Elevance Health Inc. Q3 FY2025 earnings call

• 聚焦降低护理总成本和改善成员体验，通过综合临床和福利方法，利用价值基础护理对齐激励、改善结果并引导人们至高价值、低成本环境，HealthOS和AI驱动的临床支持降低摩擦、弯曲成本曲线。
• 2025年调整后EPS重申约30美元，视为合适收益基准，排除约3美元的离散非经常性项目。
• 2026年规划谨慎，Medicaid方面成员重新验证和州项目变化致acuity升高，预计Medicaid利润率至少下降125个基点；Medicare Advantage方面采取行动改善盈利能力，聚焦驱动保留和价值的产品，退出不符合长期战略的计划；Commercial方面综合医疗药房模式和倡导解决方案受雇主认可，客户保留率强；Carelon扩展外部关系，外部收入两位数增长，Carelon Rx销售季表现强劲，Carelon Services深化与外部客户合作。
• 到2025年底超1000万成员可使用AI驱动的虚拟助手，降低预先授权请求数量，提升提供商在HealthOS平台的体验。

Medicaid: 2025年全年Medicaid运营利润率预计略为负，2026年预计至少下降125个基点，因成员重新验证和州项目变化导致acuity升高，费率更新滞后于acuity和利用率趋势；Medicare Advantage: 2027年支付年度约55%的MA成员将在4星或更高合约中，包括三个5星合约，高于2026年的约40%，体现Star表现稳步改善及投资回报；Commercial: 综合医疗药房模式和倡导解决方案受雇主欢迎，保持谨慎定价姿态，客户保留率强，基于新客户增长和大客户高保留推动收费关系扩展；Carelon: 外部收入同比两位数增长，反映药房、行为健康和专科服务的广泛势头，Carelon Rx 2026年销售季表现强劲，有多个全国账户 wins 和高保留，Carelon Services通过高价值解决方案和创新产品推出深化与外部客户的合作，但Health Benefits的enrollment动态将给Carelon带来方向性逆风（需在1月提供收益指引时确定规模）

• 2025年调整后EPS重申约30美元，视为合适收益基准，排除离散非经常性项目。
• 2026年Medicaid预计至少下降125个基点的利润率，此为初步输入，非正式指引；Medicare Advantage 2027年支付年度约55%的MA成员将在4星或更高合约中，包括三个5星合约；2026年1月提供EPS范围；Commercial方面保持谨慎定价姿态，关注客户保留和收费关系扩展；Carelon将在1月提供收益指引时确定Health Benefits enrollment动态对其的逆风规模。

• Medicaid方面，成员重新验证和州项目变化导致acuity升高，利用率持续升高，费率更新滞后于acuity和利用率趋势，存在利润率风险。
• ACA市场方面，增强补贴到期可能显著影响2026年成员数量，若不延长，将对成员产生重大影响。
• Carelon受Health Benefits enrollment动态的方向性逆风风险，需关注其规模。

Q: A.J. Rice from UBS asked about Medicaid, specifically the margin situation, interaction with states, and pressure points.

A: Gail Boudreaux and Mark Kaye responded, discussing that Medicaid margin was slightly negative in 2025 and expected to decline by at least 125 basis points in 2026 due to acuity and utilization issues, states are receptive to program changes to improve sustainability, and there are factors like cost trend worse than anticipated and rate updates not meeting expectations.

Q: Stephen Baxter from Wells Fargo asked about investment spending in 2026.

A: Mark Kaye replied that in 2026, several hundred million dollars of investments are expected, focused on technology adoption, Carelon investments, and operational and quality initiatives to advance strategic goals and enhance long-term growth.

Q: Lisa Gill from JPMorgan asked about ACA exchanges and membership impact if enhanced subsidies expire.

A: Gail Boudreaux and Mark Kaye stated that if enhanced subsidies expire, there would be a material contraction in the ACA marketplace, with lower enrollment and higher morbidity risk pool, and if extended, they would work with states to ensure continued access.

Q: Andrew Mok from Barclays asked about Health Benefits margins, Medicare margins.

A: Mark Kaye clarified that Medicaid performance was weaker than expected, ACA market cost trends remain high, Medicare expects margin stability with potential slight improvement in 2025 supported by strong retention and disciplined cost management.

Q: Justin Lake from Wolfe Research asked about Medicaid margin exit and fourth quarter margin.

A: Mark Kaye said margins deteriorated during the year, 2026 would reflect continued pressures, but 2027 would see sequential improvement as rates and operational savings take effect.

Q: Lance Wilkes from Bernstein asked about Medicaid state margins and Carelon Rx.

A: Felicia Norwood talked about variability in Medicaid state margins and potential exit if not sustainable, Peter Haytaian discussed Carelon Rx's specialty strategy and progress in script migration.

Q: Kevin Fischbeck from Bank of America asked about Medicaid risk pool shift and balanced growth in 2027.

A: Mark Kaye said the margin reduction in 2025 and 2026 guidance reflects a balanced split of acuity and utilization, and 2027 would return to a more balanced earnings growth profile with contributions from various businesses.

Q: Ann Hynes from Mizuho Securities asked about 2026 membership growth and Carelon impact.

A: Mark Kaye said Medicaid membership outlook is preliminary, expecting modest decline, and Pete Haytaian noted Carelon's strong growth with diversification mitigating membership impact risks.

Q: Joshua Raskin from Nephron Research asked about Medicaid coding trends and progress.

A: Mark Kaye and Gail Boudreaux responded that Medicaid performance is pressured by elevated acuity and utilization, state updates sharpen assumptions, and they are aggressively addressing higher coding intensity with tools to improve data capture and documentation.

Q: Ryan Langston from TD Cowen asked about state partners contemplating benefit pullback.

A: Felicia Norwood said states are looking at all levers to improve affordability, including program changes to optional medical services, with timing aligning with new contract years.

Q: Scott Fidel from Goldman Sachs asked about Medicare D-SNP and PPO.

A: Felicia Norwood and Gail Boudreaux stated that D-SNP aligns with Medicaid footprint and Carelon's value-based care, PPO has not been a strong focus and they are focused on HMO and D-SNP products for profitability.

Q: Erin Wilson Wright from Morgan Stanley asked about commercial cost trend.

A: Mark Kaye said commercial cost trend is mostly in line with expectations, with pressure in ACA market on various services and Commercial group on outpatient utilization and service unit cost mix.

Q: Benjamin Hendrix from RBC Capital Markets asked about Medicare Advantage member exits and retention.

A: Felicia Norwood said the exit strategy is intentional for sustainable performance, and they are focused on retention in continuing markets with strong Star ratings.

Q: David Windley from Jefferies asked about Medicaid margin progression and OB3 acuity shift.

A: Mark Kaye explained that 2026 is the low point for Medicaid margins, with sequential improvement in 2027 driven by cost management, budget reconciliation bill provisions, rates catching up, and prudent outlook.

Q: George Hill from Deutsche Bank asked about Medicaid bottom goalpost and margin recovery impact on 2027 earnings.

A: Mark Kaye said they wait for clear visibility before setting formal guidance, and 2026 outlook is prudent, with 2027 expected to return to balanced growth with various initiatives.