Humana Inc (HUM) 2025 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.

您好，感謝您的耐心等待。歡迎參加Humana第三季財報電話會議。（操作人員指示）請注意，今天的會議正在錄音。

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

現在我將把會議交給投資者關係副總裁麗莎·斯托納。請繼續。

Thank you, and good morning. I hope everyone had a chance to review our press release and posted 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. Following these remarks, we will host a question-and-answer session, where Jim and Celeste will be joined by George Renaudin, Humana's President of the Insurance segment; and David Dintenfass, President of Enterprise Growth.

謝謝，早安。希望大家都有機會查看我們的新聞稿和發表的評論，這些內容都可以在我們的網站上找到。今天上午，我們將首先聽取 Humana 總裁兼執行長 Jim Rechtin 和財務長 Celeste Mellet 的簡短演講。在這些演講之後，我們將舉行問答環節，屆時吉姆和塞萊斯特將與 Humana 保險部門總裁喬治·雷諾丁和企業增長總裁大衛·丁滕法斯一起回答問題。

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.

在我們開始討論之前，我需要提醒各位通話參與者註意我們的警示聲明。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。實際結果可能與此有重大差異。

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 2025 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 in future filings or communications regarding our business or results.

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 2025 年第三季度收益新聞稿中討論的詳細風險因素，因為這些風險因素與前瞻性陳述有關，以及我們在向美國證券交易委員會提交的文件中討論的其他風險。我們不承擔在未來有關我們業務或業績的文件或通訊中公開回應或更新任何前瞻性陳述的義務。

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.

今天的新聞稿、我們以往的財務新聞稿以及我們向美國證券交易委員會提交的文件，都可以在我們的投資者關係網站上找到。電話會議參與者請注意，今天的討論包含不符合公認會計原則（GAAP）的財務指標。管理層對這些非GAAP指標的使用解釋以及GAAP與非GAAP財務指標的調節表已包含在今天的新聞稿中。本次電話會議中提及的每股盈餘或 EPS 均指稀釋後每股普通股盈餘。

Finally, the call is being recorded for replay purposes. That replay will be available on the Investor Relations page of our website, humana.com, later today.

最後，通話將會被錄音以備回放之用。今天晚些時候，您可以在我們網站 humana.com 的投資者關係頁面上觀看回放。

With that, I will turn the call over to Jim.

接下來，我將把電話交給吉姆。

Thanks, Lisa, and good morning, everyone, and thank you for joining us today. Before we get started, I just want to take a second to acknowledge the tragedy that occurred here in Louisville last night, it's had quite an impact on the community, and our thoughts go out to the community and all the families who are impacted.

謝謝麗莎，大家早安，謝謝各位今天收看我們的節目。在正式開始之前，我想花一點時間表達對路易斯維爾昨晚發生的悲劇的哀悼，這場悲劇對社區造成了相當大的影響，我們向受影響的社區和所有家庭致以慰問。

With that, let me turn to the quarter, and let me hit the headlines. As you have already seen, we delivered a solid third quarter in line with our expectations. Our third quarter medical cost trends continue to be in line with expectations, and we also continue to anticipate our full year 2025 EPS outlook of approximately $17. We remain committed to achieving individual MA pretax margin of at least 3% over time, and the external environment continues to evolve largely in line with expectations, and we are executing against our plan.

接下來，讓我轉到本季度，重點關註一下新聞頭條。正如您所看到的，我們第三季業績穩健，符合預期。我們第三季的醫療成本趨勢持續符合預期，我們也繼續預期 2025 年全年每股收益約為 17 美元。我們仍致力於實現個人 MA 稅前利潤率長期至少達到 3%，外部環境也持續按照預期發展，我們正在按計畫執行。

I'll now briefly describe the progress we are making operationally. And as usual, I will frame my comments today around the four drivers of our business. The first of those is product and experience, which drive customer retention and growth. Second is clinical excellence, which delivers clinical outcomes and medical margin. Third is highly efficient operations. And fourth is our capital allocation and growth in CenterWell and Medicaid. I'm going to spend most of my time today on product and experience as well as clinical excellence.

接下來我將簡要介紹我們在營運方面取得的進展。和往常一樣，我今天的演講將圍繞著我們業務的四個驅動因素。首先是產品和體驗，它們能夠促進客戶留存和成長。其次是臨床卓越性，它能帶來臨床結果和醫療利潤。第三點是高效率的營運。第四點是我們在 CenterWell 和 Medicaid 方面的資本配置和成長。今天我將把大部分時間花在產品和體驗以及臨床卓越性上。

Let me start with our Medicare product and experience. So first, I want to emphasize that it's very early in AEP. We have roughly two weeks of incomplete data. And while we will provide a sense of what we are seeing, this is very much subject to change.

讓我先從我們的醫療保險產品和經驗說起。首先，我想強調的是，現在還處於 AEP 的早期階段。我們大約有兩週的不完整數據。雖然我們會盡量描述我們所看到的情況，但這很可能會改變。

Second, I want to reinforce how we think about growth. Our focus is on maximizing customer lifetime value and customer NPV. That's our focus. The way we do that is delivering an exceptional experience that fuels member retention. Other key growth levers like benefit design and member and product mix and channel mix are all tightly aligned with our operational capacity so that we can absorb, onboard and serve members in a way that maximizes lifetime value in NPV.

其次，我想強調我們對成長的看法。我們的目標是最大化客戶終身價值和客戶淨現值。這是我們的重點。我們實現這一目標的方式是提供卓越的體驗，從而提高會員留存率。其他關鍵成長槓桿，如福利設計、會員和產品組合以及通路組合，都與我們的營運能力緊密相關，以便我們能夠以最大化淨現值終身價值的方式吸收、接納和服務會員。

Third, I want to reinforce again that we are confident in our pricing, and we're pleased that we expect to return to growth. We will take as much growth as possible from improved retention. This is unquestionably desirable growth, and we welcome new sales. However, we are prepared to take targeted actions to slow new sales if we reach the point where the volume risk is negatively impacting member experience.

第三，我想再次強調，我們對我們的定價充滿信心，我們很高興能夠恢復成長。我們將透過提高用戶留存率來實現盡可能多的成長。這無疑是令人欣喜的成長，我們歡迎新的銷售表現。但是，如果銷售風險對會員體驗產生負面影響，我們將採取有針對性的措施來減緩新銷售。

We do recognize that you want us to provide a specific growth target. We do not think that focusing on a net growth target is the right metric because as I just shared, growth through retention is desirable, and we will take as much of it as we can. We also will not give a specific number around new sales targets because the amount that we can absorb is dependent upon member product and channel mix.

我們明白您希望我們提供具體的成長目標。我們認為，專注於淨成長目標並不是一個合適的衡量標準，因為正如我剛才所說，透過留住客戶實現成長是可取的，我們將盡可能實現這一目標。我們也不願給出具體的銷售目標數字，因為我們能夠吸收的金額取決於會員產品和通路組合。

So now as to what we are seeing, new sales are at the high end of the range -- the high end of the anticipated range of outcomes that we expected in AEP. Channel mix has meaningfully improved relative to prior years. We have greater volume in our own distribution channel with select high-performing partners and in digital distribution.

所以現在我們看到的情況是，新銷售額處於預期範圍的高端——處於我們在 AEP 中預期結果範圍的高端。與往年相比，通路組合有了顯著改善。我們在自有分銷管道（包括精選的高績效合作夥伴）和數位分銷管道中擁有更大的銷售。

This channel mix tends to be correlated with customer segments that have a higher lifetime value and are more engaged. We are also seeing favorable product mix, including higher than initially expected sales in plans with 4 stars and greater. We are not seeing outsized sales in areas where competitors have exited plans. We are experiencing significantly reduced Humana plan-to-plan mix with plan-to-plan sales down year-over-year.

這種通路組合往往與終身價值更高、參與度更高的客戶群相關。我們也看到產品組合呈現良好態勢，其中 4 星以上星級產品的銷售量高於預期。我們並沒有看到競爭對手退出計畫的地區出現超額銷售。我們發現 Humana 的計畫組合大幅減少，計畫銷售額較去年同期下降。

We believe that this is likely an early indicator that our stable benefit strategy and changes to our customer service approach are working to reduce voluntary attrition, though we need more time to validate this assumption. So while it's early, we feel good about what we are seeing so far in AEP. And as we have said previously, we will continue to monitor new sales volume and manage it dynamically. We are prepared to take further mitigating actions as we did heading into AEP if it appears that new sales will put member experience at risk.

我們認為這很可能是早期跡象，表明我們穩定的福利策略和客戶服務方式的改變正在有效降低員工自願離職率，儘管我們需要更多時間來驗證這個假設。雖然現在還為時過早，但我們對目前在 AEP 領域看到的情況感到滿意。正如我們之前所說，我們將繼續監控新增銷售並進行動態管理。如果新的銷售活動似乎會危及會員體驗，我們將像在 AEP 之前一樣，採取進一步的緩解措施。

We do recognize that there's a lot of interest in our overall growth strategy and the ongoing AEP. So I'm pleased that David Dintenfass will join Celeste, George and I for Q&A today. David joined the company nearly two years ago as President of Enterprise Growth. He came to Humana with 30 years of experience across a range of industries, including financial services, where he was focused on customer segmentation, acquisition, driving an experience that fuels retention to ultimately drive sustainable and profitable growth. David's consumer-focused experience and perspective has been and is instrumental to our journey to become a consumer healthcare company.

我們確實意識到大家對我們的整體成長策略和正在進行的年度經濟展望計劃 (AEP) 非常感興趣。所以我很高興大衛‧丁滕法斯今天能和賽萊斯特、喬治和我一起參加問答環節。David 於近兩年前加入公司，擔任企業成長總裁。他加入 Humana 之前擁有 30 年的跨行業經驗，包括金融服務業，專注於客戶細分、客戶獲取，致力於打造能夠促進客戶留存的體驗，最終實現可持續的盈利增長。David 以消費者為中心的經驗和視角，對我們成為消費者醫療保健公司的歷程起到了至關重要的作用。

Now to turn to clinical excellence, I will focus on Stars performance. Just to recap the key messages from our 8-K and audio file released in early October, we are disappointed but we are not surprised by our bonus year '27 Stars results. The results are consistent with our baseline planning scenario and our outlook remains the same as we previously communicated at our investor conference in June.

現在，為了更深入地探討臨床卓越性，我將重點放在 Stars 的表現。簡單回顧一下我們在 10 月初發布的 8-K 和音訊檔案中傳達的關鍵訊息：我們對 27 星獎勵年度的結果感到失望，但並不感到意外。結果與我們的基準規劃方案一致，我們的展望與我們在6月投資者大會上傳達的展望保持一致。

We did see operational gains in Q4 of 2024 that have continued into 2025, and we feel good about our operational progress this year. More specifically, in our current measurement year, bonus year '28, we are seeing meaningful year-over-year improvement across the vast majority of metrics. We also continue to see week-over-week improvement as recently as October, and we are showing 600,000 more gaps closed year-over-year as our momentum continues to remain steady.

我們在 2024 年第四季看到了營運方面的成長，並且這種成長勢頭一直延續到 2025 年，我們對今年的營運進展感到滿意。更具體地說，在我們目前的衡量年度（2028 年獎金年度），我們看到絕大多數指標都實現了顯著的同比改善。即使在 10 月份，我們也持續看到每週都有所改善，而且與去年同期相比，我們減少了 60 萬個缺口，我們的成長勢頭依然保持穩定。

Given the Stars program is measured on a curve, it would not be prudent to share additional results at this time. However, once the hybrid season is complete in the second quarter of next year, we will provide some additional visibility into our final operating results. However, we will not speculate on thresholds. All in, the takeaway remains that we continue to be confident that we are on the right track to return to Top Quartile Stars results in bonus year '28.

鑑於「明星計畫」的衡量標準是曲線式的，目前分享更多結果並不明智。然而，一旦混合營運季在明年第二季結束，我們將提供更多關於我們最終營運結果的資訊。但是，我們不會對閾值進行推測。總而言之，我們仍然有信心，我們正走在正確的道路上，在 2028 年獎金年度重返頂級明星行列。

Now, I'm going to turn to our highly efficient operations where we are making meaningful progress. I'm going to share a couple of examples. We recently partnered with Genpact to outsource elements of our finance capabilities. This will both improve our capabilities and it will reduce cost. We also have a newly introduced agentic AI platform, which is helping deliver capabilities like Agent Assist that help our call center advocates and agents focus on supporting our members. This is helping to improve call accuracy and deliver faster response times, which drive better outcomes and experience.

現在，我要談談我們高效的運營，我們在這方面取得了實質進展。我來分享幾個例子。我們最近與 Genpact 建立了合作關係，將部分財務能力外包出去。這既能提升我們的能力，又能降低成本。我們還新推出了智慧代理 AI 平台，有助於提供諸如代理助理之類的功能，幫助我們的呼叫中心客服人員和代理商專注於為我們的會員提供支援。這有助於提高通話準確度並加快回應速度，從而帶來更好的結果和體驗。

Collectively, we expect these items to generate greater than $100 million of savings over a few years while also improving the quality of our operations. These changes are a small sample of our multiyear transformation, which will include near-term tactical cost programs, but also longer-term efforts that change how we operate.

我們預計這些措施將在幾年內節省超過 1 億美元，同時提高我們的營運品質。這些變化只是我們多年轉型計畫的一小部分，該計畫將包括近期戰術性成本控制方案，以及改變我們營運方式的長期舉措。

Now, turning to capital allocation. We have freed up capital by selling a non-core asset, the Enclara Pharmacia business and are working to sell additional non-core assets. We also agreed to deploy capital to a deal that is expected to close this month in Florida, The Villages Health, which provides primary and specialty care services at the fastest-growing retirement community in the country. We also continue to feel good about our CenterWell Pharmacy strategies. We continue to develop our direct-to-consumer capability, and we are also moving into direct-to-employer opportunities.

現在，我們來談談資本配置。我們透過出售非核心資產——Enclara Pharmacia 業務——釋放了資金，並且正在努力出售其他非核心資產。我們也同意向佛羅裡達州的 The Villages Health 投資，預計本月將完成一筆交易。 The Villages Health 為美國發展最快的退休社區提供初級和專科護理服務。我們對 CenterWell Pharmacy 的策略依然充滿信心。我們將持續發展直接面向消費者的能力，同時也進軍直接面向雇主的市場。

So in conclusion, we are pleased with our solid performance year-to-date, and we continue to have confidence in the full year 2025 outlook. We feel good about our pricing and the outlook for AEP 2026. Bonus Year '27 Stars results were disappointing but consistent with our expectations and the outlook for Bonus Year '28 Stars continues to trend in the right direction, and we remain confident in a return to top quartile results.

總之，我們對今年迄今的穩健業績感到滿意，並且對2025年全年前景依然充滿信心。我們對我們的定價和2026年AEP的前景感到滿意。2027 年獎勵年度的 Stars 成績令人失望，但符合我們的預期，2028 年獎勵年度 Stars 的前景繼續朝著正確的方向發展，我們仍然有信心重返前四分之一的成績。

With that, I will turn it over to Celeste for a few remarks before we go to Q&A.

接下來，我將把發言權交給 Celeste，請她簡單說幾句，然後再進入問答環節。

Thank you, Jim. Our third quarter results reflect solid execution and underlying fundamentals, including membership and patient growth, revenue and medical cost trends that continue to develop consistent with our expectations.

謝謝你，吉姆。我們第三季的業績反映了穩健的執行和基本面，包括會員和病患成長、收入和醫療成本趨勢，這些都繼續按照我們的預期發展。

In addition, we experienced some favorability in the quarter, which enabled higher than previously anticipated investments. These investments were focused in areas that both accelerate our transformation and where we have seen strong returns to date, such as Stars and clinical excellence as well as in areas such as network management, which position us well for the future.

此外，本季我們也遇到了一些有利因素，使得我們能夠進行比之前預期更高的投資。這些投資主要集中在能夠加速我們轉型並迄今為止已獲得強勁回報的領域，例如星級評定和臨床卓越性，以及網路管理等領域，這些都使我們為未來做好了充分準備。

We are pleased that our year-to-date performance and outlook support reaffirmation of our full year adjusted EPS outlook of approximately $17, while also making an additional approximately $150 million in incremental investments, including the higher investments in the third quarter. As a reminder, we included the Doc Fix in our guidance for '25. If it is not implemented for '25, we may invest all or a portion of the onetime savings into items that position the company for long-term success.

我們很高興今年迄今的業績和展望支持我們重申全年調整後每股收益預期約為 17 美元，同時還追加了約 1.5 億美元的增量投資，其中包括第三季度的較高投資。再次提醒，我們在 2025 年的指導方針中加入了 Doc Fix。如果到 2025 年未能實施，我們可能會將全部或部分一次性節省的資金投資於能夠使公司長期成功的專案。

Now, turning to the balance sheet and capital deployment. I would first like to comment briefly on the days in claims payable or DCP metric. Our DCP changes, both sequentially and year-over-year were largely driven by items that are generally timing in nature and not related to claim reserve levels, including changes in processed claims inventory and provider payables.

現在，讓我們來看看資產負債表和資本部署情況。首先，我想簡單評論一下應付索賠天數或DCP指標。我們的 DCP 變化，無論是環比變化還是同比變化，主要受一些時間因素驅動，與索賠準備金水準無關，包括已處理索賠庫存和供應商應付金額的變化。

And as previously discussed, the year-over-year comparison was further impacted by changes related to the Inflation Reduction Act. Importantly, the estimate for claims Incurred But Not Reported, or IBNR, remain largely consistent in these periods, even with our year-over-year decline in individual MA membership. As we have previously shared, we believe this serves as a better indicator of the consistency in our reserve methodology and the relative strength of our claims reserves.

正如之前討論的那樣，同比數據也受到與《通貨膨脹削減法案》相關的變化的影響。重要的是，即使個人醫療保險會員人數逐年下降，已發生但未報告的索賠（IBNR）的估計值在這些時期內仍然基本保持一致。正如我們之前分享的那樣，我們認為這更能反映我們準備金方法的一致性以及我們理賠準備金的相對實力。

Now, moving to our ongoing efforts to increase the efficiency of our balance sheet. As Jim mentioned, we completed an asset sale during the third quarter and are continuing to pursue the sale of additional non-core assets while also making significant progress on capital optimization, the details of which we will share when we complete the execution.

接下來，我們將討論為提高資產負債表效率而正在進行的各項工作。正如吉姆所提到的，我們在第三季完成了一項資產出售，並且正在繼續尋求出售其他非核心資產，同時在資本優化方面也取得了重大進展，我們將在完成執行後分享相關細節。

With respect to capital deployment, we will remain prudent in our near-term approach, taking a balanced view to evaluating capital investments and returns. Accordingly, our '25 outlook does not contemplate additional share repurchase activity beyond the buybacks in the second quarter, which offset dilution from stock-based compensation.

在資本部署方面，我們將保持謹慎的近期策略，對資本投資和回報採取平衡的評估方式。因此，我們的 2025 年展望並未考慮在第二季度回購股票（抵消了股票選擇權激勵措施造成的稀釋）之外的額外股票回購活動。

From an M&A perspective, we see significant opportunities to take advantage of the current market dislocation and acquire attractive small to midsized provider businesses, such as our pending acquisition of The Villages Health, while remaining focused on managing our debt-to-cap ratio. Our debt-to-cap ratio at the end of the quarter was 40.3%, down from 40.7% as of June 30, and we continue to target a ratio of approximately 40% over the longer term.

從併購的角度來看，我們看到了利用當前市場錯位收購有吸引力的中小型醫療服務提供者的巨大機會，例如我們正在進行的對 The Villages Health 的收購，同時繼續專注於管理我們的債務資本比率。本季末，我們的負債資本比率為 40.3%，低於 6 月 30 日的 40.7%，我們將繼續以長期目標為目標，將比率維持在 40% 左右。

Looking ahead, I echo Jim's message that we feel good about our '26 pricing and the outlook for AEP. In addition, we are executing on the plan that we laid out at our Investor Day in June, managing the levers within our control with a focus on delivering best-in-class clinical excellence, transforming the company to enable scalable growth and driving enhanced operating leverage. We believe that these efforts will allow us to return the business to its full earnings power while driving better outcomes and experiences for our members, patients and associates.

展望未來，我同意吉姆的觀點，我們對 2026 年的定價和 AEP 的前景感到樂觀。此外，我們正在執行我們在 6 月份投資者日上製定的計劃，管理我們可控範圍內的各種因素，專注於提供一流的臨床卓越性，改造公司以實現可擴展的增長，並推動增強的營運槓桿。我們相信，這些努力將使公司恢復到全部獲利能力，同時為我們的會員、病患和員工帶來更好的結果和體驗。

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

接下來，我將把電話轉回給麗莎，讓她開始問答環節。

Thanks, 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. Operator, please introduce the first caller.

謝謝你，塞萊斯特。在開始問答環節之前，為了公平起見，請排隊等候的各位盡量只提一個問題。接線員，請介紹第一位來電者。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

I understand that it's too early to share any membership growth projections, but I was hoping you'd be able to offer a framework for the level of new growth that you're comfortable with before it starts to impact your operational capacity. And based on your prepared remarks, are you already starting to pull some of those levers you mentioned?

我知道現在分享任何會員成長預測還為時過早，但我希望您能提供一個框架，說明在新成長開始影響您的營運能力之前，您能夠接受的成長水平是多少。根據你事先準備好的發言稿，你是否已經開始採取你提到的那些措施了？

So this is David Dintenfass. First of all, it's good to be on my first Humana earnings call, I'm really glad to be part of this team. So Andrew, let me just take a step back and I'll answer your question, but let me just make sure the approach to growth is really clear, and Jim touched on this. Our focus is increasingly on the lifetime value and NPV of our membership. And so growth is an outcome of that, but also our current membership and retaining them is a primary objective.

這位是戴維·丁滕法斯。首先，很高興能參加我的第一次 Humana 財報電話會議，我真的很高興能成為這個團隊的一員。安德魯，讓我先退一步，然後再回答你的問題。但我想先確保成長的方法非常明確，吉姆也談到了這一點。我們越來越重視會員的終身價值和淨現值。因此，成長是這個過程的結果，但同時，我們現有的會員數量以及留住現有會員也是我們的首要目標。

How do we do that? How do we drive lifetime value and our margin objectives that we shared at Investor Day? So number one, we have to have appropriate pricing. We have to price for risk, and that is a very collaborative process working with underwriting.

我們該如何做到這一點？我們如何實現投資者日上提出的客戶終身價值和利潤率目標？所以，首先，我們必須制定合理的價格。我們必須對風險進行定價，這是一個與核保部門密切合作的過程。

It goes to number two, which is that there's been a bit of a cycle, right, which is why there's all this question about is growth good or is growth not good. And that really comes from an approach that says, we're going to grow on plans that, frankly, don't have a very attractive margin. They're attractive for the customer. We bring them in and then those plans can degrade over time.

這就引出了第二點，那就是經濟成長經歷了一個週期，對吧？所以才會有各種關於成長是好是壞的問題。這其實源自於這樣一種理念：我們要在利潤率並不十分誘人的計劃上實現成長。它們對顧客很有吸引力。我們把這些計劃引入，但隨著時間的推移，這些計劃可能會逐漸失效。

The problem is if you overgrow in those low-margin plans, you say growth might not be good. We don't think that's the right long-term strategy. We know that our customers don't want their plans to be changing constantly. So instead, what we've done is try to stabilize the margin across all of our plans. So that no matter where growth might come from, that growth is attractive for the long term.

問題在於，如果你在這些低利潤計劃中過度擴張，那麼可以說成長可能並非好事。我們認為這不是正確的長期策略。我們知道客戶不希望他們的計劃經常改變。因此，我們採取的措施是努力穩定所有計劃的利潤率。因此，無論成長來自哪裡，這種成長從長遠來看都是有吸引力的。

That goes to number three, which is a focus on the customer. So increasingly, we're saying, how do we design our plans, and we're saying, let's start with what the customers most want, which is stability, especially on their core medical benefits, and we've tried to provide that this year. Now, this is in the context that we've had two years where we've been cutting benefits, and we've also exited markets where we didn't think the margin profile is where we needed to be. That's put us in a really good position this year to follow the customer and have more stability.

這就引出了第三點，以客戶為中心。因此，我們越來越傾向於思考如何設計我們的計劃，並表示，讓我們從客戶最想要的東西入手，那就是穩定性，尤其是在他們的核心醫療福利方面，而我們今年也努力提供了這種穩定性。現在，這是在我們過去兩年一直在削減福利，並且退出了我們認為利潤率達不到預期水平的市場這一背景下發生的。這讓我們今年處於非常有利的地位，能夠更好地滿足客戶需求，並擁有更大的穩定性。

And that goes to number four, the final part, which is what we talked about at Investor Day and Jim touched on as well, which is we need to differentiate the experience in the long term. Product is important, but it's only part of the equation. If we have products that have appropriate pricing for risk, then it's about attracting members, retaining them, getting to do all the things clinically and on Stars that drive true lifetime value.

這就引出了第四點，也是最後一部分，我們在投資人日上討論過，吉姆也提到過，那就是我們需要在長期內打造差異化的體驗。產品固然重要，但它只是成功的一部分。如果我們有定價合理的產品，那麼關鍵在於吸引會員、留住會員，讓他們能夠進行所有臨床活動和星級活動，從而創造真正的終身價值。

So with that approach, you asked how much growth can we handle from an operations perspective. We are working through that very dynamically. We're not sharing a number in part because we are working on operations. The principle we have is that, first of all, let's make sure that all of our members have a great outcome, and we're retaining them at a better rate. We committed to much better retention at Investor Day, and we are fully committed to make progress on that next year.

所以，按照這種方法，您問從營運角度來看，我們能夠承受多大的成長。我們正在非常積極地解決這個問題。我們不透露具體數字，部分原因是我們正在進行營運方面的工作。我們的原則是，首先要確保所有會員都能獲得良好的結果，並且要提高會員留存率。我們在投資者日承諾大幅提高員工留存率，並且我們完全致力於在明年在這方面取得進展。

But as far as new membership, we want to make sure that every new member comes in has a great experience as well and that we're able to retain them. And we're working very dynamically across all parts of the operation to make sure that we're balancing the new member growth through our ability to consume the volume.

但就新會員而言，我們希望確保每位新會員都能擁有良好的體驗，並且我們能夠留住他們。我們正在營運的各個環節進行非常動態的協調，以確保我們能夠平衡新會員的成長和我們消化新增會員數量的能力。

Ann Hynes, Mizuho.

安海恩斯，瑞穗。

I know you don't want to give a growth number for MA membership, but can you give an update on your diversification strategy? I know you're trying to shift some members out of H5216. Can you give us an update how that strategy is going?

我知道您不想透露MA會員成長的具體數字，但您能否介紹一下您的多元化策略的最新進展？我知道你正試圖將一些成員從 H5216 中轉移出去。能否向我們介紹一下該策略的進展？

Yeah. Let me touch on that. And I'm going to start by just being very clear about what our intent is around the diversification strategy. What we are trying to do, first and foremost, is deconsolidate 5216. So I think as many of you are aware, roughly 43% to 45% of our membership has been in 5216 over the last few years. That is putting too much risk in a single contract. We should be thinking about this from a portfolio standpoint. We should have a portfolio of contracts. We should have reasonably even membership across that portfolio so that if any one contract does not perform in a given year, there is less risk to the entire business.

是的。讓我談談這一點。首先，我要非常明確地說明我們多角化策略的意圖。我們首先要做的是拆分 5216。所以我想你們很多人都知道，在過去的幾年裡，我們大約有 43% 到 45% 的會員來自 5216 地區。這樣一來，單一合約就承擔了過大的風險。我們應該從投資組合的角度來考慮這個問題。我們應該有一個合約組合。我們應該確保投資組合中的成員構成相對均衡，這樣，即使某一年某個合約未能履行，對整個業務的風險也會降低。

So that is goal number one. And we feel good that we've taken a step in that direction. It's not something you can fully accomplish in a year, but we feel good that we have taken a step in that direction, and you should see us take incremental steps really over the next two or even three cycles of product.

這是第一個目標。我們很高興朝著這個方向邁出了一步。這不是一年內就能完全實現的事情，但我們很高興已經朝著這個方向邁出了一步，在接下來的兩到三個產品週期中，你們應該會看到我們逐步取得進展。

Along with that, as you deconsolidate 5216, of course, you're going to look to contracts where you have 4 and 4.5 stars to try to create that balance. And so that is what we have done this year. We've looked to some of our contracts that have 4 to 4.5 stars to create that balance.

同時，在拆分 5216 時，你當然會尋找那些擁有 4 星和 4.5 星的合同，以努力實現這種平衡。所以，這就是我們今年所做的工作。我們參考了一些評級為 4 到 4.5 星的合同，以達到這種平衡。

And right now, we feel good that we are making real progress. We are not at a place after two weeks of data that we're going to want to talk about numbers or get super specific about it. But this was always part of the plan, and we have made good progress from what we can see in the first couple of weeks, and we'll share more as we better understand what that is -- where that's going to land in January.

現在，我們感覺很好，因為我們正在取得實質進展。經過兩週的資料收集，我們目前還不想討論具體數字或進行非常具體的分析。但這始終是計劃的一部分，從前幾週的情況來看，我們已經取得了良好的進展，隨著我們對計劃的了解加深，我們會分享更多資訊——例如到一月份的最終結果。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Just a quick follow-up first. You talked about membership growth at the high end of expectations. Can you share with us what that expectation range is on new membership?

先簡單跟進一下。您談到會員成長達到了預期的高端水平。您能否和我們分享您對新會員的預期範圍？

And then my question is, can you give us an update on your percentage of MA individual membership in fully capitated agreements this year? And what do you expect it to be next year? And are you seeing any pushback from providers in terms of giving you these lives back because they're having economic issues making a margin on these benefits?

那麼我的問題是，您能否提供今年馬薩諸塞州個人會員完全按人頭付費協議的百分比？你預計明年會是什麼情況？你是否看到醫療服務提供者因為在這些福利項目上難以獲利而對恢復你的生活福利有所抵觸？

Yeah. Hey, Justin, let me hit the first half of that, and then I'm going to hand it to George for the second half of that. On the first half, and I know you expect this answer, but we're not going to give a number. I will just go back to why we're not going to give a number. We are truly looking at multiple things. We are looking at member mix. We are looking at product mix. We are looking at channel mix because each of those impact our operations in slightly different ways.

是的。嘿，賈斯汀，讓我來唱前半部分，然後把後半部分交給喬治。關於前半部分，我知道你們期待這個答案，但我們不會給出具體數字。我再重申我們不給具體數字的原因。我們確實在考慮多方面因素。我們正在研究成員組成。我們正在研究產品組合。我們正在研究渠道組合，因為每個渠道都會以略微不同的方式影響我們的營運。

We are also ramping up operations because that's what you do when you're headed into a solid growth year. And so we are looking at all of those dynamics, and we will make adjustments along the way based on the collective set of things that we're looking at.

我們也在加強營運力度，因為在即將迎來穩健成長的一年時，這是理所當然的。因此，我們正在研究所有這些動態因素，並將根據我們所觀察到的各種因素，隨時做出調整。

And when we say that we will make adjustments, we made adjustments going into AEP. I think people recognize that. There have been reports out on that fact. And we will continue to monitor in AEP, but we'll also be looking at, hey, do we want to think about OEP differently? Do we want to think about rest of year differently? So all those factors are in play, and it just makes it really hard to say, hey, here's a number at this point in time.

當我們說我們會做出調整時，我們在進入 AEP 階段時就做出了調整。我認為人們都意識到了這一點。已有相關報道流出。我們將繼續在 AEP 中進行監測，但我們也會考慮，嘿，我們是否想以不同的方式看待 OEP？我們是否想以不同的視角看待今年的剩餘時間？所以所有這些因素都在起作用，因此很難說，嘿，在這個時候，這是一個具體的數字。

With that, I'll hand it off to George.

這樣，我就把它交給喬治了。

Thanks, Jim. So we have taken measures such as taking Part D risk back where we saw the IRA shift cost in a very significant way. As David mentioned, we have been reducing benefits for two years to reset the product so that it is a product that we and our value-based partners want to grow. And so we've taken those actions.

謝謝你，吉姆。因此，我們採取了一些措施，例如將 D 部分風險收回，因為我們看到 IRA 的成本轉移非常顯著。正如大衛所提到的，我們兩年來一直在減少福利，以重新調整產品，使其成為我們和我們以價值為導向的合作夥伴都希望發展的產品。因此，我們採取了這些行動。

In addition to those two major actions, we're also -- because of the Stars program, we are also implementing Stars mitigation programs that mitigate the impact of the Stars revenue hit based upon their success and their performance in the Stars program.

除了這兩個主要措施之外，由於“明星計劃”，我們還在實施“明星計劃”緩解措施，以根據員工在“明星計劃”中的成功和表現來減輕“明星計劃”收入損失的影響。

So we are taking very specific mitigation tactics, working with our value-based partners, looking for ways to help mitigate any headwinds that they face, work with them every day. We are out in the field talking with them about contract changes that are necessary, and we feel good about the progress we're making there.

因此，我們正在採取非常具體的緩解策略，與我們以價值為導向的合作夥伴合作，尋找幫助他們減輕任何不利因素的方法，並每天與他們合作。我們正在實地與他們討論必要的合約變更，我們對目前的進展感到滿意。

So I would just remind you that we've taken actions in the past couple of years. We also, in addition to that, have a Stars mitigation program that's going on. So when you combine those factors, we feel good about where we are with the value-based partners.

所以我想提醒各位，過去幾年我們已經採取了一些行動。除此之外，我們還有一個正在進行的「星際災難緩解計畫」。綜合以上因素，我們對與這些以價值為導向的合作夥伴之間的關係感到滿意。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

And I know you're not providing 2026 guidance today clearly, but would love if you could give some initial thoughts on the type of margin that you'll assume for the new to Humana sales growth. Is it reasonable to think that, that would be comparable to the 2% roughly you're targeting ex the Stars headwind for the overall book? And then, obviously, I'm sure it's dependent on mix, but just based on what you know today.

我知道您目前還沒有明確提供 2026 年的業績指引，但如果您能就您預計 Humana 新客戶銷售成長的利潤率類型給出一些初步想法，我將不勝感激。認為這與您預計的扣除星隊不利因素後整體投注額的 2% 左右的目標相當，這種想法合理嗎？當然，這肯定取決於具體情況，但就目前所知而言，情況就是這樣。

Yeah. So as Jim said in the opening remarks, most importantly, we're on track for the plan we laid out at our Investor Day for 2028. And it is too early to provide guidance for 2026, particularly given where we are in AEP. As we think about the margin of the new members to some extent, it will be driven by which contracts they are sold on. So obviously, those that sell on to the 4, 4.5-star contracts will come in at a higher margin. But in aggregate, we continue to expect that our margin for individual MA, excluding Stars would double in 2026 over 2025, and then we'll continue to make progress in 2026.

是的。正如吉姆在開幕致詞中所說，最重要的是，我們正朝著我們在投資者日上製定的 2028 年計劃穩步前進。現在就對 2026 年做出指導還為時過早，特別是考慮到我們目前在 AEP 中的位置。當我們考慮新成員的利潤率時，在某種程度上，這將取決於他們被出售到哪些合約中。顯然，那些將球員賣給 4 星、4.5 星合約的球員，利潤會更高。但總體而言，我們仍然預計，2026 年個人 MA（不包括 Stars）的利潤率將比 2025 年翻一番，然後我們將在 2026 年繼續取得進展。

So it's going to be really, again, like how it comes in is a question of what contracts they're sitting on. But based on all the work we did going into AEP in terms of our product design and our channel mix, we are happy with the margin we're seeing and expect it to be relatively consistent with our overall margin, although some will be above and some will be below.

所以，最終結果如何，又取決於他們手邊有哪些合約。但根據我們在 AEP 之前在產品設計和通路組合方面所做的所有工作，我們對目前看到的利潤率感到滿意，並預計它將與我們的整體利潤率保持相對一致，儘管有些會高於整體利潤率，有些會低於整體利潤率。

Ben Hendrix, RBC Capital Markets.

Ben Hendrix，加拿大皇家銀行資本市場。

I was hoping to hear a little bit more about some of your Stars recovery efforts. You noted last month that the latest round of scores did not fully reflect some of the improvements that you've implemented. And now that we've seen how 5216 has performed across the member experience and chronic conditions measures. Can you talk a little bit about the measures or general categories where you feel like you've made the most tangible progress versus the latest data?

我原本希望能多了解一些關於你們星隊恢復工作的情況。您上個月提到，最新一輪的評分並沒有完全反映您實施的一些改進措施。現在我們已經了解了 5216 在會員體驗和慢性病指標的表現。您能否談談根據最新數據，您認為在哪些措施或總體類別中取得了最顯著的進展？

Yeah. So the operations in this current year are obviously focused on HEDIS and patient safety metrics. And as I kind of referred to in my opening remarks, we're actually seeing strong progress pretty much across the board in those metrics.

是的。因此，今年的營運顯然側重於 HEDIS 和病患安全指標。正如我在開場白中提到的，我們在這些指標上幾乎全面取得了顯著進展。

And look, again, we remain confident, optimistic, positive about the operating progress that we've made across those range of metrics and the position that will put us in next year as we obviously have another set of metrics that we have to work through in the first and second quarter of next year around CAHPS and HOS and the TTY metrics. So right now, based on the things that we can control this year, it's been broad improved performance that makes us feel good about our overall trajectory.

再次強調，我們對在各項指標上取得的營運進度以及明年我們將取得的成績仍然充滿信心、樂觀和積極，因為顯然，明年第一季和第二季我們還有另一組指標需要處理，例如 CAHPS、HOS 和 TTY 指標。所以就目前而言，基於我們今年能夠控制的因素，整體表現的全面提升讓我們對整體發展軌跡感到滿意。

Yeah, George, do you want to add?

喬治，你想補充什麼嗎？

Yeah. Jim, the only thing I would add to that is part of the strategy that David laid out is including the stability. Stability will also help us as we continue to make progress in our termination rates and as well as how our members perceive us through the experience we're delivering through stable benefits. So those are also positive factors to contribute to not just the administrative measures and the health outcome measures that Jim mentioned, but overall to the CAHPS as well.

是的。吉姆，我唯一要補充的是，大衛制定的策略之一是確保穩定性。穩定性也將幫助我們繼續降低終止率，並透過穩定的福利來提升會員對我們的認知。因此，這些因素不僅對吉姆提到的行政措施和健康結果指標有正面影響，而且對 CAHPS 整體也有正面影響。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

I guess you mentioned three things, I guess, that were giving you comfort in the, I guess, quality of the membership growth that you're seeing so far. I think better channel mix, fewer plan-to-plan sales and then, I guess, lower voluntary disenrollment. Can you just kind of remind us what the MLR or margin differential is between good channel, bad channel, plan to plan, new to plan and then retention versus new membership so we can kind of better think about what it means to have those buckets growing faster? And then just on the disenrollment comment, you talked about better enrollment. Is it back to normal? Is it better than normal that you're thinking about?

我想你提到了三件事，我想，正是這三件事讓你對目前為止看到的會員成長品質感到滿意。我認為更好的通路組合、更少的計畫間銷售，以及更低的自願退訂率，都能帶來更好的效果。您能否提醒我們一下，優質通路、劣質通路、計畫與計畫、新用戶與計畫、留存用戶與新用戶之間的 MLR 或利潤差異是多少？這樣我們才能更好地思考這些細分市場成長更快意味著什麼。然後，關於退學問題，您談到如何提高入學率。恢復正常了嗎？你認為它比正常情況好嗎？

Yeah. Let me touch on two things. And then, David, if you have anything you want to add, jump in here. So we're not going to give explicit margin information here, but let me give you a little bit about the dynamics across the channels that we watch that make us feel better.

是的。我想談兩件事。大衛，如果你還有什麼要補充的，請隨時插話。所以我們在這裡不會給出明確的利潤率訊息，但讓我來談談我們關注的各個管道的動態，這些動態讓我們感覺更好。

The biggest one is actually going back to NPV and long-term value. We see better attrition rate in some channels than others or retention. So that is one piece. We have a different cost of acquisition depending on the channel. So that is another piece that we look at. And then, we tend to find that we have different engagement rates. So when you think about things like Stars, accurate diagnosis, individuals managing their medical care, we see a different engagement rate across channels. And so we look at all of those things when we're then trying to understand what the economic impact is of any given channel. So those are kind of the pieces that we look at.

最大的問題其實是回歸淨現值和長期價值。我們發現某些管道的客戶流失率或留存率比其他管道好。這是其中一部分。根據通路的不同，我們的獲客成本也不同。所以這是我們要研究的另一個面向。然後，我們往往會發現我們的參與度各不相同。所以，當你想到明星、準確診斷、個人管理醫療保健等事情時，我們會發現不同管道的參與率有所不同。因此，當我們試圖了解任何特定管道的經濟影響時，我們會考慮所有這些因素。所以，這些就是我們主要關注的面向。

And then the one other thing I do want to touch on, we do not know right now that we are seeing better retention. We just don't have the data, right? The data is not available at this point in the year. But when we see reduced plan-to-plan sales, that tends to be correlated with better retention. So we don't know what that retention number is going to be right now, but the reduced plan-to-plan sales is correlated with better retention, and we are seeing reduced plan-to-plan sales year-over-year. So those are kind of the components.

還有一點我想提一下，我們目前還不能確定我們的客戶留存率是否有提高。我們沒有這些數據，對吧？今年這個時候還沒有相關數據。但當我們看到計劃銷售額下降時，這往往與更高的客戶留存率有關。所以我們現在還不知道留存率會是多少，但是計畫銷售額的下降與留存率的提高有關，而且我們看到計畫銷售額逐年下降。以上就是它的組成部分。

Did I miss anything there, David, do you want to throw in?

大衛，我漏掉了什麼嗎？你想補充什麼嗎？

Yeah. I think you got it exactly. I don't know if you mentioned, I think there's also different complaint to Medicare Stars outcomes we see by channel. This has been a big factor, especially if you look at the broker channels, and you've seen us take some actions. That's largely based on the quality of how those customers are experiencing that relative to how the Stars outcomes are going to look.

是的。我覺得你理解得完全正確。我不知道你有沒有提到，我認為不同管道收到的關於 Medicare Stars 結果的投訴也各不相同。這是一個重要因素，尤其是如果你看看經紀商管道，你會發現我們已經採取了一些行動。這主要取決於這些顧客的體驗品質與星級評定結果之間的關係。

Joshua Raskin, Nephron Research.

Joshua Raskin，腎單位研究。

I guess I wanted to focus on this LTV and NPV focus that you're talking about. I guess, is this long-term value member as the North Star a strategic shift for the organization? Meaning, are you willing to accept different margin levels in, say, your insurance segment because you can create more margin through CenterWell? I just want to understand how this impacts long-term margins and if this is, in your view, a shift in how you've thought about things in the past as an organization.

我想重點談談你提到的LTV和NPV。我想，將長期價值會員作為組織發展的方向，是否代表組織的策略轉變？也就是說，您是否願意接受在保險業務等其他業務領域中不同的利潤率水平，因為您可以透過 CenterWell 創造更高的利潤率？我只是想了解這會對長期利潤率產生怎樣的影響，以及在您看來，這是否標誌著貴公司過去思考問題方式的轉變。

Yeah, Josh. I think it's an evolution. I think this has always been part of how the company has thought about this. But as I said, part of this question about is growth good, is it not? It comes down to the margin of that growth. And what drives lifetime value? You need to have margin to drive lifetime value. You need to have retention to drive lifetime value.

是的，喬許。我認為這是一個演變過程。我認為這始終是公司考慮這個問題的方式之一。但正如我所說，這個問題的一部分是關於成長是否是好事，不是嗎？關鍵在於成長的幅度。那麼，什麼因素決定了客戶終身價值呢？你需要一定的利潤空間來提升顧客終身價值。你需要提高用戶留存率才能提升客戶終身價值。

And we are trying to get to a place where all of our products on the insurance side have a reasonable margin. Trying to get out of the cycle of having low-margin products that are high growth and then you worry about overgrowing in them and then having to drive margin in the out years. We don't think that's great for our sustainability. We don't think it's great for the customers.

我們正在努力使保險業務的所有產品都能獲得合理的利潤。試圖擺脫這樣的惡性循環：先推出利潤率低但成長迅速的產品，然後擔心過度成長，之後幾年又不得不提高利潤率。我們認為這不利於我們的永續發展。我們認為這對顧客來說並不好。

You also brought up the enterprise value. That's absolutely part of the play here. We know that integrated health is a big part of what we think differentiates Humana and looking at the lifetime value of a customer across the entire enterprise is becoming how we look at all of our activities.

您也提到了企業價值。這絕對是這齣戲的一部分。我們知道，綜合健康是 Humana 區別於其他公司的重要因素之一，而著眼於客戶在整個企業中的終身價值，正成為我們看待所有業務活動的方式。

Hey, Josh, if I could just add one other thing to that is as the long termer here, I can just tell you that what I've seen over the past couple of years, and we've actually talked about this directly during the investor conference, which is we're taking a multiyear view towards lifetime value. And that longer-term view is having us approach products in a different way in this way that leads to better stability and I think better long-term value for the company.

嘿，喬希，如果我可以補充一點的話，作為長期投資者，我可以告訴你，過去幾年我看到的情況，而且我們在投資者大會上也直接討論過，那就是我們著眼於多年期的終身價值。這種長遠的眼光促使我們以不同的方式看待產品，進而帶來更好的穩定性，我認為也能為公司帶來更好的長期價值。

Can I just add, to pile on here. While we are focused on LTV and NPV, we recognize can't have a long term without the short term. So we are balancing the long-term value, the long-term value creation with delivering on the next year or the next quarter. So we are balancing those things. We're not just looking three and five years out.

我再補充一點。雖然我們關注的是 LTV 和 NPV，但我們也意​​識到沒有短期利益就沒有長期利益。因此，我們要在長期價值和長期價值創造與實現下一年或下一季的目標之間取得平衡。所以我們要權衡這些因素。我們不僅著眼於未來三到五年。

AJ Rice, UBS.

AJ Rice，瑞銀集團。

Just maybe on the MA market overall, there was some data out from CMS early before open enrollment that they were forecasting the market might not even grow this year. I wonder -- I know you're not commenting on your specific situation, but do you have any feel for where the overall market is? You said in your comments that where there's planned exits, you're not picking up disproportionate numbers of those. Are we finally at an area where the market has been disruptive enough that some people are just choosing fee-for-service again? Is that possibly happening?

或許就整個醫療保險市場而言，CMS 在開放註冊之前發布的一些數據顯示，他們預測今年的市場甚至可能不會成長。我想知道——我知道您不是在評論您個人的具體情況，但您對整體市場狀況有什麼看法嗎？你在評論中提到，在有規劃出口的地方，你並沒有發現不成比例的出口數量。我們是否終於到了這樣一個階段：市場已經發生了足夠大的變革，以至於有些人又開始選擇按服務付費的模式？這有可能發生嗎？

And then maybe if I can just ask you on your mitigation efforts during this open enrollment. I believe there's some notice period on commission adjustments that would probably make it tough to do that during the open enrollment. So I'm just trying to understand what are the mitigation factors that you can push on if you see too much growth in a particular area?

然後，我能否問一下您在本次開放註冊期間採取了哪些緩解措施？我認為佣金調整需要一定的通知期，這可能會使在開放註冊期間進行調整變得困難。所以我想了解的是，如果某個領域成長太快，可以採取哪些緩解措施？

Yeah. Hey, let me hit the first of those, and then I'll hand it over to David for the question around plan exits and commission growth. On the market growth, I would just point out a few things. One, the forecasts are never right, right? Like they're never right. You can go back and you can look at the five, six, seven years historically, they're never right. Second, we don't see a reason that the market should grow materially different than the way it did last year or the way it has historically.

是的。嘿，讓我先回答第一個問題，然後我會把問題交給大衛，讓他回答有關計劃退出和佣金增長的問題。關於市場成長，我只想指出幾點。第一，預測從來都不準，對吧？好像他們永遠都錯了。你可以回顧過去五、六、七年的歷史，他們從來沒有一次是對的。其次，我們認為市場成長方式不會與去年或歷史上的成長方式有實質的不同。

And so our expectation is it's going to be somewhere in the mid-single digits growth. And again, this is forecasting. So CMS is not going to be right. We're not going to be exactly right. But we don't see what the big difference is from last year in terms of where the market is at as a whole when you look across all plans. And so our expectation is growth is going to look somewhat like last year at the end of the day. And we will obviously know come January, February, but that's kind of what our expectation is at the moment.

因此，我們預期成長率將在個位數中段。再次強調，這只是預測。所以CMS肯定不行。我們不可能做到完全正確。但從整體來看所有計劃，我們看不出今年的市場狀況與去年相比有什麼很大的不同。因此，我們預計最終的成長情況會與去年大致相同。當然，到了1月、2月我們就會知道結果了，但這就是我們目前的預期。

Yeah. And AJ, the second part of your question about commissions, you've all seen we've already decommissioned a number of plans. That is a potential lever, but there are other levers. Keep in mind that we own a big part of our own distribution, including our own marketing. So we're able to do other levers beyond commissions if we want to have volume match our operational capacity in the back half of the year.

是的。AJ，關於佣金問題的第二部分，你們都看到了，我們已經取消了一些計劃。這是一個潛在的槓桿，但還有其他槓桿。請記住，我們擁有很大一部分自己的分銷管道，包括我們自己的行銷管道。因此，如果我們想讓銷售量在下半年與我們的營運能力相匹配，我們可以採取佣金以外的其他手段。

And actually, I'm going to go back to the plexes real quick. The bottom line on the plexes, we don't know if people are going to fee-for-service or if they're going to other plans. But what I would just point out, and we've said this a few times, we are at parity or below the richest plan in the market in many, many geographies. And it just so happens that in a lot of the plexed geographies, we tend to be below or behind other plans in terms of benefit structure. And so that could be playing into it. But again, we don't have enough data to know that for sure.

實際上，我打算馬上回到戲院。對於多廳影院來說，最關鍵的問題是，我們不知道人們會選擇按服務收費還是會選擇其他方案。但我想指出的是，我們已經說過好幾次了，在很多地區，我們的價格與市場上最貴的計劃持平或更低。碰巧的是，在許多複雜的地區，我們在福利結構方面往往低於或落後於其他計劃。所以這也可能是原因之一。但是，我們仍然沒有足夠的數據來確定這一點。

Elizabeth Anderson, Evercore ISI.

Elizabeth Anderson，Evercore ISI。

I was wondering if you could comment on this year's MA enrollment. Obviously, that number -- the decline in membership is coming in not as much as you had originally suspected. Given the sort of short-term dynamics with this year with that membership change, I'd be curious on that. And with all of your comments on retention for next year, how that plays into your plan to sort of double the margin number for 2026?

我想請您談談今年碩士研究生的招生情況。顯然，會員人數的下降幅度並沒有你最初預想的那麼大。考慮到今年會員變動帶來的短期動態，我很想知道答案。鑑於您對明年員工留存率的所有評論，這與您2026年將利潤率翻倍的計劃有何關聯？

Can I just ask you to repeat the first part of that? What are we not seeing?

我可以請你重複一遍前面那句話嗎？我們究竟忽略了什麼？

No, I was just saying sort of the change in MA membership numbers for this year. Like how are you sort of seeing that impact the short-term numbers? Does that sort of make any big differences versus your original assumptions in terms of maybe the fourth quarter MLR? And then as we think about 2026, given your focus on retention, how does that play into and contribute to your doubling of the margin number for next year?

不，我只是說說今年MA會員人數的變化。你認為這會對短期數據產生怎樣的影響？這與你最初的假設相比，例如第四季度MLR的情況，會有什麼大的差異嗎？那麼，展望 2026 年，考慮到您對客戶留存的重視，這將如何影響並促進您明年利潤率翻倍的目標呢？

Okay. Got it. I missed the 2025 point, so yeah.

好的。知道了。我錯過了 2025 年這個節點，所以，是的。

Yeah. Elizabeth, it's Celeste. In terms of our better-than-expected or lower-than-expected declines in membership this year, the pickup has been driven by two things. One, the retention is better. And two, sales have been on the margin better as well. But in particular, as we've gotten later in the year, the increase in the numbers has been driven by better retention. As it relates to MLR, we don't see an impact to our prior expectations based on what we picked up at the end of this year.

是的。伊莉莎白，是塞萊斯特。今年會員人數的下降幅度好於預期或低於預期，主要歸因於兩件事。第一，留存率更高。其次，銷售額的利潤率也有所提高。但尤其到了今年晚些時候，數字的成長主要得益於更高的留存率。就 MLR 而言，根據我們今年年底的觀察，我們認為不會對我們先前的預期產生影響。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛集團。

Obviously, knowing that there's still a lot more to play out in the AEP. Just based on the initial comments that you made around the sales tracking to the high end of the scenarios, can you maybe give us some insights in terms of from a product mix perspective? How you're seeing new sales tracking between PPO, HMO and then, I guess, maybe D-SNP products?

顯然，我們知道 AEP 還有很多事情要發生。僅根據您之前對銷售追蹤到高端場景所做的初步評論，您能否從產品組合的角度給我們一些見解？您如何觀察 PPO、HMO 以及 D-SNP 產品之間的新銷售追蹤情況？

And then, also on the LIS PDP commentary around most of the growth coming from the LIS. Just any observations you can give us in terms of where you're seeing that growth coming from in terms of from either competitor exits or other existing plans in the market? Just any observations around that as well.

此外，LIS PDP 評論也指出，大部分成長都來自 LIS。您能否就成長來源方面提供一些觀察，例如競爭對手退出市場或市場上的其他現有計劃？關於這一點，還有什麼看法嗎？

Yeah. I'll take the first part. I think it's really early to be able to project at that level of detail on the growth. We're just a few weeks into AEP. And what we're seeing is that across the board, we're seeing healthy growth on all segments, but not disproportionate in any one segment. We're also not seeing disproportion in any geography at the moment, including the plex markets from our competitors. So it's too early to parse it apart, but it looks like it's much more even than it is choppy.

是的。我來回答第一部分。我認為現在就對成長做出如此詳細的預測還為時過早。AEP才開始幾週而已。我們看到的是，總體而言，所有細分市場都實現了健康成長，但沒有一個細分市場的成長尤為突出。目前我們也沒有在任何地區看到不平衡現象，包括我們競爭對手的綜合市場。現在分析還為時過早，但看起來它平穩得多，而不是不穩定。

So on the PDP side, what we're seeing thus far is some strong growth there. And where we expect the majority of it to come from is from our basic and value plans. On the basic side, which I think was your question around the low income, what we saw is that we are below the benchmark in about twice the number of states as we were in '25. And so that will lead to a significant pickup in auto enrollees, and that will include, of course, competitor reassignments. What we've generally seen is that, that is good business in the PDP. And so we are thinking that, that is a very positive development.

所以就人民民主黨而言，我們目前看到的是強勁的成長。我們預計大部分收入將來自我們的基礎套餐和超值套餐。關於基本方面，我認為這是你關於低收入的問題，我們看到的是，低於基準線的州的數量大約是 2025 年的兩倍。因此，這將導致自動投保人數大幅增加，當然，其中也包括競爭對手的重新分配。我們通常看到的是，這對人民民主黨來說是件好事。所以我們認為，這是一個非常積極的進展。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

I'm sorry if I missed this, but what drove the decision to not crosswalk the group MA members from H5216? Is that just you're thinking you're going to get that back to an appropriate star rating for 2028 or other logistical reasons you didn't make that move?

如果我錯過了相關信息，我深感抱歉，但是什麼原因導致決定不讓 H5216 小組的 MA 成員進行人行橫道通行？你是因為覺得到 2028 年才能讓它恢復到適當的星級評定，還是因為其他後勤方面的原因才沒有這麼做？

Yeah. I'll jump in on that one. It goes back to two things. One is -- well, really three things. One is our attitude towards having a balanced portfolio of contracts. The second is the desire to provide stability to our members in order to drive retention. And then third is the outlook on Stars. And so it's all three of those things combined that led to that decision.

是的。我也想參與討論。歸根結底，這要追溯到兩件事。其中之一是——嗯，實際上是三件事。一是我們對待維持合約組合平衡的態度。第二點是希望提供會員穩定性，以提高會員留存率。第三點是對明星的展望。因此，正是這三件事綜合起來促成了這個決定。

George?

喬治？

Yeah, I would just say that another part of that because it's multifactorial, as Jim said, and we've been saying since we've been talking about the group business. So we remain focused on improving the group MA margins through the various renewal cycles to reflect the reimbursement environment as well as the cost environment. And our business so far, we've renewed 91% of our current group members along that line of recovering margin.

是的，我想說，這是其中的另一個方面，因為它是多因素的，正如吉姆所說，而且自從我們開始談論集團業務以來，我們也一直在說這一點。因此，我們將繼續專注於透過各種續保週期來提高集團 MA 利潤率，以反映報銷環境和成本環境。到目前為止，我們的業務已經按照利潤恢復的趨勢，續簽了 91% 的現有集團成員。

So we are making good progress there in the recontracting to improve the margin. We expect fairly solid growth in 2026 with some key new business, including a major airline, a large group in Kentucky as well as Alabama. So as far as Stars go, our plan is to move the group members away from 5216 is not to move our members away at this time because we're making good progress both on the Stars side as well as the margin recovery through the renewal cycles.

因此，我們在重新簽訂合約以提高利潤率方面取得了良好進展。我們預計 2026 年將實現相當穩健的成長，並迎來一些重要的新業務，包括一家大型航空公司、肯塔基州的一個大型集團以及阿拉巴馬州的業務。所以就 Stars 而言，我們的計劃是暫時不將集團成員從 5216 轉移出去，因為我們在 Stars 方面以及透過續約週期實現利潤率恢復方面都取得了良好的進展。

And if I can pile on again, this is again an example of not crosswalking these. It's balancing the short term and the long term. We could get a bump in the short term, but risk the longer term on Stars, and we're not willing to do that. So it's a balance of what we deliver in '26 versus what we deliver in '28 on that front.

如果我能再次強調，這又是一個例子，說明不應該將這些事項混為一談。它平衡了短期和長期利益。短期內我們可能會獲得一些收益，但長期來看，投資明星隊可能會有風險，我們不願意這麼做。所以，這需要我們在 2026 年和 2028 年在這方面取得的成績之間取得平衡。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢。

Just it sounds like medical and pharmacy trends coming in line with your expectations for 2025. I think looking back at the Investor Day, you previously assumed trend would remain elevated for '26. There's obviously the mix elements you've talked about, but any early thoughts on how 2026 cost trend development coming in relative to 2025? And then, any way to help quantify how you're thinking about the trend bender opportunity specifically for next year?

聽起來醫療和藥學的發展趨勢與您對 2025 年的預期相符。回顧投資者日，我認為你之前假設2026年的趨勢將保持在高位。顯然，正如您所提到的，存在一些混合因素，但對於 2026 年的成本趨勢發展相對於 2025 年的情況，您有什麼初步看法？那麼，有沒有什麼方法可以量化您對明年趨勢轉變機會的看法呢？

Yeah, we have talked about in the past that we expect a continuation of the same growth levels in medical and Rx cost trends into 2026. So the mid-ish -- on the higher end of mid on the medical cost side and low double digits on the Rx side of things. So we're not seeing anything that would suggest it should be different than that at the moment.

是的，我們過去曾討論過，我們預計醫療和處方藥成本的成長趨勢將持續到 2026 年。所以，醫療費用方面處於中等偏上水平，而處方藥費用方面則處於兩位數低點。所以目前我們還沒有看到任何跡象表明情況應該有所不同。

And then sorry, what was the second part of your question?

不好意思，您問題的第二部分是什麼？

Yeah. Just any way to help quantify how you're thinking about the trend bender opportunity -- clinical excellence opportunity for next year?

是的。有沒有什麼方法可以量化您如何看待明年這種改變趨勢的機會——即臨床卓越機會？

Yeah. So if you think back to our Investor Day, we talked about the levers of transformation and the clinical excellence trend vendor opportunity is one of our larger ones. We expect to make progress versus what we delivered this year. I'm not ready to size that yet. Some of that will be driven by the size and mix of our membership and then make progress again in '27 and '28, but it's too early to say where that will be just given the number of dynamics that still need to settle down.

是的。所以，如果你回想一下我們的投資者日，我們討論了轉型的槓桿，而臨床卓越趨勢供應商機會是我們最大的機會之一。我們預計今年將比今年取得更大的進步。我還沒準備好確定尺寸。其中一部分將取決於我們會員的規模和組成，然後在 2027 年和 2028 年再次取得進展，但現在說會發展到什麼程度還為時過早，因為還有很多動態因素需要穩定下來。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Could you talk to some of the margin characteristics and long-term margin targets you've got? In particular, in Medicaid, if you could talk to the differences between traditional and duals where you see long-term margins and how you perceive year one margins in that sort of business? And then over in the group MA business, what sort of J curve do you expect as you get new business in there?

能否談談你們的利潤率特徵和長期利潤率目標？尤其是在醫療補助方面，您能否談談傳統醫療保險和雙重醫療保險之間的區別，您認為這兩種醫療保險的長期利潤率如何？您又是如何看待這類業務第一年的利潤率的？那麼在集團MA業務方面，隨著新業務的加入，您預計會出現什麼樣的J型曲線呢？

And maybe just a quick clarification. You'd mentioned a direct-to-employer opportunity, I think, in CenterWell Pharmacy. So if you could just clarify that as well.

或許還需要簡單澄清一下。我想你之前提到過 CenterWell Pharmacy 有一個直接向雇主的招募機會。所以，如果您能再澄清一下就太好了。

Do you want to kick off, George?

喬治，你想開火嗎？

Yeah, I'll start. On the dual opportunity, just keep in mind that when we think about that, and we think about Medicaid since you combine those two, I'll try to hit on both of them. We prioritize our Medicaid business based upon where we think there is a great linkage to duals, including some of the changes that are currently slated for the dual integration states.

好的，我先來。關於雙重機會，請記住，當我們考慮這一點時，考慮到醫療補助計劃，因為這兩者結合起來，我會盡量兼顧兩者。我們優先考慮的醫療補助業務，是基於我們認為與雙重資格有良好聯繫的領域，包括目前計劃在雙重資格整合州進行的一些變革。

And so we have had an industry-leading win rate in procurements and Medicaid. And the reason for how we've targeted those is really to where the dual opportunity remains. And the overall reason for that, of course, is that the duals do have outsized margins compared to the traditional or MA business. And so we see that those do deliver margins in the first year.

因此，我們在採購和醫療補助方面取得了業界領先的中標率。我們之所以選擇這些目標，是因為那裡仍然存在雙重機會。當然，其根本原因在於，與傳統或混合型業務相比，雙人課程的利潤空間確實更大。因此我們看到，這些產品在第一年確實能帶來利潤。

Unlike some of the core products all year along, those dual products tend to perform well from a financial standpoint. We're seeing that. We continue to see that happen. We have won a number of Medicaid states. It allows us to increase our dual penetration in a few key markets. I would just point out that in 2026, we'll be moving into the Michigan HIDE program in Illinois, which is, as we've talked about before, a very new dual marketplace. We are also going to be growing into Illinois this year in '26 and we also have an opportunity in South Carolina, where we're carving in the dual eligible. So there's lots of great opportunity in the dual market in Medicaid that we feel very good about.

與全年的一些核心產品不同，這些雙重產品從財務角度來看往往表現良好。我們看到了這一點。我們不斷看到這種情況發生。我們贏得了多個醫療補助州的選票。這使我們能夠在幾個關鍵市場提高雙重滲透率。我只想指出，2026 年，我們將進入伊利諾伊州的密西根州 HIDE 項目，正如我們之前討論過的，這是一個全新的雙重市場。今年（2026年）我們也將進軍伊利諾州，同時在南卡羅來納州也有機會，我們正在那裡開拓雙重資格市場。因此，醫療補助雙重市場蘊藏著許多絕佳的機會，我們對此感到非常樂觀。

Yeah. And let me just quickly hit the direct-to-employer. I think people are familiar with the direct-to-consumer work that we've been doing in CenterWell Pharmacy, the partnerships, particularly around some of the GLP-1s. We have also seen some interest in similar programs, but through employers and we've been exploring that space. It's too early to know exactly what that's going to look like, but it is potentially another interesting opportunity for us to take advantage of the capability that we have in our pharmacy business.

是的。讓我快速地直接聯繫雇主。我認為大家對我們 CenterWell Pharmacy 一直以來開展的直接面向消費者的工作以及合作關係都很熟悉，特別是圍繞一些 GLP-1 類藥物的合作關係。我們也看到一些對類似專案感興趣的人，但都是透過雇主，我們一直在探索這個領域。現在要確切知道結果如何還為時過早，但這可能是我們利用自身藥房業務能力的另一個有趣機會。

Michael Ha, Baird.

Michael Ha，貝爾德。

I know it's a bit early to think about '27 advanced rate notice, but yesterday, we learned a key data point. And maybe it's unsurprising, but if your reach fee-for-service cost trend for '25 is 8.5%, usually a pretty strong leading indicator for the rate notice and clearly much higher than what was implied for the '26 final notice, I think, over 300 basis points. So when you couple that with CMS' estimate on '27 trends, it feels like you have a starting point in the advanced notice that could be north of 9% on the effective growth rate alone. Clearly, very strong for MA and very strong for Humana.

我知道現在考慮 2027 年的提前通知還為時過早，但昨天我們了解到了一個關鍵數據點。也許這並不令人意外，但如果你的 2025 年按服務收費成本趨勢為 8.5%，這通常是費率通知的一個相當有力的領先指標，而且顯然比 2026 年最終通知所暗示的要高得多，我認為超過 300 個基點。因此，當把這一點與 CMS 對 2027 年趨勢的估計結合起來時，感覺提前通知的起點，僅有效增長率就可能超過 9%。顯然，MA 和 Humana 的表現都非常強勁。

And again, I know it's early to think about it, but does this roughly make sense and jive with your internal expectations? And wondering if there are any other important variables you think we should also consider heading into the rate notice?

我知道現在考慮這個問題還為時過早，但這大致上是否合理，是否符合你的內心預期？我想知道在製定費率通知書之前，是否還有其他您認為我們應該考慮的重要變數？

Yeah. Look, I think it's -- as we've learned over the last few years, speculating on where the rate notice will land has been a very much more imprecise answer than we would like. So we're not going to comment on sort of where they are, where they're starting, what the headwinds and the tailwinds are. And we'll obviously get a first look at that in the beginning of next year.

是的。你看，我認為——正如我們在過去幾年中所了解到的——猜測稅率通知單會寄到哪裡，其結果遠比我們希望的要不準確得多。所以我們不會評論他們目前的位置、他們的起點、面臨的逆風和順風情況。我們顯然會在明年年初看到它的雛形。

Whit Mayo, Leerink Partners.

Whit Mayo，Leerink Partners。

I was just wondering if you guys had any views on the changes to the reward factor to EHO for all, whatever it's being called next year and implications on your Stars or more broadly, what you think this means for the industry? I don't think you have any challenges with your duals mix low income or disabled population, but just not sure yet what this actually means.

我只是想問大家對明年EHO獎勵機制的調整有什麼看法，不管它明年叫什麼名字，以及這對你們的星級評定會產生什麼影響，或者更廣泛地說，你們認為這對整個行業意味著什麼？我認為你們的雙語學校在低收入或殘疾人群體方面沒有任何挑戰，只是還不確定這究竟意味著什麼。

With regard to the social risk factors that go into that, we're seeing great progress. We're tracking that on a weekly basis as we're tracking all of our Stars progress. And we know that we are making very good progress there. We're seeing week-over-week improvement. So we feel that we're on track for where we need to be to have that factor be positive.

就影響這些因素的社會風險因素而言，我們已經取得了巨大進展。我們會像追蹤所有明星球員的進步一樣，每週追蹤一次。我們知道，我們在這方面取得了非常好的進展。我們看到每週都在進步。因此，我們感覺我們正朝著實現該因素為積極目標的方向前進。

We have a good mix of low income within our product mix, including our dual and even products that don't have as large of a specifically dual population with our group being on 5216, as we've talked about before, we're seeing progress there. And having a good mix of membership on 5216, even with the deconsolidation, we should still be in good shape with the social risk factor members.

我們的產品組合中低收入者的比例較為均衡，包括我們的雙薪家庭產品，甚至還有一些雙薪家庭比例不高的產品。正如我們之前討論過的，我們所在的 5216 集團在這方面取得了進展。即使進行了拆分，5216 的成員組成依然良好，我們應該能夠很好地應對社會風險因素成員。

Yeah. I'd just say, operationally, we feel good. And obviously, it's hard to tell where the thresholds are going to come in exactly. So this is just one of these things that will be difficult to forecast.

是的。我只想說，從營運層面來看，我們感覺良好。顯然，很難準確預測閾值會在哪裡出現。所以，這又是難以預測的事情之一。

With that, I just want to thank everybody for joining us this morning and for your interest in Humana. And I will say again that we're extremely appreciative of our 65,000 associates who are driving the performance that we talk about on these calls and who are serving our members and our patients every day. And so we appreciate your support, and we hope you have a great day. Thanks.

最後，我要感謝今天早上各位的到來，以及大家對Humana的關注。我再次強調，我們非常感謝我們的 65,000 名員工，正是他們推動了我們在電話會議上談到的業績，並且每天都在為我們的會員和患者提供服務。因此，我們非常感謝您的支持，並祝您有美好的一天。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了。