CymaBay Therapeutics Inc (CBAY) 2022 Q4 法說會逐字稿

All right. Good morning. Welcome to day 3 of the Barclays Healthcare Conference, we're hitting the home stretch here. I hope everyone enjoyed the conference so far. I'm Steven Valiquette, the health care services analyst here at Barclays. So first session today will be with R1 RCM. With us from the company to my right, we have Lee Rivas, the CEO; and also Jennifer Williams, the CFO. This will be a fireside chat. So I think, with that, we'll just go ahead and dive right in. So welcome.

好的。早上好。歡迎來到巴克萊醫療保健會議的第 3 天，我們已經到了最後階段。到目前為止，我希望每個人都喜歡這次會議。我是 Steven Valiquette，巴克萊銀行的醫療保健服務分析師。所以今天的第一場會議將由 R1 RCM 主持。在我右邊的公司裡，我們有首席執行官 Lee Rivas；還有首席財務官詹妮弗威廉姆斯。這將是一場爐邊談話。所以我認為，有了這個，我們將繼續前進並直接投入。非常歡迎。

Thank you.

謝謝。

Thank you.

謝謝。

So first question here, maybe just at a high level. Lee, you've been the CEO now for a few months. Maybe just talk about some thoughts on the company thus far, sitting at the helm and the goals that you have for the year?

所以這裡的第一個問題，也許只是在一個高層次上。李，你已經擔任首席執行官幾個月了。也許只是談談到目前為止對公司的一些想法，掌舵和你今年的目標？

Sure. First of all, good morning, everyone. It's good to see some familiar faces. Let me give you my kind of first 70 or so days impressions, and that will lead to some themes we'll talk about today. First, it's a great team. The legacy R1 and Cloudmed teams are coming together. The transition is going really well, starting with Jennifer in place, new Chief Commercial Officer and so on. So that's a great positive thing. The second thing I'd say is in both the end-to-end and the modular businesses, there's a ton of opportunity. So I can relay some stories I've heard from both current customers who need us now more than ever and prospective customers. So I've been on a customer tour and met at least 1 or 2 a week, physically, not by Zoom, and so have a lot of anecdotal and fact-based insights. So the second thing is just there's a lot of demand for what we do.

當然。首先，大家早上好。很高興看到一些熟悉的面孔。讓我給你我最初 70 天左右的印象，這將引出我們今天要討論的一些主題。首先，這是一支偉大的球隊。傳統的 R1 和 Cloudmed 團隊走到了一起。過渡非常順利，從 Jennifer 到位、新任首席商務官等開始。所以這是一件非常積極的事情。我要說的第二件事是在端到端和模塊化業務中，都有大量的機會。因此，我可以轉述一些我從比以往任何時候都更需要我們的現有客戶和潛在客戶那裡聽到的故事。因此，我參加了一次客戶巡迴演出，每周至少見面 1 到 2 次，而不是通過 Zoom，而是親自見面，所以我有很多軼事和基於事實的見解。所以第二件事就是對我們所做的事情有很多需求。

The third thing I'd say is I -- Jennifer and I feel very good about the earnings power of the business, $55 billion of NPR in the end-to-end business, of which $20 billion is still in onboarding phase. So when you do the math on EBITDA over the next 3 years, you get to a very impressive number. So we both feel very good about that. The fourth theme we'll talk about a good bit today is the innovation opportunity in the business around technology. So what I get really excited about, given my background in data and analytics is not just the $55 billion of NPR, but the $900 billion of NPR that we have covered with the 500 customers at Cloudmed, and 500 million patient interactions a year, the amount of medical records and claims we see give us a huge opportunity to both apply automation across the platform and to deliver insights to customers that are more predictive to avoid the errors in claims, to avoid errors in billings and be more proactive in helping our customers.

我要說的第三件事是——詹妮弗和我對這項業務的盈利能力感到非常滿意，端到端業務的 NPR 為 550 億美元，其中 200 億美元仍處於入職階段。因此，當您計算未來 3 年的 EBITDA 時，您會得到一個非常可觀的數字。所以我們都對此感覺很好。我們今天要討論的第四個主題是圍繞技術的業務創新機會。所以我真正感到興奮的是，鑑於我在數據和分析方面的背景，不僅是 550 億美元的 NPR，而且是我們覆蓋了 Cloudmed 的 500 名客戶的 9000 億美元的 NPR，以及每年 5 億次患者互動，我們看到的大量醫療記錄和索賠給了我們一個巨大的機會，既可以在整個平台上應用自動化，也可以向客戶提供更具預測性的見解，以避免索賠錯誤，避免賬單錯誤，並更積極地幫助我們的客戶.

So those are the themes we'll talk through today. Priority wise, it's simple. One is operational execution, by far, just being very focused on delivering for our customers. Two is integration, which I would just say, as a headline, is going very well, the integration of the 2 teams. Third is technology, which we'll talk through just applying technology and automation across the business. And fourth, I haven't talked about yet, but commercial growth. So leveraging the best of both the businesses, in particular, the 500 customers at Cloudmed and 500 million patient interactions a year, the amount of medical records and claims we see give us a huge opportunity to both apply automation across the platform and to deliver insights to customers that are more predictive to avoid the errors and claims, to avoid errors in billings and be more proactive in helping our customers.

這些就是我們今天要討論的主題。優先級明智，這很簡單。到目前為止，一個是運營執行，只是非常專注於為我們的客戶提供服務。二是整合，我只想說，作為標題，兩支球隊的整合進展順利。第三是技術，我們將通過在整個業務中應用技術和自動化來討論。第四，我還沒有談到商業增長。因此，利用這兩家公司的優勢，特別是 Cloudmed 的 500 名客戶和每年 5 億名患者的互動，我們看到的大量醫療記錄和索賠為我們提供了一個巨大的機會，可以在整個平台上應用自動化並提供見解給那些更有預見性的客戶，以避免錯誤和索賠，避免賬單錯誤，並更主動地幫助我們的客戶。

So those are the themes we'll talk through today. Priority wise, it's simple. One is operational execution, by far, just being very focused on delivering for our customers. Two is integration, which I would just say as a headline is going very well, the integration of the 2 teams. Third is technology, which we'll talk through just applying technology and automation across the business. And fourth, I haven't talked about yet, but commercial growth. So leveraging the best of both the businesses, in particular, the 500 customers at Cloudmed give us both visibility into potential end to end and allow us to cross-sell the modular solutions into that 500 customer base. So those are the 4 priorities that the team is very focused on.

這些就是我們今天要討論的主題。優先級明智，這很簡單。到目前為止，一個是運營執行，只是非常專注於為我們的客戶提供服務。二是整合，作為標題，我只想說這兩個團隊的整合非常順利。第三是技術，我們將通過在整個業務中應用技術和自動化來討論。第四，我還沒有談到商業增長。因此，利用這兩家公司的優勢，特別是 Cloudmed 的 500 名客戶，讓我們能夠了解潛在的端到端，並允許我們將模塊化解決方案交叉銷售給這 500 名客戶群。所以這些是團隊非常關注的 4 個優先事項。

Okay. Great. So in our coverage of R1, investors are always focused on the sales pipeline. You touched on that a little bit in some of your opening comments. Maybe just an update on the development of the pipeline, sales activity within both the end-to-end offering and modular offerings as well?

好的。偉大的。因此，在我們對 R1 的報導中，投資者始終關註銷售渠道。你在一些開場評論中稍微提到了這一點。也許只是關於管道開發的更新、端到端產品和模塊化產品中的銷售活動？

Yes. So here's what I'd say, just as a headline, pipeline is very strong. Balanced between large systems and physician groups. And what I would add is just a couple of anecdotes on what's happening in the industry. So let me give you just 2 anecdotes. One, a large system, I just (inaudible) this earlier this week, and another from a prospective customer, Jennifer and I were on a call a month ago with a prospective customer, the themes are very similar. With a large system that has national coverage, if you will, the equation pre-COVID was pretty simple, volume growth, 2%, 3%, acuity levels, normal pre-COVID, people -- individuals coming in for elective surgery, and case mix, normal trends. And so therefore, the rough equation was volume growth a couple of percentage points, payer rate increases, let's call it, 4%, manage your cost base reasonably well. And if you're a large U.S. system, you can look at the public and you can see low single-digit operating margins.

是的。所以這就是我要說的，就像標題一樣，管道非常強大。在大型系統和醫生群體之間取得平衡。我要補充的只是一些關於該行業正在發生的事情的軼事。所以讓我給你兩個軼事。一個是一個大型系統，我剛剛在本週早些時候（聽不清），另一個來自潛在客戶，珍妮弗和我一個月前與一位潛在客戶通了電話，主題非常相似。有了一個覆蓋全國的大型系統，如果你願意的話，等式在 COVID 之前非常簡單，體積增長 2%、3%、敏銳度水平、正常的 COVID 之前，人們——前來接受擇期手術的人，以及案例組合，正常趨勢。因此，粗略的等式是數量增長幾個百分點，支付率增加，我們稱之為 4%，合理地管理你的成本基礎。如果你是一個大型美國系統，你可以看看公眾，你會看到較低的個位數營業利潤率。

What's happened during COVID or really post-COVID is inflation at 6% has turned the model a bit upside down, right? So now volume is still in the low single-digit percentage. Inflation means your nurses, doctors, administrative staff are at higher costs, whether they're current employees or you're trying to hire them. Add in labor shortage, so inability to actually go find enough people, so now you have gaps in your employee base. And then you add in this dynamic where insurance companies and payers maybe even a bit more aggressive these days than they might in other times. And you can see from all the public look at payable days and see what's happening. And you have an equation where providers are under immense pressure. So for a current customer that puts pressure on us to continue to deliver, we feel confident about our ability to deliver. It allows us to -- it pushes us on a couple of fronts to optimize revenue, whether it's through coding or accelerating cash with denials management, for example.

在 COVID 期間或真正在 COVID 之後發生的事情是 6% 的通貨膨脹率使模型有點顛倒，對吧？所以現在成交量仍然處於較低的個位數百分比。通貨膨脹意味著你的護士、醫生、行政人員的成本更高，無論他們是現有員工還是你正試圖僱用他們。加上勞動力短缺，所以實際上無法找到足夠的人，所以現在你的員工基礎存在差距。然後你加入這種動態，保險公司和付款人現在可能比其他時候更激進。你可以從所有公眾看到支付天數，看看發生了什麼。你有一個等式，供應商承受著巨大的壓力。因此，對於給我們施加壓力以繼續交付的當前客戶，我們對我們的交付能力充滿信心。它允許我們 - 它推動我們在幾個方面優化收入，例如，無論是通過編碼還是通過拒絕管理加速現金。

So that's the current customer base on what's happening on what -- where we see. With prospective customers, Jennifer, feel free to add anything. But we heard verbatim from this prospective customer, and the last few prospects I've talked to this theme. Enormous financial pressure. Our cash forecast is not where we thought it would be. We are struggling to hire people administratively, especially in our revenue cycle department. And last, but not least, we have a bunch of point solutions on the technology side. We've like dabbled in this pre-COVID, and we don't have the ability to invest at scale in technology. What can you do for us? And so that's a great opportunity for us. Did you remember anything else from that discussion?

所以這就是當前的客戶群，基於我們所看到的正在發生的事情。對於潛在客戶，Jennifer，請隨意添加任何內容。但我們從這位潛在客戶那裡逐字逐句地聽到了，以及我最近談到這個主題的幾個潛在客戶。巨大的經濟壓力。我們的現金預測不是我們想像的那樣。我們正在努力招聘行政人員，尤其是在我們的收入周期部門。最後但並非最不重要的一點是，我們在技術方面有很多點解決方案。我們就像涉足了 COVID 之前，我們沒有能力在技術上進行大規模投資。你能為我們做什麼？所以這對我們來說是一個很好的機會。你還記得那次討論的其他內容嗎？

I mean, it's the investment long term and the ability to scale and invest and ultimately, automation and being able to keep up with that.

我的意思是，這是長期投資以及擴展和投資的能力，最終是自動化並能夠跟上它。

Yes. So our talk track then, so -- but where I go, and I've gotten a lot of practice in this over the last first couple of months is, R1 is really the only scale provider that has proven we can handle a large IDN, a regional system, a physician group, a specialty group. We have -- our employees are doing the work, both in the U.S., India and Philippines. This isn't us outsourcing to someone else. And we have a proven track record through organic and inorganic investment in technology, front-end scheduling, middle, coding, back-end, billing, that can add a ton of value to you, a prospective customer. So I've been really excited about that part of my work, the fourth priority, which is growth.

是的。所以我們的談話軌道，所以 - 但我去的地方，我在過去的頭幾個月裡在這方面得到了很多實踐，R1 確實是唯一一家證明我們可以處理大型 IDN 的規模提供商，一個區域系統，一個醫師組，一個專科組。我們有——我們的員工正在美國、印度和菲律賓開展這項工作。這不是我們外包給別人。通過在技術、前端調度、中間、編碼、後端、計費方面的有機和無機投資，我們擁有可靠的記錄，可以為潛在客戶增加大量價值。所以我對我工作的那一部分感到非常興奮，第四個優先事項，即增長。

Okay. Great. Some of those anecdotes, I think, were kind of helpful. And we're thinking about the value proposition of end-to-end RCM product, and from our own survey work, we've seen an uptick in interest from providers for end-to-end solutions given existing labor pressures, but also we're seeing anecdotes around provider CapEx budgetary pressures. So I'm wondering maybe how you can reconcile those 2 trends. On the one hand, you have labor driving more interest, on the other hand, health systems with budgetary pressures, and how that impacts their decision-making process? Just if we balance out, just to get thoughts around the...

好的。偉大的。我認為，其中一些軼事很有幫助。我們正在考慮端到端 RCM 產品的價值主張，並且從我們自己的調查工作中，我們看到鑑於現有的勞動力壓力，供應商對端到端解決方案的興趣有所上升，而且我們看到有關供應商資本支出預算壓力的軼事。所以我想知道如何調和這兩種趨勢。一方面，你有勞動力推動更多的興趣，另一方面，有預算壓力的衛生系統，這如何影響他們的決策過程？只是如果我們平衡，只是為了得到周圍的想法......

Jennifer, you want to take that?

詹妮弗，你想接受嗎？

Sure. So providers are under an incredible amount of pressure and they're looking for ways to, one, increase revenue; and two, reduce cost. And our solutions can do both of those things. So on the revenue front, if we talk about our modular solutions, we are -- and most of our modular solutions come from the Cloudmed solutions. And we are able to -- we're safety net. So from a CFO's perspective, at a system, there's no implementation costs upfront. And it's -- because it's a safety net solution, they are only paying us when we provide additional value to them. So it's a contingency based model. CFOs love that. There's no risk to them. So these budgetary pressures of an investment upfront that they have to incur is not there. So that's a great way from a contracting model for us to be able to continue to win business in this environment.

當然。因此，供應商承受著巨大的壓力，他們正在尋找增加收入的方法；第二，降低成本。而我們的解決方案可以做到這兩點。因此，在收入方面，如果我們談論我們的模塊化解決方案，我們是——我們的大部分模塊化解決方案都來自 Cloudmed 解決方案。我們能夠——我們是安全網。因此，從 CFO 的角度來看，在系統中，沒有預先的實施成本。而且它 - 因為它是一個安全網解決方案，所以他們只在我們為他們提供額外價值時才付錢給我們。所以這是一個基於應急的模型。首席財務官喜歡這樣。他們沒有風險。因此，他們必須承擔的前期投資預算壓力並不存在。因此，這是我們能夠在這種環境中繼續贏得業務的承包模式的好方法。

On the labor front, there's challenges there, too. And that actually creates a lot of opportunities for us as we talked about on pipeline on the end-to-end side. So we are able to -- we know that we can do it more efficiently than a system can. It goes to technology at scale, a global, scalable workforce and we have people internationally that we can deploy. And so finding people, recruiting labor, retaining labor and managing the cost of labor becomes a very attractive model. And we can guarantee savings upfront. So as part of our operating model, we're able to give the system savings out of the gate, and we go do the work to reduce the cost on the back end, consolidating vendor contract, deploying a global workforce. Automation is a big theme that the systems can't do themselves.

在勞動力方面，也存在挑戰。當我們談到端到端的管道時，這實際上為我們創造了很多機會。所以我們能夠——我們知道我們可以比系統更有效地做到這一點。它涉及大規模技術，全球可擴展的勞動力，我們在國際上擁有可以部署的人員。因此，找人、招聘勞動力、留住勞動力和管理勞動力成本成為一種非常有吸引力的模式。我們可以保證預先節省。因此，作為我們運營模式的一部分，我們能夠在一開始就節省系統成本，然後我們開始努力降低後端成本，整合供應商合同，部署全球勞動力。自動化是系統無法自行完成的一個大主題。

So while there are pressures and there are constraints in investment, it really doesn't impact our business. It actually creates tailwinds for us.

所以雖然有壓力，有投資上的限制，但它真的不會影響我們的業務。它實際上為我們創造了順風。

Okay. All right. Great. Maybe just shifting gears here a little bit. Investors also are focused on the company's NPR onboarding capacity. Since the last number you guys gave around that was maybe a $9 billion number, but maybe I just want to -- just if you can remind investors kind of where you were exiting '22 and going into this year? And if you are able to share capacity, how you've been thinking about scaling that over the next couple of years as well, that might be great.

好的。好的。偉大的。也許只是在這裡稍微換檔。投資者還關注公司的 NPR 入職能力。由於你們給出的最後一個數字可能是一個 90 億美元的數字，但也許我只是想 - 如果你能提醒投資者你退出 22 年並進入今年的地方？如果您能夠共享容量，以及您一直在考慮如何在未來幾年內擴展它，那可能會很棒。

Sure. So we did announce last summer that we were increasing our onboarding capacity. In 2022, we won more business than we have historically. It was a historical rate for us with over $13 billion of NPR that we won in '22. And we increased our onboarding capacity to the $9 billion range. The way to think about that is of the $13 billion that we contracted in '22, we are onboarding $8 billion of that now. And the remaining $5 billion is the second half Phase II of Sutter, which we will begin onboarding at the end of this year. So that $5 billion, combined with the $4 billion that we expect that we'll win in the second half of the year, creates an additional $8 billion to $9 billion going into next year. So as far as that capacity, we believe that we need to stay at capacity for the foreseeable future. Obviously, that's one of the things we'll continue to monitor. And based on our pipeline strength, based on what we're seeing in the market, we can ramp that up, we can ramp it down, but that's what we expect to see over the next -- for '23 and expected it to '24.

當然。所以我們去年夏天確實宣布我們正在增加我們的入職能力。 2022 年，我們贏得了比歷史上更多的業務。我們在 22 年贏得了超過 130 億美元的 NPR，這對我們來說是一個歷史記錄。我們將入職能力提高到 90 億美元。考慮這一點的方法是我們在 22 年簽訂的 130 億美元合同，我們現在正在加入其中的 80 億美元。剩下的 50 億美元是 Sutter 第二階段的下半年，我們將在今年年底開始入職。因此，這 50 億美元，加上我們預計將在今年下半年贏得的 40 億美元，將為明年創造額外的 80 億至 90 億美元。因此，就產能而言，我們認為在可預見的未來我們需要保持產能。顯然，這是我們將繼續監控的事情之一。根據我們的管道實力，根據我們在市場上看到的情況，我們可以提高，也可以降低，但這是我們預計在接下來的時間裡看到的——23 年，預計會是24.

Okay. Yes, that's definitely helpful. You kind of tied into that, too. I mean, how do the ongoing technology and automation investments play a role in either increasing capacity or improving the onboarding efficiency?

好的。是的，這絕對有幫助。你也有點被束縛了。我的意思是，正在進行的技術和自動化投資如何在增加容量或提高入職效率方面發揮作用？

Sure. The simple answer is reducing the need for incremental labor. But let me go in a little deeper on a couple of things that we're doing and that I'm really excited about. The first point I'd make is in the health technology industry, one of my many learnings over the last 15 years is the more embedded you are in the customer workflow, the more opportunity you actually have to deploy technology. So for example, when we see the front end of a system and all the surrounding -- I'd say, a health system and all the surrounding or host systems, so Epic, Cerner, the billing system, the patient scheduling system, we're in the workflow.

當然。簡單的答案是減少對增量勞動力的需求。但是讓我更深入地談談我們正在做的幾件事，我真的很興奮。我要說的第一點是在健康技術行業，我在過去 15 年中學到的很多東西之一是你越深入客戶工作流程，你實際部署技術的機會就越多。因此，例如，當我們看到一個系統的前端和所有周圍——我會說，一個健康系統和所有周圍或主機系統，所以 Epic、Cerner、計費系統、病人調度系統，我們'在工作流程中。

We're seeing every step when a patient is coming in to sign in, we call it patient intake. When they're coming to register, schedule and so on. That then allows us to apply technology and automation to streamline. And then for the customer, reduces the amount of people we need to apply to that task, that process. And so hence, you see -- I visited a few of our facilities in Michigan, for example. You see the pre and post on application of technology and the number of people required to do that same task. It's no different than any other industry we all interact with as consumers, whether it's airlines and the difference today are taking it and the amount of technology you're interacting with mobile and otherwise. So that's the first point I'd make is the more embedded we are, which we are, by definition, embedded in the customer workflow and our intent, the more value we can deliver to our customers.

當病人進來簽到時，我們會看到每一步，我們稱之為病人接收。他們什麼時候來註冊、安排時間等等。這樣我們就可以應用技術和自動化來簡化流程。然後對於客戶，減少我們需要應用於該任務、該流程的人員數量。因此，你看 - 例如，我參觀了我們在密歇根州的一些設施。您會看到關於技術應用的前前後後，以及完成相同任務所需的人數。它與我們作為消費者所接觸的任何其他行業沒有什麼不同，無論是航空公司還是今天的不同之處以及您與移動設備和其他設備交互的技術數量。所以我要說的第一點是，我們越深入，根據定義，我們越深入客戶的工作流程和我們的意圖中，我們就能為客戶提供更多的價值。

The second thing I'd say is application of data and analytics is a great opportunity for us. Whether it's simple things like analytics dashboards we can deliver to a customer to identify where there are issues in denials, where there are issues in billings, what have you. And on the Cloudmed side, more specifically, when you have coverage over 50 states, all payers, all care settings, all demographics, you then have the ability to be more predictive in the application of analytics. So when you see an episode of care, any issue, knee surgery, hip surgery or a more common issue, heart or diabetic issue, and you see how that instance is coded and how that instance is reimbursed, what the charges are associated with that episode, you then can identify patterns and be more predictive and be more proactive on identifying root cause issues before they actually occur. So there's a ton of value there as well. I could go on, on this, but those are a couple of themes.

我要說的第二件事是數據和分析的應用對我們來說是一個很好的機會。無論是簡單的東西，比如我們可以向客戶提供的分析儀表板，以確定拒絕問題的地方，賬單中的問題，你有什麼。在 Cloudmed 方面，更具體地說，當您覆蓋 50 多個州、所有付款人、所有護理設置、所有人口統計數據時，您就能夠在分析應用中更具預測性。因此，當您看到一個護理事件、任何問題、膝關節手術、髖關節手術或更常見的問題、心臟或糖尿病問題時，您會看到該實例是如何編碼的以及該實例是如何報銷的，與此相關的費用是多少插曲，然後您可以識別模式並更具預測性，更主動地在問題實際發生之前識別根本原因。所以那裡也有很多價值。我可以繼續說下去，但這是幾個主題。

Okay. All right. Great. Maybe shifting gears here again. Just a further update on where the Cloudmed integration efforts stand right now, and remind us of the synergy assumptions as well for investors?

好的。好的。偉大的。也許在這裡再次換檔。只是進一步更新 Cloudmed 整合工作目前的進展情況，並提醒我們投資者的協同假設？

Can you do that?

你能做到嗎？

Yes. Overall, we're very pleased with the current progress of the integration, and we're on track with what we expected at this point in the integration. Just to go into a couple of areas on the G&A front, we've consolidated most of our back-office corporate systems, HR, finance, on the legal side, most of those systems cut over at the beginning of the year. So we're now consolidated. Those teams can start to be integrated and combine the go-forward functionality. On the commercial side, as Lee mentioned, we announced at the beginning of the year that Kyle Hicok is the new commercial officer, so he has responsibility for both the end-to-end and the modular commercial teams, making really good progress there. We've talked about the build of our pipeline and the strength of our pipeline. So we're excited about the opportunities there. And then on the technology front, there will be a lot of transformation and integration still to do through this year on the technology and product development line.

是的。總的來說，我們對整合的當前進展非常滿意，並且我們正在按照我們在整合中的預期進行。只是為了進入 G&A 方面的幾個領域，我們已經在法律方面整合了我們的大部分後台公司係統、人力資源、財務，這些系統中的大部分在今年年初進行了切換。所以我們現在合併了。這些團隊可以開始整合併結合前進的功能。在商業方面，正如 Lee 提到的，我們在年初宣布 Kyle Hicok 是新的商業官，因此他負責端到端和模塊化商業團隊，在這方面取得了很好的進展。我們已經討論了管道的構建和管道的強度。所以我們對那裡的機會感到興奮。然後在技術方面，今年在技術和產品開發線上還有很多轉型和整合要做。

We'll be using the Cloudmed platform as the basis for (inaudible) platform, and we'll be migrating to the cloud. So those activities will be happening over '23. On the operations front, there's probably been less integration of those teams and less changes there because those teams are very busy trying to onboard all of our new business, both on the modular side and on the end-to-end side. And so those teams are mostly still intact where they were prior to the acquisition. And so then, from a synergy perspective, we announced that we expect we'll realize $15 million to $30 million in '23 from a cost synergy perspective, expect to be on the high end of that range, and that's really indicative of the progress that we've made.

我們將使用 Cloudmed 平台作為（聽不清）平台的基礎，我們將遷移到雲端。因此，這些活動將在 23 年後進行。在運營方面，這些團隊的整合和變化可能較少，因為這些團隊正忙於嘗試加入我們所有的新業務，無論是在模塊化方面還是在端到端方面。因此，這些團隊在被收購之前的狀態下大部分仍然完好無損。然後，從協同效應的角度來看，我們宣布我們預計從成本協同效應的角度來看，我們將在 23 年實現 1500 萬至 3000 萬美元，預計將處於該範圍的高端，這確實表明了進展我們所做的。

Those savings will be realized quarter-over-quarter. So we expect to ramp through the year at overall...

這些節省將按季度實現。所以我們預計今年總體上會增加……

Okay. Great. Next question here kind of ties into a little bit of the comments from earlier, but I just want to come back to the Cloudmed cross-sell opportunity. I think you talked about maybe $4 billion of new end-to-end NPR coming out of the Cloudmed base by 2024. So make sure that's kind of still on track, but also just maybe spend a moment or 2 just talking about really emphasizing that cross-sell opportunity?

好的。偉大的。這裡的下一個問題有點與之前的評論有關，但我只想回到 Cloudmed 交叉銷售機會。我想你談到到 2024 年可能會有 40 億美元的新端到端 NPR 從 Cloudmed 基地出來。所以確保它仍在軌道上，但也可能花一兩分鐘來談論真正強調這一點交叉銷售機會？

Yes. So on the $4 billion, look, the end-end deals are, by definition, hard to predict. So you have to rely on the quality of the pipeline, the quality of the conversations. Jennifer and I personally being involved in every one of these discussions, we feel very good about where we are in the pipeline and the $4 billion.

是的。因此，就 40 億美元而言，根據定義，端到端的交易很難預測。所以你必須依賴管道的質量，對話的質量。 Jennifer 和我親自參與了這些討論中的每一個，我們對我們在管道中的位置和 40 億美元感到非常滿意。

The cross-sell is super interesting because you have this dynamic where -- we're in -- Cloudmed is in 95 now of the top 100 systems with at least 1 solution sold. And the last 5 are probably academic medical centers, most in the Northeast. And so by definition, those large IDNs who are looking for help are likely our customers. And our end customer is either the Head of Revenue Cycle or the CFO. And so where we feel good is we have a lot of visibility when they're remotely considering any move to end-to-end services. And then we have -- the thing I would add is, there's optionality on the model they want to deploy. Either they say, "Okay, we're not ready but we'd love to expand with the full suite of services. So I'll make this up." But today, we use your retrospective under payment services, which is essentially a claim has been filed.

交叉銷售非常有趣，因為你有這種動態 - 我們在 - Cloudmed 現在在前 100 個系統中有 95 個至少售出 1 個解決方案。最後 5 個可能是學術醫療中心，大部分在東北地區。因此，根據定義，那些正在尋求幫助的大型 IDN 很可能是我們的客戶。我們的最終客戶要么是收入周期負責人，要么是首席財務官。因此，我們感覺良好的地方是，當他們遠程考慮向端到端服務的任何轉變時，我們有很多可見性。然後我們 - 我要補充的是，他們想要部署的模型具有可選性。他們要么說，“好吧，我們還沒有準備好，但我們很樂意通過全套服務進行擴展。所以我會彌補這一點。”但是今天，我們使用您的追溯支付服務，這實際上是一個索賠已經提交。

We go find opportunity before -- after reimbursed and we go help with analytics find dollars that you didn't -- wouldn't otherwise have recovered. And this customer, for example, does not buy your front-end coding analytics services, we call DRG validation, where you identify errors in coding, specific code type, errors and charges, for example. So we just expand with that customer because that is a -- we are, by definition, a safety net. We're helping them recover cash they would not otherwise recover.

我們之前去尋找機會 - 在報銷之後我們去幫助分析找到你沒有的美元 - 否則不會恢復。例如，這個客戶不購買您的前端編碼分析服務，我們稱之為 DRG 驗證，您可以在其中識別編碼錯誤、特定代碼類型、錯誤和費用等。因此，我們只是與該客戶一起擴展，因為根據定義，我們是一個安全網。我們正在幫助他們收回他們無法收回的現金。

Or we say, make this up, we had a recent discussion with -- this week with a system, and this happens to be an academic medical center that we already do work with, with Cloudmed. And you say, okay, we understand your cost to collect. In this case, we'll just say it's $80 million. And we immediately do the math, and we know what we can probably do for them given what we take over and say there's a $12 million cost savings, and their eyes light up and say, you guys can deliver equally effective revenue recovery, billing, coding, et cetera, at a lower cost to us for a hospital system and in this case, is losing money, it's a very attractive value proposition.

或者我們說，彌補這一點，我們最近與 - 本週與一個系統進行了討論，這恰好是我們已經與 Cloudmed 合作的學術醫療中心。你說，好吧，我們了解你的收款成本。在這種情況下，我們只說它是 8000 萬美元。我們立即進行了計算，我們知道我們可以為他們做些什麼，因為我們接手了，並說節省了 1200 萬美元的成本，他們的眼睛亮了起來，說，你們可以提供同樣有效的收入恢復，計費，編碼等等，對我們來說，醫院系統的成本更低，在這種情況下，正在賠錢，這是一個非常有吸引力的價值主張。

So that is an example of having already done business, them already having a favorable impression of us leading to a potential discussion around end-to-end.

所以這是一個已經開展業務的例子，他們已經對我們產生了良好的印象，從而導致圍繞端到端的潛在討論。

Okay. Great. I think we're down to our last couple of minutes here. Maybe I want to jump to 1 or 2 questions to make sure we kind of get these in. The -- obviously, in '22, not to go relive some of the hiccups that were happening midyear, but the good news is some of that's already improving. So I wonder if you just can update on some of the improvements that are (inaudible) basically with the customer onboarding challenges because in the fourth quarter you cited expectations of a return to relative normalcy in the onboarding process by the end of the first half '23. Just want to see if you guys are able to -- probably any updates and you're still on track to hit that target?

好的。偉大的。我想我們已經到了最後幾分鐘了。也許我想跳到 1 或 2 個問題，以確保我們能夠解決這些問題。很明顯，在 22 年，不要重溫年中發生的一些小問題，但好消息是其中一些是已經改善。所以我想知道你是否可以更新一些（聽不清）基本上與客戶入職挑戰有關的改進，因為在第四季度你提到了在上半年結束時入職流程恢復相對正常的預期' 23.只是想看看你們是否能夠——可能有任何更新，你們是否仍有望實現該目標？

Yes. Look, let me touch on it and Jennifer add in any commentary. A couple of things we -- I'll just try to cover a couple of things in a short period of time. The customers we talked about in Q3 and Q4 that had some operational issues, very much on track. Both of us are personally very close to those 2. And we see both of them improving for sure by the end of the first half this year. The other topic that has come up is around payer delays. And what we see is moderate improvement year-to-date. We're seeing improvement in our own metrics around AR. We've added capacity. So it's sometimes tough to disaggregate what is days payable on the payer side versus what actions we're taking, but generally positive trends.

是的。聽著，讓我談談它，Jennifer 會添加任何評論。我們有幾件事 - 我將嘗試在短時間內介紹幾件事。我們在第 3 季度和第 4 季度談到的客戶存在一些運營問題，但進展順利。我們倆個人都非常接近那兩個。我們看到他們兩個在今年上半年結束時肯定會有所改善。另一個出現的話題是關於付款人延遲的。我們看到的是年初至今的適度改善。我們看到我們自己的 AR 指標有所改善。我們增加了容量。因此，有時很難區分付款方的應付天數與我們正在採取的行動，但總體上是積極的趨勢。

That said, we've assumed a moderate improvement in our numbers for '23, potentially could be tailwinds in '24, it's not worth it.

也就是說，我們假設 23 年的數據有適度改善，24 年可能是順風，這是不值得的。

So we saw improvement in Q3, Q4, but there's still work to do. And so we expect that we'll see improvement through the first half of this year.

所以我們在第三季度、第四季度看到了改善，但仍有工作要做。因此，我們預計今年上半年會有所改善。

Okay. Great. I mean with that, perfect timing. We are on the dot. So thank you guys for your time today and enjoy the rest of the conference.

好的。偉大的。我的意思是，完美的時機。我們是在點。所以感謝大家今天的時間，並享受會議的其餘部分。

Thanks, everyone.

感謝大家。

Thanks.

謝謝。