CareMax Inc (CMAX) 2023 Q4 法說會逐字稿

Good morning, and welcome to CareMax's fourth quarter 2023 earnings call. Please note, this call is being recorded.

早上好，歡迎參加 CareMax 2023 年第四季財報電話會議。請注意，此通話正在錄音。

I would now like to turn the conference call over to Roger Ou, Senior Vice President of Investor Relations. Please go ahead.

我現在想將電話會議轉交給投資人關係資深副總裁 Roger Ou。請繼續。

Good morning, and welcome to CareMax's fourth quarter 2023 earnings call. I'm Roger Ou, Senior Vice President of Investor Relations and I'm joined today by Carlos De Solo, our Chief Executive Officer; and Kevin Wirges, our Chief Financial Officer.

早上好，歡迎參加 CareMax 2023 年第四季財報電話會議。我是投資者關係高級副總裁 Roger Ou，今天我們的執行長 Carlos De Solo 也加入了我的行列。和我們的財務長 Kevin Wirges。

During the call, we will be discussing certain forward-looking information. These forward-looking statements are based on assumptions and assessments made by CareMax's management in light of their experience and assessment of historical trends, current conditions, expected future developments and other factors they believe to be appropriate.

在電話會議期間，我們將討論某些前瞻性資訊。這些前瞻性陳述是基於 CareMax 管理層根據他們的經驗和對歷史趨勢、當前狀況、預期未來發展以及他們認為適當的其他因素的評估而做出的假設和評估。

Any forward-looking statements made during this call are made as of today, and CareMax's undertakes no duty to update or revise such statements, whether as a result of new information, future events or otherwise. Important factors that could cause actual results, developments and business decisions to differ materially from the forward-looking statements are described in the company's filings with the SEC, including the section entitled risk factors.

本次電話會議期間所做的任何前瞻性陳述均截至今日，CareMax 不承擔更新或修改此類陳述的義務，無論是由於新資訊、未來事件或其他原因。該公司向美國證券交易委員會提交的文件中描述了可能導致實際結果、發展和業務決策與前瞻性陳述存在重大差異的重要因素，包括標題為「風險因素」的部分。

In today's remarks by management, we will be discussing certain non-GAAP financial metrics. A reconciliation of these non-GAAP financial metrics to the most comparable GAAP measures can be found in this morning's earnings press release.

在今天管理階層​​的演講中，我們將討論某些非公認會計準則財務指標。這些非公認會計原則財務指標與最具可比性的公認會計原則指標的調節可以在今天早上的收益新聞稿中找到。

Now I'd like to turn the call over to Carlos.

現在我想把電話轉給卡洛斯。

Good morning, everyone, and thank you for joining our call. Today, I will begin by talking about our near term strategy to preserve our earnings power and liquidity given recent trends in the sector. I will then be discussing the steps we've taken to begin rightsizing our business for the current environment. Afterward, Kevin will discuss our Q4 financials.

大家早安，感謝您加入我們的通話。今天，我將首先討論鑑於該行業的最新趨勢，我們保持盈利能力和流動性的近期策略。然後我將討論我們為適應當前環境而開始調整業務規模所採取的步驟。隨後，凱文將討論我們第四季的財務狀況。

Over the course of 2023, we have navigated challenges, including some related to our rapid growth over the past couple of years and others affecting our industry overall. We met our membership targets with 111,500 Medicare advantage members at the year end and we met our guidance on full year revenue.

2023 年，我們克服了挑戰，其中包括一些與過去幾年快速成長相關的挑戰，以及影響整個產業的其他挑戰。截至年底，我們實現了 111,500 名 Medicare 優勢會員的會員目標，並達到了全年收入指引。

However, full year adjusted EBITDA was unfavorably impacted by prior year developments, increased flex card utilization and higher than expected medical utilization. Additionally, as we noted last quarter, some of the unfavorability had to do with claims payment patterns which develop differently from prior years.

然而，全年調整後 EBITDA 受到上一年發展、彈性卡利用率增加以及高於預期的醫療使用率的不利影響。此外，正如我們在上季度指出的，一些不利因素與與前幾年不同的索賠支付模式有關。

In light of these headwinds, we have worked with our lenders to receive limited waivers on certain financial covenants contained in our credit facility in the short term. The cumulative effects of our prior year developments and rising medical expense ratios have lengthened the time in which health plans normally pay us.

鑑於這些不利因素，我們與貸方合作，在短期內獲得對我們信貸安排中某些財務契約的有限豁免。我們前一年的發展和不斷上升的醫療費用比率的累積影響延長了健康計劃通常向我們付款的時間。

In the fourth quarter, we drew the remaining $60 million of our delayed draw term loans to continue funding our operations, all while implementing cost saving initiatives across the organization. These actions and others that we are undertaking may help bridge us to our expected MSSP payment later this year.

在第四季度，我們提取了延遲提取定期貸款中剩餘的 6,000 萬美元，以繼續為我們的營運提供資金，同時在整個組織內實施成本節約措施。這些行動和我們正在採取的其他行動可能有助於我們在今年稍後實現預期的 MSSP 付款。

In the interim, we aim to drive more structural changes operationally, financially and strategically that are designed to protect and maximize the long-term value of CareMax's. As I'll discuss, these may include strategic options to monetize the value of certain assets and right size the capital structure of the company.

在此期間，我們的目標是在營運、財務和策略上推動更多結構性變革，旨在保護和最大化 CareMax 的長期價值。正如我將討論的，這些可能包括將某些資產的價值貨幣化和調整公司資本結構規模的策略選擇。

As noted on our third quarter call, we have undergone a comprehensive operational review of the company. We have begun implementing large-scale changes with three main goals in mind. First, optimizing our cost structure to give our key stakeholders confidence in our near term liquidity. This includes cost reductions we've already taken that amount to approximately $20 million of annualized cash savings.

正如我們在第三季電話會議中指出的那樣，我們對公司進行了全面的營運審查。我們已經開始實施大規模變革，並牢記三個主要目標。首先，優化我們的成本結構，讓我們的主要利害關係人對我們的短期流動性充滿信心。這包括成本削減，我們已經實現了每年約 2000 萬美元的現金節省。

Second, emphasizing performance and profitability in our existing book of business overgrowth. And third, exploring strategic options across our lines of business to maximize the value of certain assets. These actions are designed to help position CareMax for long-term success as the US health care system continues its shift towards accountable care.

其次，強調我們現有業務過度成長中的業績和獲利能力。第三，探索我們業務範圍內的策略選擇，以最大限度地提高某些資產的價值。隨著美國醫療保健系統繼續向責任醫療轉變，這些行動旨在幫助 CareMax 取得長期成功。

In the past several months, we have streamlined our workforce, including centralizing functions under key operational leaders. Overall, we estimate our net payroll reductions are contributing $15 million of annual run rate savings.

在過去的幾個月裡，我們精簡了員工隊伍，包括將職能集中在主要營運領導之下。總體而言，我們估計淨工資削減將節省 1500 萬美元的年度運行率。

We have also acted on opportunities to consolidate our center footprint in South Florida by tucking smaller sites into larger ones, allowing us to maintain service levels for patients while lowering operating costs. Since Q3, we have been able to complete six of these consolidations resulting in fewer but more efficiently run centers.

我們也抓住機會，透過將較小的中心納入較大的中心，鞏固了我們在南佛羅裡達州的中心足跡，使我們能夠在降低營運成本的同時維持為患者提供的服務水準。自第三季以來，我們已經完成了其中六次整合，從而減少了營運中心的數量，但運作效率更高。

We believe our center rightsizing efforts today currently translate to approximately $5 million in annualized cash savings. Furthermore, we continue to work on optimizations in multiple functional areas, including transportation, shared services, IT and facilities, which may contribute additional savings this year.

我們相信，我們今天的中心規模調整工作目前可轉化為每年約 500 萬美元的現金節省。此外，我們繼續致力於多個功能領域的最佳化，包括交通、共享服務、IT 和設施，這可能會在今年帶來額外的節省。

From a clinical perspective, I am pleased to report that across all CareMax centers, we achieved an aggregate five star quality rating for the third consecutive year, showcasing our commitment to the highest quality of care for our patients.

從臨床角度來看，我很高興地向大家報告，在所有 CareMax 中心中，我們連續第三年獲得了五星級的綜合品質評級，這體現了我們對為患者提供最高品質護理的承諾。

In addition, we feel confident in the ability of our care processes to drive year over year improvement in our centers medical expense ratio. While 2023 medical expenses grew at a rapid rate due to increased medical and benefit card utilization, we believe our care management initiatives and changes in payers benefit designs may contribute to a deceleration in medical expense growth in 2024 compared to 2023. As a reminder, our consolidated MER may remain elevated due to new MSO Medicare plans converting to full risk.

此外，我們對我們的護理流程能夠推動中心醫療費用率逐年改善的能力充滿信心。雖然由於醫療和福利卡利用率增加，2023 年醫療費用快速增長，但我們相信，我們的護理管理舉措和付款人福利設計的變化可能會導致 2024 年醫療費用增長較 2023 年放緩。提醒一下，由於新的 MSO 醫療保險計劃轉換為全面風險，我們的合併 MER 可能會繼續保持較高水準。

As discussed on our prior call, we have taken what we believe to be a prudent approach toward adding new contracts in our MSO. We ended 2023 with over 75,000 MA members and are focused on helping our affiliate providers optimize and value-based care savings in their existing panels.

正如我們之前的電話會議中所討論的，我們採取了我們認為是謹慎的方法來在我們的 MSO 中添加新合約。截至 2023 年，我們擁有超過 75,000 名 MA 會員，並致力於幫助我們的附屬提供者優化其現有面板中基於價值的護理節省。

We plan on taking increased risk in most of our MA contracts in 2024, including certain contracts moving to full risk. Full-risk lives now represent about 35% of our MSO MA population up from 15% in 2023. Based on our current projections, we believe our MSO has the ability to achieve similar or better MA medical margins compared to 2023.

我們計劃在 2024 年增加我們大部分 MA 合約的風險，包括某些合約轉向完全風險。目前，完全風險生命佔 MSO MA 人口的約 35%，而 2023 年這一比例為 15%。根據我們目前的預測，我們相信我們的 MSO 有能力實現與 2023 年類似或更好的 MA 醫療利潤。

In our government ACOs medical expenditures continued to develop favorably compared to national and regional trends, which we believe reflects our team's success in managing the underlying expense trends for the MSSP and ACO reach populations. We are optimistic that the investments we've made may lead to a similar or better savings rate in 2024.

與國家和地區趨勢相比，我們政府 ACO 的醫療支出繼續有利地發展，我們相信這反映了我們的團隊在管理 MSSP 和 ACO 覆蓋人口的基本費用趨勢方面的成功。我們樂觀地認為，我們所做的投資可能會在 2024 年帶來類似或更好的儲蓄率。

Now let me give some highlights on the embedded value we believe we have built in our de novo and MSO assets. Our de novo centers are now serving over 6,000 Medicare patients under capitated at risk and fee for service contracts and are also seeing Medicaid and commercial patients.

現在讓我重點介紹一下我們認為我們在 de novo 和 MSO 資產中建立的內在價值。我們的 de novo 中心目前正在為 6,000 多名醫療保險患者提供服務，這些患者按人頭承擔風險和服務合約費用，並且還接待醫療補助患者和商業患者。

We believe we have established a critical mass of operations in dense underserved communities within New York City and Memphis, Tennessee, and we have done so while keeping the de novo losses within our guided budgets in both 2022 and 2023.

我們相信，我們已經在紐約市和田納西州孟菲斯的服務匱乏的密集社區建立了足夠數量的業務，並且在將新損失控制在 2022 年和 2023 年指導預算範圍內的同時。

We believe our work the past two years has laid the foundation for the de novo centers to achieve attractive margins and maturity. Nonetheless, the reallocation of resources toward clinical performance at our core centers and MSO entails delaying breaking even at the de novo's compared to our original plan.

我們相信，我們過去兩年的工作為 de novo 中心實現有吸引力的利潤和成熟度奠定了基礎。儘管如此，與我們最初的計劃相比，我們的核心中心和 MSO 的臨床表現資源的重新分配需要推遲 de novo 的收支平衡。

In recent months, we have had conversations with growth-minded parties that see strategic value in our de novo's. While early, we believe these discussions may potentially enable us to monetize the platform we have built in new markets, mitigate the impact of de novo losses or realize other financial benefits with these centers.

近幾個月來，我們與具有成長意識的各方進行了對話，他們看到了我們從頭開始的戰略價值。雖然還處於早期階段，但我們相信這些討論可能使我們能夠將我們在新市場中建立的平台貨幣化，減輕從頭損失的影響或透過這些中心實現其他經濟利益。

In our MSO, we believe we have accomplished our key one year goals, converting traditional fee for service contracts into value-based care agreements with a glide path to full risk, incorporate our tech enabled workflows to manage complex populations at scale and foster physician engagement in a way that maximizes their potential earnings and improves patient outcomes. With over 170,000 senior lives across MSSP, ACO reach and Medicare advantage we estimate our MSO is now accountable for over $2 billion of annual health expenditures.

在我們的MSO 中，我們相信我們已經實現了一年的關鍵目標，將傳統的服務合約費用轉變為基於價值的護理協議，並逐步實現全面風險，整合我們的技術支援的工作流程來大規模管理複雜的人群並促進醫生參與以最大限度地提高潛在收入並改善患者治療效果的方式。MSSP 擁有超過 170,000 名老年人，ACO 覆蓋範圍和醫療保險優勢，我們估計我們的 MSO 現在每年承擔超過 20 億美元的醫療支出。

In 2023, we believe we have approximately doubled shared savings under our government ACOs compared to 2021. And we believe our operating plan can further drive the savings percentage rate to high single digits or better.

我們相信，到 2023 年，與 2021 年相比，我們政府 ACO 下的共享儲蓄增加了一倍。我們相信我們的營運計劃可以進一步將儲蓄百分比提高到高個位數或更高。

In our MA book CareMax has successfully contracted with most of the leading regional health plans in their respective markets, introducing new opportunities for our affiliated providers to participate in savings. We continue to deepen these partnerships and explore new ones with payers aligned with our measured approach towards taking risk.

在我們的 MA 書中，CareMax 已成功與各自市場中大多數領先的區域健康計劃簽訂合同，為我們的附屬提供者提供了參與儲蓄的新機會。我們將繼續深化這些合作關係，並與付款人探索新的合作夥伴關係，並與我們謹慎承擔風險的方法保持一致。

In summary, given the recent industry trends, we expect 2024 to be a transition year toward more balanced levels of reimbursements and expenditures. In continuation of the process begun last year, we plan to work toward further optimizing our business for things we can control to help preserve liquidity and position our business to achieve our longer term goals. Kevin will now take you through our financial results.

總之，考慮到最近的行業趨勢，我們預計 2024 年將是報銷和支出水準更加平衡的過渡年。延續去年開始的流程，我們計劃努力進一步優化我們可以控制的業務，以幫助保持流動性並定位我們的業務以實現我們的長期目標。凱文現在將帶您了解我們的財務表現。

Thanks, Carlos, and good morning. As discussed on our third quarter call since 2021, we have grown rapidly in membership consolidated helped by contracts from acquisitions and added a significant number of new contracts.

謝謝，卡洛斯，早安。正如我們自 2021 年以來的第三季電話會議中所討論的那樣，在收購合約的幫助下，我們的會員合併人數迅速增長，並增加了大量新合約。

Our fourth quarter results reflect additional prior year development or PYDs, primarily related to updated data arising from these integrations. We have established a regular cadence of service fund reporting with most payers and continue to refine our data flows to mitigate these types of impacts in the future.

我們第四季的業績反映了去年的額外發展或 PYD，主要與這些整合產生的更新數據有關。我們與大多數付款人建立了定期的服務基金報告節奏，並繼續完善我們的數據流，以減輕未來的此類影響。

In the fourth quarter, revenues and adjusted EBITDA were negatively impacted by a combination of prior year developments, increased medical and flex card utilization and a provision for adverse deviation, which we treat as an explicit reserve separate from PYD.

第四季度，收入和調整後的 EBITDA 受到上一年發展、醫療和彈性卡利用率增加以及不利偏差撥備的綜合影響，我們將其視為與 PYD 分開的明確準備金。

As a reminder, we do not add back prior-year developments or reserves to adjusted EBITDA, but disclosed them to provide color on the in-year performance of our business. Additionally, Q4 GAAP net income was impacted by $369 million of non-cash goodwill impairment.

提醒一下，我們不會將上一年的發展或儲備加回調整後的 EBITDA，而是披露它們，以便為我們業務的年內業績提供色彩。此外，第四季 GAAP 淨利潤也受到 3.69 億美元非現金商譽減損的影響。

In the fourth quarter. Adjusted EBITDA was impacted in part by approximately $21 million of net unfavorable PYDs. Over half was related to updated historical data from two MSO Medicare plans. While the remainder was due to final sweep accruals related to our membership in our centers. We also booked $15 million of reserves for adverse deviation that are intended to absorb potential future unexpected changes in revenues for external provider costs.

在第四季。調整後的 EBITDA 部分受到約 2,100 萬美元不利 PYD 淨值的影響。超過一半與兩個 MSO 醫療保險計劃的更新歷史數據有關。其餘部分則歸因於與我們中心會員資格相關的最終應計費用。我們也為不利偏差預留了 1500 萬美元的準備金，旨在吸收外部提供者成本未來潛在的意外收入變化。

For the full year 2023 adjusted EBITDA was negative $63 million including unfavorable impacts of $42 million of total PYD and the $15 million of reserves for adverse deviation. This also includes $23 million of de novo losses, which were slightly favorable to our guidance of approximately $25 million in losses.

2023 年全年，調整後 EBITDA 為負 6,300 萬美元，其中包括 4,200 萬美元 PYD 總額的不利影響和 1,500 萬美元的不利偏差準備金。這也包括 2,300 萬美元的新損失，這比我們約 2,500 萬美元損失的指引略有有利。

Reported 2023 revenue was $751 million, including $45 million of headwinds from PYD and $5 million from reserves, putting us toward the lower end of our latest guidance range.

報告的 2023 年收入為 7.51 億美元，包括來自 PYD 的 4500 萬美元的阻力和 500 萬美元的儲備金，使我們接近最新指導範圍的下限。

Total medical expense ratio in 2023 was 91.5% and includes approximately 780 basis points from PYD and reserves. And this all members which have higher MER than our standard members, at 450 basis points of impact. In addition, we estimate year over year increases in benefit card expenses drove about 400 basis points of unfavorability in MER.

2023 年的總醫療費用率為 91.5%，其中包括來自 PYD 和儲備金的約 780 個基點。所有這些成員的 MER 都高於我們的標準成員，影響力高出 450 個基點。此外，我們估計福利卡費用的年增率導致 MER 的不利因素增加了約 400 個基點。

Finally, MER was further impacted by Medicaid redeterminations, which have caused the average Medicaid acuity normalized faster than expected for higher pre-COVID levels. To share some recent trends within our center population, we saw elevated hospitalizations in December continue into January, which is typically the height of the flu season in South Florida.

最後，MER 受到醫療補助重新確定的進一步影響，這導致平均醫療補助敏銳度正常化的速度快於新冠疫情前較高水平的預期。為了分享我們中心人口的一些最新趨勢，我們發現 12 月住院人數的增加一直持續到 1 月，這通常是南佛羅裡達州流感季節的高峰期。

However, inpatient admissions had shorter average lengths of stay and January visits detail, also moderated month-over-month. While early, we are cautiously optimistic the seasonal peak is behind us and continue to ramp our clinical programs and better manage avoidable admissions.

然而，住院患者的平均住院時間和一月的就診細節均較短，也逐月放緩。雖然還處於早期階段，但我們對季節性高峰已經過去持謹慎樂觀的態度，並將繼續擴大我們的臨床計畫並更好地管理可避免的入院人數。

Looking back, our challenges in 2023 have been more about the things we had less control over, namely the timeliness, adequacy and accuracy of data from newer health plan contracts, Medicaid redeterminations and flex card utilization.

回顧過去，我們在 2023 年面臨的挑戰更多的是我們無法控制的事情，即來自新健康計劃合約的數據的及時性、充分性和準確性、醫療補助重新確定和靈活卡的使用。

In particular, we believe the impact of flex card exceeded $30 million of medical expenses in 2023, nearly tripling from 2022. While these benefits are likely to stay in some form, would you not expect them to increase at the rate they've grown in the past two years. And we have developed plans designed to mitigate duplicative costs at our centers and work closely review our service funds for potentially improper flex card expense.

特別是，我們認為靈活卡的影響在 2023 年將超過 3,000 萬美元的醫療費用，比 2022 年幾乎增加兩倍。雖然這些好處可能會以某種形式保留下來，但您是否預計它們會以過去兩年的增長速度增加？我們制定了旨在減少中心重複成本的計劃，並密切審查我們的服務資金是否存在可能不當的彈性卡費用。

More generally, these developments have reaffirmed to us the importance of strong relationships and our business. With our legacy health plans, we have a good history of alignment and a common view towards the long-term benefits of our high-touch model. With our new payer partners, we couldn't be more excited to embark on that same journey.

更廣泛地說，這些發展向我們重申了牢固的關係和我們的業務的重要性。憑藉我們的傳統健康計劃，我們有著良好的協調歷史，並且對我們的高接觸模式的長期利益有著共同的看法。與我們新的付款合作夥伴一起，我們非常興奮地踏上同樣的旅程。

With any partner, our efforts are most successful when our payers equip us with the right data tools and access and share in the upfront investments needed to manage risks. Along those lines we expect some of the structural changes Carlos mentioned may entail refocusing resources on payers, most aligned with our strategy.

對於任何合作夥伴，當付款人為我們提供正確的數據工具並存取和分享管理風險所需的前期投資時，我們的努力才會取得最大成功。沿著這些思路，我們預期卡洛斯提到的一些結構性變化可能需要將資源重新集中在付款人身上，這最符合我們的策略。

We have done a significant amount of analysis to understand the unit economics of each health plan contract. As you might imagine, some are more favorable than others. We're planning to thoughtfully consider actions where the cost to manage a plan outweighs the financial benefits to the company.

我們進行了大量的分析，以了解每個健康計劃合約的單位經濟效益。正如您可能想像的那樣，有些比其他更受歡迎。我們計劃仔細考慮在管理計劃的成本超過公司財務收益的情況下採取的行動。

Because the outcome of these processes is uncertain, we believe it is premature to give precise guidance for 2024. In aggregate, our plan is designed to put CareMax on better footing in 2025, which we think will mark a favorable inflection point in revenue and adjusted EBITDA.

由於這些過程的結果是不確定的，我們認為現在給出 2024 年的精確指導還為時過早。總的來說，我們的計劃旨在讓 CareMax 在 2025 年奠定更好的基礎，我們認為這將標誌著收入和調整後 EBITDA 的有利拐點。

We believe headwinds in 2024 regional benchmarks for our core markets will abate or even flip to tailwinds next year. And we believe 2024 star ratings for our core plans tie net improvement compared to 2023, which should favorably impact revenues in 2025.

我們相信，2024 年我們核心市場的區域基準的逆風將會減弱，甚至明年會轉為順風。我們相信，與 2023 年相比，2024 年我們核心計畫的星級評級將實現淨改善，這將對 2025 年的收入產生有利影響。

As Carlos mentioned we drew the remaining $60 million of DDTL in Q4 and ended the year with approximately $66 million of cash. Looking ahead, we are in active strategic discussions to maximize the value of certain assets, which may help generate further liquidity to bridge the company to the MSSP payment later this year and to 2025.

正如卡洛斯所提到的，我們在第四季度提取了剩餘的 6000 萬美元 DDTL，並在年底獲得了大約 6600 萬美元的現金。展望未來，我們正在積極進行策略討論，以最大限度地提高某些資產的價值，這可能有助於產生更多的流動性，以幫助公司在今年稍後和 2025 年獲得 MSSP 付款。

In closing, the management team, Carlos and I are deeply appreciative of our team members for their steadfast support and shared vision toward accountable care. We are committed to taking the actions we believe necessary to reposition CareMax future success. We look forward to connecting with you and updating you and our future developments.

最後，管理團隊、卡洛斯和我對我們的團隊成員的堅定支持和對負責任醫療的共同願景深表感謝。我們致力於採取我們認為必要的行動來重新定位 CareMax 未來的成功。我們期待與您聯繫，向您通報最新情況以及我們未來的發展。

Thank you. This concludes today's conference call. We thank you for joining, and you may now disconnect.

謝謝。今天的電話會議到此結束。我們感謝您的加入，您現在可以斷開連接。