聯合健康 (UNH) 2024 Q4 法說會逐字稿

Good morning, and welcome to UnitedHealth Group fourth-quarter and full-year 2024 earnings conference call.

早上好，歡迎參加聯合健康集團 2024 年第四季和全年收益電話會議。

A question-and-answer session will follow UnitedHealth Group's prepared remarks.

聯合健康集團準備好發言後將舉行問答環節。

As a reminder, this call is being recorded.

提醒一下，此通話正在錄音。

Here are some important introductory information.

以下是一些重要的介紹資訊。

This call contains forward-looking statements under US federal securities laws.

本次電話會議包含美國聯邦證券法規定的前瞻性陳述。

These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations.

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。

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.

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.

此次電話會議也將參考非公認會計原則金額。

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 January 16, 2025, which may be accessed from the Investor Relations page of the company's website.

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 2025 年 1 月 16 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)。

Jennifer, thank you very much.

詹妮弗，非常感謝你。

And good morning, everyone.

大家早安。

I'd like to start by expressing a sincere thank you from my colleagues and from me for the overwhelming expressions of condolence and support following the murder of our friend Brian Thompson.

首先，我謹向我的同事和我本人表示誠摯的謝意，感謝你們在我們的朋友布萊恩·湯普森被謀殺後所表達的強烈哀悼和支持。

Many of you knew Brian personally.

你們中的許多人都認識布萊恩。

You knew how much he meant to all of us and how he devoted his time to help him make the health system work better for all of the people we're privileged to serve.

你知道他對我們所有人有多重要，也知道他如何投入時間幫助他使衛生系統更好地為我們有幸服務的所有人服務。

He would dive in with passion and caring to find solutions to improve experiences, whether for an individual consumer, an employer, or a public health agency.

他會充滿熱情和關心地致力於尋找改善體驗的解決方案，無論是針對個人消費者、雇主或公共衛生機構。

Right now, there are 400,000 nurses, doctors, case workers, customer service specialists, pharmacists, technologists, and so many others in this organization who share that commitment and are determined to advance that work.

目前，該組織中有 40 萬名護士、醫生、個案工作者、客戶服務專家、藥劑師、技術人員以及許多其他人員，他們都懷有同樣的承諾，並決心推進這項工作。

The task in front of us, all of us -- healthcare providers, payers, employers, drug companies, and policy makers -- is to continue improving quality and health outcomes for individuals and their families while lowering costs for everyone.

我們所有人——醫療保健提供者、付款人、雇主、製藥公司和政策制定者——面臨的任務是繼續改善個人及其家庭的品質和健康結果，同時降低每個人的成本。

(technical difficulty) of healthcare in America and address the areas we can make work better.

（技術難題）美國醫療保健的問題，並解決我們可以改善工作的領域。

Among those strengths, world-leading innovation, the US has developed the most advanced clinical approaches and patient-centric care at a pace not seen anywhere else.

在這些優勢中，世界領先的創新，美國以其他地方前所未見的速度開發了最先進的臨床方法和以患者為中心的護理。

It's why, if provided with the option, people from all over the world come here to seek care for the most complex conditions.

這就是為什麼，如果有選擇的話，世界各地的人們都會來到這裡尋求最複雜的疾病照護。

Yet the health system needs to function better.

然而衛生系統需要更好地運作。

Through decades of federal and state policy making and private sector innovation, we have a variety of programs, structures, and processes.

經過數十年的聯邦和州政策制定以及私營部門創新，我們擁有各種計劃、結構和流程。

There are strong merits to that variety as they can be more tailored to meet the specific needs of individuals at various stages of life and health status and provide extra help for those who need it.

這種多樣性有很大的優點，因為它們可以更加量身定制，以滿足個人在不同生命階段和健康狀況的特定需求，並為有需要的人提供額外的幫助。

It avoids a one-size-fits-all approach, but it needs to be less confusing, less complex, and less costly.

它避免了一種一刀切的方法，但需要減少混亂、減少複雜性和降低成本。

America faces the same fundamental healthcare dynamic as the rest of the world.

美國面臨著與世界其他地區相同的基本醫療保健動態。

The resources available to pay for healthcare are limited, while demand for healthcare is unlimited.

可用於支付醫療保健費用的資源是有限的，而對醫療保健的需求是無限的。

Every society wrestles with that issue and approaches it in various ways.

每個社會都在努力解決這個問題，並以各種方式處理它。

We have incredible opportunities here to improve system performance, both from a care and a cost perspective, while building upon the foundational strengths I just mentioned.

從維護和成本的角度來看，我們在這裡擁有令人難以置信的機會來提高系統效能，同時建立我剛才提到的基礎優勢。

The mission of this company, why we exist, is to improve this system for everybody and help people live healthier lives.

這家公司的使命，也是我們存在的原因，是為每個人改進這個系統，幫助人們過更健康的生活。

That means getting more people into high-quality, value-based care and keeping them healthy in the first place so fewer Americans find themselves with a chronic and, in many cases, preventable disease.

這意味著讓更多的人獲得高品質、基於價值的護理，並首先保持他們的健康，這樣就會減少美國人發現自己患有慢性疾病，並且在許多情況下是可以預防的疾病。

It means continuing to invest in programs like Medicare Advantage, which, by providing coordinated care to seniors, is proven to deliver better health outcomes at lower cost to consumers and taxpayers compared to fee-for-service Medicare.

這意味著繼續投資醫療保險優勢等計劃，事實證明，與按服務收費的醫療保險相比，該計劃通過為老年人提供協調一致的護理，能夠以更低的成本為消費者和納稅人帶來更好的健康結果。

Seniors recognize that value, which is why the majority of them choose Medicare Advantage.

老年人認識到這一價值，這就是大多數人選擇 Medicare Advantage 的原因。

It means making healthcare easier to navigate.

這意味著讓醫療保健更容易導航。

We're enhancing digital tools for consumers, harnessing data, and using AI so they can find the best value care option and decide what is best for themselves and their families.

我們正在為消費者增強數位工具，利用數據和人工智慧，以便他們能夠找到最有價值的護理選擇，並決定什麼最適合自己和家人。

People's health interactions should be as intuitive and seamless as every other aspect of their lives: banking, shopping, streaming.

人們的健康互動應該像他們生活的其他方面一樣直觀和無縫：銀行、購物、串流媒體。

This past year, we saw an extraordinary increase in the use of these modern channels.

去年，我們看到這些現代管道的使用量顯著增加。

We know there is still a large gap there, and we intend to keep at it until it is closed.

我們知道那裡仍然存在很大的差距，我們打算堅持下去，直到縮小差距。

It means making coverage and cost easier to understand.

這意味著讓覆蓋範圍和成本更容易理解。

Just one example where we already have advanced plans, we're eager to work with policy leaders to use standardization and technology to speed up turnaround times for approval of procedures and services for Medicare Advantage patients, and to materially reduce the overall number of prior authorizations used for certain MA services.

僅舉一個例子，我們已經制定了先進的計劃，我們渴望與政策領導者合作，利用標準化和技術來加快為 Medicare Advantage 患者批准程序和服務的周轉時間，並大幅減少事先授權的總數用於某些MA 服務。

Some of this work we can do on our own, and we're doing it, but we're encouraged also by industry and policy-maker interest in solving for this particular friction across the whole system.

其中一些工作我們可以自己完成，而且我們正在這樣做，但我們也受到產業和政策制定者對解決整個系統中這種特殊摩擦的興趣的鼓勵。

Ultimately, improving healthcare means addressing the root cause of healthcare costs.

最終，改善醫療保健意味著解決醫療保健成本的根本原因。

Fundamentally, healthcare costs more in the US because the price of a single procedure, visit, or prescription is higher here than it is in other countries.

從根本上來說，美國的醫療保健費用更高，因為單次手術、就診或處方的價格比其他國家更高。

The core fact is that price, more than utilization, drives system costs higher.

核心事實是，價格（而不是利用率）會導致系統成本更高。

Tackling that problem will require all parts of the system and policy makers to come together.

解決這個問題需要係統的所有部分和政策制定者齊心協力。

Lower-cost equivalent quality sites of service, for example, can be good for consumers and patients, but threaten revenue streams for organizations that depend on charging more for care.

例如，成本較低、同等品質的服務網站可能對消費者和患者有利，但會威脅到依賴收取更多照護費用的組織的收入來源。

Another example is the persistently high cost of drugs in the US, leaving American consumers, employers, and public agencies to pay disproportionately more than people in other countries.

另一個例子是美國的藥品成本持續居高不下，導緻美國消費者、雇主和公共機構支付的費用比其他國家的人高得多。

Just look at GLP-1 prices.

只要看看 GLP-1 的價格就知道了。

One drug, which costs $900 in the US, costs about a tenth of that in Europe.

一種藥物在美國的售價為 900 美元，約為歐洲的十分之一。

Pharmacy benefit managers play a vital role in holding those prices down, which is why drug companies and their allies have spent the past several years attacking them.

藥品福利管理者在壓低價格方面發揮著至關重要的作用，這就是製藥公司及其盟友在過去幾年裡攻擊他們的原因。

Optum Rx alone delivers many tens of billions of dollars in savings annually versus the pricing set by the manufacturers, including on the GLP-1s.

與製造商（包括 GLP-1）設定的定價相比，僅 Optum Rx 每年就能節省數百億美元。

That sharply reduces the gap versus other countries, but even then, prices in the US are still multiples of what the rest of the world pays for the same drugs.

這大大縮小了與其他國家的差距，但即便如此，美國的價格仍然是世界其他國家為相同藥物支付的價格的數倍。

Last year, our PBM passed through more than 98% of the rebate discounts we negotiated with drug companies to our clients.

去年，我們的 PBM 將與製藥公司談判的 98% 以上的回扣折扣傳遞給了客戶。

While we offer customers 100% pass-through options, a small number have historically elected other models.

雖然我們為客戶提供 100% 直通選項，但歷史上有少數人選擇了其他型號。

We're committed to fully phasing out those remaining arrangements so that 100% of rebates will go to customers by 2028 at the latest.

我們致力於完全逐步取消這些剩餘安排，以便最遲在 2028 年將 100% 的折扣返還給客戶。

We will continue to encourage all of our clients to fully pass these savings directly to patients at the point of sale, as we already do for all of the people we serve in our fully insured employer offerings.

我們將繼續鼓勵所有客戶在銷售點將這些節省的費用直接全部轉嫁給患者，就像我們已經為我們在完全保險的雇主產品中服務的所有人員所做的那樣。

This will help make more transparent who is really responsible for drug pricing in this country: the drug companies themselves.

這將有助於讓誰真正負責這個國家的藥品定價：製藥公司本身，變得更加透明。

Healthcare in every country is complex and the solutions are not simple.

每個國家的醫療保健都很複雜，解決方案也不簡單。

But you should expect this company to continue to work at it, finding what is needed, developing solutions, bringing those solutions to scale, making a positive impact on the lives of millions of people.

但你應該期待這家公司繼續努力，找到所需的東西，開發解決方案，擴大這些解決方案，對數百萬人的生活產生積極影響。

We deliver on our commitments to the people -- even in highly challenging periods like 2024, our results bear out that we find a way, even if it's not always how we may have initially envisioned the path.

我們兌現了對人民的承諾——即使在 2024 年這樣極具挑戰性的時期，我們的結果也證明我們找到了一條出路，即使這並不總是我們最初設想的道路。

Among some of the formidable challenges we navigated over the course of the year were the first year of the three-year CMS Medicare rate cuts, the effects of the state-driven Medicaid member redeterminations, and the Change Healthcare cyber-attack.

我們在這一年中應對的一些艱鉅挑戰包括三年期 CMS 醫療保險費率削減的第一年、國家驅動的醫療補助成員重新確定的影響以及 Change Healthcare 網路攻擊。

Our people found a way -- and consumer health outcomes and experiences, focusing on quality and expanding upon our potential to help make the health system work better for everyone.

我們的人民找到了一種方法——以及消費者的健康成果和體驗，專注於品質並擴展我們的潛力，幫助使衛生系統更好地為每個人服務。

We're invigorated by the path ahead.

我們對前面的道路感到振奮。

There are so many areas that can be enhanced, reworked, reengineered, or even scrapped to make the health system work better as we know it needs to.

有許多領域可以加強、改造、重新設計甚至廢棄，以使衛生系統按照我們所知的需求更好地運作。

That is both our responsibility and it's our passion.

這既是我們的責任，也是我們的熱情。

We begin 2025 with a strong outlook for the year as we continue to deliver on our commitments and excel for those we serve in all of our key growth pillars.

2025 年伊始，我們對這一年的前景充滿信心，我們將繼續履行我們的承諾，並在所有關鍵成長支柱中為我們所服務的對象提供卓越服務。

Now, John will walk you through this performance in a little more detail.

現在，約翰將更詳細地引導您完成這次表演。

Thank you, Andrew, and I'll add my deep gratitude for the enormous outpouring of support over the past few weeks.

謝謝你，安德魯，我要對過去幾週的大量支持表示深深的謝意。

Brian helped build this company and forged deep, trusted relationships for over 20 years, and the positive impact he had on people will be felt for years to come. (technical difficulty) 2024 results and our performance expectations for '25, including some of what we had planned to discuss with you in December.

20 多年來，Brian 幫助建立了這家公司，並建立了深厚、值得信賴的關係，他對人們產生的積極影響將在未來幾年內被感受到。 （技術難度）2024 年業績和我們對 25 年的業績預期，包括我們計劃在 12 月與您討論的一些內容。

2024 revenues of over $400 billion and adjusted earnings per share of $20 -- $27.66 were well within the outlook ranges we set out over a year ago.

2024 年營收超過 4,000 億美元，調整後每股收益為 20 至 27.66 美元，完全在我們一年多前設定的前景範圍內。

To be sure, things played out differently than initially anticipated, but it is an enduring trait of this enterprise that we deliver on our commitments to the people we serve, and to you, even amid unforeseen circumstances.

可以肯定的是，事情的發展與最初的預期不同，但即使在不可預見的情況下，我們也會兌現對我們服務的人和對您的承諾，這是這家企業的持久特徵。

Over the course of '24, we undertook initiatives and made investments to strengthen us for the future -- initiatives to improve consumer experience and bring new innovations to market more quickly, strive the most compelling ways to further our mission to help make the health system work better for everyone, and continue to optimize and refine our offerings and business portfolio to enhance future growth potential, whether that meant moving into new opportunities, reconfiguring, or moving out of areas which contribute historically but may no longer be core, all with an eye to unlocking value.

在24 年期間，我們採取了多項舉措並進行了投資，以增強我們的未來能力——改善消費者體驗並更快地將新創新推向市場的舉措，努力以最引人注目的方式進一步推進我們的使命，幫助建立健康系統更好地為每個人工作，並繼續優化和完善我們的產品和業務組合，以增強未來的成長潛力，無論這意味著進入新的機會、重新配置，還是退出歷史上做出貢獻但可能不再是核心的領域，所有這些都需要著眼於釋放價值。

We know you have a number of questions that we were not able to discuss last month.

我們知道您有很多我們上個月無法討論的問題。

So today, I'll start by stepping through a couple you have indicated are top of mind.

因此，今天，我將首先介紹您指出的最重要的幾個問題。

The first one is why our '24 medical care ratio was 150 basis points above our original outlook.

第一個是為什麼我們的 24 年醫療保健比率比我們最初的預期高出 150 個基點。

It's important to frame up the challenges of '24 to offer some perspectives on the commitment and response of our people.

重要的是要明確 24 世紀的挑戰，以便就我們人民的承諾和反應提供一些觀點。

Compared to the midpoint of the care ratio range we stepped out with over a year ago, that alone created a nearly $5 billion gap we needed to overcome.

與我們一年多前製定的護理比率範圍的中位數相比，僅此一點就造成了我們需要克服的近 50 億美元的缺口。

And that's before we get to the nearly $1 billion in business disruption impact due to the cyber-attack.

這還不算網路攻擊造成的近 10 億美元的業務中斷影響。

So we start with about $6 billion in unanticipated impacts, just from these two examples, in addition to managing through the already known multi-billion dollar impact of the Medicare rate cuts, as we sought to preserve as much benefit stability for seniors as possible.

因此，僅從這兩個例子來看，我們就從約60 億美元的意外影響開始，除了應對醫療保險降息帶來的已知的數十億美元影響之外，我們還力求盡可能保持老年人福利的穩定性。

Regarding the elements impacting our '24 care ratio, we've spoken about the key factors on prior earnings calls, so no surprises here.

關於影響我們 24 小時照護率的因素，我們已經在之前的財報電話會議上討論過關鍵因素，所以這裡並不奇怪。

The first comprise about 70% of the total impact and are comparable in magnitude to each other.

第一個影響約佔總影響的 70%，且彼此的影響程度相當。

First, the mix of people served.

首先，服務人員的組合。

We ended up with a different profile of consumer than expected.

我們最終得到的消費者概況與預期不同。

This is because of one factor; we didn't grow as anticipated due to the unusual Medicare Advantage benefit designs in the marketplace in '24.

這是因為一個因素；由於 24 年市場上不尋常的 Medicare Advantage 福利設計，我們沒有如預期成長。

Next, the timing mismatch between the health status of the remaining people being served by Medicaid and the lagging state rate updates.

接下來，醫療補助所服務的剩餘人員的健康狀況與滯後的州費率更新之間的時間不符。

Then, there were the costs related to the cyber-attack and our South America business impacts.

然後，還有與網路攻擊和我們南美業務影響相關的成本。

The remaining two elements comprise about 30% of the impact and are evenly split.

其餘兩個因素約佔影響的 30%，各佔一半。

These include a more rapid than expected acceleration in the prescribing of certain high-cost medications as drug companies took early advantage of the Inflation Reduction Act and an aggressive upshift in hospital coding intensity.

其中包括，由於製藥公司早期利用了《通貨膨脹減少法案》，某些高成本藥物的處方速度比預期更快，以及醫院編碼強度的大幅提高。

Those are the '24 care ratio elements.

這些是 '24 護理比率要素。

Next question.

下一個問題。

Given all that, are we confident in the adequacy of our pricing for '25?

考慮到所有這些，我們對 25 年的定價是否足夠有信心？

The answer is yes, and here's why.

答案是肯定的，原因如下。

To start for '25, the outlook we shared in December incorporates a view of care activity commensurate with what we saw in '24, even the care activity we experienced as we exited the year.

從 25 年開始，我們在 12 月分享的前景納入了與我們在 24 年看到的護理活動一致的觀點，甚至是我們在今年結束時經歷的護理活動。

I'll break that down with some business line perspectives.

我將從一些業務線的角度對此進行分解。

In Medicaid, we see the gap between people's health status and state rates narrowing over the course of the year.

在醫療補助中，我們看到人們的健康狀況與州費率之間的差距在這一年中不斷縮小。

Our outlook assumes a measured pacing of that process.

我們的展望假設該過程的節奏是有節奏的。

Actions to date, including the important January 1 renewal cycle, support this view.

迄今為止的行動，包括重要的 1 月 1 日更新周期，支持了這一觀點。

In commercial, pricing for '25 is appropriately capturing the care activity we are seeing.

在商業領域，25 年的定價恰當地反映了我們所看到的護理活動。

This is evidenced by growth heavily weighted toward self-funded offerings.

自籌資金產品的成長嚴重偏重就證明了這一點。

We will continue our disciplined approach.

我們將繼續採取嚴格的紀律。

In Medicare, we had strong AEP results, which included winning back people we had served previously and near-record retention.

在醫療保險方面，我們取得了強勁的 AEP 成果，其中包括贏回了我們之前服務過的人員以及接近創紀錄的保留率。

These are a direct result of our long history

這些都是我們悠久歷史的直接結果

(technical difficulty)

（技術難度）

With strong retention and the many returning consumers, we start the year with highly informed insights into the care needs of the people we will be serving.

憑藉強大的保留率和眾多回頭客，我們在新的一年開始時對我們將服務的人們的護理需求進行了深入的了解。

In addition, this year, we have seen a notable uptake of our more managed offerings, think HMO style, which provide strong value for consumers, effective care tools for doctors, and more predictable performance.

此外，今年，我們還看到我們的更多管理產品（例如HMO 風格）的顯著採用，這些產品為消費者提供了強大的價值，為醫生提供了有效的護理工具，並提供了更可預測的績效。

We expect a '25 full-year medical care ratio of 86.5%, plus or minus 50 basis points, 100 basis points above the '24 result.

我們預期「25」全年醫療保健比率為86.5%，正負50個基點，比「24」結果高出100個基點。

In addition to factors discussed earlier, the increase is driven by IRA impacts, the second year of the Medicare funding cuts, a continued mixed shift toward public sector offerings, and a respectful view of care activity.

除了前面討論的因素外，這一增長還受到 IRA 影響、醫療保險資金第二年削減、向公共部門提供的持續混合轉變以及對護理活動的尊重等因素推動。

Our '24 operating cost ratio improved about 150 basis points over the prior year.

我們的 24 年營運成本率比前一年提高了約 150 個基點。

Roughly half of the change was driven by contributions from the business portfolio initiatives mentioned earlier.

大約一半的變化是由前面提到的業務組合計劃的貢獻所推動的。

The other half was due to accelerating our efforts to realize operating efficiencies, even as we improve consumer experiences.

另一半是由於我們在改善消費者體驗的同時加快了實現營運效率的努力。

Some of these advances are a result of the very early stage impacts we are beginning to realize from AI-driven initiatives to help our customer service representatives respond to consumers' needs more effectively and quickly.

其中一些進展是我們開始意識到人工智慧驅動計畫的早期影響的結果，這些計畫旨在幫助我們的客戶服務代表更有效、更快速地回應消費者的需求。

And we see continuing opportunities, both in the near term, with operating costs for '25 improving still further and well beyond, given the rapidly expanding scope and impact of these initiatives.

鑑於這些措施的範圍和影響迅速擴大，我們在短期內看到了持續的機會，'25 的營運成本進一步改善。

These actions and the resourcefulness of our people helped deliver upon the objectives set out over one year ago and helped to partially balance the multiple billions of unanticipated impacts.

這些行動和我們人民的足智多謀幫助實現了一年多前設定的目標，並幫助部分平衡了數十億的意外影響。

With that, I'll run through our businesses, offering some key points for each, starting with Optum Health, where revenues grew to about $105 billion in '24 and are expected to approach $117 billion in '25.

接下來，我將介紹我們的業務，為每個業務提供一些要點，從 Optum Health 開始，該公司的收入在 24 年增長到約 1050 億美元，預計在 25 年將接近 1170 億美元。

Our care delivery business continues to deepen its presence in existing areas, while expanding into new geographies and services.

我們的護理服務業務繼續深化在現有領域的業務，同時擴展到新的地區和服務。

In '25, we expect Optum Health will serve about 5.4 million value-based care patients, growth of 650,000 over '24.

25 年，我們預計 Optum Health 將為約 540 萬基於價值的護理患者提供服務，比 24 年增加 65 萬。

While our current position provides a solid footing, it's a small fraction of the hundreds of millions of patients who can ultimately benefit from value-based care.

雖然我們目前的地位奠定了堅實的基礎，但它只是最終能夠從基於價值的護理中受益的數億患者的一小部分。

We see value-based care as foundational.

我們將基於價值的護理視為基礎。

It is perhaps the fullest expression of our mission.

這也許是我們使命的最充分體現。

As Andrew noted, the outdated, activities-based fee-for-service system won't help the health system work better for people.

正如安德魯所指出的那樣，過時的、基於活動的按服務收費制度無助於衛生系統更好地為人們服務。

Value-based care is outcomes-based, aligning processes, actions, and incentives, helping keep people healthy in the first place, rather than just seeing them when they are sick.

基於價值的照護以結果為基礎，協調流程、行動和激勵措施，首先幫助人們保持健康，而不僅僅是在他們生病時去看望他們。

Optum Health is an integrated, multi-payer care delivery company, helping to lead the transition to a truly sustainable value-based care system.

Optum Health 是一家綜合性多支付者護理服務公司，幫助引領向真正可持續的基於價值的護理系統的過渡。

As we move into '25, we will continue to enhance access and care integration through the home, a much-needed area to help people with their health.

進入 25 世紀，我們將繼續透過家庭加強獲取和照護一體化，這是幫助人們健康的急需領域。

More than three-quarters of our in-home patient visits result in a primary care visit within 90 days.

我們超過四分之三的家庭病患就診會在 90 天內進行初級保健就診。

Medicare Advantage patients with chronic conditions who receive a home care visit have a lower rate of ER visits, fewer inpatient stays, stronger health outcomes, and a better experience, all while saving the health system billions.

接受家庭護理就診的 Medicare Advantage 慢性病患者的急診就診率較低，住院時間較少，健康結果更好，體驗更好，同時為衛生系統節省了數十億美元。

Turning to Optum Rx, revenues in '24 grew to over $130 billion and will be about $146 billion in '25.

至於 Optum Rx，24 年的營收成長到超過 1,300 億美元，25 年將達到約 1,460 億美元。

Our pharmacy benefits management team, again, had customer retention exceeding 98% while welcoming a record 750 new clients, further proof of the value sophisticators, employers, health plans, and labor unions see in Optum Rx's ability to negotiate lower drug prices for consumers.

我們的藥品福利管理團隊的客戶保留率再次超過98%，同時迎來了創紀錄的750 名新客戶，這進一步證明了專家、雇主、健康計劃和工會認為Optum Rx 為消費者談判降低藥品價格的能力的價值。

Optum Rx's pharmacy care services support the entire system in the delivery of clinically-driven pharmacy care, serving the highest need and hardest-to-reach patients.

Optum Rx 的藥房護理服務支援整個系統提供臨床驅動的藥房護理，為最需要和最難接觸到的患者提供服務。

These offerings include community pharmacies, specialty and infusion drug services, all large, strongly growing areas with our current presence quite small.

這些服務包括社區藥局、專業和輸液藥物服務，所有這些都是大型且成長強勁的領域，而我們目前的業務規模相當小。

Optum Insight revenues were $19 billion in '24 and, in '25, will approach $22 billion, with a backlog of $35 billion as sales of new products begin to take hold and the customer clearinghouse business continues to rebuild.

Optum Insight 2024 年的營收為 190 億美元，25 年將接近 220 億美元，隨著新產品的銷售開始佔據主導地位以及客戶清算所業務的繼續重建，積壓的金額將達到 350 億美元。

The solutions offered through Optum Insight and our health technology growth pillar delivered at scale will improve consumer experience and payment and claims flows, enable access to the next best action guidance in a doctor's workflow, and help life sciences customers more rapidly bring innovations to market.

透過Optum Insight 提供的解決方案以及我們大規模交付的健康技術成長支柱將改善消費者體驗以及支付和索賠流程，使醫生能夠在工作流程中獲得下一個最佳行動指南，並幫助生命科學客戶更快地將創新推向市場。

Shifting to UnitedHealthcare, full-year revenues in '24 approached $300 billion and, for '25, will approach $340 billion as we grow to serve upwards of an additional 1.9 million people balanced across both the commercial and public sectors.

轉向 UnitedHealthcare，24 年全年收入接近 3000 億美元，25 年將接近 3400 億美元，因為我們的業務不斷增長，為商業和公共部門中超過 190 萬人提供服務。

Within our domestic commercial offerings, we grew to serve 2.4 million more people in '24 and expect to continue to grow strongly in '25, especially in our self-funded offerings, which serve some of the most sophisticated buyers of healthcare, large employers.

在我們的國內商業產品中，我們在24 年為240 萬人提供了服務，並預計在25 年繼續強勁增長，特別是在我們的自籌資金產品中，這些產品為一些最成熟的醫療保健買家、大型雇主提供服務。

The fact that so many more people are choosing UnitedHealthcare is a direct result of our bringing much-needed innovation to these more mature markets through consumer-centric offerings.

事實上，越來越多的人選擇聯合醫療保健，是我們透過以消費者為中心的產品為這些更成熟的市場帶來急需的創新的直接結果。

As noted earlier, UnitedHealthcare's '24 Medicare Advantage growth was impacted by the unusual benefit designs in the market.

如前所述，UnitedHealthcare 的 24 Medicare Advantage 成長受到市場上不尋常的福利設計的影響。

Our focus has always been on providing consumer stability and sustainable value, a factor that has built confidence and trust over the long term.

我們的重點始終是為消費者提供穩定和可持續的價值，這是長期建立信心和信任的因素。

As a result, in '25, we expect growth of up to 800,000 people in individual, group, and special needs offerings.

因此，我們預計 25 年個人、團體和特殊需求服務的人數將增加至 80 萬人。

And the growth outlook for the years ahead remains strong, with nearly half of American seniors still in outdated Medicare fee-for-service offerings, which provide less value to them and cost taxpayers more.

未來幾年的成長前景仍然強勁，近一半的美國老年人仍在使用過時的醫療保險按服務收費產品，這些產品為他們提供的價值更少，納稅人的成本更高。

In Medicaid, we expect to serve more people in '25, with redetermination activities now concluded.

在醫療補助計劃中，我們預計在 25 年為更多的人提供服務，重新確定活動現已結束。

UnitedHealthcare's value proposition is resonating with state customers, consumers, and provider partners, and we are participating in a substantial number of expansion proposals.

聯合醫療保健的價值主張引起了州客戶、消費者和提供者合作夥伴的共鳴，我們正在參與大量的擴張提案。

Most recently, we were honored to have been awarded a new opportunity in Georgia.

最近，我們很榮幸在喬治亞州獲得了一個新的機會。

Our growing businesses support and are supported by substantial financial capacities and a strong balance sheet.

我們不斷發展的業務支持並得到強大的財務能力和強大的資產負債表的支持。

In '24, we deployed nearly $17 billion in growth capital to help build for the future, further strengthening our capabilities to serve more people more comprehensively.

2024 年，我們部署了近 170 億美元的成長資本來幫助建立未來，進一步增強我們為更多人提供更全面服務的能力。

We also returned over $16 billion to shareholders through dividends and share repurchase.

我們也透過股利和股票回購向股東返還超過 160 億美元。

In '25, we expect cash flow from operations will approach $33 billion, or 1.2 times net income.

25 年，我們預計營運現金流將接近 330 億美元，即淨利潤的 1.2 倍。

We will continue to deploy growth capital and remain committed to returning to shareholders, as outlined in December.

正如 12 月所概述的那樣，我們將繼續部署成長資本，並繼續致力於回報股東。

Our growth capital deployment efforts deliver their greatest benefits over the course of two, four, or even six years, and as new capabilities are scaled and deployed across the enterprise and beyond.

隨著新功能在整個企業內外的擴展和部署，我們的成長資本部署工作將在兩年、四年甚至六年內發揮最大效益。

To summarize, our strong start to the year reinforces the growth objectives we shared last month and is underpinned by the broad growth drivers, operational excellence, and strategic capital deployment you have come to expect from us.

總而言之，我們今年的強勁開局強化了我們上個月分享的成長目標，並得到了您對我們的期望的廣泛成長動力、卓越營運和策略資本部署的支持。

Now, I'll turn it back to Andrew.

現在，我將把它轉回給安德魯。

John, thank you.

約翰，謝謝你。

The strength of this organization lies in the resilience of our people and the fundamental belief that there is no higher calling than helping other people and nothing more vital to the human condition than health care.

組織的優勢在於我們人民的韌性和基本信念：沒有什麼比幫助他人更高的使命，也沒有什麼比醫療保健對人類狀況更重要。

Looking ahead to 2025 and beyond, we're confident in our ability to continue to add value to the health system through our focus on value-based care and consumer-orientated efforts to help build the health system America deserves.

展望 2025 年及以後，我們有信心透過專注於基於價值的照護和以消費者為導向的努力，繼續為醫療系統增加價值，幫助建立美國應得的醫療系統。

That's also why we remain solidly committed to our long-term 13% to 16% growth objective, a goal that reflects both the opportunities and the capabilities that we have.

這也是我們堅定致力於實現 13% 至 16% 的長期成長目標的原因，這一目標既反映了我們所擁有的機遇，也反映了我們的能力。

And now, operator, we'll open it up for questions.

現在，接線員，我們將開放提問。

(Operator Instructions) A.J. Rice, UBS.

（操作員說明）A.J.賴斯，瑞銀。

Hello, everybody, and I appreciate the words about Brian.

大家好，我很欣賞關於布萊恩的話。

He's missed by all of us.

我們大家都很想念他。

Just maybe to focus in on the comments about cost trends and the MLR.

也許只是關注成本趨勢和 MLR 的評論。

Obviously, in the fourth quarter, there's variance relative to consensus expectations.

顯然，第四季的情況與普遍預期有差異。

It was probably a little greater than what we thought.

它可能比我們想像的要大一些。

It sounds like the cost items you're calling out are similar to the things you had seen all year long.

聽起來你所說的成本項目與你全年看到的東西相似。

Was there anything that changed in the intensity of any of those trends and anything -- any unusual items in there that impacted the results?

這些趨勢的強度是否發生了任何變化——其中是否有任何不尋常的因素影響了結果？

And it sounds like you're still confident in your '25 MLR outlook, so the nothing you saw in the fourth quarter changes your view on '25?

聽起來您對 '25 MLR 前景仍然充滿信心，所以您在第四季度看到的任何情況都沒有改變您對 '25 的看法？

(technical difficulty) to obviously go much deeper in response to your question, but just to the last part of your question, yeah, you're totally right.

（技術難度）顯然要更深入地回答你的問題，但只是到你問題的最後一部分，是的，你是完全正確的。

Nothing we saw there that changes our view of '25.

我們在那裡看到的一切都沒有改變我們對 25 的看法。

We feel very good about how we priced into '25.

我們對 25 年的定價方式感到非常滿意。

We feel really, really good about how the mix has come in in terms of that growth.

我們對這種組合在成長方面的表現感到非常非常滿意。

That's a huge difference to '24, and we really didn't see anything in Q4 that we believe represents a challenge to that view going to '25, but I'd love John to go deeper for you on the Q. Thanks.

這與 24 年有很大的不同，我們在第四季度確實沒有看到任何我們認為對 25 年的觀點構成挑戰的內容，但我希望約翰能在問題上為您進行更深入的探討。

Good morning, A.J. So a few things on this.

早安，A.J.關於這一點有幾點。

So in terms of the items that we'd called out on the third-quarter call, so hospital coding intensity and the specially prescribing trends that we were seeing, very much in line with what we saw in the third quarter in terms of that ran into the fourth quarter.

因此，就我們在第三季電話會議上提出的項目而言，醫院編碼強度和我們看到的特殊處方趨勢，與我們在第三季度看到的運作情況非常一致進入第四季度。

So in line with the view on that, we weren't seeing acceleration in that.

因此，與對此的看法一致，我們沒有看到這方面的加速。

We're seeing stabilization in those trends, I would tell you, at the levels we saw before, and we expect that to continue, that specially prescribing those trends were something we anticipated in our '25 outlook.

我想告訴你，我們看到這些趨勢趨於穩定，達到我們之前看到的水平，並且我們預計這種情況會持續下去，特別規定這些趨勢是我們在 25 年展望中所預期的。

And as we had noted it back in the third quarter, that was something that just moved faster in '24 than we expected.

正如我們在第三季指出的那樣，24 年的發展速度比我們預期的要快。

But in terms of the levels we're seeing and how we anticipated that in our '25, we feel very good about that.

但就我們所看到的水平以及我們對 25 年的預期而言，我們對此感覺非常好。

Those coding intensity levels staying at the levels that we thought that we had seen also, and then the other elements that we talked to, mixed kind of important element in terms of the improvement we see as we move into '25 and those elements.

這些編碼強度水平保持在我們認為我們也看到的水平，然後我們談到的其他元素，混合了我們在進入 25 和這些元素時看到的改進方面的重要元素。

For the call out kind of things in the 4Q, a couple of things I'd say.

對於第四季度的呼籲之類的事情，我想說幾件事。

So first of all, the move, mostly driven by seasonality -- typical seasonality, you see normal deductible wear off, those elements.

首先，這項措施主要是由季節性驅動的——典型的季節性，你會看到正常的免賠額磨損，這些因素。

A move sequentially that was similar in terms of the basis point move that we saw a year ago, also, 3Q to 4Q and that, but I'd call out a couple of things, A.J., to your point here.

這一連續的走勢與我們一年前看到的基點走勢類似，從第三季度到第四季度等等，但我想針對您的觀點指出幾件事，A.J.。

So in the sequential move, I'd call out probably 80 to 90 basis points that I'd put in the revenue effect category here.

因此，在連續的舉措中，我會調出大約 80 到 90 個基點，並將其放入此處的收入影響類別中。

So in that, think about some elements that might have been coming in, such as group MA refunds and elements there where our performance, which was strong over the course of the year and those hitting in the quarter, just some elements like that, that I'd put in the non-recurring, non-run rate revenue category in terms of impacts.

因此，考慮一下可能會出現的一些因素，例如集團 MA 退款以及我們的表現在這一年中表現強勁以及在本季度表現強勁的因素，只是類似的一些因素，就影響而言，我將其歸入非經常性、非運轉率收入類別。

And that was probably about 80 to 90 basis points of the impact 3Q to 4Q.

這可能是第三季到第四季影響的大約 80 到 90 個基點。

The flu RSV impact, that typical seasonal, that was kind of a, I'd say in the quarter, 50 to 60 basis points.

流感 RSV 的影響，即典型的季節性影響，我想說，在本季度，影響是 50 到 60 個基點。

That's kind of a normal move.

這是一個正常的舉動。

And then think of the rest of that move being in the zone of pretty much expected seasonal impact.

然後想想這項措施的其餘部分幾乎處於預期的季節性影響範圍內。

So the one element I'd call out there is the revenue effects that probably would be -- would probably be having some impact.

因此，我要指出的一個因素是收入影響，這可能會產生一些影響。

Thank you.

謝謝。

Great.

偉大的。

Thanks so much, John.

非常感謝，約翰。

And thanks again, A.J., for your question.

再次感謝 A.J. 的提問。

Next question, please.

請下一個問題。

Josh Raskin, Nephron.

喬許‧拉斯金，《尼弗龍》。

Hi.

你好。

Thanks.

謝謝。

A question on the Optum Health segment.

關於 Optum Health 部分的問題。

I guess, and I apologize if I missed this, but did you comment on the change in the consumers?

我想，如果我錯過了這一點，我很抱歉，但是你對消費者的變化發表評論了嗎？

I know you talked about portfolio changes and things like that, but the consumer count dropped about 4 million and then sort of a noticeable drop in margins.

我知道您談到了投資組合變化之類的事情，但消費者數量下降了約 400 萬，然後利潤率也明顯下降。

And I'm wondering if some of that is related to the MA rebates that you just mentioned in terms of the impact on the UHC side as well.

我想知道其中一些是否與您剛才提到的 MA 回扣有關，對全民健康覆蓋方面的影響也有關。

Yeah.

是的。

Josh, thanks so much for your question.

喬什，非常感謝你的問題。

Let me ask John to start and then ask Dr. Desai to pick up a few details on that, please.

讓我請約翰開始，然後請德賽博士了解一些相關細節。

Thanks.

謝謝。

Good morning, Josh.

早上好，喬許。

So in terms of the consumer count and impacts on that, so that would go into the category of some of the strategic initiatives that have been ongoing here.

因此，就消費者數量及其影響而言，這將屬於這裡一直在進行的一些策略性舉措的範疇。

So think about some elements where -- that we may have just been -- that we are maybe de-emphasizing in terms of our focus on that.

因此，考慮我們可能剛剛經歷過的一些元素，我們可能在關注這一點方面不再強調它們。

So an area that we deemphasized and that would go in that category is urgent care.

因此，我們不強調但屬於該類別的一個領域是緊急護理。

We're approaching that a bit differently now.

我們現在的處理方式有點不同。

There was a time when kind of standalone urgent care was an important element here.

曾經有一段時間，獨立的緊急護理是這裡的重要因素。

As you start developing more geographic density, however, in a marketplace, you can probably better serve those patients by just having one of your clinics have after hours presence and focus on that.

然而，當您開始在市場中開發更多的地理密度時，您可以透過讓您的診所之一在非工作時間營業並專注於此來更好地為這些患者提供服務。

So one area that we have diminished in terms of emphasis is urgent care, and that's one of the areas we got at.

因此，我們在重點方面減弱的一個領域是緊急護理，這也是我們所關注的領域之一。

So really, those counts were driven by somewhat narrow offerings, typically, that we had been diminishing and that were part of kind of some of the strategic initiatives that we talked about.

所以實際上，這些數量是由一些狹窄的產品驅動的，通常，我們一直在減少，這是我們談論的一些策略舉措的一部分。

In terms of kind of some of the broader margin impacts you're seeing and some of the emphasis and where Optum Health was headed in terms of in the 4Q and where their focus was, I'll turn that to Dr. Amar Desai to comment on.

關於您所看到的一些更廣泛的利潤影響、一些重點以及 Optum Health 在第四季度的發展方向以及他們的重點，我將請 Amar Desai 博士發表評論在。

Thanks, Josh.

謝謝，喬許。

Hi, Josh.

嗨，喬許。

So to take a step back, post-V28, we've been executing on our multiple-year plan to reshape the business, including efforts around direct patient engagement and medical management, as well as integrating our business to deliver on operating cost efficiency.

因此，退一步來說，在 V28 之後，我們一直在執行重塑業務的多年計劃，包括圍繞患者直接參與和醫療管理所做的努力，以及整合我們的業務以提高營運成本效率。

So as we look at the quarter, we took a number of planned actions, including restructuring and refining some of our legacy contracts, which had a one-time impact of the year.

因此，當我們回顧本季時，我們採取了一些計劃行動，包括重組和完善一些遺留合同，這些合同對今年產生了一次性影響。

We had some membership mix changes, which has been noted.

我們已經注意到了一些會員組合的變化。

And then we did make some investments in the quarter around clinical quality and the STARS program, as well as onboarding for new membership coming on for 1/1.

然後，我們確實在本季度圍繞臨床品質和 STARS 計劃以及 1 月 1 日新會員的入職進行了一些投資。

That being said, we feel very good about our position stepping into 2025.

話雖如此，我們對進入 2025 年的情況感到非常滿意。

Our AEP growth was strong.

我們的 AEP 成長強勁。

We've also had very strong retention across our care delivery organizations, again, reflecting the strength of our provider network and the differentiated care they provide.

我們的護理服務組織也擁有非常強大的保留率，這再次反映了我們的提供者網路的實力以及他們提供的差異化護理。

We also have a better understanding of V28 as we're in the second year of it.

由於現在是 V28 的第二年，我們對 V28 也有了更好的了解。

And with this progression, our pair relationships and contracts have evolved into the year.

隨著這種進展，我們的結對關係和合約已經發展到了這一年。

As we step into '25, we're in a more favorable spot.

當我們進入 25 世紀時，我們處於一個更有利的位置。

And then the impact of our engagement efforts in 2024, 85% of our value-based patients were engaged and 90% among our highest-risk patients.

然後，我們在 2024 年進行的參與工作將產生影響，85% 的基於價值的患者參與其中，90% 屬於最高風險患者。

And again, this is best-ever patient engagement for us and is the foundation for the maturation of our value-based cohorts over time.

再說一遍，這對我們來說是有史以來最好的患者參與，也是我們基於價值的群體隨著時間的推移走向成熟的基礎。

So overall, our operating model for Optum Health is stronger.

所以總的來說，我們 Optum Health 的營運模式更加強大。

It's underpinned by significant momentum around these engagement and affordability, as well as operating efficiencies.

它的基礎是圍繞著這些參與度、可負擔性以及營運效率的巨大動力。

And we're confident in delivering against our long-term margin targets.

我們有信心實現長期利潤目標。

Thanks for the question, Josh.

謝謝你的提問，喬許。

Amar, thanks so much.

阿馬爾，非常感謝。

And I'll maybe just finish off that response, Josh, if I might, by really reiterating something you heard me say just a month ago, that even in a very challenging year of 2024, with a lot of changes coming from the outside world in terms of funding reductions and the like from the administration, alongside our commitment to perform, we're also relentless around how we continue to modernize and shape the company for the longer term.

喬希，如果可以的話，我可能會重申一下你一個月前聽到我說的話，以結束這個回答，即使是在 2024 年充滿挑戰的一年，外界也發生了很多變化在政府削減資金等方面，除了我們對績效的承諾之外，我們還堅持不懈地致力於如何繼續實現公司的現代化和長期塑造公司。

And what you heard John just talk about and you just heard Amar refer to really there is, within Optum Health, alongside strengthening our core business, we recognize some parts of that business aren't necessarily as important in the future as they were in the past.

你剛剛聽到約翰談到的，你剛剛聽到阿馬爾提到的，在Optum Health 內部，除了加強我們的核心業務之外，我們認識到該業務的某些部分在未來不一定像在過去那樣重要。

We're not going to shy away from making the choices to ensure that we have real clarity and focus on what we know supports our business and, most importantly, gives us the highest chance of giving the best possible service to patients and members who we serve.

我們不會迴避做出選擇，以確保我們真正清晰並專注於我們所知道的支持我們業務的內容，最重要的是，這使我們有最大的機會為我們所關注的患者和會員提供最好的服務。

And I think during 2024, you saw the organization be very focused not just on the year, but on the shape of how we want the company to develop over the next several years.

我認為在 2024 年期間，您會看到該組織不僅非常關注這一年，而且還關注我們希望公司在未來幾年發展的方式。

And that's really what you're seeing reflected in the commentary that John and Amar just touched on.

這確實是您在約翰和阿馬爾剛剛談到的評論中看到的反映。

Josh, thanks so much for your question.

喬什，非常感謝你的問題。

If we go to the next question.

如果我們進入下一個問題。

Lisa Gill, JPMorgan.

麗莎·吉爾，摩根大通。

Thanks very much for taking my question.

非常感謝您提出我的問題。

Andrew, I want to talk about PBM reform.

安德魯，我想談談 PBM 改革。

There seems to be a very large drumbeat right now that we'll see reform at some point in 2025.

現在似乎有一個非常大的鼓聲，我們將在 2025 年的某個時候看到改革。

Really two things here.

這裡確實有兩件事。

One, what do you think that means to your business?

一，您認為這對您的業務意味著什麼？

And then secondly, you talked about educating those in the marketplace to better understand what you actually bring to the market from a PBM perspective.

其次，您談到如何教育市場中的人員，以便從 PBM 的角度更好地了解您實際上為市場帶來了什麼。

Are there incremental ways that you can potentially maybe educate Congress?

是否有漸進的方式可以教育國會？

Because it seems to be a very big disconnect versus how Congress is viewing this versus what PBMs actually do.

因為這似乎與國會的看法和 PBM 的實際做法有很大的脫節。

Lisa, thanks so much for your question.

麗莎，非常感謝你的問題。

And this is obviously a topic of a lot of people's interest.

這顯然是很多人感興趣的話題。

And that's not surprising because pharmaceutical prices in the US are too high.

這並不奇怪，因為美國的藥品價格太高了。

And I just made that super clear in my comments.

我剛剛在評論中非常明確地表達了這一點。

And it's not the first time you've heard any of us at United make those comments over the last several years.

在過去的幾年裡，這並不是你第一次聽到我們曼聯的任何人發表這些評論。

As you think about that, the issue really is that you have a situation where the PBMs are really the only effective mechanism across the system, which really holds the pharmaceutical company to account once it chooses to set its price and, by the way, also has the freedom to inflate that price every single year, which is what we see happen.

當您思考這一點時，問題實際上是，您面臨的情況是，PBM 實際上是整個系統中唯一有效的機制，一旦製藥公司選擇設定價格，它就真正讓製藥公司承擔責任，順便說一句，每年都可以自由地提高價格，這就是我們所看到的情況。

The PBM is there to try and hold that to account and negotiate on behalf of employers, unions, states, and others to try and bring down those prices.

PBM 的職責是嘗試讓其承擔責任，並代表雇主、工會、州和其他方進行談判，試圖降低這些價格。

But within that, Lisa, is the very first thing that people really need to truly understand.

但其中，麗莎，是人們真正需要真正理解的第一件事。

The PBM acts on behalf of the ultimate payer: the employer, the union, the state, and such.

PBM 代表最終付款人：雇主、工會、國家等。

It acts on their behalf because they're ultimately the ones who are typically underwriting the ultimate cost of the medicine for the patients, the consumers who are beneficiaries of their plans that are supported by those organizations.

它代表他們行事，因為他們最終通常是為患者承擔最終藥品費用的人，消費者是這些組織支持的計劃的受益者。

That is often lost in terms of how this mechanism works.

就該機制的運作方式而言，這一點常常被忽略。

And it's critical to understand it.

理解它至關重要。

What's important, therefore, is that we, and you heard me make a couple of references to this, and I hope alongside others across the sector, really focus on the facts of the situation.

因此，重要的是我們以及您聽到我多次提到這一點，我希望與整個行業的其他人一起真正關注實際情況。

Prices in America are de novo set too high relative to any other price in the world, first off.

首先，相對於世界上任何其他國家的價格而言，美國的價格從頭就定得太高了。

Secondly, they're inflated every year, which is pretty unusual when you compare that to the rest of the world.

其次，它們每年都會膨脹，與世界其他地區相比，這是非常不尋常的。

Thirdly, as we negotiate to bring those prices down, the benefit of that negotiation, those rebates which are achieved, are very significant, are passed back to the employers, unions, and states.

第三，當我們談判降低這些價格時，談判的好處，也就是所實現的回扣，是非常重要的，會回饋給雇主、工會和州。

They choose what to do with those rebates.

他們選擇如何處理這些回扣。

Now, in the case of UnitedHealthcare, where in the population of employer benefits that we manage, where we have essentially control over that decision, we pass those all the way through to the consumer and the patient who receives the drug.

現在，就聯合醫療保健公司而言，在我們管理的雇主福利群體中，我們基本上可以控制該決定，我們將這些決定一直傳遞給消費者和接受藥物的患者。

So they see the benefit of that rebate.

所以他們看到了回扣的好處。

We'd like to see others do the same.

我們希望看到其他人也這樣做。

Within that overall system, there is also opportunity for people to lose a thread of where the money goes in the system.

在整個系統中，人們也有可能不知道錢在系統中的去向。

And that is often what you hear policy makers be concerned about.

這通常是政策制定者所關心的問題。

That is why this morning, we are committing to a full 100% pass-through of all rebates that we negotiate at the PBM back to the payer, the state, or the union.

這就是為什麼今天早上，我們承諾將我們在 PBM 協商的所有回扣全部 100% 返還給付款人、州或工會。

Right now, we already passed 98% of that through.

現在，我們已經通過了 98%。

But unfortunately, even just that small residual that we retain because those clients want to pay us that way is enough to give people the excuse to argue that the system is not working properly.

但不幸的是，即使我們因客戶希望以這種方式向我們付款而保留的一小部分餘額也足以讓人們有藉口辯稱系統無法正常運作。

We're taking that excuse off the table today.

今天我們就不再考慮這個藉口了。

We are committed to full transparency.

我們致力於完全透明。

We are committed to full pass-through to clients.

我們致力於向客戶全面傳遞。

We believe that takes away the excuse of who really is setting the price.

我們認為，這消除了真正定價者的藉口。

And we would like to work with others across the system to relentlessly achieve the lowest net cost for everybody in the system.

我們希望與整個系統中的其他人合作，不懈地為系統中的每個人實現最低的淨成本。

We'd like to see patients see the benefits of that.

我們希望看到患者看到這樣做的好處。

And we'd like to work with anybody who wants to work with us to make it happen.

我們願意與任何願意與我們合作實現這一目標的人合作。

And that's how we're going to engage this year with policy makers and others across the country.

這就是我們今年與全國各地的政策制定者和其他人接觸的方式。

With that, Lisa, thanks so much for the question.

麗莎，非常感謝你的提問。

Let me go to the next question, please.

請讓我進入下一個問題。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Hi.

你好。

Thanks.

謝謝。

Just staying on the policy front, I was wondering if you had any early perspective to share on the Medicare Advantage advance notice for 2026.

就政策而言，我想知道您是否對 2026 年 Medicare Advantage 提前通知有任何早期看法可以分享。

I guess anything you see as encouraging or any potential areas of concern as you progress from advance to final.

我猜想，當你從晉級到決賽時，你認為任何令人鼓舞的事情或任何潛在的擔憂領域都會發生。

And then I guess (technical difficulty) the reimbursement that's embedded in these rates is still not reflective of the elevated cost trend that we saw in 2024, even if taking the step in the right direction.

然後我猜想（技術難度）這些費率中包含的報銷仍然不能反映我們在 2024 年看到的成本上升趨勢，即使朝著正確的方向邁出了一步。

Is that a company perspective that you share?

這是您所認同的公司觀點嗎？

Thank you.

謝謝。

Hey, Stephen.

嘿，史蒂芬。

Thanks so much for the question.

非常感謝你的提問。

I'm going to ask Tim Noel to comment on that, please.

我將請蒂姆·諾埃爾對此發表評論。

Yeah.

是的。

Thanks for the question, Stephen.

謝謝你的提問，史蒂芬。

As you know, these rates are preliminary at this point in time and won't be finalized until April, and so therefore, probably not super productive to start speculating on elements of that.

如您所知，這些利率目前是初步的，要到四月才會最終確定，因此，開始推測其中的要素可能不會非常有效。

I will say we are looking forward very much to engaging the new administration on this item and also a host of other items as it relates to the Medicare Advantage program.

我想說的是，我們非常期待與新政府就這項項目以及與醫療保險優勢計劃相關的許多其他項目進行接觸。

Thanks.

謝謝。

Great.

偉大的。

Thanks so much, Tim.

非常感謝，提姆。

And as you suggest, Stephen, what's most important is that this is all rational.

正如你所建議的，史蒂芬，最重要的是這一切都是理性的。

So it's not difficult to figure out in retrospect what trend was.

所以回想起來，不難看出什麼是趨勢。

And we'd like to hope that over the next few cycles, we see that reflected in a way that it hasn't been over the last several years.

我們希望在接下來的幾個週期中，我們能夠看到這一點以過去幾年從未有過的方式體現。

And that for us is really the important element of what we hope will come, and it's simply just rational.

對我們來說，這確實是我們希望發生的事情的重要因素，而且它只是理性的。

And it's interesting when you look at the states in Medicaid, you see that kind of rational behavior.

有趣的是，當你看看各州的醫療補助計劃時，你會看到這種理性行為。

We've seen that improve.

我們已經看到了這種情況的改善。

We've been super clear that there's been historic offset and lag, if you will, to that.

我們非常清楚，如果你願意的話，存在著歷史性的抵銷和滯後。

That's not surprising.

這並不奇怪。

That can create some discontinuity as we saw this year in '24.

正如我們今年在 24 年所看到的那樣，這可能會造成一些不連續性。

But underneath all of that, we see rational understanding and engagement from the states.

但在這一切的背後，我們看到了各國的理性理解和參與。

We super appreciate that.

我們非常感激。

It's important.

這很重要。

And that's what we want to hope to see return around the MA rate setting in a way that we have not seen over the last several years.

這就是我們希望看到 MA 利率設定以過去幾年未曾見過的方式帶來的回報。

Okay.

好的。

Next question, please.

請下一個問題。

(technical difficulty)

（技術難度）

Thanks.

謝謝。

Good morning.

早安.

I've got a question here.

我在這裡有一個問題。

But first, I wanted to ask a quick follow-up on this Medicare Advantage revenue adjustment.

但首先，我想詢問有關 Medicare Advantage 收入調整的快速後續情況。

Given the MLR for the quarter came in higher than expected, it appears this might have come as a surprise.

鑑於本季的國土資源比率高於預期，這似乎令人意外。

And given that the size of the employer segment, feels like this adjustment's pretty large, like maybe 5% or more of annual revenue.

考慮到雇主細分市場的規模，感覺這種調整相當大，可能佔年收入的 5% 或更多。

So just trying to understand, can you give us more color here?

所以只是想了解一下，你能給我們更多的顏色嗎？

How did the mechanics work?

機械師是如何工作的？

What's going on?

這是怎麼回事？

Maybe you could tell us why this would have been a surprise.

也許你可以告訴我們為什麼這會令人驚訝。

And what periods do they relate to?

它們與哪些時期有關？

Is it all 2024?

都是2024年了嗎？

And then my actual question is more on MA growth.

我的實際問題更多是關於 MA 的成長。

Curious what you saw during AEP, both in terms of what proportion of your 8% growth expectation do you expect to come from AEP.

很好奇你在 AEP 期間看到了什麼，無論是在你預期的 8% 成長預期中，AEP 所佔的比例是多少。

And then, do you still see industry growth at mid-single digits?

那麼，您仍然認為行業成長處於中個位數嗎？

Thanks.

謝謝。

Hey, Justin.

嘿，賈斯汀。

Thanks so much for the question.

非常感謝你的提問。

That was an impressive way of sneaking two in instead of one.

這是一種令人印象深刻的方式，讓兩個人而不是一個人潛入。

I'll let you get away with it just this time.

就這一次我就放過你了。

So John, if you wouldn't mind taking the first part of Justin's good question.

約翰，如果你不介意回答賈斯汀好問題的第一部分的話。

And then I'm going to ask Bobby Hunter to take the second.

然後我會請鮑比·亨特（Bobby Hunter）擔任第二個。

Bobby leads our business in Medicare.

鮑比領導我們的醫療保險業務。

So please go ahead.

所以請繼續。

Justin, good morning.

賈斯汀，早安。

So yeah, in terms of those elements, so MA kind of group customer refunds was one element of it.

是的，就這些要素而言，MA 類型的團體客戶退款就是其中之一。

And certainly, these are -- and there were a few other adjustments running through that were all put in the non-run rate revenue impacts here.

當然，這些都是——還有一些其他的調整，這些調整都被計入了非運行率收入的影響。

In terms of surprise, so perhaps not anticipated a year ago when we set out kind of in terms of our expectation for medical care ratio and revenues and such.

就驚喜而言，也許一年前我們在製定醫療保健比例和收入等方面的預期時沒有預料到。

Not a surprise in terms of where we've been the last while, though, in terms of understanding these things, because as they develop and you see, okay, better performance in certain group MA plans, there's going to be a refund that's given to those employers as we do, as we're performing well.

不過，就我們過去一段時間的情況而言，就理解這些事情而言，這並不奇怪，因為隨著它們的發展，你會看到，好吧，在某些組MA 計劃中表現更好，將會給予退款像我們一樣向那些雇主致敬，因為我們表現良好。

And then some of the other elements, I wouldn't call them surprise certain relative to a year ago.

然後是其他一些因素，相對於一年前，我不會稱它們為意外。

We didn't have those incorporated in our view in terms of relative to months ago.

與幾個月前相比，我們沒有將這些納入我們的觀點。

It would have been something we would have understood in those elements.

這是我們在這些元素中能夠理解的。

And that was one of them.

那就是其中之一。

I was trying to give an example, but there were a few and they totaled up to that 80, 90 basis points, group MA refunds being one of them.

我試著舉一個例子，但有幾個例子，總計達到 80、90 個基點，MA 組退款就是其中之一。

But I wouldn't call it a surprise to where our view has been the last few months here on this.

但我不會對我們過去幾個月對此的看法感到驚訝。

And then I'll go to Tim.

然後我會去找提姆。

No, to Bobby.

不，對鮑比。

Yeah.

是的。

Thanks, John, and thanks, Justin, for the question.

謝謝約翰，也謝謝賈斯汀提出的問題。

So in terms of AEP results, we were very pleased with how things played out for us there, very much aligned to our expectations.

因此，就 AEP 結果而言，我們對那裡的情況非常滿意，非常符合我們的期望。

And it puts us on track to achieve the full-year MA growth target of up to 800,000 that we've communicated.

這使我們有望實現我們所傳達的高達 80 萬的全年 MA 成長目標。

Really important to remember that with the selling changes for 2025, we do expect more than 50% of our full-year growth to come in AEP.

非常重要的是要記住，隨著 2025 年銷售的變化，我們預計全年增長的 50% 以上將來自 AEP。

Also worth noting, this level of growth is not something we're unfamiliar with.

另外值得注意的是，這種增長水平我們並不陌生。

And I'm really proud of our teams and the 1/1 readiness activities we've executed on to ensure a smooth transition for our new and returning customers.

我為我們的團隊和我們為確保新客戶和回頭客順利過渡而執行的 1/1 準備活動感到非常自豪。

Maybe to offer a few highlights on the growth itself, seeing really balanced and diversified growth across our products and our geographies.

也許可以提供一些關於成長本身的亮點，看到我們的產品和地區的真正平衡和多元化的成長。

In particular, some really nice strength within our HMO and full dual plan offerings.

特別是，我們的 HMO 和完整的雙重計劃產品中有一些非常好的優勢。

John also mentioned retention performing at near-record levels, a great testament to the value that we're offering to consumers.

約翰也提到，保留率的表現接近歷史最高水平，這充分證明了我們為消費者提供的價值。

And maybe last, of the members who have left us in prior years, we are seeing about three times as many return to UHC this year as compared to last year.

也許最後，在前幾年離開我們的成員中，我們看到今年返回 UHC 的人數是去年的三倍。

I really view that as a testament to the service models and experiences we offer.

我確實認為這是我們提供的服務模式和體驗的證明。

And folks clearly put a lot of value in that when they're making their decisions.

人們在做出決定時顯然非常重視這一點。

And I'm really proud to see those individuals coming back to us this year.

我很自豪看到這些人今年回到我們身邊。

In terms of the growth rate, we certainly still continue to believe in a long-term growth rate of 7% to 9%.

就成長率而言，我們當然仍繼續相信7%至9%的長期成長率。

Acknowledging that, in certain years, you can see fluctuations based on benefit changes and other factors.

承認在某些年份，您可以看到基於福利變化和其他因素的波動。

Some of that was present in 2024, and similar dynamics will play out here in 2025.

其中一些已在 2024 年出現，類似的動態也將在 2025 年出現。

So we expect '25 to generally pace in line with '24 from a growth standpoint.

因此，從成長的角度來看，我們預計 25 年的成長率將整體與 24 年保持一致。

That said, more confident than ever in the value that MA offers to consumers and the path that we're on for MA to surpass 70% penetration over time.

也就是說，我們比以往任何時候都更相信 MA 為消費者提供的價值，以及我們為 MA 隨著時間的推移滲透率超過 70% 所走的道路。

Bobby, thanks so much.

鮑比，非常感謝。

I just want to acknowledge Bobby personally because over the last couple of years, he's really led the strategizing of how to navigate through the very many external changes which have played out through V28 and the like.

我只是想親自向 Bobby 表示感謝，因為在過去的幾年裡，他確實領導瞭如何應對透過 V28 等發生的許多外部變化的策略制定。

And I think you've always heard us talk about playing a multiyear strategy here.

我想你總是聽到我們談論在這裡實施多年戰略。

And I think that's really come into fruition.

我認為這確實取得了成果。

Bobby owns a ton of the credit associated with that.

鮑比擁有大量與此相關的功勞。

And I'm delighted to see that reflected in the growth performance in the cycle we're in right now that you've just heard described.

我很高興看到這反映在我們現在所處的周期的成長業績中，正如您剛剛聽到的描述。

And it's that mix improvement that you just heard in Bobby's answer which completely differentiates 2025 from 2024 for UnitedHealthcare is super important.

您剛剛在 Bobby 的回答中聽到的混合改進對於 UnitedHealthcare 來說將 2025 年與 2024 年完全區分開來，這一點非常重要。

And all of those elements you just heard described are essentially what makes up that very important mix improvement which we've been aiming for and we feel very, very good about.

您剛剛聽到描述的所有這些元素本質上都是構成非常重要的混音改進的要素，這是我們一直致力於實現的目標，我們對此感覺非常非常好。

Let me go to the next question, please.

請讓我進入下一個問題。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Great.

偉大的。

Thanks so much, and really appreciate your comments at the beginning of the call.

非常感謝，也非常感謝您在通話開始時發表的評論。

Could you talk a little bit about one of the things I think is hanging over long-term investors out there which is levels of customer satisfaction.

您能否談談我認為長期投資者所關心的一個問題，即客戶滿意度水平。

I know that's difficult to measure, but I know NPS and other metrics are things you guys look at.

我知道這很難衡量，但我知道 NPS 和其他指標是你們關注的東西。

Can you talk a little bit about what you perceive to be the major sources of dissatisfaction in those sorts of measures?

您能否談談您認為對此類措施不滿意的主要根源是什麼？

And then, what are some of your strategies and priorities?

那麼，您的策略和優先事項是什麼？

And does it have any impacts on long-term algorithms for the company as far as economic algorithms, growth algorithms, or just where you prioritize your capabilities?

它對公司的長期演算法（經濟演算法、成長演算法或您優先考慮能力的方面）是否有任何影響？

Thanks.

謝謝。

Yeah.

是的。

Hi, Lance.

嗨，蘭斯。

Thanks so much for the question.

非常感謝你的提問。

And I mean, at the core of the company, and if you look at the mission of the company, it's all about trying to improve the health system for everybody.

我的意思是，在公司的核心，如果你看看公司的使命，那就是努力改善每個人的健康系統。

And by that, it means not just reducing the cost of that, making it more affordable, but it's also about trying to make it easier to access, less complex, less confusing.

這不僅意味著降低成本，使其更便宜，而且還意味著努力使其更容易訪問、不那麼複雜、不那麼混亂。

And as I said in my opening comments, we recognize there's still a lot of work to be done in that regard.

正如我在開場白中所說，我們認識到在這方面仍有許多工作要做。

Some of the areas like obviously claims, where people get frustrated about how long it takes for a claim to process or maybe some confusion that goes on in that, those are key areas for us to continue to work hard at to improve.

有些領域，例如明顯的索賠，人們對索賠處理需要多長時間感到沮喪，或者其中可能存在一些困惑，這些是我們繼續努力改進的關鍵領域。

And I can tell you, when you look across claims, less than half of 1% of claims are ultimately rejected for a clinical reason because, for whatever reason, they're not deemed to be a safe or effective treatment option.

我可以告訴你，當你查看索賠時，不到 1% 的索賠最終會因臨床原因被拒絕，因為無論出於何種原因，它們都不被認為是安全或有效的治療選擇。

But we all know there are other claims which get held up in the process before you get to that stage.

但我們都知道，在到達該階段之前，還有其他主張會在過程中受到阻礙。

Now, the overwhelming majority of those claims which are held up are held up because they were either sent to the wrong company, they didn't have the right information on them, the patient didn't have the right benefits, all of those things.

現在，絕大多數被擱置的索賠都被擱置，因為它們要么被發送到錯誤的公司，要么沒有正確的訊息，要么患者沒有正確的福利，所有這些事情。

Now, that could all be dealt with through technology and a more standardized approach across the industry.

現在，這一切都可以透過技術和整個行業更標準化的方法來解決。

And I'm very, very pleased to say that we are experiencing and engaged with a much heightened energy across the organization to solve this across the whole sector for everybody.

我非常非常高興地說，我們整個組織正在經歷並投入更大的精力，為整個行業的每個人解決這個問題。

And in my view, probably 85% or more of all of those claims which end up going to the wrong place and then having to be resubmitted, that could all be avoided with the adoption of real-time processing, a standardized approach, a standardized intake mechanism.

在我看來，可能有 85% 或更多的索賠最終會被發送到錯誤的地方，然後必須重新提交，而這一切都可以透過採用即時處理、標準化方法、標準化方法來避免。

That's a key area for us to focus on.

這是我們需要關注的關鍵領域。

And that -- we've alluded to that.

我們已經提到過這一點。

I mentioned an effort we're very close to around Medicare Advantage Improvement.

我提到了我們非常接近的圍繞醫療保險優勢改進的努力。

That's just one of the first steps.

這只是第一步。

And all of this sits very much in line with the work that Brian, frankly, led over the last several years to really reduce overall activity around PAs and the like.

坦白說，所有這些都與布萊恩在過去幾年中領導的工作非常一致，以真正減少圍繞 PA 等的整體活動。

And the company will continue to do that.

公司將繼續這樣做。

But I just want to emphasize the criticality of collaboration here to try and design something not just for one company, but for all companies, not just for one patient, but for all patients.

但我只是想強調合作的重要性，嘗試設計一些東西，不僅為一家公司，而且為所有公司，不僅為一名患者，而是為所有患者。

That's what we've got to work toward.

這就是我們必須努力的方向。

Really looking forward to opportunities to engage with the administration on this because they can also be an important aid to help catalyze those sorts of changes.

我真的很期待有機會在這方面與政府接觸，因為它們也可以成為促進此類變革的重要幫助。

The second area of consumer improvement opportunity where I believe we really are making great progress is just around that consumer experience.

我相信我們真正取得巨大進步的消費者改善機會的第二個領域就是圍繞著消費者體驗。

So there's no reason in the world why engaging with the healthcare system should feel any different or any less easy than any other engagement you have in your life.

因此，世界上沒有理由認為參與醫療保健系統會比您生活中的任何其他參與感覺有任何不同或不那麼容易。

And that's why we've been focused over the last several years on this move toward a consumer capability for the whole company and that, I really believe, we're making breakthroughs on in terms of how we're operating.

這就是為什麼我們在過去幾年裡一直專注於向整個公司的消費者能力邁進，我真的相信，我們正在運作方式方面取得突破。

If you just look at 1/1 of this year, so January of this year, and you just look at a couple of examples, our UHC mobile app visits were up 66% year over year.

如果你只看今年 1 月 1 日，今年 1 月，你只看幾個例子，我們的 UHC 行動應用程式訪問量比去年同期增長了 66%。

That's another record year of growth.

這又是創紀錄的成長一年。

The UHC app remains the number one healthcare app in the Google and Apple app stores.

UHC 應用程式仍然是 Google 和 Apple 應用程式商店中排名第一的醫療保健應用程式。

Across the whole of UnitedHealthcare, our consumers are choosing to increase their digital engagement with us by about a third a year.

在整個聯合醫療保健公司，我們的消費者選擇每年將他們與我們的數位互動增加約三分之一。

So the app is two-thirds up.

所以該應用程式成長了三分之二。

Everything across the whole of UHC is up by about a third.

整個全民健康覆蓋的一切都增加了約三分之一。

Our app registrations are up nearly 100% year over year.

我們的應用程式註冊量年增近 100%。

This is us moving to where American consumers want to be.

這就是我們正在向美國消費者想要去的地方邁進。

They want to talk to us digitally.

他們想透過數位方式與我們交談。

They want to use their phone to be able to access us.

他們希望使用手機來聯絡我們。

They don't want to make a phone call.

他們不想打電話。

It's been an extraordinary shift.

這是一個非同尋常的轉變。

We continue to work that way through.

我們將繼續這樣努力。

We're able to talk to members now about 10% less every year of our members are making phone calls.

現在，我們能夠與會員通話的人數每年減少約 10%。

They're getting what they need without needing to pick up the phone and make the call.

他們無需拿起電話撥打電話即可獲得所需的東西。

All of those are fantastic metrics.

所有這些都是很棒的指標。

You go to Optum Rx, the other big consumer engagement point, the most common interaction point across American healthcare is in pharmacy.

你可以去 Optum Rx，另一個大型消費者參與點，美國醫療保健中最常見的互動點是藥局。

You look at January 1, you heard already today from John, we enrolled 750 new clients.

你看看 1 月 1 日，今天你已經從約翰那裡聽到，我們註冊了 750 位新客戶。

They represented 1.6 million new American consumers who are now using Optum Rx.

他們代表了 160 萬正在使用 Optum Rx 的美國新消費者。

We're privileged to serve those people.

我們很榮幸能為這些人服務。

We were able to bring them on board at a third less cost than in the prior year.

我們能夠以比前一年低三分之一的成本吸引他們。

That is entirely due to the adoption of digital technology and other modern capabilities.

這完全歸功於數位技術和其他現代能力的採用。

Our digital engagement registrations across Optum Rx themselves are up 16%.

Optum Rx 本身的數位參與註冊量增加了 16%。

Those are all examples of how this company has been investing relentlessly first and foremost to understand what American consumers want and then build it.

這些都是該公司如何堅持不懈地投資的例子，首先也是最重要的是了解美國消費者的需求，然後建構它。

And we are committed to continue to build those capabilities and deliver the very best, most convenient experience possible, not just in the insurance business, but also in the Optum service business led by Optum Rx.

我們致力於繼續建立這些能力，並提供盡可能最好、最便捷的體驗，不僅在保險業務中，而且在 Optum Rx 領導的 Optum 服務業務中。

That's where we're going.

這就是我們要去的地方。

We're committed to this agenda, Lance.

我們致力於這個議程，蘭斯。

We always have been, and you should continue to see us make substantial improvements to make the experience of engaging with the healthcare system easier tomorrow than it was yesterday.

我們一直都是這樣，您應該繼續看到我們做出重大改進，讓明天的醫療保健系統體驗比昨天更輕鬆。

I appreciate the question.

我很欣賞這個問題。

Next question.

下一個問題。

David Windley, Jefferies.

大衛溫德利，傑弗里斯。

Thank you for taking my questions.

感謝您回答我的問題。

And Andrew, thank you.

安德魯，謝謝你。

I want to give you kudos for your emphasis on price.

我想對您對價格的重視表示讚揚。

I feel like that's underappreciated in the United States.

我覺得這在美國沒有被充分重視。

My question is around SG&A.

我的問題是關於SG&A。

If I extract -- if I ignore the portfolio changes, what you might call normal course SG&A improvement, efficiency improvement in '24 was still substantial.

如果我提取——如果我忽略投資組合的變化，你可以稱之為正常的SG&A改進，24年的效率改進仍然是巨大的。

You need another step down in 2025 per your guidance.

根據您的指導，您需要在 2025 年再次降級。

Both of those are significant relative to historical norms.

相對於歷史規範，這兩者都很重要。

Could you talk about the sources of that efficiency, perhaps a nod to AI and some of the technology that you've talked about, but the sources of those savings and the durability of the savings that you're extracting?

您能否談談這種效率的來源，也許是對人工智慧和您談論的一些技術的認可，但這些節省的來源以及您正在提取的節省的持久性？

Thank you.

謝謝。

Yeah.

是的。

David, thanks so much.

大衛，非常感謝。

I'm going to ask John to give you an overview, and then I'm going to ask our Chief Technology Officer to give you a few examples or a little insight into our ambitious, I'm going to call it, modernization agenda of technology because it's not just AI.

我將請約翰為您提供一個概述，然後我將請我們的首席技術官為您提供一些示例或對我們雄心勃勃的現代化議程的一些見解。

It's all of the different aspects.

這是所有不同的方面。

But I think it'd be good for you to hear from Sandeep.

但我認為聽到桑迪普的消息對你來說會有好處。

But John, would you mind starting off?

但是約翰，你介意開始嗎？

Good morning, David.

早安，大衛。

So the source of those savings, along the lines of the commentary that Andrew was offering a few moments ago, led by digital adoption.

因此，這些節省的來源，就像安德魯剛才發表的評論一樣，是由數位化採用帶動的。

So we serve roughly almost 150 million people across the breadth of UnitedHealth Group.

因此，我們為聯合健康集團旗下約 1.5 億人提供服務。

And as we seek to make those experiences smoother, simpler, faster, that's being led by digital adoption.

當我們尋求讓這些體驗變得更順暢、更簡單、更快時，數位化採用將成為主導。

It's being led (technical difficulty) much deeper insight into frustrations or any kind of experience the customer may be having or had so they can get to the root cause much more quickly.

它被引導（技術難度）更深入地洞察客戶可能正在經歷的挫折或任何類型的經歷，以便他們可以更快地找到根本原因。

So you're seeing those elements just accelerate.

所以你會看到這些元素正在加速。

I said it a little bit in my commentary.

我在評論裡說過一點。

It feels very early stage to us in terms of what we're actually doing here.

就我們在這裡實際所做的事情而言，我們感覺還處於非常早期的階段。

As I work with the technology team, Sandeep, and the teams and what they're hitting here, we're just kind of scratching the surface of the opportunity.

當我與技術團隊 Sandeep 以及他們的團隊以及他們在這裡所遇到的問題合作時，我們只是觸及了機會的表面。

So when you ask the important questions about durability, it's super early stage in terms of what we see as the opportunity.

因此，當您提出有關耐用性的重要問題時，就我們所認為的機會而言，現在還處於超級早期階段。

I would tell you what we're doing right now feel like just kind of the initial scratching the surface that we'd be doing in terms of where we believe we can take this and the opportunities that we're seeing.

我想告訴你，我們現在正在做的事情感覺只是我們所做的事情的初步接觸，我們相信我們可以抓住這個機會，並看到我們所看到的機會。

So one of the things we're most excited about as a team, as we sit together and we think about the experience that consumers are going to have, how we're going to be able to make these much smoother, simpler, and satisfying for everyone, including our employees who work with our customers.

因此，作為一個團隊，我們最興奮的事情之一就是，當我們坐在一起思考消費者將獲得的體驗時，我們將如何讓這些體驗變得更加順暢、簡單和令人滿意對於每個人，包括與客戶合作的員工。

And Sandeep, maybe you could offer a few comments.

Sandeep，也許你可以發表一些評論。

Sure.

當然。

Thank you, John.

謝謝你，約翰。

And thanks, David, for the question.

謝謝大衛提出這個問題。

Our AI, digital, automation, and in general, our modernization agenda has focused largely on removing administrative menial tasks in the system and improving consumer experiences.

我們的人工智慧、數位化、自動化，以及整體而言，我們的現代化議程主要集中在消除系統中的行政瑣碎任務和改善消費者體驗。

Some examples earlier that you have noticed has been around our call center efforts.

您之前註意到的一些例子是圍繞我們的呼叫中心工作的。

Andrew just mentioned we received 10% less calls for the same consumer base compared to last year.

Andrew 剛剛提到，與去年相比，針對相同消費者群體，我們接到的電話減少了 10%。

And we haven't even scaled this fully.

我們甚至還沒有完全擴展這個規模。

By the end of 2025, we will be scaling this fully.

到 2025 年底，我們將全面擴展這一規模。

And that's one of hundreds of use cases that we are scaling.

這是我們正在擴展的數百個用例之一。

Last quarter, we talked about clinical summaries for nurses that helps our nurses focus on healthcare.

上個季度，我們討論了護理師的臨床總結，幫助我們的護理師專注於醫療保健。

And that's getting scaled fully.

這正在充分擴展。

As we focus in 2025, we actually are excited about more compelling consumer experiences, helping providers and clinicians with documentations and summaries, and frankly, digitizing all the paperwork in the entire healthcare experience.

當我們聚焦在 2025 年時，我們實際上對更引人注目的消費者體驗感到興奮，幫助提供者和臨床醫生提供文件和摘要，坦白說，將整個醫療保健體驗中的所有文書工作數位化。

Think benefits documents, facilities, provider contracts, helping drive much more automated, seamless, frictionless claims processing as well.

想想福利文件、設施、供應商合同，也有助於推動更自動化、無縫、無摩擦的索賠處理。

So we're excited about the agenda.

所以我們對議程感到興奮。

Thank you.

謝謝。

Sandeep, thanks so much.

桑迪普，非常感謝。

David, I appreciate the question.

大衛，我很欣賞這個問題。

If we could move on to the next question, please.

如果我們可以繼續下一個問題，請。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

(technical difficulty) saw in '24 and that then will have effects on 2025 when thinking about the sequencing of Medicaid margins and MLRs and some of the utilization patterns.

（技術難度）在 24 年看到，在考慮醫療補助利潤和 MLR 的排序以及一些利用模式時，這將對 2025 年產生影響。

If you would help us maybe in thinking about any comments on EPS seasonality that may be different in 2025 relative to '24, and then similarly, MLR sequencing that you're thinking maybe having a bit of a different pattern around that guidance that you gave for the full year.

如果您能幫助我們考慮對 EPS 季節性的任何評論，這些評論在 2025 年可能會與 24 年有所不同，然後類似地，您認為 MLR 排序可能與您提供的指導有一些不同的模式全年。

Thanks.

謝謝。

Scott, thanks so much.

斯科特，非常感謝。

John?

約翰？

Good morning, Scott.

早安，史考特。

So I'd say in terms of seasonality, first half, second half, think of that as relatively balanced in terms of seasonality for earnings progression.

所以我想說，就季節性而言，上半年、下半年，認為獲利進展的季節性相對平衡。

In terms of medical care ratio and thinking about kind of those elements, you start first, of course, with the view that at the midpoint, the full-year care ratio will be 86.5%.

就醫療保健比率以及對這些要素的思考而言，當然，您首先開始，認為在中點時，全年醫療保健比率將為 86.5%。

So as we noted earlier, about 100 basis points above the elevated '24 level.

正如我們之前指出的，比 24 年的高水準高出約 100 個基點。

And I just had discussed '24 included a number of discrete items.

我剛剛討論過 '24 包括許多離散的項目。

And within that, the quarterly pattern will look familiar with the first quarter below the midpoint of that and the fourth quarter above the midpoint and trending up to the middle of the year.

其中，季度模式看起來很熟悉，第一季低於中點，第四季高於中點，並趨勢到年中。

And then within the year, the pattern familiar.

然後一年之內，這種模式就變得熟悉了。

So those would be the elements we'd kind of think about as that pattern is through.

因此，當該模式完成時，這些將是我們要考慮的元素。

Slope a little impacted, of course, by some of the Part D changes that are out there also that I think you're well aware of already because those have been out for a while.

當然，Slope 受到 D 部分的一些更改的影響，我認為您已經很清楚這些更改，因為這些更改已經發布了一段時間。

So the slope of that will be impacted a bit by that also.

因此，其斜率也會受到一點影響。

Those would be the key elements.

這些將是關鍵要素。

Great.

偉大的。

John, thanks so much.

約翰，非常感謝。

Appreciate it.

欣賞它。

Next question.

下一個問題。

Sarah James,

莎拉詹姆斯，

(inaudible).

（聽不清楚）。

Thank you.

謝謝。

I'll stick on MLR.

我會堅持MLR。

John, could you help us bridge '24 to '25 by sizing some of the impact of the components that you called out, like your assumptions on core trend versus IRA and any offsets like rates or non-repeat of the MA group refunds?

約翰，您能否透過評估您提出的某些組成部分的影響來幫助我們在「24」和「25」之間架起橋樑，例如您對核心趨勢與IRA 的假設以及任何抵銷措施（例如利率或MA集團退款的不重複）？

Thanks.

謝謝。

Yeah.

是的。

Good morning, Sarah.

早安，莎拉。

Certainly.

當然。

So kind of big elements that we'd call out here.

我們在這裡要提到的一些重要元素。

Certainly, the IRA impacts a mix of the people we're serving.

當然，愛爾蘭共和軍會影響我們所服務的各種人群。

We're serving more people than public sector plans, of course.

當然，我們為比公共部門計劃更多的人提供服務。

That's kind of a normal course element.

這是一種正常的課程元素。

And then, of course, a second year of the CMS funding rate reductions here.

當然，還有第二年的 CMS 資助率降低。

Elements kind of probably going the other direction here would be certainly the cyber and South America impacts.

這裡可能走向另一個方向的因素肯定是網絡和南美的影響。

We'd size those.

我們會調整它們的尺寸。

Think about that as about 30 basis points in our 2024.

2024 年，這一數字約為 30 個基點。

Some of the trend affordability and other initiatives that we have in there also.

我們也有一些趨勢負擔能力和其他措施。

And then, as I mentioned also, just taking an appropriately respectable view of the care activity environment as we step out.

然後，正如我也提到的，當我們走出去時，對護理活動環境採取適當尊重的態度。

Great.

偉大的。

Thanks so much, John.

非常感謝，約翰。

We just have time for one last question, operator.

我們只有時間回答最後一個問題，接線生。

Joanna Gajuk, Bank of America.

喬安娜·加尤克，美國銀行。

Hey.

嘿。

Good morning.

早安.

Thanks for squeezing me in.

謝謝你把我擠進去。

So I guess something that maybe didn't come up.

所以我猜想有些事情可能沒有出現。

During the discussion of MLR being high in '24, but also the outlook for '25, can you talk about the margins in your Medicare Advantage business?

在討論 24 年 MLR 較高以及 25 年前景時，您能談談您的 Medicare Advantage 業務的利潤率嗎？

So I appreciate second year or V28 and such, but just can you explain for us how the margin in that particular business was in '24 versus your target margins?

因此，我很欣賞第二年或 V28 等，但您能否為我們解釋一下該特定業務的利潤率在 24 年與您的目標利潤率相比如何？

And do you expect the margins to improve year over year in '25?

您預計 25 年利潤率會逐年提高嗎？

Thank you.

謝謝。

Joanna, thanks so much.

喬安娜，非常感謝。

Let me ask Tim Noel to respond to that.

讓我請蒂姆·諾埃爾對此做出回應。

Thanks, Joanna, for the question.

謝謝喬安娜的提問。

As we think about our long-term planning approach to Medicare Advantage, we remain consistent in our view of targeted margins.

當我們考慮我們的 Medicare Advantage 長期規劃方法時，我們對目標利潤率的看法保持一致。

And that doesn't change as we were thinking about '25 like any other year, which is good.

這並沒有改變，因為我們像其他年份一樣思考 25 年，這很好。

Because then as we think about our forward view in any sequential year, not a lot of price and catch-up that we need to engage in, and it can really focus on stability for people, the people we serve and the prospects who may want to choose us in the future.

因為當我們思考任何一個連續年份的前瞻性觀點時，我們不需要進行太多的價格和追趕，它可以真正關注人們、我們服務的人們以及可能想要的潛在客戶的穩定性未來選擇我們。

So really not a lot of change here, very consistent with how we thought about it previously.

所以這裡確實沒有太多改變，與我們之前的想法非常一致。

Great.

偉大的。

Tim, thanks so much.

提姆，非常感謝。

And Joanna, thanks so much for the question.

喬安娜，非常感謝你的提問。

Unfortunately, that's all the time we have this morning.

不幸的是，這就是我們今天早上的全部時間了。

And I want to thank you all for a robust and productive discussion.

我要感謝大家進行了熱烈而富有成效的討論。

I hope that during our session today, you heard a team that is very focused on both effectively navigating the challenges and distinct growth opportunities ahead for UnitedHealth Group, a team leading an enterprise with the capabilities and energy to help each day to make healthcare better for the people we are privileged and proud to serve.

我希望在我們今天的會議上，您聽到的是一個非常專注於有效應對聯合健康集團面臨的挑戰和獨特的成長機會的團隊，這個團隊領導著一個有能力和精力幫助每一天為人們提供更好的醫療保健的企業。

Thanks so much for your time.

非常感謝您抽出時間。

This does conclude today's conference.

今天的會議到此結束。

We thank you for your participation.

我們感謝您的參與。