Alignment Healthcare Inc (ALHC) 2025 Q1 法說會逐字稿

Good afternoon, and welcome to Alignment Healthcare's first-quarter 2025 earnings conference call and webcast. (Operator Instructions) Please note that this event is being recorded.

下午好，歡迎參加 Alignment Healthcare 2025 年第一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。

Leading today's call are John Kao, Founder and CEO; and Thomas Freeman, Chief Financial Officer.

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。

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. 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. Descriptions of some of the factors that could cause actual results that 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.

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。這些前瞻性陳述受各種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。

Although we believe our expectations are reasonable, we undertake no obligation to revise any statements to reflect changes that occur after this call.

儘管我們認為我們的預期是合理的，但我們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。

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 year ending March 31, 2025.

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 2025 年 3 月 31 日的財政年度的 10-Q 表中找到。

Hello, and thank you for joining us on our first quarter earnings conference call. We are pleased to announce a strong start to the year where we surpass the high end of guidance for each of our four key metrics.

您好，感謝您參加我們的第一季財報電話會議。我們很高興地宣布，今年我們取得了良好的開局，四個關鍵指標都超出了預期的上限。

For the first-quarter 2025, our health plan membership of 217,500 members represented approximately 32% growth year over year. This drove total revenue of $927 million, which grew approximately 47% year over year. We also delivered strong margin expansion even as we grew faster than our initial expectations.

2025 年第一季度，我們的健康計畫會員人數為 217,500 名，較去年同期成長約 32%。這推動總收入達到 9.27 億美元，年增約 47%。儘管我們的成長速度超出了最初的預期，但我們的利潤率也實現了強勁成長。

Adjusted gross profit of $107 million grew 87% year over year, which produced a consolidated MBR of 88.4%, a 250-basis-point improvement versus the prior year. Meanwhile, adjusted IBEDA of $20 million resulted in 410 basis points of margin expansion year over year and exceeded the high end of our first-quarter guidance.

調整後毛利為 1.07 億美元，年增 87%，合併 MBR 為 88.4%，比上年提高 250 個基點。同時，調整後的 IBEDA 為 2000 萬美元，導致利潤率同比擴大 410 個基點，並超過了我們第一季指引的高端。

Our strong results are once again demonstrating that our business model is Medicare Advantage done right. Building upon last year's momentum, we continue to scale our clinical model across the enterprise, including our ex-California markets, where we more than doubled our membership year over year. This resulted in first-quarter in-patient admissions per thousand of 153 in California and 145 across our ex-California markets, both of which outperformed our expectations.

我們的強勁業績再次證明，我們的商業模式是正確的醫療保險優勢計劃。在去年發展勢頭的基礎上，我們繼續在整個企業範圍內擴展我們的臨床模式，包括我們的加州以外市場，在這些市場，我們的會員數量同比增長了一倍以上。這導致第一季加州每千人住院人數為 153 人，加州以外市場每千人住院人數為 145 人，均超出了我們的預期。

As the Medicare Advantage landscape has evolved around us, our approach to serving our seniors has remained unchanged since our founding. Our model combines the product control and data visibility of a health plan, clinical insights of a modern technology platform, medical management expertise of a care delivery organization, and member experience of a consumer-first company.

隨著醫療保險優勢格局的不斷發展，我們為老年人提供服務的方式自成立以來就沒有改變。我們的模型結合了健康計劃的產品控制和數據可見性、現代技術平台的臨床見解、醫療服務機構的醫療管理專業知識以及消費者至上公司的會員體驗。

By bringing each of these capabilities together, we are creating a durable senior health platform that is enabling us to take share at an accelerated pace while controlling medical costs, just as we have demonstrated again this quarter. Given the strength of our first-quarter results and our solid growth momentum, we are raising the midpoint of our guidance ranges across each of our four key metrics. Thomas will share more in his remarks.

透過整合這些功能，我們正在創建一個持久的老年健康平台，使我們能夠以更快的速度佔領市場份額，同時控制醫療成本，正如我們本季再次展示的那樣。鑑於我們第一季業績的強勁和穩健的成長勢頭，我們將提高四個關鍵指標的指導範圍的中點。托馬斯將在他的演講中分享更多內容。

While we are proud of our recent results, we believe the biggest opportunities are still on the horizon. Despite our rapid growth in recent years, we still have less than 5% share across our existing markets. As we prepare to scale the organization in anticipation of the growth opportunity ahead, we are investing in our back-office operations, enhancing the member journey, and doubling down on our provider relationships through long-term collaborative partnerships.

雖然我們對最近的業績感到自豪，但我們相信最大的機會仍然在前方。儘管我們近年來發展迅速，但在現有市場中我們的份額仍然不到 5%。當我們準備擴大組織規模以迎接未來的成長機會時，我們正在投資後台運營，增強會員旅程，並透過長期合作夥伴關係加倍加強與供應商的關係。

With Medicare Advantage penetration now over 50% and seniors becoming a larger share of provider patient panels, we believe there will be more symbiotic opportunities to help our provider partners manage their seniors, particularly for those most at risk, like the duly eligible population and seniors with multiple chronic conditions.

隨著醫療保險優勢計劃的普及率現已超過 50%，老年人在醫療服務提供者患者小組中所佔的比例越來越大，我們相信將會有更多的共生機會來幫助我們的醫療服務提供者合作夥伴管理他們的老年人，特別是對於那些風險最高的人群，例如符合條件的人群和患有多種慢性病的老年人。

These members benefit most from the enhanced care that our Care Anywhere teams provide through greater care coordination, chronic disease management, and in-home support. We also see opportunity to further expand our competitive advantages by driving continued innovation in our AVA technology. These innovations aim to further advance our ability to improve clinical quality and member experience outcomes at lower costs.

這些會員從我們的 Care Anywhere 團隊透過更好的照護協調、慢性病管理和家庭支持提供的增強照護中受益最多。我們也看到了透過推動 AVA 技術的持續創新來進一步擴大競爭優勢的機會。這些創新旨在進一步提高我們以較低成本改善臨床品質和會員體驗結果的能力。

Each of these improvements are positioning us for the next phase of growth and maturing our operations as we scale. As we plan for 2026, we remain confident in our multi-year trajectory. First, our STARS payment advantages are widening considerably in 2026, when we will have 100% of our California members and plans rated four STARS or above, which will be approximately 40% better and positions us well to achieve our financial objectives in 2026.

每一項改進都為我們下一階段的成長做好了準備，並使我們的業務在擴大規模的同時更加成熟。當我們規劃 2026 年時，我們對我們的多年發展軌跡仍然充滿信心。首先，到 2026 年，我們的 STARS 支付優勢將大幅擴大，屆時，我們 100% 的加州會員和計劃都將獲得四星或以上的評級，這將提高約 40%，並使我們處於有利地位，能夠實現 2026 年的財務目標。

Meanwhile, our relative advantages on medical cost management, quality and STARS reimbursement will continue to support our growth objectives. Over the long term, we believe these differentiators will continue to position us for success, irrespective of the rate environment. Beyond 2026, we are pleased that the final rate notice indicated CMS's intent to continue than competitors in the state with just 59% of members in four-star or above plans.

同時，我們在醫療成本管理、品質和STARS報銷方面的相對優勢將繼續支持我們的成長目標。從長遠來看，我們相信無論利率環境如何，這些差異化因素都將繼續幫助我們成功。2026 年以後，我們很高興看到最終的費率通知表明 CMS 有意繼續保持這一勢頭，而該州僅有 59% 的會員參與四星級或以上的計劃。

Second, we believe we will be less impacted than our competitors by the third and final phase-in of V28 risk model changes, which may create an even greater opportunity for us relative to the first two years of the phase-in.

其次，我們相信，V28 風險模型變化的第三階段也是最後一階段實施對我們造成的影響將小於我們的競爭對手，這可能為我們創造相對於實施前兩年更大的機會。

And third, the final rate notice incorporates a healthy increase in benchmark rates, which more accurately reflects industry utilization trends and positions us well to achieve our financial objectives in 2026. Meanwhile, our relative advantages on medical cost management, quality and STARS reimbursement will continue to support our growth objectives.

第三，最終費率通知包含基準費率的健康成長，這更準確地反映了行業利用趨勢，並使我們預計在 2026 年實現財務目標。同時，我們在醫療成本管理、品質和STARS報銷方面的相對優勢將繼續支持我們的成長目標。

Over the long term, we believe these differentiators will continue to position us for success, irrespective of the rate environment. Beyond 2026, we are pleased that the final rate notice indicated CMS's intent to continue transitioning the current STARS reward factor into the Health Equity Index reward, now called the Excellent Health Outcomes for all reward, in rating year 2027, payment year 2028. We believe the new methodology more accurately rewards plans that perform well on clinical quality, particularly amongst complex populations.

從長遠來看，我們相信無論利率環境如何，這些差異化因素都將繼續幫助我們成功。2026 年以後，我們很高興看到最終費率通知表明 CMS 打算在 2027 年評級年度、2028 年支付年度繼續將當前的 STARS 獎勵因素轉變為健康公平指數獎勵（現稱為“所有人的優秀健康結果”獎勵）。我們相信，新方法能夠更準確地獎勵在臨床品質方面表現良好的計劃，尤其是在複雜人群中。

Finally, today we announced that Thomas has decided to step down from his role as CFO and effective tomorrow will serve as strategic advisor to the CEO. In this new role, he will focus on ensuring a smooth transition of his CFO responsibilities and supporting the company's long-term strategies and partnerships.

最後，今天我們宣布，托馬斯決定辭去財務長一職，並從明天起擔任執行長的策略顧問。在這個新職位上，他將專注於確保其財務長職責的平穩過渡，並支持公司的長期策略和合作夥伴關係。

As Thomas enters his new role, I'd like to thank him for 10 years of financial leadership and service to Alignment and its members. During this time with Alignment, Thomas helped us grow to a nationally recognized Medicare Advantage leader, profitably serving over 200,000 members across five states. He has been a trusted friend and partner throughout his tenure, and I sincerely appreciate his contributions over the past decade.

在托馬斯擔任新職務之際，我要感謝他十年來為 Alignment 及其成員提供的財務領導和服務。在 Alignment 任職期間，Thomas 幫助我們成長為全國公認的醫療保險優勢計劃領導者，為五個州的 200,000 多名會員提供盈利服務。在他的整個任期內，他一直是一位值得信賴的朋友和合作夥伴，我真誠地感謝他在過去十年中所做的貢獻。

After conducting a thoughtful and extensive search, I'm excited to introduce Jim Head, who will succeed Thomas as CFO and provide financial leadership as we continue to scale Alignment's business from its strong foundation. Jim most recently served as the Chief Financial Officer of Claritev, a publicly traded data analytics company for health plans, and joins us with more than 30 years of experience in strategic finance, healthcare, and business development.

經過深思熟慮和廣泛的搜索後，我很高興地介紹吉姆·海德 (Jim Head)，他將接替托馬斯 (Thomas) 擔任首席財務官，並在我們繼續從強大的基礎上擴展 Alignment 業務的過程中提供財務領導。Jim 最近擔任 Claritev 的財務官，這是一家公開交易的健康計畫數據分析公司，他在策略財務、醫療保健和業務發展方面擁有 30 多年的經驗。

Above all else, Jim is the financial leader best positioned to build upon our unique Medicare Advantage playbook and help us continue to scale Alignment's vision of Medicare Advantage done right. Thomas and I look forward to introducing you to Jim over the coming months as we meet with investors.

最重要的是，吉姆是一位最適合在我們獨特的醫療保險優勢計劃的基礎上進行構建的財務領袖，並幫助我們繼續擴大 Alignment 對醫療保險優勢計劃的正確願景。托馬斯和我期待在未來幾個月與投資者會面時向您介紹吉姆。

In conclusion, I'd like to thank our employees for their tireless dedication to our seniors as we continue to find industry expectations. As we step forward to the future ahead, we do so in a stronger financial and competitive position than at any time in our history.

最後，我要感謝我們的員工，感謝他們為我們的前輩所做的不懈奉獻，讓我們繼續尋找業界的期望。當我們邁向未來時，我們的財務狀況和競爭力將比歷史上任何時候都更強大。

With a sturdy foundation to build upon, we are eager to push forward to new frontiers, explore new ways to improve the lives of our members, and bring our model to more seniors everywhere.

有了堅實的基礎，我們渴望開拓新的領域，探索改善會員生活的新方法，並將我們的模式帶給世界各地更多的老年人。

Now, I'll turn the call over to Thomas to further discuss our financial results and outlook. Thomas?

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 March 2025, our health plan membership of 217,500 increased 32% year over year.

謝謝，約翰。截至 2025 年 3 月的季度，我們的健康計畫會員人數為 217,500 人，年增 32%。

Meanwhile, our first-quarter revenue of $927 million represented 47 % growth year over year. Our top line was supported by membership outperformance as our AEP momentum continued through OEP, as well as higher Part D revenue PMPM due to changes associated with the Inflation Reduction Act.

同時，我們第一季的營收為 9.27 億美元，年增 47%。由於我們的 AEP 勢頭透過 OEP 得以延續，我們的營業收入得到了會員超額表現的支持，同時由於與通貨膨脹削減法案相關的變化，D 部分收入 PMPM 也得到了提高。

Total adjusted gross profit in the quarter of $107 million grew 87% versus the first quarter of 2024. This represented an MBR of 88.4% and an improvement of 250 basis points year over year. Our first-quarter outperformance relative to guidance was driven by favorable inpatient utilization as we continue to demonstrate our ability to scale our clinical model across a larger population.

本季調整後總毛利潤為 1.07 億美元，較 2024 年第一季成長 87%。這意味著 MBR 達到 88.4%，年比提高了 250 個基點。我們第一季的表現優於預期，這得益於良好的住院利用率，因為我們繼續展示將臨床模型擴展到更大人群的能力。

Our overall in-patient admissions per 1,000 of 152 increased slightly year over year, consistent with our expectations shared last quarter due to changes in membership mix. Our first-quarter outperformance was also driven by modest favorability in our Part D MBR, which we anticipate to reverse over the next three quarters.

由於會員結構發生變化，我們每 1,000 名住院患者的總入院人數同比略有增加，這與上個季度我們的預期一致。我們第一季的優異表現也得益於 D 部分 MBR 的適度青睞，我們預期這種趨勢將在未來三個季度逆轉。

Lastly, we experienced favorable prior-period IBNP reserve releases that supported our first-quarter results. This further reinforces the strength of our ability to manage through rapid membership growth and sets a solid foundation towards our full year 2025 outlook.

最後，我們經歷了有利的前期 IBNP 儲備釋放，這支持了我們的第一季業績。這進一步增強了我們管理會員快速成長的能力，並為我們 2025 年全年展望奠定了堅實的基礎。

Moving down the P&L, SG&A in the quarter was $104 million. Our adjusted SG&A of $87 million represented 9.4% of revenue, decreasing by 160 basis points year over year. Our first-quarter result puts us squarely on track towards our full-year operating leverage target as we continue to see opportunities to scale the business and drive efficiencies throughout 2025 just as we did in 2024.

損益表中，本季銷售、一般及行政費用為 1.04 億美元。我們的調整後銷售、一般及行政費用為 8,700 萬美元，佔營收的 9.4%，年減 160 個基點。我們第一季的業績使我們正朝著全年營運槓桿目標穩步前進，因為我們繼續看到在 2025 年擴大業務規模和提高效率的機會，就像我們在 2024 年所做的那樣。

Lastly, our adjusted EBITDA of $20 million represented 410 basis points of margin expansion year over year. This was well ahead of our initial expectations and places us in a solid position to achieve our full-year profitability objectives, which we will expand upon shortly.

最後，我們的調整後 EBITDA 為 2,000 萬美元，比去年同期的利潤率擴大了 410 個基點。這遠遠超出了我們最初的預期，並使我們有能力實現全年獲利目標，我們很快就會進一步擴大這一目標。

Moving to the balance sheet. We remain in a strong position with $480 million in cash and investments at the end of the quarter.

轉到資產負債表。截至本季末，我們擁有 4.8 億美元的現金和投資，依然保持強勁勢頭。

Turning to our guidance, for the second quarter, we expect health plan membership to be between 220,000 and 222,000 members, revenue to be in the range of $950 million and $965 million, adjusted gross profit to be between $105 million and $113 million, and adjusted EBITDA to be in the range of $10 million to $18 million.

談到我們的指引，對於第二季度，我們預計健康計劃會員人數將在 220,000 至 222,000 人之間，收入將在 9.5 億美元至 9.65 億美元之間，調整後的毛利潤將在 1.05 億美元至 1.13 億美元之間，調整後的 EBITDA 將在 100 萬美元之間。

For the full-year 2025, we expect health plan membership to be between 228,000 and 233,000 members, revenue to be in the range of $3.77 billion, and $3.815 billion, adjusted gross profit to be between $420 million and $445 million, and adjusted EBITDA to be in the range of $38 million to $60 million.

對於 2025 年全年，我們預計健康計畫會員人數將在 228,000 至 233,000 人之間，收入將在 37.7 億美元至 38.15 億美元之間，調整後的毛利潤將在 4.2 億美元至 4.45 億美元之間，調整後的 EBITDA 將在 380 萬美元之間。

We are raising the midpoint of our guidance ranges across each of our four key metrics. The increase to the midpoint of our membership outlook reflects our latest visibility following a strong OEP season. Along with our membership increase, we are also raising our full-year revenue outlook to now reflect approximately $3.8 billion and 40% growth at the midpoint.

我們正在提高四個關鍵指標的指導範圍的中點。我們的會員前景中點的增加反映了我們在強勁的 OEP 季節之後的最新知名度。隨著會員人數的增加，我們也上調了全年營收預期，目前預計約 38 億美元，中位數成長率為 40%。

The increase to our revenue outlook also reflects our expectations for a continued increase in our Part D revenue PMPM through the remainder of the year. Although it's early in the year, our strong first quarter also gives us the confidence to increase the low end of both our adjusted gross profit and adjusted EBITDA ranges. The following elements are captured within our updated profitability outlook.

我們營收預期的增加也反映了我們對今年剩餘時間內 D 部分營收 PMPM 持續成長的預期。儘管現在才年初，但我們第一季的強勁表現也讓我們有信心提高調整後毛利和調整後 EBITDA 範圍的低端。我們更新後的獲利前景涵蓋了以下要素。

First, we expect continued stability in our inpatient emissions per 1,000. Similar to the first quarter, we anticipate in-patient utilization to continue to run modestly higher compared to 2024 for the remainder of the year. This is due to a shift in our mix of membership during AEP and in line with our commentary last quarter.

首先，我們預計每千名住院患者的排放量將保持穩定。與第一季類似，我們預計今年剩餘時間內住院患者利用率將繼續略高於 2024 年。這是由於我們在 AEP 期間會員結構發生了變化，並且與我們上個季度的評論一致。

Second, we anticipate our early favorability in Part D gross margin to reverse during the remainder of the year. While our first-quarter Part D MBR outperformed, we expect our Part D MBR to be slightly higher in the second through fourth quarters relative to prior expectations, leaving our Part D outlook for the full year roughly unchanged. We continue to take a prudent stance around our expectations for heightened pharmacy utilization, including oncology drugs, an approach which served us well in the first quarter.

其次，我們預計，我們早期對 D 部分毛利率的有利局面將在今年剩餘時間內發生逆轉。雖然我們第一季的 D 部分 MBR 表現出色，但我們預計第二季至第四季的 D 部分 MBR 將略高於先前的預期，因此我們對全年的 D 部分展望基本保持不變。我們繼續對藥品利用率提高（包括腫瘤藥物）的預期採取謹慎的態度，這種方法在第一季度發揮了良好的作用。

Third, we plan to invest a portion of our early outperformance towards our ongoing member engagement activities that support both our growth and profitability objectives in 2026 and beyond.

第三，我們計劃將早期優異表現的一部分投資於我們正在進行的會員參與活動，以支持我們在 2026 年及以後的成長和獲利目標。

And finally, turning to SG&A, the midpoint of our guidance implies an adjusted SG&A ratio of 10.1% for the full year. This reflects a 100-basis-point improvement year over year on top of the 320 basis points of operating leverage we delivered in 2024.

最後，談到銷售、一般及行政費用，我們指引的中點意味著全年調整後的銷售、一般及行政費用比率為 10.1%。這反映出我們在 2024 年實現的 320 個基點的營運槓桿基礎上，較去年同期成長了 100 個基點。

In terms of seasonality over the remainder of the year, we expect our second-half MBR to be higher than the first half MBR. This cadence is driven by assumptions for normal utilization seasonality patterns, including the regular flu season in the fourth quarter and greater Part D liability in the second half due to changes related to the inflation reduction.

就今年剩餘時間的季節性而言，我們預計下半年的 MBR 將高於上半年的 MBR。這種節奏是由正常利用季節性模式的假設所驅動的，包括第四季度的常規流感季節和下半年由於通貨膨脹降低相關變化而導致的 D 部分責任增加。

Additionally, we also expect our second-half SG&A ratio to be higher than the first half with the highest SG&A ratio in the fourth quarter. This is consistent with prior years and driven primarily by AEP sales and marketing costs, as well as increased staffing levels to support anticipated AEP growth.

此外，我們也預期下半年的銷售、一般及行政費用比率將高於上半年，第四季的銷售、一般及行政費用比率最高。這與前幾年一致，主要受 AEP 銷售和行銷成本以及為支援預期的 AEP 成長而增加的人員配備水準所推動。

Taken together and combined with the strength of our first-quarter outperformance, we have established a solid foundation for our full-year adjusted EBITDA outlook of $49 million at the midpoint of our updated guidance.

綜合起來，加上我們第一季的優異表現，我們為全年調整後 EBITDA 預期（即更新後的指引中位數 4900 萬美元）奠定了堅實的基礎。

Lastly, as previously shared, this will be my last earnings call. My 10-year CFO has been an incredible journey, and I'd like to extend my heartfelt appreciation to our employees for their unwavering partnership. I'd also like to thank our investors and analysts for their immense support over the last four years as a public company.

最後，正如之前所說，這將是我最後一次財報電話會議。我擔任財務長的十年是一段不可思議的旅程，我要向我們的員工表示衷心的感謝，感謝他們堅定不移的合作。我還要感謝我們的投資者和分析師在過去四年裡對上市公司的大力支持。

While it's never an easy time to step away, I'm more optimistic than ever about Alignment's opportunities ahead. As we have demonstrated time and time again, Alignment has set itself apart by balancing industry-leading growth with strong margin expansion as a result of our unique MA strategy and capabilities. I've yet to find a Medicare Advantage company better positioned to succeed as the industry continues to evolve.

雖然現在離開並不容易，但我對 Alignment 未來的機會比以往任何時候都更加樂觀。正如我們一次又一次證明的那樣，Alignment 憑藉其獨特的 MA 策略和能力，在業界領先的成長與強勁的利潤擴張之間取得平衡，從而脫穎而出。隨著產業不斷發展，我還沒有找到一家比醫療保險優勢公司更有能力取得成功的公司。

I look forward to working with John and Jim to execute a seamless transition. With that, let's open the call to questions. Operator?

我期待與約翰和吉姆合作，實現無縫過渡。現在，讓我們開始提問。操作員？

Ryan Daniels, William Blair.

瑞安丹尼爾斯、威廉布萊爾。

Yeah, congratulations to the team and thanks for taking the questions. John, maybe one for you to start. You had an interesting comment about working more with duals and patients with multiple chronic conditions and doing more care coordination with providers.

是的，恭喜團隊並感謝您回答問題。約翰，也許你可以從這個開始。您對與雙重患者和患有多種慢性病的患者進行更多合作以及與醫療服務提供者進行更多護理協調提出了有趣的評論。

So I'm curious if you're alluding there to more things like the integrated strategic partnerships such as Sutter or if there's actually some thoughts on the chalkboard about maybe doing a practice partner/tech platform where you might sell it into the market or help with provider enable even more so

所以我很好奇，您是否提到了更多類似 Sutter 這樣的綜合策略合作夥伴關係，或者您是否實際上有一些想法，例如做一個實踐合作夥伴/技術平台，您可以將其銷售到市場上，或者幫助供應商實現更多

Hey, Ryan. No, I think it's just that we do so well managing that population that and it's becoming more more important in each of our markets and I think that they're a hard population to actually manage. They have more complex conditions. They just require more sophisticated care management. And I think that that's something that differentiates us from everybody else, which is that care management capability, that we're not just dependent on captaining that out to downstream providers.

嘿，瑞安。不，我認為這只是因為我們在管理這個群體方面做得很好，而且這個群體在我們的每個市場中都變得越來越重要，我認為他們實際上是一個很難管理的群體。他們的情況更為複雜。他們只是需要更複雜的護理管理。我認為這是我們與其他人的不同之處，即護理管理能力，我們不只是依賴將其交給下游供應商。

So in the context of how we do that, I think we also are seeing really good ADK performance ex-California. And so, no, it's not limited to just the kind of California phenomenon. And I think when you combine that with the stars, it gives us that much more confidence that we can kind of extend that into new markets. I think that's what the reference is about.

因此，就我們的做法而言，我認為我們也看到了加州以外地區 ADK 的表現非常好。所以，它不僅限於加州現象。我認為，當你將其與明星結合時，它會給我們更多的信心，我們可以將其擴展到新的市場。我認為這就是參考內容的意義。

So maybe it is now that you've proven the model, you're showing that AVA is replicable in other markets, you've hit profitability, you've seen the SG&A leverage. Is this really the time you think you will look to grow in 2026 in the new markets or maybe contemplate SG&A activity? Is that what we should think?

所以也許現在你已經證明了這個模型，你表明 AVA 可以在其他市場複製，你已經實現了盈利，你已經看到了 SG&A 槓桿。您是否真的認為現在正是您在 2026 年尋求在新市場中實現成長或考慮銷售、一般及行政費用 (SG&A) 活動的最佳時機？我們該這麼想嗎？

I think, yeah, exactly. I think that we said that we're going to add new markets in the existing markets in 2026. We want to still be very thoughtful and disciplined about how we do that. And we're going to do that from operating cash. We also said that we're starting initiatives now for 2027 new market launches, which require us to have service area expansions completed in February of 2026. So all of that activity is starting now.

我認為，是的，確實如此。我想我們說過我們將在 2026 年在現有市場中增加新市場。我們仍希望對如何做到這一點保持深思熟慮和嚴謹態度。我們將利用營運現金來實現這一目標。我們還表示，我們現在正在啟動 2027 年新市場啟動計劃，這要求我們在 2026 年 2 月完成服務區域擴展。所以所有這些活動現在都開始了。

To your point, given our -- if you can echo by the way, given our strong growth, our strong margin of performance, and a lot of it is really a function of AVA and the CARE model, and the scale economies we've been able to garner is, I think, it would give us that much more credibility to think about building that business out. But I've said in the past, we don't want to get ahead of ourselves.

對於您的觀點，考慮到我們的觀點——如果您能同意的話，考慮到我們強勁的成長、強勁的業績利潤率，其中很大一部分實際上歸功於 AVA 和 CARE 模型，以及我們已經能夠獲得的規模經濟，我認為，這將使我們更有信譽去考慮拓展這項業務。但我過去曾說過，我們不想超越自己。

We want to be, again, very thoughtful. It's a very different business. Others have tried this and not been successful. And if we do it, we need to make sure it's very, very referenceable. But I still think, again, it's a strategy that we've contemplated from the beginning. And I think all the cards are starting to line up, particularly given some of the challenges that we see in the sector. I think we can help a lot of people.

我們希望再次變得非常周到。這是一項非常不同的業務。其他人也嘗試過這個但沒有成功。如果我們這樣做，我們需要確保它非常具有參考價值。但我仍然認為，這是我們從一開始就考慮好的策略。我認為所有的牌都開始排列好了，特別是考慮到我們在這個行業中看到的一些挑戰。我認為我們可以幫助很多人。

Michael Ha, Baird.

麥可·哈，貝爾德。

Hi. Thank you. Yeah. Just firstly, really a pleasure working with you, Thomas, one of the best in the game. And also congrats to Jim.

你好。謝謝。是的。首先，湯瑪斯，能和你一起工作真的很榮幸，你是這個行業中最優秀的球員之一。同時也祝賀吉姆。

And, yes, switching gears, congrats on the quarter, monster earnings beat. I was wondering first if you could elaborate a bit more on the MLR outperformance. Thomas, I know you mentioned Part D. I think you said benefited 1Q. So I’m just curious how much of your MLR outperformance this quarter was attributed to any sort of pull forward of earnings into 1Q related to that changing Part D cadence this year?

是的，換個話題，恭喜本季獲利超出預期。我首先想知道您是否可以更詳細地闡述 MLR 的優異表現。托馬斯，我知道您提到了 D 部分。我認為您說的是受益於 1Q。所以我只是好奇，本季 MLR 的優異表現有多少是歸因於今年 D 部分節奏變化導致的收益提前到第一季？

Trying to parse out, figure out what the MLR performance would have been excluding Part D? And because I also thought in your 1Q guidance, you may have already reflected that seasonality change.

試著分析一下，弄清楚如果排除 D 部分，MLR 的效能會怎麼樣？而且因為我也認為在您的第一季指導中，您可能已經反映了季節性變化。

Yeah. Hey, Mike, I appreciate the kind words, of course. So in terms of our first quarter outperformance, we did allude to some early favorability we saw in Part D that we anticipate to reverse over the second to fourth quarters, leaving our kind of our full year expectations on Part D largely unchanged. It was pretty modest, to be quite honest.

是的。嘿，麥克，我當然很感激你的善意。因此，就我們第一季的優異表現而言，我們確實提到了我們在 D 部分看到的一些早期有利因素，我們預計這些因素將在第二季至第四季發生逆轉，而我們對 D 部分的全年預期將基本保持不變。說實話，這相當謙虛。

I would not say it was a significant driver of our outperformance in the quarter, but it was slightly better than our original expectations, where I think we had taken in just a bit more cautiousness and conservatism around what the first quarter Part D results might look like, given the many changing variables for 2025.

我不會說這是我們本季表現優異的重要驅動力，但它略好於我們最初的預期，我認為考慮到 2025 年的許多變化變量，我們對第一季 D 部分的結果採取了更多的謹慎和保守態度。

Beyond Part D, I would say, you know, we did allude to some favorability in terms of our IB and P reserve releases from the prior year. Not all that fell at the bottom line, of course, because we share part of that back in the form of our risk pool and profit shares with providers. And quite honestly, a little bit of that, I think, is sort of normal course of operations.

除了 D 部分之外，我想說，您知道，我們確實提到了去年 IB 和 P 儲備釋放的一些有利因素。當然，並不是所有這些都影響到了利潤，因為我們以風險池和利潤分成的形式與供應商分享了其中的一部分。老實說，我認為，這在某種程度上是正常的運作過程。

And I think it’s very demonstrative of our ability to be both conservative, but also appropriate with how we think about our reserve setting, particularly on a big year like last year where we had a lot of growth, not just in the first half, but in the back half of 2024. But I think big picture, you know, when you think about the quarter, our utilization was right in line with expectations, in fact, slightly better on the inpatient ADK setting.

我認為這充分體現了我們既保守又合理的儲備設置能力，尤其是在去年這樣一個重要的年份，我們實現了巨大的增長，不僅在上半年，而且在 2024 年下半年。但我認為，從總體來看，當您考慮本季時，我們的使用率完全符合預期，事實上，住院 ADK 設定略好一些。

I think we’re continuing to see solid progress in terms of our, cohorts maturing and notwithstanding the Part D and the IBNR, we would have beaten the high end of our guidance range regardless without those two factors. So big picture, I think a lot of things are going well as we start the year and really set a very solid foundation towards our full year outlook.

我認為，我們在客戶群成熟方面將繼續取得穩步進展，儘管存在 D 部分和 IBNR 因素，但如果沒有這兩個因素，我們無論如何都會超過指導範圍的高端。所以從整體來看，我認為在新的一年伊始，很多事情都進展順利，為我們的全年展望奠定了非常堅實的基礎。

Great. Thank you. And then just a quick, not a quick, but my follow-up question. So, into ’26, you have a very favorable final rate notice. You have HAPS admin measure down weighting.

偉大的。謝謝。然後只是一個快速的，不是一個快速的，但我的後續問題。因此，進入 26 年，您會收到一份非常優惠的最終利率通知。您已將 HAPS 管理員衡量權重降低。

So more STAR ratings tailwinds to come. So it feels like rates are very much on your side next year, especially in a year where your competitors are still negative margins benefits likely rational again. Yeah, just understanding that once you get your thoughts on how how you’re going to approach these this favorable rate dynamic next year. Because if my math is right, even let’s say 300 bps better than expected 26 rates after you pass through about a third of it to your global cap partners, that’s still, I mean, $90 million of additional rate tailwind. So could be a very powerful part of your EBITDA bridge next year if we assume rates flow through to margins.

因此，未來將會有更多的 STAR 評級順風。因此，感覺明年利率對你非常有利，特別是在你的競爭對手利潤率仍然為負的一年，收益可能再次變得合理。是的，只要您考慮清楚明年如何應對這種優惠利率動態，您就會明白這一點。因為如果我的計算正確的話，即使假設在你將其中約三分之一的利率轉嫁給你的全球上限合作夥伴之後，利率比預期的 26 個利率高出 300 個基點，那這仍然是 9000 萬美元的額外利率順風。因此，如果我們假設利率流向利潤率，那麼這可能會成為您明年 EBITDA 橋樑中非常重要的一部分。

So just wanted to get your thoughts on your posture toward margins versus growth next year. And, yeah, any color there would be great.

所以只是想了解一下您對明年利潤率與成長的看法。是的，任何顏色都很棒。

Thanks. Yeah. Hey, Michael. It’s John.

謝謝。是的。嘿，麥可。我是約翰。

No. I I think our relative advantages in stars and our relative advantages on V28, which we’ve shared in the past, will will continue. They were obviously very pleased with the new final rate notice, and I think your assessment of the I would say the larger players is actually accurate, but I’d remind you there are still smaller players and not for profit types of players where you know anything can happen as we’ve seen in the past.

不。我認為我們在明星方面的相對優勢以及我們過去在 V28 方面的相對優勢將會繼續保持下去。他們顯然對新的最終利率通知非常滿意，我認為你對大型參與者的評估實際上是準確的，但我要提醒你，仍然有較小的參與者和非營利類型的參與者，你知道任何事情都可能發生，正如我們過去所看到的那樣。

We’ve observed that those strategies where people are buying business are not durable and so I think we’ve also demonstrated we’re not going to go chase you know dumb business and we’re right literally in the throes of the bid process now so we’re not going to comment on the margin versus growth question at this point but we feel very very well positioned.

我們觀察到，人們購買業務的那些策略並不持久，所以我認為我們也表明了我們不會去追逐愚蠢的業務，我們現在正處於競標過程的陣痛之中，所以我們現在不會對利潤率與增長問題發表評論，但我們覺得自己的定位非常非常有利。

John Ransom, Raymond James.

約翰·蘭塞姆、雷蒙·詹姆斯。

Hey there, can you hear me?

嘿，你聽得到我說話嗎？

Yes. Hey, John.

是的。嘿，約翰。

Hey, Thomas. Congratulations. Look forward to seeing where you land. So, John, a little more of a soft question, but if we think about Eva today, what’s it doing at kind of a patient engagement level that maybe is new and different than it was doing one point zero version or a couple of years ago? And then where else do you see some opportunity to continue to kind of knock you know get into that 20% of the population that’s all the cost and you know continue to drive down that cost curve?

嘿，托馬斯。恭喜。期待看到你的著陸地點。那麼，約翰，這是一個比較溫和的問題，但是如果我們今天思考一下 Eva，它在患者參與度方面做了什麼，與幾年前的版本相比，這可能是新的、不同的嗎？那麼，您還認為在哪些方面有機會繼續吸引那 20% 的人口，也就是所有成本，並且繼續降低成本曲線？

Yeah, thanks, John. I think the stratification model, the identification of who are the high risk members that AIBA gives us is really working well. Our engagement with that population continues to go up and I think the medical management and the proactive kind of at home care support all of that I think is working both in California and ex California.

是的，謝謝，約翰。我認為國際拳聯為我們提供的分層模型和高風險成員識別確實非常有效。我們與該人群的互動不斷增加，我認為醫療管理和積極主動的家庭護理支持所有這些都在加利福尼亞州和加利福尼亞州以外的地方發揮作用。

So really happy about that. I think to your point the next evolution of AIVA you know requires us to have the I call it the kind of culture of continuous improvement but we’re really looking it and zeroing in on what is the efficacy of every single module within AIVA and what is the adoption rates, what are the returns, you know what are we getting out of each module.

對此我感到非常高興。我認為正如您所說，AIVA 的下一次發展需要我們擁有一種我稱之為持續改進的文化，但我們真正關注的是 AIVA 中每個模組的功效、採用率、回報以及我們從每個模組中獲得了什麼。

And then we’re going to double down on the ones that are producing really good outcomes for us. We might sunset ones that are less and then we’re going to be very focused on how we deploy capital with respect to our capex. Having said that your question is a really good one in that I think the entire I would say member experience or member journey is going to be something that Eva helps us glue together end to end.

然後，我們將加倍努力，致力於那些能為我們帶來真正良好結果的項目。我們可能會停止那些金額較小的項目，然後我們將非常專注於如何根據資本支出部署資本。話雖如此，你的問題確實很好，因為我認為整個會員體驗或會員旅程將是 Eva 幫助我們端到端地結合在一起的東西。

And as we’ve talked about from day one having high quality ID stars and making sure that those gaps are closed at affordable costs which is the MLR management, the clinical management and having those be core competencies inside the company is what we need to do and I think AIVA is going to evolve into that and we’re being very mindful for every part of that journey really starting before a member is a member that they’re a consumer or prospect is part of that journey and they come in and they become members and how we onboard them, we support them, how we answer their questions, how we take care of them from a medical management point of view and care for the polychronic at home, and as well as ensuring that the I think the administrative functions are really really well run like STAR, gap closures, be very very compliant on Medicare risk adjustment all the kind of the operational functions.

正如我們從第一天起就談到的，我們需要擁有高品質的 ID 明星，並確保以可負擔的成本彌補這些差距，也就是 MLR 管理、臨床管理，並讓這些成為公司內部的核心競爭力，我認為 AIVA將會發展成這樣，我們非常重視這趟旅程的每個部分，從會員成為會員之前就開始了，他們是消費者或潛在客戶，是這一旅程的一部分，他們加入並成為會員，我們如何接納他們，我們如何支持他們，我們如何回答他們的問題，我們如何從醫療管理的角度照顧他們，如何照顧好健康的多重患者，同時確保我認為行政功能差距

All of that is working really well right now. We need to really automate it so that experience is completely seamless for that member. And I think that will get to ultimately what you and I’ve talked about over the years where that consumer platform, the Medicare Advantage consumer platform is going to be able to take a lot of different kind of revenue models and you know given our performance as a company we’re our best referenceable customer and so we want that we want to keep that going and then we can talk about what opportunities exist on the services side.

目前，所有這一切都運作良好。我們需要真正實現自動化，以便會員的體驗完全無縫。我認為這最終將實現你我多年來所討論的消費者平台，即醫療保險優勢消費者平台，它將能夠採用許多不同類型的收入模式，而且你知道，鑑於我們作為一家公司的表現，我們是我們最好的參考客戶，因此我們希望保持這種狀態，然後我們可以討論服務方面存在哪些機會。

Whit Mayo, Leerink Partners.

惠特·梅奧 (Whit Mayo)，Leerink Partners。

Hey, thanks and best of luck, Thomas. My first question is given the membership growth this year and some of the peer commentary on RAF issues. Can you talk about the visibility that you guys have on RAF on new members with the January premium payment from CMS? And maybe just elaborate more on the process that you have on estimating RAF on new members? Thanks.

嘿，謝謝你，祝你好運，托馬斯。我的第一個問題是考慮到今年會員的成長情況以及一些同行對皇家空軍問題的評論。您能否談談您們對 RAF 新會員透過 CMS 一月份保費支付的了解程度？也許您能更詳細地闡述一下您對新成員 RAF 進行評估的過程？謝謝。

Yeah, happy to. And I appreciate it, Whit. I’m not going anywhere overnight. So but but I appreciate the the kind words. You know, in terms of the new member revenue PMPMs, that is one of the advantages of being the health plan is we get visibility to our paid revenue PMPM on new members the first month of the year in January.

是的，很高興。我很感激，惠特。我晚上哪裡也不去。所以，但是我很感激這些善意的話語。您知道，就新會員收入 PMPM 而言，健康計劃的優勢之一是我們可以在一月份（每年的第一個月）看到新會員的付費收入 PMPM。

And so from a revenue recognition standpoint, we actually book our revenue on the new members consistent with what we’re being paid up until we see the mid-year sweeps. And so that creates a really conservative posture heading into the sweeps and ensures that we don’t find ourselves surprised by having overestimated from what we might see on new members, which again, the revenue PMPM for this year based on last year’s codes and activities, we don’t have control over. So I think we’ve historically taken a conservative approach on that and we feel very comfortable with our visibility on the new member revenue PMPMs.

因此，從收入確認的角度來看，我們實際上是根據新會員的收入來記錄我們的收入，直到我們看到年中收入為止。因此，這在進入大掃除階段時創造了一種真正保守的姿態，並確保我們不會因為高估新成員的數量而感到驚訝，而今年的收入 PMPM 基於去年的代碼和活動，我們無法控制。所以我認為我們歷來對此採取保守態度，我們對新會員收入 PMPM 的可見性感到非常滿意。

Got it. And my second question or follow-up is just on STARS. John, any new initiatives that have crystallized into 2025 for for caps or anything that you care to share? Thanks.

知道了。我的第二個問題或後續問題是關於 STARS 的。約翰，對於 2025 年的上限，您有什麼新舉措可以分享嗎？謝謝。

Yeah. No. It’s been across the board, emphasis on on pretty much everything to make sure that the regulatory changes with respect to CAPS is not something that we’re just relying on, know, is just the health equity index something we’re relying on.

是的。不。我們全方位地強調，幾乎所有事情都應確保與 CAPS 相關的監管變化不是我們所依賴的東西，而是我們所依賴的健康公平指數。

So just core operations making sure that we are performance managing our IPAs where they understand how we can improve our TAP scores and in certain situations where IPA is not doing the kind of job that we need, we are doing it. And I think that’s the main one, I think our Part D, our admin are all on track.

因此，核心營運確保我們對 IPA 進行績效管理，讓他們了解我們如何提高 TAP 分數，並且在某些情況下，當 IPA 沒有完成我們需要的工作時，我們就會做。我認為這是最重要的一點，我認為我們的 D 部分、我們的管理都在正軌上。

We feel good about that. It’s visibility that we have on a daily basis and you know I feel very good about where we are. You know I can’t comment on the litigation with CMS, I’m not going comment on that as it relates to 2026 payment but I will say that our dates of service in 2024 and our ratings of ’25 are on track.

我們對此感到很高興。這是我們每天都能看到的景象，你知道，我對我們目前的狀況感到非常滿意。您知道我無法評論與 CMS 的訴訟，我不會對此發表評論，因為它與 2026 年的付款有關，但我要說的是，我們 2024 年的服務日期和 25 年的評級都正常。

Jessica Tassan, Piper Sandler.

傑西卡·塔桑、派珀·桑德勒。

Hi, guys. Thanks so much for taking the question. Congrats on the quarter. And also, Thomas, congrats, and thanks for all the help last couple of years. I think just I’m interested to know how are you all expecting the competitive landscape in California specifically to change in ’26, just as competitors try to capitalize on the rate announcement.

嗨，大家好。非常感謝您回答這個問題。恭喜本季取得佳績。另外，湯瑪斯，恭喜你，感謝你過去幾年的所有幫助。我想我只是感興趣的是，當競爭對手試圖利用利率公告時，你們對 26 年加州的競爭格局具體會發生怎樣的變化有何預期。

I think we saw a press release from SCAN and Sutter a few weeks back. So, just interested to know what sorts of investments you might make in the fourth quarter to kind of brace the the sales force for increasingly competitive landscape?

我想我們幾週前看到了 SCAN 和 Sutter 發布的一份新聞稿。所以，我只是想知道您可能會在第四季進行哪些類型的投資，以幫助銷售人員應對日益激烈的競爭環境？

Yeah. No, I mean, I think the key thing to think about is that given the rate notice I think that’s going to advantage everybody relative to the advance notice obviously but the relative advantages for both, I would underscore both, STARS and V28 I think is something that we still feel very strongly in. You know the Sutter organization is a friend of ours, we like each other, we are one of two really plans they intend to work with in the coming year and so we feel good about that.

是的。不，我的意思是，我認為需要考慮的關鍵問題是，考慮到利率通知，我認為這顯然相對於提前通知對每個人都有利，但對於兩者的相對優勢，我想強調的是，STARS 和 V28 是我們仍然非常強烈感受到的。您知道 Sutter 組織是我們的朋友，我們彼此喜歡，我們是他們打算在來年合作的兩個真正計劃之一，因此我們對此感到很高興。

Does it create some you know complexities? Yeah it does but I’m not really particularly worried about it and I think there are some other smaller players that are in the marketplace that we have to be mindful of as it relates to kind of our short term 2026 considerations. I would be surprised if they had long term you know they were a long term threat to us.

它是否會產生一些您知道的複雜性？是的，但我並不是特別擔心，我認為市場上還有一些其他較小的參與者，我們必須注意，因為這與我們 2026 年的短期考慮有關。如果他們長期對我們構成威脅，我會感到驚訝。

I don’t particularly see that. I think from what we see but what they’re doing is not sustainable and I think we’ve again we’ve seen that come and go over the last several years. I think there’s going to be a lot of opportunity given the STARS declinations and I would think people are going to be you know certainly the larger players that we’ve all read about are going to be more margin expansion focused than anything else.

我並沒有特別看到這一點。我認為，從我們所看到的情況來看，他們所做的事情是不可持續的，我認為，我們在過去幾年中再次看到這種情況的出現和消失。我認為，鑑於 STARS 指數的下跌，將會有很多機會，而且我認為人們將會更加關注利潤率的擴張，正如我們所讀到的，那些規模較大的參與者將會比其他任何事情都更加關注利潤率的擴張。

So I feel good you know but again like I I mentioned we’re right in the middle of the bids so I’m not going to comment on that part of it but I don’t think we’ve been in a stronger position than we are right now is what I would say heading into 2026 relative to everything else. Remember the B28 thing is a big deal, it’s a big deal and many of our competitors are reliant upon global cap providers who are experiencing meaningful declination because of V28. That’s going to impact our competitors’ revenues.

所以我感覺很好，但是就像我提到的那樣，我們正處於競標的中間階段，所以我不會對這部分內容髮表評論，但我不認為我們現在處於比現在更強大的地位，我想說的是，相對於其他所有因素，我們將在 2026 年取得進步。請記住，B28 事件是一件大事，它是一件大事，我們的許多競爭對手都依賴全球上限供應商，而這些供應商由於 V28 而經歷了嚴重的衰退。這將影響我們競爭對手的收入。

That’s really helpful. I guess that actually is my next question. I’m interested to know if you guys are getting any feedback or requests from your capitated providers for increased MLR concessions or just Part D carve outs, just any changes in those contracts?

這真的很有幫助。我想這實際上是我的下一個問題。我很想知道，你們是否從按人頭計費的供應商那裡得到任何反饋或請求，要求增加 MLR 優惠或僅僅是 D 部分豁免，或者只是對這些合約進行任何更改？

And then, I guess, way that we look at it, at least your capitated provider MLRs are considerably higher than your at risk tenured member MLRs. And so just at what point do you start to kind of re assume that risk from those capitated providers to capture the margin that is effectively getting lost? Thanks.

然後，我想，從我們的角度來看，至少您的按人頭計算的提供者 MLR 明顯高於您的風險終身會員 MLR。那麼，您什麼時候開始重新承擔那些按人頭計費的供應商的風險，以獲取實際上正在損失的利潤？謝謝。

He, Jess. Thomas here. So I think in terms of your question on how we contract with our Global IPAs and providers, I’d say what we do is maybe a little bit different than a few others. And so our global cap IPAs, more often than not, they do not take any risk on Part D, nor do they have any risk on supplemental benefits. And so what that does is it creates a more, I think, aligned relationship versus what you’ve heard about in other situations nationally where providers have felt like they’re getting dumped benefit adjustments or increases on them without any seat at the table to make any kind of, you know, choices around those decisions. So from our perspective, that is not something we’ve experienced in terms of providers coming back to the table.

他，傑斯。這裡是托馬斯。因此，我認為，就您關於我們如何與全球 IPA 和供應商簽訂合約的問題而言，我想說我們的做法可能與其他一些做法略有不同。因此，我們的全球上限 IPA 通常不會承擔 D 部分的任何風險，也不會承擔補充福利的任何風險。因此，我認為，這樣做可以建立一種更協調的關係，而不是像你在全國其他情況下聽到的那樣，在這些情況下，醫療服務提供者感覺他們被剝奪了福利調整或增加的權利，而沒有任何席位來就這些決定做出任何選擇。因此，從我們的角度來看，就供應商重返談判桌而言，我們並沒有經歷過這樣的事情。

I think we’re in a pretty good place from that perspective, and we’re very aligned with them moving forward. And I think as we think about the overall book of business, you know, we do want to continue to grow the at risk book of business where we manage institutional costs, and that does allow us to share in the profits with the providers as we drive down those MBRs, those more tenured members.

我認為從這個角度來看，我們處於一個相當有利的位置，並且我們與他們的未來發展步調一致。而且我認為，當我們考慮整體業務時，您知道，我們確實希望繼續擴大我們管理機構成本的風險業務，這確實使我們能夠在降低那些 MBR 和那些更資深的成員時與供應商分享利潤。

At the same time, we have a number of good global cap partners, and we’ll continue to work with those so long as we’re hitting all of our marks on things like STARS performance, retention, data exchange, and a series of other things that are really important to us as far as ensuring that we have long term durability to our contracts.

同時，我們擁有許多優秀的全球資本合作夥伴，只要我們在 STARS 性能、保留、數據交換以及一系列對我們來說非常重要的其他事情上達到我們的標準，我們就會繼續與這些合作夥伴合作，以確保我們的合約具有長期持久性。

Joanna Kajuk, Bank of America.

美國銀行的喬安娜‧卡朱克 (Joanna Kajuk)。

Hi. Thanks so much for taking the question. So if I made a couple of related questions around reimbursement, So we’ve talking about how the final rate notice was better. So first part of the question is do you expect these rates to keep getting better as CMS tries to catch up with these higher trend levels the last few years?

你好。非常感謝您回答這個問題。因此，如果我提出了幾個有關報銷的問題，那麼我們就討論如何讓最終的費率通知變得更好。因此，問題的第一部分是，隨著 CMS 在過去幾年中試圖趕上這些更高的趨勢水平，您是否預計這些比率會繼續好轉？

And on the other hand, is there any indication or sense you’re getting in DC for any appetite for, you know, additional risk adjustment model changes maybe? And I guess if that was to happen, right, the question is like, how would you think this would impact your company? Like, would this be a headwind or kind of a repeat of the most recent experience and are there kind of opportunity to get more market share? Thank you.

另一方面，是否有任何跡像或感覺表明您在華盛頓特區對額外的風險調整模型有任何興趣？我想，如果這種情況真的發生了，那麼問題是，您認為這會對您的公司產生什麼影響？例如，這會不會是一個逆風，或是最近經歷的重複，是否有機會獲得更多的市場份額？謝謝。

That’s a great question. It’s John. You know, just I I just remind you that we built the business with specifically the ability to thrive in either an increasing or decreasing rate environment and you know as we’ve demonstrated over the last couple of years if rates are compressed which they obviously have been in the really last four years but in particular the last couple years would be 28 and the stars tightening, we have thrived and it’s because we have focused on having the best quality at the lowest cost. And so when you’re at when you’re the low cost producer of quality products you have an advantage when it’s tightened up. When rates go up which they will in 2026, our relative advantages are going to still be intact and so we think that there’s an opportunity for margin expansion.

這是一個很好的問題。我是約翰。你知道，我只是提醒你，我們建立業務的目的是為了能夠在利率上升或下降的環境中蓬勃發展，你知道，正如我們在過去幾年中所證明的那樣，如果利率被壓縮，這顯然在過去四年中一直如此，但特別是過去幾年將是28年，而且利率不斷收緊，我們仍然蓬勃發展，這是因為我們專注於以最低的成本最好的品質。因此，當您是高品質產品的低成本生產商時，您在價格緊縮時就具有優勢。當利率在 2026 年上升時，我們的相對優勢仍將保持不變，因此我們認為利潤率擴大的機會。

And so in the context of all boats rise and a rising tide. Now to some of the previous questions that others have asked, I think that the competitive dynamic is going to play to our favor just because of what you’ve been reading with the bigger folks. Smaller folks it’s hard to say what they’re going to do but again I think given our position we feel very good about where we are.

所以在水漲船高的背景下。現在回答其他人之前提出的一些問題，我認為競爭動態將對我們有利，因為你已經從大公司那裡了解了這一點。對於規模較小的公司來說，很難說他們會做什麼，但我認為，考慮到我們的地位，我們對目前的狀況感到非常滿意。

Matthew Gilmore, KeyBank.

馬修·吉爾摩（Matthew Gilmore），KeyBank。

Hey, thanks for the question and good luck to to Thomas and Jim.

嘿，謝謝你的提問，祝托馬斯和吉姆好運。

But I just wanted to follow up on some of the utilization comments, and we appreciate the visibility you all provided the ADK metric, and we understand the mixed dynamics at play this quarter. Are you able to look at that on a on a same store, same member basis? And would it be fair to assume that it was sort of flat to down if you normalize that membership mixed dynamic?

但我只是想跟進一些利用率評論，我們感謝你們提供的 ADK 指標的可見性，並且我們了解本季的混合動態。您能在同一家商店、同一會員的基礎上查看這一點嗎？如果您將會員混合動態正常化，那麼是否可以公平地假設它是持平或下降的？

Yeah, it would have been roughly flat.

是的，它應該是大致平坦的。

And then Thomas, any additional comments on utilization in terms of, other categories whether that's outpatient or however else you want to slice and dice it and anything else kind of to call out in terms of how how things are trending relative to expectations.

然後，托馬斯，關於其他類別的利用率，無論是門診還是其他任何您想細分的類別，以及就事態相對於預期的趨勢而言，您還有什麼其他需要注意的嗎？

Yeah, happy to. So I think a couple of thoughts. First is one of the reasons we like the inpatient KPI is, I think it's a very strong leading indicator for other categories of spend such as skilled nursing, home health, visits per 1,000, things that are kind of preceding the inpatient admission and that then typically occur post discharge.

是的，很高興。所以我有幾點想法。首先，我們喜歡住院 KPI 的原因之一是，我認為它是其他支出類別（如專業護理、家庭保健、每 1,000 人次就診次數）的非常強勁的領先指標，這些支出發生在住院之前，通常發生在出院後。

And so when you think about the inpatient KPI stability and in the first quarter out performance versus expectations. I think we would expect to see similar types of performance along some of those key categories. I think from an overall outpatient standpoint, we continue to feel good about the trends there. I know that was a big topic over the last few years, whereas, we didn't quite fully see the increase some of the others saw.

因此，當您考慮住院 KPI 穩定性以及第一季的表現與預期。我認為我們期望在一些關鍵類別中看到類似的表現。我認為從整體門診角度來看，我們對那裡的趨勢仍然感到樂觀。我知道這是過去幾年的熱門話題，然而，我們並沒有完全看到其他一些人所看到的成長。

I would say particularly with respect to 2024, where we now have, pretty much full visibility to last year's claims experience. That was one area that actually ran below expectations in terms of our anticipated year over year trend in 2024. So I think we're continuing to feel good about that for the first quarter and I would just add that.

我想特別指出的是，對於 2024 年，我們現在幾乎完全了解去年的索賠經驗。就我們預期的 2024 年同比趨勢而言，這實際上是低於預期的一個領域。因此，我認為我們對第一季的情況仍然感到樂觀，我只想補充一點。

From a pharmacy standpoint, we have many similar to others seen an increase in some of the pharmacy spend during the first quarter, generally a lot of their expectations, but as we've discussed in the past, I think we took a fairly conservative posture on how we thought that would unfold during 2025.

從藥房的角度來看，我們與其他公司類似，看到第一季部分藥房支出有所增加，總體而言，這在很大程度上超出了他們的預期，但正如我們過去所討論的那樣，我認為我們對 2025 年將如何發展持相當保守的態度。

And so while it is within the overall realm of expectations, we have seen a pretty sizable increase year over year, similar to others thematically, we've seen that with some of the specialty drugs, some of the non-low income subsidy populations. But I think we feel good about our ability to kind of forecast from here what the rest of the year will look like based on the first quarter results.

因此，雖然這在整體預期範圍內，但我們看到同比出現了相當大的增長，與其他主題類似，我們看到一些特種藥物、一些非低收入補貼人群也出現了這種情況。但我認為，我們對自己根據第一季業績預測今年剩餘時間業績的能力感到滿意。

Jonathan Young, UBS.

瑞銀的喬納森·楊。

Hey, thanks for the question and good luck to Thomas and Jim. But I just wanted to follow-up on some of the utilization comments, and we appreciate the visibility you all provided the 80 ks metric and we understand the mix dynamics at play this quarter. Are you able to look at that on a same store same member basis? And would it be fair to assume that it was sort of flat to down if you normalize for that membership mix dynamic?

嘿，謝謝你的提問，祝托馬斯和吉姆好運。但我只是想跟進一些利用率評論，我們感謝你們提供的 80 ks 指標的可見性，我們了解本季的混合動態。您能從同一家商店同一會員的角度來看這個問題嗎？如果您將會員組合動態標準化，那麼是否可以公平地假設它是持平或下降的？

Yeah, it would have been roughly flat.

是的，它應該是大致平坦的。

And then Thomas, any additional comments on utilization in terms of other categories, whether that’s outpatient or however else you want to slice and dice it? And anything else kind of to call out in terms of how things are trending relative to expectations?

然後托馬斯，您對其他類別的利用率還有什麼補充評論嗎，無論是門診還是其他您想細分的類別？關於事態相對於預期的趨勢，還有什麼需要指出的嗎？

Yeah, happy to. So I think couple of thoughts. First is, one of the reasons we like the inpatient KPI is I think it’s a very strong leading indicator for other categories of spend such as skilled nursing, home health, ER visits per thousand, things that are kind of preceding the inpatient admission and that then typically occur post discharge.

是的，很高興。所以我有幾點想法。首先，我們喜歡住院 KPI 的原因之一是，我認為它是其他支出類別（如專業護理、家庭保健、每千人次急診就診次數）的非常強勁的領先指標，這些支出發生在住院之前，通常發生在出院後。

And so, when you think about the inpatient KPI stability and in the first quarter outperformance versus expectations, I think we would expect to see similar types of performance along some of those key categories. I think from an overall outpatient standpoint, we continue to feel good about the trends there.

因此，當您考慮住院 KPI 穩定性以及第一季超出預期的表現時，我認為我們預計會在某些關鍵類別中看到類似的表現。我認為從整體門診角度來看，我們對那裡的趨勢仍然感到樂觀。

I know that was a big topic over the last few years, whereas, you know, we didn’t quite fully see the increase some of the others saw. I would say particularly respect to 2024, where we now have, you know, pretty much full visibility to last year’s claims experience, that was one area that actually ran below expectations in terms of our anticipated year over year trend in 2024.

我知道這是過去幾年的熱門話題，然而，你知道，我們並沒有完全看到其他人看到的成長。我想特別提到 2024 年，現在我們幾乎可以完全了解去年的索賠情況，但就我們預期的 2024 年同比趨勢而言，這實際上是低於預期的一個領域。

So I think we’re continuing to feel good about that through the first quarter. And I would just add that from a pharmacy standpoint, you know, we have many seen similar to others seen an increase in some of the pharmacy spend during the first quarter. Generally, a lot of their expectations, but as we’ve discussed in the past, I think we took a fairly conservative posture on how we thought that would unfold during 2025. And so while it is within the overall realm of expectations, we have seen a pretty sizable increase year over year.

所以我認為我們在第一季會繼續對此感到樂觀。我想補充一點，從藥局的角度來看，我們和其他人一樣，在第一季看到藥局支出增加。總體來說，他們有很多期望，但正如我們過去討論過的，我認為我們對 2025 年的發展持相當保守的態度。因此，雖然這在整體預期範圍內，但我們看到了同比相當大的成長。

Similar to others thematically, we’ve seen that with some of the specialty drugs, some of the non low income subsidy populations, but I think we feel good about our ability to kind of forecast from here what the rest of the year will look like based on the first quarter results.

與其他主題類似，我們已經看到一些特種藥物、一些非低收入補貼人群的情況，但我認為，根據第一季的結果，我們對從現在開始預測今年剩餘時間的情況的能力感到滿意。

Hey, thanks for taking the question. I guess just going back to kind of the Part D portion of the business. Are you seeing any behavior changes that are kind of becoming evident right now? I know it’s within the realm of your expectations, but is anything changing from your perspective? And how much visibility do you have right now into kind of where it’s heading towards as we progress throughout the year?

嘿，謝謝你回答這個問題。我想只是回到業務的 D 部分。您是否發現現在有任何明顯的行為變化？我知道這在您的預期範圍內，但是從您的角度來看有什麼變化嗎？那麼您現在對全年的發展方向有多少了解呢？

Yeah. Hey, Jonathan, Thomas here. I think to your point, we have seen, I think, a little bit of uptick, and like I said, the non low income subsidy population, which is where, if any, there would be some of the behavioral changes that might be caused by the changes in 2025 Part D related to the Inflation Reduction Act. So, think we’ve seen a little bit of that similar to others. At the same time, though, like I said, one of the great things about the Part D program is you get real time claims visibility.

是的。嘿，喬納森，我是湯瑪斯。我認為就你的觀點而言，我們已經看到了一些上升趨勢，就像我說的，非低收入補貼人群，如果有的話，可能會發生一些行為變化，這些變化可能是由 2025 年《通貨膨脹削減法案》 D 部分的變化引起的。所以，我想我們已經看到了一些與其他人類似的情況。但與此同時，正如我所說，D 部分計劃的一大優點是您可以獲得即時索賠可見性。

So, as we sit here through the April, and given that our first quarter generally ran within expectations, I would feel pretty good about our full year visibility. More to come as we get through the second quarter, but I would say at this point, it’s definitely a good place for us in terms of where we thought we would be when we started the year back in January.

因此，當我們進入四月時，考慮到我們的第一季整體情況符合預期，我對我們的全年前景感到十分樂觀。隨著我們進入第二季度，還會有更多消息傳出，但我想說，就目前情況而言，就我們在一月份年初所設想的而言，這對我們來說絕對是一個好位置。

Okay, and then, you know, the CMS and the administration has talked about trying to limit or reduce the use of prior authorization. They obviously haven’t introduced anything yet, but how are you kind of thinking about this and what it may mean for you and kind of the industry at large? Thanks.

好的，然後，你知道，CMS 和管理部門已經討論過嘗試限製或減少事先授權的使用。他們顯然還沒有推出任何東西，但您對此有何看法，以及它對您和整個行業意味著什麼？謝謝。

So, I think from our perspective, one of the mottos of this company is more care, not less care. And so, you know, the way we look at it is when we look at our auth and denial rates, we historically have been considerably below the national averages for Medicare Advantage, and our whole theory is built upon this idea that if you provide the right care to the right people, you’re going to have the right population engaged in order to control the vast majority of your costs.

因此，我認為從我們的角度來看，這家公司的座右銘之一是多關心，而不是少關心。所以，你知道，我們看待這個問題的方式是，當我們查看我們的授權和拒絕率時，我們歷來遠低於醫療保險優勢計劃的全國平均水平，而我們的整個理論建立在這樣的理念之上：如果你為合適的人提供合適的醫療服務，你就會讓合適的人群參與進來，從而控制絕大多數成本。

There’s going to be a much, much larger portion of the population that is going to drive a much lower portion of the overall spend, and really ensuring that they’re getting directed to the right high quality networks is our goal. So from our standpoint, it’s not something that keeps us up at night, and I would say from a competitive perspective is one of our potential tailwinds heading into the years ahead.

將會有更大比例的人口花費較少的整體支出，我們的目標是真正確保他們能夠使用正確的高品質網路。因此，從我們的角度來看，這並不是什麼讓我們夜不能寐的事情，而且我想說，從競爭的角度來看，這是我們未來幾年潛在的順風之一。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Great, thanks. Welcome Jim and Thomas. Thanks. Always enjoyed our interactions through the year, so appreciate it. I know you called out the $6 million favorable EBITDA release, but the total PYD looked really strong kind of just versus historical first quarters.

太好了，謝謝。歡迎吉姆和托馬斯。謝謝。我一直很享受我們一年來的互動，所以我很感激。我知道您提到了 600 萬美元的有利 EBITDA 釋放，但與歷史第一季相比，整體 PYD 看起來確實非常強勁。

Can you give us a sense on what maybe drove that strength versus like the historicals?

您能否向我們解釋一下，與歷史數據相比，是什麼因素推動了這種優勢？

Yeah, so I think you’re maybe referring to the difference in the footnote on our IV and R release versus what it says in the table around the prior year. And so that dynamic is really driven more so by the margin in LAE PAD that we apply against our IV and R reserves. So the way to think about that is, that’s roughly an extra 7% that we add to our reserves. That is intended to ensure that in worst case scenario, we have adequate reserves for run out purposes. But from our perspective, that 7% is something that we never anticipate really needing to use.

是的，所以我認為您可能指的是我們 IV 和 R 發布的腳註與去年表格中所述內容之間的差異。因此，這種動態實際上更受到我們針對 IV 和 R 儲備應用的 LAE PAD 保證金的驅動。所以，我們可以這樣想，這大約相當於我們額外增加了 7% 的儲備。這是為了確保在最壞的情況下，我們也有足夠的儲備以備不時之需。但從我們的角度來看，我們從未預料到真正需要使用這 7%。

It’s intended to be cushioned and keep us compliant with the states amongst other things. So I think that’s really driving the difference between the tables. So I don’t look at the, you know, $1.314 million in the footnote table as the driver in the quarter. I really focus on the 6,000,000 you mentioned in the footnote. And I would note that on that six, again, not all of that falls to the bottom line.

它的目的是起到緩衝作用，並讓我們遵守各州的規定等等。所以我認為這才是表格之間差異的真正原因。因此，我不認為腳註表中的 131.4 萬美元是本季的驅動因素。我真正關注的是您在腳註中提到的 6,000,000。我想再次指出，關於這六個，並不是所有這些都落到底線。

A portion of that we do share back with providers in the form of our risk pools and profit share. So I would say it was a part of the first quarter outperformance, but definitely not one of the larger drivers.

我們確實會將其中的一部分以風險池和利潤分成的形式回饋給供應商。所以我想說這是第一季表現優異的一部分，但絕對不是更大的驅動因素之一。

Got it. And obviously the ’26 rate over 5% is good. Is there a way I think historically, you’ve given us the weighted average rate, I think it was about 5% for 2025. Can you give us that for 2026 for alignment versus the just sort of overall rate?

知道了。顯然，26%以上的利率是好的。從歷史上看，您給出了加權平均利率，我認為 2025 年的利率約為 5%。您能否告訴我們 2026 年的調整情況以及與整體比率的關係？

Yeah, so, you know, I think we tend to focus, you know, first and foremost on sort of the top line of the table that CMS puts out the effective growth rate as a starting point for us. So, like, nationally, it looks to be about 9% for 2026. I think our weighted average across our markets is approximately 8%. And so I think that would compare to last year. Yeah, you’re right at about 5% for the overall company.

是的，所以，你知道，我認為我們傾向於首先關注表格的第一行，CMS 列出的有效成長率作為我們的起點。因此，從全國範圍來看，到 2026 年這一比例預計將達到 9% 左右。我認為我們各個市場的加權平均值約為 8%。所以我認為這與去年相比有所差異。是的，您說得對，整個公司的稅率大約是 5%。

So, you know, I think as John was saying, I think that provides us a lot of kind of flexibility as we think through both our growth and margin goals for 2026.

所以，你知道，我認為正如約翰所說的那樣，我認為這為我們在考慮 2026 年的成長和利潤目標時提供了很大的靈活性。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good evening. Just wanted to echo congratulations and best wishes to Thomas in your new role. I wanted to clarify the Part D seasonality. I think the initial expectation was that Part D MLR would improve throughout the year. Now it sounds like Part D MLR will be increasing.

嗨，晚上好。我只是想對托馬斯在新職位上的表現表示祝賀和良好的祝愿。我想澄清一下 D 部分的季節性。我認為最初的預期是 D 部分 MLR 將在全年得到改善。現在聽起來 D 部分 MLR 將會增加。

Can you help us understand what you’re seeing on Part D trends that would flip the cost curve? Because it doesn’t sound like 1Q performance was that off plan. Thanks.

您能否幫助我們了解您所看到的 D 部分趨勢，從而改變成本曲線？因為聽起來第一季的表現並沒有偏離計畫。謝謝。

Yeah, happy to take that one. So, well, I think what we would expect is that the second and third quarters do still continue to improve in terms of MBR versus the first quarter. Though I think, you know, on the fourth quarter, I think it’s possible that there could be an uptick on Part D specifically in the fourth quarter. But I think big picture, you know, we still anticipate the first half MBR to be higher than the second half on Part D.

是的，很高興接受這個。所以，我認為我們預期的是，第二季和第三季的 MBR 與第一季相比仍會繼續改善。不過，我認為在第四季度，D 部分可能會出現上漲，特別是在第四季度。但我認為從整體來看，我們仍然預期 D 部分上半年的 MBR 將高於下半年。

Great. And maybe just a follow-up on that. Thomas, I think you made a comment that Part D PMPMs would increase throughout the year. Can you help us understand what would cause that? Thanks.

偉大的。也許只是對此的後續行動。湯瑪斯，我認為您說過 D 部分 PMPM 全年都會增加。您能幫助我們了解造成這種情況的原因嗎？謝謝。

You mean from a medical expense standpoint?

您是從醫療費用的角度嗎？

I thought it was on a revenue standpoint, but if it makes if it’s on a medical expense standpoint, that would clarify.

我認為這是從收入的角度來說的，但如果是從醫療費用的角度來說，那就更清楚了。

No, that makes perfect sense. I understand the question though. Yeah, so from from a revenue standpoint, it has to do with both the suite timing, where I think we’ll likely to see some some revenue PMPM impact from the suites as we get to the end of the second quarter. And then it also has to do with the way we book our risk corridor revenue where today we are in a payable position in booking contra revenue that we would anticipate that to reverse over the course of the year and actually start contributing to overall revenue PMPM in a positive fashion.

不，這完全有道理。我明白這個問題。是的，從收入的角度來看，這與套件時間有關，我認為到第二季末，我們可能會看到套件對 PMPM 收入產生一些影響。然後，它也與我們預訂風險走廊收入的方式有關，今天我們在預訂對銷收入方面處於應付狀態，我們預計這種情況將在一年內逆轉，並實際上開始以積極的方式為整體收入 PMPM 做出貢獻。

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

謝謝。女士們、先生們，感謝你們的參與。今天的節目到此結束，大家可以斷開連結了。