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    Lance Wilkes • Bernstein

    Lance Wilkes's questions to agilon health inc (AGL) leadership

    Lance Wilkes's questions to agilon health inc (AGL) leadership • Q2 2025

    Question

    Lance Wilkes from Bernstein inquired about agilon's strategies for maintaining stability with its physician partners, the variance in 'other medical expense,' and the management process for these crucial relationships.

    Answer

    Executive Chairman Ron Williams described the partnership model, which is built on long-term arrangements with large, established local PCP groups, supported by in-market presidents and medical directors. CFO Jeff Schwaneke added that the variance in 'other medical expense' is a direct function of the individual partner share calculations.

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    Lance Wilkes's questions to HCA Healthcare Inc (HCA) leadership

    Lance Wilkes's questions to HCA Healthcare Inc (HCA) leadership • Q2 2025

    Question

    Lance Wilkes of Bernstein asked about HCA's compensation ratio and labor supply, how the company is managing these factors, and the outlook for wage inflation for the remainder of the year.

    Answer

    CFO Mike Marks described the labor environment as 'pretty stable,' with wage inflation meeting expectations. He noted that contract labor has decreased to 4.3% of salaries, wages, and benefits, approaching pre-pandemic levels. The primary area of continued cost pressure is physician professional fees, which increased about 10% year-over-year, in line with projections.

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    Lance Wilkes's questions to HCA Healthcare Inc (HCA) leadership • Q1 2025

    Question

    Lance Wilkes asked about the downstream effects of financial pressures on managed care organizations, such as changes in value-based care adoption or patient cost-sharing, and also inquired about the impact of the flu season.

    Answer

    CFO Mike Marks noted that Q1 respiratory volumes were in line with the prior year. On patient receivables, he stated that while average patient balances have increased slightly, collectability remains stable. CEO Sam Hazen added that from a broad perspective, HCA is not seeing evidence that value-based care models or changes in copays and deductibles are disrupting the overall demand for healthcare services.

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    Lance Wilkes's questions to HCA Healthcare Inc (HCA) leadership • Q4 2024

    Question

    Lance Wilkes asked about the progress on labor, including the pace of hiring, wage inflation trends, and for background on the total exposure to supplemental payment programs and what Medicaid margins would be without them.

    Answer

    CFO Mike Marks reported that contract labor as a percentage of SWD was down to around 4.5% in the quarter, reflecting improved retention and workforce development. Wage inflation was stable and is expected to remain so in 2025. Regarding Medicaid, he stated that even with supplemental programs, total Medicaid reimbursement still falls short of covering the cost of care.

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    Lance Wilkes's questions to HCA Healthcare Inc (HCA) leadership • Q3 2024

    Question

    Lance Wilkes of Bernstein asked about the drivers of improvement in the wage expense ratio, current wage inflation trends, and the impact of Medicaid redeterminations on bad debt.

    Answer

    CFO Mike Marks reported that wage rate inflation is stable in the 2.5% to 3.5% range and that this stability is factored into the 2025 outlook. Regarding bad debt, he noted that while uninsured volumes grew 7%, the overall cost of uninsured care is stable, and he does not anticipate significant changes going into next year.

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    Lance Wilkes's questions to Centene Corp (CNC) leadership

    Lance Wilkes's questions to Centene Corp (CNC) leadership • Q2 2025

    Question

    Lance Wilkes of Bernstein inquired about Centene's long-term strategy for its Marketplace risk adjustment payable, asking if the company plans to alter its product structure to reduce the payable or if it is comfortable maintaining its current position.

    Answer

    CEO Sarah London explained that for 2026, the immediate focus is on repricing to prioritize margin over membership, which could involve adjusting product tiers and networks. Looking ahead to 2027 and beyond, the strategy is to optimize the entire portfolio for sustainable profitability. She also mentioned leveraging Centene's scale to advocate for greater market transparency and policy stability, such as locking in rule changes before pricing is finalized.

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    Lance Wilkes's questions to Centene Corp (CNC) leadership • Q2 2025

    Question

    Lance Wilkes of Bernstein inquired about Centene's long-term strategy regarding its Marketplace risk adjustment payable, asking whether the company plans to alter its product structure to reduce the payable or if it is comfortable maintaining a high-payable position.

    Answer

    CEO Sarah London explained that for 2026, the immediate focus is on repricing for 'margin over membership,' which may involve adjusting product tiers and networks. Longer-term, she noted Centene is advocating for greater market transparency and for policy changes to be finalized before pricing deadlines to create a more stable environment, rather than fundamentally changing its position on payables.

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    Lance Wilkes's questions to Centene Corp (CNC) leadership • Q1 2025

    Question

    Lance Wilkes asked for more detail on specialty pharmacy trends, specifically the trend level and how it differs across PDP, MAPD, and Medicaid. He also asked if the Part D trend was from new prescriptions or higher costs, and requested a proportional breakdown of the drivers for the consolidated HBR guidance lift.

    Answer

    CEO Sarah London noted that in Medicaid, high-cost specialty drugs are a timing issue that will eventually be baked into state rates. EVP and CFO Andrew Asher specified the PDP trend is most prevalent in non-low-income members and is driven by higher utilization of drugs like Dupixent, as patients shift from assistance programs to PDP. He did not provide a specific breakdown of the HBR lift.

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    Lance Wilkes's questions to Centene Corp (CNC) leadership • Q4 2024

    Question

    Lance Wilkes asked about the Medicaid RFP pipeline, the status of appeals in Texas and Georgia, and the company's strategic priorities for investments, capability enhancements, and M&A.

    Answer

    CEO Sarah London stated that the 2025 RFP pipeline is returning to a more normal pre-COVID cadence and provided updates on the Texas and Georgia protests, which are ongoing. On strategy, she highlighted continued evaluation of M&A opportunities and a particular interest in investing in capabilities for the ICRA market, while always weighing capital allocation against the value of share repurchases.

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    Lance Wilkes's questions to Centene Corp (CNC) leadership • Q3 2024

    Question

    Lance Wilkes asked for more detail on Medicaid rates, specifically if they are set at a program or composite level, and whether the company sees utilization patterns normalizing for rejoiner cohorts.

    Answer

    CEO Sarah London clarified that while the final rate is a composite, it is built up from the underlying sub-programs. She also confirmed that run-out data shows rejoiners have high initial utilization that then normalizes, supporting the view that they create a temporary, artificial pressure on the MLR.

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    Lance Wilkes's questions to Humana Inc (HUM) leadership

    Lance Wilkes's questions to Humana Inc (HUM) leadership • Q1 2025

    Question

    Lance Wilkes inquired about the performance of individual businesses within CenterWell relative to targets, the drivers of external revenue growth in primary care, and the dynamics of internal versus external patient growth.

    Answer

    CFO Celeste Mellet reported that CenterWell's Home business was in line with expectations, while PCO and Pharmacy performed ahead of plan. She noted that durable factors like specialty mix and patient growth could lead to stronger full-year results. Revenue growth was driven by higher patient volumes and some favorable PPD, though the PPD benefit is not expected to recur.

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    Lance Wilkes's questions to Molina Healthcare Inc (MOH) leadership

    Lance Wilkes's questions to Molina Healthcare Inc (MOH) leadership • Q1 2025

    Question

    Lance Wilkes asked about network contracting, the impact of supplemental payments on hospitals, and the company's progress with value-based care (VBC) arrangements.

    Answer

    CEO Joseph Zubretsky explained that VBC is being adopted more slowly in Medicaid than in Medicare, but Molina is compliant with all state requirements and is actively working to increase penetration. CFO Mark Keim clarified that supplemental (directed) payments are typically pass-throughs that do not impact Molina's P&L, though Zubretsky noted potential cuts to them are a significant policy debate.

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    Lance Wilkes's questions to UnitedHealth Group Inc (UNH) leadership

    Lance Wilkes's questions to UnitedHealth Group Inc (UNH) leadership • Q1 2025

    Question

    Lance Wilkes asked for a breakdown of the first-quarter MLR impacts, including from premium increases and prior authorization changes, and whether any one-time positive factors supported the results.

    Answer

    President & CFO John Rex confirmed there were no one-time positive factors. He noted that while prior authorization changes were not a driver, a significant increase in wellness visits drove follow-on specialty care. He also quantified two known headwinds: a roughly 90 basis point impact from IRA-driven Part D seasonality and a roughly 60 basis point impact from the second year of V28. However, he emphasized the largest drivers were the broad-based increase in utilization and the member profile issues.

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    Lance Wilkes's questions to UnitedHealth Group Inc (UNH) leadership • Q4 2024

    Question

    Lance Wilkes of Bernstein asked about customer satisfaction levels, the primary sources of dissatisfaction, and the company's strategies for improvement, including any impact on long-term financial algorithms.

    Answer

    CEO Andrew Witty acknowledged the need to reduce system complexity, highlighting claim processing as a key focus and advocating for industry-wide standardization. He pointed to major progress in digital consumer experience, noting UHC mobile app visits were up 66% year-over-year, overall digital engagement is up by a third, and call volumes are down 10% annually as consumers shift to more convenient digital channels.

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    Lance Wilkes's questions to UnitedHealth Group Inc (UNH) leadership • Q3 2024

    Question

    Lance Wilkes inquired about the drivers of Optum Health's margin improvement, the 2025 outlook for risk contracting adoption in various segments, and other employer responses to high premium inflation.

    Answer

    John Rex, President & CFO, attributed margin improvement to ongoing portfolio refinement, focusing on core care delivery. Dr. Amar Desai, CEO of Optum Health, noted strong execution, growth in the OptumServe business, and increased outreach from payers seeking capitated arrangements. Heather Cianfrocco, President of Optum, added that interest from commercial employers in value-based care alternatives is also rising.

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    Lance Wilkes's questions to Cigna Group (CI) leadership

    Lance Wilkes's questions to Cigna Group (CI) leadership • Q3 2024

    Question

    Lance Wilkes asked about Cigna's strategic M&A criteria, particularly concerning management stability and business model volatility, and also inquired if high premium inflation is causing different behaviors from employers.

    Answer

    CEO David Cordani reiterated that Cigna's M&A criteria (strategic alignment, financial attractiveness, path to close) have not changed, but noted a more volatile asset would require a higher bar for durable synergies. CFO Brian Evanko observed that employers are adopting more precise affordability strategies, showing increased interest in specialty pharmacy programs like EnCircleRx, mental health capabilities, and precise provider networks.

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