agilon health inc (AGL) 2023 Q1 法說會逐字稿

Thank you all for joining. I would like to welcome you all to the agilon health First Quarter 2023 Earnings Conference Call. My name is Brika, and I will be your operator for today's call. (Operator Instructions)

謝謝大家的加入。歡迎大家參加 agilon health 2023 年第一季度收益電話會議。我叫 Brika，我將擔任今天電話的接線員。 （操作員說明）

I would now like to turn the call over to Matthew Gillmor, Vice President of Investor Relations. Matthew, you may begin.

我現在想把電話轉給投資者關係副總裁 Matthew Gillmor。馬修，你可以開始了。

Thank you, operator. Good afternoon, and welcome to the call. With me is our CEO, Steve Sell; and our CFO, Tim Bensley. Following prepared remarks from Steve and Tim, we will conduct a Q&A session.

謝謝你，運營商。下午好，歡迎來電。和我一起的是我們的首席執行官 Steve Sell；以及我們的首席財務官 Tim Bensley。在史蒂夫和蒂姆準備好的發言之後，我們將進行問答環節。

I'd like to remind you that our remarks and responses to questions may include forward-looking statements. Actual results may differ materially from those stated or implied by forward-looking statements due to risks and uncertainties associated with our business. These risks and uncertainties are discussed in our SEC filings. Please note that we assume no obligation to update any forward-looking statements.

我想提醒您，我們的評論和對問題的回答可能包含前瞻性陳述。由於與我們業務相關的風險和不確定性，實際結果可能與前瞻性陳述明示或暗示的結果存在重大差異。這些風險和不確定性在我們提交給 SEC 的文件中進行了討論。請注意，我們不承擔更新任何前瞻性陳述的義務。

Additionally, certain financial measures we will discuss on this call are non-GAAP financial measures. We believe that providing these measures helps investors gain a better and more complete understanding of our financial results and is consistent with how management views our financial results. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measure is available in the earnings press release and Form 8-K filed with the SEC.

此外，我們將在本次電話會議上討論的某些財務指標是非 GAAP 財務指標。我們相信，提供這些衡量標準有助於投資者更好、更全面地了解我們的財務業績，並且與管理層對我們財務業績的看法一致。這些非 GAAP 財務指標與最具可比性的 GAAP 指標的對賬可在收益新聞稿和向美國證券交易委員會提交的 8-K 表格中找到。

You'll note from the press release that we've changed the presentation for certain non-GAAP financial measures. Before Steve's remarks, Tim will review these changes.

您會從新聞稿中註意到，我們已經更改了某些非 GAAP 財務指標的介紹。在 Steve 發言之前，Tim 將審查這些更改。

So with that, let me turn the call over to Tim.

因此，讓我把電話轉給蒂姆。

Thanks, Matt. Before we give our prepared remarks, I want to review the revised presentation for adjusted EBITDA and gross profit. As you know, we've always been committed to transparency and provide a lot of details on our performance. We recently made the determination that we should include geography entry costs within adjusted EBITDA to conform to the SEC's recent guidance on non-GAAP financial measures. We will continue to provide transparency around these investments on a go-forward basis.

謝謝，馬特。在我們發表準備好的評論之前，我想回顧一下調整後的 EBITDA 和毛利潤的修訂版。如您所知，我們一直致力於透明度並提供有關我們績效的大量詳細信息。我們最近決定，我們應該在調整後的 EBITDA 中包括地理進入成本，以符合 SEC 最近關於非 GAAP 財務措施的指導。我們將繼續在前進的基礎上提供有關這些投資的透明度。

For clarity, we want to define gross profit and adjusted EBITDA before we begin the call. We've replaced network contribution with GAAP gross profit. Gross profit is total revenues, less medical services expense and other medical expenses, which include a portion of geography entry costs. Adjusted EBITDA now includes total geography entry costs, which was $12 million in the quarter. This includes the portion of geography entry costs within our other medical expenses and geography entry costs within our G&A expenses.

為清楚起見，我們希望在開始通話之前定義毛利和調整後的 EBITDA。我們用 GAAP 毛利潤取代了網絡貢獻。毛利是總收入減去醫療服務費用和其他醫療費用，其中包括一部分地域進入成本。調整後的 EBITDA 現在包括總地域進入成本，本季度為 1200 萬美元。這包括我們其他醫療費用中的地域進入成本部分和 G&A 費用中的地域進入成本。

With that, I'll turn the call over to Steve.

有了這個，我會把電話轉給史蒂夫。

Thanks, Tim. Good evening, and thank you for joining us. We've had a very successful start to the year, and we are making rapid progress against our vision to transform health care in 100-plus communities by empowering primary care doctors.

謝謝，蒂姆。晚上好，感謝您加入我們。我們今年的開局非常成功，我們正在通過賦予初級保健醫生權力來實現我們改變 100 多個社區醫療保健的願景，並取得快速進展。

We are hosting today's call from the Twin Cities in Minnesota, where we recently launched our partnership with 2 leading physician groups, Entira Family Clinics and Richfield Medical Group. Entira and Richfield are highly respected with a deep history and connectivity across the region. Through our partnership, we have introduced a new model for senior care in Minnesota with a multi-payer, full-risk platform. We see significant opportunities for growth in the Twin Cities as physicians have a strong history of participating in early value-based care models. Primary care is largely fragmented outside of several large health systems. And our partnership with Entira and Richfield is serving as a catalyst for other physicians to make a similar choice and move to full risk for their senior patients.

我們正在主持今天來自明尼蘇達州雙子城的電話會議，我們最近在那裡與 2 個領先的醫生團體 Entira Family Clinics 和 Richfield Medical Group 建立了合作夥伴關係。 Entira 和 Richfield 憑藉深厚的歷史和在該地區的聯繫而備受推崇。通過我們的合作夥伴關係，我們在明尼蘇達州引入了一種新的高級護理模式，該模式具有多付款人、全風險平台。我們看到了雙子城的重大發展機會，因為醫生在參與早期基於價值的護理模式方面有著悠久的歷史。初級保健基本上分散在幾個大型衛生系統之外。我們與 Entira 和 Richfield 的合作正在推動其他醫生做出類似的選擇，並為他們的老年患者承擔全部風險。

As discussed at our Investor Day, once the infrastructure for full risk is established in a community, other doctors can easily join our network and access a new and sustainable model for primary care. The associated long-term growth opportunity or in-market TAM in the 14 states and 32 communities we serve is now 10.5 million seniors and 33,000 primary care doctors. We are excited for more of these doctors and their senior patients to join our platform in the Twin Cities and throughout the entire agilon network.

正如我們在投資者日討論的那樣，一旦在社區中建立了全面風險基礎設施，其他醫生就可以輕鬆加入我們的網絡並獲得新的可持續初級保健模式。我們服務的 14 個州和 32 個社區的相關長期增長機會或市場內 TAM 現在是 1050 萬老年人和 33,000 名初級保健醫生。我們很高興有更多這樣的醫生和他們的老年患者加入我們在雙子城和整個 agilon 網絡中的平台。

Now to our performance in the first quarter. Our overall momentum remains strong entering 2023. During the quarter, our MA membership grew 61% to 402,000 members and revenues grew 74% to $1.14 billion. This was above our guidance ranges and supported by faster standup of new primary care doctors and pull-through of members in new markets. Our ability to pull through more members in 2023 supports our long-term earnings power as we improve the quality and efficiency of care for those senior patients over time.

現在來看我們第一季度的表現。進入 2023 年，我們的整體勢頭依然強勁。本季度，我們的 MA 會員增長了 61%，達到 402,000 名會員，收入增長了 74%，達到 11.4 億美元。這超出了我們的指導範圍，並得到了新初級保健醫生更快站起來和新市場成員的支持。我們在 2023 年吸引更多會員的能力支持我們的長期盈利能力，因為我們會隨著時間的推移提高對這些老年患者的護理質量和效率。

At the same time, our profitability continues to inflect higher, with first quarter medical margin up 88% to $162 million and adjusted EBITDA more than tripling to $24 million. Our growth in medical margin and adjusted EBITDA was especially impressive given a modest net headwind from prior year claims and revenue. Even with our stronger membership growth, our medical margin increased 17% on a per member per month basis to $135 and by 110 basis points to 14.3% of revenues. This was primarily supported by strong performance in our maturing partner markets. Our ability to expand margins while driving higher membership growth remains very distinctive, reflecting the power of our partnership model, platform and scale.

與此同時，我們的盈利能力繼續走高，第一季度醫療利潤率增長 88%，達到 1.62 億美元，調整後的 EBITDA 增長了兩倍多，達到 2400 萬美元。考慮到前一年索賠和收入的適度淨逆風，我們在醫療利潤率和調整後的 EBITDA 方面的增長尤其令人印象深刻。即使我們的會員增長強勁，我們的每位會員每月的醫療利潤也增長了 17%，達到 135 美元，增長了 110 個基點，達到收入的 14.3%。這主要得益於我們成熟的合作夥伴市場的強勁表現。我們在推動更高會員增長的同時擴大利潤的能力仍然非常獨特，反映了我們合作模式、平台和規模的力量。

With our strong start to the year, we are maintaining the full year adjusted EBITDA outlook we provided in March. Under the revised presentation that Tim outlined at the top of the call, our adjusted EBITDA outlook ranges from a loss of $3 million to a gain of $25 million, which includes $78 million to $65 million of geographic entry costs. Our guidance also reflects faster pull-through of members in our new markets and increasing confidence in the contribution from REACH based on higher than initially projected outperformance against national cost benchmarks.

憑藉今年的強勁開局，我們維持 3 月份提供的全年調整後 EBITDA 展望。根據蒂姆在電話會議頂部概述的修訂後的介紹，我們調整後的 EBITDA 前景從虧損 300 萬美元到盈利 2500 萬美元不等，其中包括 7800 萬至 6500 萬美元的地理進入成本。我們的指導還反映了成員在我們新市場中的更快拉動，以及基於高於最初預計的優於國家成本基準的表現，人們對 REACH 貢獻的信心增強。

We are also encouraged with the progress we are seeing with enrollment in our clinical programs targeted at the most complex and high-cost patients. These programs such as renal and palliative care leverage our deep alignment with primary care doctors while driving continuous improvement to patient experience, quality and cost.

我們也對我們在針對最複雜和高成本患者的臨床計劃的註冊方面取得的進展感到鼓舞。這些計劃，如腎臟和姑息治療，利用我們與初級保健醫生的深度合作，同時推動不斷改善患者體驗、質量和成本。

I'm especially proud of our performance given the magnitude of the growth we are driving across different partners, markets and payers. During the first quarter, we added 130,000-plus new Medicare Advantage lives, 8 new markets, 4 new states and 9 additional payers. With this growth, we are now operating close to 100 distinct full-risk contracts with nearly 30 payer partners, including national and regional plans.

鑑於我們在不同合作夥伴、市場和付款人中推動的增長幅度，我為我們的表現感到特別自豪。在第一季度，我們增加了 130,000 多個新的 Medicare Advantage 生命、8 個新市場、4 個新州和 9 個額外的付款人。隨著這種增長，我們現在與近 30 個付款合作夥伴簽訂了近 100 個不同的全風險合同，包括國家和地區計劃。

When you consider that most of our payer partners have never done full risk, our ability to be first in the market and build the infrastructure for risk-based care that all physicians can access is a significant competitive advantage and requires the management of complex data flows such as member and financial data reconciliations. Increasingly, we believe agilon is differentiated in our ability to move new markets to risk and successfully work with a broad diversity of payers.

當您考慮到我們的大多數付款合作夥伴從未做過全風險時，我們能夠率先進入市場並構建所有醫生都可以訪問的基於風險的護理基礎設施的能力是一項重要的競爭優勢，並且需要管理複雜的數據流例如會員和財務數據核對。我們越來越相信 agilon 在將新市場推向風險並成功地與廣泛多樣的付款人合作方面的能力與眾不同。

Before updating you on our future growth opportunities, I wanted to say a few words on our revised non-GAAP measures. The most important change is we are now including geographic entry costs within our adjusted EBITDA calculation. I want to stress that our revised presentation does not impact how we think about our business, our cash flow or returns on capital. Ultimately, our goal is to get members on the platform, improve access, quality and efficiency of care delivery and develop medical margins over the long term.

在向您介紹我們未來的增長機會之前，我想就我們修訂後的非 GAAP 措施說幾句話。最重要的變化是我們現在將地理進入成本包括在我們調整後的 EBITDA 計算中。我想強調的是，我們修改後的陳述不會影響我們對業務、現金流或資本回報的看法。最終，我們的目標是讓會員加入該平台，改善醫療服務的可及性、質量和效率，並長期發展醫療利潤。

Geographic entry costs are investments we make to set up our partnership; establish processes that enable primary care doctors to be successful in value-based care, especially around patient access and quality; and expand overall primary care capacity. Because we partner with existing physician organizations, the efficiency and returns we generate on our geographic entry costs are very compelling. As we have discussed with you in the past, member acquisition costs have consistently remained in the range of $400 to $600 per member. They generate an LTV to CAC of greater than 10:1, and these costs only grow on an absolute basis as the number of new members increases.

地理進入成本是我們為建立合作夥伴關係所做的投資；建立流程，使初級保健醫生能夠在基於價值的護理方面取得成功，尤其是在患者獲取和質量方面；擴大整體初級保健能力。因為我們與現有的醫生組織合作，所以我們在地理進入成本方面產生的效率和回報非常引人注目。正如我們過去與您討論的那樣，會員獲取成本一直保持在每位會員 400 至 600 美元的範圍內。他們產生大於 10:1 的 LTV 與 CAC，並且這些成本只會隨著新成員數量的增加而在絕對基礎上增長。

Now for an update on our 2024 partners and some early observations for 2025. As we shared with you in March, we expect 2024 will be another record year of growth. We are currently implementing over 100,000 Medicare Advantage lives across 6 new partner groups, which include primary care only groups, multi-specialty, scaled networks and health systems. Our implementation work is progressing well supported by a recently completed acquisition of mphrX and our established infrastructure in existing states and markets.

現在來了解我們 2024 年合作夥伴的最新情況以及對 2025 年的一些早期觀察。正如我們在 3 月份與您分享的那樣，我們預計 2024 年將是又一個創紀錄的增長年。我們目前正在 6 個新的合作夥伴群體中實施 100,000 多個 Medicare Advantage 生活，其中包括僅初級保健群體、多專業、規模化網絡和衛生系統。在最近完成的對 mphrX 的收購以及我們在現有州和市場建立的基礎設施的支持下，我們的實施工作進展順利。

Additionally, our early engagement with payers has been encouraging. We are optimistic that the combination of new and existing partner growth could pull through greater than 145,000 total new MA members for 2024, which would be similar to our experience of increasing expectations for final expected membership for 2023.

此外，我們與付款人的早期接觸令人鼓舞。我們樂觀地認為，新合作夥伴和現有合作夥伴的增長相結合，可以在 2024 年吸引超過 145,000 名新 MA 成員，這與我們對 2023 年最終預期成員的預期增加的經驗相似。

Our business development team is now shifting their focus to 2025. While it's very early, we are seeing significant opportunities across diverse partner types and geographies, including new markets and large physician organizations in existing markets. Similar to last year, we are encouraged with the quality of the dialogue this early in the cycle, which should translate into longer implementation periods. In fact, we expect to begin implementing several new partners for the class of 2025 during the second half of the year.

我們的業務發展團隊現在將他們的重點轉移到 2025 年。雖然現在還為時過早，但我們看到了不同合作夥伴類型和地區的重大機遇，包括新市場和現有市場中的大型醫生組織。與去年類似，我們對周期早期的對話質量感到鼓舞，這應該會轉化為更長的實施週期。事實上，我們預計將在今年下半年開始為 2025 屆畢業生實施幾個新的合作夥伴。

As I've said in the past, the inflection in demand among physician groups for a sustainable primary care model reflects both structural factors from all payers pushing for value and the level of success that our partner groups are seeing on the platform.

正如我過去所說，醫生群體對可持續初級保健模式的需求變化反映了所有推動價值的支付者的結構性因素以及我們的合作夥伴群體在平台上看到的成功程度。

I wanted to close by offering a few comments on the 2024 rate notice and recent policy developments. We are encouraged and supportive of the risk adjustment model changes included in the 2024 rate notice, including the 3-year phase-in. We believe the phased approach will limit industry disruption, especially for health plans and at-risk provider organizations that serve high-risk populations. Operationally, we are already implementing the necessary changes for the 2024 notice.

最後，我想就 2024 年利率通知和最近的政策發展發表一些評論。我們鼓勵並支持 2024 年利率通知中包含的風險調整模型變更，包括 3 年逐步實施。我們相信分階段的方法將限制行業中斷，特別是對於健康計劃和為高風險人群提供服務的風險提供者組織。在操作上，我們已經在對 2024 年的通知進行必要的更改。

As I mentioned on the last call, we believe the rate notice is very manageable for agilon. This reflects our combined power and nimbleness from centralized operations paired with local teams tightly integrated with primary care doctors as well as our focus on historically unmanaged fee-for-service markets that serve the entire Medicare Advantage population and yield relatively lower risk adjustment levels.

正如我在上次電話會議中提到的那樣，我們認為費率通知對於 agilon 來說是非常易於管理的。這反映了我們集中運營的綜合力量和靈活性，以及與初級保健醫生緊密結合的本地團隊，以及我們專注於服務於整個 Medicare Advantage 人群並產生相對較低風險調整水平的歷史上不受管理的按服務收費市場。

In addition, the distinctive levers in our business provides the ability to manage through disruption, levers such as getting more members on the platform early, delivering a more effective and longer implementation for new partners and accelerating quality and medical cost performance in mature markets.

此外，我們業務中獨特的槓桿提供了通過中斷進行管理的能力，例如儘早讓更多成員加入平台、為新合作夥伴提供更有效和更長期的實施以及在成熟市場加速質量和醫療成本績效等槓桿。

The 3-year phase-in of the risk model change removes uncertainty and reinforces our confidence in our ability to continue to inflect adjusted EBITDA in 2024 and beyond. From a macro perspective, the rate notice, along with the RADV rule, reinforces the central role of primary care doctors in our health care system, which is very positive for agilon and our partners.

風險模型變更的 3 年階段消除了不確定性，並增強了我們對我們在 2024 年及以後繼續影響調整後 EBITDA 能力的信心。從宏觀角度來看，費率通知以及 RADV 規則加強了初級保健醫生在我們醫療保健系統中的核心作用，這對 agilon 和我們的合作夥伴非常有利。

With these changes, health plans will need even closer alignment with PCPs to drive better cost and quality outcomes and support competitive benefits, while doctors will need infrastructure, resources and technology to succeed in value-based care and meet the demands from all payers, including CMS.

隨著這些變化，健康計劃將需要與 PCP 更緊密地結合，以推動更好的成本和質量結果並支持競爭優勢，而醫生將需要基礎設施、資源和技術來成功實現基於價值的護理並滿足所有付款人的需求，包括內容管理系統。

agilon's partnership and platform is the solution for existing doctors to move into full risk and the success of our growing network continues to demonstrate the critical role we and our partners are playing in transforming the overall health care system.

agilon 的合作夥伴關係和平台是現有醫生應對全面風險的解決方案，我們不斷發展的網絡的成功繼續證明我們和我們的合作夥伴在轉變整個醫療保健系統方面發揮著關鍵作用。

With that, let me turn things over to Tim.

有了這個，讓我把事情交給蒂姆。

Thanks, Steve, and good evening, everyone. I'll review highlights from our financial statements to provide some additional details on our guidance for 2023.

謝謝，史蒂夫，大家晚上好。我將回顧我們財務報表中的要點，以提供有關我們 2023 年指南的更多詳細信息。

Starting with our membership for the first quarter. Total members live on the agilon platform increased to 491,000, including both Medicare Advantage members and ACO REACH beneficiaries. Our consolidated Medicare Advantage membership increased 61% to 402,000. This was above our guidance range of 385,000 to 390,000 driven by retro membership from 4Q and the faster pull-through of members in new markets, including better-than-expected payer contracting and attribution.

從第一季度的會員資格開始。 agilon 平台上的會員總數增加到 491,000 人，其中包括 Medicare Advantage 會員和 ACO REACH 受益人。我們合併後的 Medicare Advantage 會員人數增加了 61%，達到 402,000 人。這超出了我們 385,000 至 390,000 的指導範圍，這是由第四季度的複古會員和新市場會員更快的拉動所推動的，包括好於預期的付款人合同和歸因。

Revenues increased 74% on a year-over-year basis to $1.14 billion during the first quarter, which was also above our guidance range of $1.07 billion to $1.09 billion. Revenue growth was primarily driven by membership gains in new and existing geographies. On a per member per month basis, or PMPM, revenue increased 8% during the first quarter. This was primarily driven by benchmark updates and membership mix, including higher benchmarks in several new markets.

第一季度收入同比增長 74% 至 11.4 億美元，也高於我們 10.7 億美元至 10.9 億美元的指導範圍。收入增長主要是由新的和現有地區的會員增長推動的。按每個會員每月計算 (PMPM)，第一季度收入增長了 8%。這主要是由基準更新和會員組合推動的，包括幾個新市場的更高基準。

Medical margin increased 88% year-over-year to $162 million during the first quarter. Medical margin increased both as a percentage of revenue and on a PMPM basis, even while accounting for the dilution of our membership growth. Membership margin was 14.3% of revenue during the first quarter compared to 13.2% last year, and medical margin PMPM increased 17% to $135 compared to $116 last year.

第一季度醫療利潤同比增長 88% 至 1.62 億美元。醫療利潤佔收入的百分比和 PMPM 的基礎上都增加了，即使在解釋我們會員增長的稀釋時也是如此。第一季度會員利潤佔收入的 14.3%，而去年為 13.2%，醫療利潤 PMPM 增長 17% 至 135 美元，而去年為 116 美元。

Medical margin benefited from the maturation of older markets and member cohorts which continue to offset dilution from our year 1 numbers. Medical margins for our year 2 plus partners, which excludes the dilution from year 1 markets, increased 72% during the first quarter on a dollar basis and by 47% on a PMPM basis. As we've discussed with you in the past, medical margin growth in our year 2 plus partners drives the majority of our adjusted EBITDA gains.

醫療利潤率受益於老市場和會員群體的成熟，這繼續抵消了我們第一年數字的稀釋。我們第 2 年及合作夥伴的醫療利潤率（不包括第 1 年市場的稀釋）在第一季度按美元計算增長了 72%，按 PMPM 計算增長了 47%。正如我們過去與您討論的那樣，我們第二年加上合作夥伴的醫療利潤率增長推動了我們調整後的 EBITDA 收益的大部分。

Our medical margins for the quarter included a net headwind of $12 million from prior year revenue and claims. This was primarily a function of true-ups with health plans, including new contracts, which includes both prior year claims and revenues, a number of smaller, older high-cost claims and some retro members, which also include both prior year claims and revenue.

我們本季度的醫療利潤率包括來自去年收入和索賠的 1200 萬美元的淨逆風。這主要是健康計劃調整的功能，包括新合同，其中包括前一年的索賠和收入、一些較小的、較舊的高成本索賠和一些追溯成員，其中也包括前一年的索賠和收入.

Gross profit, which is replacing network contribution, increased 82% to $77 million during the first quarter and includes $2 million in geography entry costs. The year-over-year increase in gross profit reflects our strong medical margin as well as the relative contribution of medical margin across geographies.

第一季度，取代網絡貢獻的毛利潤增長了 82%，達到 7700 萬美元，其中包括 200 萬美元的地域進入成本。毛利的同比增長反映了我們強勁的醫療利潤率以及醫療利潤率在各個地區的相對貢獻。

Platform support costs, which include market and enterprise level G&A, increased 41% to $48 million. Growth in our platform support cost continues to run well below our revenue growth and highlights the light overhead structure of our partnership model. As a percentage of revenue, platform support cost declined to 4.2% during the first quarter compared to 5.2% last year.

包括市場和企業級 G&A 在內的平台支持成本增加了 41%，達到 4800 萬美元。我們平台支持成本的增長繼續遠低於我們的收入增長，並凸顯了我們合作模式的輕型間接費用結構。平台支持成本佔收入的百分比在第一季度下降至 4.2%，而去年為 5.2%。

Adjusted EBITDA was $24 million in the quarter, which is a threefold increase from $8 million last year. Adjusted EBITDA now includes geography entry costs, which was $12 million in the first quarter of 2023 and $4 million in the first quarter of 2022. The increase to adjusted EBITDA reflects the gains in medical margin and gross profit, along with leverage against platform support costs. Adjusted EBITDA contribution from Direct Contracting was $3 million in the first quarter, similar to last year.

本季度調整後的 EBITDA 為 2400 萬美元，比去年的 800 萬美元增長了三倍。調整後的 EBITDA 現在包括地域進入成本，2023 年第一季度為 1200 萬美元，2022 年第一季度為 400 萬美元。調整後 EBITDA 的增加反映了醫療利潤和毛利潤的增長，以及對平台支持成本的槓桿作用.第一季度來自直接承包的調整後 EBITDA 貢獻為 300 萬美元，與去年相似。

Turning to our balance sheet and cash flow. As of March 31, we have over $800 million of cash and marketable securities. Cash flow from operations was negative $61 million for the quarter, which was in line with our expectations.

轉向我們的資產負債表和現金流量。截至 3 月 31 日，我們擁有超過 8 億美元的現金和有價證券。本季度運營現金流為負 6100 萬美元，符合我們的預期。

In February, we completed the previously announced acquisition of mphrX, a leading provider of value-based care technology and interoperability solutions, for a cash consideration of $44 million. agilon remains well capitalized. And given our efficient partnership model, we do not anticipate needing any external capital to drive our future growth.

2 月，我們完成了先前宣布的對基於價值的護理技術和互操作性解決方案的領先供應商 mphrX 的收購，現金對價為 4400 萬美元。 agilon 資本充足。鑑於我們高效的合作模式，我們預計不需要任何外部資本來推動我們未來的增長。

Turning now to our financial guidance for the second quarter and full year 2023. For the second quarter, we expect ending membership live on the agilon platform will grow to a range of 488,000 to 495,000, including 55% growth in MA membership to 403,000 to 405,000, and ACO REACH membership at 85,000 to 90,000.

現在轉向我們對第二季度和 2023 年全年的財務指導。對於第二季度，我們預計 agilon 平台上的最終會員人數將增長到 488,000 至 495,000，其中 MA 會員人數增長 55%，達到 403,000 至 405,000和 ACO REACH 成員在 85,000 到 90,000 之間。

We expect revenue in a range of $1.105 billion to $1.115 billion or 66% growth at the midpoint. We expect medical margin in the range of $138 million to $148 million, representing 74% growth, and adjusted EBITDA of $2 million to $10 million compared to negative $3 million in the prior year. Our adjusted EBITDA outlook for the second quarter now includes $19 million to $16 million in geographic entry costs.

我們預計收入在 11.05 億美元至 11.15 億美元之間，中間值增長 66%。我們預計醫療利潤在 1.38 億美元至 1.48 億美元之間，增長 74%，調整後的 EBITDA 為 200 萬至 1000 萬美元，而上一年為負 300 萬美元。我們調整後的第二季度 EBITDA 展望現在包括 1900 萬至 1600 萬美元的地域進入成本。

For the full year 2023, we expect total membership live on the agilon platform will grow to 490,000 to 500,000 members. This includes higher MA membership outlook of 405,000 to 410,000, representing growth of approximately 51% at the midpoint, and ACO REACH membership unchanged at 85,000 to 90,000 members.

對於 2023 年全年，我們預計 agilon 平台上的會員總數將增長到 490,000 至 500,000 名。這包括 405,000 至 410,000 的更高 MA 會員前景，代表中點增長約 51%，以及 ACO REACH 會員保持在 85,000 至 90,000 不變。

Revenue growth is now expected to increase 63% at the midpoint to a range of $4.41 billion to $4.44 billion. We anticipate medical margin in a range of $535 million to $560 million and adjusted EBITDA in the range of negative $3 million to positive $25 million. Our adjusted EBITDA outlook for the full year 2023 now includes $78 million to $65 million in geography entry costs. Finally, our adjusted EBITDA outlook includes $5 million to $10 million in contribution from REACH, but we now have increased confidence in the higher end of that range.

現在預計收入增長將在中點增長 63%，達到 44.1 億美元至 44.4 億美元的範圍。我們預計醫療利潤在 5.35 億美元至 5.6 億美元之間，調整後的 EBITDA 在負 300 萬美元至正 2500 萬美元之間。我們調整後的 2023 年全年 EBITDA 展望現在包括 7800 萬至 6500 萬美元的地理進入成本。最後，我們調整後的 EBITDA 展望包括來自 REACH 的 500 萬至 1000 萬美元的貢獻，但我們現在對該範圍的較高端增加了信心。

With that, we're now ready to take your questions. Operator?

有了這個，我們現在準備好回答你的問題了。操作員？

(Operator Instructions) We have the first question from Lisa Gill of JPMorgan.

（操作員說明）我們有來自摩根大通的麗莎吉爾的第一個問題。

Congratulations on a great quarter. Steve, I want to go back to the comments that you made about the 2024 class. And there's just so many things that are changing right now, and I understand what you're saying around the risk model changes and your ability to absorb that. But we also have changes coming for many of the plans when it comes to STARS. We do have rates that are not as robust as they've been in the last few years.

祝賀一個偉大的季度。史蒂夫，我想回到你對 2024 年課程的評論。現在有很多事情正在發生變化，我理解你所說的關於風險模型變化的內容以及你吸收這些變化的能力。但是，當涉及到 STARS 時，我們也對許多計劃進行了更改。我們的利率確實不如過去幾年那麼強勁。

I'm just curious about the conversations that you're having with the physician groups. One, is that helping to maybe accelerate some things as we think about you're now talking about this 2025 class already here and we're only in the first quarter or second quarter here of 2023? Just curious around, one, those conversations that you're having. And two, is there any more detail that you can give us to really give us the comfort going into 2024 when we think about margins and the potential impact of all these changes?

我只是對您與醫生團體的對話感到好奇。一，這是否有助於加速某些事情，因為我們認為您現在正在談論這個 2025 年的課程，而我們只是在 2023 年的第一季度或第二季度？只是好奇，一個，你正在進行的那些對話。第二，當我們考慮利潤率和所有這些變化的潛在影響時，您是否可以提供更多細節讓我們真正放心進入 2024 年？

Sure. Thanks, Lisa. Great, great question. I think for the class of '24 and even as I shared with the class of '25, we're very encouraged by the conversations. I think never has the case been stronger for physician groups to make the move to value. And that's really a macro thing. Structurally, more payers are pushing for value. In the constrained world, you talked about the benefits of better quality, the benefits of better experience, the way Medicare pays for that, all rewards a total care type relationship between the primary care doctor and their patients. And so I think that is really at the heart.

當然。謝謝，麗莎。很好，很好的問題。我認為對於 24 屆的班級，甚至當我與 25 屆的班級分享時，我們都對對話感到非常鼓舞。我認為醫生團體轉向價值的理由從未如此強烈。這真的是一個宏觀的事情。從結構上講，更多的支付者正在推動價值。在受限的世界中，你談到了更好質量的好處、更好體驗的好處、醫療保險為此支付的方式，所有這些都獎勵了初級保健醫生和他們的病人之間的全面護理類型的關係。所以我認為這是真正的核心。

The second thing I would say is the fee-for-service challenge has just become that much more dramatic. Rising labor costs for doctors, compressed primary care rates with the Medicare fee schedule, all of that makes the status quo that much more difficult. And so the combination of those structural factors are really pushing these groups forward. The payer conversations are extremely constructive. Payers are looking for us to go to new markets, bring on new members. The pull-through that Tim talked about is accelerating. We continue to bring on new members faster, and early growth is really impactful. That will benefit us in '24, to your forward question.

我要說的第二件事是，按服務收費的挑戰變得更加引人注目。醫生的勞動力成本上升，醫療保險費用表壓縮了初級保健費用，所有這些都使現狀變得更加困難。因此，這些結構性因素的結合確實在推動這些群體向前發展。付款人的談話非常有建設性。付款人正在尋找我們去新市場，帶來新成員。蒂姆談到的突破正在加速。我們繼續更快地吸引新成員，早期的增長確實很有影響力。對於你的前向問題，這將使我們在 24 年受益。

And I think the maturation in our mature partner markets, coupled with a rate notice that, as I said, is really very manageable, and we're implementing that right now, and that's going very well, I think that all leads to a very strong picture for us, not just in '23 but in '24 and beyond. And we are becoming the partner of choice for physicians, and we're moving more and more markets to value for the first time.

而且我認為我們成熟的合作夥伴市場的成熟，加上利率通知，正如我所說，真的非常易於管理，我們現在正在實施，而且進展順利，我認為所有這些都會導致非常不僅在 23 年，而且在 24 年及以後，對我們來說都是強有力的畫面。我們正在成為醫生的首選合作夥伴，我們正在首次將越來越多的市場推向價值。

We now have George Hill of Deutsche Bank.

我們現在有德意志銀行的 George Hill。

Yes. Steve, kind of a popular topic that we're hearing a lot about these days is the changes in insulin drug pricing. You would think insulin could be a meaningful cost contributor in a diabetic population as it relates to Medicare Advantage. I guess my question was just really, are the changes in insulin prices big enough to be needle movers as you guys think about medical costs and kind of the cost that your provider partners face?

是的。史蒂夫，我們最近經常聽到的一個熱門話題是胰島素藥物定價的變化。你會認為胰島素可能是糖尿病人群中有意義的成本貢獻者，因為它與 Medicare Advantage 相關。我想我的問題真的是，胰島素價格的變化是否足以在你們考慮醫療成本和供應商合作夥伴面臨的成本時起到推動作用？

Yes. No, thanks, George. I really appreciate it. I mean diabetics represent 25% to 30% of the senior population. As we shared with you at our Investor Day, we do an exceptionally good job of managing that diabetic population and controlling blood glucose levels and showing improvements in cost and keeping people out of the hospital at a magnitude of 2 to 3x better than the overall Medicare Advantage population. Insulin is a component of that. I don't think the changes that are contemplated would be a massive game changer for us. And each year, there are things that move up and down, and we believe we'd be able to manage that within the context of our overall outlook.

是的。不，謝謝，喬治。對此，我真的非常感激。我的意思是糖尿病患者佔老年人口的 25% 到 30%。正如我們在投資者日與您分享的那樣，我們在管理糖尿病人群和控制血糖水平方面做得非常出色，並顯示出成本的改善和讓人們遠離醫院的情況比整體 Medicare 好 2 到 3 倍優勢人口。胰島素是其中的一個組成部分。我不認為所考慮的變化對我們來說是一個巨大的遊戲規則改變者。每年都會有一些事情上下波動，我們相信我們能夠在整體前景的背景下進行管理。

We now have Ryan Daniels with William Blair.

我們現在有 Ryan Daniels 和 William Blair。

I'll echo the congrats on the strong start to the year. My question relates to the acceleration you saw in same-store growth in Q1 being up 14%, up from Q4 despite what appears to be kind of slower overall MA growth. Is there any nuances there to explain it? You talked about bringing on members more quickly, but I assume you've also got novel payer partners, some providers joining, maybe some share gains. Just what explains the relative strength versus the market, which is an even bigger delta than what we've seen in the past?

我將對今年的強勁開局表示祝賀。我的問題與您看到的第一季度同店增長比第四季度增長 14% 有關，儘管整體 MA 增長似乎有所放緩。有什麼細微差別可以解釋嗎？你談到了更快地吸引會員，但我假設你也有新的支付合作夥伴，一些供應商加入，也許有一些分享收益。究竟是什麼解釋了相對於市場的相對強度，這是一個比我們過去看到的更大的三角洲？

Yes. Thanks, Ryan. I mean we typically outperform above the market growth rate. We shoot for 1.5 to up to 2x that. Same geography growth has continued to be a really strong area for us. I think if you would ask what's really different on that is that our doctors continue to win in a really meaningful way and other doctors are wanting to join us in bringing new patients with them. We also have got tighter pull-through with our health plans, as Tim kind of dimensioned, which is really resulting in a faster acceleration of that same geography growth.

是的。謝謝，瑞安。我的意思是我們通常表現優於市場增長率。我們的目標是 1.5 到 2 倍。同樣的地域增長對我們來說仍然是一個非常強大的領域。我想，如果你要問真正不同的是，我們的醫生繼續以一種真正有意義的方式獲勝，而其他醫生也想加入我們，為他們帶來新的病人。正如蒂姆所說的那樣，我們的健康計劃也得到了更嚴格的實施，這確實導致了同一地域增長的更快加速。

But Tim, would you add on it?

但是蒂姆，你能補充一下嗎？

Yes. Just a couple of other things, George (sic) [Ryan]. One is we did mention in our comments that we had a little bit of retro membership coming through from last year. So that's going to help our Q1, and that's going to look like better same geography growth as well. And then the second thing is, if you remember back last year, we did have a chunk of retro membership that came in Q2. And so that actually depressed our Q1 same geography overlap a little bit, and we had a very, very strong Q2. We still think for the full year this year, our overall same geography growth is going to be around that double-digit range, just to kind of refer back to the guidance that we provided at Investor Day.

是的。 George (sic) [Ryan] 還有一些其他的事情。一是我們在評論中確實提到我們從去年開始有一些復古會員資格。因此，這將有助於我們的第一季度，而且看起來同樣的地理增長也會更好。然後第二件事是，如果你還記得去年，我們在第二季度確實有大量復古會員。因此，這實際上使我們的第一季度同一地理位置重疊了一點，而我們的第二季度非常非常強勁。我們仍然認為今年全年，我們的整體同一地域增長將在兩位數左右，只是為了回顧一下我們在投資者日提供的指導。

We now have Justin Lake of Wolfe Research.

我們現在有 Wolfe Research 的 Justin Lake。

First, I wanted to say I appreciate the increased transparency on the new market cost. I think it's really helpful. A lot of questions around cost trends, so maybe you can talk to us about the first quarter and how it shaped up first? What drove the PYD? How do you see it trend in the quarter? I mean there's a fair amount of PYD. What went well in the quarter to offset it and still allow you to kind of get the numbers?

首先，我想說我很欣賞新市場成本透明度的提高。我認為這真的很有幫助。關於成本趨勢的很多問題，所以也許你可以和我們談談第一季度以及它是如何形成的？是什麼推動了 PYD？您如何看待本季度的趨勢？我的意思是有相當數量的 PYD。本季度有什麼進展順利來抵消它並仍然讓你得到一些數字？

Yes. Thanks, Justin. I'll start with what I said in my prepared remarks. I mean the Q1 performance was really strong, membership growth, revenue growth. Membership up 61%. We were able to drive that inflection in medical margin of 110 basis points year-over-year, even inclusive of that higher growth, and it's a net $12 million of prior period development, both from a revenue and a cost perspective. And Tim can kind of dimension that for you.

是的。謝謝，賈斯汀。我將從我在準備好的發言稿中所說的話開始。我的意思是第一季度的表現非常強勁，會員增長，收入增長。會員人數增加了 61%。我們能夠推動醫療利潤率同比增長 110 個基點，甚至包括更高的增長，而且從收入和成本的角度來看，這是前期開發的淨 1200 萬美元。蒂姆可以為您確定尺寸。

I think part of it, Justin, is really a function of the true-ups that we've got. I called out we're up to almost 100 risk contracts with payers. Last year, it was at 60 across 20 different organizations. Many of those organizations were doing it for the first time. And so there's a lot of data flowing back and forth. And we need to have credible information to the point at which we can book revenue and cost. And that was a big part of the period.

賈斯汀，我認為部分原因實際上是我們所擁有的調整功能。我說我們與付款人簽訂了近 100 份風險合同。去年，它在 20 個不同的組織中達到了 60 個。其中許多組織都是第一次這樣做。所以有很多數據來回流動。我們需要獲得可靠的信息，以便我們可以記賬收入和成本。那是那個時期的很大一部分。

The utilization was very much in line with what we would expect. But I think the power of our clinical programs that I talked about, the power of the primary care physician touch points were really strong in the quarter. We enrolled thousands of seniors within those complex medical programs I talked about, things like palliative care and renal care, they had an impact in the quarter, Justin, but the impact is going to be far greater on a forward basis. So those were the things that I would dimension.

利用率非常符合我們的預期。但我認為我談到的臨床計劃的力量，初級保健醫生接觸點的力量在本季度非常強大。我們在我談到的那些複雜的醫療項目中招收了數千名老年人，比如姑息治療和腎臟護理，他們在本季度產生了影響，賈斯汀，但在未來的基礎上影響會更大。所以這些就是我要衡量的東西。

Tim?

蒂姆？

Yes. The only thing, Steve, that I would say just first before I jump into is, Justin, thanks for the comment on the transparency on the geo entry. Although I would say I think we've been very transparent all along on what those costs are. But yes, we're going to continue now to report it under this new presentation. So thanks for that comment.

是的。史蒂夫，在我開始之前我要說的唯一一件事是，賈斯汀，感謝你對地理條目透明度的評論。儘管我會說我認為我們一直對這些成本非常透明。但是，是的，我們現在將繼續在這個新的演示文稿下報告它。所以謝謝你的評論。

The only other thing I would add to what Steve said around drivers in the first quarter is we also did have obviously incremental membership that helped drive some incremental medical margin, that helped the quarter as well, both retro and just overall higher membership than we expected. As Steve said, we've got a very complex model. We are bringing a lot of new payers and a lot of new markets to risk for the first time, and that's going to result over time, and it's having some true-ups. As we move along, we, of course, really are committed to try and have the most accurate accruals for revenue and cost that we can. And so we want those true-ups to be, obviously, in a manageable level. And I think for the first quarter, a $12 million net number between revenue was actually quite manageable for us.

我要補充的唯一一件事是史蒂夫在第一季度關於司機所說的話，我們也確實有明顯增加的會員，這有助於推動一些增量醫療利潤，這也有助於本季度，無論是複古還是整體會員人數都比我們預期的要多.正如史蒂夫所說，我們有一個非常複雜的模型。我們首次將許多新的付款人和許多新市場帶到風險中，隨著時間的推移會產生這種結果，並且會出現一些調整。在我們前進的過程中，我們當然會真正致力於嘗試並儘可能獲得最準確的收入和成本應計費用。因此，我們顯然希望這些調整處於可管理的水平。我認為對於第一季度，1200 萬美元的收入淨額對我們來說實際上是可以控制的。

And when you look at the factors that drive it, they are the factors that kind of come out of that complexity, just some true-ups around both revenue across a number of payers as we got more data after we'd already reported the fourth quarter. We had a couple of old very high-cost claims that were kind of spread out through the year that we got visibility to after we closed Q4. And then we also talked about we had some retro members that came in and those members come with, of course, as I mentioned in my prepared comments, both revenue and claims as well. So there's going to be those kinds of true-ups. But again, we want to try to keep that as accurate as possible and obviously, within a manageable range, which I think it was for the first quarter.

當您查看驅動它的因素時，它們是從這種複雜性中產生的因素，隨著我們已經報告了第四次之後我們獲得了更多數據，一些付款人的收入只是一些調整四分之一。我們有一些舊的非常高成本的索賠，這些索賠在我們關閉第四季度後得到了可見的一年中分散開來。然後我們還談到我們有一些復古成員進來，當然，正如我在準備好的評論中提到的那樣，這些成員也帶來了收入和索賠。所以會有那些類型的調整。但同樣，我們希望盡量保持準確，顯然，在可管理的範圍內，我認為這是第一季度的情況。

We now have Stephen Baxter of Wells Fargo Securities.

我們現在有富國銀行證券公司的斯蒂芬巴克斯特。

This is Carol on for Steve. So we've seen the 10-Q and your payer disclosure that it looks like a lot of your growth this year is coming outside of your top 2 payers, despite both of these plans putting up membership that's probably above industry as a whole. Can you maybe talk a little bit more about what trends you're seeing across the payers and whether these top payers could be looking into members towards internal primary care assets? Any color there would be helpful.

這是史蒂夫的卡羅爾。因此，我們已經看到 10-Q 和您的付款人披露，看起來您今年的很多增長都來自您的前 2 位付款人之外，儘管這兩個計劃都建立了可能高於整個行業的會員資格。你能不能多談談你在付款人中看到的趨勢，以及這些頂級付款人是否可以調查內部初級保健資產的成員？那裡的任何顏色都會有所幫助。

Thanks for the question. I think the payer dynamic is increasingly favorable for us. We consider our payer partners to be great partners. And as I said, we added 9 payers this year. So we continue to expand the number of payers that we're working with. I think it reflects the fact that more payers want to be in value in a much larger way. It also reflects that we're going to new markets that have been 100% fee-for-service, and we're moving the market and these payers into that. And so we'll continue to diversify. We'll continue to add new payers as we expand to new markets.

謝謝你的問題。我認為付款人動態對我們越來越有利。我們認為我們的付款合作夥伴是很好的合作夥伴。正如我所說，我們今年增加了 9 個付款人。因此，我們繼續擴大與我們合作的付款人數量。我認為這反映了這樣一個事實，即更多的支付者希望以更大的方式實現價值。這也反映出我們將進入 100% 按服務收費的新市場，我們正在將市場和這些付款人轉移到那裡。因此，我們將繼續多元化。隨著我們擴展到新市場，我們將繼續增加新的付款人。

Our large national payers continue to be very strong partners, and we work with them very closely through quarterly joint operating committees. We are collaborating very closely on next year as they work through benefit designs and what they want to do around that. And also just the clinical programs and the quality performance that I talked about is very advantageous to them. So I think all of that leads to a very constructive environment for payers and one that we think is just strengthening.

我們的大型國家付款人仍然是非常強大的合作夥伴，我們通過季度聯合運營委員會與他們密切合作。我們將在明年密切合作，因為他們將通過福利設計以及他們想圍繞此做些什麼。而且我談到的臨床項目和質量表現對他們來說非常有利。因此，我認為所有這些都為付款人帶來了一個非常有建設性的環境，我們認為這種環境正在加強。

Yes. I think the only thing I would add is, when you're referring to the numbers in the Q and when you see the shift in mix amongst payers, especially in 2 of our biggest markets that we just went live with, we have pretty good regional payer representation in those markets. So you're going to naturally see a shift in that direction. I would add large markets like Maine and the physicians in the Detroit area that have a very large representation of regional payers. To Steve's point, when we go into a market, we're essentially contracting across all payers in the market. So I think that shift to markets that have very big regional payer presence is what's driving some of that mix shift that you're seeing in the Q reporting.

是的。我想我唯一要補充的是，當你提到 Q 中的數字時，當你看到付款人之間的組合發生變化時，尤其是在我們剛剛接觸的兩個最大市場中，我們有很好的這些市場中的區域付款人代表。所以你自然會看到朝那個方向的轉變。我會添加大型市場，如緬因州和底特律地區的醫生，這些市場在區域付款人中佔有很大的比例。就史蒂夫的觀點而言，當我們進入一個市場時，我們實際上是在與市場上的所有付款人簽訂合同。因此，我認為向區域支付者存在非常大的市場的轉變是推動你在 Q 報告中看到的一些混合轉變的原因。

We now have Jailendra Singh from Truist.

我們現在有來自 Truist 的 Jailendra Singh。

This is Jailendra Singh from Truist. I want to better understand your 2023 medical margin outlook. I know it's unchanged. But There seems some moving parts there. Now it has PYD from Q1, and then it looks like utilization is probably trending maybe favorable to your expectation. Maybe talk about some puts and takes, which are now in the guidance, given that you're coming in at the revenue membership higher than what you previously thought. Just some color there in the guidance.

我是來自 Truist 的 Jailendra Singh。我想更好地了解您 2023 年的醫療利潤率前景。我知道它沒有改變。但是那裡似乎有一些活動部件。現在它有第一季度的 PYD，然後看起來利用率可能呈趨勢，可能有利於您的預期。考慮到您的收入會員資格比您之前想像的要高，也許可以談談現在在指南中的一些看跌期權和看跌期權。指南中只有一些顏色。

Sure. I'll start, Tim, and then you can fill in. I mean I think it starts, Jailendra, with our Q1 performance was really strong and you've got that inflection in medical margin and adjusted EBITDA even with the PYD. So I think that the run rate out of the first quarter is extremely strong. I think if you look at sort of the rest of year and reaffirming that guide, it would have us within that 80 to 150 basis point improvement. And we just had a run rate that was north of 200 in the first quarter ex that PPD. We're able to digest sort of additional members coming on, which are going to be, obviously, at lower medical margin. The maturation of our year 2 market was strong in Q1, and that continues within the balance of the year and then just the power from our clinical programs.

當然。我會開始，蒂姆，然後你可以填寫。我的意思是我認為它開始，Jailendra，我們的第一季度表現非常強勁，你已經看到醫療利潤率的變化和調整後的 EBITDA，即使是 PYD。所以我認為第一季度的運行率非常強勁。我認為，如果你看看今年剩餘時間的情況並重申該指南，我們就會在 80 到 150 個基點的改進範圍內。而且我們在第一季度的運行率超過了 200（PPD 除外）。我們能夠消化一些新加入的成員，顯然，這些成員的醫療利潤率較低。我們第 2 年市場的成熟在第一季度很強勁，並且在今年餘下的時間裡繼續，然後只是我們臨床項目的力量。

With that, Tim, what else would you add?

有了這個，蒂姆，你還有什麼要補充的？

Yes, I think you nailed it, Steve, I think those are all the primary components driving it. I think that pointing out that coming off of a strong Q1 and absorbing the $12 million of prior period development. And then looking, going forward, I think that range that Steve was quoting of, say, 80 or 90 to 150 basis points improvement is kind of right on the trend that we showed in the first quarter.

是的，我認為你做到了，史蒂夫，我認為這些都是驅動它的主要組成部分。我認為這指出了強勁的第一季度並吸收了前期開發的 1200 萬美元。然後展望未來，我認為史蒂夫引用的範圍，比如 80 或 90 到 150 個基點的改進，與我們在第一季度顯示的趨勢是正確的。

We now have Adam Ron of Bank of America.

我們現在有美國銀行的 Adam Ron。

If I could go back to the 2024 rate model revision maybe from a different angle, on the Q1 earnings call from Humana, they were kind of touching on it. And they were saying that they think it would be a net headwind even when contemplating benefit changes, and they would look for mitigants over time. But it sounds like you're saying it's going to be a little bit more manageable than how they're painting it. And you did touch on geographic differences. They are more exposed to Florida where value-based care is more penetrated and risk scores are higher. But on the other hand, being in a new market, you would probably be more of an outlier as a new entrant, and so that would make it harder to overcome benefit changes. And so just wondering how you would frame your characterization versus maybe Humana and what differences you see between the 2 organizations.

如果我能從不同的角度回到 2024 年費率模型修訂版，在 Humana 的第一季度財報電話會議上，他們有點觸及它。他們表示，即使在考慮福利變化時，他們也認為這將是一個淨逆風，他們會隨著時間的推移尋找緩解措施。但聽起來你是在說它會比他們的繪畫方式更易於管理。你確實談到了地理差異。他們更容易接觸到佛羅里達州，那里基於價值的護理更深入，風險評分更高。但另一方面，在一個新市場中，作為一個新進入者，你可能更像是一個局外人，因此這將使克服福利變化變得更加困難。所以只是想知道您將如何構建您的特徵與 Humana 以及您在這兩個組織之間看到的差異。

Yes. Thanks, Adam. I really appreciate the question. I mean I think I'd start with the headline of there are real differences between our partnership model and payers. It is a very different model. I think that the risk adjustment changes really have emphasized the importance of the primary care physician, patient relationship. And that's our bread and butter. What do we focus on? We focus on increasing touch points, identifying the most complex patients, getting them enrolled in the clinical programs. And that's what we saw within the quarter and what gives us sort of confidence not just in '23 but in '24.

是的。謝謝，亞當。我真的很感激這個問題。我的意思是我想我會從我們的合作模式和付款人之間存在真正差異的標題開始。這是一個非常不同的模型。我認為風險調整的變化確實強調了初級保健醫生與患者關係的重要性。這就是我們的生計。我們關注什麼？我們專注於增加接觸點，識別最複雜的患者，讓他們參與臨床項目。這就是我們在本季度看到的情況，讓我們不僅在 23 年而且在 24 年都充滿信心。

I think, as I said, we're encouraged by the risk model changes and the phase-in. We've started implementing them and continue to see it as very manageable. I think it's a function of that patient-physician relationship and the proximity there, but also what you said, which is we are in markets that are 100% fee-for-service and lower overall.

我認為，正如我所說，我們對風險模型的變化和逐步實施感到鼓舞。我們已經開始實施它們並繼續認為它非常易於管理。我認為這是醫患關係的一個函數，以及那裡的接近程度，還有你所說的，我們所處的市場是 100% 按服務收費且整體較低的市場。

But I think the last thing I would say is the levers in our business, and this is a big difference versus a payer, is the value of really getting members on the platform earlier in a long-term subscription model, the ability to have these longer implementation periods, so our year 1 members are going to start in a higher place; and then the ability to show this maturation, which we saw again Q1-to-Q1 in mature markets, that just continues as you move going forward. So all of that is leading to our ability to say it's very manageable.

但我認為我最後要說的是我們業務中的槓桿，這與付款人有很大的不同，是在長期訂閱模式中更早地真正讓會員進入平台的價值，擁有這些的能力更長的實施週期，所以我們的第一年成員將從更高的地方開始；然後顯示這種成熟的能力，我們在成熟市場中再次看到 Q1 到 Q1，隨著你的前進，它會繼續。因此，所有這些都使我們有能力說它非常易於管理。

We now have Sean Dodge of RBC Capital Markets.

我們現在有 RBC Capital Markets 的 Sean Dodge。

Maybe just going back to medical margins again, you've historically talked about year 1 being in the $30 to $60 PMPM range. When we look at the class of 2024, is there anything different about composition, the geographies, the fact that you have a little bit longer lead time on implementation than you've had in the past, I guess the capabilities from the mphrX acquisition that would cause? You want medical margins for 2024 to be a bit different than they've been in the past. And I guess, directionally, where I'm heading is, could they be higher than that or at least towards the higher end of that range?

也許只是再次回到醫療利潤率，你在歷史上談到第 1 年在 30 美元到 60 美元的 PMPM 範圍內。當我們看 2024 年的班級時，在組成、地域方面有什麼不同嗎？事實上，你的實施準備時間比過去更長了一點，我猜 mphrX 收購的能力是會導致？您希望 2024 年的醫療利潤率與過去有所不同。我想，從方向上講，我要去的地方是，它們會比那個更高，或者至少接近那個範圍的高端嗎？

Yes, Sean, I think you answered the question there. I think all 3 of those things. One thing that can impact it, just as a starting point, is what's sort of the level of sophistication of the partners that we're starting with. And I think we have a pretty high level there going into the class of '24. So that gets us to a little bit of a starting point.

是的，肖恩，我想你在那裡回答了問題。我認為所有這三件事。作為起點，可能影響它的一件事是我們開始合作夥伴的複雜程度。而且我認為我們在進入 24 年級時已經達到了相當高的水平。所以這讓我們有了一點起點。

The second thing is, as we have talked about and you pointed out, we definitely have a longer implementation cycle for these members coming onboard, and that's going to help us as well. And now with the acquisition and the implementation of mphrX, we really are prioritizing that against getting up to speed faster with data that will help us also move that forward and will allow us to impact both the revenue side as well as getting markets up and started on some of our clinical programs earlier than they would otherwise. So I think all 3 of those are contributors.

第二件事是，正如我們已經討論過並且您指出的那樣，對於這些加入的成員，我們肯定有更長的實施週期，這也會對我們有所幫助。現在，隨著 mphrX 的收購和實施，我們確實在優先考慮加快數據速度，這將有助於我們也推動這一進程，並使我們能夠影響收入方面以及啟動和啟動市場在我們的一些臨床項目上，他們比其他人更早。所以我認為所有這 3 個都是貢獻者。

And because of that, we did say we're normally in that $30 to $60 range. The class of '23 looks like it's dead center, in that range, more or less. And we do think that the class of '24, and as we talked about on our Investor Day, it's going to be at or above the high end of that range.

正因為如此，我們確實說過我們通常在 30 美元到 60 美元的範圍內。 23 年的班級看起來像是死點，在那個範圍內，或多或少。我們確實認為，正如我們在投資者日談到的那樣，24 屆畢業生將達到或高於該範圍的高端。

And Sean, there's one more thing I'd love Steve to hit on this. It would just be when you're adding groups where you have existing infrastructure, there is a little bit of a different dynamic. So Steve, if you could...

肖恩，還有一件事我希望史蒂夫能在這方面有所作為。只是當您在擁有現有基礎設施的地方添加群組時，就會有一些不同的動態。所以，史蒂夫，如果你能……

Yes. So the class of '24, Sean, is really the first class in which you start to see really scaled new partners across multiple markets coming on in existing geographies in which we've got a team, we've got existing payer contracts, we've got existing clinical programs, and they are able to take advantage of all of that as they go through their implementation, which can be longer, as Tim said, for this class of 2024. So you put that as an added sort of modifier on top of it, and it leads you to the really strong potential year 1 performance.

是的。所以 24 屆，Sean，真的是第一堂課，在這堂課中，你開始看到跨多個市場的真正規模化的新合作夥伴出現在現有的地區，我們有一個團隊，我們有現有的付款人合同，我們已經有了現有的臨床項目，他們能夠在實施過程中利用所有這些，正如蒂姆所說，對於 2024 年的這一屆，實施時間可能會更長。所以你把它作為一種附加的修飾符最重要的是，它會帶您進入真正強大的潛在第一年表現。

We now have Ben Mayo of SVB Securities.

我們現在有 SVB Securities 的 Ben Mayo。

Tim, sorry, I'm just a little confused on the reserve development. The net $12 million, that's net of the retro payment, and the 10-Q has the $28 million reserve development. I'm just trying to make sure I get these numbers right, sorry.

蒂姆，抱歉，我只是對儲備開發有點困惑。淨額 1200 萬美元，扣除追溯付款，10-Q 有 2800 萬美元的儲備開發。我只是想確保我得到這些數字是正確的，抱歉。

Yes. So if you break down components, we want to make sure that, for all the reasons that we talked about, and we do have some of these variations that are going to happen versus our original estimates after we've already reported and that's just going to be driven by all the factors that we talked about, that can happen on both the revenue and the claims side. Of course, in the 10-Q, in that section, we do have to report out what the claims development was, which was a little over $28 million. We have about $16 million of revenue prior period that goes against that, of positive prior periods. So when you net those 2, it's about $12 million impact to the P&L in Q1 from all in prior periods.

是的。因此，如果你分解組件，我們希望確保，出於我們所討論的所有原因，在我們已經報告之後，我們確實會發生一些與我們最初估計相比的變化在我們談到的所有因素的驅動下，這可能發生在收入和索賠方面。當然，在 10-Q 中，在該部分中，我們確實必須報告索賠進展是什麼，略高於 2800 萬美元。前期我們有大約 1600 萬美元的收入，這與前期的積極收入相反。因此，當您將這 2 個淨額計算在內時，第一季度的 P&L 將受到前期所有影響約 1200 萬美元。

Okay. No, sorry. That's helpful. And just looking at your planned partners, are you seeing any changes with the payers to speed up the attribution process? I'm just wondering if there's anything that you're seeing that's enhancing your visibility on that process going forward.

好的。不，對不起。這很有幫助。看看您計劃的合作夥伴，您是否看到付款人有任何變化以加快歸因過程？我只是想知道您是否看到了任何可以提高您對該流程前進的可見性的事情。

With our longer-term partners, absolutely with. We are working particularly with some of the larger nationals, accelerating or shortening the period to get a member attributed, and getting them into a total care relationship is a goal of both of our organizations, agilon and the payers. So that is definitely true. We added 9 payers this year, the vast majority of which had never done risk before. They don't even have an attribution process. So we start from zero and we kind of work through. That's part of what we're doing is we're moving these markets to risk for the first time. It's just not the groups and the patients. It's also the health plans. And so we've got sort of folks across the spectrum in terms of where they're at on this process, but we continually work to improve across all of those payers.

與我們的長期合作夥伴，絕對配合。我們特別與一些較大的國民合作，加快或縮短歸因於成員的時間，並讓他們建立全面的護理關係是我們組織、agilon 和付款人的目標。所以這絕對是真的。今年我們新增了 9 個支付方，其中絕大多數之前從未做過風險。他們甚至沒有歸因過程。所以我們從零開始，然後努力完成。這是我們正在做的事情的一部分，我們正在首次將這些市場轉移到風險中。不僅僅是團體和患者。這也是健康計劃。因此，就他們在這個過程中所處的位置而言，我們有各種各樣的人，但我們不斷努力改進所有這些付款人。

We now have Jamie Perse of Goldman Sachs.

我們現在有高盛的 Jamie Perse。

Just a longer-term question, you guys just gave guidance for 2026 adjusted EBITDA of over $600 million. I'm wondering if you can help us bridge that given the new presentation structure and any longer-term considerations for geography entry costs as we start to kind of tease those pieces apart a little bit more?

只是一個長期問題，你們剛剛給出了 2026 年調整後 EBITDA 超過 6 億美元的指導。我想知道在我們開始稍微梳理這些部分時，鑑於新的演示結構和對地理進入成本的任何長期考慮，您是否可以幫助我們彌合這一點？

Sure, Jamie. So just to kind of reiterate, the geographic entry costs, they've been there all along. They're part of our business. They're really important for getting these physicians and partners into value for the first time and allows us to get patients in and start at a really good standing point. This is really just a reporting change. So we're just moving, no pun intended, the geography of these costs within our financial statements, so they're part of the adjusted EBITDA calculation. They're super predictable.

當然，傑米。因此，只是重申一下，地理進入成本一直存在。他們是我們業務的一部分。它們對於讓這些醫生和合作夥伴首次獲得價值非常重要，並使我們能夠讓患者進入並從一個非常好的立場開始。這實際上只是一個報告更改。因此，我們只是在移動（不是雙關語）我們財務報表中這些成本的地理位置，因此它們是調整後 EBITDA 計算的一部分。他們是超級可預測的。

And so it should be relatively easy to do the math. It's in that range of $400 to $600 per patient that will be added for the coming year. And so they only grow in absolute dollars when that membership grows. The return on them continues to be extremely strong. The LTV to CAC is greater than 10:1. And our commitment is to continue to dimension this for you, so that we've given you guidance for next quarter, we've given you guidance for the full year, and we'll continue to do that on a go-forward basis.

所以做數學應該相對容易。來年將增加每位患者 400 至 600 美元的費用。因此，只有當會員人數增加時，他們的絕對美元才會增長。他們的回報仍然非常強勁。 LTV 與 CAC 的比值大於 10:1。我們的承諾是繼續為您確定這一點，以便我們為您提供下一季度的指導，我們為您提供全年的指導，我們將繼續在前進的基礎上這樣做。

And then, Tim?

然後，蒂姆？

Yes. No, Steve, I think that's right. So if you try to dimension it specifically, we just said that we're going to do about $65 million to $78 million of geography entry costs this year, and that's going to support about 145,000 member growth that we've guided to for 2024 because the cost, obviously, the investment in growth, kind of is supporting that membership the year before they go live or the year before we can get them attributed or go live. And if you look forward into kind of the '24 to '26 period, we said we'd continue to add about 150,000 members a year to get to 2026.

是的。不，史蒂夫，我認為這是對的。因此，如果您嘗試具體衡量它，我們剛剛說過，我們今年將投入大約 6500 萬至 7800 萬美元的地理准入成本，這將支持我們指導的 2024 年約 145,000 名會員的增長，因為成本，顯然，增長投資，有點是在他們上線前一年或我們可以讓他們歸因或上線前一年支持該會員資格。如果你期待 24 到 26 年的時期，我們說過我們將繼續每年增加約 150,000 名成員，以達到 2026 年。

So that would say that if you use that same range of $400, $600, geography entry costs will be in the same dollar range. Obviously, it will be a much smaller percentage of our overall EBITDA. EBITDA is growing to a larger number out at that point. And to Steve's point, one of the reasons why EBITDA is growing to a larger number is because we're making these investments in growth each year. And yes, the return on investment in these are a phenomenon. Steve quoted the lifetime value to customer acquisition cost ratio. I mean another way to look at it is we're typically paying those costs back in certainly less than 2 years, usually closer to an average of about 1 year or so. We'll continue to make those investments. But I think to Steve's point, if you look at the membership that we said we're going to grow, you use that $400 to $600 per member range, that's going to be about right.

也就是說，如果您使用相同的 400 美元、600 美元範圍，則地理進入成本將在相同的美元範圍內。顯然，它占我們整體 EBITDA 的比例要小得多。在這一點上，EBITDA 正在增長到一個更大的數字。就史蒂夫的觀點而言，EBITDA 增長到更大數量的原因之一是因為我們每年都在進行這些增長投資。是的，這些投資回報是一種現象。史蒂夫引用了生命週期價值與客戶獲取成本的比率。我的意思是另一種看待它的方式是，我們通常會在不到 2 年的時間內收回這些成本，通常接近平均約 1 年左右。我們將繼續進行這些投資。但我認為史蒂夫的觀點是，如果你看看我們說我們將要增長的會員，你使用每個會員 400 到 600 美元的範圍，那將是正確的。

We now have Gary Taylor of Cowen.

我們現在有 Cowen 的 Gary Taylor。

I think this is pretty clear, but I just want to, I guess, reiterate. So if we look at the net development of $12 million and $35 million of EBITDA, under the old presentation, really, from your view, this was a $47 million EBITDA quarter versus your guide of $32 million to $37 million. That's how you're looking at this on a net basis, right?

我認為這很清楚，但我想，我想重申一下。因此，如果我們看一下 1200 萬美元和 3500 萬美元的 EBITDA 淨發展，根據舊的介紹，實際上，從您的角度來看，這是一個 4700 萬美元的 EBITDA 季度，而您的指導值為 3200 萬至 3700 萬美元。這就是你在淨基礎上看待這個問題的方式，對吧？

No. So Gary, the $12 million of net development would be medical margin, not EBITDA. You're saying you wouldn't add that to our EBITDA, is that what you're asking?

不，加里，淨開發的 1200 萬美元將是醫療利潤，而不是 EBITDA。您是說您不會將其添加到我們的 EBITDA 中，這是您要問的嗎？

Yes, under the old report.

是的，根據舊報告。

Yes. Under any reporting, we haven't changed medical margin definition. The $12 million would have been incremental to medical margin had we not had that prior period development. Typically, about half of that incremental medical margin dollars flows through to EBITDA, so it would be about half that number. Does that make sense?

是的。根據任何報告，我們都沒有改變醫療保證金的定義。如果我們沒有進行前期開發，那麼 1200 萬美元本來可以增加醫療利潤。通常，大約一半的增量醫療利潤流向 EBITDA，因此大約是該數字的一半。那有意義嗎？

Yes.

是的。

Gary, why don't you go ahead just because I know it was a numbers question. So go for it, then we'll move on.

加里，你為什麼不繼續，因為我知道這是一道數字題。所以去吧，然後我們繼續前進。

For those of us that are trying to follow and make sense of the claims payable and the receivables, I mean both of those approximately doubled sequentially versus like 65% revenue growth sequentially. I think that's just a function of new markets, new contracts, new payers and nothing is actually going to settle out until the year progresses. Is that the right way to think about both those balance sheet numbers being up?

對於我們這些試圖跟踪和理解應付索賠和應收賬款的人來說，我的意思是這兩者都大約連續翻了一番，而收入連續增長了 65%。我認為這只是新市場、新合同、新付款人的一個功能，在這一年過去之前，什麼都不會真正解決。這是考慮這兩個資產負債表數字都在上升的正確方法嗎？

It is, Gary. That's right. You're always going to see a sequential increase for our DCP, for instance, between Q4 and Q1 driven by exactly the phenomena that you're talking about. And as we move through this year and we get more and more visibility to pay claims with our new payer partners and our new markets, by the time we get to Q4, you'll see that number moderate back down again as it has in the previous couple of years.

是的，加里。這是正確的。你總是會看到我們的 DCP 連續增加，例如，在第四季度和第一季度之間，正是由你正在談論的現象驅動的。隨著我們今年的進展，我們越來越多地看到與我們的新付款人合作夥伴和新市場一起支付索賠，到我們進入第四季度時，你會看到這個數字再次溫和回落，就像它在前幾年。

Our next question comes from David Larsen from BTIG.

我們的下一個問題來自 BTIG 的 David Larsen。

I think you announced 5 new 2024 partnership wins, which seems like a lot to me. I'm assuming you're on track for 670,000 lives for fiscal '24. How far along are you in that life sort of count add guide with these 5 wins that you've announced? Are you like halfway there?

我認為您宣布了 5 個新的 2024 合作夥伴關係勝利，這對我來說似乎很多。我假設您在 24 財年有望挽救 670,000 條生命。在您宣布的這 5 場胜利中，您在生活中走了多遠？你喜歡一半嗎？

So we have announced 5 of 6 new partners, David, for the class of 2024. And what we said in our remarks is that we are at 145,000. But just like with '23 member growth, there is the potential for that number to go higher through a variety of factors. And then we're already on to the class of '25. And so what I also said in my prepared remarks is that we will begin implementing 2 partners for the of class of '25 in the second half of this year. So you continue to see this faster sales cycle. You continue to see longer implementation periods. And while there's opportunity in '24 member growth, we're on to '25 in terms of new partners and the work that we're doing there.

因此，我們宣布了 2024 屆畢業生的 6 名新合作夥伴中的 5 名大衛。我們在發言中說的是我們有 145,000 名。但就像 '23 成員增長一樣，這個數字有可能通過各種因素上升。然後我們已經進入了 25 年的班級。因此，我在準備好的發言中也說過，我們將在今年下半年開始為 25 屆畢業生配備 2 個合作夥伴。所以你會繼續看到這個更快的銷售週期。您繼續看到更長的實施週期。雖然在 24 世紀成員增長方面存在機會，但就新合作夥伴和我們在那裡所做的工作而言，我們將進入 25 世紀。

And David, I would just add that the sixth one will be announced when we're ready to announce them. We're just thoughtful about the timing around that.

大衛，我只想補充一點，第六個將在我們準備好宣佈時宣布。我們只是在考慮時間安排。

We now have Brian Tanquilut of Jefferies.

我們現在有 Jefferies 的 Brian Tanquilut。

Just a quick question. As I think about your comment about 2025 development, and that's a focus area now, and how '24 is really your bunch of scaled ones, how are those conversations changing in terms of like trying to pitch potential new partners? And then in terms of like market competition for deals, it seems like there's more money chasing, more money or more practices looking to shift to value-based, so just curious what the competitive market looks like.

只是一個簡單的問題。當我想到你對 2025 年發展的評論時，這是現在的一個重點領域，'24 真的是你的一群規模化的人，這些對話在試圖推銷潛在的新合作夥伴方面有何變化？然後就交易的市場競爭而言，似乎有更多的資金追逐、更多的資金或更多的做法希望轉向基於價值的做法，所以很好奇競爭市場是什麼樣的。

Yes. I think the power of our network is really sort of helping us within these conversations. When you think about the fact, Brian, that we've got 30-plus markets with leading groups. We're approaching 1.5% of the primary care doctors in the country on our platform, and they're bringing their senior patients with them. And then we've got national scale, like things in the clinical programs that I talked about. The track record of the success that our partners are having, in addition to the push for more value from payers that I talked about, it's accelerating. I mean the sales cycle is shortening. We are already talking to 2 partners about implementing them starting in the back half of this year. And as I said in my remarks, we're really extremely encouraged.

是的。我認為我們網絡的力量確實在某種程度上幫助了我們進行這些對話。當你想到這個事實時，布賴恩，我們有 30 多個市場和領先的團體。我們正在通過我們的平台接近全國 1.5% 的初級保健醫生，他們帶著他們的老年患者。然後我們有全國規模，就像我談到的臨床項目中的事情一樣。我們的合作夥伴所擁有的成功記錄，除了我談到的從付款人那裡獲得更多價值之外，還在加速。我的意思是銷售週期正在縮短。我們已經在與 2 個合作夥伴討論從今年下半年開始實施它們。正如我在發言中所說，我們真的非常受鼓舞。

The breadth of the types of partners that we're serving, we're now working with virtually every type of physician organization in the country. So any group that wants to talk to us, that is thinking about making the move to value, not only can we say here's our overall track record but here's a group that looks like you, thinks like you and here has been their experience. And that's the best track record that you can have in groups that are thinking about making those types of decisions.

我們所服務的合作夥伴類型廣泛，我們現在正在與該國幾乎所有類型的醫生組織合作。因此，任何想要與我們交談、正在考慮轉向價值的團體，我們不僅可以說這是我們的整體記錄，而且這裡有一個看起來像你的團體，像你一樣思考，這是他們的經驗。這是您在考慮做出此類決策的團隊中可以擁有的最佳記錄。

We have no further questions in the queue. So I'd like to hand it back to Steve Sell for any final remarks.

隊列中沒有其他問題。所以我想把它交還給 Steve Sell，請他發表最後的評論。

All right. Thank you, operator. In closing, I'd just like to say we've had a really strong start to the year, and we're making great progress against our vision.

好的。謝謝你，運營商。最後，我只想說，我們今年的開局非常強勁，而且我們在實現我們的願景方面取得了很大進展。

I do want to thank our physician partners for the trust they place on agilon. I want to thank my colleagues here at agilon for their hard work and dedication in supporting senior patients and physician partners.

我確實要感謝我們的醫生合作夥伴對 agilon 的信任。我要感謝我在 agilon 的同事們在支持老年患者和醫生合作夥伴方面的辛勤工作和奉獻精神。

And we're excited about where we're going. We look forward to updating you on our progress in future calls. And I hope everyone has a great evening. Thank you .

我們對我們要去的地方感到興奮。我們期待在未來的電話會議中向您通報我們的進展情況。我希望每個人都有一個愉快的夜晚。謝謝 。

Thank you all for joining our conference. That does conclude today's call. Please have a lovely rest of your day, and you may now disconnect your lines.

感謝大家參加我們的會議。今天的電話會議到此結束。請好好休息，現在您可以斷開線路了。