Alignment Healthcare Inc (ALHC) 2024 Q2 法說會逐字稿

Good afternoon, and welcome to Alignment Healthcare's second quarter 2024 earnings conference call and webcast. (Operator Instructions) Please be advised that today's conference is being recorded. Leading today's call are John Kehoe, Founder and CEO, and Thomas Freeman, Chief Financial Officer.

下午好，歡迎參加 Alignment Healthcare 的 2024 年第二季財報電話會議和網路廣播。（操作員指示）請注意，今天的會議正在錄製中。今天的電話會議由創辦人兼執行長 John Kehoe 和財務長 Thomas Freeman 主持。

Before we begin, we would like to remind you that certain statements made during this call would be forward-looking statements as defined by the Private Securities Litigation Reform Act. These forward-looking statements are subject to various risks and uncertainties and reflect our current expectations based on our beliefs, assumptions, and information currently available to us.

在開始之前，我們想提醒您，本次電話會議中所做的某些陳述將屬於《私人證券訴訟改革法案》所定義的前瞻性陳述。這些前瞻性陳述受到各種風險和不確定性的影響，並反映了我們基於我們的信念、假設和目前可獲得的資訊的當前預期。

Descriptions of some of the factors that could cause actual results to differ materially from those forward-looking statements are discussed in more detail in our filings with the SEC, including the Risk Factors section of our annual report on Form 10-K for the fiscal year ended December 31, 2023. Although we believe our expectations are reasonable, we undertake no obligation to revise any statements to reflect changes that occur after this call.

我們向 SEC 提交的文件中更詳細地討論了可能導致實際結果與前瞻性陳述存在重大差異的一些因素的描述，包括本財年 10-K 表格年度報告的風險因素部分截至2023 年12 月31 日。儘管我們相信我們的期望是合理的，但我們沒有義務修改任何聲明以反映本次電話會議後發生的變化。

In addition, please note that the company will be discussing certain non-GAAP financial measures that they believe are important in evaluating performance. Details on the relationship between these non-GAAP measures to the most comparable GAAP measures and reconciliation of historical non-GAAP financial measures can be found in the press release that is posted on the company's website and in our Form 10-Q for the fiscal quarter ended June 30, 2024.

此外，請注意，本公司將討論他們認為對評估績效很重要的某些非公認會計準則財務指標。有關這些非 GAAP 指標與最具可比性 GAAP 指標之間關係的詳細信息，以及歷史非 GAAP 財務指標的調節表，請參閱公司網站上發布的新聞稿以及我們本財季的 10-Q 表格。 2024 年6 月30 日。

It is now my pleasure to introduce Founder and CEO, John Kao.

現在我很高興向您介紹創始人兼執行長高約翰。

Hello, and thank you for joining us on our second quarter earnings conference call. For the second quarter 2024, our health plan membership of 175,100 members represented approximately 56% growth year-over-year and outperformed our year-end membership guidance of 170,000 to 172,000 members.

您好，感謝您參加我們的第二季財報電話會議。2024 年第二季度，我們的健康計畫會員人數為 175,100 名，年成長約 56%，超出了我們 170,000 至 172,000 名會員的年終指引。

Total revenue of $681 million grew approximately 47% year-over-year and 58% excluding ACO REACH. Adjusted gross profit of $77 million produced a consolidated MBR of 88.7% which led to our adjusted EBITDA of positive $6 million in the quarter. Both our adjusted gross profit and adjusted EBITDA achieved the high end of our second quarter guidance which places us on track toward our full year adjusted gross profit and adjusted EBITDA guidance ranges.

總營收為 6.81 億美元，年成長約 47%，不包括 ACO REACH 則成長 58%。調整後毛利為 7,700 萬美元，合併 MBR 為 88.7%，這使得我們本季調整後 EBITDA 為正 600 萬美元。我們的調整後毛利和調整後 EBITDA 均達到了第二季度指導的上限，這使我們有望實現全年調整後毛利和調整後 EBITDA 指導範圍。

As we round out the first half of the year, I'm proud of what the team has accomplished. Over the past several years, we increased investments in member experience, clinical infrastructure, distribution, and our unified data platform AVA, to realize our vision of medicare advantage done right. These investments provide us with the visibility and control required to manage our markets in real time, resulting in both exceptional growth and superior MBR outcomes. We continue to believe our platform is the model for the future of medicare advantage and our year-to-date results reinforce my optimism about our replicability and scalability over time.

當上半年即將結束時，我為團隊所取得的成就感到自豪。在過去的幾年裡，我們增加了對會員體驗、臨床基礎設施、分銷和統一資料平台 AVA 的投資，以實現我們正確實現醫療保險優勢的願景。這些投資為我們提供了即時管理市場所需的可見性和控制力，從而實現了非凡的成長和卓越的 MBR 結果。我們仍然相信我們的平台是未來醫療保險優勢的典範，我們今年迄今的業績增強了我對我們隨著時間的推移的可複製性和可擴展性的樂觀態度。

During the second quarter, we continued to drive membership growth ahead of expectations. Our sustained growth momentum was enabled by strong product offerings resulting from our virtuous cycle which reinvests savings from our unique ability to manage medical costs into richer benefit offerings. This was further supported by robust broker engagement activity and our expanding reputation for clinical quality and a superior member experience.

第二季度，我們持續推動會員成長超出預期。我們的持續成長動力得益於我們的良性循環所帶來的強大產品供應，將我們管理醫療成本的獨特能力所節省的資金重新投資到更豐富的福利產品中。強勁的經紀人參與活動以及我們在臨床品質和卓越會員體驗方面不斷擴大的聲譽進一步支持了這一點。

Heading into this AEP, we continue to deepen strong relationships with our broker partners as we become the household name for seniors seeking the best quality at the lowest cost. From a retention standpoint, our member experience in investments last year resulted in our voluntary disenrollment rate improving roughly 22% year-over-year. We achieved this while improving service levels and seamlessly onboarding approximately 63,000 net members in the last 12 months, demonstrating the scalability of our platform. Our 56% growth year-over-year makes us one of the fastest-growing MA plans in the nation, and we believe the only MA plan that has demonstrated an ability to both grow membership rapidly and manage MBR.

進入本次 AEP 後，我們將繼續深化與經紀合作夥伴的牢固關係，成為尋求以最低成本獲得最佳品質的老年人家喻戶曉的品牌。從保留率的角度來看，去年我們的會員投資經驗使我們的自願退出率比去年同期提高了約 22%。我們在實現這一目標的同時提高了服務水平，並在過去 12 個月內無縫地吸引了約 63,000 名網路會員，這展示了我們平台的可擴展性。我們 56% 的同比增長使我們成為全國增長最快的 MA 計劃之一，我們相信這是唯一一個能夠快速增加會員和管理 MBR 的 MA 計劃。

As we have said before, we are focused on profitable growth. This is enabled by our visibility and control over the value drivers required to manage our MBR; stars, risk adjustment, medical management, product development, and provider engagement. These capabilities resulted in continued utilization outperformance in the second quarter, including inpatient emissions per 1,000 of 151 which is approximately in line with the prior quarter.

正如我們之前所說，我們專注於獲利成長。這是透過我們對管理 MBR 所需的價值驅動因素的可見性和控制來實現的；星級、風險調整、醫療管理、產品開發和提供者參與。這些功能使第二季的使用率持續表現出色，包括 151 中每 1,000 名住院患者的排放量，與上一季大致持平。

Our MBR result in the second quarter is a continuation of the momentum we achieved in the first quarter where we grew 51% year-over-year, while MBR increased just 1.5%. As a reminder, new members typically join at a higher MBR, meaning faster-growing plans with a higher mix of new members, typically see a greater increase in MBR year-over-year.

第二季的 MBR 業績延續了第一季的勢頭，年增 51%，而 MBR 僅成長 1.5%。提醒一下，新會員通常會以更高的 MBR 加入，這意味著增長更快且新會員組合更多的計劃通常會看到 MBR 逐年大幅增長。

To put our performance into perspective, the average publicly-traded national health plan grew medicare advantage members just 2% year-over-year, while MBR still increased by 2.8% in the first quarter as the industry faced utilization, stars and risk adjustment challenges. Our differentiated results shared here are further highlighted in the latest investor presentation available on our Investor Relations website. While we are pleased with our MBR performance to date, we are already driving innovation to improve our clinical outcomes through pre-service care navigation, post discharge case management and IPA performance improvement, all of which we believe will continue to improve our MBR results in the future.

從我們的表現來看，公開交易的國家健康計劃平均醫療保險優勢成員同比僅增長了 2%，而 MBR 在第一季仍增長了 2.8%，因為該行業面臨利用率、星級和風險調整挑戰。我們的投資者關係網站上提供的最新投資者簡報進一步強調了我們在此分享的差異化結果。雖然我們對迄今為止的MBR 表現感到滿意，但我們已經在推動創新，透過服務前護理導航、出院後病例管理和IPA 績效改進來改善我們的臨床結果，我們相信所有這些都將繼續改善我們的MBR結果未來。

Turning to our preparation for 2025. We believe we are well positioned to deliver at least 20% growth next year and adjusted EBITDA profitability through MBR improvement and continued SG&A leverage. Our confidence in our ability to achieve both objectives is underpinned by our margin-focused bid process and our competitive advantages heading into 2025. We have added more members than any other health plan in California in 2024 and our growing market presence is increasing our competitive advantages.

談談我們為 2025 年所做的準備。我們相信，我們有能力在明年實現至少 20% 的成長，並透過 MBR 的改進和持續的 SG&A 槓桿來調整 EBITDA 獲利能力。我們對實現這兩個目標的能力充滿信心，這得益於我們以利潤為中心的投標流程以及我們進入 2025 年的競爭優勢。到 2024 年，我們增加的會員數量比加州任何其他健康計劃都要多，而且我們不斷增長的市場影響力正在增強我們的競爭優勢。

In addition to supporting our enterprise operating leverage objectives, our size and market share gains enhance our local competitive position by increasing mind share with brokers, collaboration with providers, and reputation among seniors. Even with our strong growth, our California market share stands at only 4.5%, leaving a significant room to expand further. Over the long term, we believe we can capture at least 20% share across our California markets, similar to what we've achieved in some of our most mature counties.

除了支持我們的企業營運槓桿目標之外，我們的規模和市場份額的成長還透過增加與經紀人的思想份額、與提供者的合作以及在老年人中的聲譽來增強我們的本地競爭地位。儘管我們成長強勁，但我們在加州的市佔率僅為 4.5%，進一步擴張的空間很大。從長遠來看，我們相信我們可以在加州市場佔據至少 20% 的份額，類似於我們在一些最成熟的縣所取得的成就。

In 2025, we plan to fully capitalize on our position in California where we have relative advantages on stars and risk model changes. Even after accounting for the recent CMS Star rating changes, there are still approximately 1.2 million total California seniors in HMO plans below four stars or not rated. Given our position with roughly 95% of our California members and plans that will still have four-star payment level, we anticipate a unique opportunity to capture strong growth while remaining focused on margin expansion.

到 2025 年，我們計劃充分利用我們在加州的地位，在那裡我們在星級和風險模型變化方面具有相對優勢。即使考慮到最近 CMS 星級評級的變化，仍有約 120 萬加州老年人的 HMO 計劃低於四星或未評級。鑑於我們在大約 95% 的加州會員中的地位以及仍將具有四星級付款水平的計劃，我們預計將有一個獨特的機會來實現強勁增長，同時繼續專注於利潤擴張。

Outside of California, we have more than doubled our membership year-over-year and continue to demonstrate our commitment to quality. The recent update to CMS Star ratings for payment year 2025 awarded us a five-star rating in our North Carolina and Nevada markets. By first focusing on stars and clinical outcomes, we have built a strong foundation that gives us long-term competitive advantages.

在加州以外，我們的會員數量比去年同期增加了一倍以上，並繼續體現我們對品質的承諾。最近更新的 2025 年付款年 CMS 星級評級為我們在北卡羅來納州和內華達州市場授予了五星級評級。透過先專注於明星和臨床結果，我們奠定了堅實的基礎，為我們帶來長期競爭優勢。

As we move toward consolidated profitability, we will be able to deepen our investments in these newer markets. When combined with our investments in our shared services infrastructure and our ability to scale, we see a significant opportunity to accelerate and sustain growth in these newer markets over time. Given our competitive strength in our existing markets, our focus on profitability and our solid positioning to achieve at least 20% growth, we will not enter any new states in 2025. However, we expect to prioritize further market expansion in future years while committing to sustained profitability.

隨著我們邁向鞏固獲利能力，我們將能夠深化對這些新市場的投資。結合我們對共享服務基礎設施的投資和我們的擴展能力，我們看到了隨著時間的推移加速和維持這些新興市場成長的重大機會。鑑於我們在現有市場的競爭優勢、我們對獲利能力的關注以及我們實現至少 20% 成長的穩固位，我們在 2025 年不會進入任何新的狀態。然而，我們預計未來幾年將優先考慮進一步的市場擴張，同時致力於持續獲利。

In conclusion, I'd like to thank each of our employees for their part in pioneering the Medicare Advantage model of the future. Tens of thousands of new members are choosing alignment as their senior health care partner this year, making us one of the fastest growing plans in the nation. However, we are just barely scratching the surface for the millions of seniors who need our help. And I believe we will make further inroads towards our vision for medicare done right in 2025.

最後，我要感謝我們的每一位員工為開創未來的 Medicare Advantage 模式所做的貢獻。今年，數以萬計的新會員選擇聯盟作為他們的高級醫療保健合作夥伴，使我們成為全國發展最快的計劃之一。然而，對於數百萬需要我們幫助的老年人來說，我們僅僅觸及了表面。我相信，我們將進一步推動 2025 年實現醫療保險的願景。

I look forward to sharing more as we get closer to AEP. And now I'll turn the call over to Thomas to further discuss our financial results and outlook. Thomas?

隨著 AEP 的臨近，我期待分享更多資訊。現在我將把電話轉給托馬斯，進一步討論我們的財務表現和前景。托馬斯？

Thanks, John. For the quarter ending June 2024, our health plan membership of 175,100 increased 56% year-over-year, outperforming our expectation for 50% membership growth at the midpoint of our second quarter guidance range. Our second quarter revenue of $681 million represented 47% growth year-over-year and 58% growth, excluding Aco Reach.

謝謝，約翰。截至 2024 年 6 月的季度，我們的健康計畫會員人數為 175,100 人，年增 56%，超出了我們對第二季度指導範圍中點 50% 會員增長的預期。我們第二季的營收為 6.81 億美元，年增 47%，不包括 Aco Reach 則成長 58%。

As John described, our value proposition and reputation for quality, service delivery and provider and broker partnership continue to expand in our local markets, setting us up with positive momentum heading into this AEP. Adjusted gross profit in the quarter was $77 million, representing an MBR of 88.7% and a 220 basis point improvement from the first quarter.

正如 John 所描述的，我們在品質、服務交付以及提供者和經紀人合作夥伴關係方面的價值主張和聲譽繼續在我們的當地市場擴展，為我們進入此 AEP 奠定了積極的動力。該季度調整後毛利為 7,700 萬美元，MBR 為 88.7%，較第一季提高 220 個基點。

For the second quarter in a row, we are demonstrating that industry-leading membership growth can be balanced with strong MBR performance if you have a model with differentiated visibility and control. Second quarter utilization experience continued to trend within our expectations with inpatient admissions per 1,000 of 151 continuing to drive our overall MBR performance.

我們連續第二個季度證明，如果您擁有具有差異化可見度和控制力的模型，行業領先的會員成長可以與強勁的 MBR 性能相平衡。第二季的使用體驗持續符合我們的預期趨勢，151 位患者中每 1,000 例的住院人數繼續推動我們的整體 MBR 表現。

While we believe our inpatient admissions per 1,000 performance continues to lead the industry, we still see significant room for improvement in the back half of the year which I will expand on shortly. Our utilization performance was partially offset by the overall increasing mix of new members from our strong growth outperformance who are still being on board onto our clinical programs.

雖然我們相信我們每 1,000 名住院患者的表現繼續引領行業，但我們仍然認為今年下半年還有很大的改進空間，我很快就會對此進行闡述。我們的利用績效被我們強勁的成長表現所帶來的新成員整體增加所部分抵消，這些新成員仍在參與我們的臨床計畫。

As we previously mentioned, we are also continuing to navigate heightened levels of supplemental benefit expense and atypically high unit cost increases in 2024, both of which will improve in 2025. As we closed out the second quarter, it's worth noting that we now have sufficient paid claims visibility on our first quarter dates of service experience to more fully assess our Q1 performance.

正如我們之前提到的，我們也將繼續應對 2024 年補充福利費用水準的提高和單位成本異常高的成長，這兩者都將在 2025 年得到改善。在我們結束第二季度時，值得注意的是，我們現在對第一季的服務體驗日期有足夠的付費索賠可見性，可以更全面地評估我們第一季的業績。

Given our overall volume of new membership, we are pleased to report that we remain confident in our first quarter incurred but not paid or IBNP accruals, implying both accuracy in our initial assessments as well as stability in our overall reserves.

鑑於我們的新會員總數，我們很高興地報告，我們對第一季已發生但未支付的或IBNP 應計項目仍然充滿信心，這意味著我們初步評估的準確性以及我們整體準備金的穩定性。

Turning to OpEx, SG&A in the quarter was $88 million. Our adjusted SG&A was $71 million, an increase of 27% year-over-year. Adjusted SG&A as a percentage of revenue, excluding ACO REACH, declined from 12.9% to 10.4% year-over-year, improving by approximately 250 basis points and exceeding our Q2 operating leverage expectations. Taken together, our adjusted EBITDA was positive $6 million in the quarter, achieving the high end of our outlook range and placing us on track towards our full year adjusted EBITDA guidance. Lastly, we ended the quarter with $364 million in cash and investments.

說到營運支出，本季的銷售及管理費用 (SG&A) 為 8,800 萬美元。調整後的 SG&A 為 7,100 萬美元，年增 27%。調整後的 SG&A 佔收入的百分比（不包括 ACO REACH）從 12.9% 年減至 10.4%，提高了約 250 個基點，超出了我們第二季度營運槓桿預期。總而言之，本季調整後 EBITDA 為正 600 萬美元，達到了我們展望範圍的上限，並使我們有望實現全年調整後 EBITDA 指引。最後，本季末我們擁有 3.64 億美元的現金和投資。

Moving to our guidance. For the third quarter, we expect health plan membership to be between 176,000 and 178,000 members, revenue to be in the range of $655 million and $665 million, adjusted gross profit to be between $75 million and $81 million, and adjusted EBITDA to be in the range of $0 million to positive $6 million. For full year 2024, we expect health plan membership to be between 178,000 and 180,000 members, revenue to be in the range of $2.61 billion and $2.64 billion, adjusted gross profit to be between $280 million and $310 million, and adjusted EBITDA to be in the range of a loss of $12 million to positive $12 million.

轉向我們的指導。第三季度，我們預計健康計畫會員人數將在176,000 至178,000 名會員之間，營收將在6.55 億美元至6.65 億美元之間，調整後毛利將在7,500 萬美元至8,100 萬美元之間，調整後EBITDA 將在範圍為 000 萬美元到正 600 萬美元。2024 年全年，我們預計健康計畫會員人數將在178,000 至180,000 名會員之間，收入將在26.1 億美元至26.4 億美元之間，調整後毛利將在2.8 億美元至3.1 億美元之間，調整後EBITDA 將在虧損 1,200 萬美元到正值 1,200 萬美元。

We have raised our year-end membership guidance by an additional 8,000 members based on our year-to-date outperformance and our expectation for continued growth momentum in the second half which further drives the increase in our full year revenue outlook. Since our initial expectations in January, the midpoint of our membership guidance range has increased by 16,000 members. Our outlook now implies membership growth of 50% at the midpoint versus our initial guidance of 37% and revenue growth, excluding ACO REACH, of 54% at the midpoint versus our initial guidance of 41%.

基於我們今年迄今的優異表現以及我們對下半年持續成長勢頭的預期，我們將年終會員指導增加了 8,000 名會員，這進一步推動了我們全年收入前景的增長。自 1 月我們最初的預期以來，我們的會員指導範圍中位數已增加 16,000 名會員。現在，我們的展望意味著會員成長中點為 50%，而我們最初的指導為 37%，收入成長（不包括 ACO REACH）的中點為 54%，而我們最初的指導為 41%。

Turning to profitability, our guidance remains unchanged in spite of our higher growth outlook. We are pleased with the results of our operational initiatives, investments in automation and the continuous improvement of our clinical model. These efforts have resulted in improved SG&A scale economies and closely managed MBR, giving us confidence in our full year adjusted EBITDA guidance.

談到獲利能力，儘管我們的成長前景較高，但我們的指引保持不變。我們對我們的營運計劃、自動化投資以及臨床模型的持續改進的結果感到滿意。這些努力改善了 SG&A 規模經濟並嚴格管理 MBR，使我們對全年調整後 EBITDA 指導充滿信心。

Specifically on adjusted gross profit, we expect the added gross profit dollars from our incremental membership to be offset by a continued uptick in our supplemental benefit expense which we have captured in our 2025 bids. These two factors resulted in an implied 50 basis point MBR increase to our prior guidance. The midpoint of our guidance range now represents an MBR of 88.8% which we are very well positioned to offset with SG&A scale economies.

具體而言，就調整後的毛利而言，我們預計增量會員資格所增加的毛利將被我們在 2025 年投標中捕獲的補充福利費用的持續上升所抵消。這兩個因素導致 MBR 比我們先前的指導值隱含增加 50 個基點。我們指導範圍的中點現在代表 MBR 為 88.8%，我們非常有能力用 SG&A 規模經濟來抵消這一影響。

From a utilization standpoint, our engagement rate of Care Anywhere eligibles among new members remains on target through the first half of the year. We still see significant opportunity remaining in the second half as we work toward achieving our expected year-end engagement rate of 60% from our current level of approximately 30%.

從利用率的角度來看，我們的新會員中符合 Care Anywhere 資格的參與率在今年上半年仍保持在目標範圍內。我們仍然認為下半年仍然存在重大機會，因為我們努力將預期年終參與率從目前約 30% 的水平提高到 60%。

As a reminder, we typically see a 30% improvement in its institutional claims PMPM in the 12 months following engagement compared to our control group of members that have not yet engaged. Accordingly, we see an opportunity to improve our utilization performance as we continue to onboard our new membership and ramp up new member engagement in the back half of the year with a particular eye towards the fourth quarter.

提醒一下，與我們尚未參與的成員對照組相比，我們通常會發現參與後 12 個月內，其機構主張 PMPM 提高了 30%。因此，我們看到了提高利用率績效的機會，因為我們將在下半年繼續吸收新會員並提高新會員的參與度，特別關注第四季度。

Further, as John commented on previously, we continue to see opportunity on cost management beyond the inpatient setting and are ramping up our efforts on both pre-service care navigation, post-discharge case management, and IPA performance improvement to continue to improve our overall MBR. On SG&A, our first half results demonstrate the scalability of our model with adjusted SG&A as a percentage of revenue excluding ACO REACH, declining by 200 basis points year-over-year.

此外，正如 John 先前評論的那樣，我們繼續看到住院以外的成本管理機會，並加大在服務前護理導航、出院後病例管理和 IPA 績效改進方面的努力，以繼續改善我們的整體水平主引導記錄器。在 SG&A 方面，我們上半年的業績證明了我們模型的可擴展性，調整後的 SG&A 佔收入（不包括 ACO REACH）的百分比同比下降了 200 個基點。

We continue to expect even greater improvement in the second half since we will not have the impact of onetime costs incurred last year related to the in-sourcing of our member experience function and the acceleration of AEP growth and staffing expenses. In conjunction with the increase in our membership outlook, our full year guidance now implies an adjusted SG&A as a percentage of revenue of 11.3%, representing roughly 300 basis points of improvement year-over-year, excluding ACO REACH. This improvement includes commissions and other variable expenses related to incremental growth.

我們繼續預計下半年會有更大的改善，因為我們不會受到去年與會員體驗職能內包相關的一次性成本的影響以及 AEP 成長和人員費用的加速。結合我們會員前景的提高，我們的全年指導現在意味著調整後的銷售、管理及行政費用佔收入的比例為 11.3%，相當於同比改善約 300 個基點（不包括 ACO REACH）。這項改進包括佣金和與增量成長相關的其他可變費用。

As we look towards 2025, we are increasingly excited about the growth and margin opportunity in front of us that will be supported by a number of tailwinds. First, our growth momentum in 2024 adds to our scale advantages and mind share with brokers in the upcoming AEP. Second, we believe we have appropriately captured our 2024 higher supplemental benefit expense experience in our 2025 bids. Third, our weighted average benchmark increase of 5% relative to the national average of 2.4% will make us hold for the outsized unit cost increases we are currently absorbing in 2024. Finally, our relative advantages on stars and the second phase of the V28 risk model changes will further our competitive positioning.

展望 2025 年，我們對眼前的成長和利潤機會越來越感到興奮，這些機會將得到許多有利因素的支持。首先，我們在 2024 年的成長勢頭增加了我們在即將推出的 AEP 中的規模優勢和與經紀商的心智份額。其次，我們相信我們在 2025 年投標中適當地抓住了 2024 年較高補充福利費用的經驗。第三，相對於全國平均 2.4%，我們的加權平均基準成長率為 5%，這將使我們對目前正在吸收的 2024 年單位成本大幅成長持觀望態度。最後，我們在明星方面的相對優勢和 V28 風險模型第二階段的變化將進一步增強我們的競爭地位。

In summary, the combination of these factors positions us strongly towards driving adjusted EBITDA profitability while achieving our growth target of at least 20% or greater next year.

總而言之，這些因素的結合使我們能夠強有力地推動調整後的 EBITDA 獲利能力，同時實現明年至少 20% 或更高的成長目標。

With that, let's open the call to questions. Operator?

接下來，讓我們開始提問。操作員？

(Operator Instructions) John Ransom, Raymond James.

（操作員說明）約翰·蘭塞姆、雷蒙德·詹姆斯。

Hey, good evening. I may have missed this but was there anything to call out in the quarter from the midyear sweep?

嘿，晚上好。我可能錯過了這一點，但是本季的年中大掃除有什麼值得關注的嗎？

Hey, John, this is Thomas. I can take that one. So we did pick up a bit of revenue in the second quarter related to the sweeps, both the final sweep from last year and the mid-year sweep of this year, though the majority of the revenue outperformance in the quarter was related to the membership outperformance. From a gross profit standpoint, we actually did not pick up much relative to expectations on the sweeps. And similar to last year, where we talked about how a lot of the sweeps came through with some of our globally capitated contracts, it wasn't really a significant driver of overall MBR performance in the quarter relative to expectations.

嘿，約翰，這是托馬斯。我可以接受那個。因此，我們在第二季度確實獲得了一些與抽獎相關的收入，包括去年的最終抽獎和今年年中的抽獎，儘管本季度的大部分收入表現與會員資格有關表現出色。從毛利的角度來看，相對於掃蕩的預期，我們實際上並沒有獲得太多收益。與去年類似，我們討論了我們的一些全球資本合約如何完成大量掃蕩，相對於預期而言，這並不是本季整體 MBR 業績的重要推動因素。

Okay. And then, just -- this is a question for John and I'll get back in the queue. Asked this one of your competitors but it seems like there's a plurality of people in DC who are not convinced that Medicare Advantage is a great deal for the taxpayers. When you're having those conversations with policy people, what's your elevator pitch? I mean, we know it's good for members and doctors like it but what's the pitch that says at least it's a tie, if not better, for the taxpayers.

好的。然後，這是約翰的問題，我會回到隊列中。問您的一位競爭對手，但似乎華盛頓特區有很多人不相信 Medicare Advantage 對納稅人來說是一筆划算的交易。當你與政策制定者對話時，你的電梯遊說是什麼？我的意思是，我們知道這對會員和喜歡的醫生有好處，但它的宣傳至少對納稅人來說是平局，甚至更好。

Hey, John. I'd say that the benefits for the beneficiaries and I think to your point, the doctors, I think, is pretty compelling. I think some of the recent policy changes with respect to stars and with respect to V28 and even with respect to some of the potential changes with respect to the distribution side of things, it's all getting back to what CMS really originally intended which we think is a really good thing which is to increase quality access at a more affordable price, less than fee-for-service.

嘿，約翰。我想說的是，對於受益者和醫生來說，我認為，對於你的觀點來說，這是非常引人注目的。我認為最近關於星星和 V28 的一些政策變化，甚至關於分發方面的一些潛在變化，這一切都回到了 CMS 真正最初的意圖，我們認為是一件非常好的事情是以更實惠的價格（低於服務費）提高訪問品質。

And I think that's the trend that I see happening. And I think this kind of higher standard and lowering cost, if you will, overall, for the taxpayer fundamentally is going to be better for everybody. And I think that's certainly the foundation and the infrastructure that we've built and we've been saying that since the beginning which is the companies that will win are those that are going to be providing the highest quality of care at the lowest cost.

我認為這就是我所看到的趨勢。我認為這種更高的標準和更低的成本，如果你願意的話，總的來說，對於納稅人來說，從根本上對每個人都更好。我認為這肯定是我們建立的基礎和基礎設施，我們從一開始就一直在說，那些能夠以最低成本提供最高品質護理的公司將會獲勝。

Thank you, sir.

謝謝您，先生。

Got it.

知道了。

Whit Mayo, Leerink Partners.

惠特·梅奧，Leerink 合夥人。

Hey, thanks. Good afternoon. Thomas, back on that member engagement metric that you referenced, is that 30% number for 100% of the total new members this year? Or is that a subset of the total new members? And is that for the first quarter or for the first half? Sorry.

嘿，謝謝。午安.Thomas，回到您提到的會員參與度指標，今年 100% 的新會員中是否有 30% 的數字？還是這是新成員總數的一部分？這是第一季還是上半年？對不起。

Yes. No, good questions. So what we're really talking about there is engagement of the Care Anywhere eligible population. And so as a reminder, when we onboarded our new membership this year, we quickly began running the data we are capturing from lab values, pharmacy data, authorization and utilization data through our stratification model to identify those that we thought were at greatest risk of an inpatient event and had the greatest level of comorbidities and therefore needed that proactive Care program that we call Care Anywhere.

是的。不，好問題。因此，我們真正談論的是符合 Care Anywhere 資格的人群的參與。因此，提醒一下，當我們今年加入新會員時，我們很快就開始透過我們的分層模型運行從實驗室值、藥房數據、授權和使用數據中捕獲的數據，以識別我們認為風險最大的人群這是一次住院事件，合併症程度最高，因此需要我們稱之為「隨處照護」的主動照護計畫。

And so as we have continued to identify those members over the course of the second quarter, it stands at about probably 10% of the population is eligible for that Care Anywhere program. We've engaged about 30% of them so far which is really, I'd say, consistent with our expectations this year and it's pretty consistent to where we have performed in years past. But of course, if you think about that relative to our overall population which typically runs at about 60% engagement on that more intensive set of Care programs, there's clearly a big opportunity for us to get from 30% to 60% over the back half of the year.

因此，隨著我們在第二季度繼續確定這些成員，大約有 10% 的人口有資格參加 Care Anywhere 計畫。到目前為止，我們已經聘用了大約 30% 的員工，我想說，這確實符合我們今年的預期，也與我們過去幾年的表現非常一致。但是，當然，如果你考慮相對於我們的總體人口（通常大約有60% 的人參與更密集的護理計劃），我們顯然有很大的機會在後半段將這一比例從30% 提高到60%今年的。

And so that's what we're really underscoring as a significant area of opportunity where year-to-date, we're quite pleased with our emissions per thousand performances. We mentioned that for the second quarter in a row we've run below 150 inpatient admissions per 1,000. But we still feel like there's an opportunity to do better as we continue to ramp up engagement and onboard the significant growth we've taken on this year.

因此，這就是我們真正強調的一個重要機會領域，今年迄今為止，我們對每千場演出的排放量感到非常滿意。我們提到，連續第二季每 1,000 人中住院人數低於 150 人。但我們仍然認為，隨著我們繼續提高參與度並實現今年的顯著成長，我們仍然有機會做得更好。

And maybe just my follow-up on still just staring at this 10,000 new members that you picked up in the quarter and it certainly jumps off the page. Just maybe unpack that a little bit. I presume the preponderance of that is California but maybe D-SNP, just agents. Just any other color commentary to help us sort of visualize kind of how you picked up that much growth.

也許我的後續行動仍然只是盯著您在本季招募的這 10,000 名新會員，它肯定會跳出頁面。也許只是稍微解開一下。我認為其中的優勢是加州，但也可能是 D-SNP，只是特工。只是任何其他顏色評論，可以幫助我們形像地了解您是如何獲得如此大的增長的。

Yeah, absolutely. So I think from a market positioning standpoint, I think there's sort of a few things happening. So first is our products continue to be market leading which is a function of the benefits we were able to afford based on the Care model and our overall virtuous cycle we often talk about. And so I think that leading product position has combined with this kind of growing reputation among seniors for quality and from brokers as well.

是的，絕對是。因此，我認為從市場定位的角度來看，我認為正在發生一些事情。首先，我們的產品繼續保持市場領先地位，這是我們基於護理模式和我們經常談論的整體良性循環能夠提供的好處的函數。因此，我認為領先的產品地位與老年人和經紀人之間日益增長的品質聲譽相結合。

And that's really, I think, underscored by the fact that we've maintained our star rating at four-stars or greater now for the last, I think, six or seven years in California for that HMO contract. And as we continue to grow market share, I think just that word-of-mouth grassroots movement is continuing to gain traction. From an actual product standpoint, you're right, a good portion of the membership we continue to grow at in the second quarter was through the duly eligible population.

我認為，這一事實確實強調了這一點，因為在加州的 HMO 合約中，我們在過去六、七年裡一直將星級評級維持在四星或更高。隨著我們不斷擴大市場份額，我認為這種口碑傳播的草根運動正在繼續獲得關注。從實際產品的角度來看，你是對的，我們在第二季度繼續增長的會員數量中有很大一部分是透過符合資格的人口來實現的。

That tends to be a sweet spot for us, both for our Care programs and we tend to do well financially on those members. And I think overall, our duals still stand at about 30% of our total book of business. Beyond that though, we offer products that are designed for a variety of acuities, ethnicities and income levels. So I think we're continuing to see pretty good traction amongst different product types as well.

這對我們來說往往是一個最佳點，無論是對於我們的護理計劃，還是我們在這些會員身上的財務狀況都很好。我認為總體而言，我們的雙線業務仍然占我們總業務的 30% 左右。除此之外，我們還提供專為各種視力、種族和收入水平而設計的產品。因此，我認為我們在不同的產品類型中也繼續看到相當好的吸引力。

Thanks, guys.

謝謝，夥計們。

Michael Ha, Baird.

麥可·哈，貝爾德。

Hi, thank you. So I wanted to talk about SG&A. And yes, what's really remarkable to me is that you guys are basically at the same SG&A as Humana. Yet, they are 50x your size in revenue. So it's pretty eye-opening to think about that and your ability to generate just a scaled economy, cost leverage, especially in a year where you're growing like 56%. So my first two questions would be how sustainable do you think this is going forward?

你好，謝謝。所以我想談談SG&A。是的，對我來說真正值得注意的是你們基本上與 Humana 處於相同的 SG&A 水平。然而，他們的收入規模是您的 50 倍。因此，考慮到這一點以及您創造規模經濟和成本槓桿的能力，尤其是在您成長 56% 的一年裡，真是令人大開眼界。所以我的前兩個問題是，您認為這種情況未來的可持續性如何？

Number two, any unique items to call out that may have benefitted 2Q? And then taking a step back, a general question on what you think the secret sauce is in creating your cost structure? And then I guess a question four is, are there any other low-hanging fruit opportunities or do you think you're at that point where it's all about like productivity, automation, technology and that's sort of the new stage of cost structure evolution?

第二，有什麼獨特的專案可以讓第二季受益嗎？然後退後一步，問一個一般性問題：您認為創建成本結構的秘訣是什麼？然後我想問題四是，是否還有其他唾手可得的機會，或者您認為您是否正處於生產力、自動化、技術以及成本結構演變的新階段？

Hey, Michael, great question. I'd say we kind of passed a scale threshold that we needed to really benefit from some of the investments that we've made over the past couple of years. And if you recall, we spent a lot of effort on our consumer engagement. Everything is around service delivery and around clinical quality outcomes. So that whole line of thinking around just quality as reflected in stars and as reflected in retention rates is really starting to pay off.

嘿，邁克爾，好問題。我想說，我們已經跨越了一個規模門檻，我們需要從過去幾年所做的一些投資中真正受益。如果您還記得的話，我們在消費者參與方面投入了大量精力。一切都圍繞著服務提供和臨床品質結果。因此，圍繞星級和保留率所反映的品質的整個思路確實開始得到回報。

The foundation of your question though starts with the way in which we've architected our systems, the way in which we look at our data. And so we have this kind of data architecture that's what we call a unified data architecture. And we have information that's actionable in real time. There's not a 60 or 90-day delay in reconciling claims data with eligibility data with provider databases. It's all kind of captured in a unified data architecture. That allows us to make very efficient and actionable decisions.

不過，您問題的基礎始於我們建立系統的方式以及我們查看資料的方式。所以我們有這種資料架構，我們稱之為統一資料架構。我們擁有可即時操作的資訊。將索賠資料與資格資料與提供者資料庫進行核對時不會出現 60 或 90 天的延遲。這一切都被捕捉在統一的資料架構中。這使我們能夠做出非常有效且可行的決策。

And it allows us to streamline our functional G&A in a way that we don't have to just staff up manually. And so that, I would say, is the main opportunity. And by the way, to your point, I mean -- and it's with that additional growth that we just announced came incremental commission expenses. And so to the point that you just made, these efficiencies that we're garnering from these investments in automation are even more profound. And I think we're going to be able to scale that even further.

它使我們能夠簡化職能性的一般管理費用，而不必只是手動配備人員。所以，我想說，這是主要的機會。順便說一句，就你的觀點而言，我的意思是——隨著我們剛剛宣布的額外增長，佣金費用也隨之增加。因此，就您剛才提出的觀點而言，我們從自動化投資中獲得的效率甚至更深遠。我認為我們將能夠進一步擴大規模。

The thing that should also be noted is onboarding 63,000 new members was seamless. That's a big deal. It's really quite a statement to be able to onboard all these folks and have no complaints. I'm actually at a broker event right now and I asked the brokers, and they said, no, they haven't heard any complaints from our members. They're very happy. That, I think, is a function of the systems and the automation paying off. Low-hanging fruit, I do think there's opportunities.

還應該指出的是，63,000 名新會員的入職是無縫的。這是一件大事。能夠讓所有這些人加入並且沒有任何抱怨，這確實是一個很好的聲明。實際上，我現在正在參加經紀人活動，我問經紀人，他們說，不，他們沒有聽到我們會員的任何投訴。他們很高興。我認為，這是系統的功能和自動化的回報。唾手可得的成果，我確實認為有機會。

I think there is opportunities in the way in which we work with our provider partners. I think we have set out on a path to, we call it a path to surplusing more. We want our IPAs to make more money. We want them to be more successful. I think there's opportunities there. I think there's opportunities with the way in which we're improving our clinical model, again, using AVA technology.

我認為我們與供應商合作夥伴的合作方式存在機會。我認為我們已經踏上了一條通往更多盈餘的道路。我們希望我們的 IPA 賺更多的錢。我們希望他們更加成功。我認為那裡有機會。我認為我們使用 AVA 技術改進臨床模型的方式存在機會。

On the G&A side, I think back-office automation in a variety of areas is also something that should be noted that we're able to achieve these G&A scale economies while we're doing implementations of getting more automation in our back office and our EHR and our administrative functions. So all of that is going to, I think, even lend more opportunity for us for margin expansion, the bigger we get.

在 G&A 方面，我認為各領域的後台自動化也是值得注意的，當我們在後台和我們的後台實施更多自動化時，我們能夠實現這些 G&A 規模經濟。因此，我認為，所有這些甚至將為我們提供更多的利潤擴張機會，我們規模越大。

Thank you, really appreciate that. Maybe just one more relatively long-ish question. So, yes, in a year where everyone's reducing benefits, you guys have shown that edge and not only maintaining but increasing benefits, I think, by 70 bps year-to-year. And so with that said, 2025 would be expected to be another year probably with even worse benefit reductions across the board.

謝謝你，真的很感激。也許只是一個相對較長的問題。所以，是的，在每個人都在減少福利的一年裡，你們已經表現出了這種優勢，不僅維持了福利，而且還增加了福利，我認為，每年增加了 70 個基點。話雖如此，預計 2025 年將是另一個全面福利削減更嚴重的一年。

So understanding that and also your massive advantage in star rating in California, would it be fair to say next year could be another year where Alignment had similar benefit stability? Or is it a year where you're just so far ahead in terms of competitive positioning, star ratings, funding, that investing more into benefits and taking advantage of your position might be a bigger priority? And I know it's a delicate balance between your focus on margins next year, but I'd love to hear your thoughts.

因此，了解了這一點以及您在加州星級評定方面的巨大優勢，是否可以公平地說明年可能是 Alignment 具有類似福利穩定性的另一年？或者今年您在競爭定位、星級評定、資金方面遙遙領先，因此更多地投資於福利並利用您的地位可能是更重要的優先事項？我知道明年您對利潤的關注之間存在著微妙的平衡，但我很想聽聽您的想法。

Yeah. Well, I'll just -- shout out to you, Michael. I mean you were the only one that called 50% growth last year. So having said that, we're still sticking to the 20% -- at least 20% growth dynamic. I will say that in our bids, I would say we were much more margin focused in the '25 bids. And so the degree of growth we will achieve or won't achieve, I think, is a bit of a function of what our competitors do.

是的。好吧，我只是──向你大聲喊叫，麥可。我的意思是，你是唯一一個聲稱去年增長了 50% 的人。話雖如此，我們仍然堅持 20%——至少 20% 的成長動力。我想說的是，在我們的投標中，我們在 25 年的投標中更加重視利潤。因此，我認為，我們將實現或不會實現的成長程度在一定程度上取決於我們的競爭對手的做法。

All of the kind of the rational metrics that we see with respect to star ratings, V28 exposure, and some of the perhaps aggressive pricing that they exhibited last year, lead us to conclude that you're right that people will be more conservative than not. And also, to your point, remember in 2024, we got this growth. We did not increase benefits very much, it was relatively flat. And so we just -- we still found that balance between growth and margin.

我們在星級評分、V28 曝光度以及他們去年展示的一些可能激進的定價方面看到的所有理性指標，讓我們得出這樣的結論：你是對的，人們會比不保守更保守。另外，就你的觀點而言，請記住，在 2024 年，我們實現了這種成長。我們福利沒有增加太多，比較平穩。所以我們仍然找到了成長和利潤之間的平衡。

We are very, very, very focused on margin for 2025, I'll say that. But logic would kind of conclude that we're going to have a pretty good year in growth in '25. My only caution is you still have some people doing stuff that are, I'd call it, non-sustainable in terms of their growth strategies. If they don't have the stars or they don't have the V28 kind of tailwinds like we do, they may still just price to lose money. That's certainly a possibility. But I feel really well positioned heading into '25.

我想說的是，我們非常非常非常關注 2025 年的利潤率。但從邏輯上講，我們將在 25 年迎來成長相當好的一年。我唯一要注意的是，仍然有一些人在做一些我認為就其成長策略而言不可持續的事情。如果他們沒有明星，或者他們沒有像我們一樣的 V28 那種順風車，他們可能仍然會定價虧損。這當然是有可能的。但我感覺自己在進入 25 年後處於有利位置。

Remember, last year, we said we felt good with both '24 and '25 is what we said and potentially '26, by the way, depending upon how the stars come out. And we'll find out more about stars in the next couple of months.

請記住，去年，我們說過我們對「24」和「25」感覺良好，順便說一句，還有可能對「26」感覺良好，這取決於明星的表現。在接下來的幾個月裡，我們將了解更多關於明星的資訊。

Thank you, John. I appreciate it.

謝謝你，約翰。我很感激。

You got it, Michael.

你明白了，麥可。

Jess Tassan, Piper Sandler.

傑西·塔桑，派珀·桑德勒。

Hi, guys. Thanks very much for the question. Congratulations on the results. I'm hoping you can help frame the impact of California's efforts to align Medicare and Medicaid benefits by regulating D-SNPs in the state. I'm just interested to know if there's a way for alignment to partner with the Medi-Cal plan and kind of insulate yourself from any forthcoming regulation or restrictions on growth.

嗨，大家好。非常感謝您的提問。祝賀結果。我希望您能夠透過規範加州的 D-SNP 來幫助確定加州努力協調 Medicare 和 Medicaid 福利的影響。我只是想知道是否有一種方法可以與 Medi-Cal 計劃合作，並讓自己免受任何即將到來的成長監管或限制。

Jess, it's John. Good question. Yes, we'd be very interested in partnering with Medicaid plans. I think the tactic that we've taken over the last couple of years, it's clearly an area that we spend a lot of time on -- has really allowed us to still get the kind of growth that we expect through some of the programs and products that will still be able to be sold during SCP and we just feel good about that.

傑西，是約翰。好問題。是的，我們非常有興趣與醫療補助計劃合作。我認為我們在過去幾年中採取的策略，這顯然是我們花費大量時間的一個領域，確實使我們仍然能夠通過一些計劃獲得我們期望的增長，在SCP 期間仍然可以銷售的產品，我們對此感到滿意。

I think fundamentally at a kind of consumer perspective, people don't necessarily want to be forced into a Medicaid network or a set of Medicaid products. They like our service levels. They like our benefit designs and they like our networks. And they like the clinical model of care. And so I think those things thus far have really superseded any kind of aligned network in some of the counties that we're in; and so we'll see. But thus far, we've been able to manage it pretty effectively.

我認為從根本上來說，從消費者的角度來看，人們不一定希望被迫進入醫療補助網絡或一套醫療補助產品。他們喜歡我們的服務水準。他們喜歡我們的福利設計，也喜歡我們的網路。他們喜歡臨床護理模式。因此，我認為到目前為止，這些事情確實取代了我們所在的一些縣中任何類型的聯合網絡；我們拭目以待。但到目前為止，我們已經能夠非常有效地管理它。

Great, thank you. And then I was just hoping that you could comment on utilization over the course of the second quarter. Did you see any kind of end of quarter surge in volumes in any particular setting? And then I wanted to just verify, you all said that you were increasing supplemental benefits in 2025. Is that accurate? Thanks.

太好了，謝謝。然後我只是希望您能對第二季的使用率發表評論。您是否在任何特定情況下看到季度末銷量激增？然後我想核實一下，你們都說要在 2025 年增加補充福利。準確嗎？謝謝。

Jess, Thomas, I can take those two. So on your first question in terms of utilization, I would say our utilization performance throughout the quarter was pretty steady. I think those who maybe saw an uptick in utilization in other situations may have been driven by things such as the new two-midnight rule which as we talked about on the last couple of calls, hasn't really been an issue for us given that we were already really operating under the two-midnight rule as a de facto way of adjudicating claims principally here in California. So that has not been an issue for us nor do we anticipate it being an issue for us kind of moving forward.

傑西，湯瑪斯，我可以帶他們兩個。因此，關於利用率方面的第一個問題，我想說我們整個季度的利用率表現非常穩定。我認為那些在其他情況下看到利用率上升的人可能是受到諸如新的午夜兩點規則之類的因素的推動，正如我們在過去幾次電話中討論的那樣，鑑於這一點，這對我們來說並不是真正的問題我們已經真正按照午夜兩點規則運作，作為主要在加利福尼亞州裁決索賠的事實上的方式。因此，這對我們來說不是問題，我們也預期這對我們前進來說不是問題。

On your second question on supplemental benefits, we did not speak to supplemental benefit changes or increases for 2025. Rather what we were emphasizing is that throughout the first half of 2024, we have continued to see our supplemental benefit expenses increase relative to our initial expectations to a modest extent.

關於你關於補充福利的第二個問題，我們沒有談到 2025 年補充福利的變化或增加。相反，我們強調的是，在 2024 年上半年，我們的補充福利支出相對於我們最初的預期繼續出現小幅增長。

And so that's a part of our overall updated guidance release today, is just contemplating that those will continue at slightly elevated levels over the back half of the year which, to your point, we have captured in our 2025 bid outlook but we're not really commenting on the actual levels of changes in the investments and the benefits for next year.

因此，這是我們今天發布的整體更新指導的一部分，只是考慮到這些將在今年下半年繼續保持在略高的水平，就您而言，我們已經在2025 年的出價展望中考慮到了這一點，但我們並沒有真正評論投資的實際變動水準和明年的效益。

Got it. Thanks.

知道了。謝謝。

Jared Haase, William Blair.

賈里德·哈斯，威廉·布萊爾。

Yes. Hey, guys, this is Jared on for Ryan Daniels this evening. Maybe just a quick one kind of unpacking the utilization trends a little bit further. I know last quarter, the Part D MBR was kind of a big focus. So I was hoping to just get an update there in terms of how that's tracked relative to expectations? And then what's assumed for the second half of the year?

是的。嘿，夥計們，我是賈里德，今晚為瑞安·丹尼爾斯做節目。也許只是進一步了解利用率趨勢的快速方式。我知道上個季度，D 部分 MBR 是一個焦點。所以我希望能得到關於如何相對於預期進行追蹤的更新？那麼下半年的假設是什麼呢？

Yeah. Absolutely, Jared. So I don't think we're going to break out C versus D kind of every quarter moving forward necessarily. And we really wanted to underscore that on the first quarter call just to make sure folks understood the overall mechanics and seasonality from Q1 relative to the rest of the year.

是的。當然，賈里德。所以我認為我們不一定每季都會爆發 C 與 D 的情況。我們真的想在第一季的電話會議上強調這一點，只是為了確保人們了解第一季相對於今年剩餘時間的整體機制和季節性。

But more specifically to your question, our Part D performance in the second quarter did run in line with expectations and really was not a major driver of the overall MBR on a consolidated basis relative to our Part C performance. As we look at the back half of the year, we still anticipate that Part D will be a meaningful tailwind to MBR over the next two quarters, similar to what we talked about on the last call.

但更具體地說，對於您的問題，我們第二季 D 部分的業績確實符合預期，相對於我們 C 部分的業績，在合併基礎上確實不是整體 MBR 的主要驅動力。展望今年下半年，我們仍然預計 D 部分將在未來兩個季度對 MBR 產生有意義的推動作用，類似於我們在上次電話會議中討論的內容。

Okay, that's great to hear. And then, John, I know you mentioned no new states again for 2025. I guess just wanted to touch base and sort of get the updated thoughts longer term around market expansion opportunities sort of beyond 2025. Obviously, I get the runway that you have to continue to grow share in your current footprint.

好的，很高興聽到這個消息。然後，約翰，我知道您再次提到 2025 年不會有新的州。我想我只是想接觸基礎，並了解 2025 年後市場擴張機會的長期最新想法。顯然，我知道你必須繼續擴大當前足跡的份額。

But how do you sort of balance that when you think about especially some of the larger national plans talking about exiting certain markets as they look to preserve margins and thinking about what opportunity that might open up for you in newer geographies?

但是，當您考慮特別是一些較大的國家計劃時，您會考慮退出某些市場以保留利潤，並考慮在新的地區可能為您帶來哪些機會，您如何平衡這一點？

Yeah, I think the whole governor that we have is just cash on the balance sheet and we feel really well positioned for that. But as I've said in the past, I really want us to start expanding when a couple of things start coming together. One is just producing the cash and funding the growth from cash. And I feel in a good position to do that over the next couple of years. And at the same time, we're leveraging these investments on automation that we were just talking about.

是的，我認為我們所擁有的整個州長只是資產負債表上的現金，我們覺得對此非常有利。但正如我過去所說，我真的希望我們在一些事情開始融合在一起時就開始擴張。一是產生現金並用現金為成長提供資金。我覺得在接下來的幾年我有能力做到這一點。同時，我們正在利用這些對我們剛才討論的自動化的投資。

And I think once we get these workflows and we get these systems in a way, both on the administrative side as well as the clinical side as well as the network kind of management side, you get all these things kind of matured and packaged in best practices to go along with the cash from operations. That's when we really want to take this model and get the kind of national footprint that we said we really desire to achieve in the IPO. That's still the goal, is simply now focusing on the most accretive way for we to grow and to get scale economies and get to EBITDA profitability. That's the priority now.

我認為，一旦我們獲得了這些工作流程並以某種方式獲得了這些系統，無論是在管理方面還是在臨床方面以及網絡管理方面，您都會得到所有這些成熟的東西並以最好的方式打包與營運現金結合的做法。那時我們真的想採用這種模式並獲得我們所說的我們真正希望在首次公開募股中實現的那種全國足跡。這仍然是我們的目標，只是現在專注於我們成長、實現規模經濟和實現 EBITDA 盈利的最增值方式。這是現在的首要任務。

And then what we're not quite showing everybody yet is all the work behind the scenes in terms of getting ready to have the degree of expansion I expect. The other thing I've said is I do think there is an emerging trend toward integrated delivery networks, kind of these large hospital systems that are looking for innovative ways to partner from what they're currently experiencing in Medicare Advantage. And I think you'll see that come to fruition over the next year or so.

然後，我們還沒有向大家展示的是為實現我期望的擴展程度做好準備的所有幕後工作。我所說的另一件事是，我確實認為整合交付網路正在出現一種新興趨勢，這些網路系統正在尋找創新的方式來合作，從他們目前在 Medicare Advantage 中體驗到的內容。我想你會在明年左右看到這個目標的實現。

Awesome. I appreciate all the color. Thanks.

驚人的。我欣賞所有的顏色。謝謝。

You got it.

你明白了。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Hey, this is actually Adam Ron. So first, a quick one. When you say 20% growth, are you specifically talking about enrollment? Or does that include yields, and so would yield be on top of the 20%?

嘿，這實際上是亞當·羅恩。首先，快速一點。當你說20%的成長時，你特別指的是入學率嗎？或者這是否包括收益率，那麼收益率是否會高於 20%？

Yes, I can take that one, Adam. Yes, I think we're contemplating that both membership and revenue, we feel like we can achieve 20% growth next year in 2025. I think we don't currently -- I think it's too early to say, rather, what we expect from an overall PMPM standpoint because while we do have the very positive benchmark rate uptake for 2025, we also have to take into account what we're doing in terms of our benefit designs as well as new member population, product mix, etcetera.

是的，我可以接受那個，亞當。是的，我認為我們正在考慮會員數量和收入，我們感覺明年 2025 年我們可以實現 20% 的成長。我認為我們目前還沒有——我認為從整體 PMPM 的角度來看我們的期望還為時過早，因為雖然我們確實在 2025 年有非常積極的基準利率採用，但我們還必須考慮到我們的預期我們正在做的就是我們的福利設計以及新會員群、產品組合等。

So probably too early for us to talk about revenue PMPM change year-over-year into 2025. But I think we feel good about our ability to see from that 20% growth on membership and revenue that John was alluding to previously.

因此，我們談論 2025 年收入 PMPM 同比變化可能還為時過早。但我認為我們對約翰之前提到的會員和收入 20% 的成長感到滿意。

Okay, appreciate that. And then on MLR, there's a lot of moving parts just because last year, you had a reach and then that came out and then this year, you have a very high percentage of members who are new to Alignment. You're saying there's a wide delta of MLR on those members and returning members. So I was wondering if you can give us any color on like what that delta is and like maybe what MLR was last year and this year on returning members and how that's different from new members to give us a sense of how things are trending versus what you bid.

好的，謝謝。然後在 MLR 上，有很多變動的部分，因為去年，你們已經達到了一定的範圍，然後又出現了，然後今年，你們有很高比例的新加入 Alignment 的成員。您是說這些會員和回歸會員的 MLR 有很大差異。所以我想知道您是否可以給我們提供一些信息，例如這個三角洲是什麼，也許 MLR 去年和今年的回歸會員是什麼，以及這與新會員有何不同，讓我們了解事情的趨勢與變化你出價。

Yeah, absolutely. So I would say overall, our new members are generally running relatively in line with expectations. So you all have seen our historical cohort performance in this past which would suggest that members run around 89%, maybe 90% MBRs for that at-risk population. And there's been obviously some variability in various years, a few points better or a few points worse than that. I'd say we're within that overall range right now, maybe a couple of points higher than the original kind of 89% to 90% historically but certainly within the band of expectations.

是的，絕對是。所以我想說，整體來說，我們新成員的運作狀況大致上是比較符合預期的。所以你們都已經看到了我們過去的歷史隊列表現，這表明成員為該高危險群運行了大約 89%，也許 90% 的 MBR。不同年份之間顯然存在一些差異，比這好幾分或差幾分。我想說，我們現在處於這個總體範圍內，可能比歷史上最初的 89% 到 90% 高幾個百分點，但肯定在預期範圍內。

Part of that is what I was describing on the supplemental benefits which we're seeing across our overall population, both new and loyal. From a loyal member standpoint, I would say that very similarly is continuing to run consistent with expectations, inclusive of or taking into consideration some of the supplemental benefit and unit cost dynamics we described in the call.

其中一部分就是我所描述的我們在整個人口中看到的補充福利，無論是新人口還是忠誠人口。從忠誠會員的角度來看，我想說，非常相似的是，繼續按照預期運行，包括或考慮到我們在電話中描述的一些補充福利和單位成本動態。

On that point, I want to take just a second to kind of amplify our comments on the unit cost dynamics that we're currently navigating this year. So in totality, our overall inpatient and outpatient unit costs are going up about 8% in 2024. And I would say, in a normal year and years past, we typically would have seen something closer to 3%, maybe 4% on average.

在這一點上，我想花一點時間來放大我們對今年目前正在處理的單位成本動態的評論。因此，總的來說，到 2024 年，我們的住院和門診單位總成本將上漲約 8%。我想說，在正常的一年和過去的幾年裡，我們通常會看到接近 3% 的數字，平均可能為 4%。

And that value to us in total is worth about a point of overall MLR. And so in other words, our experience year-to-date and our full year outlook had we had, what I would say, is kind of a more normalized unit cost rate update environment would have been a little less than almost 1% better on overall MLR. And so I think that's really a testament to the team and our ability to manage not just the growth, to your point but also manage some of these other dynamics around our overall unit cost experience based on the CMS rate updates this year.

對我們來說，這個價值總共相當於整體 MLR 的一個點。換句話說，我們今年迄今為止的經驗和全年展望，我想說的是，如果有一個更加標準化的單位成本率更新環境，情況會好一點不到近 1%。因此，我認為這確實證明了團隊以及我們不僅有能力管理成長（就您的觀點而言），而且還根據今年的 CMS 費率更新，圍繞我們的整體單位成本體驗管理其他一些動態。

So I think we're in a very good position based on the first half performance and I think our full year achievability on both our adjusted gross profit and adjusted EBITDA we feel very good about.

因此，我認為，根據上半年的業績，我們處於非常有利的位置，而且我認為我們對調整後毛利和調整後 EBITDA 的全年實現能力感到非常滿意。

And if I could just clarify one more thing about that. When you say unit costs are up 8%, is that because like about what Humana is talking about with the Two-Midnight Rule and doctors or hospitals are reclassifying what were previously outpatient admissions or is this just all across the board anytime someone goes there, it's just 8% higher? Basically, I'm asking this because you would have more visibility on the latter.

如果我能再澄清一件事的話。當你說單位成本上漲8% 時，是因為就像Humana 所說的「午夜兩點規則」一樣，醫生或醫院正在對以前的門診入院進行重新分類，還是因為每次有人去那裡時都會發生這種情況，僅高出8%？基本上，我問這個是因為你會對後者有更多的了解。

Yeah. So it's not related to Two-Midnight Rule, as I was saying earlier. That really is not an area of exposure for us and we've not seen any unfavorable performance due to that variable. What I'm referring to was kind of a onetime change that CMS put in place heading into 2024 when they reclassified urban and rural markets, and it caused certain markets to go up and beyond what I would say is kind of a normal increase and in other places across the country rates actually came down. So on a national basis, it was somewhat of a normal, I'd say, year-over-year change. But for our specific markets, we saw an atypically high increase that we've been able to successfully navigate thus far this year.

是的。所以這與我之前所說的午夜兩點規則無關。這確實不是我們所關注的領域，我們也沒有看到由於該變數而導致的任何不利表現。我指的是 CMS 在 2024 年對城市和農村市場進行重新分類時實施的一次性變化，這導致某些市場上漲，超出了我所說的正常增長水平，並且全國其他地方的利率實際上都下降了。因此，在全國範圍內，我想說，這是一種正常的逐年變化。但對於我們的特定市場，我們看到了非典型的高成長，今年迄今為止我們已經成功實現了這一目標。

Thank you.

謝謝。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

Hi, thanks, good evening. First question, I was hoping if you could maybe help us in terms of trying to quantify or ring fence the impact of the supplemental benefits on the MLR this year. Maybe if possible, in a similar way, Thomas, that you just did the exercise in sort of laying out the impact of the inpatient and outpatient unit costs and sort of gave us what those increased year-over-year and the impact to the MLR at about 100 basis points, is there any way you could sort of similarly sort of help quantify the supplemental benefits impact given that you talked about it impacting both the new and existing members this year?

你好，謝謝，晚上好。第一個問題，我希望您能幫助我們嘗試量化或限制今年補充福利對國土資源部的影響。也許如果可能的話，以類似的方式，托馬斯，你剛剛做了練習，列出了住院和門診單位成本的影響，並為我們提供了逐年增加的費用以及對國土資源部的影響大約100 個基點，鑑於您談到今年對新成員和現有成員的影響，您是否可以採取類似的方式來幫助量化補充福利的影響？

Yeah, happy to. I think if you were to kind of look at our overall MBR implied by our prior guidance relative to our current guidance today, it went up about 50 basis points for the full year. And I would say, if you think about the kind of the new member impact and the greater mix of new members that we were previously discussing and then you look at the supplemental benefit piece, I would say it's probably somewhere in the neighborhood of maybe 10 to 30 basis points on the new members and probably 20 to 30 basis points on a supplemental benefit expense. So it really is overall pretty consistent with expectations. It's just very slightly higher than we initially anticipated.

是的，很高興。我認為，如果你看看我們先前的指導相對於我們今天的當前指導所暗示的整體 MBR，全年就上升了約 50 個基點。我想說，如果你考慮我們之前討論過的新會員影響以及新會員的更大組合，然後再看看補充福利部分，我會說它可能在 10 左右。補充福利費用可能增加20 至30 個基點。所以整體來說確實與預期非常一致。它只是比我們最初預期的略高一些。

Okay, thanks. And then on my follow-up question, definitely would be interested in getting your guys' initial assessment on the premium stabilization program that CMS has proposed for Part D that they just came out with this week for the one-year demo. No, it's still pretty early here but if you want to give us initial observations on what you may like, what you may be concerned about with that demo program and you're thinking on potentially participating in that.

好的，謝謝。關於我的後續問題，肯定有興趣讓你們對 CMS 為 D 部分提出的高級穩定計劃進行初步評估，他們本週剛剛推出了為期一年的演示。不，現在還為時過早，但如果您想向我們提供關於您可能喜歡什麼、您可能關心該演示程序的什麼以及您正在考慮參與該演示程序的初步觀察。

Yeah. I think it's something we're evaluating but probably too early for us to provide too much of a definitive view on one way or another. I think big picture, obviously, there's a lot of changes coming down the pipeline for Part D in 2025 under the Inflation Reduction Act. And I think overall, we feel very well positioned, both from a kind of an overall benefit standpoint but also in terms of our ability to continue to navigate those through our clinical teams employed internally as well as the partnership through our PBM. So we actually feel like there's probably more opportunity than risk on the Part D changes heading into 2025 and we'll continue to evaluate the program you were just describing as part of that.

是的。我認為這是我們正在評估的事情，但對我們來說，以某種方式提供太多明確的觀點可能還為時過早。我認為，從總體上看，顯然，根據《通貨膨脹削減法案》，2025 年 D 部分將會發生很多變化。我認為總的來說，我們感覺自己處於非常有利的位置，無論是從整體利益的角度來看，還是從我們繼續透過內部僱用的臨床團隊以及透過我們的PBM 建立的合作夥伴關係來引導這些方面的能力方面。因此，我們實際上認為，到 2025 年，D 部分的變更可能帶來的機會多於風險，我們將繼續評估您剛剛描述的計劃的一部分。

Okay, thank you.

好的，謝謝。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓，TD·考恩。

Hey, good afternoon. I Just wanted to know, any way you can talk about utilization trends, maybe California versus the rest of the enrollment portfolio? Obviously, California has been the majority. But just kind of curious if California has progressed above, below utilization trends or outside. Just looking for any context you can give us there.

嘿，下午好。我只是想知道，您可以以任何方式談論利用率趨勢，也許是加州與其他招生組合？顯然，加州佔據了大多數。但我有點好奇加州的進展是否高於、低於使用率趨勢或超越趨勢。只是尋找您可以為我們提供的任何背景資訊。

Yeah, happy to, Ryan. So from an inpatient admissions per 1,000 standpoint, our ex-California markets continue to do quite well. It depends on the market. But I'd say overall, we're running pretty similar ex-California than -- or relative to what we're running in California. And I'd say over the past couple of years, we've launched these new markets we typically run better than California or in line with California.

是的，很高興，瑞安。因此，從每千人住院人數的角度來看，我們的前加州市場仍然表現良好。這取決於市場。但我想說，總的來說，我們在前加州的運作情況與在加州運行的情況非常相似，或者說相對於我們在加州的運作情況非常相似。我想說，在過去的幾年裡，我們推出了這些新市場，我們的運作通常比加州更好或與加州一致。

And really what that's a function of is the replicability efforts that we've put in place over the last few years to ensure that as we're bringing on new Care teams, we're being consistent and systematizing how we recruit for those individuals, how we train those individuals to use our tools such as AVA and then actually how we monitor them.

實際上，這就是我們在過去幾年中所做的可複製性努力，以確保在我們引入新的護理團隊時，我們對這些人的招募方式保持一致和系統化，我們如何培訓這些人使用我們的工具（例如AVA），然後實際上我們如何監控他們。

So in terms of our ability to have a centralized command and control to evaluate metrics and making sure we're seeing the right people at the right time and managing those metrics on the back end in terms of how our teams doing things like readmission rates, skilled nursing length of stay, inpatient admissions per 1,000, ER business per K, et cetera. So I think we've been pretty disciplined about how we try to build this from an operational standpoint and we're seeing the results of that as we continue to grow the population ex-California.

因此，就我們擁有集中命令和控制來評估指標的能力而言，並確保我們在正確的時間看到正確的人，並根據我們的團隊如何做重新入院率等事情來管理後端的這些指標，熟練護理人員的住院時間、每千人的住院人數、每千人的急診業務量等等。因此，我認為我們在如何從營運角度建構這一點方面一直非常自律，隨著我們繼續增加加州以外的人口，我們正在看到其結果。

Great. And then just one quick one maybe. Just talking about your non-California markets. I mean you've been in some of those markets now for a couple of years, North Carolina, etcetera. Now that you have a little bit more, maybe one more year of experience, do you intend to grow faster in those markets into '25 maybe than you would have grown into 2024?

偉大的。然後也許只是一個快速的。只是談論非加州市場。我的意思是，您已經進入其中一些市場幾年了，例如北卡羅來納州等。現在您已經有了更多一點（也許是一年）的經驗，您是否打算在 25 年之前在這些市場中以比 2024 年更快的速度成長？

Yeah, hey, it's John. Yeah, foundationally, we want and made the decision that we need to get quality established and replicability of the Care model established. And so we've been able to do that in North Carolina, we've been able to do that in Nevada. We're still working on Arizona in terms of the stars but the clinical outcomes are very, very good.

是的，嘿，這是約翰。是的，從根本上來說，我們希望並做出了決定，我們需要建立品質和建立護理模式的可複製性。因此，我們已經能夠在北卡羅來納州做到這一點，我們也能夠在內華達州做到這一點。我們仍在對亞利桑那州的明星進行研究，但臨床結果非常非常好。

And so we made the specific decision to emphasize growth from California just because I think it's been the most accretive and the lowest acquisition cost. We have just such good provider partners and such good broker partners, it just made sense for us to really double down on that. And I think we'll continue to do that. And so heading into 2025 I think because there's still so much emphasis that we have to and conviction that we're going to focus on is toward profitability, we'll see.

因此，我們做出了強調加州成長的具體決定，因為我認為這是最具增值性和最低的收購成本。我們擁有如此優秀的提供者合作夥伴和如此優秀的經紀人合作夥伴，對我們來說，加倍努力是有意義的。我想我們會繼續這樣做。因此，進入 2025 年，我認為因為我們仍然非常重視，並且堅信我們將重點關注的是盈利能力，所以我們拭目以待。

I think you'll see us be much more aggressive in '26. I think we're going to get growth in '25 in these ex-California markets. But I think you're going to get a lot of growth in '26 just because of the investments that we're going to be making, again, from the fact that we're going to be, I think, very, very well positioned on profitability. And so it starts with that and then we're going to make investments in our existing ex-California markets. And then I think we're going to take both of those, call it, factors and think about '26 new market expansions. That's kind of how we're thinking about prioritization.

我想你會看到我們在 26 年變得更加激進。我認為我們將在 25 年在這些加州以外的市場成長。但我認為你會在 26 年獲得很大的成長，這只是因為我們將進行投資，再次，因為我認為我們將變得非常非常好定位於獲利能力。因此，我們將從這裡開始，然後我們將在現有的加州以外市場進行投資。然後我認為我們將考慮這兩個因素，並考慮「26 新市場擴張」。這就是我們考慮優先順序的方式。

Great. Thank you.

偉大的。謝謝。

You got it.

你明白了。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Now that 2025 bids are behind us, maybe if you could share a bit more on the potential for margin expansion next year. What do you think is a reasonable level of expansion? And what do you think the bigger drivers will be between MLR and SG&A?

現在 2025 年的投標已經過去，也許您可以分享更多有關明年利潤擴張潛力的信息。您認為合理的擴張程度是多少？您認為 MLR 和 SG&A 之間更大的驅動因素是什麼？

So I think we'll probably withhold too much detailed commentary on 2025 benefits just given that reallocations are kind of currently underway as the direct subsidy information has come through from CMS. But I think to your kind of more broad question around the MBR versus SG&A opportunity for 2025, I think both are an opportunity.

因此，我認為我們可能不會對 2025 年福利進行太多詳細評論，因為直接補貼資訊已從 CMS 獲得，重新分配目前正在進行中。但我認為，對於您提出的有關 2025 年 MBR 與 SG&A 機會的更廣泛問題，我認為兩者都是機會。

And what I mean by that is from an MBR standpoint, as John was describing, we were, I think, continuing to be disciplined and margin-oriented in the bid process to drive MBR performance improvement into 2025. I think the extent of which you see it will in part relate to the growth we get. But I think almost irrespective of the level of growth, we see an opportunity to improve MBR next year based on how we came together in the bid process.

我的意思是，從 MBR 的角度來看，正如約翰所描述的，我認為，我們在投標過程中繼續遵守紀律並以利潤為導向，以推動 MBR 績效改善到 2025 年。我認為你看到的程度在某種程度上與我們的成長有關。但我認為，無論成長水準如何，我們都看到了明年根據我們在投標過程中的配合方式改進 MBR 的機會。

On the SG&A side of things that John was describing, while we've done a great job this year on driving close to 300 basis points of SG&A as a percentage of revenue improvement in 2024, we're still going to be north of 11% in total SG&A as a percentage of revenue this year. And as we've talked about in the past, our goal remains to get to 10% or even below that, possibly to high single digits. So I think as we continue to grow next year, we do continue to anticipate further economies of scale and SG&A leverage improvement in 2025 as well.

在 John 所描述的 SG&A 方面，雖然我們今年做得很好，將 SG&A 佔 2024 年收入改善的百分比提高了近 300 個基點，但我們仍將超過 11% SG&A 總額佔今年收入的百分比。正如我們過去談到的，我們的目標仍然是達到 10% 甚至更低，可能達到高個位數。因此，我認為，隨著我們明年繼續成長，我們確實預計 2025 年將進一步實現規模經濟和 SG&A 槓桿率改善。

Great. And if I could just follow up here. Hoping you could elaborate on some of the MLR seasonality that you're expecting this year. It looks like you're expecting MLR to improve sequentially in both 3Q and 4Q. It wasn't clear to me why 4Q MLR would improve. I think that's a bit different than historical trends. So can you walk us through that progression and maybe quantify the impact of the calendar if meaningful?

偉大的。如果我能在這裡跟進就好了。希望您能詳細說明今年 MLR 的一些季節性變化。看起來您預計 MLR 在第三季和第四季都會連續改善。我不清楚為什麼 4Q MLR 會提高。我認為這與歷史趨勢有點不同。那麼您能否向我們介紹這項進展，並量化日曆的影響（如果有意義的話）？

Yeah, happy to. So I think in terms of the third and fourth quarter dynamics and kind of in part thinking about that year-over-year, what I would say is that last year, the seasonality was a little bit distorted in that the third quarter had a couple of kind of onetime or a typically favorable prior period items that helped drive down MLR in the third quarter of last year.

是的，很高興。因此，我認為就第三季和第四季的動態以及部分與去年同期相比而言，我想說的是，去年的季節性有點扭曲，因為第三季有一些某種一次性或通常有利的前期項目幫助壓低了去年第三季的國債利率。

And on the other side, the fourth quarter was a bit opposite in that we had a couple of atypically unfavorable items that occurred in the fourth quarter last year. In particular, the inpatient unit costs I was describing actually went into effect October 1, 2023. So I would say kind of third quarter, fourth quarter dynamics aside is probably more appropriate to think about our full year guidance or even our second half guidance. And in terms of that outlook, I think we feel really good about where we stand.

另一方面，第四季的情況有點相反，去年第四季我們發生了一些非常不利的事情。特別是，我所描述的住院單位費用實際上於 2023 年 10 月 1 日生效。因此，我想說，除了第三季、第四季的動態之外，考慮我們的全年指引甚至下半年指引可能更合適。就這種前景而言，我認為我們對自己的立場感到非常滿意。

As we talked about, I think our latest guidance reflects both kind of the incremental membership we have now added and the MBR implications of that incremental growth as well as that kind of modest impact of the supplemental benefit increase. On the other side, I think we feel good about the opportunities for further improvement on Care Anywhere. And then beyond that, some of the things we talked about last quarter, including Payment Integrity and some of the non-inpatient initiatives that we're talking about today.

正如我們所討論的，我認為我們的最新指導既反映了我們現在增加的增量會員資格，也反映了增量增長對 MBR 的影響，以及補充福利增加的適度影響。另一方面，我認為我們對進一步改進 Care Anywhere 的機會感到滿意。除此之外，我們上季度討論的一些事情，包括支付完整性和我們今天討論的一些非住院計劃。

So I think kind of where we land in terms of the overall range on both gross profit and adjusted EBITDA will be somewhat dependent upon the timing of those initiatives. But big picture, I think we feel confident in our full year outlook and our ability to continue to offset that modest MBR pressure with the further economy of scale in SG&A.

因此，我認為我們的毛利和調整後 EBITDA 的整體範圍在某種程度上取決於這些措施的時間表。但從大局來看，我認為我們對全年前景充滿信心，也對我們有能力繼續透過 SG&A 進一步規模經濟來抵消適度的 MBR 壓力充滿信心。

Great, thanks for all the color.

太棒了，感謝所有的顏色。

Ladies and gentlemen, thank you for participating. This does conclude today's program, and you may now disconnect.

女士們、先生們，感謝您的參與。今天的節目到此結束，您現在可以斷開連線了。