Clover Health Investments Corp (CLOV) 2025 Q3 法說會逐字稿

Hello and welcome to Clover Health's third quarter 2025 earnings call. [Operator Instructions] If you have any objections, please disconnect at this time. Ryan, you may begin.

大家好，歡迎參加 Clover Health 2025 年第三季財報電話會議。【操作員說明】如有任何異議，請立即斷開連接。瑞恩，你可以開始了。

Good afternoon, everyone. Joining me on our call today to discuss the company's third quarter 2025 results are Andrew Toy, Clover Health's Chief Executive Officer, and Peter Kuypers, the company's Chief Financial Officer.

大家下午好。今天與我一起參加電話會議，討論公司 2025 年第三季業績的有 Clover Health 的執行長 Andrew Toy 和公司財務長 Peter Kuypers。

You can find today's press release and the accompanying supplemental slides, as well as the company's most recent investor deck in the investor events and presentation section of our website at investors.cloverhealth.com.

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，以及公司最新的投資者簡報。

This webcast is being recorded and a replay will be available in the investor relations section of the Global Health website. 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.

本次網路直播正在錄製，回放將在Global Health網站的投資者關係版塊提供。我還想提醒各位，我們在今天的電話會議中可能會發表一些前瞻性聲明，這些聲明存在風險和不確定性，包括對未來業績的預期。

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 reconciliation of those measures to GAAP measures, can be found in the earnings materials available on our website. With that, I'll now turn the call over to Andrew.

可能導致實際結果與預期結果有重大差異的因素已在我們的美國證券交易委員會文件中詳細說明，包括我們最新的 10-K 表格年度報告的風險因素部分以及其他美國證券交易委員會文件中。有關文中提及的非公認會計準則財務指標的信息，包括這些指標與公認會計準則指標的調節表，可以在我們網站上提供的收益資料中找到。接下來，我會把電話交給安德魯。

Thank you, Ryan, and welcome everyone to Clover's 3rd quarter earnings call. There are 3 main areas I want to focus on today. Firstly, that our growth engine is running well, and we remain focused on growing sustainably and profitably. Secondly, taking everyone through the drivers of our lowered guidance for 2025 adjusted EPA profitability and what we're doing to address it. In short, we do see broad systemic utilization pressure, but this is also compounded by our growth. We feel we can address this, but it did hit us significantly in 2025 because of that growth.

謝謝 Ryan，歡迎大家參加 Clover 第三季財報電話會議。今天我想重點談談以下三個面向。首先，我們的成長引擎運作良好，我們將繼續專注於永續和獲利成長。其次，我們將向大家解釋我們下調 2025 年經調整的 EPA 獲利能力預期的原因，以及我們正在採取哪些措施來解決這個問題。簡而言之，我們確實看到了廣泛的系統性利用壓力，而我們的成長也加劇了這種情況。我們認為我們可以解決這個問題，但由於這種增長，它在 2025 年對我們造成了重大影響。

And thirdly, talking about our recently announced star ratings and how we intend to ensure we can grow profitably, whether at 3.5 or 4 stars. Overall, I want to say this, we missed our targets on both overall adjusted EBITDA and stars.

第三，談談我們最近公佈的星級評定，以及我們打算如何確保無論評級是 3.5 星還是 4 星，我們都能實現盈利增長。總的來說，我想說的是，我們在整體調整後 EBITDA 和星級方面均未達到目標。

While we will remain profitable and growing, these misses aren't at all acceptable to us. They do not capture our aspiration or bar for the company. We can and will make quick adjustments. The good news is that Clover assistant remains incredibly strong as our core driver. Our CA managed returning cohorts improve year over year. CA also enabled Clover to be the top PPO in the country for the second year running on core he is clinical quality scores.

雖然我們仍將保持獲利和成長，但這些失誤是我們完全無法接受的。它們沒有反映我們對公司的期望或標準。我們可以而且將會迅速做出調整。好消息是，Clover 助手作為我們的核心驅動力仍然非常強大。我們CA管理的返校學生群逐年進步。CA 也使 Clover 連續第二年成為全國頂尖的 PPO，其核心臨床品質評分最高。

The bad news is that while we did plan for growth and utilization headwinds, we clearly didn't factor those in strongly enough or manage those tightly enough in the non-CA population, which definitionally includes the new members. So those areas are where we are going to intensely refocus going into 2026, which I think is going to be a big year for Clover.

壞消息是，雖然我們確實為成長和利用率方面的不利因素做了計劃，但顯然我們沒有充分考慮這些因素，也沒有對非 CA 人群（從定義上講，這包括新成員）進行足夠嚴格的管理。因此，我們將在 2026 年重點關注這些領域，我認為 2026 年對 Clover 來說將是重要的一年。

Okay, going into more detail, for the third quarter, we've remained adjusted EBITDA profitable on a wide network while growing membership by 35% and revenue by nearly 50% year over year. That does meet our goal of profitable growth. Other plans which grew this much on the PPO have been pushed into retreat.

好的，更詳細地說，第三季度，我們在廣泛的網路覆蓋下保持了調整後 EBITDA 的盈利，同時會員數量同比增長 35%，收入同比增長近 50%。這確實符合我們實現獲利成長的目標。其他一些在PPO框架下發展如此迅速的計劃都被迫撤退。

That said, I want to note that we did originally enter this year intending to have significantly higher overall adjusted EBITDA even with the growth. Ultimately this adjusted EBITDA pressure came firstly from the higher than expected proportion of new members and the fact that we didn't bring them under management as quickly as we originally planned.

也就是說，我想指出，我們今年的初衷是即使考慮到成長，也要實現更高的整體調整後 EBITDA。最終，這種調整後的 EBITDA 壓力首先來自於新成員比例高於預期，以及我們未能像最初計劃的那樣迅速地將他們納入管理。

And secondly, we saw increased utilization across both medical expenses and supplemental benefits similar to others in the industry. I am going to focus on the 1st and Peter will discuss more on the second.

其次，我們發現醫療費用和補充福利的使用率均有所提高，這與業內其他公司的情況類似。我將重點討論第一點，彼得將更多地討論第二點。

On an adjusted EBITDA basis, our returning members continue to have a contribution profit, but this did not fully offset the dilution from our larger than expected new member growth.

以調整後的 EBITDA 計算，我們的老會員仍能帶來利潤，但這並沒有完全抵銷新會員成長超出預期所造成的利潤稀釋。

While we had anticipated this pressure from returning to growth, we captured additional market share as competitors retreated with the market disruption effectively accelerating our growth. This has led to reduced adjusted EBITDA profitability as the cost profile of 1st year members, which we see as a combination of marketing, commissions and 1st year medics, puts pressure on our results.

雖然我們預料到恢復成長會帶來這種壓力，但隨著競爭對手的撤退，市場動盪有效地加速了我們的成長，我們也獲得了額外的市場份額。由於第一年會員的成本組成（我們認為包括行銷、佣金和第一年醫務人員的費用）給我們的業績帶來了壓力，導致調整後的 EBITDA 盈利能力下降。

For the full year 2025, we now expect to add roughly 44,000 gross new members within an expected year-end 2025 population of approximately 113,000 net members. This has had a meaningful impact on our 2025 adjusted EBITA profitability as we are scaling from a relatively smaller base and new members are generally loss making for us in the 1st year.

預計到 2025 年全年，新增會員總數將達到約 44,000 人，到 2025 年底，淨會員總數將達到約 113,000 人。由於我們是從相對較小的基數開始擴大規模，而新成員在第一年通常會給我們帶來虧損，因此這對我們 2025 年的調整後 EBITA 盈利能力產生了重大影響。

That said, our cohort experience and strong historical retention demonstrates that this large new population will bring a larger contribution profit positive base of returning members in 2026 and beyond. We also expect 2025 to be the peak year for this kind of effect.

也就是說，我們以往的經驗和強大的歷史留存率表明，這龐大的新用戶群將在 2026 年及以後帶來更大的獲利基礎，即回頭客。我們也預計 2025 年將是此類效應的高峰年。

In our modeling with our latest cohort data, we expect that we will be able to continue growth and have meaningful adjusted EBITDA profitability starting in 2026. That was our goal for 2025, but we were extrapolating new member performance as this was our 1st year of significant growth.

根據我們最新的隊列資料建模，我們預計從 2026 年開始，我們將能夠繼續成長並獲得有意義的調整後 EBITDA 獲利能力。那是我們 2025 年的目標，但由於這是我們第一年實現顯著增長，所以我們是根據新成員的表現進行推斷的。

Now that we have it under our belts, we feel more confident in our views on 2026 and beyond. Ultimately, we believe the fundamentals of our business remain strong, and the margin pressure we're seeing this year is driven by cohort dynamics. Each new member represents strong long-term value but requires time to come under full Clover assistant management.

現在我們已經掌握了這些訊息，我們對 2026 年及以後的發展前景更有信心了。最終，我們相信公司業務的基本面依然強勁，今年我們看到的利潤率壓力是由群體動態變化造成的。每個新成員都代表著強大的長期價值，但需要時間才能完全接受 Clover 助理的管理。

While that dynamic compresses margins in the near term, it's exactly what we believe builds the foundation for marginal expansion and accelerated growth in the years ahead, where we anticipate rapid improvement in outcomes and cost performance in our cohorts. Said differently, our returning clover assistant managed members remain strongly profitable and are effectively funding this reinvestment in acquiring and developing new member cohorts.

雖然這種動態在短期內會壓縮利潤率，但我們相信，這正是為未來幾年的小幅擴張和加速成長奠定基礎的因素，我們預計我們的客戶群在業績和成本效益方面將迅速改善。換句話說，我們回歸的 Clover 助理管理會員仍然盈利能力強勁，並有效地為獲取和發展新的會員群體提供再投資資金。

Our confidence in Clover's trajectory is rooted in a simple truth. We believe that our model delivers better Medicare Advantage results for more seniors. Clover Assistant is designed to identify and manage disease earlier, providing a multi-year improvement to total cost of care. When paired with our care delivery assets and the close partnership of our Clover assistant using network providers, we see consistent medical cost management year over year.

我們對 Clover 發展軌跡的信心源自於一個簡單的道理。我們相信，我們的模式能為更多老年人帶來更好的聯邦醫療保險優勢計畫效果。Clover Assistant 旨在更早發現和管理疾病，從而在多年內降低總護理成本。結合我們的醫療服務資源以及與 Clover 助理和網路供應商的緊密合作，我們實現了年復一年穩定的醫療成本控制。

We are continually focused on increasing physician adoption and remain on pace with increasing our clover assistant coverage across the book, with more than half of our new members already having received a Clover assistant visit this year, which is consistent with our internal targets. The combination of strong retention, more members, more CA engaged physicians, early disease detection leads to strong returning member cohort performance and reinforces the strength of our model and our ability to help manage conditions earlier and better for our members.

我們一直致力於提高醫生對 Clover 助理的接受度，並按計劃提高 Clover 助手在所有會員中的覆蓋率，今年已有超過一半的新會員接受了 Clover 助手服務，這與我們的內部目標一致。強大的會員留存率、更多的會員、更多加州醫生的參與以及疾病的早期發現，共同促成了強大的會員群體表現，並鞏固了我們模式的優勢以及我們幫助會員更早、更好地管理疾病的能力。

Next, I'd like to discuss the current annual enrollment period. While it's too early to provide an AEP update in detail, I would preliminarily note that we remain on track to once again deliver strong above market membership growth and retention within our priority markets. These markets are the ones where we have strong CA network coverage, and existing membership base and our home care capability.

接下來，我想談談目前的年度報名期。雖然現在詳細提供 AEP 最新情況還為時過早，但我可以初步指出，我們仍有望再次在我們的重點市場實現高於市場平均水平的會員成長和留存率。這些市場是我們擁有強大的 CA 網路覆蓋範圍、現有會員基礎和家庭護理能力的市場。

Our plan offerings reflect exactly what Clover stands for low out of pocket costs, physician choice, and real value for seniors. While most of the industry is pulling back and narrowing networks, we've doubled down on maintaining a comprehensive PPO portfolio that prioritizes open access with stable, predictable benefits.

我們的計劃方案充分體現了 Clover 的理念：低自付費用、醫生選擇權以及為老年人帶來的真正價值。當業內大多數企業都在收縮和縮小網路規模時，我們卻加倍致力於維護全面的 PPO 產品組合，優先考慮開放接取和穩定、可預測的收益。

We believe seniors deserve choice, access, and simplicity, and our 2026 plans deliver all three. Turning now to star ratings, we received a 3.5 star rating for the 2026 ratings year. This does not represent our aspiration. We want a 4-star plan. That said, let me start by explaining how our model is built to perform well, even in 3.5 star payment years.

我們相信老年人應該享有選擇權、便利性和便利性，而我們的 2026 年計畫正是提供了這三點。現在來看星級評分，我們在 2026 年的評分年度獲得了 3.5 顆星的評分。這並不代表我們的期望。我們想要一個四星級的方案。也就是說，首先讓我解釋一下我們的模型是如何構建的，即使在 3.5 星支付年份也能表現良好。

Firstly, we do not view the star rating as an inhibitor for growth. Medicare eligibles are attracted to low out of pocket costs with wide physician choice and based on our experience, we anticipate strong attraction to our plans on that basis, independent of star rating.

首先，我們不認為星級評定會阻礙成長。符合醫療保險資格的人會被低自付費用和廣泛的醫生選擇所吸引，根據我們的經驗，我們預計，僅憑這一點，我們的計劃就會受到強烈歡迎，而與星級評定無關。

We also don't perceive the star rating as a true measure of overall health care quality. Our focus remains on delivering meaningful improvements in care and outcomes for our members, and one way this commitment shows up is in our heatous results.

我們也不認為星級評定是衡量整體醫療品質的真正標準。我們始終致力於為會員提供有意義的照護和治療效果改善，而我們所取得的優異成績正是這項承諾的體現。

Clover Assistant once again powered Clover to the top of the industry for clinical quality with a heated score of 4.72 for our PPO plans, making us the highest performing PPO in the country on heinous measures. This reflects the consistent data-driven care delivered through our technology and physician partnerships which continue to improve members' health in measurable ways.

Clover Assistant 再次協助 Clover 在臨床品質方面達到行業領先地位，我們的 PPO 計劃獲得了 4.72 的高分，使我們成為全國表現最佳的 PPO。這體現了我們透過科技和醫生合作提供的持續的數據驅動型醫療服務，這些服務以可衡量的方式不斷改善會員的健康狀況。

So while our focus remains on driving better patient outcomes, we believe that the current star ratings framework does not fully reflect the clinical quality of care our members receive. We continue to actively engage with CMS to advance how quality is measured and remain committed to working constructively toward a methodology that better captures true performance.

因此，儘管我們仍然專注於改善患者的治療效果，但我們認為，目前的星級評定框架並不能完全反映我們會員所獲得的臨床照護品質。我們將繼續積極與CMS合作，推動品質衡量方式的改進，並致力於建設性地努力，以期找到能夠更好地反映真實績效的方法。

Ultimately though, we want a 4-star plan. We are walking through all areas that we underperformed on and making sure that we have plans in place, plans that also incorporate the significant growth that we have had and will continue to have.

但歸根究底，我們想要的是一個四星級的方案。我們正在逐一審視所有表現不佳的領域，並確保制定相應的計劃，這些計劃也應涵蓋我們已經取得並將繼續取得的顯著成長。

For example, while we were the top rated PPO plan in the country on heat is quality, we were greatly let down on our star scores because of very low 1 and 2 star scores on our pharmacy measures. We are very focused here and are intent on improving our performance in this area going forward.

例如，雖然我們在「保暖品質」方面是全國評分最高的 PPO 計劃，但由於我們在藥房指標上的 1 星和 2 星評分非常低，我們的星級評分大打折扣。我們非常重視這方面，並決心在未來提高我們在這一領域的表現。

Now I'll provide a counterpart health update. The new organization continues to make strong progress expanding both the reach and capabilities of our technology. During Q3, we've rolled out major new capabilities such as integrated scribing and generative AI tools that help physicians better prepare for visits, reduce administrative burden, and stay focused on patient care.

現在我將提供對方健康狀況的最新報告。新組織在擴大我們技術的影響範圍和能力方面持續取得顯著進展。第三季度，我們推出了多項重大新功能，例如整合式抄寫和生成式人工智慧工具，這些工具可以幫助醫生更好地為就診做好準備，減輕行政負擔，並專注於患者護理。

Also powered by CA and as I mentioned earlier, we have achieved industry leading clinical quality he results for the second year in a row, and we have made this capability available as part of counterpart's new enterprise offering.

此外，在 CA 的支持下，正如我之前提到的，我們連續第二年取得了行業領先的臨床品質結果，並且我們已將此功能作為競爭對手新企業產品的一部分提供。

And lastly, we're seeing good demand, and so we've expanded our go to market team and leadership to support new partnership opportunities with provider groups, health systems, and both regional and national payers.

最後，我們看到了良好的市場需求，因此我們擴大了市場推廣團隊和領導層，以支持與醫療服務提供者團體、醫療系統以及區域和國家支付方建立新的合作關係。

Together these advancements further establish counterpart health as a leading technology partner for value-based care. The key for counterpart is this Since its launch last year, we have seen tremendous resonance with health plans because our technology provides a capability to them that they've never had before. This capability is to engage smaller independent doctors who typically manage around 20 to 30% of a given planned book.

這些進展共同進一步鞏固了 Comparter Health 作為以價值為基礎的醫療保健領域領先技術合作夥伴的地位。對於競爭對手而言，關鍵在於：自去年推出以來，我們看到了健康保險計劃的巨大反響，因為我們的技術為他們提供了以前從未有過的能力。這項功能旨在吸引規模較小的獨立醫生，他們通常管理特定計劃訂單的 20% 到 30% 左右。

These doctors are often great physicians, but do not have the infrastructure to be successful in value-based care, and almost no plan has a strategy to successfully engage them. Counterpart deployments have now shown in multiple states and for multiple customers that we can effectively serve this market and we have heard that resonance with our target customers.

這些醫生往往醫術精湛，但缺乏在以價值為基礎的醫療保健體系中取得成功的必要基礎設施，而且幾乎沒有醫療計劃制定了成功吸引他們的策略。目前，我們在多個州為多個客戶部署了同類產品，證明我們可以有效地服務這個市場，我們也聽到了目標客戶的共鳴。

We believe this remains a huge blue ocean opportunity for us and provides us the opportunity to bring our technology far beyond the reach of our own and operated plants. In overall summary, our long-term trajectory is unchanged.

我們相信這仍然是一個巨大的藍海機遇，讓我們有機會將我們的技術推廣到我們自己運營的工廠無法觸及的更廣泛領域。總而言之，我們的長期發展軌跡保持不變。

Our technology is scaling as we aim to empower more and more physicians with clover assistance, and we are focused on growing our profitable returning member cohorts. We anticipate having a large contribution profit positive base of returning members in 2026 and beyond, which will fund future new member growth.

我們的技術正在不斷擴展，旨在為越來越多的醫生提供 Clover 輔助，我們專注於發展盈利的回頭客群。我們預計在 2026 年及以後，回頭客會員將擁有龐大的貢獻利潤為正的基礎，這將為未來新會員的成長提供資金。

This year is just the start of that arc, and while we have several areas we need to improve, I feel strongly we are on the right path. I'll now turn it over to Peter, who will walk through our financial performance in more detail and how we're positioning the business for adjusted EBITDA profitable growth in 2026 and beyond.

今年只是這一歷程的開始，雖然我們還有一些方面需要改進，但我堅信我們走在正確的道路上。現在我將把發言權交給彼得，他將更詳細地介紹我們的財務業績，以及我們如何為2026年及以後的調整後EBITDA盈利增長做好準備。

Thank you, Andrew. Before getting into the financials, I want to reiterate Andrew's comments that we remain confident on our long-term trajectory to achieve sustained growth and expanding profitability. Despite increased utilization and margin pressure from a higher than expected mix of new members relative to our returning base, our year-to-date underlying incurred medical cost trends, excluding pharmacy for our entire population remains strong, with a 4% increase year over year.

謝謝你，安德魯。在深入探討財務狀況之前，我想重申安德魯的觀點，即我們對實現持續成長和不斷提高獲利能力的長期發展軌跡仍然充滿信心。儘管由於新會員相對於老會員的比例高於預期，導致利用率增加和利潤率壓力上升，但我們今年迄今的基本醫療成本趨勢（不包括藥房費用）依然強勁，同比增長 4%。

We are pleased with the strong cost management, but this trend has run above our initial expectations. Combined with 35% membership and 39% insurance revenue growth year-to-date, we have maintained positive year-to-date, adjusted EBITDA, and adjusted net income.

我們對強勁的成本控制感到滿意，但這一趨勢超出了我們最初的預期。今年迄今為止，會員人數增加了 35%，保險收入成長了 39%，我們維持了年初至今的正向調整後 EBITDA 和調整後淨收入。

As we move into 2026, we expect to build on our profitability base with several clear tailwinds impacting our model, including strong member retention, our anticipated larger profitable returning member cohort, financial benefit from our increased payment year 2026, 4 star rating, further enhanced and expanded clover assisted capabilities.

展望 2026 年，我們預計將在盈利基礎的基礎上，借助幾個明顯的利好因素來鞏固我們的盈利模式，這些利好因素包括：會員留存率高、預計盈利的回頭客群體規模更大、2026 年支付額增加帶來的財務收益、4 星評級以及進一步增強和擴展的 Clover 輔助功能。

Our ability to increase PCP user adoption of Clover assistant and continued operating leverage gains as we scale. We also expect to benefit from a favorable CMS Part C rate update and an increased Part D direct subsidy.

我們有能力提高 PCP 用戶對 Clover 助手的採用率，並在規模擴大的同時持續獲得營運槓桿收益。我們也期望受益於 CMS C 部分費率的有利調整和 D 部分直接補貼的增加。

Taken altogether, we believe that Clover is well positioned for above market growth and increasing profitability through 2026 and beyond. Most importantly, we expect to benefit from the strength of Clover assistance and our returning member cohort management.

綜上所述，我們認為 Clover 已做好充分準備，將在 2026 年及以後實現高於市場平均的成長和不斷提高的獲利能力。最重要的是，我們期望能夠受益於 Clover 的強大支持和我們回歸成員群體的管理。

As this year's large group of new members mature into returning members in 2026. Our data has shown meaningful improvements as members mature within our care model, with roughly a 700 basis point improvement in MCR between year one and year two cohorts, and a 1,400 basis point MCR improvements by year three on average.

今年的大批新成員將在 2026 年成長為回歸成員。我們的數據顯示，隨著成員在我們護理模式中的成長，情況有了顯著改善，第一年和第二年隊列的 MCR 大約提高了 700 個基點，到第三年平均提高了 1400 個基點。

Notably, we deliver more contribution profit from our profitable returning member cohorts than our new member cohorts. Returning member cohorts during the 3rd quarter year-to-date 2025 period have generated approximately $217 of contribution profit per member per month as compared to a negative contribution of $110 per member per month for the new member cohorts respectively.

值得注意的是，我們從獲利的老會員群體中獲得的貢獻利潤比從新會員群體中獲得的利潤更多。截至 2025 年第三季度，回歸會員群體每月每位會員貢獻的利潤約為 217 美元，而新會員群體每月每位會員的貢獻為負 110 美元。

For this reason, as new members mature into returning cohorts and we get more members in the Clover assistant powered care, we are confident to deliver strong financial performance in the coming years. We also have conviction in our ability to deliver continued strong returning me retention in 2026.

因此，隨著新成員逐漸成長為回頭客，並且我們在 Clover 助手支持的護理服務中獲得更多成員，我們有信心在未來幾年取得強勁的財務業績。我們也堅信，在 2026 年，我們能夠持續保持強勁的客戶留存率。

First, due to the continued industry disruption from competitor pullbacks that Andrew discussed. And secondly, we believe that our current 2025 retention rate remains industry leading above 90%. Reflecting the success of last year's AAP period and our ability to continually retain members.

首先，正如 Andrew 所討論的，由於競爭對手撤退造成的持續產業混亂。其次，我們相信我們目前的 2025 年客戶留存率仍將保持在 90% 以上的行業領先水準。這反映了去年 AAP 期間的成功以及我們持續留住會員的能力。

Both of these dynamics together reinforce our confidence to better manage next year's membership mix and continue improving profitability as our cohorts mature under Clover Assistant Care Management.

這兩種動態共同增強了我們的信心，使我們能夠更好地管理明年的會員組成，並在 Clover 助理護理管理下，隨著會員群的成熟，繼續提高盈利能力。

Furthermore, a model is designed to perform profitably even in 3.5 star payment years. With 4 star years serving as upsides rather than a dependency. We continue to see strong memory demand for our wide network PPO offerings with low out of pocket cost, and our heated score of 4.72 demonstrates that Clover system consistently drives top tier clinical quality and outcomes across an open access PPO network.

此外，該模型的設計目標是即使在 3.5 星級付款年份也能獲利。4 年的輝煌成就成為優勢而非依賴。我們持續看到市場對我們覆蓋廣泛網路的 PPO 產品（自付費用低）的強勁記憶體需求，而我們 4.72 的高分錶明，Clover 系統在開放式 PPO 網路中持續推動著一流的臨床品質和結果。

Taken in aggregate, driven by Clover assistance and our differentiated model, our current view is that we expect to achieve full year positive GAAP net income in 2026 as our maturing returning member cohorts and our technology centered approach further enhance performance and expand margins.

綜合來看，在 Clover 的協助和我們差異化模式的推動下，我們目前的看法是，隨著我們成熟的回歸會員群體和我們以技術為中心的策略進一步提高業績並擴大利潤率，我們預計將在 2026 年實現全年正的 GAAP 淨收入。

Now returning to the third quarter financials, Clover's Medicare Advantage membership grew 35% year over year to over 109,000 members, delivering insurance revenue of $479 million an increase of 49% year over year.

現在回到第三季財務數據，Clover 的 Medicare Advantage 會員人數年增 35%，超過 109,000 名會員，保險收入達 4.79 億美元，年增 49%。

The year-to-date insurance revenue was $1.4 billion up 39% year over year. Next, I'll discuss the margin pressure we observed in the third quarter. Despite an elevated utilization trends and more new members compared to expectations, a year-to-date underlying incurred medical cost trends excluding pharmacy for our entire population remains strong with a 4% increase year over year.

今年迄今的保險收入為 14 億美元，年增 39%。接下來，我將討論我們在第三季觀察到的利潤率壓力。儘管醫療資源利用率上升，新增會員數量也超出預期，但今年迄今，不包括藥品費用在內的全體人口醫療成本基本發生趨勢依然強勁，同比增長 4%。

On an adjusted EBITA basis, returning members continue to be accretive to contribution profit. Although this impact was partly offset by a negative contribution profit from our new member cohort, impacting this trend is stronger than anticipated intra-year new member growth, as we are expecting to absorb more than 44,000 gross new members this year from a relatively smaller returning member base.

按調整後的 EBITA 計算，回歸成員繼續為貢獻利潤做出貢獻。儘管新會員群體帶來的負收益部分抵消了這一影響，但對這一趨勢的影響比預期中的年內新會員增長更為顯著，因為我們預計今年將從相對較小的回歸會員群體中吸收超過 44,000 名新會員。

The stronger growth was impacted by other plans dramatically shifting their offerings in 2025. By reducing benefits, shutting down commissions, and fully exiting markets earlier this year. Resulting in lower new member core performance than initial expectations.

更強勁的成長受到其他計劃在 2025 年大幅調整其產品和服務的影響。透過減少福利、停止佣金以及在今年稍早完全退出市場。導致新成員核心績效低於預期。

Specifically, medical costs in the third quarter were impacted from unfavorable claims development related to the first half of 2025 data service. we saw higher medical cost trends across inpatient and outpatient services.

具體而言，第三季的醫療成本受到與2025年上半年數據服務相關的不利索賠發展的影響。我們看到住院和門診服務的醫療成本均呈現上升趨勢。

Related to a number of high cost claims, outpatient oncology, and inpatient cardiac and surgical procedures. This is consistent with broader industry reports related to elevated hospital utilization in recent months. Importantly, we feel that we have adequately accounted for these trend developments in our updated 2025 guidance.

與多起高額索賠、門診腫瘤治療以及住院心臟和外科手術有關。這與近幾個月來醫院使用率上升的行業報告一致。重要的是，我們認為我們在更新後的 2025 年業績指引中已充分考慮了這些趨勢發展。

Turning now to Part D. Comparing year for year performance is structurally difficult given the changes in the IRA this year. That sets the continued Part D pressures that we and others in the industry discussed last quarter are higher versus expectations. We feel that we perform well on Part D this year, but we expected.

現在來看D部分。鑑於今年IRA的變化，逐年比較業績在結構上是困難的。這表明，正如我們和業內其他人士上個季度討論的那樣，D 部分的壓力持續高於預期。我們感覺今年在D部分錶現不錯，但這也在意料之中。

And intends to do better. In particular, we have seen pressure in branded and non-formulary pharmacy spends. For this reason, we have launched ongoing initiatives around medication reconciliation, generic substitution, and care coordination to optimize Part D in 2026 while maintaining access, and we feel confident that next year's higher Part D direct subsidy will also help normalize the pressures across the industry.

並打算做得更好。尤其值得注意的是，品牌藥和非處方藥的支出都面臨壓力。因此，我們啟動了一系列持續性舉措，包括藥物調和、仿製藥替代和護理協調，以在 2026 年優化 D 部分，同時保持醫療服務的可及性。我們相信，明年更高的 D 部分直接補貼也將有助於緩解整個產業面臨的壓力。

And lastly, we've seen some abnormal activity within both dental and DME that we're actively addressing and pursuing recovery and improvement activities for. We do not believe that this abnormal activity will persist into 2026.

最後，我們發現牙科和耐用醫療設備領域出現了一些異常情況，我們正在積極應對，並尋求恢復和改進措施。我們認為這種異常活動不會持續到 2026 年。

On a reported basis, year-to-date, BER was 89.4%. This is a year over year increase of 880 basis points compared to the prior year period. That said, I want to emphasize that after normalizing for prior year developments in both reporting periods, the year-to-date BER increased by 400 basis points.

據報告，今年迄今為止，誤碼率 (BER) 為 89.4%。與上年同期相比，年增880個基點。儘管如此，我還是要強調，在對兩個報告期間內的上一年發展情況進行正常化處理後，年初至今的預期收益比增加了 400 個基點。

Moving next to SG&A. We continue to execute well with cost discipline, generating strong operating leverage. Third quarter adjusted SG&A totaled $71 million or 14% of revenue, representing a 440 basis point improvements or reduction year by year.

接下來是銷售、管理及行政費用。我們繼續保持良好的成本控制，從而產生強大的營運槓桿。第三季調整後的銷售、一般及行政費用總計 7,100 萬美元，佔營收的 14%，較上年同期改善或減少 440 個基點。

The year-to-date adjusted SG&A was $237 million or 17% of revenue, improving 370 basis points year over year. as discussed previously, our ongoing veer contract reviews and negotiations with a focus on improved SLAs and benefits from pricing at scale are continuing.

截至目前，經調整後的銷售、管理及行政費用為2.37億美元，佔營收的17%，年減370個基點。如同先前所述，我們正在繼續進行Veer合約審查和談判，重點是改善服務等級協議（SLA）和規模化定價帶來的收益。

Our progress highlights the operating leverage we are achieving even as we continue to invest in growth, technology, and higher quality care management. Despite the aforementioned margin pressures, we have achieved both positive adjusted EBITDA and positive adjusted net income year-to-date.

我們的進展凸顯了我們在持續投資於成長、技術和更高品質的護理管理的同時，所取得的營運槓桿效應。儘管面臨上述利潤率壓力，但我們今年迄今已實現正的調整後 EBITDA 和正的調整後淨利潤。

This underscores the resilience of our model and our ability to manage costs effectively while scaling the business. Both adjusted EBITDA and adjusted net income for the 3rd quarter were $2 million each down $17 million year over year.

這凸顯了我們模式的韌性以及我們在擴大業務規模的同時有效控製成本的能力。第三季調整後 EBITDA 和調整後淨利潤均為 200 萬美元，年減 1,700 萬美元。

The year-to-date, adjusted EBITDA and adjusted that income remain positive at $45 million and $0.44 million dollars respectively. a year-to-date adjusted a bit of profitability, despite the higher proportion of new members relative to returning members, underscores the capability of our model and our disciplined execution in managing our strong returning cohorts.

截至目前，經調整後的 EBITDA 和經調整後的利潤分別維持在 4,500 萬美元和 44 萬美元的正值。儘管新會員相對於老會員的比例較高，但截至目前經調整後的盈利能力依然略有提升，這凸顯了我們模式的有效性以及我們在管理強大的老會員群體方面所採取的嚴格執行措施。

That said, we do expect the elevated trend we've experienced during the 3rd quarter to continue in the 4th quarter along with typical 4th quarter Medicare Advantage seasonality.

也就是說，我們預期第三季出現的成長趨勢將在第四季持續保持，同時也會受到第四季醫療保險優勢計畫季節性波動的影響。

Moving on to the balance sheet, we ended the third quarter with cash equivalents and investments totaling $396 million on a consolidated basis with $122 million at the unregulated subsidiary level.

接下來來看資產負債表，截至第三季末，我們合併後的現金等價物和投資總額為 3.96 億美元，其中非監管子公司層面的現金等價物和投資總額為 1.22 億美元。

During the third quarter of 2025, cash flow from operating activities was $12 million. we expect that our cash balances will remain strong for the remainder of 2025, which will allow us to continue to operate for a position of strength as we invest in our growth model in 2026 and beyond.

2025年第三季度，經營活動產生的現金流量為1200萬美元。我們預計2025年剩餘時間內現金餘額將保持強勁，這將使我們能夠繼續保持穩健的營運狀況，並在2026年及以後投資於我們的成長模式。

Importantly, we believe that we will continue to be self-funding as we execute on our growth strategy. Turning to guidance, we are revising a full year 2025 outlook to reflect the membership growth and utilization trends we've seen year-to-date.

重要的是，我們相信在執行成長策略的過程中，我們將繼續實現自籌資金。展望未來，我們將修訂 2025 年全年展望，以反映我們今年迄今看到的會員成長和使用趨勢。

We are increasing our Medicare advance membership guidance to now average between 106 and 108,000 members, reflecting 33% growth year every year at the midpoints and continued intra-year growth this year. we are increasing our insurance revenue guidance to be between $1 billion and $850 million and $1880 million reflecting year for year growth of 39% at the midpoint of the range.

我們將聯邦醫療保險（Medicare）預付費會員人數預期上調至平均10.6萬至10.8萬人，這意味著每年增長率將達到33%（取中間值），今年也將維持年內成長。同時，我們將保險收入預期上調至10億美元至8.5億美元和18.8億美元之間，這意味著每年成長率將達到39%（取中間值）。

We are improving our adjusted SG&A guidance to be between $325 million and $335 million. This represents adjusted SG&A as a percentage of total revenue of 17% to 18% and is an approximate 400 basis points decrease or improvements year over year at the midpoint of the range. This reflects our continued ability to gain operating leverage in our business as we grow.

我們將調整後的銷售、一般及行政費用預期提高至 3.25 億美元至 3.35 億美元之間。這表示調整後的銷售、一般及行政費用佔總收入的 17% 至 18%，以該範圍的中點計算，與上年相比下降或改善約 400 個基點。這反映了隨著業務成長，我們持續獲得營運槓桿的能力。

We are lowering both adjusted EBITA and adjusted netcom guidance to be between $15 million and $0.30 million dollars. This primarily reflects pressures related to our greater proportion of new members relative to our returning member base and higher utilization trends.

我們將調整後的 EBITA 和調整後的淨利潤預期均下調至 1,500 萬美元至 30 萬美元之間。這主要反映了新會員相對於老會員比例較高以及會員使用率上升所帶來的壓力。

Lastly, we are updating our insurance BER guidance to a range of 90% to 91%, which reflects the elevated utilization trends we've seen this year, as well as the impact of our strong new membership growth. Our view of the long-term trajectory of the business and our confidence in our ability to achieve sustainable and increasing profitability is unchanged.

最後，我們將保險業務預期收益 (BER) 指導值更新為 90% 至 91%，這反映了我們今年看到的較高利用率趨勢，以及強勁的新會員成長的影響。我們對公司長期發展軌蹟的看法以及我們實現可持續成長的獲利能力的信心沒有改變。

We expect a meaningful increase in profitability in 2026. Driven by multiple factors. First, we anticipate strong returning member retention with continued improved cohort economics of our expected larger profitable returning member cohorts along with continued favorable performance from a year 3 and all the cohorts.

我們預計2026年獲利能力將顯著提高。受多種因素驅動。首先，我們預計隨著預期中規模更大、盈利能力更強的回頭客群體經濟效益的持續改善，以及從第三年開始所有群體持續取得良好業績，回頭客的留存率將保持強勁。

Second, a 4-star payment year for PPO plans creates meaningful financial tailwinds as approximately 97% of our members are enrolled in wide network PPO offerings. Third, continued focus on increasing clover assistant coverage and PCP adoption and further investing in enhancing the platform's capabilities.

其次，PPO 計劃的 4 星付款年度將帶來顯著的財務利好，因為我們約 97% 的會員都參與了覆蓋廣泛的 PPO 服務。第三，繼續專注於提高 Clover Assistant 的覆蓋範圍和 PCP 的採用率，並進一步投資以增強該平台的功能。

Fourth, a focus on more cost efficient growth channels. Fifth, a favorable impact from the Part C, CMS final rate notice announced earlier this year, as well as from the significantly higher Part D direct subsidy.

第四，重點關注更具成本效益的成長管道。第五，今年稍早公佈的 C 部分 CMS 最終費率通知以及大幅提高的 D 部分直接補貼都產生了有利影響。

Lastly, we expect incremental efficiencies from continued SG&A leverage and optimization across variable, fixed, and growth expense categories. In summary, we continue to execute well against our long-term strategy. We are growing membership and revenue at an above market pace while achieving adjusted EA profitability year-to-date. Combined with a strong returning member cohort performance.

最後，我們預期透過持續利用銷售、管理及行政費用槓桿和優化變動費用、固定費用和成長費用類別，將逐步提高效率。總而言之，我們繼續很好地執行我們的長期策略。我們的會員數量和收入成長速度均高於市場平均水平，同時實現了今年迄今調整後的EA獲利能力。再加上老會員群的優異表現。

Clover system model differentiation. and multiple tailwinds, we believe that clover is positioned well for meaningful adjusted EBITDA expansion in 2026 and beyond. Now I'll turn the call back to Andrew for closing comments.

憑藉 Clover 系統模型的差異化以及多項利好因素，我們相信 Clover 已做好充分準備，在 2026 年及以後實現顯著的調整後 EBITDA 增長。現在我把電話轉回給安德魯，請他做總結發言。

In closing, despite margin pressure this year, we continue to deliver a stable underlying medical trend, high retention and strong returning profitable member cohorts.

總之，儘管今年利潤率面臨壓力，但我們仍然保持著穩定的基本醫療趨勢、高留存率和強勁的獲利會員群。

As such, we remain comfortable with our go forward medical cost trend heading into 2026 and feel confident to deliver continued profitability as our flywheel will spin even harder next year when we expect to have a larger returning member base managed by Clovers assistant.

因此，我們對 2026 年的醫療成本趨勢仍然感到滿意，並且有信心繼續盈利，因為明年我們預計會有更多會員回歸，由 Clovers 助理管理，屆時我們的成長動力將更加強勁。

Importantly, Clover Assistant continues to perform exactly as designed, helping physicians identify and manage disease earlier, improving outcomes and lowering costs over time.

重要的是，Clover Assistant 繼續按照設計運行，幫助醫生更早發現和管理疾病，隨著時間的推移改善治療效果並降低成本。

I remain excited about the potential we see for AI to improve the care received by our Clover members and all Medicare beneficiaries. I recently testified to Congress on AI in healthcare, where I emphasize that AI, when used properly, can be a powerful tool to drive clinical results and enhance members' access to personalized care.

我對人工智慧在改善 Clover 會員和所有 Medicare 受益人所獲得的護理方面的潛力仍然感到興奮。我最近就人工智慧在醫療保健領域的應用向國會作證，我強調，如果使用得當，人工智慧可以成為推動臨床結果和增強成員獲得個人化照護的強大工具。

You can see this in our results. We recently published another clinical white paper highlighting how Clover Assistant helps PCPs provide better care for members in underserved communities. The analysis reveals more frequent identification of diabetes, CKD, COPD, and CHF among members from disadvantaged areas joining a Clover MA plan from another MA plan in the 1st year post-enrollment.

這一點可以從我們的結果看出。我們最近發布了另一份臨床白皮書，重點介紹了 Clover Assistant 如何幫助初級保健醫生為服務不足社區的成員提供更好的護理。分析顯示，在加入 Clover MA 計劃的第一年，來自弱勢地區的會員從其他 MA 計劃轉入該計劃後，糖尿病、慢性腎病、慢性阻塞性肺病和充血性心臟衰竭的診斷率更高。

We also see the diagnosis occur at earlier clinical stages of diabetes and CKD. The analysis also showed that members of any of these diseases of aging who were seeing CAPCPs had less frequent hospitalizations and readmissions.

我們也發現，在糖尿病和慢性腎臟病的早期臨床階段就出現了診斷結果。分析還表明，患有這些老年疾病並接受 CAPCP 治療的患者住院和再入院的頻率較低。

These results reinforce that Clover assistant not only helps improve outcomes across our plan, but also uniquely supports smaller resource constrained practices in both urban and rural underserved regions where better data and coordinated care can make the greatest difference.

這些結果進一步證實，Clover 助理不僅有助於改善我們計劃中的各項成果，而且還能獨特地支持城市和農村服務不足地區資源有限的小型診所，在這些地區，更好的數據和協調的護理可以發揮最大的作用。

Taken together, our strong growth, cohort management, disciplined execution, and expanding technology capabilities give us confidence in our ability to continue to achieve profitability in 2026 and beyond while growing above market. With that, let's open it up for questions.

綜合來看，我們強勁的成長動能、客戶群管理、嚴謹的執行以及不斷擴展的技術能力，使我們有信心在 2026 年及以後繼續實現盈利，同時實現高於市場平均水平的增長。那麼，接下來就進入提問環節。

Thank you. At this time, if you'd like to ask a question [Operator Instructions] Our first question will come from Jonathan Yong from UBS. Please unmute and ask your question.

謝謝。此時，如果您想提問[操作員說明]我們的第一個問題將來自瑞銀集團的Jonathan Yong。請取消靜音並提出您的問題。

Obviously you got the elevator utilization, the quarter. Last quarter you had pharmacy and dental issues, and now it's inpatient, outpatient, alongside other supplemental benefits. I'm trying to frame out how we should think about 2026 from a BER perspective. Like I understand that the stars will be better.

顯然，你已經獲得了電梯利用率，也就是季度數據。上個季度您遇到了藥物和牙科的問題，現在又出現了住院、門診以及其他補充福利方面的問題。我正在嘗試從 BER 的角度來建立我們應該如何看待 2026 年的框架。我覺得星星會變得更漂亮。

These cohorts will mature, but at the same time you're also going to grow what seems to be fairly significant, and I'm fairly certain your benefits have gotten richer. So how do you plan on, did, is there a missed pricing issue that that may have occurred for 2026 given what's occurring here, or are you fairly confident that this is encapsulated in your bids and that you won't see a problem in 206 given what you're kind of experiencing now with outsize growth and that seems to be the driver of the pressure here.

這些群體將會成熟，但同時，你也將獲得相當可觀的收益，而且我相當肯定你的收益也變得更加豐厚。那麼，鑑於目前的情況，您打算如何應對？是否存在可能在 2026 年出現的定價問題？或者您是否相當有信心，這些問題已經包含在您的報價中，並且鑑於您目前經歷的超額增長（這似乎是造成壓力的原因），您在 2026 年不會遇到問題？

Hey Jonathan, it's Peter. Let me let me answer that question. So if you look at our earnings release and the remarks on a normalized basis, excluding prior year PPD, the underlying incurred cost trends, excluding pharmacy is around 4%.

嗨，喬納森，我是彼得。讓我來回答這個問題。因此，如果您查看我們的收益報告和正常化基礎上的評論，不包括上一年的 PPD，則基本發生的成本趨勢（不包括藥房）約為 4%。

And so given the higher utilization trend that we see and also the higher mix of new members, we think that is a solid performance now. We, like we said in the prepared remarks, we had expected to do better, so we will work on that for next year, we would say that that cost trend roughly is baked into the into the bid as well, but that's just one part, right? We have a number of other il winds as well as the 4 star payment year.

因此，鑑於我們看到的更高的利用率趨勢以及更高的新成員比例，我們認為目前這是一個穩健的表現。正如我們在準備好的演講稿中所說，我們原本期望做得更好，所以我們明年會努力改進。我們認為成本趨勢也大致反映在了投標中，但這只是其中一部分，對吧？我們還有其他一些 il winds 以及 4 星級付款年。

A debate notice on Part C. And of course the direct subsidy as well on on part D. So plus that SG&A increase la. It does not impact BER of course, but so we feel that has baked in into our bids and then also I would also say like we said in the past.

關於C部分的辯論通知。當然還有D部分的直接補助。再加上銷售、管理及行政費用的成長。當然，這不會影響誤碼率 (BER)，但我們覺得這已經體現在我們的報價中了，而且我也想說，就像我們過去說過的那樣。

We're nuclear precise of where we do our marketing and target our growth. We're focusing on so-called priority markets that meet a couple of conditions. One where we have a solid.

我們對行銷和成長目標的定位非常精準。我們專注於符合若干條件的所謂優先市場。一個我們擁有堅實基礎的地方。

Clover member base already. We also have those priority markets could coverage from the Clover system perspective and home care perspective as well. So we are targeting growing in the areas that we want to grow and that should also help BER go forward.

Clover 會員基礎已經建立。我們也可以從 Clover 系統和家庭護理的角度來覆蓋這些優先市場。因此，我們的目標是在我們想要發展的領域中成長，這也應該有助於 BER 向前發展。

Okay, and then just looking at your guidance here, I think if I were to just kind of putting the numbers together here, it looks like the BER does step up, but it, if I look at kind of the core MCR basis, it almost seems to imply that it actually steps down. I'm just trying to understand it is the, is there anything specific for how we should think about 4QR or are you guys seeing anything?

好的，那麼根據您提供的指導，我認為如果我把這些數字放在一起比較，看起來誤碼率確實有所提高，但是，如果我看一下核心最大連續性係數，它似乎暗示誤碼率實際上有所下降。我只是想弄清楚，對於 4QR 有什麼具體的思考方式嗎？或者你們有什麼發現？

Specific that would seem to imply that it actually steps down or maybe my math is wrong here.

具體來說，這似乎意味著它實際上會降級，或者可能是我的計算錯誤。

Thanks. Are you at fourth quarter to because it looks like you did. Yeah, I think that we can refer back to the remarks in my section. What we talked about essentially intra-year PPD from the second half impacting the 3rd 3rd quarter. So the way to look at is really averaging out the first three quarters to get to kind of like a baseline expectation for the 4th quarter. Okay, thanks. Yeah, thank you.

謝謝。你是不是已經到第四節了？因為看起來你好像已經到了。是的，我認為我們可以參考我前面提到的內容。我們討論的主要是下半年的年內 PPD 對第三季的影響。所以，我們應該把前三個季度的數據平均一下，以此來得出第四季的基準預期。好的，謝謝。是啊，謝謝。

Thank you. As a reminder, if you do have a question, you can use the raised hand button at the bottom of your Zoom screen. I'll just wait for another moment to allow any further questions to form a queue. Okay, well, there are no further questions on the webinar, I'll now turn the call back over to Andrew Toy for any closing remarks.

謝謝。再次提醒，如果您有任何疑問，可以使用 Zoom 螢幕底部的舉手按鈕。我稍等片刻，讓其他問題排成一列。好的，網路研討會方面沒有其他問題了，現在我將把電話轉回給 Andrew Toy，請他做總結發言。

Alright folks, thanks everyone for joining us today. Thank you, Jonathan for the questions. We appreciate everyone's continued interest in Clover and we look forward to updating you all on our progress in the quarters ahead as we go into 2026. Have a great evening, everyone. Thank you.

好了各位，感謝大家今天收看我們的節目。謝謝喬納森的提問。我們感謝大家對 Clover 的持續關注，並期待在接下來的幾個季度裡，隨著我們邁入 2026 年，向大家報告我們的進展。祝大家晚上愉快。謝謝。