Teladoc Health Inc (TDOC) 2023 Q4 法說會逐字稿

Good afternoon, ladies and gentlemen. Thank you for joining today's Teladoc Health Q4 Earnings Call. My name is Tia, and I will be your moderator for today's call. (Operator Instructions) I would now like to pass the call over to Patrick Feeley, Head of Investor Relations. Please proceed.

女士們、先生們，午安。感謝您參加今天的 Teladoc Health 第四季財報電話會議。我叫蒂亞，我將擔任今天電話會議的主持人。 （操作員指示）我現在想將電話轉給投資者關係主管 Patrick Feeley。請繼續。

Thank you, and good afternoon. Today, after the market closed, we issued a press release announcing our fourth quarter and full year 2023 financial results. This press release and the accompanying slide presentation are available in the Investor Relations section of the teladochealth.com website. On this call to discuss the results are Jason Gorevic, Chief Executive Officer; and Mala Murthy, Chief Financial Officer.

謝謝你，下午好。今天，市場收盤後，我們發布了一份新聞稿，宣布了我們第四季和 2023 年全年的財務表現。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。

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

在這次電話會議中，我們還將討論我們的未來展望，我們準備好的發言之後將進行問答環節。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 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.

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. As we start 2024, we're very much in a time of transition as an economy, an industry and a company. Teladoc Health has made significant strides in our increased focus on bottom line performance, realizing more benefits of scale over the past several quarters. This year we'll continue to accelerate that progress.

謝謝你，派崔克，謝謝大家加入我們。 2024 年伊始，我們的經濟、產業和公司正處於轉型時期。 Teladoc Health 在我們更加關注底線績效方面取得了重大進展，在過去幾季實現了更多規模效益。今年我們將繼續加快這一進程。

Our success is evident in our most profitable year-to-date, delivering 33% growth in adjusted EBITDA and free cash flow of $194 million in 2023. We also closed out 2023 with a strong selling season that yielded double-digit bookings growth over the prior year. The breadth of our product portfolio continues to drive cross-selling as approximately 75% of our bookings were upsells or expansions with existing clients. This is representative of our success driving increased product penetration through our large installed base of nearly 90 million virtual care members.

我們的成功體現在我們今年迄今最獲利的業績中，2023 年調整後EBITDA 成長33%，自由現金流達到1.94 億美元。我們也以強勁的銷售季節結束了2023 年，預訂量在2023 年實現了兩位數的成長去年。我們產品組合的廣度繼續推動交叉銷售，因為我們大約 75% 的預訂是針對現有客戶的追加銷售或擴張。這代表了我們透過近 9,000 萬名虛擬護理會員的龐大安裝基礎，成功地推動了產品滲透率的提升。

This year, we will grow our adjusted EBITDA margins and free cash flow while making continued investments in innovation. We'll do this by both growing our revenue and removing more than $85 million in expenses through efficiencies and restructuring. We're targeting 50 to 100 basis points of annual margin expansion over the next 3 years, and have line of sight to at least $425 million of adjusted EBITDA in 2025. This puts us in a strong financial position as others in the space struggle. And it provides us the flexibility to have all options on the table, including continued investments in organic innovation, tuck-in M&A, retiring debt and giving back money to our investors through share repurchase. At the same time, we will continue to grow our top line.

今年，我們將提高調整後的 EBITDA 利潤率和自由現金流，同時繼續投資於創新。為此，我們將透過提高效率和重組來增加收入並消除超過 8500 萬美元的支出。我們的目標是在未來 3 年內將年度利潤率擴大 50 至 100 個基點，並預計到 2025 年調整後的 EBITDA 至少達到 4.25 億美元。這使我們與其他同行一樣處於強勁的財務狀況。它為我們提供了靈活性，可以考慮所有選擇，包括繼續投資於有機創新、併購、償還債務以及透過股票回購將資金返還給我們的投資者。同時，我們將繼續增加我們的收入。

With approximately 90 million members and thousands of clients around the world, we continue to be the leader in whole person virtual care. We're excited to bring to market a broader range of services in areas like weight management and pediatrics this year even as we work to achieve profitability. And our productivity initiatives mean we will continue to invest in our leading technology and engagement capabilities.

我們在全球擁有約 9,000 萬名會員和數千名客戶，並繼續成為全人虛擬護理領域的領導者。儘管我們努力實現盈利，但今年我們很高興能在體重管理和兒科等領域向市場推出更廣泛的服務。我們的生產力計劃意味著我們將繼續投資於我們的領先技術和參與能力。

With that framing for where we are and where we're going, I'd like to quickly walk you through our Q4 results, our 2024 guidance, and our ongoing organizational review as key milestones in this journey.

有了我們現在和未來的框架，我想快速向您介紹我們的第四季度業績、我們的 2024 年指導以及我們正在進行的組織審查，作為這一旅程中的關鍵里程碑。

First, fourth quarter results. On the top line, our consolidated revenue grew 4% on a year-over-year basis in the fourth quarter to $661 million. Consolidated adjusted EBITDA of $114 million, grew 22% year-over-year, representing 260 basis points of year-over-year margin expansion to 17.3%. Revenue from our Integrated Care segment was in line with our expectations, growing 8% year-over-year to $384 million. Segment margins expanded 230 basis points over the prior year's fourth quarter to 14.6%, a benefit of operating leverage and improved efficiency. Including the strong fourth quarter margin result, the Integrated Care segment delivered over 320 basis points of margin expansion and 42% growth in adjusted EBITDA for the full year.

一、第四季業績。在營收方面，我們第四季的綜合營收年增 4%，達到 6.61 億美元。綜合調整後 EBITDA 為 1.14 億美元，較去年同期成長 22%，利潤率年增 260 個基點，達到 17.3%。綜合護理部門的收入符合我們的預期，年增 8% 至 3.84 億美元。由於營運槓桿和效率的提高，部門利潤率比去年第四季擴大了 230 個基點，達到 14.6%。包括第四季強勁的利潤率在內，綜合護理部門全年利潤率成長超過 320 個基點，調整後 EBITDA 成長 42%。

Turning to the BetterHelp segment. Revenue was $276 million in the fourth quarter, while adjusted EBITDA was $58 million. BetterHelp margins expanded 210 basis points over the prior year's fourth quarter, which helped drive year-over-year adjusted EBITDA growth of 11% despite lower revenue. While we're pleased to deliver double-digit adjusted EBITDA growth at BetterHelp, both for the quarter and the full year, revenue and margins were below our expectations in the quarter as we saw lower yields on marketing spend. Specifically, we experienced returns on our social media advertising spend that were below target in the second half of the year, which was a departure relative to the first half. We'll speak to guidance in a moment. But our BetterHelp outlook assumes the lower yields experienced in certain channels in the second half of 2023 will persist, and as a result, will impact our year-over-year growth rates in the first half of 2024.

轉向 BetterHelp 部分。第四季營收為 2.76 億美元，調整後 EBITDA 為 5,800 萬美元。 BetterHelp 利潤率比去年第四季成長了 210 個基點，儘管營收有所下降，但仍推動調整後 EBITDA 年成長 11%。雖然我們很高興在 BetterHelp 實現兩位數的調整後 EBITDA 成長，但本季的營收和利潤率低於我們的預期，因為我們看到行銷支出的收益率較低。具體來說，我們下半年的社群媒體廣告支出回報低於目標，與上半年相比有偏差。我們稍後會與指導人員交談。但我們的 BetterHelp 展望假設 2023 年下半年某些通路的殖利率下降將持續下去，進而影響我們 2024 年上半年的年成長率。

I'd like to take a step back and spend a few minutes providing a higher-level framework for how we're thinking about our long-term outlook. I'll begin with the Integrated Care segment. At a high level, roughly half of our Integrated Care segment revenue is derived from our U.S.-based virtual care business, including what you may think of as our traditional Teladoc general medical business. From a business model perspective, the beauty of our virtual care business is that it's a very stable asset that provides a steady source of revenue and a large client base with approximately 90 million members into which we sell additional products and services.

我想退後一步，花幾分鐘時間為我們如何思考我們的長期前景提供一個更高層次的框架。我將從綜合護理部分開始。從高水準來看，我們的綜合護理部門收入大約一半來自我們位於美國的虛擬護理業務，包括您可能認為的我們傳統的 Teladoc 一般醫療業務。從商業模式的角度來看，我們的虛擬護理業務的優點在於它是一項非常穩定的資產，可以提供穩定的收入來源和龐大的客戶群，我們向其銷售額外的產品和服務，擁有約9000萬會員。

At the same time, it's important to remember that most U.S. health care consumers have access to virtual urgent care today. So it's largely a replacement market at this point. We've consistently taken share in this market and we expect to continue to do so. But it's fairly well penetrated. And accordingly, we anticipate revenue growth from our U.S. virtual care products will be in the low single digits going forward. So think of roughly half of the Integrated Care segment as stable but lower growth.

同時，重要的是要記住，大多數美國醫療保健消費者如今都可以獲得虛擬緊急護理。所以目前這主要是一個替代市場。我們一直在這個市場上佔據份額，我們預計將繼續這樣做。但滲透得相當好。因此，我們預期未來美國虛擬護理產品的收入成長將維持在較低的個位數。因此，可以認為大約一半的綜合護理細分市場穩定但成長較低。

The remaining half of Integrated Care segment revenue is primarily comprised of our chronic care suite of products and our international virtual care business. Our general medical virtual urgent care book of business, including our 90 million members represent a long runway for continued cross-selling of our chronic care products as we execute against our land and expand strategy. And when I look at our suite of chronic care products, only about 16% of our general medical client base has access to one or more of our chronic care products today, that's up from just 12% 2 years ago. While we've made a lot of progress over the last 2 years with 16% penetration, there's still a long runway for chronic care growth within our existing virtual care book.

綜合護理部門收入的剩餘一半主要由我們的慢性護理產品套件和國際虛擬護理業務組成。我們的普通醫療虛擬緊急護理業務，包括我們的 9000 萬會員，代表我們在執行我們的土地和擴張策略時繼續交叉銷售我們的慢性護理產品的漫長道路。當我查看我們的慢性護理產品套件時，今天只有約 16% 的普通醫療客戶群能夠使用我們的一種或多種慢性護理產品，而兩年前這一比例僅為 12%。雖然我們在過去兩年中取得了很大進展，滲透率達到 16%，但在我們現有的虛擬護理手冊中，慢性病護理的成長仍有很長的路要走。

So we've been successful in selling our chronic care products through our existing client book, and that gives us a lot of confidence that we can deliver mid- to high single-digit average chronic care revenue growth over the next few years.

因此，我們已經成功地透過現有的客戶名錄銷售了我們的慢性護理產品，這給了我們很大的信心，我們可以在未來幾年內實現中高個位數的平均慢性護理收入增長。

Our international B2B business continues to be a steady contributor to revenue growth, and our expanded presence in Canada this year gives us good visibility into 2024 revenue growth. So combined, we have a reliably stable asset in our virtual care book of business and a chronic care suite of products and an international channel each growing at a higher rate. Altogether, we expect mid-single-digit annual revenue growth for the Integrated Care segment over the next 3 years.

我們的國際 B2B 業務繼續為收入成長做出穩定的貢獻，今年我們在加拿大的業務擴展使我們對 2024 年收入成長有良好的了解。因此，我們在虛擬護理業務、慢性護理產品套件和國際管道中擁有可靠且穩定的資產，每一個都以更高的速度成長。總的來說，我們預計未來 3 年綜合護理領域的年收入將實現中個位數成長。

We also see significant opportunities for margin expansion in the Integrated Care segment, from both operating leverage and productivity improvements, all while maintaining robust capacity for sustained strong investment in long-term innovation and growth. We expect this segment will drive the majority of consolidated margin growth over the next 3 years.

我們也看到綜合護理領域利潤率擴張的重大機會，無論是營運槓桿還是生產力提高，同時保持對長期創新和成長的持續強勁投資的強大能力。我們預計該細分市場將在未來三年內推動大部分綜合利潤成長。

Turning now to our outlook for BetterHelp. As we step back and think about the BetterHelp segment going forward, I think of three broad growth drivers. First, overall demand for mental health services continues to rise. And with significant unmet need, that demand is outpacing supply. Second, consumer preference for mental health services continues to shift towards the virtual modality. That continues to be a tailwind. At the same time, with our increased focus on profitable growth, as a direct-to-consumer business, BetterHelp's new member acquisition is gated somewhat by the amount of capital we can deploy at an acceptable rate of return in any given time period. This means BetterHelp's growth is in part dependent on our ability to efficiently reach new individuals to create awareness for BetterHelp services and convert them to members.

現在談談我們對 BetterHelp 的展望。當我們退一步思考 BetterHelp 細分市場的未來時，我想到了三大成長動力。首先，精神衛生服務整體需求持續上升。由於大量需求未被滿足，需求正在超過供應。其次，消費者對心理健康服務的偏好繼續轉向虛擬方式。這仍然是一個順風車。同時，隨著我們越來越注重盈利增長，作為一項直接面向消費者的業務，BetterHelp 的新會員獲取在一定程度上受到我們在任何給定時間段內以可接受的回報率部署的資本數額的限制。這意味著 BetterHelp 的成長部分取決於我們有效接觸新人、提高對 BetterHelp 服務的認識並將其轉化為會員的能力。

At its current size and scale, we believe BetterHelp is by far the largest direct-to-consumer virtual therapy provider in the market today. BetterHelp's scale and experience affords us the unique advantage of deploying a large amount of capital efficiently each year while driving strong free cash flow. The good news is, given the continued runway for growth and our well-established algorithm for deploying advertising dollars, we believe we can drive steady growth in this business at an attractive margin.

以目前的規模和規模，我們相信 BetterHelp 是迄今為止市場上最大的直接面向消費者的虛擬治療提供者。 BetterHelp 的規模和經驗為我們提供了獨特的優勢，可以每年有效地部署大量資本，同時推動強勁的自由現金流。好消息是，鑑於持續的成長勢頭以及我們完善的廣告資金部署演算法，我們相信我們能夠以有吸引力的利潤率推動這項業務的穩定成長。

We're also increasing our focus on growing BetterHelp outside the U.S. Roughly 15% of BetterHelp's fiscal year 2023 revenue was generated in international markets, primarily in English-speaking countries, such as Canada and the U.K., and we're actively working to expand BetterHelp's presence internationally. To advance this goal and accelerate BetterHelp's revenue growth internationally, we recently hired a new leader. We think there's a lot of untapped potential outside the U.S., and expect to see these efforts begin to contributing to our financial results more meaningfully as we move through 2024, particularly in the second half of the year.

我們也更重視在美國以外地區發展 BetterHelp。BetterHelp 2023 財年收入的約 15% 來自國際市場，主要是加拿大和英國等英語國家，我們正在積極努力擴大業務規模BetterHelp 的國際影響力。為了推進這一目標並加速 BetterHelp 在國際上的收入成長，我們最近聘請了一位新領導者。我們認為美國以外還有很多尚未開發的潛力，並預計隨著 2024 年的到來，特別是今年下半年，這些努力將開始為我們的財務表現做出更有意義的貢獻。

We will continue to grow BetterHelp responsibly, with an eye toward maintaining the attractive margin and free cash flow profile of the business. With over $1.1 billion in revenue and our increased focus on bottom line performance, we believe we can efficiently deploy capital to drive new customer acquisition and revenue growth at BetterHelp in the low single-digit range over the next 3 years with opportunities for modest margin expansion.

我們將繼續負責任地發展 BetterHelp，著眼於維持該業務具有吸引力的利潤率和自由現金流狀況。憑藉超過11 億美元的收入以及我們對底線績效的日益關注，我們相信我們可以有效地部署資本，在未來3 年內推動BetterHelp 的新客戶獲取和收入增長在較低的個位數範圍內，並有機會實現適度的利潤率擴張。

Before I update you on the results of our ongoing operational review, I want to reinforce our commitment to investing in technology and the long-term growth of our company. Our ability to effectively leverage data and technology to drive engagement and multiproduct utilization is fundamental to delivering better outcomes and lower costs for our clients. Our engagement capabilities underpinned by the data and data science remain a key competitive advantage. Therefore, it's important that we continue driving greater differentiation through investments in technologies such as machine learning and AI, improving our ability to engage with members on a hyper-personalized basis. So while we continue to work hard to drive productivity and efficiency across the organization, you should expect us to continue to make sizable targeted investments in product, technology and data.

在向您通報我們正在進行的營運審查的最新結果之前，我想重申我們對技術投資和公司長期發展的承諾。我們有效利用數據和技術來推動參與和多產品利用的能力對於為客戶提供更好的結果和更低的成本至關重要。我們以數據和數據科學為基礎的參與能力仍然是關鍵的競爭優勢。因此，我們必須繼續透過投資機器學習和人工智慧等技術來推動更大的差異化，提高我們與會員進行超個人化互動的能力。因此，在我們繼續努力提高整個組織的生產力和效率的同時，您應該期望我們繼續在產品、技術和數據方面進行大量有針對性的投資。

At the same time, we have increased our focus on efficiency and bottom line performance. We're driving sustained margin improvement and increased cash flow generation while continuing to make substantial investments in innovation. To date, we have identified actions that we expect will result in approximately $85 million in total annual run rate operating expense savings by the end of 2024. These savings build on the cost initiatives we delivered upon in 2023 and are expected from productivity initiatives, including automation and internal process improvements, organizational realignment and third-party spend reduction. We expect $35 million of these identified cost savings to benefit 2024 adjusted EBITDA and $43 million in total impact to 2024 GAAP expenses, inclusive of stock-based compensation.

同時，我們更加關注效率和底線績效。我們正在推動利潤率的持續改善和現金流量的增加，同時繼續對創新進行大量投資。迄今為止，我們已經確定了預計到 2024 年底將節省約 8500 萬美元年度營運費用的行動。這些節省建立在我們 2023 年實施的成本計劃的基礎上，預計將透過生產力計劃實現，包括自動化和內部流程改善、組織重組和第三方支出減少。我們預計這些已確定的成本節省中的 3500 萬美元將使 2024 年調整後的 EBITDA 受益，並對 2024 年 GAAP 費用產生總計 4300 萬美元的影響，包括基於股票的薪酬。

Our efforts to unlock productivity improvements are ongoing. And we will provide updates as appropriate. These productivity and efficiency initiatives will allow us to drive near-term growth and invest in future growth opportunities while also continuing our path towards enhanced bottom line performance and free cash flow generation. The long-term fundamentals of our business are strong, and we remain committed to expanding our leadership position in the industry.

我們正在不斷努力提高生產力。我們將酌情提供更新。這些生產力和效率舉措將使我們能夠推動近期成長並投資於未來的成長機會，同時繼續我們提高底線績效和自由現金流產生的道路。我們業務的長期基礎強勁，我們將繼續致力於擴大我們在行業中的領導地位。

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

接下來，我將把電話轉給 Mala，回顧第四季並分享我們的前瞻性指引。

Thank you, Jason, and good afternoon, everyone. Fourth quarter consolidated revenue of $661 million increased 4% year-over-year. Fourth quarter adjusted EBITDA was $114 million, an increase of 22% year-over-year, representing a margin of 17.3%. Full year consolidated revenue of $2.6 billion increased 8% over the prior year, while full year consolidated adjusted EBITDA increased 33% to $328 million. Full year adjusted EBITDA margins increased 240 basis points to 12.6%.

謝謝傑森，大家下午好。第四季綜合營收為 6.61 億美元，年增 4%。第四季調整後 EBITDA 為 1.14 億美元，較去年同期成長 22%，利潤率為 17.3%。全年綜合收入為 26 億美元，比上年增長 8%，全年綜合調整後 EBITDA 成長 33%，達到 3.28 億美元。全年調整後 EBITDA 利潤率成長 240 個基點，達到 12.6%。

Consolidated net loss per share in the fourth quarter was $0.17 compared to a net loss per share of $23.49 in the fourth quarter of 2022. Net loss per share in the fourth quarter included amortization of acquired intangibles of $0.43 per share and stock-based compensation expense of $0.28 per share.

第四季合併每股淨虧損為 0.17 美元，而 2022 年第四季每股淨虧損為 23.49 美元。第四季每股淨虧損包括每股收購無形資產攤銷 0.43 美元和股票補償費用每股0.28美元。

Fourth quarter free cash flow was $93.6 million compared to $11.7 million in the fourth quarter of 2022. Full year free cash flow was $193.7 million compared to $16.5 million in the prior year. We ended the year with over $1.1 billion in cash and cash equivalents on the balance sheet.

第四季自由現金流為 9,360 萬美元，而 2022 年第四季為 1,170 萬美元。全年自由現金流為 1.937 億美元，而前一年為 1,650 萬美元。截至年底，我們的資產負債表上的現金和現金等價物超過 11 億美元。

Turning to segment results. Integrated Care segment revenue increased 8% year-over-year to $384 million in the fourth quarter, growing 3% sequentially. For the full year, Integrated Care segment revenue increased 7% to $1.5 billion. The largest contributor to 2023 Integrated Care growth was Chronic Care revenue growth. Fourth quarter Integrated Care adjusted EBITDA was $56 million, an increase of 28% over the prior year's fourth quarter, representing a 230 basis point margin expansion.

轉向細分結果。第四季綜合護理部門營收年增 8% 至 3.84 億美元，季增 3%。全年綜合護理部門營收成長 7%，達到 15 億美元。 2023 年綜合護理成長的最大貢獻者是慢性護理收入成長。第四季 Integrated Care 調整後 EBITDA 為 5,600 萬美元，比去年第四季成長 28%，意味著利潤率擴大了 230 個基點。

During the fourth quarter, member enrollment in Chronic Care programs grew by 36,000, bringing full year net enrollment growth to 139,000. We ended the fourth quarter with Chronic Care enrollment of 1.16 million, an increase of 14% year-over-year and 3% sequentially. The biggest drivers of new Chronic Care enrollment in fiscal year 2023 were hypertension followed by our diabetes prevention and weight management programs. As of year-end, diabetes management comprised approximately half of Chronic Care program enrollment, followed by hypotension at 30% and diabetes prevention and weight management, both approximately 10% of total program enrollment. Program enrollment growth continues to benefit from our success in selling bundled Chronic Care management solutions.

第四季度，慢性病照護計畫的會員註冊人數增加了 36,000 人，全年淨註冊人數增加至 139,000 人。截至第四季末，慢性病護理註冊人數為 116 萬人，年增 14%，季增 3%。 2023 財政年度慢性病護理新註冊人數的最大驅動因素是高血壓，其次是我們的糖尿病預防和體重管理計劃。截至年底，糖尿病管理約佔慢性照護計畫註冊人數的一半，其次是低血壓（佔 30%），以及糖尿病預防和體重管理，均約佔計畫總註冊人數的 10%。計劃註冊人數的成長繼續受益於我們成功銷售捆綁慢性病護理管理解決方案。

Total Integrated Care segment membership ended the year at 89.6 million members. Average Integrated Care revenue per U.S. member of $1.42 decreased $0.02 over the prior year's fourth quarter. Excluding the impact of new virtual care members added during the year, revenue per member increased $0.06.

截至年底，綜合護理細分市場會員總數達到 8,960 萬名。每位美國會員的平均綜合護理收入為 1.42 美元，比去年第四季減少了 0.02 美元。排除年內新增虛擬護理會員的影響，每位會員的收入增加了 0.06 美元。

Turning to BetterHelp. Revenue was $276 million in the fourth quarter, roughly flat versus the prior year and down 3% sequentially. Fourth quarter BetterHelp adjusted EBITDA was $58 million, representing growth of 11% over the prior year's fourth quarter. Adjusted EBITDA margin of 21.2% increased 210 basis points over last year's fourth quarter. BetterHelp revenue for the full year was $1.1 billion, an increase of 11% over the prior year. Full year adjusted EBITDA grew 19% over the prior year to $136 million, representing a margin of 12% compared to 11.2% in the prior year.

轉向 BetterHelp。第四季營收為 2.76 億美元，與上年基本持平，季減 3%。第四季 BetterHelp 調整後 EBITDA 為 5,800 萬美元，比去年第四季成長 11%。調整後 EBITDA 利潤率為 21.2%，比去年第四季增加了 210 個基點。 BetterHelp全年營收為11億美元，較上年成長11%。全年調整後 EBITDA 比上年成長 19%，達到 1.36 億美元，利潤率為 12%，而上年為 11.2%。

Now turning to forward guidance. We expect full year 2024 revenue to be in the range of $2.635 billion to $2.735 billion, which represents year-over-year growth of approximately 1.5% to 5%. The 2024 revenue outlook includes low to mid-single-digit growth in our Integrated Care segment and flat to low single digit growth in our BetterHelp segment. We expect full year 2024 consolidated adjusted EBITDA to be in the range of $350 million to $390 million, representing year-over-year growth between 6.7% and 18.9%. Consolidated guidance includes a year-over-year increase to adjusted EBITDA margin of 150 to 250 basis points for the Integrated Care segment. And margins for the BetterHelp segment of flat plus or minus 50 basis points.

現在轉向前瞻性指導。我們預計 2024 年全年營收將在 26.35 億美元至 27.35 億美元之間，年增約 1.5% 至 5%。 2024 年的收入前景包括我們的綜合護理部門的低至中個位數增長以及我們的 BetterHelp 部門的持平至低個位數增長。我們預計 2024 年全年綜合調整後 EBITDA 將在 3.5 億美元至 3.9 億美元之間，年增 6.7% 至 18.9%。綜合指引包括綜合護理部門調整後 EBITDA 利潤率年增 150 至 250 個基點。 BetterHelp 部分的利潤率持平正負 50 個基點。

We expect full year free cash flow of $210 million to $240 million, representing year-over-year growth of 8% to 24%. Full year stock-based compensation is expected to be approximately $180 million, representing a decline of approximately $20 million. For the first quarter, we expect revenue to be in the range of $630 million to $645 million. First quarter Integrated Care segment year-over-year revenue growth is expected to be in the range of 5% to 7%, while BetterHelp segment revenue growth is expected to be down 6% to down 3% compared to the first quarter of last year.

我們預計全年自由現金流為 2.1 億美元至 2.4 億美元，年增 8% 至 24%。全年股票薪酬預計約 1.8 億美元，減少約 2,000 萬美元。我們預計第一季的營收將在 6.3 億美元至 6.45 億美元之間。第一季Integrated Care部門的營收年增率預計將在5%至7%之間，而BetterHelp部門的營收成長預計將比去年第一季下降6%至3% 。

First quarter consolidated adjusted EBITDA is expected to be in the range of $52 million to $62 million. First quarter adjusted EBITDA guidance includes Integrated Care segment adjusted EBITDA margins in the range of 10.5% to 12% and BetterHelp adjusted EBITDA margins between 5.5% and 6.5%.

第一季綜合調整後 EBITDA 預計在 5,200 萬美元至 6,200 萬美元之間。第一季調整後 EBITDA 指引包括 Integrated Care 部門調整後 EBITDA 利潤率在 10.5% 至 12% 之間，BetterHelp 調整後 EBITDA 利潤率在 5.5% 至 6.5% 之間。

One thing I want to call out related to our 2024 guidance is that we did experience a delay in launching our B2B consumer engagement efforts during the first quarter due to a technical issue in mapping new client populations. While we have fixed the issue and relaunched our marketing campaigns, we expect the cumulative effect of this onetime delay to have an impact on 2024 revenue of approximately $20 million. This $20 million impact represents approximately 140 basis points of year-over-year Integrated Care segment growth, which is reflected in our 2024 Integrated Care segment outlook.

我想指出的與 2024 年指導相關的一件事是，由於繪製新客戶群的技術問題，我們在第一季啟動 B2B 消費者參與工作確實出現了延遲。雖然我們已經解決了這個問題並重新啟動了行銷活動，但我們預計這次延遲的累積影響將對 2024 年的收入產生約 2000 萬美元的影響。這 2000 萬美元的影響代表綜合護理細分市場同比增長約 140 個基點，這反映在我們的 2024 年綜合護理細分市場展望中。

Looking beyond 2024, as reflected in today's press release, we are also providing a long-term outlook as follows: we expect consolidated annual revenue growth over the next 3 years in the low to mid-single digits, which includes annual growth of mid-single digits for the Integrated Care segment, and low single-digit for the BetterHelp segment. We are targeting 50 to 100 basis points of margin expansion annually over the next 3 years, and at least $425 million of adjusted EBITDA in 2025, inclusive of the identified cost actions discussed earlier. We anticipate margin expansion to be driven in large part by operating leverage over our technology and development and G&A line items. We expect annual declines in stock-based compensation over the next 3 years as we manage our compensation expense and march towards GAAP profitability, including an approximate $20 million year-over-year decline in 2024.

展望 2024 年之後，正如今天的新聞稿所反映的，我們還提供瞭如下長期前景：我們預計未來 3 年的綜合年收入增長將達到中低個位數，其中包括中低個位數的年增長綜合護理細分市場為個位數，而BetterHelp 細分市場則為低個位數。我們的目標是在未來 3 年內每年將利潤率擴大 50 至 100 個基點，並在 2025 年調整後 EBITDA 至少達到 4.25 億美元，其中包括先前討論的已確定的成本行動。我們預期利潤率的擴張在很大程度上是由我們的技術和開發以及一般行政費用項目的營運槓桿所推動的。我們預計，隨著我們管理薪酬支出並朝著 GAAP 盈利能力邁進，未來 3 年基於股票的薪酬將逐年下降，其中 2024 年將同比下降約 2000 萬美元。

Finally, with $1.1 billion in cash on our balance sheet, and our business generating strong and increasing amounts of free cash flow, I thought it would be helpful to remind you of our capital allocation priorities going forward. One, tuck-in M&A. We believe our large base of clients with 90 million members gives us a unique ability to bring new products to our existing book of business. We will, therefore, continue to look for opportunities to expand our capabilities.

最後，我們的資產負債表上有 11 億美元的現金，而且我們的業務產生了強勁且不斷增加的自由現金流，我認為提醒您我們未來的資本配置優先事項會有所幫助。一、集中併購。我們相信，擁有 9,000 萬會員的龐大客戶群賦予我們獨特的能力，為我們現有的業務帶來新產品。因此，我們將繼續尋找機會來擴展我們的能力。

Two, debt pay down. We have a convertible bond due in 2025 and the cash on our balance sheet allows us the flexibility to retire that issuance if we choose.

二、償還債務。我們有一張將於 2025 年到期的可轉換債券，資產負債表上的現金使我們能夠靈活地收回該債券（如果我們選擇的話）。

Three, share buybacks. The level of annual free cash flow we are generating will increasingly provide us the flexibility to do strategic share buybacks as well as minimize potential dilution from employee stock grants.

三、股票回購。我們產生的年度自由現金流水準將為我們提供策略性股票回購的靈活性，並最大限度地減少員工股票授予的潛在稀釋。

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

這樣，我會將電話轉回給傑森。

Thanks, Mala. With that, I think we'll open it up for questions. Operator?

謝謝，馬拉。至此，我想我們將開放提問。操作員？

(Operator Instructions) The first question comes 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 線路。

Jason, I just want to go back and talk for a minute about the selling season and try to square just a couple of numbers that you gave and Mala gave. So Mala talked about chronic members being up 14%. You talked about double-digit booking growth in the selling season. But yet, when you talked about the integrated business and talked about the chronic component of that, you talked about mid- to high single-digit growth. Can you help me to understand like is that you're doing more bundled programs and therefore the growth isn't as high?

傑森，我只想回去談談銷售季節，並嘗試將您提供的和馬拉提供的幾個數字平方。所以 Mala 談到長期會員成長了 14%。您談到了銷售季節兩位數的預訂成長。但是，當您談到綜合業務並談到其中的長期組成部分時，您談到了中高個位數成長。您能否幫助我理解您正在做更多的捆綁計劃，因此增長不那麼高？

And then secondly, as we think about this going forward, you talked about 16% of the base having access, is this an opportunity where 100% of your base can have access? Or is it some smaller number as I think about that what would be my question.

其次，當我們考慮未來的情況時，您提到 16% 的用戶可以訪問，這是 100% 的用戶可以訪問的機會嗎？或者當我思考我的問題時，它是一個較小的數字。

Thanks, Lisa. I appreciate the question. As we think about our longer-term outlook, we do think that we'll continue to penetrate our book of business with our Chronic Care programs. And as we've said, about 75% of our sales came from selling to existing clients. And so that's -- as we make progress and we made progress over the last 2 years from 12% to 16% penetration, we think that we will continue that progress.

謝謝，麗莎。我很欣賞這個問題。當我們考慮我們的長期前景時，我們確實認為我們將繼續透過慢性病照護計劃滲透我們的業務。正如我們所說，我們大約 75% 的銷售額來自向現有客戶銷售。因此，隨著我們取得進展，我們在過去 2 年裡從 12% 的滲透率取得了進展，達到了 16%，我們認為我們將繼續這一進展。

As I went through the bookings last year and then think about that versus this year, as we discussed in the prepared remarks, we had this temporary mapping issue with new member onboardings and that caused us to pause marketing for about 3 weeks, that has an impact of about $20 million or about 140 basis points of Integrated Care growth, almost all of which is centered on our Chronic Care programs. And so as you think about growth in Chronic Care this year, the majority, the vast majority of that impact is on our Chronic Care programs.

當我查看去年的預訂情況，然後考慮與今年相比時，正如我們在準備好的評論中所討論的那樣，我們在新會員入職方面遇到了臨時映射問題，這導致我們暫停營銷大約3 週，這有綜合護理增長約 2000 萬美元或約 140 個基點的影響，幾乎所有這些都集中在我們的慢性護理計劃上。因此，當您考慮今年慢性病照護的成長時，大多數、絕大多數影響都集中在我們的慢性病照護計畫上。

The second thing to think about for this year is, as we launched -- as we booked business in sales last year, there's always a timing question of when those sales go live and produce revenue. We did have a meaningful amount that came through of in-year revenue which started last year. And we do have some that is going to start not in January, but actually starts in the late first, beginning of second quarter. And so that's factored into the full year revenue outlook, and therefore, the growth that comes along with it.

今年要考慮的第二件事是，正如我們去年推出的那樣，當我們在銷售中預訂業務時，始終存在這些銷售何時上線並產生收入的時間問題。從去年開始，我們確實獲得了大量的年內收入。我們確實有一些不會在一月開始，但實際上會在第一季末、第二季初開始。因此，這已納入全年收入前景以及隨之而來的成長中。

We do think that Chronic Care revenue will continue to be the driver of higher levels of growth in Integrated Care, especially as you consider it relative to that very stable book of virtual care revenue. The good news about that is, it provides us the base into which we sell. And as you pointed out, we do see more and more bundled programs being sold. As we talked about at your conference actually, when we sell a bundle of services, we tend to get higher revenue but lower revenue per member than when we sell individual products. So we get higher revenue per client for the entire population, but lower revenue per member than when we sell on sort of an a la carte basis, so to speak. When you put all of that together, we feel good about the multiyear outlook of Chronic Care and international for that matter, being drivers of our Integrated Care revenue growth.

我們確實認為，慢性護理收入將繼續成為綜合護理更高水準成長的驅動力，特別是當你考慮到它相對於非常穩定的虛擬護理收入時。好消息是，它為我們提供了銷售基礎。正如您所指出的，我們確實看到越來越多的捆綁程序正在銷售。正如我們在您的會議上實際上談到的那樣，當我們銷售捆綁服務時，我們往往會獲得更高的收入，但與銷售單一產品相比，每位會員的收入會更低。因此，與我們按點菜銷售相比，我們為整個人群的每個客戶帶來了更高的收入，但每個會員的收入卻較低。當你把所有這些放在一起時，我們對長期照護和國際的多年前景感到樂觀，因為它們是我們綜合護理收入成長的驅動力。

The next question comes from the line of Stephanie Davis with Barclays.

下一個問題來自巴克萊銀行的史蒂芬妮戴維斯。

I was hoping you could talk me through some of your assumptions getting to the BetterHelp outlook. What improves the underlying assumptions to get to the back half ramp? Is there any color you can provide around the tear gearing yields and if it's improved? And just in general, how much risk is baked into the outlook, such as macro resumption?

我希望您能跟我談談您對 BetterHelp 前景的一些假設。是什麼改進了到達後半坡道的基本假設？您是否可以提供有關撕裂齒輪產量的任何顏色以及是否有所改善？總的來說，前景中有多少風險，例如宏觀經濟復甦？

So Stephanie, I'll start and then Mala can go deeper. On BetterHelp, if you think back to our third quarter earnings call, we talked about how customer acquisition cost trends in the direct-to-consumer market would result in BetterHelp growth in the lower half of our guidance range. Our original '23 outlook called for double-digit to mid-teens growth for BetterHelp, that range assumed some deterioration at the low end of the range and some improvement at the high end of the range. BetterHelp ended up growing just over 11% for the full year. So it was in the lower part of our guidance range.

史蒂芬妮，我先開始，然後馬拉可以更深入。在 BetterHelp 上，如果您回想一下我們第三季的財報電話會議，我們討論了直接面向消費者市場的客戶獲取成本趨勢將如何導致 BetterHelp 的成長達到我們指導範圍的下半部分。我們最初的 23 年展望要求 BetterHelp 實現兩位數到中位數的成長，該範圍假設該範圍的低端有所惡化，而該範圍的高端有所改善。 BetterHelp 最終全年成長略高於 11%。所以它位於我們指導範圍的較低部分。

What drove that was weaker customer acquisition trends in the second half of the year. There are a bunch of factors that go into that. In particular, we saw pressure on our customer acquisition costs in social media channels. We're fortunate, I guess the good part is, we have a diversified set of channels and the higher overall spend levels as we get to higher levels, the more we press on sort of across all of those channels. So we felt the impact of that in the second half of the year. As we made our outlook for this year in 2024, the assumption is that those higher levels of customer acquisition costs persist. We do think that we'll start to get a benefit in the back half of the year from some of our international markets as we shift dollars into those international markets, which we've seen good results, but at a limited scale thus far.

造成這種情況的原因是下半年客戶獲取趨勢疲軟。這有很多因素。特別是，我們在社群媒體管道中看到了客戶獲取成本的壓力。我們很幸運，我想好的部分是，我們擁有多元化的管道，當我們達到更高的水平時，整體支出水平越高，我們在所有這些管道上的壓力就越大。所以我們在下半年感受到了它的影響。當我們對 2024 年做出展望時，我們的假設是客戶獲取成本的較高水準持續存在。我們確實認為，隨著我們將美元轉移到這些國際市場，我們將在今年下半年開始從一些國際市場中受益，我們已經看到了良好的結果，但迄今為止規模有限。

The customer acquisition costs tend to be lower in the international markets. Although the gross -- the cost of goods sold tends to be slightly higher. And if you balance those two things, they end up at roughly the same net margin as our domestic business.

國際市場的客戶獲取成本往往較低。儘管銷售商品的總成本往往略高。如果你平衡這兩件事，它們最終的淨利潤率與我們國內業務的淨利潤率大致相同。

So when we look at the range for our outlook, it sort of brackets that current outlook, meaning if you extend the current situation forward, the lower end of the guidance assumes that there is some deterioration. The higher end of the guidance assumes some improvement.

因此，當我們審視前景的範圍時，它有點將當前的前景放在括號中，這意味著如果您將當前的情況向前延伸，則指導的下限假設存在一些惡化。指導的高端假設有一些改進。

Yes. I think you've covered most of it, Jason. What I would say, Stephanie, is we believe we have taken a measured approach to our guidance by assuming that the levels of cost per acquisition trends continue as we saw in the back half, and frankly, as we are continuing to see in the first quarter of this year. So as Jason said, if you think about the range we have provided, at the high end of the guidance range, we assume some improvement in customer acquisition trends in the second half and at the low end of the range, we assume some deterioration in those trends.

是的。我想你已經涵蓋了大部分內容，傑森。史蒂芬妮，我想說的是，我們相信我們已經對我們的指導採取了謹慎的方法，假設每次收購成本的趨勢水平繼續如我們在後半段看到的那樣，坦率地說，正如我們在上半年繼續看到的今年季度。因此，正如傑森所說，如果你考慮我們提供的範圍，在指導範圍的高端，我們假設下半年客戶獲取趨勢有所改善，而在範圍的低端，我們假設客戶獲取趨勢有所惡化。那些趨勢。

And as we said in our prepared remarks, if you sort of take a step back and just think about the BetterHelp business, what I would also say is, with our increased focus of -- on profitable growth, our -- the BetterHelp businesses new member acquisition is somewhat gated by the amount of capital we can deploy at what we would consider to be acceptable rates of return during any given period. So what that means is that the growth in BetterHelp is in part dependent on our ability to efficiently reach new individuals to create awareness for BetterHelp's products and services. So it is both, I would say, the cost per acquisition trends that we are seeing that we have factored into our business -- into our guidance and a continuing theme of how we are balancing top line growth with profitability in this business.

正如我們在準備好的演講中所說，如果您退後一步，只考慮 BetterHelp 業務，我還要說的是，隨著我們對盈利增長的日益關注，我們的 BetterHelp 業務新會員的獲取在某種程度上受到我們在任何特定時期內可以以我們認為可接受的回報率部署的資本數額的限制。因此，這意味著 BetterHelp 的成長部分取決於我們有效接觸新人以提高人們對 BetterHelp 產品和服務的認識的能力。因此，我想說，我們已經將每次收購成本趨勢納入了我們的業務——我們的指導方針，以及我們如何平衡該業務的營收成長和獲利能力的持續主題。

And it's probably evident from our comments, but it's worth calling out that with pressure on customer acquisition costs in the back half of '23, the second half of '24 will be comped against that. And so it actually has a -- the first half has a more challenging comp. The back half has a lower bar.

從我們的評論中可能可以明顯看出這一點，但值得指出的是，由於 23 年下半年客戶獲取成本面臨壓力，24 年下半年將面臨這種壓力。所以它實際上有一個——上半場有一個更具挑戰性的比賽。後半部有一個較低的欄位。

The next question comes from Jailendra Singh with Truist Securities.

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

This is Jailendra Singh from Truist. So just wanted to follow up on the question on the efficiency program, like $35 million benefit in EBITDA. It seems more than half of that is coming in Q4. Can you help us better understand why benefit from this program is more second half loaded? Are you expecting any benefit in Q1? And how is this benefit spread across two segments?

我是來自 Truist 的 Jailendra Singh。所以我只想跟進有關效率計劃的問題，例如 EBITDA 的 3500 萬美元收益。似乎其中一半以上將在第四季實現。您能否幫助我們更好地理解為什麼從這個程式中受益更多的是後半部分加載？您預計第一季會有什麼好處嗎？這種好處如何分佈在兩個細分市場？

So I would say on your second question, Jailendra, most of the benefit of these cost efficiency and cost takeout programs is really on the Integrated Care side. As we said in our prepared remarks, the Integrated Care side is where we will see more of margin expansion as we go through the year. We can drive more operating expense leverage on the Integrated Care side of the house.

所以我想說，關於你的第二個問題，Jailendra，這些成本效率和成本削減計劃的大部分好處實際上是在綜合護理方面。正如我們在準備好的發言中所說，今年我們將在綜合護理方面看到更多的利潤擴張。我們可以在綜合護理方面推動更多的營運費用槓桿。

And I would say in terms of the -- how the $35 million of benefit accrue this year on an adjusted EBITDA basis of $43 million, obviously, on a GAAP basis. Look, we are taking -- we are doing initiatives across a number of different areas, whether it be organizational improvements, including things like offshoring, whether it be productivity initiatives including automation or whether it be third-party supplier spend. So I wouldn't say that these benefits are back-end loaded into one particular quarter, we will see them ramp through the year.

我想說的是，今年 3500 萬美元的福利是如何在 4300 萬美元的調整後 EBITDA 基礎上累積的，顯然是按照 GAAP 基礎計算的。看，我們正在許多不同領域採取舉措，無論是組織改進，包括離岸外包，無論是包括自動化在內的生產力舉措，還是第三方供應商支出。因此，我不會說這些好處是後端加載到某個特定季度的，我們將看到它們在全年中不斷增加。

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

下一個問題來自 Richard Close 與 Canaccord Genuity 的對話。

I appreciate the details on the delayed enrollment engagement or marketing on the Chronic Care that you talked about and the financial impact there. But can you provide more details exactly what that was? Was that on the customer side or your side? And if it was on your side, how do you get comfortable that that's not going to happen again?

我很欣賞您談到的慢性病護理延遲註冊參與或行銷的詳細資訊以及那裡的財務影響。但你能提供更多詳細資訊嗎？是在客戶這邊還是您這邊？如果是在你這邊，你如何放心這種情況不會再發生？

We had record client implementations for January 2024. And like all health care companies who deal with eligibility files, these implementations come with just an inherent amount of complexity. In January, we discovered an issue in mapping data for some of these implementations. The number of affected members turned out to be actually very small. But with a record number of implementations happening at the same time, out of abundance of caution, we halted member communications while we diagnosed and resolved the issue. The delayed consumer -- this delayed our consumer engagement marketing by about 3 to 4 weeks and pushes out the enrollment curve for primarily our Chronic Care programs. And so as we said, we anticipate that, that delay ends up sort of rippling through by shifting out the curve to the tune of about $20 million for the full year.

我們在 2024 年 1 月的客戶實施情況創下了記錄。與所有處理資格文件的醫療保健公司一樣，這些實施也具有一定的複雜性。一月份，我們發現其中一些實作的映射資料有問題。事實證明，受影響的成員數量實際上非常少。但由於同時發生的實施數量創歷史新高，出於謹慎考慮，我們在診斷和解決問題時停止了成員通信。延遲的消費者——這使我們的消費者參與行銷延遲了大約 3 到 4 週，並推遲了我們主要慢性病護理計畫的註冊曲線。因此，正如我們所說，我們預計，這種延遲最終會透過將全年的曲線移至約 2000 萬美元來產生連鎖反應。

We've restarted the marketing engine, and we've seen absolutely no new issues. So we're confident that the issue is completely behind us. What I would say is that it was our caution in making sure that we had the full diagnosis and scope of the issue and the affected population identified before we turned our marketing campaigns back on. And as it turns out, the scale of the affected members was actually very small. So we're confident that we have it behind us. We have clearly identified the source of the issue and actually the scale of the issue was very, very small.

我們已經重新啟動了行銷引擎，並且絕對沒有看到新問題。所以我們相信這個問題已經完全過去了。我想說的是，在我們重新啟動行銷活動之前，我們謹慎地確保我們對問題進行了全面的診斷和範圍，並確定了受影響的人群。而事實證明，受影響的會員規模其實很小。所以我們有信心我們已經成功了。我們已經明確了問題的根源，實際上問題的規模非常非常小。

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

下一個問題來自傑西卡·塔桑和派珀·桑德勒的對話。

Thank you for the detail on the reporting guide. I guess maybe just in terms of ad yield on BetterHelp, I'm curious to understand maybe when you all first observe the declining ad yield in BetterHelp and just kind of whether it got worse over the course of 2023. And any update on what you've observed on year-to-date in 2024?

感謝您提供報告指南的詳細資訊。我想也許只是就 BetterHelp 上的廣告收益而言，我很想知道也許當你們第一次觀察到 BetterHelp 上的廣告收益下降時，以及它在 2023 年是否變得更糟。以及關於你的任何更新2024 年至今已觀察到什麼？

We had actually started observing the yields coming in lower than we had expected in the back half of the year. We actually had talked about it in the October third quarter earnings call, right? We had talked about the fact that last year, when we had initially given the range, we were talking about coming in at the low end of the range if we see the yields start deteriorating, being at the high end of the range if we saw improvement, and we had talked about the fact that we -- the yields are starting to come -- are lower in the back half of the year.

事實上，我們在今年下半年開始觀察到收益率低於我們的預期。我們實際上在 10 月的第三季財報電話會議上討論過這個問題，對吧？我們曾討論過這樣一個事實，去年，當我們最初給出範圍時，我們討論的是，如果我們看到收益率開始惡化，我們就會進入該範圍的低端，如果我們看到收益率開始惡化，我們將進入該範圍的高端。我們談到了這樣一個事實：今年下半年我們的收益率開始下降。

So as we said a few minutes ago, we have sort of kept watch over those trends. They have persisted through the back half of the year. They are still persisting and that is the reason why we have factored that into the guidance.

正如我們幾分鐘前所說，我們一直在關注這些趨勢。他們已經堅持了今年下半年。他們仍然堅持不懈，這就是我們將其納入指導的原因。

And as Jason said, we expect to comp that in the second half of the year, the comps get easier in the second half of the year. Having said that, that's the reason we are providing the range that we are providing. Again, similar to last year, what we would say is the high end of the range assumes improvement. The low end of the range assumes a deterioration.

正如傑森所說，我們預計在下半年進行比較，下半年的比較會變得更容易。話雖如此，這就是我們提供我們所提供的範圍的原因。同樣，與去年類似，我們想說的是，該範圍的高端假設有所改善。該範圍的低端假設惡化。

I mean, generally see improvement in January -- Jess, we generally see improvement in January. And so we monitored closely as we were going through the January time frame. And we saw them stubbornly -- especially in those channels, stubbornly higher. And so we're using that as the basis for our guidance going forward.

我的意思是，通常會在一月份看到進步 - 傑西，我們通常會在一月份看到進步。因此，我們在一月份的時間範圍內密切監控。我們頑固地看到它們——尤其是在那些管道中，頑固地走高。因此，我們將其作為我們未來指導的基礎。

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

下一個問題來自 Charles Rhyee 和 TD Cowen 的對話。

Jason, I want to go back to Innovative Care real quick. And you made mention that 16% of the general medical base has -- is one or more of the Chronic Care products and that's up from 12%, I think you said over the last few years. You also may mention that 75% of your sales are from existing clients. Can you talk a little bit about what that -- what the sales pipeline looks like? And like how often are these clients coming up for potential cross-sell. And I guess the question is, how often is it that people are just choosing not to make a decision? Because it seems like you would have a large base to be selling into, but given sort of the growth rates you're talking about, it's sort of a slow gradual improvement over time. Just trying to understand the dynamics of decision-making among clients to add Chronic Care if they don't have it already.

傑森，我想盡快回到創新護理。您提到 16% 的普通醫療基礎是一種或多種慢性護理產品，我想您在過去幾年中說過，這一比例高於 12%。您也可能會提到，您 75% 的銷售額來自現有客戶。能談談銷售通路是什麼樣的嗎？以及這些客戶進行潛在交叉銷售的頻率。我想問題是，人們有多少時候選擇不做決定？因為看起來你會有一個很大的銷售基礎，但考慮到你所說的成長率，隨著時間的推移，這是一個緩慢的逐步改善。只是想了解客戶決策的動態，以增加慢性護理（如果他們還沒有）。

I'll try to answer as many of the dimensions of that question as I can. With respect to the pipeline, we're really early in the year. And generally, what happens is we sell through the pipeline toward the end of the year. And at this point of the year, we're refreshing it. That's exactly what's happening now. So I'll reserve commentary on sort of what the pipeline looks like until later in the year when it refills and we're looking at our significant selling season sort of bolus.

我將嘗試盡可能多地回答該問題的各個方面。就管道而言，我們確實處於今年初期。一般來說，我們會在年底前透過管道進行銷售。在今年的這個時候，我們正在刷新它。這正是現在正在發生的事情。因此，我將對管道的情況保留評論，直到今年晚些時候管道重新裝滿，我們才會考慮我們重要的銷售季節的補充。

With respect to the dynamics of our client base, our sales force is broken into -- split into essentially new business reps who are out trying to sign new clients who don't have a relationship with Teladoc Health and account managers and essentially upsellers whose job is to go build our base with our existing customers.

就我們客戶群的動態而言，我們的銷售團隊被分成了幾部分——本質上是新的業務代表，他們試圖簽下與Teladoc Health 沒有關係的新客戶，以及客戶經理和本質上是其工作的追加銷售人員。就是與我們現有的客戶一起建立我們的基礎。

When we think about selling into new clients, there are essentially two dimensions of that. One is selling more products into the same population. The second is selling products into new populations within that client. That tends to happen mostly within health plans as we go into new geographies, new lines of business, such as managed Medicaid or Medicare Advantage, and we expand the population that we serve. So you're really asking, I think, mostly about that first one of selling into new clients or into existing clients, which is upselling additional products.

當我們考慮向新客戶銷售時，本質上有兩個面向。一是向同一人群銷售更多產品。第二個是將產品銷售給該客戶的新人。當我們進入新的地區、新的業務領域（例如託管醫療補助或醫療保險優勢）以及擴大我們服務的人口時，這種情況往往主要發生在健康計劃內。所以我認為，你真正問的主要是關於向新客戶或現有客戶銷售的第一個，即追加銷售額外的產品。

We're constantly working through that. And I would say the adoption for Chronic Care programs goes through an evolution. Some of those clients have other solutions that they bought previously and it's a replacement business for us. Equally as frequently we're going in with our suite of Chronic Care solutions where they don't have one in place. And so that is an evolutionary sale. It certainly doesn't happen all at once. So I wouldn't expect us to all of a sudden go from 16% to 30% or 40% penetration. We are working on solutions like our bundling structures in order to accelerate the penetration. But right now, we guide based on what we know and what our existing trends are.

我們一直在努力解決這個問題。我想說的是，慢性病照護計畫的採用經歷了一個演變。其中一些客戶之前購買了其他解決方案，這對我們來說是替代業務。同樣，我們經常使用一套慢性病照護解決方案，而他們卻沒有一套解決方案。所以這是一次漸進式的銷售。這當然不會一下子發生。所以我不認為我們的滲透率會突然從 16% 上升到 30% 或 40%。我們正在研究捆綁結構等解決方案，以加速滲透。但現在，我們根據我們所知道的和現有的趨勢進行指導。

So as we see breakthroughs to the degree that we see breakthroughs in our ability to more rapidly penetrate our book of business, we'll update our guidance. But our guidance right now is based on the progress that we're making and our outlook based on what we know, not based on any breakthroughs that we haven't yet identified.

因此，當我們看到突破達到我們更快滲透業務的能力的突破時，我們將更新我們的指導。但我們現在的指導是基於我們正在取得的進展和基於我們所知道的前景的展望，而不是基於我們尚未確定的任何突破。

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

下一個問題來自喬治·希爾與德意志銀行的對話。

I'll try to be efficient with my questions here. And I guess my first one, Mala, is on the cost savings program, which is you guys are targeting 50 to 100 basis points of margin expansion per year, but the cost savings programs alone should give you almost 150 basis points margin expansion in '24 and over [325 basis points]. So I guess I'd ask you what are the offsets in the underlying business through eroding where the cost savings programs don't give you more margin expansion?

我會盡力在這裡有效率地回答我的問題。我想我的第一個目標是成本節約計劃，即你們的目標是每年 50 到 100 個基點的利潤擴張，但僅成本節約計劃就應該為你們提供近 150 個基點的利潤擴張。24 及以上 [ 325 個基點]。所以我想我會問你，在成本節約計畫不能為你帶來更多利潤擴張的情況下，透過侵蝕，基礎業務的抵銷是什麼？

So if you just think about 2024 as we have said, we've talked about our guidance of $350 million to $390 million in adjusted EBITDA, that includes the $35 million of cost savings that we have talked about. The reality is, if you think about the way the margins we expect in 2024, the margins to play out, we are seeing some modest pressure on our gross margin line from higher clinical costs, and that's primarily associated with the expected ramping up in Primary360 volumes. We added about $30 million in Primary360 revenue over the course of '23, and that was a very, very significant increase in revenue for P360. And we expect visit volume from those members to continue to ramp up through 2024. And so that ramp will create some modest pressure on gross margins this year relative to 2023.

因此，如果您像我們所說的那樣考慮 2024 年，我們已經談到了調整後 EBITDA 3.5 億至 3.9 億美元的指導，其中包括我們談到的 3500 萬美元的成本節約。現實情況是，如果你考慮我們對2024 年利潤率的預期，即利潤率的發揮方式，我們會發現臨床成本上升對我們的毛利率線造成了一些適度的壓力，這主要與Primary360 的預期增長有關卷。在 2023 年期間，Primary360 的收入增加了約 3000 萬美元，這對於 P360 來說是非常非常顯著的收入成長。我們預計這些會員的訪問量將在 2024 年繼續增加。因此，相對於 2023 年，這種增加將對今年的毛利率造成一定的壓力。

Now that variance, that delta is being offset by leverage from operating expenses and in particular, as we said in our prepared remarks, technology and development and G&A. So that's sort of the way the sort of the margin structure is feathering through the whole P&L.

現在，這種差異，即三角洲正在被營運費用的槓桿所抵消，特別是，正如我們在準備好的評論中所說，技術和開發以及一般管理費用。這就是保證金結構貫穿整個損益表的方式。

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

下一個問題來自加拿大皇家銀行資本市場部的 Sean Dodge。

Last quarter, along with the operational review, you also talked about undertaking a portfolio assessment. Is there any update you can share on that? Are there any portfolio actions in the savings you laid out from the efficiency program? Or would those be incremental? And then maybe if you could give us some sense of what a portfolio assessment may involve? Are there particular geographies, markets, books of businesses that just don't make sense to be in anymore?

上個季度，除了營運審查之外，您還談到了進行投資組合評估。有什麼更新可以分享嗎？您從效率計畫中節省的資金中是否有任何投資組合行動？或者這些會是增量的嗎？那麼您能否讓我們了解投資組合評估可能涉及哪些內容？是否有一些特定的地區、市場、企業名錄已經不再存在了？

So I'll start by saying there are no significant portfolio changes contemplated in our guidance anything that we would do would be incremental to that. When we talk about doing a portfolio assessment, it really is looking across the business for two dimensions. One, what's the profitability and growth outlook for the various customer channels and segments, products within our portfolio, geographies, et cetera. And then second is where do we place investments. So where do we get the greatest yield on investing our dollars, especially in technology and development and advertising and marketing. So I think that's what's involved in it. If we have any significant actions, obviously, we'll announce it. A lot of it, quite frankly, is fine-tuning. Sometimes it's fine-tuning pricing. Sometimes it's fine-tuning go-to-market strategy. Sometimes it's fine-tuning service model and service intensity to make sure that we are optimizing our resource allocation versus the profitability of a given customer segment or products.

因此，我首先要說的是，我們的指導中沒有考慮重大的投資組合變化，我們所做的任何事情都將是增量。當我們談論進行投資組合評估時，它實際上是在整個業務中尋找兩個維度。第一，各種客戶通路和細分市場、我們的產品組合、地理位置等的獲利能力和成長前景如何。其次是我們在哪裡投資。那麼，我們在哪裡投資以獲得最大的收益，特別是在技術和開發以及廣告和行銷方面。所以我認為這就是其中涉及的內容。如果我們有任何重大行動，顯然我們會宣布。坦白說，其中很多都是微調。有時是微調定價。有時是微調進入市場策略。有時，需要微調服務模式和服務強度，以確保我們根據給定客戶群或產品的獲利能力來優化資源分配。

Yes, I would say -- I would add, Sean, look, as we look at our both top line growth as well as bottom line profitability, we have set expectations for the next few years, we'll continue to look at the various pieces of our business how they contribute to both top line growth as well as bottom line profitability. And so that's a review that is ongoing. We will continue to look at that.

是的，我想說 - 我想補充一點，肖恩，你看，當我們審視我們的營收成長和盈利能力時，我們已經設定了未來幾年的預期，我們將繼續關注各種我們業務的各個部分如何為營收成長和獲利能力做出貢獻。因此，這項審查正在進行中。我們將繼續關注這一點。

And as Jason said, we are judicious in the investments we make, we have talked about getting leverage from technology and development and G&A. That said, we are also going to continue to invest robustly in the business, whether it be in terms of product, data, data science. And so in order for us to fuel those investments and the investment capacity, the responsible thing for us to do is to just continue to look at all parts of our business in terms of how they are contributing to both top line as well as bottom line.

正如傑森所說，我們在投資方面是明智的，我們已經討論過從技術和開發以及一般管理費用中獲得槓桿作用。也就是說，我們也將繼續對業務進行大力投資，無論是在產品、數據或數據科學方面。因此，為了推動這些投資和投資能力，我們要做的負責任的事情就是繼續審視我們業務的所有部分，看看它們如何為營收和利潤做出貢獻。

The next question comes 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·布萊爾的對話。

Maybe a little bit of a different line of questioning. I'm just curious in regards to capital deployment. You clearly have a lot of cash. You mentioned maybe a repo, but more curious about the overall capital structure and how you view it. I know you have some of the Livongo converts of about $550 million that will be concurrent in June and then a bigger convert a couple of years after that. So how are you thinking about potential refi or use of cash to pay that down over the coming quarters?

也許有一點不同的提問方式。我只是對資本部署感到好奇。顯然你有很多現金。您提到了可能是一個回購協議，但更好奇的是整體資本結構以及您如何看待它。我知道你有一些大約 5.5 億美元的 Livongo 轉換者將在 6 月同時進行，然後幾年後會有更大的轉換。那麼，您如何考慮未來幾季可能的再融資或使用現金來償還債務？

Thanks for that question. Listen, as I step back and take a look at our capital structure, we are -- we have the flexibility with the [$1.1 billion] cash that we have on our balance sheet and the fact that we generated strong free cash flow last year. We expect to continue to generate strong free cash flow this year. So that will certainly strengthen our balance sheet even more.

謝謝你提出這個問題。聽著，當我退後一步看看我們的資本結構時，我們——我們的資產負債表上擁有[11億美元]現金，而且我們去年產生了強勁的自由現金流，因此我們具有靈活性。我們預計今年將持續產生強勁的自由現金流。因此，這肯定會進一步增強我們的資產負債表。

If I think about the uses of cash, I would say the way I would prioritize it is, as we said, first, what are the interesting M&A opportunities that are out there that we could use our balance sheet for. Obviously, as always, those M&A opportunities need to meet the criteria that we set for ourselves, right, whether they make strategic sense for us or whether they are financially attractive. But I would expect to use the strength of our balance sheet towards the right M&A opportunities.

如果我考慮現金的使用，我會說我優先考慮的方式是，正如我們所說，首先，我們可以利用我們的資產負債表來實現哪些有趣的併購機會。顯然，一如既往，這些併購機會需要滿足我們為自己設定的標準，對吧，無論它們對我們是否具有戰略意義，或者是否具有財務吸引力。但我希望利用我們資產負債表的優勢來尋找正確的併購機會。

And then I would use our cash to pay down to retire the debt specifically, you mentioned the Livongo convert, which is due in the middle of 2025. I would look to pay that convert down. We still have some time and flexibility for the $1 billion convert that is maturing in 2027.

然後我會用我們的現金來償還債務，具體來說，你提到了 Livongo 轉換，該轉換將於 2025 年中期到期。我希望償還該轉換。對於 2027 年到期的 10 億美元轉換，我們仍然有一些時間和靈活性。

And then last is, as we said, to the extent that we have even more flexibility on the balance sheet, opportunistically, strategically think about share buybacks. Share buybacks in general and to think about over the longer term to offset the potential dilution from employee stock grants. So I would think about it in those -- sort of in those different ways.

最後，正如我們所說，我們在資產負債表上擁有更大的彈性，機會主義地、策略性地考慮股票回購。一般性的股票回購，並從長遠考慮，以抵消員工股票授予的潛在稀釋效果。所以我會以不同的方式來思考這個問題。

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

下一個問題來自花旗集團的 Daniel Grosslight。

I want to go back to the BetterHelp marketing yield here. I was wondering if you could provide a little more detail on why those marketing yields remain depressed? Are consumers being a little more discerning? Are you seeing more competition from other DTC vendors? Is there another big vendor out there that's spending like you saw in '22? Any additional detail there would be very helpful.

我想回到這裡的 BetterHelp 行銷收益。我想知道您是否可以提供更多細節來說明為什麼這些行銷收益仍然低迷？消費者變得更加挑剔？您是否看到其他 DTC 供應商的更多競爭？是否還有其他大供應商的支出與您在 22 年看到的一樣？任何額外的細節都會非常有幫助。

So it's -- the answer to the second part of the question is we don't see a significant competitor driving up the rates. We do see a lot of advertisers in general going after a similar population. So I wouldn't say that it's a single competitor as opposed to the overall traffic in the ad space, so to speak.

因此，問題第二部分的答案是，我們沒有看到重要的競爭對手提高費率。我們確實看到很多廣告商總體上都在追求類似的人群。所以我不會說它是一個單一的競爭對手，而不是廣告空間的整體流量。

And then maybe the last thing I'll say is that we do see it certainly more as we spend more, right? So as we increase our ad spend, we're constantly looking at the marginal return on the -- on each incremental dollar. And so we work hard to make sure that each incremental dollar is productive for us. And to the degree that we see the curve get to an inflection where we run out of room on where we can spend that money productively then we pull back rather than chasing growth at the expense of profitability. So I think those are the major contributors to it.

也許我要說的最後一件事是，隨著我們花更多的錢，我們確實會看到更多，對吧？因此，當我們增加廣告支出時，我們會不斷關注每增加一美元的邊際回報。因此，我們努力確保每增加一美元都能為我們帶來好處。當我們看到曲線出現轉折點時，我們已經沒有足夠的空間來有效地花錢，那麼我們就會撤退，而不是以犧牲盈利能力為代價來追求成長。所以我認為這些都是其主要貢獻者。

Thank you. There are no additional questions left at this time. That concludes today's conference call. Thank you. You may now disconnect your lines.

謝謝。目前沒有其他問題。今天的電話會議到此結束。謝謝。現在您可以斷開線路。