Evolent Health Inc (EVH) 2023 Q1 法說會逐字稿

Welcome to Evolent Health's earnings conference call for the quarter ended March 31, 2023. As a reminder, this conference call is being recorded. Your host for the call today from Evolent Health are Seth Blackley, Chief Executive Officer; and John Johnson, Chief Financial Officer. This call will be archived and available later this evening for the next week via the webcast on the company's website in the section entitled Investor Relations.

歡迎參加 Evolent Health 截至 2023 年 3 月 31 日的季度收益電話會議。謹此提醒，本次電話會議正在錄音。今天 Evolent Health 電話會議的主持人是首席執行官 Seth Blackley；和首席財務官約翰·約翰遜。該電話會議將被存檔，並在下週的今晚晚些時候通過公司網站上標題為“投資者關係”的部分的網絡廣播進行播放。

I'll now hand the call over to Seth Frank, Evolent's Vice President of Investor Relations.

現在我將把電話轉給 Evolent 投資者關係副總裁 Seth Frank。

Thank you, and good evening. This conference call will contain forward-looking statements under the U.S. federal laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations.

謝謝你，晚上好。本次電話會議將包含美國聯邦法律規定的前瞻性聲明。這些陳述存在風險和不確定性，可能導致實際結果與歷史經驗或當前預期存在重大差異。

A description of some of the risks and uncertainties can be found in the company's reports that are filed with the Securities and Exchange Commission, including cautionary statements included in our current and periodic filings. For additional information on the company's results and outlook, please refer to our first quarter press release issued earlier today.

對一些風險和不確定性的描述可以在公司向美國證券交易委員會提交的報告中找到，包括我們當前和定期提交的文件中包含的警告聲明。有關公司業績和前景的更多信息，請參閱我們今天早些時候發布的第一季度新聞稿。

Finally, as a reminder, reconciliations of non-GAAP measures discussed during today's call to the most direct comparable GAAP measures are available in the summary presentation available in the Investor Relations section of our website or in the company's press release issued today and posted on the Investor Relations section of the company's website, ir.evolenthealth.com, and the Form 8-K filed by the company with the SEC earlier today.

最後，提醒一下，今天電話會議中討論的最直接可比 GAAP 指標的非 GAAP 指標的調節可以在我們網站投資者關係部分的摘要演示中找到，也可以在今天發布並發佈在網站上的公司新聞稿中找到。該公司網站 ir.evolenthealth.com 的投資者關係部分以及該公司今天早些時候向 SEC 提交的 8-K 表格。

During management's presentation and discussion, we will reference certain GAAP and non-GAAP figures and metrics that can be found in our earnings release as well as a summary presentation available on the Events section of Evolent's IR website.

在管理層的演示和討論期間，我們將參考某些 GAAP 和非 GAAP 數據和指標，這些數據和指標可以在我們的收益發布中找到，也可以在 Evolent IR 網站的事件部分中找到摘要演示。

And now I will turn the call over to Evolent's CEO, Seth Blackley.

現在我將把電話轉給 Evolent 的首席執行官 Seth Blackley。

Good evening, and thanks for joining us. My prepared comments today will focus on updating you on our quarterly results, progress on our 3 operating priorities and the status of integrating our recent acquisitions. As you know, we're hosting an investor meeting in Arlington, Virginia, with a live webcast option as well on May 23, and I'll preview that event at the end of this call. John will discuss the quarterly results in more detail and our update on guidance for the year, and we'll look forward to taking your questions at the end as always.

晚上好，感謝您加入我們。我今天準備的評論將重點向您介紹我們的季度業績、我們的 3 個運營重點的進展以及我們最近收購的整合狀況。如您所知，我們將於 5 月 23 日在弗吉尼亞州阿靈頓舉辦投資者會議，並提供網絡直播選項，我將在本次電話會議結束時預覽該活動。約翰將更詳細地討論季度業績以及我們對今年指導的更新，我們將一如既往地期待在最後回答您的問題。

Reviewing the first quarter, Evolent began 2023 with strong results. Adjusted EBITDA exceeded the top end of our guidance range, and revenue was within the range. We also continue to feel good about our guidance range for the full year. And today, we're raising the bottom end of the revenue range for the year given our high visibility into growth as the year progresses. Overall, we're happy with the strong start to the year.

回顧第一季度，Evolent 以強勁的業績開啟了 2023 年。調整後的 EBITDA 超出了我們指導範圍的上限，收入也在該範圍內。我們還繼續對全年的指導範圍感到滿意。今天，鑑於我們對今年增長的高度可見性，我們提高了今年收入範圍的下限。總體而言，我們對今年的強勁開局感到滿意。

For the quarter ended March 31, 2023, Evolent Health's reported revenue was $427.7 million, growth of 44% over the same period of 2022. Excluding the $48.5 million of revenue contribution from NIA, which was acquired during the quarter, our revenue growth rate was approximately 28%, consistent with the range of 25% to 28% we guided for 2023. And as John will discuss, we expect meaningful quarter-over-quarter revenue growth for Q2 and Q3 as we go live with our previously announced Performance Suite expansions at Molina and Humana.

截至 2023 年 3 月 31 日的季度，Evolent Health 報告收入為 4.277 億美元，較 2022 年同期增長 44%。不包括本季度收購的 NIA 的 4850 萬美元收入貢獻，我們的收入增長率為約 28%，與我們為 2023 年指導的 25% 至 28% 範圍一致。正如約翰將討論的那樣，隨著我們之前宣布的性能套件擴展的實施，我們預計第二季度和第三季度收入將出現有意義的季度環比增長在莫利納和哈馬納。

Looking at profitability. First quarter adjusted EBITDA totaled $50.5 million, an increase of $26.2 million and more than doubling results from 1 year ago. The growth in adjusted EBITDA was driven both by expansion in the base business as well as the addition of the NIA and IPG acquisitions. Adjusted EBITDA margin for the quarter totaled 11.8%, a new high watermark for the company. Our first quarter results provide a solid starting point of achieving our previously released goal of an adjusted EBITDA run rate of $300 million exiting 2024. We look forward to continued operational progress and sales momentum as the year continues.

看看盈利能力。第一季度調整後 EBITDA 總計 5050 萬美元，增加了 2620 萬美元，比一年前增長了一倍多。調整後 EBITDA 的增長是由基礎業務的擴張以及 NIA 和 IPG 收購的增加推動的。該季度調整後 EBITDA 利潤率為 11.8%，創公司新高。我們第一季度的業績為實現我們之前發布的 2024 年調整後 EBITDA 運行率為 3 億美元的目標提供了堅實的起點。我們期待今年繼續取得持續的運營進展和銷售勢頭。

Now we'll update you on Evolent's 3 core operating priorities of strong organic growth, expanding margins and optimal capital allocation. Starting with organic growth, I want to highlight 2 notable agreements signed since we last spoke in February. Recently, a national payer under contract with IPG has entered into an agreement with AMSURG, a leading ASC chain, to utilize IPG's surgical management solution as its preferred surgical implant provider nationally.

現在，我們將向您介紹 Evolent 的 3 個核心運營重點：強勁的有機增長、擴大利潤率和優化資本配置。從有機增長開始，我想重點介紹自我們上次二月份交談以來簽署的兩項重要協議。最近，與 IPG 簽訂合同的一家國家付款人與領先的 ASC 連鎖店 AMSURG 達成協議，利用 IPG 的手術管理解決方案作為其在全國范圍內的首選手術植入物提供商。

This unique national payer ambulatory surgery center agreement utilizing our surgical management solution is a testament to the value this solution creates for payers and ambulatory surgery centers mutually benefiting from site of care shift and reduced device cost. We're thrilled with this opportunity to roll out our surgical management solution into AMSURG's ambulatory surgery centers.

這項獨特的國家付款人門診手術中心協議利用我們的手術管理解決方案，證明了該解決方案為付款人和門診手術中心創造的價值，使雙方從護理轉移地點和降低的設備成本中受益。我們很高興有機會將我們的手術管理解決方案推廣到 AMSURG 的門診手術中心。

Furthermore, this expansion opens doors for cross-selling and growing our ambulatory surgery center installed base to other payers, both regionally and nationally, and it creates a blueprint for national payer relationships with other surgical chains. It's also a proof point to the synergies Evolent brings with our relationships and large national payers to elevate and cross-sell our portfolio as a one-stop specialty value-based care partner.

此外，這一擴張為交叉銷售和擴大我們的門診手術中心安裝基礎向區域和全國其他付款人打開了大門，並為全國付款人與其他手術連鎖店的關係創建了藍圖。這也證明了 Evolent 與我們的關係和大型國家付款人帶來的協同效應，以提升和交叉銷售我們的產品組合，使其成為一站式專業價值護理合作夥伴。

Second, we announced a significant oncology specialty technology and services expansion with Centene in March. To recap that announcement, Centene will expand its use of Evolent Health oncology solution across its Centene and WellCare Medicare Advantage members nationally. This agreement expands and deepens the specialty care partnership between Centene and Evolent beyond Medicaid and into the rapidly expanding MA market. We began to go live in local markets during April, adding over 800,000 MA members in 26 states by the end of 2023.

其次，我們於 3 月份宣布與 Centene 進行重大腫瘤學專業技術和服務擴展。回顧一下這一公告，Centene 將在全國范圍內的 Centene 和 WellCare Medicare Advantage 成員中擴大 Evolent Health 腫瘤學解決方案的使用。該協議擴大並深化了 Centene 和 Evolent 之間的專業護理合作夥伴關係，超越醫療補助，進入快速擴張的 MA 市場。我們於 4 月份開始在當地市場上線，到 2023 年底，我們在 26 個州增加了超過 800,000 名 MA 會員。

PMPM fees for this agreement are above reported corporate averages for the company's technology and services solution, and this is an MA book of business. This is also another excellent example of how we grow within our client base by increasing geographic and specialty reach with our proven solution to manage oncology costs and health outcomes. It's also worth noting, this was a competitive displacement of a smaller point solution.

該協議的 PMPM 費用高於報告的該公司技術和服務解決方案的公司平均水平，這是一本 MA 業務手冊。這也是我們如何利用我們經過驗證的解決方案來管理腫瘤成本和健康結果，擴大地理和專業覆蓋範圍，從而在客戶群中發展的另一個絕佳例子。還值得注意的是，這是較小點解決方案的競爭替代品。

Evolent continues to benefit from the breadth of offering and the trust we've created with our customer by meeting our operational commitments. Please note that this agreement with Centene is in addition to the $20 million of incremental adjusted EBITDA we anticipate from Centene's expansion of NIA solutions, which was built into our fully synergized estimate of $85 million from NIA by the end of 2024. These agreements announced today bring our total new partnerships to 4 year-to-date compared to our annual goal of 6 to 8 partnerships and significant expansions.

Evolent 繼續受益於產品的廣泛性以及我們通過履行運營承諾而與客戶建立的信任。請注意，與 Centene 達成的這項協議是我們預計 Centene 擴展 NIA 解決方案帶來的 2000 萬美元增量調整後 EBITDA 的補充，該解決方案已納入我們到 2024 年底從 NIA 獲得的 8500 萬美元的完全協同估計中。今天宣布的這些協議與我們的年度目標（6 至 8 個合作夥伴和重大擴張）相比，我們的新合作夥伴總數達到了 4 個。

Looking ahead, our pipeline of new business remains strong. During March, my team and I hosted a number of current customers and prospective payers. I came away highly encouraged about the power of our integrated platform and the prospects for continuing to drive strong organic revenue growth in the years ahead.

展望未來，我們的新業務渠道依然強勁。三月期間，我和我的團隊接待了許多現有客戶和潛在付款人。離開時，我對我們集成平台的力量以及未來幾年繼續推動強勁有機收入增長的前景感到非常鼓舞。

I'm also happy with our progress against our second core operating priority of expanding adjusted EBITDA margins. As noted earlier, we delivered 11.8% adjusted EBITDA margins in the first quarter, the highest in our history, and on track with our full year financial guidance for '23 as well as our path to $300 million of run rate adjusted EBITDA for 2024 exiting that year.

我也對我們在擴大調整後 EBITDA 利潤率的第二個核心運營重點方面取得的進展感到高興。如前所述，我們在第一季度實現了 11.8% 的調整後 EBITDA 利潤率，這是我們歷史上最高的，並且符合我們 23 年全年財務指引以及我們在 2024 年實現 3 億美元運行率調整後 EBITDA 的目標。那年。

Reaching this profitability level will require continued maturation of the Performance Suite book of business we already have as well as continued sales of our high-margin specialty technology and services solution. The announcements today continue to illustrate our progress against specialty technology and services growth, and we remain on track with our Performance Suite margin maturation goals in the latest quarter. We look forward to providing you additional detail on both fronts during our Investor Day.

要達到這一盈利水平，我們需要不斷成熟我們已有的 Performance Suite 業務，並持續銷售我們的高利潤專業技術和服務解決方案。今天的公告繼續說明了我們在專業技術和服務增長方面取得的進展，並且我們仍然在實現最近一個季度的性能套件利潤成熟目標。我們期待在投資者日期間為您提供有關這兩方面的更多詳細信息。

I also want to highlight that we previously indicated that Evolent would generate approximately 75% of its adjusted EBITDA dollars in 2023 from Evolent's fee-based products and 25% from our Performance Suite business. We're seeing the merits of this balanced approach with the strong top and bottom line results in the quarter. While the Performance Suite will continue to drive our highest growth rates in revenue and deliver more significant EBITDA contributions in later years, this balanced approach to delivering revenue growth and adjusted EBITDA growth will yield sustainably strong profitable growth in the years ahead.

我還想強調的是，我們之前表示，Evolent 到 2023 年調整後 EBITDA 的大約 75% 來自 Evolent 的收費產品，25% 來自我們的 Performance Suite 業務。我們看到了這種平衡方法的優點以及本季度強勁的營收和利潤結果。雖然績效套件將繼續推動我們最高的收入增長率，並在未來幾年提供更顯著的 EBITDA 貢獻，但這種實現收入增長和調整後 EBITDA 增長的平衡方法將在未來幾年帶來持續強勁的利潤增長。

Our third operating priority is optimal capital allocation. To reiterate, 2023 will be focused on execution of our cost synergy plan and accelerating our value-based specialty care position while we're confident in our market leadership. Our near-term capital allocation priority is to deleverage the balance sheet through adjusted EBITDA growth and debt reduction through strong cash generation. We will also continue to evaluate opportunities to simplify our capital structure to yield lower cost to service our debt while, at the same time, protecting common shareholders.

我們的第三個運營重點是優化資本配置。重申一下，2023 年我們將重點關注執行我們的成本協同計劃並加速我們基於價值的專業護理地位，同時我們對我們的市場領導地位充滿信心。我們的近期資本配置重點是通過調整後的 EBITDA 增長來去槓桿化資產負債表，並通過強勁的現金生成來減少債務。我們還將繼續評估簡化資本結構的機會，以降低償債成本，同時保護普通股東。

As John will discuss in more detail, strong cash generation in the quarter relative to historical seasonal expectations resulted in our net leverage ratio that is better than our previous expectations, and we remain on track to meet or exceed our target of generating $120 million or more in cash flow this year prior to interest or debt service.

正如約翰將更詳細地討論的那樣，相對於歷史季節性預期，本季度強勁的現金生成導致我們的淨槓桿率優於我們之前的預期，並且我們仍然有望達到或超過生成 1.2 億美元或更多的目標計息或還本付息前的今年現金流量。

To close, let me add a couple of points on integration and our agenda for the investor event. Our integration of NIA is on track and progressing well. We have multiple work streams underway that are a focus of the collective teams across both legacy Evolent and new members of our family from NIA. We finalized and implemented the integrated organizational design over the last few months and are beginning to see the cost capability and sales benefits of the combined company.

最後，讓我就整合和投資者活動議程補充幾點。我們與 NIA 的整合已步入正軌並且進展順利。我們正在進行多個工作流程，這些工作流程是傳統 Evolent 和 NIA 家族新成員集體團隊的重點。在過去的幾個月裡，我們最終確定並實施了一體化的組織設計，並開始看到合併後公司的成本能力和銷售效益。

During our Investor Day, we will talk more about the power of the integrated product platform, the operating model that's emerging as well as the future cross-sell opportunities and their impact on our margins. For our May 23 event, we have 3 primary goals. The first is to give you all a detailed understanding of the problems our clients face and how we solve them with our platform. You should walk away with a clear understanding of what Evolent does and how we accomplish our work.

在投資者日期間，我們將更多地討論集成產品平台的力量、新興的運營模式以及未來的交叉銷售機會及其對我們利潤的影響。對於 5 月 23 日的活動，我們有 3 個主要目標。首先是讓大家詳細了解我們的客戶面臨的問題以及我們如何通過我們的平台解決這些問題。您應該清楚地了解 Evolent 的用途以及我們如何完成我們的工作。

Second, you get exposure to a broad cross-section of our deep bench of executive talent as well as several video interviews with key clients. And third, John will provide insight into Evolent's financial model, including a deep dive on our unit economics and margin maturation opportunities. We hope you can join us in person or through the webcast. The link will be live on our IR website soon. If you want to attend in person and have not yet received a registration link, please reach out to Seth Frank.

其次，您可以接觸到我們廣泛的高管人才陣容，以及對關鍵客戶的多次視頻採訪。第三，John 將深入了解 Evolent 的財務模型，包括深入探討我們的單位經濟效益和利潤成熟機會。我們希望您能夠親自或通過網絡廣播加入我們。該鏈接很快就會在我們的 IR 網站上發布。如果您想親自參加但尚未收到註冊鏈接，請聯繫 Seth Frank。

With that, I'll turn it over to John.

有了這個，我會把它交給約翰。

Thanks, Seth. We are looking forward to seeing many of you in Arlington here in a few weeks. Before we get into our detailed results for Q1, I'd like to highlight a couple of disclosure updates we're making as we integrate NIA and move towards One Evolent. These were previewed on our February call, and now we have numbers to talk about, so let's review those.

謝謝，塞思。我們期待幾週後在阿靈頓見到你們中的許多人。在我們討論第一季度的詳細結果之前，我想強調一下我們在整合 NIA 並轉向 One Evolent 時所做的一些披露更新。這些內容已在我們二月份的電話會議上預覽過，現在我們有數字可以討論，所以讓我們回顧一下這些內容。

First, as discussed, we are now reporting our financial results in one reportable segment as we focus future growth on our specialty value-based care business and integrate the entire organization around the specialty-led strategy. To provide insight into the growth drivers of our business, we are continuing to disclose product membership and PMPM fees for our 3 core product types, which we'll describe going forward as Performance Suite, Specialty Technology and Services Suite and Administrative Services. We are also maintaining the metrics for cases and revenue per case we established last year for the parts of our business where revenue is not PMPM-driven.

首先，正如所討論的，我們現在在一個可報告的部門中報告我們的財務業績，因為我們將未來的增長重點放在基於專業價值的護理業務上，並圍繞專業主導的戰略整合整個組織。為了深入了解我們業務的增長動力，我們將繼續披露 3 種核心產品類型的產品會員資格和 PMPM 費用，我們將在未來將其描述為性能套件、專業技術和服務套件以及管理服務。我們還維護去年為收入不是由 PMPM 驅動的業務部分建立的案例和每個案例的收入指標。

Since our clients can have multiple solutions deployed over the same membership, for example, cardiology, oncology, musculoskeletal, advanced imaging and so on, we are also introducing a metric of estimated unique members to accompany our existing metrics on members by product. Let me give you a real-life example here. A Medicaid plan on the East Coast has approximately 250,000 members and 3 Evolent products deployed, Administrative Services and Specialty Technology and Services for musculoskeletal and advanced imaging. This plan will account for 5,000 Specialty and Technology Services product members and 250,000 Administrative Services product members for a total of 750,000 product members. Under our new disclosure, this plan would contribute 250,000 to our unique member count.

由於我們的客戶可以在同一會員上部署多個解決方案，例如心髒病學、腫瘤學、肌肉骨骼學、高級成像等，因此我們還引入了估計唯一會員的指標，以配合我們按產品劃分的現有會員指標。讓我在這裡給你舉一個現實生活中的例子。東海岸的一項醫療補助計劃擁有約 250,000 名會員，並部署了 3 種 Evolent 產品、行政服務​​以及針對肌肉骨骼和高級成像的專業技術和服務。該計劃將涵蓋 5,000 名專業和技術服務產品會員和 250,000 名行政服務產品會員，總共 750,000 名產品會員。根據我們新披露的信息，該計劃將為我們的獨特會員數量貢獻 250,000 名。

In total, we had an estimated 41.3 million unique members during the first quarter of 2023, with a total of 65.6 million products members for an average of 1.6 products per unique member. Given that we have 6 separate categories of PMPM-based products that we can provide any 1 member, excluding our case rate products, we believe these metrics together provide visibility into a key element of our strategy, our ability to grow within our clients and cross-sell additional solutions, further penetrating their specialty spend categories.

2023 年第一季度，我們估計總共有 4130 萬獨立會員，共有 6560 萬個產品會員，平均每個獨立會員有 1.6 種產品。鑑於我們有 6 個不同類別的基於 PMPM 的產品，我們可以向任何 1 名成員提供這些產品（不包括我們的案例率產品），我們相信這些指標共同提供了我們戰略的關鍵要素的可見性、我們在客戶中成長的能力以及跨領域的能力。 -銷售額外的解決方案，進一步滲透其專業支出類別。

Finally, to simplify your modeling efforts, we are now providing average monthly membership and corresponding PMPM fees versus period ending membership. Average membership is the primary driver of revenue for the quarter. We have provided a table showing each of these metrics quarterly back through 2022 in the earnings presentation posted to our website.

最後，為了簡化您的建模工作，我們現在提供平均每月會員資格和相應的 PMPM 費用以及期末會員資格。平均會員人數是本季度收入的主要驅動力。我們在我們網站上發布的收益演示中提供了一個表格，顯示了 2022 年之前每個季度的這些指標。

Now let's talk about the first quarter. A key theme is our Performance Suite partnerships, which continue to progress as expected and drove both our top and bottom line results in the quarter. You'll see in our 10-Q a reduction of about $20 million in claims costs related to 2022 and prior, which falls into 3 categories: First, about $9 million of the $20 million is related to reductions in revenue with minimal impact to adjusted EBITDA. This symmetric reduction can happen in Medicaid, in particular, when both Lee and our partners are performing quite well relative to minimum medical expense floors.

現在我們來談談第一季度。一個關鍵主題是我們的性能套件合作夥伴關係，它們繼續按預期取得進展，並推動了我們本季度的營收和淨利潤。您將在我們的 10-Q 中看到，與 2022 年及之前相關的索賠成本減少了約 2000 萬美元，分為 3 類：首先，2000 萬美元中的約 900 萬美元與收入減少有關，對調整後的影響最小息稅折舊及攤銷前利潤。這種對稱的減少可能會發生在醫療補助中，特別是當李和我們的合作夥伴相對於最低醫療費用底線表現良好時。

Without this onetime deduct to revenue from prior periods, our top line for the quarter would have been approximately $437 million. The remaining lower claims expense flowed through to our bottom line in the quarter and was consistent with our expectations for the year. As we discussed on our call in February, we will typically see a pickup in margins in the first 3 to 5 quarters of a Performance Suite go-live when we have the data to switch our accruals from an initial budget to being based on actual claims experience. And we saw a $7 million pickup in the quarter from such dynamics.

如果沒有一次性扣除前期收入，我們本季度的營收約為 4.37 億美元。剩餘的較低索賠費用流入我們本季度的利潤，與我們今年的預期一致。正如我們在 2 月份的電話會議上討論的那樣，當我們有數據將應計費用從初始預算轉變為基於實際索賠時，我們通常會看到性能套件上線的前 3 到 5 個季度的利潤率有所上升經驗。我們看到這種動態在本季度帶來了 700 萬美元的增長。

Finally, during Q1, we also received final performance data driving the release of about $4 million in margin that was originally anticipated for Q2 and Q3. This accelerated recognition of adjusted EBITDA from future quarters in 2023 was the main driver of results slightly exceeding our first quarter guidance range. Overall, we are pleased with the progress in our Performance Suite. These sorts of quarter-to-quarter dynamics are factored into how we forecast and guide on the business as our Performance Suite margins continue to mature at the pace we expect.

最後，在第一季度，我們還收到了最終業績數據，推動釋放了最初預計第二季度和第三季度約 400 萬美元的利潤。 2023 年未來幾個季度調整後 EBITDA 的加速確認是業績略高於我們第一季度指導範圍的主要推動力。總的來說，我們對性能套件的進展感到滿意。隨著我們的性能套件利潤繼續按照我們預期的速度成熟，這些季度與季度的動態將被納入我們對業務的預測和指導中。

I also want to highlight continued progress in our cash flow and balance sheet. As you know, we are highly focused on cash generation and delevering. We ended the quarter with net debt of $523.4 million or 3.9x our reported trailing 12-month adjusted EBITDA. Adding to our trailing 12-month adjusted EBITDA, the full year's worth of the acquired adjusted EBITDA from IPG and NIA, an additional $47.9 million, results in a ratio of 2.9x, already lower than our initial target to the end of 2023 and largely driven by cash generation in the quarter after the NIA transaction.

我還想強調我們的現金流和資產負債表的持續進展。如您所知，我們高度關注現金生成和去槓桿化。本季度結束時，我們的淨債務為 5.234 億美元，是我們報告的過去 12 個月調整後 EBITDA 的 3.9 倍。加上我們過去 12 個月的調整後 EBITDA，從 IPG 和 NIA 收購的全年調整後 EBITDA 價值額外 4790 萬美元，導致比率為 2.9 倍，已經低於我們到 2023 年底的初始目標，並且在很大程度上受到 NIA 交易後本季度現金生成的推動。

In addition, after the quarter closed, our available cash increased by an incremental $20 million from the Passport wind-down. We expect to repatriate up to an additional $10 million of cash later in this year as we complete the shutdown process for that plan. We remain committed to using excess cash to pay down our debt, and we repaid $37.5 million on our revolving facility during Q1 of '23.

此外，在本季度結束後，我們的可用現金因 Passport 到期而增加了 2000 萬美元。我們預計在今年晚些時候完成該計劃的關閉流程後，將額外匯回 1000 萬美元現金。我們仍然致力於使用多餘的現金來償還債務，並在 2023 年第一季度償還了 3750 萬美元的循環貸款。

Now let's review the numbers before turning to guidance. Revenue in the quarter was $427.7 million, an increase of 44% versus the same period in the prior year. Excluding the addition of $48.5 million in revenue from NIA in the quarter, growth was about 28%.

現在讓我們在轉向指導之前先回顧一下這些數字。該季度收入為 4.277 億美元，較上年同期增長 44%。不包括本季度 NIA 增加的 4850 萬美元收入，增長率約為 28%。

Let's break down membership and PMPMs for the quarter. We averaged 3.2 million product members on the Performance Suite during Q1 compared to $1.5 million in Q1 of '22, with an average PMPM fee of $24.66 versus $38.19 a year ago and in line with our average fees in Q4. As a reminder, the year-over-year change in average PMPM is a result of higher growth in Medicaid and commercial lines of business, which run lower than our corporate average.

讓我們來詳細分析本季度的會員資格和 PMPM。第一季度，我們的性能套件平均有 320 萬產品會員，而 22 年第一季度為 150 萬美元，平均 PMPM 費用為 24.66 美元，而一年前為 38.19 美元，與第四季度的平均費用一致。提醒一下，平均 PMPM 的同比變化是醫療補助和商業業務線增長較高的結果，這些業務線的運行低於我們的公司平均水平。

Product membership in our Specialty Technology and Services Suite was 60.5 million members during the first quarter compared to 14.3 million in the same period last year. Average PMPM fees were $0.36 for the first quarter of '23 versus $0.32 in the first quarter of '22, with the growth in membership principally driven by the addition of NIA.

第一季度，我們的專業技術和服務套件的產品會員數量為 6050 萬，而去年同期為 1430 萬。 23 年第一季度的平均 PMPM 費用為 0.36 美元，而 22 年第一季度的平均 PMPM 費用為 0.32 美元，會員數量的增長主要是由 NIA 的加入推動的。

Product members on Administrative Services, formerly Evolent Health Services, were 1.9 million compared to 2.1 million in the same period of the prior year, with an average PMPM fee of $14.91 versus $17.34 in the first quarter of '22, Total quarterly cases associated with advanced care planning and surgical management totaled 15,433 for the first quarter. And average revenue per case totaled approximately $2,555 for the first quarter, both in line with expectations.

行政服務（以前稱為 Evolent Health Services）的產品會員人數為 190 萬，而上年同期為 210 萬，平均 PMPM 費用為 14.91 美元，而 2022 年第一季度為 17.34 美元。第一季度護理計劃和手術管理總數為 15,433。第一季度每個案例的平均收入總計約為 2,555 美元，均符合預期。

Our adjusted EBITDA result was $50.5 million versus $24.3 million in the first quarter of '22, reflecting organic growth, maturation of our Performance Suite contracts and the addition of IPG and NIA. Adjusted EBITDA margin of 11.8% represented expansion of 360 basis points over the same quarter last year with the same drivers.

我們調整後的 EBITDA 結果為 5050 萬美元，而 2022 年第一季度為 2430 萬美元，反映了有機增長、Performance Suite 合同的成熟以及 IPG 和 NIA 的增加。在相同驅動因素的情況下，調整後 EBITDA 利潤率為 11.8%，較去年同期增長 360 個基點。

As a result of the close of the NIA transaction, we made 2 noncash entries related to our tax assets and liabilities, releasing the majority of our remaining valuation allowance against our deferred tax assets and accruing the remaining liability under the tax receivable agreement we have with our pre-IPO investors for a net benefit in the quarter of about $2 million. With our historical net operating losses and at current course and speed, we do not expect to have meaningful federal cash tax expenses until 2025 at the earliest.

NIA 交易結束後，我們製作了 2 個與我們的稅務資產和負債相關的非現金分錄，釋放了我們的遞延所得稅資產的大部分剩餘估值備抵，並根據我們與應收賬款協議應計的剩餘負債我們的 IPO 前投資者在本季度獲得約 200 萬美元的淨收益。鑑於我們歷史上的淨經營虧損以及目前的進程和速度，我們預計最早要到 2025 年才會出現有意義的聯邦現金稅支出。

Turning to the balance sheet. We finished the quarter with $157.5 million in cash and cash equivalents, including $32 million in cash held in regulated accounts related to the wind-down of Passport. Excluding the cash held for Passport, we had $126 million of available cash, a decrease of $26 million versus the end of the fourth quarter and slightly ahead of where we'd expect to be with normal working capital seasonality. Cash deployed for capitalized software development in the quarter was $8.1 million.

轉向資產負債表。本季度末，我們擁有 1.575 億美元的現金和現金等價物，其中包括與 Passport 終止相關的受監管賬戶中持有的 3200 萬美元現金。不包括為 Passport 持有的現金，我們有 1.26 億美元的可用現金，比第四季度末減少了 2600 萬美元，略高於我們對正常營運資金季節性的預期。本季度用於資本化軟件開發的現金為 810 萬美元。

Turning now to our outlook for the year. Based on strong underlying performance, we are reiterating our full year adjusted EBITDA guidance of $180 million to $200 million and modestly raising our revenue guidance for the year to be between $1.935 billion and $1.965 billion, an increase of $10 million at the midpoint. A couple of reminders on what goes into this outlook. On the top line, we expect to see nice quarter-over-quarter expansion across each of the next 2 quarters as we go live with previously announced Performance Suite partnerships with Molina and Humana.

現在轉向我們對今年的展望。基於強勁的基本業績，我們重申全年調整後 EBITDA 指導為 1.8 億美元至 2 億美元，並將今年的收入指導適度提高至 19.35 億美元至 19.65 億美元，中間增加了 1,000 萬美元。關於這一展望的一些提醒。總體而言，隨著我們之前宣布的與 Molina 和 Humana 建立 Performance Suite 合作夥伴關係，我們預計未來兩個季度將出現良好的季度環比擴張。

Regarding Medicaid redeterminations, we have no meaningful incremental data since the last time we spoke, and we have not changed our assumptions. 3 key reminders on those assumptions. First, most of our Medicaid revenue is derived from states like Illinois that we expect will start redetermination later in the year. Second, we expect the gross impact on our Medicaid membership to be between 8% and 10% by the end of the year, representing a couple of points of net revenue headwind this year given that Medicaid represents about 40% of our revenue. And finally, we have incorporated into our bottom line guidance an assumption that those members who come off of the Medicaid roles are healthier than those who stay on, representing a modest negative adjusted EBITDA impact as well.

關於醫療補助重新確定，自上次發言以來我們沒有任何有意義的增量數據，我們也沒有改變我們的假設。關於這些假設的 3 個關鍵提醒。首先，我們的大部分醫療補助收入來自伊利諾伊州等州，我們預計這些州將在今年晚些時候開始重新確定。其次，我們預計到今年年底，對我們的醫療補助會員資格的總體影響將在 8% 至 10% 之間，考慮到醫療補助占我們收入的 40% 左右，這意味著今年的淨收入逆風幾個百分點。最後，我們在底線指導中納入了一個假設，即那些脫離醫療補助角色的成員比留下來的成員更健康，這也代表了適度的負面調整後 EBITDA 影響。

We believe our profitability assumptions are conservative here, given that we typically have contractual rights to adjust up our PMPMs if we do, in fact, lose healthier members. Given the timing benefit to adjusted EBITDA in Q1 that I referenced earlier, we have revised our expectations for adjusted EBITDA sequencing across the quarters. We now expect Q3 2023 to be the low quarter of adjusted EBITDA, stepping back up in the next quarter to exit 2023 with a strong Q4. Accordingly, for Q2, we are expecting revenues of between $455 million and $470 million and adjusted EBITDA between $45 million and $49 million.

我們認為，我們的盈利能力假設是保守的，因為如果我們確實失去了更健康的會員，我們通常擁有調整 PMPM 的合同權利。鑑於我之前提到的第一季度調整後 EBITDA 的時機優勢，我們修改了對各季度調整後 EBITDA 排序的預期。我們現在預計 2023 年第三季度將是調整後 EBITDA 的最低季度，並在下個季度回升，以強勁的第四季度結束 2023 年。因此，我們預計第二季度的收入將在 4.55 億美元至 4.7 億美元之間，調整後的 EBITDA 將在 4500 萬美元至 4900 萬美元之間。

And with that, let's go ahead and open it up for Q&A tonight.

就這樣，讓我們今晚繼續進行問答。

(Operator Instructions) Your first question comes from the line of Sandy Draper from Guggenheim Partners.

（操作員說明）您的第一個問題來自 Guggenheim Partners 的 Sandy Draper。

Great. I guess the first question, John, I just want to make sure I understand the -- I think you said it was about a $10 million reduction in revenue. That was from prior period adjustment, and so it was nothing that happened this quarter? I just want to -- if you can maybe just walk through those dynamics.

偉大的。我想第一個問題，約翰，我只是想確保我理解——我想你說過收入減少了大約 1000 萬美元。那是前期調整的結果，所以這個季度沒有發生什麼？我只是想——如果你能回顧一下這些動態的話。

And then I guess the unrelated follow-up. I appreciate no new information on Medicaid redetermination. But just thinking about some of the commentary out of the payers around '24 that some of the -- they're expecting maybe a headwind to cost. Is that something that would have an impact on you guys? Or as you just said, maybe that you've already factored in the numbers?

然後我猜是不相關的後續行動。我很高興沒有關於醫療補助重新確定的新信息。但想想 24 年左右付款人的一些評論，他們預計成本可能會遇到阻力。這會對你們產生影響嗎？或者正如您剛才所說，也許您已經考慮了這些數字？

Sandy, good questions. On the revenue side, so it was related to 2022, and this sort of thing can happen when -- in particular, as I mentioned, in Medicaid plans, when you have very strong performance. When you release a hold on claims, claims come in better than expected. If the plan is performing very well, then the plan has a minimum MLR floor. And when we do well and the plan does well, it can result in an element like this.

桑迪，好問題。在收入方面，這與 2022 年有關，尤其是，正如我提到的，在醫療補助計劃中，當你表現非常強勁時，這種事情可能會發生。當您解除對索賠的保留時，索賠的情況會好於預期。如果計劃執行得很好，則該計劃具有最低 MLR 下限。當我們做得好、計劃做得好時，就會產生這樣的結果。

I would say, generally speaking, so more broadly on this topic, we tend to have very good insight into how these sorts of dynamics will play out over the full course of the year. The timing, though, of something like this is not at our discretion and is based on when we receive the final data from our partner health plans. And so we had expected something like this, not a surprise, and incorporated into our full year guide. The specific timing is harder to predict.

我想說，一般來說，從更廣泛的角度來說，在這個話題上，我們往往對這些動態將如何在全年中發揮作用有很好的洞察力。不過，此類事件的時間安排並非由我們自行決定，而是基於我們從合作夥伴健康計劃收到最終數據的時間。因此，我們已經預料到會出現這樣的情況，這並不奇怪，並將其納入我們的全年指南中。具體時間更難預測。

Moving to redeterminations to hit on that point. So yes, no new information that is significant. I think we'll have more information end of the second quarter into the third quarter as our major Medicaid states really get into their processes. Generally speaking, as we think of the bottom line impact on potential risk pools of the redetermination process, I would say 2 things, and our perspective has not changed.

轉向重新確定以解決這一問題。所以是的，沒有重要的新信息。我認為，隨著我們的主要醫療補助州真正進入其流程，我們將在第二季度末到第三季度獲得更多信息。一般來說，當我們考慮重新確定過程對潛在風險池的底線影響時，我會說兩件事，我們的觀點沒有改變。

The first and the most important is that the way our pricing tends to work is if there is, for example, a change in cancer prevalence in a population, then we have the ability to work with our partners to update our fees accordingly. And secondly, as I mentioned in the prepared remarks, we have incorporated an estimate, in the spirit of conservatism, of a potential impact of the risk pool shifting a little bit.

第一個也是最重要的是，我們的定價方式往往是，如果人群中的癌症患病率發生變化，那麼我們就有能力與我們的合作夥伴合作相應地更新我們的費用。其次，正如我在準備好的發言中提到的，本著保守主義的精神，我們對風險池稍微變化的潛在影響進行了估計。

So that's how we're thinking about it, feeling pretty good about where we are, and we'll continue to keep you updated as we see things move forward.

這就是我們的想法，我們對目前的情況感覺很好，當我們看到事情進展時，我們將繼續向您通報最新情況。

Your next question comes from the line of Charles Rhyee from TD Cowen.

您的下一個問題來自 TD Cowen 的 Charles Rhyee。

Great. John, just wanted to maybe follow up there when you're talking about the ability to adjust pricing, if there's changes in the population. Is that like over -- like how periodic are you able to make those changes? And I guess particularly as when we think about going with oncology with Humana into Florida and Arizona, obviously, you start to get the much bigger populations here. Maybe talk a little bit about sort of the underwriting process that you guys go through as you think about that. And then as I said -- asked earlier, how often are you able to review that?

偉大的。約翰，只是想在您談論如果人口發生變化時調整定價的能力時跟進。就這樣結束了嗎——比如你能夠多久進行這些改變？我想，特別是當我們考慮與 Humana 一起進入佛羅里達州和亞利桑那州進行腫瘤學研究時，顯然，這裡的人口開始增多。也許可以談談你們在思考這個問題時所經歷的承保過程。然後，正如我之前所說的，您多久能夠審查一次？

Yes, it's a great question, Charles. I think the most important component of this answer is that it's an ongoing dialogue with our partners. Where are we performing? How are we delivering value for them, both on the pure cost side and also network performance and quality? As we think about the sort of speed of potentially updating the fee schedule, I think the real answer to bracket it is it's not real time, and it's much faster than a health plan state cap rates. And so the key from our perspective is to be hyperfocused on performing for our customers and in regular dialogue with them on what's going on in the market and what are we seeing so that we can best align with them going into the future.

是的，這是一個很好的問題，查爾斯。我認為這個答案最重要的組成部分是與我們的合作夥伴的持續對話。我們在哪裡表演？我們如何為他們提供價值，無論是在純成本方面還是在網絡性能和質量方面？當我們考慮潛在更新費用表的速度時，我認為真正的答案是它不是實時的，而且它比健康計劃州上限費率快得多。因此，從我們的角度來看，關鍵是要高度關注為客戶提供服務，並與他們定期對話，了解市場正在發生的情況以及我們所看到的情況，以便我們能夠在未來與他們保持一致。

Okay. And maybe just a follow-up. The $4 million in EBITDA that you discussed being pulled forward from the second and third quarters, can you talk about what were the triggers that kind of released that earlier than you would have expected? And is there any additional margin that's sort of tied up in the potential performance fees that's perhaps not in the current guidance that could be -- that you might see later?

好的。也許只是後續行動。您討論的 400 萬美元 EBITDA 將從第二季度和第三季度提前，您能談談是什麼觸發了這種比您預期更早的釋放嗎？是否有任何額外的利潤與潛在的績效費用相關，而這可能不在當前的指導中——您稍後可能會看到？

Yes. So the way that this sort of thing tends to work, and as I mentioned in my earlier answer to Sandy, is highly dependent on when we get data. And mostly, what that looks like is when we get claims completion. And in this particular case, the data came in a little earlier than we expected it to. The actuarial standards, as you probably know, is to retain a margin for adverse development until you see that final claims completion. And that's the standard that we follow and we'll continue to follow over the course of the coming quarters and years.

是的。因此，正如我在之前對桑迪的回答中提到的，這類事情的運作方式很大程度上取決於我們何時獲取數據。最重要的是，當我們完成索賠時，情況就是這樣。在這個特殊情況下，數據的到來比我們預期的要早一些。正如您可能知道的那樣，精算標準是為不利發展保留餘量，直到您看到最終索賠完成為止。這就是我們遵循的標準，我們將在未來幾個季度和幾年中繼續遵循。

Your next question comes from the line of Anne Samuel from JPMorgan.

您的下一個問題來自摩根大通的 Anne Samuel。

You spoke about margin progression for Performance Suite contracts being beneficial in the quarter. I was wondering, how much does that vary by payer in terms of the maturity curve? Or is it relatively consistent?

您談到了 Performance Suite 合同的利潤增長在本季度是有利的。我想知道，付款人的到期曲線有多大差異？或者說是比較一致的？

That's a good question, Annie. I think if you were to look at the beginning to end, we typically think of it as a 36-month sort of curve, right? If you look at the beginning to end, it looks pretty consistent. And on a quarter-to-quarter basis, it can be pretty different from customer to customer. And part of that can be driven -- just like what we were just talking about, availability of data, part of it can be driven by the network and so on.

這是個好問題，安妮。我想如果你看一下從開始到結束，我們通常會認為它是一條 36 個月的曲線，對吧？如果你從頭到尾看一下，它看起來非常一致。從每個季度來看，不同客戶的情況可能會有很大不同。其中一部分是可以驅動的——就像我們剛才講的，數據的可用性，一部分可以由網絡驅動等等。

What I think we've been particularly pleased with over the last several quarters is the way that we've been able to go live with quite a significant amount of new business across a number of different states and a number of different lines of business and preserve both the ability to drive that margin maturation and to serve the -- our customers and the ultimate to the consumer here being the member.

我認為在過去的幾個季度中，我們特別滿意的是我們能夠在多個不同的州和多個不同的業務領域開展大量新業務，並且保持推動利潤成熟和服務我們的客戶以及最終成為會員的消費者的能力。

That's really helpful. And then just one more kind of housekeeping question. In your deck, you called out a wind-down of legacy clients in Administrative Services. I was just hoping maybe you could explain what that is.

這真的很有幫助。然後又是一種內務問題。在你的套牌中，你呼籲減少行政服務中的遺留客戶。我只是希望你能解釋一下那是什麼。

That's just normal churn on the EHS side of the business, Annie.

安妮，這只是 EHS 業務方面的正常流失。

Your next question comes from the line of Ryan Daniels from William Blair.

你的下一個問題來自威廉·布萊爾的瑞恩·丹尼爾斯。

My first, Seth, I wanted to get a little bit more detail from you on the payer/AMSURG announcement you made tonight. Can you just explain that a little bit more? I guess I'm curious if it's for all of AMSURG's ASC cases that use implants, number one. And then number two, is it just for ortho or does that spill into the [opto] space, as I know ophthalmology and GI are kind of their 2 biggest areas of focus?

首先，Seth，我想從您那裡獲得有關您今晚發布的付款人/AMSURG 公告的更多詳細信息。您能再解釋一下嗎？我想我很好奇這是否適用於所有使用植入物的 AMSURG ASC 病例，第一。第二，它只是用於矯正還是會滲透到[光學]領域，因為我知道眼科和胃腸道是他們的兩個最大的關注領域？

Yes. Ryan, so I think the way to think about this relationship is we IPG, which we now refer to as our surgical solution, had a relationship with an existing national payer. The national payer, I think, is happy with the work we're doing on their behalf in a small number of states and is expanding their relationship into some different ASC arrangements and want us to be involved in that to help them manage cost and trend. And so that then pulls us through into a number of new states that we weren't in to begin with, Ryan, drives obviously additional revenue and EBITDA for us.

是的。 Ryan，所以我認為思考這種關係的方式是我們 IPG，我們現在稱之為我們的手術解決方案，與現有的國家付款人有關係。我認為，國家付款人對我們代表他們在少數州所做的工作感到滿意，並且正在將他們的關係擴展到一些不同的 ASC 安排，並希望我們參與其中，以幫助他們管理成本和趨勢。這樣一來，我們就進入了許多我們一開始沒有進入的新州，瑞安，顯然為我們帶來了額外的收入和 EBITDA。

But I think the fact that we're being brought into these new states with this existing ASC that we announced today, but we'll have then the opportunity to go to other ASCs in those same markets. So I think this is just part of a normal growth strategy, and it is beyond MSK into I think -- and that's the thing about ASCs, right? It's -- surgical activity with implantable devices could be across a number of different specialties.

但我認為，事實上，我們今天宣布的現有 ASC 正在進入這些新州，但隨後我們將有機會進入這些相同市場中的其他 ASC。所以我認為這只是正常增長戰略的一部分，我認為這超出了 MSK 的範圍——這就是 ASC 的特點，對嗎？植入式設備的外科手術可能涉及許多不同的專業。

Okay. And though -- if I'm a doctor, one of the doctors working at an AMSURG center, is it going to be for all my cases that I would leverage the IPG solutions? Or is it just for cases that are with that specific payer?

好的。不過，如果我是一名醫生，是在 AMSURG 中心工作的醫生之一，我是否會在所有病例中都利用 IPG 解決方案？還是僅適用於特定付款人的案件？

In this case, it's with that payer, right? Now of course, it gives us an opportunity to do more and have a broader growth opportunity in those markets, as I mentioned earlier.

在這種情況下，是付款人的，對嗎？當然，正如我之前提到的，現在它讓我們有機會在這些市場上做更多的事情並獲得更廣泛的增長機會。

Okay. That's helpful. And then the comments you had earlier just on the Medicaid redeterminations, we've heard that as well. Some of the healthier members may be exiting on redetermination. Do you think that will provide increased incentive for managed Medicaid companies to look for solutions like yours to help them control MLR in a period where membership could be reduced and the remaining members could be higher cost? Is that a potential growth stimulant for the business?

好的。這很有幫助。然後，您之前對醫療補助重新確定的評論，我們也聽到了。一些健康的成員可能會因重新決定而退出。您認為這是否會增加受管理的醫療補助公司尋找像您這樣的解決方案的動力，以幫助他們在會員人數可能減少且剩餘會員成本可能更高的時期控制 M​​LR？這對業務來說是一個潛在的增長刺激因素嗎？

Ryan, I do think that anything that creates pressure on the payer community, this being an example, are generally good for us. In terms of creating a sales dynamic, it's helpful. I think the risk adjustment efforts that have been going on in the Medicare Advantage side fall into a similar category, again, anything that puts pressure. And so I think the answer to that is yes.

瑞安，我確實認為任何給付款人社區帶來壓力的事情（這就是一個例子）通常對我們有好處。在創造銷售動力方面，這很有幫助。我認為醫療保險優勢方面一直在進行的風險調整努力也屬於類似的類別，任何施加壓力的事情都是如此。所以我認為答案是肯定的。

And I think more broadly, one of the things that lifted us up a little bit in the conversation today that has been useful is I think as payers look at the next horizon of quality and cost management. We've done a lot with primary care. There's a lot less on the specialty side. And so we feel like we're still in early innings. And as pressure comes, that is helpful to us.

我認為更廣泛地說，在今天的談話中讓我們稍微振奮一點的有用的事情是，我認為付款人著眼於質量和成本管理的下一個視野。我們在初級保健方面做了很多工作。專業方面就少了很多。所以我們覺得我們仍處於早期階段。當壓力來臨時，這對我們很有幫助。

Your next question comes from the line of Jeff Garro from Stephens.

您的下一個問題來自斯蒂芬斯的傑夫加羅。

I want to ask a couple on the NIA integration. And so the first would just be any color you could provide on the adjusted EBITDA contribution in the quarter, if it's performing kind of in line with the annual expectations you had said earlier.

我想詢問一些關於 NIA 集成的問題。因此，第一個就是您可以提供的本季度調整後 EBITDA 貢獻的任何顏色，如果它的表現與您之前所說的年度預期相符。

Jeff, it sure is right in line. Only 10 weeks in the quarter, we had NIA, but feel good about it.

傑夫，這確實是對的。本季度只有 10 週，我們出現了 NIA，但感覺很好。

Yes. And Jeff, it's Seth. I would say, more broadly, just in terms of the integration, we mentioned in the remarks earlier, but we feel like we're on track. A lot of things going quite well, and we're very happy with where we are, having kind of finished the organizational part of the integration and now really focusing on the platform side and cross-selling all the things that come after that. So we feel quite good about where we sit right now.

是的。傑夫，是賽斯。我想說，更廣泛地說，就整合而言，我們在前面的評論中提到過，但我們覺得我們已經步入正軌。很多事情進展順利，我們對目前的狀況感到非常滿意，已經完成了整合的組織部分，現在真正專注於平台方面並交叉銷售此後的所有內容。所以我們對現在的位置感覺很好。

Yes, that's great. Maybe to follow up a little bit on that cross-sell opportunity. I know it's early, so I would love to hear about any early successes building the pipeline. But maybe the question is more appropriately to the extent that you are making sure you're not disrupting any existing sales cycle and kind of any learnings you might have about what's making you maybe more or less excited about the combined organization's ability to be a more valuable partner to your clients and prospects.

是的，那太好了。也許是為了跟進這個交叉銷售機會。我知道現在還為時過早，所以我很想听聽有關管道建設的早期成功消息。但也許這個問題更合適，因為你要確保你不會擾亂任何現有的銷售週期，以及你可能學到的任何知識，這些知識讓你或多或少對合併後的組織有能力成為一個更強大的組織感到興奮。您的客戶和潛在客戶的寶貴合作夥伴。

Yes. Yes, look, I think the things that were in the pipeline prior are proceeding as expected. When you think about cross-sell, Jeff, I think as we have talked about with IPG or vital or anything else in the past 6 to 9 months in is when you really start to bear fruit. We bought IPG last summer. First quarter, I think, was consistent with when we thought we would start seeing some opportunities like the one we announced today, and I think it would be similar in this situation with NIA.

是的。是的，看，我認為之前正在醞釀的事情正在按預期進行。 Jeff，當你考慮交叉銷售時，我認為正如我們在過去 6 到 9 個月中與 IPG 或重要的或其他任何事情討論的那樣，才是你真正開始取得成果的時候。我們去年夏天買了IPG。我認為，第一季度與我們認為我們會開始看到一些機會（如我們今天宣布的機會）的情況一致，而且我認為 NIA 的情況也會類似。

The one thing that's new and different is that we now, because of the breadth of what we have with all the assets pulled together, have the ability to talk about a really broad and deep platform that I think is quite differentiated, that, as I mentioned in the comments, we had a bunch of customers and prospective customers in a room not too long ago, and I think the attachment to the platform and where we're headed with, it is excellent. I'll say excellent. It's exciting. I think a lot of positive feedback on where we're headed, and it gives us a lot of confidence to keep running the direction we're going.

一件新的和不同的事情是，我們現在，由於我們擁有所有資產的廣度，有能力談論一個真正廣泛和深入的平台，我認為這個平台是非常與眾不同的，正如我所言評論中提到，不久前我們在一個房間裡有一群客戶和潛在客戶，我認為對平台的依戀以及我們的發展方向非常好。我會說非常好。是興奮的。我認為對於我們前進的方向有很多積極的反饋，這給了我們很大的信心繼續沿著我們前進的方向前進。

Your next question comes from the line of Jessica Tassan from Piper Sandler.

您的下一個問題來自派珀·桑德勒 (Piper Sandler) 的傑西卡·塔桑 (Jessica Tassan)。

We were hoping you could just help us understand the impact of NCH on a plan provider network. So basically, we'd love to understand how or if NCH actually reduces the friction of prior auth by kind of inserting streamlined workflows and peer-to-peer consoles. Just any anecdotes or metrics on provider satisfaction pre- and post-NCH deployment?

我們希望您能幫助我們了解 NCH 對計劃提供商網絡的影響。所以基本上，我們很想了解 NCH 如何或是否實際上通過插入簡化的工作流程和點對點控制台來減少先前身份驗證的摩擦。關於 NCH 部署前後提供商滿意度的任何軼事或指標？

Yes. Jess, it's -- so a couple of different ways I might answer the question. At the end of the day, our goal is to improve quality and reduce cost. And the more we can do that without touching a physician's workflow in any meaningful way, all the better. And that's our objective and how we do things. So many times, we auto approve something, very high auto approval rates, for instance, as you mentioned.

是的。傑西，我可以用幾種不同的方式來回答這個問題。歸根結底，我們的目標是提高質量並降低成本。我們越能在不以任何有意義的方式影響醫生工作流程的情況下做到這一點，那就越好。這就是我們的目標以及我們做事的方式。很多時候，我們會自動批准某些東西，例如，正如您提到的，自動批准率非常高。

The next thing I would mention is that very, very rarely do we actually get involved or a payer in denial. We're doing a lot more what I would think of as B2B second opinion work, right, meaning we're actually providing valuable input to that physician. And that, as you mentioned, comes in the form of peer-to-peer or some other easy way to do it that's automated.

我要提到的下一件事是，我們很少真正參與其中或付款人否認。我們正在做更多我認為是 B2B 第二意見工作的工作，對吧，這意味著我們實際上正在為該醫生提供有價值的意見。正如您所提到的，這以點對點的形式或其他一些簡單的自動化方式來實現。

And then the last thing I'd say is we do survey our physicians pretty frequently. And I think the last survey I saw was 84% on extremely satisfied with New Century for I think that was an oncology example. And so that gives us a lot of confidence that the way we're doing it is creating value, but doing it in a way that has less friction, Jess.

我要說的最後一件事是，我們確實經常對我們的醫生進行調查。我認為我看到的上一次調查中有 84% 的人對 New Century 非常滿意，因為我認為這是一個腫瘤學的例子。因此，這給了我們很大的信心，我們所做的事情正在創造價值，而且是以一種摩擦更少的方式來做，傑西。

And over time, right, we're going to hopefully improve on that, not just the 84%, but on this idea of further automating things. And I think AI could be part of that over time as could our ability to continue to do things with incentives that turn into more of a shared decision-making model with the physician and the patient rather than us having to do the intervention. So a lot of innovation in this area, and we certainly want to lead the market on moving down the path you're describing.

隨著時間的推移，我們希望能夠改進這一點，不僅僅是 84%，而是進一步實現自動化的想法。我認為隨著時間的推移，人工智能可能會成為其中的一部分，因為我們有能力繼續通過激勵措施做事，從而變成更多與醫生和患者共享的決策模型，而不是我們必須進行干預。這個領域有很多創新，我們當然希望引領市場沿著您所描述的道路前進。

Got it. That's really helpful. And then just as a quick follow-up, can you guys remind us what Evolent has been assuming for the persistence of the Bright relationship in '23 or what the contribution was in 1Q, and then just whether -- or to what extent that relationship is factored into the 2024 adjusted EBITDA run rate guide? And that's it for me.

知道了。這真的很有幫助。然後，作為一個快速的後續行動，你們能否提醒我們 Evolent 對 Bright 關係在 23 年持續存在的假設是什麼，或者在第一季度的貢獻是什麼，然後只是這種關係是否——或者在多大程度上是否已納入 2024 年調整後 EBITDA 運行率指南中？對我來說就是這樣。

Yes, I'll take that one, Jess. I believe we said that we expected between $30 million and $40 million of revenue this year from Bright. No change there. And we do not expect revenue next year.

是的，我要那個，傑西。我相信我們說過，我們預計今年 Bright 的收入將在 3000 萬至 4000 萬美元之間。那裡沒有變化。我們預計明年不會有收入。

Your next question comes from the line of Sean Dodge from RBC Capital Markets.

您的下一個問題來自加拿大皇家銀行資本市場部的 Sean Dodge。

Maybe just going back to the AMSURG deal. With the payer involvement there, I guess the way Evolent gets paid, should we think about this being like a Tech and Services kind of arrangement? Or is there some shared savings element to it, too? And then any kind of data points you can give us to help triangulate in on expected revenue and EBITDA contribution from it either this year or next?

也許只是回到 AMSURG 交易。隨著付款人的參與，我想 Evolent 獲得付款的方式，我們是否應該將其視為一種技術和服務類型的安排？或者其中也有一些共享儲蓄元素？然後，您可以向我們提供任何類型的數據點來幫助我們對今年或明年的預期收入和 EBITDA 貢獻進行三角測量嗎？

Yes. So revenue model is IPG's paid per case. It is a fee-for-service model that enables value-based care and has extremely predictable margins, something from the CFO chair that I quite like. On size, it's not huge on the top line but a nice contributor on the bottom line given the strong margins.

是的。所以IPG的收入模式是按案付費。這是一種按服務付費的模式，可以實現基於價值的護理，並且具有極其可預測的利潤率，這是我非常喜歡首席財務官主席的一點。就規模而言，它的營收並不大，但考慮到強勁的利潤率，它對盈利的貢獻很大。

Okay. Great. And then I guess if you could just give us a little bit of insight into the dynamics behind why Q3 is now expected to be the low point for EBITDA for the year. Is that just simply the $4 million in medical cost release that shifted? Or is this tied to the Bright exit or something else or a combination of all those?

好的。偉大的。然後我想您能否給我們一些關於為什麼第三季度預計將成為今年 EBITDA 低點背後的動態的一些見解。這僅僅是 400 萬美元醫療費用的轉移嗎？或者這與光明退出或其他什麼或所有這些的組合有關？

It is. Yes, it's a good question, Sean. It really is just sharpening our pencils with more data on the timing of these performance margin releases. With the acceleration of that $4 million into this quarter, we now have a better sense of how that's going to lay out across the year.

這是。是的，這是個好問題，肖恩。這實際上只是用更多關於這些績效利潤釋放時間的數據來磨礪我們的鉛筆。隨著這 400 萬美元加速進入本季度，我們現在對全年的佈局有了更好的了解。

Your next question comes from the line of Jailendra Singh from Truist.

您的下一個問題來自 Truist 的 Jailendra Singh。

So I want to go back to Sandy's question around this $9 million revenue reduction. John, you said it's related to minimum MLR rebate. I'm still a little confused like why Evolent is on hook for that. Is there some unique arrangements with this particular payer? Or is this arrangement across all your payer contracts? And how are these rebate dollars even allocated to you guys considering that you guys capitate only on certain specialties? And why would this dynamic not put a cap on your profitability? Because if trends are better, I mean you should realize that as your profit. And I'm just curious, like clarify, like why this did not impact your EBITDA in the quarter.

所以我想回到桑迪關於 900 萬美元收入減少的問題。約翰，你說這與最低 MLR 回扣有關。我還是有點困惑，為什麼 Evolent 會因此陷入困境。與該特定付款人是否有一些獨特的安排？或者您的所有付款人合同中都存在這種安排嗎？考慮到你們只對某些專業進行投資，這些回扣資金是如何分配給你們的？為什麼這種動態不會限制您的盈利能力？因為如果趨勢更好，我的意思是你應該意識到這是你的利潤。我只是好奇，想澄清一下，為什麼這沒有影響您本季度的 EBITDA。

Yes. So a couple of thoughts on that one. The first is, as you know, this is mostly limited to a Medicaid-type arrangement. And as I mentioned earlier, this is typically only relevant when we have a mature Medicaid client that's already operating at or better than our target margins, where that client itself is also doing very well. And you can imagine the look, right, if we're driving outsized margins in a world where a Medicaid client is having to ship money back.

是的。所以對此有一些想法。首先，如您所知，這主要限於醫療補助類型的安排。正如我之前提到的，這通常僅在我們擁有成熟的醫療補助客戶且其運營水平已達到或高於我們的目標利潤率且該客戶本身也表現良好時才有意義。你可以想像一下，如果我們在一個醫療補助客戶必須退回資金的世界中推動巨額利潤，那會是什麼樣子。

And so in the spirit of partnership, the way that we seek to align with our partners is consistent with their own regulations. So as claims complete, and you're able to remove [holds] on -- in your IBNR based on the final claims completion, then that can sometimes result in symmetric revenue reduction. That's what happened in this quarter.

因此，本著夥伴關係的精神，我們尋求與合作夥伴保持一致的方式與他們自己的法規保持一致。因此，當索賠完成時，您可以根據最終索賠完成情況取消 IBNR 中的[保留]，有時可能會導致對稱收入減少。這就是本季度發生的情況。

Okay. That's helpful. And then also like on the second half to first half -- like first half, second half ramp up this revenue. I know you talked about Humana and Molina contract contribution. I know you talked about EBITDA cadence. But fair to say that to the ramp you expect in second half, that's all Humana and Molina contract and partially offset by redeterminations. And in general, if you could just provide some color around Humana arrangement expected to begin the second half. What's the progress there? Kind of which quarter should we start seeing the revenue coming from that contract?

好的。這很有幫助。然後也像下半年到上半年一樣——就像上半年一樣，下半年增加了這一收入。我知道你談到了 Humana 和 Molina 的合同貢獻。我知道您談到了 EBITDA 節奏。但公平地說，對於下半年你所期望的增長，這都是Humana和Molina的合同，部分被重新確定所抵消。總的來說，如果你能為預計下半場開始的Humana安排提供一些色彩的話。那裡的進展如何？我們應該在哪一個季度開始看到來自該合同的收入？

Yes. So taking those in reverse order. Humana implementation on track to go live in Q3 (inaudible). And the rest of the revenue shaping across the year is -- as I mentioned in the remarks, we'll see a nice step-up in Q2 and then another nice step-up in Q3.

是的。所以以相反的順序進行處理。 Humana 實施有望在第三季度上線（聽不清）。正如我在評論中提到的，全年其餘收入的形成是，我們將在第二季度看到一個不錯的增長，然後在第三季度再次看到一個不錯的增長。

Your next question comes from the line of Richard Close from Canaccord Genuity.

您的下一個問題來自 Canaccord Genuity 的 Richard Close。

A little surprised with respect to the Centene and WellCare beginning to go live here in April. Can you just talk a little bit more about that rollout and the above corporate average Tech and Services in terms of what the magnitude MA is versus like Medicaid?

對於 Centene 和 WellCare 四月份開始在這裡上線有點驚訝。您能否更多地談談該推出以及高於企業平均水平的技術和服務，以及 MA 與醫療補助的規模大小？

Yes. Richard, it's Seth. I think -- good question. Look, I think it's a positive, and it speaks to the depth of the partnership that we have with our partner at Centene. And I think we're doing a nice job for them, meeting our commitments. And as we've said, I think for many, many quarters in a row, when we do that, we generally get the right to either go faster, add things, and this is a great example of that, right? And so love seeing it, it's consistent with what we thought we would see, and it's a part of our plan to the $300 million of EBITDA, Richard, that we're driving towards.

是的。理查德，我是賽斯。我認為——好問題。看，我認為這是積極的，它說明了我們與 Centene 合作夥伴的合作深度。我認為我們為他們做得很好，履行了我們的承諾。正如我們所說，我認為連續很多很多季度，當我們這樣做時，我們通常有權加快步伐，添加東西，這是一個很好的例子，對嗎？所以很高興看到它，它與我們預期會看到的一致，而且這是我們 3 億美元 EBITDA 計劃的一部分，理查德，我們正在努力實現這一目標。

So I think it's a nice piece. As we've talked about in the past, Tech and Services has a nice margin profile. And so while this kind of relationship might not be huge on the top line, approaching between $5 million and $10 million, say, at run rate, Richard, certainly, we have a really nice flow-through on the bottom line. And so we think about that bridge to the $300 million, having a nice set of arrangements like this that contribute nice EBITDA and very consistent along with the Performance Suite margin maturation, I think the biggest thing I'd want people to take away from the call today is that both of those are progressing as we hoped.

所以我認為這是一個不錯的作品。正如我們過去談到的，技術和服務的利潤率很高。因此，雖然這種關係在營收上可能不會很大，接近 500 萬美元到 1000 萬美元之間，比如說，按運行率計算，理查德，當然，我們在利潤上有一個非常好的流程。因此，我們考慮通往 3 億美元的橋樑，擁有一套像這樣的良好安排，可以貢獻可觀的 EBITDA，並且與 Performance Suite 利潤率成熟度非常一致，我認為我希望人們從今天的呼籲是，這兩項工作都如我們所希望的那樣取得進展。

Okay. And with respect to someone that's doing Tech and Services, what historically has been maybe the time line in terms of adopting the Tech and Services and then potentially transition into the Performance Suite? Is there any rule of thumb that you experienced over the last, call it, 4 years since -- 4 or 5 years since you've had NCH?

好的。對於從事技術和服務的人來說，歷史上採用技術和服務然後可能過渡到性能套件的時間線是什麼？自從您患 NCH 以來 4 年或 5 年以來，您過去經歷過什麼經驗法則嗎？

Yes, it's a good question, Richard. I don't think there is a rule of thumb on that one. We've had a couple that have switched over from Tech Services to Performance Suite. They've happened on slightly different time lines. It depends, I think, largely on what is the issue that our customer is trying to solve, and we can guarantee more savings with the Performance Suite, right? So part of the earlier question, the more pressure there is, the more likely we have opportunities, I think.

是的，這是一個好問題，理查德。我認為這方面沒有經驗法則。我們有幾個已經從技術服務轉向性能套件。它們發生的時間略有不同。我認為，這很大程度上取決於我們的客戶試圖解決的問題是什麼，並且我們可以保證通過性能套件節省更多成本，對嗎？因此，我認為，前面的問題的一部分是，壓力越大，我們就越有可能獲得機會。

We've also had a bunch of Performance Suites go straight to Performance Suite and skipped the whole Tech Services kind of stop. And I think you're going to continue to see some of both for all the reasons I just said. And I don't think there's an easy rule of thumb on it.

我們還有很多性能套件直接進入性能套件，並跳過了整個技術服務這一環節。我認為出於我剛才所說的所有原因，您將繼續看到其中的一些。我認為這沒有簡單的經驗法則。

Your next question comes from the line of David Larsen from BTIG.

您的下一個問題來自 BTIG 的 David Larsen。

I think you mentioned that the Centene win was in addition to the sort of announced deployments at the time of like this transaction. And I think I heard there was another $20 million in addition to the postsynergy $85 million of EBITDA. Did I hear that correctly?

我想你提到 Centene 的勝利是除了這次交易時宣布的部署之外的。我想我聽說除了 8500 萬美元的 EBITDA 之外，還有另外 2000 萬美元。我沒聽錯嗎？

Dave, no, we were just making the point that the MA, oncology, Tech and Services deal was not a part of the originally announced Centene NIA expansion that went into the $85 million number. There was not an additional $20 million.

Dave，不，我們只是想指出 MA、腫瘤學、技術和服務交易並不是最初宣布的 Centene NIA 擴張的一部分，該擴張涉及 8500 萬美元。沒有額外的2000萬美元。

Okay. And then in terms of the revenue impact from this Medicaid health plan, I think it was $20 million in the quarter, not $10 million or $9 million, right? It was $20 million?

好的。然後就醫療補助健康計劃對收入的影響而言，我認為該季度為 2000 萬美元，而不是 1000 萬美元或 900 萬美元，對嗎？是2000萬美元？

I think I understand. So what I thought to articulate in my prepared remarks was we had in the quarter a reduction of $20 million in total in claims expense related to 2022. About $9 million of that $20 million was associated with the revenue deduct as well. The other $11 million dropped to our bottom line.

我想我明白。因此，我想在我準備好的發言中闡明的是，本季度與 2022 年相關的索賠費用總共減少了 2000 萬美元。這 2000 萬美元中約有 900 萬美元也與收入扣除相關。另外 1100 萬美元跌至我們的底線。

Yes. And David -- I think, David, just the last comment I'd make for the group, but relative to this question is just highlighting what John said, which is these are things that we understand. We know they're coming. We forecast for them. They're in guidance. We kind of have a sense of when they're going to come up. And I would think of it as normal course things that we factor in, which is why we're continuing to end up inside of the guidance ranges.

是的。大衛——我想，大衛，這只是我對小組的最後評論，但相對於這個問題，只是強調約翰所說的話，這些都是我們理解的事情。我們知道他們要來了。我們為他們預測。他們在指導。我們大概知道它們什麼時候會出現。我認為這是我們考慮的正常過程，這就是為什麼我們繼續最終處於指導範圍內。

(Operator Instructions) Your next question comes from the line of Brian Tanquilut from Jefferies.

（操作員說明）您的下一個問題來自 Jefferies 的 Brian Tanquilut。

Okay. JP, you can wrap the call then if there's no other additional questions, if no one else has polled in.

好的。 JP，如果沒有其他問題，如​​果沒有其他人參與投票，那麼您可以結束通話。

Thank you. There are no further questions at this time. Ladies and gentlemen, this concludes today's conference call. Thank you for your participation. You may now disconnect.

謝謝。目前沒有其他問題。女士們、先生們，今天的電話會議到此結束。感謝您的參與。您現在可以斷開連接。