Teladoc Health Inc (TDOC) 2022 Q4 法說會逐字稿

Good afternoon, and thank you for attending today's Teladoc Fourth Quarter 2022 Earnings Conference Call. My name is Daniel, and I will be the moderator for today's call. (Operator Instructions) It is now my pleasure to pass the conference over to our host, Patrick Feeley, Head of Investor Relations. Patrick, the floor is yours.

下午好，感謝您參加今天的 Teladoc 2022 年第四季度收益電話會議。我叫丹尼爾，我將擔任今天電話會議的主持人。 （操作員說明）現在我很高興將會議轉交給我們的主持人，投資者關係主管 Patrick Feeley。帕特里克，地板是你的。

Thank you, and good afternoon.

謝謝，下午好。

Today, after the market closed, we issued a press release announcing our fourth quarter and full year 2022 financial results. This press release and the accompanying slide presentation are available on the Investor Relations section of the teladochealth.com website.

今天，收市後，我們發布了一份新聞稿，宣布了我們第四季度和 2022 年全年的財務業績。本新聞稿和隨附的幻燈片演示可在 teladochealth.com 網站的投資者關係部分獲取。

On this call to discuss the results are Jason Gorevic, Chief Executive Officer; and Mala Murthy, Chief Financial Officer.

首席執行官 Jason Gorevic 在此次電話會議上討論了結果；和首席財務官 Mala Murthy。

During this call, we will also provide our first quarter and full year 2023 outlook, and our prepared remarks will be followed by a question-and-answer session.

在此電話會議中，我們還將提供 2023 年第一季度和全年展望，我們準備好的評論之後將進行問答環節。

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.

請注意，我們將討論某些我們認為對評估 Teladoc Health 的業績很重要的非 GAAP 財務指標。有關這些非 GAAP 措施與最具可比性的 GAAP 措施及其調節之間關係的詳細信息，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，本次電話會議期間作出的某些陳述將是 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、不確定性和其他因素的影響，這些因素可能導致實際結果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和我們向美國證券交易委員會提交的文件，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 thanks for joining us.

謝謝你，帕特里克。下午好，感謝您加入我們。

This afternoon, I'm pleased to share strong fourth quarter results to finish what was undoubtedly a challenging year. Today, we're providing our 2023 guidance, which reflects a balanced approach to top and bottom line growth, and we'll speak to changes to our reporting that will help you better track our progress.

今天下午，我很高興與大家分享強勁的第四季度業績，以結束毫無疑問充滿挑戰的一年。今天，我們提供了 2023 年指南，該指南反映了實現收入和利潤增長的平衡方法，我們將討論報告的變化，這將幫助您更好地跟踪我們的進展。

First, let's start with a brief recap of the past quarter and year. Overall, despite a more challenging macro environment, our underlying business continues to perform with positive momentum, demonstrated by our ability to continue driving solid full year revenue growth. Fourth quarter consolidated revenue grew 15% year-over-year to $638 million, near the high end of our guidance range. For the full year, total revenue grew 18% to more than $2.4 billion.

首先，讓我們從對過去一個季度和一年的簡要回顧開始。總體而言，儘管宏觀環境更具挑戰性，但我們的基礎業務繼續保持積極勢頭，我們有能力繼續推動全年收入穩步增長。第四季度綜合收入同比增長 15% 至 6.38 億美元，接近我們指導範圍的高端。全年總收入增長 18%，超過 24 億美元。

Fourth quarter consolidated adjusted EBITDA of $94 million was in line with the outlook we provided in October, delivering upon our expectation for a significant margin increase in the quarter.

第四季度綜合調整後 EBITDA 為 9400 萬美元，符合我們在 10 月份提供的展望，符合我們對本季度利潤率大幅增長的預期。

We're pleased with the performance of our BetterHelp business, which grew 29% year-over-year in the fourth quarter, while delivering on our profitability target. We also remain excited about the momentum we're seeing for our integrated whole-person platform, which includes chronic care, mental health and Primary360, now all accessible through a single login and account in our new unified app.

我們對 BetterHelp 業務的表現感到滿意，該業務在第四季度同比增長 29%，同時實現了我們的盈利目標。我們也對我們看到的集成全人平台的勢頭感到興奮，其中包括慢性病護理、心理健康和 Primary360，現在所有這些都可以通過我們新的統一應用程序中的單一登錄和帳戶訪問。

Looking to 2023 and beyond, our leadership position in whole-person virtual care is clear. The breadth and depth of our market-leading portfolio of products and services provides a strong platform for growth and expansion. I'm very pleased with our progress as we continue to deliver on our mission and realize our vision of making virtual care the first step on any healthcare journey.

展望 2023 年及以後，我們在全人虛擬護理方面的領導地位是明確的。我們市場領先的產品和服務組合的廣度和深度為增長和擴張提供了強大的平台。我對我們的進展感到非常高興，因為我們繼續履行我們的使命並實現我們的願景，即讓虛擬護理成為任何醫療保健之旅的第一步。

Top of mind, as we begin the new fiscal year is vendor consolidation. We hear a growing desire from our clients to shift away from point solutions and toward multiproduct integrated, virtual and digital platforms. At the same time, we're seeing clients increasingly focused on demonstrated results.

當我們開始新的財政年度時，最重要的是供應商整合。我們聽到客戶越來越希望從單點解決方案轉向多產品集成、虛擬和數字平台。與此同時，我們看到客戶越來越關注展示的結果。

Teladoc Health has been at the forefront of the adoption curve, and we believe that our scale, breadth of product offering and proven outcomes will enable us to maintain and expand our position in the market.

Teladoc Health 一直處於採用曲線的最前沿，我們相信我們的規模、產品供應的廣度和經過驗證的成果將使我們能夠保持和擴大我們在市場上的地位。

While there remains a healthy demand for solutions that promise better access and outcomes, while lowering the cost of healthcare, the challenging macro environment is likely to persist. This is particularly the case with regard to ongoing economic uncertainty as well as a moderation in overall market growth rates. Given the current operating environment as well as the larger scale at which we now operate, you should expect us to balance growth and margin with an increased focus on efficiency going forward.

雖然對承諾更好的訪問和結果的解決方案仍然存在健康需求，同時降低醫療保健成本，但具有挑戰性的宏觀環境可能會持續存在。對於持續的經濟不確定性以及整體市場增長率的放緩，情況尤其如此。鑑於當前的運營環境以及我們現在運營的規模更大，您應該期望我們在增長和利潤之間取得平衡，同時更加關注未來的效率。

Part of that approach is rightsizing the cost structure to reflect the current growth rates of the business. As such, the management team has been working diligently on ways to optimize the cost structure of the organization, which includes beginning the year with some tough decisions regarding layoffs and the restructuring of some teams. This restructuring will enable us to improve efficiency while still allowing us to effectively build upon our integrated virtual care offering in a market that remains in the early innings.

該方法的一部分是調整成本結構以反映當前業務的增長率。因此，管理團隊一直在努力尋找優化組織成本結構的方法，其中包括在年初做出一些關於裁員和重組部分團隊的艱難決定。這種重組將使我們能夠提高效率，同時仍然允許我們在仍處於早期階段的市場中有效地建立我們的綜合虛擬護理產品。

These actions are reflected in our Q1 and full year 2023 outlook. This more balanced approach does not mean that we will stop relentlessly pursuing growth and increased adoption of virtual care across the industry. Virtual care's role within the healthcare industry remains underpenetrated, and we will continue to invest to expand our leadership position.

這些行動反映在我們的第一季度和 2023 年全年展望中。這種更加平衡的方法並不意味著我們將停止不懈地追求增長和增加整個行業對虛擬護理的採用。虛擬護理在醫療保健行業中的作用仍未得到充分滲透，我們將繼續投資以擴大我們的領導地位。

Our key strategic priorities remain our whole-person suite of services, including our virtual primary care offering, Primary360, our suite of chronic care management solutions and our mental health products, and continued growth in our BetterHelp consumer brand. Access to our platform is available to over 80 million individuals in the U.S. today, primarily through our relationships with employers and health plans. Over 50% of that population has access to more than one of our products. And when I look at our suite of chronic care solutions, 30% of enrollees are now utilizing more than one chronic care product.

我們的關鍵戰略重點仍然是我們的全人服務套件，包括我們的虛擬初級保健產品 Primary360、我們的慢性病護理管理解決方案套件和我們的心理健康產品，以及我們 BetterHelp 消費者品牌的持續增長。今天，美國有超過 8000 萬人可以訪問我們的平台，主要是通過我們與雇主的關係和健康計劃。超過 50% 的人口可以使用我們不止一種產品。當我查看我們的慢性病護理解決方案套件時，30% 的參與者現在正在使用不止一種慢性病護理產品。

Our BetterHelp offering provided over 1 million individuals with access to mental healthcare over the past year, many of whom are unlikely to have received any care at all, if not for our services. Our platform enabled over 22 million visits across specialties last year and over 0.5 billion digital health interactions with an unmatched consumer experience and a Net Promoter Score over 60. That breadth and scale is unrivaled in the industry and gives us a strong foundation on which to expand.

我們的 BetterHelp 產品在過去一年中為超過 100 萬個人提供了精神保健服務，如果不是因為我們的服務，他們中的許多人根本不可能接受任何護理。我們的平台去年實現了超過 2200 萬次跨專業訪問和超過 5 億次數字健康互動，具有無與倫比的消費者體驗和超過 60 的淨推薦值。這種廣度和規模在行業中是無與倫比的，為我們的擴展奠定了堅實的基礎.

With the more balanced approach I referenced a moment ago, we will pursue growth in a more focused way with the goal of expanding our margins consistently over the next several years, as we march toward GAAP profitability while still achieving attractive and sustainable top line growth rates. You see this more balanced approach reflected in our 2023 guidance today.

通過我剛才提到的更平衡的方法，我們將以更集中的方式追求增長，目標是在未來幾年持續擴大我們的利潤率，同時我們向 GAAP 盈利能力邁進，同時仍然實現有吸引力和可持續的頂線增長率.您會在我們今天的 2023 年指南中看到這種更加平衡的方法。

For the full year 2023, we expect revenue of $2.55 billion to $2.675 billion, representing year-over-year growth of 6% to 11%. We expect adjusted EBITDA of $275 million to $325 million, representing growth of 12% to 32%.

對於 2023 年全年，我們預計收入為 25.5 億美元至 26.75 億美元，同比增長 6% 至 11%。我們預計調整後的 EBITDA 為 2.75 億美元至 3.25 億美元，增長 12% 至 32%。

You'll also notice some changes in the way that we report our results in today's press release, reflective of the way we are managing the business going forward. As our BetterHelp direct-to-consumer brand has scaled up rapidly over the past few years, we also felt it is the appropriate time to provide increased disclosure for this business. As such, you will now see our results reported along 2 segments. Teladoc Health Integrated Care, which primarily consists of our B2B distribution channels including business sold through employers, health plans and providers, both domestically and internationally; and BetterHelp, which primarily consists of mental health services sold through our direct-to-consumer distribution channel. Mala will discuss some of the additional assumptions underpinning our guidance in a moment, including how we're thinking about performance between these 2 segments.

您還會注意到我們在今天的新聞稿中報告結果的方式發生了一些變化，反映了我們未來管理業務的方式。由於我們的 BetterHelp 直接面向消費者的品牌在過去幾年中迅速擴大，我們也認為現在是為這項業務提供更多信息披露的適當時機。因此，您現在將看到我們按 2 個部分報告的結果。 Teladoc Health Integrated Care，主要由我們的 B2B 分銷渠道組成，包括通過雇主、健康計劃和提供商在國內和國際銷售的業務； BetterHelp，主要包括通過我們直接面向消費者的分銷渠道銷售的心理健康服務。 Mala 稍後將討論支持我們指導的一些額外假設，包括我們如何考慮這兩個部分之間的表現。

Hopefully, you'll find this new disclosure helpful in modeling the business going forward.

希望您會發現此新披露有助於為未來的業務建模。

Let me end by saying, the company remains strongly positioned both strategically and financially. Our vision to deliver integrated whole-person virtual care and our multiproduct strategy continues to resonate in the marketplace. And from a financial perspective, we continue to generate positive free cash flow and maintain a strong balance sheet. This is a clear differentiator for Teladoc Health, and provides us with the ability to invest in the expansion of our leadership position at a time when many of our smaller competitors are facing significant financial stress.

最後讓我說，公司在戰略和財務上仍然處於強勢地位。我們提供綜合全人虛擬護理的願景和我們的多產品戰略繼續在市場上引起共鳴。從財務角度來看，我們繼續產生正的自由現金流並保持強勁的資產負債表。這是 Teladoc Health 的一個明顯差異化因素，並使我們能夠在許多較小的競爭對手面臨巨大財務壓力的時候投資擴大我們的領導地位。

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

有了這個，我將把電話轉給 Mala 來審查第四季度和我們的前瞻性指導。

Thank you, Jason, and good afternoon, everyone.

謝謝你，傑森，大家下午好。

Before I turn to the results for the quarter. I want to take a moment to discuss our new reporting structure. As Jason noted, you will see in today's release that we are now reporting along 2 new segments: Teladoc Health Integrated Care and BetterHelp. On Page 7 of the press release, you will find segment results and metrics from the prior 5 quarters to help in your modeling.

在我轉向本季度的結果之前。我想花點時間討論一下我們的新報告結構。正如 Jason 指出的那樣，您將在今天的新聞稿中看到我們現在正在報告兩個新的部分：Teladoc Health Integrated Care 和 BetterHelp。在新聞稿的第 7 頁，您將找到前 5 個季度的細分結果和指標，以幫助您進行建模。

For the Integrated Care segment, in addition to revenue and adjusted EBITDA, we are reporting total U.S. membership with access to our suite of virtual program across our B2B distribution channels. This combines the prior categories of paid members, visit fee only members and chronic care enrollees. We believe the distinction between these member types is becoming less meaningful as the revenue models of our products have become more diverse over time and as we move towards more whole-person bundled and value-based arrangements.

對於 Integrated Care 部分，除了收入和調整後的 EBITDA 之外，我們還報告了美國會員總數，可以通過我們的 B2B 分銷渠道訪問我們的虛擬程序套件。這結合了先前類別的付費會員、僅支付訪問費的會員和長期護理登記者。我們認為，隨著我們產品的收入模式隨著時間的推移變得更加多樣化，以及我們朝著更加全人捆綁和基於價值的安排邁進，這些會員類型之間的區別變得越來越不重要。

Revenue per U.S. Integrated Care member represents total segment revenue divided by reported U.S. Integrated Care membership. We are also providing total chronic care program enrollment, which represents the total number of programs in which our members are actively enrolled. We believe program enrollment is more reflective of growth in chronic care revenue, as we continue to drive multi-program enrollment among our members.

每個美國 Integrated Care 會員的收入代表分部總收入除以報告的美國 Integrated Care 會員。我們還提供了長期護理計劃的總註冊人數，這代表了我們的會員積極註冊的計劃總數。我們認為，隨著我們繼續推動會員的多項目註冊，項目註冊更能反映慢性病護理收入的增長。

For the BetterHelp segment, in addition to revenue and adjusted EBITDA, we are reporting total BetterHelp users, which represents the average number of monthly paying users of the services during the period.

對於 BetterHelp 部分，除了收入和調整後的 EBITDA 之外，我們還報告了 BetterHelp 用戶總數，代表該期間服務的平均每月付費用戶數。

Turning to results. During the fourth quarter, consolidated revenue increased 15% year-over-year to $638 million. Fourth quarter adjusted EBITDA of $94 million was in line with the outlook we provided in October and represents a $43 million increase sequentially, primarily a reflection of the advertising spend seasonality in the direct-to-consumer business as we have discussed throughout 2022.

轉向結果。第四季度，綜合收入同比增長 15% 至 6.38 億美元。第四季度調整後的 EBITDA 為 9400 萬美元，與我們在 10 月份提供的展望一致，環比增長 4300 萬美元，這主要反映了我們在整個 2022 年討論過的直接面向消費者業務的廣告支出季節性。

Integrated Care segment revenue increased 6% year-over-year to $357 million in the quarter, driven primarily by growth in Chronic Care Management and Telemedicine product revenue. Integrated Care added 5.8 million U.S. members over the prior year, representing 7% year-over-year growth and 1.4 million sequentially to end the year with 83.3 million total U.S. members. Paid members were 58.7 million for the quarter, which exceeded the high end of our prior guidance range of 57 million to 58 million members.

本季度綜合護理部門收入同比增長 6% 至 3.57 億美元，這主要是受慢性護理管理和遠程醫療產品收入增長的推動。 Integrated Care 比上一年增加了 580 萬美國會員，同比增長 7%，截至年底，美國會員總數增加了 140 萬，美國會員總數為 8330 萬。本季度付費會員為 5870 萬，超過了我們之前 5700 萬至 5800 萬會員指導範圍的上限。

Total Chronic Care program enrollment exceeded 1 million programs in the fourth quarter, representing growth of 16% over the prior year's fourth quarter. The total number of individuals enrolled in one of our Chronic Care programs was 805,000 during the quarter, an increase of 10% over the prior year's fourth quarter.

第四季度慢性病護理項目總註冊人數超過 100 萬，比去年第四季度增長 16%。本季度參加我們的一項長期護理計劃的總人數為 805,000 人，比去年第四季度增長 10%。

Average Integrated Care segment revenue per U.S. member of $1.44 was down $0.02 over the prior year's fourth quarter due to the impact of new members onboarded over the course of the year. Excluding the dilutive impact of new member additions over the course of the year, revenue per U.S. member would have increased by over 2% versus the prior year's quarter.

由於全年新會員入職的影響，每位美國會員的綜合護理部門平均收入為 1.44 美元，比去年第四季度下降 0.02 美元。排除年內新成員增加的稀釋影響，每位美國成員的收入將比去年同期增長 2% 以上。

Revenue per U.S. member increased $0.04 sequentially over the third quarter.

第三季度每名美國會員的收入環比增長 0.04 美元。

Fourth quarter adjusted EBITDA from the Integrated Care segment grew 31% year-over-year to $43.7 million, while margins expanded 230 basis points to 12.2%. Adjusted EBITDA growth was driven primarily by revenue growth and leverage over G&A expense.

綜合護理部門第四季度調整後的 EBITDA 同比增長 31% 至 4370 萬美元，而利潤率擴大 230 個基點至 12.2%。調整後的 EBITDA 增長主要是由收入增長和對 G&A 費用的槓桿作用推動的。

For the full year, Integrated segment revenue grew 6% to $1.4 billion, adjusted EBITDA declined 6% to $135 million driven primarily by increased technology and development expense.

全年，集成部門收入增長 6% 至 14 億美元，調整後的 EBITDA 下降 6% 至 1.35 億美元，這主要是由於技術和開發費用的增加。

BetterHelp segment's revenue increased 29% year-over-year in the fourth quarter to $277 million, primarily driven by growth in BetterHelp membership. BetterHelp adjusted EBITDA grew 22% year-over-year to $52.8 million in the quarter. Sequentially, adjusted EBITDA margin expanded 15 percentage points to 19.1%. This margin expansion was driven in large part by the seasonality of advertising spend, as we've discussed on prior calls.

BetterHelp 部門第四季度的收入同比增長 29% 至 2.77 億美元，這主要是受 BetterHelp 會員數量增長的推動。本季度 BetterHelp 調整後的 EBITDA 同比增長 22% 至 5280 萬美元。調整後的 EBITDA 利潤率環比擴大 15 個百分點至 19.1%。正如我們在之前的電話會議上討論的那樣，這種利潤率的增長在很大程度上是由廣告支出的季節性推動的。

For the full year, BetterHelp segment revenue grew 41% to $1 billion. Adjusted EBITDA declined 6% to $114 million representing a margin of 11.2%, a reflection of the advertising market headwinds discussed last year.

全年，BetterHelp 分部收入增長 41% 至 10 億美元。調整後的 EBITDA 下降 6% 至 1.14 億美元，利潤率為 11.2%，這反映了去年討論的廣告市場逆風。

Consolidated net loss per share in the fourth quarter was $23.49 compared to a net loss per share of $0.07 in the fourth quarter of 2021. Net loss per share in the fourth quarter includes a noncash goodwill impairment charge of $3.8 billion or $23.26 per share, stock-based compensation expense of $0.31 per share and amortization of acquired intangibles of $0.30 per share.

第四季度的綜合每股淨虧損為 23.49 美元，而 2021 年第四季度的每股淨虧損為 0.07 美元。第四季度的每股淨虧損包括 38 億美元的非現金商譽減值費用或每股 23.26 美元的股票、股票基於每股 0.31 美元的補償費用和每股 0.30 美元的收購無形資產攤銷。

The goodwill impairment charge reflects the overall operating environment, including the lower rate of growth reflected in our guidance today and overall financial market conditions, including decreased market multiples. This goodwill write-off is noncash and has no impact on our financial position or our ability to invest in the business going forward.

商譽減值費用反映了整體經營環境，包括我們今天的指導中反映的較低增長率和整體金融市場狀況，包括市場倍數下降。這種商譽註銷是非現金的，對我們的財務狀況或我們未來投資業務的能力沒有影響。

During the fourth quarter and full year, the company generated free cash flow of $12 million and $17 million, respectively. We ended the year with $918 million in cash and short-term investments on the balance sheet.

在第四季度和全年，公司產生的自由現金流分別為 1200 萬美元和 1700 萬美元。到年底，我們的資產負債表上有 9.18 億美元的現金和短期投資。

Now turning to forward guidance. For the full year 2023, we expect revenue to be in the range of $2.55 billion to $2.675 billion representing revenue growth of 6% to 11%. This revenue outlook contemplates mid- to high single-digit percentage growth in our Integrated Care segment, and low double-digit to mid-teen percentage growth in our BetterHelp segment.

現在轉向前瞻性指導。對於 2023 年全年，我們預計收入將在 25.5 億美元至 26.75 億美元之間，收入增長 6% 至 11%。這一收入前景預計我們的 Integrated Care 部門將實現中高個位數的百分比增長，以及 BetterHelp 部門的低兩位數至中等百分比的增長。

We expect total Integrated Care segment U.S. membership of 84 million to 86 million members. We expect consolidated adjusted EBITDA for the full year to be in the range of $275 million to $325 million or growth of 22% at the midpoint. Consolidated guidance assumes year-over-year adjusted EBITDA margin of flat to up 50 basis points for the Integrated Care segment, and an increase of 100 to 300 basis points for the BetterHelp segment.

我們預計 Integrated Care 部分的美國會員總數為 8400 萬至 8600 萬。我們預計全年合併調整後的 EBITDA 將在 2.75 億美元至 3.25 億美元之間，或在中點增長 22%。綜合指導假設 Integrated Care 分部的同比調整後 EBITDA 利潤率持平至 50 個基點，BetterHelp 分部增加 100 至 300 個基點。

We expect to generate free cash flow of at least $100 million in 2023, driven by both the growth in adjusted EBITDA, and an expected decline in capitalized software development costs.

在調整後的 EBITDA 增長和資本化軟件開發成本預期下降的推動下，我們預計到 2023 年將產生至少 1 億美元的自由現金流。

For the first quarter of 2023, we expect revenue of $610 million to $625 million, representing growth of 8% to 11% year-over-year. We expect adjusted EBITDA of $42 million to $50 million. First quarter consolidated guidance contemplates low- to mid-single-digit revenue growth for the Integrated Care segment, and mid- to high-teens revenue growth for the BetterHelp segment.

對於 2023 年第一季度，我們預計收入為 6.1 億美元至 6.25 億美元，同比增長 8% 至 11%。我們預計調整後的 EBITDA 為 4200 萬至 5000 萬美元。第一季度的綜合指導考慮了綜合護理部門的中低個位數收入增長，以及 BetterHelp 部門的中高收入增長。

Total Integrated Care segment U.S. membership is expected to increase to 84 million to 85 million members. We expect Integrated Care segment margins to be slightly higher than BetterHelp segment margins in the first quarter due to typical margin seasonality. It's important to remind you of the seasonality dynamic in the BetterHelp business. As we have discussed throughout 2022, we typically see slower advertising spend in the fourth quarter during the holiday season. This drives lower customer acquisition in the back half of the fourth quarter and results in the strongest seasonal margin quarter of the year for BetterHelp.

綜合護理部門的美國會員總數預計將增加到 8400 萬至 8500 萬。由於典型的利潤季節性，我們預計第一季度綜合護理部門的利潤率將略高於 BetterHelp 部門的利潤率。重要的是要提醒您 BetterHelp 業務的季節性動態。正如我們在整個 2022 年所討論的那樣，我們通常會在假日季的第四季度看到廣告支出放緩。這導致第四季度後半段的客戶獲取量下降，並導致 BetterHelp 成為本年度最強勁的季節性利潤季度。

It also results in the seasonally weakest sequential growth and margins of the year in the first quarter as advertising spend is ramped up and the customer acquisition funnel rebuild. As such, our guidance assumes the first quarter to be the low point of the year for BetterHelp margins, and we expect consistent margin progression over the course of 2023.

隨著廣告支出的增加和客戶獲取渠道的重建，這也導致第一季度季節性最弱的環比增長和利潤率。因此，我們的指引假設第一季度是 BetterHelp 利潤率今年的最低點，我們預計 2023 年利潤率將保持一致增長。

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

有了這個，我會把電話轉回傑森。

Thanks, Mala. Before we go to Q&A, I also wanted to call your attention to our Third Annual Corporate Social Responsibility Report, we issued a few weeks ago. While all of our work is mission-driven, the fact that our 5,000 colleagues take giving back to the community as seriously as delivering for our members is a source of tremendous pride. The report covers a wide range of areas where we've had an impact in the past year from delivering more than 16,000 volunteer hours, 33% more than last year, to deploying 18 autonomous telehealth devices to Ukraine in cooperation with the World Telehealth initiative.

謝謝，馬拉。在我們進行問答之前，我還想提請您注意我們幾週前發布的第三份年度企業社會責任報告。雖然我們所有的工作都是以使命為導向的，但我們的 5,000 名同事將回饋社區視為與為我們的會員提供服務一樣認真，這一事實令人深感自豪。該報告涵蓋了過去一年我們產生影響的廣泛領域，從提供超過 16,000 小時的志願服務，比去年增加 33%，到與世界遠程醫療倡議合作向烏克蘭部署 18 台自主遠程醫療設備。

I'm grateful to my colleagues for demonstrating once again our core corporate value. We're passionate about taking care of people, and I encourage you to check out the report.

我很感謝我的同事們再次展示了我們的核心企業價值。我們熱衷於照顧他人，我鼓勵您查看報告。

With that, we're happy to take your questions. Operator?

有了這個，我們很樂意回答您的問題。操作員？

(Operator Instructions)

（操作員說明）

(technical difficulty)

（技術難度）

Our first question comes from the line of Ryan Daniels of William Blair.

我們的第一個問題來自 William Blair 的 Ryan Daniels。

This is Jack Senft on for Ryan Daniels. I know you're not giving guidance specifically for the BetterHelp segment. But based on the BetterHelp users you outlined in your presentation deck, I'm curious on your expectations when it comes to growth within the user base more longer term. It looks like year-over-year fourth quarter increased pretty significantly. So do you kind of expect BetterHelp to contribute more as a percent of total revenue over time? And just if you have any longer-term expectations on growth rates? That would be much appreciated.

這是瑞恩丹尼爾斯的傑克森夫特。我知道您沒有專門針對 BetterHelp 部分提供指導。但是根據您在演示文稿中概述的 BetterHelp 用戶，我很好奇您對用戶群長期增長的期望。看起來第四季度同比增長非常顯著。那麼，您是否希望 BetterHelp 隨著時間的推移貢獻更多的總收入百分比？只是如果您對增長率有任何長期預期？那將不勝感激。

Yes. So thank you for the question. We're not in a position to give any outlook beyond 2023. We have given you hopefully, plenty of disclosure and detail for how we expect the BetterHelp business to be in 2023. Look, it's -- at this point, BetterHelp is over a $1 billion business. I don't think you're going to see it return to the type of hyper growth that this business has seen over the past few years where it grew in -- well over 100% in the past few years.

是的。謝謝你的提問。我們無法給出 2023 年以後的任何展望。我們已經滿懷希望地向您提供了大量披露信息和詳細信息，說明我們對 BetterHelp 業務在 2023 年的預期。看，在這一點上，BetterHelp 已經結束了10 億美元的業務。我不認為你會看到它恢復到過去幾年該業務增長的那種高速增長——在過去幾年中超過 100%。

But we do think, importantly, that there remains a long runway for growth in this market. If you think about virtual therapy, it's still underpenetrated and a lot of the structural issues are on access and costs aren't getting addressed in other places. So the tailwinds for this business are still very strong.

但我們確實認為，重要的是，這個市場的增長還有很長的路要走。如果你考慮虛擬療法，它仍然沒有得到充分滲透，許多結構性問題都與訪問有關，而且其他地方沒有解決成本問題。因此，這項業務的順風仍然非常強勁。

The other important thing to note is, as Jason said in his remarks -- prepared remarks, we are making a choice this year to grow a little bit slower and drive margin improvement. We have talked about the 100 to 300 basis points of margin improvement in this business.

另一件需要注意的重要事情是，正如傑森在他的評論中所說——準備好的評論，我們今年正在做出選擇，以稍微放緩增長並推動利潤率提高。我們已經談到了該業務利潤率提高 100 到 300 個基點。

And then the last thing, I'd say is BetterHelp is still likely to add more incremental revenue this year than, frankly, most of our competitors generate in total annual revenue. It's just there is a lot of scale in this business, and there's a lot of scale advantage to take advantage of in this business.

然後最後一件事，我要說的是 BetterHelp 今年仍然可能增加更多的增量收入，坦率地說，比我們大多數競爭對手的年總收入還要多。只是這項業務有很大的規模，而且在這項業務中有很多規模優勢可以利用。

The next question comes from the line of Lisa Gill with JPMorgan.

下一個問題來自摩根大通的 Lisa Gill。

Just really want to start with 2 things. Mala, you made an interesting comment around how the business is progressing going forward and you said whole-person value-based bundles. So that's my question for Jason. Can you talk to me about what you're seeing for 2023? How do we think about how value-based bundles will work and what that means to revenue and profit?

只是真的想從兩件事開始。 Mala，你就業務的發展方向發表了有趣的評論，你說的是基於全人價值的捆綁。這就是我要問傑森的問題。你能和我談談你對 2023 年的看法嗎？我們如何考慮基於價值的捆綁將如何運作以及這對收入和利潤意味著什麼？

And then secondly, Mala, you talked about the improvement in the margin and by my math, it's like 130 basis points at the midpoint of what you've given. Can you maybe just talk about like what are some of the key drivers to that margin improvement? Is it mix? Is it the realignment of the business? Like what are some of the things that we should think about that maybe are specific to '23 or things that potentially will impact the margins as we think about beyond '23?

其次，Mala，你談到了利潤率的提高，根據我的數學計算，這就像你給出的中點的 130 個基點。您能否談談提高利潤率的一些關鍵驅動因素？是混合嗎？是業務重組嗎？就像我們應該考慮的一些事情可能是 23 年特有的，或者我們在 23 年以後考慮的可能會影響利潤率的事情是什麼？

Yes. Thanks, Lisa. There's no question that, especially health plans, but also increasingly large employers are looking for us to provide value-based arrangements. And value-based arrangements can take the form of being based on clinical outcomes, being based on bending the cost curve or some combination of the 2 of them. In many cases, they are multiproduct bundles of services from us. And so if I look back at the last year, the interest from health plans and deals with value-based components is up about 4x year-over-year. And that, I think, really plays well to us.

是的。謝謝，麗莎。毫無疑問，尤其是健康計劃，還有越來越多的大型雇主正在尋求我們提供基於價值的安排。基於價值的安排可以採取基於臨床結果、基於彎曲成本曲線或兩者的某種組合的形式。在許多情況下，它們是我們提供的多產品服務包。因此，如果我回顧去年，健康計劃和基於價值的部分交易的興趣同比增長了約 4 倍。而且，我認為，這對我們來說真的很好。

Our outcomes proof points are clear, where we are driving significantly better outcomes when consumers engage in more than one of our clinical products. And we're in a fortunate position now where for our chronic care solutions, 30% of our members, who are engaging with a chronic care solution, are engaging with more than one of them. But it's also true that we're driving significant return on investment for our clients, and that obviously lends itself well to value-based arrangements.

我們的結果證明點很明確，當消費者參與我們的不止一種臨床產品時，我們正在推動更好的結果。我們現在處於一個幸運的位置，對於我們的長期護理解決方案，我們 30% 的成員正在使用一個長期護理解決方案，他們正在使用其中一個以上的解決方案。但我們正在為客戶帶來可觀的投資回報也是事實，這顯然非常適合基於價值的安排。

On average, our diabetes program delivers a return on investment of 3:1 for our clients. For those who are significantly hypertensive, meaning over 140 systolic, we're driving $58 PPPM cost avoidance and so again, those lend themselves really well to aligning us with our clients in value-based arrangements.

平均而言，我們的糖尿病項目為我們的客戶帶來了 3:1 的投資回報率。對於那些嚴重高血壓，即收縮壓超過 140 的人，我們正在推動 58 美元的 PPPM 成本規避，因此，這些人非常適合在基於價值的安排中與我們的客戶保持一致。

And then, Lisa, for your second question, if I think about our margin progression, I'd bring it down to a few key factors, right? First is, if you think about the better health margin improvement, it's really around the leverage we will get from A&M, improving the yield, the productivity of our A&M. More broadly, if you think about Integrated Care, it's about technology and development expense leverage and as well as G&A. As you know, we took some very difficult decisions earlier this year in terms of doing a layoff.

然後，麗莎，關於你的第二個問題，如果我考慮我們的利潤率進展，我會把它歸結為幾個關鍵因素，對嗎？首先，如果你考慮更好的健康利潤率改善，它實際上是圍繞我們將從 A&M 獲得的槓桿作用，提高產量，我們 A&M 的生產力。更廣泛地說，如果你考慮 Integrated Care，它是關於技術和開發費用槓桿以及 G&A 的。如您所知，我們今年早些時候在裁員方面做出了一些非常艱難的決定。

And so if you think about the measures we are taking in controlling our costs, it is around driving G&A efficiency. It's about things such as real estate consolidation. And internally, we are also driving efficiencies in our structure. We have centers of excellence now, et cetera, all of that essentially to rightsize our cost base relative to the growth rate of the business.

因此，如果您考慮我們為控製成本而採取的措施，那就是提高 G&A 效率。這是關於諸如房地產整合之類的事情。在內部，我們也在提高我們結構的效率。我們現在擁有卓越中心等，所有這些本質上都是為了根據業務增長率調整我們的成本基礎。

The next question comes from Jailendra Singh of Truist Securities.

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

First, a quick clarification to your comment, Mala. Are you willing to quantify, how much benefit does your guidance assume from the recent restructuring for 2023? And my main question, Jason, you talked about the demand for multiproduct digital health platform increasing, employees moving away from point solutions. As you look across your solutions and offerings, are there certain areas or solutions where you would like to expand into to respond to that demand? And how do you plan to approach that in terms of like build, buy or partner?

首先，快速澄清一下您的評論，Mala。您是否願意量化，您的指導從最近的 2023 年重組中獲得了多少好處？我的主要問題是，傑森，你談到了對多產品數字健康平台的需求不斷增加，員工正在遠離單點解決方案。當您查看您的解決方案和產品時，您是否希望擴展到某些領域或解決方案來響應該需求？您打算如何通過構建、購買或合作夥伴的方式來解決這個問題？

So we'll take it in order. We've given you all enough transparency on the restructuring we did. We've reduced our head count by approximately 6%, over 300 individuals during the first quarter. To be clear, the significant majority of that has been completed during the first quarter. And it's fully incorporated in both our first quarter and full year guidance, Jailendra. And the only thing I would add to that is these actions that we are taking or we have taken, it follows a period of growing investment and they will moderate the pace of expense growth for 2023. And we believe this cost structure is reflective of the current growth rate of the business.

所以我們會按順序進行。對於我們所做的重組，我們已經向您提供了足夠的透明度。我們在第一季度裁員了約 6%，超過 300 人。需要明確的是，其中絕大部分已在第一季度完成。它已完全納入我們的第一季度和全年指導 Jailendra 中。我唯一要補充的是我們正在採取或已經採取的這些行動，這是在一段投資增長期之後進行的，它們將減緩 2023 年費用增長的步伐。我們相信這種成本結構反映了業務的當前增長率。

It will allow us to improve the efficiency of the organization and importantly, while still allowing us to continue to innovate in the market. That's still in relatively early innings.

它將使我們能夠提高組織的效率，重要的是，同時仍然允許我們繼續在市場上創新。那還處於相對較早的階段。

And Jailendra, with respect to your question about multiproduct sales, there's no question that, that dominates both our pipeline and our bookings. About 70% of our bookings last year were multiproduct bookings. We continue to see that. I think it's also reflected in the success of our Primary360 product, which acts as a hub for multiple other products and clinical services. Our Primary360 product continues to get significant traction. And although it's off a small base, we'll probably triple the revenue in '23 from Primary360 versus '22.

Jailendra，關於你關於多產品銷售的問題，毫無疑問，這主導了我們的渠道和預訂。去年我們大約 70% 的預訂是多產品預訂。我們繼續看到這一點。我認為這也反映在我們的 Primary360 產品的成功上，該產品充當多種其他產品和臨床服務的中心。我們的 Primary360 產品繼續受到廣泛關注。儘管它的基數很小，但與 22 年相比，Primary360 的 23 年收入可能會增加三倍。

So if you think about continued expansion of clinical products and services, we'll look to add additional products and services that are clinical capabilities that are complementary to both our existing chronic care portfolio as well as our Primary360 product and the full sort of primary care spectrum, if you will.

因此，如果您考慮繼續擴展臨床產品和服務，我們將尋求添加額外的產品和服務，這些產品和服務具有臨床能力，可以補充我們現有的慢性護理產品組合以及我們的 Primary360 產品和全套初級護理頻譜，如果你願意的話。

In terms of build versus buy, we'll continue to look opportunistically across the market. We look at both, a, speed to market; and b, financial return on those investments with respect to deciding whether we're going to build, buy or partner those. As I think has been well documented. There are a number of companies out there who are struggling in the current financial environment, and the cost of capital is significantly higher as other companies go out and have to raise money.

在構建與購買方面，我們將繼續在整個市場上尋找機會。我們同時關注上市速度； b，這些投資的財務回報決定我們是否要建造、購買或合作這些。正如我認為已經有據可查的那樣。有許多公司在當前的金融環境中苦苦掙扎，隨著其他公司走出去並不得不籌集資金，資金成本要高得多。

We're staying closely attuned to that, but we're not stopping our pace of internal innovation. And so you see that, for example, with the launch of our one app, which provides a single interface and a single consumer experience for all of our products and services and enables us to rapidly and relatively easily deploy additional products and clinical capabilities.

我們將密切關注這一點，但我們不會停止內部創新的步伐。所以你看到了，例如，隨著我們的一個應用程序的推出，它為我們所有的產品和服務提供了單一的界面和單一的消費者體驗，使我們能夠快速、相對容易地部署額外的產品和臨床能力。

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

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

So I've been hearing about a lot of market growth outside of you guys for virtual primary care. So that would be helpful to walk through just the basics of the model for Primary360. How you're charging for it? What you're seeing for RFP activity recently versus last year? And if we should view these wins as all incremental or if there's some cannibalization risk, as folks move to whole-person care versus virtual urgent care?

所以我一直聽說虛擬初級保健在你們之外有很多市場增長。因此，這將有助於了解 Primary360 模型的基礎知識。你是怎麼收費的？與去年相比，最近的 RFP 活動有何變化？如果我們應該將這些勝利視為所有增量，或者是否存在一些蠶食風險，因為人們轉向全人護理而不是虛擬緊急護理？

Yes. Thanks, Stephanie. As I said, we're very excited about the growth in Primary360. I mentioned we expect triple the revenue in '23 that we saw in '22. We have completed several thousand primary care visits already this year, and it's growing rapidly. We will deliver, I don't know, somewhere between 5 and 10x the visits in primary care in 2023 that we did in '22 and the pipeline is rich with opportunities.

是的。謝謝，斯蒂芬妮。正如我所說，我們對 Primary360 的增長感到非常興奮。我提到過我們預計 23 年的收入是 22 年的三倍。今年我們已經完成了數千次初級保健就診，而且還在迅速增加。我不知道，我們將在 2023 年提供 5 到 10 倍的初級保健訪問量，這是我們在 22 年所做的訪問量，而且管道充滿了機會。

So I feel very good about where we are. In terms of cannibalization, we really don't see cannibalization of our general medical services by our Primary360 product. They are really serving very different purposes. One is a longitudinal relationship that's really holistic and incorporates multiple of our products and services. The other is much more episodic and acute in nature.

所以我對我們所處的位置感覺很好。在蠶食方面，我們真的沒有看到我們的 Primary360 產品蠶食我們的一般醫療服務。他們確實服務於非常不同的目的。一個是真正全面的縱向關係，包含我們的多種產品和服務。另一個本質上更加偶發和尖銳。

But I think what's encouraging for us, is that the combination of our chronic care solutions and mental health solutions come together with our Primary360 service to really provide that whole-person care. Over half of our P360 members are using more than 2 of our Teladoc services, including our chronic care solutions. And we really see that members with chronic disease are 4x as likely to engage with our Primary360 product.

但我認為對我們來說令人鼓舞的是，我們的慢性病護理解決方案和心理健康解決方案與我們的 Primary360 服務相結合，真正提供了全人護理。超過一半的 P360 成員正在使用超過 2 項我們的 Teladoc 服務，包括我們的慢性病護理解決方案。我們確實看到，患有慢性病的會員使用我們的 Primary360 產品的可能性是原來的 4 倍。

I think lastly, all of that is driving Net Promoter Scores in the 70s for our P360 product, which is not only providing new opportunities for us, but also expansion opportunities with existing clients.

我認為最後，所有這些都推動了我們 P360 產品在 70 年代的淨推薦值，這不僅為我們提供了新的機會，也為現有客戶提供了擴展機會。

Yes. The thing I'll add is we are in the very early innings for virtual primary care. But we do think, based on the momentum we are seeing, over time, it has the potential to certainly become a much larger portion of the business. The pace of adoption over the next several years is certainly going to have an impact on the Integrated Care segment growth in particular.

是的。我要補充的是，我們正處於虛擬初級保健的早期階段。但我們確實認為，根據我們看到的勢頭，隨著時間的推移，它肯定有可能成為業務中更大的一部分。未來幾年的採用速度肯定會對綜合護理部門的增長產生影響，尤其是。

So taking that comment in line with the tripling of revenues for Primary360, how can we bridge to your guidance? You've got $200 million of incremental revenue dollars. It's on a base with a tripling Primary360, BetterHelp ending your double-digit growth, is there anything to call out that would prevent you from benefiting from those growth rates?

因此，根據 Primary360 的三倍收入來考慮該評論，我們如何才能與您的指導相銜接？你有 2 億美元的增量收入。它基於三倍的 Primary360，BetterHelp 結束了您的兩位數增長，有什麼要指出的會阻止您從這些增長率中受益嗎？

Well, remember, Stephanie, that Primary360 is off a very small base in '22, which I think we were consistent about saying over the course of last year, and we've given an indication of the growth rates of both the Integrated Care segment as well as the BetterHelp segment. So I think you can bring those together to look at what the overall guidance we've given for '23 is.

好吧，斯蒂芬妮，請記住，Primary360 在 22 年的基數非常小，我認為我們在去年的過程中一直這麼說，我們已經給出了綜合護理部門的增長率指標以及 BetterHelp 部分。因此，我認為您可以將它們放在一起，看看我們為 23 年給出的總體指導是什麼。

The next question comes from the line of Richard Close. (Operator Instructions)

下一個問題來自 Richard Close。 （操作員說明）

Mala, can you talk a little bit more about the Integrated margins, what you're seeing and what you're expecting? I guess, flat to 50 base improvements. Just maybe a little bit more detail in the expansion opportunities maybe beyond 2023 in this business?

Mala，你能多談談綜合利潤率、你所看到的和你的期望嗎？我猜，持平到 50 個基礎改進。也許在 2023 年以後該業務的擴展機會中有更多細節？

Yes. So here's what I would say, if you think about the Integrated Care segment. We will drive leverage in our expense base as our revenue continues to grow and scale. If you think about what the elements of that business are, and you'll see much more in the press release about what's in the Integrated Care segment. But it's essentially think of it as growth across chronic care, Primary360, as we have talked about, our telemedicine business including mental health on the B2B side, and then growth in our hospital and health system business.

是的。如果你考慮綜合護理部分，這就是我要說的。隨著我們的收入繼續增長和擴大，我們將提高我們費用基礎的槓桿率。如果您考慮該業務的要素是什麼，您會在新聞稿中看到更多關於綜合護理部分的內容。但它本質上是將其視為慢性護理、Primary360 的增長，正如我們所談到的，我們的遠程醫療業務包括 B2B 方面的心理健康，然後是我們醫院和衛生系統業務的增長。

So if you just think of the diversity of growth opportunities across all of these -- and I'm sorry, the last important one is international, right? Because again, this is a global Integrated Care segment. So again, if you think about the growth opportunities across all of these, the margin progression will come from driving revenue and scaling revenue, number one.

因此，如果您只考慮所有這些增長機會的多樣性——對不起，最後一個重要的機會是國際性的，對吧？因為這又是一個全球綜合護理部分。因此，如果您再次考慮所有這些方面的增長機會，那麼利潤率的增長將來自推動收入和擴大收入，這是第一。

And number two, as we've talked about, just being much more efficient in our costs and expenses in that segment, whether it be technology and development expense, we are going to drive leverage in T&D expense this year. And we expect -- we will expect to continue to do that in future years. We are still investing to be clear in the business given the fact that we are still in the early innings, but we do expect to drive leverage there. And as I said, in SG&A as well.

第二，正如我們所討論的那樣，無論是技術和開發費用，還是在該領域的成本和費用方面都更有效率，今年我們將提高 T&D 費用的槓桿率。我們期望 - 我們將期望在未來幾年繼續這樣做。鑑於我們仍處於早期階段，我們仍在投資以明確業務，但我們確實希望在那裡推動槓桿作用。正如我所說，在 SG&A 中也是如此。

So it's the combination of those that will drive the margin progression in the Integrated Care segment.

因此，正是這些因素的結合將推動綜合護理領域的利潤增長。

The next question comes from George Hill of Deutsche Bank.

下一個問題來自德意志銀行的喬治希爾。

It's Maxi on for George. Your provider model has been gradually changing from a pure contracting model to more of a hybrid model. Can you give us some color on where you are now in terms of contracted versus employed providers? And how do you -- how do the restructuring and cost saving initiatives change this ratio and the pace of hiring to support membership growth?

這是喬治的馬克西。您的供應商模式已逐漸從純合同模式轉變為更多的混合模式。你能告訴我們你現在在合同供應商和僱傭供應商方面的情況嗎？你如何 - 重組和成本節約計劃如何改變這一比例和招聘速度以支持會員增長？

Yes. So we're in the process. We haven't given out a percentage of the total visits that are being taken by employed versus independent contractor physicians, but we are in the process of shifting. I think you will see us go to north of 50% of our visit volume ultimately being taken by employed physicians. What we've proven now is that we can drive actually greater physician productivity at higher consumer Net Promoter Scores and equal to better clinical integration of all of our products when we do that with an employed physician model.

是的。所以我們正在進行中。我們沒有給出受僱醫生與獨立承包商醫生進行的總訪問量的百分比，但我們正在轉移。我想你會看到我們去了 50% 以上的訪問量，最終由受僱的醫生接受。我們現在已經證明的是，當我們使用受僱的醫生模型時，我們可以在更高的消費者淨推薦值下實際提高醫生的工作效率，並且等於我們所有產品的更好的臨床整合。

We'll never get to 100%, and that wouldn't be prudent, because it's not -- you get beyond the efficiency frontier at some point. And more and more, we are also moving to employed physicians for both our general medical, more episodic visits, as well as, of course, for our more longitudinal relationships in Primary360.

我們永遠不會達到 100%，這並不謹慎，因為它不是——你在某個時候會超出效率邊界。而且，我們也越來越多地轉向僱傭醫生來進行我們的一般醫療、更多的偶發性訪問，當然還有我們在 Primary360 中更縱向的關係。

I wouldn't point you to that transition when we talked about the restructuring that we did at the beginning of this year. That was really not oriented around our physician staffing model, more it was around our OpEx and around our nonclinical staff.

當我們談論我們在今年年初進行的重組時，我不會向您指出這種轉變。這真的不是圍繞我們的醫生人員配置模型，更多的是圍繞我們的運營支出和我們的非臨床人員。

The next question comes from Jessica Tassan of Piper Sandler.

下一個問題來自 Piper Sandler 的 Jessica Tassan。

So I just was hoping you could help us square the increase in multiproduct sales with the kind of flattish average revenue per U.S. Integrated Care member over the course of 2022 relative to that 4Q '21 number you presented? And then just secondarily, Jason, if you could just remind us what's the level or type of behavioral care and care navigation that's embedded in the Primary360 offering?

所以我只是希望你能幫助我們將多產品銷售額的增長與 2022 年期間美國 Integrated Care 會員的平均收入相對於你提供的 21 年第四季度數字持平？其次，Jason，你能否提醒我們 Primary360 產品中嵌入的行為護理和護理導航的級別或類型是什麼？

So if you -- what we said in our prepared remarks, Jess, is if you think about the revenue per member and you talk about flattish. Again, remember, we onboarded a lot of new members in 2022, and there is a dilutive impact of that. If you think about the growth in membership last year, it was about a 6% to 7% growth in members. So there is a dilutive impact. If you normalize for that impact, as we said, on a year-over-year basis, we did see an increase in revenue per member of about 2% increase and it translated to about $0.04 sequentially.

因此，如果你——傑西，我們在準備好的發言中所說的是，如果你考慮每位會員的收入，並且你談論的是平淡無奇的。請再次記住，我們在 2022 年加入了許多新成員，這會產生稀釋影響。如果你考慮一下去年會員的增長，會員數量大約增長了 6% 到 7%。因此存在稀釋影響。如果你將這種影響標準化，正如我們所說，與去年同期相比，我們確實看到每位會員的收入增長了約 2%，並且連續轉化為約 0.04 美元。

The point being that we are actually seeing the impact of the revenue growth, and the different elements and components of that in our revenue per member. And again, if you think about what is included in that revenue per member, it is increases in enrollment, it's increases in visit utilization. It is increases in the growth in our hospital and health systems business. As we said, it is overall segment revenue growth and the different components of that, that will drive the increase in revenue per member.

關鍵是我們實際上看到了收入增長的影響，以及每個會員收入中的不同元素和組成部分。再一次，如果你考慮每個會員的收入中包含什麼，那就是註冊人數的增加，以及訪問利用率的增加。這是我們醫院和衛生系統業務增長的增長。正如我們所說，整體細分市場收入增長及其不同組成部分將推動每位會員收入的增長。

And then with respect to Primary360, our standard offering for Primary360 60 delivers mental health along with virtual primary care, that mental health is -- tends to be therapy as well as access to psychiatry for medication management. Having said that, not every client takes our standard or full bundle of services. And so while that is our lead offering, I just caution you that not every product -- every client takes the same bundle of services.

然後關於 Primary360，我們為 Primary360 60 提供的標準產品提供心理健康以及虛擬初級保健，心理健康往往是治療以及獲得精神病學以進行藥物管理。話雖如此，並非每個客戶都接受我們的標准或全套服務。因此，雖然這是我們的主要產品，但我只是提醒您，並非所有產品——每個客戶都接受相同的服務組合。

The next question comes from the line of Daniel Grosslight of Citi.

下一個問題來自花旗銀行的 Daniel Grosslight。

As we talk to benefits managers around virtual primary care, it seems like the integration of virtual and physical clinics has become increasingly important. I'm sure you hear the same thing. Can you remind us how you guys integrate with in-person care and if your integration strategy has changed at all?

當我們與虛擬初級保健的福利經理交談時，虛擬和實體診所的整合似乎變得越來越重要。我相信你也聽到了同樣的話。你能提醒我們你們是如何融入面對面護理的嗎？你們的整合策略是否有任何改變？

Yes, Daniel, thanks for the question. I think about it in terms of sort of 3 concentric circles. At the center is what we can deliver virtually for the consumer along all of the dimensions, including primary care, mental health, chronic care in a longitudinal and holistic manner. The second ring is around what can be delivered in the home. And so more and more, we're driving care into the home and helping to facilitate care that can be delivered in the home, whether that's diagnostic testing or actual delivery of care in the home.

是的，丹尼爾，謝謝你的提問。我從 3 個同心圓的角度來考慮它。核心是我們可以在所有維度上以虛擬方式為消費者提供的服務，包括縱向和整體的初級保健、心理健康、慢性保健。第二個環是關於可以在家中交付的東西。因此，我們越來越多地推動護理進入家庭，並幫助促進可以在家中提供的護理，無論是診斷測試還是在家中實際提供護理。

And then the third ring is referrals into the delivery system. And we always work with our clients to strive to create the most efficient referral into the physical delivery system when someone needs to be referred. The question of do -- I think that sometimes is behind that is do you want to own brick-and-mortar, so that you can refer into your own brick-and-mortar facilities. And I really don't -- I don't think that, that's a highly scalable model.

然後第三個環是轉介到交付系統。我們始終與客戶合作，努力在需要轉介時創建最有效的實體交付系統轉介。做的問題——我認為有時背後是你想擁有實體設施，這樣你就可以參考你自己的實體設施。而且我真的不 - 我不認為這是一個高度可擴展的模型。

And I think in some cases, it can provide perverse incentives to fill your own beds and fill your own brick-and-mortar capacity rather -- I'd rather be in the business of making sure that we are making the best referral the first time for the highest clinical outcomes and the greatest impact on cost of care.

而且我認為在某些情況下，它可能會提供不正當的激勵措施來填補你自己的床位並填補你自己的實體容量 - 我寧願從事確保我們首先進行最佳推薦的業務獲得最高臨床結果和對護理成本產生最大影響的時間。

The next question comes from Stan Berenshteyn of Wells Fargo.

下一個問題來自富國銀行的 Stan Berenshteyn。

I appreciate the additional color on BetterHelp, very helpful. Maybe on chronic care since nobody asked, 2020 was a pretty big enrollment year for chronic care. I'm just wondering, are any of those contracts coming up for renewal? And maybe if you can comment on what your visibility is in that segment over the next year or two?

我很欣賞 BetterHelp 上的附加顏色，非常有幫助。也許在長期護理方面，因為沒有人問過，2020 年是慢性護理的一個相當大的註冊年。我只是想知道，這些合同中有任何要續約的嗎？也許您可以評論一下您在未來一兩年內在該細分市場中的知名度？

So as we have done our very detailed planning, as we always do for 2023, I would say, we have a high degree of visibility into our chronic care contracts. Importantly, as we have set guidance, we have been reasonably prudent about how much in your revenue to expect from -- on the Integrated Care segment including chronic care. So I would say that the level of visibility that we have is high.

因此，正如我們為 2023 年所做的那樣，我們已經完成了非常詳細的計劃，我想說，我們對我們的長期護理合同有高度的了解。重要的是，由於我們已經制定了指導方針，因此我們對您的收入預期持謹慎態度——在綜合護理領域，包括長期護理。所以我想說我們的知名度很高。

And I wouldn't point to any significant contracts that are up over the course of this year.

而且我不會指出今年期間有任何重大合同。

The next question comes from the line of Sandy Draper of Guggenheim.

下一個問題來自古根海姆的桑迪德雷珀。

This is Mitchell on for Sandy. Just a few quick ones. How are you thinking about the macro environment impact on your sales cycle? And also, are you seeing any impact to underlying membership of customers from the recent job cuts?

這是桑迪的米切爾。只是一些快速的。您如何看待宏觀環境對您的銷售週期的影響？而且，您是否看到最近的裁員對客戶的潛在會員有任何影響？

Yes. I'll take the first one -- the second one first. We haven't really seen an impact on our membership from anything that might be going on in the labor market. We're always attuned to that. I'm very cognizant of the question, but we really haven't seen an impact. In some cases, we're balanced, because we participate in the commercial segments, exchange segments as well as the Medicaid segments. So sometimes we're insulated because we see a flow from one to the other, but we're really not seeing any significant impact.

是的。我先拿第一個——第二個。我們還沒有真正看到勞動力市場可能發生的任何事情對我們的會員產生影響。我們總是適應這一點。我非常了解這個問題，但我們確實沒有看到任何影響。在某些情況下，我們是平衡的，因為我們參與了商業部門、交換部門以及醫療補助部門。所以有時我們是絕緣的，因為我們看到從一個到另一個的流動，但我們真的沒有看到任何重大影響。

With respect to the buying behavior, we're more attuned to it in the BetterHelp segment and oriented around the sensitivity of the consumer, given the macroeconomic uncertainty. And certainly, we've factored that into our outlook over the course of this year. I think in the B2B segment, it really has the effect of sometimes slowing down the buying process or the decision-making process, but doesn't necessarily stop it all together.

關於購買行為，鑑於宏觀經濟的不確定性，我們在 BetterHelp 細分市場中更加適應它，並以消費者的敏感性為導向。當然，我們已經將這一點納入了今年的展望。我認為在 B2B 領域，它有時確實會減慢購買過程或決策過程，但不一定會完全停止。

I think if anything, it focuses the buyer on where they're getting the most value. And we believe that we rise to the top in that kind of an environment.

我認為，如果有的話，它會讓買家關注他們獲得最大價值的地方。我們相信，在那種環境下，我們才能登上頂峰。

The next question comes from Elizabeth Anderson of Evercore.

下一個問題來自 Evercore 的 Elizabeth Anderson。

I was wondering if you could give us a little bit more detail on BetterHelp. Like how are you sort of seeing any -- are you seeing any changes to retention compared to a year ago versus the macro environment and your change in ad spend? And then I was wondering if you could also give us an update on the group therapy sessions and how those are continuing to trend?

我想知道您是否可以向我們提供更多有關 BetterHelp 的詳細信息。就像您如何看待任何 - 與一年前相比，與宏觀環境和廣告支出的變化相比，您是否看到留存率有任何變化？然後我想知道您是否也可以向我們提供有關團體治療課程的最新信息以及這些課程如何繼續發展？

Yes. So no changes really in any of those underlying metrics. If I think about (technical difficulty)

是的。因此，這些基礎指標中的任何一個都沒有真正發生變化。如果我考慮（技術難度）

One moment, we are experiencing technical difficulties. The management team will be back in a few moments.

有一瞬間，我們遇到了技術困難。管理團隊將在幾分鐘後回來。

The Teladoc team is back. You may now resume.

Teladoc 團隊回來了。你現在可以恢復了。

Sorry, Elizabeth, we are having network issues in our offices. We do apologize. But just to finish up on your question, what I would say is if you think about the underlying operating metrics of the BetterHelp business, they have remained steady as we have exited the year into this year whether it be LTV, retention, churn, et cetera.

抱歉，伊麗莎白，我們的辦公室出現網絡問題。我們深表歉意。但只是為了結束你的問題，我想說的是，如果你考慮 BetterHelp 業務的基本運營指標，他們一直保持穩定，因為我們已經退出今年進入今年，無論是 LTV、保留、流失等等等。

And we have also seen stability thus far in terms of ad pricing. Now obviously, we are continuing to monitor that. And as we've talked about all of last year, that certainly is one of many swing factors in the BetterHelp business. But thus far, we have essentially seen a degree of stability in that market.

到目前為止，我們在廣告定價方面也看到了穩定性。現在顯然，我們正在繼續監視它。正如我們去年全年所討論的那樣，這肯定是 BetterHelp 業務的眾多搖擺因素之一。但到目前為止，我們基本上已經看到該市場有一定程度的穩定性。

Thank you. And with that, we will conclude today's call. Thank you for participating. You may now disconnect.

謝謝。至此，我們將結束今天的電話會議。感謝您的參與。您現在可以斷開連接。