LifeStance Health Group Inc (LFST) 2022 Q4 法說會逐字稿

Ladies and gentlemen, welcome to the LifeStance Health Fourth Quarter 2022 Earnings Call. Please note, today's conference is being recorded. (Operator Instructions) At this time, I will turn the conference over to Monica Prokocki, VP of Investor Relations. You may begin.

女士們，先生們，歡迎來到 LifeStance Health 2022 年第四季度財報電話會議。請注意，今天的會議正在錄製中。 （操作員說明）此時，我將把會議轉交給投資者關係副總裁 Monica Prokocki。你可以開始了。

Thank you. Good morning, everyone, and welcome to Life stance Health Fourth Quarter 2022 Earnings Conference Call. I'm Monica Prokocki, Vice President of Investor Relations. Joining me today are Ken Burdick, Chief Executive Officer; Dave Bourdon, Chief Financial Officer; and Danish Qureshi, Chief Operating Officer. We issued the earnings release and presentation before the market opened this morning. Both are available on the Investor Relations section of our website, investor.lifestane.com. In addition, a replay of this conference call will be available following the call. Before turning the call over to management for their prepared remarks, please direct your attention to the disclaimers about forward-looking statements included in the earnings press release and SEC filings.

謝謝。大家早上好，歡迎來到 Life stance Health 2022 年第四季度收益電話會議。我是投資者關係副總裁 Monica Prokocki。今天加入我的是首席執行官 Ken Burdick；首席財務官 Dave Bourdon；和首席運營官 Danish Qureshi。我們在今天早上開市前發布了收益報告和演示文稿。兩者均可在我們網站 investor.lifestane.com 的投資者關係部分找到。此外，電話會議後將提供此電話會議的重播。在將電話轉給管理層聽取他們準備好的評論之前，請注意收益新聞稿和美國證券交易委員會備案文件中包含的有關前瞻性陳述的免責聲明。

Today's remarks contain forward-looking statements, including statements about our financial performance outlook, business model and strategy. Those statements involve risks, uncertainties and other factors, as noted in our periodic filings with the SEC that could cause actual results to differ materially. In addition, please note that we report results using non-GAAP financial measures, which we believe provide additional information for investors to help facilitate comparison of prior and past performance. A reconciliation to the most directly comparable GAAP measures is included in the earnings press release tables and presentation appendix. Unless otherwise noted, all results are compared to the prior year comparative period.

今天的評論包含前瞻性陳述，包括關於我們的財務業績展望、商業模式和戰略的陳述。正如我們定期向美國證券交易委員會提交的文件中指出的那樣，這些聲明涉及風險、不確定性和其他因素，可能導致實際結果出現重大差異。此外，請注意，我們使用非 GAAP 財務指標報告結果，我們認為這為投資者提供了額外信息，有助於比較之前和過去的表現。與最直接可比的 GAAP 措施的對賬包含在收益新聞稿表和演示文稿附錄中。除非另有說明，否則所有結果均與上一年比較期相比。

At this time, I'll turn the call over to Ken Burdick, CEO of LifeStance. Ken?

此時，我會將電話轉給 LifeStance 的首席執行官 Ken Burdick。肯？

Good morning, and thank you for joining us today. I would like to start by highlighting the tremendous opportunity ahead. Life stance is leveraging our nationwide market-leading outpatient platform of over 5,600 clinicians with the mission of increasing access to trusted affordable and personalized mental health care. Our diverse mix of clinicians offers a multidisciplinary approach that allows us to treat all types of mental health diagnosis through our hybrid model of virtual and in-person care. We remain focused on reinforcing the strategic advantages offered by our hybrid model, which gives both our providers and patients, highly desired flexibility.

早上好，感謝您今天加入我們。我想首先強調未來的巨大機遇。 Life Stance 正在利用我們全國市場領先的門診平台，該平台擁有超過 5,600 名臨床醫生，其使命是增加獲得可信賴的負擔得起的個性化心理保健服務的機會。我們多樣化的臨床醫生組合提供了一種多學科方法，使我們能夠通過虛擬和麵對面護理的混合模型來治療所有類型的心理健康診斷。我們仍然專注於加強我們的混合模式所提供的戰略優勢，這為我們的提供者和患者提供了高度期望的靈活性。

Importantly, as the public health emergency, or PHE, ends in May of this year, we are well positioned to support patients by compliantly providing care, both virtually and in our centers. We are continuing to expand access to affordable high-quality care by providing mental health services through in-network commercial reimbursement. In 2022, our clinicians treated over 680,000 unique patients with approximately 5.7 million visits. Through the company's early years of tremendous growth, we've been in an all-out sprint. Now we're focused on building scalable processes and systems not only to support the level of growth we've already attained but to prepare life stance for the huge opportunity in front of us.

重要的是，由於突發公共衛生事件 (PHE) 將於今年 5 月結束，我們已做好充分準備，通過在虛擬場所和在我們的中心提供合規護理來支持患者。我們通過網絡內商業報銷提供心理健康服務，繼續擴大獲得負擔得起的高質量護理的機會。 2022 年，我們的臨床醫生治療了超過 680,000 名獨特的患者，訪問量約為 570 萬。通過公司早期的巨大增長，我們一直在全力衝刺。現在，我們專注於構建可擴展的流程和系統，不僅要支持我們已經達到的增長水平，還要為我們面前的巨大機遇做好生活準備。

As previously shared, we are committed to enhancing our operational performance and delivering profitable and sustainable growth. To that end, we continue to focus on execution, the blocking and tackling required to operate a growing business at scale. In our last earnings call, I highlighted several areas that will receive greater emphasis at Life stance going forward. First, we will focus on long-term profitability, capital discipline and generating free cash flow. For example, to improve our operating leverage and cash generation, we are in the process of evaluating life stances over 600 physical centers to optimize our real estate spend. We expect to further moderate de novo growth and consolidate approximately 30 to 40 offices with minimal to no disruption to our clinicians or patients due to the close proximity of some of our offices.

如前所述，我們致力於提高我們的運營績效並實現盈利和可持續增長。為此，我們繼續專注於執行，即大規模運營不斷增長的業務所需的阻止和應對。在我們上次的財報電話會議上，我強調了幾個在未來的 Life stance 中將受到更多重視的領域。首先，我們將專注於長期盈利能力、資本紀律和產生自由現金流。例如，為了提高我們的經營槓桿和現金生成，我們正在評估 600 多個實體中心的生活狀況，以優化我們的房地產支出。由於我們的一些辦公室距離很近，我們預計將進一步適度從頭增長並整合大約 30 至 40 個辦公室，而對我們的臨床醫生或患者的干擾最小或不受影響。

Second, we will make strategic investments in enterprise-level scalable infrastructure over the next few years, beginning this year. As a reminder, when we refer to scalable infrastructure, we mean strengthening our underlying platform through end-to-end process optimization, standardization and automation to reduce manual processes. Third, as we focus on simplifying administrative complexity, our payer strategy will become more selective. As a reminder, the bottom 50% of our payer contracts represent less than 6% of our visit volume. By the end of this year, our goal is to reduce our number of payer contracts by approximately 25%. This will reduce administrative burden while allowing us to better align with payer partners who share and invest in our vision and mission of expanding access to high-quality, affordable mental health care.

其次，從今年開始，我們將在未來幾年對企業級可擴展基礎架構進行戰略投資。提醒一下，當我們提到可擴展的基礎設施時，我們指的是通過端到端流程優化、標準化和自動化來加強我們的底層平台，以減少手動流程。第三，由於我們專注於簡化行政復雜性，我們的付款人策略將變得更具選擇性。提醒一下，我們支付合同中排名靠後的 50% 只占我們訪問量的不到 6%。到今年年底，我們的目標是將付款合同的數量減少約 25%。這將減輕行政負擔，同時使我們能夠更好地與付款合作夥伴保持一致，他們分享並投資於我們的願景和使命，即擴大獲得高質量、負擔得起的精神衛生保健的機會。

Fourth, we continue to shift toward organic growth versus acquired growth. In 2022, over 80% of our gross clinician adds were hired rather than acquired. Acquisitions were absolutely crucial to building scale and life stances early years, but with a broad footprint now in place across 34 states, we are hyper focused on the organic growth opportunity in this massive market. Finally, I'd like to highlight an encouraging data point that reflects initial progress in strengthening our operational performance. In the fourth quarter, we saw benefits to our free cash flow as a direct result of the investments we made in our revenue cycle management process.

第四，我們繼續轉向有機增長而不是收購增長。 2022 年，超過 80% 的總臨床醫生是被聘用的，而不是被收購的。收購對於早期建立規模和生活態度絕對至關重要，但現在我們的足跡遍布 34 個州，我們非常關注這個龐大市場的有機增長機會。最後，我想強調一個令人鼓舞的數據點，它反映了我們在加強運營績效方面取得的初步進展。在第四季度，我們在收入周期管理流程中進行的投資直接導致我們的自由現金流受益。

The 8-day improvement in days sales outstanding, or DSO, brought this quarter's DSO to 40 days, down from last quarter's 48 days -- turning to financial results for the fourth quarter of 2022, revenue of $229 million and center margin of $63 million exceeded our expectations. Adjusted EBITDA of $10 million was at the high end of our guidance range for the fourth quarter. While we are encouraged by these recent results, we recognize that there is much more work to do before we achieve meaningful and sustainable improvement in our operational and financial performance.

銷售未完成天數 (DSO) 縮短了 8 天，使本季度的 DSO 從上一季度的 48 天縮短至 40 天——轉向 2022 年第四季度的財務業績，收入為 2.29 億美元，中心利潤率為 6300 萬美元超出了我們的預期。調整後的 EBITDA 為 1000 萬美元，處於我們第四季度指導範圍的高端。雖然我們對最近的這些結果感到鼓舞，但我們認識到，在我們的運營和財務績效實現有意義和可持續的改善之前，還有很多工作要做。

In terms of our outlook, as we have commented previously, the next 2 years will be focused on making strategic investments in our business to fortify our operating platform. This important but unglamorous work to standardize and simplify our end-to-end processes will enable us to introduce tools that will improve the consistency, efficiency and capacity of our operations. In his prepared remarks, Dave will outline our 2023 expectations and provide specifics on the strategic investments that will begin this year. Consistent with what we committed to last quarter, Dave will also share our multiyear guidance, which serves as a bridge to our future profitability and cash flow generation. We will strengthen the foundation in 2023 and 2024 to set up life stance for success in the long term.

就我們的前景而言，正如我們之前評論的那樣，未來 2 年將專注於對我們的業務進行戰略投資，以加強我們的運營平台。這項旨在標準化和簡化端到端流程的重要但乏味的工作將使我們能夠引入能夠提高我們運營的一致性、效率和能力的工具。在準備好的發言中，Dave 將概述我們對 2023 年的期望，並提供有關將於今年開始的戰略投資的具體信息。與我們上個季度的承諾一致，Dave 還將分享我們的多年指導，作為我們未來盈利能力和現金流生成的橋樑。我們將在 2023 年和 2024 年鞏固基礎，為長期成功樹立人生立場。

In closing, I remain bullish about the opportunity in front of us. I am also realistic about the amount of enterprise-wide focus and effort that will be required to fundamentally improve our business. I am confident that our newly launched Business Transformation Office will drive the change management processes required in an organization of our size. I have led this type of transformation previously in my career, and I am confident that we have the right people, strategy and multiyear plan to effectively position life stance for the robust opportunities that lie ahead. I will now turn it over to Dave to provide additional commentary on our financial performance and outlook. Dave?

最後，我仍然看好我們面前的機會。對於從根本上改善我們的業務所需的全企業範圍的關注和努力，我也持現實態度。我相信我們新推出的業務轉型辦公室將推動我們這種規模的組織所需的變革管理流程。我之前在我的職業生涯中領導過這種類型的轉型，我相信我們擁有合適的人員、戰略和多年計劃，可以有效地為未來的強勁機遇定位人生立場。我現在將其轉交給戴夫，就我們的財務業績和前景提供更多評論。戴夫？

Thank you, Ken. I'm very pleased to participate in my first life stance earnings call. I joined this company because of its unique market position, compelling mission, significant growth opportunity and talented team. I look forward to working with our team to increase our financial discipline and improve our annual and multiyear planning processes so that we can consistently deliver on our commitments. Now turning to our fourth quarter performance. Life stance delivered strong top line results. Revenue of $229 million increased 21% year-over-year, with the outperformance in the quarter, primarily driven by higher-than-expected clinician count and productivity. Visit volumes of $1,487,000 increased 16% year-over-year. Total revenue per visit increased 4% year-over-year to $154 a -- our revenue is a function of visit volumes and total revenue per visit.

謝謝你，肯。我很高興參加我的第一次人生立場收益電話會議。我加入這家公司是因為它獨特的市場地位、令人信服的使命、重大的發展機會和才華橫溢的團隊。我期待與我們的團隊合作，加強我們的財務紀律並改進我們的年度和多年規劃流程，以便我們能夠始終如一地履行我們的承諾。現在轉向我們的第四季度業績。生活態度帶來了強勁的頂線結果。收入為 2.29 億美元，同比增長 21%，本季度表現出色，這主要是由於臨床醫生人數和工作效率高於預期。訪問量為 1,487,000 美元，同比增長 16%。每次訪問的總收入同比增長 4% 至 154 美元——我們的收入是訪問量和每次訪問總收入的函數。

Therefore, we look forward to reporting these metrics on a quarterly basis going forward. Historical information beginning with the first quarter of 2022 is provided in the earnings materials posted to our website. For the full year, we delivered revenue of $860 million, up 29% year-over-year. Additionally, the better-than-expected top line results flowed through to center margin. Center margin of $63 million in the quarter increased by 16% year-over-year. Full year center margin of $237 million grew 18% year-over-year. Adjusted EBITDA of $10 million in the quarter was at the high end of our guidance range and included investments across the business, such as growing our revenue cycle management team. These investments were accelerated. And as a result, G&A was higher than previously expected. For the full year, adjusted EBITDA was $53 million, representing 6.1% of revenue. Turning to liquidity. In the fourth quarter, we generated positive free cash flow of $26 million and $36 million in cash from operating activity.

因此，我們期待在未來每季度報告這些指標。從 2022 年第一季度開始的歷史信息在我們網站上發布的收益材料中提供。全年，我們實現了 8.6 億美元的收入，同比增長 29%。此外，好於預期的營收結果也影響到了中心利潤率。本季度中心利潤為 6300 萬美元，同比增長 16%。全年中心利潤率為 2.37 億美元，同比增長 18%。本季度調整後的 EBITDA 為 1000 萬美元，處於我們指導範圍的高端，包括整個業務的投資，例如擴大我們的收入周期管理團隊。這些投資得到了加速。結果，G&A 高於之前的預期。全年，調整後的 EBITDA 為 5300 萬美元，佔收入的 6.1%。轉向流動性。第四季度，我們產生了 2600 萬美元的正自由現金流和 3600 萬美元的經營活動現金。

As Ken mentioned, these positive improvements in cash flow were driven by improved collections. We are encouraged by this progress and see it as a tangible return on our investment in this team. Our DSO fell by 8 days quarter-over-quarter. And I'd like to highlight that each one of these days represents roughly $2.5 million. Additionally, capital expenditures were consistent with our strategy of moderating the pace of de novo center openings. We exited the quarter with cash of $109 million and net long-term debt of $225 million. We have additional debt capacity from a delayed draw term loan of $66 million as well as a $50 million revolving debt facility, providing us with sufficient financial flexibility. In terms of our outlook for 2023, we expect full year revenue of $980 million to $1.02 billion. center margin of $270 million to $290 million and adjusted EBITDA of $50 million to $62 million. Our annual guidance assumes year-over-year revenue growth driven primarily by higher clinicians and visits combined with a modest increase in the total revenue per visit.

正如 Ken 所提到的，這些現金流的積極改善是由收款改善推動的。我們對這一進展感到鼓舞，並將其視為我們對該團隊投資的切實回報。我們的 DSO 環比下降了 8 天。我想強調的是，這些天中的每一天都代表著大約 250 萬美元。此外，資本支出與我們放慢從頭開設中心的步伐的戰略是一致的。我們以 1.09 億美元的現金和 2.25 億美元的淨長期債務退出了本季度。我們通過 6600 萬美元的延遲提取定期貸款和 5000 萬美元的循環債務安排獲得了額外的債務能力，為我們提供了足夠的財務靈活性。就我們對 2023 年的展望而言，我們預計全年收入為 9.8 億美元至 10.2 億美元。中心利潤為 2.7 億美元至 2.9 億美元，調整後的 EBITDA 為 5000 萬至 6200 萬美元。我們的年度指南假設收入同比增長主要是由更高的臨床醫生和訪問量以及每次訪問的總收入的適度增長推動的。

Otherwise, we are assuming generally consistent operational performance year-over-year. Our guidance also contemplates a revenue split of roughly 50-50 in the first and second half of the year due to seasonality. We expect G&A to grow at a higher rate than revenue as we invest in strengthening the business, which is depressing margins year-over-year. For the first quarter, we expect revenue of $242 million to $252 million, center margin of $62 million to $69 million and adjusted EBITDA of $7 million to $12 million. We expect first quarter adjusted EBITDA margins to be down sequentially due to payroll taxes and seasonality related to some of our services due to the reset of patient deductibles. We also expect incremental G&A expenses in the first quarter, driven by additional investments to support the business. We then expect margins to improve for the remainder of the year, resulting in modestly more earnings in the second half versus the first half of the year.

否則，我們假設運營業績同比大體一致。由於季節性因素，我們的指引還考慮了今年上半年和下半年大約 50-50 的收入分配。我們預計 G&A 的增長速度將高於收入，因為我們投資於加強業務，這使得利潤率同比下降。對於第一季度，我們預計收入為 2.42 億美元至 2.52 億美元，中心利潤率為 6200 萬至 6900 萬美元，調整後的 EBITDA 為 700 萬至 1200 萬美元。我們預計第一季度調整後的 EBITDA 利潤率將連續下降，原因是由於患者免賠額的重置導致與我們的一些服務相關的工資稅和季節性。我們還預計，在支持業務的額外投資推動下，第一季度的 G&A 費用將有所增加。然後，我們預計今年剩餘時間的利潤率將有所提高，從而導致下半年的收益略高於上半年。

Additionally, we expect stock-based compensation expense of approximately $90 million to $110 million in 2023, including approximately $25 million from the new 2023 grants. For the year, we are expecting M&A spend of approximately $40 million, inclusive of up to $20 million in earn-outs from prior year's acquisitions. We continue to have a strong balance sheet and do not anticipate the need to raise capital in 2023. We expect to have negative free cash flow in the first half of the year, primarily driven by 2 factors: First, compensation costs such as higher payroll taxes, bonus payments and the funding of the 401(k); and second, temporarily higher DSO driven by an increase in patient responsibility as deductibles reset in January. We expect to generate positive free cash flow in the second half of the year with the absence of these first half costs, along with DSO improving from first quarter levels. As Ken highlighted, we believe it's imperative to make strategic investments in those areas, which will deliver significant long-term benefits that enable LifeStance to better serve our patients, clinicians and team members while achieving operating leverage as we continue to grow. We have identified 3 critical investments that will occur over the next 24 to 36 months. These investments are: one, implementing an HRIS system to effectively manage the entire life cycle of our employees; two, implementing a technology platform that enables credentialing and onboarding of clinicians; and three, enhancing our electronic health record or EHR experience. We will identify the nonrecurring spend for these strategic initiatives as a discrete add-back item to calculate adjusted EBITDA.

此外，我們預計 2023 年基於股票的薪酬支出約為 9000 萬至 1.1 億美元，其中包括來自 2023 年新贈款的約 2500 萬美元。今年，我們預計併購支出約為 4000 萬美元，其中包括高達 2000 萬美元的前一年收購收益。我們繼續擁有強勁的資產負債表，預計 2023 年不需要籌集資金。我們預計今年上半年的自由現金流量為負，主要受兩個因素驅動：首先，工資增加等薪酬成本稅收、獎金支付和 401(k) 計劃的資金；其次，由於 1 月份免賠額重置，患者責任增加導致 DSO 暫時升高。我們預計在沒有這些上半年成本的情況下，下半年將產生正的自由現金流，同時 DSO 比第一季度水平有所改善。正如 Ken 強調的那樣，我們認為必須在這些領域進行戰略投資，這將帶來顯著的長期利益，使 LifeStance 能夠更好地為我們的患者、臨床醫生和團隊成員服務，同時隨著我們的持續發展實現運營槓桿。我們確定了未來 24 至 36 個月內將發生的 3 項關鍵投資。這些投資是：一是實施 HRIS 系統，以有效管理我們員工的整個生命週期；第二，實施一個技術平台，使臨床醫生能夠進行資格認證和入職；第三，增強我們的電子健康記錄或 EHR 體驗。我們會將這些戰略計劃的非經常性支出確定為一個離散的追加項目，以計算調整後的 EBITDA。

Once implemented, the ongoing costs will come through as G&A. We are in the planning and implementation phases of the HRIS and the technology platform that supports credentialing and onboarding. We expect those to be completed in the next 12 to 18 months with a cost of approximately $6 million to $8 million. Of this, $2.5 million to $3.5 million will be recognized as G&A expenses with the remainder in CapEx. We anticipate that the majority of the investment will be incurred this year. The EHR initiative is in the very early stages of discovery. We expect to use most of 2023 to evaluate a range of options from collaborating with our current vendor to implementing an alternative vendor solution. We will update you when we provide 2024 guidance on our path forward, estimated costs and time line for the EHR initiative.

一旦實施，持續成本將作為 G&A 產生。我們正處於 HRIS 和支持認證和入職的技術平台的規劃和實施階段。我們預計這些將在未來 12 至 18 個月內完成，成本約為 600 萬至 800 萬美元。其中，250 萬至 350 萬美元將確認為 G&A 費用，其餘部分計入資本支出。我們預計大部分投資將在今年發生。 EHR 計劃正處於發現的早期階段。我們預計將使用 2023 年的大部分時間來評估一系列選項，從與我們當前的供應商合作到實施替代供應商解決方案。當我們就 EHR 計劃的前進道路、估計成本和時間表提供 2024 年指導時，我們將向您更新。

All in all, 2023 is going to be a busy year. We are ambitious. We are committed, and we are going to execute on our key initiatives. We know there is significant growth ahead, and we are building this company for a long and bright future. We will make the necessary investments along the way to ensure we fully capture that opportunity. In regards to our outlook through 2025, we expect organic revenue to deliver mid-teens annual growth for the next 2 to 3 years with potential future M&A being incremental to that level of growth. We expect material adjusted EBITDA margin expansion in 2024 and 2025 with a trajectory to double-digit margins by the end of 2025. We -- the improvement from current levels will be driven by rate improvement with payers, operating leverage and growth of higher-margin mental health offerings such as neuro site testing and group therapy. We expect to be free cash flow positive for 2025 to fund both organic as well as moderate M&A growth.

總而言之，2023 年將是忙碌的一年。我們雄心勃勃。我們承諾，我們將執行我們的關鍵舉措。我們知道未來會有顯著的增長，我們正在建設這家公司，以迎接一個漫長而光明的未來。我們將在此過程中進行必要的投資，以確保我們充分抓住這個機會。關於我們到 2025 年的展望，我們預計有機收入將在未來 2 到 3 年內實現十幾歲的年度增長，未來潛在的併購將增加到這一增長水平。我們預計 2024 年和 2025 年調整後的 EBITDA 利潤率將大幅增長，到 2025 年底利潤率將達到兩位數。我們 - 當前水平的改善將受到付款人利率改善、經營槓桿和更高利潤率增長的推動心理健康服務，例如神經部位測試和團體治療。我們預計 2025 年的自由現金流將為正數，為有機增長和適度的併購增長提供資金。

With that, I'll turn it over to Danish for additional color with respect to operations.

有了這個，我將把它轉為丹麥語，以獲得與操作相關的額外顏色。

Thank you, Dave. As mentioned on our last earnings call, we've aligned our teams around 2 business priorities: one, clinician growth; and two, clinician productivity. In terms of clinician growth, we saw 200 net clinician adds in the fourth quarter, bringing our total to 5,631, an increase of approximately 18% year-over-year. Importantly, this growth was approximately 80% organic. Regarding productivity, we saw our clinician capacity or the time clinicians make available to see patients trend relatively in line with the previous quarter. In terms of utilization or our ability to fill clinician time to patients, we continue driving operational discipline with a focus on the top, middle and bottom of the patient funnel.

謝謝你，戴夫。正如我們在上一次財報電話會議上提到的那樣，我們已經圍繞 2 個業務優先事項調整了我們的團隊：一是臨床醫生的成長；第二，臨床醫生的生產力。在臨床醫生增長方面，我們在第四季度看到 200 名臨床醫生淨增加，使我們的總數達到 5,631 名，同比增長約 18%。重要的是，這種增長大約有 80% 是有機的。關於生產力，我們看到我們的臨床醫生能力或臨床醫生可以看到患者的時間趨勢與上一季度相對一致。在利用率或我們為患者填補臨床醫生時間的能力方面，我們繼續推動運營紀律，重點放在患者漏斗的頂部、中部和底部。

At the top of the funnel, we made enhancements to our primary care referral team, organic search traffic, internal clinician referrals and enterprise referral partnerships. These actions delivered improvements in attracting new patients. Second, at the middle of the funnel, in terms of converting patients to scheduled appointments, we continue to leverage our digital capabilities to improve patient matching via our online booking experience, OB. By 2022 year-end, OVI was live in 20 states, and we remain on pace for a full national rollout by midyear. Additionally, we enhanced our overall user experience through better online provider profiles, reduce schedule and complexity and enhancements to our phone intake processes, all of which have led to improvements at the middle of the funnel. Finally, at the bottom of the funnel, in terms of scheduled deployments converting to completed visits, our cancellation rates improved by 0.5 point in the fourth quarter.

在漏斗的頂部，我們對我們的初級保健推薦團隊、自然搜索流量、內部臨床醫生推薦和企業推薦合作夥伴關係進行了改進。這些行動在吸引新患者方面取得了進步。其次，在漏斗的中間，在將患者轉換為預定預約方面，我們繼續利用我們的數字功能，通過我們的在線預訂體驗 OB 來改善患者匹配。到 2022 年底，OVI 已在 20 個州上線，我們將繼續保持在年中之前在全國全面推廣的步伐。此外，我們通過更好的在線供應商資料、減少時間表和復雜性以及增強我們的電話接收流程來增強我們的整體用戶體驗，所有這些都導致了漏斗中間的改進。最後，在漏斗底部，就計劃部署轉化為完成訪問而言，我們的取消率在第四季度提高了 0.5 個百分點。

All of these improvements at the top, middle and bottom funnel contributed to better-than-expected productivity in the fourth quarter. Turning to our hybrid model. As Ken mentioned, the PHE is ending on May 11, and we expect this will further magnify the competitive differentiation of our hybrid offering. Life stance can seamlessly provide services even as PHE winds down and in-person requirements resume. To avoid disruption in our patient's care, our Chief Medical Officer has set forth a plan that meets the in-person requirements for the prescribing of controlled substances. We believe our hybrid model positions us well to capture patient preferences for both in-person and virtual visits, including increasing demand for in-person care. We provide our patients with the highest degree of flexibility and our NPS score of 78 in 2022 reflects the quality of our patient experience.

頂部、中部和底部漏斗的所有這些改進促成了第四季度好於預期的生產率。轉向我們的混合模型。正如 Ken 所提到的，PHE 將於 5 月 11 日結束，我們預計這將進一步擴大我們混合產品的競爭優勢。 Life stance 可以無縫地提供服務，即使 PHE 結束並且面對面的需求恢復。為避免中斷對患者的護理，我們的首席醫療官制定了一項計劃，以滿足開具受控物質處方的要求。我們相信，我們的混合模型使我們能夠很好地捕捉患者對面對面和虛擬就診的偏好，包括對面對面護理不斷增長的需求。我們為患者提供最高程度的靈活性，我們在 2022 年的 NPS 得分為 78，反映了我們患者體驗的質量。

Turning to real estate. Physical centers remain a core part of our hybrid strategy. However, we see opportunities to optimize our existing footprint. We looked at factors like in-person usage of each center and proximity to other locations to allow us to leverage our occupancy costs and allocate resources in a thoughtful and efficient way. As a result, we plan to consolidate 30 to 40 of our existing locations while slowing our pace of de novo openings to 40 to 45 in 2023, down from 90% last year. Importantly, these efforts will allow for continued clinician ads and cause minimal to no disruption to clinicians and patients. In closing, I wanted to thank all of the operations, shared services and clinical team members that have helped drive improvements across the foundation of our business. I'm pleased that some of the early progress we've made together in my 2 quarters as Chief Operating Officer.

轉向房地產。物理中心仍然是我們混合戰略的核心部分。但是，我們看到了優化現有足蹟的機會。我們研究了每個中心的個人使用情況以及與其他地點的距離等因素，以便我們能夠利用我們的入住成本並以周到有效的方式分配資源。因此，我們計劃在 2023 年整合 30 至 40 個現有門店，同時放慢重新開業的步伐，從去年的 90% 降至 40 至 45 個。重要的是，這些努力將允許臨床醫生繼續投放廣告，並且對臨床醫生和患者造成的干擾最小甚至沒有。最後，我要感謝所有幫助推動我們業務基礎改進的運營、共享服務和臨床團隊成員。我很高興在我擔任首席運營官的兩個季度裡，我們共同取得了一些早期進展。

However, I'm fully aware that there is much more opportunity for improvement ahead as we continue to remain focused on our top priorities. With that, I'll turn it back to Ken for closing remarks.

然而，我完全意識到，隨著我們繼續專注於我們的首要任務，未來還有更多改進的機會。有了這個，我會把它轉回 Ken 的結束語。

Thank you, Danish. In closing, we are pleased that we concluded the year on a positive note. We are encouraged by the early signs of improvement, but fully recognize that we have much work ahead. Our focus remains on streamlining and standardizing our business over the next 2 years, which will pave the way for profitable and sustainable growth and long-term value creation for our shareholders. I would also like to take a moment to thank the employees of Life stance for their dedication and commitment to our patients, to our operational transformation and to our mission to improve access to high-quality, affordable mental health care. We will now take your questions. Operator?

謝謝你，丹麥人。最後，我們很高興我們以積極的基調結束了這一年。我們對早期的改善跡象感到鼓舞，但也充分認識到我們還有很多工作要做。我們的重點仍然是在未來 2 年內精簡和標準化我們的業務，這將為我們的股東實現盈利和可持續增長以及長期價值創造鋪平道路。我還想花點時間感謝 Life stance 的員工，感謝他們對我們的患者、我們的運營轉型以及我們改善獲得高質量、負擔得起的精神保健服務的使命的奉獻和承諾。我們現在將回答您的問題。操作員？

(Operator Instructions) Your first question comes from the line of Craig Hettenbach with Morgan Stanley.

（操作員說明）你的第一個問題來自摩根士丹利的 Craig Hettenbach。

Yes. It's encouraging to see the footprint optimization steps. Ken, can you maybe just talk about the competitive advantage of having brick-and-mortar, but at the same time, kind of how you envision operating more efficiently the next few years and what that might mean for kind of margins and free cash flow?

是的。看到足跡優化步驟令人鼓舞。肯，你能不能談談擁有實體店的競爭優勢，但與此同時，你如何設想未來幾年更有效地運營，以及這對利潤率和自由現金流可能意味著什麼？

Sure. So, Craig, I appreciate your comments and your question. The real estate optimization, I think, is a great example of the way in which we're trying to run the business with greater operational discipline. What we found is that the combination of de novo bills and acquisitions that we made, created an opportunity for us to take a hard look at the way the centers were being utilized -- and as we said in our prepared remarks, we think roughly 30, 35 of those centers can be consolidated with little or no disruption because of the close proximity of the offices. We are seeing -- and this is important, we are seeing increased demand and preference from our patients for in-person visits. So, we're going to be really careful to make sure that we find that right balance, having convenience and accessibility to our patients is critical.

當然。所以，克雷格，感謝你的意見和問題。我認為，房地產優化是一個很好的例子，說明我們試圖以更嚴格的運營紀律來經營業務。我們發現，我們進行的新法案和收購相結合，為我們創造了一個機會來認真審視這些中心的使用方式——正如我們在準備好的評論中所說，我們認為大約 30 ，其中 35 個中心可以在幾乎沒有或沒有乾擾的情況下進行整合，因為辦公室距離很近。我們看到——這很重要，我們看到患者對親自就診的需求和偏好增加。因此，我們將非常小心，以確保我們找到正確的平衡點，為患者提供便利和可及性至關重要。

The overlying sort of theme of much of our prepared remarks sort of speaks to the second part of your question, which is that after call it, 5 or so years of explosive growth, which certainly positioned us with a great platform that covers -- it really allows us to cover about 90% of Americans given our 34-state footprint. But now we are pivoting to a focus on both operational and financial discipline. As Dave said, that will lead to positive cash flow in the second half of this year. And we are absolutely committed to the double-digit margin as we exit 25 on.

我們準備好的大部分評論的主題都與你問題的第二部分有關，即在經歷了 5 年左右的爆炸性增長之後，這無疑使我們擁有了一個涵蓋的偉大平台——它考慮到我們在 34 個州的足跡，這真的讓我們能夠覆蓋大約 90% 的美國人。但現在我們正在轉向關注運營和財務紀律。正如戴夫所說，這將導致今年下半年出現正現金流。當我們退出 25 時，我們絕對致力於兩位數的保證金。

Got it. And then maybe just a follow-up for Danish. Can you comment on clinician retention. You mentioned some of the benefits of OBI and reduction in cancellation rates. So just looking for some more color in terms of productivity and how that's all shaping up.

知道了。然後也許只是丹麥語的後續行動。你能評論臨床醫生的保留嗎？您提到了 OBI 的一些好處和取消率的降低。所以只是在生產力方面尋找更多的顏色以及這一切是如何形成的。

Yes. So, in the fourth quarter, we did see improvements in productivity, as I mentioned in the prepared remarks, we really saw it across the full funnel, meaning top, middle and bottom. And so we were pleased with that result and kind of our discipline around utilization and ultimately how that plays out in productivity. -- as far as retention goes, we did see an improvement in the fourth quarter. This is something that, as we've talked about in the past, a permanent and consistent improvement in retention is going to be something that takes multiple quarters and really a full lift of everything around the company to ensure that we're delivering the best experience for our clinicians. So, so we're encouraged by that improvement. We don't, at this point, have any reason to believe that we need to reset our plans and how we think about retention on a go-forward basis as far as providing guidance goes...

是的。因此，在第四季度，我們確實看到了生產力的提高，正如我在準備好的評論中提到的那樣，我們確實在整個漏斗中看到了它，即頂部、中部和底部。因此，我們對這一結果以及我們圍繞利用率以及最終如何在生產力中發揮作用的紀律感到滿意。 - 就保留率而言，我們確實看到第四季度有所改善。正如我們過去所討論的那樣，永久和持續地提高保留率將需要多個季度，並且真正全面提升公司周圍的一切，以確保我們提供最好的服務為我們的臨床醫生提供經驗。所以，我們對這種改進感到鼓舞。在這一點上，我們沒有任何理由相信我們需要重新制定我們的計劃，以及我們如何在提供指導的基礎上考慮保留......

Your next question comes from the line of Lisa Gill with JPMorgan.

你的下一個問題來自摩根大通的 Lisa Gill。

I just first wanted to start with virtual versus in-person. Can you talk about where you exited 2022 and then the expectations for '23? And can I -- I heard you talk about more people wanting that in-person experience. I'm just curious, you're talking about consolidation. How much capacity do you have within your current network of centers?

我只是首先想從虛擬與面對面開始。你能談談你在 2022 年退出的地方，然後是對 23 年的期望嗎？我能不能——我聽到你說更多的人想要那種親身體驗。我只是好奇，你在談論整合。您當前的中心網絡有多少容量？

Yes. I'll take that. When we look at our overall point of care where clinicians and patients are providing service -- in Q4, 78% of our visits were virtual. That was a sequential kind of change from the previous quarter and continued trends back towards in person. We are seeing an increase in the demand from patients calling in, looking for in-person appointments. So, because of that, as Ken mentioned, we'll remain focused on ensuring we have the right balance of in-person availability through our physical locations as well as continuing to offer telemedicine appointments across kind of our network of 5,600 clinicians.

是的。我會接受的。當我們查看臨床醫生和患者提供服務的整體護理點時——在第四季度，我們 78% 的訪問是虛擬的。與上一季度相比，這是一種連續的變化，並且繼續呈回歸趨勢。我們看到患者打電話尋求面對面預約的需求在增加。因此，正因為如此，正如 Ken 提到的那樣，我們將繼續專注於確保我們通過我們的物理位置在面對面可用性方面取得適當的平衡，並繼續在我們的 5,600 名臨床醫生網絡中提供遠程醫療預約。

We believe that our optimization project right now that will take about 30, 35 legacy centers off-line will help to optimize the current capacity that we have for in person because of the close proximity of other locations. But we'll continue to look at this every quarter and every year to ensure that we are striking the right balance, including where and how many de novos that we open in any given year.

我們相信，我們目前的優化項目將使大約 30、35 個遺留中心下線，這將有助於優化我們目前的產能，因為其他地點非常接近。但我們將繼續每個季度和每年對此進行審查，以確保我們取得正確的平衡，包括我們在任何給定年份開設的地點和數量。

And what's your expectation for virtual in 2023?

您對 2023 年的虛擬化有何期待？

I don't think that we have a hard view on what percentage of the total business will be virtual as of this point. We do expect it to continue to trend down. But where that will settle out is something we'll just have to see where the market patients and patient demand takes us. For us, because of the hybrid model, we're really agnostic and are comfortable with wherever it shakes out and will continue to optimize our fiscal footprint and our delivery of digital tools ensure good quality of virtual care wherever patients and clinician preferences shake out.

到目前為止，我認為我們對虛擬業務佔總業務的百分比沒有明確看法。我們確實預計它會繼續呈下降趨勢。但是，我們只需要看看市場患者和患者需求會將我們帶到哪裡，這將在哪裡解決。對我們來說，由於混合模式，我們真的是不可知論者，無論它在哪裡發生變化，我們都會感到舒服，並將繼續優化我們的財政足跡，我們提供的數字工具確保無論患者和臨床醫生的偏好發生什麼變化，都能提供高質量的虛擬護理。

Great. And then just as a quick follow-up. Dave, thanks for the Q1 guidance. The midpoint of the margin is 3.8%. If I look at the guidance for the year, the midpoint is like 5.6%. Can you maybe just talk about the ramp in the margin over the course of the year and how we should think about it progressing and if there's any key variables that we should think about?

偉大的。然後作為快速跟進。戴夫，感謝第一季度的指導。利潤率的中點為 3.8%。如果我看一下今年的指導，中點大約是 5.6%。你能不能談談今年利潤率的上升以及我們應該如何考慮它的進展以及是否有任何我們應該考慮的關鍵變量？

Yes. Sure, Lisa. So, in my prepared remarks, I talked about the first quarter margins being down, and that was the resumption of payroll taxes for highly compensated employees. And then to -- and then to a lesser extent, we also saw lower utilization of high-margin services like neurosite testing, and that's primarily due to the reset of patient deductibles. So, as we look for the -- to the rest of the year, the reduction in payroll taxes, that's obviously going to help the increase in the higher-margin products as we get into the later quarters. And then we'll also see some modest payer rate increases. So those 3 things will contribute to higher margins from Q2 through Q4.

是的。當然，麗莎。因此，在我準備好的發言稿中，我談到了第一季度的利潤率下降，那就是對高薪員工恢復徵收工資稅。然後——然後在較小程度上，我們還看到神經部位測試等高利潤服務的利用率較低，這主要是由於患者免賠額的重置。因此，當我們尋找 - 到今年剩餘時間，工資稅的減少，這顯然將有助於我們進入後期季度時利潤率更高的產品的增加。然後我們還會看到一些適度的支付率增加。因此，這三件事將有助於從第二季度到第四季度提高利潤率。

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

你的下一個問題來自 Ryan Daniels 和 William Blair 的台詞。

This is Jackson on for Ryan Daniels. Congrats on the quarter on the strong year. This is somewhat of a follow-up on Craig and Lisa's questions. When it comes to virtual versus in-person care, I know you're experiencing more demand from patients for in-person. So just talk to that, do patients generally split between virtual in person? Or is it pretty consistent for each patient? I'm trying to parse out how you get to that 50-50 level? Is it new patients coming on where you see that -- I think it was 74% virtual come down? Or is it existing patients wanting to come back in person, possibly both? Or even if it's clinicians onboarding that desire more in person. Any commentary on that would help.

這是瑞恩丹尼爾斯的傑克遜。祝賀本季度表現強勁。這是對 Craig 和 Lisa 的問題的後續跟進。當談到虛擬護理與面對面護理時，我知道患者對面對面護理的需求越來越大。因此，就此而言，患者通常會在虛擬現實中分開嗎？還是每個患者都非常一致？我正在嘗試解析您如何達到 50-50 的水平？在你看到的地方是否有新患者出現——我認為這是 74% 的虛擬下降？或者是現有患者想要親自回來，可能兩者都有？或者即使是臨床醫生親自上崗也希望更多。對此的任何評論都會有所幫助。

Yes. So, this is Danish. So, what you generally see with patients is there is a preference for in-person or virtual for the initial visit. However, even the patients that are selecting in person for their initial visit, enjoy the flexibility of being able to move back and forth between in-person and virtual over the course of their treatment with their clinicians. And so that's one of the real positive factors of being able to operate a hybrid model is -- it gives us a significant amount of flexibility both for the patients and the clinicians as well as not just increases access, but the consistency of patients adhering to their care plan by not skipping visits and being able to switch an in-person visit that for whatever is going on in their personal life may be difficult for them to get to, they can then convert to a virtual visit and continue with their care plan.

是的。所以，這是丹麥語。因此，您通常會看到患者在初次就診時更喜歡面對面或虛擬。然而，即使是選擇親自進行初次就診的患者，也可以享受在與臨床醫生進行治療的過程中能夠在面對面和虛擬之間來回移動的靈活性。因此，能夠運行混合模型的真正積極因素之一是——它為我們提供了患者和臨床醫生的大量靈活性，不僅增加了訪問，而且患者堅持的一致性他們的護理計劃通過不跳過訪問並能夠轉換面對面的訪問，無論他們的個人生活中發生了什麼，他們可能很難到達，然後他們可以轉換為虛擬訪問並繼續他們的護理計劃.

Great. I appreciate that. As we think about the investments you discussed for 2023 and beyond, I want to focus on the second investment you mentioned, which is the credentialing piece. Just curious if this will help increase leverage when it comes to payers and especially with negotiations. If you can just comment on how that might impact the payer side? And then secondly, if this does have an impact, do you have any expectations on when to see the results flow through?

偉大的。我很感激。當我們考慮您討論的 2023 年及以後的投資時，我想關注您提到的第二項投資，即認證部分。只是好奇這是否有助於提高對付款人的影響力，尤其是在談判中。您是否可以評論這對付款方有何影響？其次，如果這確實有影響，您對何時看到結果有什麼期望嗎？

So, the investments in our credentialing processes and specifically, the systems that we mentioned or Dave mentioned in the prepared remarks, is really about improving the speed and the quality of our onboarding experience for our clinicians and helping them to get -- to ramp faster over time. So that's the primary purpose there. It would not give us -- the credentialing system would not give us any particular leverage with payers. However, as Ken mentioned in his section, one of the areas of focus that we have this year is pruning the bottom 25% of payers for us. And those bottom 25% contribute less than 1% of our total revenue. And so, we're taking complexity out of the system, improving our administrative processes as well as we can put our attention to the payers that are a more significant portion of our total our total business as well as the ones that value our services and what we provide throughout the country.

因此，對我們的認證流程的投資，特別是我們在準備好的評論中提到或 Dave 提到的系統，實際上是為了提高我們臨床醫生入職體驗的速度和質量，並幫助他們獲得 - 更快地提升隨著時間的推移。這就是那裡的主要目的。它不會給我們 - 認證系統不會給我們任何與付款人的特殊影響力。然而，正如 Ken 在他的部分中提到的那樣，我們今年的重點領域之一是為我們削減支付費用最低的 25%。而那些收入最低的 25% 貢獻的收入不到我們總收入的 1%。因此，我們正在消除系統的複雜性，改進我們的管理流程，並且我們可以將注意力放在付款人身上，這些付款人在我們的總業務中佔更重要的部分，以及那些重視我們的服務和我們在全國提供什麼。

Your next question comes from the line of Brian Tanquilut with Jefferies. Rather...

你的下一個問題來自 Jefferies 的 Brian Tanquilut。相當...

I guess, Ken, a question for you. As I think about client or patient retention, obviously, we've got the macro backdrop here and the normalization out of Covid and people going back to work in person. What are you seeing? And maybe what differentiates you from what maybe some of your more virtual competitors or peers are seeing? And how do you view the defensibility of the business, especially given your insurance exposure?

我想，肯，有一個問題要問你。當我考慮客戶或患者保留時，顯然，我們已經有了宏觀背景，以及 Covid 的正常化和人們重返工作崗位。你在看什麼？也許是什麼讓您與您的一些更虛擬的競爭對手或同行所看到的有所不同？您如何看待企業的防禦能力，尤其是考慮到您的保險風險？

Brian, I think the -- as Danish has referenced, the ability to meet our patients where they are. Sometimes they want an in-person, -- sometimes they want a virtual -- that creates a stickiness. And he also made a really important point, which is it also leads to a more regular cadence of visits. So, sort of less skipping business, which is so important to the mental help treatment that our patients receive. So, we think this is obviously the best model. We are seeing the increase in demand for in-person visits, but it's not dramatic, it's not drastic. Think of it in terms of -- maybe it's a point or 2 each quarter. We don't know where it's going to settle out. But we reached a sort of a high point during the height of Covid about 95% virtual. We're now getting towards the mid-70s, and we don't see a change in that slow but steady trend. So we like our positioning as a hybrid model.

Brian，我認為——正如 Danish 所提到的那樣，能夠在患者所在的地方與他們會面。有時他們想要面對面的——有時他們想要虛擬的——這會產生粘性。他還提出了一個非常重要的觀點，這也導致了更規律的訪問節奏。所以，有點少逃避業務，這對我們的患者接受的心理幫助治療非常重要。所以，我們認為這顯然是最好的模型。我們看到面對面訪問的需求在增加，但這並不顯著，並不劇烈。考慮一下——也許每個季度是一分或兩分。我們不知道它會在哪里安定下來。但是我們在 Covid 高峰期間達到了一個高點，大約 95% 是虛擬的。我們現在正走向 70 年代中期，我們看不到這種緩慢但穩定的趨勢發生變化。所以我們喜歡我們作為混合模型的定位。

Understand. And then I guess on the recruitment front, are you seeing any change or any maybe increased interest from some of the more traditional small solar practitioners as again, COVID is normalizing and maybe some of the volumes from those people running pure hybrid models are changing. So just any color on recruitment would be helpful.

理解。然後我想在招聘方面，你是否看到一些更傳統的小型太陽能從業者有任何變化或興趣增加，因為 COVID 正在正常化，也許那些運行純混合模型的人的一些數量正在發生變化。因此，任何關於招聘的顏色都會有所幫助。

Sure. Yes. So, our organic recruiting engine continues to remain very robust. And like we mentioned in the prepared remarks. Approximately 80% of our clinician adds in 2022 came through our organic recruiting engine. So, we feel very good about where we're positioned there and continue to make investments in scaling that team going into 2023. As far as kind of competition from mom and pops, we're not really seeing any difference in the market related to their increasing the amount of focus on recruiting than we've ever seen in the past. It's always been a competitive market, and we've really built our organic recruiting to position ourselves well there.

當然。是的。因此，我們的有機招聘引擎繼續保持非常強大。就像我們在準備好的評論中提到的那樣。到 2022 年，我們新增的臨床醫生中約有 80% 來自我們的有機招聘引擎。因此，我們對我們在那裡的定位感到非常滿意，並繼續投資以擴大該團隊到 2023 年的規模。就來自夫妻店的競爭而言，我們並沒有真正看到與以下相關的市場有任何差異他們比以往任何時候都更加關注招聘。它一直是一個競爭激烈的市場，我們確實建立了我們的有機招聘以在那裡很好地定位自己。

Your next question comes from the line of Jamie Perse with Goldman Sachs.

你的下一個問題來自高盛的 Jamie Perse。

Just wanted to spend a minute on the revenue growth guidance for 2023. I think just with the organic hires from 2022 and the acquisitions from 2022, just the maturing of the new clinicians gets you pretty far along in terms of getting to the growth guidance for 2023. And so, I'm trying to understand what's embedded in 2023 guidance for incremental new organic hires and then productivity. I think on productivity, you said a slight increase in revenue per visit. But beneath that, what are you assuming for kind of just incremental visits per clinician. Just trying to understand a couple of those drivers of the growth guidance for '23...

只想花一點時間了解 2023 年的收入增長指導。我認為，僅通過 2022 年的有機招聘和 2022 年的收購，新臨床醫生的成熟就可以讓您在獲得增長指導方面走得很遠2023 年。因此，我試圖了解 2023 年增量新有機員工和生產力指南中包含的內容。我認為關於生產力，你說每次訪問的收入略有增加。但在此之下，您假設每位臨床醫生的增量訪問是什麼。只是想了解 23 年增長指南的一些驅動因素......

Yes. I appreciate the question. This is Dave. As far as the full year guidance for 2023 from a revenue perspective, first thing, and I said in my prepared remarks, is we're not assuming any operational improvements. So, from a productivity perspective, we're assuming '23 to be pretty consistent with '22. Second point I'd make is we're not going to guide on clinicians, but we are expecting clinician growth. As Danish mentioned just a minute ago, we do have a robust clinician recruiting engine. And so we are expecting clinician growth, and that will drive visit growth throughout the year. And we feel good about mid-teens organic growth coming from the business.

是的。我很欣賞這個問題。這是戴夫。至於從收入角度來看的 2023 年全年指導，我在準備好的發言中說的第一件事是，我們不假設任何運營改進。因此，從生產力的角度來看，我們假設 23 年與 22 年非常一致。我要說的第二點是我們不會指導臨床醫生，但我們期待臨床醫生的成長。正如 Danish 剛才提到的，我們確實有一個強大的臨床醫生招聘引擎。因此，我們期待臨床醫生的增長，這將推動全年的訪問量增長。我們對來自該業務的十幾歲的有機增長感到滿意。

Okay. And then just on the center margin guidance as well. It looks like that's up as a percent of sales year-over-year. I get there's some benefits from the real estate optimization or I think rents like 8% or 9% of center cost. But for the bigger piece, which is physician compensation, what are you seeing there? Is that stable? Or are you seeing pressures there just given how much demand there is for these types of clinicians out in the market? And in that context, where can center margins go over time?

好的。然後還有中心邊距指導。看起來這佔銷售額的百分比同比增長。我從房地產優化中得到一些好處，或者我認為租金大約是中心成本的 8% 或 9%。但是對於更大的一塊，即醫生補償，你在那裡看到了什麼？那穩定嗎？或者，鑑於市場上對這些類型的臨床醫生的需求量，您是否看到了壓力？在這種情況下，隨著時間的推移，中心邊距會去哪裡？

Yes. So, for the most part, our clinicians are not salaried. And so we have less exposure from a wage perspective versus some of the other companies. And we're not seeing margin compression. As you just noted, we are guiding to a little bit of margin expansion in center margin in 2023 as our rate increases help offset the wage increases that we're passing on to our clinicians.

是的。因此，在大多數情況下，我們的臨床醫生沒有領薪水。因此，從工資的角度來看，與其他一些公司相比，我們的風險敞口較小。而且我們沒有看到利潤率壓縮。正如您剛才指出的那樣，我們正在指導 2023 年中心利潤率的一點點擴張，因為我們的利率增長有助於抵消我們轉嫁給臨床醫生的工資增長。

Your next question comes from the line of Kevin Caliendo with UBS.

你的下一個問題來自瑞銀的 Kevin Caliendo。

I wanted to talk a little bit about the impact of the payer contracting and how to think about it. If you're consolidating more -- I'm guessing, more at a national level with some of the payers or the like? And what does that end up doing in terms of overall rates? Do they become better or stronger if you're getting rid of some of the smaller more regional players. Can you just take us through sort of how this works and what the impact is with your relationship with the payers and on your reimbursement?

我想談談付款人合同的影響以及如何思考它。如果你要合併更多——我猜，更多是在國家層面與一些付款人等？就整體利率而言，這最終會產生什麼影響？如果你擺脫一些更小的區域性玩家，他們會變得更好或更強嗎？您能否簡單介紹一下這是如何運作的，以及對您與付款人的關係以及您的報銷有何影響？

So, Kevin, -- even though it's a large percentage of the payer contracts, it's a de minimis percentage of our visit volume. So Danish response, he talked about, we can take 25% of our payer contracts out, and it represents less than 1% of our volume. So therefore, it's really not going to have much leverage on our rates. The leverage is in the administrative simplicity that it creates, and it's going to help -- it will be one of the things that will help contribute to running a more efficient business.

所以，凱文，儘管它佔付款人合同的很大一部分，但它在我們的訪問量中所佔的比例很小。所以丹麥的回應，他談到，我們可以拿出 25% 的付款人合同，它只占我們交易量的不到 1%。因此，它真的不會對我們的利率產生太大影響。槓桿作用在於它創建的管理簡單性，它會有所幫助——它將成為有助於運營更高效業務的因素之一。

Okay. That part I understood. I was just wondering if this is sort of being done at more of a national level in any way. It kind of leads to my second question, which is the relationship with the payers, are they looking for anything additional from you? Any sort of data sharing or anything else in terms of strengthening the relationship between you and them and how it may impact pricing going forward? I'm just trying to think about how you might leverage the assets that you have with the payers.

好的。那部分我明白了。我只是想知道這是否以任何方式在更多的國家層面上進行。這有點引出了我的第二個問題，即與付款人的關係，他們是否正在尋找您的其他任何東西？任何形式的數據共享或其他任何加強你和他們之間關係的方式，以及它如何影響未來的定價？我只是想考慮如何利用與付款人的資產。

Yes. No, it's a great question. Let me respond to the rest of your first question, which is sort of by definition, the consolidation is really occurring with the small local and regional payers, national payers, aren't going to be affected because we're really focused on bottom quartile that only accounts for less than 1%. As it relates to the relationship with the payers, we are as interested as they are and really sharing data so that we can demonstrate the impact of well-managed mental health on things such as absenteeism, whether it's in school or at work, reduced visits to the ER and inpatient care. So, they are interested and we're doing some pilots, and that's something that we're pretty enthusiastic about over the next several years. as we move toward a more value-based care and an integrated behavioral health environment, where we're collaborating with those that provide physical care to really make sure that our patients and theirs are receiving holistic care. That is the vision for life stands. So, what you've referenced is absolutely a part of our playbook, and it will be an increasingly important part of our strategy in the years to come.

是的。不，這是一個很好的問題。讓我回答你第一個問題的其餘部分，根據定義，合併確實發生在小型地方和區域付款人、國家付款人身上，不會受到影響，因為我們真正關注底部四分之一那隻佔不到1%。由於它涉及與付款人的關係，我們和他們一樣感興趣並真正共享數據，以便我們可以證明管理良好的心理健康對缺勤等事情的影響，無論是在學校還是在工作中，減少訪問到急診室和住院治療。所以，他們很感興趣，我們正在做一些試點，這是我們在未來幾年非常熱衷的事情。隨著我們朝著更基於價值的護理和綜合行為健康環境邁進，我們正在與提供身體護理的機構合作，以真正確保我們的患者和他們的患者得到全面護理。這就是人生的願景。因此，您所引用的內容絕對是我們劇本的一部分，並且在未來幾年內它將成為我們戰略中越來越重要的一部分。

There are no further questions at this time. This concludes the Live stance Fourth Quarter 202 Earnings Call. You may now disconnect.

目前沒有其他問題。 Live stance 第四季度 202 財報電話會議到此結束。您現在可以斷開連接。