聯合健康 (UNH) 2023 Q3 法說會逐字稿

Good morning, and welcome to the UnitedHealth Group Third 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 年第三季財報電話會議。聯合健康集團發表準備好的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 cautionary statements included in our current and periodic filings.

以下是一些重要的介紹資訊。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有重大差異。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，包括我們目前和定期提交的文件中包含的警告聲明。

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 unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated October 13, 2023, which may be accessed from the Investor Relations page of the company's website.

此次電話會議也將參考非公認會計原則金額。非 GAAP 與 GAAP 金額的調整表可在 Unitedhealthgroup.com 公司投資者關係頁面的財務和收益報告部分找到。本次電話會議中提供的資訊包含在我們今天早上發布的收益報告和日期為 2023 年 10 月 13 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執行長安德魯威蒂 (Andrew Witty)。

Good morning, and thank you for joining us. The third quarter results we reported today reflect well balanced and durable growth, supported by disciplined execution and the steadfast commitment to ensure high-quality comprehensive care is well within reach for every person we're privileged to serve. Evolution in our marketplace, including regulatory changes, means agility and adaptability must continue to be defining characteristics of our company. The people of Optum and UnitedHealthcare continuously strive to find new ways to innovate, serve and grow.

早安，感謝您加入我們。我們今天報告的第三季業績反映了良好平衡和持久的成長，這得益於嚴格的執行和堅定的承諾，以確保我們有幸服務的每個人都能獲得高品質的全面護理。我們市場的演變，包括監管變化，意味著敏捷性和適應性必須繼續成為我們公司的特徵。 Optum 和 UnitedHealthcare 的員工不斷努力尋找創新、服務和發展的新方法。

As a direct result of their mission-driven focus, this year, we'll serve even more people more comprehensively than anticipated in the outlook we offered at the end of 2022. By the close of this year, we will serve nearly 900,000 additional patients under value-based care arrangements at Optum Health, almost 1 million new consumers across UnitedHealthcare's Medicare Advantage offerings and a total more than 1.5 billion scripts to the people who rely on Optum Rx.

作為他們以使命為導向的重點的直接結果，今年我們將比 2022 年底展望中的預期更全面地為更多的人提供服務。到今年年底，我們將為近 900,000 名額外的患者提供服務根據Optum Health 基於價值的護理安排，UnitedHealthcare 的Medicare Advantage 產品吸引了近100 萬新消費者，並向依賴Optum Rx 的人們提供了總計超過15 億個處方。

Based on this performance, we're strengthening our 2023 adjusted earnings outlook to a range of $24.85 to $25 per share. The confidence we have in our sustained long-term growth outlook is exemplified by the 14% third quarter revenue increase we reported this morning, more than $11 billion above last year. The sources of this growth will drive many more years of strong performance.

基於這項業績，我們將 2023 年調整後獲利前景上調至每股 24.85 美元至 25 美元。今天早上我們公佈的第三季營收成長了 14%，比去年同期增加了 110 億美元以上，證明了我們對持續長期成長前景的信心。這種成長的來源將推動未來多年的強勁業績。

Value-based care is the centerpiece of our long-term strategy, precisely because it delivers on the promise of high-quality clinical outcomes and experiences at lower cost than traditional models. This year, we expect Optum Health will serve more than 4 million people in fully accountable relationships, almost twice as many people as we served just 2 years ago. Many of these patients have serious health challenges, few economic resources and until now, often had limited access to care or the type of care they truly need.

基於價值的照護是我們長期策略的核心，正是因為它承諾以比傳統模式更低的成本提供高品質的臨床結果和體驗。今年，我們預計 Optum Health 將為超過 400 萬人提供完全負責任的關係服務，幾乎是我們兩年前服務人數的兩倍。這些患者中的許多人面臨著嚴重的健康挑戰，經濟資源很少，而且到目前為止，獲得護理或他們真正需要的護理類型的機會往往有限。

Ramping up to engage these patients require significant upfront investment and high-touch reach. These early efforts ensure we can address patients' unique needs and design personalized care plans that drive better health outcomes, increase quality of life and deliver cost savings throughout the health system. Making the investments to serve people who have endured far too many barriers to care is an easy choice for us all.

加大力度吸引這些患者需要大量的前期投資和高接觸範圍。這些早期努力確保我們能夠滿足患者的獨特需求並設計個人化護理計劃，從而推動更好的健康結果、提高生活品質並節省整個衛生系統的成本。對我們所有人來說，投資為那些經歷了太多護理障礙的人提供服務是一個簡單的選擇。

In 2023, you have seen both our commitment and financial capacity to invest to further enable our ability to serve and to grow far into the future. In recent years, we've invested significant resources in building our capabilities to care for people most effectively for the life or health stage they find themselves in, whether they need preventative or palliative care or are best served in a click at home or virtually.

2023 年，您已經看到了我們的投資承諾和財務能力，以進一步增強我們服務未來並實現長遠發展的能力。近年來，我們投入了大量資源來建立我們的能力，以便在人們所處的生命或健康階段最有效地為其提供護理，無論他們需要預防性護理還是姑息性護理，還是在家中或透過虛擬方式獲得最佳服務。

In particular, we're advancing our ability to care for people in their homes and integrating that physical care with our pharmacy and behavioral offerings. This work means developing an even more versatile clinical workforce to serve consumers in more ways through clinic-based Optum Care delivery capabilities and extending our reach to consumers who may not have ready access to physical clinics.

特別是，我們正在提高在家中照顧人們的能力，並將身體護理與我們的藥房和行為服務相結合。這項工作意味著開發一支更加多樣化的臨床人員隊伍，透過基於診所的Optum Care 交付能力以更多方式為消費者提供服務，並將我們的服務範圍擴大到那些可能無法立即前往實體診所的消費者。

Medicare Advantage continues to be a powerful force in driving superior health outcomes for consumers and in helping to lower costs at the system level. Today, about half of all seniors in the U.S. have chosen Medicare Advantage over traditional Medicare, and that number will continue to expand for very good reasons. The results are well documented. Medicare Advantage outperforms traditional fee-for-service for seniors on many measures, including lower rates of hospitalization. And they spend up to 45% less out of pocket compared to those in Medicare fee-for-service. Importantly, this high value for consumers is delivered at a lower cost to the health system.

Medicare Advantage 仍然是推動消費者獲得卓越健康成果並幫助降低系統層面成本的強大力量。如今，美國大約有一半的老年人選擇了 Medicare Advantage，而不是傳統的 Medicare，而這個數字將繼續擴大，這是有充分理由的。結果有據可查。醫療保險優惠在許多方面都優於傳統的按服務收費的老年人，包括較低的住院率。與 Medicare 按服務付費的人相比，他們的自付費用最多可減少 45%。重要的是，這種對消費者的高價值是以較低的衛生系統成本實現的。

UnitedHealthcare serves more people in high-quality 4 star and higher Medicare Advantage plans than any other organization. Looking to the 2024 enrollment period, which begins Sunday, we're confident our offerings will again resonate with consumers as they prioritize high-quality care and stable benefits.

與任何其他組織相比，UnitedHealthcare 為更多的人提供高品質的 4 星級和更高級別的 Medicare Advantage 計劃。展望週日開始的 2024 年註冊期，我們相信我們的產品將再次引起消費者的共鳴，因為他們優先考慮高品質的照護和穩定的福利。

In the reduced funding environment health plans face, I credit our teams for investing in the areas consumers value most, including $0 premium plans, no co-pays for primary, virtual and preventative care and no co-pay for hundreds of the most commonly prescribed drugs.

在健康計劃面臨資金減少的環境下，我相信我們的團隊在消費者最重視的領域進行了投資，包括0 美元保費計劃，初級、虛擬和預防性護理無需自付費用，以及數百種最常用處方的無自付費用藥物。

I want to highlight one more aspect of our growth story, the consistently strong performance of our pharmacy businesses. Pharmacy, as you know, is the most common consumer touch point in health care. What consumers and employers want more than anything is access to the most effective treatments in the moment they need them for the lowest possible cost.

我想強調我們成長故事的另一個方面，即我們的製藥業務持續強勁的業績。如您所知，藥局是醫療保健領域最常見的消費者接觸點。消費者和雇主最想要的是在需要時以盡可能低的成本獲得最有效的治療。

Optum Rx is delivering on those expectations. This most recent selling season is on track to be among our strongest, reflecting a combination of new clients and retention rates in the very high 90s. And as the coming season for 2025 develops, we're expecting another year of robust growth. Our clients tell us they value the enhancements we are making to our pharmacy offerings, providing them transparency and choice while also integrating new tools and capabilities. Notably, our pharmacy service offerings go far beyond the foundational benefit management capabilities and now account for about half of all Optum Rx revenues. We continue to expand the reach of our community pharmacies and our diverse specialty and infusion offerings are growing double digits.

Optum Rx 正在實現這些期望。最近的銷售季節有望成為我們最強勁的銷售季節之一，反映了新客戶和 90 年代極高的保留率的結合。隨著 2025 年即將到來的季節的發展，我們預計又是強勁成長的一年。我們的客戶告訴我們，他們重視我們對藥局產品所做的改進，為他們提供透明度和選擇，同時也整合了新的工具和功能。值得注意的是，我們的藥局服務產品遠遠超出了基本的福利管理能力，目前約佔 Optum Rx 所有收入的一半。我們不斷擴大社區藥局的覆蓋範圍，我們多樣化的專業產品和輸液產品正在以兩位數的速度成長。

Driving this expanding market demand is the enormous pressure facing employers, health plans, governments and others to manage and respond to manufacturer list pricing. The services offered by Optum Rx and others are the only counterbalance to drug company pricing. The foundational business objectives for PBMs is to lower costs and make medicines more affordable and accessible for individuals and families. PBMs are the only entities in the drug supply chain with that exclusive focus and incentive, and we're honored to play this critical role.

推動這一不斷擴大的市場需求的是雇主、健康計劃、政府和其他方面面臨的管理和應對製造商定價的巨大壓力。 Optum Rx 和其他公司提供的服務是製藥公司定價的唯一平衡。 PBM 的基本業務目標是降低成本並使個人和家庭更負擔得起和更容易獲得藥物。 PBM 是藥品供應鏈中唯一擁有這種專屬關注和激勵的實體，我們很榮幸能夠發揮這一關鍵作用。

These pillars of our growth, value-based care, pharmacy and our innovative benefits businesses, alongside our health technology and financial service capabilities underpin our ability to develop ever stronger value propositions for the people who receive and those who pay for care and support our confidence in a future of growth.

我們的成長、基於價值的護理、製藥和創新福利業務的這些支柱，以及我們的健康技術和金融服務能力，支撐著我們為接受護理的人和支付護理費用的人制定更強大的價值主張的能力，並支持我們的信心在未來的成長中。

And with that, I'll pass it to Dirk McMahon, our President and COO.

接下來，我會將其轉交給我們的總裁兼營運長 Dirk McMahon。

Thanks, Andrew. I recently hosted UnitedHealthcare's National Accounts Forum, where we bring together client leaders twice a year to share ideas and gather feedback. These are some of the biggest and most sophisticated companies in America that collectively employ and sponsor coverage for millions of people. And to no surprise, health care costs top their list of concerns, especially the rising cost of drugs. In addition, they want innovation, new tools to help their employees take full advantage of their benefits, achieve better health outcomes and save money. And of course, it has to be digital.

謝謝，安德魯。我最近主持了聯合醫療保健的國民帳戶論壇，我們每年兩次將客戶領袖聚集在一起，分享想法並收集回饋。這些是美國最大、最先進的公司，它們共同僱用和贊助數百萬人的保險。毫不奇怪，醫療保健成本是他們最關心的問題，尤其是不斷上漲的藥品成本。此外，他們需要創新、新工具來幫助員工充分利用福利、實現更好的健康成果並節省金錢。當然，它必須是數位化的。

Let me offer a few examples of innovation that have fueled our growth outlook, starting with our mobile platform, the primary access point for millions of UHC members. Each year, we add new capabilities to provide consumers with increased on-demand care access, highly personalized information about their benefits, real-time support, cost estimation tools, integrated pharmacy capabilities and enhanced rewards.

讓我舉幾個推動我們成長前景的創新範例，首先是我們的行動平台，這是數百萬 UHC 會員的主要接入點。每年，我們都會增加新的功能，為消費者提供更多的按需護理服務、有關其福利的高度個人化資訊、即時支援、成本估算工具、綜合藥房功能和增強的獎勵。

Another example, our newest and fastest-growing commercial offerings, which featured no annual deductibles and incentivize people to make good health care choices by offering an unprecedented view into quality and cost. When seeking care options, consumers see potential care providers' latest reviews and quality designations. And they see what they will actually pay for their care, which will help them make the most important decisions. UnitedHealthcare members and these offerings are receiving more preventative care while paying about 50% less out of pocket compared to people enrolled in traditional offerings, and their employers can reduce the total cost of care with an average savings of 11%. These results are why such new offerings are among our fastest growing.

另一個例子，我們最新且成長最快的商業產品，其特點是沒有年度免賠額，並透過提供前所未有的品質和成本視角來激勵人們做出良好的醫療保健選擇。在尋求護理選擇時，消費者會看到潛在護理提供者的最新評論和品質頭銜。他們會看到他們實際上將為他們的護理支付的費用，這將幫助他們做出最重要的決定。與參加傳統服務的人相比，UnitedHealthcare 會員和這些服務正在接受更多的預防性護理，同時自付費用減少約 50%，而且他們的雇主可以降低總護理成本，平均節省 11%。這些結果就是這類新產品成為我們成長最快的產品之一的原因。

Beyond these consumer-facing innovations, we're leveraging the latest technologies to create greater operational capacity and productivity so we can better serve consumers and focus on the highest value work. Our teams are significantly improving how quickly we respond to the millions of benefit questions we receive each year. We are using AI and natural language processing to expedite call documentation to rapidly generate accurate summaries of consumer interactions with our contact centers, saving millions of dollars in administrative work and freeing up capacity for our people to prioritize engagement.

除了這些面向消費者的創新之外，我們還利用最新技術來創造更大的營運能力和生產力，以便我們能夠更好地服務消費者並專注於最高價值的工作。我們的團隊正在顯著提高我們對每年收到的數百萬個福利問題的反應速度。我們正在使用人工智慧和自然語言處理來加快通話記錄，從而快速產生消費者與聯絡中心互動的準確摘要，從而節省數百萬美元的行政工作，並為我們的員工騰出能力來優先考慮參與。

We're also utilizing these technologies to translate and interpret unstructured data such as physician notes, which will help, for example, provide deeper insights for life sciences customers so they can better assess the efficacy of their treatments. Of course, these are just a few of the hundreds of AI applications powered by OptumInsight we are actively developing, testing and deploying today to further elevate the consumer and care provider experience while driving increased quality and lower costs.

我們也利用這些技術來翻譯和解釋非結構化數據，例如醫生筆記，這將有助於為生命科學客戶提供更深入的見解，以便他們更好地評估治療效果。當然，這些只是 OptumInsight 支援的數百個人工智慧應用程式中的一小部分，我們今天正在積極開發、測試和部署，以進一步提升消費者和護理提供者的體驗，同時提高品質並降低成本。

And with that, I'll turn it over to our CFO, John Rex.

接下來，我會將其交給我們的財務長 John Rex。

Thank you, Dirk. The Growth we reported today is a direct result of investments made over many years to develop and connect the diverse health capabilities needed to serve the people who rely on us each day, while also creating the foundational capacity to serve millions more in the years ahead. This capability development has long been in the making and is still very much underway as the opportunities to serve more people more deeply continue to expand.

謝謝你，德克。我們今天報告的成長是多年來投資的直接結果，這些投資旨在開發和連接為每天依賴我們的人們提供服務所需的多樣化衛生能力，同時也創造了在未來幾年為數百萬人提供服務的基礎能力。這種能力的發展長期以來一直在醞釀中，隨著更深入地服務更多人的機會不斷擴大，這種能力的發展仍在進行中。

Before reviewing our business results, I'll offer a few brief comments on care activity. Care patterns remain consistent with the view we shared during the second quarter, with activity levels still led by outpatient care for seniors and still most notably in the orthopedic and cardiac procedure categories. These trends remain stable at the levels we previously described. As we've noted, our outlook assumes these activity levels persist throughout next year.

在回顧我們的業務成果之前，我將就護理活動提供一些簡短的評論。護理模式與我們在第二季度分享的觀點保持一致，活動水平仍然以老年人門診護理為主，尤其是骨科和心臟手術類別。這些趨勢保持穩定在我們之前描述的水平。正如我們所指出的，我們的展望假設這些活動水準將持續到明年。

We continuously monitor a broad spectrum of patient acuity levels and have yet to see any other notable changes. For example, within oncology, the average stage at which we are first seeing cancer diagnoses remains consistent with historical patterns. As always, we remain diligent in looking for changes to the underlying health of patients.

我們持續監測廣泛的患者病情嚴重程度，但尚未看到其他顯著變化。例如，在腫瘤學領域，我們首次看到癌症診斷的平均階段與歷史模式一致。一如既往，我們仍然努力尋找患者基本健康狀況的改變。

With that, let's turn to our third quarter results. Revenues of $92.4 billion grew by 14% over the prior year, with double-digit growth again at both Optum and UnitedHealthcare. Optum Health revenues grew by 29%, approaching $24 billion, driven by an increase in the number of care services we offer and patients we serve, especially for those with complex care needs.

接下來，讓我們來看看第三季的業績。營收為 924 億美元，比上年增長 14%，Optum 和 UnitedHealthcare 再次實現兩位數成長。 Optum Health 收入增加了 29%，接近 240 億美元，這得益於我們提供的護理服務和服務的患者數量的增加，尤其是那些有複雜護理需求的患者。

Operating margins continue to reflect the initial clinical engagement activities that support the strong growth in patients we have realized this year as well as the higher care activity patterns we have discussed. Optum Rx revenues grew by 14%, approaching $29 billion, driven by the strength in our pharmacy care services offerings as well as new customer wins. Script growth of nearly 7% reflects customer response to our innovative solutions, which focus on choice and lowest net cost.

營業利潤率繼續反映了最初的臨床參與活動，這些活動支持我們今年實現的患者數量的強勁增長，以及我們討論的更高的護理活動模式。在我們藥局護理服務產品的實力以及贏得新客戶的推動下，Optum Rx 收入成長了 14%，接近 290 億美元。近 7% 的腳本成長反映了客戶對我們創新解決方案的反應，該解決方案注重選擇和最低的淨成本。

OptumInsight revenues grew by 35% to $5 billion. Revenue backlog of over $31 billion increased by more than $7 billion in part due to the change health care combination. In addition, we recently announced a partnership to provide revenue cycle, analytics and information technology services to a health system serving more than 400,000 people in the Midwest.

OptumInsight 營收成長 35%，達到 50 億美元。超過 310 億美元的積壓收入增加了超過 70 億美元，部分原因是醫療保健組合的變化。此外，我們最近宣佈建立合作夥伴關係，為中西部超過 40 萬人的醫療系統提供收入週期、分析和資訊科技服務。

Turning to UnitedHealthcare. Our commercial business added nearly 700,000 people through the third quarter. Further, selling season indications are tracking favorably, particularly in national accounts. So as '24 begins, we expect to grow to serve an additional 1 million people with commercial benefits.

轉向聯合醫療保健。截至第三季度，我們的商業業務增加了近 70 萬人。此外，銷售季節的跡像也很樂觀，特別是在國民帳戶中。因此，隨著 24 世紀的到來，我們預計將能夠為另外 100 萬人提供服務並帶來商業利益。

Within our public sector programs, we expect growth of nearly 1 million Medicare Advantage members this year. And looking to the year ahead, we're encouraged by the consumer value, stability and breadth of our offerings. And as always, we start with an expectation that we will outpace overall market growth.

在我們的公共部門計畫中，我們預計今年將增加近 100 萬名 Medicare Advantage 會員。展望未來的一年，我們產品的消費者價值、穩定性和廣度讓我們深受鼓舞。一如既往，我們一開始就期望我們將超過整體市場的成長。

Our Medicaid performance remains strong as we support people and families through the redeterminations process. Our teams are really leaning in, speaking with thousands of consumers each day. Through a comprehensive outreach program, we are helping people navigate the process and connecting them with the resources they need to retain or reinstate their health benefits or to help them find other affordable coverages. A significant majority of the people we engage with are able to retain or reinstate their coverage.

我們的醫療補助表現仍然強勁，因為我們透過重新確定流程為人們和家庭提供支援。我們的團隊確實在努力，每天與數千名消費者交談。透過全面的外展計劃，我們正在幫助人們順利完成整個流程，並將他們與保留或恢復健康福利所需的資源聯繫起來，或幫助他們找到其他負擔得起的保險。我們接觸的絕大多數人都能夠保留或恢復他們的保險。

Our capital capacities remain strong. For the first 9 months of the year, adjusted cash flows from operations were at $22.4 billion or 1.3x net income. And in that same time frame, we returned over $11.5 billion to shareholders through dividends and share repurchases.

我們的資本能力依然強勁。今年前 9 個月，調整後的營運現金流為 224 億美元，相當於淨利的 1.3 倍。在同一時間範圍內，我們透過股利和股票回購向股東返還了超過 115 億美元。

As noted, given the strength of our business performance, this morning, we have updated our '23 outlook for adjusted earnings to $24.85 to $25 per share. And as we finish strongly in '23 and look forward to '24, we're intensely focused on execution while further expanding our capacity to serve more people more deeply and building the foundations to support our growth objectives for years to come.

如前所述，鑑於我們的業務表現強勁，今天上午，我們將 23 年調整後收益展望更新為每股 24.85 美元至 25 美元。隨著我們在 23 年取得優異成績並展望 24 年，我們高度重視執行力，同時進一步擴大我們為更多人提供更深入服務的能力，並為支持我們未來幾年的成長目標奠定基礎。

Now I'll turn it back to Andrew.

現在我會把它轉回給安德魯。

Thanks, John. Before opening up for questions, I'll offer some preliminary observations about next year while reserving most of this conversation for our investor conference on November 29. Our businesses continue to build momentum, while maintaining flexibility and adaptability for an ever-changing landscape even as we invest for the future. We're focused on our strategic growth pillars and driving efficiencies throughout the enterprise at an accelerated pace.

謝謝，約翰。在開始提問之前，我將提供一些對明年的初步看法，同時將大部分對話保留在11 月29 日的投資者會議上。我們的業務繼續發展勢頭，同時保持靈活性和適應性，以適應不斷變化的環境，即使我們為未來投資。我們專注於我們的策略成長支柱並加速提高整個企業的效率。

At this distance, analyst earnings estimates for 2024 reasonably reflect the performance view we expect to offer in November with consensus near the upper end of our likely initial outlook range. Importantly, the growth we're realizing today and our expanding capacity served to further reinforce the confidence we have in our long-term 13% to 16% growth objective.

在這個距離上，分析師對 2024 年的獲利預測合理地反映了我們預計 11 月提供的業績觀點，並在我們可能的初始展望範圍的上限附近達成了共識。重要的是，我們今天實現的成長和產能的擴大進一步增強了我們對 13% 至 16% 長期成長目標的信心。

And with that, I'll now ask the operator to open up for questions.

現在，我將請接線員提出問題。

(Operator Instructions) We'll go first to Lisa Gill with JPMorgan.

（操作員指示）我們先去找摩根大通的麗莎‧吉爾。

I wanted to start with GLP-1s and really understand from 2 sides. One, when we think about rates for 2024, can you talk about what you've incorporated in rates around GLP-1s, especially around weight loss as we have new products coming to the market? And how do I think about that from the PBM side when we think about the services that you can wrap around that and sell from a PBM perspective?

我想從 GLP-1 開始，從兩個方面真正理解。第一，當我們考慮 2024 年的費率時，您能否談談您在 GLP-1 相關費率中納入的內容，尤其是隨著我們有新產品上市而在減肥方面的費率？當我們考慮可以圍繞該問題並從 PBM 角度銷售的服務時，我如何從 PBM 角度考慮這一點？

Lisa, thanks so much for the question. In a second, I'll ask Brian Thompson from UHC and Dr. Patrick Conway to respond to your comments in a little more detail. But let me just preface all of that. The thing we're most overall focused on GLP-1 space is, honestly, the pricing. We're very positive about the potential for another tool in the toolbox to help folks manage their weight. We recognize that has potential benefits. But we're struggling. And frankly, our clients are struggling with the list prices, which have been demanded of these products in the U.S., which are running at about 10x the level of price which have been paid in Western Europe. So overall, I'd say that is our focus is to try and find a way to make this a sustainable and affordable space for our clients to support.

麗莎，非常感謝你的提問。稍後，我將請 UHC 的 Brian Thompson 和 Patrick Conway 博士更詳細地回應您的評論。但讓我先介紹一下這一切。老實說，我們最關注 GLP-1 領域的是定價。我們對工具箱中另一個工具幫助人們管理體重的潛力非常樂觀。我們認識到這具有潛在的好處。但我們正在掙扎。坦白說，我們的客戶正在努力應對這些產品在美國的標價，這些產品的價格約為西歐價格水準的 10 倍。總的來說，我想說，我們的重點是嘗試找到一種方法，使其成為一個可持續且負擔得起的空間，供我們的客戶支持。

With that said, let me ask Brian to give you a perspective from UHC and how they've incorporated this in their forward view.

話雖如此，讓我請 Brian 向您介紹 UHC 的觀點以及他們如何將其納入他們的前瞻性觀點中。

Sure. Thanks for the question there, Lisa. First, to put in context, GLP-1s, over 80% on the diabetic side. So as we think about weight loss, up to maybe 20% of our total spend. And it's largely performing in line with what we had planned as we went into '23, and we feel very confident and comfortable about how we're looking at that going forward into '24. As you think about it, keep in mind, the vast majority of the coverage here is in our fee-based business. That's our self-employed customers, and that's still at less than 1/3, around 30% of our book.

當然。謝謝你的提問，麗莎。首先，就背景而言，GLP-1 超過 80% 屬於糖尿病患者。因此，當我們考慮減重時，可能會占到我們總支出的 20%。它的表現很大程度上符合我們進入 23 年時的計劃，我們對進入 24 年的前景感到非常有信心和放心。當您想到這一點時，請記住，這裡的絕大多數覆蓋範圍都是我們的收費業務。那是我們的自營客戶，但仍然不到我們帳簿的 1/3，大約 30%。

As we look forward, our customers considering to cover more or less. I would say it's a mixed bag. Some are seeking coverage, albeit dissatisfied with the price points. Some are backing off given the cost. But I wouldn't really be directional one way or the other on whether or not we're seeing more or less coverage on the weight less side as we look forward. But again, to Andrew's point, beyond just getting to the obvious lower price points, we're really trying to work with manufacturers to get to some aligned value-based constructs, getting pricing to a point where it's based on outcomes and adherence levels all the way to outright risk on utilization levels and pairing those with therapies and programs that can put less reliance on lifelong adherence requirements like these drugs currently have. We're not there yet. We're optimistic that we can get there. But clearly, price point is a key barrier.

展望未來，我們的客戶會考慮或多或少地覆蓋。我想說這是一個混合體。儘管對價格不滿意，但有些人正在尋求保險。考慮到成本，有些人正在退縮。但對於我們未來是否會看到更多或更少的減重方面的報道，我不會真正以某種方式進行指導。但同樣，安德魯的觀點是，除了達到明顯較低的價格點之外，我們確實在努力與製造商合作，以實現一些基於價值的一致結構，使定價達到基於結果和遵守水平的水平。如何徹底降低使用水平的風險，並將這些藥物與可以減少對終生依從性要求的依賴的療法和計劃相結合，就像這些藥物目前所具有的那樣。我們還沒到那兒。我們對能夠實現這一目標感到樂觀。但顯然，價格是一個關鍵障礙。

Brian, thanks so much. And Patrick, maybe from the -- from Optum Rx perspective, you could talk a little bit about the broader approaches we take.

布萊恩，非常感謝。 Patrick，也許從 Optum Rx 的角度來看，您可以談談我們採取的更廣泛的方法。

Thank you. As Andrew said, our customers, payers, employers, people we serve are concerned about the prices of GLP-1s as set by manufacturers. OptumRx will continue to negotiate lower prices through discounts over time, be transparent with our customers and implement clinical evidence-based guidelines so the right people get appropriate medicines.

謝謝。正如安德魯所說，我們的客戶、付款人、雇主、我們服務的人們都關心製造商設定的 GLP-1 價格。 OptumRx 將繼續透過長期折扣來協商更低的價格，對客戶保持透明，並實施基於臨床證據的指南，以便合適的人獲得合適的藥物。

And as you alluded to, Lisa, obesity and cardiometabolic disease is a major public issue -- health issue in the U.S. And across all of Optum, we are developing and implementing comprehensive solutions, of which medicines are only a part of on behalf of our clients and people we serve to drive better health outcomes for all and value to the health system.

正如你所提到的，麗莎，肥胖和心臟代謝疾病是一個重大的公共問題——美國的健康問題。在整個 Optum，我們正在開發和實施全面的解決方案，其中藥物只是代表我們的一部分。我們服務的客戶和人們致力於為所有人帶來更好的健康成果，並為衛生系統創造價值。

Thanks, Patrick. And Lisa, thanks so much for the question.

謝謝，派崔克。麗莎，非常感謝你的提問。

We'll go next to A.J. Rice with UBS.

我們會去 A.J. 旁邊。賴斯與瑞銀。

Similar to last quarter, the trend in margin in Optum Health and OptumInsight has been down year-to-year. I know you've called out change, particularly with OptumInsight. But I wondered if there's any ability to discuss unusual items, nonrecurring items. I know you said you had some cost reduction programs you were implementing this quarter in Optum Health. Did those impact the results? And is there any change as you look ahead to '24 and your margin expectations or targets for those 2 businesses?

與上季類似，Optum Health 和 OptumInsight 的利潤率趨勢年減。我知道您已經呼籲進行變革，尤其是 OptumInsight。但我想知道是否有能力討論不尋常的項目、非經常性的項目。我知道您曾說過本季您在 Optum Health 實施了一些成本削減計劃。這些對結果有影響嗎？展望 24 年，您對這兩項業務的利潤預期或目標是否會發生任何變化？

A.J., thanks so much for the question. I appreciate it. So let me just make a few comments, particularly as it speaks to the Optum Health part of the question that you raised. So as you look at 2023, essentially, what we've seen and we referred to this in Q2, greater growth in the number of people, patients that we've been privileged to serve this year, particularly the more complex patients. So very strong. And you heard in our opening commentary, very strong growth in the number of fully accountable lives running at about 900,000. Substantial fraction of that coming into more complex cases.

A.J.，非常感謝你的提問。我很感激。因此，讓我發表一些評論，特別是它涉及您提出的問題中的 Optum Health 部分。因此，當你展望 2023 年時，本質上是我們所看到的，我們在第二季度提到了這一點，我們今年有幸服務的人數和患者數量將出現更大增長，特別是更複雜的患者。所以非常強。你們在我們的開場評論中聽到，完全負責任的生命數量增長非常強勁，達到約 90 萬人。其中很大一部分涉及更複雜的情況。

As I said back in the last call, we're very, very pleased to have that growth that we believe that is really foundational or a key foundation for future long-term growth of the business. However, within that, the mix of that population is a little different than what we expected. That takes time to then build the engagement capabilities that we need to be able to work with those people and their care providers to ensure the very best care is delivered the most efficient and effective way.

正如我在上次電話會議中所說，我們非常非常高興能夠實現這種成長，我們認為這是業務未來長期成長的真正基礎或關鍵基礎。然而，其中的人口結構與我們的預期略有不同。這需要時間來建立我們需要能夠與這些人及其護理提供者合作的參與能力，以確保以最高效和最有效的方式提供最佳的護理。

And that's really the bulk of the investment that we're talking about. It's really taking the time, looking after those folks in the way they need to be looked after right now in advance of us being able to engage with them fully and deliver them the various interventions and advices that we can provide that we're really building throughout Optum to ensure that not just in 1 year, but over multiple years, those folks get increasingly better care delivery and better outcomes.

這確實是我們正在談論的投資的大部分。這確實需要時間，以他們現在需要的方式照顧這些人，然後我們才能與他們充分接觸，並向他們提供我們可以提供的我們正在真正建立的各種幹預措施和建議整個Optum 確保不僅在一年內，而且在多年內，這些人都能獲得越來越好的照護服務和更好的結果。

And recall that these patients, in many cases, have really been somewhat not necessarily looked after as well as they could have been by the system because of their very complexity. In some cases, they're not able to get to clinics, which is why we build -- been building up our home care capabilities and other wraparound services to the classic clinic approach. That's really the driving force.

回想一下，在許多情況下，這些患者實際上並沒有得到系統應有的照顧，因為他們非常複雜。在某些情況下，他們無法前往診所，這就是我們建立家庭護理能力和其他傳統診所方法的全方位服務的原因。這確實是驅動力。

Now as that speaks to the future, 2 things really, A.J. One is we are super confident around our ability to continue to grow the number of patients who were able to look after. Number two, as those capabilities that have been accelerated during this year begin to affect the -- both the quality positively and the cost of how these patients care is delivered, you're going to see that shine through an improved economic performance of Optum Health. And as we look forward, we're very confident about continued strengthening of that business. Make no mistake, Optum Health is having a very strong growth year, and we're taking the opportunity this year to really ready ourselves and build strength for the next many years of that business. A.J., thanks so much for the question.

現在，說到未來，確實有兩件事，A.J.一是我們對持續增加能夠照顧的患者數量的能力充滿信心。第二，隨著今年加速的這些能力開始影響——無論是積極的品質還是提供這些患者護理的成本，您將看到 Optum Health 經濟績效改善的光芒。展望未來，我們對持續加強該業務充滿信心。毫無疑問，Optum Health 將迎來非常強勁的成長年，我們將抓住今年的機會，為未來幾年的業務做好真正的準備並增強實力。 A.J.，非常感謝你的提問。

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

接下來我們將訪問 Nephron Research 的 Josh Raskin。

Understanding that you expect Medicare Advantage to grow at a healthy pace, I think you said above market again in 2024. Could you speak to that progress expected at Optum Health? I know we'll get details at the Investor Day, but how are you thinking about the transition of patients from sort of fee-for-service to these fully risk engagements? And then maybe general levels of investment for growth in light of the risk model and reimbursement model changes.

了解您預計 Medicare Advantage 將以健康的速度成長，我認為您在 2024 年再次高於市場水平。您能談談 Optum Health 預期的進展嗎？我知道我們會在投資者日獲得詳細信息，但您如何看待患者從按服務付費到這些完全風險的服務的轉變？然後，考慮到風險模型和報銷模型的變化，可能會出現整體成長投資水準。

So Josh, thanks so much for the question. I mean, obviously, we'll leave very much the detail of the elements of the growth model for when we meet with you all in November. I mean, having said that, we would no reason not to expect a continued healthy momentum in our move toward value-based care next year with continued high expectations for our ability to deliver that.

喬什，非常感謝你提出這個問題。我的意思是，顯然，我們會將成長模型要素的大部分細節留到 11 月與大家見面時再討論。我的意思是，話雖如此，我們沒有理由不期待明年我們向基於價值的護理邁進的持續健康勢頭，並對我們實現這一目標的能力繼續抱有很高的期望。

To your broader question, maybe just reflect a little bit again on 2023. So this has been a year which essentially has been obviously very heavily influenced by the change in the funding environment that was announced earlier in the year for Medicare Advantage. And we're very appreciative of the 3-year phase-in of the changes, which CMS ultimately decided to make. But obviously, those changes are essentially the equivalent to a price cut phased in over 3 years for the Medicare Advantage program.

對於您更廣泛的問題，也許只是再次思考 2023 年。因此，這一年本質上顯然受到今年早些時候宣布的 Medicare Advantage 融資環境變化的嚴重影響。我們非常感謝 CMS 最終決定進行為期 3 年的逐步實施的變革。但顯然，這些變化本質上相當於 Medicare Advantage 計劃在 3 年內分階段降價。

We're appreciative of the fact that we've had essentially 7, 8, 9 months warning of that in terms of when that was announced before we go into the '24 year. And that's allowed us, and we've taken full advantage of it to really focus on how we ready ourselves not just for 2024, but for the next 36 months. So 2023 has all for us been about ensuring that we reengineer our cost base, that we refocused our benefit strategies to those things that matter most to patients, that we strengthen and invest in our ability to manage affordability of care going forward into the system and that we're taking full advantage of building the capabilities we have already begun to construct around our consumer engagement, our technology, digital-first capabilities and ultimately doubling down on our commitment to value-based care.

我們很高興看到，在進入「24 年」之前，我們已經提前 7、8、9 個月就宣布這一點發出了警告。這讓我們能夠充分利用這一點，並真正專注於如何為 2024 年以及未來 36 個月做好準備。因此，2023 年對我們來說，我們要做的就是確保重新設計我們的成本基礎，將我們的福利策略重新集中到對病人最重要的事情上，加強和投資於管理系統中未來護理負擔能力的能力，以及我們正在充分利用我們已經開始圍繞消費者參與、技術、數位優先能力構建的能力，並最終加倍我們對基於價值的護理的承諾。

That has really been the story behind the investments of 2023 in response to the changes that have been signaled by CMS, so that we go into '24, '25, '26, '27 feeling strong, feeling that we've taken advantage of these last several months to ensure that we've adjusted and adapted our strategy and business in readiness for the change in the funding environment, which gives us strong confidence for next year and underpins our commitment to the signal I just gave you in terms of our potential for 2024.

這確實是 2023 年投資背後的故事，以響應 CMS 所發出的信號變化，因此我們進入“24”、“25”、“26”、“27”時感覺很強大，感覺我們已經利用了在過去的幾個月裡，我們確保我們調整和調整我們的策略和業務，為融資環境的變化做好準備，這給了我們對明年的堅定信心，並鞏固了我們對我剛才向你們發出的信號的承諾2024 年的潛力。

Next to Justin Lake with Wolfe Research.

毗鄰賈斯汀·萊克（Justin Lake）和沃爾夫研究中心（Wolfe Research）。

I wanted to ask about UHC performance. First, your MLR was better than our expectations, but curious how it compared to your internal estimates. And maybe you could share how that might have come across -- come in across the 3 main business segments?

我想問一下全民健康覆蓋（UHC）的表現。首先，你們的 MLR 比我們的預期要好，但很好奇它與你們的內部估計相比如何。也許您可以分享這可能是如何發生的——涉及到 3 個主要業務部門？

And then quickly, on the third quarter UAC margins, I found it interesting that while the MLR deteriorated by 50 basis points year-over-year in the quarter. Overall, UHC margins actually improved by 50 basis points. So curious what might have drove that.

然後很快，在第三季 UAC 利潤率上，我發現有趣的是，儘管該季度 MLR 年減了 50 個基點。總體而言，UHC 利潤率實際上提高了 50 個基點。很好奇是什麼推動了這一點。

Justin, thanks so much for the question. Let me ask John Rex to respond to the first part, and then Brian Thompson the second.

賈斯汀，非常感謝你的提問。讓我請約翰·雷克斯回答第一部分，然後請布萊恩·湯普森回答第二部分。

Justin. So overall, I'd call it broadly consistent with our expectations in terms of the third quarter. So a few things I'd like to highlight though. So care patterns were, as we discussed, focused again on outpatient activity with seniors. Those continue at the levels we described during the second quarter. And that's what really drove a lot of kind of the activity throughout the quarter. It's still in those categories that we have been focused on.

賈斯汀.總的來說，我認為它與我們對第三季的預期大致一致。所以我想強調一些事情。因此，正如我們所討論的，護理模式再次集中在老年人的門診活動。這些繼續保持在我們在第二季度描述的水平。這才是整個季度許多活動的真正推動力。它仍然屬於我們一直關注的類別。

The sequential move that you see from second quarter to third quarter is largely a seasonal factor. As you know well, there's always less care activity in a third quarter. That has to do just with vacations, a lot of the elements that go in there in terms of certain types of discretionary care, seasonal illnesses. So typical patterns and also Part D patterns that you see on a regular basis. In fact, if you go back to the years prior to 2020, 2Q would typically be the lowest care ratio quarter. So I'd say it's probably more typical than not, just getting back to periods that were more normalized in terms of the activities that we saw going on there.

從第二季到第三季的連續變化很大程度上是季節性因素。如您所知，第三季的護理活動總是較少。這與假期有關，其中涉及某些類型的酌情護理、季節性疾病等許多因素。這是您經常看到的典型模式和 D 部分模式。事實上，如果你回顧 2020 年之前的幾年，第二季通常是護理比率最低的季度。所以我想說，這可能比不更典型，只是回到我們所看到的活動更正常化的時期。

We continue to expect our full year medical care ratio will be -- toward the upper end of our initial 82.6%, plus/minus 50 basis point range. So very consistent with the level that we set out there back again toward the upper end of that outlook.

我們繼續預計全年醫療保健比率將接近最初 82.6% 的上限，正負 50 個基點範圍。與我們再次設定的水平非常一致，接近該前景的上限。

So -- and then the seasonal factors in the 3Q, some of those things influencing where you'd expect to be in the fourth quarter, the final quarter of the calendar year. Certainly, utilization Part D impacts. They move the other direction in the fourth quarter. So typical in that. That's amplified, of course, very much by the deductible wearout features that you see in the fourth quarter, influenza, RSV, all those patterns that come in. So we'd expect that to move the other direction here as we go into the 4Q.

那麼，然後是第三季的季節性因素，其中一些因素會影響您對第四季度（即日曆年最後一個季度）的預期。當然，D 部分的利用率會產生影響。他們在第四節轉向了另一個方向。非常典型。當然，你在第四季度看到的免賠額磨損特徵、流感、RSV 以及所有出現的這些模式在很大程度上放大了這一點。因此，當我們進入第四季度時，我們預計這會朝另一個方向發展。 。

Great. Thanks, John. And Brian?

偉大的。謝謝，約翰。布萊恩呢？

Yes. John, I think you did a good job of explaining sort of the sequencing of the medical cost ratio. What I don't want to lose sight of is I think the key point is all of our businesses in UnitedHealthcare right now are really demonstrating innovation and market success at the same time. And you're seeing that come through in these margins, whether that's our complex care and health equity strategy in Medicaid, how we're showing up with broader service offerings and conveniences like UCard and URide in MA to complement strong, stable core benefits or some of the innovations you heard around the commercial benefits in Dirk's opening remarks. This is really translating into the type of growth and performance that I think you've come to expect from UnitedHealthcare, and I think it sets up a really nice baseline that I remain optimistic about as we look forward to 2024.

是的。約翰，我認為你很好地解釋了醫療費用比率的排序。我不想忽視的是，我認為關鍵的一點是，我們聯合醫療保健的所有業務現在都真正同時展示了創新和市場成功。你會看到這些利潤的實現，無論是我們在醫療補助中複雜的護理和健康公平策略，還是我們如何在馬薩諸塞州提供更廣泛的服務產品和便利，例如馬薩諸塞州的UCard 和URide，以補充強大、穩定的核心福利，或是您在德克的開場白中聽到的一些圍繞商業利益的創新。這確實轉化為我認為您對聯合醫療保健的期望的增長和業績類型，並且我認為它建立了一個非常好的基線，在我們展望 2024 年時我對此保持樂觀。

Thank so much, Brian and John.

非常感謝，布萊恩和約翰。

The next to Stephen Baxter with Wells Fargo.

下一個是富國銀行的史蒂芬·巴克斯特。

I wanted to ask about the PBM business, obviously, interest in alternative or maybe even experimental models has been a big area of the base in the past quarter or so. I guess what are you hearing from your health plan and employer clients on their degree of interest in doing something totally transformational in terms of how they manage those benefits?

我想詢問 PBM 業務，顯然，在過去的一個季度左右，對替代甚至實驗模型的興趣一直是基地的一個重要領域。我想您從您的健康計劃和雇主客戶那裡聽到了什麼關於他們對如何管理這些福利方面進行徹底變革的興趣程度？

Stephen, thanks so much. Let me ask Patrick Conway to respond to that.

史蒂芬，非常感謝。讓我請派崔克·康威對此做出回應。

Yes. So as we interact with our clients, employers, payers and others on this, first, I'll note a recent survey came out approximately 90% of those clients are satisfied with their PBM. They're also satisfied with the level of transparency. Specifically for Optum Rx, we will continue to innovate and provide additional solutions to our clients that are comprehensive, integrated and transparent.

是的。因此，當我們與客戶、雇主、付款人和其他人就此互動時，首先我要指出的是，最近的一項調查顯示，大約 90% 的客戶對他們的 PBM 感到滿意。他們對透明度水平也感到滿意。特別是對於 Optum Rx，我們將繼續創新，為客戶提供全面、整合和透明的額外解決方案。

I'll call out one other area, transparency to the consumer. This has been a journey for us that we continue to drive transparency to the consumer to call out. One example was Price Edge, a product recently launched, that's providing consumers the most affordable medicine at the point of care. We are seeing millions of consumers access use this tool as we provide it to them. And so you'll continue to see us to drive consumer transparency and innovative solutions to our clients.

我將提到另一個領域，即對消費者的透明度。這對我們來說是一段旅程，我們將繼續向消費者呼籲提高透明度。一個例子是最近推出的 Price Edge 產品，它為消費者提供最實惠的護理藥品。我們看到數以百萬計的消費者使用我們提供給他們的這個工具。因此，您將繼續看到我們為客戶提高消費者透明度和創新解決方案。

Great. Patrick, thanks so much.

偉大的。派崔克，非常感謝。

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)。

I wanted to go back to the GLP-1 class. And I guess, as we're starting to see more outcomes data for these drugs, do you see that changing employers' willingness to cover this class given the potential long-term benefits? And how are you helping them think about potential ways to design the benefit to be able to manage that cost, which you guys talked about earlier being so much in focus for employers?

我想回到 GLP-1 課程。我想，當我們開始看到更多這些藥物的結果數據時，考慮到潛在的長期利益，您是否認為雇主承保此類藥物的意願正在改變？你們如何幫助他們思考設計福利的潛在方法，以便能夠管理該成本，你們之前談到這是雇主非常關注的？

Yes, Nathan, thanks so much for the question. I mean there's an old adage which I quite like in this context, which is the innovation that is not affordable is not innovative. And that's really the key to all of this. So I have no argument. I don't think anybody at UnitedHealth Group has any argument with the prospects and possibility for the future of this drug class. And we recognize the need, and nothing would make us happier, honestly, to be able to lean forward and see more and more folks take advantage of these sorts of opportunities.

是的，內森，非常感謝你的提問。我的意思是，在這方面我非常喜歡一句古老的格言，那就是負擔不起的創新不是創新。這確實是所有這一切的關鍵。所以我沒有什麼好爭論的。我認為聯合健康集團的任何人都對此類藥物的未來前景和可能性沒有任何異議。我們認識到這種需求，老實說，沒有什麼能讓我們更高興能夠向前邁進並看到越來越多的人利用這些機會。

But ultimately, it has to be affordable. And what we're hearing from our clients is they just -- they are really struggling to see how they embark on that journey of what they regard as a kind of open-ended financial risk. Now that's exactly why Brian earlier made the comment we did about we're trying to put forward 2 various manufacturers, a variety of different options, but we need the manufacturers to move. It's as simple as that. And we remain extremely open-minded to any model that works. We're working with our clients to ensure that they understand the various options. But they are giving us very, very, very clear signals. They need our help to make this a more affordable proposition for their employees and their members, and we'll continue to lean into that. Thanks for the question, Nathan.

但最終，它必須是負擔得起的。我們從客戶那裡聽到的是，他們真的很努力地想知道如何踏上他們認為是開放式財務風險的旅程。這正是布萊恩早些時候發表評論的原因，我們正在嘗試提出兩個不同的製造商，各種不同的選擇，但我們需要製造商採取行動。就這麼簡單。我們對任何可行的模式都保持極為開放的態度。我們正在與客戶合作，確保他們了解各種選擇。但他們給了我們非常、非常、非常明確的訊號。他們需要我們的幫助，使其成為他們的員工和會員更負擔得起的建議，我們將繼續致力於這一點。謝謝你的提問，內森。

The next to Scott Fidel with Stephens.

接下來是斯科特·菲德爾和史蒂芬斯。

Curious if you can give us your updated thoughts on -- from this vantage point, what you're thinking about the trajectory of just overall wage inflation in health care and how you're sort of planning for that. We had been seeing sort of moderation from the COVID peaks, but there certainly seems to be some pro inflationary risks out there when thinking about some of the federal policy proposals, state proposals and then obviously some of these union actions, too. So just curious on how you're thinking about wage inflation and health care moving forward and risks to that inflecting back upwards.

很好奇您能否從這個有利的角度向我們提供您的最新想法，您對醫療保健領域總體工資通膨的軌跡有何看法，以及您對此有何計劃。我們已經看到新冠疫情高峰有所放緩，但在考慮一些聯邦政策提案、州提案以及顯然還有一些工會行動時，似乎肯定存在一些助長通膨的風險。因此，我只是好奇您如何看待薪資通膨和醫療保健的發展以及其回升的風險。

Yes, absolutely. Thanks so much for the question. Let me ask Dirk to give you a few comments on that.

是的，一點沒錯。非常感謝您的提問。讓我請德克對此發表一些評論。

Yes. Well, to start, what I would say as we go out and we negotiate with various health systems for prices as we move forward, one of the key things involved in those discussions is what wage inflation is and how it's impacting your cost. As we sit here today, it's lucky that we sort of have 3-year contracts, so it's muted a little bit. But what I would also say is we see a little bit of upward pressure on unit costs related to wages. But as I sit here today, it's not something that we haven't planned for and priced about.

是的。好吧，首先，當我們出去與各個衛生系統就價格進行談判時，我要說的是，這些討論中涉及的關鍵問題之一是工資通膨是什麼以及它如何影響您的成本。當我們今天坐在這裡時，幸運的是我們有 3 年的合同，所以它有點安靜。但我還要說的是，我們看到與工資相關的單位成本有一點上行壓力。但當我今天坐在這裡時，這並不是我們沒有計劃和定價的事情。

As I think about our own business, we haven't had trouble recruiting people such as nurses, clinicians. We've actually -- people really want to work for us. And from a capacity perspective, one of the things, as we've talked about our growth so far, we have to make sure we have the appropriate labor capacity to manage all the risks that we take. And as a consequence, we do spend a lot of time looking at the market. And as I said, people want to come to work for us. They like the mission. They like the ability to transform health care. And we're pretty pleased with our ability to hire and manage our operations going forward.

當我想到我們自己的業務時，我們在招募護士、臨床醫生等人員方面沒有遇到困難。事實上，人們真的想為我們工作。從能力的角度來看，其中一件事是，正如我們到目前為止所討論的成長一樣，我們必須確保我們擁有適當的勞動力能力來管理我們所承擔的所有風險。因此，我們確實花了很多時間觀察市場。正如我所說，人們想來為我們工作。他們喜歡這個使命。他們喜歡改變醫療保健的能力。我們對未來僱用和管理營運的能力感到非常滿意。

Thanks, Dirk. Thank you very much for the question.

謝謝，德克。非常感謝你的提問。

The next to Kevin Fischbeck with Bank of America.

下一個是美國銀行的凱文‧菲施貝克 (Kevin Fischbeck)。

Great. I wanted to ask about Optum Health. I understand the commentary about membership coming in better, which creates a margin drag. But it feels like a couple of hundred thousand people, maybe low to mid-single digit more membership than you expected causing margins to drop from 8% to 7% or 12% essentially. It seems like a pretty big delta. So I assume there's other things going on in there beyond just digesting new membership growth. If not, then I guess we would know what the margin is on those new members.

偉大的。我想問 Optum Health 的情況。我理解有關會員資格增加的評論，這會造成利潤拖累。但感覺好像有幾十萬人，可能比你預期的會員數量多出低到中個位數，導致利潤率從 8% 下降到 7% 或 12%。這似乎是一個相當大的三角洲。所以我認為除了消化新會員的成長之外，還有其他事情正在發生。如果沒有，那麼我想我們就會知道這些新成員的利潤是多少。

But is there anything else you would spike out there? And how do we think about building back from where we are today to that 8% to 12% -- 8% to 10% margin target? Is it simply about getting today's membership to target margins? Or is there a cost side? It seems like you're adjusting the labor force to some degree. Is there an MLR side? Is there a rate side? Any other color to kind of help us give us ability into the 8% to 10% over time?

但還有什麼你想指出的嗎？我們如何考慮從目前的水平恢復到 8% 至 12%——8% 至 10% 的利潤率目標？只是為了讓今天的會員達到目標利潤嗎？或有成本方面嗎？看來你們正在對勞動力進行某種程度的調整。有MLR方面嗎？有利率方面嗎？隨著時間的推移，還有其他顏色可以幫助我們提高 8% 到 10% 的能力嗎？

Kevin, thanks so much for the question. So listen, by far and away, the most important phenomenon here are the things we've talked about to you already. So just to reiterate a little bit what we said to you back in Q2. So we've seen obviously the elevation in MLR, which has stabilized, hasn't really come down, isn't accelerating up, but definitely is a phenomena year-over-year, number one. Number two, increased behavioral care costs. Remember that within Optum Health, our behavioral business is -- that's where our behavioral business sits, and that has also seen significant increase year-over-year. We're very positive about that because it's a signal that people are engaging in seeking help for their behavioral conditions. And we know that, that entwines very importantly with their ongoing medical costs. But nonetheless, it's an element of elevation.

凱文，非常感謝你的提問。所以聽著，到目前為止，這裡最重要的現象就是我們已經和你們討論過的事情。因此，我想重申我們在第二季對您所說的話。因此，我們顯然看到 MLR 的升高已經穩定下來，並沒有真正下降，也沒有加速上升，但絕對是逐年上升的現象，第一。第二，行為照護成本增加。請記住，在 Optum Health 內部，我們的行為業務就是——這就是我們的行為業務所在，而且也逐年顯著成長。我們對此非常樂觀，因為這是一個信號，表明人們正在為自己的行為狀況尋求幫助。我們知道，這與他們持續的醫療費用密切相關。但儘管如此，它仍然是一種提升的元素。

And then as you rightly reiterate, a piece of it is the growth in our value-based lives and the mix of those lives. And by mix, that means complexity mix as well as geographic mix. And it takes -- as I said already today, it takes a little bit of time to build up the capabilities to allow us to engage properly with those folks at the level. We want to -- and we've really -- we have not held back on doing that, Kevin. And that's really the bulk of the investment during this cycle where we've really led into building those capabilities in readiness for the next, we hope, many years of serving these individuals higher and higher capability.

正如您正確地重申的那樣，其中一部分是我們基於價值的生活以及這些生活的混合的增長。所謂混合，意味著複雜性的混合以及地理上的混合。正如我今天已經說過的，需要一點時間來建立能力，使我們能夠與該級別的人員進行適當的接觸。我們想要——而且我們確實——我們沒有猶豫這樣做，凱文。這確實是這個週期中的大部分投資，我們真正引導建立這些能力，為下一個，我們希望，多年為這些人提供越來越高的能力做好準備。

Of course, and I made a comment earlier about reengineering our cost base. Of course, there are changes going on in our cost base across the whole organization, including Optum Health in response to the change in pricing signals from CMS. But I would put those very much kind of secondary to the core elements I've just described. We we're in a position, obviously, where we know exactly what these populations are that we're now looking after. That's been very much the basis of our forward views in terms of how we're starting to lay out for '24, '25, '26, and we feel very confident about our ability, not only to grow as an organization but to continue to strengthen margins back into the zone that you've historically been using used to. Thanks so much, Kevin, for that.

當然，我之前就重新設計我們的成本基礎發表了評論。當然，整個組織的成本基礎正在發生變化，包括 Optum Health 為回應 CMS 定價訊號的變化而發生的變化。但我會把這些放在我剛才描述的核心元素之後。顯然，我們確切地知道我們現在正在照顧的這些人群是什麼。這在很大程度上是我們對 24、25、26 年如何開始佈局的前瞻性觀點的基礎，我們對我們的能力非常有信心，不僅作為一個組織成長，而且繼續下去加強利潤率，回到您過去一直使用的區域。非常感謝，凱文。

The next to Sarah James with Cantor Fitzgerald.

接下來是莎拉詹姆斯和康托費茲傑拉。

I wanted to circle back to your comments on the strength in commercial growth in national accounts for next year. Can you give us a little bit of color on the pricing environment, given all the comments you've made on the moving pieces in cost trends? And then help us put into context that -- and the broader economy with how your clients are thinking about product selection, either in breadth or the type of products that they're purchasing from you in '24.

我想回顧一下您對明年國民帳戶商業成長強勁的評論。考慮到您對成本趨勢變化的所有評論，您能否為我們介紹定價環境？然後幫助我們將這一背景以及更廣泛的經濟背景與您的客戶如何考慮產品選擇（無論是在廣度還是在 24 年從您那裡購買的產品類型）結合起來。

Sarah, thanks so much for the question. Let me ask Dan Kueter, who looks after our Commercial Insurance business to answer that.

莎拉，非常感謝你的提問。讓我請負責我們商業保險業務的 Dan Kueter 來回答這個問題。

Yes. Thanks, Andrew. Sarah, thanks for the question. The growth that John mentioned in his comments is settled business in our national accounts fee-based segments. So we're very happy with how that's completed. We're pricing and negotiating our fully insured business for January right now, and we're comfortable with how that's materializing as well. Employers continue to focus on both affordability and innovation, and our innovative products continue to resonate significantly in the market, as Dirk highlighted in his comments.

是的。謝謝，安德魯。莎拉，謝謝你的提問。約翰在評論中提到的成長是我們國民帳戶收費領域的穩定業務。所以我們對它的完成方式感到非常滿意。我們現在正在對一月份的完全保險業務進行定價和談判，我們也對如何實現這一點感到滿意。正如德克在評論中所強調的那樣，雇主繼續專注於負擔能力和創新，我們的創新產品繼續在市場上引起重大共鳴。

Thanks so much, Dan.

非常感謝，丹。

The next to David Windley with Jefferies.

接下來是大衛溫德利和傑弗里斯。

I wanted to pivot to OptumInsight. You had commented in previous calls about a fairly heavy level of spending to integrate change and invest in that platform. I wondered if you could update us on any ongoing spend in that regard. What we should expect in terms of implementation on ProHealth and kind of trajectory of margin in OptumInsight?

我想轉向 OptumInsight。您在先前的電話會議中評論道，整合變革和投資該平台的支出相當大。我想知道您能否向我們介紹這方面持續支出的最新情況。在 ProHealth 的實施和 OptumInsight 的利潤軌跡方面我們應該期待什麼？

David, thanks so much for the question. Let me ask Roger Connor, who's our new CEO of OptumInsight to respond. Roger?

大衛，非常感謝你的提問。讓我請 OptumInsight 新任執行長 Roger Connor 回應一下。羅傑？

Thank you. And David, thank you for the question. First of all, just to say, I'm delighted to be taking over the leadership of Insight. This is a pretty unique and special business. And getting to know the people, the products and the offerings, I think we're going to make a real difference to health care. So excited by that future.

謝謝。大衛，謝謝你的提問。首先，我想說，我很高興能接手 Insight 的領導權。這是一項非常獨特且特殊的業務。透過了解人員、產品和服務，我認為我們將對醫療保健產生真正的影響。對這個未來感到非常興奮。

Just specifically, David, on your question, the change integration has gone really well, to be honest. You'll see in the Q3 margin that we had the tail end of some of that spend to integrate, but the Q3 margin is in line with our expectations. I think it is worth understanding the longer-term outlook for OptumInsight margin. We still believe that in the region of 18% to 22%. That's really driven by the mix of the businesses.

具體來說，大衛，關於你的問題，說實話，變革整合進展得非常順利。您會在第三季的利潤中看到，我們有一些支出的尾部需要整合，但第三季的利潤符合我們的預期。我認為值得了解 OptumInsight 利潤率的長期前景。我們仍然認為在 18% 到 22% 的範圍內。這實際上是由業務組合所驅動的。

As you know, we're a business that has software. We have services. So there are different margins in there. But when you take what we've created with change and you look at the overall portfolio that we have, we have this incredible portfolio that is addressing everything from clinical decision support. We've got products for admin efficiency. We've got other products for payment optimization. You add that growth engine, plus our innovation plus our margin profile, we're very confident about the future performance of Insight.

如您所知，我們是一家擁有軟體的企業。我們有服務。所以那裡有不同的邊距。但是，當您了解我們透過變革創造的產品並查看我們擁有的整體產品組合時，我們擁有這個令人難以置信的產品組合，可以解決臨床決策支援的所有問題。我們擁有提高管理效率的產品。我們還有其他用於支付優化的產品。再加上這個成長引擎，再加上我們的創新和我們的利潤狀況，我們對 Insight 的未來表現非常有信心。

That's great. And I wonder whether Dan Schumacher, who's been very heavily involved in our various health systems partnerships, might just want to reflect a little bit on -- the question obviously was around ProHealth. But rather than talking specifically, maybe just share a few thoughts about the overall evolution of those health system profiles and how they play out over the first couple of years.

那太棒了。我想知道一直積極參與我們各種衛生系統合作夥伴關係的 Dan Schumacher 是否可能只想反思一下——這個問題顯然是圍繞 ProHealth 的。但與其具體談論，也許只是分享一些關於這些衛生系統概況的整體演變以及它們在最初幾年中如何發揮作用的一些想法。

Sure. Thanks, Andrew. David, I appreciate the question. Certainly, our health system partnerships, you mentioned one that we've announced recently. It's a growing portfolio for us. Obviously, at the health system level, there's a lot of pressures. We've talked in earlier questions about wage inflation and so forth. And we have a unique opportunity to really be able to address some of those near-term challenges while at the same time, provide some capacity for future evolution of the system as they think about more digital capacities, greater outpatient catchment as well as further engagement. So those are some of the things that we can help unlock for them and their migration to value-based care. So we're encouraged by the portfolio, it continues to grow. Actually from the initial scope, 9 out of 10 have expanded from their initial scope. So continuing to grow. We're in the early days, and we see a lot of opportunity ahead of us.

當然。謝謝，安德魯。大衛，我很欣賞這個問題。當然，我們的衛生系統合作夥伴關係，您提到了我們最近宣布的一項合作夥伴關係。對我們來說，這是一個不斷成長的產品組合。顯然，在衛生系統層面，壓力很大。我們在之前的問題中討論過工資通膨等問題。我們擁有一個獨特的機會，真正能夠解決其中一些近期挑戰，同時為系統的未來發展提供一些能力，因為他們考慮更多的數位能力、更大的門診量以及進一步的參與。因此，這些是我們可以幫助他們解鎖並轉向基於價值的護理的一些事情。因此，我們對產品組合感到鼓舞，它不斷增長。實際上從最初的範圍來看，十分之九已經擴大了最初的範圍。所以繼續成長。我們還處於早期階段，我們看到前面有很多機會。

Dan, appreciate it. And thanks so much for the question.

丹，很欣賞。非常感謝你的提問。

Thank you.

謝謝。

We'll go next to Ann Hynes with Mizuho Securities.

接下來我們將討論瑞穗證券的安‧海因斯 (Ann Hynes)。

I would like to ask the GLP question more on the medical side. it sounds like right now, price appears to be the greatest barrier for widespread adoption assuming the outcome data continues to be positive. If pricing gets to a point that you view and your clients view as affordable, what do you think would be the long-term impact on care on the medical side? Are you seeing any near-term effects right now on MLR -- I should say, an MLR benefit And do you think it would be reasonable to assume, overall, MLRs should decline with greater adoption of these drugs? And maybe what categories or health spend do you think -- or do you view would be the biggest opportunity going forward?

我想問更多關於醫療方面的GLP問題。聽起來現在，假設結果數據繼續積極，價格似乎是廣泛採用的最大障礙。如果定價達到您認為並且您的客戶認為可以承受的水平，您認為對醫療方面的護理的長期影響是什麼？您現在是否看到對 MLR 的任何近期影響 - 我應該說，MLR 的益處 您認為總體而言，隨著這些藥物的更多採用，MLR 應該下降是否合理？也許您認為哪些類別或醫療支出是未來最大的機會？

Thanks so much for the question. I mean, I think, honestly, it's just way too early for us to be able to see anything like that just in terms of -- obviously, the weight loss indications are only just really coming into play. We haven't really been able to see, I'd say, anything from that perspective yet. And as I said earlier, the real focus for us right now is to try and figure out a way in which we can get to a position where the affordability of this class puts it in a zone where the people who need it can get it and can afford it. Nothing more to say on that, honestly.

非常感謝您的提問。我的意思是，老實說，對於我們來說，現在看到這樣的事情還為時過早——顯然，減肥跡象才剛剛真正發揮作用。我想說，我們還沒有真正能夠從這個角度看到任何東西。正如我之前所說，我們現在真正的重點是嘗試找出一種方法，使我們能夠達到這樣一個位置：使此類產品的負擔能力使其處於需要它的人能夠獲得它的區域，並且買得起。老實說，對此沒什麼好說的。

The next to John Ransom with Raymond James.

接下來是約翰·蘭塞姆和雷蒙德·詹姆斯。

On your fully accountable lives, what's the expectation where you'll end up the year with a number of Medicare fully advantage lives? And just looking at the eliminations, is it fair to assume that a lot of those fully accountable lives are coming out of the UAC book?

在您完全負責任的生活中，您對今年結束時擁有許多 Medicare 完全受益生活的期望是什麼？只要看看淘汰的情況，就可以公平地假設很多完全負責任的生活都來自 UAC 書中嗎？

So thanks very much for the question. I'll ask Dr. Amar Desai, who leads our Optum Health Organization just to comment a little bit on the kind of shape of the folks we look after there a degree to which they come from both UHC and obviously, many of our external partners. Amar?

非常感謝您提出的問題。我會請我們 Optum 健康組織的負責人 Amar Desai 博士對我們所照顧的人們的體型做出一些評論，他們在某種程度上來自 UHC，顯然還有我們的許多外部合作夥伴。阿瑪爾？

John, thanks very much for the question. We've had great growth and fully accountable to membership, as we mentioned earlier, adding over 900,000 patients for the year. That growth is diverse across a number of payers. We have over 100 payer partners spanning both national and regional payers. And as we think about that growth, of course, UnitedHealthcare is a core partner to us, but we continue to have the strength of our medical groups and physician networks being incredibly attractive to other payers regionally and nationally to be able to grow in their own value-based arrangements to drive outcomes and total cost of care. So we look forward to continued growth in a broad-based diverse way.

約翰，非常感謝你的提問。正如我們之前提到的，我們取得了巨大的成長，並且對會員完全負責，今年增加了超過 90 萬名患者。許多付款人的成長情況各不相同。我們擁有 100 多個付款人合作夥伴，涵蓋國家和地區付款人。當然，當我們考慮這種增長時，聯合醫療保健是我們的核心合作夥伴，但我們仍然擁有我們的醫療集團和醫生網絡的實力，對區域和全國範圍內的其他付款人具有極大的吸引力，能夠在自己的領域實現成長基於價值的安排，以推動結果和總護理成本。因此，我們期待以廣泛的多元化方式持續成長。

Amar, thank you. And thank you for the question. Jennifer, we'd take the last question now, please.

阿馬爾，謝謝你。謝謝你的提問。詹妮弗，我們現在回答最後一個問題。

Okay. We'll go last to Lance Wilkes with Bernstein.

好的。最後我們將與伯恩斯坦一起討論蘭斯威爾克斯。

On Medicaid and Medicaid redetermination, could you comment a little bit on the margin implications of the members that are getting redetermined off? Are you seeing a lot of double coverage or zero MOR on that?

關於醫療補助和醫療補助重新確定，您能否對重新確定的成員的邊際影響發表一些評論？您是否看到很多雙重保險或零 MOR ？

And then just in general, are enrollment -- disenrollment trends kind of consistent with your expectations? And do you see where those members are going to as far as individual employer are uninsured?

總的來說，入學和退學趨勢是否與您的預期一致？如果個別雇主沒有保險，您是否知道這些成員會去哪裡？

Lance, thanks so much for the question. I'm going to have Tim Spilker, who leads our community and state to respond to that. Tim?

蘭斯，非常感謝你的提問。我將請蒂姆·斯皮爾克（Tim Spilker）領導我們的社區和州對此做出回應。提姆？

Yes. Thank you, Lance, for the question. And maybe I'll start with just the enrollment trends because I think that really informs a whole number of factors. So first off, what we're seeing, I think, consistent with what states have reported is significant disenrollment for procedural reasons and what's more -- a lot of variability, frankly, across states in terms of the pacing and enrollment and even states now that are suspending terminations or reenrolling members based on guidance. So those stops and starts certainly have an impact on our membership as well as membership mix. But frankly, that's why we continue to develop even more ways to engage members and support our states. Our goal really is to help individuals find coverage.

是的。謝謝蘭斯的提問。也許我會從入學趨勢開始，因為我認為這確實反映了許多因素。因此，首先，我認為，我們所看到的情況與各州報告的一致，是由於程序原因導致大量退學，而且坦率地說，各州在進度和入學方面甚至現在各州之間存在很大差異根據指導暫停會員終止或重新註冊。因此，這些停止和開始肯定會對我們的會員資格以及會員組合產生影響。但坦白說，這就是為什麼我們繼續開發更多方式來吸引會員並支持我們的州。我們的目標實際上是幫助個人找到保險。

And so a couple of points on that. Our retrade for the programs that we've implemented exceeds our traditional programs, and we're seeing strong re-enrollment rates between 15% and 20% depending on the state. And so as a result, as John mentioned in his comments, we're retaining a significant majority of the members we engage with certainly more to do.

關於這一點有幾點。我們已實施的計劃的重新註冊率超過了傳統計劃，我們看到重新註冊率很高，介於 15% 到 20% 之間，具體取決於各州。因此，正如約翰在評論中提到的，我們保留了絕大多數與我們合作的成員，當然還有更多的事情要做。

Then second, in terms of your question around just kind of outlook, again, I think the factors around the re-enrollment has an impact on just how we think about mix. But I think it's also important that to consider the rate environment, states are taking into account a thoughtful -- taking a thoughtful and data driven approach to rate setting. And with visibility now into around 45% of our revenue for '24, really appreciative of the approach that states are taking.

其次，就您關於前景的問題而言，我認為重新註冊的因素會影響我們對混合的看法。但我認為同樣重要的是，為了考慮利率環境，各國正在考慮採取深思熟慮和數據驅動的利率設定方法。現在我們可以看到我們 24 年收入的 45% 左右，我真的很欣賞各州正在採取的方法。

So all in all, I would say both membership as well as our outlook is in line with what we expected at this point with a lot of variability. I think our membership looks good in terms of the outlook that we set at the beginning of the year. And at this point, still all this is manageable.

總而言之，我想說，會員資格和我們的前景都符合我們目前的預期，但存在著很大的可變性。我認為，就我們年初設定的前景而言，我們的會員資格看起來不錯。至此，這一切仍然是可控制的。

Tim, thanks so much. And thank all of you for your time this morning. I hope what you heard during today's call only reinforces what you've come to expect from UnitedHealth Group, an organization that's just as nimble and agile as it is focused and disciplined. Always growing, always innovating, seamlessly committed to our mission and deeply devoted to those we share. Thank you for your attention today, and we appreciate it.

提姆，非常感謝。感謝大家今天早上抽出寶貴的時間。我希望您在今天的電話會議中聽到的內容只會強化您對聯合健康集團的期望，聯合健康集團是一家既靈活又靈活、專注且紀律嚴明的組織。不斷成長，不斷創新，無縫地致力於我們的使命，並深深致力於我們共同的事業。感謝您今天的關注，我們對此表示感謝。

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。