[GUEST ACCESS MODE: Data is scrambled or limited to provide examples. Make requests using your API key to unlock full data. Check https://lunarcrush.ai/auth for authentication information.]  LongYield [@LongYield](/creator/twitter/LongYield) on x 4478 followers Created: 2025-07-20 17:19:12 UTC $ELV Elevance Health, Inc. Earnings Call Key Highlights: 📉 Full-Year Guidance Revision Elevance reduced its FY2025 adjusted EPS guidance to approximately $30, reflecting persistent elevated medical cost trends in ACA and slower-than-expected rate recovery in Medicaid. Management emphasized that this guidance reset does not anticipate a near-term recovery but rather incorporates prevailing conditions with a focus on transparency and execution. The decision follows similar adjustments by industry peers, driven by elevated morbidity in ACA markets and increased utilization in Medicaid. Despite the reset, Elevance remains committed to long-term growth, citing structural levers such as pricing, risk pool discipline, and operational efficiencies. 📊 Second Quarter Financial Results GAAP EPS was $XXXX and adjusted EPS reached $8.84, in line with internal expectations despite macro headwinds. Total medical membership declined XXXXXXX sequentially to XXXX million, primarily due to Medicaid disenrollments and lower ACA effectuation rates. Operating revenue rose XX% year-over-year to $XXXX billion, driven by higher premiums and recent acquisitions in home health and specialty pharmacy. The consolidated benefit expense ratio climbed XXX bps year-over-year to 88.9%, driven by ACA and Medicaid pressures. 🏥 ACA Market Challenges and Risk Pool Dynamics Elevated cost trends in ACA are attributed XX% to increased risk pool morbidity and XX% to higher utilization, including ER visits, behavioral health, and specialty pharmacy. Risk pool deterioration is linked to disenrolled Medicaid members entering the ACA market and attrition among lower-acuity exchange enrollees. Risk adjustment expectations remain unchanged, as Elevance’s risk mix has deteriorated in line with the broader market, not disproportionately. Fourth-quarter ACA utilization is expected to spike due to potential expiration of enhanced subsidies, prompting members to front-load care. 🏛 Medicaid Headwinds and Rate Misalignment Medicaid cost trend decelerated in Q2 but less than anticipated, with acuity driven by procedural disenrollments and tighter eligibility reviews. States have been responsive in adjusting rates; however, a full margin recovery is expected to take multiple cycles due to data lags. Full-year Medicaid margin remains positive but below long-term targets; updated guidance embeds a prolonged recovery horizon. The cost trend is now expected to be ~1/3 acuity-driven and ~2/3 utilization and coding-related, a reversal from 2024. 🧠 Medical Cost Containment and Technology Initiatives Carelon-led clinical programs, analytics, and AI-driven tools like Health OS and Intelligent Clinical Assist are being deployed to manage cost escalation and improve workflows. Over half of prior authorization requests are now processed in real time, with reduced burden for high-performing providers. Legal and analytic tools are being used to combat abusive billing practices, particularly misuse of the No Surprises Act's IDR process. Payment integrity efforts are targeting outlier provider behavior, including inflated out-of-network billing and aggressive coding tactics.  XXX engagements  **Related Topics** [quarterly earnings](/topic/quarterly-earnings) [$elv](/topic/$elv) [stocks healthcare](/topic/stocks-healthcare) [Post Link](https://x.com/LongYield/status/1946983239454720280)
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LongYield @LongYield on x 4478 followers
Created: 2025-07-20 17:19:12 UTC
$ELV Elevance Health, Inc. Earnings Call Key Highlights:
📉 Full-Year Guidance Revision
Elevance reduced its FY2025 adjusted EPS guidance to approximately $30, reflecting persistent elevated medical cost trends in ACA and slower-than-expected rate recovery in Medicaid.
Management emphasized that this guidance reset does not anticipate a near-term recovery but rather incorporates prevailing conditions with a focus on transparency and execution.
The decision follows similar adjustments by industry peers, driven by elevated morbidity in ACA markets and increased utilization in Medicaid.
Despite the reset, Elevance remains committed to long-term growth, citing structural levers such as pricing, risk pool discipline, and operational efficiencies.
📊 Second Quarter Financial Results
GAAP EPS was $XXXX and adjusted EPS reached $8.84, in line with internal expectations despite macro headwinds.
Total medical membership declined XXXXXXX sequentially to XXXX million, primarily due to Medicaid disenrollments and lower ACA effectuation rates.
Operating revenue rose XX% year-over-year to $XXXX billion, driven by higher premiums and recent acquisitions in home health and specialty pharmacy.
The consolidated benefit expense ratio climbed XXX bps year-over-year to 88.9%, driven by ACA and Medicaid pressures.
🏥 ACA Market Challenges and Risk Pool Dynamics
Elevated cost trends in ACA are attributed XX% to increased risk pool morbidity and XX% to higher utilization, including ER visits, behavioral health, and specialty pharmacy.
Risk pool deterioration is linked to disenrolled Medicaid members entering the ACA market and attrition among lower-acuity exchange enrollees.
Risk adjustment expectations remain unchanged, as Elevance’s risk mix has deteriorated in line with the broader market, not disproportionately.
Fourth-quarter ACA utilization is expected to spike due to potential expiration of enhanced subsidies, prompting members to front-load care.
🏛 Medicaid Headwinds and Rate Misalignment
Medicaid cost trend decelerated in Q2 but less than anticipated, with acuity driven by procedural disenrollments and tighter eligibility reviews.
States have been responsive in adjusting rates; however, a full margin recovery is expected to take multiple cycles due to data lags.
Full-year Medicaid margin remains positive but below long-term targets; updated guidance embeds a prolonged recovery horizon.
The cost trend is now expected to be ~1/3 acuity-driven and ~2/3 utilization and coding-related, a reversal from 2024.
🧠 Medical Cost Containment and Technology Initiatives
Carelon-led clinical programs, analytics, and AI-driven tools like Health OS and Intelligent Clinical Assist are being deployed to manage cost escalation and improve workflows.
Over half of prior authorization requests are now processed in real time, with reduced burden for high-performing providers.
Legal and analytic tools are being used to combat abusive billing practices, particularly misuse of the No Surprises Act's IDR process.
Payment integrity efforts are targeting outlier provider behavior, including inflated out-of-network billing and aggressive coding tactics.
XXX engagements
Related Topics quarterly earnings $elv stocks healthcare