Evolent Health Inc (EVH) 2023 Q4 法說會逐字稿

Welcome to the Avolon Earnings Conference Call for the quarter. And year ended December 31, 2023. As a reminder, this conference call is being recorded. Post for the call today from Evolent are Seth Blackley, Chief Executive Officer, and John Johnson, Chief Financial Officer, who will be archived and available later this evening and for the next week via the webcast on the company's website in the section titled Investor Relations I will now hand the call over to Seth Frank, everyone's Vice President of Investor Relations.

歡迎參加 Avolon 本季財報電話會議。該年度截至 2023 年 12 月 31 日。謹此提醒，本次電話會議正在錄音中。今天參加Evolent 電話會議的人員包括執行長Seth Blackley 和財務長John Johnson，他們的資訊將在今晚晚些時候以及下週透過公司網站上標題為「投資者關係」的部分的網路廣播進行存檔並提供我現在將把電話轉給大家的投資者關係副總裁塞思·弗蘭克(Seth Frank)。

Thank you and good evening. This conference call will contain forward-looking statements under 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. A description of some of the risks and uncertainties can be found in the Company's reports 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 fourth quarter press release issued earlier today. And 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 website, ir dot avnet.com and the Form eight K filed by the Company with the SEC earlier today.

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有重大差異。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，請參閱我們的第四季新聞今天早些時候發布的版本。最後，提醒一下，今天電話會議中討論的最直接可比 GAAP 衡量標準的非 GAAP 衡量標準的調節可在我們網站的投資者關係部分或公司今天發布並發布的新聞稿中的摘要介紹中找到。網站的投資者關係部分、ir dot avnet.com 以及公司今天早些時候向SEC 提交的8 K 表格。

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

現在我將把電話轉給 Evolent 的執行長 Seth Blackley。

Good evening and thanks for joining us. I'm excited to share with you our results for the fourth quarter and the full year 2023. We had another outstanding year achieving our profitability, cash flow, new business growth and operating goals for all of our stakeholders. And we remain focused on our mission of improving care for people with complex conditions.

晚上好，感謝您加入我們。我很高興與您分享我們第四季和 2023 年全年的業績。我們又度過了出色的一年，為所有利害關係人實現了獲利能力、現金流、新業務成長和營運目標。我們仍然專注於改善對患有複雜疾病的人的護理的使命。

Looking ahead today, we're providing a strong financial outlook for 2024 as well as reiterated confidence in our $300 million adjusted EBITDA run rate exit target for 2024. In addition, we'll be providing a detailed bridge between our Q4 2023 results and our $300 million run rate adjusted EBITDA target. For all the details on the numbers and metrics. Please review the press release and our supplemental investor presentation on the IR website.

今天展望未來，我們對 2024 年提供了強勁的財務前景，並重申了對 2024 年 3 億美元調整後 EBITDA 運行率退出目標的信心。此外，我們將在 2023 年第四季業績與 3 億美元運行率調整後 EBITDA 目標之間建立詳細的橋樑。有關數字和指標的所有詳細資訊。請查看投資者關係網站上的新聞稿和我們的補充投資者介紹。

As mentioned earlier, John and I will focus our comments on specific callouts that Merit comment or context from us. So we have plenty of time for your questions at the end.

如前所述，約翰和我將把我們的評論集中在值得我們評論或上下文的特定標註上。所以最後我們有足夠的時間回答你的問題。

With that, let's move to the results. Fourth quarter revenue totaled totaled $556.1 million, a growth of 45.4% year over year at the top end of our guidance range for adjusted EBITDA totaled $48.1 million growth of 48.9%. And the midpoint of our guide Evolent's core specialty care offerings drove 88% of total revenue in the quarter year over year. Specialty Care revenue grew approximately 74% versus a year ago, with the NIA. acquisition contributing approximately 19% to reported growth. The balance of 55% came from organic growth. Cash flow is a critical component of our sustainable financial model. And we ended the fourth quarter and 2024 in a strong position ahead of where we anticipated due to exceptionally strong cash collections.

接下來，讓我們看看結果。第四季營收總計 5.561 億美元，年增 45.4%，處於我們指導範圍的上限；調整後 EBITDA 總計 4,810 萬美元，成長 48.9%。我們指南中的 Evolent 核心專業護理產品佔本季總收入的 88%。NIA 的特殊照護收入比一年前增加了約 74%。收購對報告的成長貢獻了約 19%。其餘 55% 來自有機成長。現金流是我們永續財務模型的重要組成部分。由於現金回款異常強勁，我們在第四季和 2024 年結束時處於領先於我們預期的強勢地位。

Cash flow from operations in the quarter totaled $89.4 million, and we ended the year with $193 million of cash on hand.

本季營運現金流總計 8,940 萬美元，年底我們手頭現金為 1.93 億美元。

Our financial goals for 2023 was to increase our cash balance by more than $120 million before interest debt activity, acquisition costs or announced dividends. And with the strong Q4, we ended the year at over $175 million on this metric, our average product members grew to almost $80 million for the quarter. All of this growth is despite the Medicaid redeterminations headwind we've experienced in the back half of 2023 before we get into some of our new growth announcements.

我們 2023 年的財務目標是在扣除利息債務活動、收購成本或宣布的股息之前，將現金餘額增加超過 1.2 億美元。隨著第四季的強勁表現，我們在這項指標上的年收入超過 1.75 億美元，該季度我們的平均產品成員成長到近 8,000 萬美元。儘管在 2023 年下半年我們在發布一些新的成長公告之前經歷了醫療補助重新確定的逆風，但所有這些增長都是如此。

Let me say a few words about 2023. Overall. For the year, we ended with revenue of $1.96 billion, 45% year over year growth. Adjusted EBITDA for 2023 totaled $194.7 million, both at the high end of our initial guidance from a year ago. I'm incredibly proud of our team of approximately 5,000 committed mission driven professionals worldwide, who work so hard to help us collectively deliver what we promise to both shareholders and customers during a year when many in the industry faced headwinds. As we've been communicating for some time, we believe the challenges in managed care represent opportunities for Evolent given our unique value proposition and low penetration within our addressable market going forward, we continue to be focused on the principles of value creation that John, the team and I have used to guide the Company for the last 3.5 years. As a reminder, those principles are one strong organic growth to grow in profitability and three, disciplined capital allocation or inorganic growth. We have consistently outperformed our new business targets announcing an average of 11 new partners annually for the past three years versus a target of six to eight per year. This statistic is very useful directional indicator, but has also underrepresented in our growth, for example, counting important same-store expansions, which have become even more important since the NIA. acquisition, we had 12 new revenue contracts in 2023 alone versus nine used in the operating partner metric. Given that context, beginning with this year, we are simplifying our disclosure plan to count and track all material new revenue agreements, whether with new or existing partners, and we'll refer to this metric today and going forward as new revenue agreements so far in 2024, we have added four of these agreements to we announced at the January investor conference and two additional new revenue agreements today. Today we are announcing Evolent's first enterprise oncology technology and services agreement, which we recently signed with an existing health plan client specifically, we will now be providing radiation and surgical oncology management services to add to the medical oncology services. We are already providing to this health plan, which is one of the 10 largest health plans in the country. We believe this is an important agreement as it provides a path for us to bundle our radiation and surgical management capabilities and with our medical oncology in the technology and services suite, creating that PMPM expansion opportunity for the future. For example, surgical oncology costs represent approximately 17% of the PMPM of the cost of oncology in a commercial population according to a recent JAMA study. Most importantly, we believe bundling these services will allow us to provide better more holistic care to patients. We expect this new agreement announced today to add approximately $10 million in annual technology and services revenue once and full run rate in the third quarter of this year.

讓我簡單說一下2023年。全面的。今年，我們的營收為 19.6 億美元，年增 45%。2023 年調整後 EBITDA 總額為 1.947 億美元，皆為我們一年前初步指引的上限。我為我們的團隊感到無比自豪，該團隊由全球約 5,000 名致力於使命驅動的專業人士組成，他們在行業許多人面臨逆風的一年中努力工作，幫助我們共同兌現對股東和客戶的承諾。正如我們已經溝通了一段時間一樣，我們相信，鑑於我們獨特的價值主張和未來在目標市場中的低滲透率，管理式醫療中的挑戰代表了Evolent 的機遇，我們將繼續專注於John 所提出的價值創造原則，在過去的 3.5 年裡，我和我的團隊一直在指導公司。提醒一下，這些原則一是實現獲利能力的強勁有機成長，三是嚴格的資本配置或無機成長。我們始終超額完成新的業務目標，在過去三年中，我們平均每年宣布 11 個新合作夥伴，而目標是每年 6 到 8 個。這項統計數據是非常有用的方向性指標，但在我們的成長中也沒有充分體現，例如，計算重要的同店擴張，自 NIA 以來，同店擴張變得更加重要。透過收購，我們僅在 2023 年就簽訂了 12 份新收入合同，而營運合作夥伴指標中使用了 9 份新收入合約。鑑於這種情況，從今年開始，我們將簡化我們的揭露計劃，以統計和追蹤所有重要的新收入協議，無論是與新合作夥伴還是現有合作夥伴，我們今天將引用該指標，並將作為迄今為止的新收入協議到 2024 年，我們在 1 月投資者會議上宣布的協議中增加了其中四項協議，並在今天增加了兩項新的收入協議。今天，我們宣布Evolent 的第一份企業腫瘤學技術和服務協議，我們最近與現有的健康計劃客戶特別簽署了該協議，我們現在將提供放射和外科腫瘤學管理服務，以補充醫學腫瘤學服務。我們已經向該健康計劃提供資金，該計劃是該國十大健康計劃之一。我們相信這是一項重要的協議，因為它為我們提供了一條途徑，將我們的放射和手術管理能力以及我們的腫瘤醫學技術和服務套件捆綁在一起，為未來創造 PMPM 擴展機會。例如，根據最近的一項 JAMA 研究，在商業人群中，外科腫瘤治療費用約佔 PMPM 腫瘤治療費用的 17%。最重要的是，我們相信將這些服務捆綁在一起將使我們能夠為患者提供更好、更全面的護理。我們預計今天宣布的新協議將一次性增加約 1,000 萬美元的年度技術和服務收入，並在今年第三季實現全面運作。

Our second new revenue agreement disclosed today is for the Performance Suite as we work to thoughtfully expand our risk model across a broader base of specialties, we rolled out Evolent's first Performance Suite contract for advanced imaging during the fourth quarter of 2023 with a legacy NIA. client in Medicaid. This is a large health plan with a presence in multiple states. This performance suite arrangement, which we anticipate will contribute over [$80 million] in total annual revenue is designed with many of the same features as our proven models in oncology and cardiology. This performance suite arrangement builds upon an already successful risk-sharing relationship that was in place at the time of the NIA. acquisition, expanding into our Performance Suite model. Important to understand that the cost of size and scope of care in this arrangement are specific to outpatient advanced imaging such as MRIs and PET scans and Medicaid. As a result, the PMPMs will be lower than in oncology or cardiology, but we expect with the same general margin profile as our existing Performance Suite business.

我們今天披露的第二份新收入協議是針對性能套件的，因為我們致力於在更廣泛的專業基礎上深思熟慮地擴展我們的風險模型，我們在2023 年第四季度與傳統NIA 推出了Evolent 的第一份高級成像性能套件合約。醫療補助計劃的客戶。這是一項涉及多個州的大型健康計劃。我們預計這項性能套件安排將貢獻超過[8000萬美元]的年總收入，其設計具有許多與我們在腫瘤學和心臟病學領域經過驗證的模型相同的功能。這種性能套件安排建立在 NIA 時已經建立的成功的風險分擔關係的基礎上。收購，擴展到我們的 Performance Suite 模式。重要的是要了解，這種安排中的護理規模和範圍的成本是特定於門診高級影像，例如 MRI 和 PET 掃描以及醫療補助。因此，PMPM 將低於腫瘤學或心臟病學，但我們預計整體利潤率與我們現有的 Performance Suite 業務相同。

Finally, as a reminder, we announced two new revenue agreements in January. The first was a multi-product and I a cross-sell to an existing Evolent Health Clinic clients in the Northeast and a second, a new logo health plans in the Southwest. With over 100,000 unique lives in commercial and Medicare Advantage, we'll implement our oncology and advanced care planning services through our technology and services platform. So with four new revenue agreements already signed for off to a great start with respect to our grand organic growth goals, our pipeline also remains strong. During 2023, we began to see progress because of the NIA. acquisition that we believe increases Evolent's qualifications and competitiveness for large RFPs. We believe Evolent's position to have more conversations with key decision-makers, both within existing legacy NI clients and potential new customers. More importantly, health plans and risk-bearing physician groups are increasingly turning to us to help manage the cost and quality of specialty care. We have found that many plans have increased their focus on specialty care management over the past six months, some sight into the 28 risk adjustment changes and others because of general utilization pressures, we're seeing organizations placing particular importance on engaging partners that can help manage these costs in ways that improve patient experience at the same time will not increase friction with providers. We believe this is where everyone is truly differentiated. If you look at our work in oncology, as an example, many health plans is struggling with the cost of cancer care with many seen annual cost increases of over 10%. Some of these cost increases are driven by new categories of drugs as well as new indications for existing or new uses of existing medications. For example, we've seen in the marketplace as an oncologist increasingly using immunotherapies for a broad range of cancers once such therapy known as checkpoint inhibitors or PD. ones, are continuing to grow rapidly. In fact, just one popular PD. one called Keytruda and annual revenue of $25 billion in 2023. While the cost per patient of these sorts of therapeutics are dramatic in certain instances, they are worth the cost as they can be truly life-changing for patients. However, research shows that such treatments are often prescribed when it is known in advance or can be known in advance that they are unlikely to be effective to discern the effectiveness of therapies. Our clinical research has shown that it's critical that a genetic test or other companion diagnostics are completed commonly We partner with the treating oncologist to ensure these companion diagnostics are completed in the hope that the selected therapy will be the most effective for the patient. Our partnership model with oncologists is particularly well suited for these more complex and high cost situations when all the options are under consideration or approvable. And the only way to address cost and quality is by entering into a trust based dialogue with the treating oncologists.

最後，提醒一下，我們在一月宣布了兩項新的收入協議。第一個是多產品，我向東北部現有的 Evolent Health Clinic 客戶進行交叉銷售，第二個是西南地區的新標誌健康計劃。憑藉商業和 Medicare Advantage 中超過 100,000 個獨特的生命，我們將透過我們的技術和服務平台實施我們的腫瘤學和高級護理規劃服務。因此，四項新的收入協議已經簽署，為我們宏偉的有機成長目標開了一個良好的開端，我們的管道也保持強勁。2023 年，由於 NIA，我們開始看到進展。我們相信此次收購將增強 Evolent 在大型 RFP 的資格和競爭力。我們相信 Evolent 能夠與關鍵決策者進行更多對話，無論是現有的 NI 舊客戶還是潛在的新客戶。更重要的是，健康計劃和承擔風險的醫生群體越來越多地求助於我們來幫助管理專科護理的成本和品質。我們發現，在過去六個月中，許多計劃加大了對特殊護理管理的關注，其中一些計劃著眼於28 項風險調整變化，而另一些則是由於普遍的利用壓力，我們看到組織特別重視與能夠提供幫助的合作夥伴的合作。我們相信這是每個人真正與眾不同的地方。以我們在腫瘤學方面的工作為例，許多健康計劃都在與癌症護理成本作鬥爭，其中許多計劃的年度成本增長超過 10%。其中一些成本增加是由新類別的藥物以及現有藥物的現有或新用途的新適應症所驅動的。例如，我們在市場上看到腫瘤學家越來越多地使用免疫療法來治療多種癌症，這種療法被稱為檢查點抑制劑或 PD。的，正在持續快速成長。事實上，只是一位受歡迎的PD。一種名為 Keytruda 的產品，到 2023 年年收入將達到 250 億美元。雖然在某些情況下，每位患者的此類治療費用非常高，但它們是值得的，因為它們可以真正改變患者的生活。然而，研究表明，此類治療通常是在事先已知或可以提前知道它們不太可能有效辨別治療效果的情況下進行的。我們的臨床研究表明，共同完成基因測試或其他伴隨診斷至關重要。當所有選項都在考慮或批准時，我們與腫瘤學家的合作模式特別適合這些更複雜和高成本的情況。解決成本和品質問題的唯一方法是與治療腫瘤科醫生進行基於信任的對話。

Moving to our second operating priority of strong profitability. Let me reiterate a few points, and John will also discuss this in more detail. I think the success we had in 2023. And our strong outlook for 2024 is driven by our diversification across Medicare, Medicaid and commercial. In addition, we have a strong mix between our technology and services and performance fee businesses. Within the performance, we continue to see strong results in line with our expectations. While many in the industry had experienced higher than expected utilization. Q4 for us continued our prior trend of in-line performance.

轉向我們的第二個經營重點：強勁的獲利能力。讓我重申幾點，約翰也會更詳細地討論這一點。我認為我們在 2023 年取得了成功。我們對 2024 年的強勁前景是由我們在醫療保險、醫療補助和商業領域的多元化所推動的。此外，我們的技術和服務與績效費業務之間有著緊密的結合。在業績方面，我們持續看到符合我們預期的強勁業績。儘管業內許多人的利用率高於預期。第四季我們延續了先前一致的表現趨勢。

Our third investment theme is disciplined capital allocation. And in 2023, we made great strides in generating cash, delevering the business and lowering our cost of debt financing. We ended the quarter at 2.2 times net leverage, well ahead of the exit 2023 target we set at the time we acquired an IGA of less than three times further in December, we conducted a successful convertible offering that allowed us to completely swap out our existing term loan. So our only senior facility outstanding consists of $37.5 million through our revolver. And with those comments, let me hand it to John, who will provide a deep dive into our profitability and cash story now and for 2024, as well as our financial outlook.

我們的第三個投資主題是嚴格的資本配置。2023 年，我們在創造現金、去槓桿化業務和降低債務融資成本方面取得了長足進展。本季末，我們的淨槓桿率為2.2 倍，遠遠超出了我們在12 月收購IGA 時設定的2023 年退出目標，槓桿率還不到三倍，我們進行了成功的可轉換發行，使我們能夠完全置換現有的定期貸款。因此，我們唯一未償還的高級貸款包括透過我們的左輪手槍支付的 3750 萬美元。我將這些評論交給約翰，他將深入探討我們現在和 2024 年的獲利能力和現金狀況，以及我們的財務前景。

Thanks, Seth. I'll focus my remarks tonight on five areas. First, some metrics around our growth. Second adjusted EBITDA growth where it's coming from and our path to our $300 million target.

謝謝，塞思。今晚我的演講將集中在五個方面。首先，關於我們成長的一些指標。其次是調整後的 EBITDA 成長來自何處以及我們實現 3 億美元目標的路徑。

Third, a perspective on our 2023 cash flow performance and a look ahead to what we expect for cash production in 2024 for our view on key factors affecting the managed care environment in 2024 and how they might affect Evolent And finally, I will close with our Q1 and 2024 outlook and guidance beginning with top line growth. I believe Q4 of '23 demonstrates the value of our balanced growth strategy with our cross-sell delivering growth in product members. Despite a quarter over quarter decline in unique members due to Medicaid redeterminations. We're excited to continue delivering on our strategy of more products per unique member. And we ended the year at two products per unique MEMBER, up from an average of 1.6 in the first quarter of 2023 with the expansion of Evolent's performance suite into advanced imaging.

第三，對 2023 年現金流表現的展望以及對 2024 年現金產出的預期，以了解我們對影響 2024 年管理式醫療環境的關鍵因素以及它們可能如何影響 Evolent 的看法。展望和指導從營收成長開始。我相信 23 年第四季展示了我們平衡成長策略的價值，我們的交叉銷售帶來了產品成員的成長。儘管由於醫療補助計劃的重新確定，獨特會員數量環比下降。我們很高興能夠繼續實施為每個獨特會員提供更多產品的策略。隨著 Evolent 的性能套件擴展到高級成像領域，我們在年底時每個唯一會員擁有兩款產品，高於 2023 年第一季的平均 1.6 種產品。

As Beth discussed, I want to give investors a few reference points on Performance Suite PMPMs. Our capitation fees are based on the actual underlying costs of the scope that we manage. And so PMPMs can vary by population, geography and specialty. For example, oncology Performance Suite fees in Medicare are typically between $40 and $70 per member per month. And as cancer prevalence is relatively lower in Medicaid populations, fees for a similar scope of work might be between $10 and $20 per member per month. Similarly, we anticipate advanced imaging performance suite fees will vary by line of business with a smaller average based on typical costs from $3 at the low end to $10 at the high end.

正如 Beth 所討論的，我想為投資者提供一些 Performance Suite PMPM 的參考點。我們的按人頭收費是基於我們管理範圍的實際基本成本。因此，PMPM 可能會因人口、地理位置和專業而異。例如，Medicare 中的腫瘤學性能套件費用通常為每位會員每月 40 至 70 美元。由於醫療補助人口的癌症盛行率相對較低，因此類似工作範圍的費用可能在每位成員每月 10 至 20 美元之間。同樣，我們預計高級成像性能套件的費用將因業務線的不同而有所不同，基於典型成本的平均費用較小，從低端的 3 美元到高端的 10 美元。

Turning to adjusted EBITDA expansion, which remains a consistent long-term pillar for shareholder value creation, we are pleased to be on track with our profit targets as we exit the year, delivering adjusted EBITDA growth of almost 49% relative to Q4 of 2022 in May of '23.

談到調整後 EBITDA 擴張，這仍然是創造股東價值的長期支柱，我們很高興在今年結束時能夠實現我們的利潤目標，與 2022 年第四季度相比，調整後 EBITDA 增長近 49%。 5 月。

At our Investor Day, we articulated three primary sources of adjusted EBITDA growth. First, adjusted EBITDA from our recent acquisitions, second, the maturation of our performance fee contracts, and third, new growth. As you can see on slide 8 of the presentation. Our year-over-year performance for Q4 resulted from these same sources of core business performance with over $12 million of quarterly adjusted EBITDA growth from our core organic business drivers versus the same quarter last year, nearly $50 million in annualized improvements. For example, looking at 2022 performance suite launches, we saw an improvement of over 10-percentage-points in our margins between Q4 of '22 and Q4 of '23, consistent with our targets and the result of both initial actuarial conservatism and quality and cost improvements to our model during 2023. This performance in our core business was offset in part by expected headwinds from Medicaid redeterminations and the runoff of certain legacy administrative services clients during 2023. Importantly, these headwinds are well understood and time bound to see administrative services impacts complete as we exit '23. While our core business drivers will continue to propel us towards our $300 million adjusted EBITDA exit run rate target for 2024.

在投資者日，我們闡述了調整後 EBITDA 成長的三個主要來源。首先，我們最近的收購調整後的 EBITDA，其次，我們的績效費合約的成熟，第三，新的成長。正如您在簡報的幻燈片 8 中看到的那樣。我們第四季的同比業績源於這些相同的核心業務業績來源，我們的核心有機業務驅動因素帶來了超過 1200 萬美元的季度調整後 EBITDA 增長，而去年同期的年化改進接近 5000 萬美元。例如，從2022 年推出的績效套件來看，我們發現，從22 年第四季到23 年第四季，我們的利潤率提高了10 個百分點以上，這與我們的目標以及初始精算保守性和品質的結果一致。我們核心業務的這一業績在一定程度上被醫療補助重新確定所帶來的預期阻力以及 2023 年某些遺留行政服務客戶的流失所抵消。重要的是，這些不利因素是眾所周知的，並且在我們退出「23」時，行政服務影響將在一定時間內完成。我們的核心業務驅動因素將繼續推動我們實現 2024 年 3 億美元的調整後 EBITDA 退出運行率目標。

You can see the details on Slide 9 of the presentation. First, we anticipate an approximate $4 million headwind to quarterly adjusted EBITDA for Medicaid redeterminations relative to Q4 of '23, which I'll discuss more in a bit.

您可以在簡報的幻燈片 9 上查看詳細資訊。首先，我們預計相對於 23 年第四季度，醫療補助重新確定的季度調整後 EBITDA 將面臨約 400 萬美元的阻力，我將在稍後對此進行更多討論。

Second, realizing the contractual synergies from the NIA. deal by the end of this year adds approximately $35 million in annual adjusted EBITDA were approximately $9 million on a quarterly basis for our performance suites, we are projecting approximately an incremental $13 million in quarterly adjusted EBITDA exiting this year.

其次，實現 NIA 的合約綜效。今年年底的交易為我們的績效套件增加了約 3500 萬美元的年度調整後 EBITDA 約 900 萬美元，我們預計今年退出的季度調整後 EBITDA 將增加約 1300 萬美元。

And finally, on new profitable growth, we have already announced deals that we expect will contribute approximately an additional $5 million in quarterly adjusted EBITDA once they are live, leaving the range of $4 million in quarterly adjusted EBITDA.

最後，關於新的獲利成長，我們已經宣布了一些交易，我們預計這些交易一旦生效，將為季度調整後EBITDA 帶來約500 萬美元的額外貢獻，從而使季度調整後EBITDA 保持在400 萬美元的範圍內。

As our go-get.

作為我們的首選。

Let me provide some additional color on each element of this bridge. First, recall that the NIA. related synergies are both revenue and cost base. We feel high confidence in achieving them, but they are contractual in nature, new services agreements that have already starting phasing in on the revenue side.

讓我為這座橋的每個元素提供一些額外的顏色。首先，回想一下 NIA。相關的協同效應包括收入和成本基礎。我們對實現這些目標充滿信心，但它們本質上是合約性的，新的服務協議已經開始在收入方面逐步實施。

On the cost side, we continue to expect to exit the transition services agreement later this quarter.

在成本方面，我們繼續預計本季稍後將退出過渡服務協議。

For the Performance Suite, the forecasted improvement is primarily driven by initial margin expansion of just over 10% on the over $400 million in Performance Suite revenue launched during 2023, and it's consistent with what we experienced for '22 launches across 2023. And for the new business front, recall that we initially targeted $50 million of our $300 million run rate adjusted EBITDA from new growth in May of '23 or about nine months ago. We have in the range of $16 million or approximately $4 million per quarter. Of that gap remaining continuing at the same sales pace would likely get us beyond our year end targets.

對於 Performance Suite，預測的改善主要是由於 2023 年推出的 Performance Suite 收入超過 4 億美元，初始利潤率成長略高於 10%，這與我們在 2023 年推出 '22 時所經歷的情況一致。對於新業務方面，回想一下，我們最初的目標是 23 年 5 月或大約九個月前的新增長，其中 3 億美元的運行率調整後 EBITDA 中的 5000 萬美元。我們每季的資金規模約為 1,600 萬美元或約 400 萬美元。如果繼續保持相同的銷售速度，這一差距可能會讓我們超出年終目標。

Turning now to cash, when we announced the NIA. transaction, we set a goal for 2023 to increase our cash balance by more than $120 million before paying interest net debt activity, acquisition costs, earnouts and dividends. Our fiscal discipline delivered more than $175 million on this metric, resulting in a year-end cash balance of $193 million. We are pleased to have delivered this in a year when we were also investing heavily in integration and business restructuring to align our organization with our go forward strategy in value-based specialty care.

現在轉向現金，當我們宣布 NIA 時。透過此交易，我們設定了 2023 年的目標，在支付利息、淨債務活動、收購成本、獲利和股息之前，現金餘額增加超過 1.2 億美元。根據這項指標，我們的財政紀律交付了超過 1.75 億美元，年終現金餘額為 1.93 億美元。我們很高興在這一年裡實現了這一目標，當時我們還大力投資於整合和業務重組，以使我們的組織與我們在基於價值的專業護理方面的前進策略保持一致。

Going forward, we plan to provide an outlook for the cash from operations line on our cash flow statements. Our cash from operations in 2023 was $142 million, which included a benefit from net working capital of approximately $37 million. As we've previously noted, our working capital can fluctuate based on timing of customer payments. Our target for 2024 with at least $150 million in operating cash flow includes an expectation for a modest use of cash for working capital during the year. Overall, net of working capital fluctuations, we would expect growth of $80 million in our cash from operations in 2024 relative to 2023. Our capital allocation priorities for cash flow remain the same as they have been for several years to reiterate. First, we will continue to invest in capitalized product development to advance our core strategy of value-based specialty care, second, targeted strategic M&A that accelerates this strategy. And third, a disciplined capital structure that balances reasonable net leverage, share count and cash interest we continue to anticipate approximately $30 million annually in capital expenditures, primarily capitalized software development costs to continue our reinvestments in the business and competitive leadership in complex specialty care. The environment for managed care organizations. Our primary customer base has recently been characterized by two important themes in Medicaid, representing 35% of our revenue. The primary question has been the impact of redeterminations on the top and bottom lines in Medicare Advantage, representing about 42% of our revenue.

展望未來，我們計劃在現金流量表中提供營運現金流的前景。2023 年，我們的營運現金為 1.42 億美元，其中包括約 3,700 萬美元的淨營運資本利得。正如我們之前指出的，我們的營運資金可能會根據客戶付款的時間而波動。我們的 2024 年營運現金流目標至少為 1.5 億美元，其中包括預計年內適度使用現金作為營運資金。整體而言，扣除營運資本波動後，我們預期 2024 年營運現金將較 2023 年成長 8,000 萬美元。我們對現金流的資本配置優先事項與多年來重申的一樣。首先，我們將繼續投資於資本化產品開發，以推動我們基於價值的專業護理的核心策略；其次，有針對性的策略併購，以加速此策略。第三，嚴格的資本結構，平衡合理的淨槓桿、股份數量和現金利息，我們繼續預計每年約3000 萬美元的資本支出，主要用於資本化軟體開發成本，以繼續我們對業務的再投資，並在複雜的專業護理領域中保持競爭領先地位。管理式醫療組織的環境。我們的主要客戶群最近以醫療補助的兩個重要主題為特徵，占我們收入的 35%。主要問題是重新確定對 Medicare Advantage 的頂線和底線的影響，約占我們收入的 42%。

The primary question has been elevated utilization. We'd like to reiterate today our views on how these trends impact catalysts.

主要問題是利用率的提高。今天我們想重申我們對這些趨勢如何影響催化劑的看法。

First, Medicaid redeterminations continue to track our expectations. We ended the year with a gross Medicaid membership decline of 8.5% on a same-store basis compared to our forecast of 8% to 10%. And we continue to forecast a total decline in the mid 10s by the middle of this year as the membership has changed. We we've seen an expected modest increase in utilization metrics in our performance fee business. For example, we saw an average of 4.89 authorizations for cardiology services per 1,000 Medicaid members in a typical population leading up to the start of redeterminations. That same stat in Q4 of '23 was up by 1% to 4.94 authorizations per 1,000 members. We estimate that the total year-over-year impact on the bottom line from Medicaid redeterminations was approximately $3 million in Q4, again, consistent with our expectations. Importantly, sitting here in February, we are now more than 50% of the way through this process and believe we have very good insight into how it is playing out we have assumed in our guide an additional $3.5 million in quarterly impact being fully in place by the summer, which we believe is a reasonable estimate of our total gross exposure.

首先，醫療補助的重新確定持續符合我們的預期。截至年底，我們的同店醫療補助會員總數下降了 8.5%，而我們的預測為 8% 至 10%。我們繼續預測，隨著會員資格的變化，到今年年中，總人數將下降 10 多歲。我們看到績效費業務的使用率指標預計將略有成長。例如，我們發現在重新確定開始之前，典型人群中每 1,000 名醫療補助成員平均有 4.89 項心臟病服務授權。23 年第四季的相同統計數據成長了 1%，達到每 1,000 名會員 4.94 次授權。我們估計，第四季度醫療補助重新確定對利潤的整體年比影響約為 300 萬美元，再次與我們的預期一致。重要的是，在2 月坐在這裡，我們現在已經完成了這一過程的50% 以上，並且相信我們對它的進展情況有很好的了解，我們在指南中假設額外的350 萬美元的季度影響已經完全到位到夏天，我們認為這是對我們總風險敞口的合理估計。

Next regarding utilization, particularly within Medicare Advantage, there are several significant shifts underway in the MA population because the V. 28 risk model has prompted many payers to revise their plan benefit design beginning in 2024. There is growing preference among MA members for PPO plans versus HMO plans, which tend to have more limited networks and the commentary from many MCOs indicates elevated utilization during Q4, particularly for inpatient and supplemental benefit cost drivers. As we think about Evolent's recall that most of the risks that we take in specialty care requires a prior authorization. This gives us substantial insight into trends without having to wait for claims to develop. I wanted to be very clear that we have not seen in our Q4 data, any statistically significant trends on the key leading indicators that would suggest elevated costs in our risk areas. With that said, and at the same time, given the number of moving pieces, an unknown in Medicare Advantage for 2024. We believe it's prudent to take a thoughtful approach to our annual guidance for this year and with a wider range than we typically give.

接下來就利用率而言，特別是在 Medicare Advantage 內，MA 人群正在發生一些重大變化，因為 V.28 風險模型促使許多付款人從 2024 年開始修改其計劃福利設計。與 HMO 計劃相比，MA 成員越來越偏愛 PPO 計劃，後者的網絡往往更為有限，許多 MCO 的評論表明第四季度的利用率有所提高，特別是住院和補充福利成本驅動因素。當我們想到 Evolent 的召回時，我們在專業護理中承擔的大多數風險都需要事先授權。這使我們能夠深入了解趨勢，而不必等待索賠的發展。我想非常清楚地表明，我們在第四季度的數據中沒有看到關鍵領先指標有任何統計上顯著的趨勢，表明我們的風險領域的成本上升。話雖如此，但同時，考慮到變動因素的數量，2024 年的 Medicare Advantage 仍是未知數。我們認為，謹慎的做法是對今年的年度指引採取深思熟慮的方法，並且範圍比我們通常給出的範圍更廣。

Let's then turn to 2024 guidance. On the top line, we are projecting full year revenues of between 2.4 and $2.5 billion, representing approximately 25% organic growth at the midpoint, well ahead of our baseline mid 10s long-term outlook and driven by continued strong uptake of our Performance Suite products. On the bottom line, we are projecting full year adjusted EBITDA of between $235 million and $265 million, representing approximately 30% year-over-year growth at the midpoint. The bottom one-third of this outlook includes a buffer for potential unexpected increases in medical utilization in 2024, given the industry factors I mentioned a moment ago. For the first quarter, we are expecting revenues between $595 million and $610 million and adjusted EBITDA between $52 million and $58 million we expect sequential quarter to quarter growth in both revenue and adjusted EBITDA across this year as we ramp towards our exit adjusted EBITDA target of $300 million with the first half accounting for about 45% of our adjusted EBITDA for the year. This spread of adjusted EBITDA between the first and second half of the year is consistent with Evolent's performance in 2021 and 2022. We are targeting cash from operations of $150 million or better for the year and expect to deploy approximately $30 million in capitalized software developments.

然後讓我們轉向 2024 年指導。在營收方面，我們預計全年營收將在 2.4 至 25 億美元之間，中間有機成長約 25%，遠高於我們 10 年代中期長期前景的基線，並受到我們 Performance Suite 產品持續強勁採用的推動。總體而言，我們預計全年調整後 EBITDA 為 2.35 億美元至 2.65 億美元之間，相當於中位數年增約 30%。考慮到我剛才提到的行業因素，這一前景的底部三分之一包括 2024 年醫療利用率潛在意外增長的緩衝。對於第一季度，我們預計營收在5.95 億美元至6.1 億美元之間，調整後EBITDA 在5200 萬美元至5800 萬美元之間。後EBITDA 會季增 3 億美元，上半年約占我們全年調整後 EBITDA 的 45%。上半年和下半年調整後 EBITDA 的分佈與 Evolent 2021 年和 2022 年的表現一致。我們的目標是今年營運現金達到 1.5 億美元或更多，並預計部署約 3,000 萬美元用於資本化軟體開發。

With that, I will open it up for questions.

接下來，我將開放提問。

Yes, thank you. We will now begin the question and answer session to ask a question. You may press star, then one on your touchtone phone. If you are using a speakerphone, please pick up your handset before pressing the keys for any time. Your question has been addressed. You would like to withdraw, please press star then two consideration of the others. Please limit yourself to one question. Your follow-up or additional questions. You may reenter the question queue and those will be taken time at this time. We'll pause momentarily to assemble the roster.

是的，謝謝。我們現在開始問答環節來提問。您可以按星號，然後按按鍵式電話上的一個。如果您使用免持電話，請在任何時候按下按鍵之前拿起聽筒。您的問題已解決。您要退出，請按星號然後再考慮其他兩個。請只回答一個問題。您的後續或其他問題。您可以重新進入問題佇列，此時這些問題將被佔用。我們將暫停片刻以集合名單。

And the first question comes from Kevin Caliendo with UBS.

第一個問題來自瑞銀集團的 Kevin Caliendo。

Hi, guys. It's actually Andrea Alfonso in for Kevin, thank you so much for taking my question. I appreciate all the color on thinking about the sequential trends from, you know, into end of the year. I guess we talked about, you know, some of the admin service right now, et cetera. And I just wondered maybe if you sort of extract all those things and extract the Medicaid redeterminations and back to the first half. I'm just thinking about just kind of the cadence of capture. And then I guess embedded within sort of then the expectation for new business wins impacting that is that sort of more of a, you know, third quarter fourth quarter contribution.

嗨，大家好。實際上是安德里亞·阿方索 (Andrea Alfonso) 代表凱文 (Kevin)，非常感謝您回答我的問題。我欣賞所有關於思考從，你知道，到年底的連續趨勢的色彩。我想我們現在討論了一些管理服務等等。我只是想知道也許你是否可以提取所有這些內容並提取醫療補助重新確定並回到上半部分。我只是在考慮捕捉的節奏。然後我想，對新業務勝利的預期會產生影響，你知道，這更像是第三季第四季的貢獻。

Andrei and happy to take that one.

安德烈很高興接受那個。

Yes.

是的。

I'd say two things. First, relative to cadence across the year, the performance overall.

我想說兩件事。首先，相對於全年節奏，整體表現。

And then specific to your question on new business wins, as we look at EBITDA performance in 23 and compared to our key drivers in '24 one of the core observations that we would make is the some of the headwinds that we experienced in '23 from the administrative services runout and Medicaid redeterminations. And they are mostly now behind us with a little bit to go in on the Medicaid side. And our expectation for continued organic specialty performance since the increased adjusted EBITDA is very consistent with our recent performance, and that's how I'd characterize our outlook here as we move towards the $300 million exit run rate on the new business side, I guess I'd split that into what is already contracted, which you see on the page about $5 million of quarterly contribution there that will be phasing in largely across the first half of this year. And the remainder that you see on the page about $4 million per quarter. It's likely phasing in more across the full year.

然後具體到你關於新業務勝利的問題，當我們審視 23 年的 EBITDA 表現並與 24 年的主要驅動因素進行比較時，我們將做出的核心觀察之一是我們在 23 年經歷的一些阻力行政服務耗盡和醫療補助重新確定。他們現在大部分都落後我們，還有一點需要加入醫療補助方面。由於調整後的EBITDA 增加，我們對有機特種產品持續表現的期望與我們最近的表現非常一致，這就是我在新業務方面朝著3 億美元的退出運行率邁進時描述我們前景的方式，我想我我們會將其分成已經簽訂的合同，您可以在頁面上看到大約 500 萬美元的季度捐款，這些捐款將主要在今年上半年分階段到位。您在頁面上看到的剩餘部分約為每季 400 萬美元。全年可能會逐步增加。

Thank you.

謝謝。

And our next question comes from Jailendra Singh with turits, Truist Securities.

我們的下一個問題來自 Truist Securities 的 Jailendra Singh。

Thank you and thanks for taking my questions up. First, a quick cleanup question of the this a Medicaid plan for imaging contract rollout intra quarter in Q4, we calculate a PMPM and range of $5. Are we in the ballpark? And should we expect the life to kind of increase from Q4 to Q1 because it was rolled out intra quarter. Was that one clarification?

謝謝您並感謝您提出我的問題。首先，快速清理一下第四季度季度內推出的成像合約醫療補助計劃的問題，我們計算出 PMPM 和 5 美元的範圍。我們在球場上嗎？我們是否應該期望壽命從第四季度到第一季有所增加，因為它是在季度內推出的。這是一項澄清嗎？

My main question is around the new contract with an existing health plan to add radiation and surgical oncology services to existing medical oncology services, do you see opportunities with your other medical oncology services contract to add these additional oncology services? Or do you think there was something unique about this health plan? And if there is an opportunity. Are you willing to quantify.

我的主要問題是圍繞與現有健康計劃簽訂的新合同，將放射和腫瘤外科服務添加到現有的腫瘤內科服務中，您是否認為您的其他腫瘤內科服務合同有機會添加這些額外的腫瘤科服務？或者您認為這個健康計劃有什麼獨特之處嗎？如果有機會的話。你願意量化嗎？

As a lender? And I'll take the first part. You're in the zone on the PMPMs and we would expect an increase in the average performance suite lives in Q1 since we'll have a full quarter of that go-live of SAP for the other piece.

作為貸款人？我將講第一部分。您處於 PMPM 區域，我們預計第一季的平均效能套件壽命會有所增加，因為我們將在另一部分上投入整整四分之一的 SAP。

Yes, Joe, and I think the answer to the second question is yes, we do see additional opportunities for both radiation and surgical oncology, some cost technology and services side. We do very little of that today. And so across all of our technology and services arrangements where we have met Matt OnQ. I think that's a clear opportunity.

是的，喬，我認為第二個問題的答案是肯定的，我們確實看到放射和腫瘤外科、一些成本技術和服務方面的更多機會。今天我們在這方面做得很少。因此，在我們所有的技術和服務安排中，我們遇到了 Matt OnQ。我認為這是一個明顯的機會。

And then on the Performance Suite side, we actually do a little bit of radiation oncology today and we don't do surgical oncologist. I think their surgical oncology is an opportunity. We wanted to quantify the PMPM around surgery, which we did in the script, just to give you a sense to your point of it's not immaterial. What the opportunity is here just for surgery and radiation is also attractive. So this is I think it's a a real development for the Company and will benefit us both on the technology and the Performance Suite side.

然後在性能套件方面，我們今天實際上做了一些放射腫瘤學，但我們不做腫瘤外科醫師。我認為他們的腫瘤外科是一個機會。我們想要量化手術周圍的 PMPM，我們在劇本中就是這樣做的，只是為了讓你明白你的觀點，它並非無關緊要。這裡僅進行手術和放射治療的機會也很有吸引力。因此，我認為這對公司來說是一個真正的發展，並將在技術和性能套件方面使我們受益。

Thank you.

謝謝。

And the next question comes from Jeff Garrow with Stifel.

下一個問題來自 Jeff Garrow 和 Stifel。

Yes, good afternoon and thanks for taking the questions. And maybe ask a little bit more on the $4 million EBITDA go-get and certainly some positive comments from you guys about the pipeline and the setup to achieve that target. But I was hoping to get more comments on visibility and whether there's multiple paths to achieve that $4 million target. And any color you can provide on the types of contracts that you think could get you there?

是的，下午好，感謝您提出問題。也許還可以多問一些有關 400 萬美元 EBITDA 目標的問題，當然還有你們對實現該目標的管道和設置的一些積極評價。但我希望得到更多關於知名度以及是否有多種途徑來實現 400 萬美元目標的評論。您可以在您認為可以幫助您實現這一目標的合約類型上提供任何顏色嗎？

I would assume it's more technology and services, but on we'll hear what you have to say.

我認為更多的是技術和服務，但我們會聽聽您的意見。

Yes, sure. Jeff, good question. I think look, I think we tried to do in the scrub to it's I'll just reiterate, is that we have been pacing ahead of the schedule that we would need to achieve to get there, you know, on the time line for the $300 million exit, and we've been pacing slightly ahead of that. So I think the bottom line is we need to kind of continue what we're doing and we'll easily get there. And in terms of the path to get there, there are multiple ways to get there. I would say Tech Services is the main part of that. But if you go back to when we talked about this gap and what's there, there's some performance we've maturation opportunity as well. That's not in the numbers on the page, and we'll break down what's what on that, but it will more of one or more of the other could both get us there to your point.

是的，當然。傑夫，好問題。我想，我認為我們在磨砂過程中試圖做的事情是，我只是重申一下，我們一直在提前完成我們需要實現的時間表，你知道，在時間表上3 億美元退出，我們一直在稍微超前。所以我認為底線是我們需要繼續我們正在做的事情，我們會很容易到達那裡。就到達那裡的路徑而言，有多種方法可以到達那裡。我想說技術服務是其中的主要部分。但如果你回到我們談論這個差距以及那裡存在的東西時，我們也有一些成熟的機會。這不在頁面上的數字中，我們將分解其中的內容，但更多的一個或多個其他內容都可以讓我們到達您的觀點。

And just in terms of the pipeline, which I'm sure we'll talk about at some point in this call a little more detail. We've got a lot in the pipeline, lots of opportunities, whether they're RFPs are net new opportunities or same-store growth. And so we feel really good about the path to kind of closing that gap but India.

就管道而言，我相信我們會在這次電話會議的某個時候更詳細地討論這一點。我們有很多計劃和機會，無論是 RFP、淨新機會還是同店成長。因此，我們對縮小這一差距的道路感到非常滿意，但印度除外。

Thank you.

謝謝。

And our next question comes from Stephanie Davis of Barclays.

我們的下一個問題來自巴克萊銀行的史蒂芬妮戴維斯。

Again, this is in evidence key fine for me. Thank you for taking my questions. You noted that the wider guidance range reflects the unknowns around realization. Just curious if you could speak to what the high end and the low end of guidance assumes and just yes, any level of visibility you can share beyond the four new pads revenue agreements?

再說一次，這對我來說顯然是關鍵。感謝您回答我的問題。您指出，更廣泛的指導範圍反映了實現方面的未知因素。只是好奇您是否可以談談指導的高端和低端假設是什麼，是的，除了四個新的墊收入協議之外，您可以分享任何級別的可見性？

Yes, let me take that first phase. As we think about what could take us to the bottom, what could take us to the top end of the range. As I noted in the prepared remarks, that bottom thirds about $10 million is what we're viewing as our buffer for unexpected medical utilization, which again, we're not seeing. But given what we have seen in the industry writ large, we believe it's prudent to have in our outlook on the top side of the range. What could take us to 65 and beyond this year really is two things. One is timing of go-lives, largely of our technology and services suite clients and two outcomes during the year on the Performance Suite, and that's how we think about the range.

是的，讓我來談談第一階段。當我們思考什麼可以把我們帶到底部，什麼可以帶我們到範圍的頂端。正如我在準備好的演講中指出的那樣，我們將大約 1000 萬美元的底部三分之一視為意外醫療用途的緩衝，但我們同樣沒有看到這種情況。但考慮到我們在行業中所看到的情況，我們認為將我們的前景置於該範圍的頂部是謹慎的做法。今年能讓我們活到 65 歲甚至更久的事情實際上有兩件事。一是上線時間，主要是我們的技術和服務套件客戶，以及性能套件在這一年中的兩個成果，這就是我們對該系列的看法。

Thank you.

謝謝。

And the next question comes from Ryan Daniels with William Blair.

下一個問題來自瑞安·丹尼爾斯和威廉·布萊爾。

Yes, thanks for taking the questions, guys.

是的，謝謝你們提出問題，夥伴們。

Congrats on the strong performance set.

祝賀你們的強勁表現。

You said this one out, but I do want to hit on the pipeline and let me actually phrase it with a little bit more detail. Obviously, some of the Medicaid plans getting hit with redetermination. You mentioned MA plans that got higher utilization and B. 28, and then you've got things like prior authorization and pressure and utilization management hitting all payer types, including commercial. So maybe you could unpack that pipeline a little bit and how these various things are kind of driving demand for solutions such as yours and where you're seeing kind of different puts and takes in the pipeline for your product offerings?

你已經說了這個，但我確實想談談管道，讓我用更詳細的方式來表達它。顯然，一些醫療補助計劃受到了重新確定的打擊。您提到了具有更高利用率的 MA 計劃和 B.28，然後您就獲得了諸如預先授權、壓力和利用率管理之類的內容，適用於所有付款人類型，包括商業付款人類型。因此，也許您可以稍微展開一下該管道，看看這些不同的事情如何推動對像您這樣的解決方案的需求，以及您在產品供應管道中看到了哪些不同的投入和獲取？

Yes.

是的。

Yes, happy to Ryan. So look, I'd probably put it into three categories. One is the things that we have been seeing for the last three years have continued, which is, you know, kind of traditional demand for the product that's in the second category, which is newer is around what I would call more acute medical loss ratio pressure, right? Where payer is under underwriting pressure and has a gap to their goal, so their fourth quarter of this year and beyond. And that deal would have taken a year, six months to work on before all of a sudden it's a much shorter sales cycle, more focused team on their side and frankly, more RFPs and also organic opportunities. So that's kind of the second category that's newer for us over the last, say, six months. And then the third category, I would define around more integrated bundled offerings that are available to us now because of NI and IPG. and vital and Evolent of kind of pulled together in a fully integrated fashion were really not available to us call it a year ago. And those have ramped with now several of those in different pockets and things like that along the way. But I think that third category is some going to kind of be evergreen category and for us at this point and looks very promising. That help, Brian?

是的，瑞安很高興。所以看，我可能會把它分成三類。一是我們在過去三年中看到的事情仍在繼續，你知道，這是對第二類產品的傳統需求，更新的是我所說的更嚴重的醫療損失率壓力，對嗎？付款人面臨承保壓力並且與他們的目標存在差距，因此他們今年第四季及以後的目標。這筆交易本來需要一年六個月的時間才能完成，然後突然之間，銷售週期短得多，團隊更加專注，坦率地說，還有更多的 RFP 和有機機會。這是第二個類別，在過去六個月中對我們來說是較新的。然後是第三類，我將圍繞更多整合的捆綁產品進行定義，這些產品現在可以透過 NI 和 IPG 來使用。一年前，我們確實無法將“Vital”和“Evolent”以完全整合的方式結合在一起。這些資金已經增加，現在有幾個在不同的口袋裡，諸如此類的事情一路走來。但我認為第三類是某種常青類別，對我們來說，目前看起來非常有前途。有幫助嗎，布萊恩？

Yes, that's great color. Thank you so much.

是的，那是很棒的顏色。太感謝了。

Thank you.

謝謝。

And the next question comes from Anne Samuel with JPMorgan.

下一個問題來自摩根大通的安妮·塞繆爾。

Hey, guys, this is Kyle on for Andy. To my congrats on the great quarter. I was just going to ask about the Performance Suite offering and imaging. Does this change how you size your total market from within your cross-sell, Dan, that you laid out at your Investor Day. Just trying to think about how we frame this in terms of future partnerships. Thank you.

嘿，夥計們，這是安迪的凱爾。我祝賀這個偉大的季度。我只是想詢問有關 Performance Suite 產品和成像的資訊。丹，這是否會改變您在投資者日制定的交叉銷售中調整整個市場規模的方式？只是想想想我們如何在未來的合作關係中建立這一點。謝謝。

Kyle. Yes, it does increase our total addressable market. We haven't really quantified that or updated that formally does increase it a little bit. You know, we're a couple of billion out of $150 billion market. So I think it doesn't really change the big picture for us, which is we have a lot of running room. But yes, it does make make the market a little bit bigger.

凱爾.是的，它確實增加了我們的總目標市場。我們還沒有真正量化這一點，也沒有正式更新它確實會增加一點。你知道，我們在 1500 億美元的市場中只佔了幾十億。所以我認為這並沒有真正改變我們的大局，那就是我們有很大的運行空間。但是，是的，它確實使市場變得更大一些。

Thank you.

謝謝。

And the next question comes from Jessica Hansen, Piper Sandler.

下一個問題來自傑西卡·漢森、派珀·桑德勒。

I think for And the question I wanted to clarify and understand if the scope of your Florida contract with Humana has changed at all. I think initially it was limited to certain counties. Just curious to know, is that contract now statewide? And then beyond that, just maybe I'm hoping you could talk a little bit about the thought process and kind of the pricing precautions that you took in order to price the advanced imaging performance suite solutions on and just whether you're expecting kind of equivalent margins in those products in your one to three as you would in the rest of the EM performance leap up?

我認為對於我想澄清和理解的問題，您是否與 Humana 的佛羅裡達合約範圍發生了變化。我認為最初僅限於某些縣。只是想知道，該合約現在在全州範圍內嗎？除此之外，也許我希望您能談談您為先進成像性能套件解決方案定價而採取的思考過程和定價預防措施，以及您是否期望您的那些產品中的同等利潤率會像您在其他新興市場中的一到三倍那樣實現飛躍嗎？

Thanks.

謝謝。

Lot.

很多。

Yes, hey, Jazz multi always have the first. We know that Humana Florida has not changed since we announced it and it's kind of launched and are on track relative to what we shared last year.

是的，嘿，爵士多總是第一名。我們知道，自我們宣布以來，Humana Florida 並沒有發生任何變化，它已經啟動，並且相對於我們去年分享的內容而言，一切都步入正軌。

Yes.

是的。

And underwriting principles on the new advanced imaging performance, a product very similar to the way that we think about the rest of the risk that we take looking to be quite specific around the scope, for example, around protections for Evolent in terms of the way that we'd like to manage our risk and be responsive to the customers' needs in terms of delivering to them and guaranteed outcome was just one of the key buying factors that we see customers opting for the performance fees.

新的先進成像性能的承保原則，該產品與我們考慮其他風險的方式非常相似，我們希望在範圍內非常具體，例如，圍繞 Evolent 的保護方式我們希望管理我們的風險，並在交付和保證結果方面滿足客戶的需求，這只是我們看到客戶選擇績效費用的關鍵購買因素之一。

Thank you. And next question comes from Charles Rhyee. Can you comment?

謝謝。下一個問題來自 Charles Rhyee。你能發表評論嗎？

Yes. Thanks for taking the question. I wanted to follow up on an earlier question around sort of what can kind of get you to the higher end of the range this year. And I think you mentioned sort of on pharmacy maturation. Maybe when we think about that higher end of the range, what are you kind of assuming performance reimagination to kind of mirror sort of what we saw in '22 and '23? Or would you consider to be more conservative to sort of the reason maturation experience that you've had so far?

是的。感謝您提出問題。我想跟進之前的一個問題，即什麼可以讓你今年達到更高端的水平。我想你提到了藥局成熟度。也許當我們考慮範圍的高端時，你會假設性能重新想像與我們在 22 和 23 中看到的類似的鏡像是什麼？或者你會認為對你迄今為止所經歷的成熟經歷的原因更加保守嗎？

Yes, it's a good question, Charles. I think at the top end of the range that would be experienced consistent with what we saw in '22 and '23. And I think one of the items that's giving us confidence there both for '24 and as we look at the exit run rate of $300 million is the performance that we saw across '23 on the '22 launches, similar to the performance that we saw across '22 on the '21 launches. So we've now got several years here, stacked up of performance that has been consistent and with over $400 million of new Performance Suite revenue, that's that was launched in 2023 driving performance and margins and quality on that book of business across this year. Obviously, a very important focus and consistent with I think our performance over the last couple of years.

是的，這是一個好問題，查爾斯。我認為在該範圍的高端，我們所經歷的體驗將與我們在 22 年和 23 年所看到的一致。我認為，讓我們對 24 年以及 3 億美元的退出運行率充滿信心的因素之一是我們在 23 年的 22 年發布中看到的表現，與我們看到的表現類似橫跨“22”和“21”發布。因此，我們現在已經有好幾年了，業績一直保持穩定，新的 Performance Suite 收入超過 4 億美元，這是 2023 年推出的，推動了今年業務的業績、利潤和品質。顯然，這是一個非常重要的焦點，並且與我認為我們過去幾年的表現一致。

Great, thank you.

太好了謝謝。

Thank you. And the next question comes from Richard Close with Canaccord.

謝謝。下一個問題來自 Canaccord 的 Richard Close。

Yes, yes, thanks for the question. Congratulations on the quarter and appreciate all the details. Maybe SaaS on the cross-sell that you mention to Ryan's question on the pipeline. Can you talk a little bit more about the cross selling? Are you seeing strength in any particular product on the cross selling? Or where do you think most of the low-hanging fruit is there?

是的，是的，謝謝你的提問。恭喜本季並感謝所有細節。也許是您在 Ryan 的管道問題中提到的交叉銷售 SaaS。能多談談交叉銷售嗎？您是否看到交叉銷售中任何特定產品的優勢？或者您認為最容易實現的目標在哪裡？

Hey, Richard.

嘿，理查德。

Yes.

是的。

Look, I think it comes in a couple of different areas, but let me give you a few examples. One place we're seeing some strength is if you're a traditional imaging customer and that's what you had from an M&A perspective. And we have a conversation about the fact that we can incorporate imaging and genetics into a broader condition management model around cardiology oncology, eventually around MSK. It's obviously just a better proposition for the member and for the plan to look at things holistically rather than just look at a given vertical like energy, right? So I think that's one good example. A good example though, is where historically to Neville and only customer. And we have not included imaging because that was not part of our scope traditionally. And now we step into this radiation oncology excuse me, imaging or other types of imaging that makes sense for cardiology or oncology, right, critical for managing those two conditions, understanding the imaging as a for instance. So I think it's largely around the NIA. opportunity. I'd also give you some examples, though, around end of life and around IPG. And so it's a little little bit across the board, but I think the imaging and IA. examples probably leading the pack and as others have been attractive as well.

看，我認為它涉及幾個不同的領域，但讓我舉幾個例子。我們看到的一個優勢是，如果您是傳統成像客戶，那麼從併購的角度來看，您就擁有這一優勢。我們討論了這樣一個事實：我們可以將影像學和遺傳學納入圍繞心臟病腫瘤學、最終圍繞 MSK 斯隆的更廣泛的病情管理模型中。對於會員和計劃來說，這顯然是一個更好的建議，從整體上看待事物，而不是僅僅關注能源等給定的垂直領域，對嗎？所以我認為這是一個很好的例子。一個很好的例子是，歷史上內維爾是唯一的顧客。我們沒有包括成像，因為傳統上這不屬於我們的範圍。現在我們進入放射腫瘤學，對不起，影像或其他類型的影像對心臟病學或腫瘤學有意義，對管理這兩種情況至關重要，例如理解成像。所以我認為這主要是圍繞 NIA 的。機會。不過，我還會舉一些關於生命週期結束和 IPG 的例子。所以這有點全面，但我認為是成像和 IA。例子可能是領先的，其他例子也很有吸引力。

Okay.

好的。

Thank you.

謝謝。

Thank you.

謝謝。

The next question comes from David Larsen, BTIG.

下一個問題來自 BTIG 的 David Larsen。

This is Jenny Chan on for days. So it sounds like utilization has been good with you. And just would the overall increase in hip and knee procedures in the broader space. Can you talk about what you're seeing in your MSK. business specifically and also your longer term outlook and increasing the amount of risks that you take in that business?

這是珍妮陳（Jenny Chan）連續幾天的節目。聽起來您的利用率很好。更廣闊的空間內髖關節和膝關節手術的整體增加​​也將隨之而來。您能談談您在 MSK 中看到的情況嗎？具體業務以及您的長期前景以及增加您在該業務中承擔的風險程度？

Thanks.

謝謝。

Yes, happy to take it. So we do not currently take risk in MSK increases in that kind of utilization do not impact us. And on the risk side, we have talked about building a risk, taking products in musculoskeletal conditions that would look like our rest of our Performance Suite products. And that's on the roadmap for likely a 2025 launch as it continues to be an important product focus, but not for this year.

是的，很高興接受。因此，我們目前不會冒 MSK 斯隆的增加風險，因為這種利用率不會對我們產生影響。在風險方面，我們已經討論過建立風險，在肌肉骨骼條件下使用產品，這看起來就像我們其他的性能套件產品一樣。這可能是 2025 年發布的路線圖，因為它仍然是重要的產品焦點，但不是今年。

Thank you.

謝謝。

And the next question comes from Sean Dodge with RBC Capital.

下一個問題來自 RBC Capital 的 Sean Dodge。

Hey, good afternoon.

嘿，下午好。

This is Thomas Keller on for Sean. Thanks for taking the question and thanks for all the detail in the slides. I just wanted to follow up on the earlier Humana question, how should we think about the potential Performance Suite expansion outside of Florida and Arizona? Is there is there a fairly structured trial period sort of required before you can expand further? Or is this something that could be pushed into some other new states in relatively short order?

我是 Thomas Keller 替肖恩 (Sean) 發言。感謝您提出問題，並感謝幻燈片中的所有細節。我只是想跟進之前的 Humana 問題，我們應該如何考慮佛羅裡達州和亞利桑那州以外的潛在 Performance Suite 擴展？在進一步擴展之前是否需要一段相當結構化的試用期？或者這是否可以在相對較短的時間內推向其他一些新州？

Hey, there, Doug. Great question. So I think it's actually very akin to our experience with other payers over the last several years in terms of expanding from Performance Suite in one or two states to other states, which is certainly there's an opportunity there. And an intention to consider that the first order priority for us is always six to nine months of outstanding performance. We're kind of in that outstanding performance phase right now and really it down on delivering for our partner there. And I think when we do a good job on delivery that earns the right to expand into new states. And so that's our expectation that we'll have the opportunity to do that. And it's, you know, by the answer generally for the payer partners to not just do something in a couple of states, but do it more broadly. But right now, our priority is on the on the execution delivery front.

嘿，在那裡，道格。很好的問題。因此，我認為這實際上與我們過去幾年與其他付款人的經驗非常相似，即從一兩個州的 Performance Suite 擴展到其他州，這當然是一個機會。並打算考慮到我們的首要任務始終是六到九個月的出色表現。我們現在正處於表現出色的階段，並且真的非常注重為我們的合作夥伴提供服務。我認為，當我們在交付方面做得很好時，我們就贏得了向新州擴張的權利。因此，我們期望有機會做到這一點。你知道，一般來說，付款合作夥伴不僅要在幾個州做某事，而且要在更廣泛的範圍內做某事。但現在，我們的首要任務是執行交付方面。

All right.

好的。

Appreciate it.

欣賞它。

Thanks a lot.

多謝。

Welcome.

歡迎。

And thank you.

謝謝你。

Next question comes from Jack Wallace (inaudible)

下一個問題來自傑克華萊士（聽不清楚）

Yes, in fact, congrats on the quarter and thanks for taking my questions. Have been thinking about the imaging opportunity and when you're moving to a hub selling that capability how quickly does that typically turn to revenue?

是的，事實上，恭喜這個季度，並感謝您回答我的問題。一直在考慮成像機會，當您轉移到銷售該功能的中心時，通常會多快轉化為收入？

I've got a follow-up question.

我有一個後續問題。

Yes, Jackie, you know, look at fee income, we're already seeing some of that opportunity come to bear fruit for us. We've been it's been a little about a year since we closed the NIH. transaction, and we've seen several cross-sells that we've announced. And so I think we're in that zone now where those opportunities are are paying off when often takes. If you get into one of those conversations, I'll call it six months, you know, to have a sales cycle around it and again could be at a legacy and a client or a legacy Evolent client could go in either direction. But it's you know, it's it is it is bearing fruit now.

是的，傑基，你知道，看看費用收入，我們已經看到一些機會為我們帶來了成果。自從我們關閉 NIH 以來已經過去了大約一年的時間。交易，並且我們已經看到了我們已經宣布的幾項交叉銷售。因此，我認為我們現在正處於這樣的區域，這些機會在經常發生的情況下正在得到回報。如果你進行其中一次對話，我會稱之為六個月，你知道，圍繞它有一個銷售週期，並且再次可能是遺留的，客戶或遺留的 Evolent 客戶可以朝任一方向發展。但你知道，它現在正在結出果實。

So thanks. And then I know you haven't talked that much probably catch his cases business revenue per case, and it will tick up a bit in the fourth quarters. Wondering, A., what was driving that?

那謝謝啦。然後我知道你還沒有談論太多，可能會捕捉到他的每件案件的業務收入，並且在第四季度會有所上升。A. 想知道是什麼推動了這一點？

And B, we think that's going to be persistent going forward.

B，我們認為這將持續下去。

Thank you.

謝謝。

Had a tough time understanding that Jack.

很難理解傑克。

Jack, could you repeat what you just said introduced the Nacco stepped-up holidays.

傑克，你能重複一下你剛才所說的介紹納科加強假期的內容嗎？

Many airports is wondering about the cases business looked like revenue per case is up a little bit in the fourth quarter. Wondering if there's anything structurally going on there that will persist going forward, just the timing of some activity in the quarter?

許多機場都對案件業務感到好奇，似乎第四季每件案件的收入略有上升。想知道未來是否有什麼結構性的事情會持續下去，只是本季某些活動的時間安排？

Thank you.

謝謝。

Yes, nothing particularly structural. There's a seasonal component and also provide us through regular organic growth.

是的，沒有什麼特別結構性的。有季節性因素，也為我們提供定期的有機成長。

Thank you.

謝謝。

Thank you.

謝謝。

And once again, please press star then one if you would like to ask a question, what's more pressing star then and will allow you to ask a question.

再次，如果您想提問，請先按星號，然後再按一個，然後再按星號，然後再按星號，您就可以提問了。

As this does conclude the question-and-answer session. I would like to turn the floor back to Seth Frank for any closing thoughts.

問答環節到此結束。我想請賽斯·弗蘭克（Seth Frank）來聽聽我的結束語。

Thanks for joining tonight and look forward to connecting with you off-line.

感謝您今晚的加入，並期待與您線下聯繫。

And have a good evening.

祝您晚上愉快。

Thank you.

謝謝。

The conference has now concluded.

會議現已結束。

Thank you.

謝謝。

For attending today's presentation, and we now have a centralized.

對於參加今天的演示，我們現在已經集中了。