Cano Health Inc (CANO) 2022 Q4 法說會逐字稿

Good afternoon, and welcome to Cano Health Fourth Quarter 2022 Earnings Call. (Operator Instructions) Please be advised that today's conference is being recorded. Hosting today's call are Dr. Marlow Hernandez, Chairman and Chief Executive Officer; and Brian Koppy, Chief Financial Officer. The Cano Health press release, webcast link and other related materials are available on the Investor Relations section of Cano Health's website.

下午好，歡迎來到 Cano Health 2022 年第四季度財報電話會議。 （操作員說明）請注意，今天的會議正在錄製中。主持今天的電話會議的是董事長兼首席執行官 Marlow Hernandez 博士；首席財務官 Brian Koppy。 Cano Health 新聞稿、網絡廣播鏈接和其他相關材料可在 Cano Health 網站的投資者關係部分獲取。

As a reminder, this call contains forward-looking statements regarding future events and financial performance, including our guidance for the 2023 fiscal year. Investors are cautioned not to unduly rely on forward-looking statements, and such statements should not be read or understood as a guarantee of future performance or results. We intend these forward-looking statements to be covered by the safe harbor provisions for forward-looking statements contained in Section 27A of the Securities Act and Section 21E of the Securities Exchange Act.

提醒一下，本次電話會議包含有關未來事件和財務業績的前瞻性陳述，包括我們對 2023 財年的指導意見。告誡投資者不要過分依賴前瞻性陳述，此類陳述不應被閱讀或理解為對未來業績或結果的保證。我們打算將這些前瞻性陳述納入《證券法》第 27A 條和《證券交易法》第 21E 條所載前瞻性陳述的安全港條款中。

We caution you that the forward-looking statements reflect our best judgment as of today based on factors that are currently known to us, and such statements are subject to risks, uncertainties and assumptions that could cause actual future events or results to differ materially from those discussed as a result of various factors, including, but not limited to, risks and uncertainties discussed in our SEC filings. We do not undertake or intend to update any forward-looking statements after this call or as a result of new information, except as may be required by law.

我們提醒您，前瞻性陳述反映了我們根據我們目前已知的因素截至今天的最佳判斷，此類陳述受風險、不確定性和假設的影響，可能導致實際的未來事件或結果與這些陳述大不相同由於各種因素而被討論，包括但不限於我們在 SEC 文件中討論的風險和不確定性。除非法律要求，否則我們不承諾或打算在本次電話會議後或由於新信息而更新任何前瞻性陳述。

During the call, we will also discuss non-GAAP financial measures. The non-GAAP financial measures we will discuss today are not prepared in accordance with GAAP. A reconciliation of the GAAP and non-GAAP results is provided in today's press release and on the Investor Relations section of our website.

在電話會議期間，我們還將討論非 GAAP 財務措施。我們今天要討論的非 GAAP 財務措施不是根據 GAAP 編制的。今天的新聞稿和我們網站的投資者關係部分提供了 GAAP 和非 GAAP 結果的對賬。

With that, I'll turn the call over to Dr. Marlow Hernandez, Chairman and Chief Executive Officer of Cano Health. Please go ahead, sir.

有了這個，我將把電話轉給 Cano Health 董事長兼首席執行官 Marlow Hernandez 博士。請繼續，先生。

Thank you, and welcome to the call. We appreciate you joining us today. 2022 was an important growth year for Cano Health. Our total membership reached nearly 310,000 members, growing 36% from the prior year. We achieved full year revenue of over $2.7 billion and adjusted EBITDA of approximately $153 million, all while growing in new markets and service lines and most importantly, providing our patients with excellent clinical care that measurably improve their outcomes.

謝謝，歡迎來電。感謝您今天加入我們。 2022年是卡諾健康重要的增長年。我們的會員總數達到近 310,000 名，比上一年增長 36%。我們實現了超過 27 億美元的全年收入和約 1.53 億美元的調整後 EBITDA，同時在新市場和服務領域實現增長，最重要的是，為我們的患者提供卓越的臨床護理，顯著改善他們的結果。

We continued on our journey to be one of the nation's leading primary care providers. During 2022, we opened 24 de novo medical centers and added another 18 centers on a net basis through acquisitions in existing markets. We ended the year with 172 medical centers in Florida, Texas, Nevada, Illinois, New Mexico, California and Puerto Rico. Our Medicare membership grew to just under 180,000 members, a 42% year-over-year increase.

我們繼續努力成為全國領先的初級保健提供者之一。 2022 年期間，我們開設了 24 家新醫療中心，並通過在現有市場的收購淨增了 18 家中心。年底，我們在佛羅里達州、德克薩斯州、內華達州、伊利諾伊州、新墨西哥州、加利福尼亞州和波多黎各擁有 172 個醫療中心。我們的 Medicare 會員人數增長到近 180,000 人，同比增長 42%。

At the same time, Cano Health maintained its clinical excellence and high service standards, which continue to improve patient outcomes. Our full year medical cost ratio, or MCR, was 79.1%. Excluding the Medicare direct contracting program now called ACO REACH, our full year MCR was 75.1%, a significant improvement from 79.7% in the prior year.

與此同時，Cano Health 保持其卓越的臨床表現和高服務標準，繼續改善患者的治療效果。我們的全年醫療成本比率 (MCR) 為 79.1%。不包括現在稱為 ACO REACH 的 Medicare 直接承包計劃，我們全年的 MCR 為 75.1%，比上一年的 79.7% 有顯著改善。

Our admissions per thousand members, or APTs, were approximately 7% lower in 2022 compared to 2021. Our ability to keep patients healthy and out of the hospital is an important component of our model of care, which emphasizes frequent primary care visits and member engagement. When you combine our clinical outcomes with the growth in membership, we generated considerable value for our payer partners and all stakeholders.

與 2021 年相比，2022 年我們的每千名會員入院率 (APT) 下降了約 7%。我們讓患者保持健康和出院的能力是我們護理模式的重要組成部分，該模式強調頻繁的初級保健就診和會員參與.當您將我們的臨床成果與會員的增長結合起來時，我們為付款合作夥伴和所有利益相關者創造了可觀的價值。

We have great momentum in our business. However, 2022 was not without its challenges. The organization's rapid growth pressure revenue on a per member basis, particularly in our Medicare Advantage business. Factors negatively impacting Medicare Advantage revenue in 2022 included new members with lower-than-expected first year revenue per member per month, or PMPM, growth in geographies with lower revenue PMPM and a higher percentage of nonrisk members with a lower PMPM.

我們的業務發展勢頭強勁。然而，2022 年並非沒有挑戰。該組織在每個成員基礎上的快速增長壓力收入，特別是在我們的 Medicare Advantage 業務中。對 2022 年 Medicare Advantage 收入產生負面影響的因素包括第一年每位會員每月收入或 PMPM 低於預期的新會員、收入 PMPM 較低的地區的增長以及 PMPM 較低的非風險會員比例較高。

Importantly, our medical center member disenrollment rates were comparable to prior years. Consequently, lower-than-expected Medicare Advantage revenue negatively impacted our operating performance and our cash flow. And as a result, liquidity was not at the level needed to fund the growth we had planned for 2023, and we took decisive actions at the end of '22 and into '23, that have and will continue to improve cash flow and liquidity. We made the decision to dial back the addition of de novo medical centers in 2023, which is expected to reduce cash used or capital expenditures by approximately $35 million. The 13 de novos we plan to add this year are medical centers that are generally completed at the end of 2022 and require limited capital investment in 2023. We are also merging 8 smaller medical centers into nearby larger existing centers to improve center-level economics for an expected total of 177 medical centers at the end of 2023 compared to 172 at the end of 2022.

重要的是，我們的醫療中心成員退出率與往年相當。因此，低於預期的 Medicare Advantage 收入對我們的經營業績和現金流產生了負面影響。結果，流動性沒有達到為我們計劃的 2023 年增長提供資金所需的水平，我們在 22 年底和 23 年採取了果斷行動，這些行動已經並將繼續改善現金流和流動性。我們決定在 2023 年取消增加新醫療中心，預計這將減少約 3500 萬美元的現金使用或資本支出。我們計劃今年新增的 13 個醫療中心一般在 2022 年底完工，2023 年需要有限的資本投資。我們還將 8 個較小的醫療中心合併到附近較大的現有中心，以提高中心級經濟性預計到 2023 年底共有 177 個醫療中心，而 2022 年底為 172 個。

In addition, we reduced our head count, aligning to our revised growth plans, implemented tighter spending controls and negotiate better contracts with our vendors. These actions are projected to generate approximately $70 million in annual SG&A cost reductions for 2023. We also terminated underperforming affiliate positions and renegotiated payer agreements to improve our medical cost ratio, resulting in an expected benefit of approximately $20 million. Collectively, these initiatives put us on a path to meaningfully improve cash from operations as we move through this year and into 2024. That said, we will continue to evolve our organization to create sustainable growth for our patients, employees and shareholders.

此外，我們減少了員工人數，以配合我們修訂後的增長計劃，實施更嚴格的支出控制，並與我們的供應商談判更好的合同。這些行動預計將在 2023 年產生約 7000 萬美元的年度 SG&A 成本削減。我們還終止了表現不佳的附屬職位並重新談判付款人協議以提高我們的醫療成本比率，從而產生約 2000 萬美元的預期收益。總的來說，這些舉措使我們走上了從今年到 2024 年有意義地改善運營現金的道路。也就是說，我們將繼續發展我們的組織，為我們的患者、員工和股東創造可持續增長。

At Cano Health, our purpose is to help our patients live their best lives. We are inspired and fulfilled through this pursuit, which we define as our mission quality of care and lifelong bonds. Simply put, our goal to provide superior care and deliver better health outcomes for our patients is achieved when we optimize our financial performance to fulfill our mission in ever greater ways. In 2023, our financial objectives are to: one, capitalize the business; two, unlock embedded profitability by increasing capacity utilization at existing medical centers; and three, optimize our value-based platform to further improve the balance sheet and cash from operations.

在 Cano Health，我們的目標是幫助我們的患者過上最美好的生活。通過這種追求，我們受到鼓舞和滿足，我們將其定義為我們的使命護理質量和終生紐帶。簡而言之，當我們優化我們的財務業績以更好地履行我們的使命時，我們的目標就是為我們的患者提供優質護理和更好的健康結果。 2023 年，我們的財務目標是：一，業務資本化；第二，通過提高現有醫療中心的產能利用率來釋放內在的盈利能力；第三，優化我們基於價值的平台，以進一步改善資產負債表和運營現金。

We made a significant step toward our first objective by closing our recently announced $150 million term loan with Diameter Capital Partners and Rubicon Founders. This financing provides liquidity to strengthen and grow our operations. As we discussed in the past, scale and density are critically important to our operational success. In 2022, we built significant scale in density, particularly in our home state of Florida, where we have a leading position in value-based care. We have the ability to roughly double our membership at our existing medical centers without incurring significant additional expenses. And thus, by filling this available capacity, we expect to unlock significant profitability.

通過關閉我們最近宣布的與 Diameter Capital Partners 和 Rubicon Founders 的 1.5 億美元定期貸款，我們朝著第一個目標邁出了重要一步。這種融資提供了流動性來加強和發展我們的業務。正如我們過去所討論的，規模和密度對於我們的運營成功至關重要。 2022 年，我們建立了顯著的密度規模，特別是在我們的家鄉佛羅里達州，我們在基於價值的護理方面處於領先地位。我們有能力將現有醫療中心的會員人數增加一倍左右，而不會產生大量額外費用。因此，通過填補這一可用產能，我們期望釋放可觀的盈利能力。

Moreover, we are committed to reviewing all aspects of our platform to further improve cash flow and liquidity. This is part of our focus on capital management by better-allocating resources. Our scorecard for success this year will be a simplified and more efficient operating model with improved cash from operations and a stronger balance sheet. As we continue to execute on these objectives, we expect our results to better reflect the strong fundamentals of our value-based platform.

此外，我們致力於審查我們平台的各個方面，以進一步改善現金流和流動性。這是我們通過更好地分配資源來關注資本管理的一部分。我們今年的成功記分卡將是一個簡化和更高效的運營模式，以及來自運營的現金和更強大的資產負債表。隨著我們繼續執行這些目標，我們希望我們的結果能夠更好地反映我們基於價值的平台的強大基礎。

Lastly, I want to take this opportunity to thank our associates for their commitment to our mission and vision. It is during challenging times when the character of the team has revealed and our team rose to the occasion. In addition to measurably improving the quality of care, our team's cultural ability to find solutions in difficult situations differentiated us in 2022 and defines us as a company.

最後，我想藉此機會感謝我們的員工對我們使命和願景的承諾。在充滿挑戰的時期，團隊的性格得以展現，我們的團隊迎難而上。除了顯著提高護理質量外，我們團隊在困難情況下尋找解決方案的文化能力使我們在 2022 年脫穎而出，並將我們定義為一家公司。

With that, I'll turn the call over to Brian Koppy, our CFO, who will walk you through our 2022 financial results and guidance for 2023.

有了這個，我將把電話轉給我們的首席財務官 Brian Koppy，他將向您介紹我們 2022 年的財務業績和 2023 年的指導。

Thank you, Marlow, and thanks, everyone, for joining us today. Before I get started today, I'd like to let you know that we will file an extension for our 2022 10-K. We expect our 10-K to be filed on or about March 10. Given our team's efforts to reach an agreement on a new term loan and closed that transaction, we required more time to finalize the related information in the Form 10-K. As a result, all financial information presented today is subject to completion of the audit of the company's financial statements and filing of the 10-K.

謝謝 Marlow，也謝謝大家今天加入我們。在我今天開始之前，我想告訴您我們將為 2022 年 10-K 申請延期。我們預計我們的 10-K 將在 3 月 10 日左右提交。鑑於我們的團隊努力就新的定期貸款達成協議並完成該交易，我們需要更多時間來完成 10-K 表格中的相關信息。因此，今天提供的所有財務信息均以公司財務報表審計完成和 10-K 提交為準。

Total membership increased 36% year-over-year to approximately 310,000 members in the fourth quarter. This represents an increase of approximately 83,000 members from the fourth quarter of 2021. At the end of 2022, 45% of our members were Medicare Advantage, 13% were Medicare DCE, 25% were Medicaid and 17% were ACA. I would also like to highlight that in December of 2022, we completed an acquisition that included 9 medical centers and an MSO business in Florida for initial consideration of approximately $31 million in equity and $1 million in cash with future cash earn-out payments based on achieving certain measures. This acquisition added approximately 7,400 Medicare Advantage members.

第四季度會員總數同比增長 36%，達到約 310,000 名會員。這意味著比 2021 年第四季度增加了約 83,000 名會員。到 2022 年底，我們的會員中有 45% 是 Medicare Advantage，13% 是 Medicare DCE，25% 是 Medicaid，17% 是 ACA。我還想強調的是，在 2022 年 12 月，我們完成了一項收購，其中包括佛羅里達州的 9 個醫療中心和一個 MSO 業務，初步對價約為 3100 萬美元的股權和 100 萬美元的現金，未來的現金收益支付基於實現某些措施。此次收購增加了大約 7,400 名 Medicare Advantage 成員。

Total revenue for the quarter was approximately $680 million, up from approximately $492 million a year ago and $665 million in the third quarter. Total capitated revenue in the quarter was approximately $651 million, in line with our expectations. In the quarter, Medicare Advantage PMPM was $1,084, down 4% sequentially due to the increased mix of new membership. Fourth quarter Medicare DCE PMPM was $1,374, up 13% sequentially based on the latest Medicare DCE benchmark data. Additional information about our membership mix and our PMPM is available in our press release and updated financial supplement posted this evening on our website.

本季度總收入約為 6.8 億美元，高於一年前的約 4.92 億美元和第三季度的 6.65 億美元。本季度總收入約為 6.51 億美元，符合我們的預期。本季度，由於新會員組合的增加，Medicare Advantage PMPM 為 1,084 美元，環比下降 4%。根據最新的 Medicare DCE 基準數據，第四季度 Medicare DCE PMPM 為 1,374 美元，環比增長 13%。有關我們的會員組合和 PMPM 的更多信息，請參閱我們的新聞稿和今晚在我們網站上發布的最新財務補充資料。

Our medical cost ratio, or MCR, in the fourth quarter was 76.1% compared to 78.1% in the fourth quarter of 2021, while the full year 2022 MCR was 79.1% compared to 80.5% in 2021. The year-over-year improvements in the quarter and full year were driven primarily by lower MCRs in our non-DCE service lines. As we have said on prior calls, Medicare DCE has a higher MCR than our capitated revenue. So the increasing mix of Medicare DCE members increases our total MCR. Excluding Medicare DCE, our MCR was approximately 71.7% in the fourth quarter of 2022 compared to approximately 77.7% in the fourth quarter of 2021, while the full year 2022 MCR, excluding DCE, was approximately 75.1% versus approximately 79.7% in 2021.

我們的醫療成本比率（MCR）在第四季度為 76.1%，而 2021 年第四季度為 78.1%，而 2022 年全年 MCR 為 79.1%，而 2021 年為 80.5%。本季度和全年的增長主要是由我們的非 DCE 服務線中較低的 MCR 推動的。正如我們在之前的電話會議上所說， Medicare DCE 的 MCR 高於我們的人均收入。因此，越來越多的 Medicare DCE 成員組合增加了我們的總 MCR。不包括 Medicare DCE，我們的 MCR 在 2022 年第四季度約為 71.7%，而 2021 年第四季度約為 77.7%，而 2022 年全年 MCR（不包括 DCE）約為 75.1%，而 2021 年約為 79.7%。

Direct patient expense in the fourth quarter of 2022 was 11.4% of total revenue. This was above the third quarter of 9.6% and reflects higher performance-related payments to affiliates which was due to favorable performance. SG&A expense in the fourth quarter of 2022 was approximately $108 million, down from approximately $112 million in the third quarter. SG&A was 15.8% of total revenue in the quarter compared to 19% in the fourth quarter of 2021 and 16.8% in the third quarter of 2022.

2022年第四季度的直接患者費用佔總收入的11.4%。這高於第三季度的 9.6%，反映出由於良好的業績而向附屬公司支付的與業績相關的款項增加。 2022 年第四季度的 SG&A 費用約為 1.08 億美元，低於第三季度的約 1.12 億美元。 SG&A 佔本季度總收入的 15.8%，而 2021 年第四季度為 19%，2022 年第三季度為 16.8%。

We expect further improvements in our SG&A ratio in 2023 as we realize the full impact of operating efficiencies from actions taken in the fourth quarter of 2022 and early 2023. As Marlow mentioned, these actions include a reduction of head count to align with our revised plans for growth, implementation of tighter controls on spending and better contract terms with our vendors. The impact of these items is projected to generate approximately $70 million in cost reductions in 2023, which are offset by costs associated with the growth in our operations during 2022 and 2023.

我們預計 2023 年我們的 SG&A 比率將進一步改善，因為我們意識到 2022 年第四季度和 2023 年初採取的行動對運營效率的全面影響。正如 Marlow 提到的，這些行動包括裁員以配合我們修訂後的計劃為了增長，對支出實施更嚴格的控制以及與我們的供應商簽訂更好的合同條款。這些項目的影響預計將在 2023 年產生約 7000 萬美元的成本削減，這被與 2022 年和 2023 年業務增長相關的成本所抵消。

Adjusted EBITDA in the quarter was $35.7 million, up from $11.1 million a year ago. The fourth quarter adjusted EBITDA included a lower add-back for de novo losses, reflecting the roll-off of de novos that have been open for more than 1 year. Now let me turn to our cash flow and liquidity. We ended the fourth quarter with about $27 million in cash.

本季度調整後的 EBITDA 為 3570 萬美元，高於一年前的 1110 萬美元。第四季度調整後的 EBITDA 包括較低的新損失補充，反映了已開放超過 1 年的新損失的減少。現在讓我談談我們的現金流和流動性。我們在第四季度結束時擁有約 2700 萬美元的現金。

Total debt at the end of the fourth quarter was approximately $1 billion and included current and long-term debt, capital leases and payments due to -- and payments due to sellers. Our total net debt, defined as total debt less cash was $987 million as of December 31.

第四季度末的總債務約為 10 億美元，包括當前和長期債務、資本租賃和應付款項以及應付賣方的款項。截至 12 月 31 日，我們的淨債務總額（定義為總債務減去現金）為 9.87 億美元。

Cash used in operating activities was approximately $146 million for the full year and approximately $62 million in the fourth quarter. The fourth quarter use of cash was primarily due to higher working capital requirements related to higher accounts receivable. At the end of 2022, we drew $84 million of our revolver. And through the end of February 2023, we had an outstanding balance of $99 million. As we move into 2023, we remain focused on improving cash from operations and free cash flow. I will provide further details shortly.

全年經營活動使用的現金約為 1.46 億美元，第四季度約為 6200 萬美元。第四季度現金使用主要是由於應收賬款增加導致營運資金需求增加。到 2022 年底，我們從左輪手槍中提取了 8400 萬美元。到 2023 年 2 月底，我們的未清餘額為 9900 萬美元。隨著我們進入 2023 年，我們仍然專注於改善運營現金和自由現金流。我會盡快提供進一步的細節。

Earlier this week, we announced the closing of a $150 million term loan with Diameter Capital Partners and Rubicon Founders. We intend to use the net proceeds of approximately $140 million from the transaction for general corporate purposes including the repayment of outstanding amounts on our revolving credit facility. Importantly, in 2023, we intend to pay the interest on the term loan in kind instead of cash. Details on the 2023 term loan are provided in the 8-K filed on Monday, February 27. This financing provides Cano Health with the capital needed to optimize our existing capacity and unlock the embedded profitability with our medical centers. Now let me touch on our outlook for 2023 and the strategic changes we are making to improve cash flow and profitability.

本週早些時候，我們宣布結束與 Diameter Capital Partners 和 Rubicon Founders 的 1.5 億美元定期貸款。我們打算將交易所得款項淨額約 1.4 億美元用於一般公司用途，包括償還我們循環信貸額度的未償金額。重要的是，我們打算在 2023 年以實物而非現金支付定期貸款的利息。 2 月 27 日星期一提交的 8-K 中提供了有關 2023 年定期貸款的詳細信息。這筆融資為 Cano Health 提供了優化我們現有能力和釋放我們醫療中心的內在盈利能力所需的資金。現在讓我談談我們對 2023 年的展望以及我們為改善現金流和盈利能力而進行的戰略變革。

We are focused on leveraging our market-leading scale and density, particularly in Florida. Growing membership will increase capacity utilization at the existing centers, which we expect to improve margins. 2023 year-end total membership is expected to be in the range of 375,000 to 385,000 members. We expect Medicare Advantage membership to grow 7% to 9% year-over-year. We expect Medicare DCE, or ACO REACH membership to increase approximately 55% year-over-year. We received most of our new ACO REACH membership in January of each year from CMS claims-based alignment. On January 1, we had approximately 68,000 ACO REACH members. We expect this membership to decline slowly throughout the year due to natural attrition ending the year approximately 10% lower than January 2023.

我們專注於利用我們市場領先的規模和密度，尤其是在佛羅里達州。會員數量的增加將提高現有中心的產能利用率，我們預計這將提高利潤率。預計到 2023 年底，會員總數將在 375,000 至 385,000 人之間。我們預計 Medicare Advantage 會員人數將同比增長 7% 至 9%。我們預計 Medicare DCE 或 ACO REACH 會員人數將同比增長約 55%。每年 1 月，我們的大部分新 ACO REACH 成員都來自 CMS 基於聲明的對齊。 1 月 1 日，我們大約有 68,000 名 ACO REACH 成員。由於年底的自然流失率比 2023 年 1 月低約 10%，我們預計該會員人數全年將緩慢下降。

We expect Medicaid membership to be flat in 2023 as redeterminations are expected to offset underlying growth. We expect ACA membership to increase approximately 70% year-over-year. Note that we had approximately 80,000 ACA members in January 2023 due to expanded relationships with ACA payers. We expect modest increases throughout the year.

我們預計 2023 年 Medicaid 會員人數將持平，因為重新決定預計會抵消潛在增長。我們預計 ACA 會員人數將同比增長約 70%。請注意，由於與 ACA 付款人的關係擴大，我們在 2023 年 1 月擁有大約 80,000 名 ACA 成員。我們預計全年會適度增長。

Total revenue is expected to be in the range of $3.1 billion to $3.25 billion, which represents growth of approximately 16% at the midpoint. We expect Medicare Advantage revenue to be flat year-over-year as membership increases are largely offset by a 10% to 15% decline in full year Medicare Advantage or MA PMPM. We expect the MA PMPM in the first quarter of 2023 to be generally in line with the MA PMPM in the fourth quarter of 2022 and declined sequentially throughout the year as we add more new members who start with a lower PMPM.

總收入預計在 31 億美元至 32.5 億美元之間，中值增長率約為 16%。我們預計 Medicare Advantage 收入將同比持平，因為會員人數的增加在很大程度上被全年 Medicare Advantage 或 MA PMPM 下降 10% 至 15% 所抵消。我們預計 2023 年第一季度的 MA PMPM 將與 2022 年第四季度的 MA PMPM 基本一致，並且隨著我們增加更多以較低 PMPM 開始的新成員，全年將連續下降。

During 2023, we expect to have a higher proportion of nonrisk MA members compared to 2022. In 2022, non-risk members represented approximately 5% of total MA members. In 2023, we expect nonrisk members to represent approximately 10% of total MA members. Nonrisk members have a lower PMPM than at-risk members. The higher mix of nonrisk is due to growth in non-Florida markets and the impact of our December 2022 acquisition which added about 7,400 members, the significant majority of which are currently nonrisk. We anticipate converting this membership to risk over time as we integrate this acquisition into our business. We do not expect material differences in the full year revenue PMPM for our ACO REACH, Medicaid or ACA service lines compared to full year 2022.

與 2022 年相比，我們預計 2023 年非風險 MA 成員的比例會更高。到 2022 年，非風險成員約佔 MA 成員總數的 5%。到 2023 年，我們預計非風險成員約佔 MA 成員總數的 10%。非風險成員的 PMPM 低於風險成員。較高的非風險組合是由於非佛羅里達市場的增長以及我們 2022 年 12 月收購的影響，該收購增加了約 7,400 名成員，其中絕大多數目前是非風險的。隨著我們將此次收購整合到我們的業務中，我們預計隨著時間的推移，這種會員資格將轉變為風險。與 2022 年全年相比，我們預計我們的 ACO REACH、醫療補助或 ACA 服務線的全年收入 PMPM 不會有重大差異。

Turning now to MCR. We expect the full year 2023 total MCR to be in the range of 81% to 82%. In 2022, we recorded a reduction in third-party medical costs of approximately $44 million related to claims assigned to a third party. We do not expect this reduction to continue in 2023. Excluding this benefit, the normalized 2022 MCR was approximately 81%. Moreover, as in previous years, we expect MCR to be materially better in the second half compared to the first half of the year. The higher 2023 MCR guidance versus normalized 2022 MCR is primarily driven by a higher mix of ACO REACH members which typically have a higher MCR than our other service lines. The full year 2023 ACO REACH MCR is expected to be approximately 93% compared to approximately 91% in 2022.

現在轉向 MCR。我們預計 2023 年全年的總 MCR 將在 81% 至 82% 的範圍內。 2022 年，我們記錄了與分配給第三方的索賠相關的第三方醫療費用減少了約 4400 萬美元。我們預計這種下降不會在 2023 年繼續。排除這一好處，2022 年正常化的 MCR 約為 81%。此外，與往年一樣，我們預計下半年 MCR 的表現將明顯好於上半年。與標準化的 2022 MCR 相比，更高的 2023 MCR 指導主要是由 ACO REACH 成員的更高組合推動的，這些成員通常具有比我們其他服務線更高的 MCR。 2023 年全年 ACO REACH MCR 預計約為 93%，而 2022 年約為 91%。

Moving to adjusted EBITDA. As you know, we have been adding back de novo losses as part of our adjusted EBITDA calculation. This adjustment was helpful to management in evaluating the business when we were rapidly building out our center footprint, particularly in new markets where new medical centers ramp more slowly. Given our current strategy to significantly reduce the number of de novos adds, we have revised our definition of adjusted EBITDA to no longer add back de novo losses, which makes it more comparable to cash earnings. This is the only change we have made to the adjusted EBITDA calculation. Please see our earnings release and financial supplement posted to our website this evening for more information about this change.

轉向調整後的 EBITDA。如您所知，作為調整後的 EBITDA 計算的一部分，我們一直在加回從頭損失。當我們迅速擴大我們的中心足跡時，特別是在新醫療中心增長較慢的新市場，這一調整有助於管理層評估業務。鑑於我們目前的戰略是大幅減少從頭增加的數量，我們修改了調整後 EBITDA 的定義，不再添加從頭損失，這使其與現金收益更具可比性。這是我們對調整後的 EBITDA 計算所做的唯一更改。有關此更改的更多信息，請參閱今晚發佈在我們網站上的收益發布和財務補充。

Excluding de novo loss add-backs, we now expect our newly modified full year 2023 adjusted EBITDA to be in the range of $75 million to $85 million. By comparison, had we excluded de novo loss add-backs in 2022, the full year 2022 adjusted EBITDA would have been approximately $74 million using the new definition of adjusted EBITDA. And as a reminder, 2022 results include the reduction of third-party medical costs of $44 million that we do not expect to continue in 2023. Additionally, we expect 2023 interest expense to be approximately $100 million, which includes approximately $90 million of cash interest and approximately $10 million of noncash interest related to the 2023 term loan.

不包括新的損失增加，我們現在預計我們新修改的 2023 年全年調整後 EBITDA 將在 7500 萬至 8500 萬美元之間。相比之下，如果我們排除 2022 年的重新損失增加，則使用調整後 EBITDA 的新定義，2022 年全年調整後的 EBITDA 將約為 7400 萬美元。提醒一下，2022 年的結果包括減少 4400 萬美元的第三方醫療費用，我們預計這不會在 2023 年繼續發生。此外，我們預計 2023 年的利息支出約為 1 億美元，其中包括約 9000 萬美元的現金利息以及與 2023 年定期貸款相關的大約 1000 萬美元的非現金利息。

Stock-based compensation in 2023 is expected to be approximately $50 million. For reference, de novo losses, which, as we said, are no longer added back to adjusted EBITDA are expected to be approximately $45 million compared to approximately $79 million in 2022. Also, we expect capital expenditures to be approximately $15 million in 2023 compared to approximately $50 million in 2022, reflecting fewer additional de novos in 2023. In 2023, we expect cash used in operating activities will be in the range of $70 million to $80 million compared to 2022 cash used in operating activities of $146 million, a projected $71 million improvement at the midpoint. As Marlow mentioned, a key objective for 2023 is to optimize our value-based platform with the goal of improving the balance sheet and cash from operations.

預計 2023 年的股票薪酬約為 5000 萬美元。作為參考，正如我們所說，不再加回調整後的 EBITDA 的從頭損失預計約為 4500 萬美元，而 2022 年約為 7900 萬美元。此外，我們預計 2023 年的資本支出約為 1500 萬美元，相比之下到 2022 年將增加到約 5000 萬美元，反映出 2023 年新增的新項目減少。我們預計 2023 年用於經營活動的現金將在 7000 萬至 8000 萬美元之間，而 2022 年用於經營活動的現金為 1.46 億美元，預計中點改善 7100 萬美元。正如 Marlow 提到的，2023 年的一個關鍵目標是優化我們基於價值的平台，以改善資產負債表和運營現金。

As you know, our non-Florida medical centers are generating losses. In 2023, we expect non-Florida medical centers to generate approximately $100 million of revenue and approximately $40 million of adjusted EBITDA losses, excluding corporate expenses compared to approximately $70 million of revenue and $60 million of adjusted EBITDA losses, excluding corporate expenses in 2022. Note, we are using adjusted EBITDA under our newly modified definition for both periods. While we have made progress towards achieving profitability for these centers, we are committed to accelerating the company's path towards positive free cash flow.

如您所知，我們非佛羅里達州的醫療中心正在虧損。 2023 年，我們預計非佛羅里達州醫療中心將產生約 1 億美元的收入和約 4000 萬美元的調整後 EBITDA 虧損（不包括公司費用），而 2022 年將產生約 7000 萬美元的收入和 6000 萬美元的調整後 EBITDA 損失（不包括公司費用）。請注意，我們在兩個時期都根據我們新修改的定義使用調整後的 EBITDA。雖然我們在實現這些中心的盈利方面取得了進展，但我們致力於加快公司實現正自由現金流的道路。

In conclusion, during 2023, we expect to continue to generate solid revenue growth. We are taking important steps to improve our cost structure and unlock and better profitability within our medical centers to meet our goals of improving adjusted EBITDA and cash flow and maximizing long-term value for our shareholders.

總之，在 2023 年期間，我們預計將繼續產生穩健的收入增長。我們正在採取重要步驟來改善我們的成本結構，並在我們的醫療中心內釋放和提高盈利能力，以實現我們改善調整後的 EBITDA 和現金流並為股東實現長期價值最大化的目標。

With that, I will ask the operator to open the call to your questions.

有了這個，我會要求接線員打開你的問題的電話。

(Operator Instructions) Your first question is from the line of Gary Taylor with Cowen.

（操作員說明）你的第一個問題來自 Gary Taylor 和 Cowen。

Okay. That was a ton of detail, Brian. So I have to pick and choose where I want to ask. But maybe let me just start with liquidity. So make sure I have this correct, so $27 million of cash, there's another $21 million available on the revolver, and you have $150 million term loan just closed. So that's $198 million basically available to set up against the cash from ops guide you just gave?

好的。那是一大堆細節，布賴恩。所以我必須挑選我想問的地方。但也許讓我從流動性開始。所以請確保我有這個正確的，所以 2700 萬美元現金，左輪手槍上還有 2100 萬美元可用，並且你有 1.5 億美元的定期貸款剛剛關閉。那麼這 1.98 億美元基本上可以用來抵消您剛剛提供的運營指南的現金？

That's right, based in the fourth quarter.

沒錯，基於第四季度。

Okay. And one other question I've asked, how are you looking at the 2024 advanced notice and that risk score model change? Obviously, the way they're moving the weightings around on the HCCs and removing some of the diagnosis codes, there's some underlying current that some providers would be impacted more than the -- in some plans more than the 3% that CMS sizes for that risk score headwind? Do you have a thought on that yet?

好的。我問的另一個問題是，您如何看待 2024 年的提前通知和風險評分模型的變化？顯然，他們在 HCC 上移動權重並刪除一些診斷代碼的方式，有一些潛在的電流，一些提供者受到的影響會超過 - 在一些計劃中，超過 CMS 的 3% 大小風險評分逆風？你有沒有想過？

Marlow, do you want to take that?

馬洛，你想接受嗎？

Let me take that, Gary. And I apologize to you and the rest of the audience and just getting over a cold. So my voice is a bit hoarse, but please feel free to ask again, if I'm not clear. So on the rate notice, this is something we've been looking at and feel it's too early to really view anything definitive. First, the rates are not finalized. But as we look into our data, we've looked at large representative sample of our data from 2022, working with our market leaders and payers. We found that some of our members had a lower score, some members have a higher score, net-net in the absence of changes or mitigating factors. It may have a potential of a 2% headwind on our MRA scores, which is highly correlated to MA revenue PMPM.

讓我接受，加里。我向你和其他聽眾道歉，我只是感冒了。所以我的聲音有點沙啞，但如果我不清楚，請隨時再問。因此，在費率通知上，這是我們一直在關注的事情，我們認為現在真正查看任何確定的內容還為時過早。首先，利率沒有最終確定。但是，當我們研究我們的數據時，我們與我們的市場領導者和付款人一起研究了 2022 年以來的大量代表性數據樣本。我們發現我們的一些成員得分較低，一些成員得分較高，在沒有變化或緩解因素的情況下淨淨得分。它可能會對我們的 MRA 分數產生 2% 的不利影響，這與 MA 收入 PMPM 高度相關。

Important to note that mitigating factors to that roughly 2% headwind include changes to the payer mix, the payer mix itself what happens ultimately with the star ratings and that is also going to be embedded within our own payer mix. The growth in our MA population provide a risk share type of offsets and risk trend among -- or specifically MRA risk trend among other operating type of adjustments. So there's a lot that would go into answering the question once those rates are finalized.

需要注意的是，大約 2% 逆風的緩解因素包括付款人組合的變化，付款人自己混合最終會發生什麼星級評級，這也將嵌入我們自己的付款人組合中。我們 MA 人口的增長提供了一種風險份額類型的抵消和風險趨勢——或者特別是 MRA 風險趨勢與其他操作類型的調整。因此，一旦這些利率最終確定，就會有很多問題需要回答。

Direct answer is if you just look at the MRA component by itself, which should not be looked at in a vacuum, you're looking at a potential 2% headwind. We also have the benefit of starting from a much lower place than many others. And as you can see, we're taking very cautious view as to our revenue rates, PMPM this year with the impact of new membership and new geographies. Therefore, don't expect, at this point, a material impact.

直接的答案是，如果你只看 MRA 組件本身，它不應該在真空中看，你正在看一個潛在的 2% 的逆風。與許多其他公司相比，我們的起點要低得多。正如您所看到的，我們對我們的收入率、今年的 PMPM 以及新會員和新地區的影響持非常謹慎的看法。因此，不要指望在這一點上產生實質性影響。

I appreciate it. That's helpful. I was just reading recently, the American Physicians Group had sent a letter to CMS saying that the risk remodel change could disproportionately impact population -- minority populations, populations of color just because of some of the diagnosis codes they're pulling out of that. And given your larger Hispanic population, I guess, it's kind of -- it's good news. It sort of flies against what they're saying. So I appreciate the...

我很感激。這很有幫助。我最近剛讀到，美國醫師協會致信 CMS，稱風險重塑變化可能會對人口產生不成比例的影響——少數民族人口、有色人種人口，只是因為他們正在從中提取一些診斷代碼。考慮到你的西班牙裔人口較多，我想，這有點——這是個好消息。這有點違背他們所說的。所以我很欣賞...

Well, Gary, let me expand on that. And part of the reason is that there was significant changes to diabetes codes, and those rates are quite high in an underserved population and minority populations. At the same time, you have adjustments to the normalization factor, as you know, and adjustments to CHF, chronic kidney disease and other codes and it does really depend on the specific provider population and where scores are at and which specific codes are utilized. But yes, in populations that are hyper specific to a particular diagnosis code, which is more common in minority population, it may have, indeed, a disproportionate impact.

好吧，加里，讓我詳細說明一下。部分原因是糖尿病代碼發生了重大變化，而這些比率在服務不足的人群和少數民族人群中相當高。同時，如您所知，您對標準化因素進行了調整，並對瑞士法郎、慢性腎臟疾病和其他代碼進行了調整，這確實取決於特定的提供者人群、分數所在的位置以及使用的特定代碼。但是，是的，在對特定診斷代碼高度特定的人群中，這在少數民族人群中更為常見，它確實可能會產生不成比例的影響。

Got you. And I think -- I mean, to your point, I appreciate the thought. I mean if your population -- the risk score alone, the 2% headwind, it's not just an issue for you. It's an issue for the plans that you're contracting with that they need to find a way to potentially offset that with their bid and benefit package. So I appreciate the comment.

明白了我認為 - 我的意思是，就你的觀點而言，我很欣賞這個想法。我的意思是，如果你的人口——僅風險評分，2% 的逆風，這不僅僅是你的問題。對於您與之簽訂合同的計劃來說，這是一個問題，他們需要找到一種方法來潛在地用他們的出價和福利方案來抵消它。所以我很欣賞這個評論。

Your next question is from the line of Jailendra Singh with Truist Securities.

你的下一個問題來自 Truist Securities 的 Jailendra Singh。

My first question, I know there are a few moving parts here when comparing 2023 EBITDA outlook versus '22. So it will be great if you can spend some time on your expectations around the margin and MLR trends on MA lives you have brought on board over the last couple of years. Are those in line with the ramp you're expecting year 2 and beyond? Maybe any color would be helpful.

我的第一個問題，我知道在比較 2023 年 EBITDA 前景與 22 年時，這裡有一些變化。因此，如果您能花一些時間了解您在過去幾年中對 MA 生活的保證金和 MLR 趨勢的期望，那就太好了。這些是否符合您預期的第 2 年及以後的增長？也許任何顏色都會有所幫助。

So Jailendra, let me start and Brian can follow up. But we see our medical cost ratios going down year-over-year. The only reason that it's comparable is that we have, on a consolidated basis, a higher proportion of DCE members, which naturally have a higher MCR. As I mentioned in my prepared remarks, we are seeing lower utilization. So our admissions per thousand, roughly 7% down, even as we have grown, and we expect continued improvement in clinical outcomes for which the APT is a very good proxy. So overall, we're seeing margin expansion or improvement in underwriting margin. Brian and I talked about the operating adjustments that we made to gain further leverage on the business.

Jailendra，讓我開始，Brian 可以跟進。但我們看到我們的醫療成本比率逐年下降。它具有可比性的唯一原因是，在合併的基礎上，我們擁有更高比例的DCE成員，這些成員自然具有更高的MCR。正如我在準備好的發言中提到的，我們看到利用率較低。因此，即使我們已經成長，我們每千人的入院率也下降了大約 7%，我們預計臨床結果會持續改善，而 APT 是一個很好的代表。因此，總的來說，我們看到承保利潤率擴大或改善。布賴恩和我談到了我們為進一步影響業務而進行的運營調整。

On the SG&A as an example to drive more earnings and cash. So when you look at our new definition of adjusted EBITDA, which does not add back de novo losses, and it's more of that proxy for cash. You are seeing improvement year-over-year. And when we take out potentially nonrecurring reduction in third-party claims, which is $44 million, that gets you to about a $30 million comparable adjusted EBITDA versus the $80 million that we're guiding at the midpoint. So you can see there the material improvement in year-over-year. And we are integrating a significant number of new members, as you know, recently knew over the past 12 to 18 months. I'm proud of the team and how they were able to find the different action items to improve the operations and started reengineering the company for cash generation.

以 SG&A 為例，以推動更多收益和現金。因此，當您查看我們對調整後的 EBITDA 的新定義時，它不會加回從頭損失，而且更多的是現金的代表。你看到了一年比一年的進步。當我們剔除第三方索賠的潛在非經常性減少（即 4400 萬美元）時，您的可比調整後 EBITDA 約為 3000 萬美元，而我們在中點指導的是 8000 萬美元。所以你可以看到同比的實質性改善。正如您所知，我們正在整合大量新成員，這些成員是在過去 12 到 18 個月內才知道的。我為團隊感到自豪，以及他們如何找到不同的行動項目來改善運營並開始重新設計公司以產生現金。

As you know, in 2022, we got less contribution margin than expected for our members and at the same time, had an inflationary environment and higher interest rates. And our team quickly put their heads down and while continuing to serve a much higher-than-expected number of total members also expanded margins, and we're continuing that momentum into 2023 with great clinical care and also operating efficiencies.

如您所知，在 2022 年，我們的成員的邊際收益低於預期，同時處於通貨膨脹環境和更高的利率水平。我們的團隊很快就低下了頭，在繼續為遠高於預期的會員總數提供服務的同時，利潤率也有所擴大，我們將以出色的臨床護理和運營效率將這一勢頭延續到 2023 年。

Okay. That's helpful. Just one quick follow-up. You guys talked about non-quota medical centers, EBITDA loss improving there. Any color like how would you describe the trends there when compared with your internal expectations? And when you return to adding de novos in the future, should we expect any changes to your approach in terms of taking new markets outside of Florida, like in terms of approach around like picking markets around investment? Just curious like, I mean, how do you think about that.

好的。這很有幫助。只是一個快速跟進。你們談到了非配額醫療中心，那裡的 EBITDA 損失有所改善。與您的內部預期相比，您會如何描述那裡的趨勢？當你在未來重新開始增加從頭開始時，我們是否應該期待你在佛羅里達州以外開拓新市場方面的方法有任何變化，比如圍繞投資選擇市場的方法？只是好奇，我的意思是，你是怎麼想的。

Great question, Jailendra, I appreciate it. Clearly, we like the trajectory, the non-Florida markets are going. Nice improvement year-over-year from '22 to '23 which, as you know, all fits in with their scale and density strategy that we've had in those markets. And as you added more centers, you're going to get that leverage. And I would say as we would expect, those markets will continue to improve as we add more members to those existing centers since we're not really going to be adding additional medical centers in those existing markets, that new membership all funnels into the current medical centers we have there. So we would expect them to continue on that trajectory into '24 and beyond. And I think what's proven out is the markets we've selected are really strong markets for growth opportunities and the assets that we've built there are really good assets that have good growth potential.

好問題，Jailendra，我很感激。顯然，我們喜歡非佛羅里達市場的發展軌跡。從 22 歲到 23 歲，同比有了很大的進步，正如你所知，這一切都符合我們在這些市場中的規模和密度戰略。隨著您添加更多中心，您將獲得這種影響力。我想說的是，正如我們所期望的那樣，隨著我們向現有中心增加更多成員，這些市場將繼續改善，因為我們不會真正在這些現有市場中增加額外的醫療中心，新成員將全部匯集到當前我們在那裡有醫療中心。因此，我們希望他們繼續沿著這條軌跡進入 24 世紀及以後。而且我認為事實證明，我們選擇的市場是真正強大的增長機會市場，我們在那裡建立的資產非常好，具有良好的增長潛力。

Your next question is from the line of Andrew Mok with UBS.

你的下一個問題來自瑞銀集團的 Andrew Mok。

Question for Brian. Just wanted to follow up on the 2023 guidance. Your EBITDA guidance is flat to up $10 million for 2023. But I think you called out $70 million or so SG&A cost reductions. So I'm also getting $70 million better. Can you help us understand what the offsets are in the 2023 guide to hold the EBITDA relatively flat?

布賴恩的問題。只是想跟進 2023 年的指南。您的 EBITDA 指導在 2023 年持平至 1000 萬美元。但我認為您要求削減 7000 萬美元左右的 SG&A 成本。所以我也得到了 7000 萬美元。您能否幫助我們了解 2023 年指南中的偏移量是多少，以保持 EBITDA 相對平穩？

Yes. I think there's a number of puts and takes in there. On the SG&A side, it's important to note, the way I look at it is really more from a -- the higher level, which is SG&A as a percentage of revenue, which is going to significantly improve from '22 to '23. As you can imagine, we built a significant number of medical centers in 2022. And they were -- we're not all at the beginning of January, in fact, most are in the back half and even in the third quarter. So we've staffed them up, and now you have the annualization effect of those costs for those centers. So that will -- while we've made great progress in reducing our cost basis around the expenses that we have, we have the -- just the annualization effect of that ramp that we did in 2022 that now is coming into '23. So that really offsets a lot of those savings. So the nice part about it is we are seeing significant SG&A as a percentage of revenue improvement. So we are getting that leverage as we optimized our workforce and our staffing levels across the organization. So that's on the SG&A side.

是的。我認為那裡有很多投入和投入。在 SG&A 方面，需要注意的是，我看待它的方式實際上更多地是從一個更高的層面來看，即 SG&A 佔收入的百分比，它將從 22 年顯著提高到 23 年。你可以想像，我們在 2022 年建立了大量的醫療中心。而且他們 - 我們並不是在 1 月初，事實上，大多數都在後半段，甚至在第三季度。所以我們已經為他們配備了人員，現在你對這些中心的這些成本產生了年化效應。所以這將 - 雖然我們在減少圍繞我們所擁有的費用的成本基礎方面取得了很大進展，但我們有 - 我們在 2022 年所做的斜坡的年化效應現在正在進入 23 年。所以這真的抵消了很多這些節省。所以關於它的好處是我們看到 SG&A 在收入增長中所佔的比例很大。因此，我們在優化整個組織的員工隊伍和人員配置水平時獲得了這種影響力。所以這是在 SG&A 方面。

And then I think you kind of take a look at some of the other initiatives that we have in the underwriting margin side. Marlow talked about, not only have we executed a number of, I'll call it, payer and payer action items. We still believe we have more to go, and we'll talk about those as we go through the year to generate additional improvements.

然後我想你看看我們在承保保證金方面的其他一些舉措。 Marlow 談到，我們不僅執行了一些，我稱之為付款人和付款人行動項目。我們仍然相信我們還有更多的工作要做，我們將在這一年中討論這些，以產生更多的改進。

Got it. And can you provide the de novo loss -- can you provide the de novo loss number that you're expecting for 2023?

知道了。您能否提供從頭損失——您能否提供您預期的 2023 年從頭損失數字？

Yes. It's roughly, I think, $45 million or so for 2023 versus $79 million -- versus $79 million in 2022.

是的。我認為，2023 年大約為 4500 萬美元左右，而 2022 年為 7900 萬美元，而 2022 年為 7900 萬美元。

Got it. Okay. And as we assess the forward guide, I think it would be helpful to hear one last time maybe the postmortem on what exactly went wrong in 2022 with respect to the lower revenue yield on your members, and what changes you made in operations to give you confidence in projecting this forward?

知道了。好的。在我們評估前瞻性指南時，我認為最後一次聽聽關於 2022 年會員收入收益較低方面到底出了什麼問題的事後分析，以及您在運營中做出哪些改變可以給您帶來幫助會有所幫助有信心預測這一點嗎？

Yes. Let me take that, Andrew. So the PMPM surprised us negatively because of less revenue per new patients than we had historically seen in new and existing markets. We also had more non-risk patients. And as a result of those factors, which Brian described, we're taking a more cautious outlook into this year. What also compounded the issue was the rapid rise in inflation and interest rates, which as a result of us serving more patients than anticipated in total, which also was a positive surprise, but we have to definitely make the investments that our patients expect from us in our differentiated care delivery.

是的。讓我接受，安德魯。因此，PMPM 給我們帶來了負面的驚喜，因為每位新患者的收入低於我們在新市場和現有市場上的歷史經驗。我們也有更多的非風險患者。由於布賴恩所描述的這些因素，我們對今年的前景更加謹慎。使問題更加複雜的是通貨膨脹和利率的迅速上升，這是由於我們服務的患者總數超過預期，這也是一個積極的驚喜，但我們必須絕對按照患者對我們的期望進行投資在我們差異化的護理服務中。

But then you have the inflationary type cost and the higher interest expense that we have to burn. We moved decisively to make operating adjustments that on the last call, I described that at a high level, and we have now quantified for you taking out $70 million in SG&A through the negotiation with vendors and other operating efficiencies. We also moved to reduce head count, aligning it with growth. We renegotiated payer agreements, affiliate agreements. We optimize our affiliate network that improved the underwriting margin.

但是隨後您將面臨通貨膨脹型成本和我們必須燃燒的更高利息費用。我們果斷地進行了運營調整，在上次電話會議上，我在高層次上進行了描述，現在我們已經通過與供應商的談判和其他運營效率為您量化了 7000 萬美元的 SG&A。我們還採取行動減少員工人數，使其與增長保持一致。我們重新談判了付款人協議、附屬協議。我們優化了我們的聯盟網絡，提高了承保利潤率。

We have also reduced our capital expenditures, and that's a $35 million of year-over-year type of savings. So when you put all that together, combined with continued growth, great momentum in the business and the 3 items I'd described for 2023 is why I'm so confident and so excited about this year. So we had growth that outstretched our liquidity to support it. Therefore, we capitalize the business, have more roughly double of the liquidity required for this year's growth and operations.

我們還減少了資本支出，同比節省 3500 萬美元。因此，當你把所有這些放在一起，再加上業務的持續增長、強勁的發展勢頭和我為 2023 年描述的 3 個項目，這就是我對今年如此自信和興奮的原因。因此，我們的增長超出了我們的流動性來支持它。因此，我們將業務資本化，今年的增長和運營所需的流動資金大約增加了一倍。

We continue to optimize our operations, and there's further work to do there to gain efficiency. And three, we're going to fill existing capacity, which is significant and leverage the scale and density that we have. So I would like to focus in on that -- the scarcity of primary care and the long-term fundamentals and this year is going to start to unlock the value that we have intrinsically built over the last couple of years in particular.

我們繼續優化我們的運營，並且還有進一步的工作要做以提高效率。第三，我們將填補現有產能，這很重要，並利用我們擁有的規模和密度。因此，我想重點關注這一點——初級保健和長期基本面的稀缺性，今年將開始釋放我們在過去幾年中內在建立的價值。

Okay. And lastly, maybe can you provide more detail on the goodwill impairment charge of $323 million. There wasn't a lot of detail or disclosure around that. Which assets specifically did the write-down relate to?

好的。最後，您能否提供有關 3.23 億美元商譽減值費用的更多詳細信息。沒有太多細節或披露。減記具體涉及哪些資產？

Yes. I mean I would say we take a broad look at the overall organization. But the way to think about it is the test is a fair value test and is heavily determined by stock price. Our stock price, unfortunately, declined from September when we would normally do this to December require an additional goodwill test to be formed at the end of the year. So the $323 million just essentially represents the excess of that carrying value or the fair value, but it's really a broader -- broad look of the enterprise.

是的。我的意思是我會說我們對整個組織進行了廣泛的審視。但思考的方式是，該測試是公允價值測試，在很大程度上取決於股票價格。不幸的是，我們的股價從 9 月開始下跌，而我們通常會這樣做，到 12 月需要在年底進行額外的商譽測試。因此，3.23 億美元基本上代表了賬面價值或公允價值的超額部分，但它實際上是企業的更廣泛的外觀。

But doesn't it relate to the excess of the fair value of assets that you purchased?

但這不是與你購買的資產公允價值的超額有關嗎？

That's correct. So you kind of take a broad look at all of them -- take a broad look at all of them.

這是正確的。所以你有點廣泛地審視所有這些——廣泛地審視所有這些。

Okay. Nothing specifically that you point out of what's driving the write-down?

好的。你沒有特別指出是什麼導致減記？

No.

不。

Your next question comes from the line of Josh Raskin with Nephron Research.

您的下一個問題來自 Nephron Research 的 Josh Raskin。

Was there a thought about slowing membership growth to reduce sort of the short-term losses or is it more critical in your mind to fill the centers? And maybe specifically on DCE, where if you're accruing an MLR of [90%], I'm just not sure, maybe that is still profitable with a low G&A, but just curious on thoughts on membership growth.

有沒有考慮過放慢會員增長以減少短期損失，或者在您看來填補中心更重要？也許特別是在 DCE 上，如果你積累了 [90%] 的 MLR，我只是不確定，也許這在低 G&A 的情況下仍然有利可圖，但只是對會員增長的想法感到好奇。

Yes. So we have all of this embedded capacity, which we are growing organically. As you know, Josh, 2/3 of our new patients come from other patients even as we have reduced as part of our operating efficiencies, marketing costs, we continue to see robust enrollment figures at our centers in light of the state of capital markets. It certainly behooves us to moderate our growth expectations. And so the focus of this year is one in which we fill the existing capacity. We continue to harness further operating efficiencies. And we improved the internal cash generation and liquidity as we optimize our platform to selectively execute on accretive opportunities. But yes, our growth has to be in line with the cost of capital. And for us, the investment being made the great momentum in our business, will be very selective and thoughtful as to which additional growth opportunities to attain our focus this year is growth of the existing markets and centers.

是的。因此，我們擁有所有這些嵌入式能力，我們正在有機地增長這些能力。正如你所知，Josh，我們 2/3 的新患者來自其他患者，儘管我們已經降低了運營效率和營銷成本，但鑑於資本市場的狀況，我們的中心繼續看到強勁的註冊人數.我們當然有必要降低我們的增長預期。因此，今年的重點是填補現有產能。我們繼續利用進一步的運營效率。當我們優化我們的平台以選擇性地執行增值機會時，我們改善了內部現金生成和流動性。但是，是的，我們的增長必須與資本成本保持一致。對我們來說，投資正在成為我們業務的巨大動力，將非常有選擇性和深思熟慮地考慮今年實現我們關注的哪些額外增長機會是現有市場和中心的增長。

Okay. That makes sense. And then the comment in the press release and then, Marlow, that you mentioned on the call about being committed to reviewing all aspects of your value-based care platform to improve liquidity, cash flow and maximizing shareholder value. I guess simple answer -- simple question is sort of what does that mean? Are there noncore assets at Cano that you see in your view with those comments directed at sort of the non-Florida assets? Or maybe just help us understand a little bit more what that review means.

好的。這就說得通了。然後是新聞稿中的評論，然後是馬洛，你在電話中提到致力於審查基於價值的護理平台的各個方面，以提高流動性、現金流和股東價值最大化。我想答案很簡單——簡單的問題是什麼意思？在您看來，Cano 是否有非核心資產以及針對非佛羅里達州資產的評論？或者也許只是幫助我們更多地了解該評論的含義。

Yes. So our review is availing ourselves of all of the options. We've got our goals, which we have clearly defined and the options of disposition or closing or consolidation of any of our centers or operations, those are all actively being reviewed. We have a relentless focus on improving our internal cash generation, further strengthening liquidity and balance sheet.

是的。因此，我們的審查是利用所有選項。我們已經有了我們明確定義的目標，以及處置或關閉或合併我們任何中心或業務的選項，這些都在積極審查中。我們一直致力於改善內部現金生成，進一步加強流動性和資產負債表。

Got you. And the potential, when you say disposition or even closing or selling whatever, is that more a non-Florida comment? Or is that all including Florida?

明白了當你說處置甚至關閉或出售任何東西時，潛力更多的是非佛羅里達州的評論嗎？還是包括佛羅里達在內？

I think that -- it's more of an all-inclusive-type comment. Brian mentioned in the prepared remarks to give examples of how we're seeing a very strong growth improvement trajectory outside of Florida, but those markets are still the ones that are using the most cash and those centers are the ones using the most cash. So require a deeper look than our more established base business in Florida. But even in that base business in Florida, we are taking a very close look at every medical center, every operating avenue to align with our 2023 scorecard as I very specifically made that clear.

我認為 - 它更像是一種包羅萬象的評論。布賴恩在準備好的發言中提到，舉例說明我們如何在佛羅里達州以外看到非常強勁的增長改善軌跡，但這些市場仍然是使用現金最多的市場，而那些中心是使用現金最多的市場。因此，需要比我們在佛羅里達州更成熟的基礎業務更深入地了解。但即使在佛羅里達州的基礎業務中，我們也在密切關注每個醫療中心、每條運營途徑，以與我們的 2023 年記分卡保持一致，正如我非常明確地明確指出的那樣。

Your next question is from the line of Adam Ron with Bank of America.

你的下一個問題來自美國銀行的 Adam Ron。

Can we talk about the renegotiated payer contracts and give us any color what specifically changed? And you mentioned some remaining action items and just curious like what the term of those contracts typically are in terms of years. And finally, just curious how those negotiations typically go in a state like Florida, where you have like much more density versus maybe in Nevada where you don't.

我們能否談談重新談判的付款人合同，並告訴我們具體發生了什麼變化？你提到了一些剩餘的行動項目，只是好奇這些合同的期限通常是多少年。最後，我很好奇這些談判通常如何在像佛羅里達這樣的州進行，那裡的人口密度要高得多，而在內華達州則沒有。

Right. Well, let me answer that last question. First there's a scarcity of providers like ourselves with the breadth and scope of services at scaled regional and national level. And so for any payer, even if we are new to a particular market, they will have a hard time looking for provider organizations that can measurably improve quality ratings that affect HEDIS that are able to take global cap risk that are able to grow membership because of the differentiated service.

正確的。好吧，讓我回答最後一個問題。首先，像我們這樣在區域和國家層面提供廣泛服務的供應商很少。因此，對於任何付款人來說，即使我們是特定市場的新手，他們也很難尋找能夠顯著提高影響 HEDIS 的質量評級的供應商組織，這些組織能夠承擔能夠增加會員的全球上限風險，因為的差異化服務。

The second part to that is the contracts, well, they do range from evergreen contract to specific term type contracts a year or 2 and so on. It is bespoke. But the terms that are negotiated are the percent of premium or our funding rate. So that is an area that we have made significant improvements on. There are other specific terms such as the primary care cap or what kind of advance we're getting, what kind of charges we're getting for stops if we use to the payer stop-loss rather than on a third party. There is related agreements on marketing and contributions from the payers and 50-50 type campaigns. There are more nuanced components to the agreements that affect economics, including what risk levels, which parts of Medicare are included, what networks. And I don't think we should get into it on the call, but that is from a broad strokes perspective, is what we look at and what we will continue to optimize.

第二部分是合同，嗯，它們的範圍從常青合同到一年或兩年的特定期限類型合同等等。它是定制的。但協商的條款是溢價百分比或我們的融資率。所以這是一個我們已經做出重大改進的領域。還有其他具體條款，例如初級保健上限或我們獲得什麼樣的預付款，如果我們使用付款人止損而不是第三方，我們將獲得什麼樣的停止費用。付款人和 50-50 類型的活動有相關的營銷和貢獻協議。影響經濟的協議有更多細微的組成部分，包括風險水平、醫療保險的哪些部分包括在內、哪些網絡。而且我認為我們不應該在電話會議上討論它，但從廣泛的角度來看，這是我們所關注的，也是我們將繼續優化的。

No. That's helpful. I appreciate it. And last quarter and on this call, you mentioned either optimizing or deactivating affiliated providers, but it looks like at least at the end of the year, you have 1,900 providers versus the last disclosure of 1,500 for the affiliates. So is it -- should we still think about it as growing in 2023? Or...

不，這很有幫助。我很感激。在上個季度和這次電話會議上，你提到了優化或停用附屬供應商，但看起來至少在今年年底，你有 1,900 個供應商，而最近披露的附屬供應商為 1,500 個。那麼是嗎——我們是否仍應將其視為 2023 年的增長？或者...

No, we're growing, that's for sure. But growing with an eye on profitability and cash flows rather than just putting our foot on the -- meeting the demand panel. And that includes DCE or ACO reach as an example. We did do a fair amount of trimming but there were other high-performing providers that we agreed to contract with, and we do expect growth in our cap-light affiliate model as well as to fill the existing capacity on our medical centers.

不，我們正在成長，這是肯定的。但是在關注盈利能力和現金流的情況下發展，而不是僅僅把我們的腳放在滿足需求面板上。這包括 DCE 或 ACO 範圍作為示例。我們確實做了相當多的調整，但我們同意與其他高性能供應商簽訂合同，我們確實希望我們的 cap-light 聯盟模式有所增長，並填補我們醫療中心的現有容量。

Your next question is from the line of Justin Lake with Wolfe Research.

你的下一個問題來自 Justin Lake 與 Wolfe Research 的合作。

I had a couple of follow-ups. First, on the $45 million of de novo note losses, can you tell me what the definition of that is? Is that $45 million loss kind of everything outside of Florida that you built recently? Or is that just the stuff both over the last 12 months or what have you?

我有幾個後續行動。首先，關於 4500 萬美元的新票據損失，你能告訴我它的定義是什麼嗎？你最近在佛羅里達州以外建造的所有東西都損失了 4500 萬美元嗎？或者這只是過去 12 個月的事情還是你有什麼？

Yes. No, Jason, that's the way we report. The aggregate de novo loss add-backs that's across any de novo that we've opened. And keep in mind, the definition is losses ramping up to open and then 12 months after open is all part of that number.

是的。不，傑森，這就是我們報導的方式。我們打開的任何從頭開始的總從頭損失加回。請記住，定義是損失在開盤前逐漸增加，開盤後 12 個月都是該數字的一部分。

Okay. And the one thing I'd look as you take a look back, right, obviously, the adjusted EBITDA number is very different than what you would have been looking for. And as we -- one of the ways I'd love to think about it is just if I think about your business in 3 pieces, right, like the core Florida footprint that Cano was when it kind of entered the public market. You did a couple of big acquisitions, spent about $1 billion on doctors, medical center and then University Health and then everything you've built outside of Florida. If you were to break it down to those 3 pieces, just kind of broad strokes, I'd love to see kind of how you think about that $80 million of EBITDA. How would that bucket?

好的。當你回顧過去時，我會看到一件事，很明顯，調整後的 EBITDA 數字與你一直在尋找的數字非常不同。正如我們——我想考慮的一種方式就是，如果我把你的業務分成三部分，對，就像 Cano 進入公開市場時在佛羅里達州的核心足跡一樣。你做了幾筆大收購，花了大約 10 億美元用於醫生、醫療中心，然後是大學健康，然後是你在佛羅里達州以外建造的一切。如果你把它分解成這 3 個部分，只是粗略的概括，我很想看看你是如何看待這 8000 萬美元的 EBITDA 的。那個桶怎麼會？

Yes. So just it also has the second year type of costs that are not being added back that are being absorbed by that number. And as you know, we opened a significant number of medical centers relative to that original base business in Florida and outside of Florida and centers typically can take a couple of years to breakeven. Those outside of Florida take a little longer to break even because you don't have the benefit of the scale and density. We see growth across all 3 of the buckets that you mentioned in terms of the acquisitions, regional-based business and de novos in Florida and outside of Florida, we do see improvement in important components of those businesses.

是的。因此，它還有第二年類型的成本，這些成本沒有被加回去，而是被那個數字吸收了。如您所知，相對於佛羅里達州和佛羅里達州以外的原始基礎業務，我們開設了大量醫療中心，這些中心通常需要幾年時間才能達到收支平衡。佛羅里達州以外的人需要更長的時間才能達到收支平衡，因為您無法從規模和密度中獲益。我們看到您在佛羅里達州和佛羅里達州以外的收購、區域業務和從頭開始提到的所有 3 個方面都有增長，我們確實看到這些業務的重要組成部分有所改善。

And I highlighted and Brian did as well the improvement in the underwriting margins, which you can see in the consolidated business. And you can also see the SG&A improvement and obviously, the growth in general in membership, which is driven throughout the organization. The contribution margin, however, from that growth and just looking at a current cost structures from 2022 required us to make adjustments. We are relatively unique among our peers in terms of how we generate cash with a medical center business and particularly so much of our medical centers that are below capacity.

我強調了，Brian 也強調了承保利潤率的提高，你可以在合併業務中看到這一點。您還可以看到 SG&A 的改善，顯然，會員人數普遍增長，這是整個組織推動的。然而，這種增長帶來的邊際收益以及從 2022 年開始的當前成本結構要求我們做出調整。就我們如何通過醫療中心業務產生現金而言，尤其是我們許多低於產能的醫療中心，我們在同行中相對獨特。

I would say everything with we can roughly double our membership on our medical centers without additional expense. That's how much capacity availability we have in this embedded profitability among our centers. And so we have now gotten the runway to unlock that profitability. We continue to optimize the operation. We have great overall momentum and are reviewing the different additional options that I described to further improve cash flow and liquidity as we do have highly accretive opportunities in front of us, but we are taking a rather cautious look at how we deploy cash. We want to ensure that we get to our stated goal of free cash positivity and then drive additional growth from that point.

我想說的是，我們可以在不增加費用的情況下使我們醫療中心的會員人數大致翻一番。這就是我們在中心之間嵌入的盈利能力中有多少可用容量。因此，我們現在已經獲得了釋放盈利能力的跑道。我們持續優化運營。我們的整體勢頭很好，並且正在審查我描述的不同的額外選項，以進一步改善現金流和流動性，因為我們面前確實有高度增值的機會，但我們對如何部署現金持相當謹慎的態度。我們希望確保我們達到既定的自由現金積極性目標，然後從這一點開始推動額外的增長。

Your final question comes from the line of A.J. Rice with Credit Suisse.

你的最後一個問題來自 A.J.瑞士信貸的大米。

I wonder if I could maybe just make sure we tie the knot completely around the new financing and what that gives you. I know in the last few years, there's been quite a swing in the working capital demand or needs, I guess, intra year. When you look at that $70 million to $80 million of cash usage, I wonder how much -- is there a maximum point of drawdown on some of your availability that's higher than what might be implied by that $70 million to $80 million when you look at it. It sounds like you're trying taking a lot of steps to minimize volatility in your working capital. But I wondered if you've looked at that and if you have any color on it.

我想知道我是否可以確保我們完全圍繞新融資以及它給你帶來的東西打結。我知道在過去的幾年裡，流動資金需求或需求發生了相當大的波動，我猜是在一年內。當您查看 7,000 萬至 8,000 萬美元的現金使用時，我想知道有多少 - 您的某些可用性的最大提取點是否高於您查看時 7,000 萬至 8,000 萬美元可能暗示的值它。聽起來您正在嘗試採取很多措施來最大程度地減少營運資金的波動。但我想知道你是否看過那個，上面是否有任何顏色。

And I wonder also whether there was any covenant terms in the new financing or your existing financing that are particularly acting as any kind of constraint on the business going forward that you're particularly focused on? In other words, how much leeway to move forward operationally to any covenant terms that are on these deals leave you with?

我還想知道新融資或您現有的融資中是否有任何契約條款特別對您特別關注的業務發展起到任何約束作用？換句話說，這些交易中的任何契約條款給您留下了多少操作餘地？

Yes. So I think I understand where you're going. I think the way we're looking at it is we have, depending on how you -- whether you look at whether the fourth quarter or where we just talked about in the February $180 million of liquidity to execute on the goals that Marlow laid out in a very thoughtful and deliberate way. So this is the nice part about the additional financing that we just received. And it's really the covenants within the agreement are very similar to the existing term loan covenant agreements that we have. And we -- there is a maximum limit within the covenant, but it's important to note that the definition or the calculation of that credit -- adjusted EBITDA is different and more liberal than you can get right off our financial statements. But as we look at it and we look at the projections, we expect to have sufficient headroom in our leverage ratio, given where we are now.

是的。所以我想我明白你要去哪裡了。我認為我們看待它的方式是我們有，這取決於你如何 - 無論你是看第四季度還是我們剛剛在 2 月份談到的 1.8 億美元的流動性來執行馬洛制定的目標以一種非常周到和深思熟慮的方式。所以這是關於我們剛剛收到的額外融資的好部分。實際上，協議中的契約與我們擁有的現有定期貸款契約協議非常相似。而且我們 - 契約中有一個最大限制，但重要的是要注意該信用的定義或計算 - 調整後的 EBITDA 是不同的，並且比你從我們的財務報表中得到的更自由。但當我們審視它並審視預測時，我們預計，鑑於我們現在的情況，我們的槓桿率會有足夠的空間。

Okay. Obviously, the last number of months, a lot of stuff has played out in the public domain, and you guys probably would prefer to be out of the public eyesight as much as you were. I wondered -- and maybe there's nothing to talk about here, but I at least give you a chance to comment on it. When you think about adding affiliates, adding new doctors, when you think about your relations with health plans, can you just sort of comment on how things have unfolded in recent months and whether that's had any impact on your relations or the dialogue you've had, what have you done to sort of reassure key constituencies that you're on track and everything is good.

好的。顯然，在過去的幾個月裡，很多事情都在公共領域發生了，你們可能更願意像以前一樣遠離公眾視線。我想知道——也許這裡沒有什麼可談的，但我至少給了你一個評論的機會。當你考慮增加附屬機構、增加新醫生時，當你考慮你與健康計劃的關係時，你能不能評論一下最近幾個月事情的進展，以及這是否對你們的關係或你們的對話有任何影響有，你做了什麼來讓關鍵支持者相信你已經走上正軌，一切都很好。

Well, I would say, as it relates to patients, we're serving more patients than ever and far ahead of our expectations. We continue to have the same contracts with all the major national players and going very significantly. So ultimately, it comes down to the differentiators of our business, which is our ability to serve the underserved to have scale and density in key markets, in those key areas and deliver the service and clinical quality that continues to be in very high demand.

好吧，我想說，就患者而言，我們服務的患者比以往任何時候都多，而且遠遠超出了我們的預期。我們繼續與所有主要的國內球員簽訂相同的合同，而且進展非常顯著。因此，最終，它歸結為我們業務的差異化因素，這是我們為服務不足的人提供服務的能力，以在關鍵市場、關鍵領域擁有規模和密度，並提供仍然有很高需求的服務和臨床質量。

Okay. Maybe one last technical question. I think in the prepared remarks, you said in your guidance that MCR would improve in the back half versus the first half. I think that's the whole book, but maybe MA specifically. Is that related to your reinsurance? Or is there something else you're calling out when you think about that?

好的。也許是最後一個技術問題。我想在準備好的評論中，你在你的指導中說 MCR 會在後半部分比上半年有所改善。我認為這就是整本書，但也許特別是 MA。這與你的再保險有關嗎？或者，當您想到這一點時，您是否還想說些什麼？

Yes. No, I think you are right. We're expecting that the seasonal first quarter to fourth quarter pattern that we would normally expect. There's a number of factors in there. But generally, you're going to see starting off at the high end and improving throughout the year. And so it's very consistent with what we've seen in the past.

是的。不，我認為你是對的。我們預計會出現我們通常預期的季節性第一季度至第四季度模式。這裡面有很多因素。但總的來說，你會看到從高端開始並在全年不斷改進。所以這與我們過去看到的非常一致。

And thanks, everyone, for joining, and we're here for any additional follow-up questions. And thank you, and have a good evening.

感謝大家的加入，我們在這裡回答任何其他後續問題。謝謝你們，祝你們晚上愉快。

Ladies and gentlemen, thank you for participating. This concludes today's conference call. You may now disconnect.

女士們，先生們，感謝你們的參與。今天的電話會議到此結束。您現在可以斷開連接。