The program will begin in one minute. Please welcome the Head of Investor Relations of Cigna, Ralph Giacobbe.
Good morning, everyone. Thank you for joining us today for Cigna's 2022 Investor Day. I'm Ralph Giacobbe, Senior Vice President and Head of Investor Relations. It's really great to engage with everyone here live and in person, as well as welcoming those that are joining us on the webcast. On behalf of the Cigna leadership team, I just wanna express our appreciation for you all taking the time today to be with us to hear our story. It's been less than six months since I've sat in your seat, and I really couldn't be more excited to connect with you from this side of the table and help you understand what I've been able to observe over the first half of the year.
I have to emphasize, I'm really excited, you know, about being here and the opportunity I see ahead. Today you'll hear some key themes throughout the presentation showcasing our strong foundational assets, our accelerating businesses, and the opportunity for cross-enterprise leverage that positions us for attractive and healthy growth across our platforms, Evernorth and Cigna Healthcare. David Cordani, our Chairman and Chief Executive Officer, is gonna kick us off with a discussion about who we are, how we're differentiated, and how we're gonna grow. We'll then turn to Evernorth, our health services business. This team's gonna provide an overview of our industry-leading capabilities across pharmacy benefits and specialty, and highlight our rapidly evolving care businesses. We'll then take a quick break before moving to Cigna Healthcare, which as a reminder, houses our U.S. Commercial, U.S. Government, and International Health businesses.
The team will discuss our differentiated affordability, value proposition, and expansion efforts to fuel our future growth in that segment. Brian Evanko, our Chief Financial Officer, will provide a financial update, including our outlook for 2022 and the longer term. We'll then have a short break before the Q&A session with our senior leadership here today, and we'll conclude our formal program with some brief closing remarks by David. Now, just a couple of quick housekeeping items before we begin. Please note, we're gonna be making some forward-looking statements today regarding our 2022 outlook and future performance. When we make prospective comments regarding financial performance, including our full year 2022 outlook, we're gonna do so on a basis that includes the potential impact of future share repurchases and anticipated 2022 dividends.
Also, our full year 2022 outlook assumes that the pending divestiture of Cigna's international life, accident, and supplemental benefits businesses will close in the second quarter of 2022, but does not assume any impact from other business combinations or divestitures that may occur after today. 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 our most recent filings with the SEC. I also wanna remind you that Cigna uses certain non-GAAP financial measures when describing our financial results. Throughout today's presentations, when we refer to the term earnings per share or EPS, we mean adjusted income from operations in aggregate and on an adjusted per share basis. Likewise, when we refer to revenue, we mean adjusted revenue.
Definitions of these non-GAAP measures and reconciliations to the GAAP measures, as well as definitions of other key financial and business terms, are included in the Investor Day materials. Additionally, I would also note for everyone that today's presentation is being webcast live, and a full set of our slides will be available and posted to our investor relations website this afternoon. Now, before we get started with David, here's a quick video to kick us off to highlight Cigna and our healthy growth.
Making each day a chance to keep building. Gaining a deeper understanding of what people and businesses need. Being there from birth through the golden years, and guiding companies to the edge of good health frames. It's working toward a greater purpose, helping people reach their healthiest, raising their vitality so their lives are more rewarding. Fueling businesses with healthy workforces so that businesses can reach their full potential. Rewarding communities with opportunities they can build on. By closing gaps in care and opening the door to health equality. It's one day at a time, year after year, steady and growing stronger. What is it? Healthy growth. Please welcome the Chairman and Chief Executive Officer of Cigna, David Cordani.
Good morning, everyone. Let me add my welcome to Ralph's to everybody who's joining us here live in New York City. It's great to see a lot of familiar faces live after the long couple-year pause that we've been in terms of our live interactions, as well as to welcome our colleagues that are coming together through our Webex. Our team's quite excited today to talk to you about where Cigna stands today, but importantly, our growth strategy, the investments we've been making and our positioning that we have relative to sustained, attractive, healthy growth over the foreseeable future. Now, a lot's transpired since we've come together last about a year ago, and over the last year, we've continued to make progress as an organization.
We've made progress as an organization in terms of continuing to work to deliver on our mission, which is to improve the health, well-being and peace of mind of those we serve. We've made progress in terms of advancing our growth strategy. Our growth strategy not only delivers results today, but it's a sustained basis through our investments in innovation to position us for success and growth as we go forward in the future. As well, as a big part of that, is our sustained orientation relative to investing in our capabilities and broadening our reach. We'll provide examples of that throughout the course of the day, whether they're organic investments or partnership investments that we're making in terms of positioning our company.
Now, against this backdrop, we've talked now for several years around three forces that we believe as a corporation will have an indisputable, sustained impact on the broader health and well-being landscape across the globe. Those three forces, to remind you, are pharmacological innovation, where we believe, and we've seen now for several years, that the vast majority of innovation in health and well-being interventions will be pharmacological in nature, be it specialty pharmaceuticals, biosimilars, gene therapies, personalized medicines, new vaccines, and the like. Second is the acceptance of the inextricable link between mental health and physical health. I would note that the recent pandemic, the global pandemic we've all seen, have helped to reinforce this and reinforce the acceptance of this inextricable link around the world, that physical health and mental health are linked together.
Third, what we call alternative sites of care, the ability to harness technology, information, and new delivery capabilities to bring services in a more real-time, personalized, high quality, coordinated basis to individuals. Now, we not only identified these trends several years ago. We began to take decisive actions to position our company to not only respond to these trends, but thrive in a growth environment that continues to be influenced by these trends. You'll get a flavor of those throughout the course of today's conversation. To harness those trends and to serve those we have the privilege of serving, we've positioned our corporation with two growth platforms. First is Evernorth. Evernorth is our service platform. Evernorth brings together a series of services that we'll bring to life today to serve health plans, large, sophisticated commercial employers, governmental agencies, and healthcare delivery systems and medical professionals.
Our second platform is Cigna Healthcare. This houses our benefit solutions, where we bring coordinated benefits and integrated benefits together for employers, in some cases, governmental agencies, as well as individuals. We harness the power of both of these platforms to drive sustainable growth, which we'll bring to life today. Now, the fuel behind this is driven by our 70,000+ colleagues around the world, who at the end of the day, wake up every morning with the drive and the desire to make a positive difference in our customers' lives in some way, shape, or form. Also to have a positive impact in the communities as we discuss that we work, serve, and play in each and every day. That's the fundamental power and strength of our corporation.
As our colleagues around the world wake up every day to make that difference and drive that impact, it results in our ability to further deepen relationships, which is key to our growth strategy, but it's also important to ensure that we're best positioned to deliver differentiated, sustained value for our clients, our partners, and our customers. That fuel is harnessed in terms of our relentless innovation in small innovations and large innovations, in transformative innovations and otherwise, that our colleagues come together on both internally as well as in partnership. Then, as we seek to discuss all the time internally, driving differentiated results through the execution and delivery of our promise each and every day for the benefit of those we serve.
When we pull all that together, those forces enable us to deliver on a sustained basis at least 10%-13% compounded EPS over time. Now, with the tremendous free cash flow that our service-like proposition allows us to generate, an attractive dividend above and beyond that. That's the frame we stand in today. Now, as Ralph indicated, our conversation today will be guided by the three pathways to growth that we see as an organization, and we position our company to harness. Foundational growth, which I'll unpack in a moment, accelerated assets from a growth standpoint, and importantly, cross-enterprise leverage for value creation.
As we enter today's conversation, as it relates to foundational growth assets, here, think about scaled businesses that tend to be in mature markets that have predictable, sustainable growth, and importantly, very attractive cash flow generation. Additionally, these businesses, which include pharmacy benefit services, our U.S. Commercial proposition, and our International Health benefits proposition, typically create a foundational relationship that we have the ability to expand over time. Today, in 2022, this represents about 60% of the company's revenue or about $100 billion, fall in these foundational assets. We marry up against that our accelerated growth assets. Here you have higher growth businesses in very attractive markets and subsegments, typically aided by secular forces and evolving tailwinds that enable a higher growth activity. Here, specialty pharmaceuticals, our Evernorth Care business, and our U.S. Government business portfolio.
Today, in 2022, this already represents 40% of our company's revenue, or about $70 billion of revenue is in the accelerated businesses. Our third pathway to creating value is around cross-enterprise leverage, where we work in a very deliberate and disciplined fashion to create another step function of value. Now that transpires with deepening relationships. You'll think about that as cross-selling. We think about that as deepening relationships and bringing value-added services guided by information to help to increase the value for those we serve and benefit us in terms of growth. Second is our digital-first future that we see that is only enabled by harnessing the whole of the enterprise, that enables us to bring accelerated solutions to market, which we'll talk through.
Then third, as I made reference to, we've deliberately positioned the enterprise through a service-oriented capital light configuration to generate exceptional, sustainable, free cash flow. In today's discussion, we'll take some of our businesses and go deeper. In the interest of time, we're not gonna try to take every sub-business in our portfolio and touch upon them. We'll take five businesses to go deeper. Two foundational businesses, our pharmacy benefit services and our U.S. Commercial business. We'll spend time on three of our accelerate businesses, our specialty pharmacy capabilities, our Evernorth Care capabilities, and within our U.S. Government portfolio, specifically a bit more attention on our Medicare Advantage opportunity to allow us to go a little deeper into that. As our team engages in that conversation, you'll hear some common touch points that we'll go across.
We'll talk about the addressable market for those specific businesses. We'll talk about the secular trends that exist in those businesses. We'll talk about our specific growth formula in that specific business. We'll highlight points of differentiation. We'll provide some examples of strategic priorities, and then we'll string together some tangible examples as we go through those businesses, trying to bring those to life, both foundational businesses as well as accelerate businesses. Now, all of this will be guided by our view and our framework of healthy growth, because at the end of the day, growth is driven by providing differentiated value and services to those who have the privilege and opportunity to serve. Through an individual's eyes, this is guided by the notion that the individuals we have the ability to serve, in essence, wanna live healthier, more vibrant, higher vitality lives, right?
Our opportunity and responsibility is to meet those challenges and needs. For employers as well as partners, our opportunity is not to be a vendor, it's to be a partner to help their business thrive and help their business grow, and help their employee base be a differentiated asset for their organization. From a community standpoint, it means we need to step into, as we are, where there are social determinants of health issues, gaps in care issues, and community opportunities. Of course, healthy growth from a company standpoint means we need to have a resilient, durable strategy and plan and governance structure to give us the predictable, sustainable growth that you expect from us. Now, trying to achieve this means we need to step up to the challenge of the evolving healthcare environment, not the past healthcare environment. An environment that provides healthcare that's more personal.
An environment that provides healthcare that is more real-time when I need it, not when I need to queue up or when it's available, especially when you think about mental health or behavioral issues, right? At the moment in time that an individual needs it needs to be present and accessed and available. It can't be 13 days later when you could get an appointment. Healthcare that is more coordinated and steps into the inherent fragmentation that exists in the marketplace. Of course, it delivers the requisite level of high quality and healthcare that harnesses and delivers on an improved affordability promise. That's the opportunity and challenge that we step into for the benefit of those we serve. A big part of this is our orientation and our commitment to a digital-first orientation.
Now, this includes virtual care, but it's not limited to virtual care. It's not limited to urgent or episodic virtual care. There's longitudinal virtual care that is primary, behavioral, dermatological, and coordinated against that that orients around high quality providers, and that delivers both significant growth for us, but significant savings for individuals, and we'll provide examples of this. The digital-first approach also enables us on a targeted basis to have monitoring that enables us to better manage clinical outcomes for individuals dealing with chronic disease. But monitoring is only valuable if it generates an outcome, and that needs to be coordinated.
The digital-first orientation also allows us to get actionable real-time information, and I underscore actionable, to both support medical professionals and individuals to make better, more informed, more holistic decisions around treatment alternatives, as well as savings opportunities. We will bring this to life throughout the course of our conversation today. Now, as you listen to the dialogue, there are specifics to each business, but I wanna spend time on three areas that set us apart and transcend our corporation and our approach. The first is our orientation around consultative solutions. We are a solution provider. We do not deliver product to the market.
We deliver solutions that meet a buyer's needs, which starts with a deep commitment to understanding a buyer group's needs, and then drives that further by harnessing longitudinal information we have to better understand, with analytics and insights, specific needs around population health challenges, readiness to change, use of incentives, different geographic alternatives, et cetera. You marry that against a highly experienced and tenured team that faces off and serves our clients that today has on average 15 years of experience to face off, to be able to harness that information, and then pull from a wide array of solutions and capabilities to configure those suites. The consultative orientation is one. Second is our commitment and approach to partnering and innovating.
We drive innovation all day, every day on our own, and we'll continue to invest, but we also have a proven track record and deep commitment to partnering with others to accelerate innovations. Just two examples. First, our first of its kind patient assurance program that stepped into the void that exists in the United States relative to the cost of insulin. It was designed to cap an individual's out-of-pocket at $25 for a 30-day supply, period. Through partnering and working differently with pharmaceutical manufacturers, we were able to build that solution in under 100 days. Today, there are 10 million customers as part of that program. A second example in terms of partnering and innovating is challenging ourself around new pathways to care.
How could we challenge the convention around pathways to care as it relates to depression and anxiety, musculoskeletal, diabetes, certain subspecialties of oncology? We'll talk about some of that today as well. Third for us is environmental, social, and governance, or ESG as you know it. We've taken the important ESG framework and converted that to our own internal framework, which we talk about around healthy environment, where we see the inextricable link between one's environment and one's personal health. Healthy society, as I mentioned before, health disparities, gaps in care, and opportunities to drive a change from a health standpoint through society. Healthy workforce. This is where our diversity, equity, and inclusion programs, for example, are a part of as we drive within the organization. Then healthy company.
How we ensure that we have the right governance, practices, and disclosures to enable a healthy, thriving, sustainable company. By the way, as it relates to examples here, we're proud of a lot of our progress. We're never done in this area, but we're proud of a lot of our progress. For example, our public commitment to have 100% of our energy electricity consumption be from renewable electricity by 2030. Internally, we've established a DE&I council of which I chair and have co-chairs with three of my team members to spearhead and help to lead our five-year equity and inclusion program. As it relates to visibility, our diversity scorecard, where we publish externally our goals and our progress and hold ourselves accountable.
As it relates to an outside-in view, we're proud of the fact that for 5 years in a row, we've been a top 50 company in DiversityInc's rankings. From a governance standpoint, from a board configuration, 60% of our board has been refreshed over the last four years. Our current configuration against any S&P benchmark is quite positive in terms of age, tenure, gender, ethnicity, and of course, diversity of experience. We have a deep commitment to driving sustained results here. Now, as we drive the company forward, it's important to have focus. Throughout the course of today, you'll feel five growth priorities. First, we will continue to invest in our very attractive foundational assets that we will talk about today, specifically our commercial and pharmacy services business. We will invest in our foundational assets. We'll spend time on those, too.
We will drive further savings and harness further growth in our high-performing specialty assets, including the impact of biosimilars. We will build and further grow on an accelerated basis two attractive assets in our portfolio, both our Evernorth Care Services and our U.S. Government portfolio. We will continue to invest in and capitalize on our digital-first orientation for the benefit of those we serve. These investments take place, of course, through organic investments that we have a discipline and a sustained orientation around, but also through effective use of our Cigna Ventures capabilities, where we have a disciplined, focused approach to partnering with other, in often cases, earlier gestation companies, in many cases, point solutions to drive accelerated innovation and partnership together. Then, of course, target M&A where appropriate. Now, to summarize, how we will grow.
Within Evernorth, strong foundational growth driven by our pharmacy benefit services, which has been, is, and will continue to be a strong, predictable, important growth asset and foundational in terms of relationships that we are able to establish, as well as the reach from a clinical program. From an acceleration standpoint, harnessing the impact of both our specialty pharmacy capabilities through both Accredo and CuraScript, as well as our rapidly growing Evernorth Care business. From a cross-enterprise leverage standpoint, a deeper and broader relationship between Evernorth and Cigna Healthcare, which Eric will talk through at some level. How will we grow in our Cigna Healthcare platforms? At the foundational level, we will continue to invest in and drive strong, predictable growth off of our foundational asset in our U.S. Commercial that we'll talk about today, but also our International Health asset.
From an accelerated basis, we will drive accelerated growth. Specifically, what we'll talk about today is in the Medicare Advantage space as part of our government program. As it relates to cross-enterprise leverage, the healthcare portfolio will further leverage and harness innovation and new solutions that Evernorth is designing to deepen and broaden relationships with the clients we serve. When you take all that together, it gives us confidence that our sustained track record over the last decade plus of meeting or exceeding our compounded average EPS growth rate of 10%-13% will be achieved. Now, as I noted, with the cash generative nature of our businesses, an attractive dividend above and beyond that. Now as I wrap up, let me introduce you briefly to the subset of our leaders who are in the room today who will be talking to you.
I'll transition in a moment to Eric Palmer. Eric is the President and CEO of our Evernorth Health Services portfolio. Eric will partner up with two of his teammates, Amy Bricker. Amy's the President of Express Scripts Pharmacy Benefit Services business, and Matt Perlberg, who's the president of our Evernorth Pharmacy business. They will walk through the Evernorth portfolio from foundational as well as accelerated growth aspects. Noelle Eder will join. Noelle is our EVP and Chief Information Officer, and Noelle will take it down a click in the Evernorth Care section around our digital-first orientation, how we are approaching that space, and seek to bring it to life with some tangible examples, which I will assure you are exciting, both from an investor standpoint, but also from an individual standpoint of what you want for the services today for yourself and your loved ones.
as Ralph noted, after a short break, we'll come back and we'll shift to the Cigna Healthcare portion of the portfolio. Mike Triplett will lead off that, talking about our U.S. Commercial business as president of that business and our long track record of sustained delivery. Mike will transition to Chuck Berg. Chuck, who leads our Government business, will spend the vast majority of his time on the Medicare Advantage piece of the equation. Then we'll transition to Brian Evanko. Brian, as our CFO, will summarize briefly and then carry that forward in terms of our financial outlook and drill down some of the financials in terms of some of the subsegments of our businesses. As Ralph noted, we'll wrap up our formal section with a good long block of time of Q&A that the totality of this team will participate in.
Again, we're excited to be with you today, both physically here in New York City and virtually with everybody on the line. We're excited about our growth story for both the opportunity to continue to grow a great corporation, but that's fueled by our ability to deliver differentiated services for those we have the privilege to serve. With that, I'm gonna hand the program over to Eric. Thanks.
Well, thank you, David. I'm so excited to be here to share a little bit more about what we're doing with Evernorth and the future that we're creating within our health services portfolio. Today, as David said, I'm joined by Amy Bricker, who's the President of Express Scripts, Matt Perlberg, who is the President of our pharmacy businesses, and Noelle Eder, who's Cigna's Global Chief Information Officer. Together, we'll be diving into our health services business, Evernorth.
As David said, Evernorth is a key driver of the enterprise mission, of our growth, and of the future of Cigna. This morning, we're gonna walk you through some of the key Evernorth businesses and areas in detail using the framework that David just laid out for us now of foundational and accelerated and cross-enterprise leverage. I'll provide a little bit of an overview, and then I'll turn it over to Amy, who will discuss our Express Scripts pharmacy benefit services, which serve as a cornerstone, a foundation for Evernorth and provide foundational growth for our future. Our strong market position, our continued innovation in this business will continue to drive growth for us as we continue to serve the ever-changing needs of our customers. Next, Matt Perlberg will explain why our specialty pharmacy is positioned to deliver an accelerated growth.
In this business, our market-leading clinical capabilities, our track record of delivering results for our patients and our clients is a key differentiator, and we are leaders in this space. I'll come back and talk a little bit more about Evernorth Care and how this will be another key area of differentiated and accelerated growth for us as we look ahead, in the coming years. Here, we're poised to differentiate ourselves by integrating our care services businesses, especially our leading behavioral, our leading virtual care capabilities, with other solutions from across the corporation and across the Evernorth portfolio in a way that drives down costs and improves outcomes. We'll wrap with Noelle walking us through a digitally enabled example of that approach in action.
Finally, I'll share a bit of perspective on how the cross-enterprise leverage that exists both within Evernorth and across Evernorth and Cigna Healthcare, it, has the potential and will deepen our client relationships through our portfolio of innovative solutions. Before I turn it over to Amy, let me just step back and provide a little bit of context. When we launched Evernorth, our aim was really simple. Our goal is to create a health services company with the scale, the capabilities, and the reach to solve healthcare's biggest challenges, and that's the path we're on. The goal was born out of a recognition, healthcare today is too fragmented, it's too complex, and there's no easy, simple answers to fix those problems.
In healthcare, we think the best-in-class solutions really are multifaceted. They require different expertise, different perspectives, different skill sets, different capabilities, all working together to create a shared objective. That's what Evernorth brings to Cigna, brings to our clients, ultimately to our patients and customers. Now, it's important to understand the breadth and depth of services that are under the Evernorth umbrella today. This visual gives you a bit of a sense of the key businesses and capabilities that we've assembled that make up the Evernorth platform. Like I said, we'll focus on a few of those today. These portfolio assets will drive attractive, sustainable long-term growth. Collectively, when you look at these assets provide us with a holistic view of the healthcare landscape.
It provides us with a deep pool of data and insights that inform how we can close gaps in care and how we can address our patients' needs. Taken together, this combination enables us to see around corners. We can develop solutions that solve our clients' problems even before those problems are on their radar. Now today, I'm proud to say we serve more than 180 million customers already today who have access to our solutions through our health plan channels, through our relationships with employers, through our relationships directly with the government, as well as the work that we do to support healthcare with our healthcare provider partners. The depth and scale of our capabilities in these relationships allow us to bring new solutions to market, and we can do so on a pace and at a scale that's unmatched by our industry peers.
Our depth and our scale also uniquely positions us to address those critical forces that David mentioned, that we've talked about for a couple of years now, but continue to play out in how they're reshaping the healthcare landscape. Namely, the continued shift towards pharmacological innovation, healthcare treatment being pharmacy-based. A link between mental and physical health, and the opportunity to provide access to and direct to alternative sites of care that are best suited to the patient's needs. Now, Evernorth's opportunities for growth are compelling, and in fact, our value proposition is resonating with buyers. Already today, two-thirds of the Fortune 50 entrust their health with Evernorth. Seven of the top eight health companies work with us, and Evernorth has a relationship with the top ten health plans.
Let me pause for a minute just on health plans, because we're uniquely positioned to win and grow a share of spending here. Now, health plans are looking for partners that can help them deliver more comprehensive and more connected solutions. We're positioned to meet that need and do so in a way that provides a better experience for their members and clients. This is the type of solution innovation that Evernorth is focused on. Now today, Evernorth's total addressable market for health plans is massive. It's over $900 billion. Evernorth today provides services to approximately 60% of all the health plans in the U.S., but only are capturing about 9% of the addressable market. That leaves us with a lot of headroom to meaningfully deepen those relationships, to grow within our existing customers.
We also have the opportunity to cultivate new relationships, leveraging our insights and being in a position to connect our solutions and capabilities in a way that meets our health plan clients' needs. To demonstrate a little bit of the opportunity we have in front of us, let's actually just unpack our relationship at Evernorth with Cigna Healthcare and use this as a bit of an example. Now today, Evernorth manages or impacts about 30% of Cigna Healthcare's total cost of care. As we expand and Cigna Healthcare adopts more of our offerings, we're going to grow that number to about 50%. I'll spend some more on that in a moment. What differentiates Evernorth for our health plan clients is really ultimately what else will set us apart in the market overall.
Namely, our ability to understand clients' needs are unique as a fingerprint, and our ability to consultatively address those needs using our capabilities. How do we do this? We design and we implement connected data-driven solutions with precision. We work to simplify patient and client experience and drive better health outcomes. By prioritizing conditions that drive a big part of the healthcare spending. Think here about musculoskeletal conditions or oncology or diabetes, just as examples. We can take waste out of the system and drive down the cost of healthcare. Now, as a recent example, last month, we launched a new provider consult service that allows community oncologists to connect with experts on their particular subspecialty at centers designated by the National Cancer Institute. These connections allow patients to access the latest innovations while also keeping their treatments close to home.
This approach to solution development has enabled us to ultimately take risk and to guarantee outcomes, getting to better costs, better outcomes for our clients at the same time. Another enabler, and I think this is a key differentiator for us, is our open architecture approach. What this means is this enables us to connect our own point or connected solutions and partner with people, companies, entities from across the ecosystem to not only meet the client's specific needs, but to do so seamlessly. As David said in his opening remarks, we're not here to sell just products. We're working to be consultative and bring our capabilities seamlessly in with what our clients ultimately need. For our healthcare plan clients, this level of agility, coupled with our genuine investment in their success, is something that uniquely positions us to be a partner of choice.
That's not a phrase that we use lightly. In 2019, we announced our partnership with Prime Therapeutics, designed to help them grow their business. The collaboration between Evernorth and Prime Therapeutics underscores our commitment to help our partners succeed and grow. We've recently renewed that relationship, and we're providing even more services now than when we started. Just in April, we announced a five-year collaboration with Kaiser Permanente. You all know Kaiser is one of the nation's leading integrated healthcare organizations. Working together, our two businesses have complementary capabilities, and we can serve a broad range of commercial customers, government programs, and individual consumers. Working together will unlock meaningful savings while ensuring patients have access and expanded access to best-in-class providers and solutions and treatments. I'm proud of the results Evernorth's already achieved, but we've got lots more to do.
Relative to 2019, we've seen a substantial growth in the top and bottom line of our organization and exceeded our historical earnings contribution target of 4%-6% on a sustained basis. Looking ahead, our foundational and accelerated growth engines, as well as the power of cross-enterprise leverage, will position us for continued strong growth. Now we're gonna walk through each of those elements in a little bit more detail. First, I'll turn this over to Amy, who will discuss Evernorth's cornerstone and foundational business, Express Scripts. Amy.
Good morning. I appreciate so much having the opportunity. Express Scripts has ways to continue driving strong, stable, foundational growth for Evernorth and the enterprise. For the purposes of my time with you today, focus my comments on our leading and differentiated pharmacy services. For the past 36 years, Express Scripts has been a trusted partner, a loyal customer base. While so much has changed, of course, over the last three decades, what remains is that Express Scripts is the partner that will take bold action in the name of affordability. Our model keeps drug pricing low for the partners that we serve and their customers through an innovative approach.
Across our book of business, we serve a diverse customer base with 2,600 clients comprised of employers, health plans, government entities, representing more than 100 million lives and more than $200 billion in drug spend combined. That loyal customer base spans multiple segments. Our commercial division comprised of employers, health systems, labor unions, public sector clients, coalitions. They look to us to help them drive their drug costs down and look to us for predictable trends. Now, more than ever in this volatile economic environment, they need that partnership. Secondly, our health plan division and military division. We're serving regional health plans comprised of Medicare, Medicaid, commercial, exchange lives. Also, the Department of Defense, who we're so proud to serve and partner.
This unique approach helps our health plan clients grow in their respective markets to help them to compete and to win, driving our combined success and growth. We're doing that through superior cost containment strategies, but also leveraging Evernorth's breadth of services and capabilities. Lastly, our wholesale markets division. There we serve competing PBMs, health plans, retail network pharmacies. These are buyers that seek individualized point solutions. Maybe they're buying retail network or pharmacy rebates, medical rebates, home delivery, specialty pharmacy, as well as clinical programs. Key relationships here are Prime Therapeutics and Amazon Pharmacy. With this diverse client base, Express Scripts has access to a wealth of information and data, as mentioned previously, that we can drive meaningful insights and deploy timely solutions, pinpointing the drivers of cost and addressing those like no one else. Secondly, I'm sorry.
The market is mature here, and there's a real opportunity here for growth. As David and Eric both noted, one of the key forces reshaping the healthcare landscape is pharmacological innovation, and in turn, driving secular growth, as mentioned. Last year, nearly 8,000 products were in the drug development pipeline. Looking further ahead, there are numerous products that are coming to market, the majority of them treating specialty conditions, which we know carry a very high price tag. All of this to say, Express Scripts expertise is needed now more than ever. Today, we impact one in three U.S. lives in this country with an opportunity to drive our relationships even deeper. Looking forward, Express Scripts remains positioned for stable, healthy growth. We continue to show up to win, providing clients pharmacy services they want and need that are innovative, flexible, and of course, differentiated.
How do we do that? First, we bring industry-leading supply chain expertise to every single relationship. We keep drug pricing low and predictable. We're ensuring our members and their patients have access to the therapies that they need. By enrolling in our benefit management solutions, we save our clients $32 billion on average every year. Examples of these programs include our national preferred formulary or NPF. It's our largest, most sophisticated commercial formulary, serving tens of millions of members. Our NPF is considered industry-leading. It was launched in 2014. It is the largest membership of any formulary in the country. Our clinical solutions that are aligned to the NPF result in swift and safe transition to therapeutically equivalent medications at a lower cost.
Combined with clinical policies, physician engagement, and pharmacy coordination, we deliver unmatched success in converting patients to preferred alternatives. With this level of alignment, we have significant influence over pharmaceutical manufacturers in shifting market share. Second, our SafeGuardRx portfolio. It's our value-based suite of solutions. It leverages a superior clinical model, but also innovative supply chain partnerships with pharmaceutical manufacturers. This is unique in that we serve more than 11 disease states. A comprehensive solution that has very specific, targeted, objective outcomes that we're seeking to obtain, seeking to achieve, and if we don't, refunds go back to our plan sponsors. It's that simple. Secondly, in this section, our flexible and modular approach to deploying solutions provides clients real choice. Each one of our clients' needs are unique, and we know that one size does not fit all.
We're working closely with our buyers to ensure that our wealth of assets are going to meet their needs. Most will select a full-service partnership. Some want to unbundle services. Maybe it's rebate only or retail network only. Lastly, we partner consultatively. You've heard this this morning. Leveraging Evernorth's breadth of capabilities that work together to solve the most complex challenges. We are helping our clients navigate an ever-changing legislative and regulatory environment. We're working side by side with our health plan clients to help them grow in their respective markets and geographies. Our supply chain expertise, our flexible model, our consultative approach, will enable us to continue to deliver low- to mid-single-digit annual growth over the coming years. This growth is possible because our capabilities resonate with buyers, and we have deep existing relationships.
For 2023, Express Scripts is positioned for yet another year of growth, and our retention is on track to exceed 95%. Because Express Scripts is connected to Evernorth's broad suite of solutions to not only cross-sell, but also to deepen those relationships and implement meaningful services, we can meet client demand in a more sophisticated whole person way, resulting in a step change affordability, resulting in better patient outcomes and deeper, stickier relationships for the enterprise. As I wrap up here, I want you to think about all of this as possibilities for value capture and underscore that Express Scripts' business portfolio is well positioned for sustained growth and a foundational dimension of Evernorth, particularly in the areas of specialty and care delivery services will be able to expand that relationship further.
Now I'm gonna hand it over to Matt, who's gonna discuss one of Evernorth's key capabilities poised for accelerated growth, specialty pharmacy. Matt.
Thanks so much, Amy, and it's a pleasure to speak with you all today. As Amy noted, I'm gonna turn to our specialty businesses, which are highlighted by our leading specialty pharmacy, Accredo, and are positioned to deliver accelerated growth. Accredo today serves over 600,000 patients with some of the most complex conditions. We care for those patients through our 15 Therapeutic Resource Centers or TRCs, which are organized by major specialty disease state. We have a nationwide team of more than 600 field-based infusion nurses who deliver care in patients' homes, hospitals, and other on-site locations. In partnership with our pharmacy benefits business, we offer trend management solutions that drive down the cost of medications for our payer clients, as well as the patients that we serve.
Overall, specialty pharmaceuticals will grow significantly over the next several years, and the strength and the breadth of our capabilities positions us well to capitalize on that strong secular growth. While specialty medications are only used by about 2% of customers, they represent more than half of total pharmacy spend, and we expect those trends to continue. Specialty pharmacy generally is about a $315 billion market across both the pharmacy and the medical benefit, and we expect that to grow in the mid- to high-single digits over the next several years. That growth will be fueled by new drug launches, particularly in inflammatory conditions, oncology, rare conditions, as well as gene and cell therapies. Those figures include the impact of biosimilars, which will decrease specialty spend overall and represent savings for our clients and patients while helping fuel growth for Evernorth.
I'll come back and talk more about biosimilars in a little bit. The pharmacy build portion of the specialty drug market is about $190 billion. We expect that to grow to about $260 billion by 2026. Accredo has an approximate 25% share of that market and generates more than 35% of Evernorth's total revenue. Because of our unique strengths and our capabilities, we expect that we will grow faster than the overall market. Importantly, our total addressable market is not just limited to the pharmacy benefit. Today, Accredo serves patients under both the pharmacy and the medical benefit, and as I'll talk more about in a little bit, our specialty distributor, CuraScript Specialty Distribution, delivers products to more than 12,000 healthcare providers, and most of those products are administered under the medical benefit.
In addition, our total addressable market is not just limited to prescriptions adjudicated by Express Scripts. Today, about 40% of our total specialty revenue comes from sources outside of Express Scripts, such as other PBMs or other health plans. Against this backdrop of a high growth market, there are several differentiating factors which position specialty pharmacy as an accelerated growth opportunity for Evernorth. The first is our unique clinical care model that provides specialized care for patients. That includes our TRCs or our Therapeutic Resource Centers that I mentioned previously. Second is our market-leading drug access. In the specialty pharmacy space, manufacturers will often choose one or limited number of specialty pharmacies to dispense their products, and that's because of the unique handling and complex clinical capabilities needed to manage those medications.
Because of our track record and our expertise in managing those medications, we are a leader in access to limited and exclusive distribution products. As of the first quarter of this year, Accredo has access to nearly three-quarters of all limited and exclusive distribution products in the United States. When we look at the drug pipeline, it's geared towards those more complex medications where our capabilities differentiate us. This includes the emerging gene and cell therapy market. For example, today, Accredo is the only specialty pharmacy in the United States with access to the two FDA-approved gene therapies, Zolgensma and Luxturna. The third key differentiator for us is our specialty distributor, CuraScript Specialty Distribution. I mentioned that CuraScript serves over 12,000 healthcare providers, delivering some of the most complex and critical medications to physicians' offices, to health systems, to infusion centers, and to other specialty pharmacies.
CuraScript is one of the largest specialty distributors in the United States with a strategic focus on infused and injectable medications and expertise in rare and orphan drugs. In addition, many of the products which are exclusive to Accredo are also exclusive to CuraScript. I mentioned that Accredo is the only specialty pharmacy in the United States with access to the two FDA-approved gene therapies. Well, CuraScript is the exclusive distributor of both of those products. That's because we have a comprehensive suite of capabilities that can manage these complex medications all the way from the manufacturer to the patient, capabilities it has taken us decades to build.
That's a very unique and well-connected model that provides end-to-end care, regardless of whether a drug is administered under the pharmacy or the medical benefit, and regardless of whether a drug is delivered in a physician's office, in an infusion center, in a pharmacy, or inside a patient's home. Specialty pharmacy is one of the fastest-growing areas of Evernorth. In addition to the strong secular growth and the differentiating factors that I mentioned, we have other sources of growth as well. This includes increased penetration of the Cigna U.S. Commercial and Medicare lines of business, the expansion of our relationship with Prime Therapeutics, and our contract with the Department of Defense, which, starting in January 2023, will adopt Accredo as its exclusive specialty pharmacy through 2029. In addition, biosimilars will serve as an important accelerant for growth while also delivering significant savings for clients and patients.
Let me unpack biosimilars a little further. I know that many of you are likely familiar with biosimilars, but I'll level set on some basics. Biosimilars are less expensive, clinically equivalent alternatives to branded biologic products. Much like generics 20 years ago, biosimilars present the opportunity to create competition with manufacturers and drive down the cost of medications. Thus far in the U.S., we've seen a handful of biosimilars launch for products primarily administered under the medical benefit, but the largest specialty products, and particularly those under the pharmacy benefit, have yet to face competition from biosimilars, and that's about to change. Over the next three years, we expect that nearly 30% of the top 25 specialty products will face competition from generics or biosimilars. This includes Humira. Humira is a drug which treats a range of different inflammatory conditions such as rheumatoid arthritis and Crohn's disease.
Over the past decade, it's been one of the top selling drugs in the world. 2023 will finally face competition from biosimilars. More generally, we expect biosimilar usage to begin to accelerate in 2023 with more significant uptake in 2024 and beyond. Let me put some figures behind this. Today, approximately 7% of our total specialty spend faces competition from a generic or biosimilar. By 2026, we expect this ratio to exceed 25%. That translates to a $100 billion market opportunity. Of that $100 billion, we impact about $30 billion of that spend, and we expect to be able to drive savings off of that base. Capitalizing on this opportunity requires two key capabilities. Evernorth is particularly well positioned in both. The first is leading supply chain management.
As you heard Amy discuss, through our pharmacy benefits business, we have the capabilities, the reach, and the expertise to create competition and drive down the cost of those medications. The second key capability is the ability to work with physicians and patients to get patients to the right medication. Through Accredo, we're extremely well positioned to do this. We have a unique clinical model. We have specialized pharmacists that go directly into patients' homes, and they work hand in hand with physicians and patients to get patients onto the right medication, and they can help patients switch to therapeutic alternatives when appropriate. These capabilities reinforce each other. The better we are at getting patients onto the right medication, the better we can be at reducing the cost of those medications, and vice versa.
Put simply, having a leading pharmacy benefits business and a leading specialty pharmacy creates better levels of affordability and care than either business could on its own. As an organization, we have a long and rich history of creating competition, getting patients to the right medications, and making sure that we deliver improved affordability and care. In 2022, just this year, Express Scripts added Semglee to its national preferred formulary. Semglee is the first FDA-approved interchangeable biosimilar for insulin in the United States. That decision will save clients and patients $20 million just this year. Going back a little bit further in time, at the start of a generic wave, when many in our industry were reluctant to create competition with branded products, Express Scripts was not. Express Scripts added generics to its formularies at scale and worked to educate patients and providers about their benefits.
In 2014, when a new life-saving hepatitis C treatment came to market with an exorbitant price tag, we took action. We advanced a clinically equivalent alternative that saved our customers, as well as millions of other Americans, over $1 billion in just the first year. More recently, in 2021, Express Scripts preferred alternatives to Cosentyx on its national preferred formulary. Cosentyx is a drug which treats a range of different inflammatory conditions, and we were very successful in helping patients move to preferred alternatives. That model, competition, helping patients get to the right drug, lowering costs, improving care, that's at the heart of what we do. We do this day in and day out, and we have honed and refined these capabilities literally over decades. With biosimilars now on the horizon, we are once again positioned to take a leadership role in driving transformational savings.
The bulk of those savings will pass through to our clients and patients. Because of our aligned value model, when they win, we win as well, and we expect we'll retain a portion of the savings that we can generate. In sum, biosimilars create the opportunity for significant savings for clients and patients and will help fuel growth for Evernorth. Now I'm going to turn it back to Eric, who's going to talk about another area of accelerated growth for Evernorth Care Services.
Thanks, Matt. You know, the best part of my job is getting to work with the talented, passionate, and expertise that we've got within Evernorth, and Amy and Matt are great examples of that, and I'm sure you saw that come through in the last few minutes. Our specialty pharmacy capabilities are really compelling, but there's more. Let me turn to Evernorth Care Services, which is another driver of accelerated growth over the long term. Within Evernorth Care Services, we currently offer care management, which includes our well-established behavioral services, our coaching capabilities, and care delivery. That includes our virtual, our capabilities for MDLIVE, our in-home capabilities, our capabilities in providing care at the work site or even in more traditional in-office settings. When we look at the healthcare landscape, many factors are converging to shape the market opportunity here.
The U.S. healthcare system provides the world's most advanced care, yet patients, caregivers, healthcare professionals are increasingly frustrated by a system that lacks simplicity, that lacks predictability, that lacks transparency. This is not new news. Misaligned incentives reward volume over value. They reward sick care over well care. Providers are forced to rush through visits, and sadly, the most vulnerable patients are often the ones most left behind because they're confused or lack access or can't afford the care that they need. The pandemic's only made these problems worse, but it's helped to shift several dynamics, we think in a fundamental way. One, we think, and we've seen the underscoring of the connection between mental health and physical health. The stigma is breaking away around behavioral health care. This recognition comes as the mental health crisis has reached really epidemic proportions. I don't use that term lightly.
40% of adults in the U.S. now have some type of mental health or substance abuse issues. The pandemic's also led to a broader acceptance of virtual care. It's accelerated the adoption and use of that by years. More than 80% of patients who used virtual care during the pandemic reported they'd be likely to continue accessing care virtually after the pandemic. In fact, that's exactly what we're seeing with MDLIVE over the last year. Now, there's a lot of opportunity in the care services space to address these shifts while advancing a future state that takes out fragmentation and improves access, delivering better healthcare at a lower cost. As we define our addressable market, I wanna be clear.
We're focusing on specific care delivery and care management areas such as virtual and behavioral and home health that today together equate to about $370 billion of addressable market, which is a portion of the total healthcare market of $2.5 trillion. We continue to believe that partnering with physicians to expand care delivery modalities is the right approach, and we're positioned to meaningfully address critical gaps in care and build for the future unencumbered by legacy, physical retail or physical traditional models. While our current market share is emerging, we see opportunity for really outsized growth going ahead. I'd note that we're focused in a part of the market that's growing really rapidly, and we expect it to essentially hold in size over the next five years.
Now, beyond the revenue opportunity within this addressable market, we see opportunity to create better affordability and cost savings downstream for the benefit of our patients, the benefit of our customers, and really for the healthcare system overall. As I noted today, our care services segment or businesses provide a range of leading capabilities. Let me just click in a little bit further on two key areas, behavioral health and virtual care. Evernorth Behavioral Health provides a comprehensive offering that spans the spectrum of having a network, access to the network, utilization management. We provide intensive coaching. We've got almost a quarter of a million contracted professionals in facilities across the nation. We treat conditions ranging from depression to anxiety, and subspecialties focus on substance abuse, autism, and eating disorders. Our virtual care business, MDLIVE, we acquired a bit over a year ago.
MDLIVE provides patients with affordable access to quality, urgent, primary, and specialty care via virtual visits with providers. Today, we've got more than 3,000 doctors nationwide on the MDLIVE platform, and we're rapidly expanding that pool to meet the growing demand for our services. We're also developing a number of new digitally enabled care solutions, which Noelle will expand on in just a moment. As we look to the future, we expect that some 40% or more of patient interactions with providers and clinicians overall can and will take place in a virtual setting. Not only will virtual care delivery make care more accessible and affordable, it helps to allow us to identify close gaps where they exist and improve outcomes. We're at the forefront of driving the shift, and we come to this opportunity unencumbered by legacy models.
We don't have clinics to keep full or stores to keep foot traffic in. Today, our behavioral and virtual care capabilities are providing our clients with industry-leading solutions in the two areas of the market that are poised for strong secular growth. We think we can deliver even greater value by integrating them with the capabilities and solutions from across the overall Evernorth portfolio that helps get customers and patients the right care, the right time, and the right setting. Looking ahead, that approach will enable us to create a seamless end-to-end experience that connects care across conditions that drive the majority of healthcare spend. As I noted earlier, we're prioritizing conditions like musculoskeletal care or oncology or diabetes, anxiety and depression. We're also positioned to address and deliver whole person health in a way that few of our peers can.
to bring that concept of connected holistic care to life, I'm gonna hand it over to Noelle, who's gonna walk us through the impact that a deeply tailored, digital- first, virtual-led care approach can have to benefit those that we serve. Noelle.
Thank you, Eric. I'm delighted to be here with all of you today to help bring our vision of whole person healthcare to life. I think I'll start by calling your attention to the three ways we're delivering value in this context. Okay. First, today, we're providing point solutions focused on specific conditions where we see that our base of customers needs dedicated and focused attention. Second, we're integrating these solutions, meaning when we think about the best ways to help those we serve, we bring together all aspects of their life, from behavioral health and medical conditions to pharmaceutical treatments, major life events, social determinants of health, and behavior change. We believe this is the way to truly change outcomes for our customers and our business.
Third, efficiently and effectively delivering whole person healthcare is only possible if we seize this tremendous opportunity we have to leverage the power of technology and data to deliver personalized individual care proactively or in real time at the point of need. This opportunity gives us the ability to disrupt care management and care delivery by reengineering it through the patient's eyes, right? Also to reengineer risk and incentives. To do that, we have to flip the script on how care is accessed, guided, and coordinated. Now we have a unique set of assets, we have a capable group of people, and we have a strategy that positions us to do just that. I'd like to walk you through at a high level how we're executing this innovation. Our first step is rooting our business processes and our technology in a digital frame.
Doing so brings the customer to the very core of our solution development and operating model. Building up from there, we wrap our processes, the rest of our technology around those needs, and we ensure that data informs every action we take, empowering us to deliver an unprecedented level of personalization and to build a relationship of trust with our customers. In time, that relationship gives us the opportunity to guide them to the most effective care in the best possible setting for them, ultimately helping us eliminate waste in the healthcare system and deliver higher quality outcomes. Now, as you've all seen in the last two years, many conditions can be managed in part or in whole virtually. As Eric described earlier, we believe that virtual care can represent 40% of future interactions with providers and clinicians more broadly.
Our digital capability wraps around and supports virtual and every other mode of care. It's simple, it's tailored to each person, and it's available on demand, which increases ease and speed for both customers and providers. This model also gives us an incredibly rich data set, which, when combined with the patient's health record, gives both us and providers a holistic current view of the patient's needs. This integrated data embedded in a digital-first, virtual-led model gives us the ability to better predict specific outcomes before they occur, which in turn allows us to engage more on preventative health measures, offer alternative treatment pathways, better close gaps in care, and modify or enhance the customer experience in real time across conditions, regardless of whether or not an episode is acute or chronic.
As I mentioned, our clinicians can benefit from this digital engagement model as well, working with their patients across all sites of care, whether that's in the office, at home, or in a specialty care center. When we combine that with the ability to digitally optimize prescription orders, fulfillment, and management, we have a healthcare system built with ease and speed that adapts to each person's needs. Our ability to bring all of this together seamlessly is our right to win. That's why how we do this is so important. Our technology can convene capabilities and services and orchestrate workflows that account for each customer's or stakeholder's needs in real time, allowing us to efficiently personalize care to a unit of one. Because we will constantly receive and automatically learn from the data, our tools and services will continuously improve on behalf of those we serve.
Now, I think of these capabilities distinctly different from what we see in the market today. If you've had a chance to join us on our recent earnings calls, you've heard us talk about the strategic investment we're making in Evernorth Care. As David mentioned on our most recent earnings call, we wanted to talk more about the work we're doing here at Investor Day. Let's roll the video and show you what we're working on.
Healthcare is fragmented, and that impacts cost, quality, and outcomes. Others have tried to solve for these pain points by layering digital navigation over a broken system. Others try to aggregate the parts. Point solutions address one condition without connecting the dots. At Evernorth, we're charting a different course. We're building a platform that intelligently detects and delivers care when, where, and how people need it. Digital- first, virtual led, data informed, safe, secure, and privacy ensured, built for mass personalization and scale. Evernorth not only reflects the unique circumstances of the individual, it reflects the unique context of each partner, from employers to health plans to healthcare professionals. Because we believe every client, like each customer, needs solutions that drive their most important outcomes. Here's how we're doing it.
We connect health data to a remote patient monitoring environment and join clinical data with self-assessment data to determine the best care pathway. The platform assembles relevant capabilities and experience building blocks for that pathway. We personalize the experience and deliver care where you want it, digitally, virtually, or in person. We adapt, evolving to fit changing needs. Primary care, mental health care, specialty care, handling serious needs and providing ways to get and stay healthy is how we'll revolutionize what's possible one person at a time. Meet Jennifer. She's one person, but she represents the 20% of our adult population living with anxiety and depression. Jennifer needs therapy options, but she doesn't know where to start. With Evernorth, Jennifer doesn't need to search. We reach out proactively and through personalized onboarding. In minutes, we're connecting her to a therapist she'll actually keep.
Evernorth's curated experience with Jennifer, giving her what she needs in the moment and adapting to changes in her life. We show her progress over time and demonstrate impact on vitality, and we can enable shared experiences and community connection, bridging clinical networks to personal networks. Let's pause and take a breath because this is where others stop. We don't. We adapt to Jennifer and millions more over time, adapting with her and connecting care across conditions.
Like detecting a referral to a musculoskeletal program after virtual therapy, treating the back pain that's making her depression worse, preventing the need for surgery. If things get tough, we'll enhance the experience with the right support for the condition. Adding in virtual support and specialists for a care team that's up to date and always there, one tap away. Not just for Jennifer, but for everyone, one person at a time. This is how we harness technology, data, and digital to solve for customers, the people who care for them, and those who help pay for care. Less confusion, less complexity, less cost. At Evernorth, we're creating the system we need instead of reshuffling the system we have. More effective, more affordable, and engineered for each and every one of us.
As you can see, by integrating our clinical data, both historical and current, our clinical services and our digital interaction data in a cognitive, proactive, and real-time care model, we can deliver these tailored digital-first virtual led experiences. Because of that, we're in a unique position to help address whole person health and solve for the fragmentation that plagues our system today. Whole person health or the personalized coordination of care and services remains mission critical, and the need for it has only been amplified by the realities of COVID-19. By focusing our efforts in the way we describe today, we can get great clinical care, better clinical outcomes with much lower waste, creating differentiation and driving affordability. We see this as true innovation. It is informed by data.
It's driven by co-creation and collaboration across our lines of business through integrated solutions and services focused directly on customer needs. It is designed to constantly improve itself on behalf of those we serve. This is much more than just virtual care. It's much more than just digital navigation. It's rethinking the entire care experience, leveraging the power of technology throughout the customer's journey, and it is the future of what Evernorth will offer. Thank you. Eric, I'll hand it back to you.
Thank you, Noelle. That was a great way to bring to life the impact that we can have when we personalize care and when we can do it at scale, right? Taking one person at a time and expanding it at scale is a significant opportunity for us. I'm really excited about what's ahead of us. We are truly creating the system that we need instead of reshuffling the system that we have. Now, Noelle set us up to talk for me to wrap up this section by sharing a little bit about the cross enterprise leverage that exists within Evernorth Care. The principles of harnessing this leverage will also apply to how we deepen, how we grow our client relationships, and in turn, grow our business.
First, Express Scripts, strong client base and reputation in the market set us up with great opportunities to adopt new Evernorth solutions as they come to market. Our clients are increasingly calling for simpler, more connected solutions, and we're positioned to draw on our array of capabilities to meet them. Second, we're activating the enterprise leverage that exists within Cigna Healthcare. As I mentioned earlier, there's a lot of runway here, and we're underway on capitalizing that opportunity. About 30% of Cigna Healthcare's total spend is managed or impacted by Evernorth today, and we will increase this to 50% over the next five years. To put that in context, that alone generates an additional $10 billion of revenue opportunity for Evernorth.
This creates additional enterprise value across Cigna Healthcare, whether in our commercial, our individual or Medicare Advantage businesses. By activating this leverage, and as we govern Evernorth, the business of our businesses will change as we generate stable low- to mid-single-digit growth in our pharmacy benefit services and continue to deliver high single- to low double-digit growth in our accelerated businesses in specialty and care. By the result, when you put that together, we anticipate the overall proportion of the businesses in the higher growth segments will go from about 45% of Evernorth today to about 55% by 2026. I wrap up, I want to reiterate that our roadmap for growth is clear. Our pharmacy benefit services segment is a foundational element within Evernorth.
Here we've got leading capabilities, a leading market position, and we're going to continue to deliver stable, healthy growth as we continue to serve the ever-changing needs of our customers and lead in the pharmacy space. Our specialty pharmacies will serve as a scaled accelerant to drive additional growth, especially when you consider the opportunities presented by new drug innovations, including biosimilars. Evernorth Care Services, while smaller as a part of the portion of the organization today, provides an accelerated growth track in a rapidly expanding market, and we're really excited about the opportunities ahead. By intelligently connecting these solutions across all of Evernorth, we're able to meet client needs and deepen our client relationships. This in turn creates real value for our clients, and in turn, that gives us the opportunity to capture value for our shareholders.
Looking out over the next five years, we now expect to grow our revenue at a 5%-7% rate on an annual basis. This is an increase from our prior strategic targets. Brian will spend more time in the section later on today with the comprehensive impact of this change. But we're excited about the growth opportunity that exists in front of us for Evernorth, and we're confident in our ability to capture it. That brings the Evernorth section to a close. We'll now take a short break. Please be back in here in 10 minutes. Thank you.
Our program will resume in one minute. Please welcome the Chairman and Chief Executive Officer of Cigna, David Cordani.
Hello, everyone. Welcome back. I just want to spend a few minutes transitioning our thought process and teeing up the next portion of the conversation, then handing this across to our business experts. We spent a meaningful portion of our time this morning around Evernorth, the breadth of our capabilities in diving into several of our businesses, both foundational businesses as well as accelerated businesses. Now, I want to shift your thought process to the benefit side of our business portfolio and Cigna Healthcare. Using the same framework, though, foundational, accelerated, and enterprise leverage. Within the Cigna Healthcare portion of our business, we have two successful, large, growing foundational businesses. Those are the U.S. Commercial business as well as our International Health business. Today, we'll focus on the U.S. Commercial business. Just a moment on the International Health business.
That business is uniquely positioned to serve both globally mobile individuals with the largest network of its type and solution capabilities of its type. As well as with the focus of our international leadership team, intensifying focus around health and health services in specific geographies within Europe, the Middle East, as well as the Asia Pacific region, and we'll carry that conversation forward in future dialogues. Today, we'll also spend time on one of our accelerate businesses, as I noted in the opening. A portion of our U.S. Government business, specifically the Medicare Advantage business. Then we'll call out some of the cross-enterprise leverage capabilities. Now, this morning I talked about three points of differentiation that transcend the corporation, and those do play through in the Cigna Healthcare portion of the business. You'll also hear some unique points of differentiation of what sets us apart here as well.
As I tee those up, it comes through the framework of what we do each and every day for those we serve. Through an employer's lens, now more than ever, employers are looking for a partner. They're looking for a strategic partner who understands and sees the fact that for them to have a thriving, vibrant, growing business, they need healthy, productive, present, highly engaged coworkers. That's not as easy it sounds anymore. Having the capabilities to deliver that and turn a health plan offering into a growth plan offering is mission-critical. Through an individual's lens, individuals look for longer-term relationships, but relationships that respond to their expectations formed by other industries that are more personalized, more connected, and of course, deliver the affordability and value that they expect. Now within the Cigna Healthcare portion of our business, items that set us apart for those we serve.
First, our strong and differentiated provider networks. Here with intensity, seeking to focus extra effort on the highest performing clinical professionals. We've been able to prove that when our customers experience and consume service from our highest performing clinical professionals, there's a savings to the individual of 10%-15%. As it relates to value-based care within the Cigna Healthcare portfolio, today, a little over 40% of all the rewards and reimbursement in our commercial business are value-based in nature. Approximately 50% of the structures tied to our individual exchange business are value-based in nature. Approaching 75% of the relationships in Medicare Advantage are value-based in nature. Second is our ability to grow and broaden client relationships. You've gotten the flavor a little bit through the Evernorth conversation.
Yes, you'll get the flavor throughout our conversation around the services between Evernorth and Cigna Healthcare. Additionally, within Cigna Healthcare, there's further leverage opportunities, specifically in Medicare, where fully 150,000 plus individuals annually move into retirement status and present an opportunity from us, from our commercial relationships to have an opportunity to pursue from a Medicare Advantage relationship or other senior services. Relative to our global offering, which I reference is industry-leading, we have the largest indisputable network around the world of 1.5 million credentialed medical professionals to serve individuals' needs, whether on elongated needs standpoints or for shorter needs standpoints. Our ability to deepen and broaden relationships is item two.
Third, leveraging data on an enterprise basis that is longitudinal and rich in nature, all with the objective of creating better, more precise predictive modeling opportunities to anticipate events or to target with more precision care interventions and care coordination programs. Now to step back and remind you, the growth framework that's attached relative to our Cigna Healthcare portfolio has three pieces, foundational in nature, and we'll talk about the sustained, mature, attractive, consistent growth that comes out of our commercial relationships. Second, accelerated growth opportunities. We'll spend time specifically on the Medicare Advantage subset of our Government business and the growth opportunities we see in front of us off of our network, our Evernorth capabilities, and our brand leverage.
Enterprise leverage that will come across here as well, the deepening of relationship and leverage that exists between our Evernorth portfolio and our Cigna Healthcare portfolio to broaden the services that we offer to our customers and clients within Cigna Healthcare. Now to kick us off here, I'm gonna hand the program over to Mike Triplett. Mike's the long-serving President and leader of our commercial business, and has a long track record of successfully and consistently growing that business. He will describe our growth trajectory on a go-forward basis. Mike?
Thank you. All right. Thank you, David. As David said, my name is Mike Triplett, and I lead Cigna's U.S. Commercial business. It is a pleasure to be with you here in person. As many of you know, our employer-based business proudly serves the healthcare needs of more than 14 million medical customers from over 28,000 public and private employer relationships. Now, we group our employer clients into three main segments: national accounts, middle market, and a Select segment. Our experienced sales teams and our deep consultative approach is the foundation for how we create value for our clients. We work to solve their very specific needs through a diverse portfolio of products, services, and funding options.
In fact, approximately 90% of our medical customers are with clients who directly participate in the financial performance of their plan, either through an ASO funding arrangement or through some type of a hybrid funding solution. Now, in my time with you today, I'd like to talk about three things. Number one, how we view the U.S. Commercial opportunity. Number two, what makes us different. Number three, how we're going to continue to grow at attractive rates. Let's jump in. Over the next five years, total employment is expected to remain flat. However, at the same time, the healthcare spend is projected to grow 4%-6% per year, driven in part by the growing demand for healthcare services and goods.
Therefore, it's really an important point, even with low enrollment growth, in the absence of any other action, we can expect to see annual revenue growth for the U.S. Commercial market in the mid-single digits. That's just the start. We've demonstrated, and we will continue to demonstrate through our consultative approach and our innovative solutions, that we will grow at above industry rates in targeted subsegments. As you can see from this visual, Cigna has consistently outperformed the industry for revenue growth. In fact, from 2018 to 2021, we delivered average revenue growth of over 7%, double that of the industry. We have a proven sustainable foundation and track record of attractive growth. As we look at our current addressable market, it's clear that we have plenty of room to grow.
We are currently capturing approximately 10% of the membership of this market. In our national accounts and middle market segments, we're seeing momentum, and we expect to grow at or above the market and over the long term. In the Select segment, which serves employers with 50-500 employees, our fully integrated solutions create value, leading to overall improved health outcomes, total cost of care savings, and continued growth. As you know, we have frequently highlighted our strong track record of growth in Select. Over the last few years, we've continued to deliver membership and revenue growth, even at a time when employers, particularly small employers, were experiencing tremendous disruption. We're proud of these results. With a 6.5% market share in that segment today, we have room to grow.
We expect Select to deliver outsized membership growth and revenue growth over the long term in the low double digits. What's allowed us to grow above industry rates, and what will drive that growth as we look ahead? Simply put, it is how we work with our clients to understand their business strategies and the healthcare needs of their workforce, and then bring solutions that improve health outcomes at the lowest cost of care. As we look at the current labor market, employers have not only been navigating a global pandemic for the past two-plus years, but they're also now facing intense competition for talent with increasing cost pressures.
Their health plan offerings are more important than ever, and more and more, they are seeking solutions that go well beyond the traditional healthcare coverage and address areas such as improving productivity, engaging geographically dispersed employees in unique ways, and addressing the deepening epidemic of mental health and substance use issues. The reality is that clients increasingly recognize that having a healthy, vital workforce is critical to fueling their business growth. We partner with them to turn their health plans into growth plans that are able to attract and retain talent, predict and manage financial risk and cash flow, and then establish and maintain practices that improve the health of their employees and families while boosting the productivity of their workforce. We take a customized approach to address clients' needs by leveraging the full breadth of our enterprise to deliver value.
Let me share a few examples. First, we help our customers access the highest quality, most cost-effective care so that they get well and that they stay well. We partner with high-performing providers that maximize health outcomes at the lowest cost through aligned incentives. Second, we innovate and develop tailored solutions in areas like medical, behavioral, dental, and pharmacy that will maximize the value of our industry-leading clinical programs, our deep partnerships, and our care delivery capabilities. Third, we take those differentiated solutions, and we integrate them in a way that produces actionable insights. They engage customers in their health, and they control healthcare spend. We do this better than anybody else.
As employers who integrate these solutions see meaningful cost savings, and we see a significant impact, in particular with employees and dependents who have a health improvement opportunity and engage Cigna's clinical solutions, as our studies show that the cost of care savings for these individuals averages nearly $5,000 per year. Our sales team, which is the best in the industry, has decades of experience in aligning employer needs with our solutions. They will work closely with employers to help them understand their options and then make choices that best suit their needs so that they can effectively compete for talent and improve the health and well-being of their employees and families. Now as we look to drive sustained growth for the U.S. Commercial business, we'll take our proven foundation of success and continue to capture additional customers through improvements in affordability that expand our addressable market.
Each and every day, our team is laser-focused on making healthcare more affordable for our clients and customers. Through our consultative approach, we work to ensure the market recognizes the affordability gains that meet their needs. Let me walk you through this briefly. An important component of any client's buying decision is an economic evaluation of their offerings. For those clients purchasing insured products, our affordability gains show up in our premium rates directly converting to growth. For clients who are self-funded that have historically oriented their economic analysis largely on unit cost. True affordability is much more than just unit cost. We partner with employers and their benefit advisors to evolve their weighted valuation criteria so that they understand how these advancements directly benefit our affordability gains. Clients are embracing this, and this will help further or accelerate our ASO growth.
Now with that in mind, there are three specific ways we will continue to deliver greater affordability. One is through our unit cost improvements that will increase our addressable markets in under-penetrated geographies. Two is through our continued site of care optimization that ensures our customers get the most efficient, cost-effective care setting. Three, creating value through Evernorth that will improve health outcomes and lower cost. Let's start with unit costs where we're making really good progress. We have a detailed geographic tracking through internal and external data and analytics that offer a view of our competitiveness across our markets. You may remember last year, we set a goal to improve our competitive addressable markets by 25% by 2025, and we've already achieved approximately half of that goal.
Now, to provide context on how this translates into growth, our average cost position improved by 4% in markets where we improved our competitiveness. Now, this drives stronger retention, and it drives a higher close ratio. We project this to be worth approximately 100,000 incremental new customers in 2023. Additionally, our continued focus on how, when, and where care is delivered enables us to make an even greater impact on delivering affordability. Through our deep insights and analytics, we guide our customers to the highest performing providers across a number of care settings, whether those care settings be at home, via video, phone, virtual, or in person at the doctor's office, all of which bring more choice and access to quality care. Now, MDLIVE is a good example of how we're expanding our capabilities to deliver a more affordable, convenient, and connected experience.
It not only allows our customers to receive care without leaving their homes, but it also delivers a more cost-effective result. MDLIVE is another way we guide our customers to the most affordable, highest quality care, and our data shows that the average cost per medical episode of care initiated through MDLIVE is less than half of the average cost of care initiated through traditional channels. In addition to unit cost and site of care optimization, our broad portfolio of health services through Evernorth tackles the most complex and highest care needs. You've heard about many of them throughout the morning, such as our industry-leading Evernorth Care Solutions, behavioral solutions that are more important than ever for customers, families, and their caregivers. Our data shows overall health improves and cost goes down when people get the help they need.
In fact, customers diagnosed with a behavioral health condition who receive outpatient care had lower total health care costs in the first year of diagnosis and treatment by approximately $1,400. When you think about pharmacy services, we've talked about Express Scripts and our Accredo Specialty Pharmacy. In 2021, benefit plans that used these services and implemented comprehensive strategies saw a reduction in the specialty drug spend of about 6.4% compared to those who didn't have a specialty drug spend increase of 7.2%. Our healthcare benefits management solutions through Evernorth that complement our medical offerings. Evernorth works with customers and providers to determine medical necessity to avoid inappropriate care while driving the quality care at the right place and at the right time, therefore eliminating the waste from the system in high-cost areas such as MSK and high-tech radiology.
Through Evernorth, our clients saw savings of approximately $1 billion in 2021 alone. We focus on managing the total cost of care through our unit cost improvements with capabilities that maximize site of care efficiency and our national programs and solutions that reduce leading cost of care results. Now, as David mentioned, we are partnering closely with Evernorth to expand, to retain, and add relationships. We're collaborating to innovate so we can deliver even greater value to our clients and leverage each other's deep business relationships to win additional new business. We're excited about the opportunities that we have together. Our U.S. Commercial business has a proven record of delivering growth and outpacing the industry. We will drive foundational growth through continued market share gains.
We'll further accelerate as we continue to expand our addressable market through our consultative approach and improved affordability, and as we further innovate, deepen, and expand relationships through Evernorth, all of which gives us confidence in our ability to deliver sustained average annual revenue and earnings growth in our U.S. business of 6%-8% over the long term. Thank you again for your time. With that, I'd like to turn the program over to Charles Berg, President of our U.S. Government business. Thank you.
Thanks, Mike. Well, it's really nice to see a few familiar faces in the audience. Time does fly. I'm Charles Berg, and I joined Cigna at the end of January, so about four months ago. My career in healthcare has been pretty much evenly split between value-based provider businesses and health plans, most recently with HealthCare Partners and Wellcare, and before that, a few others, including Oxford Health Plans. A number of people have asked me why I decided to take this role at this time in my career, including Josh a little earlier today. The answer is pretty simple. I miss being part of a great team, working on interesting and important things. As for the first part of that, some of that team is in the room, including Aparna, who I think you had a chance to meet last year, who runs our Medicare business.
There are lots of other people throughout our Government business and throughout the company I'm honored to have an opportunity to work with. It's a great team, brings diverse experience and perspective to the Government business, and that's throughout the enterprise. I've known David for many years, so that part was easy for me. As to the second part, the Government business has always been of particular interest to me because of the people we serve in these programs. We have a very significant opportunity to provide access, benefits, and healthcare programs and resources that otherwise would not be available. I believe this is a great opportunity for Cigna with the resources we currently have and the resources that are being built across the company, in particular at Evernorth.
Before I make a few comments about our plans for the business, let me remind you of a few key facts. Our government business has two primary businesses, Medicare and our individual exchange business, which we call Individual and Family Plans or IFP. Our Medicare Advantage business, or MA, serves about 550,000 customers in 26 states in Washington, D.C. About half of our total membership is in our Texas, Tennessee, and Alabama markets. Today, I'm going to focus on the individual MA business. We know you have some questions, and it's very important to our strategic plans. I'll wrap up with a few comments on IFP.
Before we get into the growth strategy for the MA business, I wanted to briefly touch on a question I've been asked several times since I joined, which is whether Cigna is just too late to build a scale MA business. The answer to this question may be yes for some companies that are entering the MA market, but not for Cigna, given our national networks, our large customer base, our brand, and our ability to invest in the business across the enterprise. I actually believe we're in the beginning of the middle of the MA opportunity for Cigna, not at the end of anything. Let's turn to the details of the business. The industry-wide growth opportunity in MA are pretty well understood, and I'm not going to go deep into them. The secular trends are well documented.
We have seen industry-wide net growth of MA beneficiaries of about 1.5-2 million people per year over the past few years between those aging in and those switching from traditional Medicare, and we expect that trend to continue. Finally, the total addressable market in MA is fairly large at $360 billion, and we expect continued significant growth over the next five years. Given this opportunity, we began our accelerated growth plans in 2020 and have been intensely focused on our market and product expansion. This will give us a foundation for growth in the future. A broader geographic and pro-product footprint is important as we seek to serve more Cigna customers who transition from U.S. Commercial or from other Government products such as Medicare Supplement, Part D, or IFP.
As a result of our expansion efforts, we now operate in 477 counties across 26 states in Washington, D.C. Today, roughly 33% of all Medicare beneficiaries eligible reside in our MA service areas. We're well on our way to achieving our goal of reaching 50% of the total addressable market by 2025. At the same time we expanded geographically, we successfully launched new HMO offerings, adding 119 counties across 20 states. We also rapidly grew our PPO product from five counties in one state in 2019 to 392 counties across 23 states and D.C. this year. Even with this rapid expansion over the past couple years, we're still a relatively small participant in this program with approximately 2% national market share.
MA is a local business, and in markets we currently operate in, we have about 5% total market share and about 8% market share in more mature markets. The point for us is as markets mature, our competitive position improves and growth accelerates. We've previously told you that we plan to achieve target margins in MA of 45%. However, this takes time, especially in new markets and with new products. I'd like to spend just a few minutes discussing why we have a right to win in this business over the long term. First, we can leverage existing enterprise assets and capabilities. This starts with our extensive provider network and good provider relationships. Payer-provider relationships are naturally challenging, and good relationships are extremely valuable when entering into new geographies and offering new products.
Another asset is the 150,000 U.S. Commercial customers who are aging into Medicare each year. About a third of these are located in our current MA footprint. This represents a growth opportunity for us, especially as we continue to expand our geographic footprint and product offerings. Also, our partnership with Evernorth enables our MA plans to benefit from the quality and affordability strategies delivered by Evernorth's pharmacy benefit services, specialty pharmacy, and care services. Finally, our Cigna brand is associated with high customer satisfaction and with quality. Our strong net promoter score in MA, which has been 70 or higher for the past 3 years, is evidence of this.
By leveraging our existing assets and capabilities, and with the investments that are being made throughout the enterprise, we'll contribute meaningfully to Cigna's overall long-term growth with 10%-15% membership growth in MA for the foreseeable future. That's our longer-term perspective. As for 2023, we plan to return to growth, and there's four areas that we're focused on. The first is to continue optimizing our networks in each market to support competitive products and economics. This will involve a wide range of provider relationships with a focus on value-based care in support of quality and affordability. The second is to execute on the opportunity I've highlighted with existing Cigna customers. We've improved our process and our capabilities to identify these potential customers and to make them aware of the benefits of Cigna products.
The third is investments in distribution and marketing. This will include increased targeted marketing spend along with enhanced capabilities for both our brokers and our internal sales channels. Finally, our geographic expansion since 2020 will contribute more in growth in 2023 as a result of our strengthened network and product offerings. Now I'll just make a couple of comments on IFP. IFP serves approximately 350,000 people across 13 states, with our largest membership in Tennessee, Florida, and Virginia. This is an important part of our Government portfolio and of the overall enterprise, as there continues to be a significant need for a competitive and sustainable individual market. Cigna has consistently participated in this business since the inception of the exchange in 2014, allowing us to learn and grow. Like MA, IFP is a highly localized business.
We expect that this will remain a competitive market, but over time, we expect IFP to offer both growth and earnings opportunity. We'll continue to take a disciplined approach to this business, but as we have been focusing on targeted geographies today, we see a good opportunity for growth while allowing us to earn our 4%-6% target margin. Finally, Evernorth will contribute to IFP's long-term growth and success with programs and services that support our customers while driving affordability and quality. I'm excited to be a part of this Cigna team and appreciate the opportunity to share a few thoughts with you. Now I'd like to turn this over to Brian Evanko, Cigna's Chief Financial Officer.
Thanks, Charles. Morning, everybody. I want to thank you for your time. Really, it's a big block of time we asked for this morning for those of you here in person with us in New York, as well as those of you on the webcast. Thanks for your interest in Cigna. I'm Brian Evanko, Cigna's Chief Financial Officer, for those I haven't met. This morning, you already heard from our leaders about the exciting growth opportunities we have across our two growth platforms, Evernorth and Cigna Healthcare. I'm gonna spend the next 25 minutes or so reinforcing and expanding upon some of the key messages you heard. In particular, you'll hear, one, we have strong foundational businesses that we will continue to grow in the future.
These businesses often serve as the key entry point for us to have a pharmacy relationship, a medical relationship, or both with clients and customers. Two, we have a variety of accelerated growth businesses. Some of them are already scaled, like our specialty pharmacy. Some of them are emerging. These either build upon our foundational businesses, or in some instances, they provide us with exposure to adjacent high-growth segments. Three, our enterprise leverage allows us to unlock even more combined value between Evernorth and Cigna Healthcare working together. As Eric talked about, we have a significant opportunity for Cigna Healthcare to consume even more services that are supplied by Evernorth in the future. Here's how I plan to structure this segment with you today.
First off, I'll give an update on our 2022 outlook and our reaffirmed adjusted earnings per share outlook of at least $22.60 per share. Next, I'll lay out the long-term financial targets for our enterprise and for our segments, demonstrating how our foundational and accelerated growth businesses, combined with our strong cross-enterprise leverage, create attractive revenue and income growth along with strong margins. To go deeper on how our clear capital deployment framework will generate compelling returns for all of you, our shareholders, and will provide us the flexibility to successfully navigate uncertain future environments. All this will culminate in a reiteration of our commitment to deliver 10%-13% EPS growth on average over time, and in particular, over the strategic horizon we're talking about today.
I'll also highlight some of the opportunities that we have to drive EPS growth closer to the top end of that range in the outer years as our strategic investments yield more substantial financial benefits. After my remarks, we'll take a short break, and then we'll move into the Q&A segment where all the leaders you heard from this morning will join me on stage. As I go through each of these topics, you should hear the linkage to the five strategic priorities that David started with this morning. Number one, we'll continue to make targeted investments to sustain differentiation in our large foundational businesses, U.S. Commercial and Evernorth Pharmacy. Two, we'll drive savings for our clients and customers, and we'll capture a portion of that opportunity in our specialty pharmacy benefits business. That includes biosimilars as well as specialty generics.
Three, we will further build and invest in our Evernorth Care Services platform. Four, we will build and further grow our U.S. Government business that you just heard about from Chuck. The fifth item is we will capitalize and maximize the opportunity on the cross-enterprise leverage that exists between Evernorth and Cigna Healthcare. Let's start off just by spending a few minutes talking about 2022. Last month, on our first quarter earnings call, we increased our 2022 adjusted earnings outlook by $100 million to at least $7.05 billion after tax, or at least $22.60 per share. Today, we are reaffirming that guidance, and we remain confident in our ability to deliver against these commitments.
Even in the face of economic uncertainty, we are positioned to deliver for our clients, our customers, and our shareholders. Our net growth in Cigna Healthcare is projected to exceed our initial expectations for the year. You heard me talk about in our first quarter results, we lifted the full year net customer growth outlook by 150,000 lives, and we now expect to grow by 725,000 lives or more in Cigna Healthcare compared to where we were at year-end 2021. Evernorth continues to perform well. The strong growth in our specialty pharmacy, along with the expansion of many client relationships, drove 10% adjusted revenue growth year-over-year in the first quarter. Our adjusted earnings in Evernorth were in line with our expectations.
Taken all together, we remain confident in our ability to deliver against our commitment of earnings per share of at least $22.60 in 2022. Now, we turn to our long-term framework. If you look across our organization today, we have a mix of foundational businesses and accelerated growth businesses, as well as the cross-enterprise leverage that will drive attractive, sustained growth. First, I'm gonna lay out the long-term revenue growth under this framework, and then I'll dive deeper into the long-term expectations by the business segments that you're accustomed to us talking about. But taken all together, we see total annual revenue growth of 6%-8% per year, consistent with our prior targets. I'm going to first start off with our foundational businesses.
Within Evernorth, our Express Scripts business will continue to grow off of what's already a large-scale client base. You heard about that from Amy earlier. Within Cigna Healthcare, we'll continue to see attractive growth in both U.S. Commercial and in International Health, both in line to slightly above industry growth rates over the strategic horizon. Combined, these three foundational building blocks of our growth represent about 60% of our current enterprise revenue for about $100 billion of annual revenue. We expect them, in total, to grow in the low- to mid-single-digit % revenue growth rate range annually. Additionally, we intend to deliver accelerated growth in a series of other businesses within Cigna that you heard about this morning. We talked about within Evernorth, our specialty pharmacy business and Evernorth Care Services.
Within Cigna Healthcare, Chuck talked about the opportunity we have for accelerated growth within U.S. Government, particularly within the MA space. Taken together, these accelerated growth businesses today already represent about 40% of the total company's revenue or about $70 billion here in 2022. Given the numerous opportunities we have for growth in those, we will drive low double-digit revenue growth annually for the total combined accelerated growth businesses. The revenue mix between our foundational and accelerated growth businesses will change over time. Today, it's about 60% foundational, 40% accelerated. By 2026, that will be a 50/50 mix as the accelerated growth businesses grow more rapidly. In particular, over two-thirds of our revenue growth in the strategic horizon will come from the accelerated growth businesses.
Finally, our leaders gave you some tangible examples this morning about how the cross enterprise leverage opportunity we have generates value for clients, customers, and enables growth for us financially in the organization. As Eric mentioned earlier, Evernorth currently impacts about 30% of Cigna Healthcare's total cost of care today. Over time, we see that approaching 50% of Cigna Healthcare's total cost of care through expanded client relationships, along with new capabilities that Evernorth Care Services will be introducing over the coming years. The impact of the strategic component or the specific component of enterprise leverage has the potential to add $10 billion-$20 billion annually of revenue for Evernorth over time. This is just specific to the opportunity that we have with Evernorth and Cigna Healthcare working together.
As Eric talked about earlier, we also have a substantial opportunity for Evernorth to expand relationships with unaffiliated health plan clients. Let's look at the combined picture. All in, we expect 6%-8% revenue growth across the franchise when you take the weighted average of the foundational and the accelerated growth businesses. Now I'm gonna take us through the long-term targets in each of the businesses, which reconcile to this higher level framework that I just talked about. In Evernorth, our long-term expectations are to deliver adjusted annual revenue growth of 5%-7% per year on average. We'll also deliver adjusted annual earnings growth of 5%-7% on average, and we expect adjusted pre-tax margins in the range of 4.5%-5.5%.
It's important to step back and recognize the strength we've seen in Evernorth since the acquisition of Express Scripts in 2018. At the time of that acquisition, Express Scripts had been expecting average annual growth in the 2%-4% range annually. During our 2019 investor day, as we saw increased opportunity for that business, we introduced an expectation of 3%-5% annual growth. We beat that. We exceeded that meaningfully since 2019. Last year, during our 2021 investor day, we introduced an expectation of 4%-6% average annual growth off a stepped-up revenue base. We not only delivered against that, but we exceeded that over the course of the last couple of years.
Now we are further lifting our expectations for Evernorth to a strong 5%-7% growth rate in both revenue and earnings looking forward. I'd also note that this is off a much larger revenue base compared to where we were just a few years ago. Compared to the 2019 Evernorth business, the 2022 revenue base will be approximately $40 billion higher. In other words, we're now expecting a higher percentage growth rate off a substantially higher revenue base. Now I'm gonna walk through the components of the business and how these long-term expectations all fit together. As Eric laid out, there are three broad components to think about within Evernorth. The first one's our Express Scripts pharmacy benefit services.
Second one is our Accredo Specialty Pharmacy, and the third one is our Evernorth Care Services. Within Express Scripts, here we have both pharmacy benefit services and our home delivery business. These are foundational businesses for Cigna. Amy discussed how we've established a leadership position in this business through a relentless focus on lowest net cost solutions for our clients and customers, along with deep expertise in designing programs that are specific for client needs. Eric also referenced the substantial opportunity that exists through new or expanded health plan relationships with Express Scripts. Our differentiated capabilities, our market opportunities, and the secular growth give us the confidence to drive 2%-4% average annual revenue growth rates, which are approximately in line with industry growth for this business.
Secondly, our Accredo Specialty Pharmacy provides value through differentiated capabilities, such as our extensive network of Therapeutic Resource Centers, the broad network of nurses providing home infusion services, and very wide access to drugs, as you heard about from Matt this morning. He also talked about the complexity and the specialization that's required to win in the specialty pharmacy business, along with how we will lead the next wave of biosimilars. This business has strong secular growth, and the business model we've constructed is extremely difficult to replicate. Accredo has grown to now represent more than 35% of Evernorth's revenue, and it will continue growing. We expect the long-term average annual growth in Accredo to continue running in the 8%-10% range per year on average. The third component of Evernorth is our care services business.
This contains a diverse set of offerings that span care management and targeted care delivery. Both Eric and Noelle described why our approach to care delivery and care management is different than what you hear from many others in our space. We start with data, technology, and consumer insights, and then we focus on a digital-first, virtual-led experience for our clients and customers. This isn't just convenience care, but increasingly also applies to chronic conditions that benefit from precise and personalized care journeys. These strategies will be supplemented by traditional care delivery channels, but I'd note that we do not intend to own meaningful amounts of traditional physical care delivery. This approach also allows us to maintain an industry-low SG&A ratio and ensure that our customers receive optimal care at the appropriate and best sites for them.
Today, Evernorth Care Services is already delivering in excess of $10 billion annually. It's small in the context of the overall company, but it's already over $10 billion annually. We see significant headroom through a combination of addressable market expansion, broadening existing Evernorth client relationships with these capabilities and driving enterprise leverage with Cigna Healthcare. As a result, we expect revenue growth of 10%-15% or more annually in Evernorth Care Services as our investments in these emerging capabilities yield financial results for us. We also expect Evernorth Care Services margins to expand in the future as this business scales. The long-term margins for this portion of Evernorth should be above the Evernorth segment average.
Based on the differentiated value we deliver, our expanded service offerings I just discussed, and our broader addressable market, we have increased opportunity for growth in Evernorth, which led to our increase in the long-term outlook. We now expect adjusted annual revenue and income growth in the 5%-7% range per year on average, up from our prior 4%-6% expectation, even off a substantially higher revenue base. Another important consideration is the business mix shift that we expect to see within Evernorth over time. While we'll grow across the pharmacy benefit services segment, the specialty pharmacy business, and our Evernorth Care Services, the disproportionate growth in the latter two components, specialty pharmacy and care services, will create mix shift.
As a result, over time, the specialty pharmacy in Evernorth Care businesses will grow from about 45% of the revenue today to about 55% of our revenue within Evernorth by 2026. As our business mix does shift, we will look to provide you with incremental quarterly disclosures to help you track the progress on this over time. We'd also expect to see mix shift within our Cigna Healthcare business that you heard about from Mike and Chuck earlier. I'm gonna spend a minute on this now. We expect over the long term to deliver average annual adjusted revenue growth of 8%-10%, adjusted earnings growth of 8%-10%, and strong adjusted pre-tax margins of 9%-10% for our Cigna Healthcare business.
Within Cigna Healthcare, our growth today is driven by U.S. Commercial, U.S. Government, and International Health. U.S. Commercial is a foundational business with a demonstrated track record of strong performance, as you heard from Mike. Secular factors in this business are expected to drive mid-single-digit revenue growth across the industry. We expect to grow slightly after the market through expanding services, deepening relationships, and capturing above-market growth, specifically within the Select segment. This growth will be fueled by our tireless push toward improved affordability for our clients and customers. Our U.S. Commercial market share growth will not come at the expense of profit margins, but rather through a more competitive cost structure through the numerous affordability initiatives Mike described earlier, such as further improvements in our unit costs in targeted geographies, our emphasis on alternative sites of care, and enterprise leverage with Evernorth Care capabilities.
This track record of success, combined with the expansion of our target addressable market, gives us the confidence to drive 6%-8% average annual revenue growth. The margin profile of U.S. Commercial is slightly higher than the Cigna Healthcare target margin range of 9%-10%. This is due to the fact that over 85% of our medical customers are in lower revenue fee-based arrangements. U.S. Government's an accelerated growth business for us. It'll be driven primarily by our Medicare Advantage growth and in our individual exchange business. Our focus on expanding profit margins during the 2022 calendar year led to our 2022 customer volumes being down from where we were in 2021. This now provides us a new baseline with which we'll grow off of.
We expect U.S. Government long-term annual growth in revenue in the 10%-15% range due to the underlying growth of the market, our company's specific opportunities for geographic expansion, the maturation of previous geographic expansions that Chuck described, and increased conversion rates of our existing Cigna customers who are enrolled in other products, such as U.S. Commercial, Medicare Supplement or Part D pharmacy. Margins in the U.S. Government book of business are lower than the all-in Cigna Healthcare margins just given the nature of Government products. In our International Health business, our long-term expectations are to deliver average annual adjusted revenue growth of 8%-10%, with adjusted pre-tax margins slightly below the Cigna Healthcare book average. Due to the COVID-19 pandemic, Cigna Healthcare in aggregate was below our target margin goal in 2021.
We expected 2022 to show improvement in the margin profile, but still below our long-term target of 9%-10%. Our pricing execution and our numerous affordability initiatives are expected to deliver further margin improvement for Cigna Healthcare in 2023. Embedded in both the Evernorth and Cigna Healthcare financial goals that I just reviewed is the net effect of the enterprise leverage opportunity that we have between Evernorth and Cigna Healthcare. Stepping back and pulling this all together for the enterprise, the combined strength of our businesses gives us the confidence in meeting our long-term enterprise targets of adjusted annual revenue growth of 6%-8% per year, along with adjusted annual earnings growth of 6%-8%, with adjusted after-tax margins in the range of 4%-5%.
Now I'm gonna flip to our capital priorities and framework. As David and others have mentioned today, and evidenced in our financials, our highly flexible asset light structure generates a significant amount of cash flow from operations. We've intentionally structured the company to be service-based and to be asset light with very limited physical infrastructure needs, which helps us to drive an industry-low SG&A ratio, and this has positioned us well in a time of rising inflation. This asset-light model also helps us to flex rapidly during times of dynamic change in the market, including being less susceptible to variability in the labor markets. It also gives us significant financial and strategic flexibility. Our strong, consistent cash flow production currently generates a very attractive cash flow from operations yield in the high single digits. Longer term, we'd expect cash flow from operations to grow directionally in line with our earnings.
Between 2022 and 2026, we expect to generate cumulative cash flow from operations of approximately $50 billion over that five-year period, giving us significant financial capacity to deploy for strategic purposes. Now I'll walk through our capital deployment priorities and provide a little bit of detail on each of them. Our first priority is reinvestment back in our business to enable growth. Specifically, we'd expect about $10 billion or about 20% of that $50 billion to be used to fund capital expenditures and surplus to support our growth. There may be some potential variability from year to year, but on average, this is what we would expect. After funding these internal needs, the remaining approximately $40 billion of cumulative capital will be available for deployment over that five-year period.
Our second priority is maintaining a meaningful quarterly dividend. This represents a commitment from us to return value to our shareholders. We intend to continue targeting a payout ratio of about 20% of our earnings. This also happens to equate to about 20% of the $40 billion of deployable capital. We will also periodically repay debt to ensure that our target debt-to-capitalization ratio of 40% is maintained and to ensure that our credit rating remains investment grade. We'd expect to use approximately 10% of our deployable capital for this purpose, or about $4 billion over the five-year period. The remaining 70%, or $28 billion over that five-year period, is available to us for our final two capital priorities, share repurchase and strategic M&A.
We'll complement our organic growth through selective M&A in terms of assets that are strategically aligned, financially attractive, and have a high probability of closing. Broadly, we're focused on opportunities that will accelerate our strategy, either through delivering leading capabilities, expanding our reach and addressable market, or in some cases, building scale. As we announced in February, we are not considering large-scale acquisitions at the current point in time. Instead, we've decided to prioritize share repurchase for the current year, as evidenced by our commitment to repurchase at least $7 billion of our shares during 2022. While our share price remains discounted, we see share repurchase as a highly attractive use of our capital. In both 2022 and the subsequent years, our M&A priorities will be focused on two primary areas.
The first is U.S. Government programs and services, and the second is Evernorth health-oriented capabilities, such as those described earlier by Eric within the context of Evernorth Care Services. M&A in these areas must be aligned strategically to our enterprise goals and must carry high deal certainty. Any larger-scale M&A must also be accretive in year one, excluding transaction costs. As I noted earlier, we are not pursuing larger acquisitions at this point in time. We may pursue tuck-in acquisitions within our more scaled platforms in addition to those two M&A priorities I just described. This includes opportunities in our International Health business, along with targeted additions in specialty pharmacy, our pharmacy benefit services platform, as well as our U.S. Commercial business. Any of these tuck-in acquisitions must be highly attractive financially in order for us to consider them.
Ultimately, M&A is just one avenue we have to grow and develop our business, and we'll purposefully and intentionally leverage it. Additionally, we intend to organically reinvest in our business, partner for growth, and invest in earlier-stage ideas and technology through Cigna Ventures to position our company for success over the near, intermediate, and longer term. Specific uses of capital will vary from year to year, but the capital deployment framework I just walked through will largely guide our actions. Our capacity to execute against all of these capital deployment priorities is really a testament to the ongoing growth and strength of our businesses and our ability to generate very strong cash flow from operations. It demonstrates the efficiency of our asset-light, flexible framework.
Stepping back from all of this, as we leverage this powerful cash flow generation, we expect accretive capital deployment to drive average annual adjusted EPS growth of 4%-5%. Additionally, with our meaningful dividend, which currently yields almost 2%, the aggregate picture between 4%-5% of capital deployment accretion and almost 2% dividend yield drives a 5%-7% average annual return just on the strength of our capital efficiency. Bringing this all together, we have a very strong long-term shareholder value creation framework. I highlighted earlier how each of our businesses is positioned for organic long-term growth, building to an average annual adjusted earnings growth expectation of 6%-8% per year for the enterprise.
Our intentionally built asset-light framework gives us the ability to drive an additional 4%-5% of average annual adjusted EPS growth per year. That combines to deliver 10%-13% average annual adjusted EPS growth over the long term for the franchise. We have a strong track record of delivering consistently attractive EPS results over time. In fact, over the past decade, we've delivered 15% average annual EPS growth above our 10%-13% commitment. In over a decade period, that puts us in the top quartile of the S&P 500. We're confident in our ability to continue delivering on our outlook going forward. As we wrap up here, I just wanna reiterate a few points. First of all, Cigna's growth starts with our foundational businesses, Express Scripts within Evernorth and both U.S. Commercial and International Health within Cigna Healthcare.
These businesses are already scaled, they're competitively differentiated, and they have opportunities for further expansion in their respective addressable markets. We also have accelerated growth opportunities, including our Evernorth Specialty Pharmacy business and our Evernorth Care Services business, and within Cigna Healthcare, our U.S. Government business. There's tremendous opportunity to expand these areas, and they will be a larger portion of the enterprise in five years. Each of these businesses would be strong on their own, but we bring them all together. The cross-enterprise leverage that's created unlocks even more value for our clients, customers, and ultimately our shareholders. All this gives us the confidence in delivering on our guidance of at least $22.60 per share in 2022, and on delivering against the long-term growth targets of 10%-13% average annual adjusted EPS.
We begin to see opportunities in the outer years, as I mentioned earlier, between additional contributions from biosimilars ramping in 2024 and beyond, the maturation of our accelerated growth businesses such as U.S. Government, Evernorth Care Services, all of which could generate some additional EPS growth opportunity in the outer years. We see the opportunity for EPS growth to approach or even exceed the higher end of our long-term 10%-13% range in the outer years of the strategic horizon. With that said, we felt it was prudent to maintain our 10%-13% average annual EPS growth algorithm in the spirit of delivering in line or above our expectations. With that, we're gonna take a short break, and then when we come back, try to make it shorter than the last one.
We're gonna have all the leaders you heard from this morning up here on the stage with me, and we'll take your questions. Thank you.
Our program will resume in one minute.
Please welcome the Head of Investor Relations of Cigna, Ralph Giacobbe.
Hey, Ralph.
Okay, thanks. We're gonna move to our Q&A with our speakers. Just a few things before we get started. First, if you have a question, please raise your hand and wait for me to call on you. We'll have a couple of Cigna representatives walking around with microphones. Just please wait for the mic, so individuals who are participating via webcast are able to hear the question as well. Second, please identify yourself before asking the question. Then lastly, we ask you to limit yourself to one question so we can get to as many people as possible. With that, let's get started with the first question. We'll go to Scott.
Hi, Scott Fidel with Stephens. Nice to see everyone. Wanted to ask a question just on Medicare Advantage and the plan to re-accelerate the enrollment growth and get back to that 10%-15% long-term enrollment growth target. Obviously, we've had some sort of, you know, swings up and down when thinking about the trends in the Medicare Advantage growth rates for Cigna. Interested first, just as you sort of talk about that 10%-15%, I know, Chuck, you mentioned sort of getting back to growth in 2023. Just maybe if we can get some sort of specificity on whether you think you get right back to that 10%-15% or whether you see it as more of a couple year ramp.
Just related to that, whether you think that 10%-15% long-term growth you can drive just off of these organic initiatives that you have underway, or whether you also think that, you know, some of that sort of tuck-in M&A will be important for supporting that long-term growth target? Thanks.
Thanks, Scott. I think, David, why don't we have you start off with just sort of the overall framework, give some historical context, and then Charles, maybe talk about sort of the forward and the growth.
Sure thing, Bill. Scott, thanks for the broad framing of the question. First, to be clear, we continue to see this space as a very attractive long-term growth opportunity for the organization, to be fully clear relative to that. Two, the steps that we've taken over the past several years to position us for growth, moving from less than 20% of the addressable market already to 33% of the addressable market is a meaningful part of that. As you noted, our performance had ebbs and flows relative to growth over the recent past.
As we look forward, specific to a part of your question, you should think about the 10%-15% being on average per year over the strategic horizon, largely driven by organic activity that is within our control, aided by the investments that we've made in terms of expanding our reach, aided by the opportunities that exist with the aging population that exists both in the commercial as well as relative to the broader book of business. I'll hand it to Chuck to talk about 2023 and give you a little bit of guidance beyond that. Obviously, we're not guiding in detail to 2023 at this point in time.
Well, thanks, Scott. It's a longer-term process for us. I think as we indicated, and as you can see from the map, we're rapidly expanding our footprint. As we expand the footprint, we get in, we go to work to put ourselves in a better and better position to offer competitive products and grow. That's largely about optimizing the network for the product. Whether they're HMO products or PPO products, we're optimizing the network for both the composition to be able to offer the products and also for the economics to be able to grow and then achieve our target margins. So that's the process we're going through in each of those markets with this very specific on-the-ground plan.
The other thing that we do in addition to optimizing the networks over time, and it does take time, is install different programs that help us drive quality and affordability. As I mentioned, largely at this point, coming to us through Evernorth, so programs that might focus on things like post-acute care or high-cost radiology or just, you know, all the normal healthcare expenses that are trending high and where we can have a meaningful impact on affordability, which again, helps us offer better products and invest more in our products.
Let's go to A.J.
Okay. A.J. Rice from Credit Suisse. So you got 30% of what Cigna's cost structure on the Medicare benefit side looks like being addressed by Evernorth today. You're going to 50% over time. Some of that sounds like just some further penetration of what you already have. Some of that sounds like new capabilities. I wondered, are those new capabilities things that you're gonna develop internally, or does that include some tuck-in M&A? Any way to parse that out? Is it 50-50 type of thing? Maybe I'll tag on that. We hear a lot of benefit managers talking about being inundated with people presenting point solutions to them as opposed to the comprehensive offering that you're doing. How are you addressing that? Does that present challenges to you? Does that present opportunities to you?
Great. I'm gonna have Eric talk about sort of those cross-enterprise opportunities within sort of Evernorth, and then the point solutions as well, sort of the flexibility that we offer.
Great. Good to see you, A.J., and appreciate the two parts of your question there. In the first part, in terms of moving from 30%-50%, think about that really in kind of in 3 buckets. Think about the first bucket as we build and bring more solutions online, the examples of which Noelle demonstrated or previewed some of the capabilities we're building. We'll have those solutions to be able to drop into our relationships, and we'll drop those into
The insured business, they'll be available for election within our self-funded business, at a client level, depending on what's needed from our clients' perspectives. Think about that as kind of one. That election dimension, there's still opportunity there. We have solutions that we have on the shelf today that there's opportunity to do even more with throughout the U.S. Commercial relationships. The same goes true for our other health plan relationships as I teed up as well. The third thing I would point to is just we're focused in areas that are higher growth than average, right? The rate of growth in behavioral care has been in the teens or higher annually. The rate of growth from a virtual care perspective has been substantial through the pandemic, but continuing to grow.
The rate of growth that comes along with specialty pharmacy, where we're well positioned, is as a driver as well. So those elements of our solutions, our portfolio overall growing at a much faster rate than a lot of the market. So those would be the main dynamics I think about in terms of what will be behind us fueling there. You asked the question about could there be tuck-ins. Absolutely. There could be tuck-ins there. But again, we're not focused on that as the only way to help to build out that solution set. You know, and from an Evernorth perspective, we hear all the time the dynamic that you pointed out in the second part of your question in terms of needing help with bringing together these different point solutions.
that was a bit of the backdrop we tried to provide overall in terms of the approach we're bringing to not just staple those things together, but actually have a more holistic point of view, have our architecture set up in a way that we can interface effectively with those to bring a coordinated service experience overall. I actually see that as an opportunity for us to leverage the expertise that might exist out there or to build those expertise ourselves and have us be the connection layer for it.
And then, M-m-
Maybe, Ralph, just to amplify a piece on Eric's summary, come back on two pieces. One, I think what you heard from Eric is the inorganic opportunity, opportunistic. If that transpires, it accelerates the timeframe when maybe that curve goes from 30 to 50. When Eric walked through it, and Brian, think about that as today versus 2026. So potential accelerant. Second, the point solution piece, I want to come back to the way Eric articulated as well and what you call out. That's an important part of where we see opportunity in the marketplace today. It's not that the point solutions are bad or wrong, right? Point solutions inform us where there are new innovations or opportunity to address real or perceived points that are disconnected or arbitrage opportunities or value creators.
Often the more sustainable solution involves coordinating multiple point solutions. If you think about it in the way you live your life today, we all live our lives and consume services. Leave health and wellbeing aside, you consume some point solutions, but over time, you expect those point solutions to be a better coordinator around you. That's what Evernorth is positioned to do. That's what we're seeking to do. We have leading point solutions. We partner with early innovators in point solutions, but our intense focus is around coordinating and leveraging those point solutions together.
Brian, maybe just to pile on, you know, just the $10 billion-$20 billion was sort of the number that was up there. How would you frame it for folks? Because I know that's gonna be a question that we get a lot post this Investor Day.
Yeah. We described the opportunity over time, generating $10 billion-$20 billion of revenue opportunity for Evernorth. Again, that'll build gradually. We have not incorporated $20 billion into our revenue guidance, just to be clear. We've incorporated more like $10 billion over time into the long-term revenue growth algorithm. That provides us with upside potential over time to the extent we either accelerate the achievement of the 50% to total cost of care to David's example, or to the extent that we have greater attachment in the longer run of those services. That's broadly how you should think about what's embedded in the financial outlook.
Great. Thanks.
Take the next one from Lisa Gill.
Thanks very much. Lisa Gill with J.P. Morgan. Just as we look at Evernorth and the increase in the operating profit going from 4 to 6 to 5 to 7, can you talk about how much of that is actually coming from your expectations around biosimilars? As we think about biosimilars, either Amy or Matt, what are your thoughts around how they'll be placed on your national formulary? You know, as we think about Humira, will that shift its positioning on the national formulary for 2023? And how are clients or employers thinking about this?
We'll have maybe Brian go first to talk about sort of the guidance raise, and then we'll turn it over to Amy to talk about the National Preferred Formulary.
Yeah. In terms of the math, our long-term expectation of Evernorth now growing 5%-7% on both the top and bottom line compared to the previous 4%-6%, you should think of the delta as largely driven by three things, Lisa. The first one would be, we do expect an incremental contribution from biosimilars relative to our prior expectations. As each day passes, and we learn a little bit more, we get a little bit more fidelity, if you will, in terms of what to expect with the upcoming biosimilar wave. There's a component associated with that. The second component are the Evernorth Care Services that Eric talked through earlier.
As more and more of those are brought to market, and we have greater and greater penetration of those with our existing clients, you'll see a greater contribution there. The final one is the cross-enterprise leverage that we made reference to between Cigna Healthcare and Evernorth. Evernorth's a net beneficiary of that to the extent that Cigna Healthcare consumes more services. Those three things are the primary drivers of the step from 4%-6% to 5%-7%, but you should not think of any one of those as being outsized relative to the others. They're all contributors of the increase in the guide. If you wanna take the second part, Eric or Amy.
Absolutely. Appreciate the question on the formulary. Just to step back, National Preferred Formulary, again, is our largest commercial formulary within our business, representing tens of millions of patients. With respect to biosimilar specifically, it's too soon to tell you know, and to say what we'll do in 2023. At this point, remember like why we win. We win because of our strong supply chain expertise. Yes, evaluating all options with respect to pharmaceutical manufacturers, but also remember that we're a consultant to our clients. We're already talking to them about what we anticipate the number of entrants here with respect to Humira specifically, and being very planful in running a number of scenarios you can imagine. Too soon to say, yeah, in 2023, but absolutely looking to drive the most affordable options for our clients and for the business.
Great. We'll go to Matthew Borsch in the back.
Thank you. Hi. Okay, it's Matthew Borsch from BMO Capital Markets. I was hoping maybe. I know it's too early for 2023 guidance, although you're welcome to provide it if you had that. Could you just talk about some of the headwinds and tailwinds that you're contemplating, or maybe share with us at this point as you think about next year, what's gonna help you, what's gonna hurt you in particular, if there's anything that stands out?
Sure. Brian Evanko, Taylor.
Yeah. Hi, Matt. So you're right, it's too early. We'll play ball here and just give you a little bit of maybe contextual things to think about on both sides of the ledger, if you will. For one, in terms of tailwinds, we expect continued growth in the business across both the Evernorth and Cigna Healthcare franchises. We would expect to see volume growth stepping into 2023, which obviously is helpful. Two, in Cigna Healthcare, as I mentioned earlier, our target margin range is 9%-10%. We expect to end 2022 below that. We would expect some margin recapture in 2023, which gives us some tailwind on the income line specific to that segment. Lastly, we do expect some incremental contribution from biosimilars in 2023.
Now, that'll likely be a partial year effect, if you will, given in particular, as you talked about with Humira earlier, that'll be more of a latter half 2023 type of an effect, and then you'll have more of a build in 2024 and 2025 and thereafter as both that situation matures as well as additional biologics have biosimilars in the market. So those are things I would broadly think about in terms of potential tailwind stepping into 2023. On the headwind side of the house, we continue to make meaningful amounts of strategic investment in the accelerated growth platforms that you heard about today. So we would expect a meaningful amount of dollars to be continued to go into U.S. Government, a meaningful amount to continue to go into Evernorth Care Services, and we continue to invest in our specialty pharmacy capabilities.
Importantly, that provides some level of drag on the earnings in the near term until those investments start to pay off over the longer run. Additionally, whenever we have large clients, we tend to have setup costs that are associated with those. Both new client wins we have, as well as the large renewals that you heard about earlier from Eric with the Department of Defense and Prime Therapeutics, where we have some relationship expansion occurring. As a result of that, we tend to have in year one a little bit of drag on the margin profile before it reaches more of a mature state in the later contractual years. I'd broadly think about those as areas of potential tailwind and headwind.
Obviously, we also have respect for the uncertainty of the economic environment, but as I mentioned earlier, we positioned the company to navigate different scenarios around the economy.
Great. Thanks, Brian.
Ricky.
Thank you. Ricky Goldwasser, Morgan Stanley. Couple of follow-up questions. On 2023, clearly, early, but any sort of thoughts of how we should be thinking of, just employment growth given kind of like all the headlines that we're seeing? That's one. And then how are you thinking about factoring the inflationary pressures into enterprise pricing?
Great. Dave, maybe I'll have you start and frame sort of the overall environment, and then maybe Brian, take the inflation piece.
I just wanna be clear, on the first portion of, Ricky, your question, it was the recession employment dislodging potential and then over to inflation? Yes.
Yeah, 'cause if you think about the commercial guidance are at 0% to +1%, how are you thinking about within that context?
From a recessionary standpoint or a disruption standpoint, I think we need to step back and look at the backdrop that exists right now from an employment landscape. Most employers continue to confront an environment of a difficult challenge to attain full employment for their businesses to be vibrant. That's a little different dynamic than we're in today, than we might have been confronting other pre-recessionary times. I think it's rather important to think through that. Point two is, consistent with prior conversations, our commercial book of business, which is where your conversation on this topic is coming from, tends to be concentrated in subsectors that have less immediate disruption from a recessionary environment, and our prior history has shown that.
Pulling those two pieces together, when you think about recessions, earlier recessions a decade ago, the marketplace would have seen about a one-for-one movement in terms of disenrollment versus the unemployment rate. In the COVID environment, that was cut in half. A movement in unemployment rate versus disenrollment was about half. We think that the current environment will be more like the COVID-induced environment because of the underemployment in some of the organizations. Wrapping all that together, if you think about it in 2023, as it relates to employment levels or recessionary impacts on our commercial business, we would expect to grow our underlying commercial membership in 2023 at this point in time, given what you heard from Mike Triplett. I'll ask Brian to talk about inflation a little bit more broadly.
Yeah. Inflation broadly, as you think about Cigna, the direct component for us is predominantly in SG&A. As I mentioned earlier, we have a low SG&A business model, so we're less exposed than others might be in a rising inflationary time. That doesn't mean we won't have some level of wage inflation over time. We've contemplated that in our outlooks that we discussed here this morning. On the indirect side of the house, where inflation tends to make its way through is in our healthcare professional provider contracts within Cigna Healthcare and in drug pricing within Evernorth. The effects are slightly different within those different subcomponents. Cigna Healthcare, with respect to the provider contracts, we are seeing requests for higher than normal rate increases, if you will, upon renewal.
Now, keep in mind, the vast majority of our contracts are multi-year in nature. Three years is the most common term. 2022, the unit costs are essentially all locked in at this juncture, so we'll have some up for renewal in 2023, another tranche in 2024, another tranche in 2025. Our team, on behalf of our clients and customers, is using a data-driven approach to negotiate those rather than just accept the requests as they come in. We would expect, and this is currently reflected in our forward-looking pricing, some level of incremental unit cost pressure in 2023 compared to what unit costs would've been in the absence of the rising inflation that we're seeing now. Our forward-looking pricing contemplates that.
The contracts take a long time to negotiate, so we have enough lead time to reflect it in our pricing, and we feel confident that we're well matched in that regard.
Ralph, if I could just pull these two pieces together. If you think about it through a commercial employer lens or even a health plan lens, when there's dislocations or non sequiturs in movement, oftentimes that's where our solutions perform the best. In an environment of disruption, we, in many cases, see accelerated adoption of some of our more innovative solutions. Maybe some more accelerated leverage of alternative site of care opportunities within healthcare. Maybe some more aggressive use of integrated programs to enable costs to be taken out of the system by improving quality through that lens. Those are additional tools and additional opportunities that any level of disruption create in our consultative approach, pulling on the breadth of what Cigna Healthcare and what Evernorth has as well.
Go to Kevin.
Kevin Fischbeck from BofA. Question, I guess, on the commercial business. I was a little bit surprised about 4%-6% as kind of the long-term base assumption. I guess I would normally think about the lower end of that range as being how I would think about it, as 4%-6% being the risk growth. But then you've got ASO growing less than that, and then some shift from risk into ASO every year. I just wanna see if there's anything else that we should be thinking about when we think about 4%-6% of commercial. Are you thinking or are you adding specialty or anything else in there? And then is there anything else that we should be thinking about as far as the Select?
If you're growing in Select More, does that mean your business mix will, over time, move more risk versus ASO, or is there any implications from that?
Okay. Brian, why don't we start with you, and then maybe bring in Mike to talk about sort of how we went.
Yeah. On the first piece of the question, Kevin, there's obviously a range of estimates on forward-looking cost trends and revenue implications, which is why we presented a range of 4%-6%, which reflects our estimation of the all-in commercial market with all the associated services that would be equivalent to how Cigna Healthcare would talk about the market. We feel like mid-single digits from the standpoint of secular growth is a reasonable estimate based upon all those factors combined. Relative to our business, you're right in terms of if there's outsized growth in the Select segment, that will drive, relatively speaking, a little bit more guaranteed cost business, vis-à-vis ASO.
Where we do have self-funded or ASO arrangements, they'll be more integrated, meaning we'll have more of our solutions and products attached to them, which will generate additional revenue opportunity for us. All of that is why we have confidence in a low double-digit revenue growth in Select, which will help to fuel the above secular growth expectation that we have of 6%-8% average annual commercial growth over time. Mike, you wanna talk maybe a little bit about how we win in Select and how the funding arrangement decisions come through?
Absolutely. We've had a really strong track record of growth. There we've got a very strong outlook. As we think about what we've done in the marketplace, we are prioritizing our margin and rate execution, but we are driving very hard on affordability. Affordability that allows us to expand our addressable market and enables growth. It allows us to quote more business, to win more business. At the same time, we're not sitting still. We are continuing to innovate, improve on our value proposition. When you think about Select in particular, it's not about cross-selling, it's not about bundling, it's about producing a result for a client that helps them attract talent and helps them move to alternative sites of care.
As I'd said in my prepared remarks, we expect to grow Select at an outsized pace from a membership perspective to have strong revenue growth over the long term in the low double digits. With only a 6.5% market share, we feel we have plenty of room to grow. We're confident in our ability to continue to deliver. To the latter part of your question, ebbs and flows, whether insured or whether ASO. At the end of the day, it's about 85% ASO, 15% insured.
George.
Okay. Good morning. George Hill from Deutsche Bank, and thank you for taking the question. I wanna circle back to the biosimilar topic a little bit and talk about CuraScript. I guess, could you remind us which provider types the CuraScript business tends to serve, and which disease states that business tends to be most exposed to? How do you think about how you expand the scope of CuraScript, as you grow that business going forward? Like, what types of providers you can have access to. I think a lot of us, when we think about the biosimilars market, we tend to think about the drug wholesalers as being exposed to that segment as opposed to Accredo. Maybe does CuraScript roll up into Accredo, or is it carved outside of Accredo, inside of Evernorth? Thank you.
Okay. Matt?
Yeah.
I'll have you address sort of the different components of CuraScript.
No, thanks for the question. One, I would just say we're very excited about the fact that we have a differentiated set of capabilities within the specialty space. We think of Accredo and CuraScript as separate businesses, but certainly there are capabilities that we can leverage across both to drive greater affordability and care. CuraScript has a strategic focus primarily on more infused and injectable medications. Think of those as medications that are primarily gonna be administered under the medical benefit. Physicians offices, health systems, infusion centers, specialty pharmacies tend to be the customers of CuraScript. As I think about, you know, one of the big differentiators that CuraScript has in particular also is an expertise in rare and orphan drugs.
The fact that we can leverage both Accredo and CuraScript to generate better levels of affordability and better levels of care, and be able to manage some of the most complex medications all the way down from the manufacturer to the patient, is a really significant differentiator when you look at the drug pipeline, in particular with the focus on more of those rare and orphan drugs that are coming to market.
Go to Josh.
If I stand, I might not be able to see it also. I apologize. You've said you don't wanna own physical delivery assets. I guess what gave you the confidence on that alignment? Is there ultimately risk that health systems or even large provider groups align with competitors in some way at the local level, and Cigna's kinda forced to compete on more of a fee for service-based network with sort of what's left, you know, if there's sort of one large health system with you know, something else in the market?
David? Yeah, I'll turn it to you.
Yeah. Josh, first, let's talk about what we seek to own and why, and then address the core of your very important question. Throughout the course of this morning's conversation, hopefully you all received the flavor of we're deeply committed to a sub-segment of the care delivery space. When Eric walked through it, he walked through the large $2.5 trillion care delivery space, and the $370 billion that we're currently focused on that is gonna essentially double between now and 2026. That includes virtual, behavioral, specialty, and aspects of home care. We see those assets as fast-growing, leveraging coordination, national and multi-geographic in nature, and able to deliver differentiated affordability and quality.
Now, as it relates to physical assets and physical asset capability delivering, as we said before, our preference is to partner, enable, and deliver shared results. I mentioned our value-based care relationships, which are those partnerships that range anywhere between 40%-75% of our reimbursements that exist through our book of business from commercial to exchange to Medicare Advantage, are in value-based relationships that are mutually successful and engendering value. Lastly, Josh, two additional points. One, as we go forward, might we own physical delivery in certain geographies 'cause of unique attributes? That's possible. It's just not our national strategy. That would be a local accommodation for unique attributes, et cetera, from that standpoint.
Finally, I think with your thoughtful point around might you be boxed out relative to certain integrated delivery systems, I'd actually flip that on its head and say we have a lower probability of being boxed out 'cause we're not in competition with the core of their business. Actually, we're seeking to complement the core of their business and extend their care delivery resources. We're not seeking to disintermediate care professionals. We're seeking to step into the need to extend care delivery, and care delivery assets in a variety of ways. We take the opposite of that risk, and if we see that risk in a unique geography, we have the capital, the wherewithal, and the operating model to own assets, but that would be an accommodation to a local geography.
Go to Steven Valiquette.
All right. Thanks. Steven Valiquette from Barclays. For Medicare Advantage, you mentioned that your current geographic footprint today overlaps with 33% of the addressable market. Your goal is to get that to 50% addressable by 2025. I'm curious whether or not you expect any notable drag on margins in relation to that expansion, or can you absorb that and still hit your target margins either for the MA book or just overall Cigna Healthcare segment margin targets during that timeframe? Also, how big is that geographic expansion piece of the equation to get back to 10%-15% MA membership growth versus just deeper penetration of the existing markets? Thanks.
Maybe I'll have Brian start it off, just going through sort of the margin target, and then just how it fits within sort of the geographic expansion.
Sure. Yeah. As we expand into new geographies, whether that's the 33 to the 50 or the historical new expansions that we've done, Steve, there is drag when we enter a new market, because by definition, we're setting up infrastructure in a geography before there's revenue. Right? We're hiring people on the ground. We're putting marketing out into the ecosystem, et cetera, before the revenue comes in. There is an element of drag in our financials that will continue to transpire as we expand new geographies. Importantly, as you look at the portfolio of all the MA markets, the ones that are mature are performing well today.
The weighted average of the book is below our long-term expectation of 4%-5%, but the ones that are mature are already performing in line with where we'd expect them to be. Importantly, you gotta look at the weighted average of the book at any point in time to determine where we'll be on that margin profile. Also, as I mentioned earlier, we continue to make outsized strategic investments in Medicare Advantage, separate and distinct from geographic expansions. Our technology infrastructure, our people, et cetera, is also a bit of a drag on the P&L in the near term. Over time, the glide path will get to our 4%-5% range, but it won't happen overnight, as we contemplate those dynamics.
In terms of the second part of the question, David, you wanna chime in or should we go to Chuck on that?
Maybe I'll just bridge across to Chuck. Chuck, maybe I should expand. If you think about the crosswalk, you had about the 2% market share, the 5% market share, and the 8% market share. As indicative as we open up more markets, we have this pipeline of harvesting the benefit as those markets mature. Maybe describe that.
Yeah. Well, I think it's a process that takes time. Each market's different. What I would say about the maturing markets, the ones that are represented today, we refer to the 8% market share. What that means, in part, is that we've been able to optimize our network, both in terms of composition and economics that work for us and for our products longer term, which drives directly back to our ability to achieve those target margins. Each market's different. It depends what our starting point was. These markets are just different. New York's very different from L.A., which is very different from Chicago. That's our game plan.
We have a strategic plan in each market to be able to drive affordability and networks that allow us to achieve our target margins over a reasonable amount of time, which is related to the investment we're making in that market.
Take one from Nathan.
Great. Thank you. Nathan Rich from Goldman Sachs. First question is on the Cigna Healthcare margins. You know, Brian, you talked about them improving in 2023. I understand there's some near-term repricing that you're doing. When we look longer term beyond that, what do you see as the major drivers of margin expansion for the Cigna Healthcare business? Then if I could ask a follow-up on the capital deployment strategy. You know, I understand M&A is not a big piece of the strategy now. When you look at, you know, I guess I'm interested in, you know, the criteria that you're looking for, whether it be from the business or the external market, that would potentially make you kind of shift your philosophy in making M&A maybe a bigger priority than it is right now. Thank you.
Okay. Two for Brian. First on the healthcare margin trajectory, and the second on capital deployment, specific M&A.
Yeah. As it relates to the first part of the question, our margins in Cigna Healthcare in 2022, if you take our guide of $3.95 billion of income divided by the estimated revenue, you get a mid- to high-8s margin profile for Cigna Healthcare, and we said the target range is 9%-10%. We're not that far away from being within the target range. As I mentioned earlier, we would expect some margin expansion in 2023. In terms of further opportunity to have that creep up, there's a little bit of the maturation of the Government business, coming back to the last question, that over time you'll get some margin expansion there through scale and through some of those strategic investments starting to pay themselves back.
I wouldn't really call anything else out beyond that, Nathan. In terms of the M&A landscape, as we talked about in February, we thought it was important to provide clarity as it relates to this year in terms of our expectations around uses of capital. We're constantly monitoring the landscape for assets that are of interest. We may do smaller acquisitions this year, as I made reference to. Some important things that we look for, though, in terms of your question on are there catalysts that would change our point of view? Obviously, valuations matter, right? We look at relative valuations of assets that are of interest to us.
If we have to use debt for anything, we obviously care about the cost of the debt, because we're very financially disciplined when it comes to M&A and make sure that we'll generate attractive accretion off of anything. Then, as I mentioned earlier in my comments, having a high probability of closing is important, so we go through any type of an antitrust review as a first filter, before we get too far down the path with any potential prospects.
Ari?
Ari Klein, Neuberger Berman. Two questions from me. First, can you just go over the virtual interactions target of 40%? Where are you today? My understanding, the industry is, like, less than 10%, so that seems like a pretty aggressive target. How are we gonna get there? Then two, Brian, can you give us some real-time insight in terms of how people are treating COVID these days? Obviously, we're going through another wave, but it doesn't seem like anyone's spending money. Are you seeing people spend money, or are treatment costs basically down to zero? Thanks.
We'll start with on the virtual side, Eric, to start off the question, and then Brian can take the COVID piece.
Yeah. Appreciate the question and the framing. Indeed, 40% is a big jump from kind of the industry or the overall ecosystem today. There are a number of things that we think will be impacted over time there. One, there's just that there, you know, I think actually COVID has helped to accelerate use of familiarity with and comfort with digital tools as points to access. That's actually accelerated things by a handful of years probably versus what we might have envisioned, you know, before the pandemic. Two, the ability to connect the ecosystem from a, you know, again, from having data monitoring metrics coming from around the individual, actually help to make care more effective from a digital and virtual perspective as well. Bringing that through is important.
Three, there's additional specialties that we already have, whether it's in dermatology or others that will be coming on, where physical presence is less important. Four, I would say shifting away from every interaction being a reimbursed transaction to having a focus on outcomes overall means we can use care differently. This gets back to the line that was at the end of the video that I emphasized around building the healthcare system that we need, not just kind of you know forcing folks through the ones that we have today. A lot of healthcare opportunity exists by getting people the right kind of check-in points, giving them the right information, working to have the right support around them in terms of helping to address conditions and help them stay healthy in the first place.
It's those types of things that are in the path to get us to 40%. Last thing I'd say before handing it over would just be around the opportunity from a virtual behavioral perspective, right? We saw in COVID that almost instantly the behavioral platform on MDLIVE went to being adopted and ended up being two-thirds, you know, or more of the usage of our behavioral visits were serviced in a virtual way. That utilization has stayed that way. This turns out it's a better way to address those conditions. Continuing to build on that as an opportunity as well. It's small. It varies depending on the adoption of how it's utilized, how it's incented, et cetera, but it would be in single digits in total.
I would just amplify a couple pieces. One, the 40% is not underlying the business plan that was discussed today. That's to step back and say that's the opportunity that exists in the United States relative to reformatting the way care is delivered, and it's also responsive to the fact that we have a lack of supply of certain capabilities as a country, at least in geographies, whether they're behavioral professionals, primary care physicians, OBGYNs, pediatricians, geriatricians, et cetera. One, just make sure the audience knows we haven't built the business plan over achieving 40% by 2026. That's stepping back and saying, as you reformat the marketplace, both on pathways to care, as Eric articulated with behavioral care, et cetera, the art of the possible in terms of what sits in front of us.
Year-over-year, our virtual care consumption, Q1 of this year versus Q1 of last year is up 29%. As an illustration, that doesn't mean check the box. We operate the largest now virtual behavioral network in America, and we have behavioral health services that are able to come down to children age 10 and above, as an illustration. This is a journey. The size of the opportunity is tremendous. We need it from a supply chain extension. It creates more value, and we see tremendous growth, as Eric articulated in his prepared remarks as well. I'll ask Brian to peel apart your important question on COVID now.
Yeah. Good morning, Ari. Obviously a very different question here in terms of what we're seeing on the COVID side. We do continue to incur costs associated with COVID-19, despite the subvariants working their way through the system now being less severe. We have fewer people being hospitalized, and the average hospitalizations tend to be shorter in terms of the length of stay. This year, if we look at, for example, our inpatient admissions, the average cost is 60%-70% of what it was last year. The average severity has lessened. We continue to have COVID costs on the treatment side. We also continue to have testing costs, both PCR and OTC tests that we pay for. To your broader frame, obviously, we're back to normal here face-to-face in New York.
We have a lot of our customers that are back to normal. Even when I had COVID, I had no claims because it was an OTC test, and then I used OTC meds to treat myself, right? We have a lot of our customers that will not show up with claims, but we do continue to have costs that are incurred. That's been contemplated in our 2022 guidance, as we talked about in our first quarter call. We remain confident in our ability to deliver against our EPS outlook.
We have time for one last one. Ben. In the middle.
Hi, Ben Hendrix from RBC Capital Markets. Just had a quick follow-up on Medicare Advantage. You've discussed your right to win through your provider networks, the agents and Evernorth, et cetera. Can you talk more about some of the structural competitive headwinds we're seeing in the market, the increased shopping behavior, distribution channels, and some headwinds we've been seeing through the D-SNP markets? What is your distribution strategy, and how do you expect to generate persistent growth going forward?
Sure. Maybe I'll ask Chuck to start around sort of some of the structural sort of competitive dynamics in the industry. Maybe David to sort of follow up with any sort of incremental color on the backdrop.
Yeah. Well, for us, it's, you know, since we're in this phase of growth, it's about designing a distribution channel strategy for each market that we're in. We're definitely focused on the right marketing and tools that help us, one, sell to new customers, and second of all, access our current Cigna customers. We know others are sort of focused on their own strategies, but that's just part of our plan to provide the products that the brokers and the other distribution agents want to sell to their customers in our local markets. I don't have much other comments on what others are doing.
Bridging across, it's clear that you could grow in this market pretty significantly. The question at your core is, can you retain the relationships, and can you retain the relationships successfully? As Chuck went through his prepared remarks, he amplified the imperative relative to the provider relationships and having the well-honed provider relationships that are matured and that are value-based. 75% of our provider relationship reimbursements are value-based in nature. Then the NPS side of the equation, we've run for multiple years now with a Net Promoter Score in the 70s from that standpoint. The focus of your offering, making sure you're not trying to be all things to all people and working within the provider network is mission-critical. Then having this as a part of our business portfolio, where we could be disciplined, I think is mission-critical.
As it relates to the distribution piece of the equation, we have a mixed model, right? We have captive resources, we have partnered resources, and then using a data-first approach, you could determine whether or not your partnered resources are aligned and on strategy or less aligned and not on strategy. We have the ability to flex with our captive capacity or our colleagues, as well as variable capacity or other players. It's clear that the marketplace is going through an environment of change. Having this as a part of our portfolio, being highly focused geographically, being highly focused relative to the provider strategy, having a high NPS, is what gives us confidence we could have sustained attractive growth over time.
Great. Thank you, David. That wraps up the Q&A portion. I'm gonna excuse the panel and ask David to make some closing remarks.
Okay. I'll be brief because we've had a long block of time here. Let me begin my wrap-up with where I started. We appreciate your time. We appreciate you prioritizing your time to both physically be with us here in New York City, as well as joining us virtually to have a conversation around Cigna and where we see the growth opportunities going forward, and your active engagement, both formally during the Q&A and informally during the breaks. I wanna leave you with a few thoughts in terms of why Cigna in this current environment. Interestingly, even with the Q&A, there's some reinforcement to the why Cigna five points that I'm gonna walk through, reinforced by many of your very thoughtful questions. First and foremost, we see very specific secular tailwinds in our business, in the way we've configured our business that are quite attractive.
To remind you, the pharmacological innovation that we believe is indisputable over a long period of time, including the biosimilars, the connection between mental health and physical health, and the need to coordinate those services to deliver differentiated value, and the tremendous alternative site of care opportunity that exists in front of us as a society over time. Those tailwinds alone present significant secular reinforcement to our business strategy. Two, our business portfolio is built for a dynamic environment, and many of your questions go through dislocations, rightfully so. Having focused yet multiple capabilities, be they service-based in nature or benefits-based in nature, are mission critical to having a sustained track record that Brian walked through before in excess of a decade of delivering on our promise and exceeding our promise by delivering 15% EPS CAGR over an excess of a decade.
Having a business that's built for a dynamic environment is mission-critical, and our Evernorth service portfolio and our Cigna Healthcare benefit portfolio is just that. Third, differentiated capabilities. All businesses have to generate a level of differentiation. As we summarize at the enterprise level, the three pieces we amplify there are the consultative nature in which we are excited to be invited to be a solution partner to those we serve, and pull from information, a highly talented, tenured, experienced team, and then a broad array of solutions to put together the solutions that work for our client at a point in time, but then recognize that's just a start. That evolves over time. Secondly, our commitment relative to innovation and partnering.
Not just innovating and partnering, and our track record of working in partnership with others to accelerate innovation as well as innovations we're able to bring forward. Third, our proven commitment to ESG and how we've converted to be part of our business strategy, driving a well-governed organization that's changing people's lives for the better. Fourth is our multiple pathways to growth. We have multiple pathways to growth that are in front of our organization that exist within our diverse portfolio, be they foundational in nature or accelerated in nature. We've rapidly positioned this portfolio to have 60% of our revenue or $100 billion that's foundational, and fully 40% or $70 billion that exists in accelerated growth markets. As Brian illustrated, that mix of 60/40 will rapidly shift to 50/50 with the growth objectives that are in front of us.
Finally, focus priorities. We're quite a focused organization. We're not perfect, but we're quite focused in terms of feeding the organization and driving and executing. That includes disciplined, continued investment in our foundational businesses. By the way, over the last decade, that's why we continue to win on a differentiated basis there. We don't view those as stale businesses. We view those as dynamic businesses and the ability to differentiate yourself. It includes accelerated growth and savings opportunities to come from the specialty business, inclusive of the biosimilars. Our priorities include our ability to continue to build and grow our Evernorth Care business, which is already $10 billion of revenue and growing, as well as within our U.S. Government business, what we've amplified today, our Medicare Advantage business.
Fifth, our unwavering commitment to drive and innovate on a digital-first framework because we believe the opportunity is now. The value is significant to deliver more personalized, coordinated, high quality, real-time, affordable care. Not to the exclusion of the traditional way care is delivered, but to extend the traditional care delivery system and make care more present at times when our customers and patients need it, and working in complementary fashion with healthcare professionals to be able to achieve that. All of this gives us confidence in our ability this year to deliver on our recently increased EPS outlook of at least $22.60 that we increased last quarter.
would remind you that from 2020 to the end of 2022, we will have returned approximately $21 billion to shareholders through both share repurchase and dividend, underscoring the strong generative cash flow nature of our business. It provides us confidence in our ability to reaffirm our target and commitment, right? Targets are easy. Our target and commitment to generate on average 10%-13% EPS growth over time, acknowledging over a long period of time, we exceeded that objective. We put targets forward to achieve them or strive to exceed them. A lot of this is fueled by and enabled by our asset-light service business model that allows us a level of malleability and speed to innovate, as well as the high-performing cash generative nature of what sits in front of us.
We yet again are configured with approximately $50 billion of deployable or operating cash flow, of which, as Brian articulated, $40 billion is available for deployment in front of us after we've served growth needs. We thank you for your time. We thank you for your attention. Throughout the course of today, you get a flavor for our business' positions today, as well as the tremendous growth opportunity that sits in front of us. My final comment is, hopefully you feel the deep commitment our team has, not just to grow a thriving business today that has an excess of $177 billion, but to make a difference in people's lives each and every day, because that's what earns the right to serve or the opportunity and privilege to serve the next day and the next day.
That's what presents us the opportunity to partner with employers, health plans, healthcare delivery systems, and governmental agencies. Those two items need to be fused together. That's deeply rooted in our culture, and our proven track record relative to sustained growth is reinforced by that. For those who joined us through Webex, this will draw the conclusion of the formal part of our Investor Day. We thank you for joining us. For those who are physically here, with us in New York City, it also draws to a closure, but our team will be waiting around for a period of time, both those who presented, as well as our extended leadership team. Outside, I believe we have grab-and-go lunches for you. To the extent your schedules allow to hang around for a little bit and grab a bite to eat.
Knowing the curious nature of everybody in this room, to the extent you have additional questions, our colleagues here look forward to extending that conversation. Thank you again.