Aveanna Healthcare Holdings Inc (AVAH) 2025 Q4 法說會逐字稿

Good morning, and welcome to Aveanna Healthcare Holdings' fourth quarter 2025 earnings call. Today's call is being recorded, and we've allocated one hour for prepared remarks and Q&A.

早安，歡迎參加 Aveanna Healthcare Holdings 2025 年第四季財報電話會議。今天的電話會議將被錄音，我們已安排一小時用於管理層準備發言與問答。

At this time, I'd like to turn the call over to Debbie Stewart, Aveanna's Chief Accounting Officer. Thank you. You may begin.

此刻，我想把電話會議交給 Aveanna 的首席會計官 Debbie Stewart。謝謝。您可以開始了。

Thank you, and good morning, and welcome to Aveanna's fourth 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.

謝謝，各位早安，歡迎參加 Aveanna 2025 年第四季財報電話會議。我是 Debbie Stewart，本公司首席會計官。今天與我一同出席的有我們的首席執行官 Jeff Shaner，以及首席財務官 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.

在本次電話會議中，我們將發表前瞻性陳述。可能影響這些陳述並可能導致未來實際結果與目前預期結果出現重大差異的風險因素，已載於今天上午的新聞稿以及我們向美國證券交易委員會（SEC）提交的報告中。

The company does not undertake any duty to update such forward-looking statements. 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 annual report on Form 10-K when filed.

本公司不承擔更新此類前瞻性陳述的任何義務。此外，在今天的電話會議中，我們將討論若干非 GAAP 指標，我們認為這些指標有助於評估我們的經營表現。這些補充資訊的呈現不應被單獨看待，亦不應作為依 GAAP 編製之結果的替代。上述指標的調節表可見於今天上午的新聞稿（已發布於我們的網站 aveanna.com），以及在提交後我們最新的 Form 10-K 年度報告中。

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

接下來，我將把電話會議交給 Aveanna 的首席執行官 Jeff Shaner。Jeff？

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 Q4 and full year 2025 results and how we are moving Aveanna forward in 2026. My initial comments will briefly highlight our fourth quarter and full year '25 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. I will then provide updates on the recently announced Family First Homecare acquisition and how we are thinking about 2026 strategic initiatives and our full year '26 guidance before turning the call over to Matt.

謝謝你，Debbie。各位早安，感謝今天加入我們。感謝各位今天上午撥冗，協助更深入了解我們 2025 年第四季與全年業績，以及我們在 2026 年如何推動 Aveanna 持續向前。我先簡要重點說明 2025 年第四季與全年業績，以及我們為因應勞動市場所採取的措施，並分享我們與政府及優先付款方（preferred payers）持續合作、以創造更多服務量能的努力。接著，在把電話交給 Matt 之前，我將更新近期宣布的 Family First Homecare 收購案進展，並說明我們對 2026 年策略性倡議與 2026 全年指引的看法。

Now moving to highlights for the fourth quarter and full year 2025. Revenue for the fourth quarter was approximately $662 million, representing a 27.4% increase over the prior year period. Fourth quarter adjusted EBITDA was $85 million, representing a 54% increase over the prior year period, primarily due to the improved rate and volume environment and continued cost savings initiatives. Revenue for the full year 2025 was approximately $2.433 billion representing a 20.2% increase over the prior year period and full year 2025 adjusted EBITDA was $320.8 million, representing a 74.8% increase over the prior year period. As a reminder, our fourth quarter and full year 2025 results did benefit from a 53rd week due to our accounting calendar.

現在來看 2025 年第四季與全年重點摘要。第四季營收約為 6.62 億美元，較去年同期成長 27.4%。第四季調整後 EBITDA 為 8,500 萬美元，較去年同期成長 54%，主要受惠於費率與量的環境改善，以及持續推動的成本節省措施。2025 全年營收約為 24.33 億美元，較去年同期成長 20.2%；2025 全年調整後 EBITDA 為 3.208 億美元，較去年同期成長 74.8%。提醒各位，由於我們的會計日曆安排，2025 年第四季與全年業績受惠於第 53 週的影響。

As we sunset 2025, I think it's important to reflect on the three-year strategic transformation that we have successfully navigated, I am proud of the Aveanna team of leaders, employees and caregivers that believe in our mission and help execute the key strategies that returned Aveanna to our current performance. As we look forward, we remain deeply committed to our preferred payer and government affair strategies that continue to drive our growth in all three operating divisions.

在 2025 年告一段落之際，我認為回顧我們成功完成的三年策略轉型非常重要。我為 Aveanna 的領導團隊、員工與照護人員感到自豪，他們相信我們的使命，並協助落實關鍵策略，使 Aveanna 回到目前的表現水準。展望未來，我們仍將堅定投入優先付款方策略與政府事務策略，持續推動三大營運事業部門的成長。

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

如同我們先前所討論，勞動環境是我們必須解決的主要挑戰，唯有如此 Aveanna 才能重回我們相信公司可達成的成長軌道。需要強調的是，我們的產業並不存在需求問題。居家與社區式照護的需求仍然強勁，州與聯邦政府以及管理式照護組織（MCO）都在尋求能在降低整體照護成本的同時、創造更多服務量能的解決方案。

Our Q4 and full year 2025 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.

我們 2025 年第四季與全年業績顯示，我們持續使自身目標與優先付款方及政府合作夥伴的目標保持一致。透過將臨床量能聚焦於優先付款方，我們在營收與調整後 EBITDA 方面實現了穩健的年增成長。此外，透過將我們的努力與願意就提高報銷費率與價值導向協議與我們合作的付款方對齊，我們也看到照護人員招募與留任趨勢的改善。

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. Since our third 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 our caregiver labor market.

儘管我們仍在具挑戰性的環境中營運，我們的優先付款方策略支持我們在三個業務部門皆能達成常態化的成長率。自第三季財報電話會議以來，我對我們在多項費率改善計畫上、與政府及付款方合作夥伴所取得的持續進展感到欣慰，同時也持續看到照護人員勞動市場改善的跡象。

Specifically, as it relates to our private duty services business, our government affairs strategy for 2025 was twofold. First, we advanced 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. Our strong advocacy presence with both federal and state legislatures as well as solid support from our governors across our national footprint provided significant value in 2025. As it relates to private duty services rate updates, we achieved 10 rate enhancements in 2025, which was in line with our expectations.

具體而言，就我們的私人護理服務（Private Duty Services, PDS）業務而言，我們 2025 年的政府事務策略有兩個面向。第一，我們推動立法議程，力求在至少 10 個州提高報銷費率。第二，我們持續為具有複雜醫療狀況的兒童倡議，捍衛 Medicaid 費率的完整性。我們在聯邦與州立法機構的強大倡議能量，以及我們全國布局各州州長的堅實支持，在 2025 年帶來了顯著價值。就私人護理服務的費率更新而言，我們在 2025 年達成 10 項費率提升，符合我們的預期。

As we reset our legislative goals for the new year, we expect to achieve high single-digit state rate enhancements for 2026. After three years of meaningful rate movement in our PDS stakes, we are generally in a good place as we navigate 2026 and focus on cost-of-living type rate and wage adjustments moving forward. Now moving on to our preferred payer initiatives. Our goal for 2025 was to increase the number of private duty services preferred pay agreements from 22 to 30. We added eight additional preferred pay agreements in 2025, achieving our goal of 30.

在我們為新年度重新設定立法目標之際，我們預期 2026 年可達成各州費率提升的高個位數（high single-digit）水準。在我們的 PDS 州別經過三年顯著的費率變動後，整體而言，我們在因應 2026 年方面已處於相對良好的位置，並將把重點放在未來以生活成本為主的費率與薪資調整。接著談我們的優先付款方倡議。我們 2025 年的目標是將私人護理服務的優先付款協議數量由 22 份增加至 30 份。我們在 2025 年新增了 8 份優先付款協議，達成 30 份的目標。

Aveanna's preferred payer strategy continues to gain momentum and allows us to invest in caregiver wages and recruitment efforts to accelerate hiring and staffing of nurses for our patients. As we reset our preferred payer goals for 2026, we believe there is still ample room to grow in our current geography as well as new states that we enter through acquisitions.

Aveanna 的優先付款方策略持續累積動能，使我們得以投資於照護人員薪資與招募工作，以加速為病患招募並配置護理人員。在我們重新設定 2026 年的優先付款方目標之際，我們相信無論是在現有地理區域，或是透過併購進入的新州別，仍有充足的成長空間。

With that in mind, our goal for 2026 is to add eight additional agreements with a target of 38 preferred payers by the end of 2026. Additionally, our Q4 preferred pay agreements accounted for approximately 57% of our total private duty services MCO volumes. This positive momentum in preferred payer volumes continues to highlight the shift in our caregiver capacity and recruitment efforts towards our preferred payer partners.

基於此，我們 2026 年的目標是再新增 8 份協議，並以 2026 年底達到 38 家優先付款方為目標。此外，我們第四季的優先付款協議約占我們私人護理服務管理式照護組織（MCO）總服務量的 57%。優先付款方服務量的正向動能，持續凸顯我們正將照護人員量能與招募資源轉向優先付款方合作夥伴。

We believe this important volume metric will grow to the low 60% in 2026 and as we continue to align our capacity with our payer partners. 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 extremely pleased to report in Q4, our episodic mix was 78% and our total episodic volume growth was 25% compared with the prior year period. The continued investment in clinical outcomes, sales resources and a focused approach to growth is paying dividends with Q4 total admissions of 10,400 or 22.4% growth over the prior year period.

我們相信，隨著我們持續使產能與我們的付款方合作夥伴對齊，這項重要的量能指標將在 2026 年成長至 60% 出頭的水準。接下來談我們在居家健康（home health）業務中推進至優先付款方（preferred payer）的進展。我們 2025 年的目標是在回到較為正常化的成長率之際，將按療程（episodic）的付款方組合維持在 70% 以上。我非常高興地報告，第四季我們的按療程組合為 78%，且按療程總量較去年同期成長 25%。持續投資於臨床結果、銷售資源以及聚焦成長的策略正在帶來回報；第四季總入院人次為 10,400 人，較去年同期成長 22.4%。

We ended 2025 with 45 preferred pay 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 double-digit year-over-year growth in home health total episodes and improvement in our clinical and financial outcomes.

截至 2025 年底，我們在居家健康業務已簽訂 45 份優先付款方協議。我們專注於將居家健康照護人力產能與願意以按療程方式給付的付款方對齊，帶動居家健康總療程數（total episodes）年增達雙位數，並改善我們的臨床與財務成果。

As we reset expectations in home health and hospice for 2026, we believe our episodic payer mix will remain above 75% with organic growth rates approaching double digits. We also expect to sign additional preferred pay agreements in home health and are now targeting more than 50 agreements by the end of 2026. Finally, as we have achieved our desired preferred payer model on private duty services and home health and hospice, we are proceeding with a similar strategy in our Medical Solutions business.

在我們為 2026 年重設居家健康與安寧療護（hospice）的預期之際，我們相信按療程付款方組合將維持在 75% 以上，且內生成長率可望接近雙位數。我們也預期在居家健康業務簽署更多優先付款方協議，並將 2026 年底的目標上調至超過 50 份協議。最後，鑑於我們已在私人看護服務（private duty services）以及居家健康與安寧療護達成理想的優先付款方模式，我們正於 Medical Solutions 業務推進類似策略。

We're in the late stages of implementing our preferred payer strategy in Med Solutions and believe it will be fully realized in 2026. At year-end 2025, we had 18 preferred payers, and we expect that number to grow with a target of 25 total agreements in 2026 as we achieve our desired preferred payer model.

我們正處於在 Med Solutions 落實優先付款方策略的後期階段，並相信將於 2026 年全面實現。截至 2025 年底，我們有 18 個優先付款方；隨著我們達成理想的優先付款方模式，預期該數量將增加，並以 2026 年達成合計 25 份協議為目標。

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 timely fashion. I am pleased with our Q4 volume growth of approximately 92,000 unique patients served or positive 3.4% over the prior year period. As we think about Medical Solutions revenue growth in 2026, I would expect us to remain in the mid-single digits growth for the next few quarters and then returned to double-digit growth by the end of the year.

隨著我們將臨床產能與重視我們服務且能及時付款的付款方對齊，我們的毛利率已在目標區間內趨於穩定。我對第四季量能成長感到滿意：服務約 92,000 名不重複病患（unique patients），較去年同期增加 3.4%。展望 2026 年 Medical Solutions 的營收成長，我預期未來幾個季度將維持在中個位數成長，並在年底前回到雙位數成長。

We are encouraged by our rate increases, preferred pay 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 cost-effective, high-quality alternative to higher cost care settings.

我們對費率調升、優先付款方協議以及後續的招募成果感到鼓舞。隨著我們達成先前討論的費率目標，我們的業務已展現穩健的復甦跡象。居家與社區式照護（home and community-based care）將持續成長，而 Aveanna 是一個具備多元付款方基礎的綜合平台，能提供相較於高成本照護場域更具成本效益且高品質的替代方案。

Now turning to our recently announced transaction to acquire Family First Homecare, a Florida-based company with a great reputation for quality in-home pediatric care. I want to extend a warm welcome to our Family First teammates.

接下來談我們近期宣布的交易：收購 Family First Homecare。該公司位於佛羅里達州，並以高品質的到府兒科照護享有極佳聲譽。我想向 Family First 的團隊夥伴致上熱烈歡迎。

I am thrilled to continue our acquisition growth story with great companies like Thrive Skill Pediatrics and Family First home care. Both companies continue to build upon the Aveanna brand of high-quality compassionate care and the most cost-effective setting, the comfort of our patient's home. We expect the Family First transaction to close sometime in Q2 with normal regulatory approvals. I look forward to updating you on our progress over the coming quarters. Before I turn the call over to Matt, let me comment on our strategic plan and outlook for 2026.

我很振奮能與 Thrive Skilled Pediatrics 與 Family First Homecare 這樣優秀的公司一起延續我們透過併購推動成長的故事。兩家公司都持續強化 Aveanna 的品牌：在最具成本效益的照護場域——病患家中——提供高品質且富同理心的照護。在取得一般性的監管核准後，我們預期 Family First 交易將於第二季某個時間完成交割。我期待在未來幾個季度向各位更新我們的進展。在我把電話交給 Matt 之前，先談談我們的策略計畫與 2026 年展望。

We will focus our efforts on five primary strategic initiatives. First, strengthening our partnerships with government partners and preferred payers to create additional capacity and growth. Second, improving clinical outcomes and customer engagement scores while lowering the total cost of care. Third, implementing high-priority artificial intelligence and automation efforts to improve operational efficiency and productivity gains. Fourth, growing through acquisitions, while improving net leverage and generating positive free cash flow.

我們將把重點放在五項主要策略倡議上。第一，強化與政府合作夥伴及優先付款方的合作關係，以創造更多產能與成長。第二，在降低整體照護成本的同時，改善臨床結果與客戶互動評分。第三，推動高優先級的人工智慧與自動化工作，以提升營運效率與生產力。第四，透過併購推動成長，同時改善淨槓桿並創造正向自由現金流。

And finally, engaging our leaders and employees and delivering our Aveanna mission. Based on the strength of our fourth quarter and full year 2025 results and the continued execution of our key strategic initiatives, we anticipate 2026 revenue range of $2.54 billion to $2.56 billion and adjusted EBITDA range of $318 million to $322 million. We believe this '26 outlet provides a prudent view considering the challenges we still face with the evolving environment and does not include the impact of the Family First acquisition.

最後，凝聚我們的領導團隊與員工，並落實 Aveanna 的使命。基於我們 2025 年第四季與全年業績的強勁表現，以及關鍵策略倡議的持續執行，我們預期 2026 年營收區間為 25.4 億至 25.6 億美元，調整後 EBITDA 區間為 3.18 億至 3.22 億美元。我們認為此 2026 年展望在考量仍面臨的挑戰與持續演變的環境下屬於審慎觀點，且未包含 Family First 併購的影響。

In closing, I'm incredibly proud of our Aveanna team and their dedication to executing our strategic plan while holding our mission at the core of everything we do. We operate cost-effective patient-preferred and clinically sophisticated solution for our patients and families.

最後，我對 Aveanna 團隊感到無比自豪；他們在執行我們策略計畫的同時，始終將使命置於一切工作的核心。我們為病患與其家庭提供具成本效益、以病患偏好為導向且臨床上高度成熟的解決方案。

Furthermore, we are the right solution for our payers, referral sources and government partners. With that, let me turn the call over to Matt to provide further details on the quarter and our '26 outlook. Matt?

此外，對於付款方、轉介來源與政府合作夥伴而言，我們也是正確的解決方案。接下來我把電話交給 Matt，請他提供本季表現與我們 2026 年展望的更多細節。Matt？

Thank you, Jeff, and good morning. I'll first talk about our fourth quarter and full year 2025 financial results and liquidity before providing additional details on our outlook for 2026. Starting with the top line. We saw revenues rise 27.4% over the prior year period to $662.5 million. We achieved year-over-year revenue growth in all three of our operating divisions, led by our private duty services, home health and hospice and medical solutions divisions, which grew by 28.1%, 27.3% and 21.3% and compared to the prior year quarter.

謝謝你，Jeff，大家早安。在提供 2026 年展望的更多細節之前，我會先談我們 2025 年第四季與全年財務結果及流動性。先從營收（top line）開始。我們的營收較去年同期成長 27.4%，達到 6.625 億美元。我們三個營運事業部皆實現年增營收成長，其中以私人看護服務、居家健康與安寧療護，以及 Medical Solutions 事業部領先，分別較去年同季成長 28.1%、27.3% 與 21.3%。

Consolidated gross margin was $213.3 million or 32.2%. Consolidated adjusted EBITDA was $85 million, a 54% increase as compared to the prior year. This growth reflects an improved rate environment, increased volumes as well as enhanced operational efficiencies. As Jeff mentioned, this year's fourth quarter included an additional 53rd week, which had a positive impact on both revenue and earnings. As a result, the current fiscal year reflects an extra week of business activity compared to a typical year.

合併毛利為 2.133 億美元，毛利率為 32.2%。合併調整後 EBITDA 為 8,500 萬美元，較去年同期增加 54%。此成長反映了費率環境改善、量能提升以及營運效率增強。如 Jeff 所提及，今年第四季包含額外的第 53 週，對營收與獲利皆有正面影響。因此，本會計年度相較於一般年度多了一週的業務活動。

Now taking a deeper look into each of our segments. Starting with private duty services. Revenue for the quarter was approximately $541 million, a 28.1% increase and was driven by approximately 12.4 million hours of care, a volume increase of 17.9% over the prior year. Q4 revenue per hour of $43.74 was up 10.2% 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.

接著更深入檢視各事業部表現。先從私人看護服務（private duty services）開始。本季營收約為 5.41 億美元，年增 28.1%，主要由約 1,240 萬小時的照護時數帶動，量能較去年增加 17.9%。第四季每小時營收為 43.74 美元，較去年同季提升 10.2%，主要受優先付款方量能成長及先前提及的費率提升所驅動。當我們取得可接受的給付費率時，我們仍對吸引照護人員並滿足市場對我們服務需求的能力保持樂觀。

Turning to our cost of labor and gross margin metrics. We achieved $149.9 million of gross margin or 27.7%. The cost of revenue rate of $31.62 in Q4 was up $3.15 or 13% from the prior year period. Our Q4 spread per hour was $12.12 and reflecting continued normalization as we make ongoing adjustments to caregiver wages to support higher volumes and improve clinical outcomes. Moving on to our home health and hospice segment.

接著談我們的人力成本與毛利率指標。我們達成毛利1.499億美元，毛利率為27.7%。第四季每單位營收成本（cost of revenue rate）為31.62美元，較去年同期增加3.15美元或13%。我們第四季每小時價差（spread per hour）為12.12美元，反映在我們持續調整照護人員薪資以支援更高服務量並改善臨床結果的同時，整體仍在持續回歸常態化。接下來談我們的居家健康與安寧療護（home health and hospice）部門。

Revenue for the quarter was approximately $69.3 million, a 27.3% increase over the prior year. Revenue was driven by 10,400 total admissions with approximately 78% being episodic and 14,000 total episodes of care, up 25% from the prior year quarter. Medicare revenue per episode was $3,223, up 3% from the prior year quarter. 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.

本季營收約為6,930萬美元，較去年同期成長27.3%。營收主要由總入院數10,400人次所帶動，其中約78%為按療程計（episodic），以及總照護療程（episodes of care）14,000個，較去年同期增加25%。每療程的Medicare營收為3,223美元，較去年同期增加3%。我們仍持續聚焦於短期內以「適度調整規模（rightsizing）」的方式推動成長，重點放在以療程計價方式給付的優先付款方（preferred payers）。這項以療程為核心的策略加速了我們的毛利率擴張，並改善了臨床結果。

With episodic emissions well over 70%, we achieved our goal of rightsizing our margin profile and enhancing our clinical offerings, we are pleased with our Q4 gross margin of 53.7%, representing our continued focus on cost initiatives to achieve our targeted operating model. Our home health and hospice platform is dedicated to creating value through effective operational management and the delivery of exceptional patient care. Now to our Medical Solutions segment results for Q4. During the quarter, we produced revenue of $52.5 million, up 21.3% over the prior year period. Revenue was driven by approximately 92,000 unique patients served and revenue per UPS of approximately $570, up 17.9% over the prior year period.

在按療程計的入院占比遠高於70%的情況下，我們達成了適度調整毛利結構並強化臨床服務的目標；我們對第四季53.7%的毛利率感到滿意，這也代表我們持續聚焦成本措施，以達成目標營運模式。我們的居家健康與安寧療護平台致力於透過有效的營運管理與提供卓越的病患照護來創造價值。接著說明第四季醫療解決方案（Medical Solutions）部門的表現。本季營收為5,250萬美元，較去年同期成長21.3%。營收主要由約92,000名服務的獨立病患（unique patients served）所帶動，且每UPS營收約570美元，較去年同期成長17.9%。

Gross margin was approximately $26.2 million or 50% for the quarter. Medical Solutions Q4 revenue, gross margin and reimbursement rate benefited from a reserve release driven by stronger-than-expected cash collections on claims we have previously estimated as uncollectible. We expect results to normalize in Q1 with gross margins returning to the 43% to 45% range. As Jeff mentioned, we continue to implement initiatives to be more effective and efficient in our operations to achieve our targeted operating model. We're accelerating our preferred payer strategy and Medical Solutions by aligning our capacity with those payers that value our resources and appropriately reimburse us for the services we provide.

本季毛利約為2,620萬美元，毛利率為50%。醫療解決方案第四季的營收、毛利與報銷率（reimbursement rate）受惠於準備金回轉（reserve release），其原因是我們先前估計為不可收回的理賠款項，實際現金回收強於預期。我們預期第一季結果將回歸常態，毛利率回到43%至45%的區間。如Jeff所提到的，我們持續推動各項措施，使營運更有效率，以達成目標營運模式。我們正加速在醫療解決方案部門推動優先付款方策略，透過將產能與重視我們資源並能對所提供服務給予適當報銷的付款方對齊。

We expect margins to normalize 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 return to a sustained year-over-year volume growth in Medical Solutions.

隨著我們落實目標營運模式，我們預期毛利率將回歸常態，且UPS將加速成長。雖然我對目前的整合進度感到滿意，但我們正進入完成效率提升工作的最後衝刺階段，並讓醫療解決方案回到可持續的年對年服務量成長。

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 that aligning caregiver capacity with preferred payers who value our partnership is the right path forward at Aveanna with a strong momentum from Q4 and throughout 2025, we're optimistic these trends will continue into 2026. We will continue to pass through wage improvements and other benefits to our caregivers and the ongoing effort to better improve volumes.

總結來說，我們在艱難的環境中持續努力，同時把病患照護放在我們所做一切的核心。很明顯，將照護人力產能與重視我們合作關係的優先付款方對齊，是Aveanna未來正確的方向；在第四季以及整個2025年累積的強勁動能下，我們樂觀認為這些趨勢將延續至2026年。我們將持續把薪資改善與其他福利回饋給照護人員，並持續努力以進一步提升服務量。

Now moving to our balance sheet and liquidity. At the end of the fourth quarter, we had liquidity of approximately $529 million representing cash on hand of approximately $193 million, $110 million of availability under our securitization facility and approximately $226 million of availability on our revolver which was undrawn as of the end of the quarter. We had $24.5 million in outstanding letters of credit at the end of Q4. On the debt service front, we had approximately $1.49 billion of variable rate debt at the end of Q4. 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%.

接下來談資產負債表與流動性。截至第四季末，我們的流動性約為5.29億美元，包括約1.93億美元的手頭現金、證券化融資工具（securitization facility）下可用額度1.10億美元，以及循環信貸（revolver）約2.26億美元的可用額度；該循環信貸在季末尚未動用。截至第四季末，我們尚有2,450萬美元的未償信用狀（letters of credit）。在債務償付方面，截至第四季末我們約有14.9億美元的浮動利率債務。其中5.20億美元以固定利率交換（fixed rate swaps）進行避險，8.80億美元受利率上限（interest rate cap）保護，將SOFR高於3%的進一步上升曝險加以限制。

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. Looking at cash flow. Cash generated by operating activities was $125.9 million, and free cash flow was $131 million. We are encouraged by our strong cash collections and cost efficiency efforts, which drove solid operating and free cash flow in 2025.

因此，我們幾乎所有的浮動利率債務都已完成避險。我們的利率交換合約期限延伸至2026年6月，利率上限合約期限延伸至2027年2月。再看現金流。營運活動產生的現金為1.259億美元，自由現金流為1.31億美元。我們對強勁的現金回收與成本效率提升措施感到鼓舞，這些因素在2025年帶動了穩健的營運現金流與自由現金流。

We expect similar cash flow performance in 2026. As a reminder, the first quarter is typically our seasonal low point for both operating and free cash flow with improvement expected throughout the rest of the year. But before I hand the call over to the operator for Q&A, let me take a moment to address our outlook for 2026. As Jeff mentioned, we expect full year 2026 revenue range of $2.54 billion to $2.56 billion, an adjusted EBITDA range of $318 million to $322 million. This guidance does not include any impact from the Family First acquisition, which we expect to close in late Q2.

我們預期2026年將有類似的現金流表現。提醒一下，第一季通常是我們營運現金流與自由現金流的季節性低點，預期在今年其餘時間會逐步改善。不過在我把電話交給接線員進行問答之前，讓我花點時間說明我們對2026年的展望。如Jeff所提到，我們預期2026年全年營收區間為25.4億至25.6億美元，調整後EBITDA區間為3.18億至3.22億美元。此指引未包含Family First收購案的任何影響；我們預期該交易將於第二季末完成交割。

As outlined in our recent 8-K, we were paying $175.5 million in consideration or approximately 7.5 times post-synergy EBITDA. We plan to fund the transaction and related fees with cash on hand and our securitization facility. As we reflect on our Q4 results, I'd like to take a moment to express my sincere gratitude to all of 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 2026 strategic plan and look forward to providing you with further updates at the end of Q1.

如我們近期8-K所述，我們支付的對價為1.755億美元，約為協同效益後EBITDA的7.5倍。我們計畫以手頭現金與證券化融資工具來支付本交易及相關費用。回顧第四季的成果，我想藉此向所有Aveanna的同仁表達由衷的感謝。若沒有各位的辛勤付出與投入，這些強勁的成果不可能達成。展望未來，我對我們2026年策略計畫的持續落實感到振奮，也期待在第一季結束時向各位提供更多更新。

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

接下來，我把電話交給接線員。

(Operator Instructions) AJ Rice, UBS.

(接線員指示) AJ Rice，瑞銀（UBS）。

Hi, everybody. Congratulations on the Family First acquisition. Obviously, that's a decent-sized deal for you guys. And I think you've said you're going to fund that with cash and short-term borrowings. How should we think about the impact that's likely to have on leverage? And can you give us any early read on whether there's accretion there or the trajectory on the margin contribution over time?

大家好。恭喜完成Family First的收購。顯然，這對你們來說是一筆相當規模的交易。我想你們也提到會以現金與短期借款來籌資。我們應該如何看待這對槓桿（leverage）的可能影響？另外，你們能否初步談談是否具有增益（accretion），或是隨時間推移對毛利率貢獻的走勢？

Yes, AJ, we're really excited to welcome the Family First team and to the Aveanna family. They have really strong clinical outcomes, really disciplined operation and makes them a really nice cultural fit and operational fit and to our family. We value this transaction, as I said in the script, about 7.5 times post-synergy EBITDA. You could see that on a very short-term basis, having a very, very minimal impact on our leverage profile.

是的，AJ，我們非常期待歡迎Family First團隊加入Aveanna大家庭。他們的臨床結果非常出色、營運紀律嚴謹，無論在文化面或營運面都與我們非常契合。如我在講稿中所說，我們對這筆交易的估值約為協同效益後EBITDA的7.5倍。你可以看到，從非常短期的角度來看，這對我們的槓桿結構影響非常、非常有限。

But with the generated free cash flow that we will produce in 2026, you should see us slightly -- flat to slightly down as the year progresses on a pro forma basis with both of those pieces taken into consideration. We still plan on deleveraging in 2026. However, slightly not the large jumps that you've seen in the past two years. Jeff, anything else?

但就我們在 2026 年將產生的自由現金流而言，在將這兩個因素都納入考量後，你們應該會看到我們在備考基礎上，隨著年度推進大致持平到略為下滑。我們仍計畫在 2026 年去槓桿。不過，幅度會稍微小一些，不會像過去兩年你們看到的那種大幅跳升。Jeff，還有要補充的嗎？

Yes. I think, AJ, it's as Matt as well said, we've gotten leverage down to just right at 4 times. As Matt said, we should end 2026 in that range with the Family First addition. And suggest it's just another nice transaction. Thrive was a great transaction for us.

有。我想，AJ，正如 Matt 說得很到位，我們已把槓桿降到大約正好 4 倍。如 Matt 所說，加入 Family First 之後，我們在 2026 年底應該也會落在那個區間。而且我認為這又是一筆很不錯的交易。Thrive 對我們來說是一筆很棒的交易。

It densified our services, allowed us to be better payer partners, thrive mainly in Texas. This is a Florida focused deal for us. And it's a nice merger of two great companies. We got clear some regulatory hurdles over the next month or two and excited to get through those and get on to doing business with the Family First team, but a really nice acquisition for us to start the year.

它讓我們的服務更為密集，讓我們能成為更好的支付方合作夥伴；Thrive 主要在德州。這一筆則是以佛州為重點的交易。而且是兩家優秀公司的良好合併。接下來一兩個月我們要跨過一些監管門檻，期待順利通過，並開始與 Family First 團隊一起開展業務；對我們而言，這是新年度一開始就很不錯的一項收購。

Okay. Just maybe as a follow-up on the preferred provider arrangements that you're doing. At this point, do you have a pretty good geographic coverage across your footprint? Or are there still major geographies where you do not yet have it? And is the idea that the incremental that you did last year, the incremental this year, is that more density, multiple managed care Medicaid programs that you're contracting with in a given geography or is it still just trying to get the broad coverage?

好的。再追問一下你們正在推動的優選供應商安排（preferred provider arrangements）。就目前而言，你們在既有版圖上是否已經有相當完整的地理覆蓋？還是仍有一些主要地區尚未涵蓋？另外，去年新增的、以及今年新增的，概念上是提高密度——也就是在同一地區與多個管理式照護 Medicaid 計畫簽約——還是仍以追求廣泛覆蓋為主？

It's a great question. The eight we won in '25 and the additional that we're anticipating for '26 are in the current geographies that we have. I'll say current geographies post the Thrive acquisition because we added New Mexico in Kansas as our -- as two additional Medicaid states. So as we think about executing on 38 goal for this year, it is still densifying our current geographies. I would tell you, at this point, we've landed most of the major payers in the major markets.

這是個很好的問題。我們在 25 年拿下的 8 個，以及我們預期 26 年新增的，都在我們現有的地理區域內。我說的現有地理區域，是指完成 Thrive 收購之後的版圖，因為我們新增了新墨西哥州與堪薩斯州，作為兩個額外的 Medicaid 州。因此，當我們思考今年要達成 38 的目標時，仍然是在加密我們現有的地理區域。我會告訴你，就目前而言，我們在主要市場已經拿下了大多數主要支付方。

So we're rounding out some of our payer partnerships. And then I think the next steps for us, as you think about like what's next for Aveanna from a Medicaid standpoint, we still want to fill in the states like Ohio, West Virginia, Kentucky, Tennessee, that's still -- that's an open area today where we don't have any Medicaid services. So those four, five states and kind of the, call it, the Heartland, we really want to fill in -- that's how we think about additional M&A in the back half of 2026 and going in '27 on the Medicaid side of the business. Thanks, AJ.

所以我們正在把部分支付方合作關係補齊。接著我認為我們的下一步，從 Medicaid 的角度來看、也就是思考 Aveanna 接下來要做什麼，我們仍希望補上像俄亥俄州、西維吉尼亞州、肯塔基州、田納西州等州——這目前仍是一個空白區域，我們在那裡還沒有任何 Medicaid 服務。因此，這四、五個州以及所謂的「心臟地帶」區域，我們很希望補齊——這就是我們在 2026 年下半年、以及進入 27 年在 Medicaid 業務面上思考額外併購（M&A）的方向。謝謝，AJ。

Brian Tanquilut, Jefferies Group.

Brian Tanquilut，Jefferies Group。

Congrats on this acquisition. Maybe, Matt, as I think about -- to start, when I think of Family First, any other color you can share with us in terms of how we should be thinking about revenues then I guess we go back to the EBITDA contribution. But just any KPIs, any metrics that you can share with us? And then kind of related to that, Jeff, I mean, is this one of those deals where clearly you're densifying in Florida with a deal? Is this one that's been kind of like supported or encouraged by the payers where they've asked you in the past to go into new markets?

恭喜這次收購。Matt，先從 Family First 談起，關於我們應該如何看待其營收，你還能提供哪些補充資訊嗎？然後我想再回到 EBITDA 的貢獻。不過，是否有任何 KPI、任何指標可以跟我們分享？另外相關的一點，Jeff，我是說，這是不是那種很明顯能讓你們在佛州提高密度的交易？這筆交易是否也算是由支付方支持或鼓勵的——也就是他們過去曾要求你們進入新市場？

Awesome questions, Brian. And obviously, on 2026, financials themselves, the impact will depend on the timing of closing of this, obviously. That said, we really expect this to be a really smooth and efficient integration consistent on how the team successfully integrated the Thrive acquisition and brought that team onto the Aveanna platform.

很棒的問題，Brian。當然，就 2026 年的財務本身而言，影響會取決於這筆交易的交割時點。話雖如此，我們確實預期這會是一個非常順暢且有效率的整合，與團隊先前成功整合 Thrive 收購、並將該團隊納入 Aveanna 平台的方式一致。

On a revenue side of it, it's in the ballpark of $120 million of revenue, and then you can run the math for the 7.5 times based upon purchase price. All that depending on a pro forma basis. 2026, we'll see how that really lands just based upon closing timing. Jeff, do you want to add on the --

就營收面來看，大約在 1.2 億美元的量級，然後你可以依據收購價格去推算 7.5 倍的倍數。以上都取決於備考基礎。至於 2026 年，實際落點會如何，主要還是看交割時點。Jeff，你要不要補充一下--

Yes. Brian, I think Matt hit it. Thrive was right down the middle of the fairway, helped us densify our payer needs in Texas. This one is primarily Florida focused. Both companies have great reputations in the Florida market today is well respected by the MCO payers. Florida is an MCO market, right? So our MCO payers are incredibly important to us.

好。Brian，我想 Matt 已經說到重點了。Thrive 是非常標準、非常理想的一筆交易，幫助我們在德州加密以滿足支付方需求。這一筆主要聚焦在佛州。兩家公司在佛州市場都擁有很好的聲譽，且目前也受到 MCO 支付方的高度尊重。佛州是一個 MCO 市場，對吧？所以我們的 MCO 支付方對我們極其重要。

But this acquisition helps us round out the areas in Florida that we were not in geographically. So it does give us a geographic expansion within Florida. It allows us to service effectively every county in the state of Florida. And again, our payer partners are very supportive of our growth. And -- and so I think this one is right down the middle of the fairway just like Thrive.

但這次收購能幫助我們補齊先前在佛州地理覆蓋上尚未進入的區域。因此，它確實讓我們在佛州內部實現地理擴張。也讓我們能有效服務佛州的每一個郡（county）。再次強調，我們的支付方合作夥伴非常支持我們的成長。而且——我認為這一筆就像 Thrive 一樣，是非常理想、非常到位的一筆交易。

And again, excited to kind of get through the regulatory approvals here in Q1 and Q2 and get this thing closed up in the latter half of Q2.

同樣地，我們也很期待在第一季與第二季完成監管核准，並在第二季後半段把這件事完成交割。

No, that makes sense. And then, Matt, any chance you can help us bridge the 2026 EBITDA given I think you have like almost roughly $20 million of one-timers and '25 there's an extra week and then there's Thrive in there. So just try to get that bridge in the guidance from '25 actuals.

不，這很合理。另外，Matt，你能否協助我們把 2026 年的 EBITDA 串起來？因為我想你們大概有將近 2,000 萬美元的一次性項目，而 25 年又多了一週，另外還包含 Thrive。所以只是想從 25 年實際數去對照你們指引，做一個橋接。

Yes. So on the EBITDA, Brian, take that roughly $320 million. We came out earlier this year and talked about, hey, bridge that back down to the $300 million based upon the retro rate increases, the cash collections in that 53rd week itself. So really kind of your jumping off point should be around that $300 million going up to that range of about $320 million as we currently sit organically without any M&A inclusive in there. On the revenue side of things, the 53rd week and Thrive kind of do a really nice offset to one another within 20 basis points themselves.

可以。Brian，談 EBITDA 的話，以大約 3.2 億美元為基礎。我們今年稍早有提到，嘿，把它往回橋接到 3 億美元左右，原因是追溯性的費率調升、以及第 53 週本身的現金收款。所以你的起跳點其實應該在 3 億美元左右；在不包含任何併購（M&A）的情況下，單靠有機成長，我們目前看到會往上到大約 3.2 億美元的區間。就營收面而言，第 53 週與 Thrive 彼此之間形成很好的抵銷，影響大約在 20 個基點以內。

And so we're still going to be in that 5%-plus organic revenue growth as we currently sit today, but that's back in line with our normal expectations, that 5% to 7% range on revenue and a high single digit -- or medium to high single digits on EBITDA. So back into a normalized idea of Aveanna.

因此，以我們目前的狀況來看，我們仍會維持在 5% 以上的有機營收成長，但這也回到我們正常的預期，也就是營收 5% 到 7% 的區間，以及 EBITDA 的高個位數——或中到高個位數成長。也就是回到 Aveanna 較為正常化的狀態。

And Brian, one thing I'll add to that is what Will said is the EBITDA growth implied about 7% to 17%. Again, we tried to -- in my comments, layout that we expect our government -- our PDS government rate wins to kind of be sub-10 this year. Last year, we landed right at 10%, and that's a net number from positive and negative increases. So we expect that number to kind of land between -- somewhere between six and eight state rate increases in this year, and we expect them to be more cost of living oriented. So I'll call it kind of the 1% to 5% Medicaid rate win.

Brian，另外我想補充一點，正如 Will 所說，隱含的 EBITDA 成長約為 7% 到 17%。再次強調，我們在我的評論中試著說明，我們預期政府——我們的 PDS 政府費率調升勝利（rate wins）今年大致會低於 10。去年我們剛好落在 10%，而那是正向與負向調整相抵後的淨數。因此我們預期今年這個數字大概會落在——介於 6 到 8 個州的費率調升，且我們預期它們會更偏向生活成本導向。所以我會把它稱作大約 1% 到 5% 的 Medicaid 費率調升勝利。

So less number of total wins, less percentage per win, and that's really what we're factoring into our guidance as we start the year. I think as we get to May, close Q1, close Family First, we'll have a much better feel for how the year plays out, especially with our legislative efforts being in session right now in the first half of the year.

所以總體勝利件數更少、每次勝利的百分比也更低，這正是我們在年初制定財測指引時納入考量的因素。我認為等到 5 月、結束 Q1、結束 Family First 之後，我們會更清楚今年會如何發展，尤其是我們的立法推動目前正在上半年會期中進行。

Raj Kumar, Stephens.

Raj Kumar，Stephens。

Maybe just kind of focusing on the preferred payer arrangements and kind of thinking about the home health and hospice book. I guess maybe kind of you see an episodic mix trending above 75%. And I think you've previously highlighted you wouldn't be surprised if he got as high as 80%. So maybe just kind of thinking about what's embedded into 2026. And then maybe just any framing around any membership impacts, just given how volatile the membership was during on the Medicare Advantage side?

也許先聚焦在優先付款方（preferred payer）安排，並思考居家健康與安寧照護（home health and hospice）這塊業務。我想你們看到按療程（episodic）組合占比趨勢已高於 75%。而且我記得你們先前也提過，如果升到 80% 也不會意外。所以也許談談 2026 年的假設裡包含了什麼。另外，考量到 Medicare Advantage 端會員數（membership）波動很大，能否也提供一些對會員數影響的框架？

Just any color on that would be helpful.

如果能補充一些說明會很有幫助。

Yes. Raj, great question. And I'm going to take that as a complement to our -- what we call our HHH business. Like you, we're incredibly proud of their results. I think we mentioned it pushing 25% organic year-over-year admission and episodic growth is, I would tell you, first class, best class results and they've done it from just blocking and tackling.

好的。Raj，問得很好。我把這視為對我們——我們稱之為 HHH 業務——的一種肯定。跟你一樣，我們對他們的成果感到非常自豪。我想我們提過，他們的有機年增入院量與按療程成長接近 25%，我會說這是第一流、同級最佳的成果，而他們是靠著把基本功做到位（blocking and tackling）達成的。

They've done it from just being really, really, really good at providing great clinical outcomes and the right level of care to the right payers and the right patients. So we're really robust. Now that we've got a more a clear path from a federal home health rate standpoint. We continue to lean in. This is an area that we want to grow through both organic and inorganic M&A-related activities in this year.

他們就是非常、非常、非常擅長提供優異的臨床結果，並把適當層級的照護提供給合適的付款方與合適的病患。所以我們對此非常有信心。現在從聯邦居家健康費率的角度來看，我們也有更清晰的路徑。我們會持續加大投入。這是我們今年希望透過有機成長與非有機的併購（M&A）相關活動共同推動成長的領域。

But clinical outcomes are almost 4.5 stars on average for our home health locations. I think it's 4.3 stars where we sit today, gross margins in the 54%, 53%, 54%, great cash collections. As you said, episodic mix approaching 80%, and we're growing in the north of 10% year over year right now 20%. We're off to a great start to the year in Q1. These guys are having a great start to the year.

就臨床結果而言，我們居家健康據點平均接近 4.5 顆星。我想目前大約是 4.3 顆星；毛利率在 54%、53%、54% 這個區間，現金回收也很不錯。如你所說，按療程組合占比正逼近 80%，而我們目前年增成長在 10% 以上、達到 20% 左右。我們在 Q1 的開局非常好。這些團隊今年開局表現非常出色。

So I think everything we would say is we're going to continue to lean into both home health and hospice and continue to grow it. And am I concerned with the trends of managed Medicare now. I think we're doing our playbook in this business, and our teams just kick and button, taking names right now. So really excited about where we are and as we ended '25 and equally important as we sit here kind of halfway through Q1, really excited what these guys have done for the business model.

所以我想我們要傳達的是：我們會持續加大在居家健康與安寧照護的投入並持續擴張。至於我是否擔心目前受管理的 Medicare（managed Medicare）的趨勢？我認為我們正在依照這項業務的作戰手冊執行，而我們的團隊現在火力全開、表現非常強勢。所以我們對 25 年底的狀況非常振奮；同樣重要的是，當我們現在大概走到 Q1 的一半，我們也非常振奮於他們為商業模式所做出的成果。

Got it. And then maybe just on the Medical Solutions business. 2025 was a year of kind of optimization and around preferred payer strategies. As we kind of think about 2026 and given with the reimbursement dynamics was any kind of framing around what would be in a kind of appropriate run rate when we kind of ex out the reserve dynamics favorability in the quarter?

了解。那再談談 Medical Solutions 業務。2025 年算是優化的一年，並圍繞在優先付款方策略上。當我們思考 2026 年、以及在報銷（reimbursement）動態之下，能否提供一些框架：如果把本季準備金（reserve）變動帶來的有利影響排除後，什麼樣的水準會是較合適的常態化 run rate？

Debbie, why don't you take us through the reserve impact itself and then we can lay the bigger picture here?

Debbie，你要不要先帶我們看一下準備金影響本身，然後我們再談更大的全貌？

Raj, you called it out. But during the quarter, gross margin and the revenue reimbursement rate were elevated, and that was really from a reserve release that we recorded driven by improved cash collections on previously reserved claims. Now without the inclusion of that reserve release, the Medical Solutions gross margin was slightly elevated compared to our guide. But we do expect it to normalize in Q1 getting back to that 43% to 45% range.

Raj，你點得很對。但在本季，毛利率與收入報銷率偏高，主要是因為我們認列了一筆準備金回轉（reserve release），其原因是先前已提列準備的理賠（claims）現金回收改善所致。若不包含這筆準備金回轉，Medical Solutions 的毛利率相較於我們的指引仍略為偏高。但我們確實預期它會在 Q1 正常化，回到 43% 到 45% 的區間。

Yes. Will said, Debbie, I think to put the dollars in there themselves, this contribute the contribution of that was $2.5 million to $3 million that we're talking about, Raj, of additional revenue and EBITDA in the quarter. So not overly material to earnings, but it shows up in the Medical Solutions metrics in gross margin just due to its size.

是的。Will 說的，Debbie，我想把金額本身補進來：Raj，我們談的那部分貢獻大約是 250 萬到 300 萬美元，體現在本季的額外收入與 EBITDA。所以對獲利並非特別重大，但由於金額規模的關係，它會反映在 Medical Solutions 的指標上，尤其是毛利率。

On the modernization, the efforts, though, Raj, we're really excited about what the team has been able to do and what they've been accomplished so far. As we move into '26, we expect to see preferred payer numbers really significantly increase. Currently, we're sitting at 18%. We expect that to continue to grow as we become better aligned. And put our capacity with those who support us.

至於現代化（modernization）的努力，Raj，我們對團隊目前能做到的、以及已完成的成果感到非常振奮。隨著我們進入 26 年，我們預期優先付款方占比會顯著提升。目前我們約在 18%。隨著我們的對齊程度提升，我們預期這個數字會持續成長。並把我們的產能配置給那些支持我們的合作方。

There's a little bit of work to do at the same time. So we plan on wrapping this up in the front half of 2026 and that's when you'll see us return back to a double-digit growth number organically in this business and gross margins, as Debbie pointed out, sustaining in that 43% to 45% range.

同時也還有一些工作要做。因此我們計畫在 2026 年上半年完成收尾，屆時你會看到我們在這項業務上回到有機的雙位數成長，而毛利率也會如 Debbie 所指出的，維持在 43% 到 45% 的區間。

Ben Hendrix, RBC Capital Markets.

Ben Hendrix，RBC Capital Markets。

This is Drew Sterrett on for Ben Hendrix. You've previously mentioned continued wage pass-through into 2026. Can you quantify the magnitude and timing of these increases?

我是 Drew Sterrett，代 Ben Hendrix 提問。你們先前提到薪資持續在 2026 年傳導（pass-through）。你們能量化這些調升的幅度與時點嗎？

Yes. Drew, I think the way to look at it is that spread rate that we talk about a lot. Q4 was at $12.12 which is coming back down in line. But we've continued to push through wages. As we've talked about the entire year in 2025 we had some initiatives in place to really drive our volumes, and you see it impacting and really growing our volumes.

可以。Drew，我認為可以用我們經常談到的價差率（spread rate）來看。Q4 是 12.12 美元，正在回落到較一致的水準。但我們仍持續把薪資推進去。如同我們在 2025 年整年所談的，我們有一些措施來真正帶動量能，你也看到它正在影響並實際推升我們的量。

This really came down, and you can see it in our gross margins. We settled in that 28% range, which is on the higher end range that we give for that business and in line with our expectations. Looking ahead, we'll continue to actively manage spread as we do every single day, to meet the needs of our preferred payers and our payer partners.

這確實下降了，你也能在我們的毛利率中看到。我們落在約 28% 的區間，這是在我們對該業務所給區間的較高端，且符合我們的預期。展望未來，我們會一如既往每天積極管理價差（spread），以滿足我們優先付款方與付款方合作夥伴的需求。

Benjamin Rossi, JPMorgan.

Benjamin Rossi，摩根大通。

Appreciate the earlier comments regarding your state contracting. I guess just shifting focus to California, which still seems to be the outlier here on home-based nursing rates. What do you think is the realistic 2026, 2027 scenario for California here between, call it, like no change, a cost of living type increase in that 1% to 5% range or maybe a structural reset? And then under each of those scenarios, do you have any kind of commentary on impact to your PDS spread rate per hour or maybe your broader market share strategy given your stance to not exit California?

感謝你先前針對州政府合約的評論。我想把焦點轉到加州；在居家護理（home-based nursing）費率方面，加州看起來仍是這裡的異數。你認為加州在2026、2027年較為現實的情境會是什麼——例如完全不變、1%到5%區間的生活成本型調升，或是可能出現結構性重置？另外，在上述各種情境下，你能否談談對你們每小時PDS利差（spread rate）的影響，或是考量你們不退出加州的立場下，對更廣泛的市占策略會有什麼看法？

Yes. Thanks, Ben. We met with the Governor of California as early as last week. We are not in the budget. There's no PDN rate increase in the '27 budget for California as it exists today.

是的。謝謝，Ben。我們早在上週就與加州州長會面。我們不在預算案中。就目前加州現行的『27年度預算』而言，沒有PDN費率調升。

we're still lobbying and advocating to be in the -- what's called the May revised budget. If I'm scoring that as a handicap, I'd say it's less than 10% or 15% that PDN makes it in any shape, way or form in the California budget. We're certainly not expecting and we've not modeled that. And over time, I hate to say it, but over time, as our other markets have just grown at the 20%, 22%, 25% year-over-year growth rate in PDS, California is unfortunately just gotten smaller and smaller from a materiality for the company. So we still care deeply about our California patients.

我們仍在遊說並倡議，希望能納入所謂的5月修訂預算（May revised budget）。如果要我用機率來評估，我會說PDN以任何形式被納入加州預算的機率不到10%或15%。我們當然不期待這件事發生，也沒有把它納入模型。而且隨著時間推移，我不太想這麼說，但隨著我們其他市場的PDS以每年20%、22%、25%的年增率成長，加州對公司而言在重要性（materiality）上不幸地愈來愈小。所以我們仍然非常關心我們在加州的病患。

We still care debt shoveling operations. We advocate very hard. Like I said, we met with the governor last week and we continue to meet with his staff and push forward. But today, as we sit today, I'm not expecting any material change both stop gap, cost of line is potential, but I would say it's unlikely. So there's nothing baked in our guidance that California has a change in heart in 2026.

我們仍然關心我們在當地的營運。我們非常努力地倡議。如我所說，我們上週與州長會面，並持續與他的幕僚會談、推動進展。但就目前而言，我不預期會有任何重大變化；或許會有某種短期權宜（stop gap）、生活成本調整的可能性，但我會說機率不高。因此，我們的財測指引中沒有把加州在2026年『改變心意』納入任何假設。

Understood. Thanks for the additional comments there. I guess just as a follow-up, we've heard some other -- some other healthcare facilities names regarding a spillover impact from some of the delayed respiratory season and then some of the additive weather-related pressures from some of the winter storms. Just when you think about your 2026 outlook, how are you factoring any of the respiratory or weather-related impacts during 1Q?

了解。謝謝你補充說明。我想追問一下：我們聽到其他一些醫療機構提到，呼吸道季節延後帶來的外溢影響，以及冬季風暴造成的額外天候壓力。就你們的2026年展望而言，你們在第一季如何納入任何呼吸道或天候相關影響的考量？

No, I mean, definitely that's well said. We didn't put it in our prepared remarks, but we have had to fight through like all of our peers mainly snow and significant snow throughout the entire country. I'd love to say the Northeast, but via Texas all the way up through Maine. So -- but our teams do a good job fighting that through. We have a no-excuse mentality here at Aveanna.

沒有，我的意思是，你說得很對。我們沒有把這點寫進事先準備的講稿，但我們確實像所有同業一樣，主要是得挺過降雪，而且全國各地都有大量降雪。我很想說只是在東北部，但其實從德州一路到緬因州都是如此。所以——但我們的團隊很擅長把這些狀況撐過去。在Aveanna，我們有一種不找藉口的心態。

We just fight through everything that comes our way and so I don't think -- we didn't certainly change our guidance based on weather. But like our peers, we've had to fight through 2 or 3 weeks of weather in the first 10 weeks of the year. So again, I won't say it was nothing, but it's just something we handle. We move on. And we're glad whether for the most part is behind us at this point in the year and back to business.

我們就是把迎面而來的一切都撐過去，所以我不認為——我們當然沒有因為天候而調整指引。但和同業一樣，我們在今年前10週中，有2到3週都得應對天候影響。所以我不會說完全沒有影響，但這就是我們會處理的事情。我們繼續往前走。而且我們也很高興，就今年這個時間點而言，天候大致已經過去了，回到正常營運。

So I don't think you'll have any material impact. Matt mentioned in his prepared comments as a reminder, Q1 is our largest payroll tax quarter. So keep in mind, as you think about guidance, Q1 is seasonally low for our margin mainly driven by the payroll tax on our labor cost.

所以我不認為你會看到任何重大影響。提醒一下，Matt在事先準備的評論中提到，第一季是我們薪資稅最高的一季。因此在思考指引時請記得，第一季的利潤率具有季節性偏低，主要是因為薪資稅會反映在我們的勞動成本上。

Andrew Mok, Barclays Bank.

Andrew Mok，巴克萊銀行。

Given the recent increase in oil prices, can you remind us how much -- how travel is reimbursed for your caregivers and how much fuel represents as a percentage of total revenue and total cost?

鑑於近期油價上漲，你能否提醒我們：你們如何補償照護人員的差旅，以及燃油占總營收與總成本的比例大約是多少？

Great question. 80% of our revenues are driven off of shift care in the home where we don't reimburse any form of mileage or gas or fuel. And it's primarily because our nurse goes from his or her home right to the home of the patient. They're there for 8 or 10 or 12 hours and they go home. So the vast, vast, vast majority of the business at Aveanna has zero tied to gas prices and from a reimbursement standpoint, our Med Solutions has some impact on a minimum amount from our drivers.

好問題。我們80%的營收來自居家輪班照護（shift care in the home），在這部分我們不補貼任何形式的里程、汽油或燃料。主要原因是我們的護理師從他或她的住家直接前往病患家中。他們在那裡工作8、10或12小時後就回家。因此，Aveanna絕大、絕大、絕大多數的業務，從補償角度來看與油價完全無關；我們的Med Solutions業務對我們的司機有一些影響，但金額很小。

And then the business that it does impact is our home health and hospice business, and that's about 12% of our total revenue. So it's not a nothing impact for us. But thankfully, with the size and scale that we are and the diversity of our payer mix and our business mix, it's not as meaningful as it would be to some of our large home health and hospice peers.

另外，會受到影響的業務是我們的居家健康（home health）與安寧照護（hospice）業務，約占我們總營收的12%。所以對我們而言並非完全沒有影響。但幸好以我們的規模與量體，以及付款方組合與業務組合的多元性來看，其重要性不如一些大型居家健康與安寧照護同業那麼高。

Got it. Maybe just as a follow-up, can you provide a little bit more color on just the pace of pass-through to caregivers on PDS and how you expect the spread to the spread to materialize throughout the year?

了解。再追問一下：你能否更具體說明PDS對照護人員的轉嫁（pass-through）速度，以及你預期利差（spread）在全年會如何逐步呈現？

Yes, Andrew, I would go back to the gross margin line item here, 27.7% in Q4, a little bit of PTO utilization holiday pay, et cetera, that occurs in Q4, a little bit of extra compression in there. But our range should be in that 27%, 28% gross margin for the Private Duty Services segment. So we're close to it now. But as we continue to drive reimbursement rates, as Jeff mentioned, single high single digits on the governor far side as we continue to add eight more preferred payers. And as we continue to organically grow our preferred payers, take those rate wins and be able to continue to push them down to our caregivers still aligning to that 27%, 28% gross margin.

好的，Andrew。我會回到毛利率這個項目：第四季是27.7%，第四季會有一些PTO使用、假日薪資等因素，導致其中有些額外的壓縮。但我們的區間應該會落在私人照護服務（Private Duty Services）部門27%到28%的毛利率。所以我們現在已經很接近了。隨著我們持續推動補償費率上調，如Jeff提到的，在較遠端（far side）大約是高個位數（single high single digits），同時我們也會再新增8個優先付款方（preferred payers）。並且隨著我們持續讓優先付款方自然成長，取得這些費率勝利後，仍能把它們持續下放給照護人員，同時維持在27%到28%的毛利率。

Pito Chickering, Deutsche Bank.

Pito Chickering，德意志銀行。

One, If I think about the PDS business model, like the preferred payer strategy makes a ton of sense just due to the pretty large savings for managed Medicaid and it's obviously -- it's sort of more of a niche market. But if you think about home health, it's a huge market with a lot of nurses employed. So can you just walk us through why you can replicate the preferred payer strategy in the home health segment?

第一，如果我從PDS商業模式來看，優先付款方策略非常合理，因為對管理式Medicaid有相當可觀的節省，而且這顯然——也算是一個較利基的市場。但如果你看居家健康（home health），那是一個非常大的市場，有很多受雇的護理師。所以你能否帶我們了解一下，為什麼你們可以在居家健康部門複製優先付款方策略？

To, I think, one, our discipline around episodic payer mix, I think a year or two ago, people questioned whether or not being above 70% was attainable long term. I would say at this point, we've now put that behind us and said be above 75% is our long-term strategy. And over time, payers have come around. I mean at first payers did not like the episode of conversation three, four, five years ago. But when you don't bend your backbone and you keep your clinical capacity focused on the right payer base, meaning episode of payers.

第二，我想，第一點是我們在按療程（episodic）付款方組合上的紀律。我想在一兩年前，大家曾質疑長期而言是否能維持在70%以上。我會說到目前為止，我們已經把那個疑慮拋在腦後，並把長期策略定為維持在75%以上。而且隨著時間推移，付款方也逐漸接受了。我的意思是，一開始付款方並不喜歡按療程的討論——三、四、五年前是如此。但當你不改變立場、並讓你的臨床產能持續聚焦在正確的付款方基礎上，也就是按療程的付款方。

Eventually, we have found that our payers do come back around. Now clinical outcomes drive the story, right? So great clinical outcomes lead to good financial outcomes. So I think in our home health and hospice business, specifically home health, we've been able to stand behind great clinical outcomes. But I just think that when you look at -- I got eight quarters in a row here, we've been above 75% eight quarters in a row and we're approaching 80% now on an episodic basis.

最終，我們發現我們的付款方確實會回頭。現在臨床結果才是關鍵敘事，對吧？所以優異的臨床結果會帶來良好的財務結果。因此我認為在我們的居家健康與安寧（hospice）業務中，特別是居家健康，我們一直能以優異的臨床結果作為後盾。但我只是覺得，當你看——我這裡連續八個季度，我們連續八個季度都高於75%，而且現在按每個療程（episodic）口徑正接近80%。

At this point, this is the business model. We're not moving from it. and our payers have kind of caught up to us. And by the way, I want to give a shot to our payer team. We've got a world-class payer team in our home health and hospice payer leader has done a fantastic job.

在這個時間點，這就是商業模式。我們不會偏離它，而我們的付款方也算是跟上了我們。順帶一提，我想稱讚一下我們的付款方團隊。我們有一支世界級的付款方團隊，我們居家健康與安寧的付款方負責人做得非常出色。

She has been amazing. So kudos to our payer team for -- they're out every day, continuing to beat the drum, but they will not take fee-for-service, low dollar contracts because of how valuable caregivers and clinicians are in today's world. But thank you for noticing, by the way.

她一直都非常出色。所以要為我們的付款方團隊喝采——他們每天都在外面持續敲鼓推進，但他們不會接受按服務收費（fee-for-service）、低金額的合約，因為在當今環境下照護人員與臨床人員非常有價值。不過也謝謝你注意到這點。

Okay, fair enough. And then one more on Family first. How much of the $120 million of revenues are in Florida versus the other six states? And how fast can you roll out the preferred payer strategy in Florida sort of in those new markets? And is thinking about the opportunity there?

好，可以。然後再問一個關於 Family First 的問題。這1.2億美元營收中，有多少是在佛羅里達，多少是在其他六個州？以及你們能多快在佛羅里達那些新市場推行優先付款方（preferred payer）策略？你們對那裡的機會是怎麼想的？

I assume it's more acceleration of the $120 million of revenues versus sort of around the 20% margin business that the business has today.

我猜這更像是加速那1.2億美元的營收，而不是維持該業務目前大約20%利潤率的狀態。

Yes. So I think of the revenue base being kind of two-thirds, Florida, one-third everywhere else. Certainly, Florida is the state that we focused on. They do have meaningful business in other states outside of Florida, but Florida is where we focused on all and what made the most strategic rationale. They have we believe they have really good relationships in the state of Florida today from a payer standpoint.

是的。所以我把營收基礎看作大約三分之二在佛羅里達、三分之一在其他地方。當然，佛羅里達是我們聚焦的州。他們在佛羅里達以外的其他州也有相當規模的業務，但佛羅里達是我們投入重點、也是最具策略合理性的所在。從付款方角度來看，我們認為他們目前在佛羅里達州擁有非常良好的關係。

We have very good relationships as well. I think the feedback we've gotten early from the payers is very supportive and congratulatory on the standpoint of providing more cost-effective patient preferred win-win-type scenarios. But at the end of the day, these are two great companies, both providing great care. So it's not like Aveanna is superior in its service. Family First has a really, really nice job providing care in their seven states.

我們也有非常好的關係。我們早期從付款方得到的回饋非常支持，也對於能提供更具成本效益、以病患偏好為導向的雙贏情境表示祝賀。但歸根結底，這是兩家很棒的公司，雙方都提供很好的照護。所以並不是說 Aveanna 的服務更優。Family First 在其七個州提供照護的表現真的非常、非常好。

So again, we think this is good for patients. We think this is good for employees. This is good for payers. And it'll take us a little bit time as we saw with Thrive. It takes us about a half a year or so to kind of get through the integration-related efforts, systems, back office benefits to then really get to the expansion back to the expansion of care, and we think Family First be similar close, hopefully, close some point in mid-to-late Q2.

所以再次強調，我們認為這對病患有利。我們認為這對員工有利。這對付款方也有利。而且這需要一些時間，就像我們在 Thrive 看到的一樣。我們大約需要半年左右來完成整合相關工作、系統與後台效益，之後才能真正回到擴大照護的擴張上；我們認為 Family First 也會類似，希望能在第二季中後段的某個時間完成交割（close）。

And by the end of the year, we're wrapping up Family First. And I think I just want to head on again. We are committed to growing our home health and hospice business through accretive M&A. So I think you'll see us get back to the home health focused, both de novo and tuck-in M&A.

到年底，我們會把 Family First 的整合收尾。我想再重申一次。我們致力於透過具增益性（accretive）的併購來成長我們的居家健康與安寧業務。所以我認為你們會看到我們回到以居家健康為重點的策略，包括新設（de novo）與補強式（tuck-in）併購。

Sean Dodge, BMO Capital Markets.

Sean Dodge，BMO Capital Markets。

Great. It's Chris Charlton on for Sean. You've mentioned greater adoption of value-based add-ons from some of your earlier preferred partners, particularly in private duty. Can you walk us through what a typical timeline looks like from when a preferred payer is initially signed to when value-based arrangements might start contributing to revenue? And then how much visibility you have into the incremental growth on the value-based side in 2026?

很好。我是代替 Sean 的 Chris Charlton。你提到你們一些較早期的優先合作夥伴對以價值為基礎（value-based）的附加方案採用度提高，特別是在私人照護（private duty）方面。你能帶我們了解一下，從一開始簽下優先付款方到以價值為基礎的安排開始對營收產生貢獻，典型的時間軸大概是什麼樣子嗎？另外，你們對2026年以價值為基礎這一端的增量成長有多少能見度？

Great question, Chris. So I think as we ended the year with 30 preferred payers and just over 10 value-based agreements, right? So about a third of our preferred payers in PDS had a value-based agreement attached to it and think of that being over the course of three years, right? We're now starting year four. So there's definitely a lag, and we think of the lag anywhere between half a year to about 18 months, about 6 months from the time we sign a preferred payer which just means enhanced rates and enhanced wages for the caregiver, it's between half a year and about 18 months later that we expect to then add a value-based agreement.

很好的問題，Chris。所以我想，年底時我們有30個優先付款方，以及略高於10個以價值為基礎的協議，對吧？也就是說，在 PDS 的優先付款方中，大約三分之一附帶以價值為基礎的協議，而這是三年期間逐步形成的，對吧？我們現在開始進入第四年。所以確實存在時間落差，我們認為落差大約介於半年到18個月：從我們簽下優先付款方（這僅代表更高的費率以及對照護人員更高的薪資）起算，大約半年到18個月後，我們預期才會再加入以價值為基礎的協議。

We certainly want the value agreement from day one, but it takes time to work through that with the said payer. So as you think of 30 going to 38 this year, we'll guide to the value-based agreements. But I would think of somewhere from 10 going to 14 or 15 this year. And again, our payer team does a great job of continuing to remind the payer, the more we're aligned on outcomes and cost savings, the better we can do as a payer partner. So I'll also point out, remember, Q2 is the quarter where we do our annual true-ups from the previous year, and we called that out in prior years as well.

我們當然希望從第一天就有價值型協議，但與該付款方推進需要時間。所以當你們看今年從30增加到38時，我們會對價值型協議給出指引。但我會把它想成大概從10增加到14或15。同樣地，我們的付款方團隊做得非常好，持續提醒付款方：我們在結果與成本節省上越一致，作為付款方合作夥伴我們就能做得越好。我也要補充一點，記得第二季是我們針對前一年做年度結算調整（true-ups）的季度，我們在過去幾年也都有提到這點。

But I think of that nature of -- we ended the year just over 10%, and we'll probably end this year somewhere in the 14% to 15% range.

但我會把那個性質——我們去年年底略高於10%，而今年年底可能會落在14%到15%之間。

Okay. That's helpful. And then maybe going back to talking about entering new states and private duty as well. You've been successful in driving great increases across nearly all your states. How has the rates been progressing in other states where you're not currently operating?

好的。這很有幫助。然後也許回到你們談到進入新州以及私人照護的話題。你們在幾乎所有營運州都成功推動了很好的費率上調。在你們目前尚未營運的其他州，費率進展如何？

And how does this maybe impact your approach when you're considering entering new markets over the coming years and 2026?

而這可能會如何影響你們在未來幾年、以及2026年考慮進入新市場時的做法？

Yes. And it's -- let me start with it's not always right, right? So we look at a market and look at size and scale of the Medicaid population, number of PDM patients, pediatric population in that state. So when I say Ohio, there's a difference between Ohio and Wyoming, right? And Wyoming, I'm just picking this randomly may have a higher PDN rate but may only have 75 PDN patients in the entire state where Ohio has 2000.

是的。而且——我先說，這不一定總是對的，對吧？所以我們會看一個市場，評估 Medicaid 人口的規模與量體、PDM 病患數、以及該州的兒科人口。所以當我說俄亥俄州時，俄亥俄州和懷俄明州是有差別的，對吧？而懷俄明州——我只是隨機舉例——可能有較高的 PDN 費率，但全州可能只有75位 PDN 病患；而俄亥俄州則有2000位。

So again, there's other factors where we're looking at then just rate we feel confident that as we enter a state or grow in a state, we can work through both our government affairs team, working directly with the governor and the legislate websites as well as our preferred payers and our MCO partners to appropriately address wage and rate. And again, it's not just rate for the sake of rate. It's right for the sake of the right wage rate for the caregivers to attract caregivers into the home. So again, we think over time in any state, including I think Ben, who brought up California. Eventually, we're going to get California flip.

所以再說一次，除了費率之外，我們還會看其他因素；我們有信心，當我們進入某個州或在某個州擴張時，我們可以透過政府事務團隊——直接與州長及立法機關網站合作——以及我們的優先付款方與MCO合作夥伴，適當地處理薪資與費率問題。而且再強調一次，這不只是為了調高費率而調高費率。而是為了讓照護人員有正確的薪資水準，才能吸引照護人員進入居家服務。因此，我們認為隨著時間推進，在任何州都是如此；包括我想是Ben提到的加州。最終，我們會把加州也「翻轉」過來。

I mean, that's the one state say today, we've not been able get flipped to appropriate wage rate and appropriate reimbursement rate. But eventually, we'll get California. So we think every state, if you look at it over a macro period of 5 or 10 years, every state, any and every payer over time, we think we can get to move to appropriate reimbursement rate, which means an appropriate wage rate.

我的意思是，就目前來看，那是唯一一個我們還沒能翻轉到合適薪資水準與合適給付費率的州。但最終，我們會拿下加州。所以我們認為，若以5到10年的宏觀期間來看，每一個州、任何付款方，隨著時間推移，我們都能推動其走向合適的給付費率，而這也意味著合適的薪資水準。

Jared Haase, William Blair.

Jared Haase，William Blair。

Maybe I want to drill back into the 2026 outlook and specifically thinking about the volume growth opportunity for private duty. So I think we saw you benefit a little bit from sort of the elevated growth on an organic basis throughout 2025, just given all the rate and preferred payer activity that you were able to achieve last year.

我想再深入回到2026年的展望，特別是思考私人看護（private duty）的量成長機會。所以我認為，我們看到你們在2025年整體有機成長率偏高，多少受惠於你們去年達成的各項費率調整與優先付款方（preferred payer）相關的推進。

Now as we think about you getting more and more caught up on wages, I'm wondering, I guess, if there's any way to sort of contextualize how you're thinking about the runway for volume growth and opportunities to potentially sustain elevated levels of growth over the next handful of quarters.

現在當我們思考你們在薪資方面愈來愈追上進度時，我想問的是，是否有任何方式可以幫助我們理解你們如何看待量成長的跑道（runway），以及未來幾個季度是否有機會維持較高的成長水準？

Yes, Jared. We're really excited about the momentum heading into 2026 and really expect a more normalized growth rate as we enter 2026 as well. To your point, we've had those elevated rates that have been able to drive our volume forward. But we anticipate kind of that organic in that 5% to 7% range as we've guided to additional M&A add-ons like Family First incorporate or adding on top of that as well. EBITDA growing in that high single digits after you adjust out that $20 million of normalization that we backed everybody into in January.

是的，Jared。我們對邁入2026年的動能感到非常興奮，也確實預期在進入2026年時，成長率會回到較為正常化的水準。如你所說，我們先前有那些較高的費率，得以推動量向前成長。但我們預期有機成長大致落在我們指引的5%到7%區間，同時也會有額外的併購（M&A）加掛案（add-ons），例如Family First併入，或在此之上再加上其他案子。在把我們1月提到、已將大家納入的2,000萬美元正常化調整剔除後，EBITDA將以高個位數成長。

But overall, great momentum in 2025 and continue that momentum into 2026, though more -- on a more normalized basis.

但整體而言，2025年的動能很強，並會延續到2026年，只是——會是在更正常化的基礎上。

And I think, Jared, as we called out, we just don't expect to get the 30%, 40%, 50% PDS Medicaid rate increases, we're really thinking these are more in the 2% to 4% of the 3% to 5% range. And I think we've talked before, we've been in the teens state rate wins, we think this year is probably 6%, 7%, 8%, maybe 9%. If we hit 10 this year, we'd be very pleased on a net basis. So with all that baked in, I think Matt's point of PDS getting back to mid-single-digit volume and rate year over year is probably where we think the back half of this year lands. And that's what we guide to long term in our investment thesis.

而且我想，Jared，正如我們提到的，我們不預期還會再出現PDS Medicaid費率上調30%、40%、50%這種幅度；我們認為更可能是在2%到4%或3%到5%這樣的區間。我想我們之前也談過，我們過去在州層級的費率勝利（state rate wins）曾經在十幾個州；我們認為今年大概是6%、7%、8%，也許9%。如果今年淨額能達到10%，我們會非常滿意。把這些都納入後，我認為Matt提到的——PDS回到年對年中個位數的量與費率成長——大概就是我們認為今年下半年會落在的位置。而這也是我們投資論點中長期所給的指引。

And then, Jeff, I think you mentioned in the prepared remarks some of the -- or one of the core initiatives you're focusing on here is just some of the high priority AI and automation efforts. So would love to hear a little bit more about just where you're seeing some of the biggest opportunities leveraging those tools. And then I guess maybe the fine point I'd put on it is how quickly might we you start to see those initiatives ramping in terms of impacting either the cost structure or margin profile?

另外，Jeff，我想你在事先準備的講稿中提到，你們正在聚焦的一些——或其中一項核心倡議——是高優先順序的AI與自動化工作。很想多聽一些你們認為運用這些工具最大的機會在哪裡。以及我想更精準地問：我們大概多快能看到這些倡議開始放量，並對成本結構或利潤率輪廓產生影響？

Yes. I think we certainly started in the back office. So we're a couple of years into RCM automation with our RCM partners and want to continue to accelerate that. And I think part of the cash collections and the onetime and timing-related revenue enhancements last year where were related to just great collections and part of that was tied to some of our AI partnerships that helped us collect our cash and more effectively and efficiently. So I think, think of that being the long pole in the tent, meaning what we've started with and are continuing to drive and Matt and Debbie and James, who leads our CM just does a fantastic job with that.

是的。我想我們確實是先從後台開始。所以我們與RCM合作夥伴在RCM自動化上已經推進了兩年多，並希望持續加速。而且我認為，去年現金回收以及一次性與時點相關的營收提升，其中一部分來自於非常好的收款表現，而其中一部分也與我們的一些AI合作夥伴有關，幫助我們更有效率、更有效能地收回現金。所以我認為，把這視為帳篷裡最長的支柱——也就是我們已經開始、並持續推動的重點；而Matt、Debbie以及負責我們CM的James在這方面做得非常出色。

We're also pivoting now to the front office. And so we're in the piloting stages of thinking of caregiver engagement also in shift fulfillment and really how we schedule and think of engaging with our caregiver and using -- sorry, automation and AI related opportunities there. So -- and there's more. There's more on the AMS business. There's nuances we use for fax automation and some of the back office stuff that just makes the back office more efficient.

我們現在也正轉向前台。因此我們正處於試點階段，思考照護人員互動（caregiver engagement）、排班填補（shift fulfillment），以及我們如何排班、如何與照護人員互動，並運用——抱歉——自動化與AI在這方面的機會。所以——而且還不只如此。AMS業務也還有更多。我們也有一些細節做法，例如傳真自動化，以及一些讓後台更有效率的後台工作。

So I'd think of us being back office focused for the last, I'll call it, two years-plus. That will continue. And then at the end of '25, '26, we kind of pivoted to more field-facing, front office facing tied to our -- how we think of scheduling engagement of our caregivers.

所以我會把我們過去——我稱之為——兩年多的時間，視為以後台為主。這會持續下去。然後在2025年底、2026年，我們會更轉向面向現場、面向前台的工作，聚焦在——我們如何看待排班與照護人員互動。

John Ransom, Raymond James.

John Ransom，Raymond James。

So we think about the core EBIT growth this year being just below 70% on a consolidated basis, [300 more than 320-ish]. How does that look by segment? What are the highest growth segments versus the lowest growth segments of you three as we think about modeling in the future.

所以我們在想，今年核心EBIT成長在合併基礎上略低於70%，[300多到約320左右]。按事業部門來看會是什麼樣子？在你們三個部門中，哪些是最高成長、哪些是最低成長？我們在做未來模型時想了解。

Yes. So historically, Medical Solutions and home health and hospice has been our highest organic growth sections of it, John. So we've got medical solutions going through its modernization efforts at this time. And so we talked about still in that low single digits growth in the front half of 2026 by returning to that high single -- or high single digits to double-digit growth in the back half of 2026. And so there's a little bit of mutedness in that happening in H1 compared to H2.

是的。John，歷史上，Medical Solutions以及居家健康與安寧（home health and hospice）一直是我們有機成長最高的板塊。Medical Solutions目前正在進行現代化（modernization）工作。因此我們談到，2026年上半年仍會維持在低個位數成長，並在2026年下半年回到高個位數——或高個位數到雙位數的成長。所以相較於下半年，上半年會稍微被壓抑一些。

I'll tell you, home health and hospice hitting out of the gate strong just as they finish the year strong. So that will continue to be high single digits to double digits growth. But we think PDS returned back into more normalization 3.5%, 4% volume growth, adding 1 point to 1.5 points of rate growth in there, getting back to your 5% to 7% kind of range itself or 3% to 5% and on the upper end of that one. That's how we kind of have it modeled out and how we're thinking about it into '26 and beyond.

我可以告訴你，居家健康與安寧一開始就表現強勁，就像它們在年底收官時一樣強。所以那將持續維持在高個位數到雙位數成長。但我們認為PDS會回到較正常化的3.5%、4%的量成長，再加上1個百分點到1.5個百分點的費率成長，回到你所說的5%到7%那樣的區間，或3%到5%並落在其上緣。這就是我們大致的建模方式，以及我們對2026年及之後的看法。

And John, just being cost effective the fish in the back office -- corporate office. I mean I think we're down to 4.5%, corporate costs as a percentage of revenue. We think we can make that get even a little better there. So -- and then you were about to bring this up, so I want to highlight generating a meaningful amount of cash flow. So I appreciate you highlighting that great point that $131 million of free cash flow last year was well, well beyond our expectations.

還有，John，就成本效益而言，後台——公司辦公室的部分。我的意思是，我們的公司成本占營收比重，我想已降到 4.5%。我們認為那裡還能再稍微改善一些。所以——而且你正要提到這點，所以我想強調的是，我們正在產生相當可觀的現金流。所以我很感謝你點出這個重點：去年 1.31 億美元的自由現金流遠遠、遠遠超出我們的預期。

And really kudos to Matt and Debbie and the team for executing on that. generating that kind of cash moving forward just gives us optionality to continue to do deals like Family First and to use cash. So we're excited about the opportunity to do that. And thanks for asking.

也真的要稱讚 Matt、Debbie 以及團隊在這方面的執行力。未來持續產生這種規模的現金，讓我們在選擇上更有彈性，可以繼續做像 Family First 這樣的交易並使用現金。所以我們對這個機會感到很興奮。也謝謝你的提問。

You're welcome. The other question is just the PDS rate outlook. I mean, you're adding eight preferred payers, but you're only calling for 1.5%, 1%, 2% rate. Is that conservative? Or are we missing something?

不客氣。另一個問題是關於 PDS 費率的展望。我的意思是，你們新增了八個優先付款方，但你們只預期 1.5%、1%、2% 的費率。這是保守的嗎？還是我們漏掉了什麼？

I just think it shows how far along the spectrum we are in the strategy, meaning when we first started, we were getting 10% of volume or 15% of volume. Some of these now we're tucking in are smaller in nature. -- they're still niche oriented. They're really important, even a 1% volume mover if we can move into a preferred payer matters. But think of us being just further along the maturity spectrum in the preferred payers, which is why we love the idea of additional states because it opens up new markets for us.

我覺得這只是顯示我們在策略光譜上已經走到多後面了；也就是說，當我們一開始做的時候，我們拿到的是 10% 的量或 15% 的量。現在我們納入的一些案子規模比較小——但它們仍然是利基導向的。它們非常重要；即使只要能把 1% 的量移到優先付款方，也很有意義。但你可以把我們想成是在優先付款方的成熟度光譜上走得更後面了，這也是為什麼我們喜歡新增州別的想法，因為那會為我們打開新市場。

So as we think of Thrive, the New Mexico and the Kansas was so important because it opened up to brand new MCO markets for us. So -- but no, I think just as we think about the preferred payers going from 30% to 38%, we're just continuing to round out some of those final tweaks in our current markets and really focused on new expansion.

所以當我們想到 Thrive 時，新墨西哥州和堪薩斯州非常重要，因為它為我們打開了全新的 MCO 市場。所以——但不，我認為當我們看優先付款方從 30% 提升到 38% 時，我們只是持續把現有市場中一些最後的微調補齊，並且真正把重心放在新的擴張上。

Last one for me. I know we're a little over time. If we think about the -- clearly, there's synergy between the Nutrition segment and the pediatric segment. But if I think about home care hospice and personal care, I think the market is kind of mixed. -- there's really that much synergy between the three businesses.

我最後一個問題。我知道我們有點超時了。如果我們來看——很明顯，營養（Nutrition）事業與小兒（pediatric）事業之間有協同效應。但如果我想到居家照護、安寧療護（hospice）和個人照護（personal care），我覺得市場看法有點分歧——這三個業務之間真的有那麼多協同效應嗎？

And so does it help you with payer? Does it help you with nurse recruiting? What is the synergy? And I guess where I'm going with hospice multiples, M&A multiples being in the peak, if somebody came to you with a 15x multiple offer for your hospices, is that something you would consider? Or do you really think you want to knit all these pieces together definitely?

那麼它是否能在付款方（payer）方面幫到你？是否能在護理人員招募方面幫到你？協同效應是什麼？我想我想問的是，考量到安寧療護的倍數、併購倍數正處於高峰，如果有人用 15 倍的倍數來出價收購你們的安寧療護業務，這是你們會考慮的嗎？還是你們真的認為一定要把這些拼圖全部整合在一起？

Yes. First of all, it's a very thoughtful question. I'll say this. Yes, obviously, the intra nutrition business is incredibly synergistic to the PDM business. They do -- they operate as a referral entity incredibly well together.

是的。首先，這是一個非常有深度的問題。我會這麼說。是的，很明顯，內部的營養業務與 PDM 業務具有極高的協同效應。它們——它們作為轉介（referral）體系彼此配合得非常好。

We have a lot of crossover in the referral source, the payer conversations between those two businesses. The opposite is true between our PDS and our HHH business. There's very little synergies from a referral source standpoint. Even a payer standpoint, a very different conversation, as you know, I think why we love being in both businesses, one, the diversification. As we see right now, the last three years, Medicaid has been the darling right now, it's being back to Medicare being more the darling.

在這兩個業務之間，我們在轉介來源以及與付款方的溝通上有很多交集。但在我們的 PDS 與 HHH 業務之間則相反。從轉介來源的角度來看，協同效應非常少。即使從付款方角度來看，對話也非常不同；如你所知，我想這也是為什麼我們喜歡同時在這兩個業務裡：第一是多元化。就像我們現在看到的，過去三年 Medicaid 一直是市場寵兒，而現在又回到 Medicare 更像是寵兒。

We like the idea of being larger in both of these businesses, and we'd like to be larger in the HHH business over time. But no, I think we think of it as growth rates that these businesses, like home health and hospice can grow in double-digit year-over-year organic growth. We like that from a growth algorithm. So we're committed to all three segments, excited about all three segments and again, I just want to get back to block and tackling this year and being really good at executing our business plan.

我們喜歡在這兩個業務都做得更大，而且隨著時間推進，我們也希望在 HHH 業務上做得更大。但不，我認為我們看重的是這些業務的成長率——像居家健康與安寧療護，年對年有機成長可以達到雙位數。從成長算法（growth algorithm）的角度來看，我們喜歡這一點。所以我們致力於三個事業部，對三個事業部都感到興奮；而且再次強調，我想回到今年的基本功與執行面，把我們的營運計畫執行得非常到位。

We have reached the end of the question-and-answer session. I'd now like to turn the call back over to Jeff Shaner for closing comments.

問答環節到此結束。現在我想把電話交回給 Jeff Shaner 作結語。

Thank you, operator. And just thank you for your attention and look forward to catching up in mid-May on our Q1 and 2026 results. Thank you, and have a wonderful day.

謝謝你，接線員。也謝謝各位的關注，期待在 5 月中旬就我們的第一季與 2026 年業績結果再與各位交流。謝謝，祝各位有美好的一天。

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

今天的電話會議到此結束。您現在可以掛斷電話線，感謝您的參與。