Molina Healthcare Inc (MOH) 2025 Q1 法說會逐字稿

Good day and welcome to the Molina Healthcare first quarter 2025 earnings conference call.

大家好，歡迎參加 Molina Healthcare 2025 年第一季財報電話會議。

(Operator Instructions) Please note this event is being recorded.

（操作員指示）請注意，此事件正在被記錄。

I would now like to turn the conference over to Jeffrey Geyer. Please go ahead.

現在我想將會議交給 Jeffrey Geyer。請繼續。

Good morning and welcome to Molina Healthcare's first quarter 2025 earnings call. Joining me today are Molina's President and CEO Joe Zubretsky, and our CFO, Mark Keim. A press release announcing our first quarter 2025 earnings was distributed after the market closed yesterday and is available on our investor relations website.

早安，歡迎參加 Molina Healthcare 2025 年第一季財報電話會議。今天與我一起出席的還有 Molina 總裁兼執行長 Joe Zubretsky 和我們的財務長 Mark Keim。我們在昨日股市收盤後發布了一份新聞稿，宣布了 2025 年第一季的收益，可在我們投資者關係網站上查閱。

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. 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, April 24, 2025, and have not been updated subsequent to the initial earnings call.

本次通話結束後不久，重播將保留 30 天。觀看重播的數字可在收益報告中找到。對於那些收聽本次演講重播的人，我們提醒您，所有評論都是截至今天（2025 年 4 月 24 日星期四）做出的，並且在首次收益電話會議之後尚未更新。

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 first quarter 2025 earnings release.

在本次電話會議中，我們將參考某些非公認會計準則指標。在 2025 年第一季財報中可以找到這些指標與最直接可比較的 GAAP 指標的對帳。

During the call, we will be making certain forward-looking statements, including but not limited to statements regarding our 2025 guidance, the estimated amount of our embedded earnings power, and future earnings realization, expected Medicaid rate adjustments and updates, our projected MCR, organic Medicaid and marketplace membership growth, our recent RFP awards, our acquisitions and M&A activity, revenue growth related to RFPs and M&A activity, potential Medicaid funding cuts or program changes, and our long-term growth strategy.

在電話會議期間，我們將做出某些前瞻性陳述，包括但不限於有關我們 2025 年指引、我們內含盈利能力的估計金額和未來盈利實現、預期醫療補助費率調整和更新、我們預計的 MCR、有機醫療補助和市場會員增長、我們最近的 RFP 獎項、我們的收購和併購活動、與 RFP 和併購活動相關的收益、資金的成本所增約、潛在的資助

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 the 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種風險和不確定性的影響，這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美國證券交易委員會提交的 10-K 表年度報告中討論的風險因素，以及我們向美國證券交易委員會提交的 10-Q 表和 8-K 表中列出的風險因素。在我們完成準備好的演講後，我們將開始回答您的問題。

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

現在我將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 reported financial results for the first quarter. Our growth initiatives and the related increase to embedded earnings, and our full-year 2025 guidance, which we reaffirm at $42 billion of premium revenue and at least $24.50 in earnings per share.

謝謝你，傑夫，早安。今天，我將討論幾個主題。我們報告了第一季的財務表現。我們的成長計畫和相關的內含收益成長，以及我們對 2025 年全年的預期，我們重申保費收入為 420 億美元，每股收益至少為 24.50 美元。

Let me start with our first quarter performance. Last night, we reported adjusted earnings per share of $6.08 on $10.6 billion of premium revenue supported by strong operating metrics across all lines of business. Our 89.2% consolidated MCR reflects strong medical cost management and an improving rate environment. We produced a 3.9% adjusted pre-tax margin or 3% after tax, a very strong result.

讓我先從我們第一季的表現開始。昨晚，我們報告稱，受所有業務線強勁營運指標的支持，我們的保費收入達到 106 億美元，調整後每股收益為 6.08 美元。我們 89.2% 的合併 MCR 反映了強大的醫療成本管理和不斷改善的費率環境。我們的調整後稅前利潤率為 3.9%，稅後利潤率為 3%，這是一個非常強勁的業績。

In Medicaid, the business produced an MCR of 90.3% in the quarter, which was in line with our expectations. As contemplated in our initial guidance, medical costs increased moderately due to continued utilization of LTSS, high-cost drugs, and behavioral health services, as well as seasonal illnesses, the impacts of which were mostly offset by updates in the new rate cycle.

在醫療補助方面，該業務本季的 MCR 為 90.3%，符合我們的預期。正如我們最初的指導中所設想的，由於持續使用 LTSS、高成本藥物和行為健康服務以及季節性疾病，醫療成本適度增加，其影響大部分被新費率週期的更新所抵消。

In Medicare, we reported a first quarter MCR of 88.3%, which was in line with our expectations. Medical cost trend was as expected and was adequately captured by rates and risk adjustment. Our strategy of leveraging our existing Medicaid footprint to serve high acuity, low-income Medicare beneficiaries is working well. In Marketplace, the first quarter MCR was 81.7% and was higher than expected.

在醫療保險方面，我們報告第一季的 MCR 為 88.3%，符合我們的預期。醫療成本趨勢符合預期，並且可以透過費率和風險調整充分捕捉。我們的策略是利用現有的醫療補助涵蓋範圍為高敏感度、低收入的醫療保險受益人提供服務，這項策略效果良好。在市場上，第一季的 MCR 為 81.7%，高於預期。

This was the result of prior year items related to final risk adjustment and membership reconciliations, as well as a higher new store MCR related to the first quarter results of our ConnectiCare acquisition. Excluding these items, the normalized MCR was approximately 77.7%, more in line with our expectations.

這是由於去年與最終風險調整和會員對帳相關的項目，以及與我們收購 ConnectiCare 的第一季業績相關的更高的新店 MCR 造成的。排除這些項目，標準化的 MCR 約為 77.7%，更符合我們的預期。

Turning now to our growth initiatives, we continued our successful track record of winning RFPs in the quarter. In Medicaid, we successfully defended our position in Nevada, as we were awarded a contract to serve Medicaid beneficiaries in the two largest urban areas in the state. In our Medicare dual eligible business, we were awarded a contract in Illinois to provide a fully integrated dual eligible special needs plan.

現在談談我們的成長計劃，我們在本季繼續保持贏得 RFP 的成功記錄。在醫療補助領域，我們成功捍衛了我們在內華達州的地位，因為我們獲得了為該州兩個最大城市地區的醫療補助受益人提供服務的合約。在我們的醫療保險雙重合格業務中，我們在伊利諾伊州獲得了一份合同，提供完全整合的雙重合格特殊需求計劃。

This win completes the full transition of our existing MMP members to an integrated D-SNP product in all of our MMP states for January 1, 2026. We project incremental annual premium revenue of approximately $800 million from this new contract and have added $0.50 per share to our embedded earnings. This contract win also moves us closer to achieving our premium revenue target of $46 billion in 2026 and at least $52 billion, which is the low end of our target range for 2027.

此次勝利標誌著我們所有 MMP 州的現有 MMP 成員已完成向整合 D-SNP 產品的全面過渡，具體時間為 2026 年 1 月 1 日。我們預計這份新合約將帶來約 8 億美元的年度增量保費收入，並為我們的每股收益增加 0.50 美元。這次合約的勝利也使我們更接近實現2026年460億美元的保費收入目標以及至少520億美元的保費收入目標，這是我們2027年目標範圍的低端。

With respect to M&A activity, our acquisition pipeline continues to contain many actionable opportunities as we remain opportunistic in deploying capital to accretive acquisitions. Embedded earnings have now increased from approximately $7.75 to $8.65 per share. This represents approximately one-third of our current EPS and serves to support our target future growth rate.

就併購活動而言，我們的收購管道仍包含許多可行的機會，因為我們仍然會抓住機會將資本部署到增值收購中。嵌入式收益現已從每股約 7.75 美元增加到 8.65 美元。這約占我們目前每股盈餘的三分之一，並有助於支持我們未來的目標成長率。

Turning now to our 2025 guidance full-year 2025 premium revenue guidance remains unchanged at approximately $42 billion. We also reaffirm our full-year 2025 adjusted earnings per share guidance of at least $24.50 or 8% year-over-year growth.

現在談談我們的 2025 年指引，2025 年全年保費收入指引保持不變，約 4​​20 億美元。我們也重申 2025 年全年調整後每股盈餘預期至少為 24.50 美元或年增 8%。

Mark will discuss a few of the changing components within our EPS guidance, a major point of which will be that full-year 2025 Medicaid rates are projected to be slightly higher than previously expected as states reflect recent cost trends in on and off cycle rate updates.

馬克將討論我們 EPS 指導中的一些變化部分，其中一個重點是，由於各州在周期內和周期外費率更新中反映了近期的成本趨勢，預計 2025 年全年醫療補助費率將略高於先前的預期。

Given that known fact, we also increased our outlook for cost trend, reflecting some conservatism at this early point in the year. Our 2025 guidance is a strong foundation off of which to grow and to realize the embedded earnings power of the opportunities we have already secured.

鑑於這一已知事實，我們也提高了對成本趨勢的預測，反映出今年年初的一些保守態度。我們的 2025 年指引為我們的成長和實現已獲得機會的內在獲利能力奠定了堅實的基礎。

Turning now to the political and legislative landscape. In Medicaid, we continue to believe that any changes to the Medicaid program in the near term will be marginal. The general perception is that Congress and the current administration will implement Medicaid program changes through possible combinations of various funding reduction approaches in order to meet federal spending targets.

現在來談談政治和立法情勢。在醫療補助方面，我們仍然相信，短期內對醫療補助計劃的任何改變都將是微不足道的。普遍的看法是，國會和現任政府將透過各種資金削減方法的組合來實施醫療補助計劃變更，以達到聯邦支出目標。

There are many credible estimates of the potential impact of these various approaches. We continue to believe that any impacts to membership volume or the acuity of the risk pool will be manageable and will not disrupt the earnings trajectory of our business.

對於這些不同方法的潛在影響，有許多可靠的估計。我們仍然相信，對會員數量或風險池敏銳度的任何影響都是可控的，並且不會擾亂我們業務的獲利軌跡。

You are all well aware of the complex legislative process, which will ensue over the coming months to reconcile the Senate and House resolutions to a final bill. While we await a definitive legislative framework, we continue to believe that neither side of the aisle wants to see an increase in the number of uninsured, a significant reduction in benefits for those relying on government assistance or the inevitable related impact to providers.

大家都非常清楚，立法程序非常複雜，在接下來的幾個月裡，需要協調參議院和眾議院的決議，形成最終法案。在我們等待最終立法框架的同時，我們仍然相信，兩黨都不希望看到無保險人數增加、依賴政府援助的人的福利大幅減少或對醫療服務提供者造成不可避免的相關影響。

In Medicare, we are pleased with the recent CMS final rate notice for Medicare Advantage. In addition, the early read on states promoting the integration of Medicaid and Medicare bodes well for us having a significant Medicaid footprint and a competitive D-SNP offering.

在醫療保險方面，我們對 CMS 最近發布的醫療保險優勢計劃最終費率通知感到滿意。此外，早期有關各州推動醫療補助和醫療保險整合的報告預示著我們將擁有重要的醫療補助足跡和具有競爭力的 D-SNP 產品。

Finally, in marketplace, we remain confident in the stability of our membership and the outlook for the business, despite the various program integrity initiatives and a final decision on the enhanced subsidies, which would impact marketplace enrollment in 2026.

最後，在市場上，儘管各種計劃誠信舉措和關於增加補貼的最終決定將影響 2026 年的市場註冊，但我們仍然對會員的穩定性和業務前景充滿信心。

Any impacts to membership have been contemplated in current year guidance and our future year revenue outlook. States have also communicated a willingness to allow market participants to update rates for 2026 based on the final resolution of the enhanced subsidies, which would substantially mitigate any related pricing risk.

任何對會員的影響都已在本年度指導和未來年度收入展望中進行了考慮。各州也表示願意允許市場參與者根據增加補貼的最終解決方案更新 2026 年的費率，這將大大降低任何相關的定價風險。

Our first quarter results and reaffirmed full-year 2025 guidance reflect our team's disciplined approach to medical cost management in an improving rate environment. Our revenue growth and pre-tax margin profiles across all segments remain consistent with our long-term targets, and we continue to harvest and replenish embedded earnings.

我們第一季的業績和重申的 2025 年全年指引反映了我們的團隊在費率不斷提高的環境下對醫療成本管理的嚴謹態度。我們所有部門的收入成長和稅前利潤率狀況與我們的長期目標保持一致，並且我們將繼續收穫和補充內含收益。

As we take an early look into 2026, we are confident in the process for actuarial soundness and the adequacy of Medicaid rates. In reviewing publicly available information, state by state, we believe that the broad Medicaid market appears to need 200 to 300 basis points of rate in excess of trend to obtain some level of program equilibrium. If rate updates were to be made at that level, recognizing that all market participants obtain the same rate, Molina should be soon return to performing at 89% or better, perhaps also while paying into the corridors.

展望 2026 年，我們對精算的健全性和醫療補助費率的充分性充滿信心。在逐一審查公開資訊時，我們認為，廣泛的醫療補助市場似乎需要超過趨勢 200 到 300 個基點的利率才能達到一定程度的計畫平衡。如果利率更新到該水平，並認識到所有市場參與者都獲得相同的利率，莫利納應該很快就會恢復到 89% 或更高的水平，或許還能同時支付利率走廊費用。

Our businesses, while not immune to external forces, have been resilient in the face of many uncertainties over the past many years. The redetermination process is behind us. Any legislative changes to the Medicaid program are likely to be marginal and healthcare is generally less sensitive to economic cycles.

我們的業務雖然無法免受外部力量的影響，但在過去多年中面對諸多不確定因素時仍表現出韌性。重新確定的過程已經結束。對醫療補助計劃的任何立法改變都可能是微不足道的，而且醫療保健通常對經濟週期不太敏感。

Our 2025 earnings and growth profiles are solid and therefore we remain very confident in our ability to achieve our 13% to 15% long-term earnings per share growth target.

我們的 2025 年獲利和成長前景穩健，因此我們對實現 13% 至 15% 的長期每股收益成長目標的能力充滿信心。

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

說完這些，我將把電話轉給馬克，讓他對財務狀況做進一步的說明。標記？

Thanks Joe and good morning everyone. Today I'll discuss additional details on our first quarter performance, the balance sheet, and our 2025 guidance. Beginning with our first quarter results. For the quarter, we reported approximately $11 billion in total revenue and $10.6 billion of premium revenue with adjusted EPS of $6.08. Our first quarter consolidated MCR was 89.2% and reflects strong medical cost management and an improving rate environment.

謝謝喬，大家早安。今天，我將討論有關我們第一季業績、資產負債表和 2025 年指引的更多細節。從我們的第一季業績開始。本季度，我們的總營收約為 110 億美元，保費收入為 106 億美元，調整後每股收益為 6.08 美元。我們第一季的合併 MCR 為 89.2%，反映出強大的醫療成本管理和不斷改善的利率環境。

In Medicaid, our first quarter reported MCR was 90.3% and in the line with our expectations. As we expected, medical costs increased moderately due to the continued utilization of LTSS, high-cost drugs and behavioral health services, as well as seasonal illness. These were largely offset by the first quarter rate cycle, which came in as expected.

在醫療補助方面，我們第一季報告的 MCR 為 90.3%，符合我們的預期。正如我們預期的那樣，由於持續使用 LTSS、高成本藥物和行為健康服務以及季節性疾病，醫療費用適度增加。這些影響在很大程度上被第一季符合預期的利率週期所抵銷。

In Medicare, our first quarter reported MCR was 88.3%, in line with our expectations. We remain confident in the pricing and benefit adjustments we implemented for 2025. The reported MCR also reflects the improvement related to our decision to exit MAPD in 13 states.

在醫療保險方面，我們第一季報告的 MCR 為 88.3%，符合我們的預期。我們對 2025 年實施的定價和福利調整仍然充滿信心。報告的 MCR 也反映了我們決定退出 13 個州的 MAPD 所帶來的改善。

In Marketplace, our first quarter reported MCR was 81.7%. The MCR was higher than expected and driven by 2 prior year items. Lower final risk adjustment and member reconciliation adjustments. Also note that the initial new store, MCR of ConnectiCare is as expected, running higher than target early on.

在市場上，我們第一季報告的 MCR 為 81.7%。MCR 高於預期，去年同期 2 項因素影響。降低最終風險調整和會員對帳調整。還要注意的是，ConnectiCare 的初始新店 MCR 正如預期的那樣，早期就高於目標。

Altogether, these 3 non-recurring items accounted for approximately 400 basis points in the quarter. Excluding these items, the normalized marketplace MCR was approximately 77.7 and reflects seasonality that was more in line with our expectations. Our adjusted G&A ratio for the quarter was 6.8, driven by operating discipline and the continued benefit of operating leverage.

總計起來，這 3 項非經常性項目在本季佔比約為 400 個基點。排除這些項目，標準化市場 MCR 約為 77.7，反映的季節性更符合我們的預期。受經營紀律和經營槓桿持續效益的推動，本季我們調整後的 G&A 比率為 6.8。

Turning to the balance sheet. Our capital foundation remains strong. In the quarter, we harvested approximately 110 million of subsidiary dividends, and our parent company cash balance was approximately 190 million at the end of the quarter.

轉向資產負債表。我們的資本基礎依然強勁。本季我們收穫了約1.1億的子公司股息，季末我們的母公司現金餘額約為1.9億。

Our operating cash flow for the first quarter was 190 million. During the quarter, we repurchased approximately 1.7 million shares at a total cost of $500 million. Debt at the end of the quarter was 2 times trailing 12-month EBITDA and our debt-to-cap ratio was about 47.

我們第一季的經營現金流是1.9億。本季度，我們回購了約 170 萬股，總成本為 5 億美元。本季末的債務是過去 12 個月 EBITDA 的 2 倍，我們的債務與資本比率約為 47。

We continue to have ample cash and access to capital to fuel our growth initiatives. Days in claims payable at the end of the quarter was 46%, lower than normal. While our reserving policies remain consistent, the timing of payments can have quarter-to-quarter impact on reported reserves, as it did this quarter, as we had one additional claim payment cycle. We remain confident in the strength of our reserves.

我們繼續擁有充足的現金和資本來推動我們的成長計劃。本季末的理賠應付天數為 46%，低於正常水準。雖然我們的準備金政策保持一致，但付款時間可能會對報告的準備金產生逐季度影響，就像本季度一樣，因為我們有一個額外的索賠付款週期。我們對我們的儲備實力仍然充滿信心。

Next, a few comments on our 2025 guidance. As Joe mentioned, we continue to expect full year premium revenue to be approximately $42 billion. Within that number are a few moving pieces.

接下來，我們對 2025 年的指導提出幾點評論。正如喬所提到的，我們繼續預計全年保費收入約為 420 億美元。其中有一些可移動的部分。

We expect higher organic growth in our marketplace and Medicaid segments to offset the mid-year loss of our Virginia contract. Recall, we previously guided for this contract to carry through year end, but now we expect our membership to be reallocated to other MCOs mid-year. Our full-year consolidated MCR is now 88.8%. Within Medicaid, the full year MCR is unchanged at 89.9%.

我們預計市場和醫療補助部門的有機成長將有所提高，從而抵消維吉尼亞合約年中的損失。回想一下，我們之前曾指導該合約持續到年底，但現在我們預計我們的會員資格將在年中重新分配給其他 MCO。我們全年的合併 MCR 目前為 88.8%。在醫療補助計劃中，全年 MCR 保持不變，為 89.9%。

We are seeing rate increases slightly higher than we had previously expected as our state partners continue to update their actuarial data. These rate increases are offset by our outlook on full-year trend, which is now slightly higher and reflects our conservatism at this point in the year. Together, full-year rates and trends are both higher by 50 basis points and result in no change to the MCR guidance.

隨著我們的州合作夥伴繼續更新其精算數據，我們看到利率成長略高於我們先前預期的水平。這些利率的上調被我們對全年趨勢的展望所抵消，目前全年趨勢略高，反映了我們在今年這個時候的保守態度。總體而言，全年利率和趨勢均上漲 50 個基點，但 MCR 指引沒有變化。

Our MCR guidance on Medicare also remains unchanged at 89%. We remain confident in the performance of our Medicare duals and integrated product business. In the marketplace, we are increasing our full-year MCR guidance from 79% to 80%, which is the upper end of our long-term target range.

我們對醫療保險的 MCR 指引也保持不變，為 89%。我們對我們的醫療保險雙重保險和綜合產品業務的表現仍然充滿信心。在市場上，我們將全年 MCR 指導從 79% 提高到 80%，這是我們長期目標範圍的上限。

This 100-basis point increase reflects the unfavorable non-recurring impacts in the quarter I discussed earlier. The marketplace MCR trajectory for the rest of the year is largely unchanged from our prior view. We continue to expect the segment to produce mid single digit pre-tax margins.

這 100 個基點的成長反映了我之前討論過的本季的不利的非經常性影響。今年剩餘時間的市場 MCR 軌跡與我們先前的看法基本上沒有改變。我們繼續預期該部門將產生中等個位數的稅前利潤率。

Effectuation rates remain strong through the first quarter, and we are encouraged by early performance of new members added through the open enrollment and special enrollment periods. Our year-end outlook on membership increases by 40,000 to approximately 620,000 members and includes the estimated impact from income verifications and program integrity initiatives.

第一季的實施率依然強勁，透過開放註冊和特殊註冊期增加的新會員的早期表現令我們感到鼓舞。我們預計年底會員人數將增加 4 萬人，達到約 62 萬人，其中包括收入核實和計劃誠信舉措的預計影響。

We now expect the full-year G&A ratio to be approximately 6.9%, better than previously guided by 10 basis points, as we continue to drive efficiencies in our operations. We reaffirm our full-year EPS guidance of at least $24.50 per share.

由於我們繼續提高營運效率，我們現在預計全年的 G&A 比率約為 6.9%，比之前預測的高出 10 個基點。我們重申全年每股收益至少為 24.50 美元的預期。

Within that number are a few moving pieces. Our EPS guidance now includes a $0.40 benefit from share repurchases in the first quarter; $0.30 from higher volumes in our Medicaid and marketplace segments, and $0.30 commensurate with the improved G&A ratio.

其中有一些可移動的部分。我們的每股盈餘預期目前包括第一季股票回購帶來的 0.40 美元收益； 0.30 美元來自我們醫療補助和市場部門的更高交易量，以及 0.30 美元與改善的 G&A 比率相稱。

These favorable items offset a $0.60 headwind attributable to the higher marketplace MCR guidance and $0.40 loss from the mid-year termination of our Virginia contract. We continue to expect earnings to be evenly distributed throughout the year.

這些有利因素抵消了因市場 MCR 指導價上漲而產生的 0.60 美元的不利因素以及因我們弗吉尼亞合約年中終止而產生的 0.40 美元的損失。我們仍然預計全年收益將均勻分佈。

Turning to embedded earnings. Our new store embedded earnings are now approximately $8.65 per share, up $0.90 from our prior outlook of $7.75. This increase includes $0.50 from the recent duals contract win in Illinois and an additional $0.40 as we are now recognizing half of the Virginia contract loss in current year guidance rather than next year as previously expected. We expect one-third of this new store embedded earnings to emerge in 2026, giving us high confidence in our 13% to 15% long-term growth rate.

轉向內含收益。我們新店的嵌入式收益目前約為每股 8.65 美元，比我們之前預測的 7.75 美元高出 0.90 美元。這一增長包括最近在伊利諾伊州贏得的雙重合約的 0.50 美元，以及額外的 0.40 美元，因為我們現在在本年度指導中確認了弗吉尼亞州合約損失的一半，而不是之前預期的明年。我們預計，新店嵌入收益的三分之一將在 2026 年出現，這讓我們對 13% 至 15% 的長期成長率充滿信心。

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

我們的準備好的演講到此結束。接線員，我們現在可以回答問題了。

(Operator Instructions)

（操作員指示）

Stephen Baxter from Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Hey, good morning, Just wanted to start on the exchanges. I was hoping, first, you could expand what you saw on risk adjustment and also this member reconciliation dynamic. I guess specifically, with number reconciliation, what exactly are you describing there and trying to understand better why we should think about that as a nonrecurring item?

嘿，早上好，只是想開始交流。首先，我希望您能夠擴展您所看到的風險調整以及會員和解動態。我想，具體來說，對於數位核對，您究竟描述了什麼，並試圖更好地理解為什麼我們應該將其視為非經常性項目？

And then just thinking about the rest of the year guidance on the MLR line, the exchanges, obviously, you called out in kind of 400 basis points of variance than the first quarter, you're taking up the full year, I think, by now 100 basis points. So yes, rest of the year, it feels like it's relatively unimpacted.

然後，想想今年剩餘時間 MLR 線上的指導，交易所，顯然，你所說的差異與第一季相比有 400 個基點，我認為，到現在全年已經是 100 個基點了。所以是的，感覺今年剩餘時間受到的影響相對較小。

Just trying to understand kind of the continuing elements of what you saw in the first quarter, and how much of that we need to think about continuing for the rest of the year?

只是想了解您在第一季看到的持續因素，以及我們需要考慮在多大程度上延續到今年剩餘時間？

Stephen, the marketplace story is a very positive one. We did have non-recurring items in the first quarter, which elevated the MCR by 400 basis points. I'll kick it to Mark in a minute for more detail. Membership reconciliations, members that were not authorized to be in the plan, but we were servicing last year because they were -- they were on the membership roles. That was a scrub by CMS to eliminate members who lacked authorization, a one-time item.

史蒂芬，市場故事非常積極。我們在第一季確實存在非經常性項目，這使得 MCR 提高了 400 個基點。我馬上會向馬克詢問更多細節。會員對賬，那些未被授權加入計劃的會員，但我們去年為他們提供服務，因為他們 - 他們擔任會員角色。這是 CMS 為清除缺乏授權的成員而採取的一次性措施。

The other one-time item was a true-up to 2024 risk adjustment. The final piece, as typical for an acquisition, the MCR will be operating at the inherited MCR, which for ConnectiCare is in the mid to high 80s. We're still confident in bringing that down to our target to produce the full $1 of earnings accretion that resides in our embedded earnings.

另一項一次性項目是截至 2024 年的真實風險調整。最後，作為收購的典型特徵，MCR 將按照繼承的 MCR 運行，對於 ConnectiCare 來說，該 MCR 處於 85% 左右。我們仍然有信心將其降至我們的目標，從而實現內含收益中的全部 1 美元收益成長。

The marketplace story is very positive. We're going to end the year with 620,000 members, mid single digit margins, and still operating. Within our long-term range, albeit an increase from our previous guidance of 79%, now to 80%. Mark, anything to add?

市場情況非常積極。今年年底，我們的會員人數將達到 62 萬人，利潤率將達到中等個位數，並且我們仍在繼續運作。在我們的長期範圍內，儘管比我們之前預測的 79% 有所增加，但現在已達到 80%。馬克，還有什麼要補充的嗎？

Yeah Joe, I think you got it. Let me just break that down a little further. The 400 basis points is about 40 million, and that breaks down pretty much a third, a third, a third on the things that Joe talked about. I'll add a little color to them.

是的，喬，我想你明白了。讓我進一步分析一下。400 個基點大約是 4000 萬，相當於喬所談論的事情的三分之一、三分之一、三分之一。我會為它們添加一點顏色。

On the final prior year risk adjustment, I'm sure you're aware in marketplace, risk adjustment is on a relative basis, not an absolute basis like Medicare. So, it's right about now that we find relative to the other players exactly how we scored last year, and we were just a little bit less than we thought on risk adjustment when the final numbers came in.

關於最後一年的風險調整，我相信您知道在市場上，風險調整是相對的，而不是像醫療保險那樣的絕對的。所以，現在我們發現，相對於其他球員，我們去年的得分與去年的得分完全一樣，而當最終數字出來時，我們在風險調整方面的得分比我們想像的要低一點。

These are the weeklies. So that's a non-recurring, normal function of how we settle up risk adjustment. On member reconciliation, this is not FTR. This is members that were on the books last year that when they get their tax filings realized they had a policy and didn't know it.

這些是周刊。這是我們解決風險調整的一個非經常性的正常功能。就成員調解而言，這不是 FTR。這是去年登記在冊的會員，當他們提交納稅申報表時才意識到他們有一項政策，但他們並不知道。

Sometimes that's administration issues, sometimes it's broker issues, but right about now is when we see those, because that's when the tax filings come due, we're pretty confident in that number, and that's a pretty final number for last year; you know, the good news is with all the integrity stuff going on, you're going to see a lot less of that going forward.

有時這是管理問題，有時是經紀人問題，但現在我們看到的是這些問題，因為那是納稅申報到期的時候，我們對這個數字非常有信心，這是去年的最終數字；你知道，好消息是，隨著誠信問題的不斷推進，以後這種事情會越來越少。

And then lastly, as Joe mentioned on the new store impact of ConnectiCare that ran in the high 80s initially. We'll pull that down quick with the Molina playbook, but there's a little bit of noise in there that certainly pulls our reported MCR up. Roll those together, that's the 400 bps we talked about.

最後，正如喬所提到的，ConnectiCare 對新店的影響最初達到了 80 多美元。我們會根據 Molina 的劇本快速將其拉低，但其中存在一些噪音，這肯定會拉高我們報告的 MCR。把它們加在一起，這就是我們所說的 400 bps。

Andrew Mok from Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning. In the prepared remarks, you called out higher assumptions for both rates and cost trends. Cost trend, it sounds like the rates is, on the Medicaid side sounds like the cost trend is on the ACA side. Do I have that right? And what exactly are you seeing on each of those items that is informing that updated assumption? Thanks.

嗨，早安。在準備好的發言中，您提出了利率和成本趨勢的更高假設。成本趨勢，聽起來像是醫療補助方面的費率，聽起來像是 ACA 方面的成本趨勢。我有這個權利嗎？那麼，您從每一項中究竟看到了什麼來支持這項更新的假設呢？謝謝。

Andrew, I'll give you a high-level answer and then kick it to Mark. I want to be very clear on what we forecasted for the Medicaid business. We received rate updates in the first quarter $150 million, which equates to 50 basis points on a full year basis.

安德魯，我會給你一個高層次的答案，然後把它交給馬克。我想非常清楚地說明我們對醫療補助業務的預測。我們在第一季收到的利率更新為 1.5 億美元，相當於全年利率的 50 個基點。

Those will nearly entirely impact Qs two, three and four and did not have an impact in Q1. So states are obviously recognizing certain cost pressures and updating rates both on-cycle and off-cycle to compensate for.

這些幾乎會完全影響第二、三和第四季度，但對第一季沒有影響。因此，各州顯然認識到了一定的成本壓力，並更新了周期內和週期外的費率以進行補償。

The only reason we increased our trend estimate for the year is, at this early stage in the year, reflecting appropriate conservatism, we were not going to improve our Medicaid MCR by 50 basis points at this early stage. So rather than those rate increases drop through to our guidance, we offset them with a topside adjustment, if you want to call it, to medical cost trend until we see more in the second quarter. So still holding serve on our 89.9% MCR estimate in Medicaid for the year, but the rates are moving in the right direction. Mark, anything to add?

我們增加今年趨勢估計的唯一原因是，在今年的早期階段，為了體現適當的保守主義，我們不打算在早期階段將醫療補助 MCR 提高 50 個基點。因此，我們不會將這些費率上漲降至我們的預期，而是透過對醫療成本趨勢進行上行調整（如果你願意的話）來抵消它們，直到我們在第二季度看到更多。因此，我們仍然維持今年醫療補助 89.9% MCR 的估計，但費率正朝著正確的方向發展。馬克，還有什麼要補充的嗎？

That's exactly right, Joe. So, on a full year basis, Medicaid guidance unchanged at 89.9%. The only thing that's different is our rate assumption is now 5% versus 4% for the full year, and our trend assumption is 5% versus 4.5% for the full year. And again, this is all a function of the known rates we've received going forward.

完全正確，喬。因此，從全年來看，醫療補助指導額度保持不變，為 89.9%。唯一不同的是，我們的利率假設現在是 5%，而不是全年的 4%，我們的趨勢假設是 5%，而不是全年的 4.5%。再次強調，這一切都取決於我們未來收到的已知利率。

Got it. Okay, so it sounds like your forward expectations on forward rates has remained unchanged, is that right?

知道了。好的，聽起來您對遠期利率的預期保持不變，對嗎？

No, our forward rates are slightly better, so we're raising our full-year guidance from 4.5% to 5%.

不，我們的遠期利率略有提高，因此我們將全年預期從 4.5% 上調至 5%。

Right, but that's the rates you've already received and have visibility into. So are the forward rate expectations also higher? The ones that haven't been finalized.

是的，但這是你已經收到並且可以查看的費率。那麼遠期利率預期是否也更高呢？那些尚未最終確定的。

We know rates on 85% of our -- when we gave initial guidance, we knew about rates on about 75% of our revenue. That's now 85%. So yes, there is an estimate in for -- September and October rate adjustments that we still have them at a very modest level. So, the 5% annual rate increase includes 85% known rates for the year.

我們知道 85% 的利率——當我們給出初步指引時，我們知道大約 75% 的收入的利率。現在這個比例是 85%。是的，對於 9 月和 10 月的利率調整，我們估計仍處於非常溫和的水平。因此，5% 的年利率成長包括了當年 85% 的已知利率。

Got it. Understood. And you called out seasonal illness in Medicaid, which sounds like flu. Can you tell us the impact that that had on the quarter? Thanks.

知道了。明白了。您提到了醫療補助中的季節性疾病，聽起來像流感。您能告訴我們這對本季有何影響嗎？謝謝。

Yeah, we've sort of moved to the ILI definition that a lot of people have, which is largely flu at this point. We've not really given a normalized number, but I think the more helpful thing for you is we probably ran 10 million to 15 million hot versus what we might call normal. But again, we had that in our guidance, so that really wasn't a surprise to us.

是的，我們已經轉向了許多人所理解的 ILI 定義，目前它主要指流感。我們實際上並沒有給出一個標準化的數字，但我認為對你更有幫助的是，我們可能運行了 1000 萬到 1500 萬個熱點，而不是我們所謂的正常值。但同樣，我們的指導中已經有了這一點，所以這對我們來說並不令人意外。

Josh Raskin with Nephron Research.

Nephron Research 的 Josh Raskin。

Hi, thanks. I just want to ask on the exchanges, so just taking a step back, can you help us understand where the marketplace fits in your long-term strategies? I know you went through this with the Investor Day, but are there synergies or other, with the other two segments or value that comes beyond the gross margin contribution? And I understand medical margin dollars were actually up 20% in 1Q, but is there a desire to sort of bid to think differently about the annual volatility in that book at some point?

你好，謝謝。我只是想問一下關於交易所的問題，退一步來說，您能否幫助我們了解市場在您的長期策略中處於什麼位置？我知道您在投資者日已經討論過這個問題，但是除了毛利率貢獻之外，這與其他兩個部門之間是否存在協同效應或其他價值？據我了解，第一季醫療利潤實際上上漲了 20%，但是否有意在某個時候以不同的方式看待該帳簿的年度波動性？

Josh, as we said in Investor Day, the product line is completely synergistic with our pure play, government sponsored managed care theme to our strategy as people income up and down from Medicaid into Medicaid expansion into highly subsidized marketplace, people are moving in and out of life circumstances often frequently, and having a product where we can capture the member for their lifetime or as long as they're in government assistance across a broad range of products is totally synergistic.

喬希，正如我們在投資者日所說的那樣，該產品線與我們的純粹的、政府資助的管理式醫療主題完全具有協同作用，因為人們的收入從醫療補助到醫療補助擴展到高度補貼的市場，人們的生活環境經常進進出出，並且擁有一種產品，我們可以在會員的一生中或只要他們在廣泛的產品中獲得政府援助，就可以完全發揮同作用。

In fact, when they turn 65, which 50,000 members of ours due every single year, we have a D-SNP offering that captures the agents. So very, very synergistic and attractive contributor to the profile of the business. We were earning nearly double digit pre-tax margins in the last two prior years. We consciously invested that excess margin in membership growth, while still targeting mid single digit pre-tax margins.

事實上，每年有 50,000 名會員年滿 65 歲時，我們就會推出 D-SNP 計劃來吸引這些代理人。因此，這對業務形象的貢獻非常具有協同作用，並且非常有吸引力。在過去兩年中，我們的稅前利潤率接近兩位數。我們有意識地將超額利潤投資於會員成長，同時仍將稅前利潤率定為中等個位數。

We will grow the business at a rate that allows us to hit mid single digit pre-tax margins for the reason you articulated that it can be volatile when you bring on new membership, not knowing their cost profile and not having the benefit of risk adjustment means there is a cost to growth, and we want to manage that volatility. Mark, anything to add?

我們將以一定的速度發展業務，使我們能夠達到中等個位數的稅前利潤率，因為您明確指出，當您引入新會員時，業務可能會出現波動，因為不了解他們的成本狀況並且沒有風險調整的好處意味著增長是有成本的，我們希望管理這種波動。馬克，還有什麼要補充的嗎？

No, I think that's well summarized Joe, you've sometimes referred to it as a residual market, because when other things in the economy go up and down, it sort of captures the excess. Therefore, there is more volatility, Josh, and what we've always been very clear about is it's a relatively small part of our portfolio. We will price for margin and let the volume fall where it does.

不，我認為喬總結得很好，你有時稱之為剩餘市場，因為當經濟中的其他事物起伏不定時，它會捕捉到過剩的部分。因此，波動性會更大，喬希，我們一直非常清楚的是，它只是我們投資組合中相對較小的一部分。我們將根據保證金定價，並讓交易量隨其下降。

A.J. Rice from UBS.

A.J.來自瑞銀的賴斯。

Hi everybody. Thanks for the question. When you step back, you mentioned a nod to the Washington backdrop of all this chatter about Medicaid cuts adjustments, whatever. I wonder, is that -- are you seeing that in any way impact the discussions with states around rate updates or RFP processes or is what's going on in Washington and any uncertainty that creates having any impact on any of that.

大家好。謝謝你的提問。當您退一步考慮時，您提到了對華盛頓有關醫療補助削減調整等所有討論的背景的認可。我想知道，您是否認為這會以任何方式影響與各州就費率更新或 RFP 流程進行的討論，或者華盛頓正在發生的事情以及由此產生的任何不確定性是否會對其中任何一項產生任何影響。

No, A.J., I would say not. The rate discussions are pure, actuary to actuary looking at the actuarial data, and the real positive news about rates is the cost pressure are coming from cost categories that are very discrete and prominent in the rate models. LTSS rated separately, behavioral usually viewed separately, as well as high-cost drugs including GLP-1s. So, the cost pressures that the industry is experiencing are very highly profiled in the rate development environment.

不，A.J.，我認為不是。費率討論是純粹的，精算師之間會查看精算數據，而有關費率的真正積極消息是，成本壓力來自費率模型中非常離散和突出的成本類別。LTSS 單獨評級，行為通常單獨查看，以及包括 GLP-1 在內的高成本藥物。因此，產業所面臨的成本壓力在利率發展環境中非常突出。

That is, it's a debate about cost trends, it's a debate about what's a credible baseline and a trend off that baseline purely has nothing to do with the -- the Washington debate about how far to pull back Medicaid. Same thing with the RFP cycle. The RFP cycle right now is actually at a low point. It was at a high point in the last two years where we did really, really well as advertised. It is $50 billion from 2025 to 2028 in total contract value.

也就是說，這是一場關於成本趨勢的辯論，這是一場關於什麼是可信基線的辯論，而偏離該基線的趨勢純粹與華盛頓關於在多大程度上撤回醫療補助的辯論無關。RFP 週期也是一樣。目前，RFP 週期實際上處於低谷。這是我們過去兩年來的最高峰，正如我們所宣傳的那樣，我們的表現非常非常好。2025年至2028年的合約總價值為500億美元。

We have our eyes on a couple of very attractive opportunities, and the re-procurement cycle is actually at a low point as well, where we don't have a lot of re-procurements coming up in the next 24 months. But no, the dialogue in Washington is not causing any state to really rethink either the rate development process or when they re-procure their program.

我們關注的是一些非常有吸引力的機會，而且重新採購週期實際上也處於低點，未來 24 個月內我們不會有太多的重新採購。但華盛頓的對話並沒有讓任何州真正重新考慮費率制定過程或何時重新購買他們的計劃。

Justin Lake with Wolfe Research.

沃爾夫研究公司的賈斯汀·萊克 (Justin Lake)。

Thanks. Good morning. Question on effectuation rates, Joe, can you remind us what you're seeing there and then can you give us a ballpark on what the MLR looks like for those members versus the overall book?

謝謝。早安.關於實施率的問題，喬，您能否提醒我們您在那裡看到了什麼，然後您能否給我們一個大概的數值，說明這些成員的 MLR 與總體情況相比是怎樣的？

Sure. I'll give you a high-level answer and then hand it to Mark. But we've had a very successful open enrollment period in Marketplace, a very successful special enrollment period early on where we're sitting here with 660,000 members having ended last year at 400,000. Our effectuation rates seem to be better or higher than many of our competitors for a variety of reasons. Mark, do you want to elaborate?

當然。我會給你一個高層次的答案，然後把它交給馬克。但是，我們在 Marketplace 的開放註冊期非常成功，早期的特殊註冊期也非常成功，目前我們的會員人數為 660,000 人，而去年年底時會員人數為 400,000 人。由於各種原因，我們的實施率似乎比許多競爭對手更好或更高。馬克，你想詳細說明一下嗎？

Yeah, good morning, Justin. We are actually seeing pretty good effectuation rates, and you might be comparing that to what others have said in the market, and I can't really talk to their results, but I think we mentioned last time around we're either number one or number two in about 50% of our footprint. And part of effectuation is people rolling into the new cycle and seeing that their payments are maybe different than they were last year, which is a function of pricing.

是的，早上好，賈斯汀。我們實際上看到了相當不錯的實施率，你可能會將其與市場上其他人所說的進行比較，我無法真正談論他們的結果，但我認為我們上次提到過，我們在約 50% 的足跡中排名第一或第二。而部分效果是人們進入新的周期並發現他們的付款可能與去年不同，這是定價的函數。

So, some of the folks that might be losing might be at different points on the pricing scale, and I think people through effectuation are staying with Molina or in the case of SEP coming to Molina. So, we're seeing good results on both SEP and effectuation.

因此，一些可能遭受損失的人可能處於定價範圍的不同點，我認為人們透過實施會留在 Molina，或者在 SEP 的情況下會來到 Molina。因此，我們在 SEP 和效果方面都看到了良好的結果。

Now on the MLR, it's really too soon this early in the year to get a handle on that because 50% of the book is new, which is not an unusual phenomenon, but we'll have to see how that develops. And if you ask that question in the second quarter, I'll be able to give you a pretty specific view.

現在就 MLR 而言，今年年初就掌握這一情況還為時過早，因為 50% 的書都是新書，這並不是什麼不尋常的現象，但我們必須觀察其發展情況。如果您在第二季提出這個問題，我將能夠給您一個非常具體的觀點。

John Stansel from JPMorgan.

摩根大通的 John Stansel。

Great, thanks for taking my question. Last quarter you spoke to G&A being a little bit more front-loaded as you take on the IT costs for the $1 implementation cost in 2025. I think G&A came in nicely in the quarter, I guess. How are we thinking about progression for G&A this year and how we get to kind of 10 basis points lower than your initial expectation.

太好了，感謝您回答我的問題。上個季度您談到，由於您承擔了 2025 年 1 美元實施成本的 IT 成本，因此 G&A 費用會更加前期化。我認為本季的 G&A 收入表現不錯。我們如何考慮今年的 G&A 成長，以及如何達到比您最初的預期低 10 個基點的水平。

John, the G&A story is a very positive one for us. We focus on it with the same discipline and rigor that we focus on every dollar of medical costs. We've broken through the 7.0% barrier. We've broken through that, and I'm going to talk on a mixed equivalent basis because obviously mixed matters to the G&A ratio, but on a mixed equivalent basis we're comfortably in the high 6s.

約翰，G&A 的故事對我們來說非常積極。我們以對待每一美元醫療費用同樣的紀律性和嚴謹性來對待它。我們已經突破了7.0%的大關。我們已經突破了這一目標，我將在混合當量基礎上進行討論，因為混合對 G&A 比率顯然很重要，但在混合當量基礎上，我們可以輕鬆地達到 6% 的高位。

We think over time as we grow to the $55 billion of 2027 revenue target with our discipline or fixed cost leverage, we can move that down on a mixed equivalent basis into the mid 6s, perhaps even the low 6s. It's a very positive part of the story that's either going to improve margins over time in our investment thesis or serve to act as a hedge to any MCR pressure we might see over the long term. Mark, on the short term?

我們認為，隨著時間的推移，隨著我們透過紀律或固定成本槓桿向 2027 年 550 億美元的收入目標增長，我們可以在混合當量基礎上將其降至 6% 中段，甚至是 6% 出頭。這是故事中非常積極的部分，它要么會隨著時間的推移提高我們投資論文中的利潤率，要么可以作為我們可能在長期內看到的任何 MCR 壓力的對沖。馬克，短期內呢？

Yeah, John, if you look at the model for the rest of the year, expect a pretty flat G&A trajectory across the year. We had a 6.8% in the first quarter. We'll have a 6.9% in our guidance, which implies pretty flat across the full year. What's maybe driving that we talked about more of the implementation costs up-front in the year, and that's true.

是的，約翰，如果你看今年剩餘時間的模型，預計全年的 G&A 軌跡將相當穩定。第一季我們的成長率為 6.8%。我們的預期成長率為 6.9%，這意味著全年成長率將基本持平。或許是什麼促使我們在一年內討論了更多的前期實施成本，這是事實。

It's a little more front-end loaded, but the back-end loaded part is always some of the marketing costs around the OEP within Medicare and marketplace that usually drive-up G&A. So, you've got some different things going on, but I think a pretty flat G&A story through the year.

它前端負擔稍重，但後端負擔部分始終是醫療保險和市場內 OEP 周圍的一些行銷成本，這些成本通常會推高 G&A 費用。所以，你遇到了一些不同的事情，但我認為全年的 G&A 情況相當平淡。

Sarah James from Cantor Fitzgerald.

來自 Cantor Fitzgerald 的 Sarah James。

Thank you. One clarification and then a HIX question. So just to clarify, when you moved up the Medicaid cost trend 50 basis points, was that pure conservatism or did you see trend data above your prior expectations? And then on exchanges, do you think that the pricing and benefit design changes or the new member mix could change your MLR seasonality on the HIX business?

謝謝。先澄清一個問題，然後提出一個 HIX 問題。因此，需要澄清的是，當您將醫療補助成本趨勢上調 50 個基點時，這是純粹的保守主義，還是您看到的趨勢數據高於您先前的預期？然後在交易所，您是否認為定價和福利設計的變化或新會員組合會改變 HIX 業務的 MLR 季節性？

Sarah, you heard my prepared remarks correctly. In the Medicaid business, we absolutely received rate updates of $150 million, which caused us to increase our full-year rate update from previous guidance of 4.5% to 5%.

莎拉，你正確地聽到了我準備好的發言。在醫療補助業務中，我們絕對收到了 1.5 億美元的費率更新，這導致我們將全年費率更新從先前 4.5% 的指引提高到 5%。

As I said, in our member month mix 85% of rates on our member months are known at this point in time, only 15% is an estimate, those rate updates will impact quarters two, three, and four. Having known that, we then said, do we let that drop through to our guidance and drop our MCR guidance by 50 basis points, at this early stage and in this environment we decided not to.

正如我所說，在我們的會員月份組合中，目前已知的會員月份利率為 85%，只有 15% 是估計值，這些利率更新將影響第二、第三和第四季。知道這一點之後，我們接著說，我們是否讓這一數字下降到我們的指導水平，並將我們的 MCR 指導水平下調 50 個基點，在這種早期階段和環境下，我們決定不這樣做。

We saw no empirical evidence in the first quarter, which caused us to increase trend, the increase in trend from 4.5 to 5 to be commensurate with rates was entirely due to early in the year conservatism. We'd like to see how the second quarter experience emerges before making a final call on updating the Medicaid MCR for the full year. Your second question on HIX, can you repeat it, please? Do you have it Mark?

我們在第一季沒有看到任何經驗證據，這導致我們增加趨勢，趨勢從 4.5 增加到 5 以與利率相稱完全是由於今年年初的保守主義。在最終決定是否更新全年的 Medicaid MCR 之前，我們希望了解第二季的經驗如何。關於 HIX 的第二個問題，您能再重複一次嗎？馬克，你有嗎？

I would take that one. Hey Sarah, on the full-year trajectory of Marketplace MLR, we're a little flatter than normal this year or at least in prior years. First of all, we've got more new membership in SEP this year, so we're a little more conservative in our initial picks.

我會選擇那個。嘿，莎拉，就市場 MLR 的全年走勢而言，今年或至少與前幾年相比，情況略有平穩。首先，今年 SEP 的新會員較多，因此我們在最初的選擇上會更加保守一些。

But the other thing is, you'll see ConnectiCare improving through the year as new stores typically do. And then lastly, we've got a lower bronze mix this year and bronze tends to be a much more seasonal product, so a little bit flatter on the trajectory if you're modeling it.

但另一件事是，你會看到 ConnectiCare 全年都在不斷改進，就像新店通常會做的那樣。最後，今年我們的青銅混合比例較低，而且青銅往往是更具季節性的產品，因此，如果你對其進行建模，其軌跡會稍微平坦一些。

Joanna Gajuk with Bank of America.

美國銀行的 Joanna Gajuk。

Hey, good morning. Thanks so much for taking the question. So if I may, given the discussions around trend by product, I don't think I heard you talk about, MA. I know you said that in the quarter sounds like MLR was in line with expectations. So, can you talk about anything that's maybe happening in your Medicare Advantage book and are you still expecting same trend for the year? I think you had said on the last quarter, an increase of 2.7% for the year. Thank you.

嘿，早安。非常感謝您回答這個問題。因此，如果可以的話，考慮到圍繞產品趨勢的討論，我認為我沒有聽到您談論 MA。我知道您說過，本季 MLR 聽起來符合預期。那麼，您能談談您的《醫療保險優勢》一書中可能發生的任何事情嗎？您是否仍預期今年會出現同樣的趨勢？我想您說過上個季度全年成長率為 2.7%。謝謝。

Yeah, I'll take that one. So far, Medicare playing out much like we expected. We had guided to 89%, and we're still quite confident in an 89%. You're right in remembering the build, trend was about 2.7% in our original number and rates were just a little bit less than that. So far, I'm seeing utilization, B-28, all of those matters as well as the Part D under the IRA, all of those matters pretty much coming in as we anticipated. And remember, that's a much smaller part of our book.

是的，我要那個。到目前為止，醫療保險的進展與我們預期的差不多。我們之前預測是 89%，而且我們仍然對 89% 很有信心。您記得的沒錯，我們最初的數字中的趨勢約為 2.7%，而利率僅略低於這個數字。到目前為止，我看到利用率、B-28、所有這些事項以及 IRA 下的 D 部分，所有這些事項基本上都按照我們的預期進行。請記住，這只是我們書中很小的一部分。

Ryan Langston from TD Cowen

TD Cowen 的 Ryan Langston

Thanks. I want to go back to A.J.'s question. I guess on M&A, with sort of the backdrop uncertainty reconciliation and hand subsidies, et cetera., I guess is that impacting the willingness of potential M&A targets to engage on a potential deal? Or is it having any impact on the potential multiples just given we don't know where everything is going to shake out? Thanks.

謝謝。我想回到 A.J. 的問題。我想，在併購方面，考慮到背景不確定性、協調和手動補貼等，我猜這是否會影響潛在併購目標參與潛在交易的意願？或者，鑑於我們不知道一切將如何發展，它是否會對潛在的倍數產生影響？謝謝。

On the M&A front, the pipeline is still replete with opportunities. Obviously the last one we announced was the ConnectiCare acquisition, but the pipeline is full. Our M&A team is actively engaged in analyzing core products, core markets, and attractive prices if the businesses are underperforming and in this environment, as you know, performance is a challenge in this environment. Some of these smaller single state single geography companies are struggling.

在併購方面，仍充滿機會。顯然，我們宣布的最後一項是收購 ConnectiCare，但目前已籌備工作。如果業務表現不佳，我們的併購團隊會積極分析核心產品、核心市場和有吸引力的價格，在這種環境下，正如您所知，業績在這種環境下是一個挑戰。其中一些規模較小的單一州單一地區公司正在苦苦掙扎。

So no, I would say that it's not casting a pall over the M&A activity. In fact, it might even be increasing some of the flow as some of these single state operators have seen how difficult it is to run a business. We have the benefit of 22 state diversification. Single state, single geography companies don't, so I would say it's almost quite the opposite.

所以，我想說這不會讓併購活動蒙上陰影。事實上，它甚至可能會增加一些流量，因為一些單一州業者已經看到了經營企業的困難。我們擁有 22 個州多元化的優勢。單一州、單一地區的公司則不會這樣，所以我認為情況幾乎恰恰相反。

The pipeline is full of opportunities, and we hope to fulfill the commitment we've made that one-third of our forward growth rate as we said at Investor Day, is likely coming from M&A, bearing in mind that we're already at our $52 billion estimate for 2027, which is the low end of our range.

這個管道充滿了機遇，我們希望履行我們在投資者日所做的承諾，即我們未來成長率的三分之一可能來自併購，請記住，我們對 2027 年的估計已經達到 520 億美元，這是我們預期範圍的低端。

We've got 18 to 24 months to fill that other $3 billion and while nothing's a lay up in this business, highly confident we're going to do it.

我們還有 18 到 24 個月的時間來填補剩下的 30 億美元，雖然在這個行業中沒有什麼是輕鬆的，但我們非常有信心能夠做到這一點。

Lance Wilkes from Bernstein.

伯恩斯坦的蘭斯威爾克斯。

Great, thanks. Can you talk a little bit about network contracting, interested in how supplemental payments have been impacting hospitals and whether that's impacted kind of the growth and access with hospitals in your network and then also, what are you seeing as far as and what are you doing in the form of value-based care contracting?

太好了，謝謝。您能否談談網絡承包，感興趣的是補充支付對醫院有何影響，以及這是否影響了您網絡中醫院的增長和訪問，還有，您目前看到了什麼，您在基於價值的護理承包方面做了什麼？

Do you see any subcomponents of that? Do you feel you're going to need to owner partner? And maybe as you're doing that, if you can just kind of clarify and utilization, if there are any unusual puts and takes between categories of like hospital, behavioral, drugs, etc. Thanks.

您看到其中的任何子組件了嗎？您是否覺得需要業主合夥人？也許當您這樣做時，如果您可以澄清和利用，看看醫院、行為、藥物等類別之間是否存在任何不尋常的利弊。謝謝。

Lance, let me take the second part of your question first on value-based care and value-based contracting. As you know, in the past five years, most of the activity on VBC has been aimed at Medicare Advantage. That's where the lives are. That's where the premium was, and that's where a lot of the activity, it is coming to Medicaid. It is coming to Medicaid more slowly.

蘭斯，讓我先回答你問題的第二部分，關於基於價值的護理和基於價值的合約。如您所知，在過去五年中，VBC 上的大部分活動都針對醫療保險優勢計劃。那裡就是生命所在。這就是保險費的來源，也是醫療補助計劃的許多活動所在。它對醫療補助的推進速度較慢。

There are regulatory definitions of how much of your medical cost needs to go through a VBC arrangement. We are fully compliant with the minimum requirements. Now, it's about can you manage your cost structure and risk adjustment based on your relationships.

對於有多少醫療費用需要透過 VBC 安排，有監管定義。我們完全符合最低要求。現在，問題是您是否可以根據自己的關係來管理成本結構和風險調整。

We're getting there. We have our national networking unit has a VBC arm. They are actively engaged in working with our major provider partners where we have membership density to work on value-based care arrangements,

我們即將到達那裡。我們的國家網路部門有一個 VBC 部門。他們積極與我們的主要供應商合作夥伴合作，我們擁有會員密度，致力於基於價值的護理安排，

Again, over the next two or three years we will increase our penetration. Right now we are fully compliant with the regulatory rules. On your other question about supplemental payments, let me kick it to Mark and let him take that one.

再次，在未來兩三年內，我們將提高滲透率。目前我們完全遵守監管規則。關於補充付款的另一個問題，讓我把它交給馬克，讓他來回答。

Right. What you're calling supplemental payments, I think we call directed payments, and they're certainly a very big part of the formula. They're getting a little bit more attention it seems these days, but that business is usual for us.

正確的。您所說的補充付款，我認為我們稱之為定向付款，它們肯定是公式中非常重要的一部分。最近他們似乎受到了更多的關注，但這種事情對我們來說很正常。

We don't run them for the most part through the P&L, so they're not an aberration in our economics. We sometimes refer to them as pass-throughs, because they come from us, from the government, and go right to providers, and they're targeted for situations where providers need enhanced funding.

我們大部分不會透過損益表來計算它們，因此它們並不是我們經濟中的異常現象。我們有時稱它們為直通資金，因為它們來自我們，來自政府，直接流向供應商，它們針對的是供應商需要增加資金的情況。

And the policy question you're getting to with that question has to do with one of the situations that we've profiled. When you're talking about cuts to the Medicaid budget, you're really talking about enrollment reductions, benefit reductions, or payments to providers, and this is one source of payment to providers, and a provider would tell you that they're not supplemental, meaning they're enhancing their margins.

您在這個問題中提到的政策問題與我們所描述的情況之一有關。當您談論削減醫療補助預算時，您實際上談論的是減少入學人數、減少福利或減少對提供者的付款，這是向提供者付款的一個來源，並且提供者會告訴您他們不是補充性的，這意味著他們正在提高利潤率。

They're helping them make their margins. So, this is a big policy question in terms of whether the providers can bear Medicaid-related cuts of any type, either in the fee schedule or supplemental payments. I don't have a point of view on that, but that is a much of a raging debate in the policy discussions.

他們正在幫助他們賺取利潤。因此，這是一個重大的政策問題，即醫療服務提供者是否能夠承受任何類型的醫療補助相關削減，無論是費用表還是補充支付。我對此沒有看法，但這在政策討論中是一個激烈的爭論。

Michael Hall from Baird

貝爾德公司的麥可霍爾

Alright, thank you. On the exchange MLR pressure, I understand you're confident into next year these issues are non-recurring, but as you continue to press the gas pedal and exchange growth and thinking about risk adjustment specifically, have you implemented any new internal work streams to sort of help bolster this process for this year? And yeah, what gives you confidence on that? And then Joe, I believe you mentioned the early read on MA Medicaid integration is boding well so far.

好的，謝謝。關於交易所 MLR 壓力，我知道您對明年這些問題不會再次發生充滿信心，但隨著您繼續加強推動交易所發展並特別考慮風險調整，您是否實施了任何新的內部工作流程來幫助加強今年的這一進程？是的，是什麼讓您有信心呢？然後喬，我相信你提到過，到目前為止，對馬薩諸塞州醫療補助整合的早期解讀是良好的。

Are you hearing or I guess seeing anything new from states that gives you this incremental confidence, any early behavior change from states at all about how they might approach future Medicaid RFPs? And just for context, I've heard some speculation that, states might even open up Medicaid RFPs to include more plans because of this.

您是否聽到或看到各州有什麼新消息讓您更有信心，各州在如何處理未來醫療補助 RFP 方面有任何早期行為改變嗎？僅就背景而言，我聽到一些猜測，各州甚至可能因此開放醫療補助 RFP 以納入更多計劃。

So, just curious to hear what you're seeing or hearing that gives you more confidence. Thank you.

所以，我只是好奇地想聽聽您所看到或聽到的能讓您更有信心的事情。謝謝。

Well, we've heard some of those same things, but here are the facts as we know them sitting here today. Three very large states in the MMP program, which is really the only true integration program that existed, Ohio, Illinois, and Michigan. We just ran the table, very, very complex RFP submissions, intensity around true integration, one membership card, one phone number, one set of integrated benefits. You can't run one side off your Medicare platform and the other side off your Medicaid platform.

好吧，我們也聽到一些相同的事情，但以下是我們今天在這裡所了解的事實。MMP 計劃中有三個非常大的州，即俄亥俄州、伊利諾伊州和密西根州，這實際上是唯一存在的真正的融合計劃。我們剛剛運行了表格，非常非常複雜的 RFP 提交，圍繞著真正的整合、一張會員卡、一個電話號碼、一套綜合福利的強度。您不能在 Medicare 平台上運行一側，而在 Medicaid 平台上運行另一側。

And we're investing heavily, and making sure that we're able to handle those populations. The discussion around exclusively aligned enrollment is there. Whether most of the states settled there or not and allow D-SNP only plans in, we'll see.

我們正在投入大量資金，確保我們能夠應對這些人群。有關專門對齊招生的討論已經存在。我們將拭目以待，看看大多數州是否在那裡定居並只允許 D-SNP 計劃進入。

But the early discussions bode well for a company that has a very broad and deep Medicaid footprint like Molina and also has a competitive D-SNP offering. We're situated quite well and yes, we've heard the chatter that you're referencing about allowing more plans in. We'll see. We continue to believe that our integrated offering will be highly competitive.

但早期的討論對於像 Molina 這樣擁有廣泛而深入的醫療補助業務並且提供具有競爭力的 D-SNP 產品的公司來說是一個好兆頭。我們的處境很好，是的，我們聽到了您提到的關於允許更多計劃的討論。我們將拭目以待。我們始終相信，我們的綜合產品將具有極強的競爭力。

Our broker relationships are great, and the platform being truly integrated from a clinical and operational perspective is key, and we're well on our way to being there. Mark?

我們與經紀人的關係非常好，從臨床和營運角度真正整合的平台是關鍵，我們正在順利實現這一目標。標記？

On the marketplace question Michael, just so we're sending the right message, it's not growth for the sake of growth in marketplace, as I said earlier, marketplace is given a little bit of volatility in the space is first on margin and the volume will fall where it does.

關於市場問題，邁克爾，我們只是想傳達正確的訊息，市場的成長並不是為了成長而成長，正如我之前所說，市場在空間上存在一點波動，首先是保證金，然後交易量就會下降。

So, we've enjoyed a nice run of growth here, but that's because we believe the market has allowed that given what's going on as we move forward, if the cycle changes, we won't necessarily grow in a meaningful way. Separately, as you well know, the subsidies are potentially a headwind in the new year. So again, we'll price for margin and the volume's going to fall where it does.

因此，我們在這裡享受了良好的成長，但這是因為我們相信市場允許我們這樣做，考慮到我們前進的形勢，如果週期發生變化，我們不一定會以有意義的方式成長。另外，眾所周知，補貼可能會成為新的一年的阻力。因此，我們會再次根據保證金定價，而交易量也會隨之下降。

George Hill with Deutsche Bank.

德意志銀行的喬治·希爾。

Yeah, good morning, Joe. I have kind of a big picture question, and if I heard your comments, right, you said that like state Medicaid needs 200 to 300 basis points in advance of trend.

是的，早上好，喬。我有一個大問題，如果我聽到了你的評論，對的，你說像州醫療補助需要提前 200 到 300 個基點。

I imagine you guys are seeing mid to high single digit trend like everybody else. So that's basically telling the states that you need a high single digit or better rate increase. Like what's the conversation at the macro level given that 45 or 50 states are in a budget deficit situation, and I imagine they can't look around, but the answer is, Medicaid costs are going to be up 8.5% or 9% in the next couple of years.

我想你們也和其他人一樣看到了中高個位數的趨勢。所以這基本上是在告訴各州，你們需要高個位數或更高的利率成長。鑑於 45 或 50 個州處於預算赤字狀況，宏觀層面的討論是什麼，我想他們不能袖手旁觀，但答案是，醫療補助成本將在未來幾年上漲 8.5% 或 9%。

Like, what is the ask of the plans as it relates to keeping a cap on costs and like, I'm interested in like the state perspective. I understand all the actuarial sound and stuff, but like the states just can't afford high single digit spending increases in Medicaid. I'd kind of love to hear the big picture of conversations that you guys are having at the state level.

例如，這些計劃與限製成本有什麼關係，我對國家的觀點很感興趣。我理解所有的精算聲音和內容，但各州根本無法承受醫療補助支出高個位數的成長。我很想聽聽你們在州一級進行的對話的總體情況。

Yeah, certainly the strength of state budgets is a concern, but we've actually analyzed this over very long periods of time. There is very little correlation between the strength of rates and whether a state is deep red, deep blue, or purple.

是的，國家預算的實力確實令人擔憂，但我們實際上已經對此進行了很長時間的分析。利率強度與一個州是深紅色、深藍色還是紫色之間幾乎沒有關聯。

There is very little correlation between the strength of rates and whether there's a rainy day fund or not, or whether the budget is running a surplus or a deficit. Those are just the facts. Agreed that the more stressed the state budget becomes, logic would tell you that the rate conversation might be more difficult, not from an actuarial soundness perspective, but from an affordability perspective.

利率的強弱與是否有應急基金、預算是否有盈餘或赤字之間幾乎沒有關聯。這些只是事實。同意國家預算壓力越大，邏輯就會告訴你，利率對話可能會更加困難，不是從精算穩健性的角度，而是從可負擔性的角度。

We are confident that based on our analysis, the broad market, and as you know, the market sets the rate with its cost structure. We appear to be operating 200 to 300 basis -- even though we're 100 basis points off the top end of our long term range, we appear to be operating 200 to 300 basis points better than the broad market. The broad market needs that to come back to some semblance of program equilibrium.

我們相信，根據我們的分析，廣闊的市場以及如您所知的市場以其成本結構來設定價格。我們的經營狀況似乎達到了 200 至 300 個基點——儘管我們距離長期範圍的上限還有 100 個基點，但我們的經營狀況似乎比大盤高出 200 至 300 個基點。大盤需要這樣才能恢復到某種程度的程式平衡。

When that occurs and we're confident it will, we should be comfortably back at 89% or better and paying into the corridors once again. So yes, should that be kind of a big picture of concern? Absolutely. But history has shown us that the actuarial soundness concept works, particularly over the intermediate term, not necessarily in any one quarter, but it works over time and we're confident that the market will get what it needs and therefore would be comfortably back into our long term range at 89% or better here in the foreseeable future.

當這種情況發生時（我們有信心），我們應該可以輕鬆地回到 89% 或更高的水平，並再次支付走廊費用。是的，這應該是值得關注的大問題嗎？絕對地。但歷史告訴我們，精算穩健性概念是有效的，特別是在中期，不一定在任何一個季度，但它會隨著時間的推移而發揮作用，我們相信市場將得到它所需要的，因此在可預見的未來，它將輕鬆回到我們長期範圍內的 89% 或更高水平。

Dave Windley with Jefferies.

傑富瑞 (Jefferies) 的戴夫溫德利 (Dave Windley)。

Hi, good morning. Thanks for taking my questions. I wanted to ask another one on exchange. On the member reconciliations, if I understand Mark what you described, these are essentially the people that were unknowingly enrolled in a product, so several questions, sorry for this, but several questions, were the – so these are 100% subsidized people, were the subsidies clawed back to the beginning of their enrollment. Second, how -- you mentioned you think this is over.

嗨，早安。感謝您回答我的問題。我想就交換問題再問一個。關於會員對賬，如果我理解馬克你所描述的，這些人基本上是在不知情的情況下註冊了產品的人，所以我有幾個問題，很抱歉，但我有幾個問題，那就是——這些人是 100% 獲得補貼的人，補貼是否會被收回到他們註冊之初。第二，你提到你認為這一切已經結束了。

How comprehensive was CMS's review of this such that we should think that this wouldn't bleed over into 2025. And then as these low risk people, low utilizer people are coming out of the pool, how does this thing -- how does this make you think about your risk adjustment assumptions for 2025? Thank you.

CMS 對此的審查有多全面，以至於我們認為這種情況不會延續到 2025 年。然後，當這些低風險人群、低利用率人群從池子中出來時，這件事會怎樣——這會讓您如何思考 2025 年的風險調整假設？謝謝。

Great. Dave, thanks for all that. So as you described it, that's largely the case. In some cases, there is broker fraud. And in some cases, it's just people signing up for things and not being aware they did it.

偉大的。戴夫，謝謝你所做的一切。正如您所描述的，情況基本上就是這樣。在某些情況下，存在經紀人詐欺。在某些情況下，人們只是註冊了一些內容，但卻沒有意識到自己做了這些事情。

The way they find out about it generally is in their 2024 tax filing, they hear from the government that they made too much money to qualify for whatever subsidies they got. Therefore, they owe the government back some money.

他們通常是在 2024 年的報稅表中了解到這一情況的，政府告知他們賺的錢太多，不符合獲得任何補貼的資格。因此，他們欠政府一些錢。

They say, Well, gee, I never signed up for that product. We look and there were no claims, so they didn't use the product. So the government will claw back the subsidized premiums that they gave us. So those are revenue headwinds.

他們說，哎呀，我從來沒有註冊過該產品。我們查看了一下，沒有發現任何索賠，所以他們沒有使用該產品。因此政府將收回給予我們的補貼保費。所以這些都是收入上的阻力。

Now to size that, I told you there was about 40 bps or $40 million of adjustment in Marketplace from prior year, 1/3 of that is this phenomenon we're talking about. Now we're pretty much at the end of the tax season. Could we see a little bit more? Sure, but it would be a fraction of what we saw in the first quarter, which is becoming de minimis.

現在來看看這個規模，我告訴過你，與前一年相比，市場調整了大約 40 個基點或 4000 萬美元，其中 1/3 就是我們正在談論的這種現象。現在我們差不多已經到了報稅季節的尾聲。我們能看得更多一點嗎？當然，但這只是我們第一季看到的一小部分，而且這一數字已經變得微不足道了。

Now on a go-forward basis, you might recall that the integrity rules increased quite a bit for OEP just a few months ago and one of the biggest things was the agent of record lock, which made it a whole lot harder for brokers to switch people and actually made the market a lot more sticky, you didn't see the churn that you normally see. So will these kind of situations go away 100%? Of course, not. But do the new integrity rules go a long way to stop churn and maybe some fraudulent activity? I think so.

現在，從未來的角度來看，您可能還記得，就在幾個月前，OEP 的誠信規則增加了不少，其中最重要的一項就是代理人記錄鎖定，這使得經紀人更換人員變得更加困難，實際上使得市場變得更加粘稠，您不會看到通常會看到的客戶流失。那麼這種情況會 100% 消失嗎？當然不是。但新的誠信規則真的能有效阻止客戶流失甚至一些詐騙活動嗎？我認為是的。

So we really consider this a onetime, and I think it's largely behind us.

所以我們確實認為這只是一次性的事情，而且我認為它基本上已經過去了。

And to be very clear, when we receive a membership file that has a member on it, we have no reason to believe they're either not authorized or authorized, we have to service them as informed by CMS.

需要明確的是，當我們收到包含會員的會員文件時，我們沒有理由相信他們未經授權或已獲得授權，我們必須按照 CMS 的通知為他們提供服務。

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

我們的問答環節和今天的電話會議到此結束。感謝您參加今天的演講。您現在可以斷開連線。