Q2 2021 Cigna Corp Earnings Call
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Please standby for today's conference will begin momentarily. Thank you.
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Right.
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Okay.
Yeah.
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Ladies and gentlemen, thank you for standing by for Cigna second quarter 2021 results review.
At this 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 question and answer session is being recorded.
And we'll begin by turning the conference over to MS. Alexis Jones. Please go ahead Ms Jones.
So for adults and disclosures.
Regarding our results and the second quarter, we recorded and after tax special item charge of $9 million or 3 per share related to debt extinguishment costs incurred during the period.
We also recorded and after tax special item charge of $14 million or for per share for integration and transaction related costs.
As described and stays earnings release special items are excluded from adjusted income from operations and adjusted revenues and our discussion of financial results and.
Additionally, please note that when we make prospective comments regarding financial performance, including our full year 2021 outlook. We will do saw and a basis that includes the potential impact of future share repurchases and anticipated 2021 dividends and excludes the impact of any business combination or divestitures that may occur after today with that I will turn the.
Over to David.
Thanks for losses and.
Thank you to everyone for joining us and today's call.
And I'm just with a few minutes talk to you about the current environment and the forces for the shape for Ya.
And the strength and durable nature of our model that enables us to capitalize and opportunities and continue to grow even the most disruptive conditions.
And and how the strength and durability is fueling our short and long term success.
Then Brian was for more details about a second quarter results as Roosevelt and for the rest of the year and it will take your questions. So let's jump in.
During the quarter, we delivered adjusted revenue $43 billion and adjusted EPS of $5.24 per share all will we continue to drive balanced capital deployment as we execute on M&A share repurchase and reportedly different plan.
And we achieved these results and a fluid and challenging environment.
As we could do to execute our strategy, we are confident and our ability to navigate these dynamic conditions are portfolio with 3 growth platforms and enables us to create value for our clients and customers and drive for Steve business growth.
During the quarter the strength of our <unk> business was clearly a stand though we are seeing high demand for health services programs, and we continue to invest and broadening our service offerings as well as our reach.
Are sustained success validates our ability to be a trusted part group 2 weeks for customers and clients as they managed many of the most challenging aspects of health care today.
We do this by leveraging our portfolio and that includes pharmacy solutions and if it management solutions care solutions and intelligent solutions.
<unk> is helping to improve access to care keep costs down and deliver better outcomes as we serve our clients patients and customers.
And another quarter revenue and strong revenue and earnings growth reinforces at our customers and clients value of these capabilities.
And Signet medical we did see elevated medical cost pressure and the quarter as costs associated with direct COVID-19 care and the broader ramp up and utilization levels exceeded our projections.
Within this challenging environment, we continue to take proactive steps to each of our customers have access to the care. They need. This includes the elevated mental health services needed. During these unprecedented times as well as continuing to work with our customers and patients to help navigate them to optimal sites of care.
During the quarter, we achieved customer growth and Cigna medical and both are used commercial and government business and we continue to be on track for medical customer growth of at least 350000 customers and 2021.
Brian will share additional perspective on our results and outlook and his comments overall, our performance, which is strong through the first half of the year reflects the resiliency of our business and the balanced profile within our organization.
With our focus on driving performance during the remainder of the year, it's imperative that we understand and account for the challenges our customers and clients will face as well as and continued evolution and the health care landscape.
And and macro level. The environment is marked by ongoing uncertainty for business governments communities around the World for example, Covid vaccination levels and brought welcome relief for millions you have only about half of the U S is fully vaccinated and that percentage is much lower for the world's population.
With the spread of and Morgan takes Delta very Covid infections, and hospitalizations are on the rise and some regions, bringing renewed attention to travel restrictions and math mandates.
We see the economic recovery will positive has been uneven and very amongst industries as companies continue to cope with supply chain disruption emerging inflationary pressure and various issues impacting the workforce.
More broadly from a health perspective, federal and state policymakers continue to be actively engaged and as we've previously discussed we continue to see 3 primary forces of change shaping to health care landscape today and and his future.
Specifically pharmacological innovation, including specialty Pharmaceuticals gene therapies evolved oncology medications vaccines and acceleration and Biosimilars second.
Second the recognition of the link between mental health and physical health continues to grow, especially accelerated and this COVID-19 environment and third the rides and virtual care and other alternative access to care models are rapidly changing.
Together these macro dynamics for profoundly influencing buying behaviors and service innovation and healthcare.
Now with respect to clients, we are senior renewed commitment of employer clients to providing healthcare benefits vital to helping them to both attract and retain talent as well as increased productivity by maintaining a healthy workforce. This includes for example, adopting alternative side of care programs and access programs.
We've seen intensified need for affordability across all of our clients, including pharmacy services as demand searches for high price breakthrough drug therapies.
We see a desire for more consultative solution based services as many clients are confronting the convergence of social physical and mental health issues and ways they have not experienced before.
With respect to the individual customers and patients utilizing our service we see that they are increasingly valuing the employee based service models, they're benefiting from support services and help them tend to their emotional wellbeing and they have growing demand for coordination of care, both and COVID-19 in non COVID-19 events.
Against this backdrop, we are delivering differentiated value for the benefit of our customers and clients with our capabilities that address and they are emerging and evolving needs for.
For example, we have had a strong focus on providing virtual services broadening networks as well according to clinical programs.
And Ah pharmacy solutions, we've been answering the call for greater affordability as we continue to see the emergence of new and expensive pharmacological advancements.
Everywhere, it's recent expansion of our industry, 1 comprehensive weight management program illustrates the benefits of a more coordinated approach.
Patient can now receive treatment with would go be a promising new therapy for obesity and other weight management medications and.
And now with empty life fully operational within our Avenue with business and the life physicians along with other Avenue of clinicians are available to help patients.
This program expansion also includes personalized support services from health coaches peer support groups and curated digital apps. This.
This weight management effort is the latest addition to our Avenue suite of safeguard our ex programs as for impacting 2020 patients enrolled and safeguard our active save more than 6 billion and aggregate.
Inevitably care solutions, we've experienced an increase in demand for our behavior hold solutions from customers and clients as well and.
And the past year, and a half and has brought heightened stress and other personal challenges and we see many more people reaching out for help and services.
Clients now more broadly understand that someone with a chronic condition is more likely to have a mental health or substance abuse related illness and individuals are feeling the additional mental and physical challenges associated with the pandemic.
With our market, leading behavioral health capabilities, we are driving more value to our <unk> and signal medical clients and customers by providing the tools and services they need to address for mental wellbeing and deliver better sustained longterm outcomes.
Within our seeing the medical platform and use commercial and we are working closely with their employer clients and provide are integrated suite of solutions designed to make their workforce healthier and more productive.
We know that employees, receiving health and wellbeing benefits for their employers are less likely to miss work because of poor health.
A recent study shows a significant impact of the 70 fewer percent days Mrs over a year.
Where they're integrated approach, we strive to bring the right mix of solutions that reduced the workforce challenges many of our clients are facing and helping to support them to engage and retain their employees.
And affordability is and remains a primary focus across our entire portfolio as it is and signal medical.
Our clients continue to manage through and incredibly dynamic environment for their business and.
And is becoming even more important that they could count and us with greater affordability for the health care programs.
New and expensive pharmacological advancements are predominant contributed to this challenge and we've been a leader here, putting these treatments and the hand of those who need and Adam and more affordable price for example, remicade and treatment for chronic conditions, such as Crohn's disease, and rheumatoid arthritis, while life changing can also imposed significant financial burdens.
1 year of Remicade infusion costs about $30000 on average and as much as $70000 depending on side of care.
We recently launched Cigna pharmacy program that shares for prescription drug savings directly with patients who switch from Remicade to 1 of the approved biosimilars.
More than 20% of eligible patients and consultation with their provider have already switched to lower cost preferred alternative medications.
This program has an immediate benefit the clients, who save at least 10% and the cost of the drug.
And we've taken and leadership position here by supporting our patients with a 500 dollar incentive. This is a great example of aligning interests.
Over the longer term, we can drive even greater impact is biosimilars, becoming more prevalent part and the United States as helping us further improve affordability.
And and sing the medical we are actively working towards improving affordability by ensuring that our customers continue to have access to the care they need and optimize the longterm health for example, and Arizona, We conducted a highly targeted outreach program to our customers who are at high risk due to chronic condition, yet we have not been vaccinated the and.
<unk> results are encouraging and we're seeing positive increase and vaccination rates amongst targeted individuals we are not taking the learnings from that pilot and to other locations across the United States with a particular focus on increasing vaccination rates amongst those and most need.
This broad range of examples illustrates how are comprehensive and strategic approach to help and our clients and customers address or most and pressing health needs help us going forward and and this is dynamic environment. We will continue to expand the services, we offer our clients and customers and therefore, we see many more opportunities to create value for both our clients and cussed.
<unk> and as a result for your shareholders.
It is clear that the strength of our medical and pharmacy offerings combined with our strategic agility has enabled us to continue to capture growth, even and the most dynamic environment.
By delivering differentiator value.
By partnering and relentlessly innovating and by expanding our addressable markets as we brought and Ah reached new geographies and through the introduction of abroad and sweeter solutions.
When you combine this cabbeling growth potential along with our significant and operating cash flow generated by our service based capitalize model, we have confidence and our ability to meet our long term targets by achieving differentiated results, which include average annual revenue growth of 6.8% average annual EPS growth of 10% to 13% and continued to pay and.
Attracted dividend oil producing cumulative operating cash flow of approximately $50 billion through 2025.
Relative to 2021 remain committed to delivering full year EPS of at least $20.20.
Now to briefly summarize first we recognize and an environment like this and so challenging we know the growth doesn't come easily it has to be earned each and every day.
We have a proven track record of delivering differentiated value innovating and partnering and smartly expanding our addressable market to fuel sustained long term growth, even and disrupted environment.
And our company is attractive sustainable growth opportunities across our 3 well positioned growth platforms, and importantly, the strategic and capital flexibility to take advantage of opportunities with that I'll turn the call over to Brian.
Thanks, David Good morning, everyone.
Today, I'll review key aspects of Cigna second quarter results, including the ongoing impact of COVID-19 on our business and.
And I will discuss our updated outlook for the full year.
Key consolidated financial highlights for second quarter of 2021 include adjusted revenue growth of 10% to $43.1 billion.
Adjusted earnings of $1.8 billion after tax.
And adjusted earnings per share for $5.24.
Results and the second quarter reflect strong top line growth with solid contributions across our businesses.
Before I go into segments specific results and.
I'd like to spend a couple of minutes addressing the medical cost environment, we are experiencing.
Let me be clear.
Our second quarter results and our full year outlook have been adversely impacted by elevated claim costs compared to our prior expectations.
Despite this pressure are diversified portfolio of businesses and multiple earnings levers drove second quarter adjusted earnings that exceeded our expectations at the enterprise level.
Specifically within the second quarter.
Ongoing direct COVID-19 costs were above our expectations and.
And non Covid utilization returned more rapidly than we anticipated.
During my comments today, and and our Q&A, David and I will use the term baseline to refer to 2019 or prepandemic claim costs that will be trended forward for 2 years for 2021.
To provide you with an estimate for what 2021 claim costs would have been and the absence of COVID-19.
The return of non Covid utilization is very by both geography and customer group for.
For example, we saw the following within the second quarter.
And use commercial non COVID-19 costs were back to baseline level.
While and Medicare advantage non COVID-19 costs accelerated from first quarter levels, but remained slightly below baseline for the second quarter.
We expect to continue seeing elevated claim costs compared to other original expectations for the balance of 2021 within us medical.
However, the strength of our diversified portfolio of businesses and are multiple earnings levers give us the confidence to reaffirm our full year EPS outlook of at least $20.20.
Additionally, as we look forward to 2022, while we recognize the dynamic environment in which we operate we expect another year of attractive growth driven by all 3 of our growth platforms.
Now I'd like to turn to our segment level results and then provide an update on the details of our outlook as well as our capital positioning.
Regarding our segments first comment on other north.
Second quarter 2021, adjusted revenues grew 14% for $32 and $6 billion.
And adjusted pretax earnings grew 13% to $1.4 billion.
Compared to the second quarter of 2020.
Ever North strong results from the quarter were driven by ongoing organic growth driving both top and bottom line contributions and.
And continued progress on a range of affordability initiatives for the benefit for our customers and clients.
And the quarter. We also continued to make significant investments to support for ongoing growth and.
Including our virtual care platform and technology capabilities.
Are adjusted Pharmacy script volume was $410 million during the quarter, a 13% increase over second quarter 2020, driven.
Driven by strong organic growth as well as the impact of vaccine volume and a quarter.
Overall ever North delivered another strong quarter.
Continuing to create differentiated value for clients and customers, while driving better than expected top and bottom line contribution to the enterprise.
Turning to use medical second quarter adjusted revenues were $10.5 billion.
And adjusted pretax earnings were 1 billion.
Overall, our second quarter U S medical earnings reflected the impact of elevated claim costs offset by favorability from operating expenses non-recurring items and net investment income.
Regarding our medical costs, we entered the second quarter expecting a continued decline and COVID-19 related claim costs and a gradual return and broader care consumption patterns toward more normalised levels.
While these directional patterns did transpire as I noted earlier, both direct COVID-19 cost and broader utilization levels were above our expectations for the second quarter.
Direct COVID-19 costs were highest and April.
Decreasing throughout the second quarter, while non COVID-19 costs approximated baseline levels for the quarter.
Both use commercial and U S government total medical costs.
Reflecting the combined impact of direct COVID-19, and non COVID-19 costs.
Or above baseline for the quarter.
With U S. Commercial further above baseline is those customers returned to utilize the healthcare system and a slightly higher level.
Given these developments the second quarter medical care ratio was above our expectation.
We now expect that the level of non COVID-19 costs, we incurred towards the end of the second quarter will persist for the balance of the year.
This coupled with the ongoing direct COVID-19 related costs, we expect to incur has led us to raise our guidance for the full year 2021 medical care ratio.
Turning to membership we ended the quarter with 17 million total medical customer and increase of 249000 customers sequentially.
The customer growth and the quarter was largely driven by new wins and middle market and growth and the individual business through the extended special enrollment periods supported by continued strong retention across our portfolio.
All in for you S. Medical we continued driving customer growth and expanding services, while remaining focused on delivering value and supporting our customers and clients and a dynamic environment.
And our international markets business second quarter, adjusted revenues were $1.6 billion and adjusted pretax earnings for $234 million.
These results were approximately in line with our expectations.
Corporate and other operations delivered a second quarter adjusted loss of $331 million.
Overall, we continue to deliver value for all of our stakeholders with strong growth reflecting contributions across our businesses.
Led by outperformance and ever and or.
The diversified portfolio Cigna businesses, and the multiple avenues to create and ultimately capture value and allowed us to continue meeting our enterprise commitments, despite ongoing uncertainty and the marketplace.
Now turning to our updated outlook for full year 2021.
We are reaffirming our adjusted earnings per share guidance for full year 2021, other at least $20.20.
Before I walk through the outlook by segment I'd like to frame the key drivers underlying this outlook.
The updated components include and increase and expected earnings from ever North.
A decrease and expected earnings from Us medical driven by a higher medical care ratio.
A more favorable outlook for operating expenses.
And other contributions that are net favorable for the year.
Additionally, we now expect full year 2021 consolidated adjusted revenues of at least $170 billion representing growth of at least 9% from 2020, when excluding the divestiture of our group disability and life business.
Within our outlook, we now expect a full year COVID-19 related headwind of approximately $2 and 50 per share.
Primarily impacting R U S medical business this.
This includes approximately 80% related to impacts on the medical care ratio.
And approximately 20% related to lower customer volumes due to economy driven enrollment dynamics.
Finally, we now expect and adjusted SG&A ratio of approximately 7.5%.
And improvement relative to our prior outlook.
I will now discuss our 2021 and I'll look for our segments.
For ever North we now expect full year 2021, and adjusted earnings of at least $5.8 billion representing growth of at least 8% over 2020.
Reflecting the significant value, we create for our customers and clients.
For US medical we now expect full year 2021, adjusted earnings of at least $3.5 billion.
Underlying this updated outlook, we now expect the 2021 medical care ratio to be and the range of 83% and 84% driven by our updated medical cost expectations for the second half of 2021 as I previously discussed.
Regarding total medical customers, we continue to expect 2021 growth of at least 350000 customers.
All in for full year 2021, we continue to expect adjusted earnings per share of at least $20.20.
With the underlying drivers being an increase and expected earnings from ever nor.
A decrease and expected earnings from U S medical driven by a higher medical care ratio.
A more favorable outlook for operating expenses and other contributions that are net favorable for the year.
Now moving to our 2021 capital management position and outlook.
And we expect our business is to continue to drive strong cash flows and returns on capital even as we continue reinvesting to support long term growth and innovation.
I would highlight that we had some timing related items, which impacted cash flow from operations during the second quarter for.
For a full year 2021, we continue to expect at least $7.5 billion of cash flow from operations for.
Reflecting the strong capital efficiency of our well performing businesses.
Year to date as of August 4th 2021, we have repurchased about 18 million shares for about $4.1 billion.
And we now expect full year 2021 weighted average shares of $344 million to 345 million shares.
On July 28th we declared a 1 dollar per share dividend payable on September 23rd to shareholders of record as of September 8th.
Our balance sheet and cash flow outlook remains strong benefiting from our highly efficient service based orientation that drive strategic flexibility strong margins and attractive returns on capital.
So now to recap.
Results from the second quarter reflects strong top line growth with contributions across our businesses.
Additionally, we acknowledged that the environment remains fluid as evidenced by the impact of elevated medical costs and the second quarter and on our outlook for the remainder of the year EBIT with this additional pressure are diversified portfolio and multiple earnings levers have positioned us to achieve our outlook for full year 2021, all while continuing to <unk>.
Support our customers clients and coworkers, we continue to expect 2021 full year adjusted earnings of at least $20.20 per share and have continued confidence and delivering our long term EPS growth rate that will average and to 13% per year.
With that we'll 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 1 and your Touchtone zone and such.
And 1 ask for your question and ahead of you you can remove yourself from the queue by pressing star too.
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Finally, we ask that you. Please limit yourself to 1 question to allow sufficient time for questions and those remaining in the queue.
1 moment please for our first question.
Our first question comes from Mister <unk> and Vice with Credit Suisse. You May ask your question.
Hi, everybody push it all day.
There.
On the increased outlook for.
And the Ah medical cost ratio and what you are giving us relatives, COVID-19 and non clothes and it looks like.
And that was right about 2 thirds of the increased and MLR would be related to the COVID-19.
Cause given the 125 now is 250 EPS Edwin and.
I guess that would mean the remaining is the non Pope I don't want to just confirm that and with the COVID-19 clause be spread relatively evenly over the course of the year.
And the <unk> Q for and then will that be Palmer tailwind for 22 is openly that reverses.
Good morning, Ha's, Brian.
2 different questions and there I'll try to give you the the overall picture.
So as I said my my prepared comments, there, we know anticipate about $2.50 or earnings per share headwind in 2021 associated with Covid and of that approximately 80% impacts for medical care ratio and approximately 20% is related to enrollment levels being being depressed care and 2010.
1 focusing on the $2 per share.
Covid related headwind its impact and the medical care ratio. There is a few components underlying that so 1 would be the impact of Medicare advantage risk adjustor.
Revenue headwinds here and 2021, the other component of it is the level of total cost to care that we're experiencing and 2021 compared to our prior expectation, which includes both COVID-19 direct costs and it also includes Noncoverage costs and then returned earlier than we anticipated during during the year here.
And so I wouldn't necessarily parse the 2 thirds 1 third the way that you did but rather look at the total cost picture and more elevated in comparison to what we had previously expected COVID-19 costs were highest for us and the first quarter.
Within the second quarter, they were higher and April than they were and May and June and we expect for the balance of the year that Kobe costs will run at a lower level and they did and the first half of the year. So that's what's embedded and our outlook and as I said.
The non COVID-19 utilization, we're anticipating to run and approximately baseline levels for the back half of the year that plus the COVID-19 costs, we expect to incur leads us to all and cost levels slightly above our baseline for the back half of 2021 and as it relates to what we expect to unwind heading into 2022.
And if you parse apart the components for that $2 and I was just making reference to the Medicare advantage risk adjusted headwind, we expect to fully recover and 2022 so.
Between our bid strategies and the operational activities, we're seeing we are full.
Full confidence that will fully recover that component the components related to total cost to care, we expect to recover a portion of that and 2022 and so a portion of that will come through pricing actions a portion of that will come through clinical management activities and of course, and a that we expect to be a little bit of natural abatement and aggregated cost between 2021 and 2022.
So we are currently estimating that about half of that $2 per share headwind will come back and 2022 and the form of incremental earnings So think about 1 of.
Of the $2 and 57, EPS headwind returning into the P&L and 2022.
Okay. Thanks.
Thank you Mister Rice. Our next question comes from Mister Ralph to Kobe with City. Your line is helping you may ask your question.
Thanks, Good morning, just stay and on that topic I think last quarter. You would also suggested that growth would be at or above the high end in 2022, I think all of that 2020 baseline.
I guess is that still the case so the way to think about it is sort of at or above the high and and then add back that dollar that you just said bye. Thanks.
Ralph commodity and David.
And so as we think about 2022 clearly early to give you a detailed guidance, but let me try to walk through the moving parts as we think about 22 underlying our outlook will be strong base earnings growth.
Contributions from ongoing capital deployment and the recovery of some of the headwind that Brian and articulated there'll be and offset to that partially offsetting that will be.
The lack of some of the Nonrun rateable items were realizing and our 2021.
At least $20 and.
And 2000 and EPS outlook. So when you take it altogether, we expect 2022 will be in other strong year for us as it relates to growth rates. The way I'd ask you to think about that is.
First off I take at least $20.20 when we adjust that for the non renewable items, we would expect to grow at the high end of our 10% to 13% range and other way of thinking about it if you take at least $20 and 20.
Outlook for 2020, we would expect to grow at least 10% on that so and net new item and with the Nonrun rateable items that will have and 2022, but and attractive growth rate on either parameter of as we expect to have another strong year for 2022.
Thank you Mr. Chubby. Our next question comes from Mister I'm happy for Us with BMO capital markets and your likeness up and you may ask for your question.
Yes. Thank you I was hoping you could maybe just sky talk a little bit about individual business.
We can been volatile for some companies.
The extent to which you saw that and how much that that may or may not be and stuff.
Winter.
Best for you morning and statements from.
From the individual business portfolio as you know, we've been active and that marketplace since it's inception and.
After a few years of tests and learn and the marketplace stabilizing itself, we saw it and began to a more systematically expand our growth and that carries into the current year as it relates to the performance and the current year.
Some attractive growth in that business, both underlying fundamental growth as well as growth contribution from the SEPA period and as it relates to the quarter. Your question on performance and ask you to think about the underlying and what we're seeing the underlying performance of that book of business is similar to the trends and impacted Brian articulated before so.
We see and uptake.
In utilization within that book of business more approximating from a non COVID-19 standpoint baseline activity with some additional utilization on the COVID-19 side of the equation and lastly, our early look at the Sep Special Loma period. Additional lives. Those lives are performing similar to other special enrollment period lives.
We've observed before so some of the MLR that we're seeing across our broader portfolio is showing through and the individual business, but not all proportioned and either way from the overall behavior of that book.
Okay. Thank you.
Thank you Mr. Bush. Our next question comes from Mister Tests, and Lake with Wolf Research and May I ask your question.
Thanks, Good morning, 1 or 2.
Try to squeeze and a question on a follow up for years. So first you talked about you.
Being a Bob being quad in terms of non COVID-19 costs and use commercial I just want to ask how all above baseline burst and about 100 per cent and did you say you're expected to return down to 100 or do you expect me to continue with that level and in the backyard for the year and then my follow up with for Ralph Plaisted.
You're I just want to make sure we understand 2022 year or are you, saying does and a grow.
10% of 2020.
Or $20.20.
Plus a dollar for the 10% the total number and and David you keep talking to do for non-recurring costs could you just delineate what those are and how what's driving them and and how big the non-recurring items are for this year.
Good morning, just and it's Brian I'll start and then as David to the pile on here, so and the first part of your question there if I if I misspoke I apologize.
For the second quarter or non COVID-19 utilization or commercial was essentially at baseline.
That plus the direct COVID-19 related costs, we incurred put the total cost picture above baseline, but the non COVID-19 utilization was at baseline.
For the back half of the year within our commercial business, we're expecting that non COVID-19 utilization will continue to run at baseline and we will incur direct COVID-19 related costs, but at a lower level and what we saw and the first half of the year, So hopefully that clarifies a bit the commentary around commercial and the assumptions on the back.
Have relative to the non-recurring items.
You asked about you think about those is largely being SG&A oriented.
With the bulk of it being associated with litigation from from prior years, where we had some favorable developments and the quarter.
That allowed us to recognize some gains there so.
Boxing not just Directionally should think of it is about $150 million after tax so think of it and the range of 45.50.
Earnings per share in terms of the favorable benefits that we've seen here in and 2021, David you want to clarify and the 2022 commentary church adjusted to Crosswalk again for.
First from prior dialogue.
As you recall, we would have talked about face earnings capital deployment and recovery of Covid headwind is contributor to our 2022 expectations for ourselves and that remains.
The base performance the capital deployment and recovery of Covid headwind is Brian articulated to Covid headwind that opportunity is a little greater now for 2022.
And it was a quarter of ago from that perspective, the net new items, what Brian walk through which are the non recurring items and he gave your approximate order of magnitude. So again to repeat to the specific part of your question.
We believe today, if you take the at least $20.20.
That we will deliver for this year our growth rate will be at least 10%. We believe if you take the at least $20.20 and adjusted for those non-recurring items that we reference that Brian just reference the growth rate will approximate 13% herself. So those are the moving parts relative to our expectations for 2022 on either Quebec.
<unk> and other year for stronger attracted balanced performance.
And David.
Be clear of that includes the dollar.
So you're growing 10%.
With the dollar.
No. It includes just and the dollar so let's come back and previously we would have talked about baseline earnings capital deployment and the recovery of headway and that's what took us to the high end and arrange for.
Versus within the range.
Currently the expectation and includes that but the dollar is somewhat offset by the lack of the non non relatable items next year, so and and all and basis will grow in the 10% to 13% range, depending on the convention you use either to $20.20.
We will grow at least 10% all in.
Or if you look at it excluding the non-recurring items that.
Brian just articulated about 50 cents will will grow at about 13% all in.
Thank you Mr. Lee.
And come to me and Miss Lisa Gal with J P. Morgan you May ask your question.
Great. Thanks for and that's in good morning, and.
David and I'm, just wondering if I can ask about the PVM.
It's really strong and the quarter first can you talk about that 2022, selling season, and how that plays and and to that the outlet's debt that you are talking about right now and then secondly can you tell us that the number of vaccines that are included in that script count just wanted to get a better idea of what you're seeing and an overall script county bleeding vaccines.
Good morning, Lisa I'll talk about the growth outlook and the environment and then I'll ask Brian to come back and and talk about the script count and specifically the vaccine.
First we're very pleased for the performance of the ever North portfolio.
The durable nature of that and and environment and disruption provide some diversification was and the portfolio and the service delivery for our clients health plan clients corporate clients. Several clients remains quite strong as it relates to the underlying growth rate our growth and 2021 is outstanding for that portfolio and you see.
The expected growth for 2022 as we discussed previously we've known for some time that we have.
Lack of renewal of 2 health plan clients.
And we knew that many of them without we will grow again, and 2022 and and attractive right. We also recognize that given our strong performance we've been able to maintain.
Appropriate pricing discipline.
As we looked at the 2022 environment, so taken as a whole and active dynamic year for 2022, we would expect and other strong year of retention, even acknowledging those helpline clients and the mid nineties and we would expect strong underlying growth of the Avenue and the portfolio, Brian and I'll ask you to talk about the vaccine volumes within our scripts for the quarter.
Morning, Lisa so and the second quarter, we fulfilled 9 million vaccine related scripts, so out of the $410 million adjusted scripts that we fulfilled and the quarter about 9 million and those were associated with a vaccine. Obviously, that's not something to run rate given we would not expect that level of the persists for the balance of the year, but 2% to 3% of the total for volume.
Okay, great. Thank you.
Thank you Mr. <unk>. Our next question comes from Stephen Valiquette with Barclays. You May ask you questions.
Great. Thanks, how good morning, everybody.
So I guess I'm just back on the medical costs for a moment just curious and if you have any additional color on the medical cost trends versus baseline by cost category and for example, inpatient and outpatient pharmacy et cetera, and some MCA other called out.
Pedro Health and also diagnostic and lab work and its cost category and sort of training above basslines I'm curious if you're seeing those same trends as well.
Good morning, It's David let me provide a little over and utilized spread to provide some specifics of what we're seeing in terms of of.
Some of the specific categories and utilization of you.
Good call on and important category, we've unequivocally scene and and I noted in my prepared comments.
The mental health or behavioral and substance abuse categories growing we.
We see more individuals meeting and utilizing those services.
And appropriately needing and utilizing those services given the environment and and our portfolio is really well positioned to provide that level of support necessary and we believe that it's not only appropriate required it will provide some intermediate and long term benefits for those individuals obviously to clients and.
Well to ourselves and a sustainable basis beyond that we've seen and uptick in from prior levels and uptick in both inpatient and outpatient surgeries.
And the non Covid category and is Brian articulated of that categories more broadly approximated baseline.
<unk> and we've assumed under the remainder of that for the second half of the year I'll ask Friday give you a little bit more color in terms of some of the insights we're seeing in terms of the more detailed utilization patterns yeah.
Yeah sure David and good morning, Steve So just to reiterate the caves surgeries in particular for a.
Hotspot for us both in terms of inpatient and outpatient activity and the quarter and we also saw overall outpatient and professional utilization pick up pretty meaningfully and the quarter.
Emergency room utilization radiology remained below baseline and the quarter and kind of within these different categories of results systems day to service shift, which is a good thing over time, we saw inpatient shifts outpatient, particularly for some lower acuity procedures and we saw some of the emergency room utilization shift urgent care centers.
And physician offices, which we view as a good thing from the standpoint of optimizing day to care on your point about behavioral health a metric that I'll share with you just relative to prior to the pandemic within our use commercial book and 2019 about 8% of our customers for utilizing behavioral health services and as you know we have and does.
3 lead and capability and the space. This year that number is going to be up almost 40%. So we're going to have nearly 11% of our customers. This year utilizing behavioral health services, which we think is a good thing for the long term is putting a little bit of pressure on the piano. This year, but we've alluded to good thing for the long term and a recent acquisition of empty life offers us the opera.
Unity to further synergize that given the demand for virtual behavioral health is grown meaningfully over the course of the pandemic.
Okay, that's very helpful. Thanks.
Thank you Mr. Valiquette. Our next question comes from Mister Scott for now with Stevens you May I ask you a question.
Hi, Thanks, good morning.
Interesting that you can just break down the 20% of the Covid headwind that's from the lower customer volume is maybe a little more insight.
And 2 into bat in terms of some of the key customer segments and stop for you in terms of where you are seeing more of that drag and.
And that also just 1 and just to confirm on the 4 billion dollar revenue raised if you can also just break backed out by segments. It feels like <unk> and it's probably.
The bulk of that growth and just want to confirm that in terms of the segment the breakdown and a $4 billion.
Revenue ads. Thanks.
Good morning shot David.
Let me speak to the the headwind LLS Brian.
Brian and speak to the revenue raise awareness and your question correctly, you are coming out and the portion of the headwind that is <unk>.
Non MCR related and broadly we see the impact of the pandemic on employment levels.
And the commercial population broadly we've previously call that out as a headwind we previously called the other the headwind that we believed would return as a favourable tailwind over time, we're taking the posture right now that given the current employment environment.
Headwind and will more likely processed or said otherwise that's the baseline with which to grow off of will continue to grow no doubt, but that's the baseline to grow off of as as we observed the marketplace and the overall employment levels, beginning to move forward, but more slowly and and anticipated and a variety of the sector. So viewing addition, enrollment and or AG.
Brigade employment levels.
And the requisite level of change and those employment levels, having and flow and get a slower rate given the prolonged pandemic I'll ask Brian and sneak a bit more towards the 4 billion dollar revenue race morning.
Morning, Scott relative to the revenue outlook, obviously, we're very pleased with the aggregate growth for the company this year.
Of the for Bill you should think of the lion's share of that being driven by other in order to think of it as roughly 70.525 with with the other segments.
And totality of and works on track for a year, we're both revenue and earnings will grow above well above our long term average annual expectation of 4% to 6%. So we're really pleased with the performance of that business.
Thank you Mr Fi down and next question comes from Mister, Kevin and Smacked with Bank of America, you May ask your question.
Okay, great. Thanks.
I guess, the higher utilization that you're seeing this quarter I guess and didn't.
Terribly surprising given.
What other companies I've seen so far this earnings season, and I guess.
The question I would have though is what gives you confidence that this higher trend is not the beginning of and over or the tire.
Cost and a quarter is not the beginning of and overall higher trend that makes 2022 pricing.
At risk.
I guess I guess, what gives you that comment I would think that and faster return to normal and Q2 would be the first thing you saw before you saw above average trend overall, so why why isn't that a concern.
Good morning, Kevin It's Brian.
Appreciate your question, if you think about how and the second quarter unfolds and I think this is instructive for how we think about the back half of the year and into 2002. So April we saw the highest level of Kobe costs I said earlier, those track downward pretty meaningfully and May and June and the total cost to care when you combine the COVID-19 and non COVID-19 cost.
And the month of May and June is more in line with what we're expecting for the back half of 21 and as we step into 22.
So for those reasons based on the more emergent data.
Feel better about the next 18 months as compared to the first 4 months of the year, where we had particularly elevated calls from a book David anything you want to yeah. Good morning, Kevin and the only item I would add is.
And so I think we think about our book and business.
Proximately 2 thirds of our risk business has yet to be price for.
For 2022, so as you know, it's not all that portfolio of our business is not all 1.1 or front and loaded from that standpoint.
And so we have the.
The opportunity to be appropriately responsive and some marketplace changes, but the underlying assumptions that Brian articulate and and medical cost pattern are the most important part of it.
And I guess, you're saying that you got back to normal faster and Q2, then your original guidance assumed you would get back to normal.
So the price so again it feels to me and with the trajectory is is higher why would it get higher and then level off I.
I guess and the back half of the year.
I think a coyote agenda like sure the underlying question comes back to.
Brian broke up broke out the portions of it we essentially are looking at and environment and the second half of the year, where the medical costs environment will be slightly above baseline and.
And the pieces of that are that the non COVID-19 or the called traditional parts of medical costs approximate baseline and the commercial portfolio and above and beyond that there are some additional load for COVID-19.
So 1 would have to believe that either a the non COVID-19 costs are going to run and above baseline for some reason that they haven't to date.
And when we look at the way, we built up the proxy for baseline and or that the additional COVID-19 costs that were saying are added if that will be materially greater right acknowledges a fluid environment beyond a shadow without for we believe that the estimate we've made.
For the step up and aggregate for the rest of the year to run slightly above baseline isn't appropriate assessment based upon the pattern. We saw in the end of the first quarter and the way in which the second quarter's evolved and developed and as I noted we have about 2 thirds of the risk business yet to be price for 2022.
Okay. Thanks.
Thank you Mr. Fischbeck. Our next question comes from Mister Joshua asking with net fund research you May I ask you a question.
Hi, Thanks, good morning.
Just wanted to talk a little about the MLR I know you guys snap disclosing net MLR by segment Awhile back and I was wondering if you just give us some color on the changes and the MLR and the second quarter or even the first half of the year for the commercial book and maybe specifically that individual book of business, if that was different and the overall commercial and then relative to.
And to Medicare advantage and maybe it's a side how much of the increase was was risk of gesture and related versus medical costs related.
For the Justice Brian.
A few different components there to the question big.
Big picture compared to our expectations I would encourage you to think about the 3 books a business meeting the commercial risk the individual exchange and and Medicare advantage as all being approximately off by the same amount compared to our expectations in terms of total claim costs. So let's start there in terms of we are not seeing 1 being really disproportionately impacted relative to our prior ex.
Spectation, they're all off by call it that 200 basis points or so that changed and our NCR guide the Medicare advantage business, though and 2021 is further weighed down by the risk adjustment revenue headwind and so you should view the margins on and Medicare advantage business as being particularly low relative to what our long term expectations are and as we.
Step into 22, we would expect margin expansion on each of those books of business off of what we're experiencing here and and 21 as it relates to the risk adjusted headwind. That's a component of the $2 per share headwind, we haven't specifically size that it's certainly less than half of that.
I would note. We recently received our midyear settlement from CMS, which was favorable to our expectations, which gives us further confidence and our ability to fully recover the headwind and 22.
And you can.
Thank you Mr. Raskin and next question comes from Mister Kevin Kolenda with UBS. Your line is open you may I ask you a question.
Good morning, this is James care and conquer Kevin.
Just wanted to quickly follow up and see if there was any updates to your longer term targets provided on your investor day are still comfortable with those overall.
Sure and good morning.
Our longer term targets are consistent and we remain committed to them and to remind everybody. It's the are attractive revenue growth rate of 6% to 8% are EPS growth rate of.
10% to 13%.
With the and.
The dividend above and beyond that and our outlook of operating cash flow generation from current year 2025 of approximately $50 billion.
Those numbers are on average.
Over a prolonged period of time and as we've identified and Investor day as well as you look back over the last decade, and we haven't track record of delivering and.
Against those targets and objectives.
Thank you Mr. Glendale and lost our next question comes from Lance Whelks with Bernstein. Your line is open you May ask you a question.
Yeah Uhm morning goes have a question on strategic capital and deployment and if you could just talk to a little bit of long term and you're like 5 years older. So what do you think is the mix of businesses, you're you're expecting for you just kind of employer managed care Doberman managed care P. B M and and other services and as you are.
Looking at things and and.
Unemployed and that what's the landscape like as far as attractiveness of opportunities just availability of targets and and the like and within that Val.
Value based care home care Medicaid are there any new views on categories that you'd be interested and.
Lance Good morning is David.
I appreciate the forward looking orientation relative to that.
And for your question and we've got a ground back into our portfolio. The 3 platforms we have.
Which we feel very.
Positively about the services based platform with and ever North.
The U S medical platform, both commercial and government and then our international platform, we see attractive growth opportunities organically and Inorganically and all 3 as.
As we look to the future specifically you start your.
Thoughtful question in terms of kind of a Porsche meant 5 years out.
And we don't have a rigid target 5 years out that we want ex percent and category a R y percent and category Z.
But we do see and environment, where the services portion of our portfolio will continue to grow at an accelerated rate.
We see the right to win the ability to create value and.
And our strategic position there for the multiple clients segue.
Segments were able to serve there as being quite attractive and you should expect this to continue to grow.
<unk> pharmacy or care or benefits and our intelligence capability to be able to bring to arrogance. App. Secondly, we've continued to call out U S government.
As an attractive growth segment and that will transpire, both organically and inorganically as opportunities present themselves and thirdly, we could you see targeted opportunities and our international portfolio as attractive growth opportunities and a final note you articulated examples of home care, otherwise et cetera, and we will call out.
Any 1 precise example, but I'll step back and remind you as we've talked about it we see what we call alternative sites of care.
So virtual longitudinal virtual poly chronic homecare coordinated home-care as attractive additional growth opportunities within our service portfolio and we continue to extend ourselves and expand ourself within that space. So multiple strategic alternatives second strong platforms to build off.
Third the capital flexibility to be able to grow in multiple attractive markets that you appropriately called out thanks.
Thank you Mr. Well our next question comes from Mr. Eric.
Author with Morgan Stanley You May I ask you a question.
Hi, good morning so.
I have a question here first of all on the security level and so I mean I understand.
New members are coming in and similar.
Profile to existing but are you seeing any increase and acuity for.
For the existing and what kind of a task for.
And he had talked about.
Vantiv current canonization and sleep and Democrat and once I, just wanted to try and to understand how it compares and second quarter and and what are you seeing in terms of acuity and.
And then chest and and follow up on your point on French and into the U S. Government just kind of thing and you can give us maybe and maybe more direction and hymns springs from like Medicare versus medical and should we think about expansion on the medical side or is it more.
And the Chase and then.
Or set of kind of like the.
William Sighed, a pharmacy service.
Could be.
And.
Expanded into service to Medicare and Medicaid market. Thank you.
Good morning, Ricky it's Brian and I'll take the the acuity portion of the question and David.
The government components.
Big picture and we're not yet seeing signs of any meaningfully higher acuity amongst our customer base and.
Part of that due to the focus we've had and preventive care as you indicated and your question as well as.
Appropriate behavioral health utilization as we talked about earlier and.
There are a variety of metrics that we used to.
Practice and just 1 really specific 1 I'll give you we track within our commercial book of business.
And we have new cancer diagnoses, how many of them are and Ah metastatic stage when they're first diagnosed and so prior to the pandemic. If you look at the top 5 cancer types, we saw $38 and 39% of these and and metastatic stage when they when they presented to US and 2021 were and that same range, 30% to 39%. So.
And that's an indicator that we tracked and 1 of many that suggests we do not yet have those signs of acuity spikes and as I said earlier, we're also seeing a state of service shifts and the book of business, which is a mitigate overtime to the potential for for a QE coming back into the book.
David maybe you want to talk a little bit about the government for the question sure Ricky good morning.
The short answer is we see expansion opportunities in both the medical side of the equation as well as in the other north of services side and some more specifically.
And the us medical portfolio organically.
See and and continuing to deliver and pursue additional growth opportunities for both our Medicare advantage portfolio and existing Jakob geography's as well as as we've discussed before our continued expansion of those geographies and leveraging our broader product portfolio and platform as well as and our exchange portfolio as we continue to.
Expand our individual exchange portfolio, which we view is more government business versus not on the services side you reference pharmacy.
Unequivocally, but expanded beyond pharmacy to care and benefit management services as well as intelligence services for example, as we looked.
Look to continue to serve are expanding portfolio of health plan clients. They have diverse portfolios that they serve commercial obviously, a Medicare Medicaid exchange and otherwise that's an important part of our growth chassis as we go forward with dedicated resources and then ultimately direct too.
And government contractor relationships as well, so we see attractive growth opportunities and the government's face both off of the for health plan side of the business in the Cigna medical portfolio as well as from the services side of the business through revenue right.
Thank you.
Thank you Mr and lobster. Our next question comes from John Ransom with Raymond James You May ask you a question.
Hey, I'm going to ask about a happy topic, because you guys who've been beaten up this morning, and I want you know and and all that having a.
The.
If we go back you know take your time periods 12, 18.24 months, obviously the key.
BMS side of ever northwest and some.
A lot better than I think anybody expected can you.
And a point to the top 1.2 or 3 reasons why that is and then secondly, if we think about the profit model and the PVM, how does that shifted away from kind of adjudication scraped dollars and toward things like mail order and.
And kind of backward fees, and the farm and that presumably might be a bit more sticky than some of the some of the always and making money. Thanks.
Good morning, John is David.
I'll start.
Relative to your question and and I appreciate the tone, but Kennedy I don't feel beaten up.
These are dynamic and challenging times.
And we're proud of the fact that our portfolio a diverse portfolio can perform and this environment and importantly deliver for our clients our customers and patients.
And while we deliver our responsibilities from from a shareholder perspective, but I appreciate the total for your question now specifically.
As you go back in time, when we brought this portfolio together in terms of the day the companies.
We viewed obviously that we had an opportunity to bring in a meeting PVM portfolio of services, but it was broader than that and secondly, we viewed as we talk about now that pharmacological innovation was a big part of the future of healthcare and the acceleration of innovation is what we're seeing today through a whole variety of things gene therapy spell.
Salty murder.
And medications evolving biosimilars et cetera, and hence if you're going to be helping individuals.
With their overall health care needs being a leader and pharmacy services is mission critical we also saw the opportunity to expand that portfolio to a broader services platform.
Which we did through ever North and then continue to feed that broader services platform for healthy and clients for corporate clients for our government clients et cetera, and as we've noted both Brian and I have noted we're very pleased with the performance of it and the portfolio and the service for delivering and importantly, we continue to invest in that portfolio and and.
And great relative to expanding products services capabilities as well as our reach.
Now as it relates to the profit model.
Primary mechanisms that would articulate for you to think about is back to the time you reference.
He acknowledged that the financing models and we're going to change and we didn't resist that we offer choice will for a choice in terms of how purchasers our clients want to finance are offering and we've evolved for example, with a higher percentage of pass through arrangements.
For clients and the PVM services from well less and 50% for 50% or greater than 50% over 3 cycles, and we've been able to evolve our service based capabilities and our value creation capabilities for the benefit of clients and secondly, we continue to press for more aligned relationships with pharmaceutical manufacturers.
And the clinical outcomes not just the Consumptions, we know that broadband and industry has value based programs, but but thinking about them is all lined programs and then lastly.
Biosimilars start to evolve and more rapid rate the positioning of our company to have the clinical depth.
The coordination of clinical services.
The manufacturer relationships and importantly, the medical physician relationships are mission critical and as they use. The Remicade example, all those come to bear because if that patient by patient decision made with a practicing physician relative to the choices and alternatives. So again I. Appreciate your question for please.
And with the performance, but maybe even more importantly than that underlying your question. We're delighted with the strategic position that the platform gives us right now to continue to drive growth and create value going forward.
Thanks, so much.
Okay.
You Mister Ransom. Our next question comes from Mister David Blatantly with Jeffrey Your line is open and you May ask you a question.
Hi, Good morning, Thanks for taking my questions for David If I, if I go back to your.
Your growth construct and and think about a.
Thousand 20, minus the 1 timers and grow that by 13% it would seem that.
Will the dollar recovery for next year represents you know maybe 40% of that growth next year and can you talk about the factors that you see at this point.
That would be <unk>.
Limiting on your core business apart from the dollar.
So it looks like that would be.
Mid to high single digit growth, including capital deployment.
So that would that would obviously be below your trend line what are the factors limiting the core business apart from the dollars. Thank you.
David Good morning.
So again, it's early for the detailed 2022 guidance, but taking the spirit of your question. It ultimate is going to come down to 2 things.
Right and pace of evolution of the costs environment medical costs environment and rate and pace of our investment portfolio and decisions within the organization positioning us for the future. We have a track record of sustained investment and the organization for long term growth. We have is Brian articulated earlier, we have multiple growth and profit level.
And we will seek to make tradeoffs within that and ensure that we seek to deliver unattractive sustainable result.
So I think those are the 2 major points I would ask you to think about I talked about and the growth rates and frameworks of at least.
So we weren't providing guidance pencil and number rather how we're thinking about the growth platforms and trajectory and there is nothing and our underlying business portfolio. Today I'll leave you with there's nothing and a building business portfolio today that suggests that the organic underlying growth of our earnings will be demonstrably different unless we determined and we're going to make a trade off and.
The rate and pace of investment within the portfolio or theirs and anxiety.
Impact for the industry and the cost side of equation. We're just trying to frame the at least growth rates off of what we know now and made here.
That's very helpful. Thank you. Thank you David.
Thank you and and ask a question comes from Mister Stephen Baxter with Wells Fargo. You May I ask you a question.
Yeah, Hi, sorry to come back to a more near term and less happy topic.
Just thinking about the back half discussion and sort of the progression from where we were and MLR and the second quarter to the backup and it looks like you need MLR. The decline a couple of hundred based sequentially and and kind of make that work for those in terms of thinking about it and it would be really helpful. If you could potentially quantify what you're thinking about COVID-19 cost and the back half of the year relative to the second quarter.
And how we should balance out against sort of a typical deductible seasonality and we expect to be pushing up MLR sequentially and and more global here. Thank you.
Good morning, David Bryan.
And I would encourage you to think of the year and to have 1 happened to you. After the first half, we rented $83 and 6% MCR and and we're modeling the back half hit it for format approximately the same level of fees and mid point of our guidance.
Rather than looking at quarter by quarter, because there's quite a bit of variability, that's transpired and and the different months, but big picture of the first half of the year. We ran a few points above baseline and total when you combine the effective COVID-19 and non COVID-19 utilization together for the back half of the year.
Project and to run slightly above the baseline and totality and that's comprised of non COVID-19 utilization running approximately updates line.
Covid utilization on top of that to your question on how does that pattern relative to what we saw and the first half and you should think of the direct COVID-19 related costs as being the highest and the first quarter.
Lower and the second quarter, and we're modeling slightly over than that for the back half of the year on direct COVID-19 related costs of those pieces get you to that overall expectation of slightly above baseline for the back half of the year and that's essentially offsets the seasonality, we would typically see and the MCR pattern for our book of business.
Thank you Mister Baxter.
Gotcha and call back over to David credit any for closing remarks.
Sure I'll be brief when and thank everybody for joining a call and I just want to reinforce 2 points first I'm appreciative and proud of her more than 70000 coworkers and their dedication to work and to change our customers lives for the better every day and they continue to rise for the challenges and the enrollment by helping our clients our customers or patients working with our partners and and.
And our communities to drive positive change and second we continue to demonstrate the resiliency of our business and are well positioned 3 portfolios and the strength of our strategic framework given a results and our outlook with that I ask you to have a good day and we look forward to a future conversation. Thank you.
Ladies and gentlemen, and this concludes Cigna second quarter to 2021 results review Cigna Investor Relations will be available to respond to additional questions. Shortly.
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