agilon health inc (AGL) 2025 Q1 法說會逐字稿

Hello, everybody, and welcome to the agilon health first-quarter 2025 earnings conference call. My name is Elliot, and I'll be your coordinator today. (Operator Instructions)

大家好，歡迎參加 Agilon Health 2025 年第一季財報電話會議。我叫艾略特，今天我將擔任您的協調員。（操作員指示）

I'd now like to hand over to Evan Smith, Senior Vice President, Investor Relations. Please go ahead.

現在我想把麥克風交給投資人關係資深副總裁艾文‧史密斯 (Evan Smith)。請繼續。

Thank you, operator. Good afternoon, and welcome to the call. With me is our CEO, Steve Sell and our CFO, Jeffrey Schwaneke. 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.

謝謝您，接線生。下午好，歡迎來電。和我一起的是我們的執行長史蒂夫·塞爾 (Steve Sell) 和首席財務官傑弗裡·施瓦內克 (Jeffrey Schwaneke)。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，我們的評論和對問題的回答可能包括前瞻性陳述。

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. 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.

由於與我們的業務相關的風險和不確定性，實際結果可能與前瞻性陳述所明示或暗示的結果有重大差異。這些風險和不確定性在我們提交給美國證券交易委員會的文件中進行了討論。請注意，我們不承擔更新任何前瞻性陳述的義務。此外，我們將在本次電話會議中討論的某些財務指標是非 GAAP 財務指標。我們相信，提供這些指標有助於投資者更好、更全面地了解我們的財務業績，並且與管理層對我們財務業績的看法一致。

A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures is available in the earnings press release and Form 8-K filed with the SEC. And with that, let me turn the call over to Steve. Steve?

這些非 GAAP 財務指標與最具可比性的 GAAP 指標的對帳表可在收益新聞稿和向美國證券交易委員會 (SEC) 提交的 8-K 表格中找到。說完這些，讓我把電話轉給史蒂夫。史蒂夫？

Thanks, Evan. Good afternoon, and thank you for joining us. We are pleased with our first quarter results, demonstrating both the resilience and growth potential of our business model. For the quarter, we reported membership, revenue, medical margin, and adjusted EBITDA in line with our Q1 guidance range, and we remain on track to deliver in line with our full-year 2025 guidance. These collective results reflect the benefit of our previously disclosed partnership and payer exits, continued execution on quality and clinical initiatives, and better payer contracting terms to reduce Medicare Part D exposure and improve percentage of premium rates.

謝謝，埃文。下午好，感謝您加入我們。我們對第一季的業績感到滿意，這證明了我們商業模式的彈性和成長潛力。本季度，我們報告的會員人數、收入、醫療利潤率和調整後的 EBITDA 符合我們的第一季指導範圍，並且我們仍有望實現 2025 年全年指導目標。這些整體結果反映了我們先前披露的合作夥伴關係和付款人退出、繼續執行品質和臨床計劃以及更好的付款人合約條款的好處，以減少 Medicare Part D 風險並提高保費率百分比。

As expected, these results were tempered by a continued elevated cost trend in the quarter. In terms of membership, I want to underscore that our Q1 membership of 491,000 is relatively flat year-over-year, and these are essentially the same members we had on the platform in '24, net of partnership and payer plan exits and irrespective of plan changes. To remind you, given underlying market dynamics, we have taken a prudent and more cautious stance to 2025 member growth with essentially no underwriting risk on a reduced class of '25 and measured same geography growth of approximately 3%.

正如預期的那樣，本季成本持續上升的趨勢抑制了這些業績。就會員數量而言，我想強調的是，我們第一季的會員數量為49.1萬，與去年同期基本持平，扣除合作夥伴和付款人計劃退出，且不考慮計劃變更，這些會員數量與2024年平台的會員數量基本持平。需要提醒的是，考慮到潛在的市場動態，我們對2025年的會員成長採取了審慎且更為謹慎的立場，在2025年會員數量減少的情況下，我們基本沒有承保風險，並計算出同一地區會員數量的增長率約為3%。

As with prior years, we do expect some retroactive membership assignments in Q2 as we finalize contracting and attribution with payers. With these actions, essentially all of our Q1 membership, where we take financial risk, sits in year two-plus markets with a consistent and long-standing PCP patient relationship rooted in prevention, early detection, and active intervention.

與往年一樣，隨著我們最終敲定與付款方的合約和歸屬，我們預計第二季將有一些追溯性的會員分配。透過這些措施，我們第一季的會員（我們承擔財務風險）基本上都位於兩年以上的市場，並與長期穩定的PCP患者建立了根植於預防、早期發現和積極幹預的關係。

While delivering results in line with expectations, we continue to make significant progress this quarter in strengthening our network and enhancing our platform through advancements in technology, clinical pathways and operating efficiency. Our partnerships with leading physician groups continue to drive value for all stakeholders while enhancing our competitive position in a Medicare Advantage and Medicare fee-for-service market that continues to migrate towards full-risk value-driven models.

在實現符合預期的業績的同時，本季我們持續透過技術、臨床路徑和營運效率的進步，在加強網路和增強平台方面取得重大進展。我們與領先的醫生團體的合作繼續為所有利益相關者創造價值，同時增強我們在醫療保險優勢和醫療保險按服務收費市場中的競爭地位，該市場繼續向全風險價值驅動模式轉變。

As the year progresses, we expect to continue our disciplined approach to performance through reduced exposure to costs outside of our control, measured growth aligned with current market dynamics, strengthened clinical and operational capabilities to enhance quality and reduce variability, and maintained operating cost discipline. We expect these initiatives will build a stronger foundation to drive additional operating leverage and long-term performance. Looking to 2026, we are pleased to see an increase of 280 basis points in the final rate notice from CMS, which begins to meaningfully address the high cost and utilization trends experienced in recent years.

隨著時間的推移，我們期望繼續採取嚴謹的績效方法，透過減少我們無法控制的成本風險、根據當前市場動態衡量成長、加強臨床和營運能力以提高品質和減少變化、以及維持營運成本紀律。我們預計這些措施將為推動額外的營運槓桿和長期業績奠定更堅實的基礎。展望 2026 年，我們很高興看到 CMS 的最終利率通知增加了 280 個基點，這開始有效解決近年來的高成本和高利用率趨勢。

We have been encouraged by supportive comments from administration officials on the topics of value-based care and addressing the burden of chronic disease. As you will recall, early identification, diagnosis, and evidence-based treatment of chronic disease is a strong focus of our model. As we look toward the remainder of 2025, we expect to see clear signals from Congress and the administration on broader elements of Medicare policy, including Medicare Advantage.

政府官員對基於價值的照護和解決慢性病負擔等主題的支持性評論令我們感到鼓舞。您可能還記得，慢性病的早期識別、診斷和實證治療是我們模型的重點。展望 2025 年剩餘時間，我們預計國會和政府將就醫療保險政策的更廣泛內容（包括醫療保險優勢計劃）發出明確信號。

For ACO REACH, we are encouraged that CMMI maintained the model despite efforts to narrow its portfolio. Their commentary that all remaining models are expected to produce savings and/or quality improvement aligns with our experience in the REACH program, and we continue advocating for a full risk pathway beyond 2026. We expect to learn more on this topic as we progress through the year.

對於 ACO REACH，我們感到欣慰的是，CMMI 儘管努力縮減其模型組合，但仍保留了該模型。 CMMI 表示，所有剩餘的模式都有望實現成本節約和/或品質提升，這與我們在 REACH 專案方面的經驗一致，並且我們將繼續倡導在 2026 年之後建立完整的風險路徑。我們期待在今年進一步了解這個主題。

Now let me provide you with our current viewpoint on underlying market trends and an update on the initiatives we are actively pursuing to reduce variability and drive improved performance. Jeff will then provide additional color on our first quarter financial results and our outlook for the second quarter. From a utilization perspective, overall market trends in 2025 remain consistent with the prior year and in line with our initial outlook of a 5.3% full-year trend. Inpatient medical admissions were up in part driven by the flu, primary care utilization, and annual wellness visit volume was flat, and overall medical cost trend was within our expected range.

現在，讓我向您介紹我們對潛在市場趨勢的當前觀點，以及我們為減少波動性和提高績效而積極採取的舉措的最新情況。傑夫將對我們的第一季財務業績和第二季的展望提供更多說明。從利用率的角度來看，2025 年的整體市場趨勢與前一年保持一致，並符合我們最初預測的全年趨勢 5.3%。住院人數上升部分是由於流感、初級保健利用率和年度健康訪問量持平，整體醫療費用趨勢在我們的預期範圍內。

In terms of growth trends, the Medicare Advantage market continues to expand, with CMS data showing trends of 3.9% year-over-year and 1.9% year-to-date. In addition, demand from payers and PCPs for full-risk value-based care partners that can deliver on quality and cost metrics is also expanding. Against this backdrop, we see growth as a controllable lever given our consistent ability to demonstrate utilization performance 20% to 30% better than the local fee-for-service benchmark and quality scores approaching or greater than 4.25 stars.

從成長趨勢來看，醫療保險優勢市場持續擴大，CMS 數據顯示，該市場年增 3.9%，年初至今成長 1.9%。此外，付款人和 PCP 對能夠滿足品質和成本指標的全風險價值型護理合作夥伴的需求也不斷擴大。在此背景下，鑑於我們始終能夠證明利用率績效比當地按服務收費基準高出 20% 至 30%，且品質評分接近或超過 4.25 顆星，我們認為成長是一個可控的槓桿。

As such, our focus remains on profitable growth in current markets and new geographies. As I have stated in the past, our ability to weather this down cycle in MA and differentiate on medical cost and quality outcomes should position us well with health plans and physicians as the macro rate and cost spread ultimately corrects.

因此，我們的重點仍放在現有市場和新地區的獲利成長上。正如我過去所說的那樣，隨著宏觀利率和成本差距最終得到糾正，我們有能力度過 MA 的下行週期，並在醫療成本和品質結果上有所區分，這將使我們在健康計劃和醫生方面處於有利地位。

As a starting point, the recent favorable trends in payer bids and the 2026 final notice from CMS make us optimistic we will see a more favorable overall environment in '26 and beyond. As I outlined in our last call, we believe we have made significant progress in reducing operating variability and exposure in areas like Part D. In addition, we have negotiated improved economic terms with payers while improving our efficiency through market exits, cost discipline and advancements in technology, but there is more work to be done, and we are actively pursuing additional opportunities to strengthen performance through contracting, cost optimization and cash management.

作為起點，近期付款人出價的有利趨勢和 CMS 的 2026 年最終通知使我們樂觀地認為，我們將在 26 年及以後看到更有利的整體環境。正如我在上次電話會議中概述的那樣，我們相信我們在降低 D 部分等領域的營運波動性和風險敞口方面取得了重大進展。此外，我們已經與付款人協商了更好的經濟條款，同時透過市場退出、成本控制和技術進步提高了我們的效率，但還有更多工作要做，我們正在積極尋求更多機會，透過簽訂合約、成本優化和現金管理來加強績效。

With approximately 50% of our membership up for renewal on January 1, 2026, payer negotiations this year present a further opportunity to improve economic terms and predictability of performance. We have several focus areas, including: one, a further reduction in Part D exposure; two, an expansion of quality incentives; three, improved economic terms for Part C; and four, a continued narrowing of risk from supplemental benefits through better information and more rational payer bidding.

由於我們約有 50% 的會員將於 2026 年 1 月 1 日續約，今年的付款人談判為改善經濟條款和績效可預測性提供了進一步的機會。我們有幾個重點領域，包括：一、進一步降低 D 部分的風險；二、擴大品質激勵措施；三、改善 C 部分的經濟條件；四、透過更好的資訊和更合理的付款人競標繼續縮小補充福利的風險。

We expect the first three areas will have the greatest impact on our business moving forward. With respect to the fourth area, it is important to frame that our historical supplemental benefit headwind over the past two years was materially less than Part D and is anticipated to have an even lower impact in 2025 as recent payer benefit design changes reduced exposure across approximately 97% of our membership.

我們預計前三個領域將對我們未來的業務產生最大影響。關於第四個領域，重要的是要明確，過去兩年我們的歷史補充福利逆風明顯低於 D 部分，並且預計到 2025 年的影響會更低，因為最近的付款人福利設計變化減少了約 97% 的會員的風險。

In addition, given our financial data pipeline is running across a majority of our payer partners as of Q1, we now have greater visibility into detailed revenue and claims information, including Part D. As renewal discussions are ongoing with payers, we will provide more detail on our progress as we move through the year. We see our investment in technology driving a key competitive advantage going forward via improved automation and efficiency, and ultimately better quality and clinical outcomes.

此外，鑑於我們的財務數據管道自第一季度起已覆蓋大多數付款合作夥伴，我們現在可以更清楚地了解詳細的收入和索賠信息，包括 D 部分。隨著與付款人的續約討論仍在進行中，我們將在今年提供有關進展的更多詳細資訊。我們認為，透過提高自動化程度和效率，以及最終提高品質和臨床效果，我們對技術的投資將推動未來的關鍵競爭優勢。

Our enhanced data and AI capabilities will enable us to improve our execution and day-to-day operating visibility. As an example, in 2023, we acquired mphrX, enhancing our ability to gather and process data and drive insights across health care delivery networks. Since then, we've improved integration with health information exchanges, labs, EMRs and payers to speed up onboarding of agilon partners and integrate clinical data quickly, benefiting patients and physicians.

我們增強的數據和人工智慧能力將使我們能夠提高執行力和日常營運的可視性。例如，2023 年，我們收購了 mphrX，增強了我們收集和處理數據以及在整個醫療保健交付網路中獲取洞察的能力。從那時起，我們改進了與健康資訊交換、實驗室、EMR 和付款人的整合，以加快 Agilon 合作夥伴的加入并快速整合臨床數據，使患者和醫生受益。

Using AI and advanced technology, we ensure accurate identification and documentation of patients' health conditions, aiming for high-quality, cost-effective senior care. We believe our documentation practices strengthen clinical accuracy and support our value-based care model, ensuring timely care for patients.

我們利用人工智慧和先進技術，確保準確識別和記錄患者的健康狀況，旨在提供高品質、經濟高效的老年護理。我們相信，我們的文件實踐可以增強臨床準確性並支持我們的基於價值的護理模式，確保及時為患者提供護理。

For high-risk and chronically ill patients, we provide specialized programs for proactive coordinated care to improve health outcomes and reduce hospitalizations. Our investment in technology also allows improved efficiency, faster insights and real-time feedback for continuous improvement. Performance visibility across markets, payers and EMRs let us spot patterns and highlight best practices nationwide to facilitate PCP learning.

對於高風險和慢性病患者，我們提供專門的主動協調護理計劃，以改善健康狀況並減少住院治療。我們對科技的投資還可以提高效率、更快地獲得洞察力和即時回饋，從而實現持續改進。跨市場、付款人和 EMR 的績效可見度讓我們能夠發現模式並突出全國的最佳實踐，以促進 PCP 學習。

Technology is vital in our clinical pathways program, helping connect opportunities across our burden of illness, quality and care delivery programs to identify and manage chronic diseases like heart failure. These capabilities enable early primary care physician intervention to prevent disease progression, alleviate symptoms and avoid unnecessary ER visits and hospital stays.

科技在我們的臨床路徑計劃中至關重要，它有助於將我們的疾病負擔、品質和護理提供計劃中的機會聯繫起來，以識別和管理心臟衰竭等慢性疾病。這些功能使初級保健醫生能夠儘早幹預，以防止病情進展、緩解症狀並避免不必要的急診就診和住院。

Our recently launched heart failure program is a good example with two very pragmatic quality opportunities: one, to identify and diagnose the disease earlier via the primary care doctor versus later during an acute event in the ER or hospital; and two, to support our PCPs in initiating guideline-directed therapies to slow disease progression, extend survival and reduce acute exacerbations.

我們最近啟動的心臟衰竭計畫就是一個很好的例子，它提供了兩個非常實用的優質機會：一是透過初級保健醫生更早地發現和診斷疾病，而不是在急診室或醫院發生急性事件時才發現和診斷；二是支持我們的初級保健醫生啟動指南指導的治療，以減緩疾病進展、延長生存期並減少急性發作。

Many of our partnerships are in the early stages of implementing the heart failure pathway, and we look forward to reporting updates on our progress and clinical outcomes later in the year or early in 2026. With respect to our PalliUM program, we are now live across most of our markets. This program relies on the trust between a senior patient and their primary care doctor and offers significant quality of life benefits to patients and family members. For patients electing to enroll in the program, we have seen a significant reduction in hospital admissions per 1,000.

我們的許多合作夥伴正處於實施心臟衰竭途徑的早期階段，我們期待在今年稍後或 2026 年初報告我們的進展和臨床結果的最新情況。關於我們的 PalliUM 計劃，我們現在已經涵蓋了大多數市場。該計劃依賴老年患者與其初級保健醫生之間的信任，並為患者及其家庭成員提供顯著的生活品質益處。對於選擇參加該計劃的患者，我們看到每千人的住院人數顯著減少。

And in the first quarter, we saw a material increase in patients choosing to receive advanced illness management via our program. Given the positive clinical and business impacts to date, we're focused on additional expansion across partnerships and geographies in 2025, which we expect will create additional value in 2026. Finally, we continue to maintain cost discipline while investing in technology and clinical programs to further support medical margin and patient outcome improvements as well as strengthen our position with payers and PCPs.

在第一季度，我們發現選擇透過我們的計畫接受高階疾病管理的患者數量大幅增加。鑑於迄今為止積極的臨床和業務影響，我們專注於在 2025 年進一步擴展合作夥伴關係和地理，預計這將在 2026 年創造更多價值。最後，我們將繼續保持成本紀律，同時投資於技術和臨床項目，以進一步支持醫療利潤和患者結果的改善，並加強我們在付款人和 PCP 中的地位。

In closing, we see 2025 as both a transition year financially and an inflection year in terms of quality and clinical programs, payer underwriting and cost discipline, which we expect will create a stronger foundation for growth and financial performance. As we look to 2026, we are encouraged by the recent final notice and positive comments from administration officials in support of value-based care models. As the macro shows some promising signs, our investments in technology and clinical programs are starting to bear fruit, giving us confidence in our ability to accelerate performance and speed to value for our stakeholders.

最後，我們認為 2025 年既是財務上的過渡年，也是品質和臨床項目、付款人核保和成本紀律的轉折年，我們預計這將為成長和財務表現奠定更堅實的基礎。展望2026年，我們欣喜地看到近期發布的最終通知以及政府官員對基於價值的醫療模式的正面評價。宏觀經濟情勢呈現出一些正面跡象，我們在技術和臨床專案上的投資也開始取得成果，這讓我們對提升績效、加速為利害關係人創造價值的能力充滿信心。

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

說完這些，讓我把電話轉給傑夫。

Thanks, Steve, and good afternoon. For today's discussion, I will cover three key areas.

謝謝，史蒂夫，下午好。今天的討論我將涉及三個關鍵領域。

First, I will walk through our financial performance for the first quarter. Second, I'll provide an update on cost trends and the steps we are taking to manage risk and improve medical margin. And finally, I'll discuss our Q2 outlook and full year 2025 guidance, including our expectations for membership, revenue and adjusted EBITDA.

首先，我將介紹我們第一季的財務表現。其次，我將介紹成本趨勢的最新情況，以及我們為管理風險和提高醫療利潤率所採取的措施。最後，我將討論我們第二季度的展望和2025年全年的指引，包括我們對會員數量、收入和調整後EBITDA的預期。

Starting with membership. Medicare Advantage membership at the end of Q1 2025 was 491,000 members compared to 523,000 members in Q1 2024. As we discussed last quarter, our decision to take a measured approach to membership growth has resulted in a slight year-over-year decline driven by previously disclosed partner exits in a smaller 2025 class. We continue to expect our overall same geography growth rate to be in line with the broader industry for 2025. Additionally, our first quarter membership came in at the low end of our guidance range due to the timing of contract signings for the 2025 class.

從會員資格開始。2025 年第一季末，醫療保險優勢計劃會員人數為 491,000 人，而 2024 年第一季末為 523,000 人。正如我們上個季度所討論的那樣，我們決定採取一種審慎的方式來實現會員增長，這導致會員人數同比略有下降，這是由於之前披露的 2025 年合夥人退出人數較少所致。我們仍然預計，到 2025 年，我們的整體同地區成長率將與整個產業保持一致。此外，由於 2025 年合約簽署的時間，我們第一季的會員人數處於指導範圍的低端。

As a reminder, the 2025 class contracts are on a glide path approach and as such, are not driving a meaningful variance in our financial results. Our ACO REACH membership for Q1 was 114,000 members compared to 131,000 members in Q1 2024. This decrease primarily reflects the strategic decision to exit an underperforming MSSP partnership as we've previously discussed.

提醒一下，2025 級合約正處於下滑階段，因此不會對我們的財務表現產生重大影響。我們第一季的 ACO REACH 會員人數為 114,000 名，而 2024 年第一季為 131,000 名。這一下降主要反映了我們之前討論過的退出表現不佳的 MSSP 合作夥伴關係的策略決策。

Turning to revenue. Total revenue for Q1 2025 was $1.53 billion compared to $1.6 billion in Q1 2024. The primary drivers of year-over-year revenue decrease include the market and partnership exits we have previously discussed, partially offset by the 2025 class and premium growth. Additionally, during the first quarter of 2025, we recognized $10 million of revenue and $10 million of medical expense associated with retroactively assigned members from 2024.

談到收入。2025年第一季總營收為15.3億美元，而2024年第一季為16億美元。營收年減的主要原因包括我們之前討論過的市場和合作夥伴退出，但2025年級別和保費的成長部分抵消了這一影響。此外，在2025年第一季度，我們確認了1000萬美元的收入，以及與2024年追溯分配的會員相關的1000萬美元醫療費用。

Medical margin for Q1 2025 was $128 million compared to $157 million in Q1 2024. Medical costs for the first quarter of 2025 were in line with expectations and driven by continued elevated utilization, incremental flu-related costs and negative prior period development. As Steve mentioned, during the first quarter, our AWV and PCP visits were in line with expectations and medical costs continue to be driven by inpatient cases and Part B drug spend.

2025 年第一季的醫療利潤為 1.28 億美元，而 2024 年第一季為 1.57 億美元。2025 年第一季的醫療成本符合預期，受持續上升的使用率、增加的流感相關成本以及前期負面發展的影響。正如史蒂夫所提到的，在第一季度，我們的 AWV 和 PCP 就診量符合預期，醫療成本繼續受到住院病例和 B 部分藥物支出的推動。

The first quarter 2025 results included negative prior period development of $22 million, of which $7 million was associated with exited markets. The remaining development was tied specifically to one payer, including $10 million from 2023 dates of service and additional claims in the third quarter of 2024. I want to highlight that we went live on our new financial data pipeline in the first quarter that covers a significant number of our membership. We now have greater visibility and detail for both revenue and claims as we move forward, which we expect to enhance our forecasting capabilities.

2025 年第一季的業績包括 2,200 萬美元的負前期發展，其中 700 萬美元與退出市場有關。剩餘的開發資金專門與一位付款人掛鉤，包括從 2023 年服務日期起的 1000 萬美元以及 2024 年第三季度的額外索賠。我想強調的是，我們在第一季啟動了新的財務數據管道，涵蓋了我們相當一部分會員。隨著我們繼續前進，現在我們對收入和索賠有了更清晰的了解和更詳細的信息，我們期望這將增強我們的預測能力。

Our margin performance reflects disciplined cost management, improvements in payer terms and ongoing investments in clinical initiatives. While medical cost trends remained elevated, we are beginning to see the impact of our strategic actions to partially mitigate these pressures. Adjusted EBITDA for the quarter was $21 million compared to $29 million in Q1 2024. The year-over-year movement reflects continued elevated cost trends, offset by lower geography entry costs and operating cost initiatives.

我們的利潤率表現體現了嚴格的成本管理、付款人條款的改善以及對臨床項目的持續投入。儘管醫療成本趨勢持續走高，但我們已開始看到策略性措施在部分緩解這些壓力方面所取得的成效。本季調整後 EBITDA 為 2,100 萬美元，而 2024 年第一季為 2,900 萬美元。與去年同期相比，成本趨勢持續上升，但被較低的地理進入成本和營運成本措施所抵消。

Geography entry costs were lower in the first quarter of 2025, reflecting the timing of capital funding needs related to new market entries for 2026. Adjusted EBITDA related to ACO REACH was $20 million in the first quarter of 2025. Managing medical cost trends remains a top priority.

2025 年第一季的地理進入成本較低，反映了 2026 年新市場進入相關的資本融資需求的時間。2025 年第一季與 ACO REACH 相關的調整後 EBITDA 為 2,000 萬美元。管理醫療成本趨勢仍然是重中之重。

For Q1 2025, our year two plus markets medical cost trend was 5.5% compared to 6.7% in Q1 2024. As a reminder, we expect cost trends in 2025 to run approximately 150 basis points lower than 2024 due to the effect of payer bidding and the two-midnight rule. For the first quarter of 2025, we continue to take a conservative approach in our assumptions given ongoing utilization pressures in areas such as inpatient services and Part B drugs in combination with the negative prior period development. A component of the negative prior period development was associated with the third quarter of 2024, which has an updated cost trend of 9.6% year-over-year.

2025 年第一季度，我們兩年以上的市場醫療成本趨勢為 5.5%，而 2024 年第一季為 6.7%。提醒一下，由於付款人競標和兩午夜規則的影響，我們預計 2025 年的成本趨勢將比 2024 年低約 150 個基點。對於 2025 年第一季度，鑑於住院服務和 B 部分藥物等領域的持續利用壓力以及前期的負面發展，我們將繼續採取保守的假設。前期負面發展的一部分與 2024 年第三季有關，該季度的成本趨勢較上年同期更新為 9.6%。

As part of our strategy to manage risk, we have successfully reduced our exposure to Medicare Part D, with less than 30% of our membership carrying Part D risk in 2025. Additionally, we are working closely with our payer partners to refine benefit designs and improve alignment on medical cost management. Now I would like to provide a few highlights for our Q2 and full year 2025 guidance. Looking ahead, we remain focused on disciplined execution and financial improvement. For Q2, we expect Medicare Advantage membership in the range of 485,000 to 515,000, with ACO model membership projected to be between 105,000 to 115,000.

作為我們風險管理策略的一部分，我們已成功降低了對聯邦醫療保險 D 部分的風險敞口，到 2025 年，承擔 D 部分風險的會員比例將不到 30%。此外，我們正在與付款方合作夥伴密切合作，以完善福利設計並提高醫療成本管理的一致性。現在，我想就我們 2025 年第二季和全年的指導提供一些亮點。展望未來，我們將繼續專注於嚴謹的執行和財務改善。我們預計第二季聯邦醫療保險優勢計畫 (Medicare Advantage) 的會員人數將在 48.5 萬至 51.5 萬之間，而 ACO 模式的會員人數預計在 10.5 萬至 11.5 萬之間。

For the full year, our guidance for Medicare Advantage members remains unchanged at 490,000 to 520,000. For the second quarter, revenues are expected to be between $1.44 billion to $1.51 billion, while full-year 2025 revenue is expected to be in the range of $5.85 billion to $6.03 billion, reflecting the impact of membership shifts and improved revenue yield from payer contracts. The bottom end of our full-year guidance range has been increased to reflect the retroactive membership assignment and corresponding revenue recognized in the first quarter.

就全年而言，我們對 Medicare Advantage 會員的預期保持不變，仍為 490,000 至 520,000。第二季度的營收預計在 14.4 億美元至 15.1 億美元之間，而 2025 年全年收入預計在 58.5 億美元至 60.3 億美元之間，這反映了會員轉移和付款人合約收入收益率提高的影響。我們的全年指導範圍的底端已經增加，以反映第一季確認的追溯會員分配和相應的收入。

For the second quarter, medical margin is expected to be between $50 million and $70 million and full year medical margins are projected to be between $275 million to $325 million, driven by targeted initiatives in our BOI program, clinical initiatives, and operating performance. As a reminder, the class of 2025 will have a lower revenue and margin PMPM due to our measured glide path approach mentioned last quarter. Second quarter 2025 adjusted EBITDA is expected to be between negative $35 million to negative $20 million.

受我們 BOI 計畫中的針對性舉措、臨床舉措和營運績效的推動，第二季醫療利潤預計在 5,000 萬美元至 7,000 萬美元之間，全年醫療利潤預計在 2.75 億美元至 3.25 億美元之間。提醒一下，由於我們上季提到的衡量下滑路徑法，2025 年畢業生的月均收入和利潤率將會下降。預計 2025 年第二季調整後 EBITDA 將在負 3,500 萬美元至負 2,000 萬美元之間。

Our full year 2025 adjusted EBITDA guidance range remains unchanged at negative $95 million to negative $55 million, consistent with our plan to achieve financial stability while investing in long-term growth. On the balance sheet, we ended the quarter with $369 million in cash and marketable securities and another $25 million of off-balance sheet cash held by our ACO entities. We expect to use approximately $110 million of cash in 2025, and we continue to maintain a disciplined approach to capital allocation, ensuring we have the resources needed to support our business objectives while progressing toward our goal of cash flow breakeven in 2027.

我們 2025 年全年調整後 EBITDA 指導範圍保持不變，為負 9500 萬美元至負 5500 萬美元，這與我們投資長期增長的同時實現財務穩定的計劃一致。在資產負債表上，我們在本季末擁有 3.69 億美元的現金和有價證券，以及由我們的 ACO 實體持有的 2,500 萬美元表外現金。我們預計 2025 年將使用約 1.1 億美元現金，並且我們將繼續保持嚴謹的資本配置方式，確保我們擁有支持業務目標所需的資源，同時朝著 2027 年實現現金流收支平衡的目標邁進。

In summary, while we continue to operate in a challenging environment, the actions we are taking to refine our strategy, improve operational execution and financial visibility, and strengthen our financial position are evident in our first quarter performance. We remain confident in our ability to navigate the near-term headwinds and to position agilon for long-term success.

總而言之，儘管我們仍在充滿挑戰的環境中運營，但我們為完善策略、提升營運執行力和財務透明度以及增強財務狀況而採取的措施，已在第一季度的業績中得到充分體現。我們仍有信心應對短期挑戰，並為 Agilon 的長期成功奠定基礎。

With that, operator, let's move to the Q&A portion of the call.

接線員，讓我們進入通話的問答部分。

(Operator Instructions)

（操作員指示）

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

I guess maybe starting with a bigger picture one. Obviously, there's been a lot of focus on the impact of the V28 risk model transition on value-based care companies for this quarter, in particular, and whether there's anything about the transition that's proving potentially more difficult than might have been expected for various reasons. So I think it'd probably be helpful if you could just give us a quick update, I guess, on the company's thinking around V28, the impact specifically on 2025, and whether there's anything different to consider relative to the impact you faced in 2024?

我想也許可以從一個更大的圖景開始。顯然，人們非常關注 V28 風險模型轉型對本季價值型護理公司的影響，以及由於各種原因，轉型是否會比預期的更加困難。因此，我認為如果您能向我們簡要介紹一下公司對 V28 的想法、對 2025 年的具體影響，以及相對於 2024 年面臨的影響是否有任何不同需要考慮，這可能會有所幫助？

And then whether there's anything to think about from here in terms of expectations for the pacing of the remainder of the V28 phase-in.

那麼，從對 V28 剩餘階段實施進度的預期來看，是否有任何值得思考的地方。

Sure, Stephen. Thanks for the question. I think the headline is that from a risk adjustment perspective in '25, we're in line with our expectations, 2% net increase year-over-year, inclusive of about a 3% headwind from V28. I think a couple of things to consider as you think about our model is, one, the continuity that our primary care physicians have with their patients.

當然，史蒂芬。謝謝你的提問。我認為標題是從 25 年風險調整的角度來看，我們符合我們的預期，同比淨增長 2%，其中包括 V28 帶來的約 3% 的逆風。我認為，當您思考我們的模型時，您需要考慮以下幾點：第一，我們的初級保健醫生與患者之間的連續性。

Our patients have been with their PCPs on average for 10-plus years. Each year, they're doing annual wellness visit assessments with them. And so we were able to really do that work in 2024, that's reflected in what we're expecting for '25 paid.

我們的患者平均與初級保健醫生（PCP）合作超過10年。他們每年都會接受PCP的年度健康評估。因此，我們能夠在 2024 年真正完成這項工作，這反映在我們對 25 年付費的期望中。

The second is that, as I called out in my prepared remarks, our membership in '25 is essentially the membership we had in '24. It's really part of our disciplined growth. It obviously is net of those payer and partnership exits that we've talked about previously. And so I think the takeaway overall it's in line with our expectation. We did the work last year to really reflect that. It's early, but we're encouraged by what we're seeing.

第二，正如我在準備好的發言中所說的那樣，我們 1925 年的成員資格基本上與 1924 年的成員資格相同。這確實是我們規範成長的一部分。這顯然是扣除了我們之前討論過的付款人和合作夥伴退出的淨額。所以我認為整體而言，這符合我們的預期。我們去年的工作確實反映了這一點。現在還為時過早，但我們對目前看到的情況感到鼓舞。

Jeff, anything you'd add to that?

傑夫，你還有什麼要補充的嗎？

No. That is good.

不。那很好。

Elizabeth Anderson, Evercore ISI.

伊麗莎白·安德森，Evercore ISI。

I was wondering if you could talk a little bit more about anything in terms of contribution from previously exited areas or other sort of lingering impacts that you're sort of at least aware of now or sort of expecting for the rest of the year, just to sort of help us clean out the like current run rate performance of the business versus some of those legacy issues that you've dealt with.

我想知道您是否可以再多談一些關於以前退出領域的貢獻或其他揮之不去的影響，至少您現在知道這些影響，或者預計今年剩餘時間會產生這些影響，只是為了幫助我們清理當前的業務運行率表現，以及您處理過的一些遺留問題。

Yes. This is Jeff. I mean, certainly, the $7 million that we called out for unfavorable development for the exited markets would be something that kind of stays in 2024 and doesn't have an impact on 2025. Obviously, we still have some IBNR left for those days of service. But to this point, it's pretty minimal. So that would be the only thing that I think I would highlight. Steve, anything else?

是的。這是傑夫。我的意思是，我們為退出市場的不利發展而呼籲的 700 萬美元肯定會留在 2024 年，不會對 2025 年產生影響。顯然，我們仍然有一些 IBNR 可供那些天使用。但到目前為止，這還只是很小的一部分。所以，我想這應該是我唯一想強調的一點了。史蒂夫，還有什麼嗎？

Yes. I think just Elizabeth, we talked about the step-up last year from exiting those markets, which was reflected in our bridge that we shared with you on a previous call. But outside of that, no, I don't have anything else.

是的。我想就像伊麗莎白一樣，我們談到了去年退出這些市場所帶來的進步，這反映在我們上次電話會議上與您分享的橋樑中。但除此之外，我沒有其他東西了。

Jailendra Singh, Truist Securities.

Jailendra Singh，Truist Securities。

So, following up on your comments on 2026 MA final rate notice, which came in better than advanced notice. Can you help us understand how we should think about this flowing through agilon? You guys have previously talked about 40% membership being repriced for Jan 1, '25. Do those contracts get any sort of guaranteed flow-through from CMS rate update? Or are they completely dependent on how payers approach their bidding process?

因此，針對您對 2026 年 MA 最終利率通知的評論，我們進行了跟進，該通知比提前通知更好。您能幫助我們理解我們應該如何看待這種流經 agilon 的現象嗎？你們之前曾討論過 2025 年 1 月 1 日起 40% 的會員資格將重新定價。這些合約是否從 CMS 利率更新中獲得任何形式的保證流通？或者他們完全依賴付款人如何對待他們的競標過程？

And related to that, at what point will you have clarity on your rates for 2026?

與此相關，您什麼時候才能明確 2026 年的利率？

Yes. Thanks for the question, Jailendra. So you are correct. We repriced 40% of our membership for January 1 of '25. Those are percentage of premium increases.

是的。謝謝你的提問，Jailendra。所以你是對的。我們對 25 年 1 月 1 日起 40% 的會員重新定價。這些是保費增長的百分比。

So if you talk about an average 9% increase across the network or nationally, that would flow through on that baseline that you're going to take a percentage of premium on. So that, we will get the benefit of that. Obviously, there's the impact from risk adjustment in Stars quality on that. As it relates to the '26 renewals, as I called out in my prepared remarks, we've got 50% of our membership up for renewal. So between the 2 years, you're talking about the vast majority of membership being repriced.

因此，如果您談論的是整個網路或全國範圍內平均 9% 的成長，那麼這將流向您要收取一定比例保費的基線。這樣，我們就可以從中受益。顯然，星級品質的風險調整對此有影響。至於 26 次續約，正如我在準備好的演講中所說的那樣，我們有 50％ 的會員需要續約。所以在這兩年之間，你說的是絕大多數會員資格被重新定價。

We are just starting through that progress right now. There's a set of priorities that we've got against that. The first is reducing Part D exposure. We talked to you for '25, getting that below 30%. While it's early, we already have one small regional payer for '26 that is going to carve that out.

我們現在才剛開始這一進程。針對這個問題，我們制定了一系列優先事項。首先是減少 D 部分的暴露。我們和你談過 25 年的事，希望將其控制在 30% 以下。雖然現在還為時過早，但我們已經有一家 26 年的小型地區付款人將負責處理此事。

So, further progress on Part D. Additional quality incentives is a key focus for us. That's half of our programs or initiatives that are loaded in our plan for this year. We see an opportunity to increase that because we're consistently above that or a 4.25-star performance perspective. So those are really big ones.

因此，D 部分的進一步進展。額外的品質激勵是我們關注的重點。這是我們今年計劃中的項目或舉措的一半。我們看到了提高這一水平的機會，因為我們的績效水平一直高於這一水平，或者說是 4.25 星的績效水平。所以這些都是非常重要的問題。

Further economic terms that we've got on that. And then supplemental benefits is kind of fourth in our list. We've got a lot of work going on with payers in terms of improving our information around that and reducing our risk overall through their payer bidding. But those are the areas that we'll work through. That will run our normal cycle.

我們對此有了進一步的經濟了解。補充福利在我們的名單中排在第四位。我們與付款人進行了大量工作，以改善我們有關這方面的資訊並透過付款人競標降低我們的整體風險。但這些都是我們要努力解決的領域。這將使我們的循環正常進行。

So we'll be updating you on future calls in terms of our overall progress.

因此，我們將在未來的電話會議中向您通報我們的整體進展。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

I wanted to follow up on the questions around risk scores. Two things. One, you mentioned previously you're talking about pricing up 2%. I want to make sure, is that on a same patient basis? It just seems like given V28 plus some pretty mediocre rate increases, I think a lot of people think of them in the 1% range, give or take, for 2025.

我想跟進有關風險評分的問題。兩件事。第一，您之前提到過，您正在談論價格上漲 2%。我想確認一下，這是基於同一個病人嗎？看起來，考慮到 V28 加上一些相當平庸的利率成長，我認為很多人認為到 2025 年利率成長將在 1% 左右。

That number stands out as being pretty strong. So I just want to make sure it's same member. And then secondly, one of your peers mentioned seeing a bunch of new patients bouncing around because of all the disruption talked about a bunch of the new members that they got being uncoated versus 2024. Just curious if you saw any of that.

這個數字非常強勁。所以我只是想確保他們是同一個成員。其次，您的一位同事提到，由於各種幹擾，看到一大批新患者來來往往，並談到他們接收的一大批新成員將在 2024 年之前不再接受治療。我只是好奇你是否看到了這些。

Yes, Justin, thanks for both of those questions. So in terms of year-over-year improvement from a risk adjustment perspective, that is on a same member basis, members that we had last year that get -- that are continued this year that the net 2% increase is the effect of that. It's 5% gross, it's 2% net from a risk adjustment perspective on that. I think I'd just remind you that we've gone into markets that historically have been heavy fee-for-service. We start from a lower risk score.

是的，賈斯汀，謝謝你提出這兩個問題。因此，從風險調整的角度來看，就同比改善而言，這是在同一會員基礎上的，去年我們擁有的會員今年繼續增加，淨 2% 的增長就是這一影響。從風險調整的角度來看，毛利率為 5%，淨利率為 2%。我想我只是想提醒你，我們進入的市場在歷史上一直是收費服務為主。我們從較低的風險評分開始。

And so the ability to get a larger lift over year-over-year is sort of part of our approach and what we expect to see in the early years in these markets. And if you remember, 50% or nearly 50% of our membership sits in the class of '23 and '24. So we're very early in that cycle. On your second question in terms of disruption and a lot of movement, there was more movement between payers in '25 in some of our markets than we have seen in past years, but not necessarily everywhere. But as I sort of shared in response to Stephen's question, I think the distinction here is the primary care physician stays with that patient all along.

因此，實現同比更大成長的能力是我們策略的一部分，也是我們期望在這些市場早期看到的結果。如果你還記得的話，我們 50% 或接近 50% 的會員都是 23 屆和 24 屆的。所以我們正處於這個週期的早期階段。關於你的第二個問題，就中斷和大量流動而言，2025 年我們某些市場的付款人之間的流動比過去幾年要多，但不一定在所有地方都是如此。但正如我在回答史蒂芬的問題時所說的那樣，我認為這裡的區別在於初級保健醫生會一直陪伴著病人。

If you move from health plan A to health plan B, it doesn't change anything in the total care model. And so the prevention, the early detection, the assessments that went on in '24, well, they were with health plan A, that gets reflected as they carry into '25. And so that's just a function of the model that we've built around. Then there's the choices that we've made on disciplined growth. And so our membership is essentially flat year-over-year.

如果您從健康計畫 A 轉向健康計畫 B，整體照護模式不會發生任何改變。因此，24 年所進行的預防、早期發現和評估都屬於健康計畫 A，這些都體現在 25 年。這只是我們建構的模型的一個功能。然後是我們在有紀律的成長方面所做的選擇。因此我們的會員數與去年同期相比基本持平。

And those members that we had in '24, we've got in '25. The members that we did add in the class of '25, as Jeff called out, it's 20,000 in total as we get them on the platform, smallest class we've had in a while. There's no underwriting risk on those members because they're care coordination, no downside contracts for 2025. So that's, I think, some of the distinctions and what we're seeing year-over-year.

我們在 2024 年擁有的那些成員，我們在 2025 年也擁有了。正如傑夫所說，我們在 25 年級新增的成員總數為 20,000 人，我們把他們帶到了平台上，這是我們一段時間以來最小的班級。這些成員沒有承保風險，因為他們是護理協調者，2025 年沒有下行合約。所以，我認為，這就是我們逐年看到的一些差異和情況。

Amir Farahani, Bernstein.

阿米爾法拉哈尼、伯恩斯坦。

I was thinking if you can talk a little bit about your expectations for the '26 bid cycle in terms of pricing benefits and potential impact on your business. And a quick follow-up, if I may, about your EBITDA guide. I believe it incorporates a $50 million lift from operating initiatives and clinical expense management we call that. I guess it would be great to get some update how that's tracking and how much of that do you estimate you achieved in Q1?

我想您是否可以從定價優勢和對您業務的潛在影響方面談談您對 26 年招標週期的期望。如果可以的話，我想快速跟進您的 EBITDA 指南。我相信它包含了我們所說的營運計劃和臨床費用管理帶來的 5000 萬美元的收入。我想如果能了解一下進度以及您估計在第一季實現了多少目標，那就太好了？

Yes. Thanks, Amir. Good question. So I think as we said in our prepared remarks, we're optimistic about '26. We're obviously encouraged by the final rate notice.

是的。謝謝，阿米爾。好問題。所以我認為，正如我們在準備好的演講中所說的那樣，我們對 26 年持樂觀態度。我們顯然對最終的利率通知感到鼓舞。

We're encouraged by the bids that payers submitted for '25. And I think our commentary or our discussions with them and their public commentary reinforces that they're going to be pretty measured as they go into '26. But we're right in that cycle right now, and they would be putting sort of the finishing touches on those bids here in the next couple of weeks. So we can update more as we get to the next call. Your second question was $50 million in our operating initiatives.

我們對付款人為 25 年提交的投標感到鼓舞。我認為我們的評​​論或與他們的討論以及他們的公開評論都強調了他們在進入26年時將會非常謹慎。但我們現在正處於這個週期，他們將在接下來的幾週內對這些投標進行最後的潤色。這樣我們就可以在下次通話時更新更多資訊。您的第二個問題是我們的營運計劃涉及 5000 萬美元。

It's $25 million in terms of those quality incentives, and it's $25 million in terms of clinical cost-saving initiatives. Let me take the second one first. The biggest part of the clinical initiatives is our palliative program. I highlighted that in my prepared remarks. We saw an acceleration in enrollment in Q1.

就品質激勵措施而言，其投資額為 2,500 萬美元；就臨床成本節約計畫而言，其投資額為 2,500 萬美元。我先說第二個。臨床計劃中最重要的部分是我們的安寧療護計劃。我在準備好的發言中強調了這一點。我們發現第一季的入學人數增加。

Most of the savings this year is going to come from people who were enrolled last year and were enrolled in Q1 just because of the nature of the cycle and what happens across the last 12 months of end of life. And so that's sort of where we're at. We're tracking well on that. And then the second piece is in-year incentives around quality scores, delivering depending upon the payer 4 or 4.25 and even some upside if you get to 4.5%. And we are tracking well on that.

今年的大部分節省將來自去年登記並在第一季度登記的人，這僅僅是因為週期的性質以及生命終結的最後 12 個月發生的情況。這就是我們現在的處境。我們正在順利追蹤此事。第二部分是圍繞品質評分的年度激勵措施，根據付款人的 4 或 4.25 提供，如果達到 4.5%，甚至還會有一些上漲。我們正在順利追蹤此事。

We -- our docs do an excellent job in terms of managing quality, in terms of closing their care gaps. The technology that I talked about is very focused on getting them the information around that. And so while it's early in the year, we feel like we're off to a good start and tracking well across both our quality initiatives and our clinical initiatives.

我們的醫生在管理品質、縮小照護差距方面做得非常出色。我談到的技術非常注重讓他們獲得有關該方面的資訊。因此，雖然現在才年初，但我們感覺我們已經有了一個良好的開端，並且在品質計劃和臨床計劃方面都取得了良好的進展。

Lisa Gill, JPMorgan.

摩根大通的麗莎吉爾。

Just want to follow up, Steve, on the comments that were made around the medical cost trends, obviously coming in higher than expected in this quarter. And I think you called out inpatient as well as Part B. Can you maybe just talk about a couple of things? One, the level of visibility you currently have for completed claims? And then secondly, how are these trends progressing as you were exiting the quarter?

史蒂夫，我只是想跟進有關醫療成本趨勢的評論，顯然本季的醫療成本高於預期。我認為您提到了住院病人以及 B 部分。能否談幾件事？第一，您目前對已完成索賠的了解程度如何？其次，當您退出本季時，這些趨勢進展如何？

And then just lastly, I know Part D, you said is less than 30% of your book. But with the changes to Part D, I'm curious if you're seeing an increase in utilization there with the maximum out-of-pocket cost shifting pretty materially.

最後，我知道您說的 D 部分佔您書的 30% 以下。但隨著 D 部分的變化，我很好奇您是否看到那裡的利用率增加，而最高自付費用是否發生了相當大的變化。

Sure. There's a lot in that question, Lisa. So let's see. So medical cost trends in the quarter, maybe just to reset, were in line with our expectations. Our expectations were that they were going to be at elevated levels, and they came in at that level.

當然。這個問題包含很多內容，麗莎。讓我們看看。因此，本季的醫療成本趨勢（可能只是重置）符合我們的預期。我們期望他們能夠達到更高的水平，而他們也確實達到了這個水平。

So we had guided and forecasted at plus 5%, as Jeff called out, and they came in at that level within the quarter. In terms of visibility, we've worked really hard over the past few calls, we've updated you on our financial pipeline. We brought that live this quarter. That is a big milestone for us. It gives us detailed member level revenue and claims data that really allows us to better understand the total revenue and cost profile of those members.

正如傑夫所說，我們指導並預測其成長 5%，並且他們在本季度就達到了這一水平。在可見性方面，我們在過去的幾次通話中付出了很大的努力，我們向您通報了我們的財務狀況。我們在本季度實現了這一目標。這對我們來說是一個重要的里程碑。它為我們提供了詳細的會員級收入和索賠數據，讓我們能夠更好地了解這些會員的總收入和成本狀況。

And so that's encouraging as a step further to go, but a big milestone for us. You asked about the quarterly progression, I think. I think exiting the quarter, so the census data, well, two areas that drove the elevated levels of utilization in line with our expectation was inpatient and Part B as in boy. Inpatient, our census data says January and February were higher, came down in March as we move through the quarter. And so that's sort of tracking in line overall.

這對我們來說是一個鼓舞人心的進步，也是一個重要的里程碑。我認為您詢問的是季度進度。我認為在本季度結束時，人口普查數據表明，有兩個領域推動了利用率的提高，這與我們的預期一致，那就是住院病人和 B 部分（即男孩）。住院病人，我們的人口普查數據顯示，一月和二月的住院病人數量較高，但隨著本季度的推進，三月的住院病人數量有所下降。因此，這總體上是一種跟踪。

Flu, as I said in my prepared remarks, had an impact on those inpatient admissions. And then finally, in terms of Part D, I think we're down to 30%. I called out we've got another payer that's going to carve it out for '26, smaller regional payers, so not a huge impact in terms of our overall total, but a good trend line for us. And Jeff, you can talk a little bit about utilization there.

正如我在準備好的演講中所說，流感對住院病人的住院產生了影響。最後，就 D 部分而言，我認為我們已經下降到 30%。我大聲說，我們還有另一個付款人，將在 26 年內將其分拆出來，這是規模較小的地區付款人，因此對我們的總體總額不會產生巨大影響，但對我們來說是一個好的趨勢。傑夫，你可以稍微談談那裡的利用率。

Yes. As far as Part D is concerned, just a reminder that we record that net in our financial statements in the revenue line. And so -- and then given the magnitude, as Steve mentioned, below 30%, it's really not having a significant, I would say, driver as far as the shifting in the utilization pattern on our financial statements.

是的。就 D 部分而言，只需提醒一下，我們將該淨額記錄在財務報表的收入行中。所以 — — 然後考慮到幅度，正如史蒂夫所提到的，低於 30%，我想說，就我們財務報表上的利用模式轉變而言，這實際上並沒有一個顯著的驅動因素。

Ryan Langston, TD Securities.

瑞安·蘭斯頓（Ryan Langston），道明證券。

Maybe on Part D, I guess just bigger picture, if you're unable to kind of carve out maybe the rest of that past the regional payer that you mentioned, I mean, Steve, I know you said 50% of your membership is up for renewal. I guess is there a potential we could see sort of more material membership reduction into '26 if you just can't see sort of a longer-term acceptable margin profile?

也許在 D 部分，我想這只是一個更大的圖景，如果你無法將剩下的部分從你提到的區域付款人那裡劃出來，我的意思是，史蒂夫，我知道你說過 50% 的會員資格需要續訂。我想，如果您看不到長期可接受的利潤率狀況，我們是否有可能看到 26 年會員人數進一步減少？

And just real quick, can you remind us what your membership proportion is from group MA? I know in the past, you referenced it, but having a little trouble finding a recent reference to that.

簡單來說，您能否提醒我們一下 MA 集團的會員比例是多少？我知道您過去曾引用過它，但在查找最近的引用時遇到了一些麻煩。

Yes. Thanks, Ryan. Two good questions. I think Part B, one, we continue to make progress. Reducing that remaining 30% is at the top of our list, and we're off to a good start, as I called out.

是的。謝謝，瑞安。兩個好問題。我認為，B 部分，首先，我們繼續取得進展。減少剩餘的 30% 是我們的首要任務，正如我所說的，我們已經有了一個好的開始。

If you're not able to carve it out, you can corridor it. You also can be reflected in increased percentage of premium. Basically, you can pay for it more. And so I think as we go through these renewals on 50% of the membership, there's a lot of ways to get there. But I don't think that element would necessarily lead to a reduction in membership for 2026.

如果你無法將其雕刻出來，你可以將其製成走廊。您也可以從增加的保費百分比中體現。基本上，你可以支付更多。因此，我認為，當我們對 50% 的會員進行續約時，有很多方法可以實現這一目標。但我並不認為這個因素必然會導致2026年會員國數量的減少。

I think we're going to be disciplined and measured on our growth. Market growth sort of as our target this year, and we'll see as we go to next year and what things look like overall. But I don't think that would necessarily drive a reduction in membership. Your second question was on group. Our group MA penetration is really in line with the overall industry average nationally.

我認為我們將對我們的成長採取紀律和衡量措施。市場成長是我們今年的目標，我們將觀察明年的整體狀況。但我並不認為這必然會導致會員人數減少。您的第二個問題是關於小組的。我們的團體MA滲透率確實與全國整體產業平均值一致。

We said about 18%, so like 17%, 18% is industry average. In the markets we serve, we're actually underweight. So those markets have a little bit higher percentage in terms of group, but we come in at 18%. So we're about 3% under the market average there. Our trends -- you didn't ask this, but our trends in group are in line with what we see in individual.

我們說的是大約 18%，所以 17%、18% 是行業平均。在我們服務的市場中，我們實際上處於低配狀態。因此，從群體角度來看，這些市場比例略高，但我們的比例為 18%。因此我們的股價比市場平均低 3% 左右。我們的趨勢——你沒有問這個，但我們群體的趨勢與我們個人看到的趨勢一致。

So not material changes there. And I think maybe a key part of it is sort of what I said in response to Justin and Stephen is we've got the same members on the platform in '25 that we had in '24. That's true for group. That's true for individual. But specifically on group, the trend and the utilization that was experienced in '24, that's in our baseline.

因此那裡沒有實質的變化。我認為其中一個關鍵部分可能就像我在回答賈斯汀和史蒂芬的問題時所說的那樣，我們在 1925 年的平台上擁有與 1924 年相同的成員。對於團體來說確實如此。對於個人來說確實如此。但具體到群體而言，24 年經歷的趨勢和利用率都在我們的基準範圍內。

So we're not seeing a big movement in utilization, and they're with the same primary care physician that they had last year.

因此，我們沒有看到利用率出現大的變化，而且他們與去年的初級保健醫生是同一位。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

So I guess a big picture question, a follow-up, I guess, to the comments on 2026 rate notice, which came in better. So your comments when we had the preliminary rate notice, right, was that you guided to breakeven free cash flow in '27. So now with the final rate notice being better, how much of this additional, call it, 200 basis points or so improvement in the final versus preliminary, how much of that is fair to assume that would kind of fall to that improvement in free cash flow, say?

所以我想這是一個大問題，我想是對 2026 年利率通知的評論的後續，這個評論更好。因此，當我們收到初步利率通知時，您的評論是，您指導 27 年實現收支平衡的自由現金流。那麼，現在最終利率通知已經有所改善，那麼，相對於初步利率，最終利率增加了多少（比如說 200 個基點左右），其中有多少可以合理地假設會歸因於自由現金流的改善呢？

Yes. Thanks for the question, Joanna. I mean, as we said, listen, we're encouraged by the final rate notice. I think it starts to catch up on a period of higher utilization that we've seen for a while, but doesn't get us all of the way there. As we think about 2026, we're not giving guidance on that today, but that final notice is clearly a tailwind.

是的。謝謝你的提問，喬安娜。我的意思是，正如我們所說的，聽著，我們對最終的利率通知感到鼓舞。我認為它開始趕上我們一段時間以來看到的更高利用率的時期，但並沒有讓我們完全達到那種程度。當我們考慮 2026 年時，我們今天不會對此提供指導，但最終通知顯然是一個順風。

I think our disciplined growth is another tailwind that we see around that. The potential for additional quality incentives and our BOI and our clinical work is material. V28, last year, a full implementation, I mean, that's going to be a headwind. So there's going to be another step up of another 3% or so on that. And then the big question is kind of macro utilization, what happens as you move into 2026.

我認為，我們有序的成長是我們看到的另一個順風。額外的品質激勵措施、我們的 BOI 和臨床工作的潛力是巨大的。V28，去年全面實施，我的意思是，這將是一個阻力。因此，這一數字還將再增加 3% 左右。那麼最大的問題是宏觀利用率，到 2026 年會發生什麼事。

And so conceptually, if you hold everything constant, the incremental 280 basis points, that should flow through, but that's a big if. So you got to work through those other elements. And as we get better visibility on payer bids, as we progress through the year and see what utilization of other things look like, I think we'll be able to inform that more.

因此從概念上講，如果保持一切不變，增量 280 個基點應該會實現，但這只是個假設。所以你必須解決那些其他因素。隨著我們對付款人出價的了解越來越深入，隨著我們在這一年中不斷進步，並看到其他事物的利用情況，我想我們將能夠提供更多資訊。

Ryan Daniels, William Blair.

瑞安丹尼爾斯、威廉布萊爾。

Maybe another big picture one for you, Steve. As we think about the dynamics of the marketplace, kind of a hangover with higher utilization and some pressures, but then better rates in '26 and kind of a new revenue model where you have less risk and more visibility, both with your data and with the care coordination fees, how are you thinking about the pipeline and partnership growth as we think of '26, '27 and beyond and what the balance there might look like?

史蒂夫，也許對你來說這是另一個大圖。當我們思考市場動態時，會發現利用率較高和存在一些壓力，但 26 年利率會更高，而且會出現一種新的收入模式，風險更低，數據和護理協調費用的可見性更高，當我們考慮 26 年、27 年及以後時，您如何看待渠道和合作夥伴關係的增長，以及那裡的平衡會是什麼樣子？

Thanks, Ryan. Great questions. So for '26, I think we're in line with what we said on our last call. We think we're going to be in that 30,000 to 45,000 members. We'll probably weight a little bit more to existing geography or same geography growth within that just because the beta on that is lower.

謝謝，瑞安。很好的問題。因此，對於 26 年，我認為我們與上次通話中所說的一致。我們認為我們的會員數量將達到 30,000 至 45,000 名。我們可能會更加重視現有地理區域或同一地理區域的成長，因為這些區域的貝塔係數較低。

And we've got the opportunity to sort of increase that if we want to. But most of the focus right now, Ryan, is on '27. And so that class of '27, it's a rich pipeline. As I said in my prepared remarks, the demand from groups that are looking for partners that are experienced in moving them to value, taking on global risk, doing the basics around risk adjustment and utilization clinical programs is highly strong. And so that's reflected.

如果我們願意的話，我們就有機會增加這一點。但是，瑞安，現在大部分的焦點都在 27 上。所以 27 屆的人才儲備非常豐富。正如我在準備好的演講中所說，那些尋求合作夥伴的團體的需求非常強烈，這些合作夥伴要有豐富的經驗，能夠幫助他們實現價值，承擔全球風險，做好風險調整和利用臨床項目的基礎工作。這就是反映出來的。

And I think you could see that across basically all types of groups, primary care only, multi-specialty, health systems, et cetera. And so I think it's pretty robust. We still are being pretty disciplined and measured as we wait to see how this shapes overall. But I think as the macro starts to correct, there's an opportunity to lean into that demand and increase that growth but that would probably be more for '27 than it would be for '26.

我認為你可以在基本上所有類型的團體中看到這一點，僅限初級保健、多專業、衛生系統等等。所以我認為它非常強大。我們仍然保持相當的自律和審慎，等待觀察整體情況如何發展。但我認為，隨著宏觀經濟開始調整，就有機會順應這種需求並提高成長，但這對 27 年來說可能比 26 年更大。

And if I could squeeze in one quick financial one for Jeff. I just saw in the footnote, there was a negative $1.2 million charge for implementing in new geographies. Did you get a payment from a payer or reverse something that caused that?

如果我可以為傑夫擠出一點時間，告訴她財務上的問題，我剛剛在腳註中看到，在新地區實施的費用為負 120 萬美元。您是否從付款人收到付款或撤銷了導致付款的某些原因？

Yes. Yes. It's a true-up of some of our annual wellness visits. So it was a reversal of an accrual. So yes, that happened in the quarter.

是的。是的。這是我們每年進行的一些健康檢查的真實情況。所以這是應計的逆轉。是的，這在本季發生了。

Michael Ha, Baird.

麥可·哈，貝爾德。

So I understand you expect a more favorable '26 environment, especially with the final rate notice being so strong. And if you were to hold everything constant, things should go well. But with one of your largest payers, Humana facing potentially very material star ratings decline next year. I was wondering if you could speak to how you're thinking about the directional net impact of both factors to agilon. How are you thinking about the benefit of the rate notice netted against this potential decline in both member growth, financial flow-through and the loss of quality bonus and rebates?

因此，我知道您期望 26 年的環境更加有利，尤其是在最終利率通知如此強勁的情況下。如果你保持一切不變，事情就會進展順利。但作為最大的付款人之一，Humana 明年可能會面臨非常嚴重的星級下降。我想知道您是否可以談談您如何看待這兩個因素對 agilon 的方向性淨影響。您如何看待費率通知帶來的收益，以抵銷會員成長、資金流以及優質獎金和回扣損失的潛在影響？

And I know in prior years, you've mentioned you've gotten relief through incremental premium and other forms of premium. But just given the sheer magnitude of the decline with Humana Stars, how confident are you in being able to avoid this sort of headwind flow through?

我知道，前幾年您曾提到過，您透過增加保費和其他形式的保費獲得了減免。但考慮到 Humana Stars 的下滑幅度如此之大，您有多大信心能夠避免這種逆風？

Yes. Thanks for the question, Michael. I mean I think as we look at '26 and we net everything, we are optimistic. We see this opportunity for improvement coming off this transition year of '25. The final notice is materially better.

是的。謝謝你的提問，麥可。我的意思是，我認為，當我們展望 26 年並且我們將一切都做好時，我們就會感到樂觀。我們看到 2025 年這個過渡年帶來了改進的機會。最終通知實質上更好。

As you called out, we have one payer who's got a material step down in terms of their star ratings. This is something that we've gotten used to. We've gone through this with multiple payers. And so there are multiple mechanisms to correct for that. It can be increased percentage of premium.

正如您所說，我們有一位付款人的星級評分大幅下降。這是我們已經習慣的事情。我們已經與多位付款人討論過這個問題。因此，有多種機制可以糾正這個問題。可以增加保費百分比。

It can be lump sum. I mean there's just a variety of ways that you can get there. I think what we are seeing more is the value that we provide to these health plans around our quality scores. So the ability for us to deliver at 4.25 or move towards 4.5 could be really material in their overall network score and getting them above that four. And so we like the concept of incentives that reward us for that in addition to some of the offsets or compensations for the step down overall in terms of 5% from Stars.

可以是一次性付款。我的意思是，你可以透過多種方式到達那裡。我認為我們更多地看到的是我們圍繞著品質評分為這些健康計劃提供的價值。因此，我們能否達到 4.25 分或接近 4.5 分，對於他們的整體網絡得分以及能否超過 4 分來說，可能至關重要。因此，我們喜歡激​​勵措施的概念，除了從 Stars 獲得 5% 的整體降薪補償或抵消之外，還可以獎勵我們。

So I think it's a combination, Michael. I think we have to go through and work that. But what we're hearing today from all of our payers is our strong quality performance is a real differentiator. They'd like us to lean into it more.

所以我認為這是兩種情況的結合，邁克爾。我認為我們必須完成並解決這個問題。但我們今天從所有付款人那裡聽到的是，我們強大的品質表現才是真正的差異化因素。他們希望我們能夠更多地投入其中。

We're working closely with them on that last mile and how we make sure that we get quality or credit for all of that. But that's sort of how we think about quality for 2026 and how we would manage that headwind.

我們正在與他們密切合作，解決「最後一公里」的問題，並確保我們能獲得高品質的服務或信譽。但這大概就是我們對2026年品質的思考，以及我們如何面對這項挑戰。

Matthew Shea, Needham.

馬修·謝伊，尼德姆。

The development of clinical programs seems to be a rising theme that's getting more attention. You called out heart health, I think dementia and COPD are areas of interest as well. Would love to hear how those programs have gone collectively or individually relative to expectations. And then if my understanding is correct, this year is more of an investment year for those newer programs and you expect to reap more of the benefits next year. Do I have that correct?

臨床項目的發展似乎是一個越來越受到關注的新興主題。您提到了心臟健康，我認為癡呆症和慢性阻塞性肺病也是值得關注的領域。很想聽聽這些項目相對於預期而言總體或個別進展如何。如果我的理解正確的話，今年對於那些較新的項目來說更像是一個投資年，並且您期望明年獲得更多的收益。我這樣理解對嗎？

And if so, how big of a factor are these programs in improving the medical margin in 2026 just versus the broader improvement in the MA environment that you called out?

如果是這樣，那麼與您所說的 MA 環境的整體改善相比，這些項目在提高 2026 年醫療利潤率方面發揮了多大作用？

Yes. Thanks, Matthew. I mean great question. So you are right. I mean we are very focused on managing these high acuity chronic diseases.

是的。謝謝，馬修。我的意思是這個問題問得好。所以你是對的。我的意思是我們非常注重管理這些高度嚴重的慢性疾病。

And the majority of our costs come from patients with multiple chronic diseases. So doing this well is critical not just for patient health and quality outcomes, but for having a successful risk business and risk partnership. So we are very focused on that. It is early in the day. In my prepared remarks, I talked about the rollout of heart failure, which is across the majority of our markets in that clinical pathway.

我們的大部分費用來自患有多種慢性疾病的患者。因此，要做好這一點不僅對患者的健康和品質結果至關重要，而且對於成功的風險業務和風險夥伴關係也至關重要。所以我們非常關注這一點。時間還早。在我準備好的演講中，我談到了心臟衰竭的推廣，該疾病已遍布我們該臨床途徑中的大多數市場。

The focus there is around early detection and preventing disease progression across time and preventing people unnecessarily from ending up in the ER or for an inpatient admission. The early returns on that, given the technology investments we've made and the ability to provide that information for that primary care physician in the office is going pretty well. The ability to identify a patient early through a PCP versus later through an acute event in the ER and inpatient is pretty material. Now there's a lag. You identify that early.

重點在於早期發現和防止病情隨時間推移而發展，並防止人們不必要地進入急診室或住院。考慮到我們所做的技術投資以及為辦公室初級保健醫生提供資訊的能力，早期的回報相當不錯。透過 PCP 及早識別患者，而不是透過急診室和住院部的急性事件來識別患者，這種能力非常重要。現在出現了滯後。你很早就發現了這一點。

There's actually a cost around identifying it early, which is reflected in '25. But the benefit will progress across time as you step into '26 and '27. We're not dimensioning what the magnitude of that lift is. But again, just like we think doing well on quality is a differentiator for us with payers and with CMS, we believe the same thing on managing chronic disease. And so heart failure is up and running.

事實上，及早發現它是需要成本的，這在 25 年就有所體現。但當你進入 26 年和 27 年時，這種好處將會隨著時間的推移而增加。我們無法估算升力的大小。但是，正如我們認為做好品質是我們與付款人和 CMS 之間的區別一樣，我們在管理慢性病方面也抱有同樣的看法。因此心臟衰竭就開始發生。

We'll work on these other conditions, COPD, dementia, et cetera, as we progress, and we'll update you on that. I think it's going to be a little while for us to talk about the results. I did call out palliative. You didn't ask about that, but palliative is one that's been rolling for a while, and you're starting to see the impact. It's the biggest dollar impact in '25, again, because there's a lag between when a patient enrolls and the impact overall.

隨著研究的進展，我們將研究慢性阻塞性肺病、失智症等其他疾病，並向您通報最新進展。我認為我們還需要一段時間才能討論結果。我確實呼籲安寧療護。您沒有問到這一點，但安寧療護已經實施了一段時間，而且您開始看到其影響。這又是 25 年最大的美元影響，因為患者入院和整體影響之間存在滯後。

So that's sort of the progression that we're thinking about. We think we're on the right path, and it should be a nice tailwind for us as we step into '26 to get some improvement from these chronic programs.

這就是我們正在考慮的進展。我們認為我們正走在正確的道路上，當我們進入 26 年並從這些長期計劃中獲得一些改進時，這對我們來說應該是一個很好的順風。

Daniel Grosslight, Citi.

花旗銀行的丹尼爾‧格羅斯萊特（Daniel Grosslight）。

I was wondering if the better-than-expected funnel rate in '26 is informing or how it's informing your growth for the class of '26. You mentioned 30,000 to 45,000 new member adds. Do you think those folks will be on the glide path like the class of '25? And then as we think about the class of '25 graduating into '26, do you -- are you going to be more receptive to moving those members off of the glide path?

我想知道 26 年好於預期的漏斗率是否有所提示，或者它如何影響 26 屆學生的成長。您提到新增會員 30,000 到 45,000 名。您認為這些人會像 25 屆的學生一樣走上下滑之路嗎？然後，當我們想到 25 屆畢業生即將進入 26 屆時，您是否會更願意讓這些成員脫離下滑路線？

And then lastly, I just wanted to confirm, you still expect to exit 29,000 members at the end of '25?

最後，我只想確認一下，您仍然預計在 25 年底會員人數將達到 29,000 人嗎？

Yes. Good question. So let me start with the last one. Yes, we plan to exit the 29,000 members at the end of the year. For the class of '26, I mean, I guess I'd back up and say the headline is we'd like to get to risk as rapidly as possible, assuming we have appropriate economic terms.

是的。好問題。那麼讓我從最後一個開始。是的，我們計劃在年底退出29,000名會員。對於 26 屆的學生來說，我想回顧一下，標題是我們希望盡快承擔風險，假設我們有適當的經濟條件。

And so the final rate notice is material across all of our markets. As it looks towards the class of '26, it's too early for us to say what that distribution would be, but the final rate notice does obviously improve the economics overall around that. So we can update you on the next call. On the class of '25, similarly, those that are on the no downside care coordination fee this year in this difficult financial transition year, same thing with the rate notice that improved the overall economics as we would look towards '26. We'll update you on that in terms of what that looks like.

因此，最終利率通知對我們所有的市場都具有重要意義。由於著眼於 26 屆學生，現在判斷其分佈還為時過早，但最終的利率通知顯然會改善該屆學生的整體經濟狀況。這樣我們就可以在下次通話時向您通報最新情況。同樣，對於25屆畢業生來說，今年在這個艱難的金融轉型年，那些享受無下行護理協調費的機構，利率通知也同樣如此，這改善了我們26年的整體經濟狀況。我們將向您通報具體情況。

Anything on that?

有這方面的資訊嗎？

David Lawson, BTIG.

大衛·勞森（David Lawson），BTIG。

This is Jenny Shen on for Dave. For the members that you're still taking drug trend risk on, can you speak to some dynamics going on in drug pricing, what your views on drug pricing are? We saw the recent executive order that was signed on April 15. And our thought is that some of those initiatives could be favorable and a tailwind to the industry and agilon. Just any of your thoughts on drug pricing would be helpful.

我是 Jenny Shen，為 Dave 播報。對於您仍在承擔藥品趨勢風險的成員，您能否談談藥品定價的一些動態，您對藥品定價的看法是什麼？我們看到了4月15日簽署的最新行政命令。我們認為，其中一些舉措可能會對產業和 Agilon 產生有利影響並帶來順風。您對藥品定價的任何想法都會有所幫助。

I think our headline overall is that we don't believe that we can materially manage Part D risk because the majority of those prescriptions are not written by our primary care physicians, and we obviously don't have control over formulary or visibility to manufacturer rebates. And that's why we have chosen to reduce that as much as possible. We're below 30%. We've got one payer that has agreed to carve it out for 26 smaller payer, but that would reduce that number. And our goal is to take that ultimately all the way down.

我認為我們的總體標題是，我們不相信我們能夠實質地管理 D 部分風險，因為大多數處方不是由我們的初級保健醫生開的，而且我們顯然無法控制處方集或了解製造商的回扣。這就是我們選擇盡可能減少這種情況的原因。我們低於30%。我們有一家付款人同意將其劃撥給 26 家較小的付款人，但這會減少付款人的數量。我們的目標是最終徹底消除這個問題。

I don't know that we have tremendous insight on the recent policy that you talked about and how that would impact us overall. But our focus is on reducing that risk overall.

我不知道我們是否對您談到的最近的政策以及它將如何影響我們整體有深刻的了解。但我們的重點是全面降低這種風險。

George Hill, Deutsche Bank.

德意志銀行的喬治·希爾。

Two quick on, Steve. Number one, I'd love to hear you talk about your conversations on the provider side. One of your big peers talked about having to convert a sizable piece of business from risk back to fee-for-service. So I'd love to hear you talk about the comments like the appetite of providers and whether or not you feel like that's stable? And do you see any impact of the class of '26 or '27 on the provider side?

快來吧，史蒂夫。首先，我很想聽聽您談論提供者方面的對話。您的一位大同行談到必須將一大塊業務從風險業務轉回收費業務。所以我很想聽聽您談論供應商的興趣等評論，以及您是否覺得這種興趣穩定？您是否看到 26 或 27 級對提供者方面有任何影響？

And then just as it relates to Part B drug risk, do you guys feel like there's anything you can do to mitigate that or kind of improve outcomes? Or are we talking about disease states like in oncology where the providers are kind of -- they have to deliver the care, they have to deliver in cost -- what it costs. I love comments on those two areas, please.

那麼，正如它與 B 部分藥物風險相關一樣，你們覺得有什麼可以做的來減輕這種風險或改善結果嗎？或者我們談論的是腫瘤學之類的疾病狀態，其中提供者有點 - 他們必須提供護理，他們必須提供成本 - 成本是多少。我很樂意對這兩個領域發表評論。

Yes. Thanks, George. Good question. So I think what I said overall in terms of the total addressable market and the interest in physician groups is there is a strong demand to move to value overall. Is there -- given what's happened overall in the market, obviously, a discussion about help me understand what the economics look like in my market, walk me through a pro forma, if I execute in line with your early markets around the basics of burden of illness, quality, clinical programs, yes.

是的。謝謝，喬治。好問題。因此，我認為，就整體可尋址市場和醫生團體的興趣而言，總體而言，對價值的追求有著強烈的需求。是否有——考慮到市場總體情況，顯然，討論一下可以幫助我了解我的市場的經濟狀況，帶我了解一下形式，如果我按照你們早期市場在疾病負擔、質量、臨床項目等方面的基本情況執行，是的。

And so it is a more elongated discussion than it has been historically. But the challenge is the alternative of fee-for-service is not getting a whole lot better. And this final rate notice, a very big change. So that has changed the underwriting assumptions that you use within the model, and that's made some of those questions or conversations a whole lot easier.

因此，這次討論比歷史上任何一次討論都要漫長。但挑戰在於按服務收費的替代方案並沒有太大的改善。而這個最終的利率通知，是一個非常大的變動。因此，這改變了您在模型中使用的承保假設，並使其中一些問題或對話變得容易得多。

On Part B as in boy drug, it is -- the biggest driver, Jeff called this out in his script, is around oncology. It is a challenging one to manage. We do have some early initiatives that we're probably not ready to talk about that are focused on that. And it is a big area for us to manage as we go forward.

就B部分而言，就像男孩用藥一樣，傑夫在劇本中指出的那樣，最大的驅動力來自腫瘤學。這是一個很難管理的領域。我們確實有一些專注於此的早期舉措，但我們可能還沒有準備好談論它們。這是我們未來需要管理的一個很大的領域。

We kind of look at oncology as a very deep area and an opportunity for our primary care physicians to work more closely with the oncologists in their communities. So more to come on that one, George.

我們將腫瘤學視為一個非常深奧的領域，並為我們的初級保健醫生提供一個與他們所在社區的腫瘤學家更緊密合作的機會。喬治，關於這一點，我們還會繼續討論。

Whit Mayo, Leerink Partners.

惠特·梅奧 (Whit Mayo)，Leerink Partners。

Any color on the negative PYD that you took for 2023 in the quarter? It sounded like it was maybe one payer, but was that something specific around supplemental benefits, OTC Flex or anything? And then if you could just remind us what your estimated completion factor for 2024 is now?

您在本季為 2023 年採取的負面 PYD 有什麼顏色嗎？聽起來好像只有一個付款人，但這是否與補充福利、OTC Flex 或其他相關事宜有關？然後，您能否提醒我們一下您現在預計的 2024 年完成率是多少？

Let me start and Jeff can kind of give you the details. So, what we've tried to call out a couple of times is, we've talked a lot about on these calls, the work we've done over the last year to improve our visibility. Our financial data pipeline just went live in Q1. We're using it for the first time with the majority of our payers on that. So that's a big step forward, very detailed member level revenue and cost information that we weren't able to see a year ago.

讓我先開始，傑夫可以給你詳細資訊。因此，我們曾多次嘗試強調，我們在這些電話會議上多次談論了我們在過去一年中為提高知名度所做的工作。我們財務數據管道剛剛在第一季上線。這是我們第一次使用它，我們的大多數付款人都使用它。這是向前邁出的一大步，非常詳細的會員級收入和成本資訊是我們一年前無法看到的。

And that includes the detail on what Jeff will walk you through around this. But that is a very big step forward. I think that addresses the majority of this issue. If we had this a year ago, we would have seen this and been able to identify it. But Jeff, do you want to fill in?

其中包括 Jeff 將向您介紹此問題的詳細資訊。但這是一個非常大的進步。我認為這解決了該問題的大部分內容。如果我們一年前就有這個，我們就會看到它並能夠識別它。但是傑夫，你想填寫嗎？

Yes. Just to fill in the numbers, right? So we mentioned the $7 million really from exited markets, total of $22 million. $10 million was from '23 in prior days of service. And I think as Steve mentioned, this financial data pipeline on a going-forward basis kind of solves the visibility to that and then really a small amount related to 2024 dates of service.

是的。只是填寫數字，對嗎？因此，我們提到實際上有 700 萬美元來自退出市場，總計 2,200 萬美元。其中 1000 萬美元來自 23 年前的服務。我認為，正如史蒂夫所提到的那樣，這種未來的財務數據管道可以解決這個問題的可見性，以及與 2024 年服務日期相關的少量問題。

And we're roughly, I would say, 90% complete on 2024 date of service at this point.

我們可以大致說一下，截至目前，我們在 2024 年的服務日期已經完成了 90%。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

This is Thomas Walsh on for Andrew. Looking at your second quarter guidance, EBITDA seasonality appears a bit lower than prior years. Hoping you could provide any color on discrete items or expectations for 2Q and how you see the trajectory of medical margin and EBITDA across the year?

托馬斯·沃爾什 (Thomas Walsh) 代替安德魯 (Andrew)。從您第二季的預測來看，EBITDA 的季節性似乎比往年略低。希望您能對第二季的分項項目或預期提供一些信息，以及您如何看待全年醫療利潤率和 EBITDA 的走勢？

Yes, certainly. This is Jeff. I think one of the hard parts about comparing to prior years is there was a substantial amount of development in the third quarter. As we prepare our budget for the next year, we use an incurred basis. So, we put all that development in the dates of service where it belongs.

是的，當然。這是傑夫。我認為與前幾年相比，困難之處之一是第三季取得了大量發展。在編製下一年度的預算時，我們採用的是已發生基礎。因此，我們將所有這些開發都放在了其所屬的服務日期中。

And so it's kind of hard to get the quarterly trajectory. I wouldn't call out anything specific other than we're using kind of a restated income statement on an incurred basis to develop our seasonality here, and that's really what we're [targeting of]. So nothing unusual. And I would think you would see a normal progression that you've seen in the past with higher profitability in the earlier quarters and obviously, Q4 generally being the highest amount of medical costs.

因此很難獲得季度軌跡。除了我們使用一種基於已發生損益表的重述來發展我們的季節性之外，我不會說任何具體的事情，這確實是我們[針對]。所以沒什麼不尋常的。我認為你會看到一個正常的成長趨勢，就像過去一樣，前幾季的獲利能力更高，而且顯然第四季度的醫療成本通常是最高的。

This concludes our Q&A. I'll now hand back to Steve Sell for any final remarks.

我們的問答到此結束。現在我將把發言權交還給史蒂夫·塞爾 (Steve Sell)，請他做最後的評論。

All right. Thanks everyone for a good call. In summary, I think we're pleased with our first quarter results. I think they reflect: one, the resilience of our business model; and two, the solid progress that we've made on the action plan areas that we've called out to you towards the back half of last year. There's more for us to do, and we look forward to updating you on that on the next call.

好的。感謝大家的來電。總而言之，我認為我們對第一季的業績感到滿意。我認為它們反映了：第一，我們商業模式的彈性；第二，我們在去年下半年向您呼籲的行動計劃領域取得了堅實的進展。我們還有很多工作要做，我們期待在下次通話中向您通報最新情況。

Thanks, everybody.

謝謝大家。

Ladies and gentlemen, today's call has now concluded. We'd like to thank you for your participation. You may now disconnect your lines.

女士們、先生們，今天的電話會議到此結束。我們感謝您的參與。現在您可以斷開線路了。