聯合健康 (UNH) 2025 Q1 法說會逐字稿

Good morning, and welcome to the UnitedHealth Group first quarter 2025 earnings conference call. A question-and-answer session will follow UnitedHealth Group's prepared remarks. As a reminder, this call is being recorded. Here are some important introductory information, this call contains forward-looking statements under US federal securities laws.

早安，歡迎參加聯合健康集團 2025 年第一季財報電話會議。聯合健康集團的準備好的發言之後將進行問答環節。提醒一下，本次通話正在錄音。以下是一些重要的介紹性訊息，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. A description of some of the risks and uncertainties can be found in the reports that we file with the Securities and Exchange Commission, including the cautionary statements included in our current and periodic filings.

這些聲明受風險和不確定性的影響，可能導致實際結果與歷史經驗或當前預期有重大差異。我們向美國證券交易委員會提交的報告中包含了一些風險和不確定性的描述，包括我們目前和定期提交的文件中包含的警示性聲明。

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.

本次電話會議也將參考非公認會計準則金額。非 GAAP 與 GAAP 金額的對帳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。

Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated April 17, 2025, which may be accessed from the Investor Relations page of the company's website.

本次電話會議中提供的資訊包含在我們今天上午發布的收益報告和 2025 年 4 月 17 日的 8-K 表中，可從公司網站的投資者關係頁面存取。

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

現在，我將會議交給聯合健康集團執行長安德魯威蒂。

Good morning, everyone. Thank you for joining us today. UnitedHealth Group started 2025 in two seemingly disparate ways. One, continued strong growth across our businesses. Our people are providing more health benefits and services to more members and patients as the market responds to our distinct offerings.

大家早安。感謝您今天加入我們。聯合健康集團以兩種看似截然不同的方式開啟了2025年。一、各項業務持續強勁成長。隨著市場對我們獨特產品的回應，我們的員工正在為更多會員和患者提供更多的健康福利和服務。

The other way, however, was an overall performance that was frankly unusual and unacceptable. As you saw in our release, we're revising our adjusted earnings per share outlook for the year to $26 to $26.50. This morning, we'll detail for you the factors driving our revised outlook, and how we plan to address them.

然而，另一方面，坦白說，整體表現是不尋常且令人無法接受的。正如您在我們的新聞稿中看到的，我們將今年的調整後每股收益預期修改為 26 美元至 26.50 美元。今天上午，我們將向您詳細介紹影響我們修改展望的因素，以及我們計劃如何解決這些因素。

I'll start with performance, which was impacted by two broad factors in our Medicare businesses, care activity and member profiles. It's important to recognize UnitedHealthcare and Optum are distinct businesses with different models, markets and products.

我先從績效開始，績效受到我們醫療保險業務中的兩大因素的影響，即護理活動和會員概況。重要的是要認識到 UnitedHealthcare 和 Optum 是具有不同模式、市場和產品的不同企業。

In addition, Optum's Medicare business is multi-payer and not limited to just UnitedHealthcare members. Given these differences, changes in care activity and member profile do not always follow the same patterns and can result in different impacts to each business. The respective teams are urgently responding to our performance challenges.

此外，Optum 的醫療保險業務涉及多方付款人，不僅限於 UnitedHealthcare 成員。鑑於這些差異，護理活動和會員資料的變化並不總是遵循相同的模式，並且可能對每個企業產生不同的影響。各個團隊正在緊急應對我們的績效挑戰。

Starting with care activity. In UnitedHealthcare's Medicare Advantage business, we had planned for 2025 care activity to increase at a rate consistent with the utilization trend we saw in 2024. Instead, though, first quarter 2025 indications suggest care activity increased at twice that rate. Increases in physician and outpatient services were most notable and inpatient to a lesser extent. This increase in care activity was limited to our MA business and was not a factor in our commercial or Medicaid businesses. Care activity trends in those areas were as expected.

從護理活動開始。在聯合健康保險的醫療保險優勢業務中，我們計劃 2025 年的護理活動以與我們在 2024 年看到的利用率趨勢一致的速度增長。然而，2025 年第一季的跡象表明，護理活動的成長速度是這一速度的兩倍。醫師和門診服務的成長最為顯著，住院服務的成長幅度較小。護理活動的增加僅限於我們的 MA 業務，而不是我們商業或醫療補助業務的因素。這些地區的護理活動趨勢符合預期。

Turning to member profile. Unanticipated changes in our Optum Medicare membership is impacting 2025 revenue. We added more new Medicare patients to Optum Health, a portion of whom were covered by plans that were exited markets. They experienced a surprising lack of engagement last year, which led to 2025 reimbursement levels well below what we would expect and likely not reflective of their actual health status.

轉向會員資料。我們的 Optum Medicare 會員資格的意外變化正在影響 2025 年的收入。我們為 Optum Health 增加了更多新的醫療保險患者，其中一部分患者受到已退出市場的計劃的覆蓋。去年，他們出乎意料地缺乏參與，導致 2025 年的報銷水準遠低於我們的預期，而且可能無法反映他們的實際健康狀況。

Additionally, many of the current and new complex patients we serve are more affected by the CMS risk model changes that we are in the process of implementing. To be sure, it is complicated, but we're not executing on the model transition as well as we should. We must and will work to better anticipate and address these factors. Here still early in 2025, we believe they are highly addressable as we look ahead to 2026.

此外，我們服務的許多現有和新的複雜患者受到我們正在實施的 CMS 風險模型變化的更大影響。可以肯定的是，這很複雜，但我們在模型轉換方面的執行力還不夠好。我們必須而且將會努力更好地預測和解決這些因素。現在仍是 2025 年初，我們相信，展望 2026 年，這些問題是可以解決的。

Let me now talk specifically about what we're doing. First, we're ensuring the complex patients most impacted by the previous administration's Medicare funding cuts engaged in clinical and value-based programs.

現在讓我具體談談我們正在做的事情。首先，我們要確保受上屆政府削減醫療保險資金影響最大的複雜患者參與臨床和基於價值的項目。

Second, we're consistently engaging with members in their homes and in post-discharge settings. Engagement remains the key. Third, we are appropriately assessing and updating the health status of new patients, especially those at high risk levels.

其次，我們持續與會員在家中和出院後環境中互動。參與仍然是關鍵。第三，我們正在適當評估和更新新患者，特別是高風險患者的健康狀況。

Fourth, to more effectively transition to the new CMS risk model, we're investing significantly in improving physician clinical workflow to help ensure better care and timely insights on when and where care is most efficient and effective. Finally, our Medicare Advantage plan designs and pricing for 2026 will be fully informed by these trends.

第四，為了更有效地過渡到新的 CMS 風險模型，我們正在投入大量資金來改善醫生的臨床工作流程，以幫助確保更好的護理，並及時了解何時何地的護理最有效。最後，我們的 2026 年醫療保險優勢計畫設計和定價將充分考慮這些趨勢。

While we are decidedly unsatisfied with these results, our growth and foundation for improvement remains solid. UnitedHealthcare's Medicare Advantage business is on pace to serve an additional 800,000 people this year. Optum Health is on track to add 650,000 net new patients to value-based care arrangements.

雖然我們對這些結果並不滿意，但我們的成長和改進基礎仍然穩固。聯合健康保險 (UnitedHealthcare) 的醫療保險優勢計劃 (Medicare Advantage) 業務今年預計將為另外 80 萬人提供服務。Optum Health 預計將為基於價值的護理安排增加 650,000 名淨新患者。

In Medicaid, we are growing and continue to see positive momentum in closing the gap between people's health status and state rates, and we are very appreciative of our state customers for the ongoing productive discussions.

在醫療補助方面，我們正在發展，並繼續看到縮小人們健康狀況與州費率之間差距的積極勢頭，我們非常感謝州客戶正在進行的富有成效的討論。

Within Optum, so far this year, Optum Rx is off to a strong selling season, characterized by new wins as well as high retention of long-term customers. The growth of Optum Rx underscores the vital role that PBMs play in helping to reduce the price of drugs for consumers and the value that sophisticated purchases of health care, the employers, unions and governments see in our efforts to counter the high prices set by drug manufacturers and to ensure that people have convenient access to high-quality affordable drugs.

在 Optum 內部，今年到目前為止，Optum Rx 迎來了強勁的銷售季，其特點是新客戶不斷湧現，長期客戶的保留率也很高。Optum Rx 的成長凸顯了 PBM 在幫助降低消費者藥品價格方面發揮的重要作用，以及醫療保健的複雜購買、雇主、工會和政府在我們努力對抗藥品製造商設定的高價並確保人們能夠方便地獲得高品質、負擔得起的藥品方面所看到的價值。

That's more important than ever, as drug manufacturers continue to increase what they charge Americans, in some cases, 10 times what they charge people in Europe.

這比以往任何時候都更重要，因為製藥商不斷提高對美國人的收費，在某些情況下，收費是歐洲人的 10 倍。

The growth at UnitedHealthcare and Optum reflects the efforts of our 400,000 colleagues who come to work every day thinking differently about what is possible, advancing new products and ideas while constantly refining existing programs, working to make things better for the people we are privileged to serve.

UnitedHealthcare 和 Optum 的成長反映了我們 40 萬名同事的努力，他們每天上班時都以不同的方式思考什麼是可能的，推進新產品和新想法，同時不斷完善現有計劃，努力為我們有幸服務的人們提供更好的服務。

Our team continues to innovate to make accessing care easier. For example, our newest tool have sparked a more than 40% increase in digital engagement among our senior members through the first quarter. We see evidence of this in sharply higher and earlier wellness visits to their primary care physicians with total visits in the first quarter running far above the year ago period. This will help members better manage their health and promote early detection of emerging issues.

我們的團隊不斷創新，讓獲得照護變得更容易。例如，我們最新的工具在第一季就促使高級會員的數位參與度提高了 40% 以上。我們看到的證據是，患者去初級保健醫生處就診的次數大幅增加且時間提前，第一季的總就診次數遠高於去年同期。這將幫助會員更好地管理他們的健康並促進早期發現新出現的問題。

Further, Medicare Advantage also cost tax pays less and delivers more to seniors than fee-for-service Medicare, especially in value-based care arrangements. An essential approach in achieving both health outcomes and lowered costs is ensuring people get the care they need when and where they need it.

此外，與按服務收費的醫療保險相比，醫療保險優勢計劃的稅收成本更低，並且為老年人提供的服務更多，尤其是在基於價值的護理安排中。實現健康結果和降低成本的一個基本方法是確保人們在需要的時間和地點得到所需的照護。

And a good place to understand those needs better is in a seniors home. Our HouseCalls program does just that. HouseCalls, which is only available in Medicare Advantage, provides a thorough in-home clinical visit at no cost to seniors. Following CMS' best practices for such care, our clinicians review a patient's medical history, and current medications, conduct comprehensive physical exams, provide lab tests and screenings and coordinate necessary follow-on care.

養老院是更了解這些需求的一個好地方。我們的 HouseCalls 計畫正是這樣做的。HouseCalls 僅在 Medicare Advantage 計劃中提供，為老年人提供免費的全面上門臨床訪問服務。根據 CMS 針對此類護理的最佳實踐，我們的臨床醫生會審查患者的病史和當前用藥情況，進行全面的身體檢查，提供實驗室測試和篩檢，並協調必要的後續護理。

HouseCalls clinicians closed millions of care gaps last year, helping people stay out of the hospital and the emergency department and referring those in need to appropriate social services to help them live healthier at home.

HouseCalls 的臨床醫生去年彌補了數百萬個護理缺口，幫助人們避免去醫院和急診室，並將有需要的人轉介到適當的社會服務機構，幫助他們在家中過上更健康的生活。

This is Medicare Advantage innovation and value in action, helping drive proactive, preventive engagement with the health system rather than more expensive reactive acute care. These benefits and innovations and their value to seniors and taxpayers will put an unnecessary risk by funding cuts in recent years to the Medicare Advantage program.

這是醫療保險優勢計劃的創新和價值體現，有助於推動與醫療系統的主動、預防性互動，而不是更昂貴的被動急性護理。這些福利和創新及其對老年人和納稅人的價值將因近年來醫療保險優勢計劃資金的削減而帶來不必要的風險。

While we continue to navigate those funding cuts to seniors benefits, it is significant that the recently released 2026 rate notice begins to reflect the accelerating care cost trends we have experienced for some time. This will provide much needed relief to seniors and reflects policymakers understanding of the importance and the popularity of Medicare Advantage.

在我們繼續應對老年人福利資金削減的同時，​​值得注意的是，最近發布的 2026 年費率通知開始反映出我們一段時間以來經歷的護理成本加速增長的趨勢。這將為老年人提供急需的救濟，並反映出政策制定者對醫療保險優勢計劃的重要性和受歡迎程度的理解。

Our work to deliver a better experience for people and lower cost spans our enterprise as it always has. Just within the last few weeks, we've introduced several initiatives that will help people in their health care journeys.

我們的工作始終致力於為人們提供更好的體驗和更低的成本。就在過去的幾周里，我們推出了多項舉措，幫助人們享受醫療保健。

Optum Rx will remove prior authorizations on 80 drugs accounting for more than 10% of our pharmaceutical prior authorizations. And Optum Rx has aligned payment models to pharmacies more closely to their cost for drugs. This helps pharmacies manage the ever-increasing prices charged by drug manufacturers enabling pharmacists to stock more medicines and ensuring more consistent pricing and access to medicine for consumers.

Optum Rx 將取消 80 種藥物的先前授權，這些藥物占我們藥品先前授權的 10% 以上。Optum Rx 已將藥局的付款模式與其藥品成本更加緊密地結合。這有助於藥局管理藥廠不斷上漲的價格，使藥劑師能夠儲存更多藥品，並確保消費者能夠以更一致的價格獲得藥品。

26 million consumer calls were more accurately directed to the right advocate by an AI agent, improving the consumer experience and reducing wait times. We expect AI will direct over half of our calls to the best resource during 2025. All of these efforts are making things simpler and easier for consumers and providers, a goal we share with all health care stakeholders.

2,600 萬通消費者電話被人工智慧代理更準確地轉接到合適的客服人員，從而改善了消費者體驗並減少了等待時間。我們預計，到 2025 年，人工智慧將把一半以上的電話轉接給最佳資源。所有這些努力都是為了讓消費者和提供者的事情變得更簡單、更容易，這是我們與所有醫療保健利害關係人共同的目標。

Yet, we all have to contend with the stubborn fact that health care costs more in the US than it should even beyond the widely recognized disparities in drug prices. Common procedures such as heart bypass surgery, spinal fusions and heart stents are 4 times as expensive in the US as they are in Germany, Australia and the UK.

然而，我們都必須面對一個頑固的事實：除了人們普遍認識到的藥品價格差距之外，美國的醫療保健成本過高。在美國，心臟繞道手術、脊椎融合術和心臟支架等常見手術的費用是德國、澳洲和英國的四倍。

Total hip replacements are twice as much. It's simply not sustainable. As we have made clear, we are as committed as ever to continuing down the path of transparency and affordability, ensuring that Americans get the health system they deserve.

髖關節置換手術的費用是原來的兩倍。這根本就不可持續。正如我們明確表示的那樣，我們一如既往地致力於繼續走透明和可負擔的道路，確保美國人獲得應得的醫療服務。

With that, I'll turn it over to John, who will discuss first quarter performance and full year outlook in more detail. John?

接下來，我將把話題交給約翰，他將更詳細地討論第一季的業績和全年展望。約翰？

Thank you, Andrew. I'll start by walking through several updates to our '25 outlook and then elaborate on the reasons for them. As Andrew said, we now expect adjusted earnings of $26 to $26.50 per share. It's an outlook that I'm extremely disappointed to share with you. This reflects the profile of patients served at Optum Health.

謝謝你，安德魯。我將首先介紹我們對 25 年展望的幾項更新，然後詳細說明更新的原因。正如安德魯所說，我們現在預計調整後每股收益為 26 美元至 26.50 美元。我非常遺憾地與你們分享這種觀點。這反映了 Optum Health 所服務的患者的情況。

It also reflects significantly increased care activity across the UnitedHealthcare Medicare Advantage plans. Within that outlook, we expect about 50% to come in the first half of the year. We're affirming the consolidated revenue outlook of $450 billion to $455 billion we shared with you in December.

這也反映出聯合健康保險優勢計劃的護理活動顯著增加。基於這一前景，我們預計約 50% 的成長將出現在上半年。我們確認 12 月與大家分享的 4,500 億美元至 4,550 億美元的綜合收入預期。

Within this, we expect revenues for both UnitedHealthcare and Optum Rx to be better than our initial view, offsetting a reduced outlook at OptumHealth. The full year medical care ratio is now expected to be 87.5% plus or minus 50 basis points, reflecting higher utilization across senior populations and the patient mix and revenue profile of Optum Health.

在此背景下，我們預期 UnitedHealthcare 和 Optum Rx 的收入都將優於我們最初的預期，從而抵消 OptumHealth 的預期下調。目前預計全年醫療保健比率為 87.5%（正負 50 個基點），這反映了老年人群的更高利用率以及 Optum Health 的患者結構和收入狀況。

Within this range, we expect the first half of the year to be below the midpoint and the second half to be above. At Optum Health, our revenue outlook is $106 billion to $107 billion and operating earnings is $6.2 billion to $6.4 billion based on the factors discussed and which I'll get into more deeply in a moment.

在這個範圍內，我們預計上半年將低於中點，下半年將高於中點。在 Optum Health，根據所討論的因素，我們的收入預期為 1060 億美元至 1070 億美元，營業收入預期為 62 億美元至 64 億美元，稍後我將對此進行更深入的探討。

Over half of the $10 billion revenue change is the result of transitioning some legacy risk-based arrangements to fee based and is neutral to earnings. We expect about half of Optum Health's operating earnings to be in the first half. At UnitedHealthcare, the operating earnings outlook is updated to $16 billion to $16.5 billion and reflects the higher care activity we're seeing.

100 億美元收入變化中超過一半是將一些傳統的基於風險的安排轉變為基於費用的安排的結果，並且對收益沒有影響。我們預期 Optum Health 約一半的營業收入將來自上半年。聯合健康保險的營業利潤預期已更新至 160 億美元至 165 億美元，這反映了我們所看到的更高的護理活動。

Within UnitedHealthcare, pressure was largely contained within the senior business, where we saw a sharp increase in care activities that became apparent as we closed out the quarter. As noted, this was most significant for both physician and outpatient care and to a lesser extent, inpatient care.

在聯合健康保險內部，壓力主要集中在高級業務方面，我們看到該部門的護理活動急劇增加，這一點在本季度末變得明顯。如上所述，這對於醫生和門診護理而言最為重要，而住院護理的影響則較小。

In years past, this is an insight, we may not have picked up until the second quarter, so it is useful to have the information with ample time to incorporate into our '26 planning. In the quarter, we experienced percentage increases in care activity about double last year's level. Unit prices behaved as expected.

在過去的幾年裡，這是一個見解，我們可能直到第二季才意識到，因此，有充足的時間將這些資訊納入我們的 26 年計畫中是很有用的。本季度，我們的護理活動百分比增幅約為去年同期的兩倍。單價表現符合預期。

So let me start with the obvious fact that it is early in the year, and we don't know everything that might be driving our experience or how long the increase in care activity might last. But care activity was broad-based across our senior individual and group populations. One example, and group MA, member retention was about 98%. And as a result, serves well as a same member metric.

首先我要說一個顯而易見的事實：現在是年初，我們並不清楚可能導致我們經歷的所有因素，也不清楚護理活動的增加會持續多久。但護理活動廣泛涵蓋我們的老年個人和群體。舉個例子，在 MA 集團，會員保留率約為 98%。因此，它可以很好地作為同一成員指標。

Here, we observed significant increases in elective care activity in the first quarter. Of note in this population, we believe the behavior may have been impacted by the meaningfully higher member premiums, which were driven by the Medicare funding cuts.

在這裡，我們觀察到第一季選擇性護理活動顯著增加。值得注意的是，我們認為，對於這一人群，這種行為可能受到了醫療保險資金削減導致的會員保費大幅上漲的影響。

Another example across senior populations was the earlier and higher wellness visit activity we saw, which, of course, drives specialty and outpatient utilization. Some of this may be a seasonal shift in consumption patterns as wellness once a year.

另一個例子是，我們看到老年族群的健康訪視活動更早、更頻繁，這當然推動了專科和門診的利用率。其中一些可能是由於每年一次的季節性消費模式轉變。

Turning to Optum Health. As it relates to the patient profile, we experienced a couple of key elements here. First, growth in certain markets where there were meaningful plan exits. These new patients had not been engaged by their prior plans for most of last year. And we're seeing revenues associated with the patient profiles meaningfully below expected and normal levels. This is very addressable.

轉向 Optum Health。由於它與患者概況相關，我們在這裡經歷了幾個關鍵要素。首先，在存在有意義的計劃退出的某些市場中實現成長。去年大部分時間裡，這些新患者尚未按照先前的計畫接受治療。我們發現與病患檔案相關的收入明顯低於預期和正常水準。這是非常容易解決的。

Second, the ongoing execution to the new CMS risk model, while complicated given the multiyear phase-in has not been to our operational standards. Transitioning to a new model and concurrently running two distinct versions has been more operationally complex than anticipated. But no question, we need to execute better, and we will.

其次，新 CMS 風險模型的持續執行雖然很複雜，但經過多年的逐步實施，尚未達到我們的營運標準。過渡到新模型並同時運行兩個不同版本的操作比預期的要複雜得多。但毫無疑問，我們需要執行得更好，而且我們會的。

Across the enterprise, we continue to focus on operating costs to help mitigate external pressures while ensuring our workforce aligns to the areas of greatest opportunities and customer needs. Looking ahead, we see a long runway for further technology advances that will translate to more and sustained operating efficiency, which in turn drives opportunity for further innovation and advancements in the company and across the industry.

在整個企業中，我們繼續專注於營運成本，以幫助減輕外部壓力，同時確保我們的員工隊伍與機會最大、客戶需求最大的領域保持一致。展望未來，我們看到技術進步還有很長的路要走，這將轉化為更多、更持續的營運效率，從而為公司和整個行業的進一步創新和進步帶來機會。

Before we get to Q&A, I want to provide a few business highlights. At UnitedHealthcare, we still expect to serve up to 800,000 more people in Medicare Advantage this year across our individual group and dual special needs offerings. This underscores our long-standing commitment to stability and differentiated value. Our growth demonstrates UHC's deep relationship with our members.

在進入問答環節之前，我想先介紹一些業務亮點。在聯合健康保險，我們仍預計今年將透過個人團體和雙重特殊需求服務為多達 80 萬名 Medicare Advantage 會員提供服務。這強調了我們對穩定和差異化價值的長期承諾。我們的成長體現了 UHC 與會員之間的深厚關係。

People served by our community and state business increased to 7.6 million. We continue to have growth momentum with recent service expansions in Kentucky, New York and Florida. We're also encouraged by the updated Medicaid rates so far in '25 that more closely align with underlying member acuity, but funding remains insufficient to meet the health needs of patients.

我們的社區和州業務服務的人數增加到 760 萬人。隨著最近在肯塔基州、紐約州和佛羅裡達州的服務擴展，我們繼續保持成長勢頭。我們也對 25 年迄今更新的醫療補助費率感到鼓舞，該費率與基礎會員的敏銳度更加一致，但資金仍不足以滿足患者的健康需求。

Commercial self-funded membership increased by approximately 700,000 in the first quarter, a result of our continued strong product innovation. Commercial Insured membership was impacted by the individual exchange products. Our disciplined pricing approach remains consistent and as a result, we experienced some member attrition.

由於我們持續強勁的產品創新，第一季商業自費會員數量增加了約 70 萬人。商業保險會員資格受到個人交易產品的影響。我們嚴格的定價方法保持一致，因此，我們經歷了一些會員流失。

Overall, in our commercial book, we are encouraged by the early '26 selling season indications, which are showing strong retention rates.

總體而言，在我們的商業書籍中，我們對 26 年初的銷售季節跡象感到鼓舞，這些跡象顯示出強勁的保留率。

Turning to Optum. At Optum Health, we continue to expect to add 650,000 new value-based care patients this year. We're working to engage with these new members ever more rapidly. By the end of '25, we expect to have about 5.4 million value-based care patients. At Optum Insight, we have a pipeline of new products coming to market this year with exceptional customer interest.

轉向 Optum。在 Optum Health，我們預計今年將增加 65 萬名新的基於價值的護理患者。我們正在努力更快地與這些新成員接觸。到 25 年底，我們預計將有約 540 萬名基於價值的護理患者。在 Optum Insight，我們今年將推出一系列新產品，引起了客戶的極大興趣。

For example, in the first quarter, we launched AI-powered claims efficiency tools that increased productivity by over 20% for our revenue cycle management customers. Lastly, Optum Rx revenues grew 14%, exceeding $35 billion for the quarter. Both customer retention and new customer wins contributed to script growth of 3%.

例如，在第一季度，我們推出了基於人工智慧的索賠效率工具，為我們的收入週期管理客戶提高了 20% 以上的生產力。最後，Optum Rx 營收成長了 14%，本季超過 350 億美元。客戶保留和新客戶贏得均推動了腳本成長 3%。

As Andrew noted, performance in the quarter was below the standards we expect. But with disciplined and urgent execution and attention to detail, we expect a return to form in the quarters ahead.

正如安德魯所指出的，本季的表現低於我們預期的標準。但透過嚴格、緊急的執行和對細節的關注，我們預計未來幾季將會恢復正常。

With that, I'll hand it back to Andrew.

說完這些，我就把它交還給安德魯。

Thanks, John. Even with the growth of our -- I'm sorry, even with the growth our people generated this quarter, this was far from the performance we expect of ourselves. We're acutely aware it's a privilege to be a part of an organization with the capabilities to make a meaningful contribution to modernize and then simplifying the health system.

謝謝，約翰。即使我們的員工本季取得了成長——對不起，即使我們的員工本季取得了成長，但這與我們對自己的期望相比仍然相差甚遠。我們深知，能夠成為一個有能力為醫療系統的現代化和簡化做出有意義貢獻的組織的一部分是一種榮幸。

And we're committed to improving our performance in the rest of 2025 and into '26, and in doing so to delivering consistent positive results for you and returning to our long-term earnings per share growth target of 13% to 16%.

我們致力於在 2025 年剩餘時間和 2026 年提高我們的業績，從而為您帶來持續的積極成果，並恢復我們 13% 至 16% 的長期每股收益增長目標。

With that, we can now turn to your questions. Operator?

好了，我們現在可以回答您的問題了。操作員？

(Operator Instructions)

（操作員指示）

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Thanks. Good morning. My question is on Medicare Advantage cost trend. You said that you came into the year assuming trend at similar levels to 2024. Can you share with us precisely what that trend estimate was, meaning what did you expect for this year? And what are you expecting now? And can you tell us how much of that you actually saw in the first quarter?

謝謝。早安.我的問題是關於醫療保險優勢計劃的成本趨勢。您說您假設今年的趨勢與 2024 年的水平相似。您能否與我們分享趨勢預測的具體內容，即您對今年的預期是什麼？您現在期待什麼？您能告訴我們您在第一季實際看到了多少嗎？

For instance, how much did you miss your MLR by your own estimate of MLR? And how much you're expecting that to accelerate? Or how different the back three quarters is versus what you saw in the first quarter? Thanks. (multiple speakers)

例如，您自己對 MLR 的估計與 MLR 的偏差有多大？您預計這速度會加快多少？或者後三節的表現與第一節的表現有何不同？謝謝。（多位發言者）

Yeah. Justin, thanks so much for the question. I ask Tim Noel to respond just in a second in detail to your question. I mean obviously, it's still very early in the year, but we have clearly seen a pickup in trend in a specific part of the UHC business, scan the senior business. Tim will talk a little more about that to you in a second.

是的。賈斯汀，非常感謝你的提問。我請 Tim Noel 快速詳細地回答您的問題。我的意思是，顯然，現在還處於年初階段，但我們已經清楚地看到 UHC 業務的特定部分，即高級業務，呈現回升趨勢。蒂姆稍後會和你進一步討論這個問題。

It's still early, even our first quarter is only partially complete. But unusually, we've seen this pick up and which is what's obviously influencing our position here. So let me ask Tim to give you a little bit more detail on that.

現在還為時過早，我們的第一季甚至還只是部分完成。但不同尋常的是，我們看到了這種回升，這顯然影響了我們在這裡的地位。因此，請允許我請蒂姆向您詳細介紹這一點。

Morning, Justin, thanks for the question. Yeah, I'll attempt to break it all down for you here. So as was mentioned in the opening remarks, in 2025, we anticipated care levels consistent with what we observed in 2024, which felt appropriate as we stepped into the year. And what we were assuming and if you think about this as units consumed, we were assuming that in 2025, we'd see a similar increase by that metric that we observed in 2024.

早安，賈斯汀，謝謝你的提問。是的，我會嘗試在這裡為您詳細解釋這一切。正如開場白中提到的那樣，我們預計 2025 年的護理水平將與 2024 年的觀察結果一致，這對於我們進入新的一年來說是合適的。我們的假設是，如果將其視為消耗的單位，那麼我們假設在 2025 年，我們會看到該指標出現與 2024 年類似的增長。

And if you break that down in the Medicare book, you can think that in total -- in terms of total trend drivers, about one-third of that is related to increase in care activity or units consumed.

如果你在醫療保險書中對此進行細分，你可以認為總體而言 - 就總體趨勢驅動因素而言，其中約三分之一與護理活動或消耗單位的增加有關。

And what we are seeing, and again, that's focused on physician and outpatient but driving an overall 2 times increase in that level of units consumed in Q1 of 2025. And again, that metric is about one-third of the total trend drivers in the Medicare book.

我們看到的是，這再次集中在醫生和門診患者身上，但到 2025 年第一季度，消耗的單位數量將總體增加 2 倍。再次強調，此指標約佔醫療保險書中整體趨勢驅動因素的三分之一。

We are seeing that inside of the first quarter of this year, but we are making the assumption right now that, that trend will persist throughout 2025, and then also making the same assumption that it will persist into 2026, and that will shape our overall pricing assumptions.

我們在今年第一季就看到了這一點，但我們現在假設，這種趨勢將持續到 2025 年，然後同樣假設它將持續到 2026 年，這將影響我們的整體定價假設。

Now some of the drivers that John mentioned behind what we're seeing, you might presume that some of those would result in a change in our seasonal consumption patterns. But at this distance, we feel like we need to make the assumption that, that activity will persist throughout the year and into 2026.

現在，約翰提到的一些驅動因素是我們所看到的，您可能會認為其中一些會導致我們的季節性消費模式發生變化。但考慮到這一距離，我們覺得我們需要做出這樣的假設：這種活動將持續全年並持續到 2026 年。

Tim, thanks so much. Next question please.

提姆，非常感謝。請問下一個問題。

Josh Raskin, Nephron Research.

Josh Raskin，腎元研究公司。

Hi, thanks. Good morning. Can you help us connect the higher incidence of primary care visits and the Optum Health pressure? I assume you don't have that primary care issue in Optum Health which should also mitigate the downstream impact. So why are you expecting the higher follow-through if you control primary care?

你好，謝謝。早安.您能幫助我們將初級保健就診率較高與 Optum Health 壓力聯繫起來嗎？我認為 Optum Health 中不存在初級保健問題，這也應該可以減輕下游影響。那麼，如果您控制了初級保健，為什麼還要期望更高的後續治療呢？

And then based on the fact that you're seeing worse performance in Optum Health or value-based care, could you remind us why you think you can control cost better in that environment, and it's probably a good time to get the refresher on why the strategy to allocate a lot more capital to VBC in the ecosystem totally is best in the long term?

然後，基於您看到的 Optum Health 或基於價值的護理表現較差的事實，您能否提醒我們為什麼您認為您可以在這種環境下更好地控製成本，並且現在可能是時候重新思考一下為什麼在生態系統中為 VBC 分配更多資本的策略從長遠來看是最好的？

Yeah, Josh, thanks so much for the question. So I'm going to ask Tim, just to address the first part of your question, then Amar to talk a little -- Dr. Desai to talk a little bit around the Optum Health experience during the quarter and the differences of what we're seeing there, and the like, and as I said in my commentary at the beginning, the businesses do operate very different kind of models, and it's not completely surprising to see somewhat different experiences, and then I'm going to ask Heather to just do -- as you kindly requested a kind of refresher on the value-based care position.

是的，喬希，非常感謝你提出這個問題。因此，我想請蒂姆回答您問題的第一部分，然後請阿瑪爾講一講——德賽博士可以談談本季度 Optum Health 的經歷以及我們所看到的差異等等，正如我在一開始的評論中所說，這些企業確實運營著非常不同的模式，看到有些不同的經歷並不完全令人驚訝，然後我想請希瑟——正如您所要求的，對基於復價值的立場。

So we'll do that also for you. So bear with us, in the sense is probably going to take a little -- a few minutes. But Tim, if I could ask you to start, and then we'll pass over to Dr. Amar Desai.

所以我們也會為您這樣做。所以請耐心等待，這可能需要一點時間——幾分鐘。但是提姆，如果我可以請你先開始，然後我們將交給阿馬爾·德賽博士。

Yeah. Thanks, Josh, for the question. So yeah, let me just dive in a little bit -- with a little bit more detail in just some of what we're seeing that's driving the increase in care activity. Not only starts with our fee-for-service, so kind of our non-capitated community MA members, we have seen increase in physician outpatient care activity in that population.

是的。謝謝喬希提出這個問題。是的，讓我稍微深入一點——更詳細地介紹我們所看到的推動護理活動增加的一些因素。不僅從我們的按服務收費開始，對於我們的非人頭社區 MA 成員，我們已經看到該人群的醫生門診護理活動有所增加。

And one of the dynamics that we're seeing is they are generally seeking more preventative care, which is a good thing, and that also includes more in-home visits, more in-home clinical assessments.

我們看到的動態之一是，他們普遍尋求更多的預防性護理，這是一件好事，這也包括更多的上門訪問、更多的上門臨床評估。

And that, in and of itself, really not the trend driver, but it's the follow-on care that is more than what we have anticipated and that constitutes specialist visits, physician specialist visits as well as some other outpatient services.

而這本身並不是趨勢驅動因素，而是超出我們預期的後續護理，包括專家訪問、醫生專家訪問以及一些其他門診服務。

A dynamic at play in our group Medicare Advantage business is we're seeing a significant and disproportionate increase in utilization largely within our public sector group retiree business. And this is a population that experienced the greatest year-over-year premium increases. And while we've seen a similar dynamic play out historically in our individual Medicare Advantage business when premium increases have been in play, we've really never seen this dynamic before in the group MA business.

我們的團體醫療保險優勢業務中的一個動態是，我們看到利用率顯著且不成比例的成長，主要是在我們的公共部門團體退休人員業務中。這群人的保費較去年同期漲幅最大。雖然我們在個人醫療保險優勢計劃 (Medicare Advantage) 業務中看到過類似的動態，當保費上漲時，但我們從未在團體醫療保險優勢計劃 (MA) 業務中看到過這種動態。

I mean we're seeing it because of the pressures related to the Medicare funding cuts that are really driving up premiums in the group retiree business like they really never have before and kind of think groups with premiums going from $50 to $200.

我的意思是，我們看到這種情況是因為與醫療保險資金削減相關的壓力，這實際上推高了團體退休人員業務的保費，這是前所未有的，而且團體保費從 50 美元漲到了 200 美元。

I mean we did assume that we would see some care activity level increases in this population, but we're seeing far surpasses what we would have recently anticipated. And in that population as well, we are seeing more preventative care, more annual wellness visits more in-home clinical assessments. But again, the driver there also being really the follow-on care that results from that.

我的意思是，我們確實假設我們會看到這個人群的護理活動水平有所提高，但我們看到的遠遠超出了我們最近的預期。在該族群中，我們也看到了更多的預防性護理、更多的年度健康訪視和更多的家庭臨床評估。但同樣，其驅動力也確實在於由此產生的後續照護。

Hey, thanks for the question, Josh. So the results for Optum Health, to be clear, were impacted by the profile of new value-based patients in Optum Health and the second year of the V28 phase-in. We're taking actions to proactively address these issues. Our patient profile post-ADP included many new to Medicare as well as new to Optum Health who are meaningfully less engaged by their prior health plans and providers. We believe that market specific plan exits driven by V28 caused this dynamic.

嘿，謝謝你的提問，喬希。因此，需要明確的是，Optum Health 的結果受到了 Optum Health 中新的基於價值的患者概況以及 V28 實施第二年的影響。我們正在採取行動積極解決這些問題。我們的 ADP 後患者資料包括許多新加入 Medicare 以及新加入 Optum Health 的患者，他們對先前的健康計劃和提供者的參與度明顯較低。我們認為，V28 推動的市場特定計畫退出導致了這種動態。

And because of the strength and stability of our provider network, those patients chose Optum Health. Remember profile challenges were not specific to any single Medicare Advantage carrier and occurred in multi-payer geographies like Texas and Washington.

由於我們的供應商網路的強大和穩定，這些患者選擇了 Optum Health。請記住，個人資料挑戰並非針對任何單一的醫療保險優勢保險公司，而是發生在德克薩斯州和華盛頓州等多付款人地區。

Additionally, we underestimated the impact of V28, in particular as it relates to the higher acuity structure of our patient population, which is more impacted by the risk model change. Our planned actions around operating cost containment and medical expense management were not able to offset the cumulative impacts of V28 and the new member profiles.

此外，我們低估了 V28 的影響，特別是因為它與我們患者群體的更高敏銳度結構有關，而這更容易受到風險模型變化的影響。我們圍繞營運成本控制和醫療費用管理所規劃的行動無法抵銷 V28 和新會員資料的累積影響。

As it relates to care patterns for Optum Health, in general, in Q1, we see as a busier time for our physicians as we are engaging our patients. We've already engaged over 50% of all members and 75% of our complex members. This year, it's particularly important given the member profile of new Medicare and new Optum Health patients.

就 Optum Health 的照護模式而言，總體而言，在第一季度，我們認為醫生會比較忙碌，因為我們必須與病人接觸。我們已經吸引了超過 50% 的所有會員和 75% 的複雜會員。今年，考慮到新 Medicare 和新 Optum Health 患者的成員狀況，這一點尤其重要。

Also within Optum Health, we're seeing some elevation in outpatient behavioral utilizations. Again, we're taking incremental actions above and beyond what we've planned for any year to improve performance. First, enhancing access for employed and network PCPs especially around new patients to diagnose document and treat conditions.

此外，在 Optum Health 內部，我們看到門診行為利用率有所提高。再次強調，我們正在採取超出以往年度計畫的漸進式行動來提高績效。首先，增強受僱和網路 PCP 的可近性，特別是針對新患者，以便診斷、記錄和治療病情。

We're expanding home-based visits and wraparound services, particularly as it relates to post-discharge visits after in patient care. And as Andrew alluded to, we've accelerated EMR unification, deploying smarter clinical workflows and point-of-care tools to better adapt to the V28 related changes. Thanks for the question.

我們正在擴大家訪和全方位服務，特別是與患者住院護理後的出院後探訪相關的服務。正如安德魯所提到的，我們加快了 EMR 統一，部署了更聰明的臨床工作流程和護理點工具，以更好地適應 V28 相關的變化。謝謝你的提問。

Great, Thanks, Amar. And let me ask Heather to maybe just take an overview of the value-based care proposition and why we continue to believe so strongly in it.

太好了，謝謝，阿瑪爾。我想請希瑟簡單概述一下基於價值的照護主張，以及我們為什麼仍然如此堅信它。

Sure. And just I think what you're seeing here is as Andrew said, you've got two different business models here, and it's important to keep that in mind. A couple of things I'll just point out. Again, in Optum Health, capitated experience, this is specific to senior populations and our experience in a unique environment, mindful of, again, what's a new risk model, a year two risk model.

當然。我認為你在這裡看到的就像安德魯所說的那樣，這裡有兩種不同的商業模式，記住這一點很重要。我只想指出幾件事。再次，在 Optum Health，按人頭計算的經驗是針對老年人群的，我們在獨特環境中的經驗是，再次注意什麼是新的風險模型，即兩年風險模型。

And keeping in mind what Dr. Desai said, we assume and anticipate certain physician activity in the first part of the year, and that's part of our model because it drives not only that diagnosis but the treatment, so we can understand the gaps in care. So that's part of the plan, and I think that's why you don't -- it's a little different story in Optum Health.

牢記德賽博士所說，我們假設並預計今年上半年醫生會採取某些行動，這是我們模型的一部分，因為它不僅推動診斷，還推動治療，因此我們可以了解護理方面的差距。這是計劃的一部分，我認為這就是為什麼你不這樣做的原因——Optum Health 的情況略有不同。

But as Dr. Desai said, we need to be mindful of that, particularly based on two years of elevated care activity coming into this year. Now to your point, the outcomes-based model or what we call the value-based care model should naturally offset some of that for a few reasons as Dr. Desai mentioned.

但正如德賽博士所說，我們需要注意這一點，特別是考慮到今年以來護理活動連續兩年加強。現在回到您的觀點，基於結果的模型或我們所說的基於價值的護理模型應該自然地抵消其中的一些影響，原因如下，正如 Desai 博士所提到的。

Number one, engagement is key and that early engagement by a network that's aligned and activated can better identify gaps in care and manage them, and support higher preventive health care and reduced emergency visits and hospital visits.

首先，參與是關鍵，透過協調和活化的網路進行早期參與可以更好地發現護理方面的差距並加以管理，並支持更高的預防性醫療保健並減少急診就診和醫院就診。

In addition to that, what's unique about Optum Health model is the wraparound services and the in-home services, which not only help assess our members in the home, but they're able to then kick off things like post-discharge visits, high -- the more acute condition management programs that are critical to those transitions of care and help reduce total cost of care and naturally offset some of trend.

除此之外，Optum Health 模式的獨特之處在於其全方位服務和家庭服務，這不僅有助於評估我們成員在家中的情況，而且他們還可以啟動出院後訪問等事項，高級病情管理計劃對於護理過渡至關重要，有助於降低總護理成本並自然抵消一些趨勢。

But in addition to that, result in a better health outcome for our patients and a better experience and help them with a healthier life. So those are kind of the basis of our model. You then wrap the integration of our behavioral health into our model, which has increasingly more an integrated part of a care delivery system. That's what I think is differentiated about the model.

但除此之外，我們還能為患者帶來更好的健康結果和更好的體驗，幫助他們過更健康的生活。這些就是我們模型的基礎。然後，您將行為健康融入我們的模型中，該模型越來越成為護理提供系統中不可或缺的一部分。我認為這就是該模型的不同之處。

And even though to be incredibly direct and respectful of this year, we will see the impact of the revenue through the year. But the differentiated value-based care model has meant growth for Optum Health above industry in the past, and we believe you'll continue to see that. Why is that? Because, again, a better care delivery model, a better experience for our patients, but in addition to that, we see very high retention.

儘管對今年的情況非常直接和尊重，但我們仍會看到全年收入的影響。但差異化的基於價值的護理模式意味著 Optum Health 在過去實現了高於行業的成長，我們相信您會繼續看到這一點。這是為什麼？因為，再次強調，更好的護理服務模式，為我們的患者提供更好的體驗，但除此之外，我們還看到了非常高的保留率。

So these members that need the services that have higher acuity that need a more intensive care model, they stay with us. And so the work we do today will support the growth in '26. And that's why we're confident in not only the growth in '26 from a membership perspective, but because there's more members to serve out there.

因此，這些需要更高敏銳度服務和更密集護理模式的會員會留在我們這裡。因此，我們今天所做的工作將支持26年的成長。這就是為什麼我們不僅對 26 年會員數量的成長充滿信心，而且因為還有更多的會員可供服務。

In many cases, we're serving a few of the seniors in any respective geography, and we have more capacity in our networks. But in addition to that, it supports our performance.

在許多情況下，我們為各個地區的少數老年人提供服務，我們的網路擁有更大的容量。但除此之外，它還支持我們的表現。

Now I'll just note one last thing, and that is, I think through the year, you're going to watch us pace that. While we're still committed to our membership growth, we're going to be looking at particular geographies, pacing through that to ensure that we're focusing on the new membership with our PCP network and with our in-home services.

現在我只想指出最後一件事，那就是我認為在這一年中，你會看到我們的步伐。雖然我們仍然致力於會員數量的成長，但我們將專注於特定的地區，並逐步確保我們專注於透過 PCP 網路和上門服務吸引新會員。

Thanks, Heather. And I think, Josh, I really appreciate the question, and thanks, everybody for allowing us to respond to that sort of as fully as we can. I mean just maybe add a couple of comments to that. So that last set of comments from Heather when we look into, and you've often heard us talk previously about cohorts of members who choose to join Optum Health value-based care.

謝謝，希瑟。我認為，喬希，我真的很感謝這個問題，也感謝大家允許我們盡可能全面地回答這個問題。我的意思是也許可以對此添加一些評論。因此，當我們調查 Heather 的最後一組評論時，您經常聽到我們談論選擇加入 Optum Health 價值型護理的會員群體。

What we're seeing in those earlier cohorts going back to, say, 2023, for example, those folks who first came in and started to benefit from our value-based care approach, were seeing on basically all metrics outperformance in terms of the way in which that cohort and cohorts before them perform.

例如，我們在 2023 年之前的那些群體中看到，那些最先加入並開始受益於我們基於價值的護理方法的人，基本上在所有指標上都比該群體和他們之前的群體表現得更好。

So what we're seeing here is not really a challenge to the underlying principle of value-based care. What we're seeing is how to adjust to a very dramatic price cutting regime that's been implemented over the last couple of years by the administration. And it's important to recognize that, that was across the average of the industry, independent analysis would say that was about a 9% price cut across the industry.

因此，我們在這裡看到的並不是對基於價值的護理基本原則的真正挑戰。我們所看到的是如何適應政府過去幾年實施的大幅降價政策。重要的是要認識到，這是整個行業的平均水平，獨立分析表明，整個行業的降價幅度約為 9%。

Now that's a significant downdraft in terms of pressure, and obviously, that affects participants, whether you're a payer or a provider in the marketplace. And you've seen that effect over the last first year. We're now well into the second year of all of this.

就壓力而言，這是一個顯著的下降趨勢，顯然，這會影響參與者，無論您是市場上的付款人還是提供者。在過去的第一年你已經看到了這種效果。現在我們已經進入這一切的第二年了。

And what we're seeing during the second year is some of the -- let's -- I would call them second order derivative effects. So I'll give you just a couple of examples of that. You've heard one very explicitly and we've mentioned the other already on the call. So second order effect would be, for example, as this pricing pressure has continued to press down alongside a series of underfunded rate increases, you've seen premiums and benefits start to be affected in the marketplace.

我們在第二年看到的是一些——我們——我稱之為二階導數效應。所以我僅給你們舉幾個例子。您已經非常明確地聽到了其中一個，我們也已經在通話中提到了另一個。因此，二階效應是，例如，隨著這種定價壓力與一系列資金不足的利率上調一起持續下降，您會看到市場上的保費和福利開始受到影響。

Group premiums have gone up because of these price cuts. That is now driving a different behavior from group members, and that's what we've picked up in this area. And we need to do a better job of being able to predict and anticipate the second and third order effects when they come, but they are direct consequences of this transition.

由於這些降價，團體保費已經上漲。這正在推動小組成員採取不同的行為，而這正是我們在這一領域所發現的。我們需要更好地預測和預見第二階和第三階效應的出現，但它們是這種轉變的直接後果。

A second one, which we referred to and is really important within the Optum Health story for 2025 is plan exits. So we saw a very significant increase in the number of planned exits across the country last year as plans chose to respond to the price cutting pressure by essentially withdrawing their offer in multiple geographies across the country. And what we've seen is in unusually complete vacation of offers by certain plans. So to put it a different way, a 100% of participants in a particular payers plan had to find a new home. They had no way of staying in their old home.

第二個是我們提到的、對於 Optum Health 2025 年的發展至關重要的一點，那就是計劃退出。因此，我們看到去年全國範圍內計劃退出的數量顯著增加，因為該計劃選擇通過在全國多個地區撤回報價來應對降價壓力。我們看到的是，某些計劃的優惠被異常徹底地取消了。換句話說，特定付款人計畫的 100% 參與者都必須尋找新住所。他們沒有辦法繼續留在原來的家裡。

They had to find a new home. And what we saw when they came to us, where we were still offering a plan option, we saw those members had not had the level of engagement in the prior 6 to 8 months before they vacated that plant at the level you would have expected.

他們必須尋找一個新家。當他們來找我們時，我們仍在提供計劃選項，我們發現這些成員在離開工廠之前的 6 到 8 個月內，其參與度並沒有達到預期水準。

That has a direct consequence on how they are understood in terms of the reimbursement model of the system, and that's what's driving a lot of our issues in Optum Health is yes. But again, that is a temporary phenomena which gets fixed during 2025, but it is simply an example of one of the second order derivative effects of this transition of absorbing this nine or more percent decrease in pricing.

這直接影響到人們如何理解系統的報銷模式，而這正是導致 Optum Health 出現許多問題的原因。但同樣，這只是一個暫時現象，將在 2025 年解決，但它只是這種轉變的二階衍生效應之一的一個例子，即吸收價格下降 9% 或更多。

None of that really speaks to the value of value-based care. Value-based care delivers a completely different approach of trying to ensure people have more years of health and less years of health care acute treatment, trying to get ahead of the illness, trying to avoid the high cost consequences of late diagnosis and tries to make sure that we are encouraging people to think about healthy lifestyle, early engagement, making sure that we're heading off problems before they arrive.

這些都不能真正體現基於價值的護理的價值。以價值為基礎的照護提供了一種完全不同的方法，試圖確保人們擁有更多年的健康，減少醫療保健急性治療的年限，試圖預防疾病，試圖避免晚期診斷的高成本後果，並試圖確保我們鼓勵人們思考健康的生活方式，早期參與，確保我們在問題出現之前就將其解決。

And we know that works based on multiple cohorts of patients that we've been privileged to have the right to manage. What we're going through like the rest of the industry, is a dramatic, really never seen before adjustment in pricing for this marketplace.

我們知道，這項工作是基於我們有幸管理的多組患者。和業內其他公司一樣，我們正在經歷一場劇烈的、前所未有的市場定價調整。

And what we're seeing this year is two or three areas where the pressure that, that has created across the market is creating new dynamics we haven't seen. That's exactly what we're responding to here, and we believe that they are largely addressable as we go through the rest of this year, and in no way undermine our confidence in the value-based care strategy of the company.

我們今年看到的是兩個或三個領域，這些領域對整個市場帶來的壓力正在形成我們從未見過的新動態。這正是我們在此回應的問題，我們相信，隨著我們在今年剩餘時間裡解決這些問題，這些問題基本上是可以解決的，而且絕不會削弱我們對公司基於價值的護理策略的信心。

Josh, thanks so much for the question, and I'll move on to the next question.

喬希，非常感謝你的提問，我將進入下一個問題。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Thanks. Hi everybody. Just to put a finer point on some of this discussion around especially what's happening at the MA side. It sounds like you're saying most of the elevated care that you're seeing is on the group side. And it sounds like you're putting more of that on the benefit and premium changes that have occurred rather than just an underlying uptick in utilization. I want to make sure I understood that. Also on the competitive exits and the impact of that.

謝謝。大家好。只是為了更詳細地闡述關於 MA 方面發生的事情的一些討論。聽起來您說的大多數高級護理都是在團體方面。聽起來，您把更多的精力放在了已經發生的福利和保費變化上，而不僅僅是利用率的潛在上升上。我想確保我理解了這一點。還有關於競爭退出及其影響。

It doesn't sound like you're calling that out on the insurance side. You're just calling that out on the Optum side. And then finally, on Part D, you had been cautious about that coming into the year, but you're not mentioning that at all. So is that playing out about as expected?

聽起來你並不是從保險的角度提出這一點。您只是從 Optum 的角度提出這一點。最後，關於 D 部分，您對今年的情況持謹慎態度，但您根本沒有提到這一點。那麼，事情進展是否符合預期？

A.J., excuse me, thank you so much for the question. Let me ask Tim to respond.

A.J.，抱歉，非常感謝您的提問。我請蒂姆來回答一下。

Yes, good morning, A.J., thanks for the question. Yeah. So I'll hit those last two pieces first. So yeah, you're correct. We are really seeing this focused on our community Medicare Advantage and Group Medicare Advantage book.

是的，早安，A.J.，謝謝你的提問。是的。因此我將首先討論最後兩部分。是的，你是對的。我們確實看到這一點集中在我們的社區醫療保險優勢和團體醫療保險優勢書籍上。

So we're not seeing it on our chronic special needs population or our dually eligible population, also not seeing this care activity pattern in our newer members either new to Medicare or new to United. And the care activity items that we talked about last year, provider up coding and some of the pressures on specialty drugs, I'm not seeing that play into this either. Those elements are both tracking very much in line with how we've planned.

因此，我們在具有慢性特殊需求的人群或雙重合格人群中沒有看到這種情況，在我們新加入 Medicare 或 United 的新成員中也沒有看到這種護理活動模式。而我們去年討論的護理活動項目、提供者編碼以及一些特殊藥物的壓力，我也沒有看到這些影響。這些元素都按照我們的計劃進行。

And when you think about the split, it is slightly more pronounced on our group business. But if you think about our overall fee-for-service business, it's just, I would say, just slightly more than the contribution that you'd expect on the group side.

當你考慮分裂時，它在我們的集團業務中表現得更為明顯。但如果你考慮我們的整體收費服務業務，我想說，這只是比你預期的集團方面的貢獻略高一點。

And we -- while we certainly do see trends that suggest that where the premiums have increased and members are paying a high portion of that, that, that is where we're seeing this pointed pressure on care activity on the group business. However, it's very likely that some of the same underlying trends that are generating higher care activity patterns in individual community MA are also at play in the group business.

我們確實看到了一些趨勢，表明保費上漲，會員支付了很大一部分費用，這就是我們看到的團體業務護理活動面臨的明顯壓力。然而，在個人社區 MA 中產生更高護理活動模式的一些相同潛在趨勢很可能也在團體業務中發揮作用。

Great, thanks so much. Next question please.

太好了，非常感謝。請問下一個問題。

Lisa Gill, JP Morgan.

摩根大通的麗莎吉爾。

Very much and good morning. Andrew, I just want to go back to the path to the long-term growth rate. You reiterated that you feel confident you can get back there. With the 2026 rates looking better, we're going to move into the final year of V28. How do I think about what the key elements are to get back to that long-term growth rate?

非常感謝，早安。安德魯，我只是想回到長期成長率的道路。您重申您有信心能夠重返那裡。隨著 2026 年利率看起來更好，我們將進入 V28 的最後一年。我如何看待恢復長期成長率的關鍵因素是什麼？

Yeah, Lisa, thanks so much for the question. So yes, so clearly, we're pleased to see the beginning of recognition of rate increases, which actually reflect reality, which we haven't seen for the last couple of years. But that -- hopefully, that will continue to be the stance and the data will drive that in the way we saw this year.

是的，麗莎，非常感謝你提出這個問題。是的，顯然，我們很高興看到人們開始認識到升息，這實際上反映了現實，這是我們過去幾年從未見過的。但希望這將繼續成為我們的立場，並且數據將以我們今年看到的方式推動這一進程。

So very, very pleased to see that. Also pleased to see in the Medicaid books of business to continue to see great engagement with states as they also adjust to make sure that those rates are appropriate for what we're seeing.

看到這一幕我非常非常高興。也很高興地看到，醫療補助業務帳簿繼續與各州保持著良好的互動，各州也在進行調整，以確保這些費率適合我們所看到的情況。

So those are important. Obviously, next year, there will be a further step down in terms of pricing from the V28 model. So we can't ignore that. That's clearly reality. But the way we'd look at this, Lisa, is that we are very, very much -- we see very much the end of this transition period in terms of having to absorb the amount of pressure.

所以這些很重要。顯然，明年V28車型的定價將會進一步下降。所以我們不能忽視這一點。這顯然是現實。但是，麗莎，我們看待這個問題的方式是，我們非常非常——從必須承受的壓力來看，我們非常看到這個過渡期的結束。

I mean, clearly, we're a leader in all of this marketplace. We're taking almost certainly a bigger fraction, if you will, of the pressure because of our market leadership position here. We feel like we're very much getting through this. We, obviously, this year, have picked up these two or three second order derivative effects, which we're going to do a much better job of anticipating and managing for as we go into 2026.

我的意思是，顯然我們是整個市場的領導者。如果你願意的話，由於我們在這裡的市場領導地位，我們幾乎肯定會承受更大的壓力。我們感覺我們已經基本渡過了難關。顯然，今年我們已經發現了這兩三個二階導數效應，進入 2026 年，我們將更好地預測和管理這些效應。

And we think that an awful lot of the issue that we're seeing early in '25, we can fix in '25 and help us deliver stronger performance for '26, and we expect that to then be a kind of ramp into reacquiring our target growth rate momentum that we aspire to as an organization.

我們認為，我們在 2025 年初看到的許多問題都可以在 2025 年得到解決，並幫助我們在 2026 年取得更強勁的業績，我們預計這將成為我們重新獲得作為一個組織所追求的目標增長率勢頭的一種途徑。

Thank you very much. Next question.

非常感謝。下一個問題。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Yeah, hi, thanks. Just a follow-up on the trend discussion. Could you talk about where MA margins are now expected to shake out inside your 2025 guidance? And what you think is a reasonable timeline to recovering the target margins? And whether there's any change to what you're thinking is as a reasonable long-term margin target in this business? Post V28 and some of the issues you have adapting to it?

是的，嗨，謝謝。這只是對趨勢討論的後續。您能否談談目前預計的 MA 利潤率在 2025 年指導範圍內會出現什麼變化？您認為恢復目標利潤率的合理時間表是怎樣的？您認為該業務合理的長期利潤目標是否有任何變化？發布 V28 後，您在適應它時遇到了哪些問題？

And then again, my confidence that you can improve MA margins in 2026 if trend stays at this level? Thank you.

再說了，如果趨勢保持在這個水平，我有信心你能在 2026 年提高 MA 利潤率嗎？謝謝。

Steve, thanks so much. I'll ask Tim to respond to that.

史蒂夫，非常感謝。我會讓蒂姆對此作出回應。

Thanks, Stephen, for the question. So the margins that we're anticipating consistent with the changes we've announced today are still within our targeted margin range for Medicare Advantage for 2025. As we look forward to 2026 and we include the increases in care activity that we're seeing both in 2025 portion of our bid and also pricing for 2026. At this distance, we can accommodate those care activity levels and return to the historical planning target levels that we've always historically assumed.

謝謝史蒂芬提出這個問題。因此，我們預期的利潤率與我們今天宣布的變化一致，仍然在我們 2025 年醫療保險優勢計劃的目標利潤率範圍內。展望 2026 年，我們將護理活動的增加納入我們的出價中，包括 2025 年的部分以及 2026 年的定價。在這種距離下，我們可以適應這些護理活動水平，並回到我們歷史上一直假設的歷史規劃目標水平。

Great, thanks so much, Tim. Next question.

太好了，非常感謝，提姆。下一個問題。

Erin Wright, Morgan Stanley.

摩根士丹利的艾琳·賴特。

Great, thanks for taking my question. So on the policy front, I guess what is your latest thinking in terms of just PBM reform? Your model has obviously evolved on that front, but also Medicaid funding cuts and what sort of permutations you could you could anticipate there and your ability to navigate that?

太好了，感謝您回答我的問題。那麼在政策方面，我猜您對 PBM 改革的最新想法是什麼？您的模型顯然在這方面有所發展，但醫療補助資金削減也同樣如此，您可以預見哪些類型的變化，以及您應對這些變化的能力？

Yeah, Erin, thanks so much. Let me ask Patrick Conway to respond to you on the PBM side and then Krista maybe make a couple of comments on Medicaid, if that's okay. So Patrick?

是的，艾琳，非常感謝。我請帕特里克·康威 (Patrick Conway) 從 PBM 方面回答您的問題，然後克里斯塔 (Krista) 可以就醫療補助 (Medicaid) 發表一些評論，如果可以的話。那麼派崔克？

Yeah, thanks, Erin, for the question. So first, in terms of policy, we are leading in the marketplace with transparency, choice and affordability and we've had three major announcements that I think both helped drive the policy environment but also our reason we've had significant market growth. One, 100% commercial rebate pass-through, first large PBM to do that.

是的，謝謝艾琳提出這個問題。首先，在政策方面，我們在透明度、選擇性和可負擔性方面處於市場領先地位，我們已經發布了三項重要公告，我認為這不僅有助於推動政策環境，也是我們實現顯著市場成長的原因。一、100% 商業回饋轉嫁，第一家大型 PBM 這樣做。

And you're seeing that drive positive reaction in the marketplace, and it's removing any lingering doubt about our incentives. We want lower list prices and lower net prices, as Andrew said, Second, removing 25% of prior authorizations over 10% of reauthorizations, over 10% of prior authorizations, making the system simpler, better, easier for consumers and clinicians.

你會看到這在市場上引起了積極的反應，並消除了對我們的激勵措施的任何疑慮。我們希望降低標價和淨價，正如安德魯所說，其次，取消 25% 以上的先前授權、超過 10% 的重新授權、超過 10% 的先前授權，使系統更簡單、更好、更容易為消費者和臨床醫生所用。

And then third, cost-based reimbursement for pharmacies. And it's really important to know this is for all pharmacies, all drugs, all clients, rolling out. Already started in rolling out and put it across the entire book, and you heard from independent and community pharmacies their support of these changes.

第三，基於成本的藥房報銷。了解這一點非常重要，因為這適用於所有藥局、所有藥品、所有客戶。已經開始推廣並將其貫穿到整本書中，並且您聽到了獨立藥局和社區藥局對這些變化的支持。

The last thing I'd just call out just because it's new and it concerns us significantly is the Arkansas legislation that the governor signed yesterday around PBM and pharmacy ownership. We're honestly not sure what problem they're trying to solve, but let me be clear on the impact on patients. When you do that, we have general pharmacies in the state, providing integrated mental and behavioral health care. This could cut off access for those patients with things like schizophrenia, severe depression.

我最後要說的是，因為它是新法案，而且它讓我們非常關心，那就是阿肯色州州長昨天簽署的有關 PBM 和藥房所有權的法案。我們真的不確定他們想要解決什麼問題，但請讓我清楚地了解這對患者的影響。當你這樣做時，我們在州內設有綜合藥房，提供全面的心理和行為健康護理。這可能會切斷患有精神分裂症、嚴重憂鬱症等疾病的患者獲得治療的機會。

You have specialty medicine where we may have been serving a patient with cancer for years. And imagine that patient now not getting their medicine in their home. You have home infusions for elderly Americans or they may not be able to get out of their home, and we're providing their medication. And you have home delivery for people in rural parts of Arkansas. We're significantly concerned about this.

我們擁有專科醫療，可能已經為癌症患者服務多年。想像一下現在病人無法在家中得到藥物。你們為美國老年人提供家庭輸液服務，或者他們可能無法出門，我們會為他們提供藥物。您也可以為阿肯色州農村地區的人們提供送貨上門服務。我們對此非常擔憂。

We'll work with the state and the regulatory process post legislation to try to address those populations and maintain access. But we want you to hear clearly from us that our concern is about patients and maintaining access to patients across the nation to these medicines.

我們將與州政府合作，並在立法後進行監管，努力解決這些問題並保持人們的獲得醫療服務的機會。但我們希望您清楚地聽到我們所說的，我們關心的是患者，並保證全國各地的患者都能獲得這些藥物。

All right, Patrick. Thank you. Krista?

好的，派崔克。謝謝。克里斯塔？

Yeah. Thanks for the question. So on the Medicaid side, I think we won't speculate on any really specifics, but what I do want to emphasize is just regardless of any changes, our priority remains the health of our members and ensuring that they have access to high-quality coverage.

是的。謝謝你的提問。因此，在醫療補助方面，我認為我們不會對任何具體細節進行猜測，但我想強調的是，無論發生什麼變化，我們的首要任務仍然是確保會員的健康，並確保他們能夠獲得高品質的保險。

As it relates to our business, we have a really broad footprint across 32 states. We have a variety of programs and products and really decades of experience. So we remain confident in the value that managed care can provide to our state partners and our ability to support our states as they really navigate through any changes.

就我們的業務而言，我們的業務範圍遍布 32 個州。我們擁有各種各樣的項目和產品以及數十年的經驗。因此，我們仍然相信管理式醫療可以為我們的州合作夥伴提供的價值，以及我們支持各州應對任何變化的能力。

Krista, thanks so much. Just looping back to the pharmacy section. I think Patrick laid things out very well there, Erin, for you. But I also would just -- I was encouraged to see in the President's executive order earlier in the week, a kind of an interest in really looking at multiple elements of the pharmacy value chain. I think one of the things that has been honestly most disappointing over the last year or two is obsession with the role of the PBM versus everybody else in the system.

克里斯塔，非常感謝。剛剛回到藥房部分。艾琳，我認為派崔克為你把事情講得很清楚了。但我也很興奮地看到，本週早些時候總統發布的行政命令表達了對真正關注藥房價值鏈多個要素的興趣。我認為過去一兩年最令人失望的事情之一就是對 PBM 角色的痴迷，而不是系統中其他人的角色。

And if you read the EO carefully, what you'll see in there are quite good, sensible questions to explore what's going on either side of PBM in terms of the manufacturers and also ultimately, many of the providers in the network.

如果你仔細閱讀這份行政命令，你會看到其中提出了一些非常好的、合理的問題，這些問題可以探索 PBM 在製造商以及網路中的許多提供者方面的情況。

And I think what you'll see from that is the PBM plays a unique role in trying to bring down drug prices for Americans. It does that at very, very narrow margins, oftentimes taking very significant risk in the process and is really the only participant in the system that has that. It's -- the way a PBM wins more business is by successfully bringing down drug costs for its clients, and that's how it wins more accounts. That is not how the rest of the system operates.

我認為您從中會看到 PBM 在降低美國人藥品價格方面發揮獨特的作用。它以非常非常小的利潤率實現這一目標，並且經常在過程中承擔非常大的風險，而且它實際上是系統中唯一擁有這種能力的參與者。PBM 贏得更多業務的方式是成功降低客戶的藥品成本，這就是它贏得更多帳戶的方式。該系統的其餘部分並不是這樣運作的。

And I'm hopeful as the administration explores the questions that the EO raises that will become a much more thoughtful review of how to reform the whole value chain not simply one component where I think you can make very, very serious mistakes which could really damage patient access. So I was encouraged to see that from the administration.

我希望，隨著政府對行政命令提出的問題進行探討，將會對如何改革整個價值鏈進行更加深思熟慮的審查，而不僅僅是改革某個環節，我認為在某個環節中可能會犯下非常嚴重的錯誤，這可能會真正損害患者的就醫機會。因此，我很高興看到政府做出這樣的舉動。

Erin, thanks so much for the question. Next question.

艾琳，非常感謝你提出這個問題。下一個問題。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning. I was hoping to get your thoughts on the risks and implications of tariffs, particularly around the impact of pharmaceutical tariffs that are currently being contemplated by the administration? Thanks.

嗨，早安。我希望了解您對關稅的風險和影響的看法，特別是政府目前正在考慮的藥品關稅的影響？謝謝。

Yeah, Andrew, thanks so much for the question. Obviously, it's a dynamic situation in terms of what may happen around pharmaceutical tariffs are obviously going to be a process now where the administration goes through its analysis and investigation.

是的，安德魯，非常感謝你的提問。顯然，藥品關稅問題是一個動態的情況，政府現在顯然需要進行分析和調查。

So we obviously don't know what may or may not come from that. But when we look at our potential exposure to that, we feel pretty good. In fact, I'd say better than pretty good in terms of the degrees of price protection mechanisms we have in preexisting contracts.

所以我們顯然不知道這會帶來什麼或不會帶來什麼。但當我們考慮到我們可能面臨的風險時，我們感覺相當不錯。事實上，就我們現有合約中的價格保護機製而言，我認為已經比相當好更好了。

And also various pieces of legislation, which also limit the ability of manufacturers to pass price increases down through the system. So at this point, and again, given that we don't know what any tariff may or may not be. But when you look at the structure of the marketplace, we feel pretty well positioned for that, Andrew. Next question.

此外，還有各種立法也限制了製造商透過系統轉嫁價格上漲的能力。因此，就目前情況而言，我們再次強調，我們不知道關稅可能是什麼或可能不是什麼。但是當你觀察市場結構時，你會發現我們已經做好了充分的準備，安德魯。下一個問題。

Dave Windley, Jefferies.

戴夫·溫德利（Dave Windley），傑富瑞集團（Jefferies）。

Hi, good morning. Thanks for taking my question, Andrew, I appreciate your comments about kind of the macro cost of health care in the United States. We have an administration that seems more focused on budget deficit reduction, which entails cutting to health care. I guess my philosophical question here is why isn't modest, persistent underfunding of the system the right way to get those costs more in balance and to force innovation in the system?

嗨，早安。感謝您回答我的問題，安德魯，我很欣賞您對美國醫療保健宏觀成本的評論。我們的政府似乎更注重削減預算赤字，這意味著削減醫療保健經費。我想我在這裡的哲學問題是，為什麼適度、持續地減少系統資金不是使這些成本更加平衡並推動系統創新的正確方法？

And how does United operate in an environment that might bring that without having the snafus or whatever that like a V28 model brings?

那麼，美聯航如何在可能出現這種情況的環境中運營，而不會出現像 V28 機型那樣的混亂或其他問題？

So David, thanks so much for the question. And I think it's a good and deep question, actually. So there's no question that we -- what I think we need is continued strong innovation in new approaches of how to bring together different elements of the system to have a more patient-centered impact on health care. One of the characteristics, I think, of the -- of all health care marketplaces, but perhaps particularly the US is there are -- there is no shortage of innovation, but it tends to be point solutions, whether it's a new device or a new drug or a new model of care, these things tend to show up in very isolated way.

大衛，非常感謝你提出這個問題。事實上，我認為這是一個很好的、很深刻的問題。所以毫無疑問，我認為我們需要的是繼續大力創新新方法，將系統的不同要素整合在一起，從而對醫療保健產生更加以患者為中心的影響。我認為，所有醫療保健市場（尤其是美國）的一個特點是，不缺乏創新，但往往是點解決方案，無論是新設備、新藥物還是新的護理模式，這些東西往往以非常孤立的方式出現。

So we spend a lot of money on innovation in America, but we don't see the yield of that innovation. And I would argue that because it's not brought together. We don't align incentives. We don't really rethink workflows. We don't try and send everything around what gives you the best outcome for the patient over the lifetime of the patient, not just this encounter or even this year, how do you make that patient -- or how do you give that patient the opportunity for maximum numbers of great health years.

因此，我們在美國投入了大量資金進行創新，但卻沒有看到創新的成果。我認為這是因為它沒有結合在一起。我們沒有統一激勵措施。我們實際上並沒有重新考慮工作流程。我們不會嘗試把所有事情都圍繞著為患者一生帶來最好的結果，不僅僅是這次就診，甚至是今年，你如何讓那個患者——或者你如何讓那個患者有機會享受最長的健康年限。

That, for me, should be the guiding principle. And that's what value-based care is about, and it's what UnitedHealth Group is committed to innovate and drive behind. And I think we have made extraordinary progress in that. Now unfortunately, what we've seen through V28 is almost focused the price cut where the most innovation is going on. So you've seen this pressure come exactly into the program where historically, the government has funded Medicare Advantage and created a very thoughtful system, which incentivizes participants.

對我來說，這應該是指導原則。這就是基於價值的醫療照護的意義所在，也是聯合健康集團致力於創新和推動的。我認為我們在這方面取得了非凡的進步。現在不幸的是，我們透過 V28 看到的幾乎都集中在降價上，而降價正是創新最多的部分。所以你已經看到這種壓力恰恰出現在該計劃中，從歷史上看，政府一直資助醫療保險優勢計劃，並創建了一個非常周到的系統，以激勵參與者。

The only way a participant can win in Medicare Advantage is to incentivize, be able to deliver a great care experience and access experience for the member, release enough costs through efficiencies to provide benefits to members and then pay a rebate back to the government, right?

參與者在醫療保險優勢計劃中獲勝的唯一方法是激勵，能夠為會員提供良好的護理體驗和訪問體驗，透過提高效率釋放足夠的成本來為會員提供福利，然後將回扣返還給政府，對嗎？

So everybody wins in that system. And that was a very cleverly designed system by the government many years ago. It's been supported by multiple administrations of both directions since then. What we saw through V28 was really a kind of blunt instrument approach to just take money out of that system. And that's what's causing the disruption here.

因此，在這個系統中每個人都是贏家。這是政府多年前設計的非常巧妙的系統。自那時起，它得到了雙方多屆政府的支持。我們透過 V28 看到的其實是一種直接利用工具的方法，目的只是為了從系統中榨取金錢。這就是造成這裡混亂的原因。

So I don't think any -- we would never have any anxiety about saying, look, we want to see the health care budget grow by less each year. But then we should look at the whole budget. We should look at the whole system and we should look at how we can use tools to do that. What we know is that Medicare Advantage cost less than traditional Medicare.

所以我不認為——我們永遠不會擔心說，看，我們希望看到醫療保健預算每年的增長速度變慢。但我們應該看看整個預算。我們應該審視整個系統，並研究如何使用工具來做到這一點。我們知道的是，Medicare Advantage 的費用低於傳統 Medicare。

We know that when a Medicare Advantage patient is in a fully delegated value-based care managed clinic like Optum Health, they will save even more money for the system, and they will have better personal experience, they have better clinical outcomes and the government spends less money. It's those sorts of integrated approaches, which we think are the response.

我們知道，當醫療保險優勢計劃 (Medicare Advantage) 的患者在像 Optum Health 這樣完全委託的價值型護理管理診所就診時，他們將為系統節省更多資金，並且擁有更好的個人體驗、更好的臨床結果，而政府花費的錢更少。我們認為這些綜合方法就是應對之策。

And it's a bit -- I made that comment about the President's executive order on pharmacy, and I kind of invite the same, we should be thinking about the whole system and how we align the whole system, not simply looking at these kind of individual component approaches, which we've seen over the last few years.

這有點——我對總統關於藥房的行政命令發表了評論，我有點邀請同樣的想法，我們應該考慮整個系統以及如何協調整個系統，而不是簡單地看這些單獨的組件方法，我們已經在過去幾年中看到了。

And I hope very much that just like the pharmacy agenda that the President is laying out for understanding that we might have a similar one here, and that would be very positive because the answer to your question is yes, we should be able to deliver great health care at lower cost with better experience, better clinical outcome for people and for the government.

我非常希望，就像總統為理解而製定的藥房議程一樣，我們在這裡也可能有一個類似的議程，這將是非常積極的，因為對你的問題的回答是肯定的，我們應該能夠以更低的成本提供優質的醫療服務，為人民和政府提供更好的體驗、更好的臨床結果。

And that is what the mission of UHG is. And that is what the goal of value-based care and Optum Care is also. Next question?

這就是 UHG 的使命。這也是基於價值的照護和 Optum Care 的目標。下一個問題？

Ben Hendrix, RBC Capital Markets.

加拿大皇家銀行資本市場 (RBC Capital Markets) 的 Ben Hendrix。

Hi, thank you very much. I wonder if we could touch briefly on Medicaid. Just wanted to get an update on what you're seeing from state renewals through April. And if we're still on track to close that rate acuity gap by the end of the year? Thanks.

你好，非常感謝。我想知道我們是否可以簡單談談醫療補助。只是想了解一下截至四月份的州更新。我們是否仍有望在今年年底前縮小利率敏銳度差距？謝謝。

Ben, thanks so much for the question. I'm going to Krista to answer that for you.

本，非常感謝你的提問。我會讓克里斯塔來為你解答這個問題。

Yeah. Thanks for the question. We were encouraged with the progress that we made on rates in the second half of 2024, which really continued into our 1/1 rate cycle. And as John and Andrew both mentioned, overall, the gap between acuity of the population and the rate funding is really narrowing with each cycle as well as through some off-cycle adjustments that we have seen. We have -- it's really too early to call the rates on 7/1, about 35% of our revenue renews in that 7/1 cycle.

是的。謝謝你的提問。我們對 2024 年下半年在利率方面取得的進展感到鼓舞，這種進展實際上延續到了我們的 1/1 利率週期。正如約翰和安德魯都提到的那樣，總體而言，隨著每個週期以及我們所看到的一些非週期調整，人口敏銳度和利率資金之間的差距確實在縮小。我們已經—現在預測 7 月 1 日的利率還為時過早，我們約有 35% 的收入在 7 月 1 日週期內更新。

And with each cycle, that base data continues to reflect more recent experience. And so we remain optimistic with the collaborative relationships we have with our states that over the course of the year that this gap will continue to narrow.

隨著每個週期的進行，基礎數據不斷反映出更新的經驗。因此，我們對與各州的合作關係保持樂觀，並相信在未來一年內這一差距將繼續縮小。

Krista, thanks so much. Next question.

克里斯塔，非常感謝。下一個問題。

Lance Wilkes, Bernstein.

蘭斯威爾克斯、伯恩斯坦。

Great, thanks. Could you talk a little bit about the first quarter MLR impacts? And maybe breaking out the impacts that were driven by the premium increases that you described and maybe any sort of deductible increases. But also, were there impacts as a result of the way in which you're approaching prior authorization, any changes in that?

太好了，謝謝。您能否談談第一季 MLR 的影響？也許可以分解出您所描述的保費上漲以及任何類型的免賠額上漲所帶來的影響。但是，您處理事先授權的方式是否也會產生影響，有任何改變嗎？

And then do you have a sense as to maybe increased follow-through from your house calls and primary care actions as far as getting follow-up visits tied to risk adjustment activity. And lastly, were there any onetime good guys in the first quarter, which perhaps supported medical loss ratio and caused the distinction between 1Q versus guidance?

那麼，您是否認為，就與風險調整活動相關的後續訪問而言，您的上門服務和初級保健行動的後續行動可能會增加。最後，第一季是否出現了一些曾經的好人，這可能支持了醫療損失率並導致了第一季與指導之間的區別？

Thanks so much, Lance. John Rex.

非常感謝，蘭斯。約翰·雷克斯。

Good morning, Lance. Just to your last part, no, there were no onetime good guys in the quarter that would have supported that. So a few things just to point out of that. So your first point on any shifts on pre-authorization procedures or anything element like that impacting? No, nothing from that element there. Tim noted that certainly, we had much higher -- in addition to the group, which was a big factor, we had a much higher level of wellness business in the quarter.

早安，蘭斯。就你的最後一部分而言，不，本季沒有曾經的好人會支持這一點。有幾點需要指出。那麼，您首先要問的是預授權程序的任何變更或任何類似影響因素？不，那裡沒有那個元素。提姆指出，除了集團這個重要因素之外，我們本季的健康業務水準也高得多。

Those aren't the factor, though. They're super effective. They're not costly. They do drive specialty care, however, a lot of follow-on specialty care. And what we don't know is -- was that something seasonal then?

但這些都不是關鍵因素。它們非常有效。它們並不昂貴。然而，他們確實推動了專科護理，以及大量的後續專科護理。我們不知道的是──那是不是季節性的？

Is that slightly altered seasonal pattern, but so many -- that we saw so much activity and wellness visits in some populations, frankly, certain populations that 2 times the year ago levels of wellness visits. Other is about 50%, but it was broad-based in terms of that activity.

這是一個略微改變的季節性模式，但如此之多——我們看到某些人群的活動和健康訪問如此之多，坦率地說，某些人群的健康訪問量是去年同期的兩倍。其他約為 50%，但就該活動而言，其基礎廣泛。

So that was certainly an element in there. An element well known to all of you also just the change in seasonality due to the IRA driven Part D changes. Think of that as about roughly 90 basis points of impact or so in the quarter also. So that would have been an element versus kind of what you would have typically seen. And I think I know you were well aware that was kind of be a factor as we moved into this.

所以這肯定是其中的一個因素。大家所熟知的一個因素就是由於 IRA 驅動的 D 部分變化而導致的季節性變化。可以認為這在本季的影響也約為 90 個基點左右。因此，這將是一個與你通常所見不同的元素。我想我知道您很清楚這是我們進入這一階段時的一個因素。

I'm not sure that was a factor that was well anticipated in all the -- kind of all the analyst models out there for a lot of good reasons, but those IRA impacts in that zone. Certainly, kind of the Medicare funding reduction, you go into that second year of V28, also impactful of that. I think that is roughly in the 60 basis point zone. Just so I can go through a lot of elements there. But those are kind of the key factors.

我不確定這是否是所有分析師模型中都預料到的因素，因為有很多充分的理由，但 IRA 會對該區域產生影響。當然，進入 V28 的第二年，醫療保險資金的削減也會產生影響。我認為這大約在 60 個基點區域。這樣我就可以了解那裡的許多元素。但這些都是關鍵因素。

But far and away, the increased utilization and the member profile elements that we've highlighted throughout the course of this call, being by far the most impactful things in the quarter.

但毫無疑問，我們在整個通話過程中強調的利用率的提高和會員資料元素是本季迄今為止最具影響力的事情。

Thanks, John. Thanks so much. Next question.

謝謝，約翰。非常感謝。下一個問題。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，費茲傑拉領唱者。

Thank you. I just want to circle back to the tariff question quickly. Are the penalties under the IRA for pharma manufacturers who raised price above inflation enough to protect you from tariff pass-through on Medicare? And I'm not sure if that implies exchanges as well. But with those bids do earlier, like April to June, do you have to assume that tariffs are in place? Or do you think the states will give you some flexibility to submit two versions of bids with and without tariffs?

謝謝。我只是想快速回到關稅問題上。根據《個人退休帳戶法》，對那些將價格提高到高於通貨膨脹率的製藥商的處罰是否足以保護您免受醫療保險關稅轉嫁的影響？我不確定這是否也意味著交流。但是，如果這些投標是在 4 月至 6 月早些時候進行的，您是否必須假設關稅已經到位？或者您認為各州會給予您一定的彈性，讓您提交包含和不包含關稅的兩個版本的投標嗎？

Listen, Sarah, thanks so much for the question. So as I said earlier, obviously, we -- like you, we don't know yet what if, when might happen in this territory. So like you, we're watchfully waiting. As you alluded to, there's many kind of layers of government protection, if you will, within the regulations that sit over the drug companies in terms of their ability to increase price above inflation. There are things like Medicaid best price protections, specifically in the Medicaid area, which would also have potential applications here.

聽著，莎拉，非常感謝你提出這個問題。所以，正如我之前所說的，顯然，我們──像你們一樣，我們還不知道什麼時候會發生這種事。因此，像您一樣，我們也在密切關注。正如您所提到的，在監管製藥公司價格超過通貨膨脹率的能力方面，政府提供了許多層保護。諸如醫療補助最佳價格保護之類的措施，特別是在醫療補助領域，在這裡也可能有應用。

And then, of course, we have our various Optum Rx, where relevant in this conversation have their own contractual price protection. So there are multiple layers of that. Obviously, we're going to be very careful making sure that we bid in the context of that kind of mesh of protection and make sure that we do that as thoughtfully as we possibly can.

當然，我們有各種 Optum Rx，在本次對話中相關的部分都有自己的合約價格保護。因此，這其中存在多個層次。顯然，我們會非常小心，確保我們在這種保護網的背景下進行投標，並確保我們盡可能周到地進行投標。

But I just also just want to reiterate, like everybody else, we don't know yet what the reality of this is, but we're very attuned to it. And I think I've tried to share with you our sense that it should not be a significant exposure for us, but certainly not this year, and we'll be working very thoughtfully about bids and the rest, as you suggest for next year. We have time for just one last question.

但我也想重申，和其他人一樣，我們還不知道事實究竟如何，但我們對此非常關注。我想我已經嘗試與你們分享了我們的想法，即這對我們來說不應該是一個重大的風險，但肯定不是今年，我們將非常認真地考慮投標和其他事項，正如你們對明年的建議一樣。我們只剩下時間回答最後一個問題了。

Jessica Tassan, Piper Sandler.

傑西卡·塔桑、派珀·桑德勒。

Hi guys, thank you so much for the question. I wanted to ask about -- so UHC has achieved really phenomenal growth in MA year-to-date, up 521,000 members through April. Almost half of that growth has come from C-SNP plans. So just wondering if you all can elaborate on UHC's dominance in the C-SNP market? Do these plans offer the beneficiary? Why is UHC been so successful in this segment?

大家好，非常感謝你們的提問。我想問一下——今年迄今為止，UHC 在 MA 取得了真正驚人的增長，截至 4 月份會員人數增加了 521,000 人。其中近一半的成長來自 C-SNP 計劃。所以想知道你們是否可以詳細說明 UHC 在 C-SNP 市場中的主導地位？這些計劃是否為受益人提供福利？為什麼 UHC 在這領域如此成功？

And what does C-SNP enrollment mean from an economic perspective for UHC in 2025 and then over the long term? Thanks.

從經濟角度來看，C-SNP 登記對於 2025 年及以後的 UHC 意味著什麼？謝謝。

Yeah, Jessica, thanks so much. I'll ask Bobby Hunter, who looks after our M&R business to respond to that. Bobby?

是的，傑西卡，非常感謝。我會請負責我們 M&R 業務的 Bobby Hunter 對此作出回應。鮑比？

Yeah. Thanks, Jessica, for the question. So I would say, really, just overall, we're very pleased with our year-to-date growth in Medicare Advantage. And as you know, we continue to be on track to deliver on the full year growth target of up to 800,000 members. The momentum we had in AEP carried over really nicely into OEP, including notably strong retention of our existing members.

是的。謝謝傑西卡提出這個問題。所以我想說，總的來說，我們對今年迄今為止醫療保險優勢計劃的成長感到非常滿意。如您所知，我們將繼續按計劃實現全年會員人數增長至 80 萬的目標。我們在 AEP 中取得的進展順利地延續到了 OEP，包括顯著增強了我們現有會員的保留率。

And then really diversified growth across our community HMO plans, full dual plans and the plans you mentioned that are designed for members of chronic conditions. So really both from a mix and volume standpoint, we feel really good about where we sit in '25 and the outlook that, that gives us around the membership growth.

然後，我們的社區 HMO 計劃、全面雙重計劃以及您提到的專為慢性病患者設計的計劃真正實現了多元化增長。因此，無論從組合或數量的角度來看，我們對 25 年的狀況以及會員成長前景感到非常滿意。

And I would just note really the Medicare Advantage plans that we offer, the great work that we do from a value-based care integration standpoint with a collection of our providers, both internal and external really position us well to manage these members with chronic complex conditions, and we're very proud to continue to get to serve more of those members as we progress throughout the year. Thanks so much for the question.

我想指出的是，我們提供的醫療保險優勢計劃，以及我們從基於價值的護理整合角度與一系列內部和外部提供者所做的出色工作，確實使我們能夠很好地管理這些患有慢性複雜疾病的會員，我們非常自豪能夠在全年的進步中繼續為更多的會員提供服務。非常感謝您的提問。

Bobby, thanks so much. And I'd like to thank everybody for all of your questions. We appreciate your engagement very much today. While we're not satisfied with our performance to the start of 2025, I hope you've heard today our determination to improve and our enthusiasm about the path forward.

鮑比，非常感謝。我要感謝大家提出的所有問題。我們非常感謝您今天的參與。雖然我們對 2025 年初的表現並不滿意，但我希望您今天聽到了我們改進的決心和對前進道路的熱情。

We remain deeply committed to the value-based care strategy of the company, and we believe that, that is way to solve many of America's health care problems, both from a cost, but most importantly, from a patient experience and outcome perspective.

我們仍然堅定地致力於公司基於價值的醫療策略，我們相信，這是解決美國許多醫療保健問題的方法，不僅從成本角度，而且最重要的是從患者體驗和結果的角度。

And I think you -- many of you who know United well will also know and recognize that when we encounter an issue, we figure out how to work it and how to deal with it. And rest assured, we all at United are going to work our issues that we've encountered in the first quarter, solve them, and you should count on us to continue to strive towards delivering for everybody we serve and to make sure that the growth of this company returns to the kind of ranges that you would expect of us. With that, I'd like to thank everybody for your time today, and we appreciate it.

我想你們——你們中許多熟悉美聯航的人也會知道並認識到，當我們遇到問題時，我們會想辦法解決它，如何處理它。請放心，我們美聯航的所有人都會努力解決我們在第一季遇到的問題，您應該相信我們將繼續努力為我們服務的每個人提供服務，並確保公司的成長恢復到您期望的範圍。最後，我要感謝大家今天的時間來參加，我們對此表示感謝。

And ladies and gentlemen, this concludes today's call. Thank you for your participation. You may now disconnect, and have a great day.

女士們、先生們，今天的電話會議到此結束。感謝您的參與。現在您可以斷開連接，並享受美好的一天。