Molina Healthcare Inc (MOH) 2023 Q4 法說會逐字稿

Good morning, and welcome to the Molina Healthcare Fourth Quarter 2023 Earnings Call. (Operator Instructions) Please note, this event is being recorded.

早安，歡迎參加 Molina Healthcare 2023 年第四季財報電話會議。 （操作員說明）請注意，正在記錄此事件。

Standing in for Joe Krocheski today is Jeff Geyer, Vice President of Investor Relations. Please go ahead.

今天取代 Joe Krocheski 的是投資者關係副總裁 Jeff Geyer。請繼續。

Good morning, and welcome to Molina Healthcare's Fourth Quarter and Full Year 2023 Earnings Call. Joining me today are Molina's President and CEO, Joe Zubretsky; and our CFO, Mark Keim. A press release announcing our fourth quarter and full year 2023 earnings was distributed after the market closed yesterday and is available on our Investor Relations website. Shortly after the conclusion of this call, a replay will be available for 30 days. The numbers to access the replay are in the earnings release.

早上好，歡迎參加 Molina Healthcare 的 2023 年第四季和全年財報電話會議。今天加入我的有 Molina 總裁兼執行長 Joe Zubretsky；以及我們的財務長馬克凱姆 (Mark Keim)。昨天收盤後我們發布了一份新聞稿，宣布我們第四季度和 2023 年全年收益，可在我們的投資者關係網站上查看。本次電話會議結束後不久，將提供 30 天內的重播。訪問重播的號碼在收益發布中。

For those of you who listen to the rebroadcast of this presentation, we remind you that all of the remarks made are as of today, Thursday, February 8, 2024, and have not been updated subsequent to the initial earnings call.

對於那些收聽重播本簡報的人，我們提醒您，所有言論均截至今天（2024 年 2 月 8 日星期四），並且在首次財報電話會議後尚未更新。

On this call, we will refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures for 2023 and 2024 can be found in our fourth quarter 2023 earnings release. During the call, we will be making certain forward-looking statements, including, but not limited to, statements regarding our 2024 guidance, Medicaid redeterminations, our recent RFP awards and related revenue growth, our recent acquisitions and M&A activity, our long-term growth strategy and our embedded earnings power and projected 2025 earnings per share.

在這次電話會議上，我們將提及某些非公認會計原則措施。這些指標與 2023 年和 2024 年最直接可比較的 GAAP 指標的對帳可以在我們的 2023 年第四季財報發布中找到。在電話會議期間，我們將做出某些前瞻性聲明，包括但不限於有關我們2024 年指導、醫療補助重新確定、我們最近的RFP 獎勵和相關收入增長、我們最近的收購和併購活動、我們的長期計劃的聲明。成長策略和我們的內在盈利能力以及預計的 2025 年每股收益。

Listeners are cautioned that all of our forward-looking statements are subject to certain risks and uncertainties that could cause our actual results to differ materially from our current expectations. We advise listeners to review the risk factors discussed in our Form 10-K annual report filed with the SEC as well as our risk factors listed in our Form 10-Q and Form 8-K filings with the SEC. After completion of our prepared remarks, we will open the call to take your questions.

請聽眾注意，我們所有的前瞻性陳述都受到某些風險和不確定性的影響，這些風險和不確定性可能導致我們的實際結果與我們目前的預期有重大差異。我們建議聽眾查看我們向 SEC 提交的 10-K 表格年度報告中討論的風險因素，以及向 SEC 提交的 10-Q 表格和 8-K 表格中列出的風險因素。在完成我們準備好的演講後，我們將打開電話回答您的問題。

I will now turn the call over to our Chief Executive Officer, Joe Zubretsky. Joe?

我現在將把電話轉給我們的執行長喬·祖布雷茨基 (Joe Zubretsky)。喬？

Thank you, Jeff, and good morning. Today, I will discuss several topics. Our financial results for the fourth quarter and full year 2023, our growth initiatives and our strategy for sustaining profitable growth, our 2024 premium revenue and earnings guidance and an affirmation of our long-term growth targets.

謝謝你，傑夫，早安。今天，我將討論幾個主題。我們的 2023 年第四季和全年財務業績、我們的成長舉措和維持獲利成長的策略、我們的 2024 年保費收入和獲利指引以及對我們長期成長目標的確認。

Let me start with our fourth quarter performance. Last night, we reported adjusted earnings per diluted share of $4.38, an $8.4 billion of premium revenue. Our fourth quarter results and performance metrics demonstrated strong medical cost management and operating cost discipline. Medicaid continued to perform well, withstanding the impacts of the unprecedented redetermination process. Medicare experienced higher than target medical costs, consistent with prior quarters and Marketplace performed very well despite the late in year medical cost seasonality typically experienced.

讓我從我們第四季的業績開始。昨晚，我們報告調整後每股攤薄收益為 4.38 美元，溢價收入為 84 億美元。我們第四季的業績和績效指標展示了強大的醫療成本管理和營運成本紀律。儘管經歷了前所未有的重新確定過程的影響，醫療補助仍然表現良好。醫療保險的醫療費用高於目標醫療費用，與前幾季一致，儘管年末醫療費用季節性通常會出現，但 Marketplace 的表現仍然非常良好。

Our fourth quarter completes a strong year of operating and financial performance. Full year adjusted earnings per share of $20.88 represents 17% year-over-year growth, squarely in line with our long-term target range of 15% to 18% and 6% above our initial 2023 guidance of at least $19.75. Our full year premium revenue of $32.5 billion represents 5% year-over-year growth, and our pretax margin of 4.8% is at the high end of our long-term target range heading into 2024.

我們第四季的營運和財務業績表現強勁。全年調整後每股收益為 20.88 美元，年增 17%，完全符合我們 15% 至 18% 的長期目標範圍，比我們最初的 2023 年指導至少 19.75 美元高出 6%。我們的全年保費收入為 325 億美元，年增 5%，稅前利潤率為 4.8%，處於我們進入 2024 年的長期目標範圍的高端。

In Medicaid, our flagship business representing over 80% of revenue, we reported an 88.7% MCR for the full year, which is within our long-term target range. Throughout the redetermination process, we have managed through a number of factors that shape Medicaid's performance, all to land the full year result at a solid jump-off point into 2024. These factors included medical cost utilization, various state corridors and MLR minimums and prospective rate changes.

在佔收入 80% 以上的旗艦業務醫療補助中，我們報告全年的 MCR 為 88.7%，這在我們的長期目標範圍內。在整個重新確定過程中，我們管理了許多影響醫療補助績效的因素，所有這些因素都使全年結果在2024 年之前達到一個堅實的起點。這些因素包括醫療成本利用率、各種州走廊和MLR最低標準以及預期率變化。

In Medicare, the full year MCR was 90.7%. While the business is profitable, we did not meet our performance expectations due to higher utilization of supplemental benefits, in-home services and high-cost drugs. I am confident that our 2024 bid strategy, adjustments to benefit design and various operational improvements will return the business to target margins in 2024.

在醫療保險方面，全年 MCR 為 90.7%。雖然業務盈利，但由於補充福利、家庭服務和高成本藥品的利用率較高，我們沒有達到我們的業績預期。我相信，我們的 2024 年投標策略、效益設計調整和各種營運改進將使業務在 2024 年恢復到目標利潤率。

In Marketplace, we reported a 75.3% MCR for the full year, below the low end of our target range, which reflects the successful execution of our small, silver and stable strategy. This business is now positioned to grow at a rate, which allows us to sustain mid-single-digit margins.

在 Marketplace 中，我們報告全年 MCR 為 75.3%，低於我們目標範圍的下限，這反映了我們的小型、白銀和穩定策略的成功執行。該業務目前正以一定速度成長，這使我們能夠維持中個位數的利潤率。

In addition to delivering strong financial results, in 2023, we continue to execute on our profitable growth strategy to recap the growth milestones achieved in 2023. In January, we successfully re-procured our contract in Texas for the state's STAR+ program, retaining all 8 regions and likely growing market share. In July, we successfully launched our Iowa Medicaid plan following the RFP, which we had won in a highly competitive process in late 2022. In August, we announced that we were awarded a contract to once again serve Medicaid beneficiaries in the state of New Mexico. In September, we closed on the My Choice Wisconsin acquisition further expanding our market-leading LTSS franchise. In June, we agreed to acquire Bright Health California Medicare business, which we have now closed effective January 1, 2024.

除了實現強勁的財務業績外，2023 年，我們還將繼續執行盈利增長戰略，回顧2023 年實現的增長里程碑。1 月份，我們成功重新獲得了德克薩斯州STAR+ 計劃的合同，保留了全部8個項目地區和可能成長的市場份額。 7 月，我們繼RFP 後成功啟動了愛荷華州醫療補助計劃，我們在2022 年底通過激烈的競爭贏得了該計劃。8 月，我們宣布獲得一份合同，再次為新墨西哥州的醫療補助受益人提供服務。 9 月，我們完成了對 My Choice Wisconsin 的收購，進一步擴大了我們市場領先的 LTSS 特許經營權。 6 月，我們同意收購 Bright Health 加州醫療保險業務，該業務現已於 2024 年 1 月 1 日關閉。

Also effective January 1 and after another win in a highly competitive bid process, we successfully launched our Nebraska health plan. And finally, on January 1, we launched our expanded California platform, including Los Angeles County, which doubled the size of our business in the state.

同樣自 1 月 1 日起，在競爭激烈的投標過程中再次獲勝後，我們成功推出了內布拉斯加州健康計劃。最後，1 月 1 日，我們推出了擴大的加州平台，其中包括洛杉磯縣，這使我們在該州的業務規模擴大了一倍。

Collectively, these acquisitions and RFP successes represent $7 billion of annual premium revenue, a portion of which was in our 2023 results, most of which is in our 2024 guidance and all of which will be fully realized in 2025. To say we are pleased with the execution of our 2023 growth initiatives would be an understatement. But the growth story doesn't stop there. The pipeline of opportunities, fueling our future growth trajectory is extremely strong.

總的來說，這些收購和RFP 的成功代表了70 億美元的年度保費收入，其中一部分包含在我們2023 年的業績中，其中大部分包含在我們的2024 年指導中，所有這些都將在2025年完全實現。我們 2023 年成長計畫的執行情況還算輕描淡寫。但成長故事不止於此。推動我們未來成長軌跡的機會管道非常強勁。

Let me begin with reprocurements. We have submitted our RFP responses for contract renewals in Florida, Virginia and Michigan. We are proven partners with all 3 of these states, and we are confident in our ability to retain and grow these relationships.

讓我從重新採購開始。我們已提交佛羅裡達州、維吉尼亞州和密西根州合約續約的 RFP 回覆。我們是這三個州公認的合作夥伴，我們對維持和發展這些關係的能力充滿信心。

With regard to new state opportunities, including the Florida opportunity just described, there is over $50 billion of total premium revenue opportunity, active or near term, upper bid in several states over the coming years. We have already submitted bids in the states of Kansas and Georgia. With our demonstrated capabilities and referenceable track record, we remain confident in our ability to continue to win new state contracts.

關於新的州機會，包括剛剛描述的佛羅裡達州機會，未來幾年，幾個州的主動或近期的保費收入機會總額將超過 500 億美元。我們已經在堪薩斯州和喬治亞州提交了投標。憑藉我們展示的能力和可參考的業績記錄，我們對繼續贏得新的州合約的能力充滿信心。

With respect to our M&A initiatives, our acquisition pipeline remains robust with actionable opportunities and we are confident in our ability to deliver growth from this key component of our strategy. Since 2019, we have completed 8 transactions having acquired over $11 billion of premium for which we paid 22% of revenue. This capital allocation to M&A will continue to be a value driver.

就我們的併購計畫而言，我們的收購管道依然強勁，並擁有可操作的機會，我們對透過策略的這一關鍵組成部分實現成長的能力充滿信心。自 2019 年以來，我們已完成 8 筆交易，獲得了超過 110 億美元的溢價，其中我們支付了收入的 22%。這種併購資本配置將繼續成為價值驅動因素。

Turning now to our 2024 guidance. We project 2024 premium revenue of approximately $38 billion, which is consistent with our previous outlook and represents 17% year-over-year growth. We project 2024 adjusted earnings per share of at least $23.50, representing 13% year-over-year growth. Mark will take you through the detailed guidance build in a few minutes. But in the meantime, let me offer some high-level commentary.

現在轉向我們的 2024 年指導。我們預計 2024 年保費收入約為 380 億美元，這與我們先前預期的一致，年增 17%。我們預計 2024 年調整後每股盈餘至少為 23.50 美元，年增 13%。馬克將在幾分鐘內帶您完成詳細的指導建造。但同時，讓我提供一些高水準的評論。

Our projected premium revenue growth to $38 billion represents a well-balanced combination of new contract wins, acquisitions and growth in our current footprint, partially offset by the impact of Medicaid redeterminations. With respect to earnings guidance in the core business, in Medicaid, our guidance fully considers the impact of the redetermination process. From a margin perspective, this is playing out as we have predicted. The impact of acuity shifts is real, but not significant. The risk corridors, acted as a financial buffer and rates, prospective and retrospective, are largely capturing the trend impact. On a same-store basis, we are projecting the 2024 Medicaid MCR to be within our long-term range.

我們預計保費收入將成長至 380 億美元，這是新合約贏得、收購和當前業務成長的均衡組合，但部分被醫療補助重新確定的影響所抵消。對於核心業務的獲利指引，在醫療補助中，我們的指引充分考慮了重新確定過程的影響。從利潤率的角度來看，這正如我們所預測的那樣。敏銳度變化的影響是真實的，但並不顯著。風險走廊作為金融緩衝和利率，無論是前瞻性還是回顧性，都在很大程度上捕捉了趨勢影響。在同店基礎上，我們預計 2024 年醫療補助 MCR 將在我們的長期範圍內。

We expect Medicare to return to mid-single-digit profitability in 2024 as a result of our bid strategy, adjustments to benefit design and operational improvements in the legacy business. Our Marketplace product has been priced right, is competitively positioned and the risk pool has stabilized. We expect the business to achieve mid- to high single-digit margins, membership to grow over 30% and revenue to grow 17%.

由於我們的競標策略、福利設計的調整以及傳統業務的營運改進，我們預計 Medicare 的盈利能力將在 2024 年恢復到中個位數的盈利能力。我們的市場產品定價合理，具競爭力，風險池也穩定。我們預計該業務將實現中高個位數的利潤率，會員數量將成長 30% 以上，營收將成長 17%。

On top of our 2024 earnings per share guidance of at least $23.50, we now have $4 per share of new store embedded earnings, which, as you may recall, represents the expected accretion produced by our new store growth. Mark will review the components of the updated $4 per share in his remarks.

除了我們 2024 年至少 23.50 美元的每股收益指引之外，我們現在還有每股 4 美元的新店嵌入收益，您可能還記得，這代表了我們新店成長帶來的預期成長。馬克將在演講中回顧更新後的每股 4 美元的組成部分。

Our confidence in our 2024 guidance starts with a high-quality 2023 earnings baseline and then takes a thorough account of all the various factors, exogenous and company-specific that could impact earnings in 2024.

我們對 2024 年指引的信心始於高品質的 2023 年獲利基準，然後全面考慮可能影響 2024 年獲利的所有各種因素（包括外生因素和公司特定因素）。

Now a few comments on our longer-term trajectory. Our 2024 guidance picture is one more data point that validates our long-term targets of 13% to 15% premium growth and 15% to 18% adjusted earnings per share growth. We committed to these targets at our Investor Day last May, and we reaffirm that commitment today. With the majority of the $4 of new store embedded earnings expected to emerge in 2025, we already see a clear outlook to achieving the low end of our long-term EPS growth target in 2025, even before considering the execution of additional growth initiatives and driving growth from our current footprint.

現在對我們的長期軌跡進行一些評論。我們的 2024 年指引圖是另一個數據點，它驗證了我們 13% 至 15% 的溢價成長和 15% 至 18% 的調整後每股盈餘成長的長期目標。我們在去年五月的投資者日上承諾實現這些目標，今天我們重申了這項承諾。由於新店 4 美元的嵌入收益中的大部分預計將在 2025 年出現，我們已經看到了在 2025 年實現長期每股收益增長目標低端的明確前景，甚至在考慮執行額外的增長計劃和推動我們目前的足跡的增長。

In summary, we are very pleased with our 2023 performance, our trajectory to deliver the growth and profitability inherent in our 2024 guidance and the embedded earnings outlook we provided for 2025. Our confidence in continuing to achieve our long-term targets is data-driven as demonstrated by the following historical fact set. We have re-procured approximately $12 billion in existing revenue. We have added approximately $7 billion of new revenue through wins of new or expanded contracts in 7 states. From 2020 to 2023, we achieved 21% annual premium growth and 25% annual earnings per share growth. 2024 guidance, 17% premium revenue growth year-over-year, 13% earnings per share growth year-over-year. And for 2025, we expect to harvest the majority of our $4 per share of embedded earnings.

總而言之，我們對 2023 年的業績、我們實現 2024 年指導中固有的增長和盈利能力的軌跡以及我們為 2025 年提供的內在盈利前景感到非常滿意。我們對繼續實現長期目標的信心是數據驅動的正如以下歷史事實所證明的。我們重新獲得了約 120 億美元的現有收入。透過在 7 個州贏得新合約或擴大合同，我們增加了約 70 億美元的新收入。從2020年到2023年，我們實現了21%的年保費成長和25%的年每股收益成長。 2024 年指導，保費收入年增 17%，每股收益較去年同期成長 13%。到 2025 年，我們預計將收穫每股 4 美元嵌入收益的大部分。

Our strategy is clear and simple. We are in the business of providing assets to high-quality healthcare for individuals relying on government assistance. Our business model is also clear and simple. We take on capitated risk, take or make rates that are commensurate with medical cost trends, and manage those trends to consistently achieve our target margins while maintaining higher standards of quality. The execution of our strategy and business model has been and will continue to be strong, which is why we look to the future with a great deal of confidence.

我們的策略清晰而簡單。我們致力於為依賴政府援助的個人提供高品質的醫療保健資產。我們的商業模式也清晰簡單。我們承擔資本風險，採取或製定與醫療成本趨勢相稱的費率，並管理這些趨勢，以持續實現我們的目標利潤，同時保持更高的品質標準。我們的策略和業務模式的執行一直並將繼續強勁，這就是為什麼我們對未來充滿信心。

In conclusion, I want to extend my special thanks to our 19,000 associates who are dedicated to delivering access to high-quality healthcare to our members. It is my privilege to serve with such a committed and capable group of professionals.

最後，我要特別感謝我們的 19,000 名員工，他們致力於為我們的會員提供高品質的醫療保健服務。我很榮幸能夠與這樣一支忠誠且有能力的專業人士團隊一起服務。

With that, I will turn the call over to Mark for some additional color on the financials. Mark?

這樣，我會將電話轉給馬克，以獲取有關財務狀況的更多資訊。標記？

Thanks, Joe, and good morning, everyone. Today, I'll discuss some additional details on our fourth quarter and full year performance, the balance sheet redeterminations and our 2024 guidance.

謝謝喬，大家早安。今天，我將討論有關我們第四季度和全年業績、資產負債表重新確定和 2024 年指導的一些其他細節。

Beginning with our fourth quarter and full year results. For the quarter, we reported $9 billion in total revenue and $8.4 billion of premium revenue. I will note that total revenue includes approximately $380 million in reimbursement for our California MCO tax item that was retrospective to April. This item modestly distorts our reported G&A and margin ratios, but has no net economic consequence.

從我們的第四季和全年業績開始。我們報告的本季總收入為 90 億美元，保費收入為 84 億美元。我要指出的是，總收入包括約 3.8 億美元的加州 MCO 稅收項目的報銷，該項目可追溯至 4 月。該項目略微扭曲了我們報告的一般管理費用和利潤率，但沒有淨經濟後果。

On a consolidated basis, our fourth quarter MCR was 89.1% and our full year was 88.1%, reflecting continued strong medical cost management. Our full year consolidated MCR was consistent with our expectations and squarely in line with our long-term target range.

綜合來看，我們第四季的 MCR 為 89.1%，全年為 88.1%，反映出持續強勁的醫療成本管理。我們的全年綜合 MCR 符合我們的預期，也完全符合我們的長期目標範圍。

In Medicaid, our fourth quarter reported MCR was 89.2%. The MCR included a moderate impact from the net effect of redetermination acuity shifts and corridors in several states, as well as some MCR pressure from the additions of our Iowa health plan and our My Choice acquisition. Across our Medicaid segment, the major medical cost categories were largely in line with our expectations and normal quarter-to-quarter trend fluctuations. Our full year Medicaid MCR was 88.7%, within our long-term target range and consistent with our expectations.

在醫療補助中，我們在第四季度報告的 MCR 為 89.2%。 MCR 包括幾個州重新確定敏銳度變化和走廊的淨效應帶來的中等影響，以及我們愛荷華州健康計劃和 My Choice 收購帶來的一些 MCR 壓力。在我們的醫療補助部門，主要醫療費用類別基本上符合我們的預期和正常的季度趨勢波動。我們全年的醫療補助 MCR 為 88.7%，在我們的長期目標範圍內並符合我們的預期。

In Medicare, our fourth quarter reported MCR was 93.3% and our full year was 90.7%, both above our long-term target range and impacted by increased utilization of supplemental benefits, in-home services and high-cost drugs. As Joe mentioned, we are confident that our 2024 bid strategy adjustments to benefit design as well as operational improvements will produce target margins in our Medicare business in 2024.

在醫療保險方面，我們在第四季度報告的 MCR 為 93.3%，全年為 90.7%，均高於我們的長期目標範圍，並受到補充福利、家庭服務和高成本藥物利用​​率增加的影響。正如 Joe 所提到的，我們相信，我們對 2024 年福利設計的出價策略調整以及營運改善將在 2024 年為我們的醫療保險業務帶來目標利潤。

In Marketplace, our reported fourth quarter MCR was 79.8%, reflecting our continued success in returning this business to target margins. Our full year Marketplace MCR 75.3% was well below our long-term target range.

在 Marketplace 中，我們報告的第四季度 MCR 為 79.8%，反映出我們在將該業務恢復到目標利潤率方面持續取得成功。我們的全年市場 MCR 75.3% 遠低於我們的長期目標範圍。

Our adjusted G&A ratio for the quarter was 7% as reported. However, when accounting for the California pass-through premium tax item, the ratio restates to 7.3%. This result includes new business implementation spending for new contract wins in California, Nebraska and New Mexico as well as expected seasonal expenditures from Medicare and Marketplace marketing. Our full year adjusted G&A ratio was 7.2%, recognizing the California tax item in the fourth quarter, the full year G&A ratio restates to 7.3%.

據報告，本季調整後的一般管理費用率為 7%。然而，在考慮加州轉嫁保費稅項時，該比率重新調整為 7.3%。這一結果包括在加州、內布拉斯加州和新墨西哥州贏得新合約的新業務實施支出，以及醫療保險和行銷的預期季節性支出。我們全年調整後的 G&A 比率為 7.2%，考慮到第四季度的加州稅項，全年 G&A 比率重述為 7.3%。

Turning to our Bright acquisition. We successfully closed the transaction effective this past January 1, at final price of $425 million net of tax benefits which was lower than our initially announced terms. The acquisition adds 109,000 members and contributes $1.6 billion in premium this year. We acquired the business with a premium deficiency reserve, which is expected to moderate first year losses, but we still expect the acquisition to be approximately $0.50 dilutive to 2024 adjusted EPS. Now that we have owned the business for 6 weeks, we have increased confidence in our assumption that the Bright acquisition will deliver an ultimate accretion of $1 per share as final run rate margin.

談到我們對 Bright 的收購。我們成功完成了這項交易，該交易於今年 1 月 1 日生效，扣除稅收優惠後的最終價格為 4.25 億美元，低於我們最初宣布的條款。此次收購增加了 109,000 名會員，今年貢獻了 16 億美元的保費。我們以保費不足準備金收購了該業務，預計將減輕第一年的虧損，但我們仍然預計此次收購將稀釋 2024 年調整後每股收益約 0.50 美元。現在我們已經擁有該業務 6 週了，我們對 Bright 收購將帶來每股 1 美元最終運行利潤率的假設增加了信心。

Given the expectation of this modest lot in the first year, we are updating the 2024 new store embedded earnings from the Bright acquisition to $1.50 per share, reflecting this $0.50 of first year dilution.

考慮到第一年的這一適度地段的預期，我們將 Bright 收購帶來的 2024 年新店嵌入收益更新為每股 1.50 美元，反映了第一年稀釋的 0.50 美元。

Moving on to Medicaid redeterminations. In the quarter, we estimate we lost 200,000 members driven by redeterminations, bringing the full year figure to approximately 500,000. We are now updating our estimate of members gained during the pandemic to 1 million to include new business additions in 2023 and 2024 as well as the legacy business. Given the high rate of procedural disenrollments rather than through verification, we are seeing a nearly 30% reconnect rate, consistent with previous quarters. As reconnects continue, we expect the membership losses just described to restate to a lower level over the coming months. We continue to project ultimately retaining 40% of our updated members gained, which implies a net loss of 600,000 from the redetermination process.

繼續醫療補助重新確定。在本季度，我們估計因重新決定而失去了 20 萬名會員，使全年數字達到約 50 萬名。我們現在將疫情期間新增會員的估計更新為 100 萬，其中包括 2023 年和 2024 年新增的業務以及原有業務。鑑於程序取消註冊而不是通過驗證的比例很高，我們看到重新連接率接近 30%，與前幾個季度一致。隨著重新連接的繼續，我們預計剛剛描述的會員流失情況將在未來幾個月內重新降至較低水平。我們繼續預計最終將保留 40% 的更新會員，這意味著重新確定過程將帶來 600,000 的淨損失。

The offsetting positive impact from our growth initiatives is significant. We ended 2022 with 4.8 million Medicaid members, and we expect to close out 2024 with 5.1 million members, a net 300,000 member growth over a 2-year period, despite the losses from redetermination.

我們的成長舉措所抵銷的正面影響是巨大的。截至 2022 年，我們的醫療補助會員人數為 480 萬，預計 2024 年結束時，會員人數將達到 510 萬，儘管重新確定造成了損失，但在 2 年內淨增了 30 萬會員。

Moving to Medicaid rates. We now have visibility into rates impacting approximately 80% of our 2024 premium. All but one of our states have now included an acuity adjustment for redetermination for 2024. We continue to work with our state partners to ensure appropriate rates through the normal rate cycle, retroactive or mid-cycle adjustments, given the experience to date. We are confident that the requirement for actuarially sound rates will offset trends as they may emerge. Updated rates and trend assumptions have been considered in the 2024 Medicaid MCR that supports our guidance.

轉向醫療補助費率。我們現在可以了解影響 2024 年保費約 80% 的費率。除一個州外，我們所有州現已納入 2024 年重新確定的敏銳度調整。根據迄今為止的經驗，我們將繼續與州合作夥伴合作，透過正常利率週期、追溯或週期中期調整確保適當的利率。我們相信，對精算合理利率的要求將抵銷可能出現的趨勢。支持我們指導的 2024 年醫療補助 MCR 已考慮更新的費率和趨勢假設。

Turning to our balance sheet. Our capital foundation remains strong. We harvested approximately $280 million of subsidiary dividends in the quarter, and our parent company cash balance was approximately $740 million, a portion of which was used to fund the Bright Medicare acquisition just after the first of the year. Debt at the end of the quarter was 1.4x trailing 12-month EBITDA with our debt-to-cap ratio at 36.3%. These ratios reflect our low leverage position and ample cash and capital capacity for additional growth and investment.

轉向我們的資產負債表。我們的資本基礎依然雄厚。本季我們獲得了約 2.8 億美元的子公司股息，母公司現金餘額約為 7.4 億美元，其中一部分用於為年初後收購 Bright Medicare 提供資金。本季末的債務是過去 12 個月 EBITDA 的 1.4 倍，負債上限比率為 36.3%。這些比率反映了我們的低槓桿狀況以及充足的現金和資本能力，可以實現額外的成長和投資。

Our reserve approach remains consistent with prior quarters, we are confident in the strength of our reserve position. Days in claims payable at the end of the quarter was 50.

我們的儲備方法與前幾季保持一致，我們對儲備部位的實力充滿信心。季度末應付索賠天數為 50 天。

Now some additional details on our 2024 guidance, beginning with membership. In Medicaid, we expect new membership from our recent new contract wins to add approximately 650,000 members. We expect to lose 100,000 members over the remainder of the redetermination process in 2024. The net result in 2024 year-end membership of approximately 5.1 million members or 12% growth year-over-year.

現在是關於我們 2024 年指導的一些額外細節，首先是會員資格。在醫療補助計劃方面，我們預計最近贏得的新合約將增加約 65 萬名會員。我們預計在 2024 年重新確定過程的剩餘時間內將失去 10 萬名會員。最終結果是 2024 年年底會員人數約為 510 萬，年成長 12%。

In Medicare, the Bright acquisition added 109,000 members. Combined with our legacy business, we expect to end 2024 with 270,000 Medicare members, representing 58% growth year-over-year.

在醫療保險方面，Bright 的收購增加了 109,000 名會員。結合我們的傳統業務，我們預計到 2024 年底，醫療保險會員數量將達到 270,000 名，年增 58%。

In Marketplace, based on open enrollment, we expect to begin 2024 with approximately 320,000 members, representing 14% growth from year-end 2023. We expect growth to continue through the year, boosted by the redetermination conversions and ending with approximately 370,000 members, representing 31% growth year-over-year.

在Marketplace 中，根據開放註冊情況，我們預計2024 年開始將擁有約320,000 名會員，較2023 年底增長14%。我們預計，在重新確定轉換的推動下，這一增長將持續到全年，到年底將擁有約37 萬名會員，代表年增31%。

We are still 75% Silver, which bodes well for medical margin stability.

我們仍然有 75% 的白銀，這預示著醫療利潤率的穩定性。

Our 2024 premium revenue guidance is approximately $38 billion, representing 17% growth from 2023. Our revenue growth is comprised of several items: $3.3 billion of revenue tied to our recent RFP wins. To this, we add $2.4 billion of revenue from our recently closed acquisitions, including $1.6 billion from Bright and $800 million from a full year of My Choice Wisconsin. And finally, $1.7 billion of organic growth across Medicaid, Medicare and Marketplace. Partially offsetting these growth drivers is a higher estimated full year impact of $1.9 billion in decreased revenue from redeterminations.

我們的 2024 年保費收入指引約為 380 億美元，較 2023 年成長 17%。我們的營收成長由多個項目組成：33 億美元的收入與我們最近贏得的 RFP 相關。除此之外，我們還從最近完成的收購中增加了 24 億美元的收入，其中包括 Bright 的 16 億美元和 My Choice Wisconsin 全年的 8 億美元收入。最後，醫療補助、醫療保險和市場的有機成長達到 17 億美元。重新確定導致收入減少 19 億美元，預計全年影響較高，部分抵消了這些成長動力。

Moving on to earnings guidance. We expect 2024 full year adjusted earnings of at least $23.50 per share. Our EPS guidance reflects the realization of approximately $2 per share of 2023 new store embedded earnings, approximately $2 for the underlying organic growth across our current Medicaid and Medicare footprints, the realization of $0.75 benefit from the onetime nonrecurring implementation costs incurred in 2023, partially offset by $1.25 impact from redeterminations and $0.50 impact from the Bright acquisitions first year operating and carrying costs, and finally, $0.25 from a conservative view of earnings contribution from investment income.

轉向盈利指引。我們預計 2024 年全年調整後每股盈餘至少為 23.50 美元。我們的每股盈餘指引反映了2023 年新店嵌入收益每股約2 美元的實現，我們當前醫療補助和醫療保險足跡的潛在有機增長約2 美元，2023 年產生的一次性非經常性實施成本實現了0.75 美元的收益，部分抵銷重新確定的影響為 1.25 美元，Bright 收購第一年營運和持有成本的影響為 0.50 美元，最後，投資收入對獲利貢獻的保守觀點為 0.25 美元。

Turning to MCR guidance. Our consolidated medical care ratio is expected to be 88.2%. Our Medicaid MCR is expected to be 89%, at the high end of our long-term target range. This guidance reflects the inclusion of our significant new store growth, which runs at a higher MCR in the first year. Our legacy or same-store Medicaid MCR is expected to fall in the middle of our long-term range. We anticipate our Medicare MCR to be 88%, while at the high end of our long-term target range, the MCR reflects our expected success in our 2024 bid strategy adjustments to benefit design and various operational improvements. For Marketplace, we expect the MCR at the low end of the long-term target MCR range of 78% to 80%.

轉向 MCR 指導。我們的綜合醫療比例預計為88.2%。我們的醫療補助 MCR 預計為 89%，處於我們長期目標範圍的高端。該指引反映了我們新店的顯著成長，第一年的 MCR 較高。我們的傳統或同店醫療補助 MCR 預計將落在我們長期範圍的中間。我們預計我們的醫療保險 MCR 將為 88%，而處於我們長期目標範圍的高端，MCR 反映了我們在 2024 年投標策略調整中對福利設計和各種營運改進的預期成功。對於 Marketplace，我們預計 MCR 處於長期目標 MCR 範圍的低端，即 78% 至 80%。

Moving on to select P&L guidance metrics. We expect our adjusted G&A ratio to fall to 7% as new business implementation costs subside, and we leveraged the increased scale of our business. Effective tax rate of 25.7%, adjusted pretax margin of 4.6%, well within our long-term target range. Weighted average share count unchanged at 58.1 million shares and our quarterly EPS will be weighted slightly heavier towards the second half of the year as we drive improved performance in our new business portfolio additions over the course of the year.

繼續選擇損益指引指標。隨著新業務實施成本的下降以及我們業務規模的擴大，我們預計調整後的一般管理費用比率將降至 7%。有效稅率為25.7%，調整後稅前利潤率為4.6%，完全在我們的長期目標範圍內。加權平均股數維持在 5,810 萬股不變，下半年我們的季度每股收益將略有增加，因為我們在這一年中推動了新業務組合增加的業績改善。

Turning to embedded earnings. We ended 2023 with $5.50 per share of new store embedded earnings. Our 2024 guidance includes the realization of $2, resulting in a new base of $3.50. To this, we add $0.50 for the impact of Bright acquisition's first year loss, leaving us with $4 remaining at the end of 2024. We expect the majority of this to emerge in 2025 giving us further confidence in our 15% to 18% long-term growth rate for EPS.

轉向嵌入收益。 2023 年末，我們的新店嵌入收益為每股 5.50 美元。我們的 2024 年指引包括實現 2 美元，從而形成 3.50 美元的新基數。為此，我們為Bright 收購第一年虧損的影響增加0.50 美元，到2024 年底我們還剩下4 美元。我們預計其中大部分將在2025 年出現，這讓我們對15% 至18% 的長期虧損進一步充滿信心。EPS 的長期成長率。

This concludes our prepared remarks. Operator, we are now ready to take questions.

我們準備好的演講到此結束。接線員，我們現在準備好回答問題。

(Operator Instructions) The first question today comes from A.J. Rice with UBS.

（操作員說明）今天的第一個問題來自 A.J.賴斯與瑞銀。

Maybe 2 things. On the Medicare MLR margin, it sounds like you're attributing your improvements that you're expecting largely to benefit design changes and operational improvements. Any comment on what you're assuming relative to underlying utilization trends?

也許有兩件事。在 Medicare MLR 利潤方面，聽起來您將您的改進歸因於您希望很大程度上有利於設計變更和營運改進。對於您對潛在利用率趨勢的假設有何評論？

And then just on the Medicaid, you're sounding like you'll be on the legacy business in the middle of your long term MLR targets. How are you thinking about margin profile coming out of redeterminations? Is there an opportunity for further improvement? Is it steady? Any thoughts on that?

然後，就醫療補助而言，聽起來您將在長期 MLR 目標中從事傳統業務。您如何看待重新確定後的保證金狀況？還有進一步改進的機會嗎？穩定嗎？對此有什麼想法嗎？

Sure, A.J. With respect to the Medicare MLR question, we have 3 components of medical costs that ran higher than expectations. One was LTSS hours on the Medicaid side of the MMP business; second, high-cost drugs; and third, supplemental benefits, vision, dental, cash card, over-the-counter was a little too richly designed in 2023, to be honest. We pulled back on those benefits in our 2024 product design and bids. We reshaped some of the allowance based benefits to be more managed, and we're confident that, that cost category will come back into line.

當然，A.J.關於醫療保險 MLR 問題，我們發現醫療費用的 3 個組成部分高於預期。其中之一是 MMP 業務醫療補助方面的 LTSS 小時數；二是高價藥品；第三，說實話，補充福利、視力、牙科、現金卡、非處方藥在 2023 年設計得有點太豐富了。我們在 2024 年產品設計和投標中取消了這些優勢。我們重新調整了一些基於津貼的福利，以便更好地管理，我們相信，該成本類別將恢復正常。

On LTSS hours, on the Medicaid side of the MMP benefit, we know where, we know why and those corrective actions are in place. And it's not unusual in a soft economy for in-home service hours to increase. So we are very confident in the restoration of our MCRs back to the top end of the range in Medicare to 88% in 2024.

在 LTSS 時間內，在 MMP 福利的醫療補助方面，我們知道在哪裡、我們知道原因以及這些糾正措施是否已到位。在經濟疲軟的情況下，家庭服務時間增加並不罕見。因此，我們非常有信心在 2024 年將 MCR 恢復到醫療保險範圍的上限，達到 88%。

You also asked about the Medicaid MLR. And let me frame it this way, and then I'll turn it to Mark. The redetermination process actually unfolded exactly and as we had predicted. The acuity shift was noticeable, but it was -- it wasn't dramatic and it wasn't significant, but it was noticeable. And that began to happen as the redetermination process began. We then said, and it occurred that the first financial cushion would be the corridors, the payments into the corridors that existed in the latter half of 2023. That acted as a financial buffer. In the meantime, as the acuity shift became noticeable to our state partners, they began to introduce rate adjustments to account for the acuity shift. So going into 2024, the rate actions completely compensated for what we call core medical trend, completely compensated (inaudible) acuity shift and that's why we're able to print an MCR in Medicaid at the high end of the range at 89%, which includes a little bit of pressure from the new business that we put on the books.

您也詢問了醫療補助 MLR。讓我這樣構想一下，然後我會把它交給馬克。重新確定的過程實際上正如我們所預測的那樣展開。敏銳度的變化是顯而易見的，但它並不引人注目，也不顯而易見，但它是顯而易見的。隨著重新決定過程的開始，這種情況就開始發生。然後我們說，第一個財務緩衝將是走廊，即 2023 年下半年存在的走廊付款。這起到了財務緩衝的作用。同時，隨著我們的州合作夥伴注意到敏銳度的變化，他們開始引入費率調整來解釋敏銳度的變化。因此，進入 2024 年，利率行動完全補償了我們所說的核心醫療趨勢，完全補償（聽不清）敏銳度轉變，這就是為什麼我們能夠在醫療補助中以 89% 的高端打印 MCR，這包括我們記入帳簿的新業務帶來的一點壓力。

Joe summarized that well. Look, we finished 88.7% in 2023 for Medicaid. And as Joe mentioned, that included a little bit of pressure from the acuity shift from redebt but also, as we projected, the benefit of some corridors. So really tracking exactly where we expected.

喬總結得很好。看，我們 2023 年醫療補助完成了 88.7%。正如喬所提到的，這包括來自贖回敏銳度轉變的一點壓力，但正如我們預期的那樣，也包括一些走廊的好處。所以確實準確地追蹤了我們的預期。

Here in the new year on our legacy book, trend roughly equals the rates that we're getting from our state partners. So on our legacy book into '24, we're roughly seeing about a flat MLR versus where we finished 2023.

在我們的遺產書中的新的一年裡，趨勢大致等於我們從國家合作夥伴那裡得到的利率。因此，在我們 24 年的舊書中，我們大致看到 MLR 與 2023 年結束時持平。

Now why are we at an 89% in guidance? Just as Joe mentioned, we're adding significant new store business through both our acquisitions and a number of big wins. Whenever we have new store and go into our portfolio, it tends to be a little bit hotter in the first year on an MLR. So we're seeing a pretty much flat carryover on legacy, a little bit of increased pressure on new store. That's how you get to that 89% that we have in our guidance.

現在為什麼我們的指導率為 89%？正如喬所提到的，我們透過收購和一系列重大勝利增加了重要的新商店業務。每當我們有新商店並進入我們的投資組合時，MLR 的第一年往往會更熱一些。因此，我們看到傳統商店的結轉幾乎持平，而新商店的壓力略有增加。這就是您達到我們指導中的 89% 的方法。

The next question comes from Cal Sternick with JPMorgan.

下一個問題來自摩根大通的卡爾·斯特尼克。

I wanted to ask about the marketplace. It sounds like the book is running really well and I think you were a little bit more competitively priced this year than you were previously. So I guess, first, the expectation we talk about mid-single digit to high single-digit margins that you're within sort of that 5% to 7% range, do you expect to be towards the upper half of that or maybe a bit above?

我想問一下市場的狀況。聽起來這本書的銷售量非常好，我認為今年的價格比以前更有競爭力。所以我想，首先，我們所談論的預期是中個位數到高個位數的利潤率，你在5% 到7% 的範圍內，你預計會達到這個數字的上半部分，或者可能是一個上面一點？

And then second, how do you think about the market and the positioning for 2025? Do you think you're still going to maintain the current pricing position? Or do you expect to, I guess, be more competitive across your total footprint again?

其次，您如何看待2025年的市場與定位？您認為您還會維持目前的定價地位嗎？或者我想，您是否希望在整個業務範圍內再次更具競爭力？

Cal, our strategy in Marketplace until we were satisfied that the risk pool was stabilized is to keep it, as we say, small, silver and stable. But as the risk pool has stabilized, irrational pricing has pretty much left the market. We will allocate more capital to this business, and we'll grow it at a rate that allows us to earn mid- to high single-digit margins. That's the key for us. The risk pool can have inherent volatility, and we believe that a margin target of 5% to 7%, as you suggested, is the right target margin, and we will grow the business at a rate that allows us to achieve that target margin.

Cal，在我們對風險池穩定感到滿意之前，我們在市場上的策略是保持風險池小，白銀和穩定。但隨著風險池趨於穩定，非理性定價幾乎已經離開市場。我們將向這項業務分配更多資本，並以一定的速度成長它，使我們能夠獲得中高個位數的利潤。這對我們來說是關鍵。風險池可能具有固有的波動性，我們認為，正如您所建議的那樣，5％至7％的保證金目標是正確的目標保證金，我們將以能夠實現該目標保證金的速度發展業務。

We're very competitively positioned this year. We are in our silver product, we were #1 in (inaudible) 30% of our counties this year as compared to 20% last year. 75% of the book is still silver, 50% of the book is renewal, which gives us good insight to capture appropriate risk scoring. The book is very well positioned to grow. 31% membership growth, 17% revenue growth just this year. And hopefully, we'll be able to grow it at this rate in the future. All with the goal of achieving mid- to high single-digit margins.

今年我們的競爭非常激烈。我們的白銀產品今年在 30% 的縣（聽不清楚）中排名第一，而去年這一比例為 20%。這本書的 75% 仍然是白銀，50% 的書是續訂的，這為我們提供了很好的洞察力來捕捉適當的風險評分。這本書非常適合成長。今年會員人數增加了 31%，營收成長了 17%。希望我們將來能夠以這樣的速度成長。所有這些都是為了實現中高個位數的利潤率。

The next question comes from Kevin Fischbeck with Bank of America.

下一個問題來自美國銀行的 Kevin Fischbeck。

Maybe 2 questions, if I could sink it in. I guess the first one on the Medicare side. I just want to make sure I just take your commentary around MLR because you're bringing in Bright with a PDR, but you're still saying you're going to be at the overall target margin, are you talking about the core business being at target margin or even with Bright losing money, you'll be at target margin on the consolidated book?

也許有兩個問題，如果我能理解的話。我想第一個問題是關於醫療保險方面的。我只是想確保我只是接受您對 MLR 的評論，因為您引入了帶有 PDR 的 Bright，但您仍然說您將達到總體目標利潤率，您是否在談論核心業務達到目標利潤率，或者即使Bright 虧損，您的合併帳簿也會達到目標利潤率嗎？

And then thinking about the exchanges, I guess, there was potentially some issue about redetermination to keep people off and then the sickest part of that population comes on to the exchanges. Are you seeing any of that? Or does the risk pool benefit of lower subsidies, just kind of make that not really an issue?

然後考慮交易所，我想，可能存在一些關於重新決定讓人們遠離交易所的問題，然後該人群中病情最嚴重的部分就會進入交易所。你看到這些了嗎？或者風險池是否會受益於較低的補貼，從而使這不再是一個真正的問題？

Kevin. I'm going to kick it to Mark for a detailed commentary on the Medicare MLR, but I think it's really important to frame the Medicare business and its component parts. They're somewhat different and situationally, they are quite different. You have $6 billion of revenue forecasted for 2024 in Medicare, $1.6 billion is Bright newly acquired, subject to the premium deficiency reserve, as you suggested, and Mark will explain that in a minute. $2.4 billion is our legacy DSNP business and $2 billion are the MMP demonstrations where rates are received from CMS, you're not [bidding] against the benchmark.

凱文.我將請馬克對 Medicare MLR 進行詳細評論，但我認為建立 Medicare 業務及其組成部分非常重要。它們有些不同，而且在情況上也有很大不同。正如您所建議的，您預計 2024 年 Medicare 收入將達到 60 億美元，Bright 新收購的收入為 16 億美元，但須遵守保費不足準備金，Mark 稍後會對此進行解釋。 24 億美元是我們的傳統 DSNP 業務，20 億美元是 MMP 演示，其中費率是從 CMS 收到的，您不是根據基準[出價]。

So the dynamics in the book of business are quite different. You need to look at the 3 components in order to develop your view of the various profitability components.

因此，商業書中的動態是完全不同的。您需要查看這 3 個組成部分，才能形成對各種盈利能力組成部分的看法。

But with that as the backdrop in the context, I'll kick it to Mark for detailed commentary on how you build the Medicare MLR, particularly with respect to Bright and the premium deficiency reserve. Mark?

但以此為背景，我將向 Mark 提出有關如何建立 Medicare MLR 的詳細評論，特別是在 Bright 和保費不足準備金方面。標記？

Yes. Fantastic. So break comes to us with a PDR in place. With that PDR, the benefit goes into the MLR line and effectively reduces the MLR. So on the Bright component, which is 1/3 of our book, you'll see an MLR that's below our target range at the moment. On the DSNP, which is another 1/3 of our business, we're seeing trend of probably around 4%. But overall, we're able to offset that and pull that into our target range. And of course, on MMP, which is the third component of the book, the rates that we're getting from our state and CMS partners, we feel are quite adequate to bring us all told to that 88% in our MLR guidance.

是的。極好的。因此，隨著 PDR 的到位，我們迎來了突破。有了這個 PDR，收益就會進入 MLR 行並有效地降低 MLR。因此，在 Bright 組件（即我們書中的 1/3）上，您會看到 MLR 低於我們目前的目標範圍。 DSNP 占我們業務的另外 1/3，我們看到的趨勢可能約為 4%。但總的來說，我們能夠抵消這一影響並將其拉入我們的目標範圍。當然，對於 MMP（本書的第三部分），我們從州和 CMS 合作夥伴處獲得的費率，我們認為足以讓我們所有人達到 MLR 指導中的 88%。

With respect to your second question, if I remember correctly, you had to do with the exchanges and members coming off of the Medicaid roles into the exchanges. If you look at the last couple of years, membership has already -- always started the year at a higher point and ended the year at a lower point due to the natural attrition of the book. This year, we're starting the year at 320,000 members and plan to grow it to 370,000 by the end of the year. The natural attrition rate is still 2% or 3% inside that number, but we do plan to pick up more members from not only our own Medicaid plans, but competitors' Medicaid plans. I think we're seeing a penetration rate of people coming off Medicaid of about 10% of members lost.

關於你的第二個問題，如果我沒記錯的話，你必須與交易所和會員從醫療補助角色進入交易所有關。如果你看看過去幾年，由於書籍的自然流失，會員資格總是以較高的點開始新年，以較低的點結束。今年，我們年初的會員數量為 32 萬名，並計劃在年底將其增加到 37 萬名。自然流失率仍處於該數字之內的 2% 或 3%，但我們確實計劃不僅從我們自己的醫療補助計劃中，而且從競爭對手的醫療補助計劃中招募更多成員。我認為我們看到脫離醫療補助的人的滲透率約為 10%。

Mark, anything to add?

馬克，有什麼要補充的嗎？

Yes. In the past, when we picked up SEP members, they put a little pressure on our MLR. What we're seeing in the third and fourth quarter in '23 and what I expect into '24 is they'll come over at more sustaining and normalized levels. That is they won't put pressure on because they're coming off normal using services. There's not pent-up demand. They're not new to the product. So I'm expecting to see a good pickup on SEP as we did in Q3 and Q4 and not pressure on the MLR.

是的。過去我們吸收SEP成員的時候，他們給我們國土資源部帶來了一點壓力。我們在 23 年第三季和第四季看到的以及我對 24 年的預期是，它們將達到更持續和正常化的水平。也就是說，他們不會施加壓力，因為他們不再正常使用服務。沒有被壓抑的需求。他們對該產品並不陌生。因此，我預計 SEP 會像第三季和第四季一樣出現良好的回升，而不會對 MLR 造成壓力。

The next question comes from Josh Raskin with Nephron.

下一個問題來自 Josh Raskin 和 Nephron。

Two for me as well. Just the health insurance exchange membership up 31%, but revenue is up 17%. Is that state geography mix related? Or is that reductions in prices? And what's driving that versus a market that's generally raising prices?

我也有兩個。光是健康保險交易所的會員人數就增加了 31%，但收入卻增加了 17%。這與州地理組合有關嗎？或者說這就是降價？與價格普遍上漲的市場相比，是什麼推動了這個趨勢？

And then I'm still confused on Bright, how the target -- how the MLR for Bright that you're booking this year is below the target range, but you're actually increasing the embedded earnings by $0.50 to $1.50? Maybe just help us understand those 2 parts.

然後我仍然對 Bright 感到困惑，您今年預訂的 Bright 的 MLR 目標如何低於目標範圍，但您實際上將嵌入收益增加了 0.50 美元到 1.50 美元？也許只是幫助我們理解這兩個部分。

So a couple of things, Josh. Our metallic mix has remained unchanged. So what you're seeing in Marketplace is not at all metallic or mix related, that's state footprint related. As you know, we're in 14 states. And our mix among the states as we're more competitive in some, maybe not so much in others, our mix does shift a little bit. So that would be the driver there.

有幾件事，喬許。我們的金屬組合保持不變。因此，您在 Marketplace 中看到的內容根本與金屬或混合無關，而是與狀態足跡相關。如您所知，我們分佈在 14 個州。我們在各州之間的組合由於我們在某些​​州更具競爭力，而在其他州可能沒有那麼多，因此我們的組合確實發生了一些變化。那就是那裡的司機。

On Bright on the PDR, with the PDR that was booked before we bought the business, that benefits the MLR and pulls it down to a level that's actually a little bit below our target range. Now remember, our target range is largely DSNP and MMP because that's our legacy Medicare book. On the Bright, with the PDR in the MLR line, it does pull it down a little bit below our target range.

在 Bright 的 PDR 上，我們在購買該業務之前就預訂了 PDR，這對 MLR 有利，並將其拉低到實際上略低於我們目標範圍的水平。現在請記住，我們的目標範圍主要是 DSNP 和 MMP，因為這是我們遺留的 Medicare 書籍。在光明區，PDR 位於 MLR 線，它確實將其拉低至低於我們的目標範圍。

And so how does that impact -- I'm just trying to -- so it feels like with the PDR, which you guys will sort of reverse that through the year, how does the embedded earnings go up, right? I'm confused that how was Bright's MLR low, but they're losing more money.

那麼，這種影響是如何影響的——我只是想——所以感覺就像 PDR 一樣，你們將在這一年裡扭轉這一局面，嵌入收益如何上升，對嗎？我很困惑 Bright 的 MLR 為何如此之低，但他們卻損失了更多的錢。

It's a good question, and thanks for raising that. I knew we were going to get that sooner or later. So with the PDR, as you know, the PDR should largely normalize expected operating losses on a contract year. PDR accounting doesn't allow you to put all of the losses into the PDR. There are certain accounting matters that are still held out. So even with the PDR, I'll have a very small operating loss, Josh. But the other thing is, when we talk about embedded earnings, we always include the carrying costs. The embedded earnings are essentially fully capitalized or fully funded for their carrying costs. So when I say I have about $0.50 of dilution this year, it's about half operating costs that aren't covered by the PDR and about half carrying costs. Remember, we paid about $0.5 billion. The opportunity cost or interest on that is maybe the other half of the $0.50.

這是一個很好的問題，感謝您提出這個問題。我知道我們遲早會得到這個。因此，如您所知，對於 PDR，PDR 應在很大程度上使合約年的預期營運損失正常化。 PDR 會計不允許您將所有損失計入 PDR。某些會計事項仍懸而未決。因此，即使有了 PDR，我的營運損失也非常小，喬許。但另一件事是，當我們談論嵌入收益時，我們總是包括持有成本。嵌入收益基本上已完全資本化或完全為其持有成本提供資金。因此，當我說今年的稀釋度約為 0.50 美元時，大約有一半的營運成本未包含在 PDR 中，還有大約一半的持有成本。請記住，我們支付了大約 5 億美元。機會成本或利息可能是 0.50 美元的另一半。

So as a result, I'm carrying a $0.50 hole in this year's EPS bridge. Since that's a $0.50 hole, I said I'd have a $1 of ultimate benefit from this property, the $1 now goes to $1.50 because I'm going to crawl out of that hole over the next couple of years.

因此，我今年的 EPS 橋上有 0.50 美元的缺口。由於這是一個 0.50 美元的漏洞，我說我將從該房產中獲得 1 美元的最終收益，現在 1 美元變為 1.50 美元，因為我將在未來幾年內爬出該漏洞。

The next question comes from Justin Lake with Wolfe Research.

下一個問題來自沃爾夫研究中心的賈斯汀·萊克。

Just want to follow up on Bright. So a few things here. First, can you give me the PDR number that you put through there for 2024?

只是想跟進 Bright 的情況。這裡有一些事情。首先，您能給我您輸入的 2024 年 PDR 號碼嗎？

Sure. We acquired the business with a $75 million PDR on the balance sheet.

當然。我們收購了該業務，資產負債表上的 PDR 為 7,500 萬美元。

Okay. And so you're saying the -- I understand the PDR getting it to normal levels potentially, but how does the PDR get it below normal MLR levels?

好的。所以你是說——我理解 PDR 有可能使其達到正常水平，但 PDR 如何使其低於正常 MLR 水平？

The PDR books all of the losses. It picks up a little bit of the G&A losses with the medical cost losses and books them into the medical cost line. So to the extent that there were some G&A items, it will get picked up in the MLR line. It's just an accounting convention where the net of losses get picked up in one line item or the other.

PDR 記錄了所有損失。它將一部分一般管理費用損失與醫療費用損失一起計入醫療費用項目。因此，如果有一些一般及行政費用項目，它將在 MLR 行中被拾取。這只是一種會計慣例，其中損失淨額在一個或另一個行項目中計算出來。

Okay. So your point is that just thinking about the math of this, the MLR is going to go up next year because it's actually below normal, and you're seeing the SG&A will come down?

好的。所以你的觀點是，只要考慮一下這個數學問題，MLR 明年就會上升，因為它實際上低於正常水平，而你看到 SG&A 會下降？

There will be a little bit of that, Justin.

會有一點這樣的，賈斯汀。

Okay. And you expect to get this full $1 back plus in 2025?

好的。您預計在 2025 年能收回全部 1 美元嗎？

And that's the important point. The important point here, first of all, the first year losses were fully contemplated in the value we paid. So there was no surprise there. The business is running at a 92% MCR and a 14% G&A ratio. We plan to get the 92% down to 88% to 89% and the 14% down to 9% to 10%. So half to 2/3 of the turn is G&A related, and we have a very, very clear line of sight to how to take their cost burden down from 14% to 9% or 10% where it should be.

這就是重點。這裡重要的一點是，首先，我們支付的價值中充分考慮了第一年的損失。所以這並不奇怪。該業務的 MCR 率為 92%，一般管理費用率為 14%。我們計劃將 92% 的比例降至 88% 至 89%，將 14% 的比例降至 9% 至 10%。因此，一半到 2/3 的支出與 G&A 相關，我們對於如何將其成本負擔從 14% 降低到 9% 或 10% 有著非常非常清晰的目標。

That $1 of accretion is expected to emerge in the third full year of ownership. First year protected by -- mostly protected by a PDR. Second year breakeven to probably slightly profitable, full $1 of accretion and your first and third full year of ownership, getting the MCR from 92% down to 88% or 89%, getting the 14% G&A ratio down to 9% or 10%.

預計這 1 美元的增值將在所有權的第三個完整年度出現。第一年受 PDR 保護－大部分受 PDR 保護。第二年達到損益平衡，可能略有獲利，全額增值1 美元，以及您的第一年和第三年所有權，將MCR 從92% 降至88% 或89%，將14% 的G&A 比率降至9% 或10%。

Got it. And then lastly, just on -- there's a big RFP, as you know, in Florida, I think a lot of anticipation there around when that might be communicated. My understanding is we're kind of into the second round of negotiations. I assume you can't tell us whether you're still kind of in the running there. But any idea given where you are today, any idea when you think that under normal conditions that MLR would be announced? -- or it should maybe RFP would be announced, not the MLR.

知道了。最後，正如你所知，在佛羅裡達州有一個很大的 RFP，我認為人們對何時可以傳達這一訊息抱有很多期待。我的理解是我們已經進入了第二輪談判。我想你不能告訴我們你是否仍然在那裡跑步。但是考慮到您今天的處境，您認為在正常情況下 MLR 會被宣布嗎？ ——或者也許應該公佈 RFP，而不是國土資源部。

Sure. And we appreciate your sensitivity to the situation. Yes, we observed the sanctity of all these bidding process, including the ITN process, so we can't comment specifically on it. But look, as we run a nice business in Florida, it's smaller than it used to be through regions. We used to be (inaudible) statewide back in 2017, it runs really well. We're the only 4-star plant in Florida and the same team that works on all our successful bids, our $12 million of re-procured revenue and our $7 billion of new contract wins is the same team that worked on this. So we go into it with a great deal of confidence, and we would hope to expand our footprint in Florida.

當然。我們感謝您對局勢的敏感。是的，我們觀察到所有這些招標過程（包括 ITN 流程）的神聖性，因此我們無法對其進行具體評論。但你看，我們在佛羅裡達州經營著一家不錯的企業，但它的規模比以前還要小。早在 2017 年，我們就在全州範圍內（聽不清楚），運作得非常好。我們是佛羅裡達州唯一的四星級工廠，所有成功的投標、1200 萬美元的重新採購收入和 70 億美元的新合約都是由同一個團隊負責的。因此，我們充滿信心地投入其中，並希望擴大我們在佛羅裡達州的足跡。

There's $14 billion of Medicaid revenue in Florida regions where we are not currently represented. But let's see how the process plays out and hopefully, something will be announced -- awards will be announced some time later this spring.

佛羅裡達州地區有 140 億美元的醫療補助收入，但我們目前尚未在這些地區提供服務。但讓我們看看這個過程如何進行，希望能夠宣布一些事情——獎項將在今年春天晚些時候公佈。

The next question comes from Stephen Baxter with Wells Fargo.

下一個問題來自富國銀行的史蒂芬‧巴克斯特。

I appreciate all the commentary on your Medicaid expectations for the year. I was hoping you could help us think about the bridge from your Medicaid MLR exiting the year to your same-store Medicaid MLR in 2024, the -- or around the midpoint of the range. I'm curious if you think that the core could kind of get there earlier in the year because some of the 1/1 rate adjustments that we've been focused on? Or do you think that will take some time to kind of work through the business and other seasonal factors play out?

我感謝所有關於您今年醫療補助期望的評論。我希望您能幫助我們考慮從今年退出的醫療補助 MLR 到 2024 年同店醫療補助 MLR（即該範圍的中點附近）之間的橋樑。我很好奇您是否認為核心可能會在今年早些時候到達那裡，因為我們一直在關注的一些 1/1 利率調整？或者您認為這需要一些時間才能透過業務和其他季節性因素發揮作用嗎？

As a general framework for how we stay within our long-term range year-over-year, in fact, on a same-store basis, almost equivalent. We talk about the redetermination process, which late in 2023, began to put pressure on the MLR until rates caught up with it. As Mark commented in his prepared remarks, we know about Medicaid rates on 80% of our revenue for 2024. That rate increase came in at 4%, so that blends to about 3.2%. We forecasted the other 20% at less than half that. So we have a 3.5% rate increase built into our 2024 guidance. And that was exactly commensurate with trend, trend even as influenced by the modest acuity shift that we and our state customers have observed. So pretty much business as usual. There's no medical cost category that needed to be accounted for or accommodated. It's actuarially sound rates impacted by acuity adjustments at 20 of 21 of our states included, and it was completely in line with our contemplated medical cost trend even as influenced by an acuity shift.

作為我們如何逐年保持在長期範圍內的整體框架，事實上，在同店基礎上，幾乎是相同的。我們談論的是 2023 年底的重新確定過程，該過程開始對國土資源部施加壓力，直到利率趕上它。正如馬克在他準備好的發言中評論的那樣，我們知道 2024 年我們收入的 80% 的醫療補助費率為 4%，因此混合後約為 3.2%。我們預計另外 20% 的比例將不到一半。因此，我們的 2024 年指導方針中包含了 3.5% 的利率上漲。這與趨勢完全相符，即使受到我們和我們的州客戶觀察到的適度敏銳度轉變的影響。所以一切照常進行。沒有需要考慮或適應的醫療費用類別。在我們所納入的 21 個州中，有 20 個州的精算結果受到了敏銳度調整的影響，而且即使受到敏銳度變化的影響，它也完全符合我們預期的醫療成本趨勢。

Mark, anything to add?

馬克，有什麼要補充的嗎？

No, I think that's exactly right. As we look at the rates and the trend being roughly equal, our legacy book pretty much holds flat. As you know, we're bringing in a bunch of additional new business that puts a little more pressure in the first year, which ramps us out at the 89% that we have in guidance.

不，我認為這是完全正確的。當我們看到比率和趨勢大致相等時，我們的遺產書幾乎持平。如您所知，我們引入了許多額外的新業務，這在第一年帶來了更大的壓力，這使我們達到了指導價值的 89%。

The next question comes from Nathan Rich with Goldman Sachs.

下一個問題來自高盛的內森·里奇。

I wanted to ask on the Marketplace MCR, I guess moving back to the low end of the long-term range, so up about 300 basis points year-over-year. Can you just talk about what's driving that increase year-over-year? Is that just a function of the membership growth that you saw?

我想問市場 MCR，我想會回到長期範圍的低端，因此同比上漲約 300 個基點。您能談談是什麼推動了這一同比增長嗎？這只是您所看到的會員成長的函數嗎？

And then have you thought -- how, I guess, are you thinking about maybe the long-term target for that business? Is 78% to 80% still the right range to use?

然後你有沒有想過——我猜你是如何考慮該業務的長期目標的？ 78% 到 80% 仍然是正確的使用範圍嗎？

And then just one clarifying question for Mark. I think you said quarterly EPS is weighted towards the back half of the year. I think usually, the back half is about 45% of the total year. So does that mean this year will be over 50%? Or is that not the right way to interpret the comment that you made?

然後向馬克提出一個澄清問題。我想你說過季度每股收益是對下半年進行加權的。我認為通常情況下，下半年大約佔全年的45%。那麼這是否意味著今年會超過50%？或者這不是解釋您所發表評論的正確方式？

Nate, I'll take the Marketplace question first. We were running really well in the middle of 2023. Our experience was quite positive. So we consciously, consciously bid to grow the business modestly and moderately as we suggested we would. And so we price somewhat below the observed trend, not hugely below the observed trend, but slightly below the observed trend to essentially invest some of the excess margin. We earned nearly 10% pretax in that business in 2023. So in a sense, we invested some of the excess margin in growth, hence, the 31% membership growth and 17% revenue growth.

內特，我將首先回答市場問題。我們在 2023 年中期運行得非常好。我們的經驗非常積極。因此，我們有意識地、有意識地按照我們建議的那樣，適度、適度地發展業務。因此，我們的定價略低於觀察到的趨勢，不是大大低於觀察到的趨勢，而是略低於觀察到的趨勢，以實質上投資一些超額保證金。 2023 年，我們在該業務中獲得了近10% 的稅前利潤。因此，從某種意義上說，我們將部分超額利潤投入到成長中，因此，會員成長了31%，收入成長了17% 。

Mark, on the phasing -- the quarterly phasing?

馬克，關於分階段－季度階段？

Yes, absolutely. Nathan, yes, you got it right. We're normally 55-45 on the front half versus the second half of the year. I'd almost flip that around this year because the dynamics are a little bit different. One, we put on a lot of new business this year, as you can see in our revenue bridge. We got $5.7 billion of new revenue coming into the company, which always comes in just a little bit warmer in the first year, but in the first quarter in particular. So I'm expecting to get some momentum on MLRs in Medicaid and Medicare as we kind of grow into our new footprint there. So that will change the dynamic a little bit.

是的，一點沒錯。內森，是的，你說得對。我們上半年和下半年的戰績通常是 55-45。今年我幾乎會翻轉這一點，因為動態有點不同。第一，我們今年推出了許多新業務，正如您在我們的收入橋樑中看到的那樣。我們為公司帶來了 57 億美元的新收入，第一年的收入總是會稍微回升，尤其是第一季。因此，隨著我們在醫療補助和醫療保險領域的發展，我希望在 MLR 上獲得一些動力。所以這會稍微改變動態。

The other thing is, and I think Joe touched on this, very often, marketplace has attrition throughout the year such that marketplace declines during the year. This year is a little bit different. With all the members rolling off on redebt and that's expecting to pick up our fair share of them in Marketplace as they convert, we'll see a growing book in Marketplace. And as you know, we've got some confidence on the margins given that we really prioritize margin over volume in Marketplace.

另一件事是，我認為喬經常提到這一點，市場全年都會出現損耗，導致市場在這一年中下降。今年有點不同。隨著所有會員都開始償還債務，並希望在他們轉換時在 Marketplace 中獲得我們公平的份額，我們將在 Marketplace 中看到越來越多的書籍。如您所知，我們對利潤率有一定的信心，因為我們確實優先考慮市場中的利潤率而不是銷售量。

So for those 2 reasons, you're going to see a little bit more of a back-end loaded EPS trajectory this year. I think that should address your question.

因此，出於這兩個原因，今年您將看到更多的後端加載每股收益軌跡。我認為這應該能解決你的問題。

The next question comes from Sarah James with Cantor Fitzgerald.

下一個問題來自莎拉·詹姆斯和康托·菲茨杰拉德。

Can you clarify for us what you guys contemplated in for 2 midnights and V28 into your 2024 plan design and also for Bright? And when you mentioned the pressures that you were seeing on Medicare, you guys didn't flag outpatient or some of the inpatient trends that the rest of the group is seeing. So I wanted to clarify if you are seeing this.

您能否向我們解釋一下你們在 2024 年計畫設計中對《2午夜》和《V28》以及《Bright》的設想是什麼？當你們提到醫療保險所面臨的壓力時，你們並沒有指出其他人所看到的門診或住院趨勢。所以我想澄清一下您是否看到了這一點。

Sarah, I'll kick it to Mark for -- we had a very detailed analysis of the changes in the risk adjustment rules and what it meant to our book.

莎拉，我會把它交給馬克——我們對風險調整規則的變化以及它對我們的書意味著什麼進行了非常詳細的分析。

In answer to your second question. One of the reasons I articulated earlier, the configuration of our book of business being somewhat different than what I call mainstream Medicare Advantage is that we have a low income high-acuity population. Our members are using services from the first day of the year to the last day of the year. They're chronic, they have comorbidities of polychronic, and so the notion of discretionary utilization means far less to our business based on its mix than it might be to a mainstream population where discretionary orthopedic procedures are being done, screenings are taking place, perhaps pent-up demand from the pandemic. In our book of highly chronic patients, high-acuity members, that's less of a dynamic. And so the 3 cost categories that I articulated previously, LTSS hours, high-cost drugs, GLP-1s and the supplemental benefits were really the drivers in our book.

回答你的第二個問題。我之前闡明的原因之一是，我們的業務結構與我所說的主流醫療保險優勢有所不同，原因之一是我們擁有低收入的高敏銳度人口。我們的會員從一年的第一天到一年的最後一天都在使用服務。它們是慢性病，患有多慢性合併症，因此，酌情利用的概念對我們基於其組合的業務的意義遠不如對主流人群的意義，主流人群正在進行酌情整形外科手術，也許正在進行篩檢疫情期間被壓抑的需求。在我們關於高度慢性病患者、高度敏銳的成員的書中，這並不是一種動態。因此，我之前闡述的 3 個成本類別、LTSS 時間、高成本藥物、GLP-1 和補充福利確實是我們書中的驅動因素。

Mark, do you want to take the risk adjustment question?

馬克，你想回答風險調整問題嗎？

Sure. And I think, Sarah, it's important, as Joe mentioned, when we talk about Medicare, it's in fact, 3 things. Your probably question is most aimed at the DSNP or high acuity component of our Medicare, which is 1/3 of the book. Obviously, it's less relevant to MMP. On the 2 things you mentioned, on the 2 midnight rule, I've seen a little bit of buzz about that lately, and we're a little bit surprised because it's certainly not new and many of us have factored this in for quite some time. And what I always remind folks is even though there's a 2 midnight rule, providers still have to prove medical necessity. So there's really not a big window there for a change in trend or a change in risk adjustment issues as we can see it.

當然。我認為，莎拉，正如喬所提到的，當我們談論醫療保險時，這實際上是三件事。您的問題可能最針對 DSNP 或我們的 Medicare 的高敏銳度部分，這是本書的 1/3。顯然，它與MMP關係不大。關於你提到的兩件事，關於午夜規則，我最近看到了一些關於這一點的討論，我們有點驚訝，因為它肯定不是什麼新鮮事，我們中的許多人已經將這一點考慮在內了相當多的時間。時間。我總是提醒人們的是，即使有午夜 2 點的規則，提供者仍然必須證明醫療必要性。因此，正如我們所看到的那樣，趨勢的變化或風險調整問題的變化確實沒有大的視窗。

On V28, that's got some interesting dynamics. It is certainly a drag in many places for folks, but there's an interesting dynamic around V28 and high acuity. On single chronics, people use the example of diabetes where there's diabetes, but there are some other conditions that kind of correlate or highly associated with diabetes. V28 will be a reduction on risk adjustment for those kind of situations. But when there's polychronics, where there's different comorbidities that are, in fact, quite different than each other. V28 is actually helpful. And in our high-acuity chronic book, we actually have many of those polychronics, so we don't quite see the same dynamic that maybe some of the other folks do out there.

在 V28 上，有一些有趣的動態。對於人們來說，它在許多方面無疑是一種拖累，但圍繞 V28 和高敏銳度有一個有趣的動態。對於單一慢性病，人們會以糖尿病為例，但還有一些其他疾病與糖尿病有關或高度相關。 V28 將減少此類情況的風險調整。但當存在多慢性病時，就會出現不同的合併症，事實上，這些合併症彼此之間有很大差異。 V28其實很有幫助。在我們的高敏銳度慢性病書中，我們實際上有很多這樣的多重慢性病，所以我們並沒有看到其他人可能看到的相同的動態。

That's helpful. And one more clarification, if I could. Just on your comments with the exchanges, I know you guys are guiding to a really favorable MLR for this year, but is there still step-up in earnings as you mature this new book? I guess, in other words, your year 1 is still slightly below target range, right, on new members and then there would be an implied earnings lift as that book moves into the second year of operations?

這很有幫助。如果可以的話，我還需要澄清一點。就您對交易所的評論而言，我知道你們正在指導今年的 MLR 非常有利，但是隨著這本新書的成熟，收益是否仍然會有所提高？我想，換句話說，您的第一年仍然略低於新會員的目標範圍，對吧，然後當該書進入運營的第二年時，會出現隱含的收益提升嗎？

I'm not quite sure I've captured the essence of your question, but we are forecasting a 78% MCR for the year, which is at the low end of our long-term target range, which means we'll be operating high single-digit margins, certainly not the 10% pretax we achieved in 2023.

我不太確定我是否抓住了你問題的本質，但我們預測今年的 MCR 為 78%，這是我們長期目標範圍的低端，這意味著我們將保持高營運水平個位數的利潤率，當然不是我們在2023 年實現的10% 的稅前利潤。

But look, if you grow the book more aggressively, more of your members are going to be new to the book. And so you have to -- in our view, you have to strike a balance about how fast are you going to grow and how many new members you want. Every new member that comes in, you need to find risk adjustment. If they come in during SEP, if they're chronic, you better find risk adjustment quickly or they won't get to profitability in the near term. So there's very much a balance between what you get in annual enrollment, what you pick up in SEP and how one thinks about how fast do I grow the book to achieve mid-single-digit margins when the maturity of the membership and the duration of the membership is pretty important to the stability of the risk pool. You have to balance those 2 factors.

但看，如果你更積極地發展這本書，更多的會員將會是這本書的新手。因此，在我們看來，你必須在發展速度和想要多少新成員之間取得平衡。每一個新成員進來，你都需要找到風險調整。如果它們在 SEP 期間進入，如果它們是慢性的，您最好迅速發現風險調整，否則它們不會在短期內實現盈利。因此，您在年度註冊中獲得的收益、您在SEP 中獲得的收益以及當會員資格成熟和會員期限到期時我如何快速增長書籍以實現中個位數的利潤之間存在著很大的平衡。會員資格對於風險池的穩定性非常重要。你必須平衡這兩個因素。

The next question comes from George Hill with Deutsche Bank.

下一個問題來自德意志銀行的喬治·希爾。

I think Nathan and Sarah kind of covered everything I wanted to hit on the exchange, but I'll try to bring up one more topic, which is, I guess, can you talk about underlying utilization trends and kind of cost growth trends there. Because it sounds like you guys priced the book for growth in 2024, but the utilization is going to kind of continue to remain low. So I guess I'm trying to parse the spread between utilization trends and price growth for the margin expansion. Kind of any color on that would be helpful.

我認為內森和莎拉涵蓋了我想在交易所中談到的所有內容，但我會嘗試提出另一個主題，我想，您能談談那裡的潛在利用率趨勢和成本增長趨勢嗎？因為聽起來你們為這本書定價為 2024 年的成長，但利用率將繼續保持在較低水準。因此，我想我正在嘗試分析利用率趨勢和價格成長之間的差距，以實現利潤擴張。任何顏色都會有幫助。

And George, your question is focused on Marketplace?

喬治，你的問題集中在市場？

Yes, Marketplace.

是的，市場。

Yes. Look, as Joe has been very clear, we're prioritizing margin over volume in this space -- in this business. And the way we do that is we keep it silver, which we believe is the best product for both the member and the payer. But we keep it stable, which means we continue to have really good renewals.

是的。看，正如喬非常明確的那樣，在這個領域——在這個業務中，我們優先考慮的是利潤而不是數量。我們這樣做的方式是將其保留為銀牌，我們相信這對會員和付款人來說都是最好的產品。但我們保持穩定，這意味著我們繼續有很好的續訂。

As we look at our pricing objectives here, we're putting price into the market to make sure that we can defend reasonable margins here. We did concede a little bit of margin in our pricing for 2024, just because we were well below our target range. Remember, our target range is 78% to 80% and we printed something a little bit south of that in '23. So there's no reason to leave volume on the table if we can put a little bit of price back, drive some volume and still hit our margin targets. I hope that helps.

當我們審視我們的定價目標時，我們將價格投入市場，以確保我們能夠在這裡捍衛合理的利潤。我們確實在 2024 年的定價中承認了一點餘裕，只是因為我們遠低於我們的目標範圍。請記住，我們的目標範圍是 78% 到 80%，我們在 23 年列印的內容稍微偏南。因此，如果我們能夠稍微降低價格，增加一些成交量並仍然達到我們的利潤目標，就沒有理由放棄成交量。我希望這有幫助。

It does. And maybe if I can just sneak in a quick follow-up. I know it's a tiny piece of the business. But could you talk about kind of the expected disruption in PDP in '25 given the changes from IRA?

確實如此。也許我可以快速跟進。我知道這只是業務的一小部分。但您能否談談考慮到 IRA 的變化，25 年 PDP 的預期中斷情況？

I'm sorry. We didn't -- we had trouble hearing the last part of your question, George. PDP?

對不起。我們沒有──喬治，我們很難聽清楚你問題的最後一部分。人民民主黨？

Yes. But like I said, I know it's a tiny part of the business, but we're expecting kind of PDP to be pretty disruptive or disrupted in 2025 because of the IRA changes. I know it's a tiny part of the book, but if you guys have any commentary on what you're saying would be helpful.

是的。但就像我說的，我知道這只是業務的一小部分，但我們預計 PDP 會因為 IRA 的變化而在 2025 年產生相當大的破壞性或破壞性。我知道這只是本書的一小部分，但如果你們對自己所說的內容有任何評論將會有所幫助。

Yes. So on PDP, as you know, we don't price the PDP product in the IRA or the Inflation Reduction Act that you're pointing out. It's certainly a headwind for that sector, but that's not too relevant to our business, George.

是的。因此，在 PDP 上，如您所知，我們不會按照您指出的 IRA 或通貨膨脹削減法案對 PDP 產品進行定價。這對該行業來說無疑是一個逆風，但這與我們的業務不太相關，喬治。

The last question today will come from Scott Fidel with Stephens.

今天的最後一個問題將由斯科特·菲德爾和史蒂芬斯提出。

I just was interested if you can walk us through your preliminary analysis on the 2025 MA advance notice? And whether you're able to parse that down between the legacy business impact and then what you're projecting will be the preliminary impact on the Bright book?

我只是有興趣您能否向我們介紹一下您對 2025 年 MA 提前通知的初步分析？您是否能夠在遺留業務影響和您預測的對 Bright 書籍的初步影響之間進行解析？

Sure, Scott. I mean, on balance, our view is the same view that you've heard from others is that the advance notice does not appear to be adequate to compensate for trends that were all reserving. I think in our book, if you take the CMS advance notice and projected to our book, I think we're projecting about a 50 basis point, 0.5 point of rate increase, which we believe is, along with others, is insufficient, and we'll see where the final notice comes out. It usually comes out, as you know, better than that. But our view is not any different from anybody else's.

當然，斯科特。我的意思是，總的來說，我們的觀點與您從其他人那裡聽到的觀點相同，即提前通知似乎不足以彌補所有保留的趨勢。我認為在我們的書中，如果你把CMS 提前通知並預測到我們的書中，我認為我們預測了大約50 個基點，即0.5 個百分點的加息，我們認為，與其他人一樣，這是不夠的，並且我們將看看最終通知會在哪裡發布。如您所知，結果通常比這更好。但我們的觀點與其他人的觀點並沒有什麼不同。

Yes. Just to build on that, and a lot of this data is in the public domain at this point. On the effective benchmark rates in the advance notice and then risk score normalization, most folks are seeing across the entire market, the net of those at about 0, right? As Joe mentioned, we see a net of about a positive 50 bps. So we're a little bit better on the benchmark rate, and we're a little bit not so bad on the risk or normalization for some reasons I alluded to earlier. So we're seeing about a 50 bp benefit there. And obviously, the rest of STAR's impact and what ultimately everyone does with risk scores has yet to play out. But that's our initial point on the legacy book.

是的。在此基礎上，目前許多數據都處於公共領域。關於預先通知中的有效基準利率以及風險評分標準化，大多數人都看到整個市場的淨利率約為 0，對嗎？正如 Joe 所提到的，我們看到淨值上漲約 50 個基點。因此，我們在基準利率方面稍好一些，而且由於我之前提到的某些原因，我們在風險或正常化方面也沒有那麼糟糕。所以我們看到了大約 50 個基點的好處。顯然，STAR 的其餘影響以及最終每個人對風險評分所做的事情尚未發揮作用。但這是我們對遺產書的最初觀點。

And then just to clarify, so the 50 bps, that's for the overall book, right? And then I would assume that directionally the legacy book probably better in the Bright book, a little worse than the legacy in that. Is that a fair assumption?

然後澄清一下，所以 50 個基點，這是整本書的，對嗎？然後我會假設，從方向上看，《光明》書中的遺產書可能更好，但比《光明》書中的遺產稍差一些。這是一個公平的假設嗎？

We're still working our way through that. There will be a couple of things going on there. As I mentioned earlier, we're 6 weeks into owning it. We're working through those issues with the team there. There will also be a bunch of dynamics that happen this year. There are actually 2 entities there. One is community health plan and the other one brand-new day. There will be some issues between them on exactly how we balance the effects of all this between those 2 entities. So a little bit of work there and not ready to comment on that one.

我們仍在努力解決這個問題。那裡將會發生一些事情。正如我之前提到的，我們已經擁有它 6 週了。我們正在與那裡的團隊一起解決這些問題。今年還將發生一系列動態。那裡實際上有 2 個實體。一個是社區健康計劃，另一個是全新的一天。他們之間將會存在一些關於我們如何平衡這兩個實體之間所有這一切的影響的問題。因此，我們也做了一些工作，還沒有準備好對此發表評論。

But I would say that we're not anticipating in any analysis when completed on rates that would move us off of achieving the $1 accretion in the third full year of ownership. We're pretty confident in that trajectory.

但我想說的是，我們預計在任何分析完成後，利率都會使我們無法在擁有所有權的第三年實現 1 美元的增值。我們對這個軌跡非常有信心。

This concludes the question-and-answer session and also concludes the conference call. Thank you for attending today's presentation. You may now disconnect.

問答環節到此結束，電話會議也結束。感謝您參加今天的演講。您現在可以斷開連線。