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.

早上好，歡迎參加聯合健康集團 2020 年第三季度收益電話會議。問答環節將在聯合健康集團準備好的評論之後進行。提醒一下，此通話正在錄音中。

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.

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

This call will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amounts is available on the Financial and Earnings Reports section of the company's Investor Relations page at www.unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated October 14, 2020, which may be accessed from the Investor Relations page of the company's website.

本次電話會議還將參考非公認會計原則金額。非 GAAP 與 GAAP 金額的對賬可在 www.unitedhealthgroup.com 公司投資者關係頁面的財務和收益報告部分獲得。本次電話會議中提供的信息包含在我們今天上午發布的收益新聞稿和日期為 2020 年 10 月 14 日的 8-K 表格中，可從公司網站的投資者關係頁面訪問。

I will now turn the conference over to the Chief Executive Officer of UnitedHealth Group, Mr. David Wichmann. Please go ahead, sir.

我現在將把會議轉交給聯合健康集團的首席執行官 David Wichmann 先生。請繼續，先生。

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.

早上好，感謝您今天加入我們。希望過去 9 個月讓您了解該組織的價值觀和能力，以及它們如何使我們能夠在前所未有的時期為我們的客戶、患者、護理提供者、團隊成員及其家人以及您，我們的投資者提供服務挑戰。我有幸親眼目睹我們團隊每天的出色工作，這是一家創新、成長和高度適應的企業，由我們 325,000 人的同情心、專業知識和不安分的精神驅動，其中超過 120,000 人在前線提供護理。

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.

我們今年的集體經驗使我們成為一個更加堅定和充滿活力的組織，我們有潛力幫助推進公平、負擔得起、更簡單和有效的下一代衛生系統。我們的團隊將願景與對日常執行的高度關注相結合，在整個企業中提供強大、平衡的結果。

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.

第三季度調整後收益為每股 3.51 美元，與去年同期相比有所下降，這反映了我們從 COVID-19 大流行一開始就承諾採取的迅速的客戶和消費者支持行動。基於這一表現和對大流行影響的前瞻性估計，我們將調整後的 2020 年全年盈利展望更新為每股 16.50 美元至 16.75 美元的範圍。在這方面，我們仍然致力於確保為我們所服務的人積極和公平地解決由大流行引起的任何財務失衡。在此期間，我們始終如一地這樣做，即使最終結果仍不清楚，因為及時向我們的利益相關者提供救濟至關重要。服務、公平和具有長遠眼光的績效，這是您可以繼續對我們的期望。

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.

您還應該期望，隨著我們能力的擴展和環境的需要，這家企業將運用其創新精神以新的和不同的方式做出貢獻。我們已經合作並領導了臨床試驗，幫助解決了美國關鍵的 PPE 和 PCR 供應鏈問題，並在確保衛生人員安全的同時實現了更大規模的快速檢測。

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.

我們正在支持加利福尼亞州、新澤西州、北卡羅來納州和印第安納州的州檢測行動以及紐約市的接觸者追踪。我們正在支持梅奧診所的恢復期血漿開發以及一些最有希望的疫苗和抗體試驗。我們通過開發 ProtectWell 幫助實現了勞動力安全，ProtectWell 是一種協議處理技術，可確保衛生人員的安全以及企業、學校和療養院的安全開放。

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.

我們正在努力通過我們的 GetCovered 活動來協助員工的健康保險過渡，現在雇主提供該活動來幫助失業的人。我們為衛生系統提供了 20 億美元的流動性救濟。我們的客戶和消費者將實現超過 30 億美元的保費和成本分攤減免，其中包括 10 億美元的估計回扣。我們為遭受糧食不安全、無家可歸和健康差異的社區提供了超過 1 億美元的財政支持和 600 萬磅的膳食。

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.

這些努力之所以成為可能，是因為我們運營著一套有能力的業務和能力，這些業務和能力正在引領下一代衛生系統的發展並擴大我們的服務機會。今天，我想給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.

在大流行初期，我們迅速使 Optum 醫生和 UnitedHealthcare 最脆弱患者的醫生迅速適應和擴展，以滿足數百萬患者對慢性病和新發疾病的護理需求。這包括通過在患者和他們自己的醫生之間建立直接聯繫來推進遠程醫療，這是高效數字醫療的關鍵因素，確保採用將遠遠超出這場危機。今年到目前為止，OptumCare 醫生已經為他們的患者直接進行了 100 萬次數字臨床訪問，我們正在迅速開發一套專有的獨特工具，並調整我們的臨床實踐，以進一步發展和擴大這種能力。我相信您可以看到推進現代遠程醫療如何融入我們構建高性能護理系統的總體戰略。

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對慢性病的管理產生積極影響。隨著 Level2 的推出，一種旨在改善 3000 萬 2 型糖尿病患者生活的數字療法，我們正在幫助患者緩解疾病。 Level2 獨特地測量信號並應用人工智能，讓人們參與並產生更好的健康結果。在接下來的幾個月和幾年中，您可以期待我們提供更多的數字療法。

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我們的 OptumCare 平台上尤為明顯，該平台有 53,000 名醫生在 1,500 家當地以患者為中心的設施中為近 2,000 萬患者提供服務，其中超過 350 萬以某種形式的風險安排與 130 萬醫療保險優勢或正式合格的成員在全球人頭下進行。

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 通過建立更深層次的臨床醫患關係以及利用數據和人工智能使我們的臨床模型能夠及早主動地攔截和治療疾病，從而帶來更好的健康結果、價值和行業領先的患者體驗，創造了巨大的價值。我們的患者體驗更安全、更健康、更充實的生活方式，與傳統的醫療保險按服務收費支持的患者相比，平均每年在病床上花費的天數減少 1/3，在專業護理機構的天數減少 40%。此外，我們最先進的護理提供實踐以比同等的傳統醫療保險福利低 40% 以上的成本提供這種高質量的護理，其價值充分體現在為老年人提高福利和降低成本上，所有這些都在世界一流的 NPS 得分70年代中期。

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.

提高 Optum 高級護理產品的臨床成功支持我們對 OptumCare 的可觀增長目標，並展示了極大地造福消費者和商業產品的長期潛力。十多年來，我們一直在構建這個平台，並期望它在未來幾年繼續以強勁的兩位數速度增長。

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.

現代下一代衛生系統的另一個方面是以適合患者、臨床醫生、雇主和付款人的方式管理未來的專業化和昂貴的藥物。我們的 OptumRx 集成專業解決方案帶來了一種全面的方法來管理醫療和藥房利益方面的複雜條件，通過在更方便、成本更低的地點採用臨床適當的護理，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.

這種方法得益於 Optum 不斷擴大的綜合社區藥房足跡，到 2020 年，該藥房將增加 60 多個中心。接受我們輸液服務的患者數量將以兩位數的速度增長。鑑於更安全和臨床等效的患者體驗，我們預計這將成為另一個持久的增長趨勢。

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 將繼續轉型為藥房護理服務的領導者。但不同的是，我們認為藥房護理服務對人員和系統的價值在於管理個人對健康的參與，而不僅僅是供應鏈管理。這發揮了我們的優勢，並將在未來幾年為 OptumRx 的增長做出越來越大的貢獻。

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.

UnitedHealthcare 繼續關注醫療保健消費者的各種需求。在下一代衛生系統中，隨著人們尋求簡單、負擔得起並有助於實現高質量結果的解決方案，我們預計消費者的利益將越來越多地定制以滿足這些需求。 UnitedHealthcare 已經看到了我們不斷擴大的高度定制和負擔得起的個人保險的強烈反應。僅今年一年，我們為個人健康保險服務的人數就增長了 15%。同樣，在雇主贊助的保險範圍內，我們越來越多的以消費者為中心、創新和靈活的產品，如 Bind、All Savers 和醫生一致的計劃，如南加州的 Harmony，隨著這些產品的會員人數的增長而受到關注今年50%。

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.

我們知道你們中的許多人對明天開始的年度 Medicare Advantage 註冊期感興趣。 2021 年受益年將是 UnitedHealthcare 5 年來最大的 Medicare Advantage 足跡擴張，將惠及另外 320 萬人和近 300 個縣。我們比以往任何時候都更加強調我們所知道的老年人在今年尋找的東西：穩定性和價值。我們服務的大多數人的保費將持平或減少，近 250 萬人將完全沒有保費。

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.

我們繼續通過所有 Medicare Advantage 計劃創新我們的產品，其中包括 0 次共付額初級保健數字健康訪問和擴展我們的個人支持服務，例如在老年人家中進行的年度臨床健康評估，以及對許多人來說，分配專門的 UnitedHealthcare 導航器。我們預計個別 MA 將強勁增長。再加上我們集團的醫療保險收益，2021 年將成為市場領先增長的又一年。我們還預計，由於覆蓋範圍的轉變和新的市場淨收益，醫療補助將繼續增長，並期待創紀錄的 RFP 季節，因為我們尋求為更多地區的更多人提供服務。

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.

我今天早上為您描述的是我們今天為幫助引領下一代衛生系統發展而採取的舉措的樣本，這是一個對每個人都更有效的衛生系統：那些經歷護理的人，那些提供護理的人和那些支付護理費用的人。現在我將把它交給首席財務官約翰雷克斯。

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。從廣義上講，第三季度業績繼續受到顛覆性護理模式的影響，儘管程度比第二季度要小得多，因為該國許多地區穩定接近更正常的水平。

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.

在本季度內，我們今年早些時候自願採取的積極的消費者和客戶援助措施以及 COVID-19 護理和檢測成本以及更廣泛的經濟影響，大大抵消了護理延期的影響。這些因素導致調整後每股收益同比下降 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，第二季度發生的最深的護理延遲期和公認會計準則認可我們的援助行動的時間並不完全一致，這對第二季度的收益產生了更明顯的不利影響2020 年的一半。我們自願採取的措施主要影響了我們的福利業務，並導致聯合醫療保健公司第三季度的營業收入同比下降。

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.

在本季度，我們看到總護理活動現在超過了季節性基線的 95%，某些類別甚至更接近正常水平。相比之下，第二季度最低點的總體衡量標準約為 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 的 3 個業務中的每一個都繼續表現良好，但受到仍在恢復的護理模式和經濟影響的不同方式的影響。 OptumHealth 第三季度的收益同比增長 12%，因為按服務收費的做法和門診手術活動開始恢復，而承擔風險的做法仍然受到推遲護理的一些適度、持續的影響。我們的 SCA 門診手術中心在第三季度運營了約 95% 的季節性基線，而第二季度為 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.

年初至今，已有 1,000 多名新外科醫生在 SCA 進行手術，因為他們正在尋找安全、方便和高效的臨床合作夥伴。在 9 個月期間，新的外科醫生附屬機構比去年增加了近 25%。我們繼續擴大在這些環境中執行的程序的複雜性，增加了 40 多個新的服務線，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 NPS 為 92 的獨立中心。隨著選擇性護理活動完全正常化，這些持久的長期趨勢將更有利於我們未來的增長。

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 第三季度收益同比增長 24%，而該季度的收入積壓增長 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，而由於程序量大，我們繼續看到面向提供商的業務活動減少。雖然仍未完全正常化，但業務發展活動已比第二季度低得多的步伐有所增加。

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.

由於護理活動減少和經濟因素的影響，第三季度 OptimumRx 的收益同比下降了 2%。與醫生就診活動相關的首次填寫腳本與第二季度相比有了很大改善，第二季度下降了約 25%。雖然尚未完全恢復到去年的水平，但我們不斷擴大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.

轉向聯合醫療。第三季度的運營結果反映了第二季度所經歷的護理延期影響顯著緩和，但仍未達到基線水平。這被我們的援助措施、直接的 COVID-19 護理費用和經濟因素所抵消。商業產品服務的人數下降主要是由於雇主的行動。其中，對我們而言，大約 40% 的費用基數下降來自大型雇主，主要是酒店、交通和能源行業。

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，受益於州重新確定要求的持續放寬，醫療補助成員的增長加速。由於失業，我們還沒有看到實質性的 Medicaid 註冊活動。從歷史上看，這些轉變滯後於醫療保險的喪失約 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.

年初至今，我們的醫療補助業務實現了強勁的有機增長，超過 500,000 人。 Medicare Advantage 的銷售活動在第二季度因大流行而有所放緩後，繼續朝著更加正常化的模式發展。在此範圍內，我們看到現有 Medicare Advantage 參保者的計劃轉換比典型的少得多，而對於 Medicare 的新人來說，選擇 MA 而不是按服務收費，它的跟踪很好。

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.

我們繼續加深與最需要幫助的老年人的接觸，增加遠程數字傳感器套件的分發，以收集和監測重要的健康數據，並解決大流行造成的護理缺口。老年人繼續高度重視我們的 HouseCalls 計劃，第三季度的家訪次數比去年增長了近 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。第三季度現金流為 31 億美元，即淨收入的 1 倍，反映了由於通常在第二季度支付的延期付款而導致的本季度額外的聯邦稅款。年初至今的運營現金流為 161 億美元或淨收益的 1.2 倍。我們的債務與總資本比率為 39.1%，而去年同期為 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，我們已將調整後的全年盈利展望更新至每股 16.50 美元至 16.75 美元的範圍。這反映了第三季度的業績，而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推遲治療而提高的敏銳度。我們將繼續積極工作，幫助人們獲得所需的護理。

Now I'll turn it back to Dave.

現在我將把它轉回給戴夫。

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.

謝謝你，約翰。通過第三季度的收益報告，我們有時對我們的增長前景提供了一些早期的聲音。即使當前的環境不是例行公事，我仍然會嘗試提供一些有用的觀點。我們對未來 13% 至 16% 的長期盈利增長目標持堅定的信念。

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：我們迅速擴大的護理服務，現在受益於十多年來在當地建立和投資以價值為基礎的護理系統，並擴展到市場領先的急性後家庭和現代行為健康干預服務;我們有能力通過不斷創新的高價值產品跨多個渠道和市場為老年人提供支持；我們如何通過全面、個性化的護理滿足患有高度複雜疾病的人們日益增長的需求，包括商業、聯邦和州計劃中的人們；現在通過雇主和個人市場渠道提供的創新和消費者響應產品；由於多年來對提高績效、整合數據、分析和臨床信息的重大投資，我們擁有無與倫比的能力來支持更具互操作性和智能的衛生系統，從而為基於證據的下一個最佳護理行動提供必要的見解；當我們以具有社會意識的方式引領下一代衛生系統的發展時，我們不斷地分配資本並與其他創新公司保持一致。

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.

這些只是加速能力中的一小部分，它們將使我們的企業在展望未來幾年時能夠更深入地為更多人服務。至於對 2021 年的早期想法，我們預計我們的基本業務表現將強勁並很好地支持我們的長期增長目標，包括我們今天上午強調的順風。當然，大流行和相關的經濟影響仍然難以預測，而且在這個距離上，可能代表著巨大的潛在逆風。因此，我們設想最初以更保守的 2021 年起點出發，以適應這些仍在發展和未知的與 COVID 相關的影響，特別是恢復到更正常水平的護理服務和條件的步伐的經濟。

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.

隨著環境的不斷發展，我們也將繼續發展我們的思維和視角。按照我們的慣例，我們期待在今年 12 月 1 日星期二舉行的投資者會議上為您提供有關我們業務各個方面的更多觀點，該會議將在今年幾乎舉行。

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

謝謝你今天的時間。接線員，您可以打開電話提問嗎？

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

（操作員說明）我們將從 A.J.瑞士信貸大米。

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.

也許只是為了進一步了解戴夫剛剛對明年的想法所做的評論。我想在預測醫療成本趨勢時，你會看到很多變化的部分：潛在的進一步延期，可能會回來的潛在被壓抑的需求，可能存在的疫苗和治療成本，還有很多事情。考慮到明年的成本趨勢，您是如何應對的？怎麼樣——你認為競爭環境會因此而改變嗎？可能只是充實了關於預測明年醫療成本趨勢的能力有多不確定的整個評論。

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.

謝謝你，A.J.，一個非常周到的問題。希望您從準備好的評論中刪除了我們對業務表現持樂觀態度的言論。所以這在 Optum 和 UnitedHealthcare 中幾乎是普遍的。因此，我們沒有涉足一些較小的副業，但我們尤其對我們的相對競爭地位和 2021 年的增長前景持樂觀態度。

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.

但正如也表明的那樣，我們仍然非常尊重環境，包括大流行病和相關的經濟後果。我要強調的一件事，A.J.，就是你打得很好：有許多移動部分很難預測。

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.

您還應該知道，我們正在努力確保我們的慢性病會員和患者在這個前所未有的時期得到他們需要的護理。我們仍然堅定地致力於糾正可能發生的任何不平衡。

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，在這個距離上，我們確實看到我們的業務——基礎業務表現強勁，並符合我們每年 13% 至 16% 的長期增長目標，部分被這些與大流行相關的影響所抵消。因此，正如我們在 12 月所指出的那樣，考慮到可能的結果和比正常情況下更保守的全面預期，考慮到您剛剛描述的所有要素，起點可能會代表更廣泛的範圍。

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，我們在製定關於 MLR 可能降落在哪裡、如何降落的觀點時考慮到這一點——這可能是什麼可變性。一般來說，我們認為與大流行相關的整個影響是一個領域——對組織來說是一個逆風。但不要誤讀。我們非常看好我們業務強勁的潛在增長表現。

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.

我猜只是關於 OptumCare 的一個問題。並且您看到所服務的消費者的 PMPM 大幅增長。我只是想更好地了解第三季度與第二季度相比的相對錶現，這是推動每位會員收入增加的原因。然後，如果您還可以談論某種醫生招聘以及過去 6 個月的情況。

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。喬希，很好的問題，我認為你正在發揮企業的優勢之一，也是我們看好明年增長的原因之一。簡單地說，就是更多的市場，更深入地滲透到這些市場中，並且其中有更高比例的風險承擔安排。但是懷亞特，你想談得更充分嗎？

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，謝謝你，戴夫。我想，戴夫，你拍得很好。我們看到的是，隨著我們的成長，我們不僅將服務的會員數量增加到 9800 萬，而且每個會員的收入增加了 25%。這部分是由於我們將通過 OptumCare 中基於風險的安排為某人提供更廣泛的服務，而不是您可能通過 OptumHealth 中的其他一些業務看到的更輕的類型。我們預計這種趨勢將繼續下去，坦率地說，我們的 MA 風險生命和我們所服務的相關完全資本化生命的兩位數增長非常令人興奮。

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，我要說的另一篇文章是，我們已經看到對小型、集中收購以及中型和大型醫生群體的持續濃厚興趣，他們對穩定性、醫生領導力和我們在 OptumCare 中採用的基於證據的方法。

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

我們將與 Wolfe Research 一起前往 Justin Lake。

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...

想回到關於 2021 年的評論。首先，Dave，我知道你說今年的增長率將高於平均水平。想知道您是否認為共識在任何時候都會落在該範圍內？指出，鑑於業務的廣度，哪些具體細分市場......

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

賈斯汀，我們很難聽到你的聲音。如果你戴著耳機，你能拿起聽筒嗎？

Sure. Is this better?

當然。這是否更好？

No.

不。

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

不，好的。稍等一下。那個更好嗎？

It is. Thank you.

它是。謝謝你。

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?

對於那個很抱歉。所以我想做的是回到你在 2021 年發表的評論。首先，我認為，普遍的收益增長似乎目標是同比增長 11% 左右，因此低於你的 13% 到 16%。想知道您是否認為這可能——您比典型的指導更廣泛，仍然可能包括該範圍內的共識估計？

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看到 COVID 和經濟衰退問題的潛在影響可能超出典型商業會員資格的具體業務？

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，這裡是約翰雷克斯。正如戴夫所指出的那樣，我認為我們對組織的潛在增長非常有信心，因為我們展望 2021 年，並且在正常的一年中，我會想到一些事情，比如共識範圍所在的位置在這一點上，這有點像一個人們可以期待的正常區域——我們會考慮走出一個什麼樣的區域。

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，這不是一個正常的一年，而且我們每個月都學到了很多東西，我得告訴你，在這段時間裡，在過去的 6 個月裡，就我們的運作方式而言，我們的企業表現，我們需要如何回應我們所服務的人。因此，我們繼續以尊重的方式學習更多，更好地了解情況，並意識到我們所考慮的某些業務可能會產生重大影響 - 當我們考慮績效時。

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.

因此，我們在一個世界中看待它——不包括，是的，不包括我們今天所處的這個世界，它會產生與 COVID 相關的影響，這是一個很好的區域，但你應該期望我們認為那裡存在潛在的逆風，這些是否是經濟逆風，這些是否是——從客戶援助的角度來看，這些是否是我們需要做的因素，真的是——真的是直接 COVID 護理和治療成本的節奏。因此，也許是一種冗長的被問到的方式，我們仍然處於一種真正試圖對我們在環境中看到的東西做出反應並隨著環境的發展而發展我們的思維的模式。

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，我想我沒有聽說過--接了你的第二個問題。如果你能重複那個。只是很難聽。

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。我要問的是具體可能受到影響的細分市場。最重要的是，我知道 COVID 是一種潛在的不確定性。我在市場上聽到的是，很多公司都在試圖為此定價，從而為趨勢增加一點點。那是你覺得你去年做過的事情還是你仍然很保守？還是您覺得在這種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 - 我的意思是，賈斯汀，這是德克麥克馬洪。我要說的是，我們當然會根據我們對未來趨勢的最佳估計來定價。這將包括COVID。

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.

但是你問到經濟影響，所以當我們坐下來回顧第三季度時，實際上，我們的會員受到的影響比我們想像的要小一些，因為工資保護計劃以及一些大型雇主所做的休假。所以是的，會有一點磨合問題，但比我們預期的要少。

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.

因此，從會員的角度來看，我們實際上對我們的定價方式相當樂觀。我們繼續研究我們的區塊是如何以 1/1 定價的。當我們看到這一點時，我們不僅具有競爭力，而且我們每天都會對此進行監控。

Thank you, Justin. Great questions.

謝謝你，賈斯汀。好問題。

We go next to Frank Morgan with RBC Capital Markets.

我們與 RBC Capital Markets 一起來到 Frank Morgan 旁邊。

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.

約翰提到了今年 MA 市場計劃轉換減少的預期。只是好奇你是否對為什麼會這樣。

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.

只是為了跟進。我認為我們 - 我評論的其中一件事實際上是，我們看到的計劃轉換實際上比正常情況要少。我們看到的是，Medicare 新用戶大量加入 Medicare Advantage。

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

那麼蒂姆，你想補充什麼嗎？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。蒂姆·諾埃爾。是的。 John 提到的是，我們在市場上看到的是，從一個 MA 運營商切換到另一個 MA 運營商的人數有所下降。然而，我們稱之為選擇者市場的力量很大，與全年的其他保險類型相比，這些人是新有資格獲得 Medicare 或選擇 Medicare Advantage 計劃的人。因此，我們在這些類別中看到了非常好的、強勁的需求，但計劃轉換活動較輕。特別是在 3 月和 4 月，它在整個一年中都有點回升。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，當我們進入年度註冊期時，市場的動態是我們趨向於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.

我們和摩根士丹利一起去 Ricky Goldwasser 旁邊。

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?

關於醫療補助方面的問題。顯然，高失業率對入學率的影響低於您的預期。您預計影響何時達到峰值？你如何看待去醫療補助和交易所的平衡？

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?

然後在醫療補助方面，大流行是否改變了各州對將其高敏度人群從收費服務轉變為管理式護理的看法？在這個時間點，你明年有更多的醫療補助費率是什麼類型的可見性？

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?

你幾乎涵蓋了整個景觀，瑞奇。做得好。我們將盡量對所有這些做出響應。 Tim Spilker 是我們的社區和州行政總裁。蒂姆？

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。謝謝你的問題。而且您肯定觸及了我們一直在跟踪的許多因素。所以首先，就入學而言，Dirk 提到，正如約翰在他的開場評論中所做的那樣，到目前為止，我們所看到的僅就入學增長而言，實際上是由於重新確定暫停的結果關心法案。我們確實還沒有看到失業問題出現，我認為這反映了我們在商業市場上看到的一些動態。我認為，這也得到了許多外部研究的支持。所以我們繼續關注這個。我認為我們預計失業率會在某個時候出現，特別是隨著覆蓋範圍損失之間的時間範圍增加。

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.

至於你的第二個問題，就在復雜的人群周圍。是的，我們正在積極監測各州探索向管理式醫療的過渡。我們相信這是一個非常強大的價值主張，特別是對於復雜的人群，包括那些接受長期護理服務和 HCBS 服務的人群。我們知道，根據我們的經驗，管理式護理可以帶來巨大的價值，不僅在節省成本方面，而且在幫助個人留在家中、幫助人們獲得社會服務和支持方面。因此，我們一直在處理狀態並監控狀態轉換時的活動。

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 Dave 所提到的，我認為我們正在看到一個非常強大的 RFP 管道。我們希望許多州在這些州的複雜人群中提供長期護理服務。

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，我認為您的最後一個問題是關於資金和費率的。是的，所以就這一點而言，是的，我們也一直在與我們的州客戶密切合作，以確保資金在現在和 2021 年都是可持續的，特別是考慮到所有正在發揮作用的動態。各國確實在採取合理的方法來籌資。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。他們還從通過 CARES 法案獲得的一些額外聯邦資金中受益。然後，當然，提醒一下，醫療補助資金必須在精算上合理，我們的州確實繼續將其用作指導原則。

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.

所以這當然是我們關注的一個領域。我們與客戶建立了牢固的關係，到目前為止，我們對這些對話感覺良好。然後也許我要說的最後一件事是可持續資金，所有這些工作都非常重要，因為它使我們能夠投資於真正為我們的客戶以及我們的人們帶來實質性社會和健康成果的項目服務。

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

所以 Ricky，我希望那是響應性的，至少響應性足夠。謝謝你的透徹提問。

And the next question is from Gary Taylor with JPMorgan.

下一個問題來自摩根大通的 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.

兩部分的問題，以防我在第一個問題上脫穎而出。我想知道您是否可以量化消費者和客戶幫助，這對本季度的 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，只是考慮到 2021 年的成本趨勢。我認為到今年一切都已塵埃落定時，您的核心商業集團成本趨勢最終可能會下降幾百個基點至少。因此，當您考慮對 21 年的指導時，您是否認為這可能是正常的成本趨勢？你在想 - 延期會加速嗎？它可能比正常水平高 200 個基點或更多。我只是對你打算如何比賽的思考過程感興趣？ 2020 年的全押趨勢比預期的要容易嗎？

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.

好吧，我會給你第一個罷工，因為我認為我們不會在本季度量化客戶和消費者援助。我要告訴你的一件事是它很廣泛。特別是，這是醫療保險業務在初級保健和專科醫生就診時提供全額共付額豁免的主要地區之一。加里，原因是我們非常擔心並且仍然非常擔心醫療保險消費者盡快訪問他們的醫生，因為他們顯然正在管理慢性病。我們看到對該計劃的反應非常好，以至於我們將其元素擴展到第四季度。所以這就是客戶系統將繼續存在的地方。

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，我們還擴展了其他一些程序。您可能已經看到我們最初估計的 15 億美元變成了 20 億美元。部分原因是我們已經做出了額外的保費減免和調整，這將延續到今年的餘額，並適度延續到明年。因此，這為您提供了在該時間範圍內發生的交易量和數量的顏色。

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

關於 2021 年的成本趨勢，Dirk，你想談談嗎？

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，這可以追溯到戴夫最初所說的。我們確實考慮了您描述的所有這些因素。我們考慮我們期望 COVID 在檢測和治療方面做些什麼。所有與減排相關的事情，我們都會對此進行估計。我們試圖預測疫苗何時可用。

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.

因此，在我們為明年的業務定價時，所有這些都被考慮在內。我不打算深入了解與每一個相關的基點的確切數量。那是有競爭力的。但我之前提到過，我們確實監控市場上正在發生的事情，我們所看到的所有這三個桶的持續趨勢以及所有潛在成本。我們從會員增長的角度和收益的角度對我們應該在哪裡具有競爭力做出了最好的估計。這就是我們所做的。我們有精算師，我們的管理團隊在這方面經驗豐富。

We'll go next to Scott Fidel with Stephens.

我們將和斯蒂芬斯一起去斯科特菲德爾旁邊。

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.

只是想跟進 2021 年的 Medicare Advantage 以及 David 圍繞行業領先的增長預期發表的評論。我想這真的只是一個兩部分的問題。只有一個，所以我們確實有 CMS 預計 2021 年個人碩士的入學率至少增長 10%。所以只是對您對行業領先增長的評論感興趣，您如何將其納入背景以及這是否會支持雙- 2021 年個人 MA 的入學人數增長。

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，聽起來像是圍繞 MA 組的評論，在銷售方面聽起來相當樂觀。只是對您是否可以為我們量化預期感興趣-到目前為止，您認為您已經為 2021 年添加了 MA 組。

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.

澄清一下，斯科特，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表現相對於整個市場的表現。隨著時間的推移，UnitedHealthcare Medicare & Retirement 在該指標上的表現尤其出色。

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.

我特別喜歡今年，不僅是集團 MA 組件真正從 2020 年令人失望的一年，也就是 2021 年實際保單年，而且是個人的那種設置MA 並繼續我們的合格會員及其成長。這就是我發表評論的背景的本質。

Tim, do you want to add anything further?

蒂姆，你還想補充什麼嗎？

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。因此，對於個人 Medicare Advantage 的銷售顯然從明天開始。自 10 月初以來，我們一直在營銷我們的產品，從經紀人社區收到了關於我們如何定位的非常積極的反饋。再一次，如您所知，我們的首要任務是為我們所服務的成員提供穩定性和福利。當我們進入市場時，我們很高興能夠成功地為我們的會員提供這些服務。事實上，與 2020 年相比，我們 75% 的會員將在 2021 年體驗到更好的福利。我們還進行了一些額外的投資和能力來支持老年人。因此，在這種背景下，我們確實對我們在個人 MA、團體 MA 以及雙重特殊需求計劃市場中獲得份額的定位感到非常滿意。

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.

我們不會具體評論對行業增長的任何點估計，但我們真的很喜歡我們在增長內部的定位，無論它可能是什麼。對於 Dave 的評論，我們對 2021 年集團 MA 的增長感到非常興奮。

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

然後接下來，我們將與高盛一起去羅伯特瓊斯。

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?

偉大的。我想也許只是想通過 OptumCare 了解您對明年參與直接承包的最新想法。我想知道這是否會有助於您對全球上限壽命增長的預測。或者那會是增量的嗎？

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，你如何看待與機會相關的直接合同，很明顯，在 UHC 方面的 MA 周圍？

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。布賴恩湯普森在這裡。由於它與 Medicare Advantage 相關，正如您長期以來從我們那裡了解到的那樣，我們擁有現代化收費服務的企業視角。但我們肯定對任何這樣的活動感到鼓舞。我們參與了捆綁支付計劃等活動，我認為直接簽約是一個積極的嘗試，可以全面實現整體按服務收費系統的現代化。以及為什麼它顯然正在考慮直接簽約，進入 OptumCare。

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，英國電信。還有羅伯特，謝謝你的問題。我們對從按服務收費轉向基於價值的承包所做的一切努力感到非常鼓舞，因此將其視為一個積極的趨勢。

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.

直接承包建議主要面向按服務收費的小型團體，我們從事基於風險的安排已超過 10 年。因此，雖然我們會在適當的時候接受這一點，但我們與 80 多個付款人有關係，我們預計我們的 MA 和我們關心的雙重風險生活將繼續保持兩位數的增長。

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.

而且我預計直接承包不會成為我們的主要因素。但同樣，我並不是要以任何消極的方式說這句話。這是一個很好的計劃，但它是——但我們將擁抱所有發展的工具。

We'll go next to Sarah James with Piper.

我們將和派珀一起去莎拉詹姆斯旁邊。

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?

我希望你能給我們一些關於公司稅改革的背景信息。回顧 2018 年，您將收益估計為 20 億美元左右。想知道它現在在哪裡。如果產品線之間存在差異，我們應該如何考慮哪條產品線從利潤率方面受益，而哪條產品線受益於定價變化或其他項目？

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，這裡是約翰·雷克斯。所以我想我們回到你在核心保護中討論的那個以前的時期。我認為在那段時間和影響方面我們評論了很多事情。如果您還記得，在此期間，我們還評論了我們為實現未來增長而進行的投資以及我們如何長期投資於這些業務。當然，那是其中的一個元素。顯然，從那個時期開始，幾年前的現在，公司規模要大得多，所以你會認為，從有效稅率的影響來看，這種影響比我們以前的影響要小得多那時。

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.

在您談論的公司稅改革和影響的其他因素中，我認為很難在潛在影響甚至這些對特定業務的影響方面領先於任何事情，僅僅因為沒有一些- 我們只是不 - 真的不想領先於任何可能存在的政策。所以可能就這樣吧。

Next is David Windley with Jefferies.

接下來是傑富瑞的大衛溫德利。

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?

我很感興趣——我很欣賞這些評論，在準備好的評論中提供了幾種百分比的基線利用率。我很好奇這可能在本季度取得了怎樣的進展。例如，到本季度末，其中一些是否達到或超過 100%？您是否期望在第四季度達到基線以上？根據您對被壓抑的未充分利用和系統容量的評估，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?

然後只是為了標記，今年前幾個季度的 DCP 與去年同期相比相當穩定，但在第三季度下降了幾天，2 到 3 天。我想知道這如何融入到利用率去向的觀點中？

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。讓我回答一下。因此，首先，讓我就我們在本季度的使用情況以及它如何與我們上一季度所看到的情況等方面的情況給您提供更多的顏色。因此，當我們在這裡查看利用率時，我談到了我們業務中超過 95% 的基線。也許給一點顏色——在那個和不同的類別中的背景以及這些將如何發展。

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.

我要指出，如果我查看醫生服務，那將低於該基線。我會在基線的那個區域進行那種門診手術。我會把住院病人放在那個基線區域之上。

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.

當我們俯視各種人群等時，可能會就其趨勢進行一些色彩評論。所以商業化，就我們看到的利用率和我們看到的基線而言，肯定有點高；政府項目服務，較低。在這其中，我會說，在政府計劃中，比如說，社區國有企業是其趨勢方式中較低的元素。

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.

這裡有一個重要元素。因此，您提到了我們對第四季度預期的一些評論。然後，在那些被推遲的護理中，我們能夠幫助促進發生的護理。這就是我們進行投資的地方，也是我們希望在這裡發生的事情。

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.

當我們展望今年年底時，我們預計的另一個因素是，我們一直期待看到由於延遲和錯過治療而導致的敏銳度上升，我們會看到更高敏銳度的人群。我會告訴你，我們真的還沒有看到。我們在整本書中看到敏銳度提高的地方是因為 COVID-19 病例的敏銳度更高，因此您會看到該組件的敏銳度更高。但是，如果你把那個組件去掉，我們目前還沒有真正看到它在我們業務的全部範圍內。

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.

正如您一樣-就本季度的整個過程發表評論，我們所看到的，嗯，從這個角度來看，這是一個有趣的季度，因為您在整個季度中看到了該國不同地區的不同發病率季度。所以我們真的非常密切地監控。你會看到這個國家的一個特定地區，你看到感染率開始上升，你會看到延期進入這個組合。鑑於我們在整個國家的平台，我們對此有自己的看法，但你會看到延期，然後你會看到它回來。

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.

我認為我要指出的最後一件事是在我們正在談論的那種基線之內——所以我說超過 95%，我把它放在 5 分左右的區域內就該組合而言，可能是由 COVID-19 驅動的。這包括在我們正在談論的基線中。

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.

和 DCP。謝謝你提醒我。因此，DCP，同比下降，大衛，這是由於 - 實際上我們在今年早些時候採取的供應商付款加速。因此，當我們非常非常顯著地加快支付週期時，我們正試圖將流動性注入醫療保健系統，而且這種情況仍在繼續。

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.

您在第二季度看不到這一點的原因是因為第二季度醫療保健的延期非常顯著。所以 - 但是有點進入它的數學，對，你在這裡得到一個分母，每天的醫療費用在第二季度非常非常顯著地下降。因此，這不僅抵消了這些付款的影響。當我們看到護理到來時——本季度恢復到更接近正常水平，然後就出現了。所以現在你看到加速支付週期的影響出現在我們的 DCP 中，但那是有影響的。

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.

只是提醒你，讓你感覺到，正如我們在準備好的評論中所指出的那樣，這大約是向市場預付 20 億美元或加速支付。

And next is Charles Rhyee with Cowen.

接下來是 Charles Rhyee 和 Cowen。

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。也許如果我可以跟進，關於利用率，然後將其與您對 21 年前景的評論聯繫起來。聽起來住院人數略高於正常水平。其他區域略低於。總的來說，假設我們正在恢復到正常的基線利用率。考慮到我們今年的速度，然後我們考慮明年，你的想法是什麼讓你認為我們將看到利用率真正大幅上升？

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.

因為這聽起來就像當我們回到問答的早期部分時——在你的評論中，戴夫和約翰，最後是明年，你正在考慮一個更保守的起點來考慮'21 展望。我知道我們希望取消一些對今年有利的一次性項目。但也許可以幫助我們了解您對利用率的基本假設是什麼？因為在我看來，以及我們的步伐，我並不覺得明年我們會真正過度使用。也許可以幫助我們了解您在這裡看到的內容，因為我們現在進入第四季度的一部分，這給了您這種感覺。

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。因此，我的評論確實基於我們向前看時前所未有的不確定性，以及對大流行及其對經濟氣候的影響的深切尊重。這就是為什麼，當你考慮在這個距離上，走出去，認識到作為你的——對未來的期望，你通常會擴大你的範圍，你可能會採取更保守的姿態。這基本上就是我們試圖溝通的內容。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，我要評論的一件事，我想你說的那種我們見過的住院病人高於正常水平。我不會說這就是我們所在的地方。我說過，在超過 95% 的基線上，我將這些類別定位在它們如何圍繞它定位，超過 95%：住院患者的騎行略高於該基線；醫師，低於此；門診手術就在那個區域。所以這更多的是我在那裡提供的評論，而不是住院病人的運行速度高於基線。

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.

但是我們——當然，類別正在朝著這個方向發展。而且我認為它是 - 就您對使用預期的更廣泛評論而言，因此我們希望確保人們得到他們需要的護理。這就是我們最終來到這裡的原因。因此，我們將盡我們所能確保這種關懷發生。

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.

但是你聽到了今年早些時候提供的一些評論，即使是在癌症診斷方面的不同類別中發生的事情，我們顯著偏離的不同領域。這對人們來說不是一件好事。這對系統不利。我們希望確保這種護理得到交付。我們將非常積極主動地確保人們能夠獲得這些護理領域。

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，我們都可以直接訪問 OptumCare 業務。 UnitedHealthcare 非常積極主動地向弱勢群體伸出援手，並確保他們獲得所需的治療。因此，我們的目標是確保提供這種護理。有很多 - 有很多必要的護理也沒有發生。

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.

但我會回到戴夫的評論。當我們展望 2021 年和一些更早的主題時，在過去的幾個月裡，我們一直在學習東西。我們繼續發展這種想法。我們繼續覺得我們獲得了更好的視角，以及為什麼我們並不真正知道接下來幾個月的進展情況如何。所以我認為這就是你在我們的評論中所聽到的，就我們如何思考——我們為什麼思考——我們如何看待走出去以及為什麼，我們想要尊重一個環境，坦率地說，沒有人以前導航過。我認為這正是你期望我們做的——你期望我們處理它的方式。

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.

我們將在接下來的 30 到 45 天左右，積累更多的事實，更好地理解，然後在 12 月 1 日聚在一起時，盡我們所能為您提供更詳細的信息。我們有時間再問一個問題和一個快速的問答，然後我會結束。

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

我們將向伯恩斯坦的蘭斯威爾克斯提出這個問題。

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，只是想問雇主註冊，10 月份進展如何？您對第 4 季度及以後有何展望？而且，如果您可以在 OptumRx 中就每個腳本收入的真正急劇增長和利潤率的一些壓縮做出任何澄清，那也會有所幫助。

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，我認為我們無法為您提供關於 10 月和本季度的具體見解，但我們可以為您提供的見解是我們在商業市場中全面取得的進展，給您在沒有量化的情況下有某種感覺。短劍？

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。我想說的是，當您考慮第四季度時，感覺應該是，就我們在團隊中看到的持久性而言，到今年年底有很大的粘性。此外，我認為當我們展望明年時，我認為我們在劇本中談到了它，我們將有很多我們非常熱衷於下線的好產品：All Savers，我們的水平-資助產品； Bind，一個很好的產品，基本上是一個場景，你有一種基本的覆蓋水平，如果某些類別需要護理，你就會購買。然後我們有我想說的一堆以供應商為中心的產品，我們正在尋找真正高效、高質量的網絡，並且與這些產品相關的消費者自付費用較低。

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。當您查看第三季度 - 特別是第四季度時，我們在持久性方面具有良好的粘性。

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。顯然，我們對今年年初非常不滿意，但我認為隨著今年的產品選擇和產品種類繁多，而且成本結構保持一致並能夠反映在整體市場中更具競爭力的價格位置，再次適當地與成本加利潤率的前瞻性觀點掛鉤，這反映了未來市場的可變性。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。談到收入增長，我們的專業業務和輸液業務增長非常強勁。我們的社區藥店和熱那亞，這是一個很大的推動力，也是我們在年初贏得的外部客戶。如果你看看我們的服務業務，正如我所提到的，它們都是服務，它們在其中增長了近 30%。如此強勁的增長。

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同比下降的原因而言，這實際上是兩個因素：第一，在收益方面是 COVID-19 的影響。如您所知，隨著大流行，我們在第二季度的首次填充減少了。這種情況在第三季度以及我們在第三季度看到的情況繼續存在，每位成員的使用率降低以及一些損失和失業。所以這影響了我們的收入。然後在分母方面，將 2020 年添加到收入中的零售共付額添加到分母中，這實際上影響了第三季度的利潤率。

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.

總的來說，我們對我們的利潤率表現非常滿意。正如您在第二季度和第三季度之間看到的那樣，我們的收益連續增長了 16% 以及 - 並且繼續提高我們的利潤率。所以總的來說，我們看到我們執行得非常好。

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。謝謝你，蘭斯。感謝你們所有人的關注以及你們今天提出的非常周到和有見地的問題。如您所知，這是我們公司歷史上前所未有的時刻。正如你所期望的那樣，我們將繼續以全部的力量、同情心和剛毅、不安的態度做出回應和領導。我們正在滿足我們在全球服務的 1.4 億人中每一個人的獨特需求。

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，UnitedHealth Group 的 325,000 名員工仍然堅定不移地致力於我們以具有社會意識的方式推進下一代衛生系統的工作。這是一個普遍的、負擔得起的、簡單有效的衛生系統。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交流數週。我們將虛擬形式視為一個機會，讓您更深入地了解我們的公司、戰略計劃、員工和未來.非常感謝。

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

這將結束今天的節目。感謝您的參與。您現在可以斷開連接。祝你有美好的一天。