R1 RCM Inc (RCM) 2023 Q2 法說會逐字稿

Good morning. My name is Rob and I will be your conference operator today. At this time, I would like to welcome everyone to the R1 RCM Second Quarter 2023 Earnings Conference Call.

早上好。我叫羅布，今天我將擔任你們的會議操作員。此時，我歡迎大家參加 R1 RCM 2023 年第二季度收益電話會議。

(Operator Instructions)

（操作員說明）

Atif Rahim, Head of Investor Relations, you may begin your conference.

Atif Rahim，投資者關係主管，您可以開始會議了。

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, our 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，本次電話會議期間所做的某些陳述可能被視為前瞻性陳述。特別是有關我們未來增長計劃和業績的任何陳述，包括有關我們的戰略和成本的陳述儲蓄計劃、我們的流動性狀況、我們的增長機會和我們未來的財務業績均為前瞻性陳述。

These statements are often identified by the use of words such as anticipate, believe, estimate intend, design, 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. 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.

這些陳述通常通過使用諸如預期、相信、估計、意圖、設計、可能、計劃、項目、將以及類似表達或變體等詞語來識別。投資者應注意不要過分依賴此類前瞻性陳述。今天電話會議中所做的所有前瞻性陳述都涉及風險和不確定性。雖然我們可能選擇在未來某個時候更新這些前瞻性陳述，但我們目前無意這樣做，除非適用法律要求的範圍內。

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, the quality of global financial markets, our ability to timely and successfully achieve the anticipated benefits and potential synergy of the Cloudmed acquisition and factors discussed under the heading Risk Factors in our most recent annual report on Form 10-K and in our quarterly reports on Form 10-Q. We will also be referencing non-GAAP metrics on this call. For a reconciliation of non-GAAP amounts to their equivalent GAAP amounts, please refer to our press release.

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狀況（包括通貨膨脹時期、全球金融質量），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。市場、我們及時、成功實現收購Cloudmed 的預期效益和潛在協同效應的能力，以及我們最近的10-K 表格年度報告和10-Q 表格季度報告中風險因素標題下討論的因素。我們還將在本次電話會議中引用非公認會計準則指標。有關非 GAAP 金額與其同等 GAAP 金額的調節表，請參閱我們的新聞稿。

Now I'd like to turn the call over to Lee.

現在我想把電話轉給李。

Thank you, Atif. Good morning, everyone, and thank you for joining us. I am pleased to report strong second quarter results driven by our technology-focused operating model and our team of experts delivering on behalf of our customers. Revenue totaled $560.7 million, and adjusted EBITDA was $142.9 million, inclusive of an $11.6 million increase to reserves covering credit losses related to a physician customer.

謝謝你，阿提夫。大家早上好，感謝您加入我們。我很高興地報告第二季度的強勁業績，這是由我們以技術為中心的運營模式和代表客戶提供服務的專家團隊推動的。收入總計 5.607 億美元，調整後 EBITDA 為 1.429 億美元，其中包括與醫生客戶相關的信用損失準備金增加 1160 萬美元。

Adjusted EBITDA would have been well ahead of expectations, absent this reserve increase. We are pleased with our first half performance and are refining our guidance to reflect our updated outlook for the remainder of the year. Jennifer will cover the financials shortly, but first, I'd like to discuss progress against our top 3 priorities. First, operating trends across both the business and industry remain largely in line with our expectations, and we continue to help our end-to-end customers navigate complex macro dynamics across the provider industry.

如果沒有增加準備金，調整後的 EBITDA 將遠遠超出預期。我們對上半年的表現感到滿意，並正在完善我們的指導，以反映我們對今年剩餘時間的最新展望。 Jennifer 將很快介紹財務狀況，但首先，我想討論一下我們三大優先事項的進展情況。首先，整個業務和行業的運營趨勢在很大程度上仍然符合我們的預期，我們將繼續幫助我們的端到端客戶應對整個提供商行業複雜的宏觀動態。

Second, the power of our technology platform, including automation, AI and large-scale data analytics continues to strengthen our provider partnership.

其次，我們技術平台的力量，包括自動化、人工智能和大規模數據分析，繼續加強我們的供應商合作夥伴關係。

And third, commercial activity expansion reflects a strong sales model, including cross-sell opportunities and differentiated capabilities in a market where providers need us now more than ever.

第三，商業活動的擴張反映了強大的銷售模式，包括交叉銷售機會和市場中的差異化能力，供應商現在比以往任何時候都更需要我們。

Let me cover operational delivery for our customers. Our combination of people and technology allows us to proactively address evolving industry dynamics for our customers. Our global infrastructure reduces cost while continuing to achieve high-quality results.

讓我來介紹一下我們客戶的運營交付。我們的人員和技術相結合，使我們能夠主動為客戶應對不斷變化的行業動態。我們的全球基礎設施降低了成本，同時繼續實現高質量的結果。

Purpose-built technology deployments drive deep insights and accelerated cash conversion, including predictive analytics, performance benchmarking and trend management. Years of revenue cycle experience and access to data across more than 500 customers and $900 billion of NPR drives more predictability for our customers, allowing them to focus on what they do best, care for patients.

專門構建的技術部署可推動深入洞察並加速現金轉換，包括預測分析、績效基準測試和趨勢管理。多年的收入周期經驗以及對 500 多個客戶的數據和 9000 億美元的 NPR 的訪問為我們的客戶帶來了更多的可預測性，使他們能夠專注於他們最擅長的事情，即照顧患者。

Industry metrics such as payer time lines and volumes were in line with our expectations for the second quarter. Our internal efforts and customer engagement resulted in reductions to both total AR and aged AR.

付款人時間線和交易量等行業指標符合我們對第二季度的預期。我們的內部努力和客戶參與導致總 AR 和老化 AR 的減少。

As a reminder, customer-specific fluctuations are expected within these calculations and are dependent upon customer geography, care setting types and payer mix. While payer dynamics and our own operating performance have improved throughout the first half of the year, providers continue to face pressures due to sustained financial backlogs and increased cost as well as an evolving regulatory landscape. Our customers understand that our technology, expertise and unit economics continue to make us the preferred market partner.

提醒一下，這些計算中預計會出現特定於客戶的波動，並且取決於客戶地理位置、護理設置類型和付款人組合。儘管今年上半年付款人動態和我們自己的運營績效有所改善，但由於持續的財務積壓和成本增加以及不斷變化的監管環境，提供商繼續面臨壓力。我們的客戶明白，我們的技術、專業知識和單位經濟效益繼續使我們成為首選的市場合作夥伴。

Next, I would like to talk about our technology strategy, the progress we've made this year on our platform and data approach and applications of AI. First, let me start by reminding you of the problem we are solving for our customers and the technology journey we have been on for 10-plus years. Revenue cycle is a highly complex process, typically solved with manual effort at a high cost. The complexity is due to a large volume of claims compounded by limited digitization, lack of data standardization and siloed data across provider and payer systems.

接下來我想談談我們的技術戰略，以及我們今年在人工智能的平台、數據方法和應用方面取得的進展。首先，讓我先提醒您我們正在為客戶解決的問題以及我們十多年來所經歷的技術之旅。收入周期是一個高度複雜的過程，通常通過人工來解決，成本很高。其複雜性是由於大量的索賠，加上有限的數字化、缺乏數據標準化以及供應商和付款人系統之間的孤立數據。

Our technology investments have been and continue to be aimed at digitizing, standardizing and automating this process which improves both the productivity of our team and the quality of our services. Our customers typically do not have the financial capacity to invest in technology at scale and often struggle with the manual process or use fragmented point solutions.

我們的技術投資一直並將繼續致力於該流程的數字化、標準化和自動化，從而提高我們團隊的生產力和服務質量。我們的客戶通常沒有經濟能力大規模投資技術，並且經常在手動流程中苦苦掙扎或使用分散的單點解決方案。

Our technology journey has been focused largely in 3 areas: intelligent automation, patient experience and scaled analytics. Our intelligent automation work, which began in 2018, has focused on automating repeatable processes and reducing the need for labor in areas such as claims adjustments, insurance verifications and payment posting.

我們的技術之旅主要集中在三個領域：智能自動化、患者體驗和規模化分析。我們的智能自動化工作始於 2018 年，重點是實現可重複流程的自動化，並減少索賠調整、保險驗證和付款過帳等領域的勞動力需求。

Our Patient Experience Solutions, which we call entry, unifies and digitizes the scheduling, patient registration and patient payment experience which provides a combination of patient self-service and behind-the-scenes automation that makes patients' lives easier and improves the efficiency of our team.

我們的患者體驗解決方案（我們稱之為入口）統一併數字化了日程安排、患者登記和患者付款體驗，提供患者自助服務和幕後自動化的結合，使患者的生活更輕鬆，並提高我們的效率團隊。

Our scaled analytics power solutions across our customer base, by maximizing revenue opportunity identification, using our breadth of data, algorithms and expert rules across our over 500 customers. Across all of these areas, we leverage machine learning for example, to extract data from documents to personalized patient payment plans and define data anomalies that are new revenue opportunities.

我們的規模化分析為我們的客戶群提供解決方案，通過最大限度地識別收入機會，利用我們覆蓋 500 多個客戶的廣泛數據、算法和專家規則。例如，在所有這些領域，我們利用機器學習從文檔中提取數據以製定個性化患者付款計劃，並定義可帶來新收入機會的數據異常。

Now for a few specific examples of technology deployed in our second quarter. The automation team released several net new use cases. One high-value example is our enhanced prior authorization determination. This solution determines whether a prior auth is required by comparing the scheduled service against frequently changing payer policies to determine whether an authorization is required without human intervention.

現在我們來看一些第二季度部署的技術的具體示例。自動化團隊發布了幾個新的用例。一個高價值的例子是我們增強的事先授權確定。該解決方案通過將計劃的服務與頻繁更改的付款人策略進行比較來確定是否需要事先身份驗證，從而確定是否需要授權，而無需人工干預。

In another example, we continue to leverage our data by expanding our work prioritization model across our modular offerings. By analyzing the over 500 million patient encounters we touch annually, our models can more accurately predict the likelihood of collectibility and time to collection translating to more revenue for our customers faster. We expanded these models to our underpayments business, which have now automated and simplified the complex trade-offs our teams use to prioritize their work.

在另一個例子中，我們通過在模塊化產品中擴展工作優先級模型來繼續利用我們的數據。通過分析我們每年接觸的超過 5 億名患者，我們的模型可以更準確地預測收集的可能性和收集時間，從而更快地為我們的客戶帶來更多收入。我們將這些模型擴展到我們的少付業務中，現在已經自動化並簡化了我們團隊用來確定工作優先級的複雜權衡。

In summary, we made significant progress across our technology portfolio, including extending our business intelligence solutions to new clients, automating cash purchasing activities, reducing appeal generation time, consolidating legacy applications and improving stability and scale. Our efforts today create a strong foundation for us to leverage AI across our technology platform.

總之，我們在技術組合方面取得了重大進展，包括將我們的商業智能解決方案擴展到新客戶、自動化現金采購活動、減少上訴生成時間、整合遺留應用程序以及提高穩定性和規模。我們今天的努力為我們在整個技術平台上利用人工智能奠定了堅實的基礎。

We believe large language models have the potential to significantly reduce and in some areas, fully automate workloads by summarizing account histories and medical records, classifying documents enabling patients to solve more complex problems via self-service and more.

我們相信，大型語言模型有可能通過總結賬戶歷史和醫療記錄、對文檔進行分類，從而顯著減少工作量，並在某些領域實現完全自動化，使患者能夠通過自助服務等解決更複雜的問題。

Our data science and technology team has made great progress testing the applicability of these models on data from real-world use cases and we expect to have several end production by year-end. We think of AI and large language models as a significant new toolkit that when combined with our data access and revenue cycle expertise will enable us to achieve another level of automation, patient satisfaction and service quality, which will further extend our competitive advantage.

我們的數據科學和技術團隊在測試這些模型對實際用例數據的適用性方面取得了巨大進展，我們預計到年底將有幾個最終產品。我們認為人工智能和大型語言模型是一個重要的新工具包，與我們的數據訪問和收入周期專業知識相結合，將使我們能夠實現更高水平的自動化、患者滿意度和服務質量，這將進一步擴大我們的競爭優勢。

Finally, I'd like to discuss the continued strength of our commercial engines. End market dynamics remain favorable due to continued financial and capital pressures faced by providers. Large and aged AR backlogs, change in reimbursement and policy developments as well as overall costs continue to drive a need for our solutions. Despite these challenges, over 70% of providers continue to manage revenue cycle processes in-house. We believe these factors present us with sizable runway for long-term growth across the business.

最後，我想討論一下我們商用發動機的持續優勢。由於供應商持續面臨財務和資本壓力，終端市場動態仍然有利。大量且陳舊的 AR 積壓、報銷和政策制定的變化以及總體成本繼續推動對我們解決方案的需求。儘管面臨這些挑戰，超過 70% 的提供商繼續在內部管理收入周期流程。我們相信這些因素為我們整個業務的長期增長提供了廣闊的空間。

In Q2, the pipeline expanded across both end-to-end and modular opportunities for both hospital and physician customers. We saw an increase in cross-sell activity as our teams leveraged our new commercial model. We increased the number of meetings with CFOs and heads of revenue cycle, thanks to internal opportunities from Cloudmed cross-sell of legacy R1 modular solutions into the Cloudmed base and introduction of end-to-end solutions to the Cloudmed base.

在第二季度，管道擴展到醫院和醫生客戶的端到端和模塊化機會。隨著我們的團隊利用我們的新商業模式，我們看到交叉銷售活動有所增加。我們增加了與首席財務官和收入周期負責人的會議次數，這要歸功於 Cloudmed 將傳統 R1 模塊化解決方案交叉銷售到 Cloudmed 基地以及向 Cloudmed 基地引入端到端解決方案的內部機會。

On the modular side, bookings in the first half were ahead of expectations, with a faster sales and deployment cycle relative to our end-to-end solutions, we've been able to capture market demand faster with momentum expected to continue into the second half of the year. On the end-to-end side, several partnership opportunities continue to progress in our pipeline. Furthermore, there was an uptick in inbound activity throughout the first half of the year, thanks to the cross-sell efforts made by our commercial teams. As a result, we are making good progress towards our goal of signing $4 billion of NPR by year-end.

在模塊化方面，上半年的預訂量超出了預期，相對於我們的端到端解決方案，銷售和部署週期更快，我們能夠更快地捕捉市場需求，預計這一勢頭將持續到下半年半年。在端到端方面，我們的管道中繼續取得一些合作機會。此外，得益於我們商業團隊的交叉銷售努力，上半年入境活動有所增加。因此，我們正在朝著年底前簽署 40 億美元 NPR 的目標取得良好進展。

In closing, our teams remain dedicated to our 2023 priorities. We solve an important problem for our customers in a time when they need us the most. The market for our solutions is large and growing, and we have highly differentiated offerings with technology and data to maximize results for our customers.

最後，我們的團隊仍然致力於 2023 年的優先事項。我們在客戶最需要我們的時候為他們解決重要問題。我們的解決方案市場規模巨大且不斷增長，我們擁有高度差異化的產品和技術和數據，可以最大限度地為客戶帶來成果。

Now I'd like to turn the call over to Jennifer to review the financials.

現在我想把電話轉給詹妮弗，讓她審查財務狀況。

Thank you, Lee, and good morning, everyone. We are pleased to report strong second quarter results with revenue of $560.7 million and adjusted EBITDA of $142.9 million. Adjusted EBITDA for the quarter grew 64% year-over-year and was well ahead of our expectations, excluding the $11.6 million reserve taken in the quarter for the physician customer that Lee referenced earlier. I'll provide more detail on that shortly.

謝謝李，大家早上好。我們很高興地報告強勁的第二季度業績，收入為 5.607 億美元，調整後 EBITDA 為 1.429 億美元。本季度調整後 EBITDA 同比增長 64%，遠遠超出我們的預期，不包括 Lee 之前提到的本季度為醫生客戶提取的 1160 萬美元儲備金。我很快就會提供更多細節。

But first, I'd like to provide some color on revenue. Total revenue in the second quarter grew 43% year-over-year, driven by contributions from the Cloudmed acquisition completed in late Q2 of last year and revenue from new end-to-end customer wins in 2022. Normalizing for Cloudmed, revenue growth was 13% compared to the second quarter of 2022.

但首先，我想提供一些有關收入的信息。第二季度總收入同比增長 43%，這得益於去年第二季度末完成的 Cloudmed 收購的貢獻以及 2022 年新的端到端客戶贏得的收入。Cloudmed 正常化後，收入增長為與2022 年第二季度相比增長13%。

So let's go through some additional details on our revenue growth. Net operating fees of $357.8 million grew approximately 12% or $39.5 million year-over-year from new business wins. On a sequential basis, net operating fees declined $3.2 million due to normal seasonality and cash collections. We also moderated the pace of employee and vendor contract transitions at some of our newer customers. While the timing of these transitions impact net operating fee revenue, it has little or no impact on near-term adjusted EBITDA. This transition is also beneficial from an operational standpoint as it creates better stability and customer satisfaction during the onboarding process.

那麼，讓我們來了解一下有關我們收入增長的一些其他詳細信息。由於新業務的成功，淨運營費用達到 3.578 億美元，同比增長約 12%，即 3,950 萬美元。由於正常的季節性和現金回收，淨運營費用環比下降了 320 萬美元。我們還放慢了一些新客戶的員工和供應商合同過渡的步伐。雖然這些轉變的時間會影響淨運營費收入，但對近期調整後的 EBITDA 影響很小或沒有影響。從運營角度來看，這種轉變也是有益的，因為它在入職過程中創造了更好的穩定性和客戶滿意度。

Incentive fees of $30.8 million in the second quarter were ahead of our expectations, driven by strong operational performance and the achievement of cumulative performance targets for some of our customers. We are very pleased with the progress our operational teams are making here as these incentives are aligned directly to our operational metrics. Our commitment to execution drove the sequential improvement in revenue compared to last quarter. Our modular and other revenue posted another strong quarter with revenue of $172.1 million. Revenue from Cloudmed Solutions was up 20% year-over-year and remains on track to grow 20% full year.

在強勁的運營業績和部分客戶累計業績目標實現的推動下，第二季度的激勵費用為 3080 萬美元，超出了我們的預期。我們對我們的運營團隊在這裡取得的進展感到非常滿意，因為這些激勵措施與我們的運營指標直接一致。與上季度相比，我們對執行的承諾推動了收入的連續改善。我們的模塊化和其他收入再次實現強勁的季度收入，達到 1.721 億美元。 Cloudmed Solutions 的收入同比增長 20%，全年有望增長 20%。

Turning to expenses for the quarter. Non-GAAP cost of services in Q2 was $364.5 million, up $84 million year-over-year. The increase was primarily driven by Cloudmed and costs related to onboarding our new customers. On a sequential basis, non-GAAP cost of services remained relatively flat, thanks to cost discipline across our teams, benefits from automation and realization of cost synergies.

轉向本季度的支出。第二季度非 GAAP 服務成本為 3.645 億美元，同比增加 8400 萬美元。這一增長主要是由 Cloudmed 以及與新客戶入職相關的成本推動的。從環比來看，非公認會計原則服務成本保持相對平穩，這要歸功於我們團隊的成本紀律、自動化帶來的好處以及成本協同效應的實現。

Non-GAAP SG&A expenses were $53.3 million in the second quarter, which includes the reserve previously mentioned. Excluding this reserve, non-GAAP SG&A expenses would have been essentially flat from the first quarter as we realize cost synergies in real estate and in corporate functions. Let me provide some additional color on the charge taken this quarter related to one of our physician customers. In the third quarter of last year, we booked a reserve for this customer for approximately $10 million.

第二季度非 GAAP SG&A 費用為 5330 萬美元，其中包括前面提到的準備金。排除這筆儲備金，非公認會計原則的銷售、一般及行政費用與第一季度相比基本持平，因為我們實現了房地產和公司職能方面的成本協同效應。讓我對本季度與我們的一位醫生客戶相關的指控提供一些額外的信息。去年第三季度，我們為該客戶預訂了約 1000 萬美元的儲備金。

In mid-July of this year, the customer announced the decision to cease operations effective July 31. As a result, we have increased the reserve for this customer by $11.6 million in the quarter and are now fully reserved for all amounts outstanding. We are also pursuing payment for the outstanding receivables balance. Our adjusted EBITDA, as reported for the quarter was $142.9 million. Excluding the reserve, adjusted EBITDA would have been well ahead of expectations we communicated on our last earnings call. Higher incentive fees, higher modular revenue, and lower cost due to continuing operating discipline were the main drivers of this performance.

今年 7 月中旬，該客戶宣布決定於 7 月 31 日起停止運營。因此，我們在本季度為該客戶增加了 1160 萬美元的準備金，現在已為所有未償還金額全額保留。我們還在追討未清應收賬款餘額。本季度報告的調整後 EBITDA 為 1.429 億美元。不包括準備金，調整後的 EBITDA 將遠遠超出我們在上次財報電話會議上傳達的預期。更高的激勵費用、更高的模塊化收入以及由於持續的運營紀律而導致的更低的成本是這一業績的主要驅動力。

Lastly, we incurred $28.3 million in other expenses primarily related to Cloudmed integration cost and technology transformation initiatives. We remain on track to achieve approximately $30 million in cost synergies in 2023 from these activities.

最後，我們產生了 2830 萬美元的其他費用，主要與 Cloudmed 集成成本和技術轉型計劃相關。我們仍有望在 2023 年通過這些活動實現約 3000 萬美元的成本協同效應。

Now let me provide a few comments on the balance sheet. Cash and cash equivalents at the end of June were $123.1 million compared to $104.2 million at the end of March. We generated $57.4 million in cash from operations in the quarter. We also incurred $25 million for CapEx and used $12 million for debt pay down in the quarter.

現在讓我對資產負債表發表一些評論。 6 月底的現金和現金等價物為 1.231 億美元，而 3 月底的現金和現金等價物為 1.042 億美元。我們本季度的運營產生了 5740 萬美元的現金。本季度我們還產生了 2500 萬美元的資本支出，並使用了 1200 萬美元來償還債務。

Net debt at the end of the quarter was $1.65 billion, down from $1.68 billion at the end of March, driven by the debt paydown I just mentioned and a higher cash balance. As I've previously discussed, we expect net debt and leverage to continue to decline over the course of the year. Our liquidity remains strong with approximately $632 million of liquidity at the end of June, both from cash on our balance sheet and availability on our revolver.

在我剛才提到的債務償還和現金餘額增加的推動下，本季度末的淨債務為 16.5 億美元，低於 3 月底的 16.8 億美元。正如我之前討論的，我們預計淨債務和槓桿率將在今年繼續下降。我們的流動性仍然強勁，截至 6 月底約有 6.32 億美元的流動性，其中包括資產負債表上的現金和左輪手槍的可用資金。

So what does this mean for our financial outlook? We are updating our 2023 guidance to reflect our expectations for the remainder of the year. Let me start by saying that our operational performance has been strong, as demonstrated in our core financial results this quarter and year-to-date, even when considering the impact of the reserve taken for the physician customer. We are very pleased with our financial result and with the progress we are making against the priorities that we reviewed. Starting with revenue. We now expect 2023 revenue to be in a range of $2.255 billion to $2.275 billion.

那麼這對我們的財務前景意味著什麼呢？我們正在更新 2023 年指導，以反映我們對今年剩餘時間的預期。首先我要說的是，我們的運營業績一直很強勁，正如我們本季度和今年迄今為止的核心財務業績所證明的那樣，即使考慮到為醫生客戶預留的準備金的影響也是如此。我們對我們的財務業績以及我們在審查的優先事項方面取得的進展感到非常滿意。從收入開始。我們目前預計 2023 年收入將在 22.55 億美元至 22.75 億美元之間。

Our updated guidance is driven by 3 factors: number one, the wind down of the physician customer will impact revenue in the second half of the year by approximately $15 million; number two, the timing of new end-to-end business wins is expected to impact revenue in the second half by approximately $25 million. Our guidance assumes new business signed from this point forward in the year will not contribute revenue in 2023. Number three, timing of employee and vendor transitions will impact our net operating fees as we pace the ramp of our recent customer wins.

我們更新的指導是由三個因素驅動的：第一，醫生客戶的減少將影響下半年的收入約 1500 萬美元；第二，新的端到端業務獲勝的時機預計將影響下半年收入約 2500 萬美元。我們的指導假設從今年此時開始簽署的新業務不會為 2023 年貢獻收入。第三，隨著我們加快近期贏得客戶的步伐，員工和供應商過渡的時間將影響我們的淨運營費用。

It's important to note that this will not have a material impact on our adjusted EBITDA for the year as the costs will not transition to us until we execute the operational transition. Our current pace is aligned with our customer expectations. It creates stability in our operations and is the right balance in the near future as we continue to deploy new business. One additional note on revenue guidance. Our prior guidance anticipated incentive fees would increase modestly across each quarter to achieve approximately $30 million by the fourth quarter. We achieved those results in the second quarter, which included a benefit from metrics calculated on a cumulative basis. Therefore, we expect incentive fees in the second half of 2023 to remain in line with comments provided on prior calls.

值得注意的是，這不會對我們今年調整後的 EBITDA 產生重大影響，因為在我們執行運營轉型之前，成本不會轉移給我們。我們當前的步伐符合客戶的期望。它為我們的運營創造了穩定性，並且是我們在不久的將來繼續部署新業務時的正確平衡。關於收入指導的附加說明。我們之前的指導預計獎勵費用將在每個季度小幅增加，到第四季度達到約 3000 萬美元。我們在第二季度取得了這些成果，其中包括累積計算的指標帶來的收益。因此，我們預計 2023 年下半年的激勵費用將與之前電話會議中提供的評論保持一致。

We now expect 2023 adjusted EBITDA of $600 million to $615 million. This update includes 3 drivers in our business. Number one, the $11.6 million reserve for the physician customer we previously discussed. Number two, the second half EBITDA impact for the same customer as they wind down operations and we adjust our cost structure to reflect the change. And number three, better operational execution year-to-date and changes we are making to our model to ensure long-term stabilization through scale. This has allowed our operations team to realize savings on some key initiatives in the first half of the year that were already embedded in our original guidance for the second half of 2023.

我們目前預計 2023 年調整後 EBITDA 為 6 億至 6.15 億美元。本次更新包括我們業務中的 3 個驅動程序。第一，我們之前討論過的為醫生客戶準備的 1160 萬美元。第二，下半年 EBITDA 對同一客戶的影響，因為他們結束了業務，我們調整了成本結構以反映這一變化。第三，今年迄今為止更好的運營執行以及我們正在對模型進行的更改，以確保通過規模實現長期穩定。這使我們的運營團隊能夠在上半年實現一些關鍵舉措的節省，這些舉措已納入我們 2023 年下半年的原始指導中。

For the third quarter, we expect adjusted EBITDA to be slightly ahead of current consensus estimates. Overall, absent the impact from the physician customer our adjusted EBITDA would have been above the high end of our prior guidance range, thanks to the efforts of our global teams that work to serve our customers every day. We are well positioned to deliver value to healthcare providers who are unable to do so on their own, and we will continue to execute on our priorities to drive shareholder value.

對於第三季度，我們預計調整後的 EBITDA 將略高於目前的共識預期。總體而言，如果沒有醫生客戶的影響，我們調整後的 EBITDA 將高於我們之前指導範圍的上限，這要歸功於我們每天為客戶服務的全球團隊的努力。我們處於有利位置，可以為無法獨自實現這一目標的醫療保健提供者提供價值，並且我們將繼續執行我們的優先事項，以推動股東價值。

In closing, our team is executing well on both operations and on our customer performance metrics. We are on track to deliver results for the second half, in line with our updated guidance and look forward to updating you on our progress on future calls.

最後，我們的團隊在運營和客戶績效指標方面都表現良好。我們有望根據更新後的指導方針交付下半年的結果，並期待在未來的電話會議上向您通報我們的最新進展。

Now I'll turn the call over to the operator for Q&A.

現在我將把電話轉給接線員進行問答。

(Operator Instructions)

（操作員說明）

And your first comes from the line of Glen Santangelo from Jefferies.

第一個來自 Jefferies 的 Glen Santangelo 血系。

Just a lot of people are asking questions, obviously, about this customer. And everyone is trying to do these gymnastics to figure out how much the charge in this customer may be impacting the '23 full year guidance. But it sounds like, Jennifer, I heard you correctly, you don't anticipate taking any additional charges. And if we could maybe just look past '23 for a second and look to '24, based on reports and what we've seen about these companies, this customer's NPR, is it fair to say that maybe this customer represents a little bit more than 1% of your total NPR. And if we think about this customer having, let's call it, average margins, is it fair to sort of size up this customer a little bit maybe more than 1% of [Brad] and EBITDA because what I'm really trying to figure out is the impact of this customer on 2024 and beyond really.

顯然，很多人都在詢問有關這位客戶的問題。每個人都在嘗試做這些練習，以弄清楚該客戶的費用可能會對 23 年全年指導產生多大影響。但聽起來，詹妮弗，我沒聽錯，你預計不會收取任何額外費用。如果我們可以稍微回顧一下 23 世紀，看看 24 世紀，根據報告和我們對這些公司、該客戶的 NPR 的了解，可以公平地說，也許該客戶代表了更多的東西低於總NPR 的1% 。如果我們考慮這個客戶的平均利潤率，那麼稍微提高這個客戶的規模是否公平，也許超過 [Brad] 和 EBITDA 的 1%，因為我真正想弄清楚的是是該客戶對2024 年及以後的真正影響。

Thanks, Glen. Yes. So the way to think about this customer is, at this point, with the $11.6 million charge we took in the quarter, we are fully reserved for all of the AR that's outstanding. So there's no more exposure there from an AR perspective. From a just normal operations perspective in the second half of the year, we -- as we noted, we expect the revenue impact to be about $15 million. So the customer on an annual basis, about $30 million of revenue, low 30% margins here. And so that's the annual kind of impact.

謝謝，格倫。是的。因此，考慮這個客戶的方式是，在這一點上，我們在本季度收取了 1160 萬美元的費用，我們完全保留了所有未完成的 AR。所以從 AR 的角度來看，沒有更多的曝光。從下半年正常運營的角度來看，正如我們所指出的，我們預計收入影響約為 1500 萬美元。因此，客戶每年的收入約為 3000 萬美元，這裡的利潤率低至 30%。這就是年度影響。

In the second half of the year, it's $15 million on revenue. The EBITDA impact is more in the second half because we're not -- we're assuming we're not going to be generating any revenue, but it will take us some time to rightsize the cost structure. So there will be a bit of an outsized impact in the second half of the year, but will be normalized going into '24.

下半年的收入為 1500 萬美元。下半年的 EBITDA 影響更大，因為我們假設我們不會產生任何收入，但我們需要一些時間來調整成本結構。因此，今年下半年將會產生一些巨大的影響，但進入 24 年後將會正常化。

Okay. That's awesome. I really appreciate that detail. Lee, maybe if I could just ask you a quick follow-up on the current operating environment. It sounds like you're getting -- you're starting to see a tailwind from this utilization uptick that we've seen across the industry. And in your presentation, you seem to suggest that you're comfortable adding that $4 billion of NPR in the back half of the year. Could you maybe just frame the conversation you're seeing or having with your customers right now and how confident you are in that $4 billion? And just maybe what you're seeing in the market more broadly.

好的。棒極了。我真的很欣賞這個細節。 Lee，也許我可以請您快速跟進當前的操作環境。聽起來你開始看到我們在整個行業看到的利用率上升帶來的順風車。在您的演講中，您似乎表示您願意在今年下半年增加 40 億美元的 NPR。您能否簡單描述一下您現在看到的或與客戶進行的對話以及您對這 40 億美元的信心有多大？也許您在市場上看到的更廣泛的情況。

Yes. So Glen, let me touch on a few things on the market first and then Jennifer, if you have any color commentary before I get into new business. On the utilization side, largely in line with our expectations, we have a mix of customers in different geographies, different care settings. There's obviously a lot of factors that can drive variances to industry average. We're generally positive. We see some more stability. The thing you have to note is you'd have to look at our specific -- our 3 largest for example, look at the geographies, what their care settings are to kind of do the math. And so there's some -- there's always some variability within our customer base. But we feel good about it. So we're seeing what you see across the market, which is some level of stabilization in volumes.

是的。所以格倫，讓我先談談市場上的一些事情，然後詹妮弗，如果你在我進入新業務之前有任何色彩評論。在使用方面，很大程度上符合我們的預期，我們擁有來自不同地理位置、不同護理環境的客戶。顯然有很多因素會導致行業平均水平的差異。我們總體上持積極態度。我們看到了更多的穩定性。你必須注意的是，你必須看看我們的具體情況——例如我們最大的三個，看看地理位置，他們的護理環境是什麼，才能進行數學計算。因此，我們的客戶群中總是存在一些變化。但我們對此感覺良好。因此，我們看到了整個市場的情況，即成交量出現一定程度的穩定。

Jennifer, anything to add there before I get to new business?

詹妮弗，在開始新業務之前有什麼要補充的嗎？

No, I think that's in line.

不，我認為這是符合的。

Okay. On the new business side, a couple of things I'd say. First of all, the headline matter. I and the team are confident in signing at least $4 billion of NPR by year-end. Here's what I'd say a couple of things. This one is there's a little bit of a color commentary that I think it's consistent with what I've said the last couple of months, but I'll add a couple of points of emphasis. First is the market demand is strong, okay? So we have seen increased interest within mid to large systems. And it's a couple of factors.

好的。在新業務方面，我想說幾件事。首先，標題很重要。我和團隊有信心在年底前簽署至少 40 億美元的 NPR。這是我想說的幾件事。這個有一點色彩評論，我認為它與我過去幾個月所說的一致，但我會添加幾個重點。首先是市場需求旺盛好嗎？因此，我們看到人們對大中型系統的興趣日益濃厚。這是有幾個因素的。

It's very, very common themes. I personally spent most of my time on the road talking to prospective customers and current customers. And the conversation is always very similar. And it goes something like this. One is especially in certain markets on the West Coast, continued labor challenges, challenges in particular and hiring administrative staff and the cost structure of their workforce. The second is we could go on, on this 1 as well, there's still pressure on payer time lines with residual AR.

這是非常非常常見的主題。我個人大部分時間都花在路上與潛在客戶和現有客戶交談。而且談話內容總是非常相似。事情是這樣的。其中之一尤其是在西海岸的某些市場，持續的勞動力挑戰，特別是招聘管理人員及其勞動力成本結構的挑戰。第二個是我們可以繼續，在這一點上，剩餘 AR 對付款人時間線仍然存在壓力。

So depending on the market, that is always a theme within the boardrooms of these systems is what's happening in our market. And coincidentally, we can help them because we -- with the Cloudmed data of access to 95 of the top 100 systems, we have access to data across every state, every payer, every care setting. And so we can show them with what we call a net revenue variance analysis exactly what's happening in their markets and CEOs of current customers or prospective customers are just wowed by the analysis we can do given the data sets we have, but it typically shows there's hotspots, if you will.

因此，根據市場的不同，我們市場上正在發生的事情始終是這些系統董事會的一個主題。巧合的是，我們可以幫助他們，因為我們通過訪問前 100 個系統中的 95 個系統的 Cloudmed 數據，可以訪問每個州、每個付款人、每個護理機構的數據。因此，我們可以通過所謂的淨收入方差分析向他們展示他們的市場中到底發生了什麼，當前客戶或潛在客戶的首席執行官對我們根據我們擁有的數據集所做的分析感到驚嘆，但它通常表明存在熱點，如果你願意的話。

And the third thing we've heard is that there's -- the technology theme is always tricky because if you're a hospital system, there's only so much you can invest organically in technology or with vendors you hire. And then oftentimes, if you do have the capacity to invest in vendors, it's often fragmented point solutions.

我們聽到的第三件事是——技術主題總是很棘手，因為如果你是一個醫院系統，你只能對技術或你僱用的供應商進行有機投資。通常情況下，如果您確實有能力投資供應商，那麼它通常是分散的單點解決方案。

So they look to us and say, where can you help us? And the conversation Jennifer and I and my team has is, look, we have a history of significant investment in technology, both to make our operators more efficient and to drive innovation in different areas, whether it is the front end on the patient side, the middle and coding or CDI prioritization or the back end on something that sounds have been benign, but low balance AR is a big industry problem, we can apply automation to help solve that. So that's the nature of the discussion with the headline that demand is very strong.

所以他們看著我們說，你能在哪裡幫助我們？詹妮弗和我以及我的團隊的對話是，看，我們在技術方面有著大量投資的歷史，既可以提高我們的操作人員的效率，又可以推動不同領域的創新，無論是患者方面的前端，中間和編碼或CDI 優先級或後端聽起來是良性的，但低平衡AR 是一個大行業問題，我們可以應用自動化來幫助解決這個問題。這就是標題為“需求非常強勁”的討論的本質。

The second point I'd say is our pipeline. I have a lot of resources internally, a team that's been around 20 years and seen patterns for the last 10 on quality of pipeline, including my predecessor, who I still talk to a good bit. Our pipeline has a range of deals across different sizes and types for both the modular and end-to-end business, and it is very strong. I'm not -- don't give metrics on size of the pipeline. I've run sales teams.

我要說的第二點是我們的管道。我在內部擁有大量資源，這個團隊已經成立了大約 20 年，看到了過去 10 年管道質量的模式，包括我的前任，我仍然和他經常交談。我們的管道擁有一系列不同規模和類型的模塊化和端到端業務交易，而且非常強大。我不會——不要給出管道規模的指標。我管理過銷售團隊。

I understand you can always do mass gymnastics on size of the pipeline. What I would say is it is as strong or stronger than we've ever seen. And the last thing I'd make is our message and value prop is resonating. The combination of our Revenue Integrity Cloudmed business, plus the legacy R1 business is resonating. And so all signs are very positive towards signing the $4 billion by end of the year.

我知道你總是可以根據管道的大小進行大規模體操。我想說的是，它比我們見過的更強大，甚至更強。我要做的最後一件事是我們的信息和價值支柱正在引起共鳴。我們的 Revenue Integrity Cloudmed 業務與傳統 R1 業務的結合正在引起共鳴。因此，所有跡像都非常積極地推動今年年底簽署 40 億美元協議。

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

您的下一個問題來自加拿大皇家銀行資本市場部的 Sean Dodge。

And congratulations on the great progress again this quarter. Lee, your comments around strong market demand and seeing an uptick in inbound interest and end-to-end. Where do you all stand now from a nominal deployment capacity? I think you entered the year with a structure that could support $9 billion, but I also think there are plans to continue scaling that. Have you guys continued to invest there to expand that to meet this demand? .

祝賀本季度再次取得的巨大進步。 Lee，您對強勁的市場需求以及入境興趣和端到端的上升的評論。從名義部署能力來看，你們現在處於什麼位置？我認為今年你的結構可以支持 90 億美元，但我也認為有計劃繼續擴大規模。你們是否繼續在那裡投資以擴大規模以滿足這一需求？ 。

Yes, Jennifer, do you want to take that?

是的，詹妮弗，你想接受嗎？

Yes, I can answer that one. Sean, the -- from a market capacity perspective to deploy new business, we are still in that between $8 billion and $9 billion range. We're obviously monitoring it with the existing new business wins that we are continuing to deploy as well as the pipeline, as Lee indicated, being strong and just monitoring the time line of when we think those deals are coming in. It's something that we'll continue to monitor. We've kept it fairly stable since we made the investment mid last year and started to ramp some of those resources. But it's something that we'll continue to monitor to see if we need to continue to expand and make an additional investment there? Or if we're comfortable at the level that it is.

是的，我可以回答這個問題。 Sean，從部署新業務的市場容量角度來看，我們仍處於 80 億美元至 90 億美元的範圍內。顯然，我們正在通過我們正在繼續部署的現有新業務勝利以及管道來監控它，正如李指出的那樣，我們很強大，只是監控我們認為這些交易即將到來的時間線。會持續關注。自從我們去年年中進行投資並開始增加其中一些資源以來，我們一直保持相當穩定。但我們將繼續監控這一點，看看我們是否需要繼續擴張並在那裡進行額外投資？或者如果我們對目前的水平感到滿意。

Okay. And then just quickly on the payer reimbursement time lines. I think you said continues to normalize. Are we back to kind of more normal levels now? Are there still some improvements you can drive there? And then at what point can you start to release the extra resources you had to address those issues?

好的。然後很快就可以在付款人報銷時間表上完成。我認為你說的是​​繼續正常化。我們現在回到了更正常的水平嗎？您還可以在那裡進行一些改進嗎？然後你什麼時候可以開始釋放額外的資源來解決這些問題？

So on the time lines, we are -- we have seen some improvement. What I would say is it's more stable. If you look at the days claims payable, which again is not perfect, but a proxy. Some of the public payers are saying that they're up slightly in quarter and some are down. But it's somewhat mixed. So I would say, overall, fairly stable. We saw an improvement in our AR, both AR and [HR] this quarter, modest improvement. And I would say that there's still work to do. There's still opportunity for it to come down. We still aren't back to what I would say is baseline, it's still elevated from historical levels.

因此，在時間線上，我們已經看到了一些改進。我想說的是它更穩定。如果您查看應付索賠天數，這也不是完美的，而是一個代理。一些公共付款人表示，他們的季度收入略有上升，有些則有所下降。但情況有些複雜。所以我想說，總體來說，相當穩定。本季度我們的 AR 和 [HR] 都取得了進步，略有改善。我想說，還有很多工作要做。仍有下跌的機會。我們仍然沒有回到我所說的基線，它仍然高於歷史水平。

And your next question comes from the line of Charles Rhyee from TD Cowen.

您的下一個問題來自 TD Cowen 的 Charles Rhyee。

Jennifer, I wanted to follow up on Glen's question about when we think about 2024. And you mentioned, obviously, this year's EBITDA numbers impacted, obviously, by the charge, but also sort of the ongoing contribution from APP that is no longer there and this normalizing the cost structure. Given sort of what you've given us here, it sounds like that APP contribution would have been something like $3 million to $5 million in EBITDA.

詹妮弗，我想跟進格倫關於我們何時考慮 2024 年的問題。顯然，你提到今年的 EBITDA 數字顯然受到了這項費用的影響，但 APP 的持續貢獻也已不再存在，這使成本結構正常化。鑑於您在這裡向我們提供的信息，聽起來 APP 的 EBITDA 貢獻約為 300 萬至 500 萬美元。

The cost structure part, can you kind of frame sort of what kind of expense we'll be running through or sort of the deleverage you're getting on the construct until you normalize it? Is that more than the contribution perhaps? And I guess what I'm trying to get at is if we were to then add these kind of items back. Is that the right baseline number then to think about as we grow '24?

成本結構部分，您能否框架一下我們將要花費甚麼樣的費用，或者您在結構上獲得的去槓桿化，直到您將其標準化？這可能比貢獻更多嗎？我想我想要表達的是如果我們隨後將這些項目添加回來。當我們成長到 24 世紀時，這個基準數字是正確的嗎？

So on an annual basis, it's about $30 million of revenue with margins in the low 30%. So the EBITDA contribution is higher than that. And that's on an annual basis. But in the second half of the year, Charles, the way to think about the impact is obviously, the revenue is a half year impact on revenue. But on the cost side, it will take us through most of the third quarter to be able to rightsize cost. So it will have an outsized impact because we still have those costs in the business through the third quarter before we're able to really normalize it. So it will create a distorted view in the second half of the year versus just ongoing margin.

因此，每年的收入約為 3000 萬美元，利潤率僅為 30%。因此 EBITDA 貢獻高於此。這是按年度計算的。但在下半年，查爾斯，思考影響的方式顯然是，收入是半年對收入的影響。但在成本方面，我們需要在第三季度的大部分時間裡才能調整成本。因此，這將產生巨大的影響，因為在我們能夠真正使其正常化之前，我們在第三季度的業務中仍然存在這些成本。因此，與持續的利潤率相比，這將在今年下半年產生一種扭曲的觀點。

Okay. Okay. I think I'm back into that. And then, Lee, you talked a lot about automation and particularly in the use of AI. Can you envision going forward, are you -- can you think of a vision in the future where you don't even need people to look at a claim? And I know we have target margins of 35%. It's currently, I think, when -- after the merger happened. But where can that margin opportunity go to? Because if you think about a lot of the use cases you just talked about, I know you already automate a good percentage of the shared services functions.

好的。好的。我想我又回到了那個狀態。然後，李，您談論了很多關於自動化的內容，特別是在人工智能的使用方面。你能想像一下未來嗎？你能想像一個未來甚至不需要人們查看索賠的願景嗎？我知道我們的目標利潤率為 35%。我認為，目前是在合併發生之後。但這個利潤機會去哪裡呢？因為如果您考慮一下您剛才談到的許多用例，我知道您已經自動化了很大一部分共享服務功能。

But where do you see sort of that upper limit? I mean is there a possibility down the road when you think about computer vision, natural language processing, where you don't actually need a human touch to manage a claim?

但你在哪裡看到了這個上限呢？我的意思是，當你考慮計算機視覺、自然語言處理時，是否有可能實際上不需要人工干預來管理索賠？

So Charles, I love the question. I appreciate it. We are thinking very aggressively about how to get to that vision of what you talked about. And what we think about is a frictionless revenue cycle where, to your point, you don't need a person to evaluate some element of a claim. So that's absolutely part of our vision. Let me give you a little detail on just how we think about the application of automation data -- large-scale data and analytics, which, as you know, we have a significant amount of clinical payment reimbursement data through our Cloudmed customer base and then the application of some of these new tools around generative AI. .

查爾斯，我喜歡這個問題。我很感激。我們正在非常積極地思考如何實現您所談論的願景。我們考慮的是一個無摩擦的收入周期，就您而言，您不需要一個人來評估索賠的某些要素。所以這絕對是我們願景的一部分。讓我向您詳細介紹一下我們如何看待自動化數據的應用——大規模數據和分析，正如您所知，我們通過 Cloudmed 客戶群擁有大量臨床支付報銷數據，然後其中一些新工具圍繞生成人工智能的應用。 。

A couple of things. Just the way we think about it, the framework we use is we have -- 3 things we have to think about. The data has to be accessible, quality and accuracy is imperative and privacy has to be at the top of the list. So let me just touch on the first one. We have just you know this, Charles, but $55 billion of NPR end-to-end plus $900 billion of NPR touched with our Cloudmed data. So we absolutely have access to data. But that data can't be siloed across many systems, you need to think about a way to aggregate it, to access it, standardize it, and that's exactly what we have done over the course of our journey on building a data platform, building automation tools and so on.

有幾件事。正如我們思考的方式，我們使用的框架是我們必須考慮的三件事。數據必須可訪問，質量和準確性至關重要，而隱私必須放在首位。讓我談談第一個。 Charles，您知道，我們的 Cloudmed 數據涉及 550 億美元的 NPR 端到端數據，加上 9000 億美元的 NPR 數據。所以我們絕對可以訪問數據。但是這些數據不能跨多個系統進行隔離，您需要考慮一種方法來聚合它、訪問它、標準化它，而這正是我們在構建數據平台、構建數據平台的過程中所做的事情。自動化工具等。

Quality and accuracy is imperative. This isn't like other industries, consumer where you can apply technologies and trend in as you have to be super accurate, especially if you're dealing with something like coding, for example. And then privacy is a core competency of ours, which is embedded in our systems and culture everyday. So the point about this is we have -- we believe we have a right to win with our -- given that we are embedded in our customer workflows and have access to data.

質量和準確性至關重要。這與其他行業、消費者不同，您可以在其中應用技術和趨勢，因為您必須非常準確，尤其是在處理諸如編碼之類的事情時。隱私是我們的核心能力，它每天都嵌入到我們的系統和文化中。因此，重點是，我們相信我們有權利贏得勝利，因為我們已融入客戶工作流程並有權訪問數據。

So the thing I'd say, Charles, just I can give you an example on each end, right. On the automation side, this is applying RPA automation to otherwise labor-intensive and repeatable processes. An example I would use is prior authorization requires multiple touch points, accessing payer portals, et cetera. We are absolutely automating all elements of that area of revenue cycle, which historically is a point of friction to your point, Charles. We just need less people accessing the system to do to accomplish that task.

所以我想說的是，查爾斯，我可以給你舉一個例子，對吧。在自動化方面，這是將 RPA 自動化應用於其他勞動密集型和可重複的流程。我要使用的一個例子是事先授權需要多個接觸點、訪問付款人門戶等。我們絕對正在自動化該收入周期領域的所有要素，這在歷史上是您的觀點的一個摩擦點，查爾斯。我們只需要更少的人訪問系統來完成該任務。

On the analytics side, there's -- we don't talk about this enough, but -- and I use -- I have many examples, but we access an episode of care in any given state, for any given payer, in any given care setting, and we see that thousands or tens of thousands of times across the country. And when we see a charge associated with a hip surgery, we know the variance of that charge. And we could either a, have a human auditing, okay, the charge is not a variant (inaudible) we will check it or we have a model, a bot that says, "Hey, this is out of variance. Let me set in this example to an auditor right, that says, okay, it's above or beyond that reimbursement level. So that's an example of just needing less people, less touches and applying machine learning a model to that area.

在分析方面，我們對這一點的討論還不夠，但是，我用的是，我有很多例子，但是我們在任何給定的州、任何給定的付款人、在任何給定的條件下都可以獲得護理的一段經歷。護理環境，我們在全國各地看到了數千或數万次。當我們看到與髖關節手術相關的費用時，我們就知道該費用的方差。我們可以a，進行人工審核，好吧，費用不是變體（聽不清），我們會檢查它，或者我們有一個模型，一個機器人說，“嘿，這不符合方差。讓我設置這個例子對審計師來說，好吧，它超出了報銷水平。所以這是一個只需要更少的人員、更少的接觸並將機器學習模型應用於該領域的例子。

The third example I'd say is on generative AI. So this is -- there's lots of examples of ChatGPT is applied to SAs, what have you. The common theme in healthcare is 80% of data in healthcare is unstructured, okay? So think of the clinical notes in a medical record. The example we use a lot is when a denial happens from a payer, there's a write-up. And then from the provider, there has to be another write-up. What if there is an automated appeal on that claim that is auto-generated by a large language model that we have tested and verified because we see that claim thousands or tens of thousands of times or that denial.

我要說的第三個例子是關於生成人工智能。所以這就是——有很多 ChatGPT 應用於 SA 的例子，你有什麼。醫療保健領域的共同主題是醫療保健領域 80% 的數據是非結構化的，好嗎？想想病歷中的臨床記錄。我們經常使用的例子是，當付款人拒絕付款時，就會有記錄。然後從提供商處，必須有另一份書面報告。如果我們已經測試和驗證過的大型語言模型自動生成了對該聲明的自動上訴，因為我們看到該聲明數千次或數万次或該否認，該怎麼辦？

And so that's an example of where you'd otherwise have a person writing it, probably using a template, now you have a tool like generative AI that is essentially writing that without any person handling that work. So all these are examples of just needing less people, and that leads to, on the customer side, way more efficiency, faster fast collection, more insight, more prediction of where there might be problems in the claims process. And then for us, Charles, to your point, that gives us confidence in our long-range margin profile.

這就是一個例子，否則你可能需要一個人來編寫它，可能使用模板，現在你有了像生成人工智能這樣的工具，它本質上是在沒有任何人處理這項工作的情況下編寫它。因此，所有這些都是只需要更少人員的例子，這會在客戶方面帶來更高的效率、更快的收集速度、更多的洞察力、更多地預測索賠過程中可能出現問題的地方。對於我們來說，查爾斯，按照您的觀點，這讓我們對我們的長期利潤狀況充滿信心。

And do you think we can see exceeding that 35% over time? Because it seems like particularly when you start adding large language models and being able to remove more people out of the workforce, we can start getting closer to maybe not total software margins, but getting further from where we are.

您認為隨著時間的推移我們會看到超過 35% 嗎？因為看起來特別是當你開始添加大型語言模型並能夠從勞動力中剔除更多人時，我們可以開始接近也許不是總軟件利潤，而是距離我們現在的位置更遠。

Charles, I am aspirational on this, but that's a little too far out. I see good projection in the next -- I can -- I feel confident in the next couple of years. .

查爾斯，我對此充滿抱負，但這有點太遙遠了。我看到未來會有良好的預測——我可以——我對未來幾年充滿信心。 。

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

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

This is Sameer Patel on for Elizabeth Anderson. I was wondering, could you add a little bit more color on that $25 million timing impact from new wins? Sort of give us color on what your previous expectations were versus what you're expecting now?

這是伊麗莎白·安德森的薩米爾·帕特爾。我想知道，您能否為新勝利帶來的 2500 萬美元時間影響添加更多色彩？能否告訴我們您之前的期望與現在的期望？

Sure. The $25 million is based on the assumption of $4 billion in the back half of the year, the original guidance assumes essentially 1 quarter of revenue that we would sign in the back half of the year, but we would start the transitions and actually generating revenue in the fourth quarter. Based on where we sit at the beginning of August now, we've made the assumption that any deals that we sign between now and the end of the year based on a very cautious ramp and deployment process that we would not generate any revenue in year for it.

當然。 2500萬美元是基於下半年40億美元的假設，最初的指導意見基本上假設我們將在下半年簽署收入的四分之一，但我們將開始轉型並實際產生收入在第四季度。根據我們現在八月初的情況，我們假設從現在到年底我們簽署的任何交易都基於非常謹慎的斜坡和部署流程，我們今年不會產生任何收入為了它。

As Lee indicated our pipeline is still very strong, and we're confident about our ability to close business. But at this point, just where we sit in the year, the ability to generate any revenue associated with it, we made the adjustment for that.

正如李所言，我們的管道仍然非常強大，我們對完成業務的能力充滿信心。但在這一點上，就我們在這一年中所處的位置，產生與之相關的任何收入的能力，我們做出了調整。

Got it. Super helpful. And then one last quick question. Just based on your guidance, it looks like your strategic initiatives cost range is a little bit lower for the year. Is there anything specifically driving that? Is that lower integration costs or anything you're sort of postponing into 2024? Just curious on what was driving that down a little bit.

知道了。超級有幫助。最後一個簡短的問題。僅根據您的指導，您今年的戰略計劃成本範圍似乎有點低。有什麼具體的驅動力嗎？這是較低的集成成本還是您推遲到 2024 年的任何事情？只是好奇是什麼導致了這一點的下降。

It's really our integration cost and our outlook on that. We've been very, very prudent in the spend there and as efficient as we can to realize the synergies. We're still confident in the level of synergies that we'll realize this year in that $30 million range, but it will cost us less to get there, which is certainly a good indication that we'll spend less cash to do so.

這實際上是我們的整合成本和我們對此的展望。我們在那裡的支出非常非常謹慎，並儘可能高效地實現協同效應。我們仍然對今年將在3000 萬美元範圍內實現的協同效應水平充滿信心，但實現這一目標的成本會更低，這無疑是一個很好的跡象，表明我們將花費更少的現金來實現這一目標。

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

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

So I actually wanted to follow up on your comment that payer dynamics have improved recently. I know you gave some color. How much of the $6 million outperformance -- $7 million outperformance in the quarter? Would you attribute to that? Or is it all around your own technology investment or process changes? I mean some of the excuse you guys have called out in the past around labor shortage, payer even higher dollar cost claims. Just wondering if you are seeing in terms of the improvement anywhere, even if it's marginal?

所以我實際上想跟進您關於付款動態最近有所改善的評論。我知道你給了一些顏色。本季度 600 萬美元的出色表現 - 700 萬美元的出色表現有多少？你會歸因於此嗎？或者這一切都是圍繞您自己的技術投資或流程變化？我的意思是你們過去針對勞動力短缺、付款人甚至更高的美元成本索賠提出的一些藉口。只是想知道您是否在任何地方都看到了改進，即使它是邊際的？

Jailendra, on the payer time lines, look, when you see the data in the industry, it kind of indicates stable time lines, but our AR is improving modestly. So I would say that we're doing a little bit better than what would be expected in the overall industry. Now we've said on prior earnings calls that we have added labor to bring those balances down. And so we believe that our efforts on behalf of our customers are paying off to do that. That is driving in the quarter drove higher incentive fees. So that's part of the EBITDA impact is the flow-through of those higher incentive fees.

Jailendra，在付款人時間線上，當你看到行業中的數據時，這表明時間線穩定，但我們的 AR 正在適度改善。所以我想說，我們的表現比整個行業的預期要好一些。現在，我們在之前的財報電話會議上表示，我們已經增加了勞動力來降低這些餘額。因此，我們相信，我們為客戶所做的努力正在得到回報。這推動了本季度激勵費用的上漲。因此，EBITDA 影響的一部分是這些更高的激勵費用的流動。

We aren't expecting that there's going to be some huge improvement in the second half of the year. We still expect there's going to be slow, steady improvement, not just even in the second half of this year but into '24 as we come back to more historical norms on the AR and the overall payer time lines. So it was really the incentive fees that drove the performance because we would say our labor associated with that is slightly elevated, but to generate those incremental revenues, it certainly paid off.

我們預計下半年不會出現巨大改善。我們仍然預計，不僅是在今年下半年，而且到 24 年，當我們回到 AR 和整體付款人時間線的更多歷史規範時，將會出現緩慢、穩定的改善。因此，確實是激勵費用推動了業績，因為我們會說與此相關的勞動力略有增加，但為了產生這些增量收入，它肯定得到了回報。

You still expect -- so your guidance is $30 million incentive fees for both 3Q and 4Q, right, just to make sure that.

你仍然期望 - 所以你的指導是第三季度和第四季度 3000 萬美元的激勵費用，對吧，只是為了確保這一點。

No. We -- the guidance on incentive fees has remained unchanged from our prior commentary. So we expect -- because in the quarter, we saw some cumulative impact where, for some of the cumulative metrics, we had a great quarter on those metrics. So we were able to think about it catch up some of the incentive fees where they're cumulative calculations. So for the third quarter, I would expect that it will go down slightly, but then back to the $30 million by the end of the year.

不會。我們 - 關於獎勵費用的指導與我們之前的評論保持不變。所以我們預計 - 因為在本季度，我們看到了一些累積影響，對於某些累積指標，我們在這些指標上有一個很好的季度。因此，我們能夠考慮將其趕上一些獎勵費用，其中它們是累積計算的。因此，對於第三季度，我預計會略有下降，但到年底會回到 3000 萬美元。

Okay. And then I have a question on American Physician Partners customer. Clearly, the situation seems very isolated. But just curious what are your views on customer health in general? And if this development impacts your willingness to work with physician groups in future, our understanding is that you guys have another, of course, $750 million with other physician partner groups, any update that would be helpful.

好的。然後我有一個關於美國醫師合作夥伴客戶的問題。顯然，情況似乎非常孤立。但只是好奇您對客戶健康的總體看法如何？如果這一發展影響了你們未來與醫生團體合作的意願，我們的理解是，你們當然還有與其他醫生合作夥伴團體合作的 7.5 億美元，任何更新都會有幫助。

Yes. I mean -- so Jailendra, what I'd say is just strategically, this is a part of the market we need to continue to work with. We have a capability to apply technology, people, processes, global scale to that end of the market. So broadly, I'd say this is absolutely a part of the market we are going to address and help customers in that space, both on the current base as well as going after net new customers. But there's always something -- some learning here. And we have to be thoughtful about what kind of customers we take on, right, and do our own diligence on the type of work, the markets they serve, the long-term viability of that customer.

是的。我的意思是，Jailendra，我所說的只是戰略上的，這是我們需要繼續合作的市場的一部分。我們有能力將技術、人員、流程、全球規模應用於市場的這一端。總的來說，我想說這絕對是我們將在該領域解決和幫助客戶的市場的一部分，無論是在現有基礎上還是在追求淨新客戶。但總有一些東西——在這裡可以學到一些東西。我們必須深思熟慮我們要接待什麼樣的客戶，對吧，並對工作類型、他們服務的市場以及該客戶的長期生存能力儘自己的努力。

This is an isolated case, though, and we are sympathetic to a physician group that serves this part of the market and want to work with them. So I would say no change to our strategy, but every instance has some learning.

不過，這是一個孤立的案例，我們對服務這部分市場的醫生團體表示同情，並希望與他們合作。所以我想說我們的策略沒有改變，但每個實例都有一些學習內容。

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

您的下一個問題來自摩根士丹利的 Craig Hettenbach。

A question on the positive commentary around cross-sell. Lee, can you just touch on what's resonating? And then any changes in go-to-market or sales under the leadership of Kyle?

關於交叉銷售的積極評論的問題。李，你能談談什麼是引起共鳴的嗎？那麼在凱爾的領導下，上市或銷售方面有什麼變化嗎？

Yes, sure. So just to remind you, Craig, the group, what the commercial strategy is and what we changed. So we still have our President, John Sparby, that handles a lot of the customer interaction. It's a team effort. But as you noted, Hicok, who has 25-plus years of experience, similar pedigree to all the legacy R1 folks in the revenue cycle space is leading our commercial group. The strategy is leverage the Cloudmed customer base to start to move -- make advance some discussions that would eventually lead to end-to-end opportunities. Now that is very purposeful. We're very targeted because our end customer in that space is typically ahead of revenue cycle.

是的，當然。所以只是提醒你，克雷格，我們的團隊，商業策略是什麼以及我們改變了什麼。因此，我們的總裁約翰·斯帕比 (John Sparby) 仍然負責處理大量的客戶互動工作。這是團隊的努力。但正如您所指出的，希科克 (Hicok) 領導著我們的商業團隊，他擁有 25 年以上的經驗，與收入周期領域的所有傳統 R1 人員有著相似的血統。該策略是利用 Cloudmed 客戶群開始行動——推進一些討論，最終帶來端到端的機會。現在這是非常有目的的。我們的目標非常明確，因為我們在該領域的最終客戶通常領先於收入周期。

Then on the other side, and I'll come back to the first piece. But on the other side, there is a set of large R1 end-to-end customers that would benefit from Cloudmed solutions. And that is -- nothing is easy, correct, but that has gone really well advancing those discussions, either within or outside of the current end-to-end contract with our largest customers.

然後在另一邊，我會回到第一部分。但另一方面，有一群大型 R1 端到端客戶將受益於 Cloudmed 解決方案。也就是說，沒有什麼是容易的、正確的，但這確實很好地推進了這些討論，無論是在與我們最大的客戶當前的端到端合同之內還是之外。

So let me go back to the first point. The discussions are sophisticated, in that our first priority with those customers is to advance cross-sell opportunities within Cloudmed. So the discussion that is happening a lot is, let's say, we're working with a large top 100 system, and we've deployed our coding accuracy solution, what we call DRG validation, and we see a major opportunity in optimizing their underpayment, they don't use that service for us.

讓我回到第一點。討論很複雜，因為我們與這些客戶的首要任務是促進 Cloudmed 內的交叉銷售機會。因此，經常發生的討論是，假設我們正在與一個大型前100 名系統合作，並且我們已經部署了我們的編碼準確性解決方案，即我們所說的DRG 驗證，並且我們看到了優化其支付不足的重大機會，他們不為我們使用該服務。

And we have access to all their data. We know the opportunity in that -- in this example, in the underpayment space. It is a very straightforward discussion to cross-sell Cloudmed solutions within that customer. And that's why you're seeing a very strong growth and continued strong growth in Cloudmed.

我們可以訪問他們的所有數據。我們知道其中存在的機會——在這個例子中，就是在支付不足的領域。在該客戶中交叉銷售 Cloudmed 解決方案是一個非常簡單的討論。這就是為什麼您會看到 Cloudmed 的強勁增長和持續強勁增長。

The more sophisticated discussion is how do we elevate a discussion from the head of revenue cycle to the buyer of an end-to-end opportunity the CFO. And so the way that has worked, and I have a couple of examples in my head of recent discussion is we're already doing a great job with the head of revenue cycle on some climate solution. There is a discussion that we are considering expanding a relationship because we're having those same 3 problems I highlighted earlier, which is labor challenges, pressure from payers, and we're having a hard time figuring out our own technology strategy. And that discussion with the head of revenue cycle elevates to the CFO. And those are discussions we've had and what you see in our pipeline is traction from that type of cross-sell opportunity.

更複雜的討論是我們如何將討論從收入周期負責人提升到端到端機會的購買者（首席財務官）。因此，這種方式行之有效，我在最近的討論中舉了幾個例子，我們已經與收入周期負責人在一些氣候解決方案上做得很好。有一次討論稱，我們正在考慮擴大合作關係，因為我們面臨著我之前強調的三個問題，即勞動力挑戰、來自付款人的壓力，以及我們很難制定自己的技術戰略。與收入周期負責人的討論將提升至首席財務官。這些是我們進行過的討論，您在我們的管道中看到的是這種類型的交叉銷售機會的牽引力。

Got it. And then just a follow-up for Jennifer. You're making really nice progress on the integration savings and are on track there. More broadly, can you just touch about anything you're doing in the organization from an efficiency standpoint and maybe it's leveraging some technology, but just how you're thinking about kind of margins on the more intermediate term.

知道了。然後是詹妮弗的後續行動。您在集成節省方面取得了非常好的進展，並且正在步入正軌。更廣泛地說，您能否從效率的角度談談您在組織中所做的任何事情，也許它正在利用一些技術，但您如何考慮更中期的利潤率。

Sure. I mean specific to integration, like I said, we're on track on the synergy realization front. At this point, most of our back-end G&A functions are integrated. And I say we're realizing synergies there. Our facility closures and reductions in our facility footprint are done. So we will, in the back half of the year, be generating synergies from that. You saw some of the onetime other costs in the quarter for some of the facility charges we took. So those are all on track. So we feel very good about the overall integration.

當然。我的意思是具體到整合，就像我說的，我們在實現協同效應方面走上了正軌。至此，我們的大部分後端G&A功能都已經集成了。我說我們正在那裡實現協同效應。我們的設施關閉和設施佔地面積的減少已經完成。因此，我們將在今年下半年從中產生協同效應。您看到了本季度我們收取的一些設施費用的一些一次性其他成本。所以這些都已步入正​​軌。所以我們對整體整合感覺非常好。

Specific to technology and margin improvement, I think Lee gave a lot of examples on different extremes of where we're deploying technology to drive efficiencies, whether it's through just RPA and automating manual task or whether it's through more generative AI and more. What we term internally as more intelligent automation, we do expect that we'll see margin improvement as we move forward in the -- over the long term -- medium to long term from technology deployment. It's built into our model -- into our long-range models, and it's part of that margin maturity on new business as we deploy technology. So I would say that it's factored into the near-term guidance of -- medium-term guidance of the 30% margins.

具體到技術和利潤率的提高，我認為 Lee 舉了很多關於我們部署技術來提高效率的不同極端的例子，無論是通過 RPA 和自動化手動任務，還是通過更俱生成性的人工智能等等。我們內部稱之為更智能的自動化，我們確實預計，隨著我們在中長期技術部署中向前推進，我們將看到利潤率的提高。它內置於我們的模型中——我們的長期模型中，並且是我們部署技術時新業務利潤成熟度的一部分。所以我想說，它已被納入 30% 利潤率的近期指導——中期指導中。

But as Lee indicated earlier, we're constantly looking at other opportunities to continue to deploy new technologies and drive further synergies and efficiencies in the business.

但正如李早些時候指出的那樣，我們不斷尋找其他機會來繼續部署新技術並進一步推動業務協同效應和效率。

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

您的下一個問題來自美國銀行的 Michael Cherny。

This is Hanna Lee on for Mike Cherny. Could you talk a bit about the second half impact for the APP physician customer? How should we think about the full year headwind to EBITDA.

這是邁克·切爾尼 (Mike Cherny) 的漢娜·李 (Hanna Lee)。您能談談下半年對 APP 醫生客戶的影響嗎？我們應該如何看待全年 EBITDA 面臨的不利因素。

Yes. On the second half, we specifically called out the revenue impact of about $15 million in the second half of the year. On a normalized basis, it's a low 30% margin customer. But the second half of the year will be a little bit bigger impact because we won't and are not expecting to generate any revenue in the third quarter, but it will take us some time to get the cost out. So think about from a Q3 versus Q4 impact and having a larger EBITDA impact in Q3.

是的。下半年，我們特別指出了下半年約1500萬美元的收入影響。在正常化的基礎上，它是一個利潤率低至 30% 的客戶。但下半年的影響會更大一點，因為我們不會也不期望在第三季度產生任何收入，但我們需要一些時間才能消除成本。因此，從第三季度與第四季度的影響來看，第三季度的 EBITDA 影響更大。

And your next question comes from the line of Scott Schoenhaus from KeyBanc.

您的下一個問題來自 KeyBanc 的 Scott Schoenhaus。

Thanks for all that color on the uptick in cross-sell activity on the Cloudmed base and modular bookings. You maintained your 20% growth for Cloudmed for the year. What's driving the assumptions in the back half? And does any of the $4 billion in new NPR expected to be signed this year? Is there any opportunity there for cross-sell or upsell in 4Q? Or will those opportunities really emerge in 2024?

感謝 Cloudmed 基地和模塊化預訂上交叉銷售活動的增加。今年 Cloudmed 保持了 20% 的增長。是什麼推動了後半部分的假設？預計今年將簽署的 40 億美元新 NPR 協議中是否有任何一個？第四季度是否有交叉銷售或追加銷售的機會？或者這些機會真的會在 2024 年出現嗎？

Yes. So a couple of things, Scott. What's driving the Cloudmed growth is at the highest level, there is we saw a very large problem of revenue leakage, if you will, with a safety net approach to our customers. And we -- and that problem is large, 1% to 3% of total NPR across hospital systems and physician groups is well over $100 billion problem. And so it's an easy discussion to have when we're going to them and saying, we already work with you with one solution. We have the data. We see the opportunity. And so our cross-sell approach is working.

是的。有幾件事，斯科特。推動 Cloudmed 增長的是最高水平，我們看到了一個非常大的收入流失問題，如果你願意的話，對我們的客戶採取安全網方法。我們——這個問題很大，整個醫院系統和醫生團體的 NPR 總額的 1% 到 3% 遠遠超過 1000 億美元。因此，當我們去找他們並說我們已經與您合作制定了一種解決方案時，這是一個很容易進行的討論。我們有數據。我們看到了機會。所以我們的交叉銷售方法正在發揮作用。

We're also going after what have historically been net new markets for us from the old Cloudmed business, going to physician customers. And we're also innovating with net new products, right, like several new products that we're introducing to customers. So that at the highest level is what is driving continued growth in Cloudmed. On the end-to-end side, these are -- the color I would add are these are sophisticated deals. And by the way, a larger one may or may not be more sophisticated, a couple of variables that I think about when I see whether it's -- I'll give you an example.

我們還在從舊的 Cloudmed 業務中尋找歷史上對我們來說是淨新的市場，即醫生客戶。我們還在淨新產品方面進行創新，就像我們向客戶推出的幾種新產品一樣。因此，從最高層面來說，這就是推動 Cloudmed 持續增長的因素。在端到端方面，我要添加的顏色是這些都是複雜的交易。順便說一句，更大的可能會也可能不會更複雜，當我看到它是否是時，我會考慮幾個變量——我會給你一個例子。

I have a $4 billion to $5 billion NPR system we're working with, 3 hospital system type prospective customer has 1 host system, let's say, 1 EMR. That is a down in the middle. We do that all day, could onboard very quickly, but may have their own set of politics, right, local community boards, different processes, RFP or [no FP].

我正在使用一個價值 40 億至 50 億美元的 NPR 系統，3 個醫院系統類型的潛在客戶擁有 1 個主機系統，比方說，1 個 EMR。那是中間的一個向下。我們整天都這樣做，可以很快加入，但可能有自己的一套政治，正確的，當地社區委員會，不同的流程，RFP 或[無 FP]。

So there's always a few on that versus a very large system, and we have at least a couple of those in our pipeline, we would expect those to take time -- and I would expect to be -- have a very sophisticated conversation on phasing, just like we did with our last large win. And say, at what rate do we want to take on this customer? How do we think about it? The simple framework is always front end, middle, back. We historically have done a lot in the back end with AR on reimbursement, just the classic billing space. We've historically now done a lot more in the middle on coding, and more recently introduced technology on the front end and scheduling registration, coverage discovery and so on.

因此，與一個非常大的系統相比，總是有一些，而且我們至少有幾個在我們的管道中，我們希望這些需要時間 - 我希望 - 就分階段進行非常複雜的對話，就像我們上次大勝利時所做的那樣。並說，我們想以什麼速度接受這個客戶？我們如何看待這個問題？簡單的框架總是前端、中台、後端。歷史上，我們在 AR 報銷方面做了很多後端工作，只是經典的計費空間。從歷史上看，我們在編碼方面做了很多中間工作，最近又引入了前端技術、調度註冊、覆蓋發現等。

And so all of these are unique discussions. I personally on the one hand, very positive, I see blending our pipeline, I'm personally involved in all those discussions. On the other hand, I want to be very thoughtful about not pushing these unnaturally and getting them to in the right place at the right time. So the net of all this is you never really know because you're looking at a pipeline. I have confidence based on where I am and I say by, but we and the team, but we personally -- I'm in many of these discussions, feel very good about closing that on the business this year but it may turn out to be at some point end of the year, which is why we're adjusting [new] piece.

因此，所有這些都是獨特的討論。一方面，我個人非常積極，我看到混合我們的管道，我個人參與了所有這些討論。另一方面，我想非常仔細地考慮不要不自然地推動這些，並讓它們在正確的時間到達正確的位置。因此，所有這一切的最終結果是你永遠不會真正知道，因為你正在查看管道。我對自己的處境充滿信心，我說，但我們和團隊，但我們個人——我參與了許多這樣的討論，對今年結束業務感到非常滿意，但結果可能是是在今年年底的某個時候，這就是我們調整[新]作品的原因。

And your next question comes from the line of George Hill from Deutsche Bank.

您的下一個問題來自德意志銀行的喬治·希爾。

Yes. It's (inaudible) for George. I want to follow up on the earlier commentary on prior authorization. What are you seeing in the prior authorization process from the largest payers (inaudible) making it harder for providers to get paid?

是的。這是（聽不清）給喬治的。我想跟進之前關於事先授權的評論。您在最大付款人（聽不清）的事先授權流程中看到了什麼，導致提供商更難獲得付款？

No. It's a great question. There's a lot of nuances here, and I don't want to take us down a rabbit hole, but it's still a friction point, right? It's absolutely a friction point in the industry. There's a few places where you'll see a lot of attempts at innovation prior off is 1 of them. We feel like we have a huge advantage because we see the workflow. We're used to working with payers. But I would say broadly, no major changes. But look, there's still an element of -- I'd sit with lots of hospital system customers. We have them on our boards. There is a discussion that is both data backed because we can look at days of AR, we can look at time lines by payer, that is what kind of pressure are we seeing from payers? And what you have to remind folks is these payers have software tools that use to optimize reimbursement. So it's a constant battle, if you will, to make sure that providers are paid what they deserve.

不，這是一個很好的問題。這裡有很多細微差別，我不想讓我們陷入困境，但這仍然是一個摩擦點，對吧？這絕對是行業中的一個摩擦點。在一些地方，您會看到很多創新嘗試，其中之一就是。我們覺得我們有巨大的優勢，因為我們看到了工作流程。我們習慣於與付款人合作。但我想說的是，一般來說，沒有重大變化。但你看，仍然有一個因素——我會和很多醫院系統客戶坐在一起。我們的董事會上有他們。有一個討論是有數據支持的，因為我們可以查看 AR 的天數，我們可以查看付款人的時間線，這就是我們從付款人那裡看到什麼樣的壓力？您必須提醒人們的是，這些付款人擁有用於優化報銷的軟件工具。因此，如果您願意的話，這是一場持續不斷的戰鬥，以確保提供者得到應有的報酬。

So no major changes. It's specifically in prior off, but it remains a very, very significant point of friction in the system and one that we're very specifically addressing. .

所以沒有大的改變。它特別是在之前，但它仍然是系統中非常非常重要的摩擦點，也是我們非常具體解決的問題。 。

Got it. That's very helpful color. Just a quick follow-up. Are you seeing any impact from Medicare redetermination in terms of collection and time line?

知道了。這是非常有用的顏色。只是快速跟進。您認為 Medicare 重新確定對收款和時間表有何影響嗎？

Yes. No, it's a great question. No major exposure, and we anticipate minimal long-term impact just based on the time line of rollouts as well the states participating. Just in the interest of time, I'll just make 1 comment. The data we're seeing is that individuals remove will either reenroll with updated paperwork or we'll move into the exchange process. And the latter would increase revenue for providers under new commercial policies. We've also seen a minor uptick in the open uninsured population, but we have a full team dedicated to finding coverage for these claims. So broadly, we are watching this very closely, but no major impact to us.

是的。不，這是一個很好的問題。沒有重大風險，並且根據推出的時間線以及參與的州，我們預計長期影響很小。由於時間關係，我只發表1條評論。我們看到的數據是，被刪除的個人要么使用更新的文書重新註冊，要么我們將進入交換流程。後者將根據新的商業政策增加提供商的收入。我們還看到未投保的公開人口略有增加，但我們有一個完整的團隊致力於為這些索賠尋找承保範圍。總的來說，我們正在密切關注此事，但對我們沒有重大影響。

And our final question comes from the line of Jack Wallace from Guggenheim Securities.

我們的最後一個問題來自古根海姆證券公司的傑克華萊士。

Congrats on the quarter. Just wondering if we could get a quick update on Sutter. Can you remind us kind of when we expect the Phase I of that client to get to full base fee recognition. And then as a follow-up to that, timing expectations for Phase 2.

恭喜本季度。只是想知道我們是否可以快速了解薩特的最新情況。您能否提醒我們，我們預計該客戶的第一階段何時能夠獲得全額基本費用確認。然後作為後續行動，確定第二階段的預期時間。

Yes, George, great question. Just a couple of points, Jennifer, if you have anything to add. Onboarding of the first phase continues to go well. This is obviously a large flagship customer for us on the West Coast as we didn't talk about priorities, but priority number 1, absolutely for us in '23 was operational execution, and that included both stabilizing the current customer base as well as onboarding new customers. This was top of our list on onboarding.

是的，喬治，好問題。詹妮弗，如果您有什麼要補充的，請補充幾點。第一階段的入職工作繼續順利進行。對於我們在西海岸來說，這顯然是一個大型旗艦客戶，因為我們沒有談論優先事項，但對於 23 年的我們來說，第一要務絕對是運營執行，其中包括穩定當前客戶群以及入職新客戶。這是我們入職清單上的首要內容。

So I'm proud to say that the team has done a very, very good job. All metrics have been positive on onboarding Sutter. I would also highlight, they have a new CEO, CFO. It's a very strong new leadership team. I've been, what several times, met with them, educated them on our partnership to date. And overall, they've been very supportive. So we continue to make progress on the latter phases of the deal and feel good about it.

所以我很自豪地說團隊做得非常非常好。所有指標對薩特的入職都是積極的。我還要強調的是，他們有一位新的首席執行官和首席財務官。這是一個非常強大的新領導團隊。我曾多次與他們會面，向他們介紹我們迄今為止的合作夥伴關係。總的來說，他們非常支持。因此，我們在交易的後期階段繼續取得進展，並對此感到滿意。

Jennifer, anything to add?

詹妮弗，有什麼要補充的嗎？

The only thing I would say on the future phases is it's really more of '24 impact. So we would start to -- expect to start planning on the second phase, the latter part of this year and then we'll provide more guidance, obviously, as we give updates on '24. But we're not expecting any impact in '23 for the deployment of the second phase on revenue.

關於未來的階段，我唯一想說的是，它實際上更多的是 24 小時的影響。因此，我們將開始 - 預計在今年下半年開始計劃第二階段，然後我們將在 24 日發布更新時提供更多指導。但我們預計第二階段的部署不會對 23 年的收入產生任何影響。

Got you. That's helpful. Congrats on another strong execution quarter.

明白你了。這很有幫助。祝賀又一個強勁的執行季度。

And this ends our question-and-answer session. Mr. Lee Rivas, I turn the call back over to you for some final closing remarks.

我們的問答環節到此結束。李·里瓦斯先生，我將電話轉回給您，請您發表最後的結束語。

Thank you, Rob, and thank you all for joining us today. Just a few closing comments to end the call. First, as you can tell, we're very focused on strong operational execution into the second half of the year and feel very good about progress we made in the first half. The second point I hope you've got from today is our pipeline is very active across both modular and end-to-end solutions. And then third, I'm glad some questions came to me around technology. This is a big focus area for us. We are investing heavily in the progress we made already in automation, AI, machine learning and deploying generative AI and large language models into our workflows. So we look forward to updating you on future calls, and thank you again for your interest in R1.

謝謝你，羅布，也感謝大家今天加入我們。只需幾句結束語即可結束通話。首先，正如您所知，我們非常注重下半年的強勁運營執行，並對上半年取得的進展感到非常滿意。我希望您從今天了解到的第二點是，我們的管道在模塊化和端到端解決方案方面都非常活躍。第三，我很高興有人向我提出一些有關技術的問題。這是我們的一個重點領域。我們正在對自動化、人工智能、機器學習以及將生成式人工智能和大型語言模型部署到我們的工作流程中已經取得的進展進行大力投資。因此，我們期待在以後的通話中向您通報最新情況，並再次感謝您對 R1 的興趣。

This concludes today's conference call. Thank you for your participation. You may now disconnect.

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。