聯合健康 (UNH) 2022 Q4 法說會逐字稿

Good morning, and welcome to the UnitedHealth Group Fourth Quarter and Full Year 2022 Earnings Conference Call. A question-and-answer session will follow UnitedHealth Group's prepared remarks. As a reminder, this call is being recorded.

早上好，歡迎來到 UnitedHealth Group 第四季度和 2022 年全年收益電話會議。問答環節將遵循 UnitedHealth Group 準備好的評論。提醒一下，此通話正在錄音中。

Here are some important introductory information. This call contains forward-looking statements under U.S. federal securities laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the reports that we file with the Securities and Exchange Commission, including the cautionary statements included in our current and periodic filings.

這裡有一些重要的介紹信息。本次電話會議包含美國聯邦證券法規定的前瞻性陳述。這些陳述受風險和不確定因素的影響，這些風險和不確定因素可能導致實際結果與歷史經驗或當前預期存在重大差異。在我們向美國證券交易委員會提交的報告中可以找到對某些風險和不確定性的描述，包括我們當前和定期提交的文件中包含的警示性聲明。

This will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amounts is available on the financial and earnings reports section of the company's Investor Relations page at www.unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated January 13, 2023, which may be accessed from the Investor Relations page of the company's website.

這也將參考非 GAAP 金額。非 GAAP 與 GAAP 金額的對賬可在公司投資者關係頁面 www.unitedhealthgroup.com 的財務和收益報告部分找到。本次電話會議中提供的信息包含在我們今天上午發布的收益公告和日期為 2023 年 1 月 13 日的 8-K 表格中，可從公司網站的投資者關係頁面訪問。

I will now turn the conference over to the Chief Executive Officer of UnitedHealth Group, Andrew Witty.

我現在將會議轉交給 UnitedHealth Group 的首席執行官 Andrew Witty。

Thank you. Good morning, and thank you all for joining us today. Over the course of the past year, the extraordinary and dedicated people of Optum and UnitedHealthcare delivered strong, well-balanced growth, progress in developing our consumer-orientated capabilities and strengthened the many ways in which we deliver value-based care in multiple settings. Each of the five growth pillars we discussed with you at our November investor conference are powerful sources of opportunities on their own within large and expanding addressable markets. Yet what really unlocks the potential value we can provide to those we serve is the connectivity of capabilities across our enterprise.

謝謝你。早上好，感謝大家今天加入我們。在過去的一年裡，Optum 和 UnitedHealthcare 非凡而敬業的員工實現了強勁、均衡的增長，在發展我們以消費者為導向的能力方面取得了進展，並加強了我們在多種環境中提供基於價值的護理的多種方式。我們在 11 月的投資者會議上與您討論的五個增長支柱中的每一個都是巨大且不斷擴大的潛在市場中強大的機會來源。然而，真正釋放我們可以為我們服務的人提供的潛在價值的是我們整個企業的能力連接。

For example, this year, we expect 4 million people will participate in fully accountable value-based care provided by Optum Health, almost 1.8 million more than we served as we enter 2022. We're achieving this by connecting benefits, care and other services to support our patients. Many of these patients will have a Medicare Advantage plan offered by UnitedHealthcare, or one of the many other payers who are accessing Optum's expertise and capabilities in delivering this kind of comprehensive care. We will serve these patients in clinic settings, in their homes, integrating behavioral care, supported by our data-driven clinical incidents and next best actions, and all coordinated to provide the right care when and where they need it.

例如，今年，我們預計將有 400 萬人參與由 Optum Health 提供的完全負責的基於價值的護理，比我們進入 2022 年時多出近 180 萬人。我們通過將福利、護理和其他服務聯繫起來來實現這一目標支持我們的患者。這些患者中的許多人將擁有 UnitedHealthcare 提供的 Medicare Advantage 計劃，或者是許多其他付款人之一，他們正在使用 Optum 的專業知識和能力來提供這種全面的護理。我們將在我們的數據驅動臨床事件和下一步最佳行動的支持下，在診所環境中、在他們的家中為這些患者提供整合行為護理，並協調所有這些患者，以便在他們需要的時間和地點提供正確的護理。

Pharmacy is another area in which we are more deeply connecting consumers with our services. We engage 1 million people every day, finding the lowest cost options, managing their specialty drugs, offering vital in-person clinical advice at our community pharmacies, providing complex medication treatments right in their homes, or simplifying access through digital solutions in order to make the process uneventful for them. We believe this connectivity is a path to better outcomes for people and lower costs.

藥房是我們更深入地將消費者與我們的服務聯繫起來的另一個領域。我們每天與 100 萬人接觸，尋找成本最低的選擇，管理他們的專業藥物，在我們的社區藥房提供重要的現場臨床建議，在他們家中提供複雜的藥物治療，或通過數字解決方案簡化訪問，以便這個過程對他們來說平安無事。我們相信這種連通性是為人們帶來更好結果和降低成本的途徑。

It's also driving growth. By the end of 2023, we expect to have more than 750 community pharmacies, nearly 200 more than we had at the beginning of 2020. We continue to see the impact these services have at a very local and personal level, helping providers deliver more complete care and better outcomes including medication adherence rates, which are about 90% compared to the 50% U.S. average. Our pharmacists are able to take the time to get to know their patients' treatment plans and support their medication management, collaborating with other care providers.

它還在推動增長。到 2023 年底，我們預計將擁有超過 750 家社區藥房，比 2020 年初多近 200 家。我們繼續看到這些服務在當地和個人層面產生的影響，幫助提供者提供更完整的服務護理和更好的結果，包括藥物依從率，與美國平均水平 50% 相比，藥物依從率約為 90%。我們的藥劑師能夠花時間了解患者的治療計劃並支持他們的藥物管理，並與其他護理提供者合作。

We're guided in pharmacy by the principle of getting to the lowest cost for patients and clients. A good example, as more biosimilars come to market, we're positioned to offer patients their care providers and payers significantly more choices in how to secure the best prices for the therapies they need. In addition to biosimilars, we're driving affordability and prescription benefits by combining formulary and cash market pricing to ensure consumers will always get the best economics.

在藥房，我們遵循為患者和客戶降低成本的原則。一個很好的例子，隨著越來越多的生物仿製藥進入市場，我們可以為患者提供更多的選擇，讓他們的護理提供者和付款人能夠以最優惠的價格獲得他們所需的療法。除了生物仿製藥，我們還通過結合處方藥和現金市場定價來提高可負擔性和處方藥收益，以確保消費者始終獲得最佳經濟效益。

Our life-saving drugs program has made very significant progress since our announcements last year. This program offers $0 out-of-pocket cost to consumers for drugs such as insulin and epinephrine. Our goal has been to make this available throughout the U.S. And as of today, we've been approved in 48 states for our fully insured business. Moreover, 1/4 of our self-funded employers have now chosen to add this offering for their employees, and we expect that number to rise.

自去年宣布以來，我們的救生藥物計劃取得了非常重大的進展。該計劃為消費者提供 0 美元的自付費用，用於購買胰島素和腎上腺素等藥物。我們的目標是在整個美國提供此服務。截至今天，我們已在 48 個州獲得全面保險業務的批准。此外，我們 1/4 的自籌資金雇主現在選擇為其員工添加此服務，我們預計這一數字還會上升。

Getting to this point in such a short period of time was only possible through the work not just of our teams, but of state officials and others in the broader health care community and we're grateful for their support.

在如此短的時間內達到這一點，不僅要靠我們團隊的努力，還要靠州政府官員和更廣泛的醫療保健界其他人的努力，我們才能做到這一點，我們感謝他們的支持。

Looking to the year ahead, let me focus you on a couple of themes you can expect to hear from us. One is continued scaling of our commitment to American consumers. You should and will have -- who should and will have an increasing influence over their care experience. Through our core innovations, product design, enhanced digital offerings and partnerships such as RVO Health and Walmart, you will see us driving this more broadly across the enterprise, becoming closer to the consumer, helping simplify their experiences and empowering their decision-making with greater transparency speed, convenience and support.

展望未來的一年，讓我重點關注您可以從我們這裡聽到的幾個主題。一是繼續擴大我們對美國消費者的承諾。你應該而且將會 - 誰應該並且將會對他們的護理體驗產生越來越大的影響。通過我們的核心創新、產品設計、增強的數字產品和合作夥伴關係（例如 RVO Health 和沃爾瑪），您將看到我們在整個企業範圍內更廣泛地推動這一點，更貼近消費者，幫助簡化他們的體驗並賦予他們更大的決策權透明度 速度、便利和支持。

You will also hear how we are amplifying our technology capabilities. 2023 will see the emergence of an enhanced OptumInsight, bringing to life the opportunities that the legacy organizations from Optum and change creates, an acceleration of how technology can be used to health care providers and ultimately patients within the overall health system. We start this year well prepared to deliver upon the objectives we shared with you in late November, and with a deep sense of responsibility to do so on behalf of the people we are privileged to serve.

您還將聽到我們如何增強我們的技術能力。 2023 年將看到增強型 OptumInsight 的出現，為 Optum 的遺留組織和變革創造的機會帶來生機，加速技術如何用於醫療保健提供者並最終用於整個衛生系統中的患者。今年開始，我們已做好充分準備，以實現我們在 11 月下旬與您分享的目標，並懷著強烈的責任感代表我們有幸服務的人們這樣做。

With that, I'll turn it over to President and Chief Operating Officer, Dirk McMahon.

有了這個，我將把它交給總裁兼首席運營官德克麥克馬洪。

Thank you, Andrew. While the calendar shows we are two weeks into the new year, our team's 2023 started many months ago and, in some cases, years ago. We have been laying the groundwork necessary to execute on our growth strategy and sustain our momentum heading into this year and beyond.

謝謝你，安德魯。雖然日曆顯示我們已經進入新的一年兩週，但我們團隊的 2023 年在很多個月前就開始了，在某些情況下甚至是幾年前。我們一直在為執行我們的增長戰略和保持今年及以後的發展勢頭奠定必要的基礎。

To give you a sense of how this develops, I'll step through some of the work that has been [longer to way] to ready our organization to serve even more patients and customers in this new year and provide greater value for consumers across a broad range of initiatives.

為了讓您了解這是如何發展的，我將逐步完成一些 [更長時間] 的工作，讓我們的組織在新的一年里為更多的患者和客戶提供服務，並為消費者提供更大的價值範圍廣泛的舉措。

Take the many new patients we will serve under value-based care arrangements in 2023, deepening our presence in existing areas and adding new regions. Our team's preparations are extensive. That's because the transition to fully accountable care is not simply a matter of downloading a new app. The preparations include significant investments in clinical training, technology, network coordination and other activities to make certain we are ready to serve. These critical investments help us support both our current year needs and 9establish foundations for the growth into 2024 and beyond.

以我們將在 2023 年根據基於價值的護理安排服務的許多新患者為例，深化我們在現有地區的存在並增加新地區。我們團隊的準備工作很廣泛。這是因為向完全負責的護理過渡不僅僅是下載新應用程序的問題。準備工作包括對臨床培訓、技術、網絡協調和其他活動的重大投資，以確保我們已做好服務準備。這些關鍵投資幫助我們支持當年的需求，並為 9 到 2024 年及以後的增長奠定基礎。

Our ability to serve people effectively has expanded beyond the four walls of the clinic with the rapid development of our in-home clinical capabilities. These services complement our clinic-based and digital offerings and bring high-quality care access to some of the most challenged and often underserved patients in this country.

隨著我們家庭臨床能力的快速發展，我們有效地為人們服務的能力已經超越了診所的四堵牆。這些服務補充了我們基於診所的數字產品，並為該國一些最具挑戰性且往往得不到服務的患者帶來了高質量的護理。

For instance, for value-based patients, our in-home services have reduced hospital visits by 15% versus fee-for-service, delivering comparable health outcomes and achieving an NPS of approximately 80%. Within health benefits, you've heard us discuss how our innovation and commercial products is adding new growth opportunities. One of those is Surest, a unique solution to employers and employees who are looking for first dollar coverage and high transparency into quality and cost. The momentum behind Surest is strong and building. Just two years ago, 1 in 25 national accounts offered Surest as an option to more traditional plans. Thus far in 2023, it is 1 in 9, and we expect it will continue to rise.

例如，對於基於價值的患者，我們的家庭服務與按服務收費相比減少了 15% 的醫院就診次數，提供了可比的健康結果並實現了大約 80% 的 NPS。在健康益處方面，您已經聽到我們討論我們的創新和商業產品如何增加新的增長機會。其中之一是 Surest，這是一種獨特的解決方案，適用於尋求第一美元保險以及質量和成本高度透明的雇主和僱員。 Surest 背後的勢頭強勁且正在建設中。就在兩年前，每 25 個國民賬戶中就有 1 個將 Surest 作為更傳統計劃的一個選項。到 2023 年為止，這一比例為九分之一，我們預計它將繼續上升。

Our offerings for seniors are another area in which we plan, invest and build capabilities to provide new and valuable offerings for an extended period. For example, we continue to expand the range of clinical services we provide via our HouseCalls initiative. In 2023, we will increase the types of vaccinations offered, expand testing services and deploy even more real-time resources to address social determinants of health. Seniors place high value on being able to get care in their home. It comes with an NPS of 75 and is helping to drive improving retention levels as we head into 2023.

我們為老年人提供的產品是我們計劃、投資和建設能力的另一個領域，以便在較長時期內提供新的和有價值的產品。例如，我們通過 HouseCalls 計劃繼續擴大我們提供的臨床服務範圍。到 2023 年，我們將增加提供的疫苗接種類型，擴大檢測服務並部署更多實時資源來解決健康問題的社會決定因素。老年人非常重視能夠在家中獲得護理。它的 NPS 為 75，並且在我們進入 2023 年時有助於提高保留水平。

In addition, our advocacy service solutions help members achieve better health. Our solutions led to a 42% increase in closing gaps in care, up to 15% lower ER visits and an over 10% increase in clinical program enrollment compared to customers who utilize standard offerings.

此外，我們的宣傳服務解決方案可幫助會員獲得更好的健康。與使用標準產品的客戶相比，我們的解決方案使護理差距增加了 42%，急診就診次數減少了 15%，臨床項目註冊人數增加了 10% 以上。

Turning to health technology, let me offer a few early observations on our progress and long-term growth opportunities we see in this area. With the completed change health care combination, we are accelerating our investments to bring this vision of a more intelligent and simpler health system to market as rapidly as possible. We will continue to innovate in and deliver the software, data analytics, technology-enabled services, revenue cycle management and advisory services our customers expect. And we are executing on the synergies of this combination with most of the financial benefit coming from complementary growth.

談到健康技術，讓我就我們在這一領域看到的進展和長期增長機會提供一些早期觀察。隨著醫療保健組合的全面變革，我們正在加速投資，以盡快將更智能、更簡單的醫療保健系統這一願景推向市場。我們將繼續創新並提供客戶期望的軟件、數據分析、技術支持服務、收入周期管理和諮詢服務。我們正在利用這種結合的協同效應，大部分經濟利益來自互補增長。

OptumInsight is uniquely positioned to offer integrated, end-to-end technology analytics and services across the entire health care value chain. Along these lines, we recently reached 2 new comprehensive health system partnerships, with Northern Light Health in Maine and with Owensboro Health in Kentucky. The services we provide typically feature a full breadth of our advanced solutions, including information technology, revenue cycle management, analytics and supply chain tools. The key here is that our comprehensive technology solutions are resonating in the market, and we expect to see increasing momentum across all of OptumInsight as we invest in and finalize our integration activities.

OptumInsight 具有獨特的優勢，可以在整個醫療保健價值鏈中提供集成的端到端技術分析和服務。沿著這些思路，我們最近與緬因州的 Northern Light Health 和肯塔基州的 Owensboro Health 達成了 2 個新的綜合衛生系統合作夥伴關係。我們提供的服務通常包含全面的先進解決方案，包括信息技術、收入周期管理、分析和供應鏈工具。這裡的關鍵是我們全面的技術解決方案在市場上引起共鳴，我們希望在我們投資和完成我們的整合活動時看到所有 OptumInsight 的增長勢頭。

With that, now I'll turn it over to Chief Financial Officer, John Rex.

有了這個，現在我將把它交給首席財務官約翰雷克斯。

Thank you, Dirk. The investments and innovations Andrew and Dirk described and that we shared with you in November, speak to a company that has tremendous growth potential as we head into '23 and well beyond. The opportunities to serve people more deeply are tangible and accelerating, building upon a foundation of strong growth in recent years, including our 2022 performance.

謝謝你，德克。 Andrew 和 Dirk 描述的投資和創新以及我們在 11 月與您分享的投資和創新，在我們進入 23 世紀及更遠的未來之際，與一家具有巨大增長潛力的公司交談。在近年來強勁增長的基礎上，包括我們 2022 年的業績，更深入地為人們服務的機會是有形的，而且還在加速發展。

Revenue in '22 of $324 billion grew by more than $36 billion or 13% over the prior year, with well-balanced double-digit growth at both Optum and UnitedHealthcare. Fourth quarter adjusted earnings per share of $5.34 grew 19% and brought full year adjusted earnings per share to $22.19, growth of 17%. Our capital capacities remain strong. Cash flow from operations in '22 was $26.2 billion or 1.3x net income. We returned $13 billion to shareholders through share repurchase and dividends, and deployed over $20 billion in growth capital to expand our capabilities for years to come.

22 年的收入為 3240 億美元，比上一年增長超過 360 億美元或 13%，Optum 和 UnitedHealthcare 均實現了兩位數的均衡增長。第四季度調整後每股收益為 5.34 美元，增長 19%，全年調整後每股收益為 22.19 美元，增長 17%。我們的資本能力依然強勁。 22 年的運營現金流為 262 億美元或淨收入的 1.3 倍。我們通過股票回購和派息向股東返還了 130 億美元，並部署了超過 200 億美元的增長資本來擴大我們未來幾年的能力。

Turning to the performance of our businesses. OptumHealth's revenues grew by 32% in '22 to $71 billion as we expanded the number of patients served under value-based care arrangements by about 1 million. Revenue per consumer grew by 29%, driven by the increase in value-based care patients and in the levels of care we are able to offer.

談到我們的業務表現。 OptumHealth 的收入在 22 年增長了 32%，達到 710 億美元，因為我們將接受基於價值的護理安排服務的患者人數增加了約 100 萬。每位消費者的收入增長了 29%，這得益於基於價值的護理患者數量的增加以及我們能夠提供的護理水平的提高。

Consistent with our comments in November, OptumHealth is off to a strong start in '23 and will organically grow to serve an additional 750,000 value-based patients this year. OptumInsights revenues grew 20% to $14.6 billion in '22. We concluded the year with a revenue backlog of $30 billion, an increase of $7.6 billion over last year. As Dirk noted, we are advancing our investments to more rapidly unlock the positive impact OptumInsight can have for care providers and patients. We expect to make a significant portion of these important investments in the first half of the year.

與我們在 11 月份的評論一致，OptumHealth 在 23 年開局良好，今年將有機增長，為另外 750,000 名基於價值的患者提供服務。 OptumInsights 的收入在 22 年增長了 20%，達到 146 億美元。我們以 300 億美元的收入積壓結束了這一年，比去年增加了 76 億美元。正如德克指出的那樣，我們正在推進我們的投資，以更快地發揮 OptumInsight 對護理提供者和患者的積極影響。我們預計將在今年上半年進行這些重要投資的很大一部分。

OptumRx revenues grew 9%, approaching $100 billion for the year, driven by continued strong sales and the expansion of our pharmacy services businesses. Both customer retention and new customer wins were among the highest OptumRx has ever delivered, laying a strong foundation for continued market-leading growth.

OptumRx 的收入增長了 9%，全年接近 1000 億美元，這得益於持續強勁的銷售和我們藥房服務業務的擴張。客戶保留率和新客戶贏得率都是 OptumRx 有史以來最高的，為持續領先市場的增長奠定了堅實的基礎。

At UnitedHealthcare, full year revenues of nearly $250 billion grew 12%. Our strong 2023 Medicare Advantage member outlook is consistent with the objectives we shared with you in November. We expect to serve up to 900,000 more people in '23 across our individual, group and dual special needs offerings, our 8th consecutive year of above-market growth. This consistent performance underscores the product innovation, benefit stability and high-value seniors have come to rely on from us.

UnitedHealthcare 的全年收入接近 2500 億美元，增長了 12%。我們強大的 2023 年 Medicare Advantage 會員前景與我們在 11 月與您分享的目標一致。我們預計在 23 年通過我們的個人、團體和雙重特殊需求產品服務多達 900,000 人，這是我們連續第 8 年實現高於市場的增長。這種始終如一的表現凸顯了產品創新、福利穩定性和高價值老年人對我們的依賴。

Our Medicaid growth outlook for '23 incorporates an expectation that states will resume eligibility redeterminations early in the second quarter. Our objective is to ensure that people will have continuous access to benefits. And when all redetermination activities are eventually completed, we expect to serve even more people than we do today across our state-based commercial and exchange-based offerings.

我們對 23 年的 Medicaid 增長前景包含了各州將在第二季度初恢復資格重新確定的預期。我們的目標是確保人們能夠持續獲得福利。當所有重新確定活動最終完成時，我們希望通過我們基於州的商業和基於交易所的產品為比今天更多的人提供服務。

Within our commercial offerings, we expect to serve about 1 million additional people in 2023. Our new and innovative products continue to gain momentum with employers and their employees, which will lead to increasing growth in this market over the next several years.

在我們的商業產品中，我們預計到 2023 年將新增約 100 萬人。我們的創新產品將繼續受到雇主及其僱員的歡迎，這將在未來幾年推動該市場的增長。

In sum, while this year is just getting started, the early performance we are seeing across our businesses further validates our confidence in the 2023 growth and performance objectives we shared with you just 6 weeks ago.

總而言之，雖然今年才剛剛開始，但我們在各個業務中看到的早期表現進一步證實了我們對 6 週前與您分享的 2023 年增長和績效目標的信心。

Now I'll turn it back to Andrew.

現在我將把它轉回給安德魯。

Thanks, John. As we head into 2023, we're determined to build upon the momentum we've just described this morning, further advancing our mission and delivering sustainable earnings growth of 13% to 16% over the long term.

謝謝，約翰。在我們邁入 2023 年之際，我們決心在今天上午剛剛描述的勢頭的基礎上再接再厲，進一步推進我們的使命，實現 13% 至 16% 的長期可持續盈利增長。

And with that, operator, let's open it up for questions. One per caller, please.

有了這個，操作員，讓我們打開它來提問。請每位來電者一份。

(Operator Instructions) We'll take our first question from the line of A.J. Rice with Credit Suisse.

（操作員說明）我們將從 A.J. 的行中提出我們的第一個問題。瑞士信貸的大米。

Happy new year. The company seems to be taking a lot of momentum across the board into '23. I wonder when you step back and look at the swing factors that say would push the company towards the higher end of the range that you've offered in EPS or towards the lower end, what are some of the biggest swing factors in your mind in potential positives or challenges?

新年快樂。該公司似乎在全面進入 23 年時勢頭強勁。我想知道當你退後一步，看看那些說會將公司推向你所提供的 EPS 範圍的高端或較低端的搖擺因素時，你心目中的一些最大搖擺因素是什麼潛在的積極因素或挑戰？

A.J., thanks so much, and happy new year to you as well. I appreciate the question. Yes. So first off, we do feel that we're bringing a ton of momentum into 2023. We feel across the board last year, very strong performances. Most of our businesses closed out the year, actually a little ahead of where we were anticipating even when we were at the investor conference. So strong from that perspective.

A.J.，非常感謝，也祝你新年快樂。我很欣賞這個問題。是的。因此，首先，我們確實認為我們正在為 2023 年帶來巨大的動力。去年我們全面感受到了非常強勁的表現。我們的大部分業務都在這一年結束，實際上比我們在投資者會議上的預期提前了一點。從這個角度來看非常強大。

As we look into this year, I think real standout for me maybe call out just 2 or 3 points. One is just the membership roles and just the scale of growth in our membership. If you look at UHC, performance during '22, you heard us talk about that just now, we're anticipating, frankly, another 1 million plus. I wouldn't be at all surprised if we didn't exceed '22 numbers by the time we get to the end of '23. That is a huge plus and signals a tremendous amount of engagement from the marketplace in our product set across all lines of business, whether that's in the government books of business in the MA platform, our determination to make sure that we look after folks in Medicaid as they go through redetermination cycles and, of course, in our commercial books where you've seen tremendously strong growth. So that's really an area which I think is building for us a lot of confidence as we go forward.

當我們回顧今年時，我認為對我來說真正的傑出表現可能只需要 2 或 3 分。一個是會員角色和我們會員的增長規模。如果你看看 UHC，22 年的表現，你剛才聽到我們談論過，坦率地說，我們預計還會有 100 萬以上。如果我們在 23 年底時沒有超過 22 個數字，我一點也不會感到驚訝。這是一個巨大的優勢，表明市場對我們所有業務線的產品集的大量參與，無論是在 MA 平台的政府業務簿中，我們決心確保我們照顧醫療補助計劃中的人們當他們經歷重新確定週期時，當然，在我們的商業書籍中，您已經看到了非常強勁的增長。所以我認為這確實是一個在我們前進的過程中為我們建立了很多信心的領域。

And then you go across to Optum, and let me just call out record selling seasons coming through from our OptumRx platform. That's building a tremendous amount of pipeline growth for us within our business over the next several years. OptumHealth, of course, really rapid growth of value-based fully capitated lives. You'll see by the end of '23, we'll be looking after -- well, more than double the number of folks we were looking after at the end of '21. That's an extraordinary expansion, and we expect that to continue to grow hard.

然後你去到 Optum，讓我來談談我們的 OptumRx 平台帶來的創紀錄的銷售季節。在接下來的幾年裡，這將在我們的業務中為我們建立大量的管道增長。 OptumHealth，當然，真正快速增長的是基於價值的全人頭生活。你會看到，到 23 年底，我們將照顧——好吧，我們照顧的人數是 21 年底的兩倍多。這是一次非凡的擴張，我們預計它會繼續強勁增長。

OptumInsight, this year will be an emergence of a new OptumInsight. That's a business where we know we can do better. We've known that for a long time. We've been itching to get going on the integration of change in OptumInsight, which we've now been able to do. We really leaned into that in the fourth quarter. You'll see that flow through very rapidly in the first couple of quarters of this year. That's going to give us a whole new cycle of product innovation. We expect that to be a big source of lift as we go forward, backed up by an increasing momentum of being able to sign up these very large health system partnerships.

OptumInsight，今年會出現一個新的OptumInsight。這是我們知道可以做得更好的業務。我們早就知道了。我們一直渴望著手在 OptumInsight 中整合變化，現在我們已經能夠做到了。我們在第四季度真正傾向於這一點。你會在今年的前幾個季度看到這種流動非常迅速。這將為我們提供一個全新的產品創新周期。我們希望這將成為我們前進的一大推動力，並得到能夠簽署這些非常大的衛生系統夥伴關係的日益增長的勢頭的支持。

You've seen us do two since the investor conference in November in addition to the ones we already have. I remind you, these are very large scale, very sticky, multiyear relationships, really substantial sources of energy for the organization. So that really drives all of our momentum. I think where we land in the ranges we've given you is all about our ability to execute and making sure that our organization is focused on every single day, making sure we get every transaction right. We look after every patient in the right way.

自 11 月的投資者會議以來，除了我們已經擁有的那些之外，你已經看到我們做了兩次。我提醒你，這些是規模非常大、粘性很強、多年的關係，對組織來說確實是巨大的能量來源。所以這真的推動了我們所有的動力。我認為我們在我們給你的範圍內的位置是關於我們執行的能力，並確保我們的組織專注於每一天，確保我們把每一筆交易都做對。我們以正確的方式照顧每一位患者。

We make sure that we're looking after every consumer approach that we receive in the right way. And so execution is going to be what determines where we come out. The raw material in terms of the momentum for the company is just extraordinary as we look into 2023.

我們確保我們以正確的方式照顧我們收到的每一個消費者方法。因此，執行力將決定我們的出路。展望 2023 年，就公司的發展勢頭而言，原材料非常出色。

A.J., I appreciate the question. Next question, operator, please.

A.J.，我很欣賞這個問題。下一個問題，接線員，請。

The next question is from the line of Lisa Gill with JPMorgan.

下一個問題來自摩根大通的 Lisa Gill。

Great. I was wondering if maybe you could just comment on the RADV expectations for February 1. We just had our conference this week, and there was a lot of talk about this and just what managed care is generally expecting out of that ruling.

偉大的。我想知道您是否可以就 2 月 1 日的 RADV 預期發表評論。我們本周剛剛召開了會議，對此進行了很多討論，以及管理式醫療對該裁決的普遍期望。

Yes. I mean, we're not going to get into a ton of speculation because obviously, it's very, very potentially imminent. And so not sure there's tons of value there.

是的。我的意思是，我們不會進行大量猜測，因為很明顯，它非常非常有可能迫在眉睫。所以不確定那裡有很多價值。

But I would like to ask Tim Noel looks after our M&R business to maybe share some of his perspective on that. Tim?

但我想請 Tim Noel 負責我們的 M&R 業務，分享他對此的一些看法。蒂姆？

Great. Thanks for the question, Lisa. We talked about this a bit at the investor conference and don't have a lot of new information to share this morning, but let me revisit a couple of the key elements that we discussed a couple of weeks ago.

偉大的。謝謝你的問題，麗莎。我們在投資者會議上談到了這一點，今天早上沒有太多新信息可以分享，但讓我重溫一下幾週前我們討論過的幾個關鍵要素。

So first, risk adjustment is really critical to providing broad and equitable access inside the Medicare Advantage program. Also a really important part of ensuring there's no disincentives for caring for the most vulnerable. We also continue to remain very supportive of additional transparency. And here, that takes the form of more timely and consistent reviews.

因此，首先，風險調整對於在 Medicare Advantage 計劃中提供廣泛和公平的訪問非常關鍵。這也是確保不存在照顧最弱勢群體的障礙的一個非常重要的部分。我們也繼續非常支持增加透明度。在這裡，這採取了更及時和一致的審查形式。

And a few of the key elements that we're thinking about with respect to these audits is it's very important for CMS to include a fee-for-service adjuster to make sure that we're comparing original Medicare and Medicare Advantage on the same basis. And also, very important that we don't conduct these audits on decades in arrears. That comes with some challenges, of course.

我們在這些審計方面考慮的一些關鍵因素是，對於 CMS 來說，包含一個按服務收費的調整器非常重要，以確保我們在相同的基礎上比較原始 Medicare 和 Medicare Advantage .而且，非常重要的是，我們不會在拖欠數十年的情況下進行這些審計。當然，這也帶來了一些挑戰。

That said, without the final rule set, as Andrew alluded to, hard to get really narrow and specific, but we feel really good about how our results validated. Some of our sample sets were above, some of our sample sets were below. But likely more specifics to discuss at next quarter's call.

也就是說，正如安德魯所暗示的那樣，如果沒有最終的規則集，很難做到真正的狹窄和具體，但我們對結果的驗證方式感到非常滿意。我們的一些樣本集在上面，一些樣本集在下面。但可能會在下一季度的電話會議上討論更多細節。

Tim, thanks so much. And Lisa, thanks for the question. I mean I think as you just, again, just maybe step up a little bit in the broader position, obviously the whole MA program is unbelievably successful and popular program for seniors across the U.S. And of course, the biggest proof of that is the number of folks who every single year volunteer to sign up to be part of this program. And we're seeing another record year of enrollment coming through as we speak.

蒂姆，非常感謝。麗莎，謝謝你的提問。我的意思是，我認為你只是，再一次，也許只是在更廣泛的職位上加強了一點，顯然整個文學碩士項目是令人難以置信的成功和受美國各地老年人歡迎的項目。當然，最大的證據就是數字每年都自願報名參加該計劃的人。就在我們說話的時候，我們看到了又一個創紀錄的入學年。

It's super important that any changes, whether it's in this particular circumstance or any other circumstance, it's super important that folks are thoughtful about collateral consequences, making sure that what is really impressive program in terms of quality of care, reassurance provided to seniors, ability to deliver good value for the senior, good value for society, making sure that any changes are made thoughtfully and holistically is what we would be hoping to see. And obviously, we look forward to working with the administration when and if any further updates come forth. With that, Lisa, thanks so much for the question.

非常重要的是，任何變化，無論是在這種特殊情況下還是在任何其他情況下，人們都要考慮附帶後果，確保在護理質量、為老年人提供的保證、能力方面真正令人印象深刻的計劃是非常重要的為老年人提供良好的價值，為社會提供良好的價值，確保任何改變都是經過深思熟慮和全面的，這是我們希望看到的。顯然，我們期待在出現任何進一步更新時與政府合作。有了這個，麗莎，非常感謝你提出這個問題。

The next question is from the line of Josh Raskin with Nephron Research.

下一個問題來自 Nephron Research 的 Josh Raskin。

I was wondering if you could speak to the progression of earnings when you add physicians or large physician groups in OptumCare and how that changes over time. I'm specifically looking for sort of margin ranges as you first get started in the first year. When you break even, how long that takes? And then how long it takes to get to the ultimate margins?

我想知道當您在 OptumCare 中添加醫生或大型醫生團隊時，您是否可以談談收入的進展情況，以及隨著時間的推移如何變化。當你在第一年開始時，我特別在尋找某種保證金範圍。當你收支平衡時，需要多長時間？然後需要多長時間才能達到最終利潤率？

And I'm curious if the scale that you've got now, half of this book is new in the last three years, does scale accelerate some of that opportunity?

我很好奇你現在的規模，這本書的一半是過去三年的新書，規模是否會加速一些機會？

Josh, listen, thanks so much for the question. It's a really -- that's a big question. Let me just give a few thoughts towards that. So one of the key capabilities you need to be in value-based care at scale is patients. Patients because it takes 3 or 5 years of getting to know medical practices before they become part of our network and as we go through our expansion.

喬希，聽著，非常感謝你提出這個問題。這真的是一個大問題。讓我就此提出一些想法。因此，在大規模基於價值的護理中，您需要具備的關鍵能力之一是患者。患者因為在他們成為我們網絡的一部分以及我們進行擴展之前需要 3 或 5 年的時間來了解醫療實踐。

Patient then in terms of how you go through the process of building the capabilities and skills within the clinical practices to move from fee-for-service to value-based care. And of course, that patient size is reflected in how long it takes to go through this from an economic and financial perspective. And that's why as we see this rapid development now, it's kind of OptumCare, value-based care is kind of an overnight success that took 15 years to build. And that's -- it's really a truth. And we're seeing that scale now come to life and all credit to the teams who are doing that.

然後耐心地了解您如何通過在臨床實踐中建立能力和技能的過程，從按服務收費轉變為基於價值的護理。當然，從經濟和金融的角度來看，患者人數反映在需要多長時間才能完成。這就是為什麼我們現在看到這種快速發展，它是一種 OptumCare，基於價值的護理是一種一夜成名，需要 15 年才能建立起來的原因。那是——這確實是事實。我們看到這種規模現在變得栩栩如生，所有的功勞都歸功於這樣做的團隊。

In terms of what helps here, I think it's really building a muscle within your organization to continuously test, learn, correct. Test, learn, correct in terms of how we work. This is a very -- so very -- it's a somewhat delicate system because what you're dealing with, obviously, highly professional clinical decision makers on the front line who are absolutely, ultimately responsible for every decision they make in front of every patient. But you're also trying to make sure they have the right information to be able to learn from the whole system, the information we know about those folks and what's likely to happen, what could happen, what might be the best practice. And how can we get the whole of the system to operate at a higher level.

就此處的幫助而言，我認為它確實在您的組織中建立了持續測試、學習和糾正的力量。測試、學習、糾正我們的工作方式。這是一個非常 - 非常 - 這是一個有點微妙的系統，因為你正在處理的事情，顯然，前線的高度專業的臨床決策者，他們對他們在每個病人面前做出的每一個決定絕對、最終負責.但你也要努力確保他們擁有正確的信息，以便能夠從整個系統中學習，我們所了解的關於這些人的信息，以及可能發生的事情、可能發生的事情，以及可能是最佳實踐的事情。以及我們如何才能讓整個系統在更高的層次上運行。

Those sorts of pieces of progress, those areas where we relentlessly invested, give us opportunities to improve the clinical care. If we can improve the clinical care, the economics follow. So within this whole model, getting the clinical care right, getting people in the right facilities, making sure people don't spend too long in care facilities when it's unnecessary, making sure that illness is delayed, deferred because they're treated well that prevention is the priority, that's what drives all of the economics.

這些進步，我們不懈投資的那些領域，給了我們改善臨床護理的機會。如果我們能夠改善臨床護理，經濟學就會隨之而來。因此，在整個模型中，獲得正確的臨床護理，讓人們進入正確的設施，確保人們在不必要的情況下不會在護理設施中花費太長時間，確保疾病被延遲，推遲，因為他們得到了很好的治療預防是重中之重，這是推動所有經濟發展的動力。

What we're seeing, Josh, is that over the last 3 or 4 years, we are indeed being able to bring our more recent cohorts to a better economic position more quickly. That's allowing us then to continue to invest more aggressively in bringing new patients into the system. And that -- it's really that mechanism, which you're seeing come to life at the moment. Hopefully, that helps a little bit.

喬希，我們所看到的是，在過去的 3 或 4 年裡，我們確實能夠更快地將我們最近的同齡人帶入更好的經濟狀況。這使我們能夠繼續更積極地投資，將新患者帶入系統。這就是你現在看到的真正的機制。希望這能有所幫助。

We'll take the next question from the line of Justin Lake with Wolfe Research.

我們將從 Justin Lake 與 Wolfe Research 一起提出下一個問題。

Wanted to touch on cost trend. MLR was in line with your expectations for the quarter. But wanted to hear -- there's been questions about the impact of respiratory in the quarter. There's even been some discussion around a pickup in just overall utilization in December. So would love some comments on those to it, maybe just a little on how trend looked between the different businesses, commercial, Medicare and Medicaid.

想談談成本趨勢。 MLR 符合您對本季度的預期。但想听聽——有人質疑本季度呼吸系統的影響。甚至圍繞 12 月份整體利用率的回升進行了一些討論。所以希望對這些發表一些評論，也許只是關於不同企業、商業、醫療保險和醫療補助之間的趨勢如何看待。

Yes. Justin, thanks so much. I'm going to ask Brian Thompson to respond to that, please.

是的。賈斯汀，非常感謝。我要請 Brian Thompson 對此做出回應。

Yes. Thanks, Justin, for that question. Throughout the pandemic, we've been making these references to baselines, et cetera. I think, now being three years into this pandemic, I'd like to just ground an anchor more to our expectations as COVID has waned. And what I'm most encouraged by is that the fourth quarter played out as we had expected. And what we had set out inside our pricing trends are lining up really nicely as we look forward to 2023.

是的。謝謝賈斯汀提出這個問題。在整個大流行期間，我們一直在參考基線等。我認為，現在已經進入這場大流行病三年了，隨著 COVID 的減弱，我想更多地錨定我們的期望。最讓我感到鼓舞的是，第四季度的表現符合我們的預期。在我們期待 2023 年的時候，我們在定價趨勢中設定的內容非常吻合。

To your comments around the flu, as I had suggested at our investor conference, we certainly saw that spike. We have now seen that start to wane for, I think, five consecutive weeks here as we're moving forward. So to put it out like we had expected, really not a meaningful impact as I'm looking forward versus what we've planned for.

對於你對流感的評論，正如我在我們的投資者會議上所建議的那樣，我們當然看到了這種飆升。我們現在已經看到這種情況開始減弱，我認為，隨著我們向前邁進，這裡已經連續五個星期了。因此，要像我們預期的那樣發布它，真的不是一個有意義的影響，因為我期待與我們計劃的相比。

So what I'm most encouraged by is we're sort of out of that zone of the unknowns around comparing to baselines, et cetera, and really managing a book of business with greater predictability back to sort of the expectations that we had well pre-pandemic and encouraged about how all of those elements, including flu, are lining up as we look forward.

因此，最讓我感到鼓舞的是，與基線等相比，我們已經走出了未知區域，並且真正管理了一本具有更高可預測性的業務，回到了我們之前的預期-大流行並鼓勵所有這些因素，包括流感，在我們期待的時候是如何排列的。

Thanks so much, Brian. And Justin, thanks for the question.

非常感謝，布萊恩。賈斯汀，謝謝你的提問。

We'll take our next question from the line of Lance Wilkes with Bernstein.

我們將從 Lance Wilkes 和 Bernstein 的台詞中提出下一個問題。

Yes. Could you talk a little bit about the employer segment? And what I'm interested in is what was pricing like in 2023. If you think of the 6% commercial trend that used to be your pre-pandemic sort of levels, what was that like? And for those employer customers, how are they kind of waiting the need to get employees in the war for talent versus focus on maybe higher premium costs and how they're trying to control that?

是的。你能談談雇主部分嗎？我感興趣的是 2023 年的定價情況。如果你想想 6% 的商業趨勢曾經是大流行前的水平，那是什麼樣的？對於那些雇主客戶，他們是如何等待讓員工參與人才爭奪戰的需要，而不是專注於可能更高的保費成本，以及他們如何試圖控制這一點？

Lance, thanks so much. Let me ask Brian to kick off on that.

蘭斯，非常感謝。讓我請布賴恩開始吧。

Yes. Maybe I'll start, and then I'll hand it off to Dan (inaudible). I'll start with the conversation around trends. As you well know, we used to share trend information back in the day, and stopped doing so simply because it became less instructive as we were pacing through this COVID environment.

是的。也許我會開始，然後我會把它交給 Dan（聽不清）。我將從圍繞趨勢的對話開始。如您所知，我們過去常常分享趨勢信息，現在停止這樣做只是因為隨著我們在 COVID 環境中步調，它變得不那麼有指導意義了。

What I can share, and I think once we get to this zone of consistency, we'll return to those metrics, we're certainly encouraged by what we're seeing on the utilization front. I think we are seeing some durable shifts. We've seen it with respect to ER moving into urgent and in-patient to outpatient.

我可以分享的是，我認為一旦我們達到這個一致性區域，我們就會回到這些指標，我們肯定會對我們在利用率方面看到的情況感到鼓舞。我認為我們正在看到一些持久的轉變。我們已經看到急診室從急診和住院到門診。

But on the flip side, as we all know, in these labor markets, we're seeing stronger unit costs. And as we all know, unit costs still comprise the majority of the overall trend. And as I had suggested earlier in the year, we did have a higher trend planning for 2023 than 2022. But in reality, that was really a function of the first half of 2022.

但另一方面，眾所周知，在這些勞動力市場中，我們看到單位成本更高。眾所周知，單位成本仍然佔整體趨勢的大部分。正如我在今年早些時候所建議的那樣，我們對 2023 年的趨勢規劃確實高於 2022 年。但實際上，這實際上是 2022 年上半年的一個函數。

And again, I want to give that thought and belief that we are largely back to normal levels. And I think once we pace through 2023, we'll get to that zone where we can share those pricing trends. So with that, maybe a little bit more on the competitive dynamic, Dan.

再一次，我想表達我們已經基本恢復到正常水平的想法和信念。而且我認為，一旦我們步入 2023 年，我們就會到達可以分享這些定價趨勢的區域。因此，也許更多關於競爭動態的信息，Dan。

Yes. Thanks, Brian, and thanks for the question, Lance. The competitive dynamics in the commercial market remain the same as they've been, always competitive. We continue to price to our forward trend, and we have continued to do that.

是的。謝謝布賴恩，也謝謝蘭斯的提問。商業市場的競爭態勢一如既往，始終充滿競爭。我們繼續為我們的前瞻趨勢定價，我們一直在這樣做。

As Brian indicated, there has been some modifications to that, but all within the range of what we've expected and all within the range of how we've priced. So we don't see any material deviations at all from what we've expected in our plan.

正如 Brian 指出的那樣，對此進行了一些修改，但都在我們預期的範圍內，並且都在我們定價的範圍內。因此，我們沒有看到與我們計劃中的預期有任何實質性偏差。

And we'll take our next question from the line of David Windley with Jefferies.

我們將從 David Windley 和 Jefferies 那裡提出下一個問題。

In Optum Health as you have added or about to add behavioral and home, more substantial home care opportunities and have talked about those in the context of value-based care. I'm wondering what influence those have on the trajectory of revenue per member served that's already rising at a pretty rapid clip due to the full cap that you're transitioning lives into. So the home and behavioral adds to that.

在 Optum Health 中，您已經添加或即將添加行為和家庭、更實質性的家庭護理機會，並在基於價值的護理背景下討論了這些機會。我想知道這些對服務的每個成員的收入軌蹟有什麼影響，由於你正在將生活轉變為完全上限，已經在以相當快的速度增長。所以家庭和行為增加了這一點。

Yes. So I'm going to ask Dr. Wyatt Decker to make a couple of comments in a second on that. But maybe just before he does, and I think we don't particularly break out what's driving the elements of that kind of consumer served number. But you can imagine that the move to value-based care is a big driver of that.

是的。所以我要請 Wyatt Decker 博士馬上就此發表一些評論。但也許就在他這樣做之前，我認為我們並沒有特別指出是什麼推動了這種消費者服務數量的要素。但你可以想像，轉向基於價值的護理是其中的一個重要推動力。

Now one of the pieces within the home platform, just to pick out 1 of the 2 areas you called out, David, is, of course, within there, you have a substantial amount of D-SNP population, right? So that particular part of the business helps us do a much better job of looking -- giving a much better end-to-end wraparound care for complex folks often found in the D-SNP population. And of course, they represent a different type of revenue profile compared to more of a community patient. So I just make that point.

現在家庭平台中的一個部分，只是從你提到的 2 個區域中挑選出 1 個，大衛，當然，在那裡，你有大量的 D-SNP 人口，對嗎？因此，該業務的特定部分幫助我們在尋找方面做得更好——為 D-SNP 人群中常見的複雜人群提供更好的端到端環繞式護理。當然，與更多的社區患者相比，它們代表了不同類型的收入狀況。所以我只是強調這一點。

So within the home piece, it kind of a derivative phenomenon that home creates a capability, which allows us to serve D-SNP folks better. That, of course, is going to be an accelerator to the metric you were focused on.

因此，在家庭作品中，這是一種衍生現象，家庭創造了一種能力，使我們能夠更好地為 D-SNP 人服務。當然，這將加速您所關注的指標。

And maybe ask Wyatt to go a little deeper though, around how you're bringing behavioral along as well as home please?

也許請懷亞特更深入地了解一下，請問您如何將行為和家庭一起帶入？

Yes. Well, thank you, David, for the question. And it's very timely. We view home health as one of the new frontiers of providing value-based health care because of the convenience it provides and the ability to access people, like dual special needs patients that often have very difficult leaving their home to get care.

是的。好吧，大衛，謝謝你提出這個問題。而且非常及時。我們將家庭健康視為提供基於價值的醫療保健的新領域之一，因為它提供了便利，並且能夠接觸到人們，例如雙重特殊需求的患者，他們往往很難離開家去接受治療。

So you will see us both developing if you will, the platform of home care increasingly in a comprehensive fashion, as well as integrating home care with our clinic-based care model. So it really creates two growth vehicles for us, if that makes sense. And similarly, with behavioral, as we've seen during the pandemic, the need for behavioral care is immense in the U.S. market. And our ability to embed behavioral health care services within our primary care and value-based care offerings has been differentiated and will continue to grow, as well as our utilization of virtual behavioral care solutions in both the home and clinic environments.

所以你會看到我們都在發展，如果你願意的話，家庭護理平台越來越全面，以及將家庭護理與我們基於診所的護理模式相結合。因此，如果有意義的話，它真的為我們創造了兩種增長工具。同樣，正如我們在大流行期間所看到的那樣，在行為方面，美國市場對行為護理的需求是巨大的。我們將行為保健服務嵌入我們的初級保健和基於價值的保健產品的能力已經與眾不同並將繼續增長，以及我們在家庭和診所環境中對虛擬行為保健解決方案的利用。

And so we're pretty excited about how this is coming together, and we're creating a differentiated offering that helps accelerate value-based care growth and provide that comprehensive care that people made.

因此，我們對這一切如何結合在一起感到非常興奮，我們正在創造一種差異化的產品，幫助加速基於價值的護理增長，並提供人們所做的全面護理。

The next question comes from the line of Gary Taylor with Cowen.

下一個問題來自 Gary Taylor 和 Cowen 的對話。

Just looking for a couple of numbers. One, just going back to respiratory. Our recollection was maybe 4Q for you guys was about 30 basis points of MLR from respiratory. I know Brian said not meaningfully higher. So I'm assuming that means there is another 15 or 20 bps or something from respiratory this quarter?

只是在尋找幾個數字。一，只是回到呼吸。我們的回憶可能是你們的第 4 季度來自呼吸的 MLR 大約 30 個基點。我知道布賴恩說的更高沒有意義。所以我假設這意味著本季度還有 15 或 20 個基點或來自呼吸的東西？

And then just secondly, on the investment gain, about $400 million above the Street, about a couple of hundred million above the '23 guidance run rate. So just wondering, was there a realized gain in that quarter that's kind of above recurring or how we should think about that number?

其次，在投資收益方面，比華爾街高出約 4 億美元，比 23 年的指導運行率高出約兩億美元。所以只是想知道，那個季度是否有高於經常性的實際收益，或者我們應該如何考慮這個數字？

Let me ask John Rex to respond.

讓我請約翰雷克斯回應。

Gary, go back in order here. So just in terms of be very similar with Brian Thompson's commentary in terms of what we were seeing in the quarter and I think forward. So those -- that incidence was modestly elevated in the 4Q, but I'd call it modestly elevated. But very much in line with what we would have expected. And when we were in front of you back at the end of November in terms of flu and respiratory.

加里，按順序回去。因此，就我們在本季度看到的情況而言，就與 Brian Thompson 的評論非常相似而言，我認為是未來。所以那些 - 第四季度的發病率略有升高，但我稱之為適度升高。但非常符合我們的預期。當我們在 11 月底就流感和呼吸道問題回到你們面前時。

Let's put those two together in terms of just combining that whole view. So elevated, when you take it into materiality in terms of the $50 billion of medical costs in the quarter, I wouldn't call it immensely material, though, in that element. But very, very consistent.

讓我們將這兩者放在一起，將整個視圖結合起來。如此之高，當你根據本季度 500 億美元的醫療費用將其視為實質性時，我不會稱其為非常實質性的，儘管如此。但是非常非常一致。

In terms of investment income, probably wouldn't be very similar to what we reported 4Q a year ago in terms of the absolute level of investment income in there. I wouldn't -- just kind of like last year, probably wouldn't use that as my run rate stepping out into next year though. So we're still comfortable with how we established and guided for 2023 from that perspective also. So very consistent with that 4Q of last year, too.

就投資收益而言，就投資收益的絕對水平而言，可能不會與我們一年前報告的第四季度非常相似。我不會——就像去年一樣，可能不會用它作為我進入明年的運行率。因此，我們仍然對從這個角度建立和指導 2023 年的方式感到滿意。與去年的第四季度非常一致，也是。

The next question comes from the line of Scott Fidel with Stephens.

下一個問題來自 Scott Fidel 和 Stephens 的對話。

Just interested if you could summarize your key M&A priorities for 2023, and whether there's any sort of shift at all in sort of the key trends that we've seen over the last few years, which have been a big focus on adding the clinical capabilities and the scale at both OptumHealth and OptumInsight. Should we think about that continuing to be the core area of focus or any other additional elements that are worth considering?

您是否可以總結一下 2023 年的主要併購優先事項，以及我們在過去幾年中看到的主要趨勢是否有任何轉變，這些趨勢一直非常注重增加臨床能力以及 OptumHealth 和 OptumInsight 的規模。我們是否應該考慮繼續將其作為核心關注領域或任何其他值得考慮的額外因素？

Thanks so much, Scott. Before I ask John Rex to make a couple of comments on this, I'll maybe just make a few introductory notions.

非常感謝，斯科特。在我請 John Rex 就此發表一些評論之前，我可能只是提出一些介紹性的概念。

I wouldn't go into a ton of detail about where we're looking, but I would continue to say we fully anticipate continuing to deploy our capital effectively into the marketplace. You know that a hallmark of this company has been its ability to effectively and efficiently utilizes capital to supplement its organic growth, and that's been a big part of the success of the organization.

我不會詳細說明我們正在尋找的地方，但我會繼續說我們完全期望繼續有效地將我們的資本部署到市場中。你知道這家公司的一個標誌是它能夠有效和高效地利用資本來補充其有機增長，這是該組織成功的重要組成部分。

We'll continue to do that. We have a substantial number of transactions in process as we speak. As you well know, we're obviously in the process now of bringing to life the Change, OptumInsight integration, which is super important for us.

我們將繼續這樣做。就在我們說話的時候，我們有大量的交易正在進行中。如您所知，我們顯然正在實現 Change、OptumInsight 集成，這對我們來說非常重要。

As we look forward, it's a very interesting marketplace. I mean I would say that John will probably confirm this, I think what we see the pipeline of opportunities we see is probably bigger, deeper, more diverse than we've ever seen. That's been a trend that kind of picked up probably early last year, certainly continued. We'd expect to see this year to be a pretty interesting year for us.

正如我們所期待的，這是一個非常有趣的市場。我的意思是我會說約翰可能會證實這一點，我認為我們所看到的機會管道可能比我們見過的更大、更深、更多樣化。這種趨勢可能在去年年初開始出現，而且肯定會持續下去。我們希望看到今年對我們來說是非常有趣的一年。

And it's -- you know our five growth pillars. You wouldn't be at all surprised to expect us to obviously align our M&A capital investment around our growth pillars. Beyond that, I'm not sure it would be necessarily wise for us to go too much more detail. But certainly, John, I'd love you to give a bit more perspective on how you're seeing the landscape and the environment.

它是——你知道我們的五個增長支柱。期望我們明顯地圍繞我們的增長支柱調整我們的併購資本投資，您一點也不會感到驚訝。除此之外，我不確定對我們來說過多的細節是否一定是明智的。但可以肯定的是，約翰，我希望你能就你如何看待景觀和環境給出更多的觀點。

Absolutely. Scott, yes, so I'd start with just echoing what Andrew mentioned there, the way we approach this very much aligned with our five growth pillars and how we evaluate, how we look for opportunities, I should say, and where we think we should be pursuing investments and relationships.

絕對地。斯科特，是的，所以我首先要回應安德魯在那裡提到的內容，我們處理這個問題的方式與我們的五個增長支柱非常一致，我們如何評估，我們如何尋找機會，我應該說，以及我們認為我們在哪裡應該追求投資和關係。

I'd point out that these are certainly very long-lived in terms of the investments that we make, in terms of relational investments we make, in terms of understanding markets, particularly as we've heard us talk about before within the care delivery businesses and such as value-based care that these are on.

我要指出的是，就我們所做的投資而言，就我們所做的關係投資而言，就了解市場而言，特別是正如我們之前聽到我們在提供護理方面所談論的那樣，這些肯定是非常長期的業務，例如基於價值的護理。

Most of the markets that we want to address are aren't established the way that we would like them to be established, so it's very greenfield in terms of our approach to M&A as we look at marketplaces and bringing together the capabilities that we would pursue.

我們想要解決的大多數市場都沒有按照我們希望的方式建立，因此就我們的併購方法而言，這是非常新的領域，因為我們著眼於市場並將我們追求的能力結合在一起.

The environment itself that echo what Andrew previewed there, certainly a strong environment in terms of opportunity sets that we are seeing in the broad marketplace, in terms of the types of capabilities that are there, how they might fit within this enterprise and the potential.

環境本身與安德魯在那裡的預覽相呼應，就我們在廣闊市場中看到的機會集而言，當然是一個強大的環境，就那裡的能力類型而言，它們如何適應這個企業和潛力。

I think you would expect us to see like where we've been focused. Certainly, over the last number of years, you've seen us do a lot of development as it relates to components of value-based care. And you know we define that very broadly now in terms of how we think about capabilities within value-based care to bring in new capabilities also and across all the other elements. But overall characterize the environment as strong and the opportunities is among some of the most interesting, I think, that we have seen as a company.

我想你會希望我們看到我們一直關注的地方。當然，在過去的幾年中，您已經看到我們在基於價值的護理的組成部分方面進行了大量開發。你知道我們現在非常廣泛地定義了我們如何考慮基於價值的護理中的能力，以引入新的能力以及所有其他元素。但總的來說，環境是強大的，機會是我們作為一家公司所看到的最有趣的機會之一。

Yes. I'd agree with that completely, John. And I certainly, over the next several years, see this part of the agenda being a key part of our continued support of our long-term growth goals, and you should expect to see us be -- continue to be active in the space.

是的。我完全同意這一點，約翰。當然，在接下來的幾年裡，我認為這部分議程是我們繼續支持我們的長期增長目標的關鍵部分，你應該期待看到我們——繼續活躍在這個領域。

We'll take our next question from the line of Stephen Baxter with Wells Fargo.

我們將從富國銀行的斯蒂芬·巴克斯特 (Stephen Baxter) 那裡接聽下一個問題。

I wanted to follow up on the home component of the value-based care opportunity. Wondering if you'd say potentially you're further along in the penetration with the home model inside the UHC book than other payers? Any color there would be great.

我想跟進基於價值的護理機會的家庭部分。想知道您是否會說您可能比其他付款人更深入地了解 UHC 賬簿中的家庭模式？任何顏色都會很棒。

And then, any sense of how the 4 million fully accountable lives break out by clinic versus home model with the primary care setting, or also how the 750,000 member growth breaks out for 2023 would be great.

然後，任何關於 400 萬完全負責任的生活如何通過初級保健環境的診所與家庭模式爆發的感覺，或者 750,000 名成員的增長如何在 2023 年爆發的任何感覺都會很棒。

Stephen, thanks so much for the question. So first off, let me just reiterate how important we see the development of the home model, the home care platform, and we've seen that grow very substantially over the last couple of years in particular.

斯蒂芬，非常感謝你提出這個問題。所以首先，讓我重申一下我們看到家庭模式、家庭護理平台的發展是多麼重要，我們已經看到它在過去幾年中取得了非常顯著的增長。

Super important though, to recognize that it kind of -- so of course, sometimes folks can be essentially managed within just the home environment or the home care platform, and that certainly happens sometimes. But of course, what always happens, what very often happens is the clinic environment, the home environment are connected together, which is really what we're building here.

不過，認識到這一點非常重要——所以當然，有時人們基本上可以在家庭環境或家庭護理平台內進行管理，而且這種情況有時確實會發生。但是，當然，總是發生的事情，經常發生的是診所環境，家庭環境是連接在一起的，這就是我們在這裡建設的。

So it's not super instructive, I think, to think about folks who are just kind of clinic nominated or home nominated. That can happen. But not really, I think, necessarily the right way to look at it. I wouldn't look at it that way. I'd see -- I really think about it the way we've built the home capabilities as a substantial extension of what we're able to do in the clinical space.

因此，我認為，考慮那些只是診所提名或家庭提名的人並沒有太大的指導意義。那有可能發生。但我認為，不一定是正確的看待它的方式。我不會那樣看的。我會看到 - 我真的認為我們建立家庭能力的方式是我們在臨床領域能夠做的事情的實質性擴展。

And it speaks to the reality of care. People -- a lot -- not everything happens in the 20 minutes you're in the clinic, right? A ton of things happen when you're at home, and making sure that we've got care capabilities there, especially for folks who find it difficult to get out of the home or for whatever reason, find it difficult to engage with the system. That's a super important part of the environment.

它說明了護理的現實。人們——很多——不是所有事情都發生在你在診所的 20 分鐘內，對吧？當你在家時會發生很多事情，並確保我們在那裡有護理能力，特別是對於那些發現難以出門或出於任何原因難以與系統互動的人.這是環境的一個非常重要的部分。

What I'd say is that, that is resonating super strongly, not just with UnitedHealthcare, but with other payers as well. And there's no doubt that this side of the agenda has caught the imagination of other payers, and we're delighted to see the continued extension of the multi-payer dynamic of OptumHealth and Optum more generally. And this is one of the drivers of that.

我要說的是，這不僅與 UnitedHealthcare 產生了強烈的共鳴，也與其他付款人產生了共鳴。毫無疑問，議程的這一方面已經引起了其他付款人的想像，我們很高興看到 OptumHealth 和 Optum 的多付款人動態在更廣泛的範圍內繼續擴展。這是其中的驅動因素之一。

In fact, during Q4, our external growth rate -- revenue growth rate was analogous to our internal growth, or i.e. Optum was growing just as quickly with non-UHC payers as it was with UHC. And that's a super important signal for the strength of the company. So important area, you'll continue to hear more about home as we go forward. But I would look at it more as a strengthening as a whole rather than a kind of separate stream in which we would be thinking about it that way. Hopefully, that helps a little bit, Stephen.

事實上，在第四季度，我們的外部增長率——收入增長率與我們的內部增長率相似，即 Optum 與非 UHC 付款人的增長速度與 UHC 一樣快。這是公司實力的一個非常重要的信號。如此重要的區域，隨著我們的前進，您將繼續聽到更多關於家的信息。但我會把它更多地看作是一個整體的加強，而不是我們會以這種方式考慮的一種單獨的流。希望這對您有所幫助，Stephen。

Our next question comes from the line of Nathan Rich with Goldman Sachs.

我們的下一個問題來自 Nathan Rich 與高盛的合作。

The advance rate notice for '24 will be out in the coming weeks. It's clearly been well noted that the past few years have kind of been above the historical trend, and know that at some point we could see some moderation. I'd just be curious what your expectations are around that and how you view its relative importance in the context of your overall outlook for the MA market.

'24 的預付款通知將在未來幾週內發布。人們清楚地註意到，過去幾年有點高於歷史趨勢，並且知道在某個時候我們可以看到一些緩和。我只是想知道您對此有何期望，以及您如何看待它在 MA 市場整體前景背景下的相對重要性。

Nathan, yes, as you rightly say, obviously, we're getting close to when we would likely hear the rate notification. And obviously, we don't know what that's going to be. I think where we would sit is -- we think MA is an incredibly important program for seniors. I think it's been demonstrated now repeatedly the value that delivers to the individuals, the value it delivers to society. And of course, the way in which seniors are essentially voting to become part of this program just signals how effective it is.

內森，是的，正如你所說的那樣，顯然，我們很可能會聽到利率通知。顯然，我們不知道那會是什麼。我認為我們會坐的地方是——我們認為 MA 對老年人來說是一個非常重要的項目。我認為現在已經反复證明了它為個人帶來的價值，為社會帶來的價值。當然，老年人實質上投票加入該計劃的方式恰恰表明了該計劃的有效性。

We believe that one of the key elements of that effectiveness that we certainly focused on is our ability to deliver stable benefits year in, year out. So I mean bottom line for us is we hope year in, year out, that the rate notice essentially facilitates that and it allows us to continue to deliver that stability. And we look forward to seeing what that will be, and we'll work with that once it's communicated to us. Not much more we can say on that, to be honest, until we obviously get the rate notice. So thanks for the question.

我們相信，我們當然關注的有效性的關鍵要素之一是我們年復一年地提供穩定收益的能力。所以我的意思是我們的底線是我們希望年復一年，利率通知基本上促進了這一點，它使我們能夠繼續提供這種穩定性。我們期待看到那會是什麼，一旦它傳達給我們，我們就會著手處理。老實說，在我們明顯收到費率通知之前，我們對此無話可說。所以謝謝你的問題。

Next question comes from the line of Erin Wright with Morgan Stanley.

下一個問題來自 Erin Wright 與摩根士丹利的對話。

On OptumRx, your near-term OptumRx targets do imply passing on the savings from biosimilars, but can you detail some of the other levers you have here to drive the strength you're anticipating? How should we rank those drivers across pharmacy services, versus biosimilar benefits over the next, let's say, 12 to 18 months?

在 OptumRx 上，您的近期 OptumRx 目標確實意味著傳遞生物仿製藥的節省，但您能否詳細說明您在這裡擁有的其他一些槓桿來推動您預期的實力？我們應該如何在藥房服務中對這些驅動因素進行排名，而不是在接下來的 12 到 18 個月內對生物仿製藥的好處進行排名？

Great question, Erin. Before I ask Heather to give you a few more details, I think we're super pleased with the progress we've made, particularly on the biosimilar innovation that's coming this year in the next few weeks.

好問題，艾琳。在我請 Heather 向您提供更多細節之前，我認為我們對我們取得的進展非常滿意，尤其是在未來幾週內今年即將推出的生物仿製藥創新方面。

And the work that's been done within OptumRx to deliver a contracting strategy, which ensures that everybody who wants to use a HUMIRA molecule, whether that's the brand or whether it's a biosimilar, gets access to lower cost right out of the gate has been a super important innovation in terms of our contracting strategy.

OptumRx 為提供合同策略所做的工作，確保每個想要使用 HUMIRA 分子的人，無論是品牌還是生物仿製藥，都能立即獲得更低的成本，這是一個超級在我們的承包策略方面的重要創新。

So without folks having to be shifted from drugs or dislocated in the marketplace, we found a way to bring lower cost to everybody in that environment. And I really want to give credit to Heather and her team for the work that she's done to lead on all of that. As you rightly say, we're passing those benefits directly back to the payers and the folks themselves.

因此，在人們不必從藥物中轉移或在市場上流離失所的情況下，我們找到了一種方法，可以為該環境中的每個人帶來更低的成本。我真的很想感謝 Heather 和她的團隊為領導所有這些所做的工作。正如您所說的那樣，我們正在將這些好處直接回饋給付款人和人們自己。

And with that, Heather, why don't you pick up and describe what else is driving the Rx growth this year.

有了這個，Heather，你為什麼不拿起並描述今年推動 Rx 增長的其他因素。

Sure. So first, let me give you just another sense of maybe next phase when you think biosimilar and then let's hit the strength of the earnings for us in '23.

當然。所以首先，當你想到生物仿製藥時，讓我給你另一種可能是下一階段的感覺，然後讓我們在 23 年為我們帶來收益。

So as Andrew said, we intended to set up the biosimilar strategy to allow the most value to pull through in year 1 that we can to clients, and we're proud of that. But this is a multiyear strategy, and the markets dynamic will continue to watch it. What's important here is creating a marketplace for competition of the originator with a biosimilar in the specific unique environment with HUMIRA and so many manufacturers coming to market.

正如安德魯所說，我們打算制定生物仿製藥戰略，以便在第一年為客戶帶來最大價值，我們為此感到自豪。但這是一項多年戰略，市場動態將繼續關注。這裡重要的是在 HUMIRA 和眾多製造商進入市場的特定獨特環境中為原研藥與生物仿製藥的競爭創造一個市場。

But over a period of maybe, say, the next 18 months with different attributes, our strategy allows them to compete based on their clinical criteria and product attributes, how the manufacturer supports the product and then, obviously, the economics and the pricing. So that's the goal. We'll see that play out over the years. And the goal was to provide choice, not a lot of disruption and be able to extract value without restriction or exclusion. So we'll watch that play out.

但是，在未來 18 個月的不同屬性下，我們的策略允許他們根據臨床標準和產品屬性、製造商如何支持產品進行競爭，然後顯然是經濟性和定價。這就是目標。多年來，我們會看到這一點。目標是提供選擇，而不是大量的破壞，並且能夠在不受限製或排斥的情況下提取價值。因此，我們將拭目以待。

But when I think about the earnings and the strength of the position we're in or what we hoped to be by the end of '23, think of it as some of the stories you've heard us building and what we've been talking about for the last couple of years, and that's strengthen our pharmacy services.

但是，當我考慮到我們所處的收入和實力，或者我們希望到 23 年底達到的目標時，請將其視為您聽過我們建立的一些故事以及我們一直在做的事情談論過去幾年，這加強了我們的藥房服務。

I'll give you an example. Yes, the community pharmacies are growing. They're expanding quickly. But our specialty pharmacies, our frontier therapies where we serve some of the more rare disease and orphan drugs are growing as quickly. And in many of those are getting scale. So for instance, the community pharmacies are scaling to the point where we're allowed -- we have central fill supporting because we have the volume of scripts going to those community pharmacies.

我給你舉個例子。是的，社區藥房正在增長。他們正在迅速擴張。但是我們的專業藥房，我們為一些更罕見的疾病和孤兒藥提供服務的前沿療法也在迅速增長。其中許多正在擴大規模。因此，例如，社區藥房正在擴展到我們被允許的程度——我們有中央填充支持，因為我們有大量的腳本進入這些社區藥房。

And we're getting better with negotiations, we're able to negotiate harder on some of our procurement in those businesses. But also look at the PBM. You heard strong selling season again. We hope to have another strong selling season. The pricing is dynamic. We moved quickly with our pricing, with our product attributes. Our product adoption is up 40% year-over-year in our PBM products.

我們在談判方面做得越來越好，我們能夠就這些業務的一些採購進行更嚴格的談判。但也要看看 PBM。你又聽到了強勁的銷售季節。我們希望有另一個強勁的銷售季節。定價是動態的。我們在定價和產品屬性方面迅速採取行動。我們的 PBM 產品採用率同比增長 40%。

And then we've got some return on some of the investments we made in the last year or two, Optum Frontier Therapies, our partnership with RVO. So that, I think, is when you look towards the next year, focus on those areas and look for us to drive earnings growth in those particular areas.

然後我們在過去一兩年的一些投資中獲得了一些回報，Optum Frontier Therapies，我們與 RVO 的合作夥伴關係。所以，我認為，當你展望明年時，關注這些領域，並期待我們推動這些特定領域的盈利增長。

Heather, well said. And again, you've seen a real transformation of the OptumRx platform. If you look at 5 years ago, about 1/3 of the revenues in that business came from non-PBM pharmacy services. Now it's at half. As a tremendous shift on the business' scale, really is significant.

希瑟，說得好。再一次，您已經看到了 OptumRx 平台的真正轉變。回顧 5 年前，該業務約 1/3 的收入來自非 PBM 藥房服務。現在是一半。作為業務規模的巨大轉變，確實意義重大。

And I'd say one of the key themes, which is driving a lot of that is a relentless shift was the consumer in the way in which that business is orientated and building its product. Real focus on delivering the best possible deal for consumers, making sure they get the lowest net cost. And then you'll see through, as Heather just mentioned, partnerships like RVO Health, you'll see us to continue to innovate the way in which we engage with consumers to make that much more modern, much more as U.S. consumers should get and should expect.

我想說的一個關鍵主題是消費者在企業定位和構建產品方面的不斷轉變，這在很大程度上推動了這一轉變。真正專注於為消費者提供最好的交易，確保他們獲得最低的淨成本。然後你會看到，正如 Heather 剛才提到的，像 RVO Health 這樣的合作夥伴關係，你會看到我們繼續創新我們與消費者互動的方式，使它更現代，更像美國消費者應該得到的和應該期待。

The next question comes from the line of Steven Valiquette with Barclays.

下一個問題來自巴克萊銀行的 Steven Valiquette。

So regarding the acuity level of the elevated flu and respiratory costs in the fourth quarter, is there any sense for just how much of the elevated cost for, hate to call it, triple-demic, let's just call it that, I guess, for the quarter, how much of that was related to the hospital inpatient setting in particular?

因此，關於第四季度流感和呼吸系統成本上升的嚴重程度，有多少成本上升有任何意義，討厭稱之為三重流行病，我想，對於這個季度，其中有多少與醫院住院環境有關？

And then from your data, was there any sense that there may have been any slightly lower elective procedures or traditional non-COVID and non-flu-related care in the fourth quarter in light of the elevated fluid and respiratory cost and utilization?

然後從你的數據來看，鑑於液體和呼吸成本和利用率的提高，第四季度的選擇性手術或傳統的非 COVID 和非流感相關護理是否有任何感覺？

Steven, thanks so much for asking that. Listen, I think -- listen, of course, it was Q4. There was a bit more flu and (inaudible). But really, I'd say immaterial in the scheme, in the grand -- in the way I'd say in the grand scheme of the health care costs of the U.S., almost not noticeable. I mean, almost nothing to see.

史蒂文，非常感謝你提出這個問題。聽著，我想——聽著，當然，這是第四季度。有一點流感和（聽不清）。但實際上，我會說在這個計劃中並不重要，在宏偉的計劃中——就像我在美國醫療保健成本的宏偉計劃中所說的那樣，幾乎不引人注意。我的意思是，幾乎沒有什麼可看的。

And I think I wouldn't -- much as I think there was a lot of anticipation around what could be coming in this notion of different viruses all come, somehow creating this, I think you said triple pandemic, really not there. And the little elevation we saw was somewhat within the ranges of what you typically would expect in a normal Q4 early flu season, which, as Brian mentioned earlier, looks like it's -- we've seen the last five weeks coming down. That's pretty much it, yes.

而且我認為我不會——儘管我認為人們對這種不同病毒的概念可能會發生什麼有很多期待，以某種方式創造了這種情況，我想你說的是三重大流行病，真的不存在。我們看到的小幅上昇在某種程度上處於正常的第 4 季度早期流感季節通常預期的範圍內，正如 Brian 之前提到的那樣，看起來就像是——我們已經看到過去五周有所下降。差不多就是這樣，是的。

So I really wouldn't guide you to characterize this as a big deal within the overall mix of the total health care costs that we're dealing with. It really isn't.

所以我真的不會引導你將這描述為我們正在處理的總醫療保健成本的整體組合中的一個大問題。真的不是。

Our next question comes from the line of Kevin Fischbeck with Bank of America.

我們的下一個問題來自美國銀行的 Kevin Fischbeck。

Just wondering if you could talk a little bit about your expectations for redeterminations that you talked a bit about, how you see that as a membership opportunity, but some more focus on the MLR implications. I guess, if you think about the potentially significant change in the membership of the Medicaid program and the implications for the risk pool there, how are you thinking about potential margin compression and how quickly rates might be able to reflect that, if it does play out?

只是想知道您是否可以談談您對剛才談到的重新確定的期望，您如何將其視為會員機會，但更多地關注 MLR 的影響。我想，如果您考慮醫療補助計劃成員的潛在重大變化以及對那里風險池的影響，您如何考慮潛在的利潤率壓縮以及利率可能多快能夠反映出這一點，如果它確實發揮作用出去？

Kevin, thanks so much. I'm going to ask Tim Spilker, who looks after our Medicaid business to talk to that. And maybe Tim, as you do that, you could also maybe just allude a little bit on the degree of visibility you have for your book of business as you roll into 2023. That might also be helpful.

凱文，非常感謝。我要請負責我們醫療補助業務的蒂姆·斯皮爾克 (Tim Spilker) 談談這個問題。也許蒂姆，當你這樣做的時候，你也可以稍微提及一下你在進入 2023 年時對你的業務簿的可見度。這也可能會有所幫助。

Yes, absolutely. Thanks, Kevin, for the question. So certainly, a number of factors in play as we look ahead, certainly, the change in membership that we'll see as redeterminations resume. And then also acuity utilization, all of the factors really as things return to normal.

是的，一點沒錯。謝謝，凱文，提出這個問題。因此，當然，在我們展望未來時，有許多因素在起作用，當然，隨著重新確定的恢復，我們將看到成員的變化。然後是敏銳度的使用，所有的因素都隨著事情恢復正常。

So at this point, from where we look, we've got visibility at around 75% of our revenue for the year. And states, as they set that revenue, have taken all of those factors into account when setting their rates, and that revenue is in line with our expectations and consistent with the outlook that we shared in November. So we're appreciative of the balanced rational view that our states have taken as they've looked ahead, knowing that we've got many factors coming forward.

所以在這一點上，從我們的角度來看，我們今年收入的可見度約為 75%。各州在設定收入時，在設定費率時考慮了所有這些因素，收入符合我們的預期，也與我們在 11 月份分享的展望一致。因此，我們很欣賞我們各州在展望未來時所採取的平衡理性觀點，知道我們有很多因素在向前發展。

Maybe one last thing, just as we look ahead, the redetermination process will be extended. We know it will take 10 to 12 months depending on the state. And that will give us opportunities to provide data, feedback and insights to our customers, work with them to adjust as things develop. So really no changes from what we communicated in November and with a little bit more certainty now in terms of our revenue.

也許最後一件事，就像我們展望未來一樣，重新確定過程將會延長。我們知道這將需要 10 到 12 個月，具體取決於州。這將使我們有機會向我們的客戶提供數據、反饋和見解，並與他們一起隨著事情的發展進行調整。因此，與我們 11 月份溝通的內容相比，確實沒有任何變化，而且現在我們的收入方面更加確定。

Right. Thank you, Tim. I appreciate that, Kevin. Thanks for the question. Operator, we just have time for one last question, if we could go ahead, please.

正確的。謝謝你，蒂姆。我很感激，凱文。謝謝你的問題。接線員，我們只有時間回答最後一個問題，請繼續。

Our next question comes from the line of George Hill with Deutsche Bank.

我們的下一個問題來自喬治希爾與德意志銀行的對話。

I wanted to come back to the specialty drug and pharmacy initiatives. And I guess, can you talk about what percent of these drugs are going through the mail channel versus the retail channel now? Kind of how do you expect the share to shift away from retail to mail?

我想回到專業藥物和藥房計劃。我想，你能談談這些藥物現在通過郵件渠道和零售渠道的百分比是多少嗎？您如何看待份額從零售轉移到郵寄？

And then I'd tack on kind of how should we think about what the earnings power of the shifts can look like as you capture more of the specialty drugs in owned channels versus third-party channels?

然後我會強調我們應該如何考慮當你在自有渠道和第三方渠道中獲得更多的專業藥物時，這種轉變的盈利能力會是什麼樣子？

George, thanks so much for the question. Let me hand straight to Heather, please.

喬治，非常感謝你提出這個問題。請讓我直接交給 Heather。

Sure, great question. As we continue to see the pipeline in specialty drugs, I hope you can feel the urgency around us driving. And you can see it in our growth, but also in our patient care and our clinical program. So our Optum Frontier Therapies, I think, is actually a good model. I know it serves only sort of rare disease and orphan drug, but we talked about the investor conference.

當然，很好的問題。隨著我們繼續看到特殊藥物的管道，我希望你能感受到我們開車時的緊迫感。您可以在我們的成長中看到它，也可以在我們的患者護理和臨床計劃中看到它。所以我認為我們的 Optum Frontier Therapies 實際上是一個很好的模型。我知道它只服務於某種罕見病和孤兒藥，但我們談到了投資者會議。

It's got a comprehensive clinical model wrapping around it that supports not just the patients, the caregivers, the prescriber, the family, but also helps pharma to deliver the best service in those drugs. That is the model we're using to inform how we serve clients and how we serve patients in our specialty business as well.

它擁有一個全面的臨床模型，不僅支持患者、護理人員、開處方者、家庭，還幫助製藥公司提供最好的藥物服務。這就是我們用來告知我們如何為客戶服務以及我們如何在我們的專業業務中為患者服務的模型。

So think about that holistic patient advocacy, patient support, caregiver support, prescriber support, all while investing in automation. So even in our pharmacy, in our specialty pharmacy today, our automation is up. We're actually seeing over 30% higher self-service in the specialty pharmacy. That's not just mail and maintenance, that's specialty. So we're investing in the automation.

因此，在投資自動化的同時，考慮全面的患者宣傳、患者支持、護理人員支持、開處方者支持。因此，即使在我們的藥房，在我們今天的專業藥房，我們的自動化也在提高。我們實際上看到專業藥房的自助服務提高了 30% 以上。這不僅僅是郵件和維護，這是專業。所以我們正在投資自動化。

For those that have simple transactions and want to interact with us with these, but those that need more comprehensive care with complex conditions that need the value of our 24/7 pharmacist support, our team is there to help them. So we will always continue to work with our retail partners. We are -- we've got a very strong network of that. But we want to be able to serve our consumers and our clients with best-in-class specialty service.

對於那些進行簡單交易並希望與我們互動的人，但那些需要更全面的護理和復雜條件的人需要我們 24/7 藥劑師支持的價值，我們的團隊隨時為他們提供幫助。因此，我們將始終繼續與我們的零售合作夥伴合作。我們 - 我們有一個非常強大的網絡。但我們希望能夠為我們的消費者和客戶提供一流的專業服務。

Thanks, Heather. And George, thank you for the question. Listen, we come to the end of the call, I hope very much you leave the call with a sense of our optimism and focus on continued growth for the year ahead.

謝謝，希瑟。喬治，謝謝你提出這個問題。聽著，電話會議結束了，我非常希望您能帶著我們的樂觀情緒結束電話會議，並專注於來年的持續增長。

We remain intent on expanding our ability to help improve healthcare at the system and individual levels and executing with excellence for all those we serve. We look forward to sharing our progress on this journey with you again in April. And in the meantime, thank you so much for your attention this morning. We appreciate it.

我們仍然致力於擴大我們的能力，以幫助改善系統和個人層面的醫療保健，並為我們服務的所有人提供卓越的服務。我們期待在四月份再次與您分享我們在這一旅程中取得的進展。同時，非常感謝您今天早上的關注。我們很感激。

That concludes today's conference. Thank you for your participation, and you may now disconnect.

今天的會議到此結束。感謝您的參與，您現在可以斷開連接。