2025-04-17 UnitedHealth Group Incorporated (UNH) Q1 2025 Earnings Call Transcript
UnitedHealth Group Incorporated (NYSE:UNH) Q1 2025 Results Conference Call April 17, 2025 8:45 AM ET
Company Participants
Andrew Witty - Chief Executive Officer
John Rex - Chief Financial Officer
Tim Noel - Chief Executive Officer, UnitedHealthcare Medicare & Retirement
Amar Desai - Chief Executive Officer, Optum Health
Heather Cianfrocco - Chief Executive Officer, Optum
Patrick Conway - Chief Executive Officer, Optum Rx
Krista Nelson - Chief Executive Officer, Community & State
Bobby Hunter - President, Medicare
Conference Call Participants
Justin Lake - Wolfe Research
Josh Raskin - Nephron Research
A.J. Rice - UBS
Lisa Gill - JPMorgan
Stephen Baxter - Wells Fargo
Erin Wright - Morgan Stanley
Andrew Mok - Barclays
Dave Windley - Jefferies
Ben Hendrix - RBC Capital Markets
Lance Wilkes - Bernstein
Sarah James - Cantor Fitzgerald
Jessica Tassan - Piper Sandler
Operator
操作员
Good morning, and welcome to the UnitedHealth Group First Quarter 2025 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2025年第一季度财报电话会议。在联合健康集团完成预备发言后，将进行问答环节。提醒各位，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.
下面是一段重要的介绍信息。本次电话会议包含美国联邦证券法项下的前瞻性声明。这些声明存在风险与不确定性，可能导致实际结果与历史经验或当前预期有重大差异。这些风险与不确定性的部分描述载于我们向证券交易委员会提交的报告中，包括我们当前和定期文件中的警示性陈述。
This call will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amounts is available on the Financial and Earnings Reports section of the company's Investor Relations page at www.unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated April 17, 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公认会计准则（non‑GAAP）数据。non‑GAAP与GAAP数据的对账表可在公司投资者关系网页的“财务和收益报告”栏目（www.unitedhealthgroup.com）查看。本次电话会议所呈现的信息包含在我们今晨发布的收益公告及2025年4月17日提交的8‑K表格中，均可通过公司网站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.
现在我将会议交给联合健康集团首席执行官安德鲁·威蒂。
Andrew Witty
安德鲁·威蒂
Good morning, everyone. Thank you for joining us today.
大家早上好，感谢各位今天的到来。
UnitedHealth Group started 2025 in two seemingly disparate ways. One, continued strong growth across our businesses. Our people are providing more health benefits and services to more members and patients as the market responds to our distinct offerings. The other way, however, was an overall performance that was frankly unusual and unacceptable.
联合健康集团在2025年的开局呈现出两种看似截然不同的情况。其一，我们各项业务继续强劲增长。随着市场对我们独特产品的回应，我们的员工正向更多成员和患者提供更多健康福利和服务。然而另一方面，整体业绩却坦率地说异常且不可接受。
As you saw in our release, we're revising our adjusted earnings per share outlook for the year to $26 to $26.50. This morning, we'll detail for you the factors driving our revised outlook and how we plan to address them.
正如您在我们的公告中所见，我们将今年的调整后每股收益预期下调至26至26.50美元。今天上午，我们将向各位详细说明导致这一修订的因素以及我们的应对计划。
I'll start with performance, which was impacted by two broad factors in our Medicare businesses: care activity and member profiles. It's important to recognize UnitedHealthcare and Optum are distinct businesses with different models, markets and products. In addition, Optum's Medicare business is multi-payer and not limited to just UnitedHealthcare members. Given these differences, changes in care activity and member profiles do not always follow the same patterns and can result in different impacts to each business. The respective teams are urgently responding to our performance challenges.
我先从业绩说起，在我们的医疗保险业务中，业绩受两大因素影响：医疗服务活动和成员结构。必须认识到，UnitedHealthcare与Optum是不同的业务，拥有不同的模式、市场和产品。此外，Optum的医疗保险业务是多付方模式，并不限于UnitedHealthcare成员。由于存在这些差异，医疗服务活动及成员结构的变化并不总是呈现相同模式，因此对各业务的影响也不尽相同。相关团队正紧急应对我们的业绩挑战。
Starting with care activity. In UnitedHealthcare's Medicare Advantage business, we had planned for 2025 care activity to increase at a rate consistent with the utilization trend we saw in 2024. Instead though, first quarter 2025 indications suggest care activity increased at twice that rate. Increases in physician and outpatient services were most notable and inpatient to a lesser extent. This increase in care activity was limited to our MA business and was not a factor in our commercial or Medicaid businesses. Care activity trends in those areas were as expected.
先说医疗服务活动。在UnitedHealthcare的Medicare Advantage业务中，我们原本预计2025年的医疗服务活动增速将与2024年的利用率趋势保持一致，但2025年第一季度的迹象却显示该活动增速是原先预期的两倍。医师服务和门诊服务的增幅最为显著，住院服务增幅略小。这一医疗服务活动的增加仅限于我们的MA业务，对商保或医疗补助业务没有影响。后两者的医疗服务活动趋势符合预期。
Turning to member profile. Unanticipated changes in our Optum Medicare membership is impacting 2025 revenue. We added more new Medicare patients to Optum Health, a portion of whom were covered by plans that were exiting markets. They experienced a surprising lack of engagement last year, which led to 2025 reimbursement levels well below what we would expect and likely not reflective of their actual health status.
再谈成员结构。Optum Medicare成员的意外变化正影响2025年的收入。我们为Optum Health新增了更多新的医疗保险患者，其中部分患者原先投保的计划正在退出市场。他们去年表现出意外的低度参与，导致2025年的报销水平远低于我们的预期，很可能并未真实反映其健康状况。
Additionally, many of the current and new complex patients we serve are more affected by the CMS risk model changes that we are in the process of implementing. To be sure, it is complicated, but we're not executing on the model transition as well as we should. We must and will work to better anticipate and address these factors.
此外，我们服务的许多现有及新加入的复杂患者更易受到我们正在实施的CMS风险模型变更的影响。诚然，这一过程复杂，但我们的模型转换执行得并不理想。我们必须并且将努力更好地预测并解决这些因素。
Here still early in 2025, we believe they are highly addressable as we look ahead to 2026. Let me now talk specifically about what we're doing. First, we're ensuring the complex patients most impacted by the previous administration's Medicare funding cuts engage in clinical and value based programs. Second, we're consistently engaging with members in their homes and in post-discharge settings. Engagement remains the key.
2025年尚处早期，展望2026年，我们相信这些问题高度可控。接下来具体说明我们的行动。第一，我们确保受上一任政府医疗保险资金削减影响最大的复杂患者参与临床和价值导向型项目。第二，我们持续在患者家中及出院后环境与成员互动。参与度仍是关键。
Third, we are appropriately assessing and updating the health status of new patients, especially those at high risk levels. Fourth, to more effectively transition to the new CMS risk model, we're investing significantly in improving physician clinical workflow to help ensure better care and timely insights on when and where care is most efficient and effective. Finally, our Medicare Advantage plan designs and pricing for 2026 will be fully informed by these trends.
第三，我们将对新患者，尤其是高风险患者，适时评估并更新其健康状况。第四，为了更有效地过渡到新的CMS风险模型，我们正在大力投资提升医师临床工作流程，以确保获得更优的护理以及关于何时何地提供最有效护理的及时洞察。最后，我们2026年的Medicare Advantage计划设计和定价将充分反映这些趋势。
While we are decidedly unsatisfied with these results, our growth and foundation for improvement remains solid. UnitedHealthcare's Medicare Advantage business is on pace to serve an additional 800,000 people this year. Optum Health is on track to add 650,000 net new patients to value based care arrangements.
虽然我们对这些结果明显不满意，但我们的增长势头和改进基础依然稳固。UnitedHealthcare 的 Medicare Advantage 业务今年有望新增服务 80 万人。Optum Health 也预计净增 65 万名签约价值型护理的患者。
In Medicaid, we are growing and continue to see positive momentum in closing the gap between people's health status and state rates, and we are very appreciative of our state customers for the ongoing productive discussions.
在医疗补助（Medicaid）领域，我们正在持续增长，并继续缩小人群健康状况与各州支付费率之间的差距，对各州客户与我们保持富有成效的持续对话，我们深表感谢。
Within Optum, so far this year, Optum Rx is off to a strong selling season, characterized by new wins as well as high retention of long-term customers. The growth of Optum Rx underscores the vital role that PBMs play in helping to reduce the price of drugs for consumers and the value that sophisticated purchases of healthcare, the employers, unions and governments see in our efforts to counter the high prices set by drug manufacturers.
在 Optum 内部，今年迄今，Optum Rx 迎来了强劲的销售季，既取得新的客户，也保持了高比例的长期客户留存。Optum Rx 的增长凸显了药品福利管理机构（PBM）在降低消费者药价方面的关键作用，以及雇主、工会和政府等专业医疗购买方对我们遏制药企高价所展现价值的认可。
And to ensure that people have convenient access to high quality affordable drugs. That's more important than ever as drug manufacturers continue to increase what they charge Americans, in some cases, 10x what they charge people in Europe.
此外，我们致力于确保公众能方便地获得高质量、可负担的药品。在药企不断提高对美国人的收费、个别药品价格甚至达到欧洲售价十倍之际，这一点比以往任何时候都更加重要。
The growth at UnitedHealthcare and Optum reflects the efforts of our 400,000 colleagues who come to work every day, thinking differently about what is possible, advancing new products and ideas while constantly refining existing programs, working to make things better for the people we are privileged to serve. Our team continues to innovate to make accessing care easier.
UnitedHealthcare 和 Optum 的增长体现了我们 40 万名同事的努力，他们每天带着突破可能的思维投入工作，推出新产品与新理念，同时不断完善既有项目，努力让我们有幸服务的群体获得更好的体验。我们的团队持续创新，以便更轻松地获取医疗服务。
For example, our newest tools have sparked a more than 40% increase in digital engagement among our senior members through the first quarter. We see evidence of this in sharply higher and earlier wellness visits to their primary care physicians, with total visits in the first quarter running far above the year-ago period. This will help members better manage their health and promote early detection of emerging issues.
例如，在第一季度，我们最新推出的工具已使老年会员的数字互动提高了逾 40%。这体现在他们对初级保健医师的健康检查次数显著增多且更早进行，第一季度的总就诊次数远超去年同期。这将帮助会员更好地管理健康，并促进及早发现潜在问题。
Further, Medicare Advantage also costs taxpayers less and delivers more to seniors than fee for service Medicare, especially in value based care arrangements. An essential approach in achieving both health outcomes and lowered costs is ensuring people get the care they need when and where they need it. And a good place to understand those needs better is in a seniors' home. Our HouseCalls program does just that. HouseCalls, which is only available in Medicare Advantage, provides a thorough in home clinical visit at no cost to seniors.
此外，与按服务计费的传统医疗保险相比，Medicare Advantage 对纳税人的成本更低，却能为老年人提供更多保障，尤其在价值型护理模式下尤为明显。实现健康效益与成本下降的关键，在于确保人们在需要时、在需要的地点得到所需护理，而深入了解需求的最佳场所之一就是老年人的家中。我们的 HouseCalls 项目正是如此。HouseCalls 仅面向 Medicare Advantage 成员，为老年人提供免费的全面居家临床访问。
Following CMS' best practices for such care, our clinicians review a patient's medical history and current medications, conduct comprehensive physical exams, provide lab tests and screenings and coordinate necessary follow on care. HouseCall's clinicians closed millions of care gaps last year, helping people stay out of the hospital and the emergency department and referring those in need to appropriate social services to help them live healthier at home.
遵循 CMS 针对此类护理的最佳实践，我们的临床人员会查阅患者病史和当前用药，进行全面体检，提供实验室检测和筛查，并协调必要的后续护理。仅去年，HouseCalls 的临床人员就弥合了数百万个护理缺口，帮助人们避免住院或急诊，并将有需要者转介至合适的社会服务机构，让他们在家中过上更健康的生活。
This is Medicare Advantage innovation and value in action, helping drive proactive preventive engagement with the health system rather than more expensive reactive acute care. These benefits and innovations and their value to seniors and taxpayers will put an unnecessary risk by funding cuts in recent years to the Medicare Advantage program.
这正是 Medicare Advantage 的创新与价值的实践，推动人们与医疗体系进行主动的预防性互动，而非付出更昂贵的被动急性护理。近年来对 Medicare Advantage 资金的削减已将这些益处、创新及其对老年人和纳税人的价值置于不必要的风险之中。
While we continue to navigate those funding cuts to seniors benefits, it is significant that the recently released 2026 rate notice begins to reflect the accelerating care cost trends we've experienced for some time. This will provide much needed relief to seniors and reflects policymakers' understanding of the importance and the popularity of Medicare Advantage.
在我们继续应对针对老年人福利的这些资金削减之际，最近发布的 2026 年费率通知开始体现出我们一段时间以来所经历的日益加速的医疗成本趋势，这一点意义重大。这将为老年人提供急需的缓解，也反映了政策制定者对 Medicare Advantage 重要性和受欢迎程度的认可。
Our work to deliver a better experience for people and lower costs spans our enterprise as it always has. Just within the last few weeks, we've introduced several initiatives that will help people in their health care journeys. Optum Rx will remove prior authorizations on 80 drugs accounting for more than 10% of our pharmaceutical prior authorizations.
我们致力于为人们提供更佳体验并降低成本，这项工作一如既往地贯穿全集团。在过去几周内，我们推出了若干举措，旨在帮助人们的医疗旅程。Optum Rx 将取消对 80 种药物的事前授权，这些药物占我们所有药品事前授权的 10% 以上。
And Optum Rx has aligned payment models to pharmacies more closely to their cost for drugs. This helps pharmacies manage the ever increasing prices charged by drug manufacturers, enabling pharmacies to stock more medicines and ensuring more consistent pricing and access to medicine for consumers. 26 million consumer calls were more accurately directed to the right advocate by an AI agent, improving the consumer experience and reducing wait times.
此外，Optum Rx 已将对药房的支付模式与其药品成本更加紧密地对齐。这有助于药房应对药企不断上涨的进货价格，使其能够备货更多药品，并为消费者提供更稳定的药价和药品可及性。通过 AI 坐席，2600 万次消费者来电被更准确地转接到合适的客服代表，改善了客户体验并缩短了等待时间。
We expect AI will direct over half of our calls to the best resource during 2025. All of these efforts are making things simpler and easier for consumers and providers, a goal we share with all health care stakeholders. Yet, we all have to contend with the stubborn fact that health care costs more in the U.S. than it should, even beyond the widely recognized disparities in drug prices.
我们预计到 2025 年，AI 将把超过一半的来电转接至最合适的资源。所有这些努力正让消费者和医疗提供者的体验变得更加简单便捷，这也是我们与所有医疗行业利益相关者共同追求的目标。然而，我们仍必须面对一个顽固事实：美国的医疗支出高于应有水平，这不仅体现在众所周知的药价差异上。
Common procedures such as heart bypass surgery, spinal fusions and heart stents are 4x as expensive in the U.S. as they are in Germany, Australia and the UK. Total hip replacements are twice as much. It's simply not sustainable. As we have made clear, we are as committed as ever to continuing down the path of transparency and affordability, ensuring that Americans get the health system they deserve.
在美国，常见手术如冠状动脉搭桥、脊柱融合和心脏支架的费用是德国、澳大利亚和英国的四倍，髋关节置换术则贵出两倍。这显然不可持续。正如我们所强调的，我们仍将坚定不移地走在提高透明度和可负担性的道路上，确保美国人拥有他们应得的医疗体系。
With that, I'll turn it over to John, who will discuss first quarter performance and full year outlook in more detail. John?
接下来，我将把时间交给约翰，他将更详细地讨论第一季度业绩及全年展望。约翰？
John Rex
约翰·雷克斯
Thank you, Andrew.
谢谢你，安德鲁。
I'll start by walking through several updates to our ‘25 outlook and then elaborate on the reasons for them. As Andrew said, we now expect adjusted earnings of $26 to $26.50 per share. It's an outlook that I'm extremely disappointed to share with you. This reflects the profile of patients served at Optum Health. It also reflects significantly increased care activity across the UnitedHealthcare Medicare Advantage plans.
我先概述一下我们对 2025 年展望的若干更新，然后阐述原因。正如安德鲁所说，我们现在预计调整后每股收益为 26 至 26.50 美元。分享这一前景让我极为失望。这反映了 Optum Health 所服务患者的特点，也反映了 UnitedHealthcare Medicare Advantage 计划中大幅增加的就医活动。
Within that outlook, we expect about 50% to come in the first half of the year. We're affirming the consolidated revenue outlook of $450 billion to $455 billion we shared with you in December. Within this, we expect revenues for both UnitedHealthcare and Optum Rx to be better than our initial view, offsetting a reduced outlook at Optum Health.
在这一前景中，我们预计全年约 50% 的收益将在上半年实现。我们重申去年 12 月公布的 4,500 亿至 4,550 亿美元的合并收入指引。其中，我们预计 UnitedHealthcare 和 Optum Rx 的收入都将好于最初预期，从而抵消 Optum Health 前景的下调。
The full year medical care ratio is now expected to be 87.5% plus or minus 50 basis points, reflecting higher utilization across senior populations and the patient mix and revenue profile of Optum Health. Within this range, expect the first half of the year to be below the midpoint and the second half to be above.
全年医疗费用率目前预计为 87.5%，上下浮动 50 个基点，反映老年人群更高的利用率以及 Optum Health 的患者结构和收入特征。在这一范围内，预计上半年将低于中点，下半年则高于中点。
At Optum Health, our revenue outlook is $106 billion to $107 billion and operating earnings is $6.2 billion to $6.4 billion based on the factors discussed and which I'll get into more deeply in a moment. Over half of the $10 billion revenue change is the result of transitioning some legacy risk‑based arrangements to fee‑based and is neutral to earnings. We expect about half of Optum Health's operating earnings to be in the first half.
在 Optum Health，我们的收入展望为 1,060 亿至 1,070 亿美元，营业利润为 62 亿至 64 亿美元，基于前述因素，稍后我还会详细说明。在 100 亿美元收入变动中，超过一半来自将部分既有风险模式协议转为按服务收费，对利润影响中性。我们预计 Optum Health 约一半的营业利润将在上半年实现。
At UnitedHealthcare, the operating earnings outlook is updated to $16 billion to $16.5 billion and reflects the higher care activity we're seeing. Within UnitedHealthcare, pressure was largely contained within the senior business where we saw a sharp increase in care activities that became apparent as we closed out the quarter.
在 UnitedHealthcare，我们将营业利润指引更新为 160 亿至 165 亿美元，体现我们观察到的更高就医活动。在 UnitedHealthcare 内部，压力主要集中在老年人业务板块，随着季度结束，我们看到护理活动急剧增加。
As noted, this was most significant for both physician and outpatient care and to a lesser extent inpatient care. In years past, this is an insight we may not have picked up until the second quarter, so it is useful to have the information with ample time to incorporate into our 2026 planning. In the quarter, we experienced percentage increases in care activity about double last year's level. Unit prices behaved as expected.
如前所述，医师服务和门诊护理增幅最大，住院护理增幅略低。以往我们可能要到第二季度才会发现这种趋势，因此现在提前掌握信息，有助于将其充分纳入 2026 年规划。本季度的就医活动同比增速约为去年的两倍，而单价表现符合预期。
Let me start with the obvious fact that it is early in the year and we don't know everything that might be driving our experience or how long the increase in care activity might last. But care activity was broad based across our senior individual and group populations. One example, in group MA, member retention was about 98% and as a result serves well as a same member metric. Here we observed significant increases in elective care activity in the first quarter.
需要指出的是，现在仍是年初，我们尚未完全弄清所有驱动因素，也不清楚护理活动的升高会持续多久。但在老年个人与团体群体中，就医活动普遍增加。以团体 Medicare Advantage 为例，会员留存率约为 98%，因此可作为同一会员的度量指标。在这里，我们在第一季度观察到择期护理活动显著增加。
Of note in this population, we believe the behavior may have been impacted by the meaningfully higher member premiums, which were driven by the Medicare funding cuts. Another example across senior populations was the earlier and higher wellness visit activity we saw, which of course drives specialty and outpatient utilization. Some of this may be a seasonal shift in consumption patterns as wellness visits happen once a year.
值得注意的是，我们认为该人群的行为可能受到更高会员保费的影响，这些保费上涨源于 Medicare 资金削减。另一个例子是老年人群在预防保健就诊上的更早且更频繁活动，这自然带动了专科和门诊服务利用。其中部分可能是季节性消费模式的转移，因为健康体检一年一次。
Turning to Optum Health, as it relates to the patient profile, we experienced a couple of key elements here.
谈到 Optum Health 的患者结构，我们遇到了两个关键因素。
First, growth in certain markets where there were meaningful plan exits. These new patients had not been engaged by their prior plans for most of last year and we're seeing revenues associated with the patient profiles meaningfully below expected and normal levels. This is very addressable.
首先，某些市场出现显著的计划退出，从而带来增长。这些新患者去年大部分时间没有得到原先保险计划的有效管理，因而相关收入大幅低于预期和正常水平。这一问题十分可解。
Second, the ongoing execution to the new CMS risk model, while complicated given the multiyear phase in, has not been to our operational standards. Transitioning to a new model and concurrently running two distinct versions has been more operationally complex than anticipated. But no question, we need to execute better and we will.
其次，新 CMS 风险模型的持续执行因多年分阶段实施而较为复杂，其执行效果未达到我们的运营标准。在过渡到新模型的同时还要并行运行两个版本，带来的运营复杂度超出预期。但毫无疑问，我们需要并且将会更好地执行。
Across the enterprise, we continue to focus on operating costs to help mitigate external pressures, while ensuring our workforce aligns to the areas of greatest opportunities and customer needs. Looking ahead, we see a long runway for further technology advances that will translate to more and sustained operating efficiency, which in turn drives opportunity for further innovation and advancements in the company and across the industry.
在整个企业范围内，我们持续关注运营成本，以缓解外部压力，同时确保员工配置与最大机会和客户需求相匹配。展望未来，我们看到技术进一步进步的广阔空间，将带来更大且持续的运营效率，进而为公司及整个行业带来更多创新和进步机会。
Before we get to Q&A, I want to provide a few business highlights. At UnitedHealthcare, we still expect to serve up to 800,000 more people in Medicare Advantage this year across our individual group and dual special needs offerings. This underscores our long standing commitment to stability and differentiated value. Our growth demonstrates UHC's deep relationship with our members. People served by our community and state business increased to 7.6 million. We continue to have growth momentum with recent service expansions in Kentucky, New York and Florida.
在进入问答环节之前，我想分享几个业务亮点。在 UnitedHealthcare，我们仍预计今年在个人、团体及双重特殊需求计划中最多再服务 80 万名 Medicare Advantage 受益人，彰显我们长期以来对稳定性和差异化价值的承诺。我们的增长显示 UHC 与成员之间深厚的关系。我们的社区与州政府业务服务人数已增至 760 万人，并在肯塔基、纽约和佛罗里达的近期扩展中保持增长势头。
We're also encouraged by the updated Medicaid rates so far in 2025 that more closely align with underlying member acuity, but funding remains insufficient to meet the health needs of patients. Commercial self-funded membership increased by approximately 700,000 in the first quarter, a result of our continued strong product innovation.
2025 年迄今的最新 Medicaid 费率更贴合会员真实病情，这让我们备受鼓舞，但资金仍不足以满足患者的健康需求。首季度商业自保会员约增加 70 万人，得益于我们持续强劲的产品创新。
Commercial insured membership was impacted by the individual exchange products. Our disciplined pricing approach remains consistent and as a result, we experienced some member attrition. Overall in our commercial book, we are encouraged by the early ’26 selling season indications, which are showing strong retention rates.
商业保险成员受个人医保交易所产品的影响。我们始终坚持审慎的定价策略，因此出现了部分会员流失。整体而言，我们对 2026 年初期销售季的迹象感到乐观，留存率表现强劲。
Turning to Optum. At Optum Health, we continue to expect to add 650,000 new value based care patients this year. We're working to engage with these new members ever more rapidly. By the end of ’25, we expect to have about 5.4 million value based care patients. At Optum Insight, we have a pipeline of new products coming to market this year with exceptional customer interest. For example, in the first quarter, we launched AI powered claims efficiency tools that increase productivity by over 20% for our revenue cycle management customers.
再来看 Optum。在 Optum Health，我们仍计划今年新增 65 万名价值型护理患者，并正加速与这些新成员的互动。到 2025 年底，我们预计价值型护理患者总数将达到约 540 万。在 Optum Insight，我们今年将有一系列新产品上市，客户兴趣高涨。例如，第一季度我们推出了 AI 赋能的理赔效率工具，为收入周期管理客户的生产率提升了 20% 以上。
Lastly, Optum Rx revenues grew 14%, exceeding $35 billion for the quarter. Both customer retention and new customer wins contributed to script growth of 3%. As Andrew noted, performance in the quarter was below the standards we expect. But with disciplined and urgent execution and attention to detail, we expect a return to form in the quarters ahead.
最后，Optum Rx 收入增长 14%，本季度超过 350 亿美元。客户留存和新客户获胜共同推动处方量增长 3%。正如安德鲁所说，本季度业绩未达我们预期标准，但凭借严格而紧迫的执行力和对细节的关注，我们预计未来几个季度将重回正轨。
With that, I'll hand it back to Andrew.
说到这里，我把时间交还给安德鲁。
糊里糊涂不知道在说什么，说业绩极为失望但不知道失望在哪里？
Andrew Witty
安德鲁·威蒂
Thanks, John.
谢谢你，约翰。
Even with the growth of our -- I'm sorry. Even with the growth our people generated this quarter, this was far from the performance we expect of ourselves. We're acutely aware it's a privilege to be a part of an organization with the capabilities to make a meaningful contribution to modernizing and simplifying the health system.
即便——不好意思。即便我们同事在本季度实现了业务增长，这依旧远未达到我们对自身业绩的期望。我们深知，能够身处一家有能力为医疗体系的现代化与简化作出重要贡献的组织，是一种殊荣。
And we're committed to improving our performance in the rest of 2025 and into ‘26. And in doing so to delivering consistent positive results for you and returning to our long term earnings per share growth target of 13% to 16%.
我们承诺在 2025 年余下时间直至 2026 年持续提升业绩，为各位持续交付积极成果，并重返长期每股收益年增 13% 至 16% 的目标区间。
With that, we can now turn to your questions. Operator?
说到这里，我们进入答问环节。操作员？
Question-and-Answer Session
问答环节
Operator
操作员
[Operator Instructions] We'll take our first question from Justin Lake with Wolfe Research.
【操作员提示】我们接听来自沃尔夫研究公司的贾斯廷·莱克的第一个问题。
Justin Lake
贾斯廷·莱克
Thanks. Good morning. My question is on Medicare Advantage cost trend. You said that you came into the year assuming trend at similar levels 2024. Can you share with us precisely what that trend estimate was? Meaning, what did you expect for this year? And what are you expecting now? And can you tell us how much of that you actually saw in the first quarter?
谢谢，早上好。我的问题是关于 Medicare Advantage 的成本趋势。你们表示年初假设的趋势与 2024 年大致相当。能否具体说明该趋势预估值？也就是说，你们今年原本的预期是多少？现在预期又是多少？此外，能否说明第一季度已实际体现了多少？
For instance, how much did you miss your MLR by, your own estimate of MLR? And how much you are expecting that to accelerate or how different the back three quarters is versus what you saw in the first quarter? Maybe I’ll jump the margin on the --
例如，与自有估算相比，医疗费用率（MLR）偏差了多少？你们预计这种偏差会加剧多少？未来三个季度与第一季度相比会有多大差异？我或许先谈下利润率——
Andrew Witty
安德鲁·威蒂
Yeah. Justin, thanks so much for the question. I'll ask Tim Noel to respond just in a second in detail to your question. I mean, obviously, it's still very early in the year, but we have clearly seen a pickup in trend in a specific part of the UHC business again, the senior business. Tim will talk a little more about that to you in a second. It's still early, still even our first quarter is only partially complete, but unusually we've seen this pickup and which is what's obviously influencing our position here.
好的，贾斯廷，非常感谢你的提问。我会请蒂姆·诺埃尔稍后详细回答。显然，现在还在年初，但我们确实在 UHC 的某一部分业务——也就是老年人业务——看到趋势上升。蒂姆马上会详细阐述。目前仍然很早，甚至第一季度的数据还未完全结算，但这种非同寻常的上升已明显影响到我们的立场。
So let me get ask Tim to give you a little bit more detail on that.
因此，我请蒂姆来进一步说明。
Tim Noel
蒂姆·诺埃尔
Good morning, Justin. Thanks for the question. Yes, I'll attempt to break it all down for you here. So as was mentioned in the opening remarks, in 2025, we anticipated care levels consistent with what we observed in 2024, which felt appropriate as we stepped into the year. And what we were assuming and if you think about this as units consumed, we're assuming that in 2025, we'd see a similar increase by that metric that we observe in 2024.
早上好，贾斯廷。感谢提问。我在此为你详细拆解。正如开场所述，我们在 2025 年预期的就医水平与 2024 年相当，当时看来这是合理的。如果将其视为“服务量”，我们假设 2025 年该指标的增幅与 2024 年相近。
And if you break that down in the Medicare book, you can think that in total in terms of total trend drivers, about one-third of that is related to increase in care activity or units consumed. And what we are seeing and again that's focused on physician and outpatient, but driving an overall 2x increase in that level of units consumed in Q1 of 2025. And again, that metric is about one-third of the total trend drivers in the Medicare book.
若细分至 Medicare 账本，总体趋势驱动因素中约三分之一源于就医活动（即服务量）增加。我们所看到的重点仍是医师与门诊服务，其结果是在 2025 年第一季度服务量整体同比增加约两倍。而该指标占 Medicare 总趋势驱动因素的约三分之一。
We are seeing that inside of the first quarter of this year, but we are making the assumption right now that, that trend will persist throughout 2025 and then also making the same assumption that it will persist into 2026 and that will shape our overall pricing assumptions.
这一现象已在今年一季度显现。我们当前假设该趋势将在 2025 年全年持续，并同样假设将延续至 2026 年，这将塑造我们的整体定价假设。
Now some of the drivers that John mentioned behind what we're seeing. You might presume that some of those would result in a change in our seasonal consumption patterns. But at this distance, we feel like we need to make the assumption that that activity will persist throughout the year and into 2026.
关于约翰提到的若干驱动因素，你可能会认为其中一些会导致季节性消费模式变化。但以目前的距离观察，我们认为需要假设这种活动会贯穿全年并延续到 2026 年。
Operator
操作员
And we'll take our next question from Josh Raskin with Nephron Research.
接下来我们接听来自 Nephron Research 的 Josh Raskin 的问题。
Josh Raskin
Hi, thanks. Good morning. Can you help us connect the higher incidence of primary care visits and the Optum Health pressure? I assume you don't have that that primary care issue in Optum Health, which should also mitigate the downstream impact. So why are you expecting the higher follow through if you control primary care?
嗨，谢谢。早上好。您能帮我们把初级保健就诊频率上升与 Optum Health 所承受的压力联系起来吗？我认为 Optum Health 并不存在那种初级保健问题，本应减轻下游影响。既然初级保健在您掌控之中，为何仍预计会有更高的后续成本？
And then based on the fact that you're seeing worse performance in Optum Health or value based care, could you remind us why you think you can control cost better in that environment and it's probably a good time to get the refresher on why the strategy to allocate a lot more capital to VBC in the ecosystem totally is best in long term?
另外，鉴于您在 Optum Health 或价值型护理（VBC）方面表现更差，能否提醒我们为何您认为在那种环境中能更好地控制成本？现在也许正适合重温：为何在生态系统中向 VBC 投入更多资本的战略从长远看最优？
Andrew Witty
Yeah, Josh, thanks so much for the question. So I'm going to ask Tim just to address the first part of your question, then Amar to talk a little Dr. Desai to talk a little bit around the Optum Health experience during the quarter and the differences of what we're seeing there and the like. And as I said in my commentary at the beginning, the businesses do operate very different kind of models and it's not completely surprising to see somewhat different experiences.
好的，Josh，非常感谢你的提问。我会请 Tim 先回答你问题的第一部分，然后请 Amar，也就是 Desai 医生，谈谈本季度 Optum Health 的情况以及我们在那里观察到的差异。如我开场所言，这些业务的运营模式截然不同，因此出现一些不同体验并不完全令人意外。
And then I'm going to ask Heather to just do as you kindly requested a kind of refresher on the value based care position. So we'll do that also for you. So bear with us. This sounds probably going to take a little a few minutes. But Tim, if I could ask you to start and then we'll pass over to Dr. Amar Desai.
随后，我会请 Heather 按你所求简要回顾价值型护理的定位。我们也会为你做这部分内容，请稍候，大概需要几分钟。Tim，请你先开始，然后交给 Desai 医生。
Tim Noel
Yeah. Thanks, Josh, for the question. So yeah, let me just dive in a little bit with a little bit more detail into some of what we're seeing that's driving the increase in care activity. Now let me start with our fee for service, so kind of our non‑capitated community MA members. We have seen increase in physician outpatient care activity in that population.
好的，谢谢你，Josh 的提问。让我更详细地说明一下我们看到的促使护理活动增长的因素。先从按服务付费的成员说起，也就是非定额包干的社区 MA 会员。在这一群体中，我们确实看到医师门诊护理活动有所增加。
And one of the dynamics that we're seeing is they are generally seeking more preventative care, which is a good thing and that also includes more in home visits, more in home clinical assessments. And that in and of itself really not the trend driver, but it's the follow on care that is more than what we have anticipated and that constitutes specialist visits, physician specialist visits as well as some other outpatient services.
我们观察到的一个现象是，他们普遍寻求更多预防性护理——这本是好事——其中也包括更多居家访问、更多居家临床评估。单就这些本身并不是趋势驱动因素，真正推动超预期增长的是随后产生的后续护理，包括专科就诊、医师专科就诊以及其他一些门诊服务。
A dynamic at play in our group Medicare Advantage business is we are seeing a significant and disproportionate increase in utilization, largely within our public sector group retiree business. And this is a population that experienced the greatest year‑over‑year premium increases. And while we've seen a similar dynamic play out historically in our individual Medicare Advantage business when premium increases have been in play, we've really never seen this dynamic before in the group MA business.
在我们的团体 Medicare Advantage 业务中，也出现一个动态：利用率显著且不成比例地上升，主要发生在公共部门退休人员团体业务。这一群体经历了最大幅度的年比年保费上涨。虽然在个人 MA 业务中，当保费上涨时我们过去也见过类似情况，但在团体 MA 业务中从未出现过。
I mean, we're seeing it because of the pressures related to the Medicare funding cuts that are really driving up premiums in the group retiree business like they really never have before and kind of think groups with premiums going from $50 to $200. I mean, we did assume that we would see some care activity level increases in this population, but we're seeing far surpasses what we would have recently anticipated.
造成这种情况的原因在于与 Medicare 资金削减相关的压力，极大推高了团体退休计划的保费，前所未有——如保费从 50 美元涨到 200 美元左右。我们确实假设该人群的就医活动水平会有所增加，但现在看到的远超我们近期的预期。
And in that population as well, we are seeing more preventive care, more annual wellness visits, more in home clinical assessments. But again, the driver there also being really the follow on care that results from that.
在这一人群中，我们同样看到更多预防性护理、更多年度健康检查、更多居家临床评估。但再次强调，真正的驱动因素是由此产生的后续护理。
Amar Desai
阿马尔·德赛
Thanks for the question, Josh. So, the results for Optum Health, to be clear, were impacted by the profile of new value based patients in Optum Health and the second year of the V28 phase. And we're taking actions to proactively address these issues. Our patient profile post AEP included many new to Medicare as well as new to Optum Health who are meaningfully less engaged by their prior health plans and providers.
谢谢你的提问，乔什。明确来说，Optum Health 的业绩受到了价值型护理新患者结构以及 V28 阶段第二年影响。我们正在采取行动，积极应对这些问题。AEP 之后，我们的患者结构中包括许多新加入 Medicare 以及新加入 Optum Health 的患者，他们在之前的健康计划和医疗服务提供者中的参与度明显较低。
We believe that market specific plan exits driven by V28 caused this dynamic and because of the strength and stability of our provider network, those patients chose Optum Health. Member profile challenges were not specific to any single Medicare Advantage carrier and occurred in multi payer geographies like Texas and Washington.
我们认为，由 V28 驱动的特定市场计划退出导致了这种局面，而由于我们提供商网络的强大和稳定，这些患者选择了 Optum Health。这一患者结构挑战并非某一家 Medicare Advantage 承运商独有，而是在德克萨斯和华盛顿等多付方地区都出现了类似情况。
Additionally, we underestimated the impact of V28 in particular as it relates to the higher acuity structure of our patient population, which is more impacted by the risk model change. Our planned actions around operating cost containment and medical expense management were not able to offset the cumulative impacts of V28 and the new member profiles.
此外，我们特别低估了 V28 对患者群体中高严重度结构的影响，而该群体更易受到风险模型变更的冲击。我们原定的运营成本控制和医疗费用管理措施未能抵消 V28 及新患者结构带来的累积影响。
As it relates to care patterns for Optum Health, in general in Q1, we see as a busier time for our physicians as we are engaging our patients. We've already engaged over 50% of all members and 75% of our complex members. This year, it's particularly important given the member profile of new Medicare and new Optum Health patients. Also within Optum Health, we're seeing some elevation in outpatient behavioral utilizations.
关于 Optum Health 的就医模式，总体来看，第一季度是医师与患者互动最频繁的时期。我们已覆盖了超过 50% 的所有会员及 75% 的高复杂度会员。今年尤为重要，因为有大量新加入的 Medicare 和 Optum Health 患者。此外，在 Optum Health 内，我们也观察到门诊行为健康服务利用率有所上升。
Again, we're taking incremental actions above and beyond what we've planned for any year to improve performance. First, enhancing access for employee to network PCPs, especially around new patients to diagnose document and treat conditions. We're expanding home based revisits and wraparound services, particularly as it relates to post discharge visits after inpatient care. And as Andrew alluded to, we've accelerated EMR unification, deploying smarter clinical workflows and point of care tools to better adapt to the V28 related changes? Thanks for the question.
再次强调，我们正在采取超出常规年度计划的增量举措以提升业绩。首先，强化员工对网络初级保健医师的访问，特别是针对新患者以便诊断、记录并治疗其病症。我们正在扩展居家复诊和全方位配套服务，尤其是针对住院后出院访问。如安德鲁所提，我们还加快了电子病历（EMR）统一部署，引入更智能的临床工作流程和即时护理工具，以更好地适应 V28 相关的变化。谢谢提问。
Andrew Witty
安德鲁·威蒂
Great, Amar. Thanks so much. And let me ask Heather to maybe just take an overview of the value based care proposition and why we continue to believe so strongly in it.
很好，阿马尔，非常感谢。接下来我请希瑟简要介绍一下价值型护理方案，以及我们为何仍对其深信不疑。
Heather Cianfrocco
希瑟·奇安弗罗科
Sure. And just I think what you're seeing here is, as Andrew said, you've got two different business models here and it's important to keep that in mind. Couple of things I'll just point out. Again, in Optum Health capitated experience, this is specific to senior populations and our experience in a unique environment, mindful of again what's a new risk model, a year two risk model.
好的。我想如同安德鲁所言，这里有两种不同的业务模式，需要牢记在心。我要强调几点：首先，在 Optum Health 的定额包干模式中，这主要面向老年人群，并且我们在这样一个独特环境中的经验，需要时刻考虑这是新的风险模型的第二年。
And keeping in mind what Dr. Desai said, we assume and anticipate certain physician activity in the first part of the year. And that's part of our model because it drives not only that, that diagnosis, but the treatment so we can understand the gaps in care. So that's part of the plan and I think that's why you don't you it's a little different story in Optum Health. But as Dr. Desai said, we need to be mindful of that, particularly based on two years of elevated care activity, coming into this year.
并且牢记德赛博士所说，我们假设并预期年初会有一定的医师活动。这是我们模式的一部分，因为它不仅推动诊断，还推动治疗，使我们能够识别护理缺口。这也是计划的一环，我认为这也解释了为何 Optum Health 的情况略有不同。但正如德赛博士所言，鉴于过去两年护理活动的高水平，我们尤其需要对此保持警惕。
Now to your point, the outcomes based model or what we call the value based care model should naturally offset some of that for a few reasons as Dr. Desai mentioned. Number one, engagement is key, and that early engagement by a network that's aligned and activated, can better identify gaps in care, manage them, and support higher preventive health care and reduced emergency visits and hospital visits.
回到你的问题，正如德赛博士所提，基于结果的模式——或称价值型护理模式——在若干方面能自然而然地缓解一些趋势。第一，参与度是关键；一个协同并已动员的网络能够更早介入，及时识别护理缺口、进行管理，并促进更多预防性护理，减少急诊和住院次数。
In addition to that, what's unique about Optum Health's model is the wrap around services and the in home services, which not only help assess our members in the home, but they're able to then kick off things like post-discharge visits, high, the more acute condition management programs They're critical to those transitions of care and help reduce total cost of care and naturally offset some of trend, but in addition to that result in a better health outcome for our patients and a better experience and help them with a healthier life. So those are kind of the basis of our model.
此外，Optum Health 模式的独特之处在于全方位配套服务和居家服务，这不仅帮助我们在患者家中进行评估，还能启动诸如出院后随访及急性病情管理项目。这些对护理过渡至关重要，有助于降低整体护理成本，自然缓解部分成本趋势，同时改善健康结局，优化患者体验，助力更健康的生活。这些就是我们模式的基础。
You then wrap the integration of our behavioral health into our model, which is increasingly more an integrated part of our care delivery systems. That's what I think is differentiated about the model. And even though to be incredibly direct and respectful of this year, we will see the impact of the revenue, through the year. But the differentiated value based care model has meant growth for Optum Health above industry in the past and we believe you'll continue to see that.
随后，我们将行为健康服务整合进模式中，使其成为护理交付系统中日益一体化的组成部分。这正是我认为该模式的差异化所在。尽管必须坦诚地指出，今年我们会看到收入受到影响，但这一差异化价值型护理模式在过去带来了高于行业水平的 Optum Health 增长，我们相信未来也将继续如此。
Why is that? Because again, a better care delivery model, a better experience for our patients, but in addition to that, we see very high retention. So these members that need the services, that have higher acuity, that need a more intensive care model, they stay with us.
为何会如此？因为更优的护理交付模式和更佳的患者体验，同时我们也保持了极高的留存率。那些需要服务、病情更严重、需要更密集护理模式的会员，会留在我们这里。
And so the work we do today will support the growth in '26, and that's why we're confident in not only the growth in '26 from a membership perspective, but because there's more members to serve out there. In many cases, we're serving few of the seniors in any respective geography and we have more capacity in our network. But in addition to that, it supports our performance.
因此，我们今天的工作将为 2026 年的增长提供支撑，这也是我们不仅对 2026 年会员规模增长充满信心的原因，还因为市场中待服务的老年人更多。在许多地区，我们的覆盖率仍偏低，网络中还有更多容量。此外，这也有助于支持我们的业绩。
Now I'll just note one last thing and that is, I think through the year you're going to watch us pace that. While we're still committed to our membership growth, we're going to be looking at particular geographies pacing through that to ensure that we're focusing on the new membership with our PCP network and with our in-home services.
最后我要补充一点，我想在接下来的一年里，你们会看到我们如何安排节奏。虽然我们仍致力于会员增长，但会关注特定地区的节奏，以确保我们在初级保健医师网络和居家服务上重点支持新会员。
Andrew Witty
安德鲁·威蒂
Thanks, Heather. And I think Josh, I really appreciate the question and thanks everybody for allowing us to respond to that sort of as fully as we can. I mean, just maybe add a couple of comments to that. To that last set of comments from Heather, when we look into and you've often heard us talk previously about cohorts of members who choose to join Optum Health value based care.
谢谢你，希瑟。我想说，乔什，非常感谢你的提问，也感谢各位让我们尽可能全面地作出回应。我的意思是，就希瑟最后一段评论，再补充几点。当我们深入探讨时，你们也常听我们谈论那些选择加入 Optum Health 价值型护理的会员群体。
What we're seeing in those earlier cohorts going back to say 2023, for example, those folks who first came in and started to benefit from our value based care approach. We're seeing on all basically all metrics outperformance in terms of the way in which that cohort and cohorts before them have performed.
举例来说，在回溯到 2023 年的早期群体中，那些最先加入并开始受益于我们价值型护理的人群，我们在几乎所有指标上都看到他们表现优于同类以及之前的群体。
So what we're seeing here is not really a challenge to the underlying principle of value based care. What we're seeing is how to adjust to a very dramatic price cutting regime that's been implemented over the last couple of years by the administration. And it's important to recognize that that was across the average of the industry independent analysis would say that was about a 9% price cut across the industry. Now that's a significant downdraft in terms of pressure.
因此，我们所看到的并非对价值型护理基本原则的质疑，而是如何适应过去几年政府推行的极为剧烈的降价机制。需要说明的是，独立分析显示，这相当于整个行业平均约 9% 的降价——这是一个非常显著的下行压力。
And obviously that affects participants whether you're a payer or a provider in the marketplace. And you've seen that effect over the last first year. We're now well into the second year of all of this. And what we're seeing during the second year is some of the let's call I would call them second order derivative effects.
显然，这一变动影响了市场上的各方，无论是支付方还是提供方。你们已经在第一年看到了这些影响。现在我们已经进入第二年，而第二年显现出的，正是我所称的“二阶派生效应”。
So I'll give you just a couple of examples of that. You've heard one very explicitly and we've mentioned the other already on the call. So second order effect would be, for example, as this pricing pressure has continued to press down alongside a series of underfunded rate increases. You've seen premiums and benefits start to be affected in the marketplace.
我给你举几个例子。你们在电话中已经听到一个明确的例子，我们也提到过另一个。所谓“二阶效应”，例如：当降价压力持续叠加一系列资金不足的费率上调时，你会看到保费和保障开始在市场上受到影响。
Group premiums have gone up because of these price cuts. That is now driving a different behavior from group members and that's what we've picked up in this area. And we need to do a better job of being able to predict and anticipate the second and third order effects when they come, but they are direct consequences of this transition.
由于这些降价，团体保费实际上是上升的。这导致团体会员的行为发生了变化，这正是我们在这一领域所捕捉到的。我们需要更好地预测和预判这些二阶、三阶效应，但它们确实是这一转型的直接结果。
A second one, which we referred to and is really important within the Optum Health story for 2025 is plan exits. So we saw a very significant increase in the number of plan exits across the country last year. As plans chose to respond to the price cutting pressure by essentially withdrawing their offer in multiple geographies across the country.
另一个例子，也是 2025 年 Optum Health 故事中非常关键的一点，是计划退出。去年全国范围内的计划退出数量大幅增长。各大计划为应对降价压力，实质上在多个地区撤销了供给。
And what we've seen is in unusually complete vacation of offers by certain plans. So to put it a different way, 100% of participants in a particular payer's plan had to find a new home. They had no way of staying in their old home. They had to find a new home.
我们看到的是，某些计划几乎完全撤出。换句话说，某支付方计划的所有参与者都不得不寻找新的方案，无法继续留在原有计划中。
And what we saw when they came to us where we were still offering a plan option, we saw those members had not had the level of engagement in the prior six, eight months before they vacated that plan at the level you would have expected. That has a direct consequence on how they are understood in terms of the reimbursement model of the system.
当那些会员转到我们这里，选择我们仍在提供的方案时，我们发现他们在退出前的六到八个月中，参与度远低于预期。这直接影响了系统对他们在报销模型中健康状态的评估。
And that's what's driving a lot of our issues in Optum Health this year. But again, that is a temporary phenomena, which gets fixed during 2025, but it is simply an example of one of the second order derivative effects of the transition of absorbing this 9% or more percent decrease in pricing.
这也就是今年 Optum Health 面临诸多问题的原因所在。但这只是一个暂时现象，将在 2025 年得到修复，它仅仅是吸收这 9% 甚至更多降价所带来二阶效应的一个例证。
None of that really speaks to the value of value based care. Value based care delivers a completely different approach of trying to ensure people have more years of health and less years of approach of trying to ensure people have more years of health and less years of healthcare acute treatment, trying to get ahead of the illness, trying to avoid the high cost consequences of late diagnosis and tries to make sure that we are encouraging people to think about healthy lifestyle, early engagement, making sure that we're heading off problems before they arrive.
这些现象并不削弱价值型护理的价值。价值型护理是一种全然不同的方法，旨在让人们拥有更长的健康年限、更短的急性治疗年限，力求在疾病发生前介入，避免因延迟诊断带来的高昂成本，并鼓励人们早期参与、养成健康生活方式，确保在问题出现前加以化解。
And we know that works based on multiple cohorts of patients that we've been privileged to have the right to manage. What we're going through, like the rest of the industry, is a dramatic, really never seen before adjustment in pricing for this marketplace. And what we're seeing this year is two or three areas where the pressure that, that has created across the market is creating new dynamics we haven't seen.
我们已有多个患者群体证明了这一方法的有效性。如今，正如整个行业所经历的那样，这一市场的价格正在经历前所未有的剧烈调整。今年我们看到的，是市场压力在两三个方面催生了前所未见的新动态。
That's exactly what we're responding to here and we believe that they are largely addressable as we go through the rest of this year and in no way undermine our confidence in the value based care strategy of the company.
这正是我们在此要应对的挑战，我们相信随着今年余下时间的推进，这些问题大多可被解决，且绝不动摇我们对公司价值型护理策略的信心。
Josh, thanks so much for the question and I'll move on to the next question.
乔什，非常感谢你的提问，我将进入下一个问题。
Operator
操作员
Our next question comes from A.J. Rice with UBS.
我们的下一个问题来自瑞银的 A.J. Rice。
AJ Rice
Thanks. Hi, everybody. Just to put a finer point on some of this discussion around especially what's happening at the MA side, it sounds like you're saying most of the elevated care that you're seeing is on the group side. And it sounds like you're putting more of that on the benefit and premium changes that have occurred rather than just an underlying uptick in utilization. I want to make sure I understood that.
谢谢。大家好。就尤其是在 MA（Medicare Advantage）方面所发生的情况，再进一步说明一下，您似乎在说您观察到的大部分护理活动增加都出现在团体业务，而您认为这一变化更多是由福利和保费的调整所致，而不仅仅是利用率的本质性上升。我想确认我理解正确。
Also on the competitive exits and the impact of that, it doesn't sound like you're calling that out on the insurance side, you're just calling that out on the Optum side. And then finally on Part D, you had been cautious about that coming into the year, but you're not mentioning that at all. So is that playing out about as expected?
另外，关于竞争对手退出及其影响，听起来您并没有在保险业务方面提到这一点，而只是提到了 Optum 方面。最后，关于 Part D（处方药计划），您年初对其持谨慎态度，但现在完全未提及。情况是否如预期般发展？
Andrew Witty
安德鲁·威蒂
AJ, thank you so much for the question. Let me ask Tim to respond.
AJ，非常感谢你的提问。我这就请 Tim 来回答。
Tim Noel
蒂姆·诺埃尔
Yes. Good morning, AJ. Thanks for the question. Yes, so I'll hit those last two pieces first. So yeah, you're correct. We are really seeing this focused on our community Medicare Advantage and group Medicare Advantage books. So we're not seeing it on our chronic special needs population or our dually eligible population.
是的，早上好，AJ。谢谢你的提问。关于最后两点，我先来回答。是的，你说得对。我们确实看到这种情况主要集中在社区 Medicare Advantage 和团体 Medicare Advantage 的业务中。所以我们在慢性特殊需求人群或双重资助人群中并未看到此类情况。
Also, not seeing this care activity pattern in our newer members, either new to Medicare or new to United. And the care activity items that we talked about last year, provider up coding and some of the pressures on specialty drugs, I'm not seeing that play into this either. Those elements are both tracking very much in line with how we've planned.
另外，我们也没有在新加入的会员中看到这种护理活动模式，无论是新加入 Medicare 还是新加入 United 的用户。去年我们讨论过的护理活动因素，如提供者上调编码和部分专科药物费用压力等，我也没有看到它们在此体现。这些因素的变化都与我们的计划高度一致。
And when you think about the split, it is slightly more pronounced on our group business. But if you think about our overall fee for service business, it's just I would say just slightly more than the contribution that you'd expect on the group side.
论及分布，这种现象在我们的团体业务中稍显突出。但如果考虑我们整体的按服务付费业务，我认为其增幅仅略高于团体业务所贡献的增长。
And while we certainly do see trends that suggest that where the premiums have increased and members are paying a high portion of that that is where we're seeing this pointed pressure on care activity on the group business. However, it's very likely that some of the same underlying trends that are generating higher care activity patterns in individual community MA are also at play in the group business.
我们确实看到一些趋势表明，保费上涨且会员承担比例较高的情况下，团体业务的护理活动受到更明显的压力。然而，很可能在推动社区个人 MA 护理活动上升的某些相同底层趋势，也同样在团体业务中发挥作用。
Operator
操作员
Our next question comes from Lisa Gill with JPMorgan.
我们接下来的问题来自摩根大通的Lisa Gill。
Lisa Gill
Thank you very much and good morning. Andrew, I just want to go back to the path to the long term growth rate. You reiterated that you feel confident you can get back there. With the 2026 rates looking better, we're going to move into the final year of V28. How do I think about what the key elements are to get back to that long term growth rate?
非常感谢，早上好。安德鲁，我想回到实现长期增长率路径的问题上。您重申对回归目标充满信心。随着2026年费率看好，我们将进入V28最后一年。我该如何理解要回到该长期增长率的关键要素是什么？
Andrew Witty
Yeah. Lisa, thanks so much for the question. So yes, so clearly, we were pleased to see the beginning of recognition of rate increases, which actually reflect reality, which we haven't seen for last couple of years. But hopefully that will continue to be the stance and the data will drive that in the way we saw this year. So very, very pleased to see that.
是的，Lisa，非常感谢你的提问。我们很高兴看到费率上调的开端被认可，这实际上反映了现实，而过去几年我们还未见到此类情况。但希望这一态势会持续，并且数据会像今年一样推动此趋势，因此我们非常非常乐见其成。
Also pleased to see in the Medicaid books of business come to continue to see great engagement with states that they also adjust to make sure that those rates are appropriate for what we're seeing. So those are important.
我们也很高兴在医疗补助业务中继续看到与各州的高度互动，他们也在调整以确保费率与我们所见情况相匹配。这些都很重要。
Obviously, next year, there will be a further step down in terms of pricing from the V28 model. So we can't ignore that. That's clearly a reality. But the way we'd look at this, Lisa, is that we are very, very much -- we see very much the end of this transition period in terms of having to absorb the amount of pressure. I mean, clearly, we're a leader in all of this marketplace. We're taking almost certainly a bigger fraction, if you will of the pressure because of our market leadership position here.
显然，明年V28模型下的定价还将进一步下降，所以我们不能忽视这一事实。这显然是现实。但我们看待此事的方式，Lisa，是：我们非常清楚这一过渡期即将结束，因为我们已经不必再吸收如此大的压力。显而易见，我们在这一市场中处于领导地位，因此我们承受的压力几乎肯定也是更大的一部分。
We feel like we're very much getting through this. We obviously this year have picked up these two or three second order derivative effects, which we're going to do a much better job of anticipating and managing for as we go into 2026. And we think that an awful lot of the issue that we're seeing early in ‘25, we can fix in 2025 and help us deliver stronger performance for ‘26. And we expect that to then be a kind of ramp into reacquiring our target growth rate momentum that we aspire to as an organization. Thank you very much. Next question?
我们感觉已经度过大半过程。当然，今年我们已捕捉到这两到三个二阶效应，我们将在进入2026年时更好地预测和管理这些效应。我们认为，很多2025年初显现的问题都能在2025年内修复，并帮助我们在2026年实现更强劲的业绩表现。我们预计这将成为我们重拾组织长期增长率动能的一个跃升。非常感谢。下一问题？
Operator
操作员
And we'll move to our next question from Stephen Baxter with Wells Fargo.
接下来我们将接听富国银行的Stephen Baxter的问题。
Stephen Baxter
Yeah, hi, thanks. Just a follow‑up on the trend discussion. Could you talk about where MA margins are now expected to shake out inside your 2025 guidance? And what you think is a reasonable timeline for covering the target margins? And whether there's any change to what you're thinking is as a reasonable long term margin target in this business post V28 and some of the issues you have adapting to it? And then again, the confidence level you can improve any margins in 2026 if trends stays at this level?
是的，嗨，谢谢。关于趋势讨论，想再问一下：在你们2025年的指引范围内，MA 的利润率现在预计会如何表现？你认为达到目标利润率的合理时间表是什么？在V28及适应过程中遇到问题后，你们对该业务合理的长期利润率目标有何变化？另外，如果趋势保持在当前水平，你们对2026年提升利润率有多大信心？
Andrew Witty
Stephen, thanks so much. I'll ask Tim to respond to that.
Stephen，非常感谢。我这就请Tim来回答。
Tim Noel
Thanks, Stephen, for the question. So the margins that we're anticipating consistent with the changes we've announced today are still within our targeted margin range for Medicare Advantage for 2025. As we look forward to 2026 and we include the increases in care activity that we're seeing both in the 2025 portion of our bid and also pricing for 2026. At this distance, we can accommodate those care activity levels and return to the historical planning target levels that we've always historically assumed.
谢谢你，Stephen。我们预计的利润率，与今天宣布的变动保持一致，仍在我们2025年 Medicare Advantage 目标利润率范围内。展望2026年，并考虑到我们在2025年投标部分和2026年定价中所见的护理活动增加，我们目前有能力适应这些护理活动水平，并重回我们一贯假设的历史规划目标水平。
Operator
运营员
Our next question comes from Erin Wright with Morgan Stanley.
接下来我们来听摩根士丹利的Erin Wright提问。
Erin Wright
Great. Thanks for taking my question. So on the policy front, I guess, what is your latest thinking in terms of just PBM reform? Your model has obviously evolved on that front, but also Medicaid funding cuts and what sort of permutations you could anticipate there and your ability to navigate that?
好的，谢谢您接受我的提问。那么在政策方面，我想知道您对药品福利管理（PBM）改革的最新想法是什么？贵公司的模式在这方面显然已有演变，但对于Medicaid（医疗补助）资金削减及可能出现的各种变化，您能预见哪些情况，以及您如何应对这些变化？
Andrew Witty
安德鲁·威蒂
Yes, Erin, thanks so much. Let me ask Patrick Conway to respond to you on the PBM side and then Chris to maybe make a couple of comments on Medicaid, if that's okay. So Patrick?
好的，Erin，非常感谢。我先请Patrick Conway来回答有关PBM方面的问题，然后让Chris就Medicaid发表一些看法，行吗？Patrick？
Patrick Conway
Yes. Thanks, Erin, for the question. So first, in terms of policy, we are leading in the marketplace with transparency choice and affordability. And we've had three major announcements that I think both help drive the policy environment, but also are a reason we've had significant market growth. 100% commercial rebate pass through.
好的，谢谢您的提问，Erin。首先，在政策方面，我们在市场上以透明度、选择权和可负担性领先。我们已经发布了三项重大公告，我认为这既有助于推动政策环境，也显著促进了我们的市场增长。第一，100%商业折扣回扣全额转给客户。
First, large PBM to do that. And you're seeing that drive positive reaction in the marketplace and it's removing any lingering doubt about our incentives. We want lower list prices and lower net prices as Andrew said.
首先，我们是第一个这样做的大型PBM。您可以看到这在市场上引发了积极反响，消除了人们对我们动机的任何疑虑。正如安德鲁所说，我们的目标是降低标价和净价。
Second, removing 25% of prior authorizations over 10% of reauthorizations over 10% of prior authorizations making the system simpler, better, easier for consumers and clinicians. And then third, cost based reimbursement for pharmacies. And it's really important to know this is for all pharmacies, all drugs, all clients rolling out. Already started rolling out and put across the entire book. And you heard from independent and community pharmacies their support of these changes.
其次，在预先授权环节，取消了25%的审批程序，并将复审比例从10%降至10%，使系统对消费者和临床医生而言更简单、更优、更便捷。第三，对药房实行基于成本的报销。这一点非常重要，适用于所有药房、所有药品和所有客户。目前已开始全面推行，覆盖了整个业务范围。您也听到了独立药房和社区药房对这些变革的支持。
The last thing I'd just call out just because it's new and it concerns us significantly is the Arkansas Legislation that the governor signed yesterday around PBM and pharmacy ownership. We're honestly not sure what problem they're trying to solve, but let me be clear on the impact on patients. When you do that, we have Genoa pharmacies in the state providing integrated mental and behavioral health care. This could cut off access for those patients with things like schizophrenia, severe depression.
最后我要特别强调一件新事，也是我们非常担忧的：阿肯色州州长昨天刚签署了有关PBM和药房所有权的立法。老实说，我们不太确定他们想解决什么问题，但我想明确说明对患者的影响。如果实施该法案，我们在该州的Genoa药房所提供的综合心理和行为健康服务就会中断。这可能导致患有精神分裂症、严重抑郁等患者无法获得药物。
You have specialty medicine, where we may have been serving a patient with cancer for years and imagine that patient now not getting their medicine in their home. You have home infusions for elderly Americans, where they may not be able to get out of their home and we're providing their medication. And you have home delivery for people in rural parts of Arkansas.
此外，我们还提供特需药物服务，可能多年来一直为癌症患者送药到家。我们还为不能出门的美国老年人提供家庭输液服务，并为阿肯色州偏远地区的居民提供送药上门服务。
We're significantly concerned on about this. We'll work with the state in the regulatory process post legislation to try to address those populations and maintain access. But we want you to hear clearly from us that our concern is about patients and maintaining access to patients across the nation to these medicines.
我们对此深感担忧。在立法通过后的监管过程中，我们将与州政府合作，努力保障这些群体的用药渠道。但我要明确的是，我们最关心的是患者，以及确保全国患者都能获得这些药物。
Andrew Witty
安德鲁·威蒂
All right. Patrick, thank you. Krista?
好的。Patrick，谢谢你。Krista？
Krista Nelson
Yeah. Thanks for the question. So on the Medicaid side, I think we won't speculate on any really specifics, but, what I do want to emphasize is just regardless of any changes, our priority remains the health of our members and ensuring that they have access to high quality coverage. As it relates to our business, we have a really broad footprint across 32 states.
好的，谢谢提问。在Medicaid方面，我不会对具体细节做过多猜测，但我要强调的是，不论发生何种变化，我们的首要任务还是保障会员的健康，确保他们能获得高质量的保险。就我们的业务而言，我们在32个州都有广泛布局。
We have a variety of programs and products and really decades of experience. So we remain confident in the value that managed care can provide to our state partners and our ability to support our states as they really navigate through any changes.
我们拥有多种项目和产品，以及数十年的经验。因此，我们对管理式医疗为州政府伙伴提供的价值充满信心，并有能力在各州应对变化过程中提供支持。
Andrew Witty
安德鲁·威蒂
Thanks for the question. Krista, thanks so much. Just looking back to the pharmacy section. I think Patrick laid things out very well there, Erin, for you. But I also would just -- I was encouraged to see in the President's executive order earlier in the week a kind of an interest in really looking at multiple elements of the pharmacy value chain.
谢谢您的提问。Krista，非常感谢。回到药房部分，我认为Patrick已经为您阐述得很清楚，Erin。不过，我也很高兴看到本周早些时候总统发布的行政命令中，展现出对药房价值链多个环节进行全面审视的兴趣。
I think one of the things that has been honestly most disappointing over the last year or two is the obsession with the role of the PBM versus everybody else in the system. And if you read the EO carefully, what you'll see in there are quite good sensible questions to explore what's going on either side of the PBM in terms of the manufacturers and also ultimately many of the providers in the network.
坦率地说，过去一两年最令人失望的是人们过于纠结PBM在系统中的角色，而忽视了其他各方。如果您仔细阅读该行政命令，您会发现其中包含了许多合理的问题，旨在探究PBM两端的情况——包括制药商和网络中的众多提供者。
And I think what you'll see from that is the PBM plays a unique role in trying to bring down drug prices for Americans. It does that at very, very narrow margins oftentimes taking very significant risk in the process. And is really the only participant in the system that has that it's the way a PBM wins more businesses by successfully bringing down drug costs for its clients and that's how it wins more accounts. That is not how the rest of the system operates.
我认为您会从中看到，PBM在帮助美国人降低药品价格方面扮演着独特角色。它通常以极为微薄的利润率承受巨大风险，通过为客户切实降低药费来赢得更多业务和客户。而系统中的其他参与者并非如此运作。
And I'm hopeful as the administration explores the questions that the EO raises that this will become a much more thoughtful review of how to reform the whole value chain and not simply one component where I think you can make very, very serious mistakes, which could really damage patient access. So I was encouraged to see that from the administration. Erin, thanks so much for the question. Next question.
我希望政府在探讨该行政命令提出的问题时，能够对如何改革整个价值链进行更为深思熟虑的审视，而不仅仅针对某一环节，否则可能会犯极其严重的错误，严重损害患者用药的可及性。所以看到行政当局采取这种态度，我感到很鼓舞。Erin，非常感谢您的提问。下一个问题。
Operator
运营员
And our next question comes from Andrew Mok with Barclays.
接下来我们来听巴克莱的Andrew Mok提问。
Andrew Mok
Hi, good morning. I was hoping to get your thoughts on the risks and implications of tariffs, particularly around the impact of pharmaceutical tariffs that are currently being contemplated by the administration.
你好，上午好。我想听听您对关税风险及影响的看法，尤其是政府目前正在考虑的药品关税的影响。
Andrew Witty
Yeah, Andrew, thanks so much for the question. Obviously, it's a dynamic situation in terms of what may happen around pharmaceutical tariffs. Obviously, going to be a process now where the administration goes through its analysis and investigation. So we obviously don't know what may or may not come from that. But when we look at our potential exposure to that, we feel pretty good.
好的，Andrew，非常感谢您的提问。显而易见，药品关税可能带来的影响是一个动态变化的情况。目前政府将进行分析和调查，所以我们显然不知道最终结果会如何。但当我们评估自身可能面临的风险时，我们感觉相当乐观。
In fact, I'd say better than pretty good in terms of the degrees of price protection mechanisms we have in preexisting contracts and also various pieces of legislation, which also limit the ability of manufacturers to pass price increases down through the system. So at this point, and again, given that we don't know what any tariff may or may not be, but when you look at the structure of the marketplace, we feel pretty well positioned for that, Andrew. Next question?
事实上，我认为我们处于更有利的位置，因为我们的既有合同中包含了多种价格保护机制，还有各项法律法规也限制了制造商将价格上涨转嫁给后端。因此，尽管我们仍然不知道任何关税最终会如何出台，但从市场结构来看，我们认为自己已经做好了充分准备，Andrew。下一个问题？
Operator
运营员
Our next question comes from Dave Windley with Jefferies.
接下来我们来听杰富瑞的Dave Windley提问。
Dave Windley
Hi, good morning. Thanks for taking my question, Andrew. I appreciate your comments about kind of the macro cost of healthcare in the United States. We have an administration that seems more focused on budget deficit reduction, which entails cutting to healthcare.
你好，上午好。感谢您回应我的问题，Andrew。我很欣赏您关于美国医疗总体成本的看法。我们目前的政府似乎更专注于削减预算赤字，而这往往意味着减少医疗支出。
I guess my philosophical question here is, why isn't modest, persistent underfunding of the system the right way to get those costs more in balance and to force innovation in the system and how does United operate in an environment that might bring that without having without having the snafus or whatever that like a V28 model brings?
我想问一个哲学层面的问题：为什么持续适度地减少对体系的资金投入不能更好地平衡成本并推动体系创新？在这种可能发生的情况下，United（联合健康）如何运作，又如何避免V28模式可能带来的混乱？
Andrew Witty
So David, thanks so much for the question. And I think it's a good and deep question actually. So there's no question that what I think we need is continued strong innovation in new approaches of how to bring together different elements of the system to have a more patient centered impact on health care. One of the characteristics I think of all health care marketplaces, but perhaps particularly the U.S. is there is no shortage of innovation, but it tends to be point solutions, whether it's a new device or a new drug or a new model of care.
David，非常感谢您的提问。我认为这是一个很好的深层问题。毫无疑问，我认为我们需要持续且有力地在新方法上创新，将体系中不同要素整合起来，以对医疗产生更以患者为中心的影响。我认为所有医疗市场，尤其是美国，都不缺乏创新，但这些创新往往是孤立的点状解决方案，无论是新设备、新药物还是新护理模式。
These things tend to show up in very isolated ways. So we spend a lot of money on innovation in America, but we don't see the yield of that innovation. And I would argue that's because it's not brought together. We don't align incentives. We don't really rethink workflows. We don't try and center everything around what gives you the best outcome for the patient over the lifetime of the patient, not just this encounter or even this year.
这些创新往往以非常零散的方式出现。因此，我们在美国投入了大量资金用于创新，但却看不到创新成果。我认为原因在于未能将这些创新整合。我们没有对齐各方激励，没有真正重新设计工作流程，也没有尝试以患者一生的最佳健康结果为中心，而不仅仅关注单次就诊或当年效果。
How do you make that patient or how do you give that patient the opportunity for maximum numbers of great health years? That for me should be the guiding principle and that's what value based cares about and it's what UnitedHealthcare is committed to innovate and drive behind. And I think we have made extraordinary progress in that.
如何让患者拥有更多高质量的健康年？这应该是我们的指导原则，这也是价值型医疗所关注的，也是UnitedHealthcare（联合医疗）致力于创新和推动的方向。我认为我们在这方面已经取得了非凡进展。
Now unfortunately, what we've seen through V28 is almost focus the price cut where the most innovation is going on. So you've seen this pressure come exactly into the program where historically the government has funded Medicare Advantage and created a very thoughtful system, which incentivizes participants to the only way a participant can win in Medicare Advantage is to incentivize, be able to deliver a great care experience and access experience for the member, release enough cost through efficiencies to provide benefits to members and then pay a rebate back to the government, right.
但不幸的是，V28导致的结果几乎是把降价压力集中到创新最活跃的领域。您会看到，这种压力正冲击政府历来资助的Medicare Advantage（医疗保险优势计划），该计划原本是一个设计周到的体系，激励参与者的唯一方式是：提供优质的护理和便捷的就医体验，通过效率提升释放足够成本，向会员提供更多福利，并将剩余资金以回扣形式返还给政府。
So everybody wins in that system. And that was a very cleverly designed system by the government many years ago. It's been supported by multiple administrations of both directions since then. What we saw through V28 was really a kind of blunt instrument approach to just take money out of that system. And that's what's causing the disruption here. So I don't think any but we would never have any anxiety about say, look, we want to see the healthcare budget grow by less each year.
这个体系实现了多方共赢，是多年前政府巧妙设计的。此后多届政府都对其予以支持。而V28采用了一种粗暴的工具式做法，单纯抽走该体系中的资金，这正是造成当前混乱的原因。因此，我并不认为……我们对控制医疗支出年增幅不会有任何顾虑。
But then we should look at the whole budget. We should look at the whole system and we should look at how we can use tools to do that. What we know is that Medicare Advantage costs less than traditional Medicare. We know that when a Medicare Advantage patient is in a fully delegated value based care managed clinic like Optum Health, they will save even more money for the system and they will have better personal experience, they have better clinical outcomes and the government spends less money. It's those sorts of integrated approaches, which we think are the response.
但我们应该审视整体预算和整个体系，并研究如何运用各种工具实现这一目标。我们知道，Medicare Advantage的成本低于传统Medicare。我们还知道，当Medicare Advantage患者在Optum Health这类全面委托的价值型医疗管理诊所就诊时，体系将节省更多资金，患者获得更好的就医体验和临床结果，政府支付的费用也更少。正是这些一体化方法，我们认为才是解决之道。
And it's a bit I made that comment about the President's executive order on pharmacy. And I kind of invite the same. We should be thinking about the whole system and how we align the whole system, not simply looking at these kind of individual component approaches, which we've seen over the last few years. And I hope very much that just like the pharmacy agenda that the President is laying out for understanding that we might have a similar one here.
这就有点像我之前对总统关于药房发布的行政命令的评论，我也想在此提出同样的观点。我们应当从全局出发，思考如何对齐整个体系，而不仅仅关注过去几年中常见的那些局部举措。我非常希望，在类似药房议程的框架下，我们也能在此推出相应方案。
And that would be very positive because the answer to your question is yes. We should be able to deliver great healthcare at lower cost with better experience, better clinical outcome for people and for the government. And that is what the mission of UHC is. And that is what the goal of value based care and Optum Care is also. Next question.
那将是非常积极的，因为对您问题的答案是肯定的。我们应该能够以更低成本提供优质医疗，同时为患者和政府带来更好的体验和临床结果。这就是UHC（联合健康）的使命，也是价值型医疗和Optum Care目标所在。下一个问题。
Operator
运营员
Our next question comes from Ben Hendrix with RBC Capital Markets.
接下来我们来听RBC资本市场的Ben Hendrix提问。
Ben Hendrix
Hi, thank you very much. I wonder if we could touch briefly on Medicaid. Just wanted to get an update on what you're seeing from state renewals through April and if we're still on track to close that rate acuity gap by the end of the year.
您好，非常感谢。我想简单聊一下Medicaid（医疗补助）。想了解目前各州截至4月的续保情况，以及我们是否仍有望在年底前缩小费率与病情严重度之间的差距。
Andrew Witty
Thanks so much for the question. I'm going to ask Krista to answer that for you.
非常感谢您的提问。我现在请Krista来回答这个问题。
Krista Nelson
Yeah, thanks for the question. We were encouraged with the progress that we made on rates in the second half of 2024, which really continued into our 1/1 rate cycle. And as John and Andrew both mentioned, overall the gap between acuity of the population and the rate funding is really narrowing with each cycle as well as through some off cycle adjustments that we have seen.
好的，谢谢提问。我们对2024年下半年在费率方面取得的进展感到鼓舞，这些进展也延续到了我们的1月1日费率周期。正如John和Andrew都提到的，总体而言，人口病情严重度与资费水平之间的差距在每个周期以及我们观察到的一些周期外调整中，都在不断缩小。
We have -- it's really too early to call the rates on 7/1, but about 35% of our revenue renews in that 7/1 cycle. And with each cycle that base data continues to reflect more recent experience. And so we remain optimistic with the collaborative relationships we have with our states that over the course of the year that this gap will continue to narrow.
目前讨论7月1日的费率还为时过早，但约有35%的收入将在该周期续约。随着每个周期结束，基础数据会持续体现最新的经验。因此，我们对与各州的合作关系保持乐观，认为随着全年推进，这一差距将继续缩小。
Operator
运营员
And our next question comes from Lance Wilkes with Bernstein.
接下来我们来听伯恩斯坦的Lance Wilkes提问。
Lance Wilkes
Great, thanks. Could you talk a little bit about the first quarter MLR impacts and maybe breaking out the impacts that were driven by the premium increases that you described and maybe any sort of deductible increases?
好的，谢谢。能否谈一下第一季度医疗损失率（MLR）的影响，特别是您所提到的保费上涨带来的影响，以及任何免赔额的调整？
But also were there impacts as a result of the way in which you're approaching prior authorization, any changes in that? And then do you have a sense as to maybe increased follow through from your house calls and primary care actions as far as getting follow-up visits tied to risk adjustment activity? And lastly, were there any one time good guys in the first quarter, which perhaps supported medical loss ratio and caused the distinction between 1Q versus guidance?
另外，您在处理预授权方面的方式是否也带来了影响，是否有任何变化？您是否觉得，由于家庭访问和初级护理措施的推进，相关的后续就诊与风险调整活动是否有所增加？最后，第一季度是否存在任何一次性有利因素，支持了医疗损失率，使得季度表现与指引出现差异？
Andrew Witty
Thanks so much, Lance. John Rex.
非常感谢，Lance。现在请John Rex发言。
John Rex
Good morning, Lance. Just to your last part, no, there were no one time good guys in the quarter that would have supported that. So a few things just to point out a bit. So to your first point on any shifts on preauthorization procedures or anything element like that impacting no, nothing from that element there.
上午好，Lance。关于您提到的最后一点，第一季度并没有任何一次性有利因素支持那一点。下面提几点说明：首先，针对您提到的预授权程序或类似环节的任何变化，对此并不存在影响。
Tim noted that certainly we had a much higher in addition to the group, which was a big factor, we had a much higher level of wellness business in the quarter. Those aren't the factor though. They're super effective. They're not costly. They do drive specialty care. However, a lot of follow on specialty care. And that's what we don't know is was that was that something seasonal then? Is that a slightly altered seasonal pattern that so many that we saw so much activity in wellness visits in some populations, frankly, certain populations is at 2x the year ago levels of wellness visits, others about 50%, but it was broad based in terms of that activity.
Tim指出，本季度除团体业务外，我们的健康管理业务量也显著提升，这是一个重要因素。这些业务虽然成本不高且非常有效，可以促进专业医疗服务的使用，但也带来了大量后续专业护理。我们不确定这是否存在季节性因素？是否是另一种稍有变化的季节性模式？因为我们看到某些人群的健康管理就诊量是去年同期的两倍，另一些大约增长了50%，且这种增幅在各类人群中普遍存在。
So that was certainly an element in there. An element well known to all of you also just the change in seasonality due to the IRA driven Part D changes. Think of that as about roughly 90 basis points of impact or so in the quarter also. So that would have been an element that versus kind of what you would have typically seen. And I think. I know you were well aware that was kind of be a factor as we moved into this. I'm not sure that was a factor that was the well anticipated in all the -- in kind of all the analyst models out there, for a lot of good reasons, but those IRA impacts in that zone.
这无疑是一个因素。此外，由于《通胀削减法案》（IRA）驱动的D部分变化导致季节性模式改变，这一因素在本季度对指标有大约90个基点的影响。与通常情况相比，这将是一个不同寻常的因素。我知道您对此也有充分认识，只是不确定在所有分析师模型中，这一因素是否都被恰当预期到，尽管有充分的理由将其纳入考量。
Certainly, kind of the Medicare funding reductions as you go into that second year V28 also impactful of that. Think of that roughly in the 60 basis point zone. So that I can go through a lot of elements there, but those are kind of the key factors. But far and away the increased utilization and the member profile elements that we've highlighted throughout the course of this call being by far the most impactful things in the quarter.
当然，随着进入第二年，V28带来的Medicare资助减少也产生了影响，约在60个基点左右。总的来说，我可以罗列很多因素，但这些是关键因素；而最高影响力的，仍是利用率上升和会员构成特征，这是本次电话会议中反复强调的，也是本季度最重要的影响因素。
Operator
运营员
And our next question comes from Sarah James with Cantor Fitzgerald.
接下来我们来听Cantor Fitzgerald的Sarah James提问。
Sarah James
Thank you. I just want to circle back to the tariff question quickly. Are the penalties under the IRA for pharma manufacturers who raise price above inflation enough to protect you from tariffs pass through on Medicare? And I'm not sure if that implies to exchanges as well, but with those bids due earlier, like April to June, do you have to assume that tariffs are in place or do you think the states will give you some flexibility to submit two versions of bids with and without tariffs?
谢谢。我想快速回到关税问题。根据《通胀削减法案》，对药企超通胀涨价的处罚是否足以保护您免受关税通过Medicare转嫁的影响？我不确定这是否也适用于交易所，但由于投标截止期较早（如4月至6月），您是否必须假设关税已生效？还是认为各州会允许您提交含关税和不含关税两种版本的投标？
Andrew Witty
Listen, Sarah, thanks so much for the question. So as I said earlier, obviously, we don't know yet what if when might happen in this territory. So like you, we're watchfully waiting. As you alluded to, there's many kind of layers of government protection, if you will within the regulations that over the drug companies in terms of their ability to increase price above inflation. There are things like Medicaid best price protections, specifically in the Medicaid area, which would also have potential applications here.
好的，Sarah，非常感谢您的提问。如我之前所说，我们显然尚不确定在这方面会发生什么，只能密切关注。正如您所提到，法规中对药企超通胀涨价的能力设有多重政府保护层面，例如Medicaid最佳价保护等，这些也可能在此发挥作用。
And then of course, we have our various Optum Rx, where relevant in this conversation have their own contractual price protection. So there are multiple layers of that. Obviously, we're going to be very carefully making sure that we bid in the context of that kind of mesh of protection and make sure that we do that as thoughtfully as we possibly can.
此外，我们旗下的Optum Rx在相关合同中也设有价格保护机制。因此，存在多重保护网。显然，我们会非常谨慎地在该保护网的框架下进行投标，尽最大努力以最周全的方式完成。
But I just also just want to reiterate, like everybody else, we don't know yet what the reality of this is, but we're very attuned to it. And I think I've tried to share with you our sense that it should not be a significant exposure for us, but certainly not this year. And we'd be working very thoughtfully about bids and the rest as you suggest for next year. We have time for just one last question.
不过我要重申的是，就像其他人一样，我们尚不清楚实际情况如何，但对此高度关注。我想表达的是，这对我们不应构成重大风险，至少今年不会。正如您所建议，我们会非常认真地为明年的投标及其他事宜做准备。现在我们还有时间回答最后一个问题。
Operator
运营员
And our last question comes from Jessica Tassan with Piper Sandler.
最后一个问题来自Piper Sandler的Jessica Tassan。
Jessica Tassan
Hi, guys. Thank you so much for the question. I wanted to ask about -- so UHC has achieved really phenomenal growth in MA year-to-date, up 521,000 members through April, almost half of that growth has come from C-SNP plans. So just wondering if you all can elaborate on UHC's dominance in the C-SNP market? Do these plans offer the beneficiary? Why is UHC been so successful in this segment? And what does C-SNP enrollment mean from an economic perspective for UHC in 2025 and then over the long term?
大家好，非常感谢您的提问。我想问一下，截至4月，UHC在Medicare Advantage（MA）方面实现了惊人的增长，新增会员521,000名，其中近一半来自针对特殊人群的C-SNP计划。能否请您阐述一下UHC在C-SNP市场的优势？这些计划为受益人提供了哪些服务？为什么UHC在这个细分市场如此成功？从经济角度看，2025年及长期来看，C-SNP的入会对UHC意味着什么？
Andrew Witty
Thanks. Jessica, thanks so much. I'll ask Bobby Hunter who looks after our M&R business to respond to that. Bobby?
谢谢你，Jessica。我请负责我们市场与零售（M&R）业务的Bobby Hunter来回答。Bobby？
Bobby Hunter
Yeah. Thanks, Jessica for the question. So I would say really just overall, we're very pleased with our year to date growth in Medicare Advantage. And as you know, we continue to be on track to deliver on the full year growth target of up to 800,000 members. The momentum we had in AEP carried over really nicely into OEP, including notably strong retention of our existing members, and then really diversified growth across our community HMO plans, full dual plans, and the plans you mentioned that are designed for members of chronic conditions.
好的，Jessica，谢谢你的提问。总体而言，我们对今年迄今在Medicare Advantage方面的增长非常满意。正如您所知，我们仍在按计划实现全年新增至多800,000名会员的增长目标。我们在年度开放注册期（AEP）积累的势头很好地延续到了其他注册期（OEP），包括对现有会员的高保留率，以及在社区HMO计划、全双重计划及您提到的针对慢性病患者的细分计划方面实现了多元化增长。
So really both from a mixed volume standpoint, we feel really good about where we sit in '25 and the outlook that that gives us around the membership growth. And I would just note really that the Medicare Advantage Plans that we offer, you know, the great work that we do from a value based care integration standpoint with a collection of our providers, both internal and external really position us well to manage these members, with chronic complex conditions. And we're very proud to continue to get to serve more of those members, as we progress throughout the year. Thanks so much for the question.
从多元化业务量的角度来看，我们对2025年的表现及会员增长前景感到非常乐观。我还要强调，我们所提供的Medicare Advantage计划，通过与内部和外部众多提供者在价值型医疗整合方面的卓越协作，使我们能够为患有复杂慢性病的会员提供出色管理服务。随着全年推进，我们为能继续服务更多此类会员而感到自豪。非常感谢您的提问。
Andrew Witty
Bobby, thanks so much. And I'd like to thank everybody for all of your questions. We appreciate your engagement very much today. While we’re not satisfied with our performance to the start of 2025. I hope you heard today our determination to improve and our enthusiasm about the path forward. We remain deeply committed to the value based care strategy the company we believe that is there way to solve many of America’s healthcare problems both from a cost but most importantly from a patient experience and outcome perspective.
Bobby，非常感谢。我要感谢大家今天的提问和参与。尽管我们对2025年初的表现尚不满意，但我希望您今天能感受到我们改进的决心和对未来道路的信心。我们将继续坚定致力于价值型医疗战略，因为我们相信，这是解决美国医疗问题的方式，不仅能够降低成本，更能从患者体验和结果方面带来最大改善。
And I think you many of you who know United well will also know and recognize that when we encounter an issue, we figure out how to work it and how to deal with it. And rest assured, we all at United are going to work our issues that we've encountered in the first quarter solve them. And you should count on us to continue to strive towards delivering for everybody we serve and to make sure that the growth of this company returns to the kind of ranges that you would expect of us.
我相信，许多熟悉联合健康（United）的朋友也会认可：当我们遇到问题时，我们会找到解决方案并付诸行动。请放心，联合健康的每一位员工都将努力解决第一季度遇到的问题，并继续为我们所服务的所有人提供优质服务，确保公司的增长重回您所期望的水平。
With that, I'd like to thank everybody for your time today and we appreciate it.
再次感谢大家今天的参与和宝贵时间。
Operator
运营员
And ladies and gentlemen, this concludes today's call. Thank you for your participation. You may now disconnect and have a great day.
女士们、先生们，本次电话会议到此结束。感谢您的参与。您现在可以挂断，祝您有美好的一天。
热门主题
Related Articles
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 ...2017-07-18 UnitedHealth Group Incorporated (UNH) Q2 2017 Earnings Call Transcript
UnitedHealth Group Inc. (NYSE:UNH) Q2 2017 Earnings Conference Call July 18, 2017 8:45 AM ET Executives Stephen J. Hemsley - CEO David S. Wichmann - President Larry C. Renfro - VC, UnitedHealth Group and CEO, Optum John Rex - EVP and CFO Andrew Hayek ...2025-05-05 Hims & Hers Health, Inc. (HIMS) Q1 2025 Earnings Call Transcript
Hims & Hers Health, Inc. (NYSE:HIMS) Q1 2025 Earnings Conference Call May 5, 2025 5:00 PM ET Company Participants Bill Newby - Head of Investor Relations Andrew Dudum - Co-Founder and Chief Executive Officer Yemi Okupe - Chief Financial Officer ...2025-02-24 Hims & Hers Health, Inc. (HIMS) Q4 2024 Earnings Call Transcript
Hims & Hers Health, Inc. (NYSE:HIMS) Q4 2024 Earnings Conference Call February 24, 2025 5:00 PM ET Company Participants Bill Newby - Head of Investor Relations Andrew Dudum - Co-Founder and Chief Executive Officer Yemi Okupe - Chief Financial Officer ...2024-11-04 Hims & Hers Health, Inc. (HIMS) Q3 2024 Earnings Call Transcript
Hims & Hers Health, Inc. (NYSE:HIMS) Q3 2024 Earnings Conference Call November 4, 2024 5:00 PM ET Company Participants Bill Newby - Head, IR Andrew Dudum - Co-Founder and CEO Yemi Okupe - CFO Patrick Carroll - Chief Medical Officer Conference Call ...