Alignment Healthcare Inc (ALHC) 2024 Q4 法說會逐字稿

Good afternoon, and welcome to Alignment Healthcare's fourth-quarter 2024 earnings conference call and webcast. (Operator Instructions) Please note that this event is being recorded. Leading today's call are John Kao, Founder and CEO; and Thomas Freeman, Chief Financial Officer. Before we begin, we would like to remind you that certain statements made during this call will be forward-looking statements as defined by the Private Securities Litigation Reform Act.

下午好，歡迎參加 Alignment Healthcare 2024 年第四季財報電話會議和網路廣播。（操作員指示）請注意，此事件正在被記錄。主持今天電話會議的是創辦人兼執行長 John Kao；以及財務長 Thomas Freeman。在我們開始之前，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。

These forward-looking statements are subject to risks and uncertainties and reflect our current expectations based on beliefs, assumptions and information currently available to us. Descriptions of some of the factors that could cause actual results to differ materially from these 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, 2024. Although we believe our expectations are reasonable and undertake no obligation to revise any statements to reflect changes that occur after this call. 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 current comparable GAAP measures and reconciliation of historical non-GAAP financial measures can be found in a press release that is posted on the company's website and in our Form 10-K for the fiscal year ended December 31, 2024.

這些前瞻性陳述受風險和不確定性的影響，反映了我們基於當前信念、假設和可用資訊所做的當前預期。我們向美國證券交易委員會提交的文件中更詳細地討論了可能導致實際結果與這些前瞻性陳述存在重大差異的一些因素，包括截至 2024 年 12 月 31 日的財政年度的 10-K 表年度報告中的「風險因素」部分。儘管我們認為我們的預期是合理的，並且不承擔修改任何聲明以反映本次電話會議後發生的變化的義務。此外，請注意，公司將討論他們認為對評估業績很重要的某些非 GAAP 財務指標。有關這些非 GAAP 指標與最新可比較 GAAP 指標之間的關係以及歷史非 GAAP 財務指標的調節的詳細信息，可以在公司網站上發布的新聞稿和截至 2024 年 12 月 31 日的財政年度的 10-K 表中找到。

I would now like to hand the call over to your speaker today, John Kao. Please go ahead.

現在我想把電話交給今天的發言人 John Kao。請繼續。

Hello, and thank you for joining us on our fourth quarter earnings conference call. For the fourth quarter 2024, our health plan membership of 189,100 concluded a milestone year where we grew membership approximately 59%. Our final result is more than 25,000 members above the high end of our initial guidance range and reflects an additional 21% growth relative to initial expectations. As a result of our continued membership outperformance, total revenue of $701 million in the quarter grew approximately 51% year-over-year and 61% excluding ACO REACH. In the fourth quarter, each of our key margin ratios improved year-over-year even as our membership growth accelerated beyond expectations.

您好，感謝您參加我們的第四季財報電話會議。2024 年第四季度，我們的健康計畫會員人數達到 189,100 人，這是里程碑式的一年，會員人數增加了約 59%。我們的最終結果是會員數量比我們最初指導範圍的高端高出 25,000 多人，並且相對於最初的預期又增加了 21%。由於我們的會員數量持續優異，本季總營收為 7.01 億美元，較去年同期成長約 51%，不包括 ACO REACH 則成長 61%。第四季度，儘管我們的會員成長速度超出預期，但我們的各項主要利潤率均較去年同期有所提高。

Adjusted gross profit of $88 million produced a consolidated MBR of 87.5%, a 200 basis point improvement year-over-year and 50 basis point improvement, excluding ACO REACH. Combined with substantial scale economies, we delivered adjusted EBITDA of positive $1 million in the quarter and 400 basis points of margin expansion year-over-year. For the full year, total revenue of $2.7 billion grew 48% year-over-year and 59% excluding ACO REACH. Adjusted gross profit of $303 million resulted in an MBR of 88.8%. Lastly, we delivered positive adjusted EBITDA of $1 million, which reflects 200 basis points of margin expansion year-over-year and marks our first year of adjusted EBITDA profitability as a public company.

調整後的毛利為 8,800 萬美元，合併 MBR 為 87.5%，比去年同期提高了 200 個基點，不包括 ACO REACH 則提高了 50 個基點。結合顯著的規模經濟，我們本季實現了調整後 EBITDA 為正 100 萬美元，利潤率年增 400 個基點。全年總營收為 27 億美元，年增 48%，不包括 ACO REACH 則成長 59%。調整後的毛利為 3.03 億美元，MBR 為 88.8%。最後，我們實現了 100 萬美元的正調整後 EBITDA，這反映了利潤率同比擴大 200 個基點，也標誌著我們作為上市公司實現調整後 EBITDA 盈利的第一年。

Our exceptional results in 2024 highlight our differentiated ability to navigate a dynamic MA environment and demonstrate that plans can win by providing more care, not less. Our success starts with approaching Medicare Advantage as a care management business, not just an actuarial underwriting business. To execute our model, we employ more than 400 clinical staff who represent approximately 25% of our full-time employees and roughly 4% of medical expenses for at-risk members. These home and virtual-based resources leverage actionable insights from AVA to create greater control over medical quality and costs. As a result, we were able to offer market-leading benefits and grow confidently in 2024, while others in the industry took a step back to rising star standards, the first year of V28 phase-in and changes in utilization patterns.

我們在 2024 年取得的卓越業績凸顯了我們在動態 MA 環境中導航的差異化能力，並證明了計劃可以透過提供更多護理而不是更少護理來取勝。我們的成功始於將醫療保險優勢計劃視為一項護理管理業務，而不僅僅是一項精算承保業務。為了執行我們的模式，我們僱用了 400 多名臨床工作人員，他們約占我們全職員工的 25%，約佔高風險成員醫療費用的 4%。這些家庭和虛擬資源利用 AVA 的可操作見解來更好地控制醫療品質和成本。因此，我們能夠提供市場領先的優勢，並在 2024 年實現自信增長，而業內其他公司則倒退到新星標準、V28 逐步實施的第一年以及利用模式的變化。

Taken together, the results of 2024 are demonstrating our ability to capitalize on a changing MA environment that will favor plans with low-cost, high-quality outcomes. Turning to our AEP results. We entered January 2025 with 209,900 health plan members, representing 35% growth year-over-year. This resulted from a combination of 28% growth in California and more than 100% growth in our ex-California markets. Much like 2024 was a breakout year for consolidated growth, 2025 is a breakout year for growth outside of California.

總的來說，2024 年的結果表明我們有能力利用不斷變化的 MA 環境，這將有利於低成本、高品質結果的計劃。轉向我們的 AEP 結果。截至 2025 年 1 月，我們的健康計畫會員數量為 209,900 人，年增 35%。這是由於加州 28% 的成長和加州以外市場超過 100% 的成長共同作用的結果。正如 2024 年是綜合成長的突破之年一樣，2025 年也是加州以外地區成長的突破之年。

Nevada now has over 10,000 members, while each of our other ex-California states have between 5,000 and 8,000 seniors. Our ex-California growth during AEP was enabled by our industry-leading Stars results, including our 5-star contract in Nevada and North Carolina and strong medical management performance, including 2024 admissions per 1,000 of 144 for ex-California markets. These factors increased reimbursement from CMS and lower cost by improving the health of our members, both of which allow us to afford richer product benefits. In total, our successful AEP provides us with line of sight to our full year membership guidance of 227,000 to 233,000 members and further positions us to drive greater economies of scale and adjusted EBITDA margin improvement in 2025. Thomas will share more on our 2025 guidance shortly.

內華達州目前擁有超過 10,000 名會員，而我們其他前加州則各有 5,000 至 8,000 名老年人。AEP 期間我們在加州以外地區的成長得益於我們行業領先的星級業績，包括我們在內華達州和北卡羅來納州的五星級合約以及強大的醫療管理業績，其中包括加州以外市場每 1,000 人中有 2024 人入院，而每 1,000 人中有 144 人中有 144 人入院。這些因素增加了CMS的報銷金額，並透過改善會員的健康狀況降低了成本，這兩者都使我們能夠提供更豐富的產品福利。總體而言，我們成功的 AEP 為我們提供了實現全年會員人數 227,000 至 233,000 名會員的指導，並進一步使我們能夠在 2025 年推動更大的規模經濟和調整後的 EBITDA 利潤率的提高。托馬斯很快就會分享更多有關我們 2025 年指導的資訊。

Looking beyond 2025, we believe our relative advantages on Stars and the final phase-in of the V28 risk adjustment model create a multiyear pathway for robust growth and continued margin expansion. For 2025 payment year, 95% of our California members are in plans rated 4 stars or above compared to 68% for competitors in California. This is already 27% higher than competitors, and our advantage is further widening for the 2026 payment year when we will have 100% of our California members and plans rated 4 stars or above. This will be nearly 40% better than the competitors in the state who are declining to just 61% of members in 4-star or above plans. We are similarly well positioned at a national level.

展望 2025 年以後，我們相信我們在 Stars 上的相對優勢以及 V28 風險調整模型的最終實施將為強勁增長和持續的利潤率擴張創造一條多年的道路。對於 2025 年付款年度，我們 95% 的加州會員都參與了評級為 4 星或以上的計劃，而加州競爭對手的比例為 68%。這已經比競爭對手高出 27%，到 2026 年付款年度，我們的優勢將進一步擴大，屆時我們 100% 的加州會員和計劃都將獲得 4 星或以上的評級。這比該州的競爭對手好近 40%，而後者四星或以上計劃的會員比例已下降至僅 61%。我們在國家層級也同樣處於有利地位。

Approximately 98% of all alignment members are in plans that will be rated 4 stars or above in payment year 2026, which is 34% better than the industry of just 64%. Beyond our rating year 2025 star scores, which impact our 2026 payment, we see multiple years of meaningful stars tailwinds ahead of us. For rating year 2026 impacting payment year 2027, caps and admin weightings will be reduced from 4 to 2. This change would have resulted in an increase to our Raw score by approximately 0.23 during the past rating cycle for our California HMO contract, further reinforcing our Stars position. For rating year 2027 impacting payment year 2028, CMS is replacing the current reward factor with a health equity index.

約有 98% 的聯盟成員所參與的計劃將在 2026 年付款年度獲得 4 星或以上的評級，比行業平均水平（僅 64%）高出 34%。除了影響我們 2026 年付款的 2025 年評級星級評分之外，我們還看到未來數年有意義的星級順風。對於影響 2027 年付款年度的 2026 年評級年度，上限和管理權重將從 4 減少到 2。這項變更將導致我們的原始分數在上一個加州 HMO 合約評級週期內增加約 0.23，從而進一步鞏固我們的星級地位。由於 2027 年評級會影響 2028 年支付，CMS 將以健康公平指數取代目前的獎勵因素。

Our California HMO contract doesn't currently receive any benefit from the existing reward factor. So this change creates an additional potential tailwind to our raw Star score. Based on our early analysis, we believe we could achieve a star score bonus of 0.25 or greater under the new HealthEquity index. Each of these tailwinds increases our confidence in maintaining at least 4 stars and strengthens our conviction in growing membership 20% or above over the coming years while balancing margin expansion objectives. Lastly, I'd like to spend a moment to talk about the embedded gross margin opportunity within our existing membership.

我們的加州 HMO 合約目前沒有從現有的獎勵因素中獲得任何好處。因此，這項變更為我們的原始星級評分創造了額外的潛在順風。根據我們早期的分析，我們相信在新的 HealthEquity 指數下我們可以獲得 0.25 或更高的星級評分獎勵。這些順風因素都增強了我們維持至少 4 顆星的信心，並增強了我們在未來幾年內會員人數增加 20% 或以上的信念，同時平衡了利潤率擴張目標。最後，我想花點時間談談我們現有會員中蘊含的毛利率機會。

Due to our rapid growth in 2024 and 2025, over 50% of our members are expected to be in a year 1 or year 2 cohort. As we engage our at-risk members with our clinical resources, gross profit grows from $90 PMPM for our at-risk year 1 members to $230 PMPM for our at-risk members in year 5 and beyond. This dynamic creates embedded gross profit of approximately $600 million just within our existing membership base, creating a pathway to double the $300 million of gross profit we delivered in 2024 without any incremental membership growth. In closing, 2024 was a milestone year on growth and profitability improvement, while we again demonstrated the resiliency of our Stars results. By prioritizing health outcomes and putting the senior first, we have created a durable cost and quality moat that positions us to win irrespective of the policy and rate environment.

由於我們在 2024 年和 2025 年的快速成長，預計超過 50% 的會員將進入第一年或第二年。隨著我們為高風險會員提供臨床資源，毛利從第一年高風險會員的每月 90 美元增長到第五年及以後高風險會員的每月 230 美元。這種動態僅在我們現有的會員基礎上就創造了約 6 億美元的內含毛利潤，從而創造了一條途徑，使我們在 2024 年實現的 3 億美元毛利翻一番，而無需增加任何會員數量。最後，2024 年是成長和獲利能力提升的里程碑之年，同時我們再次展現了 Stars 表現的韌性。透過優先考慮健康結果並將老年人放在首位，我們創造了持久的成本和品質護城河，使我們能夠在任何政策和利率環境下獲勝。

For their dedication to our seniors, I'd like to thank each of our employees for playing their part in fulfilling our mission for Medicare Advantage done right. With that, I'll turn the call over to Thomas to further discuss our financial results and outlook. Thomas?

對於每位員工對老年人的奉獻，我要感謝他們為實現醫療保險優勢計畫的使命所做的貢獻。說完這些，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 year ending December 2024, our health plan membership of 189,100 increased 59% year-over-year. This drove total revenue just north of $2.7 billion for full year 2024, representing 48% growth year-over-year and 59% growth, excluding ACO REACH. As membership continued to accelerate during the year, we ultimately exceeded the midpoint of our initial 2024 revenue guidance by over $300 million. Full year adjusted gross profit of $303 million exceeded the high end of our latest guidance by $6 million and represented an MBR of 88.8%.

謝謝，約翰。截至 2024 年 12 月，我們的健康計畫會員人數為 189,100 人，年增 59%。這使得 2024 年全年總收入略高於 27 億美元，年增 48%，不包括 ACO REACH 則成長 59%。隨著會員人數在這一年持續成長，我們最終超越了最初 2024 年營收預期的中點超過 3 億美元。全年調整後毛利為 3.03 億美元，比我們最新預期的上限高出 600 萬美元，MBR 為 88.8%。

We continue to demonstrate the strength of our medical management capabilities during the fourth quarter with our MBR of 87.5%, marking our lowest MBR quarter of the year. Our strong finish drove our full year inpatient admissions per 1,000 for our at-risk members to 149, showing continued improvement from 156 in 2023 and 159 in 2022. Our adjusted gross profit results in the fourth quarter also benefited from the release of prior period IBNP reserves. Given the atypically large cohort of new members we onboarded during 2024, we took a prudent approach to setting initial reserves during the first through third quarters. As we closed out the year, our favorable claims runout allowed us to deliver upside relative to our prior expectations.

第四季度，我們的 MBR 為 87.5%，是今年 MBR 最低的季度，這繼續展現了我們強大的醫療管理能力。我們取得了強勁的成績，推動全年高風險成員每 1,000 人的住院人數達到 149 人，較 2023 年的 156 人和 2022 年的 159 人持續改善。我們第四季的調整後毛利結果也受惠於前期 IBNP 儲備的釋放。鑑於我們在 2024 年吸收的新成員數量異常龐大，我們在第一季至第三季採取了審慎的方式設定初始儲備金。在年底之際，有利的索賠情況讓我們實現了超出先前預期的上行收益。

Our strong admission performance in 2024, combined with our latest visibility into our 2024 claims experience together give us confidence in our 2025 outlook. Turning to OpEx. Our operating cost ratios showed year-over-year improvement given our continued growth and the elimination of onetime costs associated with the in-sourcing of our member experience functions that we incurred in the second half of last year. Full year 2024 SG&A was $371 million. Our adjusted SG&A was $301 million, an increase of just 23% year-over-year relative to membership growth of 59% year-over-year.

我們在 2024 年的強勁入院表現，加上我們對 2024 年索賠經驗的最新了解，使我們對 2025 年的前景充滿信心。轉向 OpEx。由於我們業務的持續成長以及消除了去年下半年因內部採購會員體驗功能而產生的一次性成本，我們的營運成本率較去年同期有所改善。2024 年全年銷售、一般及行政費用為 3.71 億美元。我們的調整後銷售、一般及行政費用為 3.01 億美元，與去年同期 59% 的會員成長率相比，僅成長 23%。

Adjusted SG&A as a percentage of revenue, excluding ACO REACH declined from 14.4% in 2023 to 11.1% in 2024, representing an improvement of approximately 330 basis points. Taken together, we achieved our breakeven profitability goal with full year adjusted EBITDA of positive $1 million and did so while onboarding more net new members in 2024 than in the prior 4 years combined. This demonstrates the differentiated power of our model to scale outcomes and places us on track to drive continued adjusted EBITDA margin expansion in 2025. Turning to the balance sheet. We ended the year with $471 million in cash and investments.

調整後的銷售、一般及行政費用佔收入的百分比（不包括 ACO REACH）從 2023 年的 14.4% 下降到 2024 年的 11.1%，提高了約 330 個基點。整體而言，我們實現了損益平衡的獲利目標，全年調整後的 EBITDA 為正 100 萬美元，同時 2024 年新增會員數量比前 4 年的總和還要多。這證明了我們的模型在擴大成果方面的差異化能力，並使我們預計在 2025 年繼續推動調整後的 EBITDA 利潤率擴大。轉向資產負債表。截至本財年末，我們的現金及投資總額為 4.71 億美元。

This includes net proceeds from the sale of $330 million aggregate principal convertible senior notes in the fourth quarter. The funds from this transaction were used to pay down $215 million in outstanding term loan principal and added $106 million of cash to the balance sheet, net of transaction costs. This significantly lowers our cost of capital and reduces annual interest expense by approximately $10 million moving forward. Moving to our guidance. For the first quarter, we expect health plan membership to be between 211,000 and 215,000 members, revenue to be in the range of $880 million and $895 million, adjusted gross profit to be between $89 million and $97 million and adjusted EBITDA to be between $2 million and $10 million.

其中包括第四季度出售總本金 3.3 億美元的可轉換優先票據的淨收益。此交易的資金用於償還 2.15 億美元未償還定期貸款本金，並在扣除交易成本後為資產負債表增加 1.06 億美元現金。這大大降低了我們的資本成本，並將未來每年的利息支出減少約 1,000 萬美元。轉向我們的指導。對於第一季度，我們預計健康計劃會員人數將在 211,000 至 215,000 人之間，收入將在 8.8 億美元至 8.95 億美元之間，調整後的毛利潤將在 8900 萬美元至 9700 萬美元之間，調整後的 EBITDA 將在 200 萬美元至 100 萬美元之間。

For the full year 2025, we expect health plan membership to be between 227,000 and 233,000 members, revenue to be in the range of $3.72 billion and $3.78 billion, adjusted gross profit to be between $415 million and $445 million and adjusted EBITDA to be in the range of $35 million and $60 million. Given our strong sales momentum through the first 2 months of the year, we are raising the midpoint of our year-end health plan membership guidance by 2,000 relative to our early guidance commentary provided in January. Our products continue to resonate across our markets and the strength of our early results give us confidence in our full year trajectory. Turning to revenue. The midpoint of our initial revenue guidance range of approximately $3.75 billion represents nearly 40% growth year-over-year.

對於 2025 年全年，我們預計健康計畫會員人數將在 227,000 至 233,000 人之間，收入將在 37.2 億美元至 37.8 億美元之間，調整後的毛利潤將在 4.15 億美元至 4.45 億美元之間，調整後的 EBITDA 將在 350 萬美元之間。鑑於今年前兩個月的強勁銷售勢頭，我們將年終健康計劃會員指導中位數相對於 1 月份提供的早期指導評論提高了 2,000 人。我們的產品繼續在市場上引起共鳴，早期業績的強勁表現讓我們對全年的發展軌跡充滿信心。談到收入。我們最初的營收預期範圍的中點約為 37.5 億美元，較去年同期成長近 40%。

Beyond our strong membership growth, our revenue outlook is supported by increases to our Part D revenue PMPM due to changes related to the Inflation Reduction Act and the retention of our 2024 new member cohort, partially offset by the impact of the second phase in of V28 risk model changes. Moving to our adjusted gross profit guidance. Our midpoint of $430 million represents 42% growth year-over-year. This implies an MBR of 88.5% and compounds off of our strong 2024 result where we grew adjusted gross profit by 45%. Our outlook embeds the MBR improvement from the retention of 2024 new members and modifications to our product design.

除了會員人數強勁增長之外，我們的收入前景還受到《通貨膨脹削減法案》相關變化以及 2024 年新會員群體保留帶來的 D 部分收入 PMPM 增長的支持，但第二階段 V28 風險模型變化的影響部分抵消了這一增長。轉向我們的調整後毛利指引。我們的中點是 4.3 億美元，年增 42%。這意味著 MBR 為 88.5%，並且基於我們 2024 年強勁的業績，當時我們的調整後毛利成長了 45%。我們的展望包含了保留 2024 名新會員和修改我們的產品設計所帶來的 MBR 改進。

These factors are balanced by the impact of the second phase in of the V28 risk model, initial assumptions on Part D changes associated with the Inflation Reduction Act and modestly higher utilization volume expectations due to our mix of membership. Progressing down the P&L, we expect to see further improvement in our SG&A ratio as we continue to scale our back-office functions and ex-California markets, while driving automation and productivity improvements across our shared services. Taken together, the midpoint of our adjusted EBITDA guidance range of $47.5 million implies 130 basis points of margin expansion year-over-year and reflects our confidence in underlying cost trends and operating leverage opportunities in 2025. In terms of our first quarter guidance, it's worth noting that our MBR seasonality is anticipated to shift in 2025 due to changes related to the Inflation Reduction Act. Similar to prior years, we anticipate that our Part D MBR will improve sequentially throughout the year, however, at less of a slope than in years past.

這些因素與 V28 風險模型第二階段的影響、與通貨膨脹削減法案相關的 D 部分變化的初步假設以及由於我們的會員組合而略高的利用量預期相平衡。隨著損益表的不斷下降，我們預計銷售、一般及行政開支比率 (SG&A) 將進一步改善，因為我們將繼續擴大後台職能和加州以外市場的規模，同時推動共享服務的自動化和生產力提高。綜合起來，我們調整後的 EBITDA 指導範圍的中點為 4750 萬美元，意味著利潤率同比增長 130 個基點，並反映了我們對 2025 年潛在成本趨勢和營運槓桿機會的信心。就我們的第一季指引而言，值得注意的是，由於《通膨削減法案》相關的變化，我們的 MBR 季節性預計將在 2025 年發生變化。與前幾年類似，我們預計 D 部分 MBR 將在全年逐步改善，但改善幅度將小於過去幾年。

Accordingly, the change in seasonality will modestly lower MBR in the first half of the year and conversely increase MBR in the second half of the year relative to prior years' experience, all else being equal. Beyond changes to Part D seasonality, our first quarter guidance broadly reflects our regular seasonality, which incorporates higher utilization in the first quarter of the year. In conclusion, our consistent strategy of balancing growth and profitability, combined with our differentiated Medicare Advantage platform enabled us to deliver breakout performance in 2024. As we step into 2025 with momentum on growth and confidence in our 2025 outlook, we believe we are well positioned to continue distancing ourselves from competitors this year as well as looking ahead to 2026 and beyond. With that, let's open the call to questions.

因此，在其他條件相同的情況下，與前幾年的經驗相比，季節性的變化將略微降低上半年的 MBR，相反，將增加下半年的 MBR。除了 D 部分季節性的變化之外，我們的第一季指引大致反映了我們的常規季節性，其中包括今年第一季的更高利用率。總而言之，我們一貫堅持的平衡成長與獲利的策略，加上我們差異化的醫療保險優勢平台，使我們在 2024 年取得了突破性的業績。隨著我們帶著成長動能和對 2025 年前景的信心邁入 2025 年，我們相信，我們已做好準備，在今年繼續拉開與競爭對手的距離，並展望 2026 年及以後。現在，讓我們開始提問。

Operator?

操作員？

(Operator Instructions)

（操作員指示）

Scott Fidel, Stephens.

史考特菲德爾、史蒂芬斯。

First question, just wanted to maybe unpack the guidance for 2025 for the adjusted EBITDA, which shows solid improvement in profitability, both on the top end and the bottom end of the range. There's a reasonable sort of range embedded there between the top and the bottom end. So just was hoping maybe you could give us some of your thinking around some of the key assumptions that you may have between -- that could ultimately allow you to reach the high end possibly versus the midpoint and the low end of the range.

第一個問題，我只是想解釋一下 2025 年調整後 EBITDA 的指導，這表明盈利能力無論是在範圍的頂端還是底端都有了穩步提升。在頂端和底端之間存在著合理的範圍。所以只是希望您能就您可能擁有的一些關鍵假設向我們提供一些想法——這些假設最終可能使您達到範圍的高端，而不是中點和低端。

Thomas here. Happy to take the question. So I guess, first off, I think it's probably worth noting that we feel just great about where we landed for the fourth quarter and full year 2024, which is not only important in terms of the actual outcome looking backwards, but really what it means for us looking forward as we march into 2025. And so to your question on sort of what would send us towards sort of the low end of the range versus the high end of the range, I think there's a few variables that are kind of key to us this year. So the first is, as you've heard many others in the space talk about, we are stepping into some new aspects of the Part D program under the Inflation Reduction Act.

我是托馬斯。很高興回答這個問題。所以我想，首先，我認為值得注意的是，我們對 2024 年第四季和全年的成績感到非常滿意，這不僅對於回顧過去的實際結果很重要，而且對於我們邁向 2025 年的未來也具有重要意義。因此，對於您關於什麼會讓我們走向範圍的低端與高端的問題，我認為今年有幾個變數對我們來說很關鍵。首先，正如您聽到該領域許多其他人談論的那樣，我們正在進入《通貨膨脹削減法案》下 D 部分計劃的一些新方面。

I think we've taken a prudent approach in terms of thinking through what the MLR should look like on that program in 2025. And I would say the low end of our range, in particular, has a bit more conservatism on how that would look relative to prior years. I think our 2024 experience on Part D ultimately landed within about $1 PMPM of what we expected. So I think we feel really good about our ability to forecast what that looks like. But we are being a little more conservative there on the low end just given some of the changes coming our way.

我認為我們在思考 2025 年 MLR 在該計劃中應該是什麼樣子時採取了審慎的態度。我想說的是，與前幾年相比，我們的低階產品範圍看起來更保守。我認為我們在 2024 年 D 部分的經驗最終與我們預期的每月 1 美元左右相差無幾。所以我認為我們對自己預測未來情況的能力感到非常滿意。但考慮到即將發生的一些變化，我們在低端方面會更加保守一些。

I think beyond that, it's sort of the usual suspects in terms of where our utilization and admissions per 1,000 run for the year, how our growth progresses sort of intra-quarter throughout the year and how our overall just cohorts mature from year 1 to year 2, year 2 to year 3 and so forth. But I think big picture, we feel very confident in our overall range for the year, particularly given that we do still have 50% of our members in the year 1 or year 2 cohort. I think we're in a great place looking ahead to 2025.

我認為除此之外，還有一些常見的因素，例如我們全年的利用率和每千人的入院人數、全年各個季度內的增長情況以及我們的整體群體從第 1 年到第 2 年、第 2 年到第 3 年的成熟情況等等。但我認為，從整體來看，我們對今年的整體業務範圍非常有信心，特別是考慮到我們仍有 50% 的會員屬於第一年或第二年。我認為，展望 2025 年，我們處於一個非常有利的位置。

Okay. Great. And then just as my follow-up question, I would be interested if you have this, if you have sort of the breakdown of when looking at the guidance you've given for membership growth for the full year of 2025, what do you expect that split would be between California and then non-California. Certainly nice to see growth playing out in both of those areas. And then just related to that, just in terms of engagement, are there any sort of initial indicators that you have or that you could share with us around how the new members are engaging with Aeva in the non-California markets versus the home California market?

好的。偉大的。然後，正如我的後續問題，如果您有這個，我會很感興趣，如果您對 2025 年全年會員增長的指導進行細分，您預計加利福尼亞州和非加利福尼亞州之間的比例會是多少。很高興看到這兩個領域都取得了成長。然後與此相關的是，就參與度而言，您是否有任何初步指標，或者您可以與我們分享新會員在非加州市場與 Aeva 的互動情況以及加州本土市場的互動情況？

Yes. So just on the membership point, I would expect our results for 1/1 through AEP would be kind of a good indicator as to what we expect to occur over the duration of 2025. So I think from a -- obviously, from a growth percentage standpoint, we would expect ex-California to continue to grow materially faster than California, similar to our comments on [indiscernible] and I would say Nevada, for example, would be one area where we expect continued growth during the year in addition to our other ex-California markets. That being said, I think from an overall net membership growth, we would still expect California to drive over 50% of the total net member growth, just given the success we saw during AEP and how we would anticipate that to continue through the rest of the year. And I think to your question on sort of engagement, I'd say Aeva and maybe just more generally speaking, sort of replicability of the care model ex-California, I think that remains to be one of the things we're hyper focused on and really continuing to demonstrate proof points around.

是的。因此，僅從會員角度而言，我希望從 1/1 到 AEP 的結果能夠很好地表明我們預計 2025 年期間會發生什麼。因此我認為從增長百分比的角度來看，我們預計加州以外地區的增長速度將繼續顯著快於加州，類似於我們對[音頻不清晰]的評論，我想說，例如，除了其他加州以外市場外，我們預計內華達州也是今年繼續增長的地區之一。話雖如此，我認為從整體淨會員成長來看，考慮到我們在 AEP 期間看到的成功以及我們預計這種情況將在今年剩餘時間內持續下去，我們仍然預計加州將推動總淨會員成長的 50% 以上。對於您關於參與度的問題，我想說的是 Aeva，或者更籠統地說，加州以外護理模式的可複製性，我認為這仍然是我們高度關注的事情之一，並且我們會繼續展示相關證據。

And so we mentioned in our prepared remarks that ex-California actually ran about 144 inpatient admissions per 1,000, which is better than that of the consolidated enterprise and therefore, California. So I think we're doing a nice job at sort of hiring, training, driving adoption of the tools and really making sure we're kind of being consistent market by market around how we approach our care teams and care delivery. And I think from an engagement standpoint, it doesn't really matter what the market is. From the consumer's perspective or from the seniors' perspective, they're getting ultimately better care for free in a convenient manner, i.e., in the home or virtually depending upon what they prefer, really acting as an extension of their primary care relationship. And so I don't think we see differences in terms of our ability to engage irrespective of the county or the state.

因此，我們在準備好的發言中提到，前加州實際上每 1,000 人住院人數約為 144 人，這比合併後的企業以及加州的住院人數要好。所以我認為我們在招募、培訓、推動工具採用方面做得很好，並且真正確保我們在處理護理團隊和護理服務的方式上與各個市場保持一致。我認為從參與的角度來看，市場是什麼並不重要。從消費者或老年人的角度來看，他們最終將以便捷的方式免費獲得更好的護理，即在家中或虛擬地，這取決於他們的喜好，這實際上充當了他們初級護理關係的延伸。因此，我認為，無論在哪個縣或州，我們的參與能力都沒有差異。

Adam Ron, Bank of America.

美國銀行的亞當‧羅恩 (Adam Ron)。

I got 2 questions. So first, on the MLR guidance for 2025 based on quick math in the press release, it seems like you're talking about MLR being down 30 basis points in 2025 after being up 30 basis points in 2024, which was another big growth year. Meanwhile, if I just simplistically look at how United and Humana are talking about it, United was mostly Medicare is talking about 100 basis point MLR increase into 2025, while you're saying a decrease and then Humana is saying flat, but that includes them exiting markets where it was very unprofitable. At the same time, I presume that they're both cutting benefits more than you are. And so if you could just bridge -- and you have a lot of new members coming that are more MLR dilutive than they do.

我有兩個問題。首先，根據新聞稿中快速計算得出的 2025 年 MLR 指導值，您似乎認為 MLR 在 2024 年上漲 30 個基點之後，將在 2025 年下降 30 個基點，而 2024 年又是另一個大幅增長的年份。同時，如果我只是簡單地看一下 United 和 Humana 是如何談論這個問題的，United 主要是 Medicare 談論的是到 2025 年 MLR 將增加 100 個基點，而你說的是下降，而 Humana 則說持平，但這包括他們退出非常無利可圖的市場。同時，我推測他們削減福利的幅度都比你大。因此，如果你能搭建橋樑——並且有大量新成員加入，那麼他們的 MLR 稀釋作用就會比現在更大。

And so if you could just bridge how they seem to be talking about a more severe MLR increase than you are, that would be helpful. And I have a follow-up.

因此，如果您能解釋他們似乎在談論比您更嚴重的 MLR 成長，那將會很有幫助。我還有一個後續問題。

Yes, happy to cover that. I think I can't comment on sort of the peer universe in terms of what they're seeing. But I think many of those organizations, not necessarily the 2 you mentioned per se, but just in general, a lot of these organizations are really struggling with a myriad of factors, including Stars changes impacting payment year 2025, the second year of the V28 risk model changes and, of course, the broad utilization challenges that you've seen across the industry for going back over the last 12 to 18 months. I think 2024 really is the starting point to answer your question as to why we're showing differentiated results versus others. We shared at a conference back in January that our year-to-date -- or excuse me, yes, our year-to-date MBR through the third quarter year-over-year was up about, I want to say, 200 basis points when you normalize for ACO REACH in 2023 relative to about high 50 percentage membership growth at that point in time.

是的，很高興報導這一點。我認為我無法對他們所看到的同等宇宙做出評論。但我認為其中許多組織，不一定是您所提到的那兩個組織，但總體而言，其中許多組織確實在努力應對各種因素，包括影響 2025 年支付年度的 Stars 變化、V28 風險模型變化的第二年，當然還有您在過去 12 到 18 個月中看到的整個行業面臨的廣泛利用挑戰。我認為 2024 年確實是回答您的問題的起點，為什麼我們的結果與其他人不同。我們在 1 月的一次會議上分享了我們的年初至今 - 或者對不起，是的，截至第三季度的年初至今的 MBR 同比增長了約 200 個基點，如果將 2023 年的 ACO REACH 標準化，則相對於當時約 50% 的會員增長率而言。

If you were to refresh that analysis today, we actually had our MBR for full year 2024 only up about 130 basis points year-over-year relative to 2023, and again, while growing membership 59%. If you were to contrast that with the industry, you would see that many of the peers were up 200% to 300% in 2024 alone while barely growing or in some cases, shrinking membership. And those that did grow more than 10% to 20% saw MBR increasing to the tune of 500 to 600 basis points year-over-year. So I think 2024 really demonstrates our ability to kind of control our own destiny and manage MBR while continuing to grow membership. I think 2025 is similar as we move forward, where we do have some pluses and minuses like the industry.

如果您今天刷新一下該分析，我們 2024 年全年的 MBR 實際上僅比 2023 年同比增長約 130 個基點，同時會員人數也增長了 59%。如果將其與行業進行對比，您會發現許多同行僅在 2024 年就增長了 200％ 至 300％，但會員人數幾乎沒有增長，在某些情況下甚至在減少。而那些成長率超過 10% 至 20% 的銀行的 MBR 則是年增了 500 至 600 個基點。因此，我認為 2024 年真正證明了我們有能力掌控自己的命運並管理 MBR，同時繼續增加會員人數。我認為 2025 年的情況與此類似，當我們向前發展時，確實會有一些優點和缺點，就像這個行業一樣。

We do have a couple of headwinds around V28 and some of the Part D changes in the Inflation Reduction Act I mentioned previously. But conversely, we have a significant number of members maturing from a year 1 to year 2 cohort, which is a tailwind year-over-year. We did modestly trim our benefits in certain areas between 2024 and 2025. And of course, we have the benchmark rate update for 2025, which does help us. So I think given some of those pluses and minuses, we feel very good about our ability to achieve the 2025 guidance we laid out today.

我們確實在 V28 和我之前提到的《通膨削減法案》D 部分的一些變化方面遇到了一些阻力。但相反，我們有相當數量的會員從第一年到第二年逐漸成熟，這對去年來說是一個順風。2024 年至 2025 年期間，我們確實適度削減了某些領域的福利。當然，我們有 2025 年的基準利率更新，這確實對我們有幫助。因此，我認為，考慮到這些優點和缺點，我們對實現今天制定的 2025 年指導方針的能力感到非常有信心。

That's helpful. If I could squeeze 2 questions. One, just following up very quickly on what you said and then the second one. So on the first one, if you could give one answer as to what you think the biggest delta is versus your peers? Is it like the rate notice? Or is it risk adjustment?

這很有幫助。如果我可以擠出兩個問題。第一，快速跟進你所說的內容，然後是第二點。那麼對於第一個問題，您能否給出一個答案，您認為與同行相比最大的差距是什麼？它和費率通知單一樣嗎？還是風險調整？

Or is it something else? And then the actual question is if you guys could just give -- you had mentioned in the release, but your thoughts on the 2026 rate bonus from CMS and if you have any thoughts about it?

還是其他什麼？然後實際的問題是，你們是否可以給出——你們在發布中提到過，但你對 CMS 的 2026 年利率獎金有什麼看法？你對此有什麼想法？

I'm not sure you can say it's one thing because all these variables are so interrelated. I mean I think fundamentally, our model starts with our differentiated ability to engage members and drive up quality, i.e., stars and control costs by managing care and engaging with that chronic acute high-risk population. I think that's the foundation, but it then, I think, flows through how we think about changes around V28. It impacts how we think about the benefits we can offer in the market. It impacts our ability to perform on stars to manage utilization and navigate changes such as Part D and Inflation Reduction Act.

我不確定你是否可以說這是一件事，因為所有這些變數都是相互關聯的。我的意思是，我認為從根本上來說，我們的模式始於我們吸引會員並提高品質的差異化能力，即透過管理護理和接觸慢性急性高風險人群來控製成本。我認為這是基礎，但我認為，它貫穿我們如何看待 V28 周圍的變化。它影響我們如何看待我們能在市場上提供的利益。它影響我們管理利用率和應對 D 部分和通貨膨脹削減法案等變化的能力。

So I'm not sure you can pinpoint one specific variable and say why our trends are different than others across those different more financial variables. I think it starts with just our fundamental approach to this business being different than the others. It's not just an actuarial underwriting model for us. It really starts from the perspective of care delivery, care management. And I think the other things then kind of flow down from there.

所以我不確定你是否能指出一個特定的變量，並說明為什麼我們的趨勢與其他不同的金融變數的趨勢不同。我認為這始於我們對待這項業務的根本方法與其他業務不同。對我們來說，這不僅僅是一種精算核保模式。它實際上是從護理服務和護理管理的角度開始的。我認為其他事情會從那裡開始陸續展開。

Michael Ha, Baird.

麥可·哈，貝爾德。

Congrats on the earnings. It's still rare that I think sitting here in February 2025, there's really so much visibility into tailwinds all the way out to '28. You mentioned star rates weightings driving, I think, 0.23 benefit to your rough start rating for '27 and then '28, another tailwind. I think you said 0.25 for your reward factor change. So my question is, what is your current raw star rating score for that California HMO contract?

恭喜您獲得收入。我認為，在 2025 年 2 月的這個時候，我們能夠如此清楚地看到 2028 年之前的順風趨勢，這種情況仍然很少見。您提到星級權重會為您 27 年和 28 年的粗略起始評級帶來 0.23 的收益，這是另一個順風。我認為您說的獎勵因素變化是 0.25。所以我的問題是，您目前對加州 HMO 合約的原始星級評分是多少？

And would it be fair to assume your competitors likely won't see the same magnitude benefit? Some plans might already be getting a reward factor, which means if I'm thinking about it right, just from the star rating program changes alone, you have line of sight to moving that contract up from 4 to 4.5 or even 5. And then also your competitive advantage might even widen even further. So massive tailwind. I just wanted to confirm this thesis and better understand the magnitude.

是否可以公平地假設您的競爭對手可能不會獲得同樣幅度的利益？一些計劃可能已經獲得了獎勵因素，這意味著如果我沒有想錯的話，僅從星級評定計劃的變化來看，你就有可能將合約從 4 提高到 4.5 甚至 5。那麼你的競爭優勢也可能會進一步擴大。順風如此強勁。我只是想證實這個論點並更好地理解其重要性。

Yes, absolutely. So I think you sort of hit the nail on the head there. I think at minimum, it provides a lot of buffer for us in terms of maintaining the 4-star rating for that California HMO contract. Beyond that, it certainly is a tailwind as we continue to strive towards 4.5 or 5 stars, which remains our objective. I think from a competitive standpoint, for 2024, 3 of our toughest competitors were 4 or 4.5 stars, and we still grew membership 59%.

是的，絕對是。所以我認為你說得一針見血。我認為至少，它為我們維持加州 HMO 合約的 4 星評級提供了很大的緩衝。除此之外，這無疑是一個順風，因為我們將繼續努力爭取 4.5 星或 5 星，這仍然是我們的目標。我認為從競爭的角度來看，到 2024 年，我們最強勁的 3 個競爭對手都是 4 星或 4.5 星，而我們的會員人數仍然增長了 59%。

For 2025, a couple of those continue to fall below 4 stars. And looking ahead to 2026, there's really only one competitor of ours that is above 4 stars or at or above 4 stars. And so I think from our perspective, we do see a significant opportunity to continue to grow through 2026 just based on that alone. But what I would emphasize is that it's not just Stars. And while I think these tailwinds certainly help us with our own Stars visibility, to the extent that any others in the industry benefit from some of these changes in the future, I think it goes back to all the variables I was describing previously in terms of our ability to differentiate and continue to grow disproportionately relative to our markets.

到 2025 年，其中一些將繼續跌至 4 星以下。展望 2026 年，我們的競爭對手中真正能達到 4 星以上或達到 4 星以上的只有一個。因此，我認為從我們的角度來看，僅基於這一點，我們確實看到了到 2026 年繼續增長的重大機會。但我想強調的是，這不僅僅是星星。雖然我認為這些順風肯定有助於我們提高自己的明星知名度，但在某種程度上，行業中的任何其他人將來都會從這些變化中受益，我認為它又回到了我之前描述的所有變量，即我們區分和繼續相對於我們的市場不成比例地增長的能力。

And so at the end of the day, I think our ability to be high quality and low cost is the key to success. Things like not relying on the global capitation model and really wanting to engage with our seniors directly and manage the risk ourselves are really the secret sauces that allow us to continue to grow faster than the market year in, year out. I think as you get out into 2027 and 2028, I think we still continue to see a very positive opportunity for us to continue to grow 20% or above based on the Stars results and certainly those other variables as well.

所以歸根結底，我認為高品質和低成本的能力是我們成功的關鍵。不依賴全球人頭稅模式、真正希望直接與老年人接觸並自行管理風險等，才是我們能夠年復一年保持高於市場成長速度的秘訣。我認為，隨著進入 2027 年和 2028 年，我們仍然有機會根據 Stars 的結果以及其他變數繼續實現 20% 或以上的成長。

And maybe one more question. On your cohort maturation, I know how powerful year 1 to year 2, typically, you see the largest step function MLR improvement, I think, 300 bps. I think a lot of it is also driven by the risk adjustment itself, like 10% improvement. And the magnitude of this power quite significant. We estimate it could almost be the entire bridge from '24 to '25.

也許還有一個問題。在您的群體成熟度方面，我知道第 1 年到第 2 年的強度如何，通常，您會看到最大的階躍函數 MLR 改進，我認為是 300 bps。我認為其中很大一部分也是由風險調整本身所推動的，例如 10% 的改善。而且這種力量的量級相當巨大。我們估計它幾乎可以是 1924 年至 1925 年的整座橋。

So -- but that said, in terms of this cohort maturation, everything so far tracking in line with expectations, risk adjustment capture on that '24 cohort, I guess, Care Anywhere engagement, nothing really impeding that maturation story, everything sort of moving along as expected and fueling this maturation dynamic?

所以 - 但話雖如此，就這個群體的成熟度而言，到目前為止一切都符合預期，對“24 個群體”的風險調整捕獲，我想，Care Anywhere 的參與，沒有什麼真正阻礙這個成熟故事，一切都按預期進行並推動這種成熟動力？

Yes. I think we continue to remain confident in our ability to drive those cohort results over time. I think in terms of that 2024 cohort maturing into year 2 and 2025, similarly, we feel very good about how that's continuing to evolve. I would say, keep in mind, in the second half of the year alone last year, we grew membership by about 15,000 between end of June and end of December. And so what I would say is for some of those members that we've only had on board for a couple of months, we're still continuing to engage with those.

是的。我認為，我們對自己長期推動這些團體成果的能力仍然充滿信心。我認為，就 2024 年群體在第二年和 2025 年成熟而言，同樣，我們對這一趨勢的持續發展感到非常滿意。我想說，請記住，光是去年下半年，從 6 月底到 12 月底，我們的會員人數就增加了約 15,000 人。所以我想說的是，對於一些只加入我們幾個月的成員，我們仍會繼續與他們接觸。

And so I think that just provides an incremental tailwind for us as we think about not just 2026, but also the margin opportunity moving towards 2027, where we are still just continuing to engage some of those members that have been on board for a few months. But big picture, I would say our engagement for last year did exceptionally well. We got close to that 60% goal we had previously described, and that was really a major driver of our ability to land at 149 inpatient admissions per 1,000 for full year 2024, including Q4 being our best MBR quarter of the year.

因此，我認為這為我們提供了一個漸進的順風，因為我們不僅考慮 2026 年，還考慮邁向 2027 年的利潤機會，我們仍在繼續與一些已經加入幾個月的成員接觸。但從整體來看，我想說我們去年的合作非常成功。我們已經接近先前描述的 60% 的目標，這確實是我們在 2024 年全年實現每 1,000 人住院人數達到 149 人的主要驅動力，其中第四季度是我們今年 MBR 最好的一個季度。

Matthew Gilmore, KeyBanc.

馬修·吉爾摩（Matthew Gilmore），KeyBanc。

I had the first one on guidance. Thomas had mentioned a modestly higher utilization assumption due to mix of membership. I was hoping you could unpack that a little bit. Is that just a reflection of the favorable duals mix or something else underlying that?

我有第一個指導。湯瑪斯曾提到，由於會員的混合，利用率假設會略高。我希望你能稍微解釋一下這一點。這只是有利的雙重組合的反映，還是有其他潛在因素？

Yes, that's exactly correct. So both during 2024 and then through AEP 1125, we have continued to see solid growth in our duals membership, which tends to come with slightly higher utilization. So I think in total for full year 2025, we wouldn't expect too much of a change in terms of total admissions per 1,000. It might be up a couple of percent year-over-year. But it is something that we are mindful of just given the changes in PDP mix from '23 to '24 and then '24 to '25.

是的，完全正確。因此，無論是在 2024 年還是到 AEP 1125 年，我們的雙重會員數量都持續穩定成長，而這往往伴隨著略高的利用率。因此，我認為，就 2025 年全年而言，我們預計每 1,000 人次的總入場人數不會有太大變化。與去年同期相比，可能會成長幾個百分點。但考慮到 PDP 組合從 23 年到 24 年以及從 24 年到 25 年的變化，我們必須注意這一點。

Got it. That's great. And then, Thomas, do you have any commentary for us in terms of expectations for cash flow and sort of how you're thinking about CapEx and sort of where that money is going?

知道了。那太棒了。然後，托馬斯，您對現金流預期以及您對資本支出的看法以及這些資金的去向有什麼評論嗎？

Yes. So without kind of getting into full guidance on cash flow for 2025, I guess, a couple of data points worth noting. So from an EBITDA standpoint, obviously, we did share our guidance today with the midpoint of $47.5 million. Beyond that, we would expect probably about $14 million of interest expense in 2025 and CapEx probably to the tune of $30 million to $35 million. So I think those are sort of the kind of major variables to consider.

是的。因此，雖然沒有對 2025 年的現金流提供全面的指導，但我想，有幾個數據點值得注意。因此，從 EBITDA 的角度來看，顯然我們今天確實分享了我們的指導，中間值為 4750 萬美元。除此之外，我們預期 2025 年的利息支出可能約為 1,400 萬美元，資本支出可能達到 3,000 萬至 3,500 萬美元。所以我認為這些都是需要考慮的主要變數。

Working capital tends to not be a major driver of overall cash kind of year in, year out. It just kind of depends on how some of the medical expense payables evolve relative to some of the receivables. And so I think we feel like we're in a great spot from an overall cash standpoint. We ended 2024 with over $200 million of cash at hand. And as we think about our organic growth pathway over the next several years, I think we're in a great spot to continue to achieve those targets without the need for external financing.

營運資本往往不會成為年復一年整體現金的主要動力。這只取決於部分醫療費用應付款項相對於部分應收款項的變化。因此我認為從整體現金角度來看我們處於一個很好的位置。截至 2024 年，我們手頭上有超過 2 億美元的現金。當我們思考未來幾年的有機成長路徑時，我認為我們處於一個很好的位置，可以在不需要外部融資的情況下繼續實現這些目標。

Jessica Tassan, Piper Sandler.

傑西卡·塔桑、派珀·桑德勒。

Congrats on the guidance raise and the strong results. So I wanted to just ask, understanding that new members are drag, obviously, on MBR in the first 1, 2 years, are new members in your markets outside of California starting at kind of even lower MBRs than the California -- or sorry, higher MBRs than the California members? And does that MBR trajectory eventually converge? And kind of if so, at what point -- at what year would that happen?

祝賀指導價的提升和強勁的業績。所以我想問一下，我知道新成員在前 1、2 年顯然會拖累 MBR，那麼加州以外市場的新成員的起始 MBR 是否比加州成員的還要低——或者抱歉，比加州成員的 MBR 更高？MBR 軌跡最終會收斂嗎？如果是這樣，那麼會在什麼時候──哪一年發生？

I can take that one. So I'd say it depends. It depends on the market. It depends on the product type. It depends on the provider group.

我可以接受那個。所以我認為這要視情況而定。這取決於市場。這取決於產品類型。這取決於提供者組。

So it's variable, I think, is the simple answer. There are certain markets, products, provider combinations that do start higher MBR, but what we typically see with those is there's just a greater opportunity to drive MBR improvement from year 1 through year 3, year 3 through year 5, et cetera. So sort of a steeper slope of improvement curve opportunity. But it does just depend on some of those variables I mentioned earlier.

所以我認為答案是簡單的，它是可變的。某些市場、產品和供應商組合確實會起始較高的 MBR，但我們通常看到的是，從第 1 年到第 3 年、第 3 年到第 5 年等等，推動 MBR 改進的機會更大。因此，這是一種更陡峭的改進曲線機會。但它確實取決於我之前提到的一些變數。

Got it. So they eventually do converge at roughly the same level of profitability?

知道了。那麼，它們最終的獲利水準確實會大致相同嗎？

Yes. In fact, I would say we actually see in instances where there's actually a greater opportunity to drive MBR performance ex-California than even inside of California.

是的。事實上，我想說，我們確實看到，在加州以外地區推動 MBR 表現的機會實際上比在加州內更大。

Okay. That's helpful. And then maybe just can you give some comments about retention during AEP? I know you said more than 50% in year 1, 2 cohorts, but just any commentary on retention during AEP given that you guys had emphasized margin in the 2025 benefit? So just is AEP churn higher year-over-year in '25?

好的。這很有幫助。那麼，您能否對 AEP 期間的保留發表一些評論？我知道您說過第 1 年和第 2 年群體的比例超過 50%，但鑑於你們已經強調了 2025 年福利的利潤率，您對 AEP 期間的保留率有何評論？那麼 25 年的 AEP 流失率是否較去年同期上升？

Or is it -- did some alternate reality play out?

還是——發生了一些另類現實的事情？

No. Actually, so going back a year to 1/1/24, 1/1/24 was our best AEP retention percentage in, I think, the history of the company, certainly in the last 3 or 4, 5 years before that. 1/1/25 was very similar to the 1/1/24 retention rate. So we feel very good about how that evolved during the year. We did make a couple of decisions on certain markets and certain provider contracts that were really designed to make sure that our overall MBR trajectory over a multiyear period had durability and that those contracts have -- or contracts or products have longevity to them as well.

不。實際上，回顧一年前的 1/1/24，我認為 1/1/24 是我們公司歷史上最好的 AEP 保留率，當然是在此之前的 3 或 4、5 年裡最好的。 1/1/25 的保留率與 1/1/24 的保留率非常相似。因此，我們對這一年的發展感到非常滿意。我們確實針對某些市場和某些供應商合約做出了一些決定，這些決定實際上是為了確保我們多年的整體 MBR 軌跡具有持久性，並且這些合約或合約或產品也具有長壽性。

So we did lose a couple of few thousand lives associated with some of those decisions. But I think big picture, we feel very good about how the retention played out during AEP.

因此，我們確實因為某些決定而失去了數千人的生命。但我認為從總體上看，我們對 AEP 期間的保留效果感到非常滿意。

That's helpful. And then I want to sneak in just one quick one and ask if you guys have any thoughts or just based on expectations for the final rate notice that you would like to share with us.

這很有幫助。然後，我想偷偷地快速問一下，你們有什麼想法，或者只是基於對最終費率通知的期望，願意與我們分享。

Jess, it's John. I think the last couple of years have taught us that irrespective of the reimbursement, whether they go up or down, we're just really well positioned on a relative basis, not only with what Thomas talked about in terms of stars, but the way that we've approached risk adjustment really from the beginning of the company has been not to be too aggressive around it. And so I think that's like a second relative advantage to us. Now I would expect it to be a little bit higher is what my -- just nothing more than my gut would suggest. I think the 5.93% kind of actual benchmark increase on a national basis, I think could go up a little bit.

傑西，我是約翰。我認為過去幾年的經驗告訴我們，無論報銷金額是上升還是下降，我們都處於相對有利的位置，這不僅是托馬斯所說的星級標準，而且從公司成立之初，我們在風險調整方面的做法就是不要太激進。所以我認為這對我們來說是第二個相對優勢。現在我預計它會稍微高一點，這只是我的直覺所建議的。我認為全國範圍內 5.93% 的實際基準增幅可能會略有上升。

And the only reason I would say that is predicated on the ACO rate increase as well as the fee-for-service increase and the potential inclusion of some runout in the first half of 2024. And if you just remember, there's a lot of utilization increases in the first part of 2024 that I'm not sure made it into the 5.93%. But other than that, we'll just have to wait and see. But I think we feel really good either way.

我這樣說的唯一原因是基於 ACO 費率上漲以及按服務收費上漲，以及 2024 年上半年可能會出現一些損耗。如果你還記得的話，2024 年上半年利用率會大幅增加，但我不確定是否能達到 5.93%。但除此之外，我們只能拭目以待。但我認為無論怎樣我們都感覺很好。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

This is Tiffany on for Andrew. I think some of your peers are pointing to like a significantly more dramatic upward slope on MLR from 1Q to 4Q due to the Part D IRA changes. But it seems like you guys are still assuming Part D MLR improvement throughout the year just at a flatter slope. Can you help us understand why there might be some differences in experience and whether that has anything to do with your Part D like benefit structure versus peers?

這是蒂芙尼為安德魯表演的。我認為您的一些同行指出，由於 D 部分 IRA 的變化，MLR 從第一季到第四季度出現了更顯著的上升趨勢。但看起來你們仍然假設 D 部分 MLR 全年都會以較平緩的斜率改善。您能否幫助我們理解為什麼經驗上可能會存在一些差異，以及這是否與您的 D 部分福利結構與同行相比有任何關係？

Yes, I'm happy to address that. I don't want to overly speculate on others, but I suspect part of it has to do with the fact that they also have broader stand-alone Part D or PDP offerings, which we don't have. I think in terms of our experience, going back to 2024, we shared previously that Q1 tends to be our higher MBR quarter for Part D and then it improves sequentially over the course of the year. And as I mentioned earlier, our kind of ability to forecast that and track that is quite strong, including the fact that we have sort of real-time claims visibility on Part D. And ultimately, for 2024, as I mentioned earlier, we land within about $1 where we expected PMPM.

是的，我很樂意解決這個問題。我不想過多猜測其他人，但我懷疑部分原因是他們也有更廣泛的獨立 Part D 或 PDP 產品，而我們沒有。我認為，根據我們的經驗，回顧 2024 年，我們之前分享過，第一季往往是 D 部分的 MBR 較高的季度，然後它會在全年內逐步改善。正如我之前提到的，我們預測和追蹤這一點的能力非常強，包括我們對 D 部分有即時索賠可見性。最終，到 2024 年，正如我之前提到的，我們的 PMPM 將達到我們預期的 1 美元左右。

And so moving into 2025, I do think it will be similar to years past, just less of a slope. And so as we said in our prepared remarks, I would expect that it would cause the first half to be slightly lower than prior years, all else being equal and conversely would be a slight headwind to the second half of the year year-over-year.

因此，進入 2025 年，我確實認為情況將與過去幾年類似，只是斜率較小。因此，正如我們在準備好的發言中所說的那樣，我預計這將導致上半年的業績略低於前幾年，其他條件相同，相反，這將對下半年的業績造成輕微的阻力。

Okay. That's helpful. And just a quick follow-up on G&A. I think 4Q G&A came in a little bit higher than what was implied in the guide and your 1Q guide implies about a 200 basis point Q-over-Q step down. Like can you give a little bit of color on what drove the slightly higher 4Q result and how we should think about quarterly G&A progression in 2025?

好的。這很有幫助。這只是對 G&A 的快速跟進。我認為第四季度的一般及行政開支比指南中暗示的要高一點，而您的第一季指南暗示環比下降約 200 個基點。例如，您能否稍微解釋一下是什麼導致了第四季度業績略高，以及我們應該如何看待 2025 年季度 G&A 的進展？

Yes. Ma'am, I would say, in general, you obviously have sort of a step-up as a percentage of revenue kind of as the quarters progress, typically in the back half of the year, in particular, where you have a concentration of the sales and marketing spend. I think the fourth quarter for us was a combination of that normal dynamic, including the timing of some of the sales and marketing dollars as well as the fact that we did ultimately meaningfully outperform relative to our membership expectations. So with that comes higher commission costs and certain other variable expenses that we have to continue to incur to support the incremental membership growth. And I guess, I know we've said in our prepared remarks, but worth noting again, I think in terms of sort of where we landed for the full year, I think our full year operating leverage improvement from '23 to '24 was about 330 basis points year-over-year, given that significant 59% membership growth.

是的。女士，我想說，總的來說，隨著季度的進展，您的收入百分比顯然會有所上升，特別是在下半年，因為那時您的銷售和行銷支出比較集中。我認為，第四季度對我們來說，是正常動態的結合，包括部分銷售和行銷資金的時機，以及我們最終確實超出了會員預期這一事實。因此，我們必須繼續承擔更高的佣金成本和某些其他變動費用，以支持會員數的成長。我想，我知道我們已經在準備好的發言中說過，但值得再次指出的是，我認為就我們全年的成績而言，考慮到會員人數顯著增長 59%，我認為從 23 年到 24 年，我們的全年運營槓桿率同比增長了約 330 個基點。

So I think our confidence in our ability to continue to control SG&A and kind of manage it relative to our membership growth in '25 moving forward is quite high given the success of 2024.

因此，考慮到 2024 年的成功，我認為我們對繼續控制銷售、一般和行政費用以及在 25 年以後管理其相對於會員成長的能力充滿信心。

This is going to conclude our question-and-answer session. Ladies and gentlemen, this is also going to conclude today's conference call. Thank you for participating, and you may now disconnect. Everyone, have a great day.

我們的問答環節即將結束。女士們、先生們，今天的電話會議也到此結束。感謝您的參與，您現在可以斷開連接了。祝大家有個愉快的一天。