39th Annual JPMorgan Virtual Healthcare Conference

Jan 12, 2021

Slides

Summary

9M 2020 revenue rose ~5% and operating cash flow reached $12.3B, while pandemic response accelerated digital and community-based care. Vaccination capacity, HealthHUB expansion, and continued deleveraging underpin the forward strategy.

Good morning. My name is Lisa Gill, and I am a Healthcare Services Analyst with J.P. Morgan. It is with great pleasure this morning that I introduce CVS Health. With us this morning, we have Karen Lynch, incoming CEO, Larry Merlo, outgoing CEO, and CFO Eva Boratto. Larry and Eva will join us for the Q&A session that we will begin right after Karen makes some opening comments. Welcome, Karen, and I am going to hand it off to you. Good morning, Lisa. It is nice to see you. Good morning, everyone. Larry, Eva, and I are looking forward to today's discussion. Before we begin, I would like to remind everyone that we are going to make some forward-looking statements today that are subject to risks and uncertainties, and I will direct you to the full statement that we have included on your screen right now. At CVS Health, our transformation over the last decade has enabled us to become one of the country's leading diversified health services company. As one of the most trusted brands in America, we have built a company with unmatched scale, breadth of capabilities, consumer focus, and presence in communities across the country, with a highly engaged team of nearly 300,000 colleagues. I am very proud of the CVS Health team and all that we have achieved during this past year for our customers, for our communities, and for our investors. In the first nine months of 2020, our results exceeded our expectations, a testament to our strategy and our diversified business model. Our total revenue increased by approximately 5%, and we generated significant cash flow from operations of $12.3 billion, and we continue to make progress on deleveraging. We benefited from continued growth in our PBM and government services business, once again achieving above-market growth in Medicare Advantage. We completed acquisitions that enhanced our position, and we divested businesses that were not aligned to our strategy. We also advanced a number of our health management programs. To improve access to quality and holistic care, we opened up approximately 600 HealthHUB locations in 2020, including many in underserved communities. It wouldn't be possible to talk about 2020 without highlighting our pandemic response. Our strong local presence and scale in communities across the country enabled us to play an indispensable role in the national response to COVID-19. This led us to accelerate many aspects of our strategy. While ensuring the health and safety of our employees, our frontline colleagues continue to seamlessly support customers wherever they needed us, in our CVS locations, in their homes, and virtually. As you all know, we have seen dramatic shifts in the environment. The healthcare delivery system is being redefined on how people access care. Consumer behaviors and preferences are increasingly turning to solutions characterized by greater convenience, simplicity, personalization, and on-demand access across a broad range of categories. We are all witnessing a significant shift towards digitalization. There's been a massive increase in telemedicine use, with approximately 40 times more people accessing virtual care compared to pre-COVID levels. Many of these changes will be permanent and establish a new normal. We're encouraged by these trends as they prove to us that the market is finally ready for healthcare that is driven by and responsive to the needs of consumers. As we turn to our strategy, our strategy is centered on an orientation around the consumer. We believe that solving their health needs will create future economic value for CVS Health. We're accelerating the pace of progress with our strategic roadmap and prioritizing our actions to meet these emerging consumer needs. Later this year, you'll hear more about our evolution of our growth and our value creation strategy, with clear objectives and annual milestones. You'll hear more about our new and differentiated products and services that will improve health and lower medical costs using technology, data, and digital assets. You'll hear more about our capital management strategy with a near-term focus on our continued deleveraging, investments to accelerate growth, maintaining our dividend, and post-deleveraging, an opportunity for enhanced return to shareholders over time. We're confident about the growth opportunities available for CVS Health and believe that we are well-positioned to support individuals for every meaningful moment of health throughout their lifetime. Being consumer-obsessed is truly at the heart of everything that we do and why we are uniquely positioned to exceed customer expectations. We have one of the strongest, most trusted consumer brands. We have a wide range of clinically oriented digital products and services. We have an expansive footprint in communities across the country. We have a subscription service with nearly 4 million members today and the ability to significantly expand that further. We have a broad set of innovative consumer solutions that meet the holistic needs of individuals. We have the ability to engage with consumers across all digital and in-person touchpoints in a seamless way. We will create new value with simpler, more convenient, and more personalized approaches using data and analytics that support an individual's health journey. We have more than 100 million existing loyal members across Caremark and Aetna. We will deepen these relationships by increasing the penetration of our health services to become a bigger part of the consumer's everyday health. This means that CVS Health will unlock the lifetime value for consumers, and we'll do this at scale. During the last year, we have expanded our customer base as a result of our response to COVID-19. We increased the number of consumers we interact with daily through our testing and soon to be our vaccine services. Approximately 40% of our Return Ready clients are new to CVS Health, and over 6 million people who tested for COVID at a CVS location are not currently CVS Pharmacy customers. This provides a tremendous opportunity to expand our customer base as we engage with millions of new customers through testing and vaccinations. We are using these touchpoints to shape a health experience that demonstrates the value of CVS Health and creates the opportunity to capture new loyal customers. To drive the acceleration of our strategy, we have several experienced executives joining CVS Health. We just announced that Michelle Peluso will be joining CVS Health as our Chief Customer Officer later this month, a newly created leadership role that will focus on accelerating digital transformation and our brand. We recently welcomed a new retail President, Neela Montgomery, who has extensive consumer behavior, digital, and e-commerce experience to lead our CVS Health locations across the country. Dan Finke, a seasoned managed care executive, will become President of the healthcare segment. Dan has a strong track record of driving growth and bringing consumer-driven innovation to the marketplace. Finally, Laurie Havanec, our new Chief People Officer, will be joining us in February and will be driving changes in culture, diversity and inclusion, and the workforce of the future strategies. As I begin leading CVS Health effective February 1st, my priorities include achieving our long-term financial objectives, accelerating our strategy with a focus on digital transformation, integrated value, and innovative consumer-oriented solutions, improving our medical cost management strategies, creating connected and seamless experiences across CVS Health assets for every meaningful moment of health in a consumer's lifetime, expanding our health services strategy, and advancing the state of healthcare in the United States. In February, Eva and I will share our 2021 guidance. I am confident in the future and the opportunities ahead of us to reshape healthcare. Before I hand it over to Lisa, we would like to show you this short clip on how CVS Health is supporting the national distribution of COVID vaccines. Can you roll the video, please? This changed everything, and this became the new normal. While this is not news to anyone, how we responded to all of this with surgical precision might just be. These are just some of the 10 million-plus COVID tests administered to date in one of our more than 4,000 testing locations nationwide, not to mention the millions we have helped stay at or return to their jobs and schools. This has been an effort like no other. This is the COVID-19 vaccine, an unprecedented achievement in itself. It is exactly what the world needed when the world needed it. This is the vaccine's successful delivery to our CVS Health locations across the country and to nearly 10,000 locations in neighborhoods everywhere. This is a map that cannot be rivaled. These are some of the nearly 25 million doses we will be administering each month. This is one of the more than 90,000 trusted and trained pharmacists, technicians, and nurse practitioners ready to be deployed anywhere. This is one of the 40,000 long-term care facilities they will be delivering the vaccine to. Because with over 85% of the U.S. population living within 10 miles of a CVS, we were literally built for this. So this is how we are going to put an end to this virus. It is an unprecedented achievement and exactly what the world needs when the world needs it. Lisa, I'll kick it back to you. Great. Thank you so much. Alison, did you turn my video? There we go. Hi, everybody. Thank you so much. Karen, no one is more excited for this vaccine than me. I haven't seen my father in over a year. He'll actually go to CVS and have his vaccine next Friday. I'm very hopeful that at some point, he's in Florida, that I'm going to get to see him. Let's talk about an update on this rollout. I mean, the news organizations have not been kind to this rollout of the vaccine. They've obviously highlighted a number of people waiting in lines, long lines, people that should have been part of the first group getting vaccines that haven't been vaccinated. From your perspective, how has it gone versus your initial expectations? Yeah. Well, first of all, just let me acknowledge the tremendous work that was done by Pfizer and Moderna and the other companies that really brought this vaccine to end this pandemic. Lisa, we've been working really closely for the last several months with Operation Warp Speed and the CDC. We were selected to do vaccinations at long-term care facilities. We were selected by over 40,000 long-term care facilities to do the vaccine. If you think about what we're doing right now, this isn't a mass distribution. We're in every single long-term facility day in and day out, and sometimes we're actually going into the rooms and vaccinating the most vulnerable population. To date, we have done over 8,000 of these clinics in these facilities, and we have administered over 700,000 vaccines. As of yesterday, it was about 10% of total vaccines that were administered, were administered by CVS. Now, the way the process works, Lisa, is that when they select us, the state actually has to determine where the vaccine is going. They actually have to activate the long-term care facility. Some states started activating in late December. Some states are still activating now. But we started vaccinating at the end of December. By the end of January, we will have the first round of all of those facilities nearly complete. We're making really good progress. We've completed it against the plan that we set forth. I know that there's been a lot of questions around the data, but we are on track to do what we said we were going to do. And we've been now updating our website every night to show the progress that we're making. We're working very closely with the governors to make sure that they're activating so that we can get into those long-term care facilities. The other thing I'd say, Lisa, is we are ready. We expect the federal program to open up shortly, and we are ready in our CVS pharmacies to administer the vaccine. We have over 90,000 clinicians through our pharmacists, through our pharmacy techs, through our nurses, and our nurse practitioners to be able to administer the vaccine. We do expect that we can administer 20 million to 25 million vaccines per month once the federal program opens up. So we're ready, and we're in a position to support people like your dad at getting the vaccine. We are ready to go when the overall federal program opens up. You know, what- Lisa, I- Go ahead, Larry. I'd just like to amplify one of the points that Karen made, because I really believe it's underappreciated in the media, that the average number of residents in a long-term care facility is 80. To Karen's point, we're going to them one facility at a time. Karen talked about where we are at this point. This week, we will do over 10,000 clinics in long-term care facilities, and it will take that to administer about 1 million vaccines. If you think about what Karen was just talking about in terms of when we get into the retail phase, we'll do almost 1 million vaccines a day. I think the media is confusing the need that exists in long-term care with being mass vaccination, and it's really not. It's one facility at a time. To Karen's point, we are absolutely on schedule with the plan that has been put together state by state. Yeah. How. Oh, go ahead, Lisa. No, no. Go ahead, Karen, because I was just going to ask about the financial impact. I'll hand it over to Eva in a minute, but I would just remind everyone that when we're distributing, it all depends on the availability of supply, the allocation decisions that are being made by the state, the consumer adoption. We're doing a lot on education to make sure people understand the efficacy of the vaccination, and so people need to be educated around that. Then obviously consumers selecting us, CVS Health as the place they want to go. So thank you for your dad coming to CVS. With that, I'll turn it over to Eva to talk about the economics of it. Yeah. Lisa and Karen, I think that's a great entry point into the financials, right? Because they're four of the key variables. I hope what everyone has taken away is we anticipate playing a key role in this. Our market share, where we are to date at 10%, we are bringing new customers into our stores through the COVID testing as well as the vaccination. So we see the opportunity not only for the vaccinations, but beyond as we keep these customers as longer term customers. So it's difficult to pinpoint given the variable factors that Karen outlined. A couple of things I just remind folks from a financial perspective. When you think about how this will flow through our financials, we'll get an administrative fee. I would think about that as on the commercial side, consistent with the fee for the first and second dose that CMS established. We will incur additional costs in administering the vaccine. Karen articulated, on the long-term care particularly, we're going from facility to facility, more than one trip. We have storage, we have education, we've elevated clinicians in our retail stores. The number of vaccinations will also vary not only by the supply availability, but if there's a one-dose vaccine that comes to market, that will also impact this. But I would say we're ready, and we expect to play a key role. Eva, one of the ways that we looked at it, I know it's not a one-for-one, but to look at the flu vaccination, clearly here you have no COGS, but you talked about the incremental costs that you have. Would that be a fair way to think about it being kind of a one-to-one for a flu vaccination versus COVID on perhaps an EBIT basis? What I'd say is, Lisa, similar to what we've seen with vaccinations, more of like a health service, so a higher margin. Obviously, the more efficiency we can bring through the stores and throughput, the more improvements we can make there. So, I would say the vaccines, the margin constant, the EBIT contribution will be above that of a typical script. Then- But- When we, I'm sorry, go ahead, Larry. No, no, Lisa, I was just going to say, think about the fact that you do have some added costs when you compare a COVID vaccine against a flu vaccine, okay? In terms of whether it is all of the handling or simply the fact that there is a 15-minute observation period before the individual leaves the premises. There are additional staffing considerations when you compare COVID versus seasonal flu. Then just the last question around the financial impact. You did give some preliminary numbers for 2021, right? Some things to think about. Eva, was that included in your thoughts in November, or had you not contemplated COVID at that point? No, understood, Lisa. As I said back in November on our earnings call, we took into account all of the information that we had at the time. Obviously, we did have some information related to the vaccine, so I would say it was a factor. But I would say it was not a dominant factor, right? Irrespective of the vaccine, there are many other dynamics in our business that gave us the confidence of the mid-single-digit growth off of what I called our adjusted baseline of $7.10. We will certainly provide more color on our earnings release as well as we progress throughout the vaccination rollout. Great. As we think about the enterprise, and clearly, when we were all sitting together physically a year ago, nobody anticipated that we were going to be in a worldwide pandemic throughout 2020. As you look back and you look at how quickly CVS was able to respond to all the things, Karen Lynch, that you talked about in the presentation that you just did, is there anything you take away from this pandemic that changes your long-term strategy in any way, or even changes your near or long-term investments in the company? I know you had to invest in people, right, so that you'll have the people to be able to administer this vaccine and people that were doing testing, et cetera. What does this do to the enterprise strategy longer term and investment from an investment perspective? Yeah. Let me just talk about some of the strategic things, and then I'll ask Eva Boratto to comment on the investments. Well, first of all, Lisa Gill, it definitely accelerated parts of our strategy. More importantly, it demonstrated the value of our company and the value of our strategy. It demonstrated the importance of being local and in the community, and reinforced the point that healthcare is local. It demonstrated the point around people will look for alternative sites of care when they're looking for their health needs. It demonstrated our ability to walk alongside people during their healthcare journey, albeit when they needed testing or we needed to be in the home with them, or they needed a pharmacy script and we delivered it to the home. As you think about the components that accelerate our strategy and will continue going forward, is really on this digital transformation. We were quickly able to develop digital capabilities for testing. We've actually developed a scheduling digital tool for vaccines, where when you log in to schedule your vaccination, we'll have a round trip ticket, so to speak. You'll get your second scheduled appointment, and then we'll follow up with you with texts and things like that, and phone calls, because I think that's a big thing relative to vaccines, making sure people get their second shot. We accelerated our home delivery. We changed our stores to make sure that we were bringing scripts to people because they couldn't come to the store. We advanced our Coram nurses to bring them home. A lot of the hospitals were trying to move people, patients out to do IV infusion therapy. As you can see, the parts of our strategy, technology, digital, data, and analytics, all will be areas that we continue to invest in as we move forward to meet and service the needs of our consumers. We talked about the changing demands on virtual care and telemedicine. We were able to quickly advance our e-clinic capabilities. We're working very closely on advancing our strategy around connecting virtual care to our HealthHUBs and to our homes. Those are the places that we will invest and advance our strategy going forward. I'll turn it to Eva Boratto to talk about- Yeah, that'd be great. Lisa, were you going to say something or? Yeah, no, I was just going to ask you to talk about the financial impact. As you think about the strategy around some of these things, and also, when you think about the strategy you originally laid out and the financial targets you set around integration synergies, modernization, transformation, did the pandemic change any of those either priorities or the synergies around that? Yeah. Let me take that question in a couple of pieces, and the investment plays in. First, what I'm really pleased with is we've been able, during this pandemic, to continue to advance both our efforts on our synergy, our cost initiatives, as well as our transformation. But as Karen Lynch just articulated, underneath that, areas we're emphasizing more versus previously have changed. On the synergy front, we continue to expect to deliver our $900 million in run rate synergy goal, and our modernization efforts continue. I would say on the modernization front, COVID has accelerated some areas and perhaps slowed down others. But net-net, we continue to feel good about where we are. And on the transformation front, aspects of our strategy have accelerated. If you think about diagnostics, if you think about what Karen Lynch has talked about with digital and virtual, and as you think about our capital portfolio, we'll make sure we align those investments to support the growth. And Lisa, I apologize. I want to make sure on the synergy run rate that I said $900 million, not $9 million. I'm not sure if I- So, let me just correct myself there. Overall, I walk away, we're focused on the goals that we outlined back at our investor day, as well as our deleverage goals of getting to low three times in 2022. Karen, you highlighted in your presentation the 600 HealthHUB locations. I think we get a lot of questions around this. Investors really want to better understand it. Can you maybe just walk us through the services that are provided today, the types of clients or consumers that you're servicing, and have you seen any benefit to your fully insured? On your admin side of your business, are you starting to see, whether it's MA or commercial lives, that come through the HealthHUB? Yeah. So, despite the pandemic, we were able to open up those 600 HealthHUBs. I would just comment that the HealthHUBs are one part, but not the only part of our overall clinical strategy. They're a key element, but we also have to think about how we wrap around our clinical care programs in the home and digitally, and the HealthHUB is that in-person touchpoint. Relative to the services that we provide there, obviously, our MinuteClinic services, managing chronic conditions. If you think about individuals, they don't go to their PCP every single month. But we can close gaps in care along the way for individuals when they are in between office visits. So, that's a core part of our strategy. We've been increasing our services through our pharmacy channel, and most recently, we introduced behavioral health support. So, if you think about our HealthHUB, we're wrapping a clinical team around individuals so that we can help them navigate their care. So, you have a nurse practitioner, you have a pharmacist, you have a care concierge, and you have now, we've just rolled it out in January, behavioral health support in certain of our hubs. So, think about that care management strategy in the hub. Now, we'll marry that to any digital strategies that we have, any virtual strategies that we have. But what we all know is that healthcare is human. Healthcare requires, at some point in time, for you to show up somewhere, to have someone physically touch you or do something. And so, those HealthHUBs are in those communities to provide that level of service. The other thing, Lisa, I would say is that they provide a lower site of care. What we've been doing to drive that is we've been initiating new product designs in our fully insured. So, I've talked about in the past having this zero copay, no copay benefit design. And we now have 6 million people, as of January, that have this no copay, low copay. We put it in our Medicare Advantage products this year. So, we have increased our reach largely of those 6 million members to support them through our MinuteClinic visits. And we're also partnering with local providers, where local providers are working with us so that we can close gaps in care. When they have overcapacity, they're sending some of their patients to us. So again, that local presence. The other thing that we're doing in the HealthHUBs is we're creating new services. This year, we rolled out our Medicare Resource Center, where throughout open enrollment, we were a place where people could go and be educated about Medicare Advantage. We were also able to talk to them about the services that they could visit when they came to a MinuteClinic, regardless of whether or not they were an Aetna Caremark member. It gave us another opportunity to explain to people what the HealthHUBs were, and another way of engaging people in products and services. As I said, we rolled out our face-to-face behavioral support, and we are wrapping all these clinical services together. That gives you a pretty good sense of how our HealthHUBs kind of fit into our overall strategy and the progress that we have made relative to our benefit designs. Oh, and the other thing too, Lisa, is we rolled out an Aetna Connected product last year that has the benefit designs around the HealthHUB, but it also is designed to what I always call shop at the company store, and it has all the other assets that we have, and we will be rolling that out throughout 2021. Just as a point of clarification, the 6 million members, are those all Medicare Advantage members that you talked about? Commercial and Medicare. Those total. And Medicare. Okay. Okay. 6 million in total. When we think about this financially, I can understand the aspect of whether it is Medicare Advantage or commercial to be able to lower overall costs, be able to manage these patients better. What are the other financial metrics of these mature locations? I mean, are you seeing incremental trips? Are you seeing incremental basket size? What are some of the other metrics that we should be looking at? Karen, do you want me to take that? Yep. Lisa, I recognize that the investment community is looking for these metrics, right? During COVID-19, we have been hesitant given the amount of disruption, but I will highlight a few things. One, I think what you heard from Karen is the HealthHUBs, we expect to drive value not just inside the four walls, but more broadly outside the four walls, as we say, whether it is medical costs, whether it is winning new lives, stronger retention, better connection, stickiness with our customers. A few things. In terms of the site of care that Karen mentioned, right? Through our pharmacy channels, which are part of our HealthHUB strategy, we have seen a 12% reduction in unnecessary ER visits. We also, in our MinuteClinics in the HealthHUB, saw an uptick in the usage for chronic services, achieving 16%. If you think about it, that demonstrates a willingness of customers to use our clinics differently. Front-end pharmacy performance are outperforming the control groups. I think if you think about medical costs with some of the chronic areas, they are going to take more time to have proof points and data points as you evaluate that data longitudinally. I've heard you talk a couple of times today about the virtual aspect of healthcare and tying that together. We understand that you have a relationship with Teladoc, which is one of the largest telehealth providers. Can you talk about that strategy? Two things that I want to understand a little bit better, and that's the progress of the rollout of the virtual care visits, for example, within MinuteClinic locations, or tying those two together. The question I think I've asked before and many investors have asked you around owning your own physicians. Do you feel the need to actually own your own network of physicians? The first question just being around the rollout of virtual care and how you see that going forward, and the second around, do you need to own physicians? Yeah, Lisa, we have a number of relationships with Teladoc. We sell Teladoc through our Aetna program as a buy-up for virtual care. We also have a relationship, and what we've been building out in our MinuteClinics is a double-pronged strategy. We've created e-clinic capabilities for our own nurse practitioners so that they can have face-to-face interactions with our customers. Then, when they need a physician and when a physician is necessary, they have the ability to log in and get to a primary care. In our HealthHUBs today, in our MinuteClinics today, we have the nurse practitioners that can do about 80% of what a primary care physician can do. If you think about what I just talked about, we now have the nurse practitioner, we have the pharmacist, we have behavioral health support. We do have a clinical team in those HealthHUBs, and we're continually working with our network of providers. Now, we'll continually evaluate whether or not we need providers. That's something we'll look at. Right now, we're in the midst of piloting a virtual PCP relationship with one of our large national account customers where it's all virtual, and then everything that has to be seen goes to a MinuteClinic or a HealthHUB. That's a pilot that we're exploring. Right now, we feel that we've got that coordinated care today, but we'll continually evaluate it and look at it for the future. Great. I know we only have a few minutes left here, and we haven't really talked about your PBM at all. Obviously, a big ruling with Rutledge versus PCMA. Really surprising to someone like myself that's followed the industry for a long time, because they're changing the fiduciary responsibility basically, right, with that ruling, saying that the fiduciary responsibility is not necessarily to the plan sponsor, which would be the employer or the health plan. Can you maybe just take a couple minutes to talk about what are your customers saying around this, and do they have concerns? Are there changes in contracts that are happening since this announcement? I know that the timing is kind of strange, right, in that the Court case came down, probably most of your contracts for 2021 were already signed. But I do understand that we are starting to think about the selling season for 2022. I just want to understand what clients are saying and any anticipated changes you would expect, but also any expected changes that you would see on the retail side of the business, right? Now that they're saying this was really brought up by the independent pharmacies that were looking to be reimbursed fairly from the PBM industry. Do you want to take that, Karen? Yeah. Lisa, to your point, Lisa, it is early, and I'll just emphasize, it's a very narrow decision by the court around mandating a particular pricing methodology when reimbursing pharmacy. Think of it as cost regulation, and that decision does not impact or restrict the ability to offer a different benefit design. On an apples to apples basis, Lisa, I think where you were going, it will increase, has the potential to increase costs for employers as one could speculate independent pharmacies would be paid more. I can see as this moves forward, if we're sitting across the table from each other and you're the decision maker for the J.P. Morgan benefit design, we're going to be talking about potential cost increases, and you're going to come back and say, "Well, how do we mitigate that?" And one of the mitigation elements would likely result in further restriction of the network construct. I could see that happening as a byproduct of this because today, unless I mitigated, it would end up being a pass-through to the plan sponsor. Right. Would that finally push us towards more narrow networks for pharmacy? We see that in Medicare, but we've never seen that in commercial. Could this potentially be the impetus, and could it end up hurting the independent pharmacies at the end of the day, where they thought that they're looking for better reimbursement around this and only to be cut out from a network because the cost is a pass-through to the plan sponsor? Lisa, I do believe it has the potential for that as the ultimate outcome. We have only one minute left. Karen, as incoming CEO, I ask this question every year, and Larry will remember that absolutely we should have just thrown it out the window last year with the pandemic because no one would have predicted that we were going to have a pandemic in 2020. Karen, hopefully we'll be sitting all together in San Francisco in January of 2022. What are the few things that investors will really truly appreciate about CVS 12 months from now that they don't appreciate today? I say three things. The first is our path to continued growth is strong and solid, that we have built a company with unparalleled power of our reach and responsibility and our relationships to meet the American health needs, and that they will understand that we have unmatched scale and breadth of capabilities and presence in the communities that create a unique opportunity for growth and differentiate CVS Health. Great. Well, I am looking forward to that over the next 12 months. Congratulations again on being named CEO. Larry, congratulations on your retirement and for fostering these amazing women that are part of this leadership team. I think that you were on the forefront of doing away with tobacco. You are on the forefront of really fostering women in a large organization. So, thank you for all that you have done, and I hope to keep in touch in your retirement. Lisa, you bet. Let me emphasize, I could not be happier with the board selection of Karen, and the company is in great hands with Karen and Eva at the helm. Great. Thank you. Well, with that, thanks very much, everybody. Thank you.