Humana Inc (HUM) 2024 Q3 法說會逐字稿

Good day and thank you for standing by. Welcome to the Humana third-quarter earnings call. (Operator Instructions) Please be advised that today's conference is being recorded.

美好的一天，感謝您的支持。歡迎參加 Humana 第三季財報電話會議。（操作員指示）請注意，今天的會議正在錄製中。

I would now like to hand the conference over to Lisa Stoner, Vice President, Investor Relations. Please go ahead.

現在我想將會議交給投資者關係副總裁麗莎·斯托納 (Lisa Stoner)。請繼續。

Thank you and good morning. I hope everyone had a chance to review our press release and prepared remarks, which are available on our website. We will begin this morning with brief remarks from Jim Rechtin, Humana's President and Chief Executive Officer, followed by a Q&A session where Jim will be joined by Susan Diamond, Humana's Chief Financial Officer; and George Renaudin, President of Humana's Insurance Segment.

謝謝你，早安。我希望每個人都有機會閱讀我們的新聞稿和準備好的評論，這些內容可以在我們的網站上找到。今天上午，Humana 總裁兼首席執行官吉姆·雷希廷 (Jim Rechtin) 將首先進行簡短發言，隨後進行問答環節，吉姆將與 Humana 首席財務官蘇珊·戴蒙德 (Susan Diamond) 一起參加。 George Renaudin，Humana 保險部門總裁。

Before we begin our discussion, I need to advise call participants of our cautionary statement. Certain of the matters discussed in this conference call are forward-looking and involve a number of risks and uncertainties. Actual results could differ materially. Investors are advised to read the detailed risk factors discussed in our latest Form 10-K, our other filings with the Securities and Exchange Commission, and our third-quarter 2024 earnings press release as they relate to forward-looking statements along with other risks discussed in our SEC filings.

在我們開始討論之前，我需要向電話會議參與者告知我們的警告聲明。本次電話會議討論的某些事項具有前瞻性，涉及許多風險和不確定性。實際結果可能存在重大差異。建議投資者閱讀我們最新的10-K 表格、我們向美國證券交易委員會提交的其他文件以及我們的2024 年第三季度收益新聞稿中討論的詳細風險因素，因為它們與前瞻性陳述以及所討論的其他風險相關在我們向 SEC 提交的文件中。

We undertake no obligation to publicly address or update any forward-looking statements in future filings or communications regarding our business or results. Today's press release, our historical financial news releases, and our filings at the SEC are also available on our Investor Relations site.

我們沒有義務在未來的文件或通訊中公開處理或更新任何有關我們業務或績效的前瞻性聲明。今天的新聞稿、我們的歷史財務新聞稿以及我們向 SEC 提交的文件也可以在我們的投資者關係網站上查看。

Call participants should note that today's discussion includes financial measures that are not in accordance with Generally Accepted Accounting Principles or GAAP. Management's explanation for the use of these non-GAAP measures and reconciliations of GAAP to non-GAAP financial measures are included in today's press release. And references to earnings per share, or EPS, made during this conference call refer to diluted earnings per common share. Finally, this call is being recorded for replay purposes. A replay will be available on the Investor Relations page of Humana's website, humana.com, later today.

電話會議參與者應注意，今天的討論包括不符合公認會計原則或公認會計原則的財務措施。管理階層對這些非公認會計準則衡量標準的使用以及公認會計準則與非公認會計準則財務衡量標準的調節的解釋包含在今天的新聞稿中。本次電話會議期間提到的每股盈餘（EPS）指的是稀釋後的每股普通股盈餘。最後，該通話將被錄音以供重播。今天晚些時候，Humana 網站 humana.com 的投資者關係頁面將提供重播。

With that, I'll turn the call over to Jim Rechtin.

這樣，我會將電話轉給吉姆·雷希廷 (Jim Rechtin)。

Thanks, Lisa. And good morning, everyone. Thank you for joining us. In the last quarter, I outlined four basic drivers of our business that we need to be able to deliver against over and over again. Those are, first, providing a Medicare product and experience that delivers against consumer needs and is priced with discipline. Second, it is operating with clinical excellence. This really is the foundation of industry-leading margins. It is, third, managing a highly efficient back office; and its fourth, deploying growth capital in a way that complements our Medicare Advantage core business, but really focused around CenterWell and Medicaid.

謝謝，麗莎。大家早安。感謝您加入我們。在上個季度，我概述了我們業務的四個基本驅動因素，我們需要能夠一次又一次地實現這些驅動因素。首先，提供符合消費者需求且定價嚴格的醫療保險產品與體驗。其次，它在臨床上表現卓越。這確實是行業領先利潤率的基礎。第三，管理高效率的後台；第四，以補充我們的 Medicare Advantage 核心業務的方式部署成長資本，但真正關注 CenterWell 和 Medicaid。

I'd like to review the quarter's results with a little bit of a lens towards those four drivers. Before I do that, let me just start with a few headlines. First of all, as we noted, we exceeded expectations for the quarter. We're also confident that we will achieve at least $16 of EPS for the full year, and we are comfortable with where 2024 EPS consensus sits today. Exactly where we're going to land is largely dependent on a number of investment decisions in AEP and in Stars that we continue to evaluate.

我想從這四位車手的角度來回顧本季的業績。在此之前，讓我先介紹幾個頭條新聞。首先，正如我們所指出的，我們超出了本季的預期。我們也有信心全年每股收益將達到至少 16 美元，並且我們對 2024 年每股收益目前的共識感到滿意。我們的確切目標在很大程度上取決於我們繼續評估的 AEP 和 Stars 的一些投資決策。

We also feel good that we priced our MA product for margin expansion of 2025. However, similar to our strategy for the rest of 2024, we will be balancing near-term earnings progression with investment in the business. And when we say investment in the business, certainly that is Stars, but it's also looking at investment opportunities and growth, admin cost efficiency, and medical cost management.

我們也對 MA 產品定價為 2025 年利潤率擴張感到滿意。然而，與我們 2024 年剩餘時間的策略類似，我們將平衡近期獲利進展與業務投資。當我們說對業務的投資時，當然是明星，但它也關注投資機會和成長、管理成本效率和醫療成本管理。

We understand that investors would like more clarity on the multi-year outlook of the business, and to address this, we are targeting an Investor Day in May of 2025. So let me turn to the four basic drivers for a moment. So right now, if I start with product and experience that we are delivering through our Medicare product, we're feeling pretty good about what we're delivering. And let me point out a couple of things.

我們理解投資者希望更清楚地了解該業務的多年前景，為了解決這個問題，我們的目標是在 2025 年 5 月舉辦投資者日。讓我暫時談談四個基本驅動因素。因此，現在，如果我從我們透過醫療保險產品提供的產品和體驗開始，我們對我們所提供的產品感覺非常好。讓我指出一些事情。

Our individual MA membership growth continues to outpace our expectations for the year. We anticipate at this point full-year growth, year-over-year growth of around 5%. The year started slowly in AP last autumn, but we've made pretty significant gains over the course of 2024. When we look at it, we believe that this is a reflection of disciplined product pricing that has allowed us to continue to emphasize growth at a time when others in the market have pulled back.

我們今年的個人 MA 會員成長持續超出我們的預期。我們目前預計全年成長，年增 5% 左右。去年秋天，美聯社的這一年開始緩慢，但我們在 2024 年取得了相當大的進展。當我們審視它時，我們認為這是嚴格的產品定價的反映，這使我們能夠在市場上其他公司紛紛撤退的時候繼續強調成長。

And we also attribute some of the growth to incremental marketing investments that we've made in our internal sales channel. This is a channel that we believe is increasingly important for us, and those investments have been paying off. We continue to deliver best-in-class service. Recently, we were ranked the number-one health insurer for customer experience by Forrester. This is now four years in a row of being ranked number one by Forrester. And finally, while it's early in this year's AEP cycle from what we can tell, sales appear to be generally on track with expectations.

我們也將部分成長歸因於我們在內部銷售管道中進行的增量行銷投資。我們認為這個管道對我們來說越來越重要，而這些投資已經得到了回報。我們繼續提供一流的服務。最近，我們被 Forrester 評為客戶體驗第一的健康保險公司。這是連續四年被 Forrester 排名第一。最後，雖然據我們所知，目前還處於今年 AEP 週期的早期，但銷售似乎總體符合預期。

Turning to the second driver, clinical excellence, let me start with Stars. We've acknowledged now that we've got work to do to get back to the results that we expect of ourselves and that we expect for our members and our patients and our investors. We've been moving quickly to make investments and to align incentives in our provider and pharmacy networks to close more gaps in care. We've also redirected care management and call center capacity to increase member outreach, and that is also related to gaps in care.

談到第二個驅動力，臨床卓越，讓我從星星開始。我們現在承認，我們還有很多工作要做，才能達到我們對自己以及我們的會員、病人和投資者所期望的結果。我們一直在迅速採取行動，在我們的提供者和藥房網路中進行投資並調整激勵措施，以縮小護理方面的更多差距。我們也重新調整了護理管理和呼叫中心的能力，以擴大會員範圍，這也與護理方面的差距有關。

Just last week, those efforts resulted in about 5,000 incremental primary care appointments. And I learned last night that we've got about another 3,000 to start this week, 3,000 primary care appointments scheduled. We're also making technology investments. This includes improvements to our plan finder capability. And really, the way I'd characterize it, we're on a sprint to take ground and to impact 2027.

就在上週，這些努力增加了約 5,000 個初級保健預約。我昨晚了解到，本週我們還有大約 3,000 個預約，其中安排了 3,000 個初級保健預約。我們也在進行技術投資。這包括對我們的計劃查找器功能的改進。事實上，按照我的描述，我們正在衝刺，爭取在 2027 年取得進展。

And I simultaneously feel good about the team's focus and the effort and the impact that we're making, and frankly, frustrated that we have allowed ourselves a shorter runway than we would like to make up that ground. Clinical excellence also translates to lower cost when we deliver better care. And so in Q3, medical costs are largely in line with our expectations. There's obviously some give and take across categories.

我同時對團隊的專注、努力和我們正在產生的影響感到滿意，但坦白說，我感到沮喪的是，我們讓自己的跑道比我們想要的更短。當我們提供更好的照護時，卓越的臨床表現也意味著更低的成本。因此，第三季的醫療費用基本上符合我們的預期。顯然，跨類別之間存在一些讓步。

The environment is still dynamic, and we will be careful with our expectations around medical cost trend. However, right now we are seeing some success in a number of our cost control efforts. The example I'll give is we've been extending value-based care contracts beyond primary care into areas like kidney disease and oncology care management, and we're seeing good results from that effort.

環境仍然充滿活力，我們將謹慎對待醫療費用趨勢的預期。然而，目前我們在一些成本控制方面取得了一些成功。我舉的例子是，我們一直在將基於價值的護理合約從初級護理擴展到腎臟疾病和腫瘤護理管理等領域，並且我們看到了這項努力的良好成果。

Shifting to the third driver, highly efficient back office, we do continue to make progress in this area. We're expecting a 30-basis-point decrease in our adjusted operating cost ratio for the year. And just to give one example of the type of work that is helping to drive this, we're implementing more and more uses -- use cases for AI. We recently launched a generative AI solution that allows our care management team to spend about half as much time on post-call documentation. They are still doing all the same human oversight for any clinical decision-making, but they're spending less time on documentation.

轉向第三個驅動力，即高效的後台，我們確實在這一領域不斷取得進展。我們預計今年調整後的營運成本率將下降 30 個基點。僅舉一個有助於推動這一目標的工作類型的例子，我們正在實施越來越多的用途——人工智慧的用例。我們最近推出了一個生成式人工智慧解決方案，使我們的護理管理團隊能夠將大約一半的時間花在呼叫後文件上。他們仍然對任何臨床決策進行同樣的人工監督，但他們在記錄上花費的時間更少。

That brings us to our final driver, deploying growth capital to drive efficient growth. I would argue that we're quietly building the leading senior-oriented primary care organization in the nation. Our primary care clinics are hitting their clinical and their financial targets. They're on track to mitigate V28. We recently released a study in collaboration with a leading researcher and professor from Harvard that demonstrates both the clinical and economic value the clinics create.

這給我們帶來了最終的驅動力，即部署成長資本來推動高效成長。我認為我們正在悄悄建立全國領先的面向老年人的初級保健組織。我們的初級保健診所正在實現其臨床和財務目標。他們正在努力緩解 V28 的影響。我們最近與哈佛大學的一位領先研究人員和教授合作發布了一項研究，展示了診所創造的臨床和經濟價值。

It found that our members have a better experience when they are part of a senior-focused primary care clinic. We expect to add another roughly 40 clinics this year. Often, this is through acquisition of underperforming clinics that we've demonstrated we can pretty rapidly turn around. And our patient growth continues to outpace expectations.

研究發現，當我們的會員加入專注於老年人的初級保健診所時，他們會獲得更好的體驗。我們預計今年將再增加約 40 家診所。通常，這是透過收購表現不佳的診所來實現的，我們已經證明我們可以很快扭轉局面。我們的患者成長持續超出預期。

I'm encouraged by our recent performance trajectory and growth, absent our Stars performance in BY26, and at the same time recognize that these continue to be dynamic times for the industry, and I believe it's critical that we continue to strengthen the organization by making investments to drive long-term shareholder value. This is obviously a balance with how we think about short-term earnings progression.

我對我們最近的業績軌跡和成長感到鼓舞，儘管我們在2026 年沒有獲得明星表現，但同時我也認識到，對於行業來說，這仍然是一個充滿活力的時代，我相信，我們繼續通過以下方式來加強組織至關重要：投資以推動長期股東價值。這顯然與我們對短期獲利進展的看法保持了平衡。

We look forward to providing formal 2025 guidance on our fourth-quarter call. And we will also look forward to providing a more fulsome update on our strategic initiatives and their expected impact at Investor Day, which again, we're targeting in May of 2025. Finally, I'll just say, look, our conviction remains high regarding the positive outlook for MA and for value-based care.

我們期待在第四季度電話會議中提供正式的 2025 年指引。我們也期待在投資者日提供關於我們的策略舉措及其預期影響的更全面的最新信息，我們的目標是在 2025 年 5 月舉行。最後，我只想說，看，我們對 MA 和基於價值的護理的積極前景仍然充滿信心。

And with that, we will turn to Q&A.

接下來，我們將轉向問答。

(Operator Instructions) Justin Lake, Wolf Research.

（操作員說明）Justin Lake，Wolf Research。

Thanks. Good morning. I wanted to ask about your comments on 2025 and specifically your comments on investment spending. Prior to this call, you talked to a margin improvement in MA next year, and combined with top-line growth, I think the expectation in the market was for $2 to $4 of improved earnings year over year. Given that you're talking about now, more flattish, that would seem to put that investment income spending or investment spending, I should say, at $500 million, give or take.

謝謝。早安.我想問一下您對 2025 年的看法，特別是對投資支出的看法。在這次電話會議之前，您談到了明年 MA 的利潤率提高，結合營收成長，我認為市場的預期是獲利年增 2 至 4 美元。考慮到你現在所說的，更扁平化，我應該說，投資收入支出或投資支出似乎為 5 億美元，無論多少。

Is that a reasonable ballpark, number one? Number two, can you give us some more color in terms of what you're spending that on, given you had just cut admin spending pretty dramatically over the last two to three years? Is there stuff that you overcut and you have to bring back? And then, how should we think about that rolling forward? Is there going to be a return there where it kind of nets to zero because you're going to get improved Stars, or what have you. And over what timeframe does that happen? Thanks.

第一，這是合理的大概嗎？第二，鑑於您在過去兩到三年裡剛剛大幅削減了管理支出，您能否給我們更多關於您的支出的資訊？是否有一些東西被你過度砍伐而必須帶回來？然後，我們應該如何考慮這一點？是否會有回報，因為你將獲得改進的星星，或者你有什麼，所以它的淨值為零。這會在什麼時間範圍內發生？謝謝。

So Justin, thank you for our first four questions. This is Jim, I'll start, and then I'll let Susan jump in. So let me just start with 2025. And I recognize that we're not going to be able to answer everything people would like. Obviously, we're going to give guidance here in a few months. But I'm going to try to be as clear as I can in what we are saying and what we aren't saying about 2025 right now.

賈斯汀，謝謝你提出我們的前四個問題。我是吉姆，我先開始，然後讓蘇珊插話。那麼就讓我從 2025 年開始吧。我認識到我們無法回答人們想要的一切。顯然，我們將在幾個月後在這裡提供指導。但對於 2025 年，我將盡力闡明我們正在談論的內容和未提及的內容。

The first thing I would just re-emphasize is we told everybody we felt good about our bid, meaning both our pricing and our plan exits, and what we're essentially saying is, hey, we're reaffirming that. Even after you incorporate the things that we've learned since the bid season, we still feel good about where we're at with our product. The result of that is that -- look, at a minimum, we see a 2024 performance as a floor as we head into 2025. In other words, we have room for EPS progression.

我要再次強調的第一件事是，我們告訴每個人我們對我們的出價感覺良好，這意味著我們的定價和我們的計劃都退出了，我們本質上是說，嘿，我們正在重申這一點。即使您整合了我們自投標季節以來學到的東西，我們仍然對我們的產品狀況感到滿意。結果是——至少，我們將 2024 年的表現視為進入 2025 年的底線。換句話說，我們還有 EPS 進步的空間。

What we're also saying is we do need to see some things unfold over the next few months to establish how much room is in there. Whether you think about AP results, both the final member count and member mix, as well as thinking about continued monitoring of medical cost trends, the better visibility that we have into those things, the more confident and precise we can be in where we think we'll be next year.

我們還想說的是，我們確實需要看到未來幾個月內發生的一些事情，以確定其中有多少空間。無論您考慮 AP 結果、最終會員數量和會員組合，還是考慮持續監控醫療成本趨勢，我們對這些事情的了解越深入，我們就越有信心和更準確地了解我們的想法我們明年就會。

We also are telling you, in fact, that just as importantly, we're going to be approaching 2025 with a similar posture to how we've approached the last quarter or two. Where we can make good investments to put ourselves on better footing in 2027, we're going to do that. And we're going to prioritize leaning into that long-term earnings potential over near-term EPS progression where we have good investments to make, but we're going to do that with a floor.

事實上，我們也告訴您，同樣重要的是，我們將以與過去一兩個季度類似的姿態迎接 2025 年。如果我們能夠進行良好的投資，讓自己在 2027 年擁有更好的基礎，我們就會這樣做。我們將優先考慮長期獲利潛力，而不是近期每股收益成長，我們有良好的投資可做，但我們將在有底線的情況下做到這一點。

I would love to tell you that we've got precise numbers on all of those choices and decisions. We don't. Some of that is still in flux. And in some cases, we're actually making smaller investments. And as we see those generate returns, we're doubling down on it. And so we don't have a precise number today. What we're making sure is that we're creating room to make the right decisions for 2027 in the long term. But we're telling you we can do that while establishing the floor.

我很想告訴你，我們已經掌握了所有這些選擇和決定的精確數字。我們不這樣做。其中一些仍在不斷變化。在某些情況下，我們實際上進行了較小的投資。當我們看到這些產生回報時，我們正在加倍努力。所以我們今天沒有確切的數字。我們要確保的是，我們正在創造空間，以便在 2027 年做出正確的長期決策。但我們告訴你，我們可以在建立基礎的同時做到這一點。

So again, I recognize everybody would like more clarity. I really do. And I want to reiterate that we're kind of trying to balance or focus on two things. Given the dynamic in the market, we want to be appropriately prudent and make sure that we're doing the right things to establish targets, hit those targets, build credibility over time. And we are trying to establish the best way to navigate through the next 24 months. I mean, that's really the two things that we're trying to balance here as we try to give -- set expectations the best we can.

再說一次，我認識到每個人都希望更加清晰。我真的這麼做。我想重申，我們正在努力平衡或專注於兩件事。鑑於市場的動態，我們希望保持適當的謹慎，並確保我們正在做正確的事情來建立目標，實現這些目標，隨著時間的推移建立信譽。我們正在努力尋找度過未來 24 個月的最佳方式。我的意思是，這確實是我們在嘗試給予時試圖平衡的兩件事——盡我們所能設定最好的期望。

Susan, what would you add to that?

蘇珊，你想補充什麼？

Yes -- no, I think that says it well. The only thing I might add is, Justin, that as we've begun to talk about some of the investments that we believe are needed, both for Stars but also to improve for operating performance, given some of the benchmarking work that we've done, we got some questions and concerns. Well, gosh, could the level of investments cause you to go backwards year over year?

是的——不，我認為這說得很好。賈斯汀，我唯一要補充的是，鑑於我們已經進行的一些基準測試工作，我們已經開始討論我們認為需要的一些投資，不僅是為了明星，而且為了提高營運績效完成後，我們遇到了一些問題和疑慮。好吧，天哪，投資水準會導致你逐年倒退嗎？

So I think that was one of the reasons that we wanted to introduce the floor for '25, just to make sure that it was -- and so we're prepared to give formal guidance that we made it clear that we felt like with the pricing action we did take in the '25 bids, that did give us the room and flexibility to make these needed investments while not creating a situation where we might go backwards.

所以我認為這就是我們想要引入 25 年的底線的原因之一，只是為了確保它是——所以我們準備提供正式的指導，我們明確表示我們覺得我們在25 年投標中採取的定價行動，確實為我們提供了進行這些所需投資的空間和靈活性，同時又不會造成我們可能倒退的情況。

Ann Hynes, Mizuho.

安海因斯，瑞穗。

Hi, good morning. So your MLR results imply trends were relatively stable sequentially. Is that a good characterization? And if so, what does this mean for your 2025 bids? Are they tracking in line or better than your expectations? Thanks.

嗨，早安。因此，MLR 結果顯示趨勢連續相對穩定。這是一個很好的表徵嗎？如果是這樣，這對您的 2025 年投標意味著什麼？他們的表現是否符合您的預期或比您的預期更好？謝謝。

Yes, Ann. So as we saw the results develop for the third quarter, as we said in our posted commentary, current-year claims did develop as expected in total for the MA business. There were some geography differences in terms of seeing some improvement on the inpatient side, some slight deterioration on the non-inpatient, but in total, in line with expected in terms of claims development through the third quarter.

是的，安。因此，正如我們在發布的評論中所說，當我們看到第三季度的業績發展時，本年度的索賠總額確實符合 MA 業務的預期發展。住院患者方面有所改善，非住院患者方面略有惡化，但總體而言，與第三季度索賠發展情況的預期一致，存在一些地域差異。

As Jim mentioned, as we continue to evaluate emerging trends versus what we expected at the time of bids, we continue to feel confident in how we've approached the trend assumptions within our pricing. Again, some geography differences, both across claims and risk adjustment, as we've talked to you guys in prior quarters, but in the aggregate, continue to feel good about the MLR that we would have been targeting inherently within our bid.

正如吉姆所提到的，隨著我們繼續評估新興趨勢與投標時的預期，我們仍然對我們在定價中如何接近趨勢假設充滿信心。同樣，正如我們在前幾個季度與你們討論過的那樣，在索賠和風險調整方面存在一些地理差異，但總的來說，我們仍然對我們投標中固有的目標 MLR 感到滿意。

And as we also mentioned, at least based on the early information we have access to, continue to feel like our assumptions around membership for next year, meaning the loss of a few hundred thousand members, continues to feel like a reasonable assumption.

正如我們還提到的，至少根據我們獲得的早期信息，我們仍然認為我們對明年會員資格的假設（意味著失去幾十萬名會員）仍然是一個合理的假設。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Hi, I wanted to follow up on the 2027 margin target and how you're thinking about the Stars recovery in the context of that 3% target. One, is that a realistic goal with the elevated investment spend and where your Stars scores fit today? And is there a minimum bonus level that you have in mind to deliver on that target? Thanks.

您好，我想跟進 2027 年的利潤率目標，以及您如何在 3% 的目標背景下考慮 Stars 的復甦。第一，隨著投資支出的增加以及您今天的星級分數是否適合，這是一個現實的目標嗎？您是否有為實現該目標設定的最低獎金等級？謝謝。

So I want to make sure I captured the question. So let me just play this back real quick. I think what you said is focus on 2027 is the 3% margin target, a realistic target at this point, and then what does that assume around Stars progression basically, right?

所以我想確保我抓住了這個問題。讓我快速回放一下。我認為你所說的重點是 2027 年 3% 的利潤率目標，這是目前的一個現實目標，那麼圍繞星級進展的基本假設是什麼，對嗎？

Right. Is there a minimum level you need to recover in order to deliver on that target?

正確的。為了實現該目標，您是否需要恢復最低水準？

Yes. So 3%, look, I'm going to talk a little bit out of both sides of my mouth on this. 3% is realistic and there is risk to that number. And so we just want to be super clear. We're going after it. We're doing everything we possibly can to get to that point. And in light of Stars, yes, there is risk to whether we will get all the way there in 2027 or not.

是的。所以 3%，聽著，我要在這個問題上多說幾句。 3% 是現實的，但這個數字有風險。所以我們只想說得非常清楚。我們要追趕它。我們正在盡一切努力來實現這一點。是的，就 Stars 而言，我們能否在 2027 年實現這一目標存在風險。

We have to make meaningful Stars progression is the way that I would describe it. We're not putting a specific number on it. There are too many puts and takes across different variables in the business to try to put a specific number on it. But yes, you're going to have to make some meaningful progression in Stars to get there.

正如我所描述的那樣，我們必須做出有意義的星級晉級。我們不會給出具體數字。業務中存在太多涉及不同變數的看跌期權和看跌期權，無法嘗試給出具體數字。但是，是的，你必須在 Stars 中取得一些有意義的進展才能到達那裡。

Susan, what would you add?

蘇珊，你要補充什麼？

Yes, I agree with that. And then the other thing, Andrew, that obviously, the right environment, the competitive environment, those are all things that, as we say, every year will also be important. As you know, '27 is the year where we'll have V28 behind us. Hopefully, IRA will then at that point be a very good guy versus a headwind.

是的，我同意這一點。然後另一件事，安德魯，顯然，正確的環境、競爭環境，正如我們所說，每年這些都是重要的。如您所知，27 年我們將擁有 V28。希望愛爾蘭共和軍屆時將成為對抗逆風的好人。

And so there are -- there's an environment hopefully where you do have the room to take some additional margin, which we've talked about. But those will be variables that we'll have to consider. And then I would just say, some of these investments that we've been discussing now should pay off in terms of returns over that timeframe that also support that continued margin recovery.

因此，希望有一個環境，​​您確實有空間獲得一些額外的利潤，我們已經討論過這一點。但這些都是我們必須考慮的變數。然後我想說，我們現在一直在討論的一些投資應該會在這段時間內獲得回報，這也支持利潤率的持續復甦。

Ben Hendrix, RBC Capital Markets.

本‧亨德里克斯，加拿大皇家銀行資本市場部。

Thank you very much. You flagged higher specialty drug costs within the non-inpatient utilization for the quarter. One of your peers noted a pull forward of some specialty drug utilization ahead of Part D changes next year. Is that something you would expect would be priced for as we head into 2025, or is there a component there that we should assume is a headwind for MCR modeling? Thanks.

非常感謝。您在本季度的非住院患者使用中標記了較高的特殊藥物成本。您的一位同行指出，在明年 D 部分變更之前，一些特殊藥物的使用有所提前。當我們進入 2025 年時，這是您期望的定價嗎？謝謝。

Hi, Ben. Yes, as you said, we did see some higher oncology costs in particular. I did call that out as something we were seeing in a conference I was at in early September. So we have been seeing it for a bit. We would say that our view is that it is not really largely attributable to IRA changes. They were relatively minimal in '24 in terms of member out-of-pocket exposure.

嗨，本。是的，正如您所說，我們確實看到了一些更高的腫瘤費用。我確實在九月初的一次會議上看到了這一點。所以我們已經看到它有一段時間了。我們想說的是，我們的觀點是，這並不是真正很大程度上歸因於愛爾蘭共和軍的變化。就會員自付費用而言，24 年的金額相對較少。

And so what we have seen so far is that we believe it's mostly attributable to either new treatments that have come to market or label expansions around existing treatments. And what we're seeing is, in some cases, these new treatments are being added to existing therapies, resulting in net higher unit costs than we've seen historically, and higher than we had anticipated as we evaluated the pipeline.

因此，到目前為止，我們認為這主要歸因於上市的新療法或圍繞現有療法的標籤擴張。我們看到的是，在某些情況下，這些新療法被添加到現有療法中，導致淨單位成本比我們歷史上看到的更高，並且高於我們在評估管道時的預期。

We do anticipate that we will see some further uptick in trends next year, just given the IRA changes and the introduction of the much lower maximum out-of-pocket. And so we have built in induced utilization assumptions into our '25 thinking, as well as just, again, continued sort of expectations around the emergence and uptake of some of these new therapies. So we have considered that.

考慮到 IRA 的變化以及自付費用限額的降低，我們預計明年的趨勢將進一步上升。因此，我們在 25 世紀思維中融入了誘導利用假設，以及對其中一些新療法的出現和採用的持續預期。所以我們已經考慮過這一點。

Obviously, with IRA, there is more exposure on the plan side in '25, which is why we said you can expect that we'll start -- we'll take a more thoughtful approach in terms of our early guidance around some of these things that we can see how the trends emerge relative to your expectations in light of IRA.

顯然，對於 IRA，25 年的計劃方面有更多的曝光，這就是為什麼我們說你可以期待我們會開始——我們將在圍繞其中一些問題的早期指導方面採取更周到的方法我們可以根據IRA 看到趨勢如何相對於您的期望出現。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，康托費茲傑拉。

Thank you. I was wondering, if Stars stay where they are, how much crosswalk is possible in 2026, given how you think about geographic overlap and plan ratings? And then if you could clarify on your '25 guidance, what MA margin is implied in that? Thanks.

謝謝。我想知道，如果星星保持原樣，考慮到您如何看待地理重疊和計劃評級，2026 年可能有多少人行橫道？然後，如果您能澄清您的 25 年指導，其中隱含的 MA 邊際是多少？謝謝。

Yes, so George, do you want to take the Stars question and then I can take the MA margin question?

是的，喬治，你想回答星星問題，然後我可以回答 MA 利潤問題嗎？

Sure. Hi. Thank you for the question, Sarah. So, as we think about the crosswalk possibility, we'll be evaluating that in line with lots of other things. So we certainly want to de-risk the amount of members that we have concentrating certain contracts, and we'll be thinking through that as we go into the next bid cycle.

當然。你好。謝謝你的提問，莎拉。因此，當我們考慮人行橫道的可能性時，我們將根據許多其他事情來評估它。因此，我們當然希望降低我們集中某些合約的成員數量的風險，並且在進入下一個投標週期時我們將仔細考慮這一點。

And one of the considerations will, of course, be how much progress we're making in the current Stars work that we're doing, as well as thinking about the opportunities that we have for crosswalk, the opportunities that we've talked about before with regard to our group contracts.

當然，考慮因素之一是我們在當前正在進行的星星工作中取得了多少進展，以及思考我們在人行橫道上擁有的機會，我們已經討論過的機會之前關於我們的團體合約。

So there are a number of considerations we'll be taking into hand when we do that, as well as what our '25 membership looks like and membership mix and the progress that we're seeing in medical cost management, some other items. So it is certainly one of the levers we'll be exploring, but I don't think that it is the sole by any means. There are a number of issues we'll be thinking about as we go through -- thinking about our Stars mitigation efforts as we go into next year.

因此，當我們這樣做時，我們會考慮許多因素，以及我們的 25 會員資格的情況和會員資格組合，以及我們在醫療成本管理和其他一些項目方面看到的進展。所以它肯定是我們將探索的槓桿之一，但我不認為它是唯一的。在我們經歷的過程中，我們將考慮許多問題——在進入明年時考慮我們的明星緩解措施。

Yes, and then Sarah, as far as '25 MA margins, obviously, we haven't given any specific guidance yet. Jim provided some commentary, so I'll just remind you. As we previously have talked about our '25 margin expectations on the MA side, we acknowledge them as -- because of the pressures that we were absorbing within '25, including the higher trend that emerged after filing of our 24 bids, V28, IRA, et cetera, and given the TBC threshold, there was limited ability to take true margin expansion within the pricing because the TBC would offset all of those headwinds I just mentioned.

是的，然後莎拉，就 25 MA 利潤率而言，顯然我們還沒有給出任何具體指導。吉姆提供了一些評論，所以我只是提醒你。正如我們之前談到的 MA 方面的 '25 利潤率預期，我們承認它們是 - 因為我們在 '25 內吸收的壓力，包括提交我們的 24 份投標、V28、IRA 後出現的更高趨勢等等，並且考慮到TBC 門檻，在定價範圍內實現真正的利潤擴張的能力有限，因為TBC 將抵消我剛才提到的所有這些不利因素。

So we had mentioned the majority of the margin progression we would be achieving would largely come from the plan exits where we had exited plans that were historically performing unprofitably, and we didn't feel like we had a reasonable pathway to getting them to profitable or contributing performance levels. That continues to be the case. Again, all of the emerging trend that we've seen, we continue to still feel good about those pricing decisions and how we thought about trends in the aggregate.

因此，我們提到，我們將實現的大部分利潤增長將主要來自計劃退出，我們退出了歷史上無利可圖的計劃，並且我們認為我們沒有合理的途徑讓它們實現盈利或貢獻績效水平。情況仍然如此。同樣，對於我們所看到的所有新興趨勢，我們仍然對這些定價決策以及我們對整體趨勢的看法感到滿意。

As Jim mentioned this morning, though, we are now contemplating some additional investments. The pricing action we took allowed us some flexibility to do that. And so as we've established the notion of a floor, obviously, if we end up closer to flat, the margin will be relatively comparable. But ultimately, we'll have to evaluate again how membership growth comes in, what levels of investments we do choose to make, and a variety of other things as we set guidance and certainly when we do can talk more about the inherent margin within our guide.

不過，正如吉姆今天早上所提到的，我們現在正在考慮一些額外的投資。我們採取的定價行動使我們能夠靈活地做到這一點。因此，當我們建立了下限的概念時，顯然，如果我們最終接近持平，那麼利潤將相對具有可比性。但最終，我們必須再次評估會員成長的方式、我們選擇進行的投資水平以及我們制定指導時的各種其他事項，當然，當我們這樣做時，我們可以更多地討論我們內部的固有利潤。 。

Joshua Raskin, Nephron Research.

約書亞·拉斯金，腎臟單位研究。

Hi, thanks. Good morning. Do you have a view on MA market growth in total for 2025? And then where do you think the lives that you're losing from those exits are going? Is that sort of one or two larger plans? Do you think smaller plans -- or are people going -- seniors going back to fee-for-service? And I think you just answered this, Susan, but we should assume that those lost lives have lower margins. But does that mean they have lower benefit levels, less rebates? And then lastly, how are you thinking about retention outside of the market exits?

你好，謝謝。早安.您對 2025 年 MA 市場整體成長有何看法？那麼你認為從這些出口中失去的生命會去哪裡呢？這是一兩個更大的計劃嗎？你認為較小的計劃——或者人們會——老年人會回到按服務收費嗎？我想你剛剛回答了這個問題，蘇珊，但我們應該假設那些失去的生命的利潤較低。但這是否意味著他們的福利水準較低，回扣較少？最後，您如何考慮市場退出之外的保留？

Hi, Josh, so it's George Renaudin. I'll take the question. So on the overall industry growth, we're thinking 5% to 5.5% in this coming year versus the roughly 6% the industry saw this year in our 5% performance that we are expecting as we finish out the year. So we feel pretty good about where that growth is going to come from. And if we think about our competitive positioning, it is very much aligned with our thinking at time of bids.

嗨，喬什，我是喬治雷諾丁。我來回答這個問題。因此，就整個產業的成長而言，我們預計來年的​​成長率為 5% 至 5.5%，而我們今年年底的預期為 5%，而今年產業的成長率為 6%。因此，我們對成長的來源感到非常滿意。如果我們考慮我們的競爭定位，它與我們投標時的想法非常一致。

We continue to anticipate, as Susan said, a few hundred thousand members in 2025 down, so we feel pretty good about that. From a standpoint of retention, there's a lot of work that we're doing to focus on that. We're helping our brokers. As you think about the county and plan exits, there's, of course, going to be a lot of shopping. And so we have put in place lots of tools to help those -- the sales teams, both our internal sales and outside brokers, work through the shopping experience, make sure it's a better consumer experience for our customers.

正如 Susan 所說，我們仍然預計 2025 年會員數量將減少數十萬，所以我們對此感覺很好。從保留的角度來看，我們正在做很多工作來關注這一點。我們正在幫助我們的經紀人。當您考慮進入縣城併計劃退出時，當然會進行大量購物。因此，我們部署了許多工具來幫助銷售團隊（包括我們的內部銷售人員和外部經紀人）改善購物體驗，確保為我們的客戶提供更好的消費者體驗。

And so we put in place things that allow the more real-time access and benefits; help them with a best-fit tool, so they can choose the plan that best fits their needs better. And we have also put in place, with our internal team, capabilities including AI to help them with helping those members make better decisions into the needs of the [customers].

因此，我們採取了一些措施，允許更即時的存取和收益；幫助他們使用最適合的工具，以便他們可以更好地選擇最適合他們需求的計劃。我們還與我們的內部團隊一起部署了包括人工智慧在內的能力，以幫助他們幫助這些成員根據客戶的需求做出更好的決策。[顧客]。

I would just say that on another item in retention that we're seeing some very positive results from -- and I think, in the opening comments, Jim made a comment about this, and that's -- that we are getting a better focus into our digital sales, and our new digital sales tool also is allowing us to handle members who were trying to find out as we did do some of those exits. Because, keep in mind, 98% of our members in those exit areas have another plan choice. So the digital tool is helping them make those choices easily, and we're seeing a very significant increase in the amount of digital sales we're having. As a result, all that will lead to increased retention.

我只想說，在保留的另一個項目上，我們看到了一些非常積極的結果——我認為，在開場評論中，吉姆對此發表了評論，那就是——我們正在更好地關注我們的數位銷售，以及我們新的數位銷售工具也使我們能夠處理那些試圖找出答案的會員，就像我們確實做了一些退出一樣。因為，請記住，我們在這些退出區域的會員中有 98% 有其他計劃選擇。因此，數位工具正在幫助他們輕鬆做出這些選擇，我們看到我們的數位銷售量顯著增加。因此，所有這些都將導致保留率的提高。

And then Josh, one thing I'd add to George's comments on growth, one thing to keep in mind is we do believe that '25 growth for the industry will still have some impact from the ongoing redetermination process on the MA side. We think it's probably worth about 80 basis points. We're given a deeming period. We will continue to see some attrition in the duals in particular as they lose eligibility.

然後喬希，我要在喬治關於增長的評論中補充一件事，要記住的一件事是，我們確實相信 25 年行業的增長仍將對 MA 方面正在進行的重新確定過程產生一些影響。我們認為其價值可能約為 80 個基點。我們有一個思考期。我們將繼續看到雙打隊伍中的一些人員流失，特別是當他們失去資格時。

In terms of your question about how to think about the contribution of lost lives, I would say it depends. As we've always said, for the members impacted by plan exits, those are unprofitable. So to the degree we don't retain them, that is positive. To the degree we do retain them, as George mentioned, because most of them have other plan options, that is incrementally positive because the plans that are available would be positively contributing.

至於你關於如何思考失去生命的貢獻的問題，我想說這要視情況而定。正如我們一直所說，對於受計劃退出影響的會員來說，這些都是無利可圖的。因此，就我們不保留它們而言，這是積極的。正如喬治所提到的，我們確實保留了它們，因為它們中的大多數都有其他計劃選擇，這是逐漸積極的，因為可用的計劃將產生積極的貢獻。

Across the rest of the book, if you remember, we did work very hard and intentionally to make sure we tried to protect our higher-performing plans as we did our 25 bids, so it would have taken less benefit action in those higher-performing plans. And where you'd see larger cuts is going to be those that were below our targeted margin.

在本書的其餘部分中，如果您還記得的話，我們確實非常努力且有意識地工作，以確保我們在進行25 次投標時盡力保護我們績效較高的計劃，因此在那些績效較高的計劃中會採取較少的福利行動計劃。你會看到更大的削減將是那些低於我們目標利潤的削減。

So our hope would be that within the attrition that we see, it is more concentrated within the lower performing plans. But obviously, we'll have to see how the AEP results come out. As you know, it takes longer to see the attrition information because a beneficiary has to enroll in another plan. CMS has to process it and give it to us. So we have no real visibility into that just yet but something we'll be watching closely.

因此，我們希望在我們看到的人員流失中，更多地集中在績效較低的計劃中。但顯然，我們必須看看 AEP 結果如何。如您所知，由於受益人必須加入另一個計劃，因此需要更長的時間才能看到自然減員資訊。CMS 必須對其進行處理並將其提供給我們。因此，我們目前還沒有真正了解這一點，但我們將密切關注。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Hi, thanks. You mentioned that the inpatient unit costs of Medicare came in better than expected. Could you just talk a little bit about what you saw with two midnight rules in the quarter and then just maybe more broadly how you think about the ability of the 2025 commentary to tolerate a higher level of inpatient unit costs in 2025? Thank you.

你好，謝謝。您提到醫療保險的住院單位成本比預期好。您能否簡單談談您對本季度兩條午夜規則的看法，然後更廣泛地談談您如何看待 2025 年評論是否有能力容忍 2025 年更高水平的住院單位成本？謝謝。

Hi, Steven. Yes, so you might recall, we've been talking about seeing lower inpatient unit costs really over the course of the year. And I'd say the team in retrospect has just been somewhat cautious and fully stepping up to that. And so we see further runouts to make sure that what we were seeing was durable and would continue.

嗨，史蒂文。是的，您可能還記得，我們​​一直在談論這一年中住院單位成本確實降低了。我想說，回想起來，團隊只是有些謹慎，並且全力以赴。因此，我們看到了進一步的耗盡，以確保我們所看到的情況是持久的並且會持續下去。

And that has proven to be relatively consistent; meaning, if we had fully stepped up to what we were seeing early, what we're ultimately seeing emerge continue to be consistent with that. We feel good about what we're seeing. I'd say within the third quarter itself, we start to see some of the flu and respiratory seasonality, which also tends to be lower average unit costs, which would be included in that as well.

事實證明，這是相對一致的；這意味著，如果我們完全按照我們早期所看到的那樣進行，那麼我們最終看到的結果將繼續與此一致。我們對所看到的感覺很好。我想說的是，在第三季度，我們開始看到一些流感和呼吸道季節性因素，這也往往會降低平均單位成本，這也將包含在其中。

In terms of '25, as we've always said, the way we've approached '25 is we've incorporated all of the impacts that got into our '24 baseline. With the changes we've seen across the geography, the lower inpatient unit costs, higher non-inpatient, that is all now embedded into our thinking as a jumping-off point for 25. And then we've got the normal trend as seen for '25.

就「25」而言，正如我們一直所說的那樣，我們接近「25」的方式是將所有影響納入「24」基線中。隨著我們在地理上看到的變化，住院單位成本降低，非住院成本提高，這一切現在都融入我們的思維中，作為 25 的起點。然後我們就得到了 25 年的正常趨勢。

We now have final rate changes from CMS for reimbursement. And so that obviously is included in our estimates. And so really, what we'd be exposed to is any mix changes. But I'd say based on what we've seen and the consistency of what we've seen, we feel good about how we're thinking about unit cost trends into 2025.

我們現在已收到 CMS 報銷的最終費率變更。因此，這顯然已包含在我們的估計中。事實上，我們會遇到任何混合變化。但我想說，根據我們所看到的情況以及我們所看到的一致性，我們對 2025 年單位成本趨勢的思考方式感到滿意。

Joanna Gajuk, Bank of America.

喬安娜·加尤克，美國銀行。

Hi, good morning. Thanks so much for taking the question. I guess a similar question to Steve's question, but I guess from a different angle. So instead of talking about unit costs, can we talk about utilization trends? Because we've obviously been hearing from some of the hospital companies or the publicly traded companies guiding for volume growth still above average, again in '25 after they are growing well above average this year in terms of just volumes, not just cost.

嗨，早安。非常感謝您提出問題。我猜想這是一個與史蒂夫的問題類似的問題，但我是從不同的角度猜想的。因此，我們可以不討論單位成本，而討論利用率趨勢嗎？因為我們顯然已經從一些醫院公司或上市公司聽到，他們的銷售成長仍然高於平均水平，在 25 年，他們今年的銷售成長遠高於平均水平，而不僅僅是成本。

So kind of the question for you is, just curious, what do you currently assume in your 2025 outlook when it comes to utilization? And then can you grow EPS in that scenario, that this is happening based on that pricing assumption? Thank you.

對您來說，問題是，只是好奇，您目前對 2025 年利用率的展望有何看法？然後，在這種情況下，基於定價假設，你能增加每股盈餘嗎？謝謝。

Hi, Joanna. Yes, so in terms of utilization, we have seen results that are very much in line from a utilization standpoint since we updated our estimates as of the second-quarter call. At that time, you might remember, we did step up our utilization assumptions and lower non-inpatient just based on what we were seeing in terms of some additional sort of site of service shift related to the Two Midnight Rule.

嗨，喬安娜。是的，就利用率而言，自從我們更新第二季電話會議的估計以來，我們看到的結果與利用率的角度非常一致。當時，您可能還記得，我們​​確實提高了利用率假設並降低了非住院患者數量，只是基於我們所看到的與午夜兩點規則相關的某種額外的服務站點轉移。

Our utilization has been very much in line with that since. Obviously, you've got things like respiratory season, the hurricane impact, those things that we can discreetly identify, but our core utilization, we continue to feel good about. Our utilization management impacts have been very consistent coming out of really the first quarter as well, so we feel good about those trends.

從那時起，我們的利用率就與此非常一致。顯然，你有諸如呼吸季節、颶風影響之類的事情，我們可以謹慎地識別這些事情，但我們的核心利用率，我們仍然感覺良好。從第一季開始，我們的利用率管理影響就非常一致，因此我們對這些趨勢感到滿意。

In terms of '25, we have the same normal sort of utilization trend on top of that higher '24 baseline that is inherent within our bid. And so again, there's no large incremental regulatory change expected for 2025 that should create this level of uncertainty like we were dealing with for '24. So I think we feel very good about the assumptions we're making in terms of secular sort of utilization trend.

就「25」而言，除了我們出價中固有的較高「24」基準之外，我們還具有相同的正常利用率趨勢。同樣，預計 2025 年不會出現大規模增量監管變化，不會像 24 世紀那樣造成這種程度的不確定性。因此，我認為我們對我們在長期利用趨勢方面所做的假設感到非常滿意。

George Hill, Deutsche Bank.

喬治·希爾，德意志銀行。

Yes, good morning. A little bit of a different topic. Can you guys talk about inpatient claims denial rates and how they've trended over the last 12 months? I know in the second quarter, claims appeals was a topic that came up at the margin, and a lot of the publicly traded hospital companies and private hospital companies have talked about an increase in claims denial rates. So I'm just trying to see if there's any meaningful trend to call out there and whether or not claims denials have impacted MLR in any meaningful way.

是的，早安。有點不同的主題。你們能談談住院索賠拒絕率以及過去 12 個月的趨勢嗎？我知道在第二季度，索賠上訴是一個邊緣話題，許多上市醫院公司和私人醫院公司都談到索賠拒絕率的上升。所以我只是想看看是否有任何有意義的趨勢值得指出，以及索賠否認是否以任何有意義的方式影響了國土資源部。

Hey, George. Yes, so with the Two Midnight Rule implementation, as we've been saying, that resulted in more initial approval. So in theory, you would expect fewer denials, fewer appeals. As we mentioned throughout the year, when Two Midnight Rule was implemented, we did see initially higher appeal rates and higher uphold rates for those appeals than we would have expected based on historical performance.

嘿，喬治。是的，正如我們所說，隨著午夜兩點規則的實施，這導致了更多的初步批准。因此從理論上講，您會期望更少的拒絕，更少的上訴。正如我們全年提到的，當實施「午夜兩點規則」時，我們確實看到最初的上訴率和維持率高於我們根據歷史表現所預期的水平。

As we've mentioned, we've completed audits ourselves. We've been through a CMS audit, which has validated that we believe we're appropriately evaluating the clinical rules. And what we would say is, at the time, there was a question about, was that just a pull forward and a change in seasonality of how appeals would come in? And would we see fewer appeals in the future? Because there's a reasonably long tail over which providers can appeal.

正如我們所提到的，我們自己完成了審核。我們已經通過了 CMS 審核，該審核證實我們相信我們正在適當評估臨床規則。我們要說的是，當時有一個問題，這是否只是吸引力的提前和季節性變化？未來我們會看到更少的上訴嗎？因為供應商可以訴諸相當長的尾巴。

We made the assumption that it would just result in overall higher appeals and ultimately uphold rates. That is what we have been seeing to date. We would just say we caught that early and incorporated into our estimates coming out of the first quarter. I think why you may be hearing some different commentary from hospital systems is they may not have recognized that as quickly and may have seen that higher appeal rate initially and assumed that the absolute appeals would still be comparable year over year.

我們假設這只會導致整體上更高的上訴並最終維持原判。這就是我們迄今為止所看到的情況。我們只能說，我們很早就發現了這一點，並將其納入我們第一季的估計中。我認為為什麼您可能會聽到來自醫院系統的一些不同評論，因為他們可能沒有那麼快地認識到這一點，並且最初可能已經看到較高的上訴率，並假設絕對上訴仍將逐年比較。

And what we've just seen is those appeals have been higher, which, when you think about just the magnitude of the changes, I think it's everybody just trying to understand how those new rules are being applied across the payers and then the providers. So that's, I would say, very consistent with what we've seen since the first quarter and no meaningful variation since.

我們剛剛看到的是，這些訴求越來越高，當你考慮到變化的幅度時，我認為每個人都在試圖了解這些新規則如何在付款人和提供者之間應用。所以，我想說，這與我們自第一季以來所看到的情況非常一致，並且此後沒有任何有意義的變化。

And then, George, I don't know if you want to add anything?

然後，喬治，我不知道你是否想補充什麼？

Yes, I would just add that I think you're right about the question of testing the appeals and seeing where they aren't trying to figure out exactly how the two-midnight rule will be applied. We, as you said, feel very confident about how we're applying it given the CMS audit we had the very start of the year that came out positively.

是的，我想補充一點，我認為你對測試上訴的問題是正確的，看看他們在哪裡沒有試圖弄清楚午夜兩點規則將如何應用。正如您所說，我們對如何應用它感到非常有信心，因為今年年初的 CMS 審計結果非常積極。

The other thing I would just add to that is that our clinicians continue to speak with many of the provider clinicians to talk through the issues to make sure we all have a similar way of approaching that everyone is clear and understanding what the two-midnight rule is and is not.

我要補充的另一件事是，我們的臨床醫生繼續與許多提供者臨床醫生交談，討論這些問題，以確保我們都有類似的處理方式，讓每個人都清楚並理解午夜兩點規則的含義是又不是。

Hey, not to pile on here, but let me just try to wrap all the inpatient stuff together. Broadly, I think what we're trying to convey is that since late first quarter, early second quarter, we've seen relatively stable trends. And so there was a fair amount of noise in the first quarter. I think everybody was adapting to the regulatory change.

嘿，不要在這裡堆砌，但讓我嘗試將所有住院病人的東西包裝在一起。總的來說，我認為我們試圖傳達的是，自第一季末、第二季初以來，我們看到了相對穩定的趨勢。因此，第一季出現了相當多的噪音。我認為每個人都在適應監管變化。

For us, we put a lot of attention on it at that point in time. And we think we worked through all the changes in process and approach and whatnot and have gotten to a relatively stable place. So when we look forward, we're feeling pretty good about the outlook and our ability to project what the inpatient cost is going to be, whether that's denial rates, utilization, unit cost, et cetera, relative to where we were back in the first quarter.

對我們來說，當時我們對此投入了許多注意力。我們認為我們經歷了流程和方法等方面的所有變化，並且已經達到了相對穩定的水平。因此，當我們展望未來時，我們對前景和預測住院成本的能力感到非常滿意，無論是拒絕率、利用率、單位成本等等，相對於我們之前的情況第一季。

Whit Mayo, Leerink Partners.

惠特·梅奧，Leerink 合夥人。

Hey, good morning. Maybe just a question on Stars as it relates to the lawsuit or appeal, just looking at each contract, 5216, maybe the math is off a little bit here. But it seems like you might need to flip both the Part C and D ratings on the call center to a 5 from a 4 to get back to a 4-star rating on that contract. It doesn't seem like you can do it with just improvement in one category. It seems like both. So is that an accurate statement? And I'm just wondering, how many calls ballpark are we talking about to have to overturn to see improvement in either category? Is it one? Is it multiple calls? Just any color would be helpful, thanks.

嘿，早安。也許只是一個關於明星的問題，因為它與訴訟或上訴有關，只要看看每份合同，5216，也許這裡的數學有點不對勁。但似乎您可能需要將呼叫中心的 C 部分和 D 部分評級從 4 級調至 5 級，才能恢復到該合約的 4 星級評級。似乎僅靠某一方面的改進是無法做到這一點的。似乎兩者都是。那麼這是一個準確的說法嗎？我只是想知道，我們所說的多少電話必須推翻才能看到任一類別的改進？是一個嗎？是多次調用嗎？任何顏色都會有幫助，謝謝。

Yes, in total, it's three calls across both metrics. And yes, we would need to see the three calls overturned.

是的，這兩個指標總共有 3 個呼叫。是的，我們需要看到這三個呼籲被推翻。

I would just add into that, Jim, that in addition to the three calls, one of the other things that we're talking -- that we are pursuing with CMS is the need for greater visibility and transparency into how the thresholds are calculated.

Jim，我想補充一點，除了這三通電話之外，我們正在談論的其他事情之一 - 我們正在透過 CMS 追求的是需要提高閾值計算方式的可見性和透明度。

Yes, that is correct. Yes.

是的，這是正確的。是的。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Hi, everybody. Just want to make sure I understand the early thinking on '25. If you are successful in your appeal on the Stars through litigation, would that change your view on the amount of investment you need in '25? It almost sounds like up to this point, the discussion around the Star ratings hit has been around the arbitrariness of the CMS threshold cut points and some of that, and you've had a great a track record of having very high Star ratings.

大家好。只是想確保我理解 '25 的早期想法。如果您透過訴訟成功對明星提出上訴，這會改變您對 25 年所需投資金額的看法嗎？聽起來到目前為止，圍繞星級評級命中的討論一直圍繞著 CMS 閾值切分點的任意性以及其中的一些內容，並且您擁有非常高的星級評級的良好記錄。

Now all of a sudden, it sounds like, as you guys have looked at this, you now think you need to make a lot of investment to get back on track on Stars. And I wonder, if your appeal is successful, would you not have to do that? And would that change your outlook for '25 for the better?

現在，突然之間，正如你們所看到的那樣，你們現在認為需要進行大量投資才能使 Stars 重回正軌。我想知道，如果你上訴成功了，是不是就不用這麼做了？這會讓你對 25 世紀的展望變得更好嗎？

And then, in the broad discussion about out years, there's always the discussion about trading off enrollment for margin. And obviously, we've got a lot of focus on getting you back to 3% margin, but any philosophical commentary about how much of an enrollment hit you might end up taking if the appeal is unsuccessful to get back to that 3% margin over the next couple of years with a view to '27?

然後，在關於過去幾年的廣泛討論中，總是存在著以入學率換取利潤的討論。顯然，我們非常關注讓你回到 3% 的利潤率，但是如果上訴不成功，你最終可能會遭受多少入學打擊，對此任何哲學評論都無法恢復到 3% 的利潤率。是'27？

Yes, so let me start with the appeal and its impact on how we think about 2025. So the way to think about Stars is there's two related but slightly different things. So there's the appeal related to the single -- or I guess two but similar metrics that are kind of the difference between 3.5 and 4 stars for a whole bunch of our members. That is one thing that is working its way through litigation. We're not really going to comment on that beyond what we have.

是的，讓我先談談這項呼籲及其對我們如何看待 2025 年的影響。因此，思考星星的方式是有兩個相關但略有不同的事物。因此，存在與單曲相關的吸引力——或者我猜是兩個但相似的指標，這對於我們的一大群會員來說是 3.5 星和 4 星之間的區別。這是正在透過訴訟解決的一件事。我們不會對此進行超出現有範圍的評論。

But separate is the broader trend within the Stars program of cut points and thresholds getting harder. And that's across a lot of different metrics. And so while there's one critical metric for BY 2026, broadly, I think the entire industry is looking at a movement in metrics and cut points and thresholds that is causing pretty much everybody to reevaluate how far do you have to lean into investment in this program to make sure that you can keep up with that metric movement. I don't think we're alone in that.

但與此不同的是，明星計畫中更廣泛的趨勢是，門檻和門檻變得越來越困難。這涉及很多不同的指標。因此，雖然到2026 年有一個關鍵指標，但總的來說，我認為整個行業都在關注指標、削減點和門檻的變化，這導致幾乎每個人都重新評估對該計劃的投資需要多大程度上傾斜以確保您能夠跟上該公制移動。我認為我們並不孤單。

So as we contemplate investments for next year, the appeal is not going to have any kind of meaningful impact on how we think about investment. The investment is going broadly in the program to drive better and better and better performance at a pace that exceeds what we expected previously. That's really what the investment is about at the end of the day.

因此，當我們考慮明年的投資時，這種吸引力不會對我們對投資的看法產生任何有意義的影響。該計劃的投資正在廣泛進行，以超越我們先前預期的速度推動越來越好的業績。這才是最終投資的真正目的。

George, would you -- anything you can add to that?

喬治，你能補充點什麼嗎？

I would just add, Jim, that the other thing about the investments we're making in Stars are, in many ways, the right thing to do to improve health outcomes for our members overall. The investments we're making are enhancing our provider member performance. We're talking about incentive programs to close gaps in care, which helps our health outcomes, while also improving the customer experience.

吉姆，我想補充一點，我們對 Stars 進行的投資的另一件事在很多方面都是正確的做法，可以改善我們會員的整體健康。我們正在進行的投資正在提高我們的提供者會員的績效。我們正在討論旨在縮小護理差距的激勵計劃，這有助於我們的健康成果，同時也改善客戶體驗。

It is a good thing for us to continue to work with our vendors to improve our relations with them and to improve their performance. And finally, the strengthening that we're doing around technology and integration to support operational excellence also nicely folds into many of the other things that Jim has talked about we need to focus on moving forward in both his opening comments and in his earlier letter.

對我們來說，繼續與供應商合作改善我們與他們的關係並提高他們的績效是一件好事。最後，我們圍繞技術和整合所做的加強以支持卓越運營也很好地融入了吉姆在他的開場白和之前的信中談到的我們需要重點關注的許多其他事情。

Yes, and then, AJ, the only other thing I'd remind you is we talked about investments for 2025. Just keep in mind, Stars is one piece of it, but there are investments we're making more broadly to drive just improved operational performance across a number of areas that Jim had referred to, so Stars is just one component. And then, Jim, the last question I don't think we touched on is just the philosophy of membership growth and margin trade-off, if you wanted to touch on that.

是的，然後，AJ，我要提醒您的唯一一件事是我們討論了 2025 年的投資。請記住，星星只是其中的一部分，但我們正在進行更廣泛的投資，以推動吉姆提到的多個領域的營運績效改善，因此星星只是其中的一個組成部分。然後，吉姆，我認為我們沒有觸及的最後一個問題只是會員成長和利潤權衡的哲學，如果你想觸及的話。

Yes, and again, I think this was related to how would we react to the Stars mitigation or Stars progression. Look, the short answer is we have a lot of questions around that very thing that we're going to have to answer over the next three, four, five months. So we don't have a perfect answer.

是的，我再次認為這與我們對星星緩解或星星進展的反應有關。聽著，簡短的回答是，我們對這件事有很多疑問，我們將在接下來的三、四個、五個月內回答這些問題。所以我們沒有一個完美的答案。

We've got to understand, what does the rate environment look like? How are we feeling about the progress that we're making on 2027 Stars, et cetera? So there's just a bunch of factors that we don't yet have visibility into to answer that. What I would say, just generically, is our intent is to balance long-term earnings potential with near-term earnings progression. We need to balance those. All in all, we're not going to do things that harm the business long term to work our way through a short-term issue. Now what does that mean practically? We don't know yet. We have to sort that out.

我們必須了解，利率環境是什麼樣的？我們對 2027 Stars 等方面所取得的進展有何感想？因此，我們還無法了解很多因素來回答這個問題。一般來說，我想說的是，我們的目的是平衡長期獲利潛力與近期獲利進展。我們需要平衡這些。總而言之，我們不會為了解決短期問題而做一些長期損害業務的事情。那麼這實際上意味著什麼呢？我們還不知道。我們必須解決這個問題。

David Windley, Jefferies.

大衛溫德利，傑弗里斯。

Hi, good morning. Thanks for taking my questions. I wondered on two fronts. First, on channel investment, basically, you've touched on some of this already. I recall last year that after AEP, the discussion was that the brokers were more consumed by helping existing members shop and therefore couldn't talk to new members as much, resulting in AEP growth being relatively low, more shopping expected for 2025.

嗨，早安。感謝您回答我的問題。我想知道兩個方面。首先，關於通路投資，基本上，您已經談到了其中的一些內容。我記得去年AEP之後，討論的是經紀人更多地消耗在幫助現有會員購物上，因此無法與新會員進行太多交談，導致AEP增長相對較低，預計2025年會有更多購物。

I'm wondering what you've done to address that issue. And kind of relatedly, how should we think about the cadence of membership AEP versus entry year? And then lastly, I'm wondering just if you have any early thoughts or expectations about '26 rates for early next-year announcement. Thanks.

我想知道你做了什麼來解決這個問題。與此相關的是，我們該如何考慮會員 AEP 與入會年份的節奏？最後，我想知道您是否對明年初公佈的 26 費率有任何早期想法或期望。謝謝。

Yes, so I'll start, and there are a number of -- thanks for the question, David. There are a number of things that we've done in preparation for what we knew was going to be a sales year where there's going to be a dynamic change in the industry given the industry reset that we've all talked about we're going through with benefit changes, member disruption, as we have had planned in-county exits, a number of our competitors have as well, so we know that that's going to be something that we have to focus on.

是的，所以我要開始了，有很多——謝謝你的提問，大衛。我們已經做了很多事情，為我們知道將是一個銷售年做好準備，考慮到我們都在談論的行業重置，行業將發生動態變化通過福利變化、會員中斷，正如我們計劃在縣內退出一樣，我們的許多競爭對手也有，所以我們知道這將是我們必須關注的事情。

So we continue to make investments in both our internal sales channels to include improvements in, as I mentioned before, digital self-service options. We also are making investments to help our external brokers. You also realize that we have a pretty large internal brokerage as well, and we're seeing a 70% increase in sales in that internal brokerage channel.

因此，我們繼續對內部銷售管道進行投資，包括改善數位自助服務選項，正如我之前提到的。我們也進行投資來幫助我們的外部經紀人。您也意識到我們也有相當大的內部經紀業務，我們看到該內部經紀管道的銷售額成長了 70%。

So we're going at this from both improving the experience for the members to be able to self-service in digital, improving when our sales team gets those calls in person, how they can answer those questions by giving them better tools and leveraging AI, as well as helping our external partners in providing them with more real-time data information and helping them on best benefit choices. So there's a whole host of things we're doing across the whole marketplace that we are prepared for, knowing that this is going to be a year of pretty significant change in this AEP.

因此，我們的目標是改善會員的數位自助服務體驗，改善我們的銷售團隊親自接到這些電話的時間，以及如何透過為他們提供更好的工具和利用人工智慧來回答這些問題，以及幫助我們的外部合作夥伴為他們提供更多的即時數據信息，幫助他們做出最佳的利益選擇。因此，我們正在整個市場上做很多事情，我們已經做好了準備，因為我們知道這將是 AEP 發生相當重大變化的一年。

Yes, and let me just kind of headline that our external partners are really important to us and building and strengthening our internal channel is what we have the most direct control over and we've been building capacity in that internal channel for that very reason. And that channel is also very important to us. And so we have built capacity to the degree that we feel like we reasonably can under the timeframe and the circumstances, et cetera. And at the end of the day, we still look at the market and we expect 5% to 5.5% growth at the end of the day, even with the need to kind of balance these capacity constraints.

是的，我想強調一下，我們的外部合作夥伴對我們來說非常重要，建立和加強我們的內部管道是我們最直接控制的，正是因為這個原因，我們一直在該內部管道中建立能力。這個管道對我們來說也非常重要。因此，我們已經將能力建構到了我們認為在時間框架和情況等條件下合理能夠達到的程度。最終，我們仍然關注市場，預計最終成長率為 5% 至 5.5%，即使需要平衡這些產能限制。

And then I think the last question was around 2026 rates, which, David, I would just say it's hard to -- we can't really predict what it's going to be. We would say we still have V28 and IME to be saved in, so we know those are impacts. And the big question will be, given the trend that we have seen, will we see some positive restatement embedded within the '26 rate?

然後我認為最後一個問題是 2026 年左右的利率，大衛，我想說這很難——我們無法真正預測它會是什麼。我們會說我們仍然有 V28 和 IME 需要保存，所以我們知道這些都是影響。最大的問題是，考慮到我們所看到的趨勢，我們是否會看到 26 年利率中包含一些正面的重述？

Recognizing their forward-looking '25 rate, it is seeing some trend improvement, which obviously hasn't transpired. The ACO reach detail that's shared by CMS is one sort of indicator of the trend they may be seeing. That does suggest that they are seeing some of these higher trends as well. So I think we're cautiously optimistic that the rates for next year will include an appropriate adjustment for the trend that we're all absorbing.

認識到他們的前瞻性「25」利率，看到了一些趨勢改善，但顯然尚未發生。CMS 共享的 ACO 覆蓋率詳細資訊是他們可能看到的趨勢的一種指標。這確實表明他們也看到了其中一些更高的趨勢。因此，我認為我們對明年的利率將包括對我們都在吸收的趨勢進行適當調整持謹慎樂觀的態度。

Michael Ha, Baird.

麥可·哈，貝爾德。

Hi, thank you. So just firstly, quickly to confirm, on DSNP redetermination, Susan, did you mention 80 bps of industry growth has been expected for next year? Is that presumably because of the six-month grace period they have? Are the bulk of those lives still yet to be determined -- redetermined? What percent of those lives are expected to fall off your book?

你好，謝謝。首先，快速確認一下關於 DSNP 重新確定的問題，Susan，您是否提到明年預計產業將成長 80 個基點？這大概是因為他們有六個月的寬限期嗎？這些生命中的大部分是否仍有待確定──重新確定？預計這些人中的百分之幾會從你的書中消失？

And then number two, I guess, given that you're already 11 months into the measurement year, '24 for next October's release, Star ratings, I know CAHPS still runs through June. But based on the other, I guess, let's call it roughly 70% waiving -- or actually, I guess 80% now that CAHPS is being reduced. I know you're in a sprint right now, but how are you tracking on those 80% of measures?

然後第二個，我想，考慮到你已經進入測量年 11 個月了，明年 10 月發布的 24 星評級，我知道 CAHPS 仍然持續到 6 月。但基於另一個，我猜，我們可以稱之為大約 70% 的豁免——或者實際上，我猜現在 CAHPS 正在減少，我猜是 80%。我知道您現在正處於衝刺階段，但是您如何追蹤這 80% 的措施？

More specifically, I guess what's the realistic likelihood of being able to sort of fully snap back to 80% to 90% of members and 4-star plus plans? What's your level of confidence, conviction? Or is it just very unlikely given how late into 2024 it is and how late it was, realizing how aggressive cut points are, and just the time you have left to make incremental improvements. Thank you.

更具體地說，我猜想完全恢復到 80% 到 90% 的會員和 4 星級以上計劃的現實可能性有多大？您的信心、信念程度如何？或者考慮到 2024 年已經很晚了，而且已經很晚了，意識到削減點有多麼激進，而且你還剩下時間進行漸進式改進，這是否不太可能？謝謝。

Sure, Michael. I'll take the first question, then hand it over to Jim or George for the Star question. On D-SNPs, yes, you heard that correctly. We do anticipate a headwind in 2025 as the re-determination process completes. There was pressure in 2024 as well, slightly less than, we would say, 70 or so basis points in 2024. And we think it will be about 80 basis points of pressure in 2025.

當然，邁克爾。我將回答第一個問題，然後將其交給吉姆或喬治來回答明星問題。關於 D-SNP，是的，您沒聽錯。我們預計，隨著重新確定過程的完成，2025 年將出現阻力。2024 年也存在壓力，略低於 2024 年的 70 個基點左右。我們認為 2025 年壓力將約為 80 個基點。

Frankly, part of that is because of the Change Healthcare disruption, which disrupted the ability to confirm eligibility. And so even though we've largely seen the impact on the Medicaid side, because of the deeming period, on the MA side, there is that six-month period. And so we do expect that we will see some additional dual disenrollment as they lose coverage.

坦白說，部分原因是變革醫療保健中斷，這破壞了確認資格的能力。因此，儘管我們在很大程度上看到了對醫療補助方面的影響，但由於推定期限，在 MA 方面，有六個月的期限。因此，我們確實預計，當他們失去承保範圍時，我們會看到一些額外的雙重退出。

Some of those we would expect to recapture within our non-D-SNP offerings, but some, obviously, are no longer eligible. So we've built that into our expectations all along for '25 in terms of the loss of a few hundred thousand members that is already contemplated. But yes, you did hear me correctly.

我們希望在我們的非 D-SNP 產品中重新獲得其中一些，但顯然有些不再符合資格。因此，我們一直將這一點納入我們對 25 年的預期中，因為已經考慮到會失去數十萬名會員。但是，是的，你沒有聽錯。

And then George or Jim, do you want to take the Star question?

然後喬治或吉姆，你想回答明星問題嗎？

Yes, I'll just jump in on that. The short answer is, at this point, one, you've just got limited visibility into even your own performance, and you've got no visibility into industry performance. And so we're not going to comment on industry performance or cut points or thresholds until they're actually out next year.

是的，我馬上就講到這一點。簡而言之，在這一點上，第一，你對自己的表現的了解也很有限，而且你對行業表現也沒有了解。因此，在明年真正發布之前，我們不會對行業表現或削減點或門檻發表評論。

On our own performance, we feel good about the progress that we are making. And there is risk. We're resetting expectations with four months, 3.5 months to go in the year, setting those expectations higher, driving towards higher goals.

就我們自己的表現而言，我們對所取得的進展感到滿意。並且存在風險。距離今年還有 4 個月 3.5 個月的時間，我們將重新設定預期，將這些預期設定得更高，以實現更高的目標。

And while I think we all feel good that we are making progress and leaning as an organization into it as heavily as we can, we still need time to understand exactly how those things are going to play out. So there's just -- there's not a super clear answer to the question at this point in time. But everybody is leaning into it, and that is what we need right now.

雖然我認為我們都對我們正在取得的進展感到高興，並且作為一個組織盡可能地投入其中，但我們仍然需要時間來準確了解這些事情將如何發展。所以，目前這個問題還沒有一個非常明確的答案。但每個人都在傾向於它，這就是我們現在所需要的。

With that being the last question, I'm just going to transition here and thank everybody for joining us this morning and thank everybody for your interest in Humana and in what we are trying to do to serve our patients and our members. And I want to thank our 65,000 associates who serve those members and those patients every day. We appreciate the work that they're doing, and we appreciate the support that you're giving us, so thank you.

這是最後一個問題，我要在此過渡，感謝大家今天早上加入我們，並感謝大家對 Humana 以及我們正在努力為我們的患者和會員服務的興趣。我要感謝每天為這些會員和患者提供服務的 65,000 名員工。我們感謝他們所做的工作，也感謝您給予我們的支持，所以謝謝您。

This concludes today's conference call. Thank you for participating. You may now disconnect.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連線。