Humana Inc (HUM) 2024 Q4 法說會逐字稿

Good day, and thank you for standing by. Welcome to Humana's Fourth Quarter 2024 Earnings Conference Call. (Operator Instructions) Please be advised that today's conference is being recorded.

您好，感謝您的支持。歡迎參加 Humana 2024 年第四季財報電話會議。（操作員指示）請注意，今天的會議正在錄音。

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

現在，我想將會議移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; and Chief Financial Officer, Celeste Mellet, which will be followed by a Q&A session, where Jim and Celeste will be joined by George Renaudin, President of Humana's Insurance segment.

謝謝，早安。我希望大家都有機會閱讀我們的新聞稿和準備好的發言稿，這些都可以在我們的網站上查閱。今天上午，我們將首先由 Humana 總裁兼執行長 Jim Rechtin 發表簡短演講；以及財務長 Celeste Mellet 的會談，隨後是問答環節，Jim 和 Celeste 將與 Humana 保險部門總裁 George Renaudin 一起參加。

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 fourth quarter 2024 earnings press release, as they relate to forward-looking statements along with other risks discussed in our SEC filings. We undertake no obligation to publicly address or update any forward-looking statements and future filings or communications regarding our business or results.

在我們開始討論之前，我需要向通話參與者告知我們的警告聲明。本次電話會議中討論的某些事項具有前瞻性，涉及若干風險和不確定性。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 2024 年第四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我們向美國證券交易委員會提交的文件中討論的其他風險有關。我們不承擔公開解決或更新有關我們的業務或結果的任何前瞻性聲明和未來文件或通信的義務。

Today's press release, our historical financial news releases and our filings with the SEC are all also available on our Investor Relations site. 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. Any 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. That replay will be available on the Investor Relations page of Humana's website, humana.com, later today.

今天的新聞稿、我們的歷史財務新聞稿以及我們向美國證券交易委員會提交的文件均可在我們的投資者關係網站上查閱。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 (GAAP) 的財務指標。今天的新聞稿中包含了管理階層對於使用這些非 GAAP 指標的解釋以及 GAAP 與非 GAAP 財務指標的調整。本次電話會議中提到的每股盈餘 (EPS) 均指稀釋後每股普通股盈餘。最後，本次通話將會被錄音以供重播。今天晚些時候，重播將在 Humana 網站 humana.com 的投資者關係頁面上發布。

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

說完這些，我會把電話轉給 Jim Rechtin。

Thank you, Lisa, and good morning, everyone. Thank you for joining us. I have three topics today. First, we have some new members of the team to introduce. I'm going to spend a minute talking about our performance through the framework of the four levers that drive this business. Those are the levers that were introduced in the CEO letter last summer, and I'll spend a minute on industry context.

謝謝你，麗莎，大家早安。感謝您加入我們。我今天有三個話題。首先，我們要介紹一些團隊的新成員。我將花一點時間透過推動這項業務的四個槓桿框架來談論我們的表現。這些是去年夏天執行長信中提出的槓桿，我將花一點時間介紹行業背景。

First, let me just reinforce a couple of headlines. 2024 adjusted EPS is in line with our initial guidance. This does include the investment that we made in Stars, and in growth, in the back portion of the year. We are reaffirming our 2025 outlook. We remain committed to achieving at least a 3% margin in individual MA, and we do view 2025 as a key year in that journey. And we have some management team members to help us bring fresh perspectives to that task. I'm pleased to introduce them today. I'll start with Celeste Mellet, our new Chief Financial Officer.

首先，讓我重申幾個標題。 2024 年調整後的每股盈餘與我們的初步指引一致。這確實包括我們在今年後半年對 Stars 和成長所做的投資。我們正在重申我們的 2025 年展望。我們仍然致力於在個人 MA 中實現至少 3% 的利潤率，並且我們確實將 2025 年視為這一征程的關鍵一年。我們有一些管理團隊成員幫助我們為這項任務帶來新的視野。我很高興今天介紹他們。首先請聽聽我們新任財務長 Celeste Mellet 的演講。

Celeste joins us with a lot of experience leading finance in organizations that have worked their way through difficult external headwinds. This is a good experience given the circumstances in our sector over the past couple of years and today. This includes her experience at Morgan Stanley and at Fannie Mae. You will, of course, be hearing from Celeste today, and I look forward to introducing you in a moment.

在加入我們之前，Celeste 擁有豐富的經驗，曾領導多家企業克服了外部困難，並取得了財務成功。考慮到我們行業過去幾年以及現在的情況，這是一個很好的經驗。其中包括她在摩根士丹利和房利美的工作經驗。當然，今天您將聽到 Celeste 的消息，我期待稍後向您介紹。

We also have Michelle O'Hara joining us as Chief Human Resources Officer. Her experience has been focused on evolving HR capabilities through periods of change. She comes to us from SAIC.

米歇爾·奧哈拉 (Michelle O'Hara) 也加入我們，擔任首席人力資源長。她的經驗主要集中在變革時期人力資源能力的提升。她來自上汽集團。

And we're introducing Japan Mehta as our new Chief Information Officer. Japan brings a wealth of experience managing large IT organizations in scale regulated industries. He also has experience using data and digital to better engage customers. This is a big part of our future, we believe. He was most recently at Citi.

我們任命 Japan Mehta 為我們的新任資訊長。日本在管理規模受監管行業中的大型 IT 組織方面擁有豐富的經驗。他還擁有利用數據和數位技術更好地吸引客戶的經驗。我們相信，這是我們未來的重要組成部分。他最近在花旗銀行任職。

Now let me turn to the four things that drive this business. The first of those four levers is product experience, which drives customer growth, retention and lifetime customer value. In this area, we feel that we are moving in the right direction, that we also believe that we're just scratching the surface of what can be done.

現在讓我來談談推動這項業務的四個因素。這四個槓桿中的第一個是產品體驗，它推動客戶成長、保留和終身客戶價值。在這領域，我們覺得自己正朝著正確的方向前進，同時我們也相信，我們所能夠做的事情才剛開始。

As a reminder, in 2024, we proved to have a good year of growth with nearly 5% membership growth, despite repricing our product to reflect the elevated medical cost trend that we began to see nearly two years ago. When we look at the most recent AEP and expectations for 2025, we are accomplishing the things we wanted to achieve. We're shedding unprofitable plans, we're resetting expectations and lower margin plans, and we are shifting our membership mix with a focus on sustainable long-term value.

提醒一下，儘管我們對產品進行了重新定價以反映近兩年前開始看到的醫療成本上升趨勢，但我們在 2024 年仍實現了良好的增長，會員人數增長了近 5%。當我們回顧最新的 AEP 和 2025 年的期望時，我們正在實現我們想要實現的目標。我們正在放棄無利可圖的計劃，重新設定預期並降低利潤率的計劃，我們正在轉變會員結構，重點關注可持續的長期價值。

The membership losses that we've experienced have largely been consistent with our strategy. The exception to this is our position in the D-SNP space. However, we are comfortable that we can quickly improve our positioning in this space. I also want to emphasize that we feel very good about the new member mix that we've been attracting.

我們所經歷的會員流失基本上與我們的策略一致。例外的是我們在 D-SNP 空間中的位置。然而，我們很高興能夠快速提升我們在這個領域的定位。我還想強調的是，我們對所吸引的新成員組合感到非常滿意。

The second lever is clinical excellence. This is the engine of the business. When we deliver better outcomes for our members and our patients, we also reduced system costs. When we reduce system costs, we improve our own product profitability. Clinical excellence starts with delivering on Star's performance. In the fourth quarter of 2024, we closed 650,000 care gaps. This is a significant improvement from where we started in September. We feel good about the progress that we made over the last quarter of the year. And the question, of course, is will these steps that we've taken, be enough to return us to an industry-leading position in 2027?

第二個槓桿是臨床卓越。這是業務的引擎。當我們為我們的會員和患者提供更好的結果時，我們也降低了系統成本。當我們降低系統成本時，我們提高了自己的產品獲利能力。臨床卓越始於 Star 性能的實現。2024 年第四季度，我們彌補了 65 萬個護理缺口。與我們九月開始時相比，這是一個顯著的進步。我們對今年最後一個季度所取得的進展感到滿意。當然，問題是，我們採取的這些措施是否足以讓我們在 2027 年重返業界領先地位？

As we acknowledged back in October, it will be tight, and ultimately, it will depend on the final thresholds. Having said that, I will reemphasize that we feel good about the progress we made in the fourth quarter. We are right now putting all of our energy into measurement year 2025. That is bonus year 2028, where we have a full year of runway to drive operational savings.

正如我們十月所承認的那樣，這將是嚴格的，而且最終將取決於最終的門檻。話雖如此，我還是要再次強調，我們對第四季的進展感到滿意。我們現在正把全部精力投入到 2025 年的測量工作中。那是 2028 年的獎金年，我們有整整一年的時間來實現營運節約。

Our third lever is operating with a highly efficient back office. We have made a lot of progress in this domain over the course of the last couple of years. In 2024, we improved our operating expense ratio by 40 basis points. Just to provide a few examples of what enabled this. We optimized our care model, we unified shipping activities across the enterprise. We outsourced some noncore capabilities, and we streamlined our internal distribution capability. I'd like to note that our internal distribution team performed better this year than ever, even while driving efficiency. Efficiency does not mean a decline in performance levels when we do it the right way, it is important for our team to note this and for our investors to recognize it. Despite the good progress over the past few years, we believe there is more to do and we expect to communicate a path towards additional efficiencies in the upcoming months.

我們的第三個槓桿是高效率的後台運作。在過去的幾年裡，我們在這個領域取得了很大進展。2024年，我們將營業費用率提高了40個基點。僅提供幾個例子來說明如何實現這一點。我們優化了護理模式，統一了整個企業的運輸活動。我們將一些非核心能力外包出去，並精簡了內部分銷能力。我想指出的是，我們的內部分銷團隊今年的表現比以往任何時候都好，即使在提高效率的同時。當我們以正確的方式做事時，效率並不意味著績效水準的下降，我們的團隊注意到這一點並且我們的投資者認識到這一點很重要。儘管過去幾年取得了良好的進展，但我們認為還有更多的工作要做，我們期望在未來幾個月內傳達一條提高效率的途徑。

Finally, let me touch on the last lever, which is capital allocation and growth. We feel good about the opportunities we found to expand our primary care footprint in the second half of 2024. We also feel good about the continued expansion of Medicaid organically. However, in the near future, we will need to strike a balance.

最後，讓我談談最後一個槓桿，即資本配置和成長。我們對在 2024 年下半年擴大初級保健覆蓋範圍的機會感到非常高興。我們也對醫療補助的持續性有機擴張感到高興。然而，在不久的將來，我們需要取得平衡。

Priority number 1 is recovering in a margin, as we have repeatedly said. This will require us being prudent with our balance sheet as we navigate the Stars recovery. And we must continue to grow our earnings capacity through organic reinvestment and through acquisitions. This is clearly a second priority, but it is a priority nonetheless. Both CenterWell and Medicaid are important enablers of our long-term strategy. We will be thoughtful in identifying opportunities that make sense in our current environment that allow us to continue to grow our earnings capacity while being prudent with our balance sheet.

正如我們一再說過的，首要任務是邊際復甦。這就要求我們在引導 Stars 復甦的過程中審慎對待我們的資產負債表。我們必須繼續透過有機再投資和收購來提高我們的獲利能力。這顯然是第二優先事項，但無論如何它仍然是優先事項。CenterWell 和 Medicaid 都是我們長期策略的重要推動因素。我們將認真尋找在當前環境下有意義的機會，這些機會使我們能夠繼續提高獲利能力，同時審慎管理我們的資產負債表。

Now let me spend just a moment on the insurance industry and on Medicare Advantage. It's been a volatile couple of years and more so it's been a volatile few months. The US healthcare system is complicated, it's fragmented and it's expensive. I think all of that has been pretty well established. Americans understandably, want high-quality affordable care that is easy to navigate. Too often, that is not what they are receiving today. There is no one company and there is no one sector that is responsible for this. It is a system challenge. It is the challenge of our American healthcare system.

現在，請允許我花一點時間談談保險業和醫療保險優勢計劃。過去的幾年充滿動盪，過去的幾個月更動盪不安。美國醫療保健系統複雜、分散且費用昂貴。我認為所有這些都已經得到了很好的證實。可以理解的是，美國人希望獲得價格合理、易於接受的高品質醫療服務。但很多時候，這並不是他們今天所得到的。沒有哪一家公司、哪一家部門應該要為此負責。這是一個系統挑戰。這是我們美國醫療保健系統面臨的挑戰。

Still, as I mentioned in my CEO letter last summer, Medicare Advantage plays an important role. Medicare Advantage delivers better outcomes in original Medicare. If you need evidence of this, look at the steady improvement in HEDIS performance that has been driven by MA programs. Medicare Advantage operates more efficiently than original Medicare. This can be demonstrated in our recently published value-based care report, or through the work done jointly with Harvard University, looking at value-based primary care which operates inside of the Medicare Advantage system.

不過，正如我去年夏天在執行長信中提到的那樣，醫療保險優勢計劃發揮著重要作用。醫療保險優勢計劃 (Medicare Advantage) 在原有醫療保險中提供更好的結果。如果您需要這方面的證據，請看一下 MA 專案推動的 HEDIS 績效的穩定提升。Medicare Advantage 比原始 Medicare 運作得更有效率。這可以在我們最近發布的基於價值的護理報告中得到證明，或者通過與哈佛大學聯合開展的工作來證明，研究在醫療保險優勢計劃系統內部運作的基於價值的初級保健。

Medicare Advantage also enables more affordable healthcare access to seniors. There is a reason that more than 50% of eligible Americans choose Medicare Advantage. It is of good value, it makes healthcare more affordable and easier to access. And of course, the Medicare Advantage program can be improved, and we are open to partnering with anyone interested in engaging constructively to do that.

醫療保險優勢計劃也使老年人能夠以更實惠的價格獲得醫療服務。超過 50% 的符合資格的美國人選擇 Medicare Advantage 計劃是有原因的。它很有價值，它使醫療保健變得更實惠和更容易獲得。當然，醫療保險優勢計劃可以改進，我們願意與任何有興趣並願意為此進行建設性參與的人合作。

In the meantime, there are things that we Humana can do on our own. While we cannot fix the entire healthcare system on our own, we can make it easier for our patients and our members to navigate. We can make it easier to understand what our members will have to pay when they see a doctor or require a procedure. We can do more to support our members with reminders to do preventative care to manage their chronic illnesses. We can take complicated healthcare topics and we can communicate about them more clearly and simply to our members. We can provide them better service every time they call us with a question or concern. Those are the things that we can do, that is our intent, and that is the work that is underway within Humana.

同時，我們 Humana 可以自己做一些事情。雖然我們無法獨自修復整個醫療保健系統，但我們可以讓我們的患者和會員更容易駕馭它。我們可以讓您更輕鬆地了解我們的會員在看醫生或需要接受治療時需要支付的費用。我們可以提供更多支持，提醒我們的會員進行預防性護理來管理他們的慢性疾病。我們可以討論複雜的醫療保健主題，並且可以更清楚、更簡單地與我們的會員進行溝通。每次他們致電詢問問題或疑慮時，我們都能為他們提供更好的服務。這些都是我們可以做的事情，這是我們的意圖，這也是 Humana 正在進行的工作。

With that, I will turn it over to Celeste for her to share a few words on her first month at Humana. Celeste?

現在，我將請 Celeste 分享她在 Humana 工作第一個月的一些情況。塞萊斯特？

Thank you, Jim. I'll start by echoing your belief in Humana's value proposition. This is a great company with a long successful history, strong DNA and differentiated capabilities, that has demonstrated it can improve outcomes for members and patients while driving significant value for shareholders.

謝謝你，吉姆。首先，我想重申您對 Humana 價值主張的信念。這是一家偉大的公司，擁有悠久的成功歷史、強大的 DNA 和差異化的能力，已經證明它可以改善會員和患者的治療效果，同時為股東帶來巨大價值。

While our long-term potential remains strong, our industry is in transition, facing significant regulatory and other headwinds. I have had the opportunity to lead companies in regulated industries through similar periods of volatility. It is incumbent upon us to evolve how we serve our members and operate the business to be more nimble, better able to absorb fluctuations and more consistently deliver compelling financial performance and shareholder value. As we execute on the four levers Jim has articulated, we will be stronger and better.

雖然我們的長期潛力依然強勁，但我們的產業正處於轉型期，面臨重大監管和其他阻力。我有機會帶領受監管行業的公司度過類似的動盪時期。我們有責任改善我們為會員提供服務和經營業務的方式，使其更加靈活，能夠更好地吸收波動，並更持續地提供令人信服的財務表現和股東價值。當我們執行吉姆所闡述的四個槓桿時，我們將變得更強大、更好。

I am thrilled to join an incredible team that will guide Humana through this transition. I have enjoyed getting to know my team and many of my colleagues over the last several weeks. It has been great to see how talented and committed the company is to serving our members and patients. I am energized by the opportunity to bring a fresh perspective and challenge the organization to rethink our norms so we are constantly improving, while at the same time, ensuring the aspects of our culture that have been so critical to our past successes are retained, and enabling long-term profitable, sustainable growth. And I look forward to working with many of the participants on this call over the coming months.

我很高興加入一個優秀的團隊，帶領 Humana 度過這段轉型期。在過去的幾周里，我很高興認識我的團隊和許多同事。我們很高興看到公司如此出色並致力於為我們的會員和患者提供服務。我很高興能有機會帶來新的視角，挑戰組織重新思考我們的規範，以便我們不斷進步，同時確保保留對我們過去的成功至關重要的文化方面，並實現長期盈利、可持續的增長。我期待在接下來的幾個月與本次電話會議的眾多參與者合作。

With that, I will turn the call back to Lisa to start the Q&A.

說完這些，我會把電話轉回給麗莎，開始問答環節。

Great. Thank you, Celeste. Before starting the Q&A, just a quick reminder that fairness in those waiting in the queue, we ask that you please limit yourself to one question. So operator, with that, please introduce the first caller.

偉大的。謝謝你，塞萊斯特。在開始問答環節之前，為了公平起見，我們只想提醒一下排隊等候的人們，請您將問題限制在一個範圍內。接線員，請介紹第一位來電者。

Ann Hynes, Mizuho.

安海因斯（Ann Hynes）、瑞穗（Mizuho）

I just want to focus on 2025 MLR guidance. Can you just break down the levers of the increase, what is -- what base you're assuming? What's the overall cost trend? How much is driven by IRA changes and what the impact of the greater-than-expected loss of D-SNP and MLR, that would be great.

我只想專注於 2025 年 MLR 指導。您能否分解成長的槓桿，您假設的基礎是什麼？整體成本趨勢如何？其中有多少是由 IRA 變化推動的，以及 D-SNP 和 MLR 的損失超出預期會產生什麼影響，這些都很重要。

Ann, it's Celeste. Thanks for your question. So to give you some additional color on top of what we included in our prepared remarks. First, I'll give you the drivers of the decreases in the ratio, which are improving the ratio.

安，我是塞萊斯特。感謝您的提問。因此，為了給您一些關於我們已準備好的評論中所包含內容的附加資訊。首先，我會告訴你導致該比例下降的因素，這些因素正在提高該比例。

First, the majority of the improvement is driven from the MA plan exit, which all had very high benefit ratios. We also made other adjustments to our benefits in our remaining plans, which also improved the ratio. And then finally, the favorable calendar in 2025, given both how the days fall and the extra day in 2024 due to leap year.

首先，大部分的改進是由 MA 計劃退出推動的，這些計劃的福利比率都非常高。我們也對剩餘計畫的福利進行了其他調整，這也提高了比例。最後，考慮到天數的推移以及 2024 年因閏年而多出的一天，2025 年是有利的日曆。

Second, the increases to the ratio, which are a drag. First, business mix changes given Medicaid is growing. Medicaid carries a higher benefit ratio versus MA, as you know. Second, the IRA impact, which increases the benefit ratio given increased revenue with offsetting increases in claims. And third, incremental investments, which are important to the long term, but increase the benefit ratio in the near term.

其次，該比率的增加是一個拖累。首先，由於醫療補助的不斷成長，業務組合發生了變化。如您所知，與 MA 相比，醫療補助的福利比率更高。其次，IRA 的影響，由於收入增加，抵消了索賠增加，因此福利比率上升。第三，增量投資，這對長期而言很重要，但可以提高短期的收益率。

The arrows we provided in our prepared remarks are in order of size. And we gave you the puts and takes, but we'll leave the modeling to you in terms of the impact overall.

我們在準備好的評論中提供的箭頭是按大小排序的。我們已經給出了利弊，但就整體影響而言，建模將留給您來決定。

Justin Lake, Wolfe Research.

賈斯汀·萊克（Justin Lake），沃爾夫研究公司。

As you might expect, people are trying to look through -- now that you give us '25, trying to look through '26 and understand the moving parts there. Maybe you could just -- I assume you're going to give us a lot more at the Investor Day once you have the outcome of the appeal.

正如您可能預料的那樣，人們正在嘗試查看 — — 既然您給了我們 '25，我們便嘗試查看 '26 並了解其中的活動部件。也許您可以—我想一旦您有了上訴結果，您就會在投資者日向我們提供更多資訊。

But maybe you could just frame for us, if you think about it in two buckets. One, the core business. Last year, you said before the rates came out disappointing, the company could grow $6 to $10 of earnings. Rates seem to be coming in better. Is that a reasonable framework ex the Stars? And then how would you think about Stars relative to that to give us an idea of how 2026 kind of moving parts might shape up?

但如果您從兩個角度來考慮，也許您可以為我們提供一個框架。一、核心業務。去年，在利率令人失望之前，您說過公司收益可以增加 6 至 10 美元。利率似乎正在變得更好。這是星星給出的合理框架嗎？那麼，您如何看待與此相關的星星，讓我們了解 2026 年的活動部件將如何形成？

Thanks, Justin. Let me just start by acknowledging that we typically do not provide guidance that far out all the way out to 2026. And really, that is driven by several of the factors that you just outlined. There's a bunch of unknowns that we're still navigating. The Stars litigation is a big piece of that. The final funding for MA is a big piece of that. Obviously, the preliminary notice is out. Things can change between the preliminary notice and the final rate notice. And so we'll be waiting to see how that plays out.

謝謝，賈斯汀。首先我要承認，我們通常不會提供截至 2026 年那麼遠的預測。事實上，這是由您剛才列出的幾個因素所驅動的。還有許多未知數等著我們去探索。Stars 訴訟案是其中很重要的一部分。MA 的最終資金佔了其中很大一部分。顯然，初步通知已經出來了。初步通知和最終利率通知之間情況可能會改變。我們將拭目以待，看看事情將如何發展。

What I can tell you is that what we are focused on differentially is how do we drive operating performance. And so what are the things that we can do, fully under our control, to get better at managing the business. When we do that, that leads us to a place where we can get to a sustainable, compelling competitive position in the market and then look at some level, pricing and benefits become easier and they take care of themselves that we're nailing that underlying operating performance.

我可以告訴你們的是，我們關注的不同點在於如何提升營運績效。那麼，我們可以做哪些事情來完全掌控自己，以便更好地管理業務呢？當我們這樣做時，我們就能在市場上獲得可持續的、引人注目的競爭地位，然後從某種程度上看，定價和收益變得更容易，它們會自行照顧好我們確定的底層營運績效。

And so that's really where the orientation is right now on 2026. And when we talk about operating performance, what are we talking about? We're talking about that second and the third lever. It's clinical excellence and all the components that go into it, and it is driving an efficient back office. Those two things more than anything else is really the focus for 2026, but we're not yet ready to provide guidance around that.

這就是目前 2026 年的定位。當我們談論營運績效時我們在談論什麼？我們正在討論第二個和第三個槓桿。它是臨床卓越的表現以及其中涉及的所有要素，並且它推動著高效的後台辦公室的發展。這兩件事是 2026 年最值得關注的焦點，但我們尚未準備好就此提供指導。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯 (Sarah James)，費茲傑拉領唱者。

How do you think about the path to 3% margin? Does that assume any sort of Stars improvement needed to get there? How does that balance against what you're doing on cost and pricing? Do you think the book has to shrink further to get there? And then should we think about that as being ratable or back-end loaded?

您如何看待實現 3% 利潤的途徑？這是否意味著需要任何類型的 Stars 改進才能達到這一目標？這與您在成本和定價方面所做的努力如何平衡？您認為這本書是否必須進一步縮小才能達到這個目的？那麼，我們是否應該將其視為可評級的或後端加載的？

Yes. The way to think about Stars -- or I'm sorry, the way to think about the 3% margin is, yes, you would need to have a competitive Stars position. And I'm going to go a little bit back to where I was before. You need to have a reasonably normalized rate environment, and then you need to have optimal operating performance on the levers that I just described on clinical excellence, which again is Stars. It is accurately understanding our patients' needs and doing the follow-up care that goes with that, all of which then positively impacts both quality and medical trend.

是的。思考明星的方式——或者對不起，思考 3% 利潤的方式是，是的，您需要擁有一個有競爭力的明星地位。我要稍微回到之前的地方。您需要有一個合理的標準化費率環境，然後您需要在剛才我所描述的臨床卓越性的槓桿上實現最佳的營運績效，這也是星級。我們準確地了解患者的需求並進行相應的後續護理，所有這些都對品質和醫療趨勢產生積極影響。

And then you need to optimize G&A. You need to be at a competitive place on G&A. When you get those things right, you have the financial capacity to price your benefits competitively in the market and achieve 3%. So Stars is absolutely a part of that. But that's -- those are the operating levers that we are super, super, super focused on because those are what give you the freedom to price the right way in the market.

然後您需要優化 G&A。您需要在 G&A 方面處於有競爭力的位置。當你正確處理這些事情時，你就有財務能力在市場上以有競爭力的價格為您的福利定價，並實現 3% 的收益率。所以 Stars 絕對是其中的一部分。但那是 — — 那些是我們非常、非常、非常關注的操作槓桿，因為它們讓您可以自由地在市場上以正確的方式定價。

And look, we feel like we have opportunities in every one of those, and that's -- that is what we're driving right now. Some of those will hit in '26. Some of those will hit after '26, but it will be a steady march.

瞧，我們覺得在每一個方面我們都有機會，這就是我們現在所推動的。其中一些將在26年實現。其中一些將在 26 年之後實現，但這將是一個穩步的過程。

Jim, if I can add to that. One of the things you've talked a lot about in the past, I think, to this audience is we need to get better at multiyear planning, including getting better out looking around corners and looking ahead. We have to be a lot more proactive in our decision making and planning to be much more flexible to react more quickly, and we need to be better at making trade-offs really creating the capacity, as you called out, for the most important things. We need to be ruthless about stopping things that are not driving better outcomes for our members and better returns for our shareholders. And again, really focusing on creating capacity, to do the things we really want to do and creating the most long-term value.

吉姆，如果我可以補充這一點的話。我認為，您過去經常與在座的各位談論的一件事就是，我們需要更好地進行多年期規劃，包括更好地展望未來和展望未來。我們在決策和規劃時必須更加積極主動，更加靈活，更加迅速地做出反應，我們需要更好地做出權衡，真正為最重要的事情創造能力，正如你所呼籲的那樣。我們必須堅決制止那些無法為我們的成員帶來更好結果、無法為我們的股東帶來更好回報的行為。再次強調，我們真正專注於創造能力，做我們真正想做的事情，並創造最大的長期價值。

As part of this, we'll continue to assess how to balance the aspects of our cost structure that are fixed versus variable, and how we evolve to over the longer period of time, become more variable in our cost structure. I really believe there's an opportunity here, which will allow us to absorb change faster and drive more consistent results. Along with Stars, this is one of our top priorities.

作為其中的一部分，我們將繼續評估如何平衡我們的成本結構中的固定和可變方面，以及如何在更長的時間內發展，使我們的成本結構變得更加多變。我確實相信這是一個機會，它將使我們能夠更快地吸收變化並取得更一致的成果。與星星一樣，這是我們的首要任務之一。

Joshua Raskin, Nephron Research.

喬舒亞‧拉斯金 (Joshua Raskin)，腎元研究公司。

You spoke to a few hundred million of investments that are sort of offsetting the underlying earnings growth in 2025. Can you just give some details on like the major buckets of those few hundred million? And then are those going to be ongoing each year? Or are those truly onetime in nature?

您剛才提到了數億美元的投資，這些投資將在一定程度上抵消 2025 年的潛在獲利成長。您能否詳細說明一下這幾億的主要金額是多少？那麼這些活動每年都會持續進行嗎？或者它們在本質上確實是一次性的？

And then obviously, the last one, maybe more of a follow-up even on the prior discussion. But should we think of 2025 as a floor EPS number? Or do you need to win the appeal on Stars for that to happen?

顯然，最後一個問題可能更多的是對先前討論的後續討論。但是，我們是否應該將 2025 年視為 EPS 的底線數字？或者你需要贏得 Stars 的上訴才能實現這一點？

Thanks for your question. So just to be clear, we make investments in our business every year. What we've called out and what's included in our guidance are incremental investments of a few hundred million. It's across a set of initiatives designed to improve our operating performance. So we're focused on Stars, of course. We're investing in clinical excellence, membership strategies in other areas, and we'll share more detail as the year progresses as to where this -- the ratios, they hit either the operating cost ratio or the benefit ratio, and we'll leave it at that.

感謝您的提問。需要明確的是，我們每年都會對我們的業務進行投資。我們所呼籲的和指導中包含的是幾億美元的增量投資。它涵蓋了一系列旨在提高我們營運績效的措施。因此我們當然專注於明星。我們正在對臨床卓越、其他領域的會員策略進行投資，隨著時間的推移，我們將分享更多細節，說明這些比率達到營運成本比率或收益比率，我們就到此為止了。

A.J. Rice, UBS.

A.J.賴斯、瑞銀。

Good luck, Celeste, for the new position. Look forward to working together. Let me maybe just come back to Stars commentary. Obviously, for '26 paying a year, a lot of riding on the appeal and so forth. But I noticed in your prepared remarks, the way you're describing, and I know this is out there, but we're also trying to just think about the earnings power of the company going forward. There's discussion about '27 payment year, it sounds sort of cautious about that, but then '28 sounds like the year where you think the investments you're making will bear fruit and pay off.

祝 Celeste 在新職位上一切順利。期待共同合作。讓我再回到明星的評論上。顯然，對於 26 年的年薪來說，這很大程度取決於吸引力等等。但我注意到您在準備好的發言中描述的方式，我知道這是存在的，但我們也試圖思考公司未來的盈利能力。關於 27 年付款年的討論聽起來有些謹慎，但 28 年聽起來像是您認為所做的投資將結出碩果並獲得回報的一年。

I'm trying to understand the issues around '26 Stars seem to be totally different than what you're highlighting, or quite different than what you're highlighting for '27, and maybe that's some of the underlying way in which Stars calculations are changing. I wonder if you could speak a little more to why there's a little bit of caution on and whether a favorable appeal in '26 makes any difference for '27? And the '28 seems like the year where you really think you'll -- the ore payment years obviously really be back to normalize Stars rating level?

我試圖理解 '26 星星周圍的問題似乎與你所強調的完全不同，或者與你所強調的 '27 完全不同，也許這就是星星計算發生變化的一些潛在方式。我想知道您是否可以再多說為什麼要這麼謹慎，以及 26 年的有利上訴是否會對 27 年產生影響？您認為 28 年似乎是礦石支付年份真正恢復正常星級水準的一年嗎？

Yes. A.J., this is Jim. Let me take this one. First of all, let me just start by saying we are not trying to communicate anything different about '27 than what we communicated back in October. So we are trying to hit the same tone. If anything, I think what we'd say is we feel good about the operating progress that we made in the fourth quarter of the year. So that actually is a positive. We communicated that there would be uncertainty because of threshold movement back in October, and we are simply reiterating that, that still remains the case, right. Like there's just a bunch of uncertainty around the thresholds. And we want to be clear and transparent about that. But that is not different.

是的。A.J.，這是吉姆。讓我來拿這個。首先，我要說的是，我們並不想傳達有關 27 年的任何不同於我們 10 月所傳達的訊息。因此我們試圖達到相同的基調。無論如何，我想我們會說我們對今年第四季的營運進展感到滿意。所以這其實是一件正面的事。早在 10 月份，我們就曾表示，由於門檻的變動，會出現不確定性，我們只是重申，情況仍然如此，對吧。就像閾值周圍存在著一堆不確定性。我們希望對此保持清晰和透明。但那並沒有什麼不同。

The 20 -- so now let me try to tease apart the different pieces here real quick. So 2026, again, not much we can say about the litigation, it's progressing as you would expect. It is unrelated to 2027. So whatever happens in 2026, with the litigation does not impact performance in 2027. In 2027, I'm just going to reiterate it one more time, we feel good about the progress we made operationally in the fourth quarter. I think we told everybody -- I know we told everybody back in October, that the thresholds that came out last year represented a different level of performance than what we had anticipated at the time. We were resetting our targets in the fourth quarter to reflect that, and we were on a sprint. We did sprint. We made a lot of progress. We feel good about the progress. And we don't know what the thresholds are going to look like next year, like it's kind of that plain and simple.

20 — — 現在讓我嘗試快速理清這裡的不同部分。因此，到 2026 年，我們對訴訟沒有太多可說的，它正在您預期的那樣進展。這與 2027 年無關。因此，無論 2026 年發生什麼，訴訟都不會影響 2027 年的表現。2027 年，我只想再重申一次，我們對第四季在營運上的進展感到滿意。我想我們告訴過每個人——我知道我們早在十月就告訴過每個人，去年公佈的門檻代表著與我們當時預期的不同的表現水平。為了反映這一點，我們在第四季度重新設定了目標，並且正在衝刺。我們進行了短跑。我們取得了很大進步。我們對此進展感到滿意。我們不知道明年的門檻會是什麼樣的，就像就是這麼簡單。

And then as we move into the current measurement year, so think about the activities that we're doing right now in 2025 that influence 2028. We have a whole year of runway now and we have the ability to layer in more buffer or more cushion to our targets. And so we feel better entering the new year with a full year's worth of runway. And that's really what we're trying to convey to everybody.

然後，當我們進入目前的測量年時，想想我們現在在 2025 年所做的會影響 2028 年的活動。我們現在有一整年的跑道，我們有能力為我們的目標提供更多的緩衝或更多的緩衝。因此，我們以全年的努力和狀態迎接新的一年，心情會更好。這也正是我們想要傳達給大家的。

George, is there anything -- I was worried there --

喬治，有什麼事嗎——我很擔心。--

No, that's okay, Jim. I would just add to that, A.J., that we saw that a lot of the new things we tested in the fourth quarter of last year delivered the results we were looking for. We saw great progress from the outreach we did to our members. We saw great progress of our teams working with our providers through various means to help our providers close gaps in care. And we also have seen great progress in our working with our vendor relationships.

不，沒關係，吉姆。我只想補充一點，A.J.，我們發現去年第四季度測試的許多新事物都產生了我們所期望的結果。我們在與會員的接觸過程中看到了巨大的進步。我們看到我們的團隊透過各種方式與供應商合作，幫助供應商縮小護理差距，並取得了巨大進展。我們與供應商的關係也取得了巨大進展。

So on every front that we talked about back in October, even before that, when we had our Stars call, we have made significant progress and feel very good about that progress. As Jim said, though, we are taking a very prudent approach to how we think about setting our thresholds and targets in the future and have set them in a way to have them be a significant stretch to our organization to push them to continue to excel. And so that's the reason for some of the caution you're hearing and that we are pushing our teams. We've seen great progress and feel good about where we stand right now.

因此，在我們 10 月談到的每個方面，甚至在那之前，當我們召開 Stars 會議時，我們都取得了重大進展，並且對這些進展感到非常滿意。然而，正如吉姆所說，我們在思考如何設定未來的門檻和目標時採取了非常謹慎的態度，並以某種方式設定它們，使它們對我們的組織具有重大的延伸作用，推動他們繼續追求卓越。這就是你們聽到的一些警告以及我們正在推動我們的團隊前進的原因。我們看到了巨大的進步，對目前所處的狀態感到很滿意。

Ben Hendrix, RBC Capital Markets.

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

You discussed in your prepared remarks higher than expected. D-SNP attrition for the year and caution around change in SEP rules. And I was wondering if you could provide some more detail around how you're thinking about the range of outcomes there? And then by extension, how is the attrition you saw in the SEP in that population kind of impacting or informing your MCR guidance range?

您在準備好的發言中討論的內容超出了預期。D-SNP 今年的人員流失以及對 SEP 規則變化的警惕。我想知道您是否可以提供一些更詳細的信息，說明您如何看待那裡的一系列結果？然後進一步說，您在 SEP 中看到的該人群的流失如何影響或告知您的 MCR 指導範圍？

I'll start, and then maybe Celeste can add on the benefit ratio. So look, first of all, we are pleased with the outcomes of our AEP given the members we gained versus those we lost. We have seen that our pricing strategy worked and that we are retaining members that are on path to necessary margin recovery and expansion that is critical to the point that Jim made before. We are seeing members that have a shift to higher lifetime value segments in membership. We're seeing strong performance to date in markets with a strong concentration of our best value-based partners, including states like Florida, Illinois and Texas. We are seeing higher than historical percentage of our non-SNP, our core members, sales coming from member switching from our competitor MA plans. And as Jim mentioned, we're seeing continued shift to our higher-value distribution channels. So all those things feel good in our pricing strategy.

我先開始，然後也許 Celeste 可以添加福利比率。首先，考慮到我們獲得的成員數量與失去的成員數量，我們對 AEP 的結果感到滿意。我們已經看到我們的定價策略是有效的，而且我們正在留住那些正在進行必要的利潤恢復和擴張的會員，這對吉姆之前提出的觀點至關重要。我們看到會員已經轉向終身價值較高的會員細分市場。迄今為止，我們在最有價值的合作夥伴高度集中的市場中表現強勁，包括佛羅裡達州、伊利諾伊州和德克薩斯州等州。我們發現，我們非 SNP 的核心會員銷售額中，有高於歷史百分比的銷售額來自於我們競爭對手 MA 計劃的會員轉換。正如吉姆所提到的，我們看到客戶正在持續轉向更高價值的分銷管道。因此，所有這些因素都對我們的定價策略有利。

However, as you point out, we retained fewer members than we expected in our dual products. There's a lot to be learned there and we are learning from that. We have a number of pilots in the AEP that will help us progress towards our strategies moving forward and helping our D-SNP repricing, as Jim has called out. I would also add that when you think about the dual product, don't disconnect that from the very exciting success we've had in Medicaid RFPs. With the recent wins we've had in Georgia and Texas, that takes us to 13 states. And as I think you all are aware, the connection between Medicare and Medicaid is growing stronger and the integration of the rules that are coming out. And so having a larger Medicaid footprint successfully implementing those states will also help us going into the future. So while we've retained fewer members than we expected, we feel good about how we're set up for the future.

然而，正如您所指出的，我們在雙重產品中保留的會員數量少於我們的預期。那裡有很多東西需要學習，我們正在從中學習。正如 Jim 所說，我們在 AEP 中有許多試點，它們將幫助我們推進未來的策略，並幫助我們的 D-SNP 重新定價。我還要補充一點，當您考慮雙重產品時，不要將其與我們在 Medicaid RFP 中取得的令人振奮的成功脫節。加上我們最近在喬治亞州和德克薩斯州的勝利，我們的勝利州已經達到 13 個。我想大家都知道，醫療保險和醫療補助之間的關聯越來越緊密，規則的整合也越來越緊密。因此，在這些州成功實施更大的醫療補助覆蓋範圍也將有助於我們走向未來。因此，儘管我們保留的會員數量比預期要少，但我們對未來的發展感到滿意。

Thanks, George. Just to come back to what I had said earlier on the benefit ratio. So the majority of the improvement that the underlying improvement is from plan exits. But if you recall, we deliberately exited unprofitable plans. So additional D-SNP losses helps on the margin, but most of the underlying benefit improvement was something we did very intentionally. And then we also made some adjustments to benefits in our remaining plans. So the improvements are very intentional. Just one thing I wanted to add to George's comments on D-SNP is 30,000 of the D-SNP losses were due to redeterminations. As you know, the way each state did what varies from state to state. So about 30,000 was included in that number.

謝謝，喬治。回到我之前所說的關於福利比率的問題。因此，大部分的改進，即潛在的改進都來自於計劃的退出。但如果你還記得的話，我們故意退出了無利可圖的計畫。因此，額外的 D-SNP 損失在邊際上有所幫助，但大部分潛在的福利改善是我們有意為之的。然後我們也對剩餘計畫的福利做了一些調整。所以這些改進是經過深思熟慮的。我只想補充一點，關於喬治對 D-SNP 的評論，D-SNP 的 30,000 個損失是由於重新確定造成的。正如你們所知，每個州的做法都有所不同。因此，該數字中包含了約 30,000 人。

Whit Mayo, Leerink Partners.

惠特·梅奧（Whit Mayo），Leerink Partners 合夥人。

I may have missed this, but just wanted to get an update on expectations for Part D seasonality this year, given all the changes this year and the higher deductibles that we see in the market. So just any observations would be helpful.

我可能錯過了這一點，但只是想了解今年 D 部分季節性的預期更新，考慮到今年的所有變化以及我們在市場上看到的更高的免賠額。因此任何觀察都會有幫助。

Whit, it's George. So as we think about our PDP strategy, we are pricing for margin given the additional risk of IRA. And we've taken a very disciplined approach to how we're pricing that given that increased planned liability. As you know, we're participating in the premium stabilization demonstration, and we are expecting to see growth of roughly 200,000 members versus our prior expectation of flat. There are a number of competitive dynamics that are driving that increase, including a number of plans available in '25. Of course, the premium stabilization demonstration has an impact on that. And we've maintained strong relationships with our brokers.

惠特，我是喬治。因此，當我們考慮我們的 PDP 策略時，我們會考慮到 IRA 的額外風險來為保證金定價。考慮到計劃負債的增加，我們對定價採取了非常嚴謹的方法。如您所知，我們正在參與保費穩定示範，我們預計會員數量將增長約 200,000 名，而我們之前預期的是持平。推動這一增長的有多種競爭動力，其中包括'25 年推出的多項計劃。當然，保費穩定示範對此有影響。我們與經紀人保持良好的關係。

We feel good, though, about the way we price the product. While we price for margin, we're taking a measured approach in our assumptions to our guidance, given the IRA changes and given the uncertainty there. We are monitoring throughout the year. The most recent data given that Part D and MAPD does complete more quickly in the drug space. We don't see any problems there at this point. We see that the current data supports our pricing strategy and tactics that we've taken.

不過，我們對產品的定價方式感到滿意。雖然我們根據保證金定價，但考慮到 IRA 的變化及其不確定性，我們對我們的指導假設採取了審慎的態度。我們全年都在監測。最新數據顯示，D 部分和 MAPD 在藥物領域確實完成得更快。目前我們沒有發現任何問題。我們看到當前數據支持我們採取的定價策略和策略。

Yes. And just to add to that in terms of seasonality, and I'll address the seasonality in our guidance in general since the IRA is the biggest piece of it.

是的。就季節性而言，我只是想補充一點，我將在我們的整體指導中解決季節性問題，因為 IRA 是其中最大的一部分。

So first, to remind you, our -- we expect 60% to 65% of our earnings in the first quarter which is a significant shift from last year and prior periods. And there are really four key drivers of that.

首先，提醒您，我們預計第一季的收益將達到 60％至 65％，這與去年和之前的時期相比有顯著變化。事實上，有四個關鍵驅動因素。

First, are the IRI changes, which shift more responsibility to the plan but seasonality also changes because members are working through their MOOP earlier in the year and planned liability increases as the year progress -- progresses versus CMS reinsurance kicking in, in the back half of the year like in 2024.

首先是 IRI 的變化，它將更多的責任轉移到計劃上，但季節性也會發生變化，因為成員們在年初就開始處理他們的 MOOP，並且隨著時間的推移，計劃的責任會增加——與 CMS 再保險在下半年（比如 2024 年）開始生效相比，這一變化在 2024 年有所增加。

Second is planned benefit design changes, including the addition of deductibles that were made in line with the focus of driving sustainable long-term membership growth. In both the cases of the first and the second, the member bears more expense in the beginning of the year, and we bear more expense in the end of the year, shifting earnings more towards the front of the year.

第二是計畫中的福利設計變更，包括增加免賠額，這些變更都符合推動永續長期會員成長的重點。在第一種和第二種情況下，會員在年初承擔更多的費用，而在年底承擔更多的費用，將更多的收入轉移到年初。

There are two more drivers, which are less impactful. One, and I called this out earlier, is the change in the number of days and how they fall on the calendar, including the leap year in 2024. And then finally, the timing of when we expect to make the investments we mentioned previously.

還有兩個驅動因素，影響較小。一是，我之前提到過，日曆上的天數和日期排列方式發生了變化，包括 2024 年的閏年。最後，我們預計進行先前提到的投資的時間。

Erin Wright, Morgan Stanley.

摩根士丹利的艾琳·賴特。

You touched on this a few times during the call, so I want to circle back in terms of digging into a little bit more. But in light of that CMS push for further integration, across Medicare and Medicaid and to service that D-SNP population by 2030. There are some certain requirements by 2027 as well. How do you think about your positioning at this point?

您在通話中多次提到了這一點，所以我想再回過頭來進一步深入探討。但鑑於 CMS 推動進一步整合醫療保險和醫療補助計劃，並在 2030 年之前為 D-SNP 族群提供服務。到 2027 年也有一些特定的要求。您覺得目前自己的定位是怎麼樣的？

And kind of in that spirit of being proactive and looking ahead, how do you think about that in light of your Medicaid strategy? And do any of these efforts, whether it's Stars litigation cost savings, other initiatives detract at all from your efforts on that front?

本著積極主動和展望未來的精神，您如何根據醫療補助策略考慮這個問題？這些努力，無論是 Stars 訴訟成本節省還是其他舉措，是否會削弱您在這方面的努力？

Erin, thank you for the question. As we think about the further integration of Medicare and Medicaid, as I said, the impressive win rate that our Medicaid team has had and increasing our footprint is really in line with our plans as we go out as we think towards 2030. As we've talked about before, we have a five-year plan that we started last year that carries us almost to that same period. And we are progressing very nicely along the trajectory that we expected in warning Medicaid states and increasing that footprint for that future integration.

艾琳，謝謝你的提問。當我們考慮醫療保險和醫療補助的進一步整合時，正如我所說，我們的醫療補助團隊所取得的令人印象深刻的勝率以及我們不斷擴大的影響力，確實符合我們面向 2030 年的計劃。正如我們之前談到的，我們有一個五年計劃，從去年開始實施，幾乎可以把我們帶到同一個時期。我們在警告醫療補助各州和增加未來整合影響力方面正按照預期的軌跡順利進展。

Do keep in mind, though, that the integration applies only to those states who have moved forward with HIDE and FIDE SNPs. And so when you think about that, that is almost half the states are in that bucket. So just keep that in mind as you're thinking about the Medicaid and Medicare integration rules and how they apply.

但請記住，整合僅適用於那些已經推進 HIDE 和 FIDE SNPs 的州。所以，當您考慮這一點時，您會發現幾乎有一半的州都屬於這一類。因此，當您考慮醫療補助和醫療保險整合規則及其應用方式時，請記住這一點。

One of the things we're paying a lot of attention to as we are selectively choosing which states to participate in what states to submit RFP responses, is we're making sure that we are looking at where our current duals are not just where our dual SNP members are, but also where duals exist in our core underlining products, you have to look at both. And as we're doing so, we are making sure and we're ensuring that we are prioritizing those states and that we will continue to cover the dual membership that is necessary to protect our margins and depict our growth going forward.

當我們有選擇地選擇哪些州參與以及在哪些州提交 RFP 響應時，我們非常關注的事情之一是，我們要確保不僅關注我們當前的雙重 SNP 成員的位置，還關注我們核心基礎產品中存在雙重的位置，你必須同時關注兩者。在這樣做的同時，我們要確保優先考慮這些州，並確保我們將繼續涵蓋必要的雙重會員資格，以保護我們的利潤並描繪我們未來的成長。

Yes, I just want to come back to your question about creating capacity and the way I think about it, and these are all tied together in terms of our ability to deliver for shareholders, is we need to do better on the clinical side and reduce operating cost to, one, invest in our membership. So we continue to grow profitable long-term membership. Two, invest in Stars and they're not in any particular order. Three, invest in our Medicaid growth, as you probably read in our prepared remarks, there is a J-curve associated with the business. There are -- the initial years, we are -- they are a drag on our earnings. So we need to make sure that we can do that. And then four, is to invest in growth in CenterWell, which we believe is better for our members.

是的，我只是想回到你關於創造能力的問題以及我對此的看法，這些都是與我們為股東提供服務的能力緊密相連的，我們需要在臨床方面做得更好，降低運營成本，首先，投資於我們的會員資格。因此，我們將繼續增加有利可圖的長期會員數量。二、投資明星，不分先後順序。第三，投資我們的醫療補助成長，正如您可能在我們準備好的評論中讀到的那樣，該業務存在一條 J 曲線。在最初的幾年裡，它們對我們的收入造成了拖累。所以我們需要確保我們能夠做到這一點。第四，投資於 CenterWell 的發展，我們相信這對我們的會員更有利。

All of these things are better for our members. So we really need to think about are the things we are doing getting us to one of those four things. And they're tied to Jim's levers as well.

所有這些事情對我們的成員來說都是更好的。所以我們真正需要思考的是，我們正在做的事情是否能夠讓我們實現這四件事之一。而且它們也和吉姆的槓桿緊密相關。

Scott Fidel, Stephens.

史考特菲德爾、史蒂芬斯。

I was hoping to get maybe a little more visibility or insight just into the Medicaid margin trajectory and sort of how that's flowing from '24 into '25. I know that you were expecting Medicaid margins to be at a loss in '24. Just curious, maybe you could give us a little more pinpointing on sort of where that sort of negative pretax margin percentage was in '25?

我希望能夠對醫療補助利潤軌跡以及其從 24 年到 25 年的變化有更清晰的了解或洞察。我知道您預計 24 年醫療補助利潤將會虧損。只是好奇，也許您可以給我們更準確地指出 25 年這種負稅前利潤率百分比是多少？

And then how you're thinking about -- I think in the prepared remarks, you commented on some incremental improvement, but curious on whether you think the business will get to profitability in '25 or still stay in that negative margin area?

然後您是如何考慮的——我想在準備好的評論中，您評論了一些漸進式的改進，但好奇的是，您是否認為該業務將在 25 年實現盈利，還是仍然停留在負利潤區域？

And then if I could just sneak a quick follow-up in as well. Just would love an update just on sort of what you saw in the fourth quarter as it relates to specialty Rx trends. I know that's been sort of a key area of pressure. And specifically, just around the oncology drugs, which I know have been a key area of focus. Sort of how you saw that playing out exiting the fourth quarter?

然後我是否可以偷偷快速跟進。只是想了解您在第四季度看到的最新情況，因為它與專業 Rx 趨勢有關。我知道這一直是關鍵的壓力領域。具體來說，就腫瘤藥物而言，我知道這一直是一個重點關注的領域。您如何看待第四節比賽的進展？

Scott. So I'll start with the Medicaid and then others can add in. Jim, I think we'll pick up from there.

斯科特。因此，我將從醫療補助開始，然後其他人可以添加。吉姆，我想我們會從那裡開始。

Look, the Medicaid business, given all these wins and the strength of our progress there, Medicaid is emerging as a strong scale business with meaningful earnings potential as we look forward. 2024, as you mentioned, did come in line with our expectations, and we feel good about how we ended 2024. What we're seeing as you think about '25 is we are going to see roughly 175,000, to 250,000 member growth in the Medicaid block of business. That's going to come. Split, if you think about it that way, between Virginia, which is a new state that we're implementing in the summer of this year, at least that's when we're expected to, given the state's recent discussions with us. And then we also are expecting an additional allocation of members from Kentucky.

你看，醫療補助業務，鑑於我們在那裡取得的所有這些勝利和進展，醫療補助正在成為一項規模強大的業務，具有可觀的盈利潛力。正如您所說，2024 年確實符合我們的預期，我們對 2024 年的結束感到滿意。展望 25 年，我們看到醫療補助業務板塊的會員數量將增加約 175,000 至 250,000 名。那將會發生。如果您這樣想的話，那麼維吉尼亞州是我們在今年夏天實施的新州，至少根據該州最近與我們的討論，我們預計會在那時實施。然後我們還期待來自肯塔基州的額外成員分配。

So with that, we do expect some modest improvements in margin. But as we've talked about and as Celeste mentioned the J-curve, currently, 45% of our members in 2025 are in states with less than three years of experience. So there's still maturity to do there, and we are making good progress down that maturation line as you think about our margin recoveries in that line of business.

因此，我們確實預計利潤率會略有改善。但正如我們所討論的以及 Celeste 所提到的 J 曲線，目前，到 2025 年，我們 45% 的會員所在的州的經驗不足三年。因此，該領域仍有待成熟，正如您想到該業務領域的利潤率恢復那樣，我們在成熟方面取得了良好的進展。

Our most mature state, Florida is performing the expected margin that we would have for this business. So we have a proof point that not only is it our longest, but actually, it's our largest membership as well, has matured and is in the place that we expect it to be from a margin standpoint.

我們最成熟的州佛羅裡達州正在實現我們這項業務的預期利潤。因此，我們有證據表明，它不僅是我們歷史最長的會員組織，而且實際上也是我們會員最多的組織，並且已經成熟，從利潤率的角度來看，它已經達到了我們預期的水平。

The 2025 rates, roughly 75% of our revenue, we now know exactly what those rates will be for '25. There's an additional 25% that are in what is called the pre-draft state that we do not have total clarity to. So overall, we're feeling good about where we are. The states have been very collaborative in helping to ensure that rates meet the acuity of the membership and that -- those discussions are ongoing and are progressing well.

2025 年的利率約占我們收入的 75%，我們現在確切地知道 2025 年的利率是多少。另外 25％ 處於所謂的草案前狀態，我們對此還不完全清楚。總體而言，我們對目前的狀況感到滿意。各州一直積極合作，幫助確保利率符合會員國的要求，而且這些討論正在進行中，並且進展順利。

Yes, let me just hit the specialty drugs. This will be quick. The specialty drug spend, it looks very much the way it has looked for the last couple of quarters. It is elevated, it is relatively stable. We're going to talking about specialty drugs. My guess is for a long time in the industry, but we feel like where we have priced and forecasted is the right place given what we're seeing. So yes, elevated, stable and kind of within the range of expectations that we had.

是的，我只要打專科藥就可以了。這會很快。特種藥物支出的情況與過去幾季的情況非常相似。它是升高的，相對穩定。我們將要討論特種藥物。我猜測這個行業還需要很長一段時間，但根據我們所看到的情況，我們覺得我們的定價和預測是正確的。是的，水平有所提高，較為穩定，並且處於我們預期的範圍內。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

Maybe just a couple of follow-ups. One question on the 2025 guidance. Can you give us either a numerical or qualitative, I guess, commentary about specifically the trend outlook for '25 and how does it compare to what you had experienced in '24?

也許只是一些後續行動。關於 2025 年指導方針的一個問題。您能否給我們一個數字或定性的評論，具體關於 25 年的趨勢前景，以及它與您在 24 年經歷的相比如何？

And I guess the other piece of this equation waiting order. So I understand you want to see the final rate update there. But would you assume in your guidance? Do you assume something in that range of preliminary notice? Because I guess, historically, most of the time, final rate is embedded in proposal, but just kind of what are you assuming in your guidance for those two elements would be helpful.

我想這個等式的另一部分是等待訂單。所以我明白你想看到最終的利率更新。但是你會在你的指導中假設嗎？您是否假設在初步通知的範圍內有某事？因為我想，從歷史上看，大多數情況下，最終利率都包含在提案中，但您在指導中對這兩個要素的假設會有所幫助。

Yes. Let me try to tackle both of those real quick. On trends, we're really forecasting expecting kind of normalized trend in 2025, coming off of what was elevated trend in 2024. That's, I think, the kind of easiest and simplest way to describe it. And as of right now, it's obviously very early in the year. We're not seeing anything inconsistent with that. And -- but a lot of data will come in over the course of the next 60, 90 days.

是的。讓我試著快速解決這兩個問題。就趨勢而言，我們實際上預測 2025 年將出現正常化趨勢，而 2024 年的趨勢將有所提升。我認為，這是最簡單的描述方式。而截至目前，顯然還處於今年的初期。我們沒有發現任何與此不一致的情況。而且 — — 但在接下來的 60 到 90 天內將會有大量資料湧入。

On the rate notice. We're not going to do a lot of commentary on the rate notice at this time outside of the commentary that we submit to CMS. What I will simply note is that, yes, the rate notice can change from the preliminary to the final. That's part of the reason we don't want to spend a lot of time commenting on it. And when we look at the preliminary that is out there, we would say the retrospective portion of that notice reflects what we all saw in the industry over the course of the last year, 1.5 years, and the forward-looking is still an open question.

在費率通知上。除了我們提交給 CMS 的評論之外，我們目前不會對利率通知做太多評論。我只想簡單指出的是，是的，利率通知可以從初步的變成最終的。這就是我們不想花太多時間對此發表評論的原因之一。當我們查看現有的初步數據時，我們會說該通知的回顧部分反映了我們在過去一年半中看到該行業的情況，而前瞻性部分仍是一個懸而未決的問題。

There's a forward-looking component that, I think it's a forecast, but I think we would say it probably underestimates what forward-looking trend is likely to be. And so we are -- that's kind of how we think about it right now, and there's a lot more to develop over the course of the next few months.

其中有一個前瞻性的部分，我認為它是一個預測，但我認為我們會說它可能低估了前瞻性趨勢。所以，我們就是這樣的——這就是我們現在的想法，在接下來的幾個月裡還有很多事情需要開發。

George Hill, Deutsche Bank.

德意志銀行的喬治·希爾。

You guys have kind of gotten to a lot of the big picture stuff. I think I have a follow-up on Part D, which is, I guess, Jim, early, given that it's really near, are you seeing anything that's kind of changed your margin outlook, or expectation for Part D in '25?

你們已經對許多宏觀事物有了一定的了解。我想我對 D 部分有一個跟進，Jim，我想這是很早的事情，考慮到它真的很近，您是否看到任何改變您的利潤前景或對 25 年 D 部分的預期的事情？

And then kind of a follow-up is, are you guys doing anything more aggressive to manage the drug benefit in the B space, like trying to shift B drugs to de-coverage, such that you can do -- like shift financial responsibility a little bit to the government and to the manufacturers, and whether or not you're seeing any success there?

然後接下來的問題是，你們是否有採取更積極的措施來管理 B 類藥物福利，例如嘗試將 B 類藥物轉移到取消覆蓋範圍內，這樣你們就可以將財務責任稍微轉移給政府和製造商，你們在這方面是否取得了成功？

Hey, George. It's George. I'll take this. So the -- as I've mentioned, the early data that we have on our claims for Part D, which do process more quickly, seem to confirm our expectations for utilization that we would have with the pricing. Things look sustained on the specialty side, as Jim mentioned, and on the traditional pharmacy side, things are moving along just as we would have expected. So again, it's confirming our strategy and our tactics and how we price the product and how we priced our bids for this year. We feel good about where we are.

嘿，喬治。是喬治。我要這個。因此，正如我所提到的，我們關於 D 部分索賠的早期數據確實處理得更快，這似乎證實了我們對定價利用率的預期。正如吉姆所提到的，專業方面的情況看起來持續良好，而在傳統藥房方面，情況也正如我們預期的那樣進展。所以，這再次確認了我們的策略和策略以及我們如何為產品定價以及如何為今年的投標定價。我們對目前的狀況感到很滿意。

As far as a B2B strategy, that's not a level of detail that we'll go into. But we continue to look forward to the Part D product within our MAPD, and we're seeing good progress in the PDP realm.

就 B2B 戰略而言，我們不會深入討論這個細節。但是我們繼續期待 MAPD 中的 D 部分產品，並且我們看到 PDP 領域取得了良好的進展。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

You talked about margin pressure on group MA. Maybe just a little bit more detail there on what's specifically driving that? Is that more your strategy, competitor dynamics? And then I guess, how do we think about -- or how do you think about margin improvement in the group versus the slope of where you think you can get to an individual kind of into 2027 and beyond. And then just what is kind of included in guidance for 2025 on the group?

您談到了 MA 集團的利潤壓力。能否更詳細地介紹一下具體是什麼導致了這種情況？這是否更符合你的策略、競爭對手的動態？然後我想，我們如何看待——或者您如何看待集團利潤率的提高與您認為在 2027 年及以後可以達到的個體利潤率的斜率相比。那麼，2025 年該集團的指導方針中到底包含哪些內容呢？

Sure. I'll start, Ryan. The group product, we have roughly 0.5 million members there, slightly over that. In the group MA market, what I would say as opposed to the individual market is somewhat less mature as an industry. There was a period of time, not very long ago that we're still living in where the industry was continuing to evolve and mature and offered rate guarantee contracts for multiple years. Historically, those contracts, or the long-term contracts, were in place. That is beginning to change. We're seeing change in the industry. We're seeing change in the way plans are responding to RFPs coming from large groups, especially when you think about large jumbo groups. And that's changing, but that will take some time to flow through the financials.

當然。我先開始，瑞安。我們的團體產品有大約 50 萬名會員，略多於這個數字。在團體 MA 市場中，我想說與個人市場相比，該行業成熟度略低。不久前，我們仍處於這樣一個時期：這個行業不斷發展和成熟，並提供多年的利率保證合約。從歷史上看，這些合約或長期合約已經存在。但這種情況正在開始改變。我們看到這個行業正在改變。我們看到計劃對來自大型團體的 RFP 的響應方式正在發生變化，尤其是當你想到大型巨型團體時。這種情況正在改變，但需要一些時間才能在財務上反映出來。

We do expect margin improvement in 2026 through pricing actions as those long-term contracts come up for renewal. But we will see some more pressure in '25 that's built into our guidance for 25%.

隨著這些長期合約即將續簽，我們確實預計 2026 年利潤率將透過定價行動提高。但我們在 25 年將看到更多壓力，這已包含在我們 25% 的預期中。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Can you share the splits of the incremental Stars investments across the MLR and OpEx line? And secondly, do you have any updates on the Stars mitigation effort for 2026 in the event of an unfavorable lawsuit? I know you've discussed the possibility of crosswalking the group contract, but I don't think you've committed to that plan. So any clear actions that you can point us to on the mitigation front would be helpful?

能分享 MLR 和 OpEx 線上增量 Stars 投資的分割情況嗎？其次，如果發生不利的訴訟，您對 2026 年 Stars 的緩解措施有何更新？我知道你們已經討論過交叉團體合約的可能性，但我認為你們還沒有承諾實施該計劃。那麼，您能為我們指出緩解方面的任何明確行動嗎？

Andrew, it's Celeste. On the investments, we'll provide more color as the year progresses, both in terms of the -- where in the income statement will flow and the impact to the ratios. But we'll do that as the year progresses, depending on various tests and things like that, they may fall. That may move throughout the course of the year in terms of where they come in.

安德魯，我是塞萊斯特。關於投資，隨著時間的推移，我們將提供更多的細節，包括損益表中的流動情況以及對比率的影響。但隨著時間的推移，我們會這樣做，根據各種測試和諸如此類的事情，它們可能會下降。就他們的進入情況而言，這可能會在全年內發生變化。

Yes. On the group book, I'll hit that real quick. We are still assessing that. So we have not made a decision. That's not a decision that we need to make until really late summer or even early autumn. And so we have time. And depending on how a number of things play out, that could influence the final decision. So once we have gotten there, we'll be clear with folks, but we are not there yet.

是的。在小組書上，我很快就會講到這一點。我們仍在評估這一點。所以我們還沒有做出決定。我們要到夏末甚至初秋才需要做出這個決定。所以我們還有足夠的時間。而一系列事件的進展可能會影響最終的決定。所以，一旦我們到達那裡，我們就會向人們說明情況，但我們還沒有到達那裡。

Let me just shift to saying thank you to everybody for joining us this morning and for your interest in Humana. I also just want to thank the 65,000 associates that we have who are serving our members and patients every day. When we help our members and our patients get the right care at the right place with the right outcomes, everybody wins. And that is what we are working to do every day, and that is what our 65,000 associates are working to do every day. We appreciate your support, and we hope you have a great day. Thank you.

我只想對大家今天早上加入我們並對 Humana 的關注表示感謝。我還要感謝我們每天為會員和病患服務的 65,000 名員工。當我們幫助我們的會員和患者在正確的地方得到正確的護理並獲得正確的結果時，每個人都是贏家。這就是我們每天努力做的事情，也是我們 65,000 名員工每天努力做的事情。我們感謝您的支持，並祝福您有個愉快的一天。謝謝。

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。