R1 RCM Inc (RCM) 2023 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the R1 RCM First Quarter 2023 Earnings Call. I would now like to turn the call over to Atif Rahim, Head of Investor Relations. Please go ahead.

女士們，先生們，感謝你們的支持，歡迎來到 R1 RCM 2023 年第一季度財報電話會議。我現在想把電話轉給投資者關係主管 Atif Rahim。請繼續。

Good morning, everyone, and welcome to the call. Certain statements made during this call may be considered forward-looking statements pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. In particular, any statements about our future growth, plans and performance, including statements about our strategic and cost-saving initiatives, our liquidity position or growth opportunities and our future financial performance are forward-looking statements.

大家早上好，歡迎來電。根據 1995 年《私人證券訴訟改革法案》的安全港條款，本次電話會議期間作出的某些陳述可能被視為前瞻性陳述。特別是關於我們未來增長、計劃和業績的任何陳述，包括關於我們的戰略和成本的陳述-儲蓄計劃、我們的流動性狀況或增長機會以及我們未來的財務業績都是前瞻性陳述。

These statements are often identified by the use of words such as anticipate, believe, estimate, expect, intend, designed, may, plan, project, would and similar expressions or variations. Investors are cautioned not to place undue reliance on such forward-looking statements. All forward-looking statements made on today's call involve risks and uncertainties.

這些陳述通常通過使用諸如預期、相信、估計、期望、打算、設計、可能、計劃、項目、將和類似表達或變體等詞來識別。提醒投資者不要過分依賴此類前瞻性陳述。在今天的電話會議上做出的所有前瞻性陳述都涉及風險和不確定性。

While we may elect to update these forward-looking statements at some point in the future, we have no current intention of doing so except to the extent required by applicable law. Our actual results and outcomes may differ materially from those included in these forward-looking statements as a result of various factors including, but not limited to, economic downturns and market conditions beyond our control, including periods of inflation and other risk factors under the heading Risk Factors in our annual report on Form 10-K for the year ended December 31, 2022.

雖然我們可能會選擇在未來的某個時候更新這些前瞻性陳述，但我們目前無意這樣做，除非適用法律要求。由於各種因素，包括但不限於經濟衰退和我們無法控制的市場條件，包括通貨膨脹時期和標題下的其他風險因素，我們的實際結果和結果可能與這些前瞻性陳述中包含的結果存在重大差異我們截至 2022 年 12 月 31 日止年度的 10-K 表格年度報告中的風險因素。

We will also be referencing non-GAAP metrics on this call. For a reconciliation of the non-GAAP amounts mentioned to their equivalent GAAP amounts, please refer to our press release. Now I'll turn the call over to Lee.

我們還將在此次電話會議上引用非 GAAP 指標。如需將提及的非 GAAP 金額與其等同的 GAAP 金額進行對賬，請參閱我們的新聞稿。現在我把電話轉給李。

Thank you, Atif. Good morning, everyone, and thank you for joining us. I am pleased to report a strong start to 2023 with revenue of $545.6 million, and adjusted EBITDA of $142.2 million for the first quarter. Adjusted EBITDA was ahead of expectations due to solid operating performance and lower corporate costs. We are pleased with our results and are well positioned to deliver our 2023 guidance.

謝謝你，阿提夫。大家早上好，感謝您加入我們。我很高興地報告 2023 年第一季度的收入為 5.456 億美元，調整後的 EBITDA 為 1.422 億美元。由於穩健的經營業績和較低的企業成本，調整後的 EBITDA 超出預期。我們對我們的結果感到滿意，並準備好交付我們的 2023 年指南。

Let me cover 3 key topics, then we'll hand it over to Jennifer to cover our financials. First, operational performance and trends we are seeing in the business; second, our progress in technology and automation; and third, commercial activity. We are making good progress across our operation. We are making progress in an environment that is showing steady improvement, but still requires people and technology to proactively manage the impact of payer dynamics.

讓我介紹 3 個關鍵主題，然後我們將把它交給 Jennifer 來介紹我們的財務狀況。首先，我們在業務中看到的運營績效和趨勢；第二，我們在技術和自動化方面的進步；第三，商業活動。我們在整個運營中取得了良好進展。我們正在穩步改善的環境中取得進步，但仍需要人員和技術來主動管理付款人動態的影響。

Our value proposition is clear. First, we have deep experience in managing the revenue cycle with (inaudible) representing over $55 billion of NPR. Second, we have a global model, which allows our customers to achieve high-quality results, reduces their costs and focuses on what they do best, care for patients. Third, we continue to deploy technology and automation as we are deeply embedded in our customers' workflow.

我們的價值主張很明確。首先，我們在管理收入周期方面擁有豐富的經驗（聽不清）代表超過 550 億美元的 NPR。其次，我們有一個全球模式，可以讓我們的客戶獲得高質量的結果，降低他們的成本，並專注於他們最擅長的事情，即照顧病人。第三，隨著我們深入融入客戶的工作流程，我們繼續部署技術和自動化。

This will allow us to reduce the dependency on labor over time. And last, with our Cloudmed acquisition, we have 500-plus customers and data on over 500 million patient interactions annually, which allow us to drive more predictability in our customers' operation. Now let me get in some detail on our operating metrics in the first quarter. We continue to see modest improvement in our operating metrics relative to the second half of last year.

隨著時間的推移，這將使我們能夠減少對勞動力的依賴。最後，通過收購 Cloudmed，我們每年擁有 500 多家客戶和超過 5 億次患者互動的數據，這使我們能夠提高客戶運營的可預測性。現在讓我詳細介紹一下我們第一季度的運營指標。與去年下半年相比，我們繼續看到我們的運營指標略有改善。

Our internal efforts as well as engagement with payers both directly and via our customers are yielding positive results. One area to particularly note is payer reimbursement turnaround times. While we have seen improvement in the last few months as evidenced in days payable improving on the payer side, we continue to work down a backlog of accounts receivable which, in many cases, requires increased resources to ensure conversion to cash for providers.

我們的內部努力以及直接和通過我們的客戶與付款人的接觸正在產生積極的結果。需要特別注意的一個領域是付款人報銷周轉時間。雖然我們在過去幾個月看到了改善，付款人方面的應付天數有所改善，但我們仍在繼續處理積壓的應收賬款，在許多情況下，這需要增加資源以確保供應商轉換為現金。

Our focus on execution resonates well with our customers. I have had an opportunity to meet almost all of our end-to-end and many of our modular customers in person since I stepped into the CEO role at the start of the year. The feedback has been positive regarding the actions we've taken to address longer turnaround times. Our customers have found it helpful to deconstruct our performance by explaining environmental dynamics versus what's in R1's control.

我們對執行的關注與我們的客戶產生了很好的共鳴。自從我在年初擔任首席執行官以來，我有機會親自會見幾乎所有的端到端客戶和我們的許多模塊化客戶。對於我們為解決更長的周轉時間而採取的行動，反饋是積極的。我們的客戶發現通過解釋環境動態與 R1 的控制範圍來解構我們的性能很有幫助。

For example, our customers are highly appreciative of our work when presented with data on payer trends within their geographies. We will continue to refine these analytics to benchmark our performance versus broader trends in the market. We are in a unique position to provide these analytics given our scale and the data available to us via the $900 billion of NPR and $500 million of patient encounters we touch annually.

例如，當我們的客戶看到他們所在地區的付款人趨勢數據時，他們會對我們的工作表示高度讚賞。我們將繼續完善這些分析，以將我們的績效與市場更廣泛的趨勢進行比較。鑑於我們的規模和通過 9000 億美元的 NPR 和我們每年接觸的 5 億美元的患者接觸提供給我們的數據，我們處於提供這些分析的獨特位置。

This will be part of our customer engagement strategy going forward. While we are seeing some improvements with payer dynamics in the industry and within our own operating metrics, our customers and the overall industry continue to be under incredible financial pressures. AR days are improving, but providers' costs are up year-over-year and still driving significant impact to their financials.

這將成為我們未來客戶參與戰略的一部分。雖然我們看到行業內的支付動態和我們自己的運營指標有所改善，但我們的客戶和整個行業繼續承受著難以置信的財務壓力。 AR 天數正在改善，但供應商的成本逐年上升，並且仍在對其財務狀況產生重大影響。

Our customers understand that our revenue cycle capabilities are not easily accessible independently and certainly not close to the unit economics of R1 given the combination of our global model and investments in technology. We believe we are very well positioned to address the challenges providers face through our operational capabilities, our industry expertise, our technology and our skilled automation platform.

我們的客戶明白，考慮到我們的全球模式和技術投資的結合，我們的收入周期能力不容易獨立獲得，而且肯定不接近 R1 的單位經濟效益。我們相信，我們有能力通過我們的運營能力、我們的行業專業知識、我們的技術和我們熟練的自動化平台來應對供應商面臨的挑戰。

Now I'd like to talk about our technology, automation and data. In Q1, we continue to invest in automation and integrating the legacy Cloudmed automation capabilities into the R1 ecosystem. We expanded our net new automation use cases in several areas, including authorizations, rebilling and small balance AR while scaling existing use cases across the business.

現在我想談談我們的技術、自動化和數據。在第一季度，我們繼續投資於自動化並將遺留的 Cloudmed 自動化功能集成到 R1 生態系統中。我們在多個領域擴展了我們的淨新自動化用例，包括授權、重新計費和小額餘額 AR，同時在整個業務範圍內擴展現有用例。

[Enhanced] our optimal workflow initiative in the first quarter. As a reminder, this initiative is focused on efficiency for work that cannot be fully automated by leveraging our deep revenue cycle expertise, rules and algorithms to allow automated and human-centric workflows to operate seamlessly together. Our specialists have the information they need at their fingertips to suggest necessary corrections leading to an accurate reimbursement.

[增強] 我們在第一季度的最佳工作流程計劃。提醒一下，該計劃的重點是提高無法完全自動化的工作的效率，方法是利用我們深厚的收入周期專業知識、規則和算法，讓自動化和以人為中心的工作流程無縫地協同運作。我們的專家隨時掌握所需的信息，可以提出必要的更正建議，從而實現準確的報銷。

This standard leads to higher accuracy, fewer denials, faster payment turnaround times and ultimately increase revenue for our customers. We enhanced our tools to accelerate new hire onboarding, increased team productivity and interoperability between systems. Lastly, on the data and analytics front, we deploy new machine learning-based models to better prioritize work and automatically map customer terms to R1 standards to uncover more missing charges.

該標準可提高準確性、減少拒絕、縮短付款周轉時間並最終增加我們客戶的收入。我們增強了我們的工具，以加速新員工入職、提高團隊生產力和系統之間的互操作性。最後，在數據和分析方面，我們部署了新的基於機器學習的模型，以更好地確定工作的優先級，並自動將客戶條款映射到 R1 標準，以發現更多遺漏的費用。

Collectively, these investments enhance our competitive advantage by enabling us to find more revenue for our customers. Next, I would like to discuss commercial activity. We operate in a $115 billion end market growing at roughly 10% annually and where over 70% of providers still manage their revenue cycle processes in-house. This presents us with a sizable runway for long-term growth.

總的來說，這些投資使我們能夠為客戶創造更多收入，從而增強了我們的競爭優勢。接下來，我想談談商業活動。我們在價值 1150 億美元的終端市場中運營，年增長率約為 10%，超過 70% 的供應商仍在內部管理其收入周期流程。這為我們提供了一條可觀的長期增長跑道。

Commercial activity remains robust across both end-to-end and modular deals. On the end-to-end side, we saw progression of partnerships in the pipeline as well as new entrants into the pipeline. And we continue to leverage the Cloudmed commercial engine and access to 95 of the top 100 systems to our customers to drive cross-sell opportunities across our end-to-end and modular businesses.

端到端交易和模塊化交易的商業活動依然強勁。在端到端方面，我們看到了管道中合作夥伴關係的進展以及管道中的新進入者。我們繼續利用 Cloudmed 商業引擎並向我們的客戶訪問前 100 個系統中的 95 個，以推動我們端到端和模塊化業務的交叉銷售機會。

On the modular side, activity remains equally strong with ongoing payer challenges driving increased demand for AR and denials solutions. Cross-sell activity is also starting to pick up. We're seeing interest from end-to-end customers and modular solutions that meet our customers where they are in their revenue cycle journey. We have also seen an uptick in the legacy R1 modular offering sold into the Cloudmed base, particularly for physician advisory services in Q1.

在模塊化方面，活動仍然同樣強勁，持續的付款人挑戰推動了對 AR 和拒絕解決方案的需求增加。交叉銷售活動也開始興起。我們看到了端到端客戶和模塊化解決方案的興趣，這些解決方案可以滿足我們客戶在收入周期旅程中的需求。我們還看到銷售到 Cloudmed 基地的遺留 R1 模塊化產品有所增加，特別是第一季度的醫生諮詢服務。

In closing, our team is optimistic about our business. We have a great mission managing a highly complex part of our customers' operation. We have a large market opportunity ahead of us, a strong value proposition, a highly differentiated offering and most importantly, a highly dedicated team to grow the company. Health care providers need our services more than ever before, and we believe we have the best offering to serve them. Now I'd like to turn the call over to Jennifer to review the financials.

最後，我們的團隊對我們的業務持樂觀態度。我們肩負著管理客戶運營中高度複雜部分的偉大使命。我們面前有一個巨大的市場機會、一個強大的價值主張、一個高度差異化的產品，最重要的是，一個高度敬業的團隊來發展公司。醫療保健提供者比以往任何時候都更需要我們的服務，我們相信我們可以為他們提供最好的服務。現在我想把電話轉給詹妮弗來審查財務狀況。

Thank you, Lee, and good morning, everyone. We are pleased to report solid first quarter results with revenue of $545.6 million, up 41% year-over-year and adjusted EBITDA of $142.2 million, up 59% year-over-year. Cloudmed revenue in the quarter was $125.8 million. Organically, R1 revenue grew almost 9% year-over-year, and Cloudmed revenue grew 25%. Adjusted EBITDA was ahead of expectations we outlined on our last earnings call due to operational cost discipline and timing of some of our costs for benefits, which I will provide more color on shortly.

謝謝李，大家早上好。我們很高興地報告第一季度業績穩健，收入為 5.456 億美元，同比增長 41%，調整後的 EBITDA 為 1.422 億美元，同比增長 59%。 Cloudmed 本季度的收入為 1.258 億美元。有機地，R1 收入同比增長近 9%，Cloudmed 收入增長 25%。調整後的 EBITDA 超出了我們在上次財報電話會議上概述的預期，原因是運營成本紀律和我們的一些福利成本的時間安排，我將在短期內提供更多信息。

Starting first with detail on revenue growth. Net operating fees of $361 million grew approximately 12% or $38.2 million year-over-year. On a sequential basis, revenue was up $16.6 million. Onboarding of Sutter Health, which transitioned mid-Q4 of last year, was the primary driver combined with low single-digit growth year-over-year as expected at other end-to-end and physician customers.

首先從收入增長的細節開始。淨營業費用為 3.61 億美元，同比增長約 12% 或 3820 萬美元。按順序計算，收入增長了 1660 萬美元。去年第四季度中期過渡的 Sutter Health 的入職是主要驅動因素，與其他端到端和醫生客戶預期的同比低個位數增長相結合。

Incentive fees in Q1 totaled $23.6 million, down $6.6 million compared to Q1 of last year and down $2.3 million compared to Q4. The year-over-year decline is driven by longer payer time lines we discussed on prior calls. While modest, we are very encouraged by the recent improvements in payer reimbursement time lines in the last few months. However, aged AR for our customers continues to be higher than historical trends.

第一季度的激勵費用總額為 2360 萬美元，與去年第一季度相比減少了 660 萬美元，與第四季度相比減少了 230 萬美元。同比下降是由我們在之前的電話會議上討論的更長的付款人時間線推動的。雖然不大，但我們對最近幾個月付款人報銷時間表的改進感到非常鼓舞。然而，我們客戶的老年 AR 繼續高於歷史趨勢。

This, along with the normal reset of certain KPI metrics at the start of the year resulted in a decline in the incentive fees relative to Q4 of '22. Nonetheless, we continue to expect incentive fees for the balance of the year to ramp to $30 million per quarter by the end of '23. Modular and other revenue was $161 million in Q1, which is up $128.3 million year-over-year. Cloudmed contributed $125.8 million in revenue for the first quarter, which means the legacy R1 business grew low single digits.

這一點，加上年初某些 KPI 指標的正常重置，導致激勵費用相對於 22 年第四季度有所下降。儘管如此，我們仍然預計到 23 年底，今年剩餘時間的激勵費用將增加到每季度 3000 萬美元。第一季度模塊化和其他收入為 1.61 億美元，同比增長 1.283 億美元。 Cloudmed 第一季度貢獻了 1.258 億美元的收入，這意味著傳統的 R1 業務增長低個位數。

Demand for our denials, AR and [DRGV] offering drove growth for Cloudmed while growth of the legacy R1 solutions was driven by our physician advisory services. Turning to expenses for the quarter. Non-GAAP cost of services in Q1 was $362.2 million, up $88.6 million year-over-year. This increase was driven by Cloudmed, costs related to onboarding of our new customers and net operational investments to support our new growth.

對我們的拒絕、AR 和 [DRGV] 產品的需求推動了 Cloudmed 的增長，而傳統 R1 解決方案的增長是由我們的醫生諮詢服務推動的。轉向本季度的支出。第一季度的非美國通用會計準則服務成本為 3.622 億美元，同比增長 8860 萬美元。這一增長是由 Cloudmed、與新客戶入職相關的成本以及支持我們新增長的淨運營投資推動的。

Savings from automation, vendor rationalization and global workforce transitions partially offset these increases. On a sequential basis, non-GAAP cost of services declined $2.3 million due to 3 reasons: number one, cost discipline and our operational functions; number two, realization of cost synergies; and finally, number three, timing of certain costs for health care benefits and paid time off accruals.

自動化、供應商合理化和全球勞動力轉型帶來的節省部分抵消了這些增長。按順序計算，非 GAAP 服務成本下降了 230 萬美元，原因有 3 個：第一，成本紀律和我們的運營職能；第二，實現成本協同效應；最後，第三，醫療保健福利和帶薪休假應計費用的某些時間安排。

Approximately half of the expense favorability compared to expectations in Q1 is timing related. We expect to incur these costs in year. Therefore, we do not expect the favorability will continue at the same rate in future quarters. Non-GAAP SG&A expenses of $41.2 million were up $18.4 million year-over-year primarily due to Cloudmed.

與第一季度的預期相比，大約一半的費用偏好與時間相關。我們預計將在一年內承擔這些費用。因此，我們預計未來幾個季度的受歡迎程度不會以同樣的速度持續下去。非 GAAP SG&A 費用為 4120 萬美元，同比增長 1840 萬美元，這主要歸功於 Cloudmed。

Compared to last quarter, non-GAAP SG&A expenses were down 5% or $2.1 million. Cost synergies in our corporate functions and real estate savings as part of the integration efforts drove these reductions. Adjusted EBITDA for the quarter was $142.2 million, up $52.9 million year-over-year, primarily due to the contribution from Cloudmed, which was offset in part by investments to implement new customers.

與上一季度相比，非 GAAP SG&A 費用下降了 5% 或 210 萬美元。作為整合工作的一部分，我們公司職能部門的成本協同效應和房地產節省推動了這些削減。本季度調整後的 EBITDA 為 1.422 億美元，同比增長 5290 萬美元，這主要是由於 Cloudmed 的貢獻，部分被用於實施新客戶的投資所抵消。

On a sequential basis, adjusted EBITDA was up $17.2 million, driven by incremental revenue and lower cost. Lastly, we incurred $30.2 million in other expenses. These expenses were primarily related to the integration of Cloudmed. As I mentioned on our last earnings call, we are still on track to achieve cost synergies towards the high end of the $15 million to $30 million range in 2023.

按順序計算，調整後的 EBITDA 增加了 1720 萬美元，這主要受收入增加和成本降低的推動。最後，我們還產生了 3020 萬美元的其他費用。這些費用主要與 Cloudmed 的整合有關。正如我在上次財報電話會議上提到的那樣，我們仍有望在 2023 年實現成本協同效應，達到 1500 萬至 3000 萬美元的高端。

Turning to the balance sheet. Cash and cash equivalents at the end of March were $104.2 million compared to $110.1 million at the end of '22. We generated $54.7 million in cash from operations in the quarter. We used $23 million for CapEx, $22 million for debt pay down and $13 million for cash taxes related to vesting of employee equity awards. We also voluntarily repaid (inaudible) of our revolver in Q1. Net debt at the end of the quarter was $1.68 billion with net leverage improving in line with our expectations.

轉向資產負債表。 3 月底的現金和現金等價物為 1.042 億美元，而 22 年底為 1.101 億美元。我們在本季度的運營中產生了 5,470 萬美元的現金。我們將 2300 萬美元用於資本支出，2200 萬美元用於償還債務，1300 萬美元用於與授予員工股權獎勵相關的現金稅。我們還自願在第一季度償還（聽不清）我們的左輪手槍。本季度末的淨債務為 16.8 億美元，淨槓桿率的改善符合我們的預期。

We expect net debt leverage to continue to decline over the course of the year. We also continue to maintain ample liquidity with approximately $613 million available at the end of March, both from cash and cash equivalents and availability on our revolver. Now turning to our financial outlook. We remain on track to generate revenue of $2.28 billion to $2.33 billion in 2023, and adjusted EBITDA of $595 million to $630 million.

我們預計今年淨債務槓桿率將繼續下降。我們還繼續保持充足的流動性，截至 3 月底，我們的現金和現金等價物以及我們的左輪手槍的可用性約為 6.13 億美元。現在轉向我們的財務前景。我們仍有望在 2023 年實現 22.8 億美元至 23.3 億美元的收入，並將調整後的 EBITDA 調整為 5.95 億美元至 6.3 億美元。

For the second quarter, we expect our cost structure to increase slightly due to the timing of the favorable health care benefits from Q1 and annual merit increases awarded in April. Overall, we expect Q2 adjusted EBITDA to be roughly in line with current consensus. In closing, we are very pleased with our Q1 results. I will leave you with 3 comments: number one, we are encouraged with the progress we are making in operational execution; two, we're cautiously optimistic in the trends we're seeing in the industry and in our business; and three, we remain confident in our ability to execute on our plans for the remainder of the year.

對於第二季度，我們預計我們的成本結構將略有增加，因為第一季度的有利醫療福利和 4 月份授予的年度加薪時間。總體而言，我們預計第二季度調整後的 EBITDA 將大致符合當前的共識。最後，我們對第一季度的業績感到非常滿意。我會給您留下 3 條評論：第一，我們對在運營執行方面取得的進展感到鼓舞；第二，我們對我們在行業和業務中看到的趨勢持謹慎樂觀態度；第三，我們對在今年剩餘時間內執行計劃的能力充滿信心。

I look forward to updating you on our progress in future calls. Now I'll turn the call over to the operator for Q&A. Operator?

我期待著在未來的電話會議中向您通報我們的進展情況。現在我將把電話轉給接線員進行問答。操作員？

(Operator Instructions). Our first question comes from the line of Charles Rhyee from TD Cowen.

（操作員說明）。我們的第一個問題來自 TD Cowen 的 Charles Rhyee。

Just wanted to start just maybe Lee and Jennifer, if you could help us walk through a little bit. I think there's a little bit of confusion on sort of what we're seeing in the markets in terms of strong claims growth versus some of the results that you posted. My understanding, right, is that your operating fees are working off of a lagged timing, right?

只是想從 Lee 和 Jennifer 開始，如果你能幫助我們稍微講一下。我認為我們在市場上看到的強勁索賠增長與您發布的一些結果之間存在一些混淆。我的理解是，你的運營費用是在滯後的時間裡產生的，對吧？

You're really looking at last quarter's claims that's kind of showing up into this quarter's revenues. If you can kind of just walk through some of the mechanics there, both for base operating fees and what drives that? Where the recognition comes from for that as well as the incentive fees? That would be helpful to start.

你真的在看上一季度的索賠，這些索賠在某種程度上體現在本季度的收入中。如果你能稍微了解一下那裡的一些機制，包括基本運營費用和驅動因素是什麼？認可來自哪里以及獎勵費用？這將有助於開始。

And then secondly, when would we -- because we've obviously seen very strong claims -- rebound in claims growth sort of industry-wide here, how would we see that in your results moving forward? And then maybe lastly, just on the aged AR issue, is there any -- can you walk through the dynamics where that might keep you from earning incentive fees?

其次，我們什麼時候——因為我們顯然已經看到非常強勁的索賠——索賠增長在全行業範圍內反彈，我們將如何在你的結果中看到這一點？然後也許最後，就老化的 AR 問題而言，是否有任何 - 你能談談可能阻止你賺取獎勵費的動態嗎？

Thanks, Charles. As far as our base fee goes, you're right. So the way our base fee works is that it's based on cash collections, and the cash collections are a quarter in arrears. So our Q1 base fee, there's net operating fees are based on cash from Q4. So it is a bit of a lag. On the KPIs, it's in-quarter performance. So it's metrics, depending on if it's balance sheet or income statement, those are metrics for the first quarter.

謝謝，查爾斯。就我們的基本費用而言，你是對的。因此，我們的基本費用的運作方式是基於現金收款，而現金收款拖欠了四分之一。所以我們的第一季度基本費用，淨營業費用是基於第四季度的現金。所以有點滯後。在 KPI 上，它是季度績效。所以這是指標，取決於它是資產負債表還是損益表，這些是第一季度的指標。

Some of those metrics are cumulative and so they reset at the beginning of the year. Obviously, income statement metrics reset at the beginning of the year. So that's why we typically see a dip just a normal seasonality of KPIs at the beginning of the year, but we're comfortable with where they are. They were in line with our expectations for the quarter.

其中一些指標是累積的，因此它們會在年初重置。顯然，損益表指標在年初重置。因此，這就是為什麼我們通常會在年初看到 KPI 的正常季節性下降，但我們對它們的位置感到滿意。它們符合我們對本季度的預期。

As far as claims go, the volumes that we're seeing for some of the public providers that have released the volumes for Q1, we would expect to see those as those claims are paid and cash comes in, which would result in our -- really our second half cash or base fees for our revenue. So that's the way that the claims would flow through. But remember, it's not just volumes for us. It's ultimately cash, which means is a combination of volume growth and claims, but also acuity and then any kind of payer mix dynamics.

就索賠而言，我們看到一些已經發布第一季度數量的公共供應商的數量，我們希望看到這些數量，因為這些索賠已經支付並且現金進來，這將導致我們 -實際上是我們下半年的現金或收入的基本費用。這就是索賠流轉的方式。但請記住，這不僅僅是我們的數量。它最終是現金，這意味著是數量增長和索賠的結合，也是敏銳度和任何類型的付款人組合動態的結合。

And then as far as aged AR goes, we're seeing improvement in our overall AR days and those time lines, but our aged AR is still higher than historical and has not come down as much as overall aged AR has. So that's just something we're continuing to watch. Typically, those are more complex items that we're working through anyway. So that is one metric that is still higher than historical trends and something that we're continuing to watch.

然後就老年 AR 而言，我們看到我們的整體 AR 天數和那些時間線有所改善，但我們的老年 AR 仍然高於歷史水平，並且沒有像整體老年 AR 那樣下降。所以這只是我們繼續關注的事情。通常，這些都是我們正在處理的更複雜的項目。因此，這是一個仍然高於歷史趨勢的指標，也是我們將繼續關注的指標。

Is this current level already baked into the guidance that you've given to get (inaudible) million year-end incentive fees? So in other words, if something improves on the aged AR, that would be upside?

目前的水平是否已經包含在您為獲得（聽不清）百萬年終獎勵費而提供的指導中？所以換句話說，如果對老化的 AR 有什麼改進，那會有好處嗎？

Yes.

是的。

Our next question comes from the line of Sean Dodge from RBC Capital Markets.

我們的下一個問題來自 RBC Capital Markets 的 Sean Dodge。

I'll add my congratulations on the progress in the quarter. I guess, maybe Lee or Jennifer, the added resources you all put in place to help address the payer time lines and these client issues that began to kind of ramp in earnest in Q3 of last year. As these issues are fixed and the time lines, Lee, you mentioned kind of looked to be normalizing. The headcount you added there, can that begin to be removed? Or is there an opportunity to allocate those individuals somewhere else in the organization? Maybe just help us kind of size how much incremental spend you had to help -- or add to help with those. And then once those begin to kind of taper off, what happens to those costs?

我將對本季度取得的進展表示祝賀。我想，也許是 Lee 或 Jennifer，你們都投入了額外的資源來幫助解決付款人的時間線和這些客戶問題，這些問題在去年第三季度開始真正出現。由於這些問題已得到解決並且時間線已經確定，Lee，你提到的情況看起來正在正常化。您在那裡添加的人數，可以開始刪除嗎？或者是否有機會將這些人分配到組織的其他地方？也許只是幫助我們確定您必須幫助多少增量支出 - 或者增加這些支出的幫助。然後一旦這些開始逐漸減少，這些成本會發生什麼變化？

Sean, I can take it. Jennifer, if you have any color. We would expect over time to need less headcount. However, what I'd say just building off at Jennifer's point and specifically addressing a few customers where we have added incremental headcount. We expect to continue to work down the (inaudible), for example, continue to onboard the clients we have in onboarding phase through at least the next several months.

肖恩，我可以接受。詹妮弗，如果你有任何顏色。我們希望隨著時間的推移需要更少的員工。但是，我要說的只是建立在 Jennifer 的觀點上，並專門針對我們增加了增量員工的一些客戶。我們希望繼續努力（聽不清），例如，至少在接下來的幾個月裡，繼續讓我們在入職階段的客戶入職。

So I would see the next 6 months or so as continued investment in those customers. And then after that, the combination of our teams getting more efficient, the combination of automation being applied. And the last thing is super important. We probably don't talk about it enough, but part of onboarding is not just our global scale, but it's the application of technology, and that takes a little longer in the course of our first year or 2. Once we get our technology embedded, that's where we really drive a lot more efficiency, Sean.

所以我會看到未來 6 個月左右對這些客戶的持續投資。然後在那之後，我們團隊的組合變得更有效率，自動化的組合被應用。最後一件事非常重要。我們可能談論得不夠多，但入職的一部分不僅僅是我們的全球規模，而是技術的應用，在我們的第一年或第二年的過程中需要更長的時間。一旦我們將我們的技術嵌入，這才是我們真正提高效率的地方，肖恩。

And Sean, one point to add there is that our guidance assumes that we would start to take down resources as those metrics stabilize. So that's embedded in our '23 guidance and part of what's driving EBITDA growth quarter-over-quarter.

肖恩，要補充一點的是，我們的指導假設我們將在這些指標穩定時開始減少資源。因此，這包含在我們的 23 年指導方針中，也是推動 EBITDA 環比增長的部分原因。

Okay. Then anything you can kind of offer to help us size the extra resources you've added there?

好的。那麼你能提供什麼來幫助我們確定你在那裡添加的額外資源的大小？

I mean we haven't given a number as far as investment there, but it's in the hundreds of resources that we've added to help stabilize.

我的意思是，我們還沒有給出投資的具體數字，但我們已經添加了數百種資源來幫助穩定。

Our next question comes from the line of Michael Cherny from Bank of America.

我們的下一個問題來自美國銀行的 Michael Cherny。

I appreciate the color, too, on the timing and flow relative to where you see utilization. Maybe to ask a similar type question, but in terms of what you're seeing from the modest improvement in payer turnaround times. As you see those improve, how much visibility does that give you on the incentive fee side, in particular?

我也很欣賞與您看到的利用率相關的時間和流程的顏色。也許會問類似類型的問題，但就您從付款人周轉時間的適度改善中看到的情況而言。當您看到這些改進時，這會給您帶來多大的知名度，特別是在激勵費用方面？

And any changes in terms of what you've seen so far in terms of what's embedded in the revenue guidance for incentive fees specifically? I know you don't break out incentive fees within the revenue guidance. But curious how that visibility that you get on payer turnaround times, some of which you're also helping the control with the work you're doing factors into the incentive fee visibility?

到目前為止，您所看到的關於激勵費用收入指南中嵌入的內容的任何變化？我知道您不會在收入指南中列出獎勵費用。但是好奇你在付款人周轉時間上獲得的可見性，其中一些你也在幫助控制你正在做的工作，從而影響激勵費用的可見性？

Sure. So the -- in our '23 guidance, we assumed that we would have quarter-over-quarter improvement and the payer time lines, which drives a lot of our metrics, aged AR, obviously, cash, AR days, depending on the customer, they all have a little bit different metrics, but they're all somewhat [interrelated] to this combination of AR and cash.

當然。因此 - 在我們的 23 年指南中，我們假設我們將有季度環比改進和付款人時間線，這推動了我們的許多指標，老化的 AR，顯然，現金，AR 天數，具體取決於客戶，它們都有一些不同的指標，但它們都與 AR 和現金的這種組合有些 [相互關聯]。

So we expect that the AR days will come down slowly. We don't believe that there's going to be a magical shift that's going to be materially different quarter-over-quarter, but a slow stabilization and improvement over the year. And as such, our improvement fees are assumed to be modest growth quarter-over-quarter such that we get to that $30 million per quarter level by the end of the year.

所以我們預計 AR 天數會慢慢下降。我們不相信會有一個神奇的轉變，每個季度都會有實質性的不同，而是在一年中緩慢穩定和改善。因此，我們的改進費用被假設為環比溫和增長，這樣到年底我們將達到每季度 3000 萬美元的水平。

Our next question comes from the line of Stephanie Davis from SVB Securities.

我們的下一個問題來自 SVB Securities 的 Stephanie Davis。

Lee, you touched on some tech investments in the prepared remarks. I was hoping you can go a little bit more in depth. Is this going to remain an outsourced automation project? Do you see an opportunity for this to come more in-house, just given the number of engineers out in the market now? And do you still want to kind of focus on this as an RPA project? Or do you want to lead progress with maybe a more sophisticated AI function or something else?

李，你在準備好的發言中談到了一些技術投資。我希望你能更深入一點。這是否仍將是一個外包的自動化項目？考慮到現在市場上的工程師數量，您是否認為這有更多內部機會？你還想把這個作為 RPA 項目來關注嗎？或者你想用更複雜的人工智能功能或其他東西來引領進步？

Yes. Stephanie, thanks for the question. Let me just step back and just talk through our framework on our tech investments and where we're going. This, as you know, if you -- when I laid out the priorities, at the highest level was operational improvement, make sure we deliver on customer metrics. It was technology to make sure we deliver on the integrated platform, and I'll come back to that.

是的。斯蒂芬妮，謝謝你的提問。讓我退後一步，談談我們的技術投資框架和我們的發展方向。如您所知，如果您 - 當我列出優先級時，最高級別是運營改進，請確保我們提供客戶指標。這是確保我們在集成平台上交付的技術，我會回到那個。

It was commercial progress to make sure we advance our pipeline, integrate the teams, both on the end-to-end and on the modular side and then it was ensure realization of our synergies. So those are the 4 things I've laid out for the team in my first 4 months. So let me go deeper into tech. The main components of our plan this year are Cloudmed integration. So this is integrating what is already a purpose-built revenue cycle platform through Cloudmed that we spent the last 5 years building.

這是商業上的進步，確保我們在端到端和模塊化方面推進我們的管道，整合團隊，然後確保實現我們的協同效應。所以這些就是我在頭 4 個月里為團隊準備的 4 件事。因此，讓我更深入地了解技術。我們今年計劃的主要組成部分是 Cloudmed 集成。因此，這是通過我們在過去 5 年中構建的 Cloudmed 整合了一個專門構建的收入周期平台。

It's intelligent automation, and I'll go through the details of that. And it's -- the overriding theme is preventing problems before they occur. So the way to think about this is any process that has people and manual touch points embedded in our customers' health system, so let's just pick the EMR. If there is a way to apply routine for repeatable processes through technology, that's exactly what we're doing.

它是智能自動化，我將詳細介紹它。它是——最重要的主題是防患於未然。因此，考慮這一點的方法是在我們客戶的健康系統中嵌入人員和手動接觸點的任何過程，所以讓我們選擇 EMR。如果有一種方法可以通過技術將例行程序應用於可重複的過程，那正是我們正在做的事情。

The other point I'd highlight, before I just dive in intelligent automation and answer your question around AI application, is the patient experience is at the forefront of our technology agenda. So you'll hear me and the team talk more and more about Entri Pay, which is a way that is super visible to our customers to apply technology to reduce the need for labor when it comes to the front end, i.e., registration, scheduling and patient intake.

在我深入探討智能自動化並回答您關於 AI 應用的問題之前，我要強調的另一點是患者體驗處於我們技術議程的最前沿。所以你會聽到我和團隊越來越多地談論 Entri Pay，這是一種對我們的客戶來說非常明顯的方式，可以應用技術來減少前端的勞動力需求，即註冊，調度和患者攝入量。

So those are the big kind of themes around technology. Let me touch on intelligent automation, which you've heard us talk about a few times. There's a couple of components to this, which directly answers your question. There's RPA, there's machine learning, there's AI. And I know you asked the question last time around ChatGPT, that is, for sure, at the forefront of some of our thinking, the application of large language models.

所以這些都是圍繞技術的大主題。讓我談談智能自動化，您已經聽我們談過幾次了。這有幾個組成部分，可以直接回答您的問題。有 RPA，有機器學習，有 AI。我知道你上次圍繞 ChatGPT 提出了這個問題，當然，在我們一些思考的最前沿，大型語言模型的應用。

So RPA has historically been the primary piece, which is apply Robotic Process Automation to reduce the need for incremental labor. That is still a major, major part of our agenda. The machine learning piece has also been part of the R1 priority -- technology priorities for a while, accelerated with the application of the Cloudmed platform. So the way to think about this is when we have, as I've said in the early comments, access to 500-plus customers, that means we have access to data on all 50 states, all payer types, all care settings.

因此，RPA 在歷史上一直是主要部分，即應用機器人過程自動化來減少對增量勞動力的需求。這仍然是我們議程的主要部分。機器學習部分也一直是 R1 優先事項的一部分——一段時間內的技術優先事項，隨著 Cloudmed 平台的應用而加速。所以思考這個問題的方式是，正如我在早期的評論中所說，我們可以訪問 500 多個客戶，這意味著我們可以訪問所有 50 個州、所有付款人類型、所有護理設置的數據。

And we mentioned the volume of patient interactions. We're then able to see data sets across the U.S. and be able to predict with more accuracy and build models that allow us to predict where there might be errors and claims, where there might be root cause issues and denials, for example, and then accelerate -- that helps us accelerate cash conversion. The last thing I'd point out is a question you asked on the last call around the application of the newest technologies, and there's obviously a lot of discussion around large language models.

我們提到了患者互動的數量。然後，我們能夠查看美國各地的數據集，並能夠更準確地進行預測並建立模型，使我們能夠預測哪裡可能存在錯誤和索賠，哪裡可能存在根本原因問題和拒絕，例如，以及然後加速——這有助於我們加速現金轉換。我要指出的最後一件事是你在上次電話會議上提出的關於最新技術應用的問題，顯然有很多關於大型語言模型的討論。

So let me just close on that. We think that's a huge opportunity for our business to apply those tools. And the reason is there's a couple of components, a couple of themes across our business that make this application very powerful potentially for internal operators and for our customers. One is, in order to apply those models, you need data access. We at R1 across our end-to-end and across modular are embedded in our customers' workflow and have access to data.

所以讓我結束這一點。我們認為這是我們企業應用這些工具的巨大機會。原因是有幾個組件，我們業務中的幾個主題使這個應用程序對內部操作員和我們的客戶來說非常強大。一是，為了應用這些模型，您需要數據訪問。我們在 R1 的端到端和跨模塊化都嵌入到我們客戶的工作流程中，並且可以訪問數據。

The second is in health care, different from some of the things you hear with more consumer-facing applications, there is a high, high bar for quality and accuracy. Just think about clinical codes and (inaudible) there or anything related to an electronic medical record. The third thing I'd say is privacy is key. There is 0 room for error in health care. So all these components make -- our team's view is this is a huge opportunity for our business to drive even more technology through our customers' workflow. So let me stop there, Stephanie. I hope that answered your questions.

第二個是醫療保健，與您在更多面向消費者的應用程序中聽到的一些東西不同，質量和準確性的標準很高。想想臨床代碼和（聽不清）那里或與電子病歷相關的任何東西。我要說的第三件事是隱私是關鍵。醫療保健零錯誤餘地。因此，所有這些組件 - 我們團隊的觀點是，這是我們企業通過客戶的工作流程推動更多技術的巨大機會。所以讓我就此打住，斯蒂芬妮。我希望這回答了你的問題。

So let's tie that then to the guidance. You had this massive EBITDA beat. It sounds like the margin expectation is in line for 2Q. Is the read-through that you're taking some of these extra dollars to accelerate some of these tech investments? Or is there more of a derisking of the year in this [read]?

因此，讓我們將其與指南聯繫起來。你有如此巨大的 EBITDA 擊敗。聽起來利潤率預期與第二季度一致。通讀是否表明您正在使用這些額外的資金來加速其中的一些技術投資？或者在這個[閱讀]中有更多的年度去風險？

No, we're not assuming that we're going to accelerate or spend incrementally impact compared to our original guidance. Part of the Q1 beat was timing of some of the -- just -- primarily health care and timing of PTO. So that was about half of the favorability in the first quarter. And we're -- it's early in the year. We're a quarter in.

不，與我們最初的指導相比，我們不會假設我們會加速或增加影響。第一季度節拍的一部分是一些 - 主要 - 主要是醫療保健和 PTO 的時間安排。所以這大約是第一季度支持率的一半。我們是 - 這是今年年初。我們有四分之一了。

We feel really good about the first quarter results. We feel good about the trends and we're cautiously optimistic, and we'll continue to monitor the volumes that we're seeing in claims and the providers, our customers are seeing in claim volume increases that will and should, assuming payer time lines, stay stable and continue to stabilize and improve that it will turn into increased cash, and we'll continue to monitor it and update throughout the year.

我們對第一季度的業績感覺非常好。我們對趨勢感覺良好，我們持謹慎樂觀態度，我們將繼續監控我們在索賠和供應商中看到的數量，我們的客戶看到索賠數量增加，假設付款人時間線，保持穩定並繼續穩定和改善它會變成增加的現金，我們將持續監測並全年更新。

Our next question comes from the line of Jack Wallace from Guggenheim Securities.

我們的下一個問題來自古根海姆證券公司的傑克華萊士。

Great quarter. I just wanted to talk a little bit about pipeline visibility, specifically for the deals that were anticipated in guidance for the back half of this year. And then if you could comment on the activity as it pertains to potential deals for next year and beyond. Just what that activity has looked like relative to when you reported the last quarter, and the idea there? Just trying to get an idea for how the macro conditions may have impacted that.

偉大的季度。我只想談談管道可見性，特別是今年下半年指導中預期的交易。然後，如果您可以評論該活動，因為它與明年及以後的潛在交易有關。相對於您報告上個季度時的活動情況，以及那裡的想法？只是想了解宏觀條件如何影響這一點。

Jack, I'll take that. This is Lee. A couple of things here. First, let me just reiterate the market opportunity for our business. And then let me just get into specifics on the pipeline. So as you -- as we've talked about, we operate in a $115 billion opportunity that is growing roughly 10% with 70% providers still handling the revenue cycle in-house. So that's the backdrop. And Jack, I'd love to not just talk end-to-end, but also talk about modular.

傑克，我會接受的。這是李。這裡有幾件事。首先，讓我重申一下我們業務的市場機會。然後讓我談談管道的細節。因此，正如您 - 正如我們所討論的那樣，我們在 1150 億美元的機會中運營，這個機會增長了大約 10%，其中 70% 的供應商仍在內部處理收入周期。這就是背景。 Jack，我不僅願意談論端到端，還願意談論模塊化。

So I'll touch on both. On the end-to-end side, the pipeline is strong, and we have clear visibility into what we've articulated the last few months around the $4 billion of end-to-end NPR back half of this year. So let me give you a couple of themes of what we're seeing. So a couple of things. The conversations we and the team are having with providers, specifically CEOs, CFOs, heads of revenue cycle are the same across the board.

所以我會談到兩者。在端到端方面，管道很強大，我們可以清楚地看到過去幾個月我們在今年下半年圍繞 40 億美元的端到端 NPR 闡述的內容。所以讓我給你幾個我們所看到的主題。所以有幾件事。我們和團隊與供應商，特別是首席執行官、首席財務官、收入周期負責人的對話是全面的。

Continued financial pressure, continued cost pressure, continued complexity and reimbursement that is putting pressure on their revenue cycle. And the -- not so surprising but having been in the end-to-end business for really the last year or so and before that, running the Cloudmed business on the revenue integrity side, the need for integrated technology has been a key theme.

持續的財務壓力、持續的成本壓力、持續的複雜性和報銷給他們的收入周期帶來壓力。而且——並不奇怪，但在過去一年左右的時間裡一直從事端到端業務，在此之前，在收入完整性方面運行 Cloudmed 業務，對集成技術的需求一直是一個關鍵主題。

So providers today often purchase point solutions that may not be integrated with each other and with each component, this is the front, middle and back end. And there's a real theme around the need for integrated technology across their operation. So those are the themes which kind of build right into the R1 value proposition, which is a global scaled model that allows us to deliver the same quality or higher at a lower cost.

因此，如今的供應商經常購買點解決方案，這些解決方案可能不會相互集成，也不會與每個組件集成，即前端、中端和後端。圍繞在整個運營過程中對集成技術的需求，這是一個真正的主題。因此，這些是 R1 價值主張的主題，這是一個全球規模的模型，使我們能夠以更低的成本提供相同或更高的質量。

Our historic and continued investment in technology that allows us to embed technology with our customers and a team of revenue cycle experts that can go toe-to-toe with anyone in the industry and certainly with our providers that have the experience in any number of host systems through our experience of all sizes of end-to-end clients and all care settings. So visibility is strong.

我們對技術的歷史性和持續投資使我們能夠將技術嵌入到我們的客戶和收入周期專家團隊中，他們可以與業內任何人進行面對面交流，當然也可以與我們在任何數量的主機方面都有經驗的供應商進行面對面交流系統通過我們對各種規模的端到端客戶和所有護理環境的經驗。所以能見度很強。

The pipeline is balanced. We're seeing a lot of activity in the $4 billion to $5 billion NPR range and feel very good about achieving our target back half of this year. I also want to talk about modular and just highlight a key theme that we've talked about, but I have even more conviction in the opportunity to cross-sell across our business. So a couple of examples here. So we have the Cloudmed business deployed across all geographies, across 500 customers with at least one solution sold into 95 of the top 100 systems.

管道是平衡的。我們在 40 億至 50 億美元的 NPR 範圍內看到了很多活動，並且對在今年下半年實現我們的目標感到非常高興。我還想談談模塊化，只是強調我們已經討論過的一個關鍵主題，但我更加堅信有機會在我們的業務中進行交叉銷售。所以這裡有幾個例子。因此，我們在所有地區部署了 Cloudmed 業務，覆蓋了 500 個客戶，並且至少有一個解決方案被銷售到前 100 個系統中的 95 個。

That allows that team to get visibility whenever there are opportunities with end-to-end potential clients. So that's the first thing that we're seeing good progress on. The other [place] is the opportunity to cross-sell legacy R1 modular solution to the Cloudmed base is a significant opportunity for our business. And the last is to deploy Cloudmed solutions into the legacy R1 end-to-end base. So there's multiple avenues for cross-sell.

這使得該團隊能夠在有機會接觸端到端潛在客戶時獲得可見性。所以這是我們看到良好進展的第一件事。另一個[地方]是向 Cloudmed 基地交叉銷售遺留 R1 模塊化解決方案的機會，這對我們的業務來說是一個重要的機會。最後是將 Cloudmed 解決方案部署到遺留的 R1 端到端基礎中。因此，交叉銷售有多種途徑。

What we're seeing in the modular business is continued strong traction in the underlying Cloudmed business as well as the R1 legacy modular business, where we're seeing a lot of traction, which would make sense as our customers are under pressure is the Cloudmed AR and denials solutions and continued traction in some of our clinical coding accurate solutions. So the team is very bullish on opportunities just broadly over the next several years and has very clear line of sight into end-to-end and modular targets this year.

我們在模塊化業務中看到的是基礎 Cloudmed 業務以及 R1 遺留模塊化業務的持續強勁牽引力，我們看到了很大的牽引力，這是有道理的，因為我們的客戶面臨壓力是 Cloudmed AR 和拒絕解決方案以及我們一些臨床編碼準確解決方案的持續發展。因此，該團隊非常看好未來幾年的機會，並且對今年的端到端和模塊化目標有著非常清晰的視線。

That's really helpful. And then Jennifer, one for you. The base fees were up pretty nicely quarter-over-quarter and 1Q had been a seasonally weaker quarter historically for the company. Was there any impact outside of, say, the Sutter ramping or some of the other new deals ramping, contributing to the base fee growth, you're thinking just in terms of whether it was better than expected? [let's call it] same-store NPR or collections that would have had an extra benefit sequentially?

這真的很有幫助。然後是詹妮弗，一個給你。基本費用環比增長相當不錯，而且從歷史上看，第一季度對公司來說是一個季節性較弱的季度。除了 Sutter 的增長或其他一些新交易的增長之外，是否有任何影響導致基本費用增長，你只是在考慮它是否好於預期？ [讓我們稱之為] 同店 NPR 或按順序有額外好處的系列？

No, the largest impact quarter-over-quarter for base fees was driven by Sutter as it transitioned mid-Q4. So you've got a full quarter of the Sutter base fee revenue in Q1. Outside of that, it's a low single-digit growth for other end -- collectively for our other end-to-end and physician customers.

不，對基本費用的環比影響最大的是 Sutter，因為它在第四季度中期過渡。所以你在第一季度獲得了 Sutter 基本費用收入的四分之一。除此之外，它是另一端的低個位數增長——總的來說是我們其他端到端和醫生客戶。

Our next question comes from the line of Craig Hettenbach from Morgan Stanley.

我們的下一個問題來自摩根士丹利的 Craig Hettenbach。

Good to see the really robust growth in Cloudmed, 25% in Q1. I think you've talked about expectations for 20% for the full year 2023. So just curious in terms of how you think about the cadence as you go through the year and anything to note on kind of year-on-year comps?

很高興看到 Cloudmed 的增長非常強勁，第一季度增長了 25%。我想你已經談到了對 2023 年全年 20% 的預期。所以只是想知道你如何看待這一年的節奏以及關於同比比較的任何注意事項？

We feel really good about the growth in Cloudmed in the first quarter, and we have given that 20% full year growth. We're starting off the year strong. We're certainly excited about the performance that we're seeing in our modular business, and we're going to continue to monitor it. But we feel like there's good opportunity there, and we're excited about the start of the year for the Cloudmed modular business, specifically around that growth.

我們對第一季度 Cloudmed 的增長感到非常滿意，我們已經實現了 20% 的全年增長。我們今年開局強勁。我們當然對我們在模塊化業務中看到的性能感到興奮，我們將繼續監控它。但我們覺得那裡有很好的機會，我們對 Cloudmed 模塊化業務今年的開始感到興奮，特別是圍繞這一增長。

There may be some opportunity for a little bit higher growth, but we'll continue to monitor it and see what the remaining quarters look like. We're cautiously optimistic based on the first quarter results, though, and extremely excited about it.

可能會有一些更高增長的機會，但我們將繼續監測它，看看剩下的幾個季度會是什麼樣子。不過，我們對第一季度的業績持謹慎樂觀態度，並且對此感到非常興奮。

The thing I'd add just, Craig, a reminder on the value proposition for the Cloudmed solutions. This is a model that -- the way we've grown this business as fast as we have is a couple of reasons. One is we're solving a very specific and needed problem for providers, which is to drive incremental revenue they would not otherwise have realized because of human error, errors in coding, for example, inability to hire resources either in coding or in the back end.

克雷格，我要補充的是關於 Cloudmed 解決方案的價值主張的提醒。這是一個模型——我們以如此快的速度發展這項業務的方式有幾個原因。一是我們正在為供應商解決一個非常具體和需要的問題，即推動他們因人為錯誤、編碼錯誤而無法實現的增量收入，例如，無法在編碼或後台僱用資源結尾。

And the way we go to market is we're essentially collecting -- on the first solution sale, we're getting access to all of the data that is applied to cash collections for that customer, putting in one of our solutions, let's say, for example, one of our clinical coding solutions that drives incremental revenue pre or post claim filed. And then that allows us to be able to cross-sell into that customer the next time we go to the customer with any 1 of our 9 total solutions.

我們進入市場的方式基本上是收集——在第一次解決方案銷售中，我們可以訪問所有應用於該客戶現金收集的數據，並放入我們的一個解決方案中，比方說，例如，我們的一種臨床編碼解決方案可推動索賠前或索賠後的增量收入。然後，這使我們能夠在下次使用我們的 9 種整體解決方案中的任何一種與客戶進行交叉銷售時向該客戶進行交叉銷售。

And implementation is frictionless because we have the data on the first pass solution and can then show the customer where there are additional opportunities across the revenue cycle. So just as a matter of value prop, it is a very strong value prop. And I would just add this point I made earlier on technology. Once we see a system in a state with that same payer, we have that data in our data platform that allows us to apply models and then essentially predict where there are errors and charges in reimbursement in clinical codes across the country across any level of provider.

並且實施是無摩擦的，因為我們有關於第一次通過解決方案的數據，然後可以向客戶展示整個收入周期中哪裡還有其他機會。因此，就價值支撐而言，它是一個非常強大的價值支撐。我只想補充一下我之前在技術方面提出的觀點。一旦我們看到一個系統處於同一付款人的狀態，我們的數據平台就會擁有該數據，使我們能夠應用模型，然後從根本上預測全國任何級別的提供者的臨床代碼中哪裡存在錯誤和報銷費用.

So it's a very powerful model with extreme network effects that allow us to go to customers and cross-sell solutions. The last thing I'd say is our customers talk to each other. There is a very positive reputational effect of the value of our solutions and another reason why we had such strong growth.

所以這是一個非常強大的模型，具有極端的網絡效應，使我們能夠找到客戶並交叉銷售解決方案。我要說的最後一件事是我們的客戶互相交談。我們解決方案的價值對聲譽產生了非常積極的影響，這也是我們實現如此強勁增長的另一個原因。

Got it. And maybe just a follow-up for Jennifer. I appreciate the color on Q2 expectations for adjusted EBITDA. How are you thinking about the back half of the year, just kind of tailwinds or headwinds to kind of keep in mind for the second half?

知道了。也許只是詹妮弗的後續行動。我很欣賞第二季度調整後 EBITDA 預期的顏色。您如何看待下半年，下半年要記住的順風或逆風？

Sure. So we said that EBITDA will grow sequentially quarter-over-quarter, really driven by 4 areas. One is base fees and margin maturity on new customers. So as you think about cash collections, we have some seasonality in the back half of the year just based on posting days and the amount of cash. So that will drive growth or higher EBITDA in the second half of the year naturally.

當然。所以我們說 EBITDA 將環比增長，實際上是由 4 個領域驅動的。一是新客戶的基本費用和保證金期限。因此，當您考慮現金收款時，根據過帳天數和現金數量，我們在下半年有一些季節性。因此，這將自然地推動下半年的增長或更高的 EBITDA。

With $13 billion of new wins that we won last year, those margins will continue to mature as we begin global transitions, vendor rationalization and consolidation of vendor costs, et cetera, just that normal margin maturity of new business that will happen quarter-over-quarter. The third is what we just talked about on Cloudmed growth that we'll see 20% growth in Cloudmed, which will drive as those new bookings and new wins come on board and are implemented, it will drive incremental revenue and therefore EBITDA quarter-over-quarter. And then the last is synergy realization. So as we continue to integrate the business and drive cost synergy realization, that will drive EBITDA growth quarter-over-quarter. So it is more back half loaded for those reasons.

憑藉我們去年贏得的 130 億美元新訂單，隨著我們開始全球轉型、供應商合理化和供應商成本整合等，這些利潤率將繼續成熟，新業務的正常利潤率成熟度將超過一個季度。四分之一。第三個是我們剛剛談到的 Cloudmed 增長，我們將看到 Cloudmed 增長 20%，這將隨著新預訂和新勝利的出現和實施而推動，它將推動增量收入，從而推動 EBITDA 超過四分之一-四分之一。最後是協同效應的實現。因此，隨著我們繼續整合業務並推動成本協同效應的實現，這將推動 EBITDA 環比增長。因此，由於這些原因，它的後半載更多。

Our next question comes from the line of Elizabeth Anderson from Evercore ISI.

我們的下一個問題來自 Evercore ISI 的 Elizabeth Anderson。

I guess 2 questions for me. One is, I think, Jennifer, you mentioned in one of your prior questions, you're seeing low single-digit growth in the core customer base or already implemented customers. One, should that accelerate sort of as we think about getting the collections from 1Q forward on the 1 month like just given sort of rate increases that seen year-over-year on the payer side sort of independently of utilization?

我想我有 2 個問題。一個是，我認為，詹妮弗，你在之前的一個問題中提到過，你看到核心客戶群或已經實施的客戶出現了低個位數的增長。第一，當我們考慮在 1 個月從 1Q 開始收款時，這是否應該加速，就像支付方的同比利率增長有點獨立於利用率一樣？

And then two, can you give us an update on the patient pay or the patient self-pay portion? How is that trending? Are you seeing any sort of indications of any kind of like consumer distressed or sort of changes in that area?

然後兩個，你能告訴我們患者支付或患者自費部分的最新情況嗎？趨勢如何？您是否看到任何類似消費者苦惱或該領域發生變化的跡象？

Sure. As far as the -- maybe I'll take the patient self-pay. We aren't seeing any changes on distress there or any changes on the mix that would really drive the numbers. So that's not something that we're seeing or something that we're concerned about as far as a financial impact. And then as far as the cash collections and the volumes, we're not really seeing any significant impact there.

當然。至於——也許我會讓病人自費。我們沒有看到那裡的痛苦有任何變化，也沒有看到真正推動數字增長的任何變化。因此，就財務影響而言，這不是我們所看到的或我們關心的事情。然後就現金收集和數量而言，我們並沒有真正看到任何重大影響。

As far as the utilization and the volume growth quarter-over-quarter. There is some slight growth just based on seasonality in the back half of the year. But overall, we've assumed that single-digit volume growth across the quarters. So part of it, again, to your point on utilization or payer contracts to the extent that those kick in, it's likely more of a '24 impact because of the lag in the cash collections and also the lag and the way our base fee works.

至於利用率和銷量環比增長。僅根據今年下半年的季節性因素，就會有一些小幅增長。但總的來說，我們假設各個季度的銷量增長都是個位數。所以它的一部分，再一次，對於你在使用或付款人合同方面的觀點，在那些開始的範圍內，它可能更多的是'24影響，因為現金收集的滯後以及滯後和我們基本費用的運作方式.

So if payer pricing kicks in midyear, that really becomes a 2024 impact for us because of the pricing kicks in on claims by the time the cash comes in and we have a quarter lag, it's really pushed out to the beginning of next year.

因此，如果付款人定價在年中開始，那對我們來說真的會產生 2024 年的影響，因為在現金進入時定價開始對索賠產生影響，我們有四分之一的滯後，它真的被推遲到明年年初。

Our next question comes from the line of Scott Schoenhaus from KeyBanc.

我們的下一個問題來自 KeyBanc 的 Scott Schoenhaus。

Lee and Jennifer, congrats on the execution and results. I wanted to follow up on your modular solutions commentary and cross-selling opportunities. So I think you mentioned in the prepared comments that legacy RCM modular solutions grew low single digits, driven by physician advisory services. Did you see this accelerate throughout the quarter? And should we expect this growth to accelerate if we continue to see an improving environment for health care systems? Just any color on this near- and longer-term growth opportunity would be helpful.

Lee 和 Jennifer，祝賀執行和結果。我想跟進您的模塊化解決方案評論和交叉銷售機會。所以我想你在準備好的評論中提到，在醫生諮詢服務的推動下，傳統的 RCM 模塊化解決方案增長了低個位數。您是否看到整個季度都在加速？如果我們繼續看到醫療保健系統環境不斷改善，我們是否應該期望這種增長會加速？這個近期和長期增長機會的任何顏色都會有所幫助。

Let me just touch on what I'm seeing just thematically and then Jennifer, if you want to answer the questions on just what we assume the rest of the year. So Scott, I'm personally very excited about the opportunity to cross-sell legacy R1 modular solutions into the Cloudmed base. This is a team of revenue cycle experts that have experience with customers. And the point I made before, our team has a reputation for delivering high-quality results as evidenced by our [Class IVs] in that area.

讓我先談談我在主題上看到的內容，然後是詹妮弗，如果你想回答我們對今年餘下時間的假設的問題。所以 Scott，我個人很高興有機會向 Cloudmed 基地交叉銷售遺留 R1 模塊化解決方案。這是一個具有客戶經驗的收入周期專家團隊。我之前說過，我們的團隊在提供高質量結果方面享有盛譽，我們在該領域的 [IV 級] 證明了這一點。

A couple -- the comment we made on physician advisory services is applied to several areas of R1 modular solution. So opportunities that our teams are excited about where we see traction in that modular book pipeline is physician advisory services, our ability to help that end market. The other place where we see an increased level of activity is in our VisitPay business, the patient payments [piece].

一對——我們對醫生諮詢服務的評論適用於 R1 模塊化解決方案的多個領域。因此，我們的團隊對我們在模塊化書籍管道中看到的牽引力感到興奮的機會是醫生諮詢服務，我們幫助該終端市場的能力。我們看到活動水平增加的另一個地方是我們的 VisitPay 業務，即患者付款 [piece]。

And this is -- look, the model is we have access to customers, heads of revenue cycle and technology departments. We're talking to them every day about delivering value and essentially introducing them to the teams that are the R1 legacy modular teams. So overall, we see Cloudmed continuing to grow at a strong rate, specifically with some of the solutions that are at the forefront of customer needs, i.e., AR and denials business. And then on the R1 legacy side, we're having more and more conversations with what are essentially net new opportunities for the R1 legacy modular business. Jennifer?

這是——看，模型是我們可以接觸到客戶、收入周期和技術部門的負責人。我們每天都在與他們討論交付價值，並從本質上向他們介紹 R1 遺留模塊化團隊。因此，總的來說，我們看到 Cloudmed 繼續以強勁的速度增長，特別是一些處於客戶需求前沿的解決方案，即 AR 和拒絕業務。然後在 R1 遺留方面，我們正在與 R1 遺留模塊化業務本質上的淨新機會進行越來越多的對話。詹妮弗？

Sure. As far as growth in the modular -- the legacy R1 modular business, we did assume, just based on bookings, cross-sell bookings through the year. We did assume some improvement as we go through the year on revenue growth there, but still expected to be single digits.

當然。至於模塊化的增長——傳統的 R1 模塊化業務，我們確實假設，僅基於預訂，全年交叉銷售預訂。我們確實假設我們全年的收入增長會有所改善，但仍預計將是個位數。

Our next question comes from the line of Jailendra Singh from Truist Securities.

我們的下一個問題來自 Truist Securities 的 Jailendra Singh。

I want to go back to your comment around payer reimbursement time lines improving. Just trying to better understand like how much of this is driven by like macro trends and you've talked about payers having labor shortage. Your tech initiatives, you have been helping your provider clients and provider clients themselves like pushing back MCOs. Trying to better understand the drivers like parse out what is likely permanent versus temporary? And would you say that the worst is behind us in terms of these payer claims time lines?

我想回到你關於改進付款人報銷時間表的評論。只是想更好地了解其中有多少是由宏觀趨勢驅動的，你已經談到了勞動力短缺的付款人。你的技術舉措，你一直在幫助你的供應商客戶和供應商客戶本身，比如推動 MCO。試圖更好地理解驅動程序，比如解析出什麼是永久性的，什麼是臨時性的？你會說就這些付款人索賠時間表而言，最壞的情況已經過去了嗎？

Let me give you the themes. And then, Jennifer, if you have anything to add. Jailendra, we don't know, but we can see what the trends are, which is we see steady improvement. We assume hopefully, that this gets back to normal by the end of the year, but we see steady improvement. We're still seeing some trends around high dollar claims still being an issue.

讓我給你主題。然後，Jennifer，如果你有什麼要補充的。 Jailendra，我們不知道，但我們可以看到趨勢是什麼，我們看到穩步改善。我們滿懷希望地假設，這會在年底前恢復正常，但我們看到穩步改善。我們仍然看到圍繞高美元索賠的一些趨勢仍然是一個問題。

So -- and then Jennifer already mentioned the aged AR. So between Aged AR and high dollar claims, there's still some challenges, which is why you hear us being thoughtful and conservative about how we're thinking about the back half of the year. The other point I'd make is we're getting more and more insight from our Cloudmed data sets that has become very useful for our providers around what's happening with reimbursement time lines, payer by payer in those geographies.

所以——然後 Jennifer 已經提到了老年 AR。因此，在老年 AR 和高額索賠之間，仍然存在一些挑戰，這就是為什麼你聽到我們對我們如何考慮下半年的方式深思熟慮和保守。我要說的另一點是，我們從我們的 Cloudmed 數據集中獲得了越來越多的洞察力，這些數據集對我們的供應商非常有用，因為這些數據集在這些地區的報銷時間表、付款人之間發生了什麼。

So it's allowing us to deliver more and more insight into what's happening. And therefore, as they enter negotiations with these payers, they're armed with more data and insight to be able to improve going forward. Jennifer, anything you'd add?

因此，它使我們能夠越來越深入地了解正在發生的事情。因此，當他們與這些付款人進行談判時，他們掌握了更多的數據和洞察力，以便能夠在未來進行改進。詹妮弗，你有什麼要補充的嗎？

Yes. I mean as far as the mix of just what's happening from a macro perspective versus the resources we've applied, it's a combination of both. If you look at the large public payers and their days claims payable, it's coming down slightly. So I think there is some macro trends there that there's some improvement.

是的。我的意思是，就從宏觀角度來看正在發生的事情與我們已經應用的資源的組合而言，它是兩者的結合。如果你看看大型公共支付者和他們的應付天數，它會略有下降。所以我認為那裡有一些宏觀趨勢，有一些改進。

But as Lee mentioned, some of the efforts we're putting against it from a resource perspective are also adding benefits as well. It's the worst behind us. We believe it is, and we assumed in our guidance, and we expect that we'll see a slow and steady improvement through the year. We're 1 quarter into the year, so we want to make sure that, that trend continues. But we're cautiously optimistic about the trends that we're seeing.

但正如 Lee 所提到的，我們從資源角度反對它的一些努力也增加了好處。這是我們身後最糟糕的。我們相信它是，我們在我們的指導中假設，我們預計我們將在今年看到緩慢而穩定的改善。我們已經進入今年的第一個季度，所以我們希望確保這種趨勢繼續下去。但我們對我們所看到的趨勢持謹慎樂觀的態度。

Okay. One quick clarification question. Jennifer, earlier, you talked about the (inaudible) at in the quarter. Some -- half was driven by some timing of health care benefits, and I believe you said the PTO getting pulled forward. Can you clarify what exactly you're referring there? And what was the remaining like $5 million beat versus like general cost management? Just maybe a little bit more color there.

好的。一個快速澄清的問題。詹妮弗，早些時候，你談到了本季度的（聽不清）。一些 - 一半是由醫療保健福利的某些時間推動的，我相信你說過 PTO 被提前了。你能澄清一下你指的是什麼嗎？與一般成本管理相比，剩餘的 500 萬美元有多少？那裡的顏色可能會多一點。

Sure. So the timing-related items were primarily just timing of PTO accruals, when PTO is taken and how those balances work at the end of each of the quarters when we measure it as well as health care claims. So it's just about utilization. And at the beginning of the year, oftentimes, people still haven't hit their deductibles, and there's more of self pay before the payments kick in on our behalf.

當然。因此，與時間相關的項目主要只是 PTO 應計項目的時間、PTO 的計算時間以及這些餘額在我們衡量它以及醫療保健索賠時在每個季度末如何運作。所以這只是關於利用率。在年初，通常情況下，人們還沒有達到他們的免賠額，並且在代表我們付款之前有更多的自付。

So it's really more of a timing. We don't expect our overall benefits expense to be favorable for the full year. We just believe it's timing on when those claims are hitting. And so those expenses we expect will come back in year -- just later in the year. So that's the timing piece of it. And then on the other expenses and the favorability there, it's really around labor and payroll costs are more favorable than what we expected. Some of that is based on initiatives we had expected, and we were able to execute sooner than expected. And so we were able to get some favorability there. But it's really driven by payroll.

所以這更像是一個時機。我們預計全年的整體福利支出不會有利。我們只是相信現在正是這些索賠發生的時機。因此，我們預計這些費用將在今年晚些時候回歸。這就是它的時間部分。然後關於其他費用和那裡的好感度，它實際上是圍繞勞動力和工資成本比我們預期的更有利。其中一些是基於我們預期的舉措，我們能夠比預期更快地執行。因此我們能夠在那裡獲得一些好感。但這實際上是由工資驅動的。

Our next question comes from the line of Glen Santangelo from Jefferies.

我們的下一個問題來自 Jefferies 的 Glen Santangelo。

Jennifer, I actually want to follow up on something you were just talking about, the more favorable labor and payroll costs. And I was just kind of curious about the macro environment. It certainly seems to be stabilizing. And so I'm kind of curious if you guys are seeing any softening in overall outsourcing demand at this point in time? Because it seems like during the pandemic, it was pretty obvious that hospitals were struggling. But now that things are normalizing, is that outsourcing demand? Is it starting to diminish in any way?

詹妮弗，我實際上想跟進你剛才談論的事情，更有利的勞動力和工資成本。我只是對宏觀環境感到好奇。它當然似乎正在穩定。所以我很好奇你們此時是否看到整體外包需求出現任何疲軟？因為似乎在大流行期間，很明顯醫院正在苦苦掙扎。但現在情況正在正常化，這是外包需求嗎？它是否開始以任何方式減少？

Let me just touch on a piece of this, and Jennifer if you have anything to add. There's an interesting dynamic where why I believe that our pipeline has a good mix, but our sweet spot, if you will, is the kind of $4 billion to $5 billion system. The large systems with large-scale purchasing power, if you will, and power of negotiation with payers look very different from some of these midsized systems.

讓我談談其中的一部分，如果你有什麼要補充的，詹妮弗。有一個有趣的動態，為什麼我相信我們的管道有很好的組合，但如果你願意的話，我們的最佳點是那種 40 億到 50 億美元的系統。具有大規模購買力和與付款人談判能力的大型系統看起來與其中一些中型系統截然不同。

So I'd start there that there's still pressure on systems, especially the ones that may be 3 hospitals in a geography that may not be market leaders in that geography. So that's the first point I'd make is there's an element of that. The other point I'd make is our pipeline is not just large systems. It's also Physician Group. So that's the other point of why we feel confident in what we're doing back half.

所以我從那裡開始，系統仍然存在壓力，尤其是那些可能是某個地區的 3 家醫院，但可能不是該地區的市場領導者的系統。所以這是我要說的第一點，那就是其中的一個元素。我要說的另一點是我們的管道不僅僅是大型系統。這也是醫師組。所以這就是為什麼我們對我們在後半場所做的事情充滿信心的另一點。

And then the other pieces of this, you've got the financial pressure, but also a recognition that what they're doing on the technology side may or may not be working. And in many cases, it's -- look we don't have the capacity to be able to invest even if we are making a profit this year. So there's -- I hear your point. I don't think we're out of the woods by any means just in terms of the financial pressure on systems, especially when it comes to some of those midsized systems.

然後是其他部分，你有財務壓力，但也認識到他們在技術方面所做的事情可能會或可能不會奏效。在許多情況下，即使我們今年盈利，我們也沒有能力進行投資。所以 - 我聽到了你的意思。我認為，就係統的財務壓力而言，我們並沒有以任何方式走出困境，尤其是涉及到一些中型系統時。

All right. Lee, I appreciate those comments. Maybe if I could just follow up. On the integration issues that we talked a lot about over the last several quarters, it seems like those issues are under control and maybe starting to fade into the background a little bit. And while you're comfortable with the pipeline, it seems -- have those issues in any way spilled into your discussions with new potential clients? Or do you feel like maybe we on the Street maybe make too big of a deal with that? I'm just kind of curious if some of those integration issues have impacted your selling efforts really in any way?

好的。李，我很欣賞這些評論。也許我可以跟進。關於我們在過去幾個季度中經常討論的整合問題，這些問題似乎已得到控制，並且可能開始逐漸淡出背景。雖然您對管道感到滿意，但似乎 - 這些問題是否以任何方式滲透到您與新潛在客戶的討論中？還是您覺得我們華爾街的人可能對此過於重視了？我只是有點好奇，其中一些整合問題是否真的以任何方式影響了您的銷售工作？

Glen, my short answer is generally no. No, it hasn't impacted, but we are very cognizant of making sure we do what's right for those customers, making sure they're happy and that they're seeing good things in the market, especially for like-for-like customers in those same specialty areas. So I would say, positive, not any impact, very little chatter, if you will. But we're also very focused on making sure those customers are happy.

格倫，我的簡短回答通常是否定的。不，它沒有受到影響，但我們非常清楚要確保我們為這些客戶做正確的事情，確保他們滿意並且他們在市場上看到好東西，特別是對於同類客戶在那些相同的專業領域。所以我會說，積極的，沒有任何影響，很少有喋喋不休，如果你願意的話。但我們也非常專注於確保這些客戶滿意。

Our next question comes from the line of Vikram Kesavabhotla from Baird.

我們的下一個問題來自 Baird 的 Vikram Kesavabhotla。

I just wanted to follow up on some of those comments on NPR. So I think you previously talked about adding another $4 billion of NPR in fiscal '23. Is that still your expectation? And at what point in the year do you expect to sign those deals? And then separately, I think your onboarding capacity now is up to about $9 billion. Are you seeing enough activity in the pipeline to justify maintaining that level of capacity going forward? Or do you expect to normalize that at some point?

我只是想跟進關於 NPR 的一些評論。所以我想你之前談到過在 23 財年再增加 40 億美元的 NPR。這還是你的期待嗎？您希望在一年中的什麼時候簽署這些交易？然後分別地，我認為你現在的入職能力高達約 90 億美元。您是否看到管道中有足夠的活動來證明保持該容量水平向前發展是合理的？還是您希望在某個時候將其正常化？

(inaudible) short answer, then Jennifer, you can add in on the capacity point, is we feel confident on the $4 billion. It's tough in any of these large end-to-end deals to predict timing, but we feel good about back half.

（聽不清）簡短的回答，然後詹妮弗，你可以補充一下能力點，我們對 40 億美元有信心嗎？在這些大型端到端交易中，很難預測時間，但我們對後半部分感覺良好。

And then as far as capacity, so as we announced for last year on 2022 wins, we had $13 billion of new NPR won in '22. And of that $13 billion, we're currently onboarding $8 billion of it. The remaining $5 billion is the rest of Sutter and we expect to begin deploying that into '23 and to '24. So as you think about onboarding capacity, the remaining $5 billion of Sutter plus the $4 billion we expect to win in the second half of the year will drive a need for onboarding capacity in that $8 billion to $9 billion range into '24.

然後就容量而言，正如我們去年宣布的 2022 年勝利一樣，我們在 22 年贏得了 130 億美元的新 NPR。在這 130 億美元中，我們目前正在使用其中的 80 億美元。剩下的 50 億美元是 Sutter 的其餘部分，我們預計將開始將其部署到 23 世紀和 24 世紀。因此，當你考慮入職能力時，Sutter 剩餘的 50 億美元加上我們預計在今年下半年贏得的 40 億美元將推動對 24 世紀 80 億至 90 億美元範圍內的入職能力的需求。

So we have the capacity. We invested in that last year, and we expect to remain at those levels through '24 based on the current wins that we've already won and still need to onboard in addition to what we expect to win based on our visibility into the pipeline. That's one of those that we'll continue to monitor, do we need to ramp and take an additional investment in onboarding? Do we -- can we ramp down? So that's -- it's something that we'll constantly monitor the right level of onboarding capacity we need for the future.

所以我們有能力。我們去年對此進行了投資，我們希望根據我們已經贏得的當前勝利以及我們根據對管道的可見性期望贏得的勝利，在 24 年前保持這些水平。這是我們將繼續監控的問題之一，我們是否需要增加入職培訓並進行額外投資？我們——我們可以減速嗎？所以這就是我們將不斷監控我們未來所需的正確入職能力水平的事情。

Final question comes from the line of Jeff Garro from Stephens.

最後一個問題來自 Stephens 的 Jeff Garro。

I want to ask about the progress on the integration of Cloudmed capabilities into R1's ecosystem. And just curious to what extent the new capabilities are coming on incrementally versus in batches. Also, is any training needed? Or is it just kind of intuitive for the users? And then lastly, how should we think about the lag between deployment of these incremental capabilities and driving customer and R1 financial impact?

我想問一下Cloudmed能力融入R1生態系統的進展。只是好奇新功能在多大程度上是漸進式的還是分批式的。另外，需要培訓嗎？或者它對用戶來說只是一種直覺？最後，我們應該如何考慮部署這些增量功能與推動客戶和 R1 財務影響之間的滯後？

Sure. Jeff, let me just give you the quick framework on how we think about the Cloudmed integration. And just as a backdrop, we -- Jennifer and I have a lot of experience integrating businesses. I think you know this, we started working together 12 years ago and we're on a pretty similar integration path with the businesses we ran then.

當然。傑夫，讓我給你一個關於我們如何看待 Cloudmed 集成的快速框架。作為背景，我們——詹妮弗和我在整合企業方面擁有豐富的經驗。我想你知道這一點，我們在 12 年前開始合作，我們與當時經營的企業走在非常相似的整合道路上。

Here's what I'd say based on what we've learned and where we are today. We're very much on track on integration, including realization of synergies. The 3 big buckets, I would say, are technology, operations and commercial. On the technology front, we're well on the path to having a unified data platform based on the pre- and purpose-build Cloudmed platform.

以下是我根據我們所學到的和我們今天所處的位置要說的話。我們在整合方面進展順利，包括協同效應的實現。我想說的三大桶是技術、運營和商業。在技​​術方面，我們正朝著擁有一個基於預先構建和專門構建的 Cloudmed 平台的統一數據平台邁進。

But as with any technology integration, these things always take time, you have to be pretty methodical on how you go about that. On the operations side, there is an opportunity over time to apply some of the R1 capabilities in India, Philippines to Cloudmed. So that is something that we will be working on back half of this year. And on the commercial side, the teams are very much integrated already.

但與任何技術集成一樣，這些事情總是需要時間，你必須非常有條不紊地處理它。在運營方面，隨著時間的推移，有機會將印度、菲律賓的一些 R1 功能應用到 Cloudmed。因此，這是我們將在今年下半年開展的工作。在商業方面，團隊已經非常整合。

So the modular leader, the sales leader, for example, is running both the legacy R1 modular as well as the Cloudmed commercial capabilities. And that's where we see a ton of cross-sell opportunities. So the way I'd frame it is integration or the organizational piece, back office, all the big components are done.

因此，模塊化領導者，例如銷售領導者，正在運行傳統的 R1 模塊化以及 Cloudmed 商業功能。這就是我們看到大量交叉銷售機會的地方。因此，我構建它的方式是集成或組織部分、後台，所有重要組件都已完成。

And by the end of this year, I would say we're largely done with most, although there's always pieces like technology, culture and so on that just are ongoing through time. So we feel very good about the integration in general.

到今年年底，我想說我們基本上已經完成了大部分工作，儘管總有技術、文化等部分隨著時間的推移而不斷發展。因此，我們總體上對集成感到非常滿意。

I would now like to turn the call over to Lee Rivas for closing remarks.

我現在想將電話轉給 Lee Rivas 以作結束語。

Thank you, operator, and thank you, everyone, for joining us today. Just a few closing comments. First, we feel very good about our ability to deliver on our commitments for 2023. I think you heard that loud and clear from Jennifer and me. The second point is we're very focused on operational delivery and execution for our customers.

謝謝接線員，也謝謝大家今天加入我們。只是一些結束評論。首先，我們對我們在 2023 年兌現承諾的能力感到非常滿意。我想你已經從我和詹妮弗那裡清楚地聽到了這一點。第二點是我們非常關注客戶的運營交付和執行。

The third theme, I think you heard on all the questions around our pipeline on both the end-to-end side and modular side as end market dynamics remain strong, we believe in the significant commercial opportunities, both on the end-to-end and modular side. The other theme today is on technology. We're very focused on advancing our technology agenda to drive cost efficiencies and value to our customers. So thank you all for joining us today. We look forward to updating you on our progress on future calls.

第三個主題，我想你聽到了關於端到端和模塊化方面的所有問題，因為終端市場動態依然強勁，我們相信端到端的重大商業機會和模塊化的一面。今天的另一個主題是技術。我們非常專注於推進我們的技術議程，以提高成本效率並為我們的客戶創造價值。感謝大家今天加入我們。我們期待在未來的電話會議上向您通報我們的最新進展。

Thank you, ladies and gentlemen. This does conclude today's call. Thank you for your participation. You may now disconnect.

謝謝你們，女士們，先生們。今天的電話會議到此結束。感謝您的參與。您現在可以斷開連接。