Astrana Health Inc (ASTH) 2023 Q3 法說會逐字稿

Good day, everyone, and welcome to today's Apollo Medical Holdings Third Quarter 2023 Earnings Call. (Operator Instructions) Today's speakers will be Brandon Sim, Co-Chief Executive Officer of Apollo Medical Holdings; and Chan Basho, Chief Strategy and Financial Officer.

大家好，歡迎參加今天的阿波羅醫療控股公司 2023 年第三季財報電話會議。 （操作員說明）今天的演講者是 Apollo Medical Holdings 聯合執行長 Brandon Sim；首席策略和財務長 Chan Basho。

The press release announcing Apollo Medical Holdings, Inc.'s results for the third quarter ended September 30, 2023, is available at the Investors section of the company's website at www.apollomed.net. To provide some additional background on its results, the company has made a supplemental deck available on its website. A replay of this broadcast will also be made available at ApolloMed's website after the conclusion of this call.

宣布 Apollo Medical Holdings, Inc. 截至 2023 年 9 月 30 日的第三季業績的新聞稿可在該公司網站 www.apollomed.net 的投資者部分取得。為了提供有關其結果的一些額外背景，該公司在其網站上提供了補充資料。本次電話會議結束後，ApolloMed 網站也將提供該廣播的重播。

Before we get started, I would like to remind everyone that this conference call and any accompanying information discussed herein contains certain forward-looking statements within the meaning of the safe harbor provision of the Private Securities Litigation Reform Act of 1995. These forward-looking statements can be identified by terms such as anticipate, believe, expect, future, plan, outlook and will and include, among other things, statements regarding the company's guidance for the year ending December 31, 2023, continued growth, acquisition strategy, ability to deliver sustainable long-term value, ability to respond to the changing environment, operational focus, strategic growth plans and merger integration efforts.

在我們開始之前，我想提醒大家，本次電話會議以及此處討論的任何隨附信息均包含 1995 年《私人證券訴訟改革法案》安全港條款含義內的某些前瞻性陳述。可以透過預期、相信、期望、未來、計劃、展望和意願等術語來識別，其中包括有關公司截至2023 年12 月31 日的年度指導、持續增長、收購策略、交付能力的聲明可持續的長期價值、應對不斷變化的環境的能力、營運重點、策略成長計畫和合併整合工作。

Although the company believes that the expectations reflected in its forward-looking statements are reasonable as of today, those statements are subject to risks and uncertainties that could cause the actual results to differ dramatically from those projected. There can be no assurance that those expectations will prove to be correct. Information about the risks associated with investing in ApolloMed is included in its filings with the Securities and Exchange Commission, which we encourage you to review before making an investment decision.

儘管該公司認為其前瞻性陳述中反映的預期截至目前為止是合理的，但這些陳述存在風險和不確定性，可能導致實際結果與預測結果有巨大差異。無法保證這些期望將被證明是正確的。有關投資 ApolloMed 相關風險的資訊包含在其向美國證券交易委員會提交的文件中，我們鼓勵您在做出投資決定之前先查看這些文件。

The company does not assume any obligation to update any forward-looking statements as a result of new information, future events, changes in market conditions or otherwise, except as required by law. Regarding the disclaimer language, I would also like to refer you to Slide 2 of the conference call presentation for further information.

除法律要求外，本公司不承擔因新資訊、未來事件、市場條件變化或其他原因而更新任何前瞻性聲明的義務。關於免責聲明語言，我還想請您參閱電話會議簡報的幻燈片 2 以獲取更多資訊。

With that, I'll turn the call over to ApolloMed's Co-Chief Executive Officer, Brandon Sim. Please go ahead, Brandon.

接下來，我會將電話轉給 ApolloMed 的聯合執行長 Brandon Sim。請繼續，布蘭登。

Thank you, operator. Good evening, and thank you all for joining us to discuss ApolloMed's third quarter performance.

謝謝你，接線生。晚上好，感謝大家加入我們討論 ApolloMed 第三季的業績。

We are pleased to deliver another strong quarter at ApolloMed, one in which we not only continue to deliver strong operational, clinical and financial results, but also continue to grow the momentum we've had in transforming health care for local communities across the country. The infrastructure that we have built and the alignment we have with our partners continues to accelerate the country towards our vision, one in which everyone has access to high quality, accessible and high-value care.

我們很高興 ApolloMed 再次實現強勁的季度業績，我們不僅繼續提供強勁的營運、臨床和財務業績，而且繼續增強我們在全國各地當地社區醫療保健轉型方面的勢頭。我們建立的基礎設施以及我們與合作夥伴的合作繼續加速該國實現我們的願景，即每個人都能獲得高品質、可及和高價值的照護。

Starting with financial highlights for the quarter. Revenue of $348 million grew 10% compared to the prior year period, as we experienced growth in all 3 of our segments: Care Partners, Care Delivery and Care Enablement.

從本季的財務亮點開始。營收為 3.48 億美元，比去年同期成長 10%，因為我們的所有 3 個細分市場都實現了成長：護理合作夥伴、護理交付和護理支援。

Capitated revenue grew almost 34% to around $306 million in the quarter compared to the prior year period. Adjusted EBITDA of $52 million benefited from the aforementioned strong growth in capitated revenues in the Care Partners business, and our continuing successful efforts in managing total cost of care for these members and value-based risk-bearing arrangements. Adjusted EBITDA margin was around 15%, as we continue to grow while building a sustainable business.

與去年同期相比，本季人均營收成長近 34%，達到約 3.06 億美元。調整後 EBITDA 為 5,200 萬美元，得益於上述護理合作夥伴業務人均收入的強勁增長，以及我們在管理這些會員的總護理成本和基於價值的風險承擔安排方面的持續成功努力。隨著我們在建立永續業務的同時不斷發展，調整後的 EBITDA 利潤率約為 15%。

Before getting into strategic and operational developments from the quarter, I wanted to comment on our announcement today of our intent to acquire assets related to Community Family Care Medical Group, or CFC, including their independent physician association, Restricted Knox-Keene licensed health plan and managed service organization entities.

在討論本季的策略和營運發展之前，我想對我們今天宣布的收購社區家庭護理醫療集團（CFC）相關資產的意向發表評論，包括他們的獨立醫生協會、受限諾克斯基恩許可健康規劃和託管服務組織實體。

Community Family Care is a scaled, full risk-bearing provider group, made up of more than 350 primary care providers and more than 500 specialists, managing care for over 200,000 Medicaid, Medicare and Commercial members in Los Angeles County. They have been a care enablement client since January of 2020. And we'll continue to utilize those solutions with no further onboarding period necessary as a care partner going forward.

Community Family Care 是一個規模化、完全承擔風險的提供者集團，由 350 多名初級保健提供者和 500 多名專家組成，為洛杉磯縣超過 200,000 名醫療補助、醫療保險和商業會員管理護理。自 2020 年 1 月以來，他們一直是護理支援客戶。

In addition to its unique network and robust clinical capabilities, CFC will also bring pending regulatory approval with existing Restricted Knox-Keene or RKK license for Medicaid members, which will accelerate our path to scale and full risk for this important population. Furthermore, we expect to harness synergies in shifting our existing Medicaid population to full-risk arrangements, while also moving CFC's Medicare members into full-risk arrangements utilizing our senior-focused RKK. We anticipate that this will allow us to more effectively manage total cost of care across our Medicaid book of business, while expanding access to high-quality care to even more patients across the Los Angeles metropolitan area.

除了其獨特的網絡和強大的臨床能力外，CFC 還將為醫療補助成員提供現有的限制性諾克斯基恩或RKK 許可證，以等待監管部門的批准，這將加速我們為這一重要人群實現規模化和全面風險的道路。此外，我們希望利用綜效，將我們現有的醫療補助人口轉移到全風險安排，同時利用我們以老年人為重點的 RKK 將 CFC 的醫療保險成員轉移到全風險安排。我們預計，這將使我們能夠更有效地管理整個醫療補助業務的總護理成本，同時為洛杉磯大都會區的更多患者提供高品質的照護。

Importantly, the acquisition of an existing client shows the value and synergy of leveraging both our Care Enablement and Care Partners business segments, transitioning from a vendor client relationship into one in which we are responsible for the total cost of care of their scaled membership base in a derisked and accretive fashion. We are excited to not only recognize several costs and revenue-related synergies in partnering with CFC and its providers, but far more importantly, continuing to deepen our commitment to local communities across Los Angeles and continuing to drive access, quality and value in these communities. Chan will dive more deeply into the financial details of this acquisition later in this call.

重要的是，收購現有客戶顯示了利用我們的護理支援和護理合作夥伴業務部門的價值和協同作用，從供應商客戶關係轉變為我們負責其規模化會員群的總護理成本的關係。無風險且增值的時尚。我們很高興不僅認識到與CFC 及其提供者合作帶來的一些與成本和收入相關的協同效應，而且更重要的是，繼續深化我們對洛杉磯當地社區的承諾，並繼續推動這些社區的准入、品質和價值。陳將在本次電話會議稍後更深入探討此次收購的財務細節。

Turning now to business updates from the third quarter. We continue to build on our momentum this year, with 2 new provider partnerships since our last earnings call. First, we have partnered with Associated Hispanic Physicians, a group of over 150 primary care providers and over 450 specialists in Los Angeles with around 25,000 Medicaid, Medicare and Commercial members in value-based care arrangements in order to support that group with our Care Enablement offering. We expect Associated Hispanic Physicians providers to be onboarded onto our Care Enablement platform by March of 2024.

現在轉向第三季的業務更新。自上次財報電話會議以來，我們今年繼續保持勢頭，與 2 個新的供應商合作夥伴關係。首先，我們與西班牙裔醫師協會合作，該組織由洛杉磯150 多名初級保健提供者和450 多名專家組成，擁有約25,000 名醫療補助、醫療保險和商業成員，進行基於價值的護理安排，以便通過我們的護理支援來支持該組織奉獻。我們預計西班牙裔醫師協會提供者將在 2024 年 3 月之前加入我們的護理支援平台。

Next, we expanded our relationship with Advantage Health Network, a group of approximately 15 primary care providers and several hundred specialists in Los Angeles, which supports around 4,500 Medicaid, Medicare and Commercial members in value-based care arrangements. As part of the partnership, Advantage's providers are slated to join our Care Partners business. We also acquired 5 primary care clinics in the Advantage Health Network, which will be integrated into our Care Delivery business.

接下來，我們擴大了與 Advantage Health Network 的關係，該網絡由洛杉磯約 15 家初級保健提供者和數百名專家組成，為約 4,500 名 Medicaid、Medicare 和 Commercial 會員提供基於價值的護理安排。作為合作夥伴關係的一部分，Advantage 的提供者將加入我們的護理合作夥伴業務。我們也收購了 Advantage Health Network 中的 5 家初級保健診所，這些診所將整合到我們的護理服務業務中。

Of note, Advantage Health Network has been a long-time care enablement client of ours, and will continue to benefit from the Care Enablement offering. As in the case of CFC, Advantage Health Network's providers are already onboarded onto the ApolloMed platform. This is another example of our ability to support our Care Enablement clients seamlessly and more deeply in our Care Partners business, where we manage the member's total cost of care on a capitated basis. We believe this tuck-in acquisition and partnership will be immediately accretive and will further expand our Care Delivery and Care Partners geographic footprint in the Los Angeles area.

值得注意的是，Advantage Health Network 一直是我們的長期照護支援客戶，並將繼續受益於護理支援產品。與 CFC 的情況一樣，Advantage Health Network 的提供者已經加入 ApolloMed 平台。這是我們在護理合作夥伴業務中無縫、更深入地支持護理支援客戶的另一個例子，我們在該業務中按人頭管理會員的總護理成本。我們相信，此次收購和合作夥伴關係將立即產生增值作用，並將進一步擴大我們在洛杉磯地區的護理服務和護理合作夥伴的地理足跡。

In totality, the partnerships with Community Family Care, Associated Hispanic Physicians and Advantage Health Network will strengthen our ability to provide high quality, accessible and coordinated care for local communities throughout Los Angeles.

總的來說，與 Community Family Care、Associated Hispanic Physicians 和 Advantage Health Network 的合作將增強我們為整個洛杉磯當地社區提供高品質、方便和協調的護理的能力。

Finally, we are excited to share that we have entered a strategic partnership with Wider Circle, a peer-based community health organization working with payers and providers to connect neighbors for better health. Under this partnership, our 2 organizations will provide comprehensive patient-centered care and enhanced care management for Medicaid members with complex needs, an integral component of the California Advancing and Innovating Medi-Cal or CalAIM initiative.

最後，我們很高興地告訴大家，我們已經與 Wider Circle 建立了戰略合作夥伴關係，Wider Circle 是一家基於同行的社區健康組織，與付款人和提供者合作，將鄰居聯繫起來，以改善健康狀況。根據這項合作關係，我們的兩個組織將為具有複雜需求的醫療補助成員提供全面的以患者為中心的護理和增強的護理管理，這是加州推進和創新Medi-Cal 或CalAIM 計劃的一個組成部分。

By pairing Wider Circle's community-based engagement model and our core clinical offerings and proprietary care management platform, we will strive to bring community-based, interdisciplinary and person-centered care to all who need it, especially those most underserved. We believe that this joint venture will be an especially valuable offering, given our definitive agreement to acquire Community Family Care, a full risk-bearing Medicaid organization as well as the Managed Medicaid scale that already exists in our existing and new provider group partners. This brings our total number of provider group partnerships signed for the year, so far, to 5, with 2 of those in Texas and 3 of those in California, not including our joint venture with Wider Circle and our planned acquisition of Community Family Care.

透過將Wider Circle 基於社區的參與模式與我們的核心臨床產品和專有護理管理平台相結合，我們將努力為所有需要的人，特別是那些服務最匱乏的人，提供基於社區、跨學科和以人為本的護理。我們相信，鑑於我們最終同意收購Community Family Care、一個完全承擔風險的醫療補助組織以及我們現有和新的提供者集團合作夥伴中已經存在的管理醫療補助規模，該合資企業將是一項特別有價值的產品。這使得我們今年迄今簽署的提供商集團合作夥伴總數達到5 個，其中2 個在德克薩斯州，3 個在加利福尼亞州，不包括我們與Wider Circle 的合資企業以及我們計劃收購的Community Family Care。

And our outlook for additional provider group partnerships for the remainder of this year, in both California and beyond, is very strong. Overall, we continue to be a leader in value-based care with a focus on all populations, including members in Managed Medicaid, Medicare Advantage and Medicare fee-for-service and Commercial lines of business.

我們對今年剩餘時間內在加州及其他地區建立更多提供者集團合作夥伴關係的前景非常樂觀。總體而言，我們繼續成為基於價值的護理領域的領導者，重點關注所有人群，包括管理醫療補助、醫療保險優勢和醫療保險按服務收費以及商業業務線的成員。

We believe that our scaled and highly diversified business with over 10,000 providers on platform, serving approximately 900,000 members in value-based care arrangements, alongside over 20 payer partners, positions us very strongly to accomplish our mission to provide high-quality, accessible and high-value care to all and communities across the country.

我們相信，我們規模化且高度多元化的業務在平台上擁有超過10,000 家提供商，為約900,000 名基於價值的護理安排的會員提供服務，並與20 多家付款合作夥伴一起，使我們有能力完成我們的使命，即提供高品質、可及性和高品質的服務。

And with over 90% of our revenue related to value-based care, our incentives are truly aligned with those of the patients and providers, whether in our core markets in Southern California or in our newer markets in Northern California, Nevada, Texas, and beyond.

我們90% 以上的收入與基於價值的護理相關，無論是在南加州的核心市場，還是在北加州、內華達州、德克薩斯州和美國的新市場，我們的激勵措施都與患者和提供者的激勵措施真正一致。

Our scaled value-based care infrastructure and long-proven ability to effectively manage total cost of care and patient outcomes allows us to have confidence in sustained profitability as we invest to grow our model into local communities across the country. We are excited by the continued momentum we are seeing in the business, and we'll continue to work to improve our members' health, empower physicians and effectively manage total cost of care for those we serve.

我們規模化的基於價值的護理基礎設施以及久經考驗的有效管理總護理成本和患者結果的能力使我們對持續盈利充滿信心，因為我們投資將我們的模式擴展到全國各地的當地社區。我們對業務的持續發展勢頭感到興奮，我們將繼續努力改善會員的健康、賦予醫生權力並有效管理我們服務對象的總護理成本。

To close my prepared remarks, I would like to thank our teammates and partners for believing in our vision to transform health care in local communities across the country. The accelerating growth and outcomes of our business would not be possible without your passion, dedication and support.

在結束我準備好的演講時，我要感謝我們的隊友和合作夥伴相信我們改變全國當地社區醫療保健的願景。沒有您的熱情、奉獻和支持，我們業務的加速成長和成果就不可能實現。

With that, I'll turn it over to Chan to review our financial results.

這樣，我會將其交給陳來審查我們的財務表現。

Thank you, Brandon.

謝謝你，布蘭登。

Before I review the third quarter results, I wanted to discuss our recent acquisition of Community Family Care Medical Group, including their independent physician association, Restricted Knox-Keene licensed health plan and managed service organization entities or in aggregate, CFC as well as our recently announced Term Loan A and the financial flexibility that it provides.

在回顧第三季業績之前，我想討論我們最近收購的社區家庭護理醫療集團，包括他們的獨立醫師協會、受限諾克斯基恩許可健康計劃和管理服務組織實體或總體而言，CFC以及我們最近的收購宣布定期貸款 A 及其提供的財務靈活性。

As Brandon already highlighted the strategic benefits of the CFC transaction, I'm going to provide an overview of the financials. CFC is expected to generate approximately $190 million of revenue this year, and approximately $25 million of adjusted EBITDA. Once the transaction is closed, which we expect to happen in Q1 2024, we will transition their approximately 200,000 members to our Care Partners platform. This will be meaningfully additive to our Care Partners revenue. It will also slightly increase our intersegment eliminations, since this population will continue to utilize our Care Enablement solution. The transaction price of $202 million is a combination of $152 million of cash from our balance sheet, $20 million of equity and up to $30 million of performance-based earn-outs.

由於布蘭登已經強調了 CFC 交易的戰略利益，我將概述財務狀況。 CFC 預計今年將產生約 1.9 億美元的收入，以及約 2,500 萬美元的調整後 EBITDA。一旦交易完成（我們預計將於 2024 年第一季完成），我們將把他們的約 20 萬名會員轉移到我們的 Care Partners 平台。這將顯著增加我們的護理合作夥伴收入。它還將略微增加我們的部門間消除，因為該族群將繼續使用我們的護理支援解決方案。 2.02 億美元的交易價格是我們資產負債表中 1.52 億美元的現金、2000 萬美元的股權以及高達 3000 萬美元的基於業績的盈利的組合。

Today, we also announced an oversubscribed term loan of $300 million, which increases the company's facility to $700 million with our existing $400 million revolver. We intend to use these funds to position us for future M&A transactions, which allow us to continue to expand our geographic footprint and grow our membership base. Through this process, we were able to negotiate expanded baskets within our overall facility, including increasing the maximum levels of certain forms of permitted indebtedness, increasing the maximum levels of restricted payments, including share repurchases, and increasing the maximum levels of certain investments.

今天，我們也宣布了 3 億美元的超額認購定期貸款，這使得公司的融資額度在我們現有的 4 億美元循環貸款基礎上增加到 7 億美元。我們打算利用這些資金為我們未來的併購交易做好準備，這使我們能夠繼續擴大我們的地理足跡並擴大我們的會員基礎。透過這個過程，我們能夠在整個貸款範圍內協商擴大籃子，包括提高某些形式允許的債務的最高水平、提高限制性付款的最高水平（包括股票回購）以及提高某些投資的最高水平。

The term loan is also being used to fund our recent $100 million share buyback from APC-excluded assets. We have confidence in the future growth and profitability of our business, and with this buyback, we're optimistic about our ability to generate sustainable shareholder value in the years to come. This buyback also allows us to work towards a consolidated tax return and solve for our effective tax rate.

定期貸款也用於為我們最近從 APC 排除資產中回購 1 億美元的股票提供資金。我們對業務的未來成長和獲利能力充滿信心，透過此次回購，我們對未來幾年創造永續股東價值的能力持樂觀態度。此次回購也使我們能夠努力實現綜合報稅表並解決我們的有效稅率。

Now turning to our third quarter results. Our third quarter revenue of $348.2 million increased 10% compared to a year ago, and was driven by growth in all 3 of our core segments. Our capitated revenue grew by 34% annually during the same period, from $227.6 million to $305.7 million. We ended the third quarter with 900,000 members, which is the total number of unique members we support in our Care Partners, Care Delivery and Care Enablement segments.

現在轉向我們的第三季業績。我們第三季的營收為 3.482 億美元，比去年同期成長 10%，這是由我們所有 3 個核心部門的成長所推動的。同期，我們的人均收入每年增長 34%，從 2.276 億美元增至 3.057 億美元。截至第三季末，我們擁有 90 萬名會員，這是我們在護理合作夥伴、護理交付和護理支援領域支持的獨特會員總數。

As a reminder, we take some level of medical risk in each of our Care Partner members and received the appropriate level of reimbursement. In Care Enablement, we received a smaller fee to utilize our technology platform to support third-party providers in their value-based care efforts.

謹此提醒，我們為每位護理夥伴成員承擔一定程度的醫療風險，並獲得適當程度的報銷。在護理支援方面，我們收到了較少的費用，以利用我們的技術平台支援第三方提供者基於價值的護理工作。

Because of the different financial profiles of each member, I want to take a moment to share how our membership has changed and will be changing within our segments. Our Care Enablement membership decreased to approximately 900,000 members this quarter as a result of our previously reported Care Enablement client ending their contract. Additionally, when CFC closes, we expect to see the growth of approximately 200,000 members in our Care Partners business, as we begin to take risk for those members' total cost of care.

由於每位會員的財務狀況不同，我想花點時間分享我們的會員資格已經發生以及將在我們的細分市場中發生的變化。由於我們先前報告的 Care Enablement 客戶終止了合同，本季度我們的 Care Enablement 會員數量減少至約 900,000 名。此外，當 CFC 關閉時，我們預計護理合作夥伴業務中的會員數量將增加約 200,000 名，因為我們開始承擔這些會員的總護理成本風險。

Adjusted EBITDA was $52 million compared to $57.1 million, a year ago. Sequentially, adjusted EBITDA benefited from our continued care management efforts. On a year-over-year basis, the decline was a result of our onetime 2021 NGACO payment in Q3 2022. As a reminder, the impact of that program was recognized in one quarter in 2022 and going forward. We have been and will continue to accrue the profitability of the ACO program throughout the year.

調整後 EBITDA 為 5,200 萬美元，而一年前為 5,710 萬美元。隨後，調整後的 EBITDA 受益於我們持續的護理管理努力。與去年同期相比，下降的原因是我們在 2022 年第三季一次性支付了 2021 年 NGACO 款項。我們已經並將繼續全年增加 ACO 計劃的盈利能力。

Our effective tax rate of 26% in the third quarter was lower than our historical levels due to the release of valuation allowances. As previously mentioned last quarter, our effective tax rate has been historically high due to the income tax associated with certain intercompany dividends. The release of valuation allowances offset our high historical tax rates, as we continue to work to implement measures to bring down our effective tax rate, which we anticipate being in the mid-30s by the first quarter of 2024.

由於估價備抵的釋放，我們第三季的有效稅率為 26%，低於歷史水準。如上季先前所提到的，由於與某些公司間股利相關的所得稅，我們的有效稅率一直處於歷史高點。估價津貼的釋放抵消了我們歷史上較高的稅率，因為我們將繼續努力實施降低有效稅率的措施，我們預計到 2024 年第一季度，有效稅率將達到 30 多歲。

Net income attributable to ApolloMed in the third quarter was $22.1 million compared to $23.2 million in the prior year period. Earnings per diluted share was $0.47 compared to $0.50, a year ago.

第三季 ApolloMed 淨利為 2,210 萬美元，去年同期為 2,320 萬美元。稀釋後每股收益為 0.47 美元，而一年前為 0.50 美元。

Now turning to our balance sheet. We ended the quarter with $273.9 million in cash and total debt of $209.2 million. As it relates to our long-term view on our leverage ratio, we aim to have a net leverage in the range of 2.25x to 2.75x but may experience short-term variation.

現在轉向我們的資產負債表。本季結束時，我們的現金為 2.739 億美元，債務總額為 2.092 億美元。由於這關係到我們對槓桿率的長期看法，我們的目標是將淨槓桿率控制在 2.25 倍至 2.75 倍之間，但可能會出現短期變化。

The last topic I want to cover on today's call is our guidance. Given where we are in the year, we are narrowing our range for the full year and now expect the following: In regards to revenue, we expect to be between $1.34 billion and $1.39 billion, compared to our previous range of $1.3 billion to $1.5 billion. We anticipate coming in slightly below the midpoint of our previously disclosed guidance range, primarily due to small headwinds around Medicaid redetermination and the rolling off of our previously mentioned client. We still remain very confident in our ability to continue to grow in the 20% to 30% range.

我想在今天的電話會議上討論的最後一個主題是我們的指導。鑑於我們今年的情況，我們正在縮小全年的範圍，現在預計如下： 就收入而言，我們預計收入範圍為 13.4 億美元至 13.9 億美元，而之前的範圍為 13 億美元至 15 億美元。我們預計該價格將略低於我們先前披露的指導範圍的中點，這主要是由於醫療補助重新確定方面的小阻力以及我們之前提到的客戶的退出。我們對繼續在 20% 至 30% 範圍內成長的能力仍然非常有信心。

We expect adjusted EBITDA to be between $135 million and $150 million, compared to our previous range of $120 million to $160 million. We continue to see utilization trends being stable across our at-risk book of business because of the unique capabilities of our clinical model and some initial conservatism. We expect to come in on the upper half of our previously disclosed guidance range, as well as within our target at scale EBITDA margins even as we expand into new regions and grow value-based care membership. In regards to earnings per diluted share, we expect to be between $1.10 and $1.20, compared to our previous range of $0.95 to $1.20.

我們預計調整後 EBITDA 將在 1.35 億美元至 1.5 億美元之間，而先前的範圍為 1.2 億美元至 1.6 億美元。由於我們的臨床模型的獨特功能和一些最初的保守主義，我們繼續看到我們的風險業務中的利用率趨勢保持穩定。即使我們擴展到新的地區並增加基於價值的護理會員數量，我們預計仍將達到先前披露的指導範圍的上半部分，並達到我們的規模 EBITDA 利潤率目標。至於稀釋後每股收益，我們預計為 1.10 美元至 1.20 美元，而之前的區間為 0.95 美元至 1.20 美元。

In conclusion, we're pleased with our financial performance growth partnerships and capital deployment during the third quarter, further demonstrating our platform's ability to continue to execute on 3 key operational goals: growing our membership in core and new geographies, empowering our Care Delivery and Care Partners providers to successfully move down the glide path towards value-based care, and enabling our providers to deliver excellent patient outcomes in order to effectively manage risk.

總而言之，我們對第三季度的財務業績成長合作夥伴關係和資本部署感到滿意，進一步證明了我們的平台有能力繼續執行3 個關鍵營運目標：增加我們在核心和新地區的會員數量、增強我們的護理服務和護理合作夥伴提供者能夠成功地沿著基於價值的護理的道路前進，並使我們的提供者能夠提供出色的患者治療結果，從而有效地管理風險。

The CFC transaction further diversifies our membership mix and provides us a pathway to expand our value-based care exposure. The ApolloMed platform provides a highly differentiated, pure-play, value-based care company that is profitable, growing rapidly and yields profitable and sustainable growth. We made meaningful progress in all 3 areas, and we'll continue to use this road map as we close out the year, having established a solid foundation for continued growth in 2024.

CFC 交易進一步豐富了我們的會員結構，並為我們提供了擴大基於價值的護理業務的途徑。 ApolloMed 平台提供了一家高度差異化、純業務、基於價值的護理公司，該公司盈利、增長迅速，並產生盈利和可持續增長。我們在所有 3 個領域都取得了有意義的進展，在年底時我們將繼續使用此路線圖，為 2024 年的持續成長奠定了堅實的基礎。

Brandon and I want to thank you all for your time today. We're always open to a dialogue with investors and welcome visitors to our offices in Alhambra, should any of you be in the L.A. area.

布蘭登和我要感謝大家今天抽出寶貴的時間。我們始終願意與投資者對話，並歡迎訪客來到我們位於阿罕布拉的辦公室（如果您在洛杉磯地區）。

With that, operator, let's open it up for Q&A.

那麼，操作員，讓我們開始問答。

(Operator Instructions) We'll take our first question from Ryan Daniels from William Blair.

（操作員說明）我們將接受 William Blair 的 Ryan Daniels 提出的第一個問題。

Congrats on all the momentum. Brandon, maybe one for you. Strategically, it just seems like a bevy of partnerships and the acquisition are all coming together here towards year-end. And I'm curious to hear your view on what's driving that. Obviously, some of these are prior partnerships moving to more integrated relationship. But what's really driving such strong momentum over the last few months in driving your partnership growth?

祝賀所有的動力。布蘭登，也許適合你。從策略上講，一系列合作夥伴關係和收購似乎都將在年底聚集在一起。我很想聽聽您對推動這一趨勢的看法。顯然，其中一些是先前的夥伴關係，正在轉向更加一體化的關係。但過去幾個月裡，是什麼真正推動了你們合作關係發展的強勁勢頭呢？

Ryan, thank you so much for joining the call today, and thanks for the kind words. I think we've -- we're really seeing a lot of momentum across all aspects of the business, organically in terms of kind of same provider member panel growth, organically in terms of number of partnerships we're signing with provider groups and other entities such as the Wider Circle partnership and of course, the larger acquisition that was announced today.

瑞安，非常感謝您今天參加電話會議，也感謝您的客氣話。我認為我們確實在業務的各個方面看到了很大的動力，在同一提供者成員小組的增長方面，在我們與提供者團體簽署的合作夥伴關係數量方面，在有機方面，其他實體，例如Wider Circle 合作夥伴關係，當然還有今天宣布的規模更大的收購。

I think the way I would characterize it is that these are partnerships we've been working on throughout the year. I think it happened to land in this quarter, and we decided to announce them all at the same time here. As I mentioned earlier in my prepared remarks, I think we have a very strong pipeline for even further partnerships, potentially, even for the class of 2024. And so I don't think there's anything necessarily special about this quarter. These are longer-term things that we've been working on, and we're glad to be able to announce them today.

我認為我的描述方式是，這些是我們全年一直在努力的合作關係。我認為它恰好在本季度落地，我們決定在這裡同時宣布它們。正如我之前在準備好的發言中提到的那樣，我認為我們有非常強大的管道可以進一步建立合作夥伴關係，甚至有可能為2024 屆畢業生提供支援。特別之處。這些是我們一直在努力的長期事情，我們很高興今天能夠宣布它們。

Okay. That's great. And then with the pending transaction, you mentioned you'll have RKK for Medicaid. I know you already had one with the FYB deal before. Are those different licenses, meaning do you need separate ones to run Medicaid and Commercial and Medicare in the state so that this actually does expand your risk-bearing capabilities?

好的。那太棒了。然後，在待處理的交易中，您提到您將擁有用於醫療補助的 RKK。我知道您之前已經與 FYB 達成協議。這些許可證是不同的嗎？

Yes. So in terms of the Restricted Knox-Keene licenses, which all my comments here are going to be pending regulatory approval of the transaction, of course. There are actually separate licenses necessary or at least separate approvals necessary for each line of business and each health plan in each county. And so while the plan was always to expand our existing license into new counties and into new payer relationships, this will drastically accelerate the process, we believe, again, pending regulatory approval to take on full risk for Medicaid populations across California.

是的。因此，就諾克斯基恩限制許可證而言，我在這裡的所有評論當然都將等待監管部門對交易的批准。實際上，每個縣的每個業務線和每個健康計劃都需要單獨的許可證或至少需要單獨的批准。因此，雖然計劃始終是將我們現有的許可證擴展到新的縣和新的付款人關係，但這將大大加快這一進程，我們再次相信，等待監管部門批准，為加州各地的醫療補助人群承擔全部風險。

That's helpful. And then maybe one financial, and I'll hop off and save the rest for later. But just in regards to the expanded credit line, I know it's up to $700 million. You have just over $200 million in long-term debt. Is that all part of that revolver, meaning effectively, you have $500 million available? Or is there a different structure to that $200 million plus debt that's already outstanding?

這很有幫助。然後也許是財務報告，我會下車，把剩下的留到以後再處理。但就擴大的信貸額度而言，我知道最高可達 7 億美元。您的長期債務剛超過 2 億美元。這就是左輪手槍的全部部分嗎？或者對於這 2 億美元加上已經未償還的債務是否有不同的結構？

Ryan, yes, you're correct. The $180 million is -- today, is part of the $400 million facility, which has now been expanded to $700 million.

瑞安，是的，你是對的。如今，這 1.8 億美元是 4 億美元貸款的一部分，該貸款現已擴大至 7 億美元。

And we'll take our next question from Brooks O'Neil from Lake Street Capital.

我們將回答來自 Lake Street Capital 的 Brooks O'Neil 的下一個問題。

I guess I'll follow on with Ryan. As you guys, I think, know, I'm particularly excited about the opportunity you have to take on the global risk through the RKK. And I'm just curious, obviously, Brandon just said the opportunity exists now to go after Medicaid full risk. But can you give us any update on what's going on with regard to the Medicare license that I think you acquired up in San Francisco, and whether you've had any success beginning to think about moving those capabilities across the state?

我想我會繼續關注瑞安。我想，正如你們所知，我對你們有機會透過 RKK 承擔全球風險感到特別興奮。我只是很好奇，顯然，布蘭登剛剛說現在有機會追求醫療補助的全部風險。但是，您能否向我們介紹一下您在舊金山獲得的醫療保險許可證的最新情況，以及您在開始考慮在全州範圍內轉移這些能力方面是否取得了成功？

Brooks, thank you for joining the call. It's great to hear your voice again. And thank you, Ryan, for the questions earlier. So Brooks, I ran your question on the existing Restricted Knox-Keene license, FYB. We've continued to expand the geographies, the counties in California where it's able to take on full risk for Medicare populations. And there've been several new contracts with payers that we signed since the last time we've conversed here on a quarterly call, and we continue to see good momentum in terms of getting our Medicare Advantage book of business into full-risk arrangements by next year.

布魯克斯，感謝您加入通話。很高興再次聽到你的聲音。瑞安，謝謝你之前提出的問題。布魯克斯，我針對現有的受限諾克斯基恩許可證 (FYB) 提出了您的問題。我們繼續擴大地域範圍，擴大加州能夠為醫療保險人群承擔全部風險的縣。自上次我們在這裡進行季度電話會議以來，我們已經與付款人簽署了幾份新合同，並且我們繼續看到在將我們的 Medicare Advantage 業務簿納入全風險安排方面的良好勢頭明年。

Yes, that's great. And then I think it was Chan who said that utilization has been stable. One of the big themes we've been hearing from people around the United States has been sort of strong procedure activity and growth. No one's quite sure exactly what it's all about, a rebound from the pandemic lockdowns and whatnot or some other phenomenon. But would you say that your stable utilization is a manifestation of the success of your business model and your approach to value-based care? Or can you just talk about what you're seeing out there in your markets and how you responded to it?

是的，那太好了。然後我想是陳說利用率一直很穩定。我們從美國各地的人們那裡聽到的重要主題之一是強勁的程序活動和成長。沒有人確切知道這到底是怎麼回事，是從大流行封鎖中反彈還是其他一些現象。但您是否認為您的穩定使用率是您的商業模式和基於價值的護理方法的成功體現？或者您能談談您在市場中看到的情況以及您對此的反應嗎？

Sure thing. We've seen fairly stable utilization and MCR trends across the business in totality. Of course, there are slight movements up and down based on line of business because we are a diversified business across government and commercial programs. But overall, on both inpatient and outpatient side of utilization, we believe that our unique care model is -- has always been focused on providing access, and we aren't seeing a large "rebound," so to speak, in terms of utilization in this quarter. And that kind of showed in terms of our ability to continue delivering the financial results that we expected.

當然可以。我們看到整個業務的利用率和 MCR 趨勢相當穩定。當然，由於我們是跨政府和商業項目的多元化業務，因此根據業務線會有輕微的上下波動。但總體而言，在住院和門診方面的利用方面，我們相信我們獨特的護理模式始終專注於提供訪問權限，可以說，在利用方面我們沒有看到大幅的“反彈”在本季度。這表明我們有能力繼續實現我們預期的財務表現。

Yes, that's great. And congratulations on continued success.

是的，那太好了。並祝賀您繼續取得成功。

Thank you, Brooks.

謝謝你，布魯克斯。

And next, we'll go to Adam Ron from Bank of America.

接下來，我們請來美國銀行的 Adam Ron。

I think going on what Brooks was saying, I know you don't guide quarterly, but it seems like versus the consensus estimates, EBITDA outperformed significantly. And even if you just look seasonally the cost of care line was down sequentially more than it usually is, usually sometimes, even up. And so I'm taking that to mean that there was actually MLR outperformance or at least, like you're accruing something more positively, it seems, relative to like 2022 or 2023 expectations. Is that right? Or is there not anything really to call out on MLR outperformance?

我認為按照布魯克斯的說法，我知道你不會按季度提供指導，但與共識估計相比，EBITDA 的表現似乎顯著優於預期。即使你只看季節性，護理費用也比平常下降得更多，通常有時甚至會上升。因此，我認為這意味著 MLR 實際上表現出色，或者至少，相對於 2022 年或 2023 年的預期，你似乎獲得了更積極的回報。是對的嗎？或者說 MLR 的表現真的沒有什麼值得稱讚的嗎？

Adam, the main item I'd highlight is, in Q1 and Q2, with the limited data that we have around ACO, we -- it's really breakeven. And so in Q3, we had a slight ACO true-up. And that's number one. Number two, our managed care business, MCR was stable, and those 2 things together have led to this quarter.

Adam，我要強調的主要內容是，在第一季和第二季度，由於我們關於 ACO 的數據有限，我們確實實現了收支平衡。因此，在第三季度，我們對 ACO 進行了輕微調整。這是第一名。第二，我們的管理式醫療業務 MCR 很穩定，這兩件事共同導致了本季的業績。

Okay. Yes, because it was just a significant outperformance versus consensus and then the guidance increase was pretty minimal. And so I guess is there anything in Q4 that you're kind of worried about or assuming some big step up in utilization? Or is it really just the Street was mismodeling?

好的。是的，因為與共識相比，這只是一個顯著的表現，然後指導的增加非常小。所以我想第四季有什麼事情是您擔心的或假設利用率會大幅提高嗎？或者這真的只是華爾街的建模錯誤？

Yes, Q4 will be relatively -- oh, I'm sorry, Chan.

是的，第四季度將是相對 - 哦，對不起，陳。

Go ahead, please.

請繼續。

No, no, it's okay.

不，不，沒關係。

As you'll see historically, Q4s for us are usually relatively quiet. It is -- we don't necessarily have the same level of quality bonuses or any type of shared risk true-ups. And so as you can see from our guidance, we do expect Q4 to be in line with what you've seen in historical years.

正如您從歷史上看到的那樣，我們的第四季通常相對安靜。是的——我們不一定有相同等級的品質獎金或任何類型的分擔風險調整。正如您從我們的指導中看到的那樣，我們確實預計第四季度將與您在歷史年份中看到的情況一致。

No problem. And on the revenue guidance cut due to Medicaid redeterminations, is there any margin implications of losing enough membership that it would actually impact your revenue guidance? And would you continue that pressure to extend into 2024, both on the revenue side? And are you building anything on margins?

沒問題。關於因醫療補助重新確定而導致的收入指導削減，失去足夠的會員資格是否會對利潤產生任何影響，從而實際上影響您的收入指導？您是否會在收入方面繼續施加壓力，將其延續到 2024 年？您是否正在利用利潤建造任何東西？

So for every 3 Medicaid members that through redetermination are leaving the organization, 1 is reenrolling is what we're seeing in an exchange product. And so in terms of margin, the net margin impact is quite minimal. I'd say it's on an annualized basis, probably $1 million to $1.5 million. In terms of revenue, as you saw from our decrease in guidance, it -- that is probably more of an impact where on an annualized basis, it's in the $5 million to $10 million range for 2024.

因此，我們在交換產品中看到，每 3 名通過重新確定而離開該組織的醫療補助成員，就有 1 名重新加入。因此，就利潤率而言，淨利潤率的影響非常小。我想說的是按年計算，可能是 100 萬到 150 萬美元。就收入而言，正如您從我們指導價值的下降中看到的那樣，這可能會產生更大的影響，按年化計算，2024 年收入將在 500 萬美元至 1000 萬美元之間。

That's helpful. And then the APC share buyback, was that purely motivated by the tax implications that you mentioned? Or did they want to sell? Or did you go to them? I'm just like curious what drove that and if the plan is to buyback all the shares and if that's necessary to reach your tax rate targets.

這很有幫助。然後，APC 股票回購純粹是出於您提到的稅務影響嗎？還是他們想賣掉？或是你去找他們了嗎？我只是好奇是什麼推動了這一點，以及計劃是否回購所有股票，以及是否有必要實現您的稅率目標。

Adam, I'll take this question around the APC share buyback, which was around just approximately $100 million of value. There are a couple of reasons. The first is that, as you know, from the last quarter, we were experiencing elevated levels of taxation due to essentially filing separately and not being a consolidated tax entity. Part of the reason is to -- as Chan mentioned earlier, to solve for that.

Adam，我將圍繞 APC 股票回購提出這個問題，該股票回購的價值約為 1 億美元。有幾個原因。首先，如您所知，從上個季度開始，我們的稅收水準不斷提高，因為我們基本上是單獨報稅，而不是一個綜合稅務實體。正如陳之前提到的，部分原因是要解決這個問題。

But I think regardless of that, we are very optimistic, and I think that there is a great amount of potential ahead in terms of the pipeline opportunities we've been signing, the way we've been deploying our capital and the continued strength that we're seeing in our clinical models. And we felt that this was a good time to exercise that $100 million buyback.

但我認為無論如何，我們都非常樂觀，而且我認為，就我們已經簽署的管道機會、我們部署資本的方式以及我們的持續實力而言，未來有很大的潛力。這一點。我們認為現在是實施 1 億美元回購的好時機。

I appreciate the questions. My last one would be, when you guided for the peer, you gave basically flat EBITDA guidance at the midpoint, with the rationale being that there was like Medicaid redetermination headwinds and reinvestments into growth. And so for next year, are there any major moving pieces that we should consider? I guess Medicaid redeterminations will continue. The RKK license should be somewhat lifting revenue. It sounds like on the MA side, at least, there are some deals closing. And so other than those, are there any moving pieces we should be considering?

我很欣賞這些問題。我的最後一個想法是，當您為同行提供指導時，您在中點給出了基本持平的 EBITDA 指導，其理由是存在醫療補助重新確定的阻力和對增長的再投資。那麼明年，我們應該考慮哪些重大的變化呢？我想醫療補助的重新決定將會繼續。 RKK 許可證應該會在一定程度上增加收入。聽起來至少在 MA 方面，有一些交易已經完成。那麼除了這些之外，我們還有什麼值得考慮的嗎？

Yes, of course. So I think business continues to be quite strong. We don't anticipate huge variations in medical cost ratio next year either. Of course, we haven't put out official 2024 guidance, so we will certainly update the market when that happens. But given the amount of new partnerships that we've already signed, 5 for the year, a few in the pipeline and the acquisition of CFC and continued seeing provider growth, we're quite optimistic that EBITDA will continue to grow at a healthy clip and perhaps even more at a higher rate than it did this year relative to last.

是的當然。所以我認為業務仍然相當強勁。我們預計明年的醫療費用比率不會有巨大變化。當然，我們還沒有發布官方的 2024 年指導，因此我們肯定會在發佈時更新市場。但考慮到我們已經簽署的新合作夥伴數量（今年有5 個）、一些正在醞釀中的合作夥伴關係以及對CFC 的收購以及供應商的持續增長，我們對EBITDA 將繼續以健康的速度增長感到非常樂觀與去年相比，今年的成長率可能更高。

As you remember -- you may remember, Adam, this year, there was a bit of a harsh comp in terms of the onetime next-gen ACO payment in Q3 of last year. And the rest of the business has grown tremendously, which will continue to happen, and that comp is not expected to be there for the next year.

正如您所記得的那樣，Adam，您可能還記得，今年，就去年第三季的一次性下一代 ACO 付款而言，有一些嚴厲的補償。其餘業務也取得了巨大成長，這種情況將繼續發生，預計明年不會發生這種情況。

And we'll take our next question from David Larsen from BTIG.

我們將回答來自 BTIG 的 David Larsen 的下一個問題。

Relative to our model, the gross profit really beat our estimate. Can you maybe just talk a little bit more about your -- the utilization you're seeing, the cost of services? It sounds like there was an ACO true-up. What does that mean? Does that mean that the actual claims cost came in lower than expected? Or did you get some sort of an incentive payment from CMS in the quarter? Just any more color there would be very helpful. And more importantly, do you expect that trend to continue into next year?

相對於我們的模型，毛利確實超出了我們的預期。您能否多談談您所看到的利用率、服務成本？聽起來好像有 ACO 調整。這意味著什麼？這是否意味著實際索賠費用低於預期？或者您在本季度從 CMS 獲得了某種獎勵金嗎？只要有更多的顏色就會非常有幫助。更重要的是，您預計這種趨勢會持續到明年嗎？

David, great to hear from you. Yes, thanks so much for the question. So in terms of our MCR, I'll start with ACO. What we're seeing on ACO is that we have more data really to evaluate the performance of the program in 2023. And we were able to true up where we were coming in, in costs for the first 3 months of the year relative to where we were in Q1 and Q2, which was really breakeven.

大衛，很高興收到你的來信。是的，非常感謝您的提問。因此，就我們的 MCR 而言，我將從 ACO 開始。我們在 ACO 上看到的是，我們擁有更多數據來真正評估該計劃在 2023 年的績效。第二季度，這確實是盈虧平衡的。

In terms of our overall managed care business, as we've mentioned before, we -- due to our unique clinical model as well that really provides access and quality, and we're continuing to see stable institutional metrics, both of those put together have really led to that strong performance. Lastly, also would want to mention, we saw strong sweeps payments in Q3 associated with our Medicare Advantage members.

就我們的整體管理醫療業務而言，正如我們之前提到的，我們——由於我們獨特的臨床模式以及真正提供了訪問和質量，並且我們繼續看到穩定的機構指標，這兩個指標放在一起確實帶來如此強勁的表現。最後，還想提一下，我們在第三季看到與我們的 Medicare Advantage 會員相關的大量掃款。

Okay. Great. That's very helpful. And then as some of these acquisitions and partnerships roll into the Care Partners division of the business, I'm assuming that since they were already Care Enablement clients, you have very good visibility into the membership, their utilization trends, the premium dollars, the margins on each member. So it's not like there's going to be an increase in costs as you try to stabilize these newer members like we see in some other business models, they're already sort of well-known and well managed to you. Is that correct?

好的。偉大的。這非常有幫助。然後，隨著其中一些收購和合作夥伴關係進入護理合作夥伴業務部門，我假設由於他們已經是護理支援客戶，因此您可以很好地了解會員資格、他們的使用趨勢、保費、每個成員的利潤。因此，當你試圖穩定這些新成員時，成本不會增加，就像我們在其他一些商業模式中看到的那樣，他們已經是眾所周知的並且管理得很好。那是對的嗎？

David, Brandon here. Thanks for the question. You're absolutely correct. For the clinics, for example, that we acquired, the 5 clinics that are moving into our Care Delivery segment, there will be some minor implementation integration costs, but very, very minor, but we expect those to be accretive day 1 because of the length of the relationship that we've developed over time in the Care Enablement segment.

大衛，布蘭登在這裡。謝謝你的提問。你是完全正確的。例如，對於我們收購的診所，即進入我們的護理服務部門的 5 家診所，將會有一些較小的實施整合成本，但非常非常小，但我們預計這些成本將在第一天增加，因為我們在護理支援領域隨著時間的推移建立的關係的長度。

For the larger groups, CFC, for example, and Advantage Health Network, who are already Care Enablement clients, we absolutely expect to also see that synergy. Those providers are all already onboarded onto the technology platform. They -- there will not be additional incremental cost or time associated with getting them onto the platform, and we have a very good line of sight into all those metrics that you mentioned, and how we can best take care or assist them, empower them to take care of their patient panels. And so we view that as a very -- we view that as part of the synergy of having all 3 business segments, and it gives us kind of a much more shallow J-curve, so to speak.

對於較大的團體，例如 CFC 和 Advantage Health Network，他們已經是護理支援客戶，我們絕對希望看到這種協同作用。這些提供者都已加入該技術平台。他們 - 不會有額外的增量成本或時間與讓他們進入平台相關，我們對您提到的所有這些指標都有很好的了解，以及我們如何最好地照顧或幫助他們，賦予他們權力照顧他們的病人小組。因此，我們認為這是所有 3 個業務部門協同作用的一部分，可以說，它給了我們一個更淺的 J 曲線。

Okay. Great. That's very helpful. And then do you have any initial thoughts on 2024? We'll call it like Medicare premiums or reimbursement that you expect to see from your docs, from CMS. There's been a lot of noise around RADV audits, lower premium increases in '24 relative to the increase that was seen in 2023. And there's a lot of adjustments that are going on in terms of like risk stratification. Just any thoughts or color there? Do you expect an increase in dollars coming from CMS on a per member basis in '24 relative to '23?

好的。偉大的。這非常有幫助。那麼您對2024年有什麼初步的想法嗎？我們將其稱為 Medicare 保費或您希望從 CMS 的文檔中看到的報銷。圍繞 RADV 審計存在許多噪音，相對於 2023 年的增幅，24 年的保費增幅較低。只是有什麼想法或顏色嗎？您預計 24 年每位會員從 CMS 獲得的美元與 23 年相比是否會增加？

Of course -- there has been a lot of noise, of course, lately around reimbursement rates, RADV 28 and other reimbursement items, stars as well. I think overall, we are navigating through this in a couple of ways. One, we continue to use our scaled platform to ensure that we have solid contracts with our payer partners, where I'm helping to manage their quality, stars and risk adjustment better than others, relatively speaking. And we think there's a lot of value we're providing to payers such that we are more than "paying off" kind of the types of contracts that we have with payers.

當然——當然，最近圍繞著報銷率、RADV 28 和其他報銷項目（明星）產生了很多噪音。我認為總的來說，我們正在透過幾種方式來解決這個問題。第一，我們繼續使用我們的規模化平台來確保我們與付款合作夥伴簽訂了穩固的合同，相對而言，我正在幫助他們比其他人更好地管理他們的品質、星級和風險調整。我們認為，我們為付款人提供了大量價值，因此我們不僅僅是「償還」我們與付款人簽訂的合約類型。

In addition, in terms of RADV, as we've spoken about before, we don't think we'll be impacted significantly, if at all. We've -- our average risk score is still fairly low across our Medicare Advantage population, around 1.0, which is the national average. And we don't think we've been particularly aggressive, especially when doing analysis on the actual HCCs that we've been going for in the past. So we don't expect a headwind from RADV either. I think overall, we are not foreseeing headwinds in terms of Medicare premiums, PMPM for our patients going into 2024.

此外，就 RADV 而言，正如我們之前談到的，我們認為我們不會受到重大影響（如果有的話）。我們的 Medicare Advantage 人群的平均風險評分仍然相當低，約為 1.0，這是全國平均水平。我們認為我們並沒有特別激進，尤其是在對我們過去一直在研究的實際 HCC 進行分析時。因此，我們預計 RADV 也不會帶來阻力。我認為總體而言，我們預計 2024 年患者的醫療保險保費和 PMPM 不會遇到阻力。

Okay. That's very helpful. And then just one last quick one. If we assume Medicaid is around 24% of revenue, and let's say 15% of Medicaid lives are redetermined, in total, that seems like it's maybe around 4% of revenue for Apollo Medical spread over, say, 2 years, which would be maybe 1% or 2% of impact in revenue annually for Medicaid redetermination to you guys. Does that sound reasonable or not? I mean it doesn't really sound that material to me.

好的。這非常有幫助。然後是最後一個快速的。如果我們假設醫療補助佔收入的 24% 左右，並且假設醫療補助的生活總共有 15% 被重新確定，那麼阿波羅醫療的收入的 4% 左右會分散到例如 2 年裡，這可能是每年為你們重新確定醫療補助計劃帶來1% 或2% 的收入影響。這聽起來合理嗎？我的意思是，這對我來說聽起來並不那麼重要。

Yes. I think your structure, David, is spot on. I don't think we're seeing the level of redetermination in terms of the 15% range. Yes, I would probably assume maybe half of that.

是的。大衛，我認為你的結構是正確的。我認為我們沒有看到 15% 範圍內的重新決定水準。是的，我可能會假設其中一半。

Okay. So the drag for Medicaid redetermination will be even far lower than what I had initially said?

好的。那麼醫療補助重新確定的阻力將遠低於我最初所說的？

Yes.

是的。

Okay. All right. Super. Congrats on a good quarter.

好的。好的。極好的。恭喜季度表現良好。

(Operator Instructions) And we'll take our next question from Gary Taylor from TD Cowen.

（操作員說明）我們將接受 TD Cowen 的 Gary Taylor 提出的下一個問題。

I had 2 quick questions. One, the midpoint of the EBITDA guidance is up about $2.5 million. Is it fair to think that's roughly the magnitude of the ACO true-up in the quarter? Or would you steer us materially differently from that?

我有兩個簡單的問題。第一，EBITDA 指引的中點上漲了約 250 萬美元。認為這就是本季 ACO 調整的大致幅度是否公平？或者你會以實質上不同的方式引導我們嗎？

I think it's more than just an ACO true-up. We are experiencing very strong overall sweeps payments, so I'd say that's number one. Number two, it is the MA RKKs and membership moving to those MA RKKs. And number 3 is the ACO that you mentioned.

我認為這不僅僅是 ACO 的調整。我們正在經歷非常強勁的整體掃款支付，所以我想說這是第一。第二，是 MA RKK 和會員資格轉移到這些 MA RKK。第三個是你提到的 ACO。

And of course, we're seeing -- and we've mentioned this before, we are continuing to invest in new market development. I'd say our new market development overall, I think we'd said about $5 million to $10 million per market, those investments are coming in at the lower end of the range.

當然，我們看到——我們之前已經提到過，我們正在繼續投資新市場的開發。我想說的是，我們的新市場開發總體而言，我認為我們說過每個市場約 500 萬至 1000 萬美元，這些投資處於該範圍的低端。

Got it. And then my other question would be just a follow-up on redeterminations. The Medicaid MCOs are seeing either -- you can either call it adverse selection or higher acuity, and they claim that the states are giving them positive acuity adjustments in their rates to account for the remaining population.

知道了。然後我的另一個問題只是重新決定的後續問題。醫療補助 MCO 看到了其中之一 - 你可以稱之為逆向選擇或更高的敏銳度，他們聲稱各州正在對他們的費率進行積極的敏銳度調整，以考慮到剩餘的人口。

I was just wondering, do your contracts for the professional fee risk that you're taking from the Medicaid MCOs, do they just automatically flow through any sort of rate increase like that, that the state is giving to the managed care plan upstream?

我只是想知道，您從醫療補助 MCO 處獲得的專業費用合約是否存在風險，它們是否會自動流向州政府向上游管理醫療計劃提供的任何形式的費率上漲？

Yes, we're definitely -- oh, sorry. Go ahead, Brandon.

是的，我們絕對是——哦，抱歉。繼續吧，布蘭登。

Oh, I'll start quickly. I was going to say our contracts are rate adjusted. And depending on the contract, increases in premiums could also pass through to us as a percentage of the premium that we're taking for either professional or full risk.

哦，那我就快點開始吧。我想說的是我們的合約是費率調整的。根據合約的不同，保費的增加也可能以我們為專業風險或完全風險承擔的保費的一定百分比的形式轉嫁到我們身上。

In terms of our planned and announced acquisition of Community Family Care Medical Group and their RKK license in order to take on full risk in terms of Medicaid in California, we believe that allows us to move our membership, as I mentioned earlier, across the entire Medicaid business into both -- kind of taking on both professional and institutional risk in a full-risk setting, which will also help us blunt some of the impact of professional rates being kind of fixed even as acuity potentially slightly upwards after redetermination.

就我們計劃和宣布的收購Community Family Care Medical Group 及其RKK 許可證而言，以便承擔加州醫療補助方面的全部風險，我們相信，正如我之前提到的，這使我們能夠將我們的會員資格轉移到整個社區醫療補助業務同時涉及這兩個方面——在完全風險的環境下承擔專業和機構風險，這也將幫助我們削弱專業費率固定的一些影響，即使在重新確定後敏銳度可能略有上升。

(Operator Instructions) There are no further questions at this time. I'll turn the call back to Brandon Sim, for closing remarks.

（操作員說明） 目前沒有其他問題。我會將電話轉回布蘭登·西姆 (Brandon Sim)，讓其結束語。

Thank you, everyone, for joining our earnings call for quarter 3 this afternoon or this evening. We're very excited about the potential to work together with many new partners that we announced this quarter. We think these results are reflective of our ability to build relationships locally, but very shortly as well nationally. And we're very excited about the momentum that the business has going forward.

感謝大家今天下午或今晚參加我們第三季的財報電話會議。我們對本季宣布的與許多新合作夥伴合作的潛力感到非常興奮。我們認為這些結果反映了我們在當地建立關係的能力，但很快也在全國範圍內建立關係。我們對該業務的發展勢頭感到非常興奮。

Thank you again for joining the call. We'll speak to you all soon. Have a good evening.

再次感謝您加入通話。我們很快就會與大家交談。祝你晚上愉快。

Thank you.

謝謝。

Ladies and gentlemen, this does conclude today's teleconference. We thank you for your participation. You may disconnect your lines at this time, and have a great day.

女士們、先生們，今天的電話會議到此結束。我們感謝您的參與。此時您可以斷開線路，祝您有個愉快的一天。