P3 Health Partners Inc (PIII) 2024 Q3 法說會逐字稿

Good day, and welcome to P3 Health Partners third-quarter 2024 earnings call. (Operator Instructions) Please note, this event is being recorded.

美好的一天，歡迎參加 P3 Health Partners 2024 年第三季財報電話會議。（操作員說明）請注意，正在記錄此事件。

I would now like to turn the conference over to Ryan Halsted. Please go ahead.

我現在想把會議交給瑞安‧霍斯特德 (Ryan Halsted)。請繼續。

Thank you, operator, and thank you for joining us today.

謝謝您，接線員，也謝謝您今天加入我們。

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 US federal securities laws, including statements regarding our financial outlook and long-term targets.

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。

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. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations.

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。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。

Additional information concerning factors that could cause actual results to differ from statements made on this call is contained in our periodic reports 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 these forward-looking statements.

有關可能導致實際結果與本次電話會議中的聲明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。本次電話會議期間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這些前瞻性陳述的義務。

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 used. These non-GAAP financial measures are in addition to and not a substitute for or superior to the measures or financial performance prepared in accordance with GAAP.

我們將在本次電話會議上參考某些非公認會計準則財務指標，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現金醫療保證金用過的。這些非公認會計原則財務指標是根據公認會計原則制定的指標或財務績效的補充，而不是替代或優於這些指標或財務表現。

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. Please 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。請參閱我們收益報告的附錄，以了解這些非公認會計準則財務指標與最直接可比較的公認會計準則財務指標的對帳。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 Aric Coffman, CEO of P3 Health Partners.

我現在將把電話轉給 P3 Health Partners 執行長 Aric Coffman。

Thanks, Ryan. Good afternoon, and thank you for joining us.

謝謝，瑞安。下午好，感謝您加入我們。

Today, I'll cover several key topics: the broader Medicare Advantage landscape, our third quarter 2024 results and why I'm excited for 2025. We'll go through the tangible steps we are taking to advance the initiatives we outlined in August, and this will set up P3 for success going forward.

今天，我將討論幾個關鍵主題：更廣泛的 Medicare Advantage 格局、我們 2024 年第三季的業績以及為什麼我對 2025 年感到興奮。我們將採取具體步驟來推進我們在 8 月概述的舉措，這將為 P3 今後的成功奠定基礎。

Before addressing this quarter's results, I want to provide some perspective. As you have heard from our peers and MCOs, we are in a unique time. It won't persist forever, and it will pass. What we do now to set up P3 for success coming out of this environment is a key focus of mine and our leadership team. We have a plan in place and are executing on it now.

在討論本季的業績之前，我想提供一些觀點。正如您從我們的同行和 MCO 那裡聽到的那樣，我們正處於一個獨特的時期。它不會永遠持續下去，它會過去的。我們現在所做的工作是建立 P3，以便在這種環境下取得成功，這是我和我們的領導團隊的重點。我們已經制定了計劃，現在正在執行。

It includes $130 million-plus of initiatives that will positively impact EBITDA and cash flow. The benefits will begin to be seen in Q4 and more prominently in 2025 as it is phased in.

其中包括價值超過 1.3 億美元的舉措，將對 EBITDA 和現金流產生積極影響。這些好處將於第四季開始顯現，並在 2025 年逐步顯現出來。

The overall sector is facing pent-up demand post COVID for health care services. It is in this type of environment that value-based care is in most need by our health plan partners. The demand for P3's value-based care platform is there, and I'm a strong believer that value-based care is the answer to bending the cost curve long term in solving our societal issues. Our Q3 report includes updated insights from our payers and a fresh perspective from our new CFO, Leif Pedersen.

整個產業正面臨新冠疫情後被壓抑的醫療保健服務需求。正是在這種環境中，我們的健康計劃合作夥伴最需要基於價值的照護。對 P3 基於價值的照護平台的需求是存在的，我堅信基於價值的照護是解決我們社會問題的長期成本曲線的答案。我們的第三季報告包括付款人的最新見解以及新任財務長 Leif Pedersen 的全新觀點。

Regarding elevated medical utilization, we haven't seen it across the board, whether at the provider or health plan level. It's isolated whether in Part B or certain health plans that experience adverse selection via benefit design.

關於醫療利用率的提高，無論是在提供者還是健康計畫層面，我們都沒有看到全面的提高。無論是在 B 部分還是某些透過福利設計經歷逆向選擇的健康計劃中，它都是孤立的。

During the quarter, we actually saw improvements in Part A costs, but like our peers in the sector, we faced headwinds in Part B expenses and significant retroactive adjustments, which added to the complexity of our quarterly results.

在本季度，我們實際上看到了 A 部分成本的改善，但與該行業的同行一樣，我們面臨 B 部分費用和重大追溯調整的阻力，這增加了我們季度業績的複雜性。

Retroactive adjustments added up to $35 million, and this was the majority of the EBITDA miss. We did see elevated medical utilization of approximately $5 million to $10 million versus historical trends, particularly tied to benefit design, which we expect to be mitigated in 2025 through benefit design changes indicated by our payer partners.

追溯調整總計達 3500 萬美元，這是 EBITDA 未達標的大部分。與歷史趨勢相比，我們確實看到醫療利用率增加了約500 萬至1000 萬美元，特別是與福利設計相關，我們預計透過我們的付款合作夥伴表明的福利設計變更，這種情況將在2025年得到緩解。

Now is the time to maintain our competitive edge, improve performance and move toward profitability. Over the past six months, we've had the opportunity to conduct a thorough assessment of the entire organization. We've already set several initiatives in motion, and we have concrete plans to guide our business towards sustainable growth.

現在是保持競爭優勢、提高績效並實現盈利的時候了。在過去的六個月中，我們有機會對整個組織進行徹底的評估。我們已經啟動了多項舉措，並且制定了具體計劃來指導我們的業務實現永續成長。

As we look ahead to 2025 and beyond, there are several reasons for optimism, and I'm enthusiastic about our path forward. Although we are not providing a formal outlook today, Leif and I will provide directional comments.

展望 2025 年及以後，我們有幾個樂觀的理由，我對我們的前進道路充滿熱情。儘管我們今天沒有提供正式的展望，但萊夫和我將提供方向性評論。

The $130 million-plus of improvement opportunities are in four key areas. Number one, contracts. We are enhancing our payer and provider networks and terms to strengthen collaboration expand opportunities. Number two, operating model. We are elevating operational discipline and enhancing visibility to drive better outcomes and quality documentation as well as utilization.

超過 1.3 億美元的改進機會集中在四個關鍵領域。第一，合約。我們正在增強我們的付款人和提供者網路和條款，以加強合作，擴大機會。第二，營運模式。我們正在提高營運紀律並增強可見性，以推動更好的成果、品質文件以及利用率。

Number three, operating efficiency. These measures will enhance service delivery while saving on operating cost. And finally, number four, data and analytics. We are advancing our capabilities to better support decision-making and outcomes through changing our structures and adding new capabilities such as Innovaccer.

第三，營運效率。這些措施將增強服務交付，同時節省營運成本。最後，第四，數據和分析。我們正在透過改變我們的結構和增加 Innovaccer 等新功能來提高我們的能力，以更好地支持決策和結果。

As we look ahead, we see several favorable dynamics. The Medicare Advantage repricing cycle and benefit design changes are expected to serve as a catalyst for P3's profitability in 2025. Medicare Advantage has a built-in mechanism for adapting to market shifts with a relatively short repricing cycle. We expect CMS' benchmarks will be recalibrated to reflect the ongoing elevated utilization.

展望未來，我們看到了一些有利的動態。Medicare Advantage 重新定價週期和福利設計變更預計將成為 P3 2025 年獲利能力的催化劑。Medicare Advantage 具有適應市場變化的內建機制，重新定價週期相對較短。我們預計 CMS 的基準將重新校準，以反映持續提高的利用率。

In addition, many of our health plan partners have taken actions during the 2025 bid process to target margin recapture. As part of this, it is expected that plan benefits will be less robust in 2025, which we anticipate will result in decreased utilization. We are working closely with our payer partners to quantify the impact of the benefit design changes for 2025.

此外，我們的許多健康計劃合作夥伴已在 2025 年投標過程中採取行動，以奪回利潤為目標。作為其中的一部分，預計 2025 年計劃收益將減弱，我們預計這將導致利用率下降。我們正在與付款人合作夥伴密切合作，量化 2025 年福利設計變更的影響。

Additionally, it's clear that the introduction of a broad set of star rating cut points is elevating the importance of quality performance while the recent reduction in the physician fee schedule is placing increased pressure on medical practices. We continue to see demand for P3's capabilities as evidenced by the recent signing of an agreement with the largest health system in Southern Nevada to create a CISOC or a clinically integrated system of care in Q3.

此外，很明顯，廣泛的星級評定點的引入提高了品質績效的重要性，而最近醫生費用表的減少給醫療實踐帶來了更大的壓力。我們繼續看到對 P3 功能的需求，最近與內華達州南部最大的衛生系統簽署的協議證明了這一點，該協議將在第三季度創建 CISOC 或臨床綜合護理系統。

Finally, our value-based care enablement platform and affiliate model remains intact. For example, a highly engaged partner in Oregon has seen a 40% improvement in coding and documentation accuracy while doubling its membership. We are confident in the underlying value that P3 provides and our focus on execution, albeit with a more measured and narrowed focus given the macro environment and its impact on our results.

最後，我們基於價值的護理支援平台和附屬模型保持不變。例如，俄勒岡州的一個高度敬業的合作夥伴在其成員數量增加了一倍的同時，編碼和文件準確性提高了 40%。我們對 P3 提供的潛在價值以及我們對執行的關注充滿信心，儘管考慮到宏觀環境及其對我們業績的影響，我們的關注範圍更加謹慎和狹窄。

An analysis of our fully matured market performance shows we have half of our markets in which there are greater than 80% of membership with positive medical margin. The other half of markets have less than 50% of membership with a positive medical margin. Part of the network and payer rationalization measures we have taken are related to these differences.

對我們完全成熟的市場表現的分析表明，我們有一半的市場中有超過 80% 的會員擁有正的醫療利潤。另一半市場只有不到 50% 的會員擁有正的醫療利潤。我們採取的部分網路和付款人合理化措施與這些差異有關。

I will now pivot to highlight the progress on our initiatives, which will accelerate our path to profitability and cash flow generation. With a focus on sustaining long-term relationships with our value-based care network, we are in discussions with multiple regional and national payers to provide P3 and our partners with a series of adjusted favorable economic terms.

我現在將重點放在我們的舉措所取得的進展，這將加速我們實現盈利和現金流生成的道路。為了與我們基於價值的照護網絡保持長期關係，我們正在與多個地區和國家付款人進行討論，以便為 P3 和我們的合作夥伴提供一系列經過調整的有利經濟條款。

In the cases where the path to sustainable profitability has become too elongated, we expect to exit those underperforming relationships. Our close collaboration with payers and physicians provides us with the flexibility to adapt in situations where both P3 and our physician partners are not achieving success. In some cases, we can mutually decide to wind down our operations.

在實現可持續盈利的道路變得過於漫長的情況下，我們預計會退出那些表現不佳的關係。我們與付款人和醫生的密切合作使我們能夠靈活地適應 P3 和我們的醫生合作夥伴均未取得成功的情況。在某些情況下，我們可以共同決定結束我們的業務。

Overall, we are pleased with the progress we've made with the payers and are pursuing additional contract enhancements for '24 and 2025, as appropriate. After careful evaluation, we've trimmed 63 of our provider tax ID numbers or TINs to help us enhance profitability and ensure sustainable margins. We have also trimmed our payer network by 20%, which will simplify our operations.

總體而言，我們對與付款人取得的進展感到滿意，並正在酌情尋求 24 日和 2025 年的額外合約增強。經過仔細評估，我們削減了 63 個提供者的稅號或 TIN，以幫助我們提高獲利能力並確保可持續的利潤。我們還將付款網路削減了 20%，這將簡化我們的營運。

For these markets where our internal targets were not met, we are adjusting our strategy to focus on increased density within existing markets and existing practices, where we have higher-performing networks. Next, we are focusing on providing our physicians with adequate resources to engage our members and standardize care delivery practices through an enhanced evaluation of disease burden.

對於這些未達到我們內部目標的市場，我們正在調整我們的策略，將重點放在現有市場和現有實踐中增加密度，我們在這些市場和現有實踐中擁有更高效能的網路。接下來，我們的重點是為我們的醫生提供足夠的資源，以吸引我們的會員，並透過加強對疾病負擔的評估來標準化護理服務實踐。

We are also working to curb utilization in high-cost areas, which we believe is essential for improving outcomes and optimizing costs. In 2024, we launched a new program to enhance the awareness of palliative and hospice benefits for our patients. We moved from less than 1% enrollment in 2023 to 2.3% today with a goal of 4% of the total population in 2025, consistent with a well-run population health approach.

我們也努力限制高成本領域的利用率，我們認為這對於改善結果和優化成本至關重要。2024 年，我們啟動了一項新計劃，以提高患者對安寧療護和臨終關懷福利的認識。我們的入學率從 2023 年的不到 1% 上升到今天的 2.3%，目標是到 2025 年佔總人口的 4%，這與運作良好的人口健康方法一致。

By expanding these care programs, we are providing comprehensive, patient-centered support that addresses the needs of individuals with serious illnesses leading to higher satisfaction and reduced hospitalizations. From a data visibility standpoint, our partnership with Innovaccer is on track for full implementation in 2025. We plan to lean further into these tools to better serve our payer partners.

透過擴大這些護理計劃，我們提供全面的、以患者為中心的支持，滿足患有嚴重疾病的個人的需求，從而提高滿意度並減少住院。從資料可見性的角度來看，我們與 Innovaccer 的合作關係預計將在 2025 年全面實施。我們計劃進一步利用這些工具，以更好地為我們的付款合作夥伴提供服務。

The advanced analytics and data platform enables the aggregation and unification of disparate health plan data. We can then identify the most complex patients and efficiently benchmark these patients relative to the clinical care guidelines and best practices. Additionally, the engagement tool is a sophisticated solution for our physicians to seamlessly close care gaps and improve coding accuracy at the point of care.

先進的分析和數據平台可以聚合和統一不同的健康計劃數據。然後，我們可以識別最複雜的患者，並根據臨床護理指南和最佳實踐有效地對這些患者進行基準測試。此外，參與工具是我們的醫生的一個複雜的解決方案，可以無縫地縮小護理差距並提高護理點的編碼準確性。

Another important area of focus is enhancing operating efficiency. We've strategically adjusted our approach to geographic expansion, aligned with our emphasis on expanding density within existing markets. By concentrating our efforts in established areas, we're able to foster strong provider engagement and implement more effective utilization management.

另一個重要的關注領域是提高營運效率。我們策略性地調整了地域擴張的方法，與我們對擴大現有市場密度的重視保持一致。透過將我們的努力集中在既定領域，我們能夠促進提供者的積極參與並實施更有效的利用管理。

In closing, I want to highlight a few key takeaways. First, P3 is proactively navigating a transition period that is affecting the broader Medicare Advantage industry and our company. However, P3 and the industry, including CMS and our health plan partners, are actively adjusting to this new environment.

最後，我想強調一些關鍵要點。首先，P3 正在積極度過一個影響更廣泛的 Medicare Advantage 行業和我們公司的過渡期。然而，P3 和整個產業，包括 CMS 和我們的健康計畫合作夥伴，正在積極適應這個新環境。

Many of our health plan partners have emphasized more than ever before the demand for more value-based care alignment with providers in order to better control medical costs and preserve margin. Our conviction remains high that our value-based care platform is well positioned to capitalize on these opportunities, albeit with a more measured approach.

我們的許多健康計劃合作夥伴比以往任何時候都更加強調需要與提供者進行更多基於價值的護理協調，以便更好地控制醫療成本並保持利潤。我們仍然堅信，我們基於價值的護理平台處於有利地位，可以利用這些機會，儘管採取了更謹慎的方法。

Second, we're taking decisive steps to elevate our performance in this dynamic landscape. Our strategy is two-pronged. On the financial front, we've ensured appropriate reserves as we exit 2024 and have recalibrated our step-off point to reflect the misalignment between the timing of high utilization and the benefit design changes anticipated in 2025.

其次，我們正在採取果斷措施來提高我們在這個充滿活力的環境中的表現。我們的策略是雙管齊下的。在財務方面，我們在 2024 年退出時確保了適當的儲備，並重新調整了我們的起點，以反映高利用率的時間與 2025 年預期的效益設計變更之間的不一致。

On the operational side, we're implementing initiatives with a focus on achieving best-in-class execution in areas directly under our control.

在營運方面，我們正在實施舉措，重點是在我們直接控制的領域實現一流的執行力。

Finally, I would like to formally introduce Leif Pedersen, our CFO. We previously worked together at a value-based care predecessor company to P3 Health, and I look forward to the continued collaboration. Leif?

最後，我想正式介紹一下我們的財務長 Leif Pedersen。我們之前曾在 P3 Health 的一家基於價值的護理前身公司合作過，我期待繼續合作。萊夫？

Thanks, Aric. Before diving into third quarter results, a few thoughts on my transition into the organization.

謝謝，阿里克。在深入研究第三季業績之前，我先談談我向組織過渡的一些想法。

First and foremost, I'm thrilled to be part of the P3 leadership team. P3 is a great company with extraordinary people and tremendous upside. I was drawn to P3's affiliate model because I've seen it work well. It's a proven model to bend the cost curve. The company's smaller size and entrepreneurial culture, along with the chance to make a significant impact in transforming health care delivery, were extremely compelling.

首先，我很高興能成為 P3 領導團隊的一員。P3 是一家很棒的公司，擁有傑出的人才和巨大的優勢。我被 P3 的聯盟行銷模式所吸引，因為我發現它運作得很好。這是一個經過驗證的模型，可以彎曲成本曲線。該公司較小的規模和創業文化，以及在改變醫療保健服務方面產生重大影響的機會，非常引人注目。

Additionally, my previous experience working with Aric and Bill and knowing the deep experience of Amir and the rest of the P3 leadership team have helped to facilitate the move. I've now been in this role for just over two months, and my focus over that time has been centered around three areas: one, gaining the comprehensive understanding of P3's financials; two, ensuring continuity across operations; and three, identifying opportunities for efficiencies.

此外，我之前與 Aric 和 Bill 合作的經驗以及了解 Amir 和 P3 領導團隊其他成員的豐富經驗也有助於促進這項舉措。現在我擔任這個職位才兩個多月，這段時間我的工作重點主要集中在三個方面：一是全面了解P3的財務狀況；二是了解P3的財務狀況。第二，確保營運的連續性；第三，尋找提高效率的機會。

Moving to the financial information. Our third quarter top line performance was in line with our expectations, with capitated revenue of $357.7 million and total revenue of $362.1 million, representing a 26% year-over-year growth. This growth was primarily driven by two factors. First, our member base expanded significantly, growing by 22% compared to last year and now exceeding 128,900 members. Second, we saw a notable increase in our funding, which rose by approximately 6% year over year.

轉向財務資訊。我們第三季的營收表現符合我們的預期，人均收入為 3.577 億美元，總營收為 3.621 億美元，年增 26%。這一增長主要由兩個因素推動。首先，我們的會員數量顯著擴大，與去年相比增加了 22%，目前會員數量已超過 128,900 名。其次，我們的資金顯著增加，較去年同期成長約6%。

Our medical margin was $540,000 or $1 on a PMPM basis while our adjusted operating expenses were flat on a year-over-year basis. Adjusted EBITDA loss for the quarter was $71 million or $184 on a PMPM basis. Our third quarter medical margin adjusted EBITDA results were driven by an incremental $5 million to $10 million in medical claims costs and approximately $35 million of retroactive adjustments.

我們的醫療利潤為 540,000 美元，按 PMPM 計算為 1 美元，而調整後的營運費用同比持平。本季調整後 EBITDA 損失為 7,100 萬美元，以 PMPM 計算為 184 美元。我們第三季的醫療利潤調整後 EBITDA 業績是由醫療索賠成本增加 500 萬至 1000 萬美元以及約 3500 萬美元的追溯調整推動的。

Let me take a moment and provide additional information on the retroactive adjustments. Firstly, during Q3, we had an opportunity to review year-to-date revenue expectations associated with risk adjustment accruals. Based on current risk factors and lower-than-expected performance, we thought it was appropriate to write down midyear risk adjustment receivables, contributing $15 million of negative adjusted EBITDA.

讓我花點時間提供更多有關追溯調整的資訊。首先，在第三季度，我們有機會審查與應計風險調整相關的年初至今的收入預期。基於目前的風險因素和低於預期的業績，我們認為減記年中風險調整應收帳款是適當的，從而貢獻 1500 萬美元的負調整 EBITDA。

Secondly, similar to the challenges highlighted by several of our managed care and value-based care peers, health care utilization was elevated in the third quarter. As a result, our medical expenses for the quarter experienced headwinds associated with negative prior period development that was not previously anticipated.

其次，與我們的一些管理式醫療和基於價值的醫療同行強調的挑戰類似，第三季醫療保健利用率有所提高。因此，我們本季的醫療費用遇到了與前期負面發展相關的阻力，這是先前未曾預料到的。

The uptick in utilization we experienced was primarily within our Part B medical claims, whereas Part A utilization trends have been stable. Negative medical claims development contributed about $10 million additional expense during the quarter. We expect this elevated utilization environment to be mitigated in 2025 through favorable benefit design changes and other factors.

我們經歷的利用率上升主要是在 B 部分的醫療索賠範圍內，而 A 部分的使用率趨勢一直穩定。負面醫療索賠的進展在本季度造成了約 1000 萬美元的額外費用。我們預計，透過有利的效益設計變更和其他因素，這種利用率升高的環境將在 2025 年得到緩解。

Lastly, third quarter 2024 results experienced approximately $10 million of negative impact within our network and operating expenses. The increase in costs was related to; A, unexpected prior year and in-year retroactive adjustments; B, revision of current year run rates; and C, increased operating expenses associated with higher professional fees supporting our operations as a public company and a nonincome-based tax adjustment.

最後，2024 年第三季的業績對我們的網路和營運支出產生了約 1000 萬美元的負面影響。成本增加與以下因素有關： A、非預期的上年度及本年追溯調整； B、修改當年運轉率； C，與支持我們作為上市公司營運的更高專業費用和非收入稅收調整相關的營運費用增加。

Turning to the balance sheet. P3 ended Q3 with approximately $63 million of cash. Cash flow from operations for the quarter was approximately negative $20 million. As we think about the remainder of 2024, we expect the increased medical cost drivers to continue through the end of the year.

轉向資產負債表。P3 第三季末擁有約 6,300 萬美元現金。本季營運現金流約為負 2,000 萬美元。考慮到 2024 年剩餘時間，我們預計醫療成本增加的驅動因素將持續到今年年底。

Directionally, when adjusting for any prior year impacts, we believe the adjusted EBITDA step-off point for the business is closer to an annualized quarterly $30 million loss run rate versus the $70 million that was reported in Q3 before the impact of our strategic initiatives flow through.

從方向上來說，在調整任何上一年的影響時，我們認為調整後的EBITDA 業務起點更接近年化季度3000 萬美元的虧損運行率，而在我們的戰略舉措影響之前第三季度報告的虧損率為7000 萬美元通過。

We are currently building our detailed 2025 financial operating plan, and we'll share that in early 2025. Establishing credibility and earning your trust is one of my top priorities as the new CFO of P3. The leadership team and I are focused on setting reliable targets that reflect the current market landscape and are predictable and achievable while also providing opportunities for outperformance.

我們目前正在製定詳細的 2025 年財務營運計劃，我們將在 2025 年初分享。身為 P3 新任財務官，建立信譽並贏得您的信任是我的首要任務之一。我和領導團隊專注於設定可靠的目標，這些目標反映當前的市場格局，並且是可預測和可實現的，同時也提供超越表現的機會。

We are highly focused on executing in key areas that we reviewed to capture in excess of $130 million of incremental opportunity. Approximately 60% of the total identified opportunities are related to enhanced evaluation of chronic disease burden; another 25% of the total opportunity is identified through payer and provider network rationalization; and the remaining 15% of opportunity lies in operating efficiencies, which are currently underway.

我們高度重視在我們審查的關鍵領域的執行，以捕捉超過 1.3 億美元的增量機會。約 60% 的已確定機會與加強慢性病負擔評估有關；另外 25% 的機會是透過付款人和提供者網路合理化來確定的；剩下的 15% 的機會在於營運效率，目前正在進行中。

As we execute on our value opportunity road map, we want to underscore that 2025 is poised to be a transformative year for the company.

在執行價值機會路線圖時，我們想強調 2025 年將成為公司變革的一年。

With that, I'll turn it over to Amir.

有了這個，我會把它交給阿米爾。

Thanks, Leif. As Aric alluded to, in many ways, we have been seeing a perfect storm of overall medical costs and utilization increases, whether due to increased demand of clinical services post COVID, plan benefit changes leading to higher costs, significant increased usage of Part B medications and CMS rule changes making it harder to manage costs. With this as a backdrop, let me spend a little more time discussing some of the main cost drivers and corresponding metrics.

謝謝，萊夫。正如Aric 所提到的，我們在許多方面都看到了整體醫療成本和利用率增加的完美風暴，無論是由於新冠疫情后臨床服務需求的增加、計劃福利的變化導致成本上升、B 部分藥物的使用量顯著增加CMS 規則的改變使得管理成本變得更加困難。以此為背景，讓我花更多時間討論一些主要成本驅動因素和對應指標。

Over this last quarter, we have indeed seen an increase in medical expenses, especially around Part B utilization. This was driven by many factors, increased Part B drug utilization; increased outpatient specialty costs, oncology and ophthalmology to name just two; pockets of increased emergency room use and observation utilization, especially in rural Arizona; and higher unit cost for observation status seen in all markets due to the reimbursement changes related to overnight stays, commonly referred to as the two-midnight rule.

在上個季度，我們確實看到醫療費用增加，特別是在 B 部分的使用方面。這是由多種因素推動的，B 部分藥物利用率增加；門診專科費用增加，僅舉兩例：腫瘤科及眼科；急診室使用和觀察利用率增加，特別是在亞利桑那州農村地區；由於與過夜住宿相關的報銷變化（通常稱為午夜兩點規則），所有市場中觀察狀態的單位成本較高。

In fact, we've seen a 40% increase in emergency department costs related to the two-midnight rule while also seeing higher pass-through costs from our health plan partners for supplemental benefits like dental.

事實上，我們發現與午夜兩點規則相關的急診科費用增加了 40%，同時我們的健康計畫夥伴對於牙科等補充福利的轉嫁成本也更高。

Despite the pockets of increased utilization, both emergency department admits per 1,000 numbers and observation per 1,000 numbers have remained relatively flat through the first half of 2024 at approximately 380 per 1,000 and 44 per 1,000, respectively.

儘管利用率有所增加，但截至 2024 年上半年，急診室每 1,000 名入院人數和每 1,000 名觀察人數均保持相對平穩，分別約為每 1,000 人 380 人和每 1,000 人 44 人。

Part A utilization has also been flat, with an admit per 1,000 rate of 153 for the first half of 2024 versus 159 for 2023. High-cost claims greater than $50,000 rose 23% year over year, with Part B oncological medications and treatment leading the way. Part D expenses have increased 13% during the first half of 2024, but this is in part is due to the delay in receiving Part D rebates from our plan partners.

A 部分的使用率也持平，2024 年上半年每千人錄取率為 153 人，而 2023 年為 159 人。超過 50,000 美元的高額索賠同比增長 23%，其中 B 部分腫瘤藥物和治療領先。2024 年上半年，D 部分費用增加了 13%，部分原因是我們的計畫合作夥伴延遲收到 D 部分回扣。

In regards to quality, our health plan partners have suffered from the new CMS star rating changes, with many of them being vocal about the impact. This has led to significant increases in CMS quality thresholds. But despite these changes, P3 has mitigated the impact through increased month-over-month GAAP closures from 2023 to 2024.

在品質方面，我們的健康計劃合作夥伴受到了新的 CMS 星級評級變化的影響，其中許多人都直言不諱地表達了這種影響。這導致 CMS 品質閾值顯著提高。但儘管有這些變化，P3 透過 2023 年至 2024 年逐月關閉 GAAP 的數量來減輕影響。

Because of these performance issues, cost increases and headwinds for quality coding documentation, P3 will narrow and rationalize our PCP networks to focus on those that are more engaged to perform in value-based care. For example, in our internal UM department and claims recovery department, we will continue to strive for increased delegation with more plans to manage our networks more comprehensively.

由於這些效能問題、成本增加和品質編碼文件的阻力，P3 將縮小和合理化我們的 PCP 網絡，以重點關注那些更積極地執行基於價值的護理的網絡。例如，在我們內部的UM部門和索賠追償部門，我們將繼續努力增加授權，並製定更多計劃來更全面地管理我們的網路。

For our providers, they will see more boots on the ground to improve visit access, aid in comprehensive evaluations and education on appropriate documentation of disease and quality gap closures while also having the data necessary to know their high-risk patients' preferred specialists and overall performance.

對於我們的提供者來說，他們將看到更多的實地指導，以改善就診機會，幫助進行全面評估和有關疾病適當記錄和縮小品質差距的教育，同時還擁有了解高風險患者首選專家和總體情境所需的數據表現。

From a technology standpoint, we now have the ability to directly work within our PCP electronic health record to help guide them for more comprehensive care, making their work easier and more expeditious.

從技術角度來看，我們現在能夠直接在 PCP 電子健康記錄中工作，幫助指導他們進行更全面的護理，使他們的工作更輕鬆、更快捷。

Lastly, we have new focused programs to help our providers with palliative and hospice care for our most sickly patients and new pharmacy interventions for our high-risk and polypharmacy patients. Clinically, we continue to see significant upside with our engaged providers, and we look forward to an improved fourth quarter and a strong start to '25.

最後，我們制定了新的重點計劃，幫助我們的醫療服務提供者為病情最嚴重的患者提供安寧療護和臨終關懷，並為高風險和多藥治療患者提供新的藥房幹預措施。從臨床角度來看，我們繼續看到我們參與的供應商的顯著優勢，我們期待第四季度的改善和 25 年的強勁開局。

With that, I'll pass it back to you, Aric, for closing remarks.

接下來，我會將其傳回給您，Aric，供您作結束語。

Thanks, Amir. We acknowledge that 2024 has presented significant challenges across our sector, including P3. Many of our health plan partners have emphasized more than ever before the demand for value-based care alignment with providers in order to better control medical costs and preserve margin. I am a strong believer that value-based care is the answer to bending the cost curve long term in solving our societal issues.

謝謝，阿米爾。我們承認 2024 年為我們整個產業（包括 P3）帶來了重大挑戰。我們的許多健康計劃合作夥伴比以往任何時候都更加強調與提供者保持基於價值的護理的需求，以便更好地控制醫療成本並保持利潤。我堅信，基於價值的照護是解決我們社會問題的長期成本曲線的答案。

Underpinning our near- and long-term success will rest in our ability to seamlessly serve our physician partners and their patients by focusing our investments through stratification of the opportunities. Our partners will experience a refreshed approach to executing on the model across people, process and technology.

我們近期和長期成功的基礎在於，我們能夠透過機會分層集中投資，為我們的醫生合作夥伴及其患者提供無縫服務。我們的合作夥伴將體驗到跨人員、流程和技術執行模式的全新方法。

As we covered today, we are making the tough decisions and taking the necessary steps to address these issues. Our team has implemented decisive measures this quarter, and we are continuing to execute in our key areas of focus. We are confident that these efforts will lead to improved performance versus our 2024 jumping off point, and we look forward to sharing updates on our progress as we finalize and implement these actions over the coming quarters.

正如我們今天所報道的，我們正在做出艱難的決定，並採取必要的措施來解決這些問題。我們的團隊本季採取了果斷措施，我們將繼續在重點關注領域執行。我們相信，這些努力將帶來比 2024 年起點更高的績效，我們期待在未來幾季最終確定和實施這些行動時分享我們的最新進展。

With that, let's turn to Q&A.

接下來，我們進入問答環節。

(Operator Instructions) Brooks O'Neil, Lake Street Capital Markets.

（操作員說明）Brooks O'Neil，湖街資本市場。

I guess I just have one basic question, which is I heard Leif describe $63 million of cash at the end of the quarter and about a $20 million cash flow deficit from operations. Can you just talk to us about how you see your capital availability to execute some of the things you've talked about doing on this call?

我想我只有一個基本問題，那就是我聽到 Leif 描述了本季末的現金為 6,300 萬美元，營運現金流赤字約為 2,000 萬美元。您能否與我們談談您如何看待自己的資金可用性來執行您在本次電話會議中談到的一些事情？

Yes, Brooks, thanks for the question. And just to reiterate, we did end the quarter with $63 million of cash, which supports our core operations and our strategic growth initiatives.

是的，布魯克斯，謝謝你的提問。重申一下，本季末我們確實擁有 6,300 萬美元的現金，這支持了我們的核心業務和策略成長計畫。

And as you mentioned, we did experience negative operating cash flow for the quarter of about $20 million, which is consistent with kind of our 2024 run rate. We're continuing to actively monitor our cash burn rate and really focusing on optimizing working capital and driving towards that cash flow positivity.

正如您所提到的，我們確實在本季度經歷了約 2000 萬美元的負營運現金流，這與我們 2024 年的運行率一致。我們將繼續積極監控我們的現金消耗率，並真正專注於優化營運資本並推動現金流積極性。

As we think about the initiatives we laid out, that will play an impact into how we look at cash moving forward and when the realization of some of those initiatives actually turn to cash. We're confident in our ability to maintain liquidity and with access to potential credit facilities and/or strategic financing options, if required.

當我們思考我們提出的措施時，這將影響我們如何看待未來的現金發展以及其中一些措施何時真正轉化為現金。我們對維持流動性的能力以及在需要時獲得潛在信貸便利和/或策略性融資選擇的能力充滿信心。

Josh Raskin, Nephron Research.

喬許·拉斯金，腎單位研究。

I'm going to ask a similar question to Brooks there. Just I heard at the end, you're confident in your ability to maintain liquidity, including strategic financing options. Are you pursuing additional capital raise in the fourth quarter? Is this an immediate need?

我將向布魯克斯提出類似的問題。我最後聽說，您對自己維持流動性的能力充滿信心，包括策略性融資選擇。您是否在第四季尋求額外融資？這是迫在眉睫的需要嗎？

No. Right now, we are not pursuing that immediately. And we are in the process of just evaluating our overall cash position in light of some of the initiatives that I just spoke about earlier.

不。目前，我們不會立即追求這一目標。我們正在根據我剛才談到的一些措施來評估我們的整體現金狀況。

Okay. And then second question, I heard an improvement in EBITDA off of the 2024 stepping-off point, which I believe you defined as $30 million a quarter, so something better than a loss of $120 million next year. Could you just talk a little bit more about the top line? I heard a lot of conversation around reducing risk exposure, maybe even revenues. Do you think 2025 revenues are down next year? Is that the direction that we should be thinking about?

好的。第二個問題，我聽說 EBITDA 較 2024 年的起點有所改善，我相信您將其定義為每季 3000 萬美元，所以這比明年損失 1.2 億美元要好。能多談談頂線嗎？我聽到很多關於降低風險甚至收入的討論。您認為明年 2025 年的收入會下降嗎？這是我們該思考的方向嗎？

There's going to be a few puts and takes next year as we think about revenue, as you think about kind of how we laid out our opportunities for 2025 across our payer and provider rationalization. So there will be, as we rationalize that, a slight reduction of membership that will come associated with the reduction of revenue. But to correspond and to offset that will be increases from an operating perspective and our ability to execute on our chronic condition coding and documentation.

當我們考慮收​​入時，當你考慮我們如何在付款人和提供者合理化方面佈局 2025 年的機會時，明年將會有一些調整。因此，正如我們合理解釋的那樣，隨著收入的減少，會員人數也會略有減少。但為了對應和抵消這一點，從營運角度以及我們執行慢性病編碼和文件的能力將會增強。

Yes. Josh, this is Aric.

是的。喬什，這是阿里克。

Okay. So net-net --

好的。所以網-網--

I would just say, I would expect there to be some revenue decrement from where we are today in aggregate because of the network and payer changes that we've made. We will further quantify that. And we won't have full numbers, obviously, until we get through open enrollment to see what growth we had in the practices that we're -- and the payers we're continuing with. But ballpark, we're looking at probably 20,000 members have been impacted by network rationalization, some of the changes we made with payers, if that helps.

我只想說，由於我們所做的網路和付款人變化，我預計我們目前的總體收入將會減少。我們將進一步量化這一點。顯然，在我們完成公開註冊之前，我們不會獲得完整的數據，以了解我們的實踐以及我們正在繼續的付款人有哪些成長。但大致而言，我們正在考慮可能有 20,000 名會員受到網路合理化的影響，以及我們對付款人所做的一些改變（如果有幫助的話）。

Yes. No, that's super helpful. I just -- that makes more sense that you've got 130,000-ish, maybe 20,000 are going to go away. It seems sort of impossible to make that up in terms of care management coding and things like that.

是的。不，這非常有幫助。我只是——這更有意義，你有 13 萬人左右，也許 2 萬人會消失。從護理管理編碼之類的角度來彌補這一點似乎是不可能的。

And then just lastly, I heard the $130 million of these potential improvement opportunities and maybe 60% enhanced chronic disease and then 25% is just kind of getting rid of bad provider rationalization and the operating efficiency.

最後，我聽說這些潛在的改進機會價值 1.3 億美元，也許 60% 可以改善慢性疾病，然後 25% 只是擺脫不良的供應商合理化和營運效率。

But can we just get some more specifics, maybe even on that 60% that relates to the chronic disease? Can you give us some examples of how you feel like you're bending the cost curve with immediate improvements? How much of that gets realized in 2025, just on the chronic disease, a big chunk of it?

但我們能否獲得更多具體信息，甚至是與慢性病相關的 60%？您能給我們舉一些例子來說明您如何透過立即改進來扭轉成本曲線嗎？到 2025 年，其中有多少能夠實現，僅針對慢性病，其中很大一部分？

Yes. Josh, this is Amir. So a number of things that we're looking to do and implement as we move forward, and a lot of it is when we're talking about operational efficiency is to put more boots on the ground to directly work with those providers that are driving value. So when we look at the majority of our providers that are driving value, we know they need some more tools and or information, whether it's from a care management standpoint, education from documentation and coding.

是的。喬什，這是阿米爾。因此，隨著我們的前進，我們希望做和實施的許多事情，其中​​很多是當我們談論營運效率時，就是讓更多的人直接與那些正在推動的提供者合作價值。因此，當我們審視大多數正在推動價值的提供者時，我們知道他們需要更多的工具和/或訊息，無論是從護理管理的角度來看，還是從文件和編碼方面進行教育。

Since you already know, our coding, as we've seen it, in P3 today is decent, but has a lot of opportunity to continue to grow. As you knew from the beginning of last year, we ran overall numbers of just slightly over 1.0, 1.02, things like that, that we have significant upside on that number.

如您所知，我們今天在 P3 中的編碼非常不錯，但還有很多繼續發展的機會。正如你從去年年初就知道的那樣，我們的總體數字略高於 1.0、1.02 之類的，我們在這個數字上有很大的上升空間。

In addition to that, we have opportunity to look at other people we're working with to launch information directly into the patient's charts. And that will happen in about 15% of our population with the scaling we're looking to do. So all those things should bring that value in that 60%.

除此之外，我們還有機會查看與我們合作的其他人，將資訊直接發佈到患者的圖表中。隨著我們希望擴大規模，大約 15% 的人口將發生這種情況。所以所有這些東西都應該帶來那 60% 的價值。

And Josh, this is Aric. Just to add to that, some of these things are already in motion. And so the 15% of the population that Amir was referring to there, those are patients that we've actually gotten through with a new tool, with a point of care solution that's actually integrated into the EMR and taking data from claims as well as through an algorithm to help those clinicians, not only on chronic conditions, but also closing additional gaps in care and quality measures.

喬什，這是阿里克。除此之外，其中一些事情已經在進行中。因此，阿米爾所指的 15% 的人口，我們實際上已經使用新工具解決了這些患者的問題，我們使用的護理點解決方案實際上已整合到 EMR 中，並從索賠和索賠中獲取數據。透過一種演算法來幫助這些臨床醫生，不僅可以解決慢性病問題，還可以縮小護理和品質措施方面的額外差距。

So that's live, and that launched a couple of months ago. We're now up to 13 clinics that we've launched that through, and we have a scaling plan with the partner that's helping us with that work to get out into the broader marketplace. And that's ongoing. That will be through 2025. But we feel confident with their support and what we're doing here that we'll hit a substantial proportion of the patients.

幾個月前就已經上線了。目前，我們已經在 13 家診所推出了這項服務，並且我們與合作夥伴制定了擴展計劃，幫助我們開展這項工作，進入更廣闊的市場。而且這種情況仍在持續。這將持續到 2025 年。但我們對他們的支持以及我們在這裡所做的事情充滿信心，我們將治癒相當大比例的患者。

David Larsen, BTIG.

大衛‧拉森，BTIG。

It's Jenny Shen on for Dave. First, just looking at the MCR, we have seen it start to come down sequentially since 4Q of last year. Just -- some of the higher costs that you mentioned for Part B makes sense to us. But why was there such a huge spike in the quarter? Why wasn't it more gradual? Just what you're seeing out there would be helpful.

由珍妮·沉 (Jenny Shen) 替補戴夫 (Dave)。首先，僅看 MCR，我們發現它自去年第四季以來開始連續下降。只是——您提到的 B 部分的一些較高成本對我們來說是有意義的。但為什麼本季出現如此巨大的飆升呢？為什麼不循序漸進？您所看到的內容將會有所幫助。

Yes. So Jenny, I think some of it's just delayed information that we saw from -- especially end of quarter one through quarter two, and the delay came from getting information from our plans. So when we did not have the information necessary for our plans, we were a little bit blind in seeing how some of those costs were actually escalating. So some of it is being caught a little bit behind in not knowing some of those numbers and primarily then speaking of our non-delegated plans.

是的。所以珍妮，我認為其中一些只是我們看到的延遲資訊——尤其是第一季末到第二季度，而延遲來自於從我們的計劃中獲取資訊。因此，當我們沒有計劃所需的資訊時，我們就有點盲目地看到其中一些成本實際上是如何上升的。因此，由於不知道其中一些數字，並且主要是談論我們的非授權計劃，其中一些有點落後。

Obviously, where we're delegated, we have some of that information. But we did not see in our delegated lives nearly the increase that we saw in the nondelegated. So that's what kind of explains why that MCR rapidly got worse over that period of time versus what we were expecting as we were moving through from the end of first quarter.

顯然，在我們被授權的地方，我們擁有一些此類資訊。但在我們的授權生活中，我們並沒有看到與非授權生活相比的成長。這就是為什麼 MCR 在那段時間迅速惡化，而不是我們從第一季末開始的預期。

Okay. Got it. And then just on 4Q. So we're about 1.5 months into it. And I think you also mentioned your expectation that plan benefits will be less extensive in '25, which will lead to less utilization. Just on the MCR, I'm assuming that you'll expect it to remain elevated in 4Q. But in 1Q of '25, will there be a sudden step down that we should expect?

好的。知道了。然後就在第四季。所以我們大約花了 1.5 個月的時間。我認為您還提到您預計 25 年計劃福利將不那麼廣泛，這將導致利用率降低。就 MCR 而言，我假設您預計第四季度它將保持在較高水平。但在 25 年第一季度，是否會出現我們所期望的突然下降？

So thanks, this is Aric. Thanks, Jenny. So the way we look at this, we have information from the plans on how they bid and what the impacts are on a PMPM basis, and that's complete for nearly every plan that we work with.

謝謝，這是阿里克。謝謝，珍妮。因此，我們看待這個問題的方式是，我們從計劃中獲得有關其投標方式以及 PMPM 基礎上的影響的信息，這對於我們合作的幾乎每個計劃都是完整的。

Now what we don't know yet, to be able to give you specificity as to exactly what we see in terms of the numbers, is where those patients ultimately end up after open enrollment when they have a chance to make the choice every year about what plan to join.

現在我們還不知道的是，為了能夠準確地向您提供我們在數字方面所看到的具體信息，這些患者在公開招募後最終有機會每年做出選擇，最終會走向何方？

So we'll have a lot more clarity about exactly where and to the magnitude that we expect that to have an impact. However, we do expect those benefit design changes to have immediate effect, writ large across the industry from the benefit design changes that would begin in January.

因此，我們將更清楚地了解我們期望產生影響的確切位置和程度。然而，我們確實預計這些福利設計變更將立即生效，從一月開始的福利設計變更將在整個行業中體現出來。

(Operator Instructions) Ryan Daniels, William Blair.

（操作說明）Ryan Daniels、William Blair。

This is Jack Senft on for Ryan Daniels. You mentioned that you plan to enhance payer contracts and provider contracts. I'm just wondering, can you talk about this a bit more? I'm curious if this is a large percentage of your book that you plan to negotiate with? Or is it kind of a select few that make up 80% of the book. Just kind of curious if you can talk about the portion there that will kind of go through the repricing here.

我是瑞恩·丹尼爾斯的傑克·森夫特。您提到您計劃加強付款人合約和提供者合約。我只是想知道，你能多談談這個嗎？我很好奇這是否是您計劃與之談判的書中的很大一部分？或者說是精選的少數內容佔了本書的 80%。只是有點好奇您是否可以談論將在此處進行重新定價的部分。

And then just as a quick second part. Would you look to exit relationships with payers that really weren't working with you during negotiations? Or is your kind of -- is your mind like basically made up already when you kind of enter into some of those negotiations?

然後作為快速的第二部分。您是否會考慮與在談判過程中並未與您合作的付款人解除關係？或者當你進入其中一些談判時，你的想法基本上已經下定決心了嗎？

Thanks so much for the question. This is Aric. And so a couple of things that I would address here. One is that, in terms of the payers themselves, there's a lot of movement around Part D. And so we are looking to change our position in Part D across the majority of our contracts and have good traction to do so. So that's number one.

非常感謝您的提問。這是阿里克。我想在這裡談幾件事。一是，就付款人本身而言，圍繞 D 部分有很多變動。所以這是第一。

Secondly, we've had good responses from the plans on some of the changes that we want to make. And it's a combination of things from changes in percent of premium as an example of how we're getting better terms.

其次，我們從計劃中得到了對我們想要做出的一些改變的良好回應。這是保費百分比變化的綜合因素，作為我們如何獲得更好條款的一個例子。

We reduced the overall number of contracts that we have on the payer side. We had subscale contracts that we have with payers, and so those have already been exited. And then we had some plan partners that were exiting particular markets. Again, these were small plans overall, but they weren't necessarily strong performers, and those plans exited as well.

我們減少了付款方的合約總數。我們與付款人簽訂了小額合同，因此這些合約已經退出。然後我們有一些計劃合作夥伴正在退出特定市場。再說一遍，這些計劃總體上都是小計劃，但它們不一定表現出色，而且這些計劃也退出了。

Okay. Perfect. Understood. And then just to follow up here, just given the shortfall this quarter and higher utilization trends, and I think you maybe just noted it in the previous answer here, but are you looking to exit certain markets? I know you said that you're looking to exit certain relationships with providers and payers. But would you look to exit a market in its entirety? Or is it kind of like a one-off basis? I'm just kind of curious on your approach there.

好的。完美的。明白了。然後就在這裡跟進，考慮到本季度的短缺和更高的利用率趨勢，我想您可能只是在之前的答案中註意到了這一點，但是您是否打算退出某些市場？我知道您說過您正在尋求退出與提供者和付款人的某些關係。但您會考慮完全退出市場嗎？或者這有點像是一次性的基礎？我只是對你的做法有點好奇。

Yes.I think the example I'd bring up here is Florida. And Florida, for us, was a very small -- the smallest market by far. And it was in a place where everything else is on the left part of the United States, and it wasn't a place based on the scale there that we felt it was a good place to invest for our business today. And so that's an example of one where we do plan to back out of the Florida market.

是的，我想我在這裡舉的例子是佛羅裡達州。對我們來說，佛羅裡達州是一個非常小的市場——迄今為止最小的市場。那是一個其他一切都在美國左側的地方，根據那裡的規模，我們認為它不是一個對我們今天的業務進行投資的好地方。這是我們確實計劃退出佛羅裡達市場的一個例子。

No further questions. This concludes our question-and-answer session. I would like to turn the conference back over to Aric Coffman for any closing remarks.

沒有其他問題了。我們的問答環節到此結束。我想將會議轉回給阿里克·科夫曼（Aric Coffman）發表閉幕詞。

Yes. I just want to thank everyone for their participation today. We certainly look forward to follow-up calls and getting together with you again sometime soon. Thank you very much.

是的。我只想感謝大家今天的參與。我們當然期待後續電話並很快與您再次相聚。非常感謝。

The conference has now been 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。