聯合健康 (UNH) 2021 Q4 法說會逐字稿

Good morning, and welcome to the UnitedHealth Group Fourth Quarter and Full Year 2021 Earnings Conference Call. A question-and-answer session will follow UnitedHealth Group prepared remarks. As a reminder, this call is being recorded.

早上好，歡迎參加聯合健康集團 2021 年第四季度和全年收益電話會議。問答環節將在聯合健康集團準備好的發言之後進行。提醒一下，此通話正在錄音中。

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

以下是一些重要的介紹性信息。本次電話會議包含美國聯邦證券法下的前瞻性陳述。這些陳述受到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存在重大差異。一些風險和不確定性的描述可以在我們向證券交易委員會提交的報告中找到，包括我們當前和定期提交的文件中的警示性聲明。

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. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated January 19, 2022, which may be accessed from the Investor Relations page of the company's website.

本次電話會議還將參考非公認會計原則金額。非 GAAP 與 GAAP 金額的對賬可在 www.unitedhealthgroup.com 公司投資者關係頁面的財務和收益報告部分獲得。本次電話會議中提供的信息包含在我們今天上午發布的收益發布和我們日期為 2022 年 1 月 19 日的 8-K 表格中，可從公司網站的投資者關係頁面訪問。

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

我現在將把會議轉交給聯合健康集團的首席執行官 Andrew Witty。

Thank you. Good morning, and thank you all for joining us today. I'd like to start by recognizing our colleagues, the people of Optum and UnitedHealthcare, for delivering strong results throughout 2021 and creating the momentum that is carrying us through as we enter into this year. For example, performance in two key elements of our growth strategy, accelerating the transition of patients to Optum-led value-based care and strong United Healthcare growth in serving Medicare Advantage consumers, are both tracking well with the expectations we shared with you at our recent investor conference.

謝謝你。早上好，感謝大家今天加入我們。首先，我想感謝我們的同事 Optum 和 UnitedHealthcare 的員工，他們在 2021 年全年取得了驕人的成績，並在我們進入今年時創造了推動我們前進的動力。例如，我們增長戰略的兩個關鍵要素的表現，即加快患者向 Optum 主導的基於價值的護理的過渡，以及 United Healthcare 在服務 Medicare Advantage 消費者方面的強勁增長，都與我們在我們的最近的投資者會議。

These, and the broader performance across the enterprise, confirm our confidence in our ability to advance our stated growth strategies and to support our long-term 13% to 16% EPS growth rate. When you look back at the prevailing themes for 2021, you see a story of accelerating growth, strong collaboration between Optum and UnitedHealthcare and with our many external partners helped us grow in serving both commercial and government markets, unlock new innovation, introduce integrated products and services to the marketplace and significantly increased the number of people benefiting from value-based models of care.

這些，以及整個企業的更廣泛表現，證實了我們對推進既定增長戰略並支持我們長期 13% 至 16% 每股收益增長率的能力的信心。當您回顧 2021 年的主流主題時，您會看到一個加速增長的故事，Optum 與 UnitedHealthcare 之間以及與我們的許多外部合作夥伴之間的強大合作幫助我們在服務商業和政府市場、解鎖新創新、引入集成產品和市場服務，並顯著增加了受益於基於價值的護理模式的人數。

Last year, we leveraged our technology capabilities to help physician and hospital systems better serve their patients and communities. And we sharpened our focus on the consumer, working to elevate and improve the end-to-end experience. Taken together, these efforts helped us add more than $30 billion in revenue for the year, about $10 billion above our initial outlook.

去年，我們利用我們的技術能力幫助醫生和醫院系統更好地為患者和社區服務。我們加強了對消費者的關注，努力提升和改善端到端體驗。總之，這些努力幫助我們在今年增加了超過 300 億美元的收入，比我們最初的預期高出約 100 億美元。

And you should expect similar growth in the year ahead. We see an even greater demand for integration to bring together the fragmented pieces of the health system, to harness the tremendous innovation occurring in the marketplace, to help better align the incentives for providers, payers and consumers and to organize the system around value. A health care system that is more connected, more informed, more human and more responsive to every person's unique needs.

你應該預計來年會有類似的增長。我們看到對整合的更大需求，以將分散的衛生系統整合在一起，利用市場上發生的巨大創新，幫助更好地調整對提供者、支付者和消費者的激勵，並圍繞價值組織系統。一個聯繫更緊密、信息更豐富、更人性化、更能響應每個人獨特需求的醫療保健系統。

At our investor conference, we shared five key areas for growth and for differentiated experiences across our portfolio. These growth opportunities will guide our strategy this year and for many years to come. First is care delivery, more specifically, value-based care. For UnitedHealth Group, this is more than a primary care strategy. It's a comprehensive clinical strategy encompassing our growing behavioral, home, ambulatory and virtual care capabilities.

在我們的投資者會議上，我們分享了五個關鍵增長領域以及我們投資組合中的差異化體驗。這些增長機會將指導我們今年和未來許多年的戰略。首先是護理服務，更具體地說，是基於價值的護理。對於聯合健康集團而言，這不僅僅是一項初級保健戰略。這是一項全面的臨床戰略，涵蓋了我們不斷增長的行為、家庭、門診和虛擬護理能力。

Our second growth area is health benefits, advancing the quality, innovation and consumer appeal of our benefit offerings and bringing our value-based strategy to life. We enter '22 having generated strong consumer growth in Medicare Advantage and saw further progress in Medicaid and growing momentum in our commercial business.

我們的第二個增長領域是健康福利，提高我們福利產品的質量、創新和消費者吸引力，並將我們基於價值的戰略付諸實踐。我們進入 '22，在 Medicare Advantage 中產生了強勁的消費者增長，並看到了 Medicaid 的進一步進展和我們商業業務的增長勢頭。

Next, health technology. Our major partnerships across the country help health systems improve their performance and returns, all to better support their missions. We're energized by the potential to bring these comprehensive tailored solutions to a greater number of system partners in 2022 and beyond. Fourth, health financial services, vastly improved in the health payment sector, streamlining and simplifying payments for providers, payers and consumers while reducing friction and increasing speed and convenience.

其次，健康科技。我們在全國各地的主要合作夥伴關係幫助衛生系統提高績效和回報，所有這些都是為了更好地支持他們的使命。我們對在 2022 年及以後將這些全面的定制解決方案帶給更多系統合作夥伴的潛力感到振奮。第四，健康金融服務，在健康支付領域得到了極大的改善，簡化了提供者、支付者和消費者的支付，同時減少了摩擦，提高了速度和便利性。

And finally, pharmacy services, where people interact most often with the health care system. We can better use the significant breadth, volume and value of our foundational pharmacy services and data capabilities and integrate our medical pharmacy and behavioral capabilities, all of this to provide whole person care, support the discovery of new drugs and treatments and support value-based models of care.

最後是藥房服務，人們最常與醫療保健系統互動的地方。我們可以更好地利用我們基礎藥學服務和數據能力的顯著廣度、數量和價值，並整合我們的醫療藥學和行為能力，所有這些都可以提供全人護理，支持新藥和治療的發現，並支持基於價值的護理模型。

In sum, we enter 2022 with heightened confidence in our ability to execute upon the objectives we set forth in late November. And with that, I'll turn it over to President and Chief Operating Officer, Dirk McMahon.

總之，進入 2022 年，我們對實現 11 月下旬制定的目標的能力充滿信心。有了這個，我將把它交給總裁兼首席運營官 Dirk McMahon。

Thank you, Andrew. I thought I would take a few minutes providing you with some additional details on our first growth priority: value-based care, how we have prepared for it, the investments we have made and how we see it working in the near future. This has been something we have been working on and building over the course of a decade.

謝謝你，安德魯。我想我會花幾分鐘時間為您提供一些關於我們的首要增長優先事項的更多細節：基於價值的護理、我們如何為此做好準備、我們所做的投資以及我們如何看待它在不久的將來會發揮作用。這是我們十年來一直在努力和建設的東西。

For example, there was significant operational groundwork and investment that went into supporting the 0.5 million new patients for whom OptumHealth will become accountable in 2022. Successful execution requires a lot of detailed planning, investing and building. It has become a distinctive competency of our enterprise, which we can now increasingly apply at scale.

例如，為了支持 50 萬新患者，OptumHealth 將在 2022 年對其負責，投入了大量的運營基礎工作和投資。成功執行需要大量詳細的規劃、投資和建設。它已成為我們企業的一項獨特能力，我們現在可以越來越多地大規模應用它。

So what does it take to prepare for moving to a fully accountable arrangement? Investments can be significant. As an example, in '21, we incurred over $100 million in preparation expense. Within this, there are three major work streams involved: clinical training and staff preparation, technology and data enhancement and third is network coordination.

那麼，為轉向完全負責任的安排需要做些什麼準備呢？投資可能很重要。例如，在 21 年，我們產生了超過 1 億美元的準備費用。其中涉及三個主要工作流：臨床培訓和人員準備，技術和數據增強，第三是網絡協調。

The first work stream focuses on physician education. It begins well more than a year prior. It's important to provide the resources and knowledge for physicians to begin approaching their patients differently. They engage in their patients' whole health, well ahead of taking on greater accountability. We find it to be an essential and sometimes complex shift in what our long-held fee-for-service practices. Beyond education, we ramp up our capacity in the form of physicians, nurses and other clinicians to meet the requirements of our business.

第一個工作流側重於醫師教育。它開始於一年多前。為醫生提供資源和知識以開始以不同的方式對待患者非常重要。他們在承擔更大的責任之前就參與了患者的整體健康。我們發現這是我們長期以來的按服務收費做法的重要轉變，有時甚至是複雜的轉變。除了教育之外，我們還以醫生、護士和其他臨床醫生的形式提高我們的能力，以滿足我們的業務需求。

The second area focuses on the technology systems and information needed to support patient care and effective clinical management. This includes things like patient portals and utilization management systems as well as reporting systems for teams to effectively manage.

第二個領域側重於支持患者護理和有效臨床管理所需的技術系統和信息。這包括患者門戶和利用率管理系統以及團隊有效管理的報告系統等內容。

Finally is the planning and network coordination work to support clinical oversight beyond primary care and ensure true continuity of care. This planning and coordination includes initiatives such as identifying the patients most in need and ensuring a seamless transition to high-touch clinical care services that improve health and quickly pairing patients with a personal care navigator to assist in supporting complex health needs, appointment scheduling and timely medication support on day 1.

最後是規劃和網絡協調工作，以支持初級保健以外的臨床監督並確保真正的護理連續性。這種規劃和協調包括諸如識別最需要的患者並確保無縫過渡到改善健康的高接觸臨床護理服務以及快速將患者與個人護理導航器配對以協助支持複雜的健康需求、預約安排和及時等舉措第 1 天的藥物支持。

These foundational preparations and investments have been critical in creating strong results across the variety of geographies and practices we have transitioned. We expect this expertise will serve us well as we transition even larger groups of patients in the years to come.

這些基礎準備和投資對於在我們過渡的各種地區和實踐中創造強勁的結果至關重要。我們預計，隨著我們在未來幾年過渡到更大的患者群體，這種專業知識將為我們提供良好的服務。

Before handing it over to John, I'd like to update you on how COVID has impacted our operations. Like other businesses, we have experienced moderately higher levels of attrition and more unplanned absences. We had prepared for this situation through increased recruiting capacity as well as meaningfully upgraded digital capabilities to improve customer experience and reduce call volumes. As a result, in the first 2 weeks of '22, traditionally our most demanding period, we were able to service the needs of our patients and customers.

在將其移交給 John 之前，我想先向您介紹一下 COVID 如何影響我們的運營。與其他企業一樣，我們的員工流失率和計劃外的缺勤率也較高。我們已通過增加招聘能力以及有意義地升級數字能力來改善客戶體驗並減少呼叫量，從而為這種情況做好了準備。因此，在 22 年的前 2 週，傳統上我們最苛刻的時期，我們能夠滿足患者和客戶的需求。

At the same time, we responded swiftly to the federal mandate for cash-free COVID test for consumers, a highly complex undertaking. With 4 days' notice, UnitedHealthcare created a customer digital experience for ease of reimbursement and established a partnership with Walmart and now Rite Aid that eliminates cash outlays by consumers at point of purchase. We expect more partnerships in the days ahead.

同時，我們迅速響應了聯邦對消費者進行無現金 COVID 測試的要求，這是一項非常複雜的任務。提前 4 天通知，UnitedHealthcare 創造了客戶數字體驗以方便報銷，並與沃爾瑪和現在的 Rite Aid 建立了合作夥伴關係，消除了消費者在購買時的現金支出。我們期待在未來的日子裡有更多的合作夥伴關係。

As we look forward, we believe we have the right capacity in place to execute our business priorities and meet our customers' expectations. With that, now I'll turn it over to Chief Financial Officer, John Rex.

展望未來，我們相信我們有適當的能力來執行我們的業務重點並滿足客戶的期望。有了這個，現在我將把它交給首席財務官約翰雷克斯。

Thank you, Dirk, and Happy New Year, everyone. I'll start by expanding a bit upon Dirk's comments on the COVID impacts we're seeing. In the most recent weeks, inpatient hospitalization levels for our members are similar to the January 2021 levels, even with national COVID case rates about 4x higher. For those people needing inpatient care, severity is seemingly lower as we are seeing shorter lengths of stay compared to that earlier period.

謝謝你，德克，大家新年快樂。我將首先擴展 Dirk 對我們所看到的 COVID 影響的評論。在最近幾週，我們會員的住院住院水平與 2021 年 1 月的水平相似，即使全國 COVID 病例率高出約 4 倍。對於那些需要住院治療的人來說，嚴重程度似乎較低，因為與早期相比，我們看到的住院時間較短。

At the same time, we are observing familiar correlations of care activity patterns to other periods of elevated infection rates experienced over the past 2 years. For example, in these early weeks of January, we are seeing slowing in primary care, elective visit and procedural volumes. Activity over the past several weeks shows primary care visits having declined about 10% and an even higher rate of decline in specialist visits. As always, our prime focus is on helping people get the care they need when they need it.

同時，我們觀察到護理活動模式與過去 2 年經歷的其他感染率升高時期之間熟悉的相關性。例如，在 1 月初的這幾週，我們看到初級保健、擇期就診和手術量都在放緩。過去幾週的活動表明，初級保健就診下降了約 10%，專家就診的下降率甚至更高。與往常一樣，我們的主要重點是幫助人們在需要時獲得所需的護理。

Moving now to our specific business performance. OptumHealth's revenue per consumer grew by over 30% in '21, driven by the increasing number of our patients served under value-based arrangements. Consistent with the expectations we shared in late November, we had a strong start to the year and continue to expect to add 500,000 new patients in accountable value-based relationships, benefiting from the groundwork laid over the past many years.

現在轉到我們的具體業務績效。 OptumHealth 的每位消費者收入在 21 年增長了 30% 以上，這得益於我們在基於價值的安排下服務的患者數量不斷增加。與我們在 11 月下旬分享的預期一致，我們在今年有一個強勁的開端，並繼續期望在基於責任的基於價值的關係中增加 500,000 名新患者，這將受益於過去多年奠定的基礎。

OptumInsight's earnings grew 25% in '21, with operating margins approaching 28% for the year. We ended the year with a revenue backlog of $22.4 billion, an increase of $2.2 billion over the prior year. Our expanding relationships serving health systems has been a key factor driving this growth, and we expect these partnerships to continue to grow in '22 and beyond.

OptumInsight 的收益在 21 年增長了 25%，全年營業利潤率接近 28%。到年底，我們的收入積壓為 224 億美元，比上一年增加了 22 億美元。我們為衛生系統服務的不斷擴大的關係一直是推動這一增長的關鍵因素，我們預計這些夥伴關係將在 22 年及以後繼續增長。

OptumRx earnings grew 6% for the year, driven by the continued expansion of our pharmacy services businesses, supply chain initiatives and strong cost management activities and benefiting from strong customer retention. In addition, we continue to see the impact of OptumRx's movement to a higher-value pharmacy care and specialty services orientation.

OptumRx 全年收入增長 6%，這得益於我們藥房服務業務的持續擴張、供應鏈計劃和強大的成本管理活動，並受益於強大的客戶保留率。此外，我們繼續看到 OptumRx 向更高價值的藥房護理和專業服務方向發展的影響。

Turning to UnitedHealthcare. Full year revenues of $223 billion grew 11%. As noted, our 2022 Medicare Advantage member growth outlook is very positive and consistent with the objectives we established at our November investor conference. Within the up to 800,000 new members we will serve in '22, about 3/4 will be in individual and group Medicare Advantage and the remainder in dual special needs plans. And given the steady strides we've made in quality performance, we have the opportunity to enroll people in our newly rated 5-star plans throughout the entirety of this year.

轉向聯合醫療。全年收入為 2230 億美元，增長 11%。如前所述，我們的 2022 年 Medicare Advantage 成員增長前景非常樂觀，並且與我們在 11 月投資者會議上確定的目標一致。在我們將在 22 年服務的多達 800,000 名新會員中，大約 3/4 將參加個人和團體 Medicare Advantage，其餘參加雙重特殊需求計劃。鑑於我們在質量表現方面取得的穩步進展，我們有機會在今年全年招募人員加入我們新評級的 5 星級計劃。

Our Medicaid membership outlook for '22 continues to incorporate an expectation that states resume eligibility redeterminations, resulting in modest net attrition. In January, we began serving the citizens of Minnesota and continue to support the Missouri expansion this year as well as renewed relationships with Ohio, Tennessee and Nevada. Over the course of the year, we will look to continue to expand upon the nearly 8 million individuals we serve across 31 states.

我們對 22 年的 Medicaid 會員資格展望繼續包含各州恢復資格重新確定的預期，從而導致適度的淨減員。一月份，我們開始為明尼蘇達州的市民提供服務，今年繼續支持密蘇里州的擴張，以及與俄亥俄州、田納西州和內華達州的新關係。在這一年中，我們將尋求繼續擴大我們在 31 個州服務的近 800 萬人。

We concluded '21 with commercial membership about 200,000 people ahead of the original outlook provided. Creating this momentum is the strong response we are seeing to the new innovative products you have heard us discuss, products such as NavigateNOW, which use the Optum virtual network as a first option.

我們在 21 年結束時獲得了大約 200,000 人的商業會員資格，超過了最初提供的前景。創造這種勢頭是我們看到的對您聽到我們討論的新創新產品的強烈反應，例如 NavigateNOW 產品，它使用 Optum 虛擬網絡作為首選。

Our capital capacities remain strong. Full year '21 cash flow from operations was $22.3 billion or 1.3x net income, about $2 billion above the initial outlook we shared a year ago. We continue to expect our 2022 cash flow to approach $24 billion, about 1.2x net income. And we ended '21 with a debt-to-total capital ratio of 38%. These ample capital capacities allow us to continue to accelerate our investments, while remaining committed to an advancing shareholder dividend and supporting our expected repurchase of between $5 billion and $6 billion of stock in '22.

我們的資本能力依然強勁。 21 年全年運營現金流為 223 億美元或淨收入的 1.3 倍，比我們一年前分享的初步展望高出約 20 億美元。我們繼續預計我們 2022 年的現金流將接近 240 億美元，約為淨收入的 1.2 倍。我們以 38% 的債務與總資本比率結束了 21 年。這些充足的資本能力使我們能夠繼續加速我們的投資，同時繼續致力於提高股東股息並支持我們在 22 年預期回購 50 億至 60 億美元的股票。

Our 2022 adjusted earnings per share outlook of $21.10 to $21.60 is consistent with the view we offered 7 weeks ago. From this distance, and in contrast to the past 2 years, we expect the seasonal pattern to be more consistent with our historical experience, with just under 50% of full year earnings in the first half and the first 2 quarters comparably even.

我們 2022 年調整後每股收益 21.10 美元至 21.60 美元的前景與我們 7 週前提供的觀點一致。從這個距離來看，與過去 2 年相比，我們預計季節性模式將更符合我們的歷史經驗，上半年和前兩個季度的全年收益略低於 50%。

Now I'll turn it back to Andrew.

現在我將把它轉回給安德魯。

Before we transition to the Q&A portion of the call, I hope you've already taken away the strong sense of confidence John, Dirk and I share in the growth potential of this company, rooted in the growing number of people we're serving in value-based models, the depth of relationships we're building with local health systems, our pharmacy capabilities and the innovation and consumer focus that's driving growth across our government programs, individual and commercial businesses.

在我們過渡到電話的問答部分之前，我希望你已經消除了約翰、德克和我對這家公司的增長潛力的強烈信心，這植根於我們服務的人數不斷增加基於價值的模型、我們與當地衛生系統建立的深度關係、我們的藥房能力以及推動我們政府項目、個人和商業企業增長的創新和消費者關注。

As demand for innovation and integrated solutions, products and services only continues to grow, we've never been in a better position to help bring together the fragmented pieces of health care and create more value for the people we try to serve. With that, operator, let's open it up for questions. One per caller, please.

隨著對創新和集成解決方案、產品和服務的需求持續增長，我們能夠幫助將分散的醫療保健整合在一起，為我們試圖服務的人們創造更多價值，這是前所未有的。有了這個，操作員，讓我們打開它來提問。請每位來電者一個。

(Operator Instructions) And we'll go first to Scott Fidel with Stephens.

（操作員說明）我們將首先與斯蒂芬斯一起去斯科特菲德爾。

My question was just a little follow-up just on the Medicare Advantage environment. And if you could just talk about, from your perspective, whether you've seen any material change in the level of competition in the market for 2022 relative to 2021?

我的問題只是對 Medicare Advantage 環境的一點跟進。如果你能從你的角度談談，相對於 2021 年，你是否看到 2022 年市場競爭水平有任何重大變化？

Then just would also be interested in -- if, for United, whether there's been any types of shifts in the distribution channels through which you're driving your MA growth just as we think about some of the evolving trends in Medicare?

那麼也會有興趣 - 對於曼聯來說，是否在我們考慮醫療保險的一些發展趨勢時，您推動 MA 增長的分銷渠道是否發生了任何類型的轉變？

Yes, Scott. Listen, thanks so much for the question. Before I hand it over to Tim Noel, who runs that part of our organization, let me just reiterate how pleased we are with the overall performance through the selling cycle. The number of folks who have chosen UnitedHealthcare continues to grow super well ahead of market, growing market share once again. And as we said a couple of times in our opening commentary, very much in line with the expectations that we set out for the year. So really, big picture, super positive.

是的，斯科特。聽著，非常感謝這個問題。在我把它交給負責我們組織這一部分的蒂姆·諾埃爾之前，讓我重申一下我們對整個銷售週期的整體表現感到多麼高興。選擇 UnitedHealthcare 的人數繼續超前於市場增長，市場份額再次增長。正如我們在開場評論中多次所說的那樣，非常符合我們對這一年的預期。所以真的，大局，超級積極。

I'll hand over to Tim to give you a little bit more background to all of that. Tim?

我將交給蒂姆，為您提供所有這些的更多背景知識。蒂姆？

Good. Great. Thanks, Scott, for the question. This is Tim Noel. Yes, the way I see the MA market is it's been highly competitive for a number of years. And I don't see 2022 as a step function increase and that level of competitiveness. The trend of more entrants, better benefits has really been a multiyear one. And we see this trend as being one that's very good for seniors and also one that's very good for the overall growth of the Medicare Advantage industry.

好的。偉大的。謝謝，斯科特，這個問題。這是蒂姆·諾埃爾。是的，我認為 MA 市場多年來一直競爭激烈。而且我不認為 2022 年是階梯函數增加和競爭力水平。進入者越多，福利越好的趨勢已經持續多年。我們認為這一趨勢對老年人非常有利，對醫療保險優勢行業的整體增長也非常有利。

Seniors are shopping for more value as they should be. And for our part, we're really focused on differentiating our offerings in the marketplace. And what we're doing is we're driving things, not only around benefits, but also around capabilities. Better digital tools, ease of payment, product innovation, better and more personalized service experiences, better clinical quality, more value-based and aligned care provider relationships are all part of that. And our approach continues to resonate in the marketplace. So we really like our performance and our positioning inside a very strong and growing marketplace.

老年人正在購買應有的更多價值。就我們而言，我們真正專注於在市場上區分我們的產品。我們正在做的是我們正在推動事物，不僅圍繞利益，而且圍繞能力。更好的數字工具、易於支付、產品創新、更好和更個性化的服務體驗、更好的臨床質量、更基於價值和一致的護理提供者關係都是其中的一部分。我們的方法繼續在市場上引起共鳴。因此，我們非常喜歡我們在一個非常強大且不斷增長的市場中的表現和定位。

Tim, thanks so much. And Scott, just your secondary on distribution. I think it's fair to say nothing's changed in terms of our approach to distribution. In fact, I think we've never had more distributors, agents working on our behalf across the country. So no change there whatsoever. And we are super grateful for all of the support we get from agents and brokers and others who help us get the message across well to seniors who are looking for MA as an option. So really very positive about that environment.

蒂姆，非常感謝。和斯科特，只是你的次要分銷。我認為公平地說，我們的分發方式沒有任何改變。事實上，我認為我們從未有過更多的經銷商、代理商代表我們在全國范圍內工作。所以那裡沒有任何變化。我們非常感謝代理商和經紀人以及其他幫助我們將信息傳達給正在尋找 MA 作為一種選擇的老年人的所有支持。所以對那個環境非常積極。

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

我們將與 Nephron Research 一起前往 Josh Raskin。

My question relates to OptumHealth, and the disclosures around the top line growth have been really helpful. But I'm curious more on the margin side, and specifically how margins trend over time when you take 100% global capitation. And maybe, specifically, if you're making money on the totality of that business today and maybe how that migrates over time.

我的問題與 OptumHealth 有關，有關收入增長的披露確實很有幫助。但我對利潤率方面更感興趣，特別是當你採用 100% 的全球人均時，利潤率如何隨著時間的推移而變化。也許，特別是，如果你今天從整個業務中賺錢，也許隨著時間的推移，它是如何遷移的。

Josh, thanks so much. Let me pass it over to Dr. Wyatt Decker, who looks after OptumHealth. Wyatt?

喬希，非常感謝。讓我把它交給負責 OptumHealth 的 Wyatt Decker 博士。懷亞特？

Yes, Josh, thanks for the question. Absolutely, we are positioned, the OptumHealth, as a growth platform. And we're investing in new markets and deeper penetration into established markets. As we do that and expand the capabilities, you'll continue to see us delivering on an 8% to 10% margin range. So you can anticipate us to continue to generate strong performance while investing in what will be a multiyear growth platform. Thanks.

是的，喬希，謝謝你的問題。當然，我們將 OptumHealth 定位為一個增長平台。我們正在投資新市場並更深入地滲透到成熟市場。當我們這樣做並擴展功能時，您將繼續看到我們提供 8% 到 10% 的利潤範圍。因此，您可以預期我們將繼續產生強勁的業績，同時投資於一個多年增長的平台。謝謝。

John? John Rex, I think, maybe add a little?

約翰？約翰雷克斯，我想，也許加一點？

Sure. And just, Josh, getting at your point of how does that progress over time. And Dirk did offer some nice commentary on the call in terms of the investments that we make as we're looking to move to capitation. And that does tell a kind of a multiyear story of investments as we get ready to move to capitation. So that's even before any revenue comes into the picture we're making, we're making those investments. And significant -- very significant ahead in a couple of years ahead, especially in the year ahead of those transitions before there's any kind of revenue view. So that is creating kind of that impact.

當然。只是，喬希，了解你的觀點是如何隨著時間的推移而進展的。 Dirk 確實在我們希望轉向人頭時進行的投資方面對電話會議提供了一些很好的評論。當我們準備轉向人頭時，這確實講述了一種多年的投資故事。因此，甚至在我們正在創造任何收入之前，我們就已經進行了這些投資。並且意義重大——未來幾年非常重要，特別是在這些轉變之前的一年，在沒有任何收入觀點之前。所以這正在創造那種影響。

And what Dr. Decker was describing there is, so as we seek to do that and those movements occur, we're always bearing within that a fairly significant investment load. This year, it was obviously fairly significant with the 0.5 million members that we transitioned. And we continue to accelerate. Those investments continue also, while we start getting leverage on those as we do more of it. So we're kind of bearing that within the 8% to 10% that Wyatt was describing there. Thank you.

德克爾博士所描述的是，當我們尋求這樣做並且發生這些運動時，我們總是承受著相當大的投資負擔。今年，我們過渡的 50 萬成員顯然相當重要。我們繼續加速。這些投資也在繼續，而隨著我們做的更多，我們開始利用這些投資。因此，我們可以承受懷亞特在那裡描述的 8% 到 10% 的範圍內。謝謝你。

Yes, absolutely. I think both sets of comments really point to what's happening, Josh. One way that helps me think this through a little bit is to think about vintages. So every year, there's a different number of folks who transition into the capitated environment. Of course, that number grows every time. So this year will be almost double what we did last year. Last year was almost double what we did the year before.

是的，一點沒錯。我認為這兩組評論都指向正在發生的事情，喬希。幫助我思考這一點的一種方法是考慮年份。因此，每年都有不同數量的人過渡到人頭化環境。當然，這個數字每次都在增長。所以今年幾乎是去年的兩倍。去年幾乎是我們前一年的兩倍。

As you think about it, the margin associated or the economics associated with each vintage changes year-by-year as those populations of folks stay in OptumCare for sustained periods of time. So as you think about the longer-term evolution of the economics of OptumCare, I'd encourage you to think about it, reflect on how those vintages are aging into their stabilization within the value-based environment.

正如你所想的那樣，隨著這些人群在 OptumCare 中持續一段時間，與每個年份相關的利潤或相關經濟每年都會發生變化。因此，當您考慮 OptumCare 經濟的長期演變時，我鼓勵您考慮一下，反思這些年份是如何在基於價值的環境中老化到穩定的。

We'll go next to Justin Lake with Wolfe Research.

我們將與 Wolfe Research 一起前往 Justin Lake。

Appreciate your comments on how trends is kind of starting the year with COVID. Can you give us a view of how you ended the fourth quarter and into the first quarter of -- by business segment? If I remember correctly, commercial was running a little bit higher than Medicare and Medicaid in the third quarter. And then anything you could tell us in terms of what you think maybe a rough number might be on the cost of the new home testing requirements.

感謝您對 COVID 開始這一年的趨勢的評論。您能否按業務部門向我們介紹您如何結束第四季度並進入第一季度？如果我沒記錯的話，第三季度的商業運行比醫療保險和醫療補助要高一點。然後你可以告訴我們的任何事情，你認為可能是一個粗略的數字可能是關於新家庭測試要求的成本。

So thanks so much, Justin. I'll ask Brian Thompson, President of UHC, to comment in a second. I think, overall, those trends we saw segment by segment didn't get too different as we roll through here. I would just say, as we go into the last part of the year, the last couple of weeks as Omicron really started to show its face, that's still -- we're still kind of learning exactly what the impacts of that. As you can imagine, we can see some things very quickly like physician visit. It's a little harder to know exactly what kind of complexity of claims might look like in hospitals. That will become clearer the next few weeks.

非常感謝，賈斯汀。我會請 UHC 總裁 Brian Thompson 稍後發表評論。我認為，總的來說，當我們在這裡滾動時，我們逐段看到的那些趨勢並沒有太大的不同。我只想說，隨著我們進入今年的最後一部分，最後幾週，Omicron 真正開始露面，這仍然——我們仍然在了解它的確切影響。可以想像，我們可以很快看到一些事情，比如看醫生。確切地知道醫院中索賠的複雜程度有點困難。這將在接下來的幾週內變得更加清晰。

But let me ask Brian to go a little deeper on all of that.

但讓我請布賴恩更深入地了解所有這些。

Sure, Andrew. Thanks for the question, Justin. Brian here. As Andrew alluded to, I would say our results for COVID in the fourth quarter were in line with our expectations. As you said, similar to the dialogue we had for the third quarter as well as at the investor conference, with commercial largely at baseline performance and both care and caid modestly below, still with that same dynamic of Medicaid being slightly below Medicare. So not much change there.

當然，安德魯。謝謝你的問題，賈斯汀。布賴恩在這裡。正如安德魯所暗示的那樣，我想說我們第四季度的 COVID 業績符合我們的預期。正如你所說，類似於我們在第三季度以及投資者會議上進行的對話，商業主要處於基線表現，護理和補助均略低於醫療補助，但醫療補助的動態仍略低於醫療保險。所以那裡沒有太大變化。

As you suggested, and as we had reiterated in our opening comments, Omicron obviously emerging here in December. And I think John Rex said it well. While there's certainly some differences in contagiousness and severity, the impact of abatement following these swells and infections is consistent with what we've seen in Delta and other strains prior, double-digit declines in both physician visits as well as specialist visits.

正如您所建議的那樣，正如我們在開場評論中重申的那樣，Omicron 顯然在 12 月出現在這裡。我認為約翰雷克斯說得很好。雖然在傳染性和嚴重性方面肯定存在一些差異，但在這些腫脹和感染後緩解的影響與我們之前在 Delta 和其他菌株中看到的情況一致，醫生就診和專科醫生就診均出現兩位數的下降。

So we're continuing to see that dynamic play out. What we may not have anticipated in increased testing and costs are offset with beneficial unanticipated levels of abatement. So that seems to be holding here in the early stages of Omicron.

因此，我們將繼續看到這種動態發揮作用。我們在增加的測試和成本中可能沒有預料到的東西被有益的、意想不到的減排水平所抵消。所以這似乎在 Omicron 的早期階段就成立了。

To your point, with respect to at-home testing, our focus right now is really the consumer experience. As you know, these rules came out just a week ago. Our goal has been how can we ensure that our members know where they can go and get access to those at-home tests without a cash outlay.

就您而言，關於家庭測試，我們現在的重點實際上是消費者體驗。如您所知，這些規則是在一周前發布的。我們的目標是如何確保我們的會員知道他們可以去哪裡並在沒有現金支出的情況下獲得這些家庭測試。

We've really been pleased with the various retailers that we've been working with, Walmart and Rite Aid, in particular, but many to follow, of getting this capability stood up in a matter of 4 days. We're encouraged by that. And at the same time, creating a really easy digital experience for those that do shop and need reimbursement when they go to UnitedHealthcare and My UHC, they're able to easily understand how to get that reimbursement. That's been our focus.

我們真的很高興與我們合作的各種零售商，特別是沃爾瑪和 Rite Aid，但也有許多零售商在 4 天內就獲得了這種能力。我們對此感到鼓舞。同時，為那些在 UnitedHealthcare 和 My UHC 購物並需要報銷的人創造一種非常簡單的數字體驗，他們能夠輕鬆了解如何獲得報銷。這一直是我們的重點。

I think isolating the cost of the COVID test from this distance isn't really instructive. I think if and when it remains durable as a function of not only supply and demand, but how this plays out over the course of the year. And again, I'm comforted by this offsetting dynamic of care deferral that has followed any of these unanticipated waves. Thanks, Justin.

我認為將 COVID 測試的成本與這個距離隔離開來並沒有真正的指導意義。我認為它是否以及何時保持耐用不僅取決於供需，還取決於它在一年中的表現。再一次，我對在任何這些意料之外的浪潮之後出現的這種抵消性的推遲護理動態感到欣慰。謝謝，賈斯汀。

Brian, thanks so much. And I also just want to express thanks to the folks at Walmart and Rite Aid and others who will join shortly in helping get this preferred network up so quickly. The fact that we were in a position with our partners to be able to respond to patient need from Saturday, the very first day that this was requested from the federal government, I think, speaks well to the capabilities of the private sector, the participants within the health care sector, to respond and solve problems on behalf of the country. And I think that's an example which we see repeated across the landscape. And we're very, very proud of being able to work with Walmart and Rite Aid in this particular case.

布賴恩，非常感謝。我還想對 Walmart 和 Rite Aid 的工作人員以及其他將很快加入幫助這個首選網絡快速建立起來的人表示感謝。事實上，我們與我們的合作夥伴能夠從周六開始響應患者的需求，這是聯邦政府要求的第一天，我認為，這很好地說明了私營部門的能力，參與者在醫療保健部門內，代表國家應對和解決問題。我認為這是一個我們看到在整個景觀中重複的例子。我們非常非常自豪能夠在這種特殊情況下與沃爾瑪和 Rite Aid 合作。

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

我們將與美國銀行一起去凱文菲施貝克旁邊。

Great. I just want to go back to the MA conversation for a second. Can you talk a little bit about how you're thinking about the margins in that business? And whether you think any differently about the appropriate margin or acceptable margin in that business now that you've got an ability to earn additional earnings streams through the capitation, the value-based care arrangements that you have?

偉大的。我只想回到 MA 對話一秒鐘。您能談談您如何看待該業務的利潤率嗎？既然您有能力通過人頭費、基於價值的護理安排賺取額外的收入流，您是否對該業務的適當利潤率或可接受的利潤率有任何不同的看法？

Thanks so much, Kevin. Let me ask John Rex to reflect on that. Thanks.

非常感謝，凱文。讓我請約翰雷克斯反思一下。謝謝。

Yes, Kevin, it's John here. So yes, when we think about kind of our business structure, we have separate businesses across the company. And as you know well, extremely important to us is remaining -- is retaining bright lines across those businesses. We serve over 100 payers in OptumCare. We serve many payers across the OptumInsight businesses.

是的，凱文，這裡是約翰。所以是的，當我們考慮我們的業務結構時，我們在整個公司都有獨立的業務。如您所知，對我們來說極為重要的是保留這些業務的亮點。我們在 OptumCare 為 100 多名付款人提供服務。我們為 OptumInsight 業務中的許多付款人提供服務。

And so when we think about our business, they stand alone from a margin perspective, all of our businesses. And that's very important to how we operate the company, how we serve others and how we approach the marketplace.

因此，當我們考慮我們的業務時，從利潤率的角度來看，它們是我們所有業務的獨立存在。這對於我們如何運營公司、如何為他人服務以及如何進入市場都非常重要。

Absolutely. John, thanks so much. And Kevin, thanks for the question. It's also really important to remember that every single one of our service lines, business lines is literally tested and challenged at 24/7, 365 days a year through all of its multi-payer relationships, the competitive environment we're in. I don't think there's really any space where we don't have multiple competitors at some level. And of course, with all of the variety of payers that we service, we are constantly being tested in terms of our ability to serve, making sure that we are priced competitively and the like.

絕對地。約翰，非常感謝。還有凱文，謝謝你的問題。同樣重要的是要記住，我們的每一條服務線、業務線每年 365 天、每天 24 小時都在通過其所有的多付款人關係以及我們所處的競爭環境進行測試和挑戰。我不'認為實際上沒有任何空間在某種程度上我們沒有多個競爭對手。當然，由於我們服務的付款人種類繁多，我們不斷地在服務能力方面接受測試，確保我們的定價具有競爭力等。

So I think it's a well-established and highly successful separation between the two businesses, which has performed extremely well. And most importantly, consistently delivers great value to patients, consumers, system partners who we are privileged to work with and increasingly is scoring well in areas like NPS and other measures of consumer experience and service experience.

因此，我認為這是兩個業務之間非常成熟且非常成功的分離，它的表現非常好。最重要的是，始終如一地為我們有幸與之合作的患者、消費者和系統合作夥伴提供巨大的價值，並且在 NPS 和其他消費者體驗和服務體驗衡量標準等領域得分越來越高。

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

我們將與富國銀行一起去斯蒂芬巴克斯特旁邊。

Wanted to come back to the rapid testing question. I guess, are you guys thinking about this as a definite net cost? Are you thinking their potential offsets from less expensive other testing? And then there does seem to be a push and pull between the supply and the market of rapid test today. And then the Biden Administration distributed 1 billion of these tests for free. I guess, how are you thinking about the supply that your partners are going to have access to as you have these discussions?

想回到快速測試問題。我想，你們是否認為這是一個明確的淨成本？您是否認為它們可能會抵消較便宜的其他測試？然後今天的快速測試的供應和市場之間似乎確實存在推拉。然後拜登政府免費分發了 10 億份這樣的測試。我想，在您進行這些討論時，您如何考慮您的合作夥伴將獲得的供應？

Stephen, thanks so much for the question. Yes. As Brian alluded to earlier on, I mean, at this point, a little hard to know exactly -- obviously, partly because of the demand-and-supply dynamic, exactly what the kind of scale of the testing program could be. But given you would logically expect that if there was a high sustained demand, there's probably a lot of Omicron or some kind of area in the system that would probably lead to what Brian was talking about earlier, with abatement elsewhere in the system.

斯蒂芬，非常感謝這個問題。是的。正如布賴恩早些時候提到的那樣，我的意思是，在這一點上，很難確切地知道——顯然，部分原因是供需動態，測試計劃的規模究竟有多大。但是，如果您從邏輯上預計，如果持續存在高需求，那麼系統中可能會有很多 Omicron 或某種區域，這可能會導致 Brian 之前所說的，系統中其他地方的減排量。

So at this level, I think we kind of expect these two things to somewhat offset. Obviously, we don't know. But at this level, I think it kind of makes sense. The demand and supply, obviously, that has been a challenge across the system historically.

所以在這個層面上，我認為我們有點期望這兩件事會有所抵消。顯然，我們不知道。但在這個層面上，我認為這是有道理的。顯然，從歷史上看，需求和供應一直是整個系統的挑戰。

We're very fortunate to have very established, experienced supply chain partners in this in the shape already of companies like Walmart and Rite Aid. And I'm sure they're very much focused on ensuring as much supply as they can get. But I think it's inevitable that we're going to continue to see outages as you go through these geographic kind of surges that we've characterized this pandemic from the get-go.

我們很幸運能夠在這方面擁有非常成熟、經驗豐富的供應鏈合作夥伴，例如沃爾瑪和 Rite Aid 等公司。而且我確信他們非常專注於確保盡可能多的供應。但我認為，當您經歷這些地理上的激增時，我們將不可避免地繼續看到中斷，我們從一開始就描述了這種流行病。

We'll go next to Ricky Goldwasser with Morgan Stanley.

我們將與摩根士丹利一起去 Ricky Goldwasser 旁邊。

So as we think about the MA environment, you're growing above market. Can you talk a little bit about the role that OptumCare plays in the ability to gain share? Maybe if you have any data points that compare the stickiness or attrition among United MA members that are within the OptumCare network.

因此，當我們考慮 MA 環境時，您正在超越市場。您能談談 OptumCare 在獲得份額方面所起的作用嗎？如果您有任何數據點可以比較 OptumCare 網絡內的 United MA 成員之間的粘性或損耗。

Ricky, thanks so much. Before I hand that to Brian to maybe reflect on a little bit, one of the things that I think we really are pleased about is the way in which OptumCare has developed a whole set of capabilities to deliver really enhanced focus on MA patients. Obviously, these patients have a high medical need very often. They need high touch. I've been super impressed with the development, not just in the clinic, but also through the at-home programs, where we're able to continue to make sure folks are looked after properly.

瑞奇，非常感謝。在我把它交給布賴恩可能會稍微反思之前，我認為我們真正感到高興的一件事是 OptumCare 開發了一整套能力以真正增強對 MA 患者的關注。顯然，這些患者經常有很高的醫療需求。他們需要高度接觸。我對這一發展印象深刻，不僅在診所，而且通過在家計劃，我們能夠繼續確保人們得到適當的照顧。

And actually, particularly as we've gone through the pandemic environment, people's preference to have care delivered in the home has become clearer and clearer. But Brian, maybe you could reflect a little more on how that plays through in terms of the attractiveness of what you're able to offer.

實際上，尤其是在我們經歷了大流行的環境時，人們對在家中進行護理的偏好變得越來越清晰。但是布賴恩，也許你可以多思考一下，就你所能提供的吸引力而言，它是如何發揮作用的。

Sure. I appreciate that. I think Tim really laid out a long list of things that we focus on to make sure that we remain competitive in this space. And as I think about OptumCare specifically, first and foremost, for us, it's predictability. But beyond that, where we have our best satisfaction, which, in turn, leads to our best persistency, our members that stay with us the longest is with our OptumCare partners. And I think, first and foremost, that's a benefit for us.

當然。我很感激。我認為蒂姆確實列出了一長串我們關注的事情，以確保我們在這個領域保持競爭力。當我具體考慮 OptumCare 時，首先，對我們來說，它是可預測性的。但除此之外，在我們最滿意的地方，這反過來又導致我們最好的堅持，與我們在一起時間最長的成員是我們的 OptumCare 合作夥伴。我認為，首先，這對我們有利。

I think beyond that, our journey on quality from -- as you might remember, just a short decade ago, of under 10% to almost nearly 100% was certainly at the support and help from OptumCare, not only in our relationship with them, but how we establish incentives with providers outside of OptumCare. So the list is pretty long. And I would say, if I was to point to one differentiation for UnitedHealthcare, it's certainly OptumCare.

我認為除此之外，我們的質量之旅——正如你可能還記得的那樣，就在短短十年前，從不到 10% 到幾乎 100% 肯定是在 OptumCare 的支持和幫助下，不僅在我們與他們的關係中，但我們如何與 OptumCare 之外的提供者建立激勵機制。所以這個名單很長。我想說，如果我要指出 UnitedHealthcare 的一個差異化，那肯定是 OptumCare。

Wyatt, would you like to maybe add from your perspective?

懷亞特，你想從你的角度補充一下嗎？

Yes. Well, BT touched on it, but our focus on the consumer and patient experience is relentless. And we are continuing to deploy new capabilities all the time. And Andrew, you mentioned home and community. When you look at the quality of the care that we provide, as Brian mentioned, it's now 99% of UHC members with OptumCare or enforce our -- or higher-level plans. And we don't stop there.

是的。嗯，英國電信談到了它，但我們對消費者和患者體驗的關注是無情的。我們一直在繼續部署新功能。安德魯，你提到了家庭和社區。正如布賴恩所說，當您查看我們提供的護理質量時，現在 99% 的 UHC 成員擁有 OptumCare 或執行我們或更高級別的計劃。我們不會止步於此。

And so now we have unveiled our virtual care platform that brings behavioral care to the forefront, brings virtual care and physical care and connects people to their own trusted providers. So you'll see us continuing to focus on how do we meet the needs of our members and how do we reduce friction for our patients.

因此，現在我們推出了我們的虛擬護理平台，該平台將行為護理帶到了最前沿，帶來了虛擬護理和身體護理，並將人們與他們自己可信賴的提供者聯繫起來。因此，您會看到我們繼續關注如何滿足會員的需求以及如何減少患者的摩擦。

Great. Thanks, Wyatt. Thanks so much for the question, Ricky.

偉大的。謝謝，懷亞特。非常感謝你的問題，瑞奇。

We'll go next to A.J. Rice with Credit Suisse.

我們去A.J.旁邊。瑞信的賴斯。

Obviously, labor pressures across the health care industry is a big topic. You have involvement in that in OptumHealth as well as in UHC and your discussions with your nonaffiliated providers. I wondered how -- what -- how that's impacting your business, perhaps the shift of people from -- to OptumHealth from UHC may be a mitigating factor. But any comments about what you're seeing as you try to add your clinicians in OptumHealth? And then also what you're hearing from your provider networks and how that might impact your outlook in UHC?

顯然，整個醫療保健行業的勞動力壓力是一個大話題。您參與了 OptumHealth 和 UHC 以及您與非附屬提供者的討論。我想知道這對您的業務有何影響，也許人們從 UHC 轉向 OptumHealth 可能是一個緩解因素。但是，當您嘗試在 OptumHealth 中添加您的臨床醫生時，您對所看到的內容有何評論？然後還有您從您的提供商網絡中聽到的信息，以及這可能如何影響您在 UHC 中的前景？

Thanks, A.J. Let me ask Dirk to start that one off.

謝謝，A.J.讓我請德克開始那個。

Yes. Thanks, A.J. Look, let me just take this a little bit more broad. As we look across our labor markets, it's a hot market for things like clinical talent, technology and customer service. And one of the things we and Optum did really early in the process is we scaled up our recruiting capacity. We got -- we retained -- we set up retention for some key staff. And one of the other things is we've had pretty decent retention because we have a pretty good mission along those lines. So a lot of additional staffing, a lot of sort of getting ahead of this proactively has been our major action.

是的。謝謝，A.J.看，讓我把這個更廣泛一點。縱觀我們的勞動力市場，它是臨床人才、技術和客戶服務等領域的熱門市場。我們和 Optum 在此過程的早期所做的一件事是我們擴大了招聘能力。我們得到了——我們保留了——我們為一些關鍵員工設置了保留。另一件事是我們的保留率相當不錯，因為我們在這些方面有一個非常好的使命。因此，我們的主要行動是增加大量額外的人員，提前採取很多措施。

As it relates to other providers in UnitedHealthcare, we talked about this in the last earnings call. The -- our contracts are negotiated every 3 years. So it's sort of from our perspective, yes, we're hearing that there are shortages. But we're working with those folks in the shortages. And there's a little bit of inflation, but we ultimately price for that. And like anything else in the market, the market will settle that out. And we're just being very aware of what the implications on a little bit tight labor market are. And hopefully, it will loosen up as we pace forward.

由於它與 UnitedHealthcare 的其他供應商有關，我們在上次財報電話會議中談到了這一點。 - 我們的合同每 3 年協商一次。所以從我們的角度來看，是的，我們聽說存在短缺。但我們正在與那些短缺的人合作。還有一點點通貨膨脹，但我們最終會為此付出代價。就像市場上的其他任何東西一樣，市場會解決這個問題。我們只是非常清楚勞動力市場有點緊張的影響。希望隨著我們前進，它會放鬆。

Great. Thanks so much, Dirk. And A.J., thanks so much for your question.

偉大的。非常感謝，德克。還有 A.J.，非常感謝你的提問。

We'll go next to Matt Borsch with BMO Capital Markets.

我們將與 BMO Capital Markets 一起討論 Matt Borsch。

I guess, I was hoping that you could maybe just talk a little bit more about the Medicaid redeterminations and what you're expecting in terms of the timing and the impact. Because I know you touched on modest. I'm just wondering how you're seeing mitigating factors there.

我想，我希望你能多談談醫療補助的重新決定，以及你對時間和影響的期望。因為我知道你觸及謙虛。我只是想知道你是如何在那裡看到緩解因素的。

Yes, Matt, thanks so much. I'm going to have Tim Spilker, who leads our CNS organization, to respond to that. Tim, could I pass over to you?

是的，馬特，非常感謝。我將請領導我們的 CNS 組織的 Tim Spilker 對此作出回應。蒂姆，我可以轉給你嗎？

Yes. Thank you for the question. At the investor conference, we indicated that we thought states would resume redeterminations in mid-'22. I think based on what we're seeing at this point, that assumption seems even more likely than we thought at that point.

是的。感謝你的提問。在投資者會議上，我們表示我們認為各州將在 22 年中期恢復重新裁決。我認為根據我們目前所看到的情況，這種假設似乎比我們當時想像的更有可能。

Important to note, though, that we're also working closely with our state customers to better understand the timing and the approach that they will take once they do resume. And probably, most importantly, based on the breadth of UHC's products across commercial coverage, exchange as well as Medicaid, we're confident that we'll pick up our fair share as folks transition from Medicaid to other types of coverage. So thanks for the question.

不過，重要的是要注意，我們還與我們的州客戶密切合作，以更好地了解他們恢復後將採取的時間和方法。也許，最重要的是，基於 UHC 產品在商業保險、交易所和醫療補助方面的廣泛性，我們有信心隨著人們從醫療補助過渡到其他類型的保險，我們將獲得公平的份額。所以謝謝你的問題。

Tim, thanks so much. And Matt, also, thank you.

蒂姆，非常感謝。還有馬特，謝謝。

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

我們將與高盛一起去內森·里奇（Nathan Rich）。

Just following up on some of the comments on Medicare Advantage. A couple of your peers are talking about changing how they go to market next year, both from a benefits design as well as distribute standpoint. I know it's early to talk about 2023, but I'd just be curious how this informs your approach as you strive to maintain that value differential that your plans provide?

只是跟進有關 Medicare Advantage 的一些評論。您的一些同行正在談論改變他們明年進入市場的方式，無論是從利益設計還是分配的角度。我知道現在談論 2023 年還為時過早，但我只是很好奇，當您努力保持計劃提供的價值差異時，這會如何影響您的方法？

Thanks so much, Nathan, for the question. Let me ask Tim Noel to make a couple of comments on that.

非常感謝內森的問題。讓我請 Tim Noel 對此發表一些評論。

Yes. Thanks, Nathan, for the question. As we think about 2023, certainly, a little bit too early to get into a lot of depth there given that we haven't even seen an indication of rates from CMS yet. However, when I think about broad strategic goals around distribution and product, I'm not seeing any shift in the stance that we've gone to market with in 2022 and even 2021 and years prior.

是的。謝謝，內森，這個問題。當我們考慮到 2023 年時，當然，鑑於我們甚至還沒有看到 CMS 的費率跡象，因此深入了解那裡還為時過早。然而，當我考慮圍繞分銷和產品的廣泛戰略目標時，我沒有看到我們在 2022 年甚至 2021 年及之前進入市場的立場有任何轉變。

We are very comfortable with our multichannel distribution approach. And as I indicated earlier, our approach on differentiating our products in a very robust industry continuing to resonate. So no deviation from what's been a successful formula for us and providing really great value to consumers.

我們對我們的多渠道分銷方式非常滿意。正如我之前指出的那樣，我們在一個非常強大的行業中區分我們的產品的方法繼續引起共鳴。因此，沒有偏離對我們來說成功的公式，並為消費者提供了真正的巨大價值。

Yes. I think that's exactly it, Tim. And Nathan, the focus on sustained delivery of value is incredibly important, I think, for the underpinning of how UnitedHealthcare have done so well in this environment. It's really important from a distribution broker perspective. People understand what we're offering, but it's not volatile. It's even more important after people sign up. People get what they expect.

是的。我想就是這樣，蒂姆。內森，我認為，對持續交付價值的關注是非常重要的，因為它是 UnitedHealthcare 在這種環境下表現如此出色的基礎。從分銷經紀人的角度來看，這非常重要。人們了解我們提供的產品，但它並非易變。人們註冊後，這一點更為重要。人們得到他們所期望的。

And that is really -- that served us super well. We believe the way in which we've put together this benefit package really serves the needs of the members. And it really speaks to why it's so popular. And it's why, at United, we've been able to grow market share consistently year after year after year. We'll do so again this year. We'll deliver our objectives in MA growth, and we're extremely positive about this part of our performance.

這真的是——這對我們來說非常好。我們相信，我們將這個福利組合在一起的方式確實可以滿足會員的需求。它確實說明了為什麼它如此受歡迎。這就是為什麼在曼聯，我們能夠年復一年地持續增加市場份額。今年我們將再次這樣做。我們將實現 MA 增長的目標，我們對這部分業績非常樂觀。

We'll go next to Gary Taylor with Cowen.

我們將和 Cowen 一起去 Gary Taylor 旁邊。

I Just wanted to return to OptumHealth for a minute around the fourth quarter. If we look year-to-date, OI was growing 35% almost every quarter. It was up about 17% this quarter. And then I think, for next year, you have it growing almost 30%. So was there anything else in the quarter?

我只是想在第四季度左右回到 OptumHealth 一分鐘。如果我們從年初至今來看，OI 幾乎每個季度都增長了 35%。本季度上漲了約 17%。然後我認為，明年，它會增長近 30%。那麼本季度還有其他事情嗎？

I know Wyatt talked about some of those incremental investments. I guess, it makes sense, a little more of those could have been in the fourth quarter. But anything else on the cost side at OptumCare, or anything at the MedSurg or the ASC business to call out impacting 4Q?

我知道懷亞特談到了其中一些增量投資。我想，這是有道理的，其中更多的可能是在第四季度。但是在 OptumCare 的成本方面，或者 MedSurg 或 ASC 業務中的任何其他影響第四季度的事情？

I think. Overall, no. But let me ask Wyatt just to give you a little bit more detail.

我想。總的來說，沒有。但是讓我問懷亞特只是為了給你更多的細節。

Yes. Thanks, Gary, for the question. And by far, the biggest component that you're referring to is what we've touched on, which is the investment in future growth and the platforms for managing 500,000 new risk lives in '22. We saw some modest uptick in our labor costs that were not really material to our performance, but just because I know that's on people's minds.

是的。謝謝，加里，這個問題。到目前為止，您所指的最大組成部分是我們已經觸及的內容，即對未來增長的投資以及管理 22 世紀 500,000 新風險生命的平台。我們看到我們的勞動力成本略有上升，這對我們的表現並不真正重要，但只是因為我知道這是人們的想法。

So as we continue to address that, and you'll see us continue to invest in technologies like our virtual care delivery platform, behavioral health care and home and communities. So it isn't just the risk lives in a senior clinic model, it's this comprehensive care delivery model that has multiple components of investment that will yield fruit, not only in '22, but in following years. So thank you.

因此，隨著我們繼續解決這個問題，您會看到我們繼續投資於我們的虛擬護理交付平台、行為健康護理以及家庭和社區等技術。因此，不僅在高級診所模式中存在風險，而且這種綜合護理提供模式具有多種投資組成部分，不僅在 22 年，而且在接下來的幾年中都會產生成果。所以謝謝。

Thanks, Wyatt.

謝謝，懷亞特。

We'll go next to Lance Wilkes with Bernstein.

我們將和伯恩斯坦一起去蘭斯威爾克斯旁邊。

Wanted to talk a little bit about OptumRx. And just wanted to get a sense as to the rate of growth of specialty home delivery and what the margin profile is looking like there. And maybe what the outlook is for specialty generics and biosimilars and the impacts on margin.

想談談 OptumRx。並且只是想了解專業送貨上門的增長率以及那裡的利潤率狀況。也許專業仿製藥和生物仿製藥的前景以及對利潤率的影響。

Lance, thanks so much for the question. Let me ask Heather Cianfrocco, who looks after OptumRx for us, to respond. Heather?

蘭斯，非常感謝這個問題。讓我請為我們照顧 OptumRx 的 Heather Cianfrocco 做出回應。希瑟？

Yes. So the -- I would definitely say that the specialty and home delivery business are contributing to earnings and our margin. We've seen growth in specialty from a few things. First of all, it's been rate of capture. Second, we've seen growth with our PBM clients, which, of course, drives growth when they use our specialty service, as well as we've really been investing in automation. So I'll give you an example of that.

是的。所以 - 我肯定會說專業和送貨上門業務正在為收益和我們的利潤做出貢獻。我們從幾件事中看到了專業的增長。首先，它是捕獲率。其次，我們看到了 PBM 客戶的增長，當然，當他們使用我們的專業服務以及我們一直在投資自動化時，這會推動增長。所以我會給你一個例子。

Our home delivery and our specialty businesses today are really benefiting from our investment in digital and a better consumer experience. In fact, today, 50% more of our specialty consumers are using our online and digital experience to fill their meds and refill their meds. So we're glad to see that it's resulting in a better consumer experience, but it's also contributing to the earnings of the business.

我們今天的送貨上門和專業業務真正受益於我們對數字化和更好的消費者體驗的投資。事實上，今天，超過 50% 的專業消費者正在使用我們的在線和數字體驗來補充他們的藥物和補充藥物。因此，我們很高興看到它帶來了更好的消費者體驗，但它也為企業的收益做出了貢獻。

I guess, I'd tell you, as I look forward on that business, I think about two things. The first one is continued automation and improvement in experience, integrated with the rest of our pharmacies. Think about investing with our multidose, our investment in regional integrated pharmacies closer to members' homes so that we can get medication to them faster. We're processing and filling over 80% of prescriptions same day today. So we'll continue to see that cost per script and refill cost per script improve quarter after quarter like we've seen over the last quarter.

我想，我會告訴你，當我期待這項業務時，我會考慮兩件事。第一個是與我們其他藥房整合的持續自動化和體驗改進。考慮用我們的多劑量進行投資，我們對靠近會員家的區域綜合藥房進行投資，以便我們可以更快地為他們提供藥物。我們今天在同一天處理和填寫超過 80% 的處方。因此，我們將繼續看到每個腳本的成本和每個腳本的補充成本逐季提高，就像我們在上個季度看到的那樣。

But to your point, I think the other really exciting part about our specialty business is that in '22, we're going to see a robust pipeline of generic specialty coming to market, mostly in the oncology space. And then we know in '23, we'll see additional opportunities in not just specialty generics, but additional brands in specialty classes and biosimilar.

但就您的觀點而言，我認為我們專業業務的另一個真正令人興奮的部分是，在 22 年，我們將看到一個強大的通用專業產品進入市場，主要是在腫瘤學領域。然後我們知道，在 23 年，我們不僅會在特殊仿製藥領域看到更多機會，還會在特殊類別和生物仿製藥領域看到更多品牌。

So together with the automation, the consumer service and the clinical programs that we offer in the specialty business, together with just more options affordably to our consumers, we'll continue to see that contribute meaningfully to OptumRx growth and earnings and margin.

因此，連同我們在專業業務中提供的自動化、消費者服務和臨床計劃，以及為我們的消費者提供更多負擔得起的選擇，我們將繼續看到這對 OptumRx 的增長、收益和利潤率做出有意義的貢獻。

Heather, thanks so much. I'll just add to that. I think the work that's going on inside the OptumRx team, particularly around some of the specialty areas, as well as the development of our new GPO and readiness for what is likely to be a very interesting period of loss of exclusivity on a lot of very significant pharmaceutical products, some of which are in categories which have really not had competition for many years, I think it sets up the next 24, 36 months a very interesting period.

希瑟，非常感謝。我只是補充一下。我認為 OptumRx 團隊內部正在進行的工作，特別是圍繞一些專業領域，以及我們新 GPO 的開發和準備好在很多非常有趣的時期失去排他性重要的醫藥產品，其中一些屬於多年沒有競爭的類別，我認為它為接下來的 24、36 個月設定了一個非常有趣的時期。

We're super committed to delivering medicines at the lowest possible net cost to our members and their clients. And it's an area where we expect significant potential as we roll through over the next 2 or 3 years. So I think Heather's organization is doing some great foundational work for a next wave of opportunity in the pharmaceutical space.

我們非常致力於以盡可能低的淨成本向我們的會員及其客戶提供藥品。隨著我們在未來 2 或 3 年的發展，我們預計該領域具有巨大潛力。所以我認為希瑟的組織正在為製藥領域的下一波機會做一些偉大的基礎工作。

We'll take our last question from Steven Valiquette with Barclays.

我們將向巴克萊銀行的 Steven Valiquette 提出最後一個問題。

So there was so much focus over the past year on the $1.80 EPS headwind for the company related to COVID in '21. Is the $1.80 essentially where that final number shook out for last year? Was there any deviation in either direction on any key components as we think about the reversal of roughly half of that total headwind in '22?

因此，在過去的一年中，該公司在 21 年與 COVID 相關的每股收益為 1.80 美元的逆風受到了極大的關注。 1.80 美元基本上是去年最終數字震蕩的地方嗎？當我們考慮到 22 年總逆風的大約一半的逆轉時，任何關鍵組件是否有任何方向的偏差？

Steven, thanks so much. Let me ask John to respond to that.

史蒂文，非常感謝。讓我請約翰對此作出回應。

Yes, it was materially in that zone of $1.80 is where it fell out. Look, if I would tell you where we thought it was going to be back in November, we set it in the components that would comprise that $1.80 and how they actually fell and they went through all those components. Yes, certainly, a number of them played out a little bit differently than we would have thought back at that period.

是的，它實質上處於 1.80 美元的區域，這是它跌落的地方。看，如果我告訴你我們認為它會在 11 月回到哪裡，我們將它設置在構成 1.80 美元的組件中，以及它們實際下跌的方式以及它們經歷了所有這些組件。是的，當然，其中一些的表現與我們當時所想的略有不同。

Perhaps the important learning we got over that period, though, were just the various -- the correlations that we see across the components as those -- as different case rate volumes would occur over the course of the period and such and the impacts on care activity levels and other areas.

然而，也許我們在那段時期獲得的重要學習只是各種不同的——我們在這些組成部分中看到的相關性——因為在這段時期內會出現不同的病例率，以及對護理的影響活動水平和其他領域。

So definitely, probably didn't step into the year, a year ago, predicting there would be a summer wave, actually, even. But the correlations held very, very true over that period. It was the important factor for us. So yes, within that zone of the $1.80 and -- but -- and the components that they played out, certainly, where it's instructed in, are instructing how we even think about 2022 and the impacts that we've talked about for that also.

所以肯定，可能沒有進入這一年，一年前，預測會有夏天的浪潮，實際上，甚至。但在那個時期，相關性非常非常真實。這對我們來說是一個重要因素。所以，是的，在 1.80 美元的那個區域內，而且——但是——以及它們所發揮的作用，當然，在它被指示的地方，正在指導我們如何看待 2022 年以及我們已經討論過的影響。 .

Yes, great. Thanks so much, John. And Steven, thanks very much for that last question.

對，很好。非常感謝，約翰。史蒂文，非常感謝最後一個問題。

I'd like to thank everybody for taking the time to participate in the call this morning, and we certainly appreciate your time and attention. And I hope that what you've heard from John, Dirk and our colleagues on the call today helps you see why we're so confident in our ability to continue to deliver high-quality growth while helping to improve the lives of the people we serve.

我要感謝大家抽出時間參加今天上午的電話會議，我們當然感謝您的時間和關注。我希望您今天在電話會議上從 John、Dirk 和我們的同事那裡聽到的內容可以幫助您了解為什麼我們對繼續實現高質量增長的能力如此自信，同時幫助改善我們人民的生活服務。

And we look forward to sharing our progress with you again in April. In the meantime, thanks so much for your attention. And Jennifer, thanks for hosting the call. Goodbye.

我們期待在四月再次與您分享我們的進展。同時，非常感謝您的關注。詹妮弗，感謝您主持電話會議。再見。

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

謝謝你。今天的會議到此結束。我們感謝您的參與。