Alignment Healthcare Inc (ALHC) 2025 Q3 法說會逐字稿

Good afternoon, and welcome to Alignment Healthcare's third-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 年第三季財報電話會議和網路直播。（操作說明）請注意，本次活動正在錄影。

Leading today's call are John Kao, Founder and CEO; and Jim Head, 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. These forward-looking statements are subject to various risk and uncertainties and reflect our current expectations based on our belief, assumptions, and information currently available.

今天的電話會議由創辦人兼執行長 John Kao 和財務長 Jim Head 主持。在開始之前，我們想提醒各位，本次電話會議中所做的某些陳述將構成《私人證券訴訟改革法案》所定義的前瞻性陳述。這些前瞻性陳述受到各種風險和不確定性的影響，反映了我們基於當前信念、假設和可用資訊的當前預期。

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 sections of our annual report on Form 10-K for the fiscal year ended December 31, 2024.

可能導致實際結果與這些前瞻性聲明有重大差異的一些因素的描述，已在提交給美國證券交易委員會的文件中進行了更詳細的討論，包括截至 2024 年 12 月 31 日的財政年度的 10-K 表格年度報告中的「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.

雖然我們認為我們的預期是合理的，但我們不承擔任何義務修改任何聲明以反映本次通話後發生的變化。

In addition, please note that the company will be discussing certain non-GAAP financial measures that they believe are important in evaluating performance. Details on the relationship between these non-GAAP measures to the most comparable GAAP measures and reconciliation of historical non-GAAP financial measures can be found in the press release that is posted on our company's website and our Form 10-Q for the fiscal quarter ended September 30, 2025.

此外，請注意，公司將討論一些他們認為對評估績效很重要的非GAAP財務指標。有關這些非GAAP指標與最可比較的GAAP指標之間的關係以及歷史非GAAP財務指標的調節詳情，請參閱我們公司網站上發布的新聞稿以及截至2025年9月30日的季度財務報表10-Q。

I would now like to turn the call over to John. John, you may begin.

現在我想把電話交給約翰。約翰，你可以開始了。

Hello, and thank you for joining us on our third-quarter earnings conference call. For the third quarter 2025, we exceeded the high end of each of our guidance metrics. Health plan membership of 229,600 members represented growth of approximately 26% year over year. Strong health plan membership growth supported total revenue of $994 million, increasing approximately 44% year over year. Adjusted gross profit of $127 million increased by 58% year over year.

大家好，感謝各位參加我們第三季財報電話會議。2025年第三季度，我們各項業績指標皆超出預期上限。健康計劃會員人數為 229,600 人，年增約 26%。強勁的健康計劃會員成長支撐了總收入達到 9.94 億美元，年增約 44%。經調整後的毛利為1.27億美元，較去年成長58%。

This produced a consolidated MBR of 87.2%, an improvement of 120 basis points over the prior year.

這使得綜合MBR達到87.2%，比前一年提高了120個基點。

Finally, our adjusted SG&A ratio of 9.6% improved by 120 basis points year over year. Taken together, we delivered adjusted EBITDA of $32 million, solidly surpassing the high end of our adjusted EBITDA guidance.

最後，我們調整後的銷售、一般及行政費用比率為 9.6%，較去年同期改善了 120 個基點。綜合來看，我們實現了調整後 EBITDA 3,200 萬美元，遠超過我們調整後 EBITDA 預期的上限。

Our third-quarter results now mark the third consecutive quarter in which we surpassed the high end of our adjusted gross profit and adjusted EBITDA guidance ranges and raised the full year guidance. These results were underpinned by inpatient admissions per 1,000 in the low 140s and demonstrate the power of our ability to manage risk in Medicare Advantage by placing care delivery at the center of our operations.

我們的第三季業績標誌著我們連續第三個季度超過了調整後毛利和調整後 EBITDA 預期範圍的上限，並提高了全年預期。這些結果的基礎是每千人住院人數在 140 人左右，這表明我們透過將醫療服務置於營運中心來管理 Medicare Advantage 風險的能力。

As we've demonstrated in 2024 and through our year-to-date performance in 2025, our unique model has positioned us to succeed amidst a paradigm shift in the industry marked by lower reimbursement and higher star standards. We continue to make investments that will improve operations to back-office automation, clinical engagement, AVA AI clinical stratification, and Stars durability. These investments will further separate us from our competitors.

正如我們在 2024 年以及 2025 年迄今為止的業績所證明的那樣，我們獨特的模式使我們能夠在行業範式轉變中取得成功，這種轉變的特點是報銷額降低和星級標準提高。我們將繼續進行投資，以改善運營，包括後台自動化、臨床參與、AVA AI 臨床分層和 Stars 持久性。這些投資將進一步拉開我們與競爭對手的差距。

For the full year, we now expect to deliver $94 million of adjusted EBITDA at the midpoint of our guidance range in 2025 compared to our initial full year guidance of $47.5 million at the midpoint. Jim will expand further on guidance in his remarks.

我們現在預計，2025 年全年調整後 EBITDA 將達到 9,400 萬美元（以我們指引範圍的中點計算），而我們最初給出的全年指引值為 4,750 萬美元（按中點計算）。吉姆將在演講中進一步闡述指導意見。

Moving to Stars results, 100% of our health plan members are in plans that will be rated 4 stars or above for rating year 2026, payment year 2027 compared to the national average of approximately 63%. We are once again demonstrating the consistency and replicability of our high-quality outcomes across each of our markets.

再來看星級評定結果，我們 100% 的健康計畫成員的計畫在 2026 年評定年度（2027 年支付年度）將被評為 4 星或以上，而全國平均約為 63%。我們再次證明了我們在各個市場都能取得高品質成果的一致性和可複製性。

For starters, our California HMO contract earned a 4-star rating. This is its ninth consecutive year rated 4 stars or higher. Meanwhile, our competitors in the state only have approximately 70% of members and plans rated 4 stars or higher for payment year 2027. Our ability to consistently earn high stars results from AVA's centralized data architecture that provides our organization and clinical resources with a cross-functional visibility to execute on each stars metric.

首先，我們的加州 HMO 合約獲得了 4 星評級。這是它連續第九年獲得四星以上評級。同時，我們在該州的競爭對手只有大約 70% 的會員和計劃在 2027 年的付款年度被評為 4 星或更高。我們能夠持續獲得高星級評價，得益於 AVA 的集中式資料架構，該架構為我們的組織和臨床資源提供了跨職能的可見性，從而能夠執行每一項星級指標。

In addition to our strong California performance, we now have two 5-star contracts in North Carolina and Nevada. Furthermore, we earned 4.5 stars in Texas in its first rating year. Our results outside of California not only demonstrate our commitment to quality, but also underscore the replicability of our outcomes across geographies, demographics, and provider relationships. Our latest results set us apart from our peers and create additional funding advantages in payment year 2027.

除了我們在加州的出色表現外，我們現在在北卡羅來納州和內華達州也獲得了兩份五星級合約。此外，我們在德克薩斯州首次評級就獲得了 4.5 顆星的評價。我們在加州以外的成果不僅證明了我們對品質的承諾，也強調了我們的成果在不同地理、人口統計和供應商關係中的可複製性。我們最新的業績使我們從同行中脫穎而出，並在 2027 年支付年度創造了額外的融資優勢。

Looking ahead, we believe the improvement we made to the raw star score of our California HMO plan in rating year 2026 sets a solid foundation for rating year 2027 and payment year 2028. Furthermore, we believe CMS' transition to the excellent health outcomes for all reward, formerly known as the Health Equity Index, will add cushion to our 4-star rating in California.

展望未來，我們相信，我們在 2026 年評級年度對加州 HMO 計劃的原始星級評分所做的改進，為 2027 年評級年度和 2028 年支付年度奠定了堅實的基礎。此外，我們相信，CMS 向「全民健康結果卓越獎勵」（以前稱為「健康公平指數」）的過渡將鞏固我們在加州的 4 星評級。

This change rewards health plans that effectively serve the most vulnerable low-income seniors, including those who are duly eligible. Our model is particularly well suited to manage this population with the clinical expertise and high-touch care provided by our Care Anywhere teams. Most importantly, we believe the move toward a bonus factor that focuses on clinical outcomes furthers CMS' mission to create greater alignment between quality and reimbursement.

這項改變旨在獎勵那些能夠有效服務於最弱勢的低收入老年人的健康計劃，包括那些符合資格的老年人。我們的模式特別適合管理這類人群，這得益於我們 Care Anywhere 團隊提供的臨床專業知識和貼心服務。最重要的是，我們認為，轉向以臨床結果為重點的獎金因素，有助於推進 CMS 實現其使命，即在品質和報銷之間建立更大的一致性。

Lastly, I'd like to share some early thoughts on the 2026 AEP. For the upcoming plan year, we are continuing to take a measured approach towards balancing membership growth and profitability objectives, consistent with our strategy in the past years. Our ability to deliver low cost through our care management capabilities is creating the capacity to keep benefits across our products generally stable to modestly down.

最後，我想分享我對 2026 年 AEP 的一些初步想法。在即將到來的計劃年度，我們將繼續採取穩健的措施來平衡會員成長和獲利目標，這與我們過去幾年的策略是一致的。我們透過護理管理能力提供低成本服務的能力，使我們產品的各項福利總體上保持穩定或略有下降。

We believe this disciplined approach supports our growth objectives while staying mindful of the third and final phase in of V28. Given continued disruption in the MA industry in 2026, we believe there will be an incremental opportunity to take share while growing adjusted EBITDA year over year.

我們相信，這種嚴謹的方法有助於我們實現成長目標，同時讓我們能夠兼顧 V28 的第三階段和最後一個階段。鑑於 2026 年 MA 產業持續動盪，我們相信將有機會逐步擴大市場份額，同時實現調整後 EBITDA 逐年成長。

Based on the strength of our early AEP results, we are confident that we are on track to grow at least 20% year over year. Consistent with our approach in past years, our sales operations are focused on matching seniors with the right products that support their lifestyle and growing in markets where we have the strongest provider relationships. We're very encouraged by the early activity of this selling season and look forward to sharing our full results with investors after the conclusion of the 2026 AEP.

根據我們早期 AEP 業績的強勁表現，我們有信心實現至少 20% 的年成長。與過去幾年的做法一致，我們的銷售業務專注於為老年人匹配合適的產品，以支持他們的生活方式，並在我們擁有最強供應商關係的市場中發展壯大。我們對本銷售季初期的活躍度感到非常鼓舞，並期待在 2026 年 AEP 結束後與投資者分享我們的完整業績。

Taken together, our core competency in care management, continuous improvement in member experience, and ongoing investments in AVA AI are all positioning us for further improvements to quality and outcomes. We believe we were the best Medicare solution for seniors everywhere, and we look forward to serving even more seniors across our markets in 2026.

綜上所述，我們在護理管理方面的核心競爭力、會員體驗的持續改進以及對 AVA AI 的持續投入，都使我們有能力進一步提高品質和效果。我們相信我們是各地老年人最好的醫療保險解決方案，我們期待在 2026 年為我們市場中更多的老年人提供服務。

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

現在我將把電話交給吉姆，讓他進一步討論我們的財務表現和展望。吉姆？

Thanks, John. I'm pleased to share our results for the third quarter, which were underpinned by strong execution across the board. For the third quarter, health plan membership of 229,600 increased by 26% year over year. Revenue of $994 million increased by 44% over the prior year. Outperformance in our revenue growth was predominantly driven by continued momentum in our new member sales during the quarter.

謝謝你，約翰。我很高興與大家分享我們第三季的業績，這得益於各部門的出色執行。第三季度，健康計畫會員人數為 229,600 人，年增 26%。營收達 9.94 億美元，較上年成長 44%。本季營收成長超預期主要得益於新會員銷售的持續成長動能。

Third-quarter adjusted gross profit of $127 million grew 58% compared to the prior year. This represented an MBR of 87.2% and improved by 120 basis points year over year. Outperformance of both adjusted gross profit and MBR was driven by a continuation of disciplined execution of our clinical activities. This drove inpatient admissions per 1,000 in the low 140s during the third quarter.

第三季調整後毛利為 1.27 億美元，比上年同期成長 58%。這相當於 MBR 為 87.2%，比前一年提高了 120 個基點。調整後毛利和 MBR 的優異表現得益於我們臨床活動的持續嚴格執行。這使得第三季每千人住院人數降至 140 人左右。

Meanwhile, Part D modestly outperformed our expectations as growth in utilization trends moderated sequentially. Our Part D experience through the first nine months of the year gives us confidence that all of the moving parts related to the IRA changes have been appropriately captured and that we are on pace to meet the Part D margin assumptions embedded within our guidance.

同時，D 部分略微超出了我們的預期，因為利用率成長趨勢較上季放緩。今年前九個月我們在D部分的經驗讓我們確信，與IRA變更相關的所有動態因素都已得到適當考慮，並且我們正按計劃實現我們在指導意見中設定的D部分利潤率假設。

Turning to our operating expenses. Adjusted SG&A in the third quarter was $95 million and declined as a percentage of revenue by 120 basis points year over year to 9.6%. The year-over-year improvement to our SG&A ratio was driven by the scalability of our operating platform. Additionally, we experienced a few million dollars of SG&A timing benefit in the third quarter that we expect to reverse in the fourth quarter, leaving our full year SG&A outlook roughly unchanged.

接下來談談我們的營運費用。第三季調整後的銷售、一般及行政費用為 9,500 萬美元，佔營收的百分比年減 120 個基點至 9.6%。我們的銷售、一般及行政費用比率較去年同期改善，主要得益於我們營運平台的可擴展性。此外，我們在第三季度獲得了數百萬美元的銷售、一般及行政費用時間收益，我們預計這筆收益將在第四季度逆轉，因此我們全年的銷售、一般及行政費用預期基本保持不變。

Taken together, adjusted EBITDA of $32 million resulted in an adjusted EBITDA margin of 3.3% and represents 240 basis points of margin expansion compared to the third quarter of 2024.

綜合來看，調整後的 EBITDA 為 3,200 萬美元，調整後的 EBITDA 利潤率為 3.3%，與 2024 年第三季相比，利潤率提高了 240 個基點。

Moving to the balance sheet. We ended the third quarter with $644 million in cash, cash equivalents and investments. Cash in the quarter was favorably impacted by the timing of certain medical expense payments, which resulted in higher operating cash flow during the third quarter. This timing difference also increased our Q3 days claims payable, but we expect this timing difference to normalize in the coming quarters.

接下來查看資產負債表。第三季末，我們持有現金、現金等價物和投資共 6.44 億美元。本季現金流受到某些醫療費用支付時間的有利影響，從而導致第三季經營現金流增加。這種時間差異也增加了我們第三季的索賠支付天數，但我們預計這種時間差異將在未來幾季恢復正常。

Our reservings methodology remains consistent and excluding this timing effect, we estimate that total cash would have been modestly higher sequentially and days claims payable would have been flat to modestly higher year over year. Importantly, this had no impact on the P&L.

我們的準備金計提方法保持不變，排除這種時間因素的影響，我們估計現金總額環比略有增加，而應付賠款天數同比持平或略有增加。重要的是，這並未對損益表產生任何影響。

Turning to our guidance. For the fourth quarter, we expect the following: health plan membership to be between 232,500 and 234,500 members, revenue to be in the range of $995 million to $1.01 billion; adjusted gross profit to be between $104 million and $113 million; and adjusted EBITDA to be in the range of negative $9 million to negative $1 million.

請參考我們的指導意見。對於第四季度，我們預計：健康計劃會員人數將在 232,500 至 234,500 人之間；收入將在 9.95 億美元至 10.1 億美元之間；調整後毛利潤將在 1.04 億美元至 1.13 億美元之間；調整後 EBITDA 將在負 10 萬美元至負 10 萬美元之間。

For the full year 2025, we expect the following: revenue to be in the range of $3.93 billion to $3.95 billion, adjusted gross profit to be between $474 million and $483 million, and adjusted EBITDA to be in the range of $90 million to $98 million. Building upon the strength of our third-quarter results, we once again increased the full year outlook for each of our guidance metrics. Given our year-to-date momentum on membership growth, we raised our year-end membership guidance by 2,000 members at the midpoint.

對於 2025 年全年，我們預計：營收將在 39.3 億美元至 39.5 億美元之間，調整後毛利將在 4.74 億美元至 4.83 億美元之間，調整後 EBITDA 將在 9,000 萬美元至 9,800 萬美元之間。憑藉第三季強勁的業績，我們再次提高了各項業績指標的全年預期。鑑於我們今年迄今會員成長勢頭良好，我們在年中將年底會員人數預期提高了 2,000 人。

Expectations for higher membership also drove our full year revenue outlook approximately $41 million higher at the midpoint, and we now expect to finish the year with nearly $4 billion of revenue for the full year 2025.

會員人數增加的預期也使我們全年收入預期中位數提高了約 4,100 萬美元，我們現在預計 2025 年全年收入將接近 40 億美元。

Moving to our full year profitability expectations. Our updated adjusted gross profit guidance of $479 million at the midpoint increased by $18 million. This implies an MBR of 87.9% and reflects nearly 100 basis points of MBR improvement year over year. Similarly, we increased the midpoint of our adjusted EBITDA guidance by $18 million, flowing through the entirety of the increase to the midpoint of our adjusted gross profit outlook, while full year SG&A assumptions remain roughly unchanged.

接下來談談我們對全年獲利能力的預期。我們更新後的調整後毛利預期中位數為 4.79 億美元，比預期值提高了 1,800 萬美元。這意味著 MBR 為 87.9%，反映出 MBR 比前一年提高了近 100 個基點。同樣，我們將調整後的 EBITDA 預期中位數提高了 1,800 萬美元，並將這一增幅全部計入調整後的毛利預期中位數，而全年銷售、一般及行政費用假設基本保持不變。

Our guidance assumes a portion of the strong year-to-date ADK performance persists through the fourth quarter. However, as a reminder, the final months of the year are expected to have higher utilization due to the seasonal impact of the flu. Meanwhile, we continue to take a prudent stance to our Part D assumptions given significant changes to the program this year.

我們的預測假設 ADK 今年迄今為止強勁的業績表現的一部分將持續到第四季度。不過要提醒的是，由於流感的季節性影響，預計今年最後幾個月的使用率會更高。同時，鑑於今年該計劃發生了重大變化，我們繼續對 D 部分假設採取謹慎的態度。

Lastly, on seasonality, we expect our MBR in the fourth quarter to be higher than the third quarter due to the typical seasonality of medical utilization. As a reminder, our MBR seasonality in 2025 is not comparable to 2024 due to changes to the Part D program and prior period reserve development in 2024.

最後，關於季節性因素，由於醫療利用率的典型季節性，我們預期第四季的 MBR 將高於第三季。提醒各位，由於 2024 年 D 部分計劃的變化以及前期儲備金的開發，我們 2025 年的 MBR 季節性與 2024 年不具可比性。

On SG&A, we expect an increase in expenses during the fourth quarter associated with growth-related costs, consistent with our past experience and the timing of certain expenses, which we expect to land in the fourth quarter.

關於銷售、一般及行政費用，我們預計第四季度與成長相關的成本將會增加，這與我們過去的經驗以及某些費用的發生時間一致，我們預計這些費用將在第四季度發生。

In closing, consistent execution of our core capabilities in care management is taking root in our financial results in 2025. Reiterating John's earlier remarks regarding 2026, we remain confident in our membership growth expectation of at least 20%, given our progress during the early weeks of the selling season. We believe our balanced approach to growth and profitability positions us well as we close out the remainder of the year and prepare for 2026.

最後，我們在護理管理方面的核心能力的持續有效執行，將在 2025 年的財務表現中得到體現。重申約翰先前關於 2026 年的言論，鑑於我們在銷售季初期幾週取得的進展，我們仍然對會員成長至少 20% 的預期充滿信心。我們相信，我們兼顧成長和盈利能力的平衡策略，使我們在今年剩餘時間里以及為 2026 年做好準備時處於有利地位。

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

接下來，我們開始接受提問。操作員？

(Operator Instructions) Scott Fidel, Goldman Sachs.

（操作說明）斯科特·菲德爾，高盛。

First question, and John, appreciate the sort of early insight into the growth on 2026 likely to meet or exceed your 20% growth target. And I know you're not giving guidance at this point, but just curious around the comment that you made around the market share opportunities from industry disruption. And clearly, we know there's a lot of that right now for MA.

第一個問題，約翰，非常感謝您能提前提供關於 2026 年增長情況的見解，以期達到或超過您 20% 的增長目標。我知道您目前不會給出任何指導意見，但我只是對您之前關於行業顛覆帶來的市場份額機會的評論感到好奇。很顯然，我們知道目前馬薩諸塞州有很多這樣的問題。

How would you frame that in terms of thinking about that in the context of California versus the non-California markets?

如果從加州市場與非加州市場的角度來看這個問題，你會如何闡述？

Scott, yes, I'd say very, very pleased with across-the-board growth in California and really leveraging the 5 stars in North Carolina and Nevada. So we're very pleased about the geographic kind of composition of the growth. I'd say even more importantly is kind of the product mix and the kind of provider networks that we think are very high performing and where the growth is actually occurring.

斯科特，是的，我對加州的全面增長感到非常非常滿意，並且真正利用了北卡羅來納州和內華達州的五星級優勢。因此，我們對成長的地理組成非常滿意。我認為更重要的是產品組合以及我們認為表現非常出色且實際實現成長的供應商網路類型。

And so, I think for all those reasons, we're very, very pleased just we're only two weeks into this thing. So I don't want to get too far ahead of ourselves, but two weeks in, we're really pleased with it.

所以，我認為基於以上所有原因，我們非常非常高興，而這只是兩週的時間。所以我不想操之過急，但兩週過去了，我們對此非常滿意。

The other thing I would just remind everybody, I know there's a concern that we're going to grow too much and we're going to pick up a bunch of bad business, et cetera, et cetera. I'm less worried about that simply because we had a 60% growth year in 2024. And not only do we onboard it well, we manage the risk really, really well.

我還要提醒大家一點，我知道大家擔心我們會發展過快，從而招致很多不良業務等等。我對此並不太擔心，因為我們在 2024 年實現了 60% 的成長。我們不僅能很好地完成導入工作，還能非常有效地管理風險。

And I think we're proving that we can scale the clinical model and we can actually manage the polychronic population really, really well. And so, it's just a core competency that we have that I'm not sure others can replicate at this point. So for all those reasons, I'm very pleased as to where we are.

我認為我們正在證明，我們可以擴大臨床模式的規模，並且我們實際上可以很好地管理多慢性病患者群體。所以，這是我們擁有的核心競爭力，我不確定其他公司目前能否複製。綜上所述，我對我們目前所處的位置非常滿意。

Got it. And for my follow-up question, John, I know that at a recent industry conference, you had talked about considerations around potentially pursuing some M&A or sort of partnership opportunities on the vertical integration side to unlock the MLR opportunities, particularly associated with supplemental benefits.

知道了。約翰，我的後續問題是，我知道在最近的一次行業會議上，你曾談到考慮在垂直整合方面尋求一些併購或某種合作機會，以釋放 MLR 機會，特別是與補充福利相關的機會。

And just curious around how you think about weighing or balancing the opportunities that would be related to that, like improving the MLR versus the potential risks of sort of entering new markets that may have some different fundamental dynamics and then just maybe sort of moving away from sort of this sort of core strategy you've had that's clearly been working in terms of the focused strategy on M&A?

我很好奇您是如何考慮權衡或平衡與此相關的各種機會的，例如提高MLR與進入可能具有不同基本動態的新市場的潛在風險，以及是否會偏離您一直以來行之有效的核心戰略（即專注於併購的戰略）？

Yes. No, good question, Scott. I'd say we're looking at a lot of different opportunities. And to your point, we're being very discerning. We're being very, very careful to the extent that there are tuck-in opportunities, I think we have to take those more seriously than others relative to, say, buying books of business in completely new markets.

是的。不，問得好，斯科特。我認為我們正在考慮很多不同的機會。正如您所說，我們確實非常謹慎。我們正在非常非常謹慎地對待任何可能的收購機會，我認為我們必須比其他機會（例如在全新的市場收購業務）更認真地對待這些機會。

I think we're being very thoughtful about that. I would not worry about that part of it. What I said at a prior conference was around basically supplemental benefits and tuck-in acquisitions related to what we would call captives, ancillary captives.

我認為我們在這方面考慮得非常周全。我不會擔心那部分。我在之前的會議上所談的內容，基本上是關於與我們所說的自保公司、輔助自保公司相關的補充福利和補充收購。

And when you talk about 4% to 5% of premium being really kind of applied to the supplemental business and supplemental products, it just makes sense for us to -- if we bought or started, say, some ancillary business, whether it'd be a dental PPO or a behavioral HMO or whatever it is, that we could seed it with 250,000 lives right off the bat kind of thing. And I think that there's going to be some margin improvement opportunity for us to do that, and I think we can do that with very little execution risk.

當你談到將 4% 到 5% 的保費真正用於補充業務和補充產品時，這對我們來說就很有意義了——如果我們收購或創辦一些輔助業務，無論是牙科 PPO 還是行為健康 HMO 或其他什麼，我們都可以立即為其註入 25 萬人口。我認為這樣做會為我們帶來一些利潤提升的機會，而且我認為我們可以以很小的執行風險做到這一點。

Does that answer where you're going?

這樣回答了你的問題，你知道你要去哪裡嗎？

Yes, it does. Obviously, it's going to be an evolving story, but I appreciate that insight. Thank you.

是的，確實如此。顯然，這會是一個不斷發展的故事，但我很欣賞這種洞察力。謝謝。

Matthew Gillmor, KeyBanc.

Matthew Gillmor，KeyBanc。

I want to follow-up on the 80,000 metric and the favorability on inpatient costs. I think last call, John, you talked about giving providers more tools and more data and also maybe moving some of the UM and inpatient risk back to Alignment's balance sheet.

我想跟進一下 80,000 這個指標以及住院費用方面的利多因素。約翰，我想上次通話中你談到要給醫療服務提供者更多工具和更多數據，也可能要將部分醫療利用管理和住院風險轉移回 Alignment 的資產負債表。

Can you just remind us where you are in terms of risk sharing with physicians in California? And how do you see that evolving during 2026 and beyond?

您能否簡要說明一下，您在加州與醫生進行風險分擔方面處於什麼階段？您認為這種情況在 2026 年及以後會如何發展？

Yes. Matt, great question. We're about 65% to somewhere between 65% and 70% is in what we would refer to as our shared risk business. And what that represents is really where we're working with IPAs, particularly in parts of Southern California where we have shared risk arrangements where we're managing the inpatient -- we're at risk for the inpatient risk. And what we have done starting last year is really take on more of the UM component.

是的。馬特，問得好。我們大約有 65% 到 70% 的業務屬於我們所謂的風險共擔業務。這真正代表了我們與獨立執業醫師協會 (IPA) 的合作現狀，尤其是在南加州的一些地區，我們與 IPA 簽訂了風險共擔協議，由我們來管理住院病人——我們承擔住院病人的風險。從去年開始，我們所做的就是真正承擔更多密西根大學的職責。

And we've done that in a way that is resulting in better clinical outcomes and improved financial outcomes for our IPA partners. And so, it's kind of a win-win for everybody.

我們採取的措施，為我們的 IPA 合作夥伴帶來了更好的臨床效果和更好的財務結果。所以，這對每個人來說都是一種雙贏。

And the other 1/3 of the business is still kind of globally capitated, but I think you're going to start seeing more and more of that shared risk business. I think it's more durable overall. I think there's going to be less kind of abrasion with kind of global cap kinds of entities as there's more and more shared -- it's more aligning longer term.

而剩下的 1/3 業務仍然在某種程度上是全球定額付費的，但我認為你會看到越來越多的這種風險共擔的業務模式。我認為它整體上更耐用。我認為隨著共享的增多，全球資本上限之類的實體之間的摩擦會減少——從長遠來看，這會更加協調一致。

I think outside of California, you're going to have more shared risk and/or just directly (technical difficulty) we really are the IPA. We are the network, and we are supporting the practices in terms of not only UM, but making sure that all the stars gaps are closed the way we want and our risk adjustment gaps are closed the way we want.

我認為在加州以外的地方，你會面臨更多共同風險和/或直接（技術困難），我們確實是IPA。我們是網絡，我們不僅在 UM 方面支持這些實踐，而且確保所有星級差距都按照我們想要的方式填補，我們的風險調整差距也按照我們想要的方式填補。

And frankly, that's what's caused us to get to 5 stars in North Carolina and Nevada. We have more visibility and control with the direct providers, PCP specialists, and the hospital partners. And so I think that's a trend that you're going to see more and more from us. And really, I think the team has done a very good job about kind of doing what we -- it's called de-delegation of UM.

坦白說，正是這一點讓我們在北卡羅來納州和內華達州獲得了五星級評價。我們對直接供應商、初級保健專家和醫院合作夥伴擁有更高的可見度和控制力。所以我認為，這種趨勢你們會越來越常看到我們這樣做。我覺得團隊在執行我們所謂的「取消授權」方面做得非常好。

And we've done it in a win-win way, which is really important to us because we want to make sure that we're aligned with the providers and that collectively, we can provide better clinical outcomes and better benefits for the beneficiaries.

我們以雙贏的方式實現了這一點，這對我們來說非常重要，因為我們希望確保與供應商保持一致，並且共同努力，為受益人提供更好的臨床結果和更好的福利。

Got it. That's helpful. As a follow-up, Jim had mentioned some favorability with SG&A, but that's being reinvested. Can you dimension that a little bit, both in terms of the sizing and then also where that reinvestment is going? Should we think about Stars or other items there?

知道了。那很有幫助。作為後續，Jim 提到了一些關於 SG&A 的優惠政策，但這些優惠政策將被重新投資。您能否具體說明一下，包括規模以及再投資的用途？我們應該考慮星星還是其他物品？

Yes. Sure thing. The SG&A against the consensus guidance was a handful of [$1 million] favorable in Q3. And as you noticed, we didn't adjust the full year expectations for SG&A. We kept those intact at around $385 million.

是的。當然可以。第三季銷售、一般及行政費用比預期略高 100 萬美元。正如您所注意到的，我們沒有調整全年銷售、一般及行政費用預期。我們把這些資產維持在了3.85億美元左右。

So what you're hearing from us is there was a little bit of timing issue with respect to the investments we're making. I would also say that we want to be well positioned for growth in 2026 and just make sure that we've got those resources ready.

所以，我們想告訴大家的是，我們在投資上遇到了一些時機問題。我還想說，我們希望為 2026 年的成長做好充分準備，並確保我們擁有所需的資源。

And so really, it's a timing issue. We kept our guidance intact and we outperformed a little bit in the third quarter. We think we'll kind of give it back in Q4.

所以說，這其實是時機問題。我們維持了原有的業績預期，並且在第三季略微超出了預期。我們覺得我們會在第四季把它還回去。

The only addition to Jim's point is, it's kind of a part. The question you asked about where are we investing is what -- we're not talking a lot about yet, but we will. Just the continuous improvement that we're making to improve automation across the entire organization, improved AI logic in our Care Anywhere and AVA AI.

吉姆的觀點唯一需要補充的是，它算是其中的一部分。你問到我們的投資方向，目前我們還不怎麼談論這個問題，但以後會談的。我們正在不斷改進，以提高整個組織的自動化水平，並改進 Care Anywhere 和 AVA AI 中的 AI 邏輯。

And just even more, I would say, kind of productivity improvements and efficiency in a lot of our clinical programs. All of that's happening behind the scenes and that's where the dollars are being spent. And I think these investments that we're making now are really going to start paying out even more for '26 and '27.

而且，我認為更重要的是，我們的許多臨床計畫的生產力和效率都有所提高。所有這些都在幕後進行，資金也花在了這些地方。我認為我們現在進行的這些投資，在 2026 年和 2027 年將會開始獲得更大的回報。

Michael Ha, Baird.

Michael Ha，貝爾德。

Thank you and thank you for commenting on the investor debate about doing too much growth. I want to quickly clarify first on the flip side. If you were to do less growth, I imagine that would only serve to further empower your EBITDA bridge since you have less lower-margin new members. Is that fair to say as well?

謝謝，也感謝您就投資人關於成長過快的爭論發表評論。我首先想快速澄清一下另一方面。如果成長速度放緩，我想這只會進一步增強你的 EBITDA 橋樑，因為你的低利潤新成員減少了。這樣說是否也公平？

And then my real question on Star ratings, and congrats on your Star rating results back in September and today, I know you mentioned your overall raw Star rating score increased year to year, well within 4 stars. If not, I think you mentioned very close to 4.5, but when I double-click into the contracts, 315, 3443, the summary rating for Part C and Part D seem to be 3.5, but the overall star rating, of course, is 4.0. I know that there are certain measures excluded that go into that rating ending up at 4, but I guess that face value imply your underlying ratings might have declined instead of improved.

然後，我真正的問題是關於星級評分的。恭喜您在九月和今天都獲得了星級評分結果，我知道您提到您的整體原始星級評分逐年提高，遠超 4 星。如果不是這樣，我記得您提到非常接近 4.5 分，但當我雙擊查看合約 315 和 3443 時，C 部分和 D 部分的匯總評級似乎是 3.5 分，但整體星級評級當然是 4.0 分。我知道這個評級最終是 4 分，但其中一些指標被排除在外，但我猜想從表面上看，這似乎意味著您的基礎評級可能下降了，而不是提高了。

So I was wondering if you could help sort of reconcile your commentary on the raw star ratings improvement versus the summary ratings that what they appear to indicate?

所以我想知道，您能否幫忙解釋一下您對原始星級評分提升的評論與總結評分之間似乎存在的差異？

Yes, hey, Michael, it's John. Yes. No, our overall raw score went up significantly from 3.7, whatever it was 5.2 or something like that to 4.05 or 4.06. So we're really happy about the raw score increases. I think we can probably have a sidebar conversation with you on the mechanics of it.

是的，嗨，邁克爾，我是約翰。是的。不，我們的總原始分數從 3.7 分（或 5.2 分左右）大幅提高到 4.05 分或 4.06 分。所以我們對原始分數的提升非常滿意。我想我們可以私下和你聊聊其中的具體機制。

But really, it's a data science, this is kind of how you think about the Part C, how you think about the Part D and kind of all that goes into it. But the raw scores absolutely went up, and we're happy about that.

但實際上，這是一門數據科學，這就是你思考 C 部分、D 部分以及所有相關內容的方式。但原始分數確實提高了，我們對此感到高興。

Okay, got it. Thank you. And then on G&A, sub-10%, incredibly powerful. I know you're aiming for some more improvement on G&A going forward. And I think you're now actually planning for the first time to invest into your brand. I think I saw on LinkedIn, there's a commercial video.

好的，明白了。謝謝。然後，管理費用佔比低於 10%，這非常了不起。我知道你希望未來在一般及行政費用方面能有更大的改善。我認為你現在實際上是第一次計劃投資你的品牌。我好像在領英上看過，有個商業影片。

So I was wondering how should we think about the brand investment going forward? It seems like you're implementing it starting this year. And I guess my main question is, how should we think about this new marketing effort in terms of evolving your member acquisition costs near term, long term? I imagine driving member growth through marketing and advertisement might present opportunities on the cost side versus broker commission costs.

所以我想知道，我們未來該如何看待品牌投資？看來你們是從今年開始實施的。我想問的主要問題是，我們應該如何看待這項新的行銷舉措，以及它對近期和長期會員獲取成本的影響？我認為，透過行銷和廣告來推動會員成長，可能會在成本方面帶來機會，從而降低經紀人佣金成本。

Yes. Michael, I'll take the first half, it's Jim here, and I'll let John talk about the brand. But as we continue to scale the business, there's going to be a natural decline in our SG&A ratio. But I think we're going to take a balanced approach to that in the sense that we want to continue investing in the business.

是的。邁克爾，我來講前半部分，吉姆在這裡，我讓約翰來談談品牌。但隨著我們不斷擴大業務規模，我們的銷售、管理及行政費用率自然會下降。但我認為我們會採取平衡的做法，因為我們希望繼續投資這項業務。

And I would say it's not just brand, which John will talk about in a minute, but it's also making sure that we're reinvesting back in our clinical infrastructure and the other parts of the business so we can continue to evolve our model and step ahead of the competition. So I think as we think longer term, the SG&A trends will go down, but we got to be measured and balanced about it because we want to continue to invest.

而且我認為這不僅僅是品牌問題（約翰稍後會談到這一點），還要確保我們把資金再投資到臨床基礎設施和業務的其他方面，這樣我們才能不斷發展我們的模式，並在競爭中領先一步。所以我認為，從長遠來看，銷售、一般及行政費用趨勢將會下降，但我們必須對此保持謹慎和平衡，因為我們想要繼續投資。

But John, over to you.

約翰，現在輪到你了。

Yes. I think, Michael, we're just getting big enough that it's an opportunity for us to establish not only a brand for alignment, but really, it's an opportunity for us to demonstrate what is possible if you do Medicare Advantage the way it was designed to be operated, which is why we always talk about MA done right.

是的。我認為，邁克爾，我們現在的規模已經足夠大了，這不僅是一個建立品牌形象的機會，更是一個展示如果按照醫療保險優勢計劃的設計初衷來運作，能夠取得怎樣的成就的機會。這就是為什麼我們總是談論如何正確地進行醫療保險優勢計劃。

And I think it's going to start really representing what was kind of reflected in that ad, which is it's all about serving seniors, actually changing the paradigm and the expectation, changing how people think about MA and all the good that we do and what all the good that MA can do. And so I think we're being very thoughtful about how to do that and what the brand is going to stand for. So stay tuned for that.

我認為這將真正開始體現那則廣告中所反映的內容，那就是一切都是為了服務老年人，真正改變範式和期望，改變人們對醫療助理以及我們所做的一切好事和醫療助理能夠做的一切好事的看法。所以我覺得我們正在非常認真地思考如何做到這一點，以及這個品牌將代表什麼。敬請期待。

Jessica Tassan, Piper Sandler.

傑西卡·塔桑，派珀·桑德勒。

Congrats on the really strong results. So, I wanted to follow up on AEP. Can you just maybe offer some perspective on retention versus gross new adds for '26? Just interested in the dynamic between, obviously, the competitor with really rich dental benefits versus some service area exits from another competitor. Just how should we think about the composition of that 20% net AEP growth between retained members and gross new adds?

恭喜取得如此優異的成績！所以，我想跟進AEP的情況。您能否就 2026 年的用戶留存率與新增用戶總數之間的關係提供一些見解？我只是對以下兩方面之間的動態感興趣：一家競爭對手提供非常優厚的牙科福利，而另一家競爭對手則退出了部分服務區域。我們應該如何看待這 20% 的年度淨成長（AEP 成長）的組成，即留存會員和新增會員總數之間的組成？

Yes. We're happy with both, Jess. Gross adds are strong across the board and retention is actually better than we anticipated across the board. So it's a both and situation, which is where we need to be. The investments we've made in member experience is paying off.

是的。傑西，我們對這兩個都很滿意。新增用戶數量整體表現強勁，用戶留存率也普遍高於預期。所以這是一種兼具兩者特徵的情況，而這正是我們應該達到的狀態。我們在提升會員體驗所做的投入正在發揮成效。

It continues to pay off. So really happy with both.

這樣做持續奏效。兩個都很滿意。

Okay. Got it. That's helpful. And then just as we look at [Planfinder], it seems like Alignment stands out from kind of a core benefits perspective, so really favorable on metrics like average medical move, average outpatient max cost sharing, but maybe a little less generous on supplemental benefit. Is this an appropriate conclusion?

好的。知道了。那很有幫助。然後，當我們查看 [Planfinder] 時，從核心福利的角度來看，Alignment 似乎脫穎而出，在平均醫療搬遷次數、平均門診最高費用分攤等指標上非常有利，但在補充福利方面可能稍微不那麼慷慨。這個結論合適嗎？

And can you just explain the rationale or kind of the decision to structure benefits in this way? And then just secondarily, interested to know how Alignment seems to be managing through Part D redesign despite having relatively low deductible and co-pay versus co-insurance in Tier 3. Obviously, that's working for you guys in '25, and it looks like it will continue next year. So just hoping for some comments on structure of benefits.

能否解釋一下這樣安排福利的理由或決定？其次，我很想知道 Alignment 在第三級中，儘管自付額和共同支付額相對於共同保險較低，是如何應對 D 部分的重新設計的。顯然，這對你們2025年來說是行之有效的，而且看起來明年還會繼續。所以，我希望大家能對福利結構提出一些意見。

Yes. No, everything is designed around consistency for the beneficiary. Everything is year to year. We're very thoughtful market by market. We've shared that with you all in the past, market-by-market business plans, strategies, and consistency for value creation for each beneficiary is really paramount.

是的。不，一切設計都是為了確保受益人的利益一致。所有數據都是按年計算的。我們非常注重因地制宜，逐一市場進行決策。我們過去曾與大家分享過，針對每個市場制定商業計劃、策略，並持續為每個受益者創造價值，這一點至關重要。

It's the first thing we think about. And so, you're absolutely right. We have taken the same kind of approach this past year as we have in the past, very disciplined and detailed product design strategies.

這是我們首先想到的事情。所以，你的說法完全正確。過去一年，我們採取了與以往相同的策略，即非常嚴謹且細緻的產品設計策略。

In our markets in California, Part D is very competitive. So we didn't make any material changes there. There is some shifts to coinsurance in a couple of different markets, but I think we're pretty stable across the board.

在加州市場，D部分保險的競爭非常激烈。所以，我們在這方面沒有做出任何實質的改變。有些市場出現了轉變為共同保險模式的情況，但我認為整體而言，我們的保險體系相當穩定。

John, I'd echo that. Stability is the name of the game. And as we said, we've done a really good job executing against Part D through 2025. And as we went into bids, last year's bids for this year, we were prudent and thoughtful about how we did it, but we were executing well through 2025. And so we kind of felt good about the stability in our benefits.

約翰，我同意你的看法。穩定才是關鍵。正如我們所說，我們在執行 2025 年前的 D 部分方面做得非常出色。去年我們為今年的投標做準備，我們謹慎周全地考慮了投標的方式，並且一直執行到 2025 年。因此，我們對福利的穩定性感到比較滿意。

And so we think that sets up well for next year.

因此，我們認為這為明年奠定了良好的基礎。

With respect to your supplemental question, a lot of our thinking around that has been also driven by not just the bid economics, but also by quality. Yes, so we ensure our members that we provide the right quality of supplement benefits. And so that's just something we always think about in some cases, the answer is we pretty give ourselves (inaudible) make sure we were absolutely providing like best experiencel. And so we were -- it was just something that was factored into some of our experience.

關於你的補充問題，我們在這方面的許多思考不僅受到投標經濟效益的影響，也受到品質的影響。是的，所以我們向會員保證，我們提供的營養補充品品質優良。所以，在某些情況下，我們總是會考慮這個問題，答案是我們盡力確保（聽不清楚）提供最好的體驗。所以，這就是我們經歷的一部分。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

I guess on the guidance, I think you've raised the full year EBITDA guidance 4 times over the last calendar year. I'm just trying to get an appreciation for what sort of levels you were thinking in your internal budgeting? Or was this really sort of a legitimate surprise? I appreciate the conservative guidance. Just wondering how this stacks up versus sort of where you had initially expected the year to shake out.

關於業績指引，我認為你們在過去一年中已經四次上調了全年 EBITDA 指引。我只是想了解一下您在內部預算方面考慮的是什麼樣的水平？或者，這其實算是合理的意外？我讚賞這種保守的指導。我只是想知道這和你最初預期的今年的發展相比如何。

Yes. This is the new person second call as CFO, but I would say the following. What's happened this year is we've just had a lot of good execution in a very difficult year, okay? So, I guess a couple of things coming into 2025 that were new to the Alignment in the industry, which is we continue to have the second step of V28 phase-in. We had a brand-new year of IRA, and we had a -- unique to Alignment was we had a very large cohort of new members.

是的。這是這位新任財務長第二次接受電話採訪，但我還​​是想說以下幾點。今年發生的情況是，我們在非常艱難的一年裡取得了許多良好的執行效果，懂嗎？所以，我想到 2025 年，業界的 Alignment 將迎來一些新變化，那就是我們將繼續推進 V28 的第二階段過渡。我們迎來了 IRA 的新一年，而且——這是 Alignment 獨有的特點——我們迎來了一大批新成員。

And so against that backdrop -- and we weren't ready to bet on final suites from 2024. So you had all those things swirling around as we set the year out. And what's happened throughout the course of the year is we've executed really well. And I would say executed across a whole variety of dimensions well, whether it's ADK and some of the moves that we've made with engaging with providers to manage utilization in a very constructive way.

因此，在這種背景下——我們還沒有準備好對 2024 年的最終套房進行押注。所以，在年初的時候，所有這些事情都在醞釀中。過去一年來，我們的執行力都非常出色。而且我認為，無論是 ADK 還是我們與供應商合作以非常建設性的方式管理利用率所採取的一些措施，我們在各個方面都執行得很好。

I think Part D executed well for us across the board. We got some favorability from the final suite from our new members. And so there's an aspect here of working through a pretty big change in the business and the model over the last year successfully. And I think that points well for the future for us. It's one of the reasons why I joined.

我認為D部分整體表現都很出色。我們從新成員的最終方案中獲得了一些好感。因此，這其中也包含了過去一年來公司業務和模式發生巨大變化並成功應對的面向。我認為這對我們來說是一個好兆頭，預示著美好的未來。這也是我加入的原因之一。

Great. Just real quick. I appreciate the confidence in the 20% growth, but more just to industry growth. PMS is calling for basically flat year-over-year enrollment. I think the plan said they actually expected to decline.

偉大的。就簡單說一下。我讚賞對 20% 成長率的信心，但更多的是指產業成長。PMS預測入學人數將基本與前一年持平。我認為該計劃表明他們實際上預期會下降。

Just wondering if you have any view on overall MA market growth in 2026?

想問您對2026年MA市場的整體成長有何看法？

Yes, yes, California typically is lower than the industry, again, year to year. There is a lot of disruption out there. There's a lot of changes going on out there. And so again, we feel very well positioned on the growth side and the retention side.

是的，是的，加州的水平通常低於行業平均水平，而且這種情況每年都在變化。現在到處都充滿了混亂。現在外面正在發生很多變化。因此，我們再次感覺到我們在成長和留存方面都處於非常有利的地位。

Craig Jones, Bank of America.

克雷格瓊斯，美國銀行。

So I was wondering, as we enter the final year of V28, do you have any thoughts on the likelihood of a potential V29 in the next few years? And if there is one, do you have any thoughts on the positive or negative implications to using more encounter data as part of the risk adjustment calculation?

所以我想知道，隨著V28進入最後一年，您對未來幾年推出V29的可能性有什麼看法？如果有影響，您認為在風險調整計算中使用更多就診資料會帶來哪些正面或負面的影響？

Yes. Craig, good questions. I think you're going to see some changes. This is what we hypothesized, some changes with respect to how CMS is going to deal with HRAs. I think there's going to be more, shall we call it, program integrity around ensuring there will be clinical validation around an HRA, same with kind of chart reviews.

是的。克雷格，問得好。我認為你會看到一些變化。這就是我們先前的假設，CMS 在處理 HRA 方面可能會有一些變化。我認為，在確保 HRA 有臨床驗證方面，以及在病歷審查方面，將會有更多，我們姑且稱之為，項目完整性。

The encounter-based baselining was referred to in last year's advanced notice. I don't know if they're going to be implementing any of that in this advanced notice. I would be surprised, actually. It's something that has been discussed. But in terms of how to operationalize it in a timely way, again, I'd be surprised if it was introduced to impact 2027.

去年的預先通知中提到了基於接觸次數的基線設定。我不知道他們是否會在提前通知的情況下落實這些措施。說實話，我會很驚訝。這是之前討論過的問題。但就如何及時實施而言，我再次表示，如果它能在 2027 年產生影響，我會感到驚訝。

I think from a policy point of view, a lot of what we're hearing about really is around kind of MA program integrity, so to speak, making sure that trust in the program is high and kind of gaining is eliminated. I think that's what we see. And it's unclear that they did go to an encounter-based baseline methodology. It's kind of unclear as to what the net impact would be. It is one of the reasons why we don't think it's going to get implemented for '27.

我認為從政策角度來看，我們聽到的很多內容實際上都與碩士課程的誠信有關，也就是說，要確保人們對該計畫的信任度很高，並消除任何舞弊行為。我想這就是我們看到的。目前還不清楚他們是否採用了基於接觸次數的基線方法。目前還不清楚最終會產生什麼影響。這也是我們認為它不會在 2027 年實施的原因之一。

Got it. And then just as a quick follow-up to a question earlier. I think you said your raw score for your primary plan was 4.05. And then you've talked about how that HealthEquity index next year will give you like a cushion. I think you said previously 0.25 as a tailwind, all else being equal.

知道了。然後，我想快速補充一下之前的問題。我想你說過你的主要計劃的原始得分是 4.05。然後你又提到明年的健康公平指數會為你帶來一些緩衝。我認為你之前說過，在其他條件相同的情況下，0.25 可以作為順風。

Is that still correct and that means primary plan about 4.5 for next year?

這個說法仍然正確嗎？這意味著明年的主要計劃是4.5左右嗎？

Depending upon where the cut points end up, that's kind of what we mean by that. It does give us a little bit of cushion, but we just really aren't sure what's going to happen with the cut points. We thought -- I thought that they would not be as aggressive as they were this past year. They were aggressive. We're actually really happy with the fact that we still got the 4 stars for all of our members.

這取決於分割點的最終位置，這就是我們所說的意思。這確實為我們提供了一些緩衝空間，但我們真的不確定最終的裁員點會如何變化。我當時以為——或者說我以為——他們不會像去年那樣咄咄逼人。他們具有攻擊性。我們非常高興所有會員都獲得了 4 星評價。

And I think you've also heard me say in the past, I'm not going to be happy until we get to 5 stars for every one of our plans. We're making progress on that front. But your logic is right. What we don't know is where the cut points will end up.

我想你們以前也聽我說過，除非我們所有的計畫都達到 5 顆星，否則我不會滿意的。我們在這方面正在取得進展。但你的邏輯是對的。我們不知道的是，最終的分割點會在哪裡。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

I wanted to follow up on some of the seasonal flu comments in the context of what's going on with the broader policy guidance on vaccines. Are you seeing any behavioral changes from seniors or vaccine uptake this year? And if so, how are you managing that dynamic?

我想就季節性流感的一些評論，結合疫苗相關的更廣泛的政策指導，再做進一步探討。今年老年人的行為或疫苗接種率是否有任何變化？如果是這樣，你是如何處理這種動態的？

Yes. It's a question that we've been looking at internally, and we follow our -- essentially our Part D cost, which is basically a lot of it is flu shots and literally tracking it daily, weekly. It seems to be trending pretty much in line with what we've seen in the past. I'd say a little bit softer in Q3, but picking up in October. So I don't think we see a material change in the trajectory of that.

是的。這是我們內部一直在研究的問題，我們主要關注我們的D部分成本，其中很大一部分是流感疫苗，我們每天、每週都會追蹤這部分成本。目前的趨勢似乎與我們過去看到的情況基本一致。我認為第三季會略微疲軟一些，但10月份會回升。所以我認為我們不會在這一趨勢上看到實質的變化。

And I think we're mindful in Q4 of just kind of flu as it impacts both the Part D costs, but also inpatient ADK. Q4 is typically a seasonal quarter where that impacts us a little bit more. So we are cautious about that, but it doesn't seem to be anomalous.

我認為我們在第四季度會特別關注流感，因為它不僅會影響 D 部分的費用，還會影響住院 ADK。第四季度通常是季節性季度，因此對我們的影響會更大一些。所以我們對此持謹慎態度，但這似乎並非異常現象。

Great. And as a follow-up, John, you made a number of comments today on continued investments in all things, operational, clinical, tech stars. Can you help us understand how much of that investment spend is already captured in current spend versus what's new or incremental? And it'd also be helpful to understand how much of that investment or that spend is directly earmarked for things like Stars, especially in the context of cut points moving higher?

偉大的。約翰，作為後續問題，你今天就持續投資於營運、臨床、技術等各個方面發表了一些評論。您能否幫助我們了解一下，這些投資支出中有多少已經包含在目前的支出中，又有多少是新增或增量支出？此外，了解這些投資或支出中有多少是直接用於「明星球員」之類的課程也很有幫助，尤其是在錄取標準不斷提高的情況下？

Well, I don't think it's any -- there's no leaps and bounds types of investment. What we're doing is we're being very smart in applying investment dollars. I'm talking about OpEx and CapEx across the enterprise. And that will be a little bit in the fourth quarter. What's really impacting the fourth quarter is more making sure we're prepared for growth as we typically are in Q4.

嗯，我不認為這是任何意義上的——沒有那種突飛猛進的投資類型。我們正在做的，就是非常明智地運用投資資金。我指的是整個企業的營運支出和資本支出。那大概會在第四季發生。真正影響第四季度業績的，是確保我們像往常一樣為第四季度的成長做好準備。

But as we move forward, we're making sure that we have enough room to make the investments in the platform, in our capabilities, in our human capital, et cetera, as we go forward. But none of it is dramatic. It's just making sure that we find room as we scale to reinvest back in the business and do it smartly.

但隨著我們不斷前進，我們將確保我們有足夠的空間對平台、能力、人力資本等方面進行投資。但這一切都不引人注目。我們只是想確保在擴大規模的過程中，能夠找到空間將資金再投資到業務中，並且明智地進行再投資。

And one of the things that I'm very focused on is making sure that we're really kind of underwriting that -- those investments smartly and making our choice as well.

我非常關注的一件事是確保我們真正為這些投資提供擔保——明智地進行這些投資，並做出我們的選擇。

Whit Mayo, Leerink Partners.

Whit Mayo，Leerink Partners。

John, do you know what percent of competing plans in your markets were commissionable last year and how that compares to this year?

約翰，你知道去年你所在市場中可獲得佣金的競爭計畫佔比是多少嗎？與今年相比又如何？

I can't answer that question. I actually don't know the answer. I know I do have a couple of plans stopped paying commissions. But I actually don't know and (inaudible). Most are still paying, just to be clear.

我無法回答這個問題。我其實不知道答案。我知道我的確有幾個計劃停止支付佣金。但我其實不知道。（聽不清楚）需要說明的是，大多數人仍在付費。

Yes. My follow-up was just on RADV. I was just wondering where we are on that, what the next steps are and how prepared do you think the organization is?

是的。我的後續研究只涉及 RADV。我只是想知道我們目前進展如何，下一步是什麼，以及您認為組織方面準備得如何？

Yes, and there's a little bit of a pause in the action, as you know, given the fact that the Humana case, the courts overturned RADV procedures based on Procedures Act violations. But I think our internal point of view is that CMS still has a lot of ways to pursue this, and we don't think that is going to go away. So our base case is that it's going to be here. It's just a question of timing.

是的，正如你所知，由於 Humana 案，法院以違反《程序法》為由推翻了 RADV 程序，因此行動暫時停滯了一段時間。但我認為我們內部的觀點是，CMS 仍然有很多方法可以推進此事，我們認為這個問題不會消失。所以我們的基本假設是它會在這裡。這只是時機問題。

But having said all that, we think we're well positioned. Our compliance or documentation processes are really good. We feel good about the operations and how we've set that up. And especially, we've never been an organization that has really relied on risk adjustment as a revenue tool.

但綜上所述，我們認為我們處於有利地位。我們的合規或文件流程非常完善。我們對目前的營運情況以及我們所做的安排感到滿意。尤其值得一提的是，我們從來都不是一個真正依賴風險調整作為收入工具的組織。

So we're just being prudent about that. But we do feel as the base case is that it's going to be there. Washington is not letting go of this topic just yet.

所以我們只是在這件事上謹慎行事。但我們基本上認為它會存在。華盛頓方面還沒有放棄這個話題。

Jonathan Yong, UBS.

瑞銀集團的Jonathan Yong。

Just in relation to kind of AEP again, just in terms of the live that are coming on to your books, how do they look? What's kind of the makeup in terms of, say, new to MA either and who might be switching on to your books from elsewhere? Just curious on that particular dynamic and if those members, given the volatility we've seen in the market kind of fit into the Alignment model?

再說回 AEP，就你們即將推出的現場演出而言，情況如何？就學生組成而言，比如說，有多少人是碩士新生，又有多少人是從其他地方轉而來閱讀你的書？我只是對這種特殊的動態感到好奇，考慮到我們目前看到的市場波動，這些成員是否符合聯盟模式？

Yes, it's consistent. It's still between 80% and 85% of switches. And really, it's across the board. It's not really concentrated with any particular payer that we're taking share from. It's kind of consistent across the board.

是的，這很一致。開關率仍然在 80% 到 85% 之間。而且，這種情況普遍存在。我們並沒有真正從任何特定的支付方搶佔市場份額。整體而言，情況基本一致。

And that's really in all geographies as well.

而且這種情況在所有地區都普遍存在。

Okay. Great. And then just as we kind of just thinking forward a little bit here, but as we think about, say, next year, final year of V28, the pressures in the industry, generally speaking, should hopefully have abated at that point. How do you think about a potentially more competitive environment kind of looking in the medium term, particularly with respect to possibly expanding more beyond your current markets into other states or geographies?

好的。偉大的。然後，當我們稍微展望一下未來，比如說明年，也就是 V28 的最後一年，一般來說，屆時產業內的壓力應該會有所緩解。您如何看待中期內可能出現的更具競爭性的市場環境，尤其是在可能將業務拓展到現有市場以外的其他州或地區方面？

Yes. Just remember, after V28, final third year phased in 2026, they're not going back to V24. So it's still going to be a tight reimbursement environment. Unclear what's going to happen on [starters]. But I think the way that you should think about us is our ability to manage the care for our beneficiaries allows us to control the costs.

是的。請記住，在 V28（第三年最終階段於 2026 年）之後，他們不會再回到 V24。所以報銷環境依然會很緊張。目前還不清楚接下來會發生什麼[首發球員]。但我認為，你們應該這樣看待我們：我們有能力管理受益人的護理，這使我們能夠控製成本。

And in this new world of taking away, this is called the gaming associated with coding, the organizations that can provide the highest quality care at the lowest cost will ultimately be the winners, which is why you've seen us do so well in '24 and '25.

在這個不斷減少資源的新世界中（這被稱為與編碼相關的遊戲），能夠以最低成本提供最高品質護理的組織最終將成為贏家，這就是為什麼你們看到我們在 2024 年和 2025 年取得瞭如此好成績。

And so when you kind of get it into '26, that's going to be even emphasized even more. So we feel really good about how we're positioned in '26 and beyond. And I think heading into '27, you need to start looking at what exactly are they going to do from a policy perspective. And I think we're all kind of waiting for that.

所以到了 2026 年，這一點會更加突出。因此，我們對2026年及以後的發展前景感到非常樂觀。我認為，展望 2027 年，我們需要開始從政策角度檢視他們究竟會採取哪些行動。我想我們都在等待那一天的到來。

I would just underscore program integrity, I think, is paramount to where CMS is focused.

我想強調的是，我認為專案完整性是CMS關注的首要任務。

Ryan Daniels, William Blair.

瑞安·丹尼爾斯，威廉·布萊爾。

Yes. John, maybe one for you. I noticed during your prepared comments, you mentioned the term replicability several times in discussing your business model. And I think we're seeing that with the good Star ratings outside of California. So number one, how is that also translating into MLR performance and overall margins in those newer markets?

是的。約翰，也許這件適合你。我注意到，在您事先準備好的發言中，您在討論您的商業模式時多次提到了“可複製性”一詞。我認為，加州以外地區良好的星級評分也印證了這一點。首先，這又是如何轉化為這些新興市場的 MLR 業績和整體利潤率的呢？

And then number two, given that you brought that up several times, it wasn't lost on me, is that an indication of more willingness from you and the Board to move into additional markets going forward?

其次，鑑於您多次提到這一點，我並沒有忽略，這是否表明您和董事會更願意在未來進入更多市場？

Yes, hey, Ryan, yes, absolutely. What I've stated in the past is we really wanted to fund that growth from cash flow from operations. And obviously, we're going to kind of fulfill that promise. We're being diligent in looking at both new markets within the existing state footprint that's going to be the most capital efficient, brand efficient as well, as well as looking at some new states for 2027. And so, I think you're going to see us take a much more systematic kind of best practice playbook approach toward replicating into these new markets.

是的，嘿，瑞恩，是的，當然。我之前說過，我們真的希望透過營運現金流來為這種成長提供資金。很顯然，我們會履行這個承諾。我們正在認真研究現有州範圍內的新市場，以期實現最高的資本效率和品牌效率，同時也在考慮 2027 年進入一些新的州。因此，我認為你會看到我們採取更系統化的最佳實踐方案，來將這些經驗複製到這些新市場。

I think we've come a long way in the last few years with our confidence not only in how we deploy the care model, but how we ensure that our shared services can scale in terms of ingesting the members, onboarding the members, and then caring for the members. And I think that's going to be good for seniors everywhere. So we feel really comfortable about that.

我認為在過去的幾年裡，我們取得了長足的進步，不僅增強了我們對護理模式部署的信心，也增強了我們對共享服務規模化的信心，包括接納會員、引導會員入會以及為會員提供護理服務。我認為這對世界各地的老年人來說都是一件好事。所以我們對此感到非常放心。

Ladies and gentlemen, I'm showing no further questions in the queue. And that concludes today's conference call. Thank you for your participation. You may now disconnect.

女士們先生們，隊列中不再顯示任何問題。今天的電話會議到此結束。感謝您的參與。您現在可以斷開連線了。