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CFO Joel Ackerman provided the specific figures. He stated that RPT growth excluding binders is now expected to be around 2.25% for the year, down from 3%, with the cyber incident having a $40-50 million negative impact on RPT in Q2. He also noted that the revised total treatment growth guidance of down 75-100 bps equates to roughly down 50 bps on a same-store, non-acquired basis.

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CFO Joel Ackerman clarified that the NCI variance was due to timing from the Change Healthcare outage and the underlying rate as a percentage of U.S. dialysis OI remains stable. He attributed RPT strength to the annualization of collection improvements (~$50M), stable commercial mix around 11%, and an ACA exchange population of about 3%. He declined to give a share count but pointed to higher corporate costs impacting the EPS model.

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CFO Joel Ackerman stated that while the RPT annualization is a positive factor, it was a deliberate choice not to include it in the list of 'unique' tailwinds, though he confirmed 2025 RPT growth would be above normal. He affirmed the Q3 interest expense is a reasonable quarterly run rate for 2025 and could even be slightly lower. He also confirmed no material changes to the commercial mix.

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CFO Jeff Schwaneke indicated that early discussions with payers align with their public statements about seeking improved economics. He confirmed that agilon is in active negotiations and will not proceed with a payer if the economics are not prudent for the business, noting that members in such a scenario could potentially enroll with another payer within the agilon ecosystem.

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CEO Steven Sell confirmed the 2% net risk adjustment increase is on a same-member basis, attributing the lift to starting from a lower base in historically fee-for-service markets. He noted that while there was some member movement between payers, the consistent PCP relationship maintained care continuity, and disciplined growth meant the member base was essentially flat.

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CEO Steven Sell reported that the Class of '24 performed strongly. He noted the Class of '25 is intentionally smaller at 20,000 members and utilizes a 'no downside' care management fee structure to reduce risk. For 2026, he confirmed a strong pipeline with signed letters of intent for a class larger than 2025's, reflecting strong PCP demand for new business models.

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CFO Jeffrey Schwaneke confirmed the Q3 cost trend assumption increased from 6% to 9.1%, while the Q4 trend is projected at 5.2% off a high prior-year base. He elaborated that based on historical seasonality, Q4 is expected to be the highest cost quarter, with PMPM costs roughly 3% higher than Q3. Schwaneke noted he did not have the specific CMS ACO trend number available at the moment.

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Chairman and CEO David Cordani acknowledged elevated billing sophistication, which Cigna counters with its own AI and technology, noting that affordability pressures are making employers more open to innovative solutions. President and COO Brian Evanko stated that the stop-loss business is performing as expected, with this trend not having an outsized impact, and that the company is successfully executing its plan to improve stop-loss margins.

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Chairman and CEO David Cordani confirmed the plan is to recoup stop-loss margins over the 2025 and 2026 renewal cycles. President and COO Brian Evanko added that the margin improvement plan is on track, with revised pricing being implemented while maintaining retention. CFO Ann Dennison stated that Q1 stop-loss performance is tracking to expectations and the full-year MCR for the business is assumed to remain elevated.

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Brian Evanko, CFO of The Cigna Group and CEO of Cigna Health Care, confirmed the Q4 shortfall was driven by stop-loss products due to a higher-than-expected frequency of high-cost claimants. He stated the full-year 2024 stop-loss MCR was in the low 90s, a mid-single-digit percentage worse than planned. Evanko affirmed the goal to recapture 100 basis points of margin across the Cigna Healthcare portfolio by 2027, with the majority expected in 2026.

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CEO David Cordani deferred detailed 2025 capital deployment guidance to the Q4 call but highlighted the company's track record, including $24 billion in repurchases over the last four years. Evernorth CEO Eric Palmer attributed the 23% growth in Specialty and Care Services to the first full quarter of dispensing a HUMIRA biosimilar, expansion with existing clients, and broad-based volume strength in inflammatory, oncology, and neurology therapies.

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CEO David Joyner responded that it was too early to provide specific guidance or a forecast for 2026. He conveyed confidence in the progress being made in 2025 and stated that the company plans to offer more perspective on 2026 by the end of the year.

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President and CEO David Joyner emphasized the company's focus on operating stability and respect for trend. An executive (presumably Steve Nelson) noted momentum at Aetna, with early signs of stabilization in individual MA, but acknowledged pressure in the group MA business. CFO Tom Cowhey added that the underlying Aetna business beat expectations, driven by $400 million in net favorable prior period development. He stated core Medicare trends are slightly better than the outlook, with stable inpatient trends and some outpatient favorability, though medical pharmacy trends remain high.

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CFO Tom Cowhey explained that Q4 medical trends remained elevated but were less severe than the previously discussed downside scenario, with positive prior period reserve development across all business lines. He noted modest improvement in Medicare, stabilization in Medicaid, but accelerating trends in the commercial Individual Exchange (IFP) block. Cowhey stated that the 2025 outlook remains respectful of these elevated trends, but it is too early to comment with confidence given significant membership mix changes.

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CFO Tom Cowhey clarified that the potential 700 bps MBR increase includes the release of the Q3 Premium Deficiency Reserve (PDR) but does not include a potential PDR for the group business. He outlined a scenario where trends develop unfavorably, risk adjustment accruals deteriorate, and modest induced utilization occurs. He emphasized that a key uncertainty is determining how much of the current trend is induced by 2024's rich benefits, which will not persist in 2025.

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President and CEO James Rechtin clarified that Plan Preview 1 data was not yet available. He reiterated that while Humana has made significant operational progress and expects to see improvement in its underlying metric performance, the final STAR ratings will depend on how the rest of the industry performed. He confirmed Humana will enter a quiet period on the topic until October.

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CEO Jim Rechtin confirmed they have no special insight into the legal timing. George Renaudin, President of the Insurance Segment, explained that bids are being actively worked on with a multiyear strategy to diversify contracts and balance membership with long-term earnings. While declining to share pricing strategy, both executives expressed confidence in the operational progress being made on Stars initiatives.

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President and CEO James Rechtin stated that it is too early to provide 2026 guidance due to significant unknowns like the Stars litigation and final MA rates. He emphasized that the company's primary focus is on improving underlying operating performance through clinical excellence and back-office efficiency, which he views as the key to sustainable market positioning.

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CEO Jim Rechtin and CFO Susan Diamond explained that while they see 2024's performance as a floor for 2025 EPS, they will prioritize long-term investments for 2027 over maximizing near-term earnings. They did not confirm a specific dollar amount, stating decisions are ongoing. Diamond added the 'floor' concept was introduced to assure investors that the investments would not cause a year-over-year earnings decline.

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CEO Sam Hazen stated that it is too early to commit to a specific margin framework, as the company needs more clarity on the final outcome of the enhanced premium tax credits. He expressed confidence in HCA's ability to 'own our realities' and navigate challenges to meet its financial objectives but deferred providing a specific margin target until the situation is clearer.

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CFO Mike Marks reported that in Q1, exchange plans represented approximately 8% of equivalent admissions and 10% of revenues. Regarding the potential expiration of subsidies, he stated that while it is too early to provide specific estimates, he believes some members would shift to employer-sponsored insurance, some would remain on the exchanges, and others could become uninsured.

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CFO Mike Marks noted that leverage ended the quarter at the low end of their target range and that financial policies are currently under annual review, with any updates to be announced in January. He reiterated that the manageable, ongoing effects from the 2024 hurricanes were already factored into the preliminary 2025 outlook.

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CEO Sarah London confirmed expectations for margin and earnings improvement in 2026. She detailed that the Q2 Medicaid HBR pressure was concentrated in a few states and driven by specific trends like behavioral health and home health. She expressed confidence in the second-half improvement based on targeted interventions, utilization management, fraud prevention efforts, and securing better rates, noting that about one-third of their health plans are already outperforming HBR targets.

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CEO Sarah London confirmed expectations for margin and earnings improvement in 2026. She detailed that the Q2 Medicaid HBR miss was driven by concentrated trends in behavioral health, home health, and high-cost drugs in a few key states like Florida and New York. She expressed confidence in the second-half improvement based on targeted interventions, network optimization, and securing better rates.

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EVP and CFO Andrew Asher confirmed that the latest Wakely data for 2024 was very consistent with Centene's year-end estimates, with no significant changes. He noted that while new 2025 members are showing utilization consistent with what should drive risk adjustment, the company is prudently waiting for the first 2025 Wakely data in late June before recognizing it.

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CEO Sarah London addressed the Medicaid retros, stating that while they did not materialize in Q4, the company is not counting on them for 2025, so any future receipt would be a benefit. CFO Andrew Asher explained that the Q4 prior year development was influenced by the marketplace CSR settlement, which is treated as a medical expense item.

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CFO Andrew Asher clarified that the rate increase applies to the second half of 2024 and is a 'net' rate, excluding pass-throughs and programmatic benefit changes. He noted the focus is on matching rates to the post-redetermination PMPM expense level, as underlying cost trend for continuous members remains low.

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CEO Joseph Zubretsky confirmed the math for the run rate but cautioned against simply annualizing it for 2026, highlighting key variables like the January 1 rate cycle and embedded earnings. CFO Mark Keim detailed the G&A change, noting the 2025 benefit from lower comp will be a headwind in 2026 but offset by the removal of implementation costs. He cited pundit estimates of a 30% market decline for the exchanges but did not provide a specific company forecast.

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CEO Joseph Zubretsky noted a very successful enrollment period. CFO Mark Keim added that effectuation rates are strong, likely due to competitive pricing. However, he stated it was too early to provide a specific MLR for new members, as they constitute 50% of the book, but promised more clarity in the next quarter.

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CFO Mark Keim clarified the trend outlook, explaining that while the full year-over-year trend is 4.5%, a projection off the second-half 2024 baseline would imply a more modest 2% trend for 2025, or about 50 basis points per quarter. CEO Joe Zubretsky addressed the 'rate action' comment, explaining that since Molina is only about 100 basis points above its target MCR range, it may only need a few specific rate adjustments to get back in line, unlike competitors who may be further off and require a full 'rate cycle.' He did not specify states.

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President and CEO Joe Zubretsky confirmed the building blocks for 2025 growth but hesitated to give a point estimate, citing the need to see how Q4 medical cost trends emerge against the new 2025 rates. CFO Mark Keim noted that a little less than half of the $5.75 in embedded earnings is expected in 2025. Regarding Q3 retro rates, Keim acknowledged a small positive retro benefit but stated it was netted within his bridge from Q3 to Q4 MCR.

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Chairman & CEO Saum Sutaria declined to provide a 2026 outlook, instead emphasizing the critical importance of lobbying for the extension of ACA subsidies. EVP & CFO Sun Park clarified that after normalizing for one-time items, the full-year run rate for Medicaid supplemental payments remains in the previously discussed $1.1 billion to $1.2 billion range.

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Saumya Sutaria, Chairman and CEO, reiterated that the company is not updating guidance. He noted that the diversification into the ambulatory business helps the overall SWB ratio. He emphasized the importance of retaining their own workforce to expand capacity in a high-quality way, suggesting the current performance reflects a strategic balance the company is seeking.

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Sun Park, EVP and CFO, responded that after normalizing for one-time items, the 2025 guidance assumes Medicaid supplemental payments will be consistent with the $1.16 billion from 2024. Regarding exchanges, she stated that while the high growth of 2024 won't repeat, they still expect a strong environment due to positive enrollment trends.

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Chairman and CEO Dr. Saum Sutaria confirmed that based on current planning, Tenet expects to "more than offset" the 2025 headwinds and achieve year-over-year EBITDA growth. Regarding leverage, he stated that management is "pleased with where we are" but is not providing a formal target ratio at this time, while noting that debt paydown opportunities are being actively evaluated.

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CEO Andrew Witty acknowledged the trend pickup, and Timothy Noel, CEO of UnitedHealthcare Medicare & Retirement, elaborated. Noel explained that while they planned for 2025 care activity to mirror 2024 levels, Q1 indications suggest it increased at twice that rate, primarily in physician and outpatient services. He noted the company is now assuming this elevated trend will persist through 2025 and into 2026, which will inform future pricing.

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Executive John Rex clarified the revenue adjustment (e.g., group MA refunds) was not a recent surprise and was understood as performance developed. Executive Robert Hunter reported strong AEP results, aligning with the full-year growth target of up to 800,000 members. He highlighted strong retention, a tripling of returning members versus last year, and strength in HMO and dual-eligible plans. He reaffirmed a long-term industry growth outlook of 7-9%.

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Brian Thompson, CEO of UnitedHealthcare, expressed encouragement for the duals business outlook. For Medicaid, he explained that while the volume impact from redeterminations is largely past, the business faces pressure from a lag in state rate updates reflecting the higher acuity of the remaining members. He noted the company is advocating with states to close this funding gap faster than normal rating cycles would allow.

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Executives Steve Filton and Marc Miller noted significant bipartisan support for provider tax programs at the state level, which they believe mitigates federal risk. Filton clarified that excluding Tennessee and D.C. DPP funds from guidance is consistent with their conservative policy of not including revenues until programs are fully approved by CMS, not a reflection of reduced confidence.

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Executives Steve Filton and Marc Miller noted strong, bipartisan support for provider tax programs at the state level, which they believe provides a significant pushback against federal changes. Filton clarified that excluding the TN and D.C. revenue is consistent with historical practice, as UHS does not include revenue from new programs until they receive full regulatory approval.

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