Centene Corporation (CNC) Earnings Call Transcript & Summary

Good morning, everyone. Welcome to Centene's Investor Day. I had hoped and planned to be with the team at Centene University. But unfortunately, I was not feeling well. I was advised by both my wife and my physician to stay home. I might comment I know a long time ago, you have a basic choice to make, do you want to be happy or you want to be right. And that applies when talking with your spouse or your physician. They both said, if you want to be happy, stay home. I want to start by saying that we have an concise and impactful program today. Sarah, Brent and Drew will highlight for you the concrete steps that we are taking and executed on our strategy. Centene has delivered strong results during 2021 amid a continuously evolving operating landscape. This is a result of strong leadership of this team and the dedication of our employees to support our members. Our primary objective is to deliver against our mission providing high-quality, low-cost health care to the most vulnerable populations. Importantly, our ability to improve quality and lower costs will be enhanced by our value creation plan. We have the focus and the conviction that is less assured to execute on this program and unlock its tremendous earnings potential of this company. As I look back on more than 20 years, of Centene's history. I have never been more enthusiastic about the opportunities we have ahead to serve members, grow our businesses and create significant value. I would also like at this time to take the opportunity to thank all Centene's employees who tirelessly deliver for our members and our organization every day. With that, I would like to bring up Jennifer Gilligan our Senior Vice President, Investor Relations and Finance, to kick off our strategic discussion. Jennifer?

Thank you, Michael. Good morning, everyone. I'm Jennifer Gilligan, Senior Vice President of Finance and Investor Relations. Welcome to Centene's Financial Guidance and Investor Day. We are pleased to have an opportunity to update the investor community, and thank you for spending some time with us this morning. Our press release as well as today's slide presentation are available on the Investor Relations page of centene.com. Additionally, please mark your calendars for our fourth quarter 2021 earnings call scheduled for Tuesday, February 8. Now for the obligatory forward-looking statement. Please note that various remarks we make today regarding future expectations, plans and prospects constitute forward-looking statements under U.S. securities law. Actual results may differ materially from those indicated by these statements as a result of various important factors and risks, including those discussed in the slide you see in front of you and the risk factors contained in our most recent quarterly report and other SEC filings. Centene disclaims any obligation to update this forward-looking financial information in the future. Additionally, during the presentation, we will be discussing certain non-GAAP financial measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in today's slide presentation, which will be available on our website at centene.com. I will now walk through the instructions for Q&A. For today's Q&A session, questions can be submitted through the chat function on your screen. Your question will only be visible to the Centene Investor Relations team. We will read aloud the question and the name and organization of the person submitting the question. Today's agenda includes a strategic overview from Sarah London, our Vice Chairman. Then Drew Asher, our CFO, will walk through our guidance assumptions for 2022. He will pass the floor to Brent Layton, President and COO, who will cover our core operations. And finally, the team will offer details around our value creation plan. With that, I'll pass the floor to Sarah.

Good morning. Over the last 20 years, Centene has built a unique platform as the leader in government-sponsored health care. Today, we are the largest managed Medicaid organization in the country. We are the #1 provider on the health insurance exchange. And we are among the nation's fastest-growing providers of Medicare Advantage. Through an unparalleled record of organic growth and strategic acquisitions, Centene will soon cross $125 billion in annual revenue. And our remarkable scale now makes it possible for us to provide local, high-quality and low-cost health care to more than 26.5 million Americans. We are grateful you have traveled this journey through with us. As we hope you have gathered, 2021 has been an important and exciting inflection point for the company. In June, we announced an adjusted net income margin target of at least 3.3% by 2024 and, in doing so, formalized value creation as our #1 enterprise priority. 6 months in, I can tell you with confidence that this organization, top to bottom, is now laser-focused on leveraging our size and scale to drive margin expansion and position Centene for sustained profitable growth as we move forward. We are excited to spend a large part of today's agenda on our value creation road map. But even as Drew and Brent first take you through 2022 guidance and an update on the strength of our core business lines, you will see the value creation theme underpinning our strategy at every level. We are planning to cover a lot of important content today. So before we start, I thought I would provide you with the key messages we want to make sure you listen for during today's discussion. First, we will take advantage of Centene's unique market position and grow profitably from strength. This means focusing on our core business lines of Medicaid, Marketplace and Medicare. Two, we have a clear path to increase profitability, and you will hear us provide concrete building blocks and operational guideposts you can use to hold us accountable as we move through 2022 and beyond. Three, we are committed to a comprehensive portfolio review, beginning with noncore assets. We will apply a strategic value creation lens to each, examining their financial potential, their value to our core products and their relevance to our long-term strategy. Let me say it simply. If it doesn't fit, it doesn't stay. The key update here is that we are currently looking at our international business and strategic alternatives to maximize value. Five, we are taking a fresh view of capital deployment priorities. And while we maintain a disciplined debt management strategy, we have moved away from large-scale M&A and we expect that share repurchases will play a bigger role at Centene in terms of returning value over the next 3 years. We will also be augmenting our 2024 margin target with a corresponding 2024 EPS target that Drew will unveil later in the program. Finally, and most importantly, you should hear a clear commitment from this leadership team to drive efficiencies and increase margins through each of our 3 product lines, building upon our market-leading scale to create quality outcomes for our members, an exceptional value for our shareholders. Make no mistake, reaching our value creation goals will take time, and it will take hard work. But we are certain that we have a tremendous opportunity to transform this organization in the process, creating a more seamless and efficient operation and delivering unrivaled member and provider experiences. And while much of today is about our near-term horizon between now and 2024, we are absolutely designing our road map with the future in mind. Focusing on our core business and prioritizing value creation are not just short-term ideas. They are pillars of a long-term strategy, and we fully expect that the work we do over the next 3 years will not only align with but naturally fuel our next phase of innovation and growth. We are the leader in government-sponsored health care, and we're only going to get better. We invite you to join us on this journey. Thank you, and now over to Drew.

Thank you, Sarah. So let me start with the 2021 financial update and then provide a detailed view into the future with our 2022 guidance. Then later in the program, in the section specifically dedicated to value creation, we can cover the 2023-2024 time period. So hang in there to hear about the earnings power of our value creation strategy. We continue to be on track in 2021 with 11 months under our belt despite all of the things that have been thrown at us, COVID variants and pent-up demand, to name a couple. We are, therefore, pleased to reiterate our full year 2021 adjusted diluted EPS guidance range of $5.05 to $5.15. COVID costs from the Delta variant phase of COVID are down in the fourth quarter compared to Q3 as expected, while non-COVID costs are in line with our expectations through November. Earlier this week, we completed the sale of USMM. Sarah will touch more on that in a few minutes. And as promised, we intend to buy back approximately $200 million worth of our common shares by the end of 2021. I believe this is a microcosm of what you should expect in the future from us, an objective asset evaluation, coupled with a pragmatic solution and clear shareholder value creation. While we still need to finish 2021 strong, I'm generally pleased with the company's and the team's resilience to the hurdles we faced in 2021 and this only strengthens us for 2022 and beyond. Now let's talk about what really matters, the future, starting with our commitment for enhanced transparency. To follow up from our promises at the June Investor Day, we wanted to lay out upcoming enhancements in our financial disclosures. Beginning with our next reporting period, Q4 2021, we'll be reporting not just aggregate HBR but we'll supplement that with quarterly HBR for our 3 major business lines: Medicaid, Medicare and Commercial. We plan to give you a table with historical data from each quarter of 2021 and Q4 2020 so that, as we report in 2022, you have a basis of comparison to prior year. As we looked at our historical guidance elements and fielded questions from investors, we also thought it would be helpful to make a couple of more enhancements. Historically, depreciation has been embedded in SG&A. We're going to break that out on the income statement for 2022 so that you can clearly see the 2 pieces. We will also provide guidance not just for total revenue but also total premium and service revenue. This is because a number of our metrics, including net income margin and SG&A percentage, have been and will continue to be based upon premium and service revenue. The difference between total revenue and premium and service revenue is largely pass-through revenue and premium taxes. We will also give you guidance on the cost of services ratio, which becomes a little bit more meaningful with the Magellan acquisition, which we are working to close by the end of December and is included in 2022 for guidance purposes. We hope this helps with your modeling. Let's cover a few of the major assumptions for 2022 before we get to the specific 2022 guidance. As an estimate, we are assuming that redeterminations commenced on May 1, but this will be a state-by-state evaluation for the speed and slope line of redetermination uptake. You'll see on the next slide that while Medicaid continues to grow prior to May 1, thereafter, we expect a $2 billion revenue reduction for the remainder of the year, specific to redeterminations. As we covered on the Q3 earnings call, we expect to expand margin in Marketplace and make progress towards our long-term Marketplace margin goal of 5% to 7.5% pretax. On the other hand, we expect Medicaid to move back to more normalized performance and a higher HBR compared to 2021 as COVID error risk corridors sunset and utilization returns. Our Medicaid composite net rate increase expected for 2022 is 1.3%. Our Medicare growth is expected to be strong, mid-teens strong. Brent will touch on this further in his presentation. And while we're still in the middle of the Marketplace open enrollment season, which will end on January 15, we expect to be around the 2 million member level at our peak in 2022, a pretty good showing, especially in a year where our Marketplace focus was more so on margin expansion. Our 2022 revenue growth is strong with acquisitions of Magellan and Circle modeled in, a full year of North Carolina, continued Medicaid growth through May 1 and strong Medicare growth. Headwinds include redeterminations beginning May 1, as we just discussed, and Medicaid pharmacy carve-outs in California and Ohio. Our HBR is expected to be relatively stable in 2022 with the big moving pieces being the 2 we discussed on the Q3 call, the Medicaid HBR moving up and a meaningful improvement in the Marketplace HBR. The inclusion of Magellan has a very small impact on our HBR as shown here. SG&A has a few moving pieces. First of all, when depreciation is bifurcated from true SG&A, the 2021 jump-off midpoint is 7.9%. Then recall due to the nature of the Circle business as a provider of health care, its SG&A rate is structurally higher than the managed care business. A full year of Circle mathematically lifts the SG&A rate about 10 basis points. The same holds true for a services-based business such as Magellan. With its $4.4 billion of revenue, the SG&A rate impact is approximately 20 basis points when you include Magellan in our overall mix of business. Fundamentally and most importantly, we are showing 15 basis points of positive SG&A leverage in our 2022 guidance. Here is our traditional guidance table, including our 2022 goal of adjusted diluted EPS in the $5.30 to $5.50 range, consistent with where 2022 consensus happens to be. The diluted share count includes deploying $200 million in December of 2021, including the USMM proceeds, plus a small impact from 2022 share repurchase, given the expected timing of free cash flow being late in 2022. We first need to satisfy cash uses such as the pharmacy settlement and risk-based capital to support 2022 growth. The share count also incorporates a small increase for outstanding Magellan equity awards that convert into Centene awards. And here are some additional guidance elements that should give you better insights into our full P&L for 2022. Premium and Service revenues exclude about $6 billion of pass-through and premium tax revenue. The cost of services ratio is down slightly in 2022 due to the inclusion of Magellan. And interest expense guidance includes debt levels consistent with our current balances, though we do have a goal of delevering over time. Overall, 2022 will be a foundational year, successfully creating a pathway to accelerated adjusted EPS growth to our 2024 target. The most important thing we can do in 2022 beyond achieving these financial goals is to take actions in the value creation plan that will bear fruit in 2023 and 2024. Our value creation plan is the right strategy to allow us to fully leverage our leadership position in the market, our unique capabilities as well as our scale, all coming together to unleash the true earnings power of Centene. Let me hand the presentation now over to Brent.

Well, good morning. I'm sorry that we're not in person but I look forward to seeing your smile and faces again as we increase our margins. I wanted to update you on a few developments since the last time we met and take you through our product growth development and margin enhancement plans as we head into 2022 and beyond. We have used our time wisely during COVID, and we're well-positioned for the coming years for profitable growth. Government-sponsored health care is only growing in this country. This year, Medicaid enrollment topped 82 million. with nearly 15 million citizens served by a Centene health plan, representing 67% of our total revenues through the third quarter. As we discussed in June, under a supportive administration, the health insurance marketplace has grown dramatically. Over 2.5 million additional Americans have signed up for new health insurance coverage through the 2021 special enrollment period. Ambetter continues to be the largest exchange insurer with over 2 million members, and our commercial business represents roughly 13% of Centene's revenues. Managed Care and Medicare Advantage also continues to grow in this country. Today, more than 26 million people are enrolled in a Medicare Advantage plan. This is 2 million more citizens than in 2020. Centene's Medicare Advantage products currently provides benefits to 1.2 million members. Our overall Medicare business, including Medicare Advantage, Medicare supplemental and our 4.1 million members in PDP represents 14% of our total revenues. Let's take a moment and show you what 2022 will look like. Now here you can see our 2022 footprint, which reflects growth in our Medicare and Marketplace lines of business, new product offerings in Marketplace and new populations and geographies for our Medicaid business. I'll discuss all 3 of these in depth in just a moment. Focused on our 3 core products, Centene is stepping into 2022 well-positioned for operational excellence, profitable growth, high-quality health outcomes and member satisfaction. Now let's begin with our Medicaid product. We continue to grow our Medicaid business, with successful wins and reprocurements in Ohio and Nevada. In addition, we also won the Regional Behavioral Health Authority, or RBHA, for Southern Arizona and also added the northern region of the state. The majority of our Medicaid growth has been organic, and we've always had an impressive track record in procurements. We're starting to see an uptick in RFP activity in both new and existing markets and products, and we are well-positioned in our existing markets, and we'll continue to examine all new Medicaid opportunities. We remain confident in our RFP responses and believe that we will maintain our successful procurement record. Now in addition to being the largest government-sponsored health care program, Medicaid continues to be our largest membership group and the largest driver of our revenue. We are constantly evaluating opportunities for quality improvement and value creation in our plans, which Sarah and Drew will speak to here shortly. The cornerstone of our success, though, continues to be our relationship with providers. Currently, 80% of our Medicaid members are in value-based arrangements, meaning upside opportunities. But where I really want to focus is a true partnership with providers in up and downside risk and capitation. Today, 25% of our Medicaid membership is an up and downside risk arrangements. This is a good baseline for Medicaid, but it's our goal to grow this number and continue to empower our providers, improve quality outcomes and, of course, bend the cost curve. Our Medicaid membership has continued to rise to the public health emergency. We're working closely with CMS, our state partners to understand how and when redeterminations will begin and how to ensure continuity of care for people as they roll off Medicaid into other insurance options like the exchange product. We're fully aligned with the goal of coverage continuity, and with new product offerings for those individuals and those states without Medicaid expansion, we currently offer exchange products in 8 of our Medicaid states that don't have Medicaid expansion, including Georgia, Florida and Texas. We are working aggressively with all key stakeholders on the Hill, in the States with appropriate regulatory agencies to ensure new coverage opportunities are provided in an organized and responsible manner. We are ready. We've always been deliberate with a hyper local approach to both Medicaid and the exchange. 9 years ago, our thesis was that we could create a product on the exchange that would, at a minimum, capture the churn of people who fall off Medicaid roles and into exchange products. This led us to mirror our exchange footprint to that of our Medicaid plans. We have exchange product offerings in 25 of our 29 Medicaid states. We are well-positioned for health care programs that result from the Build Back Better Act and the end of the public health emergency. On to our Marketplace product. Now COVID has created many challenges from our Marketplace members and the Ambetter product. As we began 2021, we saw COVID headwinds, of course, followed by pent-up demand in the second quarter, followed closely by the Delta variant. But today, we see great opportunity. Yes, the competition is growing in the exchange. To compete, we did not race to the bottom in our underwriting. Rather, we developed innovation and new products. This is our ninth open enrollment, not our first, not our second, and consumers in the exchange has matured. We understand our customers and have listened to their needs. Now what we learned from last year's open enrollment is that our local approach must extend to our product development, and one size does not fit all. And with this, we went from one product offering to product choices to meet the needs and the demands of our members, whether this is a tailored network or a virtual care approach or products must meet our members' demands. Now for our first 8 years, we solely offered a core network offering, and we, of course, still offer that. But in addition, in many competitive markets like South Florida, Texas and Atlanta, we are offering new products. For example, in South Florida, we're offering Ambetter value in partnership with Community Medical Group, 16 medical centers throughout Miami, which Centene purchased in 2018. This product will employ an HMO clinic model where we're able to rely on clinical management and services and referrals to help drive outcomes and cost savings. We are excited to combine both our provider and insurance expertise. Early results show that members are also responding positively, and we have currently enrolled 35,000 members in our value product and expect this number to double. Yes, we did raise our premiums in many states, pricing in some COVID experience and pent-up demand. Now while we're only a few weeks into the open enrollment, which will end in mid-January for most states, we are confident in our early results. We are seeing significant member retention. Heck, it's risk management 101, keep your members, and our retention goals are on track. We are pleased with our new member growth as well. This year, we've entered 274 new counties across 13 of our markets, including 5 new states, Louisiana, Kentucky, New Jersey, Nebraska and Oklahoma. In 2022, Ambetter will be in 49% of all U.S. counties. And we're making progress to return to our long-term goal of 5% to 7.5% margin for Ambetter. Now rounding out the products, we have Medicare Advantage. Now as you're aware, we saw extraordinary growth in Medicare Advantage from 2020 to 2021. And as Drew said, we anticipate growth in the mid-teens for 2022, which is being reflected in our annual enrollment results. Our geographic expansion for 2022 puts us in 327 new counties. This includes 3 new states: Massachusetts, Nebraska and Oklahoma, making our Medicare Advantage product available to an additional 5.3 million customers. Our future in Medicare Advantage remains bright. Now this is our second annual enrollment period with the WellCare brand, and it continues to have an incredible path for growth, combining the product expertise of WellCare with Centene's strong provider partnerships and geographic footprint. As we prepare for 2023, we will focus on better balancing our margin expansion efforts. Our focus remains improving our STAR ratings, and we see increased opportunity in coming years with the duals population, layering our Medicare Advantage product with our Medicaid health plan footprint. In short, Centene's core products and operations remain strong but we're getting stronger, focused on quality, growth and profitability. We have a clear pathway for sustainable and profitable growth in the near and long term. We continue to enhance and streamline our operations to support these goals and execute the strategies to create additional value within our products. I'll hand it over to Sarah to give you more details now about our value creation efforts.

Thanks, Brent. Since announcing our plan in June, we have harnessed all execution and project management functions of the company and formed the value creation office. Brent, Drew and I serve as the executive sponsors of the Value Creation Office, and ultimately, the 3 of us are accountable to the Board and the rest of the leadership team in ensuring that we are making the right decisions to drive necessary change. Over the last 6 months, we have engaged with and analyzed every part of the organization, including meeting in person with every business and function at Centene and the leadership teams of each of our 29 health plans. We have developed and harvested ideas based on the diverse industry experience across our management team and examined fresh synergy opportunities taking into account our present scale. We've added dozens of initiatives and refreshed our ongoing portfolio optimization processes, including a clean sheet asset review. This is all an ongoing evolution of how we work so that we remain agile, foster a culture of continuous improvement, standardize and automate administrative processes and drive excellence and innovation, all while remaining true to our mission and local approach. We are excited about the tremendous opportunities ahead. While this is a multiphase, multiyear effort, you will see us making progress on initiatives in the near term, not just in 2023 and 2024 when more of the financial impacts will be seen. Drew will now go through the financial building blocks of the value creation plan before I come back to provide additional details about some of our key in-flight initiatives.

Thank you. As Sarah highlighted, we have a clear strategy and operational framework to achieve our multiyear value creation plan targets. This is further supported by a financial framework to help drive improved performance and results from today through 2024. Through that lens, let me convert what you just heard into a financial road map for 2024. As we said in June, our margin expansion goal is to achieve at least a 3.3% adjusted net income margin by 2024. In order to provide further clarity, today, we are providing specific insights into how our plan translates into an acceleration of our earnings power and a specific adjusted EPS target for 2024. Let me walk you through the 3 major pillars of opportunity that build up to our 2024 EPS target. These include: one, SG&A expense savings; two, gross margin improvements, including medical cost savings; and three, the strategic use of capital. Our first pillar focused on SG&A expense, annual savings includes initiatives targeting improving productivity, driving efficiencies, reducing costs, organization-wide. We expect these targeted actions to save an estimated $700 million out of our over $10 billion of SG&A by 2024. Let me give you some examples. There are basic operating model opportunities to standardize and, in some cases, regionalize or centralize certain tasks, functions and processes. For example, today, we are working on consolidating call centers, which we have spread out over too many locations. We are also standardizing and centralizing certain utilization management functions, which will provide SG&A savings, and more consistency should provide an HBR benefit. While we are absolutely committed to having a strong local-based health plan model, there are a number of operating functions we can do more efficiently and effectively to serve our health plans. In addition to medical management, Sarah will talk about streamlining our pharmacy operations as a microcosm of the overall company. This specific initiative will result in systems, vendor and personnel cost savings in the SG&A pillar. We spend $350 million per year in domestic facility occupancy costs based upon our previous model, centered on a physical location for just about every employee. With our recently adopted flexible work model driven by what we learned during COVID remote work, we expect that at least 25% of our physical space can be phased out over the next few years. There are numerous automation opportunities, examples of which Sarah has covered in previous investor events, including the use of Apixio and AI. And we are going to challenge ourselves on what does a have to have versus a nice to have by applying rigorous expense management principles in a coordinated way across our growing scale. Suffice to say that in the absence of pursuing large-scale transactions, we have the next couple of years to focus on and seize SG&A opportunities. Once again, we've sized this SG&A expense savings pillar at $700 million in annual savings or approximately $0.88 of earnings power by 2024. The second pillar is gross margin expansion, which we expect to yield from both medical expense improvement as well as broader gross margin performance improvements. This pillar is meant to represent opportunities above and beyond the typical annual need to bend trend on behalf of our state, federal and individual customers. There are a few large opportunities in this category. You've heard me mention a couple of times that we will have an opportunity in 2023 and beyond to drive a more balanced bid process for Medicare Advantage. While we certainly intend to grow this business over the long run, let me do some math for you. A 1% pretax margin improvement driven by bid discipline and improved medical cost fundamentals yields $180 million in pretax earnings lift, and we will be targeting more than a 1% improvement in Medicare pretax margin over the next few years. The comprehensive RFP process that will cover our $35 billion in annual pharmacy spend also falls into this gross margin pillar. Our current contract expires in December of 2023. We expect that this will provide an incremental benefit to our customers, members and shareholders, beyond market checks and quality initiatives that we work on every year with our pharmacy benefit manager. We also have a slate of clinical initiatives to drive the annual process of trend improvement and contribute to the value creation plan. Overall, we have sized the second pillar focused on gross margin improvement at approximately $500 million or $0.62 of earnings power by 2024. Our third and final pillar of value creation is the strategic use of capital, which focuses on value-creating capital deployment activities. Beginning in the second half of 2022, we expect to generate free cash flow, which will help fuel our plans for material share repurchases over the success of 2 years. Today, we have a $1 billion share repurchase authorization in place. For perspective, for every $1 billion of share repurchases, we expect to yield $0.10 to $0.12 of earnings power depending on assumed share price and foregone interest income. Share repurchase is expected to be the largest driver of the capital deployment pillar. But we also expect our portfolio optimization review process to net -- to be a net contributor since a number of the potential asset divestitures we have modeled are slightly accretive when the majority of net proceeds are deployed for share repurchase, with the balance towards debt repayment. On that topic, while we are not pursuing large-scale acquisitions, we would consider accretive tuck-in acquisitions consistent with our core businesses. Beyond share, buyback and potential transactions, debt paydown is also a very important part of our balanced deployment of capital. Accordingly, deleveraging will also be a contributor to this third pillar as we still plan on pushing towards debt-to-EBITDA of 3.0x, 12 to 18 months post the Magellan closing. And as we look beyond the next few years, we're also thinking about other methods of providing returns to shareholders. Overall, this third strategic use of capital pillar is expected to yield at least $0.50 of earnings power by 2024. Combined, the 3 major pillars of opportunity are expected to yield approximately $2 of earnings power. When that $2 is added to the 2022 jump-off midpoint of [ 540 ], you get to $7.40 of adjusted EPS for 2024. Then accounting for some net contributions from other organic impacts, including top line growth in '23 and '24, albeit at a lower-than-average initial net margin, we get to our projected range of $7.50 to $7.75 of adjusted EPS in 2024. For the past 6 months, we've been advancing the framework and initiatives to support and execute on these 3 value-creation pillars, $700 million plus $500 million, plus $0.50. We have a number of initiatives underway in 2021 to work towards 2023 and 2024 margin expansion and earnings lift. We completely understand that investors would like updates throughout 2022 regarding our progress and milestones. This is a subset of activities in 2022 that align with the 3 pillars we just covered. Our project plans are obviously much more detailed than this, but we thought it would be instructive in a single slide to show you the timing of some of the actions we plan to take in 2022 that will bear fruit in 2023 and beyond. This management team, and just as importantly, the operator is responsible for our execution throughout Centene are all in for value creation and driving to $7.50 to -- $7.50 to $7.75 in 2024 adjusted EPS. I'll turn it back to Sarah for some more insight into the value creation plan and to wrap up.

Thanks, Drew. Let's make this real through some examples. Starting with pharmacy. As we've mentioned before, this is a great opportunity for the enterprise and one that touches on multiple pillars of the value creation framework. Our efforts will span operating model changes, technology platform consolidation, medical management optimization and direct margin improvement through procurement discipline. First, a reminder of our strategic framework. At our June Investor Day, we announced the decision to no longer operate as a PBM. We believe that we can optimize management of pharmacy benefits by outsourcing administrative PBM functions while retaining the clinical program and stakeholder engagement functions that drive differentiated member and provider experience and outcomes. This premise drove our value creation analysis and informed a road map for pharmacy transformation on multiple margin-accretive dimensions. First, platform consolidation. We currently have 3 internal PBM platforms. The decision to consolidate with our current external partner will allow us to sunset at least 2 of those platforms and optimize the remaining technology for a more focused set of functions. Over the next 12 months, we will migrate remaining business from those platforms to our current vendor. Next, operating model. This new model will allow us to transform [ evolve ] into an enterprise center of excellence that will serve all of our health plans and drive standardization across clinical protocols while still allowing for local market engagement. By converting all our markets to the same model, we anticipate SG&A savings and operating efficiencies. Finally, by consolidating our business relationship with a single external vendor, we will have maximized the leverage we can apply in an open market PBM partner bid that we will release in the middle of 2022. This is just one example of an overall operating discipline that we will maintain around holding our service providers accountable for delivering high-quality, innovative and cost-effective services to the Centene ecosystem. Overall, the vision is for a leaner, more efficient approach to delivering exceptional pharmacy benefits and services to our members. And we believe the net benefit of these changes will contribute significant run rate returns against our value creation targets. Another major VCO initiative already well underway is the creation of a model office for utilization management, which will drive centralization and standardization in one of our most important medical management functions. Why is this valuable? The benefit of having 29 health plans is that we have 29 petri dishes of innovation as we test and refine medical management strategies. The downside of 29 petri dishes is managing all the stuff that grows in them and figuring out how to disseminate best practices. The model office is designed to retain the value of local knowledge and local execution but provide the infrastructure and processes to cross-pollinate innovation while also driving standardization. This directly leads to improved quality and productivity standards, consistent application of clinical guidelines and efficient scale across operations and people resources. We recently completed the transition of Medicare UM operations into an enterprise shared services model, leveraging the best practices that came to us through the WellCare acquisition. Marketplace is in flight today and the Medicaid transition is targeted for 2022. As part of the UM optimization effort, we have also created centers of excellence to develop specialization and cross coverage for our markets to leverage. As an example, we will stand up the NICU Center of Excellence by the first quarter of 2022 and plan to do the same for our members with sickle cell blood disorders. A principle that we will come back to again and again in this value creation work is the value of technology consolidation and process standardization to unlock the significant upside of automation. By moving to standards across our markets, we not only reap the benefits from better patient outcomes but also through the automation of basic processes like authorizations. You've heard us talk about the Centene Authorization Digital Assistant, or CADA, that was built in partnership between Centene Technologies, our clinical experts and Apixio back in Q2. Since then, we've deployed CADA into 6 markets, and our plan is to extend to 15 by year-end. The success of CADA so far is undeniable. In Ohio, for CADA-eligible authorizations, 70% are now immediately approved by the algorithm. Prior to CADA, 100% of authorizations were touched by a referral specialist and nurse with 30% to 40% then being reviewed by an MD. This is a perfect example of the potential we believe AI and automation have to serve as tailwinds for our value creation journey. Finally, I want to touch on the portfolio review process that represents another major VCO effort. Value creation is the focus of every group at Centene, including M&A. We have collectively embarked on a comprehensive portfolio review during the course of this year. We are asking the same questions for each asset: does it meet the margin target? Does it deliver value to the core business? How does it fit with our strategic direction and are we the best owner? In other words, is the time, energy and capital the asset requires to flourish the highest and best use of Centene's resources? USMM is a clear example of portfolio review at work. U.S. Medical Management is a provider business dedicated to providing high-quality coordinated health care in the home, especially for frail, disabled and home-limited members. Despite strong performance in the MSSP ACO program, the business was being underutilized in our portfolio and facing compressed margins. After a strategic review of the asset, we decided to find USMM a better owner. We forged a strategic partnership with the industry leader in home-based models and a group of investors who are excited about growing this business and are willing to put significant capital to work to ensure its success. The deal positions USMM as an independent company, allowing it to operate in a more payer-agnostic disposition. As part of the deal, we also expanded our commercial contract with USMM to preserve its HBR benefits for our health plans. We closed the transaction earlier this week, as Drew mentioned, and we will be initiating share repurchases before the end of the year with the proceeds. This one was a hat trick, delivering on all 3 value-creation pillars. Now let me move on to international. Taken as a whole, Centene's international portfolio is one of the largest health care provider assets in Europe. In the U.K., we own Circle, the largest operator of independent hospitals with 50 hospitals and 1,900 beds. In Spain, we own Ribera Salud, which operates public-private partnerships, taking risk for an entire geographic area and operating care delivery as an integrated delivery network. Together, these businesses generate a little over $2 billion in revenue. Given it is noncore, we recently completed the first stage of the portfolio review process. As a result of that analysis, we are considering strategic alternatives for the international portfolio. We expect to provide more details about that work over the next few quarters. Overall, the portfolio review process is a critical aspect of our value creation plan. We have many businesses in varying stages of the portfolio review process and you should anticipate us making moves in our portfolio as we scrutinize opportunities to create value. The examples we provided across pharmacy, utilization management and the portfolio review process should give you good insight into the opportunities we have and how we are realizing them. Our intent is to share these more detailed views into the VCO pipeline and provide updates on progress as we move through 2022 and beyond. As we wrap up today's presentation, let me first thank you all for your time and interest. I will leave you with the following thoughts. Centene has a tremendous foundation across Medicaid, Medicare and Marketplace, and we have the strategy and execution engine in place to leverage our size and scale and unlock significant value for all of our stakeholders. We have a strong, motivated leadership team and established work streams with accountability to ensure execution. And we are on an exciting journey to transform Centene and position the company to play a leading role in transforming health care. Despite all the change ahead, at least one thing will remain the same. We will continue to put our members first and work tirelessly to provide high-quality, affordable health care to the most vulnerable members of our community. Thank you. And that concludes the section of our presentation. One note before I turn it back to Jen. Before we begin the Q&A portion, we want to note that we continue to be in ongoing discussions with Politan Capital. We, therefore, are only going to be answering questions pertaining to the business and our operations. Thank you. And with that, we will take your questions.

And with that, we will begin our Q&A session. We have a number of questions here around the 2022 guidance. So we're going to start there. This first one comes from Justin Lake of Wolfe Research. "You talk about 50% earnings growth between 2022 and 2024. Can you help us understand how we should think about 2023 earnings power as you progress to 2024 earnings target of $7.50 to $7.75?"

I thought you said the questions are going to be about 2022 guidance, not 2023. I appreciate the question, Justin, not surprising. Yes, if you look at where consensus is, we, as a team, have assessed 2023. And while there are many road maps to get to our $7.50 to $7.75, most of those road maps take us through the very low 6s in 2023. So we'll give guidance on the future date but where consensus sits right now would likely be included in a range, if we had to give a range today based upon what we know today.

Great. And this one sits squarely in 2022. On the revenue bridge, this question, sorry, comes from Calvin Sternick at JPMorgan. "On the revenue bridge, are Medicaid disenrollees that you expect to capture in your marketplace products reflected in that $0.6 million other growth line? Can you provide any details to help us understand the overall retention rate for members affected by Medicaid redeterminations?"

Yes. Let me start with the redetermination cons discussion because I'm sure there's a number of questions on that, and then Brent and Kevin Counihan can talk about all of the great efforts we have state by state to do what we can to capture some of that business. So redeterminations, if you step back, we have -- our Medicaid business has grown 2.4 million members since the beginning of the pandemic. Now not all of that is from -- likely from the absence of redeterminations, but a fair amount of that likely is. And so every state, as Brent will describe, will probably take a little bit different path and there's slope lines, and we've made a bunch of estimates to come up with about half of those 2.4 million members exiting our Medicaid business by year-end. And that is what gets us to the $2 billion of revenue headwind beginning in May for the back part of the year. I think that pool will get diluted to some degree because if you're redetermined because you are now employed, you may have access to employer group coverage. And then certainly, there's always an uninsured element that sticks. So that's sort of the framework we thought about. We haven't bet a lot this year in our marketplace projections on the recapture of that. but we are very bullish about our positioning to do so in the long run.

As redeterminations begin, I mean, state governments absolutely want to make sure that their citizens have coverage to insurance. So as they move from Medicaid into whether it's commercial, or whether it's the exchange or other solutions. We've been in constant contact with our state partners to basically make sure that we're working closely with them to show options and opportunities for our members or Medicaid recipients to be and receive coverage. For a long time, like I mentioned in our remarks, we worked very strongly to make sure that we match our Medicaid states with our exchange product, and we match it both by being in those states, by being in the geography and also by having a provider network that's really built and that our members and others are accustomed to from that standpoint. Kevin?

I'd just add that the American rescue plan lowered the affordability guidelines. So the 400% cap got removed; the [ APTCs ], are obviously, richer than before. I think that this what this may mean is that employers are going to be looking at ESI, particularly at the lower end of the market, and it may well be that, for some of those folks that normally would be gravitating to ESI or employer-sponsored insurance, they're going to find the marketplace increasingly attractive.

Very good. This is related, and this is a question from Mike Newshel at Evercore. "Can you size either monthly or quarterly, some way for us to think about the financial impact, if the public health emergency has extended and Medicaid redeterminations resume later than the May 1 assumption? There's a bonus round in here relative to Magellan accretion. Are you expecting Magellan accretion to be the same as when you announced the deal for year 1 and year 2?"

All right. For the bonus question, the answer is yes. That's easy. The prior question, I think, presumes that the public health emergency continues to be tied to the maintenance of effort for the absence of redeterminations. And to the extent those are bifurcated, then -- which is contemplated, I believe, in the House reconciliation bill, then the public health emergency may not dictate exactly the speed at which redeterminations uptake. But yes, there's clearly a benefit for every month or if the slope line that we've assumed changes, but we thought it was prudent to pick a date a little bit earlier than what we told you last time as we've looked at some of the momentum in Washington, D.C. beginning May 1, and we expect that to continue through the year.

Very good. This is around HBR, and the question comes from Nathan Rich at Goldman Sachs. "In the HBR guidance, waterfall, you show a 70 basis point decline or improvement in the Marketplace HBR for 2022. Marketplace HBR came in above initial expectations in 2021, and we know that we'll get some details next quarter, but can you comment on how much Marketplace HBR is up this year? And what are some of the major tailwinds for next year?"

Well, you'll see that when we give out the table, which we'll do in the fourth quarter, and that way, everyone gets all of that information at once. So you're ready for when we start reporting the first quarter of 2022 and matching that up with the past. You're right, though, it's a pretty meaningful improvement we are targeting. We took pricing actions accordingly. As you've heard us say, Michael and Brent and others say multiple times, we're not racing to the bottom, but we're being creative with our product set. And I think balanced in our approach for the Marketplace bids, and we plan to doing the same in 2023 with Medicare Advantage. So if you do the math on that aggregate impact on our HBR consolidated, it's about a 500 basis point increase -- sorry, decrease in HBR specific to Marketplace. We've got a slate of clinical initiatives, which Brent and his team works on regularly.

Absolutely. And with that, no doubt, this is very hyper local. And we're constantly working for clinical initiatives, different approaches, different products. We feel very good about things.

Great. We're going to move on to some questions related to the core businesses. This first one is around VBC. This comes from Josh Raskin at Nephron. "Can you elaborate more on your value-based care agenda and what types of providers you're working with? What are some of the differences you see when partnering with value-based care providers?"

Well, first of all, we've had conversations, whether it's FQHCs, independent docs, medical groups, health systems, ACOs for some time. But ultimately, as COVID occurred, the discussions have accelerated. And I mentioned in my comments that we've spent a lot of time with COVID, with our providers and accelerating. And so with that, we are seeing all these providers. And again, FQHCs, individual docs, medical practices, seeing Medicare HMOs now want to be Medicaid HMOs. And we're seeing not just an upside bonus, and that's why I emphasize had a real partnership is when there's risk and where we can share data and work together for better outcomes and really have cash flow to help providers make more and more investments. And that's what we're seeing. And I mentioned earlier that 25%, we have up and downside risk on Medicaid, and we will continue to grow that. And it is not just in one geography or one section of the country. That's another thing to kind of emphasize. We're seeing great interest and in some way, demand where providers really want to work in new models. So value-based is accelerating for Centene. And I think every time that we meet, we'll be able to talk about it further and further.

Great. This is a question related to Medicaid, and it comes from Stephen Baxter at Wells Fargo. "With the exception of North Carolina, it seems like there has been a slowdown in new Medicaid opportunities for the industry. What will it take to reaccelerate the outsourcing momentum? And what specific opportunities should we be on the lookout for?"

I disagree with that question. I think there's tremendous opportunity. Centene is in 29 states. There's roughly 10 states that have not turned to Medicaid managed care as an approach that a state uses. And we've been very fortunate over the many years to be able to work with states as they consider Medicaid managed care and ultimately work with them then. So I think that's one opportunity for us. Second, there's roughly 10 states for -- that does use Medicaid managed care as an opportunity that we can continue to bring different approaches that we see and we focus on such as value-based care. And then there's many states that only have one 8 category or two 8 categories. It's rare that you see a state having all the 8 categories in. I mean if you look at Georgia, Nevada and Missouri, they do not have age, blind disabled. There's opportunities in growth, about half of the states that have Medicaid managed care have long-term support services. I mean the other half do not. You're seeing the growth of intellectual development disabilities and SMI and even foster care. So I think the opportunity is tremendous.

And this gets to the heart of the pipeline, too, this next question. This comes from Michael Ha at Morgan Stanley. "As we look to the upcoming California Medicaid RFP opportunity, believe that Centene has about 40% to 50% market share in the regions coming up for reprocurement. How do you view the opportunity to gain market share in those regions and the broader growth runway in California?"

It's a great question. And California does not have one approach or on statewide bid. California has really lots of different approaches in different markets. They have county-operated health systems. They have the 2-plan model, they have geographic managed care and so forth. And we're fortunate to be a part of those -- all of those in different areas within the state. We see opportunity in current markets potentially in the geographic managed care areas like Sacramento or San Diego as they look to potentially have fewer MCOs there, and we worked very hard with the provider community and ultimately trying to show value to the state and to our customers. And we are also looking at new geographies that we're not in today. I'm sure we're not going to name where they're at. But we do see potential for growth there as well.

This is tangential and gets to some of the policy dynamics. This question comes from A.J. Rice at Credit Suisse. "The pending Build Back Better legislation being considered in Congress would close the coverage gap in nonexpansion states. Estimates suggest that this might add 2 million to 2.5 million lives, most notably in states like Florida, in Texas and Georgia. If Centene were to get a share of these lives, how many new covered lives in marketplace might the company get? Would the potential margin on these lives be different than other public exchange lives for any reasons you'd call out?"

I think it's an excellent opportunity to expand coverage from a policy standpoint. And we're well-positioned because you're right, our footprint is such that 8 out of the 11 states that have not expanded. And the largest being Florida, Georgia, Texas and North Carolina and there's a few others, and that's the lion's share of that pool of potential covered eligibles. Timing matters. And obviously, these rolling into the Marketplace business, presumably in a 94% actuarial value product. pricing probably wasn't contemplated for this population coming in. So we are advocating, for at least 2022, for protection on behalf of the industry to the extent that this population has a higher acuity. And that's not known for sure, but there are elements out there that would point in that direction given the part of the FPL ladder. But for the long run, an awesome opportunity. And I don't know if Jon Dinesman, who lives in D.C. and is close to these things, want to contribute.

Yes. Thanks, Drew. I would say one of the most important things to look at is this is an administration that is focused on leveraging Medicaid and Marketplace is the 2 chassis for growth. And when you look at the coverage gap, the one thing that is an absolute fact is they don't want to do anything that impacts the ability for people to have access to affordable coverage. So great opportunity. We're still working very closely with those at the capital and the states. But when you look at Build Back Better and when you look at what's previously happened with some of those COVID packages, it truly shows with the enhanced APTCs, and what they're trying to do with the coverage gap, that they want to finally fulfill and ensure that every American has access to affordable and high-quality care.

I'd like to add one thing. I mean, they are -- there is a great opportunity to grow. I mean just like Drew talked about, Georgia and Florida and Texas, states that we have been for many years that does not have Medicaid expansion. There's other states like the Carolinas, so it's North and South Carolina. There's even Tennessee, which we do not have a Medicaid planning, but we have a very large exchange operation there. So it's a great opportunity for growth, and we look forward to really seeing the details to Build Back Better.

If I could just add one comment to that. We have an implementation team that's been working on this for a month. We also have a navigator advisory council that's assisting us in terms of outreach. So we're feeling more prepared for the opportunity.

Doing the homework. We're going to stick with the theme of government programs. And this question comes from Matt Borsch at BMO. "How do you think about increased competition in Medicare Advantage with regard to geographic expansion by additional public companies, new efforts by Blue Cross or other existing nonpublic plans and also some of the new entrants?"

Might say we're going to see competition whether it's Medicare Advantage or whether it's going to be the exchange or whether it's Medicaid. And the bottom line, as I mentioned earlier, we're going to very focus hyper local, partner with providers, bring innovation, whether it's products for Ambetter or whether it's looking at it for benefits that make sense in Medicare Advantage. But no matter what, we're looking toward provider partnerships, and I really think that's going to fuel our growth from that standpoint. And we're also refining our marketing approach and even our distribution.

We're going to move on to some value creation questions. This first one comes from Gary Taylor at Cowen. "Can you describe the long-term revenue and EPS growth algorithm beyond 2024?"

Well, Gary, we have been thinking beyond 2024. And what we're doing here is to get the foundation of the company such that we can continue to seize opportunities as we're very well-positioned in the best part of managed care and government programs, the highest growth part. So we're not going to give 2025 or 2028 indications or guidance at this point. But we are bullish about our positioning, not just for the next 3 years, we're talking about setting this company up for success for the next decade.

Gary gets a 2 for 1 on this. His next one is around investment-grade rating. "And I know that you touched on this in the prepareds, but we've got it a number of times in the queue. So are you still targeting investment-grade rating in the near term? And what are some of the key metrics that we can look at to attract?"

Yes, we are, and we can do both. And obviously, different constituents tilt one way or the other, but our cash flow should be strong enough to be able to do both. Once again, beginning in the back part of 2022 with free cash flow and targeting debt-to-EBITDA, pushing that towards 3.0, as I mentioned in my remarks. So now that's still a very important leg of the stool as we think about long -- the competitiveness of long-term borrowing rates. And quite frankly, having the ratings reflect the size and scale of this company, especially as we make progress towards margin.

Thank you for that. This one is related to international specifically. I lost my place. Here it is. This is from Lance Wilkes at Bernstein. "On the value creation plan, a quick clarification on international. Is this business currently profitable? And more broadly for the specialty portfolio, does owning any of these businesses provide additional cross-sale or margin capture opportunities?

Yes, I'm happy to take that. Thanks, Lance. So clarification, yes, international business is profitable. And I think your question is really relevant as we think through the portfolio review framework. So we laid out the questions that we're asking of each asset about the financial profile and the fit with our short- and long-term strategy. I would say the calculus in there that it was not articulated exactly that's really important is how does this asset contribute overall to enterprise value. And so when you think about that specialty portfolio, there are absolutely assets where the P&L as it stands today, it does not tune up to our margin target, but the value it creates in the enterprise is so significant and drives a strategic principle that we don't want to let go of it. And so I would give you an example of this is our CMG asset that Brent talked about in Florida, and the value that, that organization has offered relative to a competitive advantage in the South Florida market for our Sunshine Health plan. So again, we do look at that framework kind of in a vacuum, but then we asked a larger question of what is the total enterprise value of the asset, and therefore, do we want to keep it against a longer-term plan.

Great. This next one is relative to pharmacy, and it comes from A.J. Rice at Credit Suisse. "It sounds like the transition to a single PBM platform is a 2-step process: one, consolidate on current external vendor first, then go to full RFP for 2024 transition. Will the material savings for Centene occur when the full RFP is put into place? Or kind of the consolidation with the current vendor yield significant savings for the company?"

Yes. It's definitely a 2-step process. The more material savings does come from the RFP process, but the savings from step one is not at all a throwaway. And that is because, again, we get the expense benefit of consolidating the technology footprint. And then we also get G&A benefit in terms of streamlining the human resources and the operational model.

Got it. This next one is from Dave Windley at Jefferies, and it has to do with value creation as well. "Presenters emphasize a local approach that has been characteristic of Centene. How do you mitigate the local friction to local members and stakeholders from centralizing functions? And does that potential friction add risk to reprocurements that management highlighted are ticking up?"

So I can take a first stab at this, but then I would absolutely ask Brent to weight in, and Drew as well. So you have hit on what I would call a first principle of the value creation plan, which is that we are not in any way going to move away from what we see as the differentiation of being hyper local in our approach. And so that has been a very active dialogue as we've gone through this planning and early execution phase. And in fact, as part of -- we talked about having each 1 of our 29 health plans in and sitting with those leadership teams. This was a question that we asked each one of them and set aside time specifically for the conversation. So as we go through each one of the value creation efforts, we have committed to putting a lens on top of it and making sure that we do, in no way, create abrasion relative to the value of that local approach. And the reality is that, that probably means that we will back off of some hyper perfect version of centralization because we think that the local approach is so important to how we manage our core business. But again, let me have Brent weigh in on that and Drew as well.

Yes. Centene has always been focused local from name -- all of our Medicaid plans have a local name. We don't use the name Centene and Georgia with Peach State Health Plan, in Florida with Sunshine Health Plan and on. To our approach, always making sure that we're delivering what's important to the state we're serving. And then ultimately, operations. What we're talking about is really a few things. One is some standardization, things that were around medical management approaches. Some of it could be regionalization from the standpoint of looking at solutions maybe for the Southeast or the Southwest. And some things could be centralization. But what we mean by that is things that are not going to impact what's important to that local community in that approach. And we don't believe that will cost us RFPs. In fact, it's going to enhance us to be able to really put more and more investments into our local communities, which is what we're after.

And just one last thing. Often, centralization doesn't mean physical location. It's often sweeping different functions or people into a community of like functions and keeping them embedded in the local markets. And I suspect our members don't care who reports to who from internal inside baseball. But you're right to point out that the local-based health plan model is -- we're absolutely committed to that.

Thank you all. This is a different element of value creation moving towards M&A. This question comes from Calvin Sternick at JPMorgan. "Understanding that M&A will be focused more on tuck-in opportunities going forward, but can you talk about whether or not you expect that bias will be towards health plan membership growth or services? And if on the services side, what types of services?"

Yes. Thanks for the question. The -- let me start with a little bit of background because I think it provides context for that question. As we've mentioned at the June Investor Day and since, through organic growth and strategic acquisitions, we've reached a national scale. So we're now out there seeking large transformational acquisitions. We've told you we could pursue tuck-ins or bring in-house key capabilities, and we'll always evaluate smart accretive acquisitions that come our way. But like the rest of the company, the M&A team is focused on portfolio review. And specifically on portfolio review, as we've mentioned, every single noncore asset that we own is going through the portfolio review process. And we've already made some progress on that, including the sale of the majority stake in USMM mentioned earlier this week. That review is comprehensive. And every single noncore asset that we own is going to be evaluated using the same framework that Sarah just laid out. That includes businesses we bought, businesses we've inherited through larger acquisitions and businesses we built organically. The reason I start with all that is if we are to acquire things going forward that are noncore, it's going to be evaluated using that same exact framework. So anything that comes in now, obviously, is going to be evaluated using those same 3 sets of questions. We can't tell you right now which opportunities are going to present themselves and what exactly they're going to look like, but we can tell you that that's how we're going to evaluate things going forward.

Yes. And I would just add and sort of emphasize what Colin said. I think the bias is probably more toward smaller health plan acquisitions. But if there are noncore tuck-ins, I would say the first question would be how do they align with and drive value to the core business. So that, I think, rises to the top in terms of that evaluation framework.

Thanks, everyone. We have some additional questions around 2022 guidance. So we'll go back to some of those. This first one is from Ricky Goldwasser at Morgan Stanley. "How is Omicron uncertainty factored into the 2022 guidance?"

Well, clearly, we don't have crystal balls in order to predict future variants or even the impact of current variants. But we do think about, when we're pricing business, all of the different levers of trend. And so we've got flu assumptions, which, by the way, look a little good in terms of the absence of flu so far this flu season. And once again, we don't know what's going to happen tomorrow, but so far, that looks good. We've got assumptions in for COVID, not variant-specific as many of these pricing decisions were made in the summer of 2021. We've got assumptions in for pent-up demand, especially in our Marketplace product that we mentioned in our second quarter call, and we've got trend assumptions as well. So think of all of those assumptions are fungible in terms of what actually presents itself. And we're managers. We have to manage through tough times and when things are thrown at us. And that's -- I think if you look at 2021 and how we were able to manage through things we didn't foresee as we were sitting here in 2020. I'm sure we'll be faced with that as we go ahead, but that's sort of what we do for a living.

Great. This next one comes from Michael Wiederhorn at Oppenheimer. "Can you talk about the $2 billion redetermination headwind? And can you expand on your assumptions and what that run rate will be when exiting 2022?"

That's a good question because, obviously, that started in May. And it's literally 29 different assumptions of timing based upon our feet on the ground and conversations we've had with all of our state partners in terms of what motions they may put in place and when and the speed. So if you annualize that $2 billion, it's another $2.5 billion to $3 billion. If we stay at that 1.2 million member attrition assumption, we need to see how this plays out. I'm hoping that -- and then planning for that assumption in 2022 to be prudent but we really need to see how that plays out and then how we dovetail in with our catcher's mitt, with our comprehensive Marketplace offerings across most of those markets.

Great. Thank you. This next one comes from Scott Fidel at Stephens and is related to Marketplace. "We've touched on some of this, but can you provide some more granularity on the specific margin in the Marketplace segment you are embedding into 2022 guidance? And then in which year do you expect to get back to that 5% to 7.5% long-term target in Marketplace?"

The margin that we've embedded into 2022 is below the 5% to 7.5% long-term target, but it's a hell of a lot higher than 2021. So we're excited to be able to expand margin. I mentioned in a previous question about a 500 basis point improvement in HBR, if you do the math on the 70 basis points to the entire company. So that, I think, gives you most of that answer. And then we expect to continue to make progress and push into that range as we look at the next couple of years.

Great. This is the last question that we have time for, and it comes from Michael Ha at Morgan Stanley to that long-term EPS. "So looking at your EPS bridge to 2024, $2 of value creation drives about 40% of EPS growth to 2024 with $0.10 to $0.35 from organic growth. This translate to -- translates to a low single-digit implied core growth in '23 and beyond. Do I have that characterized correctly? Can you help us basically think about organic growth?

Yes. Just like we said in June, we're still committed to charging towards a mid-single-digit organic growth rate. Some years, we'll have headwinds like redeterminations. Other years, we might have tailwinds such as really strong Medicare growth and/or large Medicaid wins. But we're pushing ourselves -- despite our huge denominator, which obviously makes the growth rate a little bit harder. We still think, fundamentally, this business, we can push for that mid-single-digit top line in the long run.

Excellent. With that, we want to thank the team for their time this morning and thank all of you for joining us. You guys know where to find me. If you have any follow-up questions, please reach out to myself or Libby Abelt. Libby's e-mail address is [email protected]. And with that, we hope to see you in person real soon.