Sysco Q2 2024 Earnings Call Transcript

Quartr
Provided by Quartr
July 25, 2024

There are 13 speakers on the call.

Operator

Good day,

Speaker 1

and welcome to the Molina Healthcare Second Quarter 2024 Earnings Conference Call. All participants will be in listen only mode. Please note this event is being recorded.

Speaker 2

I would now like to turn

Speaker 1

the conference over to Jeffrey Guyer, Head of Investor Relations. Please go ahead,

Operator

sir. Good

Speaker 3

morning, and welcome to Molina Healthcare's Second Quarter 2024 Earnings Call. Joining me today are Molina's President and CEO, Joe Zabreski and our CFO, Mark Keim. A press release announcing our 2024 earnings was distributed after the market closed yesterday and is available on our Investor Relations website. Shortly after the conclusion of this call, a replay will be available for 30 days. The numbers to access the replay are in the earnings release.

Speaker 3

For those of you who listen to the rebroadcast of this presentation, we remind you that all of the remarks are made as of today, Thursday, July 25, 2024, and have not been updated subsequent to the initial earnings call. On this call, we will refer to certain non GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in the Q2 2024 earnings release. During the call, we will be making certain forward looking statements, including, but not limited to, statements regarding our 2024 guidance, Medicaid redeterminations, expected Medicaid rate adjustments, medical cost initiatives and our projected MCR, our recent RFP awards and related revenue growth, our acquisitions and M and A activity, our long term growth strategy and our embedded earnings power and future earnings realization. Listeners are cautioned that all of our forward looking statements are subject to certain risks and uncertainties that could cause our actual results to differ materially from our current expectations.

Speaker 3

We advise listeners to review the risk factors discussed in our Form 10 ks Annual Report filed with the SEC, as well as our risk factors listed in our Form 10 Q and Form 8 ks filings with the SEC. After the completion of our prepared remarks, we will open the call to take your questions. I will now turn the call over to our Chief Executive Officer, Joe Zabrinski. Joe?

Speaker 2

Thank you, Jeff, and good morning. Today, we will provide you with updates on our reported financial results for the Q2, highlighted by $5.86 of earnings per share, which was in line with our expectations. An update on our full year 2024 guidance, which we reaffirm at $38,000,000,000 of premium revenue and at least $23.50 in earnings per share and our growth initiatives and strategy for sustaining profitable growth. Let me start with our 2nd quarter performance. Last night, we reported adjusted earnings per share of $5.86 on $9,400,000,000 of premium revenue.

Speaker 2

Our 88.6 percent consolidated MCR reflects disciplined medical cost management despite experiencing some modest medical cost pressure. We produced a 4.6% adjusted pre tax margin or 3.5% after tax, a very strong result that is in the middle of our long term target range. Year to date, our consolidated MCR is also 88.6% and our adjusted pretax margin is 4.5%, both within our long term target ranges. Our well balanced portfolio of businesses and focusing on managing medical costs continued to produce results in line with our expectations. In Medicaid, the business produced a 2nd quarter MCR of 90.8%, above our long term target range.

Speaker 2

This quarter included a one time prior year retroactive premium item in our California business. Excluding this one time item, the 2nd quarter MCR was 90.1%, elevated by higher MCRs from our new store additions, a dynamic consistent with the Q1. It also reflects slightly higher than expected medical costs in the legacy Medicaid portfolio, attributable to the ongoing acuity shift of redeterminations. We continue to have risk corridor protection in many geographies and expect that this medical cost pressure will be adequately captured by known rate adjustments in the second half of twenty twenty four. We expect our Medicaid results to improve in the second half of the year.

Speaker 2

Several data points indicate we are well on track in this regard. First, the California retrograde item will not repeat. 2nd, our new store addition results will continue to improve as they did in the Q2. 3rd, we received rates in many states for the second half of twenty twenty four that were in line with first half developing cost trends. Approximately 35% of our Medicaid premium revenue renews in the second half.

Speaker 2

Combined with several off cycle adjustments, these account for the expected legacy Medicaid NCR improvement through the remainder of the year. Then, with approximately 55% of our Medicaid premium revenue scheduled to renew on January 1, our rate cycle cadence is well timed for early 2025. Providing upside to our outlook for the balance of the year would be continued success with rate advocacy initiatives that could provide positive off cycle rate adjustments. Turning to Medicare. Our 2nd quarter reported MCR was 84.9%, representing better than expected performance across all our Medicare products, primarily due to favorable risk adjustment results as well as benefit adjustments implemented for 2024.

Speaker 2

Our newly acquired Bright business in California is performing in line with expectations, and we remain confident in ultimately delivering the full run rate accretion of $1 per share. Our strategy of leveraging our existing Medicaid footprint to serve high acuity, low income Medicare beneficiaries is working well. In Marketplace, the 2nd quarter MCR was 71.6%. This business performed better than our expectations, even as we saw higher special enrollment period membership gains from redeterminations. Our mix of renewing members, prior year pricing actions and improved risk adjustment results position us well to continue to profitably grow this book of business.

Speaker 2

Turning now to our guidance for the full year. We remain confident in delivering our full year adjusted earnings per share guidance of at least $23.50 or 13% year over year growth. Strong net investment income and known rates will offset the one time retro premium item and the 2nd quarter pressure experienced in Medicaid. Performance in our core business remains strong, and we expect second half improvements to be driven by known on and off cycle rate increases and new store MCRs reverting to Target. Our guidance also includes our Florida and Virginia contracts extending through year end.

Speaker 2

Our full year premium revenue remains unchanged at approximately $38,000,000,000 or 17% year over year growth. Our 2024 revenue and earnings per share guidance provide a strong foundation for profitable growth in 2025 and beyond, and the building blocks to get there remain intact. Now, some comments on our growth initiatives. Our business is well positioned to capitalize on unique long term growth opportunities in all three segments. First, a few comments on our recently announced acquisition of ConnectiCare from EmblemHealth.

Speaker 2

ConnectiCare currently serves approximately 140,000 members with $1,400,000,000 in annual premium revenue. This is a well diversified government sponsored health care play, which serves primarily marketplace and Medicare membership in Connecticut. Historically, our strategy has been to establish these core product lines only in our pre existing Medicaid footprint to leverage our Medicaid infrastructure. While that option is not available to us in Connecticut, a Medicaid fee for service date, we believe this is a great opportunity to execute the time tested Molina M and A playbook, acquire a stable revenue stream in our core products, deploy capital efficiently and improve the asset's performance in the proven and reliable Molina way. We expect this acquisition to provide earnings accretion of $1 in earnings per share, which is now added to our embedded earnings.

Speaker 2

Our M and A pipeline remains full of many actionable opportunities. In Medicaid, we remain confident in winning new and renewal business contracts. Some comments on recent developments. In Florida, we were recently awarded a contract that successfully retains our foothold in the state. We will retain our 52,000 Medicaid members in the Miami Dade region.

Speaker 2

In addition, by agreement, we will grow to approximately 90,000 members through preferential auto assignment. We estimate annual premium revenue of $500,000,000 In Wisconsin, we successfully defended our LTSS position as the state announced its intent to award Molina a contract to provide services in Region 5, the first of a series of regional re procurements. Additionally, we were just re awarded our sole contract position in the IRIS self directed personal care program. In Georgia, while we await the award announcement, we remain confident as to our prospects and believe that we are well positioned to serve that state's Medicaid population. And finally, there is significant market opportunity out for bid over the next 3 years.

Speaker 2

This includes the Texas Star Kids RFP, which represents a meaningful opportunity in a state where we have demonstrated recent success. In Medicare, we remain sharply focused on further penetration of low income high acuity dual eligible populations and on our high acuity MAPD population in California. The new CMS rules on Medicare and Medicaid integration position us well to attract dual eligible members over the coming years, as our footprint combines both products in most of our states, enabling a fully integrated member experience. We are in the process of further developing our suite of integrated tools products, and we will soon be establishing a new dedicated organization to lead this effort. In marketplace, we are positioned to grow organically in underpenetrated markets, given the stabilized risk profile and margins we've achieved.

Speaker 2

We believe our rate filings for 2025 make us very competitive in underpenetrated geographies and position us well to grow. As a reminder, our growth outlook in this business can be simply stated as grow at a rate that allows us to sustain mid single digit pre tax margins. We are confident in our ability to grow organically, win new state contracts and execute our M and A strategy. These remain consistent pillars of our growth strategy and we expect to meet our target of $46,000,000,000 of premium revenue in 2026. With our 2024 earnings per share guidance of at least $23.50 reaffirmed and with our embedded earnings outlook of $5 we remain committed to delivering on our long term earnings per share growth targets.

Speaker 2

As Mark will describe shortly, the building blocks to get there are intact. In summary, we are pleased with our Q2 2024 financial performance. The Medicare and Marketplace businesses significantly outperformed, while Medicaid is on track to improve in the second half of the year through known rate increases and continuing new store MCR improvements. In the meantime, we continue to focus on executing on the fundamentals, which has been the hallmark of our financial performance. The unprecedented redetermination process, which will be a 24 month journey from beginning to end, has presented some challenges that we have successfully navigated.

Speaker 2

But nothing has occurred during this period that changes our view that these are attractive businesses for the near and long term, and profitable growth can and will be sustained. In fact, our results demonstrate that the principle of rate sound is works and that Molina's unique rate corridor position protects against transient quarter to quarter fluctuations of rates and medical costs. Finally, we look forward to updating you on our outlook for sustaining profitable growth at an Investor Day event on Friday, November 8 in New York City. As in past years, we will provide you with our detailed playbook for achieving our growth targets and maintaining industry leading margins. We will outline our long term goals and how we will achieve them with the transparency and specificity that you have come to expect from us.

Speaker 2

With that, I will turn the call over to Mark for some additional color on the financials.

Operator

Thanks, Joe, and good morning, everyone. Today, I'll discuss some additional details on our 2nd quarter performance, the balance sheet, our 2024 guidance and the building blocks of our 2025 EPS outlook. Beginning with our Q2 results. For the quarter, we reported approximately $10,000,000,000 in total revenue and $9,400,000,000 of premium revenue with adjusted EPS of $5.86 Our 2nd quarter consolidated MCR of 88.6% was slightly above our expectations, but still on track to support our full year guidance. In Medicaid, our reported MCR was 90.8%.

Operator

As Joe mentioned, this result includes a 70 basis point increase from a one time retroactive premium adjustment in California related to the prior year. It is highly unusual for a state to retroactively reduce rates and all of our known and expected future rate actions are positive as states address recent trends. Adjusting for this one time prior year item, our reported MCR of 90.8 falls to 90.1. Within that result, new store additions continue to run at a higher MCR, but lower than the Q1 and in line with our expectations. Recall, new store additions comprised almost 20% of our Medicaid segment this year.

Operator

Adjusting for new store impact, our reported MCR falls another 80 basis points. We expect the MCR on this component to continue to decline over the coming quarters as these plans progress towards portfolio target margins. Excluding the one time prior year item and the new store additions, our legacy Medicaid MCR was 89.3, approximately 30 basis points above the top end of our long term target range. We continue to experience the impact of redetermination related acuity shifts, a little more pronounced in the Q2. Of course, Molina's strong performance in medical cost management means that in many states in recent years, we have typically been paying into minimum MORs and corridors, an expense averaging 200 basis points within our reported MCR.

Operator

As medical cost trend has modestly outpaced rates in the 1st and second quarters of the year, corridor expense has declined, largely shielding us from the temporary difference between rates and observed trends. We expect these corridor positions to be restored in coming quarters with our continuing medical cost discipline and the known and expected rate cycles. Looking ahead to the remainder of the year, as Joe mentioned, we expect a number of items to drive the second half Medicaid MCR lower.

Speaker 3

For the first half of twenty twenty four,

Operator

our reported Medicaid MCR was 90.2. Our guidance includes the 2nd half Medicaid MCR of 88.4, a 180 basis point improvement driven by a few items. First, we reduced the second half expected MCR for the impact of this quarter's retro rate item, a benefit of 30 basis points to the second half Medicaid MCR compared to the first half. 2nd, new store additions initially running higher than the legacy book will continue to improve as they did in the Q2 as they approach portfolio target margins. New stores, a combination of new RFP wins and acquisitions benefit from the execution of the Molina playbook quarter over quarter and we expect 80 basis points of improvement to the second half Medicaid NCR compared to the first half.

Operator

3rd, the rate cycle of our state mix is well timed to return rates in line with the trend for the remainder of 2024 into 2025. States are required to fund Medicaid MCOs with actuarially sound rates. Most states determine those rates based on demonstrated market trends and completed data rather than working hypotheses or speculation. As such, the higher trends most plans are seeing in the 1st and second quarters provides hard data for the rate setting process in coming months. We now have full visibility on higher final rates that offset observed trend representing approximately 35% of our revenue renewing in the second half of the year.

Operator

In addition to the normal rate cycle, our rate advocacy efforts have already yielded positive off cycle adjustments in 4 states that benefit the second half of the year. We are encouraged that several other states will follow this approach, although we do not include those in our guidance. Together, these known rate adjustments drive an expected benefit of 70 basis points to the second half Medicaid MCR when compared to the first half. Combining the first half reported MCR and our expectations for 180 basis point improvement in the second half as detailed results in full year Medicaid guidance of 89.3%, up from our previous guidance of 89. This small increase in full year Medicaid MCR guidance is almost entirely explained by this quarter's retro rate item.

Operator

Also in Medicaid, a few comments on membership. While 2 of our states are continuing with redetermination in the 3rd quarter, we are largely through the process. In the Q2, we estimate a net loss of 100,000 Medicaid members through redetermination, taking the cumulative total to $650,000 Due to the timing of reconnects that will continue into the 3rd and 4th quarters, our outlook for the ultimate total net loss of approximately $600,000 or 40 percent of the members gained is unchanged. Our full year membership guidance remains at 5,100,000 members. Conversions to marketplace remains strong as Medicaid members losing eligibility move to Molina Marketplace products.

Operator

In Medicare, our 2nd quarter reported MCR was 84.9. All Medicare products performed better than expected driven by favorable risk adjustments and the benefit adjustments we implemented for 2024. Utilization in the quarter reflected consistent pressure from LTSS costs and pharmacy utilization. As Joe mentioned, the integration of the Bright business is on track to provide the projected ultimate $1 of earnings accretion. In Marketplace, our 2nd quarter reported MCR was 71.6 better than expected, despite higher special enrollment period membership year to date.

Operator

We remain focused on growing this business, while producing mid single digit pretax margins. Our adjusted G and A ratio for the quarter was 6.9 as expected and reflects operating discipline and the continued benefit of fixed cost leverage as we grow our business. Turning to the balance sheet. Our capital foundation remains strong. In the quarter, we harvested approximately $175,000,000 subsidiary dividends and our parent company cash balance was approximately $235,000,000 at the end of the quarter.

Operator

Debt at the end of the quarter was unchanged and 1.4 times trailing 12 month EBITDA with our debt to cap ratio at about 33%. These ratios reflect our low leverage position and ample cash and capital capacity for additional growth in investment. Days and claims payable at the end of the quarter was 50 and consistent with prior quarters. We remain confident in the strength of our reserves. Our operating cash flow for the 1st 6 months of 2024 was lower than prior year due to the timing of corridor payments, CMS receipts as well as taxes.

Operator

This year, we made several large corridor settlement payments related to prior periods. Next, a few comments on our 2024 guidance. As Joe mentioned, we reaffirm our full year guidance with premium revenue of approximately $38,000,000,000 We continue to expect full year EPS of at least 23.50 dollars Our EPS guidance now includes $0.65 of higher expected investment income as short term rates are expected to hold up through the year, higher for longer and $0.30 from the extension of the current Florida and Virginia contracts through 2024 year end. These items are offset by approximately $0.65 from the one time retro premium adjustment and $0.30 due to Medicaid performance in the 2nd quarter. Within our guidance, the full year consolidated MCR increases slightly to 88.4%, driven by the 2nd quarter performance in Medicaid.

Operator

As detailed, the full year Medicaid MCR is now expected to be approximately 89.3%, up 30 basis points, primarily due to the 2nd quarter one time item. Our NCR guidance on Medicare remains unchanged at 88%, with strong consistent year to date performance in our Duals membership and the Bright acquisition. In Marketplace, we continue to expect the full year MTR to be 78% and at the low end of its long term target range, while producing mid single digit pre tax margins. Conversions to Marketplace due to Medicaid redeterminations are expected to continue into the second half of the year. While SEP growth typically comes with a higher MCR, we considered this in our 2024 guidance and the pricing of our 2025 bids.

Operator

Turning to embedded earnings and the building blocks of our 2025 EPS outlook. Our guidance on new store embedded earnings is now $5 per share, an increase from our prior outlook of $4 This increase reflects $1 from the ConnectiCare acquisition. We expect a little more than half of the new store embedded earnings to emerge in 2025 with the remainder in 2026. Finally, we see a clear path to achieve our EPS growth target heading into 2025. The building blocks include the embedded earnings we expect in 2025, the continuing organic growth and margin in our current footprint, and our in flight organic and inorganic strategic initiatives.

Operator

With 55% of our revenue renewing on January 1 next year, our rate cycle is well timed for 2025. Even allowing for some headwinds from likely declining interest rates next year, the path is clear and compelling. This concludes our prepared remarks. Operator, we are now ready to take questions.

Speaker 1

Yes. Thank you. We will now begin the question and answer And the first question comes from A. J. Rice with UBS.

Speaker 4

Hi, everybody. Thanks for the question. Just maybe if a point of clarification, you're calling out risk adjustment true up that's helped you both in public exchanges and in Medicare Advantage. Any way to size that and talk about how much of a positive variance it was relative to guidance? And then my other follow-up would be on the Medicaid side.

Speaker 4

Some of your peers are not all of them, but some are calling out that the legacy population they're left with seems to be having a little bit higher utilization than they had previously seen. It's not just a deterioration on the risk pool related to redeterminations. Have you seen any of that or is this what you're seeing in Medicaid 100% related to just what's happening as a result of redeterminations?

Operator

Great. Hey, good morning, A. J. I'll take the first one and Joe will pick up the second one. On risk adjustment, let's touch on Marketplace and Medicare.

Operator

On Marketplace, some of you have seen from the CMS files, we recognized about $20,000,000 of additional risk adjustment benefit from the prior year between 1st and second quarter. Remember, we have insights on the development of that through the Wakely service and other things, but across the first half, about $20,000,000 from the prior year. So, first half revenues, about $1,200,000,000 You do the math a little bit less than 20 basis points in our first half, first and second quarter MLRs for marketplace. Just for reference, it was about the same a year ago. So the year over year as compared is about the same, about 20 basis points of benefit.

Speaker 2

A. J, on your second question related to I'm sorry, please go ahead.

Speaker 4

Just on the

Operator

Say it again, A. J. A.

Speaker 2

J? A. J, I think we lost you, but let me take the second question related to medical cost trends in the business. In Medicaid, as always, you see pockets of utilization increases in various geographies and in various healthcare categories. We see some pockets of skilled nursing facility cost increases, hours in home based care.

Speaker 2

BH is spiking in a couple of geographies, but nothing we've never seen before. Pharmacy trend to high cost drugs in the GLP-1s, certainly putting some cost pressure on the system. But again, nothing out of the ordinary and nothing that can't be dealt with, particularly as our corridor position absorbs these trends and then rates kick in to pick up

Speaker 4

the slack. Okay. Thanks a lot.

Speaker 1

Thank you. And the next question comes from Andrew Mok with Barclays.

Speaker 5

Hi, good morning. Just a question on the underlying Medicaid pressure in the same store portfolio. I don't remember you calling out pressure in Q1, but sounds like that may have developed slightly worse. Is that correct? And can you clarify when core Medicaid pressure started to materialize this year?

Speaker 5

Thanks.

Operator

Sure. You are right. We saw a little bit more pressure in the legacy book in the 2nd quarter versus the Q1. And one of the drivers is just simply membership. You might recall in the Q1, we noticed that we lost about 50,000 members due to redetermination.

Operator

We were a little more than that in the second quarter at about 100,000. Just to round that out, we're currently at 650,000 total cumulative, and we expect to get back about 50,000 in the rest of the year through ReconX. So the volume, the membership up a little bit in the Q2, I don't doubt that drove a lot of the higher legacy impact we saw.

Speaker 5

Got it. But did the Q1 also come in worse than kind of what you had expected when you actually saw the claims?

Operator

It was a little bit higher than normal, but not worse than we expected in the Q1.

Speaker 5

Okay. And then secondly, it sounds like you're describing a more modest pressure relative to peers. So just wanted to better understand that experience. How much pressure was offset by the risk corridor buffer? And do you see modest pressure across most states or concentrated pressure in a few states?

Speaker 5

Thanks.

Speaker 2

The pressure is isolated. It's various healthcare cost categories in various of our individual health plans. And Mark covered this in his prepared remarks, sometimes it's overlooked. We've been routinely over the past 4 years paying into the risk corridors and minimum MLRs to the extent of about 200 basis points inside our NCR, which basically means if you're reporting an 88, you're performing at an 86, which gives you 200 basis points of cushion if a medical cost should inflect for any reason, whether it's an acuity shift or whether it's normal trend. So we see pockets of utilization increases, as I described, in various categories in various plans, but largely picked up by the corridors and mid cycle rate increases and on cycle rate increases, particularly in the second half of the year where 35% of our revenue renews in the second half.

Speaker 5

Great. Thanks for the color.

Speaker 1

Thank you. And the next question comes from Ryan Langston with C. D. Cowen.

Speaker 6

Hey, good morning. Just following up on Medicaid, we've heard some commentary just from some peers that there's this pull through effect when folks are receiving their enrollment loss information and then they might be utilizing more services before they actually use it. I guess are you seeing that same kind of experience? And then maybe further, do you have any sense of what the utilization profile actually looks like for folks who actually are able to re enroll once being redetermined off? Is that any different than sort of the normal population?

Speaker 6

Thanks.

Speaker 2

We've heard the discussion about overutilizing in advance of losing coverage. We have not experienced that. Our levers are leaving at the same MCR from the beginning of the redetermination process to the end. No change and no indication that they're using services advanced, particularly because in the termination process, many of them don't know that they've been redetermined. So they don't have any advance notice.

Speaker 2

Redetermination process. So we haven't seen that.

Operator

Ryan, I'd just build on that. What we've been citing and what many others are seeing is that of the folks that get redetermined, they lose their eligibility, 70% are for procedural reasons. That means they just didn't fill out the paperwork or weren't aware. So that certainly argues against any kind of last minute usage when in fact they weren't aware they were losing coverage. I think you also asked about the reconnects when they come back in.

Operator

Yes, very often for the 1st month, we'll see a little bit of higher utilization. And think about it, somebody lost their eligibility. They might not know they lost it until 2 or 3 months later when they go to the drugstore to fill out a script. At that point, they're utilizing, and that 1st month might be a little bit higher. But typically they're going to quickly resolve to the portfolio average.

Operator

So we're not seeing any meaningful impact there.

Speaker 2

Thank you.

Speaker 1

Thank you. The next question comes from Josh Raskin with Nephron Research.

Speaker 7

Hi, thanks. Just a clarification on the margin side of the Medicaid book. So could you just tell us what your Medicaid margins were in 1Q versus 2Q and what's embedded in guidance for the second half? And then my bigger question is just the commercial MLR last year, exchanges were 75%. I think you said 78% MLR this year.

Speaker 7

It looks like you're tracking probably favorable to that. So how are you thinking about the potential for rebates next year? And should we be thinking about a strategy of reducing price get higher membership for 2025?

Speaker 2

I'll take the last part of that first, Josh, on marketplace. Clearly, running at 72% for the first half and predicting 78% for the back half seems to be a push. But be mindful of the fact that SEP membership is quite high and those members are coming in at higher utilization rates than the existing membership. And then of course, you have a natural seasonality in the business. Now you're absolutely right.

Speaker 2

Last year, we actually invested margin in growth and we grew at $1,000,000,000 to $1,200,000,000 of revenue this year. Where we're running this year, we think we're at par. We think we're right in mid single digit land. But we could you could see us be a little more aggressive on growth next year and try to grow this business as we did in 2024 over 2023. So the margin position is solid.

Speaker 2

Again, our growth rate is going to be determined by our ability to produce mid single digit margins just given the inherent volatility that exists in the business itself.

Operator

Great. And I'll go ahead and take the second one. Josh, per our reported results, as you know, the MCR in the first quarter on Medicaid was an 89.7%. We reported a 90.8%. Across the first half of the year, that's an average of a 90.2%.

Operator

We're tracking to an 89.3 for the full year. And I gave you the walk in my prepared remarks of how the second half supports that. We have great confidence in those 3 building blocks that support that. Now the 89.3% for the full year guidance is up from 89 the last time we were together. So, we've raised the full year guidance by 30 bps.

Operator

2 thirds of that was just recognizing that one time California item we had to jump over in the Q2. So, the rest is just a little bit of pressure from the Q2 legacy business, otherwise very much on track for an 89.3% full year.

Speaker 7

Okay. So target but this year not terribly off from target margins, right? Sort of towards the lower end maybe of okay, perfect.

Operator

Correct. And I think there's enough strength that we pointed out otherwise in the business to more than overcome that 30 bps increase. So I think we're in good shape.

Speaker 8

Thank

Speaker 1

you. Thank you. And the next question comes from Kevin Fischbeck with Bank of America.

Speaker 5

Great. Thanks. I guess, we're having a hard time kind of reconciling your view about where MLR is in Medicaid versus what a lot of your peers are doing. So I guess, your comment seems to be that your risk corridors are allowing you to kind of offset a lot of this pressure. Can you give us a sense of on a gross basis then what the MLR pressure?

Speaker 5

Are you saying you had 200 basis points of risk corridor and now it's only 100? And then there's another 10 or 20 in the core net because of payables not completely matching everything. Like just kind of size it for us. It seems like everybody else seems to be saying somewhere between 100 basis points and 150 basis points of MLR pressure. And just to hear 10 or 20 basis points in the core is hard to reconcile.

Speaker 5

And then I guess you mentioned you expect people to be coming back as the year goes on. Shouldn't that be a pressure on MLR in the back half of the year? I didn't it didn't seem like you were building anything in for rejoiners putting upward pressure on MLR in your bridge from one half to 2 half?

Speaker 2

Thanks. Mark gave you the numbers in the prepared remarks that are actual. In the last 4 years, we have been paying into the corridors to the extent of 200 basis points contributing to the Medicaid MCR, 200 basis points. We said at the beginning of the redetermination process, we said this repeatedly that the corridors were going to act as a financial buffer until such times rates pick up the slack, which is exactly what's happening. So yes, suffice it to say, this year, our quarter of liability isn't 200 basis points.

Speaker 2

We've used some of it to cushion the results, but some of it does remain in various geographies in a meaningful way. Now the other point to make on the corridors is they don't just disappear forever. They replenish at the next rate cycle, whatever the state fiscal year is. And so if you get actuarially sound rates at the next rate cycle and you continue to relatively outperform that benchmark, you're back into the corridors and you're recreating that 200 basis points of cushion.

Operator

And Kevin, just a couple more thoughts. Since our last guidance in the Q1, we probably see trend across our business for the year up 150 basis points, 1.5% higher trend than we thought before. That's capturing what we saw in the Q2 and what we're expecting for the 3rd 4th. And of course, to your point, that includes the dynamic for the rejoiners and just as importantly, what we're actually jumping off in the Q2. So, we're seeing a higher trend than we previously thought of 1.5%.

Operator

Now as we detailed, we've got known rate adjustments in the second half, both on cycle and off cycle, which defray about 1% across the full year of that trend. The other 50 bps is picked up by corridors. So, we feel pretty insulated from a higher trend here both on known rates and as Joe mentioned, this very important corridor dynamic we bring to the table. So, yes, we've been carrying 200 bps over the last couple of years within our reported MCR. It will be lower this year, but that will be a function of actual rates and the ultimate trend.

Speaker 8

Okay. Thanks.

Speaker 1

Thank you. And the next question comes from Justin Lake with Wolfe Research.

Speaker 9

Thanks. Good morning. First, it looked like your PYD benefit to MLR was almost 200 basis points in the quarter. Curious if you could share with us whether that was evenly spread among the 3 segments or it was balanced in 1 or 2 specifically? And then Joe, can you talk to us a little bit about exchange?

Speaker 9

There's a lot of focus going into the elections. If the what's your view early view on if the subsidies aren't extended? The enhanced subsidies, I should say, if they aren't extended at the end of 2025, what do you think happens to the exchange population in general?

Speaker 2

On the PYD point, I'll kick it to Mark, but the first point to make before which lines of business get in effect, most of it, if not nearly all of it was picked up by prior year corridors.

Operator

Mark, do you want to take that? Right. So Justin, your question is, yes, it's a little bit bigger than we've seen in the past. We're a bigger business than we've been in the past. A lot of this stems from our payment integrity business, which reaches back into prior years to make sure that fraud, waste and abuse, things like that are addressed.

Operator

So, it's a little bit bigger. Of course, Medicaid and Medicare is where you expect to see it mostly and that's what you'll see in the queue when it comes out, little bit in marketplace, but most of it was in Medicaid and Medicare. As Joe mentioned, it really isn't a good guide this year because we were big time corridor payers last year. And of course, the prior year development goes to last year's corridors. So most of that got caught up in prior year corridors.

Speaker 2

And your question related to the exchanges, everybody's got models. We've seen models in the industry. We have our own models in terms of what would happen if the enhanced subsidies are in fact do expire. And there's industry estimates we have our own. You look at the level of subsidies, you look at your FPL cohorts, and you can argue that 10%, 20% of membership could be affected in priced out of your silver product.

Speaker 2

But then again, you have a lower priced bronze product perhaps sitting right next to it. So how many of those are going to recapture into one of your bronze products at a lower price? Hard to say. But we've seen industry estimates of 10% to 20%. And then the wild card is, if you have a bronze product sitting alongside your silver product in a certain geography, will you recapture some of that in bronze?

Speaker 1

Thank you. And the next question comes from Stephen Baxter with Wells Fargo.

Speaker 8

Hi, thanks. Just a couple of follow ups on the Medicaid discussion. I guess, could you provide us specifically the first half number that's comparable to the 200 basis points of the typical corridor expense that you cite? And then can you also update us on what underlying performance in the Medicaid book is? And then just trying to understand the rate update process, I think you suggested obviously the case may operate on part data and not theories, but it does seem like a lot of deterioration is happening in the Q2, which is not fully developed at this point.

Speaker 8

So is this largely because maybe the acuity adjustment compensated the lower level of this enrollment and that's an easier conversation? I'm just trying to understand why states would be compelled to act kind of on a more recently developing trend? Thanks.

Operator

Hey, Steven, it's Mark. There's a lot to unpack there. Can you start with the first one? I want to make sure I understand it.

Speaker 8

Yes. The 200 basis points is typical corridor expense that you cite. I would just like to know specifically in the first half of the year, if you could give us a comparable metric there. And then when we think about the percentage of your Medicaid premiums that have some level of protection from risk corridors versus are more directly exposed to the underlying performance of the business? Like is it 50% to 75%?

Speaker 8

How should we think about that?

Operator

Sure. Now, the way to think about corridors, in prior years, roughly 200 was usually embedded in our reported MCR. Corridors track to an ultimate across the full year. So you don't really know till the year is over where you come out. And again, that's going to be a function of rate and trend.

Operator

But what I can tell you is in the first half, I think about half of that normal rate was within our number, If we look at what's happened and our expected ultimates. So we're definitely using some of it year to date. And as we mentioned in our remarks here, we're expecting to use some of it in the rest of the year. So think across the full year, roughly half of that normal run rate number.

Speaker 2

And Stephen, we have very detailed models. We have an entire accounting system on NIM, MLR and corridor tracking. And one of the reasons we don't give specific numbers generally is if 50% or 75% of your premium has a corridor, you say, well, it's protected. Well, it's only protected if that's where the medical cost deterioration happens. And so looking at the gross number can just be very, very misleading.

Speaker 2

We have our arms around it. We know where we're protected. We know where we have upside opportunity. In some geographies, there's upside opportunity depending on where you are in the quarter. So we generally don't like to give specific numbers on how much premium is protected because I think it gives a false positive.

Operator

Thank

Speaker 1

you. The next question comes from Sarah James with Cantor Fitzgerald.

Speaker 10

Thank you. I appreciate you reiterating the 2026 premium guidance. I was hoping that you could refresh the bridge a little bit. When you laid it out at I Day after the 2023 base, you were talking about $4,500,000,000 of M and A and $2,500,000,000 of strategic initiatives. Is that still the mix that you see?

Speaker 10

And then when you think about M and A, how do you think about the mix between Medicaid and exchange that could play out through 2026 or that exists in your pipeline?

Speaker 2

It is possible that if we're redoing that projection right now, it would have to be a little more influenced by M and A just given where we are in the reprocurement cycle. But we're very active in the M and A space as we just demonstrated. Yes, comments have been made that the last two transactions that we executed were Medicare and Marketplace, which some people are calling non core. They're core. They're as core as Medicaid.

Speaker 2

And our pipeline is still very active with Medicaid opportunities. And you'll hopefully see Medicaid transactions here over the next 12 to 18 months. We're still very active in that space. The last 2 we did were non Medicaid, but that doesn't mean we're not actively pursuing them and working them.

Speaker 10

Thank you.

Speaker 1

And the next question comes from Michael Hall with Baird.

Speaker 11

Hi, thank you. So a quick clarification and then my real question. I was surprised to see no cash flow from ops so far, first half of the year. I know you called out some special timing, quarter payments, CMS risk free, etcetera. I'm wondering if you could break out some of the amounts of the larger pieces to help bridge this back to what maybe normalized cash in the loss would it look like?

Speaker 11

And then the real question on MA risk adjustment benefit, wondering if you could just how much specifically did you benefit from it for your 2Q MA MLR? And generally, isn't it true that, yes, the risk adjustment leads tend to result in some slight favorability, but also from my understanding, plans generally don't see a huge benefit because they simply accrue to whatever the risk adjustment was in their early 1Q payments. So my question is, how did you recognize such a large benefit? But there's something unique going on with Bright House MA assets where maybe you took a more conservative approach on the risk adjustment accrual? So more color on that would be great.

Speaker 11

Thank you.

Operator

Hey, Michael. Good morning. It's Mark. Let me take OCF. As we mentioned and for everybody's benefit, Michael is asking about a large difference in this year's 1st 6 months operating cash flow versus prior years.

Operator

Just a note on that, I think some people forget that government services MCOs have a lot lumpier cash flow than maybe some of our diversified competitors. Commercial businesses tend to have much more stable quarter to quarter OCF as do services businesses. Government businesses because of the timing of large payments, risk adjustment and corridors will be a little bit lumpier. The only other comment I'll make and I'll get into the details, Michael, is we are a growing business and a growing business should always have OCF ahead of net investment income because the growing business, that's the way the working capital cycle works, and we do. If you look at any broader timeframe, you will see that.

Operator

So, the first half is really about a couple of unique items, unique items that benefited us last year and are now just sort of catching up. So there's 3 that we'll talk about. And you'll see these on my operating cash flow in the earnings release. The largest one is the timing of risk corridor payments. Here's how to think about this.

Operator

We're accruing less this year on risk corridors than we were last year for all the reasons Joe and I just discussed. But separately, I'm paying down last year's balances. So that's a big swing in OCF, call it a little more than $500,000,000 Next one is CMS payments. It's funny, CMS payments usually come in a couple of days before the end of the quarter or a couple of days after the end of the quarter. And that makes a big difference on the reported cash flow.

Operator

About $400,000,000 of our OCS swing is exactly that. And you'll see that on the operating cash flow statement. The last one is a little bit unique. We had about $200,000,000 of cash flow benefit year over year from California taxes. You might recall that California federal taxpayers got a little bit of a delay on their tax due dates back in 2023.

Operator

So both the 2022 final tax payments as well as the estimated 2023 tax payments were delayed into the second half of the year. This year, we're right back on target. So, year over year, that's a bad guy this year. Was a good guy last year. That's $200,000,000 right there.

Operator

So I probably just walked you through the vast majority of that operating cash flow deficit you're talking about. We're very comfortable in the cash flow characteristics of the business.

Speaker 2

And again, look over any

Operator

broader period of time, a couple of On the Medicare risk adjustment, a couple of comments there. Unlike Marketplace, most of that Medicare was a benefit from this year's operations. And gosh, we're just getting a little bit better at it. We've got a bigger business. We've got the bright business.

Operator

And sure, there's always some prior year benefit, but a lot of this is we're just getting better at the risk adjustment equation across each of our individual Medicare businesses.

Speaker 1

Thank you. The next question comes from Scott Fidel with Stephens.

Speaker 7

Hi, thanks. Actually just to follow-up, I guess to sort of complete out the operating cash flow discussion. Mark, can you give us what you're expecting for the back half of 'twenty four or for the full year for CFFO? And then second, I guess, main question would be, definitely thought it

Speaker 12

would be helpful maybe if

Speaker 7

you just want to segment or bucket the dollar of embedded earnings that you're expecting from ConnectiCare in terms of sort of the key drivers of that accretion to get to the dollar build? Thanks.

Operator

Sure. On the second half OCF, a normal relationship is a little bit ahead of net income. So think of a relationship of 1.1, 1.2, 1.3, something like that. I would expect a more normalized relationship in the second half of the year. Again, looking over the 2 years in total, so much of that year over year comparison was about things unique to last year or unique to this year.

Operator

Looking at 23, 24 combined, you'll get a very normal relationship between OCF and net income that will certainly normalize in the second half of this year.

Speaker 2

And Scott, on the ConnectiCare acquisition, the business performs okay. It does not perform to Melina target margins. And as typical of these situations, we intend to improve the MCRs in both the marketplace business and the Medicare business and rationalize the G and A spend. It is not a huge undertaking. As I said, they're underperforming our targets, but not roughly underperforming.

Speaker 2

We will improve the performance by moving these simply from where they are to Molina targets. Stable membership, good brand recognition. We bought it at 25 percent of revenue, half of which is hard capital. And then we unleashed the Molina playbook to get it to our target margins, the dollar of accretion, great deal for us.

Speaker 11

Okay. Thank you.

Speaker 1

Thank you. And the last question this morning comes from George Hill with Deutsche Bank.

Speaker 12

Hey, good morning guys and thanks for sneaking me in. I hope I have 2 quick ones here. I guess you talked about the example where you have acuity getting worse and states are cutting rates. So I guess talk to us about how confident that you'll be that you'll kind of get rate in that percentage of the book going forward? Just increasingly as we're hearing like we hear about actuarial soundness, but when we talk to some state regulators, we hear actual soundness kind of with the phrase subject to budget.

Speaker 12

So kind of worried about the timing and the mismatch there. And then on the 200 basis points in the risk quarter that we discussed, I guess, can you talk about your confidence in the risk quarter, like the contributions, like it will suck up some utilization in the back half of this year. But I guess, can you talk about like how much was sucked up in Q2? And like how should we think about like the risk quarter the decrease in risk quarter contributions in Q2 and kind of how that varies through the back half of the year? Thank you.

Operator

Sure. A couple of things there. So you're mentioning the California negative retro rate adjustment. Look, I haven't personally seen one. That's the only one.

Operator

I don't expect another one. But for the rest of the year, there's not speculation. Those rate increases that Joe and I talked about in the second half of the year, both the normal rate cycle and the off cycle rates, all of those are known and committed. So not a lot of speculation there. On the 200 basis points that you're talking about of historical, you can't really think about corridors on a quarterly basis because they're an annual fiscal year concept.

Operator

So you're always accruing to an ultimate, which means you're spreading out any impact across all 4 quarters, not quarter specific. So when I think about the full year and our fiscal year accounting, we said somewhere around half of the historical 200 is about what we think we're using. That's again a guess and it will ultimately come down to the full year development of rates, trends in our medical management.

Speaker 2

And Jordan, maybe it's best to give a couple of examples. So we have Texas is a September 1 renewal. Things were running a little hot in Texas, acuity shift, etcetera. We had a high the market got a high single digit rate increase. That will have impact the second year.

Speaker 2

It's known we have it in draft form. Draft rates never decline. They can go up, but we're very confident in it. Another example is a really interesting one. It actually explains some of the trend inflection we talked about that's very mobilized and the rate actions that are taken.

Speaker 2

In Kentucky, due to the pandemic, the regulators asked the market to suspend on outpatient behavioral. We did, as did the market. What happens? Cost goes up. The market then approaches the state, presents the actuarial data, mid cycle rate increase because the behavioral program is underfunded.

Speaker 2

So the conversations with our state regulators, our customer, are very productive. They're data based and they're taking very reasonable positions, whether something is program related or whether it's acuity shift that can be actuarially supported.

Speaker 12

Helpful. Thank you.

Speaker 1

Thank you. And this concludes both the question session as well as the event itself. Thank you so much for attending today's presentation. You may now disconnect your lines.

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Earnings Conference Call
Sysco Q2 2024
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