2025-01-16 UnitedHealth Group Incorporated (UNH) Q4 2024 Earnings Call Transcript
Call Start: 08:45 January 1, 0000 9:50 AM ET
UnitedHealth Group Incorporated (NYSE:UNH)
Q4 2024 Earnings Conference Call
January 16, 2025, 08:45 AM ET
Company Participants
Andrew Witty - Chief Executive Officer
John Rex - Chief Financial Officer
Amar Desai - Chief Executive Officer, Optum Health
Tim Noel - Chief Executive Officer, UnitedHealthcare Medicare & Retirement
Bobby Hunter - President, Medicare
Sandeep Dadlani - Chief Technology Officer
Conference Call Participants
A.J. Rice - UBS
Josh Raskin - Nephron
Lisa Gill - JPMorgan
Stephen Baxter - Wells Fargo
Justin Lake - Wolfe Research
Lance Wilkes - Bernstein
David Windley - Jefferies
Scott Fidel - Stephens
Sarah James - Cantor Fitzgerald
Joanna Gajuk - Bank of America
Operator
主持人
Good morning, and welcome to UnitedHealth Group Fourth Quarter and Full Year 2024 Earnings Conference Call. A question-and-answer session will follow UnitedHealth Group's prepared remarks. As a reminder, this call is being recorded.
早上好，欢迎参加联合健康集团2024年第四季度及全年收益电话会议。联合健康集团将在预先准备的发言后进行问答环节。请注意，本次电话会议正在录音。
Here are some important introductory information. This call contains forward-looking statements under U.S. federal securities laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the reports that we file with the Securities and Exchange Commission, including the cautionary statements included in our current and periodic filings.
以下是一些重要的介绍信息。本次电话会议包含根据美国联邦证券法的前瞻性声明。这些声明存在风险和不确定性，可能导致实际结果与历史经验或当前预期存在重大差异。有关部分风险和不确定性的说明，请参阅我们向美国证券交易委员会提交的报告，其中包括我们当前和定期文件中的警示性声明。
This call will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amount is available on the financial and earnings reports section of the company's investor relations page at www.unitedhealthgroupcom. Information presented on this call is contained in the earnings release we issued this morning and in our form 8-K dated January 16, 2025, which may be accessed from the Investor Relations page of the company's website.
本次电话会议还将引用非GAAP数据。非GAAP与GAAP数据的调节表可在公司投资者关系页面的财务及收益报告部分（www.unitedhealthgroup.com）查阅。本次电话会议中提供的信息载于我们今天早上发布的收益公告以及2025年1月16日的8-K表格，这些文件可从公司网站的投资者关系页面获取。
I will now turn the conference over to the Chief Executive Officer of UnitedHealth Group, Andrew Witty.
现在，我将会议交由联合健康集团首席执行官Andrew Witty继续。
Andrew Witty
Jennifer, thank you very much, and good morning, everyone.
Jennifer，非常感谢你，大家早上好。
I'd like to start by expressing a sincere thank you from my colleagues and from me for the overwhelming expressions of condolence and support following the murder of our friend, Brian Thompson. Many of you knew Brian personally. You knew how much he meant to all of us and how he devoted his time to helping make the health system work better for all of the people we're privileged to serve. He would dive in with passion and caring to find solutions to improve experiences, whether for an individual consumer, an employer or a public health agency.
我想首先代表我的同事和我本人，对我们朋友Brian Thompson被谋杀后收到的压倒性慰问和支持表示由衷的感谢。你们中许多人曾与Brian有过私人交往，知道他对我们每个人意味着什么，以及他如何全心全意地投入时间，帮助改善我们有幸服务的所有人的医疗系统。他总是充满热情和关怀地深入寻找解决方案，以改善无论是个人消费者、雇主还是公共卫生机构的体验。
Right now, there are 400,000 nurses, doctors, case workers, customer service specialists, pharmacists, technologists and so many others in this organization, who share that commitment and are determined to advance that work. The task in front of us, all of us, healthcare providers, payers, employers, drug companies and policymakers is to continue improving quality and health outcomes for individuals and their families, while lowering costs for everyone.
目前，这个组织中有40万名护士、医生、个案工作者、客户服务专家、药剂师、技术专家以及众多其他人员，他们共同秉持这一承诺，并决心推进这项工作。摆在我们所有人面前的任务——无论是医疗服务提供者、付款方、雇主、制药公司还是政策制定者——都是在降低成本的同时，不断改善个人及其家庭的质量和健康结果。
We need to build on the unique foundational strengths of healthcare in America and address the areas we can make work better. Among those strengths, world-leading innovation, the U.S. has developed the most advanced clinical approaches and patient-centric care at a pace not seen anywhere else. It's why, if provided with the option, people from all over the world come here to seek care for the most complex conditions. Yet, the health system needs to function better.
我们需要依托美国医疗体系独有的基础优势，并着力改善那些可以做得更好的领域。在这些优势中，包括世界领先的创新能力，美国已以无与伦比的速度发展出最先进的临床方法和以患者为中心的护理模式。这也是为什么，如果有选择的话，来自世界各地的人们会来到这里寻求针对最复杂病症的治疗。然而，医疗系统仍需更高效地运作。
Through decades of federal and state policy making and private sector innovation, we have a variety of program structures and processes. There are strong merits to that variety as they can be more tailored to meet the specific needs of individuals at various stages of life and health status and provide extra help for those who need it. It avoids a one-size-fits-all approach, but it needs to be less confusing, less complex and less costly.
经过几十年的联邦和州政策制定以及私营部门的创新，我们形成了多种多样的项目结构和流程。这种多样性具有很大的优点，因为它们可以更好地针对各个生活阶段和健康状况个体的具体需求进行定制，并为有需要的人提供额外帮助。虽然这避免了一刀切的方法，但同时也需要使其变得更简明、减少复杂性并降低成本。
America faces the same fundamental healthcare dynamic as the rest of the world. The resources available to pay for healthcare are limited, while demand for healthcare is unlimited. Every society wrestles with that issue and approaches it in various ways. We have incredible opportunities here to improve system performance both from a care and a cost perspective, while building upon the foundational strengths I just mentioned.
美国所面临的基本医疗动态与世界其他国家相同：用于支付医疗费用的资源是有限的，而对医疗的需求却是无限的。每个社会都在为这个问题而苦苦挣扎，并以各种方式应对。我们在这里拥有令人难以置信的机会，可以从医疗质量和成本两个角度改善系统性能，同时依托我刚才提到的基础优势加以提升。
逆转“作死”所需要的能量趋向于无穷，根本上是没有解决方案的。
The mission of this company, why we exist, is to improve this system for everybody and help people live healthier lives. That means getting more people into high-quality value-based care and keeping them healthy in the first place, so fewer Americans find themselves with a chronic and, in many cases, preventable disease.
这家公司的使命、我们的存在理由，就是为每个人改善这一系统，并帮助人们过上更健康的生活。这意味着让更多人接受高质量、价值导向的护理，并首先保持他们的健康，从而减少美国人罹患慢性病（在许多情况下是可以预防的疾病）的比例。
It means continuing to invest in programs like Medicare Advantage, which by providing coordinated care to seniors is proven to deliver better health outcomes at lower cost to consumers and taxpayers compared to fee-for-service Medicare. Seniors recognize that value, which is why the majority of them choose Medicare Advantage.
这还意味着继续投资于诸如Medicare Advantage之类的项目，该项目通过为老年人提供协调一致的护理，已被证明能以较低的成本为消费者和纳税人提供比按服务计费的Medicare更好的健康结果。老年人认识到这种价值，这也是大多数人选择Medicare Advantage的原因。
It means making healthcare easier to navigate. We're enhancing digital tools for consumers, harnessing data and using AI so they can find the best value care option and decide what is best for themselves and their families. People's health interaction should be as intuitive and seamless as every other aspect of their lives: banking, shopping, streaming. This past year, we saw an extraordinary increase in the use of these modern channels. We know there is still a large gap there, and we intend to keep at it until it is closed.
这意味着让医疗服务变得更易于使用。我们正在为消费者升级数字工具，利用数据并应用人工智能，使他们能够找到最具性价比的护理方案，并决定对自己及家庭最有利的选择。人们与健康服务的互动应当像他们生活中的其他方面——如银行、购物、视频流媒体——一样直观和无缝。过去一年，我们看到这些现代渠道的使用显著增加。我们知道这一领域仍存在巨大差距，并计划持续努力直至弥补这一缺口。
It means making coverage and cost easier to understand. Just one example where we already have advanced plans, we're eager to work with policy leaders to use standardization and technology to speed up turnaround times for approval of procedures and services for Medicare Advantage patients and to materially reduce the overall number of prior authorizations used for certain MA services. Some of this work we can do on our own, and we're doing it, but we're encouraged also by industry and policymaker interest in solving for this particular friction across the whole system.
这意味着让保险覆盖范围和费用变得更易理解。举个例子，我们已经拥有先进的计划，并热切希望与政策领导者合作，利用标准化和技术加快Medicare Advantage患者的程序和服务审批速度，同时大幅减少某些MA服务所需的预先授权数量。这部分工作我们可以独自完成，而且正在进行中，但同时也得到了业界和政策制定者对解决整个系统中这一摩擦问题的兴趣和支持。
Ultimately, improving healthcare means addressing the root cause of healthcare costs. Fundamentally, healthcare costs more in the U.S., because the price of a single procedure, visit or prescription is higher here than it is in other countries. The core fact is that price, more than utilization, drives system costs higher. Tackling that problem will require all parts of the system and policymakers to come together. Yet, there are participants in the system who benefit from these high prices, lower-cost equivalent quality sites of service, for example, can be good for consumers and patients, but threaten revenue streams for organizations that depend on charging more for care.
归根结底，改善医疗服务意味着要解决医疗费用的根本原因。基本上，美国的医疗成本较高，因为单次手术、就诊或处方的价格比其他国家要高。核心事实是，价格而非使用率，是推高系统成本的主要因素。要解决这一问题，需要系统各个部分和政策制定者通力合作。然而，系统中也存在从高价中受益的一方，例如，低成本但质量相当的服务场所虽然对消费者和患者有利，但却威胁到那些依赖高收费获取收入的机构的收益来源。
Another example is the persistently high cost of drugs in the U.S., leaving American consumers, employers and public agencies to pay disproportionately more than people in other countries. Just look at GLP-1 prices. One drug, which costs $900 in the U.S., costs about a tenth of that in Europe. Pharmacy benefit managers play a vital role in holding those prices down, which is why drug companies and their allies have spent the past several years attacking them. Optum Rx alone delivers many tens of billions of dollars in savings annually versus the pricing set by the manufacturers, including on the GLP-1s. That sharply reduces the gap versus other countries, but even then prices in the U.S. are still multiples of what the rest of the world pays for the same drugs.
另一个例子是美国药品价格持续高企，导致美国消费者、雇主和公共机构支付的费用远高于其他国家的人们。以GLP-1药物的价格为例，在美国一款药物售价为900美元，而在欧洲大约只有其十分之一。药房福利管理者在压低这些价格方面发挥着至关重要的作用，这也是为什么过去几年制药公司及其盟友一直在攻击他们的原因。仅Optum Rx每年就能为客户节省数百亿美元，相较于制造商设定的价格（包括GLP-1药物），这一措施大大缩小了与其他国家之间的差距，但即便如此，美国的药品价格仍然是其他国家相同药品价格的数倍。
Last year, our PBM passed through more than 98% of the rebate discounts we negotiated with drug companies to our clients. While we offer customers 100% pass-through options, a small number have historically elected other models. We're committed to fully phasing out those remaining arrangements so that 100% of rebates will go to customers by 2028 at the latest.
去年，我们的PBM将与制药公司谈判的折扣返还给客户的比例超过98%。虽然我们为客户提供100%返还的选项，但历史上仍有少数客户选择了其他模式。我们承诺在最迟2028年前，完全淘汰这些剩余的安排，使100%的折扣返还给客户。
We will continue to encourage all of our clients to fully pass these savings directly to patients at the point of sale, as we already do for all of the people we serve in our fully insured employer offerings. This will help make more transparent who is really responsible for drug pricing in this country, the drug companies themselves.
我们将继续鼓励所有客户在销售时将这些节省的费用直接返还给患者，就像我们在为所有全险雇主客户提供服务时所做的一样。这将有助于使谁才是真正导致该国药品定价居高不下的责任方——即制药公司本身——更加透明。
Healthcare in every country is complex and the solutions are not simple, but you should expect this company to continue to work at it, finding what is needed, developing solutions, bringing those solutions to scale, making a positive impact on the lives of millions of people.
每个国家的医疗体系都十分复杂，解决方案也并非简单，但你们应当期望这家公司会继续努力，发现所需，开发解决方案，将这些方案规模化，并对数以百万计的人的生活产生积极影响。
We deliver on our commitments to the people we serve, including our investors. Even in highly challenging periods like 2024, our results bear out that we find a way, even if it's not always how we may have initially envisioned the path. Among some of the formidable challenges we navigated over the course of the year were the first year of the three-year CMS Medicare rate cuts, the effects of the state-driven Medicaid member redeterminations, and the Change Healthcare cyberattack.
我们兑现了对所服务人群（包括我们的投资者）的承诺。即便在2024这样极具挑战的时期，我们的业绩也证明了我们总能找到出路，哪怕这条路并不总是我们最初设想的那样。在今年我们应对的一些重大挑战中，包括三年期CMS Medicare降价的第一年、州主导的Medicaid会员资格重新确定的影响以及Change Healthcare的网络攻击。
Our people found a way to deliver solidly within the range we first offered back in November of 2023, all while improving patient and consumer health outcomes and experiences, focusing on quality and expanding upon our potential to help make the health system work better for everyone.
我们的团队设法在2023年11月首次提出的目标范围内实现了稳定的业绩，同时改善了患者和消费者的健康结果和体验，专注于质量，并不断扩展我们帮助改善整个医疗系统运作的潜力。
We're invigorated by the path ahead. There are so many areas that can be enhanced, reworked, reengineered or even scrapped to make the health system work better as we know it needs to. That is both our responsibility and it's our passion. We begin 2025 with a strong outlook for the year as we continue to deliver on our commitments and excel for those we serve in all of our key growth pillars.
我们对前方的道路充满活力。有许多领域可以得到提升、重新设计、再工程化，甚至淘汰，以使医疗系统更好地运作，正如我们所知所需的那样。这既是我们的责任，也是我们的热情所在。随着我们在所有关键增长支柱上继续兑现承诺并为所服务的人群创造卓越表现，我们以对2025年的强劲展望开启新的一年。
Now, John will walk you through this performance in a little more detail.
现在，John将为大家更详细地讲解这次业绩表现。
John Rex
Thank you, Andrew. And I'll add my deep gratitude for the enormous outpouring of support over the past few weeks. Brian helped build this company and forged deep trusted relationships for over 20 years, and the positive impact he had on people will be felt for years to come.
谢谢你，Andrew。我也要对过去几周内源源不断涌现的支持表示由衷的感谢。Brian帮助建立了这家公司，并在20多年里建立了深厚的信任关系，他对人们产生的积极影响将持续多年。
This morning, I'll discuss both 2024 results and our performance expectations for '25, including some of what we had planned to discuss with you in December.
今天早上，我将讨论2024年的业绩以及我们对2025年的业绩预期，其中包括部分我们原计划在12月与大家讨论的内容。
2024 revenues of over $400 billion and adjusted earnings per share of $27.66 were well within the outlook ranges we set out over a year ago. To be sure, things played out differently than initially anticipated, but it is an enduring trait of this enterprise that we deliver on our commitments to the people we serve and to you, even amid unforeseen circumstances.
2024年的收入超过4000亿美元，调整后每股收益为27.66美元，这些数字都完全在我们一年前设定的预期范围内。诚然，实际情况与最初的预期有所不同，但这家企业的一贯特点就是，即便在不可预见的情况下，我们仍能兑现对所服务人群以及对大家的承诺。
Over the course of '24, we undertook initiatives and made investments to strengthen us for the future, initiatives to improve consumer experience and bring new innovations to market more quickly, drive the most compelling ways to further our mission to help make the health system work better for everyone, and continue to optimize and refine our offerings and business portfolio to enhance future growth potential, whether that meant moving into new opportunities, reconfiguring or moving out of areas, which contributed historically but may no longer be core, all with an eye to unlocking value.
在2024年期间，我们采取了多项举措并进行了投资，以增强面向未来的实力，这些举措旨在改善消费者体验、加快新创新产品的上市步伐、推动最有说服力的方法来进一步实现“让医疗系统更好地为每个人服务”的使命，并持续优化和改进我们的产品及业务组合，以提升未来增长潜力——无论是进入新机遇，重构或退出那些历史上曾贡献过但可能已不再是核心领域的业务——所有这些举措都是为了释放价值。
We know you have a number of questions that we were not able to discuss last month. So, today, I'll start by stepping through a couple you have indicated are top of mind. The first one is, why our '24 medical care ratio was 150 basis points above our original outlook? It's important to frame up the challenges of '24 to offer some perspectives on the commitment and response of our people. Compared to the midpoint of the care ratio range we stepped out with over a year ago, that alone created a nearly $5 billion gap we needed to overcome, and that's before we get to the nearly $1 billion in business disruption impact due to the cyberattack. So, we start with about $6 billion in unanticipated impacts just from these two examples, in addition to managing through the already known multibillion dollar impact of the Medicare rate cuts, as we sought to preserve as much benefit stability for seniors as possible.
我们知道大家有许多上个月未能讨论的问题。因此，今天我将首先逐一说明其中几项大家最关心的问题。第一个问题是，为什么我们2024年的医疗护理比率比最初的预期高出150个基点？阐明2024年的挑战非常重要，这有助于展示我们团队的承诺和应对措施。相比于我们一年前设定的医疗护理比率中点，仅这一项就造成了近50亿美元的缺口，而这还不包括由于网络攻击所导致的近10亿美元的业务中断影响。因此，除了应对已知的数十亿美元Medicare降价影响以外，仅这两个例子就让我们面临约60亿美元的意外冲击，以尽可能保持老年人的福利稳定。
Regarding the elements impacting our '24 care ratio, we've spoken about the key factors on prior earnings calls, so no surprises here. The first comprise about 70% of the total impact and are comparable in magnitude to each other. First, the mix of people served. We ended up with a different profile of consumer than expected. This is because of one factor. We didn't grow as anticipated due to the unusual Medicare Advantage benefit designs in the marketplace in '24. Next, the timing mismatch between the health status of the remaining people being served by Medicaid and lagging state rate updates. Then, there were the costs related to the cyberattack and our South America business impacts.
关于影响我们2024年医疗护理比率的因素，我们在之前的财报电话会议中已讨论过关键因素，所以这里不会有意外。首批因素约占总影响的70%，且彼此规模相当。首先，是服务对象的构成。我们最终获得的消费者群体与预期不同，这主要是由于一个因素：由于2024年市场上非同寻常的Medicare Advantage福利设计，我们的增长未达预期。其次，是Medicaid服务对象健康状况与各州费率更新滞后之间的时机错配。最后，还有与网络攻击以及我们在南美业务影响相关的成本。
The remaining two elements comprise about 30% of the impact and are evenly split. These include a more rapid-than-expected acceleration in the prescribing of certain high-cost medications as drug companies took early advantage of the Inflation Reduction Act, and an aggressive upshift in hospital coding intensity. This is incorporated into our outlook even as we work to get it back in line. Those are the '24 care ratio elements.
剩下的两个因素约占总影响的30%，且分布均衡。其中包括，随着制药公司提前利用《降低通胀法案》，某些高成本药物的处方量加速上升，超出预期；以及医院编码强度的激进上调。尽管我们正在努力使其回归正常水平，但这些因素已纳入我们的预期之中。这些就是2024年医疗护理比率的构成因素。
Next question, given all that, are we confident in the adequacy of our pricing for '25? The answer is yes, and here's why. To start, for '25, the outlook we shared in December incorporates a view of care activity commensurate with what we saw in '24, even the care activity we experienced as we exited the year. I'll break that down with some business line perspectives.
接下来的问题是，鉴于所有这些情况，我们是否对2025年的定价充满信心？答案是肯定的，原因如下。首先，对于2025年，我们在12月分享的预期已经包含了与我们2024年看到的护理活动相匹配的观点，甚至包括我们年末经历的护理活动。我将从各业务线角度为大家逐一解析。
In Medicaid, we see the gap between people's health status and state rates narrowing over the course of the year. Our outlook assumes a measured pacing of that process. Actions to date, including the important January 1 renewal cycle, support this view.
在Medicaid方面，我们看到随着一年的推进，个人健康状况与州费率之间的差距在逐渐缩小。我们的预期假设这一过程将按稳健的节奏推进。迄今为止的措施，包括重要的1月1日续约周期，都支持这一观点。
In commercial, pricing for '25 is appropriately capturing the care activity we are seeing. This is evidenced by growth heavily weighted towards self-funded offerings. We will continue our disciplined approach.
在商业领域，2025年的定价能够恰当地反映我们所见的护理活动。这一点从自费计划占比显著增长中得到了证明。我们将继续保持严格的管理方法。
In Medicare, we had strong AEP results, which included winning back people we had served previously and near-record retention. These are a direct result of our long history of offering sustainable benefits for seniors.
在Medicare方面，我们在AEP期间取得了强劲的成果，包括赢回了之前服务过的客户和创纪录的客户保留率。这直接得益于我们长期以来为老年人提供可持续福利的历史积淀。
With strong retention and the many returning consumers, we start the year with highly informed insights into the care needs of the people we will be serving. In addition, this year, we have seen a notable uptake of our more managed offerings; think HMO style, which provides strong value for consumers, effective care tools for doctors and more predictable performance. We expect a '25 full year medical care ratio of 86.5%, plus or minus 50 basis points, 100 basis points above the '24 result. In addition to factors discussed earlier, the increase is driven by IRA impacts, the second year of the Medicare funding cuts, a continued mix shift toward public sector offerings, and a respectful view of care activity.
凭借较高的客户保留率和众多回归的消费者，我们以对未来服务对象护理需求的深刻见解开启新的一年。此外，今年我们观察到对我们更为管理化产品（如HMO模式）的显著需求提升，这种模式为消费者提供了极高的价值，为医生提供了有效的护理工具，并实现了更可预测的业绩。我们预期2025年全年的医疗护理比率为86.5%，上下浮动50个基点，比2024年高出100个基点。除前述因素外，此增长还受IRA影响、Medicare资金削减第二年的作用、公共部门产品组合持续转变以及对护理活动的稳健预期所推动。
Our '24 operating cost ratio improved about 150 basis points over the prior year. Roughly half of the change was driven by contributions from the business portfolio initiatives mentioned earlier. The other half was due to accelerating our efforts to realize operating efficiencies, even as we improve consumer experiences. Some of these advances are a result of the very early stage impacts we are beginning to realize from AI-driven initiatives to help our customer service representatives respond to consumers' needs more effectively and quickly. And we see continuing opportunities both in the near-term, with operating costs for '25 improving still further, and well beyond, given the rapidly expanding scope and impact of these initiatives.
我们的2024年运营成本比率较上一年改善了约150个基点。其中大约一半的改善归功于前面提到的业务组合举措的贡献，另一半则源自我们加速实现运营效率的努力，同时提升了消费者体验。这些进展中的一部分是由于我们从AI驱动的举措中初步获得的成效，这些举措帮助我们的客服代表更高效、迅速地响应消费者需求。鉴于这些举措范围和影响的迅速扩大，我们认为在短期内（即2025年运营成本将进一步改善）以及更长远的未来，都存在持续的机会。
These actions and the resourcefulness of our people helped deliver upon the objectives set out over one year ago, and helped to partially balance the multiple billions of unanticipated impacts.
这些举措以及我们团队的机智和资源fulness帮助实现了一年前设定的目标，并部分抵消了数十亿美元的意外影响。
With that, I'll run through our businesses, offering some key points for each, starting with Optum Health, where revenues grew to about $105 billion in '24 and are expected to approach $117 billion in '25. Our care delivery business continues to deepen its presence in existing areas, while expanding into new geographies and services. In '25, we expect Optum Health will serve about 5.4 million value-based care patients, growth of 650,000 over '24. While our current position provides a solid footing, it's a small fraction of the hundreds of millions of patients who can ultimately benefit from value-based care.
接下来，我将逐一介绍我们的各项业务，首先是Optum Health，其2024年收入约为1050亿美元，预计2025年将接近1170亿美元。我们的护理服务业务在现有领域不断巩固其市场地位，同时扩展到新的地理区域和服务领域。预计在2025年，Optum Health将为约540万接受价值导向护理的患者提供服务，比2024年增加65万人。虽然我们目前的市场地位坚实，但这只是数亿最终能够从价值导向护理中受益的患者中的一小部分。
We see value-based care as foundational. It is perhaps the fullest expression of our mission. As Andrew noted, the outdated activities-based fee-for-service system won't help the health system work better for people. Value-based care is outcomes-based, aligning processes, actions and incentives, helping keep people healthy in the first place rather than just seeing them when they are sick.
我们视价值导向护理为基础。它也许是我们使命的最充分体现。正如Andrew所指出的，过时的基于活动的按服务收费体系无法使医疗系统更好地为人们服务。价值导向护理以结果为导向，通过协调流程、行为和激励，帮助人们从根本上保持健康，而不仅仅是在他们生病时提供治疗。
Optum Health is an integrated multi-payer care delivery company, helping to lead the transition to a truly sustainable value-based care system. As we move into '25, we will continue to enhance access and care integration through the home, a much needed area to help people with their health. More than three quarters of our in-home patient visits result in a primary care visit within 90 days. Medicare Advantage patients with chronic conditions who receive a home care visit have a lower rate of ER visits, fewer in-patient stays, stronger health outcomes and a better experience, all while saving the health system billions.
Optum Health是一家综合性的多付款方护理服务公司，致力于引领向真正可持续的价值导向护理体系的转型。随着我们迈入2025年，我们将继续通过家庭护理提升服务的可及性和整合性，这是帮助人们改善健康状况急需的发展领域。超过四分之三的家庭患者访问在90天内会转为一次初级保健访问。接受家庭护理的患有慢性病的Medicare Advantage患者，其急诊就诊率更低、住院次数更少、健康结果更好且体验更佳，同时为医疗系统节省了数十亿美元。
Turning to Optum Rx. Revenues in '24 grew to over $130 billion and will be about $146 billion in '25. Our pharmacy benefits management team again had customer retention exceeding 98%, while welcoming a record 750 new clients. Further proof of the value sophisticators, employers, health plans and labor unions see in Optum Rx's ability to negotiate lower drug prices for consumers. Optum Rx's pharmacy care services support the entire system in the delivery of clinically-driven pharmacy care, serving the highest need and hardest to reach patients. These offerings include community pharmacies, specialty and infusion drug services, all large, strongly growing areas, with our current presence quite small.
接下来是Optum Rx。2024年的收入增长至超过1300亿美元，预计2025年将达到约1460亿美元。我们的药房福利管理团队再次实现了超过98%的客户保留率，同时创纪录地新增了750个新客户。这进一步证明了精明的消费者、雇主、健康计划和工会对Optum Rx议价以降低药品价格能力的认可。Optum Rx的药房护理服务支持整个系统提供以临床为驱动的药房护理，服务于需求最旺盛且最难触及的患者。这些服务包括社区药房、专科及输液药物服务，这些都是规模巨大且增长迅速的领域，而我们目前的市场份额仍然很小。
Optum Insight revenues were $19 billion in '24, and in '25, we'll approach $22 billion, with a backlog of $35 billion as sales of new products begin to take hold and the customer clearinghouse business continues to rebuild. The solutions offered through Optum Insight and our health technology growth pillar, delivered at scale, will improve consumer experience and payment and claims flows, enable access to the next best action guidance in a doctor's workflow, and help life sciences customers more rapidly bring innovations to market. And there will be much more to follow.
Optum Insight在2024年的收入为190亿美元，预计2025年将接近220亿美元，同时随着新产品销售的启动和客户清算业务的持续重建，积压订单将达到350亿美元。通过大规模交付的Optum Insight及我们的健康科技增长支柱所提供的解决方案，将改善消费者体验、支付和理赔流程，使医生工作流程中获得下一最佳行动指引成为可能，并帮助生命科学客户更快地将创新产品推向市场。未来还会有更多成果跟进。
Shifting to UnitedHealthcare. Full year revenues in '24 approached $300 billion, and for '25, we'll approach $340 billion as we grow to serve upwards of an additional 1.9 million people balanced across both the commercial and public sectors. Within our domestic commercial offerings, we grew to serve 2.4 million more people in '24 and expects to continue to grow strongly in '25, especially in our self-funded offerings, which serve some of the most sophisticated buyers of healthcare, large employers. The fact that so many more people are choosing UnitedHealthcare is a direct result of our bringing much needed innovation to these more mature markets through consumer-centric offerings.
转向UnitedHealthcare。2024年全年收入接近3000亿美元，预计2025年将达到约3400亿美元，因为我们将进一步扩展服务，新增约190万人，涵盖商业和公共领域。在我们的国内商业产品中，2024年新增服务人数达240万，并预计在2025年将继续保持强劲增长，特别是在我们的自费产品中，这些产品服务于一些最为成熟的医疗保健买家——大型雇主。越来越多的人选择UnitedHealthcare，正是因为我们通过以消费者为中心的产品向这些更成熟的市场引入了急需的创新。
As noted earlier, UnitedHealthcare's '24 Medicare Advantage growth was impacted by the unusual benefit designs in the market. Our focus has always been on providing consumer stability and sustainable value, a factor that has built confidence and trust over the long-term. As a result, in '25, we expect growth of up to 800,000 people in individual, group and special needs offerings. And the growth outlook for the years ahead remains strong, with nearly half of American seniors still in outdated Medicare fee-for-service offerings, which provide less value to them and cost taxpayers more.
如前所述，UnitedHealthcare在2024年Medicare Advantage的增长受到了市场上不寻常福利设计的影响。我们的关注点一直是为消费者提供稳定性和可持续价值，这一因素长期以来建立了信心和信任。因此，我们预计在2025年，个人、团体和特殊需求产品将增长多达80万人。而未来几年的增长前景依然强劲，近一半的美国老年人仍处于过时的Medicare按服务收费体系中，这不仅为他们提供的价值较低，还使纳税人负担更重。
In Medicaid, we expect to serve more people in '25 with redetermination activities now concluded. UnitedHealthcare's value proposition is resonating with state customers, consumers and provider partners, and we are participating in a substantial number of expansion proposals. Most recently, we were honored to have been awarded a new opportunity in Georgia.
在Medicaid方面，随着重新确定工作现已完成，我们预计2025年将服务更多的人。UnitedHealthcare的价值主张正在得到各州客户、消费者和服务提供伙伴的共鸣，我们也正参与大量扩展提案。最近，我们有幸在佐治亚州获得了一项新机遇。
Our growing businesses support and -- are supported by substantial financial capacities and a strong balance sheet. In '24, we deployed nearly $17 billion in growth capital to help build for the future, further strengthening our capabilities to serve more people more comprehensively. We also returned over $16 billion to shareholders through dividends and share repurchase.
我们的增长型业务既得到了强大财务能力和稳健资产负债表的支持，同时也反哺于此。2024年，我们部署了近170亿美元的增长资本以助力未来发展，进一步增强了我们更全面服务更多人的能力。同时，我们还通过分红和股票回购向股东返还了超过160亿美元。
In '25, we expect cash flow from operations will approach $33 billion or 1.2 times net income. We will continue to deploy growth capital and remain committed to returning to shareholders as outlined in December. Our growth capital deployment efforts delivered their greatest benefits over the course of two, four, or even six years, and as new capabilities are scaled and deployed across the enterprise and beyond.
预计在2025年，我们的经营现金流将接近330亿美元，约为净收入的1.2倍。我们将继续部署增长资本，并坚守12月所阐述的向股东回报承诺。我们的增长资本部署工作在两年、四年甚至六年的过程中发挥了最大的效益，随着新能力在整个企业乃至更大范围内的推广和应用，其效益将进一步显现。
To summarize, our strong start to the year reinforces the growth objectives we shared last month and is underpinned by the broad growth drivers, operational excellence and strategic capital deployment you have come to expect from us.
总而言之，我们年初的强劲开局进一步巩固了上个月所分享的增长目标，并得益于大家所期望的广泛增长动力、卓越的运营能力和战略性资本部署。
Now, I'll turn it back to Andrew.
现在，我将时间交还给Andrew。
Andrew Witty
John, thank you.
John，谢谢你。
The strength of this organization lies in the resilience of our people and the fundamental belief that there is no higher calling than helping other people and nothing more vital to the human condition than healthcare. Looking ahead to 2025 and beyond, we're confident in our ability to continue to add value to the health system through our focus on value-based care and consumer-orientated efforts to help build the health system America deserves. And that's also why we remain solidly committed to our long-term 13% to 16% growth objective, a goal that reflects both the opportunities and the capabilities that we have.
这个组织的力量在于我们员工的韧性以及我们坚信“帮助他人”是最高的使命，医疗保健对人类生活至关重要。展望2025年及以后，我们有信心通过专注于价值导向护理和以消费者为中心的努力，持续为医疗系统创造价值，帮助构建美国应有的医疗系统。这也是我们坚定致力于实现长期13%至16%增长目标的原因，这一目标既反映了机遇，也体现了我们的能力。
And now, operator, we'll open it up for questions.
现在，主持人，请开放提问环节。
Question-and-Answer Session
问答环节
Operator
主持人
The floor is now open for questions. [Operator Instructions] We'll go first to A.J. Rice with UBS.
现在开放提问。［主持人指示］我们首先请UBS的A.J. Rice提问。
A.J. Rice
Hello, everybody. And I appreciate the words about Brian. He's missed by all of us. Just maybe to focus in on the comments about cost trends and the MLR. Obviously, in the fourth quarter, there's variance relative to consensus expectations. It was probably a little greater than what we thought. It sounds like the cost items you're calling out are similar to the things you had seen all year long. Was there anything that changed in those - the intensity of any of those trends? And anything -- any unusual items in there that impacted the results? And it sounds like you're still confident in your '25 MLR outlook, so nothing you saw in the fourth quarter changes your view on '25?
大家好，我很感谢关于Brian的悼念之词，我们都非常怀念他。请聚焦于关于成本趋势和医疗护理比率（MLR）的评论。显然，第四季度的表现与市场普遍预期存在偏差，可能比我们预想的要大一些。听起来你们提到的成本项目与全年所见的类似。那么，这些趋势的强度上有没有什么变化？是否有任何不寻常的项目影响了业绩？而且看起来你们对2025年的MLR预期依然充满信心，那么第四季度所见的情况是否没有改变你们对2025年的看法？
Andrew Witty
A.J., thanks so much for your question. I'm going to ask John in a sec to obviously go much deeper in response to your question, but just to the last part of your question, yeah, you're totally right, nothing we saw there that changes our view of '25. We feel very good about how we priced into '25. We feel really good about how the mix has come in, in terms of that growth. That's a huge difference to '24, and we really didn't see anything in Q4 that we believe represents a challenge to that view going to '25, but I'd love John to go deeper for you on the Q. Thanks.
A.J.，非常感谢你的提问。我稍后会请John更深入地回答你的问题，但先针对问题的最后部分，没错，你说得对，第四季度的情况没有改变我们对2025年的预期。我们对2025年的定价非常有信心，也对增长所体现的产品组合感到非常满意，这与2024年有显著不同。我们在第四季度确实没有发现任何会对2025年预期构成挑战的迹象，不过我会请John为你更详细地解答这个问题。谢谢。
John Rex
Good morning, A.J. So, a few things on this. So, in terms of the items that we called out on the third quarter call, so hospital coding intensity and the specialty prescribing trends that we are seeing, very much in line with what we saw in the third quarter in terms of that ran into the fourth quarter. So, in line with the view on that, we weren't seeing acceleration in that. We're seeing stabilization in those trends, I would tell you, at the levels we saw before, and we expect that to continue.
早上好，A.J.。关于这个问题，我来说几句。在第三季度电话会议中我们提到的几项指标，比如医院编码强度和我们观察到的专科处方趋势，延续到了第四季度，与第三季度的水平基本一致。也就是说，这些趋势没有出现加速，我们看到它们在之前的水平上趋于稳定，并且我们预期这种稳定态势将会持续。
That specialty prescribing, those trends were something we anticipated in our '25 outlook. And as we had noted back in the third quarter, that was something that just moved faster in '24 than we expected, but in terms of the levels we're seeing and how we anticipated that in our '25, we feel very good about that. Those coding intensity levels staying at the levels that we thought that we had seen also. And then, the other elements that we talked to mix kind of important element in terms of the improvement we see as we move into '25 in those elements.
关于专科处方的趋势，这是我们在2025年预期中所预测的。正如我们在第三季度提到的，2024年这一趋势的推进速度确实比预期更快，但就目前的水平以及我们对2025年的预期而言，我们对此非常满意。同样，我们预期的医院编码强度也保持在我们认为合理的水平。另外，还有其他一些因素，我们在讨论中也提到，这些因素对于我们在2025年看到的改进起到了重要作用。
For the call out kind of things in the 4Q, a couple of things I'd say. So, first of all, the move vast -- mostly driven by seasonality. Typical seasonality, we see normal deductible wear offs, those elements. A move, sequentially that was similar in terms of the basis point move that we saw a year ago also, 3Q to 4Q on that, but I'd call out a couple of things, A.J., just to your point here.
对于第四季度提到的变化，我有几点要说明。首先，这种变化主要受季节性因素的驱动。比如正常的免赔额消退等因素。这种季节性变化在连续季度中与我们去年第三季度到第四季度所见的基点变化相似，但A.J.，针对你的问题，我还想补充几点。
So, in the sequential move, I'd call out probably 80 basis points to 90 basis points I put in the revenue effect category here. So, in that, think about some elements that might have been coming in, such as group MA refunds and elements there where our performance, which was strong over the course of the year, and those hitting in the quarter. Just some elements like that, that I'd put in the non-recurring revenue -- non-run rate revenue category in terms of impacts. And that was probably about 80 basis points to 90 basis points of the impact 3Q to 4Q.
在季度环比变化中，我大致将80到90个基点归入收入效应类别。也就是说，这其中包括一些可能陆续出现的因素，例如团体MA退款以及其他一些因素，这些因素在全年表现中我们的业绩非常强劲，而这些因素在本季度有所体现。我把这些因素归类为一次性收入或非正常运行收入的影响，大约占第三季度到第四季度变化的80到90个基点。
The flu RSV impact, that typical seasonal, that was kind of a, I'd say, in the quarter 50 basis points to 60 basis points. That's kind of a normal move. And then, think of the rest of that move being in the zone of pretty much expected seasonal impact. So, the one element I'd call out there is the revenue effects that probably would be -- would probably be having some impact. Thank you.
流感和呼吸道合胞病毒（RSV）的影响，这种典型的季节性因素，大概在本季度带来了50到60个基点的变化，这属于正常范围内的变动。其余部分基本上也处于预期的季节性影响区间。所以，我想特别提及的是这些收入效应因素，可能会产生一定的影响。谢谢。
Andrew Witty
Great. Thanks so much, John, and thanks again, A.J., for your question. Next question, please.
非常好。非常感谢John，也再次感谢A.J.的提问。请下一个问题。
Operator
主持人
We'll go next to Josh Raskin with Nephron.
接下来，我们请Nephron的Josh Raskin提问。
Josh Raskin
Hi, thanks. A question on the Optum Health segment. I guess, and I apologize if I missed this, but did you comment on the change in the consumers? I know you talked about portfolio changes and things like that, but the consumer count dropped about 4 million. And then, sort of a noticeable drop in margins. And I'm wondering if some of that is related to the MA rebates that you just mentioned in terms of the impact on the UHC side as well.
嗨，谢谢。我有个关于Optum Health板块的问题。我想问一下（如果我漏掉了，抱歉），你们是否有提到消费者的变化？我知道你们谈到过投资组合的调整等，但消费者数量下降了大约400万，同时利润率也明显下降。我想知道这是否与刚才提到的MA返利有关，特别是在UHC方面产生的影响？
Andrew Witty
Yeah, Josh, thanks so much for your question. Let me ask John to start and then ask Dr. Desai to pick up a few details on that, please. Thanks.
是的，Josh，非常感谢你的提问。我先请John来回答，然后再请Desai博士补充一些细节。谢谢。
John Rex
Good morning, Josh. So, in terms of the consumer count and impacts on that, so that would go into the category of some of the strategic initiatives that have been ongoing here. So, think about some elements where -- that we may have just been -- that we are maybe deemphasizing in terms of our focus on that. So, an area that we deemphasize that would go in that category is urgent care.
早上好，Josh。关于消费者数量及其影响，这属于我们正在推进的某些战略举措的范畴。可以理解为我们在某些方面可能正逐步淡化关注，其中一个领域就是急诊护理。
We're approaching that a bit differently now. There was a time when kind of standalone urgent care was an important element here. As you start developing more geographic density, however, in a marketplace, you can probably better serve those patients by just having one of your clinics have afterhours of presence and focus on that.
我们现在在这一领域的做法有所不同。曾经，独立的急诊护理是一个重要环节，但随着地理密度的提升，在市场中，你可能只需让某个诊所在非营业时间提供服务，即可更好地满足患者需求。
So, one area that we have diminished in terms of emphasis is urgent care. And that's one of the areas we got out of. So, really those counts are driven by, I'll call it, somewhat narrow offerings typically, that we have been diminishing and that were part of kind of some of the strategic initiatives that we talked about.
因此，我们在急诊护理这一领域的重视程度已经降低，这也是我们逐步退出的领域之一。实际上，这部分数据主要反映了我们正在减少的、较为有限的产品和服务，这些都是我们此前战略举措的一部分。
In terms of kind of some of the broader margin impacts you're seeing and some of the emphasis and where Optum Health was headed in terms of in the 4Q and where their focus was, I'll turn that to Dr. Amar Desai to comment on.
至于你提到的更广泛的利润率影响以及Optum Health在第四季度的定位和重点，我将把话题转给Amar Desai博士，请他来说明。
Amar Desai
Thanks, John. Hi, Josh. So, to take a step back, post V28, we've been executing on our multiple year plan to reshape the business, including efforts around direct patient engagement and medical management as well as integrating our business to deliver on operating cost efficiencies.
谢谢，John。嗨，Josh。退一步说，自V28之后，我们一直在执行一个多年计划，以重塑业务，这包括围绕直接患者参与和医疗管理的努力，以及整合我们的业务以实现运营成本效率。
So, as we look at the quarter, we took a number of planned actions, including restructuring and refining some of our legacy contracts, which had a one-time impact of the year. We had some membership mix changes, which has been noted. And then, we did make some investments in the quarter around clinical quality and the STARS program as well as onboarding for new membership coming on for 1/1.
在本季度，我们采取了多项计划中的措施，包括重组和优化部分历史合同，这对当年产生了一次性影响。我们也经历了一些会员结构的变化，这是大家所关注的。此外，本季度我们在临床质量、STARS项目以及1月1日新会员的入职培训方面也进行了投资。
That being said, we feel very good about our position stepping into 2025. Our AEP growth was strong. We've also had very strong retention across our care delivery organizations, again reflecting the strength of our provider network and the differentiated care they provide. We also have a better understanding of V28 as we're in the second year of it. And with this progression, our payer relationships and contracts have evolved into the year. As we step into '25, we're in a more favorable spot.
话虽如此，我们对进入2025年的市场地位非常有信心。我们的AEP增长强劲，而且我们的护理服务机构保持了极高的客户留存率，这再次体现了我们供应商网络的实力以及他们提供的差异化护理。随着我们进入V28的第二年，我们对这一项目有了更深入的了解，并且我们的付款方关系和合同也在这一年中得到了改善。进入2025年时，我们的形势将更加有利。
And then, the impact of our engagement efforts in 2024, 85% of our value-based patients were engaged and 90% among our highest risk patients. And again, this is best ever patient engagement for us and is the foundation for the maturation of our value-based cohorts over time.
此外，在2024年我们的参与努力中，85%的价值导向患者得到了有效参与，其中最高风险患者的参与率达到90%。这同样是我们迄今为止最佳的患者参与记录，并为我们的价值导向患者群体的成熟奠定了基础。
So, overall, our operating model for Optum Health is stronger, it's underpinned by significant momentum around these engagement and affordability as well as operating efficiencies and we're confident in delivering against our long-term margin targets. Thanks for the question, Josh.
总体来看，我们Optum Health的运营模式更为稳健，这得益于在患者参与、负担能力以及运营效率方面显著的推进势头，我们有信心实现长期的利润率目标。感谢你的提问，Josh。
Andrew Witty
Amar, thanks so much. And I'll maybe just finish off that response, Josh, if I might, by really reiterating something you heard me say just a month ago that even in a very challenging year of 2024 with a lot of changes coming from the outside world in terms of funding reductions and the like from the administration, alongside our commitment to perform, we're also relentless around how we continue to modernize and shape the company for the longer term.
Amar，非常感谢。Josh，我再补充一点，重申一下你一个月前听我说过的话：即使在2024这个极具挑战、外部世界不断出现资金削减等变化的年份中，我们不仅坚守业绩承诺，而且在持续推动公司现代化和长远发展方面也毫不松懈。
And what you heard John just talk about and you just heard Amar refer to really there is within Optum Health, alongside strengthening our core business, we recognize some parts of that business aren't necessarily as important in the future as they were in the past. We're not going to shy away from making the choices to ensure that we have real clarity and focus on what we know supports our business, and most importantly, gives us the highest chance of giving the best possible service to patients and members who we serve.
正如你刚才从John和Amar那里听到的那样，在Optum Health内部，除了加强核心业务外，我们也认识到某些业务部分在未来可能不如过去那样重要。我们不会回避做出那些确保我们真正明确并专注于支持业务的选择，最重要的是，这能让我们最大限度地为所服务的患者和会员提供最佳服务。
And I think, during 2024, you saw the organization be very focused not just on the year, but on the shape of how we want the company to develop over the next several years. And that's really what you're seeing reflected in the commentary that John and Amar just touched on.
我认为，在2024年，你们看到整个组织不仅关注当年业绩，更关注公司未来数年发展的蓝图。而这正体现在John和Amar刚才的讲话中。
Josh, thanks so much for your question. If we could go to the next question?
Josh，非常感谢你的提问。接下来我们请下一个提问。
Operator
主持人
We'll go next to Lisa Gill with JPMorgan.
接下来，我们请JPMorgan的Lisa Gill提问。
Lisa Gill
Thanks very much for taking my question. Andrew, I want to talk about PBM reform. There seems to be a very large drumbeat right now that will see reform at some point in 2025. Really two things here. One, what do you think that means to your business? And then, secondly, you talked about educating those in the marketplace to better understand what you actually bring to the market from a PBM perspective. Are there incremental ways that you can potentially maybe educate Congress? Because it seems to be a very big disconnect versus how Congress is viewing this versus what PBMs actually do.
非常感谢您接受我的提问。Andrew，我想谈谈关于PBM改革的问题。现在有一个非常强烈的呼声，认为在2025年某个时候会进行改革。这里有两点：第一，您认为这对贵公司的业务意味着什么？第二，您提到了要向市场上的相关人士普及PBM实际带来的价值。有没有可能通过增量措施来教育国会？因为国会对这一问题的看法与PBM实际的作用之间似乎存在很大脱节。
Andrew Witty
Lisa, thanks so much for your question. And this is, obviously, a topic of a lot of people's interest. And that's not surprising, because pharmaceutical prices in the U.S. are too high. And I just made that super clear in my comments, and it's not the first time you've heard any of us at United make those comments over the last several years.
Lisa，非常感谢你的提问。显然，这是一个引起广泛关注的话题，这并不令人惊讶，因为美国的药品价格实在太高了。我在发言中已经非常明确地指出这一点，而且这也不是我们联合健康过去几年中第一次发表类似的看法。
As you think about that, the issue really is that you have a situation where the PBMs are really the only effective mechanism across the system, which really holds the pharmaceutical company to account once it chooses to set its price, and by the way, also has the freedom to inflate that price every single year, which is what we see happen. The PBM is there to try and hold that to account and negotiate on behalf of employers, unions, states and others to try and bring down those prices.
仔细考虑这一点，问题在于，PBM几乎是整个系统中唯一有效的机制，一旦制药公司设定价格，PBM就会对其进行监管，而且顺便提一句，制药公司每年都有自由将价格抬高，这正是我们所看到的现象。PBM的作用就是试图对这种行为进行制衡，并代表雇主、工会、州政府等各方进行谈判，以尽量降低这些价格。
But within that, Lisa, is the very first thing that people really need to truly understand. The PBM acts on behalf of the ultimate payer, the employer, the union, the state and such. It acts on their behalf, because they're ultimately the ones who are typically underwriting the ultimate cost of the medicine for the patients, the consumers who are beneficiaries of their plans that are supported by those organizations. That is often lost in terms of how this mechanism works. And it's critical to understand it.
但在这之中，Lisa，人们首先需要真正理解的一点是：PBM是代表最终付款方行动的，即雇主、工会、州政府等。它代表他们行动，因为最终承担药品成本的通常是这些组织支持的计划中的患者或消费者。这个机制的运行方式常常被忽略，而理解这一点至关重要。
What's important, therefore, is that we, and you heard me make a couple of references to this, and I hope alongside others across the sector really focus on the facts of the situation. Prices in America are de novo set too high relative to any other price in the world, first off. Secondly, they're inflated every year, which is pretty unusual when you compare that to the rest of the world. Thirdly, as we negotiate to bring those prices down, the benefit of that negotiation, those rebates which are achieved are very significant, are passed back to the employers, unions and states. They choose what to do with those rebates.
因此，重要的是，我们（以及你听到我提到过的几次）希望与业界其他人士一起真正关注这一事实：首先，美国的药品价格从一开始就定得太高，与世界其他地方相比明显过高；其次，与全球其他地区相比，美国每年都在持续抬高价格，这非常不寻常；第三，在我们努力降低这些价格的过程中，通过谈判获得的折扣（返利）非常可观，并且这些返利会返还给雇主、工会和州政府，由他们决定如何使用这些返利。
Now, in the case of UnitedHealthcare, where in the population of employer benefits that we manage, where we have essentially control over that decision, we pass those all the way through to the consumer and the patient who receives the drug. So, they see the benefit of that rebate. We'd like to see others do the same.
以UnitedHealthcare为例，在我们管理的雇主福利人群中，我们基本上掌握了这一决策权，我们将所有返利全部传递给消费者和接受药物治疗的患者。因此，他们能够直接享受到这些返利带来的好处。我们希望其他公司也能这样做。
Within that overall system, there is also opportunity for people to lose a thread of where the money goes in the system. And that is often what you hear policymakers be concerned about. That is why this morning we are committing to a full 100% pass-through of all rebates that we negotiate at the PBM back to the payer, the state or the union. Right now, we already passed 98% of that through. But unfortunately, even that's just that small residual that we retain because those clients want to pay us that way is enough to give people the excuse to argue that the system is not working properly.
在整个系统中，人们很容易忽视资金的流向，这也是政策制定者常常关注的问题。这就是为什么今天早上我们承诺，将在PBM谈判中获得的所有返利100%返还给付款方、州政府或工会。目前，我们已经实现了98%的返还率。但不幸的是，即使只是那微小的残留部分，由于部分客户希望以这种方式支付，这也足以成为有人辩称系统运作不当的理由。
We're taking that excuse off the table today. We are committed to full transparency. We are committed to full pass-through to clients. We believe that takes away the excuse of who really is setting the price, and we would like to work with others across the system to relentlessly achieve the lowest net cost for everybody in the system. We'd like to see patients see the benefits of that, and we'd like to work with anybody who wants to work with us to make it happen. And that's how we're going to engage this year with policymakers and others across the country.
今天，我们要消除这种借口。我们承诺完全透明，并将全部返利传递给客户。我们相信这将消除关于谁真正制定价格的争议，我们也希望与系统内的其他各方合作，不懈努力，为整个系统中的每个人实现最低净成本。我们希望患者能直接看到这种好处，并愿与任何希望合作的人一起实现这一目标。这就是我们今年与政策制定者及全国各地其他人合作的方式。
With that, Lisa, thanks so much for the question. Let me go to the next question, please.
以上，Lisa，非常感谢你的提问。接下来，请下一个问题。
Operator
主持人
We'll go next to Stephen Baxter with Wells Fargo.
接下来，我们请Wells Fargo的Stephen Baxter提问。
Stephen Baxter
Hi, thanks. So, to stay on the policy front, I was wondering if you had any early perspective to share on the Medicare Advantage advance notice for 2026. I guess, anything you see as encouraging or any potential areas of concern as you progress from advance to final? And then, I guess as a related point, it seems like many would think that the reimbursement that's embedded in these rates is still not reflective of the elevated cost trend that we saw in 2024. Even if taking a step in the right direction, is that a company perspective that you share? Thank you.
嗨，谢谢。那么，就政策方面而言，我想知道您是否能分享一些关于2026年Medicare Advantage预先通知的早期看法。我猜，您是否看到了一些令人鼓舞的方面，或者在从预先通知到最终确定的过程中有任何潜在的关注领域？另外，作为一个相关问题，似乎很多人认为这些费率中包含的报销金额仍未反映我们在2024年观察到的成本上升趋势。即便这是朝着正确方向迈出的一步，这也是您所持有的公司观点吗？谢谢。
Andrew Witty
Hey, Stephen, thanks so much for the question. I'm going to ask Tim to -- Tim Noel to comment on that, please.
嘿，Stephen，非常感谢你的提问。我将请Tim——Tim Noel来对此发表评论，请。
Tim Noel
Yeah, thanks for the question, Stephen. As you know, these rates are preliminary at this point in time and won't be finalized until April. And so, therefore, probably not super productive to start speculating on elements of that. I will say we are looking forward very much to engaging the new administration on this item and also a host of other items as it relates to the Medicare Advantage program. Thanks.
是的，谢谢你的提问，Stephen。正如你所知，这些费率目前还处于初步阶段，直到四月才会最终确定。因此，现在开始对其中的各个要素进行猜测可能不是特别有意义。我想说，我们非常期待与新政府就这一议题以及与Medicare Advantage计划相关的一系列其他事项进行沟通。谢谢。
Andrew Witty
Great. Thanks so much, Tim. And as you suggest, Stephen, what's most important is that this is all rational, right? So, it's not difficult to figure out in retrospect what trend was, and we'd like hope that over the next few cycles, we see that reflected in a way that it hasn't been over the last several years. And that, for us, is really the important element of what we hope will come. And it's simply just rational and it's interesting.
很好，非常感谢Tim。正如你所说，Stephen，最重要的是这一切都是理性的，对吧？因此，回顾过去，我们很容易看出趋势是什么，我们希望在接下来的几个周期中，能够以一种过去几年未能体现的方式反映出来。这对我们来说确实是我们所期望的重要因素。这一切都是理性且富有趣味的。
When you look at the states in Medicaid, you see that kind of rational behavior. We've seen that improve. We've been super clear that there's been historic offset lag, if you will, to that. That's not surprising. That can create some discontinuity as we saw this year in '24, but underneath all of that, we see rational understanding and engagement from the state. We super appreciate that. It's important, and that's what we want to hope to see a return around the MA rate setting in a way that we have not seen over the last several years.
当你观察Medicaid各州时，你会看到这种理性行为。我们已经看到这种情况有所改善。我们已经非常明确地指出，这方面存在历史性的抵消滞后，这并不令人惊讶。正如我们在2024年所见，这可能会造成一些不连续性，但在这一切背后，我们看到了各州的理性理解和参与。我们对此非常感激。这很重要，也是我们希望在Medicare Advantage费率设定方面看到回归到过去几年未曾出现过的理性状态的原因。
Okay. Next question, please.
好的，请下一个问题。
Operator
主持人
We'll go next to Justin Lake with Wolfe Research. Thanks.
接下来，我们请Wolfe Research的Justin Lake提问。谢谢。
Justin Lake
Thanks. Good morning. I've got a question here, but first, I wanted to ask a quick follow-up on this Medicare Advantage revenue adjustment. Given the MLR for the quarter came in higher than expected, it appears this might have come as a surprise given that the employers -- the size of the employer segment, feels like this adjustment is pretty large, like maybe 5% or more of annual revenue. So, just trying to understand, can you give us more color here? How did the mechanics work? And what's going on? Maybe you could tell us why this would have been a surprise? And what periods do they relate to? Is it all 2024?
谢谢。早上好。我有个问题，但首先我想就Medicare Advantage收入调整做个跟进。鉴于本季度的MLR高于预期，这似乎令人惊讶，因为考虑到雇主部分的规模，这一调整幅度相当大，大约占年收入的5%或更多。请问能否详细说明一下，机制是如何运作的？到底发生了什么？能否解释一下为什么会令人意外？这些调整涉及哪些时期？全都是2024年的吗？
And then, my actual question is more on MA growth. Curious what you saw during AEP both in terms of what proportion of your 8% growth expectation do you expect to come from AEP? And then, do you still see industry growth at mid-single digits? Thanks.
接下来，我的实际问题更多是关于MA增长。请问在AEP期间你们观察到了什么？预计8%增长目标中有多少比例将来自AEP？另外，你们是否仍认为整个行业的增长率处于个位数中段？谢谢。
Andrew Witty
Hey, Justin. Thanks so much for the question. That was an impressive way of sneaking two instead of one. I'll let you get away with it just this time. So, John, if you wouldn't mind taking the first part of Justin's good question, and then I'm going to ask Bobby Hunter to take the second. Bobby leads our business in Medicare. So, please go ahead.
嘿，Justin，非常感谢你的提问。这真是一个巧妙地一举提出两个问题的方式，这次就让你这么做吧。接下来请John回答你问题的第一部分，然后我会请Bobby Hunter回答第二部分。Bobby负责我们Medicare业务，请你开始。
John Rex
Justin, good morning. So, yeah, in terms of those elements, so MA kind of group customer refunds was one element of it. And certainly, these are -- and there were a few other adjustments running through that were all putting the non-run rate revenue impacts here.
Justin，早上好。关于这些因素，首先是MA团体客户退款，这是其中的一个因素。当然，还有其他一些调整也在发挥作用，这些调整共同影响了非正常运行收入。
In terms of surprise or not, so perhaps not anticipated a year ago when we set out kind of in terms of our expectation for medical care ratio and revenues and such, not a surprise in terms of where we've been the last while though in terms of understanding these things, because as they develop and you see, okay, better performance in certain group MA plans, there's going to be a refund that's given to those employers as we do, as we're performing well.
至于是否令人惊讶，这在我们一年前制定医疗护理比率和收入预期时可能没有预料到，但考虑到近期的表现，这并不令人意外，因为随着情况的发展，如果某些团体MA计划表现更好，就会向那些雇主返还款项，正如我们所做的那样，说明我们的表现不错。
And then, some of the other elements, I wouldn't call them surprise. Certainly relative to a year ago, we didn't have those incorporated in our view in terms of relative to months ago, it would have been something we would have understood in those elements. And that was one of those, trying to give example. But there were a few and they totaled up to that 80 basis points, 90 basis points. Group MA refunds being one of them. But I wouldn't call it a surprise to where our view has been the last few months here on this.
至于其他一些因素，我不认为它们令人意外。相较于一年前，我们那时的预期中并没有考虑到这些因素，几个月前我们本可以预见到这些因素的存在。举个例子，这些因素总共大约贡献了80至90个基点，其中团体MA退款就是一个因素。但就我们过去几个月的预期而言，我不会说这令人惊讶。
And then, I'll go to Tim...
接下来，我就把话题交给Tim……
Andrew Witty
No, to Bobby.
不，我把它交给Bobby。
John Rex
Yeah, Bobby.
是的，Bobby。
Bobby Hunter
Yeah. Thanks, John, and thanks, Justin, for the question. So, in terms of AEP results, we are very pleased with how things played out for us. They're very much aligned to our expectations, and it puts us on track to achieve the full year MA growth target of up to 800,000 that we've communicated.
是的。感谢John，也感谢Justin的提问。关于AEP的结果，我们对表现非常满意，完全符合我们的预期，这使我们有望实现全年MA增长目标，即新增多达80万名客户。
Really important to remember that with the selling changes for 2025, we do expect more than 50% of our full year growth to come in AEP. Also worth noting, this level of growth is not something we're unfamiliar with, and I'm really proud of our teams and the 1/1 readiness activities we've executed on to ensure a smooth transition for our new and returning customers.
非常重要的一点是，随着2025年的销售模式变革，我们预计全年增长中将有超过50%来自AEP。还需要指出的是，我们对这种增长水平并不陌生，我为我们的团队以及为确保新老客户顺利过渡而开展的1月1日入职准备活动感到非常自豪。
Maybe to offer a few highlights on the growth itself, seeing really balanced and diversified growth across our products and our geographies, in particular, some really nice strength within our HMO and full dual plan offerings. John also mentioned retention performing at near record levels, a great testament to the value that we're offering to consumers.
简单介绍一下增长的亮点，我们在产品和地域上都实现了非常均衡和多元化的增长，尤其是在HMO和全双重计划产品上表现出色。John也提到了客户留存率接近创纪录，这充分证明了我们为消费者提供的价值。
And maybe lastly, of the members who have left us in prior years, we are seeing about 3 times as many return to UHC this year as compared to last year. I really view that as a testament to the service models and experiences we offer. And folks clearly put a lot of value in that when they're making their decisions, and I'm really proud to see those individuals coming back to us this year.
最后，关于以往流失的会员，今年回归UHC的比例大约是去年的3倍。我认为这充分证明了我们提供的服务模式和体验的价值。当人们做出决策时，他们显然非常重视这一点，我也非常自豪地看到这些人今年再次选择了我们。
In terms of the growth rate, we certainly still continue to believe in our long-term growth rate of 7% to 9%, acknowledging that, in certain years, you can see fluctuations based on benefit changes and other factors. Some of that was present in 2024 and similar dynamics will play out here in 2025. So, we expect '25 to generally pace in line with '24 from a growth standpoint. That said, more confident than ever in the value that MA offers to consumers and the path that we're on for MA to surpass 70% penetration over time.
关于增长率，我们依然相信长期增长率在7%到9%之间，并认识到在某些年份，由于福利变动等因素会出现波动。2024年就有类似情况，2025年也会有相似动态。因此，我们预期2025年的增长基本与2024年持平。话虽如此，我们比以往任何时候都更有信心，相信MA为消费者提供的价值，以及我们推动MA渗透率最终超过70%的路径。
Andrew Witty
Bobby, thanks so much. And I just want to acknowledge Bobby personally, because he -- over the last couple of years, he's really led the strategizing of how to navigate through the very many external changes, which have played out through V28 and the like. And I think you've always heard us talk about playing a multi-year strategy here, and I think that's really coming to fruition. Bobby owns a ton of the credit associated with that, and I'm delighted to see that reflected in the growth performance in the cycle we're in right now that you've just heard described.
Bobby，非常感谢。我也想特别感谢Bobby，因为在过去几年中，他真正主导了如何应对诸多外部变化的战略规划，这些变化通过V28等项目表现出来。我相信大家一直听我们谈论多年的战略，这一战略正在逐步实现。Bobby为此承担了大量功劳，我很高兴在当前这个周期的增长表现中看到这一点。
And it's that mix improvement that you just heard in Bobby's answer, which completely differentiates 2025 from 2024 for UnitedHealthcare, is super important. And all of those elements you just heard described are essentially what makes up that very important mix improvement, which we've been aiming for and we feel very, very good about.
而正是Bobby回答中提到的这种组合优化，彻底区分了2025年与2024年在UnitedHealthcare的表现，这非常关键。你刚才听到的所有这些要素，正构成了我们一直努力追求且我们非常满意的那种关键性组合优化。
Let me go to the next question, please.
接下来，请下一个问题。
Operator
主持人
We'll go next to Lance Wilkes with Bernstein.
接下来，我们请Bernstein的Lance Wilkes提问。
Lance Wilkes
Great. Thanks so much. And really appreciate your comments at the beginning of the call. Could you talk a little bit about one of the things I think is hanging over long-term investors out there, which is levels of customer satisfaction. I know that's difficult to measure, but I know [NDS] (ph) and other metrics are things you guys look at. Can you talk a little bit about what you perceive to be the major sources of dissatisfaction in those sorts of measures? And then, what are some of your strategies and priorities? And does it have any impacts on long-term algorithms for the company as far as economic algorithms, growth algorithms or just where you prioritize your capabilities? Thanks.
太好了，非常感谢。我也非常赞赏你在电话开始时的发言。请问您能否谈谈我认为长期投资者所关心的一个问题，即客户满意度水平。我知道这很难衡量，但我知道[NDS]（音）和其他指标是你们关注的内容。请您详细说明一下，您认为在这些衡量指标中，主要的不满来源是什么？然后，贵公司有哪些策略和重点？这是否会对公司长期的经济模型、增长模型或能力优先级安排产生影响？谢谢。
Andrew Witty
Yeah, Lance, thanks so much for the question. And listen, I mean, at the core of the company and if you look at the mission of the company, it's all about trying to improve the health system for everybody. And by that, it means not just reducing the cost of that, making it more affordable, but it's also about trying to make it easier to access, less complex, less confusing. And as I said in my opening comments, we recognize there's still a lot of work to be done in that regard.
是的，Lance，非常感谢你的提问。听我说，从公司的核心和使命来看，一切都是为了改善每个人的医疗系统。这不仅意味着降低成本、提高负担能力，还包括努力使医疗服务更易获得、更简单、更不让人感到困惑。正如我在开场发言中所说，我们认识到这方面仍有大量工作要做。
Some of the areas, like, obviously, claims where people get frustrated about how long it takes for a claim to process or maybe some confusion that goes on in that, those are key areas for us to continue to work hard at to improve. And I could tell you when you look across claims, less than half of 1% of claims are ultimately rejected for clinical reason because for whatever reason they're not deemed to be a safe or effective treatment option.
其中一些领域，比如理赔过程中人们因等待时间过长或因流程中的混乱而感到沮丧，这些都是我们需要持续努力改进的关键领域。我可以告诉你，从所有理赔中看，最终因临床原因被拒绝的理赔不到0.5%，因为无论出于何种原因，这些理赔并未被认为是不安全或无效的治疗选项。
为什么医疗保险的理赔更难，相比于汽车保险？
But we all know there are other claims which get held up in the process before you get to that stage. Now, the overwhelming majority of those claims which are held up are held up because they were either sent to the wrong company, they didn't have the right information on them, the patient didn't have the right benefits, all of those things. Now that could all be dealt with through technology and a more standardized approach across the industry.
但我们都知道，在达到那一阶段之前，还有其他理赔在流程中被延误。绝大多数被延误的理赔，是因为它们被送到了错误的公司，或者信息不全，或者患者没有获得正确的福利，诸如此类。而这一切都可以通过技术和整个行业更标准化的流程来解决。
And I'm very, very pleased to say that we are experiencing and engaged with a much heightened energy across the organization to solve this across the whole sector for everybody. And in my view, probably 85%—or more—of all of those claims, which end up going to the wrong place and then having to be resubmitted back, could all be avoided with the adoption of real-time processing, a standardized approach, a standardized intake mechanism. That's a key area for us to focus on. And that—we've alluded to that. I mentioned an effort we're very close to around Medicare Advantage improvement. That's just one of the first steps.
我非常高兴地表示，我们正以更高的热情在整个组织中推动解决这一问题，旨在为整个行业造福。在我看来，可能有85%或更多的理赔因被送错地方而不得不重新提交，这些都可以通过采用实时处理、标准化流程和标准化受理机制来避免。这是我们需要重点关注的一个关键领域。对此，我们此前已有所提及，我也提到了我们在Medicare Advantage改进方面的一个接近完成的举措，这仅仅是第一步。
And all of this sits very much in line with the work that Brian frankly led over the last several years to really reduce overall activity around PAs and the like and the company will continue to do that. But I just want to emphasize the criticality of collaboration here to try and design something not just for one company, but for all companies, not just for one patient, but for all patients. That's what we got to work toward. Really looking forward to opportunity to engage with the administration on this, because they can also be an important aid to help catalyze those sorts of changes.
所有这些工作与Brian在过去几年中所主导的减少PA等相关整体活动的工作非常契合，公司也将继续沿此方向努力。但我想强调的是，合作的重要性，我们必须共同设计出一个不仅适用于单个公司，而是适用于所有公司的解决方案；不仅适用于某一位患者，而是适用于所有患者。这是我们必须努力实现的目标。我非常期待有机会与政府部门就此进行合作，因为他们也能成为推动这类变革的重要助力。
The second area of consumer improvement opportunity, where I believe we are—we really are making great progress is just around that consumer experience. So, there's no reason in the world why engaging with the healthcare system should feel any different or any less easy than any other engagement you have in your life. And that's why we've been focused over the last several years on this move toward a consumer capability for the whole company. And that I really believe we're making breakthroughs on in terms of how we're operating.
第二个我认为我们正取得巨大进展的消费者改进机会领域，就是消费者体验。与其他生活中的交互相比，接触医疗系统不应该感到有任何不同或更复杂。这就是为什么过去几年我们一直致力于提升公司整体的消费者能力，我真心相信我们在运营方式上正取得突破。
If you just look at 1/1 of this year, so January of this year, and you just look at a couple of examples, our UHC mobile app visits were up 66% year-over-year. That's another record year of growth. The UHC app remains the #1 healthcare app in the Google and Apple App Stores. Across the whole of UnitedHealthcare, our consumers are choosing to increase their digital engagement with us by about a third a year. So, the app is two-thirds up. Everything across the whole of UHC is up by about a third. Our app registrations are up nearly 100% year-over-year. This is us moving to where American consumers want to be. They want to talk to us digitally. They want to use their phone to be able to access us. They don't want to make a phone call. It's been an extraordinary shift. We continue to work that way through.
如果你看看今年1月份的一些数据，例如，我们的UHC移动应用访问量同比增长了66%，这又创下了新高。UHC应用在Google和Apple应用商店中仍然是排名第一的医疗应用。在整个UnitedHealthcare体系中，我们的消费者选择将与我们的数字互动提升约三分之一，因此应用使用率提升了约66%。整个UHC的各项指标均同比增长约三分之一，我们的应用注册量同比增长接近100%。这表明我们正朝着美国消费者期望的方向迈进：他们希望以数字方式与我们交流，希望通过手机访问我们的服务，而不再愿意打电话。这一转变非常显著，我们将继续沿着这一方向努力。
We're able to talk to members now about 10% less every year of our members who are making phone calls. They're getting what they need without needing to pick up the phone and make the call. All of those are fantastic metrics.
此外，我们发现每年打电话联系的会员数量减少了约10%，他们无需打电话就能获得所需服务。这些都是非常出色的指标。
You go to Optum Rx, the other big consumer engagement point, the most common interaction point across American healthcare is in pharmacy. You look at the 1st of January, you heard already today from John, we enrolled 750 new clients. They represented 1.6 million new American consumers who are now using Optum Rx. We're privileged to serve those people. We were able to bring them on board at a third less cost than in the prior year. That is entirely due to the adoption of digital technology and other modern capabilities. Our digital engagement registrations across Optum Rx themselves are up 16%.
再来看Optum Rx，这是另一个重要的消费者互动点，也是美国医疗体系中最常见的互动环节，即药房。你看看1月1日的数据，正如John今天已经提到的，我们新增了750个新客户，这代表着有160万美国新消费者现在正在使用Optum Rx。我们非常荣幸能为这些人提供服务，而且我们以比去年低三分之一的成本将他们吸引进来，这完全归功于数字技术及其他现代能力的应用。Optum Rx的数字互动注册率也提高了16%。
Those are all examples of how this company has been investing relentlessly, first and foremost, to understand what American consumers want and then build it. And we are committed to continuing to build those capabilities and deliver the very best, most convenient experience possible, not just in the insurance business, but also in the Optum service business led by Optum Rx.
这些例子充分说明了本公司一直在不断投资，首先致力于了解美国消费者的需求，然后满足这些需求。我们承诺将继续建设这些能力，提供尽可能最佳、最便捷的体验，不仅在保险业务中如此，在由Optum Rx主导的Optum服务业务中亦是如此。
That's where we're going. We're committed to this agenda, Lance. We always have been, and you should continue to see us make substantial improvements to make the experience of engaging with the healthcare system easier tomorrow than it was yesterday.
这就是我们的发展方向，Lance。我们始终致力于这一议程，你会继续看到我们在不断取得实质性改进，使得明天与医疗系统的交互比昨天更加便捷。
I appreciate the question. Next question.
感谢你的提问。接下来，下一个问题。
Operator
主持人
We'll go next to David Windley with Jefferies.
接下来，我们请Jefferies的David Windley提问。
David Windley
Thank you for taking my questions. And Andrew, thank you. I want to give you kudos for your emphasis on price. I feel like that's underappreciated in the United States. My question is around SG&A. If I extract -- if I ignore the portfolio changes, the way you might call normal course SG&A improvement, efficiency improvement in '24 was still substantial. You need another step down in 2025 per your guidance. Both of those are significant relative to historical norms. Could you talk about the sources of that efficiency, perhaps a nod to AI and some of the technology that you've talked about, but the sources of those savings and the durability of the savings that you're extracting? Thank you.
感谢您接受我的提问。Andrew，也谢谢您。我想赞扬您对价格问题的重视，我觉得在美国这一点常常被低估。我的问题是关于SG&A费用的。如果我忽略掉投资组合变动，也就是您所谓的常规SG&A改善，2024年的效率提升依然非常显著。根据您给出的预期，2025年还需要进一步降低这部分费用。这两项相对于历史水平来说都非常显著。请问您能谈谈这些效率提升的来源吗？也许可以提及一下AI及您所讨论过的部分技术，以及这些节省来源的持久性。谢谢。
Andrew Witty
Yeah, David, thanks so much. I'm going to ask John to give you a kind of overview, and then I'm going to ask our Chief Technology Officer to give you a little like a few examples or a little insight into our ambitious -- I'm going to call it modernization agenda of technology, because it's not just AI, it's all of the different aspects, but I think it'd be good for you to hear from Sandeep. But John, would you mind starting off?
是的，David，非常感谢你的提问。我先请John为你概述一下，然后我会请我们的首席技术官提供一些例子或见解，介绍我们雄心勃勃的——我称之为技术现代化议程，因为这不仅仅涉及AI，而是涵盖了所有不同的方面，我觉得由Sandeep来说明会更好。但John，你能先开始吗？
John Rex
Good morning, David. So, the source of those savings along the lines of the commentary that Andrew was offering a few moments ago, led by digital adoption. So, we serve roughly almost 150 million people across the breadth of UnitedHealth Group. And as we seek to make those experiences smoother, simpler, faster, that's being led by digital adoption. It's being led by having our customer service representatives much more informed when they do pick up the phone if the customer needs to call, much deeper insight into frustrations or any kind of experience the customer may be having or had so they can get to the root cause much more quickly. So, you're seeing those elements just accelerate.
早上好，David。正如Andrew刚才所说，这些节省的来源主要得益于数字化的普及。我们服务于大约1.5亿人在整个联合健康集团中。为了让用户体验更加顺畅、简单、快捷，这一切都是由数字化推动的。当客户需要打电话时，我们的客服代表能够更充分地了解情况，并深入洞察客户所经历的挫折或其他体验，从而更快地找出根本原因。所以，你看到这些因素正在加速发挥作用。
Look, I said it a little bit in my commentary, it feels very early stage to us in terms of what we're actually doing here. And as I work with the technology team, Sandeep and the teams and what they're hitting here, these are -- we're just kind of scratching the surface of the opportunity. So, when you ask the important questions about durability, it's super early stage in terms of what we see as the opportunity. I would tell you these -- what we're doing right now feel like just kind of the initial scratching the surface that we'd be doing in terms of where we could -- where we believe we can take this and the opportunities that we're seeing.
听着，我在发言中已经提到过，就我们目前实际做的事情而言，这仍然处于非常早期的阶段。与技术团队，Sandeep和其他团队一起工作时，我们觉得只是触及了机会的皮毛。因此，当你问到关于这些节省的持久性等重要问题时，我们认为这仍处于机会的初期阶段。我想告诉你，我们现在所做的仅仅是初步探索，我们相信未来可以从中获得更多机会。
这个行业会不会受到历史数据的拖累？金融行业就非常麻烦。
So, one of the things we're most excited about is the team as we sit together and we think about the experience that consumers are going to have, how we're going to be able to make these much smoother, simpler and satisfying for everyone, including our employees who work with our customers.
我们最令人兴奋的事情之一是，团队齐心协力思考消费者将会拥有的体验，以及我们如何能让这一切变得更顺畅、更简单、更令人满意，不仅是为了客户，也包括为与客户互动的员工。
And Sandeep, maybe you could offer a few comments?
Sandeep，也许你可以说几句吗？
Sandeep Dadlani
Sure. Thank you, John, and thanks, David, for the question. Our AI, digital, automation and in general, our modernization agenda has focused largely on removing administrative menial tasks in the system and improving consumer experiences. Some examples earlier that you have noticed has been around our call center efforts. Andrew just mentioned, we received 10% less calls for the same consumer base compared to last year. And we haven't even scaled this fully. By the end of 2025, we will be scaling this fully, and that's one of hundreds of use cases that we are scaling.
当然。谢谢你，John，也谢谢你，David，的提问。我们的AI、数字化、自动化以及总体的现代化议程主要致力于消除系统中繁琐的行政性任务，并提升消费者体验。比如你们之前注意到的呼叫中心方面的例子，正如Andrew提到的，与去年相比，我们针对相同消费者群体接到的电话减少了10%，而这一措施尚未完全推广。到2025年底，我们将全面推广这一措施，这只是我们正在扩展的数百个用例中的一个。
Last quarter, we talked about clinical summaries for nurses that helps our nurses focus on healthcare, and that's getting scaled fully. As we focus in 2025, we actually are excited about more compelling consumer experiences, helping providers and clinicians with documentations and summaries, and frankly, digitizing all the paperwork in the entire healthcare experience; [think of] (ph) benefits documents, facilities, provider contract, helping drive much more automated seamless, frictionless claims processing as well. So, we're excited about the agenda. Thank you.
上个季度，我们谈到了为护士提供的临床摘要，这帮助护士专注于医疗工作，并且这一举措正在全面推广。随着我们聚焦2025年，我们实际上对提供更引人注目的消费者体验感到兴奋，这包括帮助供应商和临床医生处理文档和摘要，坦率地说，就是将整个医疗过程中的所有文书工作数字化；例如，福利文件、设施信息、供应商合同等，都有助于实现更自动化、无缝、无摩擦的理赔流程。因此，我们对这一议程充满期待。谢谢。
Andrew Witty
Sandeep, thanks so much. David, I appreciate the question. If we could move on to the next question, please?
Sandeep，非常感谢。David，我感谢你的提问。接下来请下一个问题。
Operator
主持人
We'll go next to Scott Fidel with Stephens.
接下来，我们请Stephens的Scott Fidel提问。
Scott Fidel
Hi, thanks. Good morning. I was hoping just given some of the unusual patterns that we saw in '24 and that then will have effects on 2025 when thinking about the sequencing of Medicaid margins and MLRs and some of the utilization patterns, if you would help us maybe in thinking about any comments on EPS seasonality that may be different in 2025 relative to '24? And then similarly, MLR sequencing that you're thinking maybe having a bit of a different pattern around that guidance that you gave for the full year? Thanks.
嗨，谢谢。早上好。我想请问一下，鉴于我们在2024年看到的一些不寻常的模式，并且这些模式会影响2025年在Medicaid利润率、医疗护理比率（MLR）以及部分利用率模式方面的排序，您能否就EPS季节性（每股收益的季节性变化）方面，谈谈2025年是否会与2024年有所不同？另外，关于MLR的排序，您是否认为与全年给出的指引相比，会呈现出略有不同的模式？谢谢。
Andrew Witty
Scott, thanks so much. John?
Scott，非常感谢。我请John回答一下，好吗？
John Rex
Good morning, Scott. So, I'd say in terms of seasonality, first half, second half, think of that as relatively balanced in terms of seasonality for earnings progression.
早上好，Scott。关于季节性，我认为上半年与下半年在盈利进程方面的季节性是相对平衡的。
In terms of medical care ratio and thinking about kind of those elements, you start first, of course, with a view that at the midpoint, the full year care ratio will be 86.5%. So, as we noted earlier, about 100 basis points above the elevated '24 level. And I just had discussed '24, it's included a number of discrete items. Within that, the quarterly pattern will look familiar with the first quarter below the midpoint of that and the fourth quarter above the midpoint and trending up to the middle of the year. And then, within the year, the pattern familiar.
关于医疗护理比率以及相关因素，首先我们认为全年中点时的护理比率将达到86.5%，也就是说，比2024年较高水平高出约100个基点。正如我刚才讨论的2024年情况，其中包含了多个独立项目。就季度模式而言，第一季度会低于这一中点，而第四季度则高于中点，并逐步向年中趋近，整个年度内的模式是比较熟悉的。
So, those would be the elements we'd kind of think about as that patterns through. Slope a little impacted, of course, by some of the Part D changes that are out there also, that I think you're well aware of already because those have been out for a while. So, the slope of that will be impacted a bit by that also. Those would be the key elements.
所以，这些就是我们在考虑这一模式时所关注的要素。当然，其中的趋势斜率会受到部分D计划变动的影响，我相信你对此已经非常清楚，因为这些变动已经存在一段时间了。因此，趋势斜率也会受到一些影响。这些将是关键要素。
Andrew Witty
Great. John, thanks so much. Appreciate it. Next question?
很好，John，非常感谢。接下来，下一个问题？
Operator
主持人
We'll go next to Sarah James with Cantor Fitzgerald.
接下来，我们请Cantor Fitzgerald的Sarah James提问。
Sarah James
Thank you. I'll stick on MLR. John, could you help us bridge '24 to '25 by sizing some of the impact of the components that you called out, like your assumptions on core trends versus IRA, and any offsets like rates or non-repeat of the MA Group refunds? Thanks.
谢谢。我依然关注MLR问题。John，您能否帮助我们将2024年与2025年的情况衔接起来，说明一下您提到的各组成部分的影响，比如您关于核心趋势与IRA影响的假设，以及任何类似费率或MA团体退款不再重复的抵消因素？谢谢。
John Rex
Yeah, good morning, Sarah. Certainly. So, kind of big elements that we'd call out here, certainly, the IRA impacts, a mix of our—the people we're serving, we're serving more people than public sector plans. Of course, that's kind of a normal course element. And then, of course, second year of the CMS funding rate reductions here.
是的，Sarah，早上好。当然，在这里我们会提到一些主要因素，首先是IRA的影响，以及我们服务人群的构成——我们服务的人数比公共部门计划更多，这本身就是一个常态因素。其次，还有CMS资金费率削减的第二年因素。
Elements kind of probably going the other direction here would be certainly the cyber in South America impacts, we'd size those, think about that as about 30 basis points in our 2024. Some of the trend affordability and other initiatives that we have in there also. And then, as I mentioned also, just taking appropriately respectful view of the care activity environment as we step out. Thank you.
而可能朝相反方向影响的因素则包括南美地区的网络攻击影响，我们估计这在2024年大约占30个基点，还有一些关于趋势负担能力以及其他举措的因素。此外，如我之前所提，也要以适当的尊重态度看待我们所处的护理活动环境。谢谢。
Andrew Witty
Thanks so much, John. We just have time for one last question, and operator?
非常感谢John。我们只有时间回答最后一个问题了，主持人？
Operator
主持人
We'll go next to Joanna Gajuk with Bank of America.
接下来，我们请美国银行的Joanna Gajuk提问。
Joanna Gajuk
Hey, good morning. Thanks for squeezing me in. So, I guess something that maybe didn't come up probably in the discussion of MLR being high in '24, but also the outlook for '25, can you talk about the margins in your Medicare Advantage business? So, I appreciate second year of V28 and such, but just can you explain for us how the margin in that particular business was in '24 versus your target margins? And do you expect the margins to improve year-over-year in '25? Thank you.
嗨，早上好。感谢您给我留出提问的机会。我想问一个问题，也许在关于2024年MLR偏高以及2025年展望的讨论中没有涉及到，那就是请您谈谈您在Medicare Advantage业务中的利润率情况。我理解V28第二年的情况，但能否为我们解释一下，这个业务在2024年的利润率与您设定的目标利润率相比如何？您是否预计2025年的利润率会同比改善？谢谢。
Andrew Witty
Joanna, thanks so much. Let me ask Tim Noel to respond to that.
Joanna，非常感谢。让我请Tim Noel对此进行回答。
Tim Noel
Thanks, Joanna, for the question. As we think about our long-term planning approach to Medicare Advantage, we remain consistent in our view of targeted margins. And that doesn't change as we were thinking about '25 like any other year, which is good because as we think about our forward view in any sequential year, not a lot of pricing catch-up that we need to engage in and it can really focus on stability for people, the people we serve and the prospects who may want to choose us in the future. So, really not a lot of change here, very consistent with how we've thought about it previously.
谢谢你，Joanna，关于这个问题。谈到我们对Medicare Advantage的长期规划，我们对目标利润率的看法始终保持一致。我们对2025年的预期与其他年份没有什么不同，这很好，因为从我们对未来各年度的展望来看，并不需要进行大幅的价格追赶，这让我们可以真正专注于为我们所服务的人群以及未来可能选择我们的客户提供稳定性。所以，整体来看变化不大，与我们之前的思路非常一致。
Andrew Witty
Great. Tim, thanks so much. And Joanna, thanks so much for the question. Unfortunately, that's all the time we have this morning. And I want to thank you all for a robust and productive discussion.
很好。Tim，非常感谢。Joanna，也非常感谢你的提问。不幸的是，我们今天早上的时间到此为止。我想感谢大家参与了一场充满活力且富有成效的讨论。
I hope that during our session today, you heard a team that is very focused on both effectively navigating the challenges and distinct growth opportunities ahead for UnitedHealth Group. A team leading an enterprise with the capabilities and energy to help each day to make healthcare better for the people we are privileged and proud to serve. Thanks so much for your time.
我希望在今天的会议中，您能感受到我们的团队非常专注于有效应对挑战以及把握联合健康集团未来独特的增长机遇。我们的团队领导着这家拥有强大能力和活力的企业，每天都在努力让医疗服务变得更好，为我们有幸并自豪地服务的人群创造价值。非常感谢大家的时间。
Operator
主持人
This does conclude today's conference. We thank you for your participation.
本次会议到此结束。感谢您的参与。
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