Molina Healthcare Inc (MOH) 2024 Q3 法說會逐字稿

Good morning, and welcome to Molina Healthcare's third-quarter 2024 earnings call. (Operator Instructions) Please note, this event is being recorded.

早安，歡迎參加 Molina Healthcare 的 2024 年第三季財報電話會議。（操作員說明）請注意，正在記錄此事件。

I would now like to turn the conference over to Jeffrey Geyer, Vice President, Investor Relations at Molina Healthcare. Please go ahead.

我現在想將會議交給 Molina Healthcare 投資者關係副總裁 Jeffrey Geyer。請繼續。

Good morning and welcome to Molina Healthcare's third-quarter 2024 earnings call. Joining me today are Molina's President and CEO, Joe Zubretsky; and our CFO, Mark Keim.

早安，歡迎參加 Molina Healthcare 的 2024 年第三季財報電話會議。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)。

A press release announcing our third quarter 2024 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.

昨天收盤後發布了宣布 2024 年第三季收益的新聞稿，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 are made as of today, Thursday, October 24, 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 10 月 24 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 can be found in the third-quarter 2024 earnings release.

在這次電話會議上，我們將提及某些非公認會計原則措施。這些指標與最直接可比較的 GAAP 指標的調整可以在 2024 年第三季的收益發布中找到。

During the call, we will be making certain forward-looking statements, including, but not limited to, statements regarding our 2024 guidance, Medicaid redeterminations, expected Medicaid rate adjustments and updates, Medical cost initiatives and our projected MCR, our recent RFP awards and pending RFP submissions, our acquisitions and M&A activity, revenue growth related to RFPs and M&A activity, our long-term growth strategy, our 2025 marketplace pricing, and our embedded earnings power and future earnings realization.

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、預期醫療補助費率調整和更新、醫療成本計劃和我們預計的MCR、我們最近的RFP 獎項和待提交的 RFP、我們的收購和併購活動、與 RFP 和併購活動相關的收入增​​長、我們的長期增長戰略、我們的 2025 年市場定價以及我們的內在盈利能力和未來盈利實現。

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, we will provide you with updates on our reported financial results for the third quarter, highlighted by $6.01 of earnings per share, which was in line with our expectations; an update on our full-year 2024 guidance, which we reaffirmed at $38 billion of premium revenue; and at least $23.50 in earnings per share; and our growth initiatives and strategy for sustaining profitable growth.

謝謝你，傑夫，早安。今天，我們將為您提供第三季財務業績的最新報告，其中每股收益 6.01 美元，符合我們的預期；我們對 2024 年全年指引進行了更新，我們重申保費收入為 380 億美元；每股收益至少為 23.50 美元；以及我們維持獲利成長的成長計劃和策略。

Let me start with our third quarter performance. Last night, we reported adjusted earnings per share of $6.01, a $9.7 billion of premium revenue. Our 89.2% consolidated MCR was higher than expected as we experienced some medical cost pressure in our Medicaid and Medicare segments.

讓我從我們第三季的業績開始。昨晚，我們報告調整後每股收益為 6.01 美元，溢價收入為 97 億美元。我們 89.2% 的綜合 MCR 高於預期，因為我們的醫療補助和醫療保險部門經歷了一些醫療成本壓力。

However, we still produced a 4.5% adjusted pretax margin or 3.4% after tax, a very strong result. Year-to-date, our consolidated MCR is 88.8%, slightly above our long-term target range and our adjusted pretax margin is 4.5%, which is within our long-term target range.

然而，我們仍然實現了 4.5% 的調整後稅前利潤率或 3.4% 的稅後利潤率，這是一個非常強勁的結果。年初至今，我們的綜合 MCR 為 88.8%，略高於我們的長期目標範圍，調整後的稅前利潤率為 4.5%，在我們的長期目標範圍內。

Together, these results reflect a well-balanced and well-performing portfolio of businesses.

總之，這些結果反映了均衡且表現良好的業務組合。

In Medicaid, the business produced a third quarter MCR of 90.5%, above our long-term target range. This result included a premium rate reduction in our California business that was retroactive to the beginning of the year. We are working with the state to understand its methodology and actuarial support for this adjustment, both of which remain unclear.

在醫療補助計劃中，該業務第三季的 MCR 為 90.5%，高於我們的長期目標範圍。這一結果包括我們加州業務的保費降低，可追溯至年初。我們正在與國家合作，了解其對這項調整的方法和精算支持，但這兩者都尚不清楚。

Excluding this retroactive item, the third quarter Medicaid MCR was 90%. The quarter reflects higher-than-expected medical costs, elevated by the impact of redetermination related to acuity shifts and higher utilization among our continuing population, particularly for LTSS, pharmacy and behavioral health services. However, this higher trend continued to be partially offset by three dynamics.

排除此追溯項目，第三季醫療補助 MCR 為 90%。本季度反映出高於預期的醫療成本，這是由於與敏銳度變化相關的重新確定的影響以及我們持續人口的更高利用率而增加的，特別是在 LTSS、藥房和行為健康服務方面。然而，這種上漲趨勢繼續被三種動態所部分抵消。

First, our new store additions continue to improve to our target margins. Second, on cycle and off-cycle rate adjustments went into effect during the quarter. And finally, our risk corridors continue to act as a financial buffer against elevated medical cost trend.

首先，我們新增的商店持續提高我們的目標利潤率。其次，週期內和周期外利率調整在本季生效。最後，我們的風險走廊繼續充當針對醫療成本上漲趨勢的財務緩衝。

The short-term disparity between rates and medical cost trend may have reached its widest point in the third quarter. We expect this short-term disparity to narrow, starting with known rate updates. In the third quarter, we received five on-cycle rate updates that averaged 4.5%. We also received several positive off-cycle rate adjustments, which is an important indication that many of our states have recognized that certain aspects of their program are underfunded.

費率和醫療費用趨勢之間的短期差距可能在第三季達到最大點。我們預計，從已知的利率更新開始，這種短期差距將會縮小。第三季度，我們收到了五次週期利率更新，平均為 4.5%。我們還收到了幾個積極的非週期利率調整，這是一個重要的跡象，表明我們的許多州已經認識到其計劃的某些方面資金不足。

For the fourth quarter, we received three on-cycle rate updates that averaged 9%. In total, the second half of 2024 now reflects these known rate increases that amount to a benefit of approximately $350 million or 230 basis points on the Medicaid MCR. This 230 basis point benefit along with risk corridor protection is expected to substantially offset the elevated cost trend in the second half of 2024.

第四季度，我們收到了三次週期利率更新，平均為 9%。總的來說，2024 年下半年現在反映了這些已知的費率上漲，相當於醫療補助 MCR 的收益約為 3.5 億美元或 230 個基點。預計這一 230 個基點的收益以及風險走廊保護將大大抵消 2024 年下半年成本上升的趨勢。

Looking forward to 2025, the progression of rates and cost trend is not entirely clear. 55% of our Medicaid premium renews on January 1, and we are encouraged by the draft rates we have seen from several of these states. These draft rates are an important starting point for 2025, and we remain cautiously optimistic while we wait to see how medical cost trend progresses in the fourth quarter and early 2025.

展望 2025 年，費率和成本趨勢的進展尚不完全清楚。我們 55% 的醫療補助保費將於 1 月 1 日更新，我們對其中幾個州的草案費率感到鼓舞。這些草案費率是 2025 年的重要起點，我們保持謹慎樂觀，同時等待第四季和 2025 年初醫療費用趨勢的進展。

Given the confluence of the many MCR dynamics concentrated in the quarter, we are very pleased to be operating at a 90% Medicaid MCR for the full-year, merely 100 basis points above the top end of our long-term range. With the assumption that rates may continue to improve and appropriately capture cost trend in this upcoming rate cycle, there is line of sight to be operating within our long-term MCR target range for 2025.

鑑於許多 MCR 動態集中在本季度，我們很高興全年的醫療補助 MCR 達到 90%，僅比我們長期範圍的上限高出 100 個基點。假設利率可能會繼續改善，並在即將到來的利率週期中適當地捕捉成本趨勢，那麼我們的 2025 年長期 MCR 目標範圍內的運作是有可能的。

Turning to Medicare. Our third quarter MCR was 89.6%, above our long-term target range. The medical cost pressure in the quarter was consistent with the elevated LTSS and pharmacy costs we experienced through the first half of the year, while we also experienced higher outpatient utilization in the third quarter. Our Bright business in California performed in line with expectations.

轉向醫療保險。我們第三季的 MCR 為 89.6%，高於我們的長期目標範圍。本季的醫療成本壓力與我們上半年經歷的 LTSS 和藥品成本上升一致，同時我們在第三季度也經歷了更高的門診利用率。我們在加州的 Bright 業務表現符合預期。

In marketplace, the third quarter MCR was 73%. The business continued to perform better than our expectations even with the higher special enrollment period membership gained for redeterminations this year. Our third quarter adjusted G&A ratio of 6.4% was a very strong result and reflects effective operating discipline, including labor cost management, one-time credits related to vendor contracts and leveraging our fixed cost base as we grow.

在市場上，第三季 MCR 為 73%。儘管今年因重新確定而獲得的特殊註冊期會員資格更高，但該業務的表現仍然好於我們的預期。我們第三季調整後的一般管理費用率為6.4%，這是一個非常強勁的結果，反映了有效的營運紀律，包括勞動力成本管理、與供應商合約相關的一次性信貸以及隨著我們的發展利用我們的固定成本基礎。

Turning now to our guidance for the full-year. Our full-year premium revenue remains unchanged at approximately $38 billion or 17% year-over-year growth. We maintain our full-year adjusted EPS guidance of at least $23.50 representing 13% year-over-year growth. We expect continued strong performance in our marketplace segment, G&A efficiencies and higher net investment income to offset the higher MCRs we are experiencing in Medicaid and Medicare.

現在轉向我們的全年指導。我們的全年保費收入維持在約 380 億美元不變，年增 17%。我們將全年調整後每股盈餘指引維持在至少 23.50 美元，年增 13%。我們預計我們的市場領域將繼續保持強勁的表現，一般管理費用效率和更高的淨投資收入將抵消我們在醫療補助和醫療保險方面經歷的更高的 MCR。

Our 2024 revenue and earnings per share guidance provide a strong foundation for profitable growth in 2025 and beyond and the building blocks to achieve our long-term growth targets remain intact.

我們的 2024 年營收和每股盈餘指引為 2025 年及以後的獲利成長奠定了堅實的基礎，實現我們長期成長目標的基石仍然完好無損。

Now some comments on our growth initiatives. Our business is well positioned to capitalize on long-term growth opportunities in all three segments. In traditional Medicaid, as previously reported, we retained our presence in Florida with a contract to serve approximately 90,000 members in Miami-Dade County. This contract recovery is an important component of our portfolio given the state of Florida's significant Medicare and marketplace profile.

現在對我們的成長計劃發表一些評論。我們的業務處於有利位置，可以利用所有三個細分市場的長期成長機會。如同先前所報導的，在傳統醫療補助中，我們保留了在佛羅裡達州的業務，並簽訂了為邁阿密戴德縣約 90,000 名會員提供服務的合約。鑑於佛羅裡達州重要的醫療保險和市場概況，該合約恢復是我們投資組合的重要組成部分。

In Georgia, we await the announcement of statewide contract awards. We remain confident in the strength of our proposal and our ability to serve as strong state partners for these populations. We had significant wins in the quarter in our dual eligible and integrated product businesses, which are a major strategic focus for us.

在喬治亞州，我們正在等待全州合約授予的宣布。我們對我們的提案的力度以及我們作為這些人口的強大國家合作夥伴的能力仍然充滿信心。本季我們在雙重合格和整合產品業務方面取得了重大勝利，這是我們的主要策略重點。

In Michigan, we are awarded a contract to provide benefits to the state's highly integrated dual-eligible special needs population in six service regions, including Detroit. This is an increase from our current MMP footprint of two service regions. This win facilitates the transition of our existing MMP members to a HIDE product and ensures a new dual eligible growth opportunity.

在密西根州，我們獲得了一份合同，為該州六個服務區（包括底特律）高度融合的雙重資格特殊需求人群提供福利。這比我們目前兩個服務區域的 MMP 足跡有所增加。這場勝利促進了我們現有的 MMP 會員向 HIDE 產品的過渡，並確保了新的雙重合格成長機會。

We project $1 billion of incremental premium revenue by 2027 and have added $0.50 per share to our embedded earnings. The contract, which is effective January 1, 2026, in select regions will be implemented statewide in 2027 and continue for seven years.

我們預計到 2027 年保費收入將增加 10 億美元，並在我們的嵌入收益中增加每股 0.50 美元。該合約於 2026 年 1 月 1 日在部分地區生效，將於 2027 年在全州範圍內實施，並持續七年。

Given our success in this Michigan MMP transition, we are confident about our prospects in both Ohio and Illinois.

鑑於我們在密西根州 MMP 過渡中取得的成功，我們對俄亥俄州和伊利諾伊州的前景充滿信心。

In Massachusetts, the Commonwealth awarded us a new contract to operate the One Care under 65 program and retain our position in the Senior Care Options program for 2026. Incremental revenue is expected to reach nearly $400 million in 3 years' time and for this, we have added $0.25 per share to our embedded earnings.

在馬薩諸塞州，聯邦政府授予我們一份新合同，負責運營 65 歲以下人士護理計劃，並保留我們在 2026 年高級護理選擇計劃中的地位。預計 3 年內增量收入將達到近 4 億美元，為此，我們在嵌入收益中增加了每股 0.25 美元。

Also in Medicare, beginning in 2025, we will no longer offer MAPD products in 13 states, totaling approximately $200 million in annual premium. This adjustment allows us to strategically focus on our dual eligible populations, where we increased our accounting footprint by 23% and on our low-income MAPD population in California. Recall the new CMS final rule on integration positions us well as a major Medicaid player.

同樣在醫療保險方面，從 2025 年開始，我們將不再在 13 個州提供 MAPD 產品，年度保費總額約為 2 億美元。這項調整使我們能夠策略性地關注我們的雙重資格人口（我們將會計足跡增加了 23%）以及加州的低收入 MAPD 人口。回想一下新的 CMS 關於整合的最終規則將我們定位為主要的醫療補助參與者。

In marketplace, we are positioned to grow organically in underpenetrated markets, given the stabilized risk profile and margins we've achieved. Our rate filings for 2025 are very competitive and position us to grow in underpenetrated markets. We are confident in our strategy to grow this segment at a rate that allows us to achieve mid-single-digit pretax margins.

在市場上，鑑於我們已經實現的穩定的風險狀況和利潤，我們有能力在滲透不足的市場中實現有機成長。我們 2025 年的費率申請非常有競爭力，使我們能夠在滲透不足的市場中成長。我們對此細分市場的成長策略充滿信心，使我們能夠實現中個位數的稅前利潤率。

Finally, we continue to expect that our announced acquisition of ConnectiCare will close in the first quarter of 2025. Our ability to grow organically, win new state contracts and execute M&A are the pillars of our growth strategy, and we fully expect to meet our target of $46 billion of premium revenue in 2026.

最後，我們仍然預計我們宣布的對 ConnectiCare 的收購將於 2025 年第一季完成。我們的有機成長、贏得新的州合約和執行併購的能力是我們成長策略的支柱，我們完全期望在 2026 年實現 460 億美元保費收入的目標。

With our 2024 earnings per share guidance of at least $23.50 reaffirmed and with our embedded earnings raised to $5.75 per share, we remain on track to deliver long-term profitable growth. Mark will discuss the building blocks of our 2025 outlook in his remarks.

我們重申 2024 年每股收益指引至少為 23.50 美元，並將嵌入收益提高至每股 5.75 美元，我們仍有望實現長期獲利成長。馬克將在演講中討論我們 2025 年展望的組成部分。

In summary, we are pleased with the quarter's results as we continue to power through unprecedented short-term dynamics and just keep executing on the fundamentals. Our businesses remain on solid operational and financial foundations and are positioned well for long-term profitable growth.

總而言之，我們對本季的業績感到滿意，因為我們繼續在前所未有的短期動態中發揮作用，並繼續執行基本面。我們的業務仍然擁有堅實的營運和財務基礎，並為長期獲利成長做好了準備。

We look forward to updating you on the next wave of long-term value creation at our Investor Day event on Friday, November 8 in New York City.

我們期待在 11 月 8 日星期五於紐約市舉行的投資者日活動上向您介紹下一波長期價值創造的最新情況。

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 third quarter performance, the balance sheet, our 2024 guidance and the building blocks of our 2025 EPS outlook. . Beginning with our third quarter results. For the quarter, we reported approximately $10 billion in total revenue and $9.7 billion of premium revenue with adjusted EPS of $6.01.

謝謝喬，大家早安。今天，我將討論有關我們第三季業績、資產負債表、2024 年指引以及 2025 年每股盈餘展望的基礎的一些其他細節。。從我們的第三季業績開始。本季度，我們公佈的總收入約為 100 億美元，保費收入為 97 億美元，調整後每股收益為 6.01 美元。

Our third quarter consolidated MCR of 89.2 was above our expectations, reflecting some pressure we experienced in Medicaid and Medicare during the quarter. In Medicaid, our reported MCR was 90.5%. As Joe mentioned, this result includes a 50 basis point increase due to a premium rate reduction in our California business that was retroactive to the beginning of the year.

我們第三季的綜合 MCR 為 89.2，高於我們的預期，反映出我們在本季在醫療補助和醫療保險方面經歷的一些壓力。在醫療補助中，我們報告的 MCR 為 90.5%。正如喬所提到的，這一結果包括由於我們加州業務的保費率降低而增加了 50 個基點，該保險費率追溯至年初。

With much of our California revenue in the new store, first year of operation stage, corridors were not quite at the target margin levels, so much of the impact of this rate action fell through to our bottom line.

由於我們加州的大部分收入都來自新店營運的第一年，走廊的利潤率並未完全達到目標利潤水平，因此此次利率行動的大部分影響都落入了我們的底線。

We are still working with the state to understand the rationale for this rate adjustment. It's highly unusual for a state to retroactively reduce rates and all of our other known and expected future rate actions are positive as states address recent medical cost trends.

我們仍在與政府合作，以了解此利率調整的理由。一個州追溯性降低利率是非常不尋常的，隨著各州應對最近的醫療成本趨勢，我們所有其他已知和預期的未來利率行動都是正面的。

Adjusting for this retroactive item, our reported MCR of 90.5% falls to 90%. This was in line with the second quarter and remained elevated versus our expectations, driven primarily by higher-than-expected medical costs in our legacy Medicaid portfolio.

調整此追溯項目後，我們報告的 MCR 為 90.5%，降至 90%。這與第二季的情況一致，並且仍高於我們的預期，這主要是由於我們傳統醫療補助組合中的醫療成本高於預期。

Recall the dynamics of redetermination involve joiners, leavers and stayers. Redetermination related acuity shifts continued into the third quarter, even as the imbalance of joiners and leavers began to stabilize. We saw higher utilization among our stayers population, particularly for LTSS, pharmacy, and behavioral health services.

回想一下重新決定的動態涉及加入者、離開者和留下者。儘管加入者和離開者的不平衡開始穩定下來，但與重新決定相關的敏銳度變化仍在持續到第三季。我們發現入住者群體的使用率較高，特別是 LTSS、藥局和行為健康服務。

Several dynamics served to offset these higher trends in the third quarter and muted the overall impact. First, our new store additions, which represent approximately 20% of Medicaid premium and have a higher-than-average MCR in their first year, improved during the quarter and remain on track to achieving target margins.

一些動態抵消了第三季這些較高的趨勢，並減弱了整體影響。首先，我們新增的商店約佔醫療補助保費的 20%，第一年的 MCR 高於平均水平，在本季度有所改善，並繼續實現目標利潤率。

Second, we had on-cycle and off-cycle rate adjustments in 11 states. And finally, due to our strong medical cost management, we started the year deep into risk corridors, which acted as a buffer and created a more muted impact of the acuity shift.

其次，我們在 11 個州進行了周期內和週期外利率調整。最後，由於我們強大的醫療成本管理，我們在今年伊始就深入風險走廊，這起到了緩衝作用，並創造了敏銳度轉變的更溫和的影響。

Medicaid membership at the end of the third quarter was 4.9 million and in line with the second quarter. Some continuing redeterminations in a few states in July and August were largely offset by the implementation of our New Mexico contract in the quarter. We continue to see reconnects from prior period terminations and expect continuing upside to membership from reconnects in the quarters ahead.

第三季末醫療補助會員人數為 490 萬人，與第二季持平。7 月和 8 月，一些州持續進行的一些重新確定在很大程度上被本季新墨西哥州合約的執行所抵消。我們繼續看到上期終止後的重新連接，並預計未來幾季的重新連接將繼續增加會員資格。

In Medicare, our third quarter reported MCR was 89.6%. Higher medical costs in the quarter reflected continued higher utilization of LTSS and pharmacy. We also experienced higher outpatient utilization in the third quarter, concentrated in our D-SNP population.

在醫療保險方面，我們第三季報告的 MCR 為 89.6%。本季醫療成本上升反映了 LTSS 和藥房利用率的持續提高。第三季我們的門診利用率也有所提高，主要集中在我們的 D-SNP 族群。

Separately, I will note that the prior year risk adjustment true-up in the second quarter drove a portion of the sequential increase in the MCR. Our Bright business in California performed in line with expectations.

另外，我要指出的是，去年第二季的風險調整調整推動了 MCR 的部分環比成長。我們在加州的 Bright 業務表現符合預期。

In marketplace, our third quarter reported MCR was 73% and better than expected. Special enrollment period membership increased during the quarter, but at a slower rate than the first half of the year.

在市場上，我們第三季的 MCR 為 73%，優於預期。本季特殊註冊期會員數增加，但成長速度低於上半年。

Our adjusted G&A ratio for the quarter was 6.4% and reflects effective operating discipline, including labor cost management, onetime credits related to vendor contracts, and leveraging our fixed cost base as we grow.

本季調整後的一般管理費用率為 6.4%，反映了有效的營運紀律，包括勞動力成本管理、與供應商合約相關的一次性信貸，以及隨著我們的發展利用我們的固定成本基礎。

Turning to the balance sheet. Our capital foundation remains strong. In the quarter, we harvested approximately $385 million of subsidiary dividends and our parent company cash balance was approximately $195 million at the end of the quarter.

轉向資產負債表。我們的資本基礎依然雄厚。本季度，我們獲得了約 3.85 億美元的子公司股息，季度末母公司現金餘額約為 1.95 億美元。

In the quarter, we repurchased approximately 1.5 million shares. Our full-year guidance now assumes 57.9 million shares outstanding. Debt balances and the debt-to-capital ratio increased slightly in the quarter due to our share repurchases. Debt at the end of the quarter was 1.4 times trailing 12-month EBITDA with our debt-to-cap ratio at about 35%. We continue to have ample cash and capital to fuel our growth initiatives.

本季度，我們回購了約 150 萬股股票。我們的全年指引目前假設流通股數為 5,790 萬股。由於我們的股票回購，本季債務餘額和債務與資本比率略有增加。本季末的債務是過去 12 個月 EBITDA 的 1.4 倍，債務上限比率約為 35%。我們繼續擁有充足的現金和資本來推動我們的成長計劃。

During the quarter, we also renewed our revolving credit facility for another five years and increased its capacity to $1.25 billion. Days in claims payable at the end of the quarter was 48. We remain confident in the strength of our reserves. Our operating cash flow in the first nine months of 2024 was $868 million. This was lower than the prior year, but consistent with our comments last quarter, reflects the timing of risk corridor payments, CMS receipts, and taxes.

本季度，我們也將循環信貸額度再延長五年，並將其容量增加至 12.5 億美元。季度末應付索賠天數為 48 天。我們對我們的儲備實力仍然充滿信心。2024 年前 9 個月我們的營運現金流為 8.68 億美元。這低於上一年，但與我們上季度的評論一致，反映了風險走廊付款、CMS 收入和稅收的時間。

Recall that earlier this year, we made several large corridor settlements related to prior years.

回想一下，今年早些時候，我們做出了幾個與前幾年相關的大型走廊定居點。

Next, a few comments on our fourth quarter and 2024 guidance. As Joe mentioned, we reaffirm our full-year premium revenue guidance of approximately $38 billion and our full-year EPS guidance of at least $23.50. While full-year EPS guidance is unchanged, the performance in the second half of the year changes the components as compared to our previous guidance.

接下來，對我們第四季度和 2024 年的指導進行一些評論。正如喬所提到的，我們重申全年保費收入指引約為 380 億美元，全年每股收益指引至少為 23.50 美元。雖然全年每股收益指引保持不變，但下半年的業績與我們先前的指引相比，其組成部分發生了變化。

EPS guidance has increased by $2.70 from the combined tailwinds of strong performance in marketplace, G&A efficiencies and higher net investment income, but will be offset by the higher MCRs in Medicaid and Medicare for a net unchanged view of full-year guidance. We now expect full-year 2024 MCR of 88.7% and G&A ratio of 6.8%.

由於市場強勁表現、G&A 效率和更高的淨投資收入的綜合推動，每股收益指導增加了 2.70 美元，但將被醫療補助和醫療保險 MCR 的提高所抵消，全年指導淨值不變。我們目前預計 2024 年全年 MCR 為 88.7%，G&A 比率為 6.8%。

Within Medicaid, we expect fourth quarter MCR of 89%, a decrease from 90.5% in the third quarter. The 150 basis point improvement is driven by three items: first, 50 points from the third quarter retroactive premium adjustment in California that will not recur. Next, 80 basis points from known on-cycle and off-cycle rate increases, and some benefit of our corridor position will offset trend.

在醫療補助計劃中，我們預計第四季的 MCR 為 89%，低於第三季的 90.5%。150個基點的改善是由三個因素推動的：首先，加州第三季追溯保費調整後的50個基點不會再次發生。接下來，已知的周期內和周期外利率將上漲 80 個基點，而我們的走廊地位的一些好處將抵消趨勢。

Finally, continued improvement in new store additions will contribute 20 basis points. We expect full-year Medicaid MCR of approximately 90%, up 70 basis points from our prior guidance, reflecting higher cost trend and approximately 10 basis points for the full-year impact of the third quarter retroactive premium adjustments in California.

最後，新店數量的持續改善將貢獻20個基點。我們預計全年醫療補助 MCR 約為 90%，比我們先前的指引上升 70 個基點，反映出成本上升的趨勢，以及加州第三季追溯保費調整對全年的影響約 10 個基點。

In Medicare, we expect fourth quarter MCR of 90%, an increase from 89.6% in the third quarter. This guidance assumes that third quarter utilization persists for the remainder of the year and increases the full-year MCR to 88.3%, a 30 basis point increase from our prior guidance.

在醫療保險方面，我們預計第四季的 MCR 為 90%，高於第三季的 89.6%。該指引假設第三季的使用率在今年剩餘時間內持續存在，並將全年 MCR 提高至 88.3%，比我們先前的指引提高了 30 個基點。

In marketplace, we expect fourth quarter MCR of 70.1% compared to 73% in the third quarter. This increase reflects the normal marketplace seasonality during the year and the significant SEP growth we experienced year-to-date. We expect full-year marketplace MCR of 74%, down 400 basis points from our prior guidance, reflecting strong year-to-date performance.

在市場方面，我們預計第四季的 MCR 為 70.1%，而第三季為 73%。這一增長反映了今年正常的市場季節性以及我們今年迄今為止所經歷的顯著的 SEP 成長。我們預計全年市場 MCR 為 74%，比我們先前的指引下降 400 個基點，反映出年初至今的強勁表現。

Turning to embedded earnings and the building blocks of our 2025 EPS outlook. New store embedded earnings are now $5.75 with the addition of contract wins in Michigan and Massachusetts. Both contracts are expected to begin in 2026 and achieve target margins in 2027. We expect to harvest a little less than half of our embedded earnings in 2025.

轉向嵌入收益和我們 2025 年每股收益展望的基石。加上在密西根州和馬薩諸塞州贏得的合同，新店嵌入收益目前為 5.75 美元。這兩份合約預計將於 2026 年開始，並於 2027 年實現目標利潤率。我們預計 2025 年將獲得不到一半的嵌入收益。

The building blocks include those embedded earnings we expect in 2025, the organic growth and margin in our current footprint, our in-flight organic and strategic initiatives and the year-over-year benefit of share repurchases executed in the third quarter of 2024.

這些組成部分包括我們預計 2025 年的內含收益、我們當前業務的有機增長和利潤率、我們正在進行的有機和戰略舉措以及 2024 年第三季度執行的股票回購的同比收益。

We expect some headwinds from declining interest rates next year. We caution that rates have not yet caught up with trend, and our corridor projections are now lower until replenished by the new cycle of actuarially sound rates.

我們預計明年利率下降會帶來一些阻力。我們警告說，利率尚未跟上趨勢，我們的走廊預測現在較低，直到新一輪精算合理利率得到補充。

While it's not yet clear how the short-term disparity between rates and trends will progress, these known building blocks are an important foundation to our sustaining long-term profitable growth.

雖然目前尚不清楚利率和趨勢之間的短期差距將如何發展，但這些已知的組成部分是我們維持長期獲利成長的重要基礎。

This concludes our prepared remarks. Operator, we're 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) Josh Raskin, Nephron Research

（操作員說明）Josh Raskin，Nephron Research

Hi. Thanks, Alex. I'll actually ask my second question first. So the strength in marketplace, does that change your view on the impact of potential rebate positions in 2025, just based on what you've seen in the last two years here? And could you just remind us your views? I think you mentioned that mid-single-digit margin. Just how you're titrating additional growth in 2025 versus offsetting rebates versus maintaining that mid-single-digit margin?

你好。謝謝，亞歷克斯。我實際上會先問第二個問題。那麼，僅根據您過去兩年在這裡看到的情況，市場的實力是否會改變您對 2025 年潛在折扣部位影響的看法？您能提醒我們您的看法嗎？我想你提到了中個位數的利潤。您是如何調整 2025 年的額外成長、抵銷回饋、維持中個位數利潤率的？

Sure, Josh. This will be the second straight year of outperformance in marketplace and in '24 into '25, we did invest that excess margin in our bids and expect to grow the business. And yet here we are again with another year of outperformance, and we'll continue to do the same.

當然，喬許。這將是連續第二年在市場上表現出色，在 24 年到 25 年期間，我們確實將超額利潤投資於我們的投標，並期望業務成長。然而，我們又迎來了表現優異的一年，我們將繼續這樣做。

So yes, we're targeting mid-single-digit pretax margins, but the business is positioned to grow really well next year and the year after. Now with respect to the rebate question, recall it's a three-year test, and also recall that an 80% minimum is equivalent, Mark, to what, about a 75% GAAP equivalent, correct?

所以，是的，我們的目標是稅前利潤率達到中個位數，但該業務明年和後年將實現良好成長。現在關於回扣問題，回想一下這是一個為期三年的測試，還記得 80% 的最低值相當於 75% 的 GAAP 相當值，馬克，對嗎？

Right around there. Josh, we're tracking to a 74% in our guidance this year. As Joe mentioned, the 80% nominal that everybody thinks of a minimum MLR is more like a 76-ish and as Joe mentioned, you can either pay it in a rebate or make it up on volume through pricing, and that's the direction we'll take.

就在那裡。喬什，我們今年的目標是 74%。正如 Joe 所提到的，每個人認為的最低 MLR 的 80% 名義值更像是 76 左右，正如 Joe 提到的，你可以透過回扣支付，也可以透過定價來彌補數量，這就是我們的方向。採取。

Okay. So you guys are in a rebate position, and your point is you can get that 200 basis point delta for next year. And then just a quick follow-up on the Medicaid MLR, I think it's running full year, it looks like 70 basis points higher than your previous. So maybe if you could just drill down a little bit more on LTSS, behavioral health and Rx and what's running specifically worse, what are those incremental pressures coming from?

好的。所以你們處於回饋位置，你們的觀點是明年可以獲得 200 個基點的增量。然後是醫療補助 MLR 的快速跟進，我認為它全年運行，看起來比之前高了 70 個基點。因此，如果您可以更深入地了解 LTSS、行為健康和 Rx，以及哪些情況特別糟糕，那麼這些增量壓力來自哪裡？

We expected in our initial guidance a trend in Medicaid of about 3%, and it's landing at about 6%. It's split equally between redetermination impact and impact of higher utilization of what I call our continuing membership. No one phenomenon is really driving it. It's a blend of GLP-1s and Rx, LTSS, both skilled nursing facility in-patient stays and hours in-home service benefits. .

我們在最初的指導下預計醫療補助的趨勢約為 3%，而現在則下降到 6% 左右。它在重新決定的影響和我所說的持續會員資格的更高利用率的影響之間平均分配。沒有任何一種現象能夠真正推動這一趨勢。它融合了 GLP-1 和 Rx、LTSS、熟練護理機構住院治療和小時家庭服務福利。。

And then, of course, the national phenomenon of behavioral services trending upwards as well. Really no one thing, and it's different in every geography, but those are the trends we're observing. Mark, anything to add?

當然，全國的行為服務現像也呈現上升趨勢。確實沒有一件事，每個地區的情況都不同，但這些是我們正在觀察的趨勢。馬克，有什麼要補充的嗎？

No, I think that's right, versus the initial guidance or expectations for the year were up about 300 basis points on trend. Joe mentioned, it's split between redet acuity and it's split between stayers running a little bit hotter, BH, LTSS, pharmacy. We're seeing them in pockets here, pockets there, but those are national trends.

不，我認為這是正確的，與今年的初步指導或預期相比，趨勢上漲了約 300 個基點。Joe 提到，它分為 Redet 敏銳度和運行溫度稍高的停留者、BH、LTSS、藥房。我們在這裡、那裡都看到它們，但這些都是全國趨勢。

Thank you.

謝謝。

J.J. Rice, UBS.

J.J.賴斯，瑞銀。

Hi, everybody. I think it's A.J., but anyway, if your trend is running at about 6% that would imply the rate updates you need to normalize are probably in that range, maybe a little bit higher over the next year. That's quite a bit different, as you may know, from what -- at least one of your large peers are saying they need, they're talking about low to mid-double-digit rate increases.

大家好。我認為是 A.J.，但無論如何，如果你的趨勢運行在 6% 左右，這意味著你需要標準化的利率更新可能在這個範圍內，也許明年會更高一點。正如您可能知道的那樣，這與至少您的一位大型同行表示他們需要的情況有很大不同，他們正在談論低至中兩位數的加息。

And they've also raised the question about whether state budgets can afford to update in one year what's necessary or whether we might need multiple cycles. I guess I don't know if you can comment on why there might be a difference between what you're seeing and what they're seeing but I'll throw that out and could see if I can get you to confirm the order of magnitude of the rate update you need to normalize and whether you think that's achievable over the next year?

他們也提出了這樣的問題：國家預算是否有能力在一年內更新必要的內容，或者我們可能需要多個週期。我想我不知道你是否可以評論為什麼你所看到的和他們所看到的之間可能存在差異，但我會把它扔掉，看看是否可以讓你確認訂單您需要實現正常化的利率更新幅度以及您認為明年是否可以實現？

Let me first, A.J., comment on the model of how we've been describing this since redetermination started. We knew there would be an acuity shift without question. It takes time for a state actuary to observe the acuity shift and allow rates to rate for it.

A.J.，首先讓我評論一下自重新決定開始以來我們如何描述這一問題的模型。我們知道毫無疑問，敏銳度將會發生轉變。國家精算師需要時間來觀察敏銳度的變化並允許費率對其進行評級。

There's a gap there. Being 200 basis points deep into the risk corridors would act as a buffer until rates caught up, and that's exactly what's happening here. Obviously, we're a bit short, but we're operating comfortably at 90% no matter how you cut it, we're operating comfortably at 90%.

那裡有一個缺口。深入風險走廊 200 個基點將起到緩衝作用，直到利率跟上，而這正是這裡發生的情況。顯然，我們有點短缺，但我們在 90% 的水平上舒適地運營，無論你如何削減，我們在 90% 的水平上舒適地運營。

Now with respect to rates, what gives us encouragement and great comfort are the rate updates we saw in the second half of the year. $345 million of pretax benefit to the second half, 230 basis points in the MCR.

現在就費率而言，給我們帶來鼓勵和極大安慰的是下半年我們看到的費率更新。下半年稅前收益為 3.45 億美元，MCR 提高 230 個基點。

Some of those rate updates were off cycle, meaning that states truly have recognized that components of their program were underfunded. The on-cycle rate adjustments in the third quarter averaged 4.5%. The on-cycle rate adjustments in the fourth quarter averaged nearly 9%.

其中一些利率更新是非週期的，這意味著各州確實已經認識到其計劃的組成部分資金不足。第三季週期利率調整平均為4.5%。第四季週期利率調整平均接近9%。

Now we've only seen a handful of draft rates for 1/1 when 55% of our revenue renews, but we've been encouraged by what we've seen at this early stage. So how it all maps out, depends on what cost trend emerges in the fourth quarter as to whether the strength of those 1/1 rates will truly get us back to our target MCR.

現在，當我們的收入有 55% 更新時，我們只看到了 1/1 的少數草稿費率，但我們對早期階段所看到的情況感到鼓舞。因此，這一切如何規劃，取決於第四季度出現的成本趨勢，以及這些 1/1 利率的強度是否真正能讓我們回到我們的 MCR 目標。

Mark, anything to add?

馬克，有什麼要補充的嗎？

Joe, I think that's really well summarized. There's no doubt that there's a little bit of a lag between trend and when states recognize it. But as Joe mentioned, five on-cycles, seven off in the third quarter, three more in the fourth quarter. The timing will never be perfect. But part of our equation here is those corridors make up that difference until we get into the new year and the new rate cycle.

喬，我認為這總結得很好。毫無疑問，趨勢與各國認識到這一趨勢之間存在一點滯後。但如喬所提到的，第三節有五個循環，七個循環，第四節還有三個。時機永遠不會完美。但我們這裡的部分方程式是，這些走廊彌補了這個差異，直到我們進入新的一年和新的利率週期。

So I think a combination of the states being fairly responsive in the corridor position, we're confident in our outlook.

因此，我認為各州在走廊立場上的反應相當積極，我們對我們的前景充滿信心。

Okay. That's helpful. Just on your utilization trends that you're seeing and you called out the areas of Medicaid, it sound like you're seeing a little bit of that in Medicare. Just trying to parse out, are these just the way the market is at this point or you need to get that in your rate updates both for Medicaid or Medicare? Or is there medical management opportunities for you to push back on some of what you're seeing

好的。這很有幫助。就您所看到的使用趨勢以及您指出的醫療補助領域而言，聽起來您在醫療保險中看到了一些這樣的情況。只是想分析一下，這些是否是目前市場的情況，或者您需要在醫療補助或醫療保險的費率更新中獲得這一點？或者是否有醫療管理機會讓您推翻您所看到的一些情況

Well, I think it's all relative, right? Because we all get the same rates, we're all observing the same gross trend supply-driven, demand-driven. We have proven on a sustainable basis that we are managing medical costs effectively, otherwise, we would not have historically been 200 basis points deep into the corridors on average for the past three or four years.

嗯，我認為這都是相對的，對吧？因為我們都得到相同的利率，所以我們都觀察到相同的供應驅動、需求驅動的整體趨勢。我們已經在可持續的基礎上證明，我們正在有效地管理醫療成本，否則，我們就不會在過去三、四年平均深入走廊 200 個基點。

So as rates renew, those corridors replenish. And given our expertise in medical management, care management, driving great quality scores, risk adjustment, et cetera, we plan to, and it is our intention to always be operating below whatever state benchmark exists in a minimum MLR or a corridor to always have that financial buffer available to us.

因此，隨著利率的更新，這些走廊就會補充。鑑於我們在醫療管理、護理管理、推動高品質評分、風險調整等方面的專業知識，我們計劃並且我們的意圖是始終在最低 MLR 或走廊中存在的任何州基準以下運營我們可以利用的財務緩衝。

The only thing I'd add, Joe, is when we talk about trend, we talk about net trend. So the benefit of the medical cost management that we do, UMCM all that is already in the numbers that we report. I think maybe when you hear higher trend numbers from other folks, they may have different views on how they do medical management. But again, we talk about net trends, net of all the things we do to manage costs.

喬，我唯一要補充的是，當我們談論趨勢時，我們談論的是淨趨勢。因此，我們所做的醫療成本管理的好處，UMCM 所有這些都已經在我們報告的數字中。我想也許當你從其他人那裡聽到更高的趨勢數字時，他們可能對如何進行醫療管理有不同的看法。但我們再次討論淨趨勢，扣除我們為管理成本所做的所有事情。

Okay. Thanks a lot.

好的。多謝。

Apologies to you, Mr. Rice, for misspeaking your name.

賴斯先生，我很抱歉說錯了你的名字。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，康托費茲傑拉。

Thank you. Can you help us think about what a clean jumping off point for 3Q is? You guys mentioned a onetime vendor credit, how big was that? I think also unusual tax item. And was any of the 80 basis points pressure on the core Medicaid MLR out of period? And then just a clarification.

謝謝。您能否幫助我們思考第三季的明確起點是什麼？你們提到了一次性供應商信貸，那有多大？我認為這也是不尋常的稅項。對核心醫療補助 MLR 施加 80 個基點壓力是否過時？然後只是澄清一下。

Is it -- should we think about it at 80-plus, the 200 basis points this quarter, so really 280 million year over year, that would be great. Thanks

是嗎？ 我們應該以 80 多個基點來考慮，本季 200 個基點，所以實際上同比增長 2.8 億，那就太好了。謝謝

We'd have to parse your question in the various pieces. But as I said, we are, no matter whether you pro forma the second quarter to the third, third quarter to fourth and the full year, we are comfortably operating Medicaid at 90% MCR. In fact, for the full year, embedded in our guidance is an 89.3% MSR -- MCR on the legacy book.

我們必須從各個方面來解析你的問題。但正如我所說，無論是第二季到第三季、第三季到第四季還是全年，我們都以 90% 的 MCR 輕鬆運作醫療補助。事實上，就全年而言，我們的指導中包含了 89.3% 的 MSR（舊書上的 MCR）。

It's only 30 basis points above the top end of the range. So we have a bridge, and Mark will give it to you here in a second, how we get from 90.5% in the third to 89% in the fourth would then support our guidance. Mark?

僅比區間上限高出 30 個基點。所以我們有一個橋樑，馬克很快就會給你，我們如何從第三個的 90.5% 到第四個的 89% 將支持我們的指導。標記？

Yes, absolutely. So the jumping off point on the third quarter, we reported the 90.5%, but as you know, 50 basis points was that onetime item in California. So we're jumping off a 90% from a clean basis on a third quarter. When we look at our rates and our trend in our corridors, I'm seeing a pretty significant improvement. I'm targeting an 89% for the fourth quarter.

是的，絕對是。因此，第三季的起點是 90.5%，但如您所知，50 個基點是加州曾經的專案。因此，第三季我們的業績將比乾淨的基礎上成長 90%。當我們查看走廊的費率和趨勢時，我看到了相當顯著的改善。我的目標是第四季達到 89%。

The way I get there off of a 90% is rates. We have three states with known on-cycle rates, which give me 80 bps of good guide for the fourth quarter. I'm going to assume trends another 50 bps in the fourth quarter, and I know I have corridors roughly to offset that. You add a little bit of benefit from our new stores, which continue to give us 20, 30 bps every quarter as they progress to their targets. That's your trajectory to get from a 90% adjusted to an 89%.

我達到 90% 的目標的方法是利率。我們有三個州的周期利率已知，這為我提供了第四季度 80 個基點的良好指導。我將假設第四季度的趨勢再上漲 50 個基點，而且我知道我有大致的走廊來抵消這一點。您可以從我們的新商店中獲得一點好處，隨著它們實現目標，它們每季都會繼續為我們帶來 20、30 個基點的成長。這就是從 90% 調整到 89% 的軌跡。

Now on G&A, you asked also about the jumping off point. We reported a 6.4% in the third quarter. That benefited from some vendor credits, a little bit was retro, but a little bit is sustaining. Just to cut to the chase on that, my full-year guidance will be a 6.8% on G&A. I think that gives you the building blocks to model off the rest of the year.

現在，在 G&A 上，您也詢問了起點。我們報告第三季的成長率為 6.4%。這要歸功於一些供應商信用，有一點是復古的，但有一點是可持續的。言歸正傳，我的全年指導方針是 G&A 為 6.8%。我認為這為你奠定了今年剩餘時間的基礎。

Great. Thank you.

偉大的。謝謝。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Yes. Hi. Thanks for the question. I appreciate the color on the bridge to the fourth quarter. Just wanted to follow up a little bit on that. You mentioned some of it, you're factoring in potential for some incremental trend. I guess when you think about the negative impact from acuity shifts that have been driving up MLR sequentially, rejoiner dynamics presumably contributing to that as well.

是的。你好。謝謝你的提問。我欣賞第四節橋上的色彩。只是想對此進行一些跟進。您提到了其中一些，您正在考慮一些增量趨勢的潛力。我想，當你考慮到敏銳度變化所帶來的負面影響（依序推高 MLR）時，重新加入動態可能也會造成這種影響。

Is your expectation now given where we are in the cycle that this negative incremental pressure has largely stopped as we enter the third -- entered the fourth quarter? Or is that factored into your thought process as continuing at least for another quarter or two? Thank you.

您現在的預期是否是考慮到我們所處的周期，隨著我們進入第三季或第四季度，這種負增量壓力已基本停止？或者，這會被納入您的思考過程中，並至少持續一兩個季度？謝謝。

So in the third quarter, we had pretty meaningful trend as did everybody, right? And I think there were two dynamics in the third quarter. One, there was a little more carryover from redetermination. One, it's just the weighted average math, redetermination mostly stopped in the second quarter, but the weighted average math carrying into the third quarter put a little pressure in the third quarter. The other thing is I had a couple of states that continued to do determinations in the third quarter, had two states in particular that extended into the third quarter.

所以在第三季度，我們和其他人一樣有非常有意義的趨勢，對嗎？我認為第三季有兩個動態。第一，重新確定帶來了更多的遺留影響。第一，這只是加權平均數學，重新確定大部分在第二季停止，但進入第三季的加權平均數學給第三季帶來了一些壓力。另一件事是，我有幾個州在第三季繼續做出決定，特別是有兩個州延續到了第三季。

So we saw a little bit more of the joiners leavers dynamic into the third quarter than I would have otherwise expected. And of course, the leavers having a little bit higher utilization. I don't think either of those are sustaining, which is why I'm suggesting more like a 50 basis point trend in the fourth quarter over the third, coming back to a new normal.

因此，我們看到進入第三季的加入者離職人數比我預期的要多一些。當然，離職者的利用率要高一些。我認為這兩者都不會持續，這就是為什麼我建議第四季比第三季的趨勢更像是 50 個基點的趨勢，回到新常態。

Was there a follow-up, Mr. Baxter?

巴克斯特先生，有後續行動嗎？

Yes. Well, I guess a chance, if you're giving me a follow up, so I appreciate it. Just a little bit of like what the states in terms of the rate update process are really seeing here? I mean, like to follow up on a previous question, we've heard from peer companies that there's often a multi-year lag to the claims base needed to reset rates. So in terms of the rate update being so large today, is it truing up acuity factors largely because we've seen enrollment drop off more than what have been previously projected.

是的。好吧，我想有機會，如果你給我跟進，所以我很感激。有點像各州在費率更新過程中真正看到的情況？我的意思是，就像跟進之前的問題一樣，我們從同行公司聽說，重置費率所需的索賠基礎通常存在多年的滯後。因此，就今天如此之大的比率更新而言，它是否在很大程度上調整了敏銳度因素，因為我們看到入學人數下降幅度超過了先前的預期。

Just trying to understand what is making its way into the rates and why, given that the claims experience, obviously, is still very dynamic. Thanks.

只是想了解是什麼因素影響了費率以及原因，因為索賠經驗顯然仍然非常動態。謝謝。

The rate process has not changed. The rate setting process starts with a credible baseline. Every state has a view of what that -- where that baseline should lie, whether it's the year prior, two years prior, pre-pandemic, trend off the baseline.

費率流程沒有改變。費率設定過程從可靠的基線開始。每個州都有自己的看法——基線應該在哪裡，無論是前一年、兩年前、大流行前還是偏離基線的趨勢。

And acuity shifts for any reason are always part of the rating process. The only thing that's different now is that the acuity shift is far more dramatic given the 92 million enrollees down to 72 million in a short period of time.

任何原因造成的敏銳度變化始終是評級過程的一部分。現在唯一不同的是，考慮到註冊人數在短時間內從 9,200 萬減少到 7,200 萬，敏銳度的轉變要劇烈得多。

So nothing's really changed in the rating model process. It works exactly the way it's worked historically. The only thing that's different is the acuity shift is more prominent. And by the way, it's not a secret. I mean, it's high profile.

所以評級模型過程中沒有任何真正的改變。它的工作方式與歷史上的工作方式完全相同。唯一不同的是敏銳度的轉變更加突出。順便說一句，這不是秘密。我的意思是，它的知名度很高。

Every state knows it, and there's laser-focused on it. So the fact that we're getting updates that seem to be capturing it should be no surprise.

每個州都知道這一點，並且都在重點關注這一點。因此，我們收到的更新似乎捕捉到了這一點，這一事實應該不足為奇。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

Thanks. Good morning. Wanted to focus on your 2025 comments. First, are you confirming that you believe you could do 13% to 15% next year? And specifically, Mark, you gave the -- just about $3 of that embedded earnings comes in next year, which is a great tailwind.

謝謝。早安.希望重點關注您對 2025 年的評論。首先，您是否確認明年可以達到 13% 到 15% 的目標？具體來說，馬克，你給了明年的嵌入收益中只有大約 3 美元，這是一個巨大的推動力。

On the other hand, you talked about a bunch of help from investment income and G&A and marketplace that might not reoccur, that is almost a similar number. I think you said it was like $2.70. So just trying to think about those moving parts and whether you still see that when combined with core growth getting you to that 13% to 15% target or where you expect to be in there?

另一方面，您談到了來自投資收入、一般管理費用和市場的大量幫助，這些幫助可能不會再次出現，這幾乎是相似的數字。我想你說的是 2.70 美元。因此，只要想一想那些移動的部分，當與核心增長相結合時，您是否仍然看到這些部分可以讓您達到 13% 至 15% 的目標或您期望的目標？

Well, I think -- Justin, it's Joe. I think the items that are easy to get your arms around are the embedded earnings because we have visibility into them. As Mark said, there will be a headwind from net investment income. That's pretty obvious.

嗯，我想──賈斯汀，是喬。我認為你最容易掌握的項目是嵌入收益，因為我們對它們有可見性。正如馬克所說，投資淨收入將會帶來阻​​力。這是很明顯的。

The unknown is when we talk about growth off the footprint, that's usually pretty easy to predict, but we need to see how medical cost trend emerges in the fourth quarter into the first to then conclude that the 1/1 rates, 55% of our revenue are appropriately capturing it.

未知的是，當我們談論足跡成長時，這通常很容易預測，但我們需要看看第四季度到第一季度的醫療成本趨勢如何出現，然後得出 1/1 比率，即我們的 55%收入正在適當地捕捉它。

So normally, we'd be able to give you a really good point estimate in a normal environment that our footprint should produce $1, $1.50, $2 a share. Right now, we're hesitating to do that until we see more in the fourth quarter. Mark, anything to add?

因此，通常情況下，我們能夠在正常環境下為您提供非常好的點估計，即我們的足跡應產生每股 1 美元、1.50 美元、2 美元。目前，我們正在猶豫是否要這樣做，直到第四季度我們看到更多。馬克，有什麼要補充的嗎？

Yes, a couple of things. Justin, just to set the table, you mentioned $2.70, that was part of my bridging on 2024 guidance how versus prior guidance I'm up now $2.70 on a bunch of good guys and down $2.70 on the trend in Medicaid and Medicare. So that's current year. Let's put that aside. For 2025 guidance, Joe hit it exactly right, with some of the vagaries we have right now on trend and rate, we're optimistic, but we're not ready to lay out specific numbers on that.

是的，有幾件事。賈斯汀，為了擺好桌子，你提到了2.70 美元，這是我對2024 年指導的過渡的一部分，與之前的指導相比，我現在在一群好人身上上漲了2.70 美元，在醫療補助和醫療保險的趨勢上下降了2.70 美元。這就是今年。讓我們把它放在一邊。對於 2025 年的指導，Joe 的說法完全正確，鑑於我們目前在趨勢和利率方面存在一些變幻莫測的情況，我們很樂觀，但我們還沒有準備好就此列出具體數字。

Now the biggest component of next year is the embedded earnings. As you know, we're now up to $5.75 on embedded earnings. And I said in my prepared remarks, we expect a little less than half of that to emerge next year. Pressures on net investment income, you got that one, absolutely. And you're aware, we did a small stock repurchase in the third quarter, which you'd want to factor into your numbers as well.

現在明年最大的組成部分是嵌入收益。如您所知，我們的嵌入收益現在高達 5.75 美元。我在準備好的發言中說過，我們預計明年將出現不到一半的情況。淨投資收益的壓力，你絕對得到了。您知道，我們在第三季進行了小規模股票回購，您也希望將其計入您的數據中。

Okay. Great. And then just a follow-up on the rates, right? It sounded like you got some pretty good retro rates in the quarter. You mentioned the headwind from California retro cut.

好的。偉大的。然後只是對費率進行跟進，對嗎？聽起來您在本季度獲得了一些相當不錯的復古利率。您提到了加州復古剪裁帶來的逆風。

Was there any tailwind from some of these rates in the third quarter, especially the off-cycle rates being also retroactive that we need to consider in that jump off point or were none of those retro?

第三季的某些利率是否有任何推動作用，特別是非週期利率也具有追溯性，我們需要在該起點考慮，或者這些利率都沒有追溯？

The rates that we got in the third quarter are obviously a good jumping off point going forward. The retro rates are not only retro, but also imply a new go-forward basis. So you can jump off third quarter with confidence. And then Joe mentioned, we had three new rates in the fourth quarter, which are factored into my fourth quarter outlook.

我們在第三季獲得的利率顯然是未來的一個很好的起點。費率的復古不僅是復古，還意味著新的前進基礎。所以你可以充滿信心地結束第三季。然後喬提到，我們在第四季度有三個新的費率，這些都已納入我的第四季度展望中。

Right, Mark. But to the extent they're retro, you would have dollars in the quarter that don't belong in the quarter, just like California doesn't belong in the cut, right? Was there any of that, like any offset to that 50 bps retro that's involved in the quarter.

對，馬克。但就其復古而言，你會在本季度擁有不屬於本季的美元，就像加州不屬於削減範圍一樣，對吧？是否有任何此類情況，例如本季度涉及的 50 個基點回落的任何抵消？

Just a little bit. But when I give you my bridge from the third quarter to fourth quarter, that's in my net rate increase.

只是一點點。但是，當我向您提供從第三季到第四季的過渡時，這就是我的淨利率成長。

Okay. Thanks, guys.

好的。謝謝，夥計們。

You bet.

你打賭。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Hi, good morning. I wanted to follow up on the exchanges. Can you help us understand the drivers of the outperformance in the quarter? And how would you compare this year's SEP memberships to performance of prior years? Thanks.

嗨，早安。我想跟進交流情況。您能幫助我們了解本季表現優異的驅動因素嗎？您如何將今年的 SEP 會員資格與往年的表現進行比較？謝謝。

The SEP membership this year in marketplace has been extraordinary. I think in the second quarter, it was 90,000 plus. It leveled off to 60,000 and then 50,000 each of the last 3 quarters. A normal SEP membership gain in that business is 20,000 to 25,000. So you can see that it benefited by the Medicaid redetermination process without question.

今年市場上的 SEP 會員數量非同尋常。我認為第二季度的數量超過了 90,000。它穩定在 60,000 人，然後在過去 3 個季度每季達到 50,000 人。該行業正常的 SEP 會員數量為 20,000 至 25,000 名。所以你可以看到它毫無疑問地受益於醫療補助重新確定過程。

Normally, that SEP membership comes in with higher acuity and runs higher MCRs. This year, the SEP membership came in running higher than the traditional book, but not as high. It's due to a younger demographic, a more healthy demographic and it didn't put as much pressure on the MCR as it had done historically, likely due to the fact that many of those members came in for Medicaid.

通常，SEP 會員資格具有更高的敏銳度和更高的 MCR。今年，SEP 會員資格的排名高於傳統書籍，但也沒有那麼高。這是由於人口結構更年輕、更健康，而且它沒有像歷史上那樣給 MCR 帶來那麼大的壓力，這可能是因為其中許多成員都參加了醫療補助計劃。

So the business is performing well. And I'd rather have excess margin than not because I can always invest excess margin in growth, which is exactly what we plan to do.

所以業務表現良好。我寧願擁有超額利潤，也不願沒有，因為我總是可以將超額利潤投資於成長，而這正是我們計劃要做的。

Got it. And if I could just follow up. Can you help us understand how the revenue recognition works for off-cycle rate adjustments? Do you wait for those payments to be received? Are you able to recognize those when you have a certain level of assurance and visibility into those payments?

知道了。如果我能跟進的話。您能否幫助我們了解收入確認如何用於非週期費率調整？您是否等待收到這些付款？當您對這些付款有一定程度的保證和可見性時，您能夠識別這些付款嗎？

Yes. We have a really tight accounting standard on that. We need documented evidence, not just suggestion or conversation, we book on documented evidence.

是的。我們對此有非常嚴格的會計標準。我們需要有據可查的證據，而不僅僅是建議或談話，我們以有據可查的證據為基礎。

Great. Thank you.

偉大的。謝謝。

Adam Ron, Bank of America.

亞當‧羅恩，美國銀行。

Hey, thanks so much. I have a question about core trend and the difference between what you're seeing on that versus the rate and acuity mismatch. First, has that core trend accelerated throughout the year such that 2Q was higher than 1Q, 3Q was higher than 2Q and we expect 4Q to be higher? And if not, what gives you confidence that it will slow?

嘿，非常感謝。我有一個關於核心趨勢的問題，以及您所看到的與速率和敏銳度不匹配之間的差異。首先，這個核心趨勢是否在全年加速，導致第二季度高於第一季度，第三季度高於第二季度，我們預期第四季會更高？如果沒有，是什麼讓您相信它會放緩？

And then second, if you could just break out the magnitude of how you're seeing core trend versus the acuity rate mismatch and overall, how that stacks up. I think one of your competitors said it was roughly a one-third core trend and two-third acuity versus rate. Thanks.

其次，如果您能詳細說明您所看到的核心趨勢與敏銳度不匹配的程度以及整體情況，那麼它們是如何疊加的。我想你的一位競爭對手說這大約是三分之一的核心趨勢和三分之二的敏銳度與速度。謝謝。

As I said previously, and I'll kick it to Mark, let's just take Medicaid to keep the conversation simple. We had anticipated a net trend of 3% in our initial guidance that has increased to 6%. And I guess you could say, yes, it had built during the year. We still have a trend increase going into the fourth. Even off this incredibly high cost base line, we still in our forecast had a slight trend increase into the fourth quarter.

正如我之前所說，我將把它踢給馬克，讓我們以醫療補助為例，以保持對話簡單。我們最初的指導預期淨趨勢為 3%，但現在已增加至 6%。我想你可能會說，是的，它是在這一年建造的。進入第四季我們仍然有成長的趨勢。即使在這個令人難以置信的高成本基準之外，我們的預測仍然是第四季度略有增長。

The combination of rates, trend and corridors are the reason we're operating at 90% and not 89%. So it worked exactly the way we had predicted with corridors acting as a buffer until rates caught up, and that is happening. Now we're still cautious on the 1/1 rates, as I said before. But the model is working exactly as we have predicted. The corridors act as a financial buffer, giving rates time to catch up with trend.

利率、趨勢和走廊的結合是我們以 90% 而不是 89% 運作的原因。因此，它的運作方式與我們預測的完全一樣，走廊充當緩衝區，直到利率趕上，而這種情況正在發生。正如我之前所說，現在我們仍然對 1/1 利率持謹慎態度。但模型的運作效果與我們的預測完全一致。走廊起到了金融緩衝的作用，讓利率有時間跟上趨勢。

And yes, trend did build over the year.

是的，這一趨勢確實在這一年裡形成了。

Yes. And I think, Adam, the easiest way for me to think about it because you get into timing issues quarter-to-quarter what came in when, was something retro on a full-year basis as we said before, trend is 3% higher than I initially thought in the outlook just for all the reasons we all know.

是的。我認為，亞當，這是我思考這個問題的最簡單的方法，因為你會遇到季度與季度的時機問題，正如我們之前所說，全年的情況是復古的，趨勢是高出 3%出於我們都知道的所有原因，我的前景比我原本想像的還要好。

Rates are 1.5% better than I initially thought. I'm using 1% of my corridors on a full-year basis to offset some of that mismatch, which is largely why full-year guidance went from 89% to 90%. The difference in all that math is obviously you've got a couple of California retro items in there.

利率比我原先想的要高 1.5%。我在全年基礎上使用 1% 的走廊來抵消部分不匹配，這在很大程度上是全年指導從 89% 升至 90% 的原因。所有這些數學上的差異顯然是你那裡有一些加州復古物品。

But those are the big items. And on that trend, what we've been very clear about is part of it is the ongoing imbalance of joiners and leavers and part of it is those stayers running just a little bit hotter than most of us expected.

但這些都是大項目。關於這個趨勢，我們非常清楚的是，部分原因是加入者和離開者的持續不平衡，部分原因是那些留下來的人比我們大多數人的預期要熱一點。

Adam, I keep coming back to the legacy book because the California retro and the new stores create a little bit of obfuscation, but the fourth quarter legacy book is going to produce an 88.8%. The second half is an 89.3% and the full-year, legacy book is 89.3%.

亞當，我不斷回到舊書，因為加州的復古和新商店造成了一點混亂，但第四季的舊書將產生 88.8%。下半年為 89.3%，全年遺留帳面率為 89.3%。

In this incredibly difficult time of a huge shift in the risk pool, we're operating at our legacy book only 30 basis points above the high end of our range. Combination of corridor protection, rates catching up to an accelerated trend.

在風險池發生巨大轉變的這個極其困難的時期，我們的傳統帳簿僅比我們範圍的高端高出 30 個基點。結合走廊保護，費率追趕呈現加速趨勢。

Appreciate it.

欣賞它。

Ryan Langston, TD Cowen. Please go ahead.

瑞安·蘭斯頓，TD·考恩。請繼續。

Hi. Thank you. You called out higher utilization pharmacy behavior LTC. I'm curious if any other service lines might have come in maybe better than you had expected in the 3Q? And then just on the behavioral side, you called out Kentucky last quarter specifically. Is that higher utilization still isolated to that state? Or are you now seeing that more, maybe broad-based and other geographies? Thanks.

你好。謝謝。您調用了更高利用率的藥房行為 LTC。我很好奇第三季是否有其他服務可能比您預期的更好？然後就行為方面而言，上個季度您特別提到了肯塔基州。更高的利用率仍然與該狀態隔離嗎？或者您現在是否看到更多這樣的情況，也許是基礎廣泛的和其他地區的？謝謝。

I'll answer the second question first and kick the first question to Mark. On behavioral, the reason we cited Kentucky, it was a program change that caused it. There was a suspension of utilization management in Kentucky during the pandemic, which, post caused behavioral cost to go up. We are seeing pockets of trend inflection on behavioral services broad-based across the country. In Kentucky it was more pronounced because of the program change.

我先回答第二個問題，然後把第一個問題交給馬克。在行為方面，我們引用肯塔基州的原因是專案的改變造成的。肯塔基州在大流行期間暫停了使用管理，導致行為成本上升。我們看到全國廣泛的行為服務出現了一些趨勢變化。在肯塔基州，由於計劃的改變，這種情況更加明顯。

But the stigma over receiving behavioral services is removed, providers are open for business, they really suffered in terms of service revenue during the pandemic. And of course, the pandemic created all kinds of behavioral issues in the population. So it is a national trend. The reason we called out Kentucky, it was because of a program change.

但接受行為服務的恥辱已經消除，提供者重新營業，他們在疫情期間的服務收入確實受到了影響。當然，這種流行病在人們身上造成了各種行為問題。所以這是一個全國性的趨勢。我們之所以選擇肯塔基州，是因為計劃改變了。

And back on the utilization management side, we certainly called attention to some of the challenges. I wouldn't call any specific good guys out state by state, we're in 21 states. Every state has its own story with some unique items going on here and here. But as a national trend, I wouldn't cite any specific good guys within trend.

回到利用率管理方面，我們當然提請人們注意一些挑戰。我不會逐州稱呼任何特定的好人，我們有 21 個州。每個州都有自己的故事，這裡和這裡都有一些獨特的項目。但作為一種全國趨勢，我不會引用趨勢中的任何具體好人。

Okay, thank you.

好的，謝謝。

You bet.

你打賭。

Michael Ha, Baird.

麥可·哈，貝爾德。

Thank you. Something I've been thinking about more and questioning is, I understand D-SNP lives have, I think, a six-month grace period in terms of redeterminations. So granted, I think most duly eligible lives aren't actually in the job market, but just given how high revenue PMPMs are even just a few percent change could drive compression on MLR.

謝謝。我一直在思考和質疑的是，我認為 D-SNP 生命在重新決定方面有六個月的寬限期。因此，我認為大多數符合資格的生活實際上並不在就業市場上，但考慮到 PMPM 的收入有多高，即使只有幾個百分點的變化也可能會推動 MLR 的壓縮。

So I'm curious to hear what you've seen on D-SNP redeterminations. Is there potential unexpected tail risk on these lines due to the grace period? And just trying to figure out if there's another potential shoe to drop here?

所以我很想聽聽您對 D-SNP 重新測定的看法。由於寬限期，這些線路是否有潛在的意外尾部風險？只是想知道這裡是否還有另一雙潛在的鞋子可以掉落？

I'm only pausing, Michael, because I'm having difficulty understanding the question. D-SNP lives in our Medicare book and pressure on what aspect of these D-SNP lives are you referring to?

我只是停頓了一下，邁克爾，因為我很難理解這個問題。D-SNP 存在於我們的醫療保險手冊中，您指的是這些 D-SNP 生活的哪些方面？

Yes. I guess if there is a six-month grace period on D-SNP lives and redetermination and could that impact your visibility now? Could you see that come through later on? Or maybe am I not thinking about it correctly, that would be good to get visibility on to some clarity.

是的。我想 D-SNP 生命和重新確定是否有六個月的寬限期，這會影響您現在的知名度嗎？你能看到稍後會實現嗎？或者也許我沒有正確地思考它，這將有助於獲得一些清晰的可見性。

I can only comment on our D-SNP business. As you know, our Medicare business is performing well. At 4.5% pretax margin, we target 6%, 5.5% to 6%, but in this environment, we're pretty pleased with it. The demonstrations are doing well. D-SNP book is doing well.

我只能評論一下我們的D-SNP業務。如您所知，我們的醫療保險業務表現良好。稅前利潤率為 4.5%，我們的目標是 6%、5.5% 到 6%，但在這種環境下，我們對此感到非常滿意。示威活動進展順利。D-SNP 書賣得很好。

And as I said, we expanded our accounting footprint by 23%. We're really focusing on the dual eligible D-SNP population. And of course, the Michigan win was huge.

正如我所說，我們的會計足跡擴大了 23%。我們真正關注的是符合雙重資格的 D-SNP 族群。當然，密西根州的勝利是巨大的。

We have an MMP book that's going to convert to a fully integrated product here in 2026. So I only comment that we're very bullish on the D-SNP population. We're focusing intensely on it. The final rule passed by CMS gives players with a substantial Medicaid footprint, a huge advantage to take advantage of this great growth opportunity. And it's a profitable book of business for us.

我們有一本 MMP 書，將於 2026 年轉換為完全整合的產品。所以我只是評論說我們非常看好 D-SNP 群體。我們正在密切關注它。CMS 通過的最終規則為擁有大量醫療補助足跡的參與者提供了利用這一巨大成長機會的巨大優勢。這對我們來說是一本有利可圖的商業書籍。

We have a proven track record of managing high-acuity lives effectively.

我們在有效管理高度敏銳的生活方面擁有良好的記錄。

Got it. Thank you. If I could follow up. In terms of favorable PYD, it seems like it's been pretty outsized, I think, around $700 million this year. If that goes back to normal next year, I think it's about close to 100 bps of just MLR potential headwind into '25. So wondering if you have any color on how or where that could shake out next year, at least directionally, should we be thinking about this as returning to more normal levels in '25?

知道了。謝謝。如果我能跟進的話。就有利的 PYD 而言，我認為今年的規模似乎相當大，約為 7 億美元。如果明年恢復正常，我認為 MLR 進入 25 年的潛在阻力將接近 100 個基點。因此，想知道您是否對明年這種情況如何或在哪裡發生變化有任何看法，至少在方向上，我們是否應該考慮將其視為在 25 年恢復到更正常的水平？

Well, Michael, thanks for the question. I'd start with what is normal, right? We are a bigger business in '24 than we were in '23. And yes, my PYD is bigger this year than it was last year. But we're a bigger business.

好吧，邁克爾，謝謝你的提問。我會從正常的開始，對嗎？24 年我們的業務比 23 年更大。是的，我今年的 PYD 比去年更大。但我們是一家規模更大的企業。

We're getting better and better at things like payment integrity. And as you know, when we acquire businesses, that also helps us when we look at prior year and prior period development. So I wouldn't say we're necessarily outsized this year. We're a growing business. Now on a go-forward basis, I'm not expecting any headwind from that area.

我們在支付誠信等方面做得越來越好。如您所知，當我們收購業務時，這對我們查看上一年和前期的發展也有幫助。所以我不會說今年我們一定會規模過大。我們是一家不斷發展的企業。現在展望未來，我預計該領域不會出現任何阻力。

It's part of the way we run our business. Remember, on medical cost management, there are many components to it, CM, UM, network contracting, payment integrity and making sure that in retrospect, things got settled appropriately, avoiding fraud, waste and abuse. That's a big part of our business. So I see the PYD item as a very continuing part of the business, and I wouldn't factor in anything meaningfully different next year.

這是我們經營業務方式的一部分。請記住，在醫療成本管理方面，有很多組成部分，CM、UM、網路承包、支付完整性，並確保事後看來，事情得到了適當的解決，避免欺詐、浪費和濫用。這是我們業務的重要組成部分。因此，我認為 PYD 專案是業務的一個非常持續的部分，明年我不會考慮任何有意義的差異。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

Thank you and good morning. First question just thought it might be helpful if you can maybe just sequence just to walk us through on the corridors where you stood, at the beginning of the quarter and then at the end of the quarter and then where you're expecting to be, I guess, in terms of remaining cushion at the end of the year. Just trying to understand particularly how much potential, I guess, cushion you'll still have from corridors heading into 2025?

謝謝你，早安。第一個問題只是認為，如果您可以按順序引導我們穿過您所在的走廊，在季度初，然後在季度末，然後在您期望的地方，這可能會有所幫助，我想，就年底剩餘的緩衝而言。只是想了解一下，我想，到 2025 年，走廊仍然有多大的緩衝潛力？

Sure. Scott, it's Joe. I'm going to make a framing comment and kick it to Mark for some color on the numbers. But the first thing, one of the reasons we usually hesitate to talk about corridors either in dollars or in basis points of cushion is you never know that you're going to be using it in a place where you have it.

當然。斯科特，這是喬。我將做一個框架評論，並把它踢給馬克，讓他給數字上一些顏色。但首先，我們通常不願意以美元或緩衝基點來談論走廊的原因之一是，你永遠不知道你會在擁有它的地方使用它。

If you have negative trend experience, if it happens in a place where there's no corridor protection, there's 0 protection. And if it happens everywhere we do have protection, it's 100% protected. So averages actually can be misleading. But I will tell you in each of the past four years, we've been operating with about 200 basis points of protection at every point in time. Mark?

如果你有負面趨勢的經驗，如果它發生在沒有走廊保護的地方，那麼保護就是0。如果這種情況發生在我們有保護的任何地方，那麼它就得到了 100% 的保護。所以平均值其實可能會產生誤導。但我會告訴你，在過去四年中，我們在每個時間點都以大約 200 個基點的保護進行運作。標記？

Yes. And let me just run through the usual example that we give just to everyone's level set. If a business reports an 88% MLR, in our case, an analogy might be we were really running an 86%. Again, this is just an example, and we were booking 200 basis points of corridor expense.

是的。讓我簡單介紹一下我們為每個人的水平集提供的常見範例。如果一家企業報告的 MLR 為 88%，在我們的例子中，可以類比為我們實際運行的是 86%。再次強調，這只是一個例子，我們預訂了 200 個基點的走廊費用。

Now if during that example year, the true underlying medical costs went from an 86% to 87%, you might still report the 88%, you just would have used more corridor expense, just booked less corridor expense.

現在，如果在那個範例年份，真正的基本醫療費用從 86% 上升到 87%，您可能仍然報告 88%，您只是會使用更多的走廊費用，只是預訂更少的走廊費用。

When the new rate cycle comes around, if rates are actuarially sound, the rates will have to jump enough to essentially put that corridor position back to where it was, all things being equal. So the 86% underlying medical cost goes to an 87%, the new rate trend, knocks it back to an 86%.

當新的利率週期到來時，如果利率在精算上是合理的，那麼在所有條件相同的情況下，利率將必須跳得足夠大，才能基本上使走廊位置回到原來的位置。因此，86% 的基本醫療費用降至 87%，新的費率趨勢將其回落至 86%。

Right now, that is somewhat analogous to the overall enterprise. I started off the year thinking I had about 200 basis points of corridor expense in my MLR. As you know, over the quarters, we've started to use that, and I've shown you that in my bridges.

現在，這有點類似於整個企業。年初時，我認為我的 MLR 中有大約 200 個基點的走廊費用。如您所知，在幾個季度中，我們已經開始使用它，並且我已經在我的橋樑中向您展示了這一點。

Such that I'm thinking full year ultimate, that 200 that I normally have is down to more like 100 basis points within my MLR.

因此，我認為全年最終，我通常擁有的 200 個基點在我的 MLR 中下降到了 100 個基點。

Now Joe talked about how 55% of our revenue reprices on January 1. We're optimistic on what that looks like as well as the rate increases we got in Q3, Q4. So I'm expecting some extent to replenish that corridor. Now that's all about the rate cycles, and we're not really ready to get into what's what on that.

現在 Joe 談到我們 55% 的收入如何在 1 月 1 日重新定價。我們對這一情況以及第三季、第四季的利率上漲持樂觀態度。所以我預計會在某種程度上補充這條走廊。現在這就是利率週期的全部內容，我們還沒有真正準備好了解其中的內容。

And the last thing what Joe made -- the points you have made is even with that 100 basis points of remaining corridor, it's an imperfect hedge because it depends on where the medical costs come up and where you have the remaining corridors.

喬所說的最後一件事——你所提出的觀點是，即使剩餘走廊有 100 個基點，這也是一個不完美的對沖，因為這取決於醫療費用的出現以及剩餘走廊的位置。

So there's only so much comfort you can take in that, but it is a very big part of our equation. And again, just to round it out, 200 originally in my guidance, and I probably used half of it during the course of the year.

所以你能得到的安慰是有限的，但它是我們方程式的一個非常重要的部分。再次強調一下，我最初的指導是 200，這一年我可能使用了其中的一半。

George Hill, Deutsche Bank.

喬治·希爾，德意志銀行。

Yes. Thanks for squeezing me in, guys. Mark, you might have just gotten this. But I guess -- so the expectation is you have 100 basis points of the risk corridor to use in the back half of the year. I guess, can you talk about how much you expect to have by the end? And can you talk about how much was used front half versus back half?

是的。謝謝你們把我擠進去，夥計們。馬克，你可能剛剛得到這個。但我猜——所以預計你有 100 個基點的風險走廊可以在今年下半年使用。我想，你能談談你最終期望得到多少嗎？能談談前半部和後半部的使用量嗎？

Okay. So on a -- it's best to think about this on a full-year basis because quarter to quarter, it gets a little bit more complicated. On a full-year basis, I started off the year expecting 200 across the year, a little bit in Q2, more in Q3, more in Q4, I expect to have used half of it. which means on a full-year basis within my reported MLR, I'm expecting about 100 basis points of corridor expense. And again, for the new year, it's all about the new rate cycle on what happens on resetting that.

好的。因此，最好在全年的基礎上考慮這個問題，因為逐季度來看，情況會變得更加複雜。就全年而言，我年初預計全年使用 200 個，第二季一點，第三季更多，第四季更多，我預計已經用了一半。這意味著在我報告的 MLR 內，我預計全年走廊費用約為 100 個基點。再說一遍，在新的一年裡，一切都與新的利率週期有關，重置後會發生什麼。

Okay. That's helpful. And if I could have a quick follow-up. Could you just comment on how many states do you guys still have a corridor position in? And what percent of lives are on a multi-year repricing basis.

好的。這很有幫助。如果我能快速跟進的話。您能評論一下你們在多少州仍然擁有走廊位置嗎？多少百分比的生命是在多年重新定價的基礎上的。

Like we've spoken to some states where they just say, like our rate cycles two years or more than two years. So I know we talked about like the annual rate cycle, but there are just some states who don't do this annually. Maybe on a percentage of lives, can you talk about what states are on a multi-year cycle versus a single-year cycle?

就像我們與一些州交談過一樣，他們只是說，我們的利率週期是兩年或兩年以上。所以我知道我們討論過年利率週期，但只有一些州不每年這樣做。也許就生命的百分比而言，您能談談哪些州處於多年周期與一年周期？

So, sure. Just about every one of our states has some form of a corridor, a minimum MLR or a profit sharing. And that's not news. Many of these things have been around for quite some time. What is important is what the numbers are and how that acts.

所以，當然。我們幾乎每個州都有某種形式的走廊、最低 MLR 或利潤分享。這不是什麼新聞了。其中許多事情已經存在相當長一段時間了。重要的是這些數字是什麼以及它們如何發揮作用。

But you have some form of that in just about every state. And if I understood your question right, on the pricing cycle, every state that we have reprices on an annual basis and some of them commit to on a twice a year basis to look at the rates. Most years, that's not necessary. But obviously, these days, that's an important fact.

但幾乎​​每個州都有某種形式的這種情況。如果我理解你的問題的話，關於定價週期，我們每年都會重新定價，其中一些州承諾每年兩次查看費率。大多數年份，這是沒有必要的。但顯然，如今，這是一個重要的事實。

Okay, that's helpful. Thank you.

好的，這很有幫助。謝謝。

This concludes our question-and-answer session and Molina Healthcare's third-quarter 2024 earnings call. Thank you for attending today's presentation. You may now disconnect.

我們的問答環節和 Molina Healthcare 的 2024 年第三季財報電話會議到此結束。感謝您參加今天的演講。您現在可以斷開連線。