美股醫(yī)療保健行業(yè)：管理式醫(yī)療Q1預(yù)覽

1、Equiy eseach meias | Unied ManManagedCare1Q21Preview:heSetupLoksFine;WllWe SeeAReturntoBeatandRase?Manaed ae | QuatelyUNHtokOffCOs1QargsonAprl5t: UNH wil be he ist MO to epot Q1 eanins esuls, setting he one or the goup. Given the updates povided by seveal of he Os n ealy arch and our ecent hospital

2、suveys, we boadly epect he oup o meet or beat our Q1 EPS estimates.exptoldResuts: The maniude of eanins beats or MOs s adiionaly hihest in Q but apes of as he ear poesses. This tend s diven by seasonalty n some of he key business ines and moe beneit om pior ear development in H than n H. ometmes Os

3、imit upside by einvesting heir H outperomance by aceleatng investment spending or nceasing eseve accuals, ec. eveal of he Os pesented at investor oneences in ealy arch and indcated that utlzaton rends wee nlne wih or beter than epecatons. pecfical, HUM coninues to epect depessed uiiaton or Q1 and pa

4、t of Q. The delnes in utlzaton HUM saw n Jan %) and eb 5-%) wee said to be nlne with ts expecatons. nthem indcated that enteing 2, it oecast that Q1 utliaton would be well above baselne. Whle Jan paed out as epeced, the utilzaton delne rom Jan o eb was steeper han epeced, and ontnued in to Mach. hil

5、e t is stll epected to be above baselne, Q1 (as of ealy ach) was plaing out beter han NTM expeced. UNH indcated that OVID9 inidene or Jan and eb an hher than t would have epeced meaning OVID9 costs wee hher than UNH antcpated; howeve, moe han oseting his impact was moe ae deeal than he ompany would

6、have epeced duing hose wo months. This lkely means hat H2/H21 eanins mix will be moe balanced %/%), as opposed to the nomal %/% whih UNH epeced or 21. By ine of business, UNH hs seen ommecal be ose o baselne, ediae a ite beow baselne, and ediaid a ite uther beow baselne han ediae. ina ndiated that n

7、ew COVID9 ase ounts and hospitalzatons delned qute a bt ater ts peak n he De/Jan ime ame with non- OVID utlzaton ontnuing o be an oseting aco. I now expecs Q1 EPS o be towad he op half of the 0-2% 1 EPS ane t peviously antcpated.llCOsReturntotheTypicalBatandRaseDyamicnQ?Whle we beieve, thee is uncer

8、tainy eading utlizaton, the dop n OVI9 cases and hospitalzatons patcualy n ealy 0) bodes well or utiiaton tends n 21. uthe, we beieve MOs wee consevatve in issuing their oiinal 1 outooks. Thee ae seveal taiwinds, whih ould boost eanins such as he etension of he edicae sequestaton moe beneiial to tho

9、se wih hih ediae dvantae evenue), e-inlatons impact on investment inome, the HIX EP, the etension of he Publc Healh Emegenc, and how nonepansion states use the enhanced MP, et. lenatvel, patal osettng headwinds such as the need o ncease eimbusement or he COVID9 vacine, coud miiate some of he upside.

10、 Ain, we beieve he Os have enouh aiwinds to etunto a beatandaise Q. tl, we note NC has ecenly said it ould update is oulook duing ts Q1 eanins all but no ater han ts Q2 eanins al.ResarhAalsts.J.e212 35 14 HYPERLINK mailto:aj.rice aj.ricEdurdon212 35 41 HYPERLINK mailto:eduardo.ron eduardo.ronexnderh

11、n212 35 74 HYPERLINK mailto:alexander.khan obertMon212 35 12 HYPERLINK mailto:robert.moon DICLOSURE ANDIX AT THE BACK OF THIS RORT CONTAIS IORTANT DICLOSUR, ANALYST CRTIFICATIONS,LAL NTITY DICLOSURE AND THE TATUS OF NONUS ANALYSTS. US Discosue: edit uisse does and seeks to do business wih companies

12、coveed in is eseach epots. s a esul, investos should be awae that the im may have a conlct of inerest that coudUNHRmasOurFousmefor;ANTMandCIAreVauePaysandHUM OfferstroguarrothandsaBgBefcarythsyarfromthe xtesonofthediareequstratonodayoratorm: UNH, NTM, and I oer stong visibiiy on ther ageted annual E

13、PS owth over he net seveal eas. HUM stands o beneit om he atacive owth dnamis n edicae dvantae and should be seen as he most ecessionesistant play among Os.ableofContnts HYPERLINK l _TOC_250023 xuteumary 4 HYPERLINK l _TOC_250022 Utlzaton and R Tend Epectatons or Q1 4 HYPERLINK l _TOC_250021 Medcae

14、equestaton Taiwind 5 HYPERLINK l _TOC_250020 aing evels or OVID Headwinds/Taiwinds Incopoated in Outooks 6 HYPERLINK l _TOC_250019 CompanybCompanyxptatosforQ1 8 HYPERLINK l _TOC_250018 nthem 8 HYPERLINK l _TOC_250017 ina 9 HYPERLINK l _TOC_250016 entene HYPERLINK l _TOC_250015 VS Healh HYPERLINK l _

15、TOC_250014 Humana HYPERLINK l _TOC_250013 Moina Healhcae HYPERLINK l _TOC_250012 UniedHealh Goup HYPERLINK l _TOC_250011 rerformaneandVauaton HYPERLINK l _TOC_250010 IdustryOpratgtatsts HYPERLINK l _TOC_250009 ommecal Enolment HYPERLINK l _TOC_250008 ommecal uly Insued “iskbased”) Enolment HYPERLINK

16、 l _TOC_250007 ommecal elfInsued “Non-isk/O based”) Enolment HYPERLINK l _TOC_250006 Manaed ediaid Enolment HYPERLINK l _TOC_250005 Medcae dvantae Enollment HYPERLINK l _TOC_250004 PDP Enolment Tends HYPERLINK l _TOC_250003 M/Utilzaton Tends HYPERLINK l _TOC_250002 onsoldated MR Tends HYPERLINK l _T

17、OC_250001 Investment Income Tends HYPERLINK l _TOC_250000 djusted PeTax Magin Tends ExcutiveSumaryUNH wil be the ist manaed ae company to epot ist quater eanins esuls on Thusda, pil 5h, seting he one or the oup. Given he updates povided by seveal of he MOs n ealy ach and our ecent hospital suves, we

18、 boadly epect he oup o meet or beat our Q1 EPS estimates.Figure:Q1argsRleaseDtasandstimatesNTMCICNCCVSMOHNHrnings Dt/ TimeConference Dt/ TimeConference Detils21EPS*CSEsmateY/Y ChngeCons (en)Y/Y ChngeCons (Medin)Y/Y ChngeCons Rngerince to en rince to 21ML*CS stimteY/Y Chnge (in bps)Cons (Men)Y/Y Chng

19、e (in bps)umber f sts Cons-Apr AM T-Apr AM T/A.0-.%.4-.%.5-.%.5 -.5(.1)(.0).%.%-y AM T-Apr AM T-y BMO-Apr AM T-Apr AC-Apr AM T-y :0-Apr :0-y :0-Apr :0-Apr :0-Apr :5AM TAM TAM TAM TAM TAM T-/A83/A/A834874419-.%.%-.%.%.%.%.7.8-.%.%-.%.%.%.%.5.7-.%.%-.%.%.%.%.9 -.4 -.9 -.5 -.5 -.8 -.1.(.0).1.7(

20、.1)(.0).(.0)(.0).2.%.%.%.%.%.%()0.%.%.%.%.%.%()9Source: ompany dat, redit Suie etimate, Viible Alpha, FatSet; *onenus ES etimates are from FctSe, ons MLR etimates are rom Viible AlphatilizationndMLRTrendxpecttinsfor1Q21We epect the consolidated MLs or the MOs in our coveage to be up 0 bps Y/, on ave

21、ae in Q, driven primaiy by the emoval of the HIF aning fom a 5000 bps impact depending on MO, an epecaton or a etun to moe nomalzed levels of utlzaton, lower isk adjusted evenue, and business mix moe ovenment pemiums vs commecal pemiums. ddiional, Medcaid MOs wil lkely be impaced by state pemium rat

22、e adjustments and isk shaing mechanisms.eveal of the MOs pesented at investor coneences in ealy Mach. These MOs eiher indcated that utlzaton tends wee inline wih epecatons or better than epecatons. pecical, HUM noted that it ontnues to epect depessed utlzaton or Q1 and pat of Q. HUM had seen a % dec

23、ine in utlzaton in Januay and a 5% decine in ebuay whihwee inlne wih its epecations, the decine in OVID9 cases led to a decine in hospialzatons as well s osts s OVID ases ae mateialy hher han nonOVID ases.nthem indcated that enteing , it oecasted that Q1 would be well above baselne wih Januay being

24、the hihest in tems of utlzaton elatve to baselne, wih ebuay impoving elatve to Janua, and Mach impoving elatve to ebuay but stll above baselne). The company indcated that Jauay plaed out as epeced. In ebua, the utlizaton decine om Januay was steeper thn antcpated theeoe ebruay esuls wee posiive to e

25、pecatons. The company noed that wather events coud ave plaed a ole in ebuay peomance, however, all of ANTMs eoaphies saw a decine in utlzaton but the decine was eater in aeas impaced by weathe. The decline coninued in to March as indcated by peauthoiatons. NTM indcated that whie it stll epeced Q1 to

26、 be above baselne, the quater as of ealy March) was plaing out to be beter than antcpated when the company issued ts 1 outook n Janua.UNH indcated that OVID inience or Januay and ebuary ran hiher than it would have epeced meaning OVID costs wee hiher than UNH antcpated, howeve, moe than oseting ths

27、impact was moe cae deeal than the company would have epeced duing those two months. Whle the company doesnt beleve ths is a mateial impac, it lkely means that H2/H21 eanins mix wil be moe balanced %/%) as opposed to the nomal %/% whih the company epeced or 1. Most of the net decine in utlzaton was i

28、n the outpatent and phsiian diect pimay cae cateoies. By lne of business, UNH has seen ommecal being cose to baselne, Medcae a lite below baselne, and Medcaid a lite uther beow baselne than ediae.Duing inas Q0 eanins cal, the company indcated tat it epeced 0% of is 21 EPS oulook o be eneated in Q. T

29、he ompany ndiated that new OVID9 ase ounts and hospialzatons decined qute a bit ater is peak in the De/Jan tme ame wih non- OVID utlzaton contnuing to be an ofseting aco. ddiional, the company saw some weatheelated disupton elated to the winer stoms acoss the couny both in tems of care delvey and al

30、so in the phamcy supply chain. Theeoe, the company indcated that it nw epecs Q1 EPS to be towad the top half of is 02% of is ull ear EPS ane ie., 1- %.Figure:QuarteryCosodatdLRTrdsSource: ompany dat, redit Suie etimatesMedicreSequesttionTalwindThe House has et to vote on equestaton thees an aeement

31、in place to etend the equester whih s epeced o pass and MS has asumed so. f he House votes on outher deay he edicae sequestaton uts thouh he end of 1 pior to the epotng of Q1 esuls, it s possibe hat MOs ould inlude the taiwind in heir 21 oulooks.Medcae Os would beneit rom he nne eta months or he % s

32、equester moatoium in . We estimate the addiional nine months of paments oset by LR equiements as medial epense would have to ise by % as well) would beneit MOs 1 EPS esuls by ouhly .-.%. We estmate the beneit or HUM would be 1.6 7.%) upside elatve to our urent 21 EPS estimate, .7 .%) upside or NTM,

33、.5 .%) upside or UNH, .4 .%) upside or N, and .4 .%) upside for I. ecal, Humana ideniied the eisting sequestaton elef (or Q1 ony) as ontibutng 800 mln to is 1 esuls, and nthem indcated that each quater of addiional sequestaton hoiday epesents a ite ess han .10 of EPS benei.VryingLevelsforCVIDe Incop

34、ortedinutloosThe Os all pesented ther 01 oulooks with vaing deees of headwinds and aiwinds elated to OVID. We lst the various dscosues om he MOs beow.ANTMhihlihted $0 mln of net neatve OVID impac.Includes OVID testin, teatment, vacine as well as the Medcae ee Schedue, et. pataly ofset by nonOVID uil

35、izaton beng ess han a nomal ea, piing acions and eulatoy eimbusementsNTM laed $.0-.70 of impact elated to the Medcae business /3 elatng to the Medcae ee chedue incease, the % bump in inpatent DG etended or the ul-ea, pataly oset by 3 months of sequestaton; the emainng /3 elates to lower ediae isk ad

36、justment evenue diven by ower nonOVID utlzaton n Q0Cgahihlihted .5 EPS headwind om OVID or ouhly $0 mln peta. of mpact elates to OVID estn, teatment and vacine as well as evenue pessue n ediae% elates to lower ustomer enolment mainy n he ommecal business)% elates to other pats of inaCVSlaged a 00 ml

37、n unavoable impact n ts Healhcae eneis sement elated to OVID pataly oset by a beneit om OVID9 epeced n ts etai/TC sement of beween 400 mln elated to OVID vacinatons.HCB mpact aely atibuable to ediae isk adjuster mpacs and ecent eulatory hanes n onsoldated ppopiatons ctHumanahihlhted a net neural imp

38、act om OVID Pimaily in ts IndividualGoup A business.Headwinds: mln - 1 bn of ediae isk djustment, 255 mln om OVID estng and eatment, and 5-0 mln om he edicae Phsiian ee chedue InceaseTaiwinds: .5 bn om depessed nonOVID utlzaton and 0mln om sequestaton elefUNHhas mainained is 2 bn (.0 EP) headwind el

39、ated to OVID /3 elated to UHC; /3 elated to Optum).Includes view on seveal key acos ncuding: testing and teatment view dect OVID ae osts to be ompaable to 2, epecaton or onsideably ess oset than n 20 om deerals, no assumpton or widespead usae of a meaninuly ess epensive esting standad, view hat seni

40、os have deered ae in 0 impacing odin, vacinatons ony beome pevasive airly deep ino, assume moe ulouhed individuals to ulimatey ose ommecal coveae and hat states esume ediaid edeteminatons Cassumes net uiiaton OVID and nonOVID) o be slhtly beow baselne or H21 and hen etuning o nomalzed levels or H2.

41、Ns outook aleady assumes a headwind om ediae isk odin. NC dd not update its outook with ts Q0 esuls but hihlihted potenial headwinds and aiwinds. NC sees he eadwinds and aiwins not inluded in is oulook as ikely a net positve.Potental headwinds to is oulook which inlude addiional state ate acions due

42、 o OVIelated educions in utlizaton beond the 40 mln aleady inopoated, hihethananiipated oveall COVIDelated costs, the Medcare Phsiian ee chedue update $0 mln. With espect o aiwinds, NC hihlhted coninued membeship owth as a esult of he etension of he ediaid redeteminaton suspension om he pubic health

43、 emeency, lower uiiaton trends n H beond urent pojetons, a potental meaninul incease o he MP, and he HIX specal enolment peiod. OHlaed a neatve net eect of OVID at educed level) due o a ontnuaton of many of the iskshaing oridors hat eisted n 20 and he drect osts of OVID- elated patent cae ofset by m

44、odeate utlzaton utaiment, ediae isk scoes, and net phamacy beneit aveouts. olnas ullear uidance does not ncude he Afinity acqusiion epeced to cose n Q) or he mpact of poental PHE etensions beond midpil .MOH laed wo ndustrywide envionmental chalenes hat tempoaiy pessue eanins. peciialy, MOH epecs he

45、net efect of OVID onsisting of utlzaton utaiment and diect cost of ae, oset by iskshaing oidos, to coninue to neatvely mpact earnins n 21 by appoimatey $.0 per shae.The company epecs medial suppession to have an impact of 0 mln in 2, mosty n H and easing n H. Theeoe, H21 esuls ae epeced o be seasona

46、ly hher han hstoialy om a ontribuion pespecive and H is epeced o be seasonaly ower than t has hstoial. MOH also epecs hediect ost of ae or OVID o have a ouhly 400 mln impact on esuls and iskshaing oridos o have a $0 mln mpact on esuls.Company-byompanyExpecttions In the tet and iues hat olow, we summ

47、aie our eanins epecatons or each compan.Anthemargsxptatos: We expect NTM to beat our Q1 EPS epecaton of ., down .% /. The curent Q1 onsensus mean s .4 while he onsensus median s . long with he compans Q0 eanins elease, the company ndiated that it epecs ust over % of is 21 EPS o be eneated in H1 and

48、Q1 and Q2 o be evenly spli. On a nomalzed basis, NTM would epect ouhly 56% of EPS o be eaned n he fist six months of he ea, and moe han half of hat in the ist thee months, making Q1 ts most poiable quater in a “nomal ea”.LRxptatos: Our Q1 MR estimate is .% vs. cons of .%). Our Q1 MR estmate epesents

49、 a 0 bps Y/Y ncease. On a /Y basis, he suspension of he HIF s a ouhly 0 bps headwind on a /Y basis. ecal, whie ebuay pataly diven by weather events) and ndiatons ealy n Mach came n beter han epeced, the company stil epects Q1 o be above baselne but beter han oiinaly epeced.Duing its intal 01 oulook,

50、 the ompany advised that of he 10 bps inease /Y (elatve to 9 to adjust or the HIF mpact n 0, 400 bps was OVIDelated, and a dispopotonate amount was epeced o ocur n H2. Theeore, the company epeced Qs OVID MR mpact o be moe han 00 bps and Qs OVID R mpact o be less han 00 bps.ostRetUtizatonCommtary: nt

51、hem hosted is Investor Day and pesented at an investor oneence in ealy ach. nthem indcated that enteing , it oecasted that Q1 would be well above baselne wih Januay beng he hihest in tems of uilzaton elatve to baselne, wih ebuary mpoving elatve to Janua, and ach impoving elatve to ebuay but stil abo

52、ve baselne). The ompany ndiated that Jauay paed out as epeced. In ebua, the utlzaton declne om Januay was steeper han antcpated theeoe ebuay esuls wee positve to epecatons. The ompany noed hat weather events ould have plaed a ole in ebuary peomance, howeve, all of NTMs eoaphies saw a delne in utlzat

53、on but he decine was eater n aeas mpaced by weathe. The delne coninued in to Mach as ndiated by peauthoiatons. NTM indcated that whie t stll epected Q1 to be above baselne, the quater as of ealy arch) was paing out o be beter than antcpated when he ompany ssued ts 1 oulook n Janua.ecal, OVID osts in

54、 Q0 wee above NTMs epecatons, and nonOVID uiiaton was below antcpated levels. lin, otal utlzaton was above baselne and R n Q0 was descibed as hher on a nomalzed basis, ust lower han NTMs pevious epecaton.In Q, NTM epecs otal cost tend o be vey lose to baseline with a dop n OVID laims as he vacine ol

55、out poceeds. In Q, NTM epecs total cost o be above baselne as pen-up demand etuns and hee s a houht that the acuty of ndividuals eenteing the healh ae sstem coud be worse due to a deay n eceving are. The ompany beieves ER utlzaton doesnt et back o hstoial levels. In Q, NTM epecs o be above baselne b

56、y an even eater amount than Q3 as vaiants om oher ounties potenialy ener the U. and the vacines miht not be as efecive on he vaiants. llin, NTM epecs he ullear o be above baselne.Currt1Outook: NTM epecs adusted EPS n 21 o be eater than .50 per shae up % /Y ompaed o its commentay of gowth towads he o

57、w end of ts 2% T owth aret and vs cons of .7 at the tme of poviding ts 1 oulook, diven by he passae of he onsoldated ppopiatons ct whih ncudes a oneear ncease n Medcae phsiian ates, and oher OVID9 elated impacs on NTMs ediae business. NTM indcated these iems esuled n a net neatve headwind of .0. Two

58、thds ofths mpact elates to the Medcare ee chedue inease, the 20% bump in inpatent DG etended or he ullear as pat of he pubic healh emeenc), pataly ofset by the 3 months of sequestaton. The emainng /3 elates to lower ediae isk adjustment evenue diven by ower nonOVID uiizaton n Q.lin, NTM is estmatng

59、a 00 mln OVID headwind in is 01 uidance. The $0 mln inludes thns such as OVID estn, teatment, vacine administaton as well as he Medcae ee Schedue, the sequestaton, et. whih NTM indcates is woth seveal bilons of dolas, ofset by nonOVID uiiaton beng ess han a nomal ea, piing acions and eulatory eimbus

60、ements. The 0 mln headwind is weihted a bt moe o ediae iven the populaton demoaphis most suscepibe of he popuatons), and t is skewed o H2.Opeatng evenue is epeced o be appoimatey 1.1 bln up .% /, inludng pemium evenue of 4.15.5 bn up 01.%, and LR is seen at .5.% up 90 bps. ooking o 21, NTM advised t