agilon health inc (AGL) 2023 Q4 法說會逐字稿

Good afternoon. I would like to welcome you all to agilon Health Fourth Quarter 2023 Earnings Conference Call. My name is Brika, and I will be your moderator for today. (Operator Instructions)

午安.歡迎大家參加 agilon Health 2023 年第四季財報電話會議。我叫 Brika，我將擔任今天的主持人。 （操作員說明）

I would now like to pass the conference over to your host, Matt Gillmor, Vice President of Investor Relations, to begin. So Matt, please go ahead.

現在我想將會議交給東道主投資者關係副總裁馬特·吉爾莫（Matt Gillmor）開始。所以馬特，請繼續。

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

謝謝你，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 和我們的財務長 Tim Bensley，在我們準備好的演講之後，我們將舉行問答環節。

Before we begin, 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.

在開始之前，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 in 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. Please note that Steve and Tim will be referencing a slide deck posted to our Investor Relations website during their prepared remarks.

此外，我們將在本次電話會議中討論的某些財務指標是非公認會計準則財務指標。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向 SEC 提交的 8-K 表格中找到。請注意，史蒂夫和蒂姆在準備好的演講中將引用我們投資者關係網站上發布的幻燈片。

And with that, let me turn things over to Steve.

接下來，讓我把事情交給史蒂夫。

Thanks, Matt. Good afternoon, and thank you for joining us. On today's call, I would like to walk you through the following elements. Our final results for Q4 2023, our updated guidance for 2024, an update on our member and market unit economics, a progress update on our 2024 performance action plan; and finally, our growth outlook for the class of 2025.

謝謝，馬特。下午好，感謝您加入我們。在今天的電話會議上，我想向您介紹以下內容。我們 2023 年第四季的最終結果、我們更新的 2024 年指引、我們的會員和市場單位經濟效益的更新、我們 2024 年績效行動計畫的進展更新；最後是我們對 2025 年畢業生的成長展望。

Before I get into the quarter, let me provide some context. agilon and the Medicare Advantage industry are navigating through a complex transition period. and we are taking significant steps to help mitigate the impact of this evolving environment on our business, including strengthening our reserves as well as focusing on the targeted actions we outlined in early January. While the near-term dynamics are negatively affecting our financial results, demand for our platform has never been stronger as we continue to deliver significant value to patients, payers and our PCP partners.

在進入本季度之前，讓我提供一些背景資訊。 agilon 和 Medicare Advantage 行業正在經歷一個複雜的過渡期。我們正在採取重大措施，幫助減輕這種不斷變化的環境對我們業務的影響，包括加強我們的儲備以及專注於我們在一月初概述的有針對性的行動。雖然近期的動態對我們的財務業績產生了負面影響，但隨著我們繼續為患者、付款人和我們的 PCP 合作夥伴提供巨大的價值，對我們平台的需求從未如此強勁。

The underlying fundamentals of our business model remain intact, reflected in member economics, member growth, quality outcomes and physician NPS scores, and we are well positioned to accelerate performance over the medium and long term.

我們的商業模式的基本面保持不變，反映在會員經濟、會員成長、品質成果和醫生 NPS 分數上，我們處於有利地位，可以在中長期內加速績效。

Let's now turn to the quarter. Our medical margins for the fourth quarter in 2023 were $51 million, below the midpoint of the guidance range we provided in early January. This was driven by $38 million from costs and revenue attributable to the fourth quarter and $13 million of development attributable to previous periods. Relative to our guidance from January, the higher costs in our final '23 results were driven by 2 factors. First, as we completed our financial closing process in February, we received updated data, including relatively complete claims data from our largest payers as well as additional information such as seasonality factors and census data. We completed our analysis of this data in mid-February, which indicated that medical costs for our members were higher than our previous estimate for 2023.

現在讓我們轉向本季。我們 2023 年第四季的醫療利潤率為 5,100 萬美元，低於我們 1 月初提供的指導範圍的中點。這是由第四季度的成本和收入 3800 萬美元以及前期的開發 1300 萬美元推動的。相對於我們 1 月的指引，我們 23 年最終結果中較高的成本是由兩個因素所驅動的。首先，當我們在二月完成財務結算流程時，我們收到了更新的數據，包括來自最大付款人的相對完整的索賠數據以及季節性因素和人口普查數據等其他資訊。我們在 2 月中旬完成了對這些數據的分析，這表明我們會員的醫療費用高於我們先前對 2023 年的估計。

Second, in light of this new information and the dynamic utilization environment, we have strengthened our reserves as we closed 2023. Our team developed a range of reserve scenarios, and we reserved at the high end of our estimates. The completion factor assumptions used in our 2023 close are significantly lower compared to the actual completion factors from 2022. We believe this is a prudent approach given the environment and expect to carry this forward.

其次，根據這項新資訊和動態利用環境，我們在 2023 年結束時加強了儲備。我們的團隊制定了一系列儲備方案，並按照我們估計的上限進行了儲備。與 2022 年的實際完成率相比，我們在 2023 年結算中使用的完成率假設明顯較低。考慮到當前的環境，我們認為這是一種謹慎的做法，並預計將繼續採用這種做法。

Turning to the '24 guide. We have also lowered our 2024 medical margin guidance by $155 million to $425 million at the midpoint and lowered our '24 adjusted EBITDA guidance by $87 million to negative $38 million at the midpoint. Our updated guidance assumes the $38 million medical margin shortfall attributed to the fourth quarter '23 is not seasonal and will persist into 2024. It should be noted that our revised guidance assumes a gross cost trend of 7.9% less the impact of our strategic action items and a net cost trend of approximately 6.6% in 2024. This is 250 basis points above our prior '24 expectation. And on top of the 7% medical cost trend we observed in 2023.

轉向 '24 指南。我們也將 2024 年醫療利潤指引中位數下調了 1.55 億美元，至 4.25 億美元，並將 24 年調整後 EBITDA 指引中位數下調了 8,700 萬美元，至負 3,800 萬美元。我們更新後的指引假設23 年第四季造成的3,800 萬美元醫療利潤缺口不是季節性的，並將持續到2024 年。值得注意的是，我們修訂後的指引假設總成本趨勢為7.9%，減去我們策略行動項目的影響2024 年淨成本趨勢約為 6.6%。這比我們之前的 24 年預期高出 250 個基點。除了我們觀察到的 2023 年醫療費用趨勢為 7% 之外。

Despite our higher utilization assumption, we expect to grow our medical margin by 40% in 2024 and drive meaningful gains in adjusted EBITDA. As I noted before, agilon and the Medicare Advantage industry are navigating a challenging transition period during 2023 and 2024. Health care costs among the senior population are rising faster than contemplated in CMS benchmarks and planned bids, which may be driven by post-COVID pent-up demand.

儘管我們假設利用率較高，但我們預計 2024 年醫療利潤率將成長 40%，並推動調整後 EBITDA 大幅成長。正如我之前指出的，agilon 和Medicare Advantage 行業正在2023 年和2024 年經歷一個充滿挑戰的過渡期。老年人口的醫療保健成本的增長速度快於CMS 基準和計劃投標中預期的速度，這可能是由於新冠疫情後的壓力所致。向上的需求。

We do think it's important to recognize a few things. First, Medicare Advantage has a relatively short repricing cycle, and the program is designed to adjust to changes in utilization. Over the next 12 to 24 months, we expect CMS benchmarks will reset to reflect the rise in utilization and many of our health plan partners will adjust bids and benefits to recapture margins. we expect this repricing cycle will benefit our financial performance in future periods.

我們確實認為認識到一些事情很重要。首先，Medicare Advantage 的重新定價週期相對較短，且該計劃旨在適應利用率的變化。在未來 12 至 24 個月內，我們預計 CMS 基準將重新設置，以反映利用率的上升，我們的許多健康計劃合作夥伴將調整出價和福利以重新獲得利潤。我們預計這一重新定價週期將有利於我們未來時期的財務表現。

Second, we have a strong balance sheet with approximately $500 million in cash and short-term investments. Even with the further moderation in our 2023 performance and 2024 outlook, we have significant resources to support our growth and ongoing actions to drive performance.

其次，我們擁有強大的資產負債表，擁有約 5 億美元的現金和短期投資。即使我們 2023 年業績和 2024 年前景進一步放緩，我們仍擁有大量資源來支持我們的成長和持續採取行動來推動業績。

Now to a refreshed view on the unit economics of our business as outlined in the slide presentation on our Investor Relations website. For this commentary, I'll be referencing Slides 9 through 13 of the deck. As we have consistently shared, our business model is driven by member growth and the ongoing maturation of member and market cohorts. While the macro environment has clearly impacted our overall unit economics in 2023, there are some very important takeaways from the data. First, as we show you on Page 10, despite the negative 2023 utilization environment, our members that came on the platform from 2018 to 2020, our sustained medical margin performance at attractive levels of roughly $150 per member per month.

現在，我們的投資者關係網站上的幻燈片簡報中概述了我們業務的單位經濟效益的最新觀點。對於本評論，我將參考幻燈片 9 到 13。正如我們一直分享的那樣，我們的業務模式是由會員成長以及會員和市場群體的持續成熟所驅動的。雖然宏觀環境明顯影響了 2023 年我們的整體單位經濟效益，但從數據中可以得出一些非常重要的結論。首先，正如我們在第10 頁上向您展示的，儘管2023 年的使用環境不佳，但從2018 年到2020 年加入該平台的會員，我們的醫療利潤表現持續保持在每位會員每月約150 美元的有吸引力的水平。

In our 2021 and 2022 member cohorts are showing positive margin progression. By comparison, our 2023 member cohort, representing approximately 1/3 of our membership shows the impact of higher utilization and starts off at $25 per member per month. Second, as we show you on Page 11, what we have repeatedly talked about our member and PCP growth and its impact on margin progression. We are separating out the impact of compounded mid- to upper teens same-store growth on the performance of our market cohorts. What the data shows is that our 3 earliest market classes with annual growth rates of 12% to 24% have seen between a $36 to $86 per member per month reduction in medical margin due to new member dilution. This is not dissimilar from the impact that new markets have on the platform as they also take time to mature as risk adjustment and our medical cost management levers improve.

2021 年和 2022 年，我們的會員群體顯示出正面的利潤成長。相較之下，我們的 2023 年會員群體（約占我們會員的 1/3）顯示出更高利用率的影響，且每位會員每月的起價為 25 美元。其次，正如我們在第 11 頁上向您展示的，我們反覆討論了我們的會員和 PCP 成長及其對利潤成長的影響。我們正在區分中上層青少年同店複合成長對我們市場群體績效的影響。數據顯示，我們的 3 個最早的市場類別（年增長率為 12% 至 24%）由於新會員稀釋，每個會員每月的醫療利潤減少了 36 至 86 美元。這與新市場對平台的影響沒有什麼不同，因為隨著風險調整和我們醫療成本管理槓桿的提高，它們也需要時間才能成熟。

Said differently, our strong same-store growth has created an embedded opportunity in our earliest markets to focus on new doctors and their senior patients to drive performance of those markets. This data aligns well with our '24 performance action plan as it is fully within our control.

換句話說，我們強勁的同店成長在我們最早的市場創造了一個嵌入的機會，可以專注於新醫生及其老年患者，以推動這些市場的表現。這些數據與我們的 24 小時績效行動計劃非常吻合，因為它完全在我們的控制範圍內。

Finally, our growth algorithm of growing markets, growing members, and growing medical margins remains intact, albeit with a more measured and narrowed focus given the macro environment and its impact on our results. Pivoting to our performance action plan that we discussed with you in early January. We continue to make progress against our plan, which will position us to accelerate our path to profitability and cash flow generation. As a reminder, our plan includes the following 4 elements: one, expanding support for primary care doctors, join the platform in mature markets; two, leveraging our strong payer relationships; three, addressing our data visibility gaps and four, boosting our operating efficiency.

最後，我們的市場成長、會員成長和醫療利潤成長的成長演算法保持不變，儘管考慮到宏觀環境及其對我們業績的影響，我們的關注點更加謹慎和狹窄。轉向我們在一月初與您討論的績效行動計劃。我們將繼續按照我們的計劃取得進展，這將使我們能夠加速獲利和現金流產生的步伐。提醒一下，我們的計畫包括以下4個要素：一是擴大對基層醫師的支持，加入成熟市場的平台；二是擴大對基層醫師的支持。第二，利用我們強大的付款人關係；第三，解決我們的數據可見度差距，第四，提高我們的營運效率。

Today, I wanted to provide you a brief update on our progress. Let's start with PCP onboarding and education. As a reminder, we provide structured training to primary care doctors during our implementation process with new groups, but we historically have not provided the same training to new physicians joining veteran practices. As outlined in our newly released cohort data, the strong same-store growth with doctors joining the platform in our earliest markets, has created variation in these new physicians understanding and performance in our partnerships. We are on track to deploy this training to 90% of the doctors in our targeted mature markets during the first half of 2024. We expect these efforts will improve our BOI performance and clinical program enrollment in the back half of the year, supporting our financial performance in 2025 and beyond.

今天，我想向您簡要介紹我們的進展。讓我們從 PCP 入職和教育開始。提醒一下，我們在新團體的實施過程中為初級保健醫生提供結構化培訓，但我們歷來沒有為加入資深診所的新醫生提供相同的培訓。正如我們新發布的隊列數據中所述，隨著醫生在我們最早的市場加入該平台，同店的強勁增長使這些新醫生對我們合作夥伴關係的理解和表現產生了變化。我們預計在 2024 年上半年向目標成熟市場中 90% 的醫生部署此培訓。我們預計這些努力將改善我們下半年的 BOI 績效和臨床項目註冊情況，支持我們的財務2025 年及以後的表現。

Next, payer strategy. We have been encouraged with the dialogue and level of engagement with our payer partners in recent weeks. As many of you know, we partner with leading physician groups that typically represent 20% to 30% of the independent primary care capacity within each local community. Payers rely on our partners to offer a comprehensive network and benefit and our consistent track record of quality and cost performance. From a visibility standpoint, we are now receiving detailed data for supplemental benefits from most of our large national and regional payers. We believe this will enable agilon to understand and better forecast these costs which was a source of volatility in 2023.

接下來，付款人策略。這幾週與付款合作夥伴的對話和參與程度讓我們深受鼓舞。正如你們許多人所知，我們與領先的醫生團體合作，這些團體通常代表每個當地社區獨立初級保健能力的 20% 至 30%。付款人依賴我們的合作夥伴提供全面的網路和福利以及我們一貫的品質和性價比記錄。從可見性的角度來看，我們現在正在從大多數大型國家和地區付款人那裡收到補充福利的詳細數據。我們相信這將使 agilon 能夠了解並更好地預測這些成本，而這些成本是 2023 年波動的根源。

Additionally, we have been able to negotiate targeted changes in our percentage of premium rates in key markets. This reflects that payers want to partner effectively with agilon and our groups over the long term. We expect to make continued progress deepening our engagement with payers during '24 and for 2025.

此外，我們也能夠就主要市場的保費百分比進行針對性的調整。這反映出付款人希望與 agilon 和我們的集團進行長期有效的合作。我們預計在 2024 年和 2025 年期間將在深化與付款人的互動方面取得持續進展。

For data visibility, this month, we began onboarding data from our largest payer into our new financial data pipeline, and we will begin ingesting data from other large payers over the next several months. We expect to onboard data for over 55% of our membership during the first quarter and 75% of our membership during the second quarter. This data pipeline will enable our internal teams to process and analyze payer data faster and with much more detail, which will improve our forecasting and operations.

為了數據可見性，本月，我們開始將最大付款人的數據納入新的財務數據管道，並且我們將在接下來的幾個月內開始吸收其他大型付款人的數據。我們預計在第一季為超過 55% 的會員提供數據，在第二季為 75% 的會員提供數據。這些數據管道將使我們的內部團隊能夠更快、更詳細地處理和分析付款人數據，這將改善我們的預測和營運。

We are also expanding the use of the Minerva platform we acquired in 2023 to support clinical program enrollment, and we will better leverage HIE and ADT data to impact transitions of care. Final area of focus is operating efficiency. We have taken targeted actions to reduce our platform support to 3% of revenue in 2024, additionally, we have reduced our geographic entry costs by $10 million in our updated 2024 guidance to reflect a measured approach to our growth.

我們還擴大了 2023 年收購的 Minerva 平台的使用，以支持臨床項目註冊，並且我們將更好地利用 HIE 和 ADT 數據來影響護理的過渡。最後一個重點領域是營運效率。我們已採取有針對性的行動，到2024 年將我們的平台支援減少到收入的3%，此外，我們在更新的2024 年指南中將地域進入成本降低了1000 萬美元，以反映我們的成長的審慎方法。

Now let's turn to growth with the class of 2025. Given the current environment, we are taking a measured approach to our growth. This is reflected in the quality of groups we are bringing on the platform and the longer implementation cycle we have been able to achieve in recent years. I'm pleased to share that the class of 2025 new partners will include at least 5 groups with more than 60,000 new MA members.

現在讓我們轉向 2025 屆學生的成長。考慮到當前的環境，我們正在採取審慎的方法來實現成長。這反映在我們在平台上引入的團隊的品質以及我們近年來能夠實現的更長的實施週期。我很高興地告訴大家，2025 屆新合作夥伴將包括至少 5 個團體，擁有超過 60,000 名 MA 新會員。

This will expand our network to include 36 physician groups and 3,000 primary care doctors. And as I mentioned, we have lowered our geographic entry costs to a range of $55 million to $65 million, which is down from our prior '24 estimate of approximately $70 million. It's important to note that this lower range still contemplates the potential for additional senior patients in the class of '25 to come on the platform or for incremental onboarding costs associated with the class of '26.

這將擴大我們的網絡，包括 36 個醫生團體和 3,000 名初級保健醫生。正如我所提到的，我們已將地域進入成本降低至 5500 萬至 6500 萬美元，低於我們之前 24 年估計的約 7000 萬美元。值得注意的是，這個較低的範圍仍然考慮了「25 歲」類別中更多老年患者進入平台的可能性，或與「26」類別相關的增量入職成本。

In closing, I want to offer 3 important takeaways. First, agilon is navigating through a transition period for our company and the Medicare Advantage industry. Medical costs are temporarily outpacing revenue benchmarks during 2023 and 2024. agilon and the industry, including CMS and our health plan partners, will adjust to this new environment, supporting our ability to return to a more normalized margin trajectory over time.

最後，我想提出 3 個重要要點。首先，agilon 正在經歷我們公司和 Medicare Advantage 行業的過渡期。 2023 年和 2024 年，醫療成本暫時超過收入基準。agilon 和整個行業，包括CMS 和我們的健康計劃合作夥伴，將適應這種新環境，支持我們隨著時間的推移恢復到更加正常化的利潤軌跡的能力。

Second, we are taking significant actions to improve our performance against this dynamic environment. From a forecasting perspective, this is reflected in the significant strengthening of our reserves exiting 2023, and our reset guidance for '24 that assumes recent utilization remains elevated. From an operating perspective, we are executing against the action plan we have outlined with a focus on best-in-class execution on factors we can directly control.

其次，我們正在採取重大行動來提高我們在這種動態環境中的表現。從預測的角度來看，這反映在 2023 年退出時我們的儲備顯著增強，以及我們對 24 年的重置指導（假設近期利用率仍然較高）。從營運角度來看，我們正在按照我們概述的行動計劃執行，重點是對我們可以直接控制的因素進行一流的執行。

Third and finally, our business model is working. Demand for our platform has never been stronger, and we are delivering significant value to patients, payers and our PCP partners even in a difficult environment. This is reflected in the updated member cohort information we have shared, which is translating into significant economics to our PCP partners reinvestment into local primary care and our ability to drive consistent improvement in quality measures across our network. We remain confident in the strength of our platform and physician network as well as the long-term opportunity for agilon.

第三，也是最後一點，我們的商業模式正在發揮作用。對我們平台的需求從未如此強勁，即使在困難的環境中，我們也正在為患者、付款人和我們的 PCP 合作夥伴提供巨大的價值。這反映在我們分享的更新的會員隊列資訊中，這對於我們的 PCP 合作夥伴對當地初級保健的再投資以及我們推動整個網路品質措施持續改進的能力來說，轉化為重大的經濟效益。我們對我們的平台和醫生網絡的實力以及 agilon 的長期機會仍然充滿信心。

With that, let me turn the call over to Tim for his comments.

接下來，讓我將電話轉給提姆，徵求他的意見。

Thanks, Steve, and good afternoon. I'll cover 2 items before we go into Q&A. First, additional details on our 2024 guidance; second, balance sheet and cash flow expectations. I'll reference several of the slides during my comments.

謝謝，史蒂夫，下午好。在進入問答環節之前，我將介紹 2 個項目。首先，我們的 2024 年指導的更多詳細資訊；第二，資產負債表和現金流預期。我將在評論中引用幾張幻燈片。

Starting with guidance details. You can see our updated projections for 2024 medical margin on Slide 5 of the presentation. We now expect our medical margins to be in the range of $400 million to $450 million in 2024, which compares to our prior guidance midpoint of $580 million. The primary drivers of the change includes: first, the lower starting point in 2023 medical margins, which Steve addressed. Second, our assumption that higher costs from 2023 will carry forward into 2024, including a reduced outlook for the class of 2024. Third, a partial offset from higher revenue associated with stronger performance in our burden of illness documentation efforts as we close 2023. We are now assuming a cost trend of 6.6% for 2024, which is 250 basis points over our previous 4.1% assumption.

從指導細節開始。您可以在簡報的幻燈片 5 上看到我們對 2024 年醫療利潤的最新預測。我們現在預計 2024 年我們的醫療利潤將在 4 億至 4.5 億美元之間，而我們先前的指導中位數為 5.8 億美元。這項變化的主要驅動因素包括：首先，史蒂夫提到的 2023 年醫療利潤起點較低。其次，我們假設2023 年的較高成本將延續到2024 年，包括下調2024 年畢業生的前景。第三，隨著2023 年結束，我們在疾病記錄工作負擔方面的表現更強，這部分抵消了收入的增加。目前假設 2024 年成本趨勢為 6.6%，比我們先前的 4.1% 假設高出 250 個基點。

I wanted to note that these are net all-in trends after the impact from our clinical programs. Our gross trend assumption for 2024, excluding these programs is now 7.9% compared to 5.3% previously, and it's in line with the trend we observed in the fourth quarter of 2023.

我想指出的是，這些是受到我們的臨床計劃影響後的淨總體趨勢。我們對 2024 年總體趨勢的假設（不包括這些計劃）目前為 7.9%，而之前為 5.3%，這與我們在 2023 年第四季度觀察到的趨勢一致。

On Slide 6, I wanted to call out some of the adjusted EBITDA dynamics that impacted our 2023 results and how those dynamics work in 2024. During 2023, the relatively modest growth we generated in medical margins of $8 million created negative leverage to our consolidated adjusted EBITDA. This was due to the prior year development we recorded in 2023, which lowered our medical margin. Additionally, we had a handful of markets in an EBITDA loss position, including several markets from the class of 2023. Because of this, we had higher operating expense growth relative to medical margin growth. For 2024, we expect this dynamic will reverse with medical margin growth driving more flow through to adjusted EBITDA.

在幻燈片6 上，我想指出一些影響我們2023 年業績的調整後EBITDA 動態，以及這些動態在2024 年如何發揮作用。2023 年期間，我們在醫療利潤率上實現的800 萬美元的相對溫和增長，對我們的綜合調整後淨利潤產生了負槓桿作用。息稅折舊及攤銷前利潤。這是由於我們在 2023 年記錄的上一年發展結果降低了我們的醫療利潤率。此外，我們有少數市場處於 EBITDA 虧損狀態，包括 2023 年的幾個市場。因此，相對於醫療利潤成長，我們的營運費用成長更高。到 2024 年，我們預計這種動態將會逆轉，醫療利潤成長將推動更多資金流向調整後的 EBITDA。

One key dynamic is that we expect the class of 2024 will be profitable from a market EBITDA perspective, and we don't expect prior year development to recur. From a balance sheet perspective, as Steve mentioned, we have approximately $500 million of cash and investments and minimal debt. Our available cash and investments include $495 million that is consolidated on our balance sheet and another $21 million of off-balance sheet cash associated with our ACO reach entities. Based on our updated guidance, we expect to use $125 million to $150 million of cash during 2024.

一個關鍵的動態是，我們預計 2024 年的課程從市場 EBITDA 角度來看將實現盈利，並且我們預計上一年的發展不會重現。從資產負債表的角度來看，正如史蒂夫所提到的，我們擁有約 5 億美元的現金和投資以及最低限度的債務。我們可用的現金和投資包括合併在資產負債表中的 4.95 億美元，以及與我們的 ACOreach 實體相關的另外 2,100 萬美元的表外現金。根據我們更新的指引，我們預計 2024 年將使用 1.25 億至 1.5 億美元的現金。

For reference, our cash flow realization is offset from our medical margin and adjusted EBITDA performance by about 12 months because of the timing of our settlements with payers. Based on this, our 2024 guidance would result in 2025 use of cash of about $25 million with an expectation of positive cash flow in 2026 and beyond.

作為參考，由於我們與付款人結算的時間，我們的現金流量實現從我們的醫療利潤和調整後的 EBITDA 表現中抵消了大約 12 個月。據此，我們的 2024 年指引將導致 2025 年使用約 2,500 萬美元的現金，預計 2026 年及以後將出現正現金流。

With that, operator, we are ready to take questions.

接線員，我們準備好回答問題了。

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

（操作員說明）我們在電話線上接到了摩根大通的麗莎·吉爾（Lisa Gill）的第一個問題。

What are your overall views on when we think about utilization trends, it seems that in some of your comments that maybe you think some of this is pent-up demand or is this the new normal? And you feel that ultimately, CMS and the health plans will adjust to this new normal when we think about bid. So that would be my first question. I just want to understand how you're looking at the current environment as to whether you think this is the new normal? Or do you think there's some level of pent-up demand.

當我們考慮利用率趨勢時，您的整體看法是什麼？在您的一些評論中，您似乎認為其中一些是被壓抑的需求，或者這是新常態？您認為，當我們考慮出價時，CMS 和健康計劃最終將適應這種新常態。這是我的第一個問題。我只是想了解您如何看待當前的環境，您認為這是否是新常態？或者您認為存在一定程度的被壓抑的需求嗎？

Lisa, thanks for the question. I guess I'd start by saying, I think we're operating in a very dynamic utilization environment and what we've communicated today -- so it tries to demonstrate the respect for that environment. We obviously have seen an acceleration in trend in Q4 stepping up to a Q4 trend level of 7.7%. Our assumption into '24 is that utilization continues at that level. And so we see it persisting, in looking at the data that Tim talked about. We didn't see a tremendous set of seasonality within that but concluded that this will persist and that's been reflected within our guidance for 2024.

麗莎，謝謝你的提問。我想我首先要說的是，我認為我們正在一個非常動態的利用環境中運行，以及我們今天所傳達的內容 - 因此它試圖表現出對該環境的尊重。我們顯然看到第四季的趨勢加速，達到 7.7% 的趨勢水準。我們對 24 年的假設是利用率將繼續保持在該水準。因此，透過蒂姆談到的數據，我們看到它持續存在。我們沒有看到其中存在巨大的季節性因素，但得出的結論是這種情況將持續存在，並且這已反映在我們的 2024 年指導中。

We do expect, as we said, that benchmarks will catch up with this. We'll see what the final notice looks like when we get that later in Q2, and we have been encouraged as we've talked with some of our planned partners about their plans for 2025 in terms of their bids and specifically that they will be focused on bidding for margin, and that's obviously material as it flows through to us. So our belief is that it is ongoing and it's going to be at this elevated level, at least through 2024.

正如我們所說，我們確實期望基準測試能夠趕上這一點。當我們在第二季稍後收到最終通知時，我們將看到最終通知的樣子，我們受到了鼓舞，因為我們已經與一些計劃合作夥伴討論了他們 2025 年的出價計劃，特別是他們將專注於利潤率競標，這顯然對我們來說很重要。因此，我們相信這一趨勢正在持續，並且至少到 2024 年都會保持在這個較高的水平。

And then if I just think of some of the elements in the '24 guidance, I just want to better understand the impact of V28, the Two-Midnight Rule. And then the comments that you made around supplemental benefits. So is the comment around supplemental benefits that you have less risk around some of the supplemental benefits based on negotiations with managed care. If you can just help me understand those 3, that would be great.

然後，如果我只考慮 '24 指南中的一些要素，我只是想更好地了解 V28（兩午夜規則）的影響。然後是您對補充福利的評論。關於補充福利的評論也是如此，即根據與管理式醫療的談判，您在某些補充福利方面的風險較小。如果你能幫助我理解這三個，那就太好了。

Sure. Our revenue guidance for the year includes the impact of V28, which has that rough 2% impact we've talked about, offset by our actions and the other elements in revenue. The Two-Midnight Rule is factored into our inpatient assumption in '24 and as part of that trend that Tim and I laid out for you in 2024. And then supplemental benefits as we look at the relative change from '23 to '24 across the mix of our payers, we do not see nearly as great an escalation as we saw '23 over '22 and our payer conversations right now are focused on our ability to mitigate those things we can't control like supplemental benefits, whether that's through a carve-out, whether that's through a corridor or capping that. So it's a combination of those things, Lisa. Tim, anything you'd add to that?

當然。我們今年的收入指導包括 V28 的影響，它具有我們談到的大約 2% 的影響，被我們的行動和收入中的其他因素所抵消。午夜兩點規則已納入我們在 24 年的住院假設中，也是蒂姆和我在 2024 年為您制定的趨勢的一部分。然後，當我們查看從 23 世紀到 24 世紀的相對變化時，補充福利就我們的付款人組合而言，我們並沒有看到像「23」比「22」那樣大的升級，我們現在與付款人的對話集中在我們減輕那些我們無法控制的事情（例如補充福利）的能力上，無論是通過無論是穿過走廊還是封頂。所以這是這些事情的結合，麗莎。提姆，你還有什麼要補充的嗎？

I think that's right on. By the way, so we are yes, go ahead.

我認為這是對的。順便說一句，所以我們是的，繼續吧。

No, no, you go ahead. I actually know that that's great.

不不不，你繼續吧。我其實知道那太好了。

No I was just going to say just to tag on just to quantify the supplemental benefit is we do expect to be like a slight headwind in 2024 with 20 basis points or so, but that's coming off a very big headwind that we had in 2023, so.

不，我只是想說，只是為了量化補充收益，我們確實預計 2024 年會出現 20 個基點左右的輕微逆風，但這是我們在 2023 年遇到的一個非常大的逆風，所以。

We now have the next question from Justin Lake of Wolfe Research.

現在我們有沃爾夫研究中心的賈斯汀·萊克提出的下一個問題。

I wanted to first kind of go through this bridge that you laid out for us today versus the January specifically on the medical cost side. So you have $250 million a year of medical cost PMPM kind of headwind versus $141 million before. So you had $38 million of incremental new costs in the fourth quarter. Is the way to think about it? And did you just multiply that by another 3 quarters to annualize it to kind of drive that delta? Is that what I'm looking at here for.

我想先通過您今天為我們佈置的這座橋樑與一月份的橋樑，特別是在醫療費用方面。因此，PMPM 每年的醫療費用為 2.5 億美元，而先前的醫療費用為 1.41 億美元。因此，第四季新增成本為 3,800 萬美元。有辦法思考一下嗎？您是否只是將其乘以另外三個季度以將其年化以推動該增量？這就是我在這裡尋找的目的嗎？

Yes, that's a great question. And I think the change of $38 million is total medical margin, we had a little bit of incremental revenue. I think the full change -- so the way we look at it is we essentially went into the fourth quarter, looking at all the things that Steve just went through and how we essentially have been refining our process and making sure that we get to a number that we feel is we're going to be adequately reserved for the end of the year. We actually added $68 million of medical expense to our final close versus what we were guiding to in early January. Of that $68 million, about $13 million of it is actually for some incremental membership that we realized. So we've added about $55 million of actual cost to our reserves. To get to your point, I think you were pretty close to the number.

是的，這是一個很好的問題。我認為 3800 萬美元的變化是總醫療利潤，我們有一點增量收入。我認為全面的變化——所以我們看待它的方式是，我們基本上進入了第四季度，審視了史蒂夫剛剛經歷的所有事情，以及我們基本上如何改進我們的流程，並確保我們達到一個目標我們認為我們將為今年年底預留足夠的數量。實際上，與 1 月初的指導相比，我們最終的收盤結果增加了 6,800 萬美元的醫療費用。在這 6800 萬美元中，大約 1300 萬美元實際上是用於我們意識到的一些增量會員資格。因此，我們在儲備金中增加了約 5500 萬美元的實際成本。為了表達你的觀點，我認為你已經非常接近這個數字了。

In the fourth quarter, we added about $40 million of that $55 million with the other $15 million in the previous quarters. That $40 million incremental -- that total incremental with the $40 million going into the fourth quarter leaves us with a trend on base medical expense that is accelerating in the fourth quarter. And Steve talked about some of these numbers. Our full year based medical trends, so without supplemental benefits of 7% now for 2023 for the full year, the fourth quarter accelerated to about 7.7% for the full year. We've taken that 7.7% base medical expense and essentially assume that slightly higher than that for our full year 2024. So essentially, yes, we've taken that fourth quarter step up and flow that through into 2024 guide.

在第四季度，我們增加了 5,500 萬美元中的約 4,000 萬美元，另外 1,500 萬美元是在前幾個季度增加的。這 4000 萬美元的增量——加上進入第四季度的 4000 萬美元的總增量，讓我們看到基礎醫療費用的趨勢在第四季度正在加速。史蒂夫談到了其中一些數字。我們基於全年的醫療趨勢，因此如果沒有 2023 年全年 7% 的補充福利，第四季全年將加速至約 7.7%。我們採用了 7.7% 的基本醫療費用，並假設該費用略高於 2024 年全年的費用。因此，從本質上講，我們已經採取了第四季度的措施，並將其納入 2024 年指南。

Okay. And then just a couple of things on trend. One, can you tell us some of the breakdown here of what you're seeing, specifically, one of the companies that's out there talking about inpatient and seeing some pickup in short stays even before the Two-Midnight Rule. What are you assuming for that? I don't know if you gave an answer to that question that Lisa asked on the Two-Midnight Rule specifically. What is the impact that you're assuming there? Maybe you could tell us the pickup in short stays versus total admissions? Like how much pressure does that put on total admissions?

好的。然後是一些流行趨勢。第一，您能否告訴我們您所看到的一些詳細情況，特別是其中一家公司正在談論住院病人，甚至在午夜兩點規則之前就看到短期住院人數有所增加。你對此有何假設？我不知道你是否回答了麗莎專門提出的有關“午夜兩點規則”的問題。您認為那裡的影響是什麼？或許您可以告訴我們短期停留的人數與總入場人數的比較？例如這會對總招生帶來多大壓力？

And then lastly, on ACO reach, there's been some discussion that CMS is seeing trends higher in the fourth quarter, and they've kind of talked to the ACO REACH plans about that. Can you give us some numbers there in terms of how much trend CMS is reporting in the fee-for-service program in the fourth quarter versus what they've seen year-to-date to kind of maybe measure that pickup versus MA?

最後，關於 ACO 覆蓋範圍，有一些討論稱 CMS 在第四季度看到了更高的趨勢，他們已經與 ACO REACH 計劃討論了這一點。您能否給我們一些數字，說明 CMS 在第四季度的按服務收費計劃中報告的趨勢與今年迄今為止的趨勢相比，以衡量拾取率與 MA 的情況？

Sure. So I'll take the first one and you take the ACO. So Justin, in terms of trend, we are seeing some step-up in terms of inpatient medical. It is in line with what we considered within that overall trend. And the 2-day rule is definitely contributing to that, but it's still in line with what we've laid out for Q1 and within the full year.

當然。所以我選第一個，你選 ACO。所以賈斯汀，就趨勢而言，我們看到住院醫療方面有所進步。這與我們在整體趨勢中所考慮的一致。兩天規則肯定對此有所貢獻，但它仍然符合我們為第一季和全年制定的計劃。

The other categories that we are seeing stepping up is the ones that we've talked about before, which is the surgeries principally in the outpatient side, but also seeing some inpatient surgery. A lot of that was in Q4. Some may have been driven by exhausting maximum amount of pocket and some just sort of induced utilization around that, but also specialty cost in Part B drug.

我們看到的其他類別是我們之前討論過的，主要是門診手術，但也看到一些住院手術。其中很多是在第四季。有些可能是由於耗盡了最大的口袋數量，有些只是圍繞這一點誘導利用，但也有 B 部分藥物的特殊成本。

Just on the ACO REACH side, we are also seeing in our ACO REACH numbers an acceleration in claims expense in the fourth quarter. Similar to what we're seeing on the MA side. So that's certainly coming through our numbers. The one thing that I think part of your question is -- it's a little bit different than ACO REACH is. As those claims increase, that will actually go into the final calculation for the retro trend adjustment. So as overall Medicare fee-for-service claims are going up, our costs are going up, the revenue will adjust up as well. And that's allowed us, from our perspective, to pretty much hold and we booked our final ACO REACH close pretty much in line with where we had guided.

就 ACO REACH 而言，我們在 ACO REACH 數據中也看到第四季索賠費用的加速成長。與我們在 MA 方面看到的類似。所以這肯定是透過我們的數據得出的。我認為你問題的一部分是——它與 ACO REACH 有點不同。隨著這些索賠的增加，這實際上將進入復古趨勢調整的最終計算。因此，隨著整體醫療保險服務費用索賠的增加，我們的成本也在增加，收入也會增加。從我們的角度來看，這讓我們幾乎可以堅持下去，我們預訂了最終的 ACO REACH 收盤價，這與我們指導的位置基本一致。

The full year national ACO REACH, Justin, is at 6.8% and our performance came in at 2.7%. So we beat that national benchmark by 410 basis points.

Justin，全年全國 ACO REACH 為 6.8%，我們的績效為 2.7%。因此，我們比全國基準高出 410 個基點。

That 6.8% on the national trend is pretty similar to what we're seeing for the full year on the MA side, so is what I was referring to.

全國趨勢的 6.8% 與我們在 MA 方面全年看到的非常相似，這也是我所指的。

And was there a pickup there in the fourth quarter to CMS come to you and say, we're revising that number up?

第四季是否有 CMS 來找你並說我們正在修改這個數字？

CMS doesn't come to us and say that. They just give us the claims and they give us the Medicare fee-for-service reference population data on a monthly basis.

CMS 並沒有來找我們說這些。他們只是向我們提供索賠，並每月向我們提供醫療保險服務收費參考人口數據。

We now have a question from Ryan Daniels with William Blair.

現在我們有瑞安·丹尼爾斯向威廉·布萊爾提問。

Let me start with the big picture one, just on your relationship with your managed care payers. Given some of the headwinds you're seeing, I know you've talked about getting better data feeds and maybe restructuring some of the contracts, one of your peers today actually moved down the risk adjustment or risk scale, I should say, to do some partial risk and move away from full capitation. I'm curious if you've debated internally if that's a strategy you'd consider pursuing? Or if you're just going to kind of stick with it through the storm here given the trends you see longer term in the business and the cohorts?

讓我從大局開始，即您與管理式醫療付款人的關係。考慮到您所看到的一些不利因素，我知道您已經談到了獲得更好的數據源，也許還重組了一些合同，我應該說，今天您的一位同行實際上降低了風險調整或風險規模，以做到這一點一些部分風險並擺脫全額付費。我很好奇您是否在內部爭論過這是否是您會考慮採取的策略？或者，考慮到您在業務和群體中看到的長期趨勢，您是否打算在風暴中堅持下去？

Yes, Ryan. No, listen, I really appreciate the question, and we obviously are in a volatile environment as we've talked about. I think we believe the future is value-based care and full risk value-based care. I think we building a differentiated model and it made significant investments at the market and the platform to make that a reality. And I think we've got lots of data points like the one I just shared on ACO REACH or locally with our payers that we can outperform that fee-for-service environment. But specifically to your question, I think we're in this transition period in terms of MA funding and planned bids, and we're doing it against a backdrop of an elevated utilization environment. And so -- what we're doing is we're actively tuning our payer economics and our risk sharing that we're doing that 2 ways. One is in terms of an increased percentage of premium for capitated business that we've got, and we've been able to have some success around that. We've got more conversations actually going.

是的，瑞安。不，聽著，我真的很欣賞這個問題，正如我們所討論的，我們顯然處於一個不穩定的環境。我認為我們相信未來是基於價值的照護和完全基於風險價值的照護。我認為我們建立了一個差異化的模式，並在市場和平台上進行了大量投資，以使其成為現實。我認為我們有很多數據點，就像我剛剛在 ACO REACH 上或在本地與我們的付款人分享的數據點一樣，我們可以超越按服務收費的環境。但具體到你的問題，我認為就 MA 資金和計劃投標而言，我們正處於過渡期，而且我們是在利用率環境提高的背景下進行的。因此，我們正在做的是，我們正在積極調整我們的付款人經濟學和我們正在透過兩種方式進行的風險分擔。一是我們已經獲得的按人頭業務的保費百分比增加，並且我們已經在這方面取得了一些成功。我們實際上正在進行更多對話。

And the second is reducing our exposure for elements that are really out of our control. So supplemental benefits, STARS scores outside of the ones that we control around that or just aggressive bids that lead to far higher utilization assumptions than were laid out from an actuarial perspective. And so that tuning, Ryan gets reflected in a variety of ways. But I think that's the way we're looking at it. I think our payers are looking for us to do more. We're just looking for an economic and a risk-sharing arrangement that sort of balances the environment.

第二是減少我們對真正無法控制的元素的暴露。因此，補充性的好處是，STARS 的得分超出了我們控制的範圍，或者只是激進的出價，導致利用率假設遠高於精算角度提出的假設。因此，Ryan 的調整可以透過多種方式體現。但我認為這就是我們看待問題的方式。我認為我們的付款人希望我們做得更多。我們只是在尋找一種平衡環境的經濟和風險分擔安排。

It makes sense and super helpful color. And then I'm curious, based on that commentary, especially about reducing your exposure to things that are outside of your control, which I think is noteworthy. How receptive are the payers to this? Do they kind of appreciate that, yes, you shouldn't be penalized for these things that you can't control, and we're looking for you for other value add so that they're willing to negotiate and how big of a piece of your book of M&A business has gone through that level of negotiation?

這是有道理的，而且超級有用的顏色。然後，根據該評論，我很好奇，特別是關於減少接觸那些超出你控制範圍的事情，我認為這是值得注意的。付款人對此的接受程度如何？他們是否意識到，是的，您不應該因為這些您無法控制的事情而受到懲罰，我們正在尋找您以提供其他增值服務，以便他們願意進行談判以及確定多大的部分您的併購業務簿中的談判經歷過那種程度的談判嗎？

So to date, we're relatively early in that. We have had some success across some very key markets across a couple of payers. We've got it going with many payers right now, Ryan. I would say the value that we provide is very evident to these payers, particularly in this utilization environment. and they want to have a strong primary care supply chain, and our groups represent the largest and sort of most prestigious groups within their communities. And so it's very important. So that is factored into our discussion. And we'll give you an update on the next call in terms of how that's progressing, but I think we're pretty optimistic.

到目前為止，我們在這方面還處於相對較早的階段。我們在幾個付款人的一些非常關鍵的市場上取得了一些成功。瑞安，我們現在已經與許多付款人合作了。我想說，我們提供的價值對於這些付款人來說是非常明顯的，特別是在這種使用環境中。他們希望擁有強大的初級保健供應鏈，而我們的團體代表了他們社區內最大且最有聲望的團體。所以這非常重要。所以這是我們要討論的一個因素。我們將在下次電話會議上向您通報進展情況，但我認為我們非常樂觀。

We now have Jailendra Singh of Truist Securities.

現在我們請來了 Truist 證券公司的 Jailendra Singh。

This is Eduardo on for Jailendra. Just on the bridge, it looks like the class of 2024 medical margin declined more than the total medical margin relative to your January expectations. Is there anything that you're seeing, which makes, I guess, you more cautious on the class of 2024 versus the rest of the book?

我是賈蘭德拉 (Jailendra) 的愛德華多 (Eduardo)。就在橋上，與您 1 月的預期相比，2024 年類別的醫療利潤率下降幅度超過了總醫療利潤率。我想，你看到的哪些東西讓你對 2024 年畢業生比本書的其他部分更加謹慎？

So the class of '24 assumption reflects the full step-up in the utilization trend that we talked about across the entire book. I think it drops from $76 PMPM to $52 PMPM is the math on that change. So that is the -- what's driving the change that you see there.

因此，'24 類假設反映了我們在整本書中討論的利用率趨勢的全面提升。我認為它從每分鐘 76 美元下降到每分鐘 52 美元，這是這一變化的數學結果。這就是推動你所看到的改變的原因。

And then just on the, I guess, the gross medical cost trend impact being 7.9% versus the net being 6.6%. That rough math sort of points to the clinical programs having a roughly $50 million impact on your year 2 plus lives in '24. I guess, first, does that sound right? And can you discuss, I guess, which programs do you see being the largest contributors to this trend benefit?

然後，我猜，總醫療成本趨勢影響為 7.9%，而淨成本為 6.6%。粗略的計算表明，臨床計畫對 24 世紀 2 歲以上的人的生活產生大約 5000 萬美元的影響。我想，首先，這聽起來正確嗎？我想您能否討論一下您認為哪些計劃是這一趨勢收益的最大貢獻者？

Yes. The math is right on. We think that there's a little bit of supplemental benefit headwind in those numbers as well. But the overall value of those clinical programs for us should be about 140 basis points in 2024.

是的。數學是正確的。我們認為這些數字也存在一些補充福利的阻力。但到 2024 年，這些臨床項目對我們的整體價值應該約為 140 個基點。

And Eduardo, what I would say is all of our clinical programs, palliative, renal, high risk management are focused on reducing unnecessary ER and inpatient visits. We had really good success in '23 with those with inpatient medical down 2%, which is far better than sort of what we're seeing nationally. And I think we're expanding those 2 more markets and enrolling more patients in those programs based on a more accurate assessment. So those are the things that are giving us the confidence around the numbers you just laid out.

Eduardo，我想說的是，我們所有的臨床計畫、安寧療護、腎臟治療、高風險管理都致力於減少不必要的急診和住院。我們在 23 年取得了巨大的成功，住院人數下降了 2%，這比我們在全國範圍內看到的情況要好得多。我認為我們正在擴大這兩個市場，並根據更準確的評估讓更多患者參與這些計劃。這些讓我們對您剛才列出的數字充滿信心。

We now have Whit Mayo of Leerink Partners.

我們現在有 Leerink Partners 的 Whit Mayo。

Just one clarification, a lot of numbers. What was the actual cost trend for the full year in 2023? I hear 7.7% for the fourth quarter and close to 8% for the gross trend this year. But how does it compare to the full year?

只是一個澄清，一大堆數字。 2023年全年實質成本趨勢如何？我聽說第四季成長了 7.7%，今年的整體趨勢接近 8%。但與全年相比如何呢？

For 2023, Whit?

2023 年，惠特？

Yes, yes.

是的是的。

Yes, absolutely. So our base claims trend, so this is without supplemental benefits all in for the full year, we're now -- with the incremental reserves that we booked will be 7%. So our 2023 full year trend was 7% and then the fourth quarter accelerated to 7.7%.

是的，一點沒錯。所以我們的基本索賠趨勢，所以這是沒有全年補充福利的情況，我們現在 - 我們預訂的增量準備金將為 7%。所以我們2023年全年的趨勢是7%，然後第四季加速到7.7%。

And if you include the supplemental benefit effect, the nonmedical, that 7.0% that Tim talked about with goes up to 8.2% for 2023.

如果算上非醫療的補充福利效應，提姆談到的 7.0% 到 2023 年將上升到 8.2%。

Okay. And just remind me, the percent of your claims that you've completely settled at this point for '23.

好的。請提醒我，您在 23 年的索賠中已完全解決的百分比。

Yes. So right now -- but it's a great question because 1 of the things that we did when we went in and went through all those process to make sure the adequate reserve for the full year is we compared what our assumption is right now for full year completion rate to what it would have been for the same group of markets, so a year or 2 plus markets, back knowing now what we know for our full final cost in 2022, what it should have been in '22. Last year, at this point, our completion rate with December paid and final full year incurred what the real costs were, would have been at a completion rate of about 76.5%. And we're assuming a completion rate right now on an apples-to-apples basis of about 75%. So we would have assumed that we're about 150 basis points more conservative. But in the meantime, now between then and now actually closing, we've been able to see our January page as well. So I'll hold another month of data, which is actually 2 more months of data than we had when we guided in early January, and we're just up over 80% complete.

是的。所以現在 - 但這是一個很好的問題，因為當我們進入並完成所有這些流程以確保全年有足夠的準備金時，我們所做的一件事就是我們比較了我們現在對全年的假設完成率達到同一組市場的完成率，所以一年或兩年以上的市場，現在我們知道我們在2022 年的全部最終成本是多少，22 年應該是多少。去年此時，我們的完成率（12 月已付款且最終全年發生實際成本）約為 76.5%。我們假設現在的完成率在同類基礎上約為 75%。因此，我們假設我們保守約 150 個基點。但同時，從那時到現在實際上關閉，我們也能夠看到一月份的頁面。因此，我將保留另外一個月的數據，這實際上比我們 1 月初指導時多了 2 個月的數據，而且我們已經完成了 80% 以上。

Okay. And one last one.

好的。還有最後一張。

Sorry, go ahead.

抱歉，請繼續。

No, go ahead, Steve.

不，繼續吧，史蒂夫。

I just was going to give the context of in the assessment we talked about receiving in February, doing the analysis from some of our largest national payers that are more complete than the composite that Tim talked about. But also in that were updated seasonality factors and census data because the world is moving for everyone. And so that was all incorporated into the scenarios that we talked about and ultimately where we landed on that most conservative scenario.

我只是想提供我們在二月收到的評估中的背景，對我們一些最大的國家付款人進行的分析，這些分析比蒂姆談到的綜合數據更完整。但其中也更新了季節性因素和人口普查數據，因為世界正在為每個人而變化。因此，這一切都被納入我們討論的場景中，並最終我們得出了最保守的場景。

And sorry, one last quick one. Just the change in the geographical entry costs this year. I thought that was largely a set rate for physician compensation ahead of the future fleet. What really changed there?

抱歉，最後一件事。只是今年地域進入成本的變化。我認為這很大程度上是未來艦隊之前醫生補償的固定比率。那裡真正發生了什麼變化？

Yes. So it's really one of the largest parts of our geographic entry costs are the incentives that we pay to physicians in year 0 to complete their annual wellness visits and the higher completion rate we get, obviously, the better that is for us because it allows us to have a positive impact on next year's revenue as well as do a better job of getting our members enrolled in all of these clinical programs we're talking about. We actually finished the year at a much stronger rate than we had been projecting, particularly in a couple of large markets, and that drove our 2023 number up. Of course, in 2024, that number will be lower because of the size of the class of 2025 compared to 2024.

是的。因此，我們的地理准入成本中最大的部分之一實際上是我們在第0 年向醫生支付的獎勵，以完成他們的年度健康訪問，並且完成率越高，顯然對我們來說越好，因為它允許我們對明年的收入產生積極影響，並更好地讓我們的會員參加我們正在討論的所有這些臨床項目。事實上，我們今年的成長速度比我們預期的要高得多，尤其是在幾個大型市場，這推動了我們 2023 年的數字上升。當然，到 2024 年，由於 2025 年班級規模與 2024 年相比，這一數字將會更低。

Our next question comes from Elizabeth Anderson of Evercore ISI.

我們的下一個問題來自 Evercore ISI 的 Elizabeth Anderson。

I appreciate all the additional color on what you're seeing in the data visibility. I remember a couple of weeks ago, you were talking about some of your sort of percent completion for the 2Q, for 3Q, for 4Q in terms of data visibility, can you probably give us an update on sort of, I don't know whether it's changed since the beginning of January in terms of that? Or sort of where are your expectations of where you'll be, say, at the end of 2024.

我很欣賞您在數據可見性中看到的所有附加顏色。我記得幾週前，您在談論第二季度、第三季度、第四季度在數據可見性方面的完成百分比，您能否給我們提供一些更新信息，我不知道自一月初以來，這方面是否發生了變化？或者說，您對 2024 年底的情況有何期望。

She is talking about the financial data pipeline.

她正在談論金融數據管道。

So the financial data pipeline, Elizabeth, that I talked about in my remarks, that we're standing up this year, we are receiving claims already from our largest payer and we'll have many more of our largest payers talked about in Q1, that will be north of 50% of our members will be covered within that. And by Q2, we'll have 75% of those based on our 7 largest national payers. What that does for us is it gives us the ability to really have a very consistent data set across 3/4 of our members.

因此，伊麗莎白，我在演講中談到的金融數據管道，我們今年站起來了，我們已經收到了來自我們最大付款人的索賠，我們將在第一季度談論更多我們最大的付款人，我們50 % 的會員將被覆蓋在其中。到第二季度，其中 75% 的金額將來自 7 個最大的國家付款人。這對我們來說意味著它使我們能夠在 3/4 的會員中真正擁有非常一致的資料集。

It allows us to be faster with it and to be far more detailed at the cost of care category level than we have been able to historically because you're kind of wrestling very different data sets. And so it effectively becomes our data set that as soon as it's updated, we have that ability to just move with it that much more rapidly. And so I think that's what you're referencing is where we're at on that progression, and we're on track and encouraged by that. And that will be a component as we come back and start talking to you in future calls on the assessments we're making.

它使我們能夠比以往更快地處理它，並且在護理類別層面上提供更詳細的信息，因為我們要處理非常不同的數據集。因此，它實際上成為我們的數據集，一旦更新，我們就有能力更快地使用它。所以我認為你所指的就是我們目前的進展情況，我們正在走上正軌並受到鼓舞。當我們回來並開始與您討論我們正在進行的評估時，這將是一個組成部分。

We now have Sean Dodge of RBC Capital Markets.

現在我們請來了加拿大皇家銀行資本市場部的肖恩·道奇。

Yes. For the Class of 2025, if we look at the composition of bank, can you kind of help us compare and contrast that to the '24 class? Should we think about this being a group that also launches with a relatively strong year 1 medical margins? Or will these -- again, given the composition, should we think about it being more like the '23 class?

是的。對於 2025 年畢業生，如果我們看一下銀行的組成，您能否幫助我們將其與 24 屆畢業生進行比較和對比？我們是否應該認為這是一個第一年醫療利潤率相對較高的群體？或者這些——再次考慮到組成，我們是否應該認為它更像是'23類？

So we -- thanks, Sean, for the question. We have a really strong class of '25. Very excited to be implementing them right now. As I said, it's at least 5 groups and 60,000 senior patients, and it will be at least one new state for us. If you think about it in sort of comparison to the class of '23 and '24, you're going to see a greater concentration of these new groups in existing states and markets than what we've seen. We think that's really prudent. You're able to leverage existing contracts, clinical programs, infrastructure around that. So that helps a lot. It is also in contrast like class of '23 and '24, it's less diverse.

所以我們——謝謝肖恩提出的問題。我們有一個非常強大的25年級。非常高興現在就能實施它們。正如我所說，至少有5個小組和6萬名老年患者，這對我們來說至少是一個新的狀態。如果您將其與 23 歲和 24 歲階層進行比較，您會發現這些新群體比我們所看到的更集中在現有的州和市場中。我們認為這非常謹慎。您可以利用現有合約、臨床項目和基礎設施。所以這很有幫助。與 '23 和 '24 班相比，它的多樣性較少。

You've got more sort of multi-specialty groups and primary care and not as many different types of groups within those. And then as we just talked about kind of the geo entry costs really account for the potential for more membership than that 60,000 that I talked about in the class of '25 or in longer implementation cycles for the class of '26, so some early onboarding costs for that. So that's sort of the complexion of that group. And we'll be sharing details on each one of these groups here in the coming period.

你有更多類型的多專業團體和初級保健，但其中沒有那麼多不同類型的團體。然後，正如我們剛才談到的那樣，地理進入成本確實可以解釋比我在 25 屆或更長的 26 屆實施週期中談到的 60,000 名會員更多的潛力，所以一些早期的入職為此付出的代價。這就是該族群的膚色。我們將在接下來的一段時間內分享有關每個組的詳細資訊。

Okay. And maybe just quickly on that last point. Should we think about this being kind of what the class of '25 ends up looking like? Is it prudent given kind of the backdrop to pause here or just be a lot more selective than who you're including or do you think '25 could continue to grow?

好的。也許很快就最後一點。我們是否應該考慮一下這就是 25 屆學生最終的樣子？考慮到在這裡暫停的背景是謹慎的，還是比你所包括的人更有選擇性，或者你認為「25」可以繼續成長？

Well, I think to '25 is that we said at least, right? So 5 groups and 60,000. So there is the potential for that to grow, I do think we're very prudent in terms of, in particular, our payer contracts, now this class is in the footprint that we sit in today, so you're able to leverage a lot of existing footprint. So there's probably not as much of a dynamic on that. But a big part of this is sort of the pull-through on these groups, but that's sort of where we're at right now, at least 5 groups, at least 60,000.

好吧，我認為至少我們是這麼說的，對吧？所以5組60,000。因此，這一點有增長的潛力，我確實認為我們在付款人合約方面非常謹慎，現在此類已在我們今天的足跡中，因此您可以利用許多現有的足跡。所以這方面可能沒有那麼大的動力。但這其中很大一部分是對這些群體的拉動，但這就是我們現在所處的情況，至少有 5 個群體，至少有 60,000 人。

We now have Stephen Baxter of Wells Fargo.

現在我們有富國銀行的史蒂芬‧巴克斯特。

I just wanted to ask, at this point, as you look back at sort of the cohort progression, especially the older cohorts, has there been anything that structurally changes your view of the company's ability to get back to these economics over time? I mean one thing that we've been thinking about is that on the health plan side, they have 2 levers to really deal with this. First, they have kind of the repricing, but then they're also seemingly cutting a lot of corporate overhead. So they might not even be necessarily getting back to the same medical margins that they would have had on a pre-COVID basis. So as we sort of think about it, just wondering if you could provide some thoughts around the potential achievability of those economics and, I guess, what it looks like it will be a pretty different environment going forward.

我只是想問，在這一點上，當您回顧隊列進展，尤其是較老的隊列時，是否有任何事情從結構上改變了您對公司隨著時間的推移恢復這些經濟能力的看法？我的意思是，我們一直在考慮的一件事是，在健康計劃方面，他們有兩個手段來真正解決這個問題。首先，他們進行了重新定價，但隨後他們似乎也削減了大量的公司管理費用。因此，他們甚至可能不一定能恢復到新冠疫情前的醫療利潤水準。因此，當我們思考這個問題時，只是想知道您是否可以就這些經濟學的潛在可實現性提供一些想法，我想，未來的環境將是一個非常不同的環境。

Yes, Stephen. I mean it definitely is a dynamic environment, and you've got the elevated utilization. I appreciate you're asking about the cohort data. I mean, I think clearly elevated costs impacted the member cohorts and the market cohorts that are in the deck that's on the investor website. I think we're encouraged when you look at the member cohort data, which is basically members that came on in '18 kind of how they're performing across time '19, same thing. If you look at the classes of '18, '19 and '20, they are progressing or sustaining near $150 PMPM. That's on the low side, but we've talked about that $150 to $200 is sort of where we're shooting for. And obviously, we've got some that are north above that.

是的，史蒂芬。我的意思是，這絕對是一個動態環境，而且利用率很高。感謝您詢問隊列數據。我的意思是，我認為明顯升高的成本影響了投資者網站上的會員群體和市場群體。我認為，當您查看會員群組數據時，我們會受到鼓舞，這些數據基本上是 18 年出現的會員，與 19 年期間的表現類似，同樣的事情。如果您查看 '18、'19 和 '20 的班級，您會發現他們的進步或維持在每分鐘 150 美元附近。雖然這個價格偏低，但我們已經討論過 150 至 200 美元是我們的目標。顯然，我們有一些位於此之上的北部。

The market class data, what we've shown you for the first time within that is the impact of dilution from mid-teens same-store growth year in, year out. And so it's very impactful in terms of what you're able to drive across those markets. And our action plans are focused on -- we've added 400 providers and 100,000 MA members since the initial year 1. Those are dragging those markets. So you see a $36 PMPM impact in the market class of '18, an $86 PMPM impact in the class of '19 and a $44 PMPM impact in the class of '20, those are dragging those market numbers that you see on the next page.

我們首次向您展示的市場級數據是年復一年同店成長帶來的稀釋影響。因此，就您在這些市場上的推動力而言，它非常有影響力。我們的行動計劃的重點是——自第一年以來，我們已經增加了 400 家提供者和 100,000 名 MA 成員。這些正在拖累這些市場。因此，您會看到'18 類市場的PMPM 影響為36 美元，'19 類市場的PMPM 影響為86 美元，'20 類市場的PMPM 影響為44 美元，這些影響了您在下一頁看到的市場數字。

And so our opportunity is in that action plan I talked about around addressing PCP variability. How do we focus on those new doctors, how do we focus on those new patients? How do we get them more educated and understanding sort of the elements of the value-based care model and really what's available to them within the care team to drive that improvement.

因此，我們的機會就在我談到的關於解決 PCP 變異性的行動計劃中。我們如何關注這些新醫生，我們如何關注這些新患者？我們如何讓他們接受更多教育並理解基於價值的護理模式的要素，以及護理團隊中他們可以真正使用什麼來推動這種改進。

We see that as a major opportunity for us to drive those up. And so I think we believe based on '18, '19 and '20, you can get members to that level and with markets, we've got to be able to accelerate and drive that cohort maturation for those newer members and newer PCPs at the same level. So that's kind of how we're thinking about it. That's a lever we can control, you've talked about levers outside of our control, like how plans filed their bids and their benefits. We are encouraged based on what we're hearing around that and how they're thinking about '25 that would obviously flow through dollar for dollar to us. That's part of that payer economics and risk sharing discussion that I talked about.

我們認為這是我們推動這些成長的一個重要機會。因此，我認為我們相信，基於“18”、“19”和“20”，您可以讓會員達到這一水平，並且通過市場，我們必須能夠加速並推動新會員和新 PCP 的群體成熟相同的水平。這就是我們的想法。這是我們可以控制的槓桿，您已經談到了我們無法控制的槓桿，例如計劃如何提交投標及其收益。基於我們所聽到的情況以及他們對「25」的看法，我們感到很鼓舞，這顯然會透過美元對美元流向我們。這是我談到的付款人經濟學和風險分擔討論的一部分。

And then there's obviously what will happen from a benchmark perspective and how much of this accelerated utilization will be captured within that. But we think we're in this 2-year cycle we think those elements should improve the spread '25, '26, '27 but we're really focused on what we can control, and we see this variability with newer doctors and with newer members as a great opportunity for us.

然後，顯然從基準的角度來看將會發生什麼，以及其中將捕捉多少加速利用率。但我們認為我們處於這個2 年周期，我們認為這些因素應該會改善'25、'26、'27 的傳播，但我們真正關注的是我們可以控制的內容，我們看到新醫生和新醫生的這種變化新成員對我們來說是一個很好的機會。

We now have George Hill of Deutsche Bank.

現在我們有德意志銀行的喬治·希爾。

And Steve, this is kind of like a big picture question for you, which you talked about some of your health plan partners bidding for margin for 2025, but there's kind of guardrails around what they can do, right, based upon what the final rate will the TBC, how close they want to bid to the benchmark and impact the rebate levels and things like that.

史蒂夫，這對你來說有點像一個大問題，你談到了你的一些健康計劃合作夥伴競標 2025 年的保證金，但他們可以做什麼有一些護欄，對吧，基於最終費率待定後，他們希望與基準競價有多接近並影響回扣水平等。

So I'm wondering kind of from where you sit, what do you think about the margin expansion potential in 2025? And kind of like I'm going to kind of use that as the proxy what can that look like for you guys because some of your health plan partners talked about like needing to increase margin low double-digit dollars per member per month as you look out to 2025. Just I'd be interested to hear how you think about those moving maybe to the big picture level.

所以我想知道您對 2025 年利潤擴張潛力有何看法？有點像我將用它作為代理，這對你們來說會是什麼樣子，因為你們的一些健康計劃合作夥伴談到需要增加每個會員每月低兩位數的保證金到2025 年。只是我有興趣聽聽您如何看待那些可能邁向大局的事情。

I think the math is if you do a $10 PMPM adjustment in terms of a bid across 0.5 million seniors in MA, I think it's an annual number of $60 million, right? So that -- if you talk about low double digits, that gives you the ability to sort of dimension what that could look like. And that's one element of this, George. And so I think we've had conversations with people, some people are thinking more than that. Some people, I think, are still trying to figure that out. But I think that's one piece of it. But I will come back to what I was just talking to Stephen about the thing we can control is really around this variability in the new docs and the new patients. We think that can be very material in terms of the improvement that we can see from that perspective. as well.

我認為數學是如果你對馬薩諸塞州 50 萬老年人的出價進行 10 美元的 PMPM 調整，我認為每年的數字是 6000 萬美元，對嗎？因此，如果您談論低兩位數，那麼您就能夠對可能的情況進行排序。這就是其中的一個要素，喬治。所以我認為我們已經與人們進行了​​交談，有些人的想法不止於此。我認為有些人仍在試圖弄清楚這一點。但我認為這只是其中的一部分。但我會回到我剛剛與史蒂芬談論的事情，我們可以控制的事情實際上是圍繞新醫生和新患者的這種變化。我們認為，從這個角度來看，這對於我們可以看到的改進是非常重要的。以及。

And then there's just this natural maturation in the cohorts, right, in a very difficult year, you're seeing us projecting a 40% step-up in medical margin from '23 to '24. Big part of that is this class of '24 that comes on great experience, longer implementation. But I think if you think about our business, as members mature across time, you should see this natural evolution and the spread should correct from where it sits today.

然後隊列就會自然成熟，在非常困難的一年裡，你會看到我們預計從 23 年到 24 年醫療利潤率將提高 40%。其中很大一部分是 24 屆畢業生擁有豐富的經驗和更長的實施時間。但我認為，如果你考慮我們的業務，隨著成員隨著時間的推移而成熟，你應該看到這種自然的演變，並且傳播應該從今天的位置開始糾正。

We now have Adam Ron of Bank of America.

現在我們有美國銀行的亞當·羅恩。

I'm going to ask something very similar to what's been asked already, but maybe from a different angle. So the payers are also talking about 2025 in terms of actual margin improvements, so like Humana saying something like 100, 150 basis points of margin. And if most of that comes from cutting rebates and they've given a number of something like $40 at the MAX looking at some ways of looking at it.

我要問的問題與已經問過的問題非常相似，但可能是從不同的角度。因此，付款人也在談論 2025 年實際利潤率的提高，就像 Humana 所說的 100、150 個基點的利潤率一樣。如果其中大部分來自削減回扣，並且他們已經給出了一些類似 40 美元的最高限額，以尋找一些看待它的方式。

On a percentage basis, if they're talking about 100 basis points of margin, would that be higher for you just because if that does come in the form of rebates, it's a higher percentage of the capitated benchmark? And just separately, is there a way that they do cut benefits and somehow it doesn't flow to you because you're talking about carving out risk on supplemental benefits and it's talking about a little bit of the things that are getting cut and you carve them out. Is it somehow not end up impacting your P&L? Just trying to understand like how much visibility you have into that? And how much capacity payers have to cut benefits and not flow it into agilon?

在百分比基礎上，如果他們談論的是 100 個基點的利潤，這對您來說是否會更高，因為如果確實以回扣的形式出現，那麼它佔人均基準的百分比更高？單獨來說，有沒有一種方法可以讓他們確實削減福利，但不知何故，它不會流向你，因為你正在談論消除補充福利的風險，它正在談論一些被削減的事情，而你把它們雕刻出來。它是否最終不會影響您的損益？只是想了解您對此有多少了解？以及有多少容量支付者必須削減福利而不將其流入 agilon？

So I mean, I'll just back up Adam to what I said, which is we are really trying to tune our payer economic and risk sharing arrangements in this environment. Utilization is up, and we're managing that. We should probably be receiving a larger percentage of premium, that's part of the dialogue that we have with them, given the consistency of performance from a quality perspective that we are delivering for them and for their patients.

所以我的意思是，我會支持亞當我所說的，那就是我們確實正在努力在這種環境下調整我們的付款人經濟和風險分擔安排。利用率有所上升，我們正在對此進行管理。考慮到我們為他們及其患者提供的從品質角度來看表現的一致性，我們可能應該獲得更大比例的保費，這是我們與他們對話的一部分。

So that's kind of a big part the things outside of our control, how do we look at that? Do we corridor it? Do we cap it? Do we carve it? I mean I -- getting into sort of future scenarios about what gets changed and how that flows through I don't have a perfect crystal ball on that. But I do think this idea is we are delivering an incredibly valuable service for them, and we are trying to look at a sustainable model for them and for us that it works around that. So that's sort of a general answer to your question, but I -- a lot of dialogue with them as they think about their '25 bids as they think about '25 markets and how our partnerships fit within that.

所以這是我們無法控制的很大一部分事情，我們如何看待它？我們有走廊嗎？我們限制它嗎？我們雕刻它嗎？我的意思是，我 - 進入未來的場景，了解哪些內容會發生變化以及變化如何進行，我對此沒有完美的水晶球。但我確實認為這個想法是我們正在為他們提供非常有價值的服務，我們正在努力為他們和我們尋找一個可持續的模式，它可以圍繞這個模式運作。這是對你的問題的一般性回答，但我與他們進行了很多對話，因為他們考慮了他們的 25 個投標，他們考慮了 25 個市場以及我們的合作夥伴關係如何適應其中。

Yes. I appreciate that. And then just 2 really quick follow-ups. So G&A, I think, like platform support costs are based on the current guidance of like 3% of revenue and last year's performance, I think they're growing like the mid-teens. Is that a reasonable way to think about '25 as well just on a dollar basis for platform support costs? And then finally, I think the adjusted EBITDA in '23 was around negative $90 million. Is that how we should think of operating cash flow losses in '24 as well since we're talking about a 1-year lag.

是的。我很感激。然後只有 2 個非常快速的後續行動。因此，我認為，一般管理費用（G&A），就像平台支援成本是基於當前收入的 3% 左右的指導和去年的業績一樣，我認為它們的增長速度大約在十幾歲左右。這是考慮 25 以及僅以美元為基礎的平台支援成本的合理方式嗎？最後，我認為 23 年調整後的 EBITDA 約為負 9,000 萬美元。既然我們談論的是一年的滯後，那麼我們也應該如何看待 24 年的營運現金流損失。

Yes. I think on the first one, a little early for us to be guiding to platform support costs for 2025, but we would expect that we're going to definitely continue to get leverage out of our platform support costs and continue to drive -- platforms forecast growth will be obviously well below what our revenue cost growth -- or what our revenue growth is. So specifically, a little early to say, but yes, we'll continue to get leverage for sure.

是的。我認為，在第一個方面，我們指導 2025 年的平台支援成本還為時過早，但我們預計我們肯定會繼續從平台支援成本中獲得槓桿作用，並繼續推動——平台預測成長將明顯低於我們的收入成本成長—或我們的收入成長。所以具體來說，現在說有點早，但是，是的，我們肯定會繼續獲得影響力。

On the cash flow numbers, what we talked about for 2024 is that our expectation is that will burn somewhere between $125 million and $150 million of cash use in 2024. If we hit our guidance for 2024 that we put out there, the way our cash flow works is there's kind of a delayed impact of the medical margin and EBITDA that we're generating in 2023 has a big impact on our 2024 cash flow. 2024's guided performance will have a big impact on 2025. If we can deliver our 2024 guidance, which, of course, we expect to our 2025 use of cash would go from down to about $25 million or $30 million. And then that would put us on a good trajectory to be positive cash flow in 2026 and beyond.

關於現金流量數字，我們對 2024 年的預期是，我們的預期是 2024 年將消耗 1.25 億至 1.5 億美元的現金使用。如果我們達到我們發布的 2024 年指導，我們的現金方式流量的作用是醫療利潤率有一定的延遲影響，我們在2023 年產生的EBITDA 對我們2024 年的現金流有很大影響。 2024 年的指導業績將對 2025 年產生重大影響。如果我們能夠提供 2024 年的指導，當然，我們預計 2025 年的現金使用量將從下降到約 2500 萬美元或 3000 萬美元。然後，這將使我們走上良好的軌道，在 2026 年及以後實現正現金流。

And Adam, what I would say is just we're seeing tremendous leverage on the efficiency side from the investments we're making in technology in the centralization, standardization of activities that we're doing like chart reviews that previously got done within local markets. And so I think just the scale that we've got, there's a tremendous opportunity, not just in things like discussions with payers, but also from an efficiency perspective for us to drive further around that. So I think as we continue to grow, there's going to be far greater leverage from that perspective.

亞當，我想說的是，我們在集中化、標準化活動方面進行的技術投資，在效率方面看到了巨大的影響力，就像以前在本地市場內完成的圖表審查一樣。因此，我認為就我們所擁有的規模而言，存在著巨大的機會，不僅是在與付款人的討論等方面，而且從效率的角度來看，我們可以進一步推動這一點。所以我認為，隨著我們的不斷發展，從這個角度來看，我們的影響力將會更大。

And we get very good leverage against our operating costs in our existing markets. I mean, most of the incremental costs that we add year-over-year to our platform's forecast is because we're adding markets. as our existing market base becomes a bigger and bigger part of our overall membership, we just get really good leverage out of cost in those markets.

我們在現有市場上獲得了良好的營運成本槓桿。我的意思是，我們平台預測中逐年增加的大部分增量成本是因為我們正在增加市場。隨著我們現有的市場基礎在我們全體會員中所佔的比例越來越大，我們就可以從這些市場的成本中獲得非常好的槓桿作用。

It's another benefit of growing in your existing footprint.

這是擴大現有足跡的另一個好處。

Thank you. We have no current questions on the line. So I would like to hand it back to the agilon management team for any final remarks.

謝謝。目前我們沒有任何疑問。因此，我想將其交還給 agilon 管理團隊以徵求最後意見。

Well, thank you. Obviously, we're living in a very dynamic environment. I think our '23 results and '24 guide we've shared with you are clearly impacted by those but we feel like our targeted action plan is on track and our business model is working. And I think when you look at our cohort data, even in a difficult environment, it shows the value we're providing to physicians and sort of what the long-term opportunity is within the business. So we look forward to talking with you all soon. Thanks for joining us.

嗯，謝謝。顯然，我們生活在一個非常動態的環境中。我認為我們與您分享的「23 年結果」和「24 年指南」顯然受到了這些影響，但我們認為我們的目標行動計劃正在步入正軌，我們的商業模式正在發揮作用。我認為，當你查看我們的隊列數據時，即使在困難的環境中，它也顯示了我們為醫生提供的價值以及業務中的長期機會。因此，我們期待盡快與大家交談。感謝您加入我們。

Thank you all for joining the agilon Health Fourth Quarter 2023 Earnings Conference Call. You may now disconnect your lines, and please enjoy the rest of your day.

感謝大家參加 agilon Health 2023 年第四季財報電話會議。現在您可以斷開線路，並享受接下來的一天。