LifeStance Health Group Inc (LFST) 2024 Q3 法說會逐字稿

Thank you for standing by. My name is Liz, and I'll be your conference operator today. At this time, I'd like to welcome everyone to the LifeStance Health Third Quarter 2024 Earnings Call. (Operator Instructions)

謝謝你的支持。我叫莉茲，今天我將擔任你們的會議操作員。現在，我歡迎大家參加 LifeStance Health 2024 年第三季財報電話會議。（操作員說明）

I would now like to turn the call over to Monica Prokocki, Vice President of Investor Relations. Please go ahead.

我現在想將電話轉給投資者關係副總裁 Monica Prokocki。請繼續。

Thank you, operator. Good morning, everyone, and welcome to LifeStance Health's Third Quarter 2024 Earnings Conference Call. I'm Monica Prokocki, Vice President of Investor Relations. Joining me today are Ken Burdick, Chief Executive Officer; and David Bourdon, Chief Financial Officer.

謝謝你，接線生。大家早安，歡迎參加 LifeStance Health 2024 年第三季財報電話會議。我是莫妮卡‧普羅科基 (Monica Prokocki)，投資人關係副總裁。今天加入我的是執行長肯·伯迪克 (Ken Burdick)；財務長戴維波登 (David Bourdon)。

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.lifestance.com.

我們在今天早上開盤前發布了收益報告和簡報。兩者皆可在我們網站 Investor.lifestance.com 的投資者關係部分找到。

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. 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.

在將電話轉交給管理層以聽取他們準備好的言論之前，請注意收益新聞稿和美國證券交易委員會文件中包含的有關前瞻性陳述的免責聲明。今天的言論包含前瞻性陳述，包括有關我們的財務表現、前景、商業模式和策略的陳述。這些陳述涉及風險、不確定性和我們在向 SEC 定期提交的文件中指出的其他因素，可能導致實際結果出現重大差異。

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 current 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 comparable period in the prior year.

此外，請注意，我們使用非公認會計準則財務指標報告結果，我們認為這為投資者提供了更多信息，有助於比較當前和過去的業績。收益新聞稿表和演示附錄中包含了與最直接可比較的公認會計準則衡量標準的調節。除非另有說明，所有結果均與上一年可比期間進行比較。

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 執行長 Ken Burdick。肯？

Thanks, Monica, and thank you all for joining us today. Last month, on October 10, we observed World Mental Health Day. Within our own country, the growing disconnect between the demand and supply of mental health services, remains one of the largest challenges facing Americans today. Through our mission of providing affordable and accessible mental health care, we at LifeStance relentlessly fight each day to mitigate this crisis.

謝謝莫妮卡，也謝謝大家今天加入我們。上個月，10 月 10 日，我們慶祝了世界精神衛生日。在我們自己的國家，心理健康服務的供需之間日益脫節仍然是美國人當今面臨的最大挑戰之一。LifeStance 的使命是提供負擔得起且易於獲得的精神健康保健服務，每天都在不懈地努力緩解這場危機。

Turning to financial performance. We are very pleased with the team's continued execution in the third quarter. For the eighth consecutive quarter, we have met or exceeded our expectations. Our revenue growth of 19% and our disciplined execution created solid operating leverage that yielded a 9.8% profit margin. Based on the strong performance in the third quarter, we will again be raising our full year guidance for all financial metrics.

轉向財務績效。我們對團隊在第三季的持續執行感到非常滿意。我們連續第八個季度達到或超出了我們的預期。我們 19% 的營收成長和嚴格的執行創造了堅實的營運槓桿，產生了 9.8% 的利潤率。基於第三季的強勁表現，我們將再次提高所有財務指標的全年指引。

I cannot emphasize enough the role that our clinicians have played and our achievements in the third quarter and throughout the year as well as the value they deliver every day in providing high-quality patient care. We now have a team of over 7,200 clinicians, an increase of 285 just this quarter.

我無法充分強調我們的臨床醫生所發揮的作用、我們在第三季度和全年所取得的成就，以及他們每天在提供高品質病患照護方面所提供的價值。我們現在擁有一支由 7,200 多名臨床醫生組成的團隊，光是本季就增加了 285 名。

Turning to operational execution. We continue to make progress on our initiatives to streamline the business and improve performance. First, we continued the implementation of our new operating model. As a reminder, this initiative standardizes our organization with consistent staffing and processes across our 33 states and over 550 centers. We are confident that this higher level of administrative and clinical support will position the business to scale efficiently in 2025 and beyond.

轉向營運執行。我們在簡化業務和提高績效的措施上繼續取得進展。首先，我們繼續實施新的營運模式。謹此提醒，此措施使我們的組織標準化，在 33 個州和 550 多個中心保持一致的人員配置和流程。我們相信，這種更高水準的行政和臨床支援將使我們的業務在 2025 年及以後實現高效擴展。

Additionally, we continue to roll out our new digital patient check-in tool. We have implemented it successfully in 11 states and expect to complete the national rollout by midyear 2025. While still in the early stages, we are seeing higher patient satisfaction, operational efficiencies and significant improvements in patient collections where this tool has been deployed.

此外，我們持續推出新的數位病患登記工具。我們已在 11 個州成功實施，預計在 2025 年年中完成全國推廣。雖然仍處於早期階段，但我們看到部署此工具的患​​者滿意度更高，營運效率更高，且患者收集量顯著改善。

Shifting to payer strategy, we are proud of the success that our payer engagement team has had in securing improved rates. While this represents progress, we still have a long way to go to achieve parity with physical health reimbursement.

轉向付款人策略，我們為付款人參與團隊在確保提高費率方面取得的成功感到自豪。雖然這代表著進步，但要實現與身體健康報銷的平等，我們還有很長的路要走。

As previously communicated, the third quarter is the first one where the decrease in rates from a single outlier payer with above-market reimbursement is reflected in our results. However, much of the impact of this initial rate decrease was mitigated by negotiated rate increases with other payers. Many of the new rate increases went into effect sooner than we had expected which drove the outperformance in total revenue per visit.

如同先前所傳達的，第三季是第一個在我們的業績中反映出單一異常付款人的費率下降且報銷高於市場水平的季度。然而，與其他付款人協商提高利率，減輕了最初利率下降的大部分影響。許多新的費率上調生效的時間比我們預期的要早，這推動了每次訪問總收入的出色表現。

Before concluding, I want to take a moment to comment on the recent hurricanes, Helene and Milton. My thoughts go out to each and every one of the LifeStance patients, clinicians, team members and the communities we serve that have been impacted by these storms. Dozens of our centers were affected and all but two were back up and running within one week. The remaining two centers reopened by mid-October. I am proud and appreciative of the way that our teams responded to these disasters.

在結束之前，我想花點時間評論一下最近的颶風海倫和米爾頓。我向每一位受到風暴影響的 LifeStance 患者、臨床醫生、團隊成員以及我們所服務的社區表示同情。我們的數十個中心受到影響，除了兩個中心外，所有中心都在一周內恢復並運作。其餘兩個中心於十月中旬重新開放。我對我們的團隊應對這些災難的方式感到自豪和讚賞。

We have another testament to the resilience of the team and dedication to putting our patients first. With that, I'll turn it over to Dave to provide additional commentary on our financial performance and outlook. Dave?

我們再次證明了團隊的韌性和將患者放在第一位的奉獻精神。接下來，我會將其交給戴夫，以對我們的財務表現和前景提供更多評論。戴夫？

Thanks, Ken. Slide 10, I'm pleased with the team's operational and financial performance in the third quarter. We delivered strong top line results with revenue of $313 million representing growth of 19% year-over-year. The outperformance was driven by higher total revenue per visit and increased visit volumes. Visit volumes of 2 million increased 15% year-over-year, driven primarily by clinician growth. In the third quarter, we added 285 net clinicians, which exceeded our expectations.

謝謝，肯。投影片 10，我對團隊第三季的營運和財務表現感到滿意。我們取得了強勁的營收業績，營收達 3.13 億美元，年增 19%。表現優異的原因是每次訪問總收入的增加和訪問量的增加。就診人數達到 200 萬，年成長 15%，這主要是由臨床醫生的成長所推動的。第三季度，我們淨增加了 285 名臨床醫生，超出了我們的預期。

This brings our total clinician base to 7,269, representing growth of 13% year-over-year. There is variability in the face of clinician adds throughout the year. Similar to last year, we expect a lower number of net clinician adds in the fourth quarter. With regard to clinician productivity, it came in slightly ahead of our expectations in the third quarter.

這使我們的臨床醫生總數達到 7,269 人，年增 13%。臨床醫師的面貌全年都有變化。與去年類似，我們預計第四季臨床醫師淨增加人數將會減少。關於臨床醫師的生產力，第三季略高於我們的預期。

Total revenue per visit increased 3% year-over-year to $159 primarily driven by payer rate increases that came in earlier than our previous expectations and, to a lesser extent, onetime favorability. Regarding profitability, the better-than-expected top line results flowed through the center margin. Center margin of $100 million in the quarter increased 32% year-over-year, primarily due to higher total revenue per visit, higher visit volumes and operating leverage and center costs. Outperformance in the quarter relative to our expectations was primarily driven by higher total revenue per visit, higher visit volumes and lower-than-expected spending.

每次訪問的總收入同比增長 3%，達到 159 美元，這主要是由於付費費率的增長早於我們之前的預期，以及在較小程度上受到了一次性好感度的推動。就獲利能力而言，好於預期的營收結果來自於中心利潤率。本季中心利潤率為 1 億美元，年增 32%，這主要是由於每次訪問總收入增加、訪問量增加以及營運槓桿和中心成本增加。本季的表現優於我們的預期，主要是由於每次訪問總收入增加、訪問量增加以及支出低於預期。

Adjusted EBITDA of $31 million in the quarter was very strong and exceeded our expectations, increasing 110% year-over-year. This is the fourth consecutive quarter of doubling our adjusted EBITDA year-over-year. Adjusted EBITDA as a percentage of revenue grew over 4 points year-over-year to 9.8%. The outperformance in the quarter was primarily attributable to the improvement in center margin as well as lower-than-planned spending in G&A.

本季調整後 EBITDA 為 3,100 萬美元，非常強勁，超出了我們的預期，年增 110%。這是我們調整後的 EBITDA 連續第四個季度同比翻倍。調整後 EBITDA 佔營收的百分比年增超過 4 個百分點，達到 9.8%。本季的優異表現主要歸因於中心利潤率的改善以及一般管理費用低於計劃。

Turning to liquidity. In the third quarter, we generated solid free cash flow of $18 million. We exited the quarter with $103 million in cash and net long-term debt of $279 million. Year-to-date, we have generated approximately $30 million of free cash.

轉向流動性。第三季度，我們產生了 1800 萬美元的穩定自由現金流。本季結束時，我們擁有 1.03 億美元的現金和 2.79 億美元的淨長期債務。今年迄今為止，我們已經產生了大約 3000 萬美元的自由現金。

In the fourth quarter, we are making an enhancement to our clinician value proposition by implementing a biweekly payroll cycle for our clinicians who were previously paid on a monthly basis. This will have a roughly $15 million negative impact on cash in Q4 related to the change in pay periods. Even with the impact of this payroll change, we expect to be free cash flow positive in the fourth quarter and now expect to finish the full year with meaningful positive free cash flow due to stronger year-over-year operating results, disciplined capital deployment and progress towards resolving collection issues.

在第四季度，我們透過為先前按月付款的臨床醫生實施每兩週一次的薪資週期來增強我們的臨床醫生價值主張。由於支付週期的變化，這將對第四季的現金產生約 1500 萬美元的負面影響。即使受到薪資變動的影響，我們預計第四季度的自由現金流仍將為正值，並且由於較去年同期更強勁的經營業績、嚴格的資本部署和在解決收款問題方面取得進展。

DSO improved 2 days sequentially to 47 days in the quarter. We are continuing to work through the impact from a changed health care collections disruption along with some delays from a couple of payers updating their systems to reflect higher negotiated rates. These are all timing issues that we are actively working through and we expect DSO to further improve in the fourth quarter.

本季 DSO 比上一季增加 2 天，達到 47 天。我們正在繼續努力應對醫療保健收款中斷變化的影響，以及一些付款人更新其係統以反映更高的協商費率造成的一些延遲。這些都是我們正在積極解決的時間問題，我們預計 DSO 在第四季將進一步改善。

We continue to see improvement in our leverage ratios, with both our net and gross leverage ratios improving nearly 50 basis points sequentially to 1.7 and 2.7 times, respectively. This represents a significant decline from 4.4 net and 5.3% gross leverage in Q3 of last year.

我們的槓桿率持續改善，淨槓桿率和總槓桿率均較上季提高近 50 個基點，分別達到 1.7 倍和 2.7 倍。這比去年第三季的 4.4% 淨槓桿率和 5.3% 總槓桿率顯著下降。

In terms of our outlook for 2024, we are raising our full year revenue range by $17 million at the midpoint to $1.228 billion to $1.248 billion. We are also raising our full year center margin range by $17 million at the midpoint to $382 million to $398 million, and the full year adjusted EBITDA range by $15 million at the midpoint to $105 million to $115 million.

就 2024 年的前景而言，我們將全年營收區間中位數上調 1,700 萬美元，達到 12.28 億美元至 12.48 億美元。我們還將全年中心利潤率範圍中位數提高了 1,700 萬美元，達到 3.82 億至 3.98 億美元，全年調整後 EBITDA 範圍中位數提高了 1,500 萬美元，達到 1.05 億至 1.15 億美元。

For the fourth quarter, we expect revenue of $302.5 million to $322.5 million, center margin of $89 million to $105 million and adjusted EBITDA of $18 million to $28 million. Due to some of the onetime rate favorability in the third quarter, we expect modest quarter-over-quarter decline in total revenue per visit. As previously stated, based on the adjusted EBITDA outperformance so far this year, we continue to give ourselves flexibility through the remainder of the year to make additional investments to better position us to achieve our 2025 growth objectives.

對於第四季度，我們預計營收為 3.025 億美元至 3.225 億美元，中心利潤率為 8,900 萬美元至 1.05 億美元，調整後 EBITDA 為 1,800 萬美元至 2,800 萬美元。由於第三季的一些一次性利率優惠，我們預計每次造訪總收入將環比小幅下降。如前所述，基於今年迄今調整後的 EBITDA 優異表現，我們將在今年剩餘時間內繼續保持靈活性，進行額外投資，以更好地實現 2025 年的成長目標。

Additionally, we continue to expect stock-based compensation to be at or below the bottom of our previously guided range of $80 million to $95 million. This represents a significant reduction from $99 million last year. We will open six de novos in 2024 with an additional 5 to 10 originally planned for this year, shifting into early next year. As a result, we expect substantially higher de novo openings in 2025 and will provide specifics when we deliver guidance next quarter.

此外，我們仍然預期基於股票的薪酬將等於或低於我們先前指引範圍 8,000 萬美元至 9,500 萬美元的底部。這比去年的 9,900 萬美元大幅減少。我們將在 2024 年重新開設 6 家，原計劃今年再開設 5 到 10 家，移至明年初。因此，我們預計 2025 年的新職缺數量將大幅增加，並將在下個季度發布指導時提供具體細節。

Looking ahead to 2025 I'd like to provide an early view on headwinds and tailwinds for the business. In regards to headwinds, as a reminder, we stated we would experience downward pressure and total revenue per visit not only in the back half of 2024, but also the first part of 2025 due to the single outlier payer negotiating their reimbursement to be more in line with our overall book of business. In the first quarter, we expect the last rate drop related to that same payer negotiation.

展望 2025 年，我想提供有關業務逆風和順風的早期看法。關於不利因素，提醒一下，我們表示，我們不僅會在2024 年下半年，而且在2025 年上半年都會經歷下行壓力和每次訪問總收入，因為單一異常付款人正在談判他們的報銷，以使其報銷更加合理。在第一季度，我們預計最後一次利率下降與同一付款人談判有關。

In addition, the current CMS rate proposal for 2025 is a reduction of almost 3%. We expect to be able to offset both of those decreases by improving reimbursement with other payers and now anticipate that our overall rate growth next year will be roughly flat. In regards to tailwinds, we continue to see strong growth of clinicians and patient demand, which will drive visit volumes.

此外，目前 2025 年 CMS 費率建議降低近 3%。我們預計能夠透過改善其他付款人的報銷來抵消這兩項下降，現在預計明年的整體費率成長將大致持平。在有利因素方面，我們繼續看到臨床醫生和患者需求的強勁增長，這將推動就診量。

In addition, we expect continued operating leverage. As a result of these headwinds and tailwinds, we expect minimal margin improvement next year. We feel good about our ability to navigate and absorb challenges such as the rate dynamic while also delivering on our commitments regarding mid-teens revenue growth and exiting 2025 with double-digit margins. With that, I'll turn it back to Ken for his closing remarks.

此外，我們預計營運槓桿將持續存在。由於這些逆風和順風，我們預計明年的利潤率改善幅度很小。我們對自己應對和應對利率動態等挑戰的能力感到滿意，同時也兌現了我們關於中位數收入成長和 2025 年以兩位數利潤率退出的承諾。說到這裡，我將把它轉回給肯，讓他作結束語。

Thanks, Dave. As we enter the final stretch of 2024, I'm looking forward to maintaining the momentum of the last eight quarters. Thanks to the tremendous dedication and commitment of the team, we have outperformed our expectations on nearly every metric this year, including revenue, adjusted EBITDA and free cash flow.

謝謝，戴夫。隨著我們進入 2024 年的最後階段，我期待保持過去八個季度的勢頭。由於團隊的巨大奉獻和承諾，我們今年幾乎所有指標都超出了我們的預期，包括收入、調整後 EBITDA 和自由現金流。

In a year with significant disruption to collections and an unprecedented rate reduction by an outlier payer, I'm incredibly proud of the resilience demonstrated by our entire team. We acknowledge that 2025 will be a particularly challenging year due to the rate dynamics that Dave highlighted. 2024 is shaping up to be a year of very strong margin expansion. We are well ahead of schedule in delivering on our multiyear financial commitments.

在收款受到嚴重干擾以及異常付款人史無前例的降費的一年中，我對我們整個團隊所表現出的韌性感到無比自豪。我們承認，由於 Dave 強調的利率動態，2025 年將是特別具有挑戰性的一年。 2024 年將成為利潤率強勁擴張的一年。我們遠遠提前兌現了多年的財務承諾。

As this is our last earnings call in the current calendar year, I'd like to take a moment to express my appreciation to our 10,000 colleagues who delivered the results that Dave and I have the privilege of sharing with all of you today.

由於這是我們本日曆年的最後一次財報電話會議，我想花點時間向我們的 10,000 名同事表示感謝，他們取得了戴夫和我今天有幸與大家分享的成果。

We will now take questions. Operator?

我們現在將接受提問。操作員？

(Operator Instructions) Craig Hettenbach, Morgan Stanley.

（操作員說明）Craig Hettenbach，摩根士丹利。

Yes. Ken, just on the point of total revenue per visit, you managed to put up flat sequentially, still up 3% year-over-year despite that large payer headwind. So can you just give some context in terms of the payer engagement team, some of the success you're seeing there? And what rate increases are looking like at other payers?

是的。Ken，就每次訪問的總收入而言，儘管付款人面臨巨大阻力，但您仍設法與上一季持平，但仍同比增長 3%。那麼您能否提供一些有關付款人參與團隊的背景資訊以及您在那裡看到的一些成功？其他付款人的利率上漲情況如何？

Sure, Craig. I'm really, really proud of the payer engagement team. They've done a heck of a job this year. And as you might recall, this team didn't even exist until the early part of last year. So they're they've sort of gotten their sea legs and they are executing beautifully. We had some very meaningful increases from other payers who were quite a bit below the average reimbursement, and that certainly helped to offset, as Dave described.

當然，克雷格。我對付款人參與團隊感到非常非常自豪。他們今年做得非常出色。您可能還記得，這個團隊直到去年初才存在。所以他們已經取得了一定的成功，而且執行得非常出色。我們從其他付款人那裡得到了一些非常有意義的增加，這些付款遠低於平均報銷額，這肯定有助於抵消，正如戴夫所描述的。

So I would describe the sort of the payer environment as positive, constructive, but it's not lost on us that the payers right now are going through some unique challenges between the B-28 risk scoring coating changes, higher-than-expected utilization and Medicaid rate disconnect because of the acuity difference between the pre-COVID and then the post redetermination demographic. So it's -- we take none of this for granted. We feel really good about the relationships that we are building, but we do recognize that it is a difficult time in the payer space.

因此，我將這種付款人環境描述為積極的、建設性的，但我們並沒有忘記付款人現在正在經歷B-28 風險評分塗層變化、高於預期的利用率和醫療補助之間的一些獨特挑戰由於新冠肺炎前和重新確定後人群之間的敏銳度差異，率脫節。所以我們不認為這一切是理所當然的。我們對我們正在建立的關係感覺非常好，但我們確實認識到支付領域正處於困難時期。

Understood. And then just a follow-up you touched on before the supply demand imbalance for the industry. So clearly, the demand is there. For Life sand specifically, can you hit on just some of the efforts to continue to grow clinicians? And importantly, just the mix of clinicians working more full time? Like what that means for you?

明白了。然後是您在行業供需失衡之前提到的後續問題。很明顯，需求是存在的。特別是對於 Life sand，您能談談繼續培養臨床醫生的一些努力嗎？重要的是，只是更多全職工作的臨床醫生的組合？這對你來說意味著什麼？

Yes. That's clearly our long-term strategic intent. We would like to have the vast majority of our clinicians working full time. But given this supply-demand imbalance, we're being really thoughtful and quite careful about how we do it.

是的。這顯然是我們的長期戰略意圖。我們希望絕大多數臨床醫師全職工作。但考慮到這種供需失衡，我們對於如何做到這一點非常深思熟慮和非常謹慎。

I've mentioned before that we put some incentives in place to make it more attractive to work full time. We have not seen this massive shift. We thought there might be. It hasn't worked out. We're seeing sort of modest movement. So I expect it's going to be sort of a multiyear effort.

我之前提到過，我們制定了一些激勵措施，以使全職工作更具吸引力。我們還沒有看到這種巨大的轉變。我們認為可能有。還沒有成功。我們看到了某種溫和的運動。所以我預計這將是一項多年的努力。

One of the things that we probably don't talk enough about, Craig, is the fact that we do an awful lot of hiring of people that have recently graduated. So we have become a significant training ground for those folks that graduate and are looking to obtain their license.

克雷格，我們可能談論得不夠多的一件事是，我們僱用了大量剛畢業的人。因此，我們已成為那些畢業並希望獲得執照的人的重要培訓基地。

And that serves in my mind, two very positive things. Number one, we're adding to the number of practicing clinicians in the mental health space. Number two, we can sort of teach them and, if you will, orient them to the life stands way of doing things. And that makes it, we think, much, much easier for them to get ramped up and establishing a career at LifeStance.

在我看來，這是兩件非常正面的事情。第一，我們正在增加心理健康領域執業臨床醫生的數量。第二，我們可以教他們，如果你願意的話，可以引導他們適應生活中的做事方式。我們認為，這使得他們更容易在 LifeStance 獲得提升並建立職業生涯。

Ryan Daniels, William Blair.

瑞恩·丹尼爾斯、威廉·布萊爾。

This is Jack Senft on for Ryan. First, just maybe on your capital allocation strategy going forward. Your cash balance seems to be in a pretty good spot, and I know you're reiterating the free cash flow positive guidance for the year, but you also have some long-term debt on the balance sheet. Are you planning on paying that down at all? Or will you look at opening more de novo clinics and maybe even M&A before that in 2025? Just wondering if you can kind of dig a bit deeper into what your priorities for capital are going forward.

我是瑞安的傑克·森夫特。首先，也許只是關於您未來的資本配置策略。您的現金餘額似乎處於相當不錯的位置，我知道您正在重申今年的自由現金流積極指導，但您的資產負債表上也有一些長期債務。你打算付清這筆錢嗎？或者您會考慮在 2025 年之前開設更多的 de novo 診所，甚至可能進行併購？只是想知道您是否可以更深入地了解您未來的資本優先事項。

Jack, this is Dave. I'll take that one. So as you mentioned, we feel good about our financial flexibility. Now, I have over $100 million of cash on the balance sheet. We have the $50 million of revolver still. So we feel good about our flexibility. When I think about capital deployment and our priorities as we step into 2025, 2026, make the primary use of that flexibility is, number 1 is going to be a funding internal growth. So as you mentioned, it was de novos, technology projects, things like that.

傑克，這是戴夫。我會接受那個。正如您所提到的，我們對我們的財務靈活性感到滿意。現在，我的資產負債表上有超過 1 億美元的現金。我們還留著價值 5000 萬美元的左輪手槍。所以我們對自己的靈活性感覺良好。當我考慮進入 2025 年、2026 年的資本部署和優先事項時，首先要利用這種靈活性，第一要務是為內部成長提供資金。正如您所提到的，這是從頭開始的技術專案之類的事情。

Number 2 would then be acquisitions. We said we would be more acquisitive once we were a positive free cash flow and that we would be funding acquisitions from our balance sheet. I think of those as the two primary uses of capital. I do not anticipate buying down debt, especially when you look at our leverage ratios being so healthy right now.

第二項就是收購。我們表示，一旦自由現金流為正，我們將更加積極收購，我們將從資產負債表中為收購提供資金。我認為這是資本的兩個主要用途。我預計不會購買債務，特別是當你看到我們目前的槓桿率如此健康時。

Okay. Perfect. Understood. And then just another follow-up, too. You mentioned offsetting the negative rate impact with other payer rate increases. Just kind of wondering how those rate negotiations and talks have gone with the other payers that are helping you to offset the impact. I think you mean as you noted, that the payers are kind of in a tough environment now. So just kind of curious how those conversations have gone there has been a good amount of pushback or just if you can give us any detail on that.

好的。完美的。明白了。然後還有另一個後續行動。您提到用其他付款人利率上調來抵銷負面利率影響。只是想知道那些幫助您抵消影響的其他付款人的費率談判和談判進展如何。我認為您的意思是，正如您所指出的，付款人現在處於一個艱難的環境中。因此，我只是好奇這些對話的進展情況，但遭到了大量的抵制，或者您是否可以向我們提供有關這方面的任何細節。

Yes, Jack, this is Ken again. I'll just reiterate that the team that we have built is doing a really good job so that we have ongoing conversations with payers as opposed to there's no communication until it's time for one party or the other to renegotiate rates. So I think that's really healthy.

是的，傑克，這又是肯恩。我只想重申，我們建立的團隊做得非常好，因此我們與付款人進行持續對話，而不是在一方或另一方重新協商費率之前沒有任何溝通。所以我認為這真的很健康。

I wouldn't say it is easy, but I would say that the continued loud and sustained cry from employers to gain better access for their employees and dependents is probably our single greatest lever as we have these conversations. And the fact that there really is a shortage in many, many instances, somebody tries to access mental health care and gets exhausted before they ever get their first appointment because they go through a long list and too often they find out that these clinicians are not open to seeing new patients.

我不會說這很容易，但我想說的是，雇主持續不斷地大聲疾呼，要求為其僱員和家屬提供更好的機會，這可能是我們進行這些對話時最有力的槓桿。事實上，在很多很多情況下確實存在短缺，有人試圖獲得精神衛生保健服務，但在第一次預約之前就精疲力盡了，因為他們會查看一長串清單，而且經常發現這些臨床醫生不是願意探望新患者。

So that is a very legit dynamic that, frankly, hasn't improved in spite of sort of more attention and more focus on the issue. So they are not simple. These are not sort of one conversation and done. These conversations can often take months. But as I've said, encouraged that they continue to be very constructive and productive in spite of the fact that payers are going through a challenging time right now for all the reasons I mentioned earlier.

因此，坦白說，這是一個非常合法的動態，儘管人們對這個問題給予了更多的關注和關注，但這種動態並沒有得到改善。所以他們並不簡單。這些並不是一次談話就能完成的。這些對話通常需要幾個月的時間。但正如我所說，儘管由於我之前提到的所有原因，付款人目前正在經歷一個充滿挑戰的時期，但鼓勵他們繼續保持非常有建設性和富有成效的態度。

Perfect. Makes sense. If I can just sneak one final really quick one in here. G&A had a nice sequential decrease. Is this kind of a level we should expect going forward and maybe into 2025? Just can you just touch on G&A expectations?

完美的。有道理。如果我能在這裡快速地偷偷溜進一場決賽就好了。G&A 連續下降。我們應該期待這種水準持續到 2025 年嗎？能談談一般行政費用預期嗎？

Yes. So we'll give -- certainly give more specifics on 2025 at the fourth quarter fall, when we're doing our guide for next year. But as you think about G&A, and there's an implied step-up in our fourth quarter guidance, and that's related to two things that I would point to. The first being some increased hiring related to our operating model and just the overall business in general. And then the second being some investments that will position us better for achieving our 2025 target. So you should see a step-up from the Q2, Q3 level as we finish the year.

是的。因此，當我們制定明年的指南時，我們肯定會在第四季度秋季提供有關 2025 年的更多細節。但當你想到一般行政費用時，我們第四季的指導隱含了一個進步，這與我要指出的兩件事有關。首先是與我們的營運模式以及整體業務相關的一些招募增加。第二個是一些投資，這些投資將使我們更能實現 2025 年的目標。因此，當我們今年結束時，您應該會看到第二季、第三季的水準提升。

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傑米·珀斯 (Jamie Perse)。

I was hoping you could focus on the clinician recruiting environment for a minute. Obviously, a pretty healthy number here in the third quarter, but maybe just an update on how many clinicians are in the markets you're actively recruiting what the funnel and conversion rate looks like these days? And maybe some thoughts on the competitive environment, including remaining independent?

我希望您能關註一下臨床醫生招募環境。顯然，第三季的數字相當健康，但也許只是您正在積極招募的市場中有多少臨床醫生的最新情況，這些天的漏斗和轉換率是什麼樣的？也許對競爭環境有一些想法，包括保持獨立？

Yes, Jamie, I'll take that. I would say it's fairly stable. We have not noticed a dramatic change either that has become much, much easier to recruit or more difficult. We obviously have a particular compensation model. So it tracks those that are more entrepreneurial. And if somebody wants sort of straight salary, then this is not going to be the location for them, so that takes out some portion.

是的，傑米，我會接受的。我想說它相當穩定。我們沒有註意到顯著的變化，要么變得非常非常容易招募，要么變得更加困難。顯然我們有一個特定的薪酬模式。因此它會追蹤那些更具創業精神的人。如果有人想要直接工資，那麼這裡不會是他們的工作地點，所以這需要扣除一部分。

But we continue to find significant interest on the part of both, as I mentioned earlier, people coming right out of school as well as people that are in a smaller independent practice because of some of the benefits that they will receive by coming to LifeStance, not the least of which is that we have multiple license types so that they are in a position where they can learn and have a collegial environment with clinicians. We surround them with tools that most independent practices can't afford.

但正如我之前提到的，我們仍然對剛從學校畢業的人和正在從事較小規模獨立實踐的人產生了濃厚的興趣，因為他們通過加入 LifeStance 可以獲得一些好處，最重要的是，我們擁有多種許可證類型，以便他們能夠學習並與臨床醫生擁有一個共同的環境。我們為他們提供了大多數獨立實踐無法負擔的工具。

And the professional development opportunity that we offer is something that we're going to continue to weigh into because we had a lot of feedback that that's highly desirable. So I would say we continue to be pleased with the pipeline and with our conversion.

我們將繼續考慮我們提供的專業發展機會，因為我們收到了很多非常需要的回饋。所以我想說，我們仍然對管道和我們的轉換感到滿意。

Okay. Great. And then you've had improvement really all year in center cost per visit. How should we think about that progressing going forward in light of some of the de novo comments next year that ramp in? And then just relatedly, I mean, how are you thinking about in-person versus telehealth as you start to ramp up de novo openings next year?

好的。偉大的。然後，全年每次訪問中心的成本確實有所改善。鑑於明年出現的一些新評論，我們該如何看待這項進展？與此相關的是，我的意思是，當您明年開始增加從頭開始的空缺時，您如何考慮面對面醫療與遠距醫療？

Yes, I'll take that one, Jamie. There's a couple of pieces there. So first of all, address the de novo question. So as I mentioned in my prepared remarks, we're only going to open this year, but we had 5 to 10 that just because of timing and how long it takes for the approval process and construction are pushing in the first quarter of next year and that there would be a meaningful step-up next year. Now we're not at a point of guiding. But I want to make the point that we're not going back to the old days of building like 100 de novos next year.

是的，我要那個，傑米。那裡有幾塊。首先，解決從頭開始的問題。正如我在準備好的演講中提到的，我們只會在今年開業，但我們有5 到10 個，這只是因為時間安排以及審批流程和施工需要多長時間，這些都將在明年第一季度推動明年將會有一個有意義的進步。現在我們還沒有到指導的地步。但我想指出的是，明年我們不會再回到過去建造 100 個這樣的時代。

You could think of it, it's going to be in the zone of something like what we started this year with roughly 20 de novos and then add the 5 to 10 that are delayed from this year pushing into next year. So that's -- it's going to be in that zone, but we'll tighten that up again on the fourth quarter call when we're giving guidance.

你可能會想到，這將是我們今年開始的大約 20 個從頭開始的區域，然後加上從今年推遲到明年的 5 到 10 個。所以，它將處於這個區域，但當我們提供指導時，我們將在第四季度電話會議上再次收緊這一範圍。

In regards to the in-person utilization is pretty stable second quarter to third quarter, just a little bit over 70%, virtual 30% in person. And for new patients, we're still seeing that in-person level being about 10%, higher than the average, so about 40% in person for the new patient visit.

從第二季度到第三季度，面對面的利用率相當穩定，略高於 70%，虛擬的面對面利用率為 30%。對於新患者，我們仍然發現親自就診的比例約為 10%，高於平均水平，因此新患者親自就診的比例約為 40%。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

Robleh, in for Brian. Center margin in the quarter came in really strong. And Dave, in your remarks, you noted you expect them to be relatively stable into '25. And I'm just curious if you all think the implied Q4 center margin is a good run rate for the business as we look over the next 6 to 12 months.

羅布萊（Robleh）取代布萊恩（Brian）。本季的中心利潤率非常強勁。戴夫，在您的演講中，您指出您希望他們在 25 年後保持相對穩定。我只是好奇，當我們展望未來 6 到 12 個月時，你們是否都認為隱含的第四季度中心利潤率對業務來說是一個良好的運作率。

Yes, it's Dave. I'll take that one. The way I think about 2025 is that overall, we will see some minimal margin expansion versus '24 because of the big outperformance we're seeing here in the back half of the year. And the components of that is I actually expect to see some modest compression on the -- or pressure downward on center margin, margin next year because we'll have flat TR PV, and we're still going to increase our clinician costs -- so you're going to have some pressure on center margin. At the same time, we will see the benefits of operating leverage on the G&A line, and then you can net those two together and you end up with a minimal increase in overall margins.

是的，是戴夫。我會接受那個。我對 2025 年的看法是，總體而言，與 24 年相比，我們將看到一些最小的利潤率擴張，因為我們在今年下半年看到了巨大的表現。其中的組成部分是，我實際上預計明年的中心利潤率、利潤率會出現一些適度的壓縮，或者壓力下降，因為我們的 TR PV 將持平，而且我們仍然會增加我們的臨床醫生成本。會對中心邊距造成一些壓力。同時，我們將看到 G&A 線上營運槓桿的好處，然後您可以將兩者相加，最終獲得整體利潤率的最小增長。

Got it. And then Congress has been waffling on whether to permanently extend telehealth Medicare reimbursements. And just curious on your outlook on the extension of these reimbursements considering the government funding deadline next month?

知道了。然後國會一直在考慮是否永久延長遠距醫療醫療保險報銷。只是想知道考慮到下個月的政府資助截止日期，您對延長這些報銷的看法嗎？

Yes. The -- yes, obviously, with new administration. We don't know exactly how it will play out. But as we monitor this, the increased recognition of the importance of improving access to mental health and the effectiveness of telehealth visits, we believe that there is a high, high degree of likelihood that the telehealth visit reimbursement will be sustained and maintained on into the future. So I would probably describe it as it's a discussion, but I don't sense that there's a lot of waffling sort of back and forth as to whether there should be a change, especially given the environment that we've described the disconnect between supply and demand.

是的。是的，顯然是新政府。我們不知道具體結果如何。但隨著我們對此進行監測，人們越來越認識到改善心理健康服務的重要性以及遠距醫療就診的有效性，我們相信，遠距醫療就診報銷很有可能會持續到2020年。因此，我可能會將其描述為一場討論，但我不認為對於是否應該做出改變存在很多胡扯，特別是考慮到我們所描述的供應之間脫節的環境和需求。

Stephanie Davis, Barclays.

史蒂芬妮戴維斯，巴克萊銀行。

I saw you had some really solid improvement in your clinician count. And we've been hearing some under more virtual union peers on the public and private side, talk about excess clinician capacity. So I want to hear if that is more a function of platform improvements or kind of the backdrop in the market improving. And because of the excess capacity comments I've heard from the private peers, have you looked at their platform improvements and consider borrowing any learnings from them? Or have you borrowed any learnings from them in order to kind of improving your clinician retention.

我看到您的臨床醫生人數有了一些非常顯著的進展。我們已經聽到一些公共和私人部門的虛擬工會同行談論臨床醫生能力過剩。所以我想聽聽這是否更多是平台改進的結果，還是市場改善的背景。由於我從私人同行那裡聽到了產能過剩的評論，您是否研究過他們的平台改進並考慮向他們借鑒任何經驗？或者您是否從他們那裡借鑒了任何經驗教訓，以提高您的臨床醫生保留率。

So Stephanie, maybe you can help the excess capacity. Could you explain what you're referencing and --

所以史蒂芬妮，也許你可以幫忙解決過剩產能。你能解釋一下你所引用的內容以及--

So we've heard of virtual-only peers actually having more inbound applications from clinicians, then they're able to hire or able to have utilization for, which is very opposite from what you can see. And they've attributed to platform improvement. So I've been curious if this is a function of the market or if this is a function of platform improvement as it is platform improvement, maybe what learnings you guys could borrow?

因此，我們聽說純虛擬同行實際上有更多來自臨床醫生的入站申請，然後他們能夠僱用或能夠利用，這與您所看到的非常相反。他們將其歸因於平台的改進。所以我很好奇這是市場的功能還是平台改進的功能，因為它是平台改進，也許你們可以藉鏡哪些經驗？

Yes. Well, that's actually new information to us. We have -- I mean, the number of people sort of graduating and going through training, we have not seen a substantial uplift based on your question, we'll obviously look into that but --

是的。嗯，這對我們來說實際上是新資訊。我們——我的意思是，畢業和接受培訓的人數，根據你的問題，我們沒有看到實質性的提升，我們顯然會調查這一點，但是--

I hope that means talk in the call background, huh?

我希望這意味著在通話後台通話，對吧？

Pardon me?

對不起？

I said it sounds like we need to go and do a little more deeper diving in the call background. I'm sure you will go help me on that one.

我說聽起來我們需要在通話背景中進行更深入的研究。我相信你會在這件事上幫我的。

Yeah. Again, the -- we don't see a change. I'd love to see a change in the disconnect between the demand for outpatient mental health and the supply of clinicians able to provide that as your question suggests. Perhaps, as you talk about some of these virtual only companies, they're just at a scale where whether it's their platform, whether it's their compensation model, et cetera, they are seeing more interest.

是的。同樣，我們沒有看到任何變化。我希望看到對門診心理健康的需求與能夠提供您的問題所暗示的臨床醫生的供應之間的脫節有所改變。也許，當你談論其中一些純虛擬公司時，他們只是在一定規模上，無論是他們的平台，無論是他們的薪酬模式等等，他們都看到了更多的興趣。

I have so much respect and appreciation for the work that our clinical recruiting team does because as we talk about 285 net clinicians, obviously, that means we've hired substantially more than that, given that on a base of 7,000, we do have meaningful turnover that has stabilized, but it's nonetheless a factor. So I hope that what I find when we research this further is that there is an increase in professionals that want to go into the mental health practice, but that is not something that we've seen. And frankly, it's not something that I've heard or read in the literature. So we will follow-up, and that would be very good news.

我非常尊重和讚賞我們的臨床招聘團隊所做的工作，因為當我們談論285 名淨臨床醫生時，顯然，這意味著我們僱用的人數遠多於此，考慮到以7,000 人為基礎，我們確實有有意義的工作營業額已經穩定，但這仍然是一個因素。因此，我希望當我們進一步研究時發現，想要從事心理健康實踐的專業人士有所增加，但這不是我們所看到的。坦白說，這不是我在文獻中聽到或讀到的東西。所以我們會跟進，這會是一個非常好的消息。

And a follow-up, I guess, related to that, when you think about some of the investments you're making in our improved clinician retention, have you considered any of the Gen AI tools that can kind of take the back end and documentation burdens off of folks? Or is that price point just not at an area where you've gone on investing?

我想，與此相關的後續行動是，當您考慮為提高臨床醫生保留率而進行的一些投資時，您是否考慮過任何可以獲得後端和文件的 Gen AI 工具減輕人們的負擔？還是這個價格點不在您投資的範圍內？

No, no, no, that is squarely within our fairway and very much on our radar screen. So we are piloting some of that right now. I would describe it as machine learning, where we can provide tools that dramatically improve the experience of note taking and documentation after a visit.

不，不，不，那正好在我們的球道內，並且在我們的雷達屏幕上。所以我們現在正在試點其中的一些。我將其描述為機器學習，我們可以提供工具來顯著改善訪問後的筆記和文件體驗。

So again, it's one of the advantages of our size that we can access the very best in tools that are out there, but we're being thoughtful in the way we deploy it. We're being really disciplined in our change management initiatives. But we are not only improving the tools and look to continue to do that. But as we talked about this new model, the model is improving the support that we provide our clinicians.

再說一次，我們規模的優勢之一是我們可以使用現有的最好的工具，但我們在部署它的方式上是經過深思熟慮的。我們在變革管理計劃中非常嚴格。但我們不僅改進工具，而且希望繼續這樣做。但當我們談論這個新模型時，該模型正在改善我們為臨床醫生提供的支援。

So both in terms of increased administrative support and then increased clinical leadership support. So we think that while I would never say we're done, we actually still have more to do towards the back half of this year and certainly into next year. We're going to be creating an even more positive environment within which our clinicians perform their valuable services.

因此，無論是增加行政支持，或是增加臨床領導支持。因此，我們認為，雖然我永遠不會說我們已經完成了，但實際上我們在今年下半年、尤其是明年還有更多工作要做。我們將創造一個更積極的環境，讓我們的臨床醫生提供有價值的服務。

All right. If that was the last question, I just have a couple of closing remarks. Again, I appreciate everybody's interest in LifeStance. I don't think I talk enough about the incredible work that our clinicians do. So I'll simply share that the very best part of my work week is when I read through the patient testimonials. We get literally several hundred every week, and it's a bright spot my day. The impact that we're having on lives is extraordinary.

好的。如果這是最後一個問題，我只想說幾句結束語。我再次感謝大家對 LifeStance 的興趣。我認為我對我們的臨床醫生所做的令人難以置信的工作談論得還不夠。因此，我將簡單地分享一下，我工作週中最好的部分是當我閱讀患者感言時。我們每週都會收到數百封郵件，這是我一天中的一個亮點。我們對生活的影響是非凡的。

And then finally, what I'd say is we're finishing '24 strong incredibly appreciative of the work that's done. Sometimes I have to remind myself that this company is only seven years old. We've gone through a hypergrowth phase. And more recently, we've been in what I'll call the three Ss: stabilize, standardize and strengthen. But what the future holds is incredibly exciting. The industry tailwinds are palpable, and I don't see any change. And so the best is yet to come.

最後，我要說的是，我們對 24 週年的結束感到非常感激我們所做的工作。有時我必須提醒自己，這家公司只有七年的歷史。我們已經經歷了高速成長階段。最近，我們進入了我所說的三個S：穩定、標準化和加強。但未來的前景是令人難以置信的令人興奮。產業的順風是顯而易見的，但我沒有看到任何變化。所以最好的尚未到來。

Once again, I want to thank 10,000 of my teammates who have gone through this two-year period where we are fortifying the foundation and strengthening the platforms that we can grow profitably and look forward to the years to come. So thank you, operator, and this could conclude the call.

我要再次感謝我的一萬名隊友，他們經歷了這兩年的時間，我們正在夯實基礎，加強我們可以獲利成長的平台，並展望未來。謝謝您，接線員，通話就到此結束。

Ladies and gentlemen, that concludes today's call. Thank you all for joining. You may now disconnect.

女士們、先生們，今天的電話會議到此結束。感謝大家的加入。您現在可以斷開連線。