Teladoc Health Inc (TDOC) 2020 Q1 法說會逐字稿

Welcome to Teladoc Health's First Quarter 2020 Earnings Conference Call and Webcast. (Operator Instructions) It is now my pleasure to turn the floor over to Patrick Feeley, Vice President of Investor Relations. You may begin.

歡迎來到 Teladoc Health 的 2020 年第一季度收益電話會議和網絡廣播。 （操作員說明）現在我很高興將發言權交給投資者關係副總裁 Patrick Feeley。你可以開始了。

Thank you and good afternoon. Today after the market closed, we issued a press release announcing our first quarter 2020 financial results. This press release is available in the Investor Relations section of the teladochealth.com website.

謝謝，下午好。今天收市後，我們發布了一份新聞稿，宣布了我們 2020 年第一季度的財務業績。本新聞稿可在 teladochealth.com 網站的投資者關係部分獲取。

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

我們的首席執行官 Jason Gorevic 參加了這次討論結果的電話會議；和我們的首席財務官 Mala Murthy。

During this call, we will also provide an update to our forward outlook, and our prepared remarks will be followed by a question-and-answer session.

在此電話會議期間，我們還將更新我們的前瞻性展望，我們準備好的評論之後將進行問答環節。

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.

請注意，我們將討論某些我們認為對評估 Teladoc Health 的業績很重要的非 GAAP 財務指標。有關這些非 GAAP 措施與最具可比性的 GAAP 措施及其調節之間關係的詳細信息，請參閱我們網站上發布的新聞稿。

Also, please note that certain statements made during this call will be forward-looking statements as defined by the Private Securities Litigation Reform Act of 1995. Such forward-looking statements are subject to risks, uncertainties and other factors that could cause the actual results for Teladoc Health to differ materially from those expressed or implied on this call.

此外，請注意，本次電話會議期間作出的某些陳述將是 1995 年《私人證券訴訟改革法案》所定義的前瞻性陳述。此類前瞻性陳述受風險、不確定性和其他因素的影響，這些因素可能導致實際結果Teladoc Health 與本次電話會議中明示或暗示的內容存在重大差異。

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.

有關更多信息，請參閱我們在新聞稿中的警告聲明和我們向美國證券交易委員會提交的文件，所有這些都可以在我們的網站上找到。

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

我現在想把電話轉給傑森。

Thanks, Patrick, and thank you, everyone, for joining us this afternoon. I want to start by taking this opportunity to thank all of our team members and caregivers around the world for the critical role they are playing in supporting, enabling and delivering care during this time of need.

謝謝帕特里克，也謝謝大家今天下午加入我們。首先，我想藉此機會感謝我們在世界各地的所有團隊成員和護理人員，感謝他們在這個需要幫助的時刻在支持、實現和提供護理方面發揮的關鍵作用。

At our Investor Day back on March 5, we spoke of the importance of our shared values. The last several weeks have demonstrated just how committed our team members are to living those values. I've been consistently impressed by their passion for taking care of people, their commitment to quality and their willingness to rise to the challenge on behalf of our clients and members.

在 3 月 5 日的投資者日，我們談到了共同價值觀的重要性。過去幾週證明了我們的團隊成員對踐行這些價值觀的承諾。他們對人的熱情、對質量的承諾以及代表我們的客戶和會員迎接挑戰的意願一直給我留下深刻印象。

Over 90% of our workforce continues to work from home, although our team members in China and Spain are slowly beginning to return to the office as restrictions in those countries are eased.

我們超過 90% 的員工繼續在家工作，儘管隨著這些國家/地區的限制放寬，我們在中國和西班牙的團隊成員正慢慢開始返回辦公室。

After the market closed, Teladoc Health reported strong revenue outperformance in the first quarter of 2020, driven by broad-based momentum across the business and a sharp acceleration in visit volume growth. Total revenue in the quarter grew 41% over the prior year to approximately $181 million. As a result of the increased demand for our services from clients and consumers, we are significantly raising forward guidance, including full year revenue guidance of $800 million to $825 million, representing an increase of over $100 million relative to our prior range.

市場收盤後，Teladoc Health 報告稱，在整個業務的廣泛勢頭和訪問量增長急劇加速的推動下，Teladoc Health 在 2020 年第一季度的收入表現強勁。本季度總收入比上年同期增長 41%，達到約 1.81 億美元。由於客戶和消費者對我們服務的需求增加，我們顯著提高了前瞻性指引，包括 8 億美元至 8.25 億美元的全年收入指引，比我們之前的範圍增加了 1 億多美元。

We are playing a critical role during the global outbreak of COVID-19 and have seen a significant increase in inquiries from both existing and new potential clients. Our clients are turning to us to expand our service offering to new populations and add new products during this time of need. Requests from new potential clients are increasing as the outbreak of COVID-19 has highlighted the value of access to a comprehensive virtual health care solution.

在 COVID-19 全球爆發期間，我們發揮著關鍵作用，現有和新的潛在客戶的諮詢量顯著增加。我們的客戶正在求助於我們，希望我們能在這個需要的時候將我們的服務範圍擴大到新人群並增加新產品。隨著 COVID-19 的爆發凸顯了獲得綜合虛擬醫療保健解決方案的價值，來自新潛在客戶的請求也在增加。

During the first quarter alone, we onboarded over 6 million new paid members in the U.S. across government and commercial populations. And we anticipate onboarding an additional 6 million to 7 million new members during the second quarter, culminating in the strongest first half membership growth in company history.

僅在第一季度，我們就在美國招募了超過 600 萬政府和商業人群的新付費會員。我們預計第二季度將新增 600 萬至 700 萬新會員，最終實現公司歷史上最強勁的上半年會員增長。

As discussed on our business update call 2 weeks ago, the remarkable growth across our platform has been enabled by the tremendous response on the part of our team members and physicians. We responded to the surge in demand by rapidly expanding the capacity of our physician network, including the onboarding of thousands of new providers, more than doubling the number of licensed physicians in our network. The investments in capacity made during the month of March have positioned us to meet the increased demand from existing members as well as the new members we are in the process of onboarding.

正如我們兩週前在業務更新電話會議上所討論的那樣，我們平台的顯著增長得益於我們團隊成員和醫生的巨大反應。我們通過迅速擴大醫生網絡的容量來應對需求的激增，包括招募了數千名新的提供者，使我們網絡中的執業醫師數量增加了一倍以上。 3 月份對容量的投資使我們能夠滿足現有成員以及我們正在入職的新成員不斷增長的需求。

Turning to visits. We crossed a new milestone as total visits exceeded 2 million in the first quarter, representing growth of nearly 90% as compared to the first quarter of 2019. This is particularly noteworthy as it comes just 12 months after crossing the 1 million visit per quarter mark in the first quarter of last year. While the first 2 months of the year were strong, visit volume accelerated significantly throughout March and into April as shelter-in-place orders began, $0 co-pays were implemented and brick-and-mortar facilities closed.

轉向訪問。我們跨越了一個新的里程碑，第一季度總訪問量超過 200 萬，與 2019 年第一季度相比增長了近 90%。這一點尤其值得注意，因為它距離每季度的訪問量突破 100 萬大關僅 12 個月在去年第一季度。雖然今年前 2 個月表現強勁，但隨著就地避難令開始實施、實施 0 美元共同支付以及實體設施關閉，整個 3 月和 4 月的訪問量顯著增加。

We are experiencing broad-based growth in visits across the portfolio as our diverse product offering has enabled us to step up and meet the varied health care needs of patients during the outbreak of COVID-19. While general medical visit growth has increased significantly, demand for specialist care, including behavioral health and dermatology, has accelerated even faster, reflecting the diverse nature of the need for care during this challenging time. The increased behavioral health adoption is particularly encouraging as it creates strong longitudinal relationships generating multiple visits over time, which will help drive visit volume through the rest of the year.

由於我們提供的多樣化產品使我們能夠在 COVID-19 爆發期間加強並滿足患者的各種醫療保健需求，因此我們的產品組合的訪問量正在廣泛增長。雖然一般就診人數顯著增加，但對專科護理（包括行為健康和皮膚病學）的需求增長更快，反映出在這個充滿挑戰的時期對護理需求的多樣性。行為健康采用率的提高尤其令人鼓舞，因為它建立了牢固的縱向關係，隨著時間的推移產生多次訪問，這將有助於在今年餘下時間推動訪問量。

We have also seen an increase in new users across the platform, with over 60% of visits coming from first-time users. This new user growth will have a lasting effect on utilization since member satisfaction levels are extremely strong, and our experience shows that when members use our service once, they are much more likely to use it again.

我們還看到整個平台的新用戶有所增加，超過 60% 的訪問來自新用戶。這種新用戶增長將對利用率產生持久影響，因為會員滿意度非常高，而且我們的經驗表明，當會員使用我們的服務一次後，他們再次使用它的可能性要大得多。

Importantly, new registrations increased 125% over the prior year, outpacing member growth as the outbreak of COVID-19 is driving awareness of virtual care among consumers. This significant increase in activation is particularly important to us as it feeds into the flywheel dynamic that is at the core of our member engagement efforts. Once an individual actively registers with us, it creates opportunities for our engagement team to reach that member and build a relationship. These engagement opportunities serve as the growth engine that drives visit growth and utilization within our populations. And the material growth in new activations we are currently experiencing will continue to benefit us into the future as consumers turn to Teladoc Health for more of their health care needs.

重要的是，新註冊人數比上一年增長了 125%，超過了會員增長，因為 COVID-19 的爆發正在推動消費者對虛擬護理的認識。這種激活的顯著增加對我們來說尤為重要，因為它可以提供飛輪動力，而飛輪動力是我們會員參與工作的核心。一旦有人主動向我們註冊，它就會為我們的參與團隊創造接觸該成員並建立關係的機會。這些參與機會是推動我們人口中訪問量增長和利用率的增長引擎。隨著消費者轉向 Teladoc Health 來滿足更多的醫療保健需求，我們目前正在經歷的新激活的物質增長將繼續使我們受益。

We're also seeing an encouraging demographic expansion in our user base. Visit growth rates among our younger cohorts in the range of 18 to 30 years old and among males have accelerated faster than the overall growth rates as we increasingly reach populations that have historically been lower utilizers of virtual care. Demand for our DTC mental health product, BetterHelp, help is also rapidly accelerating as conditions such as anxiety and depression are amplified by fear isolation and loneliness during the crisis. This increased utilization will continue to benefit us throughout the year given the high repeat usage profile of mental health services.

我們還看到用戶群的人口增長令人鼓舞。我們 18 至 30 歲的年輕人群和男性的訪問增長率比整體增長率更快，因為我們越來越多地接觸到歷來虛擬護理使用率較低的人群。對我們的 DTC 心理健康產品 BetterHelp 幫助的需求也在迅速增加，因為危機期間的恐懼孤立和孤獨加劇了焦慮和抑鬱等情況。鑑於心理健康服務的重複使用率很高，這種增加的使用率將在全年繼續使我們受益。

Provider interest in BetterHelp is also increasing. We added a record number of new active mental health providers during the quarter, and provider applications to deliver care to BetterHelp members have increased over 70% in just the last few months. This increased provider activity will allow us to meet the growing need for mental health services throughout the rest of the year.

提供商對 BetterHelp 的興趣也在增加。我們在本季度增加了創紀錄數量的新積極心理健康提供者，並且在過去幾個月中，向 BetterHelp 成員提供護理的提供者申請增加了 70% 以上。提供者活動的增加將使我們能夠在今年餘下的時間裡滿足對心理健康服務不斷增長的需求。

Similar to the impact on the health plan, employer and consumer channels, the COVID-19 outbreak is accelerating the adoption of virtual care among hospitals and physician groups. The Teladoc Health technology platform is enabling hundreds of hospitals and physician groups across the country to continue serving their patients, increasing flexibility and capacity while dramatically reducing physical exposure for both patients and physicians.

與對健康計劃、雇主和消費者渠道的影響類似，COVID-19 爆發正在加速醫院和醫生團體採用虛擬護理。 Teladoc Health 技術平台使全國數百家醫院和醫師團體能夠繼續為患者提供服務，提高靈活性和容量，同時顯著減少患者和醫生的身體接觸。

As virtual care becomes mainstream within the health care delivery system, we are seeing increased demand from new partners for our provider platform. This includes both the Teladoc Health technology platform as well as the InTouch Health offering, which, as you know, we have a commercial agreement in place to jointly sell the combined offering ahead of the transaction closing. We have now signed multiple new cross-sales, and the pipeline of new opportunities in the provider market for this industry-leading offering continues to grow.

隨著虛擬護理成為醫療保健提供系統中的主流，我們看到新合作夥伴對我們的提供商平台的需求不斷增加。這包括 Teladoc Health 技術平台和 InTouch Health 產品，如您所知，我們已達成商業協議，在交易完成前共同出售合併後的產品。我們現在已經簽署了多項新的交叉銷售協議，並且在供應商市場中為這一行業領先的產品提供的新機會管道繼續增長。

The broad-based demand we are seeing across distribution channels for our comprehensive product offering gives us confidence in the long-term growth opportunity for our business.

我們在各個分銷渠道中看到的對我們全面產品供應的廣泛需求使我們對我們業務的長期增長機會充滿信心。

Before I turn the call over to Mala to provide full details on quarterly performance and guidance, I would like to make a few comments on our approach to providing forward guidance this year. We know that many companies have withdrawn guidance given the uncertainty of both the expected path of the COVID outbreak as well as the broader economic impact of the pandemic. However, we felt it important to provide as much transparency as possible. Therefore, we are providing updated guidance based on what we know today.

在我將電話轉給 Mala 提供有關季度業績和指導的全部細節之前，我想就我們今年提供前瞻性指導的方法發表一些評論。我們知道，鑑於 COVID 爆發的預期路徑以及大流行的更廣泛經濟影響的不確定性，許多公司已經撤回了指引。但是，我們認為提供盡可能多的透明度很重要。因此，我們根據我們今天所知道的提供更新的指南。

Our guidance ranges assume the significant surge in visit volume that we are currently experiencing eases over the course of the next few months as $0 co-pays begin to expire and shelter-in-place orders are lifted. We expect volumes to settle in the second half of the year at a permanently higher level of utilization than pre-COVID levels as we benefit from increased consumer awareness and the impact of our engagement engine applied to newly activated and onboarded members.

我們的指導範圍假設，隨著 0 美元的共付額開始到期以及就地避難令取消，我們目前正在經歷的訪問量大幅激增在未來幾個月內會有所緩解。我們預計下半年的銷量將穩定在比 COVID 之前更高的利用率水平，因為我們受益於消費者意識的提高以及我們的參與引擎對新激活和入職會員的影響。

As the current path of the virus is unknown, our guidance ranges do not include an incremental increase in volume that could result from the virus reemerging in the fall with the same level of intensity we are currently experiencing. As such, should the virus return in the fall, particularly if it were in conjunction with the typical flu season, it could result in higher-than-expected visit volume and revenue growth.

由於病毒的當前路徑未知，我們的指導範圍不包括由於病毒在秋季以我們目前正在經歷的相同強度重新出現而導致的體積增量增加。因此，如果病毒在秋季捲土重來，特別是如果恰逢典型的流感季節，則可能會帶來高於預期的訪問量和收入增長。

Finally, our guidance ranges attempt to capture the potential impact of unemployment on the number of insured individuals based on the current macroeconomic outlook. But it remains to be seen how this unfolds.

最後，我們的指導範圍試圖根據當前的宏觀經濟前景捕捉失業對參保人數的潛在影響。但這將如何展開還有待觀察。

As this is an emerging situation, circumstances are likely to change in the coming weeks and months, but we believe our guidance ranges provide you with a reasonable baseline for 2020 results.

由於這是一種新興情況，未來幾周和幾個月內情況可能會發生變化，但我們相信我們的指導範圍為您提供了 2020 年業績的合理基線。

And with that, I'll turn the call over to Mala for a review of first quarter financials as well as detailed 2020 guidance.

有了這個，我將把電話轉給馬拉審查第一季度的財務狀況以及詳細的 2020 年指導。

Thank you, Jason, and good afternoon, everyone. I'd like to echo Jason's comments regarding the impressive response on the part of our team members and caregivers around the world. The collective willingness to step up to serve our clients and members during this time of need has been remarkable.

謝謝你，傑森，大家下午好。對於我們的團隊成員和世界各地的護理人員令人印象深刻的反應，我想附和傑森的評論。在這個需要的時候，集體願意加緊為我們的客戶和會員服務是非常了不起的。

During the first quarter, total revenue increased 41% to $180.8 million. Global subscription access fee revenue for the quarter of $137.1 million grew 29% versus the prior year, demonstrating accelerating momentum to start the year. U.S. subscription access fee revenue of $107.9 million grew 33% in the quarter versus the prior year, and international subscription revenue of $29.1 million grew 17%. The strength of the dollar versus foreign currencies resulted in a negative FX impact of $1 million in the quarter. International subscription revenue growth was 21% on a constant currency basis.

第一季度，總收入增長 41% 至 1.808 億美元。本季度全球訂閱接入費收入為 1.371 億美元，較上年同期增長 29%，顯示年初勢頭加快。本季度美國訂閱接入費收入為 1.079 億美元，同比增長 33%，國際訂閱收入為 2910 萬美元，增長 17%。美元兌外幣走強導致本季度產生 100 萬美元的負面外匯影響。按固定匯率計算，國際訂閱收入增長 21%。

Visit fee revenue for the quarter increased to $43.7 million, representing growth of 93% over the prior year, in part aided by the surge in volume we began to experience in March as the global pandemic evolved. Revenue from individuals with visit-fee-only access was $12.6 million in the quarter, representing over 200% growth versus the prior year, driven in part by rapidly accelerating utilization amongst new populations added in the back half of 2019. Visit fee revenue comprised 24.2% of consolidated revenue, up notably from 17.6% of revenue in the prior year's quarter as utilization increased significantly.

本季度的訪問費收入增加到 4370 萬美元，比去年同期增長 93%，部分原因是隨著全球大流行病的發展，我們在 3 月份開始經歷的數量激增。本季度來自僅支付訪問費的個人的收入為 1260 萬美元，比上一年增長 200% 以上，部分原因是 2019 年下半年新增人口的利用率迅速加快。訪問費收入佔 24.2佔合併收入的百分比，明顯高於去年同期佔收入的 17.6%，因為利用率顯著提高。

Turning to membership and access. U.S. paid membership increased to 43 million members, up 61% versus the first quarter of last year, a reflection of the critical role of virtual care within the health care delivery system and the accelerating adoption by clients, consumers and providers. As a reminder, the U.S. paid membership includes only members associated with the PMPM and does not include individuals with visit-fee-only access. Individuals with visit-fee-only access was $19.2 million at the end of the first quarter, up approximately $9 million versus the prior year and stable sequentially. Total visit volume exceeded 2 million visits in the quarter, representing a 92% growth rate versus the prior year. Visit volume from paid members in the U.S. grew 93% to 1.4 million visits, which represents an annualized utilization rate of 13.4%, a 230 basis point increase over last year's first quarter. Excluding the impact of the large health plan population onboarded over the past 12 months, annualized utilization during the first quarter would have been 17.9%, up 690 basis points over the first quarter of 2019. PMPM in the quarter was $0.87 compared to $1.03 in the prior year's quarter. As we have previously discussed, we expect to see a dampening effect on average PMPM when we onboard large new health plan member populations. Excluding the impact of the large health plan population added over the past 12 months, which include over 2 million Medicaid managed care members onboarded late in the first quarter, PMPM would be $1.23.

轉向成員資格和訪問。美國付費會員增加到 4300 萬，比去年第一季度增長 61%，這反映了虛擬護理在醫療保健提供系統中的關鍵作用以及客戶、消費者和提供者的加速採用。提醒一下，美國付費會員僅包括與 PMPM 相關的會員，不包括僅支付訪問費的個人。第一季度末，僅支付訪問費的個人為 1920 萬美元，比上年增長約 900 萬美元，環比穩定。本季度總訪問量超過 200 萬次，同比增長 92%。美國付費會員的訪問量增長了 93%，達到 140 萬次，年化使用率為 13.4%，比去年第一季度增長了 230 個基點。排除過去 12 個月加入大量健康計劃人口的影響，第一季度的年化利用率為 17.9%，比 2019 年第一季度增長 690 個基點。本季度 PMPM 為 0.87 美元，而上一季度為 1.03 美元上一年的季度。正如我們之前所討論的，當我們加入大量新的健康計劃成員時，我們預計會看到對平均 PMPM 的抑製作用。排除過去 12 個月增加的大量健康計劃人口的影響，其中包括第一季度末加入的超過 200 萬醫療補助管理的護理成員，PMPM 將為 1.23 美元。

Gross profit increased by $24.5 million to $108.4 million or 29% as compared to the prior year's first quarter. Gross margin percentage for the quarter was 60% compared to 65% in the first quarter of last year. As discussed on our business update call on April 14, the year-over-year decline in percentage gross margin reflects $4 million in incremental investments made to rapidly expand physician capacity in response to the outbreak of COVID-19 during the first quarter as well as the robust visit growth and visit fee revenue mix in the quarter.

與去年第一季度相比，毛利潤增加了 2450 萬美元，達到 1.084 億美元，增幅為 29%。本季度的毛利率為 60%，而去年第一季度為 65%。正如我們在 4 月 14 日的業務更新電話會議上所討論的那樣，毛利率的同比下降反映了 400 萬美元的增量投資，以快速擴大醫師能力以應對第一季度 COVID-19 的爆發以及本季度強勁的訪問增長和訪問費收入組合。

Operating expense for the quarter totaled $129.4 million or 72% of revenue compared to 83% in the first quarter of 2019. Excluding noncash charges such as depreciation and amortization, stock compensation and onetime acquisition and integration-related expenses, quarterly adjusted operating expenses were $97.7 million or 54% of revenue compared to 64% in the first quarter of last year.

本季度的運營費用總計 1.294 億美元，佔收入的 72%，而 2019 年第一季度為 83%。不包括折舊和攤銷、股票補償以及一次性收購和整合相關費用等非現金費用，季度調整後的運營費用為 97.7 美元億美元或收入的 54%，而去年第一季度為 64%。

Adjusted EBITDA increased to $10.7 million for the quarter compared to $1.2 million in the first quarter of 2019. Adjusted EBITDA margin expanded 490 basis points over the prior year's first quarter to 5.9%. EBITDA, including stock compensation and onetime acquisition-related costs, was a loss of $11.3 million for the quarter compared to a $13.3 million loss in the same period last year.

本季度調整後的 EBITDA 增至 1070 萬美元，而 2019 年第一季度為 120 萬美元。調整後的 EBITDA 利潤率比去年第一季度擴大 490 個基點，達到 5.9%。包括股票薪酬和一次性收購相關成本在內的 EBITDA 本季度虧損 1,130 萬美元，而去年同期為虧損 1,330 萬美元。

Our net loss in the quarter was $29.6 million compared to a net loss of $30.2 million in the first quarter of 2019. On a per share basis, our net loss was $0.40 for the first quarter compared to a loss of $0.43 in the first quarter of last year.

我們本季度的淨虧損為 2960 萬美元，而 2019 年第一季度為淨虧損 3020 萬美元。按每股計算，我們第一季度的淨虧損為 0.40 美元，而第一季度為虧損 0.43 美元去年。

We ended the quarter with $511 million in cash and short-term investments. Our total debt outstanding as of March 31 was $562 million, which consists of our 2 convertible notes.

我們在本季度末擁有 5.11 億美元的現金和短期投資。截至 3 月 31 日，我們的未償還債務總額為 5.62 億美元，其中包括我們的 2 份可轉換票據。

Now turning to forward guidance. Please note that all forward guidance will exclude the impact of the recently announced InTouch acquisition until the transaction closes, which we continue to expect near the end of the second quarter.

現在轉向前瞻性指導。請注意，在交易完成之前，所有前瞻性指引都將排除最近宣布的 InTouch 收購的影響，我們繼續預計交易將在第二季度末結束。

For the second quarter of 2020, we expect total revenue of $215 million to $225 million, representing growth of 65% to 73% over the prior year's quarter. We expect to add an additional 6 million to 7 million paid members in the U.S. during the second quarter, including an additional large population of Medicaid managed care members to end the quarter with approximately 49 million to 50 million U.S. paid members. We also anticipate adding visit-fee-only access on a temporary basis for an additional 2 million to 3 million individuals during the second quarter. We are providing this temporary access to help certain clients bridge gaps in care during the current outbreak of COVID-19 and expect those individuals to roll off by the end of the year. We anticipate total visits during the second quarter of between 2.3 million and 2.4 million. We expect second quarter EBITDA to be in the range of a negative $1 million to a positive $3 million, adjusted EBITDA of positive $20 million to $24 million, and net loss per share to be between $0.28 and $0.23 based on 74.6 million shares outstanding.

對於 2020 年第二季度，我們預計總收入為 2.15 億美元至 2.25 億美元，較上年同期增長 65% 至 73%。我們預計第二季度將在美國增加 600 萬至 700 萬付費會員，其中包括額外的大量 Medicaid 管理式醫療會員，到本季度結束時將有大約 4900 萬至 5000 萬美國付費會員。我們還預計在第二季度為另外 200 萬至 300 萬人臨時增加僅支付訪問費的訪問權限。我們正在提供這種臨時訪問，以幫助某些客戶彌合當前 COVID-19 爆發期間的護理差距，並預計這些人將在今年年底前退出。我們預計第二季度的總訪問量將在 230 萬至 240 萬之間。我們預計第二季度 EBITDA 為負 100 萬美元至正 300 萬美元，調整後 EBITDA 為正 2000 萬至 2400 萬美元，基於 7460 萬股流通股，每股淨虧損在 0.28 美元至 0.23 美元之間。

As Jason said, for the full year 2020, we now expect revenue to be in the range of $800 million to $825 million, up from our prior $695 million to $710 million range, representing 45% to 49% growth over the prior year, which again is substantially all organic. We expect total U.S. paid members at year-end of at least 50 million members, representing over 36% membership growth as compared to 2019, and visits-fee-only access to be available to approximately 19 million to 20 million individuals. We expect total visits to be between 8 million and 9 million, representing total visit growth of approximately 90% to 115% over the prior year. As $0 co-pay and shelter-in-place requirements are lifted, we anticipate the surge in visit volumes we are currently experiencing to moderate in the back half of the year. Although as Jason discussed, we do anticipate visit volumes will persist at a permanently higher level than prior to the COVID-19 outbreak.

正如 Jason 所說，對於 2020 年全年，我們現在預計收入將在 8 億美元至 8.25 億美元之間，高於我們之前的 6.95 億美元至 7.1 億美元範圍，比上一年增長 45% 至 49%，這同樣基本上都是有機的。我們預計年底美國付費會員總數至少為 5000 萬，與 2019 年相比，會員人數增長超過 36%，大約 1900 萬至 2000 萬個人可以使用僅支付訪問費的訪問權限。我們預計總訪問量將在 800 萬至 900 萬之間，比上一年總訪問量增長約 90% 至 115%。隨著 0 美元共同支付和就地避難要求的取消，我們預計我們目前遇到的訪問量激增將在今年下半年放緩。儘管正如 Jason 所討論的那樣，我們確實預計訪問量將持續保持在比 COVID-19 爆發之前更高的水平。

Our visit outlook does not assume an incremental increase in volume resulting from a second surge of COVID-19, which some experts are predicting will occur in the fall with the same level of intensity we are currently experiencing. We expect an EBITDA loss in the range of $14 million to $4 million and adjusted EBITDA in the range of positive $70 million to $80 million, representing growth of over 130% at midpoint. The expected EBITDA improvement reflects the significant growth in revenue in conjunction with our continued focus on operating efficiencies while still allowing us to continue to make significant investments in growth. Given the substantial revenue and gross profit outperformance anticipated for the remainder of the year, we expect to increase our level of investment in future growth opportunities, including increased investments to drive the continued adoption of virtual care and capitalize on increased consumer awareness. Net loss per share is expected to range from a loss of $1.27 to $1.13 per share-based on 74.7 million weighted shares outstanding. We expect cash flow from operations to grow consistent with adjusted EBITDA growth.

我們的訪問前景並不假設第二次 COVID-19 激增導致訪問量增加，一些專家預測第二次激增將在秋季發生，其強度與我們目前正在經歷的強度相同。我們預計 EBITDA 虧損將在 1400 萬至 400 萬美元之間，調整後的 EBITDA 將在 7000 萬至 8000 萬美元之間，中點增長率超過 130%。預期的 EBITDA 改善反映了收入的顯著增長以及我們對運營效率的持續關注，同時仍然允許我們繼續對增長進行重大投資。鑑於今年剩餘時間預期的可觀收入和毛利潤表現出色，我們預計將增加對未來增長機會的投資水平，包括增加投資以推動虛擬護理的持續採用和利用消費者意識的提高。基於 7470 萬股加權流通股，預計每股淨虧損介於 1.27 美元至 1.13 美元之間。我們預計運營現金流將與調整後的 EBITDA 增長保持一致。

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

有了這個，我會把電話轉回 Jason 的結束語。

Thanks, Mala. The recent events have provided an inflection point for the adoption of virtual care, and the opportunities in front of us have never been greater. I'm proud of how we've responded and our ability to support our clients and members in this crucial time of need. Our diverse range of product offerings and capabilities, combined with our market leadership across all distribution channels, uniquely positions us to meet the rapidly increasing demands of the marketplace. We look forward to continuing to share updates with you throughout the year. As always, thank you all for your continued interest in the Teladoc Health story.

謝謝，馬拉。最近發生的事件為採用虛擬護理提供了一個轉折點，擺在我們面前的機會從未如此巨大。我為我們的反應方式以及我們在這個關鍵的需要時刻支持我們的客戶和成員的能力感到自豪。我們多樣化的產品供應和能力，加上我們在所有分銷渠道的市場領導地位，使我們在滿足快速增長的市場需求方面處於獨特的地位。我們期待在全年繼續與您分享更新。一如既往，感謝大家對 Teladoc Health 故事的持續關注。

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

有了這個，我們將開始提問。操作員？

(Operator Instructions) Your first question will come from Lisa Gill from JPMorgan.

（操作員說明）您的第一個問題將來自摩根大通的 Lisa Gill。

Thanks very much, Jason, and for the incremental detail post last week. So I just really just want to focus on an area that you talked about, and it's obviously membership. As we think about that membership, and you talked about a number of the assumptions that you have around this, I just want to dig in, in 2 areas. One, you talked about 6 million to 7 million incremental members coming on your platform. Can you talk about if those are brand-new clients or penetration within your existing customer base?

非常感謝，傑森，以及上週的增量細節帖子。所以我真的只想專注於您談到的一個領域，這顯然是會員資格。當我們考慮該成員時，您談到了您對此的一些假設，我只想深入探討兩個領域。第一，你談到你的平台上有 600 萬到 700 萬增量成員。你能談談這些是全新的客戶還是在你現有客戶群中的滲透？

And then secondly, when you touched on unemployment, you said we have something built into our expectations for the full year guidance. I'm just wondering what you're hearing from your customers today. I mean, there's been a lot of layoffs with this anticipation that perhaps those people are going to be rehired at some point, so they're more furloughed than laid off. How do we think about the conversations that you're having and the impact that unemployment could have in the back half of the year as well as we start thinking about 2021?

其次，當你談到失業問題時，你說我們對全年指導的預期中包含了一些內容。我只是想知道您今天從客戶那裡聽到了什麼。我的意思是，已經有很多裁員預期這些人可能會在某個時候被重新僱用，所以他們休假的次數多於被解僱的次數。我們如何看待您正在進行的對話以及失業在下半年以及我們開始考慮 2021 年時可能產生的影響？

Yes. Thanks, Lisa. So on the 6 million to 7 million members we expect to add in the second quarter, it's a mix of existing clients who are expanding to new populations as well as new clients who are coming to us for the first time. We've seen that as the pipeline has built over the course of the first quarter. We began to onboard those members in the sort of latter half and really the last 1/3 of the first quarter, and that has persisted into the second quarter. So it's a combination of both existing and new.

是的。謝謝，麗莎。因此，在我們預計在第二季度增加的 600 萬至 700 萬會員中，既有正在擴展到新人口的現有客戶，也有首次來我們這裡的新客戶。我們已經看到，隨著第一季度管道的建設。我們在第一季度的後半段，實際上是最後 1/3 的時候開始招募這些成員，這種情況一直持續到第二季度。所以它是現有和新的結合。

With respect to unemployment, we think that we are less affected than other industries due to the fact that COBRA kicks in relative to benefits. And therefore, benefits get extended beyond the employment. As you said, furloughed employees frequently keep their benefits. In addition to that, we are expanding our footprint in Medicaid as well as with the exchange businesses. So we think that in some cases, that will be a shift from commercial roles to some of the exchange or managed Medicaid roles, but we will still be able to retain those members.

關於失業，我們認為我們受到的影響小於其他行業，因為 COBRA 相對於福利起作用。因此，福利超出了就業範圍。正如您所說，休假的員工經常保留他們的福利。除此之外，我們正在擴大我們在 Medicaid 以及交換業務方面的足跡。所以我們認為，在某些情況下，這將是從商業角色轉變為一些交換或管理的醫療補助角色，但我們仍然能夠保留這些成員。

Now in other cases, that won't be the case, and we're not completely immune to unemployment. And as a result, we've factored in some of the unemployment expectations that are being circulated by the economists. And we've looked on a client-by-client basis across -- especially our managed care clients to try to understand the puts and takes there.

現在在其他情況下，情況並非如此，我們也不能完全免受失業的影響。因此，我們將經濟學家傳播的一些失業預期考慮在內。我們在逐個客戶的基礎上進行了研究——尤其是我們的管理式醫療客戶，試圖了解那裡的投入和投入。

Mala, I don't know if there's anything you'd add to that.

Mala，我不知道你是否還有什麼要補充的。

The only other thing I would add, Lisa is that we are also significantly more diversified today than in years past. So just keep that in mind in terms of the furlough context.

麗莎，我要補充的唯一一件事是，與過去幾年相比，我們今天的多元化程度也大大提高。因此，就休假背景而言，請記住這一點。

Great. Well, congratulations. And Jason, it's been phenomenal to watch this the last 5 years now that everyone is finally onboard here around telehealth. So again, congratulations on what you've been able to do.

偉大的。嗯，恭喜。傑森，在過去的 5 年裡看到這一點真是太棒了，現在每個人都終於加入了遠程醫療。再次祝賀您所做的一切。

Thanks, Lisa. Really appreciate that.

謝謝，麗莎。真的很感激。

Your next question comes from Sean Wieland from Piper Sandler.

您的下一個問題來自 Piper Sandler 的 Sean Wieland。

Congrats. So Jason, you said that this has been an inflection in the trajectory of virtual care, and I just want to dig in on that for a minute. Where do you think that this goes long term? What does health care look like in 5 years because we have had this terrible pandemic where it wouldn't have changed otherwise?

恭喜。所以傑森，你說過這是虛擬護理軌蹟的一個轉折點，我只想深入探討一下。從長遠來看，您認為這會走向何方？ 5 年後的醫療保健會是什麼樣子，因為我們已經經歷了這場可怕的大流行病，否則它就不會改變？

Yes. I think as I look forward, there are 3 major areas where there have been significant changes. One, among consumers' awareness and adoption around virtual care and the willingness to shift how they've done things for generations to a new way of accessing care. And certainly, that's not just for health care. It's true across the entire spectrum of how people interact. Health care just happens to have been a fairly sticky one. Second is among physicians and hospital systems in terms of their outlook with respect to embracing virtual care as a delivery methodology. And what had been somewhat reluctant in some places has moved to vigorously embracing virtual care. In some cases, it was out of necessity, but what we're seeing is tremendously high satisfaction rates among physicians who are actually engaging in virtual care. And lastly, health plans and employers are now viewing virtual care very broadly across all specialties. And we're actually seeing significant increases in multiproduct sales and among consumers who are using multiple of our clinical products. So I would say those 3 factors all will end up being part of that inflection.

是的。我認為，在我看來，有 3 個主要領域發生了重大變化。第一，消費者對虛擬護理的認識和採用，以及將他們幾代人做事的方式轉變為獲得護理的新方式的意願。當然，這不僅僅是為了醫療保健。在人們互動的整個範圍內都是如此。醫療保健恰好是一個相當棘手的問題。其次是醫生和醫院系統對將虛擬護理作為一種交付方法的看法。在某些地方有些不情願的東西已經轉向大力擁抱虛擬護理。在某些情況下，這是出於必要，但我們看到的是實際參與虛擬護理的醫生的滿意度非常高。最後，健康計劃和雇主現在正在非常廣泛地查看所有專業的虛擬護理。我們實際上看到多產品銷售和使用我們多種臨床產品的消費者顯著增加。所以我想說這 3 個因素最終都會成為這種變化的一部分。

And so if I look out 5 years, I would say virtual care will be ubiquitous. It will be just another methodology for how people access care. They're unlikely to see the difference, sort of a bright line between one and another. And that opens up tremendous opportunities for us both to deliver that care as well as using our technology to enable that care for providers in the market. And obviously, we are, with a global footprint, uniquely positioned to benefit from that.

因此，如果我展望 5 年後，我會說虛擬護理將無處不在。這將只是人們如何獲得護理的另一種方法。他們不太可能看出區別，就像兩者之間的一條明顯界限。這為我們提供了巨大的機會，既可以提供這種護理，也可以利用我們的技術為市場上的提供者提供這種護理。顯然，我們的足跡遍布全球，具有獨特的優勢，可以從中受益。

Your next question comes from Stephanie Davis from SVB.

你的下一個問題來自 SVB 的 Stephanie Davis。

Congrats in the quarter.

祝賀本季度。

Thanks, Stephanie.

謝謝，斯蒂芬妮。

So thinking about InTouch Health, you're buying a bit of a different asset than what you originally looked at in January, both in terms of growth and scale. Could you walk us through the growth in new wins in your existing hospital business as a proxy to how we should think about the acceleration in InTouch given the demand in that market?

因此，考慮到 InTouch Health，無論是在增長還是規模方面，您購買的資產都與您在 1 月份最初看到的資產有所不同。您能否向我們介紹一下您現有醫院業務的新勝利增長，作為我們應該如何考慮考慮到該市場需求的加速 InTouch 的代表？

Yes, absolutely. I'll talk about our experience. We're working closely with the InTouch team, so I can speak a little bit about their experience. And of course, we'll be able to give you more detailed financial details when we get to the closing of that transaction.

是的，一點沒錯。我來談談我們的經歷。我們正在與 InTouch 團隊密切合作，所以我可以談談他們的經驗。當然，當我們完成該交易時，我們將能夠為您提供更詳細的財務細節。

We immediately saw hospitals, both existing clients as well as new prospects, looking to us for technology that could enable them to treat their patients remotely and to do it in a way that is sort of purpose-built for health care workflows. And that enabled us to rapidly respond with our technology platform and stand up over 30 essentially virtual clinics for hospital systems and providers across the country, onboarding thousands of physicians onto the platform and enabling them to treat their patients.

我們立即看到醫院，包括現有客戶和新的潛在客戶，都在向我們尋求技術，使他們能夠遠程治療他們的病人，並以一種專門為醫療保健工作流程構建的方式進行治療。這使我們能夠通過我們的技術平台快速做出響應，並為全國各地的醫院系統和供應商建立了 30 多個本質上是虛擬的診所，讓成千上萬的醫生加入該平台並使他們能夠治療他們的病人。

InTouch Health has seen a similar set of demand where their technology was used from the very beginning. In fact, the first patient who is being treated in a Washington State Hospital was treated using an InTouch piece of technology to distance the physician from that patient. And they've continued to see demand and similarly have seen massive increases in the daily number of transactions on their network.

InTouch Health 看到了一組類似的需求，他們的技術從一開始就被使用。事實上，在華盛頓州立醫院接受治療的第一位患者使用 InTouch 技術進行治療，從而使醫生與該患者保持距離。他們繼續看到需求，並且同樣看到他們網絡上的每日交易數量大幅增加。

And so I think what you'll see when we bring the 2 companies together is an unmatched solution that is hitting the market at a time where the market has massively increased its adoption rate. And so I think when we look back several years down the road, this will have been incredibly fortuitous timing for us to have done the acquisition. Obviously, when we announced it in January, we didn't know that this was coming. We were excited about it then, and we're ecstatic about it now.

因此，我認為當我們將這兩家公司合併在一起時，您會看到一個無與倫比的解決方案，該解決方案在市場採用率大幅提高的時候投放市場。所以我認為，當我們回顧幾年後的道路時，這對我們來說是一個非常偶然的收購時機。顯然，當我們在 1 月份宣布它時，我們並不知道它會到來。當時我們很興奮，現在我們也很欣喜若狂。

Your next question comes from Ryan Daniels from William Blair.

你的下一個問題來自威廉布萊爾的瑞安丹尼爾斯。

Yes. And congratulations on all the business momentum. Jason, one for you. Looking beyond the crisis, it seems like one of the other things that's probably occurred is there's a lot of novel players that are entering in the space. I think I was watching CNBC and saw a Microsoft commercial from Microsoft team just talking about how doctors are using this now. So Team and Zoom and a lot of other kind of nonhealth care players getting into the space. How do you see the competitive dynamic in virtual care panning out over the long term?

是的。並祝賀所有業務發展勢頭。傑森，一個給你。放眼危機之外，似乎可能發生的其他事情之一是有許多新玩家進入該領域。我想我在看 CNBC 時看到了微軟團隊的一則微軟商業廣告，它正在談論醫生現在如何使用它。因此，Team 和 Zoom 以及許多其他類型的非醫療保健公司進入了這個領域。從長遠來看，您如何看待虛擬護理的競爭動態？

Yes. Thanks, Ryan. I think there is no question that the world has changed with respect to the adoption of virtual care. And of course, that will bring others to the party who are interested in providing technology solutions, et cetera. I would say we differentiate ourselves pretty dramatically among a number of dimensions. One, certainly, our technology is purpose-built for health care. It integrates with the provider's existing systems. It is designed for health care workflows with roughly 100 use cases, clinical use cases between Teladoc and InTouch Health. And that is very different than using an off-the-shelf videoconferencing technology. We've gone up against those for years. So that's not new for us. Those technologies have been in the market before, whether that's from Cisco or Verizon or anybody else. And so I feel good about where we are on technology footing.

是的。謝謝，瑞安。我認為毫無疑問，世界在採用虛擬護理方面已經發生了變化。當然，這會將其他有興趣提供技術解決方案等的人帶到聚會中。我想說的是，我們在許多方面都非常顯著地區分了自己。其中之一，當然，我們的技術是專門為醫療保健而打造的。它與提供商的現有系統集成。它專為醫療保健工作流而設計，大約有 100 個用例，Teladoc 和 InTouch Health 之間的臨床用例。這與使用現成的視頻會議技術截然不同。多年來，我們一直在反對那些。所以這對我們來說並不新鮮。這些技術以前已經上市，無論是來自 Cisco、Verizon 還是其他任何公司。因此，我對我們所處的技術基礎感到滿意。

Second big difference is that we bring physician networks and the ability to actually deliver care with our technology solution. And that is very meaningful to hospitals. The majority of our hospitals use our physician network, either completely or to supplement their physicians in delivering virtual care, and that is a critical success factor for us.

第二大區別是我們帶來了醫生網絡和通過我們的技術解決方案實際提供護理的能力。這對醫院來說意義重大。我們的大多數醫院都使用我們的醫生網絡，或者完全使用我們的醫生網絡，或者在提供虛擬護理方面補充他們的醫生，這對我們來說是一個關鍵的成功因素。

And finally, our global presence gives us the ability to provide these technology solutions all around the world. And in fact, one of the areas of strength relative to cross-sell that we've seen already with InTouch Health is our ability to close international deals with the InTouch technology and our international team providing that sort of selling horsepower.

最後，我們的全球影響力使我們能夠在全球範圍內提供這些技術解決方案。事實上，我們已經通過 InTouch Health 看到的與交叉銷售相關的優勢領域之一是我們能夠利用 InTouch 技術和我們的國際團隊提供這種銷售能力來完成國際交易。

So I feel really good about our market position. And as you think about the convergence of payers and providers, we're uniquely positioned to provide that capability.

所以我對我們的市場地位感覺非常好。當您考慮付款人和提供者的融合時，我們具有獨特的優勢來提供這種能力。

I would also add, our technology platform is HIPAA-compliant and has shown the ability to scale up through the crisis with pretty high-volume levels. So that's important as well as a differentiation factor.

我還要補充一點，我們的技術平台符合 HIPAA 標準，並且已經顯示出能夠以相當高的容量水平擴大規模以度過危機。所以這很重要，也是一個差異化因素。

Your next question comes from Richard Close from Canaccord Genuity.

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

Yes. On a global front, Jason or Mala, can you talk a little bit about the global growth opportunity? Just looking at the quarterly results, I thought -- would have thought that maybe international would be a little bit higher from a visit. Can you just talk about what's going on, on that front?

是的。在全球方面，Jason 或 Mala，您能談談全球增長機會嗎？只是看看季度結果，我想 - 本來以為國際訪問可能會高一點。你能談談這方面的情況嗎？

Yes. Our international business has continued to perform incredibly well, and we've never seen a pipeline as strong as we see right now. Mala mentioned in the quarter that we were negatively affected by some FX and -- but for that FX, we would have seen our strongest growth internationally yet. In fact, we just signed a contract with Canada Life to roll out the full suite of our services in the U.K. to their membership, which -- so that includes general medical, behavioral health, nutrition and expert medical services. And that pipeline, really, in many markets, we've always been strong or we've historically been strong in the EU, but we're also seeing other markets, especially in South America, emerge with greater growth rates on the heels of this pandemic.

是的。我們的國際業務繼續表現得非常好，我們從未見過像現在這樣強大的管道。 Mala 在本季度提到，我們受到某些外彙的負面影響，而且——如果沒有這種外匯，我們將在國際上看到迄今為止最強勁的增長。事實上，我們剛剛與加拿大人壽簽署了一份合同，在英國向他們的會員推出我們的全套服務，其中包括一般醫療、行為健康、營養和專家醫療服務。這條管道，真的，在許多市場，我們一直很強大，或者我們在歐盟一直很強大，但我們也看到其他市場，尤其是南美洲，在緊隨其後出現了更高的增長率這次大流行。

I don't know, Mala, if you'd add anything.

我不知道，Mala，如果你想補充什麼。

No. So I think that we are -- on a constant currency basis, it grew over 20%. There is a pretty strong pipeline in place, Richard, that we are methodically working through. Just like in the U.S., we saw a real big state of requests from clients. We did -- we had the same sort of phenomenon happen internationally. And so I feel pretty confident about our growth prospects internationally as we look ahead.

不，所以我認為我們 - 在固定匯率的基礎上，它增長了 20% 以上。理查德，我們正在有條不紊地處理一條非常強大的管道。就像在美國一樣，我們看到了來自客戶的大量請求。我們做到了——我們在國際上發生了同樣的現象。因此，展望未來，我對我們在國際上的增長前景充滿信心。

Your next question comes from Jamie Stockton from Wells Fargo.

你的下一個問題來自富國銀行的傑米斯托克頓。

I guess, quickly on the PMPM, it seemed like a decent amount of the bump in visit volume came from kind of the all-you-can-eat models. If you could just talk about the timing of when you expect that to really start to show up in the way that you get paid. Are we going to see that in Q2? And maybe how durable is it? If we get the step-up, do we get it for the rest of the year?

我想，很快在 PMPM 上，訪問量的相當大的增長似乎來自某種無限量吃到飽的模式。如果你能談談你期望什麼時候真正開始以你獲得報酬的方式出現的時間。我們會在第二季度看到嗎？也許它有多耐用？如果我們得到提升，我們會在今年剩下的時間裡得到它嗎？

Mala, you want to take that?

馬拉，你要拿那個嗎？

Yes. So we should expect to see the step-up happen over the next few quarters, Jamie. So it will be in the fairly short term.

是的。因此，傑米，我們應該期待在接下來的幾個季度看到升級。所以這將是在相當短的時間內。

And Jamie, remember that the visits included is both from our medical membership as well as our direct-to-consumer mental health services, BetterHelp. So those are both in there together.

傑米，請記住，包括的訪問既來自我們的醫療會員，也來自我們直接面向消費者的心理健康服務 BetterHelp。所以它們都在一起。

Your next question comes from Sean Dodge from RBC Capital Markets.

你的下一個問題來自 RBC 資本市場的 Sean Dodge。

Maybe going back to the outlook for longer-term utilization. Jason, you touched on it a bit earlier. The pandemic accelerated the use in telehealth, some driven by a version to showing up in person to offices, but a lot, too, helped by the subsidization employers and health plans have been doing to remove the out-of-pocket costs for individuals. I guess, is there a risk over the course of this that we're conditioning people to expect telehealth to be free to them? And once we get to the other side of this, of the outbreak, are there longer-term implications that can have on things like pricing and utilization?

也許回到長期利用的前景。傑森，你之前提到過它。大流行病加速了遠程醫療的使用，其中一些受到了親自到辦公室的版本的推動，但在補貼雇主和健康計劃的幫助下，也有很多人一直在努力消除個人的自付費用。我想，在此過程中是否存在風險，即我們正在使人們期望遠程醫療對他們免費？一旦我們到達爆發的另一邊，是否會對定價和利用率等方面產生長期影響？

I don't think so, Sean. I think people recognize that this is an unusual situation, and that employers, health plans and others took unusual actions in order to address it. I think what's interesting is that we're seeing very strong growth across all of our products, not just general medical. So there's real acceptance as our B2B mental health and dermatology visits tripled in the quarter. And I guess I would also point to we are not only reporting essentially doubling our first quarter visit volume, but our outlook calls for us to double our full year visit volume. So our confidence is very, very strong relative to the post-COVID utilization rates. And again, just to echo what we said on the call, in the prepared remarks, that does not anticipate a sort of second wave, if you will, of COVID cases in the fall.

我不這麼認為，肖恩。我認為人們認識到這是一種不尋常的情況，雇主、健康計劃和其他人採取了不尋常的行動來解決這個問題。我認為有趣的是，我們看到我們所有產品的增長都非常強勁，而不僅僅是一般醫療產品。因此，我們的 B2B 心理健康和皮膚科訪問量在本季度增加了兩倍，因此得到了真正的認可。我想我還要指出，我們不僅報告說第一季度的訪問量基本上翻了一番，而且我們的展望要求我們將全年的訪問量翻一番。因此，相對於 COVID 後的利用率，我們的信心非常非常強。再一次，只是為了回應我們在電話會議上所說的，在準備好的發言中，如果你願意的話，預計秋天不會出現第二波 COVID 病例。

Your next question comes from Charles Rhyee from Cowen.

你的下一個問題來自 Cowen 的 Charles Rhyee。

I wanted to go back to, I think, it was Sean's question about sort of where you think utilization rates are going to be. And I think, Mala, you kind of said that if we back out sort of the onboarding of the large managed care client, underlying utilization was almost 18%, up 690 basis points. When we -- you kind of talked about you expect it to kind of drift back a little bit, but -- and obviously, we have a lot of new members also coming on, which I would assume probably have a lower utilization rate. On that kind of same-store sales basis, what do you -- what would you expect sort of underlying utilization to look like? Do you think we'll still be sort of at this 18% range? Or where do you think we might fall back to as sort of a jumping off point as we think about '21 and beyond?

我想回到 Sean 的問題，你認為利用率會達到什麼水平。我想，Mala，你有點說過，如果我們取消大型管理式醫療客戶的入職，基礎利用率將接近 18%，上升 690 個基點。當我們 - 你談到你希望它有點回落時，但是 - 顯然，我們也有很多新成員加入，我認為他們的利用率可能較低。在這種同店銷售的基礎上，您認為潛在的利用率是什麼樣的？您認為我們仍會保持在 18% 的範圍內嗎？或者您認為我們可以回到哪裡作為我們考慮 21 年及以後的起點？

So I think we -- I appreciate the question. I appreciate why you're asking it, Charles. I think we were -- we had a lot of discussion about giving guidance in this unusual and uncertain time, and we felt like we had enough visibility to do that through the rest of this year. I think we're going to stop short of trying to give longer-term guidance relative to what's the new normal. In terms of utilization rates, we feel very strongly that it will be materially higher than it's been in the past. And the satisfaction rates and the Net Promoter Scores that we see from the new members who are using our service for the first time give us tremendous confidence around that. But we're definitely not prepared to give longer-term utilization guidance. And I think we'll continue to see things unfold over the rest of the year. And as we do, as always, we'll continue to update our outlook.

所以我認為我們 - 我很欣賞這個問題。我明白你問這個問題的原因，查爾斯。我認為我們是——我們就在這個不尋常和不確定的時期提供指導進行了很多討論，我們覺得我們有足夠的知名度在今年餘下的時間裡做到這一點。我認為我們將停止嘗試提供與新常態相關的長期指導。就利用率而言，我們非常強烈地認為它會比過去有實質性的提高。我們從首次使用我們服務的新會員那裡看到的滿意度和淨推薦值讓我們對此充滿信心。但我們絕對不准備提供長期使用指導。而且我認為我們將在今年餘下的時間裡繼續看到事情的發展。正如我們所做的那樣，一如既往，我們將繼續更新我們的展望。

Your next question comes from George Hill from Deutsche Bank.

你的下一個問題來自德意志銀行的喬治希爾。

Jason, I want to focus in a little bit on the planned continued investment the company talked about making. I guess, where do you see the -- kind of the biggest bang for your buck from an investment perspective at this point? We talked about kind of high-teens utilization rates. And I guess, I'm just trying to figure out, like, it sounds like there's an opportunity here to put money to work. I'm intrigued, like, where you think the most attractive opportunities are to spend money. And then kind of what do you get for that from a metrics perspective?

傑森，我想稍微關註一下公司談到的計劃中的持續投資。我想，從投資的角度來看，你在哪裡看到 - 那種最大的收益？我們談到了十幾歲的高利用率。而且我想，我只是想弄清楚，就像，聽起來這裡有機會把錢投入工作。我很好奇，就像，你認為最有吸引力的機會是花錢。然後從指標的角度來看，你會得到什麼？

Yes. Thanks, George. The -- I guess I would say a few things. One, obviously, it's a unique moment where awareness has significantly increased, and we have the opportunity to invest to drive more engagement, drive more new users to the platform. And we know that we get long-term benefits from them because they come back and become repeat users. So I think you'll see us invest in those areas that pay lasting dividends and repeat dividends.

是的。謝謝，喬治。 - 我想我會說幾件事。第一，顯然，這是一個獨特的時刻，意識顯著提高，我們有機會投資以推動更多參與，吸引更多新用戶使用該平台。我們知道我們從他們那裡獲得了長期利益，因為他們回來並成為回頭客。所以我認為你會看到我們投資於那些支付持久紅利和重複紅利的領域。

We also see the acceptance for multiple products in an integrated -- and when we say multiple products, that really mean multiple clinical specialties, in an integrated fashion. And we've talked before about virtual primary care. I think you'll see us continue to push forward with that and invest in that area. And then we are seeing very, very good strength in some of our specialty businesses, and I think you'll see us continue to invest there.

我們還看到了對多種產品的綜合接受——當我們說多種產品時，這實際上意味著多種臨床專業，以一種綜合的方式。我們之前討論過虛擬初級保健。我想你會看到我們繼續推進這一領域並在該領域進行投資。然後我們在我們的一些專業業務中看到了非常非常好的實力，我想你會看到我們繼續在那裡投資。

Mala, I don't know if you'd add anything to that.

Mala，我不知道你是否願意添加任何內容。

Yes. I'd just go back to what we said during Investor Day, right? We were pretty clear in saying we'll invest in virtual primary care, we'll invest in membership marketing, we'll invest in our technology platform, continue to put investments into that. So I would say a lot of the thesis that we had on Investor Day against our investments still hold. Obviously, as Jason talked about, there is investments we have made in rapidly expanding our provider capacity, our network capacity. But I would say a lot of the thesis still hold.

是的。我只想回到我們在投資者日所說的話，對嗎？我們非常明確地說我們將投資於虛擬初級保健，我們將投資於會員營銷，我們將投資於我們的技術平台，並繼續對其進行投資。所以我想說我們在投資者日反對我們投資的很多論點仍然成立。顯然，正如傑森所說，我們已經進行了投資，以迅速擴大我們的供應商能力和網絡能力。但我想說很多論點仍然成立。

And I guess I would just add one more thing, which is, as I mentioned, we were excited about the InTouch acquisition. I think you'll see us invest heavily in that area because the time is right to capitalize on it. And we think that the return we can get for that is even greater than when we did the deal. So you'll see us continue to invest in that area.

我想我還要補充一件事，正如我提到的，我們對 InTouch 的收購感到興奮。我想你會看到我們在那個領域大量投資，因為現在是時候利用它了。而且我們認為我們可以獲得的回報甚至比我們做交易時更大。所以你會看到我們繼續在那個領域投資。

Your next question comes from Matthew Gillmor from Baird.

您的下一個問題來自 Baird 的 Matthew Gillmor。

And thanks for all you guys are doing. Jason, I was hoping you could characterize the selling season for employers and health plans. I'm sure it's quite different this year. But could you just sort of talk about activity levels, what types of populations are sort of in the discussion? And then now that we're hopefully over the COVID hump, are most of these discussions for January 1 start dates? Or do some of these buyers want to start sooner?

感謝你們所做的一切。傑森，我希望你能描述雇主和健康計劃的銷售季節。我敢肯定，今年情況大不相同。但是你能不能談談活動水平，討論中有哪些類型的人群？現在我們有望度過 COVID 的難關，這些討論中的大部分是針對 1 月 1 日的開始日期嗎？還是其中一些買家想早點開始？

Yes. Thanks for the question, Matt, and your comments. So everything has accelerated. It's a little early still to talk about the selling season for 1/1/21. But everything has accelerated, which I think is reflected in the fact that we'll add 12 million to 13 million new members in the first half of the year. And that broad-based demand across all of our products and distribution channels is showing up in the selling season.

是的。謝謝你的問題，馬特，以及你的意見。所以一切都加速了。現在談論 21 年 1 月 1 日的銷售旺季還為時過早。但一切都在加速，我認為這反映在今年上半年我們將增加 1200 萬到 1300 萬新會員。我們所有產品和分銷渠道的廣泛需求正在銷售旺季出現。

Our -- just to give you a little bit of color, our Q1 bookings, over half of them were multiproduct. So that continues to be very, very strong for us. And our average deal size in Q1 was up over 50% year-over-year. So we continue to see larger opportunities across multiple products, and that's true across all of our distribution channels. So I think it bodes very well for how we look forward into the second half of the year and 1/1/21, but again, a little early to start quantifying what the pipeline looks like for them.

我們 - 只是為了給你一點顏色，我們的第一季度預訂，其中一半以上是多產品。所以這對我們來說仍然非常非常強大。我們在第一季度的平均交易規模同比增長超過 50%。因此，我們繼續在多種產品中看到更大的機會，這在我們所有的分銷渠道中都是如此。因此，我認為這預示著我們如何展望今年下半年和 21 年 1 月 1 日，但同樣，開始量化他們的管道情況有點早。

Your next question comes from Jailendra Singh from Crédit Suisse.

你的下一個問題來自 Crédit Suisse 的 Jailendra Singh。

So I was actually wondering if you can talk about the implication of this increased awareness and adoption of telemedicine for your annual long-term revenue growth target of 20% to 30% and EBITDA margin expansion target of 200 to 300 basis points over the next 5 years. And also if you can provide any color on your expectations with respect to near-term and long-term gross margin expectations.

所以我實際上想知道你是否可以談談這種提高對遠程醫療的認識和採用對你未來 5 年 20% 到 30% 的年度長期收入增長目標和 200 到 300 個基點的 EBITDA 利潤率擴張目標的影響年。此外，如果您可以提供關於近期和長期毛利率預期的任何顏色。

So Mala, I'll let you handle the -- how do you want to characterize our long-term outlook now that everything's changed.

所以 Mala，我會讓你處理——既然一切都變了，你想如何描述我們的長期前景。

Yes. Yes. Do you want to have -- so let me start first. So what I would say, Jailendra, is there were several moving pieces in the first quarter, as you saw, in terms of our gross margin. As we think about the rest of the year and the dynamics on gross margin, there are a couple of things to keep in mind. The first is we will continue to see the surge in the second quarter as it relates to visit revenue. And that will moderate over the course of the year as the shelter-in-place, et cetera, eases. I would also say the surgeon visits included that we have seen, that we have talked about, we'll also expect -- we expect that to moderate over the year.

是的。是的。你想擁有——讓我先開始吧。所以我要說的是，Jailendra，正如你所看到的，就我們的毛利率而言，第一季度有幾個移動部分。當我們考慮今年剩餘時間和毛利率的動態時，有幾件事需要牢記。首先是我們將繼續看到第二季度的激增，因為這與訪問收入有關。隨著就地避難等措施的緩解，這種情況將在一年中有所緩和。我還要說外科醫生的訪問包括我們已經看到的，我們已經討論過的，我們也預計 - 我們預計這一年會有所緩和。

I would say for the medium to long term, my expectation is that we will -- we still have confidence in the mid-60s gross margin that we have talked about in the medium to long term. And I would also say we have talked about our gross profit growth as something that we are looking at. And you can see in the quarter, gross profit grew quite healthily at 29%, and we will continue to focus on driving that gross profit growth.

我想說，從中長期來看，我的期望是我們將 - 我們仍然對我們在中長期談到的 60 年代中期的毛利率充滿信心。我還要說的是，我們已經將我們的毛利潤增長作為我們正在關注的問題進行了討論。你可以在本季度看到，毛利潤以 29% 的速度健康增長，我們將繼續專注於推動毛利潤增長。

When it comes to overall adjusted EBITDA margin and margin expansion, my expectation is that we will continue to invest in marketing keeping pace with revenue growth, and we will continue to drive OpEx leverage from all other OpEx. And so my expectation is that the adjusted EBITDA margin expansion of 200 to 300 basis points that we talked about still holds.

當談到整體調整後的 EBITDA 利潤率和利潤率擴張時，我的預期是我們將繼續投資營銷以跟上收入增長的步伐，我們將繼續推動所有其他運營支出的運營支出槓桿。因此，我的預期是我們談到的調整後 EBITDA 利潤率擴大 200 至 300 個基點仍然有效。

Your next question comes from Matt Hewitt from Craig-Hallum Capital.

你的下一個問題來自 Craig-Hallum Capital 的 Matt Hewitt。

Just maybe to tag on that a little bit. Obviously, you've done a phenomenal job adapting to the situation. You were able to add physicians and capabilities even despite the surge. But there were a couple of hiccups as we -- and you've dealt with those as well. As we look out and given that this situation has driven faster adoption to telemedicine and to your platform, wouldn't it be safe to assume that gross margin should expand maybe at a faster rate than you previously expected? Or is the expectation that you just take those dollars and you're converting them into some of these other newer markets that you've talked about expanding into?

也許只是稍微標記一下。顯然，你在適應這種情況方面做得非常出色。即使激增，您也能夠增加醫生和能力。但是我們遇到了一些小問題——你也處理了這些問題。正如我們所看到的那樣，鑑於這種情況推動了遠程醫療和您平台的更快採用，是否可以假設毛利率的增長速度可能比您之前預期的更快？還是期望您只是拿走這些美元，然後將它們轉換成您談到要擴展到的其他一些新市場？

Yes. So that's right. We will -- we have investments that are attractive and that we need to judiciously make. And so my expectation is that we will -- just like we proved in the first quarter, we quickly invested in what we needed to through the crisis. And we -- Jason just talked about the investments that we have. We will look at those investments in the medium to longer term and make the right ones, whether it be in the U.S. or whether it be internationally. So again, my expectation is we'll make the right investments, we'll do those that give us attractive returns and support both the top line growth as well as give us the right margin profile.

是的。所以這是對的。我們將——我們有有吸引力的投資，我們需要明智地進行投資。因此，我的期望是我們將 - 就像我們在第一季度證明的那樣，我們迅速投資於度過危機所需的東西。我們——傑森剛剛談到了我們的投資。我們將著眼於中長期的投資，並做出正確的投資，無論是在美國還是在國際上。因此，我的期望是我們將做出正確的投資，我們將做那些能給我們帶來有吸引力的回報並支持收入增長並為我們提供正確的利潤率的投資。

Your next question comes from Steve Halper from Cantor.

你的下一個問題來自 Cantor 的 Steve Halper。

I know you talked about InTouch a little bit, but can you just update us in terms of your expectations on the close date and where you're at in the process and where you're at in terms of integration planning?

我知道您稍微談到了 InTouch，但您能否向我們介紹一下您對結束日期的期望、您在流程中所處的位置以及您在整合計劃方面的位置？

There's no change in our expectations of close date. We talked about the fact that we still expect it to be near the end of the second quarter. The integration process is going well. Across all the teams, there is a -- there are a lot of good quality conversations happening around integration and integration planning. So I have confidence that we will close by the end of the second quarter, and we will update our guidance in the middle of the year when we do.

我們對截止日期的預期沒有變化。我們談到了一個事實，即我們仍然預計它會在第二季度末接近尾聲。整合過程進展順利。在所有團隊中，圍繞集成和集成規劃進行了許多高質量的對話。所以我有信心我們將在第二季度末結束，我們將在年中更新我們的指導方針。

Your next question comes from Jonathan Yong from Barclays.

你的下一個問題來自巴克萊銀行的 Jonathan Yong。

So it's pretty clear telehealth is becoming a ubiquitous benefit design, but I'm curious in your discussion with customers. Have they discussed moving towards a more virtual first benefit design where they may provide the first 1 or 2 visits for free to try to help push forward telehealth given how much more prevalent it's become? Just curious if you could give us any color on that.

所以很明顯，遠程醫療正在成為一種無處不在的福利設計，但我很好奇你與客戶的討論。他們是否討論過轉向更虛擬的優先福利設計，在這種設計中，他們可以免費提供前 1 或 2 次訪問，以嘗試幫助推動遠程醫療，因為它已經變得越來越普遍？只是好奇您是否可以給我們任何顏色。

Yes, Jonathan. Look, I think you're exactly right that virtual care has been -- become ubiquitous, and we're seeing it across multiple specialties. So what may have been virtual urgent care years ago is now just virtual care, virtual health care. I think we're going to see many different plan designs coming out as employers and health plans realize the benefits of this and the positive impact it can have both on cost of care as well as health outcomes. I think virtual primary care is an example of that. I think $0 co-pays are another example of that, I think, encouraging virtual visits. But it doesn't just stop with general medical. I think you'll see plan designs that encourage virtual mental health care that include virtual center of excellence programs. We've seen interest in our virtual center of excellence as people have been unable to physically get to centers of excellence programs for large employers and health plans. So I think you're going to see that across the entire spectrum.

是的，喬納森。聽著，我認為虛擬護理已經變得無處不在，我認為你是完全正確的，而且我們在多個專業中都看到了它。所以多年前可能是虛擬緊急護理，現在只是虛擬護理，虛擬醫療保健。我認為隨著雇主和健康計劃意識到這樣做的好處以及它對護理成本和健康結果的積極影響，我們將看到許多不同的計劃設計問世。我認為虛擬初級保健就是一個例子。我認為 0 美元的共同支付是另一個例子，我認為，鼓勵虛擬訪問。但這不僅限於普通醫療。我認為您會看到鼓勵虛擬精神保健的計劃設計，其中包括虛擬卓越中心計劃。我們已經看到人們對我們的虛擬卓越中心很感興趣，因為人們無法親自前往大型雇主和健康計劃的卓越計劃中心。所以我認為你會在整個範圍內看到這一點。

Your next question comes from Kevin Caliendo from UBS.

你的下一個問題來自瑞銀的 Kevin Caliendo。

This is Adam Noble on for Kevin. Congratulations on the great results and guidance. I just wanted to ask about how you're thinking about the regulatory backdrop. In your guidance, obviously, there are a lot of changes made, particularly within Medicare. How are you thinking about those changes staying in place or being -- or maybe returning back to normal over the course of the year? And then for Medicare fee-for-service, specifically, could you talk about what type of volumes you've seen and how you're servicing that market? Is it the only? Or just a little bit more color on how you're capitalizing in that market specifically.

這是凱文的亞當諾布爾。祝賀您取得的巨大成果和指導。我只是想問一下您如何看待監管背景。顯然，在您的指導中進行了很多更改，尤其是在 Medicare 中。您如何看待這些變化保持不變或正在發生——或者可能在一年中恢復正常？然後對於 Medicare 按服務收費，具體來說，您能否談談您看到的是什麼類型的數量以及您如何為該市場提供服務？是唯一的嗎？或者就您如何具體利用該市場提供更多色彩。

Yes. It's an interesting question because there have been obviously a lot of regulatory changes in the -- with the onset of this crisis. We in -- we generally take a conservative view to forecasting. And so when we do that, we include the regulatory environment in those set of conservative assumptions. So we can't assume that all of these regulatory changes persist. And I think some are more likely than others. So our financial outlook and forecasts don't assume that they do. We will continue to work with regulators to provide them with data on where regulatory changes have had a positive impact, and we have very, very good relationships and good dialogue there. But the regulatory environment is not something that I can sort of rely on in a set of assumptions. So we don't make those -- we don't include sort of positive development there in our assumptions.

是的。這是一個有趣的問題，因為隨著這場危機的爆發，監管方面顯然發生了很多變化。我們 - 我們通常對預測持保守觀點。因此，當我們這樣做時，我們將監管環境包含在這些保守假設中。所以我們不能假設所有這些監管變化都會持續存在。我認為有些人比其他人更有可能。因此，我們的財務前景和預測並不假設他們這樣做。我們將繼續與監管機構合作，向他們提供有關監管變化產生積極影響的數據，我們在那裡擁有非常非常好的關係和良好的對話。但監管環境不是我可以在一系列假設中依賴的東西。所以我們不做那些——我們不在我們的假設中包括某種積極的發展。

With respect to the Medicare population, we did add about 0.5 million Medicare members, managed Medicare members, Medicare Advantage in the first quarter. We expect to continue to do that. We have a robust pipeline. And then for Medicare fee-for-service, most of what we've seen thus far has been providers engaging with us to use our technology platform to serve their Medicare fee-for-service members. We do think that if that persists, there would be an opportunity for some direct-to-consumer efforts. But there isn't an aggregator there other than the providers. And we do think that we will be -- our hospital and health systems business would benefit from continued reimbursement for -- by Medicare fee-for-service.

關於 Medicare 人口，我們確實在第一季度增加了約 50 萬 Medicare 會員、管理 Medicare 會員、Medicare Advantage。我們希望繼續這樣做。我們有一個強大的管道。然後對於 Medicare 按服務收費，到目前為止，我們所看到的大部分內容都是提供者與我們合作，使用我們的技術平台為他們的 Medicare 按服務收費會員提供服務。我們確實認為，如果這種情況持續存在，將有機會進行一些直接面向消費者的努力。但是除了提供商之外，那裡沒有聚合器。而且我們確實認為我們將——我們的醫院和衛生系統業務將受益於醫療保險按服務收費的持續報銷。

We are out of time for questions today. This will conclude today's conference call. Thank you for your participation. You may now disconnect.

我們今天沒有時間提問。這將結束今天的電話會議。感謝您的參與。您現在可以斷開連接。