Clover Health Investments Corp (CLOV) 2023 Q4 法說會逐字稿

Ladies and gentlemen, good afternoon and welcome to the Clover Health fourth-quarter and full-year 2023 earnings conference call. (Operator Instructions) As a reminder, today's call is being recorded.

女士們、先生們，下午好，歡迎參加 Clover Health 第四季和 2023 年全年收益電話會議。（操作員說明）謹此提醒，今天的通話正在錄音。

I would now like to turn the call over to Ryan Schmidt, Investor Relations for Clover Health. Please go ahead, sir.

我現在想將電話轉給 Clover Health 投資者關係部門的 Ryan Schmidt。請繼續，先生。

Good afternoon, everyone. Joining me on our call today to discuss the company's fourth-quarter and full-year 2023 results are Andrew Toy, Clover Health's Chief Executive Officer; and Terry Ronan, the company's Interim Chief Financial Officer. You can find today's press release and the accompanying supplemental slides in the Investor Events and Presentations section of our website at investors.cloverhealth.com. This webcast is being recorded, and a replay will be available in the Investor Relations section of the Clover Health website.

大家下午好。今天與我一起參加電話會議的還有 Clover Health 執行長 Andrew Toy；以及該公司臨時財務長特里·羅南(Terry Ronan)。您可以在我們網站 Investors.cloverhealth.com 的投資者活動和簡報部分找到今天的新聞稿和隨附的補充幻燈片。該網路廣播正在錄製中，並將在 Clover Health 網站的投資者關係部分提供重播。

I'd also like to caution you that we may make forward-looking statements during today's call that are subject to risks and uncertainties, including expectations about future performance. Factors that may cause actual results to differ materially from expectations are detailed in our SEC filings, including in the Risk Factors section of our most recent annual report on Form 10-K and other SEC filings. Information about non-GAAP financial measures referenced, including a reconciliation of those measures to GAAP measures, can be found in the earnings materials available on our website.

我還想提醒您，我們可能會在今天的電話會議中做出前瞻性聲明，這些聲明會受到風險和不確定性的影響，包括對未來業績的預期。我們向 SEC 提交的文件中詳細介紹了可能導致實際結果與預期存在重大差異的因素，包括我們最新 10-K 表格年度報告和其他 SEC 文件的風險因素部分。有關所引用的非公認會計原則財務指標的信息，包括這些指標與公認會計原則指標的調節，可以在我們網站上提供的收益材料中找到。

With that, I'll now turn the call over to Andrew.

現在，我將把電話轉給安德魯。

Thank you, Ryan. I'm very excited to be putting the finishing touches on a very strong year of execution for Clover. We've delivered a step-change improvement in our financial performance in the same year that the greater Medicare Advantage ecosystem took a step back, which I feel proves out the power of our technology-centric model.

謝謝你，瑞安。我很高興能為 Clover 的這一非常強大的執行年做最後的工作。同年，我們的財務表現取得了顯著改善，而更大的 Medicare Advantage 生態系統卻出現了後退，我認為這證明了我們以技術為中心的模式的力量。

We are aiming to deliver a profitable adjusted EBITDA year in 2024 while continuing to invest heavily in our core technology asset, Clover Assistant. We will then be in a position to return to growth during a period where we anticipate our competitors will be retreating, and we'll aim to continually build on the strategic lead we have developed. With that, let's now walk through our 2023 performance.

我們的目標是在 2024 年實現盈利的調整後 EBITDA，同時繼續大力投資我們的核心技術資產 Clover Assistant。然後，在我們預期競爭對手將撤退的時期，我們將能夠恢復成長，我們的目標是繼續鞏固我們已建立的策略領先地位。現在讓我們回顧一下 2023 年的表現。

Beginning with our insurance results, we delivered an MCR of 82.4% in the fourth quarter of 2023, bringing our full-year MCR performance to 81.2%. This outcome maintained Clover's trend of significant year-over-year MCR improvement since 2021. I want to emphasize that I'm not referring to a couple of percentage points of improvements. In two years, we've successfully reduced our insurance MCR by approximately 25 percentage points. In 2021, our insurance MCR was 106% followed by 91.8% in 2022, and then most recently, 81.2% in 2023.

從我們的保險業績開始，我們在 2023 年第四季實現了 82.4% 的 MCR，使我們的全年 MCR 表現達到 81.2%。這一結果維持了 Clover 自 2021 年以來 MCR 逐年顯著改善的趨勢。我想強調的是，我指的並不是幾個百分點的改進。兩年內，我們成功地將保險 MCR 降低了約 25 個百分點。2021 年，我們的保險 MCR 為 106%，隨後在 2022 年為 91.8%，最近在 2023 年為 81.2%。

The significant improvement in MCR since 2022 alone has driven a 181% improvement in our per member per month Insurance gross profit, which has increased from an $87 PMPM profit in 2022 to a $245 PMPM profit in 2023. Most importantly, this step-change improvement in our insurance results have translated to a full-year 2023 adjusted EBITDA loss of $45 million, which is another significant improvement from 2022's loss of $290 million. I believe that this large improvement in gross profit and adjusted EBITDA demonstrates the rapid and outstanding progress we've made to our core business and is the result of clear focus by the Clover team.

僅自 2022 年以來，MCR 的顯著改善就推動我們每位會員每月的保險毛利潤提高了 181%，從 2022 年的 87 美元 PMPM 利潤增加到 2023 年的 245 美元 PMPM 利潤。最重要的是，我們保險業績的這種逐步改善已轉化為 2023 年全年調整後 EBITDA 虧損 4,500 萬美元，這是較 2022 年 2.9 億美元虧損的又一重大改善。我相信，毛利和調整後 EBITDA 的大幅改善體現了我們在核心業務方面取得的快速且出色的進展，也是 Clover 團隊明確關注的結果。

Over the past two years, we have focused on maturing operations, including improving processes to increase the accuracy of claims payment and the accuracy of risk adjustment. We have also focused on significantly increasing value delivered through our care management platform, underpinned by Clover Assistant and Clover Home Care, which helps us deliver proactive care management at scale and bend the cost curve for our sickest members.

過去兩年，我們專注於營運的成熟化，包括改進流程，提高理賠的準確性和風險調整的準確性。我們也致力於大幅增加透過我們的護理管理平台提供的價值，該平台以 Clover Assistant 和 Clover Home Care 為基礎，幫助我們大規模提供主動護理管理，並降低病情最嚴重的會員的成本曲線。

What's most important in my mind is that these impressive insurance results were generated within the context of a benefit-rich, wide network, PPO-first approach. We believe that this is the future of Medicare Advantage. Many in the industry have spent decades constructing their operations to manage utilization and financial performance within a narrow network HMO context.

在我看來，最重要的是，這些令人印象深刻的保險業績是在福利豐富、網絡廣泛、PPO 優先的方法的背景下產生的。我們相信這是 Medicare Advantage 的未來。該行業的許多人花費了數十年的時間來建立其運營，以在狹窄的網路 HMO 環境中管理利用率和財務績效。

While this strategy was historically successful, we now see that the landscape is shifting rapidly. In fact, PPOs are growing at over 2 times the rate of these tightly controlled HMOs over the past five years. This is a clear reflection of consumer preference for choice.

雖然這項策略在歷史上是成功的，但我們現在看到情況正在迅速改變。事實上，在過去五年裡，PPO 的成長速度是這些嚴格控制的 HMO 的兩倍以上。這清楚地反映了消費者的選擇偏好。

As industry-wide PPO penetration continues to expand from its current 43% and closer to the Clover PPO rate of 95%, we expect and already see that our peers will be confronted with increasing difficulty in managing their PPOs, especially since HMO and PPO frameworks are not easily interchangeable.

隨著全行業PPO 滲透率繼續從目前的43% 擴大到接近Clover PPO 95% 的水平，我們預計並已經看到，我們的同行在管理PPO 方面將面臨越來越大的困難，特別是自從HMO和PPO 框架出現以來不易互換。

On the other hand, we have built Clover to thrive in what we expect to be the future of the Medicare Advantage program. The investments we've made to build our care management platform and to empower more physicians with Clover Assistant technology have uniquely positioned us to deliver strong clinical and financial results within a PPO as our 2023 results show.

另一方面，我們建立了 Clover，以便在我們預期的 Medicare Advantage 計劃的未來中蓬勃發展。正如我們 2023 年的結果所示，我們為建立護理管理平台並為更多醫生提供 Clover Assistant 技術而進行的投資使我們處於獨特的地位，能夠在 PPO 內提供強勁的臨床和財務業績。

Ultimately, we believe that we are the only Medicare Advantage plan with a wide network care management model that's centered on technology-empowered physicians, and this will lead to a sustainable growth advantage over our competitors.

最終，我們相信我們是唯一擁有廣泛網路護理管理模式的 Medicare Advantage 計劃，該模式以技術賦能的醫生為中心，這將帶來相對於競爭對手的可持續增長優勢。

Another industry dynamic that I'd like to discuss is the high variance in Medicare Advantage utilization trends that have recently been in the public spotlight. Going back to the first quarter of 2023, we did experience elevated trends year over year that continued to persist through year-end.

我想討論的另一個行業動態是最近成為公眾關注焦點的 Medicare Advantage 使用趨勢的巨大差異。回到 2023 年第一季度，我們確實經歷了逐年上升的趨勢，並持續到年底。

That said, this was not unexpected in terms of our modeling for the year, particularly given year-over-year changes in member mix. To be clear, we did not see anything that we were not prepared for in terms of utilization trends during Q4. And I believe that our care management platform provides us with a unique ability to navigate any underlying shifts in industry trends.

也就是說，就我們今年的模型而言，這並不意外，特別是考慮到會員組合的逐年變化。需要明確的是，在第四季的使用率趨勢方面，我們沒有看到任何我們沒有做好準備的事情。我相信我們的護理管理平台為我們提供了獨特的能力來駕馭行業趨勢的任何潛在變化。

That all said, we do, of course, recognize that trend variances across Medicare Advantage were much wider than usual in Q4 and in other plans' 2024 outlook. As such, we have layered in additional buffer in our reserving and 2024 forecasting. For the full year 2024, we will be using a similar approach to guidance as we did last year, where we will aim to solidly improve upon our outlook throughout the year.

話雖如此，我們當然認識到，第四季度和其他計劃的 2024 年前景中 Medicare Advantage 的趨勢差異比平常大得多。因此，我們在儲備和 2024 年預測中加入了額外的緩衝。對於 2024 年全年，我們將採用與去年類似的指導方法，目標是紮實改善全年的前景。

We, therefore, are guiding to the following: revenue for the insurance line of business to be between $1.25 billion and $1.3 billion; insurance MCR to be within a range of 79% to 83%; adjusted SG&A to be between $270 million and $280 million; lastly, we expect these favorable improvements to result in a full-year 2024 adjusted EBITDA range of negative $20 million to positive $20 million, representing an improvement of approximately $45 million year over year at the break-even midpoint and a $55 million improvement at the top end of our range.

因此，我們的指導目標如下： 保險業務收入在 12.5 億美元至 13 億美元之間；保險MCR在79%至83%的範圍內；將 SG&A 調整為 2.7 億至 2.8 億美元之間；最後，我們預計這些有利的改善將導致2024 年全年調整後EBITDA 範圍為負2000 萬美元至正2000 萬美元，即在盈虧平衡中點處同比改善約4500 萬美元，在盈虧平衡點處同比改善5500 萬美元。我們產品系列的高端。

We believe that we are well positioned to deliver upon our initial outlook even as we have priced in headwinds that may be coming from broader industry utilization trends into this guidance. Put another way, if those trends do not develop, I believe we are well placed to achieve the high end of our range.

我們相信，儘管我們已將更廣泛的產業利用趨勢可能帶來的不利因素納入本指引，但我們仍處於有利地位，能夠實現我們的初步前景。換句話說，如果這些趨勢沒有發展，我相信我們有能力實現我們產品範圍的高端。

Putting industry trends aside, we have significant momentum from the continued focused efforts that we have been executing on in the last two years, which will help us deliver profitable adjusted EBITDA in 2024. This momentum includes continued R&D into Clover Assistant throughout 2023, where we expect to see impact in 2024. We also had strong Clover Home Care coverage in 2023, which we expect to benefit our MedEx control throughout 2024.

撇開產業趨勢不談，過去兩年我們持續專注的努力為我們帶來了巨大的動力，這將幫助我們在 2024 年實現盈利的調整後 EBITDA。這一勢頭包括 2023 年對 Clover Assistant 的持續研發，我們預計將在 2024 年看到影響。2023 年，我們還擁有強大的 Clover 居家照護覆蓋範圍，我們預計這將有利於我們整個 2024 年的 MedEx 控制。

On the SG&A front, we are currently executing upon our previously discussed transformation to refine and replatform insurance operations, where we disclosed last year that we would expect material savings to be enjoyed in 2024. Lastly, our 2024 AEP strategy once again focused on margin, core market retention, and revenue top line. Given this, we feel good about our member levels at mix as well as our ability to achieve our 2024 profitability goals.

在 SG&A 方面，我們目前正在執行先前討論的轉型，以完善和重組保險業務平台，我們去年曾透露，我們預計將在 2024 年實現實質節省。最後，我們的 2024 年 AEP 策略再次關注利潤率、核心市場保留率和收入。有鑑於此，我們對我們的會員水準以及實現 2024 年獲利目標的能力感到滿意。

Overall, our 2023 results represent another important milestone on our path to profitability. We believe that we are well positioned to achieve the goals we've laid out for 2024 without the need for additional capital. As our business continues to mature, we strongly believe that the moat afforded by Clover Assistant and Clover Home Care, coupled with our focus and investments to improve our stars performance, will allow us to expand our positioning from steady profitability to highly profitable growth.

整體而言，我們 2023 年的業績是我們獲利之路上的另一個重要里程碑。我們相信，我們完全有能力實現 2024 年所訂定的目標，而無需額外資金。隨著我們業務的不斷成熟，我們堅信，三葉草助手和三葉草家庭護理提供的護城河，加上我們對提高明星業績的關注和投資，將使我們能夠將我們的定位從穩定的盈利能力擴展到高利潤的增長。

With that, I'll now hand it to Terry for the more detailed financial update.

現在，我將把它交給特里，以獲取更詳細的財務更新資訊。

Thanks, Andrew. Clover Health delivered an adjusted EBITDA loss of $19 million during Q4 and a loss of $45 million for the full year, both a significant improvement over the prior period losses of $80 million and $290 million in 2022, respectively.

謝謝，安德魯。Clover Health 第四季調整後 EBITDA 虧損 1,900 萬美元，全年虧損 4,500 萬美元，均較上期虧損 8,000 萬美元及 2022 年 2.9 億美元有顯著改善。

As a reminder, at this time last year, we provided initial 2023 full-year adjusted EBITDA guidance of negative $180 million at the midpoint. We came in favorable to this initial guidance by $135 million and are obviously pleased with this result as well as the momentum this brings into 2024.

提醒一下，去年這個時候，我們最初提供的 2023 年全年調整後 EBITDA 指引為負 1.8 億美元（中點）。我們對此初步指導意見表示贊同，投資額為 1.35 億美元，顯然對這一結果以及由此帶來的 2024 年勢頭感到滿意。

For the insurance segment, MCR improved to 82.4% in Q4 from 92.4% in Q4 of last year. For the full year, insurance MCR improved by more than 10 percentage points from 91.8% in 2022 to 81.2% in 2023. Our strong MCR was paired with continued revenue growth of 12% and 14% to $303 million and $1.2 billion for Q4 and the full year 2023, respectively. We continue to realize favorable impacts from various operating initiatives during the year, and we believe our full-year MCR is a good representation of the underlying performance of the business.

對於保險領域，MCR 從去年第四季的 92.4% 提高到第四季的 82.4%。全年來看，保險MCR由2022年的91.8%提升至2023年的81.2%，提升逾10個百分點。我們強勁的 MCR 伴隨著第四季和 2023 年全年的營收持續成長 12% 和 14%，分別達到 3.03 億美元和 12 億美元。我們在這一年中繼續實現各種經營舉措的有利影響，我們相信我們的全年 MCR 很好地代表了業務的基本績效。

Our non-insurance MCR during the fourth quarter was 100.2% as compared to Q4 2022 MCR of 103.6%. Full-year 2023 non-insurance MCR of 99.8% was a better result compared to our MCR of 103.4% in 2022. Our Q4 and full-year 2023 non-insurance segment revenue each declined 68% versus the prior year periods, respectively, to $198 million in Q4 and $773 million for the full year. As a reminder, the company exited the ACO REACH program at the end of the 2023 performance year to focus more effort and resources on its core Medicare Advantage offerings.

我們第四季的非保險 MCR 為 100.2%，而 2022 年第四季的 MCR 為 103.6%。與 2022 年 103.4% 的 MCR 相比，2023 年全年非保險 MCR 為 99.8%，這是一個更好的結果。我們的第四季和 2023 年全年非保險部門營收分別較去年同期下降 68%，第四季為 1.98 億美元，全年為 7.73 億美元。謹此提醒，該公司在 2023 業績年度結束時退出了 ACO REACH 計劃，以便將更多精力和資源集中在其核心 Medicare Advantage 產品上。

Fourth-quarter adjusted SG&A was $81 million, down 4% year over year. On a full-year basis, the company reduced adjusted SG&A from $312 million in 2022 to $302 million in 2023, representing cost savings of 3% since last year. In January, we successfully transitioned over to our new MA plan operational ecosystem, which we expect will provide us with a stable back office functions and the opportunity for greater economies of scale. Beginning in 2024, this transition creates both financial cost savings for Clover beyond our 2023 performance and also allows the team to focus more specifically on what we believe to be our competitive advantages.

第四季調整後的 SG&A 為 8,100 萬美元，年減 4%。就全年而言，該公司將調整後的銷售及管理費用從 2022 年的 3.12 億美元減少到 2023 年的 3.02 億美元，比去年節省了 3% 的成本。一月份，我們成功過渡到新的 MA 計劃運營生態系統，我們預計這將為我們提供穩定的後台功能和實現更大規模經濟的機會。從 2024 年開始，這一轉變不僅為 Clover 帶來了超出 2023 年業績的財務成本節省，還使團隊能夠更加專注於我們認為的競爭優勢。

Turning to the balance sheet. We finished 2023 with restricted and unrestricted cash, cash equivalents, and investments totaling $417 million on a consolidated basis with $137 million at the parent entity and unregulated subsidiary level. This result is in line with our expectations for year-end cash and as a result of various impacts that the company has discussed in the past.

轉向資產負債表。截至 2023 年，我們的限制性和非限制性現金、現金等價物和投資總計為 4.17 億美元，其中母公司和不受監管的子公司層級為 1.37 億美元。這結果符合我們對年終現金的預期，也是公司過去討論過的各種影響的結果。

Last quarter, we received both the September and October MA payments from CMS during August, September, which happened to every MA payer, temporarily elevating our Q3 cash by $103 million of the regulated entity and consolidated book. As expected, this working capital effect normalized in Q4.

上個季度，我們在8 月、9 月期間收到了CMS 的9 月和10 月MA 付款，這發生在每個MA 付款人身上，使我們的第三季度受監管實體和合併賬簿現金暫時增加了1.03 億美元。正如預期的那樣，這種營運資金效應在第四季度正常化。

In addition, consolidated and unregulated balances were also impacted by the expected Q4 $147 million cash payment to CMS for the final settlement of the 2022 performance year related to our ACO REACH participation. Overall, we believe that our current liquidity position is strong without the need for any additional capital this year.

此外，預計第四季度向 CMS 支付 1.47 億美元現金，用於與我們參與 ACO REACH 相關的 2022 業績年度最終結算，合併和不受監管的餘額也受到影響。總體而言，我們認為我們目前的流動性狀況強勁，今年不需要任何額外資本。

Having said that, like any company, we do continue to consider opportunistic financings to increase liquidity. You can expect us to continue to prudently manage our strong liquidity position as we work to achieve 2024 profitability on an adjusted EBITDA basis.

話雖如此，與任何公司一樣，我們確實繼續考慮機會性融資以增加流動性。您可以預期我們將繼續謹慎管理我們強大的流動性狀況，並努力在調整後的 EBITDA 基礎上實現 2024 年盈利。

In summary, Clover delivered impressive progress on its path to profitability this year, a significant year-over-year improvement in its key operating metrics.

總而言之，Clover 今年在獲利之路上取得了令人矚目的進展，其關鍵營運指標較去年同期顯著改善。

Now I'll turn the call back to Andrew for some closing comments.

現在我將把電話轉回給安德魯，以徵求一些結束語。

Thanks, Terry. I hope that our comments today further portray our confidence to deliver upon our 2024 targets.

謝謝，特里。我希望我們今天的評論能進一步體現我們實現 2024 年目標的信心。

Before opening it up for Q&A, I'd like to close with my thoughts on the state of our unique care management platform, which consists of differentiated AI-powered technology with Clover Assistant and asset-light wraparound care services with Clover Home Care.

在開始問答之前，我想先談談我對我們獨特的護理管理平台現狀的看法，該平台由 Clover Assistant 的差異化人工智慧驅動技術和 Clover Home Care 的輕資產全方位護理服務組成。

We see these as entirely synergistic capabilities. We aim to care for all of our membership with CA-powered physicians in our wide network. If these members need extra support and care coordination, any Clover member can have a no-cost CA-powered visit from Clover Home Care in the comfort of their own home.

我們將這些視為完全協同的能力。我們的目標是在我們廣泛的網絡中照顧由 CA 提供支援的醫生的所有會員。如果這些會員需要額外的支援和照護協調，任何 Clover 會員都可以在自己舒適的家中享受由 Clover Home Care 提供的免費 CA 服務。

For the most vulnerable and therefore highest-utilizing members, Clover Home Care deploys a fully accountable primary and palliative care program called In-Home Care. These programs are achieving meaningful scale and results.

對於最脆弱且利用率最高的會員，Clover Home Care 部署了一項完全負責的初級和安寧療護計劃，稱為「家庭護理」。這些計劃正在取得有意義的規模和成果。

Going a little deeper on the technology platform side, you may have heard me say before that we are not building insurtech, that is we're not building software to improve the administrative functions of insurance. Rather, we are building software to improve clinical care.

在科技平台方面再深入一點，你可能之前聽過我說過，我們不是在打造保險科技，也就是說，我們不是在打造軟體來改善保險的管理功能。相反，我們正在建立軟體來改善臨床護理。

We've shared in the past that returning members who see a Clover Assistant provider have far lower MCRs than those who see a non-Clover Assistant provider. Over the last few years, we've continually made investments into the CA platform. Every day, we continue to expand upon our vastly differentiated data retrieval capabilities using our superior AI-native platform to process that data rapidly and leveraging our CA network to deploy those insights to physicians to maintain the closed loop.

我們過去曾分享過，看到 Clover Assistant 提供者的回訪會員的 MCR 遠低於看到非 Clover Assistant 提供者的會員。在過去的幾年裡，我們不斷對 CA 平台進行投資。每一天，我們都在繼續擴展我們差異化的數據檢索能力，使用我們卓越的人工智慧原生平台快速處理數據，並利用我們的 CA 網路將這些見解部署給醫生以維持閉環。

We expect these meaningful advancements in Clover Assistant's capabilities to continually improve the impact that our technology has on our business performance, and more importantly, continually improve the care that our members receive.

我們期望 Clover Assistant 功能的這些有意義的進步能夠不斷提高我們的技術對我們業務績效的影響，更重要的是，不斷改善我們的會員所獲得的護理。

Switching to Clover Home Care, in 2023, approximately 5% of our members were enrolled in our In-Home Care primary care practice, where we manage our highest-risk and highest-need members. This high-touch program was able to produce approximately $500 in net PMPM medical expense savings driven by lower spend at the end of life and reduced in-patients admissions.

到 2023 年，我們轉向 Clover Home Care，大約 5% 的會員參加了我們的家庭護理初級護理實踐，我們管理最高風險和最高需求的會員。由於臨終支出減少和住院人數減少，這項高接觸性計畫能夠節省約 500 美元的淨 PMPM 醫療費用。

Beyond primary care, Clover Home Care also provides services to approximately 23% of our population via a portfolio of programs that are also primarily home-based and Clover Assistant-driven. These programs focus on advanced illness, preventative wellness, readmission reduction and behavioral health. As an example of the efficacy of these programs, where we examine our data, we see a reduction of inpatient readmissions of approximately 25% in our readmission prevention program.

除了初級護理之外，Clover 家庭護理還透過一系列計畫為約 23% 的人口提供服務，這些計畫也主要以家庭為基礎，由 Clover 助理驅動。這些計劃著重於晚期疾病、預防性健康、減少再入院和行為健康。作為這些計劃有效性的一個例子，我們在檢查數據時發現，在我們的再入院預防計劃中，住院患者的再入院率減少了約 25%。

Bringing this all together, we aim to have as much of our population as possible have access to Clover Assistant-powered care. Between our network primary care providers, our employed primary care providers and our broader Clover Home Care efforts, our software platform was engaged in caring for over two-thirds of our population in 2023.

綜上所述，我們的目標是讓盡可能多的人獲得 Clover Assistant 支持的照護。在我們的網路初級保健提供者、我們僱用的初級保健提供者和更廣泛的 Clover 家庭護理工作之間，我們的軟體平台在 2023 年為我們超過三分之二的人口提供了護理。

As you see, the foundation of Clover Assistant and Clover Home Care uniquely positions us to manage care in a PPO context. We're delighted by the continued progress of Clover Assistant and Clover Home Care and their increasing impact on our results. Our expectation is that both of these assets will continue to pay dividends and see ROI expansion over the coming years.

如您所見，Clover Assistant 和 Clover Home Care 的基礎使我們能夠在 PPO 環境中管理護理。我們對 Clover Assistant 和 Clover Home Care 的持續進步及其對我們業績的影響越來越大感到高興。我們的預期是，這兩項資產將在未來幾年繼續支付股利並實現投資報酬率的擴大。

In summary, we are obviously proud of our results and the momentum we have built in 2023. Within our PPO-first framework, Clover operates with both member choice and access to care as the key pillars of our offering. Our tech-enabled platform allows our insurance segment to offer both amazing benefits and access as well as proactive care delivery to those who need it the most, all while delivering strong financial results.

總而言之，我們顯然對 2023 年的成果和勢頭感到自豪。在我們的 PPO 優先框架內，Clover 將會員選擇和獲得照護的機會作為我們服務的關鍵支柱。我們的技術支援平台使我們的保險部門能夠為最需要的人提供驚人的福利和機會以及主動的護理服務，同時提供強勁的財務表現。

The fact that our entire clinical management model is driven by technology is something that we believe to be a significant moat for us and something that we think bodes well for the business as we move into an AI-accelerated world.

事實上，我們的整個臨床管理模式都是由科技驅動的，我們認為這對我們來說是一條重要的護城河，當我們進入人工智慧加速的世界時，我們認為這對業務來說是個好兆頭。

With that, let's move on to Q&A.

接下來，讓我們進入問答環節。

(Operator Instructions) Jason Cassorla, Citi.

（操作員指示）Jason Cassorla，花旗銀行。

Great. Thanks. Good afternoon and congrats on the quarter. Just as it relates to the $1.25 billion to $1.3 billion of 2024 revenue and guidance, can you give us a sense on what expectations are between MA enrollment declines and perhaps the offsetting PMPM growth that's embedded in that, call it, 3% top line growth at the midpoint? Thanks.

偉大的。謝謝。下午好，恭喜本季。正如它與2024 年12.5 億至13 億美元的收入和指導相關一樣，您能否讓我們了解MA 入學人數下降與其中所包含的抵消性PMPM 增長（稱之為3% 的頂線增長）之間的預期是什麼在中點？謝謝。

Yeah. Hey, Jason. So the way that we're looking at this, as we said in the remarks, is that we have been pricing the plan and the product, I think, very appropriately. And so we expect to see PMPM improvement mainly due to the effect of member mix and returning member mix.

是的。嘿，傑森。因此，正如我們在評論中所說，我們看待這個問題的方式是，我認為我們一直在為計劃和產品定價，這是非常適當的。因此，我們預期 PMPM 的改善主要是由於會員組合和回歸會員組合的影響。

So while we are managing the plan to a little bit flat, a little bit down, growth is not our main focus right now. We do expect to see significant continued improvement through plan operations and through member mix, where we would see that PMPM revenue increase. And therefore, that one would drive that revenue number.

因此，雖然我們將計劃管理得有點平淡、有點下降，但成長並不是我們目前的主要關注點。我們確實期望透過計劃營運和會員組合看到顯著的持續改進，我們會看到 PMPM 收入增加。因此，這將推動這一收入數字。

Okay. So predominantly driving to the PMPM growth. Got it. Okay. And then just a quick follow-up here is cash generation. Just as we think about the $137 million of unregulated cash at the end of the year, should we think about break-even EBITDA expectation as a proxy for cash flow from ops in '24? And then can you give us a sense on what the potential cash outflow would look like from any settlement you're up with CMS given your full ACO REACH business exit, just including the incremental working capital unwind that may happen because you completely exited the business at this point? Thanks.

好的。因此主要推動 PMPM 的成長。知道了。好的。接下來是現金產生。正如我們思考年底有 1.37 億美元不受監管的現金一樣，我們是否應該將損益兩平 EBITDA 預期視為 24 年營運現金流的代表？然後，您能否讓我們了解一下，在您完全退出ACO REACH 業務的情況下，您與CMS 達成的任何和解中的潛在現金流出會是什麼樣子，僅包括因您完全退出業務而可能發生的增量營運資金縮減在此刻？謝謝。

Yeah. So a couple of different questions you had there, great ones. I think there's a couple of different things. Number one is, as we look at the unregulated number, I would note that a lot of our profitability means that cash is inside the regulated entity right now. And we have some operational methodologies where cash would move between those two entities was partially offsetting any outflow from the unregulated. So we feel pretty good about our unregulated cash position.

是的。你在那裡提出了幾個不同的問題，這些問題都很好。我認為有幾個不同的事情。第一，當我們查看不受監管的數字時，我會注意到，我們的大部分獲利能力意味著現金目前位於受監管實體內部。我們有一些營運方法，其中現金在這兩個實體之間流動，部分抵消了不受監管的資金外流。因此，我們對不受監管的現金狀況感到非常滿意。

Regarding ACO, we have been reducing -- we did exit last year, as everyone knows, and we have been lowering our exposure. So it's a reduced exposure that we had even in 2023, which is the last year of participation in the program. So we priced all of that into our modelling for the cash flow position, and we feel good about our unregulated cash. We feel good about where we sit on the overall liquidity. And as we said, our current goal as management is to target adjusted EBITDA profitability this year without the need for any additional capital in the unregulated NSE.

關於ACO，我們一直在減少——眾所周知，我們去年確實退出了，而且我們一直在降低我們的風險敞口。因此，即使在 2023 年（即參與該計劃的最後一年），我們的風險敞口也有所減少。因此，我們將所有這些都納入我們的現金流頭寸模型中，我們對不受監管的現金感到滿意。我們對整體流動性的狀況感到滿意。正如我們所說，我們管理層目前的目標是今年調整後的 EBITDA 獲利能力，而無需在不受監管的 NSE 中增加任何資本。

Great. Thank you. And maybe if I could just follow up one last question. I guess, first, can you give us a sense on how you approach '25 bids? And then just a follow-on to that -- and understanding that you recognize MLR improvements over time when a member is attributed to the Clover Assistant, right?

偉大的。謝謝。也許我可以跟進最後一個問題。我想，首先，您能為我們介紹一下您如何處理 '25 投標嗎？然後，這只是一個後續 - 當一個成員歸因於 Clover Assistant 時，您會隨著時間的推移認識到 MLR 的改進，對吧？

I guess, given the higher pricing you've established in your plans over the past couple of years, the 20% revenue PMPM growth in '23, the likely growth in '24, can you just give us a sense on how to think about what the profitability of a new member to Clover looks like today, especially when you do decide to flip to more membership growth aspirations? Thanks.

我想，鑑於您在過去幾年的計劃中製定了更高的定價，23 年收入 PMPM 增長 20%，24 年可能增長，您能否讓我們了解一下如何考慮如今，Clover 新會員的盈利能力如何，特別是當您決定轉向更多會員增長意願時？謝謝。

Yeah. So that's a great follow-on question, Jason. I can't do it full justice here, but the way that we think about it in a couple of different ways. On that last part, we do look carefully at our LTV-CAC equation here, and there's a couple of different dimensions.

是的。這是一個很好的後續問題，傑森。我不能在這裡完全公正地描述它，但我們可以透過幾種不同的方式來思考它。在最後一部分，我們確實仔細研究了這裡的 LTV-CAC 方程，其中有幾個不同的維度。

Given that we do expect -- publicly stated by other plans that they will be pulling back and repricing their products, we really do think that there's an opportunity for us to leverage the fact that our technology-driven approach manages our membership much better than others, we believe. And what that means is, is that we don't necessarily have to improve or increase the richness of our plans as others pull back and we will enjoy a decrease in the overall customer acquisition cost.

鑑於我們確實預計 - 其他計劃公開表示他們將撤回並重新定價其產品，我們確實認為我們有機會利用這樣一個事實：我們的技術驅動方法比其他計劃更好地管理我們的會員資格， 我們相信。這意味著，當其他人退出時，我們不一定需要改進或增加我們計劃的豐富性，我們將享受整體客戶獲取成本的降低。

The other dimension is -- and we will be sharing more information later on about the effect of Clover Assistant on that LTV-CAC equation. But I think it's a very interesting lever that we get that because we drive care through CA by pulling up those CA visits and getting people CA visits earlier, we're able to also drive new -- close that LTV-CAC equation and get the profitability on our members sooner rather than later. We haven't shared that break-even point yet, but it's something that we might share in the future.

另一個維度是——我們稍後將分享更多有關 Clover Assistant 對 LTV-CAC 方程式影響的資訊。但我認為這是一個非常有趣的槓桿，因為我們透過增加 CA 就診並讓人們更早地進行 CA 就診來推動 CA 護理，我們還能夠推動新的——關閉 LTV-CAC 方程式並獲得我們的會員帶來盈利宜早不宜遲。我們還沒有分享盈虧平衡點，但我們將來可能會分享這一點。

(Operator Instructions) Richard Close, Canaccord Genuity.

（操作員說明）Richard Close，Canaccord Genuity。

Yeah. Thanks. Congratulations on the success in '23. Andrew, maybe talk a little bit more about the higher utilization that you baked into 2024. Any more specifics that you can provide? And just how to think about the low end and the high end of the range would be helpful to adjusted EBITDA.

是的。謝謝。祝賀'23取得成功。Andrew，也許可以多談談您在 2024 年實現的更高利用率。能提供更多具體資訊嗎？如何考慮該範圍的低端和高端將有助於調整後的 EBITDA。

Yeah. Absolutely. So what we've done here, just to be clearer, is that we feel very good about the momentum, and we feel very good about the improvement in the business. We do see that others have seen this variability, as I said in my remarks. And to be clear, we are not seeing any utilization that we did not anticipate. So all -- we do have higher utilization, but we did anticipate that throughout '23, we had in the quarter for Q4, nothing that we didn't -- no surprises effectively.

是的。絕對地。因此，更清楚地說，我們在這裡所做的就是我們對這種勢頭感到非常好，並且我們對業務的改善感到非常好。正如我在演講中所說，我們確實看到其他人也看到了這種變化。需要明確的是，我們沒有看到任何我們沒有預料到的利用率。所以，我們確實有更高的利用率，但我們確實預計在整個 23 年，我們在第四季度都有，沒有什麼我們沒有的——實際上沒有意外。

So what we did when we looked at our guide for -- outside of Q4, but when we look at our guide for full year 2024 is to say, look, we feel pretty good that we could target and we would land potentially near the higher end of that range that we provided. So we guided to [negative 20 to 20]. We looked and said we could come to the higher end of that range, as I said in my remarks.

因此，當我們查看第四季度之外的指南時，我們所做的是，但是當我們查看 2024 年全年指南時，我們感覺很好，我們可以瞄準，並且我們有可能接近更高的目標我們提供的範圍的末端。所以我們引導到[負20至20]。正如我在發言中所說，我們考察並表示我們可以達到該範圍的高端。

But then we said we wanted to increase the width of that range because there may be unexpected effects systemic to the environment that others are seeing that maybe haven't hit us yet. We aren't saying that we are seeing that. We are saying that we are being prudent in managing that guidance range.

但後來我們說我們想要擴大這個範圍的寬度，因為可能會對環境產生意想不到的系統性影響，而其他人已經看到這些影響可能還沒影響到我們。我們並不是說我們正在看到這一點。我們是說，我們在管理該指導範圍時持謹慎態度。

As we have Q1, Q2 and the year develops, as we have claims run out, we expect to narrow that range and hopefully provide tighter guidance on where we end up. And again, hopefully, we will have price and everything appropriately and we will see ourselves come in on the higher end.

隨著第一季、第二季和今年的發展，隨著我們的索賠到期，我們預計會縮小這一範圍，並希望對我們的最終結果提供更嚴格的指導。再次，希望我們能有適當的價格和一切，我們會看到自己進入更高端。

Okay. That's helpful. And just how are you thinking about star ratings and improving that going forward?

好的。這很有幫助。您如何考慮星級評定並進一步提升星級評定？

Yeah. Absolutely. So one thing that I will say is that we are focused on our star rating and making sure that we are able to clearly land and execute against a 3.5 star rating and then have a pathway to 4. A couple of different things that we are able to say about our performance there.

是的。絕對地。所以我要說的一件事是，我們專注於我們的星級評級，並確保我們能夠明確地達到 3.5 星評級並執行，然後有通往 4 星評級的途徑。關於我們在那裡的表現，我們可以說一些不同的事情。

Number one is that with the two key methodology being applied last year, one thing that did come into play is these new guardrails around star ratings. What that does is while the baseline for stars did shift significantly last year, there is also significantly more predictability now and where cut points will land.

第一是，隨著去年應用了兩種關鍵方法，確實發揮作用的一件事是圍繞星級評級的這些新護欄。這樣做的目的是，雖然去年明星的基線確實發生了顯著變化，但現在以及削減點的可預測性也明顯提高了。

And I think that is advantageous to not just us but all plans in terms of having higher predictability. And that's something we're pricing into all of our star rating methodology so that we know that we can manage against that 3.5 stars and then proceed nicely towards that far 4-star level.

我認為這不僅對我們有利，而且對所有計劃都有更高的可預測性。這就是我們在所有星級評定方法中定價的內容，以便我們知道我們可以管理 3.5 顆星，然後很好地朝著 4 星的水平前進。

Second of all, I do think that when we look at star rating, it's much harder to predict your star rating when you're growing significantly. And both in '23 and '24, we have a more stable membership. And because of that more stable membership, we're able to anticipate things like star rating performance.

其次，我確實認為，當我們查看星級時，當您的星級大幅增長時，預測您的星級會變得更加困難。在 23 年和 24 年，我們的會員資格都更加穩定。由於會員資格更加穩定，我們能夠預測星級表現等事情。

These things that our net inherence denominators are more stable. And we are also able to estimate utilization and revenue more accurately because we have a more stable membership base, and we have a higher returning membership. So between those two things, we do believe we have very good line of sight into where we think things will land.

這些東西使我們的淨固有分母更加穩定。我們也能夠更準確地估計使用率和收入，因為我們擁有更穩定的會員基礎，並且我們擁有更高的會員回頭率。因此，在這兩件事之間，我們確實相信我們對我們認為事情將會發生的地方有很好的視野。

Okay. If I could slip another one in. Just you said return to growth, and I'm curious, timing of that? What exactly are you, I guess, insinuating with that comment?

好的。如果我能再塞進去一張就好了。剛才你說恢復成長，我很好奇，什麼時機？我猜你這個評論到底是在暗示什麼？

Yeah. So what we're saying there is that we absolutely have been focused on adjusted EBITDA profitability and attaining adjusted EBITDA profitability without the need for additional capital, right? And so that's been our focus. It remains our focus, and we are in striking distance of that, and I feel good about that.

是的。那麼我們所說的是，我們絕對專注於調整後的 EBITDA 盈利能力，並在不需要額外資本的情況下實現調整後的 EBITDA 盈利能力，對嗎？這就是我們的重點。這仍然是我們的焦點，而且我們距離它很近，我對此感覺很好。

That means that because that has been the priority, we have not been focused on necessarily membership growth during this period, and I think that's appropriate. I also think that that has been a good strategic move on our part because those people who really took on a lot of PPO risk and didn't have managed -- those management capabilities, I think have had seen it -- be difficult for them to manage their performance because they don't have something like Clover Assistant to provide their management capabilities on that wide network.

這意味著，因為這是我們的首要任務，所以在此期間我們並沒有專注於會員數量的成長，我認為這是適當的。我還認為這對我們來說是一個很好的戰略舉措，因為那些真正承擔了很多 PPO 風險但沒有管理的人——我認為已經看到了這些管理能力——對他們來說是困難的來管理他們的績效，因為他們沒有像Clover Assistant 這樣的東西來在廣泛的網路上提供管理功能。

Now one -- we've been focused on a lot of things in the last couple of years: maturing as a public company, maturing operation, rebaselining our PMPM servicing admin costs, loss of maturation that we've been focused on to drive that at the profitability.

現在，過去幾年我們一直專注於很多事情：作為一家上市公司的成熟、運營的成熟、重新確定我們的 PMPM 服務管理成本的基準、我們一直致力於推動這一目標的成熟度的喪失在盈利能力上。

And as we get all those boxes ticked, I think you're going to see us go through that adjusted EBITDA zero pathway, deliver profit and then stop to say to ourselves, we've matured our platform, we've matured our operations, now how do we start picking up more membership again, growing top line while still enjoying the optimizations that we've delivered in the last couple of years.

當我們滿足所有這些條件時，我想你會看到我們經歷調整後的 EBITDA 零途徑，實現利潤，然後停下來對自己說，我們已經成熟了我們的平台，我們已經成熟了我們的運營，現在我們如何開始再次獲得更多會員，增加收入，同時仍然享受我們在過去幾年中提供的優化。

Jason Cassorla, Citi.

賈森·卡索拉，花旗銀行。

Great. Thanks. I just had a couple of numbers items I want to follow up on. First, can you remind us of what the SG&A cost load was for the ACO REACH business for 2023 as we think about modelling? And then second, just if there's any prior period development inside of the 2023 MLR, that 81.2%, just so we can think about the right jump-off point for '24? Thanks.

偉大的。謝謝。我只有幾個想要跟進的數位項目。首先，您能否提醒我們在考慮建模時，2023 年 ACO REACH 業務的 SG&A 成本負荷是多少？其次，如果 2023 年 MLR 中有任何前期發展，即 81.2%，那麼我們就可以考慮 24 年的正確起點？謝謝。

Yeah. So I think there's a couple of different things. One is that you can see here in our full-year results for -- we effectively loaded our results for 2023 and maybe adjustments around SG&A there in terms of adjusted EBITDA. So you can look at our SG&A run rate and our optimizations going forward and our guide really saying that we're reducing those operations largely to zero in 2024. So hopefully, that gives you an idea of like -- of what that targeting looks like. Of course, there are onetime costs related to exiting that program, but those would have been adjusted out from the adjusted EBITDA.

是的。所以我認為有一些不同的事情。其一，您可以在我們的全年業績中看到——我們有效地加載了 2023 年的業績，也許還對調整後 EBITDA 方面的 SG&A 進行了調整。因此，您可以查看我們的 SG&A 運行率以及我們未來的優化，我們的指南實際上說我們將在 2024 年將這些運營大部分減少到零。希望這能讓您了解目標定位是什麼樣子。當然，退出該計劃會產生一次性成本，但這些成本已從調整後的 EBITDA 中扣除。

The other thing on the PPE dimension is that we generally do feel like our full-year MCR is a good proxy for our complete performance. Quarter to quarter, there are some things that flow in and out, and that's expected due to IBNR and time calculations. So normally, what we say is if you look at our full-year projections and our full-year results, those give you a good idea of what our true performance is like because those PPD effects tend to net out across the full-year basis.

PPE 維度上的另一件事是，我們通常確實認為我們的全年 MCR 可以很好地代表我們的整體表現。每個季度都會有一些東西流入和流出，這是根據 IBNR 和時間計算而預期的。因此，通常情況下，我們所說的是，如果您查看我們的全年預測和全年業績，您就會很好地了解我們的真實業績，因為這些 PPD 效應往往會在全年基礎上抵消。

(Operator Instructions)

（操作員說明）

All right. So if we have no more questions, thank you, everybody, for asking those questions. So heading into 2024, I hope that everybody gets a sense for the increasing confidence that we have in achieving our profitability on an adjusted EBITDA basis in 2024 as well as the durability of that progress, setting us up for success in future years.

好的。如果我們沒有其他問題了，謝謝大家提出這些問題。因此，進入2024 年，我希望每個人都能感受到我們對在2024 年實現調整後EBITDA 基礎上的盈利能力的信心不斷增強，以及這一進展的持久性，為我們在未來幾年取得成功奠定了基礎。

We've delivered favorable results each and every quarter this year driven by the strong unit economics of our core MA business on that PPO chassis and our differentiated care management platform that we continue to significantly invest in.

今年每季我們都取得了良好的業績，這得益於我們在 PPO 基礎上的核心 MA 業務的強勁單位經濟效益以及我們繼續大力投資的差異化護理管理平台。

So between these two things, this gives us great confidence in the trajectory of our business and our ability to succeed in the long term. We expect to continue to build upon this momentum in 2024 and I look forward to updating you all on even more progress in the future. So thank you all. Thank you.

因此，在這兩件事之間，這讓我們對我們的業務軌跡和長期成功的能力充滿信心。我們期望在 2024 年繼續保持這一勢頭，我期待著向大家通報未來更多進展的最新情況。謝謝大家。謝謝。

This concludes today's Clover Health fourth-quarter and full-year 2023 earnings call and webcast. You may disconnect your lines at this time. Have a wonderful day.

今天的 Clover Health 第四季和 2023 年全年財報電話會議和網路廣播到此結束。此時您可以斷開線路。祝你有美好的一天。