Evolent Health Inc (EVH) 2024 Q1 法說會逐字稿

Welcome to the Evolent earnings conference call for the first quarter ended March 31, 2024. As a reminder, this conference call is being recorded. Your host for the call today from Evolent are Seth Blackley, Chief Executive Officer; and John Johnson, Chief Financial Officer. This call 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.

歡迎參加截至 2024 年 3 月 31 日的第一季 Evolent 收益電話會議。提醒一下，本次電話會議正在錄音中。今天 Evolent 電話會議的主持人是執行長 Seth Blackley；和首席財務官約翰·約翰遜。該電話會議將被存檔，並在今晚晚些時候和下週透過公司網站上標題為「投資者關係」的部分的網路廣播提供。

I will now hand the call to Seth Frank, Evolent's Vice President of Investor Relations. Please go ahead.

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

Thank you and good evening. This conference call will contain forward-looking statements under the US 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 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.

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，包括我們目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 measure 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 IR section of the company's website, ir.evolenthealth.com and Form 8-K filed with 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 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今天發布並發佈在公司網站上的公司新聞稿中找到。公司網站ir.evolenthealth.com 的IR 部分以及今天早些時候向SEC 提交的8-K 表格。

Finally, in addition to reconciliations, we provided details on the numbers and operating metrics for the quarter and both our press release and our supplemental investor presentation on the IR website.

最後，除了對帳之外，我們還提供了有關本季度數據和營運指標的詳細信息，以及我們在 IR 網站上發布的新聞稿和補充投資者介紹。

With that done, I hand the call over to Evolent's CEO, Seth Blackley.

完成此操作後，我將電話轉交給 Evolent 的執行長 Seth Blackley。

Good evening, and thanks for joining the call. Evolent had a strong first quarter with above expectations revenue growth and adjusted EBITDA in line with the first quarter guidance. Today, I will cover updates on various fronts, including new customer arrangements, new client go-lives, an announcement of the completion of our M&A integration work stream and our technology innovation agenda.

晚上好，感謝您加入通話。Evolent 第一季業績強勁，營收成長高於預期，調整後的 EBITDA 與第一季指引一致。今天，我將介紹各個方面的最新情況，包括新客戶安排、新客戶上線、宣布完成我們的併購整合工作流程以及我們的技術創新議程。

Let me first provide a few highlights from our first quarter results. Revenue totaled $639.7 million, a growth of 49.6% year over year. This result exceeded the top end of our Q1 revenue guide of $610 million by almost $30 million. This high revenue growth was driven by strong membership in our Performance Suite arrangements and new specialty technology and services agreements.

首先讓我提供我們第一季業績的一些亮點。營收總計6.397億美元，年增49.6%。這一結果比我們第一季營收指南的上限 6.1 億美元高出近 3,000 萬美元。這種高收入成長是由我們性能套件安排中的強大會員資格以及新的專業技術和服務協議所推動的。

Evolent's specialty care offerings now account for 91% of total revenue, up from 60% just three years ago, enabling our organization to focus on our specialty strategy. Year over year, Specialty Care revenue grew approximately 69% as reported and 62% after normalizing for the NIA acquisition in January 2023.

Evolent 的專業護理產品目前佔總收入的 91%，而三年前僅為 60%，這使我們的組織能夠專注於我們的專業策略。據報道，特殊護理收入年增約 69%，在 2023 年 1 月 NIA 收購正常化後成長了 62%。

On the membership front, we averaged 39.9 million unique members net of Medicaid redeterminations and new implementations during the quarter. Total product members eclipsed 80.6 million in the first quarter or just over two products per unique number on average.

在會員方面，本季扣除醫療補助重新確定和新實施後，我們平均擁有 3,990 萬獨立會員。第一季產品會員總數超過 8,060 萬人，平均每位唯一會員數量略多於兩種產品。

On the profitability front, adjusted EBITDA was in line with the midpoint of our guidance at $54.1 million. Our cash position remains strong with $165.1 million in cash and equivalents after what is always a historically high cash outflow quarter associated with higher working capital requirements that moderate as the year progresses.

在獲利能力方面，調整後 EBITDA 與我們指引的中位數 5,410 萬美元一致。我們的現金狀況依然強勁，現金及等價物為 1.651 億美元，在現金流出始終處於歷史高位的季度之後，營運資金需求隨著時間的推移而增加，營運資金需求也有所放緩。

Let me now update you on each of our three principles for shareholder value creation of one, strong organic growth, two, expanding profitability and three, disciplined capital allocation. On the first principle of organic growth we announced -- we are announcing today that we signed three new revenue agreements during the first quarter. Two of our new revenue agreements are with Molina building on that highly successful long-term partnership, we will be implementing both cardiology and oncology Performance Suite across both Medicaid and exchange lives in South Carolina and Mississippi. We anticipate implementing these solutions by the fourth quarter of this year.

現在讓我向您介紹我們創造股東價值的三個原則：一是強勁的有機成長，二是擴大獲利能力，三是嚴格的資本配置。根據我們宣布的有機成長的首要原則——我們今天宣布，我們在第一季簽署了三項新的收入協議。我們與 Molina 簽訂的兩項新收入協議建立在非常成功的長期合作夥伴關係的基礎上，我們將在南卡羅來納州和密西西比州的醫療補助和交換生活中實施心臟病學和腫瘤學性能套件。我們預計在今年第四季之前實施這些解決方案。

Financially, we anticipate the impact of South Carolina and Mississippi to contribute together at least $50 million of new annual revenue contribution once lives. The addition of these states increases our presence with Molina to nine states after these two states go live. Our revenue will be below 50% of the total opportunity at Molina within the current scope of services we provide today, excluding new solutions like MSK Performance Suite, leaving what we believe to be a significant opportunity to continue expanding our partnership and impact for our partner.

在財務方面，我們預計南卡羅來納州和密西西比州一旦建成，將共同貢獻至少 5000 萬美元的新年度收入貢獻。在這兩個州上線後，這兩個州的增加使我們在 Molina 的存在增加到九個州。在我們目前提供的當前服務範圍內，我們的收入將低於Molina 總機會的50%（不包括MSK Performance Suite 等新解決方案），這為我們留下了一個重要機會，可以繼續擴大我們的合作夥伴關係並為我們的合作夥伴帶來影響。

Our third new revenue agreement is a specialty technology and services contract we signed with a long-standing Evolent Medicaid health plan in the East Coast. This health plan will be adding our MSK specialty offering to help manage orthopedic surgery costs, utilization and outcomes. We anticipate implementing this solution in the third quarter across several hundred thousand Medicaid members. This contract will contribute towards the $4 million of quarterly adjusted EBITDA earnings go-get we provided in our bridge illustration for achieving the 2024 year end exit adjusted EBITDA target.

我們的第三份新收入協議是我們與東海岸長期 Evolent 醫療補助健康計劃簽署的專業技術和服務合約。該健康計劃將添加我們 MSK 斯隆的專業產品，以幫助管理骨科手術的成本、利用率和結果。我們預計在第三季在數十萬名醫療補助成員中實施該解決方案。該合約將為我們在橋樑插圖中提供的 400 萬美元季度調整後 EBITDA 收益目標做出貢獻，以實現 2024 年年底退出調整後 EBITDA 目標。

Today's announcements bring us to seven new revenue agreements year to date. In addition to new revenue agreements Q1 was productive for successful go-lives. In total, we launched 25 specialty go-lives across multiple health plan customers for the Performance Suite and the technology and services suite. These included major go-lives in new geographies for Performance Suite, including oncology and cardiology from Molina in Florida and cardiology for Florida Blue.

今天的公告為我們帶來了今年迄今的七項新收入協議。除了新的收入協議外，第一季的成功上線也富有成效。總的來說，我們為多個健康計劃客戶推出了 25 個性能套件以及技術和服務套件的專業產品。其中包括 Performance Suite 在新地區的主要上線，包括佛羅裡達州 Molina 的腫瘤學和心臟病學以及 Florida Blue 的心臟病學。

During the quarter, we also began a national implementation with Centene for MSK, technology and services suite covering several million members. Recall, we announced this agreement back in February, fulfilling a significant portion of the promised initial revenue synergies from NIA acquisition.

在本季度，我們也開始與 Centene 合作在全國實施 MSK、技術和服務套件，涵蓋數百萬會員。回想一下，我們早在 2 月就宣布了這項協議，實現了收購 NIA 所承諾的初始收入綜效的很大一部分。

From a macro perspective, industry demand remains very strong. Beyond our normal product value proposition, health care utilization pressure and health plan margin pressure are accelerating our core inbound sales opportunities. Our belief is that typical savings levers outside of specialty care are more limited in the current environment, making high-cost specialty management a critical and growing focus for health plans.

從宏觀來看，產業需求依然非常旺盛。除了我們正常的產品價值主張之外，醫療保健利用壓力和健康計畫利潤壓力正在加速我們的核心入站銷售機會。我們相信，在當前環境下，專業照護之外的典型儲蓄槓桿更加有限，這使得高成本的專業管理成為健康計畫的關鍵且日益關注的焦點。

As a result of these factors, our sales pipeline remains very strong, driven by interest in both regional and large national health plans. As a result of all of these dynamics, we are raising the midpoint of our revenue guidance for 2024 by $115 million, as John will detail shortly.

由於這些因素，在對區域和大型國家健康計劃的興趣的推動下，我們的銷售管道仍然非常強勁。由於所有這些動態，我們將 2024 年收入指引的中點提高了 1.15 億美元，約翰很快就會詳細介紹。

Moving to our second operating priority, expanding profitability. I'm excited to announce that in March, we successfully wound down the NIA transition services agreement we had in place since January of 2023 with NIA's former owner. The transition was the largest and most complex IT project in the company's history, involving hundreds of professionals globally.

轉向我們的第二個營運重點，擴大獲利能力。我很高興地宣布，今年 3 月，我們成功終止了自 2023 年 1 月以來與 NIA 前所有者簽訂的 NIA 過渡服務協議。此次轉型是公司史上規模最大、最複雜的 IT 項目，涉及全球數百名專業人士。

Most importantly, we were able to continue serving all of our customers with limited disruption. I want to thank the Evolent teams who worked tirelessly through weekends to achieve this important transition. This transition in the quarter marks another important step towards our year end run rate EBITDA target and the achievement of our $15 million of NIA cost synergies.

最重要的是，我們能夠在幹擾有限的情況下繼續為所有客戶提供服務。我要感謝 Evolent 團隊，他們週末不知疲倦地工作，以實現這一重要轉變。本季的這一轉變標誌著我們朝著年終運行率 EBITDA 目標和實現 1500 萬美元 NIA 成本協同效應邁出了重要一步。

Next, I'm pleased to share that we continue investing in the artificial intelligence opportunity at Evolus through our initial product testing. Based on our work thus far, we believe that there's a significant opportunity to reduce the costs for specialty case review while maintaining or even enhancing service quality and providing a superior user experience.

接下來，我很高興地告訴大家，我們透過初步產品測試繼續投資 Evolus 的人工智慧機會。根據我們迄今為止的工作，我們相信有很大的機會可以降低特殊案例審查的成本，同時保持甚至提高服務品質並提供卓越的用戶體驗。

As additional benefit of our AI investments, we expect we'd be able to redeploy our human capital pool to higher-value work streams that improve our product and our value proposition. We expect these benefits to begin making a more significant impact in 2025.

作為人工智慧投資的額外好處，我們希望能夠將我們的人力資本庫重新部署到更高價值的工作流程，從而改善我們的產品和價值主張。我們預計這些優勢將在 2025 年開始產生更重大的影響。

Third, our results in Q1 demonstrate the benefit of our balanced approach to value-based specialty care with earnings growth from both our non-risk and risk products and our non-risk products continue to account for approximately 70% of our annual adjusted EBITDA. As John, will share in detail, we saw increased utilization in our Performance Suite risk business in Q1, and we have lower data visibility than is typical for this point in the year.

第三，我們第一季的業績證明了我們以價值為基礎的專業護理的平衡方法的好處，我們的非風險和風險產品的收益增長，並且我們的非風險產品繼續占我們年度調整後EBITDA 的約70%。正如約翰將詳細分享的那樣，我們看到第一季效能套件風險業務的利用率增加，但我們的數據可見度低於今年此時的典型水平。

Those factors do impact our Q2 guide, but because our data visibility will increase across the year because the increases in utilization have moderated across early Q2 and because of the contractual protections available to us around prevalence and other population changes that John, will detail we remain confident in our 2024 exit run rate, adjusted EBITDA commitment of $300 million and our annual guidance.

這些因素確實會影響我們的第二季度指南，但因為我們的數據視覺性將在全年中增加，因為利用率的增長在第二季度初期有所放緩，並且因為我們可以圍繞患病率和其他人口變化提供合約保護，約翰將詳細說明我們仍然對我們 2024 年的退出運行率、調整後的 3 億美元 EBITDA 承諾以及我們的年度指導充滿信心。

Finally, I'm proud of the team for continuing to drive efficiency as we grow with our SG&A expense down sequentially versus Q4, despite sustained substantial revenue growth. And I feel we've been able to drive these efficiencies while maintaining a strong culture and talent orientation.

最後，我為團隊持續提高效率感到自豪，儘管我們的收入持續大幅成長，但我們的銷售、一般行政費用 (SG&A) 費用較第四季連續下降。我認為我們能夠在保持強大的文化和人才導向的同時提高效率。

Regarding our third investment theme of disciplined capital allocation our principles remain consistent with our communications over the last few years, which are ensuring strong organic innovation carefully managing to our leverage targets and pursuing accretive M&A to accelerate our leadership position in value-based specialty care.

關於我們的第三個投資主題，即嚴格的資本配置，我們的原則與過去幾年的溝通保持一致，即確保強大的有機創新，仔細管理我們的槓桿目標，並尋求增值併購，以加速我們在基於價值的專業護理領域的領導地位。

With respect to organic innovation, we have consistently talked about building more services to help members and their families navigate their conditions and their moments of need. Our strong belief is that shared decision making with an engaged member helps drive the highest quality most efficient care. We've addressed this opportunity thus far through our end-of-life solution, which we primarily bundle into our Performance Suite.

關於有機創新，我們一直在談論建立更多服務來幫助會員及其家人應對他們的狀況和需求的時刻。我們堅信，與積極參與的會員共同決策有助於推動最高品質、最高效的照護。到目前為止，我們已經透過我們的生命週期結束解決方案抓住了這個機會，我們主要將其捆綁到我們的效能套件中。

Our data shows that when our end-of-life solution is integrated with our oncology and cardiology solutions we have materially higher member engagement rates, generating greater referrals into palliative care, reducing the overall total cost of care versus the status quo. While most importantly aligning clinical care with patient identified goals and values in order to improve their quality of life.

我們的數據顯示，當我們的臨終解決方案與我們的腫瘤學和心臟病學解決方案整合時，我們的會員參與率顯著提高，產生更多的安寧療護轉介，與現狀相比降低了總體護理總成本。最重要的是，將臨床護理與患者確定的目標和價值觀結合起來，以提高他們的生活品質。

Last August, we also announced a pilot program with the large Blue Cross Blue Shield plan partner to offer shared decision making and better navigation of the health care system for patients diagnosed with cancer. Today, we're accelerating this initial navigation work by announcing a strategic partnership with Careology, a privately held UK based company with what we believe to be the most robust digital cancer care platform available.

去年 8 月，我們還宣布了與 Blue Cross Blue Shield 計劃合作夥伴的試點計劃，為診斷為癌症的患者提供共同決策和更好的醫療保健系統導航。今天，我們宣布與 Careology 建立策略合作夥伴關係，加速這項初步導航工作。

The Careology platform is being used extensively across the UK National Health Service to connect patients to caregivers to monitor and report symptoms associated with chemotherapy and to monitor vital signs and overall well-being. In addition, the platform manages schedules, appointments and the overall care process. We believe this solution will help manage the cost and quality of our Performance Suite members as a bundled offering and potentially become an Evolent technology and services offering in the future.

Careology 平台在英國國家衛生服務系統中廣泛使用，將患者與照護者聯繫起來，以監測和報告與化療相關的症狀，並監測生命徵象和整體健康狀況。此外，該平台還管理日程安排、預約和整體護理流程。我們相信，該解決方案將有助於管理我們 Performance Suite 成員作為捆綁產品的成本和質量，並有可能在未來成為 Evolent 的技術和服務產品。

From a business perspective, Evolent has secured the exclusive long-term right to distribute and integrate the product in the United States for the payer market. We believe this patient navigation arrangement is another good example of both innovating our solution and doing so in a capital efficient way.

從商業角度來看，Evolent 已獲得在美國支付市場分銷和整合該產品的獨家長期權利。我們相信，這種患者導航安排是創新我們的解決方案並以資本有效方式實現這一目標的另一個很好的例子。

Before I hand it to John to talk through our financials and guidance, I want to take a step back and comment on where I believe Evolent is headed in the future.

在我將其交給 John 討論我們的財務狀況和指導之前，我想退後一步，評論一下我認為 Evolent 未來的發展方向。

First, we are proud to have built an incredible and what we believe is a differentiated specialty platform. Currently growing organically at over 50% or annually, driving strong profitability and cash flow. The strong growth and profitability -- we believe our indicators of customer confidence in our ability to innovate and execute over the long term.

首先，我們很自豪能夠建立一個令人難以置信的、我們認為是差異化的專業平台。目前有機成長超過 50% 或每年，推動強勁的獲利能力和現金流。強勁的成長和獲利能力－我們相信客戶對我們長期創新和執行能力的信心指標。

Second, a rising utilization environment creates significant financial and operational pressures on health plans requiring more innovative solutions given the need to aggressively manage utilization pressures in specialty care. This will create, I believe, an important opportunity for our company for years to come.

其次，不斷上升的利用環境給健康計畫帶來了巨大的財務和營運壓力，考慮到需要積極管理專科護理中的利用壓力，需要更多創新的解決方案。我相信，這將為我們公司在未來幾年創造一個重要的機會。

And third, our innovation across areas like patient navigation, artificial intelligence and specialty expansion all provide meaningful opportunities to accelerate our platform. We understand the investing environment for small and mid-cap publicly traded health care organizations has been challenged as of late, and everyone is no exception. However, we remain very optimistic about our future and fully committed to using all the tools available to ensure shareholder value creation.

第三，我們在患者導航、人工智慧和專業擴展等領域的創新都為加速我們的平台提供了有意義的機會。我們了解中小型上市醫療保健組織的投資環境最近受到了挑戰，每個人也不例外。然而，我們對未來仍然非常樂觀，並完全致力於使用所有可用的工具來確保股東價值創造。

With that, let me hand it to John.

接下來，讓我把它交給約翰。

Thanks, Seth. We are pleased with our first quarter results and anticipate the continued solid outlook for 2024. We are raising the midpoint of our revenue guidance by $115 million and reiterating both our full year adjusted EBITDA outlook of $235 million to $265 million and our 2024 year end exit run rate of $300 million in adjusted EBITDA. Revenue growth was nearly 50% year over year versus the same quarter last year, outperforming internal and external expectations from two factors. First, about $25 million from membership growth across our Performance Suite, we expect this level to be the new quarterly baseline for the rest of the year.

謝謝，塞思。我們對第一季的業績感到滿意，並預計 2024 年的前景將持續穩健。我們將營收指引的中點上調 1.15 億美元，並重申全年調整後 EBITDA 預期為 2.35 億美元至 2.65 億美元，以及 2024 年底調整後 EBITDA 退出運作率為 3 億美元。營收年增近50%，從兩個因素來看，超出了內部和外部預期。首先，我們的績效套件的會員成長約 2500 萬美元，我們預計這一水平將成為今年剩餘時間的新季度基準。

Second, based on CMS data we received in the quarter and our consistent revenue recognition policies, we recognized an additional $18 million in shared savings for MSSP performance year 2023, along with an offsetting expense accrual of $14 million in gain share for our physician partners for $4 million of adjusted EBITDA.

其次，根據我們在本季度收到的CMS 數據以及我們一貫的收入確認政策，我們確認了2023 年MSSP 業績的額外1,800 萬美元的共享節省，以及我們的醫生合作夥伴在2023 年的收益份額中抵消了1,400 萬美元的應計費用。

Those items were ahead of our expectations for this time of the year. Note that consistent with our past practice, our cumulative accrual for PY 2023 shared savings remains at the conservative end based on data received to date, and we anticipate an incremental step up once final settlement data is received in Q3. Demand for our technology and services product also continues to be strong. We generated Q1 revenue of $89 million despite losing an estimated $6 million in quarterly Tech & Services revenue to Medicaid redeterminations and conversions to our Performance Suite, representing underlying year-over-year growth of nearly 25%.

這些項目超出了我們今年這個時候的預期。請注意，與我們過去的做法一致，根據迄今為止收到的數據，我們對2023 年共享儲蓄的累積應計仍處於保守狀態，並且我們預計一旦在第三季度收到最終結算數據，我們將逐步增加。對我們的技術和服務產品的需求也持續強勁。儘管由於醫療補助重新確定和性能套件轉換而損失了估計 600 萬美元的季度技術和服務收入，但我們第一季的收入為 8,900 萬美元，同比增長近 25%。

Regarding Medicaid redeterminations, we estimate that the process for our Medicaid population was over 80% complete as of March 31, and we estimate a same-store weighted membership decline of 10% as of the same date. Recall that our biggest Medicaid states started the process later. So our commentary here differs slightly from national MCOs. Our outlook continues to anticipate a gross decline in the mid-teens and the process is complete in this summer, consistent with our expectations and our initial forecast in 2023.

關於醫療補助重新確定，我們估計截至 3 月 31 日，醫療補助人群的流程已完成 80% 以上，並且我們估計截至同一日期同店加權會員人數下降了 10%。回想一下，我們最大的醫療補助州後來開始了這個過程。因此，我們的評論與國家 MCO 略有不同。我們的前景繼續預期整體下降幅度為 15%左右，這一過程將在今年夏天完成，這與我們的預期和 2023 年的初步預測一致。

Turning to profitability, we continue to drive efficiencies in our cost structure as we grow with adjusted SG&A costs to 8% of revenue down by 166 basis points sequentially versus Q4. Adjusted gross margin in the quarter was 16.4%, down 185 basis points sequentially versus Q4. The change in gross margin is principally driven by growth in our Performance Suite products combined with higher unit medical expenses.

談到獲利能力，我們繼續提高成本結構的效率，隨著我們的成長，調整後的銷售及行政費用 (SG&A) 成本佔營收的 8%，比第四季連續下降 166 個基點。本季調整後毛利率為 16.4%，較第四季下降 185 個基點。毛利率的變化主要是由我們的性能套件產品的成長以及單位醫療費用的增加所推動的。

The drivers of medical expenses in the quarter are as follows. First, net favorable prior year claims development in the quarter was approximately $15 million, consistent with our expectations and demonstrating our continued prudent actuarial processes and conservative approach to reserving in our risk business. This $15 million with associated with revenue refunds to our clients from corridors of approximately $10 million for an approximate net $5 million benefit to gross profit. Again, consistent with our expectations.

本季醫療費用的驅動因素如下。首先，本季的上一年淨利理賠發展約為 1500 萬美元，與我們的預期一致，並表明我們持續審慎的精算流程和保守的風險業務準備金方法。這 1500 萬美元與從大約 1000 萬美元走廊向我們的客戶退款相關，為毛利潤帶來約 500 萬美元的淨收益。再次符合我們的預期。

This favorability was offset by higher estimated medical expenses for Q1, driven both by lower data visibility and our continuous review of leading indicators. On the first because of dynamics impacting our partners, including the Change Healthcare outage, we closed the quarter with lower claims visibility than is typical even for long-standing clients. This is exacerbated by the volume of recently launched Performance Suite revenue approximately 2.5 times more than the same quarter last year, which typically has lower visibility overall.

這種好感被第一季預計醫療費用的增加所抵消，這是由於數據可見度較低和我們對領先指標的持續審查所致。首先，由於影響我們合作夥伴的動態（包括 Change Healthcare 中斷），我們在本季結束時的索賠可見度比長期客戶的典型情況還要低。最近推出的性能套件收入約為去年同期的 2.5 倍，這進一步加劇了這一情況，而去年同期的整體可見度通常較低。

The mechanics of this lower visibility in our reserving approach combined with macro commentary across the industry regarding elevated utilization, create incremental conservatism for the first quarter and our guide for Q2. Second, we incorporate leading indicators like volume and disease prevalence from authorization requests into our reserving models. And our reliance on these leading indicators is higher if our claims visibility is lower like it was for this quarter.

我們的儲備方法中可見性較低的機制，加上整個產業對利用率提高的宏觀評論，為第一季和我們第二季的指南創造了增量保守主義。其次，我們將授權請求中的數量和疾病盛行率等領先指標納入我們的儲備模型中。如果我們的索賠可見度像本季那樣較低，那麼我們對這些領先指標的依賴就會更高。

During the latter part of the first quarter, we saw increasing activity on these indicators rising to a peak in March. This observed activity from our authorization data was in both oncology and cardiology specialties for particular markets in both MA and Medicaid. Note that these indicators declined in April from their March peak.

在第一季後半段，我們看到這些指標的活動不斷增加，並在 3 月達到高峰。從我們的授權數據中觀察到的活動涉及馬薩諸塞州和醫療補助特定市場的腫瘤學和心臟病學專業。請注意，這些指標在 4 月較 3 月的峰值有所下降。

Now, as a reminder, we've previously highlighted two distinctive features of our model. The first is that we have intentionally built a diversified business that balances both risk and non-risk products. And we continue to generate close to 70% of our expected adjusted EBITDA across the year from our technology and services business. And so any potential impact of higher utilization in our Performance Suite is buffered by the other two thirds of our EBITDA guide.

現在，提醒一下，我們之前已經強調了我們模型的兩個顯著特徵。首先，我們有意識地建立了平衡風險和非風險產品的多元化業務。我們全年預期調整後 EBITDA 的近 70% 仍來自我們的技術和服務業務。因此，我們的效能套件中更高利用率的任何潛在影響都可以透過我們的 EBITDA 指南的其他三分之二來緩衝。

The second is that our Performance Suite products typically contain certain contractual protections that may adjust our capitation rates based on population changes outside of our control. So as Q1 claims complete and our visibility improves if these elevated leading indicators translate into elevated paid claims, we estimate that over 70% of the reported cost increases in Q1 can be addressed by contractual adjustments resulting in rate changes over the next 3 to 12 months.

其次，我們的績效套件產品通常包含某些合約保護，這些保護可能會根據我們無法控制的人口變化來調整我們的按人頭付費率。因此，隨著第一季索賠的完成，如果這些領先指標的提高轉化為已賠付索賠的增加，我們的可見度會提高，我們估計第一季報告的成本增長中超過70% 可以透過合約調整來解決，從而導致未來3 到12 個月的費率變化。

It is important to note that this is in normal course parts of our business. Over the last few years, we have regularly used these mechanisms to work with our partners to update rates for changes at the market in line of business levels. You will also recall that we included in our original adjusted EBITDA guidance for 2024 a $10 million buffer for changes in medical utilization based on dynamics in the market. If the leading indicators from Q1 persist beyond March and translate into claims, we will be quickly implementing the contractual changes available to us.

值得注意的是，這是我們業務正常流程的一部分。在過去的幾年裡，我們定期使用這些機制與我們的合作夥伴合作，根據業務層級的市場變化更新費率。您還記得，我們​​在 2024 年最初調整後的 EBITDA 指導中納入了 1000 萬美元的緩衝，以根據市場動態調整醫療利用率的變化。如果第一季的領先指標持續到三月之後並轉化為索賠，我們將迅速實施可用的合約變更。

However, there may be a timing lag between that elevated cost and increased fees to Evolent, which could cause our results for Q2 to be adversely impacted. As a result, we are taking a conservative approach to our adjusted EBITDA guidance for Q2 with a range of $48 million to $62 million.

然而，成本上升與 Evolent 費用增加之間可能存在時間滯後，這可能導致我們第二季的業績受到不利影響。因此，我們對第二季調整後的 EBITDA 指引採取保守態度，範圍為 4,800 萬美元至 6,200 萬美元。

Let me be specific about what could take us to the high or the low end of this range for the second quarter. In scenarios where the leading indicator data in late Q1 is transitory and or we obtain increases in our capitation rates for the quarter, we could see the top end of our range for the quarter or beyond. In scenarios where that leading indicator data translates into persistently elevated claims expense and the process for obtaining corresponding rate increases extends beyond the quarter we could see the lower end of the range.

讓我具體說明什麼可能會導致我們第二季達到該範圍的上限或下限。如果第一季末的領先指標數據是暫時的，或者我們在本季的人均付費率有所增加，那麼我們可能會看到本季度或以後的範圍的上限。如果領先指標數據轉化為索賠費用持續上升，並且獲得相應費率上漲的過程超出季度，我們可能會看到該範圍的下限。

The cost trends mitigated in April and because we have several levers to drive profitability across the year, including but not limited to these contractual protections I mentioned, we remain confident in our full year adjusted EBITDA guidance and our $300 million exit run rate target. Let's go through the path to that exit run rate target further updating the bridge we provided on the February call. On Medicaid redeterminations currently we are running in line relative to our forecast for a $3.5 million quarterly headwind versus Q4 '23 with one quarter to go, we estimate a Q1 in-quarter impact of about $2.5 million.

4 月份的成本趨勢有所緩解，而且由於我們有多種手段來推動全年盈利，包括但不限於我提到的這些合約保護，我們對全年調整後EBITDA 指導和3 億美元的退出運行率目標仍然充滿信心。讓我們仔細研究一下退出運行率目標的路徑，進一步更新我們在二月的電話會議中提供的橋樑。目前，在醫療補助重新確定方面，我們的預測與 23 年第 4 季相比將出現 350 萬美元的季度逆風，還有一個季度，我們估計第一季的季度影響約為 250 萬美元。

On NIA synergies as Seth discussed, we are on track to realize the total $8.75 million quarterly benefits by the end of this year across both cost and revenue items with about half of this value included in Q1 results. On the Performance Suite we are still early in our journey to capture the first leg of maturation that drives the $12.5 million quarterly expectation here, but we are pleased with the leading indicators of value creation and populations launched in '23 and '24. Authorization data suggests that new plan members under management are on average experiencing higher quality, more cost effective treatment regimens in oncology and cardiology, and we look forward to seeing these shifts reflected in the claims data.

正如 Seth 所討論的，關於 NIA 協同效應，我們預計在今年年底前實現成本和收入項目總計 875 萬美元的季度效益，其中約一半包含在第一季度業績中。在性能套件方面，我們仍處於成熟階段的早期階段，推動了 1,250 萬美元的季度預期，但我們對 23 年和 24 年推出的價值創造和人口領先指標感到滿意。授權數據表明，管理下的新計劃成員平均正在經歷更高品質、更具成本效益的腫瘤學和心臟病學治療方案，我們期待看到這些變化反映在理賠數據中。

Finally, on the organic growth side, we estimate that the combination of strong membership performance and recently announced tech and services deals closes approximately 25% of our quarterly adjusted EBITDA go-get, leaving just under $3 million as a go-get.

最後，在有機成長方面，我們估計，強勁的會員表現以及最近宣布的技術和服務交易相結合，將關閉我們季度調整後 EBITDA 目標的約 25%，留下略低於 300 萬美元的目標。

Shifting to cash generation, first we remain on track to meet or exceed our target of $150 million in cash flow from operations for calendar '24. Recall as the first quarter of the year is seasonally our biggest use of cash given the timing of working capital changes. Second, after the quarter closed, we closed out the NIA. earnouts for $88.75 million, slightly ahead of our initial expectations based on what has been a very successful acquisition that was additive to our corporate performance during 2023. We elected to fund 100% of this earnout in cash, avoiding dilution to our common shareholders.

轉向現金生成，首先我們仍有望達到或超過 24 日曆年營運現金流 1.5 億美元的目標。回想一下，考慮到營運資金變動的時間，今年第一季是我們季節性使用現金最多的季度。其次，季度結束後，我們關閉了 NIA。獲利為 8,875 萬美元，略高於我們最初的預期，因為這是一次非常成功的收購，為我們 2023 年的公司業績做出了貢獻。我們選擇以 100% 的現金支付該收益，避免稀釋我們的普通股股東的權益。

Turning to guidance for the full year, we are raising our revenue outlook to between $2.53 billion and $2.6 billion and reiterating our adjusted EBITDA outlook of between $235 million and $265 million as mentioned above. We continue to expect capitalized software development of approximately $30 million and total cash flow from operations in excess of $150 million, including the technology initiatives that Seth discussed.

談到全年指導，我們將營收預期上調至 25.3 億美元至 26 億美元之間，並重申調整後的 EBITDA 預期為 2.35 億美元至 2.65 億美元之間，如上所述。我們仍預期軟體開發資本化約為 3,000 萬美元，營運總現金流超過 1.5 億美元，其中包括 Seth 討論的技術措施。

For the second quarter, we are anticipating revenues between $625 million and $645 million and adjusted EBITDA between $48 million and $62 million. In closing, we remain confident in the value of our unique and diversified platform, and we are excited to continue driving value for shareholders, employees and the partners and patients we serve.

我們預計第二季的營收將在 6.25 億美元至 6.45 億美元之間，調整後的 EBITDA 將在 4,800 萬美元至 6,200 萬美元之間。最後，我們對我們獨特且多元化平台的價值仍然充滿信心，我們很高興能夠繼續為股東、員工以及我們所服務的合作夥伴和患者創造價值。

With that, we will now open it up for Q&A.

現在，我們將開放它進行問答。

(Operator Instructions)

（操作員說明）

Anne Samuel, JP Morgan.

安妮‧塞繆爾，摩根大通。

Hi, this is Kyle Aikman for Anne. Congrats on the quarter and thanks for taking my question. I was wondering if you could touch more on the macro payer landscape, things that you could point to that are pressuring these health plans. Has this gotten incrementally worse in the quarter? And does this mean that deals are closing quicker? How is it benefiting Evolent in the long term? Thank you.

大家好，我是安妮的凱爾艾克曼。恭喜本季度，感謝您提出我的問題。我想知道您是否可以更多地談論宏觀支付者的情況，您可以指出哪些因素對這些健康計劃造成壓力。本季情況是否變得越來越糟？這是否意味著交易會更快完成？從長遠來看，它對 Evolent 有什麼好處？謝謝。

Yeah, sure. Happy to take that one. So look, I think it's a bit of a perfect storm on the payers over the last handful of quarters, one pieces reimbursement, one pieces around the V28 risk adjustment on one pieces around pricing and benefits, and one piece is around utilization. I think the fact that those are all hitting kind of over the last six, nine months has created a lot of pressure that we all know about. And I think one of the remaining levers that's available to the payer community is obviously around specialty management.

好，當然。很高興接受那個。所以看，我認為過去幾個季度對付款人來說有點完美風暴，一件是報銷，一件是圍繞 V28 風險調整，一件是圍繞定價和福利，一件是關於利用率。我認為這些在過去六、九個月裡都受到了打擊，這一事實已經造成了我們都知道的很大壓力。我認為付款人社群可以使用的剩餘槓桿之一顯然是圍繞專業管理。

So that's become I'd say one of the top one or two issues when we talk to most of these payers is how do I better manage specialty costs if I can't do as much on risk adjustment as much with primary care, much go down the list. And so it has definitely increased interest in what we're doing. And I think it's increased the imbalance of the top of the funnel. I wouldn't say it necessarily has accelerated the sales cycle, but I think it's there's just generally a lot more in the funnel.

因此，當我們與大多數付款人交談時，我想說的最重要的一兩個問題之一是，如果我不能像初級保健那樣在風險調整方面做那麼多，我如何更好地管理專業成本，更多在列表中。因此，這無疑增加了人們對我們正在做的事情的興趣。我認為這增加了漏斗頂部的不平衡。我不會說它一定加速了銷售週期，但我認為漏斗中通常還有更多東西。

And it may we'll see may increase sales cycle in certain situations, but it definitely added a lot more to the funnel. And I think it what I really like about this dynamic is even setting aside the more immediate pressures. I think it's very clear this management of these high-cost specialties is a very long-term issue. A lot of its driven by pharmacy innovation and the like that's not going away.

我們可能會看到在某些情況下可能會增加銷售週期，但它肯定會增加漏斗中的更多內容。我認為我真正喜歡這種動態的一點是，甚至可以拋開更直接的壓力。我認為很明顯，這些高成本專業產品的管理是一個非常長期的問題。其中很大一部分是由製藥創新等驅動的，這種趨勢不會消失。

Amazing. Thank you.

驚人的。謝謝。

Jeff Garro, Stephens.

傑夫·加羅，史蒂芬斯。

Good afternoon. Thanks for taking the questions. Maybe we can dig in a little bit on the topic of the contractual protections and you mentioned the 3 to 12 month lag on capturing any potential rate changes and that's a bit of a wide range of time and some of it could fall out of FY25 at the high end of that range. So maybe you could help us further understand how that timing would most likely play out and how a rate change would also play out in terms of either retrospective or prospective adjustments to your rates and in turn revenue? Thanks.

午安.感謝您提出問題。也許我們可以深入探討合約保護的話題，您提到捕捉任何潛在利率變化需要 3 到 12 個月的滯後時間，這個時間範圍有點廣，其中一些可能會超出 25 財年的時間範圍。高端。那麼，也許您可以幫助我們進一步了解該時機最有可能如何發揮作用，以及費率變化在對您的費率以及收入的回顧性或前瞻性調整方面也將如何發揮作用？謝謝。

Good questions, Jeff. I'll hit three things. First on the retrospective question that many of these changes do occur retroactively, as that's an important piece here. And the second thing I'd note is that in each of these contracts, the way it's treated is different and that has to do with the particular payers' needs and how that particular contract is structured. And the last piece that I'd say is that the 12 months is from March 31, from the end of Q1, so in place by Q1 of next year as we're exiting this year.

好問題，傑夫。我會擊中三件事。首先關於回顧性問題，其中許多變化確實是追溯發生的，因為這是這裡的一個重要部分。我要注意的第二件事是，在每份合約中，處理方式都不同，這與特定付款人的需求以及特定合約的結構有關。我要說的最後一點是，這 12 個月是從 3 月 31 日開始，從第一季末開始，所以到明年第一季就到位，因為我們今年即將退出。

Kevin Caliendo, UBS.

凱文‧卡里恩多，瑞銀集團。

Hi, good afternoon, everyone. It's Andrea Alfonso for Kevin. John, thank you so much for providing all that color on why sort of the inputs for that wider range in 2Q. I wonder you could just dig into that a little bit. I think the key question being how much of that directly related to sort of that lower claims visibility on change versus that leading indicator volume? You had talked about guidance building in a $10 million buffer for EBITDA. How does that tie in versus sort of just reviewed expectations for 2Q? And then just as a follow-up for that apologies for the loaded question, but are you embedding onboarding costs for some of these customers versus prior expectations that could be depressing that number as well. Thank you, so much.

嗨，大家下午好。這是凱文的安德里亞·阿方索。約翰，非常感謝您提供了所有關於為什麼在第二季度對更廣泛範圍的輸入進行排序的顏色。我想知道你能不能深入研究一下。我認為關鍵問題是，其中有多少直接與索賠變化可見度相對於領先指標數量的降低直接相關？您曾談到為 EBITDA 建立 1000 萬美元緩衝的指導。這與剛剛審查的第二季預期有何關聯？然後，作為對這個問題的道歉的後續行動，但是您是否嵌入了其中一些客戶的入職成本與先前的預期，這也可能會壓低這個數字。太感謝了。

Yeah. Good questions, Andrea. On the mix question, how much of this sort of outlook and conservatism is from leading indicators that we're seeing in particular, we saw in March versus lower claims visibility. I think the truth of the matter there is they're inextricably linked. And in situations where we have lower claims visibility, we have to rely more on leading indicators at and the leading indicator reserving is naturally more conservative and so they sort of reinforce each other.

是的。好問題，安德里亞。關於混合問題，這種前景和保守主義有多少來自我們特別看到的領先指標，我們在三月看到了與較低的索賠可見性相比的情況。我認為事情的真相是它們有著千絲萬縷的關係。在索賠可見度較低的情況下，我們必須更依賴領先指標，而領先指標儲備自然更加保守，因此它們在某種程度上是相輔相成的。

And what I would say also is in a quarter where we have, what we'll call a normal level of visibility at where that's less of an issue. We would place less reliance on the change, the one month's worth of change and leading indicators and there's that's how we think about that. On your second question around start-up costs and otherwise, those are incorporated in the outlook, typically not that significant sort of operational lift to get these contracts live.

我想說的是，在一個季度中，我們稱之為正常可見度水平，而這並不是什麼問題。我們會減少對變化、一個月的變化和領先指標的依賴，這就是我們的想法。關於啟動成本和其他方面的第二個問題，這些都已納入展望中，通常不會對使這些合約生效產生重大的營運提升。

Charles Rhyee, TD Cowen.

查爾斯‧萊伊 (Charles Rhyee)，TD 考恩 (TD Cowen)。

Yeah, thanks for taking the question, guys. I wanted to talk a little bit more as you are about the leading indicators and just sort of -- because I know the last couple of quarters when you've been asked about utilization is trending, you've kind of commented that's been in line with your expectations.

是的，謝謝你們提出這個問題，夥伴們。我想多談談領先指標，因為我知道過去幾個季度當您被問及利用率趨勢時，您的評論有點一致與您的期望。

Here you're kind of talking that you're seeing some change, but that you've also seen that start to moderate. I guess when in the context of when you're signing new partnership deals, particularly, let's say, the new ones here with Molina, how do you factor in the trend that you're seeing at the moment as it gets factored into the agreement, is that a moving target then for each new partner as it gets signed at that moment in time?

在這裡，你有點說你看到了一些變化，但你也看到這種變化開始緩和。我想，當您簽署新的合作夥伴協議時，特別是與 Molina 簽署新的合作協議時，您如何考慮目前所看到的趨勢，因為它已納入協議中，對於每個新合作夥伴來說，當它在那一刻簽署時，這是一個不斷變化的目標嗎？

That's a good question, Charles, I'll reiterate what I said earlier that it does depend on the specific contract with a specific partner varies. But in most cases, for these sorts of moments, we will have, what we call true-up embedded in the contract that resets the capitation rate upon go-live based on trends to that point. So for example, if we go live on September 1, or October 1, we would reset the capitation rate for that contract based on claims through that point.

這是一個很好的問題，查爾斯，我會重申我之前所說的，這確實取決於與特定合作夥伴的特定合約的不同。但在大多數情況下，對於此類時刻，我們將在合約中嵌入所謂的“調整”，根據該點的趨勢在上線時重置按人頭付費率。例如，如果我們在 9 月 1 日或 10 月 1 日上線，我們將根據該時間點的索賠重置該合約的按人頭付費率。

Jessica Tassan, Piper Sandler.

傑西卡·塔桑，派珀·桑德勒。

Hi, guys. Thanks, so much for taking my question. I just want to verify you guys saw positive prior year development related to MSSP in the first quarter of '24. And then and can you just I guess our understanding was that and these MSSP reconciliation hit in third quarter. So just can you verify that you had not recognized any prior year development related to MSSP in 3Q '23 and that I guess this first quarter recon was the first that you've seen. Thanks.

嗨，大家好。非常感謝您回答我的問題。我只是想確認一下，你們在 2024 年第一季看到了與 MSSP 相關的去年積極的發展。然後，我猜我們的理解是，這些 MSSP 和解在第三季度實現。因此，您可以驗證您是否沒有認識到 23 年第三季與 MSSP 相關的任何前一年的發展，並且我猜第一季的偵察是您看到的第一個。謝謝。

Yeah, let me go through just to how we do revenue recognition for MSSP. Typically, we will start recognizing revenue in the third quarter of the performance here. And so the first dollar of revenue that we had revenue we recognized for the '23 performance here was in Q3 of last year. And each quarter we received from CMS and updated claims file other external factors, regional benchmarks and risk adjustment information and so on.

是的，讓我介紹一下我們如何對 MSSP 進行收入確認。通常，我們將在第三季的業績中開始確認收入。因此，我們在 23 年的業績中確認的第一筆收入是在去年第三季。每個季度我們都會收到來自 CMS 和更新的索賠文件的其他外部因素、區域基準和風險調整資訊等。

That allows us to narrow our actuarial range. And each quarter, we're then doing a true-up based on that narrowed range. Our orientation is to be conservative here and so as we're doing that true up each quarter, we're remaining on the conservative end. We're still booked well below where the percent shared savings came up for QY22, for example, and we'd expect to that true up to the final number in this Q3 when we get the final settlement information.

這使我們能夠縮小精算範圍。每個季度，我們都會根據縮小的範圍進行調整。我們的方向是保守，因此當我們每個季度都這樣做時，我們仍然保持保守。例如，我們的預定金額仍然遠低於 2022 年季度的共享節省百分比，當我們獲得最終結算資訊時，我們預計第三季的最終數字會是這樣。

Awesome. That's so helpful. And then my quick last question is then on the Medicaid redeterminations, did you see an incremental sequential headwind related to Medicaid redeterminations? Or was the number you cited in aggregate? Thanks.

驚人的。這很有幫助。然後我的最後一個問題是關於醫療補助重新確定，您是否看到與醫療補助重新確定相關的增量連續逆風？還是你引用的數字是合計的？謝謝。

Yeah, good question. That was incremental. And so said, another way cumulatively, since the whole process began, we have seen a headwind of $5.5 million per quarter, a headwind to adjusted EBITDA. That's consistent with our expectations. However, we thought the quarter would end.

是的，好問題。那是增量的。因此，換句話說，自整個過程開始以來，我們已經看到每季 550 萬美元的逆風，這是調整後 EBITDA 的逆風。這與我們的預期是一致的。然而，我們認為該季度將會結束。

Alright, Thanks.

好的，謝謝。

Ryan Daniels, William Blair.

瑞恩·丹尼爾斯、威廉·布萊爾。

Yeah, guys, thanks for taking the questions. Congrats on the strong start to the year. I hate to ask another one on this, but you probably anticipated it. In regards to the leading indicators kind of peaking in March and then declining in April, if we take a broader purview and look at the data through the first four months of the year, acknowledging it's somewhat limited due to change. But if we look at the four month period, how does that period reflect upon your guidance for the full year and assumptions for the Performance Suit.

是的，夥計們，感謝您提出問題。祝賀今年的強勁開局。我不想就此詢問另一個人，但你可能已經預料到了。至於先行指標在 3 月達到頂峰，然後在 4 月下降，如果我們把視野放得更廣，看看今年前四個月的數據，承認由於變化而受到一定程度的限制。但如果我們看一下這四個月的時間段，該時間段如何反映您對全年的指導和對績效套裝的假設。

Yep. It's a good question, Ryan. I think what you're seeing here in our second quarter guide is that $10 million buffer that we talked about for the full year. And so the if March is a new normal. Then we would initiate some of these contractual protections and we may be in the lower end of that guide. If March was an aberration and April was more normal, more like the rest of the year, then we could be closer to the higher end of guidance. And so it's always a little tricky in a risk business to draw a line between just two points as we've sought not to do that. But given the lower visibility because appropriate at this time.

是的。這是個好問題，瑞安。我認為您在我們的第二季指南中看到的是我們談到的全年 1000 萬美元緩衝。因此，如果三月是新常態。然後我們將啟動其中一些合約保護，我們可能處於該指南的較低端。如果 3 月是異常情況，而 4 月則更為正常，更像今年剩餘時間，那麼我們可能會更接近指導的高端。因此，在風險業務中，在兩點之間畫一條線總是有點棘手，因為我們一直試圖不這樣做。但考慮到此時能見度較低是適當的。

And then as a quick follow-up, if I could. Regarding the contract provisions you have, are those kind of automatic or you just go back with the data and there's an agreement for things like if there's increased cancer prevalence that's not your fault, you're paid to manage the cases not to avoid cases. So is it automatic or do you have to go back and actually kind of negotiate things with these payers. Thanks.

如果可以的話，然後作為快速跟進。關於您所擁有的合約條款，這些條款是自動的，還是您只需返回數據即可，並且有一項協議，例如如果癌症患病率增加不是您的錯，您將被付錢來管理病例而不是避免病例。那麼它是自動的還是你必須回去與這些付款人進行實際談判。謝謝。

Yeah. Depends on the specific contract. Generally speaking, the contracts will outline the specific sort of calculations and corridors and there is a real mathematical element to it.

是的。取決於具體合約。一般來說，合約將概述具體的計算類型和走廊，並且其中存在真正的數學元素。

Okay. Perfect.

好的。完美的。

Ryan, it's Seth. I'll add one other comment to your question, but also Jeff's question earlier. As we said in the prepared remarks this is not sort of in new territory for us. This is something we've regularly participate in each year. It's a little bit different this year given the data, but it's not really a different process so we understand how it works.

瑞安，我是賽斯。我將對你的問題添加另一條評論，還有傑夫之前的問題。正如我們在準備好的發言中所說，這對我們來說並不是一個新領域。這是我們每年都會定期參加的活動。考慮到數據，今年有點不同，但這並不是一個真正不同的過程，所以我們了解它是如何運作的。

We've done it multiple times in the past and are able to, I think, pretty accurately bake all that into our forecasts, and we reiterate this for just Q2. It's with a lot of experience having done this many times before and have a pretty good sense of how to play out.

我們過去已經做過多次，我認為能夠非常準確地將所有這些納入我們的預測，並且我們僅在第二季度重申這一點。以前做過很多次這樣的事情，經驗豐富，並且對如何發揮有很好的感覺。

I guess that's a good call, and I think there's just a heightened sensitivity to it, but that makes a ton of sense. So thank you.

我想這是一個很好的決定，而且我認為人們對此更加敏感，但這很有意義。所以謝謝。

Yes.

是的。

Jailendra Singh, Truist Securities.

Jailendra Singh，Truist 證券公司。

Thank you and thanks for taking my question. I actually want to go back to the gross margin discussion. Can you speak to your 180 basis point decline the quarter. So MSSP revenue, which came through likely helps gross margin, but offsetting you called out more performance with revenue, higher reserves and claims visibility and operation. Can you provide a little bit more that granularity like on the individual buckets on the gross margin impact? And related to that, how do you think about gross margin trends for rest of the year?

謝謝你，也謝謝你提出我的問題。我實際上想回到毛利率的討論。您能談談本季 180 個基點的下降嗎？因此，MSSP 收入可能有助於毛利率，但抵消了您透過收入、更高的準備金和索賠可見度和營運帶來的更多績效。您能否提供更詳細的信息，例如各個類別對毛利率影響的情況？與此相關，您如何看待今年剩餘時間的毛利率趨勢？

Let me take that last question first Jailendra, then I can add a little bit more color. As we've gone through before, the biggest driver of our enterprise percent gross margin is the mix between Performance Suite and tech and services. To what you saw in Q1, we saw in Q4 true, but that also was the impact of continued rapid growth in the Performance Suite, which has a lower gross margin.

讓我先回答最後一個問題 Jailendra，然後我可以添加更多顏色。正如我們之前所經歷的，我們企業毛利率的最大驅動因素是性能套件與技術和服務之間的結合。正如您在第一季所看到的那樣，我們在第四季度也看到了這一點，但這也是性能套件持續快速增長的影響，該套件的毛利率較低。

It's also true that the Q1 gross margin is depressed because of a lot of new go-lives. And for example, we had over $125 million of Performance revenue in the quarter. That was still relatively new and contributing minimally to the gross profit line. If you were to pro forma that closer to target margins, that would increase enterprise gross margins by 230 basis points-plus.

由於大量新產品的上線，第一季的毛利率也確實受到了抑制。例如，本季我們的性能收入超過 1.25 億美元。這仍然相對較新，對毛利線的貢獻微乎其微。如果預期利潤率更接近目標利潤率，企業毛利率將增加 230 個基點以上。

And so as we think about gross margin trends across the year, absent new go-lives in the Performance Suite, we would anticipate them ticking up. And as we think longer term, it's going to continue to be driven by the mix of our growth between the Performance Suite and the tech and services suite, which I sort of highlighted in the prepared remarks, we seek to have a balance.

因此，當我們考慮全年的毛利率趨勢時，如果性能套件沒有新的上線，我們預計它們會上升。從長遠來看，它將繼續受到性能套件與技術和服務套件之間的成長組合的推動，我在準備好的演講中強調了這一點，我們尋求平衡。

Then my quick follow up, actually want to go back to 2025 and a final notice clearly a lot of focus there. I want to ask the question to this like first, how are your conversations with payers position in terms of carving out some list for new customers by taking more risk with existing customers because of the cost pressure they're seeing. And would be curious on your thoughts regarding potential membership changes that might occur in 2025 as some plants focus and pricing for margin. Just maybe a why some color there?

然後我快速跟進，實際上想回到 2025 年，最後的通知顯然有很多焦點。我想先問這個問題，您與付款人的對話在透過對現有客戶承擔更多風險來為新客戶制定一些清單方面處於什麼位置，因為他們面臨著成本壓力。我想知道您對 2025 年可能發生的潛在會員資格變化的想法，因為一些工廠關注利潤並定價。也許只是為什麼會有一些顏色？

Yeah, Seth, do you are talk about them the conversations?

是的，塞斯，你在談論他們的談話嗎？

Yeah, look, I think, John, what I would say is that, as I mentioned in the prepared remarks, just a lot of pressure on the payer community right now, which is driving good demand in the product. And I continue to think that our ability to more effectively manage these categories, whether it's under performance suite or tech services, that that is a platform opportunity that I think we accrue over time and we continue to take market share and grow for that reason.

是的，約翰，我想說的是，正如我在準備好的發言中提到的那樣，目前付款人社區面臨很大的壓力，這推動了產品的良好需求。我仍然認為，我們更有效地管理這些類別的能力，無論是在性能套件還是技術服務下，這都是一個平台機會，我認為我們隨著時間的推移而積累，並且我們將繼續佔據市場份額並因此而增長。

In terms of the negotiations to your very specific question, I don't think a lot has changed there, we have always had a number of different protections, it's always part of the conversation, so as part of the negotiation. To get those aligned in terms of how it's set up. One of the things that's also true is that we can do it different ways. We have relationships where baked in the trends much higher our trend and on our fee, meaning our annual inflator on the fee is pretty significant because we're taking fewer protections and the opposite can also be true. I mean, there's not been a huge change there to the earlier question.

就你的具體問題的談判而言，我認為那裡沒有發生太大變化，我們一直有許多不同的保護措施，它始終是對話的一部分，也是談判的一部分。為了讓它們在設定方式上保持一致。同樣正確的一件事是我們可以用不同的方式來做這件事。我們的關係在趨勢和費用上都遠高於我們的趨勢，這意味著我們的年度費用上漲相當可觀，因為我們採取的保護較少，反之亦然。我的意思是，之前的問題並沒有發生巨大的變化。

Obviously, we have to take in the most recent data and pick the right market market-based trend to use in that negotiation, that's a fact it's not that hard to get our hands around and get aligned on. So that's sort of the dynamic in the marketplace. And again, there's some puts and takes on these kinds of moments. I think as we've been saying for a while, we think it's a net positive of the pressure that exists in the market in terms of the demand side.

顯然，我們必須採用最新的數據並選擇正確的基於市場的趨勢來進行談判，事實上，掌握並協調一致並不難。這就是市場的動態。再說一次，在這些時刻會有一些調整和調整。我認為正如我們一段時間以來所說的那樣，我們認為這是市場在需求方面存在的壓力的淨積極影響。

Okay. Thanks a lot.

好的。多謝。

Sean Dodge, RBC Capital Markets.

肖恩·道奇，加拿大皇家銀行資本市場部。

Yeah, thanks. Just on the Performance Suite indicators, I guess, can you give us any more detail on why you think it's stepped up in March? Was it was it concentrated with a few concentrated in any particular geography or payer or population? And was it -- you said volume, so it sounds like it was more tied to prevalence than it than it was cost, but correct me if I'm wrong there.

是的，謝謝。我想，就 Performance Suite 指標而言，您能否向我們提供更多詳細信息，說明為什麼您認為該指標在 3 月份有所提高？是否集中在某個特定的地理位置、付款人或人口？是嗎——你說的是銷量，所以聽起來它與普及率的關係比與成本的關係更大，但如果我錯了，請糾正我。

Yeah, you're not wrong Sean. We see in that authorization data. The majority of the increase is driven by what we see as changes in the population as things like disease prevalence, I'd say they're not localized to a particular geography or line of business, the pockets here, pockets there, and something obviously that we're watching closely as we go through this quarter.

是的，你沒有看錯，肖恩。我們在授權數據中看到。成長的大部分是由我們所看到的人口變化驅動的，例如疾病流行等，我想說它們並不局限於特定的地理位置或業務範圍，這裡的口袋，那裡的口袋，以及明顯的東西我們在本季度密切關注。

Okay, thanks.

好的謝謝。

Daniel Grosslight, Citi.

丹尼爾‧格羅斯萊特，花旗銀行。

Thanks for taking the question. Last quarter, you mentioned that you would expect to see around 10-percentage-points of margin improvement of 2023 Performance Suite launches in '24, similar to what you saw from '22 to '23 given some of these utilization pressures, are you still comfortable with the assumption around margin improvement of 2023 Performance Suite launches as you look at utilization and some of these pressures is there any difference between newer launches versus more mature launches or more mature Performance Suite arrangements?

感謝您提出問題。上個季度，您提到您預計2024 年推出的2023 Performance Suite 的利潤率將提高約10 個百分點，與您在22 年至23 年看到的情況類似，考慮到其中一些利用率壓力，您是否還在當您考慮利用率和其中一些壓力時，您對2023 年Performance Suite 發布的利潤率改善的假設感到滿意，較新的發布與更成熟的發布或更成熟的Performance Suite 安排之間有什麼區別嗎？

Yes, both good questions. Let me take the second first. There is not. So this isn't a specific to a new population or a more recent growth. It really isn't sort of pockets of those older clients and newer populations. So to your first question, are we still confident in that 10% execution and the margin maturation for the Performance Suite as we're exiting this year?

是的，兩個問題都很好。我先來說第二個。那沒有。因此，這並不是特定於新人口或最近的增長。它確實不是那些老客戶和新人的口袋。那麼，對於你的第一個問題，隨著我們今年退出，我們對性能套件 10% 的執行力和利潤成熟度仍然有信心嗎？

The answer is definitively yes. We feel very good based on what we're seeing in terms of the interventions that we're doing, the value that we're creating, the incremental quality that we're delivering to those members. It is true that the we may need to adjust the capitation rate or two as we sometimes do but on our ability to create value by lowering the cost of care, we feel very good about that.

答案是肯定的。根據我們正在採取的干預措施、我們正在創造的價值以及我們為這些成員提供的增量質量，我們感覺非常好。確實，我們可能需要像有時那樣調整一兩次按人頭收費，但就我們透過降低護理成本創造價值的能力而言，我們對此感到非常滿意。

Got it. Thank you.

知道了。謝謝。

Jack Wallace, Guggenheim.

傑克華萊士，古根漢。

Thanks for taking my questions. Just wanted to get an idea for the -- it sounds like the end market is building a quite a bit of demand. And you thinking about the Performance Suite, if you're able to pull in more a new customers for the Performance Suite and transfer or transition some of your tech and services customers to Performance Suite. Is there a potential that enough of that demand would put an impact on your year-end EBITDA target? To said differently, Would any of the upfront costs and actuarial assumptions for the incremental Performance Suits lives potentially be a drag in a good scenario for the medium and long term? Thank you.

感謝您回答我的問題。只是想了解一下——聽起來終端市場正在建立相當多的需求。如果您能夠為 Performance Suite 吸引更多新客戶，並將部分技術和服務客戶轉移或過渡到 Performance Suite，您就會考慮使用 Performance Suite。足夠的需求是否有可能對您的年終 EBITDA 目標產生影響？換句話說，增量績效套裝壽命的任何前期成本和精算假設是否可能會拖累中長期的良好情況？謝謝。

Yeah, Jack, Good question. I don't think so for this year on, you know, we continue to, first of all, have a nice pipeline across Performance Suite and the tech services side, it's pretty balanced if I looked at what's in there. And so I don't see a skew 0.1. And then I'd say the second point would be just that I don't think at this stage in the year on this from a timing perspective likelihood that that would happen.

是的，傑克，好問題。我不這麼認為，從今年開始，我們首先繼續在性能套件和技術服務方面擁有一個很好的管道，如果我看看裡面的內容，它是相當平衡的。所以我沒有看到 0.1 的偏差。然後我想說的第二點是，從時間角度來看，我認為在今年的這個階段不會發生這種情況。

And even as we look into next year, if you asked the question differently, I think it's the same response, which is we continue to have a pretty balanced pipeline. We like it that way. We've sort of always liked the balance between the two segments for the reasons that we've been talking about and that's continues to be what it looks like.

即使我們展望明年，如果你以不同的方式提出這個問題，我認為這是相同的答案，那就是我們仍然擁有相當平衡的管道。我們喜歡這樣。由於我們一直在談論的原因，我們一直喜歡這兩個部分之間的平衡，而且這仍然是它的樣子。

Excellent. Thank you. And then, yeah, how should we be thinking about the economics from the Careology deal? Sounds like it's a pretty interesting partnership. Should we think about that some potential upside for this year that really more of a '25 story?

出色的。謝謝。然後，是的，我們應該如何考慮 Careology 交易的經濟效益？聽起來這是一個非常有趣的合作關係。我們是否應該考慮今年的一些潛在的好處，這更像是一個 25 世紀的故事？

Yeah, Jack. So we are very excited about Careology too. The team is -- our team has done a great job, their team it's exciting partnership. I think that it's not going to have an effect on this year. We'll probably go live with our first health plan partner late this year. If I had to guess, so it's down the road a little bit. And we're going to really be targeting our Performance Suite relationships first, and at some point, it may become a tech and services product as well. But it's really about embedding it into our Performance Suite relationships similar to what we do with our end-of-life products.

是的，傑克。因此，我們對 Careology 也感到非常興奮。我們的團隊做得很好，他們的團隊是令人興奮的合作關係。我認為這不會對今年產生影響。我們可能會在今年稍後與我們的第一個健康計劃合作夥伴一起生活。如果我不得不猜測的話，那麼它就在路上了一點。我們將首先真正針對我們的性能套件關係，在某個時候，它也可能成為一種技術和服務產品。但這實際上是將其嵌入到我們的性能套件關係中，就像我們對報廢產品所做的那樣。

Got it. Thank you.

知道了。謝謝。

Stephanie Davis, SVB Leerink.

史蒂芬妮戴維斯，SVB Leerink。

Hey, guys. I've actually heard Barclays. Glad to be my new home. Thank you for taking my question. You provided a really helpful bridge on profitability. I was hoping to split hairs a little bit more and asked which of these, but the new wins mix would be more of an impact of gross margins and which of these we should think of as a headwind to growth profit dollars?

大家好。我實際上聽說過巴克萊銀行。很高興能成為我的新家。感謝您回答我的問題。您為獲利能力搭建了一座非常有幫助的橋樑。我希望能再詳細一點，並詢問其中哪一個，但新的勝利組合將更多地影響毛利率，而我們應該將哪一個視為增長利潤的逆風？

I'm not sure I understand the question, Stephanie, sorry.

我不確定我是否理解這個問題，史蒂芬妮，抱歉。

So is there a reason you will see a year-over-year decline in gross profit dollars as opposed to just a headwind to gross margin.

那麼，您會看到毛利同比下降而不只是毛利率下降，這是否是有原因的？

Good questions. Yes. So from Q4 to Q1, gross profits relatively flat it largely driven by the elevated indicators in March, as I mentioned. And the as we go through this year, continue to drive performance in the Performance Suite and those cost improvements that I mentioned, it's the benefit of some of the new launches that we've seen, which are mostly in the tech and services suite in the first half of this year. Would that should drive it forward.

好問題。是的。因此，從第四季度到第一季度，毛利相對持平，這主要是由於 3 月指標上升所致，正如我所提到的。今年，我們將繼續推動性能套件的性能以及我提到的成本改進，這是我們看到的一些新發布的好處，這些新產品主要集中在技術和服務套件中今年上半年。這會推動它前進嗎？

And then when the newly announced Molina deals go-live later this year, you'd see another dip on the percentage side, but I wouldn't necessarily anticipate a dip there on the dollar side, we expect that to continue to grow as we sort of laid out the EBITDA ramp, continuing to grow.

然後，當今年稍後新宣布的 Molina 交易上線時，您會看到百分比方面再次下降，但我不一定預計美元方面會出現下降，我們預計隨著我們的發展，這一數字將繼續增長EBITDA呈上升趨勢，並持續成長。

Alright. Helpful. Thank you. And just a quick one on the Molina contracts. How should we think about what would happen if Molina loser Florida? Does that have any impact to your business?

好吧。有幫助。謝謝。簡單介紹一下莫利納的合約。我們該如何思考如果莫利納輸給佛羅裡達州會發生什麼？這對您的業務有影響嗎？

Yeah. Too early to say what happens, we're not close to it. I think we previously expect out that sort of Molina, Florida revenue and Medicaid at less than $15 million. So that would be the top line impact if something were to change there.

是的。現在說發生了什麼還為時過早，我們還沒有接近它。我認為我們之前預計佛羅裡達州莫利納的收入和醫療補助不會超過 1500 萬美元。因此，如果那裡發生一些變化，這將是最重要的影響。

Alright. Helpful. Thank you, so much.

好吧。有幫助。太感謝了。

(Operator Instructions)

（操作員說明）

David Larsen, BTIG.

大衛‧拉森，BTIG。

Hi. Congratulations on a good quarter. For the $300 million of annualized EBITDA, should we be thinking about $75 million of EBITDA for the fourth quarter of '24? Or does the $300 million of annualized EBITDA mean in December of '24, you'll be trending at like one 1/12 of $300 million of annual EBITDA. Thanks very much.

你好。恭喜您度過了一個美好的季度。對於 3 億美元的年化 EBITDA，我們是否應該考慮 24 年第四季的 7,500 萬美元 EBITDA？或者，3 億美元的年度 EBITDA 是否意味著在 24 年 12 月，您的趨勢將是 3 億美元的年度 EBITDA 的 1/12。非常感謝。

Yeah, Dave, the way that we think about it is it's an exit number and so Q4 is probably a little under that and Q1's probably a little over that.

是的，戴夫，我們認為它是一個退出數字，所以第四季度可能會稍微低於這個數字，而第一季可能會高於這個數字。

Okay. And then in terms of the different components to getting to the $300 million there's performance we match duration, there's new growth and owners earnings from NIA and IPG. Just any update on those numbers would be great in particular, like the new growth figure? I think that was $50 million just -- are those all tracking in line with or ahead of expectations?

好的。然後，就達到 3 億美元的不同組成部分而言，我們的表現與持續時間相匹配，以及來自 NIA 和 IPG 的新增長和所有者收入。這些數字的任何更新都會特別好，例如新的成長數字？我認為這只是 5000 萬美元——這些都符合還是超出預期？

Yeah. In line, as we mentioned from the NIA synergies anticipating $8.75 million quarterly benefit there. About half of that is already in Q1, and we are well on track to achieve the rest of that. I commented on the Performance Suite already and on the new growth mentions that with the seven new relationships that we've already announced -- seven new agreements have already announced this year and strong membership taking that go get to under -- just under $3 million a quarter.

是的。正如我們在 NIA 協同效應中提到的，預計季度收益為 875 萬美元。其中大約一半已經在第一季完成，我們正在順利實現其餘目標。我已經對性能套件發表了評論，在新的增長方面提到了我們已經宣布的七項新關係——今年已經宣布了七項新協議，強大的會員資格將其納入——略低於 300 萬美元四分之一。

Great. Thanks a lot. And then just quickly on cash, just our expectations for cash flow for the year, free cash for the year? And then how should we be thinking about that for 2Q, 3Q, 4Q? And how does that compare to EBITDA, please? Thank you.

偉大的。多謝。然後很快就現金，我們對今年現金流的預期，今年的自由現金？那我們該如何考慮第二季、第三季、第四季呢？請問這與 EBITDA 相比如何？謝謝。

Yep, we affirmed our expectation of $150 million more in operating cash flow for the year. Q1 right in line with our expectations on that metric, and we'll build cash across the year.

是的，我們確認了今年營運現金流增加 1.5 億美元的預期。第一季完全符合我們對該指標的預期，我們將在全年累積現金。

Thanks very much. Appreciate it.

非常感謝。欣賞它。

This concludes our question and answer session. I would like to turn the conference back over to Seth Blackley, for any closing remarks.

我們的問答環節到此結束。我想將會議轉回塞思·布萊克利（Seth Blackley）發表閉幕詞。

Alright. Thank you, for the questions tonight. And we'll look forward to catching up offline. Have a good evening.

好吧。謝謝你今晚的提問。我們將期待線下的追趕。祝你晚上愉快。

The conference is now concluded. Thank you for attending today's presentation. You may now disconnect.

會議現已結束。感謝您參加今天的演講。您現在可以斷開連線。