Financial Data and Key Metrics Changes - The company ended 2024 with approximately $440 million in cash, outperforming cash flow projections, and expects to burn about $110 million in 2025 [49] - The company aims to achieve cash flow breakeven by 2027, with several levers to pull, including contracting and cost control [50][52] Business Line Data and Key Metrics Changes - The company operates in two programs: Medicare Advantage (MA) and ACO REACH, with ACO REACH showing about $150 million in savings and a 13% gross savings rate [8] - Quality scores in the Medicare Advantage program are above 4 stars, with year two plus markets running at 4.25 or better, which is a key differentiator [6][7] Market Data and Key Metrics Changes - The company has seen a consistent cost trend of approximately 7% in 2023 and 2024, with a projected 5.3% for 2025 [30][31] - Utilization trends have remained consistent, with inpatient spend being a significant driver, particularly in oncology drugs [55] Company Strategy and Development Direction - The company is focused on transitioning from fee-for-service to value-based care, emphasizing the importance of the primary care physician-patient relationship [4][10] - The company is being measured in its growth strategy, with a reduction in new member classes for 2025 to 20,000, while planning for 30,000 to 45,000 in 2026 [15][70] Management's Comments on Operating Environment and Future Outlook - Management acknowledges a challenging macro environment but notes strong demand from physician groups and payers for the move to value-based care [14][19] - The company is focused on improving performance and reducing volatility, having exited two partnerships last year [41][46] Other Important Information - The company has reduced its Part D exposure from 70% to 30% of its membership for 2025, aiming to further decrease this by 2026 [44] - The company is implementing a new financial data pipeline to enhance revenue and claims information accuracy [34] Q&A Session Summary Question: What are the implications of the current risk adjustment process? - The company emphasizes the importance of the PCP-patient relationship and has a robust risk adjustment process in place, including a 100% chart review process [22][24] Question: How is the company managing utilization trends? - Utilization trends are consistent with expectations, with inpatient spend being a significant driver, particularly in oncology [55] Question: What is the company's strategy for physician partnerships? - The company maintains high net promoter scores from physicians, indicating strong engagement and satisfaction with the value-based care model [59][63]

Financial Data and Key Metrics Changes - The company reported total revenue of $3 billion for the quarter, a 42% increase year over year [6] - Net income was approximately $275 million, a significant improvement of $98 million over the prior year period [7][22] - Earnings from operations grew by $112 million to $297 million, with an operating margin of 9.8%, an increase of 110 basis points year over year [8][21] - The medical loss ratio (MLR) increased by 120 basis points year over year to 75.4% [8][18] - The selling, general and administrative (SG&A) expense ratio improved to 15.8%, a 260 basis point improvement year over year, marking the lowest in the company's history [8][20] Business Line Data and Key Metrics Changes - The company closed the quarter with approximately 2 million effectuated members, a 41% increase year over year [9][16] - Membership growth was driven by strong retention and above-market growth during open enrollment [16] - The company launched Oscar Community Resources with Find Help, enhancing member services beyond medical care [10] Market Data and Key Metrics Changes - The company noted that the individual market is a cornerstone of American healthcare, driving a record low uninsured rate [13] - The proposed program integrity initiatives by CMS are seen as positive for the long-term sustainability of the market, although the shortened enrollment window may constrain shopping for plans [12][51] Company Strategy and Development Direction - The company aims to deepen market presence through new partnerships and innovative plan designs [10][14] - The focus remains on building a scalable and efficient technology infrastructure to enhance member experience and operational efficiency [11] - The company is engaged with policymakers to advocate for solutions that strengthen the individual market [13] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving 2025 targets due to disciplined execution and strong top-line growth [14][24] - The company anticipates membership trends to rise in the first half of the year but expects a decline in the latter half due to regulatory changes [31] - Management highlighted the importance of a trustworthy market and the need for adequate time for individuals to shop for plans [51] Other Important Information - The company reaffirmed its full-year guidance metrics, expecting total revenue in the range of $11.2 billion to $11.3 billion for 2025 [23][24] - Adjusted EBITDA for the quarter was $329 million, reflecting a substantial year-over-year improvement [22] Q&A Session Summary Question: Membership expectations for the second quarter and the rest of the year - Management expects membership to trend up in the first half of the year but to decline in the latter half due to regulatory changes [31][32] Question: Grace period membership context and its impact on MLR - Management indicated that the gap between effectuated and paid membership is expected to normalize, with prior period development impacting MLR [36][38] Question: Utilization patterns between new and retired members - Management noted higher inpatient utilization with favorable pharmacy trends, but specific drivers were not identified [42] Question: Thoughts on competitor exits and their impact on risk adjustment - Management views competitor exits as an opportunity, emphasizing disciplined pricing and effective risk adjustment [46][62] Question: Regulatory environment and potential impacts on enrollment - Management supports CMS efforts to strengthen ACA integrity but expressed concerns about the shortened enrollment period affecting consumer choice [51] Question: Expectations for risk adjustment as a percentage of premiums - Management does not anticipate significant adjustments to risk adjustment percentages at this time, but elevated claims could impact future expectations [64] Question: Drivers of SG&A performance and future expectations - Management attributed SG&A improvements to fixed cost leverage, variable cost efficiencies, and lower exchange fees, with expectations for gradual increases moving forward [74][75]

Financial Data and Key Metrics Changes - The company reported total revenue of $1.53 billion for Q1 2025, down from $1.6 billion in Q1 2024, primarily due to market and partnership exits, partially offset by premium growth [21][22] - Medical margin for Q1 2025 was $128 million, compared to $157 million in Q1 2024, reflecting elevated medical costs driven by increased utilization and flu-related expenses [21][22] - Adjusted EBITDA for Q1 2025 was $21 million, down from $29 million in Q1 2024, impacted by ongoing elevated cost trends [23] Business Line Data and Key Metrics Changes - Medicare Advantage membership at the end of Q1 2025 was 491,000, a decrease from 523,000 in Q1 2024, due to a cautious approach to membership growth and partner exits [19][20] - ACO REACH membership for Q1 2025 was 114,000, down from 131,000 in Q1 2024, primarily due to exiting an underperforming partnership [20] Market Data and Key Metrics Changes - The Medicare Advantage market continues to expand, with CMS data showing a year-over-year growth trend of 3.9% [10] - Overall market trends in 2025 remain consistent with the prior year, with a full-year trend expected at 5.3% [9] Company Strategy and Development Direction - The company is focused on disciplined growth, reducing exposure to costs outside of its control, and enhancing clinical and operational capabilities [7][11] - Investments in technology are seen as a key competitive advantage, aimed at improving automation, efficiency, and clinical outcomes [13][14] - The company aims to reduce Part D exposure and improve economic terms for Part C, with a focus on quality incentives [12][45] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about the 2026 environment, citing a favorable final rate notice from CMS and supportive comments from administration officials regarding value-based care [8][17] - The company anticipates clearer signals from Congress regarding Medicare policy as the year progresses [8] - Management remains cautious about ongoing utilization pressures and is taking a conservative approach to assumptions for 2025 [25][66] Other Important Information - The company ended Q1 2025 with $369 million in cash and marketable securities, expecting to use approximately $110 million of cash in 2025 [28] - The company is targeting cash flow breakeven by 2027 while maintaining a disciplined approach to capital allocation [28] Q&A Session Summary Question: Impact of V-28 risk model transition on value-based care companies - Management indicated that the risk adjustment perspective for 2025 is in line with expectations, with a 2% net increase year-over-year, inclusive of a 3% headwind from V-28 [33][34] Question: Contribution from previously exited areas - Management noted that unfavorable development from exited markets would not impact 2025 significantly, with minimal remaining IBNR for those service dates [38][39] Question: Clarity on 2026 MA final rate notice - Management confirmed that 40% of membership was repriced for January 2025, with expected benefits from the average 9% increase across the network [42][43] Question: Expectations for 2026 MA bit cycle - Management expressed optimism about the 2026 environment, with a focus on quality incentives and clinical cost-saving initiatives [60][61] Question: Visibility on completed claims and medical cost trends - Management highlighted improved visibility through a new financial data pipeline, which provides detailed member-level revenue and claims data [67][70] Question: Potential membership reduction into 2026 - Management stated that they do not anticipate a reduction in membership due to ongoing efforts to reduce Part D exposure and improve economic terms [76][77] Question: Impact of Humana's star ratings decline - Management acknowledged the potential headwind from Humana's star ratings but emphasized the company's strong quality performance as a differentiator [96][100] Question: Development of clinical programs - Management confirmed that while 2025 is an investment year for new clinical programs, benefits are expected to materialize in 2026 and beyond [107]

Financial Data and Key Metrics Changes - The company reaffirmed its full-year guidance, indicating a strong start to 2025 with Q1 results ahead of plan [5][14] - Adjusted EPS guidance for the year is approximately $16.25, with an expected insurance segment benefit ratio of 90.1% to 90.5% [15][14] - G&A costs for the quarter were slightly better than expectations, attributed to the timing of costs expected in the second and third quarters [11][14] Business Line Data and Key Metrics Changes - The Medicare product and experience maintained membership guidance for 2025, with strong performance in the Open Enrollment Period (OEP) [8] - CenterWell and Medicaid businesses showed robust patient and membership growth, with 30 new centers added through acquisition and partnership [12][14] - The company reported a 30% to 50% reduction year over year in members with weight refills due to medication adherence campaigns [11] Market Data and Key Metrics Changes - The company is seeing strong year-to-date performance in markets with high concentrations of members, particularly in Florida, Illinois, and Texas [41] - Medicaid membership growth is on track, with approximately 100,000 growth year-to-date, aligning with the expected annual growth of 175,000 to 250,000 [74] Company Strategy and Development Direction - The company is focused on operational efficiencies, increasing flexibility, and operating leverage while making investments to improve member outcomes [14] - The integration between the insurance segment and CenterWell is aimed at delivering better health outcomes and improving STARS performance [58][60] - The company is committed to returning to a 3% pre-tax margin in Medicare Advantage (MA) by 2027, with ongoing focus on quality and operational excellence [48][90] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the underlying progress of the business despite external challenges, emphasizing control over medical costs and operational efficiencies [50][52] - The company is monitoring changes in consumer behavior due to the Inflation Reduction Act (IRA) and is prepared for potential impacts on future performance [6][14] - Management highlighted the importance of navigating regulatory headwinds while focusing on controllable factors [51][52] Other Important Information - The company is actively working through STARS strategy and bids, with a focus on balancing membership and margins [32][33] - Recent fulfillment agreements with multiple companies are expected to contribute positively to growth [12][63] Q&A Session Summary Question: How much of your investments moved out of Q1? - Management indicated that most of the impact of incremental investments flowed through the MLR in Q1, with expectations for higher levels in the second through fourth quarters [20] Question: Update on the path to the 3% MA margin target? - Management reiterated focus on achieving the 3% margin, with timing tied to STARS outcomes, and no significant changes from previous communications [23] Question: Update on STARS initiatives and bids? - Management expressed confidence in progress made on STARS initiatives and ongoing work on bids, emphasizing a balanced approach to membership and margins [27][32] Question: Experience in Part D relative to expectations? - Trends in the business are consistent with expectations, with mid-single-digit growth on the medical side and low double-digit growth on the pharmacy side [36] Question: Visibility on risk adjustment and Group MA? - Management reported strong membership changes and visibility into risk adjustment, with no significant behavioral changes noted in Group MA [41][43] Question: Comments on Medicaid visibility and utilization? - Medicaid is performing in line with expectations, with strong growth and positive trends in member engagement and outcomes [75][76] Question: Clarification on GAAP EPS and valuation adjustments? - Management clarified that the adjustment in GAAP EPS guidance is unrelated to structural impairment and is part of a complex calculation [93]