Teladoc Health Inc (TDOC) 2022 Q2 法說會逐字稿

Hello, and welcome to today's Teladoc Health Q2 Earnings Call. My name is Elliot, and I will be coordinating your call today. (Operator Instructions)

您好，歡迎來到今天的 Teladoc Health Q2 收益電話會議。我的名字是 Elliot，今天我將協調你的電話。 （操作員說明）

I would now like to hand over to Patrick Feeley, Vice President and Investor Relations. The floor is yours. Please go ahead.

我現在想向副總裁兼投資者關係部的 Patrick Feeley 匯報。地板是你的。請繼續。

Thank you, and good afternoon. Today after the market closed, we issued a press release announcing our second quarter 2022 financial results. This press release and the accompanying slide presentation are available on the Investor Relations section of the teladochealth.com website. On this call to discuss the results are Jason Gorevic, Chief Executive Officer; and Mala Murthy, Chief Financial Officer.

謝謝，下午好。今天市場收盤後，我們發布了一份新聞稿，宣布了我們 2022 年第二季度的財務業績。本新聞稿和隨附的幻燈片可在 teladochealth.com 網站的投資者關係部分獲取。在這次電話會議上討論結果的是首席執行官 Jason Gorevic；和首席財務官 Mala Murthy。

During this call, we will also provide our third quarter and full year 2022 outlook, and our prepared remarks will be followed by a question-and-answer session. Please note that we'll be discussing certain non-GAAP financial measures that we believe are important in evaluating Teladoc Health's performance. Details on the relationship between these non-GAAP measures to the most comparable GAAP measures and reconciliations thereof can be found in the press release that is posted on our website.

在本次電話會議中，我們還將提供我們的第三季度和 2022 年全年展望，我們準備好的講話之後將進行問答環節。請注意，我們將討論我們認為對評估 Teladoc Health 的業績很重要的某些非 GAAP 財務指標。有關這些非公認會計原則措施與最具可比性的公認會計原則措施之間的關係及其對賬的詳細信息，請參閱我們網站上發布的新聞稿。

Also, please note that certain statements made during this call will be forward-looking statements as defined by the Private Securities Litigation Reform Act of 1995. Such forward-looking statements are subject to risks, uncertainties and other factors that could cause the actual results for Teladoc Health to differ materially from those expressed or implied on this call. For additional information, please refer to our cautionary statement in our press release and our filings with the SEC, all of which are available on our website.

此外，請注意，本次電話會議期間做出的某些陳述將是 1995 年《私人證券訴訟改革法案》所定義的前瞻性陳述。此類前瞻性陳述受風險、不確定性和其他可能導致實際結果的因素影響Teladoc Health 與本次電話會議中明示或暗示的內容存在重大差異。有關更多信息，請參閱我們在新聞稿中的警告聲明以及我們向 SEC 提交的文件，所有這些都可以在我們的網站上找到。

I would now like to turn the call over to Jason.

我現在想把電話轉給傑森。

Thank you, Patrick. Good afternoon, and thank you for joining us. After the close today, Teladoc Health reported strong second quarter results with both revenue and adjusted EBITDA coming in above the midpoint of our guidance range. We after the second half of the year positioned to expand our market leadership by delivering innovative solutions that transform the way consumers interact with the health care system.

謝謝你，帕特里克。下午好，感謝您加入我們。今天收盤後，Teladoc Health 報告了強勁的第二季度業績，收入和調整後的 EBITDA 均高於我們指導範圍的中點。在下半年之後，我們定位於通過提供改變消費者與醫療保健系統互動方式的創新解決方案來擴大我們的市場領導地位。

We do this through a relentless focus on clinical quality that enables us to deliver value to as many people as possible through an integrated whole-person care offering underpinned by technology and data. This is made possible by our broad set of capabilities and a model that allows us to integrate with all parts of the health care system without misaligned incentives inherent in other parts of the delivery system. Our second quarter outperformance as compared to guidance was primarily driven by Chronic Care revenue, where enrollment came in ahead of our expectations.

我們通過不懈地關注臨床質量來做到這一點，這使我們能夠通過以技術和數據為基礎的綜合全人護理服務為盡可能多的人提供價值。這得益於我們廣泛的能力和一個模型，該模型使我們能夠與醫療保健系統的所有部分集成，而不會出現交付系統其他部分固有的錯位激勵。與指引相比，我們第二季度的表現優於預期主要是由慢性護理收入推動的，其中註冊人數超出了我們的預期。

As discussed earlier in the year, we expected Chronic Care enrollment growth to be weighted toward the back half of 2022. However, our team has worked tirelessly during the second quarter to onboard new populations at several clients ahead of schedule, fast-tracking new program enrollment and driving over 90,000 net new enrollments during the second quarter alone. That enrollment growth came from both new and existing clients. And importantly, we continue to drive multi-program enrollment With roughly 30% of our Chronic Care members now utilizing multiple Chronic Care programs.

正如今年早些時候所討論的，我們預計慢性護理註冊人數的增長將在 2022 年下半年加權。然而，我們的團隊在第二季度不知疲倦地工作，提前在幾個客戶中加入新人口，快速跟踪新計劃僅在第二季度就增加了 90,000 多名新入學人數。入學人數的增長來自新客戶和現有客戶。重要的是，我們繼續推動多項目註冊 我們的慢性護理成員中約有 30% 現在使用多個慢性護理項目。

This is significant not only from a member penetration standpoint, but also serves to improve retention, as our members report higher satisfaction with access to more solutions. We found, for example, that member retention after 1 year is 10% higher for members enrolled in our diabetes program plus at least 1 other program as compared to those enrolled only in the diabetes program.

這不僅從會員滲透的角度來看很重要，而且還有助於提高保留率，因為我們的會員報告說對獲得更多解決方案的滿意度更高。例如，我們發現，與僅參加糖尿病計劃的會員相比，參加我們的糖尿病計劃加上至少 1 個其他計劃的會員在 1 年後的會員保留率高出 10%。

We're also finding that clinical outcomes improve for members enrolled in multiple programs. For example, A1C reduction improves as our diabetes management members go from a stand-alone solution to adding 2, 3 and 4 programs. All of this combines to help us deliver more value to our clients and members while driving greater revenue per member.

我們還發現，參加多個項目的成員的臨床結果有所改善。例如，隨著我們的糖尿病管理成員從單獨的解決方案轉變為添加 2、3 和 4 個程序，A1C 的降低會有所改善。所有這些結合起來，幫助我們為客戶和會員提供更多價值，同時為每位會員帶來更多收入。

While we were pleased to exceed our member enrollment targets during the quarter, we are continuing to see our pipeline of Chronic Care deals developed more slowly than we anticipated at the start of the year, as we discussed in our first quarter call. It remains early in the selling season, but deals continue to progress at a slower pace. We believe at least in part due to competitive noise as the market transitions from stand-alone point solutions to integrated whole-person virtual care.

雖然我們很高興在本季度超過我們的會員註冊目標，但正如我們在第一季度電話會議中所討論的那樣，我們繼續看到我們的慢性護理交易渠道的發展速度比我們在年初預期的要慢。它仍處於銷售旺季的早期，但交易繼續以較慢的速度進行。我們認為，至少部分是由於市場從獨立的單點解決方案過渡到集成的全人虛擬護理時的競爭噪音。

Based on what we're currently seeing in the marketplace, we also believe heightened economic uncertainty over the past several months is increasingly playing a part in delaying the decision-making process in the employer market. More and more, we're seeing our Chronic Care clients recognize the value of combining those products with primary care, adopting our whole person approach. And so Primary360 continues to be a significant bright spot in terms of commercial momentum.

根據我們目前在市場上看到的情況，我們還認為，過去幾個月來經濟不確定性的加劇正在越來越多地在延遲雇主市場的決策過程中發揮作用。我們越來越多地看到我們的慢性護理客戶認識到將這些產品與初級護理相結合的價值，採用我們的全人方法。因此，Primary360 在商業動力方面仍然是一個重要的亮點。

While the market remains in the early part of the adoption curve for virtual primary care, we continue to see indications of strong demand. Our clients are finding that Primary360 is expanding access to care as 2/3 of engage members had not seen a doctor in the last 2 years prior to Primary360, and nearly 1/3 say that they would not have seen a doctor at all, if not for access to Primary360.

儘管市場仍處於虛擬初級保健採用曲線的早期階段，但我們繼續看到需求強勁的跡象。我們的客戶發現 Primary360 正在擴大獲得護理的機會，因為 2/3 的參與成員在 Primary360 之前的過去 2 年中沒有看過醫生，並且近 1/3 的人說他們根本不會去看醫生，如果不適用於訪問 Primary360。

Patients are reporting high satisfaction and our members are telling us this is the result of our providers actually taking time to listen because our doctors are able to spend time delivering care rather than checking boxes on a chart and dealing with administrative overhead.

患者表示非常滿意，我們的成員告訴我們，這是我們的提供者實際上花時間傾聽的結果，因為我們的醫生能夠花時間提供護理，而不是檢查圖表上的框並處理管理開銷。

As a result of the positive experience our clients are having with Primary360, we now expect to expand our relationship with 1 of our larger health plan partners to offer Primary360 to more of its populations. This is a strong validation of the value Primary360 is delivering. And we're expanding our support of virtual first health plans for this client to several additional states starting next year.

由於我們的客戶對 Primary360 的積極體驗，我們現在希望擴大與我們較大的健康計劃合作夥伴之一的關係，以向更多的人群提供 Primary360。這是對 Primary360 提供的價值的有力驗證。從明年開始，我們正在將對該客戶的虛擬第一健康計劃的支持擴展到其他幾個州。

During the second quarter, we also signed a new agreement to expand our relationship with 1 of our larger health plan partners in the Midwest. This expansion is building upon our existing Chronic Care partnership and will enable the plan's clients to benefit from a comprehensive suite of integrated primary care and Chronic Care solutions. The agreement represents another example of our ability, not only to land and expand horizontally into new client populations, but to expand vertically with new products.

在第二季度，我們還簽署了一項新協議，以擴大我們與中西部一個較大的健康計劃合作夥伴的關係。這一擴展建立在我們現有的慢性護理合作夥伴關係的基礎上，將使該計劃的客戶能夠從一整套綜合的初級護理和慢性護理解決方案中受益。該協議代表了我們能力的另一個例子，不僅可以登陸並橫向擴展新客戶群，還可以通過新產品縱向擴展。

In another example of our whole-person strategy paying dividends, we recently announced an expanded relationship with priority health, an integrated health plan that will bring our Primary360 product bundled together with our suite of Chronic Care solutions as part of 1 holistic comprehensive integrated solution.

在我們全人戰略帶來紅利的另一個例子中，我們最近宣布了與優先健康的擴大關係，這是一項綜合健康計劃，將把我們的 Primary360 產品與我們的慢性護理解決方案套件捆綁在一起，作為一個整體綜合綜合解決方案的一部分。

I referenced these 3 deals, not just because they're important new business signed in the past few months. But because I think they illustrate 3 different examples of how we drive growth: one, landing with a client and expanding to serve new populations within that client over time; two, cross-selling new innovative products to existing clients; and three, bringing a new integrated whole-person suite of services to bear for a client bundled together into 1 offering; finally, we continue to add new capabilities to our Primary360 offering that enhance value for our members and clients.

我引用了這 3 筆交易，不僅僅是因為它們是過去幾個月簽署的重要新業務。但是因為我認為它們說明了我們如何推動增長的 3 個不同示例：第一，與客戶一起登陸並隨著時間的推移擴展以服務該客戶中的新人群；二、向現有客戶交叉銷售新的創新產品；第三，為客戶提供一套新的集成式全人服務，捆綁在一個產品中；最後，我們繼續為我們的 Primary360 產品添加新功能，為我們的會員和客戶提升價值。

During the second quarter, we added multiple new last mile enhancements in-home lab testing is now available at no additional cost to Primary360 members across the nation. And free same-day delivery of prescription medications is being rolled out in the second half of this year, which will increase both convenience and compliance.

在第二季度，我們添加了多項新的最後一英里增強功能，現在可以免費向全國的 Primary360 會員提供家庭實驗室測試。今年下半年將推出處方藥當日免費送貨服務，這將增加便利性和合規性。

So while it's still early relative to the ultimate opportunity in terms of adoption and penetration of virtual or primary care we continue to see many reasons to be excited about the momentum for our integrated Primary360 offering.

因此，雖然相對於虛擬或初級保健的採用和滲透的最終機會來說還為時過早，但我們仍然看到許多理由對我們集成的 Primary360 產品的勢頭感到興奮。

Turning to our direct-to-consumer business. we saw BetterHelp continue to deliver robust revenue growth of over 40% year-over-year as well as strong sequential growth. At the same time, BetterHelp performance did come in towards the lower end of our expectations as we continued to experience the decline in yield on marketing spend that we discussed in April. We still see smaller private competitors pursuing what we believe are low or no return customer acquisition strategies to establish market share.

轉向我們的直接面向消費者的業務。我們看到 BetterHelp 繼續實現強勁的收入同比增長超過 40% 以及強勁的連續增長。與此同時，BetterHelp 的表現確實接近我們預期的低端，因為我們繼續經歷我們在 4 月份討論的營銷支出收益率下降的情況。我們仍然看到較小的私人競爭對手追求我們認為低迴報或無回報的客戶獲取策略來建立市場份額。

Although we do not see this as sustainable, it's difficult to predict how long this dynamic may continue. We also believe that the weakening economic environment and declining consumer sentiment is likely having an effect on BetterHelp performance.

儘管我們不認為這是可持續的，但很難預測這種動態會持續多久。我們還認為，疲軟的經濟環境和消費者信心下降可能會對 BetterHelp 的表現產生影響。

Over the past few months, we've seen modest incremental decline in yield on advertising spend, which we believe may be an indication of belt tightening among consumers. With inflation on the rise, consumer confidence has now dropped to multi-decade lows. Given our significant leadership position in the DTC marketplace and our substantial scale advantage, we remain confident that we can continue to outperform the industry and drives strong financial performance as we navigate this increased level of near-term economic uncertainty.

在過去的幾個月裡，我們看到廣告支出的收益略有下降，我們認為這可能表明消費者正在勒緊褲腰帶。隨著通貨膨脹的上升，消費者信心現已降至數十年來的低點。鑑於我們在 DTC 市場的顯著領導地位和我們巨大的規模優勢，我們仍然有信心在我們應對近期經濟不確定性增加的情況下，我們可以繼續超越行業並推動強勁的財務業績。

Taking these trends in both Chronic Care and BetterHelp into account, as well as the impact of a stronger dollar on our international revenue. We believe it's more likely that our overall financial performance will be towards the lower end of our consolidated revenue and adjusted EBITDA guidance ranges in the second half.

考慮到慢性護理和 BetterHelp 的這些趨勢，以及美元走強對我們國際收入的影響。我們認為，我們的整體財務業績更有可能在下半年接近合併收入和調整後 EBITDA 指導範圍的下限。

However, there are scenarios in which our results could be above or below this due to the increased uncertainty in the broader economic backdrop, particularly as it relates to trends in consumer spending and its impact on our DTC business. We will continue to watch these near-term evolving dynamics and provide updates as appropriate.

然而，由於更廣泛的經濟背景下不確定性增加，特別是與消費者支出趨勢及其對我們的 DTC 業務的影響有關的情況下，我們的結果可能高於或低於此。我們將繼續關注這些近期不斷變化的動態，並酌情提供更新。

With that, I'll turn the call over to Mala for a review of the second quarter and our forward guidance.

有了這個，我將把電話轉給馬拉，以審查第二季度和我們的前瞻性指導。

Thank you, Jason, and good afternoon, everyone. During the second quarter, total revenue increased 18% year-over-year to $592 million. Revenue from BetterHelp, our direct-to-consumer mental health brand grew over 40% as compared to the prior year's quarter or 7% sequentially over the first quarter, representing strong growth albeit towards the lower end of our expectations as we continue to see lower yield on marketing spend as compared to the prior year.

謝謝你，傑森，大家下午好。第二季度，總收入同比增長 18% 至 5.92 億美元。我們直接面向消費者的心理健康品牌 BetterHelp 的收入與去年同期相比增長了 40% 以上，或比第一季度環比增長了 7%，儘管隨著我們繼續看到較低的預期，但仍接近我們預期的低端，但增長強勁與上一年相比，營銷支出的收益。

We ended the quarter with U.S. paid membership of 56.6 million members, an increase of 2.4 million members over the first quarter, driven by new virtual care client onboarding. Individuals with visit fee only access was $24 million at the end of the second quarter. The total number of our unique members enrolled in 1 or more of our chronic care programs was 798,000 as of the second quarter, an increase of 67,000 enrollees over the first quarter.

在新的虛擬護理客戶入職的推動下，我們在本季度結束時擁有 5660 萬會員的美國付費會員，比第一季度增加了 240 萬會員。在第二季度末，僅訪問費的個人為 2400 萬美元。截至第二季度，我們註冊一個或多個慢性護理計劃的獨特會員總數為 798,000 人，比第一季度增加了 67,000 人。

30% of our Chronic Care members are now enrolled in more than 1 program, up from 27% sequentially from the first quarter. This helped to drive new Chronic Care program enrollment of 92,000 in the quarter, bringing total program enrollment to over 1 million programs, an increase of 167,000 or 20% over the prior year.

現在，我們 30% 的慢性護理會員參加了一個以上的計劃，高於第一季度的 27%。這有助於推動本季度新的慢性護理項目註冊人數達到 92,000，使項目總註冊人數超過 100 萬，比上一年增加 167,000 或 20%。

As Jason discussed, the strong new enrollment in Chronic Care programs during the second quarter outpaced our expectations. We have now added nearly 70,000 new Chronic Care members and 127,000 new program enrollments year-to-date.

正如 Jason 所討論的，第二季度慢性護理項目的新入學人數超出了我們的預期。年初至今，我們已經增加了近 70,000 名新的慢性護理會員和 127,000 名新計劃註冊。

At the start of the year, we expect an enrollment to be more back half weighted due to the cadence of the expected population starts. However, due to our team's efforts to get new populations on-boarded faster than anticipated in the second quarter, we were able to drive more of that enrollment into the second quarter than expected.

在今年年初，由於預期人口開始的節奏，我們預計入學人數將更多地獲得後半權重。但是，由於我們的團隊努力在第二季度以比預期更快的速度讓新人口加入，我們能夠在第二季度推動更多的註冊人數超過預期。

As a result of the significant second quarter outperformance, which effectively pulled forward new enrollment from the second half as well as the floor piece of pipeline development Jason mentioned. We no longer expect enrollment gains to be weighted towards the second half of the year.

由於第二季度的顯著表現，這有效地推動了下半年的新入學人數以及傑森提到的管道開發的基礎。我們不再預計入學人數增長會在下半年得到加權。

Average U.S. revenue per member per month was $2.60 in the second quarter, up 13% from $2.31 in the prior year's quarter and up 3% sequentially from the first quarter. The sequential growth in per member per month revenue was driven primarily by BetterHelp and Chronic Care program revenue growth.

第二季度美國每位會員每月平均收入為 2.60 美元，比去年同期的 2.31 美元增長 13%，比第一季度環比增長 3%。每位會員每月收入的連續增長主要是由 BetterHelp 和慢性護理計劃收入增長推動的。

Adjusted EBITDA was $46.7 million in the second quarter compared to $66.8 million in the prior year quarter and at the high end of our guidance range. As discussed earlier this year, we expect a more pronounced margin seasonality this year as we return to a more normalized cadence of advertising spend.

第二季度調整後的 EBITDA 為 4670 萬美元，而去年同期為 6680 萬美元，處於我們指導範圍的高端。正如今年早些時候所討論的，隨著我們恢復到更加正常化的廣告支出節奏，我們預計今年的利潤率季節性會更加明顯。

It's difficult for us to see lower ad spend and higher margin in the direct-to-consumer business in the fourth quarter as we pulled back on media spend during the more expensive holiday season. As we talked about last quarter, it's important to note that in 2020 and 2021, this seasonality was less pronounced due to a weaker advertising market during the onset of the pandemic.

我們很難在第四季度看到直接面向消費者業務的廣告支出降低和利潤率提高，因為我們在更昂貴的假日季節減少了媒體支出。正如我們上個季度所討論的，重要的是要注意，在 2020 年和 2021 年，由於大流行開始期間廣告市場疲軟，這種季節性不太明顯。

Net loss per share in the second quarter was $19.22 compared to a net loss per share of $0.86 in the second quarter of last year. Net loss per share in the second quarter includes a noncash goodwill impairment charge of $18.78 per share or $3 billion.

第二季度的每股淨虧損為 19.22 美元，而去年第二季度的每股淨虧損為 0.86 美元。第二季度的每股淨虧損包括每股 18.78 美元或 30 億美元的非現金商譽減值費用。

The goodwill impairment was triggered by the decline in Teladoc Health share price with the valuation and size of the impairment charge, primarily driven by an increased discount rate and decreased market multiples for a relevant peer group of high-growth digital health care companies. Also included in net loss per share was stock-based compensation expense of $0.32 per share and amortization of acquired intangibles of $0.30 per share.

商譽減值是由於 Teladoc Health 股價下跌以及減值費用的估值和規模引起的，主要是由於相關高增長數字醫療保健公司的貼現率增加和市場倍數下降。每股淨虧損還包括每股 0.32 美元的股票補償費用和每股 0.30 美元的收購無形資產攤銷。

During the second quarter, we generated free cash flow of $47.6 million and ended the quarter with $884 million in cash and short-term investments on the balance sheet.

在第二季度，我們產生了 4760 萬美元的自由現金流，並在本季度末以 8.84 億美元的現金和資產負債表上的短期投資。

Now turning to forward guidance. While we are maintaining our full year 2022 revenue adjusted EBITDA guidance provided in April. The current trends in the direct-to-consumer and Chronic Care marketplaces as well as a headwind from the strengthening of dollar year-to-date, which at current exchange rates represents nearly a $20 million drag to our full year outlook.

現在轉向前向指導。雖然我們維持 4 月份提供的 2022 年全年收入調整後 EBITDA 指導。直接面向消費者和慢性護理市場的當前趨勢以及年初至今美元走強的不利因素，按當前匯率計算，這對我們的全年前景造成了近 2000 萬美元的拖累。

We believe it is more likely that our results will fall towards the lower end of the range. As Jason noted, there are scenarios in which our results could be above or below this due to the increased uncertainty in the broader environment, and we will continue to provide updates as appropriate.

我們認為，我們的結果更有可能跌至該範圍的下限。正如 Jason 所指出的，在某些情況下，由於更廣泛的環境中不確定性增加，我們的結果可能會高於或低於此值，我們將繼續酌情提供更新。

We expect total U.S. paid membership of 55 million to 56.5 million members, an increase of 0.5 million to 1 million members over our prior guidance. and representing growth of 6% to 8% year-over-year. We expect total visits in 2022 to be between 18.8 million and 19.3 million visits, representing growth of 22% to 25% over the prior year.

我們預計美國付費會員總數將達到 5500 萬至 5650 萬，比我們之前的指導增加 50 萬至 100 萬。同比增長 6% 至 8%。我們預計 2022 年的總訪問量將在 1880 萬至 1930 萬之間，比上一年增長 22% 至 25%。

For the third quarter of 2022, we expect revenue of $600 million to $620 million, representing growth of 15% to 19% over the prior year third quarter. We expect total U.S. paid membership in the third quarter of 55.5 million to 56.5 million. Total third quarter visits are expected to be between 4.8 million and 5 million visits.

對於 2022 年第三季度，我們預計收入為 6 億美元至 6.2 億美元，比去年第三季度增長 15% 至 19%。我們預計第三季度美國付費會員總數為 5550 萬至 5650 萬。第三季度的總訪問量預計在 480 萬到 500 萬之間。

We expect third quarter adjusted EBITDA to be in the range of $35 million to $45 million. The lower expected sequential adjusted EBITDA in the third quarter is primarily a function of a lower contribution from direct-to-consumer mental health and increased engagement spending in support of recently launched Chronic Care population.

我們預計第三季度調整後的 EBITDA 將在 3500 萬美元至 4500 萬美元之間。第三季度預期的環比調整後 EBITDA 較低主要是由於直接面向消費者的心理健康的貢獻較低以及為支持最近推出的慢性護理人群而增加的參與支出。

With that, I will turn the call back to Jason for closing remarks.

有了這個，我將把電話轉回傑森的閉幕詞。

Thanks, Mala. This week, we were pleased to welcome Mike Waters to the team as our new Chief Operating Officer. Many of you know Mike from his work building and leading the ambulatory care business at Providence health system, a leader in digitally enabled hybrid care. Mike brings a proven track record of scaling complex care operations to serve more people more efficiently. And I couldn't be more pleased to have him on the team.

謝謝，馬拉。本週，我們很高興地歡迎 Mike Waters 加入我們的團隊，成為我們新的首席運營官。你們中的許多人都認識邁克，因為他在普羅維登斯衛生系統建立和領導門診護理業務，這是數字化混合護理的領導者。 Mike 在擴展複雜的護理業務以更有效地為更多人服務方面有著良好的記錄。我非常高興他能加入球隊。

Mike joins Vidya Raman-Tangella, our new Chief Medical Officer, who joined us in April from AWS as we continue to see market-leading talent choose Teladoc Health as a place where they can make a difference by transforming the health care experience, and I'm excited for where this team will take us.

Mike 加入了我們的新首席醫療官 Vidya Raman-Tangella，他於 4 月從 AWS 加入我們，因為我們繼續看到市場領先的人才選擇 Teladoc Health 作為他們可以通過改變醫療保健體驗來發揮作用的地方，我很高興這支球隊將帶我們去哪裡。

With that, we'll open the call for questions. Operator?

有了這個，我們將打開問題的電話。操作員？

(Operator Instructions) Our first question today comes from Ryan Daniels from William Blair.

（操作員說明）我們今天的第一個問題來自 William Blair 的 Ryan Daniels。

Yes, Mala, I'm assuming you anticipated this one, given the Q3 guidance and full year guidance, but it looks like a very material ramp in EBITDA, kind of more than doubling on an absolute dollar basis from Q3 to Q4. And I appreciate some of the commentary you had on D2C spending pullback. But what else is going to drive that pretty significant increase in sequential EBITDA Q3 to Q4?

是的，Mala，鑑於第三季度的指導和全年的指導，我假設你已經預料到了這一點，但它看起來像是 EBITDA 的一個非常實質性的增長，從第三季度到第四季度的絕對美元基礎上增加了一倍以上。我很欣賞你對 D2C 支出回落的一些評論。但是，還有什麼會推動第三季度至第四季度的 EBITDA 連續大幅增長呢？

Yes, Ryan. So you're absolutely right. We have anticipated a material ramp in the guidance -- and if you think about what's driving the ramp, it's essentially the timing of our advertising and marketing spend. In the BetterHelp business, we talked about it in our prepared remarks.

是的，瑞恩。所以你是絕對正確的。我們預計指南中會出現實質性的增長——如果你考慮一下推動增長的因素，它本質上是我們的廣告和營銷支出的時機。在 BetterHelp 業務中，我們在準備好的評論中談到了它。

And we -- if you think about the BetterHelp business and the dynamics, the typical seasonality in spend is to see a ramp-up in the early part of the year and a pullback in the -- in Q4 due to the expensive holiday season. That's not a new phenomenon. But it has been significantly less pronounced during the COVID period, which muted the seasonality in the ad spend in that business, it will be more pronounced this year.

而且我們——如果你考慮一下 BetterHelp 業務和動態，典型的支出季節性是在今年年初看到一個增長，並在第四季度看到由於昂貴的假日季節而回落。這不是一個新現象。但在 COVID 期間，這種情況明顯不那麼明顯，這削弱了該業務廣告支出的季節性，今年將更加明顯。

So you should expect to see A&M spend come down materially in the fourth quarter both on a dollar basis and as a percentage of revenue. So I'd say that is primarily the reason for the significant uptick in our margins. And as I said, 1 thing just to reinforce that this factor is not new. The overall adjusted EBITDA seasonality in our business is not new.

因此，您應該期望看到 A&M 支出在第四季度大幅下降，無論是按美元計算還是佔收入的百分比。所以我想說這主要是我們利潤率大幅上升的原因。正如我所說，一件事只是為了強調這個因素並不新鮮。我們業務中整體調整後的 EBITDA 季節性並不新鮮。

If you look back prior to 2021, you would find it was difficult to see a significant ramp up in EBITDA from the first half into the second half of the year. In fact, if you look at our margin ramp from 1Q to 4Q, it has been as much as approximately 700 to 800 bps. And that was when BetterHelp was a much smaller portion of our business, right?

如果您回顧 2021 年之前的情況，您會發現很難看到從上半年到下半年的 EBITDA 顯著增長。事實上，如果您查看我們從 1 季度到 4 季度的利潤率上升，它已經高達大約 700 到 800 個基點。那時 BetterHelp 只是我們業務的一小部分，對吧？

So as we have given you more color and transparency into size of the business and the growth of the business, it is more material. And therefore, the dynamics through the year in terms of the ad spend will have now on much more perceptible impact on our overall margins.

因此，當我們為您提供更多的顏色和透明度來了解業務規模和業務增長時，它就更重要了。因此，全年廣告支出的動態將對我們的整體利潤率產生更明顯的影響。

Our next question comes from Lisa Gill from JPMorgan.

我們的下一個問題來自摩根大通的 Lisa Gill。

Jason, I want to go back to your comments around competition in a direct-to-consumer area. We saw what happened with Cerebral. And I'm just curious as to if you picked up for some market share from what happened with them, and I know you talked about others trying to just gain some lives at this point. But one, if you could talk about the competitive environment there and what you're seeing?

傑森，我想回到你對直接面向消費者領域競爭的評論。我們看到了 Cerebral 發生了什麼。我只是好奇你是否從他們發生的事情中獲得了一些市場份額，我知道你談到了其他人試圖在這一點上獲得一些生命。但是，如果你能談談那裡的競爭環境以及你所看到的？

And then secondly, I just wanted just to make sure that I understand that. So you're saying that for that big ramp between the third and the fourth quarter, it's really primarily advertising spend and you're still able to hold on to the revenue for direct to consumer on the BetterHelp side. I just want to make sure I do remember that dynamic historically, but it's obviously a much bigger number than what it's been.

其次，我只是想確保我理解這一點。所以你是說，對於第三季度和第四季度之間的大幅增長，它實際上主要是廣告支出，你仍然能夠在 BetterHelp 方面保持直接面向消費者的收入。我只是想確保我確實記得歷史上的動態，但它顯然比以前大得多。

Yes. Lisa, I can take -- maybe I'll take both of those. On the direct-to-consumer advertising costs, we just haven't seen a significant change in the paid search costs over the last 3 months. And that's what we baked into our revised guidance that we gave in April, and we talked at length about the increased expense in that channel.

是的。麗莎，我可以接受——也許我會接受這兩個。在直接面向消費者的廣告費用方面，我們只是沒有看到過去 3 個月付費搜索費用的顯著變化。這就是我們在 4 月份給出的修訂指南中所包含的內容，我們詳細討論了該渠道增加的費用。

We are seeing a modestly higher customer acquisition costs in a few channels. And it's not any 1 channel to call out. And we're really not seeing significantly higher pricing in these channels but the revenue yield we're seeing on the ad spend is just trending toward the lower end of where we expected back in April.

我們看到一些渠道的客戶獲取成本略有增加。而且它不是任何一個可以調用的渠道。我們確實沒有看到這些渠道的定價明顯更高，但我們在廣告支出上看到的收入收益率只是趨向於我們在 4 月份預期的低端。

So what we're seeing is continued sort of consistent expense but lower revenue yield, and we believe that a fair amount of that is due to greater price sensitivity in the consumer because of the overall economic backdrop and the fact that they're seeing inflation in the rest of their lives.

因此，我們看到的是持續的支出，但收入收益率較低，我們認為這在很大程度上是由於整體經濟背景以及他們看到通貨膨脹的事實，消費者對價格的敏感性更高在他們的餘生中。

So we talked about revenue growth 35% to 40% range being baked into our outlook for BetterHelp this year. We still expect that to be the case. But based on the current trends, we expect to be toward the lower end or really the bottom half of that range.

因此，我們談到了 35% 至 40% 的收入增長范圍已納入我們今年對 BetterHelp 的展望。我們仍然希望是這樣。但根據目前的趨勢，我們預計會接近該範圍的低端或真正的下半部分。

On the ad spend for BetterHelp and can we retain the revenue we're not shutting off the advertising completely. So you'll see we're not going to go to 0 on the advertising spend in the fourth quarter, but it is a significant reduction because of the greater expense per advertising impression. And therefore, we want to make sure we're making good economic decisions and therefore, we pull back at sort of the higher end of the marginal return curve.

在 BetterHelp 的廣告支出上，我們能否在不完全關閉廣告的情況下保留收入。因此，您會看到我們不會在第四季度的廣告支出上降至零，但由於每次廣告展示的費用增加，這是一個顯著的減少。因此，我們要確保我們做出了良好的經濟決策，因此，我們在邊際回報曲線的較高端回撤。

Our next question comes from Sandy Draper from Guggenheim.

我們的下一個問題來自古根海姆的 Sandy Draper。

I'm going to try to frame this in a way that makes sense. When I look, Mala, at the outperformance of U.S. paid members and I recognize that 1 that's stepping up or sort of a pull forward and maybe a little bit of commentary would be helpful about it seems to me the guidance that, that may trail down. But you also had chronic care members growing faster. Both of those are higher PMPM seems like pulling forward, it's recurring, that would have flowed through for some better revenue.

我將嘗試以一種有意義的方式來構建它。 Mala，當我看到美國付費會員的出色表現時，我認識到 1 正在加速或有點向前推進，也許一點評論會有所幫助，在我看來，指導可能會下降.但是你也有慢性護理成員增長得更快。這兩者都更高 PMPM 似乎向前推進，它是反復出現的，這本來可以帶來一些更好的收入。

So I guess the question is, basically, is that accurate? And so -- but the offset is slower ramp-up of additional new chronic care contracts and BetterHelp? I'm just trying to understand the outperformance on those 2 metrics, which I would think would be a positive impact on the second half of the year. That would be great. And if you could just quickly answer that question about the members would trail off.

所以我想問題是，基本上，這準確嗎？所以——但抵消的是額外的新慢性護理合同和 BetterHelp 的增加速度較慢？我只是想了解這兩個指標的出色表現，我認為這將對今年下半年產生積極影響。那很好啊。如果你能快速回答有關成員的問題，就會落後。

Yes. So Sandy, your observation is right. As we said, we are really pleased with the hard work that our teams have done, humans work to be able to get the populations on-boarded in the second quarter ahead of schedule, that essentially resulted in really strong enrollment numbers.

是的。所以桑迪，你的觀察是正確的。正如我們所說，我們對我們的團隊所做的辛勤工作感到非常滿意，人類努力使第二季度的人口提前入職，這基本上導致了非常強勁的入學人數。

We talked about the 67,000 net new Chronic Care members in the second quarter alone and 92,000 additional program enrollments enrollment sequentially over the first quarter. So this effort, as we said, is a pull forward of some of the enrollment that was previously expected to happen really primarily in the third quarter.

我們談到了僅在第二季度就新增了 67,000 名慢性病護理會員，並且在第一季度連續增加了 92,000 名計劃註冊。因此，正如我們所說，這項努力是對之前預計主要在第三季度進行的一些招生的推動。

So what's important to recognize is these new enrollees should contribute revenue to the rest of the year. But keep in mind that they were obviously already in our forecast, right? So it's a little bit of a uptick in revenue the back half of the year because of the pull forward.

因此，重要的是要認識到這些新註冊者應該為今年剩餘時間貢獻收入。但請記住，它們顯然已經在我們的預測中，對吧？因此，由於向前推進，下半年的收入略有上升。

However, what we've also said is given the pace of the deal closing, we have also essentially removed our assumptions for in-year contribution or revenue contribution in the back half of the year at this point from additional chronic care sort of launches. So that's really what is driving our expectations in the back half of the year for Chronic Care.

然而，考慮到交易完成的速度，我們也基本上從額外的慢性護理類推出中刪除了我們對今年下半年的年內貢獻或收入貢獻的假設。因此，這確實是推動我們在今年下半年對慢性護理的期望的原因。

So essentially, we have -- we did haircut in your revenue in April, as we talked about quite significantly, but we are also continuing to see some of the competitive dynamics in the Chronic Care space. And we did -- from a forecast from a guidance perspective, we felt it was prudent at this point to remove the rest of the -- most of the in your revenue assumptions for Chronic Care.

因此，從本質上講，我們已經在 4 月份削減了您的收入，正如我們非常重要地談到的那樣，但我們也繼續看到慢性護理領域的一些競爭動態。我們確實做到了——從指導角度的預測來看，我們認為在這一點上刪除其餘的——大部分慢性護理收入假設是謹慎的。

Our next question comes from Richard Close from Canaccord Genuity.

我們的下一個問題來自 Canaccord Genuity 的 Richard Close。

On the employer side of the business and economic uncertainty, I was just curious, are employers still poking around, but just don't want to pull the trigger because of the uncertainty? Or has the pipeline essentially dried up on new potential deals? Just any thoughts in and around that would be helpful.

關於商業和經濟不確定性的雇主方面，我只是好奇，雇主是否還在四處閒逛，只是不想因為不確定性而扣動扳機？或者管道是否已經因新的潛在交易而枯竭？只要有任何想法都會有所幫助。

Yes, Richard, thanks for the question. I appreciate it. Let me give you a little bit of color on the pipeline and then I'll try to characterize how buyers are acting. The good news for us is that our current pipeline and the late-stage pipeline, which you've heard me talk about the last couple of quarters, are both up year-over-year to the tune of about 20% relative to where they were at this time last year.

是的，理查德，謝謝你的提問。我很感激。讓我給你一點關於管道的顏色，然後我將嘗試描述買家的行為方式。對我們來說好消息是，我們目前的管道和後期管道，你聽說過我在過去幾個季度談到的，相對於它們的位置，都同比增長了約 20%去年這個時候。

We also have twice as many multimillion dollar deals in the pipeline as we did, as we entered the third quarter last year. So the pipeline, I would say, is very healthy and has improved since where we were at this time last year.

與去年進入第三季度相比，我們正在進行的數百萬美元交易的數量也是我們的兩倍。因此，我想說，管道非常健康，並且自去年這個時候以來已經有所改善。

The challenge that we're seeing is in these times of economic uncertainty, all purchases are just getting a significantly higher level of scrutiny. I think we're also facing a situation where a lot of HR leaders within organizations are dealing with a very challenging time. As you've heard and read in all of the news about companies reducing workforces, having to control costs. And so I think there is a level of distraction at the same time.

我們看到的挑戰是在經濟不確定的時期，所有採購都受到了更高水平的審查。我認為我們也面臨這樣一種情況，即組織內的許多人力資源主管都在應對一個非常具有挑戰性的時期。正如您在所有關於公司裁員、必須控製成本的新聞中聽到和閱讀的那樣。所以我認為同時存在一定程度的分心。

So while we had historically seen more midyear launches, or for our Chronic Care solutions, we're really not seeing many of them this year, which is why Mala commented about our outlook for in-year revenue, which means deals that we sell this year and launch this year. We've taken down our outlook for the back half of this year. I do feel still good about where the pipeline is and about our prospects for the selling season.

因此，雖然我們歷來看到更多的年中發布，或者我們的慢性護理解決方案，但今年我們真的沒有看到很多，這就是為什麼 Mala 評論了我們的年度收入前景，這意味著我們出售這個的交易年並於今年推出。我們已經下調了今年下半年的展望。我對管道在哪里以及我們在銷售季節的前景仍然感覺良好。

As you know, we're entering sort of the critical 3-month period of the selling season. And so we'll know a lot more as we come back to you with our third quarter results. But the pipeline is certainly healthy, and we're seeing significant interest. We're just finding it significantly delayed for purchasing decisions to be made within those organizations.

如您所知，我們正在進入銷售旺季的關鍵 3 個月期間。因此，當我們向您提供第三季度業績時，我們會知道更多。但管道肯定是健康的，我們看到了極大的興趣。我們只是發現在這些組織內做出購買決定的時間大大延遲。

Our next question comes from Stephanie Davis from SVB Securities.

我們的下一個問題來自 SVB 證券的 Stephanie Davis。

I was hoping to touch on some of the macro environment, just given some of the macro softness we're seeing across retail and pack earnings. Could you tell us more about what's baked into your 2022 and long-term guidance? And the follow-up to that, just given how different the macro is today, even compared to your Analyst Day, are we still on track for that 25% to 30% growth target?

鑑於我們在零售和包裝收益方面看到的一些宏觀疲軟，我希望能觸及一些宏觀環境。你能告訴我們更多關於你的 2022 年和長期指導的內容嗎？考慮到今天的宏觀環境有多麼不同，即使與您的分析師日相比，我們是否仍有望實現 25% 至 30% 的增長目標？

So Stephanie, I just want to be clear, we're not giving a multiyear outlook at this point. And I think we mentioned that last quarter on our call. So we're not going to comment on the multiyear outlook. With respect to the current year and our '22 outlook, we've assumed essentially status quo through the rest of the year.

所以斯蒂芬妮，我只想說清楚，我們目前沒有給出多年展望。我認為我們在電話會議上提到了上個季度。因此，我們不打算對多年前景發表評論。關於本年度和我們的 22 年展望，我們在今年剩餘時間里基本保持現狀。

If there is significant deterioration in the market just in terms of consumer sentiment, and/or the macroeconomic environment, there could be downside, particularly to the BetterHelp business. If the environment improves, then we see upside opportunity in the back half of the year.

如果僅就消費者情緒和/或宏觀經濟環境而言，市場出現顯著惡化，則可能會出現下行空間，尤其是對 BetterHelp 業務而言。如果環境有所改善，那麼我們在下半年看到了上行機會。

So that's specifically the reason for our commentary about indicating that we expect to be toward the lower end of our guidance and that there's upside and downside around that depending on how the economic scenarios play out.

因此，這就是我們發表評論的具體原因，即我們預計將接近我們指引的低端，並且取決於經濟情景如何發揮作用，這有上行和下行空間。

Yes. And Stephanie, just to add to that. If you think about the macros that are -- that may have an impact on our business, so 3 of them come to mind, right? One is, as Jason talked about, the consumer sentiment and how that impacts either positively or negatively as the months go on, on our direct-to-consumer business.

是的。還有斯蒂芬妮，只是為了補充一點。如果您考慮可能對我們的業務產生影響的宏，那麼您會想到其中的 3 個，對嗎？一個是，正如傑森所說，消費者情緒以及隨著時間的推移，這對我們的直接面向消費者的業務產生了積極或消極的影響。

The second is, as we just talked about in our prepared remarks, the direction of the euro and the possible headwinds we face on our international revenue. We have quantified it as we know -- as of now, and we'll see how those progress through the year.

第二個是，正如我們剛剛在準備好的發言中談到的那樣，歐元的走向以及我們在國際收入方面可能面臨的不利因素。正如我們所知，我們已經對其進行了量化——截至目前，我們將看到這些進展在一年中的進展情況。

Obviously, we've also talked about the employer market and the impact that -- just the thoughts of a possible moving economic slowdown is having on sentiment on, in the employer market.

顯然，我們還談到了雇主市場及其影響——僅僅是經濟可能放緩的想法對雇主市場情緒的影響。

And last is wage inflation. And what we are seeing is the impact on our business as of now is relatively modest. It's not something that we would want to -- that is not material enough for us to comment on. But again, those are -- as we refine our views for this year and then as we go into next year, -- to the extent that they are important enough, we will absolutely provide transparency to you all.

最後是工資通脹。我們所看到的是，截至目前，對我們業務的影響相對較小。這不是我們想要的——這不足以讓我們評論。但同樣，隨著我們對今年和明年的觀點的完善，在它們足夠重要的範圍內，我們絕對會為你們所有人提供透明度。

Our next question comes from Sean Dodge from RBC.

我們的下一個問題來自 RBC 的 Sean Dodge。

On BetterHelp, Jason, you mentioned the impact the economy is like we're having on subscribers. I know you've, in the past, talked about experimenting with different pricing and utilization model to give even more options to stay on the service. Have you rolled those out? And maybe give us an idea of what some of the other tools you have at your disposal to help manage BetterHelp through what could be a pretty tough period for consumers.

在 BetterHelp 上，Jason，你提到了經濟對訂閱用戶的影響。我知道您過去曾討論過嘗試不同的定價和使用模式，以提供更多選擇以繼續使用該服務。你把那些推出了嗎？也許讓我們了解您可以使用哪些其他工具來幫助管理 BetterHelp，度過對消費者來說可能相當艱難的時期。

Yes, Sean, we're always experimenting with new pricing models. And when we do that, we do that in a multifaceted test and control environment. Sometimes we do it in different geographies. Sometimes we do it through different channels. And we're always innovating around various product features and capabilities.

是的，肖恩，我們一直在嘗試新的定價模式。當我們這樣做時，我們會在多方面的測試和控制環境中這樣做。有時我們會在不同的地區這樣做。有時我們通過不同的渠道來做。我們始終圍繞各種產品特性和功能進行創新。

So what we've seen is pretty interesting in that we're not really seeing a change in our retention rates, we're not really seeing a change in the LTV for consumers who we have on the platform. We're just seeing a slight degradation of the yield per ad spend, which would indicate slightly higher price sensitivity to make that first purchase decision.

因此，我們所看到的非常有趣，因為我們並沒有真正看到我們的保留率發生變化，我們並沒有真正看到我們在平台上擁有的消費者的 LTV 發生變化。我們只是看到每次廣告支出的收益略有下降，這表明做出首次購買決定的價格敏感性略高。

Once they're on the platform, we actually haven't seen change behavior. And so we think that, that is directly related to the consumer sentiment and the current economic environment. It's difficult to be precise about that. But we know exactly what the change in yield is. It's modest, but obviously, at a large scale, it can have an impact.

一旦他們在平台上，我們實際上還沒有看到改變行為。所以我們認為，這與消費者情緒和當前的經濟環境直接相關。很難準確地說。但我們確切地知道產量的變化是什麼。它是適度的，但顯然，在大範圍內，它會產生影響。

We are consistently refining the channels that we use. And I think that's one of the critical advantages that we have. At our scale, we have the ability to continually optimize. And so we're going to keep doing that throughout this period of time. And I would just sort of remind that we did see 40% growth year-over-year in the last quarter. So -- and sequential growth from the first quarter to second quarter. So we're seeing benefit of those efforts. We just -- I would say we're taking a slightly more cautious outlook.

我們一直在完善我們使用的渠道。我認為這是我們擁有的關鍵優勢之一。在我們的規模上，我們有能力不斷優化。因此，我們將在這段時間內繼續這樣做。我想提醒一下，我們確實在上個季度看到了 40% 的同比增長。所以 - 從第一季度到第二季度的連續增長。所以我們看到了這些努力的好處。我們只是 - 我會說我們對前景持謹慎態度。

And we continue to balance between the growth, which, as Jason talked about, 40% growth as well as margins in that business. So -- and we will continue to sort of balance and optimize between those.

我們繼續在增長之間取得平衡，正如 Jason 所說，增長 40% 以及該業務的利潤率。所以——我們將繼續在它們之間進行某種平衡和優化。

Our next question comes from Charles Rhyee from Cowen.

我們的下一個問題來自 Cowen 的 Charles Rhyee。

I wanted to follow up on Sandy's question, Mala. I guess the -- your comments about -- on the revenue side, as we had greater enrollment than expected enrollment here in the second quarter. I just wanted to get a sense on the adjusted EBITDA side. Given that it's all recurring and we've signed up more than we expected, I would think that we would get more of that benefit in the back half of the year, particularly as we're looking at the third quarter guidance.

我想跟進桑迪的問題，馬拉。我猜你的評論是關於收入方面的，因為我們在第二季度的註冊人數比預期的要多。我只是想了解調整後的 EBITDA 方面。鑑於這一切都是重複發生的，而且我們的簽約數量超出了我們的預期，我認為我們將在今年下半年獲得更多的好處，特別是在我們正在查看第三季度的指導時。

Just curious, what else -- I understand you're talking about a little bit of a help, but help us maybe understand maybe if we're not going to see some sequential benefit from the pull-forward enrollment?

只是好奇，還有什麼——我知道你說的是一點幫助，但如果我們不會從前拉註冊中看到一些連續的好處，也許可以幫助我們理解？

And then secondly, on the -- when you talk about advertising spend, I think in the quarter, on a non-GAAP basis, it was $161 million for advertising and marketing. Can you give us a rough or any kind of breakdown between how much of that goes to direct-to-consumer versus just sort of the rest of the business?

其次，當你談到廣告支出時，我認為在本季度，在非公認會計原則的基礎上，廣告和營銷費用為 1.61 億美元。您能否給我們一個粗略的或任何類型的細分，其中有多少直接面向消費者，而只是其他業務？

Yes. So I don't want to go into specifics at this point in time on further breaking down our ad spend between our direct-to-consumer business and the rest of our business. The thing I would say is if you look at the various pieces of data and information we have given about our BetterHelp business, our revenue per pack, et cetera, from Investor Day until now. One can actually fairly easily back into the overall P&L is for our BetterHelp business. We've actually given enough information to you all to be able to do that. So I don't want to go into more detail on that.

是的。因此，我現在不想詳細說明如何進一步細分直接面向消費者的業務和其他業務之間的廣告支出。我想說的是，如果你看看我們從投資者日到現在提供的關於 BetterHelp 業務、每包收入等的各種數據和信息。我們的 BetterHelp 業務實際上可以相當容易地回到整體損益表。實際上，我們已經向你們所有人提供了足夠的信息，以便能夠做到這一點。因此，我不想對此進行更詳細的說明。

But for your first question, Charles, it is a good question. And what we are essentially seeing is -- we have talked about the fact that we are seeing the sort of intra-year dynamics on our warehouse business. The other thing that we have been steadily saying all along is that this is an important year for us in terms of our R&D investments.

但是對於你的第一個問題，Charles，這是一個很好的問題。我們基本上看到的是——我們已經談到了這樣一個事實，即我們看到了我們倉庫業務的年內動態。另一件我們一直在說的事情是，就我們的研發投資而言，今年對我們來說是重要的一年。

We talked about it in Investor Day. We've talked about investing in our integrated platform in new capabilities in new products, such as my strength of fleet Primary360, Chronic Care Complete, continued integration of our data that underpins bringing together all of our suite of products. That still continues.

我們在投資者日討論過它。我們已經討論過在我們的集成平台上投資新產品的新功能，例如我的車隊 Primary360、Chronic Care Complete、持續整合我們的數據，這些數據支持整合我們所有的產品套件。這仍在繼續。

So the step-up that you -- we have made a very deliberate decision to invest in R&D this year. It's a heightened level of investments relative to last year. And we are for now staying the course on that because we do expect this to result in sustained revenue growth for us in the longer term. That these R&D investments are essentially underpinning whole-person care strategy. And so we do expect to continue to stay the course on that.

所以你的進步 - 我們已經做出了今年投資研發的非常慎重的決定。與去年相比，這是一個更高的投資水平。我們現在堅持這一點，因為我們確實預計這將為我們帶來長期的持續收入增長。這些研發投資基本上是全人護理戰略的基礎。因此，我們確實希望繼續堅持下去。

I will say, having said that, we are always responsibly looking for ways to optimize our cost structure. And we'll be taking an even closer look at our cost structure as we head into 2023. And we'll be very thoughtful in the way that we balance our need to maintain our near-term profitability while continuing to make all these necessary investments to drive our longer-term growth. That is something we always do, and we will continue to do that.

我會說，話雖如此，我們一直在負責任地尋找優化成本結構的方法。進入 2023 年，我們將更仔細地審視我們的成本結構。我們將非常周到地平衡維持近期盈利能力的需求，同時繼續進行所有這些必要的投資以推動我們的長期增長。這是我們一直在做的事情，我們將繼續這樣做。

Our next question comes from Daniel Grosslight from Citi.

我們的下一個問題來自花旗的 Daniel Grosslight。

There seems to be more intense scrutiny now on the health regarding the utilization of health care data, even if being used in accordance with HIPAA. I believe a few senators sent BetterHelp and 1 of e competitors, a letter regarding this a few weeks back. I'm curious if you could just spell out for us how you -- how BetterHelp is using member data for marketing and targeting. And if this increased scrutiny on health care data and data utilization will change how you market into the DTC channel?

現在似乎對醫療保健數據的使用進行了更嚴格的審查，即使是按照 HIPAA 使用。我相信一些參議員在幾週前就此事向 BetterHelp 和 1 個競爭對手發送了一封信。我很好奇您能否向我們說明您是如何使用會員數據進行營銷和定位的。如果這種對醫療保健數據和數據利用的審查會改變您進入 DTC 渠道的方式？

Yes, of course. We received the letter, and we're providing all of the relevant information about our services. Dan, we conduct all of our operations in compliance with state, federal and international privacy laws. We also take consumer transparency extremely seriously, and we operate in compliance with all of the consumer protection laws.

是的當然。我們收到了這封信，我們正在提供有關我們服務的所有相關信息。 Dan，我們的所有運營都遵守州、聯邦和國際隱私法。我們也非常重視消費者的透明度，並且我們遵守所有消費者保護法。

We hold ourselves to HIPAA compliance standards, and we believe very strongly in the privacy of our members, and we continue to work with all the relevant parties to make sure that we are compliant.

我們堅持 HIPAA 合規標準，我們堅信會員的隱私，我們將繼續與所有相關方合作，以確保我們合規。

So I'm not going to go into the more detailed specifics given any particular ad channel. But I think it's been clear from our track record and our history that we take this extremely seriously.

因此，鑑於任何特定的廣告渠道，我不打算深入討論更詳細的細節。但我認為從我們的業績記錄和歷史中可以清楚地看出，我們非常重視這一點。

Our next question comes from George Hill from Deutsche Bank.

我們的下一個問題來自德意志銀行的 George Hill。

I guess, Mala, I have kind of a numbers question digging into the kind of the implied Q4 guidance. And I guess my first 1 is just is there going to be anything in the adjustments for reconciliation that might stand out from the prior quarters?

我想，Mala，我有一個數字問題來挖掘隱含的 Q4 指導。而且我想我的第一個問題是在和解調整中是否會有任何可能從前幾個季度脫穎而出的東西？

Because what I'm trying to do is kind of bridge the gap between the EBITDA run rate in the first 3 quarters and what we're expecting in Q4 and like if the implication is that the marketing spend needs to be reined in, we're talking about cutting the marketing spends like in half, that kind of goes back to Lisa's point around how do we retain the revenue on that?

因為我想做的是彌合前三個季度的 EBITDA 運行率與我們在第四季度的預期之間的差距，如果這意味著需要控制營銷支出，我們重新談論將營銷支出削減一半，這可以追溯到麗莎關於我們如何保留收入的觀點？

We've seen to have lost connection with George Hill.

我們已經看到與喬治希爾失去了聯繫。

George, are you still there?

喬治，你還在嗎？

He got out at the end of that.

說完他就出來了。

We move on to Jessica Tassan from Piper Sandler.

我們從 Piper Sandler 轉到 Jessica Tassan。

So the revised commentary just on the Livongo membership seasonality was helpful. Can you just confirm if your expectation is still that Chronic Care revenue grows low to mid-teens in 2022. And maybe if you could comment a little bit just on average chronic condition PMPM, given that 30% of members are now using multiple conditions, how is pricing trending relative to the kind of $75 per member per month that we used to see with stand-alone Livongo?

因此，僅針對 Livongo 會員季節性的修訂評論很有幫助。您能否確認您的預期是否仍然是慢性護理收入在 2022 年增長低至十幾歲。也許您可以就平均慢性病 PMPM 發表一點評論，因為現在 30% 的會員正在使用多種疾病，相對於我們過去在獨立 Livongo 上看到的每位會員每月 75 美元的定價趨勢如何？

Yes, Jessica. So to your first question, yes, we still expect to be in the low to mid-teens as we have talked about on the last call, just given what we said in terms of the dynamics that we are seeing on Chronic Care and given the fact that we talked about in the back half, there is pressure on in-year revenue from additional deals that we were expecting. I would expect Chronic Care revenue growth to be towards the low end of the low to mid-teens.

是的，傑西卡。因此，對於您的第一個問題，是的，我們仍然希望處於青少年中，正如我們在上次電話會議中所討論的那樣，只是考慮到我們在慢性護理方面看到的動態以及考慮到事實上，我們在後半部分談到，我們預期的額外交易給年內收入帶來壓力。我預計慢性護理收入增長將接近中低端。

And then the second question is, from a pricing perspective, we are really seeing no change in pricing. It still continues to be robust, healthy. So I don't see much of a change and pressure on -- from a pricing standpoint.

然後第二個問題是，從定價的角度來看，我們確實沒有看到定價的變化。它仍然繼續健壯，健康。因此，從定價的角度來看，我沒有看到太大的變化和壓力。

Our next question comes from A.J. Rice from Credit Suisse.

我們的下一個問題來自 A.J.瑞士信貸大米。

Two quick things to your comments and in the press release. Your utilization performance continues to step up 24% this quarter. That's a step up from last quarter and up from 19% a year ago with less COVID and a lot of mixed commentary in the market around utilization. What are you seeing that's continuing to drive that uptick? Is that Primary360? Or is it some other dynamic?

您的評論和新聞稿中的兩件事。本季度您的利用率性能繼續提高 24%。這比上一季度有所上升，比一年前的 19% 有所上升，因為 COVID 較少，市場上圍繞利用率的評論很多。你看到什麼繼續推動這種上升？那是Primary360嗎？還是其他一些動態？

And then maybe just to the comments that Jason made about the new wins you have with health plans Virtual First relatively new product offering. Can you just comment how are these structured at a high level? Are you the exclusive vendor for these health plans are you the preferred vendor as their steerage towards just a first visit? Or is there multiple business that would come to you? How are these being structured?

然後也許只是 Jason 對健康計劃 Virtual First 相對較新的產品提供的新勝利的評論。你能評論一下這些在高層次上是如何構成的嗎？您是這些健康計劃的獨家供應商嗎？您是他們的首選供應商嗎？或者有多個業務會來找你嗎？這些是如何構建的？

Sure. I can comment on the utilization. The growth in the first half of the year has been a combination of BetterHelp and our general medical volume. We've continued to see good increases in both of those areas. Mostly for BetterHelp, it's new membership coming on as we've continued to see growth there. when it comes to our general medical, it continues to be strong trends in terms of consumer engagement.

當然。我可以評論利用率。今年上半年的增長是 BetterHelp 和我們的一般醫療量的結合。我們繼續看到這兩個領域的良好增長。主要是為了 BetterHelp，隨著我們繼續看到那裡的增長，新的會員資格即將到來。就我們的普通醫療而言，就消費者參與而言，它仍然是強勁的趨勢。

The -- it's not really due at this point to our Primary360, which is still small this year. But you do indicate appropriately that we're seeing very good results in terms of new sales as we look into '23 for our Primary360. Primary360 has a number of different, I would say, access vehicles for different plans. If you think about some of the exchange-based Virtual First health plan designs, Primary360 is the default virtual primary care for those plans.

- 這不是因為我們的 Primary360，今年仍然很小。但是您確實恰當地指出，當我們調查 Primary360 的 23 年時，我們在新銷售方面看到了非常好的結果。 Primary360 有許多不同的，我會說，用於不同計劃的訪問車輛。如果您考慮一些基於交換的 Virtual First 健康計劃設計，Primary360 是這些計劃的默認虛擬初級保健。

In other areas like you probably saw we just announced or Emblem and ConnectiCare, just announced the Primary360 is now available to all individual and small group members in their fully insured plans in ConnectiCare starting July 1 of this year. That's an opt-in for a consumer to select that as a primary care provider. Not necessarily in a virtual first plan design, but just like they would select any other primary care provider.

在其他領域，如您可能看到我們剛剛宣布或 Emblem 和 ConnectiCare，剛剛宣布從今年 7 月 1 日開始，Primary360 現在可供所有個人和小團體成員在 ConnectiCare 的全保計劃中使用。這是消費者選擇作為初級保健提供者的選擇。不一定在虛擬的第一計劃設計中，但就像他們會選擇任何其他初級保健提供者一樣。

When we talk about priority health, we're bundling our Primary360 together with our Chronic Care programs into a virtual first plan design, that's a fully insured plan that employers can choose as they're making their plan design choices for '23. So it's a variety of access vehicles, depending on plan design and depending on the health plans, virtual care strategy.

當我們談論優先健康時，我們將 Primary360 與我們的慢性護理計劃捆綁到一個虛擬的第一個計劃設計中，這是一個完全保險的計劃，雇主可以在他們為 23 年做出計劃設計選擇時選擇。因此，它是多種訪問工具，取決於計劃設計，取決於健康計劃，虛擬護理策略。

What we see, though, is really tremendous results in terms of improving access to care, as I indicated in the prepared remarks, 2/3 of the people who are engaging with Primary360 haven't seen a doctor in at least 2 years. And so these are really the distant franchise from the health care system.

然而，正如我在準備好的評論中指出的那樣，我們看到的是在改善獲得護理方面確實取得了巨大的成果，參與 Primary360 的人中有 2/3 至少有 2 年沒有看過醫生。所以這些真的是遠離醫療保健系統的特許經營權。

And we're finding that those people were having a tremendous impact relative to their overall care as we end up bringing a lot of additional services to bear for them, including both mental health as well as other Chronic Care solutions.

我們發現這些人對他們的整體護理產生了巨大的影響，因為我們最終為他們帶來了許多額外的服務，包括心理健康以及其他慢性護理解決方案。

Our next question comes from Stan Berenshteyn from Wells Fargo.

我們的下一個問題來自富國銀行的 Stan Berenshteyn。

I guess sticking with BetterHelp, do you still expect BetterHelp EBITDA margin to remain accretive to company level margins for this year? And then maybe I missed this, but can you comment on what drove the sequential decline in visit fee members in the quarter?

我想堅持使用 BetterHelp，您是否仍然期望 BetterHelp EBITDA 利潤率在今年保持對公司級利潤率的增長？然後也許我錯過了這一點，但是您能否評論一下是什麼推動了本季度訪問費會員的連續下降？

Yes. So the answer to your first question is, yes, we still expect BetterHelp margins to be accretive this year to the overall enterprise margins. And as we talked about a few minutes ago, we are very thoughtful about balancing revenue growth and margins. We are talking about the 40% margin growth, balancing that with our margins.

是的。所以你的第一個問題的答案是，是的，我們仍然預計 BetterHelp 的利潤率今年會增加整體企業利潤率。正如我們幾分鐘前談到的那樣，我們非常考慮平衡收入增長和利潤率。我們談論的是 40% 的利潤率增長，與我們的利潤率相平衡。

So yes, it is accretive. And in the case of wardrobe, an answer to your second question. There was a change in our reporting that we got in terms of the members on the VFO side. And so we essentially are just adjusting that.

所以是的，它是增值的。在衣櫃的情況下，回答你的第二個問題。就 VFO 方面的成員而言，我們的報告發生了變化。所以我們基本上只是在調整它。

Our next question comes from Steven Valiquette from Barclays.

我們的下一個問題來自巴克萊銀行的 Steven Valiquette。

This is Tiffany on for Steve. Just on the Chronic Care sales type. Given that you guys mentioned you were seeing early signs of floor progression in closing deals and that we're still pretty early in the selling season. Are you making any maybe like the new or shift in the sales approach? I understand part of it may also be macro-driven, but just any color you can add there.

這是史蒂夫的蒂芙尼。就在慢性護理銷售類型上。鑑於你們提到你們在完成交易時看到了地板進展的早期跡象，而且我們仍處於銷售旺季的早期階段。您是否正在改變銷售方式？我知道它的一部分也可能是宏觀驅動的，但你可以在那裡添加任何顏色。

The answer is yes. We're constantly refining our approach, especially as we move more and more into whole person care sales where we're bundling together multiple of our Chronic Care solutions. And some of the data that I pointed to is relatively new data. So we're able to demonstrate greater success and deliver proof points to our clients relative to the benefit of buying a bundle of services.

答案是肯定的。我們不斷改進我們的方法，特別是當我們越來越多地進入全人護理銷售領域時，我們將多個慢性護理解決方案捆綁在一起。我指出的一些數據是相對較新的數據。因此，相對於購買捆綁服務的好處，我們能夠展示更大的成功並向我們的客戶提供證明點。

So for example, when mental health services are integrated into Chronic Care, members see an average of an additional 0.5% A1C reduction, almost 10 millimeters reduction in systolic blood pressure and about a 2% additional weight loss. And so those are relatively new. We haven't been bundling together these services for that long. And so we're really focused on outcomes.

因此，例如，當心理健康服務被納入慢性護理時，會員會看到平均額外減少 0.5% 的 A1C，收縮壓降低近 10 毫米，額外減輕約 2% 的體重。所以這些都是相對較新的。我們已經很久沒有將這些服務捆綁在一起了。所以我們真的很關注結果。

And quite frankly, stepping up and putting our money where our mouth is to guarantee the outcomes from the programs. And I guess I do just want to say this -- what we're seeing in terms of slowness in the pipeline turning into bookings is affecting our in-year revenue but we haven't yet seen it push beyond to -- well, we're not going to make a decision this year at all, and therefore, affect '23.

坦率地說，加緊努力，把我們的錢用在我們的嘴上，以保證項目的成果。而且我想我只是想說這一點——我們所看到的預訂量的緩慢正在影響我們的年度收入，但我們還沒有看到它超越——好吧，我們'今年根本不會做出決定，因此會影響'23。

Our next question comes from David Larsen from BTIG.

我們的下一個問題來自 BTIG 的 David Larsen。

Can you talk a little bit about the competitive dynamics in the market overall? Like Jason, when you think about the platform that you have now, are there certain assets or products or certain gaps that you want to fill? Like, for example, Accolade obviously has a benefit navigation solution. Other platforms have something called Advocacy, where it's sort of a concierge type of medicine where you have a health coach and they can sort of show you which docs to go to, if you need to. For other platforms, they're actually bearing some risk on a PMPM basis. Like when you think about your platform, are you -- just any holes that you might see?

你能談談整個市場的競爭動態嗎？像 Jason 一樣，當您考慮您現在擁有的平台時，是否有某些資產或產品或您想要填補的某些空白？例如，Accolade 顯然有一個有益的導航解決方案。其他平台有一種叫做 Advocacy 的東西，它是一種禮賓類型的藥物，你有一個健康教練，如果你需要，他們可以告訴你去哪些文件。對於其他平台，它們實際上在 PMPM 的基礎上承擔了一些風險。就像當您考慮您的平台時一樣，您是否 - 只是您可能看到的任何漏洞？

Sure, David. Actually, we do all of the things that you just mentioned. We're more and more entering into value-based arrangements with our clients. In some cases, those are for clinical outcomes in others, it's for financial cost savings and putting a portion of our fees at risk relative to those savings and sharing in the upside.

當然，大衛。實際上，我們做了你剛才提到的所有事情。我們越來越多地與客戶達成基於價值的安排。在某些情況下，這些是為了在其他情況下獲得臨床結果，這是為了節省財務成本，並使我們的一部分費用相對於這些節省和分享收益處於風險之中。

We also, as you know, have a care team model that includes coaches and a big part of our Primary360 program is making sure that we can get care to you in your home or refer you to the right physician, the first time in the event that you need to be seen in person.

如您所知，我們還擁有一個包括教練在內的護理團隊模式，我們 Primary360 計劃的很大一部分是確保我們能夠在您家中為您提供護理或將您轉介給合適的醫生，這是活動的第一次你需要親自見到。

I think the rollout and we recently announced the expansion of home lab testing, where we can dispatch someone to the home to perform phlebotomy or take urine samples -- that's a great partnership with Scarlet, which is owned by BioReference.

我認為推出，我們最近宣布擴大家庭實驗室測試，我們可以派人到家裡進行放血或採集尿液樣本——這是與 BioReference 擁有的 Scarlet 的良好合作夥伴關係。

We also announced home delivery of medications in a partnership with Capsule. And so I really see that we -- our Primary360 combined with our suite of Chronic Care and mental health solutions and of course, leveraging our expert medical services are truly differentiated in the market as the only full -- really full credit answer for the consumer.

我們還宣布與 Capsule 合作，將藥物送貨上門。所以我真的看到我們——我們的 Primary360 與我們的慢性護理和心理健康解決方案套件相結合，當然，利用我們的專業醫療服務在市場上真正與眾不同，因為它是唯一為消費者提供的完全——真正完全信用的答案.

Now that doesn't mean that we're done, of course. We're always looking to expand the scope of our offerings. And so that's why we've developed over the course of the last year, things like a program focused on CHF, a program focused on CKD, and you'll see us continue to expand the scope of our offerings.

當然，這並不意味著我們已經完成了。我們一直在尋求擴大我們的產品範圍。這就是我們在過去一年中開發的原因，例如專注於 CHF 的計劃、專注於 CKD 的計劃，您會看到我們繼續擴大我們的產品範圍。

Before we go to the next question, George, if you are hopefully still on the line, I wanted to just answer your question. So the dynamic for Q4 is, as you mentioned, it's really around BetterHelp advertising. We are looking to pull back in Q4 on ad spend, we've talked about the pricing dynamics in the holiday season. It is something that we typically do every year. So this is not a new dynamic. So that is the reason for the margin progression as it is in the fourth quarter.

在我們進入下一個問題之前，喬治，如果您希望您仍然在線，我只想回答您的問題。因此，正如您所提到的，第四季度的動態實際上是圍繞 BetterHelp 廣告。我們希望在第四季度收回廣告支出，我們已經討論了假日季節的定價動態。這是我們通常每年都會做的事情。所以這不是一個新的動態。這就是第四季度利潤率上升的原因。

And I just also wanted to reiterate at this point from a revenue perspective, we are seeing some modest incremental pressure on our yield on advertising spend in the BetterHelp business. And so -- but that could -- as we look forward to the next few months, as Jason talked about a few minutes ago, from a revenue standpoint, those dynamics could change, and it could change to the positive or it could change further to the negative.

在這一點上，我還想從收入的角度重申，我們看到 BetterHelp 業務的廣告支出收益面臨一些適度的增量壓力。所以 - 但那可能 - 正如我們期待接下來的幾個月，正如傑森幾分鐘前所說，從收入的角度來看，這些動態可能會改變，它可能會變成積極的，或者可能會進一步改變到負數。

We will just have to go through the year and see how the consumer dynamics play out and whether the consumer sentiment improves or it continues to be more towards the belt tightening loan.

我們將不得不度過這一年，看看消費者動態如何發揮作用，以及消費者情緒是否有所改善，還是繼續更傾向於緊縮貸款。

This concludes our Q&A and today's conference call. Thank you for your participation. You may now disconnect your lines.

我們的問答和今天的電話會議到此結束。感謝您的參與。您現在可以斷開線路。