聯合健康 (UNH) 2023 Q2 法說會逐字稿

Good morning, and welcome to the UnitedHealth Group Second Quarter 2023 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，歡迎參加聯合健康集團 2023 年第二季度收益電話會議。聯合健康集團準備好發言後將舉行問答環節。提醒一下，此通話正在錄音。

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 cautionaries included in our current and periodic filings.

以下是一些重要的介紹性信息。本次電話會議包含美國聯邦證券法規定的前瞻性陳述。這些陳述存在風險和不確定性，可能導致實際結果與歷史經驗或當前預期存在重大差異。對一些風險和不確定性的描述可以在我們向美國證券交易委員會提交的報告中找到，包括我們當前和定期提交的文件中包含的警告。

This call 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 July 14, 2023, which may be accessed from the Investor Relations page of the company's website.

此次電話會議還將參考非公認會計原則金額。非 GAAP 與 GAAP 金額的調節表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早上發布的收益報告和日期為 2023 年 7 月 14 日的 8-K 表格中，您可以從公司網站的投資者關係頁面訪問該表格。

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

我現在將會議交給聯合健康集團首席執行官安德魯·威蒂 (Andrew Witty)。

Thank you, and good morning, and thank you all for joining us. As we discussed a number of weeks ago, during the quarter, we saw a somewhat higher than usual range of movement in certain areas of care activity. As you'd expect, this inevitably impacted some elements of our business, but we overcame these dynamics with strength in other areas. Our second quarter performance reflects the capabilities, agility and dedication of our people as they responded to the changes. As a team, we're confident in our ability to robustly grow in this fluid health care environment.

謝謝大家，早上好，感謝大家加入我們。正如我們幾週前討論的那樣，在本季度，我們看到某些護理活動領域的變動幅度略高於平常。正如您所料，這不可避免地影響了我們業務的某些要素，但我們憑藉其他領域的優勢克服了這些動態。我們第二季度的業績反映了我們員工應對變化的能力、敏捷性和奉獻精神。作為一個團隊，我們對在這種流動的醫療保健環境中強勁發展的能力充滿信心。

Indeed, as I hope you saw in our release today, revenue growth in the quarter was strong and well balanced across our enterprise, increasing by more than $12 billion to nearly $93 billion.

事實上，正如我希望您在我們今天發布的新聞稿中看到的那樣，本季度的收入增長強勁且整個企業均衡發展，增長超過 120 億美元，達到近 930 億美元。

Let me provide a few highlights of our growth. First, the number of patients served by Optum Health under fully accountable value-based care arrangements grew by more than 900,000 over this time last year. Among the new patients we welcomed, a significant number have complex needs. These people have serious health challenges, limited economic resources and often living in communities where it can be difficult to access high-quality care. Our ability to support their needs is distinctive and a direct result of the investments we have made to provide coordinated and comprehensive medical, pharmacy and behavioral care, foundational capabilities that will help the patients we serve live healthier lives and drive growth far into the future.

讓我介紹一下我們成長的一些亮點。首先，Optum Health 在完全負責任的基於價值的護理安排下服務的患者數量比去年同期增長了 90 萬以上。在我們歡迎的新患者中，相當多的人有復雜的需求。這些人面臨嚴重的健康挑戰、經濟資源有限，而且往往生活在難以獲得高質量護理的社區。我們滿足他們需求的能力是獨特的，這是我們為提供協調和全面的醫療、藥學和行為護理而進行投資的直接結果，這些基礎能力將幫助我們服務的患者過上更健康的生活，並推動未來的增長。

Optum Rx and Optum Insight revenue grew double digits on expanded capabilities and products that are generating new sales and opportunities. UnitedHealthcare's growth was strong and diversified as well. Today, we're serving nearly 1.6 million more people in our commercial and public sector program offerings than we did last year. This durable growth, driven by our colleagues relentless focus on quality and execution, enabled us to achieve second quarter adjusted earnings per share of $6.14 and and to strengthen our full year outlook to between $24.70 to $25 per share. We know there is great interest in understanding the recent care activity I just mentioned. So I'll give you an overview of how we're seeing care progress and how we're responding.

由於功能和產品的擴展產生了新的銷售和機會，Optum Rx 和 Optum Insight 的收入實現了兩位數增長。聯合醫療保健的增長強勁且多元化。如今，我們在商業和公共部門計劃中所服務的人數比去年增加了近 160 萬人。在我們的同事對質量和執行的不懈關注的推動下，這種持久的增長使我們能夠實現第二季度調整後每股收益 6.14 美元，並將我們的全年前景提高到每股 24.70 美元至 25 美元。我們知道大家對了解我剛才提到的最近的護理活動非常感興趣。因此，我將向您概述我們如何看待護理進展以及我們如何應對。

I do want to underscore the most critical point first. Making high-quality care more affordable and accessible is at the core of our mission. Having more people obtaining the care they need is a positive trend for individuals and our health system and society. As we discussed several weeks ago, during the second quarter, we observed increased care patterns, notably in outpatient surgeries for seniors and especially with certain orthopedic procedures which may have been postponed. John will provide some additional detail on this later.

我確實想首先強調最關鍵的一點。讓高質量的護理變得更實惠、更容易獲得是我們使命的核心。讓更多的人獲得所需的護理對於個人、我們的衛生系統和社會來說是一個積極的趨勢。正如我們幾週前討論的那樣，在第二季度，我們觀察到護理模式有所增加，特別是老年人的門診手術，尤其是可能被推遲的某些骨科手術。約翰稍後將提供一些額外的細節。

As we look to 2024, we have developed compelling Medicare Advantage offerings. Our teams were of course thoughtful, both in our response to the CMS rate notice and in incorporating these care activity trends into our June benefit filings. Even in this challenging funding environment, we continue to prioritize the stability and affordability our members have come to rely on from UnitedHealthcare. We're confident that next year, we will once again grow at a pace exceeding that of the broader market.

展望 2024 年，我們開發了引人注目的 Medicare Advantage 產品。當然，我們的團隊在對 CMS 費率通知的回應以及將這些護理活動趨勢納入我們 6 月福利申報中方面都經過深思熟慮。即使在這種充滿挑戰的融資環境中，我們仍繼續優先考慮我們的會員所依賴的聯合醫療保健的穩定性和負擔能力。我們有信心明年我們將再次以超過大盤的速度增長。

While at a much lesser impact than senior outpatient care, we also are seeing increased care activity in behavioral. Over the past few years, behavioral care patterns have been accelerating as people increasingly feel comfortable seeking services. Just since last year, the percentage of people who are accessing behavioral care has increased by double digits. From our perspective, it's an encouraging sign that more people are seeking help, yet the ongoing shortage of qualified care providers has caused significant access challenges. To address the issue, Optum Health has expanded its network by tens of thousands of care professionals this year, and we are developing our benefit offerings, assuming demand for behavioral care services will continue to rise.

雖然其影響比老年門診護理要小得多，但我們也看到行為方面的護理活動有所增加。在過去的幾年裡，隨著人們越來越願意尋求服務，行為護理模式一直在加速發展。就在去年以來，接受行為護理的人數比例增加了兩位數。從我們的角度來看，這是一個令人鼓舞的跡象，越來越多的人正在尋求幫助，但合格的護理提供者的持續短缺造成了巨大的獲取挑戰。為了解決這個問題，Optum Health 今年擴大了其網絡，增加了數万名護理專業人員，並且我們正在開發我們的福利產品，假設對行為護理服務的需求將繼續增長。

Optum Health's value-based care models are continuing to deliver especially strong and measurable results for people, today, serving more than 4 million patients and dozens of payers. Optum Health and the patients and payers it serves share a common desire to seek improved health outcomes and experiences while ultimately lowering the cost of care. And we're pleased to see more evidence supporting the efficacy of value-based care.

如今，Optum Health 基於價值的護理模式繼續為人們帶來特別強勁且可衡量的結果，為超過 400 萬患者和數十名付款人提供服務。 Optum Health 及其服務的患者和付款人都有一個共同的願望，即尋求改善的健康結果和體驗，同時最終降低護理成本。我們很高興看到更多證據支持基於價值的護理的功效。

Last month, researchers at Yale Medicine, working in collaboration with Optum, published a peer-reviewed study about in-home visits, an important element in our value-based care approach. The study found patients who received our in-home preventative wellness assessments compared with those who hadn't made fewer emergency department visits and spent fewer nights in hospitals across 4 common conditions: depression, hypertension, coronary artery disease and type 2 diabetes. They also experienced reduced wait times for follow-up primary care.

上個月，耶魯大學醫學院的研究人員與 Optum 合作，發表了一項關於上門探訪的同行評審研究，這是我們基於價值的護理方法的一個重要組成部分。該研究發現，與那些沒有接受我們的家庭預防性健康評估的患者相比，沒有減少去急診室就診的次數，也減少了在醫院住院的次數，有四種常見疾病：抑鬱症、高血壓、冠狀動脈疾病和 2 型糖尿病。他們還減少了後續初級保健的等待時間。

Yale Medicine's research follows another peer-reviewed study published in [Journal] in December, which found Medicare Advantage patients in Optum's fully accountable care model showed significantly better health outcomes compared to people in Medicare fee-for-service. OptumHealth patients fared better on each of 8 key metrics, including hospital readmissions and emergency department visits. We see these results as compelling validation of the value-based care approach and signal more strongly its promise and potential as we expand these care models to many millions more patients in the years ahead.

耶魯大學醫學中心的研究是繼去年 12 月在《期刊》上發表的另一項同行評審研究之後進行的，該研究發現，與接受 Medicare 按服務收費的患者相比，採用 Optum 完全責任護理模式的 Medicare Advantage 患者的健康結果明顯更好。 OptumHealth 患者在 8 個關鍵指標中的每一項都表現更好，包括再入院和急診科就診。我們認為這些結果是對基於價值的護理方法的令人信服的驗證，並更強烈地表明了它的承諾和潛力，因為我們在未來幾年將這些護理模式擴展到數百萬更多的患者。

I'll now turn it over to UnitedHealth Group President and Chief Operating Officer, Dirk McMahon, to elaborate on how we're focusing on affordability, transparency and simplicity for the people we serve. Dirk?

現在，我將把它交給聯合健康集團總裁兼首席運營官德克·麥克馬洪 (Dirk McMahon)，詳細說明我們如何關注我們所服務的人們的負擔能力、透明度和簡單性。短劍？

Thanks, Andrew. Making high-quality care more affordable and more accessible is what we do. So it is really great to see people getting the care they need, especially as our teams are working to build more capacity and our benefit networks and care delivery resources to accommodate consumers' evolving needs. Affordability is vital. For far too many people, cost remains the most significant barrier to high-quality care. We are leaning in hard on behalf of consumers, employers and health plans to lower out-of-pocket costs and drive greater affordability throughout the system.

謝謝，安德魯。我們所做的就是讓高質量的護理變得更實惠、更容易獲得。因此，很高興看到人們獲得所需的護理，特別是我們的團隊正在努力建設更多的能力、我們的福利網絡和護理服務資源，以滿足消費者不斷變化的需求。負擔能力至關重要。對於太多人來說，成本仍然是高質量護理的最大障礙。我們正在努力代表消費者、雇主和健康計劃降低自付費用並提高整個系統的負擔能力。

As you heard from Andrew, recently we've seen an uptick in outpatient surgeries. Finding the most appropriate site of service is crucial because the cost of those procedures can differ dramatically depending upon where they are performed. Overall, evidence shows that comparable procedures performed in ambulatory surgery centers cost about half as much as traditional settings with comparable outcomes. For consumers, that translates into many hundreds of dollars in out-of-pocket cost savings for just a single procedure. And the patient satisfaction levels at our centers are among the highest in health care with NPS approaching 90%.

正如您從安德魯那裡聽到的，最近我們看到門診手術有所增加。找到最合適的服務地點至關重要，因為這些程序的成本可能根據執行地點的不同而有很大差異。總體而言，有證據表明，在門診手術中心進行的類似手術的成本大約是具有類似結果的傳統環境的一半。對於消費者來說，只需一次手術即可節省數百美元的自付費用。我們中心的患者滿意度在醫療保健領域名列前茅，NPS 接近 90%。

Also high on our affordability agenda is continuing to lower the cost of prescription drugs. Our customers, including employers, unions, health plans and governments, count on us to help them access the most effective medicines at the lowest possible cost. In fact, pharmacy benefit managers like ours are the only link in the drug supply chain, whose main purpose is to improve affordability for everyone. We go further by recommending benefit designs and providing tools to help consumers navigate their options and find the best value for their prescriptions.

我們的負擔能力議程中的另一個重點是繼續降低處方藥的成本。我們的客戶，包括雇主、工會、健康計劃和政府，依靠我們幫助他們以盡可能低的成本獲得最有效的藥物。事實上，像我們這樣的藥品福利管理者是藥品供應鏈中的唯一環節，其主要目的是提高每個人的負擔能力。我們進一步推薦福利設計並提供工具來幫助消費者瀏覽他們的選擇並找到最有價值的處方。

A recently launched feature called Price Edge, which provides the lowest cost option for a patient's medication, already has delivered millions of dollars in consumer out-of-pocket savings. Specialty drug costs continue to be a focus of every customer Optum Rx works with. Our differentiated approach to specialty is designed to serve the unique needs of patients, payers, providers and pharma partners and has allowed us to greatly expand our access to limited distribution drugs. We work to tailor our programs with individualized, single point of contact care for rare disease and clinical excellence programs for conditions such as MS, autoimmune diseases and cancer. Clients working with Optum Rx to implement all our specialty medication management programs can save up to 20% on their specialty drug costs.

最近推出的一項名為 Price Edge 的功能為患者的藥物提供了最低成本的選擇，已經為消費者節省了數百萬美元的自付費用。特種藥品成本仍然是 Optum Rx 合作的每個客戶關注的焦點。我們差異化的專業方法旨在滿足患者、付款人、提供商和製藥合作夥伴的獨特需求，並使我們能夠極大地擴大有限分銷藥物的獲取範圍。我們致力於針對罕見疾病制定個性化的單點接觸護理計劃，並針對多發性硬化症、自身免疫性疾病和癌症等疾病制定臨床卓越計劃。與 Optum Rx 合作實施我們所有特殊藥物管理計劃的客戶可以節省高達 20% 的特殊藥物成本。

Mostly related to specialty, biosimilars are another area where we are helping drive affordability in consumer choice. Earlier this year, we began offering AMGEVITA, a biosimilar to HUMIRA at parity, ensuring patients and their doctors have more options to choose from when deciding on a course of care. Recently, Optum Rx and UnitedHealthcare announced the addition of 2 new HUMIRA biosimilars: Cyltezo and Hyrimoz to our standard prescription drug list also at parity. This increased competition for the innovator drug will result in double-digit savings for our customers.

生物仿製藥主要與專業產品相關，是我們幫助提高消費者選擇負擔能力的另一個領域。今年早些時候，我們開始提供 AMGEVITA，這是一種與 HUMIRA 同等的生物仿製藥，確保患者及其醫生在決定治療方案時有更多選擇。最近，Optum Rx 和 UnitedHealthcare 宣布將 2 種新的 HUMIRA 生物仿製藥：Cyltezo 和 Hyrimoz 添加到我們的標準處方藥清單中，同樣處於同等地位。對創新藥物的競爭加劇將為我們的客戶帶來兩位數的節省。

You might also recall that a year ago, we announced our initiative to offer life-saving drugs at no cost to our customers. This benefit is available to everyone in UnitedHealthcare's Group fully insured commercial plans and has been adopted by more than 500 of our self-funded customers, increasing adherence and saving people millions of dollars. Finally, another important customer innovation that is making the health system simpler is Optum Financial's integrated card, which enables seamless access to benefits, programs and rewards for more than 13 million consumers who have issued the card since we broadly rolled it out at the start of the year.

您可能還記得，一年前，我們宣布主動向客戶免費提供救生藥物。 UnitedHealthcare 集團完全保險的商業計劃中的每個人都可以享受這項福利，並且已被我們 500 多名自籌資金的客戶採用，提高了依從性並為人們節省了數百萬美元。最後，使醫療系統變得更簡單的另一項重要的客戶創新是 Optum Financial 的集成卡，自我們年初廣泛推出該卡以來，已有超過 1300 萬發卡消費者能夠無縫獲得福利、計劃和獎勵。那一年。

Adoption and satisfaction levels have been very strong, making it much simpler for seniors to navigate the system and understand their benefits and creating a more satisfying consumer experience. These and many other results are validating our strategic approach to health care. I know from my many meetings with customers that these affordability, transparency and simplicity initiatives are resonating. They are a key reason for our continued growth in a highly competitive environment and for our confidence in maintaining our momentum as we look ahead.

採用率和滿意度非常高，使老年人能夠更輕鬆地瀏覽系統並了解他們的好處，並創造更令人滿意的消費者體驗。這些結果和許多其他結果正在驗證我們的醫療保健戰略方法。從與客戶的多次會面中我了解到，這些負擔得起、透明且簡單的舉措引起了共鳴。它們是我們在競爭激烈的環境中持續增長的關鍵原因，也是我們在展望未來時保持動力的信心的關鍵原因。

With that, let me hand it over to Chief Financial Officer, John Rex.

接下來，讓我將其交給首席財務官約翰·雷克斯 (John Rex)。

Thank you, Dirk. Adaptability and delivering greater value for the people we serve continue as foundational elements for our enterprise. These last few months are a good example, identifying evolving market trends, moving quickly to help people get the care they need, incorporating our broad and multifaceted insights into planning and, importantly, delivering on our commitments to you, our shareholders. These traits underpin our confidence not only in achieving our goals for '23, but also as we look toward '24 and beyond.

謝謝你，德克。適應性和為我們服務的人們提供更大的價值仍然是我們企業的基本要素。過去幾個月就是一個很好的例子，我們識別不斷變化的市場趨勢，迅速採取行動幫助人們獲得所需的護理，將我們廣泛和多方面的見解融入規劃中，更重要的是，履行我們對您（我們的股東）的承諾。這些特徵不僅支撐了我們實現 23 年目標的信心，而且也支撐了我們展望 24 年及以後的目標。

Before reviewing our business results, let me elaborate on the care patterns Andrew described earlier. To illustrate, in the second quarter, outpatient care activity among seniors was a few hundred basis points above our expectations. As we've highlighted, specific orthopedic and cardiac procedures had increased far above that level of variation. And as we developed and filed our 2024 Medicare Advantage offerings, we assume that these levels of heightened care activity will persist throughout next year. Overall care activity among our Medicaid and commercial populations is consistent with our expectations.

在回顧我們的業務成果之前，讓我詳細闡述一下安德魯之前描述的護理模式。舉例來說，第二季度老年人的門診護理活動比我們的預期高出幾百個基點。正如我們所強調的，特定的骨科和心臟手術的增加遠遠超過了這一變化水平。當我們開發並提交 2024 年 Medicare Advantage 產品時，我們認為這些加強的護理活動水平將持續到明年。我們的醫療補助和商業人群的總體護理活動符合我們的預期。

As always, we continue to intensely analyze trends that may indicate more severe disease progression, which could point to rising acuity. For example, in areas such as cancer, cardiovascular disease. We see no such evidence while continuing to monitor closely.

一如既往，我們繼續深入分析可能表明疾病進展更嚴重的趨勢，這可能表明病情惡化。例如，在癌症、心血管疾病等領域。我們在繼續密切監測時沒有看到此類證據。

With that, let's turn to our second quarter results. Revenue of $92.9 billion grew by nearly $12.6 billion or 16% over the prior year with double-digit growth at both Optum and UnitedHealthcare. Optum Health revenues grew by 36% to $23.9 billion, driven by an increase in the number of patients served, a growing mix of patients with more complex needs and the expanding scope of care services we can offer. Operating margins reflect the higher care activity patterns we have discussed with seniors comprising a significant majority of value-based patients served.

接下來，讓我們看看第二季度的業績。 Optum 和 UnitedHealthcare 的收入為 929 億美元，比上年增長近 126 億美元，即 16%，其中增長兩位數。 Optum Health 收入增長了 36%，達到 239 億美元，這得益於服務患者數量的增加、需求更加複雜的患者數量的增加以及我們可以提供的護理服務範圍的擴大。營業利潤率反映了我們與老年人討論的更高的護理活動模式，其中絕大多數是基於價值的患者。

Optum Rx revenues grew by 15%, surpassing $28 billion, driven by continued new customer wins and strong double-digit growth across specialty, infusion and community pharmacies. [Strip] growth of nearly 7% reflects continued demand for our affordable solutions that gives customers choice and simplify the pharmacy experience, such as biosimilar access and digital pharmacy tools. Partway into the '24 selling season, this momentum continues with strong client additions.

在持續贏得新客戶以及專業藥房、輸液藥房和社區藥房強勁的兩位數增長的推動下，Optum Rx 收入增長了 15%，超過 280 億美元。 [Strip] 近 7% 的增長反映了對我們經濟實惠的解決方案的持續需求，這些解決方案為客戶提供選擇並簡化藥房體驗，例如生物仿製藥訪問和數字藥房工具。進入 24 年銷售季節後，這種勢頭隨著強勁的客戶增加而持續。

Optum Insight revenues grew 42% to nearly $4.7 billion. The revenue backlog reached over $31 billion, an increase of $8 billion over last year, in part due to the addition of Change Healthcare. The integration and investment activities discussed on previous calls have gone well and are setting the stage for the next phase of growth for Optum Insight.

Optum Insight 收入增長 42%，達到近 47 億美元。積壓收入超過 310 億美元，比去年增加 80 億美元，部分原因是 Change Healthcare 的加入。之前電話會議中討論的整合和投資活動進展順利，為 Optum Insight 下一階段的增長奠定了基礎。

Turning to UnitedHealthcare. Our commercial business added nearly 500,000 people in the first half and continues its growth with the '24 selling season indications tracking favorably. Within our public sector programs, we continue to expect growth of over 900,000 Medicare Advantage members this year. And our Medicaid performance remains strong as we continue to support states as they initiate redeterminations. Comprehensive outreach efforts to help individuals retain coverage are underway, though it is still early as most states began this work only recently.

轉向聯合醫療保健。上半年，我們的商業業務增加了近 50 萬人，並隨著 24 年銷售季節的良好跡象繼續增長。在我們的公共部門計劃中，我們繼續預計今年 Medicare Advantage 會員人數將增長超過 900,000 名。我們的醫療補助表現仍然強勁，因為我們繼續支持各州發起重新決定。幫助個人保留保險的全面外展工作正在進行中，儘管現在還為時過早，因為大多數州最近才開始這項工作。

Our capital capacities are strong, Adjusted cash flows from operations were at $10.4 billion or nearly 2x net income in the second quarter and $15.6 billion or nearly [1.4x] net income in the first half. In the first 6 months of this year, we returned $8.3 billion to shareholders through dividends and share repurchases. And in June, our Board of Directors increased the dividend by 14%. As Andrew mentioned, based upon our growth outlook and the trends discussed, today we were able to strengthen and narrow our full year '23 adjusted earnings outlook to a range of $24.70 to $25 per share. Within this, we expect a relatively balanced pacing in the second half.

我們的資本能力很強，第二季度調整後的運營現金流為 104 億美元，接近淨利潤的 2 倍，上半年為 156 億美元，接近淨利潤的 [1.4 倍]。今年前6個月，我們通過股息和股票回購向股東返還83億美元。 6 月份，我們的董事會將股息增加了 14%。正如安德魯提到的，根據我們的增長前景和討論的趨勢，今天我們能夠加強和縮小 23 年全年調整後的盈利前景至每股 24.70 美元至 25 美元的範圍。在此範圍內，我們預計下半年的節奏將相對平衡。

Now I'll turn it back to Andrew.

現在我會把它轉回給安德魯。

John, thank you. Overall for UnitedHealth Group, looking to the second half of the year and into 2024 and beyond, we're confident that we're capturing the current landscape in our planning decisions which, in turn, gives us confidence in our ability to sustain the growth momentum shown in our first half and continue to demonstrate the adaptability, performance and mission-driven purpose of this enterprise, especially in evolving environments.

約翰，謝謝你。總體而言，對於聯合健康集團而言，展望今年下半年以及 2024 年及以後，我們有信心在規劃決策中抓住當前形勢，這反過來又讓我們對維持增長的能力充滿信心我們上半年表現出的勢頭，並將繼續展示該企業的適應性、績效和使命驅動的目標，特別是在不斷變化的環境中。

With that, operator, let's open it up for questions.

那麼，操作員，讓我們開始提問吧。

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

（操作員說明）我們將回答 A.J. 的第一個問題。瑞信的大米。

Maybe -- I appreciate the comments about what you're seeing in the care demand. Maybe on the Optum Health side, you guys, obviously top line continues to be very strong there. There's a little bit of margin degradation from first quarter to second quarter. How much of that relates to what you're describing around senior utilization? I know you've got a capitated component and you've got a fee-for-service component.

也許——我很欣賞您對護理需求的評論。也許在 Optum Health 方面，你們，顯然那裡的營收仍然非常強勁。從第一季度到第二季度，利潤率略有下降。其中有多少與您所描述的高級利用率有關？我知道你們有按人頭付費的部分，也有按服務付費的部分。

But I think last quarter, you also said that the growth in membership would be something that would pressure margins short term but obviously be a long-term positive. And then there's a lot of other things in Optum Health. Are they helping or hurting margin? Give us a little bit of flavor for what's happening underneath the aggregate number.

但我認為上個季度，您還表示會員數量的增長將在短期內對利潤率造成壓力，但顯然是長期積極的。 Optum Health 還有很多其他的東西。它們是有助於還是損害利潤率？讓我們了解一下總數字背後發生的事情。

A.J., thanks so much for the question. So first off, let me start off. I'm super pleased with the performance of Optum Health overall. And when you look at the growth of that business and particularly the expansion of the number of patients who are now looking after in value-based arrangements now about 4 million folks, not just from UHC, but of course, from many other payers as well, really strong validation of the model that we've been building, and you can continue to see us extend that. In terms of the margin compression during the Q, really, I'd say there are a couple of dynamics to that.

A.J.，非常感謝你的提問。首先，讓我開始吧。我對 Optum Health 的整體表現非常滿意。當你看到該業務的增長，特別是現在在基於價值的安排中照顧的患者數量的擴大時，現在大約有 400 萬人，不僅來自 UHC，當然也來自許多其他付款人，對我們一直在構建的模型進行了強有力的驗證，您可以繼續看到我們對其進行擴展。就 Q 期間的利潤壓縮而言，實際上，我想說有一些動態。

One is trend. And you very much echo in the senior trend comments you've heard us make earlier in the quarter and I think is well understood. A second element of that, which specifically affects Optum Health, is the behavioral growth. And I mentioned that in my prepared comments, A.J., around continued strong growth in behavioral. That certainly has played its part within Q2 for Optum Health.

一是趨勢。您非常贊同我們在本季度早些時候聽到的高級趨勢評論，我認為這是很好理解的。其中第二個特別影響 Optum Health 的因素是行為成長。我在我準備好的評論中提到，A.J.，圍繞行為的持續強勁增長。這無疑在 Optum Health 第二季度發揮了作用。

And then the third area is a kind of a good news story, but with short-term implications. So that's really the growth of the membership that's coming this year. As you know, we've grown very strongly this year, actually a little ahead of our expectations. We've also brought in a very significant number of complex patients. As we invest in helping those folks manage their care better, that puts a little pressure on the margin in the short run. But that's really laying super strong foundation stones, not just for as we move through the year but into '24, '25, '26. So those 3 elements, the senior trend piece, the behavioral piece and then the effect of the strong growth is really what explains what goes on. We're going to continue to lean into that growth very assertively. A.J., thanks so much.

第三個領域是一個好消息，但具有短期影響。這就是今年會員數量的真正增長。如您所知，我們今年的增長非常強勁，實際上有點超出了我們的預期。我們還引進了大量複雜的患者。當我們投資幫助這些人更好地管理他們的護理時，這在短期內會給利潤帶來一些壓力。但這確實奠定了超級堅固的基石，不僅是在我們度過這一年的過程中，而且是在進入“24”、“25”、“26”時。因此，這三個要素，即高級趨勢部分、行為部分以及強勁增長的影響，真正解釋了正在發生的事情。我們將繼續非常自信地推動這種增長。 A.J.，非常感謝。

We'll go next to Lisa Gill with JPMorgan.

接下來我們將與摩根大通的麗莎·吉爾進行對話。

I just want to understand, when I think about the guide to the upper end for the full year MLR, how much of that is driven by this MA outpatient trend versus behavioral? And when I think about behavioral utilization, is that being driven by a particular population? Or is it more broad-based? And how do I think about behavioral as a percentage of your cost?

我只是想了解，當我考慮全年 MLR 的上限指南時，其中有多少是由 MA 門診趨勢與行為驅動的？當我考慮行為利用時，這是由特定人群驅動的嗎？或者它的基礎更廣泛？我如何看待行為佔成本的百分比？

Lisa, thanks so very much for that. Let me ask John to just context for you a little bit the balance between the senior and behavioral and then maybe ask Dr. Decker to just give you a little bit of commentary around the type of consultation that we're dealing with in terms of the growth.

麗莎，非常感謝。讓我請約翰為您介紹一下高級和行為之間的平衡，然後也許請德克爾博士就我們正在處理的諮詢類型向您提供一些評論生長。

Lisa, it's John. So in terms of your question, the majority of the guide to the upper end of the full year is driven by what we've described in terms of the activity, the care activity we're seeing among seniors in outpatient. So that's a core there. In terms of behavioral, what we've noticed in behavioral is an increase in the number of people accessing care. Andrew had this in his comments, but a very, very significant increase, even just since a year ago in terms of the number of people that are looking to access care. It's a great thing. We are planning on that continuing. We don't see why that trend slows down. So we're designing our benefits for that to continue. As you recall, I know, Lisa, behavior resides within Optum Health. And so that's kind of an impact that we'd see in that component. And Wyatt, maybe some other commentary?

麗莎，是約翰。因此，就您的問題而言，全年高端指南的大部分內容是由我們在活動方面所描述的內容驅動的，即我們在門診老年人中看到的護理活動。這就是那裡的核心。在行為方面，我們在行為方面注意到的是獲得護理的人數有所增加。安德魯在他的評論中提到了這一點，但即使從一年前開始，尋求獲得護理的人數也出現了非常非常顯著的增長。這是一件很棒的事情。我們正計劃繼續這樣做。我們不明白為什麼這種趨勢會放緩。因此，我們正在設計我們的福利以使其繼續下去。正如你所記得的，我知道，麗莎，行為屬於 Optum Health 的範圍。這就是我們在該組件中看到的影響。懷亞特，也許還有其他評論？

Yes, absolutely. Thank you, Lisa. So you asked about the types of consultations and care being provided within behavioral. And we're seeing across the board increasing utilization. But what's encouraging from a public health perspective is it isn't strictly young people. It's across the board. We're seeing 30-, 40-, 50-year-olds accessing behavioral health care for needed care for conditions like anxiety, depression, substance use disorder. And our commitment is to make sure that they have access to that care.

是的，一點沒錯。謝謝你，麗莎。因此，您詢問了行為方面提供的諮詢和護理類型。我們看到利用率全面提高。但從公共衛生的角度來看，令人鼓舞的是，這不僅僅是年輕人。這是全面的。我們看到 30 歲、40 歲、50 歲的人正在尋求行為健康護理，以治療焦慮、抑鬱、藥物濫用等病症。我們的承諾是確保他們能夠獲得這種護理。

So as you heard from Andrew earlier, we've expanded our behavioral health care network. And we also, a couple of years ago, very thoughtfully launched a behavioral care provider services. And we now have ambulatory services available in 37 states, and we have self-paced modules for things like anxiety and depression and we add a therapist as appropriate. So you'll see us continuing to make sure our members have access as well as providing innovative, scalable solutions for behavioral health care needs across the age spectrum.

正如您之前從安德魯那裡聽到的，我們已經擴大了我們的行為醫療保健網絡。幾年前，我們還非常周到地推出了行為護理提供服務。現在，我們在 37 個州提供門診服務，針對焦慮和抑鬱等問題設有自定進度模塊，並酌情添加治療師。因此，您會看到我們繼續確保我們的會員能夠獲得服務，並為各個年齡段的行為健康護理需求提供創新、可擴展的解決方案。

Yes. Wyatt, thank you so much. So Lisa, I think you've got it there. Overall, it's very much around the senior trend phenomena. Within Optum Health, the behavioral piece plays its part. We see that very much as an area where we will continue to step up and make sure that we're delivering the care in the way that Wyatt just described to you.

是的。懷亞特，非常感謝你。麗莎，我想你已經明白了。總體而言，它很大程度上圍繞著高級趨勢現象。在 Optum Health 中，行為部分發揮了作用。我們認為這是一個我們將繼續加強的領域，並確保我們以懷亞特剛才向您描述的方式提供護理。

We'll go next to Nathan Rich with Goldman Sachs.

接下來我們將討論高盛的內森·里奇 (Nathan Rich)。

John, you mentioned the balance piecing of EPS in the back half of the year between 3Q and 4Q. Could you talk about your expectations for MCR, specifically between the 2 quarters? And how are you thinking about the trend of care activity as we head into the back half of the year given what you're seeing with respect to demand as well as some of the supply bottlenecks that [to care] being delivered maybe being removed? And do those factors differ significantly between Medicare and the commercial or Medicaid lines of business?

約翰，您提到了今年下半年第三季度和第四季度之間每股收益的平衡調整。您能否談談您對 MCR 的預期，特別是兩個季度之間的預期？鑑於您所看到的需求以及[護理]交付的一些供應瓶頸可能會被消除，您如何看待進入今年下半年的護理活動的趨勢？這些因素在醫療保險和商業或醫療補助業務範圍之間是否存在顯著差異？

Nate, thanks for the question. Yes, in terms of the balance pacing, the way I describe that is -- and MCR and how that feeds in, we'd expect the MCR to be a little bit lower in the 3Q than we saw in the 2Q, some of that seasonality, as you would fully expect. So within the contexting of balance, expect earnings to be a little bit higher marginally in 3Q than 4Q because of that typical factor in there, and thinking of an MCR somewhere in the zone of between kind of what we saw in the 1Q and 2Q just by seasonality factor. Important in that is we expect the kind of general pacing of care activity to remain consistent. That's what we've actually been seeing here. So since we've talked about this and as we've looked at the level of care activity across the company, these elements we talked about in terms of senior outpatient care are really remaining stable at the levels we talk to.

內特，謝謝你的提問。是的，就平衡節奏而言，我描述的方式是 - 以及 MCR 及其反饋方式，我們預計第三季度的 MCR 會比第二季度低一些，其中一些季節性，正如您所完全期望的那樣。因此，在平衡的背景下，預計第三季度的收益將略高於第四季度，因為那裡存在典型因素，並且考慮 MCR 位於我們在第一季度和第二季度看到的區域之間的某個區域按季節性因素。重要的是，我們期望護理活動的總體節奏保持一致。這就是我們在這裡實際看到的。因此，既然我們已經討論過這個問題，並且我們已經研究了整個公司的護理活動水平，那麼我們在高級門診護理方面討論的這些要素實際上在我們討論的水平上保持穩定。

And our expectation is it continues in that level. So as you look out to the second half of this year, our expectation, it continues at those levels that we've been seeing with the -- I mentioned a few hundred basis points above our expectations in the senior business, that continues. The only underlying factor is a little bit of seasonality that you would see occurring there.

我們的期望是它會繼續保持在這個水平。因此，當你展望今年下半年時，我們的預期將繼續保持在我們一直看到的水平，我提到了高級業務的預期比我們的預期高出幾百個基點，這種情況仍在繼續。唯一的潛在因素是你會看到那裡發生的一點季節性。

We'll go next to Justin Lake with Wolfe Research. .

我們將與沃爾夫研究中心一起去賈斯汀湖旁邊。 。

My question is on commercial trend. You mentioned it's in line with expectations. I wanted to delve a little bit deeper. I think you might have said previously that you'd priced for commercial trend to be all normal this year, so some conservatism. So does that mean that it's running above normal but in line with your pricing at this point? If it's above normal, can you tell us how Q2 emerged versus Q4, Q1, meaning that an uptick versus -- in 2Q versus 1Q or 4Q? And then just lastly, any insight on the commercial components, is outpatient of pressure here as well?

我的問題是關於商業趨勢。你提到這符合預期。我想更深入地研究一下。我想你之前可能說過，你的定價是今年商業趨勢一切正常，所以有些保守。那麼這是否意味著它的運行高於正常水平但符合您目前的定價？如果高於正常水平，您能否告訴我們第二季度與第四季度、第一季度相比是如何出現的，這意味著第二季度與第一季度或第四季度相比有所上升？最後，對商業組件的任何見解，這裡是否也有壓力？

Justin, thanks so much for the question. I mean, so really not much to see here in all honesty, first off. Where we came into the year, we -- as you alluded to, we priced for some anticipation of unit cost inflation. We've seen some of that come through. Within that, everything is tracking very much within our expectations. So we set the year anticipating a little bit of price/cost growth, if you will. But beyond that, really nothing to note and we feel good about where we sit here.

賈斯汀，非常感謝你的提問。我的意思是，老實說，首先，這裡真的沒什麼可看的。正如您所提到的，我們在今年的定價中考慮了單位成本通脹的一些預期。我們已經看到其中一些已經實現。其中，一切都在我們的預期範圍內進行。因此，如果您願意的話，我們預計今年的價格/成本會略有增長。但除此之外，真的沒有什麼值得注意的，我們對我們坐在這裡的感覺很好。

We'll go next to Josh Raskin with Nephron Research.

接下來我們將採訪 Nephron Research 的 Josh Raskin。

Do you think any of the increased utilization you're seeing on the MA side was self-inflicted in the sense that you've really augmented benefits dramatically in the last year -- really last 2 years, and perhaps that's encouraged or even catalyzed sort of an overutilization of trends relative to historical patterns and expectations? And then how did you address the utilization trends in your benefit designs for '24? I know there's sensitivity about saying something on a public call, but maybe just broad changes that you'd expected?

您是否認為您在 MA 方面看到的利用率的增加是自己造成的，因為您在去年（實際上是過去兩年）確實大幅增加了收益，也許這是鼓勵甚至催化的排序過度利用相對於歷史模式和預期的趨勢？那麼您是如何解決 24 世紀福利設計中的利用趨勢的？我知道在公開電話會議上說一些話很敏感，但也許只是您期望的廣泛變化？

Josh, thanks so much for the question. I'm going to ask Tim Noel to give you a little bit more commentary. But I think bottom line, I don't really think the benefits are driving this. I think this is -- when you look at the concentration of what we're seeing in terms of the outpatients, the orthopedics, in particular, those sorts of areas, it looks very much more like a kind of deferment of care. Super interesting when you look at maybe what's changed a little bit within that. We've seen a shift in the fraction of people who, once they have been essentially recommended for surgery, actually go through and complete the procedure. Arguably, what might drive that change is, one, more supply. So actually, it's more possible to go get it done; but two, maybe a little less reticent from an individual to go into a facility in a post-COVID environment versus a COVID environment. That feels like the thing that's shifted. And maybe ask Tim to just add a little bit to that as well, Tim.

喬什，非常感謝你的提問。我將請蒂姆·諾埃爾為您提供更多評論。但我認為底線是，我真的不認為好處是推動這一點的因素。我認為，當你看看我們在門診、骨科，特別是那些領域所看到的集中情況時，它看起來更像是一種推遲護理。當你看看其中發生的一些變化時，你會發現超級有趣。我們已經看到，一旦基本上被建議進行手術的人中，真正經歷並完成手術的比例發生了變化。可以說，可能推動這一變化的因素之一是更多的供應。所以實際上，去完成它更有可能；但第二，與新冠病毒環境相比，在後新冠病毒環境中，個人可能不太願意進入設施。感覺就像事情發生了變化。也許還可以請蒂姆補充一點，蒂姆。

Yes. Thanks, Josh. Consistent with what Andrew said, when we look at potential drivers everything from acuity to benefits added to mix of membership. Everything is really tracking very normally and in line with what we would expect. So nothing to call out there, but certainly something that we look at closely and carefully each and every year, and this year being no different. With respect to your question regarding benefits, so I think one thing to keep in mind is that the more important driver to our benefit decisions this year were the changes to the risk model.

是的。謝謝，喬什。與安德魯所說的一致，當我們考慮潛在的驅動因素時，從敏銳度到增加的會員資格組合的福利等一切。一切都非常正常地進行，符合我們的預期。因此，沒有什麼值得指出的，但肯定是我們每年都會仔細觀察的事情，今年也不例外。關於您有關福利的問題，我認為需要記住的一件事是，今年我們福利決策的更重要驅動因素是風險模型的變化。

Certainly, we've been talking a lot about care patterns, but that has far less of an impact on the benefits filed and is really one of many assumptions that we make inside of our bids. But we feel very confident in our ability to provide stability to the benefits that seniors value most, things like zero co-pays for primary care visits, zero co-pays for Tier 1 drugs. Keeping zero monthly planned premiums where we had them in the past and keeping level out of pocket maximums are very important things for benefits for stability.

當然，我們一直在談論護理模式，但這對申請的福利影響要小得多，而且實際上是我們在投標中做出的眾多假設之一。但我們對為老年人最看重的福利提供穩定的能力非常有信心，例如初級保健就診的零自付費用、一級藥物的零自付費用。將每月計劃保費保持在過去的水平，並保持自付費用最高限額水平，對於穩定效益非常重要。

And we are able to preserve those, so we're really happy about that. So on balance, combined with the great momentum we see in our value proposition, the great partnerships we have and confidence from the broker community, we feel really good about the benefits we filed. And also, as we talked about in our opening remarks, really confident in seeing that momentum pull through into some great growth results next year.

我們能夠保留這些，所以我們對此感到非常高興。因此，總的來說，結合我們在價值主張中看到的巨大動力、我們擁有的良好合作夥伴關係以及經紀商社區的信心，我們對我們所帶來的好處感到非常滿意。而且，正如我們在開場白中談到的那樣，我們非常有信心看到這種勢頭在明年帶來一些巨大的增長成果。

We'll go next to Lance Wilkes with Bernstein.

我們將和伯恩斯坦一起去蘭斯·威爾克斯旁邊。

A question on the commercial side of the business. Can you talk a little bit about membership and in the fee-based business being down? And also maybe related to that and your outlook going forward, in Medicaid redetermination, are you seeing any trends with respect to recapture of those sorts of members? Or anything that's driving the opportunity for either growth in membership or maybe you're seeing any account attrition due to weakness in the economy?

關於業務商業方面的問題。您能談談會員資格和收費業務下降的情況嗎？也許也與此相關，以及您對醫療補助重新確定的未來展望，您是否看到了重新吸引此類成員的任何趨勢？或者有什麼因素可以推動會員增長的機會，或者您可能會看到由於經濟疲軟而造成的帳戶流失？

Lance, thanks so much for the question. Before I hand it to [Dan Kite], who looks after our E&I business, I just want to make a couple of kind of high-level comments. We're seeing overall a very strong performance from our commercial business this year and also setting up, it feels like very well for the '24 season. We've seen fantastic overall growth, as I mentioned, in terms of membership. And that's been led very much by a lot of the product innovation that the team have been putting together and into the marketplace. And we see that continuing pretty assertively as we roll into '24. Just with that kind of backdrop, maybe, Dan, if you could respond to Lance's specific questions, that would be great.

蘭斯，非常感謝你的提問。在我將其交給負責我們的 E&I 業務的 [Dan Kite] 之前，我只想發表一些高層評論。我們看到今年我們的商業業務總體表現非常強勁，並且為 24 賽季做好了準備。正如我所提到的，我們在會員數量方面看到了驚人的整體增長。這在很大程度上是由團隊整合併投入市場的大量產品創新引領的。當我們進入 24 世紀時，我們看到這種情況仍在繼續。正是在這樣的背景下，丹，如果你能回答蘭斯的具體問題，那就太好了。

Yes, Lance, thanks for the question. Growth is on track for the full year. And what you see in Q2 really is represented by the contraction of 1 large customer in our fee-based business. Your question about attrition and redeterminations, the outcome of those, which will be some puts and takes, will probably determine where within our range we will fall. But the punch line is, we're on track to hit our range for this year. Good question, Lance.

是的，蘭斯，謝謝你的提問。全年增長步入正軌。你在第二季度看到的情況實際上是我們收費業務中 1 個大客戶的收縮。你關於損耗和重新決定的問題，這些結果，這將是一些看跌和接受，可能會決定我們將落在我們範圍內的哪個位置。但有趣的是，我們有望達到今年的目標。好問題，蘭斯。

Thanks, Dan. Thanks so much, Lance, for the -- and just to be super clear as well that client loss that Dan just referred to, we knew about that about a year ago, but with our expectations, forecast plan. It was something we were anticipating and makes no impact at all to our full year expectation. But thanks so much for the question.

謝謝，丹。非常感謝蘭斯，而且還要非常清楚丹剛才提到的客戶流失，我們大約一年前就知道了這一點，但按照我們的期望和預測計劃。這是我們預料到的事情，對我們全年的預期沒有任何影響。但非常感謝你的提問。

We'll go next to Kevin Fischbeck with Bank of America. .

接下來是美國銀行的凱文·菲施貝克 (Kevin Fischbeck)。 。

I just want to follow up on the Optum Health because the margin there was obviously pressured in the quarter. And I just want to understand how the margin normalization should we think about that over the next couple of years. I mean, you can -- on the MA side, you can reprice for things. It sounds like you saw it in time for your bids and costs have come in line with the way that you price. Maybe just confirm that piece first. But then since within Optum Health, you're also relying on other providers and how they price for 2024, how are you thinking about the market? If you're below target this year? Is this something you can get back to next year or just a multiyear thing depending on how others price? Or the leverage within your control? Or is this kind of a longer-term normalization?

我只想跟進 Optum Health，因為該季度的利潤率明顯受到壓力。我只是想了解未來幾年我們應該如何考慮利潤率正常化。我的意思是，你可以——在 MA 方面，你可以重新定價。聽起來您似乎及時看到了您的出價，並且成本已與您的定價方式一致。也許先確認一下那件事。但既然在 Optum Health 內部，您還依賴其他提供商以及他們在 2024 年的定價方式，您如何看待市場？如果你今年沒有達到目標？這是你可以在明年恢復的東西，還是只是一個多年的東西，取決於其他人的定價？或者你可以控制的槓桿？或者說這是一種長期的正常化？

Kevin, thanks so much for the question. So first off, as I mentioned earlier, the pressure is really coming from those 3 sources, the senior trend phenomenon that we a lot about, the very specific Optum piece around behavioral and then the growth in the book. And within that, very much a complex care patient, which, as I'm going to repeat again, is an extremely positive element of our growth going forward. That's going to be an extraordinarily important foundation stone for the future of the company. We're going to continue to lean into that growth, first and foremost. We do expect to see margins continue to strengthen, particularly as you roll through into '24. You're absolutely right. We believe we've caught this in our pricing for next year.

凱文，非常感謝你的提問。首先，正如我之前提到的，壓力實際上來自這三個來源，我們經常關注的高級趨勢現象、關於行為的非常具體的 Optum 文章以及書中的增長。其中，有一位非常複雜的護理患者，正如我將再次重複的那樣，這是我們未來發展的一個極其積極的因素。這將成為公司未來的極其重要的基石。首先，我們將繼續致力於這種增長。我們確實預計利潤率會繼續增強，尤其是進入 24 年後。你是絕對正確的。我們相信我們已經在明年的定價中考慮到了這一點。

But more importantly, the longer time we have to look after folks and wrap around care, we can deliver much better outcomes for them, as we talked about earlier. and we can also make the economic proposition better. It really builds much more sustainable capability. So all of that will kick in as well as we roll through subsequent quarters and years. This is going to be a continuing building pressure. I feel very good about that range we've laid out for Optum Health over the next several years. And actually, I think if I had the choice on a slightly suppressed margin in Q2 or the very significant growth that we've taken in, I'll take the growth all day long. And I'll take that growth because it's going to underpin years of growth going forward. Appreciate the question, Kevin.

但更重要的是，正如我們之前談到的，我們照顧人們和全面護理的時間越長，我們就能為他們提供更好的結果。我們還可以使經濟主張變得更好。它確實建立了更具可持續性的能力。因此，所有這些都將在我們接下來的季度和年份中開始發揮作用。這將是一個持續不斷的壓力。我對我們在未來幾年為 Optum Health 制定的產品範圍感到非常滿意。事實上，我認為，如果我可以選擇第二季度利潤率略有下降，或者我們所採取的非常顯著的增長，我會整天都選擇增長。我會接受這種增長，因為它將支撐未來數年的增長。感謝這個問題，凱文。

We'll go next to Gary Taylor with Cowen.

我們將和考恩一起去加里·泰勒旁邊。

I just want to talk about some of the -- or ask about some of the levers and offset because it is a little counterintuitive to hear the commentary intra-quarter about higher MLR and then seeing your largest profit segment, Optum Health, with lower margin. So this quarter, obviously, investment income was far stronger The Street was looking for, at least versus our model G&A, was better. But I know moving into the back half, I think you believe there's more time potentially to pull some of those G&A levers. So could you just talk about investment income G&A or what other offsets there might be in the back half? And how much of that is carrying forward into your '24 thinking at this point?

我只想談談其中的一些——或者詢問一些槓桿和抵消，因為聽到季度內關於更高 MLR 的評論，然後看到你最大的利潤部門 Optum Health 的利潤率較低，這有點違反直覺。 。因此，顯然，本季度的投資收益要強得多，至少與我們的 G&A 模型相比，華爾街所尋求的投資收益要好得多。但我知道進入後半部分，我認為你相信有更多的時間可能會拉動一些一般管理費用槓桿。那麼您能否談談投資收入 G&A 或下半年可能存在的其他抵消額？此時此刻，其中有多少內容已融入您的 24 世紀思維？

Yes. Very much appreciate the question. Let me ask John to make some comments to that. John?

是的。非常感謝這個問題。讓我請約翰對此發表一些評論。約翰？

Gary, it's John. So yes, you're right. The investment income has frankly, been growing strongly over the past number of quarters and continues to grow. Some of that is the backdrop of the rising interest rate environment, as you know, very well. Some of that is also a result of very active management by our treasury teams in terms of deploying more and more cash balances into interest-bearing accounts and such as they've been working hard at that over the past few quarters and advancing the productivity of that cash.

加里，是約翰。所以是的，你是對的。坦率地說，投資收入在過去幾個季度中一直強勁增長，並且仍在繼續增長。如您所知，其中一些是利率上升環境的背景。其中一部分也是我們的財務團隊非常積極管理的結果，將越來越多的現金餘額部署到計息賬戶中，例如他們在過去幾個季度一直在努力，並提高了生產力那些現金。

That's after coming off of a period of many years of a zero interest rate environment. So a lot of elements in that. In any given quarter, we can experience some gains from our -- in our investment portfolio. So that can be gained from -- anything from our regular fixed income investments to anything from our diverse venture holdings. And so those come in -- they come in at different points in time. And perhaps sometimes they're a little bit less predictable, but kind of are typically in a similar zone frankly, not outside. I don't expect those kind of things -- I don't count on those kind of things. frankly, every quarter. That's not the thing we look at. But there are elements that we've seen over time in kind of the zones that we're experiencing even now, too.

這是在結束多年的零利率環境之後。所以里面有很多元素。在任何特定季度，我們都可以從我們的投資組合中獲得一些收益。因此，這可以從我們的常規固定收益投資到我們多樣化的風險投資中的任何東西中獲得。所以這些進來了——它們在不同的時間點進來了。也許有時它們有點難以預測，但坦率地說，它們通常都在類似的區域中，而不是在外面。我不期待那樣的事情——我不指望那樣的事情。坦率地說，每個季度。那不是我們所看的東西。但隨著時間的推移，我們已經在我們現在正在經歷的區域中看到了一些元素。

Thanks, John. And maybe I'll ask Dirk to also comment a little bit. As you think about the G&A side of the equation going forward, maybe reflect a little bit on the work you're leading around technology and other interventions as we look to drive down our overall costs.

謝謝，約翰。也許我會請德克也發表一些評論。當您考慮未來的一般行政費用方面時，也許可以反思一下您在技術和其他干預措施方面所領導的工作，因為我們希望降低總體成本。

Yes. Gary, what I would say is much of the focus -- we've really been applying a lot of artificial intelligence, machine learning and natural language processing. Long term, we think there's great hope for those. And some of the short-term things that we're working on in those areas, like using generative AI to help more efficiently write medical appeal letters, things like optimizing our provider search and all of our digital properties with natural language processing and AI, doing a lot of work, improving our payment integrity models, using AI to detect waste, fraud and abuse.

是的。加里，我想說的是重點——我們確實應用了大量的人工智能、機器學習和自然語言處理。從長遠來看，我們認為這些有很大的希望。我們在這些領域正在開展的一些短期工作，例如使用生成式人工智能來幫助更有效地撰寫醫療上訴信，例如通過自然語言處理和人工智能來優化我們的提供商搜索和所有數字資產，我們做了大量工作，改進我們的支付誠信模型，使用人工智能來檢測浪費、欺詐和濫用行為。

And then a lot in the G&A world to answer basic questions in our call centers, like leveraging our benefit bots to reduce the number of calls and the labor associated with that, for simple questions like is XYZ disease covered or have I met my deductible. From long range perspective, however, I'm really optimistic about our significant data sets. Our ability to take advantage of whatever new technology comes down the pipe to improve health care, I'm really excited about it. So thanks for the question.

然後，在 G&A 領域，我們的呼叫中心會回答很多基本問題，例如利用我們的福利機器人來減少呼叫數量和與之相關的勞動力，以及簡單的問題，例如 XYZ 疾病是否得到承保或我是否達到了免賠額。然而，從長遠來看，我對我們的重要數據集非常樂觀。我們有能力利用任何即將出現的新技術來改善醫療保健，我對此感到非常興奮。謝謝你的提問。

Yes, Dirk, thanks so much. And I think, Gary, overall, and I think I tried to allude at the very beginning, Obviously, when you see a movement in care activity like we saw in the quarter, it's been great to see the range of levers that we have within the organization to respond. And you've seen what we've been able to do in the very short run. And as you would that we have more and more of those levers as you roll through into the medium and longer-term outlooks as both John and Dirk have described both in the financial side of the company but also critically in the core operating cost structure of the company, which we're going to continue to bear down on very, very assertively.

是的，德克，非常感謝。我認為，加里，總的來說，我想我一開始就試圖提到，顯然，當你看到護理活動發生像我們在本季度看到的那樣的變化時，很高興看到我們擁有的槓桿範圍組織作出回應。您已經看到了我們在短期內所做的事情。正如您所希望的那樣，當您進入中期和長期前景時，我們擁有越來越多的槓桿，正如約翰和德克在公司的財務方面以及核心運營成本結構中所描述的那樣。我們將繼續非常非常堅決地打擊這家公司。

Consequence of all of that is that even with the backdrop of some of the fluidity we've seen, We're able to continue to commit to the investment behind growth and the investment behind looking after patients as well as we possibly can and giving people a fantastic experience, which is what we think builds super sustainable shareholder value. So that's very much the priority that we're focused on.

所有這一切的結果是，即使在我們看到的一些流動性的背景下，我們也能夠繼續致力於增長背後的投資以及盡我們所能照顧患者並為人們提供幫助的投資這是一次奇妙的體驗，我們認為這可以構建超可持續的股東價值。所以這是我們關注的重點。

We'll go next to George Hill with Deutsche Bank.

我們將前往喬治山旁邊的德意志銀行。

I guess, John, I want to talk a little bit more about your expectations for the senior book in '24. You guys kind of talked about that you expect the current elevated trend to continue and price for it when you think about the MA bids. I guess, kind of talk about like what drives the visibility there from what you see now in ortho, like looking all the way out to '24. And should we think of the pricing is just kind of conservatism on UNH's part? Or like I'm kind of interested in the data that drives the visibility.

我想，約翰，我想多談談你對 24 年的高級書籍的期望。你們談到，當您考慮移動平均線出價時，您預計當前的上漲趨勢將持續下去並為其定價。我想，有點像談論什麼驅動了你現在在正交中看到的可見度，就像一直看到'24。我們是否應該認為定價只是新罕布什爾大學方面的保守主義？或者就像我對推動可見性的數據感興趣一樣。

George, thanks for the question. I'm actually going to ask Tim Noel, who leads the Medicare business to respond to that, Tim?

喬治，謝謝你的提問。我實際上要問負責醫療保險業務的蒂姆·諾埃爾（Tim Noel）對此做出回應，蒂姆？

Thanks, George, for the question. So I'll start by reiterating one thing as an important point. The biggest item though shaping this year has been -- thinking was around the risk model changes. The outpatient care patterns plays a far smaller role there. But that said, having the ability to incorporate the latest data, anything we've learned recently into our Medicare Advantage bids is extremely important in each and every year especially given how we see both key revenue and medical elements firm up inside of Q2, being able to incorporate the latest thinking that we have in our bid filings is really, really important. And because of that, we've designed a bid process that is very nimble and able to accommodate late changes.

謝謝喬治提出這個問題。因此，我首先重申一件重要的事情。今年最重要的事情是——圍繞風險模型的變化進行思考。門診護理模式在那裡發揮的作用要小得多。但話雖如此，有能力將最新數據納入我們最近在醫療保險優勢投標中學到的任何東西，每年都極其重要，特別是考慮到我們如何看待第二季度內關鍵收入和醫療要素的穩固，能夠將我們的最新想法納入投標文件中確實非常重要。正因為如此，我們設計了一個非常靈活且能夠適應後期變化的投標流程。

This year, out of respect for a developing trend, we made the assumption that some of these early indications that we are seeing in the outpatient (inaudible) have talked about would remain durable. And as we sit here today, as John has talked about, these assumptions have validated and they've also stabilized. And we feel confident that we've made the appropriate accommodations inside of our 2024 bids for all of this.

今年，出於對發展趨勢的尊重，我們假設我們在門診（聽不清）中看到的一些早期跡象將保持持久。正如約翰所說，當我們今天坐在這裡時，這些假設已經得到驗證，並且也已經穩定下來。我們相信，我們已經在 2024 年投標中為所有這些做出了適當的調整。

We'll take our last question from Scott Fidel with Stephens.

我們將回答斯科特·菲德爾和斯蒂芬斯提出的最後一個問題。

I was hoping maybe you could drill a little bit just into the announcement of the Amedisys acquisition. And maybe in particular, just talk about sort of strategy for ramping up the exposure here given the tough near-term reimbursement environment for home health. And then maybe some early thoughts around some of the integrations or synergies that you could generate from integrating Amedisys in LHCG together.

我希望您能稍微深入了解 Amedisys 收購的公告。也許特別是，考慮到家庭健康的近期報銷環境嚴峻，談談增加風險敞口的策略。然後，也許還有一些關於通過將 Amedisys 集成到 LHCG 中可能產生的一些集成或協同效應的早期想法。

Scott, thanks so much for the question. Well, first of all, we're obviously very pleased to have come to an agreement on the transaction with Amedisys, so we appreciate that. But as you'd expect, it's -- we're now in the very early stages of that process. It wouldn't be appropriate to talk about anything specific in that regard. If I just take it maybe a level higher, it's no secret that we are very strong believers in the value of home health and no secret that we believe that value -- home health capabilities, when combined with other activities in terms of wrapping care around patients, is a really important element of future value-based care, particularly as you speak towards complex patients, many of whom maybe struggle to get out of the home, maybe don't have quite the same kind of relationship with the clinic as you might often expect. So we do think that the general area is an important area. As I said, as far as the specifics are concerned, I think we're now -- we'll go through our -- the regular kind of process, and we'll update you as appropriate, but probably not much more to say today.

斯科特，非常感謝你的提問。嗯，首先，我們顯然非常高興與 Amedisys 就交易達成協議，因此我們對此表示讚賞。但正如您所料，我們現在正處於該過程的早期階段。談論這方面的任何具體內容是不合適的。如果我只是把它提升到一個更高的水平，那麼我們非常堅信家庭健康的價值，這已經不是什麼秘密了，而且我們相信這種價值——家庭健康能力，與其他活動相結合，以提供護理服務，這也不是什麼秘密。患者，是未來基於價值的護理的一個非常重要的元素，特別是當您面對複雜的患者時，他們中的許多人可能很難走出家門，也許與診所的關係不像您那樣可能經常會期待。所以我們確實認為一般區域是一個重要區域。正如我所說，就具體細節而言，我認為我們現在 - 我們將完成我們的 - 常規流程，我們將酌情向您通報最新情況，但可能無需多說今天。

Thanks so much, Scott, for the question. And thank you, everybody, for joining us this morning. We very much appreciate your time. And we hope you take away from this call our confidence in our ability to continue to perform and grow strongly while we pursue our mission and build the foundations for continued growth in 2024 and beyond. And we are very much looking forward to sharing more on our progress with you again in October.

非常感謝斯科特提出這個問題。感謝大家今天早上加入我們。我們非常感謝您的寶貴時間。我們希望您通過這次電話會議，相信我們有能力繼續表現和強勁增長，同時我們追求我們的使命，為 2024 年及以後的持續增長奠定基礎。我們非常期待在 10 月份再次與您分享更多我們的進展。

Thanks so much for your time this morning.

非常感謝您今天早上抽出時間。

This does conclude today's conference. We thank you for your participation.

今天的會議到此結束。我們感謝您的參與。