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.

早安，歡迎參加聯合健康集團2021年第四季及全年業績電話會議。聯合健康集團的發言稿結束後將進行問答環節。溫馨提示：本次電話會議正在錄音中。

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資訊。本次電話會議包含根據美國聯邦證券法所做出的前瞻性陳述。這些陳述受風險和不確定性因素的影響，可能導致實際結果與歷史經驗或當前預期有重大差異。部分風險和不確定性的描述可在我們提交給美國證券交易委員會的報告中找到，包括我們目前和定期提交的文件中載列的警示性聲明。

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.

本次電話會議也將參考非公認會計準則 (Non-GAAP) 資料。非公認會計準則 (Non-GAAP) 資料與公認會計準則 (GAAP) 資料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查閱。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以及我們 2022 年 1 月 19 日的 8-K 表格中，該表格可從公司網站的投資者關係頁面取得。

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。

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。早安，感謝各位今天加入我們。首先，我要感謝我們的同事，Optum 和 UnitedHealthcare 的全體員工，感謝他們在 2021 年取得了優異的業績，並為我們進入新年創造了強勁的動力。例如，我們成長策略的兩個關鍵要素——加速患者向 Optum 主導的價值型醫療的轉型，以及 UnitedHealthcare 在服務 Medicare Advantage 消費者方面取得的強勁增長——都與我們在最近的投資者會議上與大家分享的預期相符。

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.

這些業績以及整個企業的整體表現，堅定了我們推進既定成長策略、支持長期每股收益13%至16%成長的信心。回顧2021年的主要主題，我們會看到一個加速成長的故事。 Optum與聯合健康保險以及我們眾多外部合作夥伴之間的緊密合作，幫助我們在服務商業和政府市場方面取得成長，釋放新的創新，向市場推出整合產品和服務，並顯著增加了受益於基於價值的醫療模式的人數。

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，我們利用自身技術能力，幫助醫生和醫院系統更好地服務病患和社區。同時，我們更重視消費者，致力於提升和改善端到端體驗。這些努力幫助我們全年新增收入超過300億美元，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.

預計未來一年也將出現類似的成長。我們看到，對整合的需求將更加強烈，這將整合醫療體系中分散的各個部分，利用市場上出現的巨大創新，幫助更好地協調醫療服務提供者、付款人和消費者的激勵機制，並圍繞價值建立醫療體系。這將使醫療體系更加互聯互通、資訊更加靈通、更加人性化，並能更好地滿足每個人的獨特需求。

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，我們分享了我們投資組合中五個關鍵的成長領域和差異化體驗。這些成長機會將指導我們今年及未來多年的策略。首先是醫療服務，更具體地說是基於價值的醫療。對於聯合健康集團而言，這不僅僅是一項初級保健策略，而是一項全面的臨床策略，涵蓋我們不斷增長的行為、居家、門診和虛擬醫療能力。

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.

我們的第二個成長領域是健康福利，致力於提升我們福利產品的品質、創新性和消費者吸引力，並使我們基於價值的策略得以落地。邁入2022年，我們在醫療保險優勢計劃（Medicare Advantage）方面實現了強勁的消費者增長，在醫療補助計劃（Medicaid）方面也取得了進一步的進展，商業業務也呈現增長勢頭。

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.

接下來是醫療科技。我們在全國範圍內的主要合作夥伴致力於幫助醫療系統提升績效和回報，從而更好地支持其使命。我們充滿希望，能夠在2022年及以後將這些全面的客製化解決方案帶給更多的系統合作夥伴。第四是醫療金融服務，醫療支付領域已顯著改進，簡化了醫療服務提供者、付款人和消費者的支付流程，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，藥局服務是人們與醫療保健系統互動最頻繁的領域。我們可以更好地利用我們基礎藥房服務和數據能力的廣度、數量和價值，並整合我們的醫療藥房和行為分析能力，所有這些旨在提供全人護理，支持新藥和新療法的研發，並支持基於價值的醫療模式。

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.

總而言之，我們滿懷信心地邁入2022年，相信我們有能力實現11月底所訂定的目標。接下來，我將把時間交給總裁兼營運長德克·麥克馬洪。

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，安德魯。我想花幾分鐘時間，向您詳細介紹我們的首要成長重點：基於價值的醫療服務，我們為此做了哪些準備，進行了哪些投資，以及我們對其在不久的將來如何運作的展望。這是我們十年來一直在努力和打造的。

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 OptumHealth 將於 2022 年負責的 50 萬名新患者，我們投入了大量的營運基礎工作和投資。成功的執行需要大量的詳細規劃、投資和建造。這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將其應用於規模化營運。

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，要邁向完全可追溯的安排，需要做哪些準備呢？投資可能非常巨大。例如，在2021年，我們的準備費用超過1億美元。其中涉及三個主要工作流程：臨床培訓和人員準備、技術和數據增強，以及網路協調。

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.

第一個工作流程專注於醫生教育。這項工作早在一年多前就已啟動。為醫生提供資源和知識，讓他們以不同的方式對待患者至關重要。醫生們要積極參與病人的整體健康，而不是承擔更大的責任。我們認為，這對於我們長期以來堅持的按服務收費的模式來說，是一個至關重要且有時很複雜的轉變。除了教育之外，我們還在提升醫生、護士和其他臨床醫生的能力，以滿足我們業務的需求。

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.

第二個領域著重於支援患者護理和有效臨床管理所需的技術系統和資訊。這包括患者入口網站、利用率管理系統以及團隊有效管理的報告系統。

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.

最後是規劃和網路協調工作，以支援初級保健以外的臨床監管，並確保醫療服務的真正連續性。規劃和協調工作包括以下舉措：識別最需要幫助的患者，確保無縫過渡到高接觸式臨床護理服務，從而改善患者健康狀況；快速為患者匹配個人護理導航員，以協助滿足複雜的健康需求，安排預約，並在第一天提供及時的藥物支持。

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.

這些基礎準備和投入對於我們在各個地區和診所的轉型中取得優異成績至關重要。我們期待這些專業知識在未來幾年內為更多患者群體轉型時，能夠發揮更大的作用。

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.

在將工作交給John之前，我想先跟大家報告新冠疫情對我們營運的影響。與其他公司一樣，我們的員工流動率略有上升，計劃外缺勤也有所增加。我們已做好準備，提升招募能力，並顯著提升數位化能力，以改善客戶體驗並減少來電量。因此，在2022年的前兩週，也就是我們歷來最艱難的時期，我們仍然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，我們迅速回應聯邦政府關於消費者無現金新冠病毒檢測的強制要求，這是一項極其複雜的工作。聯合健康保險提前4天通知，打造了便捷的客戶數位化體驗，方便報銷，並與沃爾瑪以及現在的Rite Aid建立了合作夥伴關係，免除了消費者在購買時的現金支出。我們期待未來能與更多公司建立合作關係。

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，我們相信我們擁有足夠的能力來執行我們的業務重點並滿足客戶的期望。現在，我將把時間交給財務長約翰·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.

謝謝您，Dirk，祝大家新年快樂。首先，我想稍微闡述 Dirk 對我們所見的新冠疫情影響的評論。最近幾週，我們會員的住院率與 2021 年 1 月的水平相似，儘管全國新冠病例率高出約 4 倍。對於需要住院治療的人來說，病情似乎有所減輕，因為我們發現住院時間比之前有所縮短。

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，醫療活動模式與過去兩年感染率高企時期呈現類似的關聯。例如，在一月初的這幾週，我們發現初級保健、擇期就診和手術量都在下降。過去幾週的活動顯示，初級保健就診量下降了約10%，專科就診量下降的速度甚至更高。與以往一樣，我們的首要任務是幫助人們在需要時獲得所需的照護。

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.

現在談談我們具體的業務表現。 OptumHealth 的每位消費者收入在 2021 年增長了 30% 以上，這得益於我們透過價值導向型服務模式服務的患者數量不斷增加。正如我們在 11 月下旬分享的預期一樣，我們今年取得了良好的開端，並將繼續預期在負責任的價值導向型服務模式中新增 50 萬名患者，這得益於我們多年來奠定的基礎。

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 的獲利在 2021 年成長了 25%，全年營業利潤率接近 28%。截至 2021 年，我們的營收儲備為 224 億美元，比前一年增加了 22 億美元。我們不斷拓展的醫療系統服務關係是推動這一成長的關鍵因素，我們預計這些合作關係在 2022 年及以後將繼續增長。

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 全年獲利成長 6%，這得益於我們藥局服務業務的持續擴張、供應鏈舉措、強大的成本管理活動以及強大的客戶保留率。此外，我們持續看到 OptumRx 向更高價值的藥房護理和專科服務轉型所帶來的影響。

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.

談到聯合健康保險 (UnitedHealthcare)。全年營收 2,230 億美元，成長 11%。如前所述，我們對 2022 年醫療保險優勢計劃 (Medicare Advantage) 會員成長前景非常樂觀，這與我們在 11 月投資者會議上設定的目標一致。在 2022 年我們將服務的多達 80 萬名新會員中，約有四分之三將加入個人和團體醫療保險優勢計劃，其餘將加入雙重特殊需求計劃。鑑於我們在品質表現方面取得的穩步進步，我們有機會在今年全年吸引更多新晉五星級計劃的會員。

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2022年醫療補助計劃（Medicaid）會員的展望仍包含各州將恢復資格重新認定的預期，這將導致淨流失人數略有減少。今年1月，我們開始為明尼蘇達州的公民提供服務，並將繼續支持密蘇裡州的擴張，以及與俄亥俄州、田納西州和內華達州重建合作關係。今年，我們將繼續擴大服務範圍，服務對像已覆蓋31個州，目前接近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2021財年結束時，商業會員數約為20萬，超出了最初設定的預期。創造這個好勢頭的是我們看到了大家對我們所討論的創新產品的強烈反響，例如NavigateNOW，該產品將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.

我們的資本實力依然強勁。 2021年全年營運現金流為223億美元，相當於淨收入的1.3倍，比我們一年前發布的初始預期高出約20億美元。我們預計2022年的現金流量將接近240億美元，相當於淨收入的1.2倍。截至2021年，我們的負債與總資本比率為38%。充足的資本實力使我們能夠繼續加快投資步伐，同時繼續致力於提高股東分紅，並支持我們預計在2022年回購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.

我們對2022年調整後每股盈餘的預期為21.10美元至21.60美元，與我們7週前給出的預測一致。從這個角度來看，與過去兩年相比，我們預期季節性模式將與我們的歷史經驗更加一致，上半年的收益將略低於全年收益的50%，前兩季的收益也基本持平。

Now I'll turn it back to Andrew.

現在我將話題轉回給安德魯。

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.

在我們進入電話會議的問答環節之前，我希望你們已經感受到約翰、德克和我都對這家公司的成長潛力的強烈信心，這種信心源於我們在價值型模式中服務的人數不斷增加、我們與當地醫療系統建立的深厚關係、我們的藥房能力以及推動我們政府項目、個人和商業業務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、整合解決方案、產品和服務的需求持續增長，我們比以往任何時候都更有能力整合醫療保健領域分散的各個部分，為我們努力服務的人們創造更多價值。接線員，現在開始提問吧。每位來電者請提一個問題。

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

（操作員指示）我們先和史蒂芬斯一起去找史考特·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?

我的問題只是關於醫療保險優勢計劃（Medicare Advantage）環境的一個小後續問題。您能否從您的角度談談，相對於2021年，您是否認為2022年的市場競爭水準發生了實質變化？

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，我們也感興趣——對於聯合航空來說，當我們思考醫療保險的一些發展趨勢時，分銷管道是否發生了任何類型的轉變，透過這些轉變，您可以推動 MA 成長？

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，非常感謝你的提問。在把時間交給我們公司這部分業務的負責人蒂姆·諾埃爾之前，我想重申一下，我們對整個銷售週期的整體表現非常滿意。選擇聯合健康保險的顧客數量持續大幅成長，遠遠超過市場平均水平，市場佔有率再次成長。正如我們在開場白中多次提到的，這完全符合我們對今年的預期。所以，整體來看，我們非常樂觀。

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

我現在把時間交給提姆，他會為你介紹這一切的背景。提姆？

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.

很好。太好了。謝謝斯科特的提問。我是提姆·諾埃爾。是的，我認為聯合醫療保險市場多年來競爭非常激烈。我不認為2022年會出現階梯式成長，也不會達到那種程度的競爭。更多參與者、更好福利的趨勢實際上已經持續多年。我們認為這種趨勢對老年人非常有利，也對醫療保險優勢計劃（Medicare Advantage）行業的整體成長非常有利。

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.

老年人理所當然地追求更高的價值。而我們則專注於在市場上打造差異化的產品。我們所做的不僅是提升福利，更注重提升服務能力。更優質的數位工具、更便利的支付方式、更創新的產品、更優質、更個人化的服務體驗、更卓越的臨床質量，以及更基於價值、更協調一致的醫護人員關係，都是我們努力的方向。我們的方法在市場上持續獲得認可。因此，我們非常看好我們在這個強勁且不斷成長的市場中的業績和定位。

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.

提姆，非常感謝。斯科特，關於分銷，這只是你的補充。公平地說，我們的分銷方式沒有任何改變。事實上，我認為我們從未有過如此多的經銷商和代理商在全國範圍內為我們服務。所以，這方面沒有任何改變。我們非常感謝代理商、經紀人和其他人員給予我們的所有支持，他們幫助我們有效地向那些正在考慮MA的老年人傳達訊息。所以，我們對目前的環境非常樂觀。

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

接下來我們來談談 Nephron Research 的 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，關於營收成長的揭露確實很有幫助。但我更想知道利潤率方面的情況，特別是當採用 100% 全球人頭稅時，利潤率會如何隨時間變化。或者，具體來說，目前這項業務的整體獲利情況如何，以及這種獲利情況會如何隨時間變化。

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

喬希，非常感謝。我把電話轉給負責 OptumHealth 的懷亞特·德克爾醫生。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，Josh，謝謝你的提問。當然，OptumHealth 的定位是一個成長平台。我們正在投資新市場，並深入滲透成熟市場。隨著我們不斷努力並拓展業務能力，你會看到我們持續達到 8% 到 10% 的利潤率。所以，你可以期待我們繼續創造強勁的業績，同時投資於一個可持續多年的成長平台。謝謝。

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

約翰？我想是約翰·雷克斯，也許可以加一點？

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。 Josh，我想問你提到的這個隨著時間的推移會如何發展。 Dirk 在電話會議上就我們在轉向人頭稅方面的投資做了一些很好的評論。這確實展現了我們在準備轉向人頭稅的過程中，進行了多年的投資。也就是說，即使在任何收入出現之前，我們也在進行這些投資。而且，這些投資在未來幾年意義重大——非常重大，尤其是在這些轉變發生之前的一年，在出現任何收入預期之前。所以，這會產生某種影響。

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.

正如德克爾博士所描述的，當我們努力實現這一目標，而這些轉變發生時，我們始終承擔著相當大的投資負擔。今年，我們轉移了50萬會員，這顯然是相當可觀的。而且我們將繼續加速發展。這些投資仍在繼續，隨著我們投入更多資金，我們開始從中獲得槓桿作用。所以我們大致可以承受懷亞特所說的8%到10%的成長率。謝謝。

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，絕對沒錯。 Josh，我覺得這兩組評論都切中要害。一個能幫我理清思緒的方法就是想想年份。每年都有不同數量的人過渡到按人頭計費的環境。當然，這個數字每年都在增加。所以今年的人數幾乎是去年的兩倍。去年的人數幾乎是前年的兩倍。

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.

仔細想想，隨著人們在 OptumCare 的長期使用，每個年份的利潤率或經濟效益都會逐年變化。因此，在思考 OptumCare 經濟效益的長期演變時，我鼓勵大家思考一下，反思一下這些年份的方案在價值導向的環境中是如何逐漸趨於穩定的。

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

接下來我們將與 Wolfe Research 一起前往賈斯汀湖。

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.

感謝您就新冠疫情對今年的影響發表的評論。您能否按業務部門介紹一下第四季末和第一季的情況？如果我沒記錯的話，第三季商業保險的支出略高於聯邦醫療保險和醫療補助。然後，您能否大致告訴我們，新的居家檢測要求的成本是多少？

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。我稍後會請UHC總裁布萊恩湯普森發表評論。我認為，總體而言，我們觀察到的這些趨勢在各個細分領域並沒有太大差異。我想說的是，隨著我們進入今年最後階段，也就是過去幾週，Omicron公司真正開始顯露頭角，我們仍在了解其確切的影響。你可以想像，我們可以很快地看到一些數據，例如醫生就診情況。目前，我們很難確切地了解醫院理賠的複雜程度。未來幾週，情況將會更加明朗。

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

但請容許我請布萊恩更深入地探討這一切。

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。謝謝賈斯汀的提問。我是布萊恩。正如安德魯所提到的，我想說，我們第四季的新冠疫情業績符合我們的預期。正如你所說，這與我們在第三季度以及投資者會議上的討論類似，商業保險基本上保持基線水平，護理和醫療補助略低於基線水平，醫療補助略低於聯邦醫療保險的水平也保持不變。所以變化不大。

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.

正如您所說，以及我們在開場白中重申的那樣，Omicron 病毒顯然在 12 月就已出現。我認為 John Rex 說得很好。雖然傳染性和嚴重程度確實存在一些差異，但這些病毒的腫脹和感染之後的消退影響與我們先前在 Delta 病毒和其他病毒株中看到的情況一致，即醫生就診量和專科就診量均出現了兩位數的下降。

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.

所以，我們仍在持續觀察這種動態發展。我們可能未曾預料到的檢測和成本的增加，最終被意料之外的減排效果所抵消。所以，在 Omicron 的早期階段，這種情況似乎一直存在。

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.

正如您所說，關於在家檢測，我們目前的重點實際上是消費者體驗。如您所知，這些規則一周前才發布。我們的目標是如何確保我們的會員知道他們可以去哪裡進行這些在家檢測，並且無需支付任何費用。

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.

我們非常高興與眾多零售商合作，尤其是沃爾瑪和Rite Aid，以及更多後續合作的零售商，能夠在短短4天內就完成這項功能。這讓我們備受鼓舞。同時，我們也為那些在UnitedHealthcare和My UHC購物並需要報銷的客戶打造了真正便捷的數位體驗，讓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，將新冠偵測成本與疫情距離分開來看，其實並沒有什麼指導意義。我認為，它能否持續，以及何時能夠持續，不僅取決於供需關係，還取決於全年的走勢。而且，在這些意外的疫情浪潮之後，醫療服務延期的出現，也讓我感到欣慰。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.

布萊恩，非常感謝。我還要感謝沃爾瑪、Rite Aid 以及其他即將加入的人員，他們幫助這個優先網絡快速建立。我們與合作夥伴能夠從週六（聯邦政府提出請求的第一天）就開始響應患者的需求，我認為這充分證明了私營部門以及醫療保健行業參與者代表國家應對和解決問題的能力。我認為，這是一個我們在整個醫療領域反覆看到的例子。我們非常非常自豪能夠與沃爾瑪和 Rite Aid 合作解決這個特殊問題。

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

接下來我們來談談美國銀行的凱文‧菲施貝克 (Kevin Fischbeck)。

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?

太好了。我想稍微回到MA的話題上。您能不能談談您對這項業務的利潤率有什麼看法？現在您已經能夠透過人頭稅和基於價值的護理安排獲得額外的收入來源，您對這項業務的合理利潤率或可接受利潤率有什麼不同的看法？

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

非常感謝，凱文。我想請約翰·雷克斯（John Rex）談談你的看法。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，我是約翰。所以，是的，當我們考慮我們的業務結構時，我們公司內部有獨立的業務。正如你所知，對我們來說，極其重要的是保持——保持這些業務之間的明確界線。我們為 OptumCare 的 100 多家付款人提供服務。我們也為 OptumInsight 業務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.

所以，當我們思考我們的業務時，從利潤率的角度來看，它們都是獨立的，我們所有的業務都是獨立的。這對於我們如何經營公司、如何服務客戶以及如何應對市場至關重要。

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.

當然。約翰，非常感謝。凱文，謝謝你的提問。同樣重要的是要記住，我們的每一條服務線、每一項業務線，實際上都在一年365天、每天24小時、每週7天地經受著多付款人關係的考驗和挑戰，我們所處的競爭環境也是如此。我認為，我們幾乎每個領域都會面臨多個競爭對手。當然，由於我們服務的付款人種類繁多，我們在服務能力、價格競爭力等方面也不斷受到考驗。

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.

所以我認為，兩家公司之間的業務分離非常成功，而且效果非常好。最重要的是，我們始終如一地為患者、消費者以及我們榮幸合作的系統合作夥伴提供巨大的價值，並且在淨推薦值（NPS）以及其他消費者體驗和服務體驗指標方面也取得了越來越好的成績。

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

接下來我們來談談富國銀行的史蒂芬‧巴克斯特。

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?

我想回到快速檢測的問題。我想，你們是否認為這是一個確定的淨成本？你們是否考慮過其他更便宜的檢測方法可能帶來的成本抵銷？目前，快速檢測的供應和市場之間似乎確實存在著拉鋸戰。然後拜登政府免費發放了10億份快速檢測試劑盒。我想，在你們進行這些討論的時候，你們是如何考慮合作夥伴能夠獲得的供應的？

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.

史蒂芬，非常感謝你的提問。是的。正如布萊恩之前提到的，我的意思是，目前還很難確切地知道——顯然，部分原因是供需動態，測試計畫的規模究竟會有多大。但考慮到你會從邏輯上預期，如果存在持續的高需求，那麼系統中可能存在大量的Omicron或某個區域，這可能會導致布萊恩之前提到的情況，即係統中其他地方的減排。

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，我認為我們預計這兩件事會在某種程度上互相抵消。當然，我們目前還不確定。但在這個層面上，我認為這是有道理的。顯然，需求和供應一直是整個體系歷史上面臨的挑戰。

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.

我們非常幸運，在這方面擁有像沃爾瑪和來愛德這樣的成熟且經驗豐富的供應鏈合作夥伴。我相信他們非常注重確保盡可能多的供應。但我認為，隨著疫情爆發之初我們所描述的地理區域性激增，我們不可避免地會繼續看到供應中斷。

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

接下來我們來談談摩根士丹利的 Ricky Goldwasser。

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.

所以，當我們考慮併購環境時，你們的成長速度高於市場。您能否談談 OptumCare 在提升市場佔有率方面所扮演的角色？如果您能提供一些數據，比較 OptumCare 網路內 United MA 會員的黏性或流失率，或許可以。

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.

Ricky，非常感謝。在我把這個問題交給Brian稍微思考一下之前，我認為我們真正感到高興的一件事是OptumCare已經開發出一整套功能，能夠真正更好地關注MA患者。顯然，這些患者通常有很高的醫療需求。他們需要高水準的接觸。 OptumCare的進展給我留下了深刻的印象，不僅在診所，而且在居家計畫中，我們能夠繼續確保患者得到妥善的照顧。

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.

事實上，尤其是在疫情期間，人們越來越傾向於在家中接受護理。布萊恩，或許您可以進一步思考一下，這種偏好如何體現在你們提供的服務上，從而提升服務的吸引力。

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。 Tim 確實列出了一系列我們關注的重點，以確保我們在這個領域保持競爭力。就 OptumCare 而言，對我們來說，最重要的是可預測性。除此之外，我們最滿意的地方，也就是我們最持久的客戶，是那些與我們合作最久的 OptumCare 合作夥伴。我認為這對我們來說首先是一個好處。

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.

除此之外，我認為，我們的品質進步——你們可能還記得，就在短短十年前，從不到10%到幾乎100%——肯定離不開OptumCare的支持和幫助，這不僅體現在我們與他們的關係上，還體現在我們與OptumCare以外的供應商建立激勵機制上。所以，這份清單很長。如果要我指出聯合健康保險的一個差異化優勢，那肯定是OptumCare。

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

懷亞特，您願意從您的角度補充嗎？

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。英國電信提到了這一點，但我們始終專注於消費者和患者的體驗。我們也在持續部署新功能。安德魯，您提到了家庭和社區。正如布萊恩所說，就我們提供的醫療服務品質而言，現在99%的UHC成員都擁有OptumCare或執行我們或更高級別的計劃。而且我們不會止步於此。

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.

現在，我們推出了虛擬護理平台，將行為護理放在首位，將虛擬護理與實體護理相結合，並將人們與他們信賴的醫療服務提供者連接起來。因此，您將看到我們將繼續專注於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.

太好了。謝謝，懷亞特。非常感謝你的提問，瑞奇。

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

接下來我們來談談瑞士信貸的 A.J. Rice。

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，整個醫療保健產業的勞動力壓力是一個大話題。您在 OptumHealth 和 UHC 都參與了這方面工作，並且與非關聯醫療機構也進行了討論。我想知道這對您的業務有何影響，或許從 UHC 調動人員到 OptumHealth 可能會是緩解因素。但是，對於您在嘗試將臨床醫生納入 OptumHealth 時看到的情況，您有何評論？此外，您從醫療機構網絡了解到的情況以及這可能會如何影響您在 UHC 的前景？

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

謝謝，A.J。我先請 Dirk 開始吧。

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。你好，讓我更廣泛地談談這個問題。縱觀我們的勞動市場，我們發現臨床人才、技術和客戶服務等方面的市場需求非常強勁。我們和 Optum 在早期就採取的措施之一就是擴大了招募能力。我們成功留住了一些關鍵員工，並為他們制定了留任計畫。此外，我們的留任率也相當不錯，因為我們在這方面有著非常明確的目標。因此，我們的主要行動就是增派大量人員，並積極主動地應對這種情況。

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.

至於與聯合健康保險（UnitedHealthcare）旗下其他供應商的關係，我們在上次財報電話會議上討論過這個問題。我們的合約每三年協商一次。所以從我們的角度來看，是的，我們聽說存在人手短缺的問題。但我們正在與那些人手短缺的人員合作。雖然存在一些通貨膨脹，但我們最終會根據通貨膨脹來定價。就像市場上的其他東西一樣，市場最終會解決這個問題。我們非常清楚這會對略微緊張的勞動市場造成什麼影響。希望隨著我們不斷推進，這種情況會逐漸緩解。

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

太好了。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.

接下來我們來談談 BMO 資本市場的 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，我希望您能再多談談醫療補助計劃的重新認定，以及您對時間和影響的預期。我知道您提到了“適度”。我只是想知道您認為有哪些緩解因素。

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。我將請我們 CNS 部門負責人 Tim Spilker 來回答這個問題。提姆，我可以把時間交給你嗎？

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，謝謝你的提問。在投資者會議上，我們曾表示，我們認為各州將在2022年中期恢復重新確定。我認為，根據我們目前看到的情況，這種假設似乎比我們當時預想的更有可能實現。

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，值得注意的是，我們也在與各州的客戶密切合作，以便更好地了解他們恢復後的時間和方式。或許最重要的是，基於UHC產品涵蓋商業保險、交換保險以及醫療補助（Medicaid）的廣泛性，我們相信，隨著人們從醫療補助過渡到其他類型的保險，我們能夠獲得應有的份額。感謝您的提問。

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

提姆，非常感謝。還有馬特，謝謝你。

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

接下來我們來談談高盛的 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?

只是想跟進一下關於聯邦醫療保險優勢計劃（Medicare Advantage）的一些評論。您的幾位同行正在討論明年改變他們的行銷方式，包括福利設計和分銷。我知道現在談論2023年還為時過早，但我很好奇，在您努力保持計劃所提供的價值差異化的過程中，這會對您的方法產生什麼影響？

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

非常感謝Nathan的提問。我想請Tim Noel就此發表幾點看法。

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。 Nathan，謝謝你的提問。考慮到我們目前還沒有看到CMS公佈利率，所以現在深入探討2023年的情況還為時過早。然而，當我思考圍繞分銷和產品的整體策略目標時，我發現我們在2022年、甚至2021年以及更早幾年進入市場的策略沒有任何變化。

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.

我們對我們的多通路分銷模式非常滿意。正如我之前提到的，我們致力於在蓬勃發展的行業中實現產品差異化，並持續獲得市場認可。因此，我們始終秉持著成功的模式，為消費者提供真正巨大的價值。

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，提姆，我想就是這樣。內森，我認為，持續交付價值至關重要，這正是聯合健康保險在當前環境下如此成功的基礎。從分銷經紀人的角度來看，這一點至關重要。人們了解我們提供的服務，但這些服務並不穩定。在人們註冊後，這一點就更加重要了。人們最終會得到他們期望的服務。

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.

這真的對我們非常有利。我們相信，我們所製定的這項福利方案真正滿足了會員的需求。這也正是它如此受歡迎的原因。這也是為什麼美聯航能夠年復一年地持續成長市場份額的原因。今年我們將繼續保持成長勢頭。我們將實現MA成長的目標，我們對這部分業績非常樂觀。

We'll go next to Gary Taylor with Cowen.

接下來我們將與考恩一起採訪加里泰勒 (Gary Taylor)。

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?

我想再談一下第四季OptumHealth的狀況。今年迄今為止，OI幾乎每季都成長了35%。本季成長了約17%。我認為，明年的成長速度將接近30%。那麼本季還有其他什麼情況嗎？

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一些增量投資。我想，這很有道理，第四季可能會增加一些。但是，OptumCare 的成本方面，或 MedSurg 或 ASC 業務方面，還有其他方面會影響第四季嗎？

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

我認為是這樣。總的來說，沒有。不過，我想問懷亞特，他能不能再詳細地告訴你一些。

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。 Gary，謝謝你的提問。到目前為止，你提到的最重要的部分就是我們已經討論過的部分，即對未來成長的投資，以及用於管理2022年新增50萬名風險人員的平台。我們的勞動成本略有上升，但這對我們的業績影響不大，只是因為我知道大家在乎這件事。

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.

隨著我們持續致力於解決這個問題，您將看到我們持續投資於虛擬醫療服務平台、行為健康照護以及家庭和社區等技術。因此，風險不僅在於老年診所模式本身，而是這種包含多個投資組成部分的綜合醫療服務模式，它不僅在2022年，而且在未來幾年都將取得成果。謝謝大家。

Thanks, Wyatt.

謝謝，懷亞特。

We'll go next to Lance Wilkes with Bernstein.

接下來我們將和伯恩斯坦一起去見蘭斯威爾克斯。

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.

想簡單聊聊 OptumRx。我想了解一下專科送貨上門業務的成長率以及利潤率。此外，還想了解專科仿製藥和生物相似藥的前景如何，以及它們對利潤率的影響。

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

Lance，非常感謝你的提問。我想請負責 OptumRx 的 Heather Cianfrocco 來回答。 Heather？

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，專業服務和送貨上門業務確實為我們的利潤和利潤做出了貢獻。我們從幾個方面看到了專業服務的成長。首先，是客戶獲取率的提升。其次，我們的PBM客戶數量也有所成長，當然，當他們使用我們的專業服務時，這也會推動業務成長。此外，我們也一直在大力投資自動化。我給你舉個例子。

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.

如今，我們的送貨上門和特色藥業務正受益於我們在數位化和更佳消費者體驗方面的投資。事實上，如今有超過50%的特色藥消費者正在使用我們的線上和數位化體驗來取藥和續藥。我們很高興看到，這不僅提升了消費者體驗，也為業務獲利做出了貢獻。

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.

我想告訴你，展望這項業務，我主要考慮兩件事。首先是持續推動自動化和體驗改進，並與我們其他藥局整合。考慮投資我們的多劑量系統，以及投資靠近會員住所的區域性綜合藥房，以便我們能夠更快地將藥物送到他們手中。我們目前擁有超過80%的處方當天處理和配藥。因此，我們將繼續看到每處方成本和每處方續藥成本逐季下降，就像上個季度一樣。

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.

但正如您所說，我認為我們專科業務另一個真正令人興奮的地方是，在2022年，我們將看到大量仿製藥進入市場，主要集中在腫瘤領域。我們知道，在2023年，我們將看到更多機會，不僅是專科仿製藥，還包括更多專科類別和生物相似藥的品牌。

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，結合我們在專業業務中提供的自動化、消費者服務和臨床計劃，以及為消費者提供更多可負擔的選擇，我們將繼續看到這些對 OptumRx 的成長、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.

Heather，非常感謝。我補充一點。我認為OptumRx團隊內部正在進行的工作，尤其是在一些專業領域，以及我們新GPO的製定，以及為應對可能非常有意思的一段時期所做的準備，這段時期許多非常重要的藥品的獨佔權將逐漸喪失，其中一些藥品屬於多年來幾乎沒有競爭的類別，我認為這將為未來24到36個月的市場走勢奠定一個非常有趣的基調。

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.

我們致力於以盡可能低的淨成本為我們的會員及其客戶提供藥品。我們預計，在未來兩三年內，隨著我們不斷推進，這一領域將擁有巨大的潛力。所以我認為希瑟的組織正在為製藥領域的下一波機會奠定堅實的基礎。

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

我們將回答巴克萊銀行的 Steven Valiquette 提出的最後一個問題。

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?

過去一年，人們非常關注公司在2021年因新冠疫情而遭遇的每股收益1.80美元的逆風。 1.80美元的水準是否與去年的最終數字基本一致？考慮到2022年大約一半的逆風將會扭轉，關鍵組成部分的業績是否出現了任何方向的偏差？

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

史蒂文，非常感謝。我想請約翰來回答這個問題。

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，它當時基本上處於1.80美元的區間，然後就跌了下來。你看，如果我告訴你我們11月份預測的匯率會是多少，我們當時設定了構成1.80美元的因素，以及它們實際上是如何下跌的，然後它們經歷了所有這些因素。是的，當然，其中許多因素的表現與我們當時的預期略有不同。

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，我們在那段時期內獲得的重要經驗可能只是各種各樣——我們在各個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發病率，以及對護理活動水平和其他領域的影響。

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，一年前，我們可能根本沒預測到會有夏季疫情。但那段時期，相關性非常非常真實。這對我們來說很重要。所以，是的，在1.80美元的區間內——但是——它們所發揮的作用，當然，它所指示的，也在指導我們如何看待2022年，以及我們之前討論過的影響。

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

是的，太好了。非常感謝，約翰。史蒂文，非常感謝你最後一個問題。

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.

感謝各位今天上午抽空參加電話會議，我們非常感激大家的時間和關注。我希望今天約翰、德克和同事在電話會議上的發言，能幫助大家理解我們為何如此有信心，相信我們有能力繼續實現高品質成長，同時改善我們服務對象的生活。

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.

我們期待四月再次與大家分享我們的進展。同時，非常感謝大家的關注。詹妮弗，感謝你主持這次電話會議。再見。

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

謝謝大家。今天的會議到此結束。感謝大家的參與。