Cigna Corporation (NYSE:CI) Q4 2023 Earnings Call Transcript

Cigna Corporation (NYSE:CI) Q4 2023 Earnings Call Transcript February 2, 2024

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Operator: Ladies and gentlemen, thank you for standing by for the Cigna Group’s Fourth Quarter 2023 Results Review. [Operator Instructions] As a reminder, ladies and gentlemen, this conference, including the Q&A session, is being recorded. We’ll begin by turning the conference over to Ralph Giacobbe. Please go ahead.

Ralph Giacobbe: Great. Thanks, operator. Good morning, everyone. Thank you for joining today’s call. I’m Ralph Giacobbe, Senior Vice President of Investor Relations. With me on the line this morning are David Cordani, The Cigna Group’s Chairman and Chief Executive Officer; Brian Evanko, Chief Financial Officer of the Cigna Group and President and Chief Executive Officer of Cigna Healthcare; and Eric Palmer, President and Chief Executive Officer of Evernorth Health Services. In our remarks today, David and Brian will cover a number of topics including our fourth quarter and full year 2023 financial results and our financial outlook for 2024. Following their prepared remarks, David, Brian and Eric will be available for Q&A. As noted in our earnings release, when describing our financial results, we use certain financial measures including adjusted income from operations and adjusted revenues, which are not determined in accordance with accounting principles generally accepted in the United States, otherwise known as GAAP.

A reconciliation of these measures to the most directly comparable GAAP measures, shareholders net income and total revenues, respectively, is contained in today’s earnings release, which is posted in the Investor Relations section of the cignagroup.com. We use the term labeled adjusted income from operations and adjusted earnings per share on the same basis as our principal measures of financial performance. In our remarks today, we will be making some forward-looking statements, including statements regarding our outlook for 2024 and future performance. These statements are subject to risks and uncertainties that could cause actual results to differ materially from our current expectations. A description of these risks and uncertainties is contained in the cautionary note to today’s earnings release and in our most recent reports filed with the SEC.

Pertaining to our financial results, in the fourth quarter, we recorded a net after-tax special item charge of $552 million or $1.88 per share. Details of the special items are included in our quarterly financial supplement. As described in today’s release, special items are excluded from adjusted income from operations and adjusted revenues in our discussion of financial results. Additionally, please note that when we make prospective comments regarding financial performance, including our full year 2024 outlook, we will do so on a basis that includes the potential impact of future share repurchases and anticipated 2024 dividends. With that, I’ll turn the call over to David.

David Cordani: Thanks, Ralph. Good morning, everyone, and thanks for joining our call today. 2023 was a very strong year for our company with consistent performance and sustained growth. We executed with discipline across our businesses. We delivered for our customers and patients, our employer clients, our health plan partners in the others we serve. And with our expertise and diverse breadth of capabilities, we continue to improve affordability and clinical outcomes as well as continuing our work to expand access and choice. As we look forward, we’re carrying momentum into 2024 and we expect another strong year of performance in growth. Now today, I’ll focus my comments on key strategic drivers of our performance last year and how we continue to evolve and advance our business to sustain our impact on growth.

Brian will then walk through additional details about our performance for 2023 as well as our outlook for 2024. Then we’ll take your questions. Now before I go into our results, I want to comment on the announcement we made earlier this week, we reached a definitive agreement to sell our Medicare businesses to HCSC. We expect this transaction to close in early 2025, following customary legal and regulatory approvals. And while we continue to see the seniors market as an attractive growth market, we concluded that our Medicare businesses well large at about $12 billion in revenue would require sustained investments and focus and capital as well as dedicated resources that were disproportionate with their size within the Cigna Group’s portfolio.

Additionally, with Evernorth’s broad high-performing service portfolio, we will continue to serve the needs of seniors and grow our business. I would note that as part of our agreement, HCSC will be served by Evernorth for continued services for the customers we are selling. Additionally, we’re expanding the reach of Evernorth’s portfolio and see significant continued growth opportunities in Government services, including Medicare. Now as we consider the performance of our Medicare Advantage business in 2023, in the fourth quarter, results were in line with our expectations. And for the year, we balanced high-quality and competitive benefits offerings, continued target market expansion, and disciplined pricing activity. Now with that, let’s move into our 2023 headlines.

Probably for 2023, we exceeded our financial commitments. Full year total revenue, we delivered $195.3 billion. Full year adjusted earnings per share was $25.09 and cash flow from operations of $11.8 billion. This performance extends our track record of delivering consistent positive results, in the face of dynamic market conditions. It speaks to the power of our franchise and the purposeful way we’ve constructed our company, continuing to build on the strength of Cigna Healthcare, while also shaping and expanding our Evernorth Health Services platform to lead the way in addressing evolving needs in the marketplace. As a result of our focus, discipline and sustained execution, over the past decade, we’ve delivered adjusted EPS growth of more than 13% on an annualized basis.

In the five years since our acquisition of Express Scripts, we’ve achieved or surpassed every goal we established for the combined company. Through 2023, we’ve grown revenue by over $50 billion and met or exceeded our adjusted EPS objectives each year. And we’ve returned $27 billion to shareholders through share repurchase as well as attractive dividend payments. In 2023, after increasing our outlook for adjusted EPS twice over the course of the year, we had a strong finish and delivered full year adjusted EPS that was better than expectations. In short, we’ve demonstrated the ability to profitably evolve our business and services that we provide over many years, which enable us to continue to deliver on our commitments and growth. Now I’ll discuss our performance in greater detail.

I’ll start with Evernorth. In our Express Scripts business, we successfully implemented the single largest contract ever in the pharmacy benefits industry. Throughout 2023, thousands of coworkers collaborated and worked with dedication, so we’d be ready to begin fulfilling, well over 400 million annual prescriptions for 20 million Centene customers starting at the beginning of this year. Additionally, Centene was amongst hundreds of additional clients that were ready to serve in 2024 and I’m proud to say we’re off to a strong start. The good work of our team has helped us meet the needs of our customers and reinforce the trust that Centene and of the clients place in our company. Another Evernorth highlight for 2023, is that we once again advanced industry-leading innovation.

Last spring, we launched a series of innovations, including ClearCareRx, to support affordability, additional transparency and broader choice as well as independent Rx to partner and enable more closely with independent pharmacies. Then in November, we have further an expanding choice for clients funding their pharmacy benefits with Express Scripts clear network. We were the first to launch a scaled pharmacy network model offering cost-based pricing. In addition, our accelerated growth businesses with Evernorth fueled our momentum as well. Accelerated growth in Accredo specialty pharmacy and CuraScript SD businesses and in our care services businesses contributed to Evernorth’s strong top and bottom line results. With Accredo and CuraScript SD, we are supporting patients and providers with safe and effective use of the growing volume of high-cost clinically compliant specialty drugs.

We also continue building out our care service platforms to ensure patients can access care when and how they need it, while also remaining connected with physical sense of care. Our MDLIVE virtual platform, for example, is now available to over 60 million individuals as part of their benefits offering and is supporting the growing volume of care, including over 2.2 million virtual visits in 2023. Our results clearly demonstrate that with Evernorth’s leading capabilities were valued and flexible partner for health plans, employers, governmental organizations and health care providers. In Cigna Healthcare, we drove revenue and customer growth through disciplined pricing and medical cost management. We serve employers and individuals who trust us to guide them through the health care system.

Our leading clinical care programs could use to support our customers and patients, equipping them with the right information and insights they need to make the best choices for their health and vitality. Our ongoing pricing and continued progress in affordability initiatives in 2023 resulting in a medical care ratio that was better than expectations. Our U.S. Commercial Employer business had an outstanding year with continued strong growth. This was driven by our team’s continued success in strengthening our competitive position through improved affordability and leveraging our high-performance networks and digitally enabled services as we expand care access, coordination of care and overall value. Our individual exchange business performed broadly in line with our expectations for the fourth quarter.

And with the actions we’ve taken, we are on track to deliver improved profitability in 2024. In international health, we achieved another positive top and bottom line results. Our high-quality and localized health solutions, supported by our global provider network continue to resonate very well with the globally mobile population and employees of multinational corporations as well as intergovernmental organizations. Now turning to 2024. We will sustain our growth in high performance by sharply focusing on the greatest opportunities with a well-balanced portfolio of complementary businesses and a clear durable strategic growth framework. First, we will drive continued steady predictable growth from our high-performing foundational growth businesses.

Pharmacy benefit, U.S. commercial employer and our international health business. Our clients depend on our pharmacy services, for example, and our expertise as well as our leadership in lowering cost for prescription drugs and addressing growing needs such as the high demand for the GLP-1 class of drugs for weight loss in diabetes. We have a long history of guiding appropriate access to medications and providing specialized clinical support and we will continue to build on these efforts with new programs such as our EnCircleRx program. We’re also supporting customers in additional ways, including by offering enhanced digital tools to help them better understand the value of their pharmacy benefits. We’ve been successful in growing our U.S. Commercial Employer business for more than a decade and continue to view this as a growth market for the Cigna Group.

We continue to leverage the strength in coordinating a growing number of point solutions for our clients and improving clinical outcomes for our clients. Additionally, we continue to act as a disruptive innovator for small and middle-sized client needs. Second, we will build on further momentum for our accelerated growth portfolio, our fast-growing scaled specialty pharmacy business and our care service businesses. We have tremendous opportunities in these large and expanding markets with our differentiated specialty capabilities, supporting patients with high cost and clinically complex treatments. And within Care Services, we’re advancing our capabilities in behavioral health, virtual and home care, as well as coordinated care programs for specific conditions.

In summary, for 2024, we will grow our customer and revenue base again and our earnings and operating cash flow at the higher end of our long-term strategic targets. We’ve increased our expectations for full year 2024 adjusted EPS to at least $20.25, we expect our consolidated adjusted revenues to grow at least 20%, and we expect to generate at least $11 billion of operating cash flow. And we will continue to return capital to our shareholders, including a 14% increase in our quarterly dividend. Now before I wrap it up and turn it over to Brian, I also wanted to mention the announcement we made last month about expanding roles for Brian and Eric. Brian has been our Chief Financial Officer for the past three years and will continue in that role.

He will also expand his responsibilities as President and CEO of Cigna Healthcare. Eric is expanding his responsibilities as Executive Vice President of Enterprise Strategy for the Cigna Group, while also continuing as President and CEO of Evernorth Services. Brian and Eric’s expanded positions, as well as other leadership changes we announced provide further clarity of our priorities and strategy, as well as the extent of reach and impact lucid to have. Importantly, it also reinforces the depth of our management bench. At our Investor Day on March 7 in New York City, you’ll hear more from me, Brian and Eric, as well as other key leaders from across our company. We look forward to sharing with you our views of the expanded addressable markets we see and how we’ve positioned the Cigna Group to advance our next chapters of attractive growth.

Now I’ll briefly summarize. With the momentum we carried out of 2023, we are raising our guidance for EPS in 2024. We are building on a strong year of disciplined execution, performance and growth across our company. We deliver for our customers and clients and partners. We kept our commitments to our shareholders, including delivering adjusted EPS for 2023 of $25.09, which was above our outlook, and we generated $11.8 billion of cash flow from operations. We have sharpened the focus of our portfolio further to ensure that we are positioned to drive another strong year for our company. We are building on a consistent track record of disciplined execution, innovation and differentiated partnerships. We’ve increased our outlook for 2024 and now expect EPS of at least $28.25, and we will continue to advance the strategic deployment of capital, including using the majority of our discretionary cash flow for share repurchase in 2024.

We’ll have another strong year of performance, continue our track record for more than a decade of delivering against our 10% to 13% long-term adjusted EPS growth target, while maintaining an attractive dividend. And with that, I’ll turn it over to Brian.

Brian Evanko: Thank you, David. Good morning, everyone. Today, I’ll review the Cigna Group’s fourth quarter and full year 2023 results and provide our outlook for full year 2024. We’re proud to deliver another strong year for the Cigna Group, reflecting focused execution and growth across Evernorth and Cigna Healthcare. Looking at full year 2023, some key consolidated financial highlights include revenue of $195.3 billion, adjusted earnings per share of $25.09 and cash flow from operations of $11.8 billion, all well exceeding our initial expectations for the year. Fourth quarter enterprise results were particularly strong with revenue growing 12% to $51.1 billion, after-tax adjusted earnings growing to $2 billion, and adjusted earnings per share growing to $6.79.

These results reflect broad-based strength across the company, and this momentum positions us well for growth in 2024. Regarding our growth platforms, I’ll first comment on Evernorth. 2023 marked another year of sustained growth and profitability in Evernorth. As our market-leading clinical capabilities and innovative solutions continue to create differentiated value for our health plan, employer and government, clients and customers. Fourth quarter 2023 Evernorth revenues grew 12% to $40.5 billion and pre-tax adjusted earnings grew 10% to $1.9 billion, both of which exceeded expectations. Evernorth’s results in the quarter were driven by continued strong performance in our specialty pharmacy business, which saw a double-digit year-over-year revenue growth to reach $60 billion in revenues for full year 2023.

And our unwavering focus on reducing net costs for our clients as new drug innovations come to market, including GLP-1 agonists, biosimilars, specialty generics and other emerging therapies for clinically complex conditions. The fourth quarter capped a strong 2023 for Evernorth with pre-tax adjusted earnings growing 5% for the year, above expectations. We achieved this even while incurring meaningful spending related to the implementation of our Centene relationship. Evernorth’s favorable revenue and adjusted earnings growth in full year 2023, reflected strong execution and expansion across our foundational business, Express Scripts and our scaled accelerated growth business, Accredo specialty pharmacy. Now turning to Cigna Healthcare. We outperformed expectations with full year 2023 pre-tax adjusted earnings growing 9%, reflecting another year of highly effective execution.

Fourth quarter 2023 adjusted revenues were $13 billion and pre-tax adjusted earnings were $969 million, representing strong year-over-year growth. The medical care ratio was 82.2%, favorable to expectations. Our medical care ratio favorability was primarily driven by our U.S. Commercial Employer business, particularly within our stop-loss products, which outperformed expectations due to lower cost trends on high dollar claimants. Additionally, we saw lower-than-expected viral costs in the quarter with the combination of flu, COVID and RSV running below projections. As David noted in his comments, we have entered a definitive agreement with HCSC to sell our Medicare businesses. We expect to close this transaction in early 2025, following regulatory approvals.

And our full year 2024 outlook assumes full year contributions from our Medicare businesses. For fourth quarter specifically, our Medicare Advantage business generated performance broadly in line with expectations. Across Cigna Healthcare, our full year 2023 medical care ratio was 81.3%, better than expectations, benefiting from our disciplined pricing execution, continued affordability initiatives, and the favorability in our Stop Loss products. The full year MCR of 81.3% was 70 basis points better than the midpoint of our initial 2023 guidance, and is an improvement of 40 basis points from full year 2022. Moving to Cigna Healthcare medical customers. We ended 2023 with 19.8 million total medical customers, growth of approximately 1.8 million or 10% from year-end 2022, ahead of our initial guidance.

This growth was driven by U.S. healthcare, primarily from U.S. commercial employer fee-based customers, as well as growth in individual exchange and Medicare Advantage. Cigna Healthcare continues to perform well with strong underlying fundamentals. Our results reflect the strength of our differentiated value proposition and focused execution across the business as well as the stability and consistency of the U.S. commercial employer market. Overall, we’re very proud of our strong 2023 results in a disrupted market environment, reflecting the intentional design of the company’s growth platforms and our ongoing disciplined execution. This provides us with considerable momentum for 2024 and beyond. Now turning to our outlook for full year 2024, specifically.

We continue to expect strong underlying growth in Evernorth and Cigna Healthcare. We expect full year 2024 consolidated adjusted revenues of at least $235 billion, and we expect full year 2024 consolidated adjusted income from operations to be at least $8.025 billion or at least $28.25 per share, an increase from our prior outlook. When considering earnings seasonality, we would expect the adjusted earnings per share pattern to be similar to 2023. Now turning to our 2024 outlook for each of our growth platforms. At Evernorth, we expect full year 2024 adjusted earnings of at least $7 billion. We expect adjusted earnings within Evernorth to ramp as we move throughout the year with first quarter adjusted earnings contributing slightly below 20% of full year Evernorth adjusted earnings.

The earnings ramp reflects the effect of early year client-specific onboarding spend. These investments are more concentrated in the first half of the year and taper off over the course of the year. For Cigna Healthcare, we expect full year 2024 adjusted earnings of at least $4.75 billion. Assumptions in our Cigna Healthcare outlook for 2024 include approximately 19.3 million total medical customers at year-end, and we expect our medical care ratio to be in the range of 81.7% to 82.7%, with the first quarter 2024 medical care ratio expected to be below the low end of the full year guidance range to reflect typical seasonal patterns. Additionally, for the Enterprise, we project an adjusted SG&A ratio of approximately 6.1% for 2024, reflecting a higher proportion of Enterprise revenue from Evernorth, which carries a lower SG&A ratio.

And we expect the consolidated adjusted tax rate to be in the range of 20.5% to 21%. Turning to our 2023 capital management position and 2024 capital outlook. We finished 2023 strong and delivered $11.8 billion of cash flow from operations. In 2023, we repurchased 7.8 million shares of common stock for approximately $2.3 billion, and we returned $1.5 billion to shareholders via dividends. Additionally, our debt-to-capital ratio finished the year at 40.1% and an improvement of approximately 100 basis points from year-end 2022. Now, framing our 2024 capital outlook, we expect to deliver at least $11 billion of cash flow from operations through our efficient service-based business model. We expect to deploy approximately $1.5 billion to capital expenditures.

And we expect to deploy approximately $1.6 billion to shareholder dividends, reflecting our quarterly dividend of $1.40 per share, a 14% increase on a per share basis In 2024, we intend to use a majority of our discretionary cash flow for share repurchase. As we previously shared, we anticipate to, repurchase at least $5 billion within the first half of 2024. Finally, we expect full year weighted average shares outstanding to be in the range of $282 million to 286 million shares. Now to recap, our full year 2023, consolidated results exceeded expectations, reflecting continued focused execution and discipline across Evernorth and Cigna Healthcare. And our 2024 outlook reflects continued strength and momentum across our two growth platforms, Evernorth and Cigna Healthcare.

We are confident in our ability to deliver full year 2024 adjusted earnings of at least $28.25 per share. And with that, we’ll turn it over to the operator, for the Q&A portion of the call.

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Q&A Session

Operator: [Operator Instructions] Our first question comes from A.J. Rice with UBS. You may ask your question.

A.J. Rice: Hi everybody and thanks for the question. Obviously, we have the announcement on your sale of the Medicare Advantage business. And yet you’re saying you still view the business as attractive. Obviously, there’s been some volatility in some of the performance of some of the other players in this space already announced. Is this the time in your mind to sort of step back from the market and give some time for the dust to settle? Or how should we interpret the comments that you still think that segment is attractive? And then also on that, obviously, is there a speculation at least in the press about deal discussions. Your stock was quite volatile. I wonder if you could give us a little bit on how you approach large transactions, some of the financial parameters that people should keep in mind that would be hopefully reassuring for them.

David Cordani: Thank you. Good morning. It’s David. You have a lot in that question. And I appreciate it. Let me try to address some of the high points. First and foremost, we are really pleased with the nature of the transaction we’re able to structure with HCSC. We see it as a win-win. And it’s a clarification to our strategy within our portfolio. As I noted in my prepared remarks while we view the market as an attractive growth market. The required capital investment resources focus relative to its size within our portfolio, coupled with the continued elevated regulatory environment, our decision was it was best to enter this transaction. Point two is, very importantly, we’ve been quite deliberate now for several years, working to expand the service portfolio and the value proposition within Evernorth for health plan partners as it relates to their government services, be it Medicare, be it duals, be it Medicaid, et cetera.

And we’re demonstrating a very attractive proven track record of growing our government reach but through the services franchise, and we will continue to fuel that on a go-forward basis and see that as an attractive trajectory for us. As it relates to your latter part of your question, I’ll reframe our M&A criteria. I want to make sure I put that in the context of our capital deployment criteria. We continue to view, first, capital deployment priorities, investing in our business. Brian referenced the CapEx deployment of about $1.5 billion. Second, we always evaluate M&A for its appropriate attributes, which I’ll come back to in a moment. And then third, returning capital to shareholders. And as Brian noted, in 2024, in addition to raising our dividend by 14%, we expect to return the majority of our excess capital to shareholders through share repurchase with at least $5 billion in the first half of the year.

Lastly, in your action pack question, as we think about the criteria for transactions, we think about three criteria: first, strategic attraction; second, financial attraction; and then third, overall path to clarity. So is it strategically aligned? Is it financially attractive? And as a final note, when we think about the financial piece of the equation, you evaluate each deal on its own respective merits. But seeking to get high visibility in terms of your value creation for your organization if you’re going to enter into a transaction. So to repeat, we’re pleased with the decision and the transaction design. We will continue in a long-term service relationship with HCSC that further expands our proven track record within Evernorth. We see the Evernorth service portfolio as an attractive capital-light high visibility way to grow this portfolio.

And as we have in the past, we will maintain very strong discipline for capital deployment and our 2024 capital deployment priorities are quite clear. Thanks.

A.J. Rice: Thanks.

Operator: Thank you. Our next question comes from Stephen Baxter with Wells Fargo. You may ask your question.

Stephen Baxter: Yes. Hi. Thanks. I just wanted to ask another kind of quick follow-up on the Medicare Advantage. So I would be curious if you’d be willing to share maybe your five- or 10-year view of the market. So I totally appreciate that it’s a small part of your business before the sale. But you are still the eighth largest plan in the country. Do you think market share and concentration is ultimately going to look much more like the commercial market than it does today? Would love any kind of medium-term thoughts you could offer in the market. Thanks.

David Cordani: Steve, good morning, it’s David. You’re asking for a 10-year crystal ball. I think in the dynamism of the marketplace, most people come back to in terms of rolling three-year views of a given market. But stepping back, first and foremost, the Medicare Advantage offering, broadly speaking, in the marketplace is a very attractive offering for seniors. And it has a long-term proven track record of delivering attractive benefits. And importantly, clinical coordination when you get to the Medicare beneficiaries, typically dealing with a higher level of clinical burden that’s necessary for coordination. And the care outcomes, the quality outcomes, the overall value outcomes are positive. So broadly speaking, from a societal standpoint, we see MA as an important asset for the U.S. to continue to be served, supported financially and grow.

Secondly, the marketplace will see ebbs and flows in terms of the funding mechanism. We see the early look at the rate letter at the moment in time. That’s a moment in time, either acceleration or potentially deceleration for that marketplace. Third is, if you look at the senior satisfaction level, NPS broadly – Net Promoter Score broadly is attractive for Medicare Advantage. Therefore, as I noted previously to A.J.’s point, we worked really aggressively to ensure that we have a broad and we will continue to broaden the portfolio of services in support of health plans and integrated value-based care providers to be in support of value-based care, be it for Medicare Advantage tools or the commercial population. So we see the marketplace as a growth market.

Its respective growth will ebb and flow depending on reimbursement to some level from the government, lending toward benefit richness. And then ultimately, as you know, the last comment I would make is the primary wave of the baby boomer aging has reached a peak and is slowing. It’s still attractive, but that primary wave has reached its peak and is slowing somewhat. Take it as a whole, we see this as an expansion opportunity for Evernorth.

Operator: Thank you. Our next question comes from Lisa Gill with JPMorgan. You may ask your question.

Lisa Gill: Thanks very much, and good morning. I want to focus on Evernorth and maybe just understand some of the key drivers as we think about 2024. So first off, you talked about specialty in 2023. Can you talk about what your expectations are about growth in specialty in 2024? What you’re doing around services? You touched a little bit on GLP-1. But you had a really big contract with CNC coming on board, but you also had an overall good 2024 selling season. So any of the key elements you can help us to understand as to what the drivers are for that strong AOI growth in Evernorth?

Eric Palmer: Thanks, Lisa. Good morning. It’s Eric. A couple of different pieces in there. But first, let me just talk a bit about the portfolio of services that we’re focused on in terms of Evernorth and transition that into some of the drivers of growth specifically for 2024. David noted in his prepared remarks, a couple of highlights on capabilities we’re growing. But I would call out, we are seeing significant interest from the market around teams helping to better coordinate individual point solutions and alleviate some of the burden that comes along with the fragmentation of how care is administered and how employers and plans are assembling care. So us working to improve navigation and reduce point solution fatigue is a key item.

Second of all, I would note, behavioral care continues to be an area of focus, and there’s meaningful opportunity for behavioral care to be better coordinated as there’s significant comorbidities with individuals with mental health care needs, along with other care needs, and we’re in a position to help us address those challenges. The third item I’d note would be around specialty and in particular, the opportunity for us to continue to grow as there are more therapies, more choices in the specialty market as well as navigating through biosimilars. Overall, we’re positioned really well to continue to drive affordability and choice in biosimilars. And as we’ve talked about previously, that’s an important long-term multi-year tailwind in the economics and the growth of Evernorth overall.