Justin Lake: Thanks, good morning. I wanted to touch on the cost trend commentary, specifically between the Investor Day at the end of the year, looks like the MLR was a little bit higher, can you tell us what you saw there over the last month? Maybe give us some color, John, I know you guys did a great job in the second quarter of getting ahead of cost trend and utilizing some of those facility kind of insights that you have on scheduling et cetera. We’re trying to figure out whether this is just seasonality or a further pickup in utilization given the Q3 to Q4 that you saw. So, maybe you could tell us what you saw — seeing into January and just tell us where you think the Q1 comes in versus the full year? Thanks.
Andrew Witty: Hey Justin, thanks so much for the question. Let me just make a couple of comments, and I’m going to ask John Rex to give you a little bit more detail on the area you just talked about. So, you know, I think overall, as we look at ’23, overall, it came in very much in the sort of zone we expected toward the top end of that zone, but very much within the zone of what we were expecting for the full-year and we signaled back in the middle of the year. And the bulk of that story is driven by the outpatient shift in behavior around seniors that we talked about back in June. You’re right, though, post the investor conference, what we certainly saw was a click up in some seasonal activity, each of which individually are kind of pretty small.
But added together just made a bit of a difference in that last run out of the quarter, around things like RSV vaccination, which has brought with it — dragged with it, if you will, some extra utilization of services from seniors who’ve come in for their vaccine. Listen, to be clear, all of that is good news for healthcare, right? So these are seniors, many of whom had not been to the office for a long time. They’ve come back in and now got vaccinated. The physicians have picked up other things while they’ve been there. So a little bit of that going on combined with a little bit of heightened COVID activity just as we rolled out of the year. None of which we really think is durably impacting our outlook for ‘24. So we feel very solid around our ‘24 guidance point of 84, plus or minus 50 bps.
Maybe, I ask John just to give you a little bit more click down kind of insight into all about them. Go ahead, John.
John Rex: Yes. Good morning, Justin. You’re absolutely right. So the prime factor here when we think about the full-year view and where we ended up being, what we talked about much earlier in the year in terms of the outpatient care activity among senior populations. And that continuing consistent with what we saw back much earlier in the year and very supportive of what we staked out in terms of the benefit design that we stepped into ‘24 with, in particular for senior populations in our Medicare Advantage products. So all those elements very much supportive of that view and the activities we undertook earlier in the year. As it relates to kind of where we landed the full year, so 10 basis points really above kind of what we indicated at the investor conference back in November of differential and Andrew hit on those items.
Let me just kind of take it a little bit deep here. So, definitely some typical seasonality involved in there and the incremental elements were — I point out a couple of items, seniors did really respond strongly to RSV vaccinations and scheduled physician visits. Sometimes those physician visits, what we noted were driving other care activity around that. So in some cases, seniors that hadn’t perhaps been to a physician in a little while, and so they visited their PCP, got an RSV vaccine, and then in the meantime, their PCPs were able to close some additional care gaps as they were there, which is a great thing because some of these seniors hadn’t been in for a while. So important activity to occur there in the fourth quarter. So that was one of the elements that we saw there.
As it relates to kind of what we were seeing with elevated care costs for COVID, what we saw in the fourth quarter in particular in December. Overall, we’ve been noticing is that COVID admits for inpatient stays are running a higher cost per case than we traditionally saw. That actually kind of makes some sense. There are more intense cases typically that are going into inpatient stay. I will say we did notice in December that the total level of COVID admits were probably 50% to 60% above the October-November average that we had seen. So that was kind of the highest part of the year in terms of COVID inpatient admits. If I take those elements and sum together, that then more than accounts for the 10 basis points differential in our full-year view, Justin.
As that pertains to your second question, as we look out into the next year and what we see in terms of patterns, I would call it patterns commensurate, kind of, with what we saw this year in terms of just the movement, with this kind of 84% view that we view for the full-year. As I step back and reflect and just kind of thinking about where — broadly where the analyst consensus is, you picked particularly the 1Q. It’s kind of in the right — it looks like an appropriate zone in terms of staked out there for what one would expect. So thank you, Justin.
Andrew Witty: Yes. John, thank you. And Justin, thanks for the question. Appreciate that. Next question, please operator.
Operator: We’ll go next to Josh Raskin with Nephron Research.
