Q4 2023 Centene Corp Earnings Call

Good day, and welcome to the <unk> fourth quarter and full year 2020 earnings results Conference call.

Operator: Good day, and welcome to the Centene fourth quarter and full year 2023 earnings results conference call. All participants will be in listen-only mode.

All participants will be in listen only mode.

Operator: Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star then one on your telephone keypad.

Should you need assistance. Please signal a conference specialist by pressing the star followed by zero.

After todays presentation, there will be an opportunity to ask questions.

To ask a question you May press Star then one on your telephone keypad.

Operator: To withdraw your question, please press star then 2. Please note, today's event is being recorded. I would now like to turn the conference over to Jen Killigan, Head of Investment Relations. Please go ahead, Jen.

Your question. Please press Star then two.

Please note today's event is being recorded.

I would now like to turn the conference over to Jim.

Jim: Relations. Please go ahead Sir.

Jen Killigan: Thank you, Rocco, and good morning, everyone. Thank you for joining us on our fourth quarter and full year earnings results conference call. Sarah Lunden, Chief Executive Officer, and Andrew Asher, Executive Vice President and Chief Financial Officer of Centene will host this morning's conference call, which also can be accessed through our website at Centene.com. Ken Fisola, Centene's president, will also be available as a participant during Q&A. Any remarks that Centene may make about future expectations, plans, and prospects constitute forward-looking statements for the purpose of the Safe Harbor Provision under the Private Securities Litigation Reform Act of 1995. However, actual results may differ materially from those indicated by those forward-looking statements as a result of various important factors, including those discussed in Centene's most recent Form 10-K, filed on February 21, 2023, and other public SEC filings. Our Form 10-K for 2023 will be filed in the coming weeks. Centene anticipates that subsequent events and developments may cause its estimates to change. While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so.

Jim: Thank you Rocco and good morning, everyone. Thank you for joining us on our fourth quarter and full year earnings results Conference call.

Jim: They were London, Chief Executive Officer, and drew Asher Executive Vice President and Chief Financial Officer of Centene will host this morning's conference call.

Jim: It also can be accessed through our website at Centene Dot com.

Jim: Ken Fasola Central's President will also be available as a participant during Q&A.

Jim: Any remarks that Centene may make about future expectations plans and prospects constitute forward looking statements for the purpose of the safe Harbor provision under the private Securities Litigation Reform Act of 1995 actual results may differ materially from those indicated by those forward looking statements as a result of various important factors.

Jim: Including those discussed in <unk>. Most recent Form 10-K filed on February 21st 20, twenty-three and other public SEC filings our Form 10-K for 2023 will be filed in coming weeks.

Jim: Centene anticipates that subsequent events and developments may cause its estimates to change while the company may elect to update these forward looking statements at some point in the future, we specifically disclaim any obligation to do so.

Jen Killigan: The call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our fourth quarter 2023 press release, which is available on the company's website under the investor section. The company is unable to provide a reconciliation of certain 2024 measures to the corresponding gap measures without unreasonable effort due to the difficulty of predicting the timing and amounts of various items within a reasonable range. With that said, I would like to turn the call over to our CEO, Sarah Linden. Sarah?

Jim: The call will also refer to certain non-GAAP measures a reconciliation of these measures with the most directly comparable GAAP measures can be found in our fourth quarter 2023 press release, which is available on the company's website under the investors section.

Jim: The company is unable to provide a reconciliation of certain 'twenty 'twenty four measures to the corresponding GAAP measures without unreasonable effort due to the difficulty of predicting the timing and amounts of various items within a reasonable range with that I would like to turn the call over to our CEO Sterling.

Jim: Sarah.

Sarah E. James: Thanks, Jen, and good morning, everyone. Today we reported a strong finish to a very productive 2023. Fourth quarter results include adjusted earnings per share of $0.45, generating full year 2023 adjusted EPS of $6.68. The quarterly and full-year EPS results were slightly ahead of internal expectations and provide the organization with positive momentum as we head into 2024. We've been planning for and talking about 2024 for a while, and now that we're here, we're focused on positioning each of our lines of business for long-term growth while continuing the important work to fortify our platform as we prepare for 2025 and beyond. Specifically, we are working through the tail of the redeterminations process.

Sterling: Thanks, John and good morning, everyone.

Sterling: Today, we reported a strong finish to a very productive 2023.

Sterling: Fourth quarter results include adjusted earnings per share of 45 cents generating full year of 2023, adjusted EPS of $6.68.

Sterling: The quarterly and full year EPS results were slightly ahead of internal expectations and provide the organization with positive momentum as we head into 2024.

Sterling: We've been planning for I'm talking about 'twenty 'twenty four for a while and now that we're here we're focused on positioning each of our lines of business for long term growth, while continuing the important work to fortify our platform as we prepare for 2025 and beyond.

Specifically, we are working through the tail of the Redetermination process positioning centene to resume organic enrollment growth in Medicaid and to pursue new program opportunities from a position of strength.

Sarah E. James: Positioning Centene to resume organic enrollment growth in Medicaid and to pursue new program opportunities from a position of strength. We are solidifying our Medicare Advantage footprint thanks to an annual enrollment period that largely hit the mark with respect to our target membership, including sales, retention, and disenrollment. And we are capturing a powerful growth opportunity in the market, as demonstrated by the increased revenue guidance we issued this morning. We recognize that, amid these opportunities, we still have valuable bottom-line work to do.

Sterling: We are solidifying our Medicare advantage footprint, thanks to an annual enrollment period that largely hit the mark with respect to our target membership, including sales retention and enrollment.

Sterling: And we are capturing a powerful growth opportunity in marketplace demonstrated by the increased revenue guidance, we issued this morning.

Sterling: We recognize that amid these opportunities we still have valuable bottomline work to do and we are approaching that work with the same focus and disciplined execution that has defined the first two years of this management team's tenure.

Sarah E. James: And we are approaching that work with the same focus and disciplined execution that have defined the first two years of this management team's tenure. In fact, the SEND team wasted no time setting the tone for 2024 by successfully delivering what we believe to be the largest ever PBM platform migration and improving our pharmacy cost structure on behalf of our customers and members. We have processed more than 40 million scripts so far through ESI and are pleased with the way this massive undertaking has rolled out.

Sterling: In fact, the same team wasted no time setting the tone for 2024 by successfully delivering what we believe to be the largest ever P. B M platform migration and improving our pharmacy cost structure on behalf of our customers and members.

Sterling: We have processed more than 40 million scripts, so far through ESI and are pleased with the way. This massive undertaking has rolled out.

Sarah E. James: There is always a period of issue management after a change of this magnitude, and the teams have worked tirelessly and collaboratively to prioritize member access to care during this transition. We will continue to closely monitor end-to-end processing and customer service as we move through the year. Additionally, in January, Centene closed the divestiture of Circle Health, the last of our international assets, and the company can now focus solely on its domestic core business.

Sterling: There is always a period of issue management. After a change of this magnitude and the teams have worked tirelessly and collaboratively to prioritize member access to care during this transition.

Sterling: We will continue to closely monitor end to end processing and customer service as we move through the year.

Sterling: Additionally in January Centene closed the divestiture of circle health the last of our international assets and the company can now focus solely on our domestic core businesses.

Sarah E. James: Circle marks the 10th divestiture since we began the portfolio review process in late 2021, and we are pleased to have purposefully streamlined our enterprise while keeping the portfolio of divestitures net accretive to earnings and generating cash for deployment. In the broader context of value creation, our SG&A initiatives remain on track to exceed our original savings goals, and we continue to identify opportunities to drive operating efficiency through modernization and process improvement. Annual enrollment periods for both Marketplace and Medicare also contribute to our confidence in Centene's 2024 position. Continued pricing discipline in Marketplace and the deliberate actions we took to align our 2024 Medicare bids with our strategic focus on lower income and complex members yielded the intended results on both fronts. Marketplace growth was more robust than anticipated, fueled by better-than-anticipated overall market growth as individual commercial offerings continue to gain traction with an expanding consumer set.

Sterling: Circle marks the 10th divestiture since we began the portfolio review process in late 2021 and we are pleased to have purposefully streamlined our enterprise, while keeping the portfolio of divestitures net accretive to earnings and generating cash for deployment.

Sterling: In the broader context of value creation, our SG&A initiatives remain on track to exceed our original savings goals and we continue to identify opportunities to drive operating efficiency through modernization and process improvement.

Sterling: Annual enrollment periods for both marketplace and Medicare also contribute to our confidence in <unk> 'twenty 'twenty four positioning.

Continued pricing discipline and market place and the deliberate actions, we took to align our 'twenty 'twenty four Medicare bids with our strategic focus on lower income and complex members yielded the intended results on both fronts.

Sterling: Marketplace growth was more robust than anticipated fueled by better than anticipated overall market growth as individual commercial offerings continue to gain traction with an expanding consumer set.

Sarah E. James: As such, we expect to deliver both growth and our planned margin expansion in Marketplace in 2024. Together, these dynamics position us well to achieve our 2024 adjusted earnings per share guidance of greater than $6.70. With that in mind, let's click deeper into each of our core business lines. Within Medicaid, we have delivered important proof points around the power of incumbency while navigating the unprecedented dynamics of redetermination. In December, we were awarded the Arizona LTSS contract that will expand our footprint in serving complex populations in that state. That same month, we added approximately 90,000 members to our care and coverage through the successful Go Live of Medicaid expansion in North Carolina. And in early January, we successfully re-procured our New Hampshire contract, earning the top score in the Granite State among competitors. Our uniquely local footprint fosters important and trusted relationships with the communities and state partners we serve and continues to differentiate us as we retain and grow our largest business.

Sterling: As such we expect to deliver both growth and our planned margin expansion in marketplace in 2024.

Together these dynamics position us well to achieve our 2024 adjusted earnings per share guidance of greater than $6.70.

Sterling: With that let's click deeper into each of our core business lines.

Sterling: Within Medicaid we have delivered important proof points around the power of incumbency, while navigating the unprecedented dynamics of Redetermination.

Sterling: In December we were awarded the Arizona L. T. S. S contract that will expand our footprint in serving complex populations in that state.

Sterling: That same month, we added approximately 90000 members to our care and coverage through the successful go live of Medicaid expansion in North Carolina.

Sterling: And in early January we successfully re procured our new Hampshire contract, earning the top score in the granite state among competitors.

Sterling: Our uniquely local footprint fosters important and trusted relationships with the communities and state partners, we serve and continues to differentiate us as we retain and grow our largest business.

Sarah E. James: Turning to redeterminations, the process continues to track largely in line with our expectations. As of year-end, we were approximately 80% of the way through the projected member transitions, and consistent with our modeling, we ended 2023 right around 14.4 million Medicaid beneficiaries. Our health plan presidents, along with our Medicaid actuarial teams, continue to work in concert with our state partners to monitor the risk pool impact of membership changes and calibrate rates to match acuity in the near term. To that end, we received some, but not all, of the outstanding 2023 retrospective rate adjustments we mentioned during our December Investor Day before year end, and we still feel good about our 2024 Medicaid guidance as we sit here in early February. While Medicare has been a hot topic for the industry of late, we are pleased that the annual enrollment period played out largely as expected since, and our 2024 financial projections for Medicare remain unchanged from Investor Day.

Sterling: Turning to Redetermination. The process continues to track largely in line with our expectations.

Sterling: As of year end, we were approximately 80% of the way through the projected member transitions and consistent with our modeling. We ended 2023 right around $14 4 million Medicaid members.

Sterling: Our health plan presidents, along with our Medicaid actuarial teams continue to work in concert with our state partners to monitor the risk pool impact of membership changes and calibrate rates to match acuity in the near term.

Sterling: To that end, we received some but not all of the outstanding 2023 retrospective rate adjustments, we mentioned during our December Investor day before year end and we still feel good about our 'twenty 'twenty four Medicaid guidance as we sit here in early February.

Sterling: While Medicare has been a hot topic for the industry of late we are pleased that the annual enrollment period played out largely as expected for centene.

Sterling: And our 2024 financial projections for Medicare remain unchanged from Investor Day.

Sarah E. James: Duals or decent members have grown as a percentage of our Medicare enrollment as thoughtful benefit design changes allowed us to invest in and effectively refocus our book on members to whom we have the strongest ability to provide long-term value. We expect ECNIT members to represent more than 35% of our Medicare Advantage membership by year-end, an important step relative to our strategic plan. As an organization, we remain laser focused on advancing our Medicare quality agenda.

Sterling: Duals or D. SNP members have grown as a percentage of our Medicare enrollment is thoughtful benefit design changes allowed us to invest in and effectively refocus our book our members to whom we have the strongest ability to provide long term value.

Sterling: We expect D. SNP members to represent more than 35% of our Medicare advantage membership by year end and important step relative to our strategic plan.

Sterling: As an organization, we remain laser focused on advancing our Medicare quality agenda we.

Sarah E. James: We made progress on a number of initiatives in 2023 that create positive momentum as we continue to execute in 2024. This includes expanding our member outreach capacity, which ultimately allows us to conduct over 1.1 million preventive service outreach calls, reach 80% more members, and schedule 62 more appointments year over year. At the same time, we invested in digital data and provider connectivity, successfully deploying direct EMR connectivity to over 640,000 provider practices. And finally, we continue to drive core administrative and customer experience performance, with service levels remaining in the high 90s through Q4. All of these efforts are important contributors to our long-term STARS performance.

Sterling: We made progress on a number of initiatives in 2020 three that create positive momentum as we continue to execute in 2024.

Sterling: This includes expanding our member outreach capacity, which ultimately allows us to conduct over 1.1 million preventive service outreach calls.

Sterling: 80% more members and scheduled 62 more appointments year over year.

Sterling: At the same time, we invested in digital data and provider connectivity successfully deploying direct EMR connectivity to over 640000 provider practices.

And finally, we continued to drive core administrative and customer experience performance with service levels remaining in the high nineties through Q4.

Sterling: All of these efforts are important contributors to our long term stars performance goals.

Sarah E. James: In 2024, as planned, we will continue to invest in this space with an obvious focus on Medicare Advantage star ratings, but with an approach that will drive benefits across lines of business. With respect to Medicare utilization, as you heard from us in December, our 2024 bids incorporate a level of elevated medical trend related to non-inpatient services. To date, based on our full year and fourth quarter claims experience, we continue to view our pricing posture as adequate to support our 2024 Medicare Outlook. Bearing in mind the continued expectation for the multi-year phase-in of the risk adjustment model change that was finalized in 2023, we view the preliminary rates as insufficient with respect to general medical cost trend expectations.

Sterling: In 2024 as planned we will continue to invest in this space with an obvious focus on Medicare advantage star ratings, but with an approach that will drive benefit across lines of business.

With respect to Medicare utilization as you heard from US in December our 'twenty 'twenty four bids incorporate a level of elevated medical trend related to non inpatient services.

Sterling: To date based on our full year and fourth quarter claims experience. We continue to view our pricing posture is adequate to support our 2020 for Medicare outlook.

Preliminary Medicare advantage rates for 2025 were released last week.

Sterling: Bearing in mind, the continued expectation for their multi year phase in of the risk adjustment model change that was finalized in 'twenty to 'twenty three we view the preliminary rates is insufficient with respect to general medical cost trend expectations.

Sarah E. James: Drew will provide some additional thoughts on the preliminary rate in a moment. As this audience is well aware, we will receive final Medicare Advantage rates for 2025 in early April, and at the time of our first quarter call, we will have a better directional sense for bid strategy related to next year. Finally, the Marketplace.

Sterling: Drew will provide some additional thoughts on the preliminary rate in a moment.

Sterling: This audience is well aware, we will receive final Medicare advantage rates for 2025 in early April and at the time of our first quarter call. We will have a better directional sense for bid strategy related to next year.

Sterling: Finally marketplace.

Sarah E. James: As you've heard from us with increasing enthusiasm in recent months, Marketplace presents Centene with a unique opportunity for simultaneous revenue growth and margin expansion in 2024. Overall market growth was stronger than expected during this open enrollment period, and we successfully captured our target market share of the expanded pie, netting stronger than expected OEP results for the company. Within our 4.3 million member footprint as of January, our market share increased to roughly 26%, up from 23% previously, serving as another proof point of our leadership in the space. This strong enrollment result is driving the $2.5 billion increase to our full year 2024 premium and service revenue guidance. Membership mix continues to skew slightly younger, consistent with the year-over-year trend we saw last year, and distribution across middle tiers is consistent with our expectation, with silver plans representing the majority of our enrollment.

Sterling: As you've heard from us with increasing enthusiasm in recent months marketplace presents centene with a unique opportunity for simultaneous revenue growth and margin expansion in 2024.

Sterling: Overall market growth was stronger than expected during this open enrollment period, and we successfully captured our target market share of the expanded pie netting to stronger than expected OE P results for the company.

Sterling: Within our 4.3 million member footprint as of January our market share increased to roughly 26% up from 23% previously serving as another proof point of our leadership in this space.

Sterling: This strong enrollment result is driving the $2.5 billion increase to our full year 2024 premium and service revenue guidance.

Membership mix continues to skew slightly younger consistent with the year over year trend, we saw last year and distribution across metal tiers is consistent with our expectation with silver plans, representing the majority of our enrollment.

Sarah E. James: One driver of overall marketplace growth has been members impacted by Medicaid redetermination. On that front, we continue to track towards the top half of our previously provided guidance range of 200,000 to 300,000 redetermined lives captured by Ambetter. Ultimately, the individual commercial market represents a strategic opportunity for Centene, and we are excited to enable the expanding reach of these offerings as the demands of the market evolve.

One driver of overall marketplace growth had been members impacted by Medicaid Redetermination on that front, we continue to track towards the top half of our previously provided guidance range of 200 to 300000 Redetermination is captured by an better.

Sterling: Ultimately the individual commercial market represents a strategic opportunity for Centene and we are excited to enable the expanding reach of these offerings at the demands of the market evolve.

Sarah E. James: While the dynamic businesses Centene operates in continue to ebb and flow, the strength and diversification of our government-sponsored healthcare platform creates resilience. We see tremendous opportunity for our core products, both near and long term. We will continue to execute against these opportunities to improve health outcomes for our members, generate profitable growth, and drive shareholder return. Before I turn it over to Drew, I want to take just a moment to thank the entire SEND team for how you showed up in 2023 on behalf of our members and our partners.

Sterling: Well the dynamic businesses Centene operates and continue to ebb and flow the strength and diversification of our government sponsored health care platform creates resiliency.

Sterling: We see tremendous opportunity for our core products, both near and long term.

Sterling: We will continue to execute against these opportunities to improve health outcomes for our members generate profitable growth and drive shareholder return.

Speaker Change: Before I turn it over to drew I want to take just a moment to thank the entire Sun team for how you showed up in 2020 three on behalf of our members and our partners.

Sarah E. James: I am honored to work alongside you in 2024 as we make this company stronger every day and transform the health of the communities we serve one person at a time. With that, I will hand the call over to Drew for more details around our financial performance and 2024 outlook. Thank you, Sarah.

Drew: I am honored to work alongside you in 'twenty 'twenty four as we make this company stronger everyday and transform the health of the communities. We serve one person at a time.

Drew: With that I will hand, the call over to drew for more details around our financial performance in 'twenty 'twenty four outlook.

Drew: Sarah.

Drew: Today we reported fourth-quarter 2023 results, including $35.3 billion in premium and service revenue and adjusted diluted earnings per share of $0.45 in the quarter. For the full year, we reported $6.68 in adjusted EPS, growth of over 15% compared to 2022, including a 5.5% beat to our original 2023 guidance. And that's on the heels of growing adjusted EPS by 12% in 2022 compared to 2021. Our Q4 consolidated HBR was 89.5%, while our full year consolidated HBR was 87.7%, both in the range of our expectations.

Drew: We reported fourth quarter 2023 results, including $35 3 billion in premium and service revenue and adjusted diluted earnings per share of <unk> 45 cents in the quarter for the full year, we reported $6 68 of adjusted EPS growth of over 15% compared to 2022.

Drew: To including a five 5% beat to our original 2023 guidance and that's on the heels of growing adjusted EPS, 12% in 2022 compared to 2021.

Drew: Our Q4 consolidated H B R was 89, 5%.

Drew: Our full year consolidated H Bureau was 87, 7% both in the range of our expectations.

Drew: Medicaid at 90.0% for the full year was slightly higher than our expectations. As of Q3, we were 89.9% year-to-date, and we posted 90.6% in the fourth quarter. As we mentioned at our investor day in December, there were some open Medicaid retro rate adjustments. At year end, had we received those adjustments, our full year 2023 Medicaid HBR would have been about 10 basis points better. All things considered, over nine months into redeterminations, our original forecasts for membership, acuity, and rates were very close. As you can see in the membership tables, we were at 14.47 million Medicaid members at year-end, consistent with the 14.4 million we were forecasting as shared in the Investor Day Appendix.

Drew: Medicaid at 90.0% for the full year was slightly higher than our expectations as of Q3, we were 89, 9% year to date, and we posted 96% in the fourth quarter.

Drew: As we mentioned at our Investor Day in December there was some open Medicaid retro rate adjustments.

Drew: At year end, how do we receive those adjustments our full year 2023, Medicaid H B R would've been about 10 basis points better.

Drew: All things considered over nine months into Redetermination, our original forecast for membership acuity and rates were very close.

Drew: As you can see in the membership tables, we were at 14.47 million Medicaid members at year end consistent with the $14 4 million, we were forecasting as shared in the Investor day Appendix that reflects an approximate 1.9 million Medicaid member reductions since $3 31 23.

Drew: That reflects an approximate 1.9 million Medicaid member reductions since 3-31-23 due to redeterminations, as expected. To reiterate what we laid out at Investor Day, our 2024 guidance reflects a low point of 13.2 million Medicaid members at 331.24 and year-end 2024 membership of approximately 13.6 million. That all ties to our 2024 midpoint of $80.5 billion in Medicaid premium revenue. So, there are no changes to our 2024 view of Medicaid revenue, membership, or HBR. Medicare full-year HBR was 87.1%, which includes the $250 million premium deficiency reserve recorded in the fourth quarter that we first discussed with you back in April of 2023. On Medicare trend, we continue to see steady but elevated levels of outpatient trend consistent with what we began to see in Q2 and consistent with our forecast. We also saw a pickup in COVID costs in December and early January, though not alarming compared to prior COVID cycles.

Drew: Due to re determinations as expected.

Drew: To reiterate what we laid out at Investor Day, our 2024, our guidance reflects a low point of $13 2 million Medicaid members at $3 31, 24 and year end 2020 for membership of approximately 13.6 million that all ties to our 2024 midpoint of 80.5.

Drew: Billion of Medicaid premium revenue, so no changes to our 'twenty to 'twenty four view of Medicaid revenue membership or H B R.

Drew: Medicare full year H B R was 87, 1%, which includes the $250 million premium deficiency reserve recorded in the fourth quarter that we first discussed with you back in April of 2023.

Drew: On Medicare trend, we continue to see steady, but elevated levels of outpatient trend consistent with what we began to see in Q2 and consistent with our forecast.

Drew: We also saw a pickup of Covid costs in December as we mentioned in early January though not alarming compared to prior COVID-19 cycles.

Drew: We thought about the current level of trend when we booked the 2024 PDR and continue to believe our forecasts are consistent with delivering our 2024 Medicare segment guidance elements outlined at Investor Day. To help you with some math, the $250 million Premium Deficiency Reserve lifted the fourth quarter Medicare segment HBR by approximately 475 basis points and the full year Medicare HBR by approximately 110 basis points. The commercial HBR, at 79.8% for the full year, continues to be strong.

Drew: We thought about the current level of trend when we booked the 'twenty 'twenty four P. D. R and continue to believe our forecast are consistent with delivering our 2020 for Medicare segment guidance elements outlined at Investor Day.

Drew: To help you with the math the $250 million premium deficiency reserve lifted the fourth quarter Medicare segment, H B R by approximately 475 basis points.

Drew: In the full year Medicare H B R by approximately 110 basis points.

Drew: The commercial H B R. At 79, 8% for the full year continues to be strong.

Drew: Simultaneously, in Q4, we were also capturing growth from both redeterminations and the special enrollment period, and we were up to 3.9 million Marketplace members as of year-end. That is the source of the strong premium growth in the fourth quarter. And, as you heard from Sarah, we couldn't be more pleased with the growth that continued into January 2024, up to approximately 4.3 million members. This continued growth and HBR performance in 2023 set us up very well to achieve our 2024 Marketplace Goals. Moving to other P&L and balance sheet items, our adjusted SG&A expense ratio was 9.7% in the fourth quarter compared to 9.3% last year, consistent with our updated mix of business, along with Medicare distribution costs. Cash flow provided by operations was $8.1 billion for the full year, representing 2.2 times adjusted net earnings.

Drew: Simultaneously in Q4, we were also capture and growth from both Redetermination in the special enrollment period, and we were up to $3 9 million marketplace members as of year end that is the source of the strong premium growth.

Drew: In the fourth quarter and as you heard from Sara we couldnt be more pleased with the growth that continued into January 2020 for up to approximately $4 3 million members.

This continued growth at H B, our performance in 2023 sets us up very well to achieve our 2024 marketplace goals.

Drew: Moving to other P&L and balance sheet items, our adjusted SG&A expense ratio was nine 7% in the fourth quarter compared to nine 3% last year consistent with our updated mix of business along with Medicare distribution costs.

Drew: Cash flow provided by operations was $8 1 billion for the full year, representing 2.2 times. Adjusted net earnings. This was primarily driven by net earnings an increase in risk adjustment payable for marketplace and the timing of pass through payments.

Drew: This was primarily driven by net earnings, an increase in risk adjustment payable for the marketplace, and the timing of pass-through payments. Our unregulated and unrestricted cash on hand at year end was approximately $200 million. During the fourth quarter, we repurchased 397,000 shares of our common stock for $27 million. For the full year, 2023, we repurchased 22.9 million shares for $1.58 billion, a little over our goal of $1.5 billion. Our debt-to-adjusted EBITDA was 2.9 times at year-end, and our medical claims liability totaled $18.0 billion at year-end and represents 54 days in claims payable compared to 53 in Q3 of 2023 and 54 in Q4 of 2022. Looking back at 2023, it was a very good year of execution. We beat the original Adjusted EPS by 5.5%. We bought back 4% of the company's shares for a cumulative total of over 10% since Q1 of 2022. We continue to execute on divestiture. We completed five divestitures in 2023, closed the divestiture of Circle in January of 2024, and received approximately $850 million in net proceeds in January.

Our unregulated and unrestricted cash on hand at year end was approximately $200 million.

Drew: During the fourth quarter, we repurchased 397000 shares of our common stock for $27 million for the full year 2023, we repurchased $22 9 million shares for 1.58 billion a little over our goal of 1.5 billion.

Drew: Our debt to adjusted EBITDA was two nine times at year end, our medical claims liability totaled 18 point of 18.1 billion at year end and represents 54 days in claims payable compared to 53 in Q3 of 2023 and 54 in Q4 of 2022.

Drew: Looking back at 2023, it was a very good year of execution.

Drew: We beat our original adjusted EPS by five 5%.

Drew: We bought back 4% of the company's shares for a cumulative total of over 10% since Q1 of 2022.

Drew: We continue to execute on divestitures, we completed five divestitures in 2023 closed the divestiture of circle in January of 'twenty 'twenty, four and received approximately 850 million in net proceeds in January.

Drew: In total, we have completed 10 divestitures and are close to wrapping up that successful phase of value creation. On January 1st, 2024, as Sarah mentioned, we successfully executed on our PBM conversion. RFPing and moving PBMs has become one of our core competencies, and as a result of that, we've improved our pharmacy cost structure on behalf of our members and customers, and we doubled Marketplace membership since year-end 2022 and fortified Ambetter's number one position. 2023 is a pretty good year.

Drew: In total we have completed 10 divestitures and are close to wrapping up that successful phase of value creation.

Drew: On January one 2024, as Sarah mentioned, we successfully executed on our P. B M conversion.

Drew: Our F Ping and moving P. B EMS has become one of our core competencies and as a result of that we've improved our pharmacy cost structure on behalf of our members and customers.

Drew: And we doubled marketplace membership since year end, 2022, and fortified and betters number one position.

Drew: 2023 pretty good year.

Drew: We provided detailed 2024 financial guidance elements at our December Investor Day. Since then, we've gained some additional clarity around the AEP and OEP results in Medicare and the Marketplace. Medicare enrollment is tracking right in line with our expectations relative to both volume and product; I give the Medicare team credit for precision in sales, disenrollment, and membership products' mixed forecast, as well as execution in a challenging year. While Medicare Advantage is only a $16 billion revenue stream for us, it represents a meaningful margin expansion opportunity as we improve STARS over the next few years and begin to have that reflected in revenue in 2026 and beyond.

Drew: We've provided detailed 2024 financial guidance elements at our December Investor Day. Since then we've gained some additional clarity around the AEP and OE P results in Medicare and marketplace.

Drew: Medicare enrollment is tracking right in line with our expectations relative to both volume and product mix.

Drew: Give the Medicare team credit for precision and sales dis enrollment and membership products mix forecast as well as execution in a challenging year.

Drew: While Medicare advantage is only a 16 billion dollar revenue stream for us it represents a meaningful margin expansion opportunity as we improve starz over the next few years and begin to have that reflected in revenue in 2026 and beyond.

Drew: To reinforce Sarah's comments on the 2025 advance notice, we're in the process of preparing our feedback with questions so far around the adequacy of the fee-for-service trend and a new method for normalization that further reduces the rate. For us, the rate change as it sits today is approximately minus 1.3% before risk-coding. And the new risk model introduced last year, which is being phased in, still has a disproportionate negative effect on partial and full duals, the most vulnerable populations in Medicare. Our marketplace chassis continues to be well-positioned for both growth and margin. Marketplace growth is running ahead of our previous expectations, allowing us to raise our full-year 2024 consolidated premium and service revenue guidance by $2.5 billion, which takes our guidance to a midpoint of $136 billion. Appetite for Marketplace products continues to be strong as these offerings successfully provide both health care access and affordability for millions of beneficiaries.

Drew: To reinforce Sarah's comments on the 20 to 25 advanced notice we are in the process of preparing our feedback with questions. So far around the adequacy of fee for service trend and a new method for normalization thats further reduce the rate.

Drew: For us the rate change as it sits today is approximately minus one 3% before risk coding trend.

Drew: And the new risk model introduced last year, and that's being phased in.

Drew: Still has a disproportionate negative effect on partial and full duals the most vulnerable populations in Medicare.

Drew: Our marketplace chassis continues to be well positioned for both growth and margin marketplace growth is running ahead of our previous expectations, allowing us to raise our full year 2024, consolidated premium and service revenue guidance by $2.5 billion, which takes our guidance to a midpoint of.

Drew: 136 billion.

Drew: Appetite for our marketplace products continues to be strong as these offerings successfully provide both health care access and affordability for millions of beneficiaries.

Drew: At this very early point in the year, we are reiterating our 2024 adjusted EPS guidance of greater than $6.70. As we turn the page from 2023, we can quickly reflect back on our second strong year of execution from this management team and positive progression of the company. I couldn't be more excited to drive success with this team and provide affordable access to health care for our members in 2024 and beyond. Thank you for your interest in Centene. Rocko, you can open the lineup.

Drew: At this very early point in the year, we are reiterating our 2024, adjusted EPS guidance of greater than $6.70.

Drew: As we turned the page from 'twenty to 'twenty three we can quickly reflect back on our second strong year of execution from this management team and positive progression of the company.

Drew: I couldn't be more excited to drive success with this team and provide affordable access to health care for our members in 'twenty 'twenty four and beyond.

Speaker Change: You for your interest in Centene.

Speaker Change: Rocco you can open the lineup please.

Operator: Thank you. If you'd like to ask a question, please press star then 1 on your telephone keypad. If you're using a speakerphone, we ask that you please pick up your handset before pressing the key.

Rocco: Thank you if you'd like to ask a question. Please press Star then one on your telephone keypad.

Rocco: If you're using a speakerphone please pick up your handset.

Operator: To withdraw your question, please press star then two. Today's first question comes from Stephen Baxter at Wells Fargo. Please go ahead. Yeah, hi, thanks for the question. I was hoping you could expand a little bit on the Medicare outlook embedded in your guidance. You know, certainly concerned that costs in the fourth quarter could be coming in higher than expected. And you certainly reported an MLR that was a bit above consensus, even X the PDR.

Rocco: Geez.

Rocco: It's all your question. Please press Star then two.

Rocco: Today's first question comes from Stephen Baxter at Wells Fargo. Please go ahead.

Stephen C. Baxter: Yeah, Hi, Thanks for the question I was hoping you could expand a little bit on the Medicare outlook embedded in your guidance you know it certainly concern that cost in the fourth quarter could be coming in higher than expected and you certainly reported an MLR there was a bit above consensus even ex the PDR that would seem to suggest to I think most of that your Medicare assumptions for 2024.

Stephen C. Baxter: That would seem to suggest to most that your Medicare assumptions for 2024 would be pressured, but you're saying that's not the case. So I'm hoping you can expand on why that wouldn't be and maybe some of the underlying trend assumptions that you factored into your guidance here. Thank you.

Stephen Baxter: Would be pressured, but you're saying that's not the case. So hoping you can expand on why that wouldn't be and maybe some of the underlying trend assumptions that you factored into your guidance here. Thank you.

Speaker Change: Sure Stephen Good morning, and thanks for the question Yeah, we still feel comfortable with how we've accounted for trend in the 'twenty 'twenty four beds and as you heard earlier no change to 'twenty 'twenty four Medicare guidance elements, but let me talk a little bit about what we saw throughout 2023 and underlying trends, let's talk macro first and then we can talk Q.

Drew: And thanks for the question. Yeah, we still feel comfortable with how we've accounted for trend in the 2024 bids. And as you heard earlier, there will be no change to the 2024 Medicare guidance elements.

Drew: But let me talk a little bit about what we saw throughout 2023 and underlying trends. Let's talk macro first, and then we can talk about Q4. From an inpatient utilization standpoint, that was pretty consistent throughout 2023, with very little variation quarter over quarter. Where we did see a step up, as we pointed out multiple times throughout the back half of the year, was in Q2 for outpatient. And underneath that, the drivers were fairly consistent through the last three quarters of the year. So orthopedics with DME on either side of that, cardiac, and cardiovascular as a subclinical category.

Stephen Baxter: For from an inpatient utilization standpoint that was pretty consistent throughout 2023, very little variation quarter over quarter, where we did see a step up as we pointed to multiple times throughout the back half of the year was in Q2 in outpatient and underneath that the drivers were fairly consistent through the last three quarter.

Stephen Baxter: As of the year, so orthopedics with D. N me on either side of that cardiac and cardiovascular as a subclinical category. So those are pretty consistent full year.

Drew: So those were pretty consistent for the full year. What was incremental in Q4? Obviously, the biggest item was taking a $250 million PDR.

Stephen Baxter: What was incremental in Q4, obviously the biggest item was taking a $250 million PDR we.

Drew: We also saw COVID step up between Q3 and Q4, and then sequentially, month over month, in the quarter. We also saw, in Medicare-only, ILI step up late in Q4. Both of those have come back down, as we're seeing in January run-out data. We saw some RSV vaccine utilization in Q4, partly a function of our continued efforts to get seniors in for their preventive services visits.

Stephen Baxter: We also saw Covid step up between Q3, and Q4, and then sequentially month over month in the quarter.

Stephen Baxter: We also saw in Medicare only I L. I step up late in Q4, both of those have come back down as we're seeing in our in January run out data.

Stephen Baxter: We saw some RSV vaccine utilization in Q4, partly a function of our continued efforts to get seniors in for their preventive services visits you heard me talk about that in my prepared remarks that was also part of intentional investments we made in quality in Q4, as we prepared and positioned for 'twenty 'twenty four which.

Drew: You heard me talk about that in my prepared remarks. That was also part of intentional investments we made in quality in Q4, as we prepared and positioned for 2024, which, as you know, is that critical third year in our cycle, in our effort to get to 85% of members in 3 12 stars by October of 2025. So those are really the elements of both full year 23 and then in Q4, and again, I still feel comfortable with how we've accounted for the overall trend in the 24 bids and no change to 24 guidance for Medicare. Thank you. And our next question today comes from Josh Raskin with Nefron Research. Please go ahead.

Stephen Baxter: As you know is that critical third year in our cycle in our effort to get to 85% of members in three and a half stars by October of 2025. So those are really the elements of both full year 'twenty three and then in Q4 and again still feel comfortable with how we've accounted for overall trend in the 'twenty four.

Stephen Baxter: Our beds and no change to 24 guidance for Medicare.

Stephen Baxter: Thank you and our next question today comes from Josh Raskin of Nephron Research. Please go ahead.

Joshua Raskin: Yeah, Hi, Thanks, I was wondering if you give us some color on the Medicare advantage membership losses coming into the year I'm looking specifically at geographic mix relative to expectations, meaning did you lose the members where you expected and then also you know, whereas the balance of new sales and sort of gross losses consistent with expectations.

Joshua Raskin: Yeah, hi, thanks. I was wondering if you could give us some color on the Medicare Advantage membership losses coming into the year. I'm looking specifically at geographic mix relative to expectations, meaning, you know, did you lose the members where you expected? And then also, you know, were the balance of new sales and sort of gross losses consistent with expectations, and retention, you know, was that in line? Just any color on that.

Joshua Raskin: Attention was that in line just any color there would be helpful.

Yeah. Thanks, Josh we were as drew said very pleased with the way the Medicare team executed in a P and precision across all of the dimensions that you talked about again largely in line with expectations we took.

Sarah E. James: Yeah, thanks, Josh. We were, as Drew said, very pleased with the way the Medicare team executed in AEP and with precision across all of the dimensions that you talked about, again, largely in line with expectations. We took an intentional refocus in the 24-bid strategy to try to align to those lower-income, more complex members, as well as to the duals in the DSNP population. And we were successful in terms of what we're seeing relative to the concentration of duals coming out of AEP. So pretty pleased with where we intentionally focused, what the impact looked like, and again, that was really a function of the team going PVP by PVP and building Ken, I don't know if you want to talk a little bit about some of the calibration we did on distribution as part of that overall effort. Yeah, it's a really important addendum to Sarah and Drew's comments.

Speaker Change: And intentional refocus in the 24 beds strategy to try to align to those lower income more complex members as well as to the duals and the D. SNP population and successful in terms of what we're seeing relative to the concentration of duals I'm coming out of a a P. So pretty pleased.

Speaker Change: He is with where we intentionally focused what the impact look like and again that was really a function of the team got PDP by P. B P and building up a strategy, where we can invest in those numbers that we wanted to retain and in those numbers that we feel like we're going to provide the greatest long term value to can I don't know if you want to talk a little bit about some.

Speaker Change: The calibration, we did on distribution as part of that effort overall, yeah. It's a really important add Sarah Andrews comments you know.

Speaker Change: If you recall in prior quarters, we talked about the prior.

Ken: You know, if you recall, in prior quarters, we talked about the fact that we've seen a lot of penetration with teledigital brokers, and we made a conscious effort both in terms of owned assets and discipline with preferred partners that moved the mix to a balance that we're really, really comfortable with. And our owned assets perform historically far better with respect both to retention and overall quality, and we're seeing that now in preferred partners. I think the distribution system has responded to obvious opportunities to improve quality, persistency, and product mix, which, as Sarah said, is directly in line with what we were targeting. So the level of precision is both impressive and important, and directionally where we're going to go. Thank you. And our next question today comes from Kevin Fischbeck with BMA. Please go ahead.

Penetration with color digital brokers and we made a conscious effort both in terms of owned assets.

Speaker Change: And discipline with preferred partners that moved the mixed to a balance that we're really really comfortable with them and our owned assets perform historically, a far better with respect both the retention and and overall quality and we're seeing that now in preferred partners I think the distribution.

Speaker Change: The system has responded too obvious opportunities to improve quality persistency and a product mix as Sarah said is directly in line with what we were targeting so the level of precision as both our impressive important and Directionally, where we're going to go.

Thank you and our next question today comes from Kevin Fischbeck with ebay. Please go ahead.

Kevin Mark Fischbeck: Great, thanks. Just want to see, you raised the revenue guidance by $2.5 billion, but it didn't change the EPS guidance. Is there anything that you would highlight there as an offset on the EPS line, or is that just conservatism? And then just to make sure I understand the PDR, you're saying that the rate's not sufficient to cover trend. Does your PDR reflect that?

Kevin Mark Fischbeck: Great. Thanks, just want to see you raised the revenue guidance for two 5 billion, but it didn't change the EPS guidance is there anything.

Kevin Mark Fischbeck: But you would highlight there is a as an offset on the P. S line or is that just conservatism and then just to make sure I understand the P. D R.

Kevin Mark Fischbeck: You, you're saying that the rates not sufficient to cover friend is your is your PDR reflect.

Kevin Mark Fischbeck: of the current, a rate update, or does it assume something better, and if the rate update was, If all of these are fully affirmed, then the PDR might change. Thanks. Yeah, thanks, Kevin. Great question.

Kevin Mark Fischbeck: The current.

Kevin Mark Fischbeck: The rate update or does it assume something better and if the rate update where would it be.

Kevin Mark Fischbeck: Affirmed then the PDR might change thanks.

Speaker Change: Yeah. Thanks, Kevin Great question, so on the marketplace front, it's really just acknowledging that we're very early in the year and then I think you point out a really important point relative to the mechanics of the PDR and how that positioned us.

Sarah E. James: So on the marketplace front, it's really just acknowledging that we're very early in the year. And then I think you point out a really important point relative to the mechanics of the PDR and how that positioned us, with the ability to look at full-year trends in 23. So I'll let Drew talk a little bit more about those mechanics.

Speaker Change: With the ability to look at full year trend in 'twenty threes, I'll, let drew talk a little bit more about those mechanics.

Drew: Yes, so the PDR that we booked in the fourth quarter, that's for the 2024 calendar year. And so when you evaluate it in Medicare, you evaluate it on an annual basis. And so 25 really doesn't come into play there because we still have the opportunity to adjust our bids accordingly. And, obviously, we don't have a final rate notice yet. We just have the advance notice that.

Drew: Yeah. So the PDR that we booked in the fourth quarter, that's for the 'twenty 'twenty four calendar year, and so you you evaluate and Medicare you evaluate it on an annual basis.

Drew: So 25 really doesn't come into play there because we still have the opportunity to adapt our bids accordingly, and obviously, we don't have a final rate notice you had where you just have the advance notice that yeah. We've got some work to do on.

Drew: You know, we've got some work to do on the PDR. Think back to even Stephen's question. We sort of get another bite at the apple of evaluating forward trend because we set the PDR, and the accounting rules are such that you're setting the PDR based upon your forward view of how you think 24 is going to play out. So that was, you know, any trend considerations that we had were embedded in that PDR we booked in the fourth quarter. Thank you. And our next question today comes from Justin Lake at Wolf Research. Please go ahead.

Drew: On the P D R.

Drew: Back to even Stevens question.

Drew: We sort of get another bite at the Apple and are evaluating forward trend because we set the PDR and the accounting rules are such you're setting. The P. D are based upon your forward view of how you think 24 to play out so that was.

Drew: You know any trend considerations that we had were embedded in that a PDR, we booked in the fourth quarter.

Drew: Thank you and our next question today comes from Joe.

Joe: Ooh Research. Please go ahead.

Justin Lake: Thanks, good morning. Drew, I appreciate all the color on Medicare Advantage rates. You mentioned that your rate is minus 1.3%. If you're given trends in the mid-twos and you didn't really have much star impact year over year, it sounds like the combination of the model and the fee-for-service normalization is somewhere in the negative three and a half percent range.

Joe: Thanks, Good morning.

Joe: Drew appreciate all the color on Medicare advantage rates, you mentioned that your read is a minus one 3%.

Joe: Given trends in the mid twos and you didn't really have much star impact year over year. It sounds like the combination of the B 28 model and a fee for service normalization is somewhere in the negative three and a half per cent range.

Drew: First, is that math right? And then second, if so, can you compare the negative three and Seeing for 2025, at least in the advance notice. How big a negative that was in 2024, so we can understand the year-over-year kind of impact. And then, if you can, break up the impact between V-28... on both 2025 and year over year. It's going to be incredibly helpful to kind of understand what's going on there. Yeah, let me try to parse that out.

Joe: So first is that math right and then secondly, if so can you compare the negative three and a half that youre seeing for 2025 at least in the advance notice versus how big a negative that was in 2024. So we can understand the year over year or kind of impact and then can you. If you can break up the impact between <unk> 28.

Joe: For service normalization on both the 2025 and a year over year basis. It would be incredibly helpful to kind of understand what's going on there I appreciate it.

Speaker Change: Yeah, let me try to parse that out so the line item of HCC model changes, which includes the risk score normalization that you pointed out it was about a point in our evaluation of the advance notice is about a point worse than last year and part of that is the normalization Chi.

Drew: So the line item of HCC model changes, which includes the risk score normalization that you pointed out was about a point in our evaluation of the advance notice is about a point worse than last year. And part of that is the normalization change in calculation and going to like a regression model versus the omission of a base period. So that's probably as deep as we want to go on an earnings call. But if you foot up all of the elements, it's about 1.3% on an absolute basis, current as we stand today. Impact on rates. Now, that's before the risk score trend, obviously, that would push it into the positive zone. And, you know, we're going to push on some of the mechanics, and then we will, you know, we're in the position of not trying to grow Medicare Advantage; we're trying to ultimately recover margin back half of the decade. And so we'll just adjust the bids accordingly, and the products may be a little bit less attractive for seniors from an industry standpoint if we don't make a lot of progress on the final rate. Thank you. And our next question today comes from AJ Rice at UBS. Please go ahead. Thanks. Hi everyone.

Speaker Change: Range and calculation and going to like a regression model versus the omission of a base period. So that's probably as deep as we wanted to go on an earnings call, but if you put up all of the elements.

Speaker Change: It's about a one 3%.

Speaker Change: On an absolute basis.

Speaker Change: Current as we stand today impact on rates now that's before risk score trend, obviously that would push it into the positive zone.

Speaker Change: And you know, where we're going to push on some of the mechanics and then we will you know we're in the position.

Speaker Change: Not trying to grow Medicare advantage, we're trying to ultimately recover margin back half of the decade, and so we'll just adjust the bids accordingly, and the products, maybe a little bit less attractive for seniors from an industry standpoint, if we don't make a lot of progress on the final rates.

Speaker Change: Thank you and our next question today comes from AJ Rice of UBS. Please go ahead.

Speaker Change: Okay.

A J Rice: Thanks, Hi, everyone.

A J Rice: I just want to pivot over to Medicaid for a minute. Obviously, you mentioned the retro adjustments. You didn't get any marginal headwind, I guess.

A J Rice: Just wanted to pivot over to Medicaid for a minute.

A J Rice: Obviously, you mentioned the retro adjustments you didn't get marginal headwind I guess.

A J Rice: You've also talked about some states being proactive and giving you acuity adjustments ahead of time, and then you've got your normal rate cycle with the states. I wonder if there are any updated thoughts on where you land for 24 in terms of your Medicaid margin, and I think you had talked about the fact that coming out of redeterminations, you saw a potential for improvement in Medicaid margins going into 25. I just wondered if there were any updated thoughts on any of that. Yeah, thanks, AJ.

A J Rice: You've also talked about some states being proactive.

A J Rice: QED adjustments ahead of time, and then you've got your normal rate cycle with the states I Wonder if there's any updated thoughts on where your land for 'twenty four in terms of your Medicaid margin and I think you had talked about the fact that coming out of Redetermination.

A J Rice: You saw a potential.

A J Rice: Or improvement in Medicaid margins going into 25, I'm just wondering if there was any updated thoughts on any of that.

Speaker Change: Yeah. Thanks, a J, let me talk a little bit about the dynamic we saw in Q4 and then how we feel as we sit here in early February so full year H B R for Medicaid in 'twenty three it was really a function of our Q4 and what we saw in Q4 with some of that timing dynamic that we've called out since the beginning I've read.

Sarah E. James: Let me talk a little bit about the dynamic we saw in Q4 and then how we feel as we sit here in, you know, early February. So full year HBR for Medicaid in 23 was really a function of Q4. And what we saw in Q4 was some of that timing dynamic that we've called out since the beginning of redeterminations as a dynamic that we were fully expecting to be managing through the timing of matching rates with acuity as the risk pool shifts. So Q4 was a heavy member roll-off quarter, as we talked about. And later in the quarter, we saw some acuity pressure in the portfolio ahead of those 1-1 rates that had been designed to address that acuity clicking in. We also had some of those retro rates designed to address acuity coming in late in the year. And like we said, we got some of those before year-end, but not all. So we continue to work on those.

Speaker Change: The terminations of the dynamic that we were fully expecting to be managing through the timing of matching rate with acuity is the risk pool chefs. So Q4 was a heavy member roll off quarter as we talked about and later in the quarter. We saw some acuity a pressure on the portfolio ahead of those one one rates that had been designed to address that acuity.

Speaker Change: Clicking in we also had some of those retro rates also designed to address the acuity coming in late in the year and like we said we got some of those before year end, but not also continue to work on those that's really what drove that lingering pressure in Q4 and as we sit here today, we've got really solid visibility into the rate for.

Sarah E. James: That's really what drove that lingering pressure in Q4. And as we sit here today, we've got really solid visibility into the rate for our 2024 member months, 63% of the book we've got visibility for. We've got those 1-1 rates now in place, and they are, in general, coming in toward the higher end of that composite range that Drew mentioned at Investor Day of 2 to 2.5%. And then we're still working on that handful of 2023 retro rates that would then come in at 24. So you take that all together, and acknowledge it's still early in the year.

Speaker Change: Our 2024 member months, 63% of the book, we've got visibility for them. We've got those one run rates now in place and they are in general coming in towards the higher end of that composite range that drew mentioned at Investor day of 2% to 2.5%.

Speaker Change: And then we're still working on that handful of 2023 retro rates that would then come in in 'twenty four so when you take that altogether acknowledge it's still early in the year and that's that's what makes US feel good about our 90.1 midpoint for the 24 hour Medicaid H B R and then to your point.

Sarah E. James: That's what makes us feel good about our 90.1 midpoint for the 24 Medicaid HBR. And then, to your point, as any of those timing dislocations shake out in 24, and we continue to calibrate and match those up, then as we move into kind of the roll-off of redeterminations in 25 and beyond, that becomes a tailwind for the book overall. Thank you. And our next question today comes from Scott Fidel with Stevens. Please go ahead. Hi, thanks. Good morning.

Speaker Change: As though any of those timing dislocation.

Speaker Change: Shake out in 'twenty, four and we continue to calibrate and match those up then as we move into kind of the roll off of Redetermination.

Speaker Change: In 'twenty, five and beyond that becomes a tailwind for the Buck overall.

Speaker Change: Thank you and our next question today comes from Scott Fidel with Stephens. Please go ahead.

Scott J. Fidel: Hi, Thanks, Good morning, guys.

Scott J. Fidel: Just wanted to pivot back to Medicare and just interested if you could sort of talk through for us just on the inpatient side. It doesn't seem like you saw anything unusual in the fourth quarter, but I do want to confirm whether or not you did see any type of mixed shift towards more short stay inpatient visits and a reduction in observation visits, as mentioned by a large peer in Medicare. And then, just sort of sticking on this potential theme, would love just your feedback and sort of thoughts around the implementation of the two-midnight rule for MA and how you're factoring that into your 2024 outlook. Thanks.

Scott J. Fidel: I wanted to pivot back back to Medicare and just interested if you can sort of talk through for US just on the inpatient side. It doesn't seem like you saw anything unusual in the fourth quarter, but I do want to confirm whether or not you did see any type of mix shift towards more short stay inpatient visits and reduction.

Scott J. Fidel: And in an observation visits as as mentioned by a large peer of.

Scott J. Fidel: And Medicare and then just sort of sticking on this.

Scott J. Fidel: Potential theme would love just your feedback in and sort of thoughts around the implementation of the two midnight rule for M&A and how you're factoring that into your 2024 outlook. Thanks.

Drew: Yeah, thanks, Scott. As Sarah said, at the high level, inpatient was pretty steady throughout 2023. And if you go a couple of clicks below that, we looked at case mix, admits per thousand, and alts per thousand. We didn't see a Q4 uptick in inpatient.

Speaker Change: Yeah. Thanks, Scott as Sarah said at a high level inpatient was pretty steady throughout 2023 and you go a couple of clicks below that we looked at case mix add minutes per thousand offs per thousand.

Speaker Change: We didn't see a Q4 uptick in inpatient.

Drew: If you look at observation days, we saw no meaningful shift in observation days. You know, we all know the two midnight rule doesn't start till 1-1-24. But we've been on top of that, you know, preparing for that, thinking through that as we formulated our forecast for 2024. And we think we've got that nailed. And obviously, you know, the industry; we can still do medical necessity on that. But yes, we'll be observing that two midnight rule beginning in January.

Speaker Change: If you look at observation days, we saw no meaningful shift in observation days you know, we all know the two midnight rule doesn't start till one 124, but we'd been on top of that you know preparing for that thinking through that as we formulated our forecast for 2024, and we think we've got that captured and obviously you know the industry, we can still do more.

Speaker Change: Medical necessity on that but yes, we'll be observing that two midnight rule beginning of January.

Speaker Change: Thank you and our next question today comes from with.

Speaker Change: <unk> with Bernstein. Please go ahead.

Drew: Thank you. And our next question today comes from Lance Wilkes with Bernstein. Please go ahead.

Speaker Change: Great could you talk a little bit about.

Speaker Change: The pipeline and some of the upcoming bids with respect to Medicaid or some of the upcoming are a few awards and then more broadly.

Lance Arthur Wilkes: Great. Could you talk a little bit about the pipeline and some of the upcoming bids with respect to Medicaid or some of the upcoming RFP awards? And then more broadly, Sarah, if you could talk a little bit about, as you've gone through some of the recent wins, and as you're looking at satisfaction scores within states, what are areas of strength that are helping you with either retention or new wins? And are there particular areas of opportunity?

Speaker Change: If you could talk a little bit too as you've gone through some of the recent wins and as Youre looking at satisfaction scores within states. So what are the areas of strengths strengths that are helping you with either retention or new wins and are there particular areas of opportunity and what are some of the plans to address some of those areas. Thanks.

Speaker Change: Yeah. Thanks Lance for the question.

Speaker Change: So as you as you pointed out we've had some great positive momentum of late with our New Hampshire, Arizona, and North Carolina expansion and as well as Oklahoma and that makes us feel good as we roll into you know what's an active RFP season, we obviously have Florida in flight and really proud of the sons.

Sarah E. James: And what are some of the plans to address some of those areas? Thanks. Yeah, thanks, Lance, for the question. So, as you pointed out, we've had some great positive momentum of late with New Hampshire, Arizona, North Carolina expansion, as well as Oklahoma. And that, you know, makes us feel good as we roll into, you know, what's an active RFP season. We obviously have Florida in flight and are really proud of the Sunshine team and the work they're doing, as well as Georgia and then Texas for later this year in 2025.

Speaker Change: Fine team and the work, they're doing them as well as Georgia, and then Texas for a later this year and 2025 go lives. So we continue to track that and we continue to have I believe the best BD team in the business incredibly strong local teams that are being really thoughtful and incrementally.

Speaker Change: <unk> forward looking in terms of you know as we said at Investor day, making sure that we're competing on promises kept not just promises made and so that I think goes to the second part of your question, which is really what are we seeing in the market in terms of the investments we've made over the last two years around a customer satisfaction and.

Sarah E. James: So we continue to track that. We, you know, continue to have, I believe, the best BD team in the business, incredibly strong local teams that are being really thoughtful and incrementally forward looking in terms of, you know, as we said on Investor Day, making sure that we're competing on promises kept, not just promises made. And so that, I think, goes to the second part of your question, which is really, what are we seeing in the market in terms of the investments we've made over the last two years around customer satisfaction and that local community partnership? And we're really starting to see improvement in terms of partner satisfaction, provider relationships, as well as quality. So if you look at our Medicaid quality scores year over year, you're seeing really nice improvement there. Those have been things at the top of our list in terms of focus over the last two years, and I think we are starting to see those bear fruit. Those are really important drivers as states think about who they want as partners in the managed Medicaid business.

Speaker Change: That that local community partnership.

And we're really starting to see improvement in terms of partner satisfaction provider relationships.

Speaker Change: As well as quality. So if you look at our Medicaid quality scores year over year, you're seeing really nice improvement there those have been things at the top of our list in terms of focus over the last two years and I think starting to see those bear fruit. Those are really important drivers as states think about who they want as partners relative to them.

Speaker Change: Managed Medicaid business I would say the other major theme that we continue to hear and we continue to be focused on pretty organically frankly is health equity and so the emergence of the 11th 15 waivers and thinking about how to put dollars into things like housing food jobs childcare that ultimately drive pretty significant.

Sarah E. James: I would say the other major theme that we continue to hear and that we continue to be focused on pretty organically, frankly, is health equity. And so the emergence of the 1115 waivers and thinking about how to put dollars into things like housing, food, jobs, and child care that ultimately drive pretty significant health care outcomes, and that's something that states are increasingly interested in partnering over. Again, something that CENTENE has been naturally focused on as a byproduct of being local in our approach and having the strength of those longstanding incumbent relationships. So I think really good improvement in the places that we've focused on and really good core strength in the areas that are going to matter going forward. Thank you. And our next question today comes from Cal Stomach with J.P. Morgan. Please go ahead. Yeah, thanks for the question. Why don't I ask two in the market?

Speaker Change: Health care outcomes, and that's something that states are increasingly interested in partnering over again something that centene has been naturally focused on as a byproduct of being local in our approach and having the strength of those long standing incumbent relationships. So I think really good improvement.

Speaker Change: In the places that we've focused and really good core strength in the areas that are going to matter going forward.

Speaker Change: Thank you.

Speaker Change: So the so called stomach with J P. Morgan. Please go ahead.

Speaker Change: Yeah. Thanks for the question I wanted to ask you on the marketplace. So first can you talk about the demographic trends and the incremental membership you got so any insight on the acuity in metal mix of the extra members you added compared to what you initially anticipated.

Cal Stomach: So first, can you talk about the demographic trends of the incremental membership you got? So any insight on the acuity and metal mix of the extra members you added compared to what you initially anticipated? And then on ICRA and the Indiana pilot, how many members did you enroll in that product? And what are some of the key milestones you're looking to evaluate the pilots move through this year? Thanks.

Speaker Change: And then on the Indiana pilot, how many members did you enroll in that product and what are some of the key milestones you are looking to evaluate the pilot has moved through this year.

Speaker Change: Thanks, Colin for the question. So as you heard the demographics for that population that came in during OE piece for us are pretty consistent with our expectations and the distribution of tiers between silver gold and bronze also pretty consistent we still have the majority of our men.

Sarah E. James: Thanks, Cal, for the question. So, as you heard, the demographics for the population that came in during OEP for us were pretty consistent with our expectations. And the distribution of tiers between silver, gold, and bronze was also pretty consistent.

Speaker Change: <unk> in those in that silver tier so the demographics have not shifted materially one of the things that I think is interesting. This may just be the data geek in me, but if you look at what we're seeing not just in our book, but overall in the market. There are some interesting small shifts in the demographics overall that I think tell us.

Sarah E. James: We still have the majority of our members in those in that silver tier. So the demographics have not shifted materially. One of the things that I think is interesting, this may just be the data geek in me, but if you look at what we're seeing, not just in our book, but overall in the market, there are some interesting small shifts in the demographics overall that I think tell us a lot about what's actually driving the underlying growth above and beyond just what we know in terms of affordability and awareness from the enhanced APDCs and the additional marketing dollars going So we're seeing, year over year over year, the age coming down slightly, which I think supports our view that we're seeing a younger pool, we're seeing a healthier pool, and we're seeing some of those gig workers coming into the market. We're seeing the distribution in gender between male and female shift a little bit, so more men are coming into the marketplace, which we see as a signal of digging deeper into that uninsured population because women tend to move out of that population sooner.

Speaker Change: A lot about what's actually driving the underlying growth above and beyond just what we know in terms of affordability and awareness from then enhanced a P. D season, the additional marketing dollars going into navigators in the broker channel. So we're seeing year over year over a year age coming down slightly with which I think supports our.

Speaker Change: Our view that we're seeing a younger pool, we're seeing a healthier pool and we're seeing some of those gig workers coming into the market.

Speaker Change: We're seeing that the distribution between engender between male and female shift a little bit so more more men coming into the marketplace, which we see as a signal of digging deeper into that uninsured population because women tend to move sooner out of that population and then we're also seeing the gold.

Sarah E. James: And then we're also seeing the gold tier as an industry tick up a little bit, which we see as supporting our view that there's small group migration coming into the market. Obviously, we've got anecdotal evidence around that, but that's true in our book, that's true in the overall industry, and again, very consistent with what we think is driving sort of 31% overall market growth. But pleased as well with the fact that within that growth, we were able to grow our market share within our footprint. And then, relative to ICRA, obviously, that's still very much a nascent market. The Indiana pilot is very new.

Speaker Change: Here is an industry tick up a little bit, which we see is supporting our view that their small group migration coming into the market I'm. Obviously, we've got anecdotal evidence around that but that's true in our book that is true in the overall industry and again I think very consistent with what we think is driving sort of 31% overall market growth, but but please as well.

Speaker Change: With the fact that within that growth, we were able to grow our foot or our market share within footprint.

Speaker Change: And then relative to aircraft.

Speaker Change: Obviously, that's still very much a nascent market. The Indiana pilot is very new I'm happy to say that we sold our first customer in January. So are good early proof point, but the goal there for us is really to test and learn and gather data and we're pretty confident that we're gonna be incrementally smarter about how that market is evolving as we go.

Sarah E. James: I'm happy to say that we sold our first customer in January, so a good early proof point. But the goal there for us is really to test and learn and gather data. And we're pretty confident that we're going to be incrementally smarter about how that market is evolving as we go throughout the year. Thank you. And our next question today comes from Gary Taylor at TD Cowens. Please go ahead. Hi, good morning.

Speaker Change: Throughout the year.

Speaker Change: Thank you and our next question comes from.

Gary Taylor Citi Cowen. Please go ahead.

Speaker Change: Yeah.

Gary Taylor: Hi, good morning.

Gary Taylor: One clarification, one question. I just want to clarify, Drew, on the negative 1.3 percent, 25 advance notice for Centene, if that excludes stars or basically assumes for Centene no different stars impact than the negative 15 basis points that CMS size for the industry. And then my question is, I just wanted to see if you could just balance these very diverse views on MA.

Gary Taylor: One clarification one question I just wanted to clarify drew on the negative one 3% twenty-five advance notice for Centene.

Gary Taylor: Yes that excludes stars are basically as soon as for Centene no different stars impact with the negative 15 basis points that CMS sized.

Speaker Change: For the industry and then my question is I just wanted to see if you could just balance. These these very diverse views on EMEA.

Gary Taylor: Your MAMLR first nine months was down 110 basis points year over year, and the fourth quarter was up 310 excluding the entire PDR. And you only boosted the PBR by 50 million, or 30 basis points on 24. You said your MA outlook looks unchanged. So there are two camps this quarter.

Speaker Change: M. A MLR first nine months was down 110 basis points year over year fourth quarter was up 310, excluding the entire PDR.

Speaker Change: And you're only boosted the PDR by 50 million or 30 basis points. On 24, you said your M&A outlook looks unchanged. So theres two campus this quarter theirs.

Drew: Centene and United saying the sharp fourth-quarter MA MLR spike means nothing for 24, and then there's Humana, who said the sharp spike in the quarter is the new baseline heading into 24, so it's been a while since I've seen such divergent views across the industry that all had sort of the same cost acceleration, so can you just explain again why you're landing where you're landing on 2024 MA? Alright, so let me take the first one first. So of the 1.3, of the minus 1.3 percent, our star rating change is minus 0.5. So absent that, we'd be at minus 0.8. So it's a little bit heavier than the industry as a whole, which I believe CMS was at minus 0.2. So hopefully, that helps with the math there.

Speaker Change: <unk> and United saying, this sharp fourth quarter and a MLR spike means nothing for 24, and then Theres Humana, who said the sharp spike in the quarter.

Speaker Change: Is the new baseline heading into 'twenty four so it's been awhile since ive seen such divergent views across the industry that all had sort of the same cost acceleration. So can you just explain again why you're landing where you're landing on 2024 at midnight.

Speaker Change: Alright, So let me take the first one first so of the 1.3 of the minus one 3% our star rating changes minus 0.5.

Speaker Change: So absent that we'd be at minus 0.8.

Speaker Change: So, it's a little bit heavier than the industry as a whole, which I believe CMS was that minus point too. So hopefully that helps with the math there on Medicare.

Drew: On Medicare, you know, Sarah said, look, we're looking hard at our outpatient trend, which we're not happy with, but it's steady at that elevated level relative to May, June timeframe. And that's sort of what we built in the forecast. So that would be a change year over year. Inpatient, we talked about that.

Speaker Change: Erez said, we're look we're looking hard at our outpatient trend, which we're not happy with but it's steady at that elevated level relative to May June timeframe, and that's sort of what we built into the forecast so that would be a change year over year.

Speaker Change: Inpatient and we talked about that I mean, no uptick as we've noted as we said earlier.

Drew: I mean, no uptick, as we said earlier. Maybe one of the elements that may be a little bit unique with us is that, as we see the year developing, and there's a dial we have on quality spend and initiatives, and there are a lot of quality initiatives that we're going to do regardless of what our aggregate EPS result is, but we really stepped that up in Q4, and that triggered, you know, a higher level of office visits, which is a good thing, getting It triggered the RSV vaccines, which is a good thing, and we saw that coming through in December, and as Sarah mentioned, we did have ILI.

Speaker Change: Maybe one of the elements that maybe a little bit unique with us is that as we see the year developing and we there's a dial we have on quality spend and initiatives and theres a lot of quality initiatives that we're gonna do regardless of what our aggregate EPS result is but we really stepped that up in Q4.

And that triggered.

Speaker Change: You know a heavier level of office visits which is a good thing getting our members and to see their physicians. It triggered RSV vaccines, which is a good thing and we saw that coming through in December and as Sarah mentioned, we did have ili the only area of the business, where I L I influenza like illness.

Drew: The only area of the business where ILI, influenza-like illness, was higher year over year was Medicare, and obviously that's transitory. It's already come down in January, so those are the other elements that you should think about when evaluating Q4, but we feel good about our forecast. We had another bite at the apple on the PDR, Gary.

Speaker Change: It was heavier year over a year was in Medicare and obviously, that's transitory it's already come down in January. So those are the other elements that you should think about when evaluated in Q4, but we feel good about our forecast we had another bite at the Apple on the PDR areas. If we thought China was going to be 50 million higher than the $2 50.

Drew: If we thought the trend was going to be $50 million higher than the $250 million next year, the PDR would have been $300 million, and we were reported $6.61 or something like that, so we feel good about our forecast. We've got work to do in Medicare to improve the macro, but... We're ready to tackle 2024. Thank you. And our next question comes from George Hill with Deutsche Bank. Please go ahead.

Speaker Change: In next year, the PDR would have been 300 million and you know we were reported a $6.61 or something like that so I feel good about our forecast.

Speaker Change: Work to do in Medicare to improve the macro but.

Speaker Change: We're ready to tackle 'twenty 'twenty four.

Thank you and our next question comes from George who was supposed to be.

George Hill: Yeah, good morning, guys. Yeah, I actually want to ask Gary's question kind of in a slightly different way and kind of focus on what seems to be kind of two different narratives as it relates to the utilization trend, I guess, more broadly. And one is kind of the seasonal utilization of this, The next slide, please. And there's another narrative that the trend is running below baseline on an adjusted basis because of the impact of COVID, and now we have kind of a three-year heightened utilization trend to get back to baseline. So I guess I'd ask you if you kind of have a, And then the deferred utilization narrative that you guys are saying is that, like, are we kind of working through this short-term backlog as it relates to utilization that should normalize, or are we running below a longer-term trend that we need to return to, likely, a verbal tier-based approach? Yeah, I mean, I certainly prefer our narrative, and I think about it in terms really specific to Centene.

George: Yeah, Good morning, guys.

George: Yeah actually when I ask Gary's question kind of a slightly different way and kind of focusing on what seems to be kind of two different narratives as it relates to the utilization trend.

George: I guess more.

George: More broadly.

George: And one is kind of the it's like there is this seasonal utilization of this list.

George: Come through that now needs to be.

George: My baseline trend that is normal X the seasonality or the bolus and there's another narrative that is a trend is there any below baseline cool.

George: <unk> basis, because of the impact of Covid. It now we have a kind of a three year heightened utilization trend to get back to baseline.

Speaker Change: Sure I guess I would ask you if you kind of have a.

Speaker Change: Preferred utilization narrative, you guys Youre, saying like are we kind of working through this short term backlog as it relates to utilization that should normalize or are we running below our longer term trend that we need to return back to likely for a multi year basis.

Speaker Change: Yeah, I mean, I, certainly prefer our narrative and I think about it really specific to centene. So I appreciate the need to try to harmonize what different companies are saying that we remain focused on what we're seeing in our population. The idea that we saw some of this trend in Q2.

Sarah E. James: So I appreciate the need to try to harmonize what different companies are seeing, but we remain focused on what we're seeing in our population. The idea that we saw some of this trend in Q2, that we accounted for it in our 2024 bids, we feel sufficiently, we had a second bite at the apple at the end of the year with the benefit of the full year's visibility of utilization, the assumptions that we've made in 2024, how we feel about our ability to, you know, apply clinical initiatives, leverage our value-based relationships and manage through the trend that we're seeing.

Speaker Change: That we accounted for it in our 'twenty 'twenty four bids we feel sufficiently we had a second bite at the Apple at the end of the year with the benefit of the full year's visibility of utilization the assumptions that we've made in 'twenty 'twenty four how we feel about our ability to.

Speaker Change: You know apply clinical initiatives leverage our value based relationships and managed through the trend that we're seeing that's really our focus less so worrying about what others are saying.

Operator: Thank you. And our next question today comes from Dave Windley with Jeffries. Please go ahead.

Speaker Change: Thank you and our next question today comes from Dave Windley with Jefferies. Please go ahead, hi, Thanks for taking my questions. So I wanted to clarify and then ask the question. So drew you mentioned you've actually both mentioned second bite at the Apple a couple of times I wanted to make sure I understood.

Dave Windley: Hi, thanks for taking my question. So I wanted to clarify and then ask the question. Drew, you mentioned, you've actually both mentioned Second Bite at the Apple a couple of times.

Dave Windley: I wanted to make sure I understood that that was a second bite opportunity kind of up to the end of the year, or does that mean if things develop in a way that causes you to have a different view of 2024, kind of, currently, that you could go back and revise your estimate for PDR. So I wanted to clarify that. And then my question rotating over to SG&A is, where are you related to headcount rationalization, real estate rationalization, other things kind of on the basic cost cutting value creation plan list, leaving out SG&A. Where do you stand in that evolution?

Dave Windley: But that was a second bite opportunity kind of up to the end of the year or does that mean, if things develop in a way that causes you to have a different view of 'twenty 'twenty four kind of.

Dave Windley: Currently that you could go back and revise your estimate for P. D. R. So wanted to clarify that and then my question rotating over to SG&A is where are you related to head count rationalization, our real estate rationalization other things kind of on the basic cost cutting value creation plan.

Dave Windley: List to take out SG&A, where do you where do you stand in that evolution. Thank you.

Drew: Thank you. Yes, so many good questions around the PDR. And look, we don't love being in a PDR position.

Speaker Change: Yes, so good questions around the P. D R and look we don't love being in the PDR positioned but we've got work to do on Medicare, but it did give us an opportunity to reevaluate a 24 forecast as we got into January and closed the December books.

Drew: But you know, we've got work to do on Medicare, but it did give us an opportunity to reevaluate a 24-month forecast as we got into January and closed the December books. And what will happen mechanically throughout 2024 is that, you know, that PDR will largely be released in forecasted to be released in Q4, because of the mechanics of the seasonality of earnings in Medicare throughout the year. But every quarter, we reevaluate the sufficiency of that PDR relative to the 24 policy and calendar year.

Speaker Change: And what will happen mechanically throughout 'twenty 'twenty four is that you know that PDR will largely be released and are forecasted to be released in Q4 because of sort of the mechanics of the seasonality of earnings in Medicare throughout the year, but every quarter, we reevaluate the sufficiency.

Speaker Change: That P. D are relative to the 24 policy in calendar year and you know if you have to tweak it we will but that would be within the confines of 'twenty 'twenty four.

Drew: And, you know, if we have to tweak it, we will, but that would be within the confines of 2024. On SG&A, there is still plenty of opportunity ahead. I mentioned at investor day that we've got at least a couple hundred basis points more in Medicare that we've got to go after over the next few years. On real estate, largely through that, probably some tweaks here and there, but largely through, for instance, the charges around real estate, you know, we're through the bullets of that. And then we've got our slate of initiatives that we continue to tackle. Lots of efficiency opportunities. Yeah, I would echo that and just say that, you know, a lot of great execution in the first two years; we're going to realize that in 2024. But we haven't stopped.

Speaker Change: On SG&A still plenty of opportunity ahead I mentioned.

Speaker Change: Investor Day that we've got at least a couple of hundred basis points more in Medicare. We've Gotta go after over the next few years.

Speaker Change: On real estate largely through that probably have some tweaks here and there but largely through.

Speaker Change: For instance, the charges around real estate, you know where were.

Speaker Change: Through the bolus of that and.

Speaker Change: And then we've got our slate of initiatives that we continue to tackle and.

Speaker Change: Plenty of efficiency opportunities.

Speaker Change: Yeah, I would echo that and just say that you know a lot of great execution in the first two years, we're going to realize that in 'twenty 'twenty four but we haven't stopped them and you've heard us talk about building the pipeline for 2025 and beyond in terms of additional opportunities. Obviously, our long term algorithm has wanted to 2% of margin expansion built in them and we do.

Sarah E. James: And you've heard us talk about building the pipeline for 2025 and beyond in terms of additional opportunities. Obviously, our long-term algorithm has one to 2% of margin expansion built in. And we do see additional opportunities to drive efficiency in the business. As we standardize our workflows, the ability to then automate that with technology. So really pleased, not just with the execution thus far and the discipline to get us here, but really thinking about how we do work going forward. We do see opportunities for continued efficiency in the future. Thank you, and our next question today comes from Sarah James at Cantor. Please go ahead. Thank you. Could you remind us what the margin progression looks like on exchanges, like how many quarters it takes for you to get to the run rate? And then just some clarification on the PDR.

Speaker Change: See additional opportunities to drive efficiency in the business as we standardized our workflows the ability to then automate that with technology and so really pleased not just with the execution, thus far and the discipline to get us here, but really thinking about how we do work going forward, we do see opportunity for continued.

Speaker Change: Efficiency in the future.

Speaker Change: Thank you and our next question today comes from Sarah James of action for such a cancer. Please go ahead.

Speaker Change: Yeah.

Sarah E. James: Thank you could you remind us what the margin progression looks like on exchanges like how many quarters. It takes for you to get to run rate and then just the mechanics clarification on the PDR are you guys booking that as the delta between where you view costs and.

Sarah E. James: Are you guys booking that as the delta between where you view costs and target margin, where you know it would roll over kind of flat at target margin from 24 to 25, or is it that you're booking it as the view of cost to break even? If you can give us the context of that. Yeah, on your second question, it's really neither of those.

Sarah E. James: Target margin.

Sarah E. James: Hmm.

Sarah E. James: Where you know it would rollover kind of flat at target margin from 24 to 25 or is it that youre booking it as the view of course to breakeven I'm speaking to give us the context of that.

Speaker Change: Yeah on your second question, it's really neither of those is sort of the accounting principle on the marginal loss.

Drew: It's sort of the accounting principle of marginal loss. So it excludes things like marketing costs and certain investments, so think of it as the marginal loss that we're pulling into the year in which we set the bids. So certainly, it's not booked anywhere near target margins. We've got a lot of work to do to go from essentially a minus three and a half percent expected reported margin in 2024 to that four to 5% pre-tax zone as we look later in the decade. So STARS will probably be two thirds of that progression.

Speaker Change: So it excludes things like marketing costs and certain investments. So it's think of it as the marginal loss that we're pulling into the year in which we set the bids. So certainly it's not booked on it yes nowhere near our target margins. We've got a lot of work to do to go from.

Speaker Change: Essentially a minus three 5% expected reported margin in 'twenty 'twenty four two you know that 4% to 5% pre tax zone. As we look at you know later later in the decade. So starz will probably be two thirds of that progression and like I said, we still have SG&A and.

Drew: And like I said, we still have SGNA and clinical initiatives. And it is interesting that we're spending so much time on 12% of our revenue, $16 billion, an important lever, but we actually have some pretty good other businesses like Marketplace that you just asked about. The margin progression we expect, you know, it's the sophomore year in which we pick up the benefit of the SEP, Special Enrollment Period, members that come in for a couple of reasons. One is they're typically utilizing some degree of services, and they get out of the way and then become more normalized in the following calendar year.

Speaker Change: Clinical initiatives.

Speaker Change: And it is an interesting we're spending so much time on 12% of our revenue 16 billion important lever, but we actually have some pretty other good businesses like marketplace that you just asked about the margin progression, we expect the sophomore year in which we pick up the benefit of the S. P.

Speaker Change: Special enrollment period members that come in for a couple of reasons. One is there typically utilizing some degree of services and they get out of the way and then become more normalized in the following calendar year.

Drew: And also, the risk adjustment, the mechanics are punitive to some degree if you're only picking up a partial year, and then when you get a full calendar year, you have sort of the numerator and denominator sort of matching up. So we expect the benefit of last year's SEP members. If we continue to grow SEP, which isn't baked into our guidance yet, we're just at 4.3 million members, but if we continue to grow during 2024, that will be an expected tailwind for 2025.

Speaker Change: And then also the risk adjustment. The mechanics are are punitive to some degree if you're only picking up a partial year and then when you get a full calendar year, you have sort of a numerator and denominator sort of matching up. So we expect the benefit of last year's S. U P. Members. If we continue to grow F C P, which that's not baked into our.

Speaker Change: Guidance, yet we're just at $4 3 million members, but if we continue to grow during 2024 that will be unexpected tailwind for 2025 and on that point I would just note that we're seeing them increase year over year in retention of S. E T and members, which means that we're poised to capture the burner.

Sarah E. James: On that point, I would just note that we're seeing increased year over year in retention of SEP members, which means that we're poised to capture the benefit of that sophomore effect from that heavy growth we had in SEP last year. So that's a really nice trend that we've been watching and seeing retention grow year over year. Thank you. And our next question today comes from Nathan Rich at Goldman Sachs. Please go ahead.

Speaker Change: If it of that sophomore effect from that heavy growth we had in S. E. P last year. So that's a really nice trend that we've been watching and seeing that retention grow year over year.

Speaker Change: Thank you and our next question comes from Nathan Rich Goldman Sachs. Please go ahead.

Nathan Rich: So, I'll ask one on the Medicaid business. I wanted to, you know, it sounds like the HBR, so far as redeterminations have played out, has been in line with expectations. The 24 guidance has that, you know, 50 basis point headwind that was, I think, put in place for any sort of timing mismatch as it relates to acuity. I just wanted to clarify if that's something that you're seeing currently, and so, reiterating your expectations for 24, you feel like what you've seen play out so far requires that 50 basis points, or if the timing between the rate updates and, you I would say, at a high level, we're pretty pleased, just given the complexity of the portfolio and all the state-by-state dynamics, with the degree to which acuity and rate have matched up relative to timing, although obviously not perfect.

Nathan Rich: So I'll ask one on the the Medicaid business I wanted to you know it sounds like the H B R. So far as the Redetermination have played out has been in line with expectations. The 24 guidance has that 50 basis point headwind.

Nathan Rich: That was I think put in place for any sort of timing mismatch as it relates to acuity I just wanted to clarify if that's something that you're seeing currently and so you know reiterating your expectations for 'twenty four you feel like what you've seen play out. So far you know requires that 50 basis points.

Nathan Rich: Or if the timing between the rate update.

Nathan Rich: And you know the cost you are seeing in the underlying book if that timing has actually been matched up better than you had anticipated.

Nathan Rich: I would say at a high level, we're pretty pleased just given the complexity of the portfolio and all of the state by state dynamics with the degree to which acuity and rate have matched up relative to timing, obviously not perfect. We talk about what we saw in Q4 mm but across the entire.

Sarah E. James: We talk about what we saw in Q4, but across the entire portfolio, feeling pretty good about that, which is, again, part of why we're so confident in that 90.1 midpoint. But maybe, Drew, you can talk a little bit about risk corridors and other dynamics that we're tracking relative to that 50 basis points buffer. Yeah, so you also have to remember that we've got PBM savings rolling into that. We targeted that at 20 basis points, so that's sort of a nice lever that we factored into sort of getting down to 90.1.

Nathan Rich: Portfolio, feeling pretty good about that which is again part of why we're so confident in that 90.1 mid point, but maybe you can talk a little bit about sort of risk corridor and the other dynamics that you know we're tracking relative to that 50 basis point buffer. Yeah. So you also have to remember we've got a P. B M savings rolling into that we'd TARP.

Nathan Rich: But of that 20 basis points, so that would be that that's sort of a nice lever that we've factored into sort of getting down to the 90.1 and then as we think about a question from earlier 25 2026, we would expect to get back into the high 80 nines on a same mix basis.

Drew: And then, as we think about a question from earlier, on April 25, 2026, we would expect to get back into the high 89s on a same-mix basis. From a risk corridor standpoint, while it's imperfect in terms of a buffer, depending on where you have sort of trend or rate pressure, we're still at about $1.8 billion in payback for the 2023 year. So we're still in a pretty heavy payback position for our Medicaid risk corridors and minimum MLRs. It's not across every state, but it's spread across a number of states, and that is something else to think through as we think about the future and rate action and matching acuity with rates.

Nathan Rich: From a risk corridor standpoint, well, it's imperfect in terms of a buffer depending on where you have sort of trend or rate pressure. We're still worried about 1.8 billion and payback for the 'twenty two 'twenty three year. So we're still in a pretty heavy payback.

Nathan Rich: Position for our Medicaid risk corridors and minimum MLR ours.

Nathan Rich: It's not across every state, but it's spread across a number of states and that is something else to think through as we think about.

Nathan Rich: The future and you know rate action and matching acuity with rates.

Drew: Thank you, and ladies and gentlemen, this concludes our question and answer session. I'd like to turn the conference back over to the management team for any closing remarks... All right. Thanks, Rocco. Thanks, everyone, for your time and interest this morning. We look forward to providing updates as we move deeper into 2024. Thank you. This concludes today's conference call. We thank you all for attending today's presentation. You may now disconnect your lines and have a wonderful day. BF-WATCH TV 2021, The Ultimate Parody Site! BF-WATCH TV 2021

Speaker Change: Thank you ladies and gentlemen, this concludes our question and answer.

Speaker Change: I'd like to turn the conference back over to the management team for any closing.

Speaker Change: Great. Thanks, Rocco and thanks, everyone for your time and interest. This morning, we look forward to providing updates as we move deeper into 2024.

Thank you. This concludes today's conference call. We thank you all for attending today's presentation you.

Speaker Change: You may now disconnect your lines and have a wonderful day.

Speaker Change: Okay.

Speaker Change: [music].