Teladoc Health Inc (TDOC) 2021 Q4 法說會逐字稿

Good afternoon, and thank you for attending today's Teladoc Health Fourth Quarter '21 Earnings Call. My name is Sam, and I will be your moderator for today's call. (Operator Instructions) At this time, I would now like to pass the conference over to our host, Patrick Feeley, Head of Investor Relations. Patrick, please proceed.

下午好，感謝您參加今天的 Teladoc Health 21 年第四季度財報電話會議。我的名字是山姆，我將擔任今天電話會議的主持人。 （操作員說明）此時，我想將會議轉交給我們的主持人，投資者關係主管 Patrick Feeley。帕特里克，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 2021 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，下午好。今天，在市場收盤後，我們發布了一份新聞稿，宣布了我們 2021 年第四季度和全年的財務業績。本新聞稿和隨附的幻燈片可在 teladochealth.com 網站的投資者關係部分找到。在這次電話會議上討論結果的是首席執行官 Jason Gorevic；和首席財務官 Mala Murthy。

During this call, we will also provide our first quarter and full year 2022 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，我們還將提供我們的第一季度和 2022 年全年展望，我們準備好的講話之後將進行問答環節。請注意，我們將討論我們認為對評估 Teladoc Health 的業績很重要的某些非公認會計準則財務指標。有關這些非公認會計原則措施與最具可比性的公認會計原則措施之間的關係及其對賬的詳細信息，請參閱我們網站上發布的新聞稿。

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

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

I'd now like to turn the call over to Jason.

我現在想把電話轉給傑森。

Thanks, Patrick. Good afternoon, everyone, and thank you for joining us.

謝謝，帕特里克。大家下午好，感謝您加入我們。

2021 marked another record year for Teladoc Health in terms of both financial performance as well as the impact we are having on our members' lives. We launched our next-generation mental health product, myStrength Complete, combining the best of Livongo and Teladoc capabilities, and announced significant new deals for our virtual primary care product, Primary360.

2021 年是 Teladoc Health 又一個創紀錄的一年，無論是財務業績還是我們對會員生活的影響。我們推出了下一代心理健康產品 myStrength Complete，結合了 Livongo 和 Teladoc 的優勢，並宣布了我們的虛擬初級保健產品 Primary360 的重大新交易。

In the direct-to-consumer market, our BetterHelp product posted another year of record growth, exceeding $700 million in global revenue. We exited 2021 with significant sales momentum with fourth quarter bookings showing strong growth both sequentially and over the prior year. Notably, multiproduct sales represented 80% of full year bookings.

在直接面向消費者的市場中，我們的 BetterHelp 產品又實現了創紀錄的增長，全球收入超過 7 億美元。我們在 2021 年以強勁的銷售勢頭退出，第四季度的預訂量顯示出環比和去年同期的強勁增長。值得注意的是，多產品銷售佔全年預訂量的 80%。

For the fourth quarter, Teladoc Health posted another strong quarter of financial performance, as we continue to deepen member relationships and increase the care delivered to consumers. The broad-based strength across the business drove revenue of $554 million in the fourth quarter, representing an increase of 45% over the prior year, including organic growth of 32%.

第四季度，隨著我們繼續深化會員關係並增加向消費者提供的護理，Teladoc Health 公佈了又一個強勁的季度財務業績。整個業務的廣泛實力推動第四季度收入達到 5.54 億美元，比去年同期增長 45%，其中包括 32% 的有機增長。

Our vision is to become the first stop in the consumer health care journey regardless of need by delivering whole-person care to meet the complex needs of our members from physical to mental, acute to episodic and chronic to complex. To advance this vision, we continue to focus on our key strategic priorities that we believe underpin the next phase of significant growth for our company. Those priorities include expanding adoption of our integrated virtual primary care product, Primary360; expanding our mental health services to meet growing demand; and enhancing our chronic care capabilities in order to be even more impactful for clients and members.

我們的願景是通過提供全人護理來滿足我們會員從身體到精神、急性到偶發性、慢性到復雜的複雜需求，從而成為消費者醫療保健之旅的第一站，無論需求如何。為了推進這一願景，我們將繼續專注於我們認為支撐我們公司下一階段顯著增長的關鍵戰略重點。這些優先事項包括擴大採用我們的集成虛擬初級保健產品 Primary360；擴大我們的心理健康服務以滿足不斷增長的需求；並提高我們的長期護理能力，以便對客戶和會員產生更大的影響。

Importantly, we will continue to build upon the integrated Teladoc experience that unifies all our products and services, making it easier for patients, care providers and clients to realize the full value of our whole-person approach. Primary360, our virtual primary care product, enables Teladoc to become the front door to the health care system for our members. We believe our unmatched depth and breadth of capabilities positions the company as the global leader in whole-person virtual care.

重要的是，我們將繼續以整合我們所有產品和服務的 Teladoc 體驗為基礎，使患者、護理提供者和客戶更容易實現我們全人方法的全部價值。 Primary360 是我們的虛擬初級保健產品，使 Teladoc 成為我們會員醫療保健系統的前門。我們相信，我們無與倫比的能力深度和廣度使公司成為全人虛擬護理的全球領導者。

While it remains early, I am very pleased with the enrollment and engagement we're seeing in Primary360 so far. I was just reviewing data from one of our partners that recently launched a Virtual First plan supported by our Primary360 product. And the number of people choosing the plan has significantly exceeded our initial forecasts. And 75% of the members who have enrolled in that plan are entirely new to that insurer. So Primary360 is clearly proving to be a differentiating factor in the marketplace for our health plan clients.

雖然還為時過早，但我對迄今為止在 Primary360 中看到的註冊人數和參與度感到非常滿意。我剛剛查看了我們的一個合作夥伴的數據，該合作夥伴最近推出了由我們 Primary360 產品支持的 Virtual First 計劃。並且選擇該計劃的人數大大超出了我們最初的預測。加入該計劃的 75% 的成員對該保險公司來說是全新的。因此，Primary360 顯然被證明是我們的健康計劃客戶在市場上的一個差異化因素。

Virtual First plan offerings are increasingly being viewed as strategic necessities among insurers and is the leader in the space with the most robust and comprehensive offering. We're well positioned to partner with those plans. We now have over 50 clients live on Primary360, including several Fortune 500 employers and our pipeline of opportunities continues to build.

Virtual First 計劃產品越來越被保險公司視為戰略必需品，並且是該領域的領導者，提供最強大和最全面的產品。我們有能力與這些計劃合作。我們現在有超過 50 名客戶住在 Primary360 上，其中包括幾家財富 500 強雇主，我們的機會管道還在繼續建立。

Our Primary360 offering is resonating in the employer market due not only to the breadth and depth of our product but because of our ability to scale and integrate with an employer's benefit design. Large employers need a virtual primary care offering that can both serve an employee base spread across geographies and integrate with multiple insurance plans since large employers typically offer plans from more than one insurance carrier. We're uniquely positioned to be that partner given our track record of working across multiple national and regional payers.

我們的 Primary360 產品在雇主市場引起了共鳴，這不僅是因為我們產品的廣度和深度，還因為我們能夠擴展並與雇主的福利設計相結合。大型雇主需要一種虛擬初級保健服務，既可以服務於遍布各地的員工群，又可以與多種保險計劃相結合，因為大型雇主通常會提供來自多個保險公司的計劃。鑑於我們與多個國家和地區付款人合作的記錄，我們在成為該合作夥伴方面具有獨特的優勢。

We expect to launch Primary360 with several new clients over the course of the year across channels, including a newly signed partnership to launch a Virtual First health plan with a large provider-sponsored organization in the Midwest. This integrated health system deal is notable as we beat out an incumbent telemedicine provider in the process, demonstrating the power of our industry-leading suite of services. It also demonstrates progress against our strategy to bring our entire suite of products across all of our channels, including health systems.

我們預計將在今年跨渠道與幾個新客戶一起推出 Primary360，包括新簽署的合作夥伴關係，以與中西部的一家大型提供商贊助的組織推出 Virtual First 健康計劃。這項綜合衛生系統交易值得注意，因為我們在此過程中擊敗了現有的遠程醫療提供商，展示了我們行業領先的服務套件的力量。它還展示了我們在包括衛生系統在內的所有渠道中提供整套產品的戰略方面取得的進展。

In chronic care, the number of individuals enrolled in our suite of solutions grew 22% year-over-year to 729,000 at the end of the fourth quarter. Over 40% of adults in the U.S. are living with multiple chronic conditions. And as you've heard me say in the past, individuals don't view themselves as just a person with a chronic disease. They view themselves as a person who needs help accessing care and managing their entire health.

在慢性護理方面，加入我們的解決方案套件的人數同比增長 22%，到第四季度末達到 729,000 人。在美國，超過 40% 的成年人患有多種慢性病。正如你在過去聽到我所說的那樣，人們並不認為自己只是患有慢性病的人。他們認為自己是一個需要幫助才能獲得護理和管理整個健康的人。

Importantly, our approach of focusing on the whole person as opposed to a single condition continues to pay off. The percentage of chronic care members enrolled in more than one program has doubled over the prior year, resulting in total chronic care program enrollment growth of over 30%.

重要的是，我們關注整個人而不是單一條件的方法繼續得到回報。參加一個以上項目的慢性護理成員的比例比上一年翻了一番，導致慢性護理項目的總入學率增長了 30% 以上。

Last week, we announced the launch of our new Chronic Care Complete product line, which incorporates data-driven outreach to connect enrollees in our chronic care programs with Teladoc physicians. This will, for example, enable us to leverage the Teladoc physician network based on real-time data to better engage with chronic care members who may be struggling to control their disease and provide services such as adjusting care plans or optimizing medications.

上週，我們宣布推出新的慢性護理完整產品線，該產品線結合了數據驅動的外展服務，將我們慢性護理項目的參與者與 Teladoc 醫生聯繫起來。例如，這將使我們能夠利用基於實時數據的 Teladoc 醫師網絡，更好地與可能難以控制疾病並提供調整護理計劃或優化藥物等服務的慢性護理成員接觸。

Chronic Care Complete will allow us to leverage our data capabilities, including the billions of data points we've collected to date to make intelligent interventions, drive better outcomes for our members and lower cost for our clients. This integration of our telemedicine capabilities, our digital chronic care management programs and our robust data capabilities represents the latest example of our integrated stepped care approach and follows on the heels of the launch of our myStrength Complete mental health offering last year.

Chronic Care Complete 將使我們能夠利用我們的數據能力，包括我們迄今為止收集的數十億數據點來進行智能干預，為我們的會員帶來更好的結果並為我們的客戶降低成本。我們的遠程醫療能力、我們的數字慢性護理管理計劃和我們強大的數據能力的這種整合代表了我們集成階梯式護理方法的最新示例，並緊隨我們去年推出的 myStrength Complete 心理健康產品之後。

Mental health remains another key priority for us and an area where we continue to see tremendous demand for care. In the direct-to-consumer channel, our BetterHelp brand continues to drive significant growth, both in the U.S. and international markets. In the B2B channel, our new flagship myStrength Complete product, which offers both digital capabilities and virtual interactions is gaining momentum. We find that since mental health is a longitudinal relationship where members typically have several visits with their therapist or psychiatrists, it acts like a gateway for other Teladoc services. And we also find that our members who utilize mental health, combined with another Teladoc service, such as general medical or dermatology, generate revenue that's 20% to 60% higher on average than those who utilize mental health services alone.

心理健康仍然是我們的另一個關鍵優先事項，也是我們繼續看到對護理的巨大需求的領域。在直接面向消費者的渠道中，我們的 BetterHelp 品牌繼續推動美國和國際市場的顯著增長。在 B2B 渠道中，我們的新旗艦 myStrength Complete 產品（提供數字功能和虛擬交互）正在獲得動力。我們發現，由於心理健康是一種縱向關係，會員通常會多次拜訪他們的治療師或精神病醫生，它就像其他 Teladoc 服務的門戶。我們還發現，使用心理健康服務的會員與其他 Teladoc 服務（如普通醫療或皮膚病學）相結合，產生的收入平均比單獨使用心理健康服務的會員高 20% 至 60%。

So not only does multiservice usage enable better access to care and drive cost savings for our clients, but it also enables us to efficiently drive higher engagement and revenue growth.

因此，多服務的使用不僅使我們的客戶能夠更好地獲得護理並節省成本，而且還使我們能夠有效地推動更高的參與度和收入增長。

Before I turn the call over to Mala to discuss our results and financial guidance in more detail, I want to talk briefly about our outlook for 2022. For the full year, we expect revenue to be in the range of $2.55 billion to $2.65 billion, representing growth of 25% to 30%. Our expectations for strong growth are a result of the broad-based momentum we continue to see across our suite of products and services and across geographies. We have over 90 million total individuals with access to the Teladoc platform today, and we see a significant opportunity for long-term growth by expanding our relationships and going deeper with our existing clients and members as we execute against our key strategic priorities across primary care, mental health and chronic care solutions.

在我將電話轉給 Mala 以更詳細地討論我們的業績和財務指導之前，我想簡要談談我們對 2022 年的展望。全年，我們預計收入將在 25.5 億美元至 26.5 億美元之間，代表 25% 到 30% 的增長。我們對強勁增長的期望是我們繼續在我們的產品和服務套件以及跨地區看到的廣泛勢頭的結果。今天，我們有超過 9000 萬個人可以訪問 Teladoc 平台，隨著我們在初級保健領域執行關鍵戰略優先事項，我們看到了通過擴大我們的關係並與現有客戶和成員進行更深入的長期增長的重大機會、心理健康和慢性護理解決方案。

With that, I'll turn the call over to Mala for a review of fourth quarter as well as detailed '22 guidance.

有了這個，我將把電話轉給馬拉，以審查第四季度以及詳細的 '22 指導。

Thank you, Jason, and good afternoon, everyone.

謝謝你，傑森，大家下午好。

During the fourth quarter, total revenue increased 45% year-over-year to $554 million, including 32% organic growth. Access fee revenue for the fourth quarter increased 51% year-over-year to $470 million and represented 85% of total revenue, up from 81% in the prior year's quarter. We ended the quarter with U.S. paid membership of 53.6 million members, above the high end of our guidance range and an increase of 1.1 million members over the third quarter. Individuals with visit fee only access was 24.2 million at the end of the fourth quarter, representing an increase of 600,000 individuals.

第四季度，總收入同比增長 45% 至 5.54 億美元，其中包括 32% 的有機增長。第四季度的訪問費收入同比增長 51% 至 4.7 億美元，佔總收入的 85%，高於去年同期的 81%。我們在本季度結束時擁有 5360 萬會員的美國付費會員，高於我們指導範圍的高端，並且比第三季度增加了 110 萬會員。第四季度末，只收參觀費的人數為2420萬人，增加了60萬人。

Total unique members enrolled in one or more of our chronic care programs was 729,000 members as of the fourth quarter, an increase of 133,000 enrollees over the prior year's quarter and in line with our expectations. Average revenue per member per month was $2.49 in the fourth quarter, up 52% from $1.63 in the prior year's quarter and up 4% sequentially from $2.40 in the third quarter of 2021. Please note that as of the fourth quarter, BetterHelp revenue from international markets is now included in the international revenue line item and is therefore excluded from our reported U.S. revenue per member per month. Please see the schedule at the end of the earnings press release for prior period numbers recast for this change.

截至第四季度，參加我們一項或多項慢性護理計劃的唯一會員總數為 729,000 名，比上一季度增加了 133,000 名，符合我們的預期。第四季度每位會員每月平均收入為 2.49 美元，比去年同期的 1.63 美元增長 52%，比 2021 年第三季度的 2.40 美元增長 4%。請注意，截至第四季度，BetterHelp 來自國際的收入市場現在包含在國際收入項目中，因此不包括在我們報告的每個會員每月的美國收入中。請參閱收益新聞稿末尾的時間表，以了解針對此更改重鑄的前期數字。

Visit fee revenue for the fourth quarter of $69 million increased 21% year-over-year. During the fourth quarter, we provided 4.4 million visits through our network of clinicians. The visit count in the fourth quarter includes the benefit of approximately 187,000 visits in the international markets that were previously excluded from the visit count. Excluding these visits, our total visits in the fourth quarter would have been just over 4.2 million, above the high end of our prior guidance range.

第四季度的參觀費收入為 6900 萬美元，同比增長 21%。在第四季度，我們通過我們的臨床醫生網絡提供了 440 萬次訪問。第四季度的訪問次數包括之前被排除在訪問次數之外的國際市場約 187,000 次訪問的收益。不包括這些訪問，我們在第四季度的總訪問量將略高於 420 萬，高於我們先前指導範圍的高端。

Also, please note that the BetterHelp visits from individuals located outside the U.S. have moved from the U.S. visit count to the international visit count. And this shift impacts our reported utilization rate, which is a U.S.-specific metric. Please see the schedule at the end of the press release for prior period numbers recast for this change.

此外，請注意，來自美國境外的個人的 BetterHelp 訪問已從美國訪問計數移至國際訪問計數。這種轉變會影響我們報告的利用率，這是美國特有的指標。請參閱新聞稿末尾的時間表，以了解為此更改重鑄的前期數字。

Fully adjusted, total visits grew 41% over the prior year's quarter. The annualized utilization rate for our members was 22.7% in the fourth quarter, a 670 basis point increase over the prior year's quarter and a 170 basis point increase sequentially. Contributing to the strong growth was persistent strength in mental health utilization as visits more than doubled in each of the direct-to-consumer and B2B channels in 2021. After a period of low overall transmission of infectious disease due to social distancing and PPE usage, we have also begun to see infectious disease volumes rebound in the second half of 2021, growing more than 35% in the second half of the year as compared to the first half of the year and contributing to strong fourth quarter total visit growth.

全面調整後，總訪問量比去年同期增長 41%。第四季度我們會員的年化使用率為 22.7%，比上一季度增加 670 個基點，環比增加 170 個基點。 2021 年，直接面向消費者和 B2B 渠道的訪問量均增加了一倍以上，因此心理健康利用的持續強勁推動了強勁增長。由於社交距離和個人防護裝備的使用，在一段傳染病總體傳播率較低的時期之後，我們也開始看到傳染病量在 2021 年下半年出現反彈，與上半年相比，下半年增長了 35% 以上，並為第四季度總訪問量的強勁增長做出了貢獻。

Adjusted EBITDA was $77.1 million in the fourth quarter compared to $50.4 million in the prior year's quarter. Net loss per share in the fourth quarter was $0.07 compared to a net loss per share of $3.07 in the year ago period. Net loss per share in the fourth quarter included stock-based compensation expense of $0.39 per share, amortization of acquired intangibles of $0.28 per share and a noncash income tax benefit of $0.31 per share. The company generated strong operating cash flow in the quarter of $83 million, and operating cash flow for the full year was $194 million. We ended the year with $893 million in cash on the balance sheet.

第四季度調整後的 EBITDA 為 7710 萬美元，而去年同期為 5040 萬美元。第四季度每股淨虧損為 0.07 美元，而去年同期每股淨虧損為 3.07 美元。第四季度每股淨虧損包括每股 0.39 美元的股票補償費用、每股 0.28 美元的收購無形資產攤銷和每股 0.31 美元的非現金所得稅優惠。該公司在本季度產生了 8300 萬美元的強勁運營現金流，全年運營現金流為 1.94 億美元。我們在資產負債表上以 8.93 億美元現金結束了這一年。

Now turning to forward guidance. For the full year 2022, we expect revenue to be in the range of $2.55 billion to $2.65 billion, representing growth of 25% to 30% over the prior year. We expect total membership of 54 million to 56 million members, representing growth of 1% to 5% year-over-year, with the remainder of revenue growth driven by expanding revenue per member driven both by increased product penetration and product mix.

現在轉向前向指導。對於 2022 年全年，我們預計收入將在 25.5 億美元至 26.5 億美元之間，比上年增長 25% 至 30%。我們預計會員總數將達到 5400 萬至 5600 萬，同比增長 1% 至 5%，其餘的收入增長是由產品滲透率和產品組合增加推動的每個會員收入的擴大推動的。

We expect adjusted EBITDA in 2022 to be in the range of $330 million to $355 million, representing a 12.9% to 13.4% adjusted EBITDA margin and an expansion of approximately 90 to 140 basis points over 2021 after normalizing for last year's purchase price accounting benefit. We expect total visits in 2022 to be between 18.5 million and 20 million visits, representing growth of 20% to 30% over the prior year.

我們預計 2022 年調整後的 EBITDA 將在 3.3 億美元至 3.55 億美元之間，調整後的 EBITDA 利潤率為 12.9% 至 13.4%，在將去年的購買價格會計收益正常化後，將比 2021 年擴大約 90 至 140 個基點。我們預計 2022 年的總訪問量將在 1850 萬至 2000 萬之間，比上一年增長 20% 至 30%。

For the first quarter of 2022, we expect revenue of $565 million to $571 million, representing growth of 25% to 26% over the prior year's quarter. We expect total paid membership in the range of 54 million to 54.5 million in the first quarter. Total first quarter visits are expected to be between 4.3 million and 4.5 million visits representing year-over-year growth of 29% to 35% driven in part by a surge in COVID-related visits seen during January.

對於 2022 年第一季度，我們預計收入為 5.65 億美元至 5.71 億美元，比去年同期增長 25% 至 26%。我們預計第一季度的付費會員總數將在 5400 萬至 5450 萬之間。預計第一季度的總訪問量將在 430 萬至 450 萬之間，同比增長 29% 至 35%，部分原因是 1 月份與 COVID 相關的訪問量激增。

We expect first quarter adjusted EBITDA to be in the range of $51 million to $55 million. Included in first quarter adjusted EBITDA is an expected $4 million drag from incentive payments made to our network of physicians during the recent Omicron spike. Provider payments have largely normalized by the start of February, and we do not expect the increased level of incentive payments to recur.

我們預計第一季度調整後的 EBITDA 將在 5100 萬美元至 5500 萬美元之間。包括在第一季度調整後的 EBITDA 中的是，在最近的 Omicron 飆升期間，向我們的醫生網絡支付的獎勵金預計會拖累 400 萬美元。到 2 月初，提供者支付已基本正常化，我們預計獎勵支付水平不會再次增加。

I would like to talk briefly about the expected cadence of revenue and adjusted EBITDA growth over the course of this year. On the revenue side, we expect the timing of new chronic care client onboardings to be more heavily weighted towards the second half of this year. This includes the launch of large new health plan clients signed over the past several months, including HCSC and another regional Blue plan, which are scheduled to onboard in the second half of this year. We, therefore, expect to see strong sequential growth in revenue over the course of the year. Specific to the second quarter, we expect an approximate $40 million to $50 million step-up in revenue from 1Q to 2Q.

我想簡要談談今年收入的預期節奏和調整後的 EBITDA 增長。在收入方面，我們預計新的慢性護理客戶入職時間將在今年下半年獲得更大的權重。這包括推出過去幾個月簽署的大型新健康計劃客戶，包括 HCSC 和另一個區域性 Blue 計劃，計劃於今年下半年加入。因此，我們預計全年收入將出現強勁的連續增長。具體到第二季度，我們預計第一季度到第二季度的收入將增加約 4,000 萬美元至 5,000 萬美元。

On the expense side, we normally see higher engagement marketing spend in the first half of the year as we prepare to onboard new clients and members. It's also typical for us to see higher advertising spend early in the year as we take advantage of lower media pricing in the market following the conclusion of the more expensive holiday season. We expect that to be the case again this year, as we have seen a more advantageous media buying landscape early this year, which has resulted in a slightly lower customer acquisition cost.

在費用方面，我們通常會在今年上半年看到更高的參與營銷支出，因為我們準備接納新客戶和會員。在更昂貴的假期結束後，我們利用市場上較低的媒體定價，在年初看到更高的廣告支出對我們來說也很典型。我們預計今年會再次出現這種情況，因為我們在今年年初看到了更有利的媒體購買環境，這導致客戶獲取成本略低。

This will impact the quarterly cadence of adjusted EBITDA, and we expect will result in a significant margin expansion progression over the course of 2022, particularly in the second half due to our expected revenue and enrollment ramp for the chronic care programs launching later this year as well as the typical seasonality of advertising spend over the course of the year.

這將影響調整後 EBITDA 的季度節奏，我們預計將導致 2022 年期間的利潤率大幅增長，尤其是在下半年，因為我們預計今年晚些時候推出的慢性護理項目的收入和入學人數將增加以及一年中廣告支出的典型季節性。

It's important to note that the revenue and EBITDA ramp described is not dependent on significant new sales. The deals mentioned are contracts that have been signed over the past several months but are disproportionately scheduled to onboard in the second half. And we, therefore, have good visibility into the second half revenue and EBITDA progression.

值得注意的是，所描述的收入和 EBITDA 增長並不依賴於重要的新銷售額。提到的交易是過去幾個月簽署的合同，但不成比例地計劃在下半年加入。因此，我們對下半年的收入和 EBITDA 進展有很好的了解。

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

有了這個，我將把電話轉回傑森的閉幕詞。

Thanks, Mala.

謝謝，馬拉。

We remain confident in the long-term revenue and profitability outlook that we provided at our Investor Day in November. Specifically, our confidence in delivering substantial growth in '22 comes from our proven ability to have impact by improving people's lives. This morning, Teladoc Health published our second annual Corporate Social Responsibility Report, which highlights how we, as a company, seek to have an impact beyond our business and live our values in the communities we serve.

我們對我們在 11 月投資者日提供的長期收入和盈利前景仍然充滿信心。具體來說，我們對在 22 年實現大幅增長的信心來自於我們通過改善人們的生活而產生影響的成熟能力。今天上午，Teladoc Health 發布了我們的第二份年度企業社會責任報告，該報告強調了我們作為一家公司如何尋求在我們的業務之外產生影響，並在我們所服務的社區中踐行我們的價值觀。

The report highlights our commitment to taking care of people, building trust, operating responsibly and having a positive impact globally. And I'm pleased that it shows tremendous progress in 2021, including a new employee volunteerism program that delivered more than 12,000 hours of support for employee-chosen charities and making meaningful progress in hiring a more diverse workforce.

該報告強調了我們對關愛他人、建立信任、負責任地運營以及在全球產生積極影響的承諾。我很高興它在 2021 年取得了巨大進步，其中包括一項新的員工志願服務計劃，該計劃為員工選擇的慈善機構提供了超過 12,000 小時的支持，並在招聘更多元化的勞動力方面取得了有意義的進展。

I encourage you to check it out on our website and learn more about how Teladoc Health is giving back to our communities and building a sustainable enterprise. As always, thank you for your continued interest in Teladoc Health.

我鼓勵您在我們的網站上查看它，並詳細了解 Teladoc Health 如何回饋我們的社區並建立可持續發展的企業。一如既往，感謝您對 Teladoc Health 的持續關注。

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

有了這個，我們將打開問題的電話。操作員？

(Operator Instructions) Our first question is from the line of Ryan Daniels with William Blair.

（操作員說明）我們的第一個問題來自 Ryan Daniels 和 William Blair。

Yes. Can you speak a little bit more to the revenue cadence and kind of the visibility you have there? With the new plan starting up, are they kind of guaranteed, if you will, to start in the second half of the year? And do you have pretty good visibility on the number of members in PMPM, et cetera, to ensure that, that ramp occurs?

是的。你能多談談收入節奏和你在那裡的知名度嗎？隨著新計劃的啟動，如果你願意的話，他們是否有保證在下半年開始？您是否對 PMPM 等的成員數量有很好的了解，以確保出現這種增長？

Thanks, Ryan, for your question. Yes. So let me give you a little bit of color on how we see the revenue ramp sort of progressing through the year. So first is if you think about the guidance range that we just gave of 25% to 30% growth, that is consistent with the overall outlook that we provided back in November at Investor Day. As we said in our prepared remarks, Ryan, we do expect to see a meaningful ramp in revenue over the course of the year. We talked about the ramp that we are seeing in the second quarter, the $40 million to $50 million. And then we see a further ramp from there into the second half.

謝謝，瑞安，你的問題。是的。因此，讓我為您提供一些關於我們如何看待全年收入增長的顏色。首先，如果您考慮一下我們剛剛給出的 25% 至 30% 增長的指導範圍，這與我們在 11 月投資者日提供的總體前景一致。正如我們在準備好的講話中所說的那樣，瑞安，我們確實希望在今年的收入中看到有意義的增長。我們談到了我們在第二季度看到的增長，從 4000 萬美元到 5000 萬美元。然後我們看到從那裡進一步進入下半場。

So it's definitely more back half weighted as our -- as we look at the revenue progression, and we've talked about the key drivers of it, right? One is that we have multiple health plan clients that will onboard in the second half. As we talked about the ramp that we're seeing isn't dependent so much on new sales. These are deals that we have already contracted. So we have really good visibility into the sales and the revenue, it is just really a question of timing.

因此，當我們查看收入進展時，它肯定比我們的權重更多，我們已經討論了它的關鍵驅動因素，對嗎？一是我們有多個健康計劃客戶將在下半年加入。正如我們談到的那樣，我們看到的坡道並不太依賴於新的銷售。這些是我們已經簽訂的交易。所以我們對銷售和收入有很好的了解，這只是一個時間問題。

The onboarding is going to happen in the beginning of the second half and as we start that and as you see the normal enrollments of curve and the ramp hit its stride, you will see the revenue come through more in the back half than in the first half. So that's sort of how we are thinking about our overall revenue cadence for the year.

入職將在下半年開始，當我們開始時，當您看到曲線的正常註冊人數和坡道大步前進時，您會看到後半部分的收入比前半部分更多一半。這就是我們如何考慮今年的整體收入節奏。

Our next question is from Lisa Gill of JPMorgan.

我們的下一個問題來自摩根大通的 Lisa Gill。

Jason, thanks for the comments on BetterHelp, $700 million you talked about for BetterHelp this year. Can you maybe just help me to understand just a couple of things. One, when we think about BetterHelp, Mala made the comment of slightly lower acquisition costs, is that particular to BetterHelp? Are you talking about in general?

Jason，感謝您對 BetterHelp 的評論，今年您為 BetterHelp 提供了 7 億美元。你能不能幫我理解一些事情。一，當我們想到 BetterHelp 時，Mala 評論說採購成本略低，這對 BetterHelp 來說是不是特別的？你說的是一般情況嗎？

Two, when we think about clinician costs, again, you talked about $4 million of incremental incentive payments, but we hear a lot about the ability to attract and retain clinicians in the marketplace right now because we are in a mental health crisis here in the U.S. So can you talk about those things?

第二，當我們再次考慮臨床醫生成本時，您再次談到了 400 萬美元的增量獎勵金，但我們現在聽到很多關於在市場上吸引和留住臨床醫生的能力，因為我們正處於心理健康危機中美國 那你能談談那些事情嗎？

And then thirdly, when we think about BetterHelp in 2022, how do we think about how that business is growing. And you talked about those that use mental health use other services, but how do we think about retaining that member when we think about behavioral health services?

第三，當我們考慮 2022 年的 BetterHelp 時，我們如何考慮該業務的增長方式。您談到那些使用心理健康服務的人使用其他服務，但是當我們考慮行為健康服務時，我們如何考慮保留該成員？

Lisa, thanks for the questions. I think those were 3, but we'll cram them into one question. With respect to the customer acquisition costs and Mala's commentary, what she was talking about is the overall media landscape, in particular about BetterHelp. Our customer acquisition costs are down slightly as we look at this year versus the same period last year. In addition, we're seeing benefit of BetterHelp's brand awareness and really market-leading brand, which enables us to see an increase in the number of members who are signing up organically without any acquisition costs.

麗莎，謝謝你的問題。我認為那是 3 個，但我們會將它們塞進一個問題中。關於獲客成本和 Mala 的評論，她說的是整個媒體格局，尤其是 BetterHelp。與去年同期相比，今年我們的客戶獲取成本略有下降。此外，我們看到 BetterHelp 的品牌知名度和真正的市場領先品牌帶來的好處，這使我們能夠看到在沒有任何收購成本的情況下自然註冊的會員數量有所增加。

So the combination of those 2 things have been very favorable and gives us a strong outlook for the BetterHelp product specifically, but also across all of our mental health offerings. With respect to the clinician costs and the $4 million of incremental spend on top of our expectations in January, that was entirely on the physician side and due to the spike in the Omicron variant and higher-than-expected visit volume for our general medical services.

因此，這兩件事的結合非常有利，特別是讓我們對 BetterHelp 產品以及我們所有的心理健康產品都有很好的前景。關於臨床醫生成本和 1 月份超出我們預期的 400 萬美元的增量支出，這完全是在醫生方面，並且由於 Omicron 變體的激增以及我們的一般醫療服務的訪問量高於預期.

So that actually didn't impact mental health at all. We feel very good about the attraction of new therapists onto our platform. I was just talking to the team, we onboarded over 10,000 therapists last year. And just in January, we were over 1,200 new therapists on the platform. So I feel very good about access to additional talent and capacity as we continue to expand that. And that -- the combination of those 2 things, both the continued more effective customer acquisition spend as well as the access to capacity on the supply side, gives me a strong outlook because we are also seeing the benefit of product enhancements to the BetterHelp product, where we roll out things like virtual group sessions that enable us to take advantage of a one-to-many relationship and also, at the same time, increase the lifetime value and retention of our client base. So all of those things together make me very bullish on the outlook for 2022.

所以這實際上根本沒有影響心理健康。我們對新治療師對我們平台的吸引力感到非常滿意。我只是在和團隊交談，去年我們招募了 10,000 多名治療師。就在 1 月份，我們在平台上新增了 1,200 多名治療師。因此，隨著我們繼續擴大這一點，我對獲得更多人才和能力感到非常滿意。而且，這兩件事的結合，無論是持續更有效的客戶獲取支出以及供應方面的產能，都給了我一個強勁的前景，因為我們也看到了 BetterHelp 產品的產品增強帶來的好處，我們推出了諸如虛擬小組會議之類的東西，使我們能夠利用一對多的關係，同時增加客戶群的生命週期價值和保留率。因此，所有這些因素加在一起讓我非常看好 2022 年的前景。

Our next question is from the line of Jailendra Singh of Credit Suisse.

我們的下一個問題來自瑞士信貸的 Jailendra Singh。

First, a quick clarification. Some of these health plans, including HCSC, you're talking about onboarding in the second half. Were they always planned for second half? Or there were any delays for some reasons? Just trying to make sure that -- are you still maintaining your 25% to 35% growth in Chronic Care business in 2022? And is it possible for you to give some specific color around chronic enrollment expectations and cadence there? I think historically, you've talked about 70% to 80% additions coming in first half and looks like things will be different this year.

首先，快速澄清。其中一些健康計劃，包括 HCSC，您正在談論下半年的入職培訓。他們總是計劃下半場嗎？或者由於某些原因有任何延誤？只是想確保——您是否仍保持 2022 年慢性護理業務 25% 至 35% 的增長？您是否有可能針對那裡的長期入學期望和節奏給出一些特定的顏色？我認為從歷史上看，你已經談到上半年會有 70% 到 80% 的增加，看起來今年情況會有所不同。

Yes. So Jailendra, I'll give you -- answer those questions in order. In terms of the onboarding, I would say, in general, that is true. We do have one significant client that had originally planned to launch Jan 1, but candidly, due to their own internal data delays, we are now going to be launching with that client in the beginning of the second half. But I would say more broadly for the rest, it is -- the expectation was going to be launching in the start of the second half.

是的。所以 Jailendra，我會給你 - 按順序回答這些問題。就入職培訓而言，我想說，總的來說，這是真的。我們確實有一個重要客戶原計劃在 1 月 1 日推出，但坦率地說，由於他們自己的內部數據延遲，我們現在將在下半年開始與該客戶一起推出。但對於其餘部分，我會更廣泛地說，它是——預期將在下半場開始時推出。

In terms of the chronic care question that you asked, we have shared in the past that we won't give you very specific sort of outlooks along each of the different tracks that we had talked about on Investor Day every quarter. We plan to do some kind of updates on occasion once a year. But I would say just generally, we had talked about the revenue growth for chronic care back in Investor Day.

關於您提出的慢性護理問題，我們過去曾分享過，我們不會在每個季度的投資者日討論的每個不同軌道上為您提供非常具體的前景。我們計劃每年偶爾進行一次更新。但我想說的是，我們在投資者日討論過慢性護理的收入增長。

We are seeing all of the right trends as we think about chronic care revenue growth. And if I think about exiting the -- a run rate exit for 2022, I am comfortable with the growth rates that expectations that we had set back in November.

當我們考慮慢性護理收入增長時，我們看到了所有正確的趨勢。如果我考慮退出 2022 年的運行率退出，我對我們在 11 月降低的預期增長率感到滿意。

Our next question is from Richard Close of Canaccord Genuity.

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

Given the change in classification in the BetterHelp international visits and the impact -- I guess, the adjustment on utilization, what would be a good target to think about in terms of utilization rates increasing year-over-year? I think you provided some internal targets before.

考慮到 BetterHelp 國際訪問分類的變化和影響——我猜是對利用率的調整，考慮到利用率逐年增加的目標是什麼？我認為您之前提供了一些內部目標。

So if you look at the guidance that we have talked about in terms of how we see our revenue -- our visit volume growth for the full year, right, we gave you guidance for full year, you look at the strength of visit volume momentum in 4Q and for the full year. What, Richard, that gives you is sort of the key elements and ingredients of how -- we've essentially given you all the ingredients and elements on how to think about utilization for full year 2022 as compared to 2021.

因此，如果您查看我們討論過的關於我們如何看待收入的指導——我們全年的訪問量增長，對，我們給了您全年的指導，您會看到訪問量勢頭的強度在第四季度和全年。理查德，這給了你一些關鍵要素和要素——我們基本上已經為你提供了關於如何考慮與 2021 年相比 2022 年全年利用率的所有要素和要素。

So I feel very comfortable with the progress we are making in terms of the strong visit volume growth. And just some further color, just to sort of segue from the comments that Jason made on mental health overall.

因此，我對我們在訪問量強勁增長方面取得的進展感到非常滿意。只是一些進一步的顏色，只是為了從傑森對整體心理健康的評論中脫離出來。

We have talked about the strength that we are seeing in specialty visit volume, right? Specialty visit volume in 4Q grew 50% year-on-year. We've also seen -- as we talked about in our prepared remarks, we are beginning to see growth again in infectious disease volumes, right?

我們已經談到了我們在專業訪問量中看到的優勢，對吧？第四季度的專科訪問量同比增長 50%。我們還看到——正如我們在準備好的評論中談到的那樣，我們開始看到傳染病數量再次增長，對嗎？

Like that was something that was more muted through COVID with social distancing and PPE, et cetera. So these are the inputs that go into the momentum that we are seeing in our visit volume overall for '22, and you can see that in the guidance that we put out there.

就像那是通過 COVID 與社會疏遠和 PPE 等而更加靜音的東西。因此，這些是我們在 22 年總體訪問量中看到的勢頭的輸入，您可以在我們發布的指南中看到這一點。

Our next question is from Sean Dodge of RBC Capital Markets.

我們的下一個問題來自加拿大皇家銀行資本市場的肖恩道奇。

Maybe going back to chronic care. On the launching of the new Chronic Care Complete program, Jason, can you give us just a quick rundown of how that is going to be commercialized? Does that get automatically offered or built into existing chronic condition customers? Or is this something that's going to have to be sold, I guess, maybe more from scratch.

也許回到慢性護理。在啟動新的慢性護理完整計劃時，傑森，您能否簡要介紹一下該計劃將如何商業化？這會自動提供或內置到現有的慢性病客戶中嗎？或者這是必須出售的東西，我猜，也許更多的是從頭開始。

And then the revenue model with the sharing elements of Livongo and legacy Teladoc, is this something that prices like a fixed monthly charge per enrollee? Or is there going to be a variable usage component to it as well?

然後是具有 Livongo 和傳統 Teladoc 共享元素的收入模式，這是否像每個註冊者每月固定收費一樣定價？還是會有一個可變的使用組件？

Yes. Thanks, Sean. We're in the market now with our Chronic Care Complete product line. When you think about the full package, it bundles our diabetes, hypertension and pre-diabetes programs into a comprehensive package for clients which includes physician-based care. The nice thing about that, and I think the unique thing is it not only addresses multiple chronic conditions, but also targets individuals who have -- are having a hard time controlling their A1c or blood pressure, and it helps them to get back on track by optimizing their medications. So only a targeted subset of the members will be engaging with the physician component of that.

是的。謝謝，肖恩。我們的 Chronic Care Complete 產品線現已進入市場。當您考慮完整的套餐時，它將我們的糖尿病、高血壓和糖尿病前期計劃捆綁成一個全面的套餐，供客戶使用，其中包括基於醫生的護理。這樣做的好處是，我認為獨特之處在於它不僅可以解決多種慢性病，還可以針對那些難以控制 A1c 或血壓的人，它可以幫助他們重回正軌通過優化他們的藥物。因此，只有一部分成員的目標子集會參與其中的醫生部分。

When we look at it, it's I think the next step in us rolling out our stepped care approach. And of course, myStrength Complete was the prototype for that. The Chronic Care Complete offering will also have individual sort of single condition offerings into the market. So if you think about diabetes complete or hypertension complete, those will be available with the physician component and we believe that the Chronic Care Complete that's multi-condition will be the most popular option.

當我們看到它時，我認為這是我們推出階梯式護理方法的下一步。當然，myStrength Complete 就是它的原型。 Chronic Care Complete 產品還將向市場推出個別類型的單一條件產品。因此，如果您考慮完全糖尿病或完全高血壓，這些將與醫生組件一起提供，我們相信多病症的慢性護理完全將是最受歡迎的選擇。

It ends up being a fixed per participant per month fee that is sort of a composite, if you will, of the various components where diabetes is a little bit on the higher side than the composite price, hypertension is a little bit on the lower side and pre-diabetes is sort of right in line but it ends up being a very healthy revenue stream and really incent buyers to adopt a multi-condition approach. So I feel very optimistic that, that will be our lead chronic care program in the portfolio as we go through the 2022 selling season.

它最終是每個參與者每月的固定費用，如果你願意的話，這是一種綜合體，糖尿病比綜合價格略高，高血壓略低於綜合價格糖尿病前期是正確的，但它最終成為一個非常健康的收入來源，並真正激勵買家採用多條件方法。因此，我非常樂觀地認為，隨著 2022 年的銷售旺季，這將成為我們投資組合中的主要慢性護理項目。

Our next question is from Charles Rhyee of Cowen.

我們的下一個問題來自 Cowen 的 Charles Rhyee。

Maybe, Mala, I wanted to talk about the first quarter EBITDA guidance. And just trying to understand, as we think about maybe costs related to starting up Primary360 and Chronic Care Complete, et cetera. What percent of those costs would you say are sort of nonrecurring in the sense that now that once you get those programs off the ground, they would not necessarily recur going forward?

也許，馬拉，我想談談第一季度的 EBITDA 指導。並且只是試圖理解，因為我們考慮可能與啟動 Primary360 和 Chronic Care Complete 等相關的成本。你會說這些成本中有多少是非經常性的，因為一旦你開始實施這些計劃，它們就不一定會在未來再次發生？

And just to clarify, I think maybe from Jailendra's question earlier, this chronic care management membership, like what percent of the chronic care membership, that 25% to 35%, is going to be coming from the second half?

為了澄清，我想也許從 Jailendra 早些時候的問題來看，這個慢性護理管理會員，比如慢性護理會員的百分之幾，即 25% 到 35%，將來自下半年？

Yes. So -- the way I would think about the profit progression, the adjusted EBITDA progression and how you should think about the investments really is what you're asking, Charles. So the way it is going to unfold as we go through the year is as follows. First of all, as I said, you will see expansion in adjusted EBITDA margins as we go through the year. Why is that? Because it is sort of following the revenue ramping that we are seeing in the second half of the year, especially as you think about chronic care ramping through the second half of the year.

是的。所以 - 我會考慮利潤增長的方式，調整後的 EBITDA 增長以及你應該如何考慮投資真的是你要問的，查爾斯。因此，隨著我們這一年的發展，它的展開方式如下。首先，正如我所說，隨著我們這一年的發展，您將看到調整後的 EBITDA 利潤率有所擴大。這是為什麼？因為它有點像我們在下半年看到的收入增長，特別是當你考慮到下半年慢性護理的增長時。

If you think about the operating expense lines into which the investments are folded, I would say we expect to see A&M spend sort of -- as we've talked about in the prepared remarks, we are -- there is seasonality in it. And we are spending in the first half of the year as we take advantage of the low media costs and the buying opportunities it provides us, I would say, overall, for the year, I do expect A&M to be slightly higher as a percentage of revenue on a full year basis as we drive the strong growth that we have on the mental health side.

如果您考慮將投資折疊成的運營費用線，我會說我們希望看到 A&M 支出有點——正如我們在準備好的評論中談到的那樣，我們是——其中存在季節性。我們將在上半年進行支出，因為我們利用了低媒體成本及其為我們提供的購買機會，我想說，總的來說，今年，我確實預計 A&M 的百分比會略高全年收入，因為我們推動了我們在心理健康方面的強勁增長。

I do expect us to get leverage as we go through the year on the rest of operating expense, including G&A and selling. And I would say on technology and development, so on the R&D investments that we are making, I think you will see that sort of -- expected to say almost steady, if you will, in terms of percentage of revenue. So they're all slightly different in terms of how we are seeing it ramp through the year. But overall, I would say all of that is what is getting us to the profit margin expansion as we go through the year.

我確實希望我們在這一年中獲得其他運營費用的影響力，包括 G&A 和銷售。我會說關於技術和開發，以及我們正在進行的研發投資，我認為你會看到那種 - 如果你願意的話，預計會說幾乎穩定，就收入百分比而言。因此，就我們如何看待它在一年中的增長而言，它們都略有不同。但總的來說，我想說所有這些都是讓我們在這一年中實現利潤率增長的原因。

Our next question is from Jessica Tassan of Piper Sandler.

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

So I think we were really impressed to hear that BetterHelp customer acquisition cost is down. Can you maybe help us understand how some of the consumer privacy initiatives from Apple and Google, specifically Apple's app tracking transparency policy might be impacting your DTC advertising cost and productivity? And kind of what are you guys doing to mitigate the impact of those policies.

所以我認為聽到 BetterHelp 客戶獲取成本下降的消息給我們留下了深刻的印象。您能否幫助我們了解 Apple 和 Google 的一些消費者隱私計劃，特別是 Apple 的應用跟踪透明度政策可能會如何影響您的 DTC 廣告成本和生產力？你們正在做些什麼來減輕這些政策的影響。

Yes. Jess, thanks for the question. We've actually taken those all into account as we've built our models. Our team is very closely monitoring all of the developments there. I would say that we are ahead of the curve with respect to understanding what's going on there and modeling anything that would or potentially have any impact on our strategies. But with the current situation and our insight there, we don't see any significant impact on our outlook.

是的。傑斯，謝謝你的問題。實際上，我們在構建模型時已將所有這些都考慮在內。我們的團隊正在密切關注那裡的所有發展。我想說的是，在了解那裡正在發生的事情以及對可能或可能對我們的戰略產生任何影響的任何事情進行建模方面，我們處於領先地位。但就目前的情況和我們的洞察力而言，我們認為不會對我們的前景產生任何重大影響。

Our next question is from Daniel Grosslight of Citi.

我們的下一個問題來自花旗的 Daniel Grosslight。

I want to stick with BetterHelp here. Some of your competitors have had difficulties with churn and retention. Are you seeing any degradation in LTVs for 2022 in the DTC channel? And then in the B2B channel, I think it's a little less apparent, but BetterHelp is actually growing quite nicely in the EAP channel. I notice, Citi is now offering BetterHelp through our EAP. Can you talk about growth of BetterHelp in the enterprise channel apart from the DTC channel?

我想在這裡堅持使用 BetterHelp。您的一些競爭對手在流失和保留方面遇到了困難。您是否看到 DTC 頻道中的 2022 年 LTV 有任何下降？然後在 B2B 渠道中，我認為它不太明顯，但 BetterHelp 實際上在 EAP 渠道中發展得非常好。我注意到，花旗現在通過我們的 EAP 提供 BetterHelp。您能談談 BetterHelp 在 DTC 渠道之外在企業渠道中的成長嗎？

Sure. We're actually seeing improvement in our LTV. I'm aware of some of the other players in the market. I would say our team has a tremendous track record of continuing to improve LTV. That's a combination of optimizing pricing and driving product enhancements that increase the longevity of those members. I feel like sometimes having others out there who aren't performing at the same level, casts a negative shadow. And to be honest, we just outperformed in that market and in that regard.

當然。我們實際上看到了 LTV 的改善。我知道市場上的其他一些參與者。我想說我們的團隊在繼續提高 LTV 方面有著出色的記錄。這是優化定價和推動產品改進的結合，可以延長這些成員的壽命。我覺得有時有其他人在同一水平上表現不一樣，會產生負面影響。老實說，我們只是在那個市場和這方面表現出色。

With respect to BetterHelp in the B2B channel, we are finding a fertile environment among EAP plans, the model there is sort of a B2B2C customer acquisition strategy, where BetterHelp gets embedded in an EAP plan and a certain set of interactions are included in the EAP expense. And then after that, there's a warm transition into a direct paying consumer as the consumer exhausts the EAP benefit. We're finding that as an efficient not only customer acquisition strategy, but one that provides more value than the typical EAP plan of the past and is therefore valuable both to the consumer and to the sponsoring employer.

關於 B2B 渠道中的 BetterHelp，我們在 EAP 計劃中找到了一個肥沃的環境，該模型有一種 B2B2C 客戶獲取策略，其中 BetterHelp 嵌入到 EAP 計劃中，並且 EAP 中包含了一組特定的交互費用。在那之後，隨著消費者用盡 EAP 福利，向直接付費消費者的轉變是一個溫暖的過程。我們發現，這不僅是一種有效的客戶獲取策略，而且比過去典型的 EAP 計劃提供更多價值，因此對消費者和讚助雇主都很有價值。

Our next question is from George Hill of Deutsche Bank.

我們的下一個問題來自德意志銀行的喬治希爾。

Yes. I'm going to come back to BetterHelp one more time. And I guess, Mala, I'd ask -- you used the word persistency in your prepared comments. I guess, could you provide a little bit more color as it relates to the behavioral product of how much of it is growth of new members and kind of how much of it is growth of revenue per member? And kind of what is the right way to think about that as we think about the contribution of the growth of the behavioral product over time?

是的。我將再次回到 BetterHelp。我想，Mala，我會問——你在準備好的評論中使用了持久性這個詞。我想，你能否提供更多的顏色，因為它與行為產品有關，其中有多少是新成員的增長，有多少是每個成員的收入增長？當我們思考行為產品隨時間增長的貢獻時，正確的思考方式是什麼？

Yes. So George, I would say it's all of those. So if you think about the -- let me address it from both the DTC side as well as the B2B side. On the direct-to-consumer side, as we think about the momentum that we are seeing in BetterHelp, we are absolutely seeing all of the, what I would call, the operating metrics make a tremendous amount of healthy progress, whether it be the number of members, whether it be better -- lower churn and greater retention that is feeding the increasing LTV.

是的。所以喬治，我會說這就是所有這些。因此，如果您考慮-讓我從DTC 方面和B2B 方面來解決它。在直接面向消費者方面，當我們考慮在 BetterHelp 中看到的勢頭時，我們絕對看到了所有的，我所說的，運營指標取得了巨大的健康進步，無論是會員數量，無論是更好的——更低的流失率和更高的留存率，這為不斷增加的 LTV 提供了動力。

Jason just talked about what is fueling that in terms of product innovation, et cetera. And whether it be customer acquisition costs, right? And again, we have talked about why are our customer acquisition costs being managed as tightly and efficiently as it is. It is about continuously innovating with new media channels. It's things like that, that is getting us to really strong execution on the operating metrics.

Jason 剛剛談到了產品創新等方面的推動因素。以及是否是客戶獲取成本，對嗎？再一次，我們談到了為什麼我們的客戶獲取成本得到如此嚴格和有效的管理。它是關於不斷創新新媒體渠道。就是這樣，這讓我們在運營指標上執行得非常出色。

So I would say on the direct-to-consumer side, George, to answer your question, it is both more membership. It is greater LTV. And all of that is what feeds our growing revenue per member, if you will. The other thing to not underestimate is the fact that if you think about just BetterHelp as a direct-to-consumer business, the ability for us to price through in terms of the innovation that we are seeing, et cetera, is much more dynamic.

所以我會說直接面向消費者方面，喬治，回答你的問題，這既是更多的會員資格。它是更大的 LTV。如果您願意的話，所有這些都是我們不斷增長的每位會員收入的來源。另一件不可低估的事情是，如果您將 BetterHelp 視為直接面向消費者的業務，那麼我們根據我們所看到的創新等因素進行定價的能力將更具活力。

And we use data -- our data science capabilities, et cetera, in a very, very dynamic way, such that we can manage our overall margins and profitability for that business. I would say, very similar dynamic that we are seeing on the B2B side, right? Whether it be starting with the tremendous visit volume momentum that we are seeing in mental health -- in sort of our legacy mental health business. And the progress that we are making as I look at the pipeline for our myStrength Complete product that, as you know, we launched in the middle of last year, once again, we are seeing tremendous traction in the demand for our B2B mental health product.

我們以一種非常、非常動態的方式使用數據——我們的數據科學能力等等，這樣我們就可以管理該業務的整體利潤和盈利能力。我想說，我們在 B2B 方面看到的動態非常相似，對吧？無論是從我們在心理健康領域看到的巨大訪問量勢頭開始——在我們傳統的心理健康業務中。當我查看我們在去年年中推出的 myStrength Complete 產品的管道時，我們正在取得的進展，我們再次看到對 B2B 心理健康產品的需求有著巨大的吸引力.

Unsurprisingly, just given the total addressable market that is out there and the fact that we are absolutely the leader in mental health, the scale that we have in mental health is something that is helpful for us in attracting providers in getting to the economics and the execution that we are demonstrating in our numbers. So it's all of the above.

毫不奇怪，考慮到整個潛在市場以及我們絕對是心理健康領域的領導者這一事實，我們在心理健康領域的規模有助於我們吸引提供者進入經濟和我們在數字中展示的執行力。所以以上都是。

Our next question is from Stephanie Davis of SVB.

我們的下一個問題來自 SVB 的 Stephanie Davis。

I'm going to go a little bit away from the BetterHelp side of the world and actually ask more about Primary360. As this product scales up a bit more, I'd be curious in your thoughts on care navigation, how that ties in or if there is some investments to [internal care navigation] as you kind of build it out.

我將稍微遠離世界的 BetterHelp 方面，實際上詢問有關 Primary360 的更多信息。隨著這個產品的規模擴大一點，我很好奇你對護理導航的想法，它是如何联繫起來的，或者在你建立它時是否對 [內部護理導航] 進行了一些投資。

Yes. Stephanie, thanks for the question. We're really excited by the progress we're making with Primary360. The market adoption has been very strong. Consumer experience data is off the charts with 95% member satisfaction. And what we're finding is the clinical impact that we make is very significant, identifying large populations of first diagnosis for chronic conditions, either adding or altering prescriptions and to your question about helping consumers find the right care when they need to be seen in-person.

是的。斯蒂芬妮，謝謝你的問題。我們對 Primary360 取得的進展感到非常興奮。市場採用率非常高。消費者體驗數據超乎想像，會員滿意度達 95%。我們發現我們所做的臨床影響非常顯著，確定了大量慢性病的首次診斷人群，添加或更改處方以及幫助消費者在需要時找到正確護理的問題-人。

When people talk about care navigation, they mean a lot of different things. And so I want to tell -- explain what we mean by that. We mean helping the consumer get the care they need in the course of their overall health care. That does not mean administrative navigation to us. What it does mean is using the data that we have about the consumer, the actual delivery of care and deep interaction we have with the consumer to make sure that they get to the right site of care the first time.

當人們談論護理導航時，他們意味著很多不同的東西。所以我想告訴——解釋一下我們的意思。我們的意思是幫助消費者在他們的整體醫療保健過程中獲得他們需要的護理。這對我們來說並不意味著行政導航。這意味著使用我們擁有的關於消費者的數據、實際提供的護理以及我們與消費者的深度互動，以確保他們在第一時間到達正確的護理地點。

Given the combination of our digital interactions with them using devices and their interactions with our platform, the care delivery interactions we have driven out of our virtual visits, both on the mental and physical side and given our unique capabilities when it comes to expert medical opinions from our depth of experience there, we feel like we are uniquely positioned because we deeply integrate with the health plan to be able to make the most efficient referral for them when they need to be seen in-person and then act as almost a concierge on their behalf. So when we talk about care navigation, that's what we mean because we think that's the highest value form of care navigation.

鑑於我們使用設備與他們進行數字互動以及他們與我們平台的互動相結合，我們在心理和身體方面都擺脫了虛擬訪問的護理交付互動，並在專家醫療意見方面賦予了我們獨特的能力從我們在那裡的豐富經驗來看，我們覺得我們處於獨特的位置，因為我們與健康計劃深度整合，以便能夠在他們需要親自看到時為他們提供最有效的轉診，然後幾乎充當禮賓代表他們。所以當我們談論護理導航時，這就是我們的意思，因為我們認為這是護理導航的最高價值形式。

Our next question is from Ryan MacDonald of Needham.

我們的下一個問題來自 Needham 的 Ryan MacDonald。

On Primary360, I wanted to touch on the insurer channel. And you talked about the relevance that you're seeing for the offering within Virtual First plan. Just curious if you think that this is -- the growth of that product is dependent on the proliferation and addition of additional Virtual First plan? Or do you think that you can actually start to weave this into traditional plans as well?

在 Primary360 上，我想談談保險公司渠道。您談到了您在 Virtual First 計劃中看到的產品的相關性。只是好奇您是否認為這是-該產品的增長取決於其他Virtual First計劃的擴散和添加？還是您認為您實際上也可以開始將其編織到傳統計劃中？

Yes. I think the answer is both. Virtual First plan designs can be an accelerator because, of course, they provide financial incentives to the consumer to engage in a virtual primary care relationship. But I don't think that the success of Primary360 is dependent on the proliferation of Virtual First plan designs. What we see with the clinical impact that we're having as well as the member experience that we're having is one where I believe, over time, it will be a sought-after relationship and a sought-after product that driven as much by the consumer as by the plan design because of the opportunity to have more frequent interactions, to have access to a full care team, to have access to digital interactions and to get the power of the underlying data science to help drive a more personalized and better health care outcome.

是的。我認為答案是兩者兼而有之。 Virtual First 計劃設計可以成為加速器，因為當然，它們為消費者提供參與虛擬初級保健關係的經濟激勵。但我不認為Primary360 的成功取決於Virtual First 計劃設計的普及。我們所看到的臨床影響以及我們所擁有的會員體驗是，我相信，隨著時間的推移，它將成為一種搶手的關係和搶手的產品。消費者和計劃設計一樣，因為有機會進行更頻繁的互動，可以使用完整的護理團隊，可以使用數字交互並獲得基礎數據科學的力量，以幫助推動更加個性化和更好的醫療保健結果。

Our next question is from Stan Berenshteyn of Wells Fargo.

我們的下一個問題來自富國銀行的 Stan Berenshteyn。

Jason, maybe on chronic care, can you give us an update on where you stand in regards to chronic care products that are outside of the diabetic/hypertension verticals?

Jason，也許是關於慢性護理的，您能否向我們介紹一下您在糖尿病/高血壓垂直領域之外的慢性護理產品方面的最新情況？

Yes. So as you know, we launched a CKD product for chronic kidney disease. You could make the argument that that's on the same continuum, but it's a different manifestation, and obviously, a more severely ill and higher-cost population as well. You've heard us talk about continuing on the cardiometabolic continuum and branching out into other areas. I'm not going to sort of preannounce where we're going to go in our next set of chronic conditions. But what I can say is that our team is actively working on several expansion opportunities as we consistently look to expand the scope of our clinical offerings to be able to take care of the entirety of an individual and access additional populations.

是的。如您所知，我們推出了針對慢性腎病的 CKD 產品。你可以說這是同一連續體，但這是一種不同的表現形式，顯然，還有更嚴重的疾病和更高成本的人群。你聽說我們談論繼續心臟代謝連續體並擴展到其他領域。我不會預先宣布我們將在下一組慢性病中去哪裡。但我能說的是，我們的團隊正在積極尋求幾個擴張機會，因為我們一直在尋求擴大我們臨床產品的範圍，以便能夠照顧到整個個人並接觸更多的人群。

Our next question comes from Steven Valiquette of Barclays.

我們的下一個問題來自巴克萊銀行的 Steven Valiquette。

So all the color on the quarterly progression of the revenues and EBITDA was helpful. But with the 1Q '22 EBITDA margin guide in the 9% to 9.5% range and then just thinking about what you said about the revenue ramp happening in the back half of the year, just kind of playing around the model, it seems like the EBITDA margin would have to be somewhere in the high teens for the fourth quarter, maybe 17% or so, which is really the margin that I think consensus wouldn't really reflect the company hitting on a full year basis for another 3, 4 years or so from the 13% jump-off point from last year. I guess I just want to make sure that we're not missing anything in relation to what seems like that margin -- EBITDA margin again in the kind of high teens for the fourth quarter as we kind of just sort of build out all -- everything that you talked about.

因此，收入和 EBITDA 的季度進展的所有顏色都是有幫助的。但是，在 22 年第一季度 EBITDA 利潤率指南在 9% 到 9.5% 的範圍內，然後想想你所說的關於今年下半年發生的收入增長，只是在玩這個模型，似乎第四季度的 EBITDA 利潤率必須在十幾歲左右，可能在 17% 左右，這確實是我認為共識並不能真正反映公司在未來 3 年、4 年內實現全年業績的利潤率大約從去年的 13% 起跳點開始。我想我只是想確保我們不會遺漏任何與該利潤率相關的任何東西——第四季度的 EBITDA 利潤率再次處於高位，因為我們有點像建立了所有——你所說的一切。

Yes. So as you think about -- as we think about the ramp, you are right. What I would say is you are in the right ballpark. We have talked about the seasonality of revenue ramping in the second half, especially on the chronic care side. You know the margins that come with chronic care revenue. So it's not surprising that we are -- the ramp of profit and the expansion of margin is going to be back half weighted. So yes, you are in the right ballpark, absolutely, on seasonality.

是的。所以當你想到 - 當我們想到坡道時，你是對的。我要說的是你是在正確的球場。我們已經談到了下半年收入增長的季節性，特別是在慢性護理方面。您知道慢性護理收入帶來的利潤。因此，我們毫不奇怪 - 利潤的增長和利潤率的擴大將是後半部分權重。所以，是的，你在正確的球場上，絕對是季節性的。

Our next question comes from the line of David Larsen of BTIG.

我們的下一個問題來自 BTIG 的 David Larsen。

Can you talk about the impact, if any, that -- and to the public health emergency might have on the overall business. I think it's scheduled to go through mid-April, like April 16. So if we actually get through that and it's not extended again, what impact could that have on the business? Like, for example, like reimbursement for telehealth visits at parity with in-person visits, how could that change, if at all, and then also plan designs with like co-pays and deductibles being waived for COVID patients? Just any thoughts there, along with expected trends from COVID in '22 would be helpful.

您能否談談對公共衛生緊急事件可能對整體業務產生的影響（如果有的話）。我認為它計劃在 4 月中旬進行，比如 4 月 16 日。因此，如果我們真的通過了它並且不再延長，這會對業務產生什麼影響？例如，像遠程醫療就診的報銷與親自就診一樣，這種情況如何改變（如果有的話），然後還計劃設計為 COVID 患者免除類似的共付額和免賠額？那裡的任何想法以及 22 年 COVID 的預期趨勢都會有所幫助。

Yes. I don't think it will have any real impact on our outlook. Most of the plan designs that had waived co-pays on virtual visits have reverted back to charging co-pays for those visits. Most of the states who had waived licensure requirements have reverted back to requiring in-state licensure. Almost none of our business is Medicare fee-for-service. And therefore, we're really not sensitive to Medicare reimbursement. We don't get reimbursed at parity when we provide visits for our populations, we get reimbursed for our agreed-upon fees which are not at parity with an in-person visit and part of the attraction of them, quite frankly.

是的。我認為這不會對我們的前景產生任何實際影響。大多數放棄虛擬訪問共付額的計劃設計已恢復為對這些訪問收取共付額。大多數已經放棄執照要求的州已經恢復到要求州內執照。我們幾乎沒有一項業務是按服務收費的醫療保險。因此，我們對醫療保險報銷並不敏感。當我們為我們的人口提供訪問時，我們不會得到同等的報銷，坦率地說，我們得到的報銷是我們商定的費用，這些費用與親自訪問和他們的部分吸引力不相等。

So I actually don't see any real impact. The other part where I think we're beyond any questions about sort of the national health emergency is reimbursement for chronic care management, the impact of value-based care and value-based reimbursement aligns us with both the payer as well as the provider when they're taking risk. So I see really only tailwinds going forward. And as you probably know, there are several movements within Congress to continue to expand the support for both from a regulatory as well as reimbursement perspective the continued expansion of virtual care.

所以我實際上沒有看到任何真正的影響。我認為我們對國家衛生緊急情況有任何疑問的另一部分是慢性護理管理的報銷，基於價值的護理和基於價值的報銷的影響使我們與付款人和提供者保持一致他們在冒險。所以我真的看到了前進的順風。正如您可能知道的那樣，國會內部有幾項運動從監管和報銷的角度繼續擴大對虛擬護理的持續擴展的支持。

Our next question is from Dev Weerasuriya of Berenberg.

我們的下一個問題來自 Berenberg 的 Dev Weerasuriya。

Want to circle back to the operating margins and just margins in general in relation to kind of the customer acquisition costs and related sales and marketing spend required to keep patients engaged. And I'm just trying to get some color around how these differ -- we got a lot of color around BetterHelp, but maybe for P360 as well as Chronic Care, kind of how the cadence moves from, let's say, the quarter that you onboard the client toward kind of Q4 or the subsequent quarters?

希望回到運營利潤率，以及與客戶獲取成本以及保持患者參與所需的相關銷售和營銷支出相關的一般利潤率。我只是想了解一下它們的不同之處——我們在 BetterHelp 周圍有很多顏色，但也許對於 P360 和慢性護理，節奏是如何從你所在的那個季度開始變化的將客戶帶入第四季度或隨後的季度？

And then kind of the second question in relation to that is, so we see this sequential ramp-up in margin, some leverage on, I would assume, on the sales and marketing side and as well as other operating leverage through the year. How would that -- or what kind of changes are there from a year-to-year basis instead of within a year as well?

然後是與此相關的第二個問題，所以我們看到利潤率的連續上升，我認為在銷售和營銷方面以及全年的其他運營槓桿方面有一些影響。那將如何 - 或者每年而不是一年內會有什麼樣的變化？

Okay. So I'll address them in turn, Dev. If you think about the sales and marketing, as you talked about for Primary360 and Chronic Care, again, what I would say is that is where we look to the ramping of our B2B engagement marketing spend. And we have thought about the ramping of that as we -- ahead of the launches, so that, again, we are looking at pacing the timing of our A&M spend for visit volumes as we go through the year. This is on the legacy telehealth side. But as we really scale -- as the populations launch for Chronic Care, think of the spend -- the marketing spend on that roughly sort of consistent and pacing that, right? So we need the program to launch. We need the clients to launch, and then we will do the work we do on engaging with those so that we get the appropriate enrollment sort of ramping up once those clients launch on the Chronic Care side.

好的。所以我會依次解決它們，Dev。如果您考慮銷售和營銷，就像您談到 Primary360 和慢性護理一樣，我想說的是，這就是我們希望增加 B2B 參與營銷支出的地方。我們已經考慮過在發布之前增加這一點，因此，我們再次考慮在一年中調整我們的 A&M 訪問量的時間安排。這是在傳統的遠程醫療方面。但隨著我們真正擴大規模——隨著人口開始接受慢性護理，想想支出——營銷支出大致保持一致和節奏，對嗎？所以我們需要啟動程序。我們需要客戶啟動，然後我們將開展與這些客戶互動的工作，以便一旦這些客戶在慢性護理方面啟動，我們就會獲得適當的註冊。

And I'd say similarly on Primary360. So think of the client launches and the spend on the B2B marketing side as sort of consistent with that -- the marketing spend that we do on our other telehealth -- normal telehealth visit volumes, whether it be infectious diseases or specialty, think of that consistent with prior years. I think we have plenty of history, demonstrated history on the spend we do on that and the success we have on driving the momentum on that.

我會在 Primary360 上說同樣的話。因此，將客戶發布和 B2B 營銷方面的支出視為與此一致——我們在其他遠程醫療上所做的營銷支出——正常的遠程醫療訪問量，無論是傳染病還是專科，想想看與往年一致。我認為我們有很多歷史，證明了我們在這方面的支出以及我們在推動這方面勢頭方面取得的成功。

On your second question in terms of year-over-year, as I said a few minutes ago, there's no question. We are investing in our A&M spend as we -- especially on the direct-to-consumer side, and so we do expect to see growth in A&M spend. I sort of talked about the relation of that with our revenue. And I want to be clear, that is with the fact that we are seeing sort of the customer acquisition costs continue to be very efficient.

正如我幾分鐘前所說，關於你的第二個問題，這是毫無疑問的。我們正在投資我們的 A&M 支出——尤其是在直接面向消費者方面，因此我們確實希望看到 A&M 支出的增長。我談到了這與我們的收入的關係。我想明確一點，這是因為我們看到客戶獲取成本仍然非常有效。

So we continue to see the efficiencies in our marketing spend on that. We do expect to see G&A leverage. We have done that in prior years, and I would expect to continue to get operating leverage on the G&A line as our revenue ramps. And as I said a few minutes ago, we will invest, as we have shared on Investor Day, on our technology road map, on our product innovation road map and therefore, in R&D. So there are sort of -- hopefully, that gives you more color on the different line items within operating expense in '22 and how that compares to prior year.

因此，我們繼續看到我們在這方面的營銷支出的效率。我們確實希望看到 G&A 的影響力。我們在前幾年已經這樣做了，隨著我們的收入增長，我預計將繼續在 G&A 線上獲得運營影響力。正如我幾分鐘前所說，正如我們在投資者日分享的那樣，我們將投資於我們的技術路線圖、我們的產品創新路線圖，因此也會投資於研發。因此，有一些 - 希望這能讓您在 22 年的運營費用中為您提供更多顏色，以及與上一年相比如何。

There are currently no further questions waiting at this time. So that concludes the Teladoc Fourth Quarter 2021 Earnings Call. Thank you all for your participation. You may now disconnect your lines.

目前沒有其他問題在等待。 Teladoc 2021 年第四季度財報電話會議到此結束。謝謝大家的參與。您現在可以斷開線路。