2023-12-05 CVS Health.Investor Day

Larry McGrath Executive VP, Chief Strategy Officer & Chief Strategic Advisor to the CEO

\[Presentation]

All right. Good morning. Thank you all for joining us for the CVS Health 2023 Investor Day. My name is Larry McGrath. On behalf of the entire CVS Health team, I'd like to extend a warm welcome to you all joining us here in person in Boston or online through the webcast.

大家早上好，感谢大家参加 CVS Health 2023 年投资者日活动。我是 Larry McGrath。代表 CVS Health 全体团队，热烈欢迎今天亲临波士顿现场或通过网络直播参加的各位来宾。

So before we jump in, please note that the usual cautionary statements and the safe harbors apply, displayed here on screen, they're in the presentations. I would also encourage you to consult our risk factors on file with the SEC and in our latest reports on file, Form 10-K, 10-Q and 8-K.

在我们正式开始之前，请注意通常的警示性声明和免责条款适用于本次活动，相关内容已在屏幕和演示材料中显示。我们也建议您查阅我们向美国证券交易委员会（SEC）提交的风险因素，以及最新的 10-K、10-Q 和 8-K 报告。

All right, for the agenda. So Karen is going to start the day, providing a strategic update and also giving some important updates on each of our businesses. Tom is then going to follow with our financial strategy and outlook. We're then going to give you guys a break. And then after the break, we'll dig deeper into each of our core businesses, sharing our outlook, demonstrating how we are creating economic flywheels across CVS Health, and we're also going to show you how we're measuring success. Then we'll give you another break. And then after that, we'll conclude with a Q\&A session with the entire CVS Management team.

接下来介绍一下议程安排。首先由 Karen 带来战略更新，并对我们各项业务进行重要说明。随后 Tom 将介绍我们的财务战略和前景。之后大家将有一个短暂的休息时间。休息之后，我们将深入探讨各个核心业务，分享未来展望，展示 CVS Health 如何打造经济飞轮效应，并说明我们如何衡量成功。再给大家安排一次休息，之后是 CVS 高管团队的问答环节，为本次会议画上圆满句号。

So with that, it's my distinct pleasure to invite on stage, our President and Chief Executive Officer, Karen Lynch.

下面，我非常荣幸地邀请我们公司总裁兼首席执行官 Karen Lynch 登台发言。

Karen Lynch Former Executive VP & President of the Aetna

Good morning. Thank you all for joining us today. We are so excited about the opportunity to share our strategy with you and give you an update on our performance since the last time we spoke, which was actually 2 years ago, and it is incredibly hard to believe that it's been 2 years.

大家早上好，感谢各位今天的到来。我们非常高兴有机会与大家分享我们的战略，并介绍自上一次沟通以来的业务进展——那次已经是两年前了，真的很难相信时间过得这么快。

Since that time, we have made significant progress on becoming the leading health solutions company. Our mission remains the same: to build a world of health around the consumer. As a company, we are dedicated to unlocking the value in health care by delivering superior experiences, improving health and lowering the total cost of care. And we'll do this by engaging people to manage their health more conveniently and with the care and the coverage that they need to make healthier lives happen.

在过去两年中，我们在成为领先的健康解决方案公司方面取得了重大进展。我们的使命始终未变：围绕消费者打造一个健康世界。我们致力于通过提供卓越体验、改善健康状况、降低整体医疗成本，从而释放医疗价值。我们会通过让人们更便利地管理自身健康，并获得所需的照护与保障，来实现更加健康的生活。

We're doing this at a time when there are significant macro trends affecting health care. You all know consumer health is worsening. The operating environment in which health care is existing today is becoming way more complex. Government spending is shifting towards value-based care and health care costs are continuing to climb. It's our time now to drive fundamental restructuring in how health care is delivered, how, by whom and where. It's needed and it's necessary.

而我们是在宏观环境剧烈变化的背景下进行这些变革的。大家都知道，消费者健康状况正在恶化，医疗服务的运营环境变得日益复杂。政府支出正向价值导向型照护（value-based care）转移，而整体医疗成本仍在上升。现在是我们推动医疗服务根本性重构的时机——要重新定义服务方式、服务主体与服务场所。这是市场的需求，也是我们的责任。

Addressing these challenges means that we successfully need to engage people in their overall health and in moments that matter, and that could make a critical difference. As a company, we're building a world of health around the consumer to do just that. Achieving our vision requires the right set of capabilities to serve a broader patient, to serve a broader consumer and to serve a broader community, while at the same time, unlocking sustainable shareholder value with our integrated solutions. At the center of our vision is a value-based care platform, successfully engaging consumers to lower their total cost of care and creating longer, more durable relationships and improving health outcomes. Yes, all of that, all at the same time.

要解决这些挑战，我们必须在关键时刻真正促使人们参与到自身整体健康的管理中来，这将产生决定性影响。我们正是通过围绕消费者构建健康世界，来实现这一目标。要达成我们的愿景，必须具备一整套正确的能力，以服务更广泛的患者、消费者与社区，同时通过我们的整合型解决方案实现可持续的股东价值。我们愿景的核心是“价值导向型照护平台”——它能有效激发消费者参与，降低其整体照护成本，建立更长久、更稳固的关系，并改善健康结果。是的，我们正同时实现这一切。

Today, we'll share with you the progress that we're making to build convenient, connected, personal and integrated solutions, and how we're focusing on the lifetime value of a consumer, and how we're driving steadily increasing earnings growth. And we'll also provide you with an update on our financial performance and our long-term outlook, including how you should think about our guidance for 2024 and beyond. We are so excited about the incredible opportunity in front of us, and how CVS Health is uniquely positioned to create greater value for our customers, our consumers and you, our shareholders.

今天，我们将向大家介绍我们在打造便捷、互联、个性化和整合型解决方案方面取得的进展，分享我们如何聚焦消费者的终身价值，以及如何推动持续的盈利增长。同时，我们也会更新财务表现与长期前景，包括 2024 年及更远期的指引展望。我们对眼前这难得的发展机遇感到无比振奋，CVS Health 拥有独特的市场定位，将为客户、消费者以及你们——我们的股东——创造更大的价值。

Our passion, our purpose and our commitment to improving overall health, it starts at the top. We have a seasoned team of leaders with deep health care and technology expertise, and a proven track record of building, scaling and growing profitable businesses. Each member of my leadership team is here today to answer questions that you may have throughout the day. But you'll hear specifically during the presentations from Tom Cowhey, Brian Kane, Prem Shah, David Joyner, Mike Pykosz and Kyle Armbrester.

我们的热情、使命以及改善整体健康的承诺始于高层领导团队。我们拥有一支经验丰富的领导团队，在医疗健康与科技领域具备深厚专业能力，并拥有构建、扩展和增长盈利性业务的可靠成绩。今天在座的每位高管成员都会在全天会议中随时准备回答您的问题。在接下来的演讲环节中，您将重点听到来自 Tom Cowhey、Brian Kane、Prem Shah、David Joyner、Mike Pykosz 和 Kyle Armbrester 的发言。

As we stand here today, we have made real meaningful progress executing our strategy and advancing our vision for health care. We have broadened, deepened and diversified our growth portfolio under CVS Healthspire assets, including Care Delivery and our new business, Cordavis. As we said we would, we advanced our multi-payer capabilities, our value-based care capabilities with 2 strategic transactions: Signify Health and Oak Street Health, 2 premier assets that serve older adults. We've also grown our physician enablement business, CVS Accountable Care, which has over \$10 billion of managed spend in 2023 and will grow to 1 million patients in 2024.

截至目前，我们在执行战略和推进医疗健康愿景方面已取得实质性进展。我们在 CVS Healthspire 旗下的资产中拓展、深化并多元化了我们的增长组合，包括 Care Delivery（照护交付）以及我们的新业务 Cordavis。正如我们承诺的那样，我们通过两项战略性收购——Signify Health 和 Oak Street Health（两家服务老年群体的优质资产）——增强了多支付方能力与价值导向照护能力。同时，我们还扩展了医生赋能业务 CVS Accountable Care，其 2023 年管理支出超过 100 亿美元，预计在 2024 年将服务达 100 万名患者。

We said we'd divest our noncore strategic assets, and we did. We delivered our cost and operating efficiency goals and have taken further action to improve our cost structure in 2024. And as promised, we optimized our retail portfolio and are on track to meet our commitment of reducing our stores by 900 over 3 years. Importantly, we have done this while exceeding both our script and our colleague retention goals. We've increased our digital base and now have over 55 million unique digital customers. That's an impressive increase of 20 million unique customers since last time we saw you.

我们曾承诺剥离非核心战略资产，如今已兑现承诺。我们实现了成本与运营效率目标，并已采取进一步措施以优化 2024 年的成本结构。同时，按照承诺，我们也在优化零售业务组合，并有望达成三年关闭 900 家门店的目标。值得一提的是，在实现这些目标的同时，我们超额完成了处方量与员工保留率目标。我们的数字用户基础不断扩大，目前已拥有超过 5,500 万名独立数字客户，比上次与大家见面时增长了 2,000 万人，增长势头令人瞩目。

We often highlight our cash flow generation. Over 2022 and 2023, we have generated nearly \$30 billion of operating cash flow. The strength of our cash flow generation has enabled us to deploy capital strategically as well as return more than \$11 billion to shareholders over the last 24 months. We will continue to execute and deliver on our strategy and the commitments that we make.

我们一贯强调现金流创造能力。2022 至 2023 年，我们累计创造了近 300 亿美元的经营现金流。这一强劲的现金流为我们提供了战略性资本部署的能力，同时在过去 24 个月内已向股东回馈逾 110 亿美元。我们将继续执行战略，兑现承诺。

I want to spend a few minutes talking about CVS Health as a company. We are a trusted brand in health care. Our customers know us, they like us, and they trust us. We operate with a broad reach with the most important verticals in health care. We have over 300,000 purpose-driven colleagues, who execute on our vision every single day. We are a diversified company with a strong portfolio of businesses. For 2023, we're estimating that we'll achieve 300 -- over \$350 billion of annual revenue. We'll generate over \$17 billion of adjusted operating income, and we'll generate nearly \$13.5 billion of operating cash flow.

我想花几分钟时间谈谈 CVS Health 本身。我们是医疗健康领域值得信赖的品牌。客户了解我们、喜欢我们，也信任我们。我们在医疗保健最重要的垂直领域中拥有广泛触达。我们拥有超过 30 万名使命驱动的员工，每天都在推动我们的愿景落地。我们是一家业务组合强大的多元化公司。2023 年，我们预计年收入将超过 3,500 亿美元，调整后营业收入超过 170 亿美元，经营现金流将接近 135 亿美元。

We have incredible breadth of health products and services from providing coverage and financing consumers' health through our insurance products to providing \[ assets ] to quality care and access to quality care for total health needs and engaging individuals at our CVS locations, in their homes and digitally. And we deliver quality care with more than 50,000 clinicians. We're bringing these assets together to engage consumers in their health wherever they turn, however they turn, CVS Health is there. Put bluntly, this is unmatched in the industry. When all of our assets work together, we're able to lower the total cost of care, improve health outcomes, increase loyalty and improve quality and affordability.

我们的健康产品与服务覆盖极广——从通过保险产品提供保障与融资，到支持优质照护可及性，满足人们全面健康的需求，无论是在 CVS 门店、家中还是线上。我们拥有超过 5 万名临床人员，致力于提供优质照护。我们正整合这些资产，让消费者在任何时间、任何场景中都能与健康产生连接——CVS Health 始终在场。直截了当地说，这是业内无可匹敌的优势。当所有资源协同发力时，我们就能降低总体照护成本、改善健康成果、提升用户忠诚度、增强服务质量与可负担性。

We have powerful assets that work together to integrate on the moments of care that matter. We're able to provide panoramic care for all of our 100 million members. And quite frankly, we're just getting started. When an Aetna member engages with CVS Pharmacy, Caremark and our Care Delivery capabilities, we generate 3 to 4x higher enterprise lifetime value through persistency. The enterprise lifetime value that we yield is through our fully integrated members, can be -- and can be expanded to a broader addressable market beyond just Aetna with our multi-payer capabilities and our consumer reach. This feeds the economic flywheel for the overall company. And as we continue to work with our payer partners, we'll help them unlock value for their members.

我们拥有强大且协同的资产，能够在关键照护时刻实现整合，为 1 亿名会员提供全景式照护服务。坦率地说，我们才刚刚开始。当一位 Aetna 会员同时参与到 CVS 药房、Caremark 和我们的照护交付体系中时，我们能实现 3–4 倍的企业生命周期价值。这种企业生命周期价值来自于整合型会员，并可借助我们的多支付方能力和广泛用户触达能力，扩展至 Aetna 以外的更大潜在市场，从而助推整个公司的经济飞轮。随着我们与支付方合作伙伴持续协作，我们也将帮助他们为其会员释放更多价值。

I thought it was important to illustrate for you an example by walking through a member's journey. I want to take an Aetna Medicare Advantage member who has diabetes, and I'm going to call her Kate. This population is one of the most vulnerable, as you know. Kate is -- Kate has diabetes and what's interesting, she has a -- she's using a variety of services beyond what you would think of as traditional health care. In her welcome kit, Kate learns about our new CVS Health app, and she enrolls, and she has convenient access to information about our Aetna benefits and prescriptions. She has the ability to schedule an appointment with MinuteClinic. She also can shop online for health and wellness products that she may need. Through the app, she refills her diabetes maintenance medication and then visits one of our CVS pharmacies to pick it up.

我认为，通过一个实际案例来演示会员旅程是非常有意义的。让我以一位患有糖尿病的 Aetna Medicare Advantage 会员为例，我们称她为 Kate。大家都知道，这一人群是最脆弱的人群之一。有趣的是，Kate 使用的服务远远超出传统医疗的范畴。在她收到的欢迎礼包中，她了解到了我们的 CVS Health 应用并完成注册，从而可以便捷地获取 Aetna 福利与处方信息。她还可以预约 MinuteClinic 的就诊服务，并在网上购买所需的健康和保健产品。她通过 app 补充糖尿病日常用药，然后前往附近的 CVS 药房取药。

When she's speaking with a pharmacist, we learn that Kate is experiencing joint pain. And our pharmacist educates her on the availability of in-home evaluations through her health plan. Kate is easily able to schedule a visit with a Signify nurse. And during her in-home evaluation, the nurse identifies complications with arthritis and learns that the member hasn't seen her rheumatologist in many years, and doesn't have a primary care doctor who she sees regularly. The Signify Health nurse provides a list of quality value-based care physicians.

当 Kate 与药师交谈时，我们了解到她正遭受关节疼痛困扰。药师向她介绍了其健康保险计划中提供的居家评估服务。Kate 很轻松地预约了一位 Signify Health 护士上门探访。在居家评估过程中，护士发现她患有关节炎并有并发症，同时了解到她已经多年未就诊风湿科医生，且没有固定的初级保健医生。Signify Health 的护士随后向她推荐了一份优质的价值导向照护医生名单。

Interestingly enough, Kate selects Oak Street Health. The nurse helps schedule a wellness visit at the Oak -- with the Oak Street Health physician. At Kate's first visit, one of our doctors performs a thorough physical exam. And then the doctor builds a comprehensive care plan that addresses Kate's current health challenges and also recommends proactive health strategies. He then connects with Kate's rheumatologist. The doctor sets up regularly scheduled checkups, and Kate begins her care plan in order to achieve overall adherence and success.

有趣的是，Kate 选择了 Oak Street Health。护士帮助她预约了与 Oak Street Health 医师的健康评估。Kate 的首次就诊中，我们的医生为她进行了全面的体检，并制定了一套综合照护计划，既解决当前健康问题，也提出了前瞻性健康策略。医生随后联系了她的风湿科医生，并安排了定期复诊计划。Kate 随即开始执行照护方案，以确保持续治疗和改善效果。

The rheumatologist prescribes HUMIRA for her arthritis. And through her Caremark benefits and through Cordavis, Kate can access a low-cost biosimilar option, which he fills at CVS Specialty Pharmacy and has delivered to her home. Keep in mind, this is just one of many examples of the ways that our end-to-end capabilities enable us to engage in a consumer's health and generate higher lifetime enterprise value for the company.

风湿科医生为她的关节炎开具了 HUMIRA。借助 Caremark 的福利以及 Cordavis 的服务，Kate 能够使用一种低成本的生物类似药，并在 CVS Specialty Pharmacy 配药，由药房直接配送到家。请记住，这只是我们端到端能力如何参与消费者健康、进而为公司创造更高生命周期价值的众多案例之一。

In addition to improving the connections to health care for our patients, these effects will show up in our financial results in a number of ways. You should expect to see enrollment growth, improvement in margin as we manage medical expense, improvement in our medical cost ratios as we partner with value-based care providers. We should see improved star ratings, and those are just a few examples. This is the power of how all of our assets work together and how our capabilities work together to drive value for our company. Each of our core businesses are industry leaders in their own right. As stand-alone businesses, they are formidable. Together, they are unmatched.

除了改善患者与医疗服务之间的连接外，这些成果也将在多个方面体现在我们的财务业绩中。你们将会看到会员人数增长、随着我们优化医疗支出而带来的利润率改善、与价值导向照护提供者合作所促成的医疗成本比率下降；同时我们也预计星级评级将提升，这些只是其中几个例子。这正是我们各项资源与能力协同运作所带来的价值体现。我们的每一项核心业务本身就是所在领域的领导者，各自独立时已极具实力，而整合在一起时则无与伦比。

Let me talk a little bit about our Health Benefits segment, or Aetna, which serves more than 35 million members. It delivers a broad range of insurance products to effectively manage risk and coordinate benefits and ensures customers have access to high-quality provider networks and \[specialty] products, such as dental and behavioral. Aetna's diversified book of business is built to deliver high single-digit adjusted operating income growth over the long term.

接下来我来谈谈我们的健康福利板块，也就是 Aetna，目前为超过 3,500 万会员提供服务。Aetna 提供种类广泛的保险产品，有效管理风险、协调福利，确保客户可接触到高质量的医疗网络和专科服务，如牙科和行为健康服务。Aetna 多元化的业务结构旨在实现长期高个位数的调整后营业收入增长。

This growth is driven by a number of factors. Aging demographics, which are driving continued enrollment in Medicare Advantage, the funding dynamics that are shifting health benefits and driving growth in both individual exchange and Medicaid and an increased focus on innovation and quality product offerings that are driving growth in our commercial portfolio. We are positioned to benefit from these growth opportunities, and determined to drive target margins in both our Medicare Advantage and our individual exchange business.

这一增长动力来自多方面：人口老龄化推动 Medicare Advantage 持续扩容；医保资金结构变化带动个人医保市场和 Medicaid 增长；我们在商业保险产品中专注于创新与优质服务也在推动增长。我们已处于有利位置以把握这些增长机会，并致力于在 Medicare Advantage 与个人医保交易业务中实现目标利润率。

Let me comment now on our Health Services segment, or CVS Healthspire, which includes our pharmacy benefits management, our Care Delivery assets and other innovative services, such as Cordavis. The assets of the Health Services segment will generate growth of over 7% in the long term, accelerating as the contribution from Health Care Delivery grows. Starting with our Pharmacy Services businesses. Our scale and capabilities provide a clear benefit for our clients by driving down the cost of drugs and delivering critical specialty pharmacy services to patients in need. It is the leading PBM in the industry and serves nearly 90 million members.

接下来谈谈我们的健康服务板块，即 CVS Healthspire，其中包括药品福利管理（PBM）、照护交付资产以及如 Cordavis 这类创新服务。该业务板块的资产将在长期内实现超过 7% 的增长，并随着 Care Delivery（照护交付）贡献的提升而加速增长。先说我们的药房服务业务：我们的规模和能力可帮助客户有效降低药品成本，并向有需要的患者提供关键的专科药房服务。我们是业内领先的 PBM，服务对象接近 9,000 万名会员。

In the next few years, this market will experience significant opportunities to drive growth, particularly with the introduction of the biosimilar market and increasing prevalence of specialty therapies. The growth will allow us to deliver meaningful savings for our clients, while also providing opportunities for innovative offering and transparent economics. Caremark plays an important role in the Health Care Delivery system, and we will continue our history of innovation and how we deliver value to our customers.

在未来几年内，该市场将面临重大发展机遇，特别是在生物类似药市场开启以及专科疗法日益普及的背景下。这将使我们为客户带来实质性节省，同时也提供创新服务与透明经济模型的良机。Caremark 在整个医疗照护体系中扮演着关键角色，我们也将延续其创新传统，不断为客户创造价值。

Next up, our multi-payer Care Delivery business, which includes Oak Street, Signify and MinuteClinic. We provide health services to millions of patients annually through all these channels. We've entered into one of the fastest-growing health sectors and expanded our total addressable market by more than \$1 trillion. Our ability to scale and expand these capabilities will enable us to deliver accelerating growth over time. We are launching new clinical formats that will take Oak Street's full suite of pharmacy services for Medicare members and combine them with the CVS pharmacy.

接下来是我们的多支付方照护交付业务，包括 Oak Street、Signify 和 MinuteClinic。通过这些渠道，我们每年为数百万患者提供健康服务。我们已进入医疗保健中增长最快的领域之一，并将可服务市场扩大了超过1万亿美元。我们扩展和扩容这些能力的实力，将使我们能够实现持续加速的增长。我们正在推出新的临床服务模式，把 Oak Street 面向 Medicare 会员的全套药房服务与 CVS 药房相结合。

We're also advancing our technology capabilities to improve patient experience and clinical operations, while also enhancing our provider enablement capabilities to support the transition to full risk-based contracts. We've had great success in our ACO REACH business in a very short period of time. We now have all the necessary building blocks to enable providers to take risk without risking quality care. We will continue to evaluate new multi-payer capabilities to meet a broader set of consumer needs and change the long-term trajectory for CVS Health.

我们还在提升技术能力，以改善患者体验和临床运营，同时加强对提供者的赋能，支持其向完全风险型合同模式转型。我们的 ACO REACH 业务在短期内取得了巨大成功。我们现在已经具备所有必要的基础能力，使照护提供者可以承担风险而不牺牲照护质量。我们将持续评估新的多支付方能力，以满足更广泛的消费者需求，并改变 CVS Health 的长期发展轨迹。

And finally, our Pharmacy and Consumer Wellness segment. We are the leading retail pharmacy chain in the country, number one, equal, period. We have approximately 27% market share and serve over 120 million customers across more than 9,000 stores nationally. Our 30,000 trusted pharmacists represent the most frequent, personal and durable interactions in health care. We have nearly 5 million interactions with our customers every day, and we continue to deliver pharmacy script growth, improve our cost structure and provide better experiences for our consumers.

最后是我们的药房与消费者健康业务板块。我们是全美领先的零售药房连锁企业，市场排名第一，无可匹敌。我们约占 27% 市场份额，在全国 9,000 多家门店中服务超过 1.2 亿客户。我们的 3 万名值得信赖的药师代表着医疗保健中最频繁、最个性化、最持久的互动关系。我们每天与客户有近 500 万次互动，持续推动处方增长、优化成本结构，并为消费者带来更优质的体验。

However, the reimbursement dynamics in this business have been a persistent industry challenge. And as a result, we'll drive mid-single-digit declines in this business. Today, you will hear how we are proactively addressing this industry reimbursement pressure with an entire new model. This new model will ensure pharmacy reimbursement is aligned to the underlying costs of our business, while still providing our clients and customers the benefits of our purchasing economics, and we'll offer upside to our long-term growth expectations.

然而，药房业务的报销机制一直是业内长期存在的挑战。因此我们预计该业务将面临中个位数的下降。今天，您将听到我们如何通过全新模式主动应对这一行业压力。这种新模式将确保药房报销机制与我们业务的实际成本相匹配，同时仍为客户和消费者提供我们在采购方面的经济优势，并为我们的长期增长预期带来上行潜力。

These businesses combined to deliver sustainable, accelerating growth and significant operating cash flow. Our biggest opportunity and why we are so excited about the future is our ability to engage consumers at multiple touch points across our entire portfolio of businesses. This is a key differentiator for CVS Health. And this amplifier effect will drive significantly higher consumer lifetime value for our enterprise. As I said before, we've made significant progress advancing our strategy. We're also evolving our business to deliver long-term sustainable and accelerating earnings growth.

上述业务协同发展，推动可持续的加速增长与强劲的经营现金流。我们最大的机会，也正是我们对未来充满信心的原因，是我们能够在整个业务组合中与消费者在多个触点进行互动的能力。这是 CVS Health 的关键差异化优势。这种“放大器效应”将为企业带来显著提升的消费者生命周期价值。正如我之前提到的，我们在推进战略上取得了重大进展，并且正在不断演进业务模式，以实现长期可持续和加速的盈利增长。

So here's what's next. We're driving deeper engagement with consumers and leveraging technology. We're bringing excellence in our hyper local convenience. We're innovating and evolving our PBM model, and we're creating greater transparency at the retail pharmacy counter. As a company, we have incredible reach and the ability to engage people in their health. Trust in CVS Health extends well beyond our physical locations. And the trust is critical as we expand the use of our digital assets and deepen the engagement with our 55 million customers.

那么接下来要做什么？我们将加深与消费者的互动，并充分利用技术。我们将进一步提升本地化便捷服务的卓越表现，持续创新和演进 PBM 模式，在零售药房柜台上实现更高透明度。作为一家公司，我们拥有广泛的覆盖能力，能够真正让人们参与自身健康管理。人们对 CVS Health 的信任早已超越了实体门店，而这种信任对于我们拓展数字资产应用、深化与 5,500 万名客户的互动至关重要。

With our new CVS Health app, consumers will have a fully integrated personal and engaging digital experience. It will offer health and wellness services across all of our channels. Our new app will be customizable and will have white labeling capabilities for our clients. We will set the standard in digital engagement and utility.

借助新版 CVS Health 应用，消费者将获得一个全方位整合、个性化且富有吸引力的数字体验。它将覆盖我们所有渠道的健康与保健服务。新应用还可定制，并支持为客户提供白标服务。我们将树立数字化参与与实用性的行业新标准。

Beyond engaging consumers, we believe that AI and generative AI will transform health care. We're applying technology, data and analytics to every single aspect of our business. The effects will be positive and profound. And we're already seeing significant value, while continuing to preserve the importance of the human connection in health care.

除了吸引消费者参与之外，我们相信人工智能和生成式 AI 将彻底变革医疗行业。我们正将技术、数据和分析应用到公司业务的每一个环节。这些影响将是积极而深远的。我们已经看到了显著成效，同时也在始终坚持保留医疗健康中“人与人连接”的核心价值。

In Caremark, we expect these new capabilities to have significant impact on underwriting automation and client contracting. In Aetna, we're using AI to increase the efficiency of our operations. And in CVS Pharmacy, we're using AI to help automate pharmacist's workflows and improve safety and experiences.

在 Caremark，我们预计这些新能力将在承保自动化和客户合同管理方面带来重大影响；在 Aetna，我们正在利用 AI 提高运营效率；而在 CVS 药房，我们利用 AI 协助自动化药师的工作流程，提升安全性与客户体验。

In our new care delivery assets, our digital health dashboard utilizes Gen AI-enabled capabilities to summarize cases, which creates a much more convenient and better patient onboarding experience. At the same time, we are committed to responsible AI. We are ensuring that we're doing what's right for our customers, our colleagues and our patients. You've heard me say this before, but people want health care with the same convenience and digital options that they have in every other aspect of their life.

在我们新的照护交付资产中，我们的数字健康仪表板已引入生成式 AI 功能来自动汇总病例，从而大幅提升患者入组体验的便捷性与质量。与此同时，我们也坚守负责任的 AI 原则，确保一切举措都以客户、员工和患者的最佳利益为先。如我曾多次所说，人们期望医疗保健能像生活中其他领域一样，具备同样的便利性和数字化选择。

Many others are offering point solutions that only address some pain points in the health care system. No one is bringing them together in a coordinated way. We will be the leader in hyper local convenience. We're scaling our capabilities to be a national care delivery provider while delivering care locally. The result delivering integrated care, especially for complex patients, has been shown to reduce the total cost of care while also improving patient engagement. The economics are compelling. The outcomes are even better.

目前市场上许多企业都提供“点状解决方案”，仅能应对医疗体系中的某些痛点，但并未加以整合。我们将引领“超级本地化便利”潮流，在提升本地照护的同时，扩展能力成为全国性的照护交付提供者。结果表明，尤其对于复杂患者群体，整合照护既能降低整体医疗成本，又能提升患者参与度。从经济性看极具吸引力，从临床结果看更是卓越。

Signify Health has demonstrated tremendous value to its payer partners when they send clinicians to the home to deliver an in-home evaluation. The important benefit starts when a patient actually picks up the phone and when \[ Cigna's ] calling to schedule a visit. By utilizing CVS Health's trusted brand and the deep relationship we have with our pharmacies, Signify has already seen marked improvement in their ability to reach patients.

Signify Health 向付费方合作伙伴展示了巨大的价值——当其派遣临床医生上门评估时，效果尤为显著。这一过程的关键起点，是患者真正接听电话、响应来自保险方（如 Cigna）安排的评估预约。借助 CVS Health 值得信赖的品牌影响力以及我们与药房之间深厚的关系，Signify 在触达患者方面的效率已显著提升。

For example, we have surpassed our initial conversion goals with hard-to-reach Aetna members. We have been successful in connecting more than 65% of these hard-to-reach members when using our brand and our pharmacy relationships. We're also seeing the power of these connections to drive Oak Street patient growth. We're utilizing Signify's in-home touch points to educate individuals about Oak Street and encouraging them to reconnect to care. While it's still early in this initiative of the members that Signify has connected to Oak Street, more than half have scheduled appointments. That's significant.

举例而言，我们已超额完成与难以触达的 Aetna 会员的转化目标。在借助 CVS 品牌及药房关系的情况下，我们成功与超过 65% 的“难接触”会员建立了联系。我们也看到了这种连接对 Oak Street 患者增长的促进作用——我们通过 Signify 的居家接触点向用户介绍 Oak Street，并鼓励他们重新参与照护流程。尽管这项工作尚处于早期阶段，但在 Signify 成功转介至 Oak Street 的会员中，已有超过一半完成了预约，意义重大。

I want to set the record straight on the PBM business model. Contrary to all the misinformation, we have been able to consistently innovate and evolve our business in a very dynamic marketplace. We have done this while continuing to increase the value we deliver to customers by driving down lower net cost. We are the only participant in the drug supply chain that lowers the cost for our customers and our clients. And we have continued to grow over time as our model has undergone fundamental shifts. Caremark has made its mark with a long history of driving consumer innovation and choice.

关于 PBM（药品福利管理）业务模式，我希望澄清事实。与坊间诸多误解不同，我们在充满变数的市场环境中始终坚持创新与演进，同时不断降低净药品成本，从而提升客户获得的价值。我们是药品供应链中唯一能够切实为客户降低成本的参与者。我们的模式历经本质性变革，但始终保持增长。Caremark 凭借在推动消费者创新与选择方面的长期表现，已经建立起深厚影响力。

An important recent iteration of this innovative approach can be seen in the biosimilar market. The pipeline for the biosimilar market will grow over the next few years and represents a key growth opportunity for Caremark. It also offers the opportunity to deliver savings to our clients. We anticipate this market to reach over \$100 billion by 2029.

这一创新模式最近的重要演进体现在生物类似药市场。未来几年，该市场的产品线将快速扩张，为 Caremark 带来关键增长机会，也为客户带来成本节省。我们预计，到 2029 年，生物类似药市场规模将超过 1,000 亿美元。

With the creation of Cordavis, we are well positioned to help Caremark capitalize on this opportunity for their customers. Cordavis' innovative approach will be -- will create a robust and sustainable biosimilar marketplace and will help the market flourish and will deliver significant savings to our Caremark clients.

随着 Cordavis 的设立，我们已具备助力 Caremark 把握这一市场机遇的有利条件。Cordavis 的创新战略将推动建立一个强劲且可持续的生物类似药市场，不仅助力市场繁荣，也将为 Caremark 的客户带来显著节省。

But CVS isn't done yet. More innovation is still needed. That's why we're introducing a new PBM model today that strives for continued transparency. That reflects the true cost of drugs and simplifies the model while aligning incentives across all of our stakeholders. Clients that choose this model will continue to get the advantages of our best-in-class drug purchasing. Our Pharmacy Service business is an attractive, durable and cash flow generating business.

但 CVS 的创新步伐尚未止步。行业仍需要更多革新。正因如此，我们今天推出了全新的 PBM 模式，旨在实现持续透明，反映药品真实成本，同时简化结构并确保所有利益相关者的激励机制一致。选择该模式的客户，仍将享有我们行业领先的药品采购优势。我们的药房服务业务本身就是一项具有吸引力、持久性强、现金流稳定的业务。

I often get asked about the value of our Pharmacy and Consumer Wellness segment in the enterprise. I will tell you that it lies in the importance of our community presence and the power of the consumer relationships that we maintain in that business. It's a bond, and it's an important one. Pharmacy, as I said before, is the most frequently used benefit in health care. And trust is a central component of the pharmacist-patient relationship.

我经常被问及药房与消费者健康板块在整个公司的价值所在。我的回答是，这一价值体现在我们在社区中的存在感以及我们与消费者之间所建立的深厚关系。这是一种纽带，非常重要。如我此前所言，药房是医疗体系中最常被使用的福利服务，而信任则是药师与患者关系的核心。

It should come as no surprise to you that customers maintain a relationship with the pharmacist for over 10 years. And our community locations represent one of the first places that people -- that customers come when they need care. I've said this before, and I'll say it again, CVS is the best run retail pharmacy in the country, operating nationally with an unmatched level of engagement in an omnichannel way.

这对各位来说也许并不意外：客户与药师之间的关系往往维持超过十年。而我们的社区门店，是人们在需要医疗服务时最先想到的地点之一。我曾说过、今天仍要重申：CVS 是全美运营最出色的零售药房，在全国范围内开展业务，并在全渠道中展现出无与伦比的客户参与度。

In spite of all of these strengths, this business has been challenged. The change in the reimbursement levels for the services that we provide do not align with the underlying cost of this business. The status quo is what is reflected currently in our long-term guidance framework. However, we do believe that we have reached the floor on reimbursement rate erosion. And now is the right time to change it. We're doing our part by simplifying drug pricing, moving to a transparent reimbursement model with PBMs and payers, starting with Commercial business in 2025.

尽管我们具备诸多优势，但这一业务仍面临挑战。我们所提供服务的报销水平的变化，与其实际成本已严重错配。目前的情况已反映在我们的长期财务指引中。但我们相信，报销率的下滑已经触底，现在是时候推动变革了。我们正在承担应尽责任：简化药品定价、从 2025 年开始在商业保险业务中与 PBM 和支付方采用透明的报销模式。

We will transparently pass through the improvements that we get in our drug acquisition costs, continuing to use our scale and our efficiency to drive savings for our clients for many more years to come. This model will remove all cross subsidization. And it will start with the approximately 750 million commercial prescriptions that we bill annually. This change will make it easier for you, our shareholders, to understand how this business grows over time. It will be linked to our ability to grow scripts and expand our value-added services. The new reimbursement model will bring increased transparency, accountability and quality to the retail pharmacy experience and create -- and will create more opportunities for outperformance in this segment.

我们将把药品采购成本的改善完全透明地传递出去，并继续凭借我们的规模和效率，为客户长期节省成本。该新模式将彻底消除交叉补贴，并从我们每年开具的约 7.5 亿张商业处方开始实施。这一变化将使各位股东更清晰地了解该业务的增长路径，并与我们扩大处方量和增值服务的能力相挂钩。新的报销模式将为零售药房体验带来更高的透明度、责任感与质量标准，并为该业务板块创造更多超越预期的机会。

We're creating value by bringing all together these powerful assets, to engage consumers and health across multiple channels. The value generation that we create is for all of our stakeholders, our clients, our customers, our providers and our shareholders. Our segments individually each are profitable. However, when combined, they mutually reinforce growth and are more successful together than they are alone.

我们正在通过整合强大的资产组合，在多渠道中吸引消费者参与健康管理，从而创造价值。这一价值惠及所有利益相关者——包括客户、消费者、医疗提供方和股东。我们的各个业务板块单独运营时均具盈利能力，但当它们协同运作时，会相互增强、释放更大的增长潜力，效果远胜于各自为政。

Here are some examples of that. In October, we delivered some really exciting news, and I couldn't have been more proud of our team. We talked about the recovery of our Medicare Advantage star ratings in just 1 year. In that short amount of time, we are able to accomplish this by leveraging the power of our cross-company assets. And for 2025 plan year, 87% of our members will be in a 4-star rated plan, a remarkable recovery in just 1 year.

以下是几个例子：在 10 月份，我们发布了令人振奋的消息，我为团队感到无比骄傲——我们在短短一年内恢复了 Medicare Advantage 星级评级。这一成果，得益于我们有效调动了公司内部跨板块的协同资源。到 2025 计划年度，将有 87% 的会员隶属于 4 星评级计划，实现了显著的年度反弹。

In addition to these improvements, Aetna was a top performer in Part D patient safety and HEDIS domains. This was a no small part due to the work between Aetna, CVS Caremark and CVS Pharmacy. We are incredibly proud of this exceptional execution, which shows how quickly we can unite our businesses to achieve common goals. A second example is our exchange business. 2023 marked an important year for our individual exchange business. We have rapidly scaled this business and now expect to have 1.4 million members. By utilizing cross-company capabilities, you might recall, this offering was the very first co-branded Aetna CVS product and offered integrated unique solutions.

除了上述改善外，Aetna 在 D 部分的患者安全及 HEDIS 指标领域也名列前茅，这要归功于 Aetna、CVS Caremark 与 CVS Pharmacy 之间的紧密协作。我们对这一卓越执行力感到非常自豪，这也展示了我们整合业务、达成共同目标的速度。第二个例子是我们的个人医保交易市场（Exchange）业务：2023 年对这项业务而言意义重大。我们迅速扩大了规模，目前预计拥有 140 万名会员。正如大家记得的，这是 Aetna 与 CVS 首次联合推出的产品，提供了整合性、差异化的解决方案。

Interestingly, nearly 50% of these member scripts were filled at a CVS Pharmacy. And members who had a low-cost, no-cost MinuteClinic were twice as likely to use this setting as other Aetna members. We're delivering broad, addressable member, consumer and client touch points. And we are creating integrated solutions and enhancing consumer engagement across all of our channels. You can expect to see more integrated touch points with consumers and patients, and we'll be presenting more opportunities to drive down the -- drive down to lower cost of care with better outcomes and better experiences.

有趣的是，这些会员中有近 50% 的处方是在 CVS 药房配药的；而享有低成本或免费 MinuteClinic 访问权限的会员，其使用该服务的概率是其他 Aetna 会员的两倍。我们正在构建广泛的可触达会员、消费者和客户接触点，并在所有渠道中打造整合型解决方案，提升客户参与度。未来您将看到更多与消费者和患者的整合接触点，我们也将不断拓展机会，以更低的成本实现更好的健康结果与更优体验。

Simply put, we'll make what's already good even better. And we'll track our progress and success by measuring against the key metrics shown here. Practically, as we deliver on our commitments, you'll see the following: enrollment growth, improvement in margins as we manage medical spend and leverage our fixed costs. You'll see an acceleration of operating income in our CVS Healthspire businesses. You'll see stability in our medical benefit ratio as we partner with provider value -- with value-based \[ capability ] in our star ratings. All of this will enable us to meet or exceed our financial commitments to our shareholders.

简而言之，我们将在已有优势基础上再上层楼。我们将以这些关键指标作为衡量进度与成功的标准。在实际表现上，当我们兑现承诺时，您将看到以下趋势：会员人数增长、随着我们管理医疗支出并发挥固定成本杠杆，利润率提升；CVS Healthspire 业务将展现出营业收入加速增长；我们与价值导向照护能力强的医疗服务提供者合作，将确保医疗福利比率的稳定表现。这一切将确保我们达成或超越对股东的财务承诺。

I want to now shift and talk about our long-term financial guidance and lay out our approach. Our long-term financial guidance is intentionally established to create a reliable commitment while providing opportunities to outperform. As we thought about how we want to guide for 2024 and beyond, we had a number of goals that we are trying to achieve. First, we're establishing the guidance for each business anchored in their market growth rates that will allow us to consistently meet our commitments with clear identifiable opportunities for outperformance, while also providing room for disciplined strategic investments in our business and opportunities to use our strong cash flow generation to repurchase shares and drive total shareholder return, including increasing our dividend as evidenced by the announcement that we made this morning.

接下来，我想谈谈我们的长期财务指引，并阐述我们的规划方式。我们的长期财务指引是有意设定为既具可靠性又提供超预期的空间。在制定 2024 年及未来的指引时，我们考虑了多个目标。首先，我们为各项业务设定的指引将以其所在市场的增长率为基础，这使我们能稳定兑现承诺，并识别出清晰的超预期增长机会。同时也为我们在业务上进行有纪律的战略性投资提供空间，并利用强劲的现金流回购股票，提升股东总回报，包括我们今天早上宣布的增派股息。

We expect the combination of all these forces to contribute to a net total of at least 6% of adjusted EPS growth annually. We expect this baseline growth to accelerate over time for the contribution of our CVS Healthspire businesses. And finally, as we look across our portfolio to outperform, we will make progress in achieving our target margins on our \$60 billion of revenue in Medicare Advantage. So you should expect 3% to 4% to adjusted EPS growth in 2025. These factors together will position us to deliver 9% to 10% growth to adjusted EPS in 2025. And throughout the day, you will hear our confidence in our ability to achieve these long-term goals for each of our businesses.

我们预计，在上述诸多因素的合力下，我们每年的调整后每股收益（EPS）将实现至少 6% 的增长。随着 CVS Healthspire 业务的持续贡献，这一基础增长将逐步加速。最后，在整个业务组合中，我们也将努力在 Medicare Advantage 上实现目标利润率，目标收入为 600 亿美元。因此，2025 年我们预计实现 3% 至 4% 的调整后 EPS 增长。在这些因素综合作用下，我们有信心在 2025 年实现 9% 至 10% 的调整后 EPS 增长。今天全天的内容中，您会听到我们对各项业务实现这些长期目标的信心。

Before I turn this over to Tom, I want to leave you with a few closing thoughts. We have incredible opportunity in front of us. And we have many points of differentiation for CVS Health to win. As a management team, we are aligned and focused to execute on the strategy to achieve our growth goals and our financial commitments. So here's what you can expect from us, strong, sustainable growth, accelerating growth in the contributions of CVS Healthspire, powerful cash flow generation and a balanced and disciplined capital deployment strategy, including a growing dividend, a commitment to sustainable business practices and employee development and accelerating EPS growth over time.

在把时间交给 Tom 之前，我想分享几句结束语。我们面前有巨大的发展机遇，CVS Health 拥有多重差异化优势可以赢得未来。作为管理团队，我们内部高度一致，专注于执行战略，以实现增长目标和财务承诺。您可以期待我们带来：强劲、可持续的增长；CVS Healthspire 的贡献持续加速增长；强大的现金流创造力；以及平衡且有纪律的资本部署策略，其中包括不断增长的股息、可持续运营实践的承诺、员工发展的重视以及长期 EPS 增长的加速。

Our biggest differentiator is not just the collection of our assets, but how we can and will bring them together to deliver integrated solutions. Our strategy ensures that we have a realistic and achievable path to sustainable, accelerating profitable growth. CVS Health is at the heart of transforming the future of health care in this country.

我们最大的差异化优势不仅在于我们资产的规模，更在于我们如何整合这些资产，交付真正的整合型解决方案。我们的战略确保我们拥有一条切实可行的路径，通往可持续、加速的盈利性增长。CVS Health 正处于变革美国医疗保健未来的核心位置。

I want to thank you for your time. And now I'm going to turn it over to Tom Cowhey, who will give you a review of our financial performance and our outlook. Thank you.

感谢大家的聆听。现在，我将时间交给 Tom Cowhey，他将为您回顾我们的财务表现并展望未来。谢谢大家。

Tom Cowhey Executive VP & CFO

汤姆·考希，执行副总裁兼首席财务官

Good morning, everyone. It is great to see so many of you here, and thanks to everyone that joined us in [ TV Land ]. I just want to say how excited I am to be here. And one of the things that I get asked a lot is, why did you come back to CVS? And I'd say it's 2 things. First, this is just an astonishing team, and I really love working with them. Second is, I believe in the mission. CVS Health has the best platform in the health care industry to facilitate change. And I'm going to walk you through why we believe that's a fact.

大家早上好。很高兴在这里见到各位，也感谢线上参加的朋友。我非常高兴能在这里。有一个我经常被问到的问题是：“你为什么回到 CVS？”我通常会说有两个原因：第一，这是一个令人惊叹的团队，我非常喜欢与他们共事；第二，我坚信 CVS 的使命。CVS Health 拥有整个医疗行业中最有潜力推动变革的平台。接下来我会向大家解释，我们为什么对此深信不疑。

Driving accelerated performance, that's the title of my presentation, and I think it's fitting because that's what we expect to deliver. We are more convinced than ever that we have the right strategy. It's built on years of execution, but importantly, it's built now on acquisitions that are the building blocks of future growth. So today, I'm going to share a couple of things. We're going to close out '23 with our final guidance for the year. Then talk about 2024. I'm going to walk you through the long-term guidance framework. And then I'm going to talk about cash flow. It's a powerful cash flow generation machine that we have. And then we're going to talk about how we drive enterprise value creation.

“推动加速增长”是我本次演讲的主题，我认为它恰如其分，因为这正是我们致力于实现的目标。我们比以往任何时候都更确信：我们拥有正确的战略。这一战略建立在多年稳健执行的基础之上，更重要的是，它如今已经通过一系列收购，构筑了未来增长的基石。今天我将分享几方面内容：首先，我们将回顾 2023 年的最终业绩指引；接着谈谈 2024 年的预期；再来是我们的长期财务指引框架；然后我们会讲到现金流——我们具备强劲的现金流创造能力；最后，我们会探讨如何驱动企业价值创造。

So let's first quickly talk about 2023. We gave our initial guidance for 2023 on our fourth quarter call in February. When we gave that guidance, I want to remind investors, we've announced the Signify and Oak Street transactions, but they were not included in our guidance range. Since that time, 2023 had some surprises for us. Unexpected headwinds in our 340B business and utilization in Medicare Advantage that we and the rest of the industry saw increased quite meaningfully. Despite those headwinds, which pressured our business by over $1 billion of adjusted operating earnings, if you strip away the acquisitions, which is mostly the financing impact, we prevailed and actually exceeded our guidance for our core businesses. That's the power of our diversified business.

我们先快速回顾一下 2023 年。在 2 月份的第四季度财报电话会上，我们公布了 2023 年的初步指引。当时我们已经宣布收购 Signify 和 Oak Street，但这两项交易并未纳入业绩指引。随后，我们在 2023 年遇到了一些意料之外的情况：340B 项目出现逆风，Medicare Advantage 的服务使用率显著上升，这一点不仅是我们，全行业都感受到了压力。这些因素令我们调整后的营业利润承压超 10 亿美元。但如果不计入收购（主要是融资影响），我们的核心业务依然超出了原定指引，这正是我们多元化业务结构的力量所在。

We expect to close out this year consistent with our guidance on the third quarter call. Medical cost trends remain elevated, but at levels consistent with our guidance range. Performance in our vaccine franchise also remains quite strong. Cash flow from operations will also be at the upper end of our $12.5 billion to $13.5 billion range for the year.

我们预计将以与第三季度电话会议中一致的预期完成今年目标。医疗成本趋势依然处于高位，但仍在我们预设的范围内。疫苗业务的表现持续强劲。经营活动现金流也将在全年 125 亿至 135 亿美元指引的高端收口。

So what about 2024? We'll start with Health Care Benefits. Revenues are going to grow an impressive 15%, led by strong growth in our Medicare franchise. We will grow Medicare Advantage membership by approximately 600,000 members in 2024. Over 500,000 of those members will come from individual Medicare, with roughly 25% to 30% of them coming from dually eligible.

那 2024 年呢？我们先从健康保险业务（Health Care Benefits）说起。该业务收入将在 2024 年实现令人瞩目的 15% 增长，主要得益于 Medicare 业务板块的强劲发展。我们预计 2024 年 Medicare Advantage 会员将增加约 60 万人，其中超过 50 万人来自个人 Medicare 计划，约 25%-30% 为双重资格（Dually Eligible）人群。

We were very clear that we were going to maintain benefits as we thought about 2024. We were clear that we would make selected strategic investments and deliberate investments in growth. And as we look at our results, which Brian is going to talk about in more detail, we believe that we will see revenue growth from this cohort, but that this cohort will be breakeven. And that's what's included in our guidance.

在规划 2024 年时，我们就明确表示将维持福利水平，并进行有针对性的战略投资和增长投入。根据目前的预期情况（稍后 Brian 会详细说明），我们预计该人群将带来收入增长，但整体将维持盈亏平衡。这已反映在我们的业绩指引中。

As we look at MBR, the MBR will be up roughly 120 basis points. It's a function of a variety of things. As is our convention, there is no prior year development inside our guidance. That's worth about 15 basis points. We have a Stars headwind next year. That's a revenue headwind. And so it works out to be about 65 basis points of pressure on the medical benefit ratio. We'll also see roughly 20 basis points of pressure from new Medicare Advantage members as those members come in at a higher MBR than the rest of our book, a mix impact.

关于医疗福利比率（MBR），我们预计将上升约 120 个基点，背后有多种因素造成。按照惯例，我们的指引中不包含前一年发展因素，这项影响约为 15 个基点。2024 年我们还会面临星级评级（Stars）带来的收入压力，这部分将造成约 65 个基点的 MBR 压力。此外，新加入的 Medicare Advantage 会员相较于既有会员群体的 MBR 较高，因此也会带来约 20 个基点的 mix 结构影响。

The remainder is a provision for enhanced Medicare utilization that we've been discussing since the second quarter with some other puts and takes, continued Medicaid redeterminations, we've got some improvement from our individual and family plans book in there as well. We expect that adjusted operating income in this segment will grow slightly. Cost management is an important driver of this. We've talked about an $800 million program for 2024. And what we will see in Health Care Benefits is that they will represent over half of where those savings will manifest themselves on the income statement.

其余的压力主要来自 Medicare 使用率上升的准备金，我们从第二季度起就开始关注这一趋势。其他因素还包括 Medicaid 的再评估流程、个体与家庭计划的边际改善等。整体来看，我们预计该业务板块的调整后营业收入将实现小幅增长。其中成本控制将是关键驱动因素。我们已公布一项 8 亿美元的成本优化计划，其中超过一半的节约成果将在健康保险业务板块的利润表上体现出来。

Individual exchanges will be an $8 billion revenue block. That will move from a loss position in 2023 to a profit position inside 2024. Net investment income will also be a positive tailwind as we think about 2024 relative to 2023. Partially offsetting these things are some of the things that I already talked about relative to the pressures on the medical benefit ratio, lower star readings, elevated Medicare utilization, Medicaid redeterminations and the absence of PYD, prior year development.

个人保险交易市场将在 2024 年贡献 80 亿美元收入，将从 2023 年的亏损状态转为盈利状态。与 2023 年相比，净投资收益也将成为 2024 年的正面推动因素。上述积极因素部分被我们此前提到的负面因素所抵消，包括医疗福利比率的上行压力、星级评级下降、Medicare 使用率提升、Medicaid 资格重审，以及前期发展（PYD）的缺失等。

As we think about Pharmacy and Consumer Wellness, we're the leading national pharmacy chain. Accordingly, we're projecting script growth next year of roughly 3% and revenue growth of at least 6% next year. We believe our teams are the best in the industry, but they're operating in a challenging environment. So we're projecting operating income -- adjusted operating income of at least $5.5 billion. That represents continued cost of goods improvements, pharmacy script gains and front store improvements that are unfortunately offset by reimbursement pressure, lower COVID contributions, particularly in OTC test kits, which were much more robust in the early part of 2023 under the public health emergency and the prospect for a weakening consumer environment.

在药房与消费者健康业务方面，我们是全美领先的连锁药房。因此，我们预计 2024 年处方数量将增长约 3%，收入增长至少达到 6%。我们相信我们的团队是业内最强的，但也必须应对充满挑战的市场环境。因此，我们预估该业务板块的调整后营业利润将至少达到 55 亿美元。这一增长主要得益于商品成本持续优化、处方量上升和前店（前端零售）业务的改善，但也受到报销压力、新冠相关收入减少（尤其是 OTC 检测试剂盒收入自 2023 年初公共卫生紧急状态结束后明显下降）以及消费者环境可能趋弱的负面影响。

Embedded in the fourth quarter run rate and also in our 2024 outlook, there are additional investments in colleague hours. I would remind investors that we have spent over $1 billion in wage investments since 2021, and we're committed to improving experiences in retail and the communities we serve.

我们的第四季度运行节奏以及 2024 年展望中，均包含了对员工工时的新增投入。我们提醒投资者，自 2021 年以来，我们已在薪资方面投入超过 10 亿美元，并将继续致力于提升零售体验及我们所服务社区的服务质量。

Moving to Health Services. Revenues will decline here due to the loss of the Centene contract. Absent that change, revenues would actually be up about 9%, partially driven by the acquisitions. Health Services adjusted operating income will grow 3% to at least [Audio Gap].

接下来是健康服务板块。由于失去 Centene 合约，该板块收入将出现下滑。若剔除该项变动，收入本可增长约 9%，其中部分增长来自并购贡献。健康服务的调整后营业利润将增长 3%，达到至少 [音频缺失]。

Pharmacy Services, our PBM Caremark had a very, very strong '23. The model demonstrated its ability to deliver value. As we think about the outlook for '24, we've included the loss of the Centene contract, the annualization of 340 Beach program changes, which impacted us on a rolling basis in the back half of '23, will then annualize in 2024. We also have a de minimis contribution in there from Carillon that is consistent with their expectations of specialty migration of scripts in 2024 and growth in our leading specialty franchise.

关于药房服务（Pharmacy Services），我们的 PBM（药品福利管理）子公司 Caremark 在 2023 年表现非常出色，展现了其价值交付能力。在展望 2024 年时，我们计入了 Centene 合同终止的影响，以及 340B 项目的变动带来的全年化影响——这些变化在 2023 年下半年逐步体现，2024 年将完整反映。此外，Carillon 项目的贡献也已纳入，符合其在 2024 年专业药方转移趋势与我们领先专业药品业务增长的预期。

Health Care Delivery will also be a growth driver in here. We expect incremental contributions from Oak and Signify, gains in other businesses, and we expect growth in Health Care Delivery of over $200 million of adjusted operating income, offset by about $75 million of incremental pressure from our clinic investments as we accelerate growth in Oak Street clinics from 35 or so at the time of acquisition to 50 to 60 next year. Cordavis will also contribute to earnings as we unlock biosimilar value. In the aggregate, we're projecting 3% growth across these businesses.

健康医疗服务也是本板块的增长引擎之一。我们预计 Oak Street 和 Signify 将带来新增利润贡献，其他业务也会有正面增量。健康医疗服务业务预计将在 2024 年贡献超 2 亿美元的调整后营业利润。同时，我们将面临来自门诊业务投资约 7,500 万美元的额外压力，主要因 Oak Street 门诊从收购时的 35 家扩张至 2024 年的 50–60 家。Cordavis 也将为利润贡献增量，随着我们在生物仿制药市场中释放价值。总体来看，我们预计这些业务将实现约 3% 的增长。

So the total 2024 guidance is here on this page. Total revenues of at least $366 billion, adjusted operating income of in excess of $17 billion, and this represents the sum of the parts from the segments I just walked through, less corporate, where there'll be a little bit of pressure on net investment income because we were holding a lot of cash for acquisitions of the early part of the year and a slightly higher tax rate. As we think about what's happening with share count, we have said consistently that interest expense will annualize in 2024 because of the timing of the closing of our acquisitions, and that we would offset that annualization through repurchases. So we would expect to do $3.5 billion to $4 billion worth of repurchases in 2024.

综上所述，2024 年公司整体业绩指引如下：总收入将至少达到 3,660 亿美元，调整后营业利润将超过 170 亿美元。这一总额是我们刚才介绍的各业务板块利润合计减去总部板块后的结果。总部部分将面临一定净投资收益压力，原因是年初持有大量现金以应对并购，同时税率也略有上升。关于股份数量，我们始终表示，2024 年的利息支出将因并购交易的交割时点而实现全年化，我们将通过回购来抵消这部分影响。因此我们预计 2024 年将回购 35 亿至 40 亿美元的股份。

Cash flow from operations of at least $12.5 billion will make 2024 yet another in a series of years of very strong cash flow. As we think about earnings progression for 2024, we think it's probably going to be a little bit more weighted towards the back half. And the reason for that is that we're expecting that Medicare Advantage cost trends, which really accelerated starting into the second quarter, will annualize a little bit into the first half of the year, pressuring that seasonality.

经营活动现金流将在 2024 年至少达到 125 亿美元，使 2024 年成为我们连续多年强劲现金流表现中的又一年。就盈利节奏而言，我们预计 2024 年的利润更可能集中在下半年。这是因为自第二季度起 Medicare Advantage 成本趋势显著加速，该趋势将延续并在上半年体现全年化压力，从而影响季节性分布。

If that's 2024, what are we going to do after that? With the foundational acquisitions for Health Care Delivery now complete and tangible rather than theoretical, we took a very fresh look at our long-term growth formula. As we stand here today, we've shifted our model slightly. We have established market-based growth expectations that are reliable and durable for each of our segments. We also wanted to leave room for disciplined strategic investments to enable stability and growth.

那么在 2024 年之后我们将如何发展？现在我们的医疗服务核心并购已完成，增长驱动已从理论转变为可执行资产，因此我们重新审视了长期增长模型。截至目前，我们对各业务板块设定了基于市场的可靠且可持续的增长预期。同时我们也为有纪律的战略投资预留了空间，以支持稳定性和未来增长。

There are several things that we didn't do when we set out this framework. We didn't incorporate growth above those market rates. We didn't include the upside from returns from our investments. And we did not include any accelerated synergy capture. Let me be clear, while we did not include those things in our long-term growth algorithm, we wake up every day looking for ways to make them happen.

值得强调的是，在设定这一框架时，我们并未假设各业务高于市场增速的成长，也未纳入投资回报的潜在上行空间，更未计入协同效应的提前释放。换句话说，尽管这些潜在增量未体现在模型中，但我们每天都在为实现它们而努力。

So let's look at the numbers. Total segment contribution of at least 4% of adjusted EPS growth with capital adding at least 2%. That means we have a floor growth rate of at least 6%, and it accelerates over time. There were also near-term identifiable opportunities to exceed this baseline growth rate in 2025. I'm going to walk you through those in a minute.

来看具体数字：各业务板块将至少贡献 4% 的调整后每股收益增长，再加上资本配置的贡献至少 2%，使得我们具备至少 6% 的底线增长率，且这一增长率将在未来逐步加速。我们还在 2025 年发现了一些短期可识别的超额增长机会，稍后我将一一说明。

So let's walk through each of the individual segment drivers to get to the 4%. Health Care Benefits is expected to grow at least 7% in this model, very consistent with the outlook that we provided in 2021. Growth is driven by industry growth or better across all Medicare products, particularly dual eligibles, where we have relatively small market share. Medicare is now over half our revenues, and Medicare eligibles are roughly 50% of the market. We think that penetration will continue to increase, and we'll go up into the 60s. Americans recognize the value that Medicare Advantage provides, and we expect to continue to be there to provide that value for them.

接下来拆分这 4% 中的各板块增长贡献。医疗保险业务（Health Care Benefits）预计每年将增长至少 7%，这与我们在 2021 年提出的长期展望高度一致。增长将由 Medicare 各项产品推动，尤其是双重资格人群（dual eligibles），我们在该市场的份额仍相对较低。目前 Medicare 占我们整体收入已超一半，同时 Medicare 覆盖人群也占市场约 50%。我们认为这一渗透率还将进一步提升，进入 60% 区间。美国民众普遍认可 Medicare Advantage 提供的价值，我们将继续为他们提供这一服务。

Individual exchange will also continue to grow. And we have an opportunity to drive that business to a margin that's more consistent with industry targets. We think about that as being 3% to 4%. We're going to be pursuing targeted growth in Medicaid. Brian is going to talk a little bit about Oklahoma, which is a great win for our teams. And Commercial revenue growth at competitive margins continues to be a driver. Over half of the Fortune 100 continue to use Aetna is a strong and durable franchise. It's the heart of what a lot happen -- a lot of what happens at the Aetna business is based on that commercial book of business and legacy. And Brian is going to walk you through that in some more specific detail.

个人医保交易市场（individual exchange）也将继续增长，我们有机会将其利润率提升至与行业水平更为一致的 3%-4%。在 Medicaid 业务上我们将追求有针对性的增长，Brian 稍后会讲到我们在俄克拉荷马州赢得的重要项目。商业保险板块在维持竞争性利润率下也将持续增长，目前《财富》100 强中超过一半企业仍使用 Aetna 产品，这代表了 Aetna 品牌的稳定性与广泛影响力。Aetna 的许多业务与商业客户群息息相关，Brian 稍后将详细介绍这一部分。

Pharmacy and Consumer Wellness is projected to decline 5%. That's a recognition of industry forces even in the face of superior execution. Our stores are the cornerstone of our brand and our identity. They're also an important engagement engine and a driver of cash flow. Prem is going to discuss this outlook in more detail, but it is clear and it should be clear that we are not satisfied with the status quo. Today, we announced an exciting new model to stem this decline and that represents upside to our current outlook. Transitioning to the new model does not need to be successful for us to achieve this guidance, but it could stabilize this business over time.

药房与消费者健康板块预计将下降 5%，这是对行业结构性压力的反映，尽管我们执行力领先。我们的门店是品牌的核心支柱，也是客户参与和现金流的重要驱动力。Prem 将进一步说明本板块的展望，但需要明确的是：我们对现状并不满意。今天我们宣布了一个令人振奋的新模式，旨在遏制这一下行趋势，并有望带来超出当前预期的上行空间。值得一提的是，即使这一新模式尚未成功落地，我们仍可实现现有指引，但长期来看它有望稳定该业务表现。

Health Services will grow at least 7%. That's Pharmacy Services, delivering mid-single-digit growth, continued top line and script growth, market-leading specialty and strong purchasing economics. Karen highlighted innovation in a dynamic market, and our long-term guidance reflects our ability to continue to adapt. David is going to provide you some more detail on that.

健康服务板块预计将实现至少 7% 的增长。这其中包括药品服务（Pharmacy Services），将实现中个位数的增长，体现为收入和处方量的稳步提升、领先的专业药品业务以及强大的采购议价能力。Karen 也强调了我们在充满变革的市场中保持创新的能力，我们的长期指引正反映了这一适应能力。David 将为大家带来更多细节。

Our fast-growing Health Care Delivery business will also contribute to earnings growth. It will increase over time as assets grow, and we unlock deal synergies. In 5 years, Health Care Delivery assets could represent 3% to 5% of adjusted operating income for the enterprise. That contribution is after a provision for continued accelerated growth and those early losses at new Oak Street Health Clinics. Kyle and Mike are going to walk you through that in more detail. Finally, Cordavis is also an exciting opportunity to unlock the durable and robust biosimilar marketplace.

我们快速增长的医疗服务（Health Care Delivery）业务也将持续为盈利增长贡献力量。随着资产规模扩大并逐步释放并购协同效应，这部分贡献将稳步上升。预计未来五年，医疗服务业务将占公司调整后营业利润的 3% 至 5%。这一预测已经考虑了持续加速扩张的投入以及 Oak Street 新诊所初期亏损的影响。Kyle 和 Mike 稍后会详细说明。此外，Cordavis 也为我们打开了生物仿制药这一具有持久价值的市场，是一项令人振奋的机会。

So we said the floor is going to grow. Why? It's about the investments we made. It's the reason we embarked on the health care delivery strategy. If you look at the left bar, it's your kind of 80-20 split between our declining businesses, Pharmacy and Consumer Wellness and also our corporate expense buckets and our other businesses, which are growing. But with time, this mix actually changes. PCW becomes smaller and Health Care Delivery becomes an increasingly important part of the portfolio. Growth businesses moved from that 80-20 split to where the growth businesses are 85% to 90% of the portfolio. And that mix impact adds 1.5% to that floor growth rate over the next 3 years from that 2025 outlook. That brings your growth floor to 7.5% by 2028.

我们之前提到过“增长底线”将会上调，原因是什么？核心在于我们所做的投资，这正是我们开展医疗服务战略的初衷。举个例子，最初我们的业务结构大致是 80% 为增长缓慢甚至下降的业务（如药房与消费者健康、总部费用），20% 为增长型业务。但随着时间推移，结构会发生变化——PCW 占比逐步缩小，医疗服务成为越来越关键的板块。整个组合将从“80/20”逐步变为“增长业务占比 85%-90%”，这种结构性变化将在未来三年（以 2025 为基准）为底线增长率额外贡献 1.5 个百分点，即到 2028 年底线增长率将达到 7.5%。

So the floor accelerates, but I've spent enough time with the folks in this room to know that you're all going to wonder, well, how can you do better sooner. First, margin recovery in Medicare Advantage, beginning in 2025. Medicare will be over a $60 billion revenue business in 2024, and it will be earning a low single digit margin versus a 4% to 5% target. We are committed to improving margins in 2025. Our Stars improvement will help power that recovery. We have a new pricing model in pharmacy. We are going to begin to transition clients to that commercial clients in 2025. That has the potential to drive Pharmacy and Consumer Wellness towards flat results rather than down 5% per annum.

所以底线增长在加速，但我知道你们更关心的问题是：怎么才能更快地“超越底线”？首先是 Medicare Advantage 利润率将在 2025 年开始回升。预计 2024 年 Medicare 相关收入将超过 600 亿美元，目前利润率处于低个位数，而我们的目标是 4%-5%。我们已承诺将在 2025 年改善这一利润率，而星级评级（Stars）的提升将助力这一回升。此外，我们在药房业务中推出了新定价模式，预计将在 2025 年起陆续迁移商保客户。这有望将药房与消费者健康板块从每年下滑 5%，改善至持平水平。

内部出现的衰退。

Mike is also going to walk you through some really exciting opportunities to accelerate patient growth in Oak Street. Kyle is going to talk about his expanded portfolio of offerings, including in our individual business and in Medicaid, and there are further opportunities for investments to unlock incremental value, consumer-facing investments, NextGen AI, none of that's in our expectation.

Mike 稍后会讲解 Oak Street 如何通过创新手段加速患者增长。Kyle 会介绍他在个人医保和 Medicaid 板块扩展的产品组合。此外，我们还有多个投资机会可释放额外价值，如面向消费者的服务、下一代人工智能等——目前这些还未纳入我们的基本预期模型中。

So as we sit here today, we predict that the opportunities that we know about will add at least 3% to 4% to our adjusted EPS growth rate in 2025. That would bring our 2025 expected growth to 9% to 10% of our at least $8.50 projection. One of the most underappreciated strength of this business is the ability to generate cash. Over the next 3 years, we expect we're going to generate $40 billion to $50 billion of deployable cash.

综上，按现有已知机会计算，2025 年我们可在底线增长之外再实现 3%-4% 的调整后每股收益增长，从而将全年增长预期提升至 9%-10%，以至少 8.50 美元为基准。我们这家公司最被低估的一项优势，就是其强大的现金创造能力。预计未来三年我们将产生 400 亿至 500 亿美元的可动用现金流。

So what will we do with it? First, we always invest in organic growth. That includes risk-based capital on our regulated insurance entities. We've steadily increased the dividend. Our target payout ratio is now approximately 30%. And with the dividend raised today, we have increased the dividend by 33% over the course of the last couple of years. What's left allows us to be flexible in deploying cash to repurchase shares. We'll do that to offset equity dilution and drive at least 2% of adjusted EPS growth. And there's also opportunities over time for opportunistic deployment. That will include things like accretive mergers and acquisitions, and additional ways to create shareholder value. I'd note that we are very committed to our current investment-grade ratings, and we believe that this profile is consistent with that.

那我们打算如何使用这笔现金？首先，我们会持续投入于有机增长，这包括为保险子公司提供风险资本支持。我们也持续提高派息，目前的目标派息率约为 30%。今日宣布的分红上调使过去两年我们的年度分红总额增长了 33%。剩余现金将用于灵活执行股票回购，以对冲股权摊薄并贡献至少 2% 的 EPS 增长。同时，我们还将保留机会主义式部署空间，如增值型并购等，以进一步创造股东价值。我们重申：公司高度重视并承诺维持当前的投资级信用评级，而我们的资本运作安排也与这一目标一致。

So where does all this cash come from? Let me get one obvious question out of the way first. What's corporate? Corporate is mostly interest payments. It's some unallocated expenses. And then there are things like our opioid settlement payments that are included in that bucket as we think about a forward outlook. Almost more importantly, net of taxes, net of more than $1 billion of annual CapEx, our retail business, our Pharmacy and Consumer Wellness segment is 1/3 of pre-corporate cash flows. So it's not only the cornerstone of our brand. It's not only in an engagement engine. It is a significant and reliable source of free cash flow.

那么这些现金从何而来？先回答一个常见问题：“Corporate 部门包含什么？”答案是：大部分是利息支出，部分是未分配的公司费用，还有比如阿片类药物和解金等未来已知支出。更重要的是，在扣除税收和超过 10 亿美元的年资本支出后，我们的零售业务，即药房与消费者健康板块，在扣除总部前现金流中占比达三分之一。这不仅是我们品牌的基石，也是客户互动的引擎，更是重要且稳定的自由现金流来源。

Let's spend a few minutes on value creation across the enterprise. We currently serve more than 1/4 of the U.S. population. You've heard these stats before, but they bear repeating. 85% of the U.S. population lives within 10 miles of the CVS store. Nearly 5 million interactions with our customers happen in our stores every day. We have over 35 million covered members at Aetna, including all of our products. Our recent acquisitions and our new strategy with Health Care Delivery presents new opportunities for us to interact with these consumers. We can meet them at them in their homes, we can reduce barriers to care, and we can drive superior outcomes. It's a tremendous opportunity.

让我们花几分钟来探讨 CVS 全公司层面的价值创造。我们目前服务超过四分之一的美国人口。你可能已经听过这些数据，但值得再次强调：全美有 85% 的人口住在距离 CVS 门店 10 英里以内，我们每天在门店内与顾客的互动次数接近 500 万次。Aetna 覆盖的会员超过 3500 万，涵盖旗下所有产品。我们近期的收购以及新的医疗服务战略，为我们与消费者的互动带来了新的机遇——我们可以走进他们的家庭、打破医疗壁垒、实现更优的健康结果，这是一个极具潜力的机会。

And I want to walk you through how we think about what the new incremental value -- incremental member can do through a lifetime value lens. So what's this lifetime value concept? Simply put, enterprise lifetime value is the net present value from a new incremental member inside a cohort, which is primarily a function of the cash flows from that number and the duration they stay with us.

接下来，我想讲一下我们如何从“生命周期价值（lifetime value）”的视角来评估新增会员所带来的增量价值。简单说，企业生命周期价值是指：一个新增客户群体中，单个新增会员在整个合作期内所能带来的净现值，这主要取决于其产生的现金流和与我们保持关系的时长。

So how many members do we have and what are those values? The bars on this chart show the lifetime value we generate in each business. Again, it's a function of the cash flows and the average duration. So for CVS Caremark, that duration is about 12 years. That relationship is highly durable. It speaks to our capabilities, particularly in specialty pharmacy.

我们现有的会员数量是多少？他们分别能带来多少价值？这张图上的柱状图展示了各个业务线所能带来的生命周期价值，它是现金流与客户维系时间的函数。例如，在 CVS Caremark，客户平均维系时间约为 12 年，关系稳定可靠，尤其体现我们在专业药房（specialty pharmacy）领域的能力。

In Aetna, duration is lower, call it, 7 years. But dollar incremental profits and fixed cost leverage is high, yielding higher lifetime value. That last bar on the right, that's our new Health Care Delivery business. It's where we can provide better care to patients. We can just create substantial incremental value. But these are only stand-alone values, unlock more value for every new member by surrounding them with services. So not only can we provide exceptional care to those members, but we see increased medical cost savings for Aetna and Caremark members. We see improved medication adherence for CVS versus non-CVS members.

在 Aetna 平均客户维系时间稍短，大约为 7 年，但由于其利润贡献较高、固定成本杠杆效应显著，因此生命周期价值仍很可观。最右侧的柱状图代表我们的新业务——医疗服务（Health Care Delivery），我们可以为患者提供更优质的护理，从而释放巨大的增量价值。当然，这些都只是“单点业务”的独立价值。一旦我们为新增会员提供综合性服务，还能释放更大的协同效应。比如说，Aetna 与 Caremark 的客户在享受更多服务后可降低医疗支出，CVS 药房客户的服药依从性也优于其他药房用户。

Oak Street's gross savings rate in the ACO REACH program was 21%, putting it as one of the top participants in that program in their ability to drive quality and savings. Beyond those benefits, when a member uses more than one of our services, they stay with us longer. A great example is Aetna Medicare Adventure -- Advantage members, who fill the majority of their scripts with CVS Pharmacy. Those members stay with Aetna longer than those that use other pharmacies. We see these benefits across our enterprise. And the power of our ecosystem, mostly through enhanced persistency, but also through lower medical costs, enhances lifetime value by up to 10% versus the stand-alone values.

以 Oak Street 为例，其在 ACO REACH 项目中的总节省率高达 21%，是该项目中提升质量与降低成本最优秀的参与者之一。更进一步地，当客户使用我们不止一种服务时，他们与我们的关系也更为持久。例如，那些使用 CVS 药房进行大部分处方配药的 Aetna Medicare Advantage 会员，其续约率显著高于使用其他药房的用户。整个 CVS 企业都能观察到这类协同效应。我们的生态系统正是通过提升客户粘性与降低医疗成本，将会员的生命周期价值提升最多达 10%。

So what's the opportunity on increasing penetration? How do I get more of that? We've proven that we can do this. 70% of Aetna members today use Caremark. 40% of Aetna members use CVS Pharmacy. But on our individual population, on our co-branded Aetna CVS product, that penetration is closer to 50%. Less than 1% today of Aetna members use Oak Street Health. It's a lot less than 1%. Caremark members use CVS Pharmacy about 1/3 of the time. That's better than our market share, but still a great opportunity. If we were to increase all of our penetration rates by 1% across the board, we can generate up to an additional $0.5 billion of net present value across the enterprise. That's the power of our diversified model.

那么提升客户渗透率的机会在哪里？我们能否做得更多？我们已经证明我们有能力实现这一目标。目前，70% 的 Aetna 会员也使用 Caremark；40% 的 Aetna 会员使用 CVS 药房。而在联合品牌的 Aetna-CVS 产品中，这一比例提升至约 50%。但目前仅不到 1% 的 Aetna 会员使用 Oak Street Health——远远不到 1%。Caremark 的客户约有三分之一使用 CVS 药房，这已经好于市场份额水平，但仍有可观增长空间。如果我们能将各业务线的交叉渗透率平均每项提升 1%，我们就能为全集团带来多达 5 亿美元的净现值增量。这正体现出我们多元化模式的威力。

Once you understand how that flywheel works, understanding how we unlock value is pretty straightforward. We have to increase the number of interactions, the number of people we serve. Once they're in our ecosystem, we have to engage them. We have to make them, help them play an active role in managing their health. We got to expand those interactions. We have to surround them with integrated services. And if we do that, we'll see enhanced persistency and will enhance the value of those customers. If we do that, how does it show up in the financials? Enrollment growth, margin improvement, accelerated health care delivery earnings, increases in value-based membership, more stable Stars performance. And if we do all those things, we'll naturally deliver on our financial commitments.

一旦你理解了这套飞轮逻辑，价值创造就显得很直观了。我们要做的，是扩大服务人群和互动频次；当客户进入我们的生态系统后，我们要主动与他们互动，帮助他们更积极地管理自身健康；进一步扩展这些触点，并为其提供一体化服务。做到这些，我们就能增强客户粘性，提升其生命周期价值。这一切将在财务报表中体现为：注册人数增长、利润率改善、医疗服务收入加速增长、价值型护理会员增长，以及更稳定的 Stars 评级。如果这些环节落实到位，我们自然也就兑现了承诺的财务目标。

So why CVS? And for many of you, importantly, why now? We are a highly integrated high-touch enterprise. We have a reliable, diversified and accelerated earnings growth rate. We have significant cash flow, attractive returns and near-term opportunities for upside. Transforming health care requires engagement and scale. And no one is better positioned to engage, deliver clinical services and simplify health care. That's why I'm here. That's why we're all here. That's why we show up every day to transform health care, and we hope that you're going to join us.

那么，为什么选择 CVS？对你们很多人来说，更关键的是：为什么是现在？答案是，我们是一家高度整合、深度参与的企业；我们拥有可靠、多元且加速的盈利增长轨迹；我们现金流强劲，回报可观，且拥有短期内的上行潜力。要想真正变革医疗行业，必须拥有用户触达能力和规模化能力——而没有人比我们更具备这两点。正因如此，我来到这里；正因如此，我们每天都投身其中，持续推动医疗行业的变革。我们诚挚地希望你们能与我们同行。

Thank you. We're going to take a quick break before Brian is going to walk through Aetna.

谢谢大家。我们将稍作休息，之后由 Brian 带来 Aetna 业务的详细介绍。

[Break]

Brian Kane Former Executive VP & President of Aetna

All right. Welcome back. It's great to be here with you guys today. It's been a while, but I love being back, and I am really excited about being part of CVS Health and being part of Aetna. I'm going to talk to you about our diversified portfolio and our products and how powerful that is, that we're strong in all 4 major product lines, but also really want to emphasize the power of the CVS brand and the opportunity we have to truly transform the health care ecosystem, and it's very, very exciting.

好的，欢迎回来。今天能和大家在这里见面我感到非常高兴。虽然离开了一段时间，但能回到 CVS Health 和 Aetna，我感到非常兴奋。我今天将为大家介绍我们多元化的产品组合，以及我们在四大主要产品线上的强劲表现。同时，我也会特别强调 CVS 品牌的力量，以及我们有机会真正变革整个医疗健康生态系统，这一点令人非常振奋。

So I'm going to talk today about our company and our strategy. We'll do a deep dive into each one of our products. We're going to talk about how we're integrated with CVS and how we're driving the CVS enterprise and vice versa. And then I'm going to talk a lot about our growth and margin commitments.

今天的分享会包括我们的公司概况和战略，我们会深入讲解各项产品，探讨我们如何与 CVS 实现整合、如何推动 CVS 整体企业的发展，以及 CVS 如何反向推动我们业务的发展。最后，我还会详细介绍我们的增长目标与利润承诺。

So let's talk about the health care ecosystem and our strategy. Obviously, you guys are as familiar with anyone with all the trends and changes that are happening in health care, and they're significant. We have government funding challenges. We have an aging population, a lot of focus on payer provider relationships and payment models, but I believe we have an opportunity that's really unmatched in health care today. Because we're in all 4 product areas, we can manage the members throughout their entire life cycle, which is really, really powerful. And we can engage with them in a unique way that no one else can do.

让我们先谈谈当前的医疗健康生态与我们的战略。毫无疑问，在座各位都非常了解当下医疗领域正在发生的重大趋势和变革，比如政府资金压力、人口老龄化、支付方与服务提供方关系的变化、支付模式改革等。这些挑战不容忽视。但我相信，我们今天拥有一个医疗行业前所未有的机会。我们覆盖四大产品领域，可以贯穿整个生命周期地服务我们的会员，这种全程管理能力非常强大。同时，我们能以一种独特且其他企业无法复制的方式与会员建立深度联系。

And so as we think about our strategy, it's really predicated on 4 elements. One, we're going to grow our core business at or above the market at our target margins, which is very, very important. Two, our value-based opportunity, I believe, is unmatched. And that today is a little bit behind our competition. But we actually have an opportunity to leapfrog our peers, not only because of the strength of our diversified portfolio, but importantly, because of the strength of the CVS assets. Both Oak Street and Signify, all the touch points in the pharmacies, our PBM, this gives us unmatched opportunity to fundamentally change the way payers and providers interact with one another and the experiences that we provide for their members and patients, and we're very focused there.

我们的整体战略可以归结为四大核心要素：

第一，我们要在目标利润率水平下，实现核心业务高于市场平均水平的增长，这一点至关重要；

第二，我们在价值型医疗（value-based care）领域具备无与伦比的机会。虽然当前我们在这方面略落后于竞争对手，但我们完全有机会实现“跨越式超越”，这不仅归功于我们多元化的业务组合，更归功于 CVS 的资产优势。Oak Street、Signify、CVS 药房各类接触点、PBM 系统，所有这些让我们能够根本性地改变支付方与服务提供方之间的交互方式，进而改善会员与患者的整体体验。我们正集中力量推进这项工作。

Third, we're going to drive clinical excellence by creating personalized experiences by embracing digital, and importantly, leveraging the local access that only the CVS footprint can provide. And it's that constant interaction that fundamentally, we believe can alter the way a member's disease progresses, their health care outlook more generally and the way they engage with us and the way they engage with the health care system. And finally, and related, we are very focused on driving the enterprise assets, working with Oak Street and Signify to put our members in their systems, leveraging the PBM and working closely with them to ensure that our members on the medical and pharmacy side have an integrated experience in driving the local touch points in the stores. So it's very, very exciting.

第三，我们将通过个性化体验与数字化手段推动临床卓越发展，尤其是充分发挥 CVS 的线下触达能力。这种高频次、近距离的互动，能够从根本上改变会员的疾病发展轨迹、改善其健康观念，以及提升他们与我们、与整个医疗体系之间的互动质量；

第四，我们会充分联动集团内的资源，与 Oak Street 和 Signify 深度合作，将会员嵌入到他们的服务系统中；同时整合 PBM 资源，确保会员在医疗与药房端都能享受无缝对接的一体化服务，推动店内触点协同发挥价值。这些布局都非常令人振奋。

So let me just give you a little bit of a snapshot on the company. Our results have been impressive. We grew Medicare Advantage 10% over the last 4 years. We grew our revenue double digits. Our customers, and many of you are in this room, I hope, I imagine you are because we serve more than 50% of the Fortune 100, our customers really like us. Our customers engage with us. Our customers really appreciate our brand, and it's that brand that we believe we can use to grow in all of our product lines, and I just don't think that can be underestimated. And importantly, today, we serve 35 million members across all our product lines. Again, very, very powerful.

接下来，我来简要介绍一下我们公司的整体情况。我们取得了非常亮眼的业绩：过去四年，我们的 Medicare Advantage 业务增长了 10%；整体收入实现了双位数增长。我们的客户——在座可能就有不少人——他们对我们品牌的认可度非常高。我们服务于《财富》100 强企业中超过 50%的公司，客户对我们的互动与体验感到满意，并持续深化合作。我们相信，这种品牌力量可以成为我们在各条产品线上持续增长的核心动力——这一点绝不可低估。目前我们在各条业务线下总共服务着 3500 万会员，这是一项极具分量的优势。

We create significant value through all these interactions. I'll talk about the Stars more. But 87% of our members will be in 4-star plans for the 2025 funding year, a massive change in a massive recovery in a record period of time. Over 800,000 Aetna members have had Signify home visits. We've doubled our membership in Oak Street, and we are just beginning. There's a ton of opportunity here, and we're really, really excited about it.

我们通过这些互动创造了巨大的价值。稍后我会谈到 Stars 评级。2025 资助年度，87% 的会员将处于 4 星评级计划中——这是一次规模空前、恢复速度创纪录的进展。Aetna 已有超过 80 万名会员接受了 Signify 的上门服务；我们在 Oak Street 的会员数量也实现了翻倍增长。而这，仅仅是开始。这里蕴含着巨大的增长潜力，我们对此感到无比兴奋。

So as we think about the breakdown of our businesses, again, 4 major product lines. A lot of the growth that double-digit growth, not surprisingly has come from the government segment, which has been a very powerful growth driver. But we've also grown our individual business. We entered the market in 2022. And in 2023, we're going to grow north of 1 million members to end the year at about 1.4 million members. That's an extraordinary growth rate, part of it was aided by the exit of certain plans from the market, but much of it was a deliberate product expansion and market expansion opportunity because we see not only the stand-alone opportunity in individual exchanges, but also the significant enterprise value that we believe is real and meaningful.

现在让我们看看我们四大产品线的业务构成。毫不意外，推动我们实现两位数增长的主要动力来自政府相关业务，这一直是非常强劲的增长引擎。但我们的个人保险业务也取得了长足发展。我们在2022年进入该市场，预计到2023年末，会员人数将从100万增长到约140万。这一增长速度非常惊人。虽然部分增长得益于一些竞争对手的退出，但大部分是通过我们有意的产品拓展和市场拓展实现的。我们不仅看到个人保险市场本身的价值，更看到了它对整个企业长期价值的巨大拉动。

And then finally, our Commercial business. Our Commercial business is a steady grower. There's multiple elements of that business from the national accounts all the way down to the smaller market, which I'll talk about in a minute. But it's a great business, and it serves as the foundation of our franchise.

最后是我们的商业保险业务。该业务增长稳定，涵盖范围从大型全国客户到中小市场等多个层面，我稍后会详细介绍。总体而言，这是一项非常优质的业务，构成了我们整个业务体系的基石。

So what are our commitments? On the Medicare Advantage side, we're going to grow at or above the market at a 4% to 5% margin. Our IFP business, we're going to selectively expand into new states and to new counties, and over time, achieve our target margin of 3% to 4%. In Medicaid, we're going to be very thoughtful about the RFPs that we participate in. But we believe there are opportunities not only to drive the Medicaid franchise through those RFPs, but also significantly enhance our D-SNP opportunity as more and more states link and CMS links Medicare to Medicaid. And again, our compelling commercial offering cannot be understated. How powerful this franchise is, the opportunity for growth and margin is meaningful, all of which will be enhanced by, and we will in turn enhance the enterprise assets.

那我们的业绩承诺是什么？在Medicare Advantage方面，我们将实现与市场持平或高于市场的增长，并保持4%至5%的利润率。关于个人保险（IFP）业务，我们将有选择地进入新的州和县，并在中长期实现3%至4%的目标利润率。在Medicaid领域，我们会非常谨慎地评估参与哪些RFP（投标请求），但我们相信这不仅有助于扩大Medicaid业务，还能显著提升我们在D-SNP（双重特殊需要计划）领域的机会，尤其是在越来越多的州和CMS将Medicare与Medicaid关联的背景下。再次强调，我们的商业保险产品极具吸引力，这一产品线本身的增长潜力和利润空间都非常可观，同时它也会反过来增强整个CVS集团的资源协同效应。

So let's talk about each one of our businesses in turn. Starting with Medicare. Individual MA is a tremendous opportunity. As Tom mentioned, we're going to grow at least 600,000 members this year on the Medicare product. That includes individual, D-SNP and group. The large majority of which, north of $500,000, is on the individual and D-SNP side. We believe that the general enrollment market in Medicare Advantage on the individual side still has a significant room to grow. And at least for the next few years, we expect high single-digit growth to continue. As we move to the D-SNP opportunity, the dual special needs plans, we believe that the opportunity is really limitless for us.

下面我们逐一看看每项业务。首先是Medicare。个人MA市场是一个巨大的机遇。正如Tom所提到的，我们今年将在Medicare产品线上新增至少60万名会员，其中大部分——超过50万——来自个人MA和D-SNP领域。我们认为，Medicare Advantage的个人注册市场仍有广阔的发展空间，预计未来几年仍将维持高个位数的年增长率。而在D-SNP领域，也就是双重特殊需要人群计划方面，我们认为潜力几乎是“无限”的。

We have major opportunity for expansion into new counties, which we did this year and we will continue to do next year. And the penetration, which is around 50% today, we believe has no natural limit given how significant the benefit opportunity is and the experience opportunity is for a duly eligible member. And so we expect that market to continue to grow very rapidly, and it's a very attractive place, where we will participate. And it's an opportunity where we can leverage our enterprise assets in a major way.

我们在进入新的县级市场方面有巨大机会，今年我们已经扩大了覆盖范围，明年还将继续推进。目前我们在D-SNP市场的渗透率约为50%，考虑到双重合资格人群所能获得的福利与服务体验，我们认为这个渗透率没有自然上限。因此，我们预计这一市场仍将快速增长，而且是一个极具吸引力的市场，我们会积极参与其中，并在这个过程中充分发挥CVS集团的资产协同优势。

Our group MA business, it's one we don't talk about a lot, but it's a very attractive franchise. And there are different elements of the group business. There's the large end of the market, which is very competitive, high profile. The margins tend to be less, but nonetheless, it's very important implications for our business when we win and lose those contracts. And we're very thoughtful there about how we participate. As you go down market in the group MA side, mid group and small group side, the margins are higher. There's real opportunity to create value for our customers. And importantly, we believe we can continue to leverage our commercial footprint to offer the group MA product to those same accounts. And so we're very focused on growing that business.

我们还有一项不太常提起的业务——团体MA（Group Medicare Advantage）业务，但它也是一个极具价值的业务板块。团体市场分为多个层级：在大客户市场，竞争激烈、知名度高，利润率相对较低；但这些客户对我们业务影响深远，因此我们在参与时非常审慎。而在中小型团体市场，利润率更高、客户对定制化服务的需求也更强，我们确实有机会为客户创造更多价值。更重要的是，我们相信可以借助既有的商业客户关系网络，将Group MA产品推广到已有账户中。因此我们正高度重视这一业务的增长潜力。

And then finally, our PDP and [Med Sup] businesses. Both these businesses, we believe, provide a major source for conversion, it's a Medicare Advantage. We believe that our customers will benefit significantly if they move from a PDP or Med Sup product into Medicare Advantage. Now interestingly, in 2025, due to the IRA, the catastrophic risk sharing changes dramatically. It goes from 15% next year to 60%, which means plans are on the hook for 60% of the catastrophic costs. We believe that's going to have material implications for the PDP market and provide even more opportunity for conversion. Similarly, for this year, for -- coming up for 2024, we expect that PDP will decline, not immaterially, which was a deliberate strategy we pursued because we believe the economics didn't make sense. But nonetheless, we still have many, many millions of members to convert to a Medicare Advantage product.

最后我们来看PDP和Medicare Supplement（Med Sup）业务。我们认为这两项业务将是向Medicare Advantage转化的重要来源。我们相信客户从PDP或Med Sup产品转向Medicare Advantage后将获得显著益处。有趣的是，由于《通胀削减法案》（IRA）的实施，2025年起灾难性风险的成本分摊机制将发生重大变化，计划方需承担的比例将从15%上升至60%。我们认为这将对PDP市场产生实质性影响，并带来更多转化至Medicare Advantage的机会。同样，在即将到来的2024年，我们预计PDP会员数将出现显著下降，这是我们基于经济性考量而采取的有意战略调整。不过，即便如此，我们仍拥有数百万可以转化为Medicare Advantage的会员。

So what makes a strong Medicare Advantage franchise? Clearly, our star ratings, something we're very proud of that we were able to recover so quickly. And again, I can't think of another time in this industry where a company has recovered so dramatically so quickly and led the pack in HEDIS and patient safety measures with major improvements in the CAPS customer service measures.

那么，什么构成了一个强大的Medicare Advantage业务体系？显然是我们的星级评级（Star Ratings）。我们为自己能在短时间内迅速恢复评级而感到自豪。我想不出在这个行业中还有哪家公司能在如此短的时间内实现如此大幅的反弹，并在HEDIS指标和患者安全指标方面处于领先，同时在CAPS客户服务评分中也取得了显著进步。

How did we do this? Stars at Aetna and CVS is not about what the stars can deliver to the enterprise. It's not a vertical silo. It's very much an enterprise pursuit. Everyone at CVS is [internally] involved in our clinical outcomes and driving that for our membership, and creating a better member experience. And so whether that's an Aetna directly, whether that's in the PBM, whether that's in the pharmacies, whether it's in all of our other assets, everyone across the board is focused on stars. And that mindset is how we create sustainable competitive advantage in our stars scores.

我们是如何做到这一点的？在Aetna和CVS，星级评级不仅仅是企业获得收入的一种手段，它并非孤立运营，而是整个企业共同的目标。CVS内部所有部门都积极参与到提升临床结果和会员体验的过程中。不管是在Aetna、PBM、药房，还是其他任何子公司，大家都齐心协力关注星级评级。这种全员参与的理念，是我们在星级评分上建立可持续竞争优势的根本原因。

D-SNP, special needs. Again, a very, very exciting opportunity. We're growing that dramatically this year, and I'll come back and talk about it in a minute. But the opportunity to serve these members who tend to have more clinical challenges, more multi-chronic conditions is very, very significant. So again, not only do you have a great opportunity for Aetna because these members generate significant profitability both on a revenue and dollar profit basis, but also on a percentage basis from a margin perspective, but they also need to be managed in a much more intensive way. And we have the assets more than anyone to be able to manage that population.

D-SNP，即双重特殊需求人群计划，同样是一个非常令人振奋的增长点。我们今年在这个领域的增长非常迅速，稍后我会再详细介绍。这类人群通常面临更多的临床挑战和多重慢性病问题，因此服务他们的机会非常重大。对于Aetna来说，这是一个重要的增长引擎，因为这类会员不仅在营收和绝对利润上贡献巨大，在利润率方面也优于平均水平。当然，他们也需要更密集的健康管理服务，而我们在这方面拥有比任何人都更强大的资源和能力。

Value-based care. Value-based care is probably after stars, our #1 priority as an Aetna business and as an enterprise. And we are very, very focused on fundamentally changing that dynamic between payer and provider. And what does that mean? That means investments in technology. That means embracing interoperability, meaning the sharing of information between payer and provider in a bidirectional way. That means getting in providers' workflow, so that when a member or patient comes in, they benefit from all the data that Aetna and CVS has and all the analytics that we can run, so they know what the next best action is. And it means engaging with our providers in a very different way, in a very constructive way, in a very collaborative way and in a very creative way. And so we're going to be very focused on driving our VBC capabilities.

价值驱动医疗（Value-Based Care, VBC）是继星级评级之后，我们在Aetna和整个企业的头号优先事项。我们致力于根本性地改变付款方与医疗服务提供方之间的关系。具体来说，这意味着我们要加大技术投资，推动系统互联互通，实现双向的信息共享。还意味着我们要深入到医生的工作流程中，当会员或患者就诊时，医生可以利用Aetna和CVS提供的完整数据和分析结果，清楚下一步最佳治疗方案。同时我们也会以一种更加建设性、协同化和创新性的方式与医生互动。我们将在这一领域持续发力，全面推动价值医疗能力的建设。

And then finally, our product design. We believe there's opportunities to continue to innovate around products. And what does that mean? That means getting very granular about understanding our customer, not pricing to the average, not looking at broad populations, but understanding specific customer need, creating curated customer experiences, utilizing our enterprise assets and capitalizing on the CVS brand to drive an innovative product and experience for our membership. And we believe those elements will allow us to grow at or above the market from a revenue perspective and our target margins of 4% to 5%, which we're absolutely committed to delivering.

最后是产品设计方面。我们认为在产品创新方面还有很大空间。这意味着我们要更加深入地理解客户，不再面向平均人群定价，而是基于细分需求打造个性化产品与体验。我们将依托企业资源、发挥CVS品牌优势，设计高度契合会员需求的创新产品和服务体验。我们相信，这些做法将帮助我们在收入增长方面达到或超过行业平均，并持续实现4%至5%的目标利润率。这一点，我们是坚定承诺要实现的。

So let me talk about margins. I know this is near and dear to your heart. So I'm going to give you a perspective on our pathway on margins and a little color on AEP. So obviously, 2023 from a margin perspective in MA has not only been difficult for us, but it's been difficult for the industry. Utilization came back faster than anyone anticipated, and our business is being impacted by it, as you can imagine. As we move to 2024, we've captured a portion of that utilization challenge, but not all of it. And so that margin impact does trail forward into 2024. We also have the stars impact, which we've sized at $800 million for 2024. And so that's going to be a material impact on our business. And so the margins for 2024 will be low single digits, way below where we need to be.

让我谈谈利润率的问题。我知道这是你们非常关心的重点，所以我会讲讲我们在利润率方面的规划路线，并补充一些关于AEP（年度选保期）的情况。显然，从利润率角度来看，2023年对Medicare Advantage（MA）来说不仅对我们困难，对整个行业也都不容易。服务利用率的回升速度远超预期，我们的业务也因此受到了影响。进入2024年，我们虽然在一定程度上已经吸收了这些利用率带来的冲击，但尚未完全消化，因此利润压力还将延续至2024年。同时，我们也面临星级评分影响——2024年这部分的影响规模我们估计为8亿美元，对业务构成了重大冲击。所以，2024年的利润率将处于低个位数水平，远低于我们的目标水平。

However, there's a lot of exciting elements of 2024, specifically around AEP. So we're going to grow the 600,000 members, predominantly individual and D-SNP. But really interestingly, 3/4 of the members to date have been switchers. And everyone here understands the power of that, which means we capture the documentation codes that the prior carrier had, we get that right away as opposed to someone new to Medicare, where it takes a year or 2 to catch up. 75% is a high percentage. It's typically more around 50-50. And so that's a material difference.

不过2024年也有很多令人振奋的亮点，尤其是在AEP期间的表现。我们计划新增60万名会员，主要来自Individual MA和D-SNP（双重特殊需求计划）。特别有意思的是，到目前为止，其中有四分之三是从其他保险公司转换过来的会员。大家都明白这背后的优势：我们可以立即获取前一家保险公司记录的病症编码（diagnosis codes），而不像那些首次加入Medicare的新会员，我们通常需要一到两年才能完成病历文件的建立和补全。75%的转换率是一个非常高的比例，行业平均大约是50%对50%。这对我们而言是一个重大差异和优势。

The other major impact is around D-SNP. About 1/3 of our growth will be in the dual special needs area. As I mentioned, these members come in at higher dollar margin and higher percentage margin than the general enrollment product. And importantly, we don't have the stars challenge in D-SNP that we do on general enrollment because most of our D-SNP book is on an HMO chassis, and they didn't suffer from the stars change for 2024. And so I think that's a very powerful statement that allows us to capture this growth, not in a profitable way. We don't expect to earn margin on these members. And rarely you do in the first years, those of you who know that.

另一个重要因素是D-SNP业务。在我们的增长中，大约三分之一将来自双重特殊需求计划。我之前提到过，这类会员带来的每人收入和利润率通常都高于一般个体会员。而且重要的一点是，我们在D-SNP上没有遭遇星级评分（Stars）带来的压力，因为我们大部分的D-SNP产品都基于HMO结构，这部分没有受到2024年星级评分变化的负面影响。所以这也是一个极具吸引力的领域。我们当然不会指望这些会员在第一年就带来利润，那在实际业务中是很少见的。

But over time, into 2025 and beyond, the opportunity is very, very significant because as these members age, as we capture the rest of their conditions through appropriate documentation and as the cost of the distribution of an initial sale wear off, there's a big tailwind into 2025. And so that's very powerful. And of course, we expect to get our stars back in 2025. And I do expect we will get our stars back in 2025, which is a material tailwind.

但从中长期来看，尤其是进入2025年及之后，这类会员将带来非常可观的增长潜力。随着他们在计划中的时间延长，我们逐步获取完整的病情记录，同时最初获客和销售的高昂成本逐步摊销完毕，这将对2025年形成强劲助力。此外，我们预计将在2025年恢复星级评分，而我个人对这一点也充满信心。这也将成为一个实质性的追风因素（tailwind）。

And so for 2025, we expect to take significant ground against our margin targets, although we won't get all the way there, and it's going to take several years to get to the 4% to 5%. One more comment about 2024 and 2025 and [V28]. There's been some questions around V28, the impact, did we price for it? The answer is yes, we did price for it. We feel good about how we price for it. And I would just say that the mix of your business is material in terms of the impact it's going to have on your portfolio.

因此，对于2025年，我们预计将在实现利润率目标方面迈出实质性的一步，虽然不会一次性达到4%至5%的目标，但在接下来几年中会持续改善。关于2024、2025年的V28风险调整模型（版本28）也需要补充一点：我们是否在定价时考虑到了其影响？答案是肯定的，我们已将其计入定价，并对我们的定价策略感到满意。我还想强调，业务结构的不同会显著影响V28对整体业务的影响程度。

The bigger portion of D-SNPs and in particular, those in full risk relationships with value-based providers, are going to be more impacted than those who are underpenetrated on the value-based side, which Aetna is today, although we're going to change that over time. And the reason is, is that the value-based providers have tended to do a better job of capturing those codes that have been significantly curtailed. And so I think that's an important distinction. But again, the takeaway here is that we're going to make material progress in 2025, we're going to get to our long-term target margins over time, and we feel good about the 2024 growth. In fact, I would say, feel more than good, we're very excited about it because of the significant lifetime value that those members generate as we've discussed.

其中受影响最大的是那些与价值医疗提供商签署全风险合同的D-SNP会员，因为这些提供商过去对诊断编码捕捉较为充分，而许多这些代码在V28中被大幅收缩。相比之下，那些尚未深度推进价值医疗模式的公司，如当前的Aetna，受到的冲击会更小（尽管我们也会逐步推进VBC）。这是一项关键区别。总的来说，我们将在2025年取得实质性进展，逐步实现长期利润率目标。同时我们对2024年的增长表现非常有信心，甚至可以说，我们对新增会员将带来的长期价值感到非常兴奋。

So let's talk about our individual exchange business. Today, we're in 17 states. We selectively expanded in 2024. You'll see us selectively expand again in 2025. We want to be very thoughtful about how we grow this business. We don't expect the same types of growth we saw in 2023 and 2024, though we do expect to grow modestly. Importantly, 2024 for us is a margin recovery year. In 2023, we are losing a little bit of money. In 2024, we expect to make money. And in 2025, we expect meaningful margin improvement as we march towards our target margins of 3% to 4%.

接下来我们谈谈我们的个人医疗保险交易所（individual exchange）业务。到目前为止，我们已经进入了17个州。我们在2024年进行了有选择性的扩展，2025年也会继续稳健扩展。我们希望以非常审慎的方式来发展这项业务。我们并不预期会重现2023年和2024年那样的高速增长，但预计仍会实现适度增长。重要的是，2024年对我们来说是利润率恢复之年。2023年这块业务略有亏损，而我们预计2024年将实现盈利，2025年将有显著的利润率改善，朝着我们3%到4%的目标利润率迈进。

I think it's important to recognize that the way the growth came in this year in the individual business is that a lot of it was back half weighted. And so we are unable to properly document those members and get the revenue this year, but we will get it next year. And unlike Medicare, individual is a concurrent year, whereas Medicare is 1 year in advance. In other words, use the prior year to get revenue for the following year, individuals in the same year. So when we capture the revenue for 2024 and we start engaging with these members, we can have a material impact on our profits.

需要指出的是，我们今年在个人市场上的增长集中在下半年，因此我们无法在今年及时记录这些会员的病历信息，也无法在当年获得完整的报销收入。但我们将在明年获得相应收入。与Medicare不同，individual exchange是“同年度”的计价机制，而Medicare是“提前一年”的机制——即用上一年度的诊断数据来获得下一年度的收入，而individual是今年的服务获得今年的报销。因此当我们在2024年获得这些收入并与会员建立起更深入的互动时，将对我们的利润带来实质性的提升。

So what does it take to be successful? We need to be very thoughtful about the products we offer, and they need to be integrated. So as has been discussed, our individual members use the CVS pharmacies at a very high rate, close to 50% versus a market share of 27%, just to give you a sense of how meaningful that is because we've been very thoughtful about marrying the Aetna brand and the CVS brand as we design products for our members. And you'll see us continue to do that.

那如何才能在这一市场获得成功呢？我们必须对所提供的产品非常谨慎，并确保产品具备整合性。正如前面提到的，我们个人市场的会员使用CVS药房的比例接近50%，而我们在整个市场的占有率是27%。这说明我们的整合设计是有成效的——我们在设计会员产品时刻意地融合了Aetna与CVS两个品牌。未来我们还会继续强化这一策略。

Distribution and marketing, who we use as our channels, how we engage our members, what messages we send are very important. Similar in many ways to Medicare, and that it's a retail sale. You're going directly to the consumer as opposed to selling through a group. And so understanding that, working with your broker channels, making it easy to engage with us is a very important element of our value prop.

渠道与市场营销方面也是成功关键。我们如何选择分销渠道、如何与会员互动、传递怎样的信息都非常重要。这在很多方面和Medicare很像，都是“零售式”销售模式——也就是说，我们直接面向消费者，而非通过雇主团体来销售。因此，理解消费者行为、与经纪人渠道合作，并确保消费者能够轻松地与我们接触，是我们价值主张的重要组成部分。

We talked about our clinical programs. We believe that value-based care is not just for Medicare. It's also for the Commercial business. In fact, we're working with Oak Street now on how we manage some of our most acute individual and commercial patients because we think the model applies. The payment model is going to be different when you think through the incentives. But fundamentally, Oak Street has the ability to manage these patients, which we think is differentiating. And that allows us to create thoughtful networks that engages our members in a cost-effective way, which is so critical in this business.

我们还提到了我们的临床管理计划。我们认为价值医疗（value-based care）不仅适用于Medicare，也适用于商业保险业务。事实上，我们正在与Oak Street合作，探索如何更好地管理我们在individual和commercial业务中最重症的一部分病人。我们认为这套模式在这些领域同样适用，虽然支付机制和激励方式可能不同，但Oak Street具备管理这些高复杂度患者的能力，这是我们区别于其他公司的一个重要优势。这也帮助我们建立起高效的医疗网络，能够以具成本效益的方式与会员建立良好的医疗关系，这在这个业务中至关重要。

Let me talk about our Commercial business. Our priority is to continue to grow thoughtfully in this business, but not think about it as a [monolith]. Commercial has multiple subsegments. So you think about the national accounts business, self-funded, very large, tends to be competitive, and it's where our brand and legacy and our network position in multiple markets allows us to do quite well in this area. And we believe over time, when we utilize all of our CVS assets and bring them to bear on our commercial clients, it's going to be very, very powerful. Already, the integration with our PBM has been very, very powerful. And it's a unique value prop that we can provide that we're very proud of.

现在来谈谈我们的商业保险业务。我们的重点是稳健增长，但我们不会把这个市场当作一个统一的大盘来看待。Commercial业务其实分为多个子市场。例如全国性大客户（national accounts）业务，通常是自筹资金的大企业客户，这一领域竞争激烈，但凭借我们在多个市场的品牌影响力、网络覆盖和运营传统，我们在这一领域表现一直很好。我们相信，随着时间推移，将CVS的所有资产整合并提供给商业客户，将释放出巨大的潜力。目前，我们与PBM的整合已经带来了显著的协同价值，这是我们引以为傲的独特价值主张之一。

But you also have to think about the Commercial business in several other subsegments. So for example, the public and labor side. It's an area where we've done very well. We just won the North Carolina contract not too long ago, which will be if we get it through the courts, will be a very powerful 2025 win for us. But I think it's emblematic of the type of prioritization and customization and segmentation of the market that we're pursuing. And so our public and labor team has been very successful, and we have other reasonably sized RFPs out that we feel good about, where we can get business from one of our competitors.

此外，Commercial业务还包含其他几个子板块，比如公共与工会雇员群体（public and labor），这是我们表现相当突出的领域。我们最近刚赢得了北卡罗来纳州的大合同，如果法院批准，将会成为我们在2025年的一个强劲增长点。这是我们市场细分、定制化、优先排序战略的一个典型例子。我们的public and labor团队表现卓越，目前还在参与其他规模可观的RFP（招标），我们也有信心能从竞争对手手中赢得更多业务。

Similarly, the small group side, it's a business, our [AFA] product, which is effectively a level-funded premium product, has grown close to 12% over the last 2 years. We call it Small Group Nation at Aetna. They're very excited. They're very passionate about what they do. Again, that's something we talk a lot about, but it's an exciting opportunity to grow the commercial book as is our specialty franchise, dental, in vision, involuntary. These are high-margin products, low volatility, a lot of customer use. And again, using our enterprise assets, we can drive growth in those areas.

同样，小型团体业务方面，我们的 [AFA] 产品（本质上是一种定额资助的保费产品）在过去两年中增长了近12%。我们在Aetna将其称为“Small Group Nation”，团队对这项业务充满热情并非常投入。这是一个我们经常提及但仍充满增长潜力的领域。与之类似，我们的专项险种业务也具有巨大机会，例如牙科、眼科、以及雇主可选性福利等产品，这些业务利润率高、波动性低、客户使用率高。通过整合企业资源，我们可以进一步推动这些业务的增长。

And finally, we're going to be very focused on the digital capabilities. That is an absolute critical differentiator for us, not only making it easy to engage with us as their health insurer, making it easy for HR departments to engage with us, helping our members navigate care, helping them get the care they need, embracing virtual care. There's a host of initiatives we're working on that we think are very exciting that will differentiate us in the commercial market.

最后，我们将高度重视数字能力的建设。这是我们竞争优势中的关键因素之一，不仅能简化会员与我们之间的互动，也能让人力资源部门更容易与我们合作，帮助会员理清就医路径，获得他们所需的治疗，并接受虚拟医疗等服务。我们在这些方面正推进一系列令人兴奋的计划，相信会成为我们在商业市场上的差异化亮点。

这方面的内容比较少。

Our fourth product line is Medicaid. Medicaid is an area, again, that we feel very excited about and that we can leverage our enterprise assets to grow effectively. We're very thoughtful and targeted about our Medicaid expansion. Again, we believe there's a significant linkage between Medicaid participation and D-SNP. And we think CMS is focused there. We think the states are focused there. So as we think about our RFP strategy, both in terms of defending states that we're in, we're in 16 today as well as going into new states and competing there, we're very mindful of the overall environment. And we think there's a lot of opportunity there.

我们的第四条产品线是Medicaid。这一领域同样让我们感到非常兴奋，并且我们可以充分利用企业资源来有效扩张。我们对Medicaid的拓展持谨慎且有针对性的态度。我们相信，Medicaid的覆盖与D-SNP（双重特殊需求计划）之间存在紧密的联动关系。我们观察到CMS（联邦医保与医疗补助服务中心）和各州都对此高度关注。因此，在制定RFP（招标）策略时，无论是继续留守目前已经进入的16个州，还是拓展到新州参标，我们都在非常认真地评估整体环境，我们认为这当中存在大量机会。

On a stand-alone basis, too, Medicaid is attractive. The margins are a little bit lower, but the opportunity to engage with our members who are very needy from a clinical perspective, particularly in states, albeit slowly, more and more outsourced, their age bonding disabled, their long-term support services businesses. Those opportunities are real, and we want to be there to serve those members and then use our CVS assets and particularly our access points, our local access points in Medicaid is so important. And frankly, as one of the impediments to the successful health care of these members because they don't get the care that they need and they don't have the access that they need. And so as we think about our RFP design, which is a very important skill set in Medicaid to be successful and thoughtful about how you write those RFPs, incorporating things like MinuteClinic, for example, into those RFPs where we can give access to members that others can't provide, and we can guarantee that access is incredibly powerful.

即便从单独业务维度看，Medicaid 也具有吸引力。虽然利润率略低，但这一群体中临床需求重、服务缺口大的会员为我们提供了深度参与的机会，特别是在那些将残疾人及长期护理服务逐步外包的州。这些机会是真实存在的，我们希望能为这些会员提供服务，并且借助CVS的企业资源，尤其是我们在全国范围内的本地接触点来提升可及性。而事实上，“可及性不足”正是造成这些会员健康状况差的主要原因之一。因而在撰写RFP时——这在Medicaid招标中是关键能力之一——我们会特别考虑如何把诸如MinuteClinic这样的资源整合进去，从而为会员提供其他竞争对手无法保证的接触渠道。这种可及性的保障，是我们极具差异化竞争力的亮点。

And then finally, I would not discount the impact of value-based care in Medicaid as well. We are thinking about value-based care at the enterprise level across all of our business lines. Medicaid is another area where we could be successful. Similarly to the commercial side, and as I mentioned, there are very acute members who need clinical management, Oak Street is an example where they can provide that care. Believe it or not, maybe you may not be aware, but there's actually risk adjustment in Medicaid. And so we're engaging the Signify teams to do in-home assessments, not only for the documentation, but also for the clinical opportunities. And so again, the virtuous circle that we talk about, the integration between payer, provider and CVS assets are incredibly powerful.

最后，我们也绝不会低估价值医疗（value-based care）在Medicaid中的重要性。我们正在从企业层面，将价值医疗应用于各个业务线，Medicaid 是其中极具潜力的领域之一。就像商业险业务一样，Medicaid中也有大量重症会员需要临床管理，而Oak Street就是能够承担此类服务的优秀代表。也许你不知道，其实Medicaid也存在风险调整机制（risk adjustment）。因此，我们也调动了Signify团队开展上门评估，不仅用于信息记录，也识别临床干预机会。正如我们一直强调的那样，“支付方—服务提供方—CVS资源”三者之间的整合联动，构成了一个极具力量的良性循环。

And so we're committed to this enterprise growth. Again, we believe our assets are differentiating. You could see on this page, we believe that the enterprise assets yields better outcomes, both for our members and financially for us. We believe that Aetna could be a major driver of enterprise success given that we're at the top of the funnel and the members come through us, but that also we benefit significantly from the enterprise themselves.

因此，我们致力于推动整个企业的增长。我们坚信自身资产具有差异化优势。正如本页所展示，我们相信企业级资源不仅能带来更好的会员健康结果，也能为我们创造更优的财务回报。我们认为，Aetna可以成为推动整个CVS Health企业成功的核心引擎，因为我们处于“流量漏斗”的顶端——会员最先接触的是我们，同时我们自身也能显著受益于企业其他部门的协同支持。

So how should you hold us to account? Four major elements, not surprisingly, at or above enrollment growth, at or above market. That is our goal. It's going to vary from year to year depending on the external environment. But over time, we want to grow our market share. And we are committed to that. And given our enterprise capabilities, we think we can. But growth without profitability is not good growth. We have to grow at our target margins. And we're very focused on that. We talk about it all the time internally, I assure you. And we are going to take back margin in 2025 and beyond and in 2024 on the IFP side.

那么，外界应如何衡量我们的表现？有四个关键指标。第一，我们的入保会员增长应达到或超过市场水平——这是我们的目标。虽然这个数字会受外部环境影响在不同年份有所波动，但从长期看我们致力于扩大市场份额，并且我们相信依托企业资源完全具备这一能力。第二，增长必须伴随盈利。没有利润的增长不是真正的增长。我们必须实现目标利润率，这是我们高度关注的重点，我向你们保证，我们在内部对此反复讨论。我们计划在2025年及以后收复利润空间，并将在2024年实现个险（IFP）业务的利润修复。

Continuing to maintain our 4 stars, we're 87% in the most recent star period. We hope to maintain that or even improve it. It's going to be variations from year to year. It's always close. But I truly believe that how we've leveraged the enterprise, how we think across business silos is truly differentiating. And it's something that I think is a sustainable competitive advantage.

第三，我们要继续维持我们的“四星”评级。在最近的星级评估周期中，我们有87%的会员所在的计划获得了四星评级。我们希望维持甚至进一步提升这个水平。当然，这些分数每年都会略有起伏，竞争也非常激烈。但我坚信，我们跨业务部门协同、有效调动企业资源的能力是我们的关键差异化所在，也构成了可持续的竞争优势。

And then finally, and again, using the CVS assets and driving growth through them and they driving our success at Aetna's is something we're going to be very focused on. So we're going to talk to you about how many Signify in-home assessments we're doing? How many members in our Oak Street footprint? What's the overlap between our PBM and Aetna? And so you'll continue to hear us talk about that, and it's very powerful.

最后一点，我们将继续强调通过CVS企业资产来带动Aetna的增长，反过来Aetna的增长也促进整个企业的发展。我们会持续跟大家分享数据，比如我们完成了多少次Signify的上门评估？在Oak Street服务覆盖区内有多少Aetna会员？PBM（药品福利管理）与Aetna之间的重合度是多少？我们会不断提供这类信息，因为它们确实非常有力地证明了我们的协同优势。

And so I'll end where I started. This is a very exciting opportunity. I'm thrilled to be back with you. It's been a long time, 27 months. So here I am. I'm excited. I think the opportunity is enormous, and we have an opportunity to transform the health care ecosystem.

因此，我想用开始时的话作为结尾：这是一个令人振奋的机会。我非常高兴能回归并再次与你们相聚。时隔27个月，我回来了，感到无比振奋。我相信我们面前的机会巨大，我们有能力彻底重塑整个医疗健康生态系统。

So with that, I will hand it over to my friend, Prem to talk about the pharmacies.

接下来我将时间交给我的朋友 Prem，他将介绍我们的药房业务。

Prem Shah Executive VP & Group President

Thanks, Brian. Really appreciate you being part of our CVS Health Management team. Really excited to have you here. It's a privilege to be on stage today to represent the amazing care we provide every single day to all the folks and patients we serve. I'm a pharmacist by training. I spent 20 years of my career in the retail and specialty pharmacy industries. And I personally believe today, I have one of the best jobs in pharmacy, leading our Pharmacy and Consumer Wellness segment.

Prem Shah 执行副总裁兼集团总裁

谢谢你，Brian。非常感谢你加入CVS Health管理团队，我们非常高兴你在这里。今天能站在台上代表我们每天为客户和患者提供的卓越护理服务，我感到无比荣幸。我本人是药剂师出身，在零售和特药领域工作了20年。我由衷认为，今天我所担任的职务——领导我们的药房与消费者健康事业部，是整个药房行业中最棒的工作之一。

I'm excited today to share our strategy and how we're going to bring overall greater transparency to our retail pharmacy business and to the marketplace. So I'll spend a few minutes talking about the retail pharmacy industry. Retail pharmacy has been around for a long time, and it will continue to be around. It's a critical component of health care delivery in this country. Our retail stores are the cornerstone of our brand and of our consumer engagement. And it's one of the most frequent interactions in all of health care. It's especially important as you think about the things that Brian just mentioned, the aging population and the resulting ongoing incremental demand for clinical services that are going to be needed in our local communities.

今天，我非常高兴能与大家分享我们的战略，以及我们如何提升零售药房业务与整个市场的透明度。接下来我会花几分钟谈谈零售药房行业。零售药房已经存在很长时间，并且将继续存在下去。它是美国医疗服务体系中不可或缺的一部分。我们的零售门店是品牌的基石，也是我们与消费者互动的主要场所，它是整个医疗服务中最常见的接触点之一。尤其在Brian刚才提到的人口老龄化趋势下，社区对临床服务的持续增长的需求，药房的重要性愈加突出。

And as we said all day today, health care is local, pharmacy is local. And CVS has a proud, long legacy of serving our local communities. It's not changing. It's not changing because we're here. We're here to engage every consumer and gain their trust before and during their health care journeys. We're here and available when patients are sick, and need to feel better, even if that means it's on nights and weekends, when it may be challenging to find other health care service delivery assets open.

正如我们今天反复强调的，医疗服务是本地化的，药房同样如此。CVS拥有一段令人自豪、历史悠久的本地服务传统，这一点不会改变，也无需改变，因为我们始终在这里。我们会在患者医疗旅程的各个阶段参与其中，赢得他们的信任。无论是在他们生病需要及时治疗的时候，还是在夜晚或周末等其他医疗资源难以获得的时间段，我们都能提供服务。

More than 55% of our prescriptions that are acute, are dispensed on the very same day that they're prescribed. We have over 60% of our front store sales that are driven for health and wellness items. We were here, and we will continue to be here through natural disasters, public health emergencies. We played an absolutely instrumental role in our local communities during the COVID-19 pandemic as a convenient and necessary access point for testing and vaccinations. We're also here to deliver incremental clinical services. Last year alone, we delivered over 45 million immunizations in our stores.

我们超过55%的急性处方在开具当天就能完成配药；我们前店区60%以上的销售额来自健康与保健品类。在自然灾害、公共卫生紧急事件中，我们始终坚守岗位。在新冠疫情期间，我们在社区中发挥了极其关键的作用，是检测与疫苗接种的便利和必要渠道。我们也持续扩展我们的临床服务能力——仅去年一年，我们就在门店提供了超过4,500万剂免疫接种服务。

CVS Health is here for our communities, and being local is absolutely critical. But now when you think about our performance, it's critical. It's very clear that we are the best run retail pharmacy in the industry. Our scale, our engagement, our expertise, the trust that consumers have, have enabled us to deliver industry-leading performance across every domain. We've continued to grow our consumer base, continue to grow our scripts. We continue to grow share and our front store continues to grow drug share. And as Tom mentioned earlier, we continue to have strong financials.

CVS Health始终扎根于社区，而“本地化”正是我们成功的核心。说到我们的运营表现，有一点非常清楚：我们是整个行业中运营最出色的零售药房。我们的规模、客户互动能力、专业素养，以及消费者对我们的高度信任，使我们在各个维度都实现了行业领先。我们持续扩大客户群，处方数量不断增长，市场份额持续提升，前店区药品销量也在增长。如Tom早前所提，我们的财务表现也依然强劲。

Our Pharmacy and Consumer Wellness segment delivers strong cash flow generation that enables our enterprise growth. We serve over 14 million patients that have interactions with them every single week. We have 73 million patients enrolled in our ExtraCare loyalty programs. And we dispensed 1.6 billion prescriptions every single year. CVS Pharmacy offers at a scale and with a level of expertise and has the trust and engagement with our consumers like no one else. And we know consumer trust is something critical if you want to change health care. And consumer trust is extremely high with our pharmacists. Recent surveys show that greater than 90% of consumers trust their local pharmacist.

我们的药房与消费者健康业务单元创造了强劲的现金流，为企业的整体增长提供了支持。我们每周服务超过1,400万名患者；我们的ExtraCare会员计划拥有7,300万注册用户；每年我们配发16亿张处方。CVS Pharmacy的运营规模与专业水平，以及与消费者之间的信任与互动程度，是其他任何公司难以比拟的。如果你想真正改变医疗体系，赢得消费者信任是基础。而我们的药剂师正是信任的核心——最近的调查显示，超过90%的消费者信任他们本地的药剂师。

The second piece you need is satisfaction. The satisfaction levels in our pharmacy and our front store businesses are at all-time high since 2021. Lastly, we have to demonstrate results, demonstrate proven outcomes. Our clinical adherence measures are best-in-class in the marketplace. All of this is amplified by the fact that we have to be local. Remember, 85% of U.S. -- of the U.S. population of all Americans live within 10 miles of CVS pharmacy. We also have to deploy easier ways to engage with them, and we're helping consumers through our self-service omnichannel capabilities, and we now have greater than 40% of our patients interacting into those channels.

第二个关键要素是“满意度”。我们药房与前店区业务的顾客满意度自2021年以来已达到历史最高水平。最后一点，我们必须展现成果，展现经验证的临床成效。我们在临床用药依从性方面的指标在市场上处于领先地位。而所有这一切，都因为我们深入本地的服务网络而得到进一步放大。要知道，美国有85%的人口居住在距离CVS门店10英里以内。我们也正在推动更便捷的互动方式，通过全渠道的自助服务能力帮助消费者，目前已有超过40%的患者通过这些渠道与我们互动。

We have an incredibly tenured talented leadership team, leading our retail pharmacy business. And as these results demonstrate, we have the right strategy. We're executing against the right strategy to help impact one of our biggest headwinds and to differentiate us as a pharmacy and consumer of choice. One key component of our strategy is evolving how we work and how we support our colleagues and consumers.

我们拥有一支经验丰富、才华出众的领导团队，负责领导我们的零售药房业务。正如这些成果所展示的那样，我们确实拥有正确的战略，并正有力执行，以应对我们当前面临的最大挑战之一，并在市场中脱颖而出，成为消费者首选的药房品牌。我们战略中的一个关键组成部分，是不断优化我们的工作方式，以及我们对员工和消费者的支持方式。

Let me tell you a little bit more about how we're doing this. We're transforming quality and safety. For example, we have launched a clinical decision support tool, we call it Smart [ DUR ], that generates patient-specific alerts to support our pharmacists clinical conversations at the counter with their patients, making it easier for them to engage them.

让我进一步介绍我们具体是如何做的。我们正在重塑质量与安全管理。例如，我们推出了一款临床决策支持工具，称为 Smart [DUR]，它能够根据每位患者的具体情况生成个性化提醒，帮助我们的药剂师在柜台与患者进行临床沟通，使他们更容易与患者展开深入互动。

We leverage AI, and we've augmented our capabilities in our pharmacists to support key tasks such as the ability to perform prescription verification virtually or through eRx consolidation. We're deploying an unparalleled, scalable industry-leading pharmacy operating platform in RxConnect. And we're not settling with the way it is today. We continue to invest in it. And this year, we'll -- we're rolling out a dynamic workload model that shares work across stores, across our more than 9,000 stores, enabling us to operate as 1 fleet rather than managing workload individually at each store.

我们利用人工智能技术，增强药剂师执行关键任务的能力，例如远程完成处方核验，或通过电子处方集中处理（eRx consolidation）。我们还部署了业界领先、可扩展的药房运营平台RxConnect。而且我们不满足于当前的状态，仍在持续投资。今年，我们将推出一种动态工作负载模型，将任务在超过9,000家门店之间进行共享，使我们可以像一个统一舰队一样运作，而不是每家门店各自为战。

We're delivering on our digital and omnichannel innovation. Visits to cvs.com are up 11%. And our sales and digital sales are up 15%. And we're launching the same-day delivery options nationwide in our front store that we -- to complement our pharmacy offerings. Another example of where we're innovating is did you know our pharmacies receive hundreds of millions of phone calls every single year. We're testing an approach using AI that pulls out the calls to the pharmacy, helps caller serve -- self-serve digitally and where possible for funneling messages to our pharmacist that need to help patients with their clinical support. And this is all directly into our workflow for follow-up.

我们正在推动数字化与全渠道创新。cvs.com网站的访问量同比增长11%，整体销售额及数字销售额增长了15%。我们也正在前店区推广“当日送达”服务，以补充药房业务的服务能力。另一个例子是：我们的药房每年接到数亿个电话。我们正在测试一种新的AI方案，能将来电按需转为数字化自助服务，并在可能的情况下，将真正需要药剂师介入的内容定向传递，帮助他们开展后续临床支持。这一切都被直接整合进了我们的工作流程中。

Since the launch of this, it's resulted in a 50% reduction in calls requiring call action. It's also resulted in higher digital adoption, better colleague NPS and better customer satisfaction. Together, these innovations will unlock capacity for our store teams, enabling them to spend more time with our consumers and for our pharmacists to engage in more clinical care needed in our local settings. We also know that our ability to engage patients in a simple way, in a local way, drives better outcomes and ultimately lowers health care cost.

这项新方案推出以来，已使需要人工处理的来电量减少了50%；与此同时，数字化服务的使用率更高，员工净推荐值（NPS）提升，顾客满意度也有所提高。这些创新合力释放了门店团队的运营能力，使员工能将更多时间用于与消费者互动，让我们的药剂师投入更多精力进行本地所需的临床服务。我们也清楚：越简单、越本地化的患者参与方式，往往带来更好的健康结果，并最终降低整体医疗成本。

CVS Pharmacy is an anchor for our consumers, and we're a trusted constant in their health care journey. As Karen mentioned, the average tenure of a CVS Health Pharmacy patient is around 10 years. Let me give you some examples of how we bring engagement to life and how we're making health care across our enterprise more seamless and omnichannel. We start with the consumer. We've expanded it and really improved our over-the-counter supplemental benefit programs and accessibility with Aetna and other large payers and network partners. Our OTC benefit sales in our front stores are up more than 50% year-over-year.

CVS Pharmacy 是消费者心中的“定海神针”，在他们的医疗旅程中是值得信赖的恒久存在。正如Karen提到的，一位CVS Health药房患者的平均关系维持时长约为10年。下面我给大家举几个例子，说明我们是如何在实践中实现深度互动，并使整个企业的医疗服务更无缝、更多渠道整合。我们从消费者出发，扩展并改善了与Aetna及其他大型医保方和网络合作伙伴的非处方（OTC）福利项目及可及性。因此，我们门店中的OTC福利商品销售额同比增长超过50%。

We're making health care more connected and convenient. We're addressing gaps in care and supporting our care delivery assets, and we're seeing early success. For example, with Signify, we started a pilot immediately after the acquisition to engage in members on behalf of their health plans to schedule their Signify in-home health evaluation. We've seen a 66% reach rate and an incredibly strong conversion of those members. And we're seeing these results even in populations where Signify just would not contact the members anymore because they couldn't reach them. And that's because the patients trust, the CVS brand, and they trust that relationship in the local setting.

我们正让医疗服务变得更紧密、更便捷。我们在填补医疗服务的空白，并支持我们的护理交付资产，目前已初见成效。例如，在收购Signify后，我们立刻启动了一个试点项目，代表医保计划与成员接洽，安排他们的Signify居家健康评估。我们实现了66%的接触率，转化效果也非常惊人。即便是在一些Signify原本因联系不上而放弃联系的群体中，我们也取得了成功。这背后的原因，就是患者信任CVS这个品牌，信任与我们之间的本地关系纽带。

We're also connecting our patients when they need it the most. We spent a lot of time coordinating care between our assets and the rest of the health care system. Let me try to bring that to life for you. If you're a mother or a father with a sick kid, you go to the doctor's office, you get a prescription for an antibiotic. In the old model, 10 years ago, you would have got a physical prescription, you would have came to the store, you would have waited.

我们也在患者最需要帮助的时刻与他们建立联系。我们花了大量时间协调我们自身资产与整个医疗系统之间的衔接。让我通过一个实例向你展示这一点。如果你是一位带着生病孩子的母亲或父亲，你去看医生，医生为你开了抗生素。在10年前的旧模式中，你会拿到一张纸质处方，然后带着孩子来到我们的药房等待配药。

Over the course of the last 10 years, now 90% of prescriptions are electronic, eRx is what we call them. When that prescription comes to the store, what you typically do in today's model, as you call the store to find out when your prescription will be ready because obviously, your child needs it. But in the new world, the second we get to eRx when patients are engaged, we send them a message, we send them a really simple message. Would you like your prescription later today? Sooner than that in an expedited fashion? Or you don't need until tomorrow?

过去10年间，约90%的处方已经实现电子化，我们称之为eRx。在今天的模式下，当药房收到这张电子处方时，家长通常会打电话给门店，询问药什么时候可以拿到，因为他们的孩子急需。但在我们新的服务模式中，一旦我们收到eRx并检测到患者已参与进来，我们会主动发出一条非常简单的讯息：“您希望今天稍晚拿药？还是更快一点？或者您不急着今天取药，明天再拿？”

处于比较初步的科技水平。

It's a very simple dynamic, but it creates incredible service, and it creates an incredible, what I would say is health care delivery that doesn't exist today. This isn't just in pilot. We launched this earlier this year, and we've replicated this very example, 150 million times, a 150 million times since we've launched this. And it's a great example of how we can make health care more connected and convenient.

这听起来非常简单，但它提供了极具价值的服务体验，我认为这是一种目前在其他地方尚不存在的医疗服务交付方式。这不仅仅是一个试点项目——我们在今年早些时候就正式上线了这项功能，并已经复制这一模式达1.5亿次，是的，1.5亿次。这就是我们如何让医疗服务更加紧密联通与便捷的典范。

We're also making it easier to navigate. We spent a lot of time with our Caremark teams. We're bringing the prior authorization statuses into our digital assets to make it easier to share with members and consumers so they know where their prescription is and they know the prescription status in the prior authorization status. And lastly, we're making health care more local and accessible. Right after the Oak Street Health acquisition, we immediately worked with that team, and we used our CVS retail locations to increase the awareness of Oak Street Health. And we're seeing a reduction in the acquisition cost of an Oak Street Health member, demonstrating the power of our engagement and the potential of our retail footprint.

我们也在简化患者的就医路径。我们与Caremark团队密切协作，将处方的事前授权（prior authorization）状态整合进我们的数字化平台，方便成员与消费者实时查看处方流程及进度。另外，我们也在让医疗服务更加本地化与易获取。就在收购Oak Street Health后，我们立刻与该团队协同，在CVS门店内提升Oak Street Health的知名度。我们已看到每获客成本有所下降，这印证了我们品牌互动的力量与零售网络的潜能。

Moving forward, our retail pharmacy business will continue to engage in health for our consumers. We're going to do that every single day. We're going to engage more consumers in the matter -- in the moments that matter in their health, where and how they want to engage us in the local setting. We're going to harness the power and engagement and trust to build connections across the full breadth of our enterprise and care delivery assets. And ultimately, our trusted local presence will enable us to make a meaningful impact on health care trends in this country.

展望未来，我们的零售药房业务将持续以健康为核心与消费者互动。我们每天都将坚持不懈。我们会在他们健康旅程中最关键的时刻、在他们希望的方式与场景中与他们互动。我们将凭借品牌力量、消费者信任与高度参与，串联整个企业及护理交付资产。最终，我们深受信赖的本地化服务网络，将使我们能在美国医疗服务趋势中产生深远影响。

Now despite all of the things I just talked about, our market-leading growth, our unmatched scale, expertise and purchasing economics, our script in front store growth, the expansion of our clinical services and how we have driven efficiencies in our business and how we continue to drive efficiencies in our business through the operating model innovations that we bring and by continuing to optimize our footprint. Despite all of this, and as Karen and Tom alluded to earlier, this is a really challenging industry. And as a leader, it is our responsibility to chart a different course.

尽管我们在上述所有方面表现卓越——市场领先的增长、无与伦比的规模与专业实力、强大的采购经济性、处方量与前店业务的稳步提升、临床服务的拓展、运营效率的持续提升，以及通过创新运营模式和优化门店网络所带来的持续效益——但正如Karen和Tom早前所提及的，这是一个充满挑战的行业。作为行业领导者，我们有责任开辟一条不同的前进路径。

But I want to take a moment to talk about the challenges and the changes that we face. The current pharmacy reimbursement model has been effective over the last decade. We grew prescription volume, we've improved our operating efficiency, we've lowered the cost of generic drugs, and we drove adoption of generics, and all of these things have partially offset reimbursement pressure. We accomplished all of this while continuously elevating the levels of safety, quality and service to our patients. But this model has reached a point -- it's reached an inflection point that is just ripe for change because if you look forward, the adoption of generic drugs in our retail pharmacy business is now around 90%. That limits the capacity or the amount of value remaining through the higher levels of generic dispensing.

但我想稍作停留，谈谈我们所面临的挑战与变革。当前的药房报销模式在过去十年中确实发挥了作用：我们增加了处方量，提升了运营效率，降低了仿制药成本，并推动仿制药的普及。这些举措在一定程度上缓解了报销压力。我们在不断提升患者安全、质量与服务水准的同时实现了上述成果。但这个模式已经来到临界点——它已不再适用于未来，因为当前我们零售药房业务中，仿制药的使用率已高达90%，这限制了通过进一步提升仿制药占比所能释放的价值空间。

Second, branded drugs. Branded drugs consistently rise due to inflation and the rising cost of new drug prices, further widening the cost difference from generics and brands. Since 2019 alone, branded drugs have risen more than 40%. And what does this lead to? It leads to higher cost for patients and our customers' plans and PBM plan sponsors. The third piece that's happened over the course of the last couple of years is new branded market entrants, we call them GLP-1s, have further contributed to increased pharmacy cost.

第二，品牌药。品牌药的价格持续上涨，既受通胀影响，也因新药上市时定价越来越高，从而进一步扩大了品牌药与仿制药之间的成本差距。仅自2019年以来，品牌药价格就上涨了超过40%。这带来了什么后果？患者的药品负担变得更高，我们客户的医保计划和PBM计划赞助方也要承担更高的成本。过去几年中，另一个重要变化是新兴品牌药物的进入，尤其是我们所说的GLP-1类药物，也在进一步推高药房端成本。

Historically, we would manage contracting with PBM and plan sponsors in a way in which we would price our products across brands and generics. But as Karen mentioned earlier, we now find ourselves in a place where cross subsidization is no longer sustainable. Further, if you think about what that cross subsidization has done in the last decade, when high deductible health plans has risen, they've created an even more complexity and frustration for the people that walk into our pharmacies every single day. I know PBMs and payers want, need and require a local vibrant network to serve their members, and the reality is we're going to be there for them.

过去，我们与PBM和计划赞助方的合同结构是基于品牌药与仿制药之间的整体定价策略进行管理的。但正如Karen早前所提，我们如今处于一个交叉补贴不再可持续的局面。而如果回头看看过去10年的交叉补贴模式，在高自付额医保计划兴起之后，它也给每天走进我们药房的消费者带来了更多复杂性和困扰。我知道PBM和支付方希望，也需要一个本地有活力的药房网络来服务他们的会员，而我们将一如既往地成为他们的合作伙伴。

Today, as you've seen, we're taking a leadership position. We're changing this outdated reimbursement model that made sense for the last decade, but no longer works today or in the future. We're introducing a new simple model that provides value for all stakeholders across the supply chain in a much more simple, transparent and comprehensive way. The new model shifts the way we're getting paid for products and services to be provided, to being more closely aligned to the value we create as a local community pharmacy for the tens of millions of patients we serve every single year.

今天，正如你们所看到的，我们正扮演行业引领者的角色。我们正在改变一个虽然在过去十年内行之有效，但如今和未来已不再适用的过时报销模式。我们推出了一种全新的、简单的模式，以更简洁、透明且全面的方式，为整个供应链中的所有利益相关方创造价值。新的模型将我们获得药品和服务收入的方式重新定义，使其更紧密地对齐我们作为本地社区药房每年为数千万患者所创造的价值。

We're introducing what we call CVS CostVantage. It's our new pharmacy reimbursement model. Let me be really clear. We will continue to lower the cost of drugs. It is part of our scale, size and expertise by creating competition. And we're going to continue to pass through our cost of goods improvements in our new model to PBMs and payers in a very transparent fashion. So how will this work? We're going to get paid based on a very transparent formula, cost of drug, plus a clearly defined markup and a patient management fee. And it's tied to the care and value provided by our pharmacy care teams and their local communities.

我们推出了一个新模式，称为“CVS CostVantage”，这是我们新的药房报销模型。我想讲清楚一点：我们仍将继续降低药品成本。这是我们依托规模、体量与专业能力，在竞争中形成的优势的一部分。在新的模式下，我们将把采购成本的改进透明地传导给PBM和支付方。那么它是如何运作的？我们将按照一个非常透明的公式收费：药品成本 + 明确标示的加价 + 一项患者管理费用。这项费用是与我们药房团队在本地社区提供的护理服务和实际价值挂钩的。

We're launching this with our commercial payers first, the 750 million prescriptions that Karen mentioned, beginning on 1/1/'25. We're going to work together with our PBM and payer partners over the early part of 2024 to facilitate this change. Second, we're going to continue to monitor our positioning in the third-party cash discount space. And starting in Q2 2024, we're going to extend this model, the reimbursement model to certain third-party cash discount card administrators as well.

我们将在商业支付方中率先推行该模型，也就是Karen提到的每年7.5亿张处方，自2025年1月1日起开始实施。我们将在2024年初与PBM和支付方伙伴密切合作，共同推进这一变革。其次，我们还将继续评估我们在第三方现金折扣市场中的定位，并计划从2024年第二季度开始，将这一新的报销模型推广至部分第三方现金折扣卡管理方。

So why is CVS CostVantage better? It's better because we're using our expertise to build a more durable and transparent model that allows for competition and compensation for our services. It enables us to deliver the value for all of our stakeholders. It's also better because we believe CVS CostVantage should reset the financial outlook of the retail business with potential upside to our long-term guidance growth expectations with the impact of this strategic shift.

那么，CVS CostVantage 为什么更优？因为我们运用了自身的专业能力，构建了一个更具持久性、透明性、支持公平竞争并合理补偿服务价值的模型。这使我们能为所有利益相关方创造更大价值。此外，我们相信，CVS CostVantage还将重塑零售业务的财务前景，随着这一战略性转型的实施，可能为我们长期增长预期带来上行潜力。

So why is CVS CostVantage better for PBMs and health plans? As noted, we're going to continue to lower the cost of drug -- cost of goods and the cost of drugs in our model. We're going to leverage our scale, our size, our expertise in the supply chain. We're going to pass on these improvements in a much more real-time fashion. We're going to provide greater transparency to PBMs and payers. And I firmly believe that this is a crucial building block for PBMs to create a more transparent model downstream for their clients so they can pass this value on to their members. And what I know for sure is our PBM partners also want to drive more transparency for their clients as we move forward.

那为什么CVS CostVantage对PBM和医保计划也更好？如前所述，我们将继续通过该模型降低药品与采购成本，充分发挥我们的规模、体量和供应链专业优势，并以更接近实时的方式将成本改善传递出去。我们将为PBM和支付方提供更高程度的透明度。我坚信，这将成为PBM建立更透明的下游模式、并最终将价值传递给其客户和会员的关键支撑。我也清楚，我们的PBM合作伙伴在未来也希望为他们的客户推动更高的透明度。

Why is this model better for consumers? This is a really foundational step towards a transparent model for consumers. And it sets the stage for payers also to create more predictable pricing at the pharmacy counter. CVS CostVantage makes and will make pharmacy pricing much, much simpler. Personally, I spent the last 20 years in the pharmacy, PBM, specialty pharmacy businesses. I've been doing this for a long time. The time now is for change. And we're setting the stage, we're taking our leadership position and we're going to make this happen.

这个模式对消费者有什么好处？这是实现药品定价透明的基础性一步，同时也为支付方在药房柜台提供更具可预测性的价格奠定了基础。CVS CostVantage正在并将持续让药品价格变得更简单、更清晰。我个人在药房、PBM和特药业务领域已经工作了二十年，现在确实到了该变革的时候了。我们正在搭建框架，承担起行业引领者的角色，并将坚定不移地推动这一变革。

Lastly, as I mentioned at the beginning, our consumers and our patients in every local community need their local pharmacy. It's a critical access point, and it's a critical component of health care delivery. And driving a more healthy, vibrant retail pharmacy industry ensures ongoing access to local care, while our ability to continue to invest in improving service and the quality of health for our consumers. And we know engaged consumers are healthier consumers, and we know ultimately that will lower the cost of care.

最后，正如我在开头所说的，我们的消费者和患者在各自的社区中都离不开本地药房。它是重要的医疗接入点，更是整个医疗服务体系不可或缺的一部分。打造一个更健康、更有活力的零售药房行业，可以持续保障本地医疗可及性，也能让我们持续投资于服务质量与消费者健康水平的提升。而我们知道，越是积极参与的消费者，健康状况就越好，最终也会降低整个医疗系统的成本。

Finally, let me tell you why this model is better for CVS Pharmacy. First, it's transparent. It directly ties the reimbursement to the quality pharmacy services we provide and the products we dispense in our local communities. It's also sustainable and durable. It ensures the sustainability of retail economics, removing the reliance on problematic things. Problematic things like cross subsidization and drug mix risk that we're exposed to today. And it will enable us to further invest, as I said earlier, in our stores and colleagues.

最后，我想说明一下，这个新模式对CVS Pharmacy本身为何更好。首先，它具备高度透明性——它将报销金额直接与我们在本地社区提供的药学服务质量和药品分发挂钩。其次，它具有可持续性与稳定性，能够确保零售药房业务的经济可行性，并摆脱对那些现在已经成问题的机制的依赖，比如交叉补贴和药品组合风险。此外，正如我之前所说，这种模式也将使我们得以进一步投资于门店和员工。

And lastly, it's predictable. It makes it easier for all of you to understand how our business performs in a much simpler fashion. Given our scale, our local community presence, expertise and strong consumer engagement and the ability to make a meaningful difference to cost, quality and health care outcomes, CVS Health is best positioned to continue to being the pharmacy and employer of choice. By tying reimbursement directly to the underlying cost of our business and the actual cost of drugs. Imagine that, a model that makes sense and continuing to execute against our strategy.

此外，它还有一个重要优势——可预测性。它使你们所有人都能以更简单的方式理解我们业务的运行表现。鉴于我们的规模、本地社区覆盖、专业能力和强大的消费者黏性，以及我们在成本、质量和医疗结果方面带来的切实改善能力，CVS Health完全有能力持续成为消费者首选的药房品牌、员工首选的雇主。通过将报销直接与我们业务的基本成本和药品实际采购成本挂钩——想象一下，这是一个真正“讲得通”的模型，并且是我们正在坚持执行的战略。

We will be able to create a more sustainable future for our retail pharmacy business that's going to drive down costs while continuing to support our PBMs and our payers with our industry-leading acquisition costs. And we're going to pass that through in a much more transparent and real-time fashion. Model also enables us to reinvest in our business to maintain and improve the quality of service that we provide every single day.

这将使我们能够为零售药房业务打造一个更加可持续的未来，不仅能够推动成本下降，同时还能以我们业内领先的采购成本持续支持PBM和支付方。我们也将以更透明、近乎实时的方式将这些优势传导出去。这一模式还能让我们持续对业务进行再投资，从而维护和提升我们每日提供的服务质量。

Lastly, we have to also continue to deliver those best-in-class adherence rates, the clinical innovations that we have in our store to support the quality of safety of the members that we serve. And it will be easier for our investors to model. Moving forward, you can hold us accountable to the metrics that you see on this page, and we will continue to be focused on those.

最后，我们还必须继续维持行业领先的用药依从性表现，持续推动我们门店中的临床创新，以保障我们所服务会员的健康与安全。对于投资者而言，我们的业务模型也将变得更容易理解和预测。未来，你们可以根据这页展示的关键指标监督我们，我们也将始终聚焦这些指标并持续努力。

So in summary, we're committed to delivering strong, continued results. We are now and we're going to continue to be the best retail pharmacy in the industry. I ask this question a lot, can we be better? And the answer is absolutely. Can we drive better outcomes? You better believe it. On retail presence and engagement, no one, and I mean no one is better positioned than CVS Health to interact with patients at a local level and transform their health care, and make no mistake, we're going to do it.

总结一下，我们承诺将持续交付强劲的经营成果。现在我们是、未来我们仍将是这个行业中最出色的零售药房。我经常自问：我们能做得更好吗？答案是：当然可以。我们能推动更好的健康结果吗？绝对能。在本地零售覆盖与消费者互动层面，没有任何一家企业比CVS Health更具优势，我们能在本地层面与患者建立联系、改变他们的健康轨迹。毫无疑问，我们一定会做到。

With our retail pharmacy business as a front door to our enterprise, we're going to make our enterprise flywheel spin faster, engaging our consumers in their everyday health, driving improved health outcomes and lowering the cost of care and helping our enterprise businesses grow above market. And now with CVS CostVantage, we're changing the way that we are paid for our products and services. We're taking our leadership position to create a more transparent, simple, high-quality and sustainable business for the marketplace overall.

我们将零售药房业务作为整个企业的“前门”，将进一步加速我们的企业增长飞轮——更高频地参与消费者的日常健康，提升健康结果，降低整体医疗成本，并推动我们的各项业务实现高于市场的增长。而现在，凭借CVS CostVantage，我们正在改变药品与服务的回报机制。我们正以领导者的姿态，打造一个更透明、更简洁、更高质量、更具可持续性的市场生态。

I'll end where I started. I have one of the absolute best jobs in the pharmacy industry. I'm powered by incredibly strong tenured leadership team. But more importantly, empowered by the 200,000 Pharmacy and Consumer Wellness colleagues. And we will not stop, all of us will not stop until we take the power of pharmacy and the pharmacist to drive better outcomes and to lower the cost of health care.

我想以开始时的情绪作结——我拥有整个行业里最棒的工作之一。我背后有一支极其强大且经验丰富的领导团队，更重要的是，还有20万名药房与健康服务团队的同仁与我并肩作战。我们绝不会停步，直到我们真正发挥药房与药师的力量，去推动更好的健康结果，并切实降低整个医疗体系的成本。

Thank you so much for your time this morning. And now I'm pleased to introduce David Joyner to the stage.

谢谢大家今天上午的聆听。接下来，有请David Joyner上台。

David Joyner

All right. Thank you. Thank you, Prem. So one thank you for your leadership and thank you also in a really difficult operating environment in the retail industry. I really want to thank you for your persistence and investing in critical part of health care delivery system. I really believe the Prem is, at this point, the right leader at the right time and in the right place in this company. So thank you for that.

David Joyner

好的，谢谢你，Prem。首先感谢你的领导力，也感谢你在零售行业这个充满挑战的经营环境中，依然坚守岗位并持续投资于医疗服务体系中至关重要的部分。我真心认为，Prem此时此刻正是公司在这个岗位上的最佳领导人。所以再次感谢你。

So I -- for many of you that have known me, I spent 30 years with CVS Caremark, 7 years before that with Aetna. So I feel like I'm sharing this not because I want to share how old I am, but more importantly, the fact that I've been able to have a front row seat with how this company has evolved and how it continues to compete and serve customers. So that front row seat has allowed me to kind of look back in terms of where we've been and more importantly, where I believe that we're going.

我想，对于在座的许多人来说，你们都知道我曾在CVS Caremark工作了30年，在此之前还在Aetna待了7年。我说这个并不是为了暴露自己的年龄，而是想强调我有幸近距离见证了这家公司如何不断演变、竞争，并持续为客户提供服务的全过程。这个“前排视角”也让我能从过去的经历出发，更重要的是，展望未来的发展方向。

And so I know many of you have several questions as it relates to what is the future role of the PBM? What's happening specifically with the regulatory and/or legislative environment? What's the impact going to be on your business? And then equally as important is where is the growth and the path going forward? So I'm hoping to spend this morning session addressing those questions and then giving you at least hopefully some confidence in the fact that we are an adaptable, resilient business that has continued to deliver in the past and believe equally as important delivering in the future.

我知道在座很多人都会关心几个问题，比如PBM未来的角色是什么？当前监管和立法环境的变化到底意味着什么？这些变化会如何影响我们的业务？以及同样重要的，未来的增长路径在哪里？今天上午我希望能围绕这些问题做些解答，同时也希望能向大家传达我们的信心——我们是一家具备适应能力和韧性的企业，在过去已经持续交出成绩单，而未来也同样值得期待。

There's really 2 things our customers focus on. One is they want us to reduce their cost and/or manage the underlying pharmacy cost. And then secondly, they want us to deliver best-in-class service for many of the customers that we're serving. Remember, this is a pharmacy benefit. It's an investment in their employees. And so there is a really significant focus on making sure that we're delivering best-in-class service while also managing the underlying cost.

客户真正关心的其实只有两件事。第一，他们希望我们能够降低他们的药品成本，或更好地控制其基础药品开支。第二，他们希望我们能够提供行业领先的服务水平。请记住，药品福利是企业对其员工的一种投资，因此，客户高度关注我们是否既能提供一流服务，又能控制成本。

So now let me spend just a few minutes as it relates to our business today. When you look at our customer base, we have an incredibly strong multi-payer platform that basically presents leadership positions in the employer markets, labor, government and/or health plan space. So incredibly proud of the diversity and the stability of the customers that we serve. If you exclude Centene, we're back to the same type of retention rates that we've seen in the past, 98-plus percent, again, reinforcing the fact that these are customers that we've been able to serve and be able to renew and invest for future growth.

接下来我想花几分钟时间谈谈我们当前的业务状况。从客户结构上看，我们拥有一个极具实力的多支付方平台，在雇主市场、工会市场、政府与健康保险计划等领域都处于领先地位。我对我们客户基础的多样性和稳定性感到非常自豪。如果不计Centene的退出，我们的客户续约率已经恢复到了过去的水平——超过98%。这再次说明我们不仅能够服务好客户，还能够与他们保持长期关系并持续进行未来投资。

This year, in particular, we had an exceptional success rate in the employer segment. So if you look at the large national account, and I mentioned this on the earnings call there in the last call, we've actually won 60% of all the employers, national account employers that changed PBMs last year. That's a really, really powerful outcome and result, and again, a focus on the franchise that we serve in that national account marketplace. It also now puts us beyond 50% of all the Fortune 100 companies served in the country.

尤其是在今年，我们在雇主市场取得了非凡的成绩。如果看全国大型客户板块（我在上一季度财报电话中也提到过），我们赢得了去年更换PBM的雇主客户中的60%。这个成绩非常了不起，也再次显示出我们在全国大客户市场的强大影响力。如今，我们已经服务了全美超过50%的《财富》100强企业。

So why do we have this success? It's in a large part, focusing on the 2 big drivers that our customers believe are most important and most pressing today. Specialty growth. We delivered more than $1 billion worth of savings within the specialty category. And then the last one, which is obviously the theme of the day, which is the GLP-1s. And if you combine both the purchasing and formulary services that we provide on top of the utilization management, we've been able to take 70% of the cost out for this GLP-1 category.

我们为什么能取得这样的成功？很大程度上是因为我们始终聚焦于客户认为最重要、最紧迫的两个核心问题。第一个是特药支出增长问题，我们通过在特药领域的管理为客户节省了超过10亿美元。第二个，就是如今的热门议题——GLP-1类药物。结合我们的采购能力、药物目录管理服务以及合理用药管理体系，我们已帮助客户在GLP-1类别上实现了70%的成本削减。

So critically important in terms of delivering and meeting the needs of our customers, at the same time, recognizing that our work is not done. But it's that retention and the investment in our customers, the delivery of value that we bring to those customers enables us to deliver value back to you as the investors. So we've had, again, really, really solid growth, a 13.4% growth in adjusted operating income in the last 4 years, and we've also continued to outgrow the market in the specialty area.

在满足客户需求方面，这是至关重要的，同时我们也认识到工作远未结束。正是因为我们对客户的持续投入、客户留存率的保持以及我们向客户提供的价值，才使我们能够将这份价值回馈给你们——我们的投资人。我们在过去四年里实现了13.4%的调整后营业利润增长，在特药领域的增长速度也持续领先于市场。

So now let me take just a second to talk specifically about what I see as the role of the PBM going forward. So it's a -- there's been either customers that have chosen to unbundle and/or bundle. Again, ultimately, the customers choose how to contract with this. There's really 3 main parts of the PBM that we contract with customers on. The first is the broader PBM services. So it's essentially the administration, the adjudication and the facilitation of the pharmacy benefit. We've invested heavily in this area in terms of delivering a cloud-based digital platform to help us facilitate the underlying administration and the benefit configuration and coding.

接下来我想花一点时间谈谈我对PBM未来角色的看法。现在客户有些选择将服务分拆，也有些选择打包，但归根结底，是由客户决定他们如何与我们签约。我们与客户签订的PBM服务主要由三大部分构成：第一部分是广义上的PBM服务，主要是药品福利的管理、理赔和执行。我们在这个领域进行了大量投资，尤其是在构建基于云的数字化平台方面，以推动福利管理、配置和编码的现代化。

So this is a huge step forward in modernizing the systems that we support and is all powered through automation and augmentation. Again, a big theme that you've heard from the other division leaders. So it's this piece that I believe is kind of the basics of the services that we deliver. It's how -- it's what powers everything else across the business model. And continue to remind us that this is where you have to be brilliant at the basics. It's the hidden part of the -- but it's a critically important part of the PBM.

这代表我们在系统现代化方面迈出了重要一步，所有功能都由自动化和增强技术驱动。这也是今天你从其他业务负责人那里听到的一个核心主题。我认为这一部分是我们服务体系的基础，它是整个商业模式中所有其他部分的动力源泉。我们时刻提醒自己必须在“基础功”上做到极致。虽然这是PBM中看不见的部分，但却是最关键的部分之一。

The second part is where size and scale matters. The purchasing economics allows you to leverage the size and strength of a large company like CVS Caremark and deliver savings in the area of generics, and also in the area of branded pharmaceuticals. So it's a combination of our purchasing groups, creating that competition that allows us then to extend that value to our customers, of which we believe we're continuing to be a leader in the space.

第二部分是规模优势。采购经济使我们可以像CVS Caremark这样的大型公司充分利用规模和实力，在仿制药和品牌药两个领域都实现成本节约。我们通过整合采购组织、引入竞争机制，从而将这部分价值传递给客户，我们相信我们在这一领域仍然处于行业领先地位。

And then lastly, it's the dispensing assets. So we're unique, in that we have truly an omnichannel pharmacy distribution market. So we combine the strength of our retail business that Prem just shared, our home delivery or mail service and ultimately, the specialty pharmacy, but it's, again, this combination of distribution assets that allows us to uniquely position our ability to serve the members where they choose to be met. And we compete again on the dispensing assets a stand-alone specialty pharmacy, or we compete as an integrated provider, but ultimately, it's the customer's choice.

最后一部分是配药资产。我们最大的独特性在于我们拥有真正的全渠道药品配送网络。这包括Prem刚刚提到的零售业务的实力、我们的送药上门服务，以及特药业务。正是这些配送资产的组合，使我们具备独一无二的能力，在客户选择的任何渠道中为其提供服务。在配药方面，我们既可以与独立的特药药房竞争，也可以作为一体化服务提供商参与竞争，最终还是由客户来选择。

So there's a lot of discussion and a lot of debate about whether or not this is all going to break apart or whether or not it's going to be integrated. And ultimately, we believe that there's value in integration. We believe that when you combine all 3 of these underneath our umbrella that we deliver significant value both in terms of savings and the member experience. But again, it's important to note that we compete in each one of these individually and/or on an integrated basis. But again, the outcome and the proof point is that when -- and it is integrated. We have a 12% lift in Net Promoter Scores for the members that we serve.

关于PBM的未来到底是“解耦”还是“整合”，业内存在很多讨论和争议。但我们相信，一体化是有价值的。当我们把上述三项服务整合在一个平台下时，不仅能带来成本节约，也能提升会员体验。而且，我们在每个模块中都能单独竞争，也可以提供一体化服务。而实际结果也证明，采用整合模式的客户，其净推荐值（NPS）提高了12%。

So it's that combination of being able to administer, facilitate the benefit, leveraging the strength of the purchasing economics that we have in our business, and then ultimately being able to dispense and/or meet the member where they choose to access the benefit allows us to create a much more simplified, seamless experience that we believe delivers value. And then there's also a cost element to this. When used in tandem or in concert, we believe there is a significant value.

也就是说，当我们能够同时承担福利管理、利用我们的采购经济效应、并以客户偏好的方式进行配药服务时，我们就能够打造一个更加简化、流畅、无缝衔接的服务体验。这种模式可以带来真正的价值。同时，从成本角度来看，协同作业也能释放巨大效益。

So if you turn from kind of the role of the PBM where we play, how we compete, there's also a significant question about the broader regulatory environment. Karen mentioned this in her opening comments. We're trying to set the record straight in terms of how the operating income works within the PBM today.

除了PBM本身的角色定位和竞争方式，另一个重要的问题是更广泛的监管环境。Karen在开场时也提到了这点。我们现在也在努力澄清当前PBM业务中的营业利润是如何构成的。

It's really important to understand clients design their benefits and they choose how to pay us. So there are customers today that choose to have us retain a portion of the rebates to offset the administration of the benefit.

我们必须理解一件非常重要的事情：客户自行设计他们的福利方案，并决定他们希望如何向我们付款。比如现在就有一些客户选择让我们保留一部分回扣，以补贴他们的福利管理费用。

There are some that allow us and/or look for us to retain the retail pharmacy network economics in order to buy down the cost and actually lower the administration of the benefits. So as you look at how this market has changed, this has been, again, a fairly transformational change over the last decade. There was a much larger percentage of rebates and retail network retention a decade ago. That has continued to decline.

还有一些客户允许或希望我们保留零售药房网络中的一部分经济利益，以便压低整体成本，并降低其福利管理支出。从市场的演变来看，这是过去十年中一个相当深刻的结构性变化。十年前，PBM保留的回扣和零售网络收益比例要高得多，而现在这一比例已经大幅下降。

In fact, if you look today, we've talked repeatedly about the 98-plus percent rebate retention, but we haven't really talked a lot about the network piece. So 75% of our adjudicated claims are on a fully transparent basis, which essentially means that 25% are those customers that have chosen to create a spread for simplicity and the economic benefit. But ultimately, all this actually generates, again, less than 20% of the operating income for the business.

事实上，就目前而言，我们经常提到超过98%的回扣返还率，但我们没有详细说明网络部分的情况。目前我们有75%的理赔是基于完全透明的方式进行的，这意味着剩下的25%是出于操作简便和经济利益的考虑，由客户选择了“价差模式”。但归根结底，这一部分对我们整体运营利润的贡献不到20%。

A significant change what I would say a decade ago. And I would expect as we continue to evolve and adapt our model, it will be different again in the next decade. So if I addressed kind of the broader role of the PBM, the regulatory, I'd like to turn our focus towards how we're going to grow and how we're going to compete going forward. So speciality, again, has been a growth engine for our business. We're a leader in this space.

这与十年前的情况形成了巨大对比。我预计，随着我们继续演化和调整业务模型，未来十年也会再次发生重大变化。既然我们刚才讨论了PBM的角色和监管情况，现在我想将重点转向我们未来如何实现增长、如何展开竞争。特药领域仍然是我们业务增长的核心引擎，我们在该领域处于领先地位。

And if you look at kind of the tailwinds of this industry, it's really still very powerful today, just like it was, again, 5, even 10 years ago. It represents more than 50% of the spend. It's a growing marketplace, in fact, doubling the actual spend within our customers over the last 7, 8 years. And then there's competition. So you actually have biosimilars entering this space. So it's a perfect recipe for the value and the role of the PBM.

如果你看一下特药行业的基本面利好，它们今天依然非常强劲，就像5年甚至10年前一样。特药现在已经占据超过50%的药品支出，而且这个市场仍在快速增长——客户在该领域的支出在过去七八年中翻了一番。同时，竞争也在加剧，例如生物类似药的进入。这正是PBM发挥其价值与作用的绝佳环境。

And if you look specifically at the role of CVS Caremark, as I mentioned earlier, our growth rate has actually exceeded the market. So we are at a 14% growth rate compared to the industry average of 9%. And I think it's because, in large part, we're competing in all markets, and we actually have an incredibly strong franchise in the specialty space. So now let me tell you why I believe we're best positioned to compete and to grow in specialty.

具体看CVS Caremark的角色，正如我之前提到的，我们的增长率实际上超过了行业整体水平。我们的特药业务增长率达到了14%，而行业平均为9%。我认为这主要得益于我们在所有细分市场中都有布局，并且在特药领域我们拥有极为强大的业务基础。现在我来说明一下为什么我认为我们在特药领域拥有最好的竞争地位和增长潜力。

So we continue, again, as the leading specialty pharmacy provider. I believe expertise matters. I joined the company, as I said, 30-plus years ago. What we had at 30 years ago was a mail service business and a specialty pharmacy. So when you look at what we've built over the last 30 and/or 40 years, it is deep, deep clinical expertise that has allowed us to understand the patients, the drug therapies, the prescribing community, the broader manufacturer role.

我们始终是特药领域的领导者。我坚信专业能力至关重要。正如我之前说的，我加入这家公司已经30多年了。30年前我们就拥有邮购药房和特药服务。从那时到现在，我们所构建的，不只是商业规模，更是深厚的临床专业能力。这使我们能够深入理解患者、治疗方案、开药医生群体以及药品制造商的角色。

So it's allowed us again to extend our reach into becoming the largest provider of limited distribution drugs, a huge presence in terms of just understanding and the knowledge within that space, and that actually is continuing to build on the strength of -- it actually being just beyond the dispensing of medications.

这使我们得以拓展业务，成为有限分销药品的最大供应商之一，在专业理解和市场知识方面具有极大优势。这些积累不只是简单的配药服务，更是在价值链中向更高层次拓展的基础。

The second thing, which is really a continued evolution and investment in our business is in the area of technology. So we focus on the dispensing, but equally as important is moving upstream and into the actual prescriber workflow so that we actually begin to simplify and streamline the actual process of both diagnosing, prescribing and dispensing the medications.

第二点，是我们在技术领域持续演进和投入的一部分。虽然我们专注于配药环节，但同样重要的是向上游推进，进入处方医生的工作流程中，从而简化并优化从诊断、开方到配药的整个流程。

So you have 80-plus percent access to electronic medical records within our business today. And if you look at where the pain points are, it's generally in the area of utilization management, prior authorization, all of the various things we need to track and measure specific to that therapy in concert with the manufacturer, the prescriber and the patients. So again, a really, really important investment that is allowing us, again, to differentiate and separate ourselves from where the marketplace is, especially for those that are just simply focusing on dispensing the medications.

我们目前的业务覆盖了80%以上的电子病历接入率。如果你观察痛点，通常集中在用药管理、事前授权等环节，也就是我们需要与制造商、医生、患者共同追踪和管理的部分。因此，这项投入极为关键，它帮助我们进一步建立差异化优势，与那些仅专注于配药的竞争对手拉开距离。

And then lastly, this is consistent with where Prem was going on the retail side of the business. We have to continue to be a low-cost operator. So we are focusing specifically on becoming more efficient, leveraging technology to allow us to make sure that we're lowering the cost of dispense within our pharmacy creating efficiencies in terms of how we both adjudicate and/or manage the therapies that we serve.

最后，这也与Prem在零售业务方面的方向保持一致：我们必须始终是一家低成本运营商。因此我们专注于提升效率，利用技术确保我们的药房在配药环节降低成本，同时在理赔和治疗管理方面实现更高的运营效率。

So again, a strong position. I expect that this will continue to be the strength of the enterprise that we serve.

因此，我们在这一领域的地位依然坚固。我预计这一优势将继续成为我们服务企业客户的核心竞争力。

So we talk about the specialty business. And then if you look at our business, and this is -- keep repeating the fact that this business has a history of repeating itself. It's a -- when you look back, there is what I would call cycles and/or waves of drug introductions that forces the PBM to look and manage it differently.

我们谈到了特药业务。如果你观察我们的业务，会发现这个行业的变化模式具有周期性，历史总是在某种程度上重复自己。回顾过去，药品的推出往往呈现出一波波浪潮，这迫使PBM以不同方式加以应对与管理。

But at the same core at the foundation of managing these therapies, there's away 3 things that we do consistently. One is we -- when new products come to market, new therapeutic classes, we introduce competition through the use of formularies and/or manage the broader utilization with the UM programs.

但在应对这些药物浪潮的核心方法上，我们始终坚持三项原则。第一是当新产品或新治疗类别问世时，我们通过制定药物目录（formularies）引入竞争，并通过用药管理（UM）项目控制更广泛的使用。

Secondly, we actually look at the total cost of care. So if you're looking at diabetes, cardiovascular care, et cetera, we are looking at managing the total cost of the care that patient is receiving, and it's a role that the PBM, specifically CVS Caremark, has played an exceptional role.

第二，我们关注的是整体医疗成本。例如在糖尿病、心血管等领域，我们致力于管理患者接受治疗的总成本，这正是PBM，尤其是CVS Caremark所擅长并发挥卓越作用的地方。

And then lastly, when the wave and the patent expirations occur, we are incredibly quick and efficient at moving to the low-cost product to the use of generics and/or biosimilars.

最后，当药物专利期结束、形成新一轮的仿制药或生物类似药浪潮时，我们能非常迅速、高效地完成转化，推动低成本药品的使用。

So those are kind of the foundation of what a PBM does. We've talked about this has been a proven expertise within specifically CVS Caremark. And I'll talk about it in terms of kind of the 3 waves that we see. So if you look at a decade ago, it was the blockbuster brands. It was the statins, the proton pump inhibitors, and in some cases, even talking about insulin.

这些正是PBM的基本功能所在，而CVS Caremark在这些方面已经验证了自身的专业实力。接下来我想以我们所经历的“三个浪潮”为例来说明。大约十年前，第一个浪潮是重磅品牌药的兴起，比如他汀类药物、质子泵抑制剂，有时甚至包括胰岛素。

So in that category, what do we do? We introduced much more aggressive formulary processes. We chose to exclude certain medications from the therapeutic category, drove enormous value for the customers that we serve. We wrapped around that same patient population, the set of activities around managing the diabetes care. And then lastly, we drove and significantly delivered value with the generic wave that occurred.

在那个阶段，我们采取了更为激进的目录管理措施，有选择地将某些药物排除在治疗类别之外，从而为客户带来了巨大的价值。与此同时，我们围绕这些患者人群，展开了包括糖尿病管理在内的一整套服务体系。最终，随着仿制药浪潮的到来，我们推动这一转变，并由此为客户实现了显著的节省与价值释放。

贵的药不用？这个也是好的策略？

So this category, this wave was -- if you remember back 15 years ago, there were clients that were saying, how can I afford all these high-cost drugs? Well, you manage it through competition. You look specifically at the total cost of care for the patients that you're serving and then ultimately making sure that you capitalize and execute against the generic introductions. And it was that generic introduction and that now what I would call, 90% shift that occurred during the cycle, that actually helped fund the next wave.

回到15年前，当时许多客户都在问：“我怎么承担得起这些高价药物？” 你要靠引入竞争机制来管理，通过关注所服务患者的整体治疗成本，并最终借助仿制药的推出实现成本控制。正是这场仿制药的引进浪潮，以及我所称的“90%转换”——即大规模地将原研药转换为仿制药——在这一周期内得以实现，为下一波浪潮提供了资金来源。

So the next wave is specialty pharmacy. What did our customers say, I can't afford specialty medications, it's going to break the budget. It's going to need to figure out new and innovative ways in which to manage this broader category. So what did we do? We introduced the formulary. We have the leading franchise in managing these broader rare and chronic conditions with Accordant. So again, focusing on the total cost of care.

接下来的浪潮是特药（specialty pharmacy）。客户们又开始担心：“我负担不起特药，这会打破我们的预算。” 于是，我们需要探索新的创新方式来管理这一广泛的药物类别。我们的应对方式是：引入药物目录（formulary）；同时借助Accordant建立领先的慢性病和罕见病管理体系，继续聚焦于整体治疗成本。

Specialty pharmacy（特药药房）是指专门提供高复杂性、高成本、需要特殊储存或管理的处方药的药房或药品分发系统。这类药品通常用于治疗慢性、罕见或严重疾病，如癌症、自身免疫疾病（如类风湿性关节炎）、多发性硬化症、HIV/AIDS、血友病、罕见遗传病，以及现在很受关注的生物制剂（如GLP-1类降糖减重药）。

Specialty pharmacy占处方药数量不到2%，但却占药品支出超过50%，在 CVS、UnitedHealth、Cigna 等大型医疗集团眼中，specialty pharmacy 是增长最快、利润率最高的药房业务之一。

And now we're in that next wave of participating in the biosimilars that are coming to market. So it's a cycle that repeats itself. And if you look at now, what's the headline, customers saying, how do I afford the new GLP-1s? How do I afford the new cell and gene therapies? And when you look at the GLP-1s, they're priced more like a specialty drug. So there's a lot of debate, a lot of questions about the actual list price of these products.

现在我们正处于下一波浪潮：生物类似药（biosimilars）正在大量进入市场。这个周期不断重复。你再看看当下的热门议题，客户在说：“我怎么支付得起GLP-1类药物？我怎么负担得起细胞和基因疗法？” GLP-1类药物的定价就像是特药，关于它们的定价，也存在很多争议与疑问。

But again, we're going to repeat the same cycle that we've done in the last 2. We're introducing aggressive formularies and utilization management controls. We're introducing broader programs to manage not just the diabetes but also weight loss program. So a combination of these broader care management. And then we make sure we're prepared for when lower-cost generics and/or biosimilars come to market. So it's, again, a critically important kind of look back the cycle that we're in today.

但我们仍将重复之前两个周期的经验：制定更具策略性的药物目录和使用管理控制措施；不仅管理糖尿病，还要引入更广泛的减重管理计划，提供全面的护理服务；并为低价仿制药和生物类似药的到来做好准备。今天我们所处的正是这样一个非常关键的周期节点。

And more importantly, if you look at the tailwinds of this industry, how do we participate and continue to deliver the exact same value to our customers and play a significant role that we will hopefully continue to be.

更重要的是，如果你观察整个行业的顺风趋势，我们如何参与其中，并继续为客户带来相同的价值？我们希望在这个过程中继续扮演关键角色。

So one of the things I didn't talk about was the pricing model and the pricing that work. So if you look at today's pricing, it actually served that blockbuster brand category. And it's -- it was predated high deductible health plans. There was not, at that point, a lot of consumer and/or patient engagement in the cost of the drug.

还有一点我之前没讲的是定价模型及其演变。如果你看当前的定价体系，它实际上是为当年的重磅品牌药打造的，而且是在高免赔额健康计划出现之前制定的。那时，消费者或患者在药品成本方面的参与程度非常有限。

Obviously, that's changed. So you have now 90% dispensing rates on the generics. You have a good part of the customers now being exposed to the cost of the drug through coinsurance and/or high deductible plans and quite frankly, it's time to change. The model, quite frankly, was built on pricing to a basket of drugs. It was an average price. It worked really well as long as the basket stayed intact. But when that changes and you begin now to have to straddle 2 different pricing models, we want to be the leaders of change. So Prem talked about what's happening at the retail counter.

显然，现在已经不同了。仿制药的使用率已达到90%，大量消费者通过共付机制或高免赔额计划直面药品成本。坦率地说，是时候改变这个旧模型了。当前的定价体系是基于“药品篮子”的平均定价构建的——只要药品组合稳定，它就能良好运转。但当药品结构发生变化、你需要同时适应两种不同定价模式时，我们希望率先引领这一变革。正如Prem所提，零售药房的改革正是在这方面迈出了第一步。

The same issues are happening within the PBM. We feel now is the time to bring a new pricing model to market. So CVS Caremark TrueCost is the name of our new pricing model, and it's going to do a handful of things. One is it's going to simplify the pricing for the consumer. So the goal is to make sure that you move to an acquisition cost index that actually allows the member to be able to get the low-cost product based off how the pharmacies are buying the medication.

同样的问题也出现在药品福利管理（PBM）体系中。我们认为现在正是引入全新定价模型的时机。CVS Caremark TrueCost 是我们新定价模式的名称，它将实现以下几项关键目标。第一，是为消费者简化定价流程。其目标是推动转向一种“采购成本指数”，根据药房购药成本，让会员能够获得低价药品。

Secondly, we are actively promoting and encouraging our customers to also extend the discounts and rebates they receive from the manufacturer down to the true net cost of the product so that the actual member and/or patient gets access to that true net cost. And then there's a question about why do we think now is the time or why do we believe that we're best positioned. Prem mentioned just the broader stability within the pharmacy network today.

其次，我们正在积极推动并鼓励客户将他们从药品制造商处获得的折扣和返利延伸到底层价格，使实际的会员或患者能够以真实净价获得药品。至于为何我们认为现在正是时机，以及为何我们处于最佳位置，Prem 刚才也提到了，目前整个药房网络正处于较为稳定的状态。

With the rise of GLP-1s and the pressure that you're seeing within the retail business, we believe this model resets the pricing and allows us to invest in what I believe is a critically important part of the health care delivery system, which is the retail pharmacy. So you will see us focusing on those that actually can buy it well, like CVS and making sure that we're actually continuing to preserve access in underserved markets and there were all areas where, again, there may be limited availability.

随着 GLP-1 类药物的兴起以及零售业务所面临的压力，我们认为这个新模型能够重新设定价格基础，同时让我们得以投资于医疗服务体系中至关重要的一环——零售药房。因此你会看到我们将聚焦于那些具备优秀采购能力的机构，比如 CVS，同时确保我们在资源匮乏市场继续提供服务，保障那些医疗资源可能受限地区的可及性。

So it is an investment to support, stabilize the marketplace. So our clients, again, will have choice. So this notion that we are only can do it one way, the PBM model doesn't work that way. So we are going to be building a set of what I consider a strong value proposition for our customers to migrate to this new model.

这是一项旨在支撑并稳定市场的投资。因此，我们的客户依然将拥有选择权。PBM 模型从来不是“只有一种做法”，因此我们正在为客户构建一整套强有力的价值主张，以帮助他们顺利过渡到这一新模型。

Leaders in the CVS Retail side is going to be pushing, obviously, for a different model. So our job is to complement what retail is doing and ultimately be a part of change to focus on transparency for the consumer just like the transparency that our customers receive today.

CVS 零售板块的领导层显然也会推动一个不同的模式。我们的职责是配合零售业务的发展方向，最终成为这一变革的一部分——专注于为消费者带来更高的透明度，就像我们今天为客户提供的透明服务一样。

So now the question -- and this is the theme that you've heard specifically around the economic flywheel. And I do think it's important for us to, again, look back when CVS and Caremark came together, we delivered what I believe is a best-in-class and a unique product portfolio that allows us to serve both our customers and lowering cost and ultimately creating a better consumer experience.

接下来的问题，也是今天反复提到的主题之一——“经济飞轮”。我确实认为现在是时候回顾 CVS 与 Caremark 合并时的情形了。我们共同打造出业内领先、独特的产品组合，这不仅帮助我们为客户节省成本，还最终提升了消费者体验。

So when you look at maintenance choice, although it may be yesterday's news, the most important part of this thing is we changed the marketplace. We changed it from a pricing model. So 90-day and/or home delivery prescriptions are priced differently today than they were pre-CVS and Caremark coming together.

以“Maintenance Choice”计划为例，尽管这听起来像是“旧闻”，但它的关键意义在于我们重塑了整个市场的定价模式。在 CVS 与 Caremark 合并之前，90 天处方药和邮寄处方药的定价方式和现在是完全不同的。

At the time, we probably saw 50% of the patients choose mail service or home delivery and 50% choose a retail pickup and think about how the marketplace has changed.

当时，大约有一半的患者选择邮寄服务或居家送药，另一半选择零售店取药。而现在你可以看到，这一市场格局已经发生了巨大的变化。

And our model, what we're seeing now is 8 of 10 prescriptions are picked up at retail versus home delivery. So the market is changing. The consumer behavior and expectations are changing. At the same time, you would expect that there will be a broader expansion into the home delivery. So the same thing is happening in specialty. We're organizing and focusing on the specialty connect experience so that the member can actually have the product shipped to the home and/or picked up at retail.

在我们的模式中，我们目前观察到有8成的处方药是通过零售渠道取药，而不是居家配送。这说明市场正在发生变化，消费者的行为和预期也在改变。与此同时，我们也预期居家送药服务将会进一步扩展。类似的情况也正在发生在特药业务中。我们正在围绕“Specialty Connect”体验进行组织和聚焦，让会员既可以选择将药品送货上门，也可以选择到零售药店自取。

But we changed through integration and through the enterprise combination of assets, we were able to deliver a very different experience. Now you go back to 2018, CVS and Aetna came together. And if you look at where those companies were, although they were a customer, we still lagged what I would call an integration between medical and pharmacy.

但我们通过整合、通过企业资源的融合，成功打造出一种截然不同的用户体验。回顾2018年，CVS与Aetna合并。尽管当时二者已有合作关系，但在我看来，医疗保险和药品福利之间的整合仍然处于初级阶段。

So we spent the last 5 years actively building an experience that is focused differently on that consumer, that member that then extends value to how the customers that we serve sees the integration. So we're now at a 70% integration between the national account employer business between Aetna and CVS Caremark, which again is a huge growth from where it was in 2018.

因此，在过去五年中，我们积极打造了以消费者和会员为中心的整合体验，这也让客户在价值感知上看到了不同之处。目前，Aetna和CVS Caremark在大型雇主账户上的整合程度已经达到70%，相比2018年实现了巨大跃升。

And again, what I believe will be the continued investment in showing and proving and demonstrating that there is power and the integration of this enterprise.

我相信我们将持续投入，继续展示和证明企业整合所释放的巨大能量。

And now you look forward, and it's equally as important in terms of where does pharmacy fit within the value-based care model. If you look at experiences in the home, I ended up having a home assessment with the Signify position. And the very first thing that ends up happening is they dump their medications on the kitchen counter. And you spend 15 minutes trying to sort through the complexity of what happens for those members that have -- that are on many medications and confused about how to manage it.

展望未来，药房在价值导向医疗模式（value-based care）中扮演的角色也同样重要。比如在居家护理的实践中，我亲身经历了一次由Signify进行的家庭评估。评估一开始，病人就把一大堆药物倒在厨房台面上，我们花了15分钟理清这些药物的种类、用途与服用计划。很多长期服药的患者根本无从管理，十分混乱。

So pharmacy, again, is a critical part of value-based care. It's our role now to figure out how we continue to insert ourselves both in the home and/or in the primary care to again manage the overall value and the overall care for the population.

因此，药房再次证明其在价值导向医疗中的关键作用。现在我们的任务是明确如何进一步参与到居家护理和初级诊疗服务中，从而提升整体医疗价值，改善群体健康照护。

So how are we going to measure our success? It's quite frankly the same as it's been for the last many years. We've got to grow our business. And obviously, that is a focus is what my obvious experience has been here. I believe that we will continue and return our path to growth within the PBM.

我们将如何衡量自己的成功？坦率地说，这和我们多年来的标准一致：我们必须实现业务增长。这一直是我工作的核心方向，我相信我们能够在PBM业务中持续发展并重回增长轨道。

And we're going to do that because we're going to continue to focus on delivering industry-leading purchasing economics. As Prem said, the price model is not about making more money, it's about continuing to change and reset the price to allow us to again pass through those economics. And this is going to be a really important part of the model that we're delivering. We talked about the flywheel of enterprise assets.

实现这一目标的路径是我们会继续专注于提供业界领先的采购经济效益。正如Prem所说，新的定价模型不是为了赚更多钱，而是为了重新设定价格机制，使我们能够将成本节约切实传导出去。这是我们模型的关键组成部分，我们也讲到了企业资产的“飞轮效应”。

And then lastly, we've got to be best-in-class and continue our leadership position through specialty, through the ability to pull through the biosimilar opportunities.

最后，我们还必须在特药领域保持业内领先地位，并通过在生物类似药领域的延伸机会，继续巩固我们的市场领先地位。

And then lastly, in closing, let me just finish how I started. This is a business that has historically always performed exceptionally well. It's durable, resilient, adaptable. And I believe the strength in our business will continue going forward with the tailwinds that I mentioned earlier.

最后总结一下，就像我开始时说的那样，我们的业务在历史上一直表现出色，具有持久力、弹性和高度适应性。我相信，在先前提到的多重利好趋势推动下，我们的业务强势将持续展现。

So it is about specialty, the biosimilar. It's about the continued evolution of the way in which we price and position our products in the market. And then lastly is making sure that we become and maintain our leadership position in the technology space.

所以核心在于特药、生物类似药、定价模式的持续演进，以及我们在技术领域的持续领先和巩固地位。

So again, I could not be more proud to have the opportunity to lead this business. We have an incredibly strong tenured operating team that, again, I've worked with for 20-plus years, and I believe we really are best in class, and we'll continue to operate and continue to compete going forward.

我为能够领导这项事业而深感自豪。我们拥有一支非常强大、经验丰富的运营团队，其中很多人我已经共事超过20年。我坚信，我们是业内最优秀的团队，并将在未来继续保持竞争力。

So with that, let me now turn it over to my new value-based care partner, Mike Pykosz, which is going to talk about the broader Health Services business.

接下来，请允许我把舞台交给我在价值导向医疗领域的新搭档 Mike Pykosz，他将介绍我们更广泛的健康服务业务。

Michael Pykosz Former President of Health Care Delivery & Executive VP

All right. It's great to be here. I am Mike Pykosz, and I'm the Interim President of Health Services here at CVS. I've met a lot of you before in my role of CEO of Oak Street Health, when we were still a public company prior to the acquisition by CVS. I was actually one of the Co-Founders of Oak Street Health. So I joined the Oak Street -- I've started Oak Street, I guess, 11 years ago. And I could not be more proud of what we have accomplished at Oak Street.

大家好，很高兴在这里见到大家。我是Mike Pykosz，目前担任CVS健康服务部门的临时总裁。在CVS收购Oak Street Health之前，我曾是这家上市公司的首席执行官，也正是Oak Street Health的联合创始人之一。我大约是在11年前创办Oak Street Health。对于我们在这家公司取得的成就——提升老年患者的医疗质量和就诊体验，我感到无比自豪。

We have improved the quality of care. We've improved patient experience for older adults. That said, we are just scratching the surface of what patients need, and there's so much more to accomplish. And I became really excited when the CVS acquisition came about. When I realized that CVS is uniquely positioned to improve the quality of care, the cost and the patient experience for patients across this country. And that's why I'm here today in front of you.

我们提升了整体医疗质量，也改善了老年人的就医体验。但我必须说，我们只是刚刚触及了患者需求的表面，还有非常多的工作要做。当CVS宣布收购我们的那一刻，我感到无比兴奋。我意识到CVS具备独特的条件，有能力在全美范围内提升医疗质量、降低成本、优化患者体验。这也是为什么我今天站在这里与你们分享。

And I'm really excited to share with you our vision and our progress to date on that journey. So I want to cover 3 things, along with Kyle Armbrester, the CEO of Signify Health. First, we're going to talk about with the acquisition of Signify and Oak Street, how we are already one of the largest health care delivery organizations in the country. And most importantly, we have proven results and improving the quality of care and improving patient experience.

我非常期待与大家分享我们对未来的愿景，以及在这段旅程中取得的进展。接下来，我将和Signify Health的首席执行官Kyle Armbrester共同为大家介绍三件事：第一，CVS通过收购Signify和Oak Street，已经成为美国最大的医疗服务提供机构之一；更重要的是，我们的成果是有目共睹的——不论是医疗质量还是患者体验都得到了切实改善。

Second, we're going to talk about where you heard a lot about the flywheel. And we're going to talk about how we are already seeing a huge impact from the broader CVS organization on our health care delivery organization, including Oak Street to Signify and vice versa, we're able to impact the performance of those organizations as well. And last, we're going to talk about how the combination of our health care delivery platform, combined with this flywheel effect, is creating a differentiated platform that is poised for rapid future growth and impact.

第二，我们会讨论大家常听到的“飞轮效应”（flywheel）。我们会展示CVS整体生态如何已经对我们的医疗服务业务产生巨大推动，包括Oak Street对Signify的协同效应，以及反过来的影响。最后，我们会说明为什么这种健康服务平台与飞轮效应的结合，能够打造一个差异化的增长平台，使我们具备快速扩张和产生深远影响的潜力。

I want to anchor everyone on where we are today in health care delivery. In 2023, we're about $6 billion of revenue. That revenue is driven by about 14 million visits from patients and those visits are across our clinics, they're in the home and they're virtual.

我们先来看看目前CVS健康服务的基本情况。2023年，我们实现了大约60亿美元的营收，这背后是1400万次患者就诊行为的驱动，这些就诊包括诊所现场、居家医疗和远程在线三种模式。

We served a little under 9 million patients in 2023. And those patients have over 200 different payer and payer types. And that's across commercial, that's across Medicaid and obviously, that's across Medicare. Most important in this slide, we are demonstrating very strong value for our patients and for our payer partners.

2023年，我们共服务了近900万名患者，覆盖了200多种付款方及其类型，横跨商业医保、联邦医疗补助（Medicaid）以及联邦医保（Medicare）。最重要的是，从这些数据可以看到，我们为患者和付款方创造了显著价值。

Again, for example, Tom references, Oak Street Health has a 21% savings rate in the ACO REACH program. It's one of the top in the country. Signify spend significantly longer in the home than others, right, driving better patient experience. And so that differentiation is what's going to drive our future success.

以Tom提到的为例，Oak Street Health在ACO REACH计划中的节省率达到了21%，在全国名列前茅。Signify Health在居家访问服务中所花费的时间也显著高于同行，这极大提升了患者的体验。这些差异化优势将成为我们未来成功的关键推动力。

So I want to take a step back. And I want to talk about why we feel like there's such a massive opportunity for growth in health care delivery at CVS.

现在，我想稍作回顾，解释为什么我们认为CVS在健康服务领域拥有巨大的增长潜力。

The problems with the health care system we all know. We spent twice as much per person as any other industrialized country. Despite spending twice as much, we have worse health outcomes than those same countries, and patient experience is a problem. Case in point, the Net Promoter Score for the average primary care doctor is a negative 1.2. Physician burnout is a huge problem with over 40% of physicians saying they experience symptoms of burnout. So we have these problems. And that's why we need innovative models anchored in value-based care.

我们都清楚美国医疗系统面临的问题：我们的人均医疗支出是其他工业化国家的两倍，但健康结果却更差，患者的就医体验也很糟糕。举个例子，普通初级保健医生的净推荐值（Net Promoter Score）为-1.2，说明整体满意度极低。医生职业倦怠也很严重，超过40%的医生表示他们经历过倦怠症状。这些问题的存在意味着我们亟需基于价值的创新医疗模式。

We've heard about value-based care a lot today. And to me, what value-based care means is we're going to invest upfront. We're going to provide better quality care, better patient experience, that's going to lower the total cost of care. And we're going to leverage value-based contracts to capture the savings we're generating. And so we're not going to be pay in the volume of service we offer, we're going to pay how healthy we keep our patients, our members and our customers.

今天我们已经多次听到“价值导向医疗”（value-based care）这个词。对我而言，价值导向医疗的核心在于：我们要在前期进行投入，提供更高质量的护理、更优的患者体验，从而降低整体医疗成本。我们将通过价值导向的合同机制，将所创造的节省转化为我们的收入。换句话说，我们不是按提供的服务数量收费，而是按我们能让患者、会员和客户保持多健康来收费。

And so if you look at studies, right, we spend over $4 trillion a year right now in health care in the U.S., $4 trillion a year. Studies have shown that about, give or take, 25% of that is waste, right? And by waste, I mean care that doesn't actively improve the outcomes for patients or adverse acute events that could have been prevented by earlier care. So we do the math, right? That means there's $1 trillion of addressable spend today.

根据研究，美国当前每年的医疗支出超过4万亿美元。研究还表明，大约有25%的支出是“浪费”，这里的“浪费”指的是那些无法有效改善患者结果的治疗，或者原本可以通过早期干预避免的急性不良事件。换算下来，这意味着现在有高达1万亿美元的支出是可以被有效重构和节省的。

We also know that health care in the next decade is supposed to grow to over $7 trillion of spend. So now the potential impact we can make is growing to close to $2 trillion. And when you're talking about value-based models and value-based approaches, that addressable spend becomes the potential profit pool for our businesses. So any time you start talking about numbers with [ a tea ] after them, you really know this is an incredibly massive opportunity for organizations that can address these problems.

预计未来十年，美国的年度医疗支出将增长至超过7万亿美元。也就是说，我们能够产生影响的空间将接近2万亿美元。当你谈论“价值导向”医疗模式时，这些可重构支出就成为企业的潜在利润池。任何时候，当你谈论的金额单位是“万亿”（trillions）时，就说明这是一个极其庞大的机会——适合那些真正能解决问题的机构。

Our vision in the health care delivery organization is based on that opportunity. So we're going to create a fully integrated value-based ecosystem to drive superior health outcomes for our patients. And that ecosystem is going to combine innovative organizations across virtual, in the community and home-based care, like we've already done with Oak Street MinuteClinic and Signify. And we're also going to leverage physician enablement capabilities that will help us also impact the quality of care at more traditional provider settings. Kyle will talk a lot more about that.

我们在医疗服务事业中的愿景正是基于这一巨大机会。我们的目标是打造一个完全整合的“价值导向”生态系统，以推动卓越的健康成果。这个生态系统将整合虚拟护理、社区护理和居家护理等创新型服务组织，正如我们已经通过Oak Street、MinuteClinic和Signify等品牌所实践的那样。我们还将利用“赋能医生”（physician enablement）能力，帮助提升传统医疗机构中的护理质量。Kyle稍后会详细介绍这部分内容。

We're going to power this with a fully inoperable IT infrastructure. And I want to talk about what that means, but we heard that word a lot in health care and even today inoperable. And what that means, we're going to create the ability to pull in data from across the health care system, whether that be payer data, medical record data from hospital systems, data from our own assets. By pulling that data in, that all has to analyze that data across the system. It allows us to understand what patients need faster and meet their needs and hopefully keep them healthier and out of the hospital.

我们将以一个完全可互操作的IT基础设施为支撑。我想解释一下这个“可互操作”（interoperable）是什么意思，虽然它在医疗领域被频繁提及。它意味着我们要建立一个系统，可以整合来自整个医疗体系的数据，包括付款方数据、医院系统的病历数据、我们自身平台的数据等等。整合这些数据后，我们就能更迅速地了解患者的需求，及时响应，从而帮助他们保持健康，避免住院。

This interoperability is also going to be a huge advantage across CVS because we create interoperability and we create consistent data across the broader CVS ecosystem. That means when patients go to pharmacy, they go to Oak Street Health, they go to MinuteClinic, they get a Signify home visit, et cetera, et cetera, et cetera, that is going to be a common set of information, a common platform, a common experience. And that is going to be a differentiator in the patient experience that we are able to offer at this organization.

而这一“互通互联”的能力，也将成为CVS的一大竞争优势。我们将在CVS的整体生态中实现数据的标准化与共享。这意味着无论患者是在CVS药房、Oak Street Health、MinuteClinic就诊，还是接受Signify的居家访问等服务，他们的医疗信息都将在一个统一的平台上记录和共享，带来一致的服务体验。这种统一性将显著改善患者体验，成为我们区别于其他机构的核心竞争力。

Finally, we're going to monetize it through risk-bearing or value-based contracts. And again, this is a really key part of our approach and our strategy. Because by getting away from the traditional fee-for-service reimbursement that underpays for primary care service, and therefore, doesn't give patients what they need. We can actually turn it around and make that $1 trillion I talked about, that now is our profit pool, right, because we're going to capture the savings we generate through these contracts. So that's the vision of what we're building.

最后，我们将通过承担风险或价值导向的合同来实现盈利。这一点是我们战略中的关键组成部分。因为如果我们能够摆脱传统按服务收费（fee-for-service）的报销方式——这类方式往往对初级保健服务付费不足，从而无法为患者提供他们真正需要的服务——那么我们就可以实现转变。我刚才提到的那1万亿美元浪费，就可以变成我们的利润池。我们将通过这些价值导向的合同，将我们创造的节省转化为收益。这就是我们正在构建的愿景。

And again, CVS is uniquely positioned both because of the legacy assets of CVS and because of the new acquisitions of Signify and Oak Street to achieve this vision. So one of the things I want to make sure I cover today is we are already one of the largest health care delivery organizations across the country, and we're doing it across channels.

而CVS之所以具备独特优势，是因为我们不仅拥有CVS本身的传统资产，还整合了对Signify和Oak Street的全新收购。借助这些，我们具备实现这一愿景的独特能力。我要特别强调一点：我们已经是全美最大的医疗服务提供机构之一，且我们通过多渠道来实现这一点。

We have over 75,000 providers on our platform in 2024. And that includes over 1,200 centers conveniently located in the community across Oak Street and MinuteClinic, where we have over 4,000 employee providers. That includes an expected 1 million lives under management in our CVS ACO with 60,000 providers being enabled by that solution next year. And that includes over 11,000 clinicians that work at Signify that will do almost 3 million home visits this year.

2024年，我们平台上已有超过75,000名医疗服务提供者。其中包括超过1,200家便民网点，分布于Oak Street和MinuteClinic，服务团队中有4,000多名在职医生。此外，我们的CVS ACO预计将管理100万人口，并将赋能6万名提供者加入这一解决方案。而在Signify方面，我们拥有11,000多名临床医生，今年将完成近300万次居家访问。

So again, we are already one of the largest organization in the country. And as we'll talk about, [ poise ] or even more significant growth. Just as importantly, as the size is the impact we are making on quality and experience. The basis of value-based care is investing more to keep patients out there. And we're doing that at Oak Street Health. We've reduced hospitalizations by more than 50% for our patients. If you're a patient of Oak Street Health, you realize half is likely to have an acute event and go to the hospital. And that's what powers our savings.

因此，我们已经是全美最大规模的医疗服务机构之一，而且正如我们即将讲到的，我们还有更大的增长潜力。但除了规模，更重要的是我们在“医疗质量”与“患者体验”上所带来的改变。价值导向医疗的核心理念是前期投入更多，以防止患者走向急性恶化。而在Oak Street Health，我们已经成功将患者的住院率降低了50%以上。换句话说，如果你是Oak Street Health的患者，你发生急性医疗事件、被送往医院的可能性只有一般人的一半——这正是我们能够实现节约的根本原因。

And across the last 2 years, we've been the top performer in the drug contracting ACO REACH program because of that strong care model. At the same time, the health care delivery organization is driving a significantly better patient experience. I referenced the average primary care doctor has a Net Promoter Score of negative 1.2.

在过去两年中，凭借强大的护理模型，我们在联邦药物合同ACO REACH计划中始终表现最佳。同时，我们的医疗服务组织在提升患者体验方面也取得了显著成果。刚才我提到过，美国初级保健医生的平均净推荐值（NPS）为负1.2分。

For those of you who are less familiar with NPS, the range is negative 100 to 200. So the average primary care doctor is a negative 1.2. MinuteClinic has an NPS of over 81. Vastly differentiated and better experience.

给不熟悉NPS的朋友解释一下：这个分数范围从-100到+200，而初级保健医生的平均得分是-1.2。而我们旗下的MinuteClinic，其NPS得分高达81——这意味着服务质量与患者体验远远优于传统体系。

At the same time, I want to highlight that 97% of people, who have a Signify home visit indicate they like another one. They are that satisfied with their care. These are differentiated patient experiences. And I want to talk about why. One of the keys to our experience is we operate different innovative models. The different innovative models drive a better patient experience. Better patient experience drives better patient engagement.

同时，我还要特别指出，曾接受Signify居家访问的用户中，有97%表示他们愿意再接受一次。这说明他们对所获得的护理体验高度满意。这些差异化的患者体验来源于我们所采用的创新服务模式。而正是这种创新模式，造就了更佳的服务体验；而良好的体验又推动了患者更深层次的参与。

One of the keys to increasing quality is improving patient engagement. You can't change a patient's health trajectory if they're not engaged in their care, they're not coming for visits, they're not listening to you, they're not following up with you, right? That leads to better quality. The better quality and value-based contracts leads to your surplus, leads to your savings that drives your economic model. And that means you actually can afford to invest in the innovative model. So these things are all related, and we put them together an ecosystem like we're doing at CVS, it makes a massive, massive difference to care.

提升医疗质量的关键之一在于提高患者参与度。如果患者不愿意参与，不去就诊，不听从建议，不配合随访，那就无法改变他们的健康轨迹。而更高的参与度意味着更高的医疗质量，而这正是价值导向合同产生盈余、实现节省并驱动我们商业模式的基础。也就是说，它使我们有能力为创新模式投资。这一切相互关联。将它们在CVS整合成一个完整生态系统，将会对医疗服务质量产生巨大影响。

We are also already seeing the impact on these results from being broader CVS. And I'm going to turn it over to Kyle to talk more about the flywheel fact.

我们也已经开始看到，作为CVS更大生态系统的一部分，我们对这些成果的影响日益显著。接下来，我将把话题交给Kyle，让他来继续讲讲这个“飞轮效应”是如何展开的。

Kyle Armbrester

All right. Thank you, Mike. It's been an amazing experience getting to join the CVS team, getting to work with folks like Mike on the cutting edge of health care and then getting to realize that David Joyner started his career at CVS when I was 1 years old. And so getting the -- come into that whole group, it's frankly a big reason why we wanted to join from the diversity of the experience we brought together, but also just the platform.

好的，谢谢你，Mike。能够加入CVS团队，与像Mike这样处在医疗创新前沿的人一起工作，这是一段极其宝贵的经历。更让我惊讶的是，David Joyner在我一岁的时候就已经开始了他在CVS的职业生涯。所以，能够加入这样一个经验多元、底蕴深厚的团队，正是我们当初决定加入CVS的主要原因之一，不仅因为我们带来了互补的经验，更因为CVS这个强大的平台。

Second, when we went through our process, one thing that stood out about CVS, one thing that Signify needed was a national consumer health care brand. And I really believe we are the only national consumer health care brand, and I've seen and felt directly the impact that's had on our business and many of the other businesses throughout our portfolio.

其次，在我们加入CVS的过程中，有一件事非常突出——那就是CVS拥有一个全国性的消费者医疗保健品牌。这正是Signify之前所缺乏的。我真心认为，我们是全美唯一真正具备消费者识别度的全国性医疗品牌，而我也亲眼见证并亲身感受到，这一品牌效应已经对我们自身以及我们整个资产组合中的其他业务产生了深远影响。

When we kicked off our original strategy work with CVS, this was the strategy slide we showed. We wanted to engage more folks get to experience our services inside their homes. Two, we wanted to do more inside of the homes. And then finally, we wanted to help remove administrative burden from clinicians to allow them to work to the top of their license.

当我们与CVS开展初步战略对接时，我们展示的战略图有三大核心目标。第一，我们希望吸引更多用户，让他们在家中体验我们的服务；第二，我们希望在居家服务中开展更多工作；第三，我们致力于减少临床医生的行政负担，让他们能够充分发挥专业技能，从事最高价值的医疗活动。

I'm happy to say that we've continued to do that. So just a quick reminder on the in-home part of our business. We're seeing almost 34,000 members come through us being scheduled each and every day.

很高兴地告诉大家，我们的这三个方向都在持续推进中。先说说我们的居家医疗业务，每天我们都有近34,000名会员通过我们进行预约，接受服务。

As Mike said, we were just slightly under 3 million homes this year, and we're spending real quality time with these members. Almost 20 minutes of Med reconciliation and 2.5x the amount of time to get into spend with an average primary care visit. But most importantly, we pushed this business and even more so post acquisition into doing more inside the home. And so this case management referral volume has picked up dramatically. We're helping to ensure that senior women are getting mammograms. We're helping to ensure that folks are getting vaccines, immunizations at MinuteClinics. So really starting to drive this home is a nexus to bridge out and do better care for the individual's lives that we have the honor to touch.

正如Mike所提到，今年我们在全国完成了将近300万次的居家访问，而且我们确实在每位患者身上投入了时间与质量。例如，单次用药审核（medication reconciliation）就接近20分钟，这几乎是普通初级保健问诊时间的2.5倍。更重要的是，在被CVS收购之后，我们进一步推动这项业务，扩大了居家服务的内容。我们的转诊服务（case management referral）量大幅增长。我们正在帮助年长女性完成乳腺癌筛查，帮助更多人前往MinuteClinic接种疫苗。可以说，家庭医疗已经成为我们连接医疗服务和患者生活的核心纽带。

Beyond that, we've kept up with innovation. One of the biggest opportunities inside Signify is to drive more optimization through our logistics and routing platform. Many of you that studied us know that we have a large team of engineers that focus on drive time and solving one of the most complex computer science problems, which is the traveling salesman. How do you get an individual to a location with dynamic, supply and demand? And through a real investment post-acquisition, we've been able to markedly drive down this drive time to drive up utilization of our most precious asset, which is our clinical workforce.

此外，我们也持续在创新领域投入。Signify面临的最大机会之一是通过优化调度系统来提升效率。熟悉我们的人知道，我们拥有一个大型工程师团队，专注于解决一个经典的复杂算法问题——旅行推销员问题（TSP）。我们的目标是在供需动态变化的情况下，让临床医生以最优路径到达服务对象家中。通过CVS收购后的进一步投资，我们大幅降低了行车时间，从而提升了我们最宝贵资源——临床人力——的利用效率。

Beyond that, through some of that extra time, we've expanded to more diagnostic tests being done in the home. And so we're doing things like EKG, spirometry, a whole host of tests that are giving patients and members real-time access to results right in the comfort and quality of their home. But finally, that post visit is really important. And again, so much of where I believe home visits and Medicare Advantage in general are going is not just to identify things but to do something about it.

借助这些节省下来的时间，我们进一步拓展了居家检测服务的种类。我们现在可以在家中为患者进行心电图（EKG）、肺活量（spirometry）等多种诊断检测，让患者在舒适的居家环境中就能即时获得健康数据。但最终，我们认为，居家医疗和Medicare Advantage计划的真正价值，并不仅仅是发现问题，而是“发现之后要有所作为”。

And I'm proud to say Signify has been a leader in this space across all of our payer clients helping to drive better outcomes for the lives that we touch inside the homes. Here's a few more stats just on that and just to show you some of the power of the consumer brand that CVS brought to us and then what we were able to bring to some of the other assets as well.

我感到非常自豪的是，Signify在这一领域始终处于领先地位，在我们所有的付款方客户中，我们都在助力改善患者生活质量。接下来我会分享一些具体数据，让大家更直观地看到CVS消费者品牌为我们带来的力量，以及我们又如何反哺CVS生态中其他资产，协同推动这一整体愿景的实现。

So first, as Karen and Prem both mentioned, there's this population of members and we started inside Aetna that have always been very difficult for us to reach for a host of reasons, right? Many of these members tend to be high [indiscernible] members and members that need case management referrals and a lot of additional help. Through our integration with the CVS Pharmacy assets, we've been able to go out and engage with 65% of those members, just a tremendous number, way more than we ever anticipated. We brought this deal together to actually drive better differentiated care and enhanced consumer experience with them.

首先，正如Karen和Prem都提到的，我们在Aetna内部最初接触到的，有一群一直以来很难触达的会员，原因多种多样。这些会员往往是高风险人群，需要个案管理转诊和大量额外支持。通过与CVS Pharmacy资产的整合，我们已经能够成功触达这类会员中的65%，这个数字非常惊人，远远超过了我们最初的预期。我们促成这项整合的初衷，就是希望为他们带来更优质、更有差异化的照护体验。

Second, we want to do this in a technology-centric way. And so we didn't want to make it cumbersome for Prem and his pharmacy team. We already have a ton of work to do each and every day. We have to rely just on phone calls. So CVS accelerated technology investment inside Signify. We built an online scheduling portal that has API access right into our iPad application, where all those logistics and routing happen. I'm happy to say that we've had over 10,000 visits already scheduled since launching this late in Q3.

其次，我们希望以技术为核心来实现这一目标，而不是给Prem和他的药房团队增加负担。他们每天已经有很多事务需要处理。如果我们只依赖电话联络，效率太低。为此，CVS加快了对Signify的技术投资，我们搭建了一个在线预约门户，并通过API无缝接入我们的iPad应用，实现所有调度和路径规划。自第三季度末上线以来，我们已经通过该平台完成了超过10,000次预约，成绩喜人。

So it's been a tremendous success. And again, showing that power of that consumer engagement flywheel with CVS. Second, as I already alluded to, we're doing more inside the home. And so there's been an increased demand, especially since the pandemic for vaccinations, immunizations and connecting folks back. It's difficult to do in the home only because of cold chain and supply chain issues. But we've been able to bring them back and schedule them directly into MinuteClinics to make that a seamless experience for them after we start that visit inside the home.

所以这个项目取得了巨大的成功，再次验证了CVS消费者参与飞轮的力量。接下来，我之前也提到过，我们正努力在居家医疗中完成更多服务。特别是疫情以来，疫苗接种和将患者重新引导回到持续照护体系的需求显著上升。由于冷链与供应链的限制，居家接种并不容易操作，但我们现在能将患者引导到附近的MinuteClinic，做到从居家评估到门诊接种无缝衔接。

Second, and I'm proud to say this was one of the things we launched just this year with Oak Street, Signify with Aetna members is the largest and most productive channel now in the populations we serve, driving almost 55% of welcome visits into Oak Street members. So again, we're inside the home with an Aetna member, they might not have a primary care doctor or they have a relationship they'd like to change, we've been very successful and the top-performing channel now, as I just mentioned, getting folks to connect back into Oak Street.

另外让我特别自豪的是，今年我们与Oak Street一起启动的新合作：在我们所服务的群体中，Signify与Aetna会员的整合已成为最强劲的渠道，目前促成了近55%的Oak Street初诊（welcome visit）。我们在居家拜访时接触到Aetna会员——他们可能没有固定的初级保健医生，或者希望更换医生。我们成功地将他们引导至Oak Street，现在这个渠道已成为我们表现最好的会员转化路径之一。

The other part of Signify was a national leader in ACO enablement or provider enablement. The good news is when we came into CVS, they had one of the top-performing and largest ACO REACH businesses It's a business that we hadn't participated in. And we brought all of our capabilities in MSSP and some Medicare Advantage risk. When you bring that all together and which we have this year, we now have over 100 -- I'm sorry, 1 million lives under management, one of the largest ACO enablement companies in the country, helping over 60,000 providers in almost every state.

Signify还有一个重要业务是ACO赋能，也就是对医疗服务提供方的赋能。好消息是，在加入CVS时，CVS本身就拥有全美最强、规模最大的ACO REACH计划之一，而这正是我们过去未能涉足的领域。今年我们将Signify在MSSP（Medicare共享储蓄计划）和部分Medicare Advantage风险管理方面的能力整合进来，目前我们已管理超过100万名受益人，协助全美近60,000名医生，是美国最大的ACO赋能机构之一。

And the thing I'm most proud about with this business is we're not just a technology solution but we're boots on the ground, physically helping to change these practices, lift them up and drive shared savings to get better results for the patients that they touch.

而在这项业务中，我最引以为傲的是，我们不仅仅是一个技术平台，而是真正“落地作战”，亲自深入诊所、协助医生改进流程、提升绩效，并通过共盈机制（shared savings）创造更好的患者结果。

We've also scaled this business, not just in rural America, not just in academic medical centers, but across all stripes of health care to ensure that this platform has been really resilient and is touching individuals when and where they need care the most. But value-based care is a journey. And one thing that I'm also proud about is when we go in to talk to these existing facilities and they're starting down that value-based care journey, we have a program that is broad, but also deep. And so we were able to meet them with a shared savings program on the basic track, take them into enhanced, go into ACO REACH.

我们的这套ACO赋能平台不仅覆盖了美国的乡村地区和学术医疗机构，而且已在各种医疗环境中大规模推广，确保这项服务既有韧性又能在患者最需要的时候触达他们。但“价值导向照护”（value-based care）是一段旅程。让我同样骄傲的是，我们拥有一套完整而深度的计划，能根据医院或诊所的成熟度，提供不同层级的服务：从基础的共享节省方案开始，逐步升级至更高级别，最终进入ACO REACH模式。

And almost every one of our clients is asking us to help them manage delegated Medicare Advantage risk. Take care of risk adjustment, take care of the quality programs, take care of the reporting, take care of the contract and with the various payers that, we already have great relationships with. So I've been very excited about seeing this come together. It's built largely upon that integrated interoperable tech platform that Mike mentioned. And there's going to be a lot more development and excitement here for many years to come.

几乎我们所有的客户现在都在寻求我们的协助，帮他们管理下放的Medicare Advantage风险：包括风险调整、质量项目、数据报表、以及与各大付款方的合约管理——这些都是我们已有稳固关系的领域。我对这一切的发展感到非常兴奋。这一切都是基于前面Mike提到的那一体化、可互操作的技术平台。而在未来多年里，这一平台还将持续拓展，潜力无限，令人期待。

And with that, I'd love to show you guys a video just showing how all of these parts and health care delivery is starting to come together and then Michael close this up. Thank you.

接下来，我想放一段视频，展示我们如何将这些部分整合在一起，形成一个真正统一的医疗照护系统。视频之后，Michael会做总结。谢谢大家。

[Presentation]

Michael Pykosz Former President of Health Care Delivery & Executive VP

All right. I hope everyone enjoyed the video. I always find it really helpful to see what we talk about kind of in concept, in action and how it impacts an individual patient. One thing at the same time, I found it really fortuitous that, that patient chose Oak Street Health when presented those options because it really sets up the next slide perfectly, so that's lucky. There's also a joke. I can see because we're paying attention on it.

好了，希望大家喜欢刚才的视频。我总觉得，把我们所讲的概念具象化、让大家看到它是如何在一个真实患者身上起作用的，这样的展示特别有帮助。同时我也觉得很巧的是，那个患者在面对选项时恰好选择了Oak Street Health，这刚好为我接下来的幻灯片打好了铺垫。真是“运气好”。这其实是个笑话，我看得出来你们有在认真听。

All right. I know some of you are more familiar than others with Oak Street Health. Oak Street Health operates primary care centers for older adults on Medicare. We operate a fully value-based model, so we invest upfront to take better care of our patients. And if we were able to take better care of them, we keep them healthier, keep them out of the hospital that creates a surplus, and that's what drives our economic model.

好的。我知道在座有些人对Oak Street Health比较熟悉，有些人可能了解较少。Oak Street Health是为Medicare老年患者提供初级保健服务的连锁中心。我们采用的是完全基于价值导向的运营模式——也就是说，我们会在前期加大投入，提供更优质的照护。如果我们能更好地照顾这些患者，让他们保持健康、远离住院，就能带来医疗成本的节省，而正是这部分节省构成了我们的经济模型的核心。

In order to create a predictable and homogenous care environment and a similar technology offering across all of our centers, we open up our centers de novo. And so that means is with the open up our centers, we have to both build the number of patients we see over time, get our patients in our care model and then drive that savings. And so the combination of the time it takes to fill up a center and the time taken to get them in our care model creates the J curve, as we call it, for an Oak Street center, which is what you see on this page.

为了在所有门诊中心之间建立一个一致、可预测的照护环境和统一的技术平台，我们采用“从零开设”（de novo）的方式来新建中心。这意味着我们要从无到有地积累患者数量，让他们真正进入并适应我们的照护模型，然后才能逐步实现节约。因此，从开设中心到达到成熟状态之间的这段过程，我们称之为“J曲线”，这正是你在这页幻灯片中看到的内容。

And it takes about, give or take, $3 million of center operating losses to get a center to breakeven. And we've achieved what we are very strong and predictable unit economics at our Oak Street centers, some data points for you. We project in 2024 that 95% of our centers that were open in 2021 and prior will be profitable, which was about over 120 of the 129 centers at that time.

每个中心要达到盈亏平衡点，通常要承担大约300万美元的累计运营亏损。但在Oak Street，我们已经建立起非常稳健、可预测的单位经济模型。这里给你们一些数据：我们预计在2024年，那些在2021年或更早开设的中心中，有95%将实现盈利，当时这样的中心一共有129家，也就是说有超过120家将转为盈利。

More importantly, of our 39 centers that are in kind of our year 6 or more mature, those will have between $6 million and $7 million of clinic level profitability. And finally, for our centers with over 2,000 at-risk patients, which we refer to as our mature centers, still some growth opportunity, but getting close to full. Those centers will have over $8 million, a 4-wall margin in 2024.

更重要的是，在我们39家运营年限达6年及以上的中心中，每家中心的盈利能力在600万到700万美元之间。而对于那些已经拥有2000名以上“风险合同”患者的中心，我们称之为“成熟中心”，虽然还有增长空间，但已接近满载水平。这些中心在2024年的4壁利润（4-wall margin）将超过800万美元。

So hopefully, those numbers highlight both the strength of the economic model, but also consistency, you see those numbers staying consistent over time even into 2024. We also believe there is a massive market for what we're doing. We talked about the $1 trillion opportunity. A lot of that addressable cost is in Medicare patients. And innovative models like Oak Street that improve care quality and improve experience are still, I believe, in their infancy on adoption.

希望这些数字能展现出我们经济模型的优势与稳定性——即便到了2024年，它们依然表现出高度一致性。我们也坚信，这项业务面临着极其广阔的市场。我们之前谈到过，美国医疗体系存在1万亿美元的可节约支出，而其中很大一部分就集中在Medicare老年患者群体身上。而像Oak Street这样的创新照护模式，能够提升照护质量、改善患者体验，我认为在整个行业中的采用率仍处于早期阶段。

And so because of that, we are ramping up the pace of center growth that we already shared. We're going to put up 50 to 60 centers next year. And what that means is as we keep growing more centers, we're creating a larger and larger embedded set of profitability within CVS as those centers mature. We also realized that there's a huge opportunity to improve the economics by shortening the time it takes to get to maturity for our centers.

因此，我们已经在加快中心扩张的步伐——我们已分享过，明年我们将新开设50到60家中心。这意味着随着更多中心进入成熟期，CVS将拥有一个越来越庞大的利润池。同时我们也意识到，还有巨大机会可以进一步提升单位经济效益，那就是——缩短中心从开业到成熟的时间周期。

So as you can see from this graph, just adding one more patient per day -- 1 patient per day per center, will pull the curve forward a full 2 years. So those mature center statistics, those years, 6 plus center profitability we'll pull all those forward 2 years, which obviously makes a big difference in our ability to invest in more centers and drives bottom line growth for the organization.

从这张图可以看出，每个中心每天只要多增加一位患者，就能将整个盈利曲线提前整整两年。也就是说，那些运营第六年及以上、已实现高盈利能力的成熟中心，其盈利期将提前两年实现。显然，这对我们扩大中心投资能力和提升公司整体利润有着巨大的影响。

And to make sure I'm tying -- or connecting the dots, that opportunity is currently not in the guidance that I'm shared. So that's one of the focuses we do to create even more growth in health care delivery organization more broadly. This is also a place where CVS can really help us. We talked a lot about the unmatched breadth and customer member, patient engagement you find at CVS. And I'll put some numbers against that.

我要特别说明一下，目前我们分享的财务指引中还没有包含这一增长潜力。所以这是我们未来在整个医疗服务交付体系中创造更多增长的重点方向之一。而这也正是CVS能大力帮助我们的地方。我们之前多次提到，CVS拥有无与伦比的客户、会员和患者覆盖广度与互动频率。下面我会提供一些具体的数据支持。

There are over 650,000 Medicare beneficiaries visiting CVS stores in Oak Street catchments every week. There are nearly 1 million Aetna Medicare and PDP members in Oak Street catchments today. And in 2023, Signify will complete over 300,000 home visits in Medicare patients who live in Oak Street catchments. All told, that is over 4 million Medicare beneficiaries that our customers, members, patients at CVS today that live in Oak Street catchments. That number is only going to grow as we keep putting more and more Oak Street centers up.

目前每周有超过65万名Medicare受益人到访CVS门店，这些门店地处Oak Street Health服务覆盖区域。同时，现有约100万名Aetna的Medicare和处方药计划（PDP）会员也居住在Oak Street的覆盖范围内。2023年，Signify还将在这些区域的Medicare患者中完成超过30万次的上门访问。综合来看，居住在Oak Street覆盖范围内、同时也是CVS服务对象的Medicare受益人超过400万人。随着我们持续扩张Oak Street中心，这个数字还将继续增长。

So to put these numbers in a bit of context, that 1 patient per center per day I referenced on the last slide that moves the maturity curve up 2 years, that's what 50,000 total patients added additionally in 2024. So if we can capture 50,000 of the 4 million that CVS is engaging with, that level of progress will help move our J curve forward 2 years. And we're already rolling out programs and seeing really strong initial results. So some of you saw yesterday example of an Oak Street table set up in a CVS store. That's something we've rolled out in a series of markets.

为大家进一步说明：我们之前提到的“每天每个中心多一位患者、可使成熟曲线提前2年”这一目标，对应的是在2024年新增5万名患者。如果我们能从CVS现有覆盖的这400万Medicare受益人中吸引到这5万人，就可以实现那一目标。目前我们已经在部分市场推出了相关项目，并取得了非常积极的初步成果。有些人昨天可能已经看到，在CVS门店内设有Oak Street的咨询台，这就是我们在多个市场中推广的做法之一。

And what we're seeing is 1 in 6 customers we engage end up scheduling a visit with Oak Street Health. And not only are we achieving those types of results, we are improving the results. As we've innovated rapidly daily and weekly basis and done things like creating senior days and advertising those for CVS customers, we've seen the results double in that outreach.

我们发现，在与我们互动的客户中，有1/6最终会预约前往Oak Street就诊。不仅如此，随着我们快速进行产品和流程创新，例如设立“老年人专属日”并通过CVS面向客户进行推广，我们看到预约转化率已翻倍增长。

The Aetna team has identified 120,000 of those 850,000 members who could benefit from an improved primary care relationship at Oak Street Health, and we are finding ways to outreach those members to make them aware of what we're doing.

Aetna团队已从其85万Medicare会员中识别出12万名特别适合接受Oak Street Health优质初级照护的成员。我们正积极寻找触达这些人的方式，让他们了解我们的服务。

Kyle talked about this, but just to reiterate it, at Signify, over 10% of the people who just hear about Oak Street from Signify, are scheduling [indiscernible] with us. So we're in early innings of rolling these things out. But we are seeing a very strong impact already from the broader flywheel and broader engagement with CVS.

Kyle 之前提到过，我再强调一次：在Signify访问的患者中，仅仅是听说过Oak Street Health这一服务，就有超过10%的人最终预约了门诊。我们目前才刚刚开始推广这些整合策略，但从CVS庞大的客户接触网络中已经产生了非常显著的成效。

Taking a step back from Oak Street. We are just scratching the surface on what we can do with the value-based care capabilities within the CVS Health care delivery portfolio today like Kyle touched on a lot of things really well about how we're seeing the CVS ACO growing, for example. And we put together the capabilities across Signify, across CVS ACO, across Oak Street, what you find very quickly is we have everything we need for a multi-payer platform, right, or a risk-bearing MSO as we call it internally.

从Oak Street视角稍微拉远一点看，我们今天在CVS整个医疗服务交付组合中对“价值导向照护”能力的运用，其实才刚刚开始。正如Kyle提到的那样，比如CVS的ACO业务正在快速增长。当我们将Signify、CVS ACO和Oak Street的能力整合在一起后，我们已经初步建立起一个具备“多支付方服务能力”的平台——在内部，我们称之为“承担风险的医疗服务组织（MSO）”。我们拥有一切构建这一平台所需的能力。

And what that means is we can invest in one interoperable platform and that platform can serve all of our businesses. And that means we can invest more, continue to differentiate ourselves from others out in the marketplace. And then all of these different businesses, whether it be Oak Street, whether what we're doing in the MinuteClinic side, whether Signify, whether CVS ACO can benefit from those investments.

这意味着我们可以投资于一个统一互操作的平台，而这个平台能够服务我们所有的业务单元。这使我们可以进行更大规模的投资，持续在市场上形成差异化竞争优势。而我们所有的业务——无论是Oak Street、MinuteClinic、Signify，还是CVS ACO——都可以从这些投资中获益。

Let me give you an example of that. Oak Street a couple of years ago bought a company called RubiconMD that specializes in e-consults. Essentially, it allows our doctors to consult with a specialist. And they have over 400 different types of specialists on their platform, allows them to consult with the specialist to help understand if their care plan is correct. And what we find is oftentimes, our providers think they know what to do for very complex patients. But thinking what to do or believing is not enough, you need to be sure.

让我举一个例子。Oak Street几年前收购了一家名为RubiconMD的公司，该公司专注于电子会诊（e-consult）。它的核心功能是允许我们的医生与专科医生进行远程咨询。这个平台拥有400多种专科医生类型，使我们的医生可以就疑难复杂病例向专科医生咨询，以确认他们的治疗方案是否正确。我们发现，在面对复杂患者时，医生常常“认为”他们知道该怎么做，但“认为知道”远远不够，关键是要“确定”。

And in the traditional system, that means they have to send them off to a specialist. What we do in e-consults, we can get that second opinion within hours. And oftentimes, we find out that the doctor's plan is fine or we can tweak it a little bit and we can avoid that specialist visit, which is a better experience for patients, removes opportunities for things to fall through the cracks and saves cost.

而在传统体系中，这通常意味着必须将患者转诊给专科医生。而通过电子会诊，我们可以在数小时内获得第二诊疗意见。通常结果表明原始方案是可行的，或者只需略作调整，这样就可以避免实际的转诊。这不仅为患者提供了更便捷的体验，也减少了中间环节中断的风险，并节省了治疗成本。

And that's the type of capability that we invested a lot on the tech side to integrate with our workflows, et cetera. And that's thing we can roll out to the broader set of CVS Health care over assets, whether it's leveraging it from MinuteClinic and the commercial population that Aetna was -- Prem was talking about when he talked about Aetna, whether it's leveraging it for the CVS ACO, et cetera. So that's one example of this risk-bearing MSO, the scale we can build.

我们为这项能力在技术集成方面投入了大量资源，使其可以无缝整合进我们的工作流程中。现在，我们也可以将这一功能推广到CVS更广泛的健康资产体系中，比如应用在MinuteClinic、Prem在介绍Aetna时提到的商业医保人群，或是用于CVS ACO等。这就是我们正在建设的“风险承保型医疗服务组织”（risk-bearing MSO）所能体现的规模化优势的一个例子。

Another example, I'm going to talk -- another -- I'm sorry, another advantage, another opportunity is local density. When we put together all these different assets in the health care delivery and create that inoperable data infrastructure, what we can do is we can create a lot of local scale. And that opens up even more opportunities for our care model. For example, by getting more local density, we can do more with home visits for patients following a hospitalization and lower readmissions and we can leverage Signify for providing that service to Oak Street patients or for patients in the CVS ACO.

再举一个例子，也可以说是另一个优势或机会——那就是“本地密度”。当我们把这些不同的医疗交付资产整合到一起，并建立统一互操作的数据基础设施后，我们可以形成更强的本地规模效应。这将为我们的照护模式创造更多机会。比如，凭借更高的本地密度，我们可以在患者住院后开展更多上门随访服务，从而降低再入院率。而这项服务可以由Signify提供，服务对象可以是Oak Street的患者，也可以是CVS ACO的成员。

Along the same lines, more local density allows us to get more volume to specific specialists, enables us to contract more [indiscernible] them, and it allows us to help make sure we are getting people to specialists that have a more appropriate practice patterns, again, increasing quality, lowering costs.

同样地，更高的本地密度也可以让我们将更多患者导流到特定的专科医生那里，从而提高谈判能力，优化服务采购协议，同时也能确保我们将患者转诊给具有更恰当治疗模式的医生，从而进一步提升医疗质量并降低成本。

And those opportunities with the local density are things that none of our assets could do on their own. But together, right, it creates an opportunity for all of them to be better.

这些基于本地密度带来的机会是我们任何一个单独业务单元都无法独立实现的，但当它们整合在一起时，就为所有单元创造了协同提升的巨大潜力。

I want to talk about an example in the market in Chicago, right? So you can see already in Chicago, the level of density we have created when we combine all these assets. We have 28 centers in Chicago, serving over 50,000 patients at Oak Street. Signify completed 32,000 home visits on Medicare patients in the Chicago area. CVS Accountable Care is contracted with 1,500 provider partners and has 40,000 patients in the ACO. And there's 120 MinuteClinic providers across Chicago. So take that density serving over 290,000 patients today. Now we can add on the fact that Aetna has a strong presence in growing in the Chicago market.

让我举芝加哥市场的例子，你就能看到我们整合所有资产后在当地实现的密度水平。目前在芝加哥，我们有28家Oak Street中心，服务超过5万名患者；Signify在该地区的Medicare患者中完成了3.2万次上门访问；CVS的责任医疗组织（ACO）与1,500家医疗提供者建立了合作关系，覆盖4万名患者；而在芝加哥，全市还有120名MinuteClinic医生提供服务。换句话说，这样的整合布局已覆盖超过29万名患者。而且，Aetna在芝加哥市场的业务也在持续增长，这进一步放大了我们的影响力。

And we can add that, obviously, CVS Pharmacy can have incredible local presence. And that level of local density, combined with the omnichannel offering across pharmacy, across retail health, across primary care for chronically-ill patients across care in the home is something that's unmatched.

我们还可以补充一点，显然CVS Pharmacy在本地具有极强的存在感。而这种本地密度，再结合我们在药房、零售医疗、慢性病患者初级护理以及居家护理等领域的全渠道服务，构成了无与伦比的独特优势。

I am going to give an example of this coming to life. One of our on-call providers shared a story with me last week about how it was a weekend, and there was a patient who needed care right away. And Oak Street is not open on weekends. And before the CVS transaction, they probably would have set the patient to the ER, not the outcome we want, but we didn't have the asset, right? In this case, they were listening to the local MinuteClinic.

我来讲一个实际发生的例子。一位我们的值班医生上周跟我分享了这样一个故事：某个周末，有一位患者急需就医，但Oak Street在周末并不开诊。如果是在被CVS收购之前，我们大概率只能让这位患者去急诊室（ER），那不是我们希望的结果，但我们当时没有其他选择。而这次，情况不同，他们发现附近有一家MinuteClinic可以应对。

And because of a program we put together, they were actually able to co-care for the patient, leveraging the fact that they knew the patient and our relationship, they were able to talk to the MinuteClinic person while the patient was in the exam room and actually avoid the ER visit, avoid the hospitalization and create a very satisfied patient as well. So again, that's one example, but of the things that we can do now that we're combined.

由于我们提前建立了一个协作机制，医生能够与MinuteClinic的医护人员联合照护这位患者。因为他们熟悉这名患者及其病史，医生能在患者就诊时与MinuteClinic现场人员实时沟通，结果避免了前往急诊室、避免了住院，并最终让患者感到非常满意。这只是一个案例，但正是这种协同整合让我们今天拥有了全新的能力。

We are already seeing the value of the flywheel, the value of the CVS brand, impact our healthcare delivery organization in a huge way. So I anchored you earlier about $6 billion of revenue in 2023. We are projecting we'll have over $10 billion of revenue in healthcare delivery in 2024. We're almost going to double in size year-over-year.

我们已经切实看到了“飞轮效应”的价值，CVS品牌的价值也正深刻影响我们的医疗服务体系。如前所述，我们2023年医疗服务业务收入约为60亿美元，而预计2024年将超过100亿美元，实现几乎翻倍的年增长。

And we expect that rapid growth to continue. We expect to grow mid double digits for the next 5 years. And we have a lot of visibility on where that growth is going to come from. And it's going to come from assets across our healthcare delivery continuum.

我们预计这种高速增长将持续下去，未来五年我们的年增长率将维持在中等两位数水平。而且我们非常清楚这种增长将从何而来——将来自我们整个医疗服务链条上的多项资产。

We talked about we're going to put out more 3 centers and accelerate the patient growth. Kyle talked about how we increase both the number of home visits we're completing and then the services offered within those home visits. We have got an incredible traction with our ACO reach signing up more providers. And as Kyle talked about, there's also a huge need from those providers in demand to move into Medicare managed risk to eventually move into commercial risk.

我们提到我们将开设更多Oak Street中心，加速患者数量增长。Kyle提到我们不仅会增加上门访问的数量，也会扩展上门服务的类型。我们的ACO REACH项目目前吸引了越来越多医疗服务提供者的加入。同时正如Kyle所说，这些服务提供者迫切希望进一步拓展到Medicare风险管理，并最终进入商保风险管理领域。

We obviously have the capability in our platform today to take Medicare Advantage risk. Oak Street today takes it over 20 payers in 25 different states.

我们的平台显然已经具备了承担Medicare Advantage风险的能力。目前，Oak Street已与来自25个州的20多家医保机构合作开展风险合同业务。

And then finally, on the retail side, we're going to take the local community easy access that MinuteClinic provides, and we're going to make sure we're adding more capabilities on the primary care side that we're continuing to serve our commercial and IFP patients and also a multipayer and leveraging value-based concepts within that model as well as making sure we provide a convenient access point for all of our value-based care partners in all of our value-based patients across healthcare delivery to keep patients out of the hospital. And that's going to drive very significant growth for a long period of time.

最后在零售端，我们将继续借助MinuteClinic在本地社区的便利可达性，增强其初级护理能力，不仅继续服务我们的商保和个人医保（IFP）人群，也将以多支付方合作为基础，进一步嵌入价值导向型护理理念，并确保我们为所有的价值导向型护理合作伙伴和患者提供便捷的就医入口，以帮助减少住院。这将为我们带来长期而强劲的增长动力。

As important as the revenue growth is the embedded margin potential we are creating. We know today that Signify can generate a high-teens margin. We know in our mature centers at Oak Street Health that our margins in the mid-teens. We expect our ACO model to be low to mid-single digits depending on mix between MA and ACO programs.

与收入增长同样重要的是我们正在积累的利润率潜力。我们清楚目前Signify可以实现接近20%的利润率；我们也知道，在Oak Street Health的成熟中心，其利润率在中段的十几百分点。我们预计ACO模式的利润率将在低至中位数的个位数水平，这取决于Medicare Advantage（MA）和ACO项目之间的组合比例。

And we know what Retail Health can do. So as that growth happens, right, following that, following getting patients in our models, following the maturation curves, that profit will come as well. And again, as Tom referenced, this is a lot of the upside that we believe and we're really committed to delivering. We believe very strongly in our ability to do so to create a really meaningful kind of fourth pillar to what CVS offers.

我们也非常清楚零售医疗可以带来的价值。因此，随着这些业务的扩展、患者逐步进入我们的护理模式、医疗中心步入成熟阶段，利润自然也会随之释放。正如Tom所指出的，这正是我们坚信并致力于实现的潜在增值所在，我们非常有信心将其打造为CVS医疗服务体系中的“第四支柱”，并赋予其实质性的重要意义。

It's really important that we allow all of you to follow along with our progress. We are committed to giving you visibility in that. So we're going to share a set of metrics, including the number of Oak Street centers, but just importantly, the number of profitable mature Oak Street centers. We're going to share with you the number of at-risk lives we're serving, the number of home visits we're completing and the number of providers on our platform.

让各位能够清晰跟踪我们的进展非常重要，我们承诺将提供足够的透明度。因此我们将定期披露一系列关键指标，包括Oak Street中心的数量（尤其是实现盈利的成熟中心数量）、我们服务的“承担风险的患者”人数、完成的上门就诊次数以及平台上的医疗服务提供者数量等。

I started this conversation talking about the huge opportunity that's out there in healthcare, right? And you've heard about this again and again and again today that we have a unique opportunity here at CVS to meaningfully improve care quality and lower cost and improve experience. And that opportunity, again, is a $1 trillion opportunity size.

我在一开始就谈到了医疗领域所蕴含的巨大机遇。今天你们反复听到了同样的观点：CVS在改善医疗质量、降低成本、提升患者体验方面拥有独特机会。这项机会的市场规模，正如之前所述，高达1万亿美元。

And the portfolio of assets we bring is differentiated and unmatched. And we are in the very early innings of this transition. We are in the very early innings of this realization, but we firmly believe that CVS is uniquely positioned to win as this market evolves. And so we are committed to building a rapidly scaling differentiated healthcare level organization.

我们所拥有的资产组合具有高度差异化和无可匹敌的竞争优势。当前我们处在这场转型的早期阶段，也正处在兑现这一潜力的初期。尽管如此，我们坚信CVS拥有独一无二的市场定位，能够在医疗市场演进中脱颖而出。因此我们承诺要建设一家具备快速扩张能力、差异化定位的医疗服务组织。

Most importantly, we are going to drive a meaningful impact to the cost and quality for patients. And the healthcare delivery organization is going to be positively impacted by being proud of broader CVS. Everything we talked about around engaging customers in the stores, partnering with the pharmacy, partnering with Aetna is going to drive better results and we could drive on our own, and vice versa.

最重要的是，我们将切实改善患者的就医成本和护理质量。医疗服务组织将因为成为CVS整体体系中的一部分而获得积极推动。我们在门店中对客户的参与、与药房的协同、与Aetna的合作，这一切都将实现1+1>2的结果，也就是说，这些整合效果将远超我们单独努力所能达成的成绩，反之亦然。

We know that we can partner with the Health Plan. We know we can partner with Retail. We know we can partner with Caremark to also impact their results in a positive way. And we deliver on this vision and when we deliver on this vision, we will drive strong future earnings growth as we realize more and more of that potential profit pull out there. And we are very excited to be with you on this journey as we transform healthcare.

我们知道我们可以与医保计划合作，也可以与零售业务合作，还可以与Caremark合作，并对他们的业务结果产生积极推动。一旦我们实现上述愿景，我们将推动未来收益的强劲增长，持续释放潜在的利润池。我们很高兴能够与你们共同踏上这段医疗转型的旅程。

All right. So this is not advancing. But I can tell you because I remember my slides, that the next thing is a break, and we'll come back in 15 minutes for Q&A.

好，现在幻灯片没翻页，不过我记得内容，接下来是一个中场休息，15分钟后我们回来进行问答环节。

[Break]

Larry McGrath Executive VP, Chief Strategy Officer & Chief Strategic Advisor to the CEO

Welcome back. Thank you all for your attention so far. So we're going to conclude the day with a Q&A. So we've got mic runners and you raise your hands. We start with Lisa. Why don't you introduce yourself for us guys?

Larry McGrath 执行副总裁，首席战略官兼首席执行官战略顾问

欢迎回来。感谢大家迄今为止的关注。接下来我们将以问答环节结束今天的活动。我们现场配有传麦人员，请举手提问。我们从Lisa开始，请为大家做个自我介绍。

Lisa Gill JPMorgan Chase & Co

My name is Lisa Gill with JPMorgan. My first question is for Brian and Mike. We've heard a lot about the risk model changes that began in 2024. Can you talk about the impact to your businesses, Brian.

Lisa Gill，摩根大通

我是摩根大通的Lisa Gill。我的第一个问题是问Brian和Mike。我们听到很多关于2024年开始实施的风险模型变化。Brian，你能谈谈对你们业务的影响吗？

You talked about it a little bit as far as new membership coming in, but others have talked about it as being a more broad impact in '24. And obviously, there would be an impact on the providers like Oak Street as well. So if you could just give some incremental color.

你刚才稍微提到了与新增会员相关的影响，但其他人则认为这对2024年影响会更广泛。而且显然像Oak Street这样的服务提供者也会受到影响。所以如果可以的话，请你们具体再多讲一些。

Brian Kane Former Executive VP & President of Aetna

So there is an impact on our business for 2024. We've priced for it. It's just not as material as it could have been had we had a very large portion of our business in closely linked value-based relationships, full risk relationships, high portion of duals.

Brian Kane，Aetna前执行副总裁兼总裁

2024年这确实对我们的业务有一定影响，但我们在定价时已经考虑在内了。如果我们的大量业务是高度绑定的价值导向型关系、全面承担风险的合同、以及双重合格人群比例较高的情况下，影响会更大。

Those are the members in particular, and those are the relationships in particular, where there is, I would say, more breakage with respect to V28. The broader PPO populations, the broader medicare populations it's a much lower percentage impact for V28. It's also phased in over 3 years, as you know, and we fully priced for that.

这些特定人群和这种关系在V28模型下会受到更大冲击。而对于更广泛的PPO群体和Medicare群体来说，V28的影响相对较小。而且如你所知，这个模型是分三年逐步实施的，我们已经充分在定价中考虑这一因素。

Michael Pykosz Former President of Health Care Delivery & Executive VP

And I would say on the Oak Street side, there's a couple of components impacting the model changes. And keep by the model changes are phased in over 3 years, right? I thinking about the first year of the phase, and Tom has shared, and we expect an impact of around 2% for revenue for Oak Street. And that result is a combination of a couple of factors.

Michael Pykosz，医疗服务前总裁兼执行副总裁

从Oak Street角度来看，模型变更的影响包含几个方面。需要注意的是，这一变更是分3年逐步实施的。以第一年为例，Tom刚才提到，我们预计Oak Street的收入影响大约在2%左右。这一结果是多种因素综合作用的体现。

One, coming in, what are your clinical protocols and what are you documenting. And then how is the change impacting what you're documenting, right? And we're just seeing a lower impact, I think, than other groups are based on the way our clinicians created the protocols of how we capture risk.

首先，取决于你最初的临床操作规范以及你记录的信息。其次，模型变更对你记录方式的影响。就我们而言，我们临床团队的风控记录标准设定得较好，因此我们受到的影响低于其他同行。

And then number 2 is really a function of our model and how fast we can adapt to the new model. And having our center-based approach where we have consistent workflows, consistent staffing having canopy, which allow us to roll out changes very quickly.

第二个关键因素是我们的运营模式以及我们适应新模型的速度。我们的中心化运营模式具有一致的工作流程和人员配备，再加上“Canopy”平台的支持，让我们能够快速推送流程更新。

I think it's allowed us to react to the new model, right, to make sure we're capturing the new codes faster than others can as well as kind of other opportunities to improve our performance on revenue.

这使得我们比其他人更快适配新模型，更快识别新的诊断编码，并把握住相关的营收机会。

And so I think that the reason why I think in your question why you're hearing from us is slightly different than others, I think it's actually a combination of what we did historically, but also our operational excellence going forward.

所以我认为，你的问题中提到我们的反馈和其他公司有所不同，这其实是因为我们既有过往的规范实践基础，也具备未来出色的运营执行力。

Eric Percher Nephron Research

Eric Percher from Nephron Research. A question for Karen and Tom. I'd like to get your take on the enterprise impact of the pharmacy model that you've suggested. Number one, Karen, you mentioned that you've reached a floor. Is that a floor relative to your cost to serve and acquisition costs? Are you confident the rest of the industry will follow. Do they need to. And then relative to the [indiscernible] enterprise, if you're able to push for more adequate reimbursement at the pharmacy, how does that look to the PBM? And what happens if everyone follows? Does it change the PBM profitability?

Eric Percher（Nephron Research）

我是Nephron Research的Eric Percher。我有一个问题要问Karen和Tom。你们提到的药房模型对整个企业的影响是什么？首先，Karen，你提到你们已经触及了底部。这个“底部”是指你们的服务成本和获取成本吗？你们有信心整个行业都会跟进吗？他们有这个必要吗？此外，关于整个企业，如果你们能推动药房获得更合理的报销，这对PBM会产生什么影响？如果所有人都效仿，这是否会改变PBM的盈利能力？

Karen Lynch Former Executive VP & President of the Aetna

Thank you for the question. Since I joined CVS, one of the questions I always get and all the pushback on the retail business has been, what are you doing about the pharmacy reimbursement model. And we have always said for the whatever I've been here now, for the 4 years I've been as part of CVS, we had the same exact answer every single time.

Karen Lynch（前Aetna执行副总裁兼总裁）

谢谢你的提问。自从我加入CVS以来，大家一直质疑我们零售业务的一个关键问题就是：你们在药房报销模型上做了什么改变？在我加入CVS的这四年里，我们的答案始终如一。

And as we've been looking at pharmacy reimbursement, I said the definition of insanity is doing the same thing over and over and expecting a different outcome. So as we step back and we looked at sort of that pharmacy reimbursement and said, we're doing everything we can to eradicate it, and you saw that on the slides. But now we're saying we have to make a change, and we have to make a change because our consumers are demanding it, the government is demanding it.

当我们重新审视药房报销模式时，我说过：“疯狂的定义就是一遍又一遍地做同样的事却期望不同的结果。”所以我们决定必须改变。这个改变势在必行，因为消费者要求，政府也在要求。

And we have the opportunity here to drive a much more transparent model and match the economics of our purchasing of drugs to the reimbursement. So what we're trying to do, as we said, eliminate that cross subsidization, get a fair margin on every script that we write. And over time and to kind of the impact on the whole company, you're seeing our new product from the PBM match what Prem is doing. That's the intention, right? So he's offering choice to our customers to match what Prem is doing. And then obviously, Brian will make those decisions with his customers.

我们现在有机会推动一个更透明的模式，将我们购买药品的成本与获得的报销直接挂钩。我们要做的是，如我们所说，消除交叉补贴，对我们开出的每一个处方都获得公平利润。从更宏观的角度看，我们PBM的新产品正努力与Prem的做法保持一致。我们的目标就是为客户提供选择，与Prem的方向一致。而Brian当然也会基于客户需求做出决策。

But in order for us to sort of eradicate that negative 5% and stem the earnings decline, this is our answer. As Prem said, we are the leaders in the industry. It's time for us to chart the new course and important for us to really stem that earnings decline for the viability of this business because we see an important strategic component of that retail business. People come to us for care. It is a place where -- it is a business that significantly generates cash flow. And so it's important for us to make that change, and that's what we're really trying to accomplish. And I'll ask Tom to add anything else I might have missed.

为了消除负5%的盈利压力，扭转盈利下滑，这是我们给出的解决方案。正如Prem所说，我们是这个行业的领导者，现在是我们开创新路线的时候了。这个转变对于维护零售业务的可持续性至关重要，因为我们认为这项业务具有重要的战略意义。人们来CVS寻求医疗服务，这是一个重要的现金流来源。因此，我们必须做出改变，这就是我们目前努力的目标。我请Tom补充一些我可能遗漏的内容。

Tom Cowhey Executive VP & CFO

I think for you to believe that the model is going to work, you have to believe that we're at the bottom, right? And we've had one of the largest chains in the nation, declare bankruptcy. And as we look at what the dynamics are in this marketplace, I think we believe that, that time is now that the market is ripe for change, and that's why we've announced this today.

Tom Cowhey（执行副总裁兼首席财务官）

如果你想相信这个模型会奏效，那你得相信我们已经触底，对吧？我们国家最大的一家连锁药店已经申请破产。我们观察市场的整体动态时，认为现在正是市场变革的最佳时机，这也是我们今天宣布这个新模型的原因。

One of the things that I think people get confused by as you think about your PBM question is what is -- like you're going to raise prices. Is that what you're saying? No. What we're saying is, as you look at the slides, the Prem walk through, there's $1 billion plus of reimbursement pressure in the pharmacy every year. And we've offset more than half of that on an annual basis with our cost of goods improvements.

关于PBM，有个大家经常混淆的点是：你们是不是要涨价？我们的回答是，不是。如Prem在演示中提到的，药房每年面临超过10亿美元的报销压力，而我们每年通过改善进货成本，抵消了其中的一半以上。

In these new models, the cost of goods improvement is going to get automatically passed on to the customers quicker than it has been in the past, which is what Prem talked about. And so prices at the pharmacy are still going to go down. They're just going to be tied to our ability to go out into the market and source those lower costs, which we are adept at doing.

在新的模型中，这些进货成本的改善会比以前更快地传导到消费者身上——这正是Prem提到的。因此，药房的价格仍会下降，只不过这种下降是建立在我们能否以更低的成本采购药品的能力之上的，而这正是我们的强项。

As you think then about the model 5% down is in the base. And we hope that over time that this could stabilize that at a flat level at some point. And maybe even if we transitioned enough of the model, you could start to see growth as you grow scripts and share so you can actually model this business the way you would expect to model a normal business.

至于模型本身，目前基准是5%的负增长。我们希望随着时间推移，这种下滑能趋于稳定，甚至如果足够多的处方量转向新模式，随着处方数量和市场份额的增长，我们就有可能开始实现业务增长，从而像对待一个常规业务那样来建模这个药房业务。

Justin Lake Wolfe Research

Thanks, Justin Lake, Wolfe Research. Sitting, I'm probably look like I'm standing anyway. Prem, I wanted to ask you about the new model as well. First, as you roll this out for 2025, is this going to be black and white with the PBMs in terms of you're either in at this new model price cost plus or you're not in our network.

Justin Lake（Wolfe Research）

谢谢，我是Wolfe Research的Justin Lake。我坐着的时候可能看起来像站着一样。Prem，我也想问你关于这个新模型的问题。首先，2025年开始推行的时候，这个模型是否会对PBM采取“非黑即白”的方式——要么接受这个成本加成的新定价模式，要么就不在我们网络中？

Have you run it by the other PBMs, specifically Optum and Express Scripts. And then maybe you can just walk us through the economics on -- you've told us, look, we'll get to a growth rather than shrinking 5% a year, if we're able to roll out this model. What are the economics if you start losing scripts because someone's out of network?

你们有没有把这个模型提交给其他PBM，特别是Optum和Express Scripts？另外，请你再解释一下你之前提到的经济性问题——你说如果能推行这个模型，就能从每年-5%的下滑走向增长。那么如果因为某些PBM不接受而导致处方流失，会对经济性造成什么影响？

Prem Shah Executive VP & Group President

So Justin, a few things. And I think the big point and is similar to the last question is, when you think about this industry and what's happened over the course of the last decade, right, there's been a tremendous number of things that have helped us drive cost down and reimbursement down with our cost of goods, improvement across the industry, generic dispensing rates rising.

Prem Shah（执行副总裁兼集团总裁）

Justin，几点回应。首先，我想说的核心观点其实和前一个问题很类似。回顾过去十年，这个行业已经发生了很多事情，帮助我们压低成本、降低报销水平——无论是通过整个行业采购成本的优化，还是仿制药使用率的提升。

And all the other things that have happened. If you think about what we're doing with the PBMs, we are still going to be providing them very aggressive economics in terms of what we're able to deliver with our size, our scale and our operating efficiencies. So our desire is to continue to wake up every single day and drive down the cost of products for them so they can deliver that.

再加上其他一系列的行业变动。至于我们与PBM的合作，我们仍然会为他们提供极具竞争力的经济方案，依托的是我们的规模、体量和运营效率。我们的目标仍然是每天醒来都想着怎么继续降低他们的采购成本，让他们的服务也变得更有竞争力。

We're going to work with them very closely over the course of the next 2 quarters to drive this forward in terms of the model as we see fit. And those PBM negotiations will be structured in the way that I described, right? It will be a acquisition cost plus a markup plus a dispensing fee or patient management fee.

接下来两个季度，我们会密切与PBM合作，把这个新模型推进下去。关于这个模型的结构，如我之前所说，会是“采购成本 + 加成 + 调剂费（或患者管理费）”的方式。

Those things will be negotiated out over the course of the next few quarters, every PBM determining on what they provide, we'll continue for other services. And then if you think about the -- what Tom had mentioned in the remarks, right, our current base business is projecting minus 5% operating decline. That's what none of us, right? We're moving the way we want to move the model. And so we're going to continue to drive that transparency.

这些条款将在接下来的几个季度中进行谈判。每家PBM根据他们提供的服务情况来定，而我们也会在其他服务上继续保持合作。正如Tom之前在发言中提到的，我们目前的基础业务预计将出现-5%的运营下滑。我们没人愿意接受这样的现状，我们想改变现状，也正是在这样的背景下，我们想通过这个新模式来推动透明化。

I personally believe that PBMs and plan sponsors, I mean, I've been on both sides of this business, and David can comment as well. I believe it's time for change, right? Some of the things that have happened in the current pricing model for the last decade, it's antiquated. It leads to consumer friction that nobody wants in the supply chain. We're removing that. We're making this simpler. And this is a foundational step in leading the change from where we stand.

我个人非常相信PBM和医保计划方也想要这种改变。我自己在这个行业的上下游两边都干过，David也可以补充。我认为，是时候改变了。过去十年的定价模型已经过时了，它导致了消费者体验上的摩擦，而这正是我们希望消除的。我们想让流程更简洁，而这正是我们主导行业转型的基础性一步。

And so if we want to continue to do that, we want to bring this model forward. And we want to lead that change, and I firmly believe our PBM and plan sponsors will also want to drive the change in a transparent fashion. We're still there -- they're going to still hold us accountable. If our cost of goods is higher than someone else's, I suspect that we're going to have a different conversation.

如果我们想继续走这条路，我们就必须推动这个模型。我们愿意做这个领头羊，并且我坚信，PBM和医保计划的客户也会愿意以更透明的方式参与变革。当然，他们仍然会对我们提出要求。如果我们的采购成本比其他人高，我相信他们会和我们谈一谈。

Our goal is to continue to drive our cost of goods down. Our goal is to continue to have a competitive markup fee and a competitive dispensing fee. And our goal is to provide the great care we provide across this country at scale across the 9,500 stores and the 100 million-plus members who provide every single day to invest and make pharmacy better in this country. That's the goal.

我们的目标是持续降低采购成本，确保加成费和调剂费具有竞争力，同时，在全国9,500家门店、1亿多名客户中持续提供优质服务，在全美范围内推动药房服务的改进和提升。这就是我们的目标。

Karen Lynch Former Executive VP & President of the Aetna

And Justin, let me just comment on your question about will they take CVS out of their network. We serve 120 million customers today. And we're in every community in America. That would be significantly disruptive to a consumer and where people access care. I think CVS is rooted in the communities today, an essential part of where people get care. So I think people really recognize the value of what we bring in those communities.

Karen Lynch（前Aetna执行副总裁兼总裁）

Justin，我也想回应你关于PBM是否可能将CVS排除在网络之外的问题。我们目前服务着1.2亿客户，遍布全美每一个社区。如果把CVS从网络中剔除，对消费者来说将是极具破坏性的，会影响他们获取医疗服务的方式。我认为CVS如今已经深深扎根于社区，是人们获取医疗服务的重要一环。我相信大家非常清楚我们在社区中所带来的价值。

Lance Wilkes Sanford C. Bernstein & Co.

Lance Wilkes from Bernstein. Just had a question for Mike and Karen on value-based care. In particular, as you're growing that part of the business, what are the additional capabilities you're looking for? How do you prioritize other areas beyond MA like Medicaid and chronics within employer?

Lance Wilkes（Sanford C. Bernstein & Co.）

我是Bernstein的Lance Wilkes。我想请教Mike和Karen关于价值导向医疗（Value-Based Care）的问题。尤其是在你们不断扩展这一业务的过程中，你们还在寻找哪些新的能力？在MA（Medicare Advantage）以外的领域，比如Medicaid或雇主层面的慢病管理，你们如何设定优先级？

And then just understanding a little bit about -- as you look at the ramp-up in Oak Street, and you're talking about the J-curve, can you just comment a little bit about the addition of new payers as you work through a market and kind of what you normally start with as far as the number of payers and where you get to a near kind of 2 and 5? Thanks.

此外，关于Oak Street的扩展和你们提到的J曲线效应，请说明一下在进入一个市场时你们如何新增支付方？一般初期是与几家支付方合作，最终会扩展到类似2到5家的水平吗？谢谢。

Michael Pykosz Former President of Health Care Delivery & Executive VP

So on the capability front, I think one thing we're really excited about, I think we feel like we have all the core capabilities we need between what CVS had when we joined between what Kyle has brought both on the in-home side, but also on the ACO enablement side and then what Oak Street brought.

Michael Pykosz（前医疗服务总裁兼执行副总裁）

关于能力建设，我们非常兴奋的是，我们现在感觉已经拥有了所有核心能力。这包括CVS在我们加入前就具备的能力，Kyle带来的居家医疗和ACO赋能能力，以及Oak Street自身的能力。

And I think what's been great is it's almost like a puzzle piece. Some of the things that we didn't have at Oak Street that were on our road map to build signify brought to the table vice versa. So I think we have that core platform to build off of. And we think we'll be investing, I think, in the IT inside on the data side, we'll be investing in that. I think once we'll be internal, although we can look for capabilities if we need to.

值得一提的是，这些能力组合就像拼图一样互补。Oak Street以前计划自行开发的一些功能，现在由Signify提供了；反过来也是如此。所以我们已经拥有一个完整的核心平台可以持续建设。未来我们还会继续在IT和数据方面投入，虽然主要会是内部开发，但如有需要我们也会寻找外部能力。

And I think what you build when you have this platform, right, as you can know, we can now do things more strategically from an acquisition standpoint. We don't have to, we can opportunistically, whether that be specialty assets or other assets down the line. But I think we don't have anything we have to fill in a gap of our current offering.

拥有这样的平台后，我们在并购方面也能采取更具战略性的行动。不必急于补齐短板，而是可以有选择地抓住机会型资产，比如专业医疗领域的并购等。但总体而言，我们当前的产品组合已经比较完整，不存在能力缺口。

And then certainly on Oak Street question, we go-to-market multiplayer. And most of our payers, most of the national payers, we have kind of national contracts with and so when we go to market, we generally have all the national payers in that market. Some nuances in there. And then if there's a high share of local blue or a local player, we'll get them. So we generally are opening up a multiplayer today.

至于Oak Street的问题，我们采用的是多支付方模式。在大多数市场中，我们与大多数国家级支付方都有全国性合约，因此一进入市场，就通常能涵盖主要的全国性支付方。当然也有些细节上的差异，比如如果某地有占比高的Blue Cross本地计划，我们也会接入它。所以目前我们在多数市场都是以多支付方形式开展的。

Karen Lynch Former Executive VP & President of the Aetna

And Lance, if you recall, we said with the capabilities that we needed to kind of drive the acceleration of growth, we wanted to be in primary care. We want to be in the home. We want to have provider enablement capabilities. We have that basic platform today, where now you saw the effects of the economic flywheel where we really need to continue to grow and execute on that strategy. And also, as you think about this payer platform, it's multipayer. So it's not just Aetna. We have the opportunity to kind of accelerate the platform growth through our multipayer capabilities.

Karen Lynch（前Aetna执行副总裁兼总裁）

Lance，你可能还记得我们曾说过，为了加速增长，我们需要具备几项关键能力：进入初级医疗、进入家庭、以及提供医生赋能的能力。我们现在已经建立了这样的基础平台，也开始看到“经济飞轮效应”的体现，因此接下来的关键是持续增长和坚定执行这一战略。同时，这个平台本身是面向多个支付方的，并不仅限于Aetna。我们也可以利用多支付方能力来加速平台的扩展和增长。

Elizabeth Anderson Evercore ISI Institutional Equities

Elizabeth Anderson from Evercore. Maybe just to talk a little bit more about that, the new pharmacy reimbursement model. How does that impact the sort of long-term size of the store base that you need? I mean you have obviously additional services and that links into I just wanted to understand better that longer-term vision for what the right size of that?

Elizabeth Anderson（Evercore ISI机构股票部）

我是Evercore的Elizabeth Anderson。我想更深入了解一下你们新的药房报销模型。这种模型会如何影响你们未来长期所需门店数量的规模？你们显然在提供更多附加服务，这跟门店网络也有关联。我想更好地理解你们对未来理想门店数量的整体规划愿景。

Prem Shah Executive VP & Group President

Yes. If you look at the overall number of pharmacies in the entire country, it's actually down over the course of the last 5 years. I think it peaked at 65,000. It's now down with some of the closures that have happened. We want to serve our communities in an appropriate manner where it makes sense across the country, and we want to make sure there's local convenient pharmacy access where there's not pharmacy deserts.

Prem Shah（执行副总裁兼集团总裁）

当然。如果你看看美国全国范围内药房的总数，其实在过去五年中是下降的。我记得高峰时大约有65,000家药房，现在因为一些关闭而有所减少。我们希望以合理的方式服务我们的社区，确保全国范围内都能方便地获得药房服务，避免出现“药房荒漠”的问题。

That being said, where there's oversupply or other issues. I think the marketplace is already working itself out as it relates to that. But our goal is to continue to be in those markets to continue to provide it.

话虽如此，在某些供给过剩的地区或存在其他问题的地方，我认为市场机制正在自然调整。但我们的目标是在有需求的市场持续提供服务。

I think the other piece that's a real issue is that the amount of capacity of pharmacists that exists in the marketplace is also declining over the course of the next 4 years just based on college enrollments. And so I think some of that stuff will play out on its own.

另一个必须关注的现实问题是：未来四年，药剂师供给也在下降——从药学院的招生趋势就可以看出来。所以这部分资源本身也会自然收缩。

As it relates to where we want to be, we want to be in the communities where people need pharmacy services and that we can continue to deliver our pharmacy services locally. We firmly believe that, that's based on a certain methodology that we have based on MSAs and based on the way we deliver those results. But it's an essential component of healthcare.

我们希望继续扎根于那些真正需要药房服务的社区，继续在本地提供服务。我们对此有一套完整的方法论，是基于统计区域（MSA）和实际服务成果来评估的。药房是医疗服务的重要组成部分。

And I think that we're going to reach a point where you can't narrow that number of pharmacies in aggregate down anymore because at the end of the day, people need to get serviced for their pharmacy needs. And then it needs to happen in local community centering whether that's CVS, Walgreens are an independent or someone else, those types of services are going to be essential as it relates to that.

我认为我们终将达到一个平衡点，药房的总数也不能再大幅减少了——因为最终，人们必须获得药物服务。而这种服务必须在社区中心完成，无论是由CVS、Walgreens，还是独立药房提供，这类服务都将是不可或缺的。

Tom Cowhey Executive VP & CFO

Lisa, I was just going to say that one thing I just want investors to be mindful of is that we have talked about a program that we had to close 900 stores. We're 2/3 of the way through that program. We expect to close another 300 stores next year. And the results that we've seen to date have been phenomenal, just strong execution from our teams.

Tom Cowhey（执行副总裁兼首席财务官）

Lisa，我还想补充一点，希望投资人也关注我们正在推进的900家门店关闭计划。我们目前已完成了三分之二，明年还将关闭大约300家门店。截至目前，该计划执行得非常成功，我们团队表现出色。

We've retained more scripts than we originally projected. We've retained more of the front store volume than we originally projected. And importantly, in this environment, in this market, we've retained over 90% of the employees by offering them opportunities at other local stores, which is a number that we're really proud of.

我们保留的处方量超出最初预期，前端零售业务的销售也保留得比我们预计的更多。更重要的是，在当前这种市场环境下，我们通过为员工提供在其他门店工作的机会，保留了90%以上的员工，这一点我们非常自豪。

We're constantly evaluating what our footprint needs to look like, but we have one more year of our announced program that we are expecting to execute on at this stage.

我们会持续评估门店布局该是什么样子，但就目前而言，我们还会继续推进这个已经公布的一年期计划。

George Hill Deutsche Bank AG

George Hill from Deutsche Bank. I'm going to take the other side of the cost advantage question, which I think of as the true cost question. I guess, first, could you talk about whether or not this is a product that you have to sell into clients or you can just push through?

George Hill（德意志银行）

我是德意志银行的George Hill。我想从成本优势问题的另一个角度来提问，也就是“真实成本（true cost）”的问题。首先，这个产品是你们需要主动推销给客户，还是可以直接执行推动？

And it sounds like you want to push cost vantage onto your non-CVS pharmacy partners with how you discussed what reimbursement would look like under true cost, I guess, could you talk about whether or not you've had any conversations with respect to people's receptivity for that? And my last question would just be if you guys would provide any expectation on the impact of Cordavis in '24?

听上去你们希望将“成本优势”的定价模型推广到非CVS的药房合作伙伴上，就像你们所说的按真实成本报销。那你们有没有和这些合作方沟通过他们对此的接受度？最后一个问题是，你们能否提供一下对Cordavis在2024年所带来影响的预期？

David Joyner

I'll take the true cost question. So yes, we do have to package and sell the true cost offering to our customers as a client choice. We believe that they are equally as frustrated with the pricing variations and volatility. So they're asking us, quite frankly, to solve this problem for them. When I rejoined the organization in March, we had a client advisory meeting, and we laid out what their single biggest frustrations were given all of the noise and activity from their employee populations.

David Joyner

关于“真实成本”的问题由我来回答。是的，我们确实需要将这个“真实成本”定价方案作为客户的一个选项进行打包销售。我们认为，客户对当前的定价波动和不一致感到非常沮丧，坦率地说，他们正在要求我们帮他们解决这个问题。

And this is 1 of the top issues on their list is the fact that in the cash marketplace potentially is priced differently than the funded, how do you reset and/or focus on delivering more transparency to their membership, beyond the transparency that we're giving to our customers today and ultimately get to a place that is a more predictable, reliable price for the medication.

我在3月份重新加入公司时，我们举行了一次客户顾问会议，明确列出了他们最困扰的问题之一。其中一个最关键的问题就是，现金市场上的价格与医保覆盖下的价格可能存在差异，他们希望我们如何重设这个机制，并为他们的成员提供比现在更高程度的透明度，最终实现药品价格的可预测性和可靠性。

So we believe that the market is ready for something along these lines, and you've seen it within our other peer group, trying to do essentially the same thing, recognizing that there is, what I believe, an inflection point of where we are with the current pricing. As it relates to now how we take that same model and contract with other pharmacies, yes, there is one benchmark and one solution that CVS Retail is offering.

我们认为市场已准备好迎接这样的改革。你也能看到我们的同行也在尝试做类似的事情，因为大家都意识到当前的定价机制已处在一个拐点。至于如何将这一模型应用到与其他药房的合约上，是的，CVS零售提供的是一个统一的基准方案。但我们预计在与每一家药房的谈判中，最终会出现多种策略，因为它们可能不会愿意共享自己的采购成本。

And will end up probably with multiple different strategies within each one of the pharmacies that we're negotiating with as they're probably unlikely to want to share their acquisition costs, the most important thing is to reset the pricing that we have today and get to a place that, again, others are going to be able to benchmark and compete.

最重要的是，我们必须重设当下的定价机制，并实现一个可以被其他人参考和参与竞争的价格体系。

So if we accomplish that goal both with how we contract with the network, and ultimately, how we recontract with our customers to serve the members. We believe it will be a much better experience. And we'll begin, again, the same example what the PBM does is lowers cost and improved service. So the goal is going to continue to drive down the cost and get the improvements of the acquisition, improvements across the supply chain.

如果我们能在与网络药房的合同和最终为客户服务的合同上实现这个目标，我们相信将带来更好的体验。这就像PBM的本质使命一样——降低成本、提升服务。因此，我们的目标仍然是持续压低成本，并通过采购和整个供应链环节的优化来实现改善。

Tom Cowhey Executive VP & CFO

With respect to your Cordavis question, as I noted in the presentation, there is a contribution from Cordavis, and it's included in the Health Services segment projections for next year.

Tom Cowhey（执行副总裁兼首席财务官）

关于你提到的Cordavis问题，正如我在演示中指出的，Cordavis会对我们明年的业绩产生贡献，这部分已包含在健康服务（Health Services）板块的业绩预测中。

Karen Lynch Former Executive VP & President of the Aetna

And George, let me just take it up at a higher level. If you think about what's going on in the industry and you think about the intense scrutiny of pharmacy costs in America, we're doing our part to change the pricing model to lower the cost of pharmacy to drive transparency, to meet the needs of our consumer because everything starts and ends with the consumer. So if the consumer have lower drug prices, we can engage with them at the pharmacy with a broad set of assets. And that's what we're really trying to do.

Karen Lynch（前Aetna执行副总裁兼总裁）

George，我想从更高的层面回应你的问题。你看看现在整个行业的动态，以及美国社会对药品费用的高度关注，我们正在履行自己的责任，推动定价模式的变革，以降低药品成本，增强透明度，满足消费者的需求——因为一切从消费者出发，也最终回归到消费者身上。如果药品价格更低，我们就能通过药房的多元资产与他们建立更深入的联系，这正是我们正在努力实现的。

At the highest level, this is an important consumer change to lower the overall cost of drugs. And I think it meets what consumers are demanding, it meets what the regulatory environment and the scrutiny that we're under. And as Prem said in his prepared remarks, we're a leader in this industry, and we have to chart a new path.

从战略高度来看，这是一项面向消费者的重要变革，目的是降低整体药品成本。我认为这符合消费者的期望，也回应了当前监管环境和外部压力的要求。正如Prem在准备稿中所说，我们是行业领导者，必须开辟一条新路径。

Kevin Caliendo UBS Investment Bank

I'm Kevin Caliendo with UBS. So I guess what I'm trying to understand is, what does this mean for Red Oak and what you expect it means for generic pricing? Is there any change to how this model might affect Red Oak going forward? Is it as important to you in this model? And what does it sort of mean for your distribution partners as well, given these changes?

Kevin Caliendo（瑞银投资银行）

我是瑞银的Kevin Caliendo。我想了解的是，这一新模式对Red Oak意味着什么？对仿制药定价有何影响？Red Oak在这个新模式中是否仍然扮演重要角色？此外，考虑到这些变化，对你们的分销合作伙伴又会带来哪些影响？

Prem Shah Executive VP & Group President

So Red Oak wakes up every single day to lower the cost of generic drugs. There's no change in the mission of Red Oak and what they do every single day in the supply chain. And our PBM and payer customers have benefited from the great collaboration and great work that Red Oak has done over the course of the last decade, and it will benefit from it as it goes forward.

Prem Shah（执行副总裁兼集团总裁）

Red Oak每天的使命就是降低仿制药的成本。这项使命没有任何变化，他们在供应链中每天的工作仍然聚焦于此。我们的PBM以及支付方客户，在过去十年里都从Red Oak的出色合作和努力中获益良多，未来也将继续受益。

Erin Wilson Wright Morgan Stanley

It probably looks like I'm sitting, but I'm standing, Erin Wright, Morgan Stanley. Can you talk a little bit about the disciplined capital deployment strategy from here? Is it all dedicated to share buyback at this point? Or do you see opportunities from an M&A perspective?

Erin Wilson Wright（摩根士丹利）

虽然我看起来像在坐着，但其实我站着——我是摩根士丹利的Erin Wright。请谈谈你们接下来资本部署的策略。现在是否全部优先用于股票回购？还是你们在并购方面仍看到机会？

And then last one was just on a clarification, Tom, you gave that chart that gives you to 2028 mix. There's still a drag from retail pharmacy. I think there's also corporate in there, but is -- I just want to clarify how much of that is corporate versus retail pharmacy?

还有一个澄清性的问题，Tom，你在演示中展示了直到2028年的业务结构图，其中显示零售药房仍有拖累。我知道其中可能也包含一些总部层面的开支，但我想确认一下，这部分到底有多少是企业总部的拖累，多少来自零售药房？

Tom Cowhey Executive VP & CFO

Sure. So your first question on capital deployment. In the short term, we're focused on repurchases and organic initiatives, right? So as you think about what the 2024 guidance implies very specifically said, as we look at what we're doing for next year, we have annualization of interest expense, we're going to offset that with repurchasing shares. And so we expect that we'll be in the market repurchasing shares in 2024, probably to the tune $3.5 billion to $4 billion.

Tom Cowhey（执行副总裁兼首席财务官）

当然。关于你第一个问题——资本配置。在短期内，我们的重点是股票回购和有机增长项目。具体来说，如2024年指引中所示，我们预计将在利息费用年化的背景下，通过回购股份进行对冲。因此，2024年我们预计将在市场上回购约35亿到40亿美元的股票。

As you look further out, there is going to be more capital availability. The business, if we grow on the trajectory that we've outlined, we'll delever rapidly, that will create additional opportunity to lean in further than the 2% to invest in other initiatives to invest in accretive M&A. There's a variety of different things. And what we've built into long-term guide at this point is that 2% deployment, which means that naturally the model, if you run it out over a couple of years, is going to deploy and create additional capacity beyond the $40 billion to $50 billion that I put on there for the next couple of years.

从更长期来看，未来我们的资本可用性将会更强。如果我们的业务如我们所描绘的路径那样持续增长，公司的杠杆将迅速降低，从而为超过2%的再投资创造更多机会，无论是用于增长型项目，还是用于具增值效应的并购。我们在长期指引中内置的假设是2%的资本投放，这意味着如果将模型延展到几年后，除了我之前提到的未来几年可用的400亿至500亿美元资金外，还会自然释放出更多空间。

As you think about the longer-term algorithm, what's embedded in there is our traditional corporate business growing at a mid-single-digit rate, and then you've got the drag from the pharmacy and consumer wellness business being again at that 5% rate. So there is nothing baked into that long-term algorithm that rising of the floor that is contingent upon the success of the new model.

至于长期增长算法，我们预设的是传统企业业务保持中单位数的增长，而药房和消费者健康板块仍存在约5%的负增长拖累。当前的长期模型中尚未计入新模式成功带来“回升底部”的影响。

Charles Rhyee TD Cowen

Charles Rhyee with TD Cowen. Maybe a question for Prem. When we think about the starting point of down 5% operating profit growth, where does the front-end fit into this? I know we spent a lot of time talking about the pharmacy and maybe obviously, the changing retail environment. Maybe you can talk a little bit of how you're factoring that into sort of the outlook? And is it the idea that cost advantage, the benefits of that will offset a continued pressure on the front end and just how you're thinking about front end in general?

Charles Rhyee（TD Cowen）

我是TD Cowen的Charles Rhyee。我有个问题想问Prem：当我们以当前运营利润下滑5%的基点为出发点时，门店的前端业务在这个模型中的角色是什么？我们大部分时间都在谈药房和零售环境的变化。你能否谈谈你们是如何把前端业务纳入整体预期的？你们是否认为“成本优势”计划带来的好处能抵消前端持续承压的趋势？另外，你对前端业务的整体看法是什么？

Prem Shah Executive VP & Group President

Yes, I'll start, and Tom, you can comment. Look, our biggest challenge, as I laid out on that slide as it relates to our retail business has been the pharmacy reimbursement pressures that we face, right? So we continue to have a very vibrant and strong front store business that we focused on, and we continue to transform to a health and wellness destination that we're using.

Prem Shah（执行副总裁兼集团总裁）

我先来回答，Tom可以补充。从我们零售业务的角度来看，我们面临的最大挑战就是药房报销方面的压力，这是我在幻灯片中强调的重点。

It continues to perform as expected and in line with where we stand. So from my perspective, what we're doing is solving the single biggest issue we've had in terms of our pharmacy and consumer wellness segment, which is a reimbursement pressure piece.

不过，我们的前端门店业务依然非常有活力，我们也一直在将门店转型为“健康与保健目的地”，这个方向发展稳定、符合预期。所以在我看来，我们当前的战略重点是解决我们在药房和消费者健康板块上最大的痛点——即报销压力。

We're going to continue to have it. For example, this year, we won the [indiscernible] of the year. I'm not sure if you guys saw that. We have things like that, that happen as well. So we have a great team and a talented team that drives. Tom you can comment a little.

这种压力短期内还会持续。例如，我们今年获得了某个年度奖项（可能听不清具体名称），这些成就也说明我们拥有一支强大而有才干的团队在推动业务发展。Tom，你可以再补充一些细节。

Tom Cowhey Executive VP & CFO

The front of the store, we actually think margins are going to improve next year. As you look at some of the efforts that team has done, it's been exceptional. As they look at what are the right SKUs, what are the SKUs that we really want in those categories? How should we think about health and beauty, how should we think about our own CVS branded products, which performed very well at a discounted price and have great margins.

Tom Cowhey（执行副总裁兼首席财务官）

关于门店前端业务，我们实际上预计明年的利润率会有所提升。我们的团队在这一方面做得非常出色，比如他们持续优化SKU组合，挑选各品类中最具价值的产品；他们也重新审视了健康与美妆品类、以及我们自有品牌CVS产品的定位。我们的自有品牌不仅价格具有竞争力，而且毛利也非常好。

We actually think that there continues to be a lot of opportunity there. And so we feel good about the prospects for that business.

我们认为，这一部分业务仍有大量机会可挖掘，因此我们对它的前景感到乐观。

Larry McGrath Executive VP, Chief Strategy Officer & Chief Strategic Advisor to the CEO

Okay. We're going to take the last question. But before that, just one quick clarification. As it relates to our individual exchange business, our targets for the long term, we target a high single-digit top line growth and mid-single-digit margins. I heard that, that created some confusion. So I just wanted to clarify that. The last question go to Jess.

Larry McGrath（执行副总裁、首席战略官兼CEO战略顾问）

好的，我们马上进行今天的最后一个提问。但在那之前我想做一个简短的澄清，关于我们的个人医保交易所（individual exchange）业务，我们的长期目标是实现高单位数的收入增长率，以及中单位数的利润率。我们听说之前这部分信息可能有些混淆，所以特此明确一下。最后一个问题交给Jess。

Jessica Tassan Piper Sandler & Co.

I'm Jess Tassan from Piper Sandler. This is maybe for Kyle and Mike, can you discuss the assets that comprise CVS Accountable Care, is this the former signified Caravan Health business? And if not, can you just describe the assets in terms of maybe program participation, geographic density and how they're supporting providers in the community.

Jessica Tassan（Piper Sandler & Co.）

我是Piper Sandler的Jessica Tassan。我这个问题可能更适合Kyle和Mike回答。你们能否介绍一下CVS Accountable Care的资产组成？它是否是原来的Caravan Health（由Signify带来的）业务？如果不是的话，你们能否描述一下这些资产在项目参与度、地理覆盖密度以及如何支持社区提供者等方面的情况？

And then I guess just to follow-up on Lance's question, should we conclude that the Signify acquisition has checked the box on MSO capabilities?

另外，延续Lance的问题，我们是否可以理解为你们通过收购Signify，已经完整具备了MSO（医疗服务组织）方面的能力？

Kyle Armbrester

Sure. Yes. So there were 2 main assets that compromise what we now call CVS Accountable Care. First, CVS before Signify had very successfully built out one of the largest scale performance ACO reach businesses. And so they did that with their novel technology stack and internal teams that was a fully CVS build initiative.

Kyle Armbrester

当然可以。CVS Accountable Care由两大核心资产组成。首先，在收购Signify之前，CVS已经自主成功打造了业内规模领先的ACO Reach（责任医疗组织扩大覆盖）业务，依靠的是我们自主开发的技术平台和内部团队——这是完全由CVS自建的体系。

And then Caravan came via Signify, we merged those 2 things together, and that's the 1 million total lives. When you think about coverage, we're in rural health centers. So FQHCs, critical access hospitals, PPS hospitals all the way up to multistate academic medical centers. We've closed since the acquisition, 8 multistate health systems. So there's been continued traction there. There's been good top line growth just with the sales pipeline in that business as well. It's across 40-plus states, so it's across the country essentially. And it's, again, showing positive shared savings rates and it's been a really big success story of bringing the businesses together.

然后是通过收购Signify带来的Caravan Health业务。我们将这两个部分合并在一起，目前已覆盖了100万人口从覆盖范围来看，我们服务的对象包括乡村健康中心（FQHCs）、关键准入医院（critical access hospitals）、按前期付款系统运营的医院（PPS hospitals），乃至多州的学术医疗系统。自并购以来，我们已合作了8个多州医疗系统，该业务持续取得进展，销售管道也带动了可观的收入增长。目前我们的业务已遍及40多个州，几乎覆盖了全美。更重要的是，我们的业务也实现了正向共享节省率（shared savings），整合后的业务发展非常成功。

Karen Lynch Former Executive VP & President of the Aetna

I want to take this opportunity to thank all of our colleagues who wake up every single day to transform healthcare and put our consumers at the heart of everything that we do. Healthcare is a serious business, and we are serious of our ability to transform healthcare, and we are serious about our ability to achieve our financial objectives and provide our shareholders the returns they deserve.

Karen Lynch（前Aetna执行副总裁兼总裁）

我想借这个机会感谢所有每天努力工作的同事们，是你们让医疗保健持续变革，把消费者真正置于我们工作的核心。医疗是一项严肃的事业，而我们也同样严肃看待自己在医疗转型中的使命，我们也坚定地致力于实现财务目标，为股东创造应有的回报。

So I really appreciate all of your time today and your questions today and on behalf of the entire management team, I wish you and all your families a healthy and happy holiday season. Thank you.

非常感谢大家今天的时间和问题，谨代表整个管理团队，祝愿大家和家人度过一个健康而愉快的节日季。谢谢。

2023-12-05 CVS Health.Investor Day

2023-12-05 CVS Health.Investor Day

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