Q1 2021 Cigna Corp Earnings Call

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Yes.

Ladies and gentlemen, thank you for standing by for Cigna's first quarter 2021 results review.

And just time all callers are in a listen only mode.

We will conduct a question and answer session later during the conference and review procedures on how to enter queue to ask questions at that time, if you should require assistance during the call. Please press star zero on your Touchtone phone as a reminder, ladies and gentlemen, this conference, including the Q&A session is being recorded.

We'll begin by turning the conference over to MS. Alexis Jones. Please go ahead Ms Jones.

Good morning, everyone and thank you for joining today's call I am elected Johns lead principal for Investor Relations with me on the line. This morning are David <unk>, Our President and Chief Executive Officer, and Brian and Vanco, Cigna's, Chief Financial Officer and.

And our remarks today, David and Brian will cover a number of topics, including Cigna's first quarter 2021 financial results as well as an update on our financial outlook for 2021.

As noted in our earnings release, when describing our financial results Cigna uses certain financial measures adjusted income from operations and adjusted revenues, which are not determined in accordance with accounting principles generally accepted in the United States otherwise known as GAAP. A reconciliation of these measures and the most directly comparable GAAP measures shareholders' net income and total.

Revenues, respectively is contained in today's earnings release, which is posted in the Investor Relations section of Cigna Dot com.

We use the term labeled adjusted income from operations and adjusted earnings per share on the same basis as our principal measures of financial performance.

And our remarks today will be making some forward looking statements, including statements regarding our outlook for 2021 and future performance.

These statements are subject to risks and uncertainties that could cause actual results to differ materially from our current expectations.

A description of these risks and uncertainties is contained and the cautionary note to today's earnings release and and our most recent reports filed with the SEC.

Before turning the call over to David I will cover a few items pertaining to our financial results and disclosures.

Regarding our results and the first quarter, we recorded an after tax special item charge of $101 million or 29 cents per share related to debt extinguishment costs incurred during the period as well as an after tax special item charge of $22 million or six cents per share for integration and transaction related costs. We all.

Also recorded an after tax special items benefit of $21 million or six cents per share related to charges associated with litigation matters.

As described in today's earnings release, and special items are excluded from adjusted income from operations and adjusted revenues and our discussion of financial results.

As previously noted as a result of the sale of the group disability and life business and our first quarter earnings release, and quarterly financial supplement corporate and other operations combined with the results previously reported as corporate and segment previously reported as group disability and other.

And our securities filings the segment previously reported as group disability and other is now reported as other operations.

Additionally, please note that when we make prospective comments regarding financial performance, including our full year 2021 outlook. We will do so on a basis that includes the potential impact of future share repurchases and anticipated 2021 dividend and excludes the impact of any business combinations or divestitures that may occur after today, such as our <unk>.

Recently announced planned divestiture of the Texas, Medicaid business, which we expect to close and the second half of 2021.

With that I will turn the call over to David.

Thanks, a lot good morning, everyone and thank you for joining us on a call from it.

And we meet our environment remains highly dynamic with COVID-19 continues to affect the world our industry and our economy.

Cigna this rapidly changing landscape has only reinforced the tremendous responsibility we have to improve the health and wellbeing and peace of mind sales reserve.

This remains a primary focus and drives our xiaomi browser and coworkers each and every day and it's the reason we worked and continue to deliver for our customers clients patients partners and our communities all while delivering strong financial results for you our shareholders.

During the first quarter, we delivered adjusted revenue and $41 billion and.

And adjusted EPS of $4 73 per share.

We also deployed significant capital to our investors through share repurchase and the payment of a meaningful quarterly dividend reinforcing the strength of our capital light framework.

There will be other conversation from several weeks ago at our Investor day today I'm going to talk more about how we are continuing to navigate through the current environment Cabela's and meet the needs of all of our stakeholders our ability to consistently deliver strong results by executing on our growth framework and the confidence we have and achieving our increased outlook by <unk> <unk>.

During differentiated and sustained growth for the long term.

And then Brian and we'll share more details about our first quarter results and our 2021 and outlook and after that we'll take your questions.

Since we last met at our Investor Day in March the macro landscape remains fluid and the U S proposed legislation as well as regulation and executive actions seek to expand and extend and further support both public and private programs.

Globally, social and political tensions remain high and as COVID-19, with its multiple variance continues to take a toll on a number of countries such as India, where cases have again dramatically spike.

All of these forces are shaping health care and influencing the political and economic landscape around the world.

At Cigna, we are navigating through this environment and by continuing to innovate for and support our stakeholders with COVID-19 services, while also executing and other strategies to make health care more affordable predictable and simple.

For U S commercial customers, we are ensuring we get the preventative care they need including mammography colonoscopy.

Distributable cancer screenings, and childhood immunizations, which today are consistent with pre pandemic levels, reflecting the continued strength of our clinical programs and proven engagement capabilities.

With an ever north for those customers served by express scripts home delivery and we delivered further improvements and medication adherence for people with diabetes high cholesterol and high blood pressure.

At the same time, and we're also supporting mental well being of our customers. We're doing this through one best in class capabilities, where for example, we engage with oncology patients with Comorbidities by spending an average of $2000 on their behavioral health care, we can save an average of $20000 and avoidable costs.

And we continue to innovate and leverage our strategic partnerships, including for example, with Ginger through Cigna ventures, which provides industry, leading on demand and $24 seven behavioral health coaching and further extending our behavior health access from the benefit of our customers.

We're also leveraging data and and actionable intelligence to understand the most common long term complications of COVID-19 infections and.

And then building predictive models to determine who is the greatest risk and becoming the COVID-19 long haul or so we can quickly provide targeted case management and behavioral health services as well as other resources to help our customers regained their health.

For our clients, we are serving as a trusted partner by supply and the additional physical and behavioral health assistance to Adas and recovery for employees, who are affected by COVID-19.

We're helping employers and build their own communities of immunity by assisting them and launching vaccination clinics and we're leveraging our data and analytics to help employers determined when and how it is safe for employees and returned to work.

From a provider partners, we're working to guide people to the most effective types of care and further closing gaps in care with our clinical teams and our virtual capabilities.

For our coworkers were supporting them and this highly disrupted environment.

<unk> for example, providing 200 dollar incentive for coworkers, who choose to become vaccinated for COVID-19 and.

And continuing to offer expanded leave capabilities with our emergency time off program to provide flexibility necessitated by the current conditions.

And finally for our communities, we're taking steps to address social determinants of health. For example, we all know the arm statistics on the disproportionate impact that COVID-19 has had on our communities of color as.

And as part of our Safe initiative, we brought additional underground resources to targeted communities are low.

And COVID-19, and awareness campaigns and distributing PP&E kits dispatching our health improvement mobile resources to help to administer free flu shots and provide healthy meal as well as other support.

Similarly, we are leaning into fight breast cancer with the severities for example, well amongst black women remains startling to help to address this disparity GAAP weekend went directly into communities, starting and Tennessee for example, where we collaborated with local partners to offer mobile mammography bands and churches and.

And and other local neighborhood locations at.

And at Cigna balancing the needs of our stakeholders is deeply rooted in our corporate purpose, we constantly challenge ourselves by asking the basic question what more can we do.

To help us stay focused on delivering each and every day for the benefit of our customers our clients and patients and our partners.

Against this backdrop, the strength of our foundation propels us forward and guides our growth.

As we shared with you at our Investor day through our three growth platforms <unk> U S medical and international markets, we are well positioned to leverage the three trends, we see shaping health care into the future specifically pharmacological innovations the rising demand for coordinated mental and physical health services and the changing preferences.

<unk> as it relates to access to care models.

And through a proven framework, we're able to drive attractive sustained growth.

By delivering differentiated value within our portfolio of integrated coordinated and port solutions.

Continuing to work to partner and innovate and working to expand our addressable markets.

As a result, we're off to a strong start in 2021 with strong fundamental execution and strategic and capital flexibility to further our momentum into the future.

During the first quarter ever and we've continued to build on its differentiated and steady performance and just had delivered throughout the pandemic.

By evolving the health care experience for our customers and clients through continuous innovation and by building investing and strengthening our strategic partnerships.

For example in January we further expanded our partnership with Prime therapeutics by leveraging our home delivery and Accredo specialty pharmacy to drive greater value and deliver and our promise to make health care more affordable.

And also advancing our strategic capabilities with our MD life acquisition, which closed last month.

And this acquisition will expand <unk> care its ability to further broaden access lower cost of care and strategically position us to grow and the rapidly changing access to care environment.

At the same time, everyone with pharmacy is also driving affordability improvements. One example is our patient assurance program, which caps the cost of prescriptions for patients with diabetes.

During the quarter the number of patients and this program increased by 64% and.

And the valued patients delivered from this program is on track to more than double what we achieved last year.

Turning to our U S medical popcorn, we see bright spots and growth and our U S. Commercial portfolio. For example, we continued to take share and the select segment, which includes employers with 51% to 500 employees and.

Clients continue to value our integrated aligned self funded medical pharmacy, behavioral and stop loss programs.

And more broadly we are driving value by bringing differentiated offerings to market fueled by innovations and advancements we are accessing from our evernote and capabilities, particularly in areas of pharmacy services and behavioral health.

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Through our willingness to strategically partner with innovative companies like Oscar we're also well positioned to take advantage of market growth opportunities and the small employer market a market. We view as currently being underserved as a result, we accept we expect to see an uptick and growth in our U S. Commercial platform during the residual part of this year.

Additionally, one important impact and the pandemic is the businesses have expanded access to support services for the employees back and use a trusted source of information and providing and extended range of benefits to support whole person health is more and more employers recognize the critical link between mental and physical health.

And the week of COVID-19, more employers are also recognizing the connection between healthy workers higher productivity and a growing economy.

In fact, the National Bureau of economic research found that in the U S. We benefited by $1 five trillion dollars of value by having employers play a major role and health care. This reinforces the critical role our U S health care business plays as an important partner to employers and providing access to quality affordable care for the benefit of their employees.

Turning to our U S government business, we are driving strong year over year customer growth by continuing to expand our addressable markets. The number of Medicare advantage customers increased by 11% year over year, reflecting the ongoing execution of our strategy as well as our sustained strong star performance.

And the number of customers and our individual and family plan business grew by 17% year over year, driven by our geographic expansion and the introduction of new plans that provide expanded coverage for maintenance drugs to further improve affordability for customers with certain chronic conditions.

And in other international markets business, we are focused on actively supporting our coworkers customers and partners around the world who continue to be impacted by COVID-19 for example, and India. Our foundation is providing financial support through UNICEF to meet the critical needs on the ground, including additional rapid testing capabilities and expanded access to vaccines.

And we're providing matching gifts from the Cigna Foundation through our co workers, who donate to charities and India.

Staying true to our mission is not only the right thing to do it reinforces to our clients our customers and our patients our commitment to make a difference in the moments that matter most.

Our purpose driven orientation and together with our strategic flexibility created by our services based model and our capital light framework that generate significant cash flow from operations as well as our track record of strong financial performance, where we delivered 15% adjusted EPS compounded growth rate over the last decade.

All give us confidence we will continue to sustainably grow and both the short term and the long term and this dynamic environment.

And now taking into account the strength of our first quarter results. We expect our full year adjusted EPS to be at least $20 20 and 2021.

And we remain confident and our ability to deliver our long term targets of average annual adjusted revenue growth of 6% to 8%.

Average annual adjusted EPS growth of 10% to 13% and continue to play and attractive dividend, while delivering cumulative operating cash flow growth of $50 billion through 2025.

Now to briefly summarize we delivered strong first quarter results by executing our growth framework, while harnessing our capital strength to deploy meaningful capital for the benefit of our shareholders and reinvesting in our business and leveraging our strategic flexibility to continue to innovate and adapt all of which sets us up for sustained long term success.

We remain confident and our ability to continue to grow as we focus our efforts to make health care more affordable predictable and simple each and every day now with that I'll turn the call over to Brian.

Thanks, David and good morning, everyone.

Today, I'll review key aspects of Cigna's first quarter results, including the ongoing impact of COVID-19 on our business.

And I will discuss our updated outlook for the full year.

Key consolidated financial highlights for first quarter 2021 include adjusted revenue of $41 billion.

Adjusted earnings of $1 $7 billion after tax and adjusted earnings per share of $4 73.

Results from the first quarter reflects strong topline growth with contributions across our businesses and first quarter earnings came in somewhat ahead of our expectations.

The favorable first quarter earnings were primarily driven by strong other north performance.

Favorable net investment income and favorable prior year medical cost development.

Partially offset by nonrecurring operating expenses.

Our results reflect our ability to deliver and dynamic rapidly evolving environment, including navigating the ongoing impacts of the COVID-19 pandemic.

Regarding our segments I'll first comment on other north.

First quarter 2021, adjusted revenues grew to 36 billion.

And adjusted pretax earnings grew to $1 2 billion.

<unk> strong results and the quarter were driven by effective execution of supply chain initiatives.

Continued strong performance and Accredo and our industry, leading specialty pharmacy and.

And organic growth of our services with deepening partnerships, all while continuing to invest for ongoing growth.

Our adjusted Pharmacy script volume was $393 million during the quarter, a 9% increase over first quarter 2020.

Overall ever North continued its positive momentum and delivered another strong quarter of financial results.

Turning to U S. Medical we entered the year expecting to see the majority of COVID-19 testing and treatment cost pressure in the U S. Medical segment in the first half of 2021, particularly in the first quarter as we progressed throughout the first quarter. We saw COVID-19 case counts and hospitalizations declined more rapidly.

And then we originally anticipated. Additionally, as COVID-19 cases decelerated, we saw an increase in non COVID-19 utilization.

Importantly throughout all of this we continued to see key components of preventive care and utilize the pre pandemic levels for our U S commercial customers.

Taken as a whole and excluding prior year medical cost development, our first quarter medical care ratio was in line with our expectations.

With that as context, I will now comment specifically on first quarter financial results for the U S Medical segment.

First quarter adjusted revenues were $10 4 billion and.

And adjusted pretax earnings were $987 million.

Our first quarter U S. Medical earnings were slightly ahead of our expectations, primarily driven by favorable net investment income and prior year medical cost development, partially offset by nonrecurring operating expenses.

Excluding these onetime factors our U S medical earnings were in line with our expectations.

Turning to membership we ended the quarter with $16 7 million total medical customers and increase of 30000 customers sequentially.

As expected U S commercial customer volume declined sequentially due to dis enrollment throughout the first quarter, partially offset by new sales and the select segment.

And our U S government business has performed well throughout the annual open enrollment periods overall results for Cigna as U S. Medical segment reflects strong fundamentals.

And our international markets business first quarter adjusted revenues were $1 6 billion.

And adjusted pre tax earnings were $262 million.

Reflecting business growth favorable net investment income and foreign currency movements offset by higher claims costs during the period.

I would also note that a refinement to the accounting for acquisition costs led to a one time favorable benefit and the first quarter of 2020 that did not recur and the current period.

Corporate and other operations reflects a first quarter adjusted loss of $330 million.

These results reflect lower interest expense due to lower levels of outstanding debt offset by the absence of contributions from the group disability and life business, which was divested on December 31 2020.

Overall as a result of strong execution and a dynamic environment, we continue to deliver value for all of our stakeholders and strong financial results across our businesses.

Now looking forward to our outlook for full year of 2021.

As we look to the balance of the year. We expect continued strong execution across our growth platforms and we expect to make continued meaningful investments in our businesses that are responsive to the force is changing health care positioning us for continued long term growth taken as a whole we are raising our prior guidance for full year 2012.

One we now expect consolidated adjusted revenues of at least $166 billion.

Representing growth of approximately 7% after adjusting for the divestiture of our group disability and life business we.

We now expect full year 2021, consolidated adjusted income from operations to be at least $7 billion.

Or at least $20 and <unk> 20 per share within our outlook. We continue to expect a full year COVID-19 related headwind of approximately $1 25 per share primarily within our U S medical business and we continue to project and expense ratio and the range of seven 5% to 8%.

I'll now discuss our 2021 outlook for our segments Forever North we now expect full year 2021 adjusted earnings of at least $5 65 billion.

Which represents year over year growth of at least 5%.

This outlook reflects ongoing investments and our ever and our portfolio and.

Including investments and care solutions, and MD life as we continue to see significant opportunity to bring new innovative solutions to market.

And for U S medical and we continue to expect full year 2021, adjusted earnings of at least $3 8 billion.

This outlook reflects focused execution and our businesses as we expect to drive organic customer growth and deepening of customer relationships.

We expect direct COVID-19 related testing and treatment to decline throughout the balance of the year and also anticipate more normalized non COVID-19 utilization.

And with the strength of the U S. Medical first quarter results, we will further accelerate strategic investments to support future growth, thus, leaving our full year earnings outlook for U S medical unchanged.

Regarding total medical customers, we now expect 2021 growth, albeit at low.

<unk> 350000 customers.

This includes organic growth throughout the remainder of the year and our commercial business led by the middle market and select segments, partially offset by dis enrollment and national accounts.

We also expect Medicare advantage customer growth in our targeted average annual growth range of 10% to 15% and.

And we expect continued growth and our individual business.

Turning to medical costs, we continue to expect the 2021 medical care ratio to be and the range of <unk>, 81% to 82%.

Reflecting the impacts in 2021 of elevated medical costs, including the impact of direct COVID-19 related costs and more normalized non billable utilization.

And the repeal of the health insurance tax effective for 2021.

All while we continue to deliver strong clinical quality and overall affordability for our clients and customers.

We also expect continued growth and strong margins in international markets.

All in for full year 2021, we now expect consolidated adjusted income from operations other Lee.

$7 billion or.

Or at least $20 20 per share overall these expected results reflect the differentiated value strength and strategic positioning of our businesses as we delivered growth while navigating the impacts associated with COVID-19.

Now moving to our 2021 capital management position and outlook.

We expect our businesses to continue to drive exceptional cash flow with strong returns on capital even as we continue reinvesting to support long term growth and innovation.

For 2021, we continue to expect at least $7 5 billion.

Cash flow from operations, reflecting the strong capital efficiency of our well performing businesses.

During the quarter, we met our previously stated share repurchase expectations and year to date as of May six 2021, we.

We have repurchased $14 4 million shares for $3 2 billion.

And we now expect full year 2021 weighted average shares of 346 million to 348 million shares.

We ended first quarter 2021, with a debt to capitalization ratio of 39, 9% in line with our long term target of approximately 40%.

We had $2 $5 billion of cash available at the parent at the end of the quarter and on April 28, we declared a $1 per share dividend payable on June 20, <unk> to shareholders of record as of June <unk>.

Our balance sheet and cash flow outlook remains strong and benefiting from our highly efficient service based orientation that drives strategic flexibility strong margins and attractive returns on capital.

So now to recap results from the first quarter reflects strong topline growth with contributions across our businesses and first quarter earnings came in somewhat ahead of our expectations.

These favorable first quarter earnings were primarily driven by strong <unk> performance favorable net investment income and favorable prior year medical cost development, partially offset by nonrecurring operating expenses.

Our strong results give us confidence and our increased outlook for full year 2021, all while continuing to support our customers and coworkers as such we now expect 2021 full year adjusted EPS of at least $20 20 per share and have continued confidence and our long term growth targets and with that.

I will turn it over to the operator for the Q&A portion of the call.

Ladies and gentlemen at this time if you do have a question. Please press star one on your Touchtone phone. If someone asked your question ahead of you you can remove yourself from the queue by pressing star two.

Also if you're using a speakerphone please pick up your handset before pressing the buttons.

Finally, we ask that you. Please limit yourself to one question to allow sufficient time for questions from those remaining and the Q1 moment. Please for our first question.

Our first question comes from Mr. Robert Jones with Goldman Sachs Go ahead with your question Sir.

Great. Thanks for taking the question maybe just on the PBS. This segment grew pretax income 13% year over year and I think this is the quarter, where you were actually lapping some benefits from COVID-19 pull forward last year. So just wanted to see if there's anything you'd call out further within the TBM and the quarter and then Relatedly if I look at the Guy.

And from from this point forward it does seem to imply for the remaining three quarters, it's kind of mid single digit growth income growth within the Pbms. So curious if you have line of sight into what might cause a deceleration from the strong performance and the first quarter.

Good morning, Bob its Brian.

For the question and Yeah, we're really pleased with the strong start to the year and ever North, which as I mentioned and my comments gives us the confidence to increase the full year guidance to at least $5 65 billion.

Operating income quarter to quarter, there will be some level of variability and this segment. So I would encourage you not to overreact to the singular quarter that we had here, but certainly pleased with 13% quarter over quarter earnings growth I would remind you that our prime Therapeutics partnership launched April one 2020.

And so the base period last year and the first quarter did not have contributions from prime therapeutics. So that was a bit of a benefit to this quarter that will not recur to the same degree for the balance of the year. So to your point on the operating income growth appeared to slow to some degree later in the year. That's one contribution that you should you should keep in mind. Additionally, we continue to invest.

<unk> aggressively and ever north to expand and diversify the suite of solutions.

That portfolio. So as you think about care solutions benefits management insights, we will make continued organic and on a targeted basis inorganic investments to continue to expand that portfolio, which will increase SG&A and to some degree temper the income growth for the balance of the year, David anything you'd want to add to that just highlighting the fact that and support of that for example.

Our north benefits business performed very strongly in the first quarter. So on a year over year basis that was a partial contributor to the year over year increase as Brian articulated and we remain committed to continue to invest and the businesses all while meeting now our increased earnings outlook for the full year.

Great. Thanks.

Thank you Mr. Jones. Our next question comes from Mr. Ralph Giacobbe with Citi. Your line is open you may ask your question.

Great. Thanks.

The SG&A and the U S medical side was higher and I think you mentioned nonrecurring operating expenses. So just hoping you can give a little bit more details on what that exactly was and if you're willing to quantify it.

Good morning, Ralph It's Brian So maybe let me unpack the U S medical and nonrecurring items, a little bit and this might speak to the core of your question a little bit as I mentioned in my comments overall, our U S medical.

Earnings in the quarter were above our expectations.

But when you remove the effect of the three nonrecurring items were in line with our expectations. So that the three nonrecurring items that I cited we had some favorability and the quarter and net investment income, we had some favorability and the quarter and prior year medical cost development and that was offset by nonrecurring operating expenses and so to the core of your question the nonrecurring operating expenses.

As you can think of as is litigation oriented matters associated with operations from several years ago. So these are not related to current time periods is room related to anthem. These are matters from several years ago, but they are related to operations and as a result of that we chose to to book them through SG&A as opposed to considering them as a special <unk>.

And below the line or anything like that they were appropriate and our eyes to book through SG&A above the line and order of magnitude you can think of that as approximately offsetting the favorable benefit that we had from net investment income and the quarter within U S medical but those are truly nonrecurring items since they're related to periods from several years ago and and those matters should now be <unk>.

<unk>.

Okay. That's helpful. Thank you.

Thank you Mr. Jacobi. Our next question comes from Mr. Justin Lake with Wolfe Research you May ask your question.

Thanks, Good morning.

And the screen and set a couple of quick questions first.

Terms of medical cost expectations. During the year, you gave us and update on COVID-19, but wanted to get an idea of what youre thinking and into the back half of the year in terms of.

In terms of utilization pick up post the vaccine would your delta versus kind of typical trend and then.

And you divested.

Clint.

To sell that that Texas Medicaid business, just wanted to see if theres any background. There in terms of what drove you to kind of the best that and any kind of updated thoughts on your better on your credit.

Medicaid strategy going forward it would be helpful. Thanks.

Hey, Justin Good morning, It's David let me just frame the medical cost for a moment and then ask Brian to talk a little bit more about our framework and our expectations for the year and then I'll come back and address the Medicaid divestiture, and our Medicaid direction and more broadly.

First from a medical cost standpoint Big picture.

We're pleased with the start to the year Big picture broadly speaking, we're pleased to start to the year and I just want to underscore a couple of components one.

And our organization works tirelessly to try to drive elevated utilization of certain services like preventative care services and importantly, we saw and the first quarter. The use of preventative care services like mammography colonoscopy childhood immunization cervical cancer screenings to be at an approximate level of prepay them.

Levels. That's a tremendous result of offsetting what might have been a dampening to utilization the national data. We see more broadly is that utilization of those preventative care services is that a more dampened rate, but ours is at an elevated or more consistent rate from that standpoint, which is quite important and secondly, I would just remind you that and titles.

And our Medicaid comment.

The later is that we have a de minimis amount and Medicaid within our portfolio and our national data suggests through our services business.

Thrive and our services business that and the first quarter Medicaid medical costs were a bit more dampened year over year in the first quarter of 2021 that sounded effect on our portfolio, but we can see that and the services that we're providing and I'll ask Brian to give you a little bit more color forward looking on the year, then I'll come back and address Medicaid.

Yes, good morning, just and so.

Just a few other comments on the quarter and the balance of the year overall as I mentioned and my comments the U S. Medical MCR was in line with our expectations for the first quarter. When you exclude the benefit of <unk>. Prior year development. When you include the benefit of prior year development were actually a little bit favorable and the first quarter and that was at an elevated level as we expected when we stepped into the year.

<unk> for the balance of the year, we expect a deceleration and COVID-19 testing and treatment costs, we expect an uptick and non COVID-19.

Related to utilization and quarters two through four with those factors roughly offsetting one another and so when we constructed our full year outlook other than 81% to 82% medical care ratio, we've stress tested a variety of scenarios about associate with those two levers and are quite confident and our ability to achieve the full year, 81% to 82% medical care ratio for U S medic.

David maybe on the Texas, Medicaid and our broader Medicaid strategy over to you sure just and as you noted we chose to divest of that.

Single site Medicaid operations, we add so number one it was we have one of one.

And so it was one off within our portfolio that has a de minimis impact on our P&L at the enterprise level, so putting that aside we determined it was best.

Or that business to be served by an expert specialists and we're pleased to effectuate and seek to close the successful transition to Molina and we think that's beneficial to the customers being served and our co workers and that business.

Looking forward, we continue to see Medicaid and government services first and foremost is and attractive growth opportunity within our <unk> service portfolio, whether it's even worth pharmacy care, everyone benefits, even with intelligence the opportunity to bring expanded services largely through health plans today in support of Medicaid will be a growing <unk>.

And part of our portfolio over time, we see opportunities that will manifest themselves state by state on state specific service relationships against revenue and then finally as you recall from our Investor day conversation within our M&A priority. We continue to have an expansion of our U S government programs as an M&A priority. So we will be opportunistic from that.

Standpoint, if we see the ability to further strengthen any of our capabilities looking forward, but thats divestiture was again it was a one off de minimis impact and we deemed that it was best and handle the specialist thanks Carsten.

Yeah.

Thank you Mr. Lake. Our next question comes from Mr. George Hill with Deutsche Bank, You May ask your question.

Yes, good morning, guys and thanks for taking the question I guess, David I would ask a little bit more color about the MD life acquisition and how you guys are thinking about care delivery partnerships and I.

Well, a little bit of commentary maybe on how the digital formulary is progressing and if you could maybe talk about if that's kind of meaningful revenue contribution yet to be up our group segment.

So thanks for the question George So specific can be life.

It's important to.

<unk> referenced the fact that we had a and.

Our multi year relationship with MD life both.

Partnering to consume the services, but also through our very successful multiyear Cigna ventures organization. So we start from a learned shared experience and even deeper collaboration during the COVID-19 environment specific to the asset and the direction is.

And we discussed at our Investor Day, we see rapid expansion of what we call alternative side of care to be one of the three major trends as we look forward over the next five to 10 years. This is an important part of those building blocks and it's an important part of our ever north care portfolio of capabilities, we see it as much greater than <unk> or even basic virtual care triaging.

See the ability to obviously expand virtual care and primary care behavioral care, we see the ability to expand that further in terms of longitudinal chronic care programs poly chronic and ultimately complex care programs and capabilities. So it provides us an accelerant to our strategic direction.

A known partner that will now be part of the overall cigna portfolio and we're excited because net net it drives improved service improved access improved affordability with strong clinical outcomes for the benefit of our consumers, so truly and aggregate win win and the portfolio.

Specific to the digital formulary that innovation continues to be somewhat unique in the marketplace.

And our clients really appreciate the approach relative to the digital formulary, helping to essentially cure rates and apply externally validated expertise to the vast array of digital alternatives that exist and the ecosystem to help to provide employers more informed decisions for those that may have the greatest.

Outcome and impact from the benefit of the customer so I view that as a part of our consultative approach in terms of providing support and a part of our approach to in this case partner and curate additional services on a go forward basis taken as a whole we see again, our ever north care capabilities is an exciting part of the broader ever growth growth.

And capabilities and we see the ability to do that and a complementary nature with our proven value based care relationships within our cigna portfolio as well hope to health George.

Thank you Ms. Thank you we'll go next.

Mr Care. Our next question comes from Mr. A J Rice. Your line is open and <unk> with credit Suisse. You May ask your question.

Hi, everybody.

I might just ask you about the <unk>.

Selling season, both from medical and for every north on the <unk> side I know last year. There was some discussion about potentially people being delayed different people have different views as to how much of that activity actually happened I wondered.

What <unk> seen in terms of RFP activity on both sides of the business anything to discuss in terms of.

New and innovative ways that Cigna go into market and those two.

The sides of your business and any discussion about early wins losses.

Hey, Jay Good morning, it's David so relative to the selling season looking to 2020 to your question goes out.

The commercial side as well as the services side of the business.

First on the commercial side of the portfolio at this stage of the year, we're typically looking at the national accounts environment and.

Remind you that we define national accounts and for the U S commercial portfolio.

A little bit more narrowly than some of the market. So it's commercial employers 5000 or more employees, who are multistate and nature as we look to 2022 right.

Right now, we see an environment, where the RFP volume so the opportunity to pursue new business is up somewhat I think order of magnitude and 10%.

And we see the portion of our book of business that's out to bid.

As being up marginally less and that 10% number so that's a little bit of framing.

And some early traction and some early wins.

And that exist and our portfolio and as we sit here at this stage of the environment.

We're optimistic that we'll have a very good commercial outlook and aggregate for our portfolio as we look to 2020 to a branch where the trend comment and then I'll come to the ebb and worth portfolio.

Clearly affordability remains a top decision criteria for commercial employers Theres no doubt about that we've spent ample time on that at our Investor day and it remains a top strategic imperative further beyond that is the flexibility necessary and and the innovation required to truly integrate.

<unk> or coordinate mental and physical health programs, and then expand and coordinate access to care and a less fragmented way through alternative side of care framework et cetera. So we see.

The trends being well lined up to our direction as it relates to within ever North and specific to your question within pharmacy services.

As you'll recall, we have now multiple years of very attractive growth.

Under our belt as a combined organization and.

And we're pleased with that as we look to 2022.

And we have an environment where to date, our employer renewal process is manifesting itself quite strongly and our health plan renewal process is manifesting itself rather strongly.

Beyond the two known losses that we previously discussed relative to the health plan business taken as a whole we'd expect the retention and that business as we sit here right now to be a bit less than our recent couple of years, which have been historic highs and.

And the upper Ninety's, we will expect it to be more in the mid nineties as a consistent rate and then taken as a whole we will expect to see both revenue and earnings growth and our <unk> portfolio and 2022, so both pointing in a positive direction would be the summary, I would leave you with.

Okay, great. Thanks.

Thank you Mr. Rice and our next question comes from Mr. Kevin Fischbeck with Bank of America, you May ask your question.

Okay, great. Thanks.

The way that you were framing.

Framing the.

The drop off and COVID-19 utilization and then I guess, the earlier return and and volumes.

The implied that.

The COVID-19 impact might actually end up being less and what you were forecasting.

But you obviously reaffirmed that number so just any thoughts about kind of the puts and takes of COVID-19 is dropping faster than you thought and then.

Do you still feel like about half of that coming back next year is the right way to think about that thanks.

Good morning, Kevin It's Brian.

And your thoughts on your question and I appreciate the framing of it broadly in the quarter as I said earlier the MCR for U S. Medical was in line with our expectations. When you exclude the favorable benefit from prior year development and other components within we're a little bit different and we anticipate it to your point.

<unk> and 19 testing and treatment burden on our book was a little bit lower than we anticipated for the quarter. However, non COVID-19 utilization was a little bit higher than we anticipated coming into the quarter. So the net effect of those two factors led to the U S medical MCR being back in line with where we expected it to be and as we trend out the balance of the year, we continue to expect that.

Phenomenon to proceed meeting deceleration and COVID-19, 19 testing and treatment costs, and a little bit of and uptick in non COVID-19 related utilization. So to your point, we expect about 50% of the EPS headwind associated with COVID-19, and $1 25 to continue to show up and the U S medical MCR and bridging over into 2022 weeks.

And to anticipate about half of that dollar and 25 or a little bit over half of that to return in the form of of earnings and our 2022 enterprise portfolio and as such we would expect that.

Our long term annual growth rate and EPS of 10% to 13% we would expect to achieve a result, that's at or above the high end of that range relative to our updated guidance of at least $20 20 per share.

Helpful. Thanks.

Thank you Mr. Fischbeck. Our next question comes from MS. Lisa Gill with Jpmorgan you May ask your question.

Thanks very much for taking my question I just wanted to go back David and and ask a question around the comments that you made around MD life.

Specifically, you talked about expanding our primary care and longitudinal care you talked earlier about your relationship with Ginger around mental health. So.

My question here is really twofold first.

Do you see the opportunities with MD life around lowering overall medical costs versus taking a second day believed that you need to buy.

We're continuing to build out something around behavioral health and then thirdly can you just give us an idea of how many and staying alive actually use MD life today.

Lisa Thanks, and appreciate the ongoing interest in the space for sure.

So number one bigger picture framing I appreciate that you brought MD life Junior together for example, we don't we do not believe that this is a one and done.

Type activity. So we don't believe that Corp, secures itself, a virtual care asset and then they're squared for the alternative delivery space. This is a fluid environment, it's a dynamic environment and its environment that has massive promise relative to bringing expanded access and coordination of services.

And improved overall value coming back to the affordability, our organic capabilities are strong the MD life asset advances that massively but as Brian noted in his prior comments as well we continue to invest in this space. So I want you to view that we view it as a dynamic and fluid space and we very much like our positioning.

Two is just like and the we'll call it the traditional care delivery space, the coordination of physical and mental health is mission critical and.

Just because it's in a virtual care environment doesn't mean that the coordination of the leverage opportunity. There is not is not as critical and in fact, the virtual capabilities allow us to take fragmentation and out of the system more aggressively and more comprehensively to year affordability comment unequivocally, we see it and ability to further improve affordability.

And through alternative sites of care and through our virtual capabilities. You may recall from Investor Day, we identified alternative site of care or site of care leverage as a meaningful opportunity to further deflect or improve overall affordability and an example, maybe.

See already and our virtual care delivery.

And the less use of unnecessary or redundant diagnostic services, that's a tangible illustration of a improvement and affordability. Conversely, we see opportunities to even further close gaps in care or increase utilization of the right services like maintenance medications through the <unk>.

Dynamic more intimate ongoing interaction with with customers from patients from that standpoint. So my points are threefold, one continuation of investing and the urban innovation off of a very strong base to a continued need to use the capabilities to close fragmentation within the system or get more.

Three leverage most notably between the medical health and.

Mental health capabilities, and three unequivocally a contributor to further improve the affordability.

Great. Thank you.

Thank you Ms. Gill. Our next question comes from Mr. Josh Raskin with Nephron Research you May ask your question.

Hi, Thanks, Good morning here with Eric Percher as well can you speak to the progress and both the individual exchanges I think I heard and 17% number as well as the small group markets I'm, specifically interested in membership growth and when do you think you have enough information around medical cost and sort of utilization and new product et cetera to better understand it.

Profit trajectories here this year.

Hey, Josh Good morning, It's David let me just start and frame the growth trajectory and then ask Brian to provide a little bit of additional color realm.

And relative to our insights on the on the performance first we're very pleased we're very pleased with the sustained performance starting with the individual exchanges.

Just have you recall, we entered the exchanges in the first year and we've sustained engagement and the exchanges since its inception.

We've integrated within the exchanges, we've delivered a proven model and now we're in and expansion mode relative to additional geographies and large part with our collaborative accountable care and aligned value based relationships from the health care delivery system and were pleased with the results both the base results and individual exchange as well as thus.

Thus far our early look at the additional enrollment we're seeing because of the expanded SCP and I'll ask Brian just to give you a little color relative relative to that dimension as it relates to the small employer marketplace. As you know we cigna historically have not played and the small employer marketplace what.

And what we've focused above 51 lives or above 100 lives depending on the regulation more broadly we have continued to view it as an underserved market and market than it had more traditional originally designed programs less innovation and less flexibility and.

And less leverage of more modern and specialty and clinical services and our determination was it was best to pursue that market and partnership leveraging our partnership DNA.

And we've entered that market successfully with our partnership with Oscar we're really early and that journey. Some positive indicators for sure. We're early in the journey. Our early indicators are positive, though that has us accelerating our geographies.

And in collaboration with Oscar and again back to and partnership with our health care delivery partners. So Ryan maybe just a little color in terms of what we view the the process looking like and the economics within the individual exchange sure good morning, Josh.

Our individual membership year to date is a little bit above our expectations for a couple of different reasons. One as I'm sure. You know we stepped into 80, new counties and 2021 and the enrollment and the annual enrollment period, there was a little bit above our expectations. Additionally, the expanded special enrollment period window that president by it and introduced has generated some new <unk>.

And our portfolio as of the end of the first quarter. We have no reason to believe at this juncture that those those customers perform meaningfully differently than the balance of our individual exchange portfolio to your point on when will we know for sure and we will take several months as we understand the risk adjusted profile and the persistency of those new lives et cetera, but I also would ring.

Mind, you the individual exchange membership only represents about 5%, 6% of our total U S medical portfolio. So it won't be a significant needle mover relative to the MCR full year outlook for U S medical.

Thank you.

Thank you Mr. Raskin. Our next question comes from Mr. Scott Fidel with Stephens you May ask your question.

Hi, Thanks, and good morning, everyone.

A question just just person be helpful. Maybe you could break down just under $1 billion race right could you guide and how you would sort of break that down between each of the three segments. And then also interested just in and sort of what youre seeing and aggregate right now around the debate around inflation and not just say.

Medical inflation, but but obviously cigna has a lot of insights into just general.

General inflation dynamics across all of your business and so we're interested and in terms of what youre seeing and the first quarter as it relates to whether you are actually seeing inflation rising and yet and how you're thinking about the outlook for that over the course of the year. Thanks.

Hey, Scott Good morning, it's David I'm going to ask Brian just to give you a little color on a really strong sustained revenue performance and then I'll come back and see.

To address your inflation question.

Yeah, Good morning, Scott.

We are pleased with the <unk>.

Q1 performance on revenue as well as the full year increased and our guidance of other leased $166 billion. You should think of the majority of that increase coming from the other north segment, but importantly, we're also seeing strength within U S. Medical So I would think of most of it from ever north and a bit of an uptick and U S medical as well David back to you on the inflation question.

Sure Scott and the inflation question I'm going to come at it two ways first through the core visibility of our business and then more broadly for those we serve.

Thus far within our business, we do not see large trajectory change relative to what I would call cost of goods sold inflationary pressure and Theres always some make no doubt about it there is always some but through ongoing innovation ongoing productivity ongoing value based collaboration broadly speaking.

And would not cause a calling a large sea change from that standpoint.

Beyond that and the broader economy, whether we look at it through a U S lens or pockets of the markets outside the United States. There is clearly a warming up there as an indisputable warming up and the economy and there is a clearly warming up of inflationary indicators, but none of which have triggered across a threshold to suggest that any one industry.

For some unique outliers.

Any any kind of orange is going to read threshold levels of inflation, but the robustness and the economy and some of the underlying cost drivers and some subsectors are clearly beginning to elevate and I think have a lot of industry leaders watching to ensure that any movement and curves and movement and cost curves could be anticipated.

These are eradicated through pricing actions like CPG companies that are being intensely discussed.

Cost pressures and some sub sectors of.

The technology ecosystem, where the chip industry is on a pattern relative to supply and demand from that standpoint, but broadly speaking I would say again nothing affecting our space over the immediate term horizon from an inflationary standpoint.

Okay. Thanks.

Thank you Mr. Fidel our next question comes from Mr. Matthew Borsch with BMO capital markets you May ask your question.

Okay.

Hi, Thank you I, let me ask a question about Medicare advantage and the outlook.

And how do you think it's going to work with the rates I know I'm asking about 2023, and I know, that's a light year away by.

My question really is Medicare advantage.

And benefited from.

The lower expenses.

2020.

And I'm wondering how you think that's going to roll through the rate calculation because.

Right now CMS has.

2020 down 8% per capita and then increasing about 11% and.

And this year and and next year and and so I guess my question is do you think that kind of trajectory is likely from medical costs and then if you.

Can't comment on it how you think that might walk into the 2023 right.

Matthew.

A pretty complex.

Rubik's Cube, you put on the table thoughtful but complex.

I think as you are.

And as I take your question and process. Your question. If we look at the 2020 to 2021 environment.

Clearly the posture of CMS recognize the COVID-19 dislocation.

Recognize that dislocation for examples implication on risk adjusters sought to in their own methodology.

Seek to provide some offset to that relative to their rates heading environment as well as our guidance relative to delivery system reimbursement and set themselves up from what I would say is a pretty fluid and complex environment over the ensuing couple of years ahead.

And I would expect the next couple of year cycle to be a little non traditional from that standpoint, given the need to adjust the various moving parts that result, and a net rates hitting environment history would tell us that the result of all of the above plus or minus a point or two large.

<unk> gets the program to a balanced sustainable outcome.

And looking forward I would expect that because the Medicare advantage program continues to deliver outstanding value as you know for seniors and hence the tremendous support from a senior standpoint, as well as overall clinical quality and affordability of which through the bonus programs and the reimbursement programs and the federal government's budget.

Actually benefits from so I would expect it to be able to be balanced with that but a little bit more lumpy than it has been in the past and I think this year's risk adjuster true ups will be really mission critical in terms of how CMS sees the industry recapturing a little bit more of the information that they deem necessary to get the risk.

And then low factor that into the forward looking 2023, REIT environment stay tuned for more.

Okay. Good thank you.

Thank you Mr. Borsch. Your next question comes from MS. Ms. Ricky Goldwasser with Morgan Stanley You May ask your question.

Yes, hi, good morning, Thank you for taking my question.

One follow up David you talked about some of the return of.

Some of the.

Diagnostic procedures.

And in line with with with for pandemic.

Are you clearly acuity is the big uncertainty for the rest of the year, but now that you're starting to have this data is and debate and start talking to come back.

Poor preventive care.

Are you seeing any changes and acuity. That's one and then my second question goes back to M&A and investments clearly a very big focus and part of your growth strategy. So what metric do you use when you evaluate buy versus.

Versus a partner or a build decision.

Ricky Good morning, It's David let me take both of your questions.

And your first question.

To be very clear we have seen.

Consistent.

Strong utilization of preventative care services and.

And notably what I called out is for example, and the first quarter of 2021.

Broadly speaking preventative care services inclusive of mammography colonoscopy is childhood immunization cervical cancer screening plus or minus and the commercial portfolio of business approximate pre pandemic levels. We think that's a very good thing.

Let me underscore it is a very good thing and something that our team has worked tirelessly to try to effectuate elevating those levels, we see that performance against a national dataset that suggest the utilization of those preventative care services are down versus pre pandemic levels, 10% to 15% of our book of business there.

As a predictor than to the future, we see that as and mitigate for an elevation of acuity.

All other things remaining equal because youre consistently identifying and earlier stage through the preventative diagnostics or the preventative services equally as important as I noted in my prepared remarks are for example, within our <unk> portfolio and within our EB and North pharmacy portfolio for those customers being served by our mail order and we've actually seen.

And get even further elevation of medication adherence and that's really important from the chronic population to avoid spikes and acuity moving forward whether it's.

And for diabetic COPD and asthma attic or other patients from that standpoint so.

Broadly speaking, we're working tirelessly to get the right clinical quality and services to be consumed.

And supported with the clinical resources, we have to avert spikes and acuity going forward and therefore, we don't expect the and large spike and acuity.

And I'll look forward basis, given the strong preventative medication compliance as it relates to your M&A question. There is not a simple way to answer your question importantly, though to frame, we look at all either growth or expansion of capability opportunities through buy and build a life frameworks.

And we relentlessly go through a buy build a life framework. So for example today within our <unk> benefit portfolio, we're organically building out additional post acute care capabilities after evaluating buying further partnering or in sourcing those capabilities. We typically will look at that three <unk> right to win.

And our strategic positioning and and economic framework. So you'll look at it through a variety of frameworks, it's not a simple economic hurdle rate. Your question Didnt, even further and it was a single measure, but it's not a single economic hurdle rate, it's through a right to win.

Size and trajectory of the market.

The resources with which to pursue whether it's organic build collaboration through a partnership or from an acquisitive standpoint and obviously.

And economic hurdle rates come into play, which we do don't discuss publicly those new proprietary but you would imagine we're quite disciplined in terms of our return to capital thresholds break you hope that helps.

Thank you.

Thank you Ms. Goldwasser. Our next question comes from Mr. Steven Valiquette with Barclays. Your line is open you may ask your question.

Thanks, and good morning, everyone. So there was a question earlier on inflation and I actually have a question on deflation I just wanted to check the box and get your quick thoughts on generic pricing as there's been some mixed signals and.

The level of generic deflation and the first quarter.

And I was curious was there any evidence of accelerated deflation that may have played a role and better cost of goods sold and your mill and our operations within EVAR and North and also you mentioned the effective supply chain initiatives again this quarter just curious what that means for 'twenty one in particular, whether.

Is that just code for better drug purchasing and procurement this year or are there other factors within the clinical and supply chain initiatives driving better results.

Good morning, David too.

Two part question first.

There is no doubt there are some pockets of generic deflation.

Within the within the pricing environment, what is and the cost environment.

Importantly, they are inline with our expectations. So it's not a deviant or driver for deviation for us in any way shape or form.

And in terms of our broad portfolio, but unequivocally there are some pockets of deflation there in line with our expectations as it relates to the supply chain activity.

And I would ask you just to continue to think about supply chain initiatives as being and inherent strength within the overall portfolio through a variety of lenders whether its collaboration on the medical side of the equation.

The the traditional supply chain activity the value based supply chain activity et cetera, and.

We have a continuous drive to.

To improve value.

Albeit to partner as we go through the process and as we get into some more of the complex dimensions of the higher cost drugs and medications, we think theres further opportunity through the supply chain activity around value based care relationships aligned and aligned incentive relationships more specifically with the manufacturers and with ourselves on a go forward.

Basis, so I wouldn't call out any unique driver.

More importantly, it's a continuous improvement part of our portfolio and its and underlying strength of our portfolio and lastly, our sustained growth supports that and a very positively.

Got it okay. Thanks.

Thank you Mr. Valiquette, our last question comes from Mr. David Windley with Jefferies. You May ask your question.

Hi, Good morning, Thanks for squeezing me in I wanted to come back to the telemedicine topic and David thinking about.

Your capital light strategy relative to providers and network and one.

Wondering if ever north and and Cigna has an opportunity to leverage MD life and to your collaborative care.

Partnerships or otherwise into partner networks as opposed to own networks and your case.

And then Alternatively do you have an opportunity to use MD life to feed.

<unk> volume or refer volume catch volume excuse me, so to speak and parts of other parts of ever north specialty pharmacy email or delivery things things like that by owning and controlling telemedicine through MD life.

Good morning.

The question so two fold to.

And so your first part of your question and the simple answer is yes.

So it would be really clear again, we see the opportunity obviously from a.

Standalone, if you will fulfillment and delivery of the service, but also an opportunity in collaboration and alignment as a panel extender for high performing collaborative accountable care relationships and those conversations are dynamic and underway.

The second part of your question very thoughtful framework and appreciate it if we come back and think about first and foremost our ability to further improve affordability you may recall at our Investor day, we talked about.

And for major ways in which we further improve affordability off of our strong overall cost environment. Today. One is to further increase the percentage of utilization that takes place and the highest performing clinical settings.

Hey, physicians or facilities second is to work to reduce the cost of drugs. Further third is to effectively leverage alternative sites of care. For example, the difference between a knee replacement that is inpatient versus outpatient is about a third less and cost and we see a massive shift I think physical side of care.

Sure, it's similar and virtual side of care and then fourth the ability to further coordinate a fragment and system, specifically and the areas of medical and behavioral so back to your question.

And the evolution of our telemedicine and virtual care and capability present opportunities to contribute to a variety of these areas to.

To help to support individual customers and patients accessing higher cost of health care specialists or delivery system partners, helping to drive further leverage relative to the pharmaceutical equation in terms of medication compliance or alternative lower cost medications and the ability to merge or coordinate services.

<unk> behavioral and pharmacy behavioral and medical.

Being in that quarterback position with a customer a patient from that standpoint, so we see it as being complementary to a variety of those initiatives and we see it being both complementary to your first question proprietary driving on and our own and and collaborations and panel extended for high performing health care professional partners. Thanks for the question, yes. Thank you.

Thank you Mr. Windley I will now turn the call back over to David <unk> for closing remarks.

First thanks for your time today, we really appreciate spending time to discuss our Cigna results and our outlook I just want to wrap up our call with a few headlines first and foremost we delivered strong financial performance during the quarter as we continue to navigate through what is undoubtedly a dynamic environment and we work to meet and balance the needs of all of our stakeholders as we ask this champ.

And as for health care that is affordable predictable and simple.

In addition, our strong foundation driven by our growth framework and track record of success gives us confidence and our ability to achieve our increased EPS outlook for 2021 of $20 20.

And as well as position us well for ongoing long term average annual revenue growth rate of six 8% and our 10% to 13% average annual adjusted EPS growth rate, all while continuing to play and pay an attractive dividend.

And again, we thank you for joining our call and we look forward to our future conversations.

Ladies and gentlemen, this concludes cigna's first quarter 2021 results with you.

And the Investor relations will be available to respond to additional questions. Shortly.

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