Teladoc Health Inc (TDOC) 2023 Q3 法說會逐字稿

Good afternoon. Thank you for attending the Teladoc Health Third Quarter Earnings Call. My name is Matt, and I'll be your moderator for today's call. (Operator Instructions)

午安.感謝您參加 Teladoc Health 第三季財報電話會議。我叫馬特，我將擔任今天電話會議的主持人。 （操作員說明）

I'd now like to pass the conference over to our host, Patrick Feeley, Head of Investor Relations. Patrick, please go ahead.

現在我想將會議交給我們的東道主投資者關係主管 Patrick Feeley。派崔克，請繼續。

Thank you, and good afternoon. Today after the market closed, we issued a press release announcing our third quarter 2023 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. During this call, we will also discuss our fourth quarter and full year 2023 outlook, and our prepared remarks will be followed by a question-and-answer session.

謝謝你，下午好。今天收盤後，我們發布了新聞稿，宣布 2023 年第三季財務業績。本新聞稿和隨附的幻燈片簡報可在 teladochealth.com 網站的投資者關係部分取得。執行長 Jason Gorevic 出席了此次電話會議，討論結果。和財務長 Mala Murthy。在這次電話會議中，我們還將討論我們第四季度和 2023 年全年的展望，我們準備好的發言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 績效非常重要的非 GAAP 財務指標。有關這些非公認會計準則衡量標準與最具可比性的公認會計準則衡量標準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 in 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.

另請注意，本次電話會議期間所做的某些陳述將屬於1995 年《私人證券訴訟改革法案》所定義的前瞻性陳述。此類前瞻性陳述受到風險、不確定性和其他可能導致實際結果的因素的影響。Teladoc Health 與本次電話會議中明示或暗示的內容有重大差異。如需了解更多信息，請參閱我們新聞稿中的警告聲明以及我們向 SEC 提交的文件，所有這些均可在我們的網站上獲取。

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, and thanks, everyone, for joining us. This afternoon, we're pleased to report a strong third quarter with results that met or exceeded our key financial and operating guidance. Our performance reflects the fundamental strength of our business and our continued success in making better health available to our more than 90 million members.

謝謝你，派崔克，謝謝大家加入我們。今天下午，我們很高興地報告第三季的強勁業績，其業績達到或超過了我們的主要財務和營運指導。我們的業績反映了我們業務的基本實力以及我們在為超過 9000 萬會員提供更好的健康方面的持續成功。

In my prepared comments this afternoon, I want to focus on 3 key themes that reflect the value that we're delivering today and poised to deliver in the years ahead. First, our third quarter results met or exceeded our key financial and operating guidance, strengthening a solid balance sheet that distinguishes us across our industry. Second, the demand for our products and services remain strong. With the largest payers and partners globally viewing Teladoc Health's whole person care as the prescription for point solution fatigue and a disconnected health care system. And third, we are taking additional concrete steps to further accelerate our business on bottom line performance. This includes a comprehensive operational review of our business. I'll talk more about what that means in a moment.

在我今天下午準備好的評論中，我想專注於三個關鍵主題，這些主題反映了我們今天正在提供的價值以及未來幾年準備提供的價值。首先，我們第三季的業績達到或超過了我們的主要財務和營運指導，增強了我們在行業中脫穎而出的穩健資產負債表。其次，對我們產品和服務的需求仍然強勁。全球最大的付款人和合作夥伴將 Teladoc Health 的整體護理視為單點解決方案疲勞和脫節醫療保健系統的處方。第三，我們正在採取更多具體措施，進一步加速我們業務的獲利績效。這包括對我們業務的全面營運審查。我稍後會詳細討論這意味著什麼。

Let's begin with Q3 results. On the top line, our consolidated revenue grew 8% on a year-over-year basis in the third quarter to $660 million. And as a result of our continued efforts to drive margin improvements this year, our consolidated adjusted EBITDA of $89 million exceeded the high end of our expectations. We were pleased to see revenue from our Integrated Care segment grew 9% year-over-year to $374 million. Compared to the second quarter, revenue grew 4% sequentially, driven in large part by higher enrollment in our chronic care programs, where enrollment now exceeds 1.1 million active users. Driven by a combination of strong leverage over the cost structure, improving efficiency and a contribution from performance-based payments earned during the quarter, the Integrated Care segment delivered $63 million of adjusted EBITDA or a margin of 16.8%, which we believe demonstrates the leverage that's inherent in the Integrated Care business model.

讓我們從第三季的結果開始。在營收方面，我們第三季的綜合營收年增 8%，達到 6.6 億美元。由於我們今年繼續努力提高利潤率，我們的綜合調整後 EBITDA 達到 8900 萬美元，超出了我們預期的上限。我們很高興看到綜合護理部門的收入年增 9% 至 3.74 億美元。與第二季相比，營收季增 4%，這在很大程度上是由於我們的慢性病照護計畫的註冊人數增加，目前該計畫的註冊活躍用戶超過 110 萬人。在成本結構的強大槓桿作用、效率的提高以及本季度基於績效的付款的貢獻的共同推動下，綜合護理部門實現了6300 萬美元的調整後EBITDA 或16.8% 的利潤率，我們認為這證明了槓桿作用這是綜合護理業務模式所固有的。

Turning to BetterHelp, we recorded $286 million of revenue in the quarter, up 8% year-over-year and within the guidance range provided last quarter. Third quarter margins for BetterHelp improved nearly 500 basis points over the prior year's third quarter, and we're on track to deliver material EBITDA growth again in the fourth quarter, which is typically BetterHelp's seasonally strongest quarter for margin. After scaling rapidly to surpass $1 billion of revenue last year, we have since taken a more balanced approach to growth and margin at BetterHelp. This means we'll continue to prioritize profitable growth that meets or exceeds our return requirements. Customer acquisition costs remain near the midpoint of our outlook range, combined with stable gross margin trends, that means we anticipate landing near the midpoint of our prior full year segment revenue and margin guidance for BetterHelp.

轉向 BetterHelp，我們在本季錄得 2.86 億美元的收入，年增 8%，並且在上個季度提供的指導範圍內。 BetterHelp 第三季的利潤率比去年第三季提高了近 500 個基點，我們預計在第四季度再次實現 EBITDA 實質成長，這通常是 BetterHelp 利潤率季節性最強的季度。在去年收入迅速擴大到超過 10 億美元之後，我們在 BetterHelp 採取了更平衡的成長和利潤方法。這意味著我們將繼續優先考慮滿足或超過我們的回報要求的獲利成長。客戶獲取成本仍接近我們展望範圍的中點，加上穩定的毛利率趨勢，這意味著我們預期 BetterHelp 的全年分公司收入和利潤指引將接近中點。

The second theme I want to cover is client demand, where the environment remains strong for our whole person care solution. In thinking about the selling season so far, I'd call out 3 key trends. First, while there are still over 2 months left to go in the year, we're pleased that year-to-date, our bookings are tracking in line to moderately ahead of the same point last year. We're seeing strength across all key products and channels. Through the end of the third quarter, Chronic Care sales represent just over half of our total bookings in the U.S., up incrementally from the same point last year. Next, we've seen particular success in pulling through chronic care sales and enrollment via our whole person bundled solutions. We're increasingly selling access to multiple chronic care programs at a single bundled price point.

我想談的第二個主題是客戶需求，我們的全人照護解決方案的環境仍然強勁。在思考迄今為止的銷售季節時，我會指出 3 個主要趨勢。首先，雖然今年還剩下兩個多月的時間，但我們很高興今年迄今為止，我們的預訂量與去年同期相比略有領先。我們看到所有關鍵產品和通路的實力。截至第三季末，慢性護理銷售額僅占我們在美國總預訂量的一半以上，比去年同期有所上升。接下來，我們在透過我們的整體捆綁解決方案實現慢性護理銷售和註冊方面取得了特別成功。我們越來越多地以單一捆綁價格點銷售多種慢性病護理計劃。

For example, clients purchasing our Diabetes Plus bundle enable access to multiple chronic care programs, diabetes management, hypertension and weight management. This has the benefit of removing friction by creating a simpler contracting path, opening access to all programs from day 1 and driving better engagement and outcomes for our clients.

例如，購買我們的 Diabetes Plus 套裝的客戶可以享受多種慢性病護理計劃、糖尿病管理、高血壓和體重管理。這樣做的好處是，透過創建更簡單的簽約路徑、從第一天起開放所有計劃的存取權限並為我們的客戶帶來更好的參與和成果，從而消除摩擦。

It also meets the number where they are with more than 1/4 of Americans diagnosed with multiple chronic conditions. And by delivering more value to the client, it enables us to unlock better economics. Over the past 12 months, more than 2/3 of our chronic care deals included our whole person bundled solutions. That's helped drive faster program adoption, resulting in total chronic care program enrollment growth of 13% year-over-year.

它還符合超過 1/4 的美國人被診斷出患有多種慢性病的數字。透過為客戶提供更多價值，我們能夠實現更好的經濟效益。在過去 12 個月中，我們超過 2/3 的慢性病照護交易包括我們的整體捆綁解決方案。這有助於推動計畫更快採用，導致慢性病照護計畫總註冊人數年增 13%。

Finally, not only are we seeing growth within our existing client base, but we're also seeing significant competitive takeaways. This is a direct result of other players struggling to deliver for their clients and in some cases, fallout from unprofitable business models with weak balance sheets. During the third quarter, we added nearly 4 million lives to our virtual care programs in competitive takeaways.

最後，我們不僅看到了現有客戶群的成長，而且還看到了顯著的競爭優勢。這是其他參與者努力為客戶提供服務的直接結果，在某些情況下，是資產負債表薄弱、無利可圖的商業模式所造成的後果。第三季度，我們在競爭激烈的虛擬照護計畫中增加了近 400 萬人的生命。

While our Q3 results and selling season validate the value that we're delivering for our clients and members, we also recognize that there is still even greater potential to unlock business performance. We have built a strong and durable foundation for efficient growth, increasing profitability and generating cash flow. You've heard us talk about a more balanced approach to growth and margin. In 2023, we're demonstrating that we can drive material EBITDA and free cash flow growth despite a lower rate of top line growth.

雖然我們的第三季業績和銷售季驗證了我們為客戶和會員提供的價值，但我們也意​​識到，釋放業務績效的潛力仍然更大。我們為高效成長、提高獲利能力和產生現金流奠定了堅實而持久的基礎。您已經聽過我們談論更平衡的成長和利潤方法。到 2023 年，我們將證明，儘管營收成長率較低，但我們仍可以推動 EBITDA 和自由現金流的實質成長。

We will continue to focus on improving bottom line performance, and we're confident that we can continue to deliver significant EBITDA margin expansion, particularly within the Integrated Care segment. There are a few things that give us a high level of confidence in our ability to deliver EBITDA and free cash flow growth well in excess of revenue growth over the next few years. First, we are exiting a period of elevated investment following the Livongo transaction. As many projects wrap up, like our Integrated app that launched this year, we expect moderating costs will allow us to drive material operating leverage over the cost structure as we grow our top line.

我們將繼續專注於提高利潤績效，並且我們有信心能夠繼續實現 EBITDA 利潤率的顯著擴張，特別是在綜合護理領域。有幾件事讓我們對未來幾年實現 EBITDA 和自由現金流成長遠遠超過營收成長的能力充滿信心。首先，我們正在結束 Livongo 交易後的投資增加期間。隨著許多項目的結束，例如我們今年推出的整合應用程序，我們預計，隨著我們營收的成長，成本的降低將使我們能夠在成本結構上提高材料營運槓桿。

Second, over the past 12 months, we have broadly sharpened our focus on improving efficiency across the organization. You've seen those efforts begin to bear fruit this year as EBITDA and free cash flow have consistently exceeded our own expectations, which leads me to three. We're disappointed with the valuation of the stock today, which we don't believe adequately reflects the value we are driving today and will continue to drive in the future.

其次，在過去 12 個月裡，我們廣泛地加強了對提高整個組織效率的關注。你已經看到這些努力今年開始取得成果，因為 EBITDA 和自由現金流一直超乎我們自己的預期，這讓我想到了三項。我們對該股目前的估值感到失望，我們認為該估值不足以反映我們今天正在推動並將在未來繼續推動的價值。

At the same time, we also know there are significant opportunities to add value through improved business performance. To that end, we recently kicked off a comprehensive operational review of the business. This review includes 2 broad components. First, we have undertaken a portfolio assessment to identify any opportunities to sharpen the focus across our portfolio of products and services and ensure our investments remain highly selective and prioritized in the direction of our integrated whole-person care strategy.

同時，我們也知道有透過改善業務績效來增加價值的重大機會。為此，我們最近啟動了對該業務的全面營運審查。本次審查包括 2 個主要組成部分。首先，我們進行了投資組合評估，以確定任何機會來加強我們的產品和服務組合的重點，並確保我們的投資保持高度選擇性並優先考慮我們綜合的全人護理策略的方向。

Second, we are pursuing a comprehensive review of our cost structure. Following our cost reduction efforts earlier this year, we are confident that we have the right operating structure in place to support the next phase of our growth. Meanwhile, we are actively working to identify opportunities to improve upon this operating efficiency. For example, as a part of that exercise, we have begun standing up centers of excellence that will leverage shared services across the business to enable a more efficient operating structure.

其次，我們正在對成本結構進行全面審查。經過今年稍早的成本削減努力，我們相信我們擁有正確的營運結構來支持下一階段的成長。同時，我們正積極尋找提高營運效率的機會。例如，作為這項工作的一部分，我們已經開始建立卓越中心，利用整個企業的共享服務來實現更有效率的營運結構。

We are committed to a thorough review and analysis and we are working with a third party to bring an independent perspective. In short, we are accelerating our efforts to ensure that our business is operating as efficiently as possible, in order to drive profit growth at a level that is meaningfully higher than our revenue growth over the next few years. We will do this by fully tapping the operating leverage that is a market differentiator for Teladoc Health as the leader in digital health at scale. And we will do this while ensuring that our business remains centered on our mission and that no efficiencies are taken at the expense of keeping our promises to our clients or caring for our members. We look forward to sharing more details on these efforts in the coming quarters.

我們致力於進行徹底的審查和分析，並與第三方合作以提供獨立的觀點。簡而言之，我們正在加緊努力，確保我們的業務盡可能高效地運營，以推動未來幾年利潤成長明顯高於收入成長。我們將透過充分利用營運槓桿來實現這一目標，這是 Teladoc Health 作為大規模數位醫療領導者的市場差異化因素。我們將在做到這一點的同時，確保我們的業務仍然以我們的使命為中心，並且不會以犧牲對客戶的承諾或關心我們的會員為代價來提高效率。我們期待在未來幾季分享有關這些努力的更多細節。

And with that, I'll turn the call over to Mala to review the third quarter and share our forward guidance.

接下來，我將把電話轉給 Mala，回顧第三季並分享我們的前瞻性指引。

Thank you, Jason, and good afternoon, everyone. Third quarter consolidated revenue of $660 million increased 8% year-over-year. Third quarter adjusted EBITDA was $88.8 million, above the high end of our guidance range, representing a margin of 13.4%.

謝謝傑森，大家下午好。第三季綜合營收為 6.6 億美元，年增 8%。第三季調整後 EBITDA 為 8,880 萬美元，高於我們指引範圍的上限，利潤率為 13.4%。

Consolidated net loss per share in the third quarter was $0.35, compared to a net loss per share of $0.45 in the third quarter of 2022. Net loss per share in the third quarter includes amortization of acquired intangibles of $0.42 per share and stock-based compensation expense of $0.32 per share.

第三季合併每股淨虧損為 0.35 美元，而 2022 年第三季每股淨虧損為 0.45 美元。第三季每股淨虧損包括每股收購無形資產攤銷 0.42 美元及股票薪酬每股費用為0.32 美元。

Third quarter free cash flow was $68 million compared to $20 million in the third quarter of 2022. We ended the quarter with over $1 billion in cash and equivalents on the balance sheet.

第三季自由現金流為 6,800 萬美元，而 2022 年第三季為 2,000 萬美元。本季末，我們資產負債表上的現金和等價物超過 10 億美元。

Turning to segment results. Integrated Care segment revenue increased 9% year-over-year to $374 million in the third quarter, growing 4% sequentially. The largest contributor to year-over-year Integrated Care revenue growth was Chronic Care, followed by Primary360. On a sequential basis, the primary contributor to Integrated Care segment growth was the ramp-up of enrollment in chronic care programs. During the quarter, we added 49,000 new enrollments in chronic care programs, bringing total year-to-date net enrollment growth to over 100,000. We ended the third quarter with chronic care enrollment of 1.12 million, an increase of 13% year-over-year and 5% sequentially.

轉向細分結果。第三季綜合護理部門營收年增 9% 至 3.74 億美元，季增 4%。綜合護理收入年增率的最大貢獻者是慢性護理，其次是 Primary360。從環比來看，綜合護理細分市場成長的主要貢獻者是慢性護理課程入學人數的增加。本季度，我們新增了 49,000 名慢性病照護計畫註冊人數，使年初至今的淨註冊人數總數超過 10 萬人。截至第三季末，我們的慢性病護理註冊人數為 112 萬人，年增 13%，季增 5%。

The biggest drivers of new chronic care enrollment year-to-date have been hypertension, which is now approaching 30% of total program enrollment, followed by our diabetes prevention and weight management programs, which have each crossed the 100,000 enrollment mark this year. Program enrollment growth has been bolstered by our success in selling our bundled chronic care management solutions. In total, the Integrated Care segment added over 4 million members during the third quarter, ending at 90.2 million. The significant membership growth during the quarter was primarily a result of a large competitive takeaway during the quarter.

今年迄今為止，慢性病護理新註冊人數的最大推動力是高血壓，目前該項目已接近註冊人數的30%，其次是我們的糖尿病預防和體重管理項目，今年這兩個項目的註冊人數均突破了10 萬人大關。我們成功銷售捆綁式慢性病護理管理解決方案，促進了計畫註冊人數的成長。綜合護理部門在第三季總共增加了超過 400 萬會員，最終達到 9,020 萬人。本季會員數的顯著成長主要是由於本季競爭激烈。

Average Integrated Care revenue per U.S. member of $1.41 increased $0.01 over the prior year's quarter and was flat sequentially. Excluding the large new population added during the third quarter, revenue per member increased $0.04 sequentially. Third quarter Integrated Care adjusted EBITDA was $62.8 million, representing a 540 basis point margin expansion over the prior year's third quarter. That margin expansion was driven by higher gross margin due to an increased mix of subscription revenue, an increase in performance-based revenue earned during the quarter, and improved operating efficiency, particularly on the G&A line. The margin performance versus our third quarter guidance was primarily driven by lower expenses, again, most notably on the G&A line.

美國會員平均綜合護理收入為 1.41 美元，比去年同期增加 0.01 美元，與上一季持平。排除第三季新增的大量人口，每位會員的營收季增 0.04 美元。第三季 Integrated Care 調整後 EBITDA 為 6,280 萬美元，比去年第三季利潤率成長了 540 個基點。利潤率的成長是由於訂閱收入組合的增加、本季度基於績效的收入的增加以及營運效率的提高（特別是在一般管理費用方面）而提高的毛利率推動的。與我們第三季指引相比，利潤率表現主要是由費用降低所推動的，尤其是在一般管理費用方面。

Turning to BetterHelp. Revenue increased 8% year-over-year to $286 million in the third quarter, a decline of 2% sequentially, in line with our guidance range. Average monthly users increased 5% over the prior year's quarter. Third quarter BetterHelp adjusted EBITDA was $26 million, resulting in a margin of 9.1%. This represents a 490 basis point increase over the last year's third quarter, a reflection of the more stable advertising environment compared to the prior year as well as sustained gross margin improvement.

轉向 BetterHelp。第三季營收年增 8% 至 2.86 億美元，季減 2%，符合我們的指導範圍。平均每月用戶數比去年同期成長 5%。第三季 BetterHelp 調整後 EBITDA 為 2,600 萬美元，利潤率為 9.1%。這比去年第三季成長了 490 個基點，反映出與前一年相比更穩定的廣告環境以及毛利率的持續改善。

Now turning to forward guidance. We expect full year revenue to be in the range of $2.6 billion to $2.625 billion, representing growth of approximately 8% to 9%. We now expect full year consolidated adjusted EBITDA to be in the range of $320 million to $330 million, representing year-over-year margin improvement of approximately 200 to 225 basis points. We now expect full year free cash flow of approximately $175 million, up from our prior expectation of $150 million. For the fourth quarter, we expect revenue to be in the range of $658 million to $683 million. Assumed in the fourth quarter revenue outlook is high single-digit percent year-over-year growth in our Integrated Care segment and low to mid-single-digit year-over-year growth in our BetterHelp segment.

現在轉向前瞻性指導。我們預計全年營收將在 26 億美元至 26.25 億美元之間，成長約 8% 至 9%。我們目前預計全年綜合調整後 EBITDA 將在 3.2 億至 3.3 億美元之間，意味著利潤率將年增約 200 至 225 個基點。我們現在預計全年自由現金流約為 1.75 億美元，高於我們先前預期的 1.5 億美元。我們預計第四季的營收將在 6.58 億美元至 6.83 億美元之間。假設第四季的收入前景是綜合護理部門的同比高個位數成長，以及 BetterHelp 部門的低至中個位數同比增長。

One thing I would remind you of, which we've discussed previously is that the cadence of BetterHelp advertising spend in 2023 is more heavily weighted to the first half of the year than last year. This change in ad spend cadence results in quarterly year-over-year comparisons that favor the first half of 2023 to the detriment of the second half of the year. Therefore, we do not see the year-over-year growth rate expected in the fourth quarter as reflective of the underlying growth in the BetterHelp business. Fourth quarter consolidated adjusted EBITDA is expected to be in the range of $107 million to $117 million. The adjusted EBITDA outlook for the fourth quarter assumed Integrated Care segment margins between 11.5% and 12.5%, and fourth quarter BetterHelp segment margins between 22% and 23%.

我要提醒您的一件事是，我們之前討論過，2023 年 BetterHelp 廣告支出的節奏比去年更注重上半年。廣告支出節奏的這種變化導致季度同比比較對 2023 年上半年有利，對下半年不利。因此，我們認為第四季的年成長率並不能反映 BetterHelp 業務的基本成長。第四季綜合調整後 EBITDA 預計在 1.07 億美元至 1.17 億美元之間。調整後的第四季 EBITDA 前景假設 Integrated Care 部門利潤率在 11.5% 至 12.5% 之間，第四季 BetterHelp 部門利潤率在 22% 至 23% 之間。

As discussed throughout the year, our prior guidance assumed a modest deterioration in the cost of customer acquisitions at the low end of the range and an improvement at the high end of the range. Recent customer acquisition costs continue to trend within that initial outlook range, albeit in the lower half of the range. We believe trends are likely to persist in this range through year-end and you see that reflected in the revision of the high end of our revenue guidance.

正如全年討論的那樣，我們先前的指導假設客戶獲取成本在低端範圍內略有惡化，在高端範圍內有所改善。最近的客戶獲取成本繼續在最初的展望範圍內發展，儘管處於該範圍的下半部分。我們認為趨勢可能會持續到年底，這也反映在我們對收入指導上限的修改中。

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

這樣，我會將電話轉回給傑森。

Thanks, Mala. Before we go to questions, I do want to share some work that we are particularly proud of in the wake of so much tragedy in recent days. As you may have heard, BetterHelp is offering therapy to anyone impacted by the war in Israel and Gaza at no cost. The support applies to anyone affected by the war anywhere. As some of you know, BetterHelp frequently offers therapy at no cost to those in need through our social impact program.

謝謝，馬拉。在我們提問之前，我確實想分享一些在最近幾天發生如此多悲劇之後我們感到特別自豪的工作。您可能聽說過，BetterHelp 正在為任何受以色列和加薩戰爭影響的人免費提供治療。該支持適用於任何地方受戰爭影響的任何人。正如你們中的一些人所知，BetterHelp 經常透過我們的社會影響計畫向有需要的人免費提供治療。

In the past 18 months, we have responded to the Maui fires, Hurricane Ian, the war in Ukraine, the Robb Elementary Uvalde shooting and Midwest flooding, among other crises. While no one has all the right answers right now, I'm pleased that BetterHelp and Teladoc Health can make a positive contribution to healing at a time of such great suffering.

在過去 18 個月中，我們應對了毛伊島火災、伊恩颶風、烏克蘭戰爭、尤瓦爾迪羅布小學槍擊事件和中西部洪水等危機。雖然目前沒有人能給出所有正確答案，但我很高興 BetterHelp 和 Teladoc Health 能夠在如此巨大的痛苦時期為康復做出積極貢獻。

With that, we'll open it up for questions. Operator?

至此，我們將開放提問。操作員？

(Operator Instructions) The first question is from the line of Lisa Gill with JPMorgan.

（操作員說明）第一個問題來自摩根大通的 Lisa Gill。

Jason, I just have to say that that's a wonderful thing that you do. I know this is a really difficult time for a number of people. I really want to focus on a few things. I know I always asked about the selling season, but I want to focus on 2 areas, and that's really around Integrated Care. The margins we saw this quarter. How you're thinking about that business going forward? The significant wins that you said competitively, you had 4 million lives that shifted over to your Integrated offering. Can you maybe just talk to me about the competitiveness in the marketplace today, what you saw in the selling season? I'm sure you don't want to name who you took those 4 million lives from, but can you talk about were they single point solutions? Or the other parties that you feel are fairly competitive to you? Just how do we think about how you're positioned on a go-forward basis, especially on the Integrated side of your business?

傑森，我不得不說你所做的事情真是太棒了。我知道對很多人來說這確實是一段艱難的時期。我真的想專注於幾件事。我知道我總是詢問銷售季節，但我想專注於兩個領域，那就是綜合護理。我們本季看到的利潤率。您如何看待該業務的未來發展？您在競爭中所說的重大勝利，您有 400 萬人的生命轉移到了您的整合產品上。您能否和我談談當今市場的競爭力，以及您在銷售季節看到的情況？我確信您不想說出您從誰那裡奪走了這 400 萬人的生命，但您能談談它們是單點解決方案嗎？還是您認為對您有相當競爭力的其他各方？我們如何看待您的未來定位，特別是在您業務的整合方面？

Yes, thanks, Lisa. I appreciate that, and thanks for the comments on our work with BetterHelp. If I think about the competitive landscape, I think the incidence of us selling bundled solutions really speaks to the power of the breadth of our offering and how that is significantly differentiated from anyone else in the market. As we've talked about, the majority of -- our chronic care management programs make up the majority of our bookings, and the majority of our chronic care management solutions are sold as bundles of services.

是的，謝謝，麗莎。我對此表示讚賞，並感謝您對我們與 BetterHelp 合作的評論。如果我考慮一下競爭格局，我認為我們銷售捆綁解決方案的發生率確實說明了我們產品的廣度的力量以及它與市場上其他任何產品的顯著差異。正如我們所討論的，我們的大部分慢性護理管理計劃構成了我們的大部分預訂，並且我們的大部分慢性護理管理解決方案都是作為服務捆綁銷售的。

We're also seeing very significant wins where we sell additional products and services into existing clients. In many of those cases, we're replacing single-point solution or more narrow solutions by adding our products into those clients. And so I would say that the dimensions of our competitive wins come into really 3 categories: one is where we replace a single-point solution with either a bundle of solutions or by selling additional products into an existing client. Two is where our clients have -- sorry, our competitors have failed operationally and/or in terms of the value proposition for the clients, and our proven track record of success and value creation wins the day. And three is where we're replacing someone who, quite frankly, is faltering in this current economic environment because they have a business model that -- and an economic model that isn't sustainable. And we're seeing them struggle either to raise capital or quite frankly, do exist at all as a going concern.

我們也看到，我們向現有客戶銷售以外的產品和服務，並取得了非常重大的勝利。在許多情況下，我們透過將我們的產品添加到這些客戶端來取代單點解決方案或更窄的解決方案。因此，我想說，我們的競爭優勢實際上分為三類：一類是我們用一系列解決方案或向現有客戶銷售附加產品來取代單點解決方案。二是我們的客戶所擁有的——抱歉，我們的競爭對手在營運和/或為客戶提供價值主張方面失敗了，而我們在成功和價值創造方面的良好記錄贏得了勝利。第三，我們要取代的人，坦白說，在當前的經濟環境中舉步維艱，因為他們的商業模式是不可持續的。我們看到他們要么努力籌集資金，要么坦白地說，他們確實作為一個持續經營的企業而存在。

So we've seen all 3 of those. The biggest one this quarter that represented the largest competitive win was the latter, where we saw a competitor fail, and we were able to step in and replace them. And I think that really speaks to the strength of our balance sheet and the strength of our financials. And I think we said last quarter, Mala and I have never spoken to so many CFOs at clients and prospects, who are really kicking the tires to make sure that the partners they engage with are going to be here, not just today but into the future and be able to grow with them.

所以我們已經看到了這 3 個。本季代表最大競爭勝利的最大勝利是後者，我們看到競爭對手失敗了，我們能夠介入並取代他們。我認為這確實說明了我們資產負債表和財務狀況的強度。我想我們上個季度說過，馬拉和我從來沒有與如此多的客戶和潛在客戶的財務長交談過，他們真的在努力確保與他們合作的合作夥伴能夠在這裡，不僅僅是今天，而是進入未來。未來並能夠與他們一起成長。

The second part of your question or maybe the first part of your question was about Integrated Care margins. Mala, do you want to speak to that?

您問題的第二部分或問題的第一部分可能是關於綜合護理利潤。馬拉，你想談談這個嗎？

Yes, I'll speak to that, Lisa. So if I take a step back and look at our Integrated Care margin performance in the third quarter, and I look at it vis-a-vis year-over-year where, as we said in our prepared remarks, we expanded by 500 basis points. Or even if you look at it sequentially, where we have had a pretty sizable improvement over 600 basis points in our Integrated Care margins. There are a few factors and drivers across both that stand out. First of all, it is the growth that we are seeing in our chronic care book, right? So as we've talked about, that has a nice pull-through to gross margins and we are seeing leverage from that. We've also talked about the fact that in the third quarter, we saw revenue growth in a more balanced way across both chronic care and Primary360. So we're seeing the pull-through of that revenue growth in the Integrated Care side.

是的，我會談談這個，麗莎。因此，如果我退後一步，看看我們第三季度的綜合護理利潤率表現，我會與去年同期相比，正如我們在準備好的發言中所說，我們擴大了 500 個基點點。或者，即使您按順序查看，我們的綜合護理利潤率也有了相當大的改善，超過 600 個基點。兩者都有一些突出的因素和驅動因素。首先，這是我們在慢性病護理書中看到的成長，對吧？正如我們所討論的，這對毛利率有很好的拉動，我們從中看到了槓桿作用。我們也談到了這樣一個事實，即在第三季度，我們看到慢性護理和 Primary360 的收入增長更加平衡。因此，我們看到綜合護理方面收入成長的拉動。

We are seeing the results of our cost controls and the cost efficiency programs that we have already put in place this year. We are seeing the benefit of that. And as Jason talked about in his prepared remarks, as we look at the -- to an operating review across our business, certainly, we will look to additional areas where we can drive cost efficiencies. So that will be a continuing theme.

我們正在看到今年已經實施的成本控制和成本效率計劃的結果。我們正在看到這樣做的好處。正如傑森在他準備好的演講中談到的那樣，當我們審視整個業務的營運審查時，我們當然會尋找可以提高成本效率的其他領域。因此，這將是一個持續的主題。

Look, we also had, as we talked about in our prepared remarks, some amount of benefit. It's about $4 million from our performance guarantees that really was about -- that we recognized because of the outcomes we have driven. That was in -- if you look at the overall contribution to our margin expansion, it was about 100 basis points. So if you really look at what's driving the margin expansion, it is the revenue mix. And it is the cost efficiency programs that we have put in place, and we will continue to focus on that.

看，正如我們在準備好的發言中談到的那樣，我們也獲得了一些好處。我們的績效保證中大約有 400 萬美元，我們因所取得的成果而認識到了這一點。如果你看一下對我們利潤率擴張的整體貢獻，你會發現大約是 100 個基點。因此，如果你真正了解推動利潤率擴張的因素，那就是收入組合。我們已經實施了成本效率計劃，我們將繼續關注這一點。

Next question is from the line of Ryan Daniels with William Blair.

下一個問題來自瑞安·丹尼爾斯和威廉·布萊爾。

One for you on the chronic care book of business. I think you mentioned hypertension. It's about 30% and seeing strong growth in diabetes and weight management. So curious what your longer-term thoughts are on the impact potentially to that business, either favorably or unfavorably from all the GLP-1 data that's coming to market?

一份為您準備的慢性病護理商業書籍。我想你提到了高血壓。約為 30%，且糖尿病和體重管理方面的成長強勁。很好奇您對即將上市的所有 GLP-1 數據對該業務的潛在影響（無論是有利還是不利）有何長期看法？

Yes. Thanks, Ryan. As we said earlier in the year, we don't really anticipate any material financial impact from the new program that we launched and announced earlier in the year -- this year. We think that, that will have an impact for us in the future, and we expect to participate in being able to take advantage of some of the benefits of GLP-1s for people who are living with diabetes as well as for people who engage with our diabetes prevention and weight management programs. So we see that as paying off for us in the future. We also see, quite frankly, that the market is very engaged in this, and our clients are looking to us for solutions especially because of the cost of those medications.

是的。謝謝，瑞安。正如我們今年早些時候所說，我們並不真正預計今年早些時候啟動並宣布的新計劃會產生任何重大財務影響。我們認為，這將在未來對我們產生影響，並且我們希望能夠參與其中，以便能夠利用 GLP-1 為糖尿病患者以及與糖尿病相關的人們帶來的一些好處。我們的糖尿病預防和體重管理計劃。因此，我們認為這將在未來為我們帶來回報。坦白說，我們也看到市場對此非常關注，我們的客戶正在向我們尋求解決方案，特別是因為這些藥物的成本。

With respect to whether that's going to be a headwind. Yes, I would say probably the hype has gotten ahead of the reality with respect to the GLP-1s. I mean, I think I saw an analysis recently where some people said that the airlines were going to save on fuel costs when the country engages with GLP-1s and collectively loses weight. I think that gets to maybe a little bit of overhype at this point.

關於這是否會成為逆風。是的，我想說，關於 GLP-1 的炒作可能已經超越了現實。我的意思是，我想我最近看到了一份分析，其中有人說，當國家採用 GLP-1 並集體減肥時，航空公司將節省燃油成本。我認為在這一點上這可能有點過度炒作了。

We've seen the prevalence of diabetes continually increase year-over-year and is expected to increase by over 25% in the next 10 years. Well, I think that GLP-1s can have an impact on maybe moderating that rate of growth. I really don't think, and I wish it weren't the case, but I don't think we're going to suddenly see a massive decline in the need for people to engage in more comprehensive solutions that include behavior change with respect to activity, with respect to nutrition, with respect to mental health care. And so I think GLP-1s and really, we view them as a tool to enhance those programs, but don't really see them as a headwind. And I think we also -- again, going back to my initial comments, you have to take it in the context of the cost of those medications and the need for our clients to engage in programs that help manage the overall cost of them.

我們看到糖尿病的盛行率逐年持續增加，預計未來 10 年將增加 25% 以上。嗯，我認為 GLP-1 可能會對減緩成長率產生影響。我真的不這麼認為，我希望情況並非如此，但我不認為我們會突然看到人們參與更全面的解決方案（包括尊重行為的改變）的需求大幅下降活動、營養、心理保健。所以我認為 GLP-1，實際上，我們將它們視為增強這些程序的工具，但並不真正將它們視為逆風。我認為我們也——再次回到我最初的評論，你必須考慮到這些藥物的成本以及我們的客戶需要參與幫助管理其總體成本的計劃。

The next question is from the line of Jailendra Singh with Truist.

下一個問題來自 Jailendra Singh 和 Truist 的對話。

I understand we need to wait for a detailed 2024 guidance until Q4 earnings call. But I was wondering if you could give any directional color or qualitative color on revenue and margin trends? Or any additional puts and takes we should keep in mind across those 2 segments as we think about 2024 next year?

據我了解，我們需要等待詳細的 2024 年指導，直到第四季的財報電話會議。但我想知道您是否可以給出有關收入和利潤趨勢的任何方向性顏色或定性顏色？或者，當我們考慮明年的 2024 年時，我們應該在這兩個部分牢記任何其他的看跌期權和看跌期權？

Yes. I guess I'd say a couple of things and then I'll hand it to Mala for some color. I think what you heard us say today is that you can expect us -- you can expect to see our EBITDA grow faster than our revenue for the next couple of years. And that certainly will hold true or that's part of our expectations for 2024. I think you heard us talk about the selling season today for Integrated Care, being in line to modestly ahead of where we were last year at this time. We have a couple of months still left in the selling season. And we see our late-stage pipeline pretty flat relative to where it was this year. So that should give you at least a little bit of color relative to where our Integrated Care segment will be.

是的。我想我會說幾句話，然後我會把它交給馬拉，讓她給我一些顏色。我想你們今天聽到我們說的是，你們可以期待我們——你們可以期待看到我們的 EBITDA 成長速度快於我們未來幾年的營收成長。這肯定是正確的，或者說這是我們對 2024 年預期的一部分。我想您今天聽到我們談論 Integrated Care 的銷售季節，與去年同期相比略有領先。銷售季節還剩幾個月。我們發現我們的後期管道與今年相比相當平穩。因此，相對於我們的綜合護理部門的定位，這至少應該會給你一點色彩。

And client retention there continues to be in the 90s, so no material change there. And then on the BetterHelp side, I think you heard Mala say that we continue to take a more balanced approach than we had historically to revenue and margin growth there. And that you shouldn't view the fourth quarter as being indicative of the underlying growth of that business. So I think those are the -- we're going to stop short, as you expected of giving 2024 guidance at this point. We expect we'll do that in the first quarter of next year. But I think those are the components and ingredients that should go into our outlook. Mala, did I miss anything there?

那裡的客戶保留率仍然保持在 90 年代，所以那裡沒有重大變化。然後在 BetterHelp 方面，我想你聽到 Mala 說我們繼續採取比歷史上更平衡的方法來實現收入和利潤成長。而且您不應將第四季度視為該業務潛在成長的指標。所以我認為，我們將暫時停止，正如您所期望的那樣，在這一點上給出 2024 年的指導。我們預計將在明年第一季做到這一點。但我認為這些是我們展望中應該包含的組成部分和成分。馬拉，我錯過了什麼嗎？

I would just add a little bit more color on BetterHelp specifically. Thinking about the starting point for 2024, Jailendra, I think about 2 things. We have said this several times up until now, the quarterly comps line up very differently this year relative to last year. And they -- so I would think -- if you think about the first quarter, think of it as above run rate, the fourth quarter as lower than the true run rate due to the year-over-year comp, and when I talk about year-over- comps, it's about ad spend as well as the revenue growth, right?

我會專門在 BetterHelp 上添加一點顏色。思考 2024 年的起點，Jailendra，我想到了兩件事。到目前為止，我們已經說過好幾次了，今年的季度業績與去年相比有很大不同。他們 - 所以我認為 - 如果你考慮第一季度，將其視為高於運行率，由於同比比較，第四季度低於真實運行率，當我談論時關於同比比較，這與廣告支出和收入增長有關，對嗎？

Just as a reminder, what we've been saying all year is the ad spend cadence was going to be very different this year versus the last year. Last year, over half of the ad spend took place in the second half of that year. This year, it's the opposite with half of the spend taking place in the first half. So that's sort of the first thing to keep in mind.

提醒一下，我們一整年都在說，今年的廣告支出節奏將與去年大不相同。去年，一半以上的廣告支出發生在下半年。今年則相反，一半的支出發生在上半年。所以這是首先要記住的事情。

The second thing I'd say is on a full year basis, if you think about BetterHelp revenue as per our guidance has decelerated each year over the last 2 years, and that's happened for a few reasons, right? One is this business has scaled pretty rapidly over a short period of time. It's just simply a much bigger business today. So law of large numbers, you're just not going to see it continuing to grow at those hyper growth rates annually.

我要說的第二件事是在全年的基礎上，如果你考慮到根據我們的指導，過去兩年中BetterHelp 的收入每年都在下降，而這種情況的發生有幾個原因，對嗎？一是這項業務在短時間內擴展得相當快。如今，這只是一項規模更大的業務。因此，根據大數定律，你不會看到它每年繼續以如此高的成長率成長。

The second thing I'll say is, as Jason just talked about, we are managing the business differently. We are balancing top line growth as well as bottom line growth and cash flow. So certainly, that balanced approach has an increasing focus on driving ROI and margin. And that is, in instance, is going to come at a lower overall rate of top line growth.

我要說的第二件事是，正如傑森剛才談到的，我們正在以不同的方式管理業務。我們正在平衡營收成長以及獲利成長和現金流。當然，這種平衡的方法越來越注重提高投資報酬率和利潤率。舉例來說，這將帶來較低的整體收入成長率。

And then the last point is, if you look at this business, which is the largest player in the DTC virtual mental health space by far, we are also the largest advertiser of virtual mental health. And unlike many of our smaller peers, our scale enables us to drive and earn strong returns on our spend, and that gives us a real advantage. We have talked about this before. But there's only so much incremental ad spend and customer acquisitions you can drive in any short period of time. There's just a natural growth to that every year as the market shifts more and more towards virtual and as the channels themselves grow. So that does limit the amount of DTC business can profitably grow year after year. So all of this just to blend some color to the dynamics that we are certainly seeing in the BetterHelp business.

最後一點是，如果你看看這個業務，它是迄今為止 DTC 虛擬心理健康領域最大的參與者，我們也是虛擬心理健康最大的廣告商。與許多規模較小的同行不同，我們的規模使我們能夠推動並獲得豐厚的支出回報，這給了我們真正的優勢。我們之前已經討論過這個問題。但在任何短時間內，你所能推動的增量廣告支出和客戶獲取都是有限的。隨著市場越來越向虛擬化以及通路本身的發展，每年都會自然成長。因此，這確實限制了 DTC 業務量逐年獲利的成長。因此，所有這一切只是為了為我們在 BetterHelp 業務中看到的動態增添一些色彩。

The next question is from the line of Richard Close with Canaccord Genuity.

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

Jason, maybe more details on how you're thinking about investments going forward? You talked a little bit about it. But I just -- how big of a change is this compared to past years? And it sounds like you're being more restrained. So I'm just curious examples of what maybe gets prioritized?

傑森，也許可以更詳細地了解您如何考慮未來的投資？你談了一點。但我只是——與過去幾年相比，變化有多大？聽起來你變得更克制了。所以我只是好奇一些可能優先考慮的例子？

Yes. A couple of thoughts there, Richard. I think first of all, it's important to put it in the context of where we've come from over the last couple of years. We're emerging from a significant investment cycle during which we've spent a lot of time and effort building and integrating post Livongo acquisition. And so now I think it makes sense for us to look across the organization for further ways to enhance business performance. And part of that is focusing our investments on the areas where not only are we going to get the greatest return, but also are closest to the center of the bull's eye of our strategy.

是的。理查德，我有幾個想法。我認為首先，重要的是要把它放在我們過去幾年來的背景中。我們正在經歷一個重要的投資週期，在此期間我們花費了大量的時間和精力來建立和整合 Livongo 收購後的產品。因此，現在我認為我們有必要在整個組織範圍內尋找進一步的方法來提高業務績效。其中一部分是將我們的投資集中在我們不僅可以獲得最大回報而且最接近我們戰略靶心中心的領域。

I think that also, you'll see in the continued progress we're making on capitalized software. You've seen that this year. And I think you'll see that again next year as we move into more focused investments and less quite frankly, foundational investments on big chunks that have helped to get us to this point, but also put the platform in place for us to move forward.

我認為，您也會在我們在資本化軟體方面的持續進展中看到這一點。今年你已經看到了。我認為明年你會再次看到這一點，因為我們將進行更集中的投資，不那麼坦率地說，對大筆資金的基礎投資幫助我們達到了這一點，但也為我們前進奠定了平台。

You've seen that with our Integrated app. You've seen that as we've migrated some of our internal ERP and financial systems. You see that as we put in place some of the capabilities that enable us to deliver on a true Integrated experience for Primary360. And so we'll continue to focus on delivering that whole-person care in a differentiated manner, but also making sure that we're judicious in making sure that we're delivering the return on capital spend.

您已經透過我們的整合應用程式看到了這一點。當我們遷移一些內部 ERP 和財務系統時，您已經看到了這一點。您會看到，當我們實作一些功能時，我們能夠為 Primary360 提供真正的整合體驗。因此，我們將繼續專注於以差異化的方式提供全人護理，同時確保我們明智地確保我們提供資本支出回報。

The next question is from the line of Charles Rhyee with TD Cowen.

下一個問題來自 Charles Rhyee 和 TD Cowen。

This is Lucas on for Charles. I want to ask about the performance guarantees that you recognize from generating positive outcomes. I'm assuming this is related to value-based arrangements. What portion of your guys' Integrated Care segment is derived from these sorts of value-based arrangements or at least engagements that enable you to recognize performance payments? And then can you give us (inaudible) how these are structured and how you can earn from them?

這是盧卡斯替查爾斯發言。我想問一下您認為產生正面成果所帶來的績效保證。我假設這與基於價值的安排有關。你們的綜合護理部分的哪一部分來自於這些基於價值的安排或至少使您能夠確認績效付款的約定？然後您能否告訴我們（聽不清楚）這些是如何建造的以及您如何從中獲利？

Yes. Thanks for the question. The way I would think about it is, on a run rate basis, the amount of performance-based revenue tied to clinical outcomes would be in the single-digit percentage of our total Integrated Care segment revenue. So just to give you some sort of dimensions on the size of that. And the other thing I would say is we have a long history of performance against these clinical measures. We have a lot of data to support our analysis. We feel very comfortable in terms of our ability to perform against these outcome guarantees.

是的。謝謝你的提問。我的想法是，在運作率的基礎上，與臨床結果相關的基於績效的收入將占我們綜合護理部門總收入的個位數百分比。所以只是為了給你一些關於它的大小的尺寸。我要說的另一件事是，我們在這些臨床指標方面有著悠久的表現歷史。我們有大量的數據來支持我們的分析。我們對履行這些結果保證的能力感到非常滿意。

As I just said, it's a relatively small percentage of our revenue today. And finally, we also believe that we take an appropriately conservative approach in recognizing performance-based revenue. So all of it to say this is work contracts that certainly we have been used to delivering against for some time, supported by data. And it is a relatively small percentage of our overall revenue book today.

正如我剛才所說，這在我們今天的收入中所佔的比例相對較小。最後，我們也認為，我們在確認基於績效的收入時採取了適當保守的方法。因此，所有這些都表明，這是工作合同，我們肯定已經習慣在數據支援的情況下交付一段時間了。這在我們今天的總收入中所佔的比例相對較小。

The next question is from the line of George Hill with Deutsche Bank.

下一個問題來自德意志銀行的喬治·希爾。

I guess, so I would have a question on BetterHelp. And Mala, I recognize the guidance that you gave for Q4. My question is kind of now that we're about a month past the Q3 close, I guess I would just ask, like is that business from a membership perspective basically tracking in line with expectations to where you guys have guided for the balance of the year? And then, Jason, one for you quickly would be because it sounds like the company wants to take a pretty broad approach to a cost-cutting program. I don't know if there's any way to kind of size order of magnitude in the way that you're thinking about what the opportunity looks like inside of the cost structure?

我想，所以我想向 BetterHelp 提問。 Mala，我認可您為第四季度提供的指導。我的問題是，現在我們已經過了第三季結束大約一個月了，我想我只想問，從會員角度來看，業務基本上符合你們指導的平衡的預期。年？然後，傑森，很快就會給你一個答案，因為聽起來該公司希望採取相當廣泛的方法來削減成本計劃。我不知道是否有任何方法可以按照您考慮成本結構內部機會的方式來確定大小數量級？

Yes. So maybe I'll take that one first, George. And then Mala can talk about where we are. I think that actually, maybe I'll take it. The short answer is a month into the quarter, we're right in line with where our guidance is. So I can take that for Mala. I think with respect to our comprehensive operational review, we're really looking across the portfolio to ensure that everything we do is aligned with our strategic focus and maximizing our profitable growth opportunities. I think these efforts are really focused on operating efficiency, and we've stood up now centers of excellence for things like member operations, clinical operations, client operations, revenue cycle management, supply chain and purchasing, all areas where we can leverage our scale and make sure that we're driving for greater efficiency and take advantage of the opportunity to drive cost out of the business such that we can operate more efficiently.

是的。所以也許我會先拿那個，喬治。然後馬拉可以談論我們現在的處境。我想實際上，也許我會接受它。簡短的答案是，進入本季一個月後，我們與我們的指導一致。所以我可以把它當作馬拉。我認為，就我們的全面營運審查而言，我們確實正在審視整個投資組合，以確保我們所做的一切都與我們的策略重點保持一致，並最大限度地提高我們的獲利成長機會。我認為這些努力真正關注的是營運效率，我們現在已經建立了會員營運、臨床營運、客戶營運、收入週期管理、供應鏈和採購等方面的卓越中心，所有這些領域都是我們可以利用我們的規模的確保我們提高效率，並利用機會降低業務成本，以便我們能夠更有效地運作。

I mentioned before, we are emerging from a significant period of investment. And so it makes sense for us to really look at a more right-sized organization based on the cost reduction efforts that we took earlier this year and make sure that all parts of the business are contributing to our profitable growth. And I think that, that is really the fundamentals of it. We don't have anything to announce today regarding what the magnitude of the performance improvements that we expect. And as we're in the middle of that assessment right now, I think you can expect us to give you more color on that in the quarters to come as we quantify the opportunities and then help you to tie those opportunities to what we described earlier, which is EBITDA growing at a faster rate than revenue over the next couple of years.

我之前提到過，我們正在經歷一個重要的投資時期。因此，我們有必要根據今年稍早採取的成本削減措施，真正考慮建立一個規模更合適的組織，並確保業務的所有部分都為我們的獲利成長做出貢獻。我認為這確實是它的基礎。我們今天沒有任何關於我們期望的性能改進幅度的資訊。由於我們現在正處於評估階段，我認為您可以期待我們在未來幾個季度為您提供更多信息，因為我們會量化機會，然後幫助您將這些機會與我們之前描述的內容聯繫起來，即未來幾年EBITDA 的成長速度將快於營收的成長速度。

The one last thing I would add is we have talked about all of the operating expense initiatives and things we would look at. I would also say if I think about gross margin and the gross margin improvement, which has been a strong contributor to our margin expansion. Think about BetterHelp and the gross margins that we are seeing there. We are taking steps and initiatives to improve therapist productivity, whether it be group therapy, more digital interactions. So it's, I would say, both across gross margin as well as operating expense.

我要補充的最後一件事是我們已經討論了所有營運費用計劃和我們將關注的事情。如果我考慮毛利率和毛利率的改善，我也會說，這對我們的利潤率擴張做出了重要貢獻。想想 BetterHelp 以及我們在那裡看到的毛利率。我們正在採取措施和措施來提高治療師的生產力，無論是團體治療還是更多的數位互動。所以，我想說，無論是毛利率還是營運費用。

The next question is from the line of Jessica Tassan with Piper Sandler.

下一個問題來自傑西卡·塔桑和派珀·桑德勒。

So I'm curious, as you think about the kind of new guidance that EBITDA and free cash flow should grow faster than revenue over the next couple of years. Should we still be thinking about those long-term revenue growth target to mid-single digit to high single digit for Integrated Care and low double to mid-teens for BetterHelp as being valid against that new guidance? Or should we think about sort of a different revenue growth rate on a consolidated basis?

所以我很好奇，當你考慮什麼樣的新指引時，EBITDA 和自由現金流在未來幾年應該會比收入成長得更快。我們是否仍應考慮將Integrated Care 的長期收入成長目標設為中個位數到高個位數，將BetterHelp 的長期收入成長目標設為低雙位數到中雙位數，以符合新的指導方針？或者我們應該考慮在合併的基礎上採取不同的收入成長率？

Yes, Jess. So we haven't given longer-term guidance for the business as a whole or the segments. I think you'll see us come out in the first quarter of '24 with an outlook for '24. I think, quite frankly, our -- the indications that we've given today about expecting to see EBITDA growing faster than revenue for the next couple of years is probably the longest outlook that we've given in the last several quarters. I think as we solidify what the findings are and results from this operational review, that will feed into a more multiyear outlook. And we'll endeavor to give you more of a longer-term view when we're ready to. But I don't want to acknowledge or validate those numbers because I don't recall us giving a longer-term view.

是的，傑西。因此，我們沒有對整個業務或細分市場提供長期指導。我想您會在 24 年第一季看到我們對 24 年的展望。坦白說，我認為，我們今天給出的關於預計未來幾年 EBITDA 成長速度快於收入的跡象可能是我們在過去幾個季度給出的最長的展望。我認為，當我們鞏固這次營運審查的調查結果和結果時，這將有助於形成更多年的展望。當我們準備好時，我們將盡力為您提供更多更長遠的觀點。但我不想承認或驗證這些數字，因為我不記得我們曾經給過長期觀點。

The next question is from the line of Daniel Grosslight with Citi.

下一個問題來自花旗銀行的 Daniel Grosslight。

I just have a couple on Integrated Care margins and the outlook for the remainder of the year. So if I heard you correctly, at the midpoint, you expect around 12% margin for Integrated Care, which would be around 477 basis points of degradation, 100 basis points for the performance fee. So still talking around 375 basis points of degradation sequentially. I'm curious what's driving that?

我只有一些關於綜合護理利潤率和今年剩餘時間的展望。因此，如果我沒聽錯的話，在中點，您預計 Integrated Care 的利潤率約為 12%，即退化約 477 個基點，績效費為 100 個基點。所以仍然在談論大約 375 個基點的連續降級。我很好奇是什麼推動了這一點？

And then I guess if I look at the full year, what's implied by that 4Q guidance, it's around 250 basis points of margin expansion versus when we started the year, I think you thought it would be kind of flat to up 50, and then you changed that to 75 to 125 basis points, now it's significantly outperforming there. So maybe if you could just put a finer point on that and the outperformance there? And what we should expect going forward in fiscal '24?

然後我想，如果我看看全年，第四季度的指導意味著什麼，與我們年初相比，利潤率擴張了大約 250 個基點，我想你認為這會持平到 50，然後你把它改為75 到125 個基點，現在它的表現明顯優於那裡。那麼，也許您可以更詳細地闡述這一點以及那裡的出色表現嗎？我們對 24 財年的未來應該有何期待？

Yes. Thanks, Daniel, for the question. So if you think about the 4Q (inaudible) guide that we have given for Integrated Care, I'd say, there are a few factors driving exactly, as you said, the decrease in margins. So what are those? First, the fourth quarter is always the cold and flu season, and that, as you know, drives gross margin compression, right, as those volumes increase. So that's always a factor. We are also spending ahead of member onboarding, right? As you know, we have -- we've talked about the strength in bookings. We have several member onboarding starting January 1. We are spending ahead of those client launches. I would also say we continue to grow our class of W-2 physician hires and we will do so in the fourth quarter. We will increase our W-2 roles. So that certainly is a small drag to margins during the quarter. And the last thing I would say is, as you mentioned, as you noted, the -- certainly, the performance guarantees contributed about 100 basis points to the third quarter margins, and that certainly has an impact sequentially.

是的。謝謝丹尼爾提出的問題。因此，如果您考慮我們為綜合護理提供的第四季度（聽不清楚）指南，我會說，正如您所說，有幾個因素導致了利潤率的下降。那那些是什麼？首先，第四季度始終是感冒和流感季節，正如您所知，隨著銷量的增加，這會導致毛利率壓縮。所以這始終是一個因素。我們也在會員入職之前進行支出，對嗎？如您所知，我們已經討論了預訂方面的優勢。從 1 月 1 日開始，我們有多名會員加入。我們正在為這些客戶啟動之前進行支出。我還想說，我們將繼續增加 W-2 級醫生的聘用人數，我們將在第四季度這樣做。我們將增加 W-2 角色。因此，這無疑對本季的利潤率造成了小幅拖累。我要說的最後一件事是，正如您所提到的，正如您所指出的，當然，業績保證為第三季度的利潤率貢獻了約 100 個基點，這肯定會產生連續的影響。

On your second question around full year performance on the margins. And why are we seeing the expansion and the strength that we have seen. It really comes down to 2 big themes. Number one is we are seeing strength in chronic care revenue growth. That has been a consistent theme over the past few quarters. And certainly, that has exceeded our expectations when we gave the initial guide. And the second thing is all of the cost efficiency program that we are seeing the fruits of as we have rolled through the year. And Jason and I have talked about it in the last few minutes around what those are. So it's really those 2 things that have allowed us to outpace the margin expectations as we have rolled through the year.

關於你的第二個問題，關於全年利潤率的表現。為什麼我們會看到我們所看到的擴張和力量？這其實可以歸結為兩大主題。第一是我們看到慢性病照護收入成長強勁。這是過去幾季的一貫主題。當然，這超出了我們提供最初指南時的預期。第二件事是我們在這一年中看到的所有成本效率計劃的成果。傑森和我在過去幾分鐘裡圍繞著這些內容進行了討論。因此，正是這兩件事讓我們在這一年的利潤率超出了預期。

Makes sense. And then maybe just a follow-up. I'll take a shot at fiscal '24 as well. It seems like, if anything, you're going to get more margin expansion in '24 versus what you are going to achieve in '23, which is around 200, 230 basis points, right? You got that operating efficiencies that might roll through and some other less spend on the Integrated Care App. So I'm just curious, should we think about 200, 250 basis points of margin expansion going forward as kind of (inaudible) for you guys?

說得通。然後也許只是後續行動。我也會在 24 財年嘗試。看起來，如果有的話，你將在 24 年獲得更多的利潤擴張，而 23 年將實現約 200、230 個基點，對嗎？您可以提高營運效率，並減少在整合護理應用程式上的其他支出。所以我只是好奇，我們是否應該考慮將利潤率擴大 200、250 個基點（聽不清楚）？

We're going to stop short of giving a magnitude of the margin expansion. But I think by definition, the fact that we expect EBITDA to grow faster than revenue, you can take away from that, that we are targeting margin expansion again in '24, and we'll give you more insight into the magnitude of that as we get into '24 guidance.

我們將不再給出利潤擴張的幅度。但我認為根據定義，我們預計 EBITDA 增長速度快於收入這一事實，您可以從中得出，我們的目標是在 24 年再次擴大利潤率，我們將讓您更深入地了解其規模我們進入'24指導。

The next question is from the line of Elizabeth Anderson with Evercore ISI.

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

I had a question about how to think about pricing and sort of if we think about the average revenue per U.S. Integrated Care member? And then on the BetterHelp side as well. Like obviously, you had a bunch of new Integrated care members (inaudible). So I just wanted to understand, is that something we should think of as kind of ramping as those members sort of come and get geared up and so that's something that we should think about maybe over the next couple of quarters? Has that ramped? Or is that not the right way to think about it? And then obviously, you had a nice inflection in BetterHelp therapy revenue per user per month as well. So just how to think about the cadence of that as we kind of move forward?

我有一個問題是如何考慮定價以及是否考慮每個美國綜合護理會員的平均收入？然後還有 BetterHelp 方面。顯然，您有一群新的綜合護理成員（聽不清楚）。所以我只是想了解，隨著這些成員的到來並做好準備，我們是否應該考慮增加一些東西，所以這是我們應該在接下來的幾個季度考慮的事情？這已經猛增了嗎？還是這不是正確的思考方式？顯然，每個使用者每個月的 BetterHelp 治療收入也有了很好的變化。那麼，當我們向前邁進時，如何考慮這種節奏呢？

Yes. I would describe -- Elizabeth, thanks for the question. I would describe the pricing environment as stable. With respect to the members that we just onboarded in Integrated Care, it's really more of a revenue per member than a pricing question because we have to activate those members to drive visit revenue. The subscription revenue stays stable over time, but visit revenue tends to ramp. That's not really a pricing question. It's more of an activation and engagement question. And then, of course, we always look for land and expand opportunities so that we can increase our revenue per member. So when I think about pricing, I think of it as an apples-to-apples basis for either a single product or a bundle of products from one year to the next, and we're seeing it pretty stable.

是的。我會描述——伊麗莎白，謝謝你的提問。我認為定價環境是穩定的。對於我們剛加入 Integrated Care 的會員，這實際上更多的是每位會員的收入而不是定價問題，因為我們必須啟動這些會員才能增加訪問收入。訂閱收入隨著時間的推移保持穩定，但訪問收入往往會上升。這實際上並不是一個定價問題。這更多的是一個激活和參與的問題。當然，我們總是尋找土地並擴大機會，以便增加每個成員的收入。因此，當我考慮定價時，我將其視為單一產品或一組產品從一年到下一年的同類基礎，我們看到它相當穩定。

With respect to BetterHelp, we're always experimenting with pricing across markets. But overall, pricing hasn't changed in a notable way. I think if you're looking at revenue divided by user count, any small change you're seeing period-to-period is primarily a reflection of mix, including the growth of the other line item, which is mostly a DTC (inaudible) asset, that's small but growing faster. And really importantly, when you're looking at revenue in a quarter versus membership, there's quite a bit of impact or there's impact within a quarter of the timing of when members come on and then start paying for the program and/or roll off of the program. So overall, I would say pricing has remained pretty stable in that market.

對於 BetterHelp，我們一直在嘗試跨市場定價。但整體而言，定價並沒有顯著變化。我認為，如果您查看收入除以用戶數，您看到的任何一個時期之間的微小變化主要反映了混合情況，包括其他訂單項目的增長，這主要是 DTC（聽不清）資產規模雖小，但成長速度更快。非常重要的是，當您比較一個季度的收入與會員資格時，會發現相當大的影響，或者在會員加入然後開始為該計劃付費和/或退出的時間的四分之一內產生影響該程序。總的來說，我想說該市場的定價保持相當穩定。

The next question is from the line of Sean Dodge with RBC Capital.

下一個問題來自 RBC Capital 的 Sean Dodge。

Jason, you kind of alluded to it a bit in your earlier response, but just on BetterHelp, with the resumption of (inaudible) loan payments on October 1. Is there any updates you can provide on what you're seeing at least thus far into October? Any potential impact that's having on new adds or churn or any kind of discernible change in customer behavior? I mean just, I guess, in general, around BetterHelp?

Jason，您在先前的回覆中稍微提到過這一點，但只是在 BetterHelp 上，10 月 1 日恢復（聽不清楚）貸款付款。您是否可以提供至少到目前為止您所看到的任何更新進入十月？對新增加或流失或客戶行為的任何明顯變化有任何潛在影響嗎？我的意思是，我想，一般來說，圍繞著 BetterHelp？

We haven't seen anything in the data that suggests that that's had an impact. Churn has been stable. We haven't seen significant notable change, nor are we assuming any significant change in churn in our guidance. So I would say, no, we haven't seen really any impact of that.

我們沒有在數據中看到任何表明這產生了影響的內容。流失率一直穩定。我們沒有看到重大的顯著變化，我們的指導中也沒有假設客戶流失有任何重大變化。所以我想說，不，我們還沒有看到任何真正的影響。

Thank you for your question. That will conclude the conference call. Thank you for your participation. You may now disconnect your lines.

謝謝你的問題。電話會議到此結束。感謝您的參與。現在您可以斷開線路。