Elevance Health Inc (ELV) 2025 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. I would now like to turn the conference over to the company's management. Please go ahead.

女士們，先生們，感謝你們的支持，歡迎參加 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。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' Third Quarter 2025 Earnings Conference Call. My name is Nathan Rich, Vice President of Investor Relations. With us this morning on the earnings call are Gail Boudreaux, President and CEO; Mark Kaye, our CFO; Pete Haytaian, President of Carillon.

早安，歡迎參加 Elevance Health 2025 年第三季財報電話會議。我叫 Nathan Rich，是投資人關係副總裁。今天早上參加財報電話會議的有總裁兼執行長 Gail Boudreaux、財務長 Mark Kaye 和 Carillon 總裁 Pete Haytaian。

Morgan Kendrick, President of our Commercial Health Benefits business; and Felicia Norwood, President of our Government Health Benefits business. Gail will begin the call with a discussion of our third quarter performance, our planning assumptions for 2026 and the progress we've made against our strategic initiatives.

我們的商業健康福利業務總裁 Morgan Kendrick；以及我們的政府健康福利業務總裁 Felicia Norwood。蓋爾將在電話會議開始時討論我們第三季度的業績、我們對 2026 年的規劃假設以及我們在戰略舉措方面取得的進展。

Mark will then discuss our financial results and outlook in greater detail. After our prepared remarks, the team will be available for Q&A. During the call, we will reference certain non-GAAP financial 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.

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。在電話會議中，我們將參考某些非公認會計準則財務指標。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。

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. We advise the 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.

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。現在我將把電話轉給蓋爾。

Good morning, and thank you for joining us. Health care is at a pivotal moment. The industry has been challenged by rising medical and pharmacy costs and regulatory changes that will impact coverage for millions of Americans. At Elevance Health, we're focused on lowering the total cost of care and improving the member experience.

早安，感謝您加入我們。醫療保健正處於關鍵時刻。該行業面臨著醫療和藥品成本上漲以及監管變化的挑戰，這些將影響數百萬美國人的保險。在 Elevance Health，我們致力於降低護理總成本並改善會員體驗。

We're acting with urgency through an integrated clinical and benefits approach leveraging value-based care to align incentives, improve outcomes and guide people to high-value, lower-cost settings, tools like Health OS and our AI-enabled clinical support are already reducing friction, feeding decisions and bending the cost curve.

我們正在緊急採取行動，透過綜合臨床和福利方法，利用基於價值的護理來協調激勵措施、改善結果並引導人們進入高價值、低成本的環境，Health OS 和我們的人工智慧臨床支援等工具已經減少了摩擦、提供了決策並降低了成本曲線。

Our third quarter results reflected solid execution with the benefit expense ratio in line with our expectations. While results included approximately $1 of favorable items below the line, underlying performance remained consistent with the outlook we shared last quarter. We are reaffirming 2025 adjusted EPS of approximately $30 and continue to view $27 a as the appropriate earnings baseline, excluding $3 of discrete nonrecurring items.

我們的第三季業績反映出穩健的執行力，福利費用率符合我們的預期。雖然業績中包含了約 1 美元的低於預期的有利項目，但基本業績仍與我們上個季度分享的前景一致。我們重申 2025 年調整後的每股盈餘約為 30 美元，並繼續將 27 美元視為適當的收益基準，不包括 3 美元的離散非經常性項目。

As we planned for 2026, our posture is prudent and practical and we're approaching next year with discipline and focus. We want to set expectations that reflect today's realities, acknowledge uncertainties that remain and be clear about the levers we control. While we are still in our planning process for next year, there are a few key assumptions that will shape our outlook.

正如我們為 2026 年所規劃的那樣，我們的態度是審慎而務實的，我們將以紀律和專注的態度迎接明年。我們希望設定能夠反映當今現實的期望，承認仍然存在的不確定性，並明確我們所控制的槓桿。雖然我們仍在為明年做規劃，但有幾個關鍵假設將影響我們的前景。

Starting with Medicaid, continued membership reverifications and state program changes have driven acuity higher, and we are planning for at least 125 basis point year over year decline in Medicaid margins as rates like acuity and utilization trends remain elevated. This is an initial input at this early stage, not formal guidance.

從醫療補助計劃 (Medicaid) 開始，持續的會員資格重新驗證和州計劃變化已推動敏銳度上升，並且我們預計醫療補助計劃利潤率將同比下降至少 125 個基點，因為敏銳度和利用率趨勢仍然很高。這是早期階段的初步投入，而不是正式指導。

In Medicare Advantage, we've taken disciplined actions to improve profitability in 2026. We focusing on products that drive retention and value while exiting plans not aligned with our long-term strategy. For the 2027 payment year, approximately 55% of our MA members will be in four star or higher contracts, including three, five star contracts, up from about 40% for payment year 2026, demonstrating steady improvement in Star's performance and strong returns on the investments we've made.

在醫療保險優勢計劃中，我們採取了嚴格的措施來提高 2026 年的獲利能力。我們專注於推動保留和價值的產品，同時退出與我們的長期策略不一致的計劃。對於 2027 年付款年度，大約 55% 的 MA 成員將簽訂四星或更高級別的合同，包括三星、五星級合同，高於 2026 年付款年度的 40% 左右，這表明 Star 的業績穩步提升，我們的投資回報強勁。

In commercial, our integrated medical pharmacy model and advocacy solutions continue to resonate with employers. We maintained a disciplined approach to pricing, and we're pleased with strong client retention.

在商業領域，我們的綜合醫療藥房模式和宣傳解決方案繼續引起雇主的共鳴。我們保持了嚴謹的定價方法，並且對強大的客戶保留率感到滿意。

We continue to see expansion in our fee-based relationships driven by new client growth and sustained high retention among our large employer customers. Our industry-leading net Promotor scores reflect the trust employers place in our model. In the ACA market, our products are positioned to provide value to members while reflecting the higher acuity observed this year.

我們繼續看到收費關係的擴大，這得益於新客戶的成長和大型雇主客戶的持續高保留率。我們行業領先的淨推薦值反映了雇主對我們模型的信任。在 ACA 市場，我們的產品定位於為會員提供價值，同時反映今年觀察到的更高敏銳度。

We have taken a disciplined approach to pricing, while continuing to design offerings that ensure affordability and access. The anticipated expiration of enhanced subsidies would significantly impact membership in 2026. If the subsidies are extended, we work closely with states to support implementation and ensure continued access for consumers who rely on this coverage.

我們採取了嚴謹的定價方法，同時繼續設計確保可負擔性和可及性的產品。預計增強補貼將於 2026 年到期，這將對成員國產生重大影響。如果補貼延長，我們將與各州密切合作，支持實施並確保依賴此保險的消費者繼續享有補貼。

Caroline is expanding external relationships and scaling Furnas, behavioral health, specialty care management and home-based services, embedding value-based care principles throughout. External revenue grew double digits year over year, reflecting broad momentum across pharmacy behavioral and specialty services.

卡羅琳正在擴大外部關係並擴大 Furnas、行為健康、專業護理管理和家庭服務，並在整個過程中融入基於價值的護理原則。外部收入年增兩位數，反映出藥局行為和專業服務的廣泛發展動能。

Clients are turning to us for the value we deliver. Carelon Rx had another strong selling season for 2026 with several national account wins and high retention. Carelon Services continues to deepen its partnerships with external clients, driven by high-value solutions and the launch of new innovative products.

客戶之所以選擇我們，是因為我們提供的價值。Carelon Rx 在 2026 年又迎來了強勁的銷售季，贏得了多個全國性客戶，保留率很高。在高價值解決方案和創新產品推出的推動下，Carelon Services 持續深化與外部客戶的合作關係。

At the same time, enrollment dynamics and health benefits will create a directional headwind for Carillon next year, which we will size when we provide our earnings guidance in January. In Medicaid, reverification effects have raised acuity and sustained higher cost trends and states are preparing program changes that will influence the pace of rate adequacy.

同時，入學動態和健康福利將為 Carillon 明年帶來方向性的阻力，我們將在 1 月提供獲利預測時對此進行評估。在醫療補助計劃中，重新驗證的影響提高了敏銳度並維持了更高的成本趨勢，各州正在準備影響費率充足速度的計劃變更。

We are proactively working with our state partners on rate alignment, recommending program improvements such as benefit refinements and supporting states as they implement program changes. In parallel, we're expanding behavioral health interventions, strengthening specialty drug management and optimizing sites of care. These steps are designed to improve program effectiveness and bend the cost curve.

我們正在積極與各州合作夥伴合作，調整費率，建議改善計劃，例如完善福利，並支持各州實施計劃變更。同時，我們正在擴大行為健康幹預措施，加強專科藥物管理並優化護理場所。這些措施旨在提高計劃的有效性並降低成本曲線。

We are creating our own future through innovation. By year-end, more than 10 million members will have access to our AI-enabled virtual assistant, demonstrating how digital innovation is enhancing access, efficiency and engagement across our platform. For providers, we've lowered the number of prior authorization requests in the last two years, and providers Elevance Health OS platform befit from aligned data sharing, faster approvals and reduce administrative burden.

我們正在透過創新創造自己的未來。到年底，將有超過 1000 萬會員可以使用我們支援人工智慧的虛擬助手，這表明數位創新如何增強我們平台的訪問量、效率和參與度。對於提供者，我們在過去兩年中減少了事先授權請求的數量，並且提供者 Elevance Health OS 平台受益於一致的資料共享、更快的批准並減輕了管理負擔。

These initiatives collectively improve affordability, experience and productivity across Elevance Health. Looking ahead, by January, we expect greater visibility across our Medicaid rate cycle marketplace subseas and Medicare AEP results. A more complete picture of 2025 trends will refine our outlook for medical costs and the impact of our care management programs.

這些措施共同提高了 Elevance Health 的可負擔性、體驗和生產力。展望未來，到 1 月份，我們預計醫療補助利率週期市場海底和醫療保險 AEP 結果將更加清晰。更全面地了解 2025 年的趨勢將改善我們對醫療成本和護理管理計劃影響的展望。

With these -- we will then establish guidance that is both prudent and achievable. Capital deployment remains an important lever in our long-term earnings growth algorithm. Following several years of strategic acquisitions to expand Carillon capabilities, our focus is now on integrating those assets. We remain committed to disciplined capital allocation balancing investment in growth with consistent shareholder returns.

有了這些，我們就能製定既審慎又可行的指導方針。資本配置仍然是我們長期獲利成長演算法中的重要槓桿。經過數年的策略性收購擴大 Carillon 的能力，我們現在的重點是整合這些資產。我們始終致力於嚴謹的資本配置，以平衡成長投資和持續的股東回報。

We will prioritize returning capital to shareholders through share repurchases, while remaining disciplined stewards of capital. Stepping back, our message today is straightforward. We delivered results consistent with our revised outlook and reaffirm our 2025 adjusted EPS of approximately $30. We're approaching 2026 with discipline and focus and will provide an EPS range in January. While we recognize the external environment remains dynamic, we are confident in our strategy, our execution and our ability to drive sustainable value for our stakeholders.

我們將優先透過股票回購向股東返還資本，同時繼續做好資本的自律管理者。退一步來說，我們今天要傳達的訊息很簡單。我們實現了與修訂後的展望一致的結果，並重申 2025 年調整後的每股收益約為 30 美元。我們正以紀律和專注度迎接 2026 年，並將於 1 月提供每股收益範圍。雖然我們認識到外部環境仍然動態，但我們對我們的策略、執行力以及為利害關係人創造永續價值的能力充滿信心。

With that, I'll turn it over to Mark to discuss our financial results and outlook in more detail.

接下來，我將把主題交給馬克，讓他更詳細地討論我們的財務表現和前景。

Thank you, Gail, and good morning to everyone. Elevance Health reported third quarter GAAP diluted earnings per share of $5.80 and adjusted diluted earnings per share of $6.03. Our operating performance reflected enhanced medical cost management and expense discipline, consistent with the expectations we outlined last quarter.

謝謝你，蓋爾，大家早安。Elevance Health 公佈第三季 GAAP 稀釋每股收益為 5.80 美元，調整後稀釋每股收益為 6.03 美元。我們的營運表現反映了醫療成本管理和費用控制的加強，符合我們上季的預期。

We are sharpening pricing, accelerating our digitization and automation journey and embedding value-based care principles across our enterprise. Relative to the earnings cadence previously described, results this quarter benefited from the timing of planned tax actions contemplated in our full year guidance and stronger net investment income, a portion of which we intend to reinvest to support our long-term growth.

我們正在提高定價，加快數位化和自動化進程，並在整個企業中嵌入基於價值的護理原則。相對於先前描述的獲利節奏，本季的業績受益於我們全年指引中考慮的計劃稅收行動的時機以及更強勁的淨投資收益，其中一部分我們打算再投資以支持我們的長期成長。

As Gail discussed in her remarks, we are reaffirming 2025 adjusted EPS to be approximately $30 and continue to view $27 as the appropriate earnings baseline for modeling purposes. This excludes approximately $3 of nonrecurring favorable items primarily tax, the value-based provider settlement recognized in the second quarter and valuation adjustments that benefited net investment income.

正如蓋爾在她的評論中所討論的，我們重申 2025 年調整後的每股收益約為 30 美元，並繼續將 27 美元視為建模目的的適當收益基準。這不包括約 3 美元的非經常性有利項目，主要是稅收、第二季度確認的基於價值的提供者結算以及有利於淨投資收入的估值調整。

Total operating revenue for the quarter was $50.1 billion, up 12% year over year, reflecting higher premium yields, recently closed acquisitions and growth in our Medicare Advantage membership partially offset by ongoing Medicaid reverifications. We ended the quarter with 45.4 million medical members.

本季總營業收入為 501 億美元，年增 12%，反映了更高的保費收益率、最近完成的收購以及醫療保險優勢計劃會員數量的增長，但部分被正在進行的醫療補助重新驗證所抵消。本季結束時，我們的醫療會員總數達到 4,540 萬人。

This enrollment in our Medicaid membership remains concentrated among lower acuity members driven by more stringent eligibility reviews and changes to state reverification processes. The consolidated benefit expense ratio was 91.3%, aligned with our expectations. Medicaid performance reflected pressure from elevated acuity and utilization, which were not fully offset by rate update.

由於資格審查更加嚴格以及州重新驗證流程的變化，我們的醫療補助會員的登記仍然集中在低敏銳度會員中。合併福利費用率為91.3%，符合我們的預期。醫療補助的表現反映了敏銳度和利用率提高帶來的壓力，而這些壓力並沒有透過費率更新完全抵消。

We now expect our full year 2025 Medicaid operating margin to be modestly negative, establishing a baseline from which we anticipate a decline of at least 125 basis points in 2026 as rates continue to lag acuity and utilization trends remain elevated. We continue to partner closely with states on rate adequacy and operational enhancements to ensure the sustainability of their Medicaid programs.

我們現在預計 2025 年全年醫療補助營業利潤率將略為負值，由此建立的基準預計 2026 年將下降至少 125 個基點，因為費率繼續落後於敏銳度且利用率趨勢仍然很高。我們繼續與各州密切合作，確保費率充足性和營運改進，以確保其醫療補助計劃的可持續性。

Medicare Advantage costs, inclusive of Part D were marginally better than expected due to disciplined plan design and member composition. Trend has been elevated but manageable and we now expect our operating margin to increase slightly in 2025 and though still well below our long-term range. Performance in the ACA market developed somewhat favorably to the prudent expectations we set in July, the cost trends remain significantly above historical levels.

由於嚴格的計劃設計和成員組成，包括 D 部分在內的醫療保險優勢計劃成本略好於預期。趨勢有所上升但尚可控制，我們現在預計 2025 年我們的營業利潤率將略有上升，但仍遠低於我們的長期範圍。ACA 市場的表現略優於我們 7 月設定的審慎預期，成本趨勢仍遠高於歷史水準。

We continue to anticipate a high single-digit decline in full year operating margin and are planning for higher costs in the fourth quarter as members utilize their benefits ahead of coverage changes next year. Cost patterns and margins in our Commercial group business were consistent with our expectations.

我們繼續預計全年營業利潤率將出現高個位數下降，並且由於會員在明年保險範圍發生變化之前利用其福利，我們計劃在第四季度提高成本。我們商業集團業務的成本模式和利潤率與我們的預期一致。

Our integrated medical pharmacy model and advocacy solutions coupled with Talon's differentiated value-based care approach is driving higher retention and expanded fee-based relationships -- continues to deliver strong performance across both pharmacy and services, reflecting the power of our integrated platform. Kill on Rx revenue grew 20% year over year, driven by strong momentum with our largest clients, and Killon services grew by more than 50%, supported by robust organic growth and the continued integration of Caybridge.

我們的綜合醫療藥房模式和宣傳解決方案，加上 Talon 差異化的基於價值的護理方法，正在推動更高的保留率和擴大的收費關係——繼續在藥房和服務領域提供強勁的表現，反映了我們綜合平台的強大力量。由於我們最大客戶的強勁成長勢頭，Killon Rx 營收年增 20%，而得益於強勁的有機成長和 Caybridge 的持續整合，Killon 服務收入成長超過 50%。

We are making targeted investments in technology, integration initiatives and operational efficiency to sustain this growth and enhance performance across the enterprise. While Killon-Rx margins are expected to be modestly below our guidance due to these investments, -- Services is trending towards the high end of our guidance range, highlighting the strength of our differentiated value-based care model.

我們正在對技術、整合計劃和營運效率進行有針對性的投資，以維持這種成長並提高整個企業的績效。雖然由於這些投資，預計 Killon-Rx 的利潤率將略低於我們的預期，但服務業務正趨向於我們預期範圍的高端，凸顯了我們差異化的價值型護理模式的優勢。

Together, these businesses demonstrate how Kalon is driving growth across Elevance's Health. Our adjusted operating expense ratio was 10.4%, and we continue to manage the business with discipline while making targeted investments to scale -- capabilities, support and strengthen our workforce and accelerate technology adoption. Net investment income was $625 million, with approximately $150 million, primarily related to discrete valuation adjustments in our alternative investment portfolio.

這些業務共同展示了 Kalon 如何推動 Elevance 健康事業的成長。我們的調整後營業費用率為 10.4%，我們將繼續嚴格管理業務，同時進行有針對性的投資以擴大規模——能力、支持和加強我們的員工隊伍並加速技術採用。淨投資收入為 6.25 億美元，其中約 1.5 億美元主要與我們的另類投資組合中的離散估值調整有關。

Third quarter operating cash flow of $1.1 billion or 1 times GAAP net income was impacted by the cash settlement payment related to the Blue Cross Blue Shield multi-district litigation. Our balance sheet remains strong. preserving flexibility to support our growth objectives, invest in new capabilities and return capital to shareholders.

第三季的營運現金流為 11 億美元，即 1 倍的 GAAP 淨收入，受到與藍十字藍盾多地區訴訟相關的現金和解付款的影響。我們的資產負債表依然強勁，保持靈活性以支持我們的成長目標、投資新能力並向股東返還資本。

In the quarter, we repurchased $875 million of shares reflecting our disciplined approach to capital deployment and commitment to returning value to shareholders even as we continue integrating recent acquisitions. We maintained a prudent posture with respect to reserves.

本季度，我們回購了價值 8.75 億美元的股票，這體現了我們在資本配置方面的嚴謹態度以及在繼續整合近期收購的同時致力於為股東帶來價值的承諾。我們對儲備保持審慎態度。

Days in claims payable of 42.6 days, excluding the impact of Caybridge, were approximately flat year over year. Turning to next year. While we are not providing 2020 earnings guidance today, I will outline several key variables informing our planning assumptions. Our current outlook assumes our Medicaid operating margin will decline by at least 125 basis points year over year.

不包括 Caybridge 的影響，索賠支付天數為 42.6 天，與去年同期基本持平。展望明年。雖然我們今天不提供 2020 年獲利預測，但我將概述影響我們規劃假設的幾個關鍵變數。我們目前的預測是，我們的醫療補助營業利潤率將年減至少 125 個基點。

The critical factors underpinning this input include the ongoing misalignment of rates and acuity, elevated utilization trends and funding and eligibility changes in certain states. We will refine our view on our fourth quarter call as we gain visibility on the premium rates that reset in January and the impact of state specific program changes. In Medicare, we took a disciplined and thoughtful approach to 2026 bids prioritizing plans that deliver attractive value to members, while producing sustainable financial performance.

支撐這項投入的關鍵因素包括費率和敏銳度的持續錯位、利用率趨勢的上升以及某些州的資金和資格變化。隨著我們逐漸了解一月份重置的保費率以及特定州計劃變化的影響，我們將完善對第四季度電話會議的看法。在醫療保險方面，我們對 2026 年的競標採取了嚴謹而周到的方法，優先考慮那些能為會員帶來有吸引力的價值並能產生可持續財務業績的計劃。

As we have previously noted, we exited certain service areas that will impact approximately 150,000 members. We expect strong growth in Carelon to continue across both pharmacy and services, offset by the impact of expected health benefits membership losses.

正如我們之前提到的，我們退出了某些服務區域，這將影響約 15 萬名會員。我們預計，Carelon 在藥局和服務領域將繼續保持強勁成長，但預期的健康福利會員損失的影響將被抵消。

And finally, our operating expense outlook includes several hundred million dollars of incremental investments to advance our strategic goals. We are intentionally prioritizing durable, long-term performance over near-term expense leverage. These include targeted use of AI and digital tools to enhance the member and provide experience, the expansion of Carelon's capabilities and initiatives to strengthen future performance, including improvements in our Star ratings.

最後，我們的營運費用前景包括數億美元的增量投資，以推進我們的策略目標。我們有意優先考慮持久的長期業績，而不是短期費用槓桿。這些措施包括有針對性地使用人工智慧和數位工具來增強會員並提供體驗，擴展 Carelon 的能力和舉措以加強未來的表現，包括提高我們的星級評定。

Looking beyond 2026, we remain confident in the enterprises long-term algorithm. While next year will reflect challenging Medicaid dynamics, membership changes and disciplined investment we expect 2027 to mark a return to a more balanced earnings growth profile.

展望2026年後，我們仍對企業的長期演算法充滿信心。雖然明年將面臨醫療補助動態、會員變化和嚴格投資的挑戰，但我們預計 2027 年將恢復更加均衡的獲利成長狀況。

With that, operator, please open the line for questions.

接線員，請打開熱線來回答問題。

(Operator Instructions) A.J. Rice, UBS.

（操作員指示）A.J. Rice，瑞銀。

Thanks. Hi everybody. Maybe just to try to drill down a little further on the comments around Medicaid. Obviously, you're saying this year, you're slightly negative or somewhat negative and then you're going to be 125 basis point margin incrementally negative next year, it sounds like. when you're -- in your dialogue with the states, are they acknowledging that? Are they seeing you as being unique relative to other players in that trend, and therefore, it's harder to get the update. And as you talk about where the pressure points are, can you sort of give a little more flavor?

謝謝。大家好。也許只是想進一步深入了解有關醫療補助的評論。顯然，您說的是，今年的利率略微為負或有些為負，而明年的利率將逐步為負 125 個基點。聽起來，在您與各州對話時，他們承認這一點嗎？他們是否認為您相對於該趨勢中的其他玩家是獨一無二的，因此更難獲得更新。當您談到壓力點在哪裡時，您能否再多說一點？

Is it just the cost trend is worse than you would have anticipated, and you expect it to continue to be worse? Is it the rate updates are not coming in as you thought? And then are you factoring in any of this change in benefit design that states are contemplating? Or would that be potentially upside if that would occur?

成本趨勢是否比您預期的更糟糕，並且您預計它會繼續惡化？是不是利率更新沒有像您想像的那樣？那麼，您是否考慮過各州正在考慮的福利設計變更？或者如果發生這種情況，是否會帶來潛在的好處？

Thank you, A.J. Pretty fulsome question. So why don't I ask Mark to sort of frame some of how we're thinking about it and then Felicia to comment specifically about the discussions with the state. Mark?

謝謝你，A.J。這個問題問得相當透徹。那麼，我為什麼不請馬克概括一下我們對此的看法，然後讓費莉西亞具體評論一下與州政府的討論呢？標記？

Good morning. So we're not going to be providing specific point estimates for the composite rate update or the medical cost trend today. But let me clearly frame sort of the two anchors behind our outlook for at least the 125 basis points decline next year. The first is trend. Our preliminary 2026 Medicaid trends assumption is really anchored to our expected fourth quarter exit rate which we typically also view as the seasonal low point for Medicaid margins in the year. So it's really a prudent base from which to plan 2026.

早安.因此，我們今天不會提供綜合費率更新或醫療成本趨勢的具體點估計。但讓我清楚地概括一下我們對明年至少 125 個基點下降前景的兩個錨點。第一是趨勢。我們對 2026 年醫療補助趨勢的初步假設實際上是基於我們預期的第四季度退出率，我們通常也將其視為當年醫療補助利潤率的季節性低點。因此，這確實是一個規劃 2026 年的審慎基礎。

And for context, we now expect the full year 2025 Medicaid operating margin to be modestly below breakeven or approximately negative 50 basis points. And that aligns with what we've previously communicated. The trend continues to be pressured by elevated acuity and utilization driven by some of those state reverification processes and program changes. Second is rates. We do expect state rate updates to be modestly above historical levels, but still trail trend into 2026, given, say, rate cycle lag claims data and that more acute risk pool.

就背景而言，我們現在預計 2025 年全年醫療補助營業利潤率將略低於損益平衡點或約負 50 個基點。這與我們之前傳達的訊息一致。這一趨勢繼續受到一些州重新驗證流程和計劃變化所推動的敏銳度和利用率上升的壓力。第二是利率。我們確實預計州利率更新將略高於歷史水平，但考慮到利率週期滯後的索賠數據和更嚴峻的風險池，到 2026 年仍將落後於趨勢。

And so if I put those together, that gets us to our initial planning assumption for 2026. SP1671564738 And here's the important point. We do view 2026 as the trust, not the beginning of another reset period. And the actions we are taking will position us to improve through the cycle as we ultimately target that 2% to 4% margin range over time.

因此，如果我把這些放在一起，我們就得到了 2026 年的初步規劃假設。SP1671564738 這是重點。我們確實將 2026 年視為信任，而不是另一個重置期的開始。我們正在採取的行動將使我們在整個週期中不斷改進，最終目標是隨著時間的推移實現 2% 到 4% 的利潤率範圍。

So A.J., thank you for that question. Our conversations with our dates remain very constructive. The state certainly recognize the challenges around affordability in this program, but our expectation that rates remain actuarially sound. One of the things that's changed certainly in conversations this time around, is states are certainly more receptive to ways that can help reduce the overall cost of the Medicaid program improve affordability. So one of the things that we've been doing is providing them with options around the levers that they have that can certainly address some of the program changes that are increasing cost and utilization in the program.

A.J.，謝謝你提出這個問題。我們與約會對象的對話仍然非常有建設性。州政府當然認識到該計劃在負擔能力方面面臨的挑戰，但我們預計費率在精算上仍然合理。這次對話中肯定發生變化的一點是，各州肯定更願意接受有助於降低醫療補助計劃總體成本、提高可負擔性的方法。因此，我們一直在做的事情之一就是為他們提供圍繞他們所擁有的槓桿的選項，這些選項肯定可以解決一些增加計劃成本和利用率的計劃變化。

So for example, we've seen increases in certain categories of services things like ADA, which is high behavioral analysis, changes that we can make with respect to GLP-1s and other things that have been up cost.

例如，我們看到某些類別的服務增加，例如 ADA（高行為分析）、我們可以針對 GLP-1 做出的改變以及其他成本上漲的事物。

The conversations this time around have certainly not just been about raised. So states are exploring ways that they can reduce their program costs in orders so that we all have a program that's more sustainable. So at this point, I will tell you the conversations are solid. They're going very well there's been a very nice change around ideas for maintain the long-term sustainability of the Medicaid program, which we're all aligned around, and we look forward to continuing to work with our states through this process. But -- we've laid out several approaches.

這次的談話當然不僅僅是關於進步。因此，各州正在探索降低專案成本的方法，以便我們都能擁有一個更永續的專案。因此，在這一點上，我可以告訴你，對話是紮實的。一切進展順利，在維持醫療補助計劃長期可持續性的想法方面發生了非常好的變化，我們都對此持一致意見，我們期待著在此過程中繼續與各州合作。但是——我們已經制定了幾種方法。

There's greater receptivity and we look forward to continuing to work collaboratively with our state partners around the long-term sustainability of this program.

接受度更高，我們期待繼續與我們的州合作夥伴合作，確保該計劃的長期可持續性。

Thank you. Next question, please.

謝謝。請問下一個問題。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Hi, thanks. I just wanted to ask about some of the investment spending that you flagged in the slides, I think you're talking about potentially several hundred million dollars of investment Obviously, the company is investing every year. So trying to understand what you guys are trying to spike there in terms of materiality to 2026.

你好，謝謝。我只是想問您在幻燈片中提到的一些投資支出，我想您談論的是潛在的數億美元的投資，顯然，公司每年都在投資。因此，試著了解你們在 2026 年實質方面想要實現的目標。

And then it also you look at some of the commentary that you have two and speaking about the influence of investment spending on your ability to grow earnings there. Is it fair to think that some of this increased investment is transitory in nature. Just hoping we could understand that better coming off the call. Thanks.

然後，您還可以查看一些評論，其中談到投資支出對您增加收益的能力的影響。是否可以認為，部分增加的投資本質上是暫時的？只是希望我們能夠在通話結束後更好地理解這一點。謝謝。

Steve, thanks very much for the question this morning. So if we look ahead to 2026, we do expect to meet discrete investments worth several hundred million dollars and quantify that as approximately $1 of EPS really to advance our strategic goals. And these dollars are going to be really focused in three primary areas. First, technology adoption, where we're deploying AI into clinical workflows, automating roster processes, modernizing core systems already simplifying care delivery and driving efficiency. Second is Carelon investments.

史蒂夫，非常感謝您今天早上提出的問題。因此，如果我們展望 2026 年，我們確實希望實現價值數億美元的離散投資，並將其量化為每股收益約 1 美元，以真正推進我們的策略目標。這些資金將主要集中在三個領域。首先是技術採用，我們將人工智慧部署到臨床工作流程中，實現排班流程自動化，實現核心系統的現代化，從而簡化醫療服務並提高效率。第二是Carelon投資。

We're going to be scaling new client onboarding as we expand into larger upmarket accounts and build pharmacy capabilities, in our home delivery infusion and specialty locations. And then thirdly, around operational and quality initiatives. I think here, further improvements in Star ratings and deeper member engagement. And together, these investments are intended to align with our long-term growth objectives that will enhance member satisfaction and then positioning enterprise for greater operating leverage over time.

隨著我們擴展到更大的高端客戶並在我們的送貨上門輸液和專科門市建立藥房能力，我們將擴大新客戶的入職規模。第三，圍繞營運和品質措施。我認為，星級評定將會進一步提高，會員參與度也將進一步加深。總之，這些投資旨在與我們的長期成長目標保持一致，從而提高會員滿意度，並隨著時間的推移使企業獲得更大的經營槓桿。

Yes. And Stephen, I'd like to just give a little bit more perspective on some of the investments, particularly where we're heading on AI generative AI. And I think it's important not to see that we see it as a strategic enabler of what we are trying to accomplish, which will really drive more affordable, accessible and personalized care. We've been embedding AI responsibly, not just as an experiment, but at scale, and we see that they are improving our efficiency and our outcomes and also the experience for members, providers and associates. And maybe just to put some real tangible examples on that.

是的。史蒂芬，我想就一些投資提供更多的看法，特別是我們在人工智慧生成人工智慧方面的進展。我認為重要的是，我們不要將其視為我們正在努力實現的目標的策略推動因素，這將真正推動更實惠、更便利和更個人化的醫療服務。我們一直在負責任地嵌入人工智慧，這不僅僅是一項實驗，而是大規模的，我們看到它們正在提高我們的效率和成果，以及會員、供應商和同事的體驗。也許只是為了舉一些真實、具體的例子。

I shared a little bit in my opening comments. For members, for example, our personalized match feature in our Sydney helps one in five of our members right now. select the right provider using more than 500 personalized data points and improving navigation and satisfaction. We're using it across our customer service. We have tools that improve our first contact resolution, shortened ramp-up time.

我在開場白中分享了一點。例如，對於會員來說，我們雪梨的個人化配對功能目前可以幫助五分之一的會員使用超過 500 個個人化資料點來選擇合適的供應商，並提高導航和滿意度。我們在整個客戶服務過程中都在使用它。我們擁有可以提高首次聯繫解決率、縮短啟動時間的工具。

help with proactive engagement.

幫助積極參與。

And I think really importantly, for the commitments we've made on care providers, our Health OS platform is automating onboarding our contracting, our roster management, -- it's also reducing a lack of information so that we have reduced denials by more than 68% in peer-to-peer reviews by over 100%. So we're getting real-time data that's also giving us greater insight into some of the things that Felicia shared, which is how we get ahead of the cost curve. So across the enterprise, we see it as a huge opportunity to help support our productivity goals. We look at it to reduce the burdens on care providers by reducing our chart request by almost half. And then our national account teams, for example, are using it to update benefits and onboard clients.

我認為真正重要的是，對於我們對護理提供者所做的承諾，我們的 Health OS 平台正在自動化我們的合約、名冊管理——它還減少了資訊的缺乏，因此我們在同行評審中將拒絕率降低了 68% 以上，降低了 100% 以上。因此，我們獲得了即時數據，這也讓我們能夠更深入地了解 Felicia 分享的一些內容，這就是我們如何領先於成本曲線。因此，在整個企業中，我們認為這是一個幫助支持我們的生產力目標的巨大機會。我們希望透過將圖表請求減少近一半來減輕護理人員的負擔。例如，我們的國家客戶團隊正在使用它來更新福利和接納客戶。

So across the board, including for our own associates, we're investing in them as well. We just signed a partnership with OpenAI where we're going to actually train our folks to be able to use these skills appropriately.

因此，我們也在全方位地投資，包括我們自己的員工。我們剛剛與 OpenAI 簽署了合作協議，我們將培訓我們的員工，使他們能夠適當地使用這些技能。

The reason I wanted to share more detail on that is we're embedding these at scale across our operations. and prioritizing high-use impact cases that reduce, first, the complexity, they drive savings and enhance the experience, which are two of our core goals. One, reducing the cost curve and to enhancing the experience our members have. So what we see is this is going to create leverage for us, improve affordability, strengthen operational performance and support sustainable long-term growth. And to your last question around sort of the impact of those, we see these as front-loaded investments across the board.

我之所以想分享更多細節，是因為我們正在整個營運過程中大規模嵌入這些功能，並優先考慮高使用率影響案例，首先，降低複雜性，從而節省成本並增強體驗，這是我們的兩個核心目標。一是降低成本曲線並增強會員體驗。因此，我們認為這將為我們創造槓桿作用，提高承受能力，增強營運績效並支持可持續的長期成長。對於您最後一個關於這些影響的問題，我們認為這些都是全面的前期投資。

Mark shared that. We're seeing great pickup in the investments we've made in Stars. I just shared the AI investments and we think that they help support us.

馬克分享了這一點。我們看到，我們在 Stars 上的投資取得了巨大的成長。我剛剛分享了人工智慧投資，我們認為它們對我們有幫助。

Lisa Gill, JPMorgan.

摩根大通的麗莎吉爾。

Good morning and thank you. Just want to go to the individual ACA exchanges. Obviously, the time line is taking care for the extension of the enhanced subsidies. Gail or anyone on the call, can you give us any color around what the difference would be in membership as we think about '26, should be not be able to some kind of agreement and not have the enhanced subsidies in '26. And we've clearly seen what the proposed risks are by state. So really just the question is really around membership and how to think about that going into next year.

早安，謝謝。只是想去個人 ACA 交易所。顯然，時間表是為了延長增強補貼而製定的。蓋爾或電話中的任何人，您能否告訴我們，當我們考慮 26 年時，會員人數會有什麼不同，應該無法達成某種協議，也不會在 26 年增加補貼。我們已經清楚地看到了各州提出的風險。所以，真正的問題在於會員資格以及如何考慮明年的會員資格。

Yes. Thanks for the question, Lisa. I think maybe we take a little bit of a step back and then I'll have Mark talk a little about membership. But Obviously, we're really proud of the role that we play in the ACA marketplace, and we may -- we are still being very committed to the affordable access for individuals and families who rely on these plans. As we think about 2026, we've taken a very balanced approach.

是的。謝謝你的提問，麗莎。我想也許我們可以稍微退一步，然後我會讓馬克談談會員資格。但顯然，我們對自己在 ACA 市場中所扮演的角色感到非常自豪，而且我們可能——我們仍然致力於為依賴這些計劃的個人和家庭提供可負擔的醫療服務。當我們考慮 2026 年時，我們採取了非常平衡的方法。

And again, I want to talk about a little bit our filings are designed to reflect the higher acuity, and we are ready and prepared for a range of policy outcomes, including both the renewal and the potential modification of those enhanced subsidies. And we're ready to work with our states and our policymakers on that path forward.

我想再次談談我們的申請旨在反映更高的敏銳度，我們已經準備好迎接一系列政策結果，包括更新和潛在修改這些增強補貼。我們已準備好與各州和政策制定者一道努力向前邁進。

So if they are attended, we'll work quickly with regulators and states to ensure a smooth execution and continued affordability. And if there are some changes or phase downs, I think we're prepared also to work with our states closely to help people standard because I think that is the core issue here.

因此，如果有人參加，我們將迅速與監管機構和各州合作，確保順利執行並持續負擔得起。如果出現一些變化或逐步減少，我認為我們也準備好與各州密切合作，幫助人們實現標準，因為我認為這是這裡的核心問題。

So I guess before we get into the membership, I think it's really important to sort of talk about this strategically first that we think we feel very strongly we're operating responsibly and flexibly, and that our pricing supports the stability for members, but also ensuring we can sustain participation in the market for the long term.

因此，我想在討論會員資格之前，我認為首先從戰略上談論這一點非常重要，我們認為我們非常強烈地感覺到我們正在負責任和靈活地運營，我們的定價支持會員的穩定性，同時也確保我們能夠長期維持參與市場。

And we expect that to translate, obviously, into improved performance financial performance in '25. But let me have Mark maybe just comment a little bit about your membership question, which again, not having the final policy expectations, I think we still have to assume it's just planning assumptions at this point.

我們預計，這顯然會轉化為 25 年財務表現的改善。但是，請允許馬克對您的會員資格問題發表一點評論，同樣，由於沒有最終的政策預期，我認為我們仍然必須假設這只是目前的規劃假設。

And Lisa here, clearly, if the enhanced advanced premium tax credits were to expire at year-end. We'd expect a material contraction in the ACA marketplace. We've seen some of those independent estimates from the congressional budget office which indicate meaningfully lower enrollments and a much higher morbidity risk pool into 2026 under those exploration scenarios. And if back just for a second, that smaller, more acute pool does mean fewer enrollees just spray risk and sharper premium increases. And that's really what we're seeing.

麗莎，很明顯，如果增強的預付保費稅收抵免在年底到期。我們預計 ACA 市場將出現大幅萎縮。我們已經看到了國會預算辦公室的一些獨立估計，這些估計表明，在這些探索情境下，到 2026 年入學人數將顯著減少，而發病風險池將大大增加。回想一下，規模較小、較敏銳的保險池確實意味著較少的受保者承擔風險，保費上漲幅度更大。這正是我們所看到的。

Certainly, a partial extension of those premium subsidies along with the transition or a glide path that would definitely support consumers in a more stable affordable marketplace over time.

當然，部分延長這些保費補貼以及過渡或下滑路徑肯定會隨著時間的推移為消費者提供更穩定、更實惠的市場支持。

And again, I just want to reinforce that we plan for that in terms of our filings and going forward, but also recognize that they're real pressure rising costs, and we want to be a part of that solution with our policymakers as well. Next question, please.

我再次強調，我們在提交申請和未來發展方面已經為此做好了計劃，但同時也認識到成本上升確實帶來了壓力，我們也希望與政策制定者一起成為解決方案的一部分。請問下一個問題。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning. The health benefits margins finished the quarter at 1.4%, which I think implies government margins are negative. You commented that you now expect Medicare operating margins to increase slightly in '25. But I think it was unclear if that was a year over year comment or a positive revision to the outlook.

嗨，早安。本季健康福利利潤率為 1.4%，我認為這意味著政府利潤率為負。您評論說，您現在預計醫療保險營業利潤率將在 25 年略有增加。但我認為尚不清楚這是同比評論還是對前景的正面修正。

So can you clarify that comment and help us understand where Medicare margins sit for the year and there are a path back to target Medicare margin next year, given the actions you took in planned exits and benefit reductions. Thanks.

那麼，您能否澄清一下這一評論，並幫助我們了解今年的醫療保險利潤率處於什麼水平，並考慮到您在計劃退出和福利削減方面採取的行動，明年是否有辦法恢復到目標醫療保險利潤率。謝謝。

Andrew, good morning and thanks very much for the question. I anticipate we probably are going to get a couple of questions here on the margin and trends. So maybe let me start by framing high level what we're seeing and what we've incorporated into our outlook for the full year.

安德魯，早安，非常感謝您的提問。我預計我們可能會在這裡問到一些有關利潤和趨勢的問題。因此，讓我先概括一下我們所看到的以及我們在全年展望中考慮到的內容。

On Medicaid, as we spoke about earlier, performance has been weaker than expected, really as that trend does remain elevated given the high utilization and the member acuity shift driven by the ongoing state reverification efforts and program changes. Within the commercial book, our outlook incorporates trends in our ACA book, reflective of the holistic impact of higher population mobility that elevated utilization and rising unit costs.

關於醫療補助，正如我們之前提到的，其表現一直弱於預期，事實上，由於高利用率和正在進行的國家重新驗證工作和計劃變化所推動的成員敏銳度轉變，這種趨勢確實保持高位。在商業書籍中，我們的展望融合了 ACA 書籍中的趨勢，反映了人口流動性提高、利用率提高和單位成本上升的整體影響。

We're continuing to expect operating margins for our ACA business to be down year over year in the high single-digit percent range. And then commercial -- group margins to remain largely consistent with prior expectations. Now we have seen some favorability in ACA relative to our initial expectations, and you see that come through in a sense of this quarter.

我們繼續預期 ACA 業務的營業利潤率將年減高個位數百分比範圍。然後商業——集團利潤率將與先前預期的基本保持一致。現在，我們看到 ACA 相對於我們最初的預期有一些有利因素，並且您將在本季度看到這一點。

And then to your question in Medicare, we feel good about our positioning, given the composition of our membership and our results to date, we actually expect margin stability with potential for slight improvement this year. even excluding the onetime value-based care settlement that we recognized last quarter, and that's going to be supported by strong retention, disciplined cost management and product positioning and then ultimately really better recognition of that member acuity following the elevated utilization we've seen in recent years. Thank you.

然後回答您關於醫療保險的問題，我們對我們的定位感到滿意，考慮到我們的會員組成和迄今為止的業績，我們實際上預計利潤率將保持穩定，今年可能會略有改善。即使不包括我們上個季度確認的一次性基於價值的護理結算，這也將得到強大的保留率、嚴格的成本管理和產品定位的支持，最終隨著近年來利用率的提高，對會員敏銳度的認識將得到更好的提升。謝謝。

Thank you. Next question, please.

謝謝。請問下一個問題。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Thanks. Good morning. I wanted to follow up on your Medicaid comments. I appreciate the color on the 50 basis points of negative margin for this year. But I think you've been clear that this business has deteriorated through the year, and thus, the losses are probably more significant than this than the full year would indicate coming out of the year, meeting the run rate in 3Q and 4Q might be worse than that and that minus 50 basis points annually.

謝謝。早安.我想跟進您對醫療補助的評論。我很欣賞今年 50 個基點的負利潤率。但我想你已經清楚，這項業務在今年已經惡化，因此，損失可能比今年全年的損失更大，達到第三季和第四季的運行率可能比這更糟，每年減少 50 個基點。

So it would be helpful to give us more color on kind of how you see this business exiting the year, maybe the fourth quarter margin. So if you can understand how that 125 basis points compares to that Q4 run rate?

因此，如果您能向我們詳細介紹一下您對今年該業務的前景（例如第四季度的利潤率）有何看法，那將會很有幫助。那麼，您是否能理解 125 個基點與第四季的運行率相比如何？

Justin, thanks very much for the question here. And certainly, your underlying premise is correct. Margins deteriorated as the year has gone on. But we've been very clear today as I try to think forward a little bit that is going to reflect those same continued pressures in Medicaid as rates catch up to acuity. And it's important to be real about that.

賈斯汀，非常感謝你提出這個問題。當然，你的基本前提是正確的。隨著時間的推移，利潤率不斷下降。但今天我們已經非常清楚了，當我嘗試稍微向前思考時，這將反映出醫療補助中同樣的持續壓力，因為費率趕上了敏銳度。認清這一點很重要。

Again, in 2026, we do expect also those rate actions to be directionally constructive -- you heard Felicia talk to that. And to reflect that elevated acuity we've experienced since redeterminations, and that's an important turning point. At the same time, we've also spoken to not waiting and rate cycles alone, right? We've intensified key management and program integrity programs in the highest-cost categories, long-term services and support, behavioral health, specialty pharmacy.

再次，在 2026 年，我們確實預計這些利率行動也將具有方向性的建設性——您聽到 Felicia 談到了這一點。這也反映了我們自重新確定以來所經歷的敏銳度的提高，這是一個重要的轉折點。同時，我們也談到不要等待，而要單獨評估週期，對嗎？我們加強了成本最高的類別、長期服務和支援、行為健康、專業藥房等關鍵管理和專案完整性計劃。

-- and we are seeing measurable improvement. And if I put that together, that's really why we see 2026 the low point in the Medicaid margin. And from there, we would expect to see sequential improvement through 2027 as those rates and the operational savings take more of a hold. And I'd say we're pretty confident that the business ultimately will return to that 2% to 4% target margin range.

——我們看到了明顯的改善。如果我把這些綜合起來，這就是我們看到 2026 年醫療補助利潤率達到最低點的原因。從那時起，我們預計到 2027 年將會出現連續的改善，因為這些費率和營運節省將得到進一步的維持。我想說，我們非常有信心，業務最終將恢復到 2% 至 4% 的目標利潤率範圍。

Thank you, Mark. And just to put a fine point on that, kind of reiterating that we are taking a very prudent approach to Medicaid. And as we think about the 125 basis points of margin deterioration we are assuming that we enter the year at the place we exited the year. Next question please.

謝謝你，馬克。為了更明確地說明這一點，我們重申我們對醫療補助採取非常謹慎的態度。當我們考慮利潤率下降 125 個基點時，我們假設我們進入今年時的位置與退出今年時的位置相同。請問下一個問題。

Lance Wilkes, Bernstein.

蘭斯威爾克斯、伯恩斯坦。

Yes. On the Medicaid book, could you talk a little bit about how you're looking at that book, if there's a wide range of margins by state and contract, what are your opportunities to exit any contracts? Obviously, given the more significant negative margins there? And maybe just a quick follow-up over on Carelon, if you talk a little on Carelon Rx about any progress you're seeing in especially pharmacy acquisition contribution to margin stability or any sort of impacts on margin were there? Thanks.

是的。關於醫療補助計劃，您能否談談您對該計劃的看法，如果各州和合約的利潤範圍很廣，您退出任何合約的機會是什麼？顯然，考慮到那裡的負利潤率更大？也許只是對 Carelon 的快速跟進，如果您能談談 Carelon Rx，您看到的任何進展，特別是藥房收購對利潤穩定性的貢獻，或者對利潤率有任何影響嗎？謝謝。

Thanks, Lance. I'll ask Felicia to start and then Pete to comment on Carelon.

謝謝，蘭斯。我會讓 Felicia 開始，然後讓 Pete 對 Carelon 進行評論。

Good morning, Lance, thank you for the question. There certainly is great variability in performance as you go from state to state. And as you know, we have a portfolio of over 24 markets in Puerto Rico. And we take a look across the board states are certainly at a very different place. The expectation, as you heard from Mark, is that we were going to continue to work with states on their rates, program changes and the other things that we can do to improve overall performance.

早安，蘭斯，謝謝你的提問。各州的表現肯定有很大差異。如您所知，我們在波多黎各擁有超過 24 個市場的投資組合。我們全面審視一下，各州的情況確實截然不同。正如馬克所說，我們的期望是，我們將繼續與各州合作，制定稅率、專案變更以及我們可以做的其他事情來提高整體績效。

With that said, if a state is that going to deliver the expectations that we need from a financial perspective, we will certainly consider exiting that business if we can't deliver on the long term. But our framework has to consider a lot of variables. We have to take a look at the rate adequacy versus the trend that we're seeing, the prom designs, the regulatory environment and policy stability that we see there. all kinds of things with respect to our risk-sharing arrangement, operational challenges and other things.

話雖如此，如果一個州能夠從財務角度滿足我們的期望，而我們無法長期實現這一目標，我們肯定會考慮退出該業務。但我們的框架必須考慮很多變數。我們必須審視利率充足性與我們所看到的趨勢、舞會設計、監管環境和政策穩定性，以及與我們的風險分擔安排、營運挑戰和其他方面有關的各種事項。

At the end of the day, we are very much committed to Medicaid. We think it brings strong value to this enterprise. It aligns with our ability to serve incredibly vulnerable members. And our preference is to be there. But if we were to exit this, we would align that with normal changes in terms of contract extensions, which, as you know, actually happen every year because Medicaid contracts, while their four or five year contracts, the contract renews every single year.

歸根結底，我們非常致力於醫療補助計劃。我們認為它為該企業帶來了巨大的價值。這與我們為極其脆弱的成員提供服務的能力一致。我們更願意去那裡。但是如果我們要退出，我們會將其與合同延期方面的正常變化保持一致，正如你所知，合同延期實際上每年都會發生，因為醫療補助合同，雖然是四年或五年的合同，但合同每年都會續簽。

And then there's also certainly the opportunity around RFPs in that strategy with respect to exiting. But our expectations would be to do everything we could to minimize disruption and ensure continuity of care for members.

然後，就退出而言，該策略中肯定也存在著圍繞 RFP 的機會。但我們的期望是盡一切努力減少干擾並確保對會員的持續照護。

So we're going to be strong partners with our states, but we're going to be incredibly mindful around this business. and whether or not there is the ability to be there sustainably for a long term in support of our states and our members. So thank you for the question. And then I'm going to turn this over to Pete.

因此，我們將與各州建立強有力的合作夥伴關係，但我們會非常謹慎地開展這項業務，以及是否有能力長期持續地支持我們的各州和我們的成員。謝謝你的提問。然後我要把這個交給皮特。

All right, Lance. Thank you very much for the question. I appreciate it. And our specialty strategy is integral to the diversification strategy that we're deploying in pharmacy. We're very excited about it.

好的，蘭斯。非常感謝您的提問。我很感激。我們的專業策略是我們在藥局部署的多元化策略不可或缺的一部分。我們對此感到非常興奮。

We stand for whole health and driving greater affordability and simplicity and very focused on the patient experience.

我們主張整體健康，推動更大的經濟實惠性和簡單性，並高度關注患者體驗。

And this diversification strategy is very important to our long-term growth trajectory going forward. We're making really good progress as it relates to that. I think we started with the Bio Plus platform, and we continue to migrate scripts to that platform. Last year, we have -- as you know, we acquired Kroger Specialty Pharmacy. And in light of that, we had a commitment to transition those scripts by the end of this year, which we're making really good progress on very, very happy with the team's performance in that regard in terms of how that's gone from an action perspective, and we'll continue to migrate further ships as we move forward into 2026.

這種多元化策略對於我們未來的長期成長軌跡非常重要。就此而言，我們正在取得非常好的進展。我認為我們是從 Bio Plus 平台開始的，並且我們繼續將腳本遷移到該平台。如您所知，去年我們收購了 Kroger Specialty Pharmacy。有鑑於此，我們承諾在今年年底之前完成這些腳本的轉換，目前我們在這方面取得了非常好的進展，從行動的角度來看，我們對團隊在這方面的表現非常非常滿意，並且隨著 2026 年的到來，我們將繼續遷移更多的船隻。

I would also say that we look forward to really continuing to build a diversified and differentiated strategy around this, so we can garner scripts outside of Levante as well. So thanks for the question. We appreciate it.

我還想說，我們期待真正繼續圍繞這一點建立多元化和差異化的策略，這樣我們也可以在萊萬特之外收集劇本。感謝您的提問。我們對此表示感謝。

Next question please.

請問下一個問題。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great, thanks. I guess just to follow up on the Medicaid comments, trying to understand, I guess there's been a concern that the risk pool shifts that are supposed to happen from the reconciliation bill could be pulled forward. So I just want to understand how much of that risk pool shift that you kind of expect to be happening in 2026?

太好了，謝謝。我想只是為了跟進醫療補助的評論，試圖理解，我想人們一直擔心，和解法案中應該發生的風險池轉移可能會被提前。所以我只是想知道您預計 2026 年風險池會發生多大程度的轉變？

I don't know how you would quantify that, whether it's 1/3 of what you expect the next five years happens next year or some way to think about that? And then just to clarify, when you guys talked about returning to balanced growth in 2027, is that saying back to the normal growth algorithm? Or is balance kind of imply something a little bit less than the long-term growth rate? Thanks.

我不知道你會如何量化這一點，是預計未來五年發生的 1/3 會在明年發生，還是以某種方式考慮？然後需要澄清的是，當你們談到 2027 年恢復平衡成長時，是否說要恢復正常的成長演算法？或者平衡意味著比長期成長率略低一些？謝謝。

Kevin, thanks very much for the question. Let me maybe touch the first one, briefly, then I'll talk about the balanced drinks growth after that. On Medicaid, I think the way you could think about this is that the reduction in our expectations for margins this year and sort of our guidance next year of that 125 or at least 125 basis points decline really reflects a more balanced split now between acuity and utilization versus what we provided last quarter.

凱文，非常感謝你的提問。讓我先簡單談談第一個問題，然後再談飲料的均衡成長。關於醫療補助，我認為你可以這樣想：我們今年對利潤率的預期下降，以及我們對明年利潤率的指導下降了 125 個或至少 125 個基點，這實際上反映了敏銳度和利用率之間的更加平衡，與我們上個季度提供的數據相比。

On balance, when you talk about that return to a more balanced earnings growth profile we really need getting back to the growth algorithm that has characterized our business. And that means contributions from commercial, government, Carelon, supported by the operating leverage and disciplined capital deployment that we've done historically.

總的來說，當你談到回歸更平衡的獲利成長狀況時，我們確實需要回到我們業務所特有的成長演算法。這意味著來自商業、政府、Carelon 的貢獻，以及我們過去所做的營運槓桿和嚴格的資本配置的支持。

And our 2026 repositioning and investments are intended to set up 2027 for the more balanced contribution across businesses. So specifically, we would expect our earnings drivers to be more evenly distributed including improved Medicaid rate alignment, further Medicare margin normalization following our pricing actions and sustained momentum across Carelon, as you heard from Pete and our commercial franchise. Of course, on policy, the BBBA implementation is still going to be progressing.

我們 2026 年的重新定位和投資旨在為 2027 年各業務做出更均衡的貢獻。因此，具體來說，我們預計我們的獲利驅動因素將更加均勻地分佈，包括改善醫療補助率調整、在我們的定價行動之後進一步實現醫療保險利潤率正常化以及整個 Carelon 的持續發展勢頭，正如您從 Pete 和我們的商業特許經營權那裡聽到的那樣。當然，從政策上來說，BBBA的實施仍將繼續進行。

But we're confident we can manage through it with the disciplined execution. And so while we're not providing an outyear EPS growth rate today, Hopefully, you can see from our comments that we reflect that confidence that really past 2026, the business should again resemble that more balanced, consistent growth that we've historically delivered grounded in discipline and diversification across cycles.

但我們相信，只要嚴格執行，我們就能解決這個問題。因此，雖然我們今天沒有提供未來年度每股收益成長率，但希望您能從我們的評論中看到，我們反映了這樣的信心：到 2026 年以後，業務應該再次恢復到我們歷史上在紀律性和跨週期多樣化基礎上實現的更加平衡、持續的增長。

Thank you. Next question, please.

謝謝。請問下一個問題。

Ann Heinz, Mizuho Securities.

安·海因茨，瑞穗證券。

Great, thank you. I just would like to focus on membership growth in 2026. So with the Medicaid redetermination, should we assume that membership in Medicaid book will actually decline next year and that coupled with rates I'm just trying to figure out like where you have revenue actually declining?

太好了，謝謝。我只想關注 2026 年的會員成長。因此，隨著醫療補助計劃的重新確定，我們是否應該假設醫療補助計劃的會員人數明年實際上會下降，再加上費率，我只是想弄清楚您的收入實際上在哪裡下降？

Or should we assume Medicaid revenue actually grows in 2026? And then also with the Medicaid expected membership decline in for Medicaid and the ACA. Can you just give us more detail how that impacts Carillon services in Carelon. Does one of the segments have an outsized proportion from membership losses versus the other? Thanks.

或者我們應該假設醫療補助收入在 2026 年實際上會成長？此外，預計醫療補助計劃和 ACA 的會員人數也會下降。您能否詳細介紹一下這對 Carelon 的 Carillon 服務有何影響？其中一個細分市場的會員流失比例是否比其他細分市場高很多？謝謝。

Appreciate the question this morning. So the 2026 Medicaid membership outlook, while very preliminary at this point, does consider things like the continued normalization following the redetermination process as well as the impact of the state program changes and RFP outcomes.

感謝今天早上提出的問題。因此，2026 年醫療補助會員前景雖然目前還處於初步階段，但確實考慮了重新確定過程後的持續正常化以及州計劃變化和 RFP 結果的影響等因素。

Whilst we do expect some churn to persist into next year, we do expect the pace of disenrollments to be manageable and we are beginning to see stabilization in some of our markets. Overall, again, as a planning assumption, you could expect 2026 average Medicaid membership to be modestly lower than where we're in 2025. And that's going to be driven by many of the factors that we've spoken about our call today, and we'll provide more guidance as we enter January.

雖然我們確實預計明年仍將出現一些客戶流失，但我們預期客戶退出的速度將是可控的，而且我們開始看到部分市場趨於穩定。總體而言，再次作為規劃假設，您可以預期 2026 年的平均醫療補助會員人數將略低於 2025 年的水平。這將受到我們今天電話會議中談到的許多因素的影響，我們將在進入一月份時提供更多指導。

Yes, I'm going to ask maybe Pete to comment on Carelon.

是的，我可能會請 Pete 對 Carelon 進行評論。

Yes. No, thanks for the question in the context of membership impacts on Carillon going forward. Let me just step back first and talk about the growth prospects in Carelon. I think you saw that come through. You heard it through Gail's comments and Mark's comments, we're seeing very strong growth, both on the services side as well as on the pharmacy side.

是的。不，感謝您提出有關會員資格對 Carillon 未來發展的影響的問題。首先，我先回顧 Carelon 的發展前景。我想你已經看到了這一點。您從蓋爾和馬克的評論中聽到了，我們看到了非常強勁的增長，無論是在服務方面還是在藥房方面。

And importantly, we're diversifying our growth. We're seeing a lot of really nice external growth across many of our solutions. Now of course, Alliance is our largest client.

重要的是，我們正在實現成長多元化。我們看到我們的許多解決方案都取得了非常好的外部成長。當然，Alliance 現在是我們的最大的客戶。

And if Elvance has significant membership impacts, it will have some impact on Carelon, but I view that really as time bound. We have incredible momentum in the marketplace. That would be short-term we feel like depiction of our assets and our strategy will continued growth in Carelon.

如果 Elvance 對會員產生重大影響，那麼也會對 Carelon 產生一定影響，但我認為這確實有時間限制。我們在市場上擁有令人難以置信的發展勢頭。我們認為這只是短期現象，我們的資產和策略將在 Carelon 持續成長。

Thank you. Next question, please.

謝謝。請問下一個問題。

Joshua Raskin, Nephron Research.

Joshua Raskin，腎元研究。

Hi, thanks. Just a quick clarification on Medicaid. Maybe if you could just sort of delineate how much of the 125 bps next year is trend running above reimbursement? How much of that is the adverse selection continuing and that there's any impact from the BB. And then my real question is just, can you provide -- you talked a little bit about this last quarter, an update on the increased coding trend that you talked about from providers. And maybe specifically, if that's still just pockets? And have you made any progress? I think you were talking about using payment integrity tools or other areas.

你好，謝謝。只是對醫療補助做一個快速澄清。也許您可以稍微描述一下明年 125 個基點中有多少是高於償還額的趨勢？其中逆向選擇在多大程度上持續存在以及 BB 有何影響。然後我真正的問題是，您能否提供——您在上個季度談到了這一點，以及您談到的來自提供者的編碼趨勢增加的最新消息。也許具體來說，如果那仍然只是口袋？你有取得什麼進展嗎？我認為您正在談論使用支付完整性工具或其他領域。

Josh, I appreciate the question. And the short answer to it is we'll provide more specificity around our outlook for Medicaid in January. Maybe I can spend just a minute talking about really what's changed since our commentary in July on the earnings call or September at the Wells Fargo conference. And we've always consistently framed 2026 Medicaid margin is having a wide range of potential outcomes. And our preliminary guide of the 125 basis points decline sits within that range.

喬希，我很感謝你的提問。簡而言之，我們將在一月份提供有關醫療補助前景的更多具體資訊。也許我可以花一點時間談談自從我們 7 月在收益電話會議或 9 月在富國銀行會議上發表評論以來到底發生了哪些變化。我們始終一致認為，2026 年醫療補助計劃的利潤將產生廣泛的潛在結果。我們初步預測的 125 個基點的跌幅就在這個範圍內。

And really what's changed now is we have more 2025 experience, we have updated state inputs, and that's let us narrow the early view while staying prudent First, I would say our experience is clearer this year.

現在真正的變化是，我們擁有了更多的 2025 年經驗，我們更新了國家投入，這讓我們在保持謹慎的同時縮小了早期的視野。首先，我想說我們今年的經驗更加清晰。

Medicaid performance has been pressured by elevated acuity and utilization. We spoke about that last quarter and we're reiterating that commentary again today. and that has not been fully offset by rate update. We've seen disenrollments remain concentrated among lower acuity members due to those more stringent eligibility reviews and changes to the state reverification processes. And those are factors that have increased the average acuity of the remaining risk pool. And that led to our direct -- it's directly led to our guidance today that Medicaid operating margin will be below breakeven for the full year.

醫療補助的績效因敏銳度和利用率的提高而受到壓力。我們在上個季度談到了這一點，今天我們再次重申這一評論。但這並沒有被利率更新完全抵銷。我們發現，由於資格審查更加嚴格以及州重新驗證流程的變化，取消註冊的情況仍然集中在低敏銳度成員中。這些因素都增加了剩餘風險池的平均敏銳度。這直接導致了我們今天的預測，即醫療補助的營業利潤率將在全年低於損益平衡點。

The second point I'd make here is that state level updates have also sharpened our assumptions. We have seen several large states, including our home state experience budget pressure. And as a result of implementing program changes in response, and that will similarly lead to continued risk pool deterioration and that ongoing sort of near-term misalignment of rates would trend briefly on coding trends, as we spoke about last quarter, our focus really remains on working with the providers to ensure accuracy compliance and sustainability and how those member conditions are documented. We are taking meaningful steps to improve sort of that oversight so that the data capture, the clinical documentation, the vendor of site is all accurate and appropriate for our business. Thanks.

我在這裡要提出的第二點是，國家層級的更新也讓我們的假設更明確。我們看到包括我們家鄉在內的幾個大州都面臨預算壓力。作為響應而實施的計劃變更的結果，這同樣會導致風險池持續惡化，並且持續的短期利率錯位將對編碼趨勢產生短暫的影響，正如我們上個季度談到的那樣，我們的重點仍然是與提供者合作，以確保準確性、合規性和可持續性以及如何記錄這些成員的條件。我們正在採取有意義的措施來改善這種監督，以便資料擷取、臨床文件、站點供應商都是準確且適合我們的業務的。謝謝。

Yes. Thank you, Mark, and thanks for the question, Jon. Just taking a step back, and I know there's a lot of interest in this. I think I just want to reinforce. As we think about decade and our other assumptions, these are prudent planning assumptions and that we are matching our near-term dynamics with discipline.

是的。謝謝你，馬克，也謝謝你的提問，喬恩。只要退一步來看，我知道很多人對此很感興趣。我想我只是想加強一下。當我們考慮十年和其他假設時，這些都是審慎的規劃假設，我們正在將我們的近期動態與紀律相匹配。

And the work we've done this year, we are looking to position Elevance Health for a durable sustainable growth as we go beyond '26 and into '26. So just a little bit around. And as you heard from Mark, we are very aggressively addressing the higher coding intensity and we've seen it in pockets but have significant tools to advance that as well. So thank you for the question. Next question please.

我們今年所做的工作是希望 Elevance Health 在 2026 年後和 2026 年能實現持久的永續成長。所以只是稍微繞了一下。正如您從馬克那裡聽到的，我們正在非常積極地解決更高的編碼強度問題，我們已經在一些地方看到了它，但也有重要的工具來推進它。謝謝你的提問。請問下一個問題。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓 (Ryan Langston)，TD Cowen。

Hi, good morning. Thank you. I know you commented that you're working with state partners on some of these initiatives. But did I hear you say that your state partners are explicitly contemplating, pulling back on benefits or other ways to give you some relief just besides paying better rates? And if so, how long would those adjustments typically take to implement and you to maybe see any potential benefit? Thank you.

嗨，早安。謝謝。我知道您曾說過，您正在與國家合作夥伴合作進行其中一些舉措。但是我是否聽到您說過，您的州合作夥伴正在明確考慮削減福利或採取其他方式，除了支付更高的費率之外，給您一些救濟？如果是這樣，這些調整通常需要多長時間才能實施，您才能看到任何潛在的好處？謝謝。

So good morning and thank you for the question. Absolutely. I think states are looking at all of the levers that they have in order to improve affordability in this program. I mean, one of the things you have to understand is we step back and think about where states are the enhanced FMAP that states used to have to support their Medicaid programs no longer there. And so states have to look toward all the levers they have to be able to improve affordability and what really is one of the largest spend in a state budget.

早安，感謝您的提問。絕對地。我認為各州正在考慮所有可用的手段來提高該計劃的可負擔性。我的意思是，你必須明白的一件事是，我們退一步思考一下各州的情況，各州過去用來支持其醫療補助計劃的增強型 FMAP 已不復存在。因此，各州必須利用一切手段來提高負擔能力，這實際上是州預算中最大的支出之一。

Those levers include program changes that I mentioned before, including changes to a range of optional medical services that you see in the Medicaid program.

這些手段包括我之前提到的計劃變更，包括醫療補助計劃中一系列可選醫療服務的變更。

The timing of those generally aligned with the new contract here and sometimes that can be either January or July. -- but those are certainly within the power of the state to drive those changes with respect to the contracts, and we continue to work closely with them. Ultimately, our goal is to make sure that we are working with states around improving total cost of care, and being able to have at their disposal, the levers that they can to do that. combined with the work that we bring to the table around being able to deliver networks that have value-based arrangements and other ways to introduce care innovations to improve overall total care costs, are things that states are looking at.

這些變化的時間通常與這裡的新合約一致，有時可能是一月或七月——但這些變化當然在國家權力範圍內，由國家推動合約方面的變更，我們將繼續與他們密切合作。最終，我們的目標是確保與各州合作，改善醫療總成本，並讓他們能夠掌握實現這一目標所需的手段。結合我們所做的工作，能夠提供具有基於價值的安排的網絡，以及其他引入醫療創新以改善整體醫療成本的方法，這些都是各州正在關注的事情。

So I think there's an opportunity here to continue to be collaborative with our state partners around the long-term viability of this program, and we're fully aligned with our partners in doing that. Thank you.

因此，我認為這裡有機會繼續與我們的州合作夥伴就該計劃的長期可行性進行合作，並且我們與我們的合作夥伴完全一致地這樣做。謝謝。

Next question, please.

請問下一個問題。

Scott Fidel, Goldman Sachs.

高盛的史考特·菲德爾。

Hi, thanks. Good morning. I was hoping to just drill into two of the product areas in Medicare and get your updates on your thinking there. The first would be just I know -- that that's an area want to continue to focus on moving forward? And maybe give us some thoughts on how you see that positioned for 26 now that you have more insight into the competitive landscape. And then a PPO, just curious on sort of your view on that longer term. I know that you're pulling back for 2026.

你好，謝謝。早安.我希望深入了解醫療保險的兩個產品領域，並了解您在那裡的想法。首先，我知道這是我們希望繼續關注的領域嗎？現在您對競爭格局有了更多的了解，也許可以告訴我們您如何看待 26 的定位。然後是 PPO，只是好奇您對此的長期看法。我知道你們正在為 2026 年做準備。

There has been a longer-term sort of cycle of expansion and then pull back for ELV and the PPO product. So curious on just how you're thinking about sort of putting that into the longer-term strategy projective. Thanks.

ELV 和 PPO 產品經歷了長期的擴張和回落週期。我很好奇您是如何考慮將其納入長期的策略規劃。謝謝。

So thank you for the question. And certainly, it's very early in the AEP process. We're only six days into the annual election period. So we are very pleased with how we are positioned in our products and in our target markets. As you said, we took very strong focus and investments in our HMO and our duals products.

謝謝你的提問。當然，AEP 流程還處於非常早期的階段。一年一度的選舉期才剛過六天。因此，我們對我們的產品和目標市場的定位感到非常滿意。正如您所說，我們非常重視並投資於我們的 HMO 和雙重產品。

Duals has been a strategy for us for some time. It aligns very well with our Medicaid footprint, and also the ability of Carillon to help manage individuals who have complex conditions. So we invested in HMO and duals in order to make sure that we were continuing to focus on those areas that we believe drive great value for seniors and meaningful value for the enterprise.

一段時間以來，雙重策略一直是我們的策略。它與我們的醫療補助計劃覆蓋範圍非常吻合，並且 Carillon 有能力幫助管理患有複雜疾病的個人。因此，我們投資了 HMO 和雙重保險，以確保我們繼續專注於那些我們認為能為老年人帶來巨大價值、為企業帶來有意義價值的領域。

PPO has never really been a strong product focus for Elevance Health, not traditionally, we had a handful of PPO products across the. And as you know, over the last couple of years, we actually even declined our position where we had a PPO footprint, is our expectation to be able to manage the conditions of our members effectively and PPO certainly doesn't allow us to do that same way that our HMO and DISA portfolio allows us to do.

PPO 從來都不是 Elevance Health 的重點產品，傳統上，我們在整個行業中只有少數幾種 PPO 產品。如您所知，在過去的幾年裡，我們實際上甚至拒絕了我們的立場，我們有 PPO 足跡，我們的期望是能夠有效地管理我們成員的狀況，而 PPO 肯定不允許我們以與我們的 HMO 和 DISA 投資組合允許我們做同樣的事情。

So as we sit here today, we feel good about our positioning in our key markets where we made the geographic decisions to expand and go deeper are those markets where we believe we bring great value. And as we think about the strategy that we put in place a few years ago and pulled through into '26, we feel good about how we are positioned around improving our profitability and believe that we're going to make meaningful progress towards our long-term target range of 3% to 5% in our Medicare program. Thank you.

因此，今天我們坐在這裡，對我們在關鍵市場的定位感到滿意，我們做出了擴展和深入的地理決策，我們相信我們能在這些市場帶來巨大的價值。當我們思考幾年前製定並貫徹到 26 年的策略時，我們對自己在提高盈利能力方面的定位感到滿意，並相信我們將在實現醫療保險計劃 3% 至 5% 的長期目標範圍方面取得有意義的進展。謝謝。

Thanks, Felicia. Scott, just to reiterate, we've always been more heavily weighted on HMO products and it also aligns very much to our value-based care strategy and our ability to take risk, particularly with Carol on our specialty risk such as in oncology. So it's an alignment to a long-term strategy that we've had. Next question please.

謝謝，費利西亞。史考特，我再次重申一下，我們一直更加重視 HMO 產品，這也與我們基於價值的照護策略和承擔風險的能力非常吻合，特別是卡羅爾對我們的專業風險（例如腫瘤學）的重視。因此，這與我們的長期策略一致。請問下一個問題。

Erin Wright, Morgan Stanley.

艾琳·賴特，摩根士丹利。

Okay, was on mute. Anything to call out on the commercial cost trend? I mean, I think you mentioned just broader cost trends kind of in line with expectation, but any areas such as behavioral to call out that have been called out before by you and others, I guess anything else to to call from a pricing perspective or otherwise from a commercial perspective, thanks.

好的，靜音了。對於商業成本趨勢有什麼需要注意的嗎？我的意思是，我認為您提到的更廣泛的成本趨勢與預期一致，但您和其他人之前已經提到過的行為等領域，我想還有從定價角度或商業角度需要注意的其他事項，謝謝。

Erin, thanks for the question. Erin, -- in the ACA market developed somewhat favorably to our prudent expectations in the quarter despite the overall deterioration in the risk or acuity and the elevated utilization, we continue to see pressure in that ACA market across inpatient medical surgery, behavioral health, pharmacy and ER usage, on the commercial group side, elevated trends persist, but remain mostly in line with what we're expecting.

艾琳，謝謝你的提問。艾琳，儘管風險或敏銳度總體惡化且利用率上升，但本季度 ACA 市場的發展在一定程度上符合我們的審慎預期，我們繼續看到 ACA 市場在住院醫療手術、行為健康、藥房和急診室使用方面面臨壓力，在商業集團方面，上升趨勢持續存在，但仍與我們的預期基本一致。

And we have a couple of pockets there around outpatient utilization and the unit cost mix of services, including some higher-cost surgeries that we're monitoring. But for the most part, very consistent with our outlook, no concerns. Next question, please.

我們在門診利用率和服務單位成本組合方面有幾個方面進行研究，包括我們正在監控的一些成本較高的手術。但總體而言，這與我們的展望非常一致，無需擔心。請問下一個問題。

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 Medicare Advantage thinking about the 150,000 members impacted by exits and other planned changes. To what extent are these members just members that you're simply no longer competing for versus a subset that could be recaptured into other plants. And then stepping back a bit from that, how are you thinking about retention broadly in your continuing markets, especially in light of the better star ratings we saw earlier this month. Thanks.

太好了，非常感謝。醫療保險優勢計劃 (Medicare Advantage) 正在考慮因退出和其他計劃變更而受到影響的 150,000 名會員。在多大程度上，這些成員只是你不再競爭的成員，而不是可以被其他工廠重新捕捉的子集。然後稍微退一步來說，您如何看待持續市場中的保留率，特別是考慮到我們本月早些時候看到的更好的星級評定。謝謝。

Morning, Ben, and thank you for the question. Retention is certainly a big part of our strategy. And I think we've done an excellent job over the last couple of years of being focused on those places geographically and in those products where we have the best opportunity to do that.

早安，本，謝謝你的提問。保留無疑是我們策略的重要組成部分。我認為，過去幾年來，我們一直專注於那些地理位置和產品最有機會實現這一目標的地方，做得非常出色。

Our strategy in 2026 reflects a very disciplined focus on our sustainable performance over time. So we approach select plans and service areas where we didn't believe we had the opportunity to see long-term sustainable performance as we looked out towards the future of our Medicare Advantage program.

我們的 2026 年策略體現了我們對長期可持續表現的嚴格關注。因此，當我們展望醫療保險優勢計劃的未來時，我們接觸了一些我們認為沒有機會看到長期可持續表現的計劃和服務領域。

So this is a very intentional strategy that we took continuing on our AEP strategy from 2025. It gives us deeper performance in those markets where we have a larger footprint and aligns with our Medicaid business. And I think from our perspective, Ben, we are working closely with those individuals that we are not retaining to make sure that they are able to find the right plan that works for them.

因此，這是我們從 2025 年開始延續 AEP 策略而採取的一項非常有針對性的策略。它使我們在擁有更大影響力的市場中獲得了更好的表現，並且與我們的醫療補助業務保持一致。本，我認為從我們的角度來看，我們正在與那些我們沒有留住的個人密切合作，以確保他們能夠找到適合他們的正確計劃。

But we feel good about the focus, the strategy, the footprint and the products that we've laid out for 2026, and look forward to continuing to improve our overall performance in Medicare Advantage. So thank you for the question.

但我們對 2026 年制定的重點、策略、足跡和產品感到滿意，並期待繼續提高我們在醫療保險優勢計劃方面的整體表現。謝謝你的提問。

Next question, please.

請問下一個問題。

Dave Windley, Jefferies.

戴夫溫德利 (Dave Windley)，傑富瑞 (Jefferies)。

Hi, thanks for taking my question. I wanted to come back to Medicaid and try to understand a little bit of progression. I understand that you're highlighting some reverification activity that is ongoing in your markets. it seems that OB3 will trigger another round of acuity shift maybe starting as early as late.

你好，謝謝你回答我的問題。我想回到醫療補助計劃並嘗試了解一些進展。我理解您正在強調您所在市場正在進行的一些重新驗證活動。 OB3 似乎將引發另一輪敏銳度轉變，可能最早或最晚開始。

And our assumptions are our understanding is that, that could be fairly significant. And so I'm trying to marry that with your expectations for sequential improvement in Medicaid margin through '27 when you are facing what seems like another acuity shift ahead of a catch-up situation from late '26 through '27. Thank you.

我們的假設是，我們的理解是，這可能相當重要。因此，我試圖將其與你對 27 年醫療補助利潤率連續改善的預期結合起來，而你正面臨著在 26 年末到 27 年追趕形勢之前似乎又一次敏銳度轉變的情況。謝謝。

Dave, thanks very much for the question. So let me do a little bit of a progression here. As we think about 2026, about evenly split two key drivers, rates continue to lag higher acuity and in persistently elevated cost trends. On the first driver rates continuing to lag higher acuity, that's really compounded by the state reverification processes. Those program changes that we've spoken about and that's really where those higher disenrollments are raising that acuity.

戴夫，非常感謝您的提問。因此，讓我在這裡做一些進展。當我們展望 2026 年時，兩個關鍵驅動因素大致平分秋色，利率繼續落後於更高的敏銳度和持續上升的成本趨勢。首次駕駛員費率繼續落後於更高敏銳度，這實際上因國家重新驗證流程而變得更加複雜。我們已經討論過的那些計劃變化以及更高的取消入學率確實提高了這種敏銳度。

On persistently elevated cost trends, this is simply utilization remaining above historical norms across several categories that we continue to monitor, and I spoke about a little bit ago. 2026 -- or at least our view is 2026 will be the low point for us in Medicaid margins. And we're going to see sequential improvement in 2027. And there are really four concrete drivers that underline our view. First, tighten medical cost management, right? And that means expanding behavioral health interventions, they mean strengthening specialty drug management.

在成本持續上升的趨勢中，這只是我們持續監測的幾個類別的利用率仍然高於歷史標準，我剛剛談到了這一點。 2026 年—或至少我們認為 2026 年將是我們的醫療補助利潤率的最低點。我們將在 2027 年看到連續的改善。實際上，有四個具體的驅動因素支持了我們的觀點。第一，加強醫療費用管理，對吧？這意味著擴大行為健康幹預，意味著加強特殊藥物管理。

That means optimizing sites of care. And you heard from Felicia, we're actively working with the states on that rate alignment and program refinements. These programs are in flight, and they are really designed to ban that cost of care curve as 2026 progresses into 2027. Second is the budget reconciliation build provision. Those are phased and manageable. Clearly, we know that federal changes under the build that are going to be staggered primarily effective in '27 and '28.

這意味著優化護理網站。正如費利西亞所說，我們正在積極與各州合作，調整費率並完善計劃。這些計劃正在進行中，其真正目的是在 2026 年至 2027 年期間禁止這種護理成本曲線。第二是預算調節建設準備金。這些都是分階段的並且可管理的。顯然，我們知道，根據該法案，聯邦改革將分階段實施，主要在 27 年和 28 年生效。

But that's going to allow us time to plan and collaborate with the states. And importantly, that pacing then reduces execution risk and supports a more steadier transition of the risk pool. The third one is rates, right? Rates are going to begin to catch up to trend and reverification impact. states are starting to incorporate more recent experience into base rates, albeit with lags.

但這將使我們有時間與各州進行規劃和合作。重要的是，這種節奏可以降低執行風險並支持風險池更穩定地轉變。第三個是利率，對嗎？利率將開始趕上趨勢和重新驗證的影響。各州開始將最近的經驗納入基準利率，儘管有滯後。

And so as 2025 and '26 experience rolls into the state cycles, we expect further alignment and progress. And so finally, I would say our 2026 outlook is intentionally prudent and and therefore, a credible base off of which to build.

因此，隨著 2025 年和 2026 年的經驗進入國家週期，我們期待進一步的協調和進步。最後，我想說，我們對 2026 年的展望是經過深思熟慮的，因此是一個可靠的基礎。

Yes, thanks, Mark. Dave, just to put a finer point on one of Mark's discussions around, as you think about the implementation of the bill in '27. It is not complete reverification. It's less than 20% of our membership will be impacted. So I think you need to sort of size that in terms of that. So that's why we feel '26 is the lower point.

是的，謝謝，馬克。戴夫，我想對馬克的討論進行更細緻的闡述，關於 27 年該法案的實施。這並不是完整的重新驗證。我們的會員中受影響的人數不到 20%。所以我認為你需要根據這個來判斷其大小。所以這就是為什麼我們認為 26 是最低點。

And we do see that as manageable going forward. And we do believe that the risk impacts we have seen in some states, some of our larger states have accelerated some of that redetermination work even into '25. So that gives us confidence. I'll take the last question, please.

我們確實認為未來這是可以控制的。我們確實相信，我們在一些州、一些較大的州看到的風險影響已經加速了一些重新確定工作，甚至加速到25年。這給了我們信心。請讓我回答最後一個問題。

George Hill, Deutsche Bank.

德意志銀行的喬治·希爾。

Yes. I think Dave took one of my Medicaid question, some work. I have a quick 2 point around it on Medicaid. I guess, number one, is there a way to put a bottom goalpost around Medicaid expectations for you said you expect it to be greater than -- or call it, down about 125 basis points. I guess, is there a way to put a bottom limit on that? And then I thought your answer to the last question was great. But if Medicaid margin recovery is pushed out another year, does that impact your ability to earnings in 2017?

是的。我認為戴夫回答了我的一個有關醫療補助的問題，有些工作。我對醫療補助計劃有 2 點看法。我想，第一，有沒有辦法為醫療補助預期設定一個最低目標，您說您預計它會大於 - 或稱之為下降約 125 個基點。我想，有沒有辦法對此設定底限？然後我認為你對最後一個問題的回答很棒。但是，如果醫療補助利潤恢復再推遲一年，這會影響您 2017 年的獲利能力嗎？

George, thanks very much for the feedback and for the question -- understand the interest in incurring to a floor, but we believe it's more responsible to wait until we have clear visibility before setting formal guidance. There are obviously a lot of key variables that we're monitoring. Certainly, January Medicaid rate updates is an important one. But now I think more broadly across the business, the Medicare AEP outcomes, the status of the enhanced subsidies, the cost trends really through the rest of the year.

喬治，非常感謝您的回饋和提問——我們理解大家對設定底線的興趣，但我們認為，在製定正式指導之前，等到我們有了清晰的認識後再進行，才是更負責任的做法。顯然，我們正在監控許多關鍵變數。當然，一月份醫療補助費率更新非常重要。但現在我更廣泛地考慮整個業務，醫療保險 AEP 的結果、增強補貼的狀況、以及今年剩餘時間的成本趨勢。

And so all of that factors into our thinking holistically in how we think about 2026, and really what we wanted to share with you on the call today is our preliminary view into key planning variables and assumptions for next year. And we'll come back with more specificity in January to answer detailed questions. Thanks George.

因此，所有這些因素都會影響我們對 2026 年的整體思考，而我們今天在電話會議上真正想與大家分享的是我們對明年關鍵規劃變數和假設的初步看法。我們將在一月份提供更具體的資訊來回答詳細問題。謝謝喬治。

Thank you. And again, just so we're clear, we're not waiting on rate cycles. We're doing a lot. So we're not victim only to this. I think that's really important. And then secondarily, as Felicia shared throughout the course of this call, we have -- we're in the midst of those discussions with our states. They are meeting constructively.

謝謝。再次強調，我們不會等待利率週期。我們做了很多事。所以我們並不是唯一的受害者。我認為這真的很重要。其次，正如費莉西亞在整個通話過程中所說的那樣，我們正在與各州進行討論。他們正在進行建設性的會談。

But again, we wanted to give a planning assumption that we thought was very prudent going into '26. Let me please close because I want to thank you again for your continued confidence in Elevance Health. As you've heard, we've taken decisive steps to strengthen our foundation, advancing affordability, enhancing the member and provider experience and positioning our enterprise for sustainable growth.

但再次強調，我們想給出一個規劃假設，我們認為這對 26 年來說非常謹慎。最後，請容許我再次感謝您對 Elevance Health 的持續信任。正如您所聽到的，我們已採取果斷措施來鞏固我們的基礎，提高可負擔性，增強會員和提供者的體驗，並為企業的永續發展做好準備。

These efforts are grounded in our whole health strategy which connects our physical behavior on social health to deliver a more affordable, personalized and effective care. I want to take a moment now to thank our associates across Elevance Health for their dedication to our members, care providers and the communities we serve.

這些努力以我們的整體健康策略為基礎，將我們的身體行為與社會健康聯繫起來，以提供更實惠、個人化和有效的護理。現在，我想花點時間感謝 Elevance Health 的同事對我們的會員、照護人員和我們服務的社區的奉獻。

It's your commitment to affordability, experience and outcomes that is the cornerstone of our success. We remain focused on disciplined execution, innovation and delivering consistent value for our members, our partners and our shareholders. Thank you for joining us today. We look forward to demonstrating our continued progress as we execute on our strategy.

您對可負擔性、體驗和成果的承諾是我們成功的基石。我們始終專注於嚴謹的執行、創新並為我們的會員、合作夥伴和股東提供持續的價值。感謝您今天加入我們。我們期待在執行策略的過程中展示我們不斷的進步。

Ladies and gentlemen, a recording of this conference will be available for replay after 11:00 AM today through November 21, 2025. You may access the replay system at any time by dialing (800) 391-9853, and international participants can dial (203) 369-3269. This concludes our conference for today. Thank you for your participation for using Verizon conferencing. You may now disconnect.

女士們、先生們，本次會議的錄音將於今天上午 11:00 之後至 2025 年 11 月 21 日提供重播。您可以隨時撥打 (800) 391-9853 存取重播系統，國際參與者可以撥打 (203) 369-3269。今天的會議到此結束。感謝您參與使用 Verizon 會議。您現在可以斷開連線。