InnovAge Holding Corp (INNV) 2023 Q3 法說會逐字稿

Good day, and thank you for standing by, and welcome to the InnovAge Third Quarter 2023 Earnings Conference Call. (Operator Instructions) Please be advised that today's conference is being recorded.

美好的一天，感謝您的耐心等待，歡迎參加 InnovAge 2023 年第三季度收益電話會議。 （操作員指示）請注意，今天的會議正在錄製中。

I would now like to hand the conference over to your speaker today, Ryan Kubota, Director of Investor Relations. Please go ahead.

現在我想將會議交給今天的發言人，投資者關係總監 Ryan Kubota。請繼續。

Thank you, operator. Good afternoon, and thank you all for joining the InnovAge Fiscal 2023 Third Quarter Earnings Call. With me today is Patrick Blair, President and CEO; and Barbara Gutierrez, CFO. Dr. Rich Feifer, Chief Medical Officer, will also be joining the Q&A portion of the call.

謝謝你，接線員。下午好，感謝大家參加 InnovAge 2023 財年第三季度收益電話會議。今天與我在一起的是總裁兼首席執行官帕特里克·布萊爾 (Patrick Blair)；和首席財務官芭芭拉·古鐵雷斯 (Barbara Gutierrez)。首席醫療官 Rich Feifer 博士也將參加電話會議的問答部分。

Today, after the market closed, we issued a press release containing detailed information on our quarterly results. You may access the release on our company website, innovage.com. For those listening to the rebroadcast of this call, we remind you that the remarks made herein are as of today, Tuesday, May 9, 2023, have not been updated subsequent to this call.

今天，市場收盤後，我們發布了一份新聞稿，其中包含有關我們季度業績的詳細信息。您可以在我們公司的網站 innovage.com 上訪問該版本。對於那些收聽本次電話會議重播的人，我們提醒您，本文中的言論截至今天（2023 年 5 月 9 日星期二），在本次電話會議之後尚未更新。

During our call, we will refer to certain non-GAAP measures. A reconciliation of these measures to the most directly comparable GAAP measures can be found in our fiscal third quarter 2023 earnings press release, which is posted on the Investor Relations section of our website. We will also be making forward-looking statements, including statements related to our remediation measures, including scaling our capabilities as a provider, expanding our payer capabilities and strengthening our enterprise functions, future growth prospects, the status of current and future regulatory actions, Florida De Dovo centers and other expectations. Listeners are cautioned that all of our forward-looking statements involve certain assumptions and are inherently subject to risks and uncertainties that can cause our actual results to differ materially from our current expectations. We advise listeners to review the risk factors discussed in our Form 10-K annual report for fiscal year 2022 and our subsequent reports filed with the SEC, including our quarterly report on Form 10-Q for our fiscal third quarter 2023.

在我們的電話會議中，我們將參考某些非公認會計原則措施。這些指標與最直接可比的 GAAP 指標的調節可以在我們網站的投資者關係部分發布的 2023 財年第三季度收益新聞稿中找到。我們還將做出前瞻性聲明，包括與我們的補救措施相關的聲明，包括擴大我們作為提供商的能力、擴大我們的付款人能力和加強我們的企業功能、未來的增長前景、當前和未來監管行動的狀況、佛羅里達州德多沃中心等期待。請聽眾注意，我們所有的前瞻性陳述都涉及某些假設，並且本質上受到風險和不確定性的影響，這些風險和不確定性可能導致我們的實際結果與我們當前的預期存在重大差異。我們建議聽眾查看我們 2022 財年 10-K 表格年度報告以及我們向 SEC 提交的後續報告（包括 2023 財年第三季度 10-Q 表格季度報告）中討論的風險因素。

After the completion of our prepared remarks, we will open the call for questions. I will now turn the call over to our President and CEO, Patrick Blair. Patrick?

在完成我們準備好的發言後，我們將開始提問。我現在將把電話轉給我們的總裁兼首席執行官帕特里克·布萊爾。帕特里克？

Thank you, Ryan, and good afternoon, everyone. I want to start by expressing my ongoing gratitude to our InnovAge colleagues, participants, government partners and the investor community who support our organization.

謝謝瑞安，大家下午好。首先，我要向支持我們組織的 InnovAge 同事、參與者、政府合作夥伴和投資者群體表示持續的感謝。

Let me begin by humbly sharing what the InnovAge team has accomplished in the last 19 months. We resolved audit deficiencies across half our centers while simultaneously building trust with our federal and state regulatory partners. We closed mission-critical people, process and technology gaps, identified as causes of the audit deficiencies, and strengthened our operations. We implemented Epic at half our centers and have a path to being fully operational at every center by year-end. We made a healthy down payment on a set of essential payer capabilities that we believe will better position us to manage medical costs going forward, and we reversed the negative trends of financial performance and are now in the phase of growth and margin recapture.

首先，我要謙虛地分享一下 InnovAge 團隊在過去 19 個月中所取得的成就。我們解決了一半中心的審計缺陷，同時與聯邦和州監管合作夥伴建立了信任。我們縮小了關鍵任務人員、流程和技術差距（確定為審計缺陷的原因），並加強了我們的運營。我們在一半的中心實施了 Epic，並有望在年底前在每個中心全面投入運營。我們為一系列基本付款人能力支付了可觀的首付，我們相信這將使我們能夠更好地管理未來的醫療成本，並且我們扭轉了財務業績的負面趨勢，現在正處於增長和利潤恢復階段。

These accomplishments were made possible by the efforts of literally thousands of InnovAge employees. Thank you all for what you have done to make this happen.

這些成就是通過數千名 InnovAge 員工的努力才得以實現的。感謝大家為實現這一目標所做的一切。

As many of you know, 1 week ago, we reached an important milestone in our transformation by being released from enrollment sanctions in Sacramento, California by the Department of Healthcare Services, which was the last remaining sanction. With the support of CMS and the State of California and our unwavering commitment to sustainable improvement, we're now able to enroll new participants across all 17 InnovAge centers as well as responsibly pursue opportunities in new markets.

正如你們許多人所知，一周前，我們在轉型過程中實現了一個重要的里程碑，醫療服務部解除了加利福尼亞州薩克拉門託的入學制裁，這是最後一項製裁。在 CMS 和加利福尼亞州的支持下，以及我們對可持續改進的堅定承諾，我們現在能夠在所有 17 個 InnovAge 中心招募新參與者，並負責任地在新市場中尋求機會。

This moment can be viewed as the end of one chapter in the beginning of a new one. Our centers have been focused on closing compliance gaps and building the infrastructure, business processes, talent and culture to consistently achieve operational excellence. The chapter in front of us will build on the shoulders of the last, and we'll concentrate on aspiring to deliver best-in-class quality and participant satisfaction, which we believe will result in consistent, responsible, profitable growth. The hard work of performance improvement begins now.

這一刻可以被視為一章的結束，新一章的開始。我們的中心一直致力於縮小合規差距並建設基礎設施、業務流程、人才和文化，以持續實現卓越運營。我們面前的這一章將建立在上一章的基礎上，我們將專注於提供一流的質量和參與者滿意度，我們相信這將帶來持續、負責任、盈利的增長。績效改進的艱苦工作現在就開始了。

On the leadership front, we continue to augment the organization with additional high-impact talent, most notably and recently, the addition of our Chief Operating Officer, Chris Bent. Chris has decades of multisite care delivery operations experience. Her experience will be essential to not only building on the team's great work over the last 19 months but also to creating a more scalable infrastructure to support the significant opportunities ahead.

在領導方面，我們繼續通過更多高影響力人才來增強組織實力，最引人注目的是最近增加了我們的首席運營官克里斯·本特 (Chris Bent)。克里斯擁有數十年的多站點護理服務運營經驗。她的經驗不僅對於鞏固團隊過去 19 個月的出色工作至關重要，而且對於創建更具可擴展性的基礎架構以支持未來的重大機遇也至關重要。

We also saw a few encouraging operational milestones this quarter, perhaps most notably, Census is now increasing on a sequential basis albeit modestly for the first time since November 2021. Also, our financial trends are improving as we reported adjusted EBITDA of $3.8 million this quarter. Barb will spend some time dimensionalizing both the results and the underlying trends, which are expected to impact future quarters.

本季度我們還看到了一些令人鼓舞的運營里程碑，也許最值得注意的是，人口普查現在環比增長，儘管是自2021 年11 月以來首次小幅增長。此外，我們的財務趨勢正在改善，我們報告本季度調整後EBITDA 為380 萬美元。巴布將花一些時間對結果和潛在趨勢進行維度化，預計這將影響未來幾個季度。

Additionally, as I noted briefly, we're midway through implementing our industry-leading PACE-specific version of Epic in all of our centers. That all said, I don't believe our progress will be a straight line up in the right. There will be inevitable surprises ahead and gearing up the organization for growth will take some time. We also need to acknowledge that our risk mix has been negatively impacted primarily by the inability to enroll new participants in our largest market until recently. This dynamic can understandably take significant time to rebalance itself.

此外，正如我簡要指出的，我們正在所有中心實施業界領先的 PACE 特定版本的 Epic。話雖如此，我不相信我們的進步會是一條直線。未來不可避免地會出現意外，為組織的發展做好準備需要一些時間。我們還需要承認，我們的風險組合受到了負面影響，主要是由於直到最近才無法在我們最大的市場中招募新參與者。可以理解的是，這種動態需要大量時間來重新平衡。

Our focus and progress trajectory remain consistent with what we shared last quarter, and so my comments today will encompass a regulatory update, progress in our focus areas and perspectives on the quarterly financial performance.

我們的重點和進展軌跡與我們上季度分享的內容保持一致，因此我今天的評論將包括監管更新、我們重點領域的進展以及對季度財務業績的看法。

Let me begin the regulatory update by expressing my sincere appreciation to our government partners for their confidence in us and for their ongoing partnership. As I mentioned last quarter, we are committed to remaining fully vigilant to ensure that a rigorous compliance focus is bedrock to InnovAge's way of doing business. As I just noted and discussed in our May 1, press release, we have been released from enrollment sanctions in Sacramento by the California Department of Healthcare Services and can begin enrolling again. To be sure, this is good news for our ability to pursue our broader desired footprint in California. While Sacramento currently has only a small census of about 130 participants today, we believe it's an attractive market and has the potential to drive meaningful organic growth, especially with our JV partners, Adventist Health and Eskaton.

首先，我要向我們的政府合作夥伴表示衷心感謝，感謝他們對我們的信任以及持續的合作關係。正如我上季度提到的，我們致力於保持充分警惕，以確保嚴格的合規性重點是 InnovAge 開展業務的方式的基石。正如我剛剛在 5 月 1 日的新聞稿中指出和討論的那樣，我們已解除加州醫療服務部在薩克拉門託的招生製裁，可以再次開始招生。可以肯定的是，這對於我們在加利福尼亞州追求更廣泛的期望足蹟的能力來說是個好消息。雖然薩克拉門托目前只有約 130 名參與者的小規模人口普查，但我們相信這是一個有吸引力的市場，並且有潛力推動有意義的有機增長，特別是與我們的合資夥伴 Adventist Health 和 Eskaton 合作。

In the state of Florida, we're also excited to share that we resumed the administrative process to open centers in Tampa and Orlando. Recall, we began the construction on these facilities in mid-2021 and intentionally hit pause to focus on remediating the Colorado and California audit findings in 2022. We aspire for these 2 centers to meet our high expectations for participant experience. Each center is approximately 35,000 square feet, has a potential mature census of 1,300 participants and incorporates numerous historical best practices to optimize care delivery.

在佛羅里達州，我們也很高興地告訴大家，我們恢復了在坦帕和奧蘭多開設中心的行政程序。回想一下，我們於 2021 年中期開始建設這些設施，並有意暫停，以便在 2022 年專注於糾正科羅拉多州和加利福尼亞州的審計結果。我們渴望這兩個中心能夠滿足我們對參與者體驗的高期望。每個中心面積約為 35,000 平方英尺，可進行 1,300 名參與者的潛在成熟人口普查，並結合大量歷史最佳實踐來優化護理服務。

The opening of these 2 centers is expected to expand our total census capacity by over 20%. As I've noted in the past, the administrative process will likely take months. We're holding ourselves accountable to execute everything within our control to get them operational as quickly as possible, which we anticipate will be later this calendar year. And you can be sure that our commitments to CMS related to quality, compliance and operational excellence extend to our Florida centers as well.

這兩個中心的開業預計將使我們的人口普查總能力擴大 20% 以上。正如我過去指出的，行政流程可能需要幾個月的時間。我們有責任執行我們控制範圍內的一切，以使它們盡快投入運行，我們預計這將在今年晚些時候完成。您可以確信，我們對 CMS 的質量、合規性和卓越運營承諾也延伸到了我們的佛羅里達中心。

I also wanted to touch on the ongoing corrective action plan in Colorado. Our partners at CMS and the state have continued to hold us to a very high standard post sanction, appropriately so. And while we are aligned, I want to acknowledge that the overall time, effort and scope of the post sanction monitoring continues to be significant. As a result, these efforts are expected to create a modest but ongoing headwind to our local staffing costs and the rate of staffing ratio improvement for the remainder of the calendar year.

我還想談談科羅拉多州正在進行的糾正行動計劃。我們的 CMS 合作夥伴和國家在製裁後繼續以非常高的標準要求我們，這也是恰當的。雖然我們意見一致，但我想承認，制裁後監測的總體時間、精力和範圍仍然很重要。因此，這些努力預計將對我們當地的員工成本和日曆年剩餘時間的員工比率改善率產生適度但持續的不利影響。

Consistent with my comments over the past few quarters, our near-term priorities remain straightforward. We need to ensure a highly compliant and operationally effective business while executing a responsible growth strategy. Our key objectives have also not changed. We want to increase our same-center and de novo enrollment growth rate; increase our revenue per participant through more effective state rate setting discussions to ensure rates are fair and actuarially sound; strengthen our payer capabilities to better manage unnecessary utilization and provider costs; run our center operations more efficiently and effectively, which enables our staff to focus on what matters most: the health and well-being of our participants; and enhance discipline at the corporate level to better leverage our fixed cost base.

與我過去幾個季度的評論一致，我們的近期優先事項仍然很簡單。我們需要確保業務高度合規且運營有效，同時執行負責任的增長戰略。我們的主要目標也沒有改變。我們希望提高同中心和從頭入學增長率；通過更有效的國家費率制定討論來增加我們每個參與者的收入，以確保費率公平且精算合理；加強我們的付款人能力，以更好地管理不必要的使用和提供商成本；更高效、更有效地運營我們的中心運營，使我們的員工能夠專注於最重要的事情：參與者的健康和福祉；加強公司層面的紀律，以更好地利用我們的固定成本基礎。

On the growth front, we've been focusing on adding the right talent, ensuring the team has the right tools for the job, expanding our referral channels and improving forecasting effectiveness. In the last few months, we've seen more lead volume than any other time across both field and digital channels. We're focused now on qualifying these leads and on enrollment conversion. This is a team effort between us and our state partners who ultimately process the enrollments. We continue to challenge ourselves to improve each dimension of the enrollment funnel to be more productive, consistent and predictive each month.

在增長方面，我們一直致力於增加合適的人才，確保團隊擁有適合工作的合適工具，擴大我們的推薦渠道並提高預測有效性。在過去的幾個月裡，我們在現場和數字渠道上看到的潛在客戶數量比任何其他時候都多。我們現在的重點是確定這些潛在客戶的資格和註冊轉化。這是我們和最終處理註冊的州合作夥伴之間的團隊努力。我們繼續挑戰自己，改進註冊渠道的各個方面，使每個月變得更加高效、一致和可預測。

In Colorado specifically, I wanted to spend a minute detailing the shape of the anticipated enrollment over the coming months. Recall, we were released sanctions at the end of January. We enrolled our first group of new participants on the first available date of March 1, consistent with required PACE enrollment processing time lines. At the same time, we are actively developing a pipeline of potential PACE participants who have expressed an interest in enrolling. We are facilitating the necessary third-party approvals to satisfy Medicare and/or Medicaid requirements to join PACE, which can take on average between 60 and 90 days.

特別是在科羅拉多州，我想花一分鐘的時間詳細介紹未來幾個月的預期入學情況。回想一下，我們在一月底解除了製裁。我們在 3 月 1 日第一個可用日期註冊了第一批新參與者，與所需的 PACE 註冊處理時間線一致。與此同時，我們正在積極開發一批表示有興趣加入的潛在 PACE 參與者。我們正在促進必要的第三方批准，以滿足加入 PACE 的 Medicare 和/或 Medicaid 要求，這平均需要 60 到 90 天。

And critically, we have been intentional within our centers to gradually reintroduce new enrollments as it's a muscle and mindset we have not flexed in over a year. It's been a deliberate ramp-up in Colorado over the last few months, and we anticipate it will take at least another quarter to have confidence in our enrollment run rate.

至關重要的是，我們一直有意在我們的中心內逐步重新引入新的入學人數，因為這是我們一年多來沒有展示的力量和心態。過去幾個月，科羅拉多州的入學率一直在有意提高，我們預計至少還需要一個季度才能對我們的入學率產生信心。

In addition to the organic focus, we're pleased with the level of activity in the market for tuck-in acquisitions and new partnership opportunities. That said, we're resolved that nothing distract us from our compliance focus in filling the existing center capacity. We will continue to be opportunistic and will focus on organizations that share our commitment to quality and participant-centric care.

除了有機關注之外，我們對市場上的收購和新合作機會的活動水平感到滿意。也就是說，我們決心不讓任何事情分散我們在填補現有中心容量方面的合規重點。我們將繼續抓住機會，並將重點關注那些與我們一樣致力於高質量和以參與者為中心的護理的組織。

Last quarter, I mentioned the importance of using the rate setting process both on and off cycle as an opportunity to work closely with states to ensure we receive actuarially sound rate adjustments that properly consider the acuity and underlying risk of our participants as well as the inflationary factors inherent in our business. Primarily as a byproduct of sanctions, our risk mix now comprises a disproportionate share of participants with greater health care and supportive housing needs, like assisted living. And as we have discussed before, our population was also disproportionately impacted by COVID.

上個季度，我提到了利用周期內和周期外的利率設定流程作為與各州密切合作的機會的重要性，以確保我們獲得精算合理的利率調整，適當考慮參與者的敏銳度和潛在風險以及通貨膨脹。我們業務固有的因素。主要作為製裁的副產品，我們的風險組合現在由擁有更多醫療保健和支持性住房需求（例如輔助生活）的參與者組成。正如我們之前討論過的，我們的人口也受到了新冠疫情的不成比例的影響。

Now more than ever, it is incumbent on us to empirically prove out our medical cost experience to our state partners, which we believe to be higher today than is reflected in the historical data that can be used to set future rates. To support our work here, we recently hired [Randy Brock] as Senior Vice President of Medical Economics. Randy brings decades of experience from Anthem and Amerigroup working to ensure rates for Medicaid managed long-term care and dual-eligible programs reflect the true cost of serving these high-need populations. Barb will provide an update on the current rate-setting activity and timing of when new rates will go into effect.

現在，我們比以往任何時候都更有責任向我們的國家合作夥伴憑經驗證明我們的醫療費用經驗，我們認為今天的醫療費用高於可用於設定未來費率的歷史數據中反映的水平。為了支持我們在這裡的工作，我們最近聘請了 [Randy Brock] 擔任醫學經濟學高級副總裁。蘭迪帶來了 Anthem 和 Amerigroup 數十年的經驗，致力於確保醫療補助管理的長期護理和雙重資格計劃的費率反映為這些高需求人群提供服務的真實成本。 Barb 將提供當前利率制定活動的最新信息以及新利率生效的時間。

Our portfolio of clinical initiatives, or CVIs, continues to progress. We now have a strong perimeter around the near-term opportunities and accountable leaders to drive these initiatives forward. However, as I've mentioned in the past, these will be dials, not switches, and we do not expect the financial impact of these initiatives to materially contribute to our financial results until next fiscal year. I would also note that the current portfolio of initiatives is primarily prophylactic and that we're looking for improvement to offset currently elevated cost until we have added enough new participant growth to balance the risk pool.

我們的臨床計劃組合（CVI）不斷取得進展。現在，我們圍繞近期機會和負責任的領導者建立了強大的邊界來推動這些舉措向前發展。然而，正如我過去提到的，這些將是旋鈕，而不是開關，我們預計這些舉措的財務影響在下一財年之前不會對我們的財務業績產生實質性貢獻。我還要指出的是，當前的舉措組合主要是預防性的，我們正在尋求改進以抵消當前增加的成本，直到我們增加足夠的新參與者增長來平衡風險池。

As an example, our focus on resource management led to the identification of short-stay skilled nursing facility, or SNF, utilization is a top priority. We launched an initiative to determine where and when this service is clinically needed for participants and defined alternative care settings for times when it is not necessary. As a result of these efforts, we have achieved a meaningful reduction in monthly short-stay SNF utilization over the last 12 months. Furthermore, for those participants needing a SNF for short-stay medical care, our average monthly short-stay SNF days has dropped approximately 25% over the fiscal year to date.

例如，我們對資源管理的關注導致了短期熟練護理設施（SNF）的識別，利用率是重中之重。我們發起了一項倡議，以確定參與者在臨床上何時何地需要這項服務，並在不需要時定義替代護理環境。通過這些努力，我們在過去 12 個月內實現了每月短期住宿 SNF 利用率的大幅下降。此外，對於那些需要 SNF 進行短期醫療護理的參與者來說，我們的平均每月短期 SNF 天數比本財年迄今為止減少了約 25%。

This is great progress on an important cost driver, but we have other cost categories like inpatient admissions that are stubbornly higher than our current expectations. In addition to our initiatives discussed last quarter, we're kicking off a new effort focused on lowering external provider unit costs went out of line with benchmarks. We'll also be streamlining our assisted living facility network to match our capacity to provide compliance oversight and to better meet the needs of our census. We believe this initiative will help lower our external provider costs and improve the participant experience.

這對於一個重要的成本驅動因素來說是巨大的進步，但我們的其他成本類別（例如住院費用）始終高於我們當前的預期。除了上季度討論的舉措之外，我們還啟動了一項新的工作，重點是降低與基準不符的外部提供商單位成本。我們還將精簡我們的輔助生活設施網絡，以匹配我們提供合規監督的能力，並更好地滿足人口普查的需求。我們相信這一舉措將有助於降低我們的外部提供商成本並改善參與者體驗。

Turning to center operations. As I mentioned earlier, we have 9 of our 17 centers live on Epic with the remainder scheduled for the first half of fiscal year '24. We've made the decision to pull forward the Colorado market go live to early fiscal year '24. Pulling forward the 6 centers in Colorado earlier than originally anticipated will likely create modest G&A headwinds in fiscal year '24, but we believe the expected benefit will more than offset the incremental investment. Though it takes many months to achieve full adoption and the expected benefits of a new system, we're encouraged by the operational efficiencies that are emerging and the positive feedback our administrative and clinical teams are sharing. We expect the Epic investment to be a powerful enabler to drive better compliance, productivity and clinical staff satisfaction.

轉向中心運營。正如我之前提到的，我們 17 個中心中有 9 個中心在 Epic 上運行，其餘中心計劃在 24 財年上半年運行。我們決定將科羅拉多市場的上線時間提前至 24 財年年初。比最初預期提前推進科羅拉多州的 6 個中心可能會在 24 財年造成適度的一般行政費用阻力，但我們相信預期收益將足以抵消增量投資。儘管新系統需要幾個月的時間才能實現全面採用並達到預期效益，但我們對正在出現的運營效率以及我們的管理和臨床團隊分享的積極反饋感到鼓舞。我們預計 Epic 的投資將成為推動更好的合規性、生產力和臨床工作人員滿意度的強大推動力。

We also continue to make meaningful progress implementing our new triad operating model, which focuses on the partnership among the center directors, nursing directors and medical directors at the center, regional and national levels. The triad model is predicated on driving better participant care, making faster operating decisions and improving center level contribution margin. We're starting to see the impact of forming this tight-knit team with aligned incentives and joint accountability.

我們還繼續在實施新的三位一體運營模式方面取得有意義的進展，該模式側重於中心、區域和國家各級的中心主任、護理主任和醫療主任之間的伙伴關係。三合一模型的前提是推動更好的參與者護理、更快地做出運營決策以及提高中心級別的邊際貢獻。我們開始看到組建這個緊密團結、激勵一致、共同負責的團隊所產生的影響。

Regarding corporate costs, we continue to maintain discipline to hold corporate staffing costs constant as we grow back into our fixed cost base. The hiring controls we put in place 6 months ago have helped us better match our hiring pace and volume to our financial targets. We continue to focus on actions to ensure our G&A relative to revenue is aligned while using savings as a funding mechanism for tools and technology that will improve efficiency and effectiveness. We believe there is a virtuous cycle behind these efforts in which our employees can be more productive, satisfied and scalable. Additionally, we've also looked beyond the P&L and found opportunities to optimize our working capital, which we believe will drive approximately $10 million of benefit once fully implemented by the start of fiscal year '24.

關於企業成本，隨著我們恢復到固定成本基礎，我們將繼續保持紀律，保持企業員工成本不變。我們在 6 個月前實施的招聘控制措施幫助我們更好地將招聘速度和數量與我們的財務目標相匹配。我們繼續專注於採取行動，確保我們的一般管理費用與收入保持一致，同時利用節省作為工具和技術的融資機制，以提高效率和效益。我們相信這些努力背後存在一個良性循環，使我們的員工能夠提高工作效率、滿意度和規模。此外，我們還超越了損益表，找到了優化營運資金的機會，我們相信，一旦在 24 財年開始全面實施，這將帶來約 1000 萬美元的效益。

Turning to financial performance. We reported revenue of $172.5 million, a sequential improvement of approximately 3% compared to last quarter. We ended the quarter serving approximately 6,310 participants. For the quarter, we reported center level contribution margin of $28.8 million and a corresponding center level contribution margin ratio of 16.7% compared to second quarter fiscal year '23 center-level contribution margin of $22.6 million, an increase of $6.2 million and margin improvement of 320 basis points.

轉向財務績效。我們公佈的收入為 1.725 億美元，比上季度環比增長約 3%。本季度結束時，我們為大約 6,310 名參與者提供了服務。我們報告本季度的中心級邊際貢獻率為2880 萬美元，相應的中心級邊際貢獻率為16.7%，與23 財年第二季度的中心級邊際貢獻率為2260 萬美元相比，增加了620 萬美元，利潤率提高了320個基點。

The quarter overall demonstrated incremental progress in our core focus areas. However, as I mentioned at the outset, it remains too early to take the results of the quarter and extrapolate them into the future. We had the benefit of a few onetime tailwinds, which Barb will discuss, and we continue to face medical cost pressures from our deconditioned participant risk mix, which will take some time to normalize. To help contextualize that point, our consolidated RAF score as of March 31 was 2.53, which is up approximately 5% relative to our year-to-date average. To accelerate rebalancing of our risk pool, we will continue to focus on employing this flat capacity at our existing centers. Particularly in the Colorado market, resuming enrollment growth will drive better labor utilization in our centers and help rebalance our mix of new and tenured participants, which should improve participant expense PMPMs.

本季度總體上顯示了我們核心重點領域的逐步進展。然而，正如我在一開始提到的，現在就得出本季度的結果並推斷未來還為時過早。我們受益於一些一次性的順風，巴布將討論這一點，並且我們繼續面臨來自我們不完善的參與者風險組合的醫療成本壓力，這需要一些時間才能正常化。為了幫助說明這一點，截至 3 月 31 日，我們的 RAF 綜合得分為 2.53，相對於我們今年迄今的平均分上升了約 5%。為了加速我們風險池的重新平衡，我們將繼續專注於在現有中心利用這種固定容量。特別是在科羅拉多州市場，恢復入學增長將推動我們中心更好的勞動力利用率，並有助於重新平衡新參與者和終身參與者的組合，這應該會改善參與者費用 PMPM。

In closing, the team's collective dedication to our participants and hard work through this last chapter, along with numerous investments in new processes, is beginning to unlock the full potential of the organization. I greatly appreciate their tireless efforts and continued commitment and the ongoing support of our valued government partners. We look forward to continuing to demonstrate incremental improvement quarter-over-quarter in each of our focus areas and are seeking additional catalysts to deliver breakthrough impact and value to the organization over time. I know I speak for the entire organization that we are thrilled to be returning to our core mission of expanding PACE to the many deserving underserved seniors across the country.

最後，團隊對參與者的集體奉獻和最後一章的辛勤工作，以及對新流程的大量投資，正在開始釋放組織的全部潛力。我非常感謝他們的不懈努力、持續承諾以及我們尊貴的政府合作夥伴的持續支持。我們期待著在每個重點領域繼續展示季度環比的漸進式改進，並正在尋求額外的催化劑，以便隨著時間的推移為組織帶來突破性的影響和價值。我知道我代表整個組織表示，我們很高興能夠回到我們的核心使命，將 PACE 擴展到全國許多應得的、服務不足的老年人。

Now I will turn it over to Barb.

現在我將把它交給巴布。

Thank you, Patrick, and good afternoon, everyone. Today, I will provide some highlights from our third quarter fiscal year 2023 performance and some insights into the trends we are seeing through the end of the fiscal year. As with our previous earnings calls, I will refer to sequential comparisons relative to the second quarter in order to provide a more meaningful picture of our performance.

謝謝帕特里克，大家下午好。今天，我將提供 2023 財年第三季度業績的一些亮點，以及對我們在本財年末看到的趨勢的一些見解。與我們之前的財報電話會議一樣，我將參考與第二季度的連續比較，以便更有意義地了解我們的業績。

At the end of the quarter, we served approximately 6,310 participants. Compared to the prior year, this represents an ending census's decline of 7.1% and a 2.2% decline compared to the second quarter of fiscal year 2023. We reported approximately 19,060 member months for the third quarter, a 7.6% decrease over the prior year and a decrease of 2.1% over the second quarter of fiscal 2023. The enrollment freeze in Colorado had the greatest impact on member months and census compared to the third quarter of fiscal 2022 and sequentially. However, we are pleased that we are now ramping up the enrollment of new participants following our release from sanctions in Colorado in late January and have begun to ramp up the enrollment process in Sacramento as well following our release from sanctions on May 1.

截至本季度末，我們為大約 6,310 名參與者提供了服務。與上一年相比，這意味著最終人口普查下降了7.1%，與2023 財年第二季度相比下降了2.2%。我們報告第三季度會員月數約為19,060 人，比上一年下降7.6%，與 2023 財年第二季度相比下降了 2.1%。與 2022 財年第三季度及隨後的季度相比，科羅拉多州的入學凍結對會員月份和人口普查的影響最大。然而，令我們感到高興的是，繼 1 月下旬科羅拉多州解除制裁後，我們現在正在加大新參與者的註冊力度，並在 5 月 1 日解除制裁後，也開始加大薩克拉門託的註冊流程。

The timing of our Colorado sanction release in late January, coupled with the typical enrollment processing time line of 30 to 60 days as well as the enrollment cycle for new participants starting at the beginning of each month, translates into limited enrollment during the quarter. However, we are steadily gaining momentum as the process continues to mature and we anticipate returning to a more normalized growth run rate in the next few quarters. We also expect Sacramento to follow a similar time line with respect to the ramp-up of new participant enrollment as we reengage with the local community and connect with potential participants.

我們的科羅拉多州制裁於 1 月底發布，加上典型的 30 至 60 天的註冊處理時間以及從每個月初開始的新參與者註冊週期，導致本季度的註冊數量有限。然而，隨著流程的不斷成熟，我們正在穩步獲得動力，我們預計在未來幾個季度將恢復到更加正常化的增長率。我們還期望薩克拉門託在我們重新與當地社區接觸並與潛在參與者建立聯繫時，在增加新參與者註冊方面遵循類似的時間表。

Additionally, during the quarter, we consolidated our Germantown center in Pennsylvania and moved existing participants and staff to our Allegheny and Henry Avenue centers. The move, which included prior approval from CMS and the state as well as participants and employee input, transitioned approximately 170 participants to newer, larger centers with additional amenities less than 5 miles away. As a result, total center count has decreased from 18 to 17.

此外，在本季度，我們整合了賓夕法尼亞州的日耳曼敦中心，並將現有參與者和員工轉移到我們的阿勒格尼和亨利大道中心。這一舉措得到了 CMS 和州政府的事先批准以及參與者和員工的意見，將大約 170 名參與者轉移到了距離不到 5 英里的更新、更大的中心，並配備了額外的便利設施。結果，中心總數從 18 人減少到 17 人。

Total revenue decreased by 2.7% to $172.5 million compared to the third quarter of fiscal year 2022, principally due to the sanctions though slightly offset by the ramp-up of new enrollments in Colorado. The decrease was also partially offset by the annual increase in Medicaid and Medicare rates, which are net of the full reinstatement of sequestration in July 2022. Additionally, our risk scores increased quarter-over-quarter by 9.5%, reflecting the overall increased acuity of our participants in our risk pool. Compared to the second quarter, revenue increased 3% primarily as a result of an increase in Medicare rates. This increase was partially offset by lower member months associated with sanctions despite the ramp-up of new enrollments in Colorado.

與 2022 財年第三季度相比，總收入下降 2.7%，至 1.725 億美元，主要是由於製裁造成的，但科羅拉多州新入學人數的增加略有抵消。這一下降也被醫療補助和醫療保險費率的年度增長所部分抵消，這些費率扣除了2022 年7 月全面恢復隔離的影響。此外，我們的風險評分環比增長了9.5%，反映出總體敏銳度的提高。我們風險池中的參與者。與第二季度相比，收入增長了 3%，主要是由於醫療保險費率的上漲。儘管科羅拉多州新註冊人數有所增加，但與製裁相關的會員月數減少部分抵消了這一增長。

We incurred $89.8 million of external provider cost during the quarter, a 13% decrease compared to the prior year. The decrease was driven by lower member months, coupled with a 5.9% decrease in cost per participant. The cost per participant decrease was primarily due to lower inpatient cost per admit as a result of the Omicron spike in the prior year and lower short-stay skilled nursing utilization, as Patrick referenced in his prepared remarks. The decrease is partially offset by an increase in assisted living and permanent nursing facility utilization as well as unit cost. Sequentially, external provider costs decreased by 4%, primarily as a result of lower census and lower per member per month pharmacy expense due to higher-than-anticipated rebates, partially offset by an increase in inpatient utilization and cost per admit, which is typically elevated during the winter months as a result of seasonality.

本季度我們產生了 8,980 萬美元的外部提供商成本，與上一年相比下降了 13%。這一下降是由於會員月數減少以及每位參與者的成本下降了 5.9%。正如帕特里克在他準備好的講話中提到的那樣，每位參與者的成本下降主要是由於前一年 Omicron 激增導致每次入院的住院費用降低以及短期熟練護理利用率的降低。這一下降被輔助生活和永久護理設施利用率以及單位成本的增加部分抵消。隨後，外部提供者成本下降了 4%，主要是由於人口普查減少以及回扣高於預期導致每位會員每月藥房費用降低，但部分被住院患者利用率和每次入院成本的增加所抵消。由於季節性原因，冬季月份有所升高。

Cost of care, excluding depreciation and amortization of $53.9 million, was 17% higher compared to the prior year. Similar to our experience last quarter, the primary cost drivers include the following items: one, salaries, wages and benefits, which accounts for approximately 80% of the total variance increased due to higher headcount as a result of filling key vacancies, higher wage rates and increased labor costs associated with ongoing audit remediation and compliance efforts; two, third-party audit and compliance support as we work through the audit and proactively performed self-audit in our non-sanctioned markets; three, fleet and contract transportation driven by higher average daily attendance in our centers, an increase in external appointments and higher fuel costs; and four, increased building maintenance and security costs associated with growth in average daily attendance.

不計折舊和攤銷的護理成本為 5,390 萬美元，比上年增加 17%。與我們上季度的經驗類似，主要成本驅動因素包括以下幾項：一是薪資、工資和福利，約佔總差異的 80%。由於填補關鍵空缺而導致員工人數增加、工資水平提高，導致差異增加與持續的審計補救和合規工作相關的勞動力成本增加；二、第三方審計和合規支持，幫助我們完成審計並在非制裁市場主動進行自我審計；第三，車隊和合同運輸的推動因素包括中心日均出勤率的增加、外部預約的增加以及燃料成本的上漲；第四，隨著日均出勤率的增加，建築維護和安保成本也隨之增加。

Cost of care increased 5% over the second quarter of fiscal 2023, primarily due to increased wage rates and headcount, coupled with an increase in building maintenance. Central level contribution margin, which we define as total revenue less external provider costs and cost of care, excluding depreciation and amortization, was $28.8 million for the third quarter compared to $28 million in the prior year and $22.6 million in the second quarter of fiscal 2023. As a percentage of revenue, center level contribution margin for the quarter was 16.7%, representing a 90 basis point improvement over the prior year and a 320 basis point improvement over the prior quarter.

與 2023 財年第二季度相比，護理成本增加了 5%，這主要是由於工資率和員工人數增加，以及建築維護費用的增加。第三季度的中央貢獻利潤率（我們將其定義為總收入減去外部提供商成本和護理成本，不包括折舊和攤銷）為2880 萬美元，而上一年為2800 萬美元，2023 財年第二季度為2260 萬美元按佔收入的百分比計算，本季度中層貢獻利潤率為 16.7%，比上年提高 90 個基點，比上一季度提高 320 個基點。

Sales and marketing expense was $5.3 million, an $800,000 decrease compared to the prior year. The decrease was mainly due to lower sales headcount as a result of the sanctions, partially offset by onetime costs related to organizational realignment completed in the third quarter of 2022. Compared to the second quarter of fiscal year 2023, sales and marketing expense increased by $1.5 million, primarily due to increased marketing spend and sales headcount following the Colorado sanction lift and the addition of traditional media in all non-sanctioned markets.

銷售和營銷費用為 530 萬美元，比上年減少 80 萬美元。減少的主要原因是製裁導致銷售人員減少，但部分被 2022 年第三季度完成的組織重組相關的一次性成本所抵消。與 2023 財年第二季度相比，銷售和營銷費用增加了 1.5 美元萬，主要是由於科羅拉多州制裁解除後營銷支出和銷售人員數量增加以及所有非制裁市場中傳統媒體的增加。

Corporate, general and administrative expense was $27.6 million, a $3 million increase compared to the prior year. This was primarily due to an increase in headcount to support compliance and bolster organizational capabilities, an increase in third-party legal spend and an increase in software license and maintenance expenses including Epic. These costs were partially offset by a reduction in bad debt expense and lower consulting expense associated with laying the groundwork for strengthening organizational capabilities. Sequentially, corporate, general and administrative expense decreased $1.2 million due to lower third-party legal expense, reduction in contract services associated with Epic implementation in our centers in the East region, continued tapering of certain third-party consultant expenses associated with improving organizational capabilities and a reduction in bad debt expense. These decreases were partially offset by an increase in headcount and employee-related costs and an increase in software license and maintenance expenses.

公司、一般和行政費用為 2,760 萬美元，比上年增加 300 萬美元。這主要是由於支持合規性和增強組織能力的人員數量增加、第三方法律支出的增加以及包括 Epic 在內的軟件許可和維護費用的增加。這些成本被壞賬費用的減少和與加強組織能力奠定基礎相關的諮詢費用的減少所部分抵消。隨後，由於第三方法律費用減少、與東部地區中心 Epic 實施相關的合同服務減少、與提高組織能力相關的某些第三方顧問費用持續減少，公司、一般和管理費用減少了 120 萬美元以及壞賬費用的減少。這些減少被員工人數和員工相關成本的增加以及軟件許可和維護費用的增加部分抵消。

Net loss was $7.3 million compared to a net loss of $3.2 million in the third quarter of fiscal 2022. We reported a net loss per share for the fiscal third quarter of $0.05 on both a basic and diluted basis. Our weighted average share count was 135,601,327 shares for the third quarter on both a basic and fully diluted basis.

淨虧損為 730 萬美元，而 2022 財年第三季度的淨虧損為 320 萬美元。我們報告第三財季的基本每股淨虧損和稀釋後每股淨虧損均為 0.05 美元。第三季度，我們的加權平均股數（基本股和完全稀釋股）均為 135,601,327 股。

Adjusted EBITDA, which we calculate by adding interest, taxes, depreciation and amortization, onetime adjustments for transaction and offering related costs and other nonrecurring or exceptional costs to net income, was $3.8 million compared to $1.9 million in the third quarter of fiscal year 2022 and negative $2 million in the second quarter of fiscal year 2023. Our adjusted EBITDA margin was 2.2% for the third quarter compared to 1.1% for the third quarter of fiscal year 2022 and negative 1.2% for the second quarter of fiscal year 2023. The sequential quarter-over-quarter improvement in adjusted EBITDA and adjusted EBITDA margin is primarily a function of increased Medicare capitation rate, improvement in external provider cost per member per month resulting from pharmacy rebates and lower G&A, partially offset by increased cost of care and increased sales and marketing.

調整後 EBITDA 為 380 萬美元，而 2022 財年第三季度為 190 萬美元，調整後 EBITDA 為 380 萬美元，調整後 EBITDA 為 380 萬美元。 2023 財年第二季度負200 萬美元。第三季度調整後EBITDA 利潤率為2.2%，而2022 財年第三季度為1.1%，2023 財年第二季度為負1.2%。調整後EBITDA 和調整後EBITDA 利潤率的季度環比改善主要是由於醫療保險按人頭付費率提高、藥房回扣和一般管理費用降低導致每位會員每月外部提供商成本的改善，但部分被護理成本增加和銷售額增加所抵消和營銷。

We do not add back any losses incurred in connection with our de novo centers in the calculation of adjusted EBITDA. De novo center losses, which we define as net losses related to preopening and start-up ramp through the first 24 months of de novo operations, were approximately $880,000 for the third quarter primarily related to centers in Florida.

在計算調整後的 EBITDA 時，我們不會加回與我們的 de novo 中心相關的任何損失。 De novo 中心虧損（我們將其定義為與 de novo 運營前 24 個月內開業前和啟動階段相關的淨虧損），第三季度約為 880,000 美元，主要與佛羅里達州的中心相關。

Turning to our balance sheet. We ended the quarter with $121.7 million in cash and cash equivalents plus $45.8 million in short-term investments. We had $89.1 million in total debt on the balance sheet, representing debt under our senior secured term loan plus finance lease obligations and other commitments. For the third quarter, we recorded cash flow from operations of $29.1 million, inclusive of $26 million of deferred revenue, and we had $4.7 million of capital expenditures.

轉向我們的資產負債表。截至本季度末，我們擁有 1.217 億美元的現金和現金等價物，加上 4580 萬美元的短期投資。我們的資產負債表上的債務總額為 8,910 萬美元，包括我們的高級擔保定期貸款下的債務加上融資租賃義務和其他承諾。第三季度，我們的運營現金流為 2910 萬美元，其中包括 2600 萬美元的遞延收入，資本支出為 470 萬美元。

As Patrick indicated, in this quarter, we benefited from certain onetime or timing-related tailwinds which cannot be extrapolated for the remainder of fiscal 2023 or into fiscal 2024. Over the remainder of the fiscal year and into the next fiscal year, trends will evolve related to enrollment growth, post-sanction cost structure and the impact of CVIs. With that said, I will provide some additional visibility around the following trends we are seeing.

正如帕特里克指出的那樣，在本季度，我們受益於某些一次性或與時間相關的順風車，這些順風車無法推斷到2023 財年剩餘時間或2024 財年。在本財年剩餘時間和下一財年，趨勢將會演變與入學增長、制裁後成本結構和 CVI 的影響有關。話雖如此，我將圍繞我們所看到的以下趨勢提供一些額外的信息。

Regarding census, while our focus remains on ramping up our enrollment efforts in Colorado and Sacramento, I want to briefly provide some additional detail on the impact of Medicaid redetermination as a result of the end of the public health emergency. The nature of our population and the complexity of the Medicaid services our participants receive results in a comprehensive financial qualification as compared to the more traditional Medicaid-only population. Additionally, we completed annual Medicaid redetermination throughout the public health emergency with a dedicated team to support these efforts. Our process enables us to provide a high degree of service to participants to monitor eligibility, assist with the redetermination process, address potential issues with eligibility in real-time and track future renewal dates, which we believe will result in minimal pre-COVID levels of financial disenrollment.

關於人口普查，雖然我們的重點仍然是加大科羅拉多州和薩克拉門託的登記力度，但我想簡要提供一些關於公共衛生緊急情況結束後醫療補助重新確定的影響的更多細節。與更傳統的僅享受醫療補助的人群相比，我們人口的性質和醫療補助服務的複雜性導致我們的參與者獲得了全面的財務資格。此外，我們在整個公共衛生緊急情況下完成了年度醫療補助重新確定，並有專門的團隊來支持這些工作。我們的流程使我們能夠為參與者提供高水平的服務，以監控資格、協助重新確定流程、實時解決潛在的資格問題並跟踪未來的續訂日期，我們相信這將導致新冠疫情前的最低水平財務註銷。

Regarding revenue. As we said last quarter, effective January 1, we experienced a low double-digit Medicare rate increase associated with an annual increase in county rates, coupled with an increase in risk scores. This positive outcome was tempered by a low single-digit Medicaid rate decrease from the state of California, resulting in a net mid-single-digit rate increase in the aggregate. To appropriately optimize our opportunity to be accurately compensated for the full risk profile of our participants, we are building out our internal competencies around revenue participants and around the rate-setting process to more actively engage with our regulators. Most of our states, including Colorado, are on a July 1 fiscal year, and we plan to utilize these augmented capabilities during the rate setting cycle currently in progress.

關於收入。正如我們上個季度所說，自 1 月 1 日起，我們經歷了兩位數的低位醫療保險費率上漲，這與縣費率的年度上漲以及風險評分的增加有關。這一積極成果受到加利福尼亞州醫療補助費率低個位數下降的影響，導致總體費率出現中個位數的淨增長。為了適當優化我們的機會，以準確補償參與者的全部風險狀況，我們正在圍繞收入參與者和費率制定流程構建我們的內部能力，以更積極地與監管機構合作。我們的大多數州，包括科羅拉多州，都處於 7 月 1 日的財政年度，我們計劃在當前正在進行的利率設定週期中利用這些增強的功能。

Finally, some thoughts on cost of care, external provider costs and overall central level margins. In the midterm, we continue to believe that we can obtain margins similar to what we experienced before the sanctions, although the composition of our central level costs may look slightly different. The investments that we have made, particularly in staff-related costs, have elevated our cost of care expense compared to historical levels, but we are driving value through other revenue and cost focus areas such as our payer initiatives and CVIs to bend the curve and deliver margin over time. Though it will take multiple quarters to return to more robust margins, our focus remains on the key drivers, specifically, accelerating census growth which also serves to rebalance the participant risk pool as well as to unlock staffing capacity; optimizing revenue per participant through diligence on the accuracy of risk scores; and executing on clinical value initiatives to improve participant care and reduce unnecessary costs. all of which we expect will drive a meaningful improvement in our margin profile.

最後，關於護理成本、外部提供商成本和總體中央利潤率的一些想法。從中期來看，我們仍然相信我們可以獲得與製裁前相似的利潤率，儘管我們的中央成本構成可能看起來略有不同。與歷史水平相比，我們所做的投資，特別是與員工相關的成本，提高了我們的護理費用成本，但我們正在通過其他收入和成本重點領域（例如我們的付款人計劃和CVI）來推動價值，以彎曲曲線和隨著時間的推移交付保證金。儘管需要多個季度才能恢復更強勁的利潤率，但我們的重點仍然是關鍵驅動因素，特別是加速人口普查增長，這也有助於重新平衡參與者風險池並釋放人員配置能力；通過對風險評分準確性的調查來優化每個參與者的收入；執行臨床價值計劃，以改善參與者護理並減少不必要的成本。我們預計所有這些都將推動我們的利潤狀況顯著改善。

In closing, we are excited to be turning a page as we begin to focus on growth and expansion once again. We remain extremely proud of the hard work and accomplishments that have brought us to this point, and we look forward to expanding access to PACE in the future to the many seniors who could benefit from the program.

最後，我們很高興能夠翻開新的一頁，再次開始專注於增長和擴張。我們仍然對我們走到這一步的辛勤工作和成就感到非常自豪，我們期待著未來將 PACE 的使用範圍擴大到許多可以從該計劃中受益的老年人。

Operator, that concludes our prepared remarks. Please open the call for questions.

接線員，我們準備好的發言到此結束。請打開電話提問。

(Operator Instructions) And our first question comes from Lisa Gill from JPMorgan.

（操作員說明）我們的第一個問題來自摩根大通的 Lisa Gill。

Congratulations on getting everything back up online. But let me just first start with -- you've given us a lot of information but really not quantifying anything. I'm just curious as to when you think you'll be in a position to maybe give us some incremental numbers and when you'll bring back guidance, would be my first kind of overarching question. And then secondly, maybe if you can just also help us to think about the speed at which you'll be able to backfill your capacity in your center. Like how quickly can you start to ramp back up again?

恭喜您將所有內容恢復到網上。但首先讓我開始——你給了我們很多信息，但實際上沒有量化任何東西。我只是好奇你什麼時候可以給我們一些增量數字，什麼時候你會帶回指導，這將是我的第一個首要問題。其次，也許您也可以幫助我們考慮一下您能夠以何種速度回填中心的容量。比如你能多快開始重新恢復活力？

Lisa, it's Patrick. Let me just kind of jump in on the guidance question and then I'll hand it off to Barb to fill in anything I missed. Clearly, it's our intention to provide guidance on a go-forward basis. But I think the question is, we're not ready today to say exactly when that will be. We do believe it's appropriate to take a bit of a conservative posture on the timing for that. And there's sort of a few reasons that I think we hit in the script, but just sort of come to mind, for one, it's still a pretty dynamic business as we just exit the sanctions and begin to grow again in our largest market, which has really had a pretty significant impact on the company. And then there's still a number of drivers that we just like a bit more clarity on before providing guidance.

麗莎，是帕特里克。讓我簡單介紹一下指導問題，然後我會將其交給 Barb 來填寫我錯過的任何內容。顯然，我們的目的是提供未來的指導。但我認為問題是，我們今天還沒有準備好確切地說出具體時間。我們確實認為在時機上採取保守態度是適當的。我認為我們在劇本中提到了一些原因，但我想到的是，首先，它仍然是一個非常有活力的業務，因為我們剛剛退出製裁併開始在我們最大的市場再次增長，確實對公司產生了相當大的影響。然後，我們仍然希望在提供指導之前更清楚地了解一些驅動因素。

I think one which we touched on is we're making great progress in Florida, but it's still a question of exactly when is Florida going to start generating revenue. And I think that's something we want to have a better read on. Barb mentioned our participant mix. And there's still a question just how quickly is that risk pool going to rebalance and normalize as a result of the growth? And so we're trying to get as much of a read on that as quickly as we can. And then we talk about the staffing ratios in Colorado. It's a big market, there's a lot of people. And so the growth rate in Colorado following a year of not growing can have real impact on those ratios. We have to understand that. And we also -- I also mentioned, I think, in my prepared remarks, just this notion of the post monitoring oversight by the regulators continues to be pretty resource intensive. And so we're going to work hard over the next few months to dial all these things in. But I don't think we're ready to say today exactly what date guidance will be reinstituted but we're very committed to getting there as quickly as possible. Barb, anything you'd add?

我認為我們談到的一個問題是我們在佛羅里達州取得了巨大進展，但佛羅里達州何時開始創收仍然是一個問題。我認為這是我們想要更好地閱讀的內容。巴布提到了我們的參與者組合。還有一個問題是，隨著增長，風險池會以多快的速度重新平衡和正常化？因此，我們正在努力盡快獲得盡可能多的信息。然後我們討論科羅拉多州的人員配置比例。市場很大，人也很多。因此，科羅拉多州在一年沒有增長後的增長率會對這些比率產生真正的影響。我們必須明白這一點。我想，在我準備好的發言中，我們還提到，監管機構進行事後監督的概念仍然需要大量資源。因此，我們將在接下來的幾個月裡努力完成所有這些工作。但我認為我們今天還沒有準備好確切地說出將重新制定指導的日期，但我們非常致力於實現這一目標盡快。巴布，你還有什麼要補充的嗎？

No.

不。

And maybe her second question.

也許是她的第二個問題。

Yes -- and yes, glad to answer any other specific questions, Lisa. That was helpful.

是的——是的，很高興回答任何其他具體問題，麗莎。這很有幫助。

And the second one was just really around the ramp. Now that Sacramento is back online, how quickly can you start to get new patients into your facilities?

第二個就在坡道附近。現在薩克拉門托已恢復上線，您可以多快開始讓新患者進入您的設施？

Yes. Good question. So we -- the sanctions were lifted in Colorado, I think it was January 23. It took us a bit of time to ramp up the enrollment process. So our March enrollment was, I'll say, good given the time that we had, but it was limited as you -- if you compare that to sort of historical run rates. But in April and May, we've had nice momentum. So I think we're tracking well with our internal targets, and we've got a solid pipeline of prospects who are interested in joining PACE. I think we're probably seeing a few more that need to get their Medicaid coverage, which can take 60 to 90 days, but that's not everyone in the pipeline. So we still have some -- we definitely have some folks that are ready to enroll now.

是的。好問題。所以我們——科羅拉多州取消了製裁，我想那是 1 月 23 日。我們花了一些時間來加快註冊流程。因此，我想說，考慮到我們所擁有的時間，我們三月份的入學情況很好，但如果你將其與歷史運行率進行比較的話，它和你一樣有限。但在四月和五月，我們的勢頭很好。因此，我認為我們正在很好地跟踪我們的內部目標，並且我們擁有穩定的有興趣加入 PACE 的潛在客戶渠道。我認為我們可能會看到更多的人需要獲得醫療補助，這可能需要 60 到 90 天的時間，但這並不是每個人都在等待。所以我們仍然有一些人——我們肯定有一些人現在已經準備好註冊。

I expect that we're going to get back to our historical run rate in Colorado in the first quarter of the new fiscal year. We're certainly challenging ourselves to pull that forward and improve productivity in every market. But I think that's -- and if I sort of zoom out and think about the full business, I would say, excluding de novos, we expect to be back at historical net monthly enrollment levels in the first quarter of 2024 of our fiscal year. We're certainly challenging ourselves to do it faster. But right now, that feels like the right trajectory to get back to those historical levels.

我預計我們將在新財年第一季度恢復科羅拉多州的歷史運行率。我們當然會挑戰自己，推動這一進程並提高每個市場的生產力。但我認為，如果我縮小範圍並考慮整個業務，我會說，排除新的業務，我們預計將在 2024 財年第一季度恢復到歷史月度淨註冊水平。我們當然會挑戰自己，以更快地做到這一點。但現在，這感覺像是回到歷史水平的正確軌跡。

(Operator Instructions) And our next question comes from Matt Larew from William Blair.

（操作員說明）我們的下一個問題來自威廉·布萊爾的馬特·拉魯（Matt Larew）。

This is actually Madeline on for Matt. I was just wondering, obviously, small sample size right now, but have you seen -- anything you can say about acuity trends in the population that you're enrolling in Colorado so far or like risk score trends there?

這實際上是瑪德琳為馬特做的。我只是想知道，顯然，現在的樣本量很小，但是你有沒有看到——關於你目前在科羅拉多州註冊的人口的敏銳度趨勢或那裡的風險評分趨勢，你能說些什麼嗎？

I think it's a bit too early before that. We're just a couple of months in here, and it takes a little time for the participant profile and the claims history to build. So it's just a little early to answer that.

我認為在此之前有點太早了。我們在這裡才幾個月，需要一點時間來建立參與者資料和索賠歷史記錄。所以現在回答這個問題還為時過早。

Got it. And just thinking about the enrollment process in general. I think you mentioned that you're sort of learning to exercise that muscle again. Anything that you've learned from the Colorado process that you think would make Sacramento more smooth or make it easier to start on adding new patients in Sacramento?

知道了。只是考慮一下一般的註冊過程。我想你提到過你正在學習再次鍛煉那塊肌肉。您從科羅拉多州的流程中學到了什麼，您認為這將使薩克拉門托更加順利，或者使在薩克拉門托開始增加新患者變得更容易？

No, I think one of the things that we focused on a lot is really spending time to build our referral engagement channels. So we have a variety of community-based organizations that we work with, everything from sort of benefits counseling to faith-based organization to food pantries, foster care, housing alternatives. I mean, the list goes on. I think we did a really nice job of building a game plan in Colorado for each of those channels. And we've gotten a jump-start on that in Sacramento. So I think just getting a great view of the landscape is really important. And I also think that Sacramento is just one center. So it's a lot less complex to sort of ramp up than the whole -- our largest market has been in Colorado. So I think we got our first enrollment already in Sacramento. So I think we're feeling good about the ramp up there, and we think it will kind of follow the shape of Colorado in terms of build-out.

不，我認為我們非常關注的事情之一是真正花時間建立我們的推薦參與渠道。因此，我們與各種基於社區的組織合作，從福利諮詢到基於信仰的組織，再到食品儲藏室、寄養、住房替代方案。我的意思是，這樣的例子不勝枚舉。我認為我們在科羅拉多州為每個渠道製定了遊戲計劃方面做得非常好。我們在薩克拉門托已經開始了這方面的工作。所以我認為欣賞風景非常重要。我也認為薩克拉門托只是一個中心。因此，與整體相比，擴大規模要簡單得多——我們最大的市場位於科羅拉多州。所以我認為我們已經在薩克拉門托迎來了第一批入學。所以我認為我們對那裡的坡道感覺很好，我們認為它在建設方面會遵循科羅拉多州的形狀。

And then just one more for me. Thinking about the Florida centers, I think you mentioned last quarter that you were leading on some licensures, like adult day care license and things like that. Is that still sort of what's holding up the process? Or can you talk a little bit about what more there is to do in Florida from a regulatory standpoint? .

然後再給我一個。考慮到佛羅里達州的中心，我想您上個季度提到您在一些許可證方面處於領先地位，例如成人日托許可證等。這仍然是阻礙這一進程的原因嗎？或者您能否從監管的角度談談佛羅里達州還有哪些工作要做？ 。

Sure, sure. Well, first thing I would say is we're very pleased with the progress. We've had great engagement with the state. I think we're sort of blessed to have them -- to have the state so interested in us entering the market as a PACE provider. We resumed as soon as the sanctions were lifted, in Colorado, we resumed the application process. We're pleased with the adult day care application. It's -- that's what we're executing on right now, is the adult day care application. And then there's a state readiness review and a CMS review and then there's the 3-way agreement. So overall, I think we're tracking nicely to get this done before the end of the calendar year, and we're going to do everything we can that's in our control to pull that forward even earlier in the year if possible. So I couldn't be more excited about Florida.

一定一定。嗯，我首先要說的是我們對進展感到非常滿意。我們與國家進行了很好的接觸。我認為我們很幸運能擁有他們——國家對我們作為 PACE 提供商進入市場如此感興趣。制裁一解除，我們就恢復了，在科羅拉多州，我們恢復了申請程序。我們對成人日托申請感到滿意。這就是我們現在正在執行的成人日托應用程序。然後是州準備情況審查和 CMS 審查，然後是三方協議。因此，總的來說，我認為我們正在很好地跟踪在日曆年年底之前完成這項工作，並且我們將盡我們所能，在可能的情況下，在今年早些時候推動這項工作。所以我對佛羅里達感到非常興奮。

And our next question comes from Jamie Perse from Goldman Sachs.

我們的下一個問題來自高盛的 Jamie Perse。

This is [Najeeb] a for Jamie Perse. So I was just wondering about external provider costs, I mean, they were down this quarter. And I was just wondering if -- where do you expect it to trend going forward or past this quarter in terms of percentage?

這是傑米·珀斯 (Jamie Perse) 的 [Najeeb]。所以我只是想知道外部提供商的成本，我的意思是，他們本季度有所下降。我只是想知道，您預計本季度未來或過去的百分比趨勢如何？

Yes, sure. So, Hi it's Barbara. I'll take that question. So the -- you're right, the trend is down this quarter. We did mention that in large part, that was due to a pharmacy rebate that we received during the quarter. So about 2/3 of that decrease relates to that. But there is definitely, we are seeing some improvement as it relates to some of our clinical value initiatives and other things we're focusing on. I think both Patrick and I in our prepared remarks, for example, mentioned some efforts related to the short-stay skilled nursing facility that we're seeing some nice trends. So embedded in that decrease are some nice trends related to the medical cost. But for this quarter, in particular, that was -- the bulk of it, 2/3 of it was related to the pharmacy rebate.

是的，當然。那麼，嗨，我是芭芭拉。我來回答這個問題。所以——你是對的，本季度的趨勢是下降的。我們確實提到，這在很大程度上是由於我們在本季度收到的藥房回扣。因此，大約 2/3 的下降與此相關。但肯定的是，我們看到了一些改進，因為它與我們的一些臨床價值計劃和我們關注的其他事情有關。例如，我認為帕特里克和我在準備好的發言中都提到了與短期停留熟練護理設施相關的一些努力，我們看到了一些良好的趨勢。因此，這種下降背後隱藏著一些與醫療費用相關的良好趨勢。但特別是在本季度，其中大部分，2/3 與藥品回扣有關。

And thank you. And I am showing no further questions. I would now like to turn the call back over to Patrick Blair, President and CEO, for closing remarks.

謝謝你。我沒有提出任何進一步的問題。現在，我想將電話轉回給總裁兼首席執行官帕特里克·布萊爾 (Patrick Blair)，讓其致閉幕詞。

Well, thank you very much. I appreciate everyone who joined the call. We continue to believe that the company is on the right track, and we're excited about our future and excited about closing one chapter and beginning a new chapter. And we look forward to the discussion on our incremental progress in another few months. So thank you for your time today.

好的，謝謝。我感謝所有加入通話的人。我們仍然相信公司正走在正確的軌道上，我們對我們的未來感到興奮，對結束一個篇章並開始新的篇章感到興奮。我們期待在接下來的幾個月內討論我們的漸進進展。謝謝您今天抽出時間。

This concludes today's conference call. Thank you for participating. You may disconnect. Thank you.

今天的電話會議到此結束。感謝您的參與。您可以斷開連接。謝謝。