The Cigna Group (CI) Earnings Call Transcript & Summary

Good morning. My name is Lisa Gill, and I'm the health care services analyst with JPMorgan. It is with great pleasure this morning that we have with us Cigna. With us from Cigna is CEO, David Cordani. Once David goes through a few of the slides, we're going to come back and do a Q&A. So with that, David, I'm going to turn it over to you.

Lisa, thank you. A Happy New Year to everyone, and it's good to be together at least virtually for this important conversation. We have a few slides that we put forth landing points, given that we're not all physically present, that I'm going to make reference to. And also, what I'm going to try to do is call out the headlines for those slides over the next 5 to 10 minutes and then hand it back to Lisa to facilitate our conversation here. Let me start, though, by summarizing everything in 3 macro headlines. Macro headline number one. At Cigna, we've positioned our U.S. portfolio of businesses to have 2 scaled, high-performing growth franchises, one of which you would know is a health plan franchise that has our Commercial and our Government portfolio of businesses. The other is our service franchise that you know as Evernorth. Each of those businesses are performing in an interesting environment. Each of those businesses have attractive growth opportunities in front of them, both strategically and operationally. But 2 additional points. The additional point number one is they provide leverage back and forth to one another. Evernorth is a servicer of Cigna, Cigna is an innovation partner for Evernorth, helps to evolve product, programs and services, not just for our consumption, but for the delivery to our large portfolio of corporate health plan, governmental agency and clinical partners on the Evernorth franchise. And then the last point is that, as proven throughout the course of the pandemic, the strategic positioning of those 2 businesses provide some level of complementary performance in environments of dislocation. So when a headwind blows in one business, oftentimes, it creates a tailwind in another business, enabling us to continue to perform. Headline number two for us. In aggregate, we're pleased. As we end this calendar year 2021, we'll report final results in early February, to be able to reaffirm coming into this important conference, our commitment to deliver at least $20.35 of EPS, even in this volatile, dynamic environment. And then the fourth point is, as the environment continues to unfold, we're pleased to yet again reconfirm our ability to grow our EPS at least 10% off of that $20.35 number. Not a rebased number, but off that $20.35 number. So those are the macro headlines. If you look at Slide #2. Underscoring our 2021 performance, I'll just highlight how proud I am of the Cigna team around the globe who continues to rise to the occasion and serve the clients, customers and partners we're able to serve. We continue to broaden our distribution channel, if you will the reach of who we're able to service, each and every day and drive additional innovations in the marketplace. And then lastly, we've positioned this portfolio to be a high converter of cash. So our operating cash flow conversion rate, which I'll comment on a little later, continues to be high. And the deployment of that for shareholder value creation in 2021 was meaningful, deploying well over $7 billion directly back to our shareholders in repurchase and in dividends. If you look at your next slide, just a headline relative to 2022. Very importantly, before the midpoint of 2021, looking at the environment we're operating in and projecting forward the disruption in 2021 continuing to 2022, meaning the pandemic and the economic dislocations around the globe. We were very clear in mid-2021 that we would smartly, but on a focused basis, prioritize margin expansion as we look toward 2022 across our various lines of business, and even while doing so, would continue to be able to generate attractive revenue growth. We leveraged the portfolio to be able to achieve that, and I'm sure Lisa will tease out in the Q&A the positioning of the -- some of the subcomponents of the business. And importantly, we continued to invest. We continue to invest back in our portfolio organically. While expanding that margin, investing in new capabilities around affordability, access, care innovation and service innovation. And then finally, very importantly, we remain on track to deliver that $50 billion of operating cash flow from 2021 to 2025, leveraging that broad high-performing services portfolio that we operate in. Now as I mentioned, we invest for the future because we view that the future has continued change that will drive it. And I'm going to call out 3 dimensions of change before I wrap up. The first of which, if you look at your next slide, is the acceleration of pharmacological innovation. We believe the next 5 to 10 years in health care and well-being services around the world will be heavily influenced by pharmacological innovation. We see the new drug approval process manifesting itself, we see innovations in specialty pharmaceuticals, we see the biosimilars, we see the new vaccines that are manifesting themselves. All of which create tremendous societal opportunity from clinical intervention, in many cases curative. But they also create complexity in terms of how those services are accessed, coordinated importantly, from a clinical coordination to get the desired effect and then creating affordability around that. And we, as an organization, have positioned ourselves to be in a leadership position relative to that. If you look at your next slide, we click that down one notch just to highlight a capability, an important capability within Evernorth, and that's Accredo, our specialty pharmacy services. Accredo is a large, scaled, high-performing specialty pharmacy set of capabilities within our portfolio that touches well over 90% of all specialty drugs that are available and a higher percentage of spend from that standpoint, and continues to be a strong performer for those we serve: Our physician partners, our health plan partners, our employer client partners and ultimately the individual patients we serve. And in many cases, an Accredo clinician is invited into the home of one of our patients to facilitate the infusion and care coordination that is alongside of that. And we believe that over the ensuing years, especially with the biosimilar wave that we're about to see, we at Evernorth will be on the leading edge of innovation and care delivery coordination as Express Scripts was quite some time ago when the marketplace moved from a brand to generic dimension. And we've worked hard to ensure that Accredo is extraordinarily well positioned relative to that. And the net value proposition there is a benefit to society at large because it's an affordability improvement; and with the right clinical coordination, both off of pharmacy services and medical services, it's a care coordination opportunity from a societal standpoint. As I mentioned, I wanted to be brief because Lisa has a broad level of questions to guide us through. So as I carry us forward to my concluding comments, as we look forward, I indicated that there were 3 forces of change that we think are indisputable that we've sought to position our portfolio against. The first I commented on: Pharmacological innovation. We think chemical innovations will be the predominant way health and well-being services evolve in the marketplace. Our positioning is strong today and we continue to invest in that. Number two is the global acceptance now, not U.S. but a global acceptance now more broadly, around the imperative around whole person health or mental wellbeing and physical wellbeing, being more coordinated to get the overall clinical quality for an individual, life quality for an individual, but also affordability solution. We're positioned today with our behavioral health, our pharmacy and our medical resources. We continue to expand access to behavioral, both through traditional network, but importantly through coordinated virtual services as well. And that takes us to the third and final piece, which is what we call alternative care delivery. All too often and all too significantly in the United States, for example, the vast majority of care has been in a physical site of care delivery. And while we deem that, that will continue to take place, technology presents tremendous opportunities to bring care in a more personalized, efficient and coordinated basis to the individual, not to remove the physical access to care, but to extend the physical access to care significantly. So you can think about that as virtual care; virtual primary; virtual primary and behavioral; coordinated chronic care programs like MSK, diabetes and polychronic populations using technology smartly. And we've positioned Cigna's capabilities with the inclusion of -- not exclusively, but with the inclusion of MDLIVE to be able to lead in this space and then ultimately extend into the home in terms of a much more coordinated basis. So to summarize. Well-positioned portfolios; performing well in this dynamic environment; delivering on our promise for those we serve, importantly; and being able to deliver on our EPS performance in 2021; and an outlook for 2022 that remains attractive, not off of a rebased number, but off of our expectation of the number we will deliver for 2021. With that, I'll turn it over to Lisa, and I look forward to the Q&A portion of our call.

David, thank you so much for those comments. And one of the first things that really stood out to me is as you talked about prioritizing margin. And we heard from a competitor in the MA space last week, and then we were with them yesterday. They talked about the loss of membership due to prioritization, that they didn't have a competing product. Is there -- do you have any idea at this point around membership for both MA or commercial as we think about 2022?

Sure. So Lisa, we were very explicit again, to reiterate that point. Margin expansion was an imperative for us as we stepped into 2022. And I would remind all of our listeners that we've had multiple years of significant revenue growth at or above our growth algorithm from that standpoint. So the scale of revenue that we have to work with within the franchise is quite meaningful. Headline for 2022: We will grow revenue again in our franchise, even with the puts and takes of margin expansion and expand margin, specific to the point you articulated. As we sit here today, we would expect a very attractive net Commercial life growth relative to our history of low single digit medical life growth. We would expect to be able to deliver that again in Commercial. And expand margin, and we could peel that back. We would expect to expand margin in Medicare, but have a Medicare Advantage life growth that's below our algorithm. The net of the health plan algorithm will be an attractive result. And as we looked at the positioning in the marketplace for 2020, all while we improve the value prop of our MA offering by being able to take revenue and affordability enhancements, we saw posture from many players in the marketplace cause our relative posture to knock down a notch in certain of the markets. And we were accepting that because we prioritize the margin. So when you take Commercial and Medicare Advantage, our Commercial proposition is performing well and will expand the margin and have very attractive unit or customer growth. Medicare Advantage will perform, the margin will expand, but our unit growth will be lower, our membership growth will be lower for 2022. I'd remind our audience, too, Medicare Advantage is about 5% of the revenue of the franchise. So we're able to make those trade-offs and still have an aggregate franchise result that's positive.

And that makes sense. The other thing that's come out in the last day or so is the impact from the new ruling on home testing. I was very surprised that the Biden administration put this in effect for January 15, and they announced it on January 10, so short time frame. So the first question would be, did you already have something built into your expectations as we think about 2022 on testing? And then secondly, how do we think about the puts and takes? Some believe that by having home testing, which is less expensive than, say, going to the physician office, it actually may save health plans money in some way.

So maybe let me try to provide 3 points on this topic. One is, in aggregate, for 2022, our underlying assumption is that the aggregation of costs for our Commercial block of business and our Medicare block of business will be slightly above baseline, where baseline would be if the pandemic didn't manifest itself. So when you take all the puts and takes of treatment, vaccination, testing, care, deferred care, et cetera, our working assumption was that it would be slightly above, so the pandemic continues on through the marketplace. Point two is, through our Evernorth portfolio of services, we had already recently and previously set up some expanded services for at-home testing support and otherwise through that lens. So we kind of got ahead of this curve from that standpoint as a service provider and an expansion of services through that lens. And third, maybe to the core of your question, it's really to be determined, Lisa, I think, for all of us to see how it manifests itself. But let me just frame it. If you take an OTC test, an OTC test, let's pick $12, $12.50 on average for that, one OTC test at that cost, you could consume 10 to 15 OTC tests to offset the cost of 1 lab test. So now we have to see, point one is, do we see an uptick, and for how long, of OTC tests? And is there somewhat of a downtick in lab tests? Two, are we finding illness sooner that helps us avoid more acute events from that standpoint? And three, even in the current Omicron data, we're seeing is while the occurrence is up significantly, the percent of the population that's finding themselves hospitalized is at the lowest conversion rate from that standpoint. So yes, it will increase costing -- cost for testing. We have solutions built into our franchise that are ready to support. The question is, does it offset some of the lab testing and/or help to avert some other health care consumption, being physician office or facility-based test -- facility-based consumption.

And we won't know that, right, until we start to see the data at some point in 2022. As we think about COVID cost and non-COVID utilization across the different lines of business, what have you seen since we last spoke? Talking in November, December time frame, we had Omicron come. To your point, it is lower acuity. But are you seeing hospitalizations? Are you seeing people push out any type of elective surgeries? And how do we think about it, generally speaking?

If we think about this historically, because we've gone through the equivalent of waves of COVID in the pandemic. As -- in general, as COVID has accelerated, you've seen some dimensions of deferral, less deferral in Commercial, more deferral in some of the Government lines of business on average. And I think that's the behavior of the individuals. The individuals covered under Commercial are more active in terms of engagement work and otherwise through that lens. Two is, as we look at this fourth quarter and the latter part of the fourth quarter, as I noted, we saw, for example, in the month of December, the highest number of COVID-verified cases since the start of the pandemic, but the lowest conversion percentage of those cases to hospitalization. So the volume is there in terms of the transmission, but the acuity being meaningfully lower. And I would say, broadly speaking, we don't see in the Commercial portfolio of business -- and to remind, again, our listeners, 85% of our Commercial portfolio is self-funded, so we act as fiduciaries in support of our employer clients. We don't see massive defraying of services in that portfolio of businesses. We could see medication compliance, we could see preventative screening, we could see preventative diagnostic screening, acute consumption is transpiring. You'll see some offset, timing-wise, for a shorter duration of some outpatient services that we're able to monitor. But broadly speaking, that pattern hasn't changed very much.

David, one of the items you highlighted at your Investor Day was expanding your geographic footprint, especially with emphasis on expanding the number of cost-competitive geographies. Can you talk maybe about some of the key drivers that will enable you to become more cost-competitive over the next couple of years?

Yes. So expanding our addressable market is the strategic frame that, that fits under. For each of our lines of business in the United States on the health plan side, we view those businesses as MSA or even sub-MSA level when you look at the level of competition. And yes, we understand it's a national market, make no doubt about it. We're a large national player, but you compete locally, all health care is local and all health care is personal. So for each line of business, Medicare Advantage, individual exchange, Commercial, there's a methodical growth of the number of geographies or MSAs that we are in. Example. Medicare Advantage for 2019, we were below 20% of the addressable market. Today, we're about 1/3. So methodically increasing that. The exchanges, continuing to methodically grow that part of the landscape, and on targeted geographies for the Commercial population. The underlying driver is focus of resources, scale that you bring into the location. And very importantly, Lisa, a cornerstone of us there are value-based care relationships. Are we able to enter -- and the marketplace is using that terminology a little differently, so let me define it. Are we able to enter relationships with cornerstone health care providers in locations that reimburse not just for volume of consumption, but for outcome, both clinical quality, service quality and affordability? That's critical to our success, and we focus intensely on being able to move and build network or access offerings that are value-based in nature. And then you augment that with the more open access framework as opposed to open access and then find a value-based alternative. So continue to make progress there, pleased with the progress and pleased with the collaboration we have with our health care professional partners in key geographies.

You started the discussion, you talked about the 2 components of Cigna. And as we think about Evernorth, when we think about the vast amount of different services that you can provide, for example, to an employer. Can you talk about your ability to really configure those point solutions? And are you starting to see more employers buy across the whole platform, right? When we think about behavioral health, you think about virtual health care, as you talked about. You know that I know Express Scripts well and the PBM aspect and how important specialty is. But can you talk about maybe where you are from a penetration standpoint today with some of those ASO clients that you work with? And the opportunities that you see.

Yes. Lisa, very much appreciate the way you framed it. I do know you know the legacy Express Scripts business really well. So when you think about Evernorth, think about 4 different addressable markets: Large corporate clients; health plans; governmental agencies; and increasingly, health care delivery system partners, that are taking on some sort of performance-based responsibility and/or potentially may even have their own insurance or service offering and they need some service expansion. And then within Evernorth, we have 4 portfolios of service: Evernorth Pharmacy, Evernorth Benefits, Evernorth Care and Evernorth Intelligence. So the answer to your question is, we take Evernorth to the marketplace all day every day with dedicated resources to corporate clients; health plans, which are a significant part of our portfolio and a meaningful growing part of our portfolio; governmental agencies; as well as delivery system partners. And our entire strategy is built around identifying where we can deliver value to them, to your point, with point solutions. And a common point solution to establish a relationship on is a pharmacy solution, either a traditional PBM or a specialty solution, 40% of our Accredo business has no PBM relationship at all. That's a great proof point of the strength of that, yet it presents a relationship to build off of. And then we seek to expand those relationships as we're able to create more value for those clients with additional services. And those services, to your point, are more coordination of services. We'll take a medical and behavioral service and we'll get it together. It could be for diabetes only. It could be for a population of the program. It could be for a geographic-specific piece of the program. That's a fundamental part of our Evernorth value proposition and it's a fundamental part of why Evernorth has grown pretty meaningfully over the first 3 years of Express Scripts being a part of Cigna and now Evernorth up and running for over a year from that standpoint.

You also talked about pharmaceutical innovation. We talk about biosimilars. I think one of the ones that a lot of us that have followed this industry for a long time are excited about HUMIRA losing patent protection. Can you talk about it, though, specific to your PBM? I think over the years, there's been a question around the actual rebate that is earned on a drug like HUMIRA. So I understand that when you go to your customer, we're looking at the net price, right? And I've heard you talk in the past about the fact that well north of 90% of those rebates now go back to your customer. So I think you've even said something like 95%, David, tell me I'm in the ballpark there. But -- so if we think about that and we think about the biosimilar, is there a huge opportunity here? Or will it still be the net cost will be better for the plan sponsor at the end of the day because of the rebate?

The simple answer is we think biosimilars are a tremendous opportunity, both socially as well as for Evernorth within our portfolio. So to your point, no doubt. The evolution of the way in which the pharmacy services financing model works has put us in a position to be able to lean into and seek to lead in the biosimilar space as opposed to accommodate or resist. That's a really important headline. Getting to total net cost that is attractive is mission-critical. In the case of biosimilars, as you very well know because you're a student of the industry, for the totality, this is not as simple as a brand to generic change. This needs to be thought more like brand to brand, one patient at a time. So having leading pharmacy services capability, including specialty, but also importantly, medical relationships and medical services because, ultimately, the coordination is one patient, one physician at a time. But our organization is extremely excited about this. We're behind other OECD countries in terms of biosimilar adoption. It's about time, the curve is upon us, and we are going to lean into it. And you're correct. The financing mechanisms and the multiple ways in which we're able to capture a fair return are mature enough to put us in a position to be very aggressive as that curve manifests itself. And it's a part where we have meaningful resources ready to roll. Financiers, employers, health plans, governmental agencies will benefit, individuals from an affordability will benefit. And the care coordination piece of the equation is mission-critical, we've positioned our franchise to be in a leadership position there.

We've talked for a long time about changes from a PBM perspective, right, that the -- we've seen this evolution of the business model as we've moved towards generics, we've seen the evolution towards specialty. But there's been a lot of talk around taking risk around certain products, right? So product A, the manufacturer says it's better to work with them. And I know that Express Scripts has done this in the past, when we think about some of the Hep C drugs that came to market. How do you think about the future, especially being the leader in specialty, around new types of payment models in the marketplace? Number one. And number two. When I think about Express Scripts for 2021, you did lose a couple of health plan pieces of the business that are a headwind here in 2022. How are you thinking about the 2023 selling season? I know it's early, but managed care companies and others that are really large start to make their decisions now.

Yes. Yes. So let me hit that last piece first and then come back. We give context for everybody. If you look at Express Scripts volumes, as we enter -- as we exit 2021, Express Scripts and Cigna have been together for 3 years. When you factor in the transitioning client from day 1 and the onboarding of Cigna with Express Scripts and then all the organic growth, Express Scripts' script volume as we end 2021 is 50% greater than its starting point 3 years ago with a transitioning client. We've grown massively. We've grown fundamentally and massively across the franchise and successfully with strong service. And while we never want to lose any client, we recognize that it does happen over time. But the aggregate growth profile for the franchise has been significant. The emerging growth opportunity that sits in front of us is also quite attractive, both in terms of, as you articulated earlier on, Lisa, deepening our relationship with clients. So it's not just net new adds, it's taking innovations and deepening the relationship with clients. And not just corporate clients, our health plan clients, mission-critical in terms of driving that. And the team is excited about the '23 and '24 selling season that is in front of us as we look forward. So quite, quite attractive growth opportunities over a sustained period of time. And we've grown higher than our growth algorithm for a few years, a little lower than the average because the average is on average over time. We're on track to achieve that on a sustained basis. Back to your first point, which I think is really powerful. When you boil it down, what are customers and clients asking for? Affordability, predictability and simplicity. So you start with affordability. And your prior questions went to total low cost, as I mentioned, of affordability through the eyes of the payer. But your question comes right back now to predictability. The franchise has the tools to, if you say, for example, take your word, take risk or provide peace of mind and provide predictability for subsets or modules, whether it's in the specialty space, transitional space, gene therapies, et cetera, we see that as an additional opportunity. We tested the market by leaning in aggressively with some early gene therapy positioning with our Embarc program, that's all built around predictability, providing peace of mind. And there are new generation-solutions that will stand up in short order that the team is bringing forward all around the notion of predictability. Because for some buyers, they need the predictability to be married up against the affordability for the business model. Others don't need the predictability or the risk mechanism, to use your term, to play through. That's an added opportunity for us and one we're excited about.

Yes. When we talked a little earlier about some of the Evernorth services that are in the market. You talked, about -- we all know about the PBM, we've spent a good amount of time talking about that. We talked about benefits. But when you think about Evernorth Care, you touched this a little bit earlier when you talked about virtual primary care, virtual chronic care, virtual behavioral health. Can you talk about the assets that you have today? And I think, David, you made a comment that it's not exclusive to MDLIVE. So can you maybe talk about what you see in the virtual care world, number one? And then number two, do you feel the need to own physicians or own clinics from a care model perspective?

Yes. So as you think about care assets that we believe and we desire to own, they fall into a few categories. One you know really well, specialty pharma. There's a lot of clinicians in the specialty pharma model that are necessary. For example, we have a nurse within a 1-mile drive of 90% of all Americans today. Not of our patients, 90% of all Americans. Two, behavioral health. Three, virtual health. Four, some aspects of home care. Now let me come back to the early part of your question. we see the leveraging of technology is presenting an opportunity for, yes, virtual care. That's why I said not exclusive to MDLIVE. We love the asset. We love the capabilities. We want that in our portfolio. We like the platform. So it's virtual care, it's longitudinal virtual care, which means primary-first, primary behavioral coordinated. But then being able to take the platform and say, how do you design a digital-first virtual chronic program for MSK, for diabetes, et cetera, that are carried forward, but in a coordinated way? Not one that disintermediates the primary care physician, but extends it and coordinates from the home to the physician and in between and then for the polychronic population. The build-out that's transpiring in our organization with proof points and early generation offerings along that continuum are manifesting itself in one of our markets. We stood up a new oncology program for January 1 of this year that levers some of the virtual capabilities, some of the pharmacy capabilities and otherwise. An MSK solution, a diabetes solution, et cetera, in terms of carrying it forward. And those solutions will be offered to not just corporate clients, health plan clients, governmental agencies, et cetera, on a go-forward basis. On the primary care delivery, we don't believe we need to own, to be really clear. We seek to partner and enable through value-based care. We are willing to own in select geographies if that -- if we deem that the only way to get the right access and accessibility profile. For example, we own a scaled asset in Arizona today. But that will be a market-specific decision where the local geographic norms speak to it. The virtual is more longitudinal, that's national and global capabilities. The physical delivery will be a highly localized decision.

Do you have the digital assets you need to do -- today to do exactly what you talked about, which is to really integrate and coordinate that care across your platform?

I don't believe an organization will ever have all the assets that are optimally positioned. Because of the rate and pace of innovation, we like the tools we have. So when you think about what we do all day every day from innovation, we spend a significant amount of operating resources on innovation. We use Cigna Ventures as a way in which of accelerating partnerships. And so if you think about the space we're talking about here, think about Ginger, Cricket, Buoy, an AI asset, a digital behavioral asset, et cetera, to be able to have collaborations with. And then situationally, we'll use our acquisition capabilities to bring capabilities in. As it relates to the build that's in front of us right now, we like the tools we have. This remains an inorganic priority. There may be additional bolt-ons. You'll see that come into the organization, but it will be organic, partnered and situationally acquired bolt-ons that are brought in. And this is going to be a body of change for the industry as a whole, including ourselves, for the ensuing years. But we like the position we're in right now.

And I think that kind of leads to my question around capital deployment, right? You generate a lot of cash flow. How do we think about M&A as part of that capital deployment strategy? And you bought MDLIVE after you made an investment in them. Cigna Ventures recently made an investment in Bright Health. How do we think about some of the investments that you make and the areas that you're most interested in from an M&A perspective?

Sure. So first, big picture on capital deployment. As we've proven as an organization with the Cigna portfolio, the Evernorth portfolio, our international portfolio, we have the ability to have a very attractive and-capital deployment strategy. So to fund internal growth through R&D and otherwise, to pay attractive dividend, to be active in share repurchase and to be active inorganically where it makes sense. So the overall framing is that and strategy is fundamental to who we are today and on a go-forward basis. Two is market conditions will inform whether or not we're more active in share repurchase or more active in M&A from that standpoint. Over time, we think once you take out feeding ourselves from an internal growth standpoint, paying an attractive dividend over time, it probably plays out. And if you back-test us over a longer duration of time, it plays out about 50-50 in terms of share repurchase and M&A. In any given year, it seldom 50-50, right? Things play out over time. As it relates to inorganic priorities, we currently have 4 that are articulated. And if our viewers back-test our corporation, we've had 4 or 5 over the last dozen years. And any actions we've taken have fallen into those categories, and those 4 are consistent with our last Investor Day. In no particular order: To further our care delivery capabilities and coordination capabilities; to further our digital and technological capabilities; Lisa, to a prior question, to further our U.S. government capabilities; on a targeted basis, to further our in-country global health care capabilities from that standpoint. So strategic position, attractive; capital health, attractive, presents the opportunity to have that and strategy. And over time, after dividend and feeding additional internal growth, it will be about 50-50 over time. But it will ebb and flow based upon market conditions.

And that kind of leads to the question of divestitures, right? So getting out of the European business. So many of the companies that I follow in health care services are leaving Europe. How do I think about your portfolio post what you've announced thus far? Are there other divestitures that you think about or things that you don't think are core to your overall portfolio?

Sure. So I mean, just one edit to your statement. I want to be respectful of my European colleagues. We're not exiting our European business. It's the subset of our Asia-Pac portfolio, Asia-Pacific portfolio. And again, for our listeners, we operate a scale business in some geographies that are a bit different than a traditional portfolio. It's direct-to-individual supplemental services that are offered in select countries. We've taken about 7 of those countries, we package them up, and that sale will close in this fiscal year. We deem that to be a good, prudent use of shareholder position. It was less strategically leverageable against where we're going deeper into the health side of the equation, it was more supplemental. It's a business that we grew tremendously over the last decade. And we'll net about $5.4 billion after tax from that transaction. To the core of your question, too, we've demonstrated, which I think is a strength: Not just a willingness, a proactivity, to looking at ourselves and looking at our portfolio and subsegmenting our portfolio and determining whether or not we should continue to invest in or not, or in some cases, divest. We divested the group insurance asset prior to this. We divested this subset of the asset. There's no scale piece of the asset that's on the horizon in front of us. We like our strategic positioning of the portfolio right now as an organization.

And I guess -- you're right. I did misspeak. Internationally -- I think Europe, and it's not Europe when I think about what you're selling.

That's okay.

So David, we have less than 3 minutes together, and I think you know that I like to end my sessions with talking about when we sit together a year from now, what do you think investors will appreciate about Cigna that they don't necessarily appreciate today?

Yes. I think as we look forward in just a year, a short year in front of us, I believe strongly that there'll be better appreciation for the sustained growth trajectory that sits in front of our franchise. We've been able to prove that we have the ability to grow our portfolio on a sustained basis over the last decade and the reconfigured portfolio over the last 3 years. And that sustained growth is for all the wonderful dialogue you led through relative to the innovation that's transpiring. This is not a maintain-and-operate portfolio. This is a broad health service portfolio of sustained innovation and service delivery to a very broad addressable market. Not just corporate clients, our health plan portfolio is a leading part of our portfolio of services, the governmental subsegment of the portfolio. So I believe the marketplace will better appreciate the growth performance we have and the addressable market and growth opportunity we have in front of us as opposed to looking at it through a traditional ends of health plan business through a rigid lens and a PBM definition that, in all due respect, is yesterday's definition; versus a pharmacy services portfolio that exists in a health service portfolio that is bringing solutions to the largest sophisticated buyers in America to improve affordability, predictability and simplification.

I really appreciate that comment, especially on the PBM side. But in your opinion, what do you think it takes for people to finally think of it that way? Because I feel that the last 3-plus years, right, since you've come together with Express Scripts, you've really focused on all of those things, affordability, bringing the product to the marketplace, delivering on the numbers on the Express Scripts side. But I don't feel like your stock still gets any kind of multiple around that. Do you think it's just going to take time for investors to relook at this and realize that there should be a multiple ascribed to a business that has the kind of growth and savings that they're generating for clients, et cetera? And how sticky it is, right? We talked about the fact that you lost a couple of clients, but your retention rate is still well in the 90% range.

Yes. Our retention rate is sustainable in the mid-90s range. And we've run it as high as 98%, which is a best-in-class retention rate from that standpoint. Stepping back and personalizing, I'm a large individual shareholder. So I'm all into this proposition. And my personal holdings has grown every year since I've worked for this corporation. The value creation opportunity in front of us. First, for those we serve. We serve 190 million customer relationships around the world. It starts with serving the customer relationships, earning the right to growing the franchise, growing it responsibly and having a sustainable return. We've converted that in cash flow that is proven. And I think what we've done is we've demonstrated that the PBM is not an atrophying asset, the PBM is a cornerstone relationship that gets established. And take the word PBM out and let's go to a more macro level. Corporations, health plans, governmental agencies establish a relationship either off of a medical relationship or off of a pharmacy relationship. We are positioned to have leading capabilities around that and innovation around. So our sustained performance is the most important piece of the equation. And demonstrating that our reach carries into multiple distribution segments, that we're able to have that sustained growth. We're quite confident in the leadership team that we're a tremendous value today, which is why we took the definitive position to buy back so much of our stock in 2021. And our proven track record to convert so much of our earnings to operating cash flow and deployable cash flow also in an environment of uncertainty, we think, will get better appreciation going forward.

Well, that's very helpful. We'll end it here. Thank you so much for your time today. Thanks, everyone, for tuning in. If you have any questions, feel free to reach out to me or anybody on my team. Thank you so much, David. I hope to see you soon.

Thank you so much, Lisa. Take care.