Aveanna Healthcare Holdings Inc (AVAH) 2024 Q1 法說會逐字稿

Good morning, and welcome to Aveanna Healthcare Holdings first quarter 2024 earnings conference call. Today's call is being recorded, and we have allocated 1 hour for prepared remarks and Q&A. At this time, I'd like to turn the call over to Debbie Stewart, Aveanna's Chief Accounting Officer. Thank you. You may begin.

早安，歡迎參加 Aveanna Healthcare Holdings 2024 年第一季財報電話會議。今天的電話會議正在錄音，我們分配了 1 個小時來準備發言和問答。現在，我想將電話轉給 Aveanna 的首席會計官 Debbie Stewart。謝謝。你可以開始了。

Good morning, and welcome to Aveanna's first quarter 2024 earnings call. I am Debbie Stewart, the Company's Chief Accounting Officer. With me today is Jeff Shaner, our Chief Executive Officer, and Matt Buckhalter, our Chief Financial Officer.

早上好，歡迎參加 Aveanna 的 2024 年第一季財報電話會議。我是黛比·斯圖爾特，公司首席會計官。今天與我在一起的有我們的執行長 Jeff Shaner 和我們的財務長 Matt Buckhalter。

During this call, we will make forward-looking statements. Risk factors that may impact those statements and could cause actual future results to differ materially from currently projected results are described in this morning's press release and the reports we file with the SEC. The company does not undertake any duty to update such forward-looking statements.

在本次電話會議中，我們將做出前瞻性陳述。今天上午的新聞稿和我們向 SEC 提交的報告中描述了可能影響這些陳述並可能導致未來實際結果與當前預測結果有重大差異的風險因素。本公司不承擔更新此類前瞻性陳述的任何義務。

Additionally, during today's call, we will discuss certain non-GAAP measures, which we believe can be useful in evaluating our performance. The presentation of this additional information should not be considered in isolation or as a substitute for results prepared in accordance with GAAP. A reconciliation of these measures can be found in this morning's press release, which is posted on our website aveanna.com and in our most recent quarterly report on Form 10-Q when filed.

此外，在今天的電話會議中，我們將討論某些非公認會計準則衡量標準，我們認為這些衡量標準有助於評估我們的績效。不應孤立地考慮此附加資訊的呈現，也不應將其視為根據 GAAP 準備的結果的替代品。這些措施的協調可以在今天上午的新聞稿中找到，該新聞稿發佈在我們的網站 aveanna.com 上，以及我們提交的最新季度報告 10-Q 表格中。

With that, I will turn the call over to Aveanna's Chief Executive Officer, Jeff Shaner. Jeff?

接下來，我會將電話轉給 Aveanna 的執行長 Jeff Shaner。傑夫？

Thank you, Debbie. Good morning and thank you for joining us today. We appreciate each of you investing your time this morning to better understand our Q1 2024 results and how we are moving Aveanna forward in 2024 and beyond.

謝謝你，黛比。早安，感謝您今天加入我們。我們感謝大家今天早上花時間更了解我們 2024 年第一季的業績，以及我們如何推動 Aveanna 在 2024 年及以後向前發展。

My initial comments will briefly highlight our first quarter, along with the steps we are taking to address the labor markets and our ongoing efforts with government and preferred payers to create additional capacity. I will then provide insight on how we are thinking about year two of our strategic transformation and our enhanced outlook for 2024 prior to turning the call over to Matt to provide further details into the quarter and our refreshed outlook.

我的初步評論將簡要介紹我們的第一季度，以及我們為解決勞動力市場問題而採取的措施，以及我們與政府和首選付款人持續努力創造額外產能的努力。然後，我將介紹我們如何考慮戰略轉型的第二年以及我們對 2024 年增強的前景的看法，然後將電話轉給馬特，以提供有關本季度和更新後的前景的更多詳細信息。

In addition, I would like to take a moment and welcome Jerry Perchik, our new Chief Legal Officer to Aveanna. Jerry has spent the last two decades dedicated to high-quality health care in the home setting. Jerry brings a wealth of experience in regulatory and legal affairs, mergers and acquisitions, and general corporate law. We feel blessed to have Jerry join our Aveanna team.

此外，我想花一點時間歡迎我們新任首席法務官 Jerry Perchik 來到 Aveanna。傑瑞在過去的二十年裡一直致力於家庭環境中的高品質醫療保健。Jerry 在監管和法律事務、併購以及一般公司法方面擁有豐富的經驗。我們很高興 Jerry 加入我們的 Aveanna 團隊。

Now moving to the highlights for the first quarter. Revenue for the first quarter was approximately $491 million, representing a 5.2% increase over the prior year period. First quarter adjusted EBITDA was $34.9 million, representing a 22.5% increase over the prior year period, primarily due to the improved payer rate environment as well as cost reduction efforts.

現在轉向第一季的亮點。第一季營收約4.91億美元，比去年同期成長5.2%。第一季調整後 EBITDA 為 3,490 萬美元，比上年同期成長 22.5%，這主要歸功於付款人費率環境的改善以及成本削減的努力。

As we have previously discussed, the labor environment represented the primary challenge that we needed to address to see Aveanna resume the growth trajectory that we believed our company could achieve. It is important to note that our industry does not have a demand problem. The demand for home and community-based care continues to be strong with both state and federal governments and managed care organizations asking for solutions that can create more capacity.

正如我們之前所討論的，勞動力環境是我們需要解決的主要挑戰，以確保 Aveanna 恢復我們相信公司能夠實現的成長軌跡。需要注意的是，我們這個行業不存在需求問題。對家庭和社區護理的需求持續強勁，州和聯邦政府以及管理式護理組織都在尋求能夠創造更多能力的解決方案。

Our Q1 results highlight that we continue to align our objectives with those of our preferred payers and government partners. By focusing our clinical capacity on our preferred payers, we achieved year-over-year growth in revenue and adjusted EBITDA. We also experienced improvement in our caregiver hiring and retention trends by aligning our efforts to those payers willing to engage with us on enhanced reimbursement rates and value-based agreements.

我們第一季的業績突顯了我們繼續將我們的目標與我們的首選付款人和政府合作夥伴的目標保持一致。透過將我們的臨床能力集中在我們的首選付款人身上，我們實現了收入和調整後 EBITDA 的同比增長。透過將我們的努力與那些願意與我們合作提高報銷率和基於價值的協議的付款人結合起來，我們的護理人員招聘和保留趨勢也得到了改善。

While we continued to operate in a challenging labor and inflationary environment, our preferred payer strategy allows us to return to a more normalized growth rate in our business segments. Since our fourth quarter earnings call, I am pleased with the continued progress we have made on several of our rate improvement initiatives with both government and preferred payers, as well as the continued signs of improvement in the caregiver labor market.

雖然我們繼續在充滿挑戰的勞動力和通貨膨脹環境中運營，但我們的首選付款人策略使我們能夠在業務部門恢復到更正常化的成長率。自從第四季財報電話會議以來，我對我們與政府和優先付款人的幾項費率改善計劃的持續進展以及護理人員勞動力市場持續改善的跡象感到高興。

Specifically, as it relates to our private duty services business, our goal for 2024 is to continue to execute on our legislative strategy to improve reimbursement rates in our various states, with particular emphasis on Georgia, Massachusetts, and California, which represent approximately 15% of our PDS revenue. As a reminder, we achieved rate increases in 19 states in 2023.

具體來說，由於它與我們的私人值班服務業務相關，我們2024 年的目標是繼續執行我們的立法策略，以提高各州的報銷率，特別是喬治亞州、馬薩諸塞州和加利福尼亞州，這些州的報銷率約為15%我們的 PDS 收入。提醒一下，我們在 2023 年實現了 19 個州的利率上調。

While we are pleased that our PDS legislative messaging has been well received by state legislatures, we still have much work to do. As an example of the work ahead, our PDN rate request was not included in the California governor's proposed budget. We believe that we made significant strides with the governor, Medical Department, and the California legislature, demonstrating the importance of PDN rate investments and how they support an overall lower health care cost, improved patient satisfaction, and quality outcomes.

雖然我們很高興我們的 PDS 立法資訊得到了州立法機構的好評，但我們仍然有很多工作要做。作為未來工作的一個例子，我們的 PDN 費率請求並未包含在加州州長的擬議預算中。我們相信，我們與州長、醫療部和加州立法機構合作取得了重大進展，展示了 PDN 費率投資的重要性以及它們如何支持整體降低醫療保健成本、提高患者滿意度和品質結果。

However, we need to further accelerate our preferred payer strategy and government affairs efforts to continue to advocate for children with complex medical conditions. We have a proven track record of expanding our preferred payer programs and will enhance our efforts in California similar to our approach in other states.

然而，我們需要進一步加快我們首選的付款人策略和政府事務工作，以繼續為患有複雜疾病的兒童辯護。我們在擴大首選付款人計劃方面擁有良好的記錄，並將加強我們在加州的努力，類似於我們在其他州的做法。

As we look at our preferred payer initiatives in other states, our goal for 2024 is to increase the number of PDS preferred payer agreements from 14 to 22. In the first quarter, we added 4 additional preferred payer agreements, increasing our total to 18. I'm very proud of our payer relations team as they continue to develop partnerships with managed care organizations to find solutions for children with complex medical conditions.

當我們審視其他州的首選付款人計畫時，我們的 2024 年目標是將 PDS 首選付款人協議的數量從 14 個增加到 22 個。第一季度，我們新增了 4 項優先付款人協議，使總數達到 18 項。我為我們的付款人關係團隊感到非常自豪，因為他們繼續與管理式醫療組織發展合作夥伴關係，為患有複雜醫療狀況的兒童尋找解決方案。

Aveanna' preferred payer strategy is gaining momentum and allowing us to invest in caregiver wages and recruitment efforts to accelerate hiring and staffing of nurses for our patients. Additionally, we are introducing a new PDS volume indicator that demonstrates how we think about our momentum with our PDS preferred payers. Some of our PDS states, like Colorado, for example, are predominantly Medicaid reimbursed with little to no managed care penetration.

Aveanna 首選的付款人策略正在獲得動力，使我們能夠投資於護理人員薪資和招募工作，以加快為病患招募和配備護理人員的速度。此外，我們還推出了新的 PDS 交易量指標，該指標展示了我們如何看待 PDS 首選付款人的勢頭。我們的一些 PDS 州，例如科羅拉多州，主要由醫療補助報銷，管理式醫療滲透率極低甚至沒有。

For this reason, we will report our PDS preferred payer volumes against the total MCO opportunity. Our 18 current PDS preferred payer agreements account for just over 40% of the total PDS MCO volumes as defined above. This updated metric defines the opportunity for Aveanna to continue shifting our capacity and efforts towards our payer partnership.

因此，我們將根據 MCO 機會總量報告我們的 PDS 首選付款人數量。我們目前的 18 項 PDS 首選付款人協議佔上述 PDS MCO 總量的 40% 多一點。這項更新後的指標定義了 Aveanna 繼續將我們的能力和努力轉向付款人合作夥伴關係的機會。

Now moving to our preferred payer progress in home health. Our goal for 2024 is to maintain our episodic payer mix above 70% while returning to a more normalized growth rate. In Q1, our episodic mix was 75%, and we achieved positive total episode growth of 1.7% over the prior year period. Q1 marked the first time, we've had sequential and year-over-year episodic growth since we entered the home health market. We also signed two additional episode agreements within the quarter.

現在轉向我們在家庭健康方面的首選付款人進展。我們 2024 年的目標是將間歇性付款人組合保持在 70% 以上，同時恢復到更正常化的成長率。第一季度，我們的劇集組合為 75%，總劇集比去年同期成長了 1.7%。自從我們進入家庭健康市場以來，第一季標誌著我們第一次實現連續和同比的間歇性成長。我們還在本季簽署了兩份額外的劇集協議。

I am so proud of our home health and hospice leadership team and their commitment to driving positive clinical outcomes, episodic growth, and profitability. We will continue to remain focused on aligning our home-health caregiver capacity with those payers willing to reimburse us on an episodic basis and focus on improved clinical and financial outcomes.

我為我們的家庭健康和臨終關懷領導團隊以及他們對推動積極的臨床結果、間歇性增長和盈利能力的承諾感到非常自豪。我們將繼續專注於使我們的家庭保健護理人員的能力與那些願意定期向我們報銷的付款人保持一致，並專注於改善臨床和財務結果。

We are encouraged by our early 2024 rate increases, preferred payer agreements, and subsequent recruiting results. Our business is demonstrating signs of recovery as we achieve our rate goals previously discussed. Home and community-based care will continue to grow, and Aveanna is a comprehensive platform with a diverse payer base, providing a cost-effective, high quality alternative to higher cost care settings. And most importantly, we provide this care in the most desirable setting, the comfort of the patient's home.

我們對 2024 年初的升息、首選付款人協議以及隨後的招聘結果感到鼓舞。隨著我們實現先前討論的費率目標，我們的業務顯示出復甦的跡象。家庭和社區照護將繼續成長，Aveanna 是一個擁有多元化支付者基礎的綜合平台，為更高成本的照護環境提供具有成本效益、高品質的替代方案。最重要的是，我們在最理想的環境中提供這種護理，即患者舒適的家中。

Before I turn the call over to Matt, let me comment on our strategic plan and refreshed outlook for 2024. As we enter year two of our strategic transformation, we remain highly focused on those initiatives that create a positive momentum in 2023. We will continue to focus our efforts on four primary strategic initiatives. Number one, enhancing partnerships with government and preferred payers to create additional caregiver capacity.

在我把電話轉給 Matt 之前，讓我先談談我們的策略計畫和 2024 年的新展望。隨著我們進入策略轉型的第二年，我們仍然高度關注那些在 2023 年創造積極勢頭的舉措。我們將持續聚焦四項主要策略措施。第一，加強與政府和首選付款人的合作夥伴關係，以創造額外的護理人員能力。

Two, identifying cost efficiencies and synergies that allow us to leverage our growth. Three, managing our capital structure and collecting our cash while producing positive free cash flow. And fourth, engaging our leaders and employees and delivering our Aveanna mission.

第二，確定成本效率和協同效應，使我們能夠利用我們的成長。第三，管理我們的資本結構並收集現金，同時產生正的自由現金流。第四，讓我們的領導者和員工參與並實現我們的 Aveanna 使命。

Based on the strength of our first quarter results and the continued execution of our key strategic initiatives, we now expect full year 2024 revenue to be greater than $1.97 billion and adjusted EBITDA to be greater than $150 million. We believe our revised outlook provides a prudent view considering the challenges we still face with the evolving labor environment, and hopefully it proves to be conservative as we continue to execute throughout the year.

基於我們第一季的強勁業績以及關鍵策略舉措的持續執行，我們現在預計 2024 年全年營收將超過 19.7 億美元，調整後 EBITDA 將超過 1.5 億美元。我們認為，考慮到我們在不斷變化的勞動力環境中仍然面臨的挑戰，我們修訂後的前景提供了審慎的觀點，並希望隨著我們全年繼續執行，它被證明是保守的。

In closing, I am very proud of our Aveanna team. We offer a cost-effective, patient preferred, and clinically sophisticated solution for our patients and families. Furthermore, we are the right solution for our payers, referral sources, and government partners. By partnering with preferred payers, we can and will move reimbursement rate and wage metrics in meaningful ways that support our growth. This strategy allows us to hire, retain, and engage more caregivers and providing the mission of Aveanna every day.

最後，我為我們的 Aveanna 團隊感到非常自豪。我們為患者和家屬提供經濟高效、患者首選且臨床複雜的解決方案。此外，我們是付款人、推薦來源和政府合作夥伴的正確解決方案。透過與首選付款人合作，我們可以並將以有意義的方式改變報銷率和工資指標，以支持我們的成長。這項策略使我們能夠僱用、保留和吸引更多的護理人員，並每天履行 Aveanna 的使命。

With that, let me turn the call over to Matt to provide further details on the quarter and our 2024 outlook. Matt?

接下來，讓我將電話轉給 Matt，以提供有關本季和 2024 年展望的更多詳細資訊。馬特？

Thanks, Jeff, and good morning. I'll first talk about our first quarter financial results and liquidity before providing additional details on our refreshed outlook for 2024.

謝謝，傑夫，早安。我將首先討論我們第一季的財務表現和流動性，然後提供有關我們更新的 2024 年展望的更多詳細資訊。

Starting with the top line, we saw revenues rise 5.2% over the prior year period to $491 million. We experienced revenue growth in two of our operating divisions led by private duty services and medical solutions segments, which grew by 5.9% and 9.9% compared to the prior year quarter. Consolidated gross margin was $145.9 million or approximately 30%, representing a 1% increase over the prior year period.

從營收開始，我們看到營收比去年同期成長 5.2%，達到 4.91 億美元。我們的兩個營運部門的收入實現了成長，以私人服務和醫療解決方案部門為主導，與去年同期相比分別成長了 5.9% 和 9.9%。綜合毛利率為 1.459 億美元，約 30%，較上年同期成長 1%。

Consolidated adjusted EBITDA was $34.9 million, a 22.5% increase as compared to the prior year, reflecting the improved payer rate environment as well as cost reduction efforts taking hold.

合併調整後 EBITDA 為 3,490 萬美元，比上年增長 22.5%，反映出付款人利率環境的改善以及成本削減措施的落實。

Now taking a deeper look at each of our segments. Starting with private duty services, revenue for the quarter was approximately $395 million, a 5.9% increase and was driven by approximately 10.3 million hours of care, a volume increase of 4.9% over the prior year. While volumes have improved over the prior year, we continued to be constrained in our top line growth due to the shortage of available caregivers. Although we are continuing to see signs of improvement in the labor markets.

現在更深入地了解我們的每個細分市場。從私人值班服務開始，本季營收約 3.95 億美元，成長 5.9%，主要得益於約 1,030 萬小時的照護時間，比上年增長 4.9%。儘管數量比上一年有所改善，但由於可用護理人員的短缺，我們的收入成長仍然受到限制。儘管我們繼續看到勞動力市場改善的跡象。

Q1 revenue per hour of $38.48 was up $0.36 or 1% as compared to the prior year quarter. We remain optimistic about our ability to attract caregivers and address market demands for our services when we obtain acceptable reimbursement rates.

第一季每小時收入為 38.48 美元，比去年同期增長 0.36 美元，即 1%。當我們獲得可接受的報銷率時，我們對吸引護理人員並滿足市場對我們服務的需求的能力保持樂觀。

Turning to our cost of labor and gross margin metrics, we achieved $100.1 million of gross margin or 25.4%, a 3.9% decrease from the prior year quarter, primarily driven by some timing related items and overall strengthening of our PDS reserve. The cost of revenue rate of $28.73 in Q1 was influenced by payroll taxes. Despite the ongoing wage pressures in the labor markets, our Q1 spread per hour was $9.75. We expect spread per hour to normalize to the $10 to $10.50 range beginning in Q2 and continue to improve in the second half of 2024.

就我們的勞動成本和毛利率指標而言，我們實現了1.001 億美元的毛利率，即25.4%，比去年同期下降3.9%，這主要是由於一些與時間相關的項目以及我們的PDS 儲備的整體加強所推動的。第一季的收入成本率為 28.73 美元，受到薪資稅的影響。儘管勞動力市場持續存在工資壓力，我們第一季的每小時工資仍為 9.75 美元。我們預計每小時點差將從第二季開始正常化至 10 至 10.50 美元範圍，並在 2024 年下半年繼續改善。

Moving on to our home health and hospice segment, revenue for the quarter was approximately $54.6 million, a 2.7% decrease over the prior year. Revenue was driven by 10,100 total admissions with approximately 75% being episodic and 12,100 total episodes of care, up 7% sequentially from Q4. Medicare revenue per episode for the quarter was $3,070, up 3.4% from the prior year quarter.

接下來是我們的家庭健康和臨終關懷部門，該季度的收入約為 5,460 萬美元，比前一年下降 2.7%。收入由總入院人數 10,100 人次推動，其中約 75% 為偶發性患者，總護理次數為 12,100 人次，較第四季度環比增長 7%。該季度每集醫療保險收入為 3,070 美元，比去年同期增長 3.4%。

We continue to focus on rightsizing our approach to growth in the near term by focusing on preferred payers that reimburse us on an episodic basis. This episodic focus has accelerated our margin expansion and improved our clinical outcomes. With episodic admissions well over 70%, we have achieved our goal of rightsizing our margin profile and enhancing our clinical offerings.

我們繼續專注於短期內調整我們的成長方式，並專注於定期向我們償還費用的首選付款人。這種間歇性的關注加速了我們的利潤擴張並改善了我們的臨床結果。偶發入院率遠超過 70%，我們已經實現了調整利潤率和增強臨床產品的目標。

As we navigate 2024, we believe our admission growth will normalize in the 3% to 5% range. We are committed to a disciplined approach to growth while shifting our capacity to those payers who value our clinical resources. We're pleased with our Q1 gross margin of 53.1%, up 15.8% over the prior year period and representing a continued focus on cost initiatives to achieve our targeted margin profile.

展望 2024 年，我們相信入學人數成長將正常化在 3% 至 5% 的範圍內。我們致力於採取嚴格的成長方式，同時將我們的能力轉移給那些重視我們臨床資源的付款人。我們對第一季毛利率為 53.1% 感到滿意，比去年同期成長 15.8%，這表明我們繼續關注成本計劃，以實現我們的目標利潤率。

Q1 gross margins benefited for some timing related entries and should normalize in the 49% to 51% range moving forward. Our home health and hospice platform is dedicated to creating value through effective operational management and the delivery of exceptional patient care.

第一季的毛利率受益於一些與時間相關的條目，並應在 49% 至 51% 的範圍內正常化。我們的家庭健康和臨終關懷平台致力於透過有效的營運管理和提供卓越的患者護理來創造價值。

Now, to our Medical Solutions segment results for Q1. During the quarter, we produced revenue of $41 million, a 9.9% increase over the prior year. Revenue was driven by approximately 92,000 unique patients served with an 8.2% increase over the prior year period and revenue per UPS of approximately $446. Gross margins were $17 million or 40.8% for the quarter, up 9.8% over the prior year period and in line with our targeted margin profile for medical solutions.

現在，我們的醫療解決方案部門第一季的業績。本季度，我們實現營收 4,100 萬美元，比上年增長 9.9%。營收由約 92,000 名獨特患者提供的服務推動，比去年同期成長 8.2%，每個 UPS 的營收約為 446 美元。本季毛利率為 1,700 萬美元，成長 40.8%，比去年同期成長 9.8%，符合我們醫療解決方案的目標利潤狀況。

We continue to implement initiatives to be more effective and efficient in our operations to leverage our overhead as we continue to grow. We are accelerating our preferred payer strategy and medical solutions by aligning our capacity with those payers that value our services and appropriately reimburse us for the care we provide. As we expand our national enteral presence and solidify our position as the leading provider of enteral nutrition in the country, we plan to refine our partnerships with payers to better support our growth.

我們持續實施舉措，提高營運效率，在不斷發展的過程中充分利用我們的管理費用。我們正在加速我們首選的付款人策略和醫療解決方案，透過將我們的能力與那些重視我們的服務並適當補償我們提供的護理的付款人相結合。隨著我們擴大國內腸內業務並鞏固我們作為國內腸內營養領先提供者的地位，我們計劃完善與付款人的合作夥伴關係，以更好地支持我們的成長。

In summary, we continue to fight through a difficult labor environment while keeping our patient care at the center of everything we do. It is clear to us that shifting caregiver capacity to those preferred payers, we value our partnerships is the path forward at Aveanna. As Jeff stated, our primary challenge continues to be reimbursement rates. With the positive momentum we experienced in Q1, we remain optimistic that such trends will continue throughout 2024. As we continue to make progress with the rate environment, we will pass through wage improvements and other benefits to our caregivers and the ongoing effort to better improve volumes.

總之，我們繼續努力克服困難的勞動環境，同時將病患照護作為我們所做一切的中心。我們很清楚，將護理人員的能力轉移給那些首選的付款人，我們重視我們的合作夥伴關係，這是 Aveanna 的前進道路。正如傑夫所說，我們的主要挑戰仍然是報銷率。憑藉我們在第一季經歷的積極勢頭，我們仍然樂觀地認為這種趨勢將在 2024 年持續下去。隨著我們在費率環境方面不斷取得進展，我們將向護理人員提供薪資提高和其他福利，並不斷努力更好地提高數量。

Now moving to our balance sheet and liquidity. At the end of the first quarter, we had liquidity in excess of $220 million representing cash on hand of approximately $42.6 million, $10 million of availability under our securitization facility and approximately $168 million of availability on our revolver, which was undrawn as of the end of the quarter. Lastly, we have $32 million and outstanding letters of credit at the end of Q1.

現在轉向我們的資產負債表和流動性。截至第一季末，我們的流動性超過2.2 億美元，其中手頭現金約為4,260 萬美元，證券化工具下的可用資金為1,000 萬美元，左輪手槍的可用資金約為1.68 億美元，截至年底尚未提取。最後，截至第一季末，我們有 3,200 萬美元的未償信用證。

On the debt service front, we had approximately $1.48 billion of variable rate debt at the end of Q1. Of this amount, $520 million is hedge with fixed rate swaps and $880 million is subject to an interest rate cap, which limits further exposure to increases in SOFR above 3%. Accordingly, substantially all of our variable rate debt is hedged. Our interest rate swaps extend through June 2026, and our interest rate caps extend through February 2027.

在償債方面，截至第一季末，我們的可變利率債務約為 14.8 億美元。其中，5.2 億美元透過固定利率掉期進行對沖，8.8 億美元受到利率上限的限制，這限制了 SOFR 成長超過 3% 的進一步風險。因此，我們幾乎所有的浮動利率債務都進行了對沖。我們的利率掉期有效期至 2026 年 6 月，利率上限有效期至 2027 年 2 月。

One-off item I would mention related to our debt is that we have no material term loan maturities until July of 2028. Looking at cash flow, cash provided by operating activities was negative $12 million for the quarter and free cash flow was negative approximately $12.7 million. Q1 is traditionally our highest cash outflow for the year, and we continue to expect to be a positive operating cash flow company in 2024. We also expect to see continued cash flow benefits as our top line and cost management initiatives come to fruition.

我要提到的與我們的債務相關的一次性事項是，我們在 2028 年 7 月之前沒有重大定期貸款到期。從現金流來看，本季經營活動提供的現金為負 1,200 萬美元，自由現金流為負約 1,270 萬美元。 Q1傳統上，這是我們今年現金流出最高的公司，我們繼續預計 2024 年將成為一家正營運現金流的公司。隨著我們的營收和成本管理計畫取得成果，我們也預計將看到持續的現金流效益。

Before I hand the call over to the operator for Q&A, let me take a moment to address our revised outlook for 2024. As Jeff mentioned, we currently expect full year revenue to be greater than $1.97 billion and adjusted EBITDA to be greater than $150 million. As we think about seasonality, we expect our revenue to grow as rate increases are implemented throughout the year and as our volumes grow.

在我將電話轉交給接線員進行問答之前，讓我花點時間談談我們修改後的 2024 年展望。正如傑夫所提到的，我們目前預計全年營收將超過 19.7 億美元，調整後的 EBITDA 將超過 1.5 億美元。當我們考慮季節性時，我們預計隨著全年費率的增加和銷售的成長，我們的收入將會成長。

Accordingly, we expect approximately 47% to 48% of our full year guided adjusted EBITDA to be recognized in the first half of 2024. As most of our annual rate increases typically become effective in the second half of the year, we expect our adjusted EBITDA to ramp as we use these increases to attract and retain more caregivers and drive volumes. Our EBITDA will also accelerate as we realize the benefits of our continued cost saving initiatives.

因此，我們預計全年引導調整後 EBITDA 的約 47% 至 48% 將在 2024 年上半年確認。由於我們的大部分年度升息通常會在下半年生效，因此我們預計調整後的 EBITDA 將大幅增加，因為我們利用這些升息來吸引和留住更多的護理人員並增加銷售。隨著我們意識到持續的成本節約舉措的好處，我們的 EBITDA 也將加速。

In closing, I'm proud of all of our Aveanna team members and our hard work in achieving our Q1 results. I look forward to our continued execution of our 2024 strategic plan and updating you further at the end of Q2.

最後，我為所有 Aveanna 團隊成員以及我們為實現第一季業績所做的辛勤工作感到自豪。我期待我們繼續執行 2024 年策略計劃，並在第二季末向您進一步通報最新情況。

With that, let me turn the call over to the operator.

這樣，我就把電話轉給接線生。

(Operator Instructions)

（操作員說明）

Ben Hendrix, RBC Capital Markets.

本‧亨德里克斯，加拿大皇家銀行資本市場部。

Hey, thank you, guys, and congratulations on the quarter. Appreciate the new stats on your payer arrangements as a percentage of the overall managed care opportunity. I just wanted to get your thoughts on how you expect that to pace from the current 40% range and then geographically, kind of how that's progressing and where the next opportunities are? I know you've made good progress in Texas. California is a little bit of a different environment, but kind of where's the low-hanging fruit? And how should we think about that pacing? Thanks.

嘿，謝謝你們，夥計們，祝賀這個季度。了解付款人安排的新統計數據佔整體管理式醫療機會的百分比。我只是想了解一下您對目前 40% 範圍內的成長預期如何，然後從地理上看，進展如何以及下一個機會在哪裡？我知道你在德克薩斯州取得了很大的進步。加州的環境有點不同，但容易實現的目標在哪裡呢？我們該如何考慮這種節奏？謝謝。

Hey, Ben. Good morning. Thanks for the question. Yeah, I think first of all, this indicator makes a lot more sense on the potential opportunity that we have out there with the states that have migrated away from pure Medicaid to a Medicaid MCO states. And having 40% of our total volume, I think tells the reader that we're pretty far along in this process. We're a couple of years into this preferred payer strategy.

嘿，本。早安.謝謝你的提問。是的，我認為首先，這個指標對於我們與那些已經從純粹的醫療補助轉移到醫療補助 MCO 州的州所擁有的潛在機會更有意義。占我們總體積的 40%，我想告訴讀者我們在這個過程中已經走了很遠了。我們採用這種首選付款人策略已經有幾年了。

Some of the largest payers in the largest states are in that -- in the first, what we call the first 14 preferred payers at the end of last year, I think we've mentioned that before on calls. And I think low 40s percentage points will probably move, quarter by quarter in very small increments from this point forward. It'll take us landing numerous preferred payer agreements to kind of get the basis to move materially.

最大州的一些最大付款人是這樣的——首先，我們稱之為去年年底前 14 個優先付款人，我想我們之前在電話會議上已經提到過這一點。我認為，從現在開始，40 多個百分點可能會以非常小的增量逐季變化。我們需要達成許多優先付款人協議，才能為實質進展奠定基礎。

If I looked out a year or two, Ben, do I think that this number could be over 50%? And I think the answer is yes, that we believe we'll get over 50% of our total volumes and continue progress. But I wouldn't expect this to move by 5% or 10% per quarter. I would expect it to move in small increments of 1% or 2%.

Ben，如果我觀察一兩年，我認為這個數字可能會超過 50% 嗎？我認為答案是肯定的，我們相信我們將獲得超過總銷量的 50% 並繼續取得進展。但我預計這一數字不會每季成長 5% 或 10%。我預計它會以 1% 或 2% 的小幅增量移動。

But, I think if we use Q1 as an example, our team executed four additional preferred payer contracts in the first quarter. We're off to a nice start. Some of these are pretty small in volume, but very important in the states that they're in.

但是，我認為如果我們以第一季為例，我們的團隊在第一季額外執行了四份優先付款人合約。我們有了一個好的開始。其中一些的數量相當小，但在它們所在的州卻非常重要。

And I think we use California to your point as an example. The majority of California PDN patients are still on the traditional Medical fee-for-service, but we're able to partner with some of the whole-child models and some of the MCOs that are in the state. And as families move into those programs, we have preferred payer agreements with them. So that will help accelerate our volume in states like California that are still primarily a Medicaid product.

我想我們用加州來說明你的觀點。大多數加州 PDN 患者仍然採用傳統的按服務付費醫療模式，但我們能夠與該州的一些全童模式和一些 MCO 合作。當家庭加入這些計劃時，我們優先與他們簽訂付款人協議。因此，這將有助於加快我們在加州等州的銷售量，這些州仍然主要是醫療補助產品。

But I guess I'll close with at the end of the day, you read it right, Ben, really nice continued momentum on the preferred payer strategy inside the PDS division. Really proud of how both the government affairs team and the preferred payer teams are working to execute our strategy. I think our momentum will continue in that as we think about '24 and '25.

但我想我會在一天結束時結束，你沒看錯，Ben，PDS 部門內首選付款人策略的持續勢頭非常好。對於政府事務團隊和首選付款人團隊如何努力執行我們的策略感到非常自豪。我認為當我們考慮'24和'25時，我們的勢頭將繼續下去。

Great. Thank you very much.

偉大的。非常感謝。

Thanks, Ben.

謝謝，本。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

Thanks. Good morning. First question, just a two parter just on the PDS in terms of some of the modeling. First on the revenue rate. So it looks like that's been up around 1% year over year in each of the last two quarters. Just wondering whether that's a good run rate now for the balance of the year on the revenue rate or whether you do expect that to move higher at all?

謝謝。早安.第一個問題，只是關於 PDS 的一些建模方面的兩個合作夥伴。首先是收入率。因此，過去兩個季度的年成長率似乎都在 1% 左右。只是想知道，對於今年餘下的收入率來說，現在的運行率是否良好，或者您確實預計這一運行率會更高？

And then just the second part would be on the gross margin in PDS. Matt had talked about some timing items, I guess, affecting the first quarter as well as adding to the reserve. If you could maybe elaborate on that? And then just talk about how you see gross margins for PDS tracking over the balance of the year.

第二部分是 PDS 的毛利率。我想，馬特談到了一些時間項目，這些項目影響了第一季並增加了儲備。能否詳細說明一下？然後談談您如何看待今年餘下時間 PDS 跟踪的毛利率。

Obviously, Scott. Thank you. Yeah, I think as you think about PDS rate, we do over 10 million hours per quarter at this point. So it takes a lot of new rate to lift the basis. And I think Matt use the growth rate of PDS kind of in that 3% to 5%, but between volume and rate the last few quarters, obviously we're in the high end of that last two, three quarters, which we're really proud of. I mean, to talk about 5% volume and rate lift for our -- for our 10 million hours a quarter is a huge accomplishment to our team.

顯然，斯科特.謝謝。是的，我認為當你考慮 PDS 費率時，我們目前每季的工作時間超過 1000 萬小時。因此需要大量新利率來提升基差。我認為馬特使用 PDS 的成長率在 3% 到 5% 之間，但在過去幾個季度的數量和成長率之間，顯然我們處於過去兩個、三個季度的高端，我們正在真的很自豪。我的意思是，每季 1000 萬小時的工作量和費率提升了 5%，這對我們的團隊來說是一項巨大的成就。

But yeah, I think you think of it generally correct that we'll be in the higher end of that 3% to 5% range. Volume is 3% to 4% of it; rate is 1% to 1.5% of it as we move forward. And ultimately, we think that will moderate back to more like 3% volume, 2% rate, or 3.5% volume. But in the environment we're in today where we're kind of in that 4% volume, 1% rate. That's probably the right way to think of it.

但是，是的，我認為你認為我們將處於 3% 至 5% 範圍的高端，這通常是正確的。體積為其3%~4%；隨著我們的進展，利率將是 1% 到 1.5%。最終，我們認為成交量將回落至 3%、2% 或 3.5%。但在我們今天所處的環境中，我們的銷量是 4%，比率是 1%。這可能是正確的思考方式。

Now on the cost side, Matt will give you kind of thoughts about our spread and how we think of Q2 and the rest of the year.

現在在成本方面，馬特將向您介紹我們的價差以及我們對第二季和今年剩餘時間的看法。

Yeah, Scott, Q1's a temporary headwind, always with just a higher payroll taxes that significantly impact us being a labor company. So that right off the bat. Had a little bit of headwind temporarily in nature with some of our reserves and we did the right thing of increasing reserves to make sure that we're in a solid position kind of moving forward as well. Expect us to be in that $10 to $10.50 spread range in Q2 and Q3 and Q4. We're pretty confident and comfortable with where that's currently sitting in and probably will land there for the entire year as well.

是的，斯科特，第一季是一個暫時的逆風，總是伴隨著更高的工資稅，這對我們作為一家勞工公司產生了重大影響。所以馬上就可以了。我們的一些儲備暫時遇到了一些逆風，我們做了正確的事情，增加了儲備，以確保我們也處於向前發展的穩固地位。預計第二季、第三季和第四季的價差範圍將在 10 美元至 10.50 美元之間。我們對目前的情況非常有信心，也很滿意，而且很可能全年都會如此。

I think it's fair to say, Scott, to Matt's comment our Q1 gross margin will be probably -- will most likely be the low for the year -- not the quarter, but for the year. And I think it's fair to expect us to be above 26% moving forward, I think, Matt said it well, we'll be in that $10 to $10.50 range, even in Q2 as we move forward.

史考特，我認為公平地說，根據馬特的評論，我們第一季的毛利率可能是——很可能是今年的最低點——不是季度，而是全年。我認為預計我們未來的成長率將超過 26% 是公平的，我認為，馬特說得很好，即使在我們前進的第二季度，我們也將處於 10 美元至 10.50 美元的範圍內。

26%, 28% range is our go-forward range for PDS; good business. We're able to drive volume growth with that spread or with that gross margin as well. And so as we continue to win the preferred payer contracts, government affairs wins that come in, we'll continue to pass through those wage improvements to our caregivers. So you won't see expansion there from those rate increases necessarily but more solidifying in it in solid spot.

26%、28%範圍是我們PDS的前進範圍；好工作。我們能夠透過這種價差或毛利率來推動銷售成長。因此，當我們繼續贏得優先付款人合約、政府事務勝利時，我們將繼續將這些薪資改善轉嫁給我們的護理人員。因此，您不一定會看到這些利率上漲帶來的擴張，但會在堅實的地方更加鞏固。

Okay, got it. And then just my follow-up question, I just wanted to ask about operating cash flow and was negative in the first quarter, but you had guided for that. Maybe if you could help us walk through your thoughts on operating cash flow for the second quarter? And then I know you expect to be positive for the full year, could you put a number around that in terms of range?

好，知道了。然後是我的後續問題，我只想詢問營運現金流，第一季為負值，但您對此進行了指導。也許您可以幫助我們談談您對第二季度營運現金流的想法嗎？然後我知道您預計全年業績將保持樂觀，您能否給出一個範圍內的數字？

Then last part on the operating cash flow will be. I'm not sure about necessarily this year, but if you continue to sort of normalized margins, how you guys are thinking about, let's call it over the next year or two maybe, sort of settling out on what you think your EBITDA to cash flow conversion can look like. Thanks.

然後是關於經營現金流的最後一部分。我不確定今年是否一定如此，但如果你繼續保持正常化的利潤率，你們在想什麼，讓我們在未來一兩年內稱之為，解決你認為你的 EBITDA 兌現的問題流量轉換可以是這樣的。謝謝。

All right, Scott. I'm going to unpack this one. So let me stumble through and you come back and catch me up, alright right?

好吧，斯科特。我要拆開這個包裝。所以讓我跌跌撞撞地過去，然後你回來接我，好嗎？

I'll help you Matt. If you need any of the pieces of that, I'm happy to help.

我會幫助你，馬特。如果您需要其中的任何部分，我很樂意提供協助。

Appreciate it. So, first off, great 2023 cash flow year. First year, over $12 million free cash flow for Aveanna, really proud of our teams and being able to achieve it. We did have a little benefit of some timing items in 2023 that were a little bit of a headwind in 2024, specifically in Q1. Q1 was actually a pretty darn good quarter for us, and we're expecting a more significant headwind there. But there's some cash management and great operations and through our adjustments are getting so much cleaner as well, we've been able to drop some of that cash flow through.

欣賞它。所以，首先，2023 年是現金流優異的一年。第一年，Aveanna 的自由現金流超過 1200 萬美元，我們為我們的團隊並能夠實現這一目標感到非常自豪。我們確實從 2023 年的一些計時專案中獲得了一些好處，而這些專案在 2024 年（特別是第一季）有點不利。第一季對我們來說實際上是一個非常好的季度，我們預計那裡會出現更嚴重的阻力。但有一些現金管理和良好的運營，透過我們的調整也變得更加乾淨，我們已經能夠減少一些現金流。

Q2 will probably be similar concept to Q1 as well, just as we have some of our timing items come through, specifically related to when revenue is -- or when cash comes in from revenue. TPL season is always a headwind for us at the very beginning of the year that starts to subside in the back half of Q2 and really jumps up into Q3. So I would think about it sequentially roughly the same in Q2. And this is all ballpark that we're talking about are really starting to compound and get there in Q3, getting us back to being a positive free cash flow operating cash flow company in 2024.

第二季的概念也可能與第一季類似，就像我們已經完成了一些時間項目一樣，特別是與收入何時或何時從收入中獲得現金有關。TPL 賽季對我們來說在年初總是一種逆風，這種逆風在第二季後半段開始消退，並在第三季真正上升。所以我會認為第二季的情況大致相同。這就是我們正在談論的所有大概情況，它們確實開始復合並在第三季度實現，使我們在 2024 年重新成為一家正自由現金流運營現金流公司。

As you think about the out years, our team has done such a great job, one, with cash collections, two, with operations, but even just our EBITDA, such a healthier, cleaner EBITDA as well. I think a lot of that is starting to drop through and you're seeing that play out through our cash flow and we'll continue to see that. We do have some costs coming out this year. We are doing some items to remove cost out. So I'm not saying those are going to be zero going forward, but we're doing the things right now to be benefit in the long run for organization and will benefit us in 2024 and 2025.

想想過去幾年，我們的團隊做得非常出色，一是現金回收，二是運營，但即使只是我們的 EBITDA，也是如此健康、乾淨的 EBITDA。我認為其中許多已經開始消失，你會看到它透過我們的現金流發揮作用，我們將繼續看到這一點。今年我們確實有一些費用。我們正在做一些項目來消除成本。因此，我並不是說這些未來將為零，但我們現在正在做的事情是為了從長遠來看對組織有利，並將在 2024 年和 2025 年使我們受益。

And Scott, it's a great springboard to Matt's point from operating cash flow to really your last part of your question on really profitability. And I think Matt laid out last four, five quarters that we were committed to taking thoughtful cost out of the company as we scale the company. And I think you see that -- and you saw at the end of '23, you see it in our Q1 results, you'll see it again in Q2 and moving forward.

斯科特，這是馬特觀點的一個很好的跳板，從經營現金流到你關於真正盈利能力的問題的最後一部分。我認為馬特在過去的四、五個季度中指出，我們致力於在擴大公司規模時降低公司成本。我認為你看到了這一點 - 你在 23 年底看到了這一點，你在我們第一季度的結果中看到了這一點，你將在第二季度再次看到它並繼續前進。

I may have gotten ahead of myself last earnings call when I said 10% by the end of the year, that's probably a bit aggressive. But I think you'd think it was on a March back to $200 million a year and EBITDA and our goals are set on doing the right things to get there. And I think we've been in the 7% EBITDA -- adjusted EBITDA margins, we're approaching 8% as we speak. But the most -- I think the exciting part for us is we see that clear path over '24, '25, and '26 and really marching the company back to being a double digit EBITDA company.

上次財報電話會議我說到今年年底達到 10% 時，我可能有點言過其實了，這可能有點激進。但我想你可能會認為，這是在 3 月回到每年 2 億美元的時期，而 EBITDA 和我們的目標是透過採取正確的措施來實現這一目標。我認為我們的 EBITDA 利潤率已經達到 7%，調整後的 EBITDA 利潤率正在接近 8%。但最重要的是，我認為對我們來說最令人興奮的部分是，我們看到了 24 年、25 年和 26 年的清晰道路，並真正使公司重新成為兩位數的 EBITDA 公司。

And none of it's easy. It's all hard work and it's thoughtful work. But I think Matt said it well, our teams have embraced this idea of being efficient and effective as we grow the company and we've moved, but last year was home health and hospice. This year, we're focused on our PDS division. We continue to focus on corporate both last year and this year. But we're -- we've taken meaningful cost out of the company in '23, we're taking additional meaningful cost the company in '24, and already thinking about '25.

這一切都不容易。這都是艱苦的工作，也是深思熟慮的工作。但我認為馬特說得很好，隨著公司的發展，我們的團隊已經接受了這種高效和有效的理念，我們已經搬家了，但去年是家庭健康和臨終關懷。今年，我們的重點是 PDS 部門。去年和今年我們持續關注企業。但我們——我們已經在 23 年從公司中削減了有意義的成本，我們在 24 年為公司削減了額外的有意義的成本，並且已經在考慮 25 年了。

So we're real excited about how that relates to both improved adjusted EBITDA margin, but also to your point being a cash generating company moving forward. And kudos to our teams for all the work they've done to get us there. Thanks, Scott.

因此，我們對這與調整後 EBITDA 利潤率的提高以及貴公司作為一家不斷發展的現金產生公司的觀點有何關係感到非常興奮。感謝我們的團隊為我們實現這一目標所做的所有工作。謝謝，斯科特。

Thanks and helpful to get those intermediate term of bogeys you just added in. So appreciate that. Thank you.

感謝並幫助獲得您剛剛添加的那些中間柏忌。所以很感激。謝謝。

Thanks.

謝謝。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Hey, good morning, guys. Thanks for taking my question's. On the preferred payer strategy, what percent of all PDS volume today is handled by managed Medicaid versus Medicaid fee-for-service?

嘿，早上好，夥計們。感謝您回答我的問題。在首選付款人策略中，今天所有 PDS 量的百分之多少是由託管醫療補助與醫療補助按服務收費處理的？

Pito, we don't necessarily give that metric on the volume standpoint. We do obviously give a breakout on the revenues. You can kind of back into it a little bit on some math standpoint from it. Going back to that 40%, we're really proud of our teams for achieving that. And I'll say our operations teams for providing that care and reaching out our clinical teams for leaning into those patients but obviously, our payer relations teams on top of it as well.

Pito，我們不一定從數量的角度給出這個指標。顯然，我們確實對收入進行了突破。你可以從數學的角度稍微回顧一下它。回到 40%，我們為我們的團隊實現這一目標感到非常自豪。我想說的是我們的營運團隊提供了這種護理，並聯繫我們的臨床團隊來了解這些患者，但顯然，我們的付款人關係團隊也在此之上。

You'll see that continue to grow, as Jeff stated earlier organically, just as you know patients are coming out of hospital and bringing into it, but also as we continue to sign new preferred payer agreements. We've got to go out there; 22 this year. We saw a nice jump up in Q1 and we'll continue to see that throughout the year. So that will add to it.

正如傑夫之前所說，您會看到這一數字繼續增長，就像您知道患者正在出院並進入醫院一樣，而且隨著我們繼續簽署新的首選付款人協議。我們必須出去；今年22。我們在第一季看到了良好的跳躍，我們將在全年繼續看到這種情況。所以這會增加它。

I guess the only negative headwind to it wouldn't be on a volume standpoint, it actually be a positive because it would give us more opportunity if that states continue to migrate on a Medicaid system over to an MCO. We'll work our best to see if we can get out in front of some of those conversations, some of those MCO payers. But I guess that could actually bring it down temporarily in nature, but open up the population for us to even drive that and have meaningful conversations as well.

我想唯一的負面阻力不是從數量角度來看，它實際上是一個積極的阻力，因為如果各州繼續從醫療補助系統遷移到 MCO，它將給我們更多的機會。我們將盡最大努力看看是否能夠在其中一些對話中、在一些行管令付款人面前脫穎而出。但我想這實際上可能會暫時降低自然界的水平，但會為我們開放人口，甚至推動這一進程並進行有意義的對話。

And Pito, I guess think of the 40% -- so think separate the two government affairs primarily still focused on moving Medicaid fee-for-service rates; take Oklahoma last year. Obviously, we shifted our focus this year, too, specifically Georgia, Massachusetts and California. Think of those three primarily still government affairs oriented and then go back to that 40% indicator. That's our preferred payer strategy team, right? That is 40% of the total opportunity for us to execute on MCO payer partners and national commercial partners on the Medicaid space.

我想 Pito 會想到 40%，所以認為分開兩個政府事務主要仍然集中在改變醫療補助服務費率上；以去年的俄克拉荷馬州為例。顯然，我們今年也轉移了重點，特別是喬治亞州、麻薩諸塞州和加州。想想這三個主要仍以政府事務為導向，然後回到 40% 的指標。這是我們首選的付款人策略團隊，對吧？這占我們在醫療補助領域執行 MCO 付款合作夥伴和國家商業合作夥伴的總機會的 40%。

So think of us almost halfway there from a total opportunity standpoint on a preferred payer strategy, but as Matt said, I don't want to take away from -- in Georgia, we still have a government affairs strategy. In Massachusetts, we still have a government affairs strategy. We talked about last year, Oklahoma and other states like that. So we're doing both.

因此，從整體機會的角度來看，我們在首選付款人策略上幾乎已經完成了一半，但正如馬特所說，我不想剝奪 - 在喬治亞州，我們仍然有政府事務策略。在麻薩諸塞州，我們仍然有政府事務策略。我們去年談到了俄克拉荷馬州和其他類似的州。所以我們兩者都做。

And I'm proud to say we're winning more than we're losing on both sides of that equation. Our work is never done. California is a perfect example to remind us all. Our work is never done. We need to move the PDN right in California long term, just to help the families -- be able to get their children home and keep their children's homes.

我很自豪地說，在等式兩邊，我們贏得的都多於失去的。我們的工作永遠不會完成。加州是一個提醒我們所有人的完美例子。我們的工作永遠不會完成。從長遠來看，我們需要將 PDN 移至加州，只是為了幫助這些家庭——能夠讓他們的孩子回家並保住他們孩子的家。

Okay. So [I just think we're] half way there. If we take a five-year plus view here, if you move 100% of your managed Medicaid into a preferred, that would be about 80% of our volumes are handled by managed Medicaid and 20% are handled by Medicare fee-for-service. Is that a ballpark number?

好的。所以[我認為我們已經]成功了一半。如果我們在這裡採取五年以上的觀點，如果您將 100% 的託管醫療補助轉為首選，那麼我們大約 80% 的交易量由託管醫療補助處理，20% 由醫療保險按服務收費處理。這是一個大概的數字嗎？

That's probably a bit strong. There's still some large states that are still --. I'll use two examples, California and Colorado are still primarily fee-for-service states and both are very different. But I think Matt said it well, over time, Pito as you already know, most states are moving to an MCO strategy. So I think in our lifetime here, last seven years and the next five years, the majority of the states through the PDM product, will move to a Medicaid MCO.

這恐怕有點強了。仍有一些大州仍在--.我將舉兩個例子，加州和科羅拉多州仍然主要是按服務收費的州，兩者都有很大的不同。但我認為馬特說得很好，隨著時間的推移，皮托，正如你所知，大多數州都在轉向行動管制令策略。因此，我認為在我們的一生中，過去七年和未來五年，大多數州將透過 PDM 產品轉向醫療補助 MCO。

Now as we've learned with states like Texas, it takes three or four years. I mean, it's a very thoughtful process. So it's not a fast flip. It's a very thoughtful process because of the fragility of our patient population. But think of us having great opportunity on both sides, different customers that we're selling to and talking to, but both the government affairs and the preferred payer strategy, both can work depending on what the state is.

現在，正如我們從德克薩斯州等州了解到的那樣，這需要三到四年的時間。我的意思是，這是一個非常深思熟慮的過程。所以這不是一個快速翻轉。由於我們患者群體的脆弱性，這是一個非常深思熟慮的過程。但想想我們雙方都有很好的機會，我們向不同的客戶銷售和交談，但政府事務和首選付款人策略都可以根據國家情況而發揮作用。

Okay. Fair enough. But then just looking at that sort of 40% number, I mean that's extraordinary. What accomplishment for you guys. I guess as you look at your hourly growth is pretty strong in the quarter. And obviously, it [just comps] the year was still pretty strong hourly growth. Any color on actually how much you're growing organically in preferred provider networks versus everyone else? Is there a structurally different hourly growth rate between those two?

好的。很公平。但只要看看 40% 的數字，我就覺得這已經很了不起了。你們有什麼成就。我想，正如您所看到的，本季每小時的成長相當強勁。顯然，它[只是比較]這一年的每小時增長仍然相當強勁。與其他公司相比，您在首選提供者網路中實際有機增長了多少，有什麼顏色嗎？這兩者之間的每小時成長率是否存在結構性差異？

It really is, Pito. I'll relate it back to like hiring the actual nurse. It is still the haves and have-nots, right? So the good news is over the last two years, we've eliminated a number of -- we've reduce the number of states and payers that we work with who don't have acceptable rates to hire nurses, right? So we've either stopped working with those payers and shifted our capacity and time attention to payers who are willing to engage with us or we've taken the states who had very low rates and we've eliminated that by increasing the rate significantly.

確實如此，皮托。我會將其與僱用真正的護士聯繫起來。仍然是有產者和無產者，對嗎？所以好消息是，在過去的兩年裡，我們已經消除了一些——我們已經減少了與我們合作的州和付款人的數量，這些州和付款人無法以可接受的價格僱用護士，對吧？因此，我們要么停止與這些付款人合作，並將我們的能力和時間注意力轉移到願意與我們合作的付款人身上，要么我們選擇費率非常低的州，並通過大幅提高費率來消除這種情況。

Again, primary focus this year, Georgia, Massachusetts, and California because we need to move those rate. Those are still Medicaid rates that really are not attractive from a reimbursement to be able to hire RNs or LPNs. But yes, if you saw within the business or if you said to one of our operators, non-preferred payers, how much volume are you generating? In most cases, the answer would be negative and a non-preferred payer, we're not even flat, we're moving backwards. And it's not an accident.

同樣，今年的主要焦點是喬治亞州、馬薩諸塞州和加利福尼亞州，因為我們需要調整這些利率。這些仍然是醫療補助費率，對於僱用註冊護士或 LPN 的報銷確實沒有吸引力。但是，是的，如果您在業務中看到，或者您對我們的一位運營商（非首選付款人）說，您產生了多少交易量？在大多數情況下，答案是否定的，並且是非首選付款人，我們甚至沒有持平，我們正在倒退。這並非偶然。

It is, we are shifting our caregiver capacity. We're putting all of our recruitment efforts in said market like Texas to our payer partners. And honestly, Pito, it's what they're paying us to do. I mean, they're giving us accelerated rates and value-based agreements with the intent that we're going to live through that and give them our nurses and give them our capacity. So it's your opportunity.

事實上，我們正​​在改變我們的護理人員能力。我們將在德克薩斯州等上述市場的所有招聘工作交給我們的付款合作夥伴。老實說，皮托，這就是他們付錢給我們的目的。我的意思是，他們為我們提供了加速的費率和基於價值的協議，目的是讓我們能夠度過這一時期，並為他們提供我們的護士並為他們提供我們的能力。所以這是你的機會。

Pito. I can't believe you didn't touch on home health and home health gross margins and how proud you are of our team.

皮托。我不敢相信您沒有提到家庭健康和家庭健康毛利率以及您為我們的團隊感到多麼自豪。

Just to throw it out. Well there's so much unpack areas, I guess going forward, sticking to PDS for one second because it's such a huge strategy for you guys. Can you actually begin disclosing what the organic growth rate is on preferred? Just as we look at our excel models, we actually help sort of model this as team tenders going forward.

就是想把它丟掉。好吧，有太多的解包區域，我想繼續前進，堅持 PDS 一秒鐘，因為這對你們來說是一個巨大的策略。您實際上可以開始披露首選的有機增長率嗎？正如我們查看 Excel 模型一樣，我們實際上在團隊未來招標時幫助對此進行建模。

And then at the point on home health obviously we saw, a strong episodic growth. Obviously, we commissions as you're sort of shifting away. I guess, is this the right gross margin level we should think about going forward or -- and as you roll into the back half of the year as we move past payroll taxes? Are we actually expanding gross margins from these levels of 53%?

然後，在家庭健康方面，我們顯然看到了強勁的間歇性成長。顯然，我們會在您離開時進行委託。我想，這是我們應該考慮的正確毛利率水準嗎？我們的毛利率是否真的在 53% 的基礎上擴大？

I think as Matt laid out, 53% was a little hot for us and was helped by some one-time items. We think of it more in the 49% to 51%. I think based on where we are and the strength we've had with our episodic percentage being well north of 70%, we're probably a 50%-plus gross margin business in home health and hospice for the majority of this year. And as you know, that 18 months of work by our home health and hospice leadership team to get there.

我認為正如 Matt 所指出的，53% 對我們來說有點熱，並且得到了一些一次性物品的幫助。我們更多考慮的是 49% 到 51% 的人。我認為，根據我們的現狀以及我們的偶發百分比遠高於 70% 的實力，今年大部分時間我們在家庭健康和臨終關懷業務的毛利率可能超過 50%。如您所知，我們的家庭健康和臨終關懷領導團隊經過 18 個月的努力才實現了這一目標。

I think the thing that we're most proud of and that is, now we have finally overlapped our comps to where we're actually generating a positive year over year and sequential growth. Now, Q1 is our seasonal. I mean we have a decent Florida business. Q1 is up. It's a better season for us in our Florida business, but be that 1.7% positive growth -- it's the first time we've had positive episodic year-over-year comps in almost three years.

我認為我們最引以為豪的事情是，現在我們終於將我們的業績重疊到我們實際上實現了逐年正增長和環比增長。現在，第一季是我們的季節性。我的意思是我們在佛羅裡達州有不錯的生意。Q1 已上線。對於我們佛羅裡達州的業務來說，這是一個更好的季節，但 1.7% 的正增長——這是我們近三年來第一次出現積極的逐年同比增長。

And I think our team is really set on the fact that they can generate somewhere between 1% and 3% organic growth moving forward at a roughly 50% gross margin. You know the industry well, it's tough days in home health right now. The fact that we're able to do this, it's just an incredible amount of diligence by our team.

我認為我們的團隊確實相信他們能夠以大約 50% 的毛利率實現 1% 到 3% 的有機成長。您很了解這個行業，現在家庭健康的日子不好過。事實上，我們能夠做到這一點，只是我們團隊付出了令人難以置信的努力。

So we're excited about that. And honestly, as we look forward, we think the AMS business will start to show similar trends as the home health and hospice division has been as we continue to implement our preferred payer strategy throughout medical solutions, but yet will be in that 49% to 51% gross margin and I believe will be a positive year-over-year growth of total episodes from this point forward for rest of the year.

所以我們對此感到興奮。老實說，隨著我們繼續在整個醫療解決方案中實施我們的首選付款人策略，我們認為 AMS 業務將開始表現出與家庭健康和臨終關懷部門類似的趨勢，但仍將處於 49% 51% 的毛利率，我相信從此時開始，今年剩餘時間總劇集數將實現同比正增長。

Awesome. And then one last quick question, just following on Scott's question on cash flow from ops. You said 2Q being negative. Back half, you'll be positive, getting positive cash flow from ops. Is we'd be modeling '24 cash flow from ops in the same range as last year, is that a good ballpark range? Or any color of how should we be modeling that? Thanks so much.

驚人的。然後是最後一個快速問題，緊接著史考特關於營運現金流的問題。你說2Q是負數。後半部分，你會很積極，從營運中獲得正的現金流。我們是否會在與去年相同的範圍內對 24 年營運現金流進行建模，這是一個不錯的大致範圍嗎？或者我們應該如何建模任何顏色？非常感謝。

I think, I would hinder that a little bit, I would say take it back a little bit. We had a really good year last year. But as I mentioned, we've benefited from some timing related items that came through. So I would just say, hey, positive is a good year for us on top of this one and for a little bit north of that, awesome. But really, 2025 is when you see the big jump up. It's really to the diligence of our teams of just good clean operations and growing our business organically.

我想，我會阻礙一點，我會說收回一點。去年我們度過了非常美好的一年。但正如我所提到的，我們從一些與時間相關的項目中受益。所以我只想說，嘿，積極的一年對我們來說是美好的一年，除此之外，再往上一點，太棒了。但實際上，2025 年是你看到大幅躍升的時候。這確實取決於我們團隊的勤奮，良好的清潔營運和有機的業務成長。

Thanks, guys.

多謝你們。

Thanks, Pito.

謝謝，皮托。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

Good morning. You've got Taji on for Brian. Thanks for taking my question. So looking at the margins, I know that you guys had provided some really great detail on the gross margin, but thinking about the OpEx in the business. Obviously, even with gross margin stepping down sequentially, you were able to extract a good amount of costs out of P&L. Just curious, is that the right jumping point that we should be thinking about for this year? How much more juice is there to squeeze within that line item?

早安.你已經為布萊恩安排了塔吉。感謝您提出我的問題。因此，看看利潤率，我知道你們提供了一些關於毛利率的非常詳細的信息，但考慮到了業務中的營運支出。顯然，即使毛利率連續下降，您也能夠從損益表中提取大量成本。只是好奇，這是我們今年應該考慮的正確跳躍點嗎？該訂單項目中還有多少果汁可以榨取？

I going to start with kind of the sequential part of it. As we've talked, Taji, the last three or four quarters, this was an absolute focus of ours. Knowing that gross margin is very hard to move in this business that being effective and efficient was key to us. I think the best part of the story as we talk, we really focused the last 15 months on home health and hospice, and corporate.

我將從它的連續部分開始。正如我們所說，塔吉，過去三、四個季度，這是我們的絕對焦點。我們知道，在這項業務中，毛利率很難提高，因此有效和高效對我們來說至關重要。我認為在我們談論的故事中最精彩的部分是，我們在過去 15 個月中真正關注的是家庭健康、臨終關懷以及企業。

We've pivoted this year to focusing on our largest business unit, which is private duty services. We're being thoughtful about it, right? Because we have a very large PDS business. But I think as you think probably more importantly about '25, we see the opportunity to continue to be efficient and effective in our business. Matt, you might touch just on the quarterly run rate?

今年我們的重點是我們最大的業務部門，即私人值班服務。我們正在考慮這個問題，對嗎？因為我們有非常龐大的PDS業務。但我認為，正如您對 25 年的看法可能更重要一樣，我們看到了繼續保持業務高效和有效的機會。馬特，你可能只談一下季度運行率？

Yeah. And just on gross margin itself. Q1's a compressed gross margins as been that labor business, Taji that we talked about and state taxes are significant for us. We see as a sequential jump up just immediately as those roll off into Q2. And then as well, as we continue to focus on this and in take meaningful cost out of OpEx, but also we do the right thing on the gross margin line and making sure that we're paying people the appropriate amount of money and being very diligent in there.

是的。就毛利率本身而言。第一季的毛利率被壓縮，因為我們談到的勞動力業務、塔吉和州稅對我們來說意義重大。我們認為，隨著這些數據滾入第二季度，我們會立即看到連續的跳躍。然後，當我們繼續關注這一點並從營運支出中獲取有意義的成本時，我們也在毛利率上做了正確的事情，並確保我們向人們支付了適當的金額，並且非常裡面很勤奮。

I think you'll see it expand throughout the year. Q1's historically, as I said, our lowest quarter out of the entire year on a GM basis. But Q2, Q3, and Q4, I think you'll see minimal sequential step-up.

我想你會看到它在全年中不斷擴大。正如我所說，從歷史上看，第一季是我們全年業績最低的季度。但是第二季度、第三季度和第四季度，我認為您會看到最小的連續升級。

Great. That's really helpful. And then just back to the commentary on California, I know you guys expressed disappointment by not being included in the rate budget, but obviously you're still thinking there's an enhanced effort towards driving rate increases, the two pronged rate increases.

偉大的。這真的很有幫助。然後回到對加州的評論，我知道你們對沒有被納入費率預算表示失望，但顯然你們仍然認為需要加強推動費率上漲，兩方面加息。

But thinking about state budget itself, right and your continued efforts to trying get rate increases, maybe can you just talk about you're learning from prior efforts, and how you're incorporating this into your continued efforts towards getting including state budget? And I know there's some moving pieces that are out of your control, right, like a deficit, et cetera. But just curious to hear your learnings and how you're going to take this for revitalized approach to portraying your value prop and the need for rate increases within your business essentially.

但是，考慮一下國家預算本身，以及您為提高利率而做出的持續努力，也許您可以談談您正在從之前的努力中學習，以及您如何將其融入到包括國家預算在內的持續努力中？我知道有些變化是你無法控制的，像是赤字等等。但我只是好奇地想聽聽您的經驗教訓，以及您將如何利用這一點來重新煥發活力，以描繪您的價值支柱以及您的業務中對利率增長的需求。

It's a very thoughtful question, Taji, and thank you. We're two-plus years straight of working on California and needing -- knowing that we needed to lift the rate. And again, we represent the families of the complex medical children in the state. So it's less about Aveanna, it's more about how do we help the families. And I think we've learned in California that even a great story in a difficult budget time is difficult to get through. And so the governor has been very open to understanding our plight and the plight of our families.

這是一個非常深思熟慮的問題，塔吉，謝謝你。我們在加州工作了兩年多，並且需要——知道我們需要提高利率。再說一遍，我們代表該州複雜的醫學兒童的家庭。因此，這不是關於 Aveanna，而是關於我們如何幫助這些家庭。我認為我們在加州已經了解到，即使是在預算困難的時期寫出的精彩故事也很難看完。因此，州長非常願意理解我們和我們家庭的困境。

Dr. [Valle], who runs HHS, has been very open, but they've also been very open for the fact that they're in a significant deficits situation and it's difficult to optically pass through a meaningful rate increase while you're cutting many, many, many other programs. And I think we just got caught up in that kind of prop wash.

負責HHS 的[Valle] 博士一直非常開放，但他們也非常開放地接受這樣一個事實，即他們處於嚴重赤字的情況下，而且在你處於困境的情況下，很難從視覺上通過有意義的加息。我認為我們只是陷入了這種道具清洗之中。

I know this for us, it's not an if, it's a win, meaning as the largest provider of PDN service in the state of California, we have to just keep fighting the good fight. And to your point, learned from what worked and what maybe didn't work and refine our efforts. We continue to partner with both of the current Governor's team, Dr. Ghaly, and many legislatures with our peers and the families.

我知道這對我們來說不是如果，而是勝利，這意味著作為加州最大的 PDN 服務提供者，我們必須繼續打好這場仗。就您的觀點而言，我們從有效的方法和可能無效的方法中吸取了教訓，並改進了我們的努力。我們繼續與現任州長團隊加利博士以及許多立法機構以及我們的同行和家屬合作。

We're not expecting to be in this year's budget. The May revise budgets throughout any time now, probably the next two weeks. We're not expecting PDN to be in that. I think it's highly unlikely we'll be in the final budget. There's just not the appetite for rate improvements.

我們預計不會出現在今年的預算中。梅現在隨時（可能是未來兩週）修改預算。我們並不期望 PDN 參與其中。我認為我們不太可能進入最終預算。人們對提高利率沒有興趣。

We ask for a 40%. We were not a asking for 2% or 3% rate. We are asking for 40%. And 40% is the right number to move the needle. I think the part of this that we have learned over the last I call it six to eight months is more families are voting in California with their need to get services.

我們要求 40%。我們並沒有要求 2% 或 3% 的利率。我們要求 40%。40% 是推動改變的正確數字。我認為我們在過去的六到八個月中了解到的部分是，更多的家庭因需要獲得服務而在加州投票。

And so what we are seeing is one by one by one families moving away from the Medicare fee-for-service program and moving into either the whole child model programs, which there are a few in California or finding themselves to have a payer like Kaiser or someone like Kaiser who does have either commercial or an MCO carve out in the state. And those MCOs and whole-child models programs had partner with companies like Aveanna at enhanced rates, which is great. So we can staff their cases, we can bring their children home.

因此，我們看到的是一個又一個的家庭正在放棄醫療保險按服務收費計劃，轉而採用整個兒童模式計劃（加州有一些這樣的計劃），或者發現自己有像凱撒這樣的付款人或者像Kaiser這樣在該州有商業或MCO 業務的人。這些 MCO 和全童模特兒計劃以更高的價格與 Aveanna 等公司合作，這很棒。這樣我們就可以為他們的案件提供人員，我們可以帶他們的孩子回家。

So if we look at the MCO companies in California, they would tell us exactly what the rate is for PDN in the state. And we've shared that with the current governor's team and legislature because there's no magic behind it. It just takes the right rate to pay the right wage. But if you said it means looking at crystal ball, how long was that in California?

因此，如果我們查看加州的 MCO 公司，他們會準確地告訴我們該州 PDN 的費率是多少。我們已經與現任州長團隊和立法機構分享了這一點，因為背後並沒有什麼魔力。只需要適當的利率即可支付適當的工資。但如果你說這意味著看水晶球，那在加州有多久了？

My gut is it's a few more years that it's --. We continue to help families transition out to the MCO plans, but it's very slow movement, 1%, 2%, 3% movement at a time and that we continue to partner for another year or two with the California Governor, maybe even the next governor and legislature to ultimately get it done.

我的直覺是還需要幾年--.我們繼續幫助家庭過渡到 MCO 計劃，但進展非常緩慢，一次 1%、2%、3%，我們將繼續與加州州長合作一兩年，甚至可能是下一年州長和立法機關最終完成它。

I think when we look back after five years, California will raise the PDN rate meaningfully because they have to; not because they want to, because they have to. And so we'll be proud that we were part of that process, but it will take two or three times as long as we thought and probably take two or three times as much money as we thought. So but we're committed to it. We work on behalf of the families we serve, and so we won't rest until our work is done.

我認為五年後當我們回顧時，加州將有意義地提高 PDN 費率，因為他們必須這麼做；不是因為他們想這樣做，而是因為他們必須這麼做。因此，我們會為自己參與了這個過程而感到自豪，但這將花費我們想像的兩到三倍的時間，並可能需要我們想像的兩到三倍的資金。所以，但我們致力於此。我們為我們所服務的家庭而工作，因此我們的工作完成之前不會休息。

Great. Thank you.

偉大的。謝謝。

Thank you, Taji.

謝謝你，塔吉。

Ladies and gentlemen, we have reached the end of the question-and-answer session, and I would like to turn the call back to Jeff Shaner for closing remarks.

女士們、先生們，問答環節已經結束，我想將電話轉回給傑夫·沙納（Jeff Shaner）做總結發言。

Thank you, David, and thank you, everyone, for your interest in our Aveanna story. We look forward to updating you on our continued progress at the end of Q2. With that, have a great day.

謝謝大衛，也謝謝大家對我們艾維娜故事的興趣。我們期待在第二季末向您通報我們的持續進展。就這樣，祝你有美好的一天。

This concludes today's conference. Thank you, for your participation and you may disconnect your lines at this time.

今天的會議到此結束。感謝您的參與，此時您可以斷開線路。