Centene Corporation (NYSE:CNC) Q4 2023 Earnings Call Transcript

Centene Corporation (NYSE:CNC) Q4 2023 Earnings Call Transcript February 6, 2024

Centene Corporation misses on earnings expectations. Reported EPS is $8.0E-5 EPS, expectations were $0.43. CNC isn’t one of the 30 most popular stocks among hedge funds at the end of the third quarter (see the details here).

Operator: Good day and welcome to the Centene fourth quarter and full year 2023 earnings results conference call. All participants will be in listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today’s presentation, there will be an opportunity to ask questions. To ask a question, you may press star then one on your telephone keypad. To withdraw your question, please press star then two. Please note today’s event is being recorded. I would now like to turn the conference over to Jenn Gilligan, Head of Investor Relations. Please go ahead, ma’am.

Jenn Gilligan: Thank you Rocco and good morning everyone. Thank you for joining us on our fourth quarter and full year earnings results conference call. Sarah London, Chief Executive Officer, and Drew Asher, Executive Vice President and Chief Financial Officer of Centene will host this morning’s conference call, which also can be accessed through our website at centene.com. Ken Fasola, Centene’s President will also be available as a participant during Q&A. Any remarks that Centene may make about future expectations, plans and prospects constitute forward-looking statements for the purpose of the Safe Harbor provision under the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by those forward-looking statements as a result of various important factors, including those discussed in Centene’s most recent Form 10-K filed on February 21, 2023 and other public SEC filings.

Our Form 10-K for 2023 will be filed in coming weeks. Centene anticipates that subsequent events and developments may cause its estimates to change. While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so. This call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most direct comparable GAAP measures can be found in our fourth quarter 2023 press release, which is available on the company’s website under the Investor section. The company is unable to provide a reconciliation of certain 2024 measures to the corresponding GAAP measures without unreasonable effort to due to the difficulty of predicting the timing and amounts of various items within a reasonable range.

With that, I would like to turn the call over to our CEO, Sarah London. Sarah?

Sarah London: Thanks Jenn, and good morning everyone. Today, we reported a strong finish to a very productive 2023. Fourth quarter results include adjusted earnings per share of $0.45, generating full year 2023 adjusted EPS of $6.68. The quarterly and full year EPS results were slightly ahead of internal expectations and provide the organization with positive momentum as we head into 2024. We’ve been planning for and talking about 2024 for a while, and now that we’re here, we’re focused on positioning each of our lines of business for long term growth while continuing the important work to fortify our platform as we prepare for 2025 and beyond. Specifically, we are working through the tail of the redeterminations process, positing Centene to resume organic enrolment growth in Medicaid and to pursue new program opportunities from a position of strength.

We are solidifying our Medicare Advantage footprint thanks to an annual enrolment period that largely hit the mark with respect to our target membership, including sales, retention and dis-enrollments, and we are capturing a powerful growth opportunity and marketplace, demonstrated by the increased revenue guidance we issued this morning. We recognize that amid these opportunities, we still have valuable bottom line work to do, and we are approaching that work with the same focus and disciplined execution that has defined the first two years of this management team’s tenure. In fact, Centene wasted no time setting the tone for 2024 by successfully delivering what we believe to be the largest ever PBM platform migration and improving our pharmacy cost structure on behalf of our customers and members.

We have processed more than 40 million scripts so far through ESI and are pleased with the way this massive undertaking has rolled out. There is always a period of issue management after a change of this magnitude, and the teams have worked tirelessly and collaboratively to prioritize member access to care during this transition. We will continue to closely monitor end-to-end processing and customer service as we move through the year. Additionally in January, Centene closed the divestiture of Circle Health, the last of our international assets, and the company can now focus solely on our domestic core businesses. Circle marks the tenth divestiture since we began the portfolio review process in late 2021, and we are pleased to have purposefully streamlined our enterprise while keeping the portfolio of divestitures net accretive to earnings and generating cash for deployment.

In the broader context of value creation, our SG&A initiatives remain on track to exceed our original savings goals, and we continue to identify opportunities to drive operating efficiency through modernization and process improvement. Annual enrolment periods for both marketplace and Medicare also contribute to our confidence in Centene’s 2024 positioning. Continued pricing discipline in marketplace and the deliberate actions we took to align our 2024 Medicare bids with our strategic focus on lower income and complex members yielded the intended results on both fronts. Marketplace growth was more robust than anticipated, fueled by better than anticipated overall market growth as individual commercial offerings continued to gain traction with an expanding consumer set.

As such, we expect to deliver both growth and our planned margin expansion in marketplace in 2024. Together, these dynamics position us well to achieve our 2024 adjusted earnings per share guidance of greater than $6.70. With that, let’s dig deeper into each of our core business lines. Within Medicaid, we have delivered important proof points around the power of incumbency while navigating the unprecedented dynamics of redeterminations. In December, we were awarded the Arizona LTSS contract that will expand our footprint in serving complex populations in that state. That same month, we added approximately 90,000 members to our care and coverage through the successful go-live of Medicaid expansion in North Carolina, and in early January we successful re-procured our New Hampshire contract, earning the top score in the Granite State among competitors.

Our uniquely local footprint fosters important and trusted relationships with the communities and state partners we serve, and continues to differentiate us as we retain and grow our largest business. Turning to redeterminations, the process continues to track largely in line with our expectations. As of year end, we were approximately 80% of the way through the projected member transitions and, consistent with our modeling, we ended 2023 right around 14.4 million Medicaid members. Our health plan presidents along with our Medicaid actuarial teams continue to work in concert with our state partners to monitor the riskful impact of membership changes and calibrate rates to match acuity in the near term. To that end, we received some but not all of the outstanding 2023 retrospective rate adjustments we mentioned during our December investor day before year end, and we still feel good about our 2024 Medicaid guidance as we sit here in early February.

While Medicare has been a hot topic for the industry of late, we are pleased that the annual enrolment period played out largely as expected for Centene, and our 2024 financial projections for Medicare remain unchanged from investor day. Duals, or DSNP members have grown as a percentage of our Medicare enrolment as thoughtful benefit design changes allowed us to invest in and effectively refocus our book on members to whom we have the strongest ability to provide long term value. We expect DSNP members to represent more than 35% of our Medicare Advantage membership by year end, an important step relative to our strategic plan. As an organization, we remain laser focused on advancing our Medicare quality agenda. We made progress on a number of initiatives in 2023 that create positive momentum as we continue to execute in 2024.

This includes expanding our member outreach capacity, which ultimately allows us to conduct over 1.1 million preventive service outreach calls, reach 80% more members, and schedule 62 more appointments year-over-year. At the same time, we invested in digital data and provider connectivity, successfully deploying direct EMR connectivity to over 640,000 provider practices; and finally, we continue to drive core administrative and customer experience performance with service levels remaining in the high 90s through Q4. All of these efforts are important contributors to our long term stars performance goals. In 2024, as planned, we will continue to invest in this space with an obvious focus on Medicare Advantage star ratings, but with an approach that will drive benefit across lines of business.

With respect to Medicare utilization, as you heard from us in December, our 2024 bids incorporate a level of elevated medical trend related to non-inpatient services. To date, based on our full year and fourth quarter claims experience, we continue to view our pricing posture as adequate to support our 2024 Medicare outlook. Preliminary Medicare Advantage rates for 2025 were released last week. Bearing in mind the continued expectation for the multi-year phase-in of the risk adjustment model change that was finalized in 2023, we view the preliminary rates as insufficient with respect to general medical cost trend expectations. Drew will provide some additional thoughts on the preliminary rate in a moment. As this audience is well aware, we will receive final Medicare Advantage rates for 2025 in early April, and at the time of our first quarter call, we will have a better directional sense for bid strategy related to next year.

Finally, marketplace. As you’ve heard from us with increasing enthusiasm in recent months, marketplace presents Centene with a unique opportunity for simultaneous revenue growth and margin expansion in 2024. Overall, market growth was stronger than expected during this open enrolment period and we successfully capture our target market share of the expanded pie, netting to stronger than expected OEP results for the company. Within our 4.3 million member footprint as of January, our market share increased to roughly 26%, up from 23% previously, serving as another proof point of our leadership in the space. This strong enrolment result is driving the $2.5 billion increase to our full year 2024 premium and service revenue guidance. Membership mix continues to skew slightly younger, consistent with the year-over-year trend we saw last year, and distribution across middle tiers is consistent with our expectations with silver plans representing the majority of our enrolment.

One driver of overall marketplace growth has been members impacted by Medicaid redeterminations. On that front, we continue to trend towards the top half of our previously provided guidance range of 200,000 to 300,000 re-determined lives captured by Ambetter. Ultimately, the individual commercial market represents a strategic opportunity for Centene and we are excited to enable the expanding reach of these offerings as the demands of the market evolve. While the dynamic businesses Centene operates in continue to ebb and flow, the strength and diversification of our government-sponsored healthcare platform creates resiliency. We see tremendous opportunity for our core products, both near and long term. We will continue to execute against these opportunities to improve health outcomes for our members, generate profitable growth, and drive shareholder return.

Before I turn it over to Drew, I want to take just a moment to thank the entire Centene team for how you showed up in 2023 on behalf of our members and our partners. I am honored to work alongside you in 2024 as we make this company stronger every day and transform the health of the communities we serve one person at a time. With that, I will hand the call over to Drew for more details around our financial performance and 2024 outlook.

Drew Asher: Thank you Sarah. Today, we reported fourth quarter 2023 results, including $35.3 billion in premium and service revenue and adjusted diluted earnings per share of $0.45 in the quarter. For the full year, we reported $6.68 of adjusted EPS, growth of over 15% compared to 2022, including a 5.5% beat to our original 2023 guidance, and that’s on the heels of growing adjusted EPS 12% in 2022 compared to 2021. Our Q4 consolidated HBR was 89.5% while our full year consolidated HBR was 87.7%, both in the range of our expectations. Medicaid at 90.0% for the full year was slightly higher than our expectations. As of Q3, we were 89.9% year-to-date and we posted 90.6% in the fourth quarter. As we mentioned at our investor day in December, there were some open Medicaid retro rate adjustments.

At year end, had we received those adjustments, our full year 2023 Medicaid HBR would have been about 10 basis points better. All things considered, over nine months into redeterminations, our original forecasts for membership, acuity and rates were very close. As you can see in the membership tables, we were at 14.47 million Medicaid members at year end, consistent with the 14.4 million we were forecasting, as shared in the investor day appendix. That reflects an approximate 1.9 million Medicaid member reduction since 3/31/23 due to redeterminations, as expected. To reiterate what we laid out at investor day, our 2024 guidance reflects a low point of 13.2 million Medicaid members at 3/31/24 and year-end 2024 membership of approximately 13.6 million.

That all ties to our 2024 midpoint of $80.5 billion of Medicaid premium revenue, so no changes to our 2024 view of Medicaid revenue, membership or HBR. Medicare full year HBR was 87.1%, which includes the $250 million premium deficiency reserve recorded in the fourth quarter that we first discussed with you back in April of 2023. On Medicare trend, we continue to see steady but elevated levels of outpatient trend consistent with what we began to see in Q2 and consistent with our forecasts. We also saw a pick-up of COVID costs in December, as we mentioned in early January, though not alarming compared to prior COVID cycles. We thought about the current level of trend when we booked the 2024 PDR and continue to believe our forecasts are consistent with delivering our 2024 Medicare segment guidance elements outlined at investor day.

To help you with some math, the $250 million premium deficiency reserve lifted the fourth quarter Medicare segment HBR by approximately 475 basis points, and the full year Medicare HBR by approximately 110 basis points. The commercial HBR at 79.8% for the full year continues to be strong. Simultaneously in Q4, we were also capturing growth from both redeterminations and the special enrolment period, and we were up to 3.9 million marketplace members as of year end – that is the source of the strong premium growth in the fourth quarter. As you heard from Sarah, we couldn’t be more pleased with the growth that continued into January 2024, up to approximately 4.3 million members. This continued growth and HBR performance in 2023 sets us up very well to achieve our 2024 marketplace goals.

Moving to other P&L and balance sheet items, our adjusted SG&A expense ratio was 9.7% in the fourth quarter compared to 9.3% last year, consistent with our updated mix of business along with Medicare distribution costs. Cash flow provided by operations was $8.1 billion for the full year, representing 2.2 times adjusted net earnings. This was primarily driven by net earnings, and increase in risk adjustment payable for marketplace, and the timing of pass-through payments. Our unregulated and unrestricted cash on hand at year end was approximately $200 million. During the fourth quarter, we repurchased 397,000 shares of our common stock for $27 million. For the full year 2023, we repurchased 22.9 million shares for $1.58 billion, a little over our goal of $1.5 billion.

Our debt to adjusted EBITDA was 2.9 times at year end. Our medical claims liability totaled $18.0 billion at year end and represents 54 days in claims payable compared to 53 in Q3 of 2023, and 54 in Q4 of 2022. Looking back at 2023, it was a very good year of execution. We beat original adjusted EPS by 5.5%. We bought back 4% of the company’s shares for a cumulative total of over 10% since Q1 of 2022. We continue to execute on divestitures. We completed five divestitures in 2023, closed the divestiture of Circle in January of 2024, and received approximately $850 million in net proceeds in January. In total, we have completed 10 divestitures and are close to wrapping up that successful phase of value creation. On January 1, 2024, as Sarah mentioned, we successfully executed on our PBM conversion.

RFPing and moving PBMs has become one of our core competencies, and as a result of that, we have improved our pharmacy cost structure on behalf of our members and customers, and we’ve doubled marketplace membership since year-end 2022 and fortified Ambetter’s number one position. 2023 – pretty good year! We had provided detailed 2024 financial guidance elements at our December investor day. Since then, we’ve gained some additional clarity around the AEP and OEP results in Medicare and marketplace. Medicare enrolment is tracking right in line with our expectations relative to both volume and product mix. I give the Medicare team credit for precision in sales, disenrollment and membership product mix forecasts, as well as execution in a challenging year.

While Medicare Advantage is only a $16 billion revenue stream for us, it represents a meaningful margin expansion opportunity as we improve stars over the next few years and begin to have that reflected in revenue in 2026 and beyond. To reinforce Sarah’s comments on the 2025 advance notice, we are in the process of preparing our feedback with questions so far around the adequacy of fee for service trend and a new method for normalization that further reduced the rate. For us, the rate change as it sits today is approximately minus-1.3% before risk coding trend, and the new risk model introduced last year and that’s being phased in still has a disproportionate negative effect on partial and full duals, the most vulnerable populations in Medicare.

Our marketplace chassis continues to be well positioned for both growth and margin. Marketplace growth is running ahead of our previous expectations, allowing us to raise our full year 2024 consolidated premium and service revenue guidance by $2.5 billion, which takes our guidance to a midpoint of $136 billion Appetite for marketplace products continues to be strong as these offerings successfully provide both healthcare access and affordability for millions of beneficiaries. At this very early point in the year, we are reiterating our 2024 adjusted EPS guidance of greater than $6.70. As we turn the page from 2023, we can quickly reflect back on our second strong year of execution from this management team and positive progression of the company.

I couldn’t be more excited to drive success with this team and provide affordable access to healthcare for our members in 2024 and beyond. Thank you for your interest in Centene. Rocco, you can open the line up, please.

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Q&A Session

Operator: Thank you. [Operator instructions] Today’s first question comes from Stephen Baxter at Wells Fargo. Please go ahead.

Stephen Baxter: Yes, hi. Thanks for the question. I was hoping you could expand a little bit on the Medicare outlook embedded in your guidance. It’s certainly a concern that cost in the fourth quarter could be coming in higher than expected, and you certainly reported in MLR that it was a bit above consensus, even ex- the PDR. That would seem to suggest, too, I think most that your Medicare assumptions for 2024 would be pressure, but you’re saying that’s not the case, so hoping you can expand on why that wouldn’t be, and maybe some of the underlying trend assumptions that you factored into your guidance here. Thank you.

Sarah London: Sure, Stephen. Good morning, and thanks for the question. Yes, we still feel comfortable with how we’ve accounted for trend in the 2024 bids, and as you heard earlier, no change to 2024 Medicare guidance elements; but let me talk a little bit about what we saw throughout 2023 and underlying trends. Let’s talk macro first and then we can talk Q4. From in inpatient utilization standpoint, that was pretty consistent throughout 2023 – very little variation quarter over quarter. Where we did see a step up, as we pointed to multiple times throughout the back half of the year, was in Q2 in outpatient, and underneath that, the drivers were fairly consistent through the last three quarters of the year, so orthopedics with DME on either side of that, cardiac and cardiovascular as a subclinical category, so those were pretty consistent full year.

What was incremental in Q4, obviously the biggest item was taking a $250 million PDR. We also saw a COVID step-up between Q3 and Q4 and then sequentially month-over-month in the quarter. We also saw in Medicare only, ILI step up late in Q4. Both of those have come back down, as we’re seeing in January run-out data. We some RSV vaccine utilization in Q4, partly a function of our continued efforts to get seniors in for their preventative services visits – you heard me talk about that in my prepared remarks. That was also part of intentional investments we made in quality in Q4 as we prepared and positioned for 2024, which as you know is that critical third year in our cycle and our effort to get to 85% of members and 3.5 stars by October of 2025, so those are really the elements of both full year ’23 and then in Q4, and again still feel comfortable with how we’ve accounted for overall trend in the ’24 bids and no change to ’24 guidance for Medicare.

Operator: Thank you. Our next question today comes from Josh Raskin with Nephron Research. Please go ahead.

Josh Raskin: Yes, hi. Thanks. I was wondering if you could give us some color on the Medicare Advantage membership losses coming into the year. I’m looking specifically at geographic mix relative to expectations, meaning did you lose the members where you expected, and then also were the balance of new sales and sort of gross losses consistent with expectations, retention, was that in line? Just any color there would be helpful.

Sarah London: Yes, thanks Josh. We were, as Drew said, very pleased with the way the Medicare team executed in AEP and precision across all of the dimensions that you talked about, again largely in line with expectations. We took an intentional refocus in the ’24 bid strategy to try to align to those lower income, more complex members, as well as the duals and the DSNP population, and successful in terms of what we’re seeing relative to the concentration of duals coming out of AEP, so pretty pleased with where we intentionally focused, what the impact looked like, and again that was really a function of the team going PBP by PBP and building up a strategy where we could invest in those members that we wanted to retain, and in those members that we feel like we’re going to provide the greatest long term value to. Ken, I don’t know if you want to talk a little bit about some of the calibration we did on distribution as part of that effort overall?

Ken Fasola: Yes, it’s a really important add to Sarah and Drew’s comments. If you recall, in prior quarters we talked about the prior penetration with tele-digital brokers, and we made a conscious effort both in terms of owned assets and discipline with preferred partners that moved the mix to a balance that we’re really, really comfortable with, and our owned assets performed historically far better with respect both to retention and overall quality, and we’re seeing that now in preferred partners. I think the distribution system has responded to obvious opportunities to improve quality, persistency, and product mix, as Sarah said, is directly in line with what we were targeting, so the level of precision is both impressive, important and directionally where we’re going to go.

Operator: Thank you. Our next question today comes from Kevin Fischbeck with BofA. Please go ahead.

Kevin Fischbeck: Great, thanks. Just want to see–you raised the revenue guidance by $2.5 billion, but didn’t change the EPS guidance. Is there anything that you would highlight there as an offset on the EPS line, or is that just conservatism? Then just to make sure I understand the PDR, you’re saying that the rate’s not sufficient to cover trend. Does your PDR reflect the current rate update or does it assume something better, and if the rate update were to be reaffirmed, then the PDR might change? Thanks.