聯合健康 (UNH) 2024 Q3 法說會逐字稿

Good morning, and welcome to UnitedHealth Group Third Quarter 2024 Earnings Conference Call. A question-and-answer session will follow UnitedHealth Group's prepared remarks. As a reminder, this call is being recorded.

早上好，歡迎參加聯合健康集團 2024 年第三季財報電話會議。聯合健康集團準備好發言後將舉行問答環節。謹此提醒，此通話正在錄音中。

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

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

This call will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amounts is available on the financial and earnings reports section of the company's Investor Relations page at www.unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated October 15, 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。本次電話會議中提供的資訊包含在我們今天早上發布的收益報告和日期為 2024 年 10 月 15 日的 8-K 表格中，您可以從公司網站的投資者關係頁面訪問該表格。

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

我現在將會議交給聯合健康集團執行長安德魯威蒂 (Andrew Witty)。

Good morning, and thank you for joining us. As you saw in our release, the people of UnitedHealth Group continued to deliver on our growth pillars. Our teams are providing more people with more high-quality healthcare services and benefits, and restlessly looking for ways to simplify the health system and deliver more value for patients, employers and providers alike.

早安，感謝您加入我們。正如您在我們的新聞稿中看到的，聯合健康集團的員工繼續實現我們的成長支柱。我們的團隊正在為更多的人提供更優質的醫療保健服務和福利，並不懈地尋找簡化醫療系統並為患者、雇主和提供者等提供更多價值的方法。

By the end of this year, we will have grown to serve more than 2 million new consumers with commercial offerings, fulfill more than 1.6 billion prescriptions through Optum Rx and care for 4.7 million people in value-based arrangements. Our people will have done all this and more in a challenging period navigating the first year of the CMS Medicare rate cuts and its impact on member mix, the effects of the state-driven Medicaid member redeterminations, certain novel care patents and the Change Healthcare cyberattack.

到今年年底，我們將透過商業產品為超過 200 萬新消費者提供服務，透過 Optum Rx 開立超過 16 億張處方，並以基於價值的安排為 470 萬人提供護理。我們的員工將在充滿挑戰的時期完成所有這一切以及更多工作，應對CMS Medicare 降費的第一年及其對會員結構的影響、國家驅動的Medicaid 會員重新確定的影響、某些新穎的護理專利和Change Healthcare 網路攻擊。

While many of those factors could not have been anticipated, thanks to our people's efforts, we can affirm a full year 2024 earnings outlook still within the range we first offered back in November 2023. It's a distinctive part of the culture of UnitedHealth Group that we continue to strive to deliver on our financial commitments to you through changing environments and unforeseen challenges.

儘管其中許多因素是無法預料到的，但由於我們員工的努力，我們可以確認2024 年全年盈利前景仍在我們於2023 年11 月首次提出的範圍內。我們在不斷變化的環境和不可預見的挑戰中，繼續努力履行我們對您的財務承諾。

As we look to 2025, and I will address this shortly. We remain in a dynamic period for the healthcare sector. Amid this, it's important that we continue to invest in the durable, value-creating capabilities of this company that support our 13% to 16% long-term growth objective. We will balance our commitments to investing in the promising future before us with managing the known and potential challenges. We remain highly optimistic for the future, even as we are respectful of the pressures the sector faces again next year.

展望 2025 年，我很快就會討論這個問題。我們仍處於醫療保健產業的動態時期。其中，重要的是我們要繼續投資該公司持久的、創造價值的能力，以支持我們 13% 至 16% 的長期成長目標。我們將在投資充滿希望的未來的承諾與應對已知和潛在的挑戰之間取得平衡。我們對未來保持高度樂觀，儘管我們尊重該行業明年再次面臨的壓力。

Even within this environment, we're well positioned to continue our growth in the years ahead. I want to highlight two important reasons for this optimism. First is our relentless focus on execution, quality and innovation. In particular, we continue to work tirelessly to improve people's experiences with the health system. To that end, this month, we launched a first-of-its-kind national Gold Card program, which will reduce the number of prior authorizations by 500,000 every year for qualified in-network providers. This can help improve both the quality and the affordability of care, while reducing friction in the system.

即使在這種環境下，我們也有能力在未來幾年繼續成長。我想強調這種樂觀的兩個重要原因。首先是我們對執行、品質和創新的不懈關注。特別是，我們繼續不懈地努力改善人們的衛生系統體驗。為此，本月我們推出了首個國家金卡計劃，每年將為合格的網路內供應商減少 50 萬個預先授權的數量。這有助於提高護理品質和負擔能力，同時減少系統中的摩擦。

Artificial intelligence is starting to be an important tool in improving our work. Our advanced practice clinicians use AI to summarize legacy patient histories, freeing up hundreds of hours that can be better spent caring for people. Our nurses use generative AI to review document more efficiently, saving time and improving patient service. AI is helping our consumer advocates, powering tens of millions of consumer interactions and provider searches. This allows our advocates to spend more time with people and more complex inquiries, driving better efficiency while all improving the consumer experience as reflected in higher NPS scores.

人工智慧開始成為改善我們工作的重要工具。我們的高級實踐臨床醫生使用人工智慧來總結遺留患者病史，從而騰出數百個小時來更好地用於護理患者。我們的護理師使用生成式人工智慧來更有效地審查文檔，從而節省時間並改善患者服務。人工智慧正在幫助我們的消費者權益倡導者，為數千萬次消費者互動和提供者搜尋提供動力。這使得我們的倡議者能夠花更多的時間與人們打交道並進行更複雜的詢問，從而提高效率，同時改善消費者體驗，這體現在更高的 NPS 分數上。

And finally, using AI to help build software is enabling technology engineering teams to enhance the speed and quality necessary to help drive our technology modernization. Our focus on execution and quality is also evident in the Medicare Advantage plans we are offering for 2025. Once again, we focused on consumer value and, as much as possible, on benefit stability even as we navigated the adverse Medicare-funded environment. With annual enrollment beginning today, we believe we will continue to be a top choice for consumers.

最後，使用人工智慧幫助建立軟體使技術工程團隊能夠提高必要的速度和質量，以幫助推動我們的技術現代化。我們對執行和品質的關注在我們為 2025 年提供的 Medicare Advantage 計劃中也得到了體現。從今天開始每年招生，我們相信我們將繼續成為消費者的首選。

A second element underpinning our growth is delivery on our commitment to the transition of the health system to value-based care. For over 20 years, there has been a bipartisan consensus among healthcare experts and policymakers that value-based care, that is integrated, patient-centered and outcome focused care, is superior to the often fragmented and unnecessarily expensive fee-for-service system. Across four presidential administrations, CMS has called for private-public innovation in the development of value-based care models in Medicare and Medicaid. It provides better outcomes for patients. It saves money for the customers and taxpayers who fund care, and it empowers clinicians to focus on providing the most beneficial care.

支撐我們成長的第二個因素是兌現我們對衛生系統向基於價值的照護轉型的承諾。 20多年來，醫療保健專家和政策制定者之間達成了兩黨共識，即基於價值的護理，即以患者為中心和以結果為中心的綜合護理，優於通常分散且不必要的昂貴的按服務收費系統。在四屆總統政府中，CMS 一直呼籲在醫療保險和醫療補助中開發基於價值的護理模式時進行公私創新。它為患者提供了更好的結果。它為資助護理的客戶和納稅人節省了資金，並使臨床醫生能夠專注於提供最有益的護理。

The rationale for this decade-long effort to develop value-based care is both simple and sound. It moves from incentives based solely on volume to incentives based on a patient's health outcomes and experience. And it helps ensure patient care is delivered not at the highest cost sites of service, but rather those that combine the highest quality and value.

十年來致力於發展基於價值的護理的理由既簡單又合理。它從僅基於數量的激勵轉變為基於患者的健康結果和體驗的激勵。它有助於確保患者護理不是在成本最高的服務地點提供，而是在那些結合了最高品質和價值的服務地點提供。

The effectiveness of value-based care for patients is proven and powerful, and it's good for the system. At UnitedHealth Group, we're purposefully organized to support the transition to value-based care. It requires deep engagement with patients, setting the foundation to move to more coordinated care, connecting patients to primary care earlier, driving clinically accurate diagnoses, more effectively recognizing and managing chronic conditions, and slowing disease progression.

基於價值的患者護理的有效性已被證明且強大，並且對系統有利。在聯合健康集團，我們有目的地組織起來支持向基於價值的護理的過渡。它需要與患者深入接觸，為轉向更協調的護理奠定基礎，更早地將患者與初級護理聯繫起來，推動臨床準確的診斷，更有效地識別和管理慢性病，並減緩疾病進展。

We're seeing the benefits of this work come to fruition. People served by OptumHealth value-based care models are more likely to receive cancer screenings and be in better control of their diabetes and hypertension than people in fee-for-service Medicare, and 10% less likely to visit the emergency room or be readmitted to hospital. One example of the impact of better care coordination is our Emergency Room Safe Discharge Program, which helps patients who may be at risk for unnecessary and expensive ER use and readmissions.

我們正在看到這項工作的好處正在顯現。與接受付費醫療保險的人相比，接受 OptumHealth 基於價值的護理模式的人更有可能接受癌症篩檢，更好地控製糖尿病和高血壓，並且前往急診室或重新入院的可能性降低 10%醫院。更好的護理協調的影響的一個例子是我們的急診室安全出院計劃，該計劃幫助可能面臨不必要和昂貴的急診室使用和再入院風險的患者。

We have learned that the specific ways in which a discharge is managed can have a substantial impact on readmissions, which are a problem for both patients and facilities. Our nurse care managers proactively engaged the emergency teams to provide them relevant information from the outpatient medical record and to facilitate a safe discharge. This approach, currently in eight markets, is already helping to avoid hundreds of inpatient stays each month, it preserves emergency resources for those who truly need them, saves money and is a better experience for patients.

我們了解到，管理出院的具體方式會對再入院產生重大影響，這對病人和機構來說都是一個問題。我們的護理護理經理主動與急救團隊合作，向他們提供門診病歷中的相關信息，並促進安全出院。這種方法目前已在八個市場推廣，已經幫助每月避免了數百例住院，為真正需要的人保留了緊急資源，節省了資金，並為患者提供了更好的體驗。

Our many care offerings now serve people in value-based care arrangements in dozens of service areas, integrating primary, surgical, behavioral and home care. These patients come from many diverse payers and employers, a clear sign of confidence from the market that we're on the right track. This is the value proposition of UnitedHealth Group: Committed to serving patients, providers, payers and customers with quality, integrity and innovation, and joining with federal and state governments in the effort to help build a better health system that meets the needs of all stakeholders now and into the future.

我們的許多護理產品現在為數十個服務領域的人們提供基於價值的護理安排，整合了初級護理、外科護理、行為護理和家庭護理。這些患者來自許多不同的付款人和雇主，這是市場對我們走在正確軌道上的信心的明顯跡象。這就是聯合健康集團的價值主張：致力於以優質、誠信和創新的方式為患者、提供者、支付者和客戶提供服務，並與聯邦和州政府一起努力幫助建立一個更好的醫療系統，滿足所有利害關係人的需求現在和未來。

Fundamentally, we continue to grow because more people and organizations are purchasing more of the products and services we offer. It's a simple statement to make, yet a hard thing to do year in and year out. But it's the enduring reason for our optimism about the long-term growth and future of this enterprise.

從根本上說，我們不斷發展，因為越來越多的人和組織正在購買更多我們提供的產品和服務。這是一個簡單的說法，但年復一年做到卻是一件困難的事。但這是我們對這家企業的長期成長和未來樂觀的持久理由。

Now I'll turn it over to John Rex, our President and Chief Financial Officer.

現在我將把它交給我們的總裁兼財務長約翰雷克斯。

Thank you, Andrew. Strong growth across the company sets us up well to deliver upon our commitments to you. Amid all the puts and takes of this unusual year, we are seeing what we always look for -- new products and innovations taking root among customers, more people being served through our services and continued improvement in the experience people have. These are key to our long-term success.

謝謝你，安德魯。本公司的強勁成長使我們能夠很好地履行對您的承諾。在這個不尋常的一年裡，我們看到了我們一直在尋找的東西——新產品和創新在客戶中紮根，更多的人透過我們的服務獲得服務，以及不斷改善人們的體驗。這些都是我們長期成功的關鍵。

I'll start today by offering some observations on care activity patterns as we know that is most likely top of mind for many of you. Certain care patterns persisted at higher levels than we expected in the period for three specific and, we believe, primarily transitory reasons, two of which we noted last quarter.

今天我將首先提供一些對護理活動模式的觀察，因為我們知道這很可能是你們許多人最關心的問題。在此期間，某些護理模式持續處於高於我們預期的水平，原因是三個具體原因，我們認為主要是暫時性原因，其中兩個原因我們在上個季度指出。

First, the still pronounced upshift in coding intensity by hospitals, which we flagged last quarter. In some cases, the coding options are extreme. Certain entities have been notably and persistently aggressive, having upshifted their coding intensity factors by more than 20%. We are actively addressing this unnecessary additional cost burden to the health system.

首先，醫院的編碼強度仍然明顯上升，我們在上個季度指出了這一點。在某些情況下，編碼選項是極端的。某些實體一直表現出明顯且持續的攻擊性，將其編碼強度因子提高了 20% 以上。我們正在積極解決衛生系統不必要的額外成本負擔。

The second item, also noted last quarter, is the continued timing mismatch between the current health status of Medicaid members and state rate updates. States often use care activity data that is well over a year old in setting their rates. That typically has minimal impact when member mix levels are relatively stable, but with eligibility redetermination significantly shifting, both the number and average acuity of people covered has changed. As a result of the lagging care activity data, as well as the annual rate cycle timing, updates remain well short of current care activity, a factor that for us was more pronounced through the period than anticipated.

上個季度也注意到的第二個問題是醫療補助成員目前的健康狀況與州費率更新之間持續的時間不符。各州經常使用一年多前的護理活動數據來設定費率。當會員組合水準相對穩定時，這通常影響很小，但隨著資格重新確定的顯著變化，所覆蓋人數和平均敏銳度都發生了變化。由於護理活動數據滯後以及年度費率週期時間安排，更新仍遠低於當前的護理活動，對我們來說，這一因素在此期間比預期更為明顯。

A third item that emerged more substantially in the period was a rather rapid acceleration in the prescribing of certain high-cost specialty medications, primarily those used to treat cardiovascular disease, autoimmune disorders and cancer. We believe a contributing factor to the acceleration was the Inflation Reduction Act, which eliminated the individual coinsurance requirement during the catastrophic coverage phase. As many of you know, more people enter this phase in the second half of the year. While we anticipated this will become a more meaningful factor in 2025, drug manufacturer campaigns pushed some of this activity into this year, more sharply than anticipated.

在此期間出現的第三個更顯著的問題是某些高成本特殊藥物的處方速度相當快，主要是用於治療心血管疾病、自體免疫疾病和癌症的藥物。我們認為，加速這一趨勢的一個因素是《通貨膨脹削減法案》，該法案取消了災難性承保階段的個人共同保險要求。眾所周知，下半年有更多的人進入這個階段。雖然我們預計這將在 2025 年成為一個更有意義的因素，但藥品製造商的活動將部分此類活動推遲到了今年，其力度比預期更大。

With that, let's turn to our third quarter results. Revenues of $101 billion grew more than 9% over the prior year, with strong growth again at both Optum and UnitedHealthcare. OptumHealth revenues grew by over $2 billion and are approaching $26 billion. This was driven by an increase in both the number and type of care services we offer and the patients we serve, especially in the home and among those with complex needs.

接下來，讓我們來看看第三季的業績。 Optum 和 UnitedHealthcare 的營收再次強勁成長，達到 1,010 億美元，比上年成長 9% 以上。 OptumHealth 營收成長超過 20 億美元，接近 260 億美元。這是由於我們提供的護理服務的數量和類型以及我們服務的患者的數量和類型的增加，特別是在家庭中和有複雜需求的患者中。

Optum Rx revenues grew by over $5 billion to more than $34 billion, driven by strength in our pharmacy care offerings as well as growth in pharmacy benefits management from new customers and expanding specialty services. OptumInsight revenues in the quarter were stable, approaching $5 billion, and the nearly $33 billion revenue backlog increased by more than $1 billion from last year.

Optum Rx 收入成長超過 50 億美元，達到超過 340 億美元，這得益於我們藥房護理產品的實力以及新客戶和不斷擴大的專業服務帶來的藥房福利管理的增長。 OptumInsight本季營收穩定，接近50億美元，近330億美元的營收積壓較去年增加超過10億美元。

Turning to UnitedHealthcare. Our domestic commercial business has added more than 2.4 million people through the third quarter. Selling season indications are tracking favorably as we head into '25, reflecting continued strong uptake of UnitedHealthcare's innovative offerings. Our Medicare Advantage plans on offer this fall, balance providing as much benefit stability as possible for seniors, while contending with the CMS funding cuts, IR changes and expected care patterns. The initial Stars ratings for plan year '26 for consumers in 4-star or better-rated plans, is largely consistent with what we saw in our initial results last year. As has been the case in recent years, we expect these percentages to increase.

轉向聯合醫療保健。截至第三季度，我們的國內商業業務新增人數超過 240 萬人。進入 25 世紀，銷售旺季的跡象表現良好，這反映出聯合醫療保健創新產品的持續強勁成長。我們的 Medicare Advantage 計劃於今年秋季推出，平衡為老年人提供盡可能多的福利穩定性，同時應對 CMS 資金削減、IR 變化和預期護理模式。計劃第 26 年針對 4 星級或更高評級計劃的消費者的初始星級評級與我們去年的初步結果基本一致。與近年來的情況一樣，我們預計這些百分比將會增加。

In Medicaid, our new state customer expansion and retention performance remains strong, including recent awards in Massachusetts, Colorado, Rhode Island, Florida and Michigan. We hope to continue to support people and families in the post-redeterminations period, and are advocating with states to ensure adequate funding and resources for these often underserved people.

在醫療補助方面，我們的新州客戶擴張和保留表現仍然強勁，包括最近在馬薩諸塞州、科羅拉多州、羅德島州、佛羅裡達州和密西根州獲得的獎項。我們希望在重新決定後的時期繼續為人們和家庭提供支持，並與各國一起倡導確保為這些經常得不到充分服務的人們提供足夠的資金和資源。

Our capital capacities remain strong and continue to underpin our long-term growth objectives. In the quarter, cash flows from operations were $14 billion or 2.2 times net income, and year-to-date were nearly $22 billion. So far this year, we have returned $9.6 billion to shareholders via dividends and share repurchase. Additionally, we have invested more than $11 billion in a wide range of strategic opportunities, including updating and extending our long-standing and productive relationship with AARP to better serve older Americans.

我們的資本能力依然強勁，並持續支撐我們的長期成長目標。本季營運現金流為 140 億美元，是淨利的 2.2 倍，年初至今接近 220 億美元。今年到目前為止，我們已透過股利和股票回購向股東返還 96 億美元。此外，我們還投資了超過 110 億美元用於各種戰略機會，包括更新和擴展我們與 AARP 的長期且富有成效的關係，以更好地為美國老年人服務。

As highlighted last quarter, after the cyberattack, we prioritized devoting resources to support care providers over some activities such as share repurchase. Payments and claims flows for most care providers have normalized, and repayment of these capital advances is underway.

正如上季所強調的那樣，在網路攻擊之後，我們優先考慮投入資源來支持醫療服務提供者，而不是股票回購等一些活動。大多數護理提供者的付款和索賠流程已經正常化，這些預付款的償還正在進行中。

Regarding Change Healthcare, for full year '24, we now estimate the business disruption costs will be about $0.75 per share, an increase of $0.10 from the former midpoint. As you may recall, business disruption largely encompasses the loss of revenues combined with the cost of keeping these capabilities fully ready to serve. These effects are not excluded from adjusted earnings. We continue to work with customers to bring transaction volumes back to pre-event levels and to win new business with our now more modern, secure and capable offerings. We expect to continue to build back the business to pre-attack levels over the course of '25, and estimate next year's full year impact will be roughly half of the '24 level.

關於 Change Healthcare，我們現在估計 24 年全年的業務中斷成本約為每股 0.75 美元，比之前的中點增加了 0.10 美元。您可能還記得，業務中斷主要包括收入損失以及保持這些功能完全準備好服務的成本。這些影響並不排除在調整後的收益之外。我們將繼續與客戶合作，將交易量恢復到活動前的水平，並利用我們現在更現代化、安全和強大的產品贏得新業務。我們預計將在 25 年期間繼續將業務恢復到攻擊前的水平，並估計明年全年的影響將約為 24 年水平的一半。

As we enter the final quarter of the year, we are narrowing our 24 adjusted earnings outlook to a range of $27.50 to $27.75 to reflect business disruption impacts and the care patterns we discussed. Our company's ability to deliver within the range of the commitments established nearly a year ago, even in challenging circumstances, is another example of the discipline and innovation of the enterprise and the confidence we have in delivering diverse growth for the long term.

隨著進入今年最後一個季度，我們將 24 日調整後獲利前景縮小至 27.50 美元至 27.75 美元的範圍，以反映業務中斷影響和我們討論的護理模式。即使在充滿挑戰的環境下，我們公司也有能力履行近一年前製定的承諾，這是企業紀律和創新的另一個例子，也是我們對實現長期多元化成長的信心的另一個例子。

Now I'll turn it back to Andrew.

現在我會把它轉回給安德魯。

Thanks, John. Before we turn to your questions, I want to provide some preliminary observations about next year, which we'll review in more depth at our upcoming investor conference. Perhaps the most important element is that our businesses are operating well and our growth potential remains strong. We see continued momentum in the selling season performance for UnitedHealthcare's commercial business and Optum Rx, which both offer best-in-class innovation and performance for customers.

謝謝，約翰。在我們回答你們的問題之前，我想提供一些關於明年的初步觀察，我們將在即將舉行的投資者會議上更深入地回顧這些觀察。也許最重要的因素是我們的業務運作良好，成長潛力依然強勁。我們看到 UnitedHealthcare 的商業業務和 Optum Rx 的銷售季表現持續強勁，兩者都為客戶提供一流的創新和性能。

The consumer value proposition of Medicare Advantage continues to be highly compelling, and we see strong growth potentially in this market for many years to come. The OptumHealth value-based care businesses that we've been building for well over a decade are beginning to approach the very early stages of their potential, and will be a key differentiating growth factor in the years ahead.

醫療保險優勢的消費者價值主張仍然非常引人注目，我們看到這個市場在未來許多年都有強勁的成長潛力。我們十多年來一直在打造的 OptumHealth 基於價值的護理業務正開始發揮其潛力的早期階段，並將成為未來幾年的關鍵差異化成長因素。

At the same time, and as we build for the future and contemplate our 2025 outlook, we're taking into account several unique dynamics. First, the concurrent timing of the second year of the CMS Medicare rate cuts and the most significant Inflation Reduction Act impacts into a single year, and the negative effects of that on the people we serve. Second, within Medicaid, the time and mismatch of state customer rate actions, which do not yet reflect the higher acuity of remaining consumers. And third, a respectful view of the care activity that John noted, we're actively addressing and managing for these and continuing to believe our 2025 planning assumptions appropriately capture these components, though we will be prudent in an initial early view.

同時，當我們展望未來並思考 2025 年的前景時，我們正在考慮一些獨特的動態。首先，CMS 醫療保險第二年的降息和最重要的通貨膨脹削減法案對一年的影響同時發生，以及這對我們服務的人們的負面影響。其次，在醫療補助範圍內，州客戶評分行動的時間和不匹配，尚未反映出剩餘消費者的更高敏銳度。第三，對約翰指出的護理活動的尊重，我們正在積極解決和管理這些問題，並繼續相信我們的 2025 年規劃假設適當地涵蓋了這些組成部分，儘管我們在最初的早期觀點中會保持謹慎。

The majority of those 2025 factors are expected to be most impactful to the UnitedHealthcare businesses. As a result, we anticipate stepping out for 2025 more conservatively than is typical. At this distance, we expect the upper end of the likely range we'll offer in December has been around $30 per share. As always, we will seek to advance beyond this initial view as the year progresses, and we remain committed to and focused on our long-term 13% to 16% earnings per share growth objective. We see 2025 as a year of opportunity in building to that commitment. So you will see us investing in our growth pillars aggressively, modernizing our company with AI and other technologies and always exercising discipline in our operating performance.

預計 2025 年的大多數因素將對聯合醫療保健業務影響最大。因此，我們預計 2025 年的行動將比平常更保守。按照這個距離，我們預計 12 月報價範圍的上限約為每股 30 美元。像往常一樣，隨著時間的推移，我們將努力超越這一最初的觀點，我們仍然致力於並專注於我們 13% 至 16% 的長期每股收益成長目標。我們認為 2025 年是實現這項承諾的機會之年。因此，你會看到我們積極投資於我們的成長支柱，利用人工智慧和其他技術實現我們公司的現代化，並始終在我們的營運績效中嚴格遵守紀律。

We look forward to discussing this with you in much greater detail at our investor conference on December 4 in New York. Now operator, we'll take some questions.

我們期待在 12 月 4 日於紐約舉行的投資者會議上與您更詳細地討論這個問題。現在接線員，我們將回答一些問題。

(Operator Instructions) Lisa Gill, J.P. Morgan.

（操作員說明）Lisa Gill，J.P. Morgan。

John, I want to go back to where you talked about your observations here in the fourth quarter. Can you talk about some of those that you expect to impact '25? And I really want to focus on the third one, which you talked about the rapid acceleration in Rx, but you also talked about the positive impact that you're seeing within your Optum Rx business on the specialty side. How do we think about that playing into '25?

約翰，我想回到你在第四季談論你的觀察的地方。您能談談您預計會對 25 世紀產生影響的一些因素嗎？我真的想重點談談第三個問題，您談到了 Rx 的快速加速，但您也談到了您在 Optum Rx 業務中看到的專業方面的積極影響。我們如何看待進入 25 年後的情況？

Lisa, thanks so much for the question. Let me ask John to start, and then I'm going to ask Brian,, UHC, to make a couple of comments, and then we'll come back to Patrick for Optum Rx. It's a wide range in set of impacts that you're alluding to. So let me start with John.

麗莎，非常感謝你的提問。讓我請約翰開始，然後我將請布萊恩 (UHC) 發表一些評論，然後我們將回到帕特里克討論 Optum Rx。您提到的影響範圍很廣。讓我從約翰開始。

Lisa, thank you. So just a few comments here and maybe kind of the shape some of these messages here. So first of all, in terms of what we would expect to persist, what we expect to subside here. So I'd start with our planning assumption, as Andrew noted, we're looking for some of these elements here. What was different for us in the quarter than the thoughts we would have had at the end of last quarter is, most notably, what we saw in terms of the rapid increase in the specialty drugs, and we'll get a little bit more to that.

麗莎，謝謝你。所以這裡只是一些評論，也許可以塑造其中一些訊息。首先，就我們期望持續存在的情況而言，我們期望在這裡消退的情況。因此，我將從我們的規劃假設開始，正如安德魯指出的那樣，我們正在尋找其中的一些元素。對我們來說，本季與上季末的想法不同的是，最值得注意的是，我們看到了特種藥物的快速增長，我們將獲得更多資訊那。

But really it was a midyear issue, we think relate -- tied into the IRA, and the components has shifted for that. And as you look at some of the prescribing patterns that are out there, they just dipped sharply in the second half of the year. And we would have been planned on some of that happening really more next year. The pull forward in this year was one of those elements that was a bit unexpected. I think the other elements are probably more understood out there, the timing mismatch in Medicaid has been in the conversation, what we've been seeing in the providing coding intensity also more understood. So maybe we'll go around a little bit to Brian Thompson and let him address some of those elements.

但我們認為，這實際上是一個年中問題——與 IRA 相關，而組成部分已經為此發生了變化。當你觀察一些現有的處方模式時，你會發現它們在今年下半年急劇下降。我們本來計劃明年會發生更多這樣的事。今年的提前是有點出乎意料的因素之一。我認為其他要素可能更容易被理解，醫療補助中的時間不匹配已經出現在對話中，我們在提供編碼強度中看到的內容也更容易被理解。因此，也許我們會向布萊恩湯普森（Brian Thompson）請教一下，讓他解決其中的一些問題。

Sure, John. Lisa, as John mentioned, specialty Rx, again, largely contained to our Medicare Advantage book. And let me start with I feel very adequately priced for how this will play out in 2025 despite the surprise here in the second half, and you might ask how that's possible. What we had done is planned for the IRA to drive a greater induced utilization as it continued to roll out with the biggest elements being 2025. Obviously, there's a lower out-of-pocket maximum for consumers in '24. We expected that to play out more in 2025. We're seeing that accelerate into 2024, but not at levels that would suggest we're not covered for it in 2025.

當然，約翰。正如約翰所提到的，麗莎，專業處方藥，很大程度上包含在我們的醫療保險優惠書中。首先，儘管下半年出現了意外，但我覺得 2025 年的情況非常合理，您可能會問怎麼可能。我們所做的事情是計劃讓 IRA 推動更大的誘導利用率，因為它繼續推出，最大的元素是 2025 年。我們預計這種情況將在 2025 年發揮更大的作用。

Again, I thought it would be a little more gradual. We've certainly seen some manufacturers doing some promotion. I believe that's also contributing. But certainly feel good about how we've priced for it in 2025 because we did anticipate these step-ups, particularly with the large-scale changes and more richness and benefit for consumers that will come to play out in 2025.

我再次認為這會更漸進。我們當然看到一些製造商在做一些促銷活動。我相信這也是有貢獻的。但我們對 2025 年的定價肯定感到滿意，因為我們確實預料到了這些進步，特別是 2025 年將出現大規模的變化以及為消費者帶來更多的豐富性和利益。

And Patrick, maybe just reflect on it from an Optum Rx position.

派崔克（Patrick），也許只是從 Optum Rx 的角度思考一下。

Yes. So in terms of Optum Rx, first, I would call out volume where we had a record PBM selling season last year that plays into this year and renewal rates in the high 90s. The growth in mix, including in specialty, drives significant revenue growth for us. I call out pharmacy services, which, as you know, Lisa, and our specialty arena, significant growth, but also in infusion, hospital health system and our community pharmacy platforms.

是的。因此，就 Optum Rx 而言，首先，我要指出去年 PBM 銷售季創紀錄的銷量，今年的銷量和續訂率高達 90 美元以上。包括專業領域在內的產品組合的成長為我們帶來了顯著的收入成長。我強調藥房服務，正如你所知，麗莎和我們的專業領域顯著增長，而且在輸液、醫院衛生系統和我們的社區藥房平台方面也是如此。

And then -- and new products and services, including around specialty, whether it's Savings IQ, which has saved consumers over $1 billion this year; or Price Edge, where we have over 9 million members and saved consumers $125 million; or Wait Engage, we've got a number of new products and services around the specialty arena that continue to deliver value to our customers. And we're really purpose-built to help our customers manage specialty spend.

然後是新產品和服務，包括圍繞專業產品和服務，無論是 Savings IQ，今年已為消費者節省了超過 10 億美元；或 Price Edge，我們擁有超過 900 萬會員，為消費者節省了 1.25 億美元；或者等待參與，我們在專業領域推出了許多新產品和服務，繼續為我們的客戶提供價值。我們確實是專門為幫助客戶管理專業支出而設計的。

Great. Thanks, Patrick. And thanks, Lisa, for the question. Next question.

偉大的。謝謝，派崔克。謝謝麗莎提出的問題。下一個問題。

AJ Rice, UBS.

AJ 賴斯，瑞銀集團。

So I appreciate the early comments on 2025. I wonder if relative to sort of a normal year of 13% to 16% growth, is there any way to sort of size some of the different headwinds and tailwinds you're looking at to formulate what looks like a $30 about 8% growth?

因此，我很欣賞關於 2025 年的早期評論。看起來30 美元大約有8% 的成長？

AJ, thanks so much for the question. Let me just context this a little bit. First off, as you would see in a typical year, we'd always start the year with a plan to obviously deliver but ideally be, and that will continue to be the culture of the organization. We are clearly in a unusual situation right now in terms of the various pressures that we've seen coming externally from particularly government funding reductions and to some extent, the continued strength of MedEx cost, probably net-net or still somewhat hangover effects of the COVID pandemic still playing through the system, both in terms of volume and also some pressure on unit cost that we've seen. All of which you see in the kind of pressure that we see this year.

AJ，非常感謝你的提問。讓我簡單介紹一下這一點。首先，正如您在典型的一年中看到的那樣，我們總是以一個明顯交付但理想的計劃來開始新的一年，這將繼續成為組織的文化。就我們所看到的各種外部壓力而言，我們現在顯然處於一種不尋常的情況，特別是政府資金的減少，以及在某種程度上，醫療快遞成本的持續走強，可能是淨淨成本或仍有一定程度的後遺症效應。所有這些你都可以在我們今年看到的壓力中看到。

Now as we think about 2025, it's -- what we're trying to set out here, A.J., is something really important for the long-term future of the company. So those external pressures which we've described, I think, clearly both in the press release and in the commentary this morning, we're being clear about what they are. At the same time, what we mustn't do is pull away from investing in what's going to drive the future of this organization over the next decade. What does that mean? That means really making sure we're investing in filling out and continue to build out our value-based care platforms. It means really leaning into taking advantage of the technology opportunities, which now exist in reality.

現在，當我們思考 2025 年時，A.J.，我們試圖在這裡闡述的內容對於公司的長期未來來說非常重要。因此，我認為，我們在新聞稿和今天早上的評論中清楚地描述了這些外部壓力，我們很清楚它們是什麼。同時，我們絕不能放棄對未來十年推動本組織未來發展的投資。這意味著什麼？這意味著真正確保我們投資於填寫並繼續建立我們基於價值的護理平台。這意味著真正傾向於利用現實中存在的技術機會。

So the chance to really modernize our full stack across our organization, transform the way in which we develop new products, give us opportunity to bring forth a new look OptumInsight based on much newer technologies, give us the opportunity to transform consumer experience, something which is sadly lacking across US healthcare. All of those things are opportunities which sit, right now, they sit in the same year as we have these various headwinds that we've been talking about. And so what we're doing for 2025 is we're putting in place what we believe is a really responsible plan really focused on making sure we don't pull back from investment in the long term, right, not short-change in the next decade, and that's what we're leaning into in terms of making sure our '25 plan is responsible for longer-term value creation of the organization.

因此，我們有機會真正實現整個組織的全端現代化，改變我們開發新產品的方式，讓我們有機會基於更新的技術推出 OptumInsight 的新面貌，讓我們有機會改變消費者體驗，這遺憾的是，美國醫療保健領域缺乏這種能力。所有這些事情現在都是機遇，它們都在同一年，因為我們面臨著我們一直在談論的各種逆風。因此，我們為 2025 年所做的就是製定我們認為真正負責任的計劃，真正專注於確保我們不會撤回長期投資，對吧，而不是短期變化。的25 計畫負責為組織創造長期價值。

Now as I said at the beginning of the response to your good question, A.J., we're always going to go into every cycle aiming to do better than we lay out at the beginning. But I think it's appropriate for us to make sure that we build a plan for 2025, which acknowledges the external pressures and make sure that we retain the capabilities to continue to build what we think is a really distinctive set of capabilities, which will play out very powerfully for the next 10 years. Thank you for your question.

現在，正如我在回答你的好問題時所說的那樣，A.J.，我們總是會進入每個週期，目標是比我們一開始設定的做得更好。但我認為，我們應該確保制定 2025 年計劃，承認外部壓力，並確保我們保留繼續建立我們認為真正獨特的能力的能力，這些能力將發揮作用未來10年將非常強大。謝謝你的提問。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Thanks for the color on the MLR factors that you called out. When you think about the Q3 MLR unfavorably developing in the quarter, is it fair to think that all three of those factors were about the same? Or would you call out one of them as maybe being larger? And when we think about the coding and utilization management, I guess, operationally, what needs to happen for you to make progress on this front. I don't think you've attributed much of this to midnight rule to date. Can you update us on whether that changed at all in the quarter? And maybe if not, where are the pressures manifesting on the coding side?

感謝您指出的 MLR 因素的顏色。當您考慮第三季 MLR 在本季度的不利發展時，認為所有這三個因素大致相同是否公平？或者你會說其中一個可能更大嗎？當我們考慮編碼和使用率管理時，我想，在操作上，您需要做什麼才能在這方面取得進展。到目前為止，我認為您還沒有將這很大程度上歸因於午夜規則。您能否向我們介紹本季情況是否發生了變化？如果不是的話，編碼上的壓力體現在哪裡？

Yes. Thanks very much. I'm going to ask John to start and then ask Brian to give you a little bit more perspective on that also.

是的。非常感謝。我將請約翰開始，然後請布萊恩也為您提供更多對此的看法。

Stephen, and yes, I would say in the quarter versus our initial expectations that we shared with you a quarter ago, it was really -- they were all roughly in the same zone in terms of impact in the quarter. Those elements that we called out, kind of, give or take, but they're roughly in the same zone as we look at them. Brian?

史蒂芬，是的，我想說的是，與我們在一個季度前與大家分享的最初預期相比，本季度的情況確實如此——就本季度的影響而言，它們都大致處於同一區域。我們所提出的那些元素，有點給予或索取，但它們與我們所看到的大致處於同一區域。布萊恩？

Yes. Thanks for the question. As it relates to upcoding to inpatient stays versus what we feel is more appropriately build at outpatient, we did expect that behavior to somewhat subside here in the third quarter. Last quarter, we had talked about the timing of that spike being largely related to our own utilization management waivers during the cyberattack, but it certainly has persisted. As John mentioned at the outset, this is a few large systems driving it.

是的。謝謝你的提問。由於它涉及住院住院的升級編碼，而不是我們認為更適合在門診建立的編碼，我們確實預計這種行為會在第三季度有所減弱。上個季度，我們曾討論過該高峰的時間很大程度上與我們在網路攻擊期間的利用率管理豁免有關，但它確實持續存在。正如約翰一開始提到的，這是由一些大型系統所驅動的。

And we certainly do remain focused on evaluation of this practice. It's a key part of our utilization management. The difference between an inpatient and outpatient stay is largely borne by our consumers on an already too-expensive cost of care in a hospital setting. So we remain vigilant on focusing on this, hoping to see it abate to levels that we're more used to seeing in the past, and we'll continue to review this as we look forward.

我們當然仍然專注於對這種做法的評估。這是我們利用管理的關鍵部分。住院和門診之間的差異主要由我們的消費者承擔醫院環境中已經過於昂貴的護理費用。因此，我們對此保持警惕，希望看到它下降到我們過去更習慣看到的水平，並且我們將在展望未來時繼續審查這一點。

All right. Brian, thanks so much. will.

好的。布萊恩，非常感謝。將要。

Josh Raskin, Nephron Research.

喬許·拉斯金，腎單位研究。

There seems to be more moving pieces to the Medicare Advantage landscape than usual entering 2025. So maybe can you just take a step back and speak to your strategy over the next few years? And specifically, how important is growth in Medicare Advantage to UnitedHealth's overall enterprise strategy? And then maybe a potential weakness from competitors changes how you think about coming to market.

進入 2025 年，醫療保險優勢領域似乎比平常有更多的動人因素。具體來說，Medicare Advantage 的成長對於 UnitedHealth 的整體企業策略有多重要？然後，競爭對手的潛在弱點可能會改變您對進入市場的看法。

Josh, thanks very much for the question. Let me just make a couple of comments and then ask Tim Noel, who leads our M&R business, to go a little deeper for you. And obviously, very timely given that today is the first day of the selling season for the new MA year going into 2025. So as you look across the whole of UnitedHealth Group, Medicare Advantage, of course, is a very important part of the business, but it is one of several different pieces of what really a very diversified group of healthcare businesses. There are obviously linkages from Medicare Advantage to Optum, in particular. Obviously, through OptumHealth and elsewhere.

喬什，非常感謝你的提問。讓我發表幾點評論，然後請領導我們的 M&R 業務的 Tim Noel 為您進行更深入的探討。顯然，考慮到今天是進入 2025 年的新 MA 年度銷售季節的第一天，這一消息非常及時。它只是真正非常多元化的醫療保健業務集團的幾個不同部分之一。尤其是 Medicare Advantage 與 Optum 之間有明顯的關聯。顯然，是透過 OptumHealth 和其他地方。

But I would say over time, what you're seeing is as important as MA is, you'll see many other elements of the business continue to grow, and that's critical for the long-term sustainability of the company, of course. And that's why we've laid out the five growth pillars of the business over the last two or three years, Josh, as really signposts of where you should expect us to deploy capital, it's where we put our mind share, it's where we look for opportunities to improve the healthcare system. So whether that in benefit design, whether that be in building our value-based care, bringing new technologies to the marketplace, transforming and modernizing pharmacy or bringing forward what ought to be a state-of-the-art financial services capability into a part of the economy, which represents 20% of GDP, those are the five growth areas of the company.

但我想說，隨著時間的推移，你所看到的東西與 MA 一樣重要，你會看到業務的許多其他要素繼續成長，當然，這對公司的長期永續發展至關重要。這就是為什麼我們在過去兩三年裡列出了業務的五個成長支柱，喬什，作為您應該期望我們在哪裡部署資本的真正路標，這是我們投入精力的地方，這是我們關注的地方尋求改善醫療保健系統的機會。因此，無論是在福利設計方面，無論是在建立基於價值的醫療服務、將新技術推向市場、對藥房進行轉型和現代化，還是將最先進的金融服務能力融入到醫療保健的一部分中。 GDP的20%，這是公司的五個成長領域。

MA is an important element within all of that, but it is one of several key opportunities for us to drive forward. Now having said all of that, as we come into this cycle, I think what we're seeing is the benefits of some very thoughtful calm, not overreactive planning last year. And I think the way in which the team led us through 2024 in terms of benefit design has proven out to be on balance, right, given the very, very many moving parts that you correctly alluded to, I think that sets us up in a good place in terms of how we enter this year. We'll see how this cycle goes. I'll ask Tim to give more comment.

MA 是所有這一切中的一個重要因素，也是我們推動前進的幾個關鍵機會之一。說了這麼多，當我們進入這個週期時，我認為我們看到的是去年一些非常深思熟慮的冷靜而不是過度反應計劃的好處。我認為，事實證明，團隊在效益設計方面引導我們度過2024 年的方式是平衡的，對吧，考慮到您正確提到的非常非常多的移動部件，我認為這讓我們處於一個平衡的狀態。我們將看看這個週期如何進行。我會請蒂姆發表更多評論。

But most importantly, it really gives us confidence as we look out over the next four or five years that we're not -- we don't feel like we're having to fix significant problems that were avoided, if you will, that we didn't make those step mistakes a year ago which is always a thing to worry about in this situation, where we have a lot of moving parts. It's critical not to be over reactive. It's critical to be very much consumer patient-centric, and that's really been the guidepost that we followed. I think served as well. And Tim, I think, is going to serve us well this year. Tim?

但最重要的是，它確實給了我們信心，因為我們展望未來四五年，我們不覺得我們必須解決那些被避免的重大問題，如果你願意的話，一年前我們並沒有犯這些步驟錯誤，在這種情況下，我們總是需要擔心，因為我們有很多活動部件。重要的是不要過度反應。以消費者患者為中心至關重要，這確實是我們遵循的路標。我認為也起到了作用。我認為蒂姆今年將為我們提供良好的服務。提姆？

Good. Thanks, Josh, for the question. Yes, and I would underscore some of the pieces that Andrew mentioned. And also, yes, it is a very dynamic period right now in the Medicare marketplace. But our strategy and our vision here for the business really doesn't change a lot. So I'll just underscore a couple of those that are key to this environment today.

好的。謝謝喬希的提問。是的，我會強調安德魯提到的一些內容。而且，是的，目前醫療保險市場正處於一個非常活躍的時期。但我們的策略和業務願景確實沒有太大變化。因此，我將強調對當今環境至關重要的幾個因素。

One is that we've always had a long-term planning view, and that's never more important than it is today. And right now, that includes a very rational response in any particular year to the revenue pressures that the program is facing. And then you saw that play out for us in '24, you'll see that continue to play out as Andrew alluded to, that ensures that we don't have any deferred maintenance and pricing carryover into subsequent year, given the environment that we're in.

一是我們一直有長期規劃的觀點，這一點從未像現在這樣重要。目前，這包括在任何特定年份對該計劃面臨的收入壓力做出非常理性的反應。然後你會在24 年看到這種情況的發生，你會看到這種情況繼續發生，正如安德魯提到的那樣，這確保了我們不會有任何延期維護和定價結轉到下一年，考慮到我們的環境進來了

Along with that, we always strive to provide as much stability as possible to consumers in any one year. And then this year, in 2025, that has been preserving PCP copays of $0 for our consumers and trying to do what we can to make sure that co-pays are near $0 for the most commonly prescribed medications as well. And then also to preserve as much choice as possible that we have for consumers. That's really important for Medicare beneficiary, that we design products plans that meet their needs and listening to what consumers want, will always be a core element as well.

除此之外，我們始終努力在任何一年為消費者提供盡可能多的穩定性。今年，也就是 2025 年，我們的消費者的 PCP 共付額一直維持在 0 美元，並盡力確保最常用處方藥物的共付額也接近 0 美元。然後也要為消費者保留盡可能多的選擇。這對醫療保險受益人來說非常重要，我們設計滿足他們需求的產品計劃並傾聽消費者的需求，也永遠是核心要素。

And lastly, and this is really important, this environment is continuing to create more value. And the headline there is around our partnership with our value-based care providers. That's the best opportunity for us to continue to create value in light of some of the pressures that the program is facing. And we continue to see great opportunities there, and that's what we're leaning into right now.

最後，這一點非常重要，這種環境正在繼續創造更多價值。標題是我們與基於價值的護理提供者的合作夥伴關係。鑑於該計劃面臨的一些壓力，這是我們繼續創造價值的最佳機會。我們繼續在那裡看到巨大的機會，這就是我們現在所傾向於的。

And finally, the new technologies that are emerging around AI and ML are giving us some really nice opportunities to provide more efficiencies in our operation and be able to pass those efficiencies along the beneficiaries, and be another considerable way that we offset some of the headwinds of the program. So yes, very dynamic environment. But really, our strategy and some of the core principles and foundations of our Medicare Advantage programs don't change.

最後，圍繞人工智慧和機器學習出現的新技術為我們提供了一些非常好的機會，可以提高我們的營運效率，並能夠將這些效率傳遞給受益者，並成為我們抵消一些不利因素的另一種重要方式的程序。所以是的，非常有活力的環境。但實際上，我們的策略以及 Medicare Advantage 計劃的一些核心原則和基礎並沒有改變。

Thanks, Tim. And I just want to thank Tim and his team for -- if you just step back, Josh, and you're super well aware of this, and you just look at the amount of regulatory change, change in funding dynamics, IRA coming into the marketplace, insufficient growth coefficient in terms of future MA funding on top of V-28 cuts, what Tim's team has done is basically try to neutralize a lot of that volatility and noise in terms of how it flows through to touch patients and members. It's really important that stability, never more important to have that than in this cycle we're in right now. Because otherwise, you would see tremendous amount of, I think, disturbing volatility flow through into the market.

謝謝，蒂姆。我只是想感謝蒂姆和他的團隊 - 如果你退後一步，喬什，你非常清楚這一點，你只要看看監管變化的數量，資金動態的變化，IRA 的進入市場，除了V-28 削減之外，未來MA 資金的成長係數不足，提姆的團隊所做的基本上是試圖消除大量波動和噪音，以影響患者和會員的流動方式。穩定非常重要，在我們現在所處的這個週期中，穩定最重要。因為否則的話，我認為你會看到大量令人不安的波動流入市場。

And we're not going to do that. We are going to put our patients and our members first. We're going to strive to do everything we possibly can to give them a fantastic experience. By working with Optum, we believe that for many of those patients, we can introduce them to an unparalleled set of quality outcomes, both in terms of care and cost and experience. And that work has never been more valuable than when you see the kind of volatility that we've seen last year. And we're going to see again next year because of the things that have already been announced.

我們不會那樣做。我們將把病人和會員放在第一位。我們將竭盡全力為他們提供美妙的體驗。透過與 Optum 合作，我們相信對於許多患者來說，我們可以向他們介紹一系列無與倫比的優質結果，無論是在護理、成本還是體驗方面。當你看到我們去年看到的那種波動時，這項工作從未像現在這樣更有價值。由於已經宣布的事情，我們明年將再次見面。

And what you're seeing us plan for is how to work through that. We're not going to sacrifice the long-term potential of all of what we built in this short period of volatility. What we're going to do is work to insulate members, make sure that members have great experience. And today is the first selling day, and hopefully, lots of folks are going to be picking up the line to UHC today.

你看到我們計劃的是如何解決這個問題。我們不會犧牲我們在這段短暫的波動時期所建立的一切的長期潛力。我們要做的就是努力隔離會員，確保會員有豐富的經驗。今天是第一個銷售日，希望今天有很多人願意接聽 UHC 的電話。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

Given all the volatility, you've been -- we've seen in the sector, I was hoping you could share with us some incremental color on how your Medicaid business, ex duals, and your Medicare Advantage business including duals are performing in the third quarter and for the full year of 2024 relative to target margins? And maybe also give us some color on the expected pace of potential improvement that's implied within 2025 guidance, if there is any improvement expected?

考慮到我們在該行業看到的所有波動，我希望您能與我們分享一些關於您的醫療補助業務、前雙重保險和醫療保險優勢業務（包括雙重保險）在該領域的表現的一些增量信息。也許還可以讓我們了解 2025 年指導中隱含的潛在改進的預期速度（如果預期有任何改進的話）？

Yes, Justin, thanks so much for the question. Let me ask Brian to respond.

是的，賈斯汀，非常感謝你的提問。讓我請布萊恩回應。

Justin, let me start with duals, and I would say we remain very encouraged about the outlook for our duals business, certainly about the position of those products as we approach 2025. I think that will be a growth element for us. In 2024, obviously, we talked about it in our prepared remarks last quarter as well as this quarter, one of the three items contributing is the pressure we see from redeterminations. And that's obviously impacting our Medicaid book. I'd like to say that we probably weathered the storm on the volume impact or redeterminations, and that's now behind us. What we're really looking at now is how do these rates catch up to where our current cost trends are.

賈斯汀，讓我從雙打開始，我想說，我們對雙打業務的前景仍然感到非常鼓舞，尤其是在我們接近 2025 年時這些產品的地位。顯然，我們在上個季度和本季準備好的演講中談到了 2024 年，其中三個因素之一就是我們從重新決定中看到的壓力。這顯然影響了我們的醫療補助書。我想說的是，我們可能經歷了銷售影響或重新確定的風暴，現在已經過去了。我們現在真正關心的是這些費率如何跟上我們當前的成本趨勢。

And I think we've seen some strong momentum with our state partners, but it's not yet responsive to the trends that we're seeing real time. And we're hopeful that through our partnership and our advocacy that we'll close this gap on funding at a faster rate than maybe normal rating cycles would suggest. But the key items in the quarter, again, were just higher volumes of disenrollment. And if I was to point to one element beyond just the traditional acuity of those that left and those that stayed that we had planned for, I'd point to behavioral care.

我認為我們已經看到與我們的國家合作夥伴的一些強勁勢頭，但它尚未對我們實時看到的趨勢做出反應。我們希望，透過我們的合作夥伴關係和我們的倡導，我們將以比正常評級週期所建議的更快的速度縮小這一資金差距。但本季的關鍵問題仍是退學人數增加。如果我要指出一個超越我們計劃的離開和留下的傳統敏銳度的因素，我會指出行為護理。

Many of our states have looked to us to expand access to behavioral care. And I think many of us that partner with our states have done so. That does have some cost implications. So we're really hopeful that these states will be more responsive than traditional rating cycles would suggest, and that we'll see these tailwind soon as we pay through this big year, again, largely the volume being the driver of the implications in year and now hopeful that we'll see these rating cycles catch up to our cost trends that we're seeing emerge.

我們的許多州都希望我們擴大獲得行為照護的機會。我認為我們許多與我們各州合作的人已經這樣做了。這確實會產生一些成本影響。因此，我們真的希望這些州能夠比傳統評級週期所建議的反應更快，並且當我們在這個重要的一年中支付時，我們很快就會看到這些順風，再次，很大程度上是數量是今年影響的驅動因素現在我們希望看到這些評級週期能夠趕上我們所看到的成本趨勢。

Great. Brian, thanks so much.

偉大的。布萊恩，非常感謝。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

I was hoping just to talk a over to the commercial business and how some of those -- I guess, those three elements, obviously, excluding the Medicaid one, but the other two elements that you talked about that were -- costs were coming in higher than expected. Just if you could maybe sort of bifurcate that between commercial group and then commercial individual, and I guess how you're seeing those flow through into both of those markets. And then just on the individual side, just how that informs your view on how you've priced your exchange products for 2025, and sort of comfort with the margin trajectory there?

我希望只是談談商業業務，以及其中一些——我猜，這三個要素，顯然不包括醫療補助，但你談到的其他兩個要素——成本是如何產生的高於預期。如果您可以將商業團體和商業個人之間的情況分開，我猜您如何看待這些流入這兩個市場。然後就個人而言，這如何影響您對 2025 年交易所產品定價的看法，以及對那裡的保證金軌跡是否滿意？

Yes, Scott, thanks so much. Let me ask Brian to give you kind of an overarching view, and then maybe pass to Dan Kueter to give you a little deeper on the commercial business.

是的，斯科特，非常感謝。讓我請布萊恩給你一個整體的看法，然後也許可以請丹·庫特給你更深入地了解商業業務。

Yes, Scott, thanks for the question, it provides me an opportunity to clarify. The three items that we mentioned at the outset and throughout really aren't a part of our commercial business. What we've talked about, obviously, redeterminations in the Medicaid space and the other pressure points around inpatient stays and specialty -- largely around Medicare Advantage. I feel really good about not only our performance, but our cost management inside our commercial business, and I'll hand it to Dan Keuter, our CEO of that business.

是的，斯科特，謝謝你的提問，它為我提供了澄清的機會。我們在開頭和全文中提到的三個項目確實不屬於我們的商業業務。顯然，我們所討論的是醫療補助領域的重新確定以及圍繞住院和專科的其他壓力點——主要圍繞醫療保險優勢。我不僅對我們的業績感到非常滿意，而且對我們商業業務內部的成本管理也感到非常滿意，我會將其交給我們該業務的執行長 Dan Keuter。

Yes. Thanks, Brian. And Scott, thanks for the question. I can offer that in the exchange business, as you asked about, our pricing is respectful of the brand and the other market dynamics in that space, which include our product offering, our geographic footprint and the competitive environment. For 2025, we have priced with a forward view of our cost in full respect for trend. As Brian and John have noted, those impacts that are driving some trend in the government programs are not applicable to the commercial business, whether that be on the individual side or the group side.

是的。謝謝，布萊恩。斯科特，謝謝你的提問。我可以在交易所業務中提供這一點，正如您所問的那樣，我們的定價尊重品牌和該領域的其他市場動態，其中包括我們的產品供應、我們的地理足跡和競爭環境。對於 2025 年，我們在充分尊重趨勢的情況下對成本進行了前瞻性定價。正如布萊恩和約翰所指出的，那些推動政府計畫某些趨勢的影響並不適用於商業業務，無論是個人方面還是團體方面。

So our outlook on trend for 2025 is consistent with our view for 2024, and the drivers in the commercial business remain the things that we have discussed for some time now: provider unit cost, pharmacy cost and enabling expanded access to behavioral health services. So those have been the driver in '24. We expect those to continue into '25. And we have priced both the individual business and the group business with full respect and awareness of those trend items.

因此，我們對2025 年趨勢的展望與我們對2024 年的看法是一致的，商業業務的驅動因素仍然是我們已經討論了一段時間的事情：提供者單位成本、藥品成本以及擴大行為健康服務的覆蓋範圍。所以這些都是 24 年的驅動力。我們預計這些將持續到 25 年。我們對個人業務和集團業務的定價都充分尊重和了解這些趨勢項目。

Dan, thank you so much. And really, the two elements that Dan just raised there, the pharmacy unit cost and utilization, and of course, the hospital unit cost, are two kind of strategic areas that we really want to lean into. And we've been very outspoken for years about the need to bring down a list price of drugs. We continue to advocate very strongly for that. Until that happens, we continue to utilize all of the tools at our disposal through Optum Rx to try and bring down those costs on behalf of our members and on behalf of the companies who we serve within the commercial books of business.

丹，非常感謝你。事實上，丹剛才提出的兩個要素，藥局單位成本和利用率，當然還有醫院單位成本，是我們真正想要關注的兩個策略領域。多年來，我們一直直言不諱地表示需要降低藥品目錄價格。我們將繼續大力倡導這一點。在此之前，我們將繼續利用 Optum Rx 所掌握的所有工具，代表我們的會員以及我們在商業帳簿中服務的公司嘗試降低這些成本。

We're also exploiting as much as we possibly can, opportunities to be leaders in how we think about biosimilar adoption and how we create wraparound programs on important areas like weight loss. All of which are designed to try and bring down essentially the ever kind of increase in inflationary pressure that we see from the drug bill, and that's an important one.

我們也盡可能地利用機會，在如何思考生物相似藥的採用以及如何在減肥等重要領域創建全面計劃方面成為領導者。所有這些措施的目的都是為了從根本上降低我們從藥品法案中看到的不斷增加的通膨壓力，這是一項重要的舉措。

The second one Dan referred to is hospital unit costs. And we've seen really some unusually aggressive and high unit cost asks, we are very much -- we fully recognize the critical role of the hospital systems and hospitals, obviously, within the care delivery environment. But we need to -- we want to continue to work to try and find new compact, a new way of working with hospitals. We want to see less abrasion in the marketplace. We believe that ought to come with more competitive rates in the marketplace. We see a critical role for hospitals as acuity needs rise and rise. But at the same time, we see great opportunity for us to partner with the right health systems to create much better value for money for the overall system.

丹提到的第二個是醫院單位成本。我們確實看到了一些異常激進和高單位成本的要求，我們非常 - 我們完全認識到醫院系統和醫院在護理服務環境中的關鍵作用。但我們需要──我們希望繼續努力尋找新的契約，一種與醫院合作的新方式。我們希望看到市場上的磨損更少。我們相信，這應該會在市場上帶來更具競爭力的價格。隨著視力需求的不斷增加，我們看到醫院發揮著至關重要的作用。但同時，我們看到了與正確的衛生系統合作的絕佳機會，為整個系統創造更好的經濟效益。

So the two areas we really want to be a willing partner to innovate. And whether that be with drug companies who are interested in new ways of working to bring down cost or whether that's with hospital systems who want to work with us to reimagine what the patient experience, the doctor experience is, and all part of bringing down the unit cost, those are areas that are super important for the long run, and it's going to be a space where you're going to see us continue to be very active in terms of putting forward ideas, trying -- piloting new approaches. The national Gold Card program I mentioned 30 minutes ago, is just one example, and we're going to continue to look for those sorts of opportunities.

因此，我們確實希望成為這兩個領域願意創新的合作夥伴。無論是對降低成本的新工作方式感興趣的製藥公司，還是希望與我們合作重新構想患者體驗、醫生體驗以及降低成本的所有部分的醫院系統。您將看到我們在提出想法、嘗試新方法方面繼續非常積極。我 30 分鐘前提到的國家金卡計畫只是一個例子，我們將繼續尋找此類機會。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Could you talk a little bit about OptumHealth? And I had three points there. If you could talk a little bit about some of the drivers of margin improvement in the quarter. If you talk about the outlook for 25 for risk contracting. In particular, what things might be driving that as far as adoption in MA and if you're seeing adoption in other segments like employer. And then maybe a sort of related question, are you seeing any other responses in the employer segment to the high premium inflation environment that's out there, like PBC adoption, but also things like binder or whatever?

您能談談 OptumHealth 嗎？我在那裡得到了三分。您能談談本季利潤率改善的一些驅動因素嗎？如果你談論 25 風險收縮的前景。特別是，哪些因素可能會推動 MA 的採用，以及您是否看到雇主等其他領域的採用。然後也許是一個相關的問題，您是否看到雇主部門對現有的高保費通膨環境有任何其他反應，例如採用 PBC，但也有諸如活頁夾之類的東西？

Yes. Thanks so much,. Let me ask John just to comment on margin. And I'd like to go to Dr. Desai, who looks after OptumHealth, on your second two points, if that's okay.

是的。非常感謝，。讓我請約翰就保證金發表評論。如果可以的話，我想請負責 OptumHealth 的 Desai 博士談談你的後兩點。

Lance, it's John. Yes, a few things benefiting Optum here is as it continues to progress. Let's start with -- now this is roughly a $100 billion a year business that we've been building over the past decade or so, advancing strongly along the way and we're able to make refinements in the business as we look ahead and such. So that is -- you should expect us to see us continue to refine the portfolio that we are in the types of businesses that we're in. What is OptumHealth is mostly a care delivery business at this point versus kind of what it was maybe even five years ago.

蘭斯，是約翰。是的，Optum 受益的一些事情是它的不斷進步。讓我們開始吧——現在，我們在過去十年左右的時間裡一直在打造每年約 1000 億美元的業務，一路強勁推進，我們能夠在展望未來時對業務進行改進等。所以，你應該期待我們看到我們繼續完善我們所從事的業務類型的投資組合。

And so you should continue to see us focus the portfolio strongly on that. So we'll focus the portfolio on those businesses that make a lot of sense for us, and we will not be in businesses that don't hang as tightly with the theme we have in value-based care and where we're heading for this business for the next decade. In addition to legacy elements in there, such as maybe contracts and such that needed refinements that have been in there for a while, and so moving those along, also getting them into a better zone. So really, the company performing very strongly, fundamentally in here and the type of engagement they're having with the people that they serve at OptumHealth.

因此，您應該繼續看到我們的投資組合重點關注這一點。因此，我們將把投資組合集中在那些對我們來說很有意義的業務上，我們不會參與那些與我們基於價值的護理主題和我們的發展方向不緊密相關的業務。業務。除了其中的遺留元素之外，例如合約等需要改進的元素，這些元素已經存在了一段時間，因此將它們向前推進，也讓它們進入更好的區域。事實上，該公司在這方面的表現非常強勁，從根本上講，以及他們與 OptumHealth 所服務的人員的互動類型。

And Dr. Desai and his team and how they've advanced that with the engagement of the most complex patients. Those are the fundamental drivers of how that business has performed. And then our job is to make sure that we refine the portfolio, refine the elements here as we look ahead for the next decade and build.

還有德賽博士和他的團隊，以及他們如何透過最複雜的患者的參與來推進這一目標。這些都是該業務表現的基本驅動力。然後我們的工作是確保我們在展望未來十年和建設時完善產品組合、完善這裡的元素。

Great. Thanks, John. And Amar?

偉大的。謝謝，約翰。阿瑪爾呢？

Thanks for the question, Lance. So first of all, we feel very good about the overall performance of OptumHealth. We are continuing to execute against our three-year plan that we put in place in 2023, focused on medical cost management and affordability initiatives, clinical engagement, our operating cost management activities and then accelerated diversified growth in some of our services businesses.

謝謝你的提問，蘭斯。所以首先我們對OptumHealth的整體表現感覺非常好。我們將繼續執行 2023 年制定的三年計劃，重點關注醫療成本管理和負擔能力計劃、臨床參與、我們的營運成本管理活動，然後加速我們一些服務業務的多元化成長。

On that point, in particular, with services, we're pleased with the growth in our OptumServe business, where we've had new product launches in the areas of medical disability exams that have resonated very well in the marketplace and have contributed to a leading position as a clinical provider for the largest government and federal agencies in the country.

在這一點上，特別是在服務方面，我們對 OptumServe 業務的成長感到高興，我們在醫療殘疾檢查領域推出了新產品，這些產品在市場上引起了很好的反響，並為作為國內最大的政府和聯邦機構的臨床提供者，處於領先地位。

As it relates to your broader question around growth across payers, we have strong relationships with over 100 planned partners and are poised to execute on a broad, diverse growth agenda. In fact, in this dynamic rate environment and benefit environment we've discussed here, we're actually seeing increased outreach from payers who are looking for really an enduring partner who can operate in capitated arrangements. In particular, a number of productive discussions ongoing around funding and market level planning as we plan for AEP, but also in other lines of business.

由於它涉及您關於付款人成長的更廣泛問題，因此我們與 100 多個計劃合作夥伴建立了牢固的關係，並準備好執行廣泛、多樣化的成長議程。事實上，在我們在這裡討論的這種動態的費率環境和福利環境中，我們實際上看到付款人正在擴大外展範圍，他們正在尋找真正能夠按資本安排運營的持久合作夥伴。特別是，在我們規劃 AEP 時，圍繞資金和市場層面的規劃正在進行許多富有成效的討論，但在其他業務領域也是如此。

And foundational to all of these conversations is really first and foremost, the quality of our providers anchored in the community, particularly our ability to achieve clinical outcomes, including closing gaps in care for Starz programs and HEDIS measures, the strength of that network in the geographies that plan partners are looking to grow in, and then continued focus around our clinical engagement. In fact, year-to-date, we've engaged over 80% of our members. 90% year-to-date for our highest risk members. So when I take that together, great momentum and strength to not only grow but grow in a broad and diverse way across multiple lines of business. Thanks for the question.

所有這些對話的基礎實際上首先是社區中提供者的質量，特別是我們實現臨床結果的能力，包括縮小 Starz 計劃和 HEDIS 措施的護理差距、該網絡在社區中的實力。區，然後繼續關注我們的臨床參與。事實上，今年迄今為止，我們已經吸引了超過 80% 的會員。今年迄今為止，我們風險最高的會員的比例為 90%。因此，當我把這些結合起來時，巨大的動力和力量不僅會成長，而且會在多個業務領域以廣泛和多樣化的方式成長。謝謝你的提問。

Great. Amar, thank you very much. And I'm going to ask Heather in a second just to give a little bit of perspective from Hersey the Head of Optum in terms of the value-based care ambition and where we're looking to take that particularly as it differentiates. But both Heather and I have recently been out with some of our key commercial clients, and it's been striking to me the rise in interest and -- it's a beginning, I think, but the rise in interest for some commercial employers to start to explore moving to value based as an alternative.

偉大的。阿瑪爾，非常感謝你。我稍後會問 Heather，請他從 Optum 負責人 Hersey 的角度談一下基於價值的護理雄心，以及我們希望採取哪些特別是因為它與眾不同的觀點。但希瑟和我最近都與我們的一些主要商業客戶進行了交流，對我來說，興趣的上升令人震驚——我認為這是一個開始，但一些商業雇主開始探索興趣的上升轉向基於價值作為替代方案。

And I do think that we're going to see that start to move forward now. It's one of the reasons we've been investing heavily in some new groups, I'll call out particularly Kelsy Sabol that joined Optum just a couple of years ago. They're really good at the leading edge of that kind of model. And I do think that we're going to see -- Lance, to your good question, I think we're going to see that start to evolve over the next few years. And we're certainly starting to see the beginnings of important employers begin to ask those questions. And there are obviously some who already do it, and I'd expect to see that trend accelerate as we go forward.

我確實認為我們現在將會看到這種情況開始向前發展。這也是我們大力投資一些新團隊的原因之一，我要特別提到幾年前剛加入 Optum 的 Kelsy Sabol。他們非常擅長這種模型的前沿。我確實認為我們將會看到——蘭斯，對於你提出的好問題，我認為我們將會看到這種情況在未來幾年內開始發展。我們當然開始看到重要的雇主開始提出這些問題。顯然有些人已經這樣做了，我預計隨著我們的前進，這種趨勢會加速。

But Heather, it'd be good just to share a little bit how you're viewing the overall value-based care kind of point of differentiation, maybe from a member perspective and the like.

但是希瑟，如果能分享一下您如何看待基於價值的整體護理的差異點，也許是從會員的角度等角度，那就太好了。

Yes. Thanks, Andrew. And just maybe, Lance, thanks for the opportunity. I think you're right, you're seeing -- in this dynamic environment and a complex funding environment, you're seeing the value proposition of the value-based care in the sense that Amar described it, not just for those plan sponsors that predominantly take risk for Medicare Advantage, but we're seeing it from employers as well direct to employer.

是的。謝謝，安德魯。只是也許，蘭斯，謝謝你給我這個機會。我認為你是對的，你看到了——在這個動態的環境和複雜的融資環境中，你看到了阿馬爾所描述的基於價值的護理的價值主張，而不僅僅是針對那些計劃發起人主要為醫療保險優惠承擔風險，但我們也看到雇主也直接面對雇主。

And I think the principles of it, as Andrew said, is one, they're looking for alternatives that give clear predictability. They're looking for a better member holistic experience, and that means integrating their wellness programs, it means better answers and closer proximity to the wraparound services they need, including behavioral health and at times home-based services. And it means, again, more predictability and the ability to invest dollars in other areas of well-being and health for our employers.

我認為，正如安德魯所說，其原則之一是，他們正在尋找能夠提供明確可預測性的替代方案。他們正在尋求更好的會員整體體驗，這意味著整合他們的健康計劃，這意味著更好的答案和更接近他們所需的全方位服務，包括行為健康，有時甚至是家庭服務。這再次意味著我們的雇主有更多的可預測性和在其他福祉和健康領域投資的能力。

The other thing I'd point out is not only to Amar's point are we continuing to invest in value-based care. And with every month, we see more aligned physicians with better tools, with better platforms with increased signals and incentives to ensure that they're focused on the outcomes and the affordability of our members. And you're seeing that show through in OptumHealth's performance. But don't forget the other services, they -- across Optum, also help our payers and our employers, including our risk and quality services that we offer through OptumInsight. Those are the administrative and clinical services, they're more high-powered, they're more universal. We're using AI to bring down the cost of those and increase the universes.

我要指出的另一件事不僅符合阿瑪爾的觀點，我們也繼續投資於基於價值的照護。每個月，我們都會看到更多的醫生擁有更好的工具、更好的平台以及更多的訊號和激勵措施，以確保他們專注於結果和會員的負擔能力。您可以從 OptumHealth 的表現中看到這一點。但不要忘記 Optum 的其他服務，它們也幫助我們的付款人和雇主，包括我們透過 OptumInsight 提供的風險和優質服務。這些是行政和臨床服務，它們更強大，更普遍。我們正在使用人工智慧來降低這些成本並擴大宇宙。

And in Optum Rx, Optum Rx PBM services, if the employer or the plan wants it, is a value-based accountable construct. They can do a pass-through where they manage the cost, or they can do an accountable construct when we talk about our clear guarantee programs. We take the risk for all of those services, including the specialty services. Now it's really important to note, I think this is incredibly important that with guarantee or accountability, our clients don't lose transparency. Optum Rx stands for transparency, but we're trying to make it simpler and we're trying to take accountability.

在 Optum Rx 中，如果雇主或計畫需要的話，Optum Rx PBM 服務是一個基於價值的負責任的建構。他們可以在管理成本時進行傳遞，或者當我們談論我們明確的保證計劃時，他們可以進行負責任的建構。我們承擔所有這些服務的風險，包括專業服務。現在需要注意的是，我認為透過保證或責任，我們的客戶不會失去透明度，這一點非常重要。 Optum Rx 代表透明度，但我們正在努力使其變得更簡單，並且我們正在努力承擔責任。

So I would point to the value-based services across Optum and say, yes, they're resonating with payers. We're seeing that, and that's why we're so optimistic about our long-term value proposition. But every other service that Optum offers through Insight, through the Bank and throughout Optum Rx contributes to that value-based mission and helps all of our clients, payers, state customers, federal customers, employers, and should benefit our consumers with better outcomes and with a better experience.

因此，我將指出 Optum 的基於價值的服務，並說，是的，它們與付款人產生了共鳴。我們看到了這一點，這就是為什麼我們對我們的長期價值主張如此樂觀。但是Optum 透過Insight、銀行和整個Optum Rx 提供的所有其他服務都有助於實現基於價值的使命，並幫助我們所有的客戶、付款人、州客戶、聯邦客戶、雇主，並且應該以更好的結果使我們的消費者受益。

Heather, thanks so much. And Lance, thanks again for the question.

希瑟，非常感謝。蘭斯，再次感謝您的提問。

Joanna Gajuk, Bank of America.

喬安娜·加尤克，美國銀行。

So I just have a follow-up question on the OptumHealth discussion sites question was about margins. But I want to ask about revenues. In the quarter, the revenues actually did decline sequentially quarter-over-quarter from second quarter, about 4%. So -- and I know there was a commentary around streamlining the portfolio and some contracts. So is that sequential decline and a fraction that you -- there was something that actually did already take place in the third quarter in terms of exiting maybe some underperforming contracts or business lines? So can you comment on that?

所以我有一個關於 OptumHealth 討論網站的後續問題是關於利潤的。但我想問一下收入狀況。本季的收入實際上比第二季度環比下降了約 4%。所以——我知道有關於簡化投資組合和一些合約的評論。那麼，連續下降和一小部分是不是——第三季度實際上已經發生了一些事情，例如退出一些表現不佳的合約或業務線？你能對此發表評論嗎？

And I guess, were margins also benefiting from investment income and to what degree? And then I guess for the quarter, real question is about trying to ask again what you assume for margins in OptumHealth next year.

我想，利潤率是否也受益於投資收入？然後我想對於本季來說，真正的問題是再次詢問您對 OptumHealth 明年利潤率的假設。

Thanks so much, Joanna. Let me -- I think actually the sequential is a pretty straightforward explanation, let me just ask John to give you a little detail on that.

非常感謝，喬安娜。讓我——我認為實際上順序是一個非常簡單的解釋，讓我請約翰給你一些細節。

On, yes, so the refinements that I was discussing would be the primary impact in terms of the sequential and what you're seeing sequentially in terms of revenues. And as we continue to refine the portfolio, refine contracts, legacy contracts that might be out there and work ahead on that. That would be the really prime component that we'd see in there.

是的，所以我正在討論的改進將是對順序以及您在收入方面順序看到的主要影響。隨著我們繼續完善投資組合、完善合約、可能存在的遺留合同，並繼續努力。這將是我們在那裡看到的真正主要的組件。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，康托費茲傑拉。

I was hoping you could give us a little bit more color on OptumInsight. So excluding change, how are -- how is the sales pipeline and margins going versus your expectations on the nonchange business? And then on change specifically, as we think about its transition into 2025, is that business an earnings drag? And how should we think about the revenue being a headwind or a tailwind compared to '24?

我希望您能為我們提供有關 OptumInsight 的更多資訊。因此，排除變化，銷售通路和利潤率與您對不變業務的預期相比如何？然後具體到變化，當我們考慮向 2025 年過渡時，該業務是否會拖累盈利？與 24 年相比，我們該如何看待收入是逆風還是順風？

Sarah, thanks so much. I'm going to ask Roger Connor, who leads OptumInsight, to give you a little deeper on this. But I just want to thank and acknowledge that the tech team and the OptumInsight team more broadly for the extraordinary response to the change attack, and Joe shared you in a second, the great progress we've made in recovery in that business. Continues to be -- work to do, obviously, bringing back all the clients who we asked to go work with other folks during the attack. We did the right thing in terms of protecting the system and encouraging people to find alternatives.

莎拉，非常感謝。我將請 OptumInsight 的領導者 Roger Connor 為您提供更深入的了解。但我只想感謝並承認技術團隊和 OptumInsight 團隊對變革攻擊做出了非凡的反應，喬立即向您分享了我們在該業務恢復方面取得的巨大進展。顯然，我們還有很多工作要做，要把我們要求在襲擊期間與其他人一起工作的所有客戶帶回來。在保護系統和鼓勵人們尋找替代方案方面，我們做了正確的事。

We're now bringing them back. We've made a huge step forward in that. That work will continue as we roll into new year, as you heard in the introductory comments, but great progress on that. And the speed at which we will to rebuild a modern platform has been just extraordinary. And I think actually bodes very well for us in the future in terms of how we think about our speed of technical modernization as an organization. More broadly, I think it's also given us the stimulus to really really reimagine what the future of OptumInsight is going to be, and I'll pass it now to Roger to give you a little more detail on just where we are on the recovery and, more importantly, on the nonchange modernization aspects.

我們現在正在把他們帶回來。我們在這方面已經向前邁出了一大步。正如您在介紹性評論中所聽到的那樣，隨著我們進入新的一年，這項工作將繼續進行，但在這方面取得了巨大進展。我們重建現代平台的速度非常快。我認為，就我們如何看待作為一個組織的技術現代化速度而言，這對我們來說實際上是一個好兆頭。更廣泛地說，我認為這也激勵我們真正重新構想 OptumInsight 的未來，我現在將其轉交給羅傑，讓您更詳細地了解我們的復甦情況和情況更重要的是，在不變的現代化方面。

Thanks, Andrew, and thanks very much for the question. I think hopefully, you're going to get a sense of the confidence we feel in OptumInsight going into 2025 as we move through the change event. Maybe if I just start there, first of all, with the cyber recovery and in terms of the progress that's been going well. From a Q3 perspective, you'll see that the business disruption reduced quarter-on-quarter.

謝謝安德魯，非常感謝你提出這個問題。我想，當我們經歷變革事件時，您將會感受到我們對 OptumInsight 進入 2025 年的信心。也許如果我從這裡開始，首先是網路復原以及進展順利。從第三季的角度來看，您會發現業務中斷環比減少。

I suppose where we're focused through the first half of the year has really been on the restoration of the systems, and we've made very good progress. Not really, it's all about reconnecting our customers. And as John shared, we are seeing slightly higher business disruption trend going into the end of the year, and some of that will carry over. Maybe just a couple of reasons to a little bit deeper as to why that's happening. From a reconnection perspective, customers are coming back. We're actually making good progress there. What we're seeing is the volume that's coming back isn't coming back to the pre-attack levels. And customers are really looking for vendor redundancy, what they're out there looking for is in another one or two sources of their software systems, for example.

我想我們上半年的重點確實是系統的恢復，並且我們已經取得了很好的進展。並非如此，這一切都是為了重新連結我們的客戶。正如約翰分享的那樣，我們看到年底業務中斷趨勢略有上升，其中一些將持續下去。也許只有幾個原因可以更深入地解釋為什麼會發生這種情況。從重新連結的角度來看，客戶正在回歸。我們實際上在那裡取得了良好的進展。我們看到的是，恢復的交易量並未恢復到攻擊前的水準。客戶確實在尋找供應商冗餘，例如，他們正在尋找的是其軟體系統的另一個或兩個來源。

Now we understand that. We think that's a good thing for the health system, but that is having an impact on us this year. But that also creates an opportunity for us. We've got an opportunity to go out and get new customers or sales and become an additional supplier for them. So again, that's a focus. That's going to take a little bit longer, a slightly more complex implementation time. So when you add those two factors together, that's why you see that carryover impact into 2025. I think it's important just to understand just the scope of OptumInsight overall.

現在我們明白了。我們認為這對衛生系統來說是一件好事，但這對我們今年產生了影響。但這也為我們創造了機會。我們有機會出去獲得新客戶或銷售，並成為他們的額外供應商。再說一遍，這是一個焦點。這將需要更長一些、更複雜的實施時間。因此，當您將這兩個因素加在一起時，您會看到這種影響會延續到 2025 年。

Because if you look at our core business outside of change, which is the vast majority of OptumInsight, that's where we're feeling very confident around the opportunities that we've got through the end of this year and going into next year. And you can see that we're performing well. We've got momentum. You can see that in our operating earnings in terms of outperformance in terms of our growth year-to-year when you adjust for change.

因為如果你看看我們在變革之外的核心業務，這是 OptumInsight 的絕大多數，那麼我們對今年年底和明年的機會非常有信心。你可以看到我們表現良好。我們有動力。當您根據變化進行調整時，您可以在我們的營業收入中看到，我們的逐年成長表現優於我們。

That confidence comes really in a couple of areas. One, the market needs us. The payer and provider markets are where we see real opportunity. There's significant cost pressure in that client base, and they really see our services and software as a bit of a sweet spot. That's where we can help and provide their solutions. And then where I'm actually most excited is what we're going to do in innovation and what we're doing in innovation to accelerate currently, because we're building off that new modernized tech environment that we've built this year at Insight. And we're using AI to not only transform the functionality of our current products, like payment integrity revenue cycle, but to create these differentiated products and creating this exciting portfolio of AI-driven innovations.

這種信心確實體現在幾個方面。一、市場需要我們。付款人和提供者市場是我們看到真正機會的地方。這個客戶群面臨著巨大的成本壓力，他們確實認為我們的服務和軟體是一個不錯的選擇。這就是我們可以幫助他們並提供解決方案的地方。然後，我實際上最興奮的是我們將在創新方面做的事情以及我們目前正在加速創新的事情，因為我們正在建立我們今年在洞察力。我們使用人工智慧不僅可以改變我們目前產品的功能，例如支付完整性收入週期，而且可以創造這些差異化產品並創建令人興奮的人工智慧驅動創新組合。

Now the good news about Insight is that we can go and test those with our partners with UnitedHealthcare, we test them with OptumHealth. We conclude our big health system partnerships. That allows us to test these things quickly and bring them to market fast. And you're going to see us doing that more as we go into next year. So when I add that underlying market opportunity, I add that this AI-fueled acceleration of innovation, that's why I think that we've got -- we're really set up well going into 2025 and for our performance next year.

現在，關於 Insight 的好消息是，我們可以與 UnitedHealthcare 的合作夥伴一起測試這些內容，我們與 OptumHealth 一起測試它們。我們結束了我們的大衛生系統合作夥伴關係。這使我們能夠快速測試這些東西並將它們快速推向市場。進入明年，你會看到我們在這方面做得更多。因此，當我添加潛在的市場機會時，我會補充說，人工智慧推動的創新加速，這就是為什麼我認為我們已經為進入 2025 年以及明年的業績做好了準備。

Great. Thanks, Roger.

偉大的。謝謝，羅傑。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

SG&A has been a strong contributor to earnings this year. Just curious how we should think about the permanency of some of those cost changes as we look forward to 2025. Is there anything that you would call out as being more temporary in nature?

SG&A 對今年的獲利做出了巨大貢獻。只是好奇，當我們展望 2025 年時，我們應該如何考慮其中一些成本變化的永久性。

Thanks so much for the question. Listen, I think you should expect us to be very, very disciplined around cost management. And again, I want to go back to first principles. I'll take you back to the investor conference last year in New York. I stood on the stage and I said, look, essentially, what you're seeing from the CMSP28 rate change is a price cut. I mean that's what it is. And the price cut requires us to respond accordingly.

非常感謝你的提問。聽著，我認為您應該期望我們在成本管理方面非常非常嚴格。再一次，我想回到首要原則。我將帶您回顧去年在紐約舉行的投資者會議。我站在講台上說，看，本質上，你從 CMSP28 利率變化中看到的是降價。我的意思是事情就是這樣。而降價要求我們做出相應的反應。

And a key piece of that response, if you want to protect members, which we do is we have to take cost down inside the organization, and we have to try and eliminate waste in the MedEx environment outside of the company. So we have been relentless around how can we find sustainable cost reductions for the organization, particularly in both businesses. You see this year, I'd say, Optum, in particular, has been doing a remarkable job of taking cost out. I think there's more to go, and we will be very relentless about that.

如果你想保護會員，這項因應措施的關鍵部分就是我們必須降低組織內部的成本，我們必須努力消除公司外部 MedEx 環境中的浪費。因此，我們一直不懈地致力於如何為組織找到可持續的成本削減，特別是在這兩個業務領域。我想說，今年 Optum 在降低成本方面做得非常出色。我認為還有更多工作要做，我們將對此不懈努力。

And as an organization, we recognize the payer has the right to change the price they want we have to respond. Cost reduction is a key piece of it. And MedEx management is the other key piece, and those are going to be two really important features of the future for the organization in terms of how we robustly respond to all of this. So yes, you should expect more of that, and it will be a key piece of the plan going forward.

作為一個組織，我們認識到付款人有權更改他們希望我們做出回應的價格。降低成本是其中的關鍵部分。 MedEx 管理是另一個關鍵部分，就我們如何強有力地應對這一切而言，這些將成為組織未來的兩個非常重要的特徵。所以，是的，你應該期待更多，這將是未來計劃的關鍵部分。

We just have time for one last question, if we could take the last one, please.

我們只有時間回答最後一個問題，請回答最後一個問題。

Erin Wright, Morgan Stanley.

艾琳·賴特，摩根士丹利。

So you mentioned some of the internal investments just around AI and other initiatives into 2025. But what about broader capital deployment? I guess,how should we be thinking about the priorities heading into 2025 in the context of everything that's going on in and otherwise, but also just what's embedded in your expectation share buybacks or otherwise?

您提到了一些圍繞人工智慧的內部投資以及到 2025 年的其他舉措。我想，我們應該如何考慮進入 2025 年的優先事項，不僅要考慮到 2025 年發生的所有事情，還要考慮到您預期的股票回購或其他方面的內容？

And I'll ask John just to comment in a second. But broadly speaking, our capital deployment is going to be very much led by our five growth pillars of focus for the organization. So as you think about that benefits business, obviously, UnitedHealthcare, value-based care, our technology-led opportunities, our pharmacy businesses and of course, financial services. Those are going to be the areas in which we think about capital deployment. Value-based care is really the organizing principle, which binds all of that together. So that's going to be a key kind of element to that also.

我會請約翰稍後發表評論。但從廣義上講，我們的資本部署將在很大程度上由我們組織重點關注的五個成長支柱主導。因此，當你想到這對業務的好處時，顯然，聯合醫療保健、基於價值的護理、我們以技術為主導的機會、我們的製藥業務，當然還有金融服務。這些將是我們考慮資本部署的領域。基於價值的護理實際上是組織原則，它將所有這些結合在一起。所以這也將是其中的關鍵要素。

And then I would add to that, something we talked about over the last two years extensively is consumerization. You should expect us to continue to challenge and push on how we can constantly modernize the consumer experience that we're able to offer. Technology as a facilitator of that, but also philosophy as a facilitator of that, right? The organization is changing. It's biased to being much more consumers in the way it thinks and operates. We want to continue to bring that to life. So those five growth pillars, the opportunities, the technology of the 2020s gives us, and then a shift in emphasis from the company towards a more consumerist experience, those are really the guide points.

然後我想補充一點，過去兩年我們廣泛討論的問題是消費化。您應該期待我們繼續挑戰並推動如何不斷現代化我們所能提供的消費者體驗。技術是其中的促進者，哲學也是其中的促進者，對嗎？組織正在改變。它的思維和運作方式偏向於成為更多消費者。我們希望繼續將其變為現實。因此，這五個成長支柱、機會、2020 年代的技術為我們帶來了，然後重點從公司轉向更消費主義的體驗，這些確實是指導點。

And then, John, maybe just more broadly summarize beyond that element, if you could, for capital.

然後，約翰，如果可以的話，也許可以對資本進行更廣泛的總結。

Yes, Erin. So you should see -- expect our capital deployment agenda remain very much like it has the past many years, focused on expanding the capabilities of the company, orienting how we look at that, orienting around our five growth pillars,and where we need to be adding capabilities, clearly generating strong returns for shareholders as we deploy that capital. So first and foremost, that's always been the first priority, how can we build new capabilities for the company that will deliver strong returns for shareholders for the next decade, and where should we be putting that capital. That will continue very much the same. You shouldn't see any shift on that.

是的，艾琳。所以你應該看到——預計我們的資本部署議程仍然與過去很多年一樣，專注於擴大公司的能力，確定我們的看法，圍繞我們的五個增長支柱，以及我們需要的地方增加能力，在我們部署這些資本時顯然會為股東帶來豐厚的回報。因此，首先也是最重要的，這始終是首要任務，我們如何為公司建立新的能力，以便在未來十年為股東帶來豐厚的回報，以及我們應該把這些資本投入到哪裡。這種情況仍將持續下去。你不應該看到這方面有任何變化。

That's always first priority. And then we look at other elements there in terms of in share repurchase and dividend and those other elements where we can return capital to shareholders. So you should see that be very, very steady as you look to the decade ahead in terms of how we've always approached this business.

這始終是第一要務。然後我們來看看股票回購和股利方面的其他要素，以及我們可以向股東返還資本的其他要素。因此，當您展望未來十年時，您應該看到我們一直以來如何處理這項業務，這將非常非常穩定。

Great. And thank you for the question, and thank you all for your questions this morning. As we look to conclude in this year and further preparing for 2025, we're excited about the future of UnitedHealth Group. We believe we have the focus, the discipline and the adaptability to continue to grow our 13% to 16% long-term target. And we remain, as always, committed to the people we serve.

偉大的。謝謝大家提出的問題，也謝謝大家今天早上提出的問題。當我們期待今年結束並進一步為 2025 年做準備時，我們對聯合健康集團的未來感到興奮。我們相信，我們有專注力、紀律和適應性，能夠繼續實現 13% 至 16% 的長期目標。我們一如既往地致力於為我們所服務的人們服務。

Despite the challenges that we see in the environment externally, we believe at UnitedHealth Group, we have the right mix of people, capabilities, passion and compassion to allow us to not just navigate 2025, but actually in doing so, set the foundations for continued differentiated performance for many years to come.

儘管我們在外部環境中看到了挑戰，但我們相信，在聯合健康集團，我們擁有適當的人員、能力、熱情和同情心，使我們不僅能夠順利度過2025 年，而且實際上在此過程中為持續發展奠定了基礎。

We appreciate very much your attention this morning. Look forward to having the chance to see you in person in New York at our investor conference. Thank you.

我們非常感謝您今天早上的關注。期待有機會在紐約的投資者會議上與您見面。謝謝。

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

今天的會議到此結束。我們感謝您的參與。