agilon health inc (AGL) 2024 Q3 法說會逐字稿

Good afternoon and thank you for joining the agilon health third-quarter 2024 earnings conference call. My name is Kate and I will be the moderator for today's call. (Operator Instructions)

下午好，感謝您參加 agilon health 2024 年第三季財報電話會議。我叫凱特，我將擔任今天電話會議的主持人。（操作員說明）

I would now like to turn the call over to Leland Thomas with agilon health. Leland, you may proceed.

我現在想將電話轉給擁有 agilon health 的 Leland Thomas。利蘭，你可以繼續了。

Thank you operator. Good afternoon and welcome to the call with me is our CEO Steve Sell and our CFO Jeff Schwanke. Following our prepared remarks, we will conduct a Q&A session. 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.

謝謝運營商。下午好，歡迎與我們的執行長 Steve Sell 和財務長 Jeff Schwanke 通話。在我們準備好的發言之後，我們將進行問答環節。在我們開始之前。我想提醒您，我們的言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。

These risks and uncertainties are discussed in our SEC filings. Please note that we assume no obligation to update any forward-looking statements. Additionally, certain financial measures we will discuss in this call are non-GAAP financial measures.

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。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。

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.

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。

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

接下來，讓我把事情交給史蒂夫。

Thanks Leland, good afternoon and thank you for joining us. On today's call, I would like to walk you through the following. One, an overview of our third quarter financial results and updated 2024 guidance. Two, the key actions we are taking to drive improved profitability, improve execution and further strengthen our business. Three, despite the challenges of the last year, the underlying strength of our core business fundamentals and demand from payers and physicians. And four, the factors impacting our jumping off point for 2025, including an improved business mix, exiting 2024.

謝謝利蘭，下午好，謝謝您加入我們。在今天的電話會議上，我想向您介紹以下內容。一是我們第三季財務業績概述和更新的 2024 年指引。第二，我們為提高獲利能力、提高執行力和進一步加強業務所採取的關鍵行動。第三，儘管去年面臨挑戰，但我們核心業務基本面的潛在實力以及付款人和醫生的需求。第四，影響 2025 年起點的因素，包括 2024 年結束時業務組合的改善。

Before I dive in, let me provide some context. We are clearly disappointed with the results we are sharing today and expect to drive meaningful improvement in the future. But we believe our core business is strong and we are taking the necessary actions to continue to strengthen the platform, improve execution and manage through a challenging environment against the backdrop of long term demand for improved cost and quality performance led by primary care doctors.

在深入探討之前，讓我先提供一些背景資訊。我們顯然對今天分享的結果感到失望，並期望在未來推動有意義的改進。但我們相信我們的核心業務很強大，在初級保健醫生主導的對提高成本和品質績效的長期需求的背景下，我們正在採取必要的行動，繼續加強平台，提高執行力，並在充滿挑戰的環境中進行管理。

Our Q3 report and updated guide reflect additional information from our payers and a new perspective from our new CFO with the goal of capturing known risks and providing a solid foundation from which to build. Against this backdrop, we believe in the value proposition for our network and platform to be a sustainable performance vehicle for physicians and payers in full risk value based care.

我們的第三季報告和更新的指南反映了來自付款人的更多資訊以及新財務長的新視角，其目標是捕捉已知風險並為構建奠定堅實的基礎。在此背景下，我們相信我們的網路和平台的價值主張是為醫生和付款人提供完全基於風險價值的護理的可持續績效工具。

Pursuing this long term vision has required some tough near term decisions to exit selected partnerships and narrow the footprint of health plans we will work with in 2025. Our positioning for long term sustainability includes a current cash position and cash flow management levers intended to allow us to weather the storm, even as we take actions to accelerate the path to profitability and positive cash flow.

追求這個長期願景需要做出一些艱難的近期決定，以退出選定的合作夥伴關係並縮小我們將在 2025 年合作的健康計劃的範圍。我們的長期永續發展定位包括目前的現金狀況和現金流管理槓桿，旨在讓我們能夠渡過難關，即使我們採取行動加速獲利和正現金流的道路。

Finally, we see recent events, like an increased set of stars cut points that raised the bar on the importance of quality performance and another reduction in the physician fee schedule that pressures doctor practices as indicators that the move to value will only increase in the coming years.

最後，我們看到最近發生的事件，例如越來越多的明星削減分數，提高了品質績效的重要性，以及醫生費用表的另一次減少，這給醫生的實踐帶來壓力，這表明向價值的轉變只會在未來增加年。

Now, turning to our third quarter results, MA membership continued its growth trend increasing 37% year- over-year to 525,000 members driven by stronger than expected same geography growth in the continued expansion of our new partner class. Total revenue grew 28% to $1.45 billion, albeit a lower than forecasted premium yield. We are raising our full year membership guidance from 519,000 to 527,000 members and increasing our full year revenue guidance from $6.025 billion to $6.057 billion. And I will provide you with the projected end of year impact on membership and revenue from the decision to exit selected partnerships and pay your contracts.

現在，轉向我們第三季的業績，MA 會員繼續保持成長趨勢，年成長 37%，達到 525,000 名會員，這得益於我們新合作夥伴類別的持續擴張，同地域成長強於預期。總營收成長 28%，達到 14.5 億美元，儘管保費收益率低於預期。我們將全年會員人數指導從 519,000 名會員提高到 527,000 名，並將全年收入指導從 60.25 億美元提高到 60.57 億美元。我將為您提供退出選定合作夥伴關係並支付合約的決定對會員資格和收入的預計年底影響。

Third quarter medical margin was a loss of $58 million or minus $36 per member per month, which was below our expectations due to three factors. Prior period revenue settlements with payers primarily tied to risk adjustment and part D, a reduction in expected 2024 revenue from lower than projected risk adjustment and higher than forecasted medical expenses.

第三季醫療利潤損失為 5,800 萬美元，即每位會員每月減去 36 美元，由於三個因素，數字低於我們的預期。前期與付款人的收入結算主要與風險調整和 D 部分相關，即由於低於預期的風險調整和高於預期的醫療費用而導致 2024 年預期收入減少。

Our reported Q3 medical costs reflect an updated view on trend and seasonality across the year with Q1 developing more favorably, unfavorable development from Q2 and an increased Q3 cost trend estimate. We continue to take a prudent posture on in quarter cost trends until our leading indicator. Census data indicates otherwise.

我們報告的第三季醫療成本反映了對全年趨勢和季節性的最新看法，第一季的發展更加有利，第二季的發展不利，第三季的成本趨勢估計增加。在我們的領先指標出現之前，我們將繼續對季度成本趨勢採取謹慎的態度。人口普查數據顯示情況並非如此。

In terms of medical margin guidance, we are lowering our 2024 medical margin guide to $225 million compared to our previous guidance at the low end of the $400 million to $450 million range. Of note, we have recognized approximately $100 million of negative medical margin through the third quarter from 2023 and earlier periods.

在醫療利潤指引方面，我們將 2024 年醫療利潤指引下調至 2.25 億美元，而先前的指引為 4 億至 4.5 億美元範圍的低端。值得注意的是，我們已經確認從 2023 年及之前的第三季開始，醫療利潤率出現了約 1 億美元的負值。

Accordingly, we believe the medical margin step off point for next year is now about $325 million before the impact of the strategic actions that we are announcing today and other in process actions. Adjusted EBITDA loss for the third quarter was minus $96 million due to lower MA medical margin. For the full year, '24 we are lowering our adjusted EBITDA guidance range reflecting Q3 results in a Q4 forecast of lower risk adjustment revenue and an elevated medical expense environment.

因此，我們認為，在我們今天宣布的戰略行動和其他正在進行的行動的影響之前，明年的醫療利潤率目前約為 3.25 億美元。由於 MA 醫療利潤率下降，第三季調整後 EBITDA 虧損為負 9,600 萬美元。對於 24 年全年，我們將降低調整後的 EBITDA 指引範圍，反映第三季的結果，第四季預測風險調整收入較低，醫療費用環境較高。

Well, the environment is challenging and the results for the current period are disappointing. A deeper look at our performance reveals a strong core business with solid fundamentals, an increasingly relevant value proposition and a significant total addressable market in need of a better solution.

嗯，環境充滿挑戰，目前的結果令人失望。更深入地審視我們的業績，可以發現我們擁有強大的核心業務、堅實的基礎、日益相關的價值主張以及需要更好解決方案的重要總體目標市場。

We are encouraged by a number of factors. First, greater than 80% of our year one plus partnerships are producing positive market level MA adjusted EBITDA on an incurred basis despite the macro headwind and producing meaningful distributions to our partner practices. Notably, our class of 2024 is performing at the high end of our typical year one market medical margin range, as these newer partners benefit from platform maturation and network learnings.

我們受到許多因素的鼓舞。首先，儘管存在宏觀逆風，但我們一年中超過80% 的一加合作夥伴關係在已發生的基礎上產生了積極的市場水平MA 調整後的EBITDA，並對我們的合作夥伴實踐產生了有意義的分配。值得注意的是，我們 2024 屆畢業生的表現處於典型第一年市場醫療利潤範圍的高端，因為這些新合作夥伴受益於平台成熟和網路學習。

We see high demand from payers and partners reflected in our consistent quarterly additions of new doctors and members and our class of 2025 should add approximately 45,000 members. The recently released star scores for 2025 reinforce our value to payers as every partner minus one on the platform in measurement year 2023 scored above the critical 4 star threshold and a majority of our partners were above 4.25 stars.

我們看到付款人和合作夥伴的高需求反映在我們每季不斷增加的新醫生和會員中，我們的 2025 屆會員應該會增加約 45,000 名會員。最近發布的2025 年星級評分強化了我們對付款人的價值，因為在2023 年衡量中，平台上每一位減一的合作夥伴的評分都高於關鍵的4 星門檻，而且我們的大多數合作夥伴都高於4.25 顆星。

Our ACO reach results show our network as a top performer in terms of quality and meaningful gross savings to CMS driven by an overall cost trend, nearly 300 basis points better than the benchmark average. Despite these strengths, we have areas of exposure to factors like part D and supplemental benefit risk and we have a small subset of partnerships in need of meaningful improvement. With this assessment and against the backdrop of a challenging environment we are announcing the following actions in process.

我們的 ACO 覆蓋範圍結果表明，我們的網路在品質和整體成本趨勢驅動的 CMS 顯著總節省方面表現最佳，比基準平均值高出近 300 個基點。儘管有這些優勢，我們仍面臨 D 部分和補充福利風險等因素的影響，我們有一小部分合作夥伴關係需要有意義的改進。根據這項評估，在充滿挑戰的環境背景下，我們宣布正在採取以下行動。

One to exit two partnerships and approximately 10% of our payer contracts. Two to reduce the data on elements outside our control by narrowing our 2025 exposure to part D risk and three to delay the onboarding of one class of 2025 physician partner, given local payer dynamics.

其中一項是退出兩個合作夥伴關係以及大約 10% 的付款人合約。其中兩個是透過縮小 2025 年 D 部分風險敞口來減少我們無法控制的因素的數據，第三個是考慮到當地付款人的動態，推遲 2025 年一類醫生合作夥伴的入職。

First across a network of 26 partnerships in a year end projected 527,000 MA members and 128,000 reach members we have mutually decided to exit two partnerships experiencing substantial adjusted EBITDA losses in 2024. In addition to the payer contracts associated with the exited partnerships we will also be non renewing several unprofitable payer contracts in continuing partnerships.

首先，在年底預計有 527,000 名 MA 成員和 128,000 名reach 成員的 26 個合作夥伴網絡中，我們共同決定退出兩個在 2024 年經歷大幅調整後 EBITDA 損失的合作夥伴關係。除了與已退出的合作夥伴關係相關的付款人合約外，我們還將不再續簽持續合作夥伴關係中的幾項無利可圖的付款人合約。

These actions will reduce our projected end of year 2024 membership by roughly 45,000 to 75,000 members, and our annualized revenue by approximately $470 million to $785 million. We are working to exit each of these contracts as of December 31, 2024, although a few of them may continue through 2025. These were not easy decisions, but in this challenging environment, we concluded these partnerships would take too long to reach profitability and we needed to consider the health and future success of the broader network. As always, these decisions were made in close collaboration with our physician partners.

這些行動將使我們預計到 2024 年底的會員人數減少約 45,000 至 75,000 名，年化收入減少約 4.7 億至 7.85 億美元。我們正在努力在 2024 年 12 月 31 日之前退出這些合同，儘管其中一些合約可能會持續到 2025 年。這些不是容易做出的決定，但在這個充滿挑戰的環境中，我們得出的結論是，這些合作夥伴關係需要很長時間才能實現盈利，我們需要考慮更廣泛網絡的健康狀況和未來的成功。一如既往，這些決定是與我們的醫生合作夥伴密切合作做出的。

Second, against our long term goal of reducing the beta in our business, we now expect for 2025 more than 50% of our membership will have some type of risk mitigation for Part D through Carve Outs Corridor or other risk mitigation strategies.

其次，根據我們降低業務貝塔值的長期目標，我們現在預計到 2025 年，超過 50% 的會員將透過 Carve Outs Corridor 或其他風險緩解策略來緩解 D 部分的某種類型的風險。

Our recent discussions reinforce the unique value levers that agilon's network brings payers in terms of quality scores above and Part C medical trends below their broader fee for service network. With the evolving environment, we believe that how we manage Part D risk in partnership with our payers is a critical decision.

我們最近的討論強化了 agilon 網路為付款人帶來的獨特價值槓桿，其品質得分高於其更廣泛的服務網絡費用，C 部分醫療趨勢低於其更廣泛的服務網絡費用。隨著環境不斷變化，我們相信如何與付款人合作管理 D 部分風險是一個關鍵決定。

Third, in close collaboration with a 2025 physician partner, the decision was made to delay the onboarding of this group until financial data exchange with three regional payers in that market improved. We will continue to work closely with this partner and the regional payers to monitor the local dynamics and reassess inclusion in our 2026 partnership class. The net effect of these actions is that we have improved our baseline market mix exiting 2024, both in terms of the run rate and reduced beta which should yield a stronger jumping off point for 2025.

第三，與 2025 年醫生合作夥伴密切合作，決定推遲該小組的加入，直到與該市場三個區域付款人的財務數據交換得到改善。我們將繼續與該合作夥伴和地區付款人密切合作，監控當地動態並重新評估是否納入我們的 2026 年合作夥伴類別。這些行動的最終效果是，我們改善了 2024 年退出的基準市場組合，無論是在運行率還是降低的貝塔值方面，這都將為 2025 年帶來更強的起點。

As indicated earlier, we believe the membership step off for 2025 will be 452,000 to 482,000 MA members before the addition of 45,000 MA members from the class of '25. And based on our revised guidance, the medical margin step off point for next year is now about $325 million before the key actions, I have described.

如前所述，我們認為 2025 年 MA 會員數將減少 452,000 至 482,000 名，然後再增加 25 屆 45,000 名 MA 會員。我已經描述過，根據我們修訂後的指導意見，在採取關鍵行動之前，明年的醫療利潤起點約為 3.25 億美元。

The investor materials on our website provide more information on the impact of these actions on membership revenue and our market mix and we'll be dimensioning the expected margin lift in more detail early next year. In addition to these actions, we see a series of factors and execution opportunities that will impact our '25 performance.

我們網站上的投資者資料提供了有關這些行動對會員收入和我們的市場組合的影響的更多信息，我們將在明年初更詳細地確定預期利潤率的提升。除了這些行動之外，我們還看到一系列因素和執行機會將影響我們 25 年的表現。

These include repricing 40% of our membership for a January 2025 renewal. Across multiple markets and payers, we are seeing an improved percentage of premium economic terms as well as additional incentive dollars tied to our partners quality performance. Payer bid information, we have received updated payer bid information for 90 plus percent of our membership. Well, each bid varies by market and payer. The composite indicates these bids will be a blended tailwind for next year.

其中包括對 40% 的會員資格進行重新定價，以便於 2025 年 1 月續約。在多個市場和付款人中，我們看到優質經濟條款的比例有所提高，並且與我們合作夥伴的品質績效相關的額外獎勵資金也有所增加。付款人出價資訊，我們已收到 90% 以上會員的最新付款人出價資訊。嗯，每個出價都因市場和付款人而異。綜合數據表明，這些出價將成為明年的混合動力。

Improved burden of illness assessment, we see a clear execution opportunity for improvement among our internal teams, partners and payers to ensure that the verified burden of illness or risk adjustment is appropriately reflective of the acuity mix of our population. This work involves tight integration with our partners electronic medical records, the identification of new complex conditions, a thorough physician and care team review and a tight payer data exchange and feedback loop.

透過改進疾病負擔評估，我們看到了內部團隊、合作夥伴和付款人之間明確的改進執行機會，以確保經過驗證的疾病負擔或風險調整能夠適當反映我們人口的敏銳度。這項工作涉及與我們的合作夥伴電子病歷的緊密整合、新的複雜情況的識別、徹底的醫生和護理團隊審查以及嚴格的付款人資料交換和反饋循環。

Our expanded payer data pipeline will be instrumental in strengthening our collective performance. Improved PCP engagement, the key performance driver for the class of 2024 is seen in the tight grouping of your primary care doctors across our partnerships translating into improved medical cost, quality and assessed burden of illness performance.

我們擴大的付款人資料管道將有助於加強我們的集體績效。PCP 參與度的提高是 2024 屆畢業生的關鍵績效驅動因素，這體現在我們的合作夥伴關係中初級保健醫生的緊密分組中，這轉化為醫療成本、品質和評估的疾病負擔績效的改善。

The expansion of our quarterly active panel management reviews to 20 plus markets, reinforced by an expanded team of regional medical directors should be a tailwind heading into next year. Data visibility both in terms of leading indicators and detailed member level revenue and cost information is such an important lever in our execution of a multi payer market based strategy.

我們的季度主動小組管理審查擴展到 20 多個市場，並得到擴大的區域醫療總監團隊的加強，這應該會成為明年的一大推動力。領先指標和詳細的會員等級收入和成本資訊的資料可見性是我們執行基於多支付者市場的策略的重要槓桿。

In 2024, we have made meaningful progress on both fronts with 85 plus percent of total members in our financial data pipeline with a detailed member view and 80 plus percent of members with payer census data that provides us a two week lag view on in patient utilization.

到2024 年，我們在這兩方面都取得了有意義的進展，我們的財務數據管道中85% 以上的會員擁有詳細的會員視圖，80% 以上的會員擁有付款人普查數據，為我們提供了患者利用率兩週滯後的視圖。

In closing and before I turn it over to Jeff, I want to reiterate that the value of our business model remains strong with both physicians and payers. And we continue to be confident in the progress we are making to enable primary care doctors in this volatile macro environment.

最後，在我將其交給傑夫之前，我想重申，我們的商業模式對醫生和付款人來說仍然具有強大的價值。我們對在這個動蕩的宏觀環境中為初級保健醫生提供支援所取得的進展仍然充滿信心。

We have made important decisions that strengthen our business and we believe this will support near and long term performance and the path to profitability as the macro environment improves.

我們已經做出了加強業務的重要決策，我們相信，隨著宏觀環境的改善，這將支持近期和長期業績以及獲利之路。

With that, let me turn the call over to Jeff.

接下來，讓我把電話轉給傑夫。

Thanks, Steve. Good evening. I'll start by reviewing our overall financial performance, review highlights from our third quarter results and discuss our guidance for the full year 2024, while framing our thoughts on 2025. Now that I have been here for almost four months, I've had the opportunity to complete a comprehensive review of our organization, gaining valuable insights and observations into the business model and identifying areas in need of improvement.

謝謝，史蒂夫。晚安.我將首先回顧我們的整體財務業績，回顧第三季業績的亮點，並討論我們對 2024 年全年的指導，同時建立我們對 2025 年的想法。現在我已經在這裡工作了近四個月，我有機會完成對我們組織的全面審查，獲得對業務模式的寶貴見解和觀察，並確定需要改進的領域。

These findings, in addition to the most recent data we've received detailing our performance and risk adjustment, prior period development and higher continued utilization have changed our view for the third quarter of 2024 and the full year. As a result, we have recorded significant adjustments during the third quarter and accordingly have made revisions to our full year 2024 expectations.

這些發現，加上我們收到的詳細說明我們的業績和風險調整、前期發展和更高的持續利用率的最新數據，改變了我們對 2024 年第三季和全年的看法。因此，我們在第三季進行了重大調整，並相應地修改了 2024 年全年預期。

As Steve highlighted, the demand for the value we create for our payer and provider partners has never been higher. We have proven the business model drives higher quality health care and lower overall costs even in a challenging macro environment. However, it is not without challenges. We continue to improve our back end process and invest in data timeliness and quality that will drive better visibility on our performance.

正如史蒂夫所強調的那樣，對我們為付款人和提供者合作夥伴創造的價值的需求從未如此之高。我們已經證明，即使在充滿挑戰的宏觀環境中，這種商業模式也能推動更高品質的醫療保健並降低整體成本。然而，這並非沒有挑戰。我們繼續改進後端流程，並投資於數據及時性和質量，這將提高我們績效的可見度。

We believe these improvements in combination with contracting changes surrounding Part D will enhance our ability to reduce volatility around risk adjustment, Part D and medical costs. When excluding prior period development for 2023 and prior dates of service, we believe 2024 represents a solid foundation to grow the top and bottom line heading into 2025.

我們相信，這些改進與 D 部分的合約變更相結合，將增強我們減少風險調整、D 部分和醫療費用波動的能力。當排除 2023 年的前期開發和先前的服務日期時，我們認為 2024 年為 2025 年收入和利潤的成長奠定了堅實的基礎。

Now for the financial details from the quarter. Medicare advantage membership was approximately 525,000 members at the end of the third quarter, representing a year-over-year increase of 37%. Year-over-year growth was driven by membership class of 2024 with strong same geography growth.

現在了解本季的財務細節。截至第三季末，醫療保險優勢會員人數約為 525,000 名，年增 37%。同比增長是由 2024 年會員級別推動的，同一地區的增長強勁。

Total revenues increased 28% on a year-over-year basis to $1.45 billion during the third quarter. Year-to-date revenues increased 39% to $4.53 billion. This growth was primarily driven by the class of 2024 markets and solid organic growth in our existing classes.

第三季總營收年增 28%，達到 14.5 億美元。年初至今的營收成長了 39%，達到 45.3 億美元。這一成長主要是由 2024 年市場類別和我們現有類別的穩健有機成長所推動的。

Third quarter medical service expense increased to $1.51 billion compared to $1.02 billion last year. The 47% growth compared to last year was driven by the expansion of the 2024 class and higher utilization compared to the third quarter of last year.

第三季醫療服務費用增至 15.1 億美元，去年同期為 10.2 億美元。與去年相比增長 47% 的原因是 2024 級的擴大以及與去年第三季相比利用率的提高。

Our first quarter 2024 cost trend estimate is now 7.4% down from the 8.2% that we reported last quarter. Our second quarter 2024 trend assumption increased to 8.2% versus our previous assumption of 7.3%. Our third quarter 2024 cost trend assumption is now 9.1% versus our initial assumption of 6% recognizing that we don't have substantial paid claims data for Q3.

我們對 2024 年第一季成本趨勢的估計比上季報告的 8.2% 下降了 7.4%。我們對 2024 年第二季趨勢的假設增加至 8.2%，而先前的假設為 7.3%。我們的 2024 年第三季成本趨勢假設現在為 9.1%，而我們最初的假設為 6%，因為我們沒有大量第三季的已付索賠資料。

Given the utilization environment we have seen this year, we have assumed higher costs for the fourth quarter and increased our cost assumptions by an incremental $25 million relative to our prior expectations. We now expect the fourth quarter cost trends to be 5.2% off a high cost quarter last year. Medical margin for the third quarter was a loss of $58 million compared to positive medical margin of $111 million in 2023.

鑑於我們今年看到的利用環境，我們假設第四季度的成本較高，並且相對於先前的預期增加了 2500 萬美元的成本假設。我們現在預計第四季的成本趨勢將比去年高成本季下降 5.2%。第三季的醫療利潤率為虧損 5,800 萬美元，而 2023 年的醫療利潤率為 1.11 億美元。

As mentioned earlier, medical margin was below our guidance range as a result of several items. First, we lowered our year-to-date revenues by $65 million driven by lower than expected risk adjustment performance for 2024. This is based on mid year risk adjustment information we received from our payer partners during the third quarter.

如前所述，由於多項原因，醫療利潤率低於我們的指導範圍。首先，由於 2024 年風險調整績效低於預期，我們將年初至今的營收減少了 6,500 萬美元。這是基於我們在第三季從付款合作夥伴收到的年中風險調整資訊。

Second, we recognize $60 million of unfavorable prior period development related to 2023 and prior dates of service driven primarily by updated statement data regarding Part D costs and final risk adjustment information for 2023.

其次，我們認識到與 2023 年和先前服務日期相關的 6000 萬美元不利前期發展，主要是由有關 D 部分成本和 2023 年最終風險調整信息的更新報表數據驅動的。

And lastly, we recorded additional medical expense of $25 million during the quarter driven by the continuation of elevated current year medical costs. Platform support costs were $42 million and consistent with the third quarter of 2023, and the second quarter of 2024, and represent about 3% of revenues in line with our target for the year.

最後，由於本年度醫療費用持續上漲，我們在本季記錄了 2,500 萬美元的額外醫療費用。平台支援成本為 4,200 萬美元，與 2023 年第三季和 2024 年第二季一致，約佔營收的 3%，符合我們今年的目標。

Geography entry costs were down 60% at $7 million compared to $18 million in 2023. Geography entry costs favorability was driven by continued diligence on operating expenses, lower capital support funding needs and the delay of a market expansion from 2025 to 2026.

與 2023 年的 1,800 萬美元相比，地理報名成本下降了 60%，為 700 萬美元。對營運費用的持續調查、較低的資本支持融資需求以及 2025 年至 2026 年市場擴張的延遲推動了地域進入成本的優惠。

Third quarter adjusted EBITDA of negative $96 million compared to positive $6 million in '23 is attributable to trends previously discussed weighing on medical margin. ACO model entities continue to perform well and our quarter end membership was 132,000, which is slightly ahead of our expectations. ACO model adjusted EBITDA was $12 million versus $18 million in the third quarter of 2023.

第三季調整後 EBITDA 為負 9,600 萬美元，而 20 年為正 600 萬美元，這歸因於先前討論的對醫療利潤率造成壓力的趨勢。ACO 模型實體持續表現良好，季度末會員數量為 132,000 名，略高於我們的預期。ACO 模型調整後的 EBITDA 為 1,200 萬美元，而 2023 年第三季為 1,800 萬美元。

The year-over-year decline was driven by higher utilization experienced in the third quarter this year relative to the increased revenue.

年比下降的原因是今年第三季相對於收入增加的利用率較高。

Turning to our balance sheet and cash flow. Agilon ended the quarter with cash and marketable securities of $399 million and another $113 million of off balance sheet cash held by our ACO model entities. As a reminder, cash held by ACO model entities will fluctuate based on inflows and outflows related to operations of the program. This cash includes unsettled payments which are expected to occur in the fourth quarter of this year.

轉向我們的資產負債表和現金流。截至本季末，Agilon 的現金和有價證券為 3.99 億美元，我們的 ACO 模型實體持有另外 1.13 億美元的表外現金。提醒一下，ACO 模型實體持有的現金將根據與該計劃營運相關的流入和流出而波動。這些現金包括預計在今年第四季發生的未結算付款。

We use $9 million of cash during the third quarter consistent with our expectations, reflecting the seasonality of our annual wellness visits and distributions to physician partners and settlements with payers. Our expected use of cash for the year is now approximately $165 million versus our previous expectations of $125 million to $150 million. This is driven by the increase in prior period development we recognized this quarter which has an in year cash flow impact.

我們在第三季使用的現金為 900 萬美元，符合我們的預期，反映了我們年度健康就診和向醫生合作夥伴分配以及與付款人結算的季節性。我們今年預計的現金使用量目前約為 1.65 億美元，而先前的預期為 1.25 億至 1.5 億美元。這是由我們本季認識到的前期發展增加所推動的，這對年內現金流產生了影響。

As we have discussed previously, our cash flow from operations improved during the second half of the year as we settle with payers for performance from the prior year. Additionally, given the lower expectations for 2024 performance, we have updated our 2025 cash usage to approximately $110 million. We expect to end the year with approximately a $365 million of cash on the balance sheet inclusive of the off balance sheet cash associated with the ACO model entities. We continue to believe we have adequate capital on the balance sheet to achieve break even cash flow which we now expect to occur in 2027.

正如我們之前所討論的，我們的營運現金流在下半年有所改善，因為我們與付款人就上一年的業績進行了結算。此外，鑑於 2024 年業績的預期較低，我們已將 2025 年現金使用量更新為約 1.1 億美元。我們預計到年底，資產負債表上的現金約為 3.65 億美元，其中包括與 ACO 模型實體相關的表外現金。我們仍然相信，我們的資產負債表上有足夠的資本來實現現金流收支平衡，我們現在預計這將在 2027 年實現。

Turning now to our updated outlook for the full year of 2024. We have raised our MA membership guidance range to 527,000 members from 519,000 members at the midpoint, recognizing our growth through the third quarter. We have increased the midpoint of our total revenue guidance range by $32 million which reflects lower risk adjustment offset by incremental membership for the year.

現在轉向我們對 2024 年全年的最新展望。我們已將 MA 會員指導範圍從中間值的 519,000 名會員提高到 527,000 名會員，承認我們在第三季度的成長。我們將總收入指導範圍的中點提高了 3,200 萬美元，這反映出今年會員數增加所抵銷的風險調整較低。

Given the previously discussed third quarter 2024 medical margin headwinds and our updated fourth quarter 2024 assumptions, we are lowering our full year 2024 medical margin midpoint to $225 million compared to our previous guidance of the low end of $400 million to $450 million. Additionally, we are lowering our just but the guidance range to a negative $135 million to a negative $155 million.

鑑於先前討論的2024 年第三季醫療利潤率不利因素以及我們更新的2024 年第四季假設，我們將2024 年全年醫療利潤率中點下調至2.25 億美元，而先前的指引為4 億至4.5 億美元的下限。此外，我們還將指導範圍降低至負 1.35 億美元至負 1.55 億美元。

As we have demonstrated, we continue to make the appropriate adjustments necessary to improve profitability, which in the past has included exiting markets, renegotiating unfavorable contracts and optimizing operating cost.

正如我們所證明的那樣，我們繼續進行必要的適當調整以提高獲利能力，這在過去包括退出市場、重新談判不利的合約和優化營運成本。

As we begin to think about 2025, when you exclude roughly $100 million of unfavorable development from prior years, we believe the 2025 step off point for medical margin is around $325 million. This is before the impact of any of the measures we are taking to improve profitability including the anticipated exit of two unprofitable partnerships and underperforming contracts.

當我們開始考慮 2025 年時，如果排除前幾年約 1 億美元的不利發展，我們認為 2025 年醫療利潤率的起點約為 3.25 億美元。這是在我們為提高盈利能力而採取的任何措施產生影響之前，包括預期退出兩個不盈利的合作夥伴關係和表現不佳的合約。

Reduction in Part D exposure and other strategic actions, given the actions we are taking in 2024, we want to emphasize that 2025 will likely represent a turning point for the company.

鑑於我們在 2024 年採取的行動，減少 D 部分風險和其他策略行動，我們想強調，2025 年可能代表公司的轉折點。

With that, let me turn it back to Steve for some closing comments.

說到這裡，讓我把它轉回史蒂夫，請他發表一些結束語。

Thanks Jeff. In summary, we readily acknowledge that 2024 has not unfolded as we expected, and we are taking the necessary steps to address that. We believe that the decisive actions we have taken this quarter coupled with the continued execution of our targeted action plan will result in improved performance versus our 2024 jumping off. We look forward to updating you as these actions are finalized over the next few quarters.

謝謝傑夫。總而言之，我們承認 2024 年並沒有像我們預期的那樣發展，我們正在採取必要的措施來解決這個問題。我們相信，我們本季採取的果斷行動，加上我們目標行動計畫的持續執行，將導致我們的業績比 2024 年的起點有所提升。我們期待在接下來的幾季完成這些行動後向您通報最新情況。

With that, let's turn to Q&A.

接下來，我們進入問答環節。

(Operator Instructions)

（操作員說明）

Lisa Gill, JPMorgan

麗莎吉爾，摩根大通

Thanks very much and thanks for all the details. Steve, I just want to go back to some of your comments on talking about '25. You talked about repricing 40% of your book of business. You talked about an improvement and the renewal percentage as well as incentives. Can you give us an idea like what that looks like across the 40%? And how do I think about the the other 60%? Is it that there wasn't an issue with the other 60% or this is all that you were able to negotiate as we think about '25?

非常感謝並感謝所有細節。史蒂夫，我只想回到你關於談論“25”的一些評論。您談到了對 40% 的業務進行重新定價。您談到了改進、續訂百分比以及激勵措施。可以跟我們介紹一下 40% 的人是什麼樣子嗎？我如何看待另外 60% 的人？是否與其他 60% 沒有問題，或者這就是我們在考慮 25 年時能夠協商的全部內容？

Yeah, thanks. Thanks for the question, Lisa. So, I think we feel very good about the progress we've made with payers since our last call, a quarter ago. The re-pricing that you're specifically asking about was for the 40% of the membership in the book that was up for renewal. So that's the significance of the 40%.

是的，謝謝。謝謝你的提問，麗莎。因此，我認為自從一個季度前的上次電話會議以來，我們對付款人所取得的進展感到非常滿意。您特別詢問的重新定價是針對書中需要續約的 40% 的會員資格。這就是40%的意義。

I think what we're seeing is not only improved economic or percentage of premium terms, but increasingly because of the importance of quality, a upside incentive for better quality performance and I shared with you the strength that we saw in the recently released stars results.

我認為我們看到的不僅是經濟或保費條款百分比的改善，而且越來越多地因為質量的重要性，這是對更好質量績效的上行激勵，我與您分享了我們在最近發布的星級結果所看到的實力。

So our value proposition to payers is reflected within that. The other piece is Part D that expands across more than just that 40% of membership. And as I said, we've got multiple negotiations that have progressed pretty far. At this point we're saying at least 50% or more, we have some sort of mitigation on Part D risk, whether that's a carve out a corridor or some other arrangements.

因此，我們對付款人的價值主張就體現在其中。另一部分是 D 部分，其覆蓋範圍不僅限於 40% 的會員。正如我所說，我們已經進行了多次談判，並且取得了巨大進展。在這一點上，我們說至少 50% 或更多，我們對 D 部分的風險有某種緩解措施，無論是開闢一條走廊還是其他一些安排。

One other area, I'll just call out is, in this environment that we're in and given the value prop that we have to our payers. We are seeing the ability to have year one alternative economic arrangements for our year one partners as they come on with no downside, a care management fee that then is a glide path into a risk arrangement.

我要指出的另一個領域是，在我們所處的環境中，我們為付款人提供了價值支撐。我們看到有能力為我們的第一年合作夥伴提供第一年的替代經濟安排，因為他們的到來沒有任何負面影響，護理管理費是進入風險安排的一條滑道。

Once we've been able to get all of the data that we need with these local payers, which has become such a critical aspect of success in our model. So that's the flavor on the negotiation. The other piece is the payer bids that have been received, Lisa. We've got 90 plus percent of our membership in very detailed bids. And while we're not giving an overall dimension of that, we are saying that it's going to be a favorable tailwind for us and it varies pretty dramatically based on market and based on payer.

一旦我們能夠從這些本地付款人那裡獲得所需的所有數據，這已成為我們模型成功的關鍵方面。這就是談判的味道。另一件是已收到的付款人出價，麗莎。我們 90% 以上的會員都參與了非常詳細的投標。雖然我們沒有給出總體情況，但我們說這對我們來說將是有利的推動力，並且根據市場和付款人的不同，情況差異很大。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

Thanks. First question I wanted to ask is Jeff, first of all, welcome. Appreciate all the detail here. On the trend numbers you gave us the, if I have it correctly you heard, you said that the trend is 10% in the third quarter and you're assuming 5% in the fourth quarter. Is that right?

謝謝。我想問的第一個問題是傑夫，首先，歡迎。欣賞這裡的所有細節。關於你給我們的趨勢數字，如果我沒聽錯的話，你說第三季的趨勢是 10%，而你假設第四季是 5%。是這樣嗎？

No. What we said Justin was, we originally assumed 6% in the third quarter, which is now a little over 9%, 9.1%. So 2%, 3% went from 6% to [91] in Q4, 5.2%.

不。我們說賈斯汀是，我們最初假設第三季是6%，現在是9%多一點，9.1%。因此，第四季的 2%、3% 從 6% 上升到 [91] 5.2%。

(multiple speakers) Yeah, that was based off a high step off last year, right?

（多位發言者）是的，這是基於去年的高進步，對嗎？

Yeah. So that's what I was going to ask. Is there any way given that we don't have visibility to that step off? Can you maybe share (inaudible) number with us in the third quarter versus what you're assuming in the fourth quarter? (multiple speakers).

是的。這就是我要問的。鑑於我們看不到該步驟，有什麼辦法嗎？您能否與我們分享第三季的（聽不清楚）數字與您對第四季的假設？（多個發言者）。

Yeah, I will tell you that the fourth quarter is, and we use history for this, right. So we went back several years looking at how the fourth quarter plays out compared to all the other quarters, Q1, Q3, the fourth quarter will be the highest quarter of the year. So we've got the PM PM recorded up. I would say roughly 7% higher than Q1 and 3% higher than then Q3, I believe.

是的，我會告訴你第四季是，我們使用歷史來描述這一點，對吧。因此，我們回顧了幾年前的情況，看看第四季度的表現與其他所有季度（第一季、第三季）相比如何，第四季將是一年中表現最高的季度。所以我們已經記錄了 PM PM。我認為比第一季高出約 7%，比第三季高出 3%。

Yeah, roughly 3% higher than Q3. So generally, we've looked at historical seasonality and that's what we have in the forecast and obviously we added there $25 million to that number.

是的，比第三季高出約 3%。一般來說，我們研究了歷史季節性，這就是我們在預測中的情況，顯然我們在這個數字上增加了 2500 萬美元。

Okay. And, I'd love to get you an update on what CMS is assuming for fee for service trend. Can you give us that number from what is CMS using for the ACO trend for 2024 at the moment?

好的。而且，我很樂意向您提供有關 CMS 對服務費用的假設趨勢的最新資訊。您能否提供我們 CMS 目前用於 2024 年 ACO 趨勢的數字？

Yeah, I don't have that number off the top of my head, Justin. We can get back to you.

是的，賈斯汀，我腦子裡沒有這個數字。我們可以回覆您。

Adam Ron, Bank of America.

亞當‧羅恩，美國銀行。

Hey, thanks for the question. So sorry if I could have stitched this together from your comments, but there were a lot of numbers and want to make sure I got this. So what is the amount of cash you expect to end 2024 with?

嘿，謝謝你的提問。很抱歉，如果我可以根據您的評論將其拼湊在一起，但有很多數字，我想確保我得到了這個。那麼，您預計 2024 年底將擁有多少現金？

And then if adjusted EBITDA is this year going to be [100] negative negative $145 million. Does that mean next year's cash burn should be roughly equal to that. And then on the ACR reach cash, do you have to exit ACR reach to get that cash and wouldn't exit and also be a cash drag?

那麼，如果今年調整後的 EBITDA 將為負 [100] 負 1.45 億美元。這是否意味著明年的現金消耗應該大致相當於這個數字。然後在 ACRreach 現金方面，您是否必須退出 ACRreach 才能獲得現金，並且不會退出並且也成為現金拖累？

No, just, just a couple of things. So I'll just go through the numbers that we quoted. So number one, we said we're going to end the year at roughly $365 million that includes the ACO cash. Now you see you see the [110] in the script, but in reality, after we make those payments in the fourth quarter ACO cash is roughly about $35 million.

不，只是，只有幾件事。因此，我將僅瀏覽一下我們引用的數字。第一，我們說年底的收入約為 3.65 億美元，其中包括 ACO 現金。現在您可以看到腳本中的 [110]，但實際上，我們在第四季度支付這些款項後，ACO 現金約為 3500 萬美元。

So the $365 million we end the year includes about $35 million of ACO cash. The other thing that we indicated is it based on this year's performance. Next year, we think our cash usage is going to be $110 million. So that we originally had $25 million. Now the update, it's $110 million of cash burn. And to your last question, you do not have to get out of the program to get the cash. There are mechanisms that we have where effectively we're charging an administrative fee to the ACOs that monetize that cash.

因此，我們年底的 3.65 億美元包括約 3500 萬美元的 ACO 現金。我們指出的另一件事是基於今年的表現。明年，我們預計現金使用量將達到 1.1 億美元。所以我們最初有 2500 萬美元。現在更新一下，現金消耗達到 1.1 億美元。對於你的最後一個問題，你不必退出該計劃才能獲得現金。我們有一些機制，可以有效地向 ACO 收取管理費，從而將這些現金貨幣化。

I was just going to say we, I think we sit in a strong cash position and part of the actions we're taking today are intended to really accelerate our path to profitability and cash flow positive and obviously impact the cash needs on a go forward.

我只是想說，我認為我們擁有強大的現金狀況，我們今天採取的部分行動旨在真正加速我們的盈利和現金流積極之路，並明顯影響未來的現金需求。

Yeah, and around that if you could quantify a few things. So you mentioned that in 2025 on 90% of your members, you're seeing a net tailwind from the bids that you saw from payers. So I'm wondering if there's any number you could give us and maybe like an amount of supplemental benefits that you think would flow through that you would get?

是的，如果你能量化一些事情的話。所以您提到，到 2025 年，您將在 90% 的會員身上看到來自付款人的出價帶來的淨順風。所以我想知道您是否可以向我們提供任何數字，也許您認為您會獲得一定數量的補充福利？

And then the second piece is in the slides that you posted, there's a bar that shows the size that you have or it's like representing the contracts you expect to exit. It looks like it's around $20 million by like eyeballing it. Is that the right way to think about it? Thanks.

然後第二部分是在您發布的幻燈片中，有一個欄位顯示您擁有的規模，或者就像代表您期望退出的合約。目測大約有2000萬美元左右。這是正確的思考方式嗎？謝謝。

So, Adam, thanks for the questions. On the payer bids, I think what we're comfortable sharing is we've got them for 90 plus percent of our membership and that is a net tail win for next year at a composite basis. And we're not mentioning beyond that.

那麼，亞當，謝謝你的提問。關於付款人出價，我認為我們願意分享的是，我們 90% 以上的會員都獲得了付款人出價，從綜合來看，這是明年的淨尾贏。除此之外我們不會提及。

In terms of the two partnerships that were leaving and the impact on the membership and revenue we do dimension that from a margin perspective what I said in my prepared remarks is we'll share that with you early next year as we finalize '24 and we finalize all of that. So we are not giving you a number on that today, but calling out that it will obviously be a positive.

就即將離開的兩個合作夥伴關係以及對會員和收入的影響而言，我們確實從利潤角度考慮了這一點，我在準備好的發言中所說的是，我們將在明年初與您分享這一點，因為我們最終確定了“24”，我們完成這一切。因此，我們今天不會就此給出具體數字，但會指出這顯然是正面的。

Yeah, I think just real quick, I mean, obviously we wouldn't be taking those actions if it wasn't meaningful. So it's meaningful, but I wouldn't use that bar is some representation of the amount.

是的，我認為很快，我的意思是，如果沒有意義，顯然我們不會採取這些行動。所以它很有意義，但我不會使用該條來表示金額。

George Hill, Deutsche Bank.

喬治·希爾，德意志銀行。

Yeah. Good morning. Kind of a follow up as it relates to the $325 million. Jumping off point for medical margin, I guess we is. Steve is the right way to think about that is that that's the baseline for 2025 expectations. And then that would basically imply that the business is going to be kind of break even on the, I should say the expectation is the business might be break even and modestly negative on a reported basis in 2025?

是的。早安.這是與 3.25 億美元相關的後續行動。我想我們是從醫療利潤出發的。Steve 正確的思考方式是，這是 2025 年預期的基線。那麼這基本上意味著該業務將在某種程度上實現收支平衡，我應該說，預計該業務可能會在 2025 年實現收支平衡，並且在報告的基礎上略有負值？

And I guess I would ask a little bit more about, like, can you tell us you talked about like the, I'll call it the membership erosion and the medical management dollar erosion kind of, what are some of the other assumptions that kind of underline or underpin that $325 million step off? Like the way I'm looking at it is thinking about it is like that's the step off for '25 (inaudible)

我想我會問更多一點，例如，你能告訴我們你談到的，我稱之為會員資格侵蝕和醫療管理美元侵蝕，還有哪些其他假設？就像我看待它的方式正在思考它一樣，這就是 '25 的步驟（聽不清楚）

Yeah, real quick, Georgia. It's pretty simple. Effectively what we're saying is if you take our 2024 performance and you back out all the prior period development, that's really for 2023 dates of service. If you back out the $100 million that's kind of what I call a run rate, exiting '24, meaning that's what the business is performing on an incurred basis, exiting 2024.

是的，很快，喬治亞。這很簡單。實際上，我們所說的是，如果您採用我們 2024 年的業績並取消所有前期開發，那麼這實際上是針對 2023 年的服務日期。如果你收回 1 億美元，這就是我所說的運行率，退出 24 年，這意味著這就是企業在已發生基礎上的表現，退出 2024 年。

So, and this is before, I think the actions that obviously Steve mentioned. So the exits and other things that we're doing. So we're just trying to give you some context if you take the out of period things out, that's kind of the baseline. And your second question, restate that second question clear on the second part of your question, George.

所以，這是之前，我認為史蒂夫顯然提到的行動。所以我們正在做出口和其他事情。因此，如果您剔除過時的內容，我們只是想為您提供一些背景信息，這就是基線。喬治，你的第二個問題，請在你的問題的第二部分中清楚地重申第二個問題。

Well, I guess the second question is if we think of the $325, the $325 is kind of, I'll call it the normalized or the adjusted medical margin for 2024. I guess, as you think about that number, I know you guys haven't given the full preliminary 2025 guidance yet. I guess I would just ask from where you sit right now. What are the big moving pieces? The big puts and takes that you see as it relates to your visibility to '25?

嗯，我想第二個問題是，如果我們考慮 325 美元，325 美元是一種，我將其稱為 2024 年標準化或調整後的醫療利潤。我想，當你們想到這個數字時，我知道你們還沒有給出完整的 2025 年初步指引。我想我只想從你現在坐的地方問。有哪些大的動人之處？您看到的大看跌期權和大看跌期權與您對“25”的知名度相關嗎？

Yeah. So I I tried to call that out a little bit in my script, George. So I, I think you've got that revised step off run rate of $325. We've got the, the impact from the exit of these partnerships that Adam just talked about that we're going to give you an update on early next year as we finalize that. We've got a whole host of payer activities, I would call it the repricing percentage of premium, the quality incentives.

是的。所以我試著在我的劇本中稍微強調這一點，喬治。所以我認為，修改後的步數運行費率為 325 美元。我們已經了解了亞當剛剛談到的退出這些合作夥伴關係的影響，我們將在明年初敲定後向您提供最新情況。我們有一系列的付款人活動，我稱之為保費重新定價百分比，品質激勵。

The Part D obviously that will be an update for next year, both from a revenue and a cost perspective as we have a greater percentage of folks that have a mitigated impact from that. And then the payer bids that Adam also asked about.

從收入和成本的角度來看，D 部分顯然將是明年的更新，因為我們有更大比例的人因此受到的影響減輕。然後亞當也詢問了付款人的出價。

So those are significant. There's the BOI improvement year-over-year. And I think, we think our improvement will be roughly in line with what we saw in '24. Stars beyond the incentives that I talked about will have roughly the same amount of members in four star plus plans. And then obviously, there's a utilization assumption that, we'll talk about more as we get closer to, to 2025. But those would be, I think kind of the puts and takes. Jeff, would you add anything to that?

所以這些都很重要。BOI 逐年改善。我認為，我們認為我們的改進將與我們在 24 年看到的大致一致。除了我談到的獎勵之外的星級將在四星級+計劃中擁有大致相同數量的會員。顯然，有一個利用率假設，當我們接近 2025 年時，我們將討論更多。但我認為這些就是看跌期權。傑夫，你能補充點什麼嗎？

Yeah. No, I think that covers it.

是的。不，我認為這涵蓋了它。

Elizabeth Anderson, Evercore ISI.

伊麗莎白·安德森，Evercore ISI。

Hi guys. This is Samir on for Elizabeth Anderson. I just wanted to ask about the mid year risk adjustment impact. Is there anything different that caused that this year versus prior years? It seems like it's something relatively new, at least to this degree. So what maybe, if you could provide a little bit more color on what's driving that? Was that presumably it wasn't like the outage with change, but just trying to understand what it was.

嗨，大家好。這是薩米爾為伊莉莎白·安德森配音的節目。我只是想問一下年中風險調整的影響。今年與往年相比有什麼不同造成的嗎？至少在這個程度上，這似乎是一個相對較新的東西。那麼，如果您能提供更多關於推動這一趨勢的因素的話，又會怎麼樣呢？大概這與變更中斷不同，只是想了解它是什麼。

Yes, Samir, thanks for the question. I mean, I think our headline is we see this as a clear execution opportunity for improvement between our team and our partners and our payers. We've kind of diagnosed that GAAP and dimension it out in 2024 on a paid '24 basis, it's $100 million between the $65 million. We've shared this quarter and the [36] that we shared last quarter.

是的，薩米爾，謝謝你的提問。我的意思是，我認為我們的標題是我們認為這是一個明確的執行機會，可以改善我們的團隊、合作夥伴和付款人之間的關係。我們已經對 GAAP 進行了診斷，並在 2024 年以 24 小時付費為基礎確定了其規模，在 6500 萬美元之間為 1 億美元。我們分享了本季和上季分享的 [36]。

You are right. This has been a historical area of strength in which our revenue has restated favorably relative to what we've guided. In '24, we had raised our expectation relative to prior years. That was based on a tremendous amount of activity that we had at the end of '23. And what we found is our ultimate adoption and capture through our position partners and our payers was lower than that.

你是對的。這是一個歷史性的優勢領域，我們的收入相對於我們的指導結果是有利的。24 年，我們相對於前幾年提高了預期。這是基於我們在 23 年底進行的大量活動。我們發現，透過我們的職位合作夥伴和付款人，我們的最終採用率和獲取率都低於此。

And so we see that as clear work in front of us and the good news, this is an annual cycle. We have the same patient base that has those same conditions and there's the ability to assess and capture those for the coming year. And as I said, for '25, I think, we think our improvement will be in line with our '24 list. For '26, we see a larger opportunity based on the work that we're doing. But Jeff, what would you have?

因此，我們認為這是擺在我們面前的明確工作和好消息，這是一個年度週期。我們擁有具有相同條件的相同患者群，並且有能力評估和捕獲來年的這些條件。正如我所說，對於 25 年，我認為我們的改進將與我們的 24 清單保持一致。對於 26 年，我們根據我們正在做的工作看到了更大的機會。但是傑夫，你想要什麼？

Yeah, I mean, I think if you just go back to like Steve mentioned, we did a lot of work in '23. That work produced a lot of great BOI lift. We thought that was going to translate on a one to one basis. And ultimately, it didn't. We found some gaps. We're closing those gaps. We're late in the year, obviously. So the impact on '25 will be minimal. But as we look to '26, we'd really look for a step up at that point.

是的，我的意思是，我想如果你像史蒂夫提到的那樣，我們在 23 年做了很多工作。這項工作為 BOI 帶來了巨大的提升。我們認為這將在一對一的基礎上進行翻譯。最終，它沒有。我們發現了一些差距。我們正在縮小這些差距。顯然，我們今年已經太晚了。所以對 '25 的影響將是最小的。但當我們展望 26 年時，我們確實會尋求在那時取得進展。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓，TD·考恩。

Hi, thank you. On the partnership exits, understanding you're exiting two, but it looks like there's still three that would be unprofitable. I guess, what's the the thought of keeping those three? And if the trajectory of profitability doesn't sort of change in the next maybe 6 to 12 months, would you consider further action on those particular partnerships? Thanks.

你好，謝謝。關於合夥企業的退出，我們知道您將退出兩個，但看起來仍然有三個無法獲利。我想，保留這三個人的想法是什麼？如果獲利軌跡在未來 6 到 12 個月內不會發生變化，您會考慮對這些特定的合作夥伴關係採取進一步行動嗎？謝謝。

Yeah, Ryan, thanks for the question. I mean, I think we feel like we have a very strong network. To your point, we've got 26 partnerships, 655,000 senior patients across region MA. We've mutually decided to exit two of those in the attachment. We show you that five of those 26 are not yet profitable at that market level on an EBITDA basis.

是的，瑞安，謝謝你的提問。我的意思是，我認為我們擁有一個非常強大的網路。就您而言，我們在馬薩諸塞州地區擁有 26 個合作夥伴、655,000 名老年患者。我們共同決定退出附件中的其中兩個。我們向您展示，以 EBITDA 計算，這 26 家公司中有 5 家尚未在該市場水平實現盈利。

I think the difference between the two and the other three is the magnitude of loss that sits within those two. And the the time frame that it would take to return those two partnerships to profitability and that's based on a mutual dialogue in the payer dynamic within those markets that are part of that. Those three are much closer. We see several of those getting to profitability in 2025 and or very close to it.

我認為兩者和其他三個之間的區別在於這兩者之間的損失程度。以及使這兩個合作夥伴關係恢復盈利所需的時間框架，這是基於作為其中一部分的市場內付款人動態的相互對話。這三個人距離更近了。我們預計其中一些企業將在 2025 年或非常接近實現盈利。

So I think it's the magnitude, I think it's the time line. And I think it's a combination of things with payers and partners that affect each one of those differently, but that the logic behind the two out of the five.

所以我認為這是規模，我認為這是時間線。我認為這是付款人和合作夥伴的綜合因素，對每一者都有不同的影響，但五者中的兩者背後的邏輯是不同的。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Yeah. Hi, thanks. Just a couple of first trend. I guess first, what drove the revision to Q2 cost trend? And then second, I guess, could you be a little bit more specific about why you don't think we should be jumping off from Q4 from a trend perspective, I guess.

是的。你好，謝謝。只是幾個第一趨勢。我想首先，是什麼推動了第二季成本趨勢的修正？其次，我想，您能否更具體地說明一下，為什麼您認為我們不應該從趨勢角度出發，從第四季開始。

What specifically about Q4? Do you view as being transient or non-recurring or I guess said differently like what period of history do you think represents a better seasonality pattern to be modeling off of than last year? Thanks.

Q4具體是什麼？您是否認為這是暫時的或非經常性的，或者我想用不同的說法，例如您認為哪個歷史時期代表了比去年更好的季節性模式？謝謝。

Yeah, a quick, I mean, obviously we can, we get paid claims data every, every quarter, right, every month. So part of the, I'd say the recast on the trend data for Q2 is more paid claim data. And specifically, it looks like the month of May specifically was higher than we originally anticipated.

是的，很快，我的意思是，顯然我們可以，我們每個、每季、每個月都會獲得已賠付的理賠資料。因此，我想說第二季趨勢數據的重述是更多付費索賠數據。具體來說，五月的情況似乎比我們最初預期的要高。

But we're going from [7.3 to 8.2]. I would, I would also combine that, however, with Q1, which went from [8.2 to 7.4.] And so in general, what I'd say is those two pretty much offset as far as the fourth quarter. I mean, we wouldn't use the fourth quarter because the seasonality of the business, I mean, over the years, Q1 is a lot less than Q4. I mean, and we haven't given a trend number for 2025 yet. So, we're not necessarily saying that we're giving a trend number for '25. So I don't know if that answers your question.

但我們要從[7.3至8.2]。不過，我也會將其與第一季結合起來，第一季從[8.2 到7.4]。的。我的意思是，我們不會使用第四季度，因為業務的季節性，我的意思是，多年來，第一季比第四季度少很多。我的意思是，我們還沒有給出 2025 年的趨勢數字。因此，我們不一定是說我們給了 '25 的趨勢數字。所以我不知道這是否回答了你的問題。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Hi, good evening. Wanted to follow up on the negative risk adjustment. It's still not clear to me why this came in so much worse than you expected. So, is this a data issue or a forecasting issue? And it sounds like some of the operational changes and investments will take some time to plan. We'd love to get an update there. And I guess how do we get comfort that you're properly accruing risk adjustment now, so that this issue doesn't recur next year. Thanks.

嗨，晚上好。希望跟進負面風險調整。我仍然不清楚為什麼情況比你預期的要糟糕得多。那麼，這是資料問題還是預測問題？聽起來一些營運變化和投資需要一些時間來規劃。我們很樂意在那裡獲得更新。我想我們如何才能放心，您現在正在適當地進行風險調整，以便明年這個問題不會再次出現。謝謝。

Yeah. So a couple of things. Number one, I think if you have to go back and we did all this work and investment in the BOI program in 2023. The results of that investment were very strong and so that effectively led us to a risk adjustment forecast that now looking back it we had expectations at higher than what's actually coming in.

是的。有幾件事。第一，我想如果你必須回去的話，我們在 2023 年就完成了 BOI 計畫的所有工作和投資。這項投資的結果非常強勁，因此有效地引導我們做出了風險調整預測，現在回想起來，我們的預期高於實際情況。

And the reality is what Steve had mentioned is that there's gaps in the processes that we have identified and we're going to be able to close. And so I think that's effectively, the work that we did didn't translate on a one to one basis to the ultimate ultimate RF score. So that's the first thing.

事實上，史蒂夫提到的是，我們已經確定的流程中存在差距，我們將能夠彌補這些差距。所以我認為這很有效，我們所做的工作並沒有一對一地轉換為最終的 RF 分數。這是第一件事。

The second thing is, this is, I would say this hasn't been a historical problem, right? It's typically restated favorably. I would call this an isolated incident where we invested heavily the year before.

第二個就是,這個就是,我想說這不是歷史問題,對吧?它通常會得到有利的重申。我認為這是一個孤立的事件，我們在前一年投入了大量資金。

And then lastly on the confidence, I mean, that would be one of the reasons why I say we're confident in the 2024 number. The second reason is that we got the mid year data through the payers from the government. We've tied to that data. We have looked at the history of what we've achieved on a mid year to final wrap lift.

最後關於信心，我的意思是，這就是我說我們對 2024 年數字充滿信心的原因之一。第二個原因是我們透過政府付款人獲得了年中數據。我們已經與這些數據連結起來。我們回顧了從年中到最終總結提升所取得的成就的歷史。

So we have that baked into the calculation. And then the other thing we did is we reached out to all of our large payers and asked what their view was on what they have in their forecast for lift between the mid year and the final. And so again, our jobs to come up with the best estimate, we feel pretty comfortable we got covered.

所以我們將其納入計算中。然後我們做的另一件事是我們聯繫了所有的大付款人，詢問他們對年中和決賽之間的成長預測有何看法。再說一次，我們的工作是提出最好的估計，我們對我們所得到的保障感到非常滿意。

Jack Slevin, Jefferies.

傑克·斯萊文，杰弗里斯。

Hey, thanks for taking the question. Fairly simple one, just looking back, I get that you don't want to put all the moving pieces together 2025 is you're still sort of figuring it out. But if you try to isolate Part D and maybe if you look back to 2023, do you have, maybe a sense of magnitude or, I mean, best case or an actual number, but if not sort of a general sense of magnitude on how much Part D is weighing down on med margin and on EBITDA. Thanks.

嘿，謝謝你提出問題。相當簡單，回顧過去，我知道你不想在 2025 年將所有移動的部分放在一起，因為你仍在弄清楚這一點。但是，如果你嘗試孤立 D 部分，也許你回顧 2023 年，你是否有一種規模感，或者我的意思是，最好的情況或實際數字，但如果不是關於如何實現的一般性規模感D 部分的大部分影響了中期利潤率和EBITDA。謝謝。

Yeah, Jack. So it is a negative impact. We're not dimensioning that today. I think there's two issues we see with the, one is the underlying performance. But the other issue is just the lag. The amount of time it takes to close out Part D from the prior year in the visibility that we have around that, which is leading us to this goal with all of our payer partners to really mitigate our exposure to that, whether that's through this carve out or a corridor or other mechanisms and that's important.

是的，傑克。所以這是一個負面影響。我們今天不考慮這個問題。我認為我們看到了兩個問題，一個是潛在的性能。但另一個問題就是滯後。從我們的可見度來看，完成上一年 D 部分所需的時間，這促使我們與所有付款合作夥伴一起實現這一目標，以真正減輕我們面臨的風險，無論是通過這一努力外面或走廊或其他機制，這很重要。

I mean, as I said, in my remarks, how we deal with Part D risk is very important to our payer partners. Many of them say, hey, the primary care physician does have some role within it, but they agree with us that our ability to control all of it. And more importantly, the ability to see the information we need to accurately forecast that is challenging.

我的意思是，正如我在演講中所說，我們如何處理 D 部分風險對於我們的付款合作夥伴非常重要。他們中的許多人說，嘿，初級保健醫生確實在其中發揮了一些作用，但他們同意我們的觀點，我們有能力控制這一切。更重要的是，如何查看我們需要的資訊來準確預測這一點具有挑戰性。

And so that's the construct under which, particularly as we step into Ira and the dollars increase to mitigate more of our membership against that. And then for the balance, just like with everything else, we're going to forecast it very cautiously.

這就是在這種情況下，特別是當我們進入愛爾蘭共和軍並且美元增加以減輕我們更多會員國的反對時。然後為了平衡，就像其他所有事情一樣，我們將非常謹慎地預測它。

Michael Hall, Baird.

麥可霍爾，貝爾德。

Hi, thank you. So I understand you have initiatives in play to improve your data visibility. But in terms of just fully closing the clean lag, proving pair data exchange GAAP. I was wondering if you could talk more about whether there is a potential pathway to full claims delegation. It seems to me that could or would be that potential ultimate fix or sort of a panacea to your claims cost, trend and risk adjustment data lag issues. So, excuse me. So I want to ask, is the technology offering you guys have set up to handle that or are there other hurdles or any other factors that would keep you from taking on full claims delegation? Thank you.

你好，謝謝。因此，我了解您正在採取措施來提高資料可見性。但就完全消除乾淨延遲而言，證明了配對資料交換的公認會計原則。我想知道您是否可以更多地談談是否存在全面索賠授權的潛在途徑。在我看來，這可能或將會成為解決索賠成本、趨勢和風險調整數據滯後問題的潛在最終解決方案或靈丹妙藥。所以，請原諒。所以我想問，你們提供的技術是否可以解決這個問題，或者是否有其他障礙或任何其他因素阻止您承擔完整的索賠委託？謝謝。

Yeah, Michael. thanks for the question. I mean, I spent a lot of years delegating in California to a number of entities that paid claims downstream. That is not a model that works in most of the country nor do most of the payers that we work with have the ability to do that.

是的，邁克爾。謝謝你的提問。我的意思是，我花了很多年的時間在加州委託一些支付下游索賠的實體。這種模式並不適用於美國大部分地區，我們合作的大多數付款人也沒有能力做到這一點。

And so the alternative is the financial data pipeline that we've been updating you on, the ability to get detailed member and claims information that is on a, It's on a lag of the payers. It's on a lag to us. The big leap we've made is this leading indicator data, the census data that Jeff referenced that we rely on to book our trends within in the quarter that gives us on a two day to a two week lag, a very good idea about what's happening in patient setting across our network.

因此，另一種選擇是我們一直在向您更新的財務數據管道，能夠獲取詳細的會員和索賠信息，這是關於付款人的滯後。這對我們來說是滯後的。我們取得的巨大飛躍是領先指標數據，傑夫提到的人口普查數據，我們依靠它來記錄本季度的趨勢，這給了我們兩天到兩週的滯後，這是一個很好的想法發生在在我們網路中的患者環境中。

And so that the big leap that we've made around that. We continue to add other data in in terms of HIE data, lab data, pharmacy, data, et cetera, that gives us a better view around that. But to be successful in these markets, we need to be able to get access to that. And as I called out, if we can't get certain information from payers, we won't be working with them.

我們圍繞著這個問題取得了巨大的飛躍。我們繼續添加 HIE 數據、實驗室數據、藥學數據等方面的其他數據，這使我們能夠更好地了解這一點。但為了在這些市場取得成功，我們需要能夠進入這些市場。正如我所說，如果我們無法從付款人那裡獲得某些信息，我們就不會與他們合作。

And so that's affected some of the decisions that we've made, whether it's contracts with payers for delaying, bringing on a new partner for the class of 2025 that was less of an issue with our partner. They were kind of ready to go. It was with those payers, we couldn't get that information and we just did not feel comfortable standing it up.

因此，這影響了我們做出的一些決定，無論是與付款人簽訂延遲合同，還是為 2025 屆畢業生引入新的合作夥伴，這對我們的合作夥伴來說不是一個問題。他們已經做好了出發的準備。對於那些付款人來說，我們無法獲得這些資訊，而且我們只是覺得堅持下去感到不舒服。

Sean Dodge, RBC.

肖恩·道奇，加拿大皇家銀行。

Hey, good afternoon. This is Thomas Keller on for Sean. Thanks for taking the question. Sorry if I missed this earlier, but you all mentioned alternative risk terms for year one markets. Can you go over those in a little more detail? Is there something new that's starting in 2025? I just want to make sure I understand the distinction. Thanks.

嘿，下午好。我是 Thomas Keller 替肖恩 (Sean) 發言。感謝您提出問題。抱歉，如果我之前錯過了這一點，但你們都提到了第一年市場的替代風險術語。能更詳細地介紹一下這些內容嗎？2025 年有新的事情發生嗎？我只是想確保我理解其中的差異。謝謝。

Yeah, Thomas, thanks for the question. There is something new in 2025. I think that the headline is we provide a lot of value to our payer partners. They really want us to be with them over the long haul in this move to value. All of them have aggressive goals about expanding more of their senior members into value.

是的，托馬斯，謝謝你的提問。2025 年有一些新的事情。我認為標題是我們為付款合作夥伴提供了許多價值。他們真的希望我們能夠長期與他們一起邁向價值。他們所有人都有雄心勃勃的目標，就是讓更多高階會員發揮價值。

And so in '25, probably for the majority of that class, we will end up with contracts for the first year that are no downside in a care management fee that gets us set up around our burden of illness work, the quality work, the clinical programs, get the right data so you can underwrite as you move into year two and beyond.

因此，在25 年，可能對於該班的大多數人來說，我們最終將簽訂第一年的合同，這些合同對於護理管理費來說沒有任何負面影響，這使我們能夠圍繞疾病工作的負擔、高品質的工作、臨床計劃，獲取正確的數據，以便您可以在進入第二年及以後的時候承保。

And so that is new. It's a glide path into full risk, but it's all part of this stand up in the year and it just allows us a little bit more flex and protection based on what have been some historical data exchange issues that end up being very challenging when you're taking full risk.

這是新的。這是一條滑向全面風險的道路，但這都是今年站立的一部分，它只是讓我們根據一些歷史數據交換問題獲得更多的靈活性和保護，這些問題最終會變得非常具有挑戰性。承擔全部風險。

Got it. Helpful. Thanks for the distinction.

知道了。有幫助。感謝您的區分。

Sure.

當然。

(Operator instructions)

（操作員說明）

Daniel Grosslight, Citi.

丹尼爾‧格羅斯萊特，花旗銀行。

Hi guys. Thanks for taking the question. Actually, I had a similar question to the last one on the glide path. Really two questions. One more mechanical and the second one, a little more big picture. On the mechanical side, I assume with this glide path you don't recognize revenue on a gross basis. You recognize that care management fee or maybe a net saving fee as revenue.

嗨，大家好。感謝您提出問題。事實上，我對滑行路徑上的最後一個問題有類似的問題。確實是兩個問題。一張是機械圖，第二張是大圖。在機械方面，我認為透過這種下滑路徑，您不會在總基礎上確認收入。您將護理管理費或淨儲蓄費視為收入。

And then the bigger picture question is just on the model and if perhaps these challenges may necessitate moving away from 100% fully capitated type of model and entering into more downside protection for you or maybe just upside downside with corridors. Any change in kind of the overall model away from 100% capitated that you're contemplating in '25 and beyond?

然後，更大的問題就在於模型，這些挑戰是否可能需要放棄 100% 完全資本化的模型，並為您提供更多的下行保護，或者可能只是走廊的下行保護。您考慮在 25 年及以後對 100% 資本化的整體模型進行任何更改嗎？

So I'll let Jeff answer the accounting question in a second. But Daniel, as we think about this, this is a glide path in the initial year with the idea of moving to full risk over time. I think it's reflective of the challenging environment in which we're in. And so there's always the possibility to extend that, if we need to across a period of time.

我稍後讓傑夫回答會計問題。但丹尼爾，正如我們所思考的那樣，這是第一年的滑行路徑，隨著時間的推移轉向完全風險。我認為這反映了我們所處的充滿挑戰的環境。因此，如果我們需要跨越一段時間，總是有可能延長這個期限。

But I think we feel like full risk value based care delivers the best quality and cost outcomes. It's the place of real value to have with our payers. We need to get economics that align with that in terms of percentage of premium. We need to get incentives for the value that we bring them like the quality program that I talked about.

但我認為我們認為基於風險價值的全面照護可以提供最佳的品質和成本結果。這是對我們的付款人來說真正有價值的地方。我們需要在保費百分比方面獲得與此相符的經濟學。我們需要對我們為他們帶來的價值進行激勵，就像我談到的品質計劃一樣。

And so that sort of the way that we're approaching it and we need to get data because, that's one of our biggest hit. When we get data and we're able to align with our physician partners, we've demonstrated an ability to perform extremely well on a Part C medical trend relative to whatever that local benchmark is.

這就是我們處理它的方式，我們需要獲取數據，因為這是我們最大的成功之一。當我們獲得數據並且能夠與我們的醫生合作夥伴保持一致時，我們就展示了相對於當地基準而言，在 C 部分醫療趨勢上表現出色的能力。

So that's the path and how we think about it. But in this environment, this seems like a smart glide path as you bring on. I did share with you that 80 plus percent of our partnerships are already positive adjusted EBITDA at the market level, even in this challenging environment, and we see the opportunity obviously for that to improve.

這就是我們的路徑以及我們的想法。但在這種環境下，這似乎是一條明智的下滑路徑。我確實與大家分享過，即使在這個充滿挑戰的環境中，我們 80% 以上的合作夥伴已經在市場層面實現了正調整 EBITDA，而且我們顯然看到了改善這一點的機會。

Yeah, real quick, Daniel, on the accounting issue. You're right. Yeah, it depends on the contract terms, but it could be no gross reporting.

是的，很快，丹尼爾，關於會計問題。你說得對。是的，這取決於合約條款，但可能不是粗略的報告。

Thank you at this time. There are no further questions registered in the queue. So I will turn the call back over to the management team for any additional remarks.

這次謝謝你了。隊列中沒有登記任何其他問題。因此，我會將電話轉回管理團隊，以徵求任何補充意見。

Great. Thanks to all of you for joining the call. Obviously '24 is not unfolded the way we expected. But I think we feel very good about the actions that we've communicated today and the strength of our core business as we've communicated. So thank you and we'll talk to you soon.

偉大的。感謝大家加入通話。顯然'24並沒有按照我們預期的方式展開。但我認為我們對今天所傳達的行動以及我們所傳達的核心業務的實力感到非常滿意。謝謝您，我們很快就會與您聯絡。

That concludes today's call. Thank you all for your participation and 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了。