Humana Inc. (HUM) Earnings Call Transcript & Summary

Good afternoon. My name is Lisa Gill, and I'm the health care services analyst here with JPMorgan. It is with great pleasure that we have Humana with us this afternoon. With us, we have Bruce Broussard, CEO; as well as Susan Diamond, CFO, who will join us for the breakout session after Bruce makes a couple of opening comments. Bruce, welcome, and I'll hand it off to you.

Thanks, Lisa, and it's great being here, and thanks for including us in your conference. I would like to begin with the discussion of our 8-K and then -- that we filed last week and some clarifying comments, especially as we consider the webcast last week. A lot of the comments we made, I didn't fully -- the intentions of those comments didn't fully come alive in the -- from our investor point of view. So I want to spend a few minutes there. And my comments are going to be really in 3 areas. My first area is going to be around the industry and our belief in the industry. Second comment will be around our 2022 and 2023 actions. And our fourth will be -- third will be around our membership and specifically around our margin and some comments that we want to clarify there. First, we want to say that we are big believers in the Medicare Advantage program. Medicare Advantage provides some structure that is really where the health care industry is going around value-based care, social determinants of health, allowing a much more affordable product and also providing our beneficiaries the financial security. The second part of it is that it is also demonstrated through the last number of years the deep support from a bipartisan Congressional periods. We've seen this not only in the current administration, but also in previous administrations. On top of that, we see significant growth in the area of MA when you compare it to Medicare fee-for-service. MA has outgrown Medicare fee-for-service for a number of years as a result of deep value proposition not only in the plan itself, but more importantly in the care coordination and the clinical outcomes. Second thing I want to address is that we have not seen significant industry shifts. We continue to believe the industry is really on a trajectory of long-term growth, and we believe that the continued growth in the areas of the health care services side and in addition in the insurance side offers some very, very long-term opportunities. This year specifically is a year that we decided to protect our margin through conservative pricing. We continue to believe that was appropriate. But as a result of some of the aggressive, both from a competitive point of view and from a marketing point of view, it did have its disadvantage. And I'll talk briefly about that. Third is, we remain confident in our ability to achieve long-term earnings growth, specifically to meet our target of 11% to 15% growth. Humana has been long in the Medicare area and proving its innovation in areas like our clinical service area, our ability to drive clinical outcomes and our integrated care model. And we continue to see that as serving us well in the future as the fundamentals of the industry continue to be strong and our competitive advantage continues to be well positioned. Now I'd like to spend just a few minutes specifically on 2022 and 2023. First, we do need to address our value proposition. And we feel, in 2023, we'll be able to address that specifically as a result of our continued strength in our clinical programs and the ability to continue to gain return on investments from our investments we've made over the last number of years such as primary care, home care and also our technology investments. And then lastly, as we have done in many -- past years, we will continue to improve the productivity of our cost structure, specifically in our administrative costs. We've done this many times before in areas like when the HIF was in and out, our -- when the Aetna deal broke, and we regained our membership in 2017. In addition, we have been able to do this also in years where we've seen our value proposition at a negative level. We feel, in 2023, we'll be able to achieve that as we have in the past. With respect to marketing, we have seen elevated level of marketing, and that has served the industry well over the past number of years as a result of the education and the awareness the marketing has created. This year was a disadvantage for us as a result of our value proposition and really hurt our ability to grow and the ability for us, not only from a sales point of view, but more impactful has been our retention. We continue to look at the marketing as an opportunity in the future. And as our value proposition improves, we will continue to be able to take advantage of the awareness that it creates. And so we look at the marketing as actually being a positive as our value proposition improves. I do want to talk briefly about the sales channel. The sales channel has commoditized, over the past number of years, the value proposition of MA. When I made the commodity comment last year, it was really -- I mean, last week, it was really more around the sales channel and not the industry. What we have experienced over the last few years is that the telephonic sales channel continues to sell on price versus selling on the total value of Medicare Advantage. As we have seen in other sales channels that are not telephonic that the value proposition is much broader than price to discuss care coordination, some of our services that we offer, including some of the planned benefits such as social determinants of health. And when those discussions happen, we see a deeper engaged member and a member that has longer tenure with us as a company. As we enter 2023 planning, we will continue to evaluate how we use the various different sales channels and, in addition, working with our partners in the telephonic sales channel in continuing to focus not only on sales, but also retention and the ability to continue to incentivize not only sales growth, but more importantly, how do we retain over a longer period of time our members. We also are continuing to work internally around our ability to retain our members, especially the members that are early in tenure with us and the ability to engage with them in a much broader fashion, so as they do use our benefits, they begin to start using them in a deeper fashion and in a more engaged fashion. The last topic I wanted to discuss is really around our margin. Over the last number of years, our industry, and specifically Humana, has changed. And more specifically, we as an organization have evolved from just a company that has a health plan. It's a company that serves our MA members with broader services such as specialty and our home health services and our primary care along with our pharmacy. And as we think about MA margin and as we think about the individual MA margin, we continue to see the benefits of offering these additional services in the totality of our earnings capability with an individual member. In fact, as we study it, a member has 2 to 4x greater margin improvement as they use the services outside of just the plan itself. As far as we've talked on many occasions, our strategy is to continue to build the capacity and the expansion of these health care services, which ultimately improves the margin on our MA individual business. And so as we progress forward, we'll continue to provide deeper understanding of how we can and continue to increase our margin not only on the individual MA side, but in addition on the combined services that we offer. And this gives us confidence in our ability to achieve our 4.5% to 5% margin target in totality as we look at the individual MA not only on the plan side, but also the health care services. So in closing, I want to reiterate that we are very bullish on the long-term aspects of MA. The industry has significant benefits to offer both members, health plans and also providers. And we will continue to be oriented to achieving our targets of not only membership growth, margin improvement, but also our long-term earnings per share growth of 11% to 15%. So with that, Lisa, I'll turn it over to you to begin the question and answer side.

Thank you so much, Bruce, and thank you for those comments. And Susan Diamond is also with us. And I just really want to follow up on just a couple of quick things and then we'll talk about some other stuff as it pertains to your business. But one of the questions that we've gotten around this 2022 hiccup and thoughts going into 2023 is that you'll need to make some investments. And you reiterated this 4.5% to 5% margin on your Medicare Advantage business. So can you talk about that value proposition? What you think that will entail for 2023? And what that could potentially do to margin? And then secondly, I think you're probably going to say that it's a little early to know exactly which members have terminated, but I'm just curious around the tenure of those members. Because if I remember our conversations with you previously, the longer the members on the platform of Humana, generally they're more profitable. You know, right, what kind of services that they need, you know how to be able to manage that patient better. So why don't we start with those 2 questions?

Sure. And I'll take the latter and maybe Susan can spend a little bit of time on both of them, but I'll just explain. What we've seen this year is a significant number of our members that are 1 year or less actually were part of the churn that we've experienced. That's not saying that we didn't have churn in other cohorts, but a material amount of that churn was in the 1-year level. Obviously, they're profitable after the first year. But in addition, as you articulated, the engagement and the participation in our clinical programs are not as great. And in result, our ability to really affect the total opportunity is limited with only a year of participation in [indiscernible]. Susan, do you have anything to add to that and maybe just the first question she asked?

Sure. I can address the first question, and thank you, Lisa, for having us today. Glad to be with you. As it respects the '23 investment and what it will require to get us back to a growth leading position, what I would say is it's important to remember that as we approached our '22 bids, as we've said previously, we did approach them more conservatively. And I would describe it as we would have embedded a more normal course or typical level of conservatism as we do any year. And then we explicitly added an additional incremental amount related to the COVID -- ongoing COVID uncertainty really in the hopes that we could ensure that we set ourselves up for 2022 to deliver against our earnings target and, to the degree possible, remove any overhang and ongoing uncertainty related to earnings. So as we did our bid planning and created some estimates of what we expected our membership growth to be, as we shared with our initial estimates, we did believe that as a result of this increment -- that incremental conservatism that we would find ourselves at a slightly disadvantaged position relative to prior year and that our growth will be impacted. And our initial estimates were that we'd grow about 8%, which we did expect to be slightly below the industry rate. Now that we've had the benefit of seeing the ADP results, and obviously, you're seeing the higher disenrollment as we discussed, resulting in lower growth, we will certainly need to reevaluate what overall investment is needed. I think based on our initial estimates, we would have expected that the additional conservatism that we embedded for COVID, as that hopefully proved to be unnecessary, would create some tailwinds that allowed us to reinvest in products and get back to the competitive position we needed. Now that we've seen greater pressure on the growth than we anticipated, we'll need to do additional work to see what additional investment might be required. And to be honest, we'll need to have the benefit of the full visibility of industry enrollment. We should begin to see that mid-January when CMS releases the broader enrollment data. And that will allow all of our market teams to do additional analysis to really assess which plans are winning in the market, how do we stand up to those on a benefit value basis network. We'll also continue to evaluate our marketing and distribution strategies. And we'll take all of that into account in assessing what additional investment is required to return to an industry-leading growth position. As we evaluate that, we'll continue to look for ways to create capacity to make those needed investments, as Bruce mentioned, across productivity, operational efficiency, accelerating returns off of existing investments in primary care and home and technology, as Bruce mentioned, to see if we can create the needed capacity to return to industry-leading growth. Whether that will take 1 year or potentially longer remains to be seen and will require to view additional analysis going through the benefit of full information to make that assessment. And that is something that we will certainly keep you apprised of as we begin our work and continue our work around '23 planning and come out of those bids, we'll certainly keep you informed on our ongoing expectations. But as Bruce said, we remain very confident in our ability to do so. We just have some more work to do to develop the specifics around that plan.

And then just my last question really would be just the comment that the Bruce made around telephonic, really focused around price, right? You talked a lot that people have only been on the platform for 1 year, so they were happy to switch to another provider. Do you think post COVID that we move back to more traditional channels and that, that will make a difference? Or do you think that the e-channel and telephonic are more here to stay even post the pandemic period?

Lisa, I would say they're here to stay. I think they will evolve the channel. The telephonic channel that we see today and the digital channel that we see today will continue to evolve. I think today, our digital purchases are much smaller than the telephonics side. We anticipate over time that, that will actually be a great channel to utilize. But I do believe when I talk about the evolution, it's not only where it's done, but it's also what's done within that channel. And I believe that over time, the telephonic side -- because everyone is [indiscernible] It's against the business interest and, frankly, the members' interest to have this kind of churn that it's going to evolve to really selling beyond price and selling beyond the discussion that we had last week, where I talked about the commoditization of the channel itself. I believe the total value of Medicare is something that really differentiates not only the MA, but also differentiates the plan within the industry as a whole.

That makes sense. We obviously can't have this conference without talking about COVID because that's why we're all sitting virtual rather than sitting together at a conference. So Susan, I've heard you talk about COVID cost and non-COVID cost and the fact that they've somewhat offset each other. Can you give us any update of what you've seen more recently? And our expectation, it -- one, is there some type of built-up demand, especially on elective type of procedures for 2022? And two, how do we think about this variant, Omicron, and the severity of what you've seen on some of your membership, both commercial as well as your Medicare Advantage products?

Sure, happy to. As we have shared previously, in our Medicare Advantage business, as you said, we have seen -- any time we've seen spikes in COVID, we have seen offsetting reductions in non-COVID utilization. And that's been fairly consistent on the inpatient side and then further depression that we've seen on the non-inpatient side that offsets the higher cost of a COVID hospitalization. And as I said, that's been very consistent. On the commercial business, it is important to note that, that does perform differently. And that aside from the initial onset of the pandemic when we saw the lowest levels of utilization, since then, we have not seen a full offset in non-COVID utilization during surges on the commercial side. And that was one of the reasons we decided to take some pricing action in the third quarter as we saw that emerge, hoping to mitigate any ongoing pressure into 2022 in the commercial business. And we'll just have to continue to monitor the overall trend. Back to the Medicare business, as we think about and evaluate the Omicron variant, what's been interesting is that it has performed a bit differently than prior surges. We did start seeing an uptick earlier this year, but it was not consistent across all markets and the rate of acceleration varied across the state. We were seeing through the end of December an increase in COVID cases, but it was at least a less steep trajectory than we saw in previous surges. Now more recently, coming out of the holidays and certainly the first week of January, we are seeing a significantly larger increase in hospitalization rates. And so that is something we'll continue to monitor. But to date, as we've seen those increases, we do continue to see the one-for-one offset in reduced non -- or inpatient non-COVID utilization. As we said before, we don't have the same real-time visibility into non-inpatient trend, and so that will take a little bit longer for us to evaluate, and we'll certainly update everyone on our fourth quarter earnings call in early February. In terms of severity, it's really too early for us to be able to assess our internal experience as with respect to Omicron variant, but we're certainly watching the external commentary and experience in other countries, which at least initially does seem to suggest that while transmission rates are higher, the severity of symptoms and the need for hospitalization and ICU and ventilation level care is much lower. And so we're somewhat optimistic that we will see similar results relative to previous surges. As it respects trend demand, we did see some evidence of that in our 2021 experience. We were watching trends closely. And I would say as the vaccination was successfully rolled out and the country began to open in certain service categories like scheduled orthopedic procedures, colonoscopies and other preventative trainings and chemotherapy as well, we did see for a short period of time utilization came above what we have described as sort of historical baseline level, where we tried to estimate, in the absence of COVID, what would we expect utilization to run. So for a short period of time, we did see certain service categories where it was logical to think there might be some pent-up demand come through that then sort of reduced back down. And so we believe that the way we approached our 2022 trend forecasting that we have a level of pent-up demand embedded in our estimates similar to 2021, although one could argue that given the overall depression we've experienced in '21 is less than 2020, that arguably, there's less pent-up demand that we'll see come through. But we're confident in the way we've assessed it and that we have it covered in our current '22 [indiscernible].

But one of the other things that has come up in this -- in the Biden administration is for health plans to actually now cover testing. And as we move forward, how do we think about your expectations of what was built into your numbers for 2022 around testing? And then secondly, what are your thoughts around actual reimbursement rates? I know there's generally like a fee schedule tied to it, but do you have emergency pricing in place today for labs and it's far higher than what we've seen traditionally for a requisite for something like a viral type of lab test?

Sure, happy to take that. So on the testing front, we did anticipate for 2022 that we would be responsible for testing costs. There's still a lot going on as it respects how is that going to be managed. Obviously, the administration has been buying additional testing in and said that they will make that available. So much like the vaccines, we'll need to monitor exactly how that will play out over the course of 2022. And to the degree the administration and the government provides the actual test and/or vaccines, we would expect to continue to cover the cost of the administration of those. But we'll have to see at what point can we bear the full burden of those costs. That is something that we had anticipated for '22. So to the degree we don't bear that full cost, there could be some tailwind that we could see in 2022. Having said that, there is one item that we continue to watch more on the commercial side related to surveillance testing, whether it's return to work or return to school. We don't believe the intent is that commercial plans would be responsible for that type of testing, but rather exposure testing. But there's a lot of complexity to understand how will that be identified and managed. So we continue to work with the administration to understand and provide some feedback on how that might work and remains to be seen. In terms of the cost of the testing in and of itself, we do continue to monitor what we're being charged. On the Medicare side, it can be governed by the fee-for-service schedule, so that one is pretty straightforward. On the commercial side, though, there you do have some susceptibility if it's non-par and where someone like try to charge higher rates. We monitor that very closely and certainly have taken some additional action in terms of our coverage to make sure that beneficiaries only are paying reasonable cost for access to testing. And again, some of that will depend on what exactly happens with the availability of testing through the government through 2022 as well.

I know you're not going to give us a specific number, but I have to ask this question. In 2021 guidance, you had $600 million of net COVID headwinds, and you indicated that '22 guidance would also include an unquantified net COVID headwind. Now that we closed the books on '21, is there a way to tell us how that $600 million actually trended versus what the original expectation was? And then secondly, is there a way to maybe frame it? Is it roughly in line, half the size or anything that you can give us? And you know I have to ask you, even though you may not be comfortable giving it to us.

Yes, absolutely. It's a fair question because as we've said in our initial commentary about 2022, we do intend to go out with an initial guide that targets the low end of our range. But within that guide, we will contemplate a specific COVID headwind. Our past experience has suggested that any time we have a surge, at least again on the Medicare side, we see a full offset such that the total medical costs have actually continued to run below baseline. But again, given the ongoing uncertainty related to COVID and the variety of things that we will need to learn more about over time, including just sort of underlying morbidity and impacts of higher mortality and other things longer term, we thought it was prudent to include a COVID headwind such that we could embed it in our initial guide. And if it proves to be conservative, you would see that release over the course of the year and hopefully position us to beat against our initial earnings target, and we felt that was important. As it respects to the magnitude of the headwind itself, it's important to remember that our second quarter earnings call that is when we disclosed the $600 million COVID-related headwind in our MA business. At the time, we were able to offset that by other operating outperformance, things like prior period development and Medicaid and specialty outperformance as well as the full integration of the Kindred -- the rest of the 60% ownership in Kindred. We also, though, at that time indicated that, that estimate was also predicated on non-COVID utilization running 2.5% below baseline in the back half of the year. On our third quarter call then, we updated that information to say that we now expected all-in utilization to run 1% below baseline in the fourth quarter versus the previous 2.5% expectation, and that's what resulted in the additional headwind of $1 EPS production for the full year. Now at that time, we did reaffirm our -- recently rather, on January 6, we did reaffirm our guide of $20.50 for 2021. So I can say that we continue to feel good about the overall net headwind that we communicated on the third quarter call. When you think about 2022, it's important to remember that, that headwind that we experienced in '21 was primarily driven by 2 things. The first was risk adjustment, and that headwind was really due to the significant depression in utilization in 2020 that we've talked about as well as estimating the rate at which health care utilization would rebound in the first half of the year. Remember that when we entered 2021, we were entering with significantly depressed utilization levels because of the late 2020 COVID surge, and ultimately, we saw that non-inpatient utilization in particular rebounded faster than we had initially expected, although it was still running below baseline. And as we discussed previously, we continue to track the expected diagnosis codes for -- that was received in 2021 to support our '22 reimbursement. We've been tracking that throughout the year, and those continue to come in, in line with expectations. And our '22 estimates, as we disclosed, we are planning for a return to baseline health care utilization levels. So we're not counting on any sustained depressed utilization to support our guide in 2022. And so for those reasons, we feel like those larger headwinds we faced in 2021 will not recur to the same degree in 2022. So while you said at this time, we are not prepared to give an exact amount related to what we'll embed in our 2022 guide, we certainly will do that on our call on February 2. So you have transparency to that. But certainly, as you said, as you think about the net headwind we've experienced, which is that $1 adjustment to EPS, that's certainly one input that we're considering. But again, we aren't prepared today to give it an explicit amount, but we do intend to do that on our fourth quarter call so that investors have full transparency to what that is. And then hopefully, that frees unnecessary -- we see that unwind in additional earnings throughout the year.

That's really helpful. Bruce, we talked a little bit about some of your value proposition of primary care, home, technology, et cetera. Humana has really invested in building out your health care services capabilities and really has an emphasis on home health. There seems to be kind of 2 strategies in the market with some preferring to own the delivery of the assets, others choosing to contract or JV or partner? First, can you talk about where you believe it's better to own the delivery of those assets? And secondly, what incremental advantage do you get by owning versus contracting or JV or partner in the marketplace?

Well, few things there. I think, in general, we do believe that integrating care in the plan is an important value proposition. We find like the coordination of care has significantly improved as a result of that, and so we think that integration is there. And we see that in our primary care area, we're starting to see it in our home area that we've been able to overlay a value-based payment model. And obviously, we see that in some of our partnerships that we have with other providers in the marketplace that we don't own, but we have a deep partnership with. So we do believe this integration of care is an important part of that. We do believe also as we integrate that care and the opportunity of the earnings that come from our members participating in those health care services is just another opportunity that we have and continuing to expand our both addressable market of revenue and, at the same time, also offer another growth trajectory for our shareholders. And related to that, as we think about the total addressable market, just from a membership point, we also are able to take those health care services capabilities and expand them into other non-Humana member services. So whether it's serving other payers that don't have the assets or in addition being able to take advantage of some of the new innovative reimbursement models like direct contracting. So the addressable market gets bigger for us as you think about value-based payment models, as you think about the ability to own these assets. And so it's a culmination of the belief in integrated care and the continued integration of that. It's the opportunity for us to basically in-source additional revenue for us as an organization and expand the opportunity on our existing membership. And the third is to be able to expand the addressable market that we're able to really bring what we do well. And that's really -- and that's around value-based care and the ability to coordinate care in complicated populations such as chronic and duals and other [ populations ] that are really expensive and utilized in the health care system.

That leads to another question that someone asked me today around CenterWell. You recently had an investor survey where you said, among other things, would you like to see CenterWell off balance sheet or on balance sheet with some level of dilution? How are you thinking about it internally? And what did investors tell you if you have any insight as to what way they'd like to see it would be my first question? And then secondly, when we think about CenterWell as a competitor to some other companies that you actually have investments in like an Oak Street, how do we think about CenterWell competing with an Oak Street? Or do you not really consider them to be competitors in the marketplace?

I'll try to take both of those, and then, Susan, please add to it. I think on the latter question, the market is so early. I know there's a -- from the investors' point of view, they see a number of companies that have gone public over the last number of years. And it sort of gives a view that it's -- there's a lot of penetration in the marketplace. We are very early in primary care specifically dedicated to seniors, and the market is big. One of the reasons why we do support partners in the marketplace that are affiliates to our -- to us, we really believe that the capacity to help our insurance plan and our members is an important part of what we're of the need. And so to really fill the demand that's out there. But over the long term, we also believe having assets like CenterWell as a complementary nature and continuing to expand, that serves not only the ability to develop additional capacity to meet our needs, but also build a long-term business opportunity for us as an organization. As we think about the expansion of CenterWell, we are thinking about it from a balance point of view. We understand the investors are very oriented to the shorter-term growth of our earnings per share and our -- that's a priority for them. And so what we are working through is what is that balance. How much is on balance sheet and how much is off balance sheet? But we do believe, as we think about this, the combination of on-balance sheet with a combination of acquisitions that helps any kind of dilution that you get from -- where that occurs from the on-balance sheet and off-balance sheet is a really good balance to maintain the long-term strategic nature, fulfill that capacity that we're trying to obtain, but at the same time, ensure that our short-term growth and long-term growth targets are completely met.

Bruce, you've mentioned Direct Contracting, right, a new program by CMS. Can you talk about your initial views on how Direct Contracting has gone? And how many lives that Humana has today and future opportunities around Direct Contracting?

It is early, and we were obviously one of the early participants in the program. We've done it on 2 sites to really test and learn what is on the plan side and then what is on the provider side. So CenterWell as a participant in it and so as Humana has a plan. Within the Humana plan, we actually utilized some of our owned assets along with some affiliates in the surveying of those individuals that are in the direct contracting side. And we see some early positive results. There's a lot of learning from it. So we wanted to start out small. So our membership is below 10,000 members in that particular area. And -- but we're learning a lot and really helping support the federal government in bringing other programs that bring opportunity to value-based contracting within the Medicare Advantage area. But I would say, Lisa, we have a long ways to go, not so much as a company, but as an industry to continue to evolve Direct Contracting. And I think over the next few years, we'll see substantial learning from it and then the decision of does the government want to expand it or not.

Bruce, I would be remiss if I don't ask something about your PBM, just given that I've followed PBMs for over 20 years and now they're all parts of other companies. But I look at the success that Humana has had, especially around mail order. I look at Humira that, that will lose patent protection next year and the amount that flows through mail. Can you talk about the opportunities that you continue to see, number one, just with your PBM overall? You've got a new platform, right, that you're building with Anthem. And then secondly, what do you see specifically to like specialty and biosimilar? Are there real opportunities there for Humana?

Just on the latter question, we continue to build on our specialty business and actually has been a really great growth for us over the last few years and the expansion of that. Obviously, that is much more selling to referral sources like doctors and our ability to expand our value proposition, both in the drugs that we can offer and, at the same time, the services we offer to pharma and in addition to the providers. And so we -- that's a great opportunity. And as you well know, that's one of the fastest-growing parts of the pharmaceutical area. And so we're excited about continuing to do that. On the mail order side, COVID has been a real great opportunity for us in that not only early on in being able to fill the needs of our members, but over time, the convenience of home delivery is a really important aspect. And we're seeing the continued migration of that opportunity going forward. And we continue to see the opportunity to have more penetration in our mail order and be able to leverage not only the opportunity it brings from a profitability point of view, but also from a convenience point of view, which increases the medication adherence. In that, what you've seen the organization invest in is not only the technology side, but really an orientation of increasing the delivery speed. And so we've reduced greatly the amount of time it takes to fulfill the order, but more importantly, to fulfill it in a very cost-effective fashion. Because as you well know, the shorter delivery times are more -- are much -- are costly. So how do you balance the convenience in the shorter time with the opportunity to continue to keep your margin. We've done a really good job in that over the last few years, and that's an area of significant focus for us over the next few years.

Yes. Bruce, we only have 1 minute left, but I'd like to ask my large-cap companies this as we end our presentations each year. And that's I know you're going through a tough time right now with the membership announcement last week, but what do you think that investors will appreciate next year, when hopefully we are in-person together, about Humana that maybe they're not appreciating today?

I would say, first, just the strength of our brand. What I see and what we see over a number of years, in 2022, AEP wasn't an example of that, but our ability to sell through the good times and the tough times is a result of our brand. And the care coordination, the services that we offer and, in addition, just the innovation we have in plan design. And I know this year has been a disappointment for our investors, but that doesn't overcome the great opportunity we have and the ability to continue to innovate. So I would say that. The second thing is, just the power of MA, I just feel -- I know some of the comments last week created some concern of MA. But I just -- and our company is a big believer in the strength of Medicare Advantage and what it does in multiple different aspects all the way from encouraging value-based care to all what it does for the minority populations from social determinants of health in addition to the stability it brings for our members. And then lastly, I would say is, the continued expansion of our health care services side that allows not only for us to provide integrated care deeper, but it also provides the opportunity to expand our margin opportunity as a company, and then lastly, also expand the addressable market we are able to serve with what we do so well [indiscernible] chronic members and patients.

Great. Well, thank you. I'm going to end it there. I really appreciate spending the time with you and Susan. We'll talk to you when you report earnings. If you have incremental questions, by all means reach out to me or Lisa Stoner at Humana on the Investor Relations side. Thanks again so much, Susan and Bruce.

Thank you.

Bye. Thanks.

Thank you.