Good morning, everybody, and welcome to the Deutsche Bank Healthcare Summit. I'm George Hill. I'm the Healthcare Technology and Services Analyst at Deutsche Bank. I cover the MCOs and a bunch of the healthcare technology stuff. I call it the stuff. Very happy to have with us this morning, Centene CEO, Sarah London, and CFO, Drew Asher. Good morning, guys. Hey. Thanks for coming back. Sarah, you guys reiterated your 2026 guidance this morning of at least $4.80. I thought I would kick it to you to start. I guess just talk to us about the reiterated guidance, any other introductory comments that you want to make, and then for Sarah and Drew, if there's anything that you want to say as it relates to utilization or the moving pieces, or if there's anything different, would love to hear what you guys have to say to kick it off. Happy to provide a couple updates on the quarter and then go deeper into any of it. Obviously reiterated our full-year adjusted dilutive EPS guidance of greater than $4.80 this morning. Pleased with the trajectory of the business through two months of the quarter. We are in line with expectations. Trends that we're seeing in Q3 broadly across lines of business consistent with trends that we saw in Q2. Some of the highlights for business lines. Medicaid rates are coming in in line with expectations, and consistent with that 5% composite full-year outlook for rates overall. In addition to just continued focus on quality and affordability initiatives, our major focus is obviously working with our state partners as they are gearing up and, in some cases, starting to implement work requirements. That's taking more and more of the focus on the local level. From a marketplace standpoint, we are through the pricing cycle, continue to be focused in that business on sustainable margin versus membership. We've also continued to engage with CMS on program integrity efforts across the ACA, and believe that we've fully accounted for the potential impacts of that work in our full-year guidance. Obviously, thinking about where we were with that business at this time, sitting here at this conference last year, very pleased with the recovery, and still on track for that 4.5%-5% margin for 2026. Medicare also gearing up for major selling season. We talked a little bit about this on the Q2 call, but our focus in Medicare going into 2027 was really portfolio simplification and continuing to focus that portfolio and design explicitly around duals and complex populations and markets where we feel like we can be competitive, both because of our overlap with our Medicaid footprint, and the ability to leverage those local resources to deliver a differentiated service model. I think that's what you'll see. Obviously, we'll have a more fulsome view of the competitive landscape in Medicare over the next month or so as we get the landscape files. But really focused on building a platform there that will set us up for breakeven or better in 2027 and continued margin progression thereafter, and continue to feel good about how that business is performing in 2026. Last but not least, PDP. We're pleased to be below benchmark in all 34 of our regions going into 2027. I think this news sort of came out after the Q2 call, but the discontinuation of the premium subsidies in the demo, we tend to take a conservative approach in terms of relying on the continuation of the demo. Not concerned about the impact of that in 2027, and continue to be on track for 3%+ margins in PDP. All in all, feel good about where we are in the quarter. Feel very good about where the business is year to date. Okay. Sounds fantastic. Drew, anything to add? That was a great summary. Sarah, great summary. All right. With that, I think we'll dive into some of the specifics. Given that it's one of your larger lines of business, I'll start with Medicaid. Maybe I'll just ask you to get a little bit more granular. Maybe update us on the outlook for segment profitability in 2026. Maybe talk about cadence a little bit and any parts of the business you'd call out as it relates to strength or weakness, either from a rate perspective or utilization perspective. Yeah, not much has changed since our view on the Q2 call. So obviously came into the year aiming for the flat HBR 93.7 and then saw strength in Q1, so still on track for that 93.5. So still showing margin improvement in year. We did talk about the fact that because some of our states are sort of tightening their processes around eligibility in preparation for work requirements, and then some states are actually pulling forward components of the H.R. 1 implementation that we were expecting an increase in membership decline, so that's the target, originally 6%-8% to 9% of the end of the year. So still on track for that. Trends that we're seeing in the quarter, very consistent with the trends that we've been tracking broadly. So behavioral health, home health, high-cost drugs, those are the areas that we have really focused a number of our initiatives. Again, not a lot different. We are learning more about how states are approaching and planning to approach work requirements. Most states are leaning toward a monthly eligibility check, which will create a more gradual impact around the membership declines over 2027 and 2028. I think that will be very helpful both in terms of ensuring that members have the right support, we have the ability to deliver documentation, get them engaged in work opportunities, and community engagement opportunities, and that rates have a chance to keep pace with the membership and acuity shifts. Then we have a couple of states that have already started implementation of work requirements, and so far things are playing out in line with expectation, but very early, smaller states, so not sort of a full extrapolation. A lot of good data coming out of the back half of this year that I think will help us inform our view of how this is going to play out in 2027 and 2028. Yeah. Maybe I'll double-click on one of those points for a second. As it relates to your guys working with the states around work requirements and community engagement requirements. Can you spend a second talking about what is Centene's role there and what role do you play versus, where do you guys play a role in the process versus at what point does the, I'll call it either the state administrator or the state organization, play the role in determining eligibility? Yeah. Well, eligibility is determined by the state in all cases. But we have an important role to play in terms of being able to provide data that we have. If you think about what just recently came out from CMS in terms of the definition of medical frailty, which broadly define categories for states, which provides a little bit more flexibility, but I think was actually helpful in terms of guiding states to leverage objective data that exists in systems, and some of that is data that we have. So one of our major areas of focus over the last couple of months has been building the data interfaces with states. As they think about that automatic or ex parte determination of eligibility, we can help them be fully informed on that initial decision. The other big piece is really helping to make sure that members are educated about what information they need to provide, what process they need to go through in order to document the places that they're already engaged, and therefore eligible. We have a number of resources. We have work programs in 17 states that we can leverage. We have great partnerships with nonprofits. We know a lot about how to get people engaged in work and in the community. Every state's a little bit different in terms of where they snap the line on that engagement. But broadly, they are looking for us and for the other community partners to create opportunities for members to be engaged, and ultimately to be eligible. I've said this before, but the goal of work requirements from a CBO standpoint was to create budget savings. But when you get down to the level of the Medicaid directors, really the goal, and even from CMS has this perspective, the goal is to get folks engaged and working and engaged in the community because we know that that actually drives better health outcomes. Yeah. There's really good alignment on the ground around that. That's fantastic. That's great color. You talked about the rates trending towards the 5% composite that you guys were targeting. Given that we're now two weeks into September, Drew Asher, maybe I would kick it to you and ask, how did 9/1 rates develop, and did they develop in line with expectations? Is there anything that you'd call out, either from a state perspective or maybe from a retro perspective, as to how rates are developing as we think about the cadence in the year? We've got visibility into both 9/1 rates and 10/1 rates. Some of them aren't final final, but I think we're in the second round of one of our large states. Really consistent, as Sarah London said, with that composite for the full year of 5%. Still not adequate to sort of recover and get to a margin that we want to be at in the long run. You asked about margin before in Medicaid. We're actually sitting here with a positive margin. Now, it's inadequate and it's not satisfying, and we've got work to do to match rates and acuity. But relative to a couple of our other peers, one of them says -1.1%, one of them says -1.75%. We're at a different starting point because we're positive in margin, pre-tax margin, all in for Medicaid. We need to get that back to that long-term goal. That's what we're going to be working on over the next couple of years. Yeah. I'll double-click on that for a second, too. As you look at the evolving political environment and the political climate, I'd even say the economic environment, do you think about the long-term margin environment for Medicaid as stable and in line with historical expectations, or do you feel like that needs an adjustment at all? I think we need to work through, obviously, near-term impacts of policy changes. But there's nothing that we've seen that suggests structurally, long-term margins wouldn't get back to where they've been historically. I think, again, if you think about the policy changes even that we went through and are now in the process of implementing, there was, I think, really good indication of the fact that there is bipartisan support for these programs, and it is important to make sure that they are appropriately funded. I would also say what's interesting is, as states are facing budget pressure historically, and I would say we're seeing a little bit of this now, is it opens up a different conversation about moving the 40% of dollars that are still in fee-for-service Medicaid into managed care, because that budget certainty is a really important value proposition for the states. Now, it needs to come with quality outcomes, and so as we think about industry-leading cost structure, industry-leading health outcomes, that is an important value proposition and story to tell. But I think there's actually an opportunity for potentially more growth in managed care because of the value we bring in a budget-compressed environment. Yeah. Whenever we do our channel checks talking with state administrators, it always tends to be the budget challenges that force people to increasingly consider managed care. Let me reinforce something that I think this gang already knows, but the community rating aspect in Medicaid is such that the pool of data is aggregated each state from all the payers, so there's a relativity. The program as a whole needs to have some margin, and if you can outperform the average of that pool like we have historically, and we expect to prospectively, then that creates a nice opportunity to get back to margins, like Sarah said, towards our long-term goals. It does matter how other people are performing relative to our performance, given that community rating aspect. Yeah. Well, one thing I'll say, a thesis that I work on that I'd like to just kind of bounce off you guys and maybe verify, is that when we talk to state administrators or state representatives, they tend to be solving for a budget number as opposed to a PMPM number or an expense number. OB3 is going to change the math of their budget number, probably by reducing enrollment significantly, which could create an opportunity for rate. If membership is coming down, you're trying to solve for a number, rate comes up. Is that a thesis that makes any sense? I'd say, am I just crazy? Or I'd be interested in, as you have conversations with state partners, how the enrollment versus rate discussion progresses, especially as you guys think about what is sustainable and rate not keeping up with trend the last several years. Yeah, to me, it's a direct derivative of the broader thesis that came through in redeterminations. We did see that, right? We obviously had a disconnect between rate and acuity in the short term, but as we've seen strength in rates catch up, part of that has been the fact that the total budget reduced because membership reduced. States are dealing with other budget pressures because of state-directed payment reductions and things like that, so I don't know that that's a one-to-one, but I do think the idea that the rates need to be actuarially sound and that states want to make sure that benefits are appropriately funded, and there are dollars there from membership declines. Again, we continue to see constructive conversations with our counterpart state actuaries, and I think this process, we pointed to it before, but now as it's playing out, the discrete nature of the population and subpopulations where you can get to a very specific rate cell around this population, this subpopulation, and do the math with more precision, I think is helping in the rate conversation. That's helpful. As enrollment has shifted as the year has gone on, can you talk about Oh, looks like I've gotten a question too far. I wanted to ask about how trend is developing year to date, just in the Medicaid population. You already highlighted drugs and other cost categories. I'd just ask you to revisit again, anything running hotter or colder than expectations. I work with Tito on our team, who covers the hospital space where the hospitals have seen challenges. It'd just be interesting if you wanted to go either by state or by disease category, if there's anything hotter or colder as it relates to trend. I think trends have been broadly developing in line with expectation. We've obviously deployed a myriad initiatives around quality and affordability. Those areas that we've been watching and have been driving outsized trends, which are behavioral health, home and community-based services, and high-cost drugs, continue to be sort of the repeat offenders. We did, and we talked about this a little bit on Q1 and Q2 call, is sort of some year-over-year abatement relative to behavioral health, largely in the ABA space because people have really started to focus on both the getting members to higher quality providers and just a wide array of fraud, waste, and abuse that we've cracked down on in that space. So I think we are seeing the fruits of our labor come through over the last 18 months. But nothing that's really become a new outlier or hotspot. Q3, again, very much in line with what we saw in Q2. Is there a way to quantify in any way the impact of your efforts or how you quantify the impact of fraud, waste, and abuse reduction? I think about this like the corollary on the commercial side would be companies have called out the IDR impact in commercial. Is there a way to, just because we've seen so many headlines about fraud, waste, and abuse in the Medicaid space, is there a way to kind of quantify what we've seen there? Yeah, we can quantify specific situations. I think we called out a provider in N.Y. that we finally got shut down through the court system late last year. Absolutely, we can quantify that impact on our N.Y. health plan as we tote up sort of our goals and initiatives internally. It goes into sort of the trend management overall, and every year we've got to bend trend on behalf of our customers, why we're hired, and implement quality and affordability initiatives. In the last year and a half, there's just been more incident of fraud, waste, and abuse. As you heard Sarah say on that Q1 and Q2 call, the tools that we've developed, including using AI to very promptly identify, we create a trust factor with, I think, 70 data points. We're able to sort of shut down and pend claims while we do research a lot faster than 1.5 years ago. We're responding to what we see in the market. That all goes into the management of net trend. Okay. For Medicaid, I want to ask you to provide 2027 guidance, and you talked a little bit about the community engagement and no work requirements. I guess at this distance, is there a way to paint in broad strokes how you see the impact of OB3 on the business in 2027? You kind of talked about the cadence of 2027 to 2028 and monthly reverifications. Just kind of, again, to whichever way you would like to characterize, however you're thinking about the impact on Medicaid in 2027 and 2028. Yeah, I think our goal continues to be to deliver margin progression in 2027, despite what we know are going to be some degree of headwind from the acuity shift and not having total visibility yet to whether rates will perfectly on time match to when those acuity impacts start to come through the business. Broadly speaking, again, if you think about the fact that our expansion business is, call it 18% of our overall Medicaid book anywhere in the range of the estimates out there of 25%-40% of members that will become ineligible, that takes you down to a mid-single-digit percentage, and then you roll that out over two years. Then you think about the fact that we're dropping 8%-9% in 2026, and we're able to absorb the impact of that acuity shift with both rate and our own trend initiatives. That's what makes us feel like we can manage through this. But it is going to take blocking and tackling. It is going to take good data-driven rate advocacy. It is going to take community engagement. That's all of the infrastructure that we're gearing up and prepared to do with the goal of continuing to deliver margin progression in 2027 and 2028. Okay. I'll quip, Drew, you won't have to answer this question for me next year, but is there a way to characterize how we should think about the magnitude of margin progression, maybe looking out over a multi-year basis? I think we need some more data to see that. Obviously, that'll be incorporated in guidance for 2027 and when we give guidance for 2027. But I think you're right. The goal is net progress on the positive weight on the scale. The muscles that were built between payer and customer through the redetermination era have resulted in us getting a couple of states for 7/1 to pay us in the July 1st, 2026 rate what the estimate is of the impact of OB3, and the rest of them for that 7/1 cohort agreeing to revisit 1/1 once they decide how they're actually going to implement and execute. That's a lot different than coming into, and then ultimately out of the redetermination era. So I think that will help us achieve that sort of net progression. We just don't have the specific magnitude at this point. I have not heard Centene talk about this topic yet, but one of your peers has talked about and has started to execute upon market exits. Is that something that Centene would think about? How do you think about the framework for how you evaluate whether or not you continue to stay in or exit markets? Yeah, our first priority is always to try to work with our state partners to navigate program reform and get to a place where we can deliver the level of service that we want at a sustainable margin. We are running a business, and if we feel like long-term, structurally, we aren't going to be able to get there, then we have evaluated markets. If you think about the decision we made on the Florida SMI program, that's an example of that. We made a similar decision relative to programs in Hawaii. But we also balanced that with a really thoughtful look at, one, making sure the state program is strong enough, and we have a very measured approach to moving members and not overly impacting our members as we do that. That's not a knee-jerk thing. It's a decision that is always made very carefully, and it's very much been the exception versus the rule, but we're always looking across all lines of business. We are looking at our portfolio to say where are the geographies where we can be successful long term, and where are the geographies where maybe we can't. Is the Florida behavioral an example of that? Was that a piece of business where you guys chose to make an exit where it just didn't seem like it could be profitable? And maybe, Drew, if you could kind of remind us of the financial impact of the Florida ADA exit. Yeah. So, it was really all about the new contract and what we would have had to agree to 10/1/2026 and beyond. And there was a lot of pressure in 2025. Some of that is being corrected for 2026, but then there are new changes go into place, like a drop in margin and the addition of a withhold, supplemental benefits that were required, and just a multi-year guarantee by the payer of affordability initiatives and sort of bending trend that we looked at as a pack, as you said. Now we're out. So that was more of the decision making around that piece of business. But for us, it's about $1.5 billion of revenue per quarter. So that'll be a pickup as we head into 2027. I have to keep an eye on the clock because I think I've spent a ton of time on Medicaid, and there's actually other topics I wanted to pick. You'll forgive my pop culture reference. I'm going to move on to Medicare Advantage, and the first rule of Stars Club seems to be you don't talk about Stars Club. Plan Preview 2 has hit, and there's been a lot of chatter online about the cut points. I would ask at a high level, as you guys got your Plan Preview 2 and you're on your path to margin recovery in MA, anything that is alarming or anything that is comforting in what you guys saw? If you tell me that George Hill, first rule of Stars Club is I'm not going to talk about Stars Club. I will abide by Stars Club rules until I answer at a high level and say everything we've seen in line with our expectations. If you go back to what we talked about on the Q2 call, we are still delivering raw improvement in quality measures. We have done a lot of work over the last couple of years to strengthen that program. We also, starting two years ago, I think, saw the writing on the wall in terms of the degree of program reform that was likely coming, as well as continued acceleration in the cut points. The fact that our focus on duals is at some level dissonant with the fact that the program does not case mix adjust sufficiently. Right. Again, we've talked repeatedly about a lot of work to create a buffer around that. We came into this year, again, expecting to drive improvement, expecting to see some pressure in our results because of the cut points and because of the program changes from last year, but having built the appropriate buffer for that. So our view is still very confident in break even or better in 2027, and then setting the book up for continued margin progression. We continue to advocate with CMS for Stars reform relative to focusing on those complex dual members and taking into account what is realistic expectation, how do we actually measure quality for that membership? We're running that play in parallel. Okay. You mentioned duals and special needs populations. I'll ask this question because it's kind of a hot button topic, which is one of your smaller peers called out that they were seeing called a hotspot as it related to SNFs and institutional and some inpatient. I know I've asked this question several times. I'll ask it again. This is kind of specific to MA, but kind of any hotspots that you're seeing as it relates to MA, and do any of those things jump out to you guys as places that you're seeing? No, I mean, the trends in MA have been very consistent this year. The places that are sort of, again, slight outside trend drivers, some of that outpatient, a little bit of high-cost drugs, very consistent. Same thing so far in Q3. I continue to feel good about how that business is performing. Okay. Yeah, pretty pleased with the execution in Medicare Advantage this year, and to Sarah London's earlier point, that sort of being a linchpin in being able to manage this business with a duals focus, even without really good Stars scores. But real good stability and execution and feel good about that progression. Am I remembering right, your duals penetration's in the low 50% range? Does that sound right? 40%. Okay. 40% range. For D-SNP. For D-SNP. Maybe just stepping back for a second, could you remind us again about how you guys thought about your MA bid framework for 2027? Sounds like you guys are focused on that core D-SNP market, and I would say a focus on margin enhancement versus growth. Maybe, I do not know if you could even spend a minute on talking about how that factors into, I will not call it sub-components, but like benefit side. What are the wrinkles that you guys can do with benefit design to drive margin enhancement in MA and in the duals market? Yeah. Again, the focus is simplifying the portfolio, really focusing on markets and products where we feel like, again, align with sort of dual complex member focus, footprint overlap with Medicaid markets where we feel like we have been and can be competitive, places where we have strong network. In addition to just pure benefits, some of those other factors, and then making sure that where we are making investments, we are leaning towards those benefits that we know really drive impact and outcome for those complex members. All of those levers went into the process, thinking about 2027 bids. Then to your point, we have been laser-focused on getting to profitability in MA, less so on membership. I think you will see that in the way that plays out- Okay in 2027. Are you able to talk about any of the assumptions that kind of underpaid the bid process for 2027, and probably most importantly, there would be trends? How are you guys thinking about how trend persists in 2027 versus 2026? Yeah. We have a view of trend over the last couple of years, and sort of similar to coming into 2026, where while we're managing trend, and it's consistent with our expectation, it's still high on a historical absolute basis, and we carried forward that perspective into 2027. Okay. A question that I've been getting frequently from investors as it relates to margin expansion in MA is, 2026 appears to be a solid MA margin expansion year for most companies in the space, given the backdrop of a very strong rate. The rate for 2027 will not be as robust, but to your point, trend is expected to continue to still be high. What is the right way to think about year-over-year margin and I'll ask this both for Centene and Drew, be interested in how you think about the space. What is the right way to think about year-over-year margin expansion opportunities in MA, given the trend is likely to be durable, rate will be much less robust, but a lot of people are going to cut benefits where they can. Would just appreciate your thoughts there. Yeah. If you start macro and think about the attractiveness of Medicare Advantage, despite you hear about a few years of benefit cuts, but benefits were loaded up earlier this decade. The relativity is still 11%, 12%, 13% better than fee-for-service if you add in all the benefits, including the MAPD, the Part D benefit embedded within MA. I think it's still an attractive market. It's really the degree of growth would be the debate, given continued probable, certainly for us, focused benefit decisions. Yeah, I still think it's going to be an attractive market for a senior making a decision, looking independently or maybe on an absolute basis relative to fee-for-service. Our margin progression is going to be getting to profitable. Right. Right. Or even or better in 2027. Right. I would ask you kind of brought up Stars, and I will ask a question about Stars Reform, where we will expect to see these technical notes will come around October 1st. Stars Reform seems to be a popular topic with most MA plans. A plan made the comment to me yesterday that we cannot go in this litigation cycle forever as it relates to Stars Reform. I guess, could you talk for a second about what you would expect to see in Stars Reform, and I guess, it would seem like you guys are preparing for that now or thinking about that now. Be interested in how you are thinking about Stars Reform at a high level and kind of where you think it could and should go. Yeah. Part of our effort over the last couple of years was to, again, sort of de-risk the impact of Stars because Stars Reform is a big, complicated thing, right? That is like- I agree that running a prospective quality program through the courts is probably not a sustainable way to do that. To be fair to the team at CMS, that is a big, complicated undertaking to figure out what does reform look like. Do you do a little bit? Do you do a lot? What should success look like? I do think, interestingly, it is in line with broader discussions that are happening, not just in D.C., but across the country, around how do you actually get to a more refined view of how to measure health outcomes and real quality impact of managed care in a way that is sustainable and where you can demonstrate progress and is aligned with long-term value for society, frankly. Even in Medicaid, there are something like 170 measures if you take the super set of measures that we are responsible for across 30 states, and the idea that you're going to be able to invest U.S. dollars for bang for the buck outcomes across that many measurement details, all of which are different, just doesn't make sense. I think there's a great opportunity to say, what are the core set of clinical measures that really demonstrate health impact for the senior population? How do we think about what are reasonable targets given the complexity of members across the continuum? Let's focus on everybody putting dollars towards that, and then increasingly focus on a way of measuring that through data that is empirical as opposed to subjective, and where there's no concern about people are gaming the system, just run the data digitally. If you get your gap closed, you get your gap closed. If you get your clinical measure at the right spot, great. That feels to me directionally like it would be good progress, but it's not a thing to take on lightly. Right. When I think about timing of this, given where we are on the calendar, it seems unlikely that you guys could see the financial impact of Stars Reform before 2030, 2031, given that we'll be into 2027 soon. There's no proposed rule, there's been no comment periods. Would that jive with your expectations? From a process standpoint, I think, again, the idea that people are making decisions today about investments against a measurement framework, and the idea that you would change that mid-cycle, I think is really complicated. I agree that I think it probably has an out year look to it, but we've seen a lot of program changes in a short period of time. I think we're always sort of braced for some of that uncertainty. Again, it goes back to why we pulled all of these other levers around value-based contracting, SG&A, being really thoughtful about bids in order to maintain the profitable recovery trajectory of the business, somewhat agnostic of what the Stars Reform looks like, obviously wanting to continue to drive good quality outcomes regardless. Okay. Let's pivot to the other side of the Medicare Part D business for a second and talk about Part D. Can you, still trending towards margins of greater than 3% for 2026? Absolutely. As somebody in the audience asked earlier, what are you doing there? Talk to us about what's driving the strength. Talk to us a little bit about sustainability, and expectations for the balance of the year and how we think about 2027. Yeah. A big piece of it is cost structure, and I've said this a number of times, but I think us not owning a PBM actually benefits us. There's not an internal struggle of where to park margin. We can go out and procure the best cost structure available with the mechanisms that we have embedded in our contract, and then have our members avail themselves of that cost structure for the product, and then into a reasonable margin on that product as well. That's a piece of it. I think, the fact that we've built up knowhow since 2006, some of you guys were around for DMA in 2006. That helps in all the data that we have. And we have a really good partner in CMS in terms of the program structure. Then just I think the thoughtfulness of the bid team and the assumptions around, we're not betting on demos continuing. So the sunsetting of some of those demos really, we're okay with, in terms of our 2027 bids. So it's a good business now. It's a $25 billion, $26 billion business, and with the direct subsidy going up 27% next year, which was consistent, in the zone of what we were forecasting, that should be some nice revenue growth there as well. You're correct. The margin, you have to think about a reset every year with the bid and where are you going to reset that to, and we're going to work on refining that at the point in time when we give guidance for next year. The body language you should read on us is that we are pretty pleased with our positioning for 2027, and probably tilt a little bit towards being in a better position than the rest of the industry. Maybe some growth, but we really need to see the landscape files to declare anything. To declare victory. You brought up your PBM partner, and we were talking before we took the stage. You guys have had a lot of success working with your PBM partner, and I will ask the question open-ended, how much opportunity is left for Centene financially as it relates to its relationship with its PBM partner, and how much more work is there to do there to squeeze costs out? There is always work to do, and this partner is new to us as of January 1st, 2024, so there are other levers to be pulled. While we have a really good relationship, and there has been some strong execution in areas by our partner, there are other areas, and there are some operational things that can improve. We are looking at our specialty drug cost structure with them and what can we do to sort of bend that curve. So there is definitely still opportunity for, once again, for us doing our jobs, to enable our members to avail themselves of the best cost structure out there and available. We have got the contractual mechanisms, because we have been through a number of rodeos, where we can achieve that on behalf of our members. Yeah. I have this on my question list, which you guys saw in advance. It is just the 340B question. I am not going to ask how exposed are you guys to 340B, but the way I will ask it is getting more 340B pricing in your book a cost opportunity given what your patient population looks like? Right? Almost 50% of people are D-SNPs, high Medicaid population. I would think most of your beneficiaries should be getting the best possible price on drugs. Is that kind of an avenue to-- You guys should not be filling a lot of claims that look like commercial claims. You should not be filling a lot of claims that look like 340B claims. Is that the right way to think about some of the opportunities there, or is that the right way to think about 340B in Centene? Yeah. I think on behalf of our members and our customers, we want 340B to work the way it was originally intended, to support FQHCs and rural hospitals. And obviously, there is some gaming out there. We are sort of the second derivative of that. But we do see some impact, for instance, in rebate collection rates, that we work with our PBM on to make sure we can get precise on that, and that we are doing the best we can to make sure that we are not getting gamed by some of that duplicative arm wrestling out there with other parts of the healthcare ecosystem. But largely, we are a downstream impact from that. But we watch that relative to our rebate yields. Okay. I do not want to turn this into a PBM conversation. I want to keep this a Part D conversation. I know you just said that you are going to talk about this as you guys go to give guidance for 2027. But is the right way to think about the margin framework in standalone D is that you guys will probably bid for a margin profile that looks like a 2026 target, and then the business performs as the business performs in 2027? I know a lot of investors are focused on what is the step down as it relates to the margin profile in Part D in 2027. Well, we are 3%+ now, and we came out of the chute at 2%. In the prior year, we came out of the chute, meaning original guidance at 1%, but that was artificially low because of the volatility caused by the Inflation Reduction Act, the IRA. So I think as we get every year removed from that and get visibility into the non-low-income specialty trend and other drivers of costs, we can get more and more comfortable in that 3% zone in the long run, like average a bunch of future years. We still need to see landscape files and look at blocks of business and membership distribution to be able to actually set precision around where we guide to coming out of the chute in 2027. But I think that would be the right long-term way to think about this. Okay. That is helpful. I got to keep my eye on the clock here, as we are now sub four minutes. I am going to pivot to ACA. And you just updated us on the margin expectations for the product in 2026. It seems like pricing for 2027 is expected to be strong. You guys are going to run this business for margin versus growth. Program integrity came up a lot on the last call, and I think it was shortly after you guys reported there was the talk of a bunch of beneficiaries in ACA without their security numbers, and you continue to see the fraud waste abuse crackdown in that space. Would love to kind of hear how you guys saw and heard that, and how it is impacting how you guys approach the business in the second half of the year. Yeah. It has been a very collaborative process with CMS because there is data on both sides that needs to be contemplated. Frankly, this is the case with all program integrity initiatives over many years with CMS. They have some data, we have some data. We try to reconcile that to have a really good understanding of what to do next. We had good visibility to the quantum around those initiatives as we thought about, certainly as we gave guidance in the Q2 call, and obviously reaffirming today. We feel like we believe we fully accounted for the 2026 impacts of that, but also had enough visibility to think about what that might do to the market overall in terms of 2027. What degree of contraction that we might have expected in 2027 is, of course, somewhat getting pulled into 2026. How all of that then plays into risk adjustment assumptions. When we say believe we fully accounted for, it is kind of the full view of not just membership and revenue in 2026, but then what does that do to the relativity of the risk pool? Yeah. You bring up the other side of that. You guys feel comfortable with what you forecast as it relates to enrollment. Do you feel the same level of comfort as it relates to acuity and what you are seeing in the acuity change? A wrinkle that I am going to tack onto that is that as we come into the end of the year, I will ask it as an effectuation question. Do you worry about members dropping at the end of the year? I use the example of you will have a member who uses that November premium payment to pay for their Thanksgiving travel expenses, and then they use the December payment to buy Christmas gifts, because sometimes that is what that market looks like. How do you feel about the people? Are you worried about how comfortable that you forecast the deterioration in the back half of the year correctly? Is there anything that you see that we should? We've been watching that very closely because I think there was a question coming into this year of how affordability pressures would impact behavior, and if it would be any different, particularly given the size of membership shift because of the expiration of the eAPTCs. Everything we've seen month to month, including some of those periods that we tend historically, seasonally to see more pressure, have largely developed in line with expectation. We did, and we talked about this, we have forecasted membership attrition from peak through the end of the year. That included our view of the membership that might come out of the market because of the program integrity initiative. All of that is really in that view that we will see lower membership toward the end of the year, and nothing underlying is any different than I think we were expecting. Yeah. Still feel really good about the 4.5%-5% pre-tax margin that we guided to, inclusive of not just the clawback, as Sarah London referenced, with the sort of the members that are deemed unauthorized enrollment, but also what we believe is a prudent forecast of the risk adjustment impact of that. Okay. Only a few seconds left. I'll ask one. It's a corporate question. First, Drew Asher, we're sorry to see you go. I think I speak for everybody who covers managed care that strong, long-tenured CFOs in this space that are good are few and far between. So a personal well wishes, but sorry to see you go. But in the last year, you're not the only person who's announced a departure. The company's done a couple of rounds of restructuring. Would love to just hear your comments on morale. It's a cost structure question. It's a capabilities question. Do you have the right people to continue to execute the business going forward? Do you have enough of those people? Would just love how you're thinking about corporate cost structure. We, as an industry and as a business, have gone through a lot of change in the last couple of years. I think, interestingly, I think, and we have undertaken sort of the opportunity to redesign and transform the company in that moment, right? Rather than just sort of hunkering down. I think it's really about, to your question, what are the capabilities that we need and what talent do we need, and how do we think about delivering industry-leading health outcomes with an industry-leading cost structure? I think the organization has really rallied around that. I think there's an excitement about where we're going and what we can do. That doesn't mean change isn't hard. It's hard to say goodbye to colleagues. We've tried to be very transparent about that, consistent with our culture. But I think people are really geared up about what this next phase could look like for the organization, the impact that we can have on members. And I think sort of the mantra internally is the thing that isn't changing is our mission. And that to me, is very real and very tangible every day. So, I'm also very sad to see Drew go, but he's not allowed to go anywhere Right till the end of 2027. And he's been an incredible thought partner and is helping to make sure we have the right people in the right seats, and they have the benefit of all of the knowledge of this organization as we go forward. Yeah, this was a planned long runway intentional, so that we have almost 1.5 years. And I've already worked really closely with Chris Neczypor. I think you guys are going to love him. He comes in for four months without having to be the CFO, but being able to dive in, and he's off to the races internally. And then flip the CFO keys to him as of 1/1. But as Sarah said, I'm going to have my paw prints working with our actuarial wizards on the 2028 bids, still helping to support the company throughout 2027. And that will get me to my 60th birthday in 2028 and the ability to actually go do some things that my wife and I have just never been able to do because these jobs are Because I'm always calling you Yeah very consuming. Thank you. Well, we're a little bit over. Guys, I greatly appreciate the time. Thank you very much. Thank you.