agilon health inc (AGL) 2023 Q3 法說會逐字稿

Hello, everyone, and welcome to the agilon health Third Quarter 2023 Earnings Conference Call. My name is Carla, and I will be your operator for today's call. (Operator Instructions)

大家好，歡迎參加 agilon health 2023 年第三季財報電話會議。我叫卡拉，我將擔任您今天通話的接線生。 （操作員說明）

I will now hand you over to your host, Matthew Gillmor, Vice President of Investor Relations. Matthew, please go ahead.

現在我將把您交給東道主投資者關係副總裁 Matthew Gillmor。馬修，請繼續。

Thanks, operator. Good afternoon, and welcome to the call. With me is our CEO, Steve Sell; and our CFO, Tim Bensley.

謝謝，接線生。下午好，歡迎您的來電。和我在一起的是我們的執行長 Steve Sell；以及我們的財務長 Tim Bensley。

Before we begin, we'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.

在開始之前，我們想提醒您，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中明示或暗示的結果有重大差異。我們向 SEC 提交的文件中討論了這些風險和不確定性。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 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.

此外，我們將在本次電話會議上討論的某些財務指標是非公認會計原則指標。我們相信，提供這些措施有助於投資者更好、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保持一致。這些非 GAAP 財務指標與最具可比性的 GAAP 指標的調整表可在收益新聞稿和 8-K 表格中找到。

Following prepared remarks from Steve and Tim, we'll conduct a Q&A session. During the Q&A session, we'd ask everyone to please limit themselves to one question so we can get through as many questions as possible.

在史蒂夫和提姆準備好發言後，我們將舉行問答環節。在問答環節，我們要求每個人只回答一個問題，以便我們能夠回答盡可能多的問題。

With that, I'll turn things over to Steve.

這樣，我就把事情交給史蒂夫了。

Thanks, Matt. Good evening, and thank you for joining us. Momentum across our business remains strong, and we are making rapid progress against our vision to transform health care in 100-plus communities by empowering primary care doctors.

謝謝，馬特。晚上好，感謝您加入我們。我們的業務勢頭依然強勁，我們的願景正在快速取得進展，即透過增強初級保健醫生的能力來改變 100 多個社區的醫療保健狀況。

As an indicator of our success, this year we are on track to reinvest more than $250 million into local primary care based on the high-quality cost-effective care being delivered by our partners. These results are enabling our partner groups to expand access to preventative services, improve quality outcomes and drive value for the communities they serve. I want to thank my agilon colleagues and our partners for their trust in each other and their belief and support in a network that is shaping a better health care system for our country.

作為我們成功的指標，今年我們預計在合作夥伴提供的高品質、具成本效益的護理基礎上，向當地初級護理再投資超過 2.5 億美元。這些成果使我們的合作夥伴團體能夠擴大獲得預防性服務的機會，提高結果品質並為他們所服務的社區創造價值。我要感謝我的 agilon 同事和我們的合作夥伴對彼此的信任以及對正在為我們國家塑造更好的醫療保健系統的網絡的信念和支持。

Before discussing our performance for the quarter, I wanted to take a few moments to highlight our decision to sell our Hawaii business. As we have discussed with you, Hawaii operates very differently compared to our core partner markets in the Continental U.S. In our core partner markets, we leverage a common operating structure. This operating structure is centered around a long-term joint venture with a scaled physician group and non-delegated multi-payer relationships with health plans and CMS.

在討論我們本季的業績之前，我想花一些時間強調我們出售夏威夷業務的決定。正如我們與您討論的那樣，與我們在美國大陸的核心合作夥伴市場相比，夏威夷的運作方式非常不同。在我們的核心合作夥伴市場中，我們利用共同的營運結構。該營運結構以與規模化醫生集團的長期合資企業以及與健康計劃和 CMS 的非委託多付款人關係為中心。

The key differences in Hawaii's operations, namely the lack of a joint venture partnership with a large physician group, a much smaller senior patient physician panel size and Hawaii's delegated MSO infrastructure made our Hawaii business increasingly less strategic to agilon and created a drag on our financial results.

夏威夷業務的主要差異，即缺乏與大型醫生集團的合資夥伴關係、高級患者醫生小組規模小得多以及夏威夷授權的MSO 基礎設施，使得我們的夏威夷業務對agilon 來說越來越缺乏戰略意義，並拖累了我們的財務結果。

We are pleased to transition MDX Hawaii to a new owner that is better positioned to invest into the business and optimize its delegated infrastructure, which should benefit patients and the community at large. The sale of Hawaii will enhance our ability to focus even more specifically on our partner markets at a point in time when we are driving increasing success across a PCP's entire senior panel.

我們很高興將 MDX Hawaii 移交給新所有者，新所有者能夠更好地投資業務並優化其委託的基礎設施，這將使患者和整個社區受益。當我們在 PCP 的整個高級小組中不斷取得成功時，出售夏威夷將增強我們更加專注於合作夥伴市場的能力。

This quarter and going forward, you will hear us consistently highlight the power and importance of our integrated senior business across Medicare Advantage and the traditional Medicare populations. Our ability to generate successful outcomes for patients, PCPs and the system in a multi-payer full risk model is increasingly unique. Our focus on this opportunity will pay dividends in the years to come.

本季及今後，您將聽到我們不斷強調我們跨 Medicare Advantage 和傳統 Medicare 人群的綜合老年業務的力量和重要性。我們在多支付者全風險模型中為患者、PCP 和系統產生成功結果的能力越來越獨特。我們對這一機會的關注將在未來幾年帶來回報。

Turning now to the quarter. Partner market performance was again extremely strong across both MA and ACO REACH. All of our key financial metrics were generally in line or above our guidance ranges, especially on an underlying basis. Our results continue to demonstrate the unique power of our model to inflect profitability while driving significant growth.

現在轉向本季。 MA 和 ACO REACH 的合作夥伴市場表現再次極為強勁。我們所有的關鍵財務指標總體上都符合或高於我們的指導範圍，特別是在基本基礎上。我們的結果繼續證明了我們的模型在推動顯著成長的同時影響獲利能力的獨特力量。

During the quarter, our total membership on the platform increased 43% to 508,000 members, and revenues increased 75% to $1.2 billion. This was above our guidance and was supported by the successful onboarding of new PCPs and faster pull-through of members, particularly in new markets.

本季度，我們平台上的會員總數增加了 43%，達到 508,000 名會員，收入增加了 75%，達到 12 億美元。這超出了我們的指導方針，並得到了新 PCP 的成功入職和會員更快吸收的支持，特別是在新市場。

Adjusted for the sale of MDX Hawaii, our partner market growth was even stronger with total membership up 49% and revenue up 85%. Even with our faster membership growth, adjusted EBITDA continues to inflect higher, increasing more than $20 million year-over-year to a loss of $6 million for the quarter. This was in line with our outlook and supported by strong medical margin gains in our partner markets across MA and REACH.

在根據 MDX Hawaii 的銷售情況進行調整後，我們的合作夥伴市場成長更加強勁，會員總數成長了 49%，營收成長了 85%。儘管我們的會員成長速度較快，調整後的 EBITDA 仍持續走高，年增超過 2,000 萬美元，本季虧損 600 萬美元。這符合我們的預期，並得到 MA 和 REACH 合作夥伴市場醫療利潤強勁成長的支持。

Adjusted for Hawaii, our partner market EBITDA was positive $6 million for the quarter, well above our outlook. And it was even stronger on an underlying basis as our results included some net negative development from 2022. Our combined medical margin across MA partner markets and REACH was strong in the quarter, with MA generating $111 million and REACH generating $55 million. These results demonstrate the power of a PCP focusing on the most complex patients across their entire senior panel with differentiated information and care team resources.

根據夏威夷調整後，本季我們的合作夥伴市場 EBITDA 為正 600 萬美元，遠高於我們的預期。而且，由於我們的業績包括自2022 年以來的一些淨負發展，其基礎更為強勁。本季度我們在MA 合作夥伴市場和REACH 的綜合醫療利潤率強勁，MA 產生1.11 億美元，REACH 產生5500 萬美元。這些結果證明了 PCP 透過差異化資訊和護理團隊資源專注於整個高級小組中最複雜的患者的力量。

As an example, our year 2 plus partner markets in MA and REACH both generated over $130 per member per month in medical margins year-to-date. Think about the value delivery to our PCP partners and the health system when we generate this magnitude of savings across an average panel size of 400 to 500 senior patients.

例如，年初至今，我們在 MA 和 REACH 的第 2 年及以上合作夥伴市場每位會員每月的醫療利潤均超過 130 美元。想想當我們在 400 至 500 名老年患者的平均小組規模中產生如此巨大的節省時，我們為 PCP 合作夥伴和衛生系統帶來的價值。

From a guidance perspective, we have raised our membership revenue and adjusted EBITDA outlook for 2023. This was supported by the growth and margin progression in our MA partner markets, including REACH and the sale of MDX Hawaii.

從指導角度來看，我們提高了會員收入，並調整了 2023 年 EBITDA 前景。這得益於我們的 MA 合作夥伴市場的成長和利潤成長，包括 REACH 和 MDX Hawaii 的出售。

We also plan to maintain a more conservative reserving approach as we exit 2023. And this is intentionally reflected in our medical margin outlook for MA and will support our future performance in 2024. Our ability to execute against our adjusted EBITDA targets during 2023 and enhance our visibility to 2024 continues to reflect the strength and durability of our model.

我們也計劃在2023 年退出時保持更保守的準備金方法。這有意反映在我們對MA 的醫療利潤率展望中，並將支持我們2024 年的未來業績。我們有能力在2023 年執行調整後的EBITDA 目標，並增強我們的能力到 2024 年的可見度繼續反映了我們模型的強度和耐用性。

As I have discussed with you previously, the key differences in our model are driving differentiated clinical and financial performance. Unlike the traditional fee-for-service system, which predominates across health care, all patients in our model have a fully aligned or attributed relationship with their primary care doctor. And through agilon's platform, our PCP partners have the data and resources to proactively impact patient care. This translates into specific differences in the way health care is utilized and managed, and this shows up in our business in very tangible ways.

正如我之前與您討論的那樣，我們模型的主要差異正在推動差異化的臨床和財務績效。與在醫療保健領域占主導地位的傳統按服務收費系統不同，我們模型中的所有患者都與其初級保健醫生有著完全一致或歸屬的關係。透過 agilon 的平台，我們的 PCP 合作夥伴擁有數據和資源來主動影響病患照護。這轉化為醫療保健利用和管理方式的具體差異，並以非常實際的方式體現在我們的業務中。

For example, we continue to have outstanding results in the standardized star ratings measures. For 2024 stars, the percentage of our membership in 4+ star plans will increase modestly to approximately 84%. However, as most of you know, plan-level star ratings also include the performance of non-agilon providers.

例如，我們在標準化星級評定方面繼續取得優異的成績。對於 2024 顆星，我們的 4+ 星計畫會員比例將小幅增加至約 84%。然而，正如大多數人所知，計劃層級的星級評定還包括非 agilon 提供者的表現。

For our year 2 plus partners agilon's specific performance is 4.3 stars and increased nicely year-over-year. This was despite more stringent cut points and relatively flat star ratings industry-wide. We continue to excel in areas like preventative cancer screens, diabetes control and medication adherence. Our quality results will drive meaningful value to our patients and the health care system in the years ahead. And because of our high member retention, agilon and our physician partners will share in this value over the long term.

對於我們第二年以上的合作夥伴，agilon 的具體表現為 4.3 顆星，並且逐年大幅成長。儘管整個行業的評分標準更加嚴格且星級評級相對平坦，但情況仍然如此。我們在預防性癌症篩檢、糖尿病控制和藥物依從性等領域持續表現出色。我們的高品質成果將在未來幾年為我們的患者和醫療保健系統帶來有意義的價值。由於我們的會員保留率很高，agilon 和我們的醫生合作夥伴將長期分享這一價值。

Additionally, our ability to drive differentiated cost performance was clearly evident in the recently released ACO REACH results for 2022. This data allows agilon to compare our performance against the unmanaged fee-for-service system as well as other value-based care models. During 2022, our Reach ACOs drove nearly 10% savings relative to the Medicare benchmark. This was more than 2.5x better than the program average and our results included more than 90,000 beneficiaries in diverse markets.

此外，我們推動差異化成本績效的能力在最近發布的 2022 年 ACO REACH 結果中顯而易見。這些數據使 agilon 能夠將我們的績效與非託管服務收費系統以及其他基於價值的護理模式進行比較。 2022 年，我們的 Reach ACO 相對於 Medicare 基準節省了近 10%。這比計劃平均高出 2.5 倍以上，我們的結果包括不同市場的 90,000 多名受益人。

agilon also returned nearly $30 million in guaranteed savings to the Medicare Trust Fund last year. As you can see from our REACH results this quarter, our differentiated cost performance has carried into 2023.

agilon 去年也向醫療保險信託基金返還了近 3,000 萬美元的保證儲蓄。從我們本季的 REACH 結果可以看出，我們差異化的性價比已經延續到了 2023 年。

Looking forward, we believe our leadership position as the platform and network moving physicians to full risk has grown considerably. This is a function of the magnitude of savings we are generating across the entire senior panel of a primary care doctor.

展望未來，我們相信，作為讓醫生承擔全面風險的平台和網絡，我們的領導地位已大大增強。這是我們在初級保健醫生的整個高級小組中產生的節省幅度的函數。

Our timing is also important. As primary care physicians and the broader system increasingly need a scalable solution for multi-payer full risk. This dynamic is driving the ongoing inflection we are seeing from a demand perspective among both physician groups and health systems.

我們的時機也很重要。隨著初級保健醫生和更廣泛的系統越來越需要一個可擴展的解決方案來應對多支付者的全面風險。從醫生群體和衛生系統的需求角度來看，這種動態正在推動我們所看到的持續變化。

For the class of 2024 new partners, we now expect 25,000 new ACO REACH members, and we are increasing our expectation from 100,000 to 110,000 new MA members. At this point in the year, we are nearly complete with our payer contracted cycle, which gives us better visibility into the membership pull-through. We also now have a clear line of sight to a very strong class of 2025 with multiple new partners signed, including independent groups and health systems. Implementation for this class has already begun, which should bode well for future performance.

對於 2024 屆新合作夥伴，我們現在預計將有 25,000 名新 ACO REACH 會員，並將預期從 100,000 名新 MA 會員增加到 110,000 名。今年的這個時候，我們幾乎完成了付款人合約週期，這使我們能夠更好地了解會員資格的變化。我們現在也對 2025 年非常強大的班級有了清晰的認識，並簽署了多個新合作夥伴，包括獨立團體和健康系統。該類別的實作已經開始，這對於未來的效能來說是個好兆頭。

Before turning the call over to Tim, I wanted to offer a few comments on 2024. We remain highly confident in the trajectory of our adjusted EBITDA inflection and expect to share an initial view in early January. As we have discussed previously, we operate in a very forward-looking model, and our visibility into the key drivers for next year's performance are quite high.

在將電話轉給蒂姆之前，我想對 2024 年發表一些評論。我們對調整後 EBITDA 拐點的軌跡仍然充滿信心，並預計在一月初分享初步觀點。正如我們之前所討論的，我們以非常前瞻性的模式運營，並且我們對明年業績的關鍵驅動因素的了解非常高。

First, we have a large and growing class of 2024 new partners with an attractive margin profile that should be meaningfully accretive to adjusted EBITDA. This is a function of the longer implementation cycle for this class and targeted investments we have made around technology and centralizing key processes.

首先，我們擁有大量且不斷成長的 2024 年新合作夥伴，他們的利潤率頗具吸引力，應該會對調整後的 EBITDA 產生有意義的增值。這是此類產品實施週期較長以及我們圍繞技術和集中關鍵流程進行的有針對性的投資的結果。

Next, the combined strength of our 2023 run rate margins across our integrated senior business will have key positive implications for 2024. First, our REACH performance will carry forward, driven by our ability to maintain the cost differential compared to the benchmark. And second, the reserve actions we have taken in Medicare Advantage should reduce the risk of negative claims development next year.

接下來，我們綜合高階業務的2023 年運行率利潤率的綜合實力將對2024 年產生關鍵的積極影響。首先，在我們維持與基準相比成本差異的能力的推動下，我們的REACH 績效將繼續前進。其次，我們在醫療保險優勢中採取的準備金行動應該會降低明年出現負面索賠的風險。

Finally, we remain very confident in our ability to manage the new risk adjustment model starting in 2024. The impact to agilon from the V28 model change is relatively modest. And given the limited maturity of our partner markets and senior membership, our ability to mitigate this impact is very high.

最後，我們對從 2024 年開始管理新風險調整模型的能力仍然非常有信心。V28 模型變更對 agilon 的影響相對較小。鑑於我們的合作夥伴市場和高級會員的成熟度有限，我們減輕這種影響的能力非常強。

With that, let me turn things over to Tim.

接下來，讓我把事情交給提姆。

Thanks, Steve, and good evening, everyone. I'll now review highlights from our third quarter results and our updated outlook for 2023.

謝謝史蒂夫，大家晚上好。我現在將回顧我們第三季業績的亮點以及我們更新的 2023 年展望。

Starting with our membership for the third quarter, total members live on the agilon platform increased to approximately 508,000 including both Medicare Advantage and ACO REACH. Our consolidated Medicare Advantage membership increased 58% to 420,000, driven by the addition of new partner geographies and 9% growth with our same geographies. Adjusted for Hawaii, MA membership in our core partner markets grew 69% to $384,000 and our same geography growth was 12%.

從第三季的會員資格開始，agilon 平台上的會員總數增加到約 508,000 名，其中包括 Medicare Advantage 和 ACO REACH。由於新合作夥伴地區的增加以及我們相同地區的成長 9%，我們的合併 Medicare Advantage 會員人數增加了 58%，達到 42 萬名。根據夏威夷調整後，我們核心合作夥伴市場的馬薩諸塞州會員資格增長了 69%，達到 384,000 美元，而我們同一地區的會員資格增長了 12%。

Reported revenues increased 75% on a year-over-year basis to $1.2 billion during the third quarter. Year-to-date, revenues increased 73% to $3.5 billion. Revenue growth was primarily driven by membership gains in new and existing geographies.

第三季報告營收年增 75%，達到 12 億美元。年初至今，營收成長了 73%，達到 35 億美元。收入成長主要是由新地區和現有地區的會員成長所推動的。

On a per member per month basis or PMPM, third quarter revenue increased 11%. This was primarily driven by benchmark updates and membership mix, including higher benchmarks in several new markets. Adjusted for Hawaii, revenues increased 85% to $1.1 billion and revenue PMPM increased 10% during the third quarter.

以每位會員每月或 PMPM 計算，第三季營收成長了 11%。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。根據夏威夷調整後，第三季營收成長了 85%，達到 11 億美元，PMPM 營收成長了 10%。

For our MA business, medical margin on a reported basis increased 42% year-over-year to $108 million during the third quarter. Year-to-date, medical margin increased 67% to $408 million. While this was below our outlook for the quarter, the difference was primarily driven by performance in Hawaii.

對於我們的 MA 業務，第三季的醫療利潤率年增 42% 至 1.08 億美元。年初至今，醫療利潤率成長了 67%，達到 4.08 億美元。雖然這低於我們對本季的預期，但差異主要是由夏威夷的業績造成的。

Adjusted for Hawaii, medical margins increased 46% year-over-year to $111 million for the third quarter and was in line with our expectation, even with approximately $6 million of net negative development. On a per member per month basis, medical margins across our core partner markets increased by 4% year-to-date to $119, driven by the maturation of markets and member cohorts. For our year 2 plus partner markets, medical margin PMPM increased 17% to $134 on a year-to-date basis.

按夏威夷調整後，第三季的醫療利潤率年增 46% 至 1.11 億美元，符合我們的預期，儘管淨負成長約為 600 萬美元。以每位會員每月計算，在市場和會員群體成熟的推動下，我們核心合作夥伴市場的醫療利潤今年迄今增長了 4%，達到 119 美元。對於我們第 2 年及以上的合作夥伴市場，醫療利潤 PMPM 較年初至今成長了 17%，達到 134 美元。

MA medical margins for the quarter included a net $8 million in negative development, including $9 million in prior year claims, offset by $1 million in prior year revenue, $2 million of the net development was attributed to Hawaii and the remaining $6 million was attributed to our core partner markets. The negative claims development this quarter was almost entirely isolated to system issues with a single payer related to supplemental benefit costs. As we discussed last quarter, we are making focused investments to improve our visibility into data gaps with payers.

馬薩諸塞州本季的醫療利潤包括800 萬美元的淨負發展，其中包括上一年索賠的900 萬美元，被上一年收入的100 萬美元抵消，淨發展中的200 萬美元歸因於夏威夷，其餘600 萬美元歸因於夏威夷。我們的核心合作夥伴市場。本季的負面索賠發展幾乎完全與單一付款人與補充福利成本相關的系統問題無關。正如我們上季度討論的那樣，我們正在進行重點投資，以提高我們對付款人數據差距的可見度。

Excluding the year-to-date development, MA Medical margins would have been approximately $125 PMPM in our partner markets and $143 PMPM in our year 2 plus partner markets. We think this is an important metric as it better reflects the year-to-date run rate performance of our MA business in light of the sale of MDX Hawaii and the actions we have taken to minimize the risk of negative development in 2024.

排除今年迄今的開發，MA Medical 在我們的合作夥伴市場中的利潤約為 125 美元 PMPM，在我們的第 2 年及以上合作夥伴市場中約為 143 美元 PMPM。我們認為這是一個重要的指標，因為它更好地反映了我們的 MA 業務今年迄今的運行率表現，考慮到 MDX Hawaii 的出售以及我們為盡量減少 2024 年負面發展風險所採取的行動。

For our ACO REACH business, we continue to be very encouraged with the performance, which again outperformed our guidance this quarter. REACH generated $55 million of medical margin in the quarter and $117 million year-to-date, which is a twofold increase from last year. Additionally, on a per member per month basis, REACH profitability this year is roughly comparable to the year 2 plus MA partner markets. This level of performance is encouraging and underscores the power of our multi-payer full risk platform.

對於我們的 ACO REACH 業務，我們的業績繼續令人鼓舞，本季再次超越了我們的指導。 REACH 本季創造了 5,500 萬美元的醫療利潤，年初至今創造了 1.17 億美元的醫療利潤，比去年增長了一倍。此外，以每位會員每月計算，今年 REACH 的獲利能力與第二年及 MA 合作夥伴市場大致相當。這種表現水準令人鼓舞，並突顯了我們多支付者全風險平台的力量。

While REACH is not consolidated in our financial results, we do think it is relevant to think about our medical margin performance on a combined basis across our MA partner markets and REACH. This is because our combined MA and REACH performance is what drives our key profitability metric, adjusted EBITDA.

雖然 REACH 並未合併在我們的財務業績中，但我們確實認為有必要在 MA 合作夥伴市場和 REACH 的綜合基礎上考慮我們的醫療利潤表現。這是因為我們的 MA 和 REACH 綜合績效是推動我們關鍵獲利指標（調整後 EBITDA）的動力。

For 2023, our combined medical margins for MA partners and REACH are consistent with our original guidance expectations. As Steve mentioned, this sets a strong foundation for performance in 2024. Our adjusted EBITDA on a reported basis was negative $6 million in the quarter compared to negative $26 million last year.

2023 年，我們對 MA 合作夥伴和 REACH 的綜合醫療利潤率與我們最初的指導預期一致。正如史蒂夫所提到的，這為 2024 年的業績奠定了堅實的基礎。根據報告，我們本季調整後的 EBITDA 為負 600 萬美元，而去年為負 2,600 萬美元。

On a year-to-date basis, adjusted EBITDA was positive $28 million compared to negative $20 million last year. As a reminder, adjusted EBITDA includes geography entry costs primarily associated with new partners that would generate revenue in 2024. The year-over-year gain in adjusted EBITDA reflects the increase to our medical margins across both MA and REACH as well as platform support leverage, partially offset by performance in Hawaii and the net negative development.

年初至今，調整後 EBITDA 為正 2,800 萬美元，而去年為負 2,000 萬美元。提醒一下，調整後的 EBITDA 包括主要與 2024 年將產生收入的新合作夥伴相關的地域進入成本。調整後的 EBITDA 的同比增長反映了我們在 MA 和 REACH 方面的醫療利潤率以及平台支持槓桿的增加，部分被夏威夷的表現和淨負發展所抵消。

Excluding Hawaii, our adjusted EBITDA would have been positive $6 million for the quarter and $42 million on a year-to-date basis. From a utilization standpoint, composite utilization across MA and REACH was generally in line with expectations. For MA, we did observe an increase in utilization during May and early June, which resulted in some in-period development that we recognized during the third quarter. This was contemplated in our guidance, and trends moderated back towards normalized levels during the third quarter.

如果不包括夏威夷，本季調整後的 EBITDA 將為正 600 萬美元，年初至今為 4,200 萬美元。從利用率的角度來看，MA 和 REACH 的綜合利用率整體符合預期。對於 MA，我們確實觀察到 5 月和 6 月初的利用率增加，這導致了我們在第三季度認識到的一些同期發展。我們的指導中考慮到了這一點，第三季趨勢回落至正常水平。

For REACH, utilization during the first half of 2023 developed favorably relative to our expectation. As a reminder, our results in REACH better reflect our real-time performance against the unmanaged fee-for-service system because of how the benchmark mechanics work.

對於 REACH，2023 年上半年的使用率發展優於我們的預期。提醒一下，由於基準機制的工作方式，我們在 REACH 中的結果更好地反映了我們相對於非託管按服務收費系統的即時效能。

Turning now to our outlook for full year 2023. Please note that our updated guidance excludes MDX Hawaii for the full year. We have raised and narrowed our adjusted EBITDA outlook to a range of $6 million to $18 million from a prior range of $0 to $23 million. We have also updated our membership and revenue outlook, which are both higher on an underlying basis, excluding MDX Hawaii.

現在轉向我們對 2023 年全年的展望。請注意，我們更新後的指引不包括 MDX Hawaii 全年。我們已將調整後 EBITDA 前景從先前的 0 至 2,300 萬美元上調至 600 萬至 1,800 萬美元。我們也更新了我們的會員資格和收入前景，兩者的基本面均較高（不包括 MDX Hawaii）。

From a medical margin perspective, our revised outlook is $455 million to $470 million and is approximately $50 million lower than our prior range. This reflects two factors: First, the removal of Hawaii represents about $20 million of this change; second, one of our primary goals is to exit 2023 with appropriately conservative reserving posture in MA. In light of this, we continue to proactively refine our model to account for utilization trends as well as any potential blind spots with health plans.

從醫療利潤率的角度來看，我們修訂後的前景為 4.55 億至 4.7 億美元，比我們之前的範圍低約 5,000 萬美元。這反映了兩個因素：首先，夏威夷的移除代表了這項變化的約 2,000 萬美元；其次，我們的主要目標之一是以適當保守的 MA 儲備姿態退出 2023 年。有鑑於此，我們繼續積極完善我們的模型，以考慮使用趨勢以及健康計劃的任何潛在盲點。

We have assumed utilization will not moderate any further from recent levels, which accounts for $30 million of the change to our MA medical margins. We think this is a prudent approach and is informed by our decision to maintain a more conservative reserving posture. We are pleased to make these decisions, which provide a strong foundation for future performance while still modestly raising our adjusted EBITDA guidance. Full details on our fourth quarter and full year guidance can be found in the earnings press release.

我們假設利用率不會比最近的水平進一步下降，這占我們 MA 醫療利潤變化的 3000 萬美元。我們認為這是一種審慎的做法，我們決定保持更保守的儲備態度。我們很高興做出這些決定，這為未來的業績奠定了堅實的基礎，同時仍然適度地提高了我們調整後的 EBITDA 指導。有關我們第四季度和全年指導的完整詳細信息，請參閱收益新聞稿。

With that, let me turn the call back to Steve for some brief closing comments.

接下來，讓我將電話轉回給史蒂夫，請他發表一些簡短的結論。

Yes. Thanks, Tim. Before opening up the lines, I want to emphasize three key points. First, the sale of our Hawaii business enhances our ability to focus even more specifically on our differentiated core partner business and positions us for continued success in '24 and beyond. Second, our leadership position as the platform and network, moving physicians to full risk has grown considerably, and you can see it in the clinical and financial results we are driving and in the accelerating demand from physicians in independent groups and health systems. And third, with access to better data, resources and incentives, our primary care doctors are actively managing the way health care is utilized across their entire senior panel, which is yielding meaningfully better outcomes for doctors, patients in agilon.

是的。謝謝，蒂姆。在開篇之前，我想強調三個重點。首先，出售夏威夷業務增強了我們更加專注於差異化核心合作夥伴業務的能力，並使我們能夠在 24 年及以後繼續取得成功。其次，我們作為平台和網路的領導地位，使醫生承擔全部風險，這一地位已大大增強，您可以從我們正在推動的臨床和財務結果以及獨立團體和衛生系統中醫生不斷增長的需求中看到這一點。第三，透過獲得更好的數據、資源和激勵措施，我們的初級保健醫生正在積極管理整個高級小組的醫療保健利用方式，這為阿吉隆的醫生和患者帶來了有意義的更好的結果。

With that, we are now ready to take your questions.

至此，我們現在準備好回答您的問題了。

(Operator Instructions) We will now take our first question, which comes from Lisa Gill from JPMorgan.

（操作員說明）我們現在將回答第一個問題，該問題來自摩根大通的 Lisa Gill。

Congratulations on the sale of Hawaii. Wanted to just follow up on the medical cost side. So Tim, you talked about system issue with a single payer, data gaps with that payer. If I remember last quarter, you also talked about increasing reserves to try to account for some of this going into the back half of the year and then we saw that the prior period development here in this quarter. Can you just talk about where you are on that data gap, the systems issue? Do you feel like that's one fully behind you?

恭喜出售夏威夷。想跟進醫療費用方面。提姆，您談到了單一付款人的系統問題以及該付款人的數據差距。如果我記得上個季度，您還談到了增加準備金，以試圖解決下半年的一些問題，然後我們在本季度看到了前期的發展。能談談您在數據差距、系統問題上的進展嗎？你覺得那是個完全在你後面的人嗎？

And then secondly, when talking about utilization, you said in line, you saw a little bit of a bump in May and June. What we saw with some of the Medicare Advantage players in the most recent quarter is that in the quarter, they actually saw higher costs than we're projecting even beyond May and June. And one of the largest players talked about some COVID hospitalizations that they saw towards the end of the September quarter. So just want to really understand what you saw, what your expectations were and if you have anything on the COVID side or if you've seen anything on the COVID side?

其次，在談到利用率時，您在隊列中說，您在五月和六月看到了一點點的增長。我們在最近一個季度看到的一些 Medicare Advantage 參與者的情況是，在本季度，他們的成本實際上比我們預計的更高，甚至超過了 5 月和 6 月。最大的參與者之一談到了他們在九月季度末看到的一些新冠住院病例。那麼，我只想真正了解您所看到的情況、您的期望是什麼，以及您是否對新冠病毒有任何了解，或者您是否看到了新冠病毒方面的任何情況？

So Lisa, I'll start, and Tim can chime in. I mean, I think I'll start with we raised EBITDA guide on the year because of the strong overall performance across MA and REACH across nearly 500,000 senior patients, and that really sets a strong foundation for '24.

那麼麗莎，我開始，蒂姆可以插話。我的意思是，我想我將從我們提高今年的 EBITDA 指南開始，因為 MA 和 REACH 在近 500,000 名老年患者中表現強勁，這確實是為“24 」奠定了堅實的基礎。

From a utilization perspective, composite utilization was in line with our overall expectations. As Tim kind of outlined, we did see a step-up in Q2 utilization in MA and REACH. The MA was within our guide, REACH actually developed favorably relative to sort of what our expectation was around that intra-period. In Q3, we've seen a deceleration. And our guide makes an assumption on utilization that will be flat through the end of the year, and that's reflected in the reserve [posture] that Tim talked about in terms of an extra $3 million. But Tim, you want to talk about?

從利用率角度來看，綜合利用率符合我們的整體預期。正如 Tim 所概述的那樣，我們確實看到 MA 和 REACH 的第二季度利用率有所提高。 MA 在我們的指導範圍內，REACH 實際上相對於我們對該時期內的預期有良好的發展。在第三季度，我們看到了減速。我們的指南假設利用率到年底將持平，這反映在蒂姆談到的額外 300 萬美元的儲備[立場]。但是提姆，你想談什麼？

Yes. Lisa, just a couple of things specifically to your question. First of all, on the prior period development, I think we have made a lot of progress this year in partnering with the payers out there to try to close some of these gaps. Essentially, some of these information issues are caused by just the complexity of our model, and that's also -- it's also a feature of the model, right? We've got over 30 payers, over 100 payer contract combinations in our markets.

是的。麗莎，針對您的問題，有幾件事。首先，關於前期的發展，我認為今年我們在與付款人合作以試圖縮小其中一些差距方面取得了很大進展。從本質上講，其中一些資訊問題是由我們模型的複雜性引起的，這也是模型的一個特徵，對吧？我們的市場中有 30 多個付款人、100 多個付款人合約組合。

But having said that, I think we made good progress. The issue in this quarter was a very specific issue with just 1 payer. Hopefully, that was a lingering issue that we've now figured out where the gap was and should be okay with that going forward.

但話雖如此，我認為我們取得了良好的進展。本季的問題是一個非常具體的問題，只有 1 個付款人。希望這是一個揮之不去的問題，我們現在已經弄清楚了差距在哪裡，並且應該可以解決這個問題。

In terms of the utilization trend, remember last quarter when we talked about this, we said, hey, we haven't seen the spike up yet. We didn't have enough information from May or June to really see what some of the payers were referring to. We did want to make sure that we had covered the possibility that there would be some higher utilization in our guidance going forward. As it turned out, as we just reported, we did see some increased utilization in May that was -- greatly started to moderate in June. And as we've seen so far, started to -- continued to moderate in early Q3 as well.

就利用率趨勢而言，還記得上個季度我們討論這個問題時，我們說，嘿，我們還沒有看到飆升。我們沒有從五月或六月獲得足夠的資訊來真正了解一些付款人所指的內容。我們確實想確保我們已經涵蓋了未來指導中利用率更高的可能性。事實證明，正如我們剛剛報導的那樣，我們確實看到 5 月份的利用率增加，但 6 月開始大幅放緩。正如我們到目前為止所看到的，第三季初也開始繼續放緩。

I'm not completely surprised by that. Compared to some of the comments that I've made from some of the big payers, I mean I think our model and even some of them have said should be performing better than the average out there. So the fact that we saw a spike up and some moderation down is probably just a factor also of the strength of our model.

我對此並不完全感到驚訝。與我從一些大支付者那裡得到的一些評論相比，我的意思是我認為我們的模型，甚至他們中的一些人所說的應該表現得比那裡的平均水平更好。因此，我們看到的飆升和適度下降的事實可能也是我們模型強度的一個因素。

On COVID specifically, we're actually seeing -- if you go back to last year, which is -- you might want to think about that as the first really sort of post big COVID year. We did actually see some seasonality with COVID start to spike up last year in kind of the August and September time frame in terms of utilization. We did see some of that again this year, although actually lower spike up in COVID this year than even what we saw last year. And the overall magnitude of hospitalization from COVID in terms of a spike up versus the baseline is not really material and not causing any material change in our medical margin performance or our medical margin outlook.

具體到新冠疫情，我們實際上看到——如果你回到去年——你可能會想把它看作是新冠疫情後第一個真正的大年份。事實上，我們確實看到去年 8 月和 9 月的使用率開始出現因新冠疫情而出現的季節性上升。今年我們確實再次看到了一些這樣的情況，儘管今年新冠病毒的峰值實際上比我們去年看到的還要低。與基線相比，新冠住院治療的整體規模並不重要，也不會導致我們的醫療利潤率表現或醫療利潤率前景發生任何重大變化。

We will now take our next question from Justin Lake from Wolfe Research.

現在我們將回答沃爾夫研究中心的賈斯汀·萊克提出的下一個問題。

I wanted to start off -- I've got a couple of questions, but want to start off on the REACH performance. So you said it was $55 million of medical margin. So give or take half your medical margin in the quarter, what were you expecting it to be in the original guide?

我想開始——我有幾個問題，但想從 REACH 性能開始。所以你說這是 5500 萬美元的醫療利潤。因此，在本季度給予或減少您的醫療利潤的一半，您對原始指南中的預期是多少？

Yes. Justin, just real quick before -- we can obviously talk a lot about the performance of REACH was just really -- continue to be really positive in the quarter as it had kind of year-to-date so far, but the $55 million of medical margin that we talked about for REACH is not part of our consolidated results. So the $108 million of medical margin that we reported, which does include Hawaii. In addition to that, if you look at the footnote showing the unconsolidated ACO REACH entities, we had $55 million there and about $18 million of EBITDA (inaudible).

是的。賈斯汀，剛才非常快——我們顯然可以談論很多有關 REACH 的表現，該季度的表現仍然非常積極，因為到目前為止，它已經達到了今年迄今為止的水平，但是 5500 萬美元的我們討論的REACH 醫療利潤率不屬於我們綜合業績的一部分。我們報告的 1.08 億美元醫療利潤中確實包括夏威夷。除此之外，如果你看一下腳註，顯示了未合併的 ACO REACH 實體，我們在那裡有 5500 萬美元，還有大約 1800 萬美元的 EBITDA（聽不清楚）。

And I apologize, that's a very (inaudible).

我很抱歉，這是非常（聽不清楚）的。

Justin, if I can just -- if I can just add to that, Justin. I mean I think we're driving really strong medical margin performance across the entire physician panel across both REACH and MA. And so the $55 million that Tim talked about is driven by beating that national benchmark by more than 300 basis points. In my remarks, I talked about the '22 results. You're seeing that in '23. But the same things that are driving success in REACH are driving success in MA, and our partner market medical margins came in at $111 million in MA which is sort of in our guide. And when you adjust for that PPD, it's actually at the high end of our guide. And I think it's just a function of this model that we've got around high touch and our ability to drive better access cost and quality outcomes. So that's what I'd highlight.

賈斯汀，如果我可以——如果我可以補充一點，賈斯汀。我的意思是，我認為我們在 REACH 和 MA 的整個醫生小組中推動了非常強勁的醫療利潤率表現。因此，提姆談到的 5500 萬美元是由比國家基準高出 300 多個基點推動的。在我的發言中，我談到了 22 年的結果。你在 23 年就看到了這一點。但推動 REACH 成功的同樣因素也推動了 MA 的成功，我們的合作夥伴市場醫療利潤在 MA 中達到 1.11 億美元，這在我們的指南中是這樣的。當你調整 PPD 時，它實際上處於我們指南的高端。我認為這只是這個模型的一個功能，我們擁有高接觸度以及我們推動更好的訪問成本和品質結果的能力。這就是我要強調的。

Yes. I mean the ACO REACH population has been more traditionally an unmanaged population. So there is a big opportunity for us there. We tended to be even as we move through this year. We have very good current data from CMS on our members and we tended to be a little bit conservative. So we actually saw even positive development as we moved into Q3. We had guided about a $12 million EBITDA flow-through for ACO REACH. We ended up with some positive development flowing through from the previous quarter -- $18 million overall, so far during the year. The way you make money in ACO REACH is -- the way you perform well in ACO REACH is essentially you just outperform the Medicare fee-for-service reference population on cost performance, and we're outperforming that on a year-to-date basis by over 300 basis points. So the model really is starting to prove to be very valuable on the ACO REACH side.

是的。我的意思是，ACO REACH 群體傳統上一直是不受管理的群體。所以我們那裡有一個很大的機會。今年我們的表現趨於平穩。我們從 CMS 獲得了關於我們會員的非常好的當前數據，但我們傾向於有點保守。因此，當我們進入第三季度時，我們實際上看到了積極的發展。我們為 ACO REACH 引導了約 1,200 萬美元的 EBITDA 流通。與上一季相比，我們最終取得了一些積極的進展——今年迄今總計 1800 萬美元。您在 ACO REACH 中賺錢的方式是——您在 ACO REACH 中表現良好的方式本質上是您在成本效益方面優於 Medicare 按服務收費參考人群，而我們今年迄今的表現優於這一水平基差超過300個基點。因此，該模型確實開始被證明在 ACO REACH 方面非常有價值。

And then Justin, what was your real question? Sorry.

然後賈斯汀，你真正的問題是什麼？對不起。

Well, the other question I was going to ask on ACO REACH, and again, I could be -- it's been a long couple of days, I might be off again. But my recollection of the Investor Day was that you guys actually kind of titrated lower your expectations for ACO REACH. I think I was looking at it and you would expect that, I think, in 2026 to be at -- am I recalling the number right, $35 million of profitability?

好吧，我要在 ACO REACH 上問的另一個問題，我可能會——已經過去了很長的幾天，我可能會再次休假。但我對投資者日的回憶是，你們實際上降低了對 ACO REACH 的期望。我想我正在研究這個問題，你會預計到 2026 年，盈利能力將達到 3500 萬美元，我是否記得正確的數字？

That's right.

這是正確的。

Okay. So it sounded like you had kind of gotten more conservative or is the thought process there like, hey, let's take that number down a bit. So 6 months later, you're running at that run rate already looks like. Is that a number that you think we should be looking at differently than from the Investor Day? Are you thinking about that business differently?

好的。所以聽起來你有點變得更保守了，或者思考過程是這樣的，嘿，讓我們把這個數字稍微減少一點。所以 6 個月後，您已經按照看起來的速度運行了。您認為我們應該以不同於投資人日的方式看待這個數字嗎？您對這項業務的看法是否有所不同？

Yes, absolutely. I mean our emphasizing the power across the entire senior panel is hopefully one of the big takeaways that you're going to have. The way the mechanics and the ACO REACH model work is you carry forward your performance, and you need to beat that underlying benchmark, which we would expect we're going to do again next year. And so I think we feel like we're going to have much stronger performance going forward. We've already seen it this year-to-date. And it's -- we have much more valuable and readily available and consistent information, which is giving us high confidence in that.

是的，一點沒錯。我的意思是，我們強調整個高級小組的權力希望是您將獲得的重大收穫之一。機制和 ACO REACH 模型的工作方式是你繼續提高你的表現，你需要超越這個基本基準，我們預計明年我們會再次這樣做。所以我認為我們感覺我們未來將會有更強勁的表現。今年迄今為止我們已經看到了這一點。我們擁有更有價值、更容易取得且一致的訊息，這讓我們對此充滿信心。

We will now take our next question from Stephen Baxter from Wells Fargo.

現在我們將回答來自富國銀行的史蒂芬·巴克斯特的下一個問題。

I just wanted to try to clarify the discussion a little bit on the revisions to the medical margin guidance. So I think I'm following you that you're saying $20 million of the lower $50 million to $55 million revision on medical margins related to pulling Hawaii out. So I guess that leaves, call it, the $30 million for the continuing partner markets. I'm just trying to understand kind of the $30 million in the context of the quarter you just had. It does look like including -- I guess, I wanted to strip out the Hawaii results out of the quarter. It doesn't really look like you were kind of off your medical margin guidance that you provided for the third quarter. So just trying to understand why you have $30 million lower medical margin on a core basis if the quarter was relatively in line. Ex Hawaii, it kind of implies that it's primarily related to the fourth quarter. Just trying to correct my understanding of that, hopefully, if that made sense.

我只是想嘗試澄清一下有關醫療保證金指南修訂的討論。所以我想我同意你的說法，你說的是夏威夷撤軍相關的醫療利潤調整後的 5000 萬至 5500 萬美元中的 2000 萬美元。所以我想剩下的 3000 萬美元可以用於持續合作夥伴市場。我只是想了解剛剛那個季度的 3000 萬美元。它看起來確實包括在內——我想，我想把夏威夷的業績從本季中剔除。看起來您並沒有偏離為第三季提供的醫療利潤指引。因此，我們只是想了解一下，如果本季相對穩定，為什麼核心醫療利潤率會降低 3,000 萬美元。在夏威夷之前，這有點暗示它主要與第四季有關。只是試圖糾正我對此的理解，希望如此，如果這有意義的話。

I mean I think a key goal for us was to raise and be adjusted EBITDA in the year. We were able to do that based on the strong performance across REACH and across MA. To your point, in those partner markets, they were very strong.

我的意思是，我認為我們的一個關鍵目標是在今年提高並調整 EBITDA。我們能夠做到這一點是基於 REACH 和 MA 的強勁表​​現。就您而言，在這些合作夥伴市場中，他們非常強大。

The second goal was to really put ourselves in a position from a reserving standpoint in which we could significantly mitigate the chance of any negative development into 2024. And so I think that, coupled with this utilization outlook, which we think is prudent that the deceleration we're seeing in Q3 will not necessarily continue. That's what puts that $30 million on top of the $20 million that you take out for Hawaii. So that's really the logic around it.

第二個目標是從儲備的角度真正把自己置於一個位置，這樣我們就可以顯著降低到2024 年出現任何負面發展的可能性。因此，我認為，再加上這種利用前景，我們認為減速是謹慎的我們在第三季看到的情況不一定會持續下去。這就是你為夏威夷掏出的 2000 萬美元加上這 3000 萬美元的原因。這就是它的邏輯。

Yes, I think that's right. I mean we -- as we close Q3, if you put the prior period development aside and you take the Hawaii, which was -- did perform below our expectation for the quarter out of it, our overall medical margin PMPM did perform well within the range that we had guided to. So we were very happy with that.

是的，我認為這是對的。我的意思是，當我們結束第三季度時，如果您將前期的發展放在一邊，並以夏威夷為例，該季度的表現確實低於我們的預期，我們的整體醫療利潤率 PMPM 確實在我們引導到的範圍。所以我們對此感到非常高興。

On the other hand, that was a combination of higher revenue as we synced up our final -- got all the mid-years in and synced up our final or the next round of our rev estimates for the year as well as some higher medical expenses that flowed through from that May and early June spike that we saw.

另一方面，這是因為我們同步了最終的收入，同步了所有年中的收入，並同步了我們的最終或下一輪的年度轉速估計，以及一些更高的醫療費用這是從我們看到的五月和六月初的峰值開始的。

So we just looked at the rest of the year and said, hey, if we just assume that there's not really any further moderation, and we want to continue to make sure that we minimize the possibility of any prior period development bleeding over into 2024, that's an additional $30 million of just medical expense versus what we had in our previous guidance. And we were able to do all that in addition with the strength of the ACO REACH business and the other actions that we just identified. We're on top of that in a position to essentially slightly increase our overall adjusted EBITDA guidance for the year.

所以我們只看了今年剩下的時間，然後說，嘿，如果我們只是假設實際上沒有任何進一步的緩和，並且我們希望繼續確保我們最大限度地減少任何前期發展滲透到 2024 年的可能性，與我們之前的指導相比，這光是醫療費用就額外增加了3000 萬美元。除了 ACO REACH 業務的實力和我們剛剛確定的其他行動之外，我們還能夠做到這一切。除此之外，我們也能夠稍微提升今年調整後的 EBITDA 整體指引。

We will now take our next question from Gary Taylor from Cowen.

現在我們將回答來自 Cowen 的 Gary Taylor 的下一個問題。

A couple of questions. The first one, just on Hawaii. Why was that -- I think I'm talking at the EBITDA line, if I wrote it down correctly. But why was that an $11 million drag in the third quarter when I think in the first half, it was only a $2.5 million drag? Like and all those sort of metrics on Hawaii got quite a bit worse in the third quarter.

有幾個問題。第一個，就在夏威夷。為什麼會這樣——如果我寫得正確的話，我想我正在談論 EBITDA 線。但為什麼第三季會拖累 1,100 萬美元，而我認為上半年拖累的只是 250 萬美元呢？就像夏威夷的所有這些指標在第三季都變得更加糟糕。

Yes. I mean, generally speaking, as we move through the year, there is a -- seasonally, our medical margin does drop down. In Hawaii and particularly, that drives some pretty big deleverage because it's a delegated model, we have a higher cost basis there. And so in the third quarter, without any acceleration of medical margin, you would see a bigger and bigger drag on EBITDA as we move through. And your math is correct, the absolute drag of Hawaii in the quarter was about $12 million on the EBITDA line.

是的。我的意思是，一般來說，隨著一年的推移，我們的醫療利潤率確實會下降。特別是在夏威夷，這推動了一些相當大的去槓桿化，因為它是一種委託模式，我們在那裡有更高的成本基礎。因此，在第三季度，如果醫療利潤率沒有任何加速，你會看到 EBITDA 受到越來越大的拖累。你的數學是正確的，夏威夷本季 EBITDA 線的絕對拖累約為 1200 萬美元。

Got it. So just normal seasonality. The second one was, I guess, I'm kind of probably not the only one struggling a little bit with the negative PYD that keeps showing up, but the concept also that you've been building reserves. But net-net, how do we think about carrying?

知道了。所以只是正常的季節性。第二個是，我想，我可能不是唯一一個在不斷出現的負 PYD 中掙扎的人，而且還有一個概念，就是你一直在建立儲備。但是net-net，我們如何看待攜帶呢？

End of the day, the PYD says the prior year's cohort medical margin wasn't as good as you originally thought. The boosting of reserves says this year, medical margin won't be as high. How do we think about carrying that in over the next couple of years? Like how does this development reserve building impact how you're thinking about modeling the cohort medical margin development?

最終，PYD 表示，去年的隊列醫療利潤率並不像您最初想像的那麼好。準備金的增加表明今年醫療利潤率不會那麼高。我們如何考慮在未來幾年內實現這一目標？例如，這種發展儲備的建造如何影響您對隊列醫療利潤發展建模的考慮？

I can start, Tim, and you can jump in. I mean, Gary, I think the thought process is we've been building this year to remove the issue for next year. And so this year, we have the impact of the negative PPD in our results.

我可以開始，提姆，你也可以插話。我的意思是，加里，我認為我們今年一直在建構的思考過程是為了消除明年的問題。因此，今年我們的業績受到了負面 PPD 的影響。

We also have the impact of the build, which is there to try and put us in a position where we don't have it going forward to next year. So I think you step off with a very strong run rate across REACH and MA. I think we have a plan to not have PPD recurring, which we've had in the last couple of years. So that should really help as we do that.

我們也受到了建設的影響，它試圖讓我們處於明年無法實現的情況。因此，我認為您在 REACH 和 MA 方面的運行率非常高。我認為我們有一個計劃，以防止產後憂鬱症再次發生，這是我們在過去幾年中所做的。因此，當我們這樣做時，這確實會有所幫助。

And then we have a really strong class coming in for '24 that we just told you is larger than we had previously told you. And the performance of that class we expect to be at the very high end of our typical margin range. And so all of those things, I think as you look towards '24, are real positives for us. And that's been our goal, our goal has been to deliver on the EBITDA for this year and to try and take this issue around negative PPD off the table. And we've had the ability to do that because of the strong performance.

然後我們有一個非常強大的班級即將進入 24 年，我們剛剛告訴過你們，這個班級比我們之前告訴你們的要大。我們預計該類別的性能將處於我們典型利潤範圍的非常高端。因此，我認為，當你展望 24 世紀時，所有這些事情對我們來說都是真正的正面因素。這就是我們的目標，我們的目標是實現今年的 EBITDA，並嘗試解決負 PPD 問題。由於出色的表現，我們有能力做到這一點。

We will now take our next question from Jailendra Singh from Truist Securities.

現在我們將回答來自 Truist Securities 的 Jailendra Singh 的下一個問題。

One quick clarification if you're willing to share, who was the buyer for Hawaii asset? Was it a related party? And then my main question is on the topic of utilization trends. Like one of your fair partners, Humana, talked about recently -- about having higher MLR from their PPO book of business, which I believe is like almost more than half of your membership, curious what you are seeing in terms of utilization trends among PPO members versus HMO members.

如果您願意分享的話，請快速澄清一下，誰是夏威夷資產的買家？是關聯方嗎？我的主要問題是關於使用趨勢的主題。就像您的公平合作夥伴之一Humana 最近談到的那樣，他們的PPO 業務簿中有更高的MLR，我相信這幾乎是您一半以上的會員，好奇您在PPO 的利用率趨勢方面看到了什麼會員與 HMO 會員。

And one more kind of same topic, like some payers have talked about offering Flex cards and OTC benefits as they view this as an advantage next year, how have been your discussions with them about getting reimbursed for this pressure as you are effectively taking on for them?

還有一個相同的話題，就像一些付款人談論過提供彈性卡和OTC 福利，因為他們認為這是明年的一個優勢，您與他們討論如何獲得這種壓力的報銷，因為您正在有效地承擔這一壓力他們？

So that's 3 questions in one. I'll go down -- so the buyer is an experienced California-based organization that's really strong in delegated model services, so really strong in claims, very strong in customer service. And we think they're a great match with MDX Hawaii. So that's the first point.

這是 3 個問題合而為一的問題。我會繼續下去——買家是一家經驗豐富的加州組織，在委託模型服務方面非常強大，在索賠方面非常強大，在客戶服務方面也非常強大。我們認為他們與 MDX Hawaii 是絕配。這是第一點。

In terms of our PPO experience, we've talked about this before. We are probably the largest risk-based player in terms of PPO in the country. Our PPO business is just over 50% of our membership, it's also the fastest-growing component. And our PPO business is -- performance is in line with our HMO business.

就我們的PPO經驗而言，我們之前已經談過這一點。就 PPO 而言，我們可能是該國最大的基於風險的參與者。我們的 PPO 業務僅佔會員總數的 50% 以上，也是成長最快的組成部分。我們的 PPO 業務表現與我們的 HMO 業務一致。

And I think the reason for that is the differences in our model. a large payer with a broad network versus our high-touch PCP patient model, which has the ability to guide that patient on where they're going to go for specialty care. At our Investor Day, we shared over 90% of specialty referrals come through that primary care physician even in a PPO model, that is allowing us to really deliver cost-effective care. And so our PPO experience is very strong.

我認為原因是我們模型的差異。擁有廣泛網路的大型付款人與我們的高接觸性 PCP 患者模型相比，後者能夠指導患者前往哪裡接受專業護理。在我們的投資者日，我們分享了超過 90% 的專科轉診，即使是在 PPO 模式中，也是透過初級保健醫生進行的，這使我們能夠真正提供具有成本效益的護理。因此，我們的 PPO 經驗非常豐富。

And then just on the -- I think your question is on the Flex card side, our conversations with folks is that on an aggregate basis, we're probably seeing a reduction in those year-over-year in terms of the total dollars across our population that will be out on those.

然後，我認為您的問題是在 Flex 卡方面，我們與人們的對話是，從總體上看，我們可能會看到這些卡的總美元數同比有所減少。我們的人民將不接受這些。

Our next question comes from George Hill from Deutsche Bank.

我們的下一個問題來自德意志銀行的喬治·希爾。

One is actually pretty similar to Jailendra's that I want to ask at a higher level, that I know that kind of going into the back half of the year, we were looking at a lot of the Medicare Advantage ACOs to ratchet back on benefit design given the kind of the poor rate environment for '24 and the changes to the risk model. But it looks like most of them preserved benefits despite kind of the tough rate environment. I was wondering if you could -- and you kind of communicated that the negative rate environment would flow through to their risk-bearing care providers. So I guess maybe just walk us through at a high level how you guys are thinking about what looks like a preservation of benefits and what looks like a tougher revenue environment? And just kind of how you're thinking about that with respect to medical margin and EBITDA margin?

一個實際上與 Jailendra 的非常相似，我想在更高的層面上詢問，我知道進入今年下半年，我們正在考慮很多 Medicare Advantage ACO，以逐步恢復福利設計。24 年的不良利率環境以及風險模型的變化。但看起來，儘管利率環境嚴峻，但他們中的大多數仍保留了福利。我想知道你是否可以——你傳達了這樣的訊息：負利率環境將影響他們承擔風險的照護提供者。所以我想也許只是從高層次向我們介紹一下你們是如何考慮什麼看起來像是保留福利以及什麼看起來像是更艱難的收入環境？您如何看待醫療利潤率和 EBITDA 利潤率？

Yes. So I mean, George, I think our outlook on '24 is strong for the reasons I talked about strong run rate, strong class coming in for '24 being able to manage that new risk adjustment model very well.

是的。所以我的意思是，喬治，我認為我們對 24 年的前景是強勁的，因為我談到了強勁的運行率，24 年的強大類別能夠很好地管理新的風險調整模型。

I think our view on aggregate supplemental benefits is that there will be a net pullback on those for the markets that we're in. It's a market by market basis, we don't have a lot of D-SNP in our markets. And so that's kind of the view. And so that would be neutral to a net tailwind, meaning the supplemental benefit experience from '23 to '24. But the big drivers are really the step-off in the run rate, the strong class of '24 and then just our ability to drive kind of medical margin maturation year-over-year.

我認為我們對整體補充福利的看法是，我們所在市場的福利將會出現淨回調。這是一個逐個市場的基礎，我們的市場中沒有很多 D-SNP。這就是這種觀點。因此，這對淨順風來說是中性的，這意味著從 23 年到 24 年的補充福利體驗。但最大的推動因素實際上是運行率的下降、24 強類別以及我們逐年推動醫療利潤成熟的能力。

And George, I'd add one thing. I think when you look at our geographic exposures relative to some of the companies you were referring to, we've got a very different geographic exposure and a very different patient population that we serve. And it -- that's what really drives our view that the changes that you talked about are very manageable for agilon.

喬治，我想補充一件事。我認為，當你看到我們相對於你所指的一些公司的地理風險時，你會發現我們的地理風險非常不同，我們服務的患者群體也非常不同。這才是真正推動我們觀點的原因，即您所談論的變化對於 agilon 來說是非常容易管理的。

Our next question comes from Whit Mayo from Leerink Partners.

我們的下一個問題來自 Leerink Partners 的 Whit Mayo。

Yes, I've got just two really quick ones. But Steve, you've talked about the investments you guys are making, the 60s blind spots on trend. Is there any update or anything you can share that gives you confidence that you're seeing some of these gaps begin to be improved here. And I just want to be clear, I'm a little confused here on the guidance here. But I think it was last quarter, you guided to a $30 million increase in the reserves within the third quarter range. And so are you saying there's another $30 million now on top of the previously contemplated $30 million? Sorry, I'm just -- I think some of us are a little confused.

是的，我只有兩個非常快的。但史蒂夫，你談到了你們正在進行的投資，以及 60 年代的趨勢盲點。是否有任何更新或任何內容可以分享，讓您有信心看到其中一些差距開始得到改善。我只是想澄清一下，我對這裡的指導有點困惑。但我認為是上個季度，你們指導在第三季度範圍內增加了 3000 萬美元的準備金。那麼您是說，除了之前設想的 3000 萬美元之外，現在還有另外 3000 萬美元？抱歉，我只是——我想我們中的一些人有點困惑。

Yes. So maybe we can start with the guidance. I think last time we talked about a total of $60 million in Q3. And what we are saying is there's another $30 million in Q4. So that is the combination of those two. I think it's -- and we're able to do that because of the strong overall performance across.

是的。所以也許我們可以從指導開始。我想上次我們談到了第三季總計 6000 萬美元。我們所說的是第四季還有 3000 萬美元。這就是這兩者的結合。我認為我們能夠做到這一點是因為整體表現強勁。

In terms of the investments that we're making, I do think we're making progress with our payer partners on the data submission, I think it's really in terms of getting that information from there where we're getting it in a faster way. But the other thing I would tell you is that our REACH real-time data tells us that we're tracking pretty well with that. And that we're able to manage things within kind of the ranges that we expected. Inpatient continues to be down, outpatient is up, but we will take that trade kind of all day long. And that's true across MA and across REACH. But those investments we made and the new data officer we brought in is making us better for that. And we are building reserves so that we make sure we're adequately reserved if development does come through.

就我們正在進行的投資而言，我確實認為我們正在與付款合作夥伴在數據提交方面取得進展，我認為這實際上是在以更快的方式從那裡獲取資訊方面。但我要告訴你的另一件事是，我們的 REACH 即時數據告訴我們，我們對此進行了很好的追蹤。我們能夠在我們預期的範圍內管理事情。住院人數持續下降，門診人數增加，但我們將整天進行這種交易。整個 MA 和 REACH 都是如此。但我們所做的投資和我們引入的新數據官正在讓我們在這方面做得更好。我們正在建立儲備，以確保在開發確實實現時我們有足夠的儲備。

So can I ask just one -- sorry, I'm confused on this point. So does the guidance -- is it 60 total? Or is it 90 now?

那麼我可以問一個問題嗎——抱歉，我對這一點感到困惑。那麼，指導意見總共是 60 嗎？還是現在90了？

Yes. So when we came through the second quarter and said, hey, we're going to basically increase our outlook for reserves because we didn't feel like we had clear visibility to some of the increases in utilization that the big payers were putting out there. So now we've actually seen that. We did see that spike up in May, moderated a lot in June came back down, continued to come down in July. So we've now accounted for that, and that was part of our increase on a rate basis the $60 million of medical expense that we had forecast or that we had guided through coming out of the second quarter. And we've accounted for that all now in the third quarter results that we just published.

是的。因此，當我們進入第二季度並說，嘿，我們基本上會提高我們的儲備前景，因為我們覺得我們沒有清楚地看到大支付者在那裡投入的利用率的一些增長。所以現在我們實際上已經看到了這一點。我們確實看到 5 月飆升，6 月大幅放緩，隨後回落，7 月繼續下降。所以我們現在已經考慮到了這一點，這是我們按費率增加的一部分，即我們預測或指導的第二季醫療費用增加了 6000 萬美元。我們已經在剛發布的第三季業績中考慮到了這一切。

As we look forward now to the fourth quarter, we've assumed that even though the spike in May clearly has moderated down some that we're not going to forecast that it's going to moderate any further our guidance has then anticipated, it's going to moderate any further, and that would essentially represent an additional $30 million that we've put into our medical margin or medical expense forecast for the second half and is the second reason why our medical margin forecast for MA has come down.

當我們現在展望第四季度時，我們假設，儘管 5 月份的峰值明顯有所放緩，但我們不會預測它會進一步放緩我們的指導預期，但它將會如果進一步放緩，這實際上意味著我們在下半年的醫療利潤或醫療費用預測中額外投入了3000 萬美元，這也是我們對MA 醫療利潤預測下降的第二個原因。

So if an additional $30 million makes this assumption that we don't see any further moderation in claims and puts us, we believe, in a strong position to minimize the possibility that they'll be negative development bleeding through into 2023. And we're able to do that at the same time maintaining and actually slightly raising the midpoint of our overall EBITDA guidance for the year.

因此，如果額外的 3000 萬美元做出這樣的假設，即我們認為索賠不會進一步減少，並且我們相信，我們將處於有利地位，可以最大限度地減少索賠持續到 2023 年出現負面發展的可能性。我們能夠做到這一點，同時維持並實際上略微提高我們今年整體EBITDA 指導的中點。

We will now take our next question from Adam Ron from Bank of America.

現在我們將回答來自美國銀行的 Adam Ron 的下一個問題。

I have a quick one on cash flow. It seems like adjusted EBITDA is up $50 million year-to-date year-over-year, but cash flow from operations is actually down. It looks like working capital used to -- like doubled year-over-year. Just wondering what's driving that if it's a timing thing, if we should expect a step-up in Q4 and just generally, how we should think about EBITDA flow through into cash flow?

我對現金流有一個快速了解。調整後的 EBITDA 似乎比去年同期增長了 5000 萬美元，但營運現金流實際上下降了。看起來營運資金過去一年比一年前翻了一番。只是想知道是什麼推動了這一趨勢，如果這是一個時機問題，如果我們預計第四季度會出現成長，那麼一般來說，我們應該如何考慮 EBITDA 流入現金流？

Yes. Adam, thanks for the question. It's always a timing thing with cash flow. Our cash flow when you think about what our final payments and our big payments come in from payers when years are settled up and our surplus has settled up, we typically do have a lag of when EBITDA is generated versus when we actually see the cash for that. So the fact that we have a large number of new payers and a large number of new markets this year, I think something like 34% of our members are actually from this year or on the MA side are actually from our new markets, that just exacerbates that delay essentially.

是的。亞當，謝謝你的提問。現金流始終是一個時間問題。當你考慮我們的最終付款和我們的大額付款來自付款人的現金流量時，當多年結清並且我們的盈餘已經結清時，我們通常確實會在產生EBITDA 的時間與我們實際看到現金的時間之間存在滯後。那。事實上，今年我們有大量的新付款人和大量的新市場，我認為我們大約 34% 的會員實際上來自今年，或者 MA 方面實際上來自我們的新市場，這只是本質上加劇了這種延遲。

So we always say that the EBITDA that we're generating this year, we would primarily see transitioning into improved cash flow in the next year. So a little bit in the third quarter, we also have just with the sheer number of new payers and new markets we have, a little bit of a timing issue even when we would normally get some of that settled up. And so we've got maybe a little bit less cash payments that came in, in Q3 that will come in through the rest of the year. But yes, we always do have a timing disconnect between the EBITDA we're generating and the cash that we receive for that performance.

因此，我們總是說，我們今年產生的 EBITDA，我們將主要看到明年轉變為現金流的改善。因此，在第三季度，我們也遇到了數量龐大的新付款人和新市場，即使我們通常會解決其中的一些問題，但也存在一些時間問題。因此，我們在第三季收到的現金付款可能會少一些，而今年剩餘時間將會收到現金付款。但是，是的，我們產生的 EBITDA 與我們因業績而收到的現金之間確實存在時間脫節。

Our next question comes from Jamie Perse from Goldman Sachs.

我們的下一個問題來自高盛的 Jamie Perse。

First one, quick clarification on the $60 million medical margin reduction year-to-date. How much of that is from changes in utilization patterns that you've seen and how much of that is from insulation from future prior period development?

首先，快速澄清今年迄今 6,000 萬美元的醫療利潤減少。其中有多少是由於您所看到的利用模式的變化以及有多少是由於與未來前期發展的隔離？

And then my second question, just on new membership for next year, the 25,000 from ACO REACH, 110,000 from MA. You guys have previously said a higher starting point on medical margin per member per month next year. I think you've given above 60 for that on the MA side. How should we think about that in light of what you're seeing in utilization and the new reserving policies? And a similar question on ACO REACH. Just do you think the 300 basis point delta versus the benchmark can hold next year?

然後是我的第二個問題，關於明年的新會員，ACO REACH 的 25,000 名會員，MA 的 110,000 名會員。你們之前說過明年每個會員每月的醫療利潤起點會更高。我想你在 MA 方面的評分已經超過 60 分了。根據您所看到的利用率和新的預訂政策，我們應該如何考慮這一點？還有 ACO REACH 的類似問題。您認為明年相對於基準的 300 個基點的 Delta 值還能維持嗎？

So maybe I'll take the second one first. So I think that -- we think we're going to be really strong with this class of '24 next year and above that $60 PMPM range. And our implementation has gone extremely well around that. It's part of our investments in technology, it's part of a faster sales cycle. So there's a longer implementation period. So that's on the MA side.

所以也許我會先選第二個。所以我認為，我們認為明年 24 年級的 24 級和高於 60 美元 PMPM 範圍的產品將會非常強大。我們的實施在這方面進展得非常好。這是我們技術投資的一部分，也是更快銷售週期的一部分。所以實施週期比較長。這就是 MA 方面的情況。

On the REACH side, we believe our performance is going to carry forward for us. It's always in relation to sort of the net or the macro utilization across the entire Medicare book overall. But every year, we've been positive relative to that. Anywhere from 100 to 300 plus basis points. So I think we would expect for all the reasons we talked about earlier, that would continue for us on a go-forward basis.

在 REACH 方面，我們相信我們的表現將會持續下去。它總是與整個醫療保險帳簿的網路或宏觀利用率有關。但每年，我們對此都持正面態度。 100 到 300 多個基點之間。因此，我認為，出於我們之前討論過的所有原因，我們預計這種情況將繼續下去。

Yes. And just to follow on then back to the beginning of the question, just to follow on the REACH question. I mean one of the things that we've talked about is, of course, REACH, the revenue benchmark, what we're going to get paid basically moderates within the year based on utilization. So as long as we continue to do a good job, which we have been doing of outperforming the Medicare fee-for-service benchmark performance, then we'll continue to drive really good performance on REACH. And as I said this year, we're outperforming that fee-for-service population with our population by over 300 basis points.

是的。然後回到問題的開頭，繼續討論 REACH 問題。我的意思是，我們討論的其中一件事當然是 REACH，即收入基準，我們將在一年內根據利用率獲得的報酬基本上是適度的。因此，只要我們繼續做好工作，我們一直在努力超越 Medicare 按服務收費基準績效，那麼我們將繼續在 REACH 方面取得真正良好的績效。正如我今年所說，我們的人口比按服務付費的人口高出 300 個基點以上。

So our model is really having a very positive impact. You really see the power of the model on that. It was previously largely unmanaged population. In terms of the guidance that we put out for medical expense in the fourth quarter, we basically -- just to reiterate what I said before, looked at it and said, hey, let's kind of take a viewpoint that the spike up in May that moderated down somewhat in June and July is not going to moderate down further. And based on that, we're putting a full another $30 million into our medical expense forecast and therefore, medical margin forecast for the fourth quarter.

所以我們的模式確實產生了非常正面的影響。你確實看到了模型的力量。以前主要是未管理的人口。就我們在第四季度提出的醫療費用指導而言，我們基本上只是重申我之前所說的話，看看它並說，嘿，讓我們採取一種觀點，即 5 月份的醫療費用飆升6月有所放緩，7 月不會進一步放緩。在此基礎上，我們將另外 3,000 萬美元用於醫療費用預測，從而預測第四季的醫療利潤率。

We think that, that puts us in a good position to meet one of our key objectives, which is let's be appropriately reserved to not have any prior period development bleed over into 2024. So I don't really want to divide it into categories as much as to say, we've looked at the expense trend and tried to be appropriately conservative to try to make sure that we're preventing or at least minimizing the possibility of that happening again next year.

我們認為，這使我們能夠很好地實現我們的關鍵目標之一，即讓我們適當保留，以免任何前期開發拖延到 2024 年。因此，我真的不想將其分為以下幾類：可以說，我們已經研究了支出趨勢，並試圖採取適當的保守態度，以確保我們能夠防止或至少最大限度地減少明年再次發生這種情況的可能性。

We will now take our next question from Elizabeth Anderson from Evercore ISI.

現在我們將回答來自 Evercore ISI 的 Elizabeth Anderson 的下一個問題。

One, I was hoping you could speak sort of qualitatively on -- I know you've talked about how you're doing like additional reserving and et cetera to help sort of manage the utilization as we go into 2024. I think you also mentioned in your prepared remarks that you're also making some qualitative changes on that. So just wondering how you're sort of thinking about that in terms of the claim management. And then secondarily, I was just wondering if you could comment a little bit further on the change in trajectory of geographic entry costs and how that has sort of trended versus your initial expectations given the large size of the class.

第一，我希望你能定性地談論一下——我知道你已經談到了你如何做額外的預留等，以幫助我們進入 2024 年時管理利用率。我想你也提到在你準備好在的發言中，你也對此做出了一些質的改變。所以只是想知道您在索賠管理方面是如何考慮的。其次，我只是想知道您是否可以進一步評論地理入學成本軌蹟的變化，以及考慮到班級規模較大，與您最初的預期相比，這種變化的趨勢如何。

So I think Elizabeth on your first one, Tim walked through the math on the reserves. I think maybe what you're speaking to is we have added an SVP of Data Solutions and we are working much more closely with payer partners to make sure that we're getting data in a consistent and more ready fashion around that. So we're making progress on that. Do you want to talk about geo entry cost?

所以我認為伊莉莎白在你的第一篇文章中，提姆完成了儲備金的數學計算。我想您所說的可能是我們增加了一位數據解決方案高級副總裁，並且我們正在與付款合作夥伴更加密切地合作，以確保我們能夠以一致且更準備的方式獲取數據。所以我們正在這方面取得進展。您想談談地理進入成本嗎？

Yes. And I was just going to say to add to that, I wasn't quite -- sorry, Elizabeth. I wasn't quite sure what the premise of the first question, but if it's along those lines. The other thing I would say is on prior period development is, obviously, we did have some key partner market prior period development in this quarter that we just reported. But the good news is I think we have made a lot of progress across our broad payer platform with improving the quality and the timeliness of information we're getting from them. And if there's a silver lining in this quarter, it was really a very specific limited issue with one payer. So hopefully, the investments we're making there, the investments and more expertise that we brought in is going to really pay some dividends going forward. So we're feeling better about that.

是的。我只是想說補充一點，我不太——抱歉，伊莉莎白。我不太確定第一個問題的前提是什麼，但如果是這樣的話。我要說的另一件事是關於前期發展，顯然，我們剛剛報告的本季確實有一些關鍵合作夥伴市場的前期發展。但好消息是，我認為我們在廣泛的支付平台上取得了很大進展，提高了我們從他們那裡獲得的資訊的品質和及時性。如果說本季還有一線希望的話，那確實是一個付款人面臨的非常具體的有限問題。因此，希望我們在那裡進行的投資、我們帶來的投資和更多專業知識能夠在未來真正帶來一些紅利。所以我們對此感覺好多了。

On geographic entry costs, we were a little bit better in the quarter than what we had forecast. We're trying to make sure that we're -- since that's a new way that we're essentially reporting our adjusted EBITDA this year that were a little bit conservative in that number, but we were a little bit better. But I think overall, going forward, our all-in geographic entry cost, we still expect to be in the $400 to $600 range per new member that we're implementing for the next year. So I don't think we're going to see a lot of movement and we'll probably continue to stay within that range.

在地域進入成本方面，本季我們的表現比我們的預測要好一些。我們正在努力確保我們——因為這是我們今年報告調整後 EBITDA 的新方式，這個數字有點保守，但我們的情況要好一些。但我認為總體而言，展望未來，我們預計明年實施的每位新會員的總地域進入成本仍將在 400 至 600 美元的範圍內。所以我認為我們不會看到太多的變動，我們可能會繼續保持在這個範圍內。

Our next question comes from Sean Dodge from RBC Capital Markets.

我們的下一個問題來自加拿大皇家銀行資本市場的肖恩·道奇。

This is Thomas Keller on for Sean. Just one on the higher acuity clinical programs you'll have. With your capabilities already fully implemented across your -- the older cohorts 2018, 2019, I guess, during '22. And so I guess what I'm looking to understand is kind of your latest thoughts on the upside from the rollout of these capabilities for those cohorts that are already generating medical margin PMPMs kind of north of 200.

我是 Thomas Keller 替肖恩 (Sean) 發言。只是您將擁有的更高敏銳度臨床計劃中的一項。我想，在 2018 年、2019 年的老一輩群體中，你們的能力已經充分發揮，我猜是在 22 年期間。因此，我想我想了解的是，對於那些已經產生了 200 以上醫療利潤 PMPM 的群體來說，推出這些功能所帶來的好處是你們的最新想法。

Yes. Thanks for the question. I mean I think one of the distinctive parts of our model is that we've got these programs around renal, around palliative, around high risk managements, that are part of the care team around that PCP. We get much better enrollment rates and much better impact. That's how we're able to drive things like negative inpatient trends.

是的。謝謝你的提問。我的意思是，我認為我們模式的獨特部分之一是我們圍繞腎臟、安寧療護、高風險管理制定了這些計劃，這些計劃是圍繞 PCP 的護理團隊的一部分。我們獲得了更好的入學率和更好的影響力。這就是我們如何推動負面住院趨勢等事情的發生。

To date, we're about 60% implemented across all of our markets. Our earliest markets do have those rolled out. By the end of '24, we will have them across all markets, including the '24 markets. So I think we do believe that there's upside from these clinical programs as we get them more fully rolled out.

迄今為止，我們已在所有市場中實施了約 60%。我們最早的市場確實已經推出了這些產品。到 24 年底，我們將在所有市場上提供它們，包括 24 個市場。因此，我認為我們確實相信，當我們更全面地推廣這些臨床計畫時，它們會帶來好處。

Our next question is from Jack Wallace from Guggenheim.

我們的下一個問題來自古根漢的傑克華萊士。

Just to follow up on the cash flow question from earlier. And just given the moving pieces this year, so Hawaii larger than normal, new class for next year, the incremental reserves. You do think that it's reasonable to expect the free cash flow positive next year? Is that maybe more realistic for '25 time line?

只是為了跟進之前的現金流問題。考慮到今年的活動，夏威夷比正常情況更大，明年的新等級增量儲備。您認為明年自由現金流為正的預期是否合理？對於 25 年的時間軸來說，這可能更現實嗎？

Yes, we're still -- and one of the things I said before is we had a very big class coming this year. Actually, that class is performing really well. I think that 2020, cut to 2024 is going to be even a stronger performing class, but we're really pleased with the large class that we brought in this year and where they're performing. As all of the incremental EBITDA that we're generating this year kind of flows into next year, that's going to be a big supporter of our ability to generate positive free cash flow this year.

是的，我們仍然——我之前說過的一件事是，今年我們有一個非常大的班級。事實上，這個班級表現得非常好。我認為 2020 年，也就是 2024 年，將會有一個表演更強勁的班級，但我們對今年引入的大班級以及他們的表演感到非常滿意。由於我們今年產生的所有增量 EBITDA 都將流入明年，這將有力支持我們今年產生正自由現金流的能力。

So for now, we're still on track to do that. Obviously, we'll keep you updated as things move through next year. But we're -- at this point, we're still feeling pretty good about next year being kind of a transition year into positive free cash flow.

因此，目前我們仍有望做到這一點。顯然，隨著明年事情的進展，我們會及時向您通報最新情況。但在這一點上，我們仍然對明年是向正自由現金流過渡的一年感到非常滿意。

We have no time for further questions. So with that, I will hand back to Steve Sell, CEO, for final remarks.

我們沒有時間進一步提問。因此，我將請執行長史蒂夫·塞爾 (Steve Sell) 發表最後的評論。

Thank you, everyone. We appreciate your interest in our company, and we look forward to updating you on future calls. So we will talk to you soon.

謝謝大家。感謝您對我們公司的興趣，我們期待在未來的電話中向您通報最新情況。所以我們很快就會和你談談。

This concludes today's call. Thank you all for your participation. You may now disconnect your lines.

今天的電話會議到此結束。感謝大家的參與。現在您可以斷開線路。