Fresenius Medical Care AG (FMS) 2024 Q2 法說會逐字稿

Thank you, Alice. Good morning, good afternoon or good evening, depending on where you are. I would like to welcome you to our earnings call for the second quarter of this year. We appreciate you joining us today.

謝謝你，愛麗絲。早上好、下午好或晚上好，取決於您所在的位置。歡迎您參加我們今年第二季的財報電話會議。我們感謝您今天加入我們。

As always, I do start out the call by mentioning our cautionary language that is in our Safe Harbor statement as well as in our presentation and in all the materials that we have distributed earlier today. For further details concerning risks and uncertainties, please refer to these documents as well as to our SEC filings. The call is scheduled for 60 minutes.

像往常一樣，我在電話會議一開始就提到了安全港聲明、簡報以及今天早些時候分發的所有資料中的警示性語言。有關風險和不確定性的更多詳細信息，請參閱這些文件以及我們向 SEC 提交的文件。通話時間預計為 60 分鐘。

We have prepared a presentation and we’ll have time for your questions after the prepared remarks. As always, we would like to limit the number of questions to two in order to give everyone the chance to ask. In case there are further questions and time left, we will gladly offer a second round.

我們已經準備了一份演示文稿，在準備好的演講後我們將有時間回答您的問題。像往常一樣，我們希望將問題數量限制為兩個，以便讓每個人都有機會提問。如果還有其他問題和剩餘時間，我們很樂意提供第二輪。

Let me now welcome Helen Giza, our CEO and Chair of the Management Board; and Martin Fischer, our CFO. Helen will begin the presentation with an update on the major developments and Martin will provide a review of the financial performance in the second quarter. Afterwards, we are happy to take your questions.

現在請允許我歡迎我們的執行長兼管理委員會主席 Helen Giza；和我們的財務長馬丁費雪 (Martin Fischer)。海倫將首先介紹主要進展的最新情況，馬丁將回顧第二季度的財務表現。之後，我們很樂意回答您的問題。

With that, Helen, the floor is yours.

好了，海倫，地板就是你的了。

Thank you, Dominik. Welcome, everyone. Thank you for joining our presentation today and for your continued interest in Fresenius Medical Care.

謝謝你，多米尼克。歡迎大家。感謝您今天參加我們的演講並感謝您對 Fresenius Medical Care 的持續關注。

I will begin my prepared remarks on slide 4. We continue to deliver on our commitments while executing against our strategic plan and working through the company transformation and turnaround efforts. I am proud of the progress we are making in realizing improved financial performance and progress towards our 2025 group margin target.

我將從幻燈片 4 開始我準備好的演講。我們繼續履行我們的承諾，同時執行我們的策略計劃並努力完成公司轉型和扭虧為盈。我對我們在改善財務表現和實現 2025 年集團利潤目標方面取得的進展感到自豪。

While there is clearly more work to be done and external factors to address, overall, we have made important progress to strengthen our business and position ourselves for sustainable profitable growth over the medium and long term. None of that would be possible without each and every one of our employees around the globe, for which they have most gratitude.

雖然顯然還有更多工作要做，外部因素需要解決，但總體而言，我們在加強業務並為中長期可持續盈利增長做好準備方面取得了重要進展。如果沒有我們全球的每一位員工，這一切都是不可能實現的，他們對此深表感激。

Within Care Delivery, while still muted, we saw a sequential improvement in same market treatment growth in the US, with more promising developments in June. Adjusted for the exit from less profitable acute care contracts, same market treatment growth in the US was flat.

在醫療服務領域，雖然仍處於低迷狀態，但我們看到美國相同市場治療成長的連續改善，六月的發展更有希望。根據利潤較低的急診合約的退出進行調整後，美國的同一市場治療成長持平。

During our previous earnings call, I mentioned that we were seeing higher mortality levels at the start of the year in the US than we anticipated. Through the second quarter, we have seen continued elevated trailing 12-month mortality, and we saw an extended influenza season and are seeing increased COVID cases. This translated to a 60 basis point higher mortality than we had expected at the point of giving guidance. We are closely monitoring the development of mortality.

在我們先前的財報電話會議上，我提到美國年初的死亡率高於我們的預期。整個第二季度，我們看到過去 12 個月的死亡率持續上升，流感季節延長，新冠肺炎病例增加。這意味著死亡率比我們在給予指導時的預期高出 60 個基點。我們正在密切監測死亡率的發展。

In parallel, we continue to work on the volume pieces that are in our control, such as streamlining the admissions process and reducing mistreatments. Value-based care remains an important element of our strategy in the US, with its focus on improving patient outcomes and reducing total cost of care for the industry. In the second quarter, our value-based care book of business contributed with revenue growth and slightly improved its profitability. Through the first half of the year, value-based care was a positive contributor to the operating income.

同時，我們繼續致力於我們控制範圍內的工作，例如簡化招生流程和減少虐待。基於價值的照護仍然是我們在美國策略的重要組成部分，其重點是改善患者的治療效果並降低行業的總護理成本。第二季度，我們的價值護理業務貢獻了收入成長，並略微提高了獲利能力。上半年，基於價值的照護對營業收入做出了積極貢獻。

On the international side, we continue to move at pace on our portfolio optimization plan. In the second quarter, we closed the previously announced divestment of Cura Day Hospitals Group in Australia and our dialysis clinic networks in Chile, Ecuador, Sub-Saharan Africa and Turkey. The divestitures of clinic operations in Curacao, Guatemala and Peru were closed in July. The refocus on our high-performing core international countries is supporting a sustainable profitable growth development.

在國際方面，我們持續加快投資組合優化計劃。第二季度，我們完成了先前宣布的澳洲 Cura Day Hospitals Group 以及智利、厄瓜多、撒哈拉以南非洲和土耳其透析診所網路的撤資。庫拉索島、危地馬拉和秘魯的診所業務剝離已於 7 月結束。重新關注我們的高績效核心國際國家正在支持可持續的獲利成長發展。

Last quarter, I spoke about the important leadership changes in Care Delivery, and this was an important step to further enhance our operational excellence. Our main focus is to analyze, benchmark, streamline and implement our major operational processes to improve efficiency, speed, enhance the patient experience and reduce costs, while maintaining our already high standards of patient safety and quality.

上個季度，我談到了護理服務領域的重要領導層變動，這是進一步增強我們卓越營運的重要一步。我們的主要重點是分析、基準測試、簡化和實施我們的主要營運流程，以提高效率、速度、增強患者體驗並降低成本，同時保持我們本已很高的患者安全和品質標準。

Finally, within Care Delivery, our 2025 margin outlook assumes moderate reimbursement increases. We would like to see a higher reimbursement increase for our services than the proposed 2.1%, in particular, given the level of inflation that the industry is facing. However, that increase is within our assumption, and we are currently providing our comments to the draft rule.

最後，在護理服務領域，我們的 2025 年利潤率展望假設報銷金額適度增加。我們希望看到我們的服務報銷增幅高於提議的 2.1%，特別是考慮到該行業面臨的通貨膨脹水平。然而，這種增長是在我們的假設之內的，我們目前正在對規則草案提出評論。

Turning to Care Enablement. I’m very proud of the progress we continue to make here. Driving this positive margin development is continued execution of targeted pricing initiatives. China continues to be an important and attractive market for us, even taking into account the impact of volume-based procurement. We minimized the VBP impact by restructuring our sales channel and the mix of products offered in the respective tenders. We have localized production where it gives us an advantage of the right to play in profitable market segments.

轉向護理支援。我對我們在這裡不斷取得的進步感到非常自豪。推動利潤率積極發展的是持續執行有針對性的定價措施。即使考慮到批量採購的影響，中國仍然是我們一個重要且有吸引力的市場。我們透過重組銷售管道和各個招標中提供的產品組合，將 VBP 的影響降至最低。我們進行在地化生產，這使我們能夠在有利可圖的細分市場中佔據優勢。

VBP has now been introduced in the first province in June, and had a limited impact on our earnings development in the second quarter. In the second half, we expect a low to mid-double-digit million euro impact on our earnings development, which is assumed in our outlook for the year. While FME25 savings benefit both segments at this stage in the program, a significantly greater proportion of savings are planned to come from Care Enablement. To this extent, the optimization of our supply chain and manufacturing footprint remains in focus.

目前，VBP已於6月在第一個省份推出，對我們第二季的獲利發展影響有限。下半年，我們預計對我們的獲利發展產生低至中兩位數的影響，這是我們在今年的展望中所假設的。雖然 FME25 節省的資金在該計劃的這個階段對兩個部門都有利，但計劃中的大部分節省將來自護理支援。從這個意義上說，我們的供應鏈和製造足跡的最佳化仍然是重點。

Another priority for Care Enablement is preparing for the rollout of high-volume HDF in the US, with the introduction of the 5008X machine. I’m excited to report that as part of the preparation, the first 5008X patient treatments in the US were successfully performed in June. Part of the rollout will include education on high-volume HDF for the treatment modality. For our capital markets audience, Dr. Frank Maddux, our Chief Global Medical Officer, will host an educational expert call on high-volume HDF from a medical perspective on September 16. Information about the call is available on our Investor Relations website.

Care Enablement 的另一個優先事項是準備在美國推出高容量 HDF，推出 5008X 機器。我很高興地報告，作為準備工作的一部分，美國首例 5008X 患者治療已於 6 月成功進行。推廣工作的一部分將包括針對治療方式的高容量 HDF 的教育。對於我們的資本市場觀眾，我們的首席全球醫療官 Frank Maddux 博士將於 9 月 16 日主持一場從醫學角度探討大容量 HDF 的教育專家電話會議。有關此次電話會議的資訊可在我們的投資者關係網站上找到。

Moving to slide 5. In the second quarter, we delivered organic revenue growth of 2%, with positive contributions from both segments. The increased operating income and improved margin were mainly driven by continued momentum in our Care Enablement business.

轉到投影片 5。第二季度，我們的有機收入成長了 2%，這兩個部門都做出了積極貢獻。營業收入的增加和利潤率的提高主要得益於我們的護理支援業務的持續成長動能。

This was supported by strong contributions from the execution of our FME25 program. FME25 contributed EUR57 million in additional savings. With this, we are year-to-date already above the low end of our full year FME25 savings target range of EUR100 million to EUR150 million, and I can say that we expect to hit the top end of the range. In line with our disciplined financial policy, we reduced our net financial debt and improved our leverage ratio within the lower end of our net leverage target corridor, to which Martin will come back later.

這得歸功於我們 FME25 計畫執行的大力貢獻。FME25 額外節省了 5700 萬歐元。至此，我們今年迄今已經高於全年 FME25 節省目標範圍 1 億歐元至 1.5 億歐元的下限，而且我可以說，我們預計將達到該範圍的上限。根據我們嚴格的財務政策，我們減少了淨金融債務，並在淨槓桿目標走廊的下限內提高了槓桿率，馬丁稍後會回來。

Underscoring our commitment to sustainability and reducing our CO2 emissions, we announced that we had entered into virtual power purchase agreements for renewable energy during the second quarter. This is an important step toward our goal of becoming a carbon-neutral now operations by 2040. vPPA do introduce a degree of volatility that can impact earnings. In the second quarter, vPPAs had a positive mid single-digit million euro impact on earnings, which was allocated to both segments. Given our year-to-date performance through the second quarter and development of our assumptions to date, we are confirming our full year 2024 outlook.

為了強調我們對永續發展和減少二氧化碳排放的承諾，我們宣布我們已在第二季簽訂了再生能源的虛擬電力購買協議。這是我們實現到 2040 年實現碳中和的目標的重要一步。第二季度，vPPA 對收益產生了數百萬歐元的正面影響，這些影響分配給了這兩個部門。鑑於我們今年第二季迄今的業績以及迄今為止我們假設的發展，我們確認了 2024 年全年展望。

I will now hand over to Martin to walk you through the second quarter financial performance in more detail.

現在我將請馬丁向您詳細介紹第二季的財務表現。

Thank you, Helen, and welcome to everyone on the call. I will recap our second quarter financials beginning on slide 7. In the second quarter, we recorded organic growth – organic revenue growth of 2%, supported by both Care Delivery and Care Enablement. On an outlook base, revenue grew by 0.1%. Revenue development was negatively impacted by the successful execution of our portfolio optimization plan. The divestitures realized during the second quarter accounted for 170 basis points of growth.

謝謝你，海倫，歡迎大家參加電話會議。我將從幻燈片 7 開始回顧我們第二季度的財務狀況。第二季度，在護理服務和護理支援的支持下，我們實現了有機成長，有機收入成長了 2%。從前景來看，收入成長了 0.1%。我們的投資組合優化計劃的成功執行對收入發展產生了負面影響。第二季實現的資產剝離成長了 170 個基點。

During the second quarter, operating income on an outlook base improved by 8%, driven by the performance of Care Enablement. This resulted in a meaningful margin improvement of 70 basis points, bringing us closer to our 2025 margin target band. Divestitures realized during the second quarter had a neutral effect on operating income development.

第二季度，在 Care Enablement 業績的推動下，基於展望的營業收入成長了 8%。這使得利潤率顯著提高了 70 個基點，使我們更接近 2025 年的利潤率目標範圍。第二季實現的資產剝離對營業收入發展有中性影響。

Next on slide 8. This slide provides an overview of the 70 basis points group margin improvement on an outlook base. On the left, you see how we get from the second quarter 2023 operating impact to the starting point of our outlook based by adjusting for special items and divestiture.

接下來是投影片 8。這張投影片概述了基於前景的 70 個基點的集團利潤率改善。在左側，您可以看到我們如何透過調整特殊專案和資產剝離，從 2023 年第二季的營運影響到我們的展望起點。

In the middle, the chart shows the quarterly margin contribution by segment. The decrease in profitability for Care Delivery from a high prior year basis was positively offset by meaningful increase in Care Enablement earnings contribution, which I will elaborate more in the subsequent slides. Corporate also had a positive impact driven by FME25 savings as well as positive phasing of insurance costs.

中間的圖表顯示了各細分市場的季度利潤貢獻。護理服務獲利能力較去年較高水準的下降被護理支援獲利貢獻的大幅成長所抵消，我將在隨後的幻燈片中對此進行詳細闡述。FME25 節省以及保險成本的積極分階段也對企業產生了積極影響。

On the right, special items in the quarter include a positive humor site remeasurement effect, which was offset by costs related to FME25 and the legal form conversion as well as effects from portfolio optimization.

右側，本季的特殊項目包括積極的幽默網站重新測量效果，該效果被與 FME25 和法律形式轉換相關的成本以及投資組合優化的效果所抵消。

Turning to slide 9. Care Delivery revenue decreased by 1% on an outlook base despite an organic growth contribution of 2%. As you might recall, we decided not to adjust our numbers in the current financial year for the divestitures we are closing in this year, and to absorb this impact in our guidance range. Therefore, this decline reflected the impact of divestitures realized in the first half of this year, which had a negative 240 basis point impact on the revenue of Care Delivery.

轉到投影片 9。儘管有機成長貢獻為 2%，但根據展望，護理交付收入下降了 1%。您可能還記得，我們​​決定不對本財年即將完成的資產剝離調整數據，並將這一影響納入我們的指導範圍。因此，這一下降反映了今年上半年實現的資產剝離的影響，這對 Care Delivery 的收入產生了 240 個基點的負面影響。

In Care Delivery US, revenue increased by 1% on an outlook base, driven by growth in our value-based care business, reimbursement rate increases and a favorable per payer mix impact. As Helen described earlier, elevated mortality continues to weigh on the US. volume development, resulting in a sequentially improved, but flat same market treatment growth when adjusting for the exit of less profitable acute the contract.

在美國護理服務領域，由於我們基於價值的護理業務的增長、報銷率的提高以及有利的每個付款人組合的影響，收入在展望基礎上增長了 1%。正如海倫之前所述，死亡率上升繼續給美國帶來壓力。成交量的成長，導致環比改善，但在調整利潤較少的尖銳合約時，市場處理成長持平。

In the second quarter, we recorded an operating income decline of 7% compared to the high prior year basis. As expected, this results in a sequential margin improvement against the first quarter of this year.

第二季度，我們的營業收入與去年同期相比下降了 7%。正如預期的那樣，這導致利潤率比今年第一季連續改善。

Our earnings development was strongly impacted by labor and inflationary cost increases, both developing in line with our expectations for the full year. In the second quarter of 2023, we had comparatively low level of labor costs, with still a large number of open positions that resulted in a tougher base comparison. For 2024, we are still assuming a net 3% increase in labor expenses due to higher wage inflation and staffing requirements. This is in line with our expectations.

我們的獲利發展受到勞動力和通膨成本增加的強烈影響，兩者的發展都符合我們對全年的預期。2023年第二季度，我們的勞動成本水準相對較低，但仍有大量空缺職位，導致基數比較更加困難。對於 2024 年，由於薪資通膨和人員配置要求較高，我們仍假設勞動力支出淨增加 3%。這符合我們的預期。

Inflationary cost in Care Delivery largely relate to higher costs for medical supplies. Also, business growth was negatively impacted by elevated bad debt reserves due to higher AR associated with the vendor change post the cyber incident at Change Healthcare. Despite our flat volume development in the US., this was partially offset by positive business growth driven by favorable pricing and payer mix developments as well as further FME25 savings.

醫療服務的通貨膨脹成本很大程度上與醫療用品成本上升有關。此外，由於 Change Healthcare 發生網路事件後與供應商變更相關的 AR 增加，壞帳準備金增加也對業務成長產生了負面影響。儘管我們在美國的銷售成長持平，但這被有利的定價和付款人組合發展以及進一步的 FME25 節省推動的業務積極成長所部分抵消。

Turning to slide 10. In the second quarter, Care Enablement revenue grew by 3% on an outlook basis. This was supported by 3% organic revenue growth and primarily driven by continued pricing momentum. On an outlook basis, operating income for Care Enablement quadrupled compared to the prior year basis. This increase was driven by business growth, again, reflecting the positive pricing development, savings from FME25, compensating for inflationary cost increases and negative foreign currency exchange effects.

轉到投影片 10。根據展望，第二季護理支援收入成長了 3%。這得益於 3% 的有機收入成長，主要是由持續的定價動能推動的。從前景來看，護理支援的營業收入與前一年相比翻了兩番。這一成長同樣是由業務成長推動的，反映了積極的定價發展、FME25 的節省、補償了通貨膨脹成本的增加和負面的外匯影響。

As mentioned by Helen in the second quarter, volume-based procurement in China had a slight impact on Care Enablement business growth due to the rollout of the first province. As assumed in our outlook, the impact from volume-based procurement on our operating income will be more pronounced in the second half of 2024. The meaningful second quarter margin increase for Care Enablement represents an important step forward towards our 2025 margin target band. The performance in the first half of this year positions us very well to deliver against our plans.

正如Helen在第二季所提到的，由於第一個省份的推出，中國的帶量採購對護理賦能業務的成長產生了輕微影響。正如我們的展望所假設的，帶量採購對我們營業收入的影響將在 2024 年下半年更加明顯。Care Enablement 第二季利潤率大幅成長，代表我們朝 2025 年利潤率目標邁進了重要一步。今年上半年的表現使我們能夠很好地實現我們的計劃。

Turning to slide 11. The decrease in our operating cash flow was primarily impacted by the timing of 2 developments. In response to the cyber incident at Change Healthcare in the first quarter, we made the decision to change vendors as a measure to mitigate this risk in the future. Also, the standing up of new providers resulted in a delay in collection in the second quarter, the cash impact is expected to be recovered in the third quarter. And we have made already significant progress on this in July.

轉到投影片 11。我們的經營現金流量減少主要受到兩項開發時間的影響。為了因應第一季 Change Healthcare 發生的網路事件，我們決定更換供應商，作為未來減輕此風險的措施。此外，新供應商的加入導致第二季收款延遲，現金影響預計將在第三季恢復。七月份我們已經在這方面取得了重大進展。

Our operating cash flow development was also negatively impacted by the phasing of federal income tax payments in the US. We do continue to enforce our strict financial policy and use divestment proceeds for further deleveraging.

我們的經營現金流量發展也受到美國分階段繳納聯邦所得稅的負面影響。我們確實繼續執行嚴格的財務政策，並利用撤資收益進一步去槓桿化。

Total debt and lease liabilities were reduced not only compared to the second quarter of last year, but also compared to the end of last year by EUR417 million. Also, total net debt and lease liabilities decreased. Our net leverage ratio improved to 3.1x, approaching the lower end of our self-imposed target corridor of 3x to 3.5x. We also paid out the annual dividend in the second quarter. In line with our 2025 strategic ambitions and current capital allocation priorities, deleveraging remains our top priority. We continue to execute against our portfolio optimization plans, and proceeds will continue to be used to further reduce that.

債務和租賃負債總額不僅比去年第二季減少，而且比去年年底減少了 4.17 億歐元。此外，淨債務和租賃負債總額也有所下降。我們的淨槓桿率提高至 3.1 倍，接近我們自行設定的 3 倍至 3.5 倍目標區間的下限。我們還在第二季支付了年度股利。根據我們2025年的策略目標和目前的資本配置重點，去槓桿仍然是我們的首要任務。我們繼續執行我們的投資組合優化計劃，收益將繼續用於進一步減少此計劃。

I will now hand over to Helen to finish with our outlook.

現在我將請海倫來完成我們的展望。

Thank you, Martin. I will pick up the slide on slide 14 with an update on our outlook assumptions.

謝謝你，馬丁。我將繼續第 14 張投影片，更新我們的前景假設。

Overall, we are well on track to deliver against our financial outlook for this year. When we compare our assumptions, which we shared in February against where we stand after the first half of the year, we are broadly in line with our budgeted phasing except for one KPI. We initially assumed US. same-market treatment growth of 0.5% to 2% for 2024. Given the continued elevated mortality I described earlier as well as the operational challenges like severe weather impacts, it is less likely that we will finish the year in that range. While we are encouraged by the first signs of operational progress as well as solid growth in treatment in June, it is prudent to refine our expectations for the US same-market treatment growth to be in a range of flat to 0.5%.

總體而言，我們有望實現今年的財務前景。當我們將 2 月分享的假設與上半年之後的情況進行比較時，除了一個 KPI 之外，我們與預算階段基本一致。我們最初假設美國。 2024 年同市場治療成長率為 0.5% 至 2%。考慮到我之前描述的死亡率持續上升以及惡劣天氣影響等營運挑戰，我們不太可能在今年結束時保持在這個範圍內。雖然我們對 6 月營運進展的初步跡像以及治療量的穩健成長感到鼓舞，但謹慎的做法是將我們對美國同市場治療量成長的預期調整為持平至 0.5%。

You heard me say before that the slower recovery of the US.A. market treatment growth post-COVID certainly does not couple our outlook for the year, and we remain confident in the underlying fundamentals of the industry. Despite the muted volume development, year-to-date, our business growth has developed in line with our planned phasing for the year. And as already outlined, FME25 is fully on track to reach the upper end of the target range. And as you can see, our headwinds for 2024 are all in line with the expected phasing for the year.

你之前聽我說過，美國的復甦速度較慢。新冠疫情後的市場治療成長肯定不會影響我們今年的前景，我們對該行業的基本面仍然充滿信心。儘管今年迄今銷量成長緩慢，但我們的業務成長符合我們今年的計劃階段。正如已經概述的那樣，FME25 完全有望達到目標範圍的上限。正如您所看到的，我們 2024 年的不利因素都與今年的預期階段一致。

Turning to slide 14. Based on the just outlined overall development against our assumptions compared to the planning for the year and the outlook for the remainder of the year, we are confirming our 2024 outlook of low to mid-single-digit revenue growth and mid- to high teens operating income growth for the full year. Given the several moving pieces, I would like to see a couple of more months of development before narrowing our full year and 2025 outlook.

轉到投影片 14。根據剛剛概述的總體發展情況，與我們的假設相比，與今年的規劃和今年剩餘時間的前景相比，我們確認 2024 年收入增長為低至中個位數，運營為中至高青少年的前景全年收入增長。考慮到一些變化，我希望在縮小我們全年和 2025 年的展望之前再看到幾個月的發展。

This concludes my prepared remarks, and I will now hand back to Dominik to start the Q&A.

我準備好的發言到此結束，現在我將交回多明尼克開始問答。

Thank you, Helen. Thank you, Martin. Before I hand over for the Q&A, I would like to remind everyone to limit your questions to two. I think we have sufficient time for questions if we have remaining time, which I guess we can go another round. And with that, I would ask you to open the Q&A.

謝謝你，海倫。謝謝你，馬丁。在進行問答之前，我想提醒大家將問題限制在兩個以內。我認為如果還有剩餘時間，我們有足夠的時間提問，我想我們可以再進行一輪。接下來，我想請您開始問答。

Veronika, Citi.

維羅妮卡，花旗。

Hi, guys. Good afternoon. I hope you can hear me okay. I will keep it to the 2 questions, please. My first one is just, Helen, on same-market treatment growth rate in the US. I don’t think any surprises there but, if you could elaborate a little bit on what June looked like relative to the sort of minus 0.1 that you reported, for the quarter as a whole. And I guess, if I look at the guidance range, it still is pretty wide in terms of what it implies for the back half of the year. So I don’t know – I hate to ask this question, but do anyhow, which is how you feel about is the lower bound or the upper bound more likely at the state and sort of how you’re thinking through that? Excuse me. That would be my first question. And then my second question is on the Care Enablement margin. Congratulations, nice to see some continued improvement here. Just curious if you can discuss a little bit the contribution from pricing in Q2 and how important that was, and your thoughts that you might have on the back half of the year and whether you could maintain this kind of year-on-year improvement momentum that you’ve shown in the second quarter? Thank you.

嗨，大家好。午安.我希望你能聽到我的聲音。我將保留這兩個問題。海倫，我的第一個問題是關於美國同一市場治療的成長率。我認為這不會有什麼意外，但是，如果您能詳細說明整個季度 6 月份相對於您報告的負 0.1 的情況。我想，如果我看一下指導範圍，就其對今年下半年的影響而言，它仍然相當寬廣。所以我不知道——我不想問這個問題，但無論如何，你的感覺是下限還是上限更有可能在狀態以及你的思考方式上那？打擾一下。這是我的第一個問題。我的第二個問題是關於護理支持利潤。恭喜，很高興看到這裡有一些持續的改進。只是好奇您是否可以討論一下第二季度定價的貢獻以及它的重要性，以及您對下半年的想法以及是否可以保持這種同比改善勢頭你在第二季度展示過什麼？謝謝。

Hi, Veronika, thank you. We took a bet earlier of how many times we get the same market treatment growth question different ways. So let’s try and unpack this a little bit and hopefully put more color to it. Clearly, as we are kind of getting under this data and obviously with the data lag that we get on some of the mortality, we can now see that this impact of mortality in the first half, as I mentioned, is around about 60 basis points. And that was not contemplated when we were kind of thinking about guidance at the start of the year. We obviously know as we’re sitting flat through half one, the outlook and how we think about half two is critical here.

嗨，維羅妮卡，謝謝你。我們之前就打賭，我們有多少次以不同的方式得到相同的市場待遇成長問題。因此，讓我們嘗試稍微解開它，並希望為其增添更多色彩。顯然，由於我們正在了解這些數據，並且顯然由於我們獲得的一些死亡率的數據滯後，我們現在可以看到，正如我所提到的，上半年死亡率的影響約為 60 個基點。當我們在年初考慮指導時，並沒有考慮到這一點。我們顯然知道，當我們在第一半場比賽中表現平平時，前景以及我們對第二半場的看法至關重要。

What we are seeing, we’ve obviously got this elevated mortality. But in June, specifically, and this is where maybe kind of – I got a lot of encouragement from. The work that Craig is doing with the Care Delivery team, we knew we needed some time to get it going and get under that. But in June, we started to see some improvements in our admission time, which is terrific. We also saw missed treatments improving, and both of those areas were kind of very, very focused efforts that we’re far from John, but we’re making improvements.

我們所看到的，死亡率明顯升高。但具體來說，在六月，這也許是我得到了很多鼓勵的地方。克雷格正在與護理服務團隊一起做的工作，我們知道我們需要一些時間來讓它繼續下去並接受它。但到了六月，我們開始看到入場時間有所改善，這真是太棒了。我們也看到錯過的治療有所改善，這兩個領域都是非常非常集中的努力，我們距離約翰還很遠，但我們正在做出改進。

And I think the most encouraging piece for me is June treatment per day were the strongest they’ve been this year and actually the strongest they’ve been since June of 2023. I clearly see that work continuing. And we’ve always talked about the self-help, if you will, to kind of get this operational excellence back. So that’s giving me some confidence that the work is meaningful and pulling through.

我認為對我來說最鼓舞人心的是 6 月每天的治療量是今年以來最強的，實際上也是自 2023 年 6 月以來最強的。我清楚地看到這項工作仍在繼續。如果你願意的話，我們一直在談論自助，以恢復這種卓越的營運。因此，這給了我一些信心，讓我相信這項工作是有意義的並且能夠順利完成。

You know we had kind of a slew of weather in Q1. Obviously, Hurricane Beryl caught our attention in July. We kind of did have clinics affected there. I mean we had about 75 clinics in the in the area affected by the hurricane, but we got those up and running pretty quick and a good testament to the team. So while there will be a weather impact kind of small, when it all kind of washes out. But I think what I can see of weekly data is that the trends are encouraging for the first couple of weeks of July. So look, that’s the kind of how we then kind of get to sizing the 0 to 0.5.

你知道我們在第一季遇到了很多天氣。顯然，颶風貝裡爾在 7 月引起了我們的注意。我們在那裡的診所確實受到了影響。我的意思是，我們在受颶風影響的地區大約有 75 家診所，但我們很快就啟動並運行了這些診所，這對團隊來說是一個很好的證明。因此，雖然天氣影響很小，但當一切消失時。但我認為從每週數據可以看到，七月前幾週的趨勢令人鼓舞。所以看，這就是我們如何調整 0 到 0.5 的大小。

What we are also assuming at this point is – clearly COVID is getting headline attention again. We are assuming for the back half of the year that the mortality level stays kind of where it is. So in terms of how does that number change positively, it’s – if that comes down faster than we’ve been seeing or we get quicker acceleration of some of these some of these initiatives. So we feel – recognizing we had to put a new range out there because even though we were kind of hoping it would be more of an exit rate on an average rate after Q1, clearly, with the half one performance, we wanted to modify and put a realistic range out there for what we can see now.

我們此時也假設──顯然，新冠肺炎疫情再次成為頭條新聞。我們假設今年下半年死亡率水準將維持在現有水準。因此，就這個數字如何積極變化而言，問題在於——下降速度是否比我們看到的要快，或者我們是否能更快地加速其中一些舉措。因此，我們認為 - 認識到我們必須在那裡設置一個新的範圍，因為儘管我們有點希望第一季之後的平均退出率，但顯然，憑藉半個表現，我們希望修改並設置一個我們現在可以看到的現實範圍。

Thank you for the call out on the Care Enablement margin. We always promised it was coming, and I know it was hard to see when we had such low numbers last year. But the team is doing a terrific job, and we are delivering on the plans that we laid out there. And to your question about how much is pricing, about two-thirds of it actually is pricing in the quarter.

感謝您對護理支持利潤的呼籲。我們總是承諾它會到來，我知道去年我們的數字如此之低，這是很難想像的。但團隊做得非常出色，我們正在實現我們所製定的計劃。至於你關於定價多少的問題，實際上大約三分之二的定價是本季定價的。

Excellent. Thanks. So much, guys.

出色的。謝謝。就這麼多，夥計們。

Richard Felton, Goldman Sachs Group

理查費爾頓，高盛集團

Thank you for taking my questions. Two please from me. So my first one, again, on treatment volume growth. And I suppose in context of the slower recovery that you’ve seen this year, I’d be really interested to hear your thoughts on the medium-term outlook. I think previously, you had spoken about treatment volumes gradually returning to sort of the 2% to 3% volume growth for US. dialysis. So my question is, do you still see a plausible path back to that level of treatment volume growth in the strategic period? My second question, maybe one for Martin is on leverage. It’s already at 3.1x, which is near the bottom of your self-imposed corridor. There’s a few tailwinds to free cash flow in the second half. So maybe in context of that, could you remind us of your capital allocation priorities, given that you’re already near the sort of lower end of that leverage corridor range? Thank you.

感謝您回答我的問題。請從我這裡來兩個。我的第一個主題又是關於治療量的成長。我想，鑑於今年你們看到的復甦速度較慢，我真的很想聽聽你們對中期前景的看法。我想之前您曾談到美國的治療量逐漸恢復到 2% 至 3% 的增長水平。透析。所以我的問題是，您是否仍然認為有可能回到策略時期治療量成長水準？我的第二個問題，也許是馬丁的一個問題，是關於槓桿作用的。它已經是 3.1x，接近你自己設置的走廊的底部。下半年自由現金流有一些有利因素。因此，考慮到您已經接近槓桿走廊範圍的下限，您能否提醒我們您的資本配置優先事項？謝謝。

Hi, Richard, thanks for the question. Yes, look, clearly, we have some elevated mortality, and that 60 basis points hurt. I’m not going to lie. But the – nothing has changed in our kind of belief in underlying fundamentals of this business. And we are confident that we will return to that 2% to 3% growth rate once we kind of see this normalization of the kind of the COVID effect.

嗨，理查德，謝謝你的提問。是的，顯然，我們的死亡率上升，60 個基點會造成傷害。我不會說謊。但我們對這項業務基本面的信念並沒有任何改變。我們有信心，一旦看到新冠疫情效應正常化，我們將恢復 2% 至 3% 的成長率。

We – clearly still stand behind our neutral effect for the new drug class, which was also something that kind of – there was a lot of noise around and I think we’re seeing that play out. So I think we see that growth rate. I think the thing that’s been challenging is the timing of getting there. And I think that language of 2% to 3% in a normalized mortality landscape should hold. But right now, we’re still saying 2% to 3% by the end of 2025 as an exit rate. Obviously, we’re watching this development as we all are every month and quarter, day or week. So we will see how that plays out. But nothing is telling us that, that 2% to 3% isn’t achievable.

我們——顯然仍然支持我們對新藥類別的中性效應，這也是這樣的——周圍有很多噪音，我認為我們正在看到這種情況的發生。所以我認為我們看到了這樣的成長率。我認為最具挑戰性的是實現這一目標的時機。我認為在正常化死亡率情況下 2% 到 3% 的說法應該成立。但目前，我們仍認為到 2025 年底，退出率將達到 2% 到 3%。顯然，我們每個月、每季、每天或每週都在關注這項發展。所以我們將看看結果如何。但沒有任何跡象表明 2% 到 3% 是不可能實現的。

Martin, do you want to take the leverage question?

馬丁，你想回答槓桿問題嗎？

Yes, sure. Thank you, Richard. So we are quite pleased with the progress that we made to come down to 3.1% to 3.1x. And as I outlined, we will continue to de-lever, and our focus on that will not waver. We will continue to use the proceeds from the divestiture, and we are quite comfortable with approaching the lower end of the self-imposed range, especially given the current environment that we’re in. So nothing changed in our prioritization to capital allocation in that regard.

是的，當然。謝謝你，理查。因此，我們對將速度降低至 3.1% 至 3.1 倍所取得的進展感到非常滿意。正如我所概述的，我們將繼續去槓桿，我們對此的關注不會動搖。我們將繼續使用剝離所得的收益，並且我們對接近自我設定範圍的下限感到非常滿意，特別是考慮到我們目前所處的環境。因此，我們在這方面的資本配置優先順序並沒有改變。

Great. Thanks very much.

偉大的。非常感謝。

Graham from UBS.

來自瑞銀的格雷厄姆。

Hi, guys. Thanks for taking my questions. So one on volume again, Helen, apologies. But it’s a slightly different approach, which is when you look at the business over the midterm, what is the volume rate that really makes this work? Does it need to be at least two as we go forward in order to get to what you think is the optimum margin presumably towards the upper end of the midterm range? And then just a sort of housekeeping one, was I correct in hearing that you kind of intimated you would like to narrow that ‘25 guidance at the Q3 results, just to double check that. Thank you.

嗨，大家好。感謝您回答我的問題。所以再次音量，海倫，抱歉。但這是一種略有不同的方法，即當您在中期審視業務時，真正使這項工作發揮作用的銷量率是多少？隨著我們前進，為了達到您認為的最佳利潤（可能接近中期範圍的上限），它是否需要至少為兩個？然後，這只是一種內務處理，我聽說你有點暗示你想縮小第三季結果的 25 指導範圍，只是為了仔細檢查一下，這是正確的嗎？謝謝。

Hi, Graham, yes, look, I think we know in this industry that when we see that 2% to 3% growth, we can really maximize the operating leverage, and that’s kind of just the knock-on effect of all of that. Like I say, I don’t see – there’s no reason for us to believe that it doesn’t get there. I think we’ve been quite prudent, particularly these past 18 months of taking cost out where we can, both on the clinic closures and driving efficiencies and our overall FME25 program. So I think that it’s no reason to suggest that we’re not back even at that low end of 2% to 3%, and then that makes this much more kind of beneficial from an operating leverage perspective.

嗨，格雷厄姆，是的，我想我們知道，在這個行業，當我們看到 2% 到 3% 的成長時，我們真的可以最大限度地提高營運槓桿，這就是所有因素的連鎖反應。的。就像我說的，我沒有看到──我們沒有理由相信它沒有實現。我認為我們一直非常謹慎，尤其是在過去 18 個月中，我們盡可能地降低了成本，無論是在診所關閉、提高效率還是我們的整體 FME25 計劃方面。因此，我認為沒有理由表明我們不會回到 2% 到 3% 的低端，從營運槓桿的角度來看，這使得這更加有利。

Yes, on your question on ‘25 guidance, I had – and I’m trying to be a lady of my word. I had thought that we would be in a position when – part this year to kind of tighten that. I know there’s a lot of questions of your range is still quite wide. If you’re tightening it, what are you doing with it? I think as we kind of start to see these developments along next quarter, if we have enough insight in to be able to call some of the pluses and the minuses that we’re seeing with a bit more certainty, we will certainly give an update. But yes, I want to have a degree of certainty into both the pluses and the minuses before we do that. So more to come, I guess, is the takeaway there.

是的，關於你關於 25 指導的問題，我已經回答了，並且我正在努力成為一名言出必行的女士。我原以為我們會在今年分開時採取某種收緊措施。我知道你的問題很多，範圍還很廣。如果你收緊它，你會拿它做什麼？我認為，當我們在下個季度開始看到這些發展時，如果我們有足夠的洞察力，能夠更加確定地指出我們所看到的一些優點和缺點，我們肯定會給出一個更新。但是，是的，在我們這樣做之前，我希望對優點和缺點有一定程度的確定性。我想，接下來還有更多的內容。

Okay. Great. Thanks a lot.

好的。偉大的。多謝。

Thank you. The next question comes from Hassan.

謝謝。下一個問題來自哈桑。

Thank you. I have a couple, please. So I’m going to ask the volume question again, but slightly differently. How are you thinking about the deviation from today’s flat growth to a more normalized growth rate in terms of A, share losses, B, mortality today, C, CKD mortality; and then other SGLT2s or GLP-1s for diabetes, if at all? And why do you think 2025 will be better? How are referrals trending? And then secondly, also on 2025 margins, what to your mind today are the key drivers impacting both the upper and lower end? And I appreciate you said that treatment dynamics aren’t toppling this year’s guide, but is it driving any meaningful risk around next year?

謝謝。我有一對，請。因此，我將再次提出音量問題，但略有不同。您如何看待從今天的平坦增長到更正常化的增長率的偏差：A，份額損失，B，今天的死亡率，C，CKD 死亡率；然後是其他治療糖尿病的 SGLT2 或 GLP-1，如果有的話？為什麼你認為 2025 年會更好？推薦趨勢如何？其次，同樣就 2025 年的利潤而言，您認為影響高端和低端的關鍵驅動因素是什麼？我很欣賞你所說的治療動態並沒有推翻今年的指導，但它是否會在明年帶來任何有意義的風險？

Thank you.

謝謝。

Hi, Hassan. Thanks for your question. Look, I think it’s a fair different approach on volume. I think it’s all of the above, honestly. Clearly, we’re looking for normalized kind of – normalizing our – I’m posing or normalizing, I’m going to say improving our operations. And I think the work that we are doing on admissions, missed treatments and so on and cancellations is really playing into that. I do think this mortality that we’re seeing slightly elevated has to normalize. We’ve always been blind to what is happening up the CKD funnel, particularly in the earlier stages in CKD. So I think that has to normalize. And as I mentioned, we’re still standing behind our neutral impact on SGLT2s. The numbers that we are seeing then, I think I shared them on the last call is still low percentage number of patients taking them and the fallout rate very, very high.

嗨，哈桑。謝謝你的提問。聽著，我認為這是一種在數量上相當不同的方法。老實說，我認為以上都是。顯然，我們正在尋求一種標準化——我所說的標準化——我想說的是，改善我們的營運。我認為我們在入院、錯過治療等和取消方面所做的工作確實發揮了作用。我確實認為我們看到的死亡率略有上升必須正常化。我們一直對 CKD 漏斗中發生的事情視而不見，尤其是在 CKD 的早期階段。所以我認為這必須正常化。正如我所提到的，我們仍然支持對 SGLT2 的中立影響。我們當時看到的數字，我想我在上次電話會議上分享的數字仍然很低，服用它們的患者數量仍然很低，而且後果率非常非常高。

Look, in terms of why do I see 2025 being better, I think there’s a lot of these things that we expect to play out over the course of this year and particularly the things in our control that we can accelerate. And look, on the key drivers, it probably doesn’t in terms of what goes up or down and has the impact, probably not much different to the headwinds tailwind slide that you see for 2024. Those pieces are always the same pieces in play, and whether they land at the top end or bottom end is kind of can quickly get you to the bottom end or top end of your guidance.

聽著，至於為什麼我認為 2025 年會更好，我認為我們預計在今年內會發生很多這樣的事情，特別是我們可以加速控制的事情。看看，就關鍵驅動因素而言，它可能不會上升或下降，也不會產生影響，可能與您在 2024 年看到的逆風順風下滑沒有太大不同。這些棋子在遊戲中始終是相同的棋子，無論它們落在頂端還是底端，都可以快速讓您到達指導的底端或頂端。

So clearly, the and maybe the other piece I would add is as we continue to work with our book of business and we get more insights there, that is also helping us drive reduced hospitalizations, improving hospital starts and obviously improving outcomes there. So I think for me, it’s this continued path of the strategy we put out there. And as you can see, like these lots of small movements on these small numbers have an impact one way or the other. But I’m really pleased with the progress and the progression we’ve had through 18 months. And I think that volume piece and all the different parts of it normalizing, obviously, will help operating leverage and the cost structure next year.

很明顯，我要補充的另一件事是，隨著我們繼續與我們的業務合作，我們在那裡獲得更多見解，這也有助於我們減少住院治療，改善醫院開工率，並明顯改善那裡的結果。所以我認為對我來說，這是我們在那裡制定的策略的持續路徑。正如你所看到的，這些小數字的大量小變動會以某種方式產生影響。但我對 18 個月以來我們的進展和進展感到非常滿意。我認為，銷售部分及其所有不同部分的正常化顯然將有助於明年的營運槓桿和成本結構。

Thank you.

謝謝。

Victoria from Berenberg.

來自貝倫貝格的維多利亞。

Thanks for taking my questions. I have two. The first one is just on your clinics in the US It looks like you’ve added some during the quarter. Is this because you may be cut back by too many last year? And then my second question is just on your wage inflation and staff costs. A lot of the large hospital groups, which reported in the last week or so, they’ve noted better staff availability and falling contract labor costs. So I was just wondering if you’ve seen a similar trend and if wage inflation is still around the 3% level? Thank you.

感謝您回答我的問題。我有兩個。第一個是關於您在美國的診所，看起來您在本季添加了一些診所。這是因為去年你們可能削減太多的開支了嗎？我的第二個問題是關於你們的薪資通膨和員工成本。許多大型醫院集團在上週左右的報告中指出，員工可用性有所改善，合約勞動成本有所下降。所以我想知道您是否也看到類似的趨勢，薪資通膨率是否仍在 3% 左右？謝謝。

Thanks, Victoria. I’ll take those both. Yes, you’re right. We do have a slight increase in our clinics in this quarter, and that’s okay. I don’t want that to sound like we closed 75 and now we’re – now we’re opening some more. We’re being very, very targeted of where we’re adding clinics.

謝謝，維多利亞。我會把這兩樣都拿走。是的，你是對的。本季我們的診所數量確實略有增加，這沒關係。我不希望這聽起來像是我們關閉了 75 個，現在我們正在開放更多。我們非常非常有針對性地選擇在哪裡增加診所。

And there is still, from us approving a clinic or whether that be a de novo to actually getting it fully up and operating, that does take some time. So some of this has been a little bit of it has been what’s in the pipe. But then secondly, us then being quite deliberate of, we’ve exited those markets or those clinics where we can’t be profitable, but we do want to add twofold, one where we are at capacity in a particular region and there’s growth to be taken by adding more volume in that area or secondly, where we have a clear line of sight into go after growth, and then we’re adding them there, too. So it’s not that we’re closing in the same region and reopening. This is very, very targeted. And we will continue to be intentional about where we add over time.

從我們批准一家診所，或是否從頭開始，到真正全面啟動和運營，這確實需要一些時間。所以其中一些已經是管道中的一部分了。但其次，我們經過深思熟慮，我們已經退出了那些我們無法獲利的市場或診所，但我們確實想增加兩倍，一是我們在特定地區和那裡有能力的地方。 ，或者其次，我們對追求成長有清晰的視線，然後我們也在那裡增加它們。因此，我們並不是在同一地區關閉然後重新開放。這是非常非常有針對性的。隨著時間的推移，我們將繼續關注我們的添加內容。

On your wage inflation question, for us, we’re still standing behind our net 3% labor number. And you can see from the half year, we’re fully on track. Don’t forget that net 3% is a combination of the wage increases, plus some efficiencies. And there are some markets where we are paying a little bit higher, but I feel, you can kind of see from the results, we’re clearly managing that within the overall numbers here.

關於薪資通膨問題，對我們來說，我們仍然支持 3% 的淨勞動力數字。從半年的情況來看，我們完全步入正軌。不要忘記，淨成長 3% 是薪資成長加上一些效率提高的組合。在某些市場上，我們支付的費用要高一些，但我覺得，你可以從結果中看到，我們顯然是在總體數字範圍內管理這一點。

So and I think the other part of that, which you perhaps didn’t tease out, but the kind of the hiring our open positions is still is around 3,500, which is what we had seen last quarter. What I would say on that is there is the mix of that 3,500 has is showing an incremental improvement in the nursing staff. So that’s also good. I mean clearly, we still have PCT openings, but if we have less nursing openings, that’s great for the clinics too. So overall, great progress on labor and managing their cost structure there.

所以我認為另一部分，你可能沒有弄清楚，但我們的空缺職位的招聘數量仍然在 3,500 人左右，這就是我們上個季度看到的情況。我想說的是，這 3,500 名護理人員的組合顯示出護理人員的逐步改善。所以這也很好。我的意思很明確，我們仍然有 PCT 空缺，但如果我們減少護理空缺，這對診所來說也很好。總的來說，那裡的勞動力和成本結構管理取得了巨大進展。

Hugo from BNP Paribas.

法國巴黎銀行的雨果。

Okay, good. Thanks for taking my questions. Just a few on my end. First on value-based care. I know it’s always tricky to model that, but can you help us understand the revenue growth contribution and earnings contribution in the quarter, and how we should think about that in the back half of the year with the phase in Q3, Q4?

好的，很好。感謝您回答我的問題。我這邊只有幾個。首先是基於價值的護理。我知道建模總是很棘手，但是您能否幫助我們了解本季的營收成長貢獻和獲利貢獻，以及我們應該如何考慮下半年第三季、第四季的情況？

Second, on the PPS rate, Helen, maybe can you comment for us on the latest development and also the change in wage index or does that play a role for next year? And lastly, another unsurprising question on volume growth, but you adjust to flat to 50 basis points for the year. Does that mean that we can expect the exit rate to be at the end of the year, above 50 basis points or still below that? Thank you.

其次，關於 PPS 利率，Helen，您能否為我們評論一下最新的發展以及工資指數的變化，或者這對明年會產生影響嗎？最後，關於成交量成長的另一個不足為奇的問題，但您將今年的增幅調整為持平至 50 個基點。這是否意味著我們可以預期年底退出率將高於 50 個基點或仍低於該水準？謝謝。

Thanks, Hugo. I think we got all of that. Martin, do you want to take the BBC question, and I’ll take the PPS rate and higher finance market treatment growth.

謝謝，雨果。我想我們已經得到了這一切。馬丁，你想回答 BBC 的問題嗎？

Okay. So on the BBC or on the interval, we did see a positive contribution in the quarter that was predominantly also driven by positive program contribution from our CKCC program that we are participating. Also, when we look at the first half, we see that there is a positive volume as well as margin contribution that we do have. And so far, we are very positive with the progress. There is volatility. As you all know, there is also a little bit of lumpiness in the quarter. So we look at that holistically for the full year, but we do expect a positive contribution, as we stated before, to continue, and we are on a good track.

好的。因此，在 BBC 或間歇期，我們確實看到了本季度的積極貢獻，這主要也是由我們參與的 CKCC 計劃的積極計劃貢獻所推動的。此外，當我們回顧上半年時，我們發現我們確實有正面的銷售和利潤貢獻。到目前為止，我們對進展非常樂觀。有波動性。眾所周知，本季也存在一些波動。因此，我們從整體上看待全年的情況，但正如我們之前所說，我們確實期望積極的貢獻能夠繼續下去，而且我們正走在良好的軌道上。

Thanks, Martin. On your PPS rate question, obviously, we kind of saw that increase and that kind of – what it looks like a little bit of an odd adjustment on the efficiency adjusters. So we kind of see that PPS rate is the 1.8 and then the efficiency adjustor is the 0.9 and then improvements in QIP. So overall, we’re kind of seeing kind of this 2.1% net. I think there’s still work to get under on the on what that efficiency adjuster ends up being. And of course, we’re commenting on that in the in this kind of comment period. So I think, obviously, we will have more to talk about that in Q3, but we kind of stating it exactly how CMS is officially stating it overall, that 2.1% higher comparator.

謝謝，馬丁。關於你的 PPS 費率問題，顯然，我們看到了這個成長和效率調節器的那種看起來有點奇怪的調整。所以我們看到 PPS 率為 1.8，然後效率調整器為 0.9，然後 QIP 有所改進。總的來說，我們看到的是 2.1% 的淨值。我認為，對於效率調節器的最終結果，仍有待深入研究。當然，我們會在這樣的評論期內對此進行評論。因此，我認為，顯然，我們將在第三季度對此進行更多討論，但我們的表述方式與 CMS 官方總體表述的方式完全相同，即比較值高 2.1%。

On the same market treatment growth phasing, obviously, I kind of tried to outline kind of what we see, kind of some of those moving parts there. I think we’re kind of continuing to kind of work through our operational improvements, which we should expect to improve over the year. If we see improvement in mortality, we will see how that plays out between Q3 and Q4. Kind of you can hear it in my voice, I think it’s a little bit more of whatever we put out there is phasing, we will have to kind of it’s a bit of a crystal ball.

顯然，在同一市場治療成長階段中，我試圖概述我們所看到的情況，以及其中的一些活動部件。我認為我們正在繼續透過我們的營運改善來開展工作，我們預計這一點將在一年內得到改善。如果我們看到死亡率有所改善，我們將看到第三季和第四季的情況如何。你可以從我的聲音中聽到這一點，我認為這更像是我們推出的任何東西的分階段，我們必須將其視為有點像水晶球。

So, obviously, the trend is looking encouraging for June and early part of July, I am hopeful that, that continues. But we are probably not tearing this apart month-by-month in terms of the guidance range right now and obviously why we have a range out there. But I think we can kind of see line of sight into what takes this up to the higher end and the lower end.

因此，顯然，六月和七月初的趨勢看起來令人鼓舞，我希望這種情況能持續下去。但我們現在可能不會逐月分解指導範圍，以及為什麼我們有一個範圍。但我認為我們可以看到是什麼將其推向高端和低端。

Thank you very much.

非常感謝。

James from Jefferies.

來自杰弗里斯的詹姆斯.

Hi. Thanks for taking my questions. Two if I can, please. Firstly, you mentioned KPIs are in line with budget, except volume growth. So, given this is an important KPI, given your fixed costs, I am just wondering what’s changed elsewhere to compensate, or should we be thinking more of the lower end of the guidance range for this year? And as you are assuming mortality is the same in second half, if it ends up being higher, how much risk is there you actually need to lower your guidance at nine months, given you need to wait for more visibility before narrowing it? And I will come up for a follow-up. Thank you.

你好。感謝您回答我的問題。如果可以的話請給我兩個。首先，您提到除了銷售成長之外，KPI 與預算相符。因此，鑑於這是一個重要的 KPI，考慮到您的固定成本，我只是想知道其他地方發生了什麼變化來彌補，或者我們是否應該更多地考慮今年指導範圍的下限？由於您假設下半年的死亡率相同，如果最終會更高，那麼您實際上需要在九個月時降低指導值的風險有多大，因為您需要等待更多的可見度才能縮小指導範圍？我會跟進。謝謝。

Thanks James. Yes, look, I think the KPIs and where you can see them in the range, and we are trying to be very transparent with how we are seeing it. The acceleration of FME25 in particular is really compensating for that volume piece. So, I think you can kind of see we are sitting right in the middle of all of those KPIs. And if you take the volume offset by FME25, which I now see at the top end, I think that’s compensating. Yes, to kind of the how much does that mortality number play into it.

謝謝詹姆斯。是的，你看，我認為關鍵績效指標以及你可以在範圍內看到它們的位置，我們正在努力讓我們如何看待它變得非常透明。特別是 FME25 的加速確實補償了該體積部分。所以，我想你可以看到我們正處於所有這些關鍵績效指標的中間。如果你用 FME25 抵消音量，我現在看到它位於頂端，我認為這是補償。是的，要了解死亡率的影響有多大。

I think that, honestly, is a little bit the crystal ball of how is mortality going to hold at this elevated level, or hopefully come down. If it does go higher, we would have to see how much and what that does on the guidance range. But obviously, you know me, I am never striving for the low end here and wanted to make sure we can deliver on the expectations.

老實說，我認為這有點像水晶球，可以預測死亡率將如何保持在如此高的水平，或者有望下降。如果它確實走高，我們將不得不看看其對指導範圍的影響有多大以及有何影響。但顯然，你知道我，我從來不追求低端，並希望確保我們能夠實現期望。

So, I think this is just kind of I know you probably expect me to say this, we are just going to take this a quarter over time, and we will have more insights for the time we get to Q3. I mean let’s not forget, we nearly generally have a strong Q4 in terms of phasing, not expecting that to look different this year. So, I just ask for some patience and grace to kind of help us kind of just keep working through these numbers as they develop over the next couple of months here until we get to Q3.

所以，我認為這只是我知道你可能希望我這麼說，我們將在一個季度內完成這個工作，到第三季時我們將有更多的見解。我的意思是，我們不要忘記，我們在第四季度的階段性方面幾乎總體表現強勁，預計今年情況會有所不同。因此，我只是請求一些耐心和寬容，以幫助我們繼續處理這些數字，因為它們將在接下來的幾個月中發展，直到我們進入第三季。

Thank you. And then just a second follow-up on the Care Enablement, the EUR33 million FME savings, should we be thinking this is a minimum per quarter for the rest of the year with the sustainable improvements to help us think about the margin there? Thank you.

謝謝。然後是護理支持的第二個後續行動，即 3300 萬歐元的 FME 節省，我們是否應該認為這是今年剩餘時間每個季度的最低限度，並通過可持續改進來幫助我們考慮那裡的利潤？謝謝。

Yes. Martin, do you want to take that?

是的。馬丁，你想接受這個嗎？

Yes, James. So, I wouldn’t take that as a proxy of a minimum of a quarter. There will be continued strong contribution, and we have indicated that overall, we will be hitting the high end of the EUR100 million to EUR150 million that we anticipated. And we have also said that we expect the majority of the savings to hit the P&L of Care Enablement, as we said before, as a contribution. So, we have EUR41 million left to the top end, if you wish, we are at EUR109 million currently. And I mean, EUR66 million, if I would take to – follow your assumption, would be a bit of too high and too ambition a contribution. So, assume a bit lower there. I think the EUR150 million for overall is a good guidance to reach.

是的，詹姆斯。因此，我不會將其視為至少四分之一的代表。我們將繼續提供強勁的貢獻，我們已表示，總體而言，我們將達到我們預期的 1 億至 1.5 億歐元的上限。我們也說過，正如我們之前所說，我們預期大部分節省將達到護理支援的損益表，作為貢獻。因此，我們還剩下 4,100 萬歐元，如果您願意的話，我們目前的金額為 1.09 億歐元。我的意思是，如果我願意——遵循你的假設，6600 萬歐元的捐款有點太高、太雄心勃勃了。所以，假設稍微低一些。我認為 1.5 億歐元的總體目標是一個很好的指導。

Thank you.

謝謝。

David Adlington from JPMorgan

摩根大通的大衛‧阿德林頓

Hi guys. Thanks for the questions. One on volumes, again, I favor slightly different, ultimately big volume growth between the US and ex-US I just wondered if you are seeing different levels of mortality or something else is going on between US and ex-US? And then secondly, just in terms of Care Enablement, I just wonder you have any initial feedback on the 5008X and how does that take relative to your expectations?

嗨，大家好。感謝您的提問。關於數量，我再次贊成美國和美國以外地區之間略有不同、最終大幅增長的數量我只是想知道您是否看到美國和美國以外地區之間的死亡率水平不同或是否發生了其他情況？其次，就護理支援而言，我只是想知道您對 5008X 有任何初步回饋嗎？

David. Hi. There is a little bit of a difference in the volume growth between CD US. and CDI, as you can know after we back out the divestitures there. So, Martin, I don’t know if you want to give a further bridge on that?

大衛.你好。CD US 之間的銷售成長略有差異。和 CDI，在我們取消剝離之後你就知道了。那麼，馬丁，我不知道你是否想在這方面提供進一步的幫助？

Yes. So, what we saw in CD International was a same market treatment growth of about 1.9% in quarter two, which is higher as you indicated, and also compare that to the USA market treatment growth, which was adjusted for the acute care, the minus 0.1%. And we do see, and that’s what we also, I think communicated, a difference in mortality rates or elevation of mortality rates between international markets and the US. markets as well.

是的。因此，我們在CD International 看到的是第二季度約1.9% 的市場治療增長，正如您所指出的，這一數字更高，並將其與美國市場治療增長進行比較，美國市場治療增長針對急症護理進行了調整，負值0.1%。我們確實看到了國際市場和美國之間死亡率或死亡率上升的差異，我認為這也是我們所傳達的。市場也是如此。

Thank you. And then, David, your question about the 5008X. Yes, I mean we are obviously very, very excited here doing that first treatment in a clinic in the Boston area. We had – we ended up doing a call with the clinic and speaking to the patients and the nursing staff, and everybody was really excited about the new machine.

謝謝。然後，David，你關於 5008X 的問題。是的，我的意思是，我們顯然非常非常興奮在波士頓地區的一家診所進行第一次治療。我們最終給診所打了電話，與患者和護理人員交談，每個人都對這台新機器感到非常興奮。

We yes, we continue to get working through the strategic launch plans here and thinking through how we launch, but yes, and kind of obviously the medical community. So, a lot more to come, we will update that in due course as we get closer to the launch next year, but the very, very encouraged by all that we are seeing there and the actual treatment itself. And I think just as a reminder, I think everybody knows that 5008 is not in our plan for 2025. There is still the rollout planned at the end of ‘25. And I think that will also all play into our kind of capital markets update in next year for the next few years of what our expectations are there.

是的，我們繼續制定策略發布計劃，並思考如何發布，但是，是的，顯然是醫學界。因此，還有更多的內容，隨著明年的推出，我們將在適當的時候進行更新，但我們所看到的一切以及實際的治療本身非常非常令人鼓舞。我想提醒一下，我想每個人都知道 5008 不在我們 2025 年的計畫中。仍計劃在 25 月底推出。我認為這也將影響明年我們對未來幾年資本市場的預期更新。

Perfect. Can I just come back on the mortality difference between the US. and international, do you have any idea why there is the difference?

完美的。我可以談談美國之間的死亡率差異嗎？和國際，你知道為什麼會有差異嗎？

So, I mean the absolutely the amount of difference or it didn’t mean the drivers of the difference behind, because we have not communicated the absolute difference in mortality range so far. There is a difference here in flu being longer in the US than in Europe, and there is also a difference between what we saw in COVID cases. But I think the flu in the US lasted about two months longer than it was seen in other areas in general.

所以，我的意思是絕對的差異量，或者它並不意味著差異背後的驅動因素，因為到目前為止我們還沒有傳達死亡率範圍的絕對差異。美國流感的持續時間比歐洲長，而且我們在新冠病例中看到的情況也存在差異。但我認為美國的流感持續時間比其他地區的持續時間要長約兩個月。

Thank you.

謝謝。

Falko from Deutsche Bank

Falko，來自德意志銀行

Thank you. Good afternoon. Sorry, I will have to go back to the same-store treatment growth again for my first question. So, right, you mentioned this encouraging trend in June and July. What are some of the risks that, that could reverse again, right? What could essentially get in the way that this trend doesn’t get better and better now as the months progress? That’s my first question. And then secondly, on the CMS rate increase, right, 2.1% potentially next year, how much of a shortcut would that still be when you consider your expected cost increases next year? Thank you.

謝謝。午安.抱歉，對於我的第一個問題，我將不得不再次回到同店治療成長。所以，是的，您在六月和七月提到了這一令人鼓舞的趨勢。有哪些風險可能會再次逆轉，對吧？隨著幾個月的進展，這種趨勢不會變得越來越好，從根本上來說是什麼阻礙了這個趨勢？這是我的第一個問題。其次，關於 CMS 費率上漲，對吧，明年可能會上漲 2.1%，當您考慮明年的預期成本上漲時，這仍然是多少捷徑？謝謝。

Look, I think the only thing that I would point to on the same market treatment growth is if mortality was now different to what we assumed. And I guess that could go higher or lower in terms of how we kind of how we see the next rest of the year play out. I think I feel really good about the pull-through of our operational improvements and the fact that we are starting to see signs of that is obviously confirmatory of that.

聽著，我認為在同一市場治療成長方面我唯一要指出的是，現在的死亡率是否與我們假設的不同。我想這可能會更高或更低，這取決於我們如何看待今年接下來的時間。我認為我對我們營運改進的實現感到非常滿意，而且我們開始看到這種跡象的事實顯然證實了這一點。

Yes, CMS, look, I think we will see where the this 2% or 2.1% that we are seeing, we have always said we have been planning in our forecast for moderate increases. The 2% was maybe as expected, and clearly, we are going to provide commentary on that. We usually see final being a little higher than the preliminary rate, we will see.

是的，CMS，看，我想我們會看到我們所看到的 2% 或 2.1%，我們一直說我們一直在計劃適度增長。2% 可能符合預期，顯然我們將對此發表評論。我們通常會看到最終利率略高於初步利率，我們拭目以待。

And of course, we continue to look at that spread between the reimbursement increase and the cost increase. Obviously, this is where the kind of the utilization and efficiencies also help that story. But we will see where the final rule plays out and kind of go from there. I think that’s all we can do at this point. But again, it’s in line with our expectations for our outlook.

當然，我們會繼續關注報銷增加和成本增加之間的差異。顯然，這就是利用率和效率也有助於這個故事的地方。但我們將看到最終規則的實施，並從那裡開始。我認為這就是我們目前所能做的。但這再次符合我們對前景的預期。

Okay. Thanks. And just a quick follow-up, if I can. Helen, you mentioned COVID a few times throughout the call. To what extent is that really a problem again in your clinics also with regards to your staff?

好的。謝謝。如果可以的話，請快速跟進。海倫，您在整個電話會議中多次提到了新冠病毒。對於您的診所以及您的員工而言，這在多大程度上再次成為一個真正的問題？

Yes. Look, I think the what we are seeing is definitely I saw some – I mean you all know in Germany, and I saw some headlines from the US last night for California, I think. We are clearly seeing significant increases in cases. We are not seeing it as severe, but of course, our patient the kind of the hospitalization rates are lower. But of course, our patient population is one of the most vulnerable.

是的。聽著，我認為我們所看到的肯定是我看到了一些——我的意思是你們都知道在德國，我想我昨晚看到了美國加利福尼亞州的一些頭條新聞。我們清楚地看到病例顯著增加。我們認為情況並不嚴重，但當然，我們的病人住院率較低。但當然，我們的患者群體是最脆弱的群體之一。

So, I think we are just the fact that we have seen through the first half this elevated mortality, it also takes six weeks to eight weeks to kind of get this kind of data on what did what’s the cause of that mortality. So, I think this combination of, the combination of increased COVID cases, knowing we have got a delay, I think we are just definitely watching it.

因此，我認為我們只是看到了上半年死亡率上升的事實，還需要六週到八週的時間才能獲得此類數據，以了解造成死亡率的原因。所以，我認為，結合新冠病例的增加，知道我們已經推遲了，我認為我們肯定會關注它。

And obviously, we don’t tease out. We stopped doing that last year or the year before, actually, excess deaths due to COVID. We are just now talking about the all-cause mortality, which and as I have said, in half one, we saw a 60 basis points higher. So, yes, it’s I think obviously, as I mentioned in my talk outline, something that we are watching closely.

顯然，我們不會挑釁。我們去年或前年停止了這樣做，事實上，由於新冠肺炎造成的死亡人數過多。我們現在正在談論全因死亡率，正如我所說，半年以來，我們看到全因死亡率上升了 60 個基點。所以，是的，正如我在演講大綱中提到的，我認為顯然這是我們正在密切關注的事情。

Thank you.

謝謝。

Robert from Morgan Stanley.

來自摩根士丹利的羅伯特.

Yes. Thanks for taking my questions. I have a couple. Just following up on that excess mortality point, I guess one question I had, is this effectively just sort of the new norm for the business? And if so, what’s your conviction getting to the kind of medium-term profitability targets if this sort of slightly slower growth level is the kind of average going forward, because obviously, you had the additional savings or the higher end of the savings, I guess this year, which has helped. I just wondered if you had this started a growth environment sort of next year and the year beyond, what would that sort of influence your view on the mid-term margin targets? That was the first question.

是的。感謝您回答我的問題。我有一對。就在超額死亡率點之後，我想我有一個問題，這實際上只是一種業務新規範嗎？如果是這樣，如果這種稍微放緩的增長水平是未來的平均水平，那麼您對實現中期盈利目標的信念是什麼，因為顯然，您有額外的儲蓄或較高的目標我想今年的儲蓄有所幫助。我只是想知道，如果您在明年和後年開始了某種成長環境，這會對您對中期利潤目標的看法產生什麼影響？這是第一個問題。

And then the second one was, just looking at the progress at yourself versus DaVita. Are you seeing any differences in sort of market share at all over the last sort of 6 months to 12 months? I know you called out some of the regional differences before as an explanation of why you had different same-store treatment growth in the US because different parts of the US at different sort of climate issues, I guess over the last sort of six months. So, I just wondered, is there anything specifically going on there, you are seeing gains and losses in certain regions of the US, that would be helpful?

第二個是，看看你自己與達維塔相比的進展。您是否發現過去 6 個月到 12 個月的市佔率有任何差異？我知道你之前提到了一些地區差異，以解釋為什麼你在美國有不同的同店待遇增長，因為我猜在過去六個月裡，美國不同地區面臨著不同類型的氣候問題。所以，我只是想知道，那裡是否有什麼特別的事情發生，你看到美國某些地區的收益和損失，這會有幫助嗎？

Thank you.

謝謝。

Thanks Robert. We do believe it’s the new norm because we have seen a little bit of a spike in elevation that we can point to it being the kind of the flu season and COVID cases. Obviously, in a post-COVID world, it will come down, and now we are seeing it tick back up. So, I don’t think it’s a new high level of the norm. I think this one is just really a function of this season.

謝謝羅伯特。我們確實相信這是新常態，因為我們已經看到海拔略有上升，我們可以指出這是流感季節和新冠病例的情況。顯然，在後新冠疫情時代，這一數字將會下降，而現在我們看到它正在回升。因此，我不認為這達到了新的高標準。我認為這確實是本賽季的一個功能。

And maybe the surrogate there is looking at Europe. We know that Europe has come down below this pre-pandemic mortality level. And I think we would expect the US. to normalize as well, and kind of looking to kind of just make that improvement. I mean obviously, there is some – kind of seeing what those play out and how it plays out over the next few quarters will be key.

也許那裡的替代者正在關注歐洲。我們知道，歐洲的死亡率已降至疫情前的水平以下。我認為我們會期待美國。也實現正常化，並且希望能夠做出改進。我的意思是，顯然，關鍵是看看這些結果如何以及在接下來的幾季中如何發揮作用。

And I think for me, that’s obviously a big part of why I am excited about the new innovation in 5008X. I mean I think with that come into trial, we have been showing that, that treatment can – using that therapy can also improve mortality over time by 23%.

我認為對我來說，這顯然是我對 5008X 的新創新感到興奮的一個重要原因。我的意思是，我認為隨著試驗的進行，我們已經證明，這種治療可以——隨著時間的推移，使用這種療法還可以將死亡率降低 23%。

So, I think it’s also looking to see what we can do ourselves in this environment using this new innovation. In terms of the progress against DaVita, I am not going to comment on the competition. I will comment on things in our control. Yes, I would comment that regionally, we do kind of participate in the country in different ways and get affected by mostly weather, somewhat similar depending on where we are in the same regions or differently.

因此，我認為我們也在尋找利用這項新創新在這種環境下自己能做些什麼。至於對陣 DaVita 的進展，我不會對比賽發表評論。我將對我們控制範圍內的事情發表評論。是的，我想說的是，從區域來看，我們確實以不同的方式參與這個國家，並且主要受到天氣的影響，根據我們在同一地區或不同地區的位置，有些相似。

And clearly, the fact that I have got a significant operational turnaround in place means that we have improvements to do here. And that’s in my control and our work to do and kind of that’s also why I am encouraged by what I am already seeing as this work has really hit the ground in execution now and being addressed. So, I think we can get that back on track here over the course of the year.

顯然，我已經實現了重大的營運轉變，這意味著我們需要改進。這在我的控制範圍內，也是我們要做的工作，這也是為什麼我對我已經看到的情況感到鼓舞，因為這項工作現在已經真正落地執行並得到解決。因此，我認為我們可以在今年內讓這一點重回正軌。

Understood. Thank you very much.

明白了。非常感謝。

Maria from Bank of America.

來自美國銀行的瑪麗亞。

Hello. Thank you for taking my question. Just one, if I may. I wonder if you could give us an update on the job opening position and where you are seeing going forward into the rest of the year, and how could that potentially help your utilization in the clinics? Thank you.

你好。感謝您回答我的問題。如果可以的話，就一個。我想知道您能否向我們提供有關職位空缺的最新資訊以及您對今年剩餘時間的展望，以及這對您在診所的利用有何潛在幫助？謝謝。

Hi Marianne, thanks for your question. Yes, as I mentioned, we are still sitting at about that 3,500 open positions. Clearly, in a pre-COVID world, we always talked about the optimum being around 2,500 to 3,000. That difference we are managing with kind of contract labor or kind of maybe not needing so much depends on kind of what the utilization is for volume.

嗨瑪麗安，謝謝你的問題。是的，正如我所提到的，我們仍然持有大約 3,500 個空缺職位。顯然，在新冠疫情之前的世界中，我們總是談論 2,500 到 3,000 左右的最佳價值。我們透過合約工或可能不需要太多來管理的差異取決於數量的利用率。

What we have see we are obviously this shift of a little bit less open positions for nursing is good. And kind of I think the other metric that we are driving pretty hard is this un-constrained clinics, which continues to come down every quarter. So, obviously, as we un-constrain those clinics due to labor, that’s where that helps the utilization. And I think it makes the number broadly around 200 constrained clinics now at the end of Q2. So, obviously, as we are getting the labor in able to un-constrain clinics helps the operating leverage, helps the volume numbers.

我們看到，護理職缺的減少顯然是件好事。我認為我們正在努力推動的另一個指標是不受約束的診所，它每個季度都在持續下降。因此，顯然，當我們取消對這些診所的勞動力限制時，這將有助於利用。我認為，到第二季末，受限制的診所數量大致約為 200 家。因此，顯然，當我們讓勞動力不受診所限制時，有助於提高營運槓桿，有助於增加數量。

Thank you.

謝謝。

Okay. So, then we go to the next one. The last question comes – the second round from Graham from UBS.

好的。那麼，然後我們進入下一個。最後一個問題是第二輪，來自瑞銀集團的葛拉漢。

Thanks guys for taking a follow-up. I suppose there is a lot of focus on volumes. So, what are the areas that does tend to surprise, at least over the last year or so? It’s just been on price mix. I am presuming a chunk of that is Medicare and sort of value-based care. Is that something that can persist?

感謝大家的跟進。我認為人們非常關注數量。那麼，至少在過去一年左右的時間裡，哪些領域確實令人驚訝呢？這只是價格組合的問題。我認為其中很大一部分是醫療保險和基於價值的護理。這是可以堅持的事嗎？

And are we may be slightly thinking about it this in a wrong way, and we should also think about not just the number of patients, but how you can generate more value for those patients, because I think it’s one of the things that we probably haven’t discussed as much. It would be good to get a sense of as we go through at least this period where mortality is normalizing.

我們是否可能以錯誤的方式思考這個問題，我們還應該不僅考慮患者的數量，還應該考慮如何為這些患者創造更多價值，因為我認為這是其中之一我們可能還沒有討論過那麼多。當我們至少經歷這個死亡率正常化的時期時，最好能有所了解。

Thank you, Graham. I was hoping you weren’t going to hop back in and ask the same market treatment growth question in a different way. So, I really appreciate this question. Yes, you are absolutely right. And for me, it’s truly about driving profitable growth, right. And our mix, I am very, very pleased with how that continues to progress. Our commercial mix that you have heard me say many times, it’s staying a little sticky and going up a little bit every quarter, and the same for MA.

謝謝你，格雷厄姆。我希望您不會跳回來以不同的方式提出相同的市場處理成長問題。所以，我真的很感激這個問題。是的，你說得完全正確。對我來說，這確實是為了推動獲利成長，對吧。我對我們的組合的持續進展感到非常非常滿意。你已經聽我說過很多次了，我們的商業組合保持著一點粘性，並且每個季度都會上升一點，MA 也是如此。

So, I think that is a function of our contracting strategy. And yes, very, very pleased with what that is delivering on the top line. So, yes, it’s obviously, the volume, I get the many questions, but the price and the reimbursement, and the kind of mix is also important there. And then of course, kind of our continued focus on kind of home where we kind of want to continue to drive that. And as I already mentioned, the benefits of our BBC business to also drive optimal start.

所以，我認為這是我們承包策略的功能。是的，我對它帶來的營收非常非常滿意。所以，是的，很明顯，數量，我收到了很多問題，但價格和報銷以及混合類型也很重要。當然，我們會繼續關注我們想要繼續推動這一目標的家園。正如我已經提到的，我們 BBC 業務的好處還可以推動最佳啟動。

So, kind of many things that we see, we see working well. And I think it’s kind of why I kind of sit here and we can kind of walk through all these moving parts. And you can kind of see where we are in the midpoint of the guidance. And I am still able to kind of confirm where we were and cover the volume piece with kind of positive contributions elsewhere.

所以，我們看到很多事情都運作得很好。我認為這就是為什麼我坐在這裡，我們可以走過所有這些活動的部分。您可以看到我們處於指南的中間位置。我仍然能夠確認我們的位置，並在其他地方做出積極的貢獻來涵蓋這一卷。

Okay. And maybe just a quick follow-up, in terms of the additional mortality that you have seen of late, does that really stand out, if you think about the last like 10 years, 15 years, or it’s just one of those things that can happen in a for example, this year, an extended flu season?

好的。也許只是一個快速的後續行動，就你最近看到的額外死亡率而言，如果你想想過去 10 年、15 年，或者只是其中之一，這真的很突出嗎？時可能會發生什麼事？

Yes. I haven’t been here 10 years or 15 years, but sometimes it feels like. But the – what I would say there is, we do know that we get these more pronounced flu seasons every couple of years. I think in a post-COVID world, we had just seen very, very light flu seasons. So, the – this is a little bit of a – when we were setting the guidance, we weren’t seeing this mortality tick up, and we were like, okay, we are kind of in this return to growth.

是的。我已經 10 年或 15 年沒有來這裡了，但有時感覺就像是。但我要說的是，我們確實知道每隔幾年就會出現更明顯的流感季節。我認為在後新冠疫情時代，我們剛剛經歷了非常非常輕微的流感季節。所以，這有點像當我們制定指導時，我們沒有看到死亡率上升，我們就想，好吧，我們正在恢復成長。

And now we are kind of looking at this a little bit in the way of you may seeing a prolonged flu season, which we haven’t seen maybe in kind of in previous years for some time. So, it is cyclical, but I think with all the COVID and the vaccinations and people were getting flu vaccines, it had definitely subsided over the last few. I think what we would say and probably why we are not talking about COVID mortality versus flu mortality, it’s increasingly hard to differentiate now between the causes for mortality and we are just trying to kind of look at this overall number and unpack it where we can. But we kind of obviously, we have had some really, really bad flu years in the past. And this is not really, really bad, but kind of clearly more than what we have seen in the last few years.

現在我們看待這個問題的方式有點像你可能會看到一個漫長的流感季節，而我們在前幾年可能已經有一段時間沒有看到這種情況了。所以，它是週期性的，但我認為隨著所有的新冠病毒和疫苗接種以及人們接種流感疫苗，它在過去幾年中肯定已經消退。我認為我們要說的是，也許為什麼我們不談論新冠死亡率與流感死亡率，現在越來越難以區分死亡率的原因，我們只是想看看這個總體數字並對其進行分析我們能做到的地方。但很明顯，我們過去經歷過一些非常非常嚴重的流感。這並不是真的非常糟糕，但顯然比我們過去幾年看到的情況嚴重得多。

Okay, great. Thanks.

好的，太好了。謝謝。

A lot guys. Appreciate the 2Q. We are on time and we have no further questions, but we are at a time as well. So I would like to thank all of you for listening and asking these differentiated question on same market treatment growth. And I do hope you all get a sunny and relaxed summer break and Helen and Martin will look forward to engage again in September with all of you being on the road a lot.

很多傢伙。欣賞2Q。我們準時到達，沒有其他問題，但我們也準時了。因此，我要感謝大家傾聽並提出這些有關相同市場待遇成長的差異化問題。我確實希望你們都能度過一個陽光明媚、輕鬆的暑假，海倫和馬丁將期待在九月再次與你們見面，你們所有人都會經常在路上。

Thanks everybody. Have a great summer. Take care.

謝謝大家。祝你夏天愉快。小心。