P3 Health Partners Inc (PIII) 2024 Q4 法說會逐字稿

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

大家好，歡迎參加 P3 Health Partners 2024 年第四季財報電話會議。（操作員指示）請注意，此事件正在被記錄。

I would now like to turn the conference over to Mr. Ryan Halstead of Investor Relations. Please go ahead, sir.

現在我想將會議交給投資者關係部門的 Ryan Halstead 先生。先生，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 US federal securities laws, including statements regarding our financial outlook and long-term target. 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.

謝謝接線員，謝謝您今天加入我們。在我們繼續電話會議之前，我想提醒大家，本次電話會議中所做的某些聲明根據美國聯邦證券法屬於前瞻性聲明，包括有關我們的財務前景和長期目標的聲明。這些前瞻性陳述僅是預測，主要基於我們對未來事件和財務趨勢的當前預期和預測，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。這些聲明受風險和不確定性的影響，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陳述不同的因素的更多信息，包含在我們向美國證券交易委員會提交的定期報告中。本次電話會議中所做的前瞻性陳述僅代表截至本電話會議之日的觀點，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 and cash used. These non-GAAP financial measures are in addition to and not a substitute for or superior to the measures by financial performance prepared in accordance with GAAP.

我們將在本次電話會議上參考某些非 GAAP 財務指標，包括調整後的營業費用、調整後的 EBITDA、每位會員每月調整後的 EBITDA、醫療利潤率、每位會員每月醫療利潤率和所用現金。這些非 GAAP 財務指標是依照 GAAP 編製的財務績效指標的補充，並非取代或優於這些指標。

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. 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.

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 GAAP 財務指標。請參閱我們的收益報告附錄，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。

Information presented on this call is contained in the press release that we issued today in our SEC filings, which may be accessed from the Investors page of the P3 Health Partners website.

本次電話會議中提供的資訊包含在我們今天在 SEC 文件中發布的新聞稿中，您可以從 P3 Health Partners 網站的投資者頁面中存取。

I will now turn the call over to Aric Coffman, CEO of P3 Health Partners.

現在我將電話轉給 P3 Health Partners 執行長 Aric Coffman。

Thank you for joining us today. I'd like to begin with three key headlines. First, we entered this year focused on strengthening our business for near-term profitability. Our programmatic initiatives, which we have previously quantified as representing over $130 million of adjusted EBITDA opportunity, are on schedule. Second, we are reaffirming our 2025 guidance on all metrics except for total members, which we are slightly raising. Third, the macro environment is improving in the Medicare sector following years of pressure due to factors like V28, cost trends, rich benefit designs and higher quality bonus thresholds. Our early indicators for 2025 are showing positive trends, and we are seeing flow through on benefit design changes and utilization.

感謝您今天加入我們。我想從三個關鍵標題開始。首先，我們今年的重點是加強業務以實現近期獲利。我們的計劃舉措正在按計劃進行，我們之前已將其量化為代表超過 1.3 億美元調整後 EBITDA 機會的舉措。其次，我們重申了 2025 年所有指標的指導方針，但總會員數除外，我們將略微提高總會員數。第三，在經歷了多年因 V28、成本趨勢、豐富的福利設計和更高的品質獎金門檻等因素而承受的壓力之後，醫療保險行業的宏觀環境正在改善。我們針對 2025 年的早期指標顯示出正面的趨勢，我們看到了福利設計變化和利用率的流動。

Further, the improved payer bids in CMS's 2026 advanced notice signal a more favorable trajectory for 2026. And as payer benefit design changes are expected to rationalize, they will contribute an estimated $30 to $35 per member per month of incremental medical margin benefit. Finally, we have significantly enhanced our senior leadership team with the addition of multiple key new hires with substantial industry experience.

此外，CMS 2026 年提前通知中付款人出價的提高預示著 2026 年的發展軌跡將更加有利。隨著付款人福利設計變化預計趨於合理，他們將為每位會員每月貢獻約 30 至 35 美元的增量醫療邊際福利。最後，我們透過增加多名具有豐富產業經驗的關鍵新員工，大大增強了我們的高階領導團隊。

Turning now to fourth-quarter results. We reported membership growth from 4Q '23 to 4Q '24 of 13%, with revenue growing 7% to $371 million. On an annual basis, we ended 2024 with revenues of $1.5 billion or 18% growth year over year. Our fourth-quarter medical margin of $7 million decreased year over year due to the elevated utilization trends, which persisted through the quarter.

現在來談談第四季的業績。我們報告稱，從 2023 年第四季到 2024 年第四季度，會員數量增加了 13%，營收成長了 7%，達到 3.71 億美元。以年度計算，到 2024 年，我們的營收為 15 億美元，年增 18%。由於利用率上升趨勢持續整個季度，我們的第四季醫療利潤為 700 萬美元，年減。

Adjusted EBITDA for the quarter was a loss of $68 million which included unfavorable out-of-period true-ups related to a single payer partner. Excluding these costs, adjusted EBITDA results are on track with our 2024 jumping off point. As benefit design changes rationalize over the coming months and years, these network expenses will normalize serving as a tailwind to adjusted EBITDA.

本季調整後的 EBITDA 虧損 6,800 萬美元，其中包括與單一付款人合作夥伴相關的不利的期外調整。除去這些成本，調整後的 EBITDA 結果與我們的 2024 年起點一致。隨著未來數月和數年福利設計變化的合理化，這些網路費用將正常化，成為調整後 EBITDA 的順風。

Now moving on to our full-year 2025 guidance. We have reaffirmed our 2025 outlook for revenues of $1.35 billion to $1.5 billion and adjusted EBITDA between negative $35 million and $5 million positive. Our growth strategy moving forward is deliberate with a focus on growing profitably, and we expect to achieve profitability this year.

現在來看看我們的 2025 年全年指引。我們重申了 2025 年的預期：營收為 13.5 億美元至 15 億美元，調整後的 EBITDA 為負 3,500 萬美元至正 500 萬美元之間。我們未來的成長策略是經過深思熟慮的，重點是獲利成長，我們預計今年將實現獲利。

We are encouraged by the early trends so far in the first few months of the year that gives us further confidence in our targets. Leif will walk through the building blocks of our full-year 2025 guidance, and Amir will share some initial utilization trends.

今年頭幾個月的早期趨勢令我們感到鼓舞，這讓我們對我們的目標更有信心。Leif 將介紹我們 2025 年全年指導的組成要素，而 Amir 將分享一些初步的利用趨勢。

Building on the programmatic initiatives set forth in 2024, we are carrying strong momentum into Q1 of 2025. We remain on track to realize our $130 million-plus EBITDA improvement opportunity comprised of $20 million in operational efficiencies, $35 million in contract rationalization, and $75 million in operational execution.

基於 2024 年制定的計畫舉措，我們將以強勁勢頭邁入 2025 年第一季。我們仍有望實現 1.3 億美元以上的 EBITDA 改進機會，其中包括 2000 萬美元的營運效率、3500 萬美元的合約合理化和 7500 萬美元的營運執行。

Starting off with operational efficiencies, we executed on our objective of reducing operating expenses by $20 million. As we said in the latter half of 2024, we executed on our planned contract rationalization with both provider network and payers to yield $35 million of EBITDA improvement. This included the elimination of roughly 60 TINs in the provider network and a handful of payer contracts that have already been completed. Additionally, we are on track for incremental EBITDA improvements of another $25 million to $30 million in our remaining contracts through renegotiation and ongoing network hygiene.

從提高營運效率開始，我們實現了減少 2,000 萬美元營運費用的目標。正如我們在 2024 年下半年所說的那樣，我們按照計劃與供應商網路和付款人進行合約合理化，以實現 3500 萬美元的 EBITDA 改善。其中包括取消提供者網路中約 60 個 TIN 和少量已經完成的付款人合約。此外，透過重新談判和持續的網路清理，我們預計在剩餘合約中再增加 2,500 萬至 3,000 萬美元的 EBITDA。

Now I'll pivot to operational execution. Annually evaluating the patients is a cornerstone of high-quality and successful medical management. To that end, we are making strong progress on our burden of illness program and are on track in Q1. By engaging our physician network with a combination of new processes and tools, we are assessing our patients more thoroughly and earlier in the year, reflecting their unique disease burden, building care plans, which then allows more time in the year for needed treatment and support and closure of quality gaps.

現在我將轉向營運執行。每年對患者進行評估是高品質和成功的醫療管理的基石。為此，我們在疾病負擔計劃方面取得了重大進展，並在第一季步入正軌。透過將我們的醫生網絡與新流程和工具相結合，我們可以在年初更徹底地評估我們的患者，反映他們獨特的疾病負擔，制定護理計劃，從而在一年中留出更多時間進行所需的治療和支持並彌補品質差距。

As an example, P3's medical group and affiliates where we have deployed new tools with the largest patient population achieved a 20% year-over-year improvement in assessing burden of illness through improved point-of-care tools and processes. In addition, because of these programs, we are also seeing positive trends on our medical expense initiatives.

例如，我們部署了新工具的擁有最多患者的 P3 醫療集團及其附屬機構透過改進的護理點工具和流程，在評估疾病負擔方面實現了同比增長 20%。此外，由於這些計劃，我們也看到醫療費用計劃呈現正面趨勢。

We made significant investments in field operations for 2025, and I'm very pleased by the reception to our care enablement model from the providers across our markets. Additionally, we've introduced P3 Restore, an innovative program now available in all of our markets. This initiative offers personalized one-on-one sessions with a physician coach aimed at reducing physician burnout, which is a crucial part of our strategy to transform healthcare and improve engagement, yielding better patient outcomes and longer clinician tenure.

我們對 2025 年的現場營運進行了大量投資，我對我們的護理支援模式受到各個市場供應商的歡迎感到非常高興。此外，我們還推出了 P3 Restore，這是一項創新計劃，現已在我們所有的市場推出。該計劃提供與醫生教練進行個性化的一對一課程，旨在減少醫生倦怠，這是我們轉變醫療保健和提高參與度的策略的重要組成部分，可帶來更好的患者治療結果和更長的臨床醫生任期。

Also serving as a testament to the strength of the P3 platform is our ability to attract world-class talent. Shelly Martin joins us as Regional Market President. Shelly's track record of building high-performing teams and scaling innovative care models as demonstrated at OptumCare Utah and Kaiser will be invaluable as we continue to expand our market presence.

我們吸引世界級人才的能力也證明了 P3 平台的實力。Shelly Martin 加入我們，擔任區域市場總裁。Shelly 在 OptumCare Utah 和 Kaiser 所展現的打造高績效團隊和擴展創新護理模式的業績記錄對於我們繼續擴大市場佔有率具有無價的價值。

Equally exciting is the appointment of Todd Smith as our new Chief Legal and Compliance Officer. Todd's extensive experience in healthcare law, regulatory compliance and risk management at Elevance Health, Bright Health Group, and Optum places him at center stage to guide our legal and compliance strategies. Both Shelly and Todd have proven their ability to navigate the intricacies of value-based and risk-bearing models, which aligns perfectly with P3's mission.

同樣令人興奮的是，我們任命 Todd Smith 為我們的新首席法律和合規官。Todd 在 Elevance Health、Bright Health Group 和 Optum 的醫療保健法、法規合規性和風險管理方面擁有豐富的經驗，這使他成為指導我們法律和合規策略的核心。Shelly 和 Todd 都證明了他們能夠駕馭基於價值和風險承擔模型的複雜性，這與 P3 的使命完全一致。

With that, I'll pass the call to Leif.

說完，我就把電話轉給 Leif。

Thanks, Aric. At-risk membership was 123,800, an increase of 14% year over year. Top-line results in 2024 were strong as the team executed on and delivered revenue of $1.5 billion, representing 18% year-over-year growth. On a PMPM basis, capitated revenue increased 2.5% year over year when adjusting for the one-time change in accounting for the recognition of revenue associated with our delegated health plans and their final payments, impacting approximately $21 PMPM in 2023.

謝謝，阿里克。高危險會員人數為123,800人，較去年同期成長14%。2024 年的營收業績表現強勁，團隊執行並實現了 15 億美元的收入，年增 18%。以 PMPM 計算，在調整與我們的委託健康計劃及其最終付款相關的收入確認的一次性會計變更後，人頭收入同比增長 2.5%，對 2023 年的 PMPM 產生了約 21 美元的影響。

Fourth-quarter 2024 revenue was $371 million, a 7% increase over fourth quarter of 2023 or a 16% increase year over year after adjusting for the one-time change of accounting in Q4 2023. On a PMPM basis, revenue increased 3% quarter over prior-year quarter when adjusted for the change in accounting. Growth was primarily driven by sustained organic expansion in our established markets and partially tempered by reduced PMPM funding.

2024 年第四季營收為 3.71 億美元，比 2023 年第四季成長 7%，在調整 2023 年第四季的一次性會計變更後，年增 16%。根據 PMPM 計算，經會計變更調整後，營收較去年同期成長 3%。成長主要由我們成熟市場的持續有機擴張所推動，並部分受到 PMPM 資金減少的影響。

Full-year medical margin of $85.5 million decreased by approximately 37% year over year or $70 on a PMPM basis. The full-year compression was driven by elevated medical expenses, especially Part D expenses. We reduced our Part D expense in Q4 2024 and have made progress in reducing in half our membership with Part D risk. Our platform support costs as a percentage of operating revenue are 6.1% in 2024, which is down from 7.7% in 2023.

全年醫療利潤為 8,550 萬美元，年減約 37%，以 PMPM 計算下降 70 美元。全年壓縮是由於醫療費用增加，尤其是 D 部分費用增加。我們在 2024 年第四季減少了 D 部分費用，並在將 D 部分風險會員人數減少一半方面取得了進展。我們的平台支援成本佔營業收入的百分比在 2024 年為 6.1%，低於 2023 年的 7.7%。

Adjusted EBITDA loss for the full year was $167.2 million for 2024 compared to a loss of $85.5 million in the prior year. On a per member per month basis, 2024 adjusted EBITDA loss was $147, a $45 change from the prior year. Adjusted EBITDA loss for the fourth quarter of 2024 was $67.6 million or approximately $175 PMPM basis.

2024 年全年調整後 EBITDA 虧損為 1.672 億美元，而前一年虧損為 8,550 萬美元。以每位會員每月計算，2024 年調整後的 EBITDA 虧損為 147 美元，比前一年減少 45 美元。2024 年第四季調整後 EBITDA 虧損為 6,760 萬美元，約每月 1.75 億美元。

Our fourth-quarter prior-period development associated with IBNR were relatively small, reflecting stability in our reserving practices as we are now adequately positioned. Additionally, our new reserving process, introduced in Q1 2024, has now been in place for three quarters, making it established framework that provides us with stronger visibility. We feel confident in the accuracy of the data exiting 2024, including any associated lags, which further supports our ability to manage reserves effectively.

我們在第四季度與 IBNR 相關的前期發展相對較小，反映了我們的儲備實踐的穩定性，因為我們現在已做好充分準備。此外，我們在 2024 年第一季推出的新儲備流程現已實施三個季度，這使其成為為我們提供更強可視性的既定框架。我們對 2024 年數據的準確性充滿信心，包括任何相關的滯後，這進一步支持了我們有效管理儲備的能力。

From an internal control standpoint, a key achievement over the past year was the successful remediation of seven previously identified material weaknesses. Looking ahead to 2025, our primary focus is maintaining the strong control environment established in 2024 while also driving execution of our clinical and operational initiatives. I'm confident in the meaningful progress P3 is making towards long-term sustainable growth.

從內部控制的角度來看，過去一年的一項重要成就是成功修復了先前發現的七個重大缺陷。展望 2025 年，我們的主要重點是維持 2024 年建立的強大的控制環境，同時推動我們的臨床和營運計畫的執行。我對 P3 在長期可持續成長方面取得的有意義的進展充滿信心。

Turning to our 2025 guidance. We are slightly increasing our total membership expectation to 109,000 to 119,000 in 2025 due to the growth of our ACO membership. For the full year, we are reaffirming our revenue range of $1.35 billion to $1.5 billion. Our revenue guidance includes MA funding increases of 3.1%. In addition, the revenue guide includes reductions in overall membership as a result of network rationalization, which is partially offset by favorable premium increases, including the benefit of renegotiated payer contracts and member mix shift.

轉向我們的 2025 年指導。由於 ACO 會員數量的增長，我們預計 2025 年會員總數將略微增加至 109,000 至 119,000。對於全年而言，我們重申收入範圍為 13.5 億美元至 15 億美元。我們的收入指導包括 MA 資金增加 3.1%。此外，收入指南還包括由於網路合理化而導致的會員總數的減少，但這部分被有利的保費上漲所抵消，包括重新談判的付款人合約和會員結構轉變帶來的好處。

As a reminder, we re-contracted 25% of our payer partners effective January 1, 2025, and expect to recontract 50% in 2025, effective for plan year 2026, with the remainder being executed effective 2027. We are issuing guidance for medical margin to be in the range of $174 million to $210 million in 2025, and our medical margin PMPM in the range of $133 to $147. Our medical margin guidance includes a benefit from rationalizing underperforming provider and payer contracts; improving execution across affordability programs, including hospice and palliative care; and positive changes from benefit plan designs, including reducing total Part D risk membership by 50%, offset by regional medical cost inflation in 2025.

提醒一下，我們已與 25% 的付款人合作夥伴重新簽訂合同，自 2025 年 1 月 1 日起生效，預計在 2025 年重新簽訂 50% 的合同，自 2026 計劃年度起生效，其餘合同將於 2027 年生效。我們發布的指導意見是，2025 年醫療利潤率將在 1.74 億美元至 2.1 億美元之間，而我們的醫療利潤率 PMPM 將在 1.33 美元至 1.47 美元之間。我們的醫療利潤指導包括合理化表現不佳的提供者和付款人合約所帶來的好處；改善包括臨終關懷和安寧療護在內的可負擔計劃的執行情況；福利計劃設計也發生了積極變化，包括將 D 部分風險會員總數減少 50%，但到 2025 年，這一變化將被地區醫療成本通膨所抵消。

We are reaffirming our adjusted EBITDA guidance range of negative $35 million to $5 million positive for the fiscal year. This guidance incorporates an expected $8 million contribution from our ACO operations. Additionally, we've realized nearly $20 million in operating cost efficiencies, which will be reflected throughout the remainder of 2025. It's important to note that due to the seasonal utilization patterns, we typically see lower EBITDA as a proportion of full-year guidance in the first and fourth quarters compared to the second and third quarters.

我們重申本財年調整後的 EBITDA 指引範圍為負 3,500 萬美元至正 500 萬美元。該指導意見包含了我們 ACO 營運預計提供的 800 萬美元貢獻。此外，我們還實現了近 2,000 萬美元的營運成本效率，這將在 2025 年剩餘時間內得到體現。值得注意的是，由於季節性利用模式，我們通常看到第一季和第四季的 EBITDA 佔全年指引的比例低於第二季和第三季。

Turning to our balance sheet. At December 31, our cash balance was $38.8 million, noting an additional $15 million of capitation revenue was received in the first week of January 2025.

轉向我們的資產負債表。截至 12 月 31 日，我們的現金餘額為 3,880 萬美元，值得注意的是，2025 年 1 月第一周又收到了 1,500 萬美元的人頭稅收入。

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

說完這些，我就把麥克風交給阿米爾。

Thanks, Leif. As Aric and Leif described, there have been many factors leading to the current '24 medical expense trends, many of which were due to either health plan benefit changes with increasing pass-through costs, increased facility unit costs, whether from hospitals, dialysis centers or higher utilization of elective or surgical procedures and higher Part D drug utilization.

謝謝，萊夫。正如 Aric 和 Leif 所描述的，導致當前 24 種醫療費用趨勢的因素有很多，其中許多是由於健康計劃福利變化導致轉嫁成本增加，設施單位成本增加（無論是來自醫院、透析中心還是選擇性或外科手術的利用率更高以及 D 部分藥物的利用率更高）。

Despite these trends leading to overall higher costs, our utilization trends actually showed slight improvement in admits per 1,000, emergency department per 1,000 and observation rates per 1,000 at 0.5%, 1%, and 3%, respectively, in quarter four '24. We did see, however, increased [SNP] average length of stay from 17 to 19 days in our markets. And as Aric and Leif mentioned, we reduced our Part D exposure from certain plans.

儘管這些趨勢導致整體成本上升，但我們的使用率趨勢實際上顯示，2024 年第四季每 1,000 人的入院率、每 1,000 人的急診率和每 1,000 人的觀察率分別略有改善，分別為 0.5%、1% 和 3%。然而，我們確實看到 [SNP] 在我們的市場上的平均停留時間從 17 天增加到 19 天。正如 Aric 和 Leif 所提到的，我們減少了某些計劃的 D 部分風險。

Before I go on to discuss 2025, let me start by saying as the Co-Founder and the Chief Medical Officer of P3, there has been a palpable reinvigoration of our staff from our new leadership, driving improved morale and a strong sense of purpose to our mission for both our providers and the patients. As mentioned earlier, new for '25 is the investment in our care enablement model to put more resources, people, and point-of-care tools in our affiliate provider offices to aid them with improved scheduling, especially on our high-risk, rising-risk and high-cost patients, ensuring better access and improved visit volumes and other administrative tasks necessary to perform well in value-based care.

在繼續討論 2025 年之前，首先請允許我以 P3 聯合創始人兼首席醫療官的身份說一句，我們的新領導層明顯地為我們的員工注入了新的活力，提高了員工的士氣，並增強了我們為醫療服務提供者和患者完成使命的使命感。如前所述，25 年的新舉措是對我們的護理支援模式進行投資，將更多的資源、人員和護理點工具投入到我們的附屬提供者辦公室，以幫助他們改善日程安排，特別是針對我們的高風險、上升風險和高費用患者，確保更好的訪問和提高就診量以及在基於價值的護理中表現良好所需的其他管理任務。

From this initiative, we have already seen improved interest in our PCPs from all markets, leading to improved documentation for burden of illness, as Aric described, improved quality, Part C measures from 28.6% when looking at April of '24 versus March of '25, early utilization trends on par with quarter four of '24, and significantly improved SNP average length of stay now trending at 14 days. In addition, in both our California and Nevada markets, where we are delegated for utilization management, high-cost elective cases are trending down by 25% in California and 12.5% in Nevada.

透過這項舉措，我們已經看到各個市場對我們的 PCP 的興趣有所提高，從而改善了疾病負擔記錄，正如 Aric 所描述的，質量也有所提高，從 24 年 4 月到 25 年 3 月，C 部分指標從 28.6% 上升到 28.6%，早期利用率與 24 年第 4 天住院時間持平，目前為平均住院時間為顯著趨勢與 24 年住院時間持平。此外，在我們負責利用率管理的加州和內華達州市場，高成本選擇性病例在加州下降了 25%，在內華達州下降了 12.5%。

Objectively, but also very important, we're seeing tremendous provider appreciation with the P3 Restore program, which is something unique and a differentiator compared to others in the provider enablement platform. Driving a greater sense of purpose and getting back to the why of becoming a physician allows for a different mindset and a better foundation to perform well in value-based care.

客觀地，但同樣非常重要的是，我們看到提供者對 P3 Restore 計畫的高度讚賞，與提供者支援平台中的其他計畫相比，該計畫是獨一無二的，具有差異化優勢。增強目標感並重新認識成為醫生的初衷，可以帶來不同的思維方式和更好的基礎，從而更好地進行基於價值的護理。

P3 has also contracted and is in the process of expanding new capitation and UM contracts for oncology as well as creating sub-caps for things like tighter management of musculoskeletal conditions. Many of our health plan contracts are already showing decreased medical expense pass-throughs and a reduction in Part D exposure.

P3 還簽訂了合同，並且正在擴大腫瘤學的新人頭稅和 UM 合同，以及為諸如肌肉骨骼疾病的更嚴格管理等方面創建子上限。我們的許多健康計劃合約已經顯示出醫療費用轉嫁減少以及 D 部分風險降低。

The care enablement model is also creating more direct opportunities with our PCPs to drive more appropriate referrals to more cost-effective in-network specialists plus improved referrals to palliative care and hospice for improved care of our sickest patients. This is a key directive of ours, increasing the number of patients enrolled in hospice from 2.3% in '24 to 4% in '25.

護理支援模式也為我們的 PCP 創造了更多直接機會，以便將患者轉診給更具成本效益的網絡內專家，並改善對安寧療護和臨終關懷的轉診，從而改善對病情最嚴重的患者的護理。這是我們的一項重要指令，將入住安寧療護醫院的病患人數從 1924 年的 2.3% 增加到 1925 年的 4%。

Of course, we will continue to drive performance in our successful COPD program and begin new ones like focusing on our patients with polypharmacy to reduce potential utilization expense and comorbidity. P3 understands the market dynamics that Aric described above, and we are strengthening our model where care happens, at the point of care, within the offices of our primary care physicians.

當然，我們將繼續推動我們成功的 COPD 計劃的績效，並開始新的計劃，例如關注使用多種藥物的患者，以減少潛在的使用費用和合併症。P3 了解 Aric 上面描述的市場動態，我們正在加強我們的模式，即在護理點、在我們的初級保健醫生辦公室內進行護理。

And with that, I'm going to turn it back to the operator to open the floor to questions. Operator?

現在，我將把時間交還給接線員，開始回答問題。操作員？

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

（操作員指示）布魯克斯奧尼爾（Brooks O'Neill），Lake Street Capital Markets。

This is Aaron on the line for Brooks. And so I appreciate the added color on the guidance there. I was wondering if you could maybe elaborate on maybe the timing around reaching the potential profitability, understanding the commentary on the call around the reduction in membership and mix shift dynamics, but if you could maybe add a little bit of the key puts and takes that led you to the range you provided and how we should maybe think about the cadence towards that profitability target?

這是亞倫為布魯克斯接電話。因此，我很欣賞那裡的指導所添加的色彩。我想知道您是否可以詳細說明實現潛在盈利能力的時間，理解有關會員減少和組合轉變動態的電話評論，但您是否可以添加一些關鍵的利弊，這些利弊導致您得出所提供的範圍，以及我們應該如何考慮實現該盈利目標的節奏？

Yeah. This is Leif. Let me take a stab at answering the question for you. So as we think about guidance for 2025, we have our three major inputs, one, which we've outlined in the $130 million of operating plan improvements is on the revenue side of things. And the way we're thinking about this for 2025 is we're thinking about getting about 7.5% increase in revenue year over year as a result of our identification of burden of illness, our base rate assumptions as to the increase in revenue year over year, and then some impacts related to contracting. All three of those parties go into that 7.5% increase.

是的。這是萊夫。讓我試著回答你這個問題。因此，當我們考慮 2025 年的指導時，我們有三個主要投入，第一，我們在 1.3 億美元的營運計劃改進中概述了收入方面。我們對 2025 年的考慮是，由於我們對疾病負擔的確定、我們對收入逐年增加的基本利率假設以及與承包相關的一些影響，我們預計收入將逐年增加約 7.5%。這三個政黨都參與了 7.5% 的成長。

And then you think about medical costs as another major driver of -- opportunity for improvement from an EBITDA perspective in 2025. And we're looking at about a $16 PMPM improvement year over year. And how we came to that conclusion was we increased our run rate for normal course inflation of medical costs year-over-year inflationary costs in addition to -- added an additional amount for the second half of 2024, where we saw elevated costs across Part A and Part B. And then we offset that by some specific programs that we have across hospice and palliative care that we think are going to be really influential in 2025 as well as some chronic condition programs.

然後，您會認為醫療成本是另一個主要驅動因素——從 2025 年 EBITDA 的角度來看，這是改善的機會。我們預計，與去年同期相比，PMPM 將提高約 16 美元。我們得出這個結論的原因是，我們提高了醫療成本正常通膨的運作率，即同比通膨成本，此外，還增加了 2024 年下半年的額外金額，因為我們看到 A 部分和 B 部分的成本上升。然後，我們透過臨終關懷和安寧療護中的一些特定計劃來抵消這一影響，我們認為這些計劃將在 2025 年以及一些慢性病計劃中產生真正的影響。

And then the last but not the least, but the TIN rationalization and payer rationalization that we performed at the end of 2024. And then the last piece, obviously, is our OpEx, which is pretty straightforward.

最後但並非最不重要的一點是，我們在 2024 年底進行的 TIN 合理化和付款人合理化。最後一點顯然是我們的營運支出，這很簡單。

Got it. Thanks for that color. And then I guess from the cash then, I think you ended around $39 million to end the year. Expectations -- maybe you could talk a little bit about, comparative to 2024, what you're expecting for 2025 on the cash front as you're sort of beginning to implement these new initiatives. Thanks for taking the questions.

知道了。謝謝你這個顏色。然後我猜從當時的現金來看，我認為到年底你的現金約為 3900 萬美元。期望—也許您可以談談與 2024 年相比，您對 2025 年現金的期望，因為您已經開始實施這些新措施。感謝您回答這些問題。

Yeah, absolutely. Yeah. You hit the nail on the head. At December 31, 2024, we were at $38.8 million of cash. What's not reflected as of that date is we received $15 million of additional capitation revenue in early January. That brings that total effective starting cash position to about $54 million. And so that's just the kind of level set.

是的，絕對是如此。是的。你說得太對了。截至 2024 年 12 月 31 日，我們的現金為 3,880 萬美元。截至該日期尚未反映的是，我們在 1 月初收到了 1500 萬美元的額外人頭稅收入。這使得總有效起始現金部位達到約 5,400 萬美元。這就是一種水平集。

In addition, in February, we received an additional $30 million to help fund our first-half 2025 operating cash needs. As you guys well know, we're regularly assessing our liquidity requirements through our cash forecasting processes and scenario planning. We continue to have full support and backing of our Board. And we will continue to access capital markets as cash needs to rise as we think about that in 2025.

此外，2 月份，我們又收到了 3,000 萬美元，以幫助我們滿足 2025 年上半年的營運現金需求。眾所周知，我們會透過現金預測流程和情境規劃定期評估我們的流動性需求。我們繼續得到董事會的全力支持。考慮到 2025 年現金需求將會增加，我們將繼續進入資本市場。

Josh Raskin, Nephron.

喬許·拉斯金（Josh Raskin），Nephron。

So I guess just to start, maybe we start with the fourth-quarter results. I was sort of thinking of a stepping-off point. I think we talked about last quarter about $30 million when you adjusted 3Q for some of the one-time items. And then I thought I heard the prior-period reserve development wasn't significant in the quarter. So did 4Q come in line with your expectations? Or what was the deviation relative to the 3Q just in terms of sort of that underlying run rate?

所以我想首先，我們可以從第四季的業績開始。我當時正在思考一個起點。我認為我們上個季度討論過大約 3000 萬美元，當時您對第三季度的一些一次性項目進行了調整。然後我想我聽說本季前期儲備發展並不顯著。那麼第四季是否符合您的預期？或者，就基本運行率而言，與第三季相比偏差是多少？

Yeah, Josh. Good question. And you did hit the commentary from our Q3 release about the $30 million kind of exit run rate of Q4. In Q4, we did have a couple of one-time things hit the P&L, and they were negative in nature, and they were to the tune of about $17 million.

是的，喬希。好問題。您確實觸及了我們第三季發布的關於第四季度 3000 萬美元退出運行率的評論。在第四季度，我們的損益表中確實出現了幾項一次性的負面影響，損失約為 1700 萬美元。

They weren't related to IBNR. They were related to some other items that were part of the cleanup of, I'll just say, the accounting processes as I came in and transitioned over from my predecessor. And so those would be one-time in nature, and should be excluded from the total Q4 EBITDA numbers.

它們與 IBNR 沒有關係。它們與其他一些項目有關，這些項目是我上任並從前任手中接過會計流程時清理的一部分。因此，這些本質上是一次性的，應該排除在第四季度 EBITDA 總數字之外。

But it still sounds like $20 million -- even if you exclude the $17 million, you're still about $20 million worse than 3Q. Is that just seasonality? I know 1Q, 4Q are typically lower, but is there anything else to deteriorate in terms of utilization trends or anything like that?

但這聽起來仍然像是 2000 萬美元——即使排除 1700 萬美元，仍然比第三季差約 2000 萬美元。這只是季節性嗎？我知道第一季、第四季通常較低，但就利用率趨勢或類似情況而言，還有什麼其他惡化的情況嗎？

Hey, Josh. This is Amir. Sorry for the delay. Yeah, we did see increase in unit cost. We did have COVID, RSV, the typical things you'd see in that seasonality that did increase some of those costs there as well. We did have a plan of ours, one of our plans, that had some poor performance as far as how they were looking at and working with some of their payment methodologies with their underlying providers, which we also had to take in that quarter.

嘿，喬希。這是阿米爾。抱歉耽擱了。是的，我們確實看到單位成本增加了。我們確實有 COVID、RSV，這些都是在那個季節常見的典型疾病，這些疾病也確實增加了那裡的一些成本。我們確實有一個計劃，我們的一個計劃，在他們如何看待和使用他們的一些支付方法與他們的底層供應商合作方面表現不佳，我們也必須在那個季度採取這些計劃。

Okay. And then now moving to 2025, so it's an improvement in EBITDA of about $153 million, just using your midpoint. So we've talked about the $130 million that you guys have already made up. So one is, I think you talked about potentially getting some of the $130 million in 4Q. So did any of that come through? And then what makes up that incremental sort of $23 million above and beyond the $130 million?

好的。現在轉到 2025 年，EBITDA 將提高約 1.53 億美元（僅使用中點）。我們已經討論過你們已經籌集的 1.3 億美元。所以首先，我認為您談到了可能在第四季度獲得 1.3 億美元的一部分。那麼這些都實現了嗎？那麼，除了 1.3 億美元之外的 2,300 萬美元增量是由什麼構成的呢？

So Josh, this is Aric. Most of the $130 million, aside from some of the OpEx that we took care of in Q4 that we should have seen some benefit from there, most of it's coming in 2025 out of the $130 million plan. And just to state that we were intentional about calling it a $130-plus million plan.

喬希，這是阿里克。這 1.3 億美元中的大部分，除了我們在第四季度處理的部分營運支出（我們應該從中看到一些收益）之外，大部分都將在 2025 年從 1.3 億美元計劃中支出。需要說明的是，我們特意將其稱為一項價值 1.3 億多美元的計劃。

So there's a few things probably to mention that are within our commentary today. One is around our partnership with the payers. And so we found some opportunities with the payers beyond what was in our original $130 million improvement plan that we're working through with them right now. We're quantifying that in the $25 million range in terms of additional improvements we expect to get.

因此，我們今天的評論中可能需要提及一些事情。一是關於我們與付款人的合作關係。因此，我們與付款人一起發現了一些機會，超出了我們最初 1.3 億美元改進計劃的範圍，我們目前正在與他們合作。我們預計獲得的額外改進金額約為 2500 萬美元。

And that would also include, Josh, some of the network changes that we talked about last quarter as well. We have about 20 TINs that we put on, what I'd call, a watch list to look at their performance overall, and we're continuing to monitor that performance. And by the end of this quarter, we will make some determinations after we have enough run out to see if we need to action those as well like we did last year.

喬希，這也包括我們上個季度討論過的一些網路變化。我們將大約 20 個 TIN 放入我所說的監視清單中，以查看它們的整體表現，並且我們將繼續監視這些表現。到本季末，當我們有足夠的資金後，我們會做出一些決定，看看是否需要像去年一樣採取這些行動。

Okay. Got you. And then just last one. I've heard a couple of numbers in the Part D, and I just don't think I got it down right. But where are you in terms of getting out of Part D risk? 25% of your contracts have already been adjusted. And then did you say 50% this year and then the remaining 75% for 2027?

好的。明白了。然後是最後一個。我聽過 D 部分中的幾個數字，但我認為我並沒有完全理解。但是，就擺脫 D 部分風險而言，您處於什麼位置？25% 的合約已經調整。那麼您是否說今年實現 50%，然後在 2027 年實現剩餘的 75%？

No. So about half of our Part D risk is gone at this point. And then we're working with the other payers this year to see if we're able to get the other portion of the Part D out. So we expect that to be on 1/1/26 if we're successful.

不。因此，目前我們的 D 部分風險大約有一半已經消失。今年我們將與其他付款人合作，看看是否能夠獲得 D 部分的其他部分。因此，如果我們成功的話，我們預計會在 1/1/26 實現。

Hey, Josh, just one other question because I think I was interpreting -- did that answer your question, sorry?

嘿，喬希，我還有一個問題，因為我想我正在翻譯——這回答了你的問題嗎，抱歉？

Yeah. That's what I was looking for. Just how much -- what percentage of your members are you at risk for? It sounds like you're halfway there.

是的。這正是我所尋找的。您的會員中有多少人面臨風險？聽起來你已經成功一半了。

David Larsen, BTIG.

BTIG 的 David Larsen。

Hi. I think you mentioned some improving trends in utilization, Amir. There were three areas. Can you just sort of repeat those? And were those in 4Q? Or is that what you are currently seeing in 1Q of '25? And then how complete is the 1Q data? We're only sort of three months into the year. It's my understanding it takes time to basically collect all that data. What gives you that visibility? Thanks.

你好。阿米爾，我認為您提到了利用率的一些改善趨勢。有三個區域。你能重複一遍嗎？這些都是在第四季嗎？或者這就是您目前在 2025 年第一季看到的情況？那麼第一季的數據有多完整？今年才剛過三個月。據我了解，收集所有數據基本上需要時間。什麼讓你有如此高的知名度？謝謝。

Yeah. Hey, Dave. So going back to quarter four, so quarter four, although we started to see some trends in admits per K, ER per K, office per K, showing slight decreases in that trend, which was great, we still saw unit costs being elevated as well as increasing surgical costs and things like that overall. So we end up having a higher cost structure in quarter four, as we described earlier.

是的。嘿，戴夫。回到第四季度，在第四季度，儘管我們開始看到每千例入院人數、每千例急診室人數、每千例辦公室人數的一些趨勢，這些趨勢略有下降，這很好，但我們仍然看到單位成本在上升，手術成本也在增加，諸如此類的總體情況。因此，正如我們之前所描述的，我們在第四季度的成本結構最終會更高。

However, those trends still seem to be continuing in quarter one as we look into the first six weeks of the year. So we do have some line of sight. You're right. We don't have all the claims as of yet, but it's a good indicator from what we see from a census perspective and things like that.

然而，當我們回顧今年的前六週時，這些趨勢似乎在​​第一季仍在繼續。所以我們確實有一些視線。你說得對。我們目前還沒有收到所有的索賠，但從人口普查的角度和類似情況來看，這是一個很好的指標。

The other thing is where we're delegated, as you know, we are in for a number of our plans. We were able to start to see as well high-cost procedures, surgical procedures, things like that, were actually decreased from what we saw from quarter one of '24, which is also a good harbinger for, hey, we're sort of on the right track as we're looking forward to going further down the road into '25.

另一件事是我們被委派到哪裡，正如你所知，我們參與了許多計劃。我們也開始看到高成本的程序、外科手術等實際上比 24 年第一季有所減少，這也是一個很好的預兆，嘿，我們有點走在正確的軌道上，我們期待在 25 年走得更遠。

So those are the signs we wanted to make sure we mentioned to the Street and to people like yourselves to show that, hey, things have been better, which could be due to not only in our conversations with our providers but also in regards to planned benefit changes, things like that, that may have also helped to effect -- or I should say, effectuate lower utilization starting in '25.

因此，這些都是我們想要確保向華爾街和像你們這樣的人提到的跡象，以表明情況已經好轉，這可能不僅歸功於我們與供應商的對話，還歸功於計劃中的福利變化等事情，這些事情可能也有助於實現——或者我應該說，從 25 年開始實現更低的利用率。

Okay. And did you have a medical trend, a percent number that you reported for the fourth quarter on how that compares to last year?

好的。您是否有醫療趨勢，您報告的第四季度與去年相比的百分比數字是多少？

I did not. What we described was what we were looking at from the quarter -- from the 1% -- the 0.5%, the 1%, and the 3% was indeed what we are seeing as a trend for the whole year in comparison in for '24 versus '23. That is true. Let me say it that way.

我沒有。我們所描述的是我們從本季觀察到的情況——從 1% 到 0.5%、1% 和 3% 確實是我們所看到的 24 年與 23 年全年的趨勢。確實如此。讓我這樣說吧。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

I guess just in the context of you talking about some positive trends in Q1, how do we think about seasonality through the year, obviously, with some of the changes in Part D kind of upending the quarterly dynamics?

我想，就在您談論第一季的一些積極趨勢的背景下，我們如何看待全年的季節性，顯然，D 部分的一些變化會顛覆季度動態？

So we typically see seasonality. Obviously, the first quarter, fourth quarter are usually the quarters that we see the most utilization just in general. That's why it seems positive. We're seeing some of the utilization trends, even though early, that are looking better for quarter one of '25.

所以我們通常會看到季節性。顯然，第一季和第四季通常是我們看到利用率最高的季度。這就是為什麼它看起來是積極的。儘管還處於早期階段，但我們看到了一些利用率趨勢，2025 年第一季的趨勢看起來會更好。

And like I said earlier, it's probably due to a number of confluent things, whether what we're doing to meeting with our providers and how we're working the care enablement model that we described earlier, but also in regards to benefit changes that have also helped, meaning increasing ER co-pays, things like that, we've seen from certain plans to defer some of that utilization. So these things working together are actually helping us to see a better quarter one than we've seen in the past.

正如我之前所說的，這可能是由於許多因素共同作用的結果，無論是我們與醫療服務提供者的會面，還是我們如何使用之前描述的護理支持模式，也包括有幫助的福利變化，例如增加急診室共同支付等，我們已經看到某些計劃推遲了部分利用率。因此，這些因素共同作用，實際上幫助我們看到了比過去更好的第一季業績。

Got it. And then I think I -- sorry, go ahead.

知道了。然後我想我——抱歉，請繼續。

No, I would just say -- I just want to make sure that helps, that was clear.

不，我只想說——我只是想確保這有幫助，這很清楚。

Yeah, it does. Thank you. And I guess, just last thing for me. I thought I caught in your prepared remarks saying that Medicare in the macroenvironment for 2025 was improving. I guess can you just elaborate on that? Is that just more kind of you carving out Part D? Or is there something you think structurally changing in '25, maybe just some of the benefit changes and things like that? Thanks.

是的，確實如此。謝謝。我想，這對我來說只是最後一件事。我認為我從您準備好的發言中了解到了這一點，即 2025 年宏觀環境下的醫療保險正在改善。我想您能詳細說明一下嗎？這是否只是您劃分 D 部分的另一種方式？或者您認為 25 年會發生一些結構性變化，可能只是一些福利變化之類的事情？謝謝。

Thanks, Ryan. This is Aric. And I think the biggest thing is really looking at the benefit design change that happened from '24 to '25 and what we expect will continue to happen from '25 into '26. And that's a combination of base benefits as well as supplemental benefits, things like flex cards and those kinds of things going away, and other reductions that are moving utilization down. So it's kind of a nice spot to see and to be in, because we are seeing those things start to flow through.

謝謝，瑞安。這是阿里克。我認為最重要的事情是真正關注 24 年至 25 年福利設計的變化，以及我們預計 25 年至 26 年將繼續發生的變化。這是基本福利和補充福利的結合，彈性卡等福利正在消失，其他削減措施也在降低使用率。所以這是一個很好的觀察點，因為我們看到這些事情開始流動。

Ryan Daniels, William Blair.

瑞安丹尼爾斯、威廉布萊爾。

This is Jack Senft on for Ryan. I think most of my questions have been answered already. But you noted that you're looking to recontract 50% of the payer partners this year and more next year. I'm curious if you can comment on how those conversations have gone thus far.

我是傑克‧森夫特 (Jack Senft)，代替瑞安 (Ryan)。我想我的大部分問題都已經得到解答了。但您指出，您希望今年與 50% 的付款合作夥伴重新簽約，明年則希望與更多付款合作夥伴重新簽約。我很好奇您是否可以評論一下迄今為止這些對話的進展。

Is this something where you are seeing a good amount of pushback or maybe it's fairly expected, and it's a fairly easy conversation? Just curious if you can give us any insights on to kind of what you're seeing there. Thanks.

您是否看到對此有相當大的阻力，或者這在意料之中，而且這是一個相當輕鬆的對話？我只是好奇您是否可以告訴我們您在那裡看到的情況。謝謝。

Well, I think we're -- thanks for the question. And I think we're really fortunate that we have good partnerships with our payer partners. We're in this together in a lot of ways. And what that means for their performance is when we do well, they get to do well, and there are things that we provide that they're not able to do.

嗯，我想我們——感謝您的提問。我認為我們非常幸運，我們與付款方合作夥伴建立了良好的合作關係。我們在很多方面都同舟共濟。對他們的表現來說，這意味著當我們做得好時，他們也能做得好，而我們提供的一些東西是他們無法做到的。

And so when you think about things like quality numbers for the plans, they need the help that we can provide. When you think about the shift with the primary care providers and the networks in their markets, they need help there, too. And they recognize that we can provide that to them. So it's a mutual partnership, and that doesn't always mean that they are always easy conversations, but we try to strive to land in a place that's mutually beneficial.

因此，當您考慮計劃的品質數字等問題時，他們需要我們提供的幫助。當你考慮到初級保健提供者及其市場網絡的轉變時，他們也需要幫助。他們認識到我們可以為他們提供這些。所以這是一種互惠的夥伴關係，但這並不意味著對話總是輕鬆的，但我們會努力達成互惠互利的協議。

Okay. Understood. Thanks. Maybe just as a follow-up too, I think you noted in your prepared remarks that you're expanding new capitation contracts and it sounded like it was on the specialty side. Is this something that's rolled out like through a pilot program? Or maybe if you can just dive into that a little bit and just kind of comment on the demand you're seeing from the specialty side?

好的。明白了。謝謝。也許只是作為後續行動，我認為您在準備好的發言中提到過，您正在擴大新的人頭稅合同，這聽起來像是在專業方面。這是透過試點計畫推出的嗎？或者您可以稍微深入探討一下這個問題，並評論一下您從專業方面看到的需求？

And then maybe just as a follow-up, is that something that could impact results like this year, next year? I'm just kind of curious how that plays into P3's overall positioning kind of going forward. Thanks.

然後也許只是作為後續問題，這是否會影響今年、明年的結果？我只是有點好奇這對 P3 未來的整體定位有何影響。謝謝。

Sure. So yeah, definitely -- this is Amir. There's a number of things happening this year. We've had certain partners that have done some cap with us that are going to be expanding their capitation agreements with us, which is great for things like oncology. We're looking at sub caps as well to help control certain spend.

當然。是的，絕對是──這是阿米爾。今年發生了很多事。我們已經有一些合作夥伴與我們達成了一些協議，他們將擴大與我們的人頭稅協議，這對於腫瘤學等領域來說非常有用。我們也在研究子上限，以幫助控制某些支出。

I mentioned musculoskeletal in my remarks. But there are opportunities that we're seeing with certain providers that we can actually help control some of the costs in regards to some of the utilization we're seeing with key specialties as well as even looking at Part B drugs to some extent. So all these things will be seen to -- starting in '25 for sure, some probably starting in the middle of the year of '25 and going into '26.

我在我的評論中提到了肌肉骨骼。但是，我們看到某些供應商有機會實際上幫助控制一些成本，這些成本涉及我們在關鍵專業領域看到的一些利用率，甚至在某種程度上涉及 B 部分藥物。因此，所有這些事情都肯定會在 25 年開始發生，有些可能在 25 年中期開始，一直持續到 26 年。

This concludes our question-and-answer session as well as our conference call for today. Thank you for attending today's presentation. You may now disconnect.

今天的問答環節和電話會議到此結束。感謝您參加今天的演講。您現在可以斷開連線。