Hi, good morning everybody. Thanks for joining us. My apologies, we're late because it's my fault. Time zone confusion. It's my pleasure to welcome The Cigna Group to our conference and Northwell, CEO, Eric Palmer, who's going to make a few introductory comments, and then we'll move into Q&A.
Thanks, Gary. Good morning everyone. Thank you. I appreciate the opportunity to just couple of comments on the Zoom chart given our previous assigned responsible man of cloud of our organization for delivery in 2021. 2021 was Evernorth for two years, as a brand, as a unified kind of business unit. 2019 to here, Evernorth delivers 14% revenue growth in 2021, 9% earnings from this. That's a really nice foundation for what we want to do for the future. More in aggregate, I've seen the corporation delivered on its earnings this year besides last year as well, which was certainly fulfilling for me, having just been involved in setting out a long-term target a number of years ago. To those who returned to 2022, been through this year with momentum and with strength.
Continue to see really strong demand for our services, as we continue to build on the depth of our client relationships and continue to build out wins on the board. Strong retention, mid-90% retention within Evernorth, and a conclusion of a couple of losing to decisions that were made centrally in more than a year ago. I want to continue to leverage Evernorth's facilities to respond to the three forces that we think are fundamentally changing the future of healthcare, and that is pharmacological innovation, link between medical and physical health, and the movement toward care being in a lot of different places, specifically home and virtual. I've picked 2022 to be a strong year for Evernorth. We've already guided to driving top line at a patient 4% revenue growth through this segment. Bottom line at 5% in line with our long-term targets.
As we look longer- term, I'm really encouraged by the growth of The Cigna Group as it continues to deliver. Cigna or specialty pharmacy continues to be a leader, I'd argue the leader, in the specialty pharmacy space at the third of Evernorth Avenue, provides differentiated contributions, differentiated value proposition in specialty pharmacy care, which is an area that's growing rapidly. Biosimilars, Cigna a really exciting opportunity for us to see the capabilities that we've tapped to bring together clinical expertise, specialty pharmacy expertise, supply chain expertise, and match those with the needs of our patients and our clients. Evernorth is going to continue to grow and thrive with significant demand for behavioral care. I want to continue to build on our capabilities at Evernorth. In closing, from an opening remarks perspective, I think we're well- positioned for future growth.
2022 is going to be another strong year for Evernorth, and I'm always proud of Cigna Enterprise. I'm very good wishing that to Dr. Kautzner.
Sorry to rush you in. The Zoom session before we were talking about Northwell, so then I said Northwell instead of Evernorth. I'm just compounding my errors this morning. Let's see if I can recover and add something that will be helpful for our clients. I'm sorry to rush you, Eric. Can we talk about Evernorth? Talk about competitive landscape. I've had a number of questions from folks about like CVS had a really strong selling season. I'm just wondering if there's any change there. You mentioned Evernorth's retention, but is there anything to point to around health systems that have switched or, you know, anything or even just sort of coming out of the pandemic? Should we be anticipating like a, you know, higher switching and a little more turnover? What are your thoughts on the competitive environment?
Yeah, I think it's important to say there are no worries on the pandemic and that sort of thing. I think at a macro level, I would not call out any particular changes or things that would be particularly unusual from a cycle or things along those lines. I think we continue to do really well from a competitive perspective. We've got new demand to already sign up for competition or right in the thresholds of the selling season for 2023 on the smaller mid-series health plans and the commercial accounts who are already talking to particularly larger plans for 2024 and beyond. I'm just trying to continue to feel positive and optimistic there. I would not call out on any change of switching or things along.
I know most investors still view Evernorth through the PBM lens, and obviously that's a large part of what keeps you with Evernorth. Maybe could you talk a little bit about the contribution that some of the other services that you started to bring into the segment are contributing to its total revenue profile? Is there a way to think about, you know, here's sort of legacy PBM profile, but then here's the growth profile of specialty pharmacy and pharmacy services and behavioral and some of the other stuff that you've brought into the division?
Yeah, of course. Kind of looking at it hypothetically, there certainly is a meaningfully scaled business in the form of pharmacy services with sales. We should talk about the components of what drives the revenues and the lifestyle. I think there's a couple of different things. First of all, as a pure specialty pharmacy, that's something like a third of Evernorth's revenue overall. That's continued to grow. That's what I was saying in my opening remarks. That continues to be something where we've got a leading set of capability kind of selling at a decent rate. Within the quote-unquote PBM, kind of the legacy of the PBM, this is an area that continues to evolve as well. You've got clinical solutions, you've got our home delivery operations, you've got our business plan programs where we're administering some of the values for managing the supply chain.
Each of those is modular contributors as well. I want to make sure that we walk past here to touch on the pharmacy as those elements are the biggest components of the revenue model as we sit here today. As we look ahead, virtual care is holding on to rapid growth to continue to drive out of FDI. Behavioral health is holding on to the behavioral growth that we've had in terms of surveys. It's in the book of business, other trends as well. Pharmacy is holding on. Our other corporate ground is holding on to the use of our data and intelligence as an enabler. Those are all being higher growth areas as smaller elements of the delivery of the picture right now. We should expect a lot more closure around some of those items as we get later in the year. We can also have a discussion today as it provides for.
Talk a little bit about behavioral and what do you think the long-term importance of that is within the scope of both Cigna and Evernorth? You've seen some announcements about your relationships with Ginger and [VLI] I'm pronouncing that properly. What's sort of the vision for behavioral and how do you see that growing within Evernorth?
Yeah, I think behavioral is going to be an important element of the historical value subscription to some kind. I think if you just now, over the last couple of years, going to be more of a situation for the important time that kind of the mind-body connection is taking place. On top of that, pivoting as a closer accelerated some of the stresses and the dynamics that have kind of made the team even more upfront from a behavioral perspective. Evernorth going forward is a real opportunity for us to be in a position to observe in a more digital way. I think it's even leveraging VLI as an example as a way to engage and connect individuals with to add subscriptions. Sometimes Cigna is going to teach someone you've done some of the privacy in your home, in your car, or whatever.
One of the things I think is just fascinating is we saw a huge shift in behavioral services to virtual meta and fashion a few years ago now. It's changed that way by and large. Clinical services were changing to open that up. I've gone somewhat all the way to the level of the sort of pre-pandemic because of the change in virtual care. Behavioral changed that. I used to go to the connectivity of behavioral care in this setting has been one of the things I think of as well. I think that Evernorth's mission to not just address the behavioral visit, but then actually connect with the right dimensions of what other typical care does an individual need or vice versa. Have a medical visit and recognize that someone's in need of behavioral care and we can come out and help them.
We know that when we've got the right types of interventions and the same engagement on a behavioral or mental health type of a diagnosis, we can give to you lower total cost of higher productivity and a better position for employees of Cigna overall. We have an expertise and more business cases. Anyway, the opportunity is set for even more deeply connecting behavioral care into the healthcare ecosystem is significant and has been one of the right parts too, I think, in this way.
Am I right though that that component of the business resides in Evernorth for the healthcare services side of it?
Yeah, sure. I'll mention the historical connection just to point out that some of the capabilities that were part of legacy Cigna.
Got it. How do you think about, you know, you talked about sort of three significant now macro trends, and one of the things I was curious about is how do you seem to do, or do you need to invest in sort of the trend of site of care? You know, you've seen other companies, other healthcare companies that either have ambulatory physician, surgery centers, home health, urgent care, sort of different things. I think you guys would agree there's a pretty significant opportunity around, you know, site of care. Is that something you still intend to drive contractually? Do you think there's an opportunity to invest in that opportunity? How do you think about it?
Yeah, I think there's an opportunity to build on what we already have in terms of owned assets in this space, which do have a number in terms of the provided care around in the home. It's a whole much bigger than we would be according to that element. Of course, partnerships are going to be important as well. Partnerships are an important kind of foundational element of how we do business. We'll continue to invest in resources, but we'll also continue to grow our capabilities. Here again, a good example that points to the life of every life. I would point to the life of what we already do today in patient homes is fantastic. We have clinicians that can cover over 90% of the country now and to date, let's spend the point on a pharmacy life. That's a nice chance to sell off of.
We've got programs that are helping the individual be in, you know, acute care in the home, whether that's providing clinician or primary care in the home or other types of just acute services that entities have. Those are more limited geographies, but we would see that as an opportunity to typically build on that as an ownership perspective as well.
I think I'm going to value this here a little bit, and I was going to ask you about your, I can't even talk today, your Ally, which I think resides inside of Evernorth. I think it's a consulting business that helps physicians transition to risk. It popped up on my radar because I saw it on a list or a ranking you were doing, top 20 consultants, physician consultants, and it was ranked very highly. I imagine in the scope of Evernorth, it's a pretty small piece, but do you want to talk a little bit about what your Ally does and sort of the broader value-based care strategies inside of Evernorth?
Sure. For sure, Ally's kind of went where it is, so that's a service that aims to drive value-based contributions on physician needs, right? That helps to enable the physician to move to value-based care. We're going, that's a staggering action to sort of transform the financial element of this business to set more of the efficiency of our most deeply rooted value-based collaboratives, that collateral for clients, but companies collecting accountable to organizations, their Ally's concerns at the core of enabling those, again, Ally's in their lives to provide measures, right? Etc, to stay. That's to tell you some of what your Ally is. In terms of its as an activity or its as a P&L, it's very modest.
In terms of the outcomes it can create though and helping to get more aligned for driving to better outcomes in terms of payment and the life from a physician perspective, it's pretty powerful and it's just a part of how we line up the subscription work that we provide for The Cigna Group Health Plan as well as for, you know, some of the other non-Cigna Health Plans.
Does Cigna Ventures fall under Evernorth in your umbrella, or is that something I want to ask about? I don't want to take your own distraction.
Cigna Ventures is a capability that is generally part of the Enterprise Holding Company. I have a board seat on it. I'm very involved in it. I think of it as an internal innovation driver for the Enterprise. A number of the areas is probably aligned with, I would say, as well, but just to be clear, it is.
Got it. There was an announcement from additional funding into Cigna Ventures last week. That sounds like you guys are in a line. Anything to call out? Like you talked about, you know, the three sort of significant macro factors and opportunities that Cigna as a corporation is trying to seek to guarantee. Anything Cigna Ventures is doing that is unique or different or worth calling out or really just aligned with, you know, take keys for what your opportunities are?
One of the other couple of things I would talk. One, it's been, since we just announced that we were getting another $250 million in large matures fund. This is on top of four or five years ago now, we had to deploy $250 million into the first kind of launch of interest. That's been tremendously successful for us, both in terms of the financial returns, but I would say even more based on the conditions I've seen this past year with new and innovative partners and things along those lines. The recapitalization or the increase of the $250 million is intended to continue and build on the success that we've got there. Again, in terms of areas of focus, I'm about it is aligned with those courses that we talked about. I talked about it as aligned with defining a partner's potential opportunities to create healthcare workflow.
The Ventures is actually where we first started to do SAMD Live and that turned into a connected partnership that ultimately comes to an end with the acquisition that we acquired the entirety of the company a few years ago. The other thing I definitely note with the Ventures work overall is for them to really interesting to, I think we are differentiated in terms of how we can work with a partner or not. We don't show up just with a checkbook. We show up with opportunities to test and evaluate to and advance their business models as well. With either your clients that we've got that are our business or development programs that we've been following in relation to grant and investment, particularly values all throughout. It's been a heavy set to deploy.
Okay, for our last couple of minutes here, I want to talk about biosimilars a little bit. You've cited these as significant long-term opportunities for clients to save money, but opportunities for Evernorth as well. I guess when we think about Humira coming off or having biosimilar competition next year, our first thought is, man, that's a drug that's generated a lot of rebate. It's going to be part of the rebate ecosystem. Is there just a lot of rebate going away? How do you think about biosimilars creating earnings opportunities for The Cigna Group? How does that flow through contractually? An observation from our pharma team, biotech team has been so far that biosimilars have kind of acted like branded. They've been a little bit cheaper. They haven't really acted like generic. I know one of the Humira biosimilars has interchange company designation.
The thought is, does that mean it's really going to behave more like generics? There are four or five questions there. One, just the biosimilar opportunity. How do we think about rebates going away? How does your historic opportunity to make the margin on generics play out? Walk us through how you're thinking about that.
Yeah, I think at the most practical level, we're really excited about the opportunity that's presented with biosimilars. It's not like we've decided to put biosimilars and seeing it on the horizon for a long time. I've been investing in it. It's not like we're getting a delicate variety of things. The opportunities that's there, we're more excited about, first of all. Second of all, I think the dynamics at an everyday sort of a level that are exciting to us are around having more competition, right? I think this is just another texture of competition. In the long run, what we do with our work in the supply chain is work from leverage the power of competition to get you better outcomes for our health plan clients, for our employer clients, and ultimately that's for our patients. That's really valuable.
Now, exactly how that gets monetized depends on the types of arrangements we have from a client perspective. Even the types of dynamics that I drew for clients where we've got full pass-through types of rebate arrangements versus where we're a little bit more, but we just have a dollar amount of a guarantee we're dealing with on those lines. Can't get exactly how the funds might be supported by this or that. For us to assure we're in a position to have our incentives aligned with our client's incentives, we will do better when we can deliver lower costs to our clients. Whether that shows up in the form of additional rebate dollars, whether that shows up in the form of gains that we can earn, or it shows up in the form of us being able to even more effectively manage the cost guarantees.
Those are all things that will be of value for us and things that we're working on. The other dimension I would just call out is it's important to understand that the physical media is more complicated to have a solution than going from brand to a generic to a mass pharma. We're really well- positioned to drive this. The clinical depth to drive this is that skill of expertise and relationships throughout ecosystems in order to have an incident. Whether that's the pharmacists that we've got in our specialty pharmacy or the depth of the supply chain or the ability to drive campaigns at an individual level or to drive the right kind of communication with the subscribers. I think we've got all of the needed kinds of elements to really maximize the opportunities that you're more directly excited about that.
We're out of time , Eric thanks very much. Ralph, good to see you on the other side of the screen as well. We'll leave it there. Thanks for joining us today, Mike.
Thanks . Thank you.