Good day, ladies and gentlemen, and thank you for standing by. Welcome to the Humana Inc. Q1 2022 Earnings Conference Call. At this time, all participants are in a listen only mode. After the speaker's presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star, then one on your telephone keypad. As a reminder, this conference call is being recorded. If you require any further assistance, please press Star then zero. At this time, I would like to turn the conference over to Ms. Lisa Stoner, Vice President of Investor Relations. Ma'am, please begin.
Thank you and good morning. In a moment, Bruce Broussard, Humana's President and Chief Executive Officer, and Susan Diamond, Chief Financial Officer, will discuss our Q1 2022 results and our updated financial outlook for 2022. Following these prepared remarks, we will open up the line for a question-and-answer session with industry analysts. Joe Ventura, our Chief Legal Officer, will also be joining Bruce and Susan for the Q&A session. We encourage the investing public and media to listen to both management's prepared remarks and the related Q&A with analysts. This call is being recorded for replay purposes. That replay will be available on the investor relations page of Humana's website, humana.com, later today. Before we begin our discussion, I need to advise call participants of our cautionary statement. Certain of the matters discussed in this conference call are forward-looking and involve a number of risks and uncertainties.
Actual results could differ materially. Investors are advised to read the detailed risk factors discussed in our latest Form 10-K or other filings with the Securities and Exchange Commission and our Q1 2022 earnings press release as they relate to forward-looking statements, and to note in particular that these forward-looking statements could be impacted by risks related to the spread of and response to the COVID-19 pandemic. Our forward-looking statements should therefore be considered in light of these additional uncertainties and risks, along with other risks discussed in our SEC filings. We undertake no obligation to publicly address or update any forward-looking statements in future filings or communications regarding our business or results. Today's press release, our historical financial news releases, and our filings with the SEC are all also available on our investor relations site.
Call participants should note that today's discussion includes financial measures that are not in accordance with generally accepted accounting principles or GAAP. Management's explanation for the use of these non-GAAP measures and reconciliations of GAAP to non-GAAP financial measures are included in today's press release. Finally, any references to earnings per share or EPS made during this earnings call refer to diluted earnings per common share. With that, I'll turn the call over to Bruce Broussard.
Thank you, Lisa, and good morning and thank you for joining us. Today, Humana reported financial results for the Q1 of 2022, reflecting a solid start to the year. I will speak briefly about our Q1 results and outlook for the rest of the year before providing an update on our strategy and the steps we're taking to position Humana for continued long-term success. Adjusted earnings per share for the Q1 were $8.04, which was above our initial expectations. This outperformance was primarily driven by favorable pharmacy results combined with lower than planned administrative expenses, some of which is due to timing. All other lines of business are performing as expected or slightly positive, further contributing to our strong quarter.
We raised our full year 2022 adjusted EPS guidance by $0.50 to approximately $24.50, representing 19% growth over our 2021 results. Importantly, our updated financial guidance continues to include an explicit $1 COVID headwind. Our updated guidance also includes the dilutive impact related to the pending divestiture of the company's 60% ownership of Kindred at Home's Hospice and Personal Care Division. Susan will provide additional detail on our Q1 quarter performance and our full year outlook in a moment. Turning to our previously announced billion-dollar value creation initiative. You recall we committed to delivering this value for the enterprise through cost productivity initiatives and value acceleration from our previous investments.
This will create capacity to fund growth and investment in our Medicare Advantage business, driving more robust benefits and lower costs for our members, which we believe will lead to improved membership growth. In addition, it enables further investment in our healthcare service capabilities, including expansion of our value-based home health model and transformation of the consumer experience and home delivery service model in Humana Pharmacy. I'm pleased to report with the work completed to date, we remain confident in our ability to realize this value for investment in 2023. As shared in February, we are focused on four key areas that will drive the value creation. Strategic initiatives, organizational efficiencies, third-party spend, and automation and digital advancement. We indicated the value would be largely split evenly across the four categories. Through work completed in recent months, we've established goals throughout the business within the four key areas.
We now expect strategic initiatives to account for about a quarter of our goal. Organizational efficiencies and third-party spend will each comprise about a third. The remaining 10% of value realized in 2023 will come from automation, which given the nature of the work will drive some incremental impact in 2024. Susan will provide additional details on the progress made to date. We are pleased with the quick pivot of our teams to support the value creation initiative. It is important to maintain our focus on one of Humana's core differentiators, our strong culture. Currently, we are seeing a slight decrease in engagement, but remain in the top 20% of industry leaders. Engagement scores are impacted in part by the internal uncertainty around our value creation initiative, as well as the strong external market pull, economic disruption, and the inflationary environment.
Importantly, we are seeing strong engagement with our nursing population, which is currently at 89%, and we are proud that 86% of our physicians would advocate for Humana as a great place to work. While challenging choices remain to fully realize our goal, I am confident our team is equal to the task and understands the purposeful approach we are taking to make Humana even an even stronger company. In addition to creating capacity to invest in our Medicare Advantage product for 2023, we are also focused on working closely with our distribution partners to improve the retention of our members. We continue to work with our call center partners to more closely replicate the experience delivered by our employed agents through enhanced training.
We are also focused on service level agreements aimed at improving the quality of the sales experience and ultimately the customer satisfaction and retention. As part of this work, we have developed a new computer-based training modules for our call center agents that focus on behaviors linked to customer complaints. While still early, we are pleased to see, have seen a decrease in complaints to CMS year-over-year. With respect to compensation for external brokers, we have introduced new compensation structures designed to improve overall quality by more closely tying administrative service fees to specific quality assurance activities and service levels, as well as addressing agent level compensation to promote individual quality performance. Within our proprietary sales channel, we are looking at opportunities to advance our payer agnostic capabilities to improve our ability to support consumers who desire more choice.
In addition, we are making investments to better link digital first shoppers to our internal sales agents. Digital shoppers are now able to not only complete an application online, but also request that one of our internal sales agents visit their home to discuss Medicare Advantage plan options. The digital shopper is also able to directly connect to one of our internal sales call center agents from Humana.com to assist them in their shopping experience. Finally, we are working with brokers across our distribution channels to, in both internal and external, to engage the customers in activities that are positively correlated to retention. This includes onboarding activities designed to promote engagement prior to plan effective date, as well as efforts to help members understand and fully utilize their plan's benefits, such as assisting in the activation of their healthy food card.
With respect to 2022 Medicare Advantage membership trends, results of the open enrollment period trended slightly better than our initial expectations, driven by higher sales and improved voluntary termination rates, both of which we view favorably. The outperformance was partially offset by higher deaths related to the pandemic in the first couple months of the year. Turning to our healthcare service businesses. As you know, we introduced CenterWell as the new brand to describe and connect our payer-agnostic healthcare service offerings. We have significantly expanded our healthcare service capabilities, including our senior-focused primary care, pharmacy, and home care offerings to better serve our medical members while also increasing our total addressable market. We've been developing our healthcare services capabilities in three phases. The first is building the capabilities.
We are accomplishing this through a combination of organic build, as we've done with our pharmacy business, inorganic growth as a result of our acquisition of Kindred at Home, as well as through partnerships such as those we have with Heal and DispatchHealth, which are site of care innovators in the home. The second phase includes enhancements to align with the value-based principles to improve health outcomes, as well as expanding the capabilities to achieve the desired scale. Our primary care business is in this phase today as we are expanding our geographic presence through a mix of building de novo centers as well as tuck-in acquisitions.
The third phase is integrating these capabilities in select local markets. We believe the integration of CenterWell Primary Care, Home Health, and Pharmacy in a local market will lead to improved health outcomes, increased customer satisfaction, and decrease in the total cost of care, while also building additional profit pools for the enterprise. Recall that a health plan member who utilizes the full suite of our healthcare service assets can drive 2-4 times the direct margin contribution for the enterprise as compared to the health plan margin alone. This is what we refer to as the flywheel effect. Let me highlight some of the progress we've made moving our various capabilities through these three phases, starting with home.
We started our journey with Kindred at Home in 2018, acquiring 40% minority interest with the belief that a key component of the next generation of integrated care delivery model was the ability to provide care to consumers in their home, meeting them where they want to be in a preferred lower cost setting, while also recognizing that the traditional volume-based fee-for-service model limits innovation in home health. We completed the full acquisition of Kindred at Home in August 2021, reflecting our continued commitment to investing in home-based clinical solutions that drive improved patient outcomes, increased satisfaction for patients and providers, and value for health plan partners. We took another step on this journey last week with the announcement of the divestiture of our majority interest in Kindred at Home's Hospice and Personal Care divisions to Clayton, Dubilier & Rice, or CD&R.
We explored a broad range of alternatives for the hospice and personal care businesses and believe this transaction best allows us to accomplish our previously stated intent of divesting majority ownership of these nine core businesses while maintaining a strategic minority interest through our remaining stake. With CD&R's established physician relationships, value-based care expertise, and record of supporting providers to deliver high-quality care for patients, we are certain these divisions are well-positioned for success under the joint ownership of Humana and CD&R. Importantly, we are pleased that when viewing this transaction in conjunction with our purchase of the broader Kindred at Home platform, we have been able to achieve our objective of substantially increasing our footprint in home care by acquiring one of the leading home health platforms in the country at an attractive valuation for our shareholders.
Our home capabilities were further expanded with the acquisition of onehome last year. onehome's management service organization capabilities and experience providing home health, infusion, and durable medical equipment services establishes the platform for our value-based home care model. We remain on track to begin the launch of the value-based model in North Carolina and Virginia in June, with the expansion in additional geographies planned for late this year and early 2023. Beyond shifting to value in integrating DME and infusion, onehome will also have the ability to help members navigate the broader care ecosystem. For example, if a member lacks a primary care provider, onehome could connect the member with a high-value local option, including Humana's primary care organization. In addition, if a member would benefit from home delivery of chronic medications, onehome can help the member set up the home delivery through our Humana Pharmacy.
We believe these efforts can lead to both improved member experience and better health outcome, demonstrating the power of integrating our health service capabilities in the local market. Turning to primary care, we are actively scaling our platform through a combination of de novo expansion and inorganic growth. We are the largest senior-focused value-based primary care provider in the nation, with 214 centers today. This includes 37 centers in the Welsh, Carson, Anderson & Stowe joint venture, which began in 2020. We expect to have approximately 250 centers by year-end and intend to add 30-50 centers per year going forward.
As shared in February, we are committed to funding the organic growth of our primary care organization in 2023 and beyond through a combination of on- and off-balance sheet financing, such that we expect no dilution to earnings growth from the organic expansion. As of March 31st, the 2020 cohort of 20 centers opened within Welsh, Carson, Anderson & Stowe joint venture had an average of 520 Medicare risk patients per center, approximately 60 patients per center higher than planned. In addition, our cumulative EBITDA results were in line with the plan. We are pleased with the results to date, which have demonstrated the performance consistent with the expected J-curve. We continue work to establish off-balance sheet structure that will be leveraged beginning in 2023.
We are applying the proof points and learnings from our joint venture with Welsh, Carson to optimize the go-forward financing structure, considering enhancements such as limiting the financing to only the operating expenses. We look forward to sharing additional details when finalized in the coming weeks. Our pharmacy business is the most mature of our healthcare service businesses, driving significant value to the enterprise, with industry-leading mail order penetration resulting in improved medication adherence and better health outcomes for our health plan members. 38% of our individual Medicare Advantage members utilized our mail order services in the Q1 , 100 basis points increase year-over-year. This increase is due in part to the fact that Medicare Advantage members retained in 2022 used Humana Pharmacy home delivery services nearly 9% more frequently than members who disenrolled.
This is another demonstration that members who engage with our healthcare service businesses not only create incremental enterprise profit, but are more loyal to our health plans. This result demonstrates the impact of investments we're making to transform the consumer experience and home delivery service model through improved e-commerce and logistics capabilities and additional distribution sites, allowing us to deliver prescriptions to our members within one-two days. As you know, we committed to providing additional transparency into our healthcare service businesses in 2022, which began with in the new disclosures we provided on the home and primary care in our Q1 earnings release. Susan will also provide further 2022 performance details during her commentary.
In addition, we look forward to hosting a virtual investor update on September 15th, 2022, where we will discuss the operational model and the long-term growth and earnings potential for the primary care and home businesses, the benefits of integrating our healthcare service capabilities in local markets and driving penetration by our health plan members as well, a progress update on our $1 billion value creation initiative, and current thoughts on improving our Medicare Advantage membership growth for 2023, and the long-term outlook for the company, considering future earnings growth opportunities balanced against the ongoing investments necessary to advance our strategy. In closing today, I want to reiterate that we are pleased with our strong start to the year, with all our business lines performing well. In addition, we remain confident in our ability to deliver on our $1 billion value creation plan.
This will allow us to create the needed capacity to fund growth and investments in our Medicare Advantage business, which we believe will drive significant improvement in our membership growth, as well as further expansion of our healthcare service capabilities while still delivering on our long-term earnings growth target in 2023. With that, I'll turn the call over to Susan.
Thank you, Bruce, and good morning, everyone. I will provide an update on our Q1 results, including line of business performance details, our outlook for the full year, and progress made to date on our $1 billion value creation plan. Finally, I will provide an update on capital deployment, including the planned use of proceeds from the pending divestiture of our majority interest in Kindred's hospice and personal care businesses. Today, we reported Q1 2022 adjusted earnings per share of $8.04, driven primarily by lower than anticipated administrative costs, some of which is timing in nature, and outperformance in our pharmacy business. All other lines of business are performing as expected or slightly positive, further contributing to our strong quarter.
Inpatient utilization was favorable across our Medicare and commercial businesses due to a faster decline in COVID admissions and slower rebound in non-COVID admissions than we've seen during previous surges, and we will need to continue to monitor how utilization further rebounds in the coming weeks. Typically, we would not raise guidance at this stage, as it is too early to fully evaluate results and medical cost trends in particular. However, given the main drivers of our Q1 outperformance, we are raising our full year guidance by $0.50 to approximately $24.50, representing nearly 19% growth over our actual 2021 results.
Importantly, this revised guide continues to anticipate $1 of conservatism to cover a net COVID headwind should it emerge, and also anticipates the estimated impact to earnings of divesting 60% of our interest in the Kindred hospice and personal care businesses later this year. With respect to quarterly earnings seasonality, at this time, we expect the percentage of Q2 earnings to be in the low 30s. We want to reiterate, however, that investors should continue to focus on the full year estimates as quarterly development will continue to be impacted by ongoing COVID-related timing dynamics. With that, I will now provide additional details on our Q1 performance by segment, beginning with our retail segment. As Bruce discussed, results of our open enrollment period trended slightly better than previous estimates.
If these trends continue for the remainder of the year, we expect our individual Medicare Advantage growth to be slightly above the midpoint of our current guidance range of 150,000-200,000 members. Revenue for the quarter was in line with expectations, with individual Medicare Advantage PMPMs of 8% year-over-year. We continue to expect our PMPM yield to be in the high single-digit range for the full year. Turning to claims trend, total medical costs in our Medicare Advantage business ran largely in line with expectations in the Q1 . We experienced lower than anticipated inpatient utilization, offset by higher inpatient unit costs and lower than projected favorable prior period development. As it relates to prior period development, we saw inpatient unit costs for the Q4 of 2021 restate higher than anticipated.
As claims were received, the average cost of non-COVID hospitalizations restated higher, and hospitalizations occurring in December 2021 restated as a COVID admission, whereas the initial authorization request reflected a non-COVID admitting condition. Recall that we incur an additional 20% payment on any Medicare admission with a COVID diagnosis under the public health emergency, even when it is not the reason for the admission. These incidental COVID admissions represented 10%-15% of total COVID admissions during the Delta wave, increasing to 25%-30% with the Omicron wave, resulting in a meaningful increase in average unit costs. We will need to continue to monitor inpatient unit cost trends and COVID positivity rates throughout the year.
With respect to current year utilization, COVID admissions peaked in January at 65 admissions per thousand and then began reducing more quickly than we've seen historically, ending the quarter at approximately 2.5 admissions per thousand, the lowest level we have seen since June 2021, just before the rise of the Delta variant. Non-COVID admissions did not rebound as quickly as COVID declined, resulting in net inpatient utilization favorability for the Q1 , although it continues to rebound towards expected levels. We considered the higher Q4 2021 inpatient unit costs in our Q1 estimates, resulting in overall inpatient costs running generally consistent with expectations. As previously shared, we have limited visibility into non-inpatient trends until claims are received, and so, as is customary, our Q1 results assume non-inpatient utilization is in line with previous expectations.
All in, we are pleased with the early performance of our Medicare Advantage business and continue to expect a 50 basis points improvement in our individual MA pre-tax margin in 2022. However, as previously shared, much remains to be learned about the long-term impacts of COVID, including the impact of higher mortality on the morbidity of our Medicare members. Provided COVID levels remain low, we will have an opportunity to further evaluate baseline trends relative to our estimates. Moving to PDP. Membership trends are tracking favorable due to higher sales in the Walmart Value Plan and lower voluntary terminations in the Premier Plan. As a result, we have updated our full year guidance to down 100,000 members versus our previous projection of down 125,000 members.
In addition, we continue to expect approximately 80,000 PDP members to move to a Humana Medicare Advantage product this year. Our Medicaid business performed well in the Q1 , experiencing lower than expected COVID costs. The Medicaid team is actively preparing for the Ohio contract implementation, which we expect to occur later this year. We updated our full year Medicaid membership guidance from a range of down 50,000-100,000 to a range of down 25,000-50,000 to reflect the extension of the public health emergency to mid-July. In addition, we were pleased to receive notification in the Q1 that the Louisiana Department of Health announced its intent to award Humana a contract to serve Medicaid beneficiaries.
We now expect the state to rescore the previously submitted RFPs, with a decision anticipated in late May, and we are optimistic that we will once again score well, given the strength of our offering. We continue to be very proud of our Medicaid program and success growing our footprint organically. Group and Specialty segment results were slightly favorable, with both our Group Medical and Specialty businesses contributing to the positive results. The fully insured Group Medical business experienced favorable inpatient utilization due to fewer COVID admissions, similar to what we experienced in the Medicare business, partially offset by slightly higher than expected membership losses. The rating actions taken in the back half of 2021 to incorporate expected ongoing COVID costs resulted in slightly higher attrition than originally anticipated. Our Specialty business also outperformed, as utilization, particularly for dental services, continues to run lower than expected.
To the extent this lower dental utilization continues, we plan to reduce pricing to our Medicare Advantage business in 2023 accordingly. Our healthcare services segment had a strong start to the year. As previously mentioned, our pharmacy business meaningfully outperformed expectations, driven by higher than expected increases in mail order penetration, lower unit costs due to favorable underlying drug mix, and lower cost to fill. We currently expect the favorability to persist throughout the year, although with some moderation, as our previous estimates contemplated increasing mail order penetration rates over the course of the year. Our efforts to drive increased mail order penetration are demonstrating success. With 38% of our individual Medicare Advantage members utilizing our home delivery services in the Q1 , a 100 basis point increase year-over-year.
As Bruce mentioned, Medicare Advantage members retained in 2022 used Humana Pharmacy's home delivery services nearly 9% more frequently than members who disenrolled, also contributing to the strong start to the year. As a result of the outperformance seen in the pharmacy business, we have increased our full-year healthcare services adjusted EBITDA guidance by $50 million- $1.725 billion-$1.875 billion from the previous range of $1.675 billion-$1.825 billion. This adjustment also contemplates the estimated impact to EBITDA of divesting 60% of our interest in the Kindred at Home Hospice and Personal Care businesses later this year. At this time, we have not updated revenue or operating expense guidance points, as the impact could vary depending on the timing of the transaction close. Turning to the home.
Beginning with our Q1 release issued this morning, we disclosed episodic and total admissions for our home health business. Episodic admissions are up 3.5% year over year, while total admissions are up 4.9% year over year, largely consistent with expectations. For the full year, we continue to expect home health admissions to be up mid-single digits. We also provided detail regarding members covered by our proprietary value-based home health model. We continue to expect approximately 15% of our Medicare Advantage members to be supported by this model as of year-end 2022, as we expand to additional markets, including Virginia and North Carolina, beginning at the end of June.
Within 5 years, we expect to support 50% of our Medicare Advantage membership with our value-based home health model and believe it will deliver mid-single-digit reductions in overall home health, DME, and infusion spend within 12-18 months of implementation and mid-double-digit reductions at maturity while improving patient outcomes. The nursing labor shortage continues to be a concern for the home health industry broadly, and we continue to closely monitor clinical staffing levels, capacity, and admission trends, making targeted investments to sustainably improve the recruitment and retention of nurses to position the business for further growth. We are particularly focused on markets where growth has been negatively impacted by insufficient nursing capacity. We are seeing positive results from our efforts, including a 5% reduction in full-time nurse voluntary turnover in the Q1 , as well as improved recruiting in March attributed to the return to face-to-face recruiting.
We are encouraged by the improvement we are seeing in recruiting and voluntary nursing turnover but acknowledge there is much more work to be done. The hospice business performed well in the quarter, with total admissions up 9% year-over-year, fueled by a general improvement in referrals led by increased access to facility-based sources, investments in the business to expand clinical capacity, mainly in the form of dedicated on-call nursing staff, and winter storms that negatively impacted missions in the prior year. Turning to our primary care organization, results ran in line with expectations for the quarter.
We enhanced our primary care disclosures to include a breakout of clinics by de novo, which includes all new centers opened since 2020 under our Welsh, Carson, Anderson & Stowe joint venture, wholly owned, representing all centers not in the Welsh, Carson, Anderson & Stowe joint venture, and IPA, which reflects patients served by our Conviva MSO. We also updated our patients served metrics to only include Medicare patients covered by a value-based payment model, as this is our focus and represents the primary growth driver for the business. As of March 31st, we operate a total of 214 centers serving 180,000 patients in Medicare value-based arrangements while also supporting 58,000 patients under IPA arrangements. We operate 37 de novo centers, which are focused on driving panel growth and patient engagement to ensure our patients' needs are identified and we can begin our care planning.
This early engagement supports our ability to identify and slow disease progression. We opened five new de novo centers in the Q1 and 14 since March 2021, representing a 61% increase year-over-year. These centers grew paneled membership by 4,500 in the Q1 and 9,100 year-over-year, a 163% increase in patients served. We operate an additional 177 wholly owned centers serving 166,000 patients in Medicare value-based arrangements, primarily in Florida and Texas. We are focused on continuing to grow these centers organically and inorganically while also focusing on improving clinical and financial outcomes by leveraging our senior-focused multidisciplined care model supported by proprietary workflow technology and analytics.
Since March 2021, we have increased our wholly owned center count by 30 and Medicare patients served by 37,000 or 29%, with approximately two-thirds of this patient growth attributed to acquisitions of Florida and Texas-based primary care practices and approximately 1/3 due to organic growth, including patients served under DCE contracts. As we monitor the continued performance improvement of our wholly owned centers, we are pleased to report that 15 are producing our targeted EBITDA contribution of $2 million or greater and have an average panel size of 1,500 Medicare Advantage risk patients. Additionally, 69 of our wholly owned centers are EBITDA positive compared to 51 at this time last year. Finally, I would like to add to Bruce's commentary on our $1 billion value creation plan, highlighting some of our recent progress.
We are tracking various initiatives across discrete stages of development, starting with ideation, followed by sizing, design and execution, and finally, realization of savings. We gain confidence as each initiative moves through the stages, and we're pleased that initiatives valued at approximately $575 million are now in the design and execute phase. We continue to believe that the majority of initiatives will be implemented in the back half of 2022, which was contemplated in our initial guidance. Our lower than expected administrative expenses in the Q1 in part reflect management actions that accelerated savings we otherwise expected later this year, as well as some timing related variances. We remain confident in our ability to achieve our goal, creating capacity to fund additional investment in 2023, and we'll continue to share updates on our progress throughout the year.
From a capital deployment perspective, we expect to receive approximately $2.8 billion in cash proceeds upon closing of the pending Kindred Hospice transaction. As shared last week, the enterprise value of Kindred Hospice is $3.4 billion. The $2.8 billion in proceeds is made up of approximately $2 billion related to the repayment of debt from Kindred Hospice to Humana and $800 million reflective of 60% of the $1.4 billion equity value. We intend to use the majority of the proceeds for debt repayment as we look to deleverage back towards our target of approximately 35%. In addition, as previously disclosed, we continue to plan for a customary level of share repurchase in 2022. We expect our debt to capitalization ratio to be approximately 40% at the end of the year.
Before closing, I would again reiterate that we had a strong quarter with all businesses demonstrating positive fundamentals supporting our full year guidance raise. There are a number of items we will need to continue to monitor to fully assess 2022 performance, including non-COVID utilization trends, the rate of COVID positivity, and inpatient unit cost trends, which is why we believe it is prudent to continue to allow for COVID conservatism in our guidance. Finally, we are pleased with the progress made to date on the value creation plan and remain confident in our ability to achieve our goal, creating capacity for further investment in our Medicare Advantage business and expansion of our healthcare services capabilities while still delivering on our long-term earnings growth target in 2023. With that, we will open the lines up for your questions.
In fairness to those waiting in the queue, we ask that you limit yourself to one question. Operator, please introduce the first caller.
Yes, ma'am. Our first question or comment comes from the line of Kevin Fischbeck from Bank of America. Your line is open.
Okay, great. Thanks. I guess I just wanted to dig in a little bit more to the guidance raise, if I understood it correctly. You know, it seems like a little over half of it's from the services business being higher and the rest is G&A. We read that as you feel better at the lower end of your G&A guidance. It doesn't look like you changed the range there. I just want to make sure that I understand the MLR guidance is unchanged. There seems to be, again, some questions about how MLR looks given the decline in DCP. Thanks.
Sure. Happy to take that. To your first point, yes, as you think about the raise relative to our performance for the Q1 , first, I would mention that, consensus was lower than our internal estimates for the Q1. As we think about it internally, we think about $1 of the outperformance is what we were looking at from an internal perspective. And you are correct. You can think about that as roughly half attributed to lower administrative expenses and half attributed to the pharmacy outperformance. As we thought about the year, as you said, you know, and as I said, we do expect that the pharmacy outperformance will continue, although with some moderation.
That will allow us to support the $0.50 raise, as well as the dilution that we're currently estimating from a hospice divestiture later this year. On the administrative expenses, as I mentioned, some of that is timing, some of that is a pull forward of savings we would have otherwise expected later in the year, so not necessarily incrementally positive. We'll wanna see how that continues to develop, and then, you know, we'll also look to see if we continue to see some favorability that may allow for some additional investment in the distribution and marketing strategy that we've talked to you about, and may allow us to accelerate some of those investments, again, if we continue to see favorability. We are not taking any of that into the full-year guide currently.
On the MLR, I would say looking at the retail MLR in particular, analysts' ranges were quite wide, as we looked at the models. You know, the comparison to what's reported this morning is heavily influenced by the few that actually responded to this survey. I think that's part of it. As I mentioned in my comments, from an individual Medicare perspective, I can tell you that the MLR came in as we expected. Per my commentary, we did see positive utilization on the inpatient side, due to COVID. With COVID, while we saw higher absolute levels in January, it declined more quickly than we'd seen historically and than we would've expected, and non-COVID was not able to rebound as quickly as COVID declined. That was certainly positive.
Given the high level of COVID, however, and the higher rate of what we refer to as that incidental COVID, where it wasn't the admitting condition, but there is a COVID positivity diagnosis, that translates to additional unit costs. We did see higher unit costs, as a result. As I mentioned, we also considered the higher unit costs that we saw restated for Q4 in our Q1 estimates.
As you think about that all in, the Q1 results reflect inpatient pretty much in line with expectations. For non-inpatient, just given how early in the year it is and the limited visibility, we have those in the Q1 at expectations as well. We'll continue to watch those things over the course of the year, but feel good about the early indicators we're seeing and no source for concern about what we're anticipating for individual MA or retail MLRs.
Thank you. Our next question or comment comes from the line of Nathan Rich from Goldman Sachs. Your line is open.
Hi, good morning, and thanks for the question. I wanted to ask on your bid strategy for 2023, and in the release you talked about the final rate notice, and you expect rates to be up for Humana 4.6%, a little bit below the sector average, and I think more of a gap than you faced in recent years. I guess, how does that impact the strategy for 2023? And then I appreciate the details that you gave Bruce upfront about kind of the plan design and distribution strategy. Do you have an updated view on how you might allocate that $1 billion of savings across plan design and distribution that you know will ultimately provide the best ROI on those investments? Thank you.
Relative to the rate notice and our investment, I would say we feel very confident that we are gonna have the ability to be competitive in 2023. Even though we might have a little bit some because of our Star scores, we see higher Star scores in absolute, but on a relative change, it's lower than the industry there. We still have the same amount of dollars going in into the program. The second part of your question, just about the allocation among the various different components, the buckets, so to speak, between plan design and the distribution and marketing. We just don't feel comfortable today to give you that disclosure.
As we enter the, you know, latter part of the year and, you know, we're in the AEP cycle, we'll probably give you more details there, but I think today it would be best that we don't do that.
Thank you.
Fair enough. Thank you.
Our next question or comment comes from the line of Justin Lake from Wolfe Research. Your line is open.
Thanks. Good morning. Bruce, wanted to follow up on your commentary around the Investor Day. Specifically, you know, you talked about doing something in June. You pushed it till September. Just curious on the driver of that. You know, what have you been hearing from investors in terms of what they'll be looking for at that Investor Day? Specifically, any thoughts around, you know, margin targets in the Medicare Advantage business? Thanks.
Yeah, as I mentioned, we are shooting for September, and the reason for the move between June to September is we just felt that the information would be more relevant as we entered the latter part of the year for a few reasons. First, we'll be, you know, closer to AEP and provide more thoughts around our go-to-market strategy since we're getting close to that. Second, we'll have more progress on the billion-dollar program, and I know that's important in the short run. Those are really why we just felt that getting later in the year would be important to allow more timely information for the investors.
Relative to the subject matters, I mean, we do look at an important part of our strategy of the healthcare services business being important. I think giving more disclosure on what that looks like and the strength of that over longer periods of time will be an important discussion. In addition, we will discuss just our earnings potential and the growth in our earnings potential, including how that affects margin and our view on the margin side. We will discuss that. As you articulated, it is an area of particular interest by our investors, and we will be prepared to discuss both the individual MA margin and also just how healthcare services impacts the enterprise side.
Last, we'll also just, you know, be able to give the investors much more update just on how we see the healthcare service business growing and the impact it has in the integration of within the market itself. Because, as what I articulated, we're building the capabilities, we're leveraging and scaling the capabilities, and then in addition, an important part of that value is the integration in the local market, as I referred to in the commentary around the flywheel effect. That'll be an important discussion that we'll have.
Thank you. Our next question or comment comes from the line of Matthew Borsch from BMO Capital Markets. Your line is open.
Yeah. Thank you. You know, as I'm looking back, I know there have been other years where it seemed like you have weighted your MA product design towards earnings improvement. Whether it was deliberately or somewhat unintentional, that seemed to be the case for this year. I'm just wondering if I can ask what, why that isn't more apparent in the Medicare Advantage profit margin that you've seen so far this year? I would have expected that to be a bigger driver, maybe on the medical cost ratio side of the upside this quarter.
Sure, Matthew, I can take that. You're right. As you look at the Q1 , and again, you're looking at retail MERs versus individual MA. There are some differences in terms of the underlying product mix, year over year, particularly around Medicaid, and some growth in DCE membership, which has a higher MER than individual MA. Again, I do wanna reiterate that from an internal perspective, as we look at the underlying businesses, each are performing as we would expect, so no concerns there. In terms of one other difference I would highlight in terms of just the Q1 specifically is the change in prior period development year over year.
You know, with COVID, there were a lot of changes in claim processing, payment policy changes as a result of some of the stress the hospital systems were under, and so that significantly impacted prior period development. We anticipated a significant decline in prior period development year-over-year, and that will disproportionately impact the Q1 results, which is why in our earnings release, we gave you the detail on what that would look like, if you just stripped out PPD and the noise that that creates. It's hard to tell whether some of the analysts fully understood or anticipated the magnitude of that change year-over-year. Those are really some of the main drivers.
I just wanna stress that we continue to feel comfortable with our expectation of a 50 basis point improvement in the individual MA margin, as we said, and believe we're on track to do that and no early, you know, early concerns. The other thing to keep in mind is the $1 of COVID contingency. You can assume that's largely in the retail MER expectation. As we said in our commentary, we continue to hold that conservatism within our guide. If it proves unnecessary over the course of the year, then that would benefit the retail MERs as well.
Very helpful. Thank you.
Sure.
Thank you. Our next question or comment comes from the line of Kevin Caliendo from UBS. Your line is open.
Thanks so much. I just wanna get a little bit of better understanding, maybe a better way to ask this is, what do you expect the MLR trend to look like over the course of the year? Meaning, given what we saw in the Q1 with the prior period development, if we kinda just take where we started this year and where you expect to end, how would you see it? Is it more of a straight line, or is there gonna be a little bit more of a hockey stick to the back end of the year? Just the part of that question, I guess, is, did you see any of the COVID headwinds in 1Q at all for MLR?
Hi, Kevin. This is Susan. In terms of your second question around the COVID headwinds, we would say that we did not see a COVID headwind emerge in the Q1 . As I mentioned, given the dynamics we saw with the utilization patterns, the way we've thought about it is not just the absolute gross COVID impact, but rather net of any offsetting reductions in non-COVID. As I mentioned, while January saw higher COVID levels, and in fact, we saw that that was the highest level of COVID admissions in any given month since the start of the pandemic, in February and March. Given the rate of decline, and how much faster that was versus previous surges, we just didn't see non-COVID have the ability to rebound at the same pace.
That's true both across Medicare and commercial. We would say that was net positive. As we said, you know, in our Q4 commentary, you know, we'll be very cautious in releasing that dollar of contingency that we're holding, just recognizing the longer COVID goes on, you know, we just don't wanna assume that patterns will remain the same as we've seen historically. Then, as I mentioned in my commentary, just the rate of sort of COVID positivity itself, while the public health emergency is in force, will drive additional unit costs for any admission that does happen to have a COVID positive diagnosis associated with it. We'll need to continue to watch that. In terms of MLRs, with the exception of the PPD that I mentioned, that will disproportionately impact the Q1 .
I think if you normalized for that, then I would say there's nothing sort of unique about this year that we would expect MERs to be, you know, to vary other than the fact that sequestration, if you recall, is, you know, still in play, the waiver for the Q1 . It will reduce by half for the Q2 and then is assumed to be back in force for Q3 and Q4 . That will cause a little bit of seasonality differences year-over-year. Aside from that, I can't think of anything else specifically that we would expect unless, you know, as I said, the COVID, depending on what happens with COVID, which we've acknowledged could create some quarterly variation.
Thank you.
Thank you. Our next question or comment comes from the line of A.J. Rice from Credit Suisse. Your line is open.
Hi, everybody. I thought I might just ask you about the home health Kindred at Home business and some of the things you're doing there. First of all, I think, Susan, you called out some labor challenges that you're trying to address. I wondered how widespread those are in the business, and have they gotten worse in the Q1 versus what you saw in the fourth, or are they getting better? On the virtual value-based work you're doing, I'm just trying to make sure I understand. Is that Kindred at Home contracting with the Humana MA plans, or is it subcontracting with your primary care docs? How does that work, and how do you manage the steerage of the patients to make sure they end up in your home health operations and not someone else's?
Hey, A.J. Sure. Happy to take that. The first question on labor challenges, I would say, they're fairly widespread. There are certainly some markets where we have sufficient capacity, and we're certainly doing everything we can to take advantage of growth opportunities there. But generally speaking, some of the larger markets where there is more of an opportunity, we continue to see challenges. I would say though they're getting a little bit better, primarily due to the fact that COVID has subsided. So some of the labor challenges are due to nurses having to quarantine as a result of COVID. As we see that, you know, come down to, again, the lowest levels we have seen, that certainly helps as we have more nurses available.
As I mentioned in my commentary, we are also pleased to see that we, you know, our initiatives are having some positive impact on recruiting nurses and then retaining those nurses, again, creating some additional capacity. I don't wanna diminish the fact that it continues to be a challenge. We continue to watch sort of the wage environment, and other sort of resources being used to recruit and retain nurses, and we'll try to make sure we stay, contemporary with that. On the value-based model, the way that works is oneHome, which is a company you might recall we acquired last year, which currently provides home health DME and infusion, services to our Florida and Texas-based members under a value-based model. That is the model that we are looking to expand.
OneHome actually contracts with the health plan under a capitated arrangement for all of the spend for those three service categories. In markets where there are downstream risk providers, they will then downstream sub-cap with those providers. OneHome is the one taking the full risk on those services. What's unique about that model is the way that it is structured is they act as a convener and relieve some administrative burden from referring providers, where the referring provider can refer a patient in for the home health DME and infusion services, and oneHome will take responsibility for placing all of those services. In the absence of that model, the referring provider has to discretely coordinate all of those services, which can lead to some fragmentation and dislocation in the way care is delivered.
With the onehome model, they will take responsibility, and where possible then, they can refer that patient directly into Kindred or other high-quality home health providers in the market based on capacity, and other things. That, typically, as we launch the market, we will go in with, you know, a more broad network to avoid any sort of provider and patient friction at start. As the providers get more comfortable and understand the model, then we will look to then begin referring those patients into our high-quality providers in the market, and certainly with Kindred top of mind. That's how it works. Happy to answer any other questions when we talk later today, if you like.
Okay.
Thank you. Our next question or comment comes from the line of Stephen Baxter from Wells Fargo. Your line is open.
Hi. Thanks. Appreciate all the color on utilization and PYD. Certainly gave us a lot to digest. Just wanted to ask a clarifying question on the lower than expected PYD. On the inpatient unit cost side, you know, can you just clarify, you know, whether or not the higher unit cost you experienced was purely the result of these incidental COVID dynamics? If you were to look at the remaining inpatient non-COVID utilization, I guess, how did that compare to your expectations on the unit cost side? I guess big picture, just an update on acuity trends and how they're running on the non-COVID population. Thank you.
Sure, Stephen. Yes, so on the PYD, we did see lower. Prior period was favorable, it was just lower than we had previously expected and really attributable to higher inpatient unit costs in the Q4 . There were two main drivers of that. One was higher non-COVID inpatient unit costs. They were quite high in the Q4 . Frankly, there's still some work we're doing to understand why that is. Also on the COVID admissions, you know, as we set reserves at year-end, we have the benefit of authorization data, and so we have really good data on the absolute level of admissions. From a utilization perspective, you know, claims have restated just as we would have expected. The absolute level of admissions is consistent with what we thought.
What we saw, however, is of those admissions we anticipated more restated as a COVID admission, when on the initial authorization they did not reflect COVID as the reason for the admission. We would have contemplated those as non-COVID admissions. Given the significant difference in unit costs for a COVID admission versus non-COVID, that caused our December unit costs to restate higher. I'd say it's a little bit of a mixture, with December, you know, specifically related to COVID and the previous months more reflective of increases in the non-COVID unit costs, which we're still studying. Those are things, again, we wanna see how those continue to play out. For the Q1 estimates, we have contemplated those higher unit costs.
In terms of acuity, I would say broadly, we do not believe we're seeing an increase in acuity of the patients across any of our lines of business. There's no indicators of that so far. We think, again, when you're talking about the level of, you know, particularly in the Q4 of sort of COVID admissions, to some degree, this is a reflection too of, you know, as you see that higher incidental COVID positivity rate, as I mentioned, the admissions that are then sort of left in the non-COVID bucket tend to be higher average unit cost, and in this case, just happened to restate higher than we had initially expected.
Next question, please. Our next question or comment comes from the line of Ricky Goldwasser from Morgan Stanley. Your line is open.
Yeah. Hi, good morning. Just wanted to focus on the pharmacy outperformance. I think you said it was about half of the dollar upside from your initial targets. What specifically kind of like drove the outperformance? I know, Susan, you mentioned that the existing members that are using your pharmacy services had a higher utilization of mail versus the one that off-boarded. Is that sort of the entirety of it? Is it just kind of like that member mix, or are there other more underlying trends that we can extrapolate for the rest of the year?
Hi, Ricky. Yeah, sure. Happy to answer that. There were a couple of contributors to the pharmacy outperformance. One, as you said, was related to just some of the slightly favorable membership we saw across MAPD and PDP, from an absolute perspective. As you mentioned, and Bruce and I highlighted, what we saw was that the members that were retained by the health plan through AEP had a higher use of Humana Pharmacy than members who disenrolled in AEP, and it was about a 9% difference. That was a larger difference than we have seen historically, so it was not something we had specifically anticipated. That higher membership and that dynamic of retaining more members who are more likely to use Humana Pharmacy contributed to some of the volume outperformance.
I would say there was additional volume outperformance even above that, and we think that's a reflection of the continued investments we're making in the pharmacy business, to improve the service delivery model, and experience overall. We implemented a number of initiatives over the course of 2021 designed to drive improved mail order penetration and use of the pharmacy business and saw success there, and we've seen further success in the first part of 2022, just beyond what we had originally anticipated. As I mentioned, we did anticipate higher mail order penetration in 2022 versus 2021, and are just seeing that come in slightly higher even than we had expected, which we view very positively. In addition, we did see lower unit costs.
That is a function of just the underlying drug mix, and the negotiated rates, and so that is contributing as well. We also saw a favorable cost to fill. As a result of some of the investments and enhancements they're making in the service delivery model, and Bruce referred to some of those investments, we are also seeing some positivity with reduced cost to fill than we expected. All of those we view very favorably. Generally, you can assume that those do continue, although, as I mentioned, you know, we do expect some moderation because our plan did contemplate continued increases in mail order penetration over the course of the year.
As we described in the commentary, you can think about our thinking on pharmacy is, you know, raising $0.50 now, that reflects the outperformance, and then also that outperformance allowing us to cover the potential dilution from a hospice divestiture, assuming that we don't use the proceeds for share repurchase.
Thank you. Our next question or comment comes from the line of Joshua Raskin from Nephron Research. Your line is open.
Thanks. Good morning. I wanted to clarify the 2022 sort of run rate or jumping off point for next year. Should we think about the $24.50 + $1 as sort of that starting point? Maybe you could give us a little bit more color on the hospice dilution in 2023, or if buybacks or something else will offset that. Apologize for the long question, but the real questions really are there potential headwinds for 2023 that we should be thinking about that would preclude you from attaining, you know, your long-term EPS target and, you know, specifically thinking about investments in primary care, et cetera?
Hey, Josh. For your first question, we would say that you should think about the 2022 baseline at the $24.50. Similar to how we talked about it in our initial guide, we would just encourage you not to get ahead of us on the dollar of COVID contingency. As I mentioned, there's still a lot to see in terms of how, you know, medical costs play out over the course of the year, and utilization more broadly, morbidity, et cetera. You can consider the baseline, for now the $24.50, and we'll continue to be transparent about what we're seeing.
You know, certainly pleased with the ability this early to raise and get towards the higher end of our range, and certainly hope that, you know, we can see continued progress, but would encourage you to consider the baseline for now at the $24.50. In terms of hospice dilution, as we said, you know, for 2022, the pharmacy outperformance will allow us to cover any, you know, potential dilution. You know, we're internally anticipating that the transaction would likely close Q3 . That's what we're thinking about in terms of our current guide. As we've talked about, this has been something that we've been planning and looking at options for some time.
From a 2023 perspective, we have always been anticipating that we would divest a majority stake in hospice, and so that is contemplated and will be contemplated in our earnings progression in 2023, where we would expect to, you know, again, see a return to higher levels of Medicare growth while also delivering within our targeted long-term range of 11%-15% off of that $24.50 baseline, despite the hospice divestiture. For the proceeds, as I mentioned in my commentary, my preference would be to use as much as possible towards deleveraging, just so we can get that down and give us some additional flexibility. We mentioned in my commentary that we would expect to be at approximately 40% by year-end versus the 45% we reported for the Q1 .
We do expect to use a majority for debt repayment.
Okay. 11%-15%, even including the dilution off of a $24.50. That's the right way to think about it?
Yes. Yes, exactly.
All right, perfect. Thanks.
Thank you. Our next question or comment comes from the line of Scott Fidel from Stephens. Your line is open.
Hi, thanks. Good morning, everyone. Interested just in getting your thoughts on Medicare provider contracting the environment for FY 2023. Just as we're tracking all of the proposed Medicare FFS provider rate updates that are coming out from CMS, most of them are tending to be notably lower than what the final MA rates actually came in at. Just interested whether you see any type of positive arbitrage around that variance, or do you think ultimately that providers will be pushing for higher MA rate increases than what they seem to be getting on a net basis in Medicare FFS, at least based on the proposed rates so far?
Hey, Scott. Yeah, to your point, right now, you know, we'll have to see obviously what the final rates come in at. Currently, with what we've seen preliminarily, they are lower than the overall average sort of rate increase in terms of the rate book. On the hospital contracting side, I would say most of our contracts are tied to fee-for-service reimbursement, and so typically, you know, we would not see much, you know, whatever those rates come out with is what we would see. It's not to say that we might not see some providers come and sort of wanna talk to us. I would say they may wanna talk to us about some other components of our contracts, in terms of how we handle claims processing and audits and some other things.
I would not anticipate that we would be opening contracts up to move off of them, you know, being tied to the Medicare reimbursement rate. I think that there are some other service categories, home health is one example, where we tend to pay lower than Medicare fee-for-service rates. Depending on where those rates come in, you know, that could be an area where providers may come where they're being paid less than Medicare reimbursement, and they may wanna have a conversation of that in this inflationary environment. We'll continue to monitor it. I would say that at this point, based on what we've seen, we're not considering that a significant headwind that we're considering for 2023 and would view it as something that we can manage through.
Susan, fair to say that you are seeing some favorability here between the final MA rates and the likely net provider FFS rates, right?
I mean, based on what's come out so far, and then that's what it would suggest, and we'll have to see where the final rates come in.
Okay. Thank you.
Thank you. Our next question or comment comes from the line of David Windley from Jefferies. Your line is open.
Hi, good morning. Just focusing on the home health build-out and expansion there. You mentioned, I think, onehome relative to Texas and Florida, launching your value-based in North Carolina and Virginia. Can you talk about how rapidly you can continue to expand markets with that strategy? You know, is that mostly an organic strategy, or are there some inorganic bolt-ons that you could add to that to accelerate it?
Yep. A few things. I think our goal is to get to close to 50%, over the next five years, of our members to be in that. That's the full relationship with oneHome, and there's really a components of that relationship. One is around the actual ability to, as Susan was describing, the value-based payment area where you manage that and you go through oneHome from a contractual point of view. The second part of it is the build-out of DME and their pharmacy. As you look at sort of the length of time it takes, it actually is the latter part, the DME and the pharmacy, that takes more time than the actual contractual side.
What we're testing right now is actually a sort of a light and a heavy model, so to speak. The heavy model has everything, and the light model is really more oriented to the contractual area of that. We're hoping that will facilitate getting to the 50% quicker as a result of that and actually provide further improvement on the clinical cost, both in the clinical cost of the actual cost of providing the services, but also downstream prevention of ER visits and hospital admissions there. It's really two-pronged, and again, we're trying to find how we can facilitate it quicker through a lighter model that doesn't just have to require the build-out of the DME and the pharmacy side.
Yeah. The one thing I would add to Bruce's comment is today the model is deployed in markets that are heavy, risk-based primary care. We're moving into markets where that's not the same dynamic, and so we're really interested to see how these first implementations go. Assuming those go well, then I do think we would look to go ahead and accelerate some of the further expansion. Wanna make sure we fully assess sort of how the model works, and anything that we need to learn in the environment, recognizing it's a little bit different.
Your second question was organic versus inorganic. This will be mostly organic. I think there's not a lot of assets out there to buy. In addition, I think the integration of it will probably not be as fruitful as us just continuing to build the organic side.
Thank you.
Thank you. Our next question or comment comes from the line of Lisa Gill from JPMorgan. Your line is open.
Thanks very much. I just really wanted to ask about your risk-based primary care relationships. Can you talk about the percentage of premium that are under those types of relationships and the impact to MLR? If I think about primary care services more broadly, how do you think about virtual healthcare?
I'll take that. Today, it's about two-thirds of our revenue is within the Medicare Advantage business is really with practices that are under a risk model. Now, that varies between a full risk to we refer to as a path risk, which is up and down, but whether it's a bonus or up and down risk, with some collar around protection of it. We do see continued growth in that area and continued not only improvement in the number of members that are under that relationship, but also more and more of our practices are in surplus, which we really consider as being the most important value because this means that they are earning more dollars than they would in a fee-for-service environment.
First, we do measure not only the total, but also the effectiveness and the impact it has on providers. Relative to virtual health, I would say we look at that as a virtual primary care. We look at that as not only being part of the primary care itself and being incorporated in our relationship. In addition, we are testing through our Heal relationship, actually attribution of individuals to a virtual health provider. Then the ability to not only use virtual health but also go into the home. It's not office space, it's actually a traveling physician along with a virtual health component to it, and they are actually attributed the patient.
We are testing that in a few markets as we speak today with a partnership that we have with one of our joint venture relationships we have, Heal.
Thank you. Our next question or comment comes from the line of Gary Taylor from Cowen. Your line is open.
Hi. Good morning. I just wanna go back to reserves for a second. Just a couple parts to my question. I know, days claims payable only down 0.7 of a day sequentially, but the fee for service, IBNR piece was down about three sequentially. Just wanted some help if there was anything in particular driving that. Then my second part of the question was, you're sitting at 43 days claims payable. There's a comment that, you know, pre-pandemic you ran closer to 40. Just wondering, is that just sort of an FYI, or are you alluding to the fact that as we sort of move post-pandemic, you anticipate moving back towards 40 and releasing some of those reserves into earnings over time?
Yeah. Hi, Gary. To your point, you know, there is a lot of noise just the last couple of years due to COVID, and the impact to sort of claim submission timelines, you know, capitated provider surplus amounts and payments. I know we've talked about that the last number of quarters and the magnitude of the impact of those dynamics. That's why we provided the reference to the pre-COVID levels, which we think is a better benchmark to assess, because it's hard to otherwise normalize for all of those considerations.
As you said, you know, we are sitting three days above what our average ran pre-COVID, which we view as a more relevant comparator, and feel good about the level of reserves that we're sitting on as of the end of the quarter.
Could I just follow up real quick? Is the dollar of COVID cushion in your view sort of already sitting in reserves and would be released, or is part of that anticipated to be generated by 2022 operating results?
Yeah. I would say, in terms of what's currently sitting in DCP, to the degree some of our reserve estimates for the Q1 , or prior year proved to be conservative, as that would unwind, then, you know, that would have been some of what is currently reflected in the reserve levels.
Thank you.
The way we thought about, you know, in our plan anyway, we sort of layered in that conservatism ratably. As we said, you know, in the earlier commentary, you know, we certainly did not see a net COVID headwind in the Q1 , but we're being cautious about how we think about unit cost trend in particular.
Got it. Thanks.
Thank you. Ladies and gentlemen, this concludes the Q&A session. I would now like to turn the conference over to Mr. Bruce Broussard for any closing remarks.
Well, thank you, and thank you for all our investors both participating today and continuing to support the company. As you know, we've communicated, we continue to believe that we started with a strong year and look forward to continuing that progression throughout the remaining part of the year. Then lastly, I'd like to thank our 90,000 employees that are every day going to work to help support both these results, but more importantly, our members and patients that we serve on a daily basis. Thank you, and everyone have a great day.
Ladies and gentlemen, thank you for participating in today's conference. This concludes the program. You may now disconnect. Everyone, have a wonderful day.