聯合健康 (UNH) 2023 Q4 法說會逐字稿

Good morning, and welcome to the UnitedHealth Group Fourth Quarter and Full Year 2023 Earnings Conference Call. (Operator Instructions) As a reminder, this call is being recorded.

早安，歡迎參加聯合健康集團2023年第四季及全年財報電話會議。 （操作說明）提醒各位，本次電話會議正在錄音。

Here is 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項下的前瞻性陳述。這些陳述受風險和不確定性因素的影響，可能導致實際結果與歷史經驗或當前預期有重大差異。部分風險和不確定性因素的描述可在我們向美國證券交易委員會提交的報告中查閱，包括我們目前和定期文件中包含的警示性聲明。

This call will also reference non-GAAP amounts. A reconciliation of 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 contained in the earnings release will be issued -- we issued this morning is in our Form 8-K dated January 12, 2024, which may be accessed from the Investor Relations page of the company's website.

本次電話會議也將提及非GAAP財務數據。非GAAP財務資料與GAAP財務資料的調節表可在公司投資人關係頁面（www.unitedhealthgroup.com）的財務和獲利報告部分查閱。本次電話會議中提及的資訊將包含在獲利報告中－我們今天上午發布的獲利報告已於2024年1月12日發布，該報告可在公司網站的投資者關係頁面查閱。

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

現在我將把會議交給聯合健康集團執行長安德魯威蒂。

Thank you, and good morning, and thank you all for joining us today.

謝謝大家，早安，謝謝各位今天蒞臨。

As we conclude 2023 and embark on a new year, I'd like to express my gratitude to our more than 400,000 talented colleagues who really are UnitedHealth Group. It's directly due to their tireless efforts over the past year that we expanded our opportunities to serve more people more comprehensively.

在2023年即將結束、新的一年即將到來之際，我謹向我們超過40萬名才華橫溢的同事們致以衷心的感謝，他們才是聯合健康集團的真正基石。正是由於他們在過去一年中的不懈努力，我們才能擴大服務範圍，為更多人群提供更全面的服務。

As I reflect on our 2023 performance, certainly, the shift in care activity among seniors was an important element for us to manage effectively. And the reduced Medicare Advantage funding outlook was a significant influence on how we prepared for 2024 and all the way through to 2026.

回顧2023年的業績，老年人照護活動的變化無疑是我們需要有效應對的重要因素。此外，聯邦醫療保險優勢計畫（Medicare Advantage）資金前景的縮減也對我們2024年乃至2026年的備戰工作產生了重大影響。

Despite the shift in care patterns and the commensurate pressure felt during '23, we've been able to both deliver on our growth commitments and invest and prepare for a reduced MA funding cycle over the next 3 years. Even considering these factors, 2023 marked a year of balanced, sustainable growth for UnitedHealth Group. Importantly, we also strengthened the foundations from which we will continue to grow in 2024 and beyond.

儘管2023年醫療模式發生了轉變，我們也感受到了相應的壓力，但我們依然實現了成長目標，並為未來三年醫療保險融資週期縮短做好了投資和準備。即便考慮到這些因素，2023年對聯合健康集團而言仍然是平衡且可持續成長的一年。更重要的是，我們也鞏固了未來在2024年及以後持續發展的基礎。

To illustrate briefly. During 2023, Optum Health approached growth of 900,000 more patients under value-based care. UnitedHealthcare added over 1.7 million new consumers in its Medicare and commercial offerings. Optum Rx managed an additional 100 million prescriptions for people. Optum Financial handled more than $500 billion in consumer, payer and care provider payments. And OptumInsight facilitated more than 23 billion electronic transactions.

簡而言之，2023年，Optum Health在以價值為基礎的醫療服務模式下新增了近90萬名病患。 UnitedHealthcare在其聯邦醫療保險和商業保險產品中新增了超過170萬名消費者。 Optum Rx為病患管理了1億份額外的處方。 Optum Financial處理了超過5000億美元的消費者、支付方和醫療服務提供者付款。 OptumInsight促成了超過230億筆電子交易。

The increasingly impactful ways we can engage with patients, consumers, care providers and customers resulted in revenue growth of over $47 billion and adjusted earnings per share growth of over 13% in 2023.

我們與患者、消費者、照護人員和客戶互動的方式日益有效，使得 2023 年的收入成長超過 470 億美元，調整後每股盈餘成長超過 13%。

Looking to '24, '25 and beyond, we will continue to drive quality, simplicity, affordability and accessibility to help improve health care system-wide. And we remain confident in and committed to our long-term 13% to 16% adjusted earnings per share growth rate.

展望2024年、2025年及未來，我們將持續致力於提升醫療服務的品質、簡化流程、降低成本並提高可近性，以協助改善整個醫療保健系統。我們對長期調整後每股盈餘成長率13%至16%的目標仍充滿信心且堅定不移。

Having held our investor conference just 6 weeks ago, I'll take only a few minutes this morning to recap what you should expect from us this year, starting with our work in value-based care.

就在六週前，我們召開了投資者大會。今天早上，我只想花幾分鐘時間回顧今年大家應該對我們抱持的期望，首先是我們在基於價值的醫療保健方面的工作。

Value-based care for us is a proven way of overcoming many of the widely recognized shortcomings of a fee-for-service-based health system, such as fragmented consumer experience and incentives that can emphasize volume over quality. Our value-based offerings empower physicians to provide more connected, coordinated and comprehensive care, align incentives among consumers, care providers and health plans, deliver better health outcomes and improve costs.

對我們而言，以價值為基礎的醫療模式已被證明是克服按服務收費醫療體系諸多公認缺陷的有效途徑，例如消費者體驗碎片化以及激勵機制可能過於注重數量而忽視質量。我們以價值為基礎的醫療服務能夠幫助醫生提供更緊密聯繫、更協調、更全面的醫療服務，協調消費者、醫療服務提供者和醫療保險計劃之間的激勵機制，從而改善健康結果並降低醫療成本。

At the end of 2023, Optum Health served more than 4 million patients in fully accountable value-based arrangements in partnership with many dozens of health plans. By the end of this year, Optum Health will grow to serve at least another 750,000 patients under such arrangements for a total of more than twice the number of people we served just 2 years ago.

截至2023年底，Optum Health與數十家健康保險公司合作，透過完全負責的價值導向醫療服務模式，為超過400萬名患者提供服務。今年底，Optum Health將新增至少75萬名此類服務患者，總服務人數將是兩年前的兩倍多。

Yet even with the strong growth and significant investments we've made, our market presence is still quite modest and the opportunity expansive: 4 million patients served, just a small fraction of the many more people whose health ultimately will benefit from these models of care; and a total Optum Health revenue base, which today represents only 2% of the $5 trillion U.S. health care system spend. We have a considerable distance to go to achieve the broad, positive system-wide impact for people's health we believe we can help drive.

儘管我們取得了強勁增長並進行了大量投資，但我們的市場份額仍然相當有限，而發展機會卻十分廣闊：我們服務了400萬患者，但這僅僅是眾多最終將受益於這些醫療模式的人群中的一小部分；目前，Optum Health的總收入僅占美國5萬億美元醫療保健系統支出的2%。我們距離實現我們堅信能夠推動的、對全系統健康產生廣泛積極影響的目標，還有很長的路要走。

Turning to our consumer focus. We're working hard to help consumers more easily find experience and pay for health care, and that includes using their health benefits. One example of our progress can be seen in the results of UnitedHealthcare's commercial benefits business. Our most recently completed selling season was among our strongest in recent years.

接下來談談我們對消費者的關注。我們正努力幫助消費者更輕鬆地獲得醫療保健服務並支付相關費用，這也包括如何使用他們的健康福利。聯合健康保險商業福利業務的表現就是我們取得進展的一個例證。我們最近完成的銷售季是近年來業績最好的銷售季之一。

The majority of this growth will come from our relationships with large employers, among the most sophisticated buyers of health benefits. Our customers tell us we are focused on what their employees value most: Lower cost, simpler experiences and adaptable benefits that meet their unique needs and circumstances. And the consumer NPS for these new innovative products is some 20-plus points higher than traditional health plans.

大部分成長將來自我們與大型雇主的合作關係，他們是健康福利領域最成熟的買家之一。我們的客戶告訴我們，我們專注於員工最重視的方面：更低的成本、更便利的體驗以及能夠滿足他們獨特需求和情況的彈性福利。而且，這些創新產品的消費者淨推薦價值 (NPS) 比傳統健康計畫高出 20 多個百分點。

But we have more to do. Our goal is to become the trusted source for health care information and advice, a go-to marketplace for health services, payments and benefits, all through a few simple taps on a consumer's phone.

但我們還有更多工作要做。我們的目標是成為值得信賴的醫療保健資訊和建議來源，以及醫療服務、支付和福利的一站式平台，所有這些都只需消費者在手機上輕點幾下即可完成。

One of our larger consumer offerings is Medicare Advantage, which I'd like to touch on briefly. We're proud of our long track record of growth and of delivering for the people who choose our offerings. During the recently completed annual enrollment period, we added about 100,000 more consumers, and we remain committed to our full year goal of 450,000 to 550,000.

我們面向消費者的主要產品之一是聯邦醫療保險優勢計劃（M​​edicare Advantage），我想在此簡要介紹一下。我們為長期以來持續成長的業績以及為選擇我們產品的客戶提供的優質服務而感到自豪。在最近結束的年度註冊期間內，我們新增了約10萬名消費者，並且我們仍然致力於實現全年45萬至55萬的目標。

We believe our assumptions of ongoing care activity and approach to supplemental benefit management are entirely appropriate for the environment we are planning for and feel positive about our positioning for growth entering this 3-year period.

我們相信，我們對持續照護活動的假設和補充福利管理方法完全適合我們正在規劃的環境，並且對進入這三年發展期的成長定位感到樂觀。

One additional item as we close out the year. To achieve our enterprise-wide long-term goals, we must consistently ensure best use of our resources, both time and capital, to enable us to serve people more effectively and deliver value for our shareholders.

在年終之際，還有一點需要說明。為了實現公司整體的長期目標，我們必須始終確保最佳利用資源，包括時間和資金，從而更有效地服務員工，並為股東創造價值。

As you likely saw, we recently agreed to the sale of our Brazil operations, where our dedicated colleagues serve people with care and compassion. We highly value the relationships we've developed over more than a decade in Brazil. After carefully evaluating our best course, we ultimately determined a sale was the right step for the people we serve and for us, to best focus our energies on the many compelling growth opportunities that we consistently discuss with you.

正如您可能已經了解到的，我們最近同意出售我們在巴西的業務。我們敬業的同事們在那裡以關懷和同情心服務人們。我們非常珍惜過去十多年來在巴西建立的良好關係。經過慎重評估，我們最終認為出售業務對我們所服務的人們以及我們自身而言都是正確的選擇，這樣我們才能將精力集中在我們一直與您探討的眾多極具吸引力的增長機會上。

And with that, I'll turn it over to Dirk McMahon, UnitedHealth Group's President and Chief Operating Officer. Dirk?

接下來，我將把發言權交給聯合健康集團總裁兼營運長德克·麥克馬洪。德克？

Thanks, Andrew. Our growth is rooted in innovation and our intense desire always to do better. We're investing heavily in ways to accomplish that, increasing digital engagement and using AI to be more efficient, and then measuring our performance through Net Promoter Scores to be sure we're hitting the mark.

謝謝安德魯。我們的成長源自於創新和對精益求精的不懈追求。我們正大力投資各種實現目標的方式，例如提升數位互動、利用人工智慧提高效率，並透過淨推薦價值 (NPS) 來衡量績效，確保我們達到預期目標。

The impact of our digital engagement efforts was evident in our 1/1 performance metrics. As Andrew noted, we brought on one of our biggest cohorts of new people served via our commercial offerings, and our technology played an important role in making the process work well.

我們的數位互動措施的成效在1/1績效指標中顯而易見。正如Andrew所指出的，我們透過商業服務吸引了迄今為止最大的新用戶群之一，而我們的技術在這過程中發揮了重要作用。

Since last month, the UHC mobile app consistently ranked #1 or #2 in the Apple App Store medical category and on Google Play. Through the first week of the year, mobile app installs were up over more than 100% year-over-year, and our chat volume was more than twice our historical average.

自上個月以來，UHC行動應用程式在蘋果應用商店醫療類應用程式和Google應用程式商店的排名一直穩居第一或第二。今年第一周，行動應用程式安裝量年增超過100%，聊天量也超過了歷史平均的兩倍。

At Optum Rx, digital investments enabled us to bring on a record number of new clients who brought with them more than 3 million new consumers, onboarded with improved customer service scores and at an overall cost 8% lower than last year. More consumers served, higher satisfaction and lower costs.

在Optum Rx，數位化投資使我們能夠吸引創紀錄數量的新客戶，這些客戶帶來了超過300萬新消費者，客戶滿意度也得到了提升，總體成本比去年降低了8%。服務了更多消費者，顧客滿意度更高，成本更低。

Our investments in AI and other advanced technology play an important role in improving customer service and in productivity throughout the enterprise. For example, we are removing repetitive tasks from our workflows by using AI to help with tasks, such as responses to consumer inquiries, updating provider directories and summarizing interactions with customers and patients. This frees up our service staff and clinicians to focus on solving more complicated tasks for the people we serve.

我們在人工智慧和其他先進技術方面的投資，對提升客戶服務水準和提高整個企業的生產力發揮著重要作用。例如，我們利用人工智慧輔助處理諸如回覆客戶諮詢、更新供應商名錄以及總結與客戶和患者的互動等重複性工作，從而簡化了工作流程。這使我們的服務人員和臨床醫生能夠騰出精力，專注於為我們服務的對象解決更複雜的問題。

And recently, we launched a new capability where we use real-time admissions and discharge data to engage high-risk MA members immediately after an emergency department visit, enabling them to follow up care to ensure high-quality post-admit outcomes and avoid readmissions. This rapid response, driven by timely clinical, data has improved member engagement rates by over 300% and has an NPS of 83.

最近，我們推出了一項新功能，利用即時入院和出院數據，在急診就診後立即聯繫高風險醫療保險優勢計劃 (MA) 會員，幫助他們獲得後續護理，確保高品質的出院後治療效果，並避免再次入院。這項基於及時臨床數據的快速反應措施，已將會員參與率提高了 300% 以上，淨推薦值 (NPS) 達到 83 分。

NPS remains a vital way to measure how we're performing for our customers and consumers and how our digital initiatives and other efforts are impacting those measures and leading to improved retention.

NPS 仍然是衡量我們為客戶和消費者提供服務情況以及我們的數位化措施和其他努力如何影響這些指標並提高客戶留存率的重要方法。

A couple of examples. Through digital optimization, we're providing consumers with on-demand access to care, highly personalized benefits information, real-time support and integrated pharmacy capabilities. This is translating into significant NPS improvements in many of our businesses. And we've removed friction from the system through expanded access to 24/7 virtual visits and UnitedHealthcare's efforts to eliminate nearly 20% of prior authorizations.

舉幾個例子。透過數位化優化，我們為消費者提供按需就醫、高度個人化的福利資訊、即時支援和一體化藥局服務。這顯著提升了我們許多業務的淨推薦價值 (NPS)。此外，我們還透過擴大全天候虛擬就診服務範圍以及聯合健康保險公司 (UnitedHealthcare) 努力減少近 20% 的事先授權，消除了系統中的摩擦。

Throughout '24, you should expect to see an even greater investment in our digital capabilities as we continue to identify opportunities to: Leverage technology to reduce administrative costs, improve productivity and further enhance the consumer experience at both Optum and UnitedHealthcare.

2024 年，我們將繼續增加對數位化能力的投資，尋找機會，利用科技降低管理成本，提高生產力，並進一步提升 Optum 和 UnitedHealthcare 的消費者體驗。

And now I'll turn it over to John Rex, UnitedHealth Group's Chief Financial Officer. John?

現在我把麥克風交給聯合健康集團的財務長約翰·雷克斯。約翰？

Thank you, Dirk. Our colleagues' ongoing focus on further expanding and strengthening the foundations which underpin our growth pillars is paving the way for consistent growth in 2024 and beyond.

謝謝你，德克。我們的同事們持續致力於進一步拓展和加強支撐我們成長支柱的基礎，這為2024年及以後的持續成長鋪平了道路。

Revenue in '23 of $372 billion grew by over 14%, with double-digit growth at both Optum and UnitedHealthcare. Fourth quarter adjusted earnings per share of $6.16 grew 15% and brought full year adjusted earnings per share to $25.12, growth of 13%.

2023年營收達3,720億美元，成長超過14%，其中Optum和UnitedHealthcare均達到了兩位數成長。第四季調整後每股收益為6.16美元，成長15%，全年調整後每股收益為25.12美元，成長13%。

As Andrew noted earlier, at the end of December, we entered into an agreement to sell our Brazil operations and expect to close in the first half of this year. Upon closing, we expect to record a charge of approximately $7 billion, the majority of which is noncash and largely due to foreign currency translation losses accumulated over several years. The impact of this onetime charge will be excluded from our '24 adjusted earnings per share measure. For your modeling purposes, the full year '24 outlook incorporated about $6 billion of revenue for Brazil or about 1.5% of consolidated revenue.

正如安德魯之前提到的，我們在12月底達成協議出售我們在巴西的業務，預計今年上半年完成交易。交易完成後，我們預計將提列約70億美元的費用，其中大部分為非現金支出，主要源自於多年來累積的外匯折算損失。這筆一次性費用的影響將從我們2024年的調整後每股盈餘中剔除。為了方便您進行建模，2024年全年展望中已包含巴西業務約60億美元的收入，約佔合併收入的1.5%。

Before reviewing our business results, I'll offer some brief comments on care activity. Care patterns remain consistent with those we shared with you in the first half of '23. Activity levels continue to be led by outpatient care for seniors, with orthopedic and cardiac procedure categories among the more prominent. As we've noted, our benefit design approach assumed these activity levels persist throughout '24, and the care patterns we observed exiting '23 reconfirmed that decision.

在回顧我們的業務成果之前，我先簡單談談醫療服務活動。醫療服務模式與我們在2023年上半年與大家分享的情況基本一致。老年門診服務仍然是主要的醫療服務項目，其中骨科和心臟手術尤其突出。正如我們先前所提到的，我們的福利方案設計是基於2024年全年醫療服務活動水準將保持不變的假設，而我們在2023年底觀察到的醫療服務模式也再次印證了這個假設。

On the margin, we saw some modest late year seasonal activity, such as strong and welcome response from seniors to schedule physician visits to receive RSV vaccinations. In some cases, these were accompanied by additional necessary care being obtained, especially for people that had not seen a physician in some time, a positive outcome for people's health.

在其他方面，我們看到了一些適度的年末季節性活動，例如老年人積極預約醫生接種呼吸道合胞病毒疫苗，這一反應熱烈，令人欣喜。在某些情況下，他們也同時獲得了其他必要的醫療服務，特別是對於那些一段時間未就醫的人來說，這對他們的健康來說是一個積極的信號。

In sum though, as we reflect on full year '23 results, overall care activity was broadly in line with the views we've shared earlier. And as we enter '24, we're confident in the response of pricing and benefit design actions we undertook, with care patterns continuing to be supportive of our care ratio outlook of 84%, plus or minus 50 basis points.

總而言之，回顧2023年全年業績，整體護理活動基本上符合我們先前的觀點。展望2024年，我們對所採取的定價和福利設計措施的成效充滿信心，護理模式也繼續支持我們84%的護理比率預期，上下浮動50個基點。

Turning to the performance of our businesses in '23. Optum Health's revenues grew by 34% to over $95 billion as we increased the number of patients served under value-based care arrangements by about 900,000 to more than 4.1 million, expanded services in the home and broadened and deepened the levels and types of care we offer.

回顧我們 2023 年的業務表現。 Optum Health 的收入增長了 34%，超過 950 億美元，這得益於我們在基於價值的醫療安排下服務的患者人數增加了約 90 萬，達到 410 多萬人，擴大了家庭服務，並拓寬和深化了我們提供的護理水平和類型。

OptumInsight's revenues grew 30% to $18.9 billion. We concluded the year with a revenue backlog of $32.1 billion, an increase of $2.1 billion over last year. This growth was driven by our diverse and expanding product portfolio which connects many of the key stakeholders across health care. Whether it's launching new decision support solutions for providers, claims-editing software for payers, or simplifying the payment process for all, our continued investments are fostering the next phase of OptumInsight growth.

OptumInsight 的營收成長 30%，達到 189 億美元。年底，我們的營收積壓訂單為 321 億美元，較前一年增加 21 億美元。這一增長得益於我們多元化且不斷擴展的產品組合，該組合連接了醫療保健領域的眾多關鍵利益相關者。無論是為醫療服務提供者推出新的決策支援解決方案，為支付方提供理賠編輯軟體，還是簡化所有支付流程，我們持續的投資都在推動 OptumInsight 進入下一個成長階段。

Optum Rx revenues grew 16% to over $116 billion, driven by the continued addition of new clients, expansion within existing relationships and organic growth of our pharmacy services businesses. In 2023, both customer retention and new wins were among the best Optum Rx has delivered.

由於新客戶的持續成長、現有客戶關係的拓展以及藥房服務業務的自然成長，Optum Rx 的營收成長了 16%，超過 1,160 億美元。 2023 年，客戶留存率和新客戶拓展量均創下 Optum Rx 的史上最佳紀錄。

At UnitedHealthcare, full year revenues of over $281 billion grew nearly 13%. Adding to Andrew's earlier comments, within Medicare Advantage, we expect a majority of our full year growth outlook to be realized outside the annual enrollment period, with the growth patterns consistent with those we have experienced over more recent years.

聯合健康保險公司全年營收超過2,810億美元，成長近13%。正如安德魯之前所說，在聯邦醫療保險優勢計劃方面，我們預計全年增長預期的大部分將在年度參保期之外實現，增長模式與我們近年來所經歷的增長模式一致。

Our Medicaid enrollment outlook for 2024 balances 2 key elements. First is that state redetermination activities will be largely completed by midyear. And second, that growth within existing states, such as North Carolina and other new opportunities, will partially offset these impacts.

我們對2024年醫療補助計劃（Medicaid）參保人數的預測主要考慮兩個關鍵因素。首先，各州的重新認定工作將在年中基本完成。其次，現有參保州（例如北卡羅來納州）的成長以及其他新機會將部分抵消這些影響。

Within our domestic commercial offerings, we expect to serve about 1.5 million additional people in '24, a strong result. And we are encouraged by the continued positive customer response we are experiencing as we look ahead.

在國內商業領域，我們預計2024年將新增約150萬用戶，這是一個強勁的成績。展望未來，我們對持續收到的正面客戶回饋感到鼓舞。

Our ample capital capacities continue to underpin our long-term growth objectives. Cash flow from operations in '23 was $29 billion or 1.3x net income. We returned nearly $15 billion to shareholders through share repurchase and dividends and deployed over $10 billion in growth capital to build for the future.

我們充裕的資本實力持續支撐著我們的長期成長目標。 2023年，我們的營運活動現金流為290億美元，相當於淨利的1.3倍。我們透過股票回購和分紅向股東返還了近150億美元，並投入超過100億美元的成長資本用於未來發展。

To summarize. Our '23 performance and start to the new year further solidifies and reinforces our confidence in both the '24 and long-term growth objectives we shared with you at the end of November.

總而言之，我們2023年的業績以及新一年的開局進一步鞏固和增強了我們對2024年以及我們在11月底與大家分享的長期增長目標的信心。

Now I'll turn it back to Andrew.

現在我把麥克風交還給安德魯。

Thanks, John, and thank you, Dirk. Heading into 2024, I hope you all sense our confidence. We have talented people who are committed to our effort to help build a simpler, more consumer-friendly health system for the people we serve. And we're well positioned to continue to deliver on the well-established commitments we've made.

謝謝約翰，也謝謝德克。展望2024年，我希望大家都能感受到我們的信心。我們擁有才華洋溢的團隊，他們致力於為我們服務的民眾建構一個更便利、更人性化的醫療體系。我們完全有能力繼續履行我們所做出的各項承諾。

Operator, let's open it up for questions.

操作員，現在開始接受提問。

(Operator Instructions) We'll go first to Justin Lake with Wolfe Research.

（操作說明）我們將首先與 Wolfe Research 一起前往賈斯汀湖。

I wanted to touch on the cost trend commentary. Specifically, between the Investor Day and the end of the year, it looks like the MLR was a little bit higher. Can you tell us what you saw there over that last month? Maybe give us some color.

我想談談成本趨勢的問題。具體來說，從投資者日到年底，MLR（主貸款利率）似乎略有上升。您能否談談過去一個月您觀察到的情況？能否詳細解釋一下？

John, I know you guys did a great job in the second quarter of getting ahead of cost trend and utilizing some of those facility kind of insights that you have on scheduling, et cetera. We're trying to figure out whether this is just seasonality or a further pickup in utilization given the Q3 to Q4 that you saw. So maybe you could tell us what you're seeing into January. And just tell us where you think the Q1 comes in versus the full year.

約翰，我知道你們在第二季度做得非常出色，成功控制了成本趨勢，並充分利用了你們在生產計劃等方面的專業知識。我們正在努力弄清楚這只是季節性因素，還是像你們在第三季到第四季一樣，產能利用率進一步提升的結果。所以，你能不能跟我們說說你對一月情況的看法？而你認為第一季與全年相比會處於什麼位置？

Justin, thanks so much for the question. Let me just make a couple of comments, and then I'll ask John Rex to give you a little bit more detail on the area you just talked about.

賈斯汀，非常感謝你的提問。我先簡單說幾點，然後我會請約翰·雷克斯就你剛才提到的那個方面再詳細解釋一下。

So I think overall, as we look at '23, overall, it came in very much in the sort of zone we expected. Towards the top end of that zone, but very much within the zone of what we're expecting for the full year and we signaled back in the middle of the year. And the bulk of that story is driven by the outpatient shift in behavior around seniors that we talked about back in June.

所以總的來說，回顧2023年，整體情況基本上符合我們的預期。雖然接近預期範圍的上限，但完全在我們全年預期之內，我們在年中也曾發出過這樣的訊號。而這主要得益於我們在6月討論過的老年人門診就診行為的轉變。

You're right, though. Post the investor conference, what we certainly saw was a click up in some seasonal activity, each of which individually are kind of pretty small, but added together, just made a bit of a difference in that last run out of the quarter. Around things like RSV vaccination, which has brought with it, dragged with it, if you will, some extra utilization of services from seniors who've come in for their vaccine.

你說得對。投資人會議之後，我們確實看到一些季節性活動有所增加，雖然每項活動單獨來看增幅都不大，但加起來，對本季末的業績產生了一定的影響。例如呼吸道合胞病毒（RSV）疫苗接種，就帶動了老年人接種疫苗後對服務的額外需求。

Listen. To be clear, all of that is good news for health care, right? So these are seniors, many of whom have not been to the office for a long time. They've come back in and now got vaccinated. The physicians have picked up other things while they've been there.

聽著。說清楚點，這對醫療保健來說都是好消息，對吧？這些都是老年人，其中許多人已經很久沒來診所了。他們回來後接種了疫苗。醫生們在他們就診期間也發現了其他一些問題。

So a little bit of that going on, combined with a little bit of heightened COVID activity just as we rolled out the year. None of which we really think is durably impacting our outlook for '24. So we feel very solid around our '24 guidance point of 84%, plus or minus 50 bps.

所以，這些因素疊在一起，再加上年初新冠疫情活動略有加劇，都會對2024年的業績產生一定影響。但我們認為這些因素都不會對我們2024年的業績展望造成持久性影響。因此，我們對2024年84%的業績指引（上下浮動50個基點）非常有信心。

Maybe I'll ask John just to give you a little bit more click-down kind of insight into all of that now. Go ahead, John.

或許我應該請約翰再給你詳細解釋。約翰，請便。

Justin, you're absolutely right. So the prime factor here when we think about the full year view and where we ended up being what we talked about, much earlier in the year in terms of the outpatient care activity among senior populations; and that continuing consistent with what we saw back much earlier in the year and very supportive of what we staked out in terms of the benefit design that we stepped into '24 with, in particular for senior populations and our Medicare Advantage product. So all those elements very much supportive of that view and the activities we undertook earlier in the year.

賈斯汀，你說得完全正確。所以，當我們展望全年形勢，以及最終結果如何時，最關鍵的因素是我們年初討論過的老年人群門診服務活動情況；這與我們年初的觀察結果一致，也與我們2024年制定的福利方案（特別是針對老年人群和我們的聯邦醫療保險優勢計劃）高度契合。所有這些因素都有力地支持了這一觀點以及我們年初開展的各項活動。

As it relates to kind of where we landed the full year, so 10 basis points really above kind of what we indicated at the investor conference back in November of differential. And Andrew hit on those items, let me just kind of take it a little bit deep here.

至於我們全年的最終業績，比我們在11月份投資人大會上預測的利差高出10個基點。安德魯也談到了這些，讓我再深入探討。

So definitely some typical seasonality involved in there. And the incremental elements were -- I'd point out a couple of items. Seniors did really respond strongly to RSV vaccinations and scheduled physician visits. Sometimes those physician visits, what we noted, were driving other care activity around that. So in some cases, seniors that hadn't perhaps been to a physician in a little while.

所以，這其中肯定存在一些典型的季節性因素。而其他一些因素——我想指出幾點。老年人對呼吸道合胞病毒疫苗和定期就診的反應非常強烈。我們注意到，有時這些就診會帶動其他相關的醫療保健活動。因此，在某些情況下，有些老年人可能已經有一段時間沒有去看醫生了。

And so they visited their PCP, got an RSV vaccine. And then in the meantime, their PCPs were able to close some additional care gaps as they were over there. It was a great thing because some of these seniors haven't been in for a while. So important activity to occur there in the fourth quarter. So that was one of the elements that we saw there.

於是他們去看了家庭醫生，接種了呼吸道合胞病毒疫苗。同時，他們的家庭醫生也趁此機會彌補了一些其他方面的醫療缺口。這非常重要，因為有些老年人已經很久沒有就診了。所以，在第四季進行這些醫療活動意義重大。這是我們觀察到的其中一個面向。

As it relates to kind of what we were seeing with the elevated care costs for COVID. What we saw in the fourth quarter and particularly in December, overall, what we've been noticing is COVID admits for our inpatient states are running a higher cost per case than we traditionally saw. That actually kind of makes some sense. There are more intense cases typically that are going into inpatient state.

就我們觀察到的新冠肺炎醫療成本上升問題而言，尤其是在第四季和12月份，我們注意到，新冠肺炎住院患者的單例成本普遍高於以往水準。這其實也合情合理，因為通常情況下，需要住院治療的重症患者數量更多。

I will say we did notice in December that the total level of COVID admits were probably 50% to 60% above the October, November average that we had seen. So that was kind of the highest part of the year in terms of COVID inpatient admits. If I take those elements in sum together that more than accounts for the 10 basis points differential in our full year view, Justin.

我想說的是，我們注意到12月份新冠肺炎住院總人數可能比10月和11月的平均值高出50%到60%。所以，就新冠肺炎住院人數而言，那算是全年最高的時期了。賈斯汀，如果我把這些因素加起來，就足以解釋我們全年預測中10個基點的差異了。

As that pertains to your second question, as we look out into the next year and what we see in terms of patterns, I would call it patterns commensurate kind of with what we saw this year in terms of just the movement with this kind of 84% view that we view for the full year.

至於你的第二個問題，展望來年，就我們所看到的趨勢而言，我認為這些趨勢與我們今年看到的趨勢大致相當，我們對全年的展望是 84%。

As I step back and reflected just kind of thinking about where -- broadly where the analyst consensus is, you picked particularly the 1Q, it's kind of in the right -- it looks like an appropriate zone in terms of staked out there for what one would expect. Thank you, Justin.

當我冷靜下來思考，大致了解分析師的共識後，你特別提到了第一季度，這似乎很合理——就預期而言，這似乎是一個合適的區間。謝謝你，賈斯汀。

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

接下來我們連線腎單位研究的喬許‧拉斯金。

Can you describe the competitive environment for Medicare Advantage? And I'm specifically thinking about how you've adjusted benefits in 2024 as part of a 3-year process. I don't want to put words in your mouth, but it sounds like you're trying to adjust for the majority of the risk model changes in one fell swoop. And I'm curious how you think that plays out and positions you not just for '24, but then for '25 and '26 as well.

您能描述一下聯邦醫療保險優勢計劃（M​​edicare Advantage）的競爭環境嗎？我特別想了解您是如何在三年計畫中調整2024年的福利的。我不想妄加揣測，但聽起來您似乎想一次調整大部分風險模型的變化。我很想知道您認為這種調整會帶來怎樣的影響，以及它不僅會影響您在2024年的前景，還會影響您在2025年和2026年的前景。

Josh, thank you so much. Before I ask Tim Noel to give you more detail on your question, I mean, listen. I think the way we've looked at the shift in the rate notice is a 3-year set of adjustments, and that's why we've been very thoughtful about how we plan, not just, frankly, benefit design, but how we continue to accelerate our management of OpEx through the organization, how we've continued to focus on eliminating unnecessary care and waste within the system through our various medical management capabilities.

喬什，非常感謝。在我請提姆·諾埃爾詳細解答你的問題之前，我想先聽我說。我認為我們對費率調整通知的解讀是，這是一項為期三年的調整計畫。正因如此，我們才如此慎重地制定計劃，不僅包括福利方案的設計，還包括如何持續加快整個機構的營運支出管理，以及如何透過我們各種醫療管理能力，持續致力於消除系統內不必要的醫療服務和浪費。

So it's really a 3-pronged set of agendas which we're going to be focused on over the next 3 years. And we've been very, very thoughtful about making sure that we are setting those tables in a way which we can be sustainable on through this cycle so that we're not taking sharp left turns or right turns halfway through the period.

所以，未來三年我們將重點放在三個方面的議程。我們一直在深思熟慮，確保這些議程的製定能讓我們在這個週期內可持續發展，避免在週期中途突然轉向。

With that kind of overall perspective, maybe ask Tim to give you a little bit more deep dive on the competitive environment and how he's very specifically planning for this.

從這個整體角度來看，或許可以請 Tim 更深入分析競爭環境，以及他為此所製定的具體計畫。

Yes. Thanks, Josh, for the question. So I agree with Andrew's comments, and couple of things to start with is there's been a number of changes to the Medicare Advantage and Part D programs over the last 18 months to 2 years that are really phasing in over multiple years. And as we plan for 2024, we once again took a very rational view to the environment and also a long-term view with always our overarching goal being benefit stability for our members.

是的。謝謝Josh的提問。我同意Andrew的觀點，首先要說明的是，過去18個月到2年裡，Medicare Advantage和Part D計畫都進行了一些調整，這些調整其實是在幾年內逐步實施的。在製定2024年計畫時，我們再次以非常理性的視角看待市場環境，並著眼於長遠發展，始終將保障會員福利的穩定性作為我們的首要目標。

As we step into benefit planning in future years, we really feel like we have got a very thoughtful way to respond to all of those changes that will be encountered by the Medicare Advantage and Part D programs into 2025 and beyond.

展望未來幾年的福利規劃，我們深感我們已經找到了一種非常周全的方法來應對 Medicare Advantage 和 Part D 計劃在 2025 年及以後將遇到的所有變化。

And certainly, as we look forward, we don't believe that we have any material pricing catch-up to do in future periods and feel like we've got a very thoughtful response to the changes that will be encountered by the program into 2025 and 2026. So we think the forward view of our competitive outlook is quite solid and quite strong as we think about growth over the long term.

當然，展望未來，我們認為未來一段時間內無需在價格方面進行任何實質性的追趕，並且我們對該項目在2025年和2026年將遇到的變化做出了非常周全的應對。因此，我們認為，從長遠來看，我們對自身競爭前景的展望相當穩固且強勁。

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

接下來我們將介紹瑞銀集團旗下的 A.J. Rice。

Just -- I apologize, it's sort of granular, but we're getting asked a lot of questions about it. The 2 metrics, days claims payable down a couple of days, year-to-year, sequentially, some from third quarter.

抱歉，我可能說得有點細枝末節，但我們被問了很多相關問題。這兩個指標分別是：應付理賠天數，年比和季比都減少了幾天，部分數據來自第三季。

And then the prior period development being down $100 million maybe accounts for some of the variants on MLR, I'm guessing. I don't know if that's what you were guiding for when you updated -- last updated your outlook. But any comment on that as well?

而前一期發展虧損1億美元或許可以解釋MLR的一些波動，我猜是這樣。我不知道您上次更新展望時是否考慮到了這一點。對此您有什麼看法嗎？

Let me ask John to address that, A.J. Thank you.

讓我請約翰來回答這個問題，A.J. 謝謝。

So first, on the days claims payable, so 2.8-day sequential decline, 2 days year-over-year. So primarily, the single largest factor would be exactly what you pointed to, the change in prior period development. So that has a significant impact. If you look about a year ago, where we were in prior period development and where we were even in the 3Q. So the significant impact on that part, that would be the other -- the main factor.

首先，就理賠支付天數而言，季減2.8天，年減2天。因此，最主要的單一因素正如您所指出的，是前期發展的改變。這產生了顯著影響。如果您回顧大約一年前，以及我們第三季的前期發展情況，您會發現這部分的主要影響因素。

In terms of other contributing factors that we saw. We did see in the fourth quarter some modest acceleration in provider claims submission timing. So just speed up in terms of those submissions, how quickly we're receiving them from date of service in terms of receipt.

就其他影響因素而言，我們觀察到第四季度供應商提交理賠申請的速度略有加快。也就是說，從服務日期到我們收到理賠申請的速度都有所加快。

We also saw -- noted that, as it related to the fourth quarter, some higher claims intensity in the first part of the quarter, particularly October. So that's a factor that impacts the denominator, MedEx per day, in the days claims payable metric, and that was a piece that was in that also.

我們也注意到，就第四季而言，季度初，特別是10月份，索賠強度增加。這會影響到索賠支付天數指標中的分母——每日醫療費用，這也是其中的一個因素。

As it relates to the $100 million of unfavorable medical development in the quarter, put that mostly at the items that we were talking about in my response to Justin's question. So the respiratory-related activity that we saw in there, the modestly higher cost per case for inpatient COVID admits, really kind of those were the main factors that we had in there in terms of contributing to the unfavorable development.

至於本季1億美元的不利醫療支出，主要集中在我回答賈斯汀的問題時提到的那些項目。例如，我們看到的呼吸系統相關疾病活動，以及新冠肺炎住院病例的單例成本略有上升，這些確實是造成不利支出的主要因素。

No, it's a good question, A.J. And as John just said, even back in the sort of second half of Q3, we saw -- we've seen subsequently that this RSV pickup and this phenomena of more services being delivered around the vaccination was already starting as we were rolling out through Q3, which is really what explains that.

不，A.J.，你問得好。正如約翰剛才所說，早在第三季下半段，我們就看到——後來我們也看到，RSV 病例的增加以及圍繞疫苗接種提供更多服務的現象，在我們第三季度推廣疫苗接種時就已經開始了，這才是真正的原因。

So in many ways, this kind of Q3 issue of negative development and then the slight pressure at the end of the year is kind of the same story. And it all -- which is why we don't feel it has any real direct relevance in terms of thinking through 2024. Thanks for the question, though. I appreciate that.

所以從很多方面來看，第三季出現的負面發展問題以及年底的略微壓力，本質上是一回事。正因如此，我們認為這些問題與展望2024年並沒有直接的關聯。不過，謝謝你的提問，我很感激。

We'll go next to Lisa Gill with JPMorgan.

接下來我們連線摩根大通的麗莎吉爾。

I want to go to Optum Health and just maybe talk about the medical cost trend there. John, just going specifically to the comments that you made. Did you see something similar in Optum Health? Are we seeing anything different there?

我想去Optum Health公司，跟他們聊聊醫療費用趨勢。約翰，我只想具體談談你剛才提到的情況。你在Optum Health公司也看過類似的情況嗎？我們那邊的情況有什麼不同嗎？

And then also, I just want to understand the claim lag there. We've heard from some others that there can be a pretty big claim lag when we think about the providers versus the payers.

另外，我還想了解理賠延遲的問題。我們從其他人那裡了解到，如果考慮到醫療服務提供者和支付方之間的差異，理賠延遲可能會相當嚴重。

So let me ask John to start, and then maybe ask Heather to make a couple of comments on the claim dynamic. Go ahead, John.

那麼，我先請約翰發言，然後或許可以請希瑟就索賠動態發表一些看法。約翰，請開始吧。

Yes, Lisa, so definitely could have seeing seniors obtaining RSV vaccinations and kind of some of the respiratory activity that was going on in the quarter. So broadly similar features.

是的，麗莎，所以肯定能看到老年人接種呼吸道合胞病毒疫苗，以及本季發生的一些呼吸道疾病活動。所以整體上是類似的特徵。

For Optum Health, one of the comments that we've made throughout the year though also has to do with the progression here of taking on a large block of new membership. So we took on about 900,000 new members as we started the year. And one of the comments we've made throughout the year is engaging with these members.

對於Optum Health而言，我們全年都在強調的一點是，我們新增會員數量龐大。年初時，我們新增了約90萬名會員。而我們全年都在強調的一點是，要與這些會員保持良好的互動。

Because the most important thing we need to do is have a clinical engagement with these members in terms of start improving their health outcomes, getting them in to see physicians, having our clinicians interacting -- having -- interacting with them. And it's a comment we've made throughout the year as we've seen the Optum Health margin progression.

因為我們最需要做的，就是與這些會員進行臨床互動，從而改善他們的健康狀況，讓他們去看醫生，讓我們的臨床醫生與他們互動。在過去一年中，隨著Optum Health利潤率的提升，我們也一直在強調這一點。

So one of the great things, we probably started the year kind of roughly a 20% engagement level with that new -- about 900,000 member block. We exit the year having engaged with about 80% of these members. Super important factor as we think about Optum Health, as we think about 2024 and how -- and that progression. And that's been a big focus of the team at Optum Health all year long, of getting that engagement in so we can have impact on their health. But far and away, that's -- especially given what this population is like, they typically have complex needs, that's important.

值得一提的是，年初時我們與新加入的約90萬會員的互動率大概只有20%。而到了年底，我們已經與其中約80%的會員建立了互動。這對於我們思考Optum Health的未來，以及展望2024年的發展方向和後續進展而言，都是至關重要的因素。 Optum Health團隊全年都致力於提高會員互動率，以便更好地改善他們的健康狀況。尤其考慮到這部分人群的特殊性——他們通常有著複雜的健康需求——這一點顯得尤為重要。

Another really important marker. As it relates to the new membership of patients that we're bringing in to Optum Health for 2024, again, so I talked about that 20% engagement level we started '23 with. For 2024, we're going to start with a 50% engagement level with that new membership. So we're making advances in that, and that's exactly what you should expect from the team. Their efforts have been really, really strong.

另一個非常重要的指標。這與我們2024年加入Optum Health的新病患會員有關。我之前提到過，我們在2023年初的會員參與率是20%。而到了2024年，我們將把新會員的參與率提高到50%。我們在這方面取得了進展，而這正是大家應該對團隊抱持的期望。他們的努力真的非常卓有成效。

Great. Thanks, John. Maybe, Heather, you could comment on Lisa's question around claims. And then I'd like to ask Amar also to follow up on your perspective on engagement and what's driving that. Please go ahead, Heather.

太好了，謝謝約翰。希瑟，或許你可以就麗莎關於索賠的問題發表一下看法。然後，我還想請阿瑪爾談談你對用戶參與度以及驅動因素的看法。希瑟，請開始吧。

Sure. So the only thing -- the thing I would add, too, so I appreciate on top of John's point. When you think about engaging the patient early, then it's really in the clinician's hands. And I think that the way we think about our clinicians is that importance to your point about visibility then to kind of action.

當然。我唯一想補充的是──我也很認同約翰的觀點。當你考慮儘早與患者互動時，關鍵在於臨床醫師。我認為我們對臨床醫生的重視程度，正如你所說，在於提高可見度，然後採取行動。

And the way we think about our clinicians is, once we get that engagement, and as John said, early engagement is so important, then our clinicians having the tools. And I think we've been -- what's really essential for us is those 130,000 clinicians having visibility early, what to do next.

我們對臨床醫生的看法是，一旦我們獲得了他們的參與——正如約翰所說，早期參與至關重要——那麼我們的臨床醫生就需要擁有相應的工具。我認為我們一直以來所做的事——對我們來說真正重要的是，讓這13萬名臨床醫生儘早了解下一步該做什麼。

And the first thing is that they've got the technology, they've got solutions around them, they've got referral management practices, that they can engage with high-quality specialists when they need to for outpatient procedures. And then that they've got the supports in behavioral health and the home and community-based -- home and community services that we've been investing heavily in over the last year.

首先，他們擁有相應的技術、解決方案和轉診管理機制，可以在需要進行門診手術時聯繫到高品質的專家。其次，他們也擁有行為健康方面的支持，以及我們在過去一年中大力投資的居家和社區服務。

And then the last thing I would point to is the contract protections that we've been focused on with our payers to be sure that the structures are in place so that our clinicians can practice in a responsible way. They've got visibility into the dynamics that are happening with the patients, and then they've got the supports in place with the payers.

最後我想強調的是，我們一直致力於與支付方簽訂合同，以確保各項機製到位，從而使我們的臨床醫生能夠以負責任的方式行醫。他們能夠了解患者的病情動態，並且能夠獲得支付方的支持。

Amar?

阿瑪爾？

Yes. Thanks for that question. Look, I think I'd reiterate the point around our highest-risk complex members, where we're engaging at a 2x higher rate than the same time last year.

是的，謝謝你的提問。我想再次強調我們針對高風險複雜患者群體的情況，目前我們的介入頻率是去年同期的兩倍。

And within engagement and our clinical programs, I'd focus around referral management and high-value, evidence-based medicine programs, including our Optimal Care program, where a majority of our clinicians are engaged with these evidence-based programs, are able to get patients the care that they need; and importantly, get the support with the provision of wraparound services, including specifically home-based services, so that the highest-risk groups have their care connected from the primary care setting into the home.

在參與和我們的臨床項目方面，我將重點放在轉診管理和高價值的實證醫學項目，包括我們的「最佳照護」項目。我們的大多數臨床醫生都參與了這些循證項目，能夠讓患者獲得所需的護理；更重要的是，還能獲得全方位服務的支持，特別是居家服務，以便讓高風險群體能夠從初級保健機構獲得居家護理。

Amar, thanks. And John, maybe just to tie up the whole question.

阿瑪爾，謝謝。約翰，或許你只是想把整個問題總結。

Yes. And Lisa, tying up just on the last part of your question here regarding visibility into care activity, claims lag. No, we don't -- that's not a factor. Just given the model of Amar's business and how those groups run, we -- frankly, it's one of the areas where we get probably early sensing mechanisms in terms of the care activity that's going on. It's one of the early sensing mechanisms from much earlier in the year when we were able to talk about what we were seeing in the senior populations, and their -- the care activity within orthopedic and other procedures. So that's not a factor. In fact, if anything, it's probably a strength of the organization.

是的。麗莎，最後再補充你關於醫療活動可見性和理賠滯後的問題。不，我們不存在這個問題——這不是問題所在。就Amar的業務模式和這些團隊的運作方式而言，坦白說，這正是我們能夠及早感知醫療活動的領域之一。早在年初，我們就能利用這種早期感知機制，了解老年族群在骨科和其他手術方面的醫療活動。所以，這根本不是問題。事實上，這或許正是我們組織的優勢所在。

Yes. Thanks, John. Lisa, thanks so much for the question. And we obviously just spent a couple of minutes there talking about engagement, and I hope that gave you a strong sense of some of the progress we've made over the last 12 months in this area.

是的。謝謝你，約翰。麗莎，非常感謝你的提問。我們剛剛花了幾分鐘時間討論用戶參與度，我希望這能讓你對我們在過去12個月裡在這個領域取得的一些進展有一個清晰的了解。

I would say we're night and day in a different position today than we were a year ago. In terms of our ability to be engaged with these complex patients, making sure our physicians are ready to go. That's a really important aspect of what's building our confidence for 2024.

我認為，我們如今的處境與一年前相比，可謂天壤之別。尤其是在我們能夠更好地應對這些複雜的患者病情，確保我們的醫生隨時準備就緒方面。這對於增強我們對2024年的信心至關重要。

And I make no apology for just spending a couple more minutes making sure you hear some of the great work that's gone on over the last year, to ensure that we've got these very high levels of engagement and real substance behind that engagement, so that these patients will be supported and managed really positively going through '24. That's what then underpins and unlocks the whole opportunity of value-based care for Optum Health. Lisa, thank you for your question.

我毫不猶豫地再花幾分鐘時間，向您介紹過去一年裡我們所做的出色工作，確保我們擁有如此高的參與度，並且這種參與度背後有切實有效的措施，從而使這些患者在2024年期間能夠得到積極的支持和管理。這正是Optum Health以價值為導向的醫療保健模式的基石和實現途徑。麗莎，謝謝你的提問。

We'll go next to Stephen Baxter with Wells Fargo.

接下來我們來採訪富國銀行的史蒂芬‧巴克斯特。

I was hoping you could talk a little bit out what you're seeing for cost performance in the group commercial, or exchange, or Medicaid businesses. When you step back, is it still appropriate to attribute all the pressure really you've seen in 2023 to seniors? Or should we be on the line for anything else there?

我希望您能談談您在團體商業保險、交易所保險或醫療補助業務中觀察到的成本效益。從整體來看，您是否仍認為2023年的所有壓力都應歸咎於老年人？或者我們應該考慮其他因素？

Stephen, thanks so much. Maybe I'll ask Brian, just to give you a kind of overarching summary of what UHC is seeing in its different books of business. Brian?

史蒂芬，非常感謝。或許我可以問問布萊恩，讓他給你大致概括一下UHC在不同業務領域的狀況。布萊恩？

Yes, I appreciate that. Thanks, Stephen, for the question. And I think I'll just lead with, I feel really good, not only about how we finished the year in UnitedHealthcare 2023 growth at the top end of our ranges, performance, run-in positions across the board. But also as we step into the businesses for 2024, feel very good about the key assumptions that underpin our plan, and very optimistic.

是的，我很感激。謝謝史蒂芬的提問。我想先說，我感覺非常好，不僅因為我們2023年聯合健康保險的成長預期達到了預期範圍的上限，而且在各項業務的初期階段都表現出色。同時，展望2024年的業務發展，我對支撐我們計畫的關鍵假設也感到非常樂觀。

And you mentioned a couple of areas. You're right. As we've discussed some of these elements with respect to cost trend, they are centered in our senior community. And I think the message around those other businesses, nothing to see here, and really aligned with our expectations, some good stability and durability in the underlying elements, both utilization and unit cost of our trend outlook, and obviously feel very confident in how we're showing up competitively when you look at our growth outlook.

您提到了幾個方面，沒錯。正如我們之前討論的成本趨勢相關因素，它們主要集中在我們的老年社區。至於其他業務，我認為一切正常，與我們的預期基本一致，基礎要素（包括利用率和單位成本）都保持著良好的穩定性和持久性，這符合我們的趨勢展望。顯然，我們對自身的競爭力以及成長前景都非常有信心。

So very optimistic about UnitedHealthcare, durability in those other lines that you're suggesting, and a lot to look forward to here in the year.

我對聯合健康保險 (UnitedHealthcare) 非常樂觀，您提到的其他幾家公司也都很穩健，今年有很多值得期待的事情。

We'll go next to Lance Wilkes with Bernstein.

接下來我們將連線伯恩斯坦和蘭斯威爾克斯。

Can you talk a little bit about Optum Rx, the drivers of growth in the quarter, in particular top line? And then if you can comment a little on revenue per Rx? And do you have any programs that, either in the fourth quarter or in '24, that you've been rolling out that are capturing some of the increased demand on topics like GLP-1s that might be contributors to some of the strong performance?

您能否談談Optum Rx的情況，特別是本季推動成長的因素，尤其是營收成長？另外，能否簡單介紹一下每張處方藥的收入？您在第四季或2024年是否推出了一些項目，以滿足市場對GLP-1等藥物日益增長的需求，這些項目可能也是業績強勁增長的原因之一？

Lance, thanks so much for the question. Before I ask Patrick to start the response on Optum Rx, first off, I just want to note a super strong selling year for us in Optum Rx, probably our best ever. Extraordinary and across a wide range of categories, plans, public service, states, as well as obviously commercial. And really, really pleased with the differentiated product offering really built on transparency, choice and of course cost. And so we feel we've built a strong momentum in '23 rolling into '24.

蘭斯，非常感謝你的提問。在派崔克開始回答關於Optum Rx的問題之前，首先我想強調一下，Optum Rx今年的銷售業績非常強勁，可能是我們有史以來最好的一年。業績表現卓越，涵蓋了廣泛的類別、計劃、公共服務、州以及商業領域。我們對差異化的產品供應感到非常滿意，這些產品真正做到了透明、選擇豐富，當然還有價格優勢。因此，我們感覺2023年已經累積了強勁的成長勢頭，並將延續到2024年。

Patrick, you may want to go a little deeper, maybe share a little detail on Weight Engage, specifically around the question that Lance raised around GLPs.

Patrick，你可能需要更深入地探討一下，分享一些關於 Weight Engage 的細節，特別是 Lance 提出的關於 GLP 的問題。

Yes. Thanks, Lance, for the question. So as Andrew said, really diverse growth, both new business and high retention rates. So one of our best selling years ever. I'd also call out the pharmacy services expansion, the organic growth there across the diverse set of pharmacy services, cost management.

是的。謝謝蘭斯的提問。正如安德魯所說，我們的成長非常多元化，既有新業務成長，也有很高的客戶留存率。所以，這是我們有史以來銷售業績最好的年份之一。我還想特別提一下藥局服務的擴張，以及藥局各項服務的自然成長和成本控制。

And then last, as you mentioned, new products and services. Just to call out one, Weight Engage. So comprehensive management, medication, provider support, client support, lifestyle modification, digital. So a comprehensive solution across Optum, not just Optum Rx, partnering with Optum Health and OptumInsight. Already live with clients and robust interest in the marketplace because patients, members, employers want comprehensive solutions that demonstrate better health outcomes at lower total cost of care.

最後，正如您所提到的，還有新產品和服務。舉個例子，Weight Engage。它提供全面的管理、藥物治療、醫護人員支援、客戶支援、生活方式調整和數位化服務。這是一個涵蓋Optum所有業務的綜合解決方案，不僅限於Optum Rx，還與Optum Health和OptumInsight合作。該方案已在客戶中上線，並在市場上引起了廣泛關注，因為患者、會員和雇主都希望獲得能夠以更低的醫療總成本實現更佳健康效果的綜合解決方案。

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

接下來我們連線美國銀行的凱文‧菲什貝克。

I guess I'm still just struggling with the concept of 2023 coming in worse, but this having no impact on the 2024 outlook. Are you saying that the incremental pressure is really just like flu, RSV, and therefore unlikely to replicate at these levels next year? Because the negative development speaks to costs earlier in the year also coming in worse, which implies that the baseline has -- the core baseline is also higher. So can you just help me reconcile why this isn't raising the base for next year?

我還是不太理解，為什麼2023年的情況會更糟，但這不會影響2024年的前景。你是說，這種增量壓力實際上就像流感、呼吸道合胞病毒感染一樣，因此不太可能在明年達到相同的水平嗎？因為這種負面發展意味著年初的成本也會更高，這意味著基線——核心基線——也更高了。所以，你能幫我解釋一下，為什麼這不會提高明年的基數嗎？

And I guess, within that, you may feel comfortable with the guidance range for MLR. But is there a reason to be at the higher end of the range to start the year? Or is the midpoint still where you're orienting?

我想，在這個範圍內，您可能對MLR的指導區間感到滿意。但是，年初就選擇區間上限是合理的嗎？還是您仍然傾向於區間中點？

So I'll ask John to go a little deeper. Obviously, as you know, Kevin, we've set an MLR target next year, which is in fact higher than the actual closeout for this year in any case, which takes into consideration some of that kind of elevation which we've seen throughout the year. So I'm going to call it the core elevation associated with the outpatient senior behaviors that we've been talking about now for several quarters.

所以我請約翰再深入解釋一下。顯然，正如你所知，凱文，我們明年設定了醫療損失率（MLR）目標，實際上這個目標比今年的實際收支平衡點要高，這其中考慮到了我們今年觀察到的一些增長趨勢。所以我將其稱為與我們過去幾季一直在討論的老年門診行為相關的核心成長趨勢。

And then as we've talked a little bit already, this end of Q4 type of a small seasonality variation, we don't think is really durable or relevant to the rest of the year. But John, maybe go a little deeper on that.

正如我們之前簡單討論過的，第四季末這種小幅季節性波動，我們認為並不持久，也不會對今年剩餘時間產生太大影響。約翰，或許你可以更深入地探討這個問題。

Sure. So -- yes. So the elements that contributed to the unfavorable development being around respiratory activity that was going on, as the seniors came in to get vaccines, another care was being delivered and such. And that higher inpatient cost per case for the COVID admits that we were seeing. So those would largely be the contributors of the elements that we are seeing here in terms of that unfavorability.

當然。是的。導致疫情不利發展的因素主要集中在呼吸系統疾病方面，例如老年人接種疫苗、接受其他照護等等。此外，我們看到新冠肺炎住院病例的單例住院費用也較高。這些因素在很大程度上導致了我們目前看到的不利局面。

So you're absolutely correct in your assumption. That doesn't impact our run-in assumption as we think about our outlook for 2024, and which -- so keeps us right squarely in where we thought we'd be as we were at our investor conference, is taking out the 84% plus/minus 50 basis points.

所以你的假設完全正確。這並不影響我們對2024年展望的初始假設，也因此——正如我們在投資者會議上所預期的那樣——剔除84%正負50個基點的影響，我們仍然保持著預期的水平。

Really as we look across the scope of our businesses and we think, reflect on how we performed in 2023, the scope of it being very much with what we saw back in midyear of 2023, this is -- the run-in factors are about outpatient care activity among senior populations which we incorporated into our bids. The elements that you're appropriately referring to in 4Q, again, not factors impacting our view at all in terms of how we staked out '24 and how we expect to perform in '24. Really good question.

實際上，當我們縱觀我們的業務範圍，回顧我們在2023年的表現時，其範圍與我們在2023年年中觀察到的情況非常相似——這些影響因素主要集中在老年人群的門診護理活動上，而我們已將這些因素納入了我們的投標方案中。您在第四季提到的那些因素，同樣不會影響我們對2024年的展望以及我們對2024年業績的預期。這是一個很好的問題。

Yes. And I'd also just add, I mean, as you would fully expect, Kevin, we're reviewing the leading indicators of care activity, frankly, daily, weekly, monthly, and have been all year. And we've also been investing significantly in increasing numbers of early warning signals, if I can put it that way, to strengthen our radar capability to see this.

是的。我還想補充一點，正如你所料，凱文，我們一直在審查護理活動的主要指標，坦白說，我們每天、每週、每月都在審查，而且全年都在這樣做。此外，我們也投入大量資金來增加早期預警訊號的數量，以增強我們預警的能力，從而更好地發現這些問題。

And I can tell you, we're really not seeing any deviation from what we've been telling you all year in terms of the core activities across the system. The seasonal bumps at the end of the year, obviously, a little different. But in terms of outpatient utilization, all of those lines of activity that we've been discussing at different times with you, the patterns there, very supportive of how we've stepped out for '24.

我可以告訴大家，就整個系統的核心活動而言，我們並沒有看到任何偏離我們全年向大家傳達的訊息的情況。當然，年底的季節性波動可能會略有不同。但就門診利用率而言，我們之前多次與大家討論過的所有活動，其模式都非常支持我們為2024年制定的計畫。

We'll go next to Scott Fidel with Stephens.

接下來我們將和史蒂芬斯一起採訪史考特·菲德爾。

I was hoping to just hop back over to Optum Health for a second. And just as it relates, one, to the margin targets that you gave us at Investor Day, for the 7.7% to 8%, just want to see if those are still the appropriate targets for 2024.

我原本想再簡單看一下Optum Health的狀況。另外，關於您在投資者日上給出的7.7%到8%的利潤率目標，我想確認一下這些目標對於2024年是否仍然合適。

And then maybe if we could walk through the sort of pacing exercise with OH margins, given the expected step-up from the exit rate in the fourth quarter, how you're thinking about those OH margins for 1Q and then sort of pacing over the course of the year.

然後，如果我們能一起探討一下營業利潤率的調整策略，考慮到第四季度預期退出率的上升，您是如何考慮第一季的營業利潤率，以及您如何安排全年的營業利潤率。

Scott, thanks so much for the question. I'm going to ask Dr. Desai to make a couple of comments, and then I'm going to loop back to John just to talk through some of the phasing of the year around margin on that.

斯科特，非常感謝你的提問。我會請德賽博士發表一些看法，然後再和約翰討論一下全年利潤率調整的具體細節。

But bottom line, no change in our guidance for Optimum Health. We feel good about going to talk about where we've staked out for Optum Health next year. A ton of work done during 2023 to strengthen the business. You saw that beginning to show through as we roll through the second half. We continue to expect that to be a very strong driver of improvement as we go into 2024. A lot of that work we talked about already today around engagement, is a key element of our confidence in being able to build our profile of that business.

但總而言之，我們對Optimum Health的績效預期保持不變。我們對明年Optimum Health的發展規劃充滿信心。 2023年我們做了大量工作來加強業務。隨著下半年的到來，這些努力開始顯現成效。我們預計這將成為2024年業績成長的強勁動力。我們今天已經談到的圍繞用戶參與度的大量工作，是我們提升Optimum Health業務形象的關鍵。

And Amar, maybe you could go a little deeper, and then John can close out with discussing on the progression.

Amar，或許你可以再深入探討一下，然後John可以總結一下進展。

Thanks for the question, Scott. We're confident in our 7.7% to 8.0% target for 2024. We've discussed engagement in detail. The second important piece is our medical management programs, which we've scaled effectively.

謝謝你的提問，斯科特。我們對2024年7.7%到8.0%的目標很有信心。我們已經詳細討論過用戶參與度。第二個重要面向是我們的醫療管理項目，我們已經有效地擴大了這些項目的規模。

I talked a little bit about OptumCare and evidence-based guidelines. What I would reiterate is the work we're doing across our network with payment integrity. Again, with the idea of being able to provide the right support services across our network.

我剛才簡單談到了OptumCare和實證指南。我想再次強調的是，我們正在整個網路內開展支付誠信的工作。我們這樣做的目的是為了能夠為整個網路提供適當的支援服務。

The last piece I would also hit on is our initiatives around OpEx, which have been progressing well and are on track, driving operating efficiencies and G&A discipline across the organization. And it really with focus on more consistency in our systems and unification of our operating platform. So we feel very good about the 7.7% to 8.0% as we go into '24.

最後我想強調的是我們在營運效率（OpEx）方面的舉措，這些舉措進展順利，按計劃進行，正在推動整個組織的營運效率提升和行政管理規範化。這些措施的重點在於提高系統的一致性，並統一我們的營運平台。因此，我們對2024年7.7%至8.0%的成長目標非常有信心。

Great. Thanks so much, Amar. John?

太好了。非常感謝，阿瑪爾。約翰？

Yes, Scott. So as Amar said, feel very good about where we established our margin objectives for 2024. The element super important here is, again, how these new patient cohorts progress as they come into our business, and we're able to engage with them clinically and improve their health outcomes, make sure we're able to close care gaps.

是的，斯科特。正如阿瑪爾所說，我對我們設定的2024年利潤率目標感到非常滿意。這裡最重要的因素是，這些新患者群體在我們這裡就診後的發展情況，以及我們能否在臨床上與他們互動並改善他們的健康狀況，確保我們能夠彌合醫療服務方面的差距。

And the progress that Amar and team's accomplished during 2023 in terms of getting those engagement levels will assist a lot in terms of the health of the people that we're serving here, and then particularly this cohort from 2023, the 900,000 new patients, that we're able to serve and how that business performs over the course of the year. So that's a big step into it.

Amar 和他的團隊在 2023 年取得的進展，尤其是在提高用戶參與度方面，將極大地幫助我們服務人群的健康狀況，特別是 2023 年新增的 90 萬名患者，以及我們全年的業務表現。這是一個巨大的進步。

Another big step into it is this group of 750,000 new patients that came on to the business. The fact that we were able to get engagement levels significantly higher than where we were at last year with the new cohort will help also. So it gives us a lot of confidence in where we're stepping out in terms of serving these people throughout the course of the coming year.

另一個重大進展是新增了75萬名患者。我們能夠大幅提高新患者的參與度，這無疑也對我們大有裨益。因此，我們對未來一年服務這些患者充滿信心。

In terms of your comment, you'd expect typical than seasonality factors to weigh in how the quarters perform. So much more think about that as seasonality factors, so they're probably having impact here. So typical in terms of seasonal factors that we would have experienced this year, starting with a stronger base that sets us up well to reach our targets.

關於您的評論，您可能會認為影響季度業績的因素更多是常規因素而非季節性因素。因此，我們更多地將其視為季節性因素，它們可能確實產生了影響。就我們今年經歷的季節性因素而言，情況比較典型，因為我們擁有一個更強勁的基數，這為我們實現目標奠定了良好的基礎。

We'll go next to Erin Wright with Morgan Stanley.

接下來我們連線摩根士丹利的艾琳·賴特。

So a question on Optum Rx. Over the past year, there's been some evolving dynamics around -- and news flow around the regulatory changes for PBMs. Unbundling, there were some news flow there as well as pharmacy reimbursement model changes, such as cost-plus type of approach.

關於Optum Rx，我有個問題。過去一年，藥品福利管理機構（PBM）的監管變化引發了一些動態變化和新聞報導。例如，藥品分割以及藥局報銷模式的改變，如成本加成模式，也出現了一些相關新聞。

I guess how are you thinking about potential implications of some of these dynamics, if any at all? And do these dynamics have a material impact on Optum Rx? Or how are you thinking about those profit drivers remaining intact kind of going forward for the PBM?

我想問的是，您如何看待這些動態變化可能帶來的潛在影響？如果有的話？這些動態變化是否會對Optum Rx產生實質影響？或者，您認為這些利潤驅動因素在未來能否持續維持對藥品福利管理機構（PBM）的影響？

Erin, thanks so much for the question. Let me ask Heather to give you some comments there. As you know, Heather's been very, very involved with the various legislative processes, and it'd good to get her perspective on that.

艾琳，非常感謝你的提問。我請希瑟就此發表一些看法。你知道，希瑟一直非常積極地參與各種立法程序，聽聽她的意見會很有幫助。

Sure. Thanks. So maybe just quickly, I'll say, completely respectful of the evolving dynamic, and just make the headline that our business is incredibly dynamic. I'd be remiss if I don't say, again, at this juncture, that we continue to engage because it's incredibly important to note that, in a space where affordable drugs -- affordable prescription drugs to consumers is on everybody's mind, including ours, and that's what the PBM is built to do.

當然。謝謝。那麼，我只想簡單說一句，在充分尊重不斷變化的情況的前提下，我想強調的是，我們的業務發展迅速。在這個關鍵時刻，我必須再次強調，我們會繼續積極參與，因為這一點至關重要。在藥品價格——尤其是處方藥價格——成為每個人（包括我們）的焦點，而這正是藥品福利管理機構（PBM）的使命所在。

We are really pressing to make sure that policymakers understand that it's important to preserve choice for clients. It's important to make sure that we preserve value-based structures because we know that value-based is the way to ensure that we deliver lower price -- the lower-cost drugs, and we can't break that alignment of incentives where PBMs work with payers to reduce costs. And that it is incredibly important that discounts remain because there's no indication that rebates drive list cost -- list prices up. The PBMs work as a counterweight against high drug cost.

我們正在竭力確保政策制定者理解，維護客戶的選擇權至關重要。維護以價值為導向的體係也至關重要，因為我們知道，只有以價值為導向才能確保提供價格更低的藥品，而藥品福利管理機構（PBM）與支付方合作降低成本的這種激勵機制是不可打破的。此外，折扣的保留也極為重要，因為沒有任何跡象顯示回扣會推高藥品標價。藥品福利管理機構（PBM）的角色在於抑制高昂的藥品價格。

That being said, you've seen in our model how diverse the business is. And across Optum Rx, across the PBM, across the pharmacy services, it's a multitude of businesses. And we really listen to our clients. We exist on behalf of our clients, and we compete in a highly competitive market, and we win because our model translates. It translates in transparency, it translates in innovation and it translates in partnership to our clients.

也就是說，您已經從我們的模式中看到了業務的多元化。從Optum Rx到藥品福利管理（PBM），再到藥局服務，涵蓋了眾多業務。我們始終傾聽客戶的需求。我們以客戶為中心，在競爭激烈的市場中脫穎而出，而我們之所以能夠成功，是因為我們的模式切實可行。這種模式體現在透明度、創新以及與客戶的緊密合作。

So we'll follow the client, we'll be incredibly respectful of the legislation, but I feel really good that we act quickly, we act responsibly, and we work towards value. And you see that in the results. You see that in the growth. But most importantly, you see that in the client validation of the model.

所以我們會聽從客戶的意見，嚴格遵守相關法律法規，但我非常欣慰的是，我們行動迅速、負責任，並且致力於創造價值。這一點從結果中就能看出，從成長中就能看出，但最重要的是，客戶對我們模式的認可也證明了這一點。

So I feel good about where we're positioned. I feel good about the experience in 2023 as a guide to that, but feel really confident in the growth in '24.

所以我對我們目前所處的位置感到滿意。我對2023年的經驗感到樂觀，認為它將為我們指明方向，但我對2024年的成長充滿信心。

Heather, thanks so much. And Erin, thanks very much for the question. I'm sure there will continue to be debate around this area. High drug cost, of course, is a big issue for everybody.

希瑟，非常感謝。艾琳，也非常感謝你的提問。我相信圍繞這個話題的討論還會繼續下去。當然，高昂的藥價對每個人來說都是一個大問題。

First and foremost, we need to see list prices come down. That's the most important thing that can make a big difference here. I would say that as you look at all the different ideas which float up from time to time around reform in this area, there really isn't anything that we don't offer in some form or fashion to our clients and our customers.

首先，我們需要看到標價下降。這是最關鍵、最能產生影響力的因素。我想說的是，儘管圍繞這一領域的改革方案層出不窮，但實際上，我們幾乎都能以某種形式或方式為客戶提供所需的服務。

And the reality is we think that's the right position. We think we should be offering a portfolio of different tools, different product designs, which allows people to choose what's right for them. Because what a state wants, what a union wants, what are corporation wants differs. And it's super important that their views are taken into account here.

事實上，我們認為這才是正確的立場。我們應該提供一系列不同的工具和產品設計，讓使用者能夠根據自身需求選擇最適合的方案。因為不同政府機構、工會和企業的需求各不相同，充分考慮他們的意見至關重要。

We believe we do that well in the diversity of our product offering, and that's what's underpinning our record growth and it underpins our confidence for '24. I appreciate that, Erin.

我們相信，我們在產品多樣性方面做得很好，這正是我們實現創紀錄成長的基石，也是我們對2024年充滿信心的原因。我對此表示讚賞，艾琳。

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

接下來我們連線高盛的內森·里奇。

Great. I wanted to ask on the Medicare AEP enrollment that you talked about, the 100,000 lives that you added. I guess were there any differences in terms of what consumers responded to this year or differences in the retention rate relative to what you're expecting?

好的。我想問您提到的Medicare AEP註冊情況，也就是新增的10萬名參保人。我想問的是，今年消費者的反應或投保率與您預期有什麼不同嗎？

And just can you help us think about the drivers of membership growth over the year as you need it to get to the guidance that you gave for the full year?

您能否幫助我們思考一下，在您需要的情況下，哪些因素會推動全年的會員成長，以便我們能夠實現您先前給予的全年指導目標？

Yes, Nathan, thanks so much for the question. Let me ask Tim Noel to give you that.

是的，內森，非常感謝你的提問。我這就請提姆·諾埃爾來回答你。

Yes. Thanks for the question, Nathan. So once again, the Medicare environment, selling environment is highly competitive. And we probably saw one of the more aggressive years of pricing that we've ever seen in the 2024 session.

是的，謝謝你的提問，內森。再次強調，醫療保險市場，也就是銷售市場，競爭非常激烈。而且，我們可能在2024年的談判中見證了有史以來最激烈的定價競爭之一。

We guided at investor conference to growth of 450,000 to 550,000 lives, which is a little bit more modest than we have grown in past years, but it's reflective of our response to the new risk model changes, what we saw in outpatient utilization patterns early in '23 and reflecting that into 2024 pricing.

我們在投資人大會上預測，未來將新增 45 萬至 55 萬名患者，這比我們過去幾年的成長幅度要小一些，但這反映了我們對新的風險模型變化的應對措施，以及我們在 2023 年初看到的門診利用模式，並將這些因素反映到 2024 年的定價中。

And as we close out AEP, I would say that we were a little bit light against what we were thinking kind of end of November. Most of that actually is in the group business, some of the very aggressive benefits, a little bit more switching, drove some of our term rates a bit higher in AEP than we were initially thinking.

隨著AEP（年度就業計畫）的結束，我想說，我們的實際表現比11月底的預期略低。這主要體現在團體業務方面，一些非常優惠的福利以及更多的轉換，導致我們的部分定期壽險費率在AEP期間略高於預期。

But we still feel like we're going to have a much heavier weighting of our growth outside of the annual enrollment period, from February to December. And this is really just a continuation of a trend that we have seen play out over the last 5 years really. And in fact, last year, we drove 430,000 lives of growth or about 60% of our total growth in the period from February to December.

但我們仍然認為，我們的成長主要將來自年度招生期以外的時期，也就是2月到12月。這實際上只是過去五年來一直存在的趨勢的延續。事實上，去年2月到12月期間，我們新增了43萬名投保人員，約佔總成長量的60%。

This is a portion of the selling season that we really do well in -- given our large dual footprint and also the fact that some of the selling in AEP tends to be focused on some of those headline benefits that have been really aggressively positioned. And throughout the remainder of the year, there tends to be some switching back as folks think more deeply about things like network, the fulfillment of supplemental benefits, overall service and delivery of product.

這是我們銷售旺季的黃金時期——這得益於我們龐大的雙重業務覆蓋範圍，以及AEP期間的部分銷售重點往往放在那些我們大力宣傳的明星福利上。而在一年中的其他時間，隨著人們更深入地思考網路、補充福利的落實、整體服務以及產品交付等議題，銷售策略往往會有所轉變。

So I guess the headline is it is a very aggressive marketplace this year. We feel like we're positioned really well for '25 and '26 on how we priced, and very pleased with what we've done so far and excited about our opportunity, once again, to have a really great growth in the selling period from February to December of '24.

所以我覺得最主要的一點是，今年的市場競爭非常激烈。我們感覺，就定價策略而言，我們已經為2025年和2026年做好了充分的準備，我們對目前為止的業績非常滿意，並且對2024年2月至12月銷售季再次實現大幅增長的機會感到興奮。

Last question, please, operator.

最後一個問題，接線生。

We'll go next to Gary Taylor with Cowen.

接下來我們請考恩和加里·泰勒發言。

Most of my questions have been asked. I'll throw this one out, too. We've been seeing more articles about health system just dropping their MA contracts. Some of those articles cite United. I know historically, most of these types of contracts that -- conflicts that make the press historically ultimately come to term. So I'm just wondering, is this just a media thread? Or do you think there's something more measurable happening here with your health system partners?

我的大部分問題都已經被問過了。我再問一個。最近我們看到很多文章報導一些醫療系統終止了他們的醫療保險協議（MA協議）。其中一些文章提到了聯合健康保險公司（United Health）。我知道，從歷史來看，這類合約——尤其是那些引發媒體關注的衝突——最終大多都會以和解告終。所以我想問的是，這只是媒體炒作嗎？還是說你們的醫療系統夥伴之間存在一些更實際的問題？

Gary, thanks so much. Let me ask Brian to respond to that.

加里，非常感謝。我請布萊恩回覆一下。

Gary, thanks for the question. I would say, overall, the disruptions that we see in the market this year are, I would say, at or even lower than historical comparisons on average, leaving 2023.

加里，謝謝你的提問。總的來說，我認為今年市場出現的動盪程度與歷史平均值持平，甚至低於2023年的平均值。

I will say though that any disruption for our consumers is too much. They come to rely on an in-network provider relationship. They have a coverage expectation from their health plan. So we obviously want to avoid that type of network disruption, and we however do need to balance that ambition with affordability.

不過，我必須指出，任何對消費者造成的干擾都是不可接受的。他們已經習慣了與網路內醫療服務提供者的關係，也對他們的醫療保險計劃抱持相應的保障期望。因此，我們當然希望避免這種網路中斷，但我們也需要在確保價格可負擔性的同時，兼顧這一目標。

Now as we speak specifically to the Medicare Advantage space, we did have some deals that came down to the wire. And I do think that had some impact on AEP. And again, going to Tim's commentary around our confidence February forward, where we have those deals intact, I think you'll see that response in our growth as well. But again, on average, really not much change overall compared to historical periods on disruptions.

現在，具體來說，就聯邦醫療保險優勢計劃（M​​edicare Advantage）領域而言，我們確實有一些交易直到最後一刻才敲定。我認為這對年度註冊期（AEP）產生了一定影響。再次強調，正如提姆之前所說，我們對2月份及以後的前景充滿信心，因為這些交易目前仍然有效，我認為我們的成長也會反映出這種信心。但總的來說，與以往的市場波動相比，整體而言並沒有太大變化。

Yes. No, it's well said, Brian. And I think, obviously, Gary, we -- what you're seeing here is we're working on -- really hard on behalf of our clients, on behalf of patients, on behalf of government, to make sure that we're getting the very best cost associated for the care delivered. And it's important that, that negotiation is robust.

是的。沒錯，布萊恩，你說得對。而且我認為，很明顯，加里，我們——你現在看到的是，我們正在代表我們的客戶、患者和政府，竭盡全力確保我們能以最優的成本獲得所需的醫療服務。而這種強而有力的談判至關重要。

And the good news is that the overwhelming majority get resolved. We really don't like to see disruption happen. Unfortunately, occasionally, it does. But rest assured, we're making good progress in this area. As Brian said, no real kind of difference in outcome to what we've seen in previous years.

好消息是，絕大多數問題都能解決。我們當然不希望看到任何混亂發生。但遺憾的是，這種情況偶爾還是會發生。不過請放心，我們在這方面正在取得良好進展。正如布萊恩所說，最終結果與往年並無太大差異。

With all of that, let me say thank you for all of your questions. Very much appreciated.

最後，我要感謝大家提出的所有問題，非常感謝。

And as you've heard, we're confident in our mission, focused on our growth pillars, delivering innovation that matters and disciplined in our operations and in our approach to the market. And we look forward to delivering on our commitments in 2024 to our customers, patients and shareholders.

正如您所聽到的，我們對自身的使命充滿信心，專注於成長支柱，致力於提供真正重要的創新，並在營運和市場策略方面保持嚴謹的態度。我們期待在2024年履行對客戶、病患和股東的承諾。

Very much appreciate your attention this morning, thank you, and look forward to talking with you between calls. Thank you very much.

非常感謝您今天上午的關注，謝謝。期待在通話間隙與您交流。非常感謝。

That will conclude today's call. We appreciate your participation.

今天的電話會議到此結束。感謝您的參與。