Our latest analysis shows that our most mature Cigna Collaborative Care arrangements have delivered quality performance and total medical costs that are superior to market averages. For example, we are encouraging the use of urgent care facilities and offering extended office hours, which helps reduce unnecessary emergency room visits by up to 50%. We have closed 21% more gaps in care thanks in part to our embedded care coordinators, who help with prescription adherence and work to ensure continuity of care for our customers.

And one of our initiatives recently demonstrated a diabetic compliance rate, which was over 20% better than market average. Today, the scale of our efforts is significant. These programs encompass more than 1.3 million customers in 31 states with over 63,000 doctors, including more than 24,000 primary care physicians and nearly 40,000 specialists.

Our commitment to affordable and superior health outcomes for our customers and the ongoing innovation we continue to drive is one of the key ways Cigna continues to deliver differentiated value and ensures superior competitive positioning for the future.

As we look ahead, we recognize we are operating in a dynamic global environment characterized by existing and emerging disruptions that create formidable business challenges as well as opportunities. As we have discussed in the past, Medicare Advantage programs will face disruption. We believe our strong U.S. seniors footprint and leading physician engagement capabilities positions us for long-term success in this growing segment.

While global markets remain fluid, our focused strategy, differentiated capabilities and competitively-differentiated global footprint positions Cigna for sustained long-term growth. For the full-year 2014, we are confident that each of our business segments will deliver continued growth. In addition, our businesses are producing strong returns on capital, giving us the flexibility to create additional shareholder value through capital deployment opportunities. Taking these items into account, we remain committed to our long-term average annual EPS growth target of 10% to 13%.

Now, to briefly summarize my remarks before turning it over to Tom, Cigna's strong financial performance during the first quarter marks another quarter of competitively-attractive earnings and revenue growth and provides a strong start to 2014. Our strong balance sheet and high levels of free cash flow give us flexibility to deliver additional shareholder value. In this disrupted environment, Cigna is leading through change, ensuring that our customers, clients and shareholders will benefit from the value of our differentiated capabilities and focused strategy execution. Within that environment, we have demonstrated proven capabilities with our physician collaboratives to deliver outstanding clinical and affordability outcomes.

And now, I'll turn the call over to Tom for a more detailed look at our results and outlook. Tom?

Thomas A. McCarthy, Chief Financial Officer & Executive Vice President

Thanks, David. Good morning, everyone. In my remarks today, I will review Cigna's first quarter 2014 results and discuss our outlook for the full year. We've had a very strong start to the year, driven by continued effective execution of our strategy with significant contributions from each of our business segments.

Some key highlights from the quarter include: consolidated revenues grew to $8.5 billion, driven by continued growth in our targeted markets; consolidated earnings were $501 million; quarterly earnings per share were $1.83, representing growth of 6% over the first quarter of 2013; and free cash flow was strong. And we returned $650 million to shareholders through share repurchase on a year-to-date basis. Overall, the strength of our first quarter performance provides us with solid momentum for the year.

Regarding the segments, I will first comment on our Global Health Care segment. Global Health Care results were strong in both our Commercial and Seniors books of business. First quarter premium and fees for Global Health Care grew 3% to $6 billion. This reflects continued good growth in our Commercial business, partially offset by the expected reimbursement reduction in our Seniors business and our exit from the Limited Benefits business. We ended first quarter 2014 with 14.2 Global Medical Customers, growing by 90,000 customers. First quarter earnings grew 3% to $439 million and were driven by revenue growth in specialty contributions as well as favorable medical costs across both our Commercial Employer and Seniors businesses.

Turning now to medical costs, as David indicated, we continue to improve health outcomes for the benefit of our customers, driven by engagement with physicians and value-based solutions for our customers and clients. Our Commercial medical cost trend continues to be among the lowest in the industry, and given that 85% of our U.S. Commercial customers are in transparent ASO funding arrangements, our clients directly benefit from these favorable medical costs.

Regarding medical care ratios, in our U.S. Commercial Guaranteed Cost business, our first quarter 2014 medical care ratio, or MCR, was 76.1% on a reported basis or 78% excluding prior-year reserve development. Our Guaranteed Cost results reflect continued favorable medical costs within our Employer business. Overall, we are pleased with results of our Commercial Risk businesses, which continue to reflect strong pricing, disciplined underwriting and continued effective medical management and physician engagement.

In our Seniors business, our first quarter MCR for Medicare Advantage was 82.7% on a reported basis or 84.1% excluding prior-year reserve development. First quarter Medicare Advantage results were better than expected, with good early progress on the network and medical management actions we discussed last quarter to improve medical costs for our Seniors business. Across our Commercial and Senior Risk books of business, our first quarter earnings included favorable prior-year reserve development of $30 million after-tax compared to $48 million after-tax in the first quarter of 2013.

Moving to operating expenses, for the first quarter 2014, the total Global Health Care operating expense ratio was 21.9%, which reflects the impact of the industry fee, which added 110 basis points to the expense ratio in the quarter as well as efficiency gains and some favorable timing impacts. To recap, we've had a strong start to 2014 in our Global Health Care business.

Now, I will discuss the results of our Global Supplemental Benefits business, which continues to deliver attractive growth and profitability. Premiums and fees grew 13% quarter-over-quarter for Global Supplemental. First quarter earnings were $53 million, reflecting strong customer retention, business growth and effective operating expense management, with some modest claim pressure in South Korea.

For Group Disability and Life, first quarter results were strong, with premium and fee increases of 7% over first quarter 2013. First quarter earnings in our Group business increased to $67 million, driven by business growth as well as lower benefit and operating expense ratios.

For our Corporate & Other Operations, results totaled to an after-tax loss of $58 million for the first quarter of 2014. Overall, as a result of the continued effective execution of our strategy, our first quarter results reflect strong revenue and earnings contributions from each of our business segments as well as continued significant free cash flow.

Turning to our investment portfolio, in the first quarter, we recognized net realized investment gains of $27 million after-tax, coupled with a strong net investment income result. We continue to be pleased with the quality and diversification of our investment portfolio.

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