聯合健康 (UNH) 2020 Q3 法說會逐字稿

Good morning and welcome to the UnitedHealth Group Third Quarter 2020 Earnings Conference Call. A question-and-answer session will follow UnitedHealth Group's prepared remarks. As a reminder, this call is being recorded.

早安，歡迎參加聯合健康集團2020年第三季財報電話會議。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 is 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 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包含的警示性聲明。

This call will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amounts is available on the Financial and Earnings Reports section of the company's Investor Relations page at www.unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated October 14, 2020, 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「財務及獲利報告」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於 2020 年 10 月 14 日發布的 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, Mr. David Wichmann. Please go ahead, sir.

現在，我將會議交給聯合健康集團執行長戴維‧威奇曼先生。先生，請發言。

Good morning, and thank you for joining us today. The past 9 months have hopefully provided you a window into both the values and capabilities of this organization and how they enable us to serve our customers, patients, care providers, team members and their families and you, our investors, in a period of unprecedented challenge. I'm fortunate to witness up close the exceptional work of our team every day, an innovative, growing and highly adaptable enterprise driven by the compassion, expertise and restless spirit of our 325,000 people, over 120,000 of them providing care on the front lines.

早安，感謝您今天的到來。希望過去九個月能讓您了解我們組織的價值觀和能力，以及它們如何幫助我們在前所未有的挑戰時期服務我們的客戶、患者、醫護人員、團隊成員及其家屬，以及您——我們的投資者。我很榮幸能夠近距離見證我們團隊每天的卓越工作。我們是一家創新、成長且適應性極強的企業，由我們32.5萬名員工（其中超過12萬名在一線提供醫療服務）的關懷、專業技能和永不放棄的精神驅動。

Our collective experiences over this year have made us an even more deeply committed and energized organization about our potential to help advance the next-generation health system, one which is fair, affordable, simpler and effective. Our team combines the vision with sharp focus on day-to-day execution, delivering strong, well-balanced results across the enterprise.

這一年來，我們共同的經驗使我們更加堅定地致力於推動下一代醫療體系的發展，一個公平、可負擔、更簡化、更有效率的體系。我們的團隊將願景與對日常執行的高度關注相結合，在整個企業範圍內實現了強勁、均衡的成果。

Third quarter adjusted earnings were $3.51 per share, with the decline from the year ago quarter, reflecting the swift customer and consumer support actions we committed to from the very beginning of the COVID-19 pandemic. Based upon this performance and forward estimate of pandemic impacts, we are updating our full year 2020 adjusted earnings outlook to a range of $16.50 to $16.75 per share. In this, we remain committed to ensuring any financial imbalances arising from the pandemic are addressed proactively and fairly for those we serve. We have done this consistently over this period even as the ultimate outcomes remain unclear as the timeliness of relief to our stakeholders is critical. Service, fairness and performance with a long-term view, this is what you can continue to expect from us.

第三季調整後每股收益為3.51美元，較去年同期有所下降，這反映了我們自新冠疫情爆發之初就承諾採取的迅速的客戶和消費者支持行動。基於此業績以及疫情影響的前瞻性估計，我們將2020年全年調整後每股盈餘預期上調至16.50美元至16.75美元。為此，我們將繼續致力於確保積極、公平地應對疫情造成的任何財務失衡，並造福我們所服務的客戶。儘管最終結果尚不明朗，但在此期間，我們始終堅持這樣做，因為及時向利害關係人提供援助至關重要。服務、公平和長遠的業績，正是您可以繼續期待我們為您提供的服務。

You should also expect this enterprise will apply its innovative spirit to contribute in new and different ways as our capabilities expand and circumstances require. We have partnered on and led clinical trials, helping resolve the nation's critical PPE and PCR supply chain issues and enabling more rapid testing at considerable scale while keeping the health workforce safe.

隨著我們能力的提升和情勢的需要，您也應該期待這家企業將運用其創新精神，以新的、不同的方式做出貢獻。我們與多家企業合作並領導了臨床試驗，幫助解決了國家關鍵的個人防護裝備 (PPE) 和聚合酶鍊式反應 (PCR) 供應鏈問題，並在保障醫護人員安全的同時，實現了更大規模、更快速的檢測。

We are supporting state testing operations in California, New Jersey, North Carolina and Indiana and contact tracing in New York City. We are supporting the Mayo Clinic's development of convalescent plasma and some of the most promising vaccine and antibody trials. We have helped enable the workforce safety through the development of ProtectWell, a protocol processing technology to enable the safety of the health workforce as well as the safe opening of businesses, schools and nursing homes.

我們支持加州、新澤西州、北卡羅來納州和印第安納州的州級檢測工作，以及紐約市的接觸者追蹤工作。我們支持梅奧診所開發恢復期血漿，以及一些最有前景的疫苗和抗體試驗。我們透過開發ProtectWell（一項協議處理技術）協助保障了醫護人員的安全，並確保企業、學校和安養院的安全復工。

We're working to assist with employees' health coverage transitions through our GetCovered campaign, now being offered by employers to assist people who have lost their job. We provided $2 billion in liquidity relief for the health system. And our customers and consumers will realize over $3 billion in premium and cost-sharing relief, including $1 billion in estimated rebates. We have contributed more $100 million of financial support and 6 million pounds of meals for communities suffering from food insecurity, homelessness and health disparities.

我們正在透過「GetCovered」活動協助員工完成醫療保險過渡。該活動目前由雇主發起，旨在幫助失業人士。我們為醫療系統提供了20億美元的流動性援助。我們的客戶和消費者將獲得超過30億美元的保費和分攤費用援助，其中包括預計10億美元的退款。我們已為遭受糧食不安全、無家可歸和醫療差距困擾的社區提供了超過1億美元的財政支持和600萬磅餐點。

These efforts are possible because we operate a capable set of businesses and capacities that are leading the development of the next-generation health system and expanding our opportunities to serve. Today, I'd like to give you a brief sense of this work.

這些努力之所以能夠實現，是因為我們擁有一系列強大的業務和能力，它們正在引領下一代醫療體系的發展，並擴大我們的服務機會。今天，我想向大家簡要介紹一下這項工作。

Early in the pandemic, we quickly enabled Optum physicians and the physicians of UnitedHealthcare's most vulnerable patients to adapt and expand rapidly to meet the needs of millions of patients for care of chronic and emerging conditions. This included advancing telehealth by creating direct connections between patients and their own physicians, a critical element to highly effective digital health, ensuring adoption will extend well beyond this crisis. So far this year, OptumCare physicians have facilitated 1 million digital clinical visits directly with their patients, and we are rapidly developing a proprietary set of distinctive tools and aligning our clinical practices to further develop and amplify this capability. I'm sure you can see how advancing modern telehealth fits into our overall strategy to build high-performing systems of care.

在疫情初期，我們迅速幫助 Optum 醫生以及聯合健康保險 (UnitedHealthcare) 旗下最弱勢患者的醫生適應並迅速擴展，以滿足數百萬患者對慢性病和新興疾病的護理需求。這包括透過在患者與其醫生之間建立直接聯繫來推進遠距醫療，這是高效數位醫療的關鍵要素，確保遠距醫療的應用能夠持續到疫情結束後。今年迄今為止，OptumCare 醫師已為患者直接提供了 100 萬次數位化臨床問診。我們正在快速開發一套專有的獨特工具，並調整我們的臨床實踐，以進一步發展和增強這項能力。我相信您一定能夠理解，推動現代遠距醫療與我們建構高效醫療體系的整體策略高度契合。

Our growing therapeutics capacities are positively impacting the management of chronic diseases. With the introduction of Level2, a digital therapy developed to improve the lives of the 30 million people with type 2 diabetes, we are helping patients move toward remission of the disease. Level2 uniquely measures signals and applies artificial intelligence, engaging people and producing better health outcomes. You can expect more digital therapeutics from us in the coming months and years.

我們不斷增長的治療能力正在積極影響慢性病的管理。 Level2 是一款旨在改善 3000 萬 2 型糖尿病患者生活的數位療法，隨著它的推出，我們正在幫助患者逐步緩解病情。 Level2 獨具匠心地測量訊號並應用人工智慧，從而吸引人們並帶來更佳的健康結果。在未來的幾個月和幾年裡，我們將推出更多數位療法，敬請期待。

Our growing capacities are especially apparent within our OptumCare platform where 53,000 physicians across 1,500 local patient-centered facilities served nearly 20 million patients, over 3.5 million of these in some form of risk arrangements with 1.3 million Medicare Advantage or duly eligible members under global capitation.

我們不斷增長的能力在 OptumCare 平台上表現得尤為明顯，該平台擁有 1,500 個以患者為中心的本地醫療機構的 53,000 名醫生，為近 2,000 萬名患者提供服務，其中超過 350 萬名患者以某種形式簽訂了風險協議，130 萬名患者為人 Medicare Advantage 或全球合格的合格成員。

OptumCare created substantial value by building a deeper clinician-patient relationship and by leveraging data and artificial intelligence to enable our clinical model to intercept and treat disease early and proactively, leading to better health outcomes, value and industry-leading patient experiences. Our patients experience safer, healthier, more fulfilling lifestyles, spending 1/3 fewer days per year on average in a hospital bed and 40% fewer days in a skilled nursing facility than patients supported by traditional Medicare fee-for-service. Moreover, our most advanced care delivery practices deliver this high-quality care at upwards of 40% lower cost than the equivalent traditional Medicare benefit with the value fully reflected in improved benefits and lower costs for seniors, all at world-class NPS scores in the mid-70s.

OptumCare 透過建立更深層的醫病關係，並利用數據和人工智慧，使我們的臨床模式能夠及早主動地發現和治療疾病，從而創造了巨大的價值，從而帶來了更好的健康結果、價值和行業領先的患者體驗。我們的患者體驗到更安全、更健康、更充實的生活方式，與享受傳統聯邦醫療保險按服務收費服務的患者相比，平均每年住院天數減少三分之一，在專業護理機構的住院天數減少 40%。此外，我們最先進的醫療服務實踐能夠以比同等傳統聯邦醫療保險福利低 40% 以上的成本提供高品質的醫療服務，其價值充分體現在老年人福利的提升和成本的降低上，所有這些均達到了 75% 左右的世界一流 NPS 評分。

Improving clinical success of Optum's senior care offerings supports our considerable growth goals for OptumCare and also demonstrates the longer-term potential to greatly benefit consumers and commercial offerings. We have been building this platform for over a decade now and expect it to continue to grow at strong, double-digit rates for years to come.

Optum 老年護理產品的臨床成功率不斷提升，不僅支持我們為 OptumCare 設定的宏偉增長目標，也展現出其將為消費者和商業服務帶來巨大益處的長期潛力。我們建構這個平台已超過十年，並預計未來幾年將繼續保持強勁的兩位數成長。

Another aspect of a modern, next-generation health system is managing the specialized and costly medications of the future in a way which works for patients, clinicians, employers and payers. Our OptumRx integrated specialty solution brings a total approach to managing complex conditions across both the medical and pharmacy benefits where we are able to generate up to $37,000 in annual savings per patient by employing clinically appropriate care at more convenient, lower-cost sites.

現代新一代醫療系統的另一個面向是，以病人、臨床醫生、雇主和付款人都能受益的方式管理未來專科和昂貴的藥物。我們的 OptumRx 整合專科解決方案為醫療和藥房層面的複雜疾病管理提供了全面的方案。透過在更便利、更低成本的場所提供臨床適用的護理，我們能夠為每位患者每年節省高達 37,000 美元的費用。

This approach is enabled by Optum's growing footprint of integrated community pharmacies, which will grow by over 60 centers in 2020. And the number of patients served with our infusion services will grow at double-digit rates. We expect this to be another durable growth trend given the much safer and clinically equivalent patient experience.

這項策略得益於 Optum 不斷擴張的社區綜合藥局網絡，預計到 2020 年，該網絡將新增 60 多家中心。同時，接受我們輸液服務的患者數量也將以兩位數的速度成長。鑑於患者體驗更加安全且臨床體驗更加一致，我們預計這將成為另一個持久的成長趨勢。

We see OptumRx as continuing to transform to be a leader in pharmacy care services. But differently, we believe the value people and the system from pharmacy care services resides in managing personal engagement in health, not just supply chain management. This plays to our strength and will increasingly contribute to the growth of OptumRx in the years ahead.

我們認為 OptumRx 正在持續轉型，力求成為藥局護理服務的領導者。但不同的是，我們認為藥局護理服務的價值在於管理個人參與健康事務，而不僅僅是供應鏈管理。這充分發揮了我們的優勢，並將在未來幾年持續協助 OptumRx 的成長。

UnitedHealthcare continues to focus on the varied needs of health care consumers. In the next-generation health system, we expect consumer benefits to become increasingly customized to meet these needs as people search for solutions which are simple, affordable and help enable quality outcomes. UnitedHealthcare has seen strong reception to our expanding suite of highly tailored and affordable individual coverages. This year alone, the number of people we serve with individual health coverage has grown by 15%. Likewise, in employer-sponsored coverage, our growing set of consumer-centered, innovative and flexible offerings, such as Bind, All Savers and physician aligned plans, such as Harmony in Southern California, are gaining traction with membership in these offerings having grown over 50% this year.

聯合健康保險 (UnitedHealthcare) 持續關注醫療保健消費者的多樣化需求。在下一代醫療體系中，我們預計消費者的福利將日益個人化，以滿足這些需求，因為人們正在尋求簡單、實惠且有助於實現高品質成果的解決方案。聯合健康保險不斷擴展的高度客製化且價格實惠的個人保險產品系列廣受歡迎。光是今年，我們服務的個人健康保險人數就增加了 15%。同樣，在雇主贊助的保險方面，我們不斷增長的以消費者為中心、創新靈活的產品組合，例如 Bind、All Savers 和醫生指定的計劃（例如南加州的 Harmony），也越來越受歡迎，這些產品的會員人數今年增長了 50% 以上。

We know many of you are interested in the annual Medicare Advantage enrollment period, which opens tomorrow. The 2021 benefit year will be UnitedHealthcare's largest Medicare Advantage footprint expansion in 5 years, reaching an additional 3.2 million people and nearly 300 additional counties. We are emphasizing what we know seniors are looking for this year even more than ever: stability and value. Premiums for most people we serve will be flat or reduced, and nearly 2.5 million people will have no premium at all.

我們知道，許多人都對明天開始的年度聯邦醫療保險優勢計劃 (Medicare Advantage) 註冊期感興趣。 2021 年福利年度將是聯合健康保險 (UnitedHealthcare) 五年來規模最大的聯邦醫療保險優勢計劃 (Medicare Advantage) 覆蓋範圍擴張，新增覆蓋 320 萬人，覆蓋近 300 個縣。我們強調老年人比以往任何時候都更需要的是：穩定性和價值。我們服務的大多數人的保費將持平或降低，近 250 萬人將完全免保費。

We continue to innovate our product offerings with all Medicare Advantage plans featuring 0 copay primary care digital health visits and the expansion of our personal support services, such as an annual clinical health assessment delivered in a senior's home and, for many, the assignment of a dedicated UnitedHealthcare navigator. We expect strong growth in individual MA. And when combined with our group Medicare gains, 2021 is shaping up to be another year of market-leading growth. We also expect continued growth in Medicaid due to transitions in coverage and net new market gains and are looking forward to a record RFP season as we seek to serve more people in more geographies.

我們持續創新產品，所有聯邦醫療保險優勢計劃均提供零自付費用初級保健數位健康就診，並擴展了我們的個人支援服務，例如在老年人家中進行的年度臨床健康評估，以及為許多老年人指派一位專門的聯合健康保險導航員。我們預計個人醫療保障 (MA) 將強勁成長。加上我們團體聯邦醫療保險 (Medicare) 的成長，2021 年有望再次成為市場領先的成長之年。由於覆蓋範圍的轉變和新增市場的淨收益，我們也預期醫療補助 (Medicaid) 將繼續成長，並期待著創紀錄的招標書 (RFP) 季，因為我們致力於在更多地區服務更多人群。

What I've described for you this morning is a sampling the initiatives we are pursuing today to help lead in the development of the next-generation health system, a health system that works better for everyone: those who experience care, those who provide care and those who pay for care. Now I'll turn it over to Chief Financial Officer, John Rex.

我今天早上向大家介紹的，只是我們目前正在推行的一些舉措，旨在引領下一代醫療體系的發展，一個更好地服務於所有人的醫療體系：包括醫療服務的接受者、醫療服務的提供者以及醫療服務的付費者。現在，我將把發言權交給財務長約翰·雷克斯。

Thank you, Dave. Broadly speaking, third quarter results continued to be impacted by disruptive care pattern, albeit to a much lesser extent than in the second quarter as many regions of the country stabilized nearer to more normalized level.

謝謝你，戴夫。總體而言，第三季度的業績繼續受到顛覆性護理模式的影響，儘管影響程度遠低於第二季度，因為全國許多地區的醫療狀況已趨於穩定，接近正常化水平。

Within the quarter, care deferral impacts were more than offset by the proactive consumer and customer assistance measures we voluntarily undertook earlier this year as well as COVID-19 care and testing costs and broader economic effects. These factors resulted in a 10% year-over-year decline in adjusted earnings per share.

本季度，我們自願採取的積極消費者和客戶援助措施，以及新冠疫情護理和檢測成本以及更廣泛的經濟影響，抵消了護理延期的影響。這些因素導致調整後每股收益較去年同期下降10%。

As we discussed last quarter, the deepest period of care deferral, which occurred in the second quarter, and the timing of GAAP recognition of our assistance actions don't entirely line up, which makes for a more pronounced adverse impact to earnings in the second half of 2020. The measures we voluntarily undertook mostly impact our benefits businesses and contributed to UnitedHealthcare's third quarter operating earnings decline from a year ago.

正如我們上個季度所討論的那樣，第二季度發生的最長時間的護理延期與 GAAP 確認我們的援助行動的時間並不完全一致，這對 2020 年下半年的收益產生了更明顯的不利影響。我們自願採取的措施主要影響了我們的福利業務，並導致聯合健康保險第三季的營業收入較去年同期下降。

In the quarter, we saw total care activity now exceeding 95% of seasonal baseline, with certain categories even more closely approaching normal. This compares to an overall measure of about 2/3 at the lowest point in the second quarter.

本季度，我們的整體護理活動已超過季度基線的95%，某些類別的護理活動甚至更接近正常水平。相較之下，第二季最低點時，整體照護活動約為正常水準的2/3。

Each of the 3 Optum businesses continue to perform well, while affected in different ways by still-recovering care patterns and economic effects. OptumHealth's third quarter earnings increased 12% over year as fee-for-service practices and ambulatory surgery activity began to recover while risk-bearing practices still experienced some modest, continuing effect from deferral of care. Our SCA ambulatory surgery centers operated about 95% of seasonal baseline in the third quarter compared to 55% in the second quarter.

Optum旗下三家子公司均持續表現良好，但受到仍在復原中的醫療模式和經濟影響的不同影響。 OptumHealth第三季獲利年增12%，這得益於按服務收費的診所和門診手術業務開始復甦，而風險承擔診所仍受到醫療延期的影響，且影響不大。我們的SCA門診手術中心在第三季的營運量約為季度基線的95%，而第二季度僅為55%。

Year-to-date, over 1,000 new surgeons have performed procedures with SCA as they seek a safe, convenient and efficient clinical partner. New surgeon affiliations for the 9-month period rose nearly 25% over last year. And we continue to expand the complexity of procedures performed in these settings, having added over 40 new service lines, nearly double last year.

今年迄今，已有超過1,000名新外科醫生在SCA進行手術，尋求安全、便利、高效的臨床合作夥伴。過去9個月，新外科醫生的合作數量較去年同期增加了近25%。我們持續提昇在這些環境中所進行的手術的複雜程度，新增了40多個服務項目，幾乎是去年的兩倍。

Patients increasingly prefer these free-standing centers with NPS measured at 92. These durable, long-term trends will benefit our growth even more strongly in the future as elective care activity fully normalize.

患者越來越喜歡這些獨立的中心，NPS 測量值為 92。隨著選擇性護理活動的完全正常化，這些持久的長期趨勢將在未來更加有利於我們的成長。

OptumInsight third quarter earnings increased 24% year-over-year, while the revenue backlog grew by $0.5 billion in the quarter to nearly $20 billion. Payer services and state government business performed strongly while we continue to see lower activity in the provider-facing businesses due to procedural volumes. While still not fully normalized, business development activity has increased from the second quarter's much lower pacing.

OptumInsight 第三季獲利年增 24%，營收積壓本季增加 5 億美元，達到近 200 億美元。付款人服務和州政府業務表現強勁，而面向提供者的業務活動由於流程量增加而持續減少。雖然業務拓展活動尚未完全恢復正常，但較第二季緩慢得多的節奏增加。

OptimumRx earnings declined 2% year-over-year in the third quarter as script volumes were impacted by lower care activity and economic factors. First-fill scripts, which are correlated to physician visit activity, greatly improved from the second quarter, which was down about 25%. While not yet fully back to prior year levels, revenues in our expanding pharmacy services businesses have grown nearly 30% year-to-date.

由於診療活動減少和經濟因素影響了處方量，OptimumRx 第三季獲利年減 2%。與醫師就診活動相關的首次配藥處方量較第二季大幅改善，第二季下降了約 25%。雖然尚未完全恢復到去年同期水平，但我們不斷擴張的藥房服務業務的收入今年迄今已增長近 30%。

Turning to UnitedHealthcare. Third quarter operating results reflect a considerable moderation of the care deferral impact experienced in the second quarter while still not at baseline levels. This was more than offset by our assistance measures, direct COVID-19 care costs and economic factors. The number of people served in commercial products declined primarily due to employer actions. Within this, for us, about 40% of the fee base decline came from very large employers, primarily in the hospitality, transportation and energy sectors.

談到聯合健康保險。第三季的營運表現反映出第二季醫療照護延期的影響已顯著減弱，但仍未達到基準水準。我們的援助措施、新冠疫情直接醫療成本以及經濟因素抵消了這種影響。商業產品服務的人數下降主要由於雇主的行動。其中，我們約40%的費用基數下降來自大型雇主，主要集中在旅館、交通和能源產業。

During the third quarter, growth in Medicaid membership accelerated, benefiting from the continued easing of state redetermination requirements. We have not yet seen material Medicaid enrollment activity due to job loss. And historically, these transitions lag loss of health care coverage by about 6 months.

第三季度，受惠於各州重新認定要求的持續放寬，醫療補助（Medicaid）投保人數加速成長。我們尚未看到因失業導致的醫療補助參保人數大幅增加。從歷史上看，這些轉變通常比醫療保險覆蓋範圍的喪失滯後約6個月。

Our Medicaid business has seen strong year-to-date organic growth of over 500,000 people. Sales activity in Medicare Advantage has continued to move toward more normalized patterns after seeing some slowing in the second quarter due to the pandemic. Within this, we have seen considerably less plan switching than typical for existing Medicare Advantage enrollees, while selection of MA over fee-for-service for people new to Medicare, it's tracking well.

我們的醫療補助 (Medicaid) 業務年初至今實現了強勁的有機成長，服務對象超過 50 萬人。醫療保險優勢計劃 (Medicare Advantage) 的銷售活動在第二季度因疫情而放緩後，繼續朝著更正常化的方向發展。其中，我們發現現有醫療保險優勢計劃受益人的計劃轉換情況遠低於正常水平，而對於新加入醫療保險 (Medicare) 的人來說，選擇醫療管理 (MA) 而非按服務收費的模式也進展良好。

We continue to deepen our engagement with those seniors most in need, increasing the distribution of remote digital sensor kits to collect and monitor vital health data and address gaps in care generated by the pandemic. Seniors continue to highly value our HouseCalls program with the number of home visits in the third quarter growing by nearly 30% over last year.

我們持續深化與最需要幫助的老年人的聯繫，增加遠端數位感測器套件的分發力度，以收集和監測重要的健康數據，並彌補疫情造成的護理缺口。長者持續高度重視我們的「家訪」（HouseCalls）計畫，第三季的家訪次數較去年同期成長了近30%。

Our liquidity and financial position remains strong. Third quarter cash flows of $3.1 billion, or 1x net income, reflects the extra federal tax payment in the quarter due to the deferral of payments typically paid in the second quarter. Year-to-date cash flows from operations are $16.1 billion or 1.2x net earnings. And our debt to total capital ratio of 39.1% compares to 43.7% in the year ago quarter.

我們的流動性和財務狀況依然強勁。第三季現金流為31億美元，相當於淨收入的1倍，這反映了由於通常在第二季繳納的款項延期而導致的本季額外聯邦稅款。年初至今的營運現金流為161億美元，相當於淨收入的1.2倍。我們的負債與總資本比率為39.1%，去年同期為43.7%。

As noted earlier, we have updated our full year adjusted earnings outlook to a range of $16.50 to $16.75 per share. This reflects third quarter performance while anticipating the fourth quarter will reflect continued customer assistance measures, normalization in care patterns and rising acuity as a result of missed and deferred treatments. We will continue to work proactively to help people obtain the care they need.

如前所述，我們已將全年調整後獲利預期上調至每股 16.50 美元至 16.75 美元。這反映了第三季的業績，同時預計第四季度將反映持續的客戶援助措施、護理模式的正常化以及因錯過和延期治療而導致的診療敏銳度上升。我們將繼續積極主動地幫助患者獲得所需的照護。

Now I'll turn it back to Dave.

現在我將話題轉回給戴夫。

Thank you, John. With the third quarter earnings report, we have, at times, provided some early soundings on our growth outlook. Even as the current environment is anything but routine, I'll still try to offer some useful perspectives. We approach the future with continued conviction on our long-term 13% to 16% earnings growth objective.

謝謝，約翰。在第三季的收益報告中，我們有時會對成長前景做出一些初步的預測。即使目前的環境並非常規，我仍會嘗試提供一些有用的觀點。我們始終堅信未來13%至16%的長期獲利成長目標。

Some of the factors giving us confidence include: our rapidly expanding care delivery services, now benefiting from over a decade of building and investing in local, value-based care systems and extension into market-leading post-acute home and modern behavioral health intervention services; our ability to support seniors across multiple channels and markets with increasingly innovative high-value offerings; the way we meet the growing needs of people with highly complex conditions with comprehensive, personalized care, including people across commercial, federal and state-based programs; the innovative and consumer-responsive products now being offered through the employer and individual market channels; our unmatched ability to support a more interoperable and intelligent health system as a result of significant investments over many years to improve performance, integrating data, analytics and clinical information to provide essential insights to evidence-based next-best care actions; and our restless drive to allocate capital and align with other innovative companies as we lead in the development of the next-generation health system in a socially conscious way.

讓我們充滿信心的一些因素包括：我們快速擴張的醫療服務，現在受益於十多年來在本地價值型護理系統的建設和投資，以及向市場領先的急性後期家庭和現代行為健康幹預服務的擴展；我們透過日益創新的高價值產品，跨多個管道和市場為老年人提供支持的能力；我們透過全面、個性化的護理高度滿足立項目的人員；現在透過雇主和個人市場管道提供的創新和消費者響應產品；我們多年來在改進性能方面進行了大量投資，整合數據、分析和臨床信息，為基於證據的下一個最佳護理行動提供重要見解，從而擁有無與倫比的支持更具互操作性和智能的醫療系統的能力；我們不懈地推動資本配置和引領其他創新公司保持一致，以其他社會意識發展的方式領導。

These are just a few of the accelerating capabilities which will enable our enterprise to serve more people much more deeply as we look to the years ahead. As to early thoughts on 2021, we expect our underlying business performance to be strong and well supportive of our long-term growth objectives, including the tailwinds we have highlighted throughout this morning. The pandemic and related economic impact, of course, remain difficult to predict and at this distance, likely represent a significant potential headwind. As a result, we envisioned stepping out initially with a more conservative all-in 2021 starting point to accommodate these still-developing and unknown COVID-related impacts, in particular, the pacing of a return to more normal levels of care services and the condition of the economy.

這些只是我們加速發展的部分能力，這些能力將使我們的企業在未來幾年能夠更深入地服務更多人。至於2021年的初步設想，我們預計我們的基本業務表現將強勁，並有力地支持我們的長期成長目標，包括我們今天上午一直強調的利多因素。當然，疫情及其相關的經濟影響仍難以預測，而且就目前來看，很可能構成重大的潛在阻力。因此，我們最初設想在2021年以更為保守的總體規劃為起點，以適應這些仍在發展且未知的新冠疫情相關影響，特別是恢復到更正常水平的步伐以及經濟狀況。

As the environment continues to evolve, we will also continue to evolve our thinking and perspective. And as is our custom, we look forward to providing you further perspectives on all aspects of our business at our Investor Conference on Tuesday, December 1, which will be held virtually this year.

隨著環境的不斷變化，我們也將不斷改進我們的思維和視角。一如既往，我們期待在12月1日星期二舉行的投資者會議上，為您提供關於我們業務各個方面的更多見解。今年的投資者會議將以線上方式舉行。

Thank you for your time today. Operator, can you please open the line for questions?

感謝您今天的寶貴時間。接線員，請問您可以接通我們的熱線嗎？

(Operator Instructions) We'll take our first question from A.J. Rice with Crédit Suisse.

（操作員指示）我們將回答瑞士信貸的 A.J. Rice 提出的第一個問題。

Maybe just to pursue a little bit further the comments that Dave just made about thinking about next year. I guess predicting the medical cost trend, you got a lot of moving parts there: potential further deferrals, potential pent-up demand that could come back, cost of vaccines and therapies that could be there, a number of things. And thinking about the cost trend for next year, how are you approaching that? How -- do you see a competitive environment that's changing as a result of that? Just maybe flesh that whole comment about how uncertain the ability to predict the medical cost trend is for next year.

也許我只是想進一步探討戴夫剛才關於明年的思考。我想，預測醫療成本趨勢有很多因素在起作用：潛在的進一步延期、可能再次出現的被壓抑的需求、可能存在的疫苗和療法成本等等。說到明年的成本趨勢，您是如何看待的？您認為競爭環境會因此發生什麼樣的變化？或許可以補充一下關於預測明年醫療成本趨勢的能力有多不確定的那段話。

Thank you, A.J., a very thoughtful question. Hopefully, you took away from the prepared remarks that we're optimistic about the performance of our business. So that's pretty much universal across Optum and UnitedHealthcare. So we didn't get into some of the smaller side businesses, but we're optimistic, in particular, about our relative competitive position and the growth prospects for 2021.

謝謝A.J.，這個問題問得非常有深度。希望您從準備好的發言中了解到，我們對業務表現持樂觀態度。 Optum和UnitedHealthcare幾乎都持這種態度。雖然我們沒有涉及一些規模較小的副業，但我們對我們的相對競爭地位以及2021年的成長前景尤其樂觀。

But as also indicated, we remain deeply respectful of the environment, both the pandemic and related economic consequences. And one thing I would underscore, A.J., is what you hit very well: there are a number of moving parts which are very difficult to predict.

但如文中所述，我們仍高度重視環境，包括疫情及其相關的經濟後果。 A.J.，我想強調的一點，你的觀點非常正確：有很多因素是難以預測的。

And you should also know that we're extending our efforts to ensure that our chronic members and patients are getting the care that they need during this unprecedented time. And we also still have a strong commitment towards correcting any imbalances that could occur.

你們也應該知道，我們正在加倍努力，確保我們的慢性病成員和患者在這個前所未有的時期得到他們需要的治療。我們仍然堅定地致力於糾正任何可能出現的不平衡現象。

So at this distance, we do see our business -- underlying business performing strongly and aligned to our long-term growth objectives, which are 13% to 16% per year, offset in part by these pandemic-related effects. So the starting point, as we indicated in December, will likely represent a wider range given the possible outcomes and a more conservative all-in expectations than normal that you would normally see from us given the -- all the elements that you just described.

因此，從目前來看，我們確實看到我們的業務——基礎業務——表現強勁，並且符合我們每年13%至16%的長期成長目標，但部分抵消了疫情相關影響。因此，正如我們在12月份指出的那樣，考慮到可能出現的結果，起點可能會比通常情況下更為保守，考慮到您剛才描述的所有因素，我們通常會給出更保守的總體預期。

So we're taking that into consideration as we develop our point of view about where our MLR might land, how -- what the variability of that might be. We see it, generally speaking, that whole pandemic-related impacts as being an area -- a headwind for the organization. But don't misread it. We are very bullish on the strong, underlying growth performance of our business.

因此，我們在製定 MLR 可能落在哪裡以及其波動性如何的觀點時，會將這一點納入考慮。我們認為，整體而言，疫情相關的所有影響都會對公司造成不利影響。但請不要誤讀。我們對公司強勁的潛在成長表現非常樂觀。

And the next question is from Josh Raskin with Nephron Research.

下一個問題來自 Nephron Research 的 Josh Raskin。

Just a question on OptumCare, I guess. And you're seeing big growth in the PMPMs there on the consumers served. And I just want to better understand the relative performance sort of 3Q year-over-year versus 2Q, kind of what's driving that increase in revenue per member. And then if you could also talk about sort of physician recruiting and how that's going over the last 6 months.

我想問的只是關於 OptumCare 的問題。您看到 OptumCare 服務的客戶平均每位會員的每月收入 (PMPM) 大幅成長。我想更了解第三季與第二季的年比表現，以及是什麼推動了每位會員的營收成長。然後，您能否談談醫生招募的情況，以及過去六個月的進展？

Sure. Josh, great question, and I think you're hitting on one of the strengths of the enterprise and one of the reasons why we're bullish on its growth for next year. Simply said, it would be more markets, more deeply penetrated into those markets and a higher percentage of them having a risk-bearing arrangement. But Wyatt, do you want to talk more fully?

當然。 Josh，這個問題問得很好，我認為你指出了這家企業的優勢之一，也是我們看好明年成長的原因之一。簡言之，就是要拓展更多市場，更深入滲透這些市場，並且提高這些市場的風險分擔比例。 Wyatt，你想更詳細地談談嗎？

Yes. Sure. Thanks, Josh, and thank you, Dave. I think, Dave, you captured it well. What we're seeing is as we grow, we not only have increased the number of members we serve to 98 million, but we've increased by 25% the revenue per member. And that's being driven in part by the more extensive services that we would offer somebody through a risk-based arrangement in OptumCare versus the lighter type you might see through some of the other businesses within OptumHealth. We expect that trend to continue, and frankly, are very excited double-digit growth in our MA risk lives and related fully capitated lives that we serve.

是的，當然。謝謝喬希，也謝謝戴夫。戴夫，我覺得你說得很好。我們看到的是，隨著業務的成長，我們服務的會員數量不僅增加到了9,800萬，而且每位會員的收入也增加了25%。這部分得益於我們透過OptumCare基於風險的方案為人們提供的服務更加廣泛，而OptumHealth旗下其他一些業務提供的服務則可能更輕量級。我們預計這一趨勢將持續下去，坦白說，我們非常高興我們服務的MA風險人壽保險和相關的全額人壽保險實現了兩位數的增長。

The other piece I'd say, Josh, around your question about physician recruitment is we have seen continued robust interest in both small, tuck-in acquisitions as well as medium and large physician groups who are attracted to both stability, the physician leadership and the evidence-based approach that we've embraced in OptumCare.

喬希，關於你關於醫生招聘的問題，我想說的另一點是，我們看到人們對小型、小型收購以及中型和大型醫生團體的興趣持續濃厚，他們被 OptumCare 的穩定性、醫生領導力和循證方法所吸引。

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。

Wanted to circle back to the comments on 2021. First, from a consensus in and around 11% range for growth year-on-year, Dave, I know you said that the rate is going to be wider than average this year. Wondering if you think consensus will fall within that range at any point? Making the point as to, given the breadth of the business, what specific segments...

我想回到關於2021年的評論。首先，戴夫，我知道您之前說過，市場普遍認為同比增長在11%左右，今年的增速將高於平均水平。您認為市場普遍認為的成長速度是否會落入這個區間？考慮到業務的廣度，具體有哪些細分領域…

Justin, we're having a hard time hearing you. If you're on a headset, can you pick up a handset?

賈斯汀，我們聽不清楚你說話。如果你戴著耳機，能接聽一下嗎？

Sure. Is this better?

當然。這樣好些了嗎？

No.

不。

No. Okay. Hold on a second. Is that better?

不。好的。等一下。這樣好些了嗎？

It is. Thank you.

是的。謝謝。

Sorry about that. So I wanted to do was circle back to the comments you made on 2021. First, consensus earnings growth, I think, appears to look like it's targeting around 11% year-over-year, so below your 13% to 16%. Wondering if you think that might -- you're wider than typical guidance, still might include that consensus estimate within the range?

抱歉。我想回到你對2021年的評論。首先，我認為市場普遍預期的獲利成長目標似乎是年增11%左右，低於你預測的13%到16%。你認為這個預期——雖然比典型的指引範圍更廣——是否仍然可能將市場普遍預期納入這個範圍？

And then can you point us to the specific businesses where you're seeing the potential impact of the COVID and recession concerns maybe beyond just the typical commercial membership?

然後，您能否向我們指出，您認為哪些特定的企業可能受到 COVID 和經濟衰退擔憂的影響，而不僅僅是典型的商業會員？

Sure. John?

當然。約翰？

Justin, it's John Rex here. As Dave pointed out, I think we are quite confident in terms of the underlying growth of the organization as we look towards 2021 and kind of, in a normal a year, I would think kind of things like even kind of where that consensus range sits at this point would be kind of like a normal zone that one could expect of an -- what an area that we would think about stepping out with.

賈斯汀，我是約翰·雷克斯。正如戴夫指出的那樣，展望2021年，我認為我們對公司的潛在成長充滿信心。在正常的年份裡，我認為，即使是目前這個共識區間，也應該處於一個正常的區間，我們可以預期──也就是我們考慮踏出這一步的區間。

We are very respectful to the fact how it's anything but a normal year, and we've learned so much every month, I got to tell you, during this period, over the last 6 months and in terms of how we operate, how our businesses perform, how we need to respond for the people we serve. And so we continue to be in a respectful mode in terms of learning more, understanding the situation better and realizing there could be significant impacts in certain businesses as we think about -- as we think about performance.

我們非常尊重這一事實，因為今年絕非尋常之年。我必須告訴大家，在過去的六個月裡，我們每個月都學到了很多東西，包括我們的營運方式、業務表現，以及我們如何應對我們所服務的客戶。因此，我們將繼續保持這種尊重的態度，以便學習更多知識，更好地了解情況，並意識到疫情可能會對某些業務產生重大影響，尤其是在我們考慮業績表現的時候。

So we look at it in a world of -- excluding, yes, excluding kind of this world we operate in today with kind of COVID-related impacts, a good zone, but you should expect that we think that there are potential headwinds within there, whether those are economic headwinds, whether those are -- whether those are factors in terms of what we need to do from a customer assistance perspective and really kind of -- really the pacing of direct COVID care and treatment cost. So perhaps a long-winded way of getting asked, we are in a mode still of really trying to be responsive to what we're seeing in the environment and evolve our thinking as that environment evolves.

所以，我們把眼光放在一個排除新冠疫情影響的世界裡，這是一個好的環境，但你應該預料到，我們認為其中存在潛在的阻力，無論是經濟阻力，還是客戶支持方面需要我們做什麼的因素，以及新冠直接護理和治療成本的節奏。所以，或許用一種冗長的方式問，我們仍然在努力對所見的環境做出反應，並隨著環境的變化而調整我們的思維。

And Justin, I don't think I've heard -- picked up your second question. If you could repeat that one. It was just hard to hear.

賈斯汀，我想我沒聽清楚──我接了你的第二個問題。你能重複一遍嗎？我聽不太清楚。

Yes. What I was asking is specifically around the segments that could be impacted. And most of all, I know COVID is a potential uncertainty. What I've heard in the market is a lot of companies are trying to price for that, adding a little bit to trend. Is that something that you felt like you did for last year or you're just still being conservative? Or do you feel like that's something that's tough to do in this environment?

是的。我問的是具體哪些細分市場可能會受到影響。最重要的是，我知道新冠疫情是一個潛在的不確定性。我聽說市場上有很多公司試圖將疫情的影響納入定價，這稍微影響了趨勢。您覺得這種做法和去年一樣嗎？還是您仍然比較保守？或者您覺得在目前的環境下很難做到這一點？

Now -- I mean, Justin, this is Dirk McMahon. What I would say is we're, of course, going to price to our best estimate of forward trends. That's going to include COVID.

現在──賈斯汀，我是德克‧麥克馬洪。我想說的是，我們當然會根據對未來趨勢的最佳估計來定價。這其中會包含新冠疫情的影響。

But you asked about the economic impact, so as we sat back and we looked at the third quarter, actually, our membership was a little less impacted than we thought it was going to be because of things like the Payroll Protection Program as well as some furloughs that large employers did. So yes, there will be a little bit of a run-in problem, but less than what we expected.

但你問到經濟影響，我們回顧一下第三季度的情況，發現實際上，由於工資保護計劃（PPP）以及一些大型雇主實施的強制休假等措施，我們的會員受到的影響比我們預想的要小一些。所以，確實會有一些磨合期問題，但比我們預期的還要小。

So from a membership standpoint, we're actually fairly optimistic about how we priced. We continue to look at how our block is priced for 1/1. And as we look at that, we're more than competitive and we monitor that every day.

所以從會員的角度來看，我們對自己的定價其實相當樂觀。我們會繼續關注我們的區塊如何以1/1的價格定價。這樣一來，我們的競爭力就更強了，我們每天都會監控這一點。

Thank you, Justin. Great questions.

謝謝賈斯汀。這個問題問得真好。

We go next to Frank Morgan with RBC Capital Markets.

接下來我們來談談加拿大皇家銀行資本市場的弗蘭克摩根 (Frank Morgan)。

John mentioned a expectation for a decline in plan switching this year in the MA market. Just curious if you any color on why you expect that to be the case.

John提到，預計今年MA市場的計畫轉換數量會下降。我想知道您能解釋為什麼會發生這種情況。

Just to follow up. I think what we -- one of the things I commented on was actually, we are seeing less plan switching than normal actually. And what we're seeing is strong adoption of people new to Medicare coming into Medicare Advantage.

順便問一下。我想說的是，我之前提到的一件事是，我們看到的計劃轉換比平常少。我們看到的是，新加入Medicare的人越來越多地加入Medicare Advantage計劃。

So Tim, do you want to add anything? Tim Noel?

那麼提姆，你還有什麼要補充嗎？蒂姆·諾埃爾？

Yes. Yes, Frank, thanks. Tim Noel. Yes. What John alluded to is that what we've seen in the marketplace is a decline in people that are switching from one MA carrier to the next. However, a lot of strength in what we call the chooser market, which are folks that are newly eligible for Medicare or people that are choosing Medicare Advantage plans compared to other coverage types throughout the course of the year. So we've seen really good, strong demand in those categories, but the plan switching activity was lighter. And in particular, in March and April, it's come back a little bit throughout the course of the year. And actually, we've seen some better activity recently.

是的。是的，弗蘭克，謝謝。提姆·諾埃爾。是的。約翰提到的是，我們在市場上看到的是，從一家聯邦醫療保險承保人轉換到另一家的人數有所下降。然而，我們所說的選擇者市場卻表現強勁，這些人指的是新近獲得聯邦醫療保險資格的人，或者在一年中相比其他保險類型選擇聯邦醫療保險優勢計劃的人。因此，我們看到這些類別的需求非常強勁，但計劃轉換活動較少。特別是在3月和4月，全年的轉換活動都有所回升。實際上，我們最近看到了一些更好的活動。

So the dynamic in the marketplace as we head into annual enrollment period is one where we're trending back to an environment that's more normal compared to selling seasons in the past.

因此，當我們進入年度招生期時，市場動態正趨向於回到與過去的銷售季節相比更正常的環境。

We go next to Ricky Goldwasser with Morgan Stanley.

接下來我們來談談摩根士丹利的 Ricky Goldwasser。

Question on the Medicaid side. Obviously, enrollment impact from higher unemployment is coming in lower than you expect. When do you expect the impact to peak? How do you think about the balance of going to Medicaid versus exchanges?

關於醫療補助（Medicaid）方面的問題。顯然，高失業率對投保人數的影響低於您的預期。您預計這種影響何時達到高峰？您如何看待醫療補助和醫療交易所之間的平衡？

And then on the Medicaid side, has the pandemic changed how states think about transitioning their higher-acuity populations to Managed Care from fee for service? And what type of visibility do you have more Medicaid rates for next year at this point of time?

那麼，在醫療補助（Medicaid）方面，疫情是否改變了各州如何看待將高風險族群從按服務收費模式過渡到管理式醫療（Managed Care）？目前來看，您對明年醫療補助費率的預期如何？

You pretty much covered the entire landscape, Ricky. Well done. We will try to be as responsive as possible on all of that. Tim Spilker is our Chief Executive for Community & State. Tim?

Ricky，你幾乎涵蓋了所有情況。幹得好。我們會盡力回應所有問題。 Tim Spilker 是我們的社區與州執行長。 Tim？

Yes. Thanks for the question. And you were definitely hitting on a lot of the factors that we've been tracking. So first up, just in terms of enrollment, and Dirk mentioned, as did John in his opening comments, so far, what we've seen just in terms of enrollment gains is really the result of the suspension of redeterminations as a result of the CARES Act. We really have not yet seen unemployment pull through, and I think that's reflective of some of the dynamics that we're seeing in the commercial market. And that's been supported, I think, by a lot of external studies as well. So we continue to watch this. I think we would expect that unemployment would pull through at some point, especially as the time frame between loss of coverage increases.

是的，謝謝你的提問。你肯定提到了很多我們一直在追蹤的因素。首先，就入學人數而言，Dirk 和 John 在開場白中都提到過，到目前為止，我們所看到的入學人數增長實際上是《關懷法案》暫停重新認定的結果。我們確實還沒有看到失業率回升，我認為這反映了我們在商業市場看到的一些動態。我認為，許多外部研究也支持這一點。所以我們會繼續關注這個問題。我認為，我們預計失業率會在某個時候回升，尤其是在失去保險的時間間隔增加的情況下。

As for your second question, just around complex populations. Yes, we are actively monitoring states as they explore transitions to Managed Care. We believe there's a very strong value proposition, especially for complex populations, including those that receive long-term care services and HCBS services. We know, based on our experience, that Managed Care can deliver significant value, not just in terms of cost savings, but also in terms of helping individuals remain in their homes, helping people access social services and support. And so we've been working with states and monitoring states activity as they transition.

至於您的第二個問題，主要針對複雜人群。是的，我們正在積極監控各州向管理式醫療過渡的探索情況。我們認為，這具有非常強大的價值主張，尤其適用於複雜人群，包括那些接受長期照護服務和家庭健康保險計劃 (HCBS) 服務的人。根據我們的經驗，我們知道管理式醫療可以帶來巨大的價值，不僅體現在成本節約方面，還體現在幫助人們留在家中、獲得社會服務和支持方面。因此，我們一直在與各州合作，監測各州在過渡過程中的活動。

I think we are seeing a very robust RFP pipeline, as Dave mentioned. And we're hopeful that many states include long-term care services in complex populations in those.

正如戴夫所說，我認為我們看到了非常強勁的RFP管道。我們希望許多州能夠將複雜人群的長期照護服務納入其中。

And then finally, I think your last question was on funding and rate. Yes, and so just on that one, yes, this is something that we've also been working closely with our state customers on really to ensure that funding is sustainable, both now and into 2021, especially considering all the dynamics in play. States are really taking a rational approach to funding. They're leveraging the appropriate risk management mechanisms depending on their experience. That could include risk corridors and MLR structures. They're also benefiting from some of the additional federal funding through the CARES Act. And then, of course, just as a reminder, Medicaid funding must be actuarially sound, which our states really do continue to use as a guiding principle.

最後，我想您最後一個問題是關於資金和利率的問題。是的，就這一點而言，我們一直在與各州的客戶密切合作，以確保資金的可持續性，無論是現在還是到2021年，尤其是考慮到目前的所有動態因素。各州確實在採取合理的資金籌措方式。他們根據自己的經驗，利用適當的風險管理機制。這可能包括風險走廊和MLR結構。他們也受益於《關懷法案》提供的一些額外聯邦資金。當然，需要提醒的是，醫療補助資金必須經過精算，而我們各州確實會繼續以此作為指導原則。

So this is certainly an area of focus for us. We have strong relationships with our customers, and we feel good about those conversations thus far. And then maybe just the last thing I'd say is sustainable funding and all of this work is really critical as it enables us to invest in programs that really do drive substantial social and health outcomes for our customers as well as for the people that we serve.

所以這無疑是我們重點關注的領域。我們與客戶保持著良好的關係，迄今為止的溝通也讓我們感到滿意。最後我想說的是可持續的資金，所有這些工作都至關重要，因為它使我們能夠投資於那些真正能為我們的客戶以及我們所服務的人帶來顯著社會和健康成果的項目。

So Ricky, I hope that was responsive, at least responsive enough. Thank you for the thorough question.

Ricky，我希望你的回答夠清晰，至少夠清晰。謝謝你提出這麼透徹的問題。

And the next question is from Gary Taylor with JPMorgan.

下一個問題來自摩根大通的加里泰勒 (Gary Taylor)。

Two-part question, just in case I strike out on the first one. I was wondering if you could quantify the consumer and customer assistance, how that impacted the MLR this quarter.

這個問題分成兩個部分，以防萬一第一個問題我答錯了。我想知道您能否量化一下消費者和客戶協助，看看這對本季的 MLR 有何影響。

The second part of the question, just thinking about cost trend heading in 2021. I think by the time this year is all said and done, you might end up being, on your core commercial group cost trend, down a couple of hundred basis points at least. So when you're thinking about your guidance for '21, are you thinking it could be a normal cost trend on top of that? Are you thinking it -- deferrals would accelerate? It could be 200 basis points or more higher than normal. I'm just interested in your thought process on how you're going to comp? Was it easier than expected all-in trend for 2020?

問題的第二部分，只是思考2021年的成本趨勢。我認為到今年年底，你們的核心商業集團成本趨勢可能會至少下降幾百個基點。所以，當你考慮21年的業績指引時，你是否認為這可能是正常的成本趨勢？你是否認為－延期付款會加速？它可能會比正常水準高出200個基點或更多。我只是想知道你對如何進行補償的思考過程？ 2020年的整體趨勢是否比預期的要輕鬆？

Well, I'll give you the strike on the first one because I don't think we're going to quantify customer and consumer assistance in the quarter. The one thing I will tell you is it's extensive. In particular, this is one of the primary quarters where the Medicare business was offering full copay waivers on both primary care and specialist visits. And the reason for that, Gary, is that we were deeply concerned and remain deeply concerned that Medicare consumers access their physician just as quickly as possible because they're obviously managing chronic disease. And we saw a very nice response to that program, so much so that we're extending elements of it into the fourth quarter. So that's where customer systems will continue.

嗯，我先不說第一個，因為我認為我們不會在本季量化客戶和消費者援助。我要告訴你的是，這項援助範圍很廣。特別是，這是Medicare業務首次在初級保健和專科醫生就診中提供全額自付費用豁免的主要季度之一。加里，這樣做的原因是，我們過去非常擔心，現在仍然非常擔心Medicare消費者能否盡快就醫，因為他們顯然正在應對慢性病。我們看到了對該計劃的良好反響，因此我們將部分內容延續到第四季度。所以，客戶系統將繼續在第四季運作。

In addition to that, we extended some other programs. You probably saw that our $1.5 billion initial estimate went to $2 billion. And in part, that was because of additional premium waivers and adjustments that we have made that will extend through the balance of this year and modestly into next as well. So that gives you color for the kind of the volume and the quantity of things that were going on during that time frame.

除此之外，我們也延長了一些其他項目。您可能已經看到，我們最初估算的15億美元已增加到20億美元。部分原因是我們實施了額外的保費減免和調整，這些措施將延續到今年年底，並適度延續到明年。這樣，您就可以大致了解這段時間內的專案數量和規模。

With respect to cost trends in 2021, Dirk, do you want to speak to that?

關於 2021 年的成本趨勢，德克，您想談談嗎？

Yes. I would say, Gary, this goes back to what Dave said originally. We do consider all those factors you described. We consider what we expect COVID to do with respect to testing, with respect to treatment. All things that are associated with abatement as well, we make an estimate of that. We try to make a forecast when the vaccines would become available.

是的。我想說，加里，這又回到了戴夫最初說的。我們確實考慮了你所描述的所有因素。我們考慮了我們預期新冠疫情對檢測和治療的影響。所有與疫情緩解相關的因素，我們都進行了估算。我們試圖預測疫苗何時能夠上市。

So all those things are considered as we price our business for next year. I'm not going to get into the exact number of basis points associated with each one of those. That's competitive. But I mentioned earlier, we do monitor what's going on in the market, what we see with the ongoing trends in all 3 of those buckets as well as all the underlying costs. And we make our best estimate as to where we should land to be competitive from a membership growth standpoint as well as an earnings standpoint. That's what we do. And we have actuaries, and we have our management teams that are pretty experienced with that.

所以，我們在為明年的業務定價時，會考慮所有這些因素。我不會詳細討論每個基點的具體數值。這是為了保持競爭力。但我之前提到過，我們確實會密切關注市場動態，關注這三個方面持續的趨勢以及所有潛在成本。我們會盡力預估，從會員成長和獲利的角度來判斷我們應該達到什麼樣的水平才能保持競爭力。這就是我們所做的。我們有精算師，也有經驗豐富的管理團隊。

We'll go next to Scott Fidel with Stephens.

接下來我們將和史蒂芬斯一起採訪史考特·菲德爾。

Just wanted to follow up on Medicare Advantage for 2021 and the comments that David made around industry-leading growth expectations. And I guess really just a 2-part question to this. Just one, so we do have CMS projecting the, at least, 10% enrollment growth for individual MA for 2021. So just interested in terms of your commentary on industry-leading growth, how you take that into context and whether that would support double-digit enrollment growth in individual MA for 2021.

我想跟進一下2021年聯邦醫療保險優勢計劃（Medicare Advantage）以及David關於行業領先增長預期的評論。我想這個問題其實可以分成兩個部分。首先，CMS預測2021年個人健保（MA）的註冊人數至少會增加10%。所以我想問您對行業領先增長的評論，您是如何看待這個預期的，以及這是否會支持2021年個人醫保（MA）的註冊人數實現兩位數的增長。

And then just secondly, it sounded like the comments around group MA, it sounded pretty bullish in terms of sales. Just interested if you can maybe quantify for us the expected -- the group MA lives that so far you think you've added for 2021.

其次，關於MA集團的評論聽起來相當樂觀，尤其是在銷售方面。您能否量化一下MA集團的預期－您認為到目前為止，您認為2021年新增的銷售額是多少？

Just to clarify, Scott, from at least my standpoint, what I really look at is the number of people served and what our performance will be relative to the market overall. And as has been pretty consistent over time, UnitedHealthcare Medicare & Retirement has outperformed on that metric in particular.

史考特，我來澄清一下，至少從我的角度來看，我真正關注的是服務的人數，以及我們的業績相對於整體市場的表現。一直以來，聯合健康保險（UnitedHealthcare）的醫療保險和退休保險（Medicare & Retirement）在這項指標上的表現都相當出色。

What I like about this year, in particular, is what not only the group MA component really coming off of a -- what would be a disappointing year in 2020, meaning the 2021 actual policy year, but also the kind of the setup for individual MA and continuation with our duly eligible members and their growth. So that's the essence of the backdrop of the comment that I made.

今年我尤其喜歡的一點是，不僅因為團體保險組合險（MA）部分真正擺脫了令人失望的2020年（也就是2021年實際保單年度）的影響，還因為個人保險組合險的設置以及我們符合條件的會員的延續性以及他們的增長。這就是我剛才評論的背景。

Tim, do you want to add anything further?

提姆，你還有什麼要補充的嗎？

Yes, yes. Thanks, Scott. So selling obviously starts tomorrow for individual Medicare Advantage. We've been marketing our products since the beginning of October, receiving really positive feedback from the broker community about how we're positioned. And once again, as you know, our top priority is providing stability and benefits for the members that we serve. And as we go to market, we are happy to have succeeded in providing that for our members. And in fact about 75% of our members will experience improving benefits in 2021 compared to 2020. And we also made some additional investments and capabilities to support seniors. So given that backdrop, we do feel really good about our positioning to gain share in individual MA, group MA as well as the dual special needs plans market.

是的，是的。謝謝，斯科特。個人醫療保險優勢計劃（Medicare Advantage）的銷售顯然明天就開始了。我們從十月初就開始行銷我們的產品，經紀人群體對我們的定位回饋非常積極。再次強調，如您所知，我們的首要任務是為我們服務的會員提供穩定性和福利。隨著我們進入市場，我們很高興能夠成功地為會員提供這些服務。事實上，與2020年相比，我們約有75%的會員在2021年將享有更好的福利。我們也增加了一些投資和能力來支持老年人。因此，有鑑於此，我們對我們的定位感到非常滿意，能夠在個人綜合保障（MA）、團體綜合保障（MA）以及雙重特殊需求計劃市場中贏得份額。

We're not going to comment specifically on any point estimate for industry growth, but we really like our positioning from inside of the growth, whatever that might be. And to Dave's comments, we're really excited about our group MA growth in 2021.

我們不會具體評論任何行業成長的點估計，但我們非常看好自己在成長中的定位，無論成長前景如何。正如戴夫所說，我們對2021年集團平均銷售收入的成長感到非常興奮。

And then next, we'll go to Robert Jones with Goldman Sachs.

接下來，我們來談談高盛的羅伯特瓊斯。

Great. I guess maybe just want to get your latest thinking on participating in direct contracting next year, obviously, through OptumCare. I was wondering if this would contribute at all to your projections around global cap lives growth. Or would that be incremental?

太好了。我想問您對明年參與直接簽約（顯然是透過 OptumCare）的最新想法。我想知道這是否會對您關於全球人壽保險成長的預測有所貢獻？或者說，這只是漸進式的貢獻？

And then maybe just relatedly, how are you thinking about direct contracting relative to the opportunity, obviously, around MA on the UHC side?

然後也許只是相關的，您如何看待相對於 UHC 方面的 MA 機會的直接簽約？

Let's start with UHC.

讓我們從 UHC 開始。

Sure. Brian Thompson here. As it relates to Medicare Advantage, as you've known from us for a long time, we've had the enterprise perspective of modernizing fee-for-service. But we're certainly encouraged by any activities like this. We participate in things like bundled payment programs, et cetera, and I see direct contracting as a positive to try to modernize the overall fee-for-service system in total. And why it obviously is looking at direct contracting, to go into OptumCare.

當然。我是 Brian Thompson。關於醫療保險優勢計劃 (Medicare Advantage)，正如您很久以前了解的那樣，我們一直從企業角度考慮如何實現按服務收費的現代化。但我們當然對任何類似的活動感到鼓舞。我們參與了捆綁支付計劃等等，我認為直接簽約對於全面實現按服務收費系統的現代化具有積極意義。這就是為什麼我們顯然正在考慮直接簽約，以進入 OptumCare 的原因。

Yes. Thanks, BT. And Robert, thanks for the question. We are very encouraged by every effort to move from fee-for-service to value-based contracting, so view this as a positive trend.

是的。謝謝，BT。羅伯特，謝謝你的提問。我們對從按服務收費模式轉向基於價值的合約模式的每一項努力都感到非常鼓舞，所以認為這是一個積極的趨勢。

The direct contracting proposals are primarily geared towards smaller groups that are in fee-for-service, and we have been in risk-based arrangements for over 10 years. And so while we will embrace this where it's appropriate, we have relationships with over 80 payers, and we'll expect to see continued double-digit growth of our MA and dual-risk lives that we care for.

直接簽約方案主要針對按服務收費的小型群體，而我們採用基於風險的方案已有十多年。因此，我們將在適當的情況下採用這種方案，目前我們與80多家付款方建立了合作關係，我們預計我們承保的併購和雙重風險人群將繼續保持兩位數的成長。

And I don't anticipate that the direct contracting will be a major factor for us. But again, I don't mean to say that in any kind of a negative way. It's a good program, but it's -- but we will embrace all vehicles to grow.

我預計直接簽約不會成為我們的主要因素。但我再次強調，我這麼說絕對不是想貶低我們。這是一個好的項目，但我們會擁抱所有類型的投資工具來促進成長。

We'll go next to Sarah James with Piper.

接下來我們將和 Piper 一起去見 Sarah James。

I was hoping you could give us some context around corporate tax reforms. Looking back to 2018, you sized the benefit around $2 billion. Wondering where that sits now. And if there's a difference between product lines and how we should think about which line benefited on the margin side versus what's passed through for pricing changes or other items?

我希望您能為我們介紹一下企業稅改的背景。回顧2018年，您估計這項改革的收益約為20億美元。我想知道現在這個數字是多少。不同產品線之間是否有差異？我們應該如何看待哪些產品線的利潤率較高，哪些產品線的利潤率會因為價格變動或其他項目而下降？

Sarah, it's John Rex here. So I think we go back to the -- that former period that you were discussing in core protection. I think there are a number of things that we commented on during that period and in terms of impact. And if you recall, during that period, we also commented about investments that we are making as a result to build for future growth and how we were investing in the businesses for the longer term. Certainly, that was an element there. Clearly, kind of since that period, a number of years ago now, the company is much, much larger, so you would expect that kind of that impact is kind of much smaller from an effective tax rate impact than we would have had back in that time.

莎拉，我是約翰‧雷克斯。我想我們回到你之前討論的核心保護問題。我認為我們在那段時期就影響力方面發表了一些看法。如果你還記得的話，在那段時期，我們也談到了我們為未來成長的投資，以及我們如何進行長期業務投資。當然，這是其中的一個因素。顯然，從那段時期開始，也就是幾年前，公司規模已經大了很多，所以你可以預期，有效稅率的影響會比當時小得多。

Among the other elements that you're talking to in corporate tax reform and impacts, I think it's tough really to kind of get out ahead of anything in terms of potential impact and even how those impact on specific businesses just because there isn't some -- we just don't -- really don't want to get ahead of any kind of policy that might be out there. So probably would just leave it at that.

在您談到的企業稅改革及其影響的其他因素中，我認為很難提前預測任何潛在影響，甚至很難預測這些影響會對特定企業造成怎樣的影響，因為目前還沒有——我們真的不想——提前預測任何可能出台的政策。所以，可能就到此為止了。

Next is David Windley with Jefferies.

接下來是 Jefferies 的 David Windley。

I'm interested in -- I appreciate the comments, several kind of percentage of baseline utilization numbers offered in the prepared remarks. I'm curious how that has progressed perhaps through the quarter. For example, by the end of the quarter, were some of those at or above 100%? Are you expecting that to get to above baseline in the fourth quarter? And based on your assessments of kind of pent-up underutilization and system capacity, how long might you expect that to last?

我感興趣的是——感謝各位的評論，以及準備好的評論中提供的幾種基準利用率百分比數字。我很好奇整個季度的進展。例如，到本季末，其中一些是否達到或超過了100%？您是否預期第四季的利用率會超過基準水準？根據您對積壓的利用率不足和系統容量的評估，您預計這種情況會持續多久？

And then just to tag on, the DCP for the first couple of quarters of the year, had been pretty consistent year-over-year, but at the third quarter is down a couple of days, 2 to 3 days. I'm wondering how that folds into that view of where utilization is going?

補充一下，今年前幾季的DCP年比變化相當穩定，但第三季下降了幾天，大概2到3天。我想知道這與利用率的走向有什麼關係？

John Rex. Let me answer to get at those. So first of all, let me give you a little more color in terms of what we saw in utilization over the course of the quarter and how it fits to what we were seeing last quarter and such. So I spoke to kind of baseline exceeding 95% across our businesses as we look at the utilization at this point here. Maybe give a little color kind of -- context within that and different categories and how those would trend.

約翰·雷克斯。我來回答一下這些問題。首先，我想稍微詳細地介紹一下我們本季的使用率情況，以及它與上個季度的比較情況。我之前提到，我們目前業務的使用率已經超過了95%。或許可以稍微介紹一下其中的背景，以及不同類別的使用率趨勢。

I'd point out, if I look at physician services, that would be below that baseline. I'd put kind of outpatient surgery, that kind of -- right at kind of in that zone at baseline. And I'd put inpatient above that baseline zone.

我想指出的是，如果我看一下醫生服務，我會發現它低於基線。我會把門診手術之類的放在基線區域內。而住院手術則放在基線區域之上。

As we look down at kind of various populations and such, maybe a little color commentary in terms of how that trends. So commercial, certainly kind of higher in terms of where we're seeing utilization and where we're seeing against baseline; government program services, lower. And within that, I would say, kind of within the government programs, let's say, the community state business being the lower element of those in the way it's trending.

當我們觀察不同人群的情況時，或許可以稍微評論一下這種趨勢。商業服務，就利用率和與基線相比而言，肯定更高；而政府項目服務則較低。其中，我想說，在政府計畫中，比如說社區、州立業務，其趨勢相對較低。

One important element here. So what you referred to some of the commentary we had for our expectations for the fourth quarter. And then so among those were that care that has been deferred, that we are able to help facilitate that care incurs. And that's kind of where we're making investments and what we want to see happen here.

這裡有一個重要因素。您剛才提到了我們對第四季預期的一些評論。其中就包括那些被延後的護理，我們能夠幫助促成這些護理的發生。這正是我們正在投資的領域，也是我們希望看到的結果。

The other element that we anticipate as we look towards the end of the year is we have been anticipating to see rising acuity because of deferred and missed treatment, we'd see a higher-acuity population. I would tell you, we really haven't seen that yet. Where we see rising acuity on the overall book is it's because of the COVID-19 cases that come in at a higher acuity level, and so you see a higher acuity on that component. But if you take that component out, we don't really see it across the full scope of the book of our business at this point.

展望年底，我們預期的另一個因素是，由於延誤治療和錯過治療，我們一直預期病例數會上升，我們將看到病例數更高的人。但我想說，我們目前還沒有看到這種情況。我們看到整體病例數上升是因為新冠病例數較高，所以這部分病例數也會更高。但如果撇開這部分病例數不談，目前我們還沒有看到它在整個業務範圍內都出現。

As you're -- to your comment over in terms of over the course of the quarter, what we saw, well, it was an interesting quarter from that perspective because you saw different incidence rates in different parts of the country over the course of the quarter. So we really monitor that quite closely. And you would see as a particular part of the country, you saw infection rates begin to rise, you would see deferral come into that mix. Given our platform across the entire country, we have a viewpoint into that, but you see deferral and then you'd see it come back in.

正如您所說——就本季度而言，我們看到的情況是，嗯，從這個角度來看，這是一個有趣的季度，因為您在本季度看到了全國不同地區的發病率不同。因此，我們確實非常密切地監測這一點。您會看到，在某個特定地區，感染率開始上升，然後會出現延期的情況。鑑於我們涵蓋全國的平台，我們對此有自己的看法，但您會看到延期的情況，然後又會再次出現。

I think the last thing that I would place, I would just point out is within kind of that baseline that we're talking about -- and so I said exceeding 95%, I put kind of in the zone of 5 points or so were probably COVID-19-driven in terms of within that mix. And that's inclusive in the baseline we're talking about.

我想最後要指出的是，在我們討論的基線範圍內——我之前說超過95%，我指的是大概5個百分點左右的疫情影響可能是由新冠疫情驅動的。這已經包含在我們討論的基線範圍內了。

And then DCP.

然後是 DCP。

And DCP. Thank you for reminding me. So DCP, the decline year-over-year, David, so that is due to the -- really the acceleration in provider payments that we took on earlier in the year. So as we -- really, we're trying to get liquidity injected into the health care system when we accelerated our payment cycles very, very significantly, and that continues.

還有DCP（住院費用），謝謝你提醒我。 David，DCP的同比下降實際上是由於我們今年早些時候加快了醫療機構的付款速度。因此，我們確實在努力為醫療保健系統注入流動性，大幅加快了付款週期，而且這種情況還在持續。

The reason you wouldn't have seen that in the second quarter is because of the very significant deferral of medical care in the second quarter. So -- but kind of getting into the math of it, right, you get a denominator here where medical cost per day was declining very, very significantly in the second quarter. So that more than offset the impact of those payments. As we saw care come -- being restored much closer to normal levels this quarter, then that comes up. And so now you're seeing the impact of that accelerated payment cycle show up in our DCP, but that was impacting.

你在第二季度沒有看到這種情況的原因是第二季醫療費用大幅推遲。所以——但深入計算一下，你會發現一個分母，第二季每日醫療費用下降非常非常顯著。所以這足以抵消這些付款的影響。隨著我們看到醫療服務在本季恢復到更接近正常水平，這種情況就會顯現出來。所以現在你看到加速付款週期的影響體現在我們的DCP中，但這確實產生了影響。

And just to remind you, give you a sense of that, as we indicated in the prepared remarks as well, it's around a $2 billion advance to the market or acceleration in payment.

只是為了提醒您，讓您了解這一點，正如我們在準備好的評論中所指出的那樣，這相當於向市場預付約 20 億美元或加速付款。

And next is Charles Rhyee with Cowen.

接下來是 Cowen 公司的 Charles Rhyee。

Yes. Maybe if I could follow-up on that, about utilization and then tie it back to sort of your comments around the outlook for '21. It sounds like inpatient volume is a little bit above normal. Other areas are a little bit below. And overall, let's say, we're kind of getting back to a normal baseline utilization. Given at that kind of pace that we're on this year and then we think about next year, what is it in your thinking that makes you think that we're going to see a really big uptick in utilization?

是的。或許我可以繼續問一下關於利用率的問題，然後把它和您對2021年前景的評論連結起來。聽起來住院人數略高於正常。其他地區略低於正常水準。總的來說，我們的利用率正在恢復到正常的基線水平。考慮到我們今年的成長速度，再考慮明年，您認為是什麼讓您認為利用率會大幅上升？

Because it sounds like when we go back to the earlier part of the Q&A when you're -- in your comments, Dave and John, at the end was next year, you're thinking about a more conservative starting point to think about the '21 outlook. And I understand that we'd want to back out some of the onetime items that were positive for this year. But maybe help us understand a little bit what is your underlying assumptions for utilization? Because it seems to me and the pace that we're going at, it doesn't strike me that we're going to really have really overutilization per se next year. Maybe help us understand what maybe you're seeing here as we're now into part of the fourth quarter that kind of gives you that sense.

因為聽起來，當我們回到問答環節的早期部分時，戴夫和約翰，在你們的評論中，最後提到了明年，你們正在考慮一個更保守的起點來思考21年的前景。我知道我們想要剔除一些對今年有利的一次性項目。但也許可以幫助我們稍微了解一下你們對利用率的基本假設是什麼？因為在我看來，按照我們目前的節奏，我認為明年我們不會真的出現過度利用的情況。也許可以幫助我們理解你們現在看到的情況，因為我們現在已經進入了第四季度，這給了你們這種感覺。

Yes. So my comments are really grounded in the unprecedented uncertainty as we look forward and a deep respect for the pandemic and its impact on the economic climate. And that's why, as you think about being at this distance, stepping out, recognizing that as your -- kind of the future expectation, you would normally widen your range and you would probably take a more conservative posture. And that's essentially what we were trying to communicate. John, do you have anything further to add?

是的。所以我的評論其實是基於我們展望未來時前所未有的不確定性，以及對疫情及其對經濟環境影響的深切擔憂。正因如此，當你考慮到保持距離，走出去，意識到你對未來的預期，你通常會擴大你的範圍，你可能會採取更保守的立場。這正是我們試圖傳達的。約翰，你還有什麼要補充的嗎？

No, Charles, the one thing I'd comment and I think you said kind of we've seen inpatient kind of above normal. I wouldn't say that's where we are. I said on that exceeding 95% baseline, I was orienting those categories around how they orient around that, exceeding 95%: that inpatient rides a little above that; physician, below that; and outpatient surgery is kind of right in that zone. So that's more the commentary that I was providing there, not that inpatient is running above baseline yet.

不，查爾斯，我想評論的一件事，我想你說過，我們看到住院病人的人數有點高於正常水平。我不認為這就是我們現在的水平。我說的是超過95%的基線，我是根據這些類別如何圍繞超過95%來調整的：住院病人略高於這個水平；醫生低於這個水平；門診手術正好在這個區域。所以，這更多的是我提供的評論，而不是說住院病人已經超過基線了。

But we -- certainly, categories are progressing to that. And I think it goes -- in terms of your broader commentary into what to expect for utilization, so we want to make sure people get the care they need. That's why we're here, ultimately. And so we're going to do everything in our power to make sure that, that care occurs.

但我們——當然，類別正在朝著這個方向發展。我認為——就您對醫療利用率預期的更廣泛的評論而言，我們希望確保人們得到他們需要的護理。這就是我們最終存在的原因。因此，我們將竭盡全力確保提供這種護理。

But you heard some of the commentary offered earlier in the year even in terms of what was going on in different categories in terms of cancer diagnoses, different areas that we're off significantly. That's not kind of good for people. That's not good for the system. We want to make sure that, that care is getting delivered. And there are areas of care that we're going to be very proactive in making sure that people are able to access that.

但您今年早些時候聽到了一些評論，甚至談到了癌症診斷等不同類別的進展，以及我們存在嚴重偏差的不同領域。這對病人不利，對醫療體係也不利。我們希望確保醫療服務能夠得到提供。我們將非常積極主動確保某些領域的醫療服務能夠惠及病患。

In our business, we have both direct access in the OptumCare businesses. UnitedHealthcare is being very proactive in its outreach to vulnerable populations and making sure that they're getting the treatments that they need. So our ambition is to make sure that, that care is delivered. There's much -- there's a lot of necessary care that's not happening also.

在我們的業務中，我們與 OptumCare 業務都有直接聯繫。聯合健康保險 (UnitedHealthcare) 非常積極主動地接觸弱勢群體，確保他們獲得所需的治療。因此，我們的目標是確保醫療服務能夠得到滿足。目前還有很多必要的醫療服務尚未滿足。

But I'd come back to Dave's commentary. As we look out to 2021 and some of the earlier themes, we've been learning stuff all along the way over the past many months. And we continue to evolve that thinking. We continue to feel like we get better perspective and why deeply respectable in terms of we don't really know how this moves over the next several months also. So I think that's what you hear in terms of our commentary, in terms of how we think -- why we think -- how we think about stepping out and why, that we want to be respectful of an environment, frankly, that no one has navigated before. And I think that's just what you would expect us to -- the way you'd expect us to approach it.

但我還是想回到戴夫的評論。展望2021年以及之前的一些主題，過去幾個月裡，我們一直在學習。而我們仍在不斷改進這種思維。我們感覺自己獲得了更好的視角，並且值得我們尊敬，因為我們真的不知道未來幾個月的情況會如何發展。所以，我想這就是你們從我們的評論中聽到的，關於我們如何思考——為什麼我們思考——我們如何看待走出去，以及為什麼我們要尊重一個坦率地說，以前沒有人經歷過的環境。我想這正是你們期望我們做的事——你們期望我們處理這件事的方式。

And we'll take this next 30, 45 days or so to accumulate more facts, understand even better and then lay all this out for you in more detail to the best of our ability when we get together on December 1. We have time for one more question with a quick question and answer, and then I'll close.

我們將用接下來的 30 到 45 天左右的時間來累積更多事實，進行更深入的了解，然後在 12 月 1 日聚會時盡我們所能，更詳細地向您闡述這一切。我們還有時間再問一個問題，進行快速問答，然後我就結束發言了。

And we'll take that question from Lance Wilkes with Bernstein.

我們將從伯恩斯坦的蘭斯威爾克斯那裡回答這個問題。

Yes, just wanted to ask for employer enrollment, how's that progressing in October? And what's your outlook for 4Q and beyond? And if you can give any clarification in OptumRx on kind of the real sharp increase in revenue per script and some of the compression in margin, that would be helpful, too.

是的，我只是想問雇主登記的情況，十月進展如何？您對第四季及以後的展望如何？如果您能解釋一下 OptumRx 每處方收入的大幅成長以及利潤率的下降，那也會很有幫助。

So I don't think we'll be able to give you insights into October and the quarter specifically, but what we can give you insights into is what the progresses we're making across the board in the commercial market going forward, give you some sense of that without quantifying it. Dirk?

因此，我認為我們無法向您提供關於 10 月份和本季度的具體信息，但我們可以讓您了解未來我們在商業市場上全面取得的進展，讓您對此有所了解，而無需量化。德克？

Yes. I would say that as you think about the fourth quarter, the sense should be is there's a good amount of stickiness with respect to the end of this year in terms of persistency that we're seeing with our groups. And further, I think as we look at next year, I think we talked about it in the script, we'll have a lot of good products coming off the assembly line that we're very enthused about: All Savers, our level-funded product; Bind, a good product, which basically is a scenario where you have a kind of base level of coverage and you buy up if care is needed in certain categories. Then we have what I would say a bunch of provider-centric products, where we're looking at really efficient, high-quality networks and having low consumer out-of-pockets associated with those.

是的。我想說，展望第四季度，我們應該感覺到，就我們各集團的持續性而言，到今年年底，我們的產品將具有相當強的黏性。此外，展望明年，我想我們在計劃中已經討論過了，我們會有很多優秀的產品推出，我們對此充滿熱情：All Savers，我們的分級分攤產品；Bind，一款不錯的產品，它的基本方案是，您擁有某種基礎保障，如果需要某些類別的醫療服務，您可以購買。此外，我們還推出了一系列以醫療服務提供者為中心的產品，我們致力於打造真正高效、高品質的網絡，並降低消費者的自付費用。

So what I would say is we're optimistic about our product portfolio for next year. As you look at the third -- the fourth quarter specifically, we've had good stickiness in terms of our persistency.

所以我想說的是，我們對明年的產品組合持樂觀態度。具體到第三季度和第四季度，我們的產品在持續性方面表現出了良好的黏性。

Yes. I think the commercial business is doing a nice job. Obviously, we're very dissatisfied with the start of this year, but I think they've come on stronger as the year has progress with a wide array of product choices and offerings, but also getting their cost structures in line and being able to reflect that in more competitive price positions in the market overall, again, appropriately indexed to the forward view of cost-plus margin, which reflects the variability of the future marketplace. John, do you want to touch on the script?

是的。我認為商業業務做得很好。當然，我們對今年的開局非常不滿意，但我認為隨著今年的進展，他們的表現會越來越好，產品選擇和供應更加豐富，成本結構也更加合理，並且能夠反映出市場整體上更具競爭力的價格定位。同樣，這與成本加成利潤率的前瞻性預期相符，這反映了未來市場的變化。約翰，你想談談劇本嗎？

Sure. Lance, John Prince. Talking about revenue growth, we've had really strong growth in our specialty business as well as infusion. Our community pharmacies and -- which is Genoa, that has been a big driver as well as our external client wins we had on the beginning of the year. If you look at our services businesses, which is both services, as I mentioned, they're growing almost 30% inside that. So really strong growth in that.

當然。蘭斯，約翰‧普林斯。說到營收成長，我們的專科業務和輸液業務都實現了強勁成長。我們的社區藥房，尤其是熱那亞，是推動我們成長的重要動力，此外，我們年初也贏得了一些外部客戶。如果您看看我們的服務業務，也就是我提到的兩種服務，它們的成長都接近30%。所以說，這方面的成長確實非常強勁。

In terms of our margin and why it's declined year-over-year, it's really 2 factors: One, on the earnings side is the impact of COVID-19. As you know, with the pandemic, we've had less first fills in Q2. That continued in Q3 as well as we've seen in Q3, less utilization per member as well as some loss and unemployment. So that's impacted our earnings. And then on the denominator side, the retail copayment, which was added to revenue in 2020, was added to the denominator, which actually impacted the margin in Q3.

就我們的利潤率及其年減的原因而言，實際上有兩個因素：首先，在收益方面，是新冠疫情的影響。眾所周知，受疫情影響，我們第二季的首次就診量有所減少。這種情況在第三季也持續存在，正如我們在第三季所看到的，每位會員的利用率有所下降，同時也出現了一些損失和失業。這影響了我們的收益。其次，在分母方面，2020年計入收入的零售自付費用也計入了分母，其實影響了第三季的利潤率。

Overall, we're quite pleased with our margin performance. As you see between Q2 and Q3, our earnings grew sequentially by 16% as well as -- and continue to improve our margins. So overall, we're seeing we're executing very well.

整體而言，我們對利潤率表現非常滿意。如您所見，第二季和第三季期間，我們的獲利環比成長了16%，而且利潤率還在持續提升。所以，整體而言，我們的業績表現非常出色。

Yes. Thanks, John. Thank you, Lance. And thank all of you for your interest and the very thoughtful and insightful questions that you offered today. As you know, this is an unprecedented time in our company's history. And as you've come to expect, we will continue to respond and lead with the full strength, compassion and fortitude, restlessness. We're serving the unique needs of every one of the 140 million people we serve around the world.

是的。謝謝，約翰。謝謝，蘭斯。也感謝大家的關注，以及你們今天提出的這些非常有見地的問題。正如你們所知，這是我們公司歷史上前所未有的時刻。正如你們所期待的，我們將繼續以全力、同理心、毅力和不懈怠來應對挑戰，引領發展。我們正在滿足全球1.4億人中每一位的獨特需求。

Despite the challenging times, the 325,000 people of the UnitedHealth Group are deeply committed, and they're energized about our work to advance the next-generation health system in a socially conscious way. It's a health system that will be universal, affordable, simple and effective. And we look forward to engaging you in several weeks at our upcoming annual investor conference on Tuesday, December 1. We see the virtual format as an opportunity to provide you an even deeper view of our company, its strategic plans, its people and our future. Thank you very much.

儘管面臨挑戰，聯合健康集團的32.5萬名員工依然堅定地投入工作，並對我們以社會責任感為導向推進下一代醫療體系的工作充滿熱情。這是一個全民共享、經濟實惠、簡單有效的醫療體系。我們期待在即將於12月1日（星期二）舉行的年度投資者大會上與您相聚。我們認為線上會議是一個讓您更深入了解我們公司、策略規劃、員工和未來的機會。非常感謝！

And this will conclude today's program. Thanks for your participation. You may now disconnect. Have a great day.

今天的節目就到這裡。感謝您的參與。現在可以斷開連線了。祝您擁有美好的一天。