Astrana Health Inc (ASTH) 2024 Q2 法說會逐字稿

Good day, everyone, and welcome to today's Astrana Health Second Quarter 2024 earnings call. (Operator Instructions) Today's speakers will be Brandon Sim, President and Chief Executive Officer of Astrana Health; and Chan Basho, our Chief Operating and Financial Officer.

大家好，歡迎參加今天的 Astrana Health 2024 年第二季財報電話會議。（操作員說明）今天的演講者是 Astrana Health 總裁兼執行長 Brandon Sim；以及我們的首席營運和財務長 Chan Basho。

The press release announcing Astrana Health Inc's results for the second quarter ended June 30, 2024, is available at the Investors section of the company's website at www.astranahealth.com. The company will discuss certain non-GAAP measures during this call.

宣布 Astrana Health Inc 截至 2024 年 6 月 30 日的第二季業績的新聞稿可在該公司網站 www.astranahealth.com 的投資者部分取得。該公司將在本次電話會議上討論某些非公認會計準則措施。

Reconciliations to the most comparable GAAP measure are included in the press release 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 a strong health website after the conclusion of this call.

新聞稿中包含了與最具可比性的公認會計準則衡量標準的調節，以提供有關其結果的一些額外背景。該公司已在其網站上提供了補充資料。電話會議結束後，還將在一個強大的健康網站上重播該廣播。

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.

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附帶信息均包含 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。

These forward-looking statements can be identified by terms such as anticipate, believe or expect future plan outlook and will include, among other things, statements regarding the company's guidance for the year ending December 31, 2024, for continued growth or acquisition strategy, ability to deliver sustainable long-term value, ability to respond to changing environment, operational focus, strategic growth plans and merger integration efforts.

這些前瞻性陳述可以透過預期、相信或預期未來計畫前景等術語來識別，除其他外，將包括有關公司截至 2024 年 12 月 31 日的年度指導、持續成長或收購策略、能力的陳述。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 materially from those projected and there can be no assurance that those expectations will prove to be correct.

儘管該公司認為截至目前其前瞻性陳述中所反映的預期是合理的。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重大差異，並且不能保證這些預期將被證明是正確的。

Information about the risks associated with investing in Astrana 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 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.

有關投資 Astrana 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先查看這些文件。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 Astrana Health, President and Chief Executive Officer, Brandon Sim, please go ahead, Brandon.

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

Thank you, operator. Good evening, and thank you all for joining us today, continuing our strong start to the year. The second quarter results we reported today reflect the progress, scale and momentum. We continue to build here at a strong health as we drive towards our mission to empower entrepreneurial providers and deliver high-quality, high-value and accessible health care to local communities across the country.

謝謝你，接線生。晚上好，感謝大家今天加入我們，繼續我們今年的強勁開局。我們今天報告的第二季業績反映了進展、規模和勢頭。我們繼續在這裡建立強大的健康體系，努力實現我們的使命，賦予創業提供者權力，並為全國各地的當地社區提供高品質、高價值和可及的醫療保健服務。

I'll start with some key financial and operational updates for the quarter, which continue to deliver on our strategic roadmap of one, increasing membership and drive sustainable growth to increasing alignment through total cost of care responsibility in value-based arrangements.

我將從本季度的一些關鍵財務和營運更新開始，這些更新將繼續實現我們的策略路線圖，即增加會員數量並推動可持續成長，以透過基於價值的安排中的總護理責任成本來增強一致性。

And three, empowering our providers with our technology and clinical infrastructure in order to achieve superior patient outcomes while managing costs. Then I'll cover the partnerships and acquisition. We announced since the quarter close, and Chan will discuss our financial performance and guidance outlook.

第三，利用我們的技術和臨床基礎設施為我們的提供者提供支持，以便在管理成本的同時實現卓越的患者治療效果。然後我將介紹合作夥伴關係和收購。我們自季度結束以來就宣布了這一消息，陳將討論我們的財務表現和指導前景。

Starting with financial highlights, we continued to execute at a high level as strong and health revenue grew to $486.3 million, a 40% increase compared to the same period last year. And adjusted EBITDA rose to $47.9 million, a 34% increase year over year. This resulted in an adjusted EBITDA margin of approximately 10%, continuing to demonstrate our differentiated ability to drive profitable growth.

從財務亮點開始，我們繼續保持高水準執行，醫療保健收入成長至 4.863 億美元，與去年同期相比成長 40%。調整後 EBITDA 升至 4,790 萬美元，較去年同期成長 34%。這導致調整後的 EBITDA 利潤率約為 10%，繼續證明了我們推動獲利成長的差異化能力。

Our strong revenue and profitability growth was driven primarily by robust organic growth in our care partner segment, as well as the successful completion and integration of the community Family Care acquisition, along with continued success in managing the total cost of care for our members and value-based risk-bearing arrangers.

我們強勁的收入和盈利能力增長主要得益於我們的護理合作夥伴細分市場的強勁有機增長，以及社區家庭護理收購的成功完成和整合，以及在管理會員總護理成本和價值方面的持續成功基於風險承擔的安排者。

Moving on to business updates, Astrana continue to execute on our first strategic pillar, increasing membership in new and existing geographies. During the second quarter, we entered the state of Arizona through our care partner segment, partnering with an anchor primary care physician group with over 45 primary care providers serving over 50,000 patients across Medicare, Medicaid and commercial lines of business.

接下來是業務更新，阿斯特拉納繼續執行我們的第一個戰略支柱，增加新地區和現有地區的會員數量。第二季度，我們透過護理合作夥伴部門進入亞利桑那州，與一個擁有超過 45 家初級保健提供者的主力初級保健醫生團隊合作，為 Medicare、Medicaid 和商業業務線的 50,000 多名患者提供服務。

Astrana will serve as the group's exclusive care enablement provider with providers anticipated to onboard into our care enablement platform by the end of 2024 and expected to begin participating in value-based arrangements in 2025.

阿斯特拉納將作為該集團的獨家護理支援提供商，預計供應商將於 2024 年底加入我們的護理支援平台，並預計於 2025 年開始參與基於價值的安排。

We also continue to make progress on our second goal, increasing our responsibility for members, total cost of care and value-based arrangements. From a timing perspective, the movement of several partial risk contracts into full-risk arrangements is expected to occur in the second half of the year.

我們也繼續在第二個目標上取得進展，增加我們對會員的責任、總照護成本和基於價值的安排。從時間角度來看，一些部分風險合約轉向全風險安排的轉變預計將在今年下半年發生。

As of July 1, 2024, our full-risk business makes up approximately 60% of total capitation revenue compared to 46% as of July 1, 2023. And we continue to be on track to meet our previously stated goal of having around two thirds of our capitation revenue coming from a full risk ecosystem by January 1, 2025.

截至 2024 年 7 月 1 日，我們的全風險業務約佔總人均收入的 60%，而截至 2023 年 7 月 1 日這一比例為 46%。我們繼續被期望實現先前提出的目標，即到 2025 年 1 月 1 日，我們約有三分之二的人均收入來自完整的風險生態系統。

Finally, consistent with recent quarters, our utilization and cost trends in the second quarter have remained within expectations for our Medicare Advantage managed Medicaid and commercial books of business. Given our continued focus on ensuring members are receiving timely and appropriate care in the right settings.

最後，與最近幾季一致，我們第二季的使用率和成本趨勢仍符合我們的 Medicare Advantage 管理的醫療補助和商業業務帳簿的預期。鑑於我們持續關注確保會員在正確的環境中獲得及時和適當的照顧。

We are noticing a small uptick in inpatient utilization related to a surge in COVID-19 cases throughout California, but we believe we remain within expectations in terms of current year guidance, and we will continue to monitor the situation as it relates to our Medicare ACOs. We have noticed an uptick in cost trends, but that increase remains lower than national trend.

我們注意到，與整個加州COVID-19 病例激增相關的住院患者利用率小幅上升，但我們相信，就今年的指導而言，我們仍處於預期之內，並且我們將繼續監控與我們的Medicare ACO 相關的情況。我們注意到成本趨勢有所上升，但增幅仍低於全國趨勢。

Moving on to recent activity, we continue to believe that our platform, consisting of clinical capabilities, proprietary technology and a strong operating team drives our differentiated ability to produce operating leverage, great patient outcomes and ultimately, our goal of sustainable high growth with effectively manage costs.

談到最近的活動，我們仍然相信，我們的平台由臨床能力、專有技術和強大的運營團隊組成，能夠推動我們產生運營槓桿、良好的患者治療效果的差異化能力，並最終實現我們通過有效管理實現可持續高成長的目標。

And after the quarter ended, we continue to be active in order to capitalize on those advantages, investing in continued organic and inorganic growth through several parts, several partnerships as well as an acquisition. First, we deepened our relationship with one of our important payer partners, Anthem Blue Cross by entering into a partnership where we will build and operate primary care clinics that are jointly branded between Astrana Care and Anthem Blue Cross.

在本季度結束後，我們繼續積極利用這些優勢，透過多個部門、多個合作夥伴關係以及收購來投資於持續的有機和無機成長。首先，我們加深了與我們重要的付款合作夥伴之一 Anthem Blue Cross 的關係，建立了合作夥伴關係，我們將建立和營運由 Astrana Care 和 Anthem Blue Cross 聯合品牌的初級保健診所。

The partnership underscores our organization's commitment to increasing access to care and in particular will be focused on providing a convenient delightful consumer experience complete with readily available walk-in visits, same-day telemedicine, online appointment scheduling and the latest technology.

此次合作強調了我們組織致力於增加獲得醫療服務的機會，特別是致力於提供便利、愉快的消費者體驗，包括方便的上門就診、當日遠距醫療、線上預約安排和最新技術。

Our very first Astrana Care, Anthem Blue Cross clinic has already opened in Whittier, California, and we look forward to continuing our partnership with a pipeline of clinics across the state of California.

我們的第一家 Astrana Care Anthem Blue Cross 診所已在加州惠提爾開業，我們期待繼續與加州的一系列診所合作。

Next, we announced that we joined forces with elation health a primary care focused electronic health record company, serving over 32,000 clinicians in order to form a nationwide partnership to empower primary care providers in value-based care.

接下來，我們宣布與Elation Health 合作，這是一家專注於初級保健的電子健康記錄公司，為超過32,000 名臨床醫生提供服務，以建立全國性的合作夥伴關係，為初級保健提供者提供基於價值的護理。

The first part of our partnership is a collaboration to build and scale risk-bearing entities, including accountable care organizations and clinically integrated networks anchored by providers on allegiance platform policing will support providers in these networks with its EHR and billing technology, while Astrana will serve as the exclusive care enablement partner for these risk-bearing entities as well as take on risk when appropriate in our care partners business.

我們合作夥伴關係的第一部分是合作建立和擴展風險承擔實體，包括責任護理組織和由忠誠平台上的提供者錨定的臨床整合網絡，警務將透過其電子病歷和計費技術支援這些網絡中的提供者，而阿斯特拉納將提供服務作為這些風險承擔實體的獨家護理支援合作夥伴，並在我們的護理合作夥伴業務中適當承擔風險。

In combination, we believe that this partnership will demonstrate that the right tools and organizational capabilities in jointly scale sustainable value-based care.

總而言之，我們相信這種夥伴關係將證明正確的工具和組織能力可以共同擴展可持續的基於價值的護理。

Second part of the partnership is to put that model into practice, we entered the state of Hawaii as part of this collaboration, partnering with a provider organization of over 100 primary care providers serving just under 20,000, primarily Medicare Hawaii. Operationally, we have already onboarded that organization onto our care, enabling platform with full integration expected to be completed by the end of the third quarter of 2024. In addition, we expect to begin participating in risk-bearing arrangements through our care partner segment in that state by 2025.

合作夥伴關係的第二部分是將這一模式付諸實踐，作為合作的一部分，我們進入了夏威夷州，與一個由100 多家初級保健提供者組成的提供者組織合作，為近20,000 人提供服務，主要是夏威夷醫療保險。在營運上，我們已經將該組織納入我們的照顧範圍，實現完全整合的平台預計將在 2024 年第三季末完成。此外，我們預計到 2025 年將開始透過我們在該州的護理合作夥伴部門參與風險承擔安排。

Finally, I'm excited to share more about our recently announced definitive agreement to acquire Collaborative Health Systems or CHS, a value-based care enablement organization serving around 2,500 primary care providers and 100,000 primarily senior members, and the company of Centene Corporation.

最後，我很高興與大家分享更多有關我們最近宣布的收購Collaborative Health Systems 或CHS 的最終協議的信息，CHS 是一家為約2,500 名初級保健提供者和100,000 名主要高級會員提供服務的基於價值的護理支援組織，以及Centene Corporation 公司。

The acquisition of CHS further supports our mission to expand our footprint in order to provide high-quality and high value care to all Americans. Strategically, CHS is a natural fit in three ways. First, CHS's provider network bolsters and complements our existing Texas network, as well as provides us meaningful density across states in the South and along the East Coast, including New Mexico, Alabama, Georgia, Florida, Virginia, Maryland and Connecticut. Second, we believe that, there exists an opportunity for us to further develop clinical processes and care models and drive operational efficiencies across the CHS enterprise through our care enablement platform, a playbook that we've deployed successfully before across multiple markets.

收購 CHS 進一步支持我們擴大業務範圍的使命，以便為所有美國人提供高品質和高價值的照護。從策略上講，CHS 在三個方面是天然契合的。首先，CHS 的提供者網絡增強並補充了我們現有的德克薩斯州網絡，並為我們提供了南部和東海岸各州的有意義的密度，包括新墨西哥州、阿拉巴馬州、喬治亞州、佛羅裡達州、維吉尼亞州、馬裡蘭州和康乃狄克州。其次，我們相信，我們有機會進一步開發臨床流程和護理模式，並透過我們的護理支援平台（我們先前在多個市場成功部署的劇本）來提高整個 CHS 企業的營運效率。

Third, CHS and its existing full risk contracts across multiple payers and geographies advances our ability to participate in value-based arrangements that will allow us to make greater investments in local communities and align reimbursement with outcomes.

第三，CHS 及其現有的跨多個付款人和地區的全風險合約提高了我們參與基於價值的安排的能力，這將使我們能夠對當地社區進行更多投資，並使報銷與結果保持一致。

The intended acquisition of CHS requires regulatory approval and is not expected to close until later this year. The business is expected to run up to a $10 million loss on a standalone basis in 2024, but the pro forma impact to Astrana will be dependent on the close date, which we expect to occur in the fourth quarter of this year.

對 CHS 的收購計劃需要監管部門的批准，預計要到今年稍後才能完成。預計到 2024 年，該業務的獨立虧損將高達 1,000 萬美元，但對阿斯特拉納的預期影響將取決於截止日期，我們預計該截止日期將在今年第四季發生。

Upon closing, we plan to rapidly integrate the business and anticipate an annualized run rate revenue of around $450 million in 2025 with a breakeven adjusted EBITDA contribution. Over a three to four year period, we expect to operate the business at a more normalized adjusted EBITDA margin profile, like that of the core Astrana business.

交易完成後，我們計劃快速整合業務，預計 2025 年年化運作收入約為 4.5 億美元，並實現損益兩平調整後 EBITDA 貢獻。在三到四年的時間內，我們預計將以更正常化的調整後 EBITDA 利潤率狀況經營該業務，就像核心阿斯特拉納業務一樣。

With the deployment of our technology and clinical capabilities and with the synergies we believe exist across our complementary organizations, we believe that, we can drive access and high quality care for CHS' members, while also capturing the embedded EBITDA in the business in the near to midterm.

透過部署我們的技術和臨床能力，以及我們認為互補組織之間存在的協同效應，我們相信，我們可以推動 CHS 會員獲得高品質的護理，同時在不久的將來獲得業務中嵌入的 EBITDA到中期。

As you've now heard, Astrana Health is entering a new phase of scale. Through the three new partnerships and the acquisition I discussed today, we continue to not only reinforce our existing markets in California, Nevada, and Texas, but also plant meaningful footholds into nine new states across the Hawaiian Islands, the South, and the East Coast. Beginning in 2025, we anticipate that pro forma the CHS acquisition, Astrana Health will proudly serve over 1.1 million patients in value-based care arrangements across 12 states. And we plan to continue to grow at a rapid pace, while maintaining a focus on ensuring long-term sustainability and profitability.

正如您現在所聽說的，Astrana Health 正在進入一個新的規模階段。透過我今天討論的三個新的合作夥伴關係和收購，我們不僅繼續加強加州、內華達州和德克薩斯州的現有市場，而且還在夏威夷群島、南部和東海岸的九個新州建立有意義的立足點。從 2025 年開始，我們預計，在收購 CHS 後，Astrana Health 將自豪地為 12 個州的超過 110 萬名患者提供基於價值的護理安排。我們計劃繼續快速成長，同時繼續專注於確保長期可持續性和盈利能力。

As we've demonstrated in partnerships and acquisitions in the past, we intend to do this by driving the Astrana flywheel of: One, using our technology platform and operating leverage to drive efficiencies. Two, reinvesting those savings into patient access to care and local clinical capabilities, all powered by our scalable care models and analytics, which should ultimately, three, drive better patient outcomes and savings in risk-bearing arrangements.

正如我們過去在合作和收購中所展示的那樣，我們打算透過推動阿斯特拉納飛輪來實現這一目標：第一，利用我們的技術平台和營運槓桿來提高效率。第二，將這些節省的資金再投資於患者獲得護理和當地臨床能力的機會，所有這些都由我們可擴展的護理模型和分析提供支持，第三，最終將推動更好的患者治療結果並節省風險承擔安排。

We believe that our continued growth validates the Astrana flywheel, reinforces our depth in core markets, expands our organic growth opportunities, and continues to prove that value-based care can be done successfully in communities across the country.

我們相信，我們的持續成長驗證了阿斯特拉納飛輪，增強了我們在核心市場的深度，擴大了我們的有機成長機會，並繼續證明基於價值的護理可以在全國各地的社區成功開展。

In closing, I want to thank all our teammates, providers, and partners for their unwavering belief in our mission. With that, I'll now turn it to Chan Basho to discuss our financial performance and guidance outlook. Chan?

最後，我要感謝我們所有的隊友、提供者和合作夥伴對我們使命的堅定信念。接下來，我將請 Chan Basho 討論我們的財務表現和指導前景。陳？

Thank you, Brandon, and good evening, everyone. We achieved strong financial performance in Q2, thanks to focused execution of our strategy. While operating in a dynamic environment. We're pleased with the continued progress we are making in Q2 towards meeting our financial and company-wide commitments.

謝謝你，布蘭登，大家晚上好。由於集中執行我們的策略，我們在第二季度取得了強勁的財務表現。在動態環境中運行。我們對第二季在履行財務和全公司承諾方面取得的持續進展感到高興。

Total revenue this quarter increased 40% to $486.3 million compared to the prior year period, with carrier partners contributing $463.3 million in revenue, an increase of 44% compared to the prior year period. This growth was mainly fueled by higher capitation revenue, which resulted from the shift to full-risk arrangements within our core risk-bearing organizations and the incorporation of CFC earlier this year.

本季總收入較去年同期成長 40%，達到 4.863 億美元，其中營運商合作夥伴貢獻了 4.633 億美元的收入，較去年同期成長 44%。這一成長主要是由於我們的核心風險承擔組織內轉向全風險安排以及今年稍早合併 CFC 帶來的按人頭收入增加。

Adjusted EBITDA was $47.9 million in the quarter, which represents a 34% increase from $35.8 million in the prior year period. Net income attributable to Astrana Health was $19.2 million, an increase of 46% from $13.2 million in the prior year quarter. Earnings per share on a diluted basis were $0.4, up 43% from $0.28 in the prior year period.

本季調整後 EBITDA 為 4,790 萬美元，比去年同期的 3,580 萬美元成長 34%。Astrana Health 的淨利潤為 1,920 萬美元，比去年同期的 1,320 萬美元增長 46%。攤薄後每股收益為 0.4 美元，比去年同期的 0.28 美元增長 43%。

Now focusing on our balance sheet, our liquidity position remains strong with $325 million in cash and cash equivalents and total debt amounting to $446 million compared to $335 million in cash and cash equivalents and total debt of $393 million last quarter. Our total debt changed due to a strategic drawdown on our credit facility to finance the CSC acquisition.

現在關注我們的資產負債表，我們的流動性狀況依然強勁，現金和現金等價物為3.25 億美元，債務總額為4.46 億美元，而上季度現金和現金等價物為3.35 億美元，債務總額為3.93 億美元。由於為收購 CSC 融資而策略性削減信貸額度，我們的總債務發生了變化。

Cash flow from operating activities in the first half of 2024 were $29.2 million, which is a decline of $4.3 million compared to the prior year period, primarily driven by increase in working capital associated with the ACO reach program and income tax payments. We continue to expect our cash flow from operating activities for the year to be approximately 50% to 55% of adjusted EBITDA, as I mentioned previously.

2024 年上半年營運活動產生的現金流量為 2,920 萬美元，比上年同期減少 430 萬美元，主要是由於與 ACO 覆蓋範圍計劃和所得稅繳納相關的營運資金增加。正如我之前提到的，我們仍然預計今年經營活動產生的現金流量將約為調整後 EBITDA 的 50% 至 55%。

Finally, I'll wrap up my remarks by sharing our financial outlook for the year after taking our recent initiatives and capital allocation strategy into account, we are raising the bottom end of our revenue guidance to $1.75 billion while maintaining the top end of the range of $1.85 billion. We're maintaining our full year outlook for adjusted EBITDA as we continue to invest incremental profitability into developing new markets such as Arizona and Hawaii.

最後，在考慮到我們最近的舉措和資本配置策略後，我將透過分享我們今年的財務前景來結束我的發言，我們將收入指導的下限提高至 17.5 億美元，同時維持該範圍的上限18.5 億美元。我們維持調整後 EBITDA 的全年預期，因為我們繼續將增量獲利能力投資於開發亞利桑那州和夏威夷等新市場。

In addition, due to the purchase price allocation related to the acquisition of Community family care, IPA and health plan, we are updating our amortization of intangibles as a result we are revising our EPS guidance to a range of $1.12 to $1.36 per share. For a closer look at the quarterly cadence for the remainder of the year, we expect revenue to come in at around a $455 million run rate as we continue to move members into full-risk arrangements in the latter part of the year.

此外，由於與收購社區家庭護理、IPA 和健康計劃相關的購買價格分配，我們正在更新無形資產攤銷，因此我們將 EPS 指導修訂為每股 1.12 美元至 1.36 美元。為了更仔細地觀察今年剩餘時間的季度節奏，我們預計收入將達到 4.55 億美元左右，因為我們將在今年下半年繼續將會員納入全風險安排。

In terms of adjusted EBITDA, consistent with comments on our Q1 call, we expect the second quarter adjusted EBITDA contribution to represent the highest quarter this year, followed by a step down in the third quarter and another in the fourth. This deviates from historical patterns due to the inclusion this quarter of sweeps and quality incentive payments in the high single digit millions range, which we typical clean recognized during the third quarter in previous years.

就調整後 EBITDA 而言，與我們對第一季電話會議的評論一致，我們預計第二季調整後 EBITDA 貢獻將成為今年最高季度，隨後第三季和第四季將有所下降。這偏離了歷史模式，因為本季的掃蕩和品質獎勵支付金額高達數百萬美元，我們在前幾年的第三季通常都清楚地認識到了這一點。

Overall, we believe that our year-to-date results and revised guidance continue to demonstrate the strength and differentiation of our Astrana Health platform. Moving forward, we will continue to prioritize execution, operational efficiency and strategic capital allocation to position us for driving sustained growth and improving the market presence of our business.

總體而言，我們相信我們今年迄今的業績和修訂後的指導意見繼續證明了我們 Astrana Health 平台的優勢和差異化。展望未來，我們將繼續優先考慮執行、營運效率和策略資本配置，以推動我們業務的持續成長和提高市場佔有率。

With that, I'll leave it to you, operator for questions.

那麼，我將把問題留給接線員您。

(Operator Instrustions) Jailendra Singh, Truist Truist Securities.

（運營商信託公司）Jailendra Singh，Truist Truist 證券公司。

Thank you and thanks for taking my questions. I was wondering if you could provide a little bit more color on the utilization trends you experienced in Q2. I believe for Q1, you guys talked about bookmarking of your 5% trend, but ended up seeing 2.5%. I know you called out COVID-driven some inpatient utilization in California, but just curious how trends played out for Q2 versus your expectations, and any breakdown in terms of areas we are seeing favorable trends and areas where trends are running slightly higher?

謝謝您並感謝您回答我的問題。我想知道您是否可以提供更多關於您在第二季度經歷的利用率趨勢的資訊。我相信在第一季度，你們談論了 5% 趨勢的書籤，但最終看到了 2.5%。我知道您提到了加州由新冠疫情驅動的一些住院患者利用率，但只是好奇第二季度的趨勢與您的預期相比如何，以及我們看到有利趨勢的領域和趨勢略高的領域是否有任何細分？

Hey, Jailendra. Thanks for the question. Great to hear from you. In terms of utilization, they're very much overall within expectations for the second half of the year. We did expect to see we do expect to see a slight uptick in utilization and it's pretty consistent with seasonality, as you see in the latter part of the second half of the year.

嘿，賈蘭德拉。謝謝你的提問。很高興收到你的來信。就利用率而言，總體而言，它們在下半年的預期之內。我們確實預計利用率會略有上升，並且與季節性非常一致，正如您在今年下半年下半年所看到的那樣。

And also, as many of you've seen, there has been a slight uptick in terms of COVID in California, as well as we have built that into our guidance for the remainder of the year. It's nothing out of the blue and it's what we're prepared for.

而且，正如你們許多人所看到的，加州的新冠肺炎疫情略有上升，我們已將其納入今年剩餘時間的指導中。這並不是什麼突如其來的事情，我們已經準備好了。

And just to clarify, is that the primary reason why you did not narrow down EBITDA guidance range, but you did narrow down revenue guidance range that you can calculate but I need any outcome there.

需要澄清的是，這就是您沒有縮小 EBITDA 指導範圍的主要原因，但您確實縮小了可以計算的收入指導範圍，但我需要那裡的任何結果。

I think with the with the transactions that we've announced and our commitment around continuing to reinvest in the business we are on, we're at a good place in terms of our current profitability and on and we'll be using on any are opportunities to reinvest in the business as possible.

我認為，透過我們已經宣布的交易以及我們對繼續對我們正在進行的業務進行再投資的承諾，我們在當前的盈利能力方面處於一個良好的位置，並且我們將在任何領域使用盡可能對業務進行再投資的機會。

Okay. My quick follow up on the CHS margin ramp expectations as Brandon and you talked about getting to breakeven in 2025 after the deal is closed and improving in out years. Can you provide more specifics around synergies and key drivers considering that there are not many market overlaps between Australia and CHS and does the part of the margin ramp include moving some lives from partial risk to full risk, please?

好的。我對 CHS 利潤率的快速跟進提高了預期，布蘭登和您談到了交易完成後在 2025 年實現收支平衡，並在未來幾年有所改善。考慮到澳洲和CHS 之間沒有太多市場重疊，您能否提供有關協同效應和關鍵驅動因素的更多具體信息，並且利潤率上升的部分是否包括將一些人的生命從部分風險轉變為完全風險？

Just to clarify, the current guidance that Chan provided does not include, any sub period for CHS's intended acquisition. To answer your question, I believe in the earnings supplement, we provided some details around that ramp. CHS is expected to lose on an annualized run rate basis around $10 million or so on a run rate basis in 2024.

需要澄清的是，Chan 提供的當前指導不包括 CHS 擬收購的任何子時期。為了回答你的問題，我相信收入補充，我們提供了有關該斜坡的一些細節。以年化運行率計算，CHS 預計到 2024 年將損失約 1,000 萬美元左右。

We will update our guidance when we figure out when that is going to close, which is anticipated to take place in the fourth quarter of this year, pending regulatory approval and customary closing conditions. We think that, as mentioned before, by 2025, we should, with synergies, breakeven on that business, on an adjusted EBITDA contribution basis. We've committed to, that being at a profitable margin in 2026, and then at the $10 million mark or more in 2027. And that is, on the earnings supplement as well.

當我們確定何時結束時，我們將更新我們的指導意見，預計將在今年第四季進行，等待監管部門的批准並滿足慣例成交條件。我們認為，如同先前所提到的，到 2025 年，我們應該透過協同效應，在調整後的 EBITDA 貢獻的基礎上實現該業務的損益平衡。我們承諾在 2026 年實現盈利，並在 2027 年實現 1000 萬美元或更多。也就是說，還有收入補貼。

Thanks a lot.

多謝。

(Operator Instructions) Adam Ron, Bank of America.

（操作員指示）Adam Ron，美國銀行。

And thanks for the question. Got going sort of [central Andrew's] question. I think last quarter on the earnings call, you said that utilization was coming in a couple of hundred basis points better. And I believe that that was on a claims completion that was through the quarter end. So there, first to clarify, there wasn't any negative development from Q1 and then two.

謝謝你的提問。開始討論[中央安德魯的]問題。我認為上個季度的財報電話會議上，您說利用率提高了幾百個基點。我相信這是截至季度末的索賠完成。因此，首先需要澄清的是，第一季和第二季沒有任何負面進展。

If you're saying that now utilization is in line with expectations, but Q1 was so much further below. Is that now saying that Q2 is running 300 basis points above what you booked coming into the year? Just trying to understand the magnitude of what you're saying?

如果您說現在的利用率符合預期，但第一季的利用率遠低於預期。現在是說第二季的運行比您今年預訂的高出 300 個基點嗎？只是想了解你所說的話的嚴重性嗎？

Yes, Adam, yes. So just to kind of open up then kind of break apart that question last quarter, we and as we can see now, Q1 was better than expected in Q2. It's coming in line with what our expectations. It's on par for the quarter. And on that. Yes, it does. Does that make sense?

是的，亞當，是的。因此，為了打開並分解上個季度的問題，我們現在可以看到，第一季的表現好於第二季的預期。它符合我們的預期。與本季持平。關於這一點。是的，確實如此。這樣有道理嗎？

But that is it better than when you came into the year like versus initial guidance?

但這比你進入這一年時的初始指導更好嗎？

I would say it's really around where we expected for the quarter. We saw a slight uptick in the ACO population less than the national trends. And we, as you can see in terms of our guidance. We continue to see on that the year progressing well.

我想說，這確實符合我們對本季的預期。我們發現 ACO 人口略有上升，低於全國趨勢。正如您在我們的指導中看到的那樣。我們繼續看到這一年進展順利。

Okay. And then for the rest of the year and kind of just thinking about you mentioned outperformance funding additional expansion into new markets. And so does that mean that basically no matter what you're not planning on raising EBITDA guidance for the rest of the year, given that if there is upside you would be invested?

好的。然後在今年剩下的時間裡，想想你提到的出色表現，為進一步擴張新市場提供資金。那麼，這是否意味著基本上無論發生什麼，你都不打算提高今年剩餘時間的 EBITDA 指導，因為如果有上升空間，你就會進行投資？

And then in terms of like future years, how are you thinking about what do you consider to be excess upside versus what you would allow to flow to the bottom line? Like are you targeting like a 20% EBITDA growth number and then investing the rest? Like how are you weighing those things? Thanks.

然後，就未來幾年而言，您如何考慮什麼是您認為的過度上漲與您允許流入的底線？您的目標是 20% 的 EBITDA 成長數字，然後投資其餘部分嗎？例如你如何權衡這些東西？謝謝。

Hey, Adam. Thanks for the question. No, I wouldn't hold an EBITDA guidance change out of the question necessarily that we absolutely wouldn't. I think we're weighing the very strong pipeline of development activity that we're seeing, especially given some of the recent announcements. We've been putting effort into continuing to diversify the business, including, for example, with our partnership with Elation, and working on deepening now 12 states that we would be in, pro forma in 2025, deepening our relationships and networks and ability to hit the ground running there and capitalize on some of the synergies, that we expect to do so in 2025. So, I wouldn't say necessarily that, it's out of the question. But I do think that we're happy with 20% EBITDA, near to mid term kind of growth rate consistently. And we want to make sure that we're setting the foundation to really win and be the preeminent value-based care platform in the country in the near to mid term as well. So, we're balancing those two things and that's kind of where our investment and capital allocation is shaking now.

嘿，亞當。謝謝你的提問。不，我不會認為 EBITDA 指引的改變是不可能的，我們絕對不會。我認為我們正在權衡我們所看到的非常強勁的開發活動，特別是考慮到最近發布的一些公告。我們一直在努力繼續實現業務多元化，包括與 Elation 的合作夥伴關係，並致力於深化我們預計 2025 年將進入的 12 個州，深化我們的關係和網絡以及能力我們預計將在2025 年實現這一目標，並利用其中的一些協同效應。所以，我不一定這麼說，這是不可能的。但我確實認為我們對 20% 的 EBITDA 感到滿意，接近中期的持續成長率。我們希望確保我們為真正獲勝奠定基礎，並在中短期內成為該國卓越的基於價值的護理平台。因此，我們正在平衡這兩件事，這就是我們的投資和資本配置現在正在動搖的地方。

Appreciate it. Thank you.

欣賞它。謝謝。

Ryan Daniels, William Blair.

瑞恩·丹尼爾斯、威廉·布萊爾。

Yes. Thanks for taking the questions and congrats on the quarter and even more so the strategic developments. Maybe a couple on that, with the Elation EHR partnership to empower VBC for their providers, can you double click on that a little bit?

是的。感謝您提出問題並祝賀本季度，更重要的是戰略發展。也許有一些關於這一點，透過 Elation EHR 合作夥伴關係為他們的提供者提供 VBC，您可以雙擊一下嗎？

I'm curious, if that's something that's going to be sold by Elation back into that 32,000 clinician base, number one. And then number two, do you know how many of them are already in value based care arrangements such that it's not part of the addressable market? Is it really looking for those clinicians that haven't yet moved to leverage the care enablement platform to do so?

我很好奇，Elation 是否會將該產品重新賣回擁有 32,000 名臨床醫生的第一基地。第二，您知道其中有多少人已經處於基於價值的照護安排中，因此它不屬於目標市場的一部分嗎？它真的在尋找那些尚未利用護理支援平台的臨床醫生嗎？

Ryan, thanks for the question. Yes, there are two parts to this, or three parts really. I'll answer your questions first. We really envision it as a bidirectional partnership. For example, we're working to jointly sell Elation's electronic health record as well as our billing services, which are part of our care enabling platform, for example, to affiliate providers that are already bearing risk with us in some form or fashion.

瑞安，謝謝你的提問。是的，這有兩個部分，或者實際上是三個部分。我先回答你的問題。我們確實將其視為一種雙向合作關係。例如，我們正在努力共同銷售Elation 的電子健康記錄以及我們的計費服務，這些服務是我們的護理支援平台的一部分，例如，向已經以某種形式或方式與我們一起承擔風險的附屬提供者出售。

That's one. Two, certainly, we look to bring our risk-bearing capabilities and enablement capabilities to clinicians, those 32,000 clinicians that are already on the electronic health record, sold by Elation. There's definitely a large opportunity we believe to organize and aggregate providers into risk-bearing entities, such as ACOs or CINs in that population.

這是一個。第二，當然，我們希望將我們的風險承擔能力和支援能力帶給臨床醫生，即 Elation 出售的電子健康記錄中已經存在的 32,000 名臨床醫生。我們相信，將提供者組織和聚合到承擔風險的實體中，例如該群體中的 ACO 或 CIN，這絕對是一個巨大的機會。

I believe that a large majority of the 32,000 clinicians do not yet participate meaningfully in a value-based arrangement today. Certainly not all of Part B raised, certainly not full risk. So we think there is a meaningful market capture opportunity in terms of helping providers, who are on Eletion, which is suited for value-based care, especially given the integrations we're building out with them, to participate and move along their risk letter with us.

我相信，今天 32,000 名臨床醫生中的絕大多數尚未有意義地參與基於價值的安排。當然不是所有 B 部分都籌集了，當然不是全部風險。因此，我們認為，在幫助適用於基於價值的護理的 Eletion 服務提供者參與和推進他們的風險信函方面，特別是考慮到我們正在與他們建立的集成，存在著一個有意義的市場佔領機會。我們一起。

Okay. That's super helpful. And then, I'm going to ask a similar question on your partnership with Anthem Blue Cross and the Astrana Care Clinics. I'm curious how you think about those ramping to scale or what we would call the J-curve, I guess, in the industry, given that they seem to be exclusive to Anthem and some of the Allied Pacific IPA members.

好的。這非常有幫助。然後，我將就您與 Anthem Blue Cross 和 Astrana Care Clinics 的合作關係提出類似的問題。我很好奇您如何看待這些擴大規模的行為，或者我想，在行業中我們稱之為 J 曲線，因為它們似乎是 Anthem 和一些聯合太平洋 IPA 成員所獨有的。

Is there such scale in that market just with that payer and Allied Pacific that you expect those to ramp pretty quickly? And maybe more broadly, how might those clinics ramp out over time and contribute? Thanks so much.

光是該付款人和 Allied Pacific 的市場規模是否就足以讓您預期這些規模會很快成長？也許更廣泛地說，這些診所隨著時間的推移會如何發展並做出貢獻？非常感謝。

Thank you, Ryan. And we you're right, other clinics are exclusively for Astrana and one of our affiliate IPAs for who are participating in an Anthem Blue Cross plan. We think that the ramp-up would look frankly, very similar, if not slightly better than the typical ramp-up, given that there is we specifically chose to build those clinics in areas where we think there could be a lot of gains and for Allied Physicians as well as the Anthem Blue Cross. So, their institute strategically chosen not necessarily in areas where we already have full saturation, but areas where we think there could be improvements in terms of access, you high-quality care providers, a community.

謝謝你，瑞安。我們是對的，其他診所專門為參與 Anthem Blue Cross 計劃的阿斯特拉納和我們的附屬 IPA 之一服務。坦白說，我們認為，考慮到我們特別選擇在我們認為可能會帶來很多收益的地區建立這些診所，因此，坦率地說，增長看起來非常相似，甚至比典型的增長要好一點。 Anthem Blue Cross。因此，他們的機構策略性地選擇的領域不一定是我們已經完全飽和的領域，而是我們認為在准入、高品質照護提供者和社區方面可以改進的領域。

So I'm giving our presence in California and the blue has presence in California. We actually do think that membership at those clinics will ramp up pretty nicely, and we're tracking that very closely as we start for the first clinic, certainly in the couple that we plan to build the remainder of this year.

所以我在加州展示了我們的存在，而藍色在加州也存在。事實上，我們確實認為這些診所的會員數量將會大幅增加，並且在我們開始開設第一家診所時，我們會非常密切地跟踪這一情況，當然，我們計劃在今年剩餘時間建立的診所也是如此。

Super helpful. Congrats again on all the strategic process during the quarter. Thanks.

超有幫助。再次恭喜本季的所有策略流程。謝謝。

David Larsen, BTIG.

大衛‧拉森，BTIG。

Hi. All of the health plans have been talking about pressure on their Medicare cost ratio. Like for example, CVS this morning talked about pressures within the exchanges and also Medicaid and then also obviously Medicare Advantage. Part of this is being driven by the conversion to version 28.

你好。所有的健康計劃都在談論醫療保險成本比率的壓力。例如，CVS 今天早上談到了交易所內部的壓力以及醫療補助，然後顯然也談到了醫療保險優勢。部分原因是向版本 28 的轉換。

Just any thoughts there, like, how are you managing through this? It seems like you're managing through it very well. Can you provide a number, a percent for the medical trend that you saw in the quarter? And then, just, can you maybe just remind me on the risk-sharing arrangements. When you're not in full risk, how do the dollars flow? Like how much risk does the doc plan hospital you take? Thank you.

只是有一些想法，例如，你是如何處理這個問題的？看起來你處理得很好。您能否提供一個數字，即您在本季度看到的醫療趨勢的百分比？然後，您能否提醒我風險分擔安排。當你沒有完全承擔風險時，美元如何流動？例如醫師為您安排的醫院承擔了多大的風險？謝謝。

Hi, Dave. Thanks for the question. I think we're seeing relatively stable utilization, as we mentioned earlier. As John mentioned earlier, low low to mid single-digits depending on line of business relative to last year cost trends and those continue to stabilize for us in of the anticipated uptakes are included in 2024 guidance that you reiterated. And the reasons for that are really the what we believe to be the strength of the Astrana Care model.

嗨，戴夫。謝謝你的提問。正如我們之前提到的，我認為我們看到了相對穩定的利用率。正如約翰之前提到的，低到中個位數取決於業務線相對於去年的成本趨勢，以及您重申的 2024 年指導中包含的預期吸收量繼續穩定的情況。我們認為，這正是阿斯特拉納護理模式的優點。

We've for a long time have not relied on excess revenue capture from a V-28 or risk coding perspective in order to maintain the medical loss ratios that we do. We've had very, very tight integrations between primary and specialty care providers as well as with the hospital ecosystem, especially as we move into full risk arrangements.

很長一段時間以來，我們一直沒有依靠從 V-28 或風險編碼的角度獲取超額收入來維持我們所做的醫療損失率。我們在初級和專科護理提供者以及醫院生態系統之間進行了非常非常緊密的整合，特別是當我們進入全面風險安排時。

We think those and more, the hybrid, affiliate and employment model, the access to care that we're providing by building these neighborhood sites, so on and so forth, really have allowed us to moderate utilization and revenue headwinds in a way that others maybe are not are struggling a little more with.

我們認為，這些以及更多，混合、附屬和就業模式，我們透過建造這些社區場所提供的醫療服務，等等，確實使我們能夠以其他人無法比擬的方式緩和利用率和收入逆風。再掙扎一點。

We believe that's why payers will want to continue working with us, especially as we expand our presence across the United States from coast-to-coast. So, we do think that's part of our advantage and we are continuing to see that low to mid single-digits trend as sustainable and properly accounted for the rest of the year even with things like COVID or the Australian flu portending a worse flu season for us, all things that Chan mentioned earlier.

我們相信，這就是付款人希望繼續與我們合作的原因，特別是當我們將業務擴展到美國各地時。因此，我們確實認為這是我們優勢的一部分，我們繼續認為中低個位數的趨勢是可持續的，並且正確地考慮到了今年剩餘時間，即使像新冠病毒或澳大利亞流感這樣的事情預示著更糟糕的流感季節。

Great. That's very helpful. Thank you. And then when we think about you taking on more full risk, I'm going from like maybe 60%, I think up to two thirds or higher. What does that mean in terms of revenue growth? And when I look at your managed vibes of like over 1 million managed lives, but are we saying that 60% of those are full risk or is it something far lower as a percentage of lives?

偉大的。這非常有幫助。謝謝。然後，當我們考慮您承擔更全面的風險時，我的風險可能會從 60% 上升到三分之二或更高。這對收入成長意味著什麼？當我看到你們對超過 100 萬條受管理生命的管理氛圍時，我們是說其中 60% 是完全風險的，還是說這個比例遠低於生命的百分比？

So I guess what I'm getting at is is the revenue growth potential by going to full risk for more lives, much higher than what people might think it is. Just any more color there would be great. Thank you.

所以我想我得到的是透過為更多的生命承擔全部風險而帶來的收入成長潛力，遠高於人們可能想像的水平。只要有更多的顏色就太好了。謝謝。

Dave, in terms of as we move from the 60% to the two-thirds percentage in terms of revenue by year end, we do expect to see that revenue growth as you alluded to. It's built into our revenue forecast for this year. And as we start seeing that membership move over, you will see in a large portion there will also be an equivalent improvement in terms of the number of lives in CP. Is that helpful?

戴夫，隨著我們到年底的收入比例從 60% 上升到三分之二，我們確實預計會看到您提到的收入成長。它已納入我們今年的收入預測中。當我們開始看到會員資格轉移時，您會發現在很大程度上 CP 的生命數量也會有同等的改善。有幫助嗎？

Yes. That's very helpful.

是的。這非常有幫助。

Maybe I can jump in quickly and just note that, today 60% of the revenue, capitated revenue by risk arrangement, breaks down around [60 40] between full risk and partial risk. We've guided for that to be around twothree by the end of the year. In terms of membership, because of how we've prioritized.

也許我可以快速介入並指出，今天 60% 的收入（按風險安排計算的資本收入）在完全風險和部分風險之間分解為 [60 40] 左右。我們預計到今年底將達到二、三點左右。就會員資格而言，是因為我們的優先順序。

As I mentioned in the past, which members to bring over to full risk first based on the contracts, based on utilization, our knowledge of the patient base, cohort, so on and so forth. Around 28% of the members are in a full risk arrangement by on a membership basis, not on a percentage of capitated revenue basis.

正如我過去提到的，首先根據合約、利用情況、我們對患者基礎、隊列等的了解，讓哪些成員承擔全部風險。大約 28% 的會員按照會員資格而不是按人頭收入的百分比進行全額風險安排。

You can find some of these details on slide 9 of our settlement deck for this earnings quarter. So, what that means is, really, we think there's still a long road ahead to continue moving members into risk. We're going to do so prudently, in order to protect margins and make sure that we're able to provide the same standard of care that we're used to providing in the past, and we'll continue to provide updates on a quarterly basis on both revenue percentage of revenue as well as percentage of members that have moved over to full risk.

您可以在本財報季度結算平台的第 9 張投影片上找到其中一些詳細資訊。所以，這實際上意味著，我們認為繼續讓會員陷入風險還有很長的路要走。我們將謹慎行事，以保護利潤並確保我們能夠提供與過去相同的護理標準，並且我們將繼續提供有關更新的信息按季度計算收入佔收入的百分比以及已轉入完全風險的會員的百分比。

That's very helpful. Thank you. So what I'm hearing is that as more of those lives move into full risk arrangements. The benefit in the revenue growth from full risk will far surpass what you see at the end of fiscal '24. In terms of the full risk sort of revenue impact, it can keep going much higher in '25 and beyond as more of those lives convert over to full-risk.

這非常有幫助。謝謝。所以我聽到的是，隨著越來越多的人進入全面風險安排。全面風險帶來的營收成長收益將遠超過 24 財年末的情況。就完全風險對收入的影響而言，隨著越來越多的人轉向完全風險，它在 25 年及以後可能會繼續走高。

Yes, that's correct. That's absolutely correct. And the other thing is around timing as well. If there's a contract that begins halfway through the year or three quarters of the way through the year, '24 financial year will only record the sub-period and will not include the full impact. So, certainly in '25, you'll see a more fulsome revenue impact from the converting force.

是的，這是正確的。這是絕對正確的。另一件事也與時間有關。如果合約在一年中或四分之三期間開始，則「24」財政年度將僅記錄子期間，而不會包括全部影響。因此，在 25 年，您肯定會看到轉換力量對收入產生更顯著的影響。

Great. Thanks very much, and congrats on good quarter.

偉大的。非常感謝，並恭喜季度表現良好。

Brooks O'Neil, Lake Street Capital.

布魯克斯·奧尼爾，湖街資本。

Good afternoon guys. Nice quarter. I've got a couple of questions and I'm going to try to be sneaky by wrapping three questions into one and my second question, so stay tuned. But number one, I think in your CHS press release you mentioned specifically Centene as a major payer relationship there and then I thought I heard you say earlier on the call that, there were maybe as many as 10 or 12 payers. Just talk a little bit about the opportunity with Centene and the opportunity you see with some of these other payers?

各位下午好。不錯的季度。我有幾個問題，我將嘗試偷偷摸摸地將三個問題合併為一個和第二個問題，所以請繼續關注。但第一，我認為您在CHS 新聞稿中特別提到Centene 作為那裡的主要付款人關係，然後我想我聽到您早些時候在電話會議上說過，可能有多達10 或12 個付款人。請簡單談談 Centene 的機會以及您在其他付款人中看到的機會？

Hey, Brooks. Good to hear from you. Thank you for the question and thank you for. Yes, that's right. We on the corporate health systems asset was acquired from 17, but it was not a Centene only asset. It was the paired narcotic multi-payer, multi-line of business enabling organization. We believe we collaborate very well with the Centene organization.

嘿，布魯克斯。很高興收到你的來信。謝謝你的提問，也謝謝你。是的，沒錯。我們的企業醫療系統資產是從 17 收購的，但這並不是 Centene 唯一的資產。這是成對的麻醉品多支付者、多業務線支援組織。我們相信我們與 Centene 組織合作得很好。

We have contracts for value-based arrangements today already with them. And we plan to jointly expand those relationships in order to serve additional markets and members and the communities that Centene serves as well. So that's something that we look forward to expanding.

今天我們已經與他們簽訂了基於價值的安排合約。我們計劃共同擴大這些關係，以便為 Centene 服務的更多市場、成員和社區提供服務。所以這是我們期待擴大的事情。

But at the same time, as I mentioned earlier, it is a payer-agnostic, line of business agnostic organization. So, we do plan to, in addition to that, continue to enable CHS and its providers to serve members across all payer types, and payer partners. I think it's a multipronged approach, Brooks, that will be taken there with CHS.

但同時，正如我之前提到的，它是一個與付款人無關、與業務線無關的組織。因此，除此之外，我們確實計劃繼續使 CHS 及其提供者能夠為所有付款人類型的會員以及付款合作夥伴提供服務。布魯克斯，我認為 CHS 將採取多管齊下的方法。

Makes total sense. Here's my big question and I apologize, but it's required by your operator. When I was young, my parents used to constantly caution me not to let my eyes get bigger than my stomach. I don't know, if your parents use the same phraseology with you when you were young, but you probably know what they were talking about.

完全有道理。這是我的大問題，我很抱歉，但這是您的運營商要求的。當我年輕的時候，我的父母經常告誡我不要讓我的眼睛比我的肚子大。我不知道你小時候，你的父母是否也對你使用同樣的措辭，但你可能知道他們在說什麼。

And I'm curious, as you think about three main things related to your significant business expansion and development. I would love you to reassure me that, you're not letting your eyes get bigger than your stomach and you can really manage all of this stuff. So, one thing is the assumption of global risk, which I know you have a lot of experience with. Second thing is, your focus on all three of the major market segments which is Medicaid, Commercial and Medicare.

我很好奇，當您思考與您的重大業務擴張和發展相關的三件主要事情時。我希望你能向我保證，你不會讓你的眼睛變得比你的胃大，你真的可以處理所有這些事情。因此，一件事是全球風險的假設，我知道您對此有很多經驗。第二件事是，您專注於所有三個主要市場領域，即醫療補助、商業和醫療保險。

And then third is you are relatively aggressive addition of strategic partnerships and acquisitions over the past couple of years. Just help us a little bit to think about your organization and your management team's ability to manage all this stuff and continue to deliver the exceptional results you've been delivering, since I got involved a couple of years ago?

第三，過去幾年你相對積極地增加了策略夥伴關係和收購。請幫助我們思考您的組織和您的管理團隊是否有能力管理所有這些事情並繼續交付自從我幾年前參與以來一直交付的卓越成果？

Thanks for the questions, Brooks. I appreciate the saying, absolutely is a proverb that I heard both of me growing up as well. We definitely share that common thinking here. I think the way we think about it is, we certainly turned down our share of partnerships, potential acquisitions, capital deployment opportunities in the past couple of years, especially when there was what we perceived to be a bit spread between what was being demanded based on the market conditions at the time and what we could reliably underwrite, given our care model and structure.

謝謝你的提問，布魯克斯。我很欣賞這句話，這絕對是我成長過程中聽到的諺語。我們在這裡肯定有著共同的想法。我認為我們的想法是，在過去幾年中，我們當然拒絕了合作夥伴關係、潛在收購、資本部署機會的份額，特別是當我們認為基於需求的內容之間存在一些差距時考慮到當時的市場狀況以及考慮到我們的護理模式和結構，我們可以可靠地承保什麼。

I think now that, that has changed, and in addition to conditions changing, our capabilities have changed. We feel a lot more comfortable, expanding at the pace that you're now seeing, because we have spent the past couple of years, building out these systems, the automation, the infrastructure, the teams, the people, and the muscle memory frankly in order to do this in a repeatable way at larger and larger scales.

我認為現在情況已經發生了變化，除了條件變化之外，我們的能力也發生了變化。以你們現在看到的速度擴張，我們感覺舒服多了，因為我們在過去幾年裡一直在構建這些系統、自動化、基礎設施、團隊、人員和肌肉記憶。可重複的方式做到這一點。

So, you may recall a couple of years ago, we were talking about, $5 million to $10 million acquisition, small tuck-ins, small IPA client improvements. Late last year, we talked about CFC, which we've now fully integrated, and have had no issues doing so in a pretty seamless fashion.

所以，你可能還記得幾年前，我們談論過 500 萬到 1000 萬美元的收購、小額投入、小額 IPA 用戶端改進。去年年底，我們討論了 CFC，現在我們已經完全整合它，並且以非常無縫的方式進行整合沒有任何問題。

And we feel comfortable repeating that muscle, using that muscle memory rather and repeating the motion, the Astrana Flywheel that I talked about earlier, to continue expanding across the market and bringing what we're doing to more communities across the country as is our mission.

我們很舒服地重複這種肌肉，使用肌肉記憶，而不是重複運動，我之前談到的阿斯特拉納飛輪，繼續在市場上擴張，並將我們正在做的事情帶到全國更多的社區，這是我們的使命。

So, absolutely hear you. We'll continue to make sure that, our eyes don't get too aggressive, but we do feel that, we are prepared and we've spent a lot of time and energy building infrastructure to make sure, we're going to succeed and have a scalable platform.

所以，絕對聽你的。我們將繼續確保，我們的目光不會變得過於激進，但我們確實感到，我們已經做好準備，我們花費了大量的時間和精力來建設基礎設施，以確保我們會成功並擁有一個可擴展的平台。

Awesome. I'll say two things in closing. One is you guys are doing a great job, and two, I know there is an immense opportunity out there and I applaud you for continuing to go after it.

驚人的。最後我要說兩件事。一是你們做得很好，二是我知道那裡有巨大的機會，我為你們繼續追求它而鼓掌。

Thank you.

謝謝。

Jack Slevin, Jefferies.

傑克·斯萊文，杰弗里斯。

Hi, guys. Thanks for taking the question and congrats on solid work this quarter. I'll try to keep these a little on the shorter end, and a lot of my questions have been asked already. Maybe I want to take through with the first one go with CHS, but from a little bit of a different angle.

嗨，大家好。感謝您提出問題，並祝賀本季的紮實工作。我會盡量簡短地講這些，而且我的很多問題已經被問到了。也許我想透過 CHS 來完成第一個，但從一個不同的角度來看。

Just wondering, if you could give a little more details on sort of the bridge from that current unprofitable state to breakeven next year and sort of what the groundwork is to get there and why you have confidence in it? And then, what it looks like to progress forward from there towards more normalized margins or sort of that target you put out of above $10 million of EBITDA by 2027?

只是想知道，您是否可以提供更多關於從目前的無利可圖狀態到明年盈虧平衡的橋樑的詳細信息，以及實現這一目標的基礎是什麼以及為什麼您對此有信心？然後，從那裡開始朝著更正常的利潤率或到 2027 年 EBITDA 超過 1000 萬美元的目標前進會是什麼樣子？

Is that sort of business as usual or are things going to be a bit different, just given in different geographies and a little bit different of an asset than some of the others you've integrated in the last couple of years?

這種業務是否一切如常，還是會有所不同，只是在不同的地區提供，並且資產與您在過去幾年中整合的其他一些資​​產略有不同？

Hi Jack, thanks for the question, As we said before, we believe in delivering mobile care in a scalable fashion and like a dot plot like I spoke about with Brooks second ago, we spent a lot of time building out what we believe to be scalable care models, operational systems and technology that allow us to deliver that local care at scale in an efficient way.

嗨，傑克，謝謝你的問題，正如我們之前所說，我們相信以可擴展的方式提供移動護理，就像我第二次與布魯克斯談到的點圖一樣，我們花了很多時間來構建我們認為的內容可擴展的護理模式、操作系統和技術使我們能夠以有效的方式大規模提供本地護理。

And when we when we're talking about doing the deal and it was really not a necessarily a scaled book of business and unnecessary the core market of for the core business of the fee owner. And I think provider organizations provider enablement really is our core competency and we have both had a lot of tools that will allow us to at least in the first year to braces that breakeven mark and primarily via cost synergies.

當我們談論進行交易時，它實際上不一定是規模化的業務，也不一定是費用所有者核心業務的核心市場。我認為提供者組織的提供者支援確實是我們的核心能力，我們都擁有很多工具，這些工具將使我們至少在第一年能夠實現收支平衡，主要是透過成本協同效應。

And I talked about earlier my prepared remarks around here, one, really focusing on using our operating leverage. We need a technology platform and infrastructure to drive savings, investing that into local care capabilities. And then reinvesting those dollars. So that in the medium to long term, there's a lower trend in terms of total cost of care. And that's what we plan to do here with with CHS.

我早些時候談到了我在這裡準備的言論，第一，真正專注於利用我們的營運槓桿。我們需要一個技術平台和基礎設施來推動節省，並將其投資於當地的護理能力。然後將這些美元再投資。因此，從中長期來看，總照護成本呈現下降趨勢。這就是我們計劃對 CHS 所做的事情。

So to answer your question, the first year, it's really going to be a little bit of maybe low-hanging fruit in terms of clinical, but primarily our efficiency improvements are driven by our current loan platform. We're going to reinvest those dollars into some of the dollars into making sure that we have a long-term sustainable base in these markets and build out the depth of those markets. And then over the medium term, we believe that that will drive our medical margin up as it has in other acquisitions, partnerships. And we've done with us.

因此，回答你的問題，第一年，在臨床方面，這確實是一些容易實現的成果，但主要是我們效率的提高是由我們目前的貸款平台推動的。我們將把這些美元再投資到一些美元上，以確保我們在這些市場上擁有長期可持續的基礎，並擴大這些市場的深度。從中期來看，我們相信這將推動我們的醫療利潤率上升，就像其他收購、合作關係一樣。我們已經完成了。

Got it. Really helpful. Thanks for that, Brandon. And then my second one, just quickly maybe taking it from the deck. I think this is the first time you've called Nevada a core existing market, rather than talking about it as sort of a new entry And the news that we got there for May and what's going to sort of roll on for the back half of this year in 2025 seems to be along the line of significant momentum there.

知道了。真的很有幫助。謝謝你，布蘭登。然後是我的第二個，可能很快就從甲板上拿走了。我認為這是您第一次將內華達州稱為核心現有市場，而不是將其視為一個新的進入市場，我們在五月份得到的消息以及下半年的情況將如何發展今年（2025 年）似乎將沿著這條線取得重大進展。

I guess the question would be, a lot of the sort of boxes have been checked from my perspective for that to look a lot like California. Do you feel that way? And sort of what does it look like in terms of getting that to sustainable profitability and profitability that looks like California? What's left to do there? Is it just a little bit more work beyond '25 or does it feel like you have the density there to sort of weave it into the overall operations? Thanks.

我想問題是，從我的角度來看，很多類似的方框都經過檢查，看起來很像加州。你有這樣的感覺嗎？在實現可持續盈利和像加州那樣的盈利方面，它是什麼樣子的？那裡還可以做什麼？是 25 年後需要做更多的工作，還是感覺你有足夠的密度將其融入整體營運中？謝謝。

Thanks, Jack. So in terms of Nevada, we as you know, we've been scaling rapidly. We feel very strong about the market we are on. We've opened up new locations and we've continued to expand in terms of our affiliate provider network in the geography 2025. We do feel we're going to grow be over that hump and it is very much turning into a sustainable business.

謝謝，傑克。因此，就內華達州而言，如您所知，我們一直在迅速擴大規模。我們對我們所處的市場感覺非常強烈。我們開設了新的地點，並在 2025 年繼續擴大我們的聯盟行銷商網絡。我們確實覺得我們將跨越這個難關，並在很大程度上轉變為永續發展的業務。

Awesome great to hear, and thanks again, guys. Congrats on the quarter.

太棒了，很高興聽到，再次感謝你們。恭喜本季。

Thanks.

謝謝。

Michael Ha, Baird.

麥可·哈，貝爾德。

Hi. Thank you and congrats on CHS. Just wanted to ask you another question or a couple of questions on this one. So $450 million of anticipated run rate revenue on 129,000 lives would seemingly imply close to, I think, $300 revenue PMPM. And I know you mentioned CHS has full-risk contracts, but $300 would seem to imply you're taking partial risk on a book that's mostly MA lives. Is that true?

你好。謝謝您並恭喜 CHS。只是想問你另一個問題或關於這個問題的幾個問題。因此，我認為 129,000 個生命中 4.5 億美元的預期運行率收入似乎意味著接近 300 美元的 PMPM 收入。我知道你提到 CHS 有全風險合同，但 300 美元似乎意味著你在一本主要是 MA 生命的書上承擔部分風險。這是真的嗎？

And if I'm running the math correctly, assuming 12.5%, 25% target margins on partial risk, the embedded earnings opportunity over three to four years, would that be around $56 million to $113 million of annualized EBITDA off of, of course, the current $450 million revenue? So wondering if that's roughly in the ballpark. And maybe if I could squeeze one more. The '25 earn out potential, curious what are the targets or specific performance targets tied to?

如果我計算正確，假設部分風險的目標利潤率為 12.5%、25%，三到四年內的內在獲利機會，年化 EBITDA 大約為 5,600 萬至 1.13 億美元，當然，目前4.5億美元的收入？所以想知道這是否大致在範圍內。也許我可以再擠一粒。'25 人挖掘潛力，好奇目標或具體績效目標與什麼相關？

Michael, great to hear from you. So in terms of your first question, in terms of the lives as well as the revenue PMPM, a large portion of, or a certain portion of those lives are actually MSSP lives and we do not account for the top-line revenue associated with those MSSP lives. So for the value-based care lives, which are Medicare Advantage lives as well as the ACO reach lives, we are recording the revenue.

邁克爾，很高興收到你的來信。因此，就你的第一個問題而言，就生命以及收入 PMPM 而言，這些生命的很大一部分或某一部分實際上是 MSSP 生命，我們不考慮與這些生命相關的頂線收入MSSP 還活著。因此，對於基於價值的護理生命，即 Medicare Advantage 生命和 ACOreach 生命，我們正在記錄收入。

So that's the net of the $450 million. In terms of the MSSP, you would not see the revenue impact. What you will see in terms of revenue on MSSP will really be the net profitability for that book of business. If that works for you, I'll move on to the second part of the question.

這就是 4.5 億美元的淨額。就 MSSP 而言，您不會看到收入影響。您在 MSSP 上看到的收入實際上是該業務的淨利潤。如果這對您有用，我將繼續討論問題的第二部分。

Yes, that's great. Thank you. That makes sense.

是的，那太好了。謝謝。這是有道理的。

Okay, great. So in terms of the earnout. We prefer not to get into specific details in terms of the performance targets with the earnout, but they are focused on aligning both on our long-term incentives as well as on the partner organization and on where we're very excited about this growth chapter. And we're very focused on the integration efforts on post post close and look forward to really growing into these new geographies.

好的，太好了。所以就收益而言。我們不想透露績效目標和獎金方面的具體細節，但他們的重點是與我們的長期激勵措施、合作夥伴組織以及我們對這一成長篇章感到非常興奮的方面保持一致。我們非常專注於交易結束後的整合工作，並期待真正發展到這些新的地區。

Got it. Thank you. And if I may ask another question, maybe two-in-one. In the press release for CHS, you mentioned Astrana and Centene will continue to work together, expand the scope of value based partnership. Am I reading too much into it? Or, is there a plan that you guys are now going to work more closely, where Centene might increase your alignment with Astrana, perhaps move more of their MA or Medicaid members over to Astra and like full risk global cap?

知道了。謝謝。如果我可以問另一個問題，也許是二合一的問題。在 CHS 的新聞稿中，您提到 Astrana 和 Centene 將繼續合作，擴大基於價值的合作關係範圍。我是不是讀太多了？或者，你們現在是否有一個要更密切合作的計劃，Centene 可能會增加你們與 Astrana 的聯盟，或許將更多的 MA 或醫療補助成員轉移到 Astra 以及全風險全球上限？

And maybe even just more broadly just given the funding environment in '25, which is a challenge and elevated cost trend. I feel like it's accentuating the need for MA plans to align members to value-based care. I'm wondering if you're seeing any change in appetite from MA payers to really want to accelerate that, increase member attribution into Astrana? In other words, are you seeing, like, this funding environment creating maybe, like, a more favorable member growth pipeline into Astrana?

甚至更廣泛地說，考慮到 25 年的融資環境，這是一個挑戰和成本上升的趨勢。我覺得這強調了 MA 計劃使會員與基於價值的護理保持一致的必要性。我想知道您是否發現 MA 付款人的興趣發生了任何變化，真的想要加速這一進程，增加會員對阿斯特拉納的歸屬感？換句話說，您是否看到這種融資環境可能會為阿斯特拉納創造更有利的會員成長管道？

Yes. I think there are a couple of things, we mean by that. The first is that, Centene and CHS today have a relationship, where they are delegating risk, as well as the delegated function to CHS, which we believe is very innovative, and we would anticipate that to continue post the close of the transaction, similar to how we work with Centene and its subsidiaries today, in California.

是的。我認為有幾件事，我們的意思是。首先，Centene 和 CHS 今天建立了一種關係，他們將風險以及委託職能委託給 CHS，我們認為這是非常創新的，我們預計交易結束後將繼續這種關係，類似我們今天如何與Centene 及其位於加州的子公司合作。

We think that allows for a great degree of collaboration, data sharing, data visibility, and ultimately better outcomes for patients, because of that model. That's something that we're excited about. That's part of that kind of read through there.

我們認為，由於該模型，可以實現很大程度的協作、數據共享、數據可見性，並最終為患者帶來更好的結果。這是我們感到興奮的事情。這是那種閱讀的一部分。

We also believe, Cemteme going to be a very good partner of ours. They're obviously good partner of CHS's and we think that there is a lot of room to work together, as we already do, to continue serving members in areas where, both of our organizations want to better the healthcare delivered to those communities. So, we are looking forward to continuing doing that with Centene, in particular, but also some of the continuing the relationships that CHS already has today.

我們也相信，Cemteme 將成為我們非常好的合作夥伴。他們顯然是 CHS 的良好合作夥伴，我們認為有很大的合作空間，就像我們已經做的那樣，繼續為我們兩個組織都希望為這些社區提供更好的醫療服務的領域的成員提供服務。因此，我們特別期待繼續與 Centene 合作，同時也期待繼續保持 CHS 目前已經建立的一些關係。

Got it. Thank you, guys.

知道了。謝謝你們，夥計們。

Craig Jones, Stifel.

克雷格瓊斯，斯蒂菲爾。

Thank you. Yes, most of it has already been answered, but maybe with all these new states that you're entering, do you expect you need to do more M&A to build out the, provider density in all these new geographies, or do you think you can do it largely organically? Thanks.

謝謝。是的，大部分問題已經得到解答，但也許隨著您進入的所有這些新州，您是否期望需要進行更多併購來在所有這些新地區建立供應商密度，或者您認為您可以很大程度上有機地做到這一點嗎？謝謝。

Thanks for the question. I think it will be a combination of both. I mean, look, we've done a lot of M&A. This was a deal that we thought was that we modeled to be that crosses our threshold internally to do M and A. If we continue to see opportunities to rapidly develop our depth in some of these new markets, that's something we will do.

謝謝你的提問。我認為這將是兩者的結合。我的意思是，看，我們已經進行了很多併購。我們認為這筆交易是我們在內部進行併購時跨越門檻的交易。

Obviously, we are always in organic growth mode and we continue to drive depth, especially with some of the brands recognition that the CHS and CHS affiliated entities have in their local markets, and gives a great opportunity to expand the rate of organic growth in those markets because of that jump start.

顯然，我們始終處於有機增長模式，並且我們繼續推動深度，特別是 CHS 和 CHS 附屬實體在當地市場的一些品牌認知度，並為擴大這些地區的有機增長率提供了絕佳的機會。這種快速啟動。

So I think it's going to be a combination of both. Chan, I think, has guided to a certain leverage ratio in the past that's maintained for this quarter and we are going to continue to look for opportunities to accretively deploy capital to meet our strategic needs. In the meantime, we think this gives us a great jumping off point to expand organically in these new states.

所以我認為這將是兩者的結合。我認為，陳先生過去指導了一定的槓桿率，並在本季度維持這一水平，我們將繼續尋找機會來增加部署資本，以滿足我們的戰略需求。同時，我們認為這為我們在這些新州進行有機擴張提供了一個很好的起點。

Okay, thanks.

好的，謝謝。

Thank You.

謝謝。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓，TD·考恩。

Great. Good evening. Thanks for squeezing me in. Appreciate it. Just quickly on kind of this moving more partial risk to full risk. I guess what are those conversations like with your payer partners kind of given the utilization environment and maybe the benefit landscape backdrop? Are they more willing now to maybe give you a higher proportion of premiums than maybe typical we think of 85% or something like that? Or, maybe more willing to carve out particular areas of benefits that you might not be able to affect maybe as much. Just wondering what those conversations are like. Thanks.

偉大的。晚安.謝謝你把我擠進去。欣賞它。只是很快就將部分風險轉變為全部風險。我想考慮到使用環境以及利益景觀背景，與您的付款合作夥伴的對話是什麼樣的？他們現在是否更願意給你比我們通常認為的 85% 或類似的比例更高的保費？或者，也許更願意開拓出你可能無法影響那麼多的特定領域的好處。只是想知道這些對話是什麼樣的。謝謝。

Hi, Ryan. Thanks for the question. Our conversations with our peer partners are quite collaborative. We're here to support them, help them scale, as well as our goal is to provide our overall comprehensive care model to more and more communities across America. And we're going to do that, where we have a certain level of delegation.

嗨，瑞安。謝謝你的提問。我們與同儕合作夥伴的對話非常具有協作性。我們來這裡是為了支持他們，幫助他們擴大規模，我們的目標是為美國越來越多的社區提供我們的整體綜合護理模式。我們將在擁有一定程度的授權的情況下做到這一點。

We have a certain set of rates, rebates, quality payments, division of financial responsibility. So it really varies by pair and we work in collaboration to make it work for all parties involved, the provider that's caring for the member, the member in terms of the net benefits, the payer as well as us.

我們有一定的費率、回扣、品質付款、財務責任劃分。因此，它確實因人而異，我們共同努力，使其適用於所有相關方、照顧會員的提供者、會員的淨收益、付款人以及我們。

Great. Thank you.

偉大的。謝謝。

Thank you. 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.

謝謝。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並度過愉快的一天。