有建設性。因此，我們不會再對那裡將要發生的任何新事情做出預測。我們已經取得了進展，我們繼續預計這將是一個進步。

And then as Mark said, we're urgently working, honestly, to bend the cost trend. But again, in terms of a forward look and outlook, we haven't taken that into guidance, but again, I know that it's important. I'll turn it over to Mark to talk a little bit about your percentage issue and how that frames out.

正如馬克所說，我們正在緊急努力扭轉成本趨勢。但是，就前瞻性和展望而言，我們還沒有將其納入指導，但我再次知道這很重要。我將把話題交給馬克，讓他稍微談談你的百分比問題以及它是如何形成的。

Yeah, very briefly, AJ, if you think about the reduction in full year guidance split between ACA and Medicaid is slightly more weighted towards ACA.

是的，簡而言之，AJ，如果您考慮一下 ACA 和 Medicaid 之間全年指導份額的減少，那麼 ACA 的權重會略微增加。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Hi. Thanks. Just wanted to ask on the Medicaid side. I think the concern is kind of broadly that you're going to continue to get caught up on, I guess, what I would refer to as base period rates being incorrectly set, but then there's going to be a disconnect or potentially at risk of being a disconnect on forward trend where you're going to be continually underpaid there.

你好。謝謝。只是想問一下醫療補助方面的問題。我認為大家普遍擔心的是，你會繼續陷入所謂的基準期利率設定錯誤的問題，然後就會出現與未來趨勢脫節或可能存在脫節的風險，導致你持續被低薪。

I guess how do you think about that dynamic? Do you think that's an accurate characterization of really kind of what's happening right now? And how do you think you address that with states if you need to make some argument for higher forward trend than you've received over the past couple of years? Thanks.

我猜您如何看待這種動態？您認為這是否準確地描述了當前正在發生的事情？如果您需要為比過去幾年更高的未來趨勢提出一些論據，您認為該如何與各州解決這個問題？謝謝。

Yeah. Thanks for the question, Stephen. Just a couple of thoughts. I think first, we're going through what I would call an unusual cycle coming out of the pandemic where there was significant redeterminations, the acuity change pretty dramatically, and we have asked the states to move forward their view from their normal practices, and they've been very constructive.

是的。謝謝你的提問，史蒂芬。只是一些想法。我認為首先，我們正在經歷一個我稱之為疫情爆發的不尋常週期，其中進行了重大的重新確定，敏銳度發生了相當大的變化，我們已要求各州從其正常做法中推進他們的觀點，並且他們一直非常具有建設性。

So again, I just want to reinforce that the discussions with the states based on the data that we've been sharing with them, they've been very responsive, and those rates have aligned when we look at our [7-1] rating.

因此，我再次強調，我們與各州就我們一直分享的數據進行了討論，他們的反應非常積極，而且當我們查看我們的 [7-1] 評級時，這些比率已經一致。

We're seeing, again, though, some additional just because of moving forward of some of the new regulations that are coming in, additional redeterminations. And so that data needs to catch up with the states. Our sense is that will normalize over a couple of rate cycles. And again, they're using actuarially sound data. We're getting it in front of them faster than they've ever used it. And I think that's a very positive sign.

不過，我們再次看到，由於一些新法規的出台，出現了一些額外的重新確定。因此，數據需要跟上各州的腳步。我們的感覺是，這將在幾個利率週期內恢復正常。而且，他們使用的是精算可靠的數據。我們以比他們使用速度更快的速度將其呈現在他們面前。我認為這是一個非常積極的信號。

Maybe I'll ask Mark if he wants to comment a little bit more specifically on the discussion with the states.

也許我會問馬克是否想就與各州的討論發表更具體的評論。

And very briefly, I'd add on here. So the updated guidance that we put out this year does anticipate slower trend deceleration together with that ongoing risk pool pressure to persist in the second half. Importantly here, Medicaid margins are still expected to show year-over-year improvement in the back half. We do expect them to remain positive for the full year, albeit below our long-term targets.

我想在這裡簡單補充一下。因此，我們今年發布的最新指南確實預期趨勢減速將放緩，同時持續的風險池壓力將持續存在。重要的是，預計下半年醫療補助利潤率仍將較去年同期有所改善。我們確實預計全年業績仍將保持正成長，儘管低於我們的長期目標。

Lisa Gill, JPMorgan.

摩根大通的麗莎吉爾。

Good morning. Can you maybe just talk about what you're seeing on Medicare Advantage. Gail, I think you made a comment that you have MA strength in the quarter, but just curious around what you're seeing on trend there. And you also made a comment around your bids for '26 around margin recovery. So maybe if you could just give us a little more color as to how you're thinking about bids as well for Medicare Advantage.

早安.您能否談談您對醫療保險優勢計劃的看法？蓋爾，我認為您評論說本季度您的 MA 實力強勁，但我只是好奇您在那裡看到的趨勢是什麼。您還針對 26 年的出價以及利潤率恢復發表了評論。因此，如果您可以向我們詳細介紹您對醫療保險優勢計劃 (Medicare Advantage) 投標的看法，也許可以。

Sure. Thanks for the question, Lisa. Let me directly address your question on trend in Medicare Advantage. It remained elevated, but it came in line with -- consistently with our expectations. So similar to what we've been sharing in the first quarter and along other conferences, very much consistent in line, so we didn't see any difference.

當然。謝謝你的提問，麗莎。讓我直接回答您關於醫療保險優勢計劃趨勢的問題。它仍然處於高位，但符合——始終符合我們的預期。與我們在第一季和其他會議上分享的內容非常相似，非常一致，所以我們沒有看到任何差異。

Let me ask Felicia to talk a little bit about our bid strategy and share how we're thinking about that.

讓我請費莉西亞稍微談談我們的競標策略並分享我們對此的看法。

Good morning, Lisa and thank you for the question. As we look ahead to 2026, it is still too early to be specific about our bid. But I will say that we continued a very disciplined and thoughtful approach in terms of how we approach the bid knowing that there is going to be the potential for some volatility as we head into 2026. We prioritized the plan offerings that we believe are going to deliver strong retention for us and sustainable long-term value for our members.

早安，麗莎，謝謝你的提問。展望 2026 年，現在具體說明我們的出價還為時過早。但我要說的是，我們在競標方面繼續採取非常嚴謹和深思熟慮的方法，因為我們知道，在邁入 2026 年時可能會出現一些波動。我們優先考慮那些我們認為能夠為我們帶來強大保留率並為我們的會員帶來可持續的長期價值的計劃產品。

We specifically focused on geographies and plan types that we've been very much focused on as we go forward, namely our HMO, our duals and certainly looking to lean into margin as we think about 2026. So it's too early to comment on the more specifics of that, but we feel very good about how we are positioned, the actions we've taken to lean into margins as we go forward and the progress we continue to make around stabilizing and improving our margins in the MA program.

我們特別關注我們未來非常關注的地區和計劃類型，即我們的 HMO、我們的雙重計劃，當然，我們也希望在考慮 2026 年時能夠傾向於利潤率。因此，現在評論更多細節還為時過早，但我們對我們的定位、我們為在未來發展過程中降低利潤率而採取的行動以及我們在穩定和提高 MA 計劃利潤率方面繼續取得的進展感到非常滿意。

Thank you, Felicia. And the only add I would make is just a reminder, this has been a multiyear strategy for us over the last several bid cycles where we're really focused on trying to get to stability in this marketplace and have taken those approaches. So thank you and next question, please.

謝謝你，費莉西亞。我唯一要補充的是提醒一下，在過去的幾個競標週期中，這一直是我們的多年策略，我們真正專注於努力實現這個市場的穩定，並採取了這些方法。謝謝您，請問下一個問題。

Lance Wilkes, Bernstein.

蘭斯威爾克斯、伯恩斯坦。

Great, thanks. Could you comment a little bit on the utilization you're seeing, understanding risk pool deterioration in a couple of those lines. If you could just talk a little bit about utilization you're seeing by category, inpatient, outpatient, et cetera, and then also differences by segment. And along those lines, if you could comment on prior period development, how things are developing in reserves. Thanks.

太好了，謝謝。您能否對所看到的利用率發表一些評論，了解其中幾行中風險池的惡化情況。如果您可以稍微談談按類別（住院病人、門診病人等）看到的利用率，以及按部分看到的差異。並且沿著這個思路，如果您可以評論一下前期的發展情況，儲備情況如何。謝謝。

Thanks very much for the question here. Maybe let me start off by saying the ACA marketplace is in the midst of a broad recalibration that is exerting near-term pressure on managed care performance across the industry. And there are several underlying drivers, some of which I called out a moment ago, but principally among them the migration of membership for Medicaid post redeterminations on to the exchanges.

非常感謝您在這裡提出的問題。首先我想說的是，ACA 市場正處於廣泛的重新調整之中，這將對整個產業的管理式醫療績效產生短期壓力。有幾個潛在的驅動因素，其中一些我剛才已經提到過，但其中最主要的是醫療補助計劃重新確定後會員資格轉移到交易所。

And that, together with the lower effectuation rates we're seeing in some states has made the resulting risk pool much more acute, and that's really what's driving the elevated medical cost trends. So in effect, again, you could think about this as a market-wide mobility shift not in Elevance specific pricing or risk adjustment issue.

而且，再加上我們在某些州看到的較低的實施率，導致風險池變得更加嚴重，而這才是醫療成本上升趨勢的真正原因。因此實際上，您可以將其視為整個市場的流動性轉變，而不是 Elevance 特定的定價或風險調整問題。

As we think about the individual categories, as I noted earlier, chief among them is emergency room and behavioral health services. Maybe just to call out one stat here. For the ACA, we are seeing members in our 2024, '25 cohort utilizing the emergency room at nearly 2 times the level of our commercial group members. And then finally, on prior year or prior period development, there's nothing of particular note to call out here. As you'll recall or as you'll see in our filed earnings release this morning was approximately $40 million for the quarter.

當我們考慮各個類別時，正如我之前提到的，其中最重要的是急診室和行為健康服務。也許只是在這裡調出一個統計數據。對於 ACA 來說，我們發現 2024 年和 2025 年隊列中的會員使用急診室的次數幾乎是我們商業團體會員的 2 倍。最後，關於前一年或前一時期的發展，這裡沒有什麼特別值得注意的。您可能還記得，或者正如您在我們今天上午提交的收益報告中看到的，本季的收益約為 4000 萬美元。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Thanks. Good morning. Just a couple of numbers questions here. First, I appreciate your color on the split of the guidance revision. If I think about the impact here, would it be fair to say your Medicaid margins are now maybe in the 1% range. And maybe the exchanges are slightly negative. And then just given the potential for margin improvement in Medicare, the exchanges and Medicaid next year, do you see the potential to grow above the 12% LRP next year? And maybe you could share your view of head with the tailwinds in 2026. Thanks.

謝謝。早安.這裡只有幾個數字問題。首先，我很欣賞您對指導修訂的分歧的看法。如果我考慮這裡的影響，可以公平地說，您的醫療補助利潤率現在可能在 1% 的範圍內嗎？或許交流會有些負面。那麼，考慮到明年醫療保險、交易所和醫療補助的利潤率有可能提高，您是否認為明年的 LRP 有可能超過 12% 呢？也許您可以分享您對 2026 年順風發展的看法。謝謝。

Thanks very much for the question. There's a couple there. Maybe to start, let me -- we do not break out individual business margins, but we do expect our operating margin on the individual ACA business to decline year-over-year in the high single-digit percent range. And that really underscores why we're proactively leaning into disciplined '26 pricing, why we're intensifying the key management programs that are in flight.

非常感謝您的提問。那裡有一對夫婦。首先，我們不會公佈單一業務的利潤率，但我們預計單一 ACA 業務的營業利潤率將同比下降高個位數百分比範圍。這確實強調了為什麼我們要積極主動地傾向於規範的 26 定價，為什麼我們要加強正在進行的關鍵管理計劃。

Why we're looking at selective provider contract actions, again, to help rebuild margin and ensure long-term sustainability. As I mentioned earlier, on Medicaid, margins are still expected to show year-over-year improvement in the back half. They will remain positive for the full year, albeit below our long-term guide.

為什麼我們要再次考慮選擇性供應商合約行動，以幫助重建利潤並確保長期可持續性。正如我之前提到的，就醫療補助而言，預計下半年利潤率仍將較去年同期有所改善。儘管低於我們的長期指導，但全年仍將保持積極態勢。

Yeah. Thanks, Mark. And Justin, to your second question, as we said, we're really not in a position to give formal guidance, but let me sort of frame some of the areas because there are a number of variables. One of the -- in terms of the opportunities we see, I guess, I would price to, first and foremost, significant discipline in our pricing for cost trends. And that is across the ACA, which we've already talked about, our product filings, are addressing this higher market acuity and the potential for further deterioration in the risk pool, should subsidies not be renewed.

是的。謝謝，馬克。賈斯汀，關於你的第二個問題，正如我們所說，我們確實無法提供正式的指導，但讓我概括一些領域，因為存在許多變數。就我們看到的機會而言，我想，首先，我會根據成本趨勢對定價進行嚴格的約束。我們已經討論過的《平價醫療法案》以及我們的產品備案正在解決更高的市場敏感度以及如果不續簽補貼，風險池可能進一步惡化的問題。

In Medicaid, we're also, as we also shared on this call working with other states to ensure that our rates are tracking to the member acuity as well as preparing for the policy shifts that can occur. And then finally, a Medicare Advantage and as Felicia just spoke to, we have put very disciplined benefit designs and have focused on sustainable position and margin recovery.

在醫療補助方面，正如我們在這次電話會議中所分享的那樣，我們仍在與其他州合作，以確保我們的費率能夠跟上會員的敏銳度，並為可能發生的政策變化做好準備。最後，醫療保險優勢，正如費莉西亞剛才所提到的，我們制定了非常嚴謹的福利設計，並專注於可持續的地位和利潤恢復。

And then I'd add to that in terms of those opportunities, we also continue to expect ongoing strong growth and performance from our Carelon business, as you heard from the call today and an ongoing what we're seeing in our pipelines. The biggest unknown for us right now is the policy uncertainties around the ultimate disposition of the enhanced subsidies in the individual ACA market. Whether they expire or there's a step down, I think, is really an important factor going into it.

然後我想補充一點，就這些機會而言，我們還將繼續期待我們的 Carelon 業務持續強勁增長和表現，正如您在今天的電話會議上聽到的那樣，以及我們在管道中持續看到的情況。目前我們面臨的最大未知數是圍繞個人 ACA 市場增強補貼的最終處置政策的不確定性。我認為，它們是否會到期或是否會下降，是一個非常重要的因素。

The impact of the Market Integrity rule, which will come into play, which we think is a positive, quite frankly, for the discipline in the market. But again, we need to be able to understand that. So it's early for us to define. I'll share again what I said in my comments earlier. While those are unknowns, we are taking action now.

市場誠信規則將發揮作用，坦白說，我們認為這對市場紀律來說是正面的影響。但同樣，我們需要能夠理解這一點。因此我們現在下定義還為時過早。我將再次分享我之前在評論中所說的內容。儘管這些都是未知數，但我們現在正在採取行動。

While we haven't put them into the 2025 reforecast, we are working very hard to make sure that we bend the trend on areas that Mark has talked about, some of the aberrant billing practices we're seeing, but also around areas that we think we can have an impact like ER utilization and things like that. So we'll be back to you with more clarity as the year progresses, but wanted to give you a sense of both the opportunities we see and the unknowns that we're facing as we go through this year.

雖然我們還沒有將它們納入 2025 年的重新預測中，但我們正在努力確保改變馬克談到的領域的趨勢，我們看到的一些異常計費實踐，以及我們認為我們可以產生影響的領域，如急診室利用率等。因此，隨著時間的推移，我們會向您提供更清晰的信息，但我們希望讓您了解我們在今年看到的機會和麵臨的未知數。

Next question please.

請問下一個問題。

Erin Wright, Morgan Stanley.

摩根士丹利的艾琳·賴特。

Great. More along those lines about some of the areas that are under your control. I guess more specifically, what are you doing maybe differently in terms of cost structure initiatives throughout the balance of the year and into next year? And can you speak to the major timing magnitude of those and how you're thinking about that as you approach some of those items that are more under your control? Thanks.

偉大的。更多關於您所控制的一些領域的內容。我想更具體地說，在今年餘下的時間裡以及明年，您在成本結構舉措方面可能做了哪些不同的事情？您能否談談這些事情的主要時間尺度，以及當您處理一些更受您控制的事情時，您是如何考慮這些事情的？謝謝。

Yeah. Thanks very much, Erin. I mean I think there's a number of things that are within our control. Obviously, we have been managing our cost structure. Most with really, quite frankly, this was something we committed to at the beginning of the year, but the transformation of using technology fundamentally to simplify our processes, to automate our processes. That is ongoing, and we have shown, I think, very strong discipline, and that will continue, and that will drive run rate for us.

是的。非常感謝，艾琳。我的意思是，我認為有很多事情是我們可以控制的。顯然，我們一直在管理我們的成本結構。坦白說，這是我們在年初承諾要做的事情，但轉型是從根本上利用技術來簡化我們的流程，實現流程自動化。這是正在進行的，我認為我們已經表現出非常嚴格的紀律，而且這種情況將繼續下去，並將提高我們的運行率。

We're also using our data and using AI, quite frankly, to get ahead of the cost curve. And what I mean by that is really trying to shift left to understand what's happening earlier in the process. and making sure that we are identifying these trends, particularly these billing abnormalities that we're seeing, one great example of that is the IDR process, which Mark spoke about. This quarter, we took very aggressive action and filed a legal suit against what we think is the misuse of the IDR process under the No Surprises Act.

坦白說，我們還在使用數據和人工智慧來降低成本。我這樣說的意思是，我們實際上試圖向左移動，以了解流程早期發生的情況。並確保我們識別這些趨勢，特別是我們看到的這些計費異常，一個很好的例子就是馬克談到的 IDR 流程。本季度，我們採取了非常積極的行動，並根據《無意外法案》對我們認為濫用 IDR 流程的行為提起了訴訟。

And just to put that in perspective, we've seen out of network providers and their billing partners submit thousands of disputes sometimes hundreds in a single day, and our payment request can be significantly inflated, which is costing the entire health care system sometimes those are from as much as 21 times billed charges, just to give some perspective on this. We fully support that act, but we also know that it has to be implemented appropriately. So that's one example. We're also leaning into the work that Carelon has done. We had very good results in Carelon.

為了更清楚地說明這一點，我們看到網路供應商及其計費合作夥伴在一天內提交了數千起爭議，有時甚至數百起，我們的付款請求可能會被大大誇大，這會給整個醫療保健系統帶來成本，有時這些成本甚至高達帳單費用的 21 倍，這只是對此提供一些看法。我們全力支持法案，但我們也知道必須妥善實施法案。這是一個例子。我們也傾向於 Carelon 所做的工作。我們在Carelon取得了非常好的成績。

So you think about the areas that Mark talked about our ability to take more of that and manage it through Carelon, I think, is really important, whether it's around specialty services, areas like that. So again, we haven't embedded that in the trend right now, but we are clearly working on oncology, severe mental illness, MSK products, things of that nature that we think are important for affordability over the long haul. But again, it takes time to implement, and we know that the issues specifically in the individual ACA market are because the entire market has exhibited this increase in acuity across the board. So thank you very much for the question and next question, please.

因此，您考慮馬克談到的我們是否有能力利用更多資源並透過 Carelon 進行管理，我認為這非常重要，無論是圍繞專業服務還是其他領域。所以，再說一次，我們現在還沒有將其嵌入趨勢中，但我們顯然正在研究腫瘤學、嚴重精神疾病、MSK 產品以及我們認為對於長期可負擔性很重要的這類產品。但同樣，這需要時間來實施，我們知道，個人 ACA 市場中存在的問題是因為整個市場都表現出了這種敏銳度的提高。非常感謝您提出這個問題，請再問一個問題。

Ben Hendrix, RBC Capital Markets.

加拿大皇家銀行資本市場 (RBC Capital Markets) 的 Ben Hendrix。

Great. Thank you very much. Just wondering if the current environment is making any -- or probably drastic changes to your capital allocation strategy this year. Are you still thinking about the kind of 50-50 split of investment versus return on capital? And then to the extent that the M&A and organic reinvestment piece of it is changing, are there shifts there that may allocate more capital internally versus for example, adding capabilities to Carelon or other activities. Just any thoughts on capital allocation for the rest of the year? Thank you.

偉大的。非常感謝。只是想知道當前的環境是否會對您今年的資本配置策略產生任何或可能巨大的改變。您是否仍在考慮投資與資本報酬率各佔一半的問題？那麼，就併購和有機再投資部分的變化而言，是否存在可能在內部分配更多資本而不是例如為 Carelon 或其他活動增加能力的變化。對於今年剩餘時間的資本配置有什麼想法嗎？謝謝。

Ben, thanks very much for the question. In the second quarter, we repurchased approximately $380 million worth of shares. But importantly here, our adjusted share repurchase pacing in the second quarter was different, and it was different because we wanted to ensure we had enough flexibility heading into what we see as a dynamic rate and margin environment. That said, in my opinion, with the stock trading well below what we see as its intrinsic value, I really wanted to make sure that we retain full flexibility to be more opportunistic in the periods ahead.

本，非常感謝你的提問。第二季度，我們回購了價值約 3.8 億美元的股票。但重要的是，我們在第二季調整後的股票回購節奏有所不同，這是因為我們希望確保在我們所看到的動態利率和利潤率環境中擁有足夠的靈活性。儘管如此，在我看來，由於股票交易價格遠低於我們所認為的內在價值，我真的希望確保我們保留充分的靈活性，以便在未來時期內獲得更多機會。

We are firmly on track to achieve our full year diluted weighted average share count of 225 million to 226 million. But the idea is we want to be opportunistic. More broadly on M&A, our focus in 2025 is really on integration and scaling of the acquisitions that we completed last year. So we do anticipate lower levels of M&A activity this year with a greater emphasis, as I mentioned a minute ago on opportunistic share repurchases.

我們預計將實現全年攤薄加權平均股數 2.25 億至 2.26 億股的目標。但我們的想法是抓住機會。更廣泛地講，在併購方面，我們 2025 年的重點實際上是整合和擴大我們去年完成的收購。因此，我們確實預期今年的併購活動水準會降低，而且會更加重視機會性股票回購，正如我剛才提到的。

And then as I try to think over the long term, we're going to maintain consistency with our algorithm, meaning we'll target deploying about 50% of free cash flow towards M&A, organic reinvestment back into the business with the other 50% being returned to shareholders, including 30% for share repurchases and about 20% for dividends. Thank you.

然後，當我嘗試進行長遠思考時，我們將保持與我們的演算法的一致性，這意味著我們的目標是將大約 50％ 的自由現金流用於併購，有機再投資回業務，另外 50％ 返還給股東，包括 30％ 用於股票回購和約 20％ 用於股息。謝謝。

Joshua Raskin, Nephron Research.

Joshua Raskin，腎元研究。

Hi. Thanks. Good morning. I guess my question is really about your commentary around creating more stability and predictability and maybe what could be done differently in the future. We've spoken about the potential for risk pool changes, both in the ACA exchanges and on the Medicaid side. And so how do you change that pricing process for the ACA or rate negotiations with the state? What makes this business more predictable in the future?

你好。謝謝。早安.我想我的問題實際上是關於您對創造更多穩定性和可預測性的評論，以及未來可以採取哪些不同的做法。我們已經討論了風險池變化的可能性，包括 ACA 交易所和醫療補助方面。那麼，您如何改變 ACA 的定價流程或與州政府的費率談判？什麼使得這項業務在未來更可預測？

Thanks very much for the question, Josh. Let me maybe step back for a moment. We continue to see the ACA market as a valuable and a complementary business to our Carelon and Medicaid segment. And that's because it enables us to extend affordable coverage to more consumers while maintaining balanced profitable growth. We very much appreciate CMS's ongoing efforts to promote stability in the individual market and get that gets at the heart of your question.

非常感謝你的提問，喬希。讓我先退一步。我們繼續將 ACA 市場視為我們 Carelon 和 Medicaid 部門的寶貴且互補的業務。這是因為它使我們能夠向更多消費者提供負擔得起的保險，同時保持平衡的獲利成長。我們非常感謝 CMS 為促進個人市場穩定所做的持續努力，並以此解答您的問題。

They included several provisions in the recently finalized marketplace integrity and affordability rule that supported that goal, including, for example, the elimination of the monthly special enrollment periods. They strengthened pre-enrollment verification of income. And I think all of that contributes. And importantly, I'd add, our rate filings that are upcoming for the '26 cycle will capture both the current acuity and our expectation for further deterioration in the risk pool in 2026. And so in my opinion, and our opinion as a management team, more obviously could be done here.

他們在最近最終確定的市場誠信和可負擔性規則中加入了支持該目標的幾項條款，例如取消每月的特殊註冊期。加強入學前收入核查。我認為所有這些都有貢獻。而且重要的是，我想補充一點，我們即將提交的 26 年周期利率申報將反映當前的敏銳度以及我們對 2026 年風險池進一步惡化的預期。因此，在我看來，以及我們作為管理團隊的看法中，顯然可以做更多的事情。

Ultimately, we believe the AC market will likely be smaller and higher acuity driven next year, especially if the enhanced subsidies expire. And one other quick comment just on Medicaid from an earlier question. We do expect the full year 2025 Medicaid cost trend to be driven approximately a third from acuity and about two-thirds from utilization and coding.

最終，我們認為明年空調市場規模可能會更小，但受更高敏銳度驅動，尤其是在增強補貼到期的情況下。還有另一個關於醫療補助的簡短評論，來自先前的問題。我們確實預計，2025 年全年醫療補助成本趨勢約三分之一來自敏銳度，約三分之二來自利用率和編碼。

Dave Windley, Jefferies.

戴夫·溫德利（Dave Windley），傑富瑞集團（Jefferies）。

Hi. Thanks for taking my question. I wanted to confirm an understanding and then pose a question. So Mark, to your earlier answer on ACA, if I understand right on risk adjustment, you're basically saying the pool is deteriorating, your book is basically shifting in line with the broader risk pool. So your risk adjustment assumptions don't change, your risk transfer assumptions don't change from your beginning of your expectations? Is that the right understanding of what you're saying? And therefore, the pressure on your book is reflective of just the deterioration of the book. Is that right?

你好。感謝您回答我的問題。我想確認一下理解，然後再提出一個問題。所以馬克，對於你之前關於 ACA 的回答，如果我對風險調整的理解正確的話，你基本上是說風險池正在惡化，你的賬簿基本上是隨著更廣泛的風險池而變化的。所以您的風險調整假設不會改變，您的風險轉移假設從您最初的預期來看也不會改變？這是對您所說內容的正確理解嗎？因此，書上的壓力只是書的損壞程度的體現。是嗎？

Dave, that is spot on. And I would go one step further to say you could think about the acuity in the ACA market at this point in time, largely being stabilized post those lower effectuation rates the industry saw in April.

戴夫，你說得非常正確。我想進一步說，您可以考慮一下目前 ACA 市場的敏銳度，在 4 月份行業實施率較低之後，該市場基本上已經穩定下來。

That's great. And that tees up my actual question, which is what assumptions are you making about further attrition in the overall membership and therefore, shifts in risk pool in light of kind of thinking about, one, pre-pandemic, the ACA market attrited month by month by month normally.

那太棒了。這就引出了我真正的問題，即您對整體會員人數的進一步減少以及因此而導致的風險池變化做出了哪些假設，首先，在疫情之前，ACA 市場通常會逐月減少。

And then two, to your point, that some of this acuity is coming from membership shifting from Medicaid. And I think you also made -- one of the management team members made a reference to non-Medicaid expansion states. And my concern would be that some of those Medicaid shifts will be found to be ineligible in the ACA market. Now that might help the risk pool in fact. But what -- again, what assumptions are you making about the further attrition this year in the ACA enrollment base? Thank you.

其次，正如您所說，這種敏銳度部分來自於醫療補助計劃的會員轉移。我認為您也提到了——其中一位管理團隊成員提到了非醫療補助擴展州。我擔心的是，一些醫療補助計劃的轉變會被發現不符合 ACA 市場的規定。事實上這可能對風險池有幫助。但是——再說一次，您對今年 ACA 入學人數的進一步減少做出了什麼假設？謝謝。

Great question. To be clear, at least for the remainder of 2025, we've assumed membership stability in the ACA base. What we have done is think about what fourth quarter utilization is going to do. And here, obviously, if Congress allows the enhanced premium tax credits to lapse at the year-end, we will expect a measurable last chance uptick in fourth quarter utilization as some members are going to schedule their elective care before their out-of-pocket costs rise in 2026. And starkly, the reason I bring this up is that this use it or lose it pattern has been modest in the individual market because most ACA enrollees either use coverage consistently throughout the year or they're going to hold us for financial protection.

好問題。需要明確的是，至少在 2025 年剩餘時間內，我們假設 ACA 基礎的會員人數保持穩定。我們所做的就是思考第四季的利用率將會如何。顯然，如果國會允許增強的保費稅收抵免在年底失效，我們預計第四季度的利用率將出現可衡量的最後機會上升，因為一些成員將在 2026 年自付費用上漲之前安排他們的選擇性護理。坦白說，我之所以提起這一點，是因為這種「用了就失去」的模式在個人市場上並不常見，因為大多數 ACA 受益人要么全年持續使用保險，要么將向我們尋求財務保護。

However, the combination of what we're seeing now with this higher prevailing acuity and the likely subsidy clip has led us to believe that we're going to see a much more meaningful Q4 surge than in prior years. And that's the key assumption that we've now embedded in our full year guidance outlook.

然而，結合我們現在所看到的情況，加上普遍存在的較高敏銳度和可能的補貼速度，我們相信，我們將看到第四季度比前幾年更有意義的增長。這就是我們現在在全年指導展望中嵌入的關鍵假設。

Ann Hynes, Mizuho Securities.

瑞穗證券的安‧海因斯 (Ann Hynes)。

Hi. Good morning and thank you. Several times, you talked about increased coding, I think Mark one of your responses, you noted that HIX, you saw increased coding. Can you just elaborate on those comments? Are you seeing increased coding across all segments. And you did, I think, mentioned you said a certain set of providers. Can you elaborate on that comment?

你好。早安，謝謝。有幾次，您談到了編碼的增加，我想標記您的一個回應，您注意到 HIX，您看到了編碼的增加。能詳細說明一下這些評論嗎？您是否看到所有部分的編碼都有所增加。我認為您確實提到過一組特定的提供者。能詳細說明一下這篇評論嗎？

And I think there's some indication that going forward providers might utilize AI to help document and code better. As a health insurer, how do you view this as a risk? And how do you underwrite for this behavior change?

我認為有跡象表明，未來的提供者可能會利用人工智慧來幫助更好地記錄和編碼。身為一家健康保險公司，您如何看待這種風險？您如何承擔這種行為改變的責任？

Yes. Thank you for the question, Anne. I think there's a lot there. So let me clarify these questions because I think they're important. So I already spoke to the IDR issue, which is very specific. And I think that one has driven, what I'll call very unnecessary costs beyond what -- across the entire health system. And as you've heard, we're taking a very aggressive approach against those billing companies that are doing that.

是的。謝謝你的提問，安妮。我認為那裡有很多東西。所以讓我澄清一下這些問題，因為我認為它們很重要。我已經談到了 IDR 問題，這是一個非常具體的問題。我認為這導致了整個醫療系統產生不必要的成本。正如您所聽到的，我們對那些這樣做的計費公司採取了非常嚴厲的措施。

So that's one specific pocket. The other one is, I would say it's actually more isolated pockets where hospitals are using some AI-enabled coding tools that can increase document acuity and in turn unit costs. We have flagged these because we've been tracking those, as I said, with our analytics earlier in the quarter.

這是一個特定的口袋。另一個是，我想說，實際上是在更孤立的地區，醫院正在使用一些支援人工智慧的編碼工具，這些工具可以提高文件的敏銳度，進而降低單位成本。我們標記了這些，因為正如我在本季度早些時候所說的那樣，我們一直在透過分析來追蹤它們。

And it is one potential contributor to outlier claims and higher allowed amounts. We are, though, putting those through our payment integrity process. So in a bit of a catch-up game, honestly, but we're very, very careful about that. And we are differentiating by the way, between what we'll call responsible innovation and inappropriate coding.

這是導致異常索賠和允許金額更高的潛在因素之一。不過，我們正在將這些納入我們的支付完整性流程。所以說實話，這有點像一場追趕遊戲，但我們對此非常非常小心。順便說一下，我們正在區分所謂的負責任的創新和不適當的編碼。

We do support providers using this technology to improve their documentation and patient outcomes and actually think that's a very good thing. So when those tools are used to inflate revenue, it's another issue, and that's where we're really focused on these outlier cases where we're seeing aberrant patterns. And we're using our technology to identify those aberrant patterns earlier.

我們確實支持提供者使用這項技術來改善他們的文件和患者結果，並且實際上認為這是一件非常好的事情。因此，當這些工具被用來增加收入時，這就是另一個問題，而這正是我們真正關注這些異常情況的地方，我們看到了異常模式。我們正在利用我們的技術來更早地識別這些異常模式。

And in those issues, we are -- in those cases, we are taking swift action. In terms of your last issue, I think it's quite frankly, about us making sure that we are looking at all the patterns. And we think that the use of AI is actually very helpful when it aligns us like in the areas of prior authorization where you can get the documentation and the medical records aligned immediately, and we have the same data and then we're not going back and forth.

對於這些問題，我們——在那些情況下，我們正在採取迅速行動。關於您提到的最後一個問題，坦白說，我認為我們要確保看到所有的模式。我們認為，當人工智慧使我們在事先授權領域保持一致時，它的使用實際上非常有幫助，在這種領域中，您可以立即對齊文件和醫療記錄，並且我們擁有相同的數據，然後我們就不會來回走動。

So I think that's a positive in the system. But where we see it like in the IDR process, just increase that doesn't help anything around the system. We're going after that. So I want to just differentiate between that, but it has been a contributor, and it's something that we think is that we need a focused response to and that's where we're using our technology as well.

所以我認為這是系統的一個積極方面。但我們在 IDR 過程中看到，僅僅增加它對系統沒有任何幫助。我們就去追尋它。所以我只是想區分這兩者，但它確實是一個因素，我們認為我們需要對此做出重點回應，這也是我們使用科技的地方。

Thank you for the question. Next question, please.

謝謝你的提問。請回答下一個問題。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great. Thanks. I just want to go back to an earlier line of questioning about Medicaid. Because going into redeterminations, there was a lot of optimism from the industry about being proactive about risk pool shifts, understanding those shifts, better real-time data and we're still struggling with dealing with these types of things.

偉大的。謝謝。我只是想回到之前關於醫療補助的問題。因為進入重新確定階段，業界對積極主動地應對風險池轉變、了解這些轉變、獲得更好的即時數據抱有很多樂觀態度，但我們仍在努力處理這些類型的事情。

And I appreciate that, in many ways, the risk pool shifts have been unprecedented, but it does seem like what Trump is doing with his bill is going to create other period of the next three to five years of unprecedented risk pool shifts as well. So why should we be assuming any improvement in Medicaid margins over the next couple of years if there seems to be this lag here between rate setting and the data coming in around where costs are real time? Thanks.

我讚賞這一點，從很多方面來說，風險池的轉變都是前所未有的，但川普透過他的法案所做的似乎也將在未來三到五年內創造前所未有的風險池轉變。那麼，如果費率制定和成本即時數據之間存在滯後，我們為什麼要假設未來幾年醫療補助利潤率會有所改善？謝謝。

Well, first, thanks for the question, Kevin. I think as we think about this, we still think that both Medicaid and the ACA markets are both very positive markets. And yes, there's been a period of dislocation in what's happened. But again, it has been unprecedented given what the amount of redeterminations that occurred first in the Medicaid market and now what we're seeing in the risk pool as we think about what is happening longer term with what this potential bill could do. We're monitoring those implications, particularly the enhanced work requirements, changes to the subsidy eligibility that may impact Medicaid and ACA.

嗯，首先，謝謝你的提問，凱文。我認為，當我們考慮這一點時，我們仍然認為醫療補助和 ACA 市場都是非常積極的市場。是的，發生的事情確實存在一段時間的混亂。但是，考慮到醫療補助市場首先發生的重新確定次數，以及現在我們在風險池中看到的情況，這是前所未有的，因為我們正在考慮這項潛在法案可能產生的長期影響。我們正在監測這些影響，特別是加強的工作要求和可能影響醫療補助和 ACA 的補貼資格變化。

And while they may present, I guess, what we'll call near-term enrollment pressure because we think we're going to be able to work through them. We've long maintained that these strong partnerships with the states and our capabilities can help them actually deliver a much better outcome. And again, we are not passive in this relationship with the state. They're looking to us in terms of capabilities we have in the commercial market to help them manage through this. We know that a lot of the early redeterminations were administrative and the states -- quite frankly, the states struggled with the amount of volume and process.

我想，儘管它們可能會帶來所謂的近期入學壓力，但我們認為我們能夠解決這些問題。我們一直堅信，與各州建立強有力的夥伴關係以及我們的能力可以幫助他們取得更好的結果。再次強調，我們在與國家的關係中並不是被動的。他們希望我們能夠利用我們在商業市場的能力來幫助他們解決這個問題。我們知道，許多早期的重新確定都是行政性的，而各州——坦白說，各州在數量和流程方面遇到了困難。

So we've learned a lot in this process. We're going to have to work through them and also moving up the experience that we're seeing on the acuity of the population using that data earlier. We're seeing more constructive engagement from the states. Their actuaries are now, I think, quite aware of the kind of shifts that occur when this enrollment changes. So again, we have to work through what work requirements will mean. We've had it in a few states.

因此我們在這個過程中學到了很多。我們必須努力解決這些問題，同時也要利用這些數據來提升我們先前所看到的關於民眾敏銳度的經驗。我們看到各州的參與正在變得更加建設性。我認為，他們的精算師現在非常清楚當這種入學變化發生時會發生什麼樣的變化。因此，我們必須再次弄清楚工作要求意味著什麼。我們在一些州已經經歷過這種情況。

That will be something new for most states to have to implement. We've got some time to implement that. But again, I think those are all really important factors, and we consider this partnership with the states that we need to help them get through this process. But overall, I just want to reiterate, we do continue to think that these are core strategic franchises and that it's a short-term volatility issue that we're going to get through, and we feel really good about sort of the kind of how we're pacing through it. And as Mark said, we are seeing sequential improvement.

對大多數州來說，這將是一項必須實施的新措施。我們有時間來實現這一點。但我再次認為這些都是非常重要的因素，我們認為與各州建立這種夥伴關係是我們需要的，以幫助他們度過這一進程。但總的來說，我只想重申，我們確實繼續認為這些是核心策略特許經營權，這是我們將要解決的短期波動問題，我們對於我們如何解決這個問題感到非常滿意。正如馬克所說，我們看到了連續的改善。

Thank you very much for the question. Next question.

非常感謝您的提問。下一個問題。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Thanks. Mark, I hope I heard you right, but I think you said Medicaid cost trend decelerated into the second quarter slightly, but underlying utilization increased. I guess if I have that right, do you really have a sense on what's actually driving that utilization pick up. And we've seen some commentary by other competitors of states carving in benefits without suitable rate increases. Are you seeing that in your states? Thank you.

謝謝。馬克，我希望我聽到了您的意思，但我認為您說的是醫療補助成本趨勢在第二季度略有放緩，但基本利用率有所增加。我想，如果我說得對的話，您是否真的知道是什麼真正推動了利用率的上升？我們也看到一些其他州的競爭對手發表的評論，稱他們在沒有適當提高稅率的情況下削減福利。您在自己的州看到了這種情況嗎？謝謝。

Thanks very much for the question. I simply say Medicaid cost trend did moderate in the second quarter. The slowdown was far less pronounced than we had expected. And to the point Gail made a couple of moments ago, we are seeing more disenrollments among relatively lower acuity members, especially as states and act more stringent eligibility reviews and that obviously raises the average acuity of the remaining population.

非常感謝您的提問。我只是說醫療補助成本趨勢在第二季確實有所緩和。經濟放緩的程度遠低於我們的預期。正如蓋爾剛才提出的觀點，我們看到在敏銳度相對較低的成員中取消註冊的人數越來越多，特別是隨著各州採取更嚴格的資格審查措施，這顯然提高了剩餘人口的平均敏銳度。

In terms of where we're seeing elevated utilization, I'd call out LTSS, behavioral health, inpatient medical surgery care, and those dynamics are what's putting upward pressure on costs and explain why that trends deterioration is unfolding more gradually than we first anticipated. And then again, a third from acuity, two-thirds from utilization coding and I acknowledge that is different from 2024, where we indicated 60% was acuity, 40% was utilization.

就我們看到的使用率上升而言，我會指出長期護理服務 (LTSS)、行為健康、住院醫療外科護理，這些動態對成本造成了上行壓力，並解釋了為什麼這種趨勢的惡化比我們最初預期的要緩慢。再說一次，三分之一來自敏銳度，三分之二來自利用率編碼，我承認這與 2024 年不同，其中我們指出 60％ 是敏銳度，40％ 是利用率。

And that's simply affected simply a result of the fact that most redetermination related acuity impacts have now been absorbed while the elevated utilization is what we're seeing come through.

而這只是因為大多數與重新確定相關的敏銳度影響現在已經被吸收，而我們看到的是利用率的提高。

Yeah. And Ryan, to the last part of your question on the carve ins, the normal process for states implementing new programs is generally, we work with their actuaries on what we think is the right amount. And if for some reason, there's a dislocation in that, we continue to work with them. And they are usually very responsive. So again, I would look at that is not the biggest contributor.

是的。瑞安，關於你問題的最後一部分關於附加條款的問題，各州實施新計劃的正常流程一般是，我們與他們的精算師一起確定我們認為合適的金額。如果由於某種原因，出現了混亂，我們仍會繼續與他們合作。而且他們通常反應非常敏捷。因此，我再次認為這不是最大的貢獻者。

I would a big contributor at least for us. I would look at that really as an issue of timing for the most part and generally getting that right as they get more mature in the program.

至少對我們來說，我會做出很大的貢獻。我認為這在很大程度上是一個時間問題，並且通常隨著他們在計劃中變得更加成熟，這個問題就會得到正確的解決。

Next question, please.

請回答下一個問題。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，費茲傑拉領唱者。

Thank you. Can you talk about how Carelon margins are lining up compared to your initial expectations? And then some of the growth-related pressure on the Rx side from growth in large employers and specialty and then on services from CareBridge. When do you expect that to normalize? Or is the shift in CarelonRx more the long-term margin shift with the mix?

謝謝。您能談談 Carelon 的利潤率與您最初的預期相比如何嗎？然後，Rx 方面的一些成長相關壓力來自於大型雇主和專業機構的成長，以及 CareBridge 的服務。您預計什麼時候能夠恢復正常？或者 CarelonRx 的轉變更多的是隨著組合而發生的長期利潤轉變？

Let me have Pete Haytaian, who leads that business comment.

請聽聽主持該商業評論的 Pete Haytaian 的發言。

Thanks for the question. Sorry, you asked a lot there about Carelon, so I'll try to cover it all. On the services side, again, really strong growth, as we've talked about, and that's contributed to the year-over-year performance improvement. And as it relates to margins and service as you specifically asked about, they came in within our expectations, slightly down from last year. Again, that was largely driven by CareBridge as well as continued expansion of risk arrangements and taking on more risk, both in Elevance Health and externally. We're also very happy about what we're seeing externally in terms of growth.

謝謝你的提問。抱歉，您問了很多有關 Carelon 的問題，所以我會盡力涵蓋所有內容。正如我們所討論的，服務方面再次實現了強勁增長，這有助於業績的同比提升。正如您特別詢問的利潤率和服務，它們符合我們的預期，比去年略有下降。再一次，這主要是由 CareBridge 推動的，以及風險安排的持續擴大和承擔更多風險（無論是在 Elevance Health 內部還是外部）。我們也對外部的成長感到非常高興。

And so that is all contributing to our performance. In terms of how that progresses through the year, I think that that's what you were asking as well. Similarly, because of seasonality in these risk deals, we'll see that margin decrease throughout the year. And again, with the addition of CareBridge, our margin moderates because it comes with a different profile from a margin perspective.

這一切都有助於我們的表現。至於這一年進展如何，我想這也是您所問的。同樣，由於這些風險交易的季節性，我們會看到利潤率全年下降。而且，隨著 CareBridge 的加入，我們的利潤率會有所緩和，因為從利潤率的角度來看，它具有不同的特徵。

On the Rx side, similarly, very strong growth. In fact, it was our strongest year of growth yet. And that actually is contributing to the issues associated with our margin. The year-over-year performance from an operating perspective actually improved in pharmacy pretty nicely, 7.8% in the quarter. Margins were lower because of very significant growth that we're seeing. We continue to do well down market and middle market but also we're seeing an expansion at the upper end of the market with some large jumbo accounts.

在 Rx 方面，同樣出現了非常強勁的成長。事實上，這是我們迄今為止成長最強勁的一年。這實際上加劇了與我們的利潤相關的問題。從營運角度來看，藥局的年比業績實際上有了相當好的改善，本季成長了 7.8%。由於我們看到非常顯著的成長，利潤率較低。我們在低端市場和中端市場繼續表現良好，但我們也看到高端市場正在擴張，擁有一些大型巨額帳戶。

And so we're investing in that pretty heavily as it relates to both this year and going into next year. And I would largely put that in the context of a lot of the differentiated services that we're working on along with our commercial business on programs like Total Health Connect that is really oriented to whole health and differentiated customer service. So we look forward to that continued growth and expansion in our pharmacy business.

因此，我們對此進行了大量的投資，因為這與今年和明年都息息相關。我主要將其置於我們正在進行的許多差異化服務的背景下，同時也開展我們的商業業務，例如真正面向整體健康和差異化客戶服務的 Total Health Connect 等項目。因此，我們期待我們的藥房業務繼續成長和擴張。

George Hill, Deutsche Bank.

德意志銀行的喬治·希爾。

Yeah. Good morning, guys and thank you for taking the questions. Mark, except for the Q4 surge in acuity in the ACA business, it seems like you called out. I guess first, I would ask, can you kind of quantify the expectation there. And are there any other onetime items or things that you would call out in the guide as it relates to the back of the year assumptions given that the deterioration kind of in the earnings power looks pretty significant in the back half of the year. Thank you.

是的。大家早安，感謝你們回答問題。馬克，除了 ACA 業務在第四季度敏銳度激增之外，似乎你已經發出了警告。我想首先問的是，您能否量化那裡的期望。鑑於下半年獲利能力的下降看起來相當明顯，您是否會在指南中指出與今年後期假設相關的其他一次性項目或事項？謝謝。

Thanks very much for the question. Maybe I'll take this is to talk a little bit about seasonality between the third and fourth quarter. We do anticipate a modestly higher portion of earnings to be realized in the third quarter compared to the fourth quarter. And while our fourth quarter outlook reflects some utilization pull forward in the ACA exchange business, as you mentioned, I'd say there's also evolving seasonality dynamics that we've called out previously in Part D offering. The expected step down in earnings is lower than what one normally would expect. And there are two factors here.

非常感謝您的提問。也許我會藉此來談談第三季和第四季之間的季節性。我們確實預計第三季實現的收益比例將比第四季略高。雖然我們的第四季度展望反映了 ACA 交易業務的一些利用率提前，但正如您所提到的，我想說，我們之前在 D 部分產品中提到的季節性動態也在不斷變化。預期的收入下降幅度低於人們通常的預期。這裡有兩個因素。

First, in fact, most important, we expect a discrete nonoperating tax benefit to be recognized at year-end. And then second, to a lesser extent, the savings from the incremental expense reduction efforts, our in-flight medical cost management programs, they're going to have the greatest impact in Q4 helping to offset that higher trend that we've modeled into our business. And so taken together, those two factors would account for what we're seeing and likely what you're asking about George.

首先，事實上，最重要的是，我們預計年底將確認一項單獨的非營業稅收收益。其次，在較小程度上，增量費用削減措施、我們的飛行中醫療成本管理計劃所節省的費用將在第四季度產生最大影響，有助於抵消我們在業務中模擬的更高趨勢。所以綜合起來，這兩個因素可以解釋我們所看到的情況以及您可能詢問的有關喬治的情況。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢。

Great. Thanks for taking my question. Just on Medicaid, I guess, given the continued disconnect there, I mean, you've talked about this being a near-term issue, wanting to be a continued partner to states, but your comments before around the potential for normalization rates, cycle normalization over the next couple of rate cycles, are you coming to a point where it could make sense to potentially exit states or reduce footprints within certain populations? Or maybe what would you have to see outright to start considering those possibilities, I guess, in context if you're trying to improve margins for that business? Thanks.

偉大的。感謝您回答我的問題。就醫療補助而言，我想，鑑於那裡持續存在的脫節，我的意思是，您已經談到這是一個近期問題，希望成為各州的持續合作夥伴，但您之前關於正常化利率的可能性、未來幾個利率週期的周期正常化的評論，您是否已經到了退出各州或減少某些人群的足跡是有意義的地步？或者，如果您想提高該業務的利潤率，那麼也許您必須直接看到什麼才能開始考慮這些可能性？謝謝。

Yes. Thanks for the question. I think there's a couple of things. One, states in our footprint have been very responsive in terms of the alignment of what we've shown them. And we do believe at this stage, it is really catching the data up once we have the data in front of them.

是的。謝謝你的提問。我認為有幾件事。首先，我們所涵蓋的各州對於我們向他們展示的內容的一致性反應非常積極。我們確實相信，在現階段，一旦我們將資料擺在他們面前，它就能真正趕上資料的速度。

They have been, again, improving the rates to align with the acuity of the population. So I think that question is clearly, we're always looking at ensuring that we have a stable Medicaid population that is aligned to the acuity and we get appropriate rates. And I think it's premature from what we've seen from our states to make those kind of determinations because, again, it's been very productive, and our states have been very responsive. Although again, it's a lag because what they're facing as well. So again, but we are always looking at this and thank you very much for the question.

他們再次提高了費率，以適應民眾的敏銳度。所以我認為這個問題很明顯，我們一直在尋求確保我們擁有穩定的醫療補助人口，與敏銳度一致，並獲得適當的費率。我認為，從各州的情況來看，現在做出這樣的決定還為時過早，因為這些決定非常有成效，而且各州的反應也非常積極。不過，這又是一個滯後，因為他們也面臨同樣的問題。再說一次，但我們一直在關注這個問題，非常感謝您的提問。

Next question, please.

請回答下一個問題。

Whit Mayo, SVB Leerink.

惠特·梅奧 (Whit Mayo)，SVB Leerink。

Hey. Thanks. Just a quick one. Maybe just an update on where you think you are around commercial margins now in light of all the commentary and how you're thinking about the pace of getting back to the targets? And any comments maybe on midyear renewals for your fully insured business. Thanks.

嘿。謝謝。只是快速的。也許只是根據所有評論更新您認為目前的商業利潤率處於什麼水平，以及您如何考慮恢復目標的速度？您可能對您已投保的業務的年中續保有任何意見。謝謝。

Whit, thank you very much for the question. I'll start by saying that we continue to be very pleased with the trajectory of our large group commercial margin recovery over the past couple of years. In 2025, our guidance continues to include expected strong consistent margin performance.

惠特，非常感謝你的提問。首先我要說的是，我們對過去幾年大型集團商業利潤率的復甦軌跡感到非常滿意。2025 年，我們的指導方針繼續包括預期強勁而持續的利潤率表現。

On utilization in that group just because we haven't touched on it, I'd say group medical trend continues to remain elevated, but really importantly, in line with what we've expected and what we priced for. Similar cost pressures in that market, emergency room visits, physician-delivered BH services and specialty pharmacy. And if I think overall commercial margins, we obviously expect a slight decline this year. That just reflects the performance of our ACA business, which we've spoken about.

關於該群體的利用率，因為我們還沒有觸及它，我想說團體醫療趨勢繼續保持高位，但真正重要的是，這與我們的預期和定價一致。市場也有類似的成本壓力，包括急診室就診、醫生提供的 BH 服務和專科藥局。如果我認為整體商業利潤率的話，我們顯然預計今年會略有下降。這恰恰反映了我們之前談到的 ACA 業務的表現。

Thanks, Mark. And maybe I'll ask Morgan Kendrick just to talk a little bit about what he's seeing in the market. I think that's an important context.

謝謝，馬克。也許我會請摩根·肯德里克稍微談談他在市場上看到的情況。我認為這是一個重要的背景。

Yeah. Whit, thanks for the question. As Mark said, outside of ACA, we're pretty pleased with the way that how the business is actually performing. And you made reference to the large group insured or risk business earlier in your question. And that's one where I think we're seeing the market harden quite a bit relative to pricing. Several years back, there was sort of a run on membership.

是的。惠特，謝謝你的提問。正如馬克所說，除了 ACA 之外，我們對業務的實際表現感到非常滿意。您剛才在問題中提到了大型團體保險或風險業務。我認為，我們看到市場在定價方面已經相當強硬了。幾年前，曾出現會員搶購的現象。

It's certainly the market sort of rationalized around the proper trends and the proper pricing on the business. So when we finish, we -- the second largest cohort of ours was July, we're really comfortable with how it manifested as far as the retention on that business. And where there is opportunity to continue to sell the large group fully insured products quite nicely in our geographies, albeit there is a desire for many entities who have some level of risk tolerance to move to self-funded.

這無疑是市場圍繞著適當的趨勢和適當的業務定價而進行的合理化。因此，當我們完成時，我們的第二大群體是七月份，就該業務的保留率而言，我們對其表現感到非常滿意。儘管許多具有一定風險承受能力的實體希望轉向自籌資金，但我們仍有機會繼續在我們的地區很好地銷售大型團體全額保險產品。

So that's when we see the loss on the actual risk side. It's typically moving over to a self-funded opportunity with us. But again, quite pleased with the business, and that's consistent with how we're looking at the national business, of course, albeitreally, really strong performance.

那時我們就會看到實際風險的損失。這通常會轉向我們的自籌資金機會。但是，我對業務感到非常滿意，這與我們對全國業務的看法一致，當然，儘管表現確實非常強勁。

Thank you, Morgan. And I think the theme there, just to sort of call it out is we've seen a I think a much more rational hardening market and are fully insured across the board and Morgan and the team have done a nice job there. We have time, I think, for one more question.

謝謝你，摩根。我認為這裡的主題是，我們已經看到了一個更理性的強化市場，並且全面投保，摩根和團隊在那裡做得很好。我想我們還有時間再回答一個問題。

Michael Hall, Baird.

麥可霍爾，貝爾德。

Hi. Thank you. Quick one first on exchanges. I understand the FTR checks this year had been delayed to the summer. Is that already concluded? Has that member attrition been reflected in your updated guide? Just trying to understand if that could be another issue to drop?

你好。謝謝。首先快速討論一下交流。據我了解，今年的 FTR 檢查已推遲到夏季。那已經結束了嗎？會員流失是否已反映在您更新的指南中？只是想了解這是否會是另一個需要解決的問題？

And then my main question, I guess, the piggyback off of Kevin, and Stephen's question, but maybe to frame it slightly differently. As we look ahead and as it relates to work requirements, as we think about Georgia, Arkansas precedents, what we just experienced with three determinations the large dis-enrollment from procedural reasons.

然後我的主要問題，我想，是凱文和史蒂芬問題的副產品，但也許表達方式略有不同。當我們展望未來並考慮到工作要求時，當我們思考喬治亞州、阿肯色州的先例時，我們剛剛經歷了三次由於程序原因而大規模取消入學資格的決定。

And now with the new timeline starting '27, all the preparation states need, especially with what you mentioned with how they've struggled with all the volume of processes. How do you gain comfort that work requirements won't catalyze another big procedural disenrollment situation and widen that rate acuity mismatch even further over the next few years? Thank you.

現在，新的時間表從 27 年開始，各州都需要做好一切準備，特別是您提到的他們如何在大量流程中掙扎。您如何確保工作要求不會引發另一起大規模的程序性取消註冊情況，並在未來幾年進一步擴大費率敏銳度不匹配的情況？謝謝。

Thanks for the question. There's a number embedded in there. Maybe I'll ask Felicia to address sort of the work requirements component. Thank you.

謝謝你的提問。其中嵌入了一個數字。也許我會請費莉西亞 (Felicia) 來解決工作要求部分的問題。謝謝。

No. Thank you for the question, Michael. I'll start by saying that we have very good experience in terms of work requirement programs and working collaboratively with our state partners. When it's all said and done, we've operated in multiple regulatory environments. And the expectation from us is to be a good state partner in helping them through some of the operational challenges.

不。謝謝你的提問，麥可。首先我想說的是，我們在工作要求計劃和與國家合作夥伴合作方面擁有非常豐富的經驗。總而言之，我們已經在多種監管環境中開展業務。我們期望成為良好的政府合作夥伴，幫助他們克服一些營運挑戰。

So we are going to be providing them with opportunities to understand how you can do this more efficiently. States certainly are always pressured when it comes to resources and staffing to support this kind of activity. And so we are there to make sure that we bring innovative programs to help them meet the needs of beneficiaries. We have that experience in Indiana, which early implemented work requirements. Georgia is another state where work requirements are in place today.

因此，我們將為他們提供機會，了解如何更有效地做到這一點。在資源和人員支持此類活動方面，各州當然總是面臨壓力。因此，我們要確保推出創新計劃來幫助他們滿足受益者的需求。我們在印第安納州有過這樣的經驗，該州很早就實施了工作要求。喬治亞州是目前另一個實施工作要求的州。

And I think we've been able to work very effectively with our state partners to make sure that we are bringing the value to the table to support our states and equally important, support members and individuals who rely on Medicaid programs to make sure that they continue to have access for necessary care as we go through this period.

我認為我們已經能夠與我們的州合作夥伴非常有效地合作，以確保我們能夠為各州提供支持，同樣重要的是，支持依賴醫療補助計劃的成員和個人，以確保他們在我們度過這一時期時能夠繼續獲得必要的護理。

Thank you, Felicia, and thank you to everyone on the line. As you heard on the call today, we're actively addressing the levers that we can control, even as the ACA Medicaid markets go through a period of recalibration. The actions we're taking to align pricing, stabilize trend and drive operating leverage will position us for improved performance in 2026.

謝謝你，費莉西亞，也謝謝電話裡的每一個人。正如您今天在電話會議上聽到的那樣，即使 ACA 醫療補助市場正在經歷一段重新調整期，我們也在積極解決我們可以控制的槓桿問題。我們為調整價格、穩定趨勢和推動營運槓桿的行動將使我們在 2026 年獲得更好的表現。

At the same time, we're making the right strategic investments to enhance the embedded earnings power of the business and enable the enterprise to achieve its long-term growth objectives. Thank you for your interest in Elevance Health, and thank you for joining our call today.

同時，我們正在進行正確的策略性投資，以增強企業的內在獲利能力，並使企業實現其長期成長目標。感謝您對 Elevance Health 的關注，也感謝您今天參加我們的電話會議。

Ladies and gentlemen, a recording of this conference will be available for replay after 11:00 AM today through August 17, 2025. You may access the replay system at any time by dialing (866) 511-1890 and international participants can dial (203) 369-1945.

女士們、先生們，本次會議的錄音將於今天上午 11:00 之後至 2025 年 8 月 17 日提供重播。您可隨時撥打 (866) 511-1890 存取重播系統，國際參與者可撥打 (203) 369-1945。

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

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。