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.

早上好，歡迎參加聯合健康集團 2023 年第四季和全年收益電話會議。 （操作員說明）謹此提醒，此通話正在錄音。

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.

這是一些重要的介紹性資訊。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 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.

此次電話會議也將參考非公認會計原則金額。非 GAAP 與 GAAP 金額的調整表可在公司投資者關係頁面 www.unitedhealthgroup.com 的財務和收益報告部分找到。本次電話會議中包含的資訊將在收益發布中發布——我們今天早上發布的是日期為 2024 年 1 月 12 日的 8-K 表格，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)。

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

謝謝大家，早安，謝謝大家今天加入我們。

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 年即將結束並開啟新的一年之際，我謹向我們超過 40 萬名才華橫溢的同事表示感謝，他們確實是聯合健康集團的一員。正是由於他們過去一年的不懈努力，我們才有機會更全面地為更多人服務。

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.

當我回顧我們 2023 年的表現時，毫無疑問，老年人照護活動的轉變是我們有效管理的重要因素。 Medicare Advantage 資金前景的下調對我們為 2024 年乃至 2026 年做好準備的方式產生了重大影響。

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.

儘管護理模式發生了轉變，並且在 23 年期間感受到了相應的壓力，但我們仍然能夠兌現我們的成長承諾，並為未來 3 年縮短 MA 融資週期進行投資和準備。即使考慮到這些因素，2023 年對聯合健康集團來說也是平衡、可持續成長的一年。重要的是，我們也鞏固了我們在 2024 年及以後繼續發展的基礎。

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.

簡單說明一下。 2023 年，Optum Health 接受基於價值的照護的患者數量將增加 90 萬名。 UnitedHealthcare 在其 Medicare 和商業產品中增加了超過 170 萬名新消費者。 Optum Rx 為人們額外管理了 1 億張處方。 Optum Financial 處理超過 5000 億美元的消費者、付款人和護理提供者付款。 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、照護提供者和客戶互動的方式越來越有影響力，導致 2023 年收入成長超過 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「24」、「25」及以後，我們將繼續提高品質、簡單性、可負擔性和可近性，以幫助改善整個醫療保健系統。我們對調整後每股收益 13% 至 16% 的長期成長率仍然充滿信心並致力於實現。

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.

剛剛在六週前舉行了投資者會議，今天早上我將只用幾分鐘的時間來回顧一下您今年對我們的期望，首先是我們在基於價值的醫療方面的工作。

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.

對我們來說，基於價值的照護是一種行之有效的方法，可以克服按服務收費的醫療系統中許多被廣泛認可的缺點，例如分散的消費者體驗和強調數量而不是品質的激勵措施。我們基於價值的產品使醫生能夠提供更互聯、協調和全面的護理，協調消費者、護理提供者和健康計劃之間的激勵措施，提供更好的健康結果並降低成本。

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 與數十個健康計畫合作，以完全負責任的基於價值的安排為超過 400 萬名患者提供服務。到今年年底，Optum Health 將在此類安排下為至少另外 75 萬名患者提供服務，總數是我們兩年前服務人數的兩倍多。

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.

然而，即使我們實現了強勁增長和重大投資，我們的市場份額仍然相當有限，但機會卻很廣闊：為 400 萬患者提供服務，只是最終健康受益於這些護理模式的更多人的一小部分。 ; Optum Health 的總收入基礎目前僅占美國醫療保健系統 5 兆美元支出的 2%。要實現我們相信可以幫助推動的對人們健康的廣泛、積極的全系統影響，我們還有很長的路要走。

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.

轉向我們的消費者焦點。我們正在努力幫助消費者更輕鬆地獲得醫療保健體驗並支付醫療費用，其中包括利用他們的健康福利。聯合醫療保健商業福利業務的表現就是我們進步的一個例子。我們最近完成的銷售季節是近年來最強勁的銷售季節之一。

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.

這一增長的大部分將來自我們與大型雇主的關係，其中包括最成熟的健康福利購買者。我們的客戶告訴我們，我們專注於他們的員工最重視的東西：更低的成本、更簡單的體驗以及滿足他們獨特需求和情況的適應性福利。這些創新產品的消費者 NPS 比傳統健康計畫高出約 20 多點。

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。我們的目標是成為醫療保健資訊和建議的值得信賴的來源，成為醫療服務、支付和福利的首選市場，這一切都只需消費者在手機上簡單點擊幾下即可實現。

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.

我們較大的消費者服務之一是 Medicare Advantage，我想簡單介紹一下。我們為我們長期的成長記錄以及為選擇我們產品的人們提供服務而感到自豪。在最近完成的年度註冊期間，我們增加了約 100,000 名消費者，我們仍然致力於實現 450,000 至 550,000 名的全年目標。

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和補充福利管理方法的假設完全適合我們正在規劃的環境，並對我們進入這三年期間的成長定位持積極態度。

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.

當我們結束這一年時，還有一個額外的項目。為了實現整個企業的長期目標，我們必須始終如一地確保充分利用我們的資源，包括時間和資本，以便我們能夠更有效地為人們服務，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.

正如您可能看到的，我們最近同意出售我們的巴西業務，我們敬業的同事以關懷和同情心為人們服務。我們高度重視十多年來在巴西建立的關係。在仔細評估了我們的最佳路線後，我們最終確定出售對我們所服務的人和我們來說是正確的一步，以便最好地將我們的精力集中在我們不斷與您討論的許多引人注目的成長機會上。

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

接下來，我會將其交給聯合健康集團總裁兼營運長 Dirk McMahon。短劍？

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。我們的成長植根於創新和我們始終做得更好的強烈願望。我們正在大力投資以實現這一目標，增加數位參與度並使用人工智慧來提高效率，然後透過淨推薦值衡量我們的績效，以確保我們達到目標。

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.

我們的數位參與努力的影響在我們的 1/1 績效指標中顯而易見。正如安德魯所指出的，我們透過我們的商業產品引進了最大的一批新員工，我們的技術在使流程順利進行方面發揮了重要作用。

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 Apple App Store 醫療類別和 Google Play 上一直排名第一或第二。今年第一周，行動應用程式安裝量年增超過 100%，我們的聊天量是歷史平均的兩倍多。

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，數位投資使我們能夠帶來創紀錄數量的新客戶，帶來了超過 300 萬新消費者，客戶服務評分得到改善，總體成本比去年降低了 8%。服務更多的消費者，更高的滿意度和更低的成本。

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.

我們對人工智慧和其他先進技術的投資在改善客戶服務和整個企業的生產力方面發揮著重要作用。例如，我們透過使用人工智慧來幫助完成任務，從工作流程中刪除重複性任務，例如回應消費者查詢、更新提供者目錄以及總結與客戶和患者的互動。這使我們的服務人員和臨床醫生能夠專注於為我們服務的人解決更複雜的任務。

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，使用即時入院和出院數據在急診就診後立即與高風險 MA 成員互動，使他們能夠跟進護理，以確保高品質的入院後結果並避免再次入院。在及時的臨床數據的推動下，這種快速反應將會員參與率提高了 300% 以上，NPS 為 83。

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的服務以及我們的數位計畫和其他努力如何影響這些衡量標準並提高保留率的重要方法。

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。透過數位優化，我們為消費者提供按需護理、高度個人化的福利資訊、即時支援和整合藥房功能。這正在轉化為我們許多業務中 NPS 的顯著改進。我們透過擴大 24/7 虛擬就診的訪問範圍以及 UnitedHealthcare 努力消除近 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.

在整個 24 年，您應該會看到我們對數位能力的更大投資，因為我們將繼續尋找機會：利用科技降低 Optum 和 UnitedHealthcare 的管理成本、提高生產力並進一步增強消費者體驗。

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

現在我將把它交給聯合健康集團財務長約翰雷克斯。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。我們的同事持續致力於進一步擴大和加強支撐我們成長支柱的基礎，為 2024 年及以後的持續成長鋪平道路。

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%.

23 年收入達 3,720 億美元，成長超過 14%，Optum 和 UnitedHealthcare 均達到兩位數成長。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.

正如安德魯早些時候指出的，12 月底，我們簽訂了出售巴西業務的協議，預計將在今年上半年完成。交易完成後，我們預計將記錄約 70 億美元的費用，其中大部分是非現金，主要是由於幾年來累積的外幣換算損失。這項一次性費用的影響將不包括在我們 24 年調整後每股盈餘指標中。出於建模目的，24 年全年展望納入了巴西約 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，我將就護理活動提供一些簡短的評論。照護模式與我們在 23 年上半年與您分享的保持一致。活動量繼續以老年門診護理為主，其中骨科和心臟手術類別最為突出。正如我們所指出的，我們的福利設計方法假設這些活動水準在整個 24 年持續存在，而我們觀察到的 23 年退出的護理模式再次證實了這一決定。

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.

另一方面，我們在年底看到了一些溫和的季節性活動，例如老年人對安排醫生就診以接種 RSV 疫苗做出了強烈而受歡迎的反應。在某些情況下，這些措施還伴隨著獲得額外的必要護理，特別是對於一段時間沒有看過醫生的人來說，這對人們的健康來說是一個積極的結果。

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，當我們回顧 23 年全年結果時，整體護理活動與我們先前分享的觀點大致一致。當我們進入 24 年時，我們對我們所採取的定價和福利設計行動的反應充滿信心，護理模式繼續支持我們 84% 的護理比率前景，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.

轉向我們 23 年業務的表現。 Optum Health 的收入增加了34%，超過950 億美元，因為我們將基於價值的護理安排服務的患者數量增加了約90 萬，達到超過410 萬，擴大了家庭服務，並擴大和深化了我們的護理水平和類型。提供。

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 的營收成長了 30%，達到 189 億美元。今年我們的積壓收入為 321 億美元，比去年增加了 21 億美元。這一增長是由我們多樣化且不斷擴大的產品組合所推動的，該產品組合將醫療保健領域的許多關鍵利益相關者聯繫起來。無論是為提供者推出新的決策支援解決方案、為付款人提供索賠編輯軟體，還是簡化所有人的付款流程，我們的持續投資都在促進 OptumInsight 下一階段的成長。

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.

由於新客戶的不斷增加、現有關係的擴展以及我們的藥房服務業務的有機增長，Optum Rx 收入增長了 16%，達到超過 1,160 億美元。 2023 年，客戶留任率和新勝利都是 Optum Rx 的最佳成績之一。

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.

UnitedHealthcare 全年營收超過 2,810 億美元，成長近 13%。除了安德魯先前的評論之外，在醫療保險優勢範圍內，我們預計全年成長前景的大部分將在年度參保期之外實現，成長模式與我們近年來經歷的成長模式一致。

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 年醫療補助註冊的展望平衡了 2 個關鍵要素。首先，國家重新確定活動將在年中基本完成。其次，北卡羅來納州等現有州的成長和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.

在我們的國內商業服務中，我們預計在 2024 年將為約 150 萬人提供服務，這是一個強勁的結果。展望未來，我們對客戶持續積極的反應感到鼓舞。

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.

我們充足的資本能力持續支撐我們的長期成長目標。 23 年營運現金流為 290 億美元，相當於淨利的 1.3 倍。我們透過股票回購和股息向股東返還近 150 億美元，並部署了超過 100 億美元的成長資本來建立未來。

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.

總結一下。我們 '23 的業績和新一年的開始進一步鞏固和加強了我們對 '24 和長期增長目標的信心，我們在 11 月底與您分享了這一目標。

Now I'll turn it back to Andrew.

現在我會把它轉回給安德魯。

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，謝謝你，德克。邁入2024年，希望大家都能感受到我們的信心。我們擁有才華橫溢的人才，他們致力於幫助我們為我們服務的人們建立一個更簡單、對消費者更友善的醫療系統。我們完全有能力繼續履行我們已做出的既定承諾。

Operator, let's open it up for questions.

接線員，讓我們打開提問吧。

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

（操作員指示）我們將首先與沃爾夫研究中心一起前往賈斯汀湖。

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.

我想談談成本趨勢評論。具體來說，從投資者日到年底，MLR 似乎有點高。您能告訴我們上個月您在那裡看到了什麼嗎？也許給我們一些顏色。

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很好，領先於成本趨勢並利用了你們在調度等方面的一些設施類型的見解。鑑於您所看到的第三季度到第四季度，我們正在試圖弄清楚這是否只是季節性因素，還是利用率的進一步上升。所以也許你可以告訴我們你在一月看到了什麼。請告訴我們您認為第一季與全年相比如何。

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。讓我發表一些評論，然後我將請 John Rex 為您提供有關您剛才談到的領域的更多詳細資訊。

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.

所以我認為總體而言，當我們回顧 23 年時，總體而言，它非常符合我們的預期。接近該區域的頂端，但很大程度上處於我們對全年的預期區域內，並且我們在年中發出了信號。這個故事的大部分內容是由我們在六月討論過的老年人行為的門診轉變所驅動的。

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.

不過你是對的。投資者會議結束後，我們確實看到了一些季節性活動的增加，每項活動單獨來看都相當小，但加在一起，只是在本季度的最後一次活動中產生了一些影響。圍繞著RSV疫苗接種等事情，如果你願意的話，它會帶來一些額外利用來自前來接種疫苗的老年人的服務。

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。需要明確的是，所有這些對於醫療保健來說都是好消息，對嗎？這些都是老年人，其中許多人已經很久沒有去辦公室了。他們已經回來並接種了疫苗。醫生們在那裡時還發現了其他東西。

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.

因此，就在我們推出這一年的時候，這種情況正在發生，再加上新冠病毒活動加劇。我們真正認為這些都不會持久影響我們對 24 世紀的前景。因此，我們對 24 年指導點 84% 感到非常穩固，上下浮動 50 個基點。

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.

也許我會請約翰為您提供更多關於現在所有這些的深入了解。繼續吧，約翰。

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。因此，當我們考慮全年情況時，最重要的因素是我們在今年早些時候就老年人群的門診護理活動所討論的結果；這與我們今年早些時候看到的情況保持一致，並且非常支持我們在進入 24 世紀的福利設計方面所提出的目標，特別是針對老年人和我們的 Medicare Advantage 產品。因此，所有這些因素都非常支持這一觀點以及我們今年早些時候開展的活動。

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.

由於它與我們全年的目標有關，因此比我們在 11 月投資者會議上表示的差異實際高出 10 個基點。安德魯談到了這些問題，讓我在這裡深入探討。

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.

所以肯定涉及到一些典型的季節性。增量元素是－我想指出幾個項目。老年人確實對 RSV 疫苗接種和定期就診反應強烈。我們注意到，有時這些醫生的就診正在推動圍繞這一點的其他護理活動。因此，在某些情況下，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.

因此他們去看了 PCP，接種了 RSV 疫苗。同時，他們的 PCP 能夠彌補他們在那裡的一些額外護理缺口。這是一件很棒的事情，因為其中一些老年人已經有一段時間沒有來了。第四季將發生如此重要的活動。這就是我們在那裡看到的元素之一。

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.

因為這與我們所看到的新冠護理費用上漲有關。我們在第四季度，特別是在 12 月看到的情況是，總的來說，我們注意到新冠病毒承認我們的住院州的每個病例成本比我們傳統上看到的要高。這其實有點道理。通常有較嚴重的病例進入住院狀態。

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，我們在 12 月確實注意到，新冠肺炎入院總人數可能比我們看到的 10 月和 11 月平均水平高出 50% 到 60%。因此，就新冠住院患者而言，這是今年最高的時期。如果我把這些因素加在一起，那麼我們全年觀點的差異就超過了 10 個基點，賈斯汀。

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.

這與你的第二個問題有關，當我們展望明年以及我們在模式方面看到的情況時，我將其稱為與我們今年看到的這種 84 運動相稱的模式我們對全年的看法百分比。

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.

當我退後一步，思考一下——從廣義上講，分析師的共識在哪裡，你特別選擇了第一季度，它有點正確——就放在那裡的目標而言，它看起來像是一個合適的區域。會期望。謝謝你，賈斯汀。

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

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

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 Medicare Advantage 的競爭環境嗎？我特別考慮了你們在 2024 年如何調整福利，作為 3 年流程的一部分。我不想把話放在你嘴裡，但聽起來你正試著一口氣調整大部分風險模型的變化。我很好奇你認為這會如何發揮作用，並讓你不僅在 24 年，而且在 25 年和 26 年也處於有利位置。

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，非常感謝你。在我請蒂姆·諾埃爾就你的問題提供更多細節之前，我的意思是，聽著。我認為我們看待利率通知變化的方式是為期三年的調整，這就是為什麼我們非常仔細地考慮我們如何計劃，坦率地說，不僅僅是福利設計，而是我們如何繼續為了透過組織加速我們對運營支出的管理，我們如何透過各種醫療管理功能繼續專注於消除系統內不必要的護理和浪費。

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.

因此，這實際上是一套三管齊下的議程，我們將在未來三年內專注於。我們非常非常深思熟慮地確保我們以一種能夠在這個週期中可持續的方式設定這些表格，這樣我們就不會在這個週期的中途急速左轉或右轉。

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.

有了這種整體視角，也許可以要求蒂姆讓你更深入地了解競爭環境以及他是如何為此做出具體規劃的。

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。謝謝喬希的提問。因此，我同意 Andrew 的評論，首先有幾件事是，在過去 18 個月到 2 年裡，Medicare Advantage 和 Part D 計劃發生了許多變化，這些變化實際上是在多年內逐步實施的。在我們對 2024 年的規劃中，我們再次對環境採取了非常理性的看法，同時也採取了長期的觀點，我們的首要目標始終是會員的利益穩定。

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.

當我們進入未來幾年的福利規劃時，我們確實覺得我們已經有了一種非常周到的方法來應對 Medicare Advantage 和 Part D 計劃到 2025 年及以後將遇到的所有這些變化。

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，正如我們展望的那樣，我們認為在未來一段時間內我們不會有任何實質性的定價追趕，並且感覺我們對該計劃在 2025 年將遇到的變化做出了非常深思熟慮的回應到2026 年。因此，當我們考慮長期成長時，我們認為我們的競爭前景的前瞻性是相當穩固和強勁的。

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

我們會去 A.J. 旁邊。賴斯與瑞銀。

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.

只是——我很抱歉，這有點具體，但我們被問到了很多關於它的問題。這兩個指標，即應付索賠天數逐年下降了幾天，其中一些比第三季度下降了幾天。

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?

我猜，前期開發成本下降了 1 億美元，這可能是 MLR 的一些變體的原因。我不知道這是否是您上次更新 Outlook 時所指導的內容。但對此有何評論？

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

讓我請約翰解決這個問題，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，就應付理賠天數而言，季減 2.8 天，年減 2 天。因此，首先，最大的因素正是您所指出的，即前期發展的變化。所以這有很大的影響。如果你看看大約一年前，我們處於前期開發階段，甚至在第三季。因此，對該部分的重大影響將是另一個主要因素。

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.

就我們看到的其他影響因素而言。我們確實在第四季度看到提供者索賠提交時間略有加快。因此，只要加快這些提交的速度，我們從服務之日起收到它們的速度就可以了。

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.

我們還注意到，由於與第四季度相關，該季度第一部分的索賠強度有所增加，特別是十月。因此，這是影響分母的一個因素，即每日醫療快遞、應付索賠天數指標，這也是其中的一部分。

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.

由於它涉及本季度 1 億美元的不利醫療發展，因此主要放在我們在回答賈斯汀問題時討論的項目上。因此，我們在那裡看到的與呼吸系統相關的活動，以及住院新冠肺炎患者的每例成本稍高的情況，確實是導致不利發展的主要因素。

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，這是個好問題，A.J.正如約翰剛才所說，即使早在第三季下半年，我們就看到——我們隨後看到，隨著我們推出疫苗接種，這種RSV 回升以及圍繞疫苗接種提供更多服務的現像已經開始了。Q3，這是真正的解釋。

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.

因此，從許多方面來說，第三季的負面發展問題和年底的輕微壓力都是同一個故事。這就是為什麼我們認為它與 2024 年的思考沒有任何真正的直接相關性。不過，謝謝你的提問。我很感激。

We'll go next to Lisa Gill with JPMorgan.

接下來我們將與摩根大通的麗莎·吉爾進行對話。

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，也許只是談談那裡的醫療費用趨勢。約翰，我只想具體談談您發表的評論。您在 Optum Health 中看過類似的內容嗎？我們在那裡看到什麼不同嗎？

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，我只是想了解那裡的索賠滯後。我們從其他一些人那裡聽說，當我們考慮提供者與付款人時，可能會存在相當大的索賠滯後。

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.

因此，讓我請約翰開始，然後也許請希瑟對索賠動態發表一些評論。繼續吧，約翰。

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，所以肯定會看到老年人接種 RSV 疫苗以及本季發生的一些呼吸活動。如此廣泛相似的功能。

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 來說，我們全年發表的評論之一也與吸收大量新會員的進展有關。因此，我們在年初就吸收了大約 90 萬名新會員。我們全年提出的意見之一就是與這些成員接觸。

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.

因為我們需要做的最重要的事情是與這些會員進行臨床接觸，開始改善他們的健康結果，讓他們去看醫生，讓我們的臨床醫生與他們互動。這是我們全年所做的評論，因為我們看到了 Optum Health 利潤率的進展。

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.

因此，最偉大的事情之一是，我們在今年一開始就大約有 20% 的參與度，大約有 90 萬名新會員。今年結束時，我們與其中約 80% 的成員進行了接觸。當我們思考 Optum Health 時，當我們思考 2024 年以及如何發展時，這是超級重要的因素。這是 Optum Health 團隊全年的一大重點，即讓人們參與其中，以便我們能夠對他們的健康產生影響。但從長遠來看，尤其是考慮到這個群體的情況，他們通常有複雜的需求，這很重要。

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.

另一個非常重要的標記。由於這與我們在 2024 年引入 Optum Health 的新病患會員有關，所以我再次談到了我們從 23 年開始的 20% 的參與度。到 2024 年，我們將從新會員的 50% 參與度開始。因此，我們正在這方面取得進展，這正是您對團隊的期望。他們的努力真的非常非常強大。

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.

偉大的。謝謝，約翰。也許，希瑟，你可以評論麗莎關於索賠的問題。然後我還想請阿瑪爾跟進您對參與度的看法以及推動這一點的因素。請繼續，希瑟。

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。所以唯一的事情 - 我也會添加的事情，所以我對約翰的觀點表示讚賞。當您考慮儘早讓患者參與時，這實際上就掌握在臨床醫生的手中。我認為我們對臨床醫生的看法是對你關於可見性的觀點的重要性，然後是對行動類型的重視。

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，一旦我們獲得了參與，正如約翰所說，早期參與非常重要，那麼我們的臨床醫生就擁有了工具。我認為對我們來說真正重要的是 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，他們擁有技術，他們有解決方案，他們有轉診管理實踐，他們可以在需要門診手術時與高品質的專家合作。然後他們得到了行為健康以及基於家庭和社區的支持——我們在過去一年裡一直在大力投資的家庭和社區服務。

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.

我要指出的最後一件事是我們一直專注於與付款人的合約保護，以確保結構到位，以便我們的臨床醫生能夠以負責任的方式執業。他們可以了解患者的動態，然後向付款人提供適當的支援。

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。謝謝你提出這個問題。聽著，我想我要重申一下我們風險最高的綜合體成員的觀點，我們的參與率比去年同期高出兩倍。

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計劃中，我將重點關注轉診管理和高價值的循證醫學計劃，包括我們的最佳護理計劃，我們的大多數臨床醫生都參與了這些循證計劃，能夠為患者提供他們所需的照護；重要的是，透過提供全方位服務（包括專門的家庭服務）獲得支持，以便最高風險群體的照護從初級照護環境連接到家庭。

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

阿馬爾，謝謝。約翰，也許只是為了解決整個問題。

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（Lisa）將您問題的最後一部分與護理活動的可見性聯繫起來，聲稱存在滯後。不，我們不——這不是一個因素。只要考慮到阿馬爾的業務模式以及這些團體的運作方式，坦白說，這是我們在正在進行的護理活動方面可能獲得早期感知機制的領域之一。這是今年早些時候的早期感知機制之一，當時我們能夠談論我們在老年人群中看到的情況，以及他們在骨科和其他手術中的護理活動。所以這不是一個因素。事實上，如果有的話，這可能是組織的優勢。

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，約翰。麗莎，非常感謝你的提問。顯然，我們只是在那裡花了幾分鐘討論參與度，我希望這能讓您強烈感受到我們過去 12 個月在這一領域取得的一些進展。

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.

我想說，我們今天的處境與一年前不同。就我們與這些複雜患者接觸的能力而言，確保我們的醫生做好了準備。這是增強我們對 2024 年信心的一個非常重要的面向。

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.

我不會為僅僅多花幾分鐘確保你們聽到去年發生的一些偉大工作而道歉，以確保我們有如此高水平的參與和參與背後的真正實質內容，所以這些患者將在24 世紀得到真正積極的支持和管理。這就是支撐和釋放 Optum Health 基於價值的護理的全部機會的原因。麗莎，謝謝你的提問。

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

接下來我們將與富國銀行一起去史蒂芬‧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、交換或醫療補助業務中所看到的成本效益。當你退後一步，將 2023 年你所看到的所有壓力歸咎於老年人是否仍然合適？或者我們應該在線詢問其他事情嗎？

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。也許我會問布萊恩，只是為了給你一個關於 UHC 在其不同業務書中所看到的內容的總體總結。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，我很欣賞這一點。謝謝史蒂芬提出這個問題。我想我會領導，我感覺非常好，不僅僅是關於我們如何在聯合醫療保健 2023 年的增長中達到我們範圍的頂端，表現，以及全面的磨合位置。但當我們踏入 2024 年的業務時，我們對支撐我們計劃的關鍵假設感到非常滿意，並且非常樂觀。

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.

你提到了幾個領域。你說得對。正如我們已經討論了其中一些與成本趨勢相關的要素，它們集中在我們的高級社群中。我認為圍繞其他業務的信息，這裡沒有什麼可看的，並且確實與我們的預期一致，底層元素具有良好的穩定性和耐用性，我們的趨勢前景的利用率和單位成本，並且顯然對我們的方式非常有信心當你看看我們的成長前景時，我們就會表現出競爭力。

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.

因此，對聯合醫療保健（UnitedHealthcare）非常樂觀，您所建議的其他產品線的耐用性，以及今年的許多值得期待的事情。

We'll go next to Lance Wilkes with Bernstein.

我們將和伯恩斯坦一起去蘭斯威爾克斯旁邊。

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，本季成長的驅動因素，特別是營收？那麼您能否對每次治療的收入發表一些評論？你們是否有任何計劃，無論是在第四季度還是在 2024 年，都推出了一些計劃來捕捉對 GLP-1 等主題的一些日益增長的需求，這些主題可能會促成一些強勁的業績？

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。在我請派崔克開始對 Optum Rx 做出回應之前，首先，我只想指出 Optum Rx 的銷售非常強勁，這可能是我們有史以來最好的銷售年度。非凡且跨越廣泛的類別、計劃、公共服務、州以及明顯的商業。我們對真正建立在透明度、選擇和成本基礎上的差異化產品感到非常非常滿意。因此，我們認為我們在 23 年到 24 年間已經建立了強勁的勢頭。

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，您可能想更深入一點，也許分享一下有關 Weight Engage 的一些細節，特別是圍繞 Lance 提出的 GLP 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。謝謝蘭斯提出這個問題。正如安德魯所說，真正多元化的成長，包括新業務和高保留率。這是我們有史以來最暢銷的年份之一。我還要強調藥局服務的擴張、各種藥局服務和成本管理的有機成長。

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，新產品和服務。只是想提出一個，Weight Engage。因此，綜合管理、藥物治療、提供者支持、客戶支持、生活方式改變、數位化。因此，與 Optum Health 和 OptumInsight 合作，整個 Optum（而不僅僅是 Optum Rx）的全面解決方案。已經與客戶共存並對市場產生了濃厚的興趣，因為患者、會員、雇主希望獲得全面的解決方案，以較低的總護理成本展示更好的健康結果。

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

接下來是美國銀行的凱文‧菲施貝克 (Kevin Fischbeck)。

I 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?

我想我仍然在為 2023 年會變得更糟的概念而苦苦掙扎，但這對 2024 年的前景沒有影響。您是說增量壓力真的就像流感、呼吸道合胞病毒一樣，因此明年不太可能複製到這些水平嗎？因為負面的發展表明今年早些時候的成本也變得更糟，這意味著核心基線也更高。那你能幫我解釋為什麼這沒有提高明年的基數嗎？

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，在此範圍內，您可能會對 MLR 的指導範圍感到滿意。但是否有理由在年初保持在區間的較高端呢？或者中點仍然是您所定位的位置嗎？

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.

所以我會請約翰更深入一些。顯然，正如您所知，凱文，我們已經設定了明年的MLR 目標，實際上無論如何，該目標都高於今年的實際收尾目標，其中考慮了我們在整個過程中看到的一些此類提升那一年。因此，我將其稱為與門診老年行為相關的核心提升，我們已經討論了幾個季度了。

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.

正如我們已經討論過的那樣，第四季末出現了一個小的季節性變化，我們認為這種變化並不真正持久或與今年剩餘時間相關。但是約翰，也許更深入一點。

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。所以——是的。因此，導致不利發展的因素是圍繞著正在進行的呼吸活動，當老年人進來接​​種疫苗時，正在提供另一種護理等等。新冠肺炎的每例住院費用較高，這也證明了我們所看到的情況。因此，這些因素很大程度上是造成我們在這裡看到的不利因素的因素。

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.

所以你的假設是完全正確的。當我們思考 2024 年的前景時，這不會影響我們的磨合假設，而且這使我們完全保持在我們在投資者會議上的預期位置，即剔除 84%加減 50 個基點。

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.

事實上，當我們審視我們的業務範圍並思考，反思我們在 2023 年的表現時，它的範圍與我們在 2023 年年中看到的情況非常相似，這是——磨合因素是關於我們將老年人群的門診護理活動納入了我們的投標中。再次強調，您在第四季度適當提到的要素，根本不會影響我們對 24 年的計劃以及我們對 24 年的預期表現的看法。真是個好問題。

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，我的意思是，正如您所完全期望的那樣，凱文，我們正在審查護理活動的領先指標，坦率地說，每天、每週、每月以及全年都是如此。我們也大力投資增加預警訊號數量（如果我可以這麼說的話），以加強我們的雷達能力來發現這一點。

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.

我可以告訴你，就整個系統的核心活動而言，我們確實沒有看到與我們一整年告訴你的情況有任何偏差。年底的季節性波動顯然有點不同。但就門診利用率而言，我們在不同時間與您討論過的所有這些活動、那裡的模式，都非常支持我們 24 小時的計劃。

We'll go next to Scott Fidel with Stephens.

我們將和史蒂芬斯一起去斯科特·菲德爾旁邊。

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.

我本來希望能回到 Optum Health 看看。正如它所涉及的，第一，與您在投資者日向我們提供的 7.7% 至 8% 的利潤率目標相關，只是想看看這些是否仍然是 2024 年的合適目標。

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，考慮到第四季度退出率的預期上升，也許我們可以透過 OH 利潤率來進行這種節奏練習，您如何考慮第一季的 OH 利潤率，然後在一年的課程。

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。我將請德賽博士發表一些評論，然後我將回到約翰那裡，討論今年的一些分階段的保證金。

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.

但最重要的是，我們的最佳健康指南沒有改變。我們很高興能夠談論明年我們為 Optum Health 制定的目標。 2023 年為加強業務做了大量工作。當我們進入下半場時，你會看到這一點開始顯現出來。我們仍然期望，在進入 2024 年時，這將成為推動改進的強大動力。今天我們圍繞參與度討論的許多工作，是我們有信心能夠建立該業務形象的關鍵要素。

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

阿瑪爾，也許你可以更深入一點，然後約翰可以討論進展來結束。

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% 至 8.0% 的目標充滿信心。我們已經詳細討論了參與度。第二個重要部分是我們的醫療管理計劃，我們已經有效地擴展了該計劃。

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.

我談了一些 OptumCare 和循證指南。我要重申的是我們在整個網路中為支付誠信所做的工作。同樣，我們的想法是能夠透過我們的網路提供正確的支援服務。

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.

我還要提到的最後一點是我們圍繞營運支出的舉措，這些舉措進展順利並且步入正軌，推動了整個組織的營運效率和一般行政管理紀律。它確實專注於我們系統的一致性和操作平台的統一。因此，當我們進入 24 年時，我們對 7.7% 到 8.0% 的成長率感覺非常好。

Great. Thanks so much, Amar. John?

偉大的。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。因此，正如 Amar 所說，我們對 2024 年的利潤率目標的製定感到非常滿意。這裡超級重要的因素是，這些新患者群體在進入我們的業務時如何取得進展，我們能夠在臨床上與他們接觸並改善他們的健康狀況，確保我們能夠縮小照護差距。

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 和團隊在 2023 年在達到這些參與水平方面取得的進展將對我們在這裡服務的人們的健康有很大幫助，特別是 2023 年的這群人，即 900,000 名新患者，我們能夠提供服務以及該業務在一年中的表現如何。所以這是邁出的一大步。

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.

另一個重大進步是這批 75 萬名新患者加入了該業務。事實上，我們能夠讓新群體的參與度顯著高於去年，這一事實也將有所幫助。因此，這讓我們對來年為這些人提供服務的方向充滿信心。

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.

就您的評論而言，您預計典型因素而非季節性因素會影響季度表現。更多地將其視為季節性因素，因此它們可能會產生影響。就季節性因素而言，我們今年會經歷如此典型的情況，從更強大的基礎開始，這使我們能夠很好地實現我們的目標。

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

接下來我們將與摩根士丹利一起討論艾琳·賴特 (Erin Wright)。

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 的問題。在過去的一年裡，圍繞 PBM 監管變化出現了一些不斷變化的動態和新聞。分拆方面，有一些新聞報告以及藥房報銷模式的變化，例如成本加成類型的方法。

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?

我想您如何看待其中一些動態的潛在影響（如果有的話）？這些動態會對 Optum Rx 產生重大影響嗎？或者您如何看待 PBM 未來保持完好無損的利潤驅動因素？

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。讓我請希瑟給你一些評論。如你所知，希瑟非常非常參與各種立法程序，很高興了解她對此的看法。

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。因此，我會說，也許只是很快，完全尊重不斷變化的動態，並成為我們的業務令人難以置信的動態的標題。如果我在這個節骨眼上不再次表示我們繼續參與，那就是我的失職，因為值得注意的是，在一個每個人都關心消費者負擔得起的藥物——消費者負擔得起的處方藥的領域，包括我們的，這就是 PBM 的建造目的。

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.

我們確實迫切希望確保政策制定者明白，為客戶保留選擇權非常重要。重要的是要確保我們保留基於價值的結構，因為我們知道基於價值的結構是確保我們提供更低價格（成本更低的藥品）的方法，而且我們不能打破 PBM 發揮作用的激勵措施的一致性與付款人一起降低成本。保持折扣非常重要，因為沒有跡象表明折扣會推高標價——標價上漲。 PBM 可以平衡高昂的藥品成本。

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.

話雖這麼說，您已經在我們的模型中看到了業務的多樣性。跨 Optum Rx、跨 PBM、跨藥房服務，涉及眾多業務。我們認真傾聽客戶的意見。我們代表客戶而存在，我們在競爭激烈的市場中競爭，我們之所以獲勝，是因為我們的模式已經轉變了。它意味著透明度、創新以及與客戶的合作關係。

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.

因此，我們將遵循客戶的要求，我們將非常尊重立法，但我感覺非常好，因為我們行動迅速，我們採取負責任的行動，並且我們努力實現價值。您會在結果中看到這一點。你可以在成長中看到這一點。但最重要的是，您可以在模型的客戶端驗證中看到這一點。

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.

所以我對我們的定位感覺很好。我對 2023 年的經驗感覺良好，作為這方面的指導，但對 24 年的成長非常有信心。

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，非常感謝你的提問。我確信圍繞這一領域的爭論將會繼續。當然，高昂的藥品成本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.

首先也是最重要的是，我們需要看到標價下降。這是可以產生巨大影響的最重要的事情。我想說的是，當你看到圍繞這一領域的改革時不時出現的所有不同想法時，我們確實沒有什麼不以某種形式或方式向我們的客戶和客戶提供的。

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.

事實是我們認為這是正確的立場。我們認為應該提供不同工具、不同產品設計的組合，讓人們可以選擇適合他們的工具。因為國家想要什麼、工會想要什麼、公司想要什麼是不同的。在這裡考慮他們的觀點是非常重要的。

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，我們在產品供應的多樣性方面做得很好，這支撐著我們創紀錄的成長，也支撐著我們對「24」的信心。我很感激，艾琳。

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)。

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?

偉大的。我想問您提到的 Medicare AEP 登記，您添加的 100,000 條生命。我想今年消費者的反應或保留率相對於您的預期是否有任何差異？

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年中會員成長的驅動因素，因為您需要它來獲得全年的指導？

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。讓我請提姆·諾埃爾給你這個。

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。所以再次強調，醫療保險環境、銷售環境競爭非常激烈。我們可能會在 2024 年看到定價最為激進的一年。

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.

我們在投資者會議上指導死亡人數增加45 萬至55 萬，這比過去幾年的增長幅度要小一些，但這反映了我們對新風險模型變化的反應，即我們在早期門診使用模式中看到的情況。 '23 並將其反映到 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.

當我們結束 AEP 時，我想說，我們對 11 月底的想法有點輕率。其中大部分實際上是在集團業務中，一些非常激進的福利，更多的轉換，使我們的 AEP 中的一些期限利率比我們最初想像的要高一些。

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，在年度招生期間（2 月至 12 月）之外，我們將更加重視成長。這實際上只是我們在過去五年中看到的趨勢的延續。事實上，去年我們帶動了 43 萬人的成長，約佔 2 月至 12 月期間總成長的 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.

這是我們在銷售季節中表現出色的一部分——考慮到我們巨大的雙重足跡，以及 AEP 的一些銷售往往集中在一些真正積極定位的標題優勢上。在今年剩下的時間裡，隨著人們更深入地思考網路、補充福利的實現、整體服務和產品交付等問題，往往會出現一些轉變。

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.

所以我想今年的標題是這是一個非常激進的市場。我們覺得我們在 25 和 26 年的定價方面處於非常有利的位置，對我們迄今為止所做的事情感到非常滿意，並對我們的機會感到興奮，再次在銷售期間實現真正的巨大增長從2024年2月到12月。

Last question, please, operator.

最後一個問題，接線生。

We'll go next to Gary Taylor with Cowen.

我們將和考恩一起去加里·泰勒旁邊。

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?

我的大部分問題都被問到了。這個我也丟掉吧我們已經看到更多關於衛生系統剛剛放棄其 MA 合約的文章。其中一些文章引用了曼聯的說法。我知道，從歷史上看，大多數此類合約都會發生衝突，從而使新聞界最終達成協議。所以我只是想知道，這只是媒體線程嗎？或者您認為您的衛生系統合作夥伴正在發生一些更可衡量的事情？

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

加里，非常感謝。讓我請布萊恩對此做出回應。

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。我想說，總體而言，我們今年在市場上看到的混亂程度等於或甚至低於 2023 年的歷史平均值。

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.

但我要說的是，對我們消費者的任何干擾都太大了。他們開始依賴網路內的提供者關係。他們對健康計劃有承保預期。因此，我們顯然希望避免這種類型的網路中斷，但我們確實需要在這一目標與承受能力之間取得平衡。

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，當我們專門談論醫療保險優勢領域時，我們確實有一些交易即將完成。我確實認為這對 AEP 產生了一些影響。再說一次，提姆對我們對二月信心的評論，我們的交易完好無損，我想你也會看到我們成長中的這種反應。但同樣，平均而言，與歷史時期的中斷相比，整體上並沒有太大變化。

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。不，說得好，布萊恩。我認為，顯然，加里，我們——你在這裡看到的是我們正在努力——代表我們的客戶、代表患者、代表政府，非常努力，以確保我們獲得與所提供的護理相關的最佳成本。重要的是，談判是強而有力的。

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解決了。我們真的不希望看到破壞發生。不幸的是，有時確實如此。但請放心，我們在這一領域正在取得良好進展。正如布萊恩所說，結果與我們前幾年所看到的沒有真正的差異。

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

說到這裡，我要對大家提出的所有問題表示感謝。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.

正如您所聽說的，我們對我們的使命充滿信心，專注於我們的成長支柱，提供重要的創新，並在我們的營運和市場方法中遵守紀律。我們期待在 2024 年兌現對客戶、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.

非常感謝您今天早上的關注，謝謝，並期待在通話期間與您交談。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。我們感謝您的參與。