P3 Health Partners Inc (PIII) 2023 Q3 法說會逐字稿

Good afternoon, everyone, and welcome to the P3 Health Partners Third Quarter Results Conference Call. (Operator Instructions) As a reminder, this conference is being recorded. I will now turn the conference over to Karen Blomquist, Vice President of Investor Relations of P3. Please go ahead.

大家下午好，歡迎參加 P3 Health Partners 第三季業績電話會議。 （操作員指示）謹此提醒，本次會議正在錄製中。我現在將會議交給 P3 投資者關係副總裁 Karen Blomquist。請繼續。

Thank you, operator, and thank you for joining us today. Before we proceed with the call, I would like to remind everyone that certain statements made during this call are forward-looking statements under the U.S. federal securities laws, including statements regarding our financial outlook and long-term targets. These forward-looking statements are only predictions and are based largely on our current expectations and projections about future events and financial trends that we believe may affect our business, financial condition and results of operations.

謝謝您，接線員，也謝謝您今天加入我們。在我們進行電話會議之前，我想提醒大家，本次電話會議中所做的某些陳述屬於美國聯邦證券法規定的前瞻性陳述，包括有關我們的財務前景和長期目標的陳述。這些前瞻性陳述只是預測，主要基於我們目前對未來事件和財務趨勢的預期和預測，我們認為這些事件和財務趨勢可能會影響我們的業務、財務狀況和營運績效。

These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. Additional information concerning factors that could cause actual results to differ from these statements made on this call is contained in our periodic report filed with the SEC. The forward-looking statements made during this call speak only as of the date hereof, and the company undertakes no obligation to update or revise the forward-looking statements.

這些陳述存在風險和不確定性，可能導致實際結果與歷史經驗或當前預期有重大差異。有關可能導致實際結果與本次電話會議中所做陳述不同的因素的更多資​​訊包含在我們向 SEC 提交的定期報告中。本次電話會議中所做的前瞻性陳述僅代表截至本新聞稿發布之日的情況，本公司不承擔更新或修改前瞻性陳述的義務。

We will refer to certain non-GAAP financial measures on this call, including adjusted operating expense, adjusted EBITDA, adjusted EBITDA per member per month, medical margin, medical margin per member per month -- medical margin per member per month for persistent lives and cash burn. These non-GAAP financial measures are in addition to and not a substitute or superior to the measures of financial performance prepared in accordance with GAAP.

我們將在本次電話會議上提及某些非公認會計原則財務指標，包括調整後的營運費用、調整後的EBITDA、每位會員每月調整後的EBITDA、醫療保證金、每位會員每月的醫療保證金－每位會員每月的持久生命和醫療保證金燒錢。這些非公認會計原則財務指標是根據公認會計原則編制的財務績效指標的補充，而不是替代或優於這些指標。

There are a number of limitations related to the use of these non-GAAP financial measures. For example, other companies may calculate similarly titled non-GAAP financial measures differently. Refer to the appendix of our earnings release for a reconciliation of these non-GAAP financial measures to the most directly comparable GAAP measures. Information presented on this call is contained in the press release that we issued today and in our SEC filings, which may be accessed from the Investors page of the P3 Health Partners website.

使用這些非公認會計準則財務指標有許多限制。例如，其他公司可能會以不同的方式計算類似名稱的非公認會計準則財務指標。請參閱我們收益發布的附錄，以了解這些非 GAAP 財務指標與最直接可比較的 GAAP 指標的對帳。本次電話會議中提供的資訊包含在我們今天發布的新聞稿和 SEC 文件中，您可以從 P3 Health Partners 網站的投資者頁面存取這些文件。

I will now turn the call over to Dr. Abdou, CEO and Co-Founder of P3.

我現在將把電話轉給 P3 執行長兼聯合創始人 Abdou 博士。

Thanks, Karen, and thank you all for joining our third quarter 2023 conference call. I would like to update you all on our third quarter financial results, 2023 guidance as well as provide preliminary 2024 guidance.

謝謝凱倫，也謝謝大家參加我們的 2023 年第三季電話會議。我想向大家介紹我們第三季財務業績、2023 年指導的最新情況，並提供 2024 年初步指引。

I will start off with some few big picture comments. We are pleased to be able to report that we are tracking towards our 2023 full year guidance as expected. Our overall momentum remains very strong. While our third quarter EBITDA is lower than anticipated by approximately $15 million, this is predominantly due to some timing elements impacting our EBITDA realization, which Atul will provide further details on shortly.

我將從一些大局評論開始。我們很高興能夠報告，我們正在按預期追蹤 2023 年全年指引。我們的整體勢頭仍然非常強勁。雖然我們第三季的 EBITDA 比預期低約 1500 萬美元，但這主要是由於一些時間因素影響了我們的 EBITDA 實現，Atul 很快就會提供更多詳細資訊。

The key point is that we expect about $15 million to $20 million of final payment for 2023 -- for 2022 data services to be realized in the fourth quarter, and that will drop to -- down to adjusted EBITDA. I'm also pleased to be able to report that our cash burn, defined as cash flow from operations less CapEx for the third quarter was $8 million, and we are on track to be cash flow breakeven in 2024 as previously discussed.

關鍵點是，我們預計 2023 年最終付款約為 1500 萬至 2000 萬美元，2022 年數據服務將在第四季度實現，這將降至調整後 EBITDA。我還很高興能夠報告，我們的現金消耗（定義為第三季度營運現金流減去資本支出）為 800 萬美元，正如之前所討論的，我們預計在 2024 年實現現金流盈虧平衡。

We are providing a preliminary 2024 adjusted EBITDA guidance of positive $20 million to positive $40 million. The guidance range assumes $60 million EBITDA from persistent lives that's our baseline. We will provide more detailed guidance in January 2024.

我們提供的 2024 年調整後 EBITDA 初步指引為正 2,000 萬美元至正 4,000 萬美元。指引範圍假設持久壽命的 EBITDA 為 6000 萬美元，這是我們的基準。我們將於 2024 年 1 月提供更詳細的指導。

On to our third quarter and year-to-date highlights. Revenue for the quarter was $288 million, an increase of approximately 16% over the prior year's quarter. And year-to-date, revenue of $920 million also grew 16% versus the prior year period.

接下來是我們的第三季和今年迄今為止的亮點。該季度營收為 2.88 億美元，比去年同期成長約 16%。今年迄今為止，營收為 9.2 億美元，較上年同期成長 16%。

Medical margin for the quarter was $36 million, $126 million year-to-date, on track to meet our guidance of $155 million to $175 million for the year. Medical margin per member per month for the quarter on all lives was $115 per member per month and $135 PMPM on a year-to-date basis. Medical margin PMPM for our persistent lives was $241 PMPM on a year-to-date basis. That is consistent with the mature market range of $150 to $200-plus PMPM reported by our peer, agilon, which we consider a valuable benchmark.

本季的醫療利潤率為 3,600 萬美元，年初至今為 1.26 億美元，預計將達到我們今年 1.55 億至 1.75 億美元的指引。本季所有生命的每位會員每月的醫療利潤為每位會員每月 115 美元，年初至今為 135 美元 PMPM。今年迄今為止，我們持久生命的醫療利潤 PMPM 為 241 美元 PMPM。這與我們的同行 agilon 報告的 150 美元至 200 美元以上 PMPM 的成熟市場範圍一致，我們認為這是一個有價值的基準。

Persistent lives are defined as the lives were on our platform in December 2022 and are on our platform in January 2023. Medical claim expense PMPM for our Medicare Advantage lives were approximately negative 2% year-to-date. That is a reflection of the power of the P3 model and ability to build the cost curve with more persistent lives on our platform.

持續性生命的定義是 2022 年 12 月和 2023 年 1 月在我們平台上的生命。年初至今，我們的 Medicare Advantage 生命的醫療索賠費用 PMPM 約為負 2%。這反映了 P3 模型的力量以及在我們的平台上建立具有更持久生命週期的成本曲線的能力。

Adjusted EBITDA for the quarter was negative $22.3 million compared to a negative $40.3 million in the prior year. The $22.3 million includes the impact of noncash in the quarter, $3.8 million true-up of employee health care costs and does not take into account the accrual for the revenue recognition for final payment of 2023 -- for data service 2022 that we expect will be captured in the fourth quarter.

本季調整後 EBITDA 為負 2,230 萬美元，而前一年為負 4,030 萬美元。 2,230 萬美元包括本季非現金的影響、380 萬美元的員工醫療保健成本調整，並且沒有考慮 2023 年最終付款的收入確認的應計費用——我們預計 2022 年的數據服務將是在第四季度被捕獲。

Year-to-date adjusted EBITDA was negative $41.2 million compared to the prior year of negative $87.9 million, which is 53% improvement. Said differently, we cut our losses in half.

年初至今，調整後 EBITDA 為負 4,120 萬美元，而上年為負 8,790 萬美元，提高了 53%。換句話說，我們將損失減少了一半。

As we look forward to 2024, we would like to provide you with some insight as to how we see next year shaping up. As I just shared, our baseline for 2024 starts with the expectation that our persistent lives will contribute approximately $60 million of EBITDA in the year. Additionally, we expect to take on meaningful new lives and growth in 2024. We are expecting to achieve this growth in a very capital efficient way by continuing to focus on existing and adjacent markets while leveraging our existing infrastructure in a meaningful way.

展望 2024 年，我們希望為您提供一些關於我們對明年的展望的見解。正如我剛才分享的，我們對 2024 年的基準始於預期我們的持久生活將在這一年貢獻約 6000 萬美元的 EBITDA。此外，我們預計將在2024 年實現有意義的新生活和成長。我們期望透過繼續專注於現有和鄰近市場，同時以有意義的方式利用我們現有的基礎設施，以非常資本高效的方式實現這一增長。

We have various conversations ongoing with payers, providers and health systems, including potential JV and strategic partnership opportunities. Based on all this, I remain bullish on our opportunities to thrive in the years to come. Now I would like to turn the call over to Bill Bettermann, our Chief Operating Officer.

我們正在與付款人、提供者和衛生系統進行各種對話，包括潛在的合資和策略合作機會。基於這一切，我仍然看好我們在未來幾年蓬勃發展的機會。現在我想將電話轉給我們的營運長 Bill Bettermann。

Thank you, Sherif. I plan to cover 3 topics today: first, how we judge our own operating performance and the effectiveness of the P3 model; second, ACO reach; and third, highlights from our California market.

謝謝你，謝里夫。今天我打算講三個主題：第一，我們如何判斷自己的經營績效和P3模型的有效性；第二，ACO到達；第三，我們加州市集的亮點。

We, as a management team, judge our own operating performance on a PMPM basis as well as versus publicly available benchmarking data. On the last point, we have a publicly traded peer, agilon health, with a similar affiliate business model, so the data is readily available and relevant. We have the utmost respect and admiration for what agilon has achieved and use it as a natural benchmark for the P3 business, knowing there are some differences in the model and mix in membership.

作為管理團隊，我們根據 PMPM 以及公開的基準數據來判斷自己的營運績效。關於最後一點，我們有一個公開交易的同行 agilon health，具有類似的附屬業務模式，因此數據很容易獲得且相關。我們對 agilon 所取得的成就懷有最大的尊重和欽佩，並將其作為 P3 業務的自然基準，因為我們知道其模式和會員組合存在一些差異。

The first relevant data point is revenue per member per month growth for the quarter. This is a relevant data point to answer the question, is the P3 model effective at engaging patients and assessing the disease burden appropriately? P3's revenue PMPM growth for the quarter was 11% and agilon's was the same. P3's revenue PMPM year-to-date was $985; agilon's was $945. We are pleased about that.

第一個相關數據點是該季度每位會員每月的收入成長。這是回答以下問題的相關數據點：P3 模型是否有效吸引患者並適當評估疾病負擔？ P3 本季的營收 PMPM 成長率為 11%，agilon 的成長率相同。 P3 今年迄今的 PMPM 收入為 985 美元； agilon 的售價為 945 美元。我們對此感到高興。

The second data point is medical margin PMPM, which is directly tied to the effectiveness of P3's model in absolute terms and relative to a JV model. It answers the question, does the P3 model bend the cost curve as effectively as the JV model? It is the fundamental value prop in value-based care, premiums less medical claims.

第二個數據點是醫療利潤 PMPM，它與 P3 模型的絕對有效性以及相對於合資模型的有效性直接相關。它回答了這樣一個問題：P3 模式是否能像 JV 模式一樣有效地彎曲成本曲線？它是基於價值的照護（保費減去醫療索賠）的基本價值支柱。

P3's medical margin PMPM is $135 year-to-date. agilon's was $119 PMPM year-to-date and $134 PMPM for 2-year plus markets. P3's persistent lives medical margin PMPM is $241 year-to-date. We're already operating at mature margins of a JV model.

今年迄今為止，P3 的醫療利潤 PMPM 為 135 美元。 agilon 的年初至今為 119 美元 PMPM，2 年以上市場為 134 美元 PMPM。今年迄今為止，P3 的持久生命醫療利潤 PMPM 為 241 美元。我們已經以合資模式的成熟利潤率運作。

The third data point is gross profit PMPM. P3's year-to-date gross profit PMPM was $56 PMPM versus agilon's at $45 PMPM. We feel really good about that.

第三個數據點是毛利潤PMPM。 P3 年初至今的毛利 PMPM 為 56 美元 PMPM，而 agilon 的毛利為 45 美元 PMPM。我們對此感覺非常好。

There are some differences in the 2 models. We are not fully scaled yet and expect to leverage our infrastructure in a similar fashion as we grow over the coming years. P3 owns roughly 100% of its adjusted EBITDA, and so we don't expect significant minority interest expense going forward as we become adjusted EBITDA profitable. We don't have significant geographic entry costs. We generally grow adjacent to our existing markets given the significant white space available to pursue this strategy.

2 種型號有些差異。我們尚未完全擴展，預計隨著我們未來幾年的發展，以類似的方式利用我們的基礎設施。 P3 大約擁有其調整後 EBITDA 的 100%，因此，隨著我們實現調整後 EBITDA 獲利，我們預計未來不會出現大量少數股東利息支出。我們沒有很高的地域進入成本。鑑於有大量空白空間可用於實施此策略，我們通常會在現有市場附近發展。

P3's cash burn year-to-date was $61 million versus agilon's at $107 million. We also enjoyed lower cost of membership acquisition than our peers. The majority of our provider adds are driven by inbound inquiries by those attracted to our operating model, and this really allows us to avoid long sales cycles.

P3 今年迄今的現金消耗為 6,100 萬美元，而 agilon 為 1.07 億美元。與同業相比，我們的會員獲取成本也更低。我們的大多數供應商增加都是由那些被我們的營運模式所吸引的入站查詢所推動的，這確實使我們能夠避免較長的銷售週期。

Additionally, 20% of P3's revenue is delegated, which has positive cash flow dynamics attributed to it. We expect to grow that over time so our cash flow dynamics will mirror that of a health plan, premiums upfront, pay claims later. The delegated model also enables important operating benefits related to better data clarity, accuracy and timing versus non-delegated, which is helpful to drive physician adoption of our P3 model in better managed medical cost trend.

此外，P3 20% 的收入被授權，這帶來了積極的現金流動態。我們預計隨著時間的推移，現金流量將不斷增長，這樣我們的現金流動態將反映健康計劃、預付保費、稍後支付索賠的情況。與非授權相比，授權模型還可以帶來與更好的數據清晰度、準確性和時間表相關的重要營運優勢，這有助於推動醫生在更好地管理醫療成本趨勢中採用我們的P3模型。

Finally, we have a lower mix of ACO REACH lives today. Regarding ACO REACH, we have roughly 7,000 lives today and plan to increase that substantially over the coming years. With our current 2,700 and growing PCPs that we have, the ACO REACH program allows us to create greater depth into each of our practices by offering the benefits of this program to patients being seen by those PCPs who are not currently in a risk-based arrangement. Migrating those patients to an ACO REACH program further entrenches the value-based care concept with our clinicians and allows us to better serve those patients.

最後，我們今天的 ACO REACH 生活組合較低。關於 ACO REACH，我們目前約有 7,000 條生命，並計劃在未來幾年大幅增加這一數字。我們目前擁有 2,700 名 PCP，並且數量還在不斷增加，ACO REACH 計劃使我們能夠更深入地了解我們的每項實踐，為那些目前未處於基於風險安排的 PCP 就診的患者提供該計劃的好處。將這些患者轉移到 ACO REACH 計劃進一步鞏固了我們臨床醫生基於價值的護理理念，並使我們能夠更好地為這些患者提供服務。

We continue to see an increase in engagement level of our clinicians as they deepen their understanding of the value-based care program due to proper incentive alignment, increased use of our data tools and education, as well as working with our care management teams for very sick, high-utilizing patients. This increased adoption and engagement is very encouraging and bodes very well for our clinical, financial and operational performance going forward.

我們繼續看到臨床醫生的參與程度不斷提高，因為他們加深了對基於價值的護理計劃的理解，這是由於適當的激勵調整、更多地使用我們的數據工具和教育，以及與我們的護理管理團隊合作，以實現非常好的目標。生病的、高利用率的患者。採用率和參與度的增加非常令人鼓舞，並且對我們未來的臨床、財務和營運績效來說是個好兆頭。

Lastly, I want to take a minute to focus on one of our newer markets, California, which we entered in December of 2021. We have approximately 8,500 Medicare Advantage members in this market. Much of this market is based solely on affiliate providers as we don't have a medical group presence here. If we compare the California market from September of 2023 year-to-date versus prior year-to-date, you will see some significant improvements we've made in this market's performance.

最後，我想花一點時間關注我們的一個新市場——加州，我們於 2021 年 12 月進入該市場。該市場大約有 8,500 名 Medicare Advantage 會員。這個市場的大部分完全基於附屬提供者，因為我們這裡沒有醫療團體。如果我們將 2023 年 9 月至今的加州市場與去年至今進行比較，您會發現我們在該市場的表現方面取得了一些重大改進。

If you start with revenue PMPM, third quarter 2023 year-to-date, it was $1,134 PMPM versus year-to-date prior, it was $976 PMPM. That's an increase of 16%. Medical margin PMPM, third quarter year-to-date 2023, it was positive $244 PMPM versus year-to-date prior, it was negative $45 PMPM, a nearly $300 positive swing. One key element driving this performance is our commitment to building very strong relationships with our affiliate providers. We've partnered with them to see many of their patients in our senior center where we believe we have done a tremendous job of closing care gaps and identifying their chronic conditions to help aid their PCPs in providing the best care.

如果從 PMPM 收入開始，2023 年第三季年初至今，PMPM 收入為 1,134 美元，而年初至今為 PMPM 976 美元。增幅為 16%。醫療利潤率 PMPM，2023 年至今第三季度，為正值 244 美元，而年初至今為負值 45 美元，正值波動近 300 美元。推動這項業績的關鍵因素是我們致力於與我們的附屬提供者建立非常牢固的關係。我們與他們合作，在我們的老年中心探望他們的許多患者，我們相信我們在縮小護理差距和確定他們的慢性病方面做了巨大的工作，以幫助他們的 PCP 提供最好的護理。

We believe we have also optimized our health plan contracts to assure full alignment with our payer partners and will expand upon the coordination of care with the stronger performing plans.

我們相信，我們也優化了我們的健康計劃合同，以確保與我們的付款合作夥伴完全一致，並將擴大護理與表現更強勁的計劃的協調。

I want to thank you for your time today. And now I will turn the call over to Atul Kavthekar, our CFO.

我想感謝您今天抽出時間。現在我將把電話轉給我們的財務長 Atul Kavthekar。

Thanks, Bill, and good afternoon, everyone. I'll start by discussing our recent quarter and how we are progressing towards meeting our full year guidance. Then I'll provide updates on our liquidity position and our significantly lower cash burn in the quarter and finish up with some thoughts around our preliminary 2024 adjusted EBITDA guidance.

謝謝比爾，大家下午好。我將首先討論我們最近的季度以及我們如何在實現全年指導方面取得進展。然後，我將提供有關我們的流動性狀況的最新資訊以及本季度顯著降低的現金消耗，並最後對我們初步的 2024 年調整後 EBITDA 指導提出一些想法。

I'll begin with our results for the quarter and year-to-date. Top line results for the third quarter were strong, with capitated revenue of $285 million and total revenue of $288 million representing growth of 17% and 16%, respectively, compared to the prior year. Year-to-date, capitated revenue was $910 million, and total revenue was $920 million, representing an improvement of approximately 16% on each metric compared to the same period in the prior year.

我將從本季和年初至今的業績開始。第三季的營收表現強勁，人均營收為 2.85 億美元，總營收為 2.88 億美元，較上年同期分別成長 17% 及 16%。年初至今，人均所得為 9.1 億美元，總營收為 9.2 億美元，各項指標均較上年同期成長約 16%。

On a PMPM basis, this roughly equates to a 16% improvement, reflective of improved funding on the nearly 75% of persistent members on our platform, which we define as members who have been with P3 since the start of the calendar year.

在 PMPM 的基礎上，這大約相當於 16% 的改進，反映了我們平台上近 75% 的持久會員的資金增加，我們將這些會員定義為自年初以來一直在 P3 的會員。

In the third quarter, our medical margin improved to $36 million or $115 on a PMPM basis, which is a roughly 6x improvement compared to the prior year. Year-to-date, medical margin improved nearly 25x to $126 million. Gross profit in the quarter improved significantly over the prior year to $9 million or $29 PMPM compared to a slight loss in the prior year. Year-to-date, gross profit increased to $52 million or $56 PMPM compared to a loss in the prior year. This is yet another quarter in which we have demonstrated significant progress on these measures and that provides a clearer picture on our ability to manage and improve our members' health.

第三季度，我們的醫療利潤率提高至 3,600 萬美元，以 PMPM 計算為 115 美元，與前一年相比大約提高了 6 倍。今年迄今為止，醫療利潤率提高了近 25 倍，達到 1.26 億美元。本季的毛利比上年大幅提高，達到 900 萬美元或 29 PMPM，而上年略有虧損。年初至今，毛利增加至 5,200 萬美元，與前一年的虧損相比，每分鐘利潤增加 56 美元。這是我們在這些措施上取得重大進展的又一個季度，這讓我們更清楚地了解了我們管理和改善會員健康的能力。

Going forward, we have targeted several new initiatives that we will be laser focused on that are designed to be even more impactful in managing our medical costs. We will be sharing much more about them and the delivered results in subsequent calls.

展望未來，我們已經制定了幾項新舉措，我們將重點關注這些舉措，這些舉措旨在對管理我們的醫療費用產生更大的影響。我們將在後續電話會議中分享更多有關它們和交付結果的資訊。

As it relates to operating expense trends, we saw a significant drop in our platform support costs, going from 12% of revenue in the third quarter of '22 down to 9% in the current quarter. I continue to be very pleased with the team's commitment to continuous improvement and operational innovation. And as I've said in the past, we will continue to monitor our spending carefully and incorporate this mindset into our everyday cash management.

由於與營運支出趨勢相關，我們看到平台支援成本大幅下降，從 22 年第三季佔營收的 12% 下降到本季的 9%。我仍然對團隊對持續改進和營運創新的承諾感到非常滿意。正如我過去所說，我們將繼續仔細監控我們的支出，並將這種心態納入我們的日常現金管理中。

Adjusted EBITDA for the quarter was a loss of $22 million, a significant improvement compared to a loss of $40 million in the prior year. Year-to-date, 2023 adjusted EBITDA loss was $41 million compared to a loss of $88 million in the same period of '22, another significant area of improvement.

本季調整後 EBITDA 虧損 2,200 萬美元，與上一年虧損 4,000 萬美元相比有了顯著改善。年初至今，2023 年調整後 EBITDA 損失為 4,100 萬美元，而 2022 年同期的損失為 8,800 萬美元，這是另一個重大改進領域。

Let me provide some additional color on this quarter's adjusted EBITDA. Our adjusted EBITDA for the quarter reflects several notable elements, including favorable IBNR adjustment recommended by our actuaries of roughly $3.8 million noncash charge related to employee insurance costs; and finally, no recognition of any revenues in connection with our estimated 2023 final payment related to the 2022 dates of service.

讓我對本季調整後的 EBITDA 提供一些額外的資訊。我們本季調整後的 EBITDA 反映了幾個值得注意的因素，包括我們的精算師建議的有利的 IBNR 調整，即與員工保險成本相關的約 380 萬美元的非現金費用；最後，不確認與 2022 年服務日期相關的 2023 年預計最終付款相關的任何收入。

All in all, we are pleased with the quarter's results and plan to drive the company to higher performance over the next several quarters. To that end, we are reaffirming our full year 2023 guidance. We still expect 2023 revenue to be between $1.2 billion and $1.25 billion, adjusted EBITDA of between negative $30 million to negative $50 million, and our medical margin to be between $155 million and $175 million.

總而言之，我們對本季的業績感到滿意，並計劃在接下來的幾季推動公司取得更高的業績。為此，我們重申 2023 年全年指引。我們仍預期 2023 年營收將在 12 億美元至 12.5 億美元之間，調整後 EBITDA 將在負 3,000 萬美元至負 5,000 萬美元之間，醫療利潤率將在 1.55 億美元至 1.75 億美元之間。

With regards to our liquidity, our position is solid. We ended the quarter with approximately $58 million in cash. And consistent with our messaging last quarter, our cash burn was substantially lower than in prior quarters at approximately $8 million of burn in Q3. While this is reflective of a more normalized burn rate in the near term, we continue to march down a path that leads us to profitability next year and positive cash flow soon thereafter.

就我們的流動性而言，我們的地位是穩固的。本季結束時，我們擁有約 5800 萬美元的現金。與我們上季度傳達的訊息一致，我們的現金消耗大幅低於前幾季度，第三季度的現金消耗約為 800 萬美元。雖然這反映了短期內燒錢率更加正常化，但我們繼續沿著一條讓我們明年實現盈利並很快實現正現金流的道路前進。

Looking forward, and as Sherif mentioned earlier, we are expecting to continue the positive trends we've seen in terms of member growth, revenue, medical margin and operating expenses. Specifically, we have high visibility into some of the key drivers of our business, including our persistent member economics, our new membership growth pipeline, our funding in 2024 adjusted for the V28 model, our growing ACO REACH penetration along with its better unit economics, and specific areas of opportunity in our medical cost management.

展望未來，正如謝里夫之前提到的，我們預計在會員成長、收入、醫療利潤和營運費用方面將繼續保持我們所看到的正面趨勢。具體來說，我們對業務的一些關鍵驅動因素有很高的了解，包括我們持久的會員經濟效益、我們新的會員成長管道、我們根據V28 模型調整的2024 年資金、我們不斷增長的ACO REACH 滲透率以及更好的單位經濟效益，以及我們醫療成本管理的具體機會領域。

We will provide further details at a future investor conference in early 2024, but we're expecting to generate adjusted EBITDA between positive $20 million and positive $40 million. We are pleased to share our continued optimism and excitement at the near-term and long-term prospects of P3 and look forward to sharing more specific details with you in the coming weeks.

我們將在 2024 年初舉行的未來投資者會議上提供更多詳細信息，但我們預計調整後的 EBITDA 將在 2000 萬美元到 4000 萬美元之間。我們很高興與大家分享我們對 P3 的近期和長期前景的持續樂觀和興奮，並期待在未來幾週內與您分享更多具體細節。

Operator, let me make some closing comments, and then we'll go to Q&A. So today in the call, we shared with you -- reaffirmed our EBITDA and medical margin guidance for 2023. We shared with you that our revenue was up 16%. Our capitated revenue was up 17%. We also shared with you that our Medicare Advantage medical expense year-to-date per member per month, when you compare it with the Medicare Advantage year-to-date 2022, the trend is down, negative 2% improvement in the medical cost, and that reflects the power of P3 model and the success that we're seeing.

接線員，讓我做一些結束語，然後我們將進入問答環節。因此，今天在電話會議中，我們與您分享了 2023 年 EBITDA 和醫療利潤率指引。我們與您分享了我們的收入成長了 16%。我們的人均收入成長了 17%。我們也與您分享了我們的 Medicare Advantage 年初至今每位會員每月的醫療費用，當您將其與 2022 年至今的 Medicare Advantage 進行比較時，趨勢是下降的，醫療費用下降了 2%，這反映了P3 模型的力量以及我們所看到的成功。

The medical margin had improved 306% year-over-year, $36 million for the quarter over $9 million last year quarter. Gross profit was $9 million positive versus $6 million negative last year, same quarter. OpEx is down 18% to 20% year-over-year. Our cash burn, as we shared with you, is $8 million for the entire quarter. Our EBITDA has improved from last quarter and year-to-date, '23 over '22 by 53%, as we mentioned and shared with you that basically, we cut our losses in half over this year.

本季醫療利潤率年增 306%，達到 3,600 萬美元，去年同期為 900 萬美元。毛利為正 900 萬美元，而去年同季為負 600 萬美元。營運支出較去年同期下降 18% 至 20%。正如我們與您分享的，我們整個季度的現金消耗為 800 萬美元。我們的 EBITDA 比上季和今年迄今有所改善，'23 比 '22 提高了 53%，正如我們提到並與您分享的那樣，基本上，我們今年的虧損減少了一半。

And we've shared with you our preliminary projection for EBITDA positive 2024, between $20 million and $40 million. So with that, operator, we're ready for Q&A.

我們已經與您分享了我們對 2024 年 EBITDA 盈利的初步預測，預計在 2000 萬美元到 4000 萬美元之間。操作員，我們已經準備好要進行問答了。

(Operator Instructions) Our first question comes from Brooks O'Neil with Lake Street Capital Markets.

（操作員說明）我們的第一個問題來自 Lake Street Capital Markets 的 Brooks O'Neil。

Congratulations on the significant progress you've made. I have a couple of questions. I guess I'd like to -- first, just to ask you, I think, Sherif, you mentioned that you expect a meaningful drop down in Q4 related to the claims experience in the prior year. When you're thinking about the $20 million to $40 million of positive EBITDA you commented about expecting in 2024, is that dependent on any kind of similar drop down from prior year?

恭喜您所取得的重大進步。我有一些問題。我想我想 - 首先，我想問你，謝里夫，你提到你預計第四季度與上一年的索賠經歷有關的大幅下降。當您考慮 2024 年預期的 2000 萬至 4000 萬美元的 EBITDA 收益時，這是否取決於上一年的任何類似下降？

Well, I think -- Brooks, first, thank you very much, and I appreciate the question. That's exactly why I put those summary caps at the end. It's -- we're going to continue to improve that. The revenue will continue to go up, 16% to 17%. The medical cost will continue to trickle down. And as a result, our actuarial, as I said, recommended that we start releasing some of the reserves that we put in IBNR. Our medical margin has improved 300% year-over-year. I don't even have to do that. But if we continue to improve, and the contribution from the persistent life is $241 PMPM. So you can extrapolate that continuation of revenue, medical costs go down, medical margin go up, gross profit go up, OpEx -- we're all focused on continuing to be more efficient and leverage the infrastructure. The cash burn continue to go down, then that's our path for $20 million to $40 million EBITDA.

嗯，我想——布魯克斯，首先，非常感謝你，我很欣賞這個問題。這正是我將這些摘要上限放在最後的原因。我們將繼續改進這一點。收入將繼續增長16%至17%。醫療費用將持續下降。因此，正如我所說，我們的精算師建議我們開始釋放 IBNR 中的一些準備金。我們的醫療利潤率年增了 300%。我什至不必這樣做。但如果我們繼續改進，堅持不懈的生活的貢獻是 $241 PMPM。因此，您可以推斷收入持續成長、醫療成本下降、醫療利潤率上升、毛利上升、營運支出上升——我們都專注於繼續提高效率並充分利用基礎設施。現金消耗持續下降，這就是我們實現 2,000 萬至 4,000 萬美元 EBITDA 的路徑。

That's great. I think it's going to be important for you to get there. And it sounds like you're on track to do so. So that's fantastic. Let me just ask you about the growth you commented about in new lives for 2024. Obviously, historically, when you've had new lives come in, they tend to be depressing to some of the profit and performance you've had. How confident are you that you can bring in new lives next year and still continue the improvement you're seeing now?

那太棒了。我認為到達那裡對你來說很重要。聽起來你正在這樣做。所以這太棒了。讓我問一下您所評論的 2024 年新生命增長。顯然，從歷史上看，當新生命到來時，它們往往會抑制您已有的一些利潤和業績。您對明年能夠帶來新生活並繼續保持現在所看到的進步有多大信心？

We're very confident, Brooks, because we've added some lives this year. We've added on the same network. We've added on the same geography and markets. We went to the market in the county next door so that we can leverage the infrastructure, and we're going to continue to do so. And we're seeing more and more as not only the patient maturation take place, but the physician engagement maturation takes place, the time from landing in our platform and soaring into a successful medical margin is getting shorter and shorter. So we're very confident that we will be able to grow and maintain the trajectory that we shared with you today.

布魯克斯，我們非常有信心，因為今年我們增加了一些生命。我們已新增至同一網路。我們增加了相同的地理位置和市場。我們去了隔壁縣的市場，這樣我們就可以利用基礎設施，我們將繼續這樣做。我們越來越多地看到，不僅患者成熟，醫生參與也成熟，從登陸我們的平台到飆升至成功的醫療利潤的時間越來越短。因此，我們非常有信心能夠發展並維持我們今天與您分享的發展軌跡。

Great. Let me ask one last question. I think it was Atul mentioned the funding improvement that you've achieved this year. My sense is that our friends at CMS have made some changes to the risk adjustment mechanisms in Medicare Advantage. Again, how confident are you that you can continue to drive improved funding next year in the environment we all anticipate for 2024?

偉大的。讓我問最後一個問題。我認為阿圖爾提到了你們今年取得的資金改善。我的感覺是，我們 CMS 的朋友對 Medicare Advantage 中的風險調整機制進行了一些更改。同樣，在我們都預計 2024 年的環境中，您對明年能夠繼續推動融資改善有多大信心？

I'll turn the answer to Dr. Bacchus. He's here with us in the room. He is our co-founder and Chief Medical Officer. Dr. Bacchus?

我會把答案轉給巴克斯博士。他和我們一起在房間裡。他是我們的共同創辦人兼首席醫療官。巴克斯博士？

Brooks, good to hear your voice again. Yes, I mean for us, as we've heard me describe before, a few different factors are really important in making sure that we can continue to perform in driving not only proper documentation for each and every one of our patients through our education modules and things that we do today, but also, it comes from -- as Sherif is describing, the maturity of those practices that understand it. So those things all bode well for us upfront.

布魯克斯，很高興再次聽到你的聲音。是的，我的意思是對我們來說，正如我們之前聽我所描述的那樣，有幾個不同的因素對於確保我們能夠繼續透過我們的教育模組為我們的每位患者提供適當的文檔非常重要我們今天所做的事情，而且正如謝里夫所描述的那樣，它來自於那些理解它的成熟實踐。所以這些事情對我們來說都是好兆頭。

In addition to that, as we've talked about, we've also had -- we have a better opportunity in regards to when we're looking at where we currently reside in our current RAF with the opportunity that still exists. So in analyzing our populations, we still know we have significant opportunity, even with the revenues that Sherif described. So we are quite excited as we even move to version 24 to 28 to continue to perform in the risk adjustment coding standpoint.

除此之外，正如我們所討論的，我們還有一個更好的機會，當我們考慮我們目前在英國皇家空軍中的位置時，我們仍然存在機會。因此，在分析我們的人口時，我們仍然知道我們擁有巨大的機會，即使有謝里夫所描述的收入。因此，我們非常興奮，因為我們甚至轉向版本 24 到 28，以繼續從風險調整編碼的角度執行。

The next question comes from Josh Raskin with Nephron Research.

下一個問題來自 Nephron Research 的 Josh Raskin。

I got a couple as well. I think I heard affiliated PCPs was 2,700. Correct me if I'm wrong, if that's not the updated number. And if you got a total member -- total at-risk membership number for the quarter as well?

我也有一對。我想我聽說附屬 PCP 是 2,700 名。如果我錯了，如果這不是更新的數字，請糾正我。如果你有一個總會員數－該季度的總風險會員數？

Yes. Thanks for that question. So that's right. So we are just a little over 2,700 PCPs in the overall platform.

是的。謝謝你提出這個問題。所以說是這樣的。因此，我們整個平台中的 PCP 略多於 2,700 個。

And members?

還有會員呢？

And total members are about 110,000 members year-to-date, Medicare at-risk.

今年迄今為止，會員總數約為 11 萬名，醫療保險面臨風險。

There's a lot more on the platform, but if you just count the at-risk population, the 110,000 and there's 4,000 or 5,000 that we -- on value-based shared savings, shared risk with Humana and Blue Cross in Arizona. So you can put the Medicare at 114,000.

該平台上還有更多內容，但如果你只計算高風險人群，那麼 110,000 人中還有 4,000 或 5,000 人，我們與亞利桑那州的 Humana 和 Blue Cross 進行基於價值的共享儲蓄和風險共享。因此您可以將 Medicare 定為 114,000。

Okay. Got you. And then can you talk about negotiations with payers for 2024? I assume you're mostly set on all of that. I'm specifically thinking about how you're dealing with those changes to the risk model that you mentioned? And then are they -- are your cap payments increasing? Are they cutting out some benefits? I'm just curious on data like that. And then also curious if you're having conversations with any new payers at this point that you don't currently work with.

好的。明白你了。然後您能談談 2024 年與付款人的談判嗎？我想你已經對所有這些都做好了準備。我特別想知道您如何處理您提到的風險模型的這些變化？然後他們——你的上限付款是否增加了？他們是否削減了一些福利？我只是對這樣的數據感到好奇。然後也很好奇您是否正在與目前尚未合作的任何新付款人進行對話。

Yes. So we're pleased to announce that we did sign a multiyear multistate contract with [Ascan] Health, which we did not have a contract with before. And as probably the only new payer that we did not have any contract with, we expanded our relationship with Aetna in Oregon. We expanded our relationship with ATRIO, the local health plan to multiple new counties in Oregon. And that's about -- and I think we're in the -- we haven't signed anything new in California, but we will.

是的。因此，我們很高興地宣布，我們確實與 [Ascan] Health 簽署了一份多年的多州合同，而我們之前沒有與該公司簽訂過合約。作為可能是唯一一個沒有與我們簽訂任何合約的新付款人，我們擴大了與俄勒岡州 Aetna 的關係。我們將與當地健康計劃 ATRIO 的關係擴展到俄勒岡州的多個新縣。這就是——我認為我們在——我們還沒有在加州簽署任何新協議，但我們會的。

Okay. And then -- but how are the negotiations just in terms of how are they trying to keep you whole in light of the reimbursement changes for 2024? Are you getting an extra percent or 2 on the [CAP] payments? Or just any color on that would be helpful, too.

好的。然後，考慮到 2024 年的報銷變化，他們如何努力讓您保持完整，談判進度如何？您是否會從 [CAP] 付款中獲得額外百分之一或百分之二的收益？或任何顏色都會有幫助。

Yes. So the biggest driver for the percentage of premium that as you improve the RAV that value of that percentage of premium would increase. As you saw, we had a 17% increase in our PMPM year-over-year. So there's no change in the percentage of premium that we -- we said we have a multiyear contract that's not open for negotiation. Most of them aren't this year. However, we participated in -- 2 things about the benefit. We participated in putting the benefits that impact our -- and I think vast majority of health plan. We're very logical and very supportive and very mindful of that impact downstream on us.

是的。因此，保費百分比的最大驅動因素是，當您提高 RAV 時，保費百分比的價值將會增加。如您所見，我們的 PMPM 年比增長了 17%。因此，我們的保費百分比沒有變化——我們說我們有一份不公開談判的多年合約。大多數都不是今年的。然而，我們參與了──有關福利的兩件事。我們參與制定了影響我們——我認為絕大多數健康計劃——的福利。我們非常有邏輯，非常支持，並且非常注意下游對我們的影響。

Second, we have a language to protect us in the medical benefits change, and that will adjust our premium if there's any adjustment, adjusted only upward, not downward.

其次，我們有一種語言可以在醫療福利變化中保護我們，如果有任何調整，我們的保費就會調整，只向上調整，而不是向下調整。

Okay. Got you. Got it. That's helpful. And then just to sneak one last one in. It sounded like $60 million of EBITDA expected in 2024 on the persistent members. So if you think about the $20 million to $40 million, sort of the expectation would be to lose $20 million to $40 million on sort of the new cohort of members. I'm just curious, how does that compare on a PMPM basis maybe relative to what new members are losing in 2023?

好的。明白你了。知道了。這很有幫助。然後只是偷偷地加入最後一項。聽起來，2024 年，持久會員預計將獲得 6000 萬美元的 EBITDA。因此，如果您考慮 2000 萬至 4000 萬美元，那麼預計新會員群體將損失 2000 萬至 4000 萬美元。我只是很好奇，以 PMPM 為基礎，與 2023 年失去的新成員相比，情況如何？

So I'm not sure it's -- we want to go back to '23, and I'll have Atul to either answer that or I can get back to you on this. As far as '24, the only thing that we're giving right now, Josh, is the EBITDA guidance. We'll have a lot more details by January, maybe JPMorgan Conference or so.

所以我不確定——我們想回到 23 年，我會讓 Atul 來回答這個問題，或者我可以回覆你。喬希，就 24 年而言，我們現在提供的唯一內容是 EBITDA 指導。我們將在一月份之前獲得更多詳細信息，也許是在摩根大通會議上。

Our next question comes from Gary Taylor with TD Cowen.

我們的下一個問題來自 Gary Taylor 和 TD Cowen。

Just a couple for me. I do just want to make sure I understand the item you were -- the timing issue you were referring to from 3Q to 4Q. So this is $15 million to $20 million of non-delegated revenue that's going to go revenue line straight to EBITDA that doesn't run through any of your health plan receivables, and that's just primarily from one plan? Just is there any more you can tell us about that?

對我來說只是一對。我只是想確保我理解您所指的項目——您提到的從第三季到第四季的時間安排問題。那麼，這是 1500 萬至 2000 萬美元的非授權收入，將直接計入 EBITDA，不涉及您的任何健康計劃應收帳款，而且主要來自一項計劃？您還能告訴我們更多嗎？

Those are -- that is in reference to the settlement, the final settlement that is associated with '22 dates of service that is considered '23 revenue payment. And so the expectation, and we're working with our auditors to make sure that, that's auditable and recognized in the year in which we believe it should be. And there's -- and that's consistent with the way we've treated in the past is to be able to recognize that. And that's just sort of our rough estimate. That's a constrained estimate that we've arrived at based on a couple of years now of history and performance. So that's what that's in reference to, Gary.

這些是——指的是和解，與被視為「23 收入付款」的「22 服務日期」相關的最終結算。因此，我們正在與審計師合作，以確保這一期望在我們認為應該的年份是可審計和認可的。這與我們過去對待這一點的方式是一致的，那就是能夠認識到這一點。這只是我們的粗略估計。這是我們根據幾年來的歷史和表現得出的有限估計。這就是所指的內容，加里。

Okay. But that's not -- you're still treating that on a cash basis. Basically, it's not anywhere the accruals so far.

好的。但事實並非如此——你仍然以現金為基礎來對待它。基本上，到目前為止，還沒有應計費用。

So far, and Sherif had mentioned this at the end of the last call, in fact. But today, we're treating it all as cash basis. What we feel is it is more informative and it is easier for our investors to understand if it's treated on an accrual basis in the period in which it's to be recognized. And that's something that we're working with the auditors on. It's just -- it's not really a question of whether or not it's '23 revenue. The question is, are we able to audit it and actually recognize it on an accrual basis before the end of the year.

事實上，到目前為止，謝里夫在上次通話結束時已經提到了這一點。但今天，我們將其全部視為現金基礎。我們認為，如果在確認期間按權責發生製進行處理，它的資訊量會更大，我們的投資者也更容易理解。這就是我們正在與審計師合作的事情。這只是——這並不是一個是否是 23 年收入的問題。問題是，我們是否能夠在年底前對其進行審計並按權責發生製實際確認。

But this is different from the sweep revenue, for example, you booked in the 2Q? Is it different?

但這和掃收入不一樣，例如你是2Q預訂的？有什麼不同嗎？

It is the same. The sweep revenue that was booked in the second quarter is related to '21 dates of service that is really '22 revenue. But since the '22 year was closed, that was recognized in this current year. So if you recall, in '21, we booked essentially 2 sweeps. In '22, we booked essentially no sweeps. And what we are trying to do is to get back into much more of a systematic basis of accruing this once a year. And there's -- this is the year we think we can demonstrate that from an audit standard that we can get back on track to accruing it again in the year that it should be recognized. Is that helpful?

這是相同的。第二季登記的總收入與「21 號服務日期」相關，實際上是「22 號」收入。但由於 22 年已結束，這一點在今年得到了認可。所以如果你還記得的話，在 21 年，我們基本上預訂了 2 次掃蕩。 22 年，我們基本上沒有預訂掃蕩。我們正在努力做的是恢復每年一次累積的系統性基礎。我們認為，今年我們可以證明，從審計標準來看，我們可以回到正軌，並在應該得到認可的一年再次累積它。有幫助嗎？

Yes, I think so. And so I was just trying to piece together a little bit of seasonality. But if that would have showed up this quarter, EBITDA would be better, fourth quarter EBITDA would be worse, that would reflect the typical seasonal pattern in your profitability, I think. Is that correct?

是的，我想是這樣。所以我只是想拼湊出一些季節性的東西。但如果這一點在本季度出現，EBITDA 會更好，第四季度 EBITDA 會更差，我認為這將反映您盈利能力的典型季節性模式。那是對的嗎？

I think that's correct, Gary. And going forward, but I think here's the key. Going forward, what it does is I think it just takes -- it sort of smooths out revenue to a degree. And I think it just makes it a little bit easier to understand. And that's the whole point of this is, to get away from some of this choppiness that makes it more challenging to understand the model.

我認為這是正確的，加里。展望未來，但我認為這是關鍵。展望未來，我認為它所做的只是——在一定程度上平滑了收入。我認為這只是讓它更容易理解一點。這就是整個要點，擺脫這種不穩定的情況，因為這種不穩定使理解模型更具挑戰性。

Last one for me. I mean the 2024 EBITDA guidance is pretty impressive, well above consensus. I know you don't want to give us a whole lot on '24 at this point. But that's going to be driven by, obviously, medical margin improvement, but also depends on the size of the cohort you bring in. And at this point of the year, I think you'd have pretty good line of sight on new payer contracts, new physician affiliations, et cetera. So I guess maybe could you answer this, do we think about -- you'd kind of slowed down the growth in '23 as you focused on medical margin. Is '24 a year where we think the new cohorts materially start accelerating again in size? Or do we think fairly static in size? Or give us sort of any sense on what you're thinking about the direction of revenue growth next year.

最後一張給我。我的意思是 2024 年 EBITDA 指導非常令人印象深刻，遠高於共識。我知道您現在不想在 24 日向我們提供太多資訊。但這顯然將受到醫療利潤率改善的推動，但也取決於您引入的群體規模。在今年的這個時候，我認為您對新的付款人合約有很好的視野、新的醫生隸屬關係等等。所以我想也許你可以回答這個問題，我們是否考慮過——當你專注於醫療利潤時，你會在 23 年放慢成長速度。我們認為 24 年是新群體規模再次實質加速成長的一年嗎？或者我們認為尺寸相當靜態？或請告訴我們您對明年營收成長方向的看法。

Yes. So we expect meaningful growth in revenue and membership and improvement on EBITDA, as we shared with you for -- in 2024.

是的。因此，正如我們與您分享的那樣，我們預計 2024 年收入和會員資格將實現有意義的成長，並且 EBITDA 也會有所改善。

Our next question comes from Ryan Daniels with William Blair.

我們的下一個問題來自瑞安·丹尼爾斯和威廉·布萊爾。

I'm going to continue with that trail of questioning. And I'm curious at this point in the year, how visible the growth in at-risk lives is for you, meaning do you have new partners or new payers signed? And if we take that in the move with more ACO REACH lives, kind of how visible is the member growth at this point in the year as we look to 2024?

我將繼續這一問題。我很好奇，在今年的這個時候，高風險生命的成長對您來說有多明顯，這意味著您是否有新的合作夥伴或新的付款人簽約？如果我們將這一點考慮在內，增加 ACO REACH 生命，那麼展望 2024 年，今年此時的會員成長有多明顯？

It's very visible, Ryan. It's comfortably -- that's why we're comfortable calculating the EBITDA. We're just not prepared to give any guidance on membership revenue or any other items. It will be meaningful growth. It will be new counties. There will be a couple of new payers, will be some partnerships as well.

這是非常明顯的，瑞安。這很舒服——這就是為什麼我們可以輕鬆計算 EBITDA。我們只是不准備就會員收入或任何其他項目提供任何指導。這將是有意義的成長。這將是新的縣。將會有一些新的付款人，也會有一些合作夥伴。

So a little bit of everything. And then a couple of financial questions. The corporate G&A cost, obviously down nicely year-over-year, but still up about $6 million sequentially. I think you mentioned there was an insurance hit of nearly $4 million, which explains a lot of that uptick. I would assume it's in that line item. But how should we think of that SG&A spend on a go-forward basis for our models? Is this a pretty good quarterly run rate? Or do we need to adjust that?

所以一切都一點點。然後是幾個財務問題。公司 G&A 成本明顯較去年同期大幅下降，但仍比上一季增加約 600 萬美元。我想你提到保險損失接近 400 萬美元，這在很大程度上解釋了這一上漲。我假設它在該行項目中。但我們該如何看待我們模式的未來 SG&A 支出呢？這是一個相當不錯的季度運作率嗎？或者我們需要對此進行調整嗎？

No. So for the quarter, I think you hit it correctly. So in the quarter, we actually had about -- it was closer to $5 million of a hit. About $3.8 million of it is related to periods outside of the third quarter. So that's kind of how you can think of a normalized -- think of it about $1 million, a little bit over $1 million per quarter. But going forward, I think one of the things that we've been stressing here, and you've seen some demonstration of it, is a continued prioritization, focus on efficiency. And we'll just continually get better.

不。所以對於本季度，我認為你的做法是正確的。因此，在本季度，我們實際上獲得了接近 500 萬美元的點擊量。其中約 380 萬美元與第三季以外的時期有關。這就是標準化的方式——想像一下 100 萬美元，每季略高於 100 萬美元。但展望未來，我認為我們在這裡一直強調的事情之一，你已經看到了一些演示，就是繼續優先考慮，專注於效率。我們會不斷變得更好。

I think over time, OpEx will grow as the company grows. But I think it will grow at a much, much slower rate than what you've seen in the past. It's going to be disciplined. It's going to be in a way that is more appropriate for a growing company. So I think if you looked at the third quarter, if you shave off about $4 million for sort of out-of-period dollars, I think that gives you a good starting point, but I think that we'll still expect to see -- I'm still expecting to see a little bit of improvement in the fourth quarter. But -- and we'll -- as I said, going into '24, we'll give some more specific guidance around that.

我認為隨著時間的推移，營運支出將隨著公司的發展而成長。但我認為它的成長速度將比你過去看到的要慢得多。它將受到紀律處分。這將是一種更適合成長型公司的方式。因此，我認為，如果你看看第三季度，如果你削減約 400 萬美元的期外資金，我認為這給了你一個很好的起點，但我認為我們仍然期望看到 - - 我仍然期望在第四季看到一點點改善。但是，正如我所說，進入 24 年，我們將就此提供一些更具體的指導。

No, that's very helpful though. And then last question, I just want to make sure I have a complete understanding of the nomenclature you're using. When you talk about persistent lives, can you remind us, is that lives that have been on the platform for more than a year or that were on the platform at the start of like 2022? What defines that? Because those are some impressive metrics and kind of shows the power of the model over time. So I want to make sure I understand that.

不，但這非常有幫助。最後一個問題，我只是想確保我完全理解您所使用的術語。當您談到持久生活時，您能否提醒我們，是指已經在平台上存在一年多的生活，還是2022年初在平台上的生活？那是什麼定義的呢？因為這些是一些令人印象深刻的指標，並且在某種程度上顯示了模型隨著時間的推移的力量。所以我想確保我理解這一點。

Our definition of persistent is similar to what CMS uses. So the patient that our platform of December of the prior year, as I said on the call, December '22, the definition of our persistent life in '23, anybody that was on the platform in December that showed up again in January, that we consider those persistent lives. Some of them have been here only for like a month, some of them have been for 36-plus months, some of them have been for 11 months since the beginning of the year. So that's the distance traveled.

我們對持久性的定義與 CMS 使用的類似。因此，患者認為我們前一年 12 月的平台，正如我在電話中所說，22 年 12 月，我們在 23 年持久生活的定義，任何在 12 月平台上並在 1 月再次出現的人，我們思考那些持久的生活。他們有的才來這裡一個月左右，有的已經待了36個多月，有的從年初就已經待了11個月了。這就是行駛的距離。

And do you have an average age of that cohort for patients that are persistent, given that some of them were on in December, but they've been on for multiple years? Do you know the age of that cohort? I don't know if that's something you calculated.

考慮到其中一些患者在 12 月就開始使用，但他們已經使用了多年，您是否知道該隊列中持續患者的平均年齡？你知道那群人的年齡嗎？不知道是不是你計算出來的。

I'm sure somebody does. So I can get it to you by the end of the day today. As a matter of fact, I'm really going to message our analytics folks. Certainly, somebody does. Yes, I'll get it to you and I'll share it with the group.

我確信有人這樣做。所以我可以在今天結束之前把它交給你。事實上，我真的要傳訊息給我們的分析人員。當然，有人會這樣做。是的，我會把它交給你，並與小組分享。

Our next question comes from David Larsen with BTIG.

我們的下一個問題來自 BTIG 的 David Larsen。

This is [Penny Shen] on for Dave Larsen. Congrats on the quarter. I just wanted to know if you could elaborate more on the opportunity that you see with the fully delegated lives. I think you mentioned that you're ranging around 20% right now. Just the opportunity there and maybe what percent you expect to reach by 2024?

我是戴夫·拉森 (Dave Larsen) 的 [Penny Shen]。恭喜本季。我只是想知道您是否可以詳細說明您在完全授權的生活中看到的機會。我想你提到過你現在的範圍在 20% 左右。只是那裡的機會，也許您預計到 2024 年會達到多少百分比？

So thank you, Penny. Nice to meet you. Tell David and say hi. So the delegated lives are now, like I said, is about 20%. We are targeting to reach about, I want to say, 30%, 35%. Pretty much all the new contracts that we signed, like with [Ascan] and others, are fully delegated. So a lot of that growth and Humana that we signed in Nevada, that's fully delegated. So all this will come in with fully delegated and we're hoping to grow those. We are in discussion with United, Aetna and Centene to convert, and that would be the other 60% of lives that we have. That then we will head to 90% mark. So that is the trajectory that we have.

所以謝謝你，佩妮。很高興見到你。告訴大衛並打個招呼。所以，正如我所說，現在的授權生命約為 20%。我想說，我們的目標是達到 30%、35% 左右。我們簽署的幾乎所有新合同，例如與 [Ascan] 和其他公司簽署的合同，都是完全委託的。因此，我們在內華達州簽署的許多成長和 Humana 協議都已完全授權。因此，所有這些都將在完全授權的情況下實現，我們希望擴大這些授權。我們正在與 United、Aetna 和 Centene 討論轉換，這將是我們剩下 60% 的生命。然後我們將達到 90% 的目標。這就是我們的軌跡。

Okay. That sounds great. And then just on the ACO REACH side of the business, I think you've mentioned before that they generally start out with lower margins than MA, but they ramp up to be equal or even better. Just any thoughts on that opportunity and the time line to ramping?

好的。聽起來不錯。然後就 ACO REACH 方面的業務而言，我想您之前已經提到過，他們一開始的利潤率通常低於 MA，但後來逐漸達到相同甚至更好的水平。對這個機會和提升的時間線有什麼想法嗎？

Penny, this is Bill. So actually, some of the recent data that we've seen is that even overall, the new lives coming in on ACO REACH are actually quite profitable. But as we see over time, they continue to grow just like our Medicare Advantage lives. So we actually see a very nice pop with our new ACO REACH lives as well as those persistent ACO REACH lives that we will see in the coming years.

佩妮，這是比爾。事實上，我們最近看到的一些數據表明，即使總體而言，ACO REACH 帶來的新生命實際上也相當有利可圖。但隨著時間的推移，我們看到，它們就像我們的 Medicare Advantage 一樣不斷增長。因此，我們實際上看到了新的 ACO REACH 生活以及未來幾年我們將看到的持久 ACO REACH 生活的非常好的流行。

Okay. Great. And just the last one for me. Any thoughts on the current utilization trends? And any details in terms of like inpatient versus outpatient utilization, and maybe some thoughts on GLP-1?

好的。偉大的。對我來說只是最後一件。對目前的使用趨勢有何想法？住院病人與門診病人的使用情況有何詳細信息，也許還有一些關於 GLP-1 的想法？

Penny, Dr. Bacchus here. So as far as we said, I mean we've actually been able to bend that cost curve down. We were down by 2% over this last year with the expenditures of people who we're very, very concerned with. So jumping right to the GLP-1 question. Yes, we do have patients that are utilizing GLP-1s, but we're also seeing clinical improvements in regards to cardiovascular disease and the other things that we use GLP-1s for, not necessarily just for blood sugar alone. It is nice to see that for our population being senior populations, it's not necessarily something that you see like in commercial populations where a lot of people are using GLP-1 for potential weight loss and things like that. So we are a little bit, I'll say, covered with our senior populations that we manage.

佩妮，巴克斯博士在這裡。就我們所說的而言，我的意思是我們實際上已經能夠降低成本曲線。我們非常非常關心的人的支出比去年下降了 2%。所以直接跳到 GLP-1 問題。是的，我們確實有患者正在使用 GLP-1，但我們也看到了心血管疾病以及我們使用 GLP-1 的其他用途的臨床改善，而不僅僅是血糖。很高興看到，對於我們的老年人群來說，這不一定是你在商業人群中看到的情況，那裡很多人使用 GLP-1 來實現潛在的減肥之類的目的。所以我想說，我們管理的老年人口有點多。

From an inpatient standpoint and things like that, we continue to do and work with our plans. We are able to do concurrent review, especially on not only those delegated lives but also we do have some UM opportunities where we're not fully delegated. So we'll continue to do that as well and work with our plans to improve inpatient utilization, whether it's direct hospitalization or even post acute. So those are all things that we look at as well as being able to risk stratify our population very, very well to understand who are those populations at risk that are very high-cost, high-risk, rising risk populations so that our care management teams are working directly with not only our CMOs in our markets, but directly with our providers and patients to maximize their care and access.

從住院病人的角度來看，我們將繼續按照我們的計畫行事。我們能夠進行並行審查，尤其是不僅在那些被授權的生活中，而且我們確實有一些未完全授權的 UM 機會。因此，我們也將繼續這樣做，並按照我們的計劃來提高住院病人的使用率，無論是直接住院還是急性住院後。因此，這些都是我們所關注的事情，並且能夠非常非常好地對我們的人群進行風險分層，以了解哪些人群是高成本、高風險、不斷上升的風險人群，以便我們的護理管理團隊不僅直接與我們市場上的CMO 合作，也直接與我們的提供者和患者合作，以最大限度地提高他們的護理和獲取機會。

So these are all things that we do collectively to drive down that medical expense, and we have some real good actions going forward into '24.

因此，這些都是我們集體做的事情，以降低醫療費用，並且我們在 24 世紀採取了一些真正的良好行動。

Ryan, by the way, the question about the age, the average age of the persistent life is 73 years old.

Ryan，順便問一下年齡的問題，堅持生活的平均年齡是73歲。

This concludes our question-and-answer session. I would like to turn the conference over to Dr. Sherif Abdou for any closing remarks.

我們的問答環節到此結束。我想將會議轉交給謝里夫·阿卜杜博士發表閉幕詞。

Thank you, operator. So today, we reaffirm the guidance for EBITDA and medical margin for '23, as I shared with you before. I shared with you revenues up 16% to 17%; our medical claims expense for the Medicare Advantage lives, 2% better, negative, lower than it was last year; and our medical margin is 300% improved. Our gross profit is $15 million better than it was the same quarter last year. Our OpEx is 18% to 20% improved and lower year-over-year. Our cash burn is down to $8 million for the entire quarter, and our EBITDA losses compared to last year is 53% better. We've also shared with you our 2024 preliminary EBITDA -- adjusted EBITDA guidance of positive $20 million to positive $40 million for 2024.

謝謝你，接線生。因此，今天，我們重申了 23 年 EBITDA 和醫療利潤率的指導，正如我之前與您分享的那樣。我與大家分享的是營收成長了 16% 到 17%；我們的 Medicare Advantage 醫療理賠費用比去年好 2%，為負值，低於去年；我們的醫療利潤率提高了 300%。我們的毛利比去年同期增加了 1500 萬美元。我們的營運支出年增了 18% 至 20%，但有所下降。整個季度我們的現金消耗減少至 800 萬美元，而 EBITDA 損失與去年相比減少了 53%。我們也與您分享了我們的 2024 年初步 EBITDA——調整後的 2024 年 EBITDA 指導為正 2000 萬美元至正 4000 萬美元。

With that, I thank you all very much and look forward to our next conversation.

在此，我非常感謝大家，並期待我們的下一次對話。

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

會議現已結束。感謝您參加今天的演講。您現在可以斷開連線。