Aveanna Healthcare Holdings Inc (AVAH) 2025 Q3 法說會逐字稿

Good morning and welcome to Aveanna's third-quarter 2025 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 2025 年第三季財報電話會議。我是黛比·斯圖爾特，公司的首席會計官。今天陪我一起的有我們的執行長傑夫·沙納和我們的財務長馬特·巴克霍爾特。

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，我們將發表一些前瞻性聲明。可能影響這些聲明並可能導致未來實際結果與當前預測結果存在重大差異的風險因素，已在今天早上的新聞稿和我們向美國證券交易委員會提交的報告中進行了描述。本公司不承擔更新此類前瞻性聲明的任何義務。

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，我們將討論一些我們認為有助於評估我們績效的非GAAP指標。不應孤立地看待這些補充信息，也不應將其視為按照公認會計原則編制的結果的替代品。這些措施的對比可以在今天早上的新聞稿中找到，該新聞稿已發佈在我們的網站 aveanna.com 上，也可以在我們最近提交的 10-Q 季度報告中找到。

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

接下來，我將把電話交給 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 Q3 2025 results and how we are moving Aveanna forward in 2025. My initial comments will briefly highlight our third-quarter results, 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.

謝謝你，黛比。早安，感謝各位今天收看我們的節目。感謝各位今天上午抽出寶貴時間，更深入了解我們 2025 年第三季的業績以及 Aveanna 在 2025 年的發展方向。我的開場白將簡要介紹我們第三季的業績，以及我們為應對勞動力市場問題而採取的措施，還有我們與政府和首選支付方為創造更多產能而正在進行的合作。

I will then provide updates on the Thrive Skilled Pediatric Care integration, the current regulatory environment, and year three of our strategic plan before turning the call over to Matt to provide further details into the quarter.

接下來，我將介紹 Thrive Skilled Pediatric Care 整合的最新進展、當前的監管環境以及我們戰略計劃的第三年進展，然後將電話交給 Matt，讓他提供本季度的更多詳細信息。

Moving to highlights for the third quarter. Revenue for the third quarter was approximately $622 million, representing a 22.2% increase over the prior-year period. Third-quarter adjusted EBITDA was $80.1 million, representing a 67.5% increase over the prior-year period, primarily due to the improved rate and volume environment and continued cost savings initiatives. We continue to execute our strategic transformation strategy, focusing on obtaining adequate rates from our payer and government partners for the services we provide, which is clearly evidenced in our third quarter results.

接下來是第三節比賽的精彩片段。第三季營收約 6.22 億美元，較上年同期成長 22.2%。第三季調整後 EBITDA 為 8,010 萬美元，比上年同期成長 67.5%，主要原因是費率和銷售環境改善以及持續的成本節約措施。我們繼續執行策略轉型策略，重點是為我們提供的服務從支付方和政府合作夥伴那裡獲得足夠的費率，這在我們的第三季業績中得到了充分體現。

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, 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 create more capacity while reducing the total cost of care.

正如我們之前討論過的，勞動力環境是我們需要解決的主要挑戰，只有解決了這個問題，Aveanna 才能恢復我們認為公司能夠實現的成長軌跡。值得注意的是，我們這個產業並不存在需求問題。對居家和社區照護的需求仍然強勁，州政府、聯邦政府和醫療管理機構都在尋求能夠提高照護能力並降低總照護成本的解決方案。

Our Q3 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 solid year-over-year growth in revenue and adjusted EBITDA. We also experienced improvement in our caregiver hiring and retention trends by aligning our efforts with those payers willing to engage with us on enhanced reimbursement rates and value-based agreements. While we continue to operate in a challenging environment, our preferred payer strategy supports our ability to achieve normalized growth rates in all three of our business segments.

我們第三季的業績表明，我們繼續將我們的目標與我們首選的支付方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首選的支付方，我們在收入和調整後的 EBITDA 方面實現了穩健的同比增長。透過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方保持一致，我們在護理人員的招聘和留任方面也取得了進步。儘管我們仍在充滿挑戰的環境中運營，但我們首選的支付方策略支持我們在所有三個業務部門實現正常成長率的能力。

Since our second-quarter earnings call, I am pleased with the continued progress we have made on several of our rate improvement initiatives with both government and payer partners, as well as continued signs of improvement in the caregiver labor market. Specifically, as it relates to our Private Duty Services business, our government affairs strategy for 2025 is twofold. First, we are advancing our legislative agenda to improve reimbursement rates in at least 10 states. And second, we continue to advocate for Medicaid rate integrity on behalf of children with complex medical conditions.

自從第二季財報電話會議以來，我對我們在與政府和支付方合作夥伴的幾項費率改善計劃中取得的持續進展感到滿意，同時護理人員勞動力市場也持續出現改善跡象。具體而言，就我們的私人護理服務業務而言，我們 2025 年的政府事務策略分為兩方面。首先，我們正在推進立法議程，以提高至少 10 個州的報銷率。其次，我們繼續代表患有複雜疾病的兒童倡導醫療補助費率的完整性。

We have a strong advocacy presence with both federal and state legislatures, as well as solid support from our governors across our national footprint. State legislators have continued to recognize how meaningful private duty nursing is to the overall cost savings and improved outcomes of our nation's most vulnerable children. As it relates to Private Duty Services rate updates, we achieved 10 rate enhancements this year, which was in line with our expectations. At this point, our Private Duty Services legislative agenda is primarily wrapped up for this year, and we have transitioned our efforts towards similar legislative goals for 2026.

我們在聯邦和州立法機構中擁有強大的遊說力量，並在我們業務覆蓋的全國各地獲得了州長的堅定支持。州議員一直意識到，私人照護對於降低整體成本和改善我國最弱勢兒童的健康狀況具有多麼重要的意義。關於私人護理服務價格調整，我們今年實現了 10 項價格上調，符合我們的預期。目前，我們今年的私人護理服務立法議程已基本完成，我們將把工作重點轉移到 2026 年的類似立法目標上。

Now, moving on to preferred payer initiatives. Our goal for 2025 was to increase the number of Private Duty Services preferred payer agreements from 22 to 30. We added five additional preferred payer agreements in Q3 and are currently positioned at 30 agreements in total. Aveanna's preferred payer strategy continues to gain momentum along with the Thrive SPC acquisition, which broadened our strategy into two new states, Kansas and New Mexico.

接下來，我們來談談優選支付方計畫。我們 2025 年的目標是將私人護理服務優選付款方協議的數量從 22 家增加到 30 家。我們在第三季新增了五項優選付款人協議，目前協議總數達到 30 項。Aveanna 的首選支付方策略隨著對 Thrive SPC 的收購而持續發展壯大，此次收購將我們的策略擴展到了堪薩斯州和新墨西哥州這兩個新州。

Additionally, our Q3 preferred payer agreements account for approximately 56% of our total PDS MCO volumes, inclusive of our recent Thrive acquisition. This positive momentum and preferred payer volumes continue to highlight the shift in our caregiver capacity and recruitment efforts towards our Private Duty Services preferred payer partners.

此外，我們第三季的首選付款方協議約占我們 PDS MCO 總業務量的 56%，其中包括我們最近收購的 Thrive。這一積極勢頭和首選付款方的業務量持續凸顯了我們在護理人員能力和招聘工作方面向私人護理服務首選付款方合作夥伴的轉變。

Now, moving to our preferred payer progress in Home Health. Our goal for 2025 was to maintain our episodic payer mix above 70% while returning to a more normalized growth rate. I am pleased to report in Q3, our episodic mix was 77%, and our total episodic volume growth was 14.2% compared with the prior-year period. The continued investments in clinical outcomes, sales resources, and a focused approach to growth are now paying dividends with Q3 total admissions of 9,700 in total, or 9% growth over the prior-year period.

接下來，我們來看看家庭醫療保健領域首選支付方的進展。我們 2025 年的目標是在維持按次付費比例 70% 以上的同時，恢復到更正常的成長率。我很高興地報告，第三季我們的劇集佔比為 77%，劇集總銷量較上年同期增長 14.2%。對臨床結果、銷售資源和專注增長方式的持續投資現在正在獲得回報，第三季度總入院人數為 9,700 人，比上年同期增長 9%。

We have 45 preferred payer agreements in Home Health. Our dedicated focus on aligning our Home Health caregiver capacity with those payers willing to reimburse us on an episodic basis has led to positive year-over-year growth and improvement in our clinical and financial outcomes. Finally, as we have achieved our desired preferred payer model in Private Duty Services and Home Health and Hospice, we are proceeding with a similar strategy in our Medical Solutions business. We're in the mid-stages of implementing our preferred payer strategy in Medical Solutions and believe it will be fully realized by early 2026.

我們在家庭醫療保健領域擁有 45 項優選支付方協議。我們致力於使我們的家庭醫療保健護理人員能力與那些願意按次付費的付款方相匹配，這使得我們的臨床和財務結果逐年增長和改善。最後，由於我們在私人護理服務、家庭健康和臨終關懷領域實現了我們理想的首選支付方模式，我們正在醫療解決方案業務中採取類似的策略。我們目前正處於在醫療解決方案領域實施首選支付方策略的中期階段，並相信到 2026 年初將全面實現。

To date, we have 18 preferred payers in Medical Solutions, and we expect that number to grow as we achieve our desired preferred payer model. Our gross margins have stabilized in our desired range as we align our clinical capacity with those payers that value our services and pay us in a timely fashion. I am pleased with our Q3 volume of approximately 91,000 unique patients served as we work to achieve our target operating model. While we expect our volume growth to be muted for the remainder of the year, we are experiencing improvement in our clinical outcomes, customer satisfaction, and financial outcomes.

截至目前，我們在醫療解決方案領域擁有 18 家首選支付方，隨著我們實現理想的首選支付方模式，我們預計這一數字還會成長。隨著我們調整臨床能力以適應那些重視我們服務並及時付款的支付方，我們的毛利率已穩定在我們期望的範圍內。對於我們第三季服務約 91,000 名獨立患者的數量，我感到很滿意，我們正在努力實現我們的目標營運模式。雖然我們預計今年剩餘時間銷售成長將較為緩慢，但我們的臨床結果、客戶滿意度和財務結果均有所改善。

Our Medical Solutions business is well on its way to achieving its target operating model, and we look forward to updating you on its continued progress. We are encouraged by our rate increases, preferred payer agreements, and subsequent recruiting results. Our business has demonstrated solid 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 our patients' home.

我們的醫療解決方案業務正朝著實現目標營運模式穩步邁進，我們期待向您報告其後續進展。我們對費率上漲、與優選付款方達成的協議以及隨後的招聘成果感到鼓舞。我們的業務已展現出強勁的復甦跡象，我們實現了先前討論過的利率目標。居家和社區照護將繼續發展，Aveanna 是一個擁有多元化支付方基礎的綜合平台，為成本更高的護理機構提供了一種經濟高效、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，那就是患者舒適的家中。

As it relates to our recent acquisition of Thrive Skilled Pediatric Care, I am very pleased with the integration efforts and the continued focus on superior clinical and customer experiences with our patients and families. We are on target to complete our integration by the end of this year. Our leadership team has done a nice job staying focused on our mission while achieving the expected synergies in this transaction. The Thrive acquisition is accretive to our '25 results and a great addition to our Aveanna family.

關於我們最近收購的 Thrive Skilled Pediatric Care，我對整合工作以及我們持續致力於為患者和家屬提供卓越的臨床和客戶體驗感到非常滿意。我們預計在今年年底前完成整合工作。我們的領導團隊做得很好，在本次交易中，他們始終專注於我們的使命，並實現了預期的協同效應。收購 Thrive 將提升我們 2025 年的業績，並壯大我們的 Aveanna 大家庭。

Now turning to the current regulatory environment with Medicaid and Medicare updates, we continue to be quite busy with our advocacy efforts. We have focused our efforts on two fronts: supporting overall Medicaid policy and defending the Medicare Home Health benefit for American seniors. On the Medicaid front, we continue to believe our patient population fared relatively well in the OBBA legislation. Pediatric and adult patients with complex medical conditions were not directly targeted in the bill, and our view is that PDM was mostly insulated in the almost $1 trillion cut to Medicaid.

現在，我們轉向當前的監管環境，包括醫療補助和醫療保險的更新，我們將繼續忙於我們的倡議工作。我們已將工作重點放在兩個方面：支持整體醫療補助政策和捍衛美國老年人的醫療保險居家健康福利。在醫療補助方面，我們仍然認為我們的病患群體在《俄亥俄州預算優化法案》(OBBA) 的立法下獲得了相對較好的待遇。患有複雜疾病的兒科和成人患者並未直接受到該法案的針對，我們認為，在近 1 兆美元的醫療補助削減中，PDM 基本上不受影響。

With that said, we are experiencing general headwinds with state Medicaid directors and governors as they plan for potentially less overall Medicaid funding and shouldering more of their Medicaid costs in the future. As it relates to the proposed Home Health rule for calendar year 2026, we continue to voice our disappointment by the significance of these proposed cuts. We are aligned with the National Alliance for Care at Home and our Home Health peers in our strong opposition to this proposed rule.

儘管如此，由於各州醫療補助計劃主任和州長們計劃未來醫療補助資金總額可能減少，並承擔更多醫療補助成本，我們目前正面臨普遍的阻力。對於擬議的 2026 年家庭健康規則，我們仍然對這些擬議削減的幅度表示失望。我們與全國居家照護聯盟和居家照護領域的同行一致強烈反對這項擬議規則。

Since our last call, we've had many productive conversations with legislative leaders, both Republican and Democrat, as well as CMS leadership on the devastating impacts of the proposed Home Health rule. We submitted our comment letter during the CMS open comment period and have continued to advocate in all 38 Aveanna states for the current administration, CMS, and Congress to halt any cuts to Home Health. We do expect to receive the final calendar year 2026 rule in the coming days. And although not overly material to Aveanna's 2026 results, this rule is critically important to millions of seniors in America.

自上次通話以來，我們與共和黨和民主黨的立法領導人以及 CMS 領導層就擬議的家庭健康規則的毀滅性影響進行了多次富有成效的對話。我們在 CMS 公開徵求意見期間提交了意見信，並繼續在 Aveanna 的所有 38 個州倡導現任政府、CMS 和國會停止削減家庭醫療保健方面的任何措施。我們預計將在未來幾天內收到 2026 年日曆年的最終規則。雖然這條規則對 Aveanna 2026 年的業績影響不大，但對美國數百萬老年人來說卻至關重要。

Before I turn the call over to Matt, let me comment on our strategic plan and enhanced outlook for 2025. We will continue to focus our efforts on five primary strategic initiatives. First, enhancing partnerships with government partners and preferred payers to create additional capacity and growth. Second, identifying cost efficiencies and synergies that allow us to leverage our growth. Third, modernizing our Medical Solutions business to achieve our target operating model. Fourth, managing our capital structure and collecting our cash while producing positive free cash flow. And finally, engaging our leaders and employees and delivering our Aveanna mission.

在將電話交給 Matt 之前，我想先談談我們的策略計畫和 2025 年的展望。我們將持續集中精力推進五項主要策略舉措。首先，加強與政府合作夥伴和首選支付方的合作，以創造更多能力和成長。其次，要找出能提高成本效益、發揮綜效的因素，以促進我們的成長。第三，實現醫療解決方案業務的現代化，以實現我們的目標營運模式。第四，管理我們的資本結構並收回現金，同時產生正的自由現金流。最後，我們要調動領導和員工的積極性，實現 Aveanna 的使命。

Based on the strength of our third quarter and year-to-date results, we now anticipate 2025 revenue to be greater than $2.375 billion and adjusted EBITDA to be greater than $300 million. We believe this enhanced 2025 outlook provides a prudent view considering the challenges we still face with the evolving regulatory environment.

根據我們第三季和年初至今的強勁業績，我們現在預計 2025 年的營收將超過 23.75 億美元，調整後的 EBITDA 將超過 3 億美元。我們認為，考慮到我們仍然面臨的不斷變化的監管環境所帶來的挑戰，這種增強後的 2025 年展望提供了一個審慎的觀點。

In closing, I'm incredibly proud of our Aveanna team and their dedication to executing our strategic transformation while holding our mission at the core of everything we do. 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.

最後，我為我們的 Aveanna 團隊感到無比自豪，他們致力於執行我們的策略轉型，並將我們的使命置於我們一切工作的核心。我們為患者及其家屬提供經濟實惠、患者青睞且臨床先進的解決方案。此外，我們也是支付方、轉診機構和政府合作夥伴的理想選擇。

With that, let me turn the call over to Matt to provide further details on the quarter and our 2025 outlook. Matt?

接下來，我將把電話交給 Matt，讓他詳細介紹本季業績以及我們對 2025 年的展望。馬特？

Thank you, Jeff, and good morning. I'll first talk about our third-quarter financial results and liquidity before providing additional details on our improved outlook for 2025. Starting with top line, we saw revenues rise 22.2% over the prior-year period to $621.9 million. We achieved year-over-year revenue growth in two of our operating divisions, led by our Private Duty Services and Home Health and Hospice division, which grew by 25.6% and 15.3% compared to the prior-year quarter.

謝謝你，傑夫，早安。我將先談談我們第三季的財務表現和流動性情況，然後再詳細介紹我們對 2025 年前景的改善情況。首先來看營收，與去年同期相比成長了 22.2%，達到 6.219 億美元。我們兩個營運部門實現了同比增長，其中私人護理服務和家庭健康與臨終關懷部門表現最為突出，與上年同期相比分別增長了 25.6% 和 15.3%。

Consolidated gross margin was $202.8 million or 32.6%. Consolidated adjusted EBITDA was $80.1 million, a 67.5% increase as compared to the prior year. This growth reflects an improved rate environment, increased volumes, as well as enhanced operational efficiencies.

合併毛利率為 2.028 億美元，即 32.6%。調整後的綜合 EBITDA 為 8,010 萬美元，較上年增長 67.5%。這一增長反映了利率環境的改善、交易量的增加以及營運效率的提高。

Now taking a deeper look into each of our segments. Starting with Private Duty Services, revenue for the quarter was approximately $514 million, a 25.6% increase, and was driven by approximately 11.8 million hours of care, a volume increase of 12.9% over the prior year. Q3 revenue per hour of $43.51 was up 12.7% compared to the prior-year quarter, primarily driven by preferred payer volume growth and the rate enhancements previously discussed. We remain optimistic about our ability to attract caregivers and address market demands for our services when we obtain acceptable reimbursement rates.

現在讓我們深入了解我們的各個板塊。以私人護理服務為例，該季度營收約為 5.14 億美元，成長 25.6%，這主要得益於約 1,180 萬小時的護理服務，比上年同期增長 12.9%。第三季每小時收入為 43.51 美元，比上年同期增長 12.7%，主要得益於優先付款方數量增長和之前討論過的費率提升。我們仍然對吸引護理人員和滿足市場對我們服務的需求保持樂觀，前提是能夠獲得可接受的報銷率。

Turning to our cost of labor and gross margin metrics. We achieved $149.3 million of gross margin or 29%. The cost of revenue rate of $30.89 in Q3 was up $2.27 or 8.9% from the prior-year period. Our Q3 spread per hour was $12.62. We expect spread per hour to normalize as we continue to make ongoing adjustments to caregiver wages to support higher volumes and improve clinical outcomes.

接下來我們來看看勞動成本和毛利率指標。我們實現了 1.493 億美元的毛利，即 29%。第三季營收成本率為 30.89 美元，比去年同期成長 2.27 美元，成長 8.9%。我們第三季每小時的差價為 12.62 美元。隨著我們不斷調整護理人員的薪資以支持更高的工作量和改善臨床結果，我們預計每小時的差價將趨於正常化。

Moving on to our Home Health and Hospice segment, revenue for the quarter was approximately $62.4 million, a 15.3% increase over the prior year. Revenue was driven by 9,700 total admissions, with approximately 77% being episodic, and 12,900 total episodes of care, up 14.2% from the prior-year quarter. Medicare revenue per episode was $3,215, up 3.6% from the prior quarter. We continue to focus on right-sizing 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.

接下來來看我們的家庭健康和臨終關懷部門，該季度的收入約為 6,240 萬美元，比上年增長了 15.3%。收入主要來自 9,700 例入院病例（其中約 77% 為臨時入院），以及 12,900 例治療病例，比上年同期增長 14.2%。Medicare 每例收入為 3,215 美元，比上一季成長 3.6%。我們將繼續專注於調整近期成長策略的規模，並專注於按次付費的優選付款方。這種分階段的關注加速了我們的利潤率擴張，並改善了我們的臨床結果。

With episodic admissions well over 70%, we have achieved our goal of right-sizing our margin profile and enhancing our clinical offerings. We're pleased with our Q3 gross margin of 53.3%, representing our continued focus on cost initiatives to achieve our targeted margin profile. Our Home Health and Hospice platform is dedicated to creating value through effective operational management and the delivery of exceptional patient care.

由於臨時入院率超過 70%，我們實現了調整利潤率和提升臨床服務的目標。我們對第三季 53.3% 的毛利率感到滿意，這反映了我們持續專注於成本控制措施以實現目標利潤率。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 Q3. During the quarter, we produced revenue of $45.1 million, essentially flat from the prior-year period. Revenue was driven by approximately 91,000 unique patients served, and revenue per UPS of approximately $495, up 0.6% over the prior-year period. Gross margin was approximately $20.3 million or 45% for the quarter.

現在，讓我們來看看我們醫療解決方案部門第三季的業績。本季度，我們實現了 4,510 萬美元的收入，與去年同期基本持平。收入主要來自服務約 91,000 名獨立患者，每 UPS 的收入約為 495 美元，比去年同期增長 0.6%。本季毛利約 2,030 萬美元，毛利率為 45%。

As Jeff mentioned, we continue to implement initiatives to be more effective and efficient with our operations to achieve our targeted operating model. We're accelerating our preferred payer strategy in Medical Solutions by aligning our capacity with those payers that value our resources and appropriately reimburse us for the services we provide. We expect gross margins to normalize in the 42% to 44% range and UPS to accelerate its growth as we implement our targeted operating model. While I'm pleased with the integration efforts to date, we are entering the final push to complete our efficiency efforts and get back to focusing on growth in Medical Solutions.

正如傑夫所提到的，我們將繼續實施各項舉措，以提高營運效率和效益，從而實現我們設定的營運模式目標。我們正在加快推進醫療解決方案領域的首選支付方策略，將我們的能力與那些重視我們的資源並能為我們提供的服務支付適當報酬的支付方相匹配。我們預計毛利率將恢復到 42% 至 44% 的正常水平，隨著我們實施目標營運模式，UPS 的成長速度也將加快。雖然我對迄今為止的整合工作感到滿意，但我們正在進入最後的衝刺階段，以完成效率提升工作，並重新專注於醫療解決方案的成長。

In summary, we continue to fight through a difficult environment while keeping our patients' care at the center of everything we do. It's clear to us that aligning caregiver capacity to those preferred payers who value our partnership is the path forward at Aveanna. With the positive momentum we experienced in Q3, we remain optimistic that such trends will extend throughout 2025. We will continue to pass through wage improvements and other benefits to our caregivers in the ongoing effort to better improve volumes.

總之，我們將繼續在艱難的環境中奮鬥，同時始終把病人的照護放在我們一切工作的中心。對我們來說，很明顯，將護理人員的能力與那些重視我們合作關係的首選付款方相匹配，是 Aveanna 的發展方向。憑藉第三季取得的正面勢頭，我們仍然樂觀地認為，這種趨勢將在2025年持續下去。我們將繼續提高護理人員的薪資和其他福利，以持續改善護理工作量。

Now moving to our balance sheet and liquidity. At the end of the third quarter, we had liquidity of approximately $479 million, representing cash on hand of approximately $146 million, $106 million of availability on our securitization facility, and approximately $227 million of availability on a revolver which was undrawn as of the end of the quarter. We had $23 million in outstanding letters of credit at the end of Q3.

接下來我們來看看資產負債表和流動性。第三季末，我們的流動資金約為 4.79 億美元，其中包括約 1.46 億美元的現金、1.06 億美元的證券化融資額度以及截至季末尚未提取的約 2.27 億美元的循環信貸額度。截至第三季末，我們有 2,300 萬美元的未結信用證。

During the quarter, we refinanced our first lien credit facility and increased the revolving credit facility's availability from $170 million to $250 million. The combined $1.325 billion first lien term loan was also extended and is now set to mature in 2032. These actions enhance our balance sheet strength and liquidity, allowing us to continue executing on our strategic priorities. This progress underscores our strong operating performance and the confidence our financing partners have in Aveanna.

本季度，我們對第一順位抵押貸款進行了再融資，並將循環貸款額度從 1.7 億美元增加到 2.5 億美元。總額為 13.25 億美元的優先擔保定期貸款也已延期，將於 2032 年到期。這些舉措增強了我們的資產負債表實力和流動性，使我們能夠繼續執行我們的策略重點。這項進展凸顯了我們強勁的營運表現以及融資夥伴對 Aveanna 的信心。

On the debt service front, we had approximately $1.49 billion of variable rate debt at the end of Q3. Of this amount, $520 million is hedged 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，截至第三季末，我們有大約 14.9 億美元的浮動利率債務。其中，5.2 億美元透過固定利率互換進行對沖，8.8 億美元受到利率上限的限制，從而限制了 SOFR 利率進一步上漲至 3% 以上的風險敞口。因此，我們幾乎所有的浮動利率債務都進行了避險。我們的利率交換協議有效期至 2026 年 6 月，我們的利率上限協議有效期至 2027 年 2 月。

Looking at year-to-date cash flow, cash generated by operating activities was $76.1 million, and free cash flow was $86.2 million. We're encouraged by the strong cash collections and expect to generate additional free cash flow throughout the remainder of the year.

從年初至今的現金流來看，經營活動產生的現金為 7,610 萬美元，自由現金流為 8,620 萬美元。強勁的現金回收情況令我們倍感鼓舞，預計今年剩餘時間內將產生更多自由現金流。

Before I hand the call over to the operator for Q&A, let me take a moment to address our improved outlook for 2025. As Jeff mentioned, we now expect full-year revenue to be greater than $2.375 billion and adjusted EBITDA to be greater than $300 million. As a reminder, this year's fourth quarter includes an additional 53rd week, which will have a positive impact on both revenue and earnings. The presence of this extra week means the current fiscal year contains an additional week of business activity compared to most years.

在將電話交給接線員進行問答之前，請容許我花一點時間談談我們對 2025 年的展望。正如傑夫所提到的，我們現在預計全年收入將超過 23.75 億美元，調整後 EBITDA 將超過 3 億美元。提醒一下，今年的第四季多了 53 週，這將對收入和利潤都產生正面影響。由於多了一周，本財年比往年多了一周的業務活動時間。

As we reflect on our Q3 results, I'd like to take a moment to express my sincere gratitude to our Aveanna teammates. These strong results would not have been possible without your hard work and dedication. Looking ahead, I'm excited for the continued execution of our 2025 strategic plan and look forward to providing you with further updates at the end of Q4.

回顧第三季業績，我想藉此機會向 Aveanna 的全體團隊成員表達我由衷的感謝。如果沒有你們的辛勤工作和奉獻精神，這些優異的成績是不可能的。展望未來，我對我們 2025 年戰略計劃的繼續執行感到興奮，並期待在第四季度末向大家提供更多最新進展。

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

那麼，我這就把電話轉給接線生。

(Operator Instructions) Pito Chickering, Deutsche Bank.

（操作員說明）皮托·奇克林，德意志銀行。

Every year, the fourth quarter EBITDA has been higher than the third quarter. Are there any headwinds that we should be thinking about for the fourth quarter? Just trying to understand the implied guidance that you have for the fourth quarter after your very strong third quarter, or is it just the standard conservatism that you've been doing for the past few years?

每年第四季的 EBITDA 都高於第三季。第四季有哪些不利因素需要考慮？我只是想了解一下，在你們第三季業績非常強勁之後，你們對第四季的業績預期是什麼？還是說，你們只是延續了過去幾年一直採取的保守策略？

Peter, this is our eleventh quarter of beat and raise. And I think as we think of Q3, we are very proud of the results, a clean quarter, a very clean quarter in Q3. Q4, with the exception of the 53rd week that Matt talked about, so a fourteenth week in Q4, should be very similar to Q3. We do have some seasonality that we play through at the end of the year, so the last part of the quarter has a little bit of holiday seasonality. But no, fundamentally we think of Q4 in the same realm as we think of the performance of business in Q3.

彼得，這是我們第十一季的「超越與提升」策略。我認為，回顧第三季度，我們對所取得的成績感到非常自豪，第三季成績非常出色。除了馬特提到的第 53 週（即第四季的第 14 週）之外，第四季應該與第三季非常相似。我們在年底會安排一些季節性活動，所以季度末會帶一些節日氣氛。但從根本上來說，我們認為第四季與第三季的業務表現屬於同一範疇。

And again, we've created a prudent, we use the word prudent, some people call it conservative view of a beat and raise mentality. We are proud to have raised revenue at least $75 million and raised EBITDA at least $30 million quarter to quarter. And if I go back to how we started the year, we started the year with a goal to achieve $200 million of EBITDA, both organically and with the addition of Thrive, which you'll hear us keep talking about Thrive, it's been a great little tuck-in acquisition for us, great business addition to our core business.

我們再次創造了一種謹慎的，我們用「謹慎」這個詞，有些人稱之為保守的節拍和提升心態。我們很自豪地宣布，每季營收至少成長了 7,500 萬美元，EBITDA 至少成長了 3,000 萬美元。回顧年初，我們的目標是實現 2 億美元的 EBITDA，這既包括內生成長，也包括收購 Thrive 帶來的成長。你會經常聽到我們談論 Thrive，它對我們來說是一次非常棒的小型收購，也是對我們核心業務的絕佳補充。

We'll have raised guidance after three quarters by $100 million of EBITDA, or a 50% guidance raise. So again, we continue to be a conservative group. We love the beat and raise mentality, but raising guidance over three quarters by $100 million on a $200 million basis is, in our minds, still a good day's work.

三個季度後，我們將把 EBITDA 預期上調 1 億美元，即預期上調 50%。所以，我們依然是保守派團體。我們喜歡業績超出預期並上調預期的心態，但在我們看來，在 2 億美元的基礎上，將三個季度的業績預期上調 1 億美元，仍然是一項不錯的成績。

Yeah, Jeff, I'll just add to that that obviously operational performance has been amazing by the team, but also the exceptional care that the team's been delivering as well. I'll get back to it though. There's a lot more work to do, Peter. I mean, we're going to get back to work. We're going to continue to chop wood and do what we do best.

是的，傑夫，我還要補充一點，團隊的運作表現非常出色，團隊提供的照護也同樣出色。我會繼續處理的。彼得，還有很多工作要做。我的意思是，我們要回去工作了。我們將繼續砍柴，做我們最擅長的事。

We're going to continue to focus on providing not only the best patient care, we're also going to continue to strengthen our balance sheet, leverage our organization once again. As you saw, significant leverage coming down from the beginning of the year to where we ended Q3, and we'll continue to do that in the quarters as well.

我們將繼續專注於提供最好的患者護理，同時也將繼續加強我們的資產負債表，再次發揮我們組織的優勢。正如你所看到的，從年初到第三季末，槓桿率大幅下降，而且我們將繼續在接下來的幾個季度中保持這一趨勢。

Right. And then -- So a follow-up here, you've scaled up your preferred payer agreements throughout 2025, which makes this a pretty funky sequential growth this year. In the last couple of years, you keep it at about 26% of annual EBITDA. So is it fair to take third-quarter results and annualize that as you think about a launch pad for 2026 earnings, and even that could be conservative, I guess, with the five preferred payers you signed this quarter?

正確的。然後——所以這裡還有一個後續問題，你們已經擴大了 2025 年的首選付款人協議規模，這使得今年的環比增長相當奇特。近幾年，你將其維持在年度 EBITDA 的 26% 左右。那麼，在考慮 2026 年獲利的啟動資金時，將第三季業績進行年化計算是否合理？考慮到本季簽署的五份優先支付協議，即使這樣也可能過於保守了。

It's a fair question, Pito. Again, we'll start with we're staying focused on finishing the year strong. So our goals right now are to finish out 2025 and finish out strong. We point people to there's a lot of momentum in the business, as you pointed out.

皮托，你問得好。再次重申，我們將繼續專注於以強勢表現結束今年。所以我們現在的目標是順利完成2025年的工作，並且圓滿成功。正如您所指出的，我們向人們表明，這個行業發展勢頭強勁。

PDS and our HHH businesses are both just hitting their strides in great ways. Med Solutions, we still are working through, and I hope you read into our comments in Med Solutions, we're doing a tremendous amount of work. We're very proud of our team, what they're doing as we speak, but I want to finish that over the next kind of three to four months so they can get back to the growth algorithm that we have gotten used to.

PDS 和我們的 HHH 業務都正處於蓬勃發展的階段。我們仍在努力解決醫療解決方案方面的問題，希望您能仔細閱讀我們在醫療解決方案方面的評論，我們正在做大量的工作。我們為我們的團隊感到非常自豪，也為他們現在所做的工作感到自豪，但我希望在接下來的三到四個月內完成這項工作，以便他們能夠回到我們已經習慣的成長演算法中。

Two things I'll point out just to keep in mind. One, we had a significant amount of wage pass-through as the year has played out, and so Matt will keep bringing us back to -- if you look at Q2, we pointed out $9 million of timing-related and wage pass-through. We had additional wage pass-through in Q3. We're still passing additional wage through in Q4, so that will continue to play through the first part of next year.

有兩點要注意。第一，隨著這一年的進行，我們有大量的工資轉嫁，因此 Matt 會不斷提醒我們——如果你看一下第二季度，我們指出有 900 萬美元與時間相關的工資轉嫁。第三季我們還有額外的薪資轉嫁。我們仍在第四季度支付額外的工資，因此這種情況將持續到明年上半年。

And then we talked about 10 rate wins this year. It's really more than 10, but it nets down with a couple of temporary rate decreases that are in place. So we had a great year in rate wins, but we are feeling and we are hearing the general headwinds of state Medicaid systems. So we expect a similar rate story from a total number of rate wins next year, but we are working through and hearing general headwinds as the OBBA reality has just settled in on Medicaid systems. So we would point people towards that general headwind as we fight through '26 Medicaid rates throughout America.

然後我們討論了今年取得的 10 項費率成長。實際上超過 10，但由於目前實施了一些臨時降息措施，實際降息會縮小。雖然我們在費率方面取得了巨大成功，但我們感受到了各州醫療補助系統普遍面臨的不利因素。因此，我們預計明年的費率成長總數將與去年類似，但隨著 OBBA 的現實剛剛在 Medicaid 系統中確立，我們正在努力克服並聽到一些普遍的阻力。因此，在全美範圍內與 2026 年醫療補助費率作鬥爭時，我們會引導人們關注這一普遍的逆風。

That's why we love being in 29 states and continuing to grow. We love that each Medicaid system is uniquely different, and I'd expect us to do more Thrive-like acquisitions in '26 to continue to build out more Medicaid states.

這就是為什麼我們喜歡在29個州開展業務並不斷發展壯大的原因。我們喜歡每個醫療補助系統都各具特色，我預計我們在 2026 年會進行更多類似 Thrive 的收購，以繼續在更多州建立醫療補助體系。

(Operator Instructions) Brian Tanquilut, Jefferies.

（操作說明）Brian Tanquilut，傑富瑞集團。

Maybe Jeff, just to follow up on that comment. So in PDS, you've seen nice strength in hours, obviously, and as we think about the rate increases you've received year-to-date, does that translate to better hours? Is that the right jumping-off point in terms of your capacity as we think about 2026? And then maybe for Matt as a follow-up, historically you've kind of spoken about $10 to $10.50 spread rate in PDS. So how should we think about the path to that level, or is that still the right level to be thinking about considering that you've got rate increases flowing through and there's a timing dynamic?

或許傑夫，我只是想補充剛才的評論。所以，在 PDS 中，工時方面顯然表現良好，考慮到您今年迄今為止獲得的加薪，這是否意味著工時會更好？就我們考慮 2026 年的能力而言，這是正確的出發點嗎？然後，也許可以給 Matt 提個後續問題，從歷史上看，你在 PDS 中曾談到 10 美元到 10.50 美元的價差。那我們該如何看待達到該水平的路徑呢？或者考慮到利率上漲的趨勢以及時間上的動態變化，該水平是否仍然是我們應該考慮的正確水平？

I’d pick up the Q3 PDS volume of just over 11.8 million hours of care being delivered. That obviously includes the Thrive acquisition. I would tell you that’s the full impact of the Thrive acquisition, and that Thrive at 13% year-over-year growth. Thrive was about 5% of that 13%, so it still keeps our volume in line with where it was in Q2 at 6% or 7% volume growth.

我會選擇第三季 PDS 的數據，該數據顯示護理服務時長略高於 1,180 萬小時。這顯然包括對 Thrive 的收購。我會告訴你，這就是 Thrive 收購的全部影響，Thrive 的年增長率達到了 13%。Thrive 約佔這 13% 中的 5%，因此我們的銷量仍與第二季 6% 或 7% 的銷售成長保持一致。

But I think that 11.8 million hours is the right basis to move into Q4 with. We’ll have some seasonality, some normal seasonality as we move into 2026. I think, as I mentioned to Peter, a lot of our rate wins were pent-up rate wins from 2024 moving into 2025. We expect, as we reset our legislative goals for 2026, we’ll probably still set a goal of being double-digit rate wins.

但我認為 1180 萬小時是進入第四季的合適基礎。進入 2026 年，我們將面臨一些季節性因素，一些正常的季節性因素。我認為，正如我跟彼得提到的那樣，我們取得的許多利率優勢都是從 2024 年到 2025 年積壓下來的利率優勢。我們預計，在重新設定 2026 年的立法目標時，我們可能仍然會設定目標，並爭取兩位數的利率優勢。

But as we said last quarter, and we’ll say again, and we’ll say next quarter, we expect those rate wins to be smaller in nature, 2%, 3%, very specific like holiday overtime rates. As we work with our government partners, we do expect the PDS rate wins to be generally smaller than they’ve been over the course of the last two and a half years. The great part is we’re prepared for that, we’re well positioned for that as it relates to the preferred payers and the five additional rate wins. Thrive helped.

但正如我們上個季度所說，我們還會再次說，下個季度我們還會說，我們預計這些費率的提高幅度會比較小，2%、3%，而且非常具體，例如假日加班費率。在我們與政府合作夥伴共同努力的過程中，我們預計 PDS 利率的提高幅度總體上會比過去兩年半以來的水平要小。最棒的是，我們已經為此做好了準備，我們在優先付款人和另外五項費率方面都處於有利地位。Thrive 幫了大忙。

The addition of New Mexico and Kansas as two brand-new MCO states helped us in that execution, but that was the thesis of why we did the Thrive acquisition was to roll that new market and the current business into our relationships, and it has played out exactly as we would have expected. So I expect us to continue to execute additional preferred payer wins in Q4, and we’ll reset that goal for 2026.

新墨西哥州和堪薩斯州這兩個全新的 MCO 州的加入幫助我們實現了這一目標，但這正是我們收購 Thrive 的初衷，即把這個新市場和現有業務納入我們的關係網絡，而事實證明，它完全符合我們的預期。因此，我預計我們將在第四季度繼續贏得更多首選付款方，我們將把該目標重新設定為 2026 年。

Yeah, and Ryan, to your point on the spread itself, as expected, Q3 came right back in line with our Q1 expectations. We made sure to discuss Q2 ad nauseam last quarter for people to understand that that was a little bit hot. But gross margin settled in line nicely, right around 29% for our PDS segment. That’s in line with our expectations. It’s probably a little bit on the higher end of that 26% to 28% range that we’ve come to guide to in the long run here. But looking ahead, there’s still additional wage pass-through to include to our caregivers, and so we’ll do those wages along with some other benefits, but that will bleed into 2026 as well. So not only will that occur in Q4, but we’ll see that in Q1 and Q2 of next year too.

是的，瑞安，關於價差本身，正如預期的那樣，第三季完全符合我們第一季的預期。上個季度我們反覆討論了第二季的情況，讓大家明白當時的情況有點火爆。但毛利率穩定在合理水平，我們的PDS業務部門的毛利率約為29%。這符合我們的預期。這可能略高於我們長期以來一直建議的 26% 到 28% 的範圍。但展望未來，我們還需要向護理人員支付額外的工資，因此我們將把這些工資以及其他一些福利一起發放，但這也將延續到 2026 年。所以這種情況不僅會在第四季發生，而且我們也會在明年的第一季和第二季看到這種情況。

That makes sense. And then maybe my follow-up would be just on the balance sheet. So now that you’ve done your refi, your EBITDA base has gone up, so the leverage ratio has gone down. I mean, how should we be thinking about your views on capital structure and then maybe capital deployment towards acquisitions?

這很有道理。然後，我的後續工作可能就只關注資產負債表了。既然你已經完成了再融資，你的 EBITDA 基數增加了，因此槓桿率下降了。我的意思是，我們應該如何看待您對資本結構以及資本在收購方面的部署的看法？

Thanks. Awesome question. Yeah, really proud of our teams and what they’ve been able to accomplish. These great operating results and clinical results have allowed us to really focus on our cash collections as well. It takes a village to be able to do that on a continuous basis, but $86 million of free cash flow year-to-date, that’s amazing expectations from our team and what we’ve been able to achieve.

謝謝。好問題。是的，我為我們的團隊以及他們所取得的成就感到非常自豪。這些優異的營運表現和臨床表現也讓我們能夠真正專注於現金回收。要持續做到這一點需要整個團隊的努力，但今年迄今為止的 8,600 萬美元自由現金流，這超出了我們團隊的預期，也超出了我們所取得的成就。

We’ll add to that in Q4 as well. Q4 is historically our best quarter for free cash flow generation as well. But looking ahead, we’ll continue to do that. We’ll bring in additional free cash flow in 2026, and we’ll use that for potential M&A opportunities. But we’re going to do what makes the most sense at Aveanna, and whether that is deploying for M&A or paying down debt, we’ll just be thoughtful on any dollars that we use.

我們將在第四季繼續增加這部分投入。從歷史數據來看，第四季也是我們自由現金流產生最好的季度。但展望未來，我們將繼續這樣做。我們將在 2026 年獲得額外的自由現金流，並將這些現金流用於潛在的併購機會。但是，在 Aveanna，我們會做最合理的事情，無論是用於併購還是償還債務，我們都會謹慎使用每一分錢。

Thanks, Ryan.

謝謝你，瑞恩。

Benjamin Rossi, JPMorgan.

班傑明‧羅西，摩根大通。

I guess just turning to the value-based care contracting, when thinking about your progress towards your broader goal of signing ten VBC contracts this year, can you walk us through the market appetite you’re seeing from your payer partners here? And then have you seen any shift in how payers are maybe viewing value-based care contracts for private duty nursing going forward?

我想就基於價值的醫療合約而言，在考慮您今年簽署十份 VBC 合約的更廣泛目標的進展情況時，您能否向我們介紹一下您從支付方合作夥伴那裡看到的市場需求？那麼，您是否觀察到支付方對未來私人護理服務的價值導向醫療合約的看法有任何轉變？

Hey, Ben, good morning. Thanks for the question. Yeah, I think the answer is just more and more. So I’ll go back to the Thrive acquisition and why it made so much sense and why we’ll do more Thrive-like acquisitions in PDS moving forward. Our preferred payers just want more nurses and they want more of our capacity, and even we are limited on how much nursing capacity we can give them. So, as we talk to our now 30 preferred payers, and again, many of them are national, the leading Medicaid payers in America. They just want more of what we have to offer, both in the amount of nurses and the relationship that we have that is tied to total cost of care through HBR and fill rates.

嘿，本，早安。謝謝你的提問。是的，我認為答案是越來越多。所以，我將回到對 Thrive 的收購，以及為什麼這項收購如此有意義，以及為什麼我們將在 PDS 繼續進行更多類似 Thrive 的收購。我們首選的付款方只需要更多的護士，他們需要我們更多的護理能力，但即使是我們，我們能提供給他們的護理能力也是有限的。因此，當我們與目前 30 家首選付款方進行洽談時，其中許多都是全國性的，是美國領先的醫療補助付款方。他們只是想要我們提供的更多服務，包括護士的數量，以及我們與 HBR 和入住率相關的、與總護理成本掛鉤的關係。

We’ve had conversations even this week with some of our national payers, and although it takes time to add that value-based agreement. And just as a reminder, we have bonus-only, so it’s only upside, we don’t take institutional risk today in any of our value-based agreements. It’s upside rewards only based on our ability to bend the cost curve.

本週我們已經與一些國家支付者進行了對話，儘管達成基於價值的協議需要時間。再次提醒大家，我們只提供獎金，所以只有收益，我們目前在任何基於價值的協議中都不承擔機構風險。其潛在回報僅取決於我們控製成本曲線的能力。

Most of our payers are just wanting more of Aveanna and more of what we have to offer. I can tell you from having closed the Thrive transaction, we’ve gotten a couple of nice feedbacks from our payer leaders, how impressed they were and how proud they are that we’ve been able to deploy more nurses to their families and their patients. So I’d expect that trend to continue as we reset our goals for 2026, but no slowdown from our MCO partners. They want more of what we have to offer.

我們的大多數付費用戶只是希望獲得更多 Aveanna 的服務以及我們提供的更多產品。我可以告訴你，在完成對 Thrive 的交易後，我們收到了來自支付方領導的一些很好的反饋，他們對我們能夠為他們的家庭和病人派遣更多護士感到非常印象深刻和自豪。因此，我預計隨著我們重新設定 2026 年的目標，這一趨勢將繼續下去，但我們的 MCO 合作夥伴不會放慢腳步。他們想要更多我們能提供的產品或服務。

Great, thanks for the comments. Just as a follow-up, maybe on the Home Health and Hospice front, seeing nice volume growth there, episodic mix picked up nicely. The cost of revenue seemed like that maybe ticked up a bit and was a bit of a drag on gross margin. I guess anything going on within that segment from the expense side, just with growth out there otherwise outpacing top-line?

太好了，謝謝你的評論。作為後續補充，家庭健康和臨終關懷方面，我們看到了不錯的業務量增長，分集節目的播出量也增長良好。營業成本似乎略有上升，對毛利率造成了一定拖累。我猜想，該業務板塊的支出方面是否發生了什麼變化，導致其他方面的成長超過了營收成長？

No, nothing crazy there, Ben. Obviously, thanks for looking at that 15.3% growth in that division. That division is outstanding. Hospice, phenomenal growth. Episodic growth, amazing. 77% admissions are coming in as episodic as well.

不，沒什麼大不了的，本。顯然，感謝您關注該部門15.3%的成長率。這個部門非常出色。臨終關懷，發展迅速。這種階段性成長令人驚訝。 77%的入學新生也是以階段性入學的方式加入的。

Those are also delivering great care afterwards. Those are funneling right into great star ratings for our teams on top of it. 53.3% gross margin that's right in line with our expectations. 55% and change last quarter, it was a little bit high. We kind of alluded to that one. We're continuing to invest in some training through some Heartways programs with that team, but really just nothing to be concerned about. It's right in line with our expectations.

他們後續也提供了很好的照顧。此外，這些都直接轉化為我們團隊極高的星級評分。毛利率為53.3%，完全符合我們的預期。上季的毛利率為55%多一點，略高一點。我們其實已經暗示過這一點了。我們正在透過 Heartways 的一些專案繼續為該團隊提供一些培訓，但真的沒什麼好擔心的。這完全符合我們的預期。

And I think Matt said it well, Ben. It's three years worth of work. So again, it's three years' worth of our team staying focused on the preferred payer strategy. And again, as we think of Medical Solutions, think of what you're seeing now in Home Health and Hospice as what the future of Medical Solutions will be where we drive the majority of our volume will be aligned with our preferred payers, and that really is what drives our growth.

我覺得馬特說得很好，本。這是三年來的工作成果。所以，這再次證明了我們團隊三年來一直專注於首選支付方策略。再次強調，當我們思考醫療解決方案時，請將您現在在家庭健康和臨終關懷領域看到的情況視為醫療解決方案的未來，我們大部分的業務量將與我們首選的支付方保持一致，而這才是真正推動我們成長的動力。

But no, Matt said it well. Really proud of our Home Health and Hospice team. They've done a great job and they've stayed focused on episodic care, which is the right payment model for that business. Thanks, Ben.

但是，馬特說得很好。為我們的居家照護和臨終關懷團隊感到​​非常自豪。他們做得很好，並且一直專注於階段性護理，這對於該行業來說是合適的支付模式。謝謝你，本。

Thank you. Next question comes from Raj Kumar with Raymond James. Please go ahead.

謝謝。下一個問題來自 Raymond James 公司的 Raj Kumar。請繼續。

Hi, good morning. Maybe kind of uncovering the hours growth, decently strong, so just maybe trying to get the disclosures on kind of how census or patients served trended relative to the hours per census yield and kind of remaining opportunities. Just trying to think about the spread normalizing and the company being able to hire and retain more nurses to be able to serve more volume. So maybe just trying to break that out and how much more room is there on the hours per census side, and then what are you seeing from the census opportunity perspective as well?

您好，早安。或許可以揭示一下工時增長情況，相當強勁，所以或許可以嘗試披露人口普查或服務患者人數的趨勢與每次人口普查的工時產出以及剩餘機會之間的關係。我只是想看看疫情傳播情況能否恢復正常，公司能否招募和留住更多護士，從而能夠服務更多患者。所以，或許我們可以試著把這個問題單獨分析一下，看看每次人口普查的時間還有多少提升空間，以及從人口普查機會的角度來看，您又看到了什麼？

Yeah, I would say they're directly in line with each other, Raj. Obviously, I would go back to the statement that everybody is always asking for more and they're needing more, and whether that is our current census that we have on there or patients that are waiting in the hospital to be discharged onto our service as well. So with the preferred payer strategy, we have been able to staff more hours and also pay our caregivers more to staff more hours and work more hours at the same time.

是的，我認為它們完全一致，拉傑。顯然，我會回到之前的說法，那就是每個人都總是要求更多，他們需要更多，無論是我們目前的人口普查數據，還是在醫院等待出院接受我們服務的病人。因此，透過優先支付方策略，我們既可以增加員工工時，也可以支付給護理人員更高的工資，讓他們能夠同時增加員工工時和工作時間。

But correlated effect, there's still high demand within our preferred payers and outside of it. There's just limited capacity with those caregivers, and there always will be, unfortunately. So as we lean into these relationships, we're going to do our best to fill as many shifts as possible on behalf of our patients and really drive that growth that you're seeing in our volume right now.

但相關效應表明，無論是在我們首選的支付方內部還是外部，仍然存在很高的需求。護理人員的數量有限，而且很遺憾，這種情況將一直存在。因此，隨著我們更加重視這些關係，我們將盡最大努力為我們的患者安排盡可能多的班次，並真正推動您現在看到的業務量成長。

Yeah, and maybe on the Home Health and Hospice side, just with the preferred payer strategy, maybe just want to be able to compare overall reimbursement on your episodic rates versus fee-for-service and where that discount stands, or even if you're reaching parity. Any information on that would be helpful as well.

是的，或許在家庭健康和臨終關懷方面，就首選支付方策略而言，或許只是想比較一下按次計費與按服務付費的總體報銷情況，以及折扣力度如何，甚至是否達到了平價。任何相關資訊將不勝感激。

Yeah, I wouldn’t say we’re reaching parity. So it’s why we focus at almost 80%. We’ve said 70% is our target. It wouldn’t shock me if we moved that to greater than 75%, now that we’ve been four quarters in a row at north of 75% episodic. It’s the way of the future in this business. I think our peers have figured it out. We’ve figured it out. Episodic is the right way to think of it.

是的，我不會說我們已經達到平等了。所以這就是我們把重點放在近 80% 的原因。我們說過，70%是我們的目標。如果我們將這個比例提高到 75% 以上，我不會感到驚訝，因為我們已經連續四個季度超過 75% 的病例為偶發性病例。這是該產業未來的發展方向。我認為我們的同行已經找到了答案。我們已經想明白了。用「分集式」來形容比較貼切。

It’s a fair reimbursement for great clinical care and great outcomes. But I wouldn’t say there’s parity between non-episodic and episodic. There’s not parity, and that’s why we do very little of it. And it hasn’t hurt us. Our referral sources understand it. Our payer partners understand it. Just like PDS, they want more nursing, more therapy care, and they want a lower total cost of care for the geriatric patients. So yeah, you’ll see us stay focused on this level of care with these payers being the focus, and it wouldn’t shock me if we start touching 80% of our business on a go-forward basis. We are that committed to being an episodic provider in Home Health. Thank you, Raj.

這是對優質臨床護理和良好療效的合理回報。但我不會說非單元劇和單元劇之間有對等關係。不存在對等現象，這就是為什麼我們很少做這件事的原因。而且這並沒有傷害到我們。我們的推薦來源都明白這一點。我們的支付方合作夥伴都明白這一點。就像PDS一樣，他們希望獲得更多的照護、更多的治療服務，並且希望降低老年患者的總照護成本。所以，是的，你會看到我們繼續專注於這一級別的護理，重點仍然是這些付款方，如果我們未來開始觸及我們 80% 的業務，我不會感到驚訝。我們致力於成為家庭醫療保健領域的臨時服務提供者。謝謝你，拉傑。

AJ Rice, UBS.

AJ Rice，瑞銀集團。

First, obviously you've made a big push and been successful in getting these preferred payers set up in the PDS business. I wonder if you have had enough time to sort of see over time how that relationship has evolved. Do you get annual updates consistent with what you've been getting historically? Have you seen it evolve in any way that's worth calling out?

首先，顯然你們已經大力推進，並且成功地讓這些首選付款方進入了 PDS 業務領域。我想知道你是否有足夠的時間去觀察這段關係隨著時間的推移是如何演變的。你們每年收到的更新是否與以往一樣？你有沒有看到它有任何值得一提的改變？

I think I would say we're in year four of our longest, most mature relationships, and we're in year three of a lot of the other relationships. So to your point, we're a couple of years into this. I think some of the things that kind of popped out of this that maybe we didn't know going into it or didn't strategize were some of the soft things like collections and working together to help specific high-acuity families get home and stay home.

我認為我們最長、最成熟的戀愛關係已經進入第四年，而其他許多戀愛關係也都進入了第三年。所以，正如你所說，我們已經為此努力了兩年。我認為，這件事中湧現的一些事情，可能是我們事先沒有預料到或沒有製定策略的，例如一些軟性的事情，例如募款和共同努力幫助一些病情嚴重的家庭回家並待在家裡。

And just some of the other things like value-based agreement add-ons. The rate is what starts this -- rate and wage, so let me be specific. The incremental rate we get, the majority of it goes to wages, we’ve talked about that now for three years to the nurses. But some of the soft stuff that then kind of adds on over time really becomes the value-based agreement, but also the collections. We talked this year about having millions of dollars of better collections, and some of that is from calling our payer partners and having them help us with some aged accounts, and they've just been great partners on that front. So that's some of the soft stuff that's come.

還有一些其他的東西，例如基於價值的協議附加條款。利率是這一切的起點——利率和工資，所以讓我具體說明一下。我們獲得的增量工資，大部分都用於支付工資，我們已經和護士們談了三年了。但有些軟性的東西，隨著時間的推移而逐漸累積起來，就變成了基於價值的協議，以及收款。今年我們討論瞭如何提高數百萬美元的收款效率，其中一部分是透過聯繫付款方合作夥伴，讓他們幫助我們處理一些逾期帳款實現的，他們在這一方面一直是非常棒的合作夥伴。以上就是一些比較輕鬆的內容。

But I’d also say they’ve picked up the phone and called us on a tough patient that has been back to the hospital three or four times in a few months, and they'll ask us to dive in and really address that patient to help that family. That’s some of the benefits that we’re able to get them. We don’t ask for rate enhancements from our preferred payers every year, so we’re thoughtful on when we go back to the well with them on needing some kind of COLA or cost-of-living adjustment.

但我還要說，他們也曾打電話給我們，詢問一些棘手的病人，這些病人幾個月內已經三四次住院，他們會要求我們深入研究並真正解決該病人的問題，以幫助該病人及其家人。這就是我們能夠為他們帶來的一些好處。我們不會每年都要求我們首選的付款方提高費率，所以我們會仔細考慮何時再次與他們商討需要某種生活成本調整或COLA。

Sometimes that is every other year or every third year. So when we go back to some of those conversations, it’s a productive conversation. It’s a how much do we need to move nurse wages to continue to meet their needs? But I think as we’ve said before, out of all 30 preferred payers, whether they've been with us for four years or four months, every one of them wants more of our nurses, and that is the constant theme we hear from all of our payers.

有時是每兩年一次，有時是每三年一次。所以當我們回顧那些對話時，會發現那是一次有成效的對話。我們需要將護士薪水提高多少才能繼續滿足他們的需求？但我認為正如我們之前所說，在所有 30 家首選付款方中，無論他們與我們合作了四年還是四個月，他們都希望獲得更多我們的護士，這是我們所有付款方不斷表達的主題。

Okay, maybe for my follow-up, just thinking about the organic and inorganic growth in PDS as well as in adult home care. Some of your peers are saying if we can just get the final rate notice done, that could open the floodgates, give us more clarity on the deals and where to look for expansion opportunities. Others are saying that's not enough—we need more clarity on the long-term reimbursement profile. On the PDS side, you're saying you're seeing a little caution in some states. I guess I'm just wondering, is there anywhere where you're thinking about leaning in more to new opportunities, growth—either organic development or acquisitions—or where you're being a little more cautious?

好的，我的後續問題是，思考一下 PDS 以及成人居家護理領域的有機成長和無機成長。一些同行表示，如果我們能完成最終的費率通知，那可能會打開閘門，讓我們更清楚地了解交易情況以及在哪裡尋找擴張機會。其他人則表示這還不夠——我們需要更清楚地了解長期報銷方案。在PDS方面，你的意思是說你看到一些州方面採取了一些謹慎的態度。我只是想問一下，您是否正在考慮在某些方面更加積極地抓住新的機遇，實現增長——無論是自然增長還是收購——還是在某些方面更加謹慎？

Yeah, I’ll go back to who we are to start with. Almost 80% of our company is generated from our PDS segment, so that is the underpinning of Aveanna always has been and certainly is. We added two new states with Thrive, so we're now in 29 Medicaid states. I think Matt and I would tell you we'd like to be in about 38, maybe 40 total Medicaid states. There are a couple of key states that our large national Medicaid partners are in that we're not like Ohio, West Virginia, Kentucky. Those states, we don’t have any Medicaid presence there today. So over time, we’d like to fill those states in.

是的，我會回到我們最初的身份。我們公司近 80% 的收入來自我們的 PDS 部門，因此，這始終是 Aveanna 的基石。我們透過 Thrive 新增了兩個州，現在我們已經涵蓋了 29 個 Medicaid 州。我想我和馬特會告訴你，我們希望能在大約 38 個，也許 40 個 Medicaid 州開展業務。有幾個關鍵州是我們大型國家醫療補助合作夥伴所在的州，但我們的情況與俄亥俄州、西維吉尼亞州、肯塔基州不同。目前，我們在那些州沒有任何醫療補助計劃（Medicaid）的覆蓋範圍。所以隨著時間的推移，我們希望能夠填補這些州的空白。

We want to continue to expand our Medicaid reach both pediatric and adult. We're a skilled-focused company, AJ, so we always lead with skilled services, nursing services—that is our focus. And then I guess, Matt, pivoting back to Home Health. We're in a good position that only today about 10% of our revenues is in Home Health and Hospice. We're big believers in Home Health. We believe Home Health is the right solution for America's seniors, and we'd like to see a nice rule settled here. But Matt, how do you think about deployment?

我們希望繼續擴大我們的醫療補助覆蓋範圍，包括兒童和成人。AJ，我們是一家以技術為導向的公司，所以我們始終以技術服務、護理服務為先導——這是我們的重點。然後，我想，馬特，又回到了家庭護理領域。目前，我們只有大約 10% 的收入來自家庭健康和臨終關懷，這讓我們處於有利的位置。我們非常支持居家醫療。我們認為居家照護是美國老年人的正確解決方案，我們希望看到這方面能製定出一項完善的規則。但馬特，你對部署有什麼看法？

Yeah, no, I’ll just go back to that. We're always going to continue to advocate on behalf of our patients and our families regardless of the industry, regardless of the division. We're going to continue what we do best. We're going to deliver that exceptional patient care that people know us for. We're going to do that in the most cost-efficient setting in that patient's home.

不，我還是回去吧。無論身處哪個行業，無論屬於哪個部門，我們都將繼續為我們的患者及其家屬爭取權益。我們將繼續做我們最擅長的事。我們將繼續提供大家所熟知的卓越病患照護服務。我們將在患者家中以最具成本效益的方式進行這項工作。

And then regardless of any policy changes out there, AJ, we're going to focus on that quality care, operational efficiencies, and those close partnerships with our payers. We think that by maintaining those really high standards and demonstrating really good clinical outcomes, everything will work out in the long run here.

AJ，無論政策如何變化，我們都將專注於提供高品質的醫療服務、提高營運效率，並與支付方建立緊密的合作關係。我們認為，只要保持這些高標準並展現出非常好的臨床效果，從長遠來看，一切都會好起來的。

I think we're well positioned with our size, scale, density, technology, and our clinical outcomes—that these partnerships will continue to grow and that we'll be on the right side of healthcare, that we will be a cost savings to the healthcare system.

我認為憑藉我們的規模、體積、密度、技術和臨床成果，我們處於有利地位——這些合作關係將繼續發展，我們將站在醫療保健的正確一邊，我們將為醫療保健系統節省成本。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

Just to follow up on the hours growth, can you spike out the contribution of Thrive in the quarter and how volumes performed on the same-store basis? Because it still looks like a pretty meaningful increase year-over-year. And once Thrive is fully integrated, what is the annualized earnings contribution expected from that?

為了進一步了解工時成長情況，能否詳細說明 Thrive 在本季的貢獻以及同店銷售額的表現？因為看起來仍然比去年同期成長了相當可觀的幅度。Thrive 完全整合後，預計每年能帶來多少收益貢獻？

Yeah, Andrew, with the Thrive business, first off, it's a really great business. The team has done a really nice job integrating it into the Aveanna organization. Q3, to your point, reflects the full financial impact of Thrive. It was in there for a very full quarter. If you go back and look at our Q2 on an hours basis, we're in the mid to high single digits. That's exactly organically what Aveanna was doing as well in Q3. The incremental growth you're seeing is from Thrive.

是的，安德魯，首先，Thrive 是一家非常棒的公司。團隊在將其融入 Aveanna 組織方面做得非常出色。正如您所說，第三季反映了 Thrive 的全部財務影響。它在那裡待了整整一個季​​度。如果回顧我們第二季的小時數，我們會發現我們的成長率在個位數中高段。這正是 Aveanna 在第三季自然而然所做的事情。你看到的增量成長來自 Thrive。

What we talked about previously, Thrive’s coming in at roughly $100 million of revenue and about a 7.5 times multiple from the purchase price post-synergies. We're going to be just a little bit north of that, but the team has done a phenomenal job getting after synergies, integrating the organization, and really bringing them in to be part of Aveanna.

正如我們之前討論過的，Thrive™ 的收入約為 1 億美元，協同效應後的收購價格約為收購價格的 7.5 倍。我們最終的業績會比預期略高一些，但團隊在尋求協同效應、整合組織以及真正將他們納入 Aveanna 方面做得非常出色。

And I think Matt said that well. We've been guiding people over three to five years that PDS should be in that 4% to 5% organic growth rate. We've been a couple of points north of that now for three quarters plus. Q3 represented that organically, we were in that same kind of 6.5% to 7% organic and then the nice addition of Thrive. Again, I think as we came out of Q2, we guided people to think of Q2 as $79 million versus $88 million because of the $9 million of timing, and then we said there’s a couple million dollars or more of wage pass-through. So we thought that the organic business would land kind of in the mid to high 70s, which is where it did.

我覺得馬特說得很好。在過去的三到五年裡，我們一直引導人們將 PDS 的有機成長率保持在 4% 到 5% 之間。過去三個多月裡，我們的氣溫一直比這個數值高出幾個百分點。第三季有機成長佔比與之前持平，介於 6.5% 到 7% 之間，此外還有 Thrive 的加入，無疑是個好消息。再說一遍，我認為在第二季結束時，我們引導人們將第二季的收入視為 7,900 萬美元而不是 8,800 萬美元，因為其中有 900 萬美元的時間差異，然後我們說，還有幾百萬美元或更多的工資轉嫁。所以我們認為有機食品業務的銷售額大概會在70%到70%之間，而實際情況也確實如此。

And then as Matt talked about, the addition of Thrive comfortably settled us right at that $80 million amount. That’s the full impact. We're wrapping up integration literally in the month of November, and we'll have some AR runoff into early to mid next year, that’s normal as the systems run off. But we're really putting the integration to bed here in the month of November and excited to go do it again.

正如 Matt 所說，Thrive 的加入使我們的收購金額剛好達到了 8,000 萬美元。這就是全部影響。我們將在 11 月完成整合工作，AR 系統會有一些過渡期持續到明年年初到年中，這是系統運作的正常現象。但我們將在 11 月徹底完成整合工作，並期待再次進行這項工作。

Great. I wanted to follow up on some of the comments around the uncertainty around state budgets and the indirect impact that might have on reimbursement. Are those comments more directional in nature, or are there specific actions that states are taking that are driving that more prudent posture?

偉大的。我想就一些關於州預算不確定性及其可能對報銷產生的間接影響的評論進行補充說明。這些評論更多的是方向性的，還是各國正在採取的具體行動促成了這種更謹慎的姿態？

Yeah, it's more directional in nature, but we spent the entire year talking to both governors, state Medicaid budget directors, and the key majority leaders in almost 30 states. It's been the same similar conversation in all 29 states, which is a little bit of uncertainty, a little bit of let’s see how this shakes out, a little bit of we want to see how the OBBA settles in. So I think at this point, most states have kind of figured out what it means to them.

是的，它更側重於方向性，但我們花了一整年的時間與兩位州長、州醫療補助預算主管以及近 30 個州的關鍵多數黨領袖進行了交談。在所有 29 個州，討論的內容都大同小異，其中既有幾分不確定性，也有幾分「讓我們看看事情會如何發展」的想法，還有幾分「我們想看看 OBBA 如何落實」。所以我覺得目前大多數州都已經大致弄清楚這對他們意味著什麼了。

Wisconsin was a big winner this year. Wisconsin had a major increase to their Medicaid PDN rate. But we had a couple of states that temporarily put in 2%, 3% reductions just so they could balance their 2026 budget. So we've seen a little bit of everything in the process, but I think as we think of '26 and '27, we think that generally in nature there are going to be some headwinds the states have to work through.

威斯康辛州是今年的大贏家。威斯康辛州的醫療補助計劃 PDN 費率大幅上漲。但有幾個州為了平衡 2026 年的預算，暫時削減了 2% 或 3% 的開支。所以在這個過程中，我們看到了各種各樣的情況，但我認為，當我們展望 2026 年和 2027 年時，我們認為，總體而言，各州在自然環境方面將會遇到一些需要克服的阻力。

I think the diversity of the 29 states puts us in a nice position. Some states win, some states hold, some states are going to just be out there for a little bit, but that diversification is a positive for Aveanna.

我認為29個州的多元化使我們處於有利地位。有些州會勝出，有些州會保持穩定，有些州會暫時處於觀望狀態，但這種多樣性對 Aveanna 來說是一個利好因素。

Yeah, please proceed.

好的，請繼續。

John, sorry, we didn’t hear that question.

約翰，抱歉，我們沒聽到這個問題。

You guys went on mute for a minute. So just going back to your payer relationships, what you said you offered to bend the cost curve and it’s an upside-only deal. What does that mean exactly? And my follow-up is, does having a payer deal in pediatrics grease the skids for a payer deal on Home Health and Hospice and Medical Solutions?

你們剛才靜音了一會兒。所以回到你與付款方的關係，你說過你提出可以降低成本，而且這是一個只有收益的部分。那到底是什麼意思？我的後續問題是，在兒科領域達成支付方協議是否會為在家庭健康、臨終關懷和醫療解決方案領域達成支付方協議鋪平道路？

Let me start with the second one because the second one’s easier than the first one. And I’ll use United as an example. Our answer would be, no. It’s two totally separate sections of the payer itself. United Community, which is our Medicaid business, is totally different than United Medicare Advantage. We talk to both sides of United in this example, but the paths never really cross inside of their shops.

讓我先從第二個問題開始，因為第二個問題比第一個問題容易解決。我將以美聯航為例。我們的答案是否定的。這是付款人本身的兩個完全獨立的部分。United Community（我們的 Medicaid 業務）與 United Medicare Advantage 完全不同。在這個例子中，我們與曼聯的雙方都進行了交談，但他們的店鋪內部卻從未真正交集。

And most of our payer partners, talking to a Medicaid pediatric rate person has very little benefit to the Medicare geriatric rate peer. Many times they don’t even know who the peer is in nature. So unfortunately, it doesn’t bleed over.

而且，我們的大多數支付方合作夥伴，與 Medicaid 兒科費率人員交談，對 Medicare 老年人費率人員幾乎沒有任何好處。很多時候，它們甚至不知道自然界中的同伴是誰。所以很遺憾，它不會滲漏。

But going back to your first question about our payer contracts, first of all, each of our nine value-based agreements to date are in addition to an enhanced rate. So all 30 of our preferred payers have an enhanced rate, which means an enhanced wage for the nurse in those cases. All nine of the value-based agreements are different in nature, even some of those with the same payer, they’re different, but most of them focus on two fundamental things. One is fill rate, the amount of hours that we’ve been authorized to fill, and the goal is that we fill as many of those hours as possible. The payer wants us to fill 100%. Most of our targets are between 80% and 90%, where our goals are to land between 80% and 90% fill rate.

但回到你關於付款方合約的第一個問題，首先，我們迄今為止的九項基於價值的協議都是在提高費率的基礎上額外提供的。因此，我們所有 30 個首選付款方都提高了費率，這意味著在這些情況下，護士的薪水也會提高。這九項基於價值的協議性質各不相同，即使是與同一付款方達成的協議，它們也各不相同，但大多數協議都側重於兩件基本的事情。一是填滿率，也就是我們被授權填滿的工時數，我們的目標是盡可能填滿這些工時。付款方要求我們完成 100%。我們的大部分目標都在 80% 到 90% 之間，我們的目標是達到 80% 到 90% 的填充率。

And then the second part is really HBR or MLR, however they think of it, as some form of a target cost for the actual services that we provide, and really tying to acute care spend, right? So reducing the acute care spend. Most of our nine contracts have something to do with the two of them. There may be a third and fourth, like customer satisfaction and other feedback from customers, but most of them are driven by HBR percentage and a fill rate target.

然後第二部分實際上是 HBR 或 MLR，不管他們怎麼理解，都是我們實際提供服務的某種目標成本，並且與急性護理支出密切相關，對吧？因此，要減少急診護理支出。我們的九份合約中大部分都與他們兩人有關。可能還有第三和第四個因素，例如客戶滿意度和客戶的其他回饋，但大多數因素都是由 HBR 百分比和訂單完成率目標驅動的。

And just to ask the obvious question, so the fact that you just have more nurses, you have more athletes on the field, one phone call from them and they can get more spots filled than calling five of your smaller competitors. I know it’s probably not that simple, but is that a big piece of it?

問一個顯而易見的問題：既然你們有更多的護士，更多的運動員在場上，他們只需打一個電話，就能比給五個規模較小的競爭對手打電話填補更多的空缺。我知道事情可能沒那麼簡單，但這算是其中很重要的一環嗎？

It’s scale. They want scale. They want scale of nurses, but also scale of geography. They want technology. They want our clinical outcomes. They want the best. But yeah, they want more nurses.

它的規模。他們想要規模。他們不僅需要護士的規模，也需要地理上的規模。他們想要科技。他們想要了解我們的臨床結果。他們想要最好的。是的，他們需要更多護士。

And most of these payers, if you think of their geography, they’re in a state like Texas. They’re in both Dallas, but they’re also maybe in South Texas. So it’s urban and very rural, and they want both. They want you to cover both of those with equal tenacity. But yes, they want our alignment of our nurses and our scale with the scale of their beneficiaries. But yeah, that is, you’ve nailed it.

而且，從地理位置來看，這些付款人大多位於像德州這樣的州。他們既在達拉斯，也可能在德州南部。所以它既有城市風貌，又非常鄉村，而他們兩者都想要。他們希望你以同樣的力道報道這兩件事。是的，他們希望我們的護理人員隊伍和規模與他們的服務對象規模相符。沒錯，你說得太對了。

Ben Hendrix, RBC Capital Markets.

Ben Hendrix，加拿大皇家銀行資本市場。

Hi, this is Michael Murray on for Ben. Thanks for taking my question. We're getting a lot of questions on the sustainability of growth of the preferred payer relationships. Can you give us an idea of the room to run here? You targeted 30 in 2025. Any idea what the goal would be for 2026?

大家好，我是麥可‧莫瑞，代我為本報道。謝謝您回答我的問題。我們收到了很多關於首選支付方關係成長可持續性的問題。您能大概說這裡有多大的活動空間嗎？你的目標是到 2025 年達到 30 人。你們對2026年的目標有什麼想法嗎？

And then what is the potential to increase the number of patients you take within a preferred payer relationship?

那麼，在與優選支付者建立合作關係的情況下，增加病患數量的潛力有多大？

Hey Michael, good morning. I guess I'll start with, some people ask us, what inning are you in in the preferred payer strategy? Clearly we're past the first inning, but we're way before the ninth inning. I'll put it that way. We're somewhere in the middle of the story.

嗨，邁克爾，早安。我想先回答一下，有些人會問我們，你們在優選支付方策略方面處於第幾局？顯然我們已經過了第一局，但離第九局還遠。我就這麼說吧。我們現在正處於故事的中段。

We've added volume metrics in PDS. Our goal would be at some point in the future to add a volume metric in Medical Solutions tied to the number of preferred payer accounts. If you think of our PDS volumes today, we announced this quarter that 56% of our MCO volumes are aligned with the preferred payer. I think that would tell you we're a little bit more than halfway there.

我們在PDS中加入了銷售指標。我們的目標是在未來的某個時候，在醫療解決方案中添加一個與首選付款方帳戶數量掛鉤的銷售指標。如果以我們目前的 PDS 業務量來看，我們本季宣布，我們 56% 的 MCO 業務量與首選付款人一致。我認為這說明我們已經完成了一半多一點。

We've said before, we don't think that we'll get to 100% of the MCO volumes being a preferred payer, but we should get to the low to mid-80s and maybe one day the high-80s in percentages over the next couple of years. So I think as we reset our goals, we met as a team a few weeks ago and started planning for '26, we're in our budgets as we speak now, as we reset our goals for '26, clearly 30 is no longer the goal. We'll be somewhere in the mid to high 30s, maybe even approaching 40.

我們之前說過，我們認為我們無法讓所有 MCO 業務量都成為首選支付方，但在未來幾年內，我們應該能達到 80% 到 85% 的百分比，甚至有一天能達到 80% 以上。所以我覺得，當我們重新設定目標時，幾週前我們團隊開會開始為 2026 年做計劃，我們現在正在製定預算，當我們重新設定 2026 年的目標時，很明顯 30 不再是目標了。我們大概會在30多歲，甚至可能接近40歲。

But it's also the value and why we're looking for additional markets. Thrive is a great example. We added two brand-new states and picked up a couple of preferred payers in those states right out of the gate enhanced relationships. So I’d tell you there’s still a long runway in front of us.

但這也是它的價值所在，也是我們尋找其他市場的原因。Thrive 就是一個很好的例子。我們新增了兩個州，並且立即在這些州找到了幾個首選付款方，從而加強了合作關係。所以我想告訴你，我們面前還有很長的路要走。

And again, what we're doing in Med Solutions is exactly the same as what we've done in Private Duty Services and Home Health and Hospice, which is to find the preferred payers, define the target operating model, and then align our capacity with those payers. And that’s what you’ll hear us talk about in '26 for Med Solutions.

再次強調，我們在醫療解決方案領域所做的，與我們在私人護理服務、家庭健康和臨終關懷領域所做的完全相同，那就是找到首選的付款方，確定目標運營模式，然後使我們的能力與這些付款方保持一致。這就是我們將在 2026 年為 Med Solutions 所談論的。

And then I had a follow-up question on capital structure. I wanted to see what your intermediate leverage targets were, and do you anticipate hitting those through EBITDA growth, or would you use cash flow to pay down debt?

然後我還有一個關於資本結構的後續問題。我想了解你們的中期槓桿目標是什麼，你們預計是透過 EBITDA 成長來實現這些目標，還是會利用現金流來償還債務？

Great question, Michael. And obviously, once again, really impressed with the team being not only a free cash flow generating organization but a meaningful free cash flow generating organization. $146 million cash on hand to end the quarter, that's phenomenal work from the team through cash collections and operations efforts. We're currently sitting at 4.62 times net leverage currently, and we're down almost 3 turns of leverage this year. We were 2.77 turns last year.

問得好，麥可。顯然，我再次對團隊的表現印象深刻，他們不僅能產生自由現金流，而且能產生可觀的自由現金流。季度末現金儲備高達1.46億美元，充分體現了團隊在現金回收和營運方面的卓越工作。我們目前的淨槓桿率為 4.62 倍，今年以來槓桿率下降了近 3 倍。我們去年是2.77轉。

We've got a line of sight to continue deleveraging the organization in the out quarters as well. We have an internal goal to make sure we have a three handle in front of that. That's something we're going to be at. We probably won't be there wrapping up this year, but into 2026 and into 2027, we expect to have a three handle in front of that.

我們也看到了持續降低公司外部部門槓桿率的希望。我們內部的目標是確保前面有三個把手。這是我們接下來要做的事。我們今年可能無法實現這個目標，但到 2026 年和 2027 年，我們預計在此之前達到三個把手。

We'll be thoughtful with our dry powder. It's always nice to have dry powder sitting out there for some potential deals that might come through, but if it makes the most sense to the organization, we're not afraid of paying down debt at the same time. I think thoughtfulness is what you should take away from this one, but right now, we're going to sit on that and see if any opportunities arise.

我們會謹慎使用乾粉。手頭上有一些現金儲備以備不時之需固然很好，但如果這對組織來說是最合理的，我們不怕同時償還債務。我認為你應該從這件事中學到的是深思熟慮，但現在，我們要先考慮一下，看看是否會出現任何機會。

David MacDonald, Truist Securities.

David MacDonald，Truist Securities。

Good morning. Thank you. Guys, just one last -- just kind of curious. Wanted to piggyback on AJ's question from earlier. Just with regards to Home Health and some of the uncertainty there. I'm just curious, has that impacted the strength of the pipeline of opportunities there for you guys?

早安.謝謝。各位，最後一個問題——我只是有點好奇。我想藉用AJ之前提出的問題。僅就居家醫療保健以及其中存在的一些不確定因素而言。我只是好奇，這是否影響了你們那邊的機會儲備？

And what would you need to see in terms of the final rule to get comfortable starting to potentially more meaningfully deploy capital there just given some of the reimbursement uncertainty?

考慮到報銷方面的一些不確定性，您需要看到最終規則的哪些方面才能放心地開始更有意義地在該領域部署資金？

Yeah, it's a great question, David. There's been a lot of activity in the last six months, small, medium-sized activity in both Medicaid and Medicare, both Home Health and Hospice on the Medicare side from an M&A standpoint. We've looked at a bunch of little or tuck-in type opportunities on both Medicaid and Medicare. We've not been in a position to date where we've been ready to pull the trigger on a Home Health or Hospice asset, pending the final rule.

是的，大衛，這是一個很好的問題。在過去六個月裡，醫療補助和醫療保險領域都出現了許多中小規模的併購活動，醫療保險方面的家庭健康和臨終關懷領域也出現了不少併購活動。我們已經考察了 Medicaid 和 Medicare 中許多小型或補充性的機會。在最終規則出台之前，我們目前還沒有準備好對家庭健康或臨終關懷資產採取任何行動。

Our expectations are that the rule would be somewhere close to neutral, to zero. That’s probably a little bit of an aggressive expectation, but that is the ask that we have on hand from the industry at large, basically, a multi-year pause and no cuts. We will leverage the 78% of the business to grow the 10% of the business. We've said that before and we mean it. So we'll leverage our Medicaid book to grow on the Medicare side.

我們預計該規則將接近中性，甚至接近零。這可能有點過於樂觀了，但基本上，這是我們對整個行業的要求，即多年暫停生產，不進行任何裁員。我們將利用公司78%的業務來發展剩餘的10%的業務。我們之前說過，而且我們是認真的。因此，我們將利用我們在醫療補助方面的業務來擴大聯邦醫療保險業務。

We're really not a Hospice buyer at mid-teens multiples, right? So we're more disciplined as a buyer. We like to buy where we can buy in the high single-digits, low double-digits, and have a clear path to mid single-digits post-synergy.

我們真的不會以十幾倍的價格購買安寧療護用品吧？所以身為買家，我們更有自律性。我們喜歡在股價能達到個位數高點、兩位數低點時買入，並且在綜效後能有明確的路徑將股價提升至個位數中位數。

So we’d like to see something that is close to zero or effectively zero as a cut. By the way, we expect to see that next week. So our intel says that that probably is coming out late next week or certainly the following week. So we will know soon enough. And I think for all of us, David, it's just getting certainty. Just give us a certain answer that we can read into the future with this administration, and then we're ready to go to work.

所以我們希望看到的削減幅度接近零或實際上為零。順便說一句，我們預計下週就能看到。根據我們的情報，這件事可能會在下週晚些時候或最遲下下周公布。所以很快就會知道了。我認為對我們所有人來說，大衛，關鍵在於獲得確定性。只要給我們一個明確的答案，讓我們能夠根據本屆政府的政策展望未來，我們就可以開始工作了。

I would like to turn the floor over to Jeff for closing remarks.

我謹將發言權交給傑夫，請他作總結發言。

Thank you, Stacey, and thank you so much for your interest in our Aveanna story. We look forward to updating you on our continued progress right after the first of the year. Thank you, and have a great day.

謝謝你，Stacey，也非常感謝你對我們Aveanna故事的關注。我們期待在新年伊始就向您報告我們的最新進展。謝謝，祝您今天過得愉快。

This concludes today's teleconference. You may disconnect your lines at this time, and thank you for your participation.

今天的電話會議到此結束。現在您可以斷開線路了，感謝您的參與。