Gary Taylor: Just a couple — maybe one question, one clarification. I know last year, at this time, you gave very precise enrollment growth guidance and perhaps that was because of the shortfall in the ’22 enrollment. But I guess, maybe in absence of that, are you still generally anticipating when you say you would grow at industry or better that the industry would grow high single digit. Is that still your general expectation? And then just a slight clarification, I guess, to the back half of Josh’s question. You do talk about benefit design change as impacting MLR and certainly, some of that was intentional and we knew that coming into the year or benefit investments. made. CVS this morning was talking about more OTC benefits, etcetera.
I just wondered if year-to-date, given the pretty substantial investment you made in OTC and Flex and that sort of thing. If you’re learning anything about how members are using those benefits over the course of the year? Is the monthly utilization of those allowances accelerating as the year has gone by, etcetera?
Bruce Broussard: I’ll take the first question just on the growth guidance and I’ll let Susan take the second question. On the growth guidance, we continue, as we mentioned, we believe that will grow at or equal to the industry. I think there’s ranges of what the industry estimate will be, rent is from 6% to the 8% or so but we feel really comfortable with that. And that comfort, [indiscernible] is coming from our continued feedback from our brokers, not just where we are positioning in the marketplace. We continue to see both the brand and the benefits continuing to be competitive and never the cheapest but to be competitive in the marketplace. So we’re getting really good feedback there. So I would just say we just feel that today, we will follow the growth of the industry.
We do feel we’re not as competitive as we were last year and the way we’ve positioned our product and therefore, that’s why we’ve backed a little bit off from being disproportional to being right at the industry or greater growth.
Susan Diamond: And as respect to your same question, so as you think about the benefit of investments we made, there was obviously living contemplated in our pricing in our initial guidance and one toward our initial MLR guidance. As we’ve seen the higher utilization, particularly in sort of benefits you mentioned like that are more relatives like we’ve done in the flex as we spoke to. I would say we are seeing a higher utilization on some of those benefit investments than we would have expected. But again, we’re seeing it across the existing membership base as well as in the new members. So it’s, again, not a selection issue where we’re just attracting people that or attracting that we’re seeing existing members who now have access to those riches also utilizing them in the higher rate as well.
Particularly on the dental side, I would say with optimization, we’re seeing [indiscernible] just more dollars being utilized versus more utilizes overall. So sort of the cost per visit, as you can see about it going up where I’m sure the with Dennis in the optometric and when they got a patient in there, they’re trying to maximize that sort of revenue per patient. So we’re seeing some higher cost procedures or services like dentures and some other things routinely within that utilization. With the way some of those benefits are designed continue to flex, we do have less opportunities intra year to try to mitigate some of that and it does require adjustments to the benefit of that. And so some of that, particularly in the Flex benefits early in the year, we did make some adjustments in our ’24 plan designs to account for that and implement some additional restrictions and benefit reductions.
So that is one thing you’ll see. So we’ll continue to monitor, as I would say, broader utilization just relative to what we had expected off of that benefit investment that we implemented in a few of those specific categories.
Operator: Our next question will come from the line of George Hill with Deutsche Bank.
George Hill: Was that George Hill? If so, I’ll talk.
Susan Diamond: Yes. [Indiscernible].
George Hill: Sorry, Susan. And the end of the operator cut off of mind. I just want to make sure I heard you right. When you said were you seeing higher MLR pressure PPO [ph] versus HMO plans? And I guess my question, I want to make sure I heard that right and then my question would be, is there a meaningful MLR difference typically between the HMO and the PPO plans. And kind of how should we think about that going forward as you’re kind of seeing broader demand for the PPO plans and kind of that share is expected to increase in mix going forward?
Susan Diamond: Yes, you did hear me correctly that we are seeing more pressure in our PPOs versus our HMO. Some of that’s a reflection of a lot of the newer plan designs we’ve implemented over the last years having more PPO and you saw the introduction across the industry of the $0 PPO [ph], an example. Since you tend to have a lower margin profile than our legacy HMO products. Some of that’s also a reflection of this geographic mix differences. Obviously, we have strong penetration in HMO products and some of our [indiscernible] and highly risk-insured markets. Today historically [indiscernible] although we’re seeing more and more of a more sophisticated with providers to take risk on [indiscernible] and difference in the months to see better financial results, including lower MLRs and higher contribution to MTN.
Operator: Our next question comes from the line of Sarah James with Cantor Fitzgerald.
Sarah James: So the hospitals this quarter have pretty consistently been talking about pressure on the claims review process for physician fees, especially in the ED and the difference between inpatient versus monitoring. And I’m wondering if you’re seeing any savings on those — on your claims review process for those in ’23 or what you expect in ’24? And if there are some areas that you’re looking to improve or enhance your teams or process on in ’24.
Susan Diamond: Take on post memory. Would you mind repeating that question? We didn’t get I’m sorry.
Sarah James: Sure. So the hospitals have pretty consistently been talking about some pushback on the claims review process for physicians, physician fees, physicians in ED as well as the inpatient versus monitoring classification. I’m wondering if that’s an area that you’re seeing any savings in, in ’23 or expect two in ’24. If not those areas, If there are some areas that you’re focused on for claims review as you approach ’24 and managing.
Susan Diamond: Thank you, Sarah. So yes, I think you’re referring to some of the utilization management practices and those are typically done on the front end. We do that wherever possible where we will have the opportunity to review for medical necessity and appropriate setting. So whether that’s a full inpatient admission or an observation stay. We’ve had those programs in place for many, many years. There are some changes coming in 2024 based on some new CMS regulations. And those do change the way some of those programs will work. Those don’t take effect until January 24. So I would say no meaningful changes experienced in ’23 but we are anticipating those changes in ’24. Those did represent a headwind to us, recognizing that we won’t be able to have as much impact as we have historically from those efforts and we did account for that in the bid.
