Astrana Health Inc (ASTH) 2023 Q4 法說會逐字稿

Good day, everyone, and welcome to today's Astrana's Health fourth quarter and full-year 2023 earnings call. (Operator Instructions)

大家好，歡迎參加今天的阿斯特拉納健康第四季和 2023 年全年財報電話會議。（操作員說明）

Today's speakers will be Brandon Sim, President, Chief Executive Officer of Astrana Health; and Chan Basho, Chief Operating and Financial Officer. The press release announcing Astrana Health results for the full year and fourth quarter ended December 31, 2023 is available at the Investors section of the company's website at www.astranahealth.com.

今天的演講者是 Astrana Health 總裁兼執行長 Brandon Sim；以及首席營運官和財務官 Chan Basho。宣布 Astrana Health 截至 2023 年 12 月 31 日的全年和第四季度業績的新聞稿可在該公司網站 www.astranahealth.com 的投資者部分獲取。

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 Astrana's Health website after the conclusion of the call.

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。電話會議結束後，阿斯特拉納健康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 and any accompanying information discussed herein contains certain forward-looking statements within the meaning of the Safe-Harbor provisions 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 ended 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.

在開始之前，我想提醒大家，本次會議以及此處討論的任何隨附資訊均包含 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。這些前瞻性陳述可以透過預期、相信、預期、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 日止年度的指導、持續增長的陳述。 、收購策略、交付能力、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、規劃和合併整合工作。

Although the company believes that the expectations reflected in these 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 could be no assurance that those expectations will prove to be correct.

儘管該公司認為這些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。

Information about the risks associated with investing in Astrana's Health is included in its filings with the Securities and Exchange Commission, which we encourage you to review before making an investment decision. The company does not assume any obligation to update any forward-looking statements as a result of new information, future events, and changes in marketing conditions or otherwise, except as required by law. Regarding the disclaimer language, I would also like to refer to you to slide 2 of the conference call presentation for further information.

有關投資 Astrana's Health 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仔細閱讀這些文件。除非法律要求，否則本公司不承擔因新資訊、未來事件和行銷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 Astrana Health's President and Chief Executive Officer, Brandon Sim. Please go ahead, Brandon.

接下來，我將電話轉給 Astrana Health 總裁兼執行長 Brandon Sim。請繼續，布蘭登。

Good evening, and thank you all for joining us today.

晚上好，感謝大家今天加入我們。

We are proud to announce another year marked by rapid scaling of our unique care model to empower providers and improve healthcare for local communities at Astrana Health. We coupled that with robust financial achievements, ensuring that our growth efforts are sustainable and maintaining a focus on profitability. We continue to execute against our multidimensional strategic roadmap.

我們很自豪地宣布，在新的一年裡，我們獨特的護理模式將快速擴展，以增強 Astrana Health 醫療服務提供者的能力並改善當地社區的醫療保健。我們將其與強勁的財務業績相結合，確保我們的成長努力可持續，並保持對獲利能力的關注。我們繼續執行我們的多維戰略路線圖。

One, focusing on expanding our membership base across existing and new geographies. Two, increasing the level of accountability and risk we are responsible for in our value-based care contracts. Three, empowering our providers to achieve superior patient outcomes, and four, executing strategic acquisitions to further accelerate our growth trajectory for the foreseeable future. We are confident that the infrastructure we have built and the momentum we have in our value-based care platform will continue to accelerate the country towards our vision, one in which every American has access to high-quality, high-value healthcare.

第一，專注於擴大我們在現有和新地區的會員基礎。第二，提高我們在基於價值的護理合約中所承擔的責任和風險水準。第三，使我們的提供者能夠實現卓越的患者治療效果；第四，執行策略性收購，以在可預見的未來進一步加速我們的成長軌跡。我們相信，我們所建立的基礎設施和我們在基於價值的醫療平台中所擁有的動力將繼續加速國家實現我們的願景，即每個美國人都能獲得高品質、高價值的醫療保健。

I'll begin by highlighting our financial accomplishments for the fourth quarter of 2023. We recorded total revenue of $353 million, an increase of 20%, and adjusted EBITDA of $29 million, an increase of 22.7% from the fourth quarter of 2022.

首先，我將重點介紹我們 2023 年第四季的財務成就。我們的總營收為 3.53 億美元，成長 20%，調整後 EBITDA 為 2,900 萬美元，較 2022 年第四季成長 22.7%。

For the full year of 2023, Astrana Health achieved total revenues of $1.39 billion, an increase of 21.2% year over year and adjusted EBITDA of $146.6 million, up 4.7% year over year, yielding an adjusted EBITDA margin of 11% which is within our short-term target EBITDA range of 10% to 15%. This was despite headwinds in terms of Medicaid redetermination, increased utilization and costs due to our investments in growth, infrastructure, and new market entry.

2023 年全年，Astrana Health 實現總營收 13.9 億美元，年增 21.2%，調整後 EBITDA 為 1.466 億美元，年成長 4.7%，調整後 EBITDA 利潤率為 11%，處於我們的預期範圍內。短期目標EBITDA範圍為10%至15%。儘管我們在成長、基礎設施和新市場進入方面的投資導致醫療補助重新確定、利用率和成本增加等方面存在阻力，但情況還是如此。

Turning now to the business updates for the year. Since our last earnings call, we have formed a new partnership with BASS Medical Group. A key pillar of Astrana's unique care model is the deep integration between primary care providers and specialists networks, and our long-term strategic partnership with BASS is, in our view, an expression of this thesis. This relationship is set to enhance the value-based care framework and operational capabilities for BASS Medical Group, which boasts over 400 providers across key Northern California counties.

現在轉向今年的業務更新。自上次財報電話會議以來，我們與 BASS 醫療集團建立了新的合作夥伴關係。阿斯特拉納獨特的護理模式的關鍵支柱是初級保健提供者和專家網絡之間的深度整合，我們認為，我們與 BASS 的長期戰略合作夥伴關係就是這一論點的體現。這種關係旨在增強 BASS 醫療集團基於價值的護理框架和營運能力，該集團在北加州主要縣擁有 400 多家醫療服務提供者。

Our collaborative efforts aimed to deliver top-tier care through value-based models to a diverse patient base across all lines of business throughout Northern California. Operationally, our collaboration with BASS involves establishing a premier, high-quality independent provider network or IPA in Northern California, which we expect to fully transition to full risk in 2025 and beyond by leveraging our Restricted Knox-Keene license to foster new aligned care models.

我們的合作旨在透過基於價值的模式向整個北加州各業務線的多元化患者群體提供頂級護理。在營運上，我們與BASS 的合作包括在北加州建立一個一流的、高品質的獨立提供者網路或IPA，我們預計透過利用我們的受限諾克斯-基恩許可證來培育新的一致護理模式，該網路將在2025 年及以後完全過渡到完全風險。

Our primary care provider networks will have wider access to an aligned high-quality specialist network, which will enable care coordination and will help manage cost effectiveness as these providers will also be supported by our technology platform, as they join Astrana's Care Enablement platform in 2024. This will extend our value-based care footprint in the Greater San Francisco Bay Area, while enriching our network with more primary care physicians and specialists.

我們的初級保健提供者網絡將更廣泛地訪問一致的高品質專家網絡，這將實現護理協調並幫助管理成本效益，因為這些提供者也將得到我們的技術平台的支持，因為他們將於2024 年加入阿斯特拉納的護理支援平台。這將擴大我們在大舊金山灣區基於價值的照護足跡，同時透過更多的初級保健醫生和專家豐富我們的網路。

Next, I'd like to highlight our ability to replicate our success in the Southern California and new markets, having recently entered several new states. Our approach to market expansion is flexible, rooted in our history of building partnerships with physician practices and adapting to local market dynamics.

接下來，我想強調我們在南加州和新市場複製成功的能力，最近我們已經進入了幾個新的州。我們的市場擴張方法是靈活的，植根於我們與醫生實踐建立合作夥伴關係並適應當地市場動態的歷史。

Whether through partnerships, de novo builds, acquisitions, the technology offerings, our ability to flexibly utilize our care partners, care delivery, and care enablement offerings to adapt to the needs of local providers and communities, allows us to remain adaptive and nimble as we enter these new markets.

無論是透過合作夥伴關係、從頭開始建立、收購、技術產品，我們靈活利用我們的護理合作夥伴、護理服務和護理支援產品來適應當地提供者和社區的需求的能力，使我們能夠在我們的工作中保持適應性和靈活性。進入這些新市場。

In Nevada, the notable presence of both the payer and the health system partner has guided our expansion into Clark County, where we have established over a year of operational experience. In addition to our initial entry via a chain of own primary care clinics in our care delivery segment, we have now augmented that footprint by building a care partners network of over 300 high-quality, high-value primary care providers and specialists. We continue to focus on building density in each new market we enter, and we expect our Nevada market to be run rate breakeven by the end of the year.

在內華達州，付款人和醫療系統合作夥伴的顯著存在引導我們擴展到克拉克縣，我們在那裡建立了一年多的營運經驗。除了我們最初透過自己的初級保健診所連鎖店進入我們的護理服務領域外，我們現在還透過建立一個由300 多家高品質、高價值的初級保健提供者和專家組成的護理合作夥伴網絡來擴大這一足跡。我們繼續專注於在我們進入的每個新市場中建立密度，我們預計我們的內華達市場將在年底前實現運行率盈虧平衡。

Following our acquisition of Texas Independent Providers and Independent Provider Association into our care partner segment in September of 2023, we have achieved significant advancements within the state of Texas as well. Our efforts have successfully expanded our network of exclusive primary care providers and our membership base.

2023 年 9 月，我們將德州獨立醫療服務提供者和獨立醫療服務提供者協會收購為我們的護理合作夥伴細分市場後，我們在德州也取得了重大進展。我們的努力成功擴大了我們的獨家初級保健提供者網絡和會員基礎。

As we strategically continue to add specialty coverage in Harris County, we have made notable strides in securing incremental Medicare Advantage contracts with health plans. We are committed to further enlarging our clinical footprint within the region, and thereby enhancing our delivery of value-based care.

隨著我們策略性地繼續增加哈里斯縣的專科覆蓋範圍，我們在確保與健康計劃簽訂增量醫療保險優勢合約方面取得了顯著進展。我們致力於進一步擴大我們在該地區的臨床足跡，從而加強我們提供基於價值的護理。

We continue to view our pipeline of partnerships and expansion opportunities as very robust, and we'll provide further updates as they occur. As previously communicated, we plan to enter at least one to two new markets per year and invest $5 million to $10 million per market to do so. The 2024 guidance that Chan will discuss later on this call will include the costs of planned new market entry.

我們仍然認為我們的合作夥伴關係和擴張機會非常強勁，我們將在發生時提供進一步的更新。正如之前所傳達的，我們計劃每年至少進入一到兩個新市場，並為此在每個市場投資 500 萬到 1000 萬美元。Chan 稍後將在本次電話會議上討論的 2024 年指導方針將包括計劃進入新市場的成本。

Next, we have significantly advanced our capability to engage and manage our patients in full-risk arrangements since announcing our acquisition of Community Family Care, or CFC, in November of 2023. We're excited to share that on January 31, 2024, we seamlessly onboarded CFC's IPA as an Astrana Care partner, which manages the healthcare of over 200,000 members in the Los Angeles, California area across Medicare, Medicaid, and commercial payers. The acquisition of the CFC health plan and MSO entities are still on track to close by the end of the first-quarter 2024.

接下來，自 2023 年 11 月宣布收購社區家庭護理 (CFC) 以來，我們顯著提高了在全風險安排中參與和管理患者的能力。我們很高興與大家分享，我們於2024 年1 月31 日無縫加入CFC 的IPA，成為Astrana Care 合作夥伴，該合作夥伴管理加州洛杉磯地區Medicare、Medicaid 和商業付款人超過200,000 名會員的醫療保健。對 CFC 健康計劃和 MSO 實體的收購仍有望在 2024 年第一季末完成。

We are also excited to announce our rebranding to Astrana Health, Nasdaq ticker ASTH as of February 26, 2024. This new brand identity reflects our expanding national presence and commitment to delivering quality care nationwide as we support forward-thinking providers and care teams in creating a constellation of high-quality care.

我們也很高興地宣布，自 2024 年 2 月 26 日起，我們將更名為 Astrana Health，納斯達克股票代碼為 ASTH。這個新的品牌標誌反映了我們不斷擴大的全國影響力以及在全國範圍內提供優質護理的承諾，因為我們支持具有前瞻性思維的提供者和護理團隊創建一系列高品質護理。

Additionally, we've made several key leadership changes to continue to support that growth, including new roles for Dr. Thomas Lam, myself, and Chan Basho, while also warmly welcoming Dr. Dinesh Kumar as Chief Medical Officer. Our commitment to accessible, high-quality, value-based care and our proven track record in managing care costs and patient outcomes give us confidence in our ongoing profitability and growth. The momentum we are experiencing is a testament to our team's dedication and the innovative strategies we are employing to enhance healthcare delivery.

此外，我們還進行了幾項關鍵的領導層變動，以繼續支持這一增長，包括任命 Thomas Lam 博士、我本人和 Chan Basho 為新職位，同時熱烈歡迎 Dinesh Kumar 博士擔任首席醫療官。我們致力於提供可及的、高品質的、基於價值的護理，以及我們在管理護理成本和患者結果方面的良好記錄，使我們對我們持續的盈利能力和增長充滿信心。我們所經歷的勢頭證明了我們團隊的奉獻精神以及我們為加強醫療保健服務而採用的創新策略。

In closing, I extend my deepest gratitude to our team, our providers, and our partners for their unwavering support and shared vision of transforming healthcare in communities across the nation.

最後，我向我們的團隊、我們的提供者和我們的合作夥伴表示最深切的感謝，感謝他們堅定不移的支持和改變全國社區醫療保健的共同願景。

I will now pass the discussion to Chan Basho, Chief Financial and Operating Officer, for a detailed review of our financial results.

我現在將把討論轉交給財務和營運長 Chan Basho，以詳細審查我們的財務表現。

Thank you, Brandon.

謝謝你，布蘭登。

We continue to deliver strong results, reporting total revenue of $1.39 billion for 2023, an increase of 21% from $1.14 billion in 2022. Our topline growth was driven by growth in all three of our core segments. In aggregate, adjusted EBITDA was $146.6 million, up 4.7% from $140 million in the prior year. Net income attributable to Astrana Health was $60.7 million, an increase of 34.3% from $45.2 million in 2022. Earnings per share on a diluted basis were $1.29, up 30.3% from $0.99 in the prior year.

我們持續取得強勁業績，2023 年總營收為 13.9 億美元，比 2022 年的 11.4 億美元成長 21%。我們的收入成長是由所有三個核心細分市場的成長所推動的。整體而言，調整後 EBITDA 為 1.466 億美元，比上一年的 1.4 億美元成長 4.7%。歸屬於 Astrana Health 的淨利潤為 6,070 萬美元，比 2022 年的 4,520 萬美元成長 34.3%。攤薄後每股收益為 1.29 美元，比上年的 0.99 美元增長 30.3%。

Now turning over to the balance sheet. We remain well-capitalized and well-positioned to execute on our growth initiatives. We ended the fourth quarter with $293.8 million in cash and cash equivalents compared to $288 million at the end of 2022. Total debt at the end of the fourth quarter was $282 million.

現在轉向資產負債表。我們仍然擁有充足的資本和有利的條件來執行我們的成長計劃。截至第四季末，我們的現金和現金等價物為 2.938 億美元，而 2022 年底為 2.88 億美元。第四季末的債務總額為 2.82 億美元。

Our substantial liquidity continues to support our strategy around sustained growth. I'd like to formally announce the spin-off of the real estate portion of the APC-excluded assets as we have discussed in prior quarters. As a reminder for all, the real estate portion of APC-excluded assets are the consolidated real estate assets held by APC common shareholders. As we have described in the past, they are solely for the benefit of our affiliate APC and its shareholders.

我們充足的流動性繼續支持我們持續成長的策略。我想正式宣布分拆 APC 除外資產的房地產部分，正如我們在前幾個季度討論過的那樣。提醒大家，APC 排除資產中的房地產部分是 APC 普通股東持有的合併房地產資產。正如我們過去所描述的，它們完全是為了我們的附屬公司 APC 及其股東的利益。

On December 26, 2023, APC, a consolidated affiliate of Astrana Health, completed a restructuring transaction to separate APC's real estate business. As a result of this strategic spinoff, we're now able to consolidate our tax filing status into a single entity. This will avoid our historical tax implications related to intercompany dividends. Due to this change, our tax rate in 2023 was 35.6% versus our tax rate of 47.2% in 2022.

2023 年 12 月 26 日，Astrana Health 的合併子公司 APC 完成了重組交易，以分離 APC 的房地產業務。由於這次策略分拆，我們現在能夠將我們的報稅狀態合併為一個實體。這將避免與公司間股利相關的歷史稅務影響。由於這項變化，我們 2023 年的稅率為 35.6%，而 2022 年的稅率為 47.2%。

Moving forward, 2024 full-year effective tax rate is expected to be approximately 34%. As a note, as you review our 2023 financials, our balance sheet as of December 31, 2023 no longer reflects the real estate business assets and liabilities. However, our income statement reflects the results of operations of such businesses through December 26, 2023.

展望未來，2024年全年有效稅率預計約34%。請注意，當您查看我們 2023 年的財務數據時，我們截至 2023 年 12 月 31 日的資產負債表不再反映房地產業務資產和負債。然而，我們的損益表反映了截至 2023 年 12 月 26 日此類業務的營運結果。

I want to highlight a nuance in Q4 associated with bonuses paid out by APC-excluded assets to their provider shareholders. This one-time bonus in Q4 2023 of $14 million ran through COGS and will skew medical costs if one is using COGS as the numerator and capitated revenue as the denominator. Going forward post spinoff, our financial statements will no longer need to be separated between Astrana Health assets and excluded assets.

我想強調第四季度的一個細微差別，即 APC 排除資產向其提供者股東支付的獎金。2023 年第四季的 1,400 萬美元一次性獎金透過銷貨成本計算，如果使用銷貨成本作為分子，人均收入作為分母，將會扭曲醫療成本。分拆後，我們的財務報表將不再需要區分 Astrana Health 資產和排除資產。

As we wrap up 2023 and think about 2024, I'd like to touch on four key areas. ACO, utilization management, HCC model changes, and our movement to full risk. We now have over 37,000 members in a Medicare Advanced Payment Program.

在我們結束 2023 年並思考 2024 年時，我想談四個關鍵領域。ACO、利用率管理、HCC 模型變化以及我們向全面風險的轉變。我們現在有超過 37,000 名 Medicare 預付款計畫會員。

In 2024, we launched a new MSSP for providers in our Astrana Health family who are at an earlier stage in their value-based care journey for their fee-for-service Medicare patients. The cornerstone of our strategy is empowering these providers with actionable data to ensure exceptional patient outcomes. Across both our MSSP and our full-risk ACO reach, we continue to invest in our care management and technology infrastructure to ensure both programs' continued success.

2024 年，我們為 Astrana Health 系列中的提供者推出了新的 MSSP，這些提供者正處於為按服務付費 Medicare 患者提供基於價值的護理之旅的早期階段。我們策略的基石是為這些提供者提供可操作的數據，以確保卓越的患者治療效果。在我們的 MSSP 和全風險 ACO 範圍內，我們繼續投資於我們的護理管理和技術基礎設施，以確保這兩個項目持續成功。

In regards to utilization management, we continue to monitor utilization trends, with the latest data indicating a very slight uptick in Medicare Advantage utilization as seen across the industry. However, due to our diverse pair mix, our overall utilization is in line with historical trends. Our 2024 forecast includes these assumptions moving forward.

在使用率管理方面，我們持續監控使用率趨勢，最新數據顯示整個產業的 Medicare Advantage 使用率略有上升。然而，由於我們的多元化組合，我們的整體利用率符合歷史趨勢。我們對 2024 年的預測包括這些未來的假設。

Around the HCC model changes to v28, we see a nominal change within our managed care population in 2024 and a less than 1% change in our ACO population in 2024 versus 2023. Our 2024 forecast also includes the projected impact from these changes moving forward.

圍繞 HCC 模型更改為 v28，我們看到 2024 年我們的管理式醫療人群發生了名義上的變化，而 2024 年我們的 ACO 人群與 2023 年相比變化不到 1%。我們對 2024 年的預測也包括這些變化未來的預期影響。

Now, when we look at our financials today, the majority of our managed care financials are on a partial risk basis. What that means is, today, we are recording the professional risk of our overall care model. Over the next 24 months, we expect to move more and more from a professional risk basis to a full risk basis. We will capture a higher portion of the premium dollar, improving our ability to coordinate care across the healthcare spectrum for patients, and improving our financial unit economics.

現在，當我們查看今天的財務狀況時，我們的大部分管理式醫療財務狀況都是基於部分風險的。這意味著，今天我們正在記錄我們整體護理模式的專業風險。在接下來的 24 個月中，我們預計將越來越多地從專業風險基礎轉向全面風險基礎。我們將獲得更高比例的保費，提高我們在整個醫療保健範圍內協調患者護理的能力，並改善我們的財務單位經濟效益。

Last quarter, our full-risk book of business made up 46% of total capitation revenue. As of January 1, our full-risk business makes up 49% of total capitation revenue. We expect our full-risk business to continue to grow this year.

上季度，我們的全風險業務佔總收入的 46%。截至 1 月 1 日，我們的全風險業務佔人均總收入的 49%。我們預計今年我們的全風險業務將持續成長。

In summary, we have the capacity today to manage full-risk members and to perform delegated pair-like functions such as utilization management, care management, and claims processing. With this change, we're now moving further up the risk continuum while continuing to deliver high-quality care for our members.

總之，我們今天有能力管理全風險成員並執行委託的配對功能，例如使用管理、護理管理和索賠處理。透過這項變化，我們現在進一步提高風險連續性，同時繼續為我們的會員提供高品質的照護。

Turning now to our 2024 guidance. We expect to be between $1.65 billion and $1.85 billion of revenue. We remain confident in our growth due to the execution of our organic and inorganic growth plans as well as our transition to full risk. We anticipate that our adjusted EBITDA will range from $165 million to $185 million. Our expectations are based on the stability of utilization trends across our at-risk portfolio and a conservative approach to projections.

現在轉向我們的 2024 年指導。我們預計營收將在 16.5 億美元至 18.5 億美元之間。由於我們有機和無機成長計劃的執行以及向全面風險的過渡，我們對我們的成長仍然充滿信心。我們預計調整後的 EBITDA 將在 1.65 億美元至 1.85 億美元之間。我們的預期是基於我們創投組合的利用率趨勢的穩定性以及保守的預測方法。

As we shift towards accommodating a greater number of full-risk patients, we foresee enhancements in our operational efficiencies and institutional risk management. This strategic shift is expected to positively impact our unit economics. In regards to gap earnings per diluted share, we expect to be between $1.28 per share and $1.52 per share. While we are providing guidance on a full-year basis, we recognize the importance of understanding the nuances that each quarter may present.

隨著我們轉向容納更多的全風險患者，我們預計我們的營運效率和機構風險管理將會提高。這一戰略轉變預計將對我們的單位經濟效益產生積極影響。至於稀釋後每股收益差距，我們預計在每股 1.28 美元至 1.52 美元之間。雖然我們提供全年指導，但我們認識到了解每個季度可能出現的細微差別的重要性。

With the closing of CFC IPA and the future planned closing of CFC Health Plan, we anticipate a notable uplift in our revenue from Q4 2023 to Q1 2024 and even further in Q2 2024 when we will experience a full quarter of impact from CFC in our financials. Historically, our business has experienced seasonal trends in line with industry norms. Our margin typically is normalized for Q1 while expanding in the second and third quarters as one-time settlements are recognized before returning to a normalized level in the fourth quarter.

隨著CFC IPA 的結束以及CFC Health Plan 未來計畫的結束，我們預計從2023 年第四季到2024 年第一季度，我們的收入將顯著增加，甚至在2024 年第二季度進一步增加，屆時我們將經歷CFC 對我們財務狀況的整整一個季​​度的影響。從歷史上看，我們的業務經歷了符合行業規範的季節性趨勢。我們的利潤率通常在第一季實現標準化，同時在第二季和第三季擴大，因為在第四季度恢復到標準化水準之前會確認一次性結算。

It's important to note that while we strive for operational excellence and margin improvements, our strategic investments in market expansion and transition to full risk are timed to optimize long-term growth, which may result in quarter-to-quarter margin variability.

值得注意的是，雖然我們努力追求卓越營運和提高利潤率，但我們在市場擴張和向全面風險過渡方面的策略投資是為了優化長期成長，這可能會導致季度與季度之間的利潤率波動。

We believe this context is crucial for our investors as it provides a lens through which to view our quarterly performance within the framework of our annual guidance. Finally, I want to reiterate the bright future ahead for our strong business development pipeline coupled with the strength of our model as we look ahead to 2025, 2026, and beyond.

我們認為，這種背景對我們的投資者至關重要，因為它提供了一個鏡頭，可以透過它在年度指導框架內查看我們的季度業績。最後，我想重申，展望 2025 年、2026 年及以後，我們強大的業務發展管道以及我們的模式實力將帶來光明的未來。

With that, I'm going to hand it back over to Brandon.

有了這個，我要把它交還給布蘭登。

In conclusion, we are proud of the positive impact we've had on the communities we serve, our growth partnerships, our financial achievements, and our capital deployment strategy over the past year, showcasing our platform's capacity to consistently achieve three main operational objectives. One, expanding our member base in both existing and new geographies. Two, supporting our care delivery and care partners providers in their transition to value-based care. And three, empowering our providers to achieve outstanding patient outcomes for full risk.

總而言之，我們對過去一年對我們所服務的社區、我們的成長夥伴關係、我們的財務成就和我們的資本部署策略產生的積極影響感到自豪，這展示了我們的平台持續實現三個主要營運目標的能力。第一，擴大我們在現有和新地區的會員基礎。第二，支持我們的護理服務和護理合作夥伴提供者向基於價值的護理過渡。第三，使我們的醫療服務提供者能夠在完全風險的情況下實現出色的患者治療結果。

The recent partnership with BASS Medical Group, the acquisition of CFC IPA and CFC Health plan, and the continued move towards full risk further diversify our membership mix and provide us with pathways to expand our value-based care exposure.

最近與 BASS 醫療集團的合作、收購 CFC IPA 和 CFC Health 計劃以及繼續向全風險邁進，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。

The Astrana Health platform provides a highly differentiated, peer-play, value-based care company that is not only growing rapidly, but also yields profitable and sustainable growth. We have made strong progress across all three objectives and have established a solid foundation for a bright future of continued growth and impact in 2024. And we're excited to further accelerate our mission to provide every American with access to high-quality, high-value healthcare. Thank you all for your time today.

Astrana Health 平台提供了一家高度差異化、同業競爭、基於價值的護理公司，該公司不僅成長迅速，而且實現盈利和可持續增長。我們在所有三個目標上都取得了強勁進展，並為 2024 年持續成長和影響的光明未來奠定了堅實的基礎。我們很高興能夠進一步加快我們的使命，為每個美國人提供高品質、高價值的醫療保健服務。感謝大家今天抽出時間。

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) Ryan Daniels, William Blair.

（操作說明）Ryan Daniels、William Blair。

Yeah. Hey, guys. This is Jack Senft on for Ryan Daniels. Thanks for taking the questions. In terms of EBITDA margins, you ended 2023 with EBITDA margins of about 11%. And if we take the midpoint of the 2024 guide, adjusted EBITDA margin is right at about 10%, which is still impressive. But I know the integration of the RKK license is supposed to bring some margin improvement, and I know that you're focused on operational efficiency.

是的。大家好。我是瑞恩·丹尼爾斯的傑克·森夫特。感謝您提出問題。就 EBITDA 利潤率而言，2023 年底，您的 EBITDA 利潤率約為 11%。如果我們採用 2024 年指南的中點，調整後的 EBITDA 利潤率約為 10%，這仍然令人印象深刻。但我知道 RKK 許可證的整合應該會帶來一些利潤率的提高，而且我知道你們關注的是營運效率。

So is the flat margin outlook just more conservatism? Is it that the RKK won't have too much of an impact yet in 2024, or is it may be just like the new market entry costs causing it? Can you just kind of walk us through the puts and takes of the EBITDA margin for 2024?

那麼，利潤率持平的前景是否只是更保守呢？是說RKK到2024年還不會產生太大的影響，還是可能就像新的市場進入成本造成的？您能否向我們介紹一下 2024 年 EBITDA 利潤率的變動？

You're right, the midpoint of revenue and the adjusted EBITDA 5% to 10% margin. And there are a couple of puts and takes there. We first note that we've historically been conservative in our first attempt out at a guidance set of range numbers for the year. We'd also point out that there are a couple of headwinds in the industry, obviously around Medicare Advantage, around the risk model, while we think we are relatively insulated from some of the changes that others may be experiencing.

你是對的，收入的中點和調整後的 EBITDA 5% 到 10% 的利潤率。那裡有一些放和取。我們首先註意到，我們在首次嘗試制定今年的指導範圍數字時歷來都是保守的。我們還指出，該行業存在一些不利因素，尤其是圍繞醫療保險優勢和風險模型，而我們認為我們相對不受其他人可能正在經歷的一些變化的影響。

Again, due to an abundance of caution, that does put a slight headwind versus historical margins. I would also note that impacts of Medicaid redetermination or any lingering effects of that as well as continued investment in our platform and new market entry are all baked into our guidance as currently contemplated.

同樣，由於高度謹慎，這確實對歷史利潤造成了輕微的阻力。我還想指出，醫療補助重新確定的影響或任何揮之不去的影響，以及對我們平台的持續投資和新市場進入都已納入我們目前預期的指導中。

I'll turn it over to Chan to add anything else.

我會把它交給 Chan 來添加其他內容。

Yeah, no. I think you covered everything, Brandon.

是的，不。我認為你涵蓋了一切，布蘭登。

Okay. Great. Appreciate that. Just a quick follow-up then, too. So just kind of focusing on the growth outside of California, I'm just kind of curious how we should think about that. I know a lot of the commentary lately has been focused on the California market just given the RKK for Medicare and Medicaid. And I think, too, in your prepared remarks, you mentioned that Nevada will be run rate breakeven by year end. So just kind of given the success that you are seeing outside of California, are you beginning to possibly look at additional geographies as well, or just kind of what is your mindset with respect to furthering penetration outside of the California market?

好的。偉大的。感謝。那麼也只需快速跟進即可。因此，我只是關注加州以外的成長，我只是好奇我們應該如何考慮這一點。我知道最近很多評論都集中在加州市場，因為考慮到 RKK 的醫療保險和醫療補助計劃。我也認為，在您準備好的演講中，您提到內華達州將在年底前實現運行率盈虧平衡。因此，考慮到您在加州以外地區看到的成功，您是否也開始考慮其他地區，或者您對於進一步滲透到加州以外的市場有何想法？

Yeah, definitely. So as previously guided, we will continue to look to expand into one or two new markets per year. Those market entry costs, which we've typically run at the low end of the $5 million to $10 million range that I guided to on the call have been baked into our guidance ranges for the year as well on the adjusted EBITDA line. We typically look at markets in terms of building depth rather than trying to fill every single state on the map.

是的，絕對是。因此，按照先前的指導，我們將繼續尋求每年擴展到一到兩個新市場。這些市場進入成本通常處於我在電話會議上指導的 500 萬美元至 1000 萬美元範圍的低端，已納入我們今年的指導範圍以及調整後的 EBITDA 線。我們通常從建立深度的角度來看待市場，而不是試圖填滿地圖上的每個州。

So I think there's a certain level of deliberation when we enter a new market. But when we do, we want to ensure that the care model, the technology infrastructure is deployed in a systematic way that allows us to continue breaking even within that two-year time period as we had guided to before as well. So that's the intent. With Nevada and Texas ramping up and Nevada expected to be run-rate profitable this year, we are certainly looking towards additional markets.

所以我認為，當我們進入一個新市場時，需要進行一定程度的深思熟慮。但當我們這樣做時，我們希望確保以系統化的方式部署護理模式和技術基礎設施，使我們能夠像我們之前所指導的那樣，在兩年時間內繼續實現收支平衡。這就是目的。隨著內華達州和德克薩斯州的發展，內華達州預計今年將實現盈利，我們當然正在尋找更多市場。

Okay. Great. And then if I can just sneak one final one in here. So PP&E decreased pretty substantially this quarter. Just wanted to double click, is this all because of the APC real estate spinoff or was there something else that just caused that impact?

好的。偉大的。然後如果我能把最後一張偷偷放進去就好了。因此，本季 PP&E 大幅下降。只是想雙擊，這都是因為 APC 房地產分拆還是有其他原因造成了這種影響？

Yeah, I think you're correct in terms of with our changes in terms of the real estate spinoff, you will see those appropriate changes in the balance sheet.

是的，我認為你對我們在房地產分拆方面的變化是正確的，你會在資產負債表中看到這些適當的變化。

Brooks O'Neil, Lake Street Capital Markets.

布魯克斯·奧尼爾，湖街資本市場。

Just following up on Jack's last question, I just want to be 100% clear that you guys are including this $5 million to $10 million per new market entry, but you haven't included any assumption about the impact of whatever you do to enter these new markets in terms of affiliations, partnerships, et cetera.

繼續傑克的最後一個問題，我只是想 100% 清楚地表明，你們每個新市場進入都包括了 500 萬到 1000 萬美元，但你們沒有包括任何關於進入這些市場的影響的假設。新市場，包括附屬關係、合作夥伴關係等。

So our '24 forecast includes the investments we will be making for these one to two markets. So it is built into the numbers today.

因此，我們 24 年的預測包括我們將為此到兩個市場的投資。所以它已被納入今天的數字中。

The investments are, but not the impact of a new group or a new partnership or whatever in these new markets. See what I'm asking?

這些投資是新集團或新合作夥伴關係或其他新市場中任何事物的影響，但不是這些影響。明白我在問什麼嗎？

Both the investment into business development, marketing, et cetera, as well as potential ongoing operating costs of operating the group are baked into the guidance.

對業務開發、行銷等的投資，以及營運集團的潛在持續營運成本都納入了指導意見。

Okay. Okay. I think, I got that. Obviously, there has been a lot of talk about elevated medical costs from some of the payers in particular United, Aetna, Humana. I'm curious, do you have any sense that providers in your core markets saw elevated medical costs, and do you have a sense that it was your approaches to medical management and value-based care that enabled you to do a good job of controlling those medical costs? Or do you have any comments? Do you see what I'm asking?

好的。好的。我想，我明白了。顯然，一些付款人，特別是美聯航、安泰保險和Humana，已經就醫療費用上漲進行了許多討論。我很好奇，您是否認為核心市場的醫療服務提供者的醫療成本上漲？您是否認為正是您的醫療管理和基於價值的護理方法使您能夠很好地控製成本那些醫療費用？或您有意見嗎？你明白我在問什麼嗎？

Yes, let me give it a try, Brooks. Thank you for the question. I think, I would say that it's difficult for us to comment on the regional performance of any of our payer partners but given the level of interest that we are seeing from our payer partners in terms of aligning members to our value-based care platform, we think that what we can speak about is that the strength of our care model and the durability and management of costs, medical costs associated with the patient that we are financially and clinically responsible for has been a value add to our payer partners.

是的，讓我嘗試一下，布魯克斯。感謝你的提問。我認為，我想說，我們很難對任何付款人合作夥伴的區域表現發表評論，但考慮到我們從付款人合作夥伴那裡看到的對使會員與我們基於價值的護理平台保持一致的興趣程度，我們認為，我們可以談論的是，我們的護理模式的優勢以及成本的持久性和管理，與我們在財務和臨床上負責的患者相關的醫療成本為我們的付款合作夥伴帶來了增值。

We continue to see strong interest in partnership and expanding our already successful partnerships into new regions, into growing the book of business that we have with our payer partners. And we look forward to continue serving them and helping them decrease any fluctuations that they may be facing as well for our patient panels.

我們繼續看到對合作夥伴關係的濃厚興趣，並將我們已經成功的合作夥伴關係擴展到新的地區，擴大我們與付款合作夥伴的業務範圍。我們期待繼續為他們提供服務，幫助他們減少我們的患者群體可能面臨的任何波動。

Sure. All that makes sense. That's very helpful. Thank you. So, let me just ask one last one. And, you know, I'm just trying to get my arms around the whole notion of you guys taking full risk, which I believe is a great development and something you're more than capable of handling. I'm assuming that the big opportunity in the marketplace is to reduce inpatient hospital costs. Can you just talk a little bit about that and how the hospitals are viewing the transition that's going on out there in the world? Not that you ask the deer how he feels about the hunter being in the field. But just tell me what you see in the marketplace on what the conversations are like out there?

當然。這一切都是有道理的。這非常有幫助。謝謝。那麼，讓我問最後一個問題。而且，你知道，我只是想理解你們要承擔全部風險，我相信這是一個巨大的進步，你們完全有能力應付。我認為市場上的巨大機會是降低住院費用。您能否簡單談談這一點以及醫院如何看待世界上正在發生的轉變？不是你問鹿對獵人在田野裡的感覺如何。但請告訴我您在市場上看到的對話是什麼樣的？

Thanks for the question. I think there is a bit of a divergence in the health systems and hospitals we work with. Those that have a plan in place as there are changes in Medicare Advantage and as there are changes in utilization trends, we've seen them successful, especially when they're working with us to keep the lower acuity and lower dollar per bed day patients out of the hospital and ensuring that the appropriate place of care is being used for a given procedure or for a given patient.

謝謝你的提問。我認為我們合作的衛生系統和醫院之間存在一些分歧。那些因 Medicare Advantage 的變化以及使用趨勢的變化而製定計劃的人，我們看到他們取得了成功，特別是當他們與我們合作以保持較低的敏銳度和每床日費用較低的患者時出院並確保針對特定程序或特定患者使用適當的照護場所。

While we -- we think there's greater and greater awareness among hospitals and health systems around the benefits of doing that. And we continue to be in conversations with a lot of large health systems and hospitals to bring that model to the geographies that we serve.

我們認為，醫院和衛生系統越來越意識到這樣做的好處。我們繼續與許多大型衛生系統和醫院進行對話，以將該模式帶到我們服務的地區。

Brooks, I may have missed one of your earlier questions. I apologize around what was baked into our '24 estimates as well, so maybe I'll answer that quickly. All the costs of new market entry are baked into the bottomline guidance, but our revenues are pretty minimal, zero to minimal, baked in on the top line for new groups that we may partner with this year. So that's the top and the bottom line for new partnerships and new markets for 2024.

布魯克斯，我可能錯過了你之前提出的問題。對於我們 24 年預估中包含的內容，我也表示歉意，所以也許我會很快回答這個問題。進入新市場的所有成本都納入了底線指導，但我們的收入非常小，為零到極小，納入了我們今年可能合作的新集團的頂線。這就是 2024 年新合作夥伴關係和新市場的首要目標和底線。

Thank you for clarifying that. I was thinking that was the answer, but I didn't actually hear you say it. So hearing you say it is very helpful. Thank you again.

感謝您澄清這一點。我以為這就是答案，但我實際上並沒有聽到你說出來。所以聽到你說這非常有幫助。再次感謝你。

Thank you, Brooks.

謝謝你，布魯克斯。

David Larsen, BTIG.

大衛‧拉森，BTIG。

Can you please talk a little bit more about the data files, Chan, how current they are? Like Agilent talked about getting more data, higher utilization claims. Privia talked about getting more accurate forecasts with data and higher utilization. Do you basically have all the '23 data now? Are we through that? And we have high conviction that we're there. Sorry for the background noise.

Chan，您能否多談談資料文件，它們的最新情況如何？就像安捷倫談到的獲得更多數據、更高利用率的說法一樣。Privia 談到透過數據和更高的利用率獲得更準確的預測。現在你基本上已經掌握了23年的所有數據了嗎？我們通過了嗎？我們堅信我們就在那裡。抱歉有背景噪音。

Around our visibility into data, I think we have as good of a visibility as could be had. As we had mentioned before, we operate in a delegated environment where we are responsible for authorizing prior authorization requests, managing the referrals in our network, as well as paying the claims associated or the cost of the claims associated with the claims and authorizations that we process.

關於我們對數據的可見性，我認為我們擁有盡可能好的可見性。正如我們之前提到的，我們在委託環境中運營，我們負責授權事先授權請求，管理我們網路中的推薦，以及支付相關索賠或與我們的索賠和授權相關的索賠費用。過程。

That, combined with our proprietary data infrastructure and our team's ability to predict based on historical usage and the trends that we are seeing, give us a good amount of visibility into where utilization might trend, call it, a quarter or two ahead of time. That's not to say, of course, that something couldn't happen. We're talking about elective procedures here, but in terms of our data visibility, we think we are pretty confident in our ability to see how trends are evolving over time. As far as 2023, I think Chan can answer how much of that is baked in today.

再加上我們專有的數據基礎設施和我們的團隊根據歷史使用情況和我們所看到的趨勢進行預測的能力，使我們能夠提前一兩個季度充分了解利用率的趨勢。當然，這並不是說某些事情不會發生。我們在這裡討論的是選擇性程序，但就我們的數據可見性而言，我們認為我們對了解趨勢如何隨時間演變的能力非常有信心。就 2023 年而言，我認為陳可以回答其中有多少是在今天實現的。

Yeah, thanks, Brandon.

是的，謝謝，布蘭登。

Okay. That's great. No, go ahead please.

好的。那太棒了。不，請繼續。

Yeah, sure, David. Our unique delegated model really allows us to have close to real-time authorization data. At this time, in terms of our authorizations, it's in the 98, 99 percentile range in terms of claims that we expect in the future. So we feel quite comfortable around our management business.

是的，當然，大衛。我們獨特的委託模型確實使我們能夠擁有接近即時的授權資料。目前，就我們的授權而言，就我們預期未來的索賠而言，它處於 98、99 個百分點的範圍內。因此，我們對我們的管理業務感到非常滿意。

Okay. That's great. And can you talk a little bit about BASS, please? Privia mentioned them. And from what they said, it sounds like their relationship with BASS isn't going to change. Can you just talk about how that's going to fit into your entire network? It seems like it makes a lot of sense to me, like they have specialty services. Your primary care groups can refer there. You can basically keep the care in your network and perhaps improve cost trend as well. A little more description there would be helpful.

好的。那太棒了。您能談談 BASS 嗎？普里維亞提到了他們。從他們的說法來看，他們與 BASS 的關係似乎不會改變。您能談談這將如何融入您的整個網路嗎？這對我來說似乎很有意義，就像他們有專業服務一樣。您的初級保健小組可以在那裡轉診。您基本上可以將護理保留在您的網路中，也許還可以改善成本趨勢。多一點描述會有幫助。

Sure thing. I haven't heard the exact comments, but I think based on your portrayal, I would agree. There are different services that are being provided to BASS Medical Group. And at the end of the day, our goal is to help those providers, multi-specialty as well as some primary care in BASS Medical Group to be as successful as possible and to deliver a high quality of care to their patient population in a differentiated way.

當然可以。我還沒有聽到確切的評論，但我認為根據你的描述，我會同意。BASS 醫療集團提供不同的服務。最終，我們的目標是幫助 BASS 醫療集團的提供者、多專業以及一些初級保健盡可能取得成功，並以差異化的方式為其患者群體提供高品質的護理方式。

What we are going to provide to them is that we are going to provide our risk ecosystem, including contracts, value-based care infrastructure, the full suite of delegated services, as we talked about before, contracting, credentialing, utilization management, care management, claims payments, et cetera, to BASS, in addition to performing some of the care management and clinical programs necessary in order to succeed in a value-based care contract over time. That's something we're beginning to do this year.

我們要向他們提供的是我們將提供我們的風險生態系統，包括合約、基於價值的護理基礎設施、全套委託服務，正如我們之前討論的那樣，簽約、認證、利用管理、護理管理、索賠付款等，此外還執行一些必要的護理管理和臨床計劃，以便隨著時間的推移成功簽訂基於價值的護理合約。這是我們今年開始做的事情。

I think in my prepared remarks, we talked about creating a network, an IPA, as well as moving that as appropriate into the Restricted Knox-Keene full-risk upside-down side construct as time goes on probably in 2025. We think that this will lead to better accountable care results for the patients that BASS serves. And I think that is a separate business than the one that BASS may be currently using another company for.

我認為在我準備好的發言中，我們討論了創建一個網絡、一個IPA，以及隨著時間的推移，可能在2025 年將其適當地轉移到受限制的諾克斯-基恩全風險顛倒結構中。我們認為這將為 BASS 服務的患者帶來更好的負責任的護理結果。我認為這是一項獨立的業務，而不是 BASS 目前可能使用另一家公司從事的業務。

Again, at the end of the day, we think there's room for everyone, and we look forward to helping BASS and its providers execute and provide really good care to the San Francisco Bay Area community.

再說一次，歸根結底，我們認為每個人都有空間，我們期待幫助 BASS 及其提供者執行並向舊金山灣區社區提供真正良好的護理。

Okay. That's very helpful. Thank you. And then just one last quick one. For CFC, I think that they bring an incremental $20 million or more of EBITDA. Is that included in your guidance? Thanks very much, and then I'll hop back in the queue.

好的。這非常有幫助。謝謝。然後是最後一個快速的。對於 CFC，我認為他們帶來了 2000 萬美元或更多的 EBITDA 增量。這是否包含在您的指導中？非常感謝，然後我會回到隊列中。

Yes. In terms of CFC, CFC is baked into our guidance. We did close in terms of a two-step acquisition, the IPA, in January. And we're still on track to close the second part, which is the full risk-bearing Restricted Knox-Keene license at the end of Q1.

是的。就 CFC 而言，CFC 已納入我們的指導。一月份，我們確實完成了一項分兩步​​驟收購的 IPA。我們仍在按計劃完成第二部分，即第一季末的完全承擔風險的受限諾克斯基恩許可證。

Okay. Great. Congrats on a great quarter.

好的。偉大的。恭喜您度過了一個出色的季度。

Adam Ron, Bank of America.

亞當‧羅恩，美國銀行。

I have a question about how this RKK license flows in over the next 24 months, as you mentioned. I was a little surprised to hear that you said, the full risk, the percentage of total capitation went from like 46 to 49. I would have expected a bigger swing given it was January and that if you were going to renegotiate contract with an insurer, I would assume most of it would happen in January. And so when you mentioned 24 months, did you really mean like 12 months from now and then 12 months after that when those things take effect or can you renegotiate throughout the year?

正如您所提到的，我有一個關於 RKK 許可證在未來 24 個月內如何流通的問題。聽到你說，完全風險，佔總人均的百分比從 46 上升到 49，我有點驚訝。鑑於現在是一月份，我預計會有更大的波動，而且如果你要與保險公司重新談判合同，我會假設大部分會在一月份發生。因此，當您提到 24 個月時，您真的是指從現在開始的 12 個月，然後是 12 個月後這些事情生效，還是您可以全年重新談判？

So first, it's less about the contract negotiation, and it's more about the regulatory approvals. So even if the contract's negotiated, there's a joint filing, and then there's a process with the DMHC for us to be able to move these members to full risk. So as you're thinking about the Medicare Advantage FYB membership, if that will continue to happen throughout this year in terms of the CFC and Medicaid-related members, you won't see that change until the CFC RKK closes.

因此，首先，這不是合約談判的問題，而是監管部門批准的問題。因此，即使合約經過談判，也會有聯合備案，然後與 DMHC 有一個流程，讓我們能夠讓這些成員承擔全部風險。因此，當您考慮 Medicare Advantage FYB 會員資格時，如果 CFC 和 Medicaid 相關會員在今年全年繼續出現這種情況，那麼在 CFC RKK 關閉之前您不會看到這種變化。

Okay. So what would cause it to be evenly distributed then across 24 months if it's waiting on a regulatory license? Like is it something that's going to be lumpy where one quarter is finally approved and you get most of the benefit there or --

好的。那麼，如果等待監管許可，什麼會導致它在 24 個月內均勻分配？就像是有些事情會變得不穩定，四分之一最終獲得批准，你會在那裡獲得大部分好處，或者--

Yeah, it is going to be lumpy. It's not going to be evenly distributed. And so as we have a contract that the DMHC approves, you will see that step up in membership.

是的，它會變得凹凸不平。它不會均勻分佈。因此，當我們簽訂了 DMHC 批准的合約時，您將看到會員資格的提升。

Okay. And when you say contract, is that -- so with each individual payer for each individual product line, you have to get a separate approval and separate --

好的。當你說合約時，是這樣的——對於每個單獨的產品線的每個單獨的付款人，你必須獲得單獨的批准和單獨的--

That's correct. Yeah, for every county, for each line of business and contract, there's a separate approval.

這是正確的。是的，對於每個縣、每個業務領域和合同，都有單獨的批准。

Okay. And are you specifically trying to do this in a more -- like are you trying to measure the pacing of it, or is it just you're applying basically as fast as you can, and you just expect that it would take 12 to 24 months?

好的。您是否專門嘗試以更多方式執行此操作，例如您是否試圖衡量其節奏，或者只是您基本上盡可能快地應用，並且您只是期望需要 12 到 24幾個月？

We are going as fast as we can through the process. It does take time.

我們正在盡可能快地完成這個過程。這確實需要時間。

Yeah. Okay. And then on the MSSP, it was interesting. So can you give us like how many members are in MSSP versus ACO REACH in 2024 and then recap maybe what happened with ACO REACH in 2023? And then you mentioned the v28 might be 50 base points, 100 base points of revenue of ACO REACH in 2024. And I think there is an increase in the discount rate of another 1%. So would you expect 20 for your performance to repeat or would there be a degradation in ACO REACH? And maybe that's why you're moving into MSSP. And so just understanding more of some of the original Medicare programs would be really helpful.

是的。好的。然後在 MSSP 上，這很有趣。那麼您能否告訴我們 2024 年 MSSP 與 ACO REACH 中有多少成員，然後回顧一下 ACO REACH 在 2023 年發生了什麼？然後你提到v28可能是2024年ACO REACH收入的50個基點、100個基點。而且我認為折扣率還會再增加1%。那麼您是否希望您的表現重複 20 次，或者 ACO REACH 是否會下降？也許這就是您轉入 MSSP 的原因。因此，多了解一些原始的醫療保險計劃將會非常有幫助。

Sure thing. I don't think we have officially disclosed MSSP numbers. I would say it's between certainly more than 5,000 members since it has to be. And then I would say probably less than 10,000 members. So it's in that range. The rest of the Accountable Care Organization members are in our ACO REACH program. In terms of V-28 impact, Chan will take that part of the question.

當然可以。我認為我們還沒有正式披露 MSSP 數字。我想說，肯定有超過 5,000 名成員，因為這是必須的。然後我想說可能不到 10,000 名會員。所以它在這個範圍內。其餘的責任醫療組織成員都在我們的 ACO REACH 計劃中。關於 V-28 的影響，陳將回答這部分問題。

So in terms of our impact on the ACO REACH, we're expecting a 1% impact due to v28 in 2024, those numbers are baked into our full-year guidance. Is that helpful or --

因此，就我們對 ACO REACH 的影響而言，我們預計 2024 年 v28 會產生 1% 的影響，這些數字已納入我們的全年指導中。這樣有幫助嗎？--

Yes. But is there any way to think about how, I guess, maybe just -- so we have the ACO REACH numbers in '22 from the government, and so did 20 -- was '23 an improvement? And do you expect further improvement in '24?

是的。但有沒有辦法思考，我想，也許只是——所以我們從政府那裡得到了 22 年的 ACO REACH 數據，20 也如此——23 是一個改進嗎？您預計 24 年會有進一步改善嗎？

Yeah. We expect our performance in '24 to be a little bit better than 2023, so about overall 2% to 3% margin in 2024.

是的。我們預計 24 年的業績將比 2023 年好一些，因此 2024 年的整體利潤率約為 2% 至 3%。

Okay. That's super helpful.

好的。這非常有幫助。

Just to be clear, the 2% to 3% margin Chan is discussing is post, I would say that's care platform, quote-unquote contribution post distributions to providers, post incentives, post bonuses, quality, et cetera.

需要明確的是，Chan 討論的 2% 到 3% 的利潤是崗位，我想說的是護理平台、對提供者的後分配、崗位激勵、崗位獎金、品質等等。

Interesting. Okay. And then, so just to understand your comment about the quarterly cadence earlier, it sounds like the quarters are going to be somewhat variant in terms of earnings contribution. And so is the seasonality going to be similar to '23 or '22, or is it the way we could think about first half, second half just so we don't have to be surprised in Q1. Maybe that's going to be the highest contributor, just more of a finer point around that would be helpful.

有趣的。好的。然後，為了理解您之前對季度節奏的評論，聽起來這些季度在盈利貢獻方面會有所不同。因此，季節性是否會與 23 年或 22 年類似，或者我們可以這樣考慮上半年、下半年，這樣我們就不必對第一季感到驚訝。也許這將是最大的貢獻者，只要有更多的細節就會有所幫助。

Yeah, you'll see some -- you will see similarity to 2023. Q3, as we've seen historically, is the highest quarter followed by Q2, then Q1, and lastly Q4.

是的，你會看到一些東西——你會看到與 2023 年的相似之處。正如我們從歷史上看到的那樣，第三季度是最高的季度，其次是第二季度，然後是第一季度，最後是第四季度。

That's helpful. And on the MA utilization comment, that was a new comment. I thought that the previous commentary or the way you were talking about it was that you weren't seeing really MA utilization pressure and that maybe you thought that regionally it was more of a problem elsewhere, but it sounds like in Q4 you were surprised by that. And so you do have like -- with delegated claims more visibility into it, but why wouldn't that have been picked up in like the Q3 call?

這很有幫助。關於 MA 利用評論，這是一個新評論。我認為之前的評論或您談論的方式是，您沒有看到真正的 MA 利用率壓力，也許您認為從區域角度來看，其他地方的問題更大，但聽起來您在第四季度感到驚訝那。因此，您確實有類似的委託聲明，可以對其進行更多了解，但為什麼沒有像第三季電話會議那樣注意到這一點呢？

Yeah, I think what we're trying to say is, in Q4, November, December, we saw a slight uptick as we have seen in historical years, and that is captured in our guidance.

是的，我認為我們想說的是，在第四季度、11 月、12 月，我們看到了歷史年份中看到的輕微上升，這在我們的指導中得到了體現。

Okay. So slight uptick is similar to, like, sequentially, you're saying, and that's a similar sequential increase to historical, or you're saying you're starting to see some of the pressure that -- the outsized pressure that other payers are talking about?

好的。因此，輕微的上升類似於您所說的連續增長，這與歷史記錄類似，或者您說您開始看到一些壓力——其他付款人面臨的巨大壓力談論什麼？

Yes, that's correct, Adam. I think we had commented before that we are seeing slight increases in certain pockets, you know, inpatient, senior utilization, for example, certain elective surgeries. I think we had discussed that on previous earnings calls, but nothing that we couldn't manage through and nothing that would have changed our guidance. I don't want to say that there is literally zero impact that we are feeling. It is something that we have managed through and is included in our guidance for 2024.

是的，這是正確的，亞當。我想我們之前曾評論過，我們看到某些領域略有增加，你知道，住院病人、老年人的使用率，例如某些選擇性手術。我想我們在之前的財報電話會議上已經討論過這個問題，但沒有什麼是我們無法解決的，也沒有什麼會改變我們的指導。我不想說我們感受到的影響其實是零。我們已經解決了這個問題，並將其納入我們的 2024 年指導中。

Okay. And if I heard you -- just want to clarify the last thing. If I heard you correctly, you're saying, what is the $14 million bonus you were mentioning that was in cost of services?

好的。如果我聽到你的話——只是想澄清最後一件事。如果我沒聽錯的話，您是說，您提到的服務成本中的 1400 萬美元獎金是多少？

So pre the spin-off of the APC-excluded assets, if APC-excluded assets does a bonus distribution as they did in Q4 to their shareholders, that ends up running through the consolidated P&L. So oftentimes there's a question around, well, why did implied MCR go up? So I just wanted to be very clear in terms of what that bonus was, the amount, and when it happened. Yeah, going forward, you won't see this happen.

因此，在分拆不包括 APC 的資產之前，如果不包括 APC 的資產像第四季度那樣向股東進行紅利分配，那麼最終會納入合併損益表。所以常常有人問，為什麼隱含 MCR 會上升？所以我只是想非常清楚地說明獎金是什麼、金額以及何時發生。是的，展望未來，你不會看到這種情況發生。

Okay. I guess last one, if I could squeeze it in. The cost-of-service ratio, if we just divide and maybe take out the $14 million payment in 2023, would you think it'd be higher or lower in 2024, and what would be the drivers around that? That would be my last question.

好的。我想最後一個，如果我能把它塞進去的話。服務成本比率，如果我們在 2023 年將 1400 萬美元的付款分開並取出，您認為 2024 年它會更高還是更低？驅動因素是什麼？這是我的最後一個問題。

I would say it's going to be pretty consistent. If you look at the partners segment specifically and the cost-of-care ratio for '23 in partners, we expect it to be pretty consistent in '24.

我想說它會非常一致。如果您具體查看合作夥伴細分市場以及合作夥伴中 '23 的護理成本比率，我們預計它在 '24 中將非常一致。

Perfect.

完美的。

Jack Slevin, Jeffries.

傑克·斯萊文，杰弗里斯。

Hi, guys. Congrats on the quarter and thanks for taking the question. Happy to be jumping on here. A lot of them already asked. For me, I guess looking forward, right, it has been a couple months since we've seen announcements of new partnerships, whether it be enablement or some others, right, since 3Q call. How is the pipeline shaping up when you think about the enablement business, both in California and then maybe filling out some of the other geographies. Any color you can get there would be really great.

嗨，大家好。恭喜本季度，感謝您提出問題。很高興能在這裡跳躍。很多人已經問過了。對我來說，我想展望未來，對吧，自第三季電話會議以來，我們已經有幾個月沒有看到新合作夥伴關係的公告了，無論是支持還是其他一些合作夥伴關係。當您考慮加州以及其他一些地區的支援業務時，管道是如何形成的。你能買到的任何顏色都會很棒。

Hi, Jack. Thank you for joining the call. So I think overall, the new business development pipeline remains very strong, probably as strong as we've ever seen it. With the turmoil in the market and some of the headwinds facing some of our other companies in this space, we think where we are one of the few differentiated players who can take risk. We're not shying away from taking risk in a prudent fashion, in a data-driven and analytics-driven fashion, and are able to succeed in those constructs. That means that when we go talk to provider groups, when we look for partnerships, even when we're selling our Care Enablement solutions into the market.

嗨，傑克。感謝您加入通話。因此，我認為總體而言，新業務開發管道仍然非常強勁，可能與我們所見過的一樣強勁。由於市場動盪以及我們在這個領域的其他一些公司面臨的一些阻力，我們認為我們是少數能夠承擔風險的差異化參與者之一。我們並不迴避以謹慎的方式、以數據驅動和分析驅動的方式承擔風險，並且能夠在這些結構中取得成功。這意味著當我們與提供者團體交談時，當我們尋找合作夥伴時，甚至當我們向市場銷售我們的護理支援解決方案時。

And remember, it's a flexible model for a given geography, depending on what the providers' preferences are in that market. We have a variety of tools to address those preferences. When we are selling those suite of products across enablement delivery and partners, we're seeing a tremendous response. I think over the past couple of years, there has been noise, and there has been a lot of capital at very low costs of capital that has shielded or hidden, kept hidden actual performance or lack thereof.

請記住，對於給定的地理位置，這是一個靈活的模型，具體取決於該市場中提供者的偏好。我們有多種工具來滿足這些偏好。當我們透過支援交付和合作夥伴銷售這些產品套件時，我們看到了巨大的反響。我認為在過去的幾年裡，出現了噪音，並且有大量資本以非常低的資本成本屏蔽或隱藏、隱藏實際績效或缺乏實際績效。

And as that environment has changed, as we're all aware on this call, our model continues to stand out as a differentiated model, and that's helping us win and participate in a large number of business development opportunities, some of which we have already shared with the public. So it's very strong, and we're excited to continue growing our impact across the country.

隨著環境的變化，正如我們在這次電話會議上都知道的那樣，我們的模式作為差異化模式繼續脫穎而出，這幫助我們贏得併參與大量業務發展機會，其中一些我們已經擁有與公眾分享。所以它非常強大，我們很高興能夠繼續擴大我們在全國範圍內的影響力。

Got it. Really, really helpful. One more for me. Just thinking about the commentary on continued 25% growth in the medium term and beyond in the presentation, when you look at that, revenue growth has been really strong. I guess the sense that the rest of the industry has is that '24 is the bottom when it comes to margins and profitability in risk-based businesses.

知道了。真的，真的很有幫助。再給我一份。只要想想簡報中對中期及以後持續 25% 成長的評論，當你看到這一點時，收入成長確實非常強勁。我猜業內其他人的感覺是，就基於風險的業務的利潤率和盈利能力而言，24 年是底部。

Do you get the sense that you've scaled through it and weathered some of it and there's opportunity for an acceleration in core economics as you look to '25 and '26 or let me know, I guess, how you're thinking about that sustainable growth outlook and where we sit as far as your financials from a utilization perspective in '24?

你是否感覺到你已經經歷了它並經受住了其中的一些考驗，當你展望'25和'26時，核心經濟有機會加速，或者讓我知道，我想，你是如何看待這個問題的可持續成長前景以及我們從24 年利用率角度來看您的財務狀況如何？

Sure. No, thanks for the question. I want to start off quickly by remembering what the company looked like in 2019 when I joined this organization. We had done $561 million of revenue, $54.2 million of adjusted EBITDA. Mid point of guidance for this year is $1.75 billion of revenue and $175 million of adjusted EBITDA. That is, we have grown the business at a 26% CAGR clip on both the top and the bottom lines for five years in a row. And that's not going to change going forward. That's something that we have the proven ability to manage through, whether a cycle comes, a cycle goes, companies come, peers come, peers go.

當然。不，謝謝你的提問。我想快速開始，記住 2019 年我加入這個組織時公司的情況。我們的營收為 5.61 億美元，調整後 EBITDA 為 5,420 萬美元。今年的指導中位數是 17.5 億美元的營收和 1.75 億美元的調整後 EBITDA。也就是說，我們的業務收入和利潤連續五年以 26% 的複合年增長率成長。未來這一點不會改變。這是我們已經證明有能力管理的事情，無論一個週期來了，一個週期去了，公司來了，同行了，同行走了。

Our model has been durable. It is diversified across lines of business. It is now becoming increasingly diversified across geography, and it is backed by a world-class data engineering team and software engineering platform that allows us to have visibility into the future that we think will serve us well as we take on more risk.

我們的模型非常耐用。它的業務多元化。現在，它在地理上變得越來越多元化，並得到了世界一流的數據工程團隊和軟體工程平台的支持，使我們能夠洞察未來，我們認為這將在我們承擔更多風險時為我們帶來好處。

Given the immediate levers that Chan had discussed, for example, some of the movement into -- sorry, movement into full-risk contracts in California, we believe that already gives us strong visibility into that continued near-term revenue and EBITDA growth. And frankly, any geographies continuing to succeed are almost a cherry on top.

考慮到陳所討論的直接槓桿，例如，一些轉向——抱歉，轉向加州的全風險合同，我們相信，這已經讓我們對近期收入和 EBITDA 的持續增長有了很強的了解。坦白說，任何繼續取得成功的地區幾乎都是錦上添花。

But it is part of our growth algorithm to continue growing one or two markets a year. We are seeing new markets so far ramp as expected, and we're very optimistic, especially given the business development pipeline, as I mentioned earlier, around where we can go for the next three to five years at least.

但每年繼續成長一兩個市場是我們成長演算法的一部分。到目前為止，我們看到新市場正在按預期成長，我們非常樂觀，特別是考慮到業務開發管道，正如我之前提到的，至少在未來三到五年內我們可以發展。

Really helpful color, Brandon. Appreciate it. Congrats again on the quarter and all the recent developments.

真的很有幫助的顏色，布蘭登。欣賞它。再次恭喜本季度和所有最近的進展。

Jailendra Singh, Truist Securities.

Jailendra Singh，Truist 證券公司。

First of all, I want to go back to BASS Medical Group Partnership topic. Was this a comparative process or more of an exclusive discussion? And there was some confusion on the loan that was offered to BASS as part of inter-partnership. Maybe you can help clarify that as well.

首先，我想回到BASS醫療集團合作關係的話題。這是一個比較過程還是更多的排他性討論？作為合作夥伴關係的一部分，向 BASS 提供的貸款也存在一些混亂。也許你也可以幫助澄清這一點。

Hi, Jailendra. Thank you for joining the call. It's great to hear from you. Yes, happy to answer those questions. Without saying too much, I would say that the process was a competitive one. We were not the only bidder in the process, and we are glad that we were chosen. And I think the durability of the model, that we've proven the growth - the consistent growth of that model, both on the revenue and adjusted EBITDA lines, were proof points, you know, for that group, among others, including our, you know, demonstration of our technology, the demonstration of our care models, the alignment mechanisms that we use, et cetera, to help win that process. But to answer your question, to our knowledge, it was a competitive process.

嗨，賈蘭德拉。感謝您加入通話。很高興收到你的來信。是的，很高興回答這些問題。不用說太多，我想說這個過程是一個競爭過程。我們並不是這個過程中唯一的投標人，我們很高興被選中。我認為該模型的耐用性，我們已經證明了增長 - 該模型在收入和調整後的 EBITDA 方面的持續增長，是證明點，你知道，對於該群體以及其他人來說，包括我們的，你知道，展示我們的技術、展示我們的護理模式、我們使用的協調機制等等，以幫助贏得這一進程。但據我們所知，回答你的問題是一個競爭過程。

Around the loan, I think we disclosed more information around the loan in our press release associated with our four year earnings. So, I'm happy to answer any other questions around the loan if that has not been answered, but the intent is for them to invest those dollars alongside us to continue to expand the footprint of both primary and multi-specialty care across the San Francisco Bay Area.

關於貸款，我認為我們在與我們四年收益相關的新聞稿中披露了更多有關貸款的資訊。因此，如果尚未得到解答，我很樂意回答有關貸款的任何其他問題，但目的是讓他們與我們一起投資這些美元，以繼續擴大整個舊金山的初級和多專業護理的足跡舊金山灣區。

Okay. And then my follow-up here is that I know you gave some color around revenue and EBITDA growth on a consolidated basis. I was just wondering if you can provide a little bit more color around expectations across the three business segments like care enablement, partners, and delivery, either directionally or qualitatively in terms of revenue growth and EBITDA trends in '24 versus last year?

好的。我的後續行動是，我知道您對合併後的收入和 EBITDA 成長進行了一些闡述。我只是想知道您是否可以就 24 年與去年相比的收入增長和 EBITDA 趨勢方面的方向性或質量性方面，圍繞護理支持、合作夥伴和交付等三個業務部門的預期提供更多信息？

Hi, Jailendra. Thanks for the question. The majority of our growth will be based in our partners division, since it is the majority of our revenue today. With our continued growth in relationships, as well as our rich BD pipeline, you will see a large portion of that growth come through partners. Enablement will grow equivalently to partners. And in terms of delivery, I would not - delivery will grow as it's grown historically. It won't scale at the level of partners.

嗨，賈蘭德拉。謝謝你的提問。我們的大部分成長將來自我們的合作夥伴部門，因為它是我們今天收入的大部分。隨著我們關係的持續成長以及我們豐富的業務發展管道，您將看到很大一部分成長來自合作夥伴。支援將與合作夥伴同等增長。在交付方面，我不會——交付會隨著歷史的增長而增長。它不會在合作夥伴層面上擴展。

Okay. And then my last one around this community family group acquisition, I believe when you announced the deal, it was expected to generate like around $190 million revenue and $25 million EBITDA. But based on some filings in California, it looks like perhaps it's generating a higher run rate of revenue. Is that driven by moving some of these lives to full risk with the RKK license that is being acquired here?

好的。然後是我關於社區家庭集團收購的最後一篇文章，我相信當您宣布這項交易時，預計將產生約 1.9 億美元的收入和 2500 萬美元的 EBITDA。但根據加州的一些文件，看起來它可能會產生更高的收入運行率。這是因為這裡獲得的 RKK 許可證讓其中一些人面臨完全的風險嗎？

Yes, exactly, Jailendra. Thank you for doing the research there. That's great. I think we had previously noted that in the middle of 2023, when CFC was still a care enablement client of ours, that we had helped them successfully move from a partial risk to a full risk construct. And the 190 number was a trailing 12-month number as of the reported date. I forget exactly the date, but it was not including the full year impact of that change from partial risk to full risk.

是的，確實如此，賈蘭德拉。感謝您在那裡進行研究。那太棒了。我想我們之前已經注意到，在 2023 年中期，當 CFC 仍然是我們的護理支援客戶時，我們已經幫助他們成功地從部分風險轉變為完全風險結構。190 是截至報告日期的過去 12 個月的數字。我忘記了確切的日期，但它不包括從部分風險到完全風險的變化對全年的影響。

That's also part of why we had previously noted in previous calls that there was infrastructure we had invested in, technology, people, services, et cetera, operations in 2022 and '23 in order to fully enable that shift of our care enablement clients, you know, close to 200,000, maybe 190,000 members into a four-way construct.

這也是為什麼我們之前在先前的電話會議中指出，我們投資了基礎設施、技術、人員、服務等，以及 2022 年和 23 年的運營，以便充分實現我們的護理支持客戶的轉變，您要知道，接近200,000，也許190,000 名成員加入了四向結構。

That's also why we guided to us being confident that we can redo this or continue to do this rather across both our own Restricted Knox Keene license that we had already had as well as the one that we hope to close on that Chan mentioned earlier sometime, you know, by the end of Q1. So, to answer your question, yes, that was part of the impact was the movement into the Restricted Knox Keene full risk construct for the 190,000 or so members.

這也是為什麼我們引導我們充滿信心，我們可以重做或繼續這樣做，而不是透過我們自己已經擁有的受限諾克斯基恩許可證以及我們希望在某個時候完成陳早些時候提到的許可證，你知道，到第一季末。所以，回答你的問題，是的，影響的一部分是為大約 190,000 名會員進入受限諾克斯基恩完全風險結構。

Great. Thanks, guys.

偉大的。多謝你們。

Thank you so much, Jailendra.

非常感謝你，賈蘭德拉。

Gary Taylor, TD Cowen.

加里·泰勒，TD·考恩。

Hi. Good evening. Most of my questions answered. Just wanted to ask a couple. You talked about just a little bit of elevated trend in MA and obviously you're moving increasingly to full risk. How are you guys tackling supplemental benefits, particularly around OTC and flex that really seem to catch a lot of capitated groups off guard because one, they haven't carted those out and two, they haven't been able to find much ability to impact that benefit consumption.

你好。晚安.我的大部分問題都得到了解答。只是想問幾個。您談到了移動平均線的一點上升趨勢，顯然您正在逐漸轉向全面風險。你們如何解決補充福利問題，特別是在 OTC 和 Flex 方面，這似乎確實讓很多資本群體措手不及，因為一，他們還沒有把這些福利拿出來，二，他們還沒有找到太大的影響能力從而有利於消費。

Hi, Gary, good to hear from you. So it is a continuous focus within the California market, especially Los Angeles County being one of the most competitive in terms of OTC and supplemental benefits. Over time, we've worked with the plans to get to the appropriate contract type that allows us to make sure we are getting the appropriate dollars that we need to take care of the members and we're not impacted by potential changes around OTC benefits and other supplementary benefits.

嗨，加里，很高興收到你的來信。因此，這是加州市場持續關注的焦點，尤其是洛杉磯縣，它是 OTC 和補充福利最具競爭力的縣之一。隨著時間的推移，我們制定了適當的合約類型的計劃，這使我們能夠確保我們獲得照顧會員所需的適當資金，並且我們不會受到 OTC 福利潛在變化的影響以及其他補充福利。

Also, there's good payer diversity in terms of the percentage of our revenue that comes from any one health plan. And so, there is, you know, there's a bit of a hedge across our business, across both line of business, you know, Medicaid and Medicare, commercial as well as in terms of which plan that we are talking about in terms of these specific subliminal benefits involved.

此外，就任何一項健康計劃的收入百分比而言，付款人也具有良好的多樣性。因此，您知道，我們的業務、醫療補助和醫療保險、商業以及我們正在談論的計劃方面都存在一些對沖。涉及特定的潛意識利益。

Got it. Well, apparently some pretty good foresight there, then, versus peers. My last one would just be, my understanding is California DHCS is going to hold Restricted Knox-Keene and other risk-bearing groups to 85% MLR in 2025, but the actual formula for how that will be calculated hasn't been finalized in the regs, or at least I haven't seen it. Do you know if those regs are finalized, and then how do you think about that minimum MLR impacting your shift to full risk in California in the next couple of years?

知道了。嗯，與同行相比，顯然有一些相當好的遠見。我的最後一個想法是，我的理解是，加州 DHCS 將在 2025 年將受限制的諾克斯-基恩和其他風險承擔群體的 MLR 控制在 85%，但實際的計算公式尚未最終確定。規則，或者至少我沒見過。您知道這些規定是否最終確定嗎？那麼您如何看待最低 MLR 會影響您未來幾年在加州轉向完全風險的情況？

Yes, it's a great question, Gary. First part of your question, the regs have not yet been finalized, and we're working closely with other providers in the coalition to better understand the regulations as they're coming together. In terms of the second part of your question, you are right. There is this DHCS requirement associated with the Medi-Cal book of business and the MLR associated with it. Now I just want to remind you we have multiple lines of business and we believe we will be able to work through this as we have done with other regulatory changes within the state.

是的，這是一個很好的問題，加里。你的問題的第一部分是，這些法規尚未最終確定，我們正在與聯盟中的其他提供者密切合作，以便在法規出台時更好地理解這些法規。就你問題的第二部分而言，你是對的。此 DHCS 要求與 Medi-Cal 業務手冊和與之相關的 MLR 相關。現在我只想提醒您，我們有多個業務線，我們相信我們將能夠解決這個問題，就像我們在州內其他監管變化中所做的那樣。

Okay. Got it. Thank you.

好的。知道了。謝謝。

Thank you. There are no further questions at this time.

謝謝。目前沒有其他問題。

Thank you all for joining our earnings call today and for discussing some of the results from our 2023 full year, as well as some of our guidance for 2024. We greatly appreciate the time you spent this evening. And please reach out to us at investors at astranahealth.com if you have any further questions. Thank you again and good evening.

感謝大家今天參加我們的財報電話會議，並討論我們 2023 年全年的一些結果以及我們對 2024 年的一些指導。我們非常感謝您今晚度過的時光。如果您有任何其他問題，請透過 astranahealth.com 聯絡我們的投資者。再次感謝您，晚上好。

Thank you. That concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation.

謝謝。今天的電話會議到此結束。此時您可以斷開線路。感謝您的參與。