I'm gonna get started here. Just make sure this is on there. We're gonna get started here with our next session in healthcare services. I'm Scott Fidel. I'm the Healthcare Services Analyst with Stephens. Really pleased to have our next panel with Modivcare. We've got a nice contingent of the management team here up on the stage with me. To my right, we've got Heath Sampson. Heath is the President and CEO. Barb Gutierrez to my left. Barb just recently joined the company as Chief Financial Officer, so it's great to have you here. Also to my left, we've got Kevin Ellich. Kevin is VP of Investor Relations. Then also to the far right here, we've got Ken Shepard.
Ken is the CFO of the non-emergency medical transportation business, which is Modivcare's largest business. Modivcare is a provider of several different solutions for customers, focused on the largest business is the non-emergency medical transportation business. They're the largest provider of those services in the country. Then, that's with their mobility business, and then they have a home business, which includes two platforms: Personal Care and then also remote patient management. So great to have you all here with us today. Heath, I thought maybe just to kick the mic over to you if you wanted to just-
Mm-hmm
... You know, maybe give a quick introduction to Modivcare. It's, it's been a pretty dynamic year.
Mm-hmm.
Sort of a lot going on, so maybe if you wanted to just sort of try to package that together-
Mm-hmm
... Into what you think the key themes are for investors here-
Mm-hmm
... As we're sort of, you know, wrapping up 2023-
Mm-hmm
... And starting to look ahead to 2024.
Yeah, great. Well, thanks for having us. I really appreciate it. Welcome to everybody here. First I'll start off, you, you talked about the different services we have, and I'll start maybe from a, from a customer perspective and why that's the case, 'cause that's where I just drove up from Louisville, meeting with a customer, talking about why they choose us and, and these specific services. And I'm sure at this conference or everywhere after this, you're in, in front of payers as well. So our main customers, though facilities providers are also customers, but really the payers are our customers, and this was the discussion I had around our services.
And first thing is, and this is just the way it is, if you think about what the pressures of what payers are going under, they're struggling with access, quality, and cost. So our individual services, whether that's NEMT, Personal Care, or devices in home, those have to be the best service at the lowest cost. But really what's driving the stickiness and ensuring that we have the right growth and margin, is that we understand their member, and we understand their member around not just the transaction, but what that transaction does for this. And why I say that's important, for transportation, our biggest issue, which we're gonna get into all the right stuff around margin and cash flow.
But really for us, because we're the largest, because we have scale, because these 34 million members, when we get individuals and talk to our customers that way, that's why we stick. We spent half of my customer meeting today, which was on dialysis members, and what we can do for those dialysis members around quality, access, and cost. This gets back to why our services win in the end to our customers, is because we have unique access. They see... sometimes it's hard for the payer to get in touch with their customer. We see their customer every day, whether that's for a trip, whether that's in someone's home for four hours or 24 hours, or we have a device. So you think about that for a second.
That access is really the differentiator for us, and then access at scale across all our services, that's the strategy in the future. That's why we grow, that's why we win. So that's now that I have a wonderful team in place, if some of you who I've talked to in the past know that there's been a lot of change, so I've been wearing multiple hats. My focus now is on customers and driving that, and I look forward to sharing more around that. So then taking a step back, which is, thanks, Heath, for that, but really kind of where has the business been? And if you look at, it's been about a year since I've been full-time in this role, and a lot of the transformation has been standard blocking and tackling around people, ops excellence, kind of growth and innovation.
So we've invested in all those, a big chunk of that operational excellence to ensure that we can take advantage of our scale and size, and that's really across all our businesses that we've been doing. And then within the last year, a lot of the change coming out of COVID. Again, I'm sure this question happens, just about everybody that's here at this stage or anybody else. What's happening with kind of utilization or normalization of healthcare? That is felt more than any in our transportation business or NEMT business, and the reason for that is because of the way the contracts are structured. It's a capitated model for us, and that caused a lot of noise within our working capital, and even as we come out into more normalized margin. That was the story of the past and really crescendoed in Q2.
So in Q2 when we settled that all up, it was a big drain on our working capital, and then we're getting back to kind of some normalized margins. So Q3 now is this reset. Everything that I said on the Q2 call, we've delivered on... and really is getting back to executing on that strategy. And then the focus is within, within NEMT now is, "Oh, okay, I see this business is working after COVID. You're generating cash, you're generating margin. Great!" So we're at the really good point now for people to listen to the strategy, and then also we're gonna get into this dig into that NEMT business to ensure that we have the rigid growth and rigid margins that I've been talking about. So I look forward to it. I couldn't be more...
I'm sure there's people on the phone from my team listening, and I really couldn't be more happy about the leadership team, and all the way down to all the changes that we have made and people leaning in. So I look forward to sharing that for the rest of the meeting.
All right, great. Well, thanks, thanks for that intro, Heath, and, let's start with digging into the NEMT business.
Mm-hmm.
Obviously, that's been sort of front of mind-
Mm-hmm
... You know, throughout this year. You know, core platform for the company, obviously has faced some digestion sort of post-COVID-
Mm-hmm
... Snd it's sort of, you know, evolving towards normalization. So margins have clearly, probably of anything-
Mm-hmm
... NEMT margins, I would say, would be the key sort of-
Mm-hmm
... Near-term focus for investors. Clearly, you saw that, degradation in the second quarter.
Mm-hmm.
Sub-6%, now you've started working your way up,
Mm-hmm
... You know, in the third quarter. Still plenty of room-
Mm-hmm
... Though, to get back to that sort of 9%-12%-
Mm-hmm
... Long-term range. I think, you know, let's sort of think about getting to 9%-10% right first-
Mm-hmm
… Even before—
Right
... The 11%-12% I think everybody would think would be reasonable. So we're gonna definitely dig into some of the key drivers of that, but, I think it is, you know, there's... Because of the importance, you know, of this sort of, metric-
Mm-hmm
... Maybe start with,
Mm-hmm
... Before we sort of dig in, how should investors be thinking about-
Mm-hmm
... That, that trajectory of NEMT-
Mm-hmm
... Margins as we think about-
Mm-hmm
... Your 2023 guidance, sort of what's implied for 4Q?
Mm-hmm.
And then how does that sort of evolve, you know, into next year?
Yeah. So, I'll start with the drivers, and you're starting to see the business come out of COVID, and the stuff we did in the past to make sure that we have rigid margins. So we're in that kinda, call it 6%-7%. We're in that 7% range. So that's the right range to base off of, and then how do we grow around that? And really how we get to 9%-10%, because of all the things we did in the past, and specifically over these last two years. Let me start there first. The NEMT business is made up of many different contracts, whether that's full capitated, full risk, to shared risk, to kind of fee-for-service.
That kind of mix was misbalanced in the past, as well as even within individual contracts, we were misbalanced from a pricing perspective. So a big part of what we've done over the last 12-18 months is get the right contracts in place to ensure that all the contracts blend to right... to this margin that we've guided to, this 9%-12%. So that hard work really set us up to ensure that we really protected the downside in margins. So that's the right way to think about it today. So that's where we are today. So now how do you get back up? And really, the main- there's two main reasons, and these are gonna seem obvious.
It really is for us. We're pretty manual when we talk about engaging with members, whether most of it's via phone call, and then when we do a trip across, we do 34 million trips, as well as 34 million members. Those are done with people in the field. So that, automating or modernizing that line item, is what gets us back to the low end of our range. It's that simple. So, so protected, the contracts are set. Control what we can control. Modern automation, that I'll talk about probably in a little bit, is gonna get us back to that margin.
And then on top of that, how you get more scale too, is winning in sales, and we've completely transformed our go-to-market strategy, all the way from what we do in the field to what we do at the C level, hunters versus farmers versus account managers, and then really, and, and, and this is why we're winning all the time, this is why we won $110 million TCV last quarter. This is why we won $138 million TCV this quarter. This is why we have a lot of confidence in our $700 million of MCO business. Why we have a lot of confidence winning more of that $1.3 billion state business. It's because we have the transportation business set right. We have the scale, we have the performance, and then it gets back to...
I'll tie this back to why our customers are buying from us is that discussion I had at the beginning. The trip is just table stakes in my mind. It really is, what are you doing around that member? And because we have 34 million members, and because we have national contracts with these people, we can really move the needle for them to ensure cost is taken out, Star Ratings improve, and if we do that, they'll stay with us all day, which is why you're seeing the growth. We are winning way more than we're losing, by far, especially for the people that understand that. So in summary, with where we are with NEMT, there's no shortage of work that we have to do. There's a lot. We have the team in place, a new team in place.
We have lots of project management around that. We need to get that cost out, and we will get that cost out. We think it's around $90 million in total. To offset redetermination, we kinda need to get about $30 million. So that's the right way to think about it if you wanna understand timing. Redetermination, about $30 million, if you take the midpoint. Costs that we need to get out to match that off. So then when you do that, and we exit out of this year, we should be at the lower range of our exiting, exiting the lower end of that 9% range. And then in 2025, the things that I just talked about, we should start ticking back up into that higher range.
A lot of conviction around the past, a lot of proof that needs to continue to show up, and it will for us, that COVID's behind us, and we're excited about that.
Okay, and even thinking about even more short term, so if we are at the 7.3% margin-
Mm-hmm
... In the third quarter-
Mm-hmm
... Where do you see that exiting? You know, sort of, and that's embedded into the outlook for the, you know, at the end of this year.
Yeah, so you should see it kind of holding around this kind of 7.75-
Okay
... Range, and it mainly is, it's the timing of redetermination and the timing of the cost outflow, right?
Mm-hmm. Mm-hmm.
And when redetermination starts kind of slowing down, our costs should be picked up, then you'll start seeing it tick up.
Mm-hmm.
So the right guess, and this is a guess, around timing of redetermination, we have a really good handle on the total, like most people do, and we have... It's, in between our range would be $30 million. We said $20 million-$40 million, so let's just take $30 million for the sake of it. We feel good about that. It's just the timing of the peak. The right way to think about it based on everything that's been happening, is probably mid-2024. It was a little earlier before. You've heard people say because of the states ran, it's likely gonna be around that. So that fits well for aligning to all the initiatives that we have in place on the cost side to match.
So, think about margins kind of being in that range, and then coming out of mid-2024, it should start ticking up and exit at that 9% range.
Okay.
It's a great way to think about it.
Okay, so-
Though we haven't guided yet.
Yeah.
And we'll, we'll do that... It's tough to give a specific number out until you give the whole picture, but at the same time, I appreciate the complexity in the, in the NEMT business, so I wanna... Hopefully this is helpful for people to start boxing in and thinking about it.
Yeah, absolutely. Yeah, that's, that's not an easy business externally-
Mm-hmm
... To sort of be able to get all the pieces-
Yeah
... You know, to predict margins, so.
Yeah, ironically, though, and so externally, it's tough for you guys to look at. Customer-wise, the reason why I get C-level discussions is because it really matters to them. Whether that matters to them because we know, whether that's an MA or Medicaid, that getting people to their doctor, and now plans are responsible for outside of the clinical, they just are, transportation is critical. And then also, when it goes wrong, it really goes wrong. The letter gets sent to the CEO. So ironically, that sounds tough. Ironically, we're getting a lot of attention, and then now that we're showing what we can do beyond the trip is allowing us to win as many contracts as we are, not just in NEMT, but across the entire company.
Yeah. And so if we even sort of took what you just said there, and, you know, exiting 2024 at 9% would certainly be a big step forward.
Mm-hmm.
Frankly, I don't think we've even got that in our-
Yeah
... In our model at this point. But it sounds like from what you're saying, we should maybe think about it as a step function with sort of a tale of two halves, where-
Mm-hmm
... You're gonna have a sort of profile for the first half of 2024-
Mm-hmm
... that's gonna still reflect the headwind from redetermination, implementing these cost saves.
Right.
And then as we get into the back half of next year, you're gonna have the redeterminations having sort of played out, the cost savings, you know, sort of ramping further, and there's just gonna be a step function higher-
Correct
... In the margins.
Yeah, that's the way to think about it.
Okay.
All near-term stuff, right? And we I think we've done a good job this last quarter, and we'll continue to do going forward, is really around kind of timing around redetermination and timing around the cost. It's controllable to me right now, which is a great place to be.
Okay. And then sort of a critical element of that clearly is the cost savings and-
Mm-hmm
... So we've got $30 million-$50 million-
Mm-hmm
... Sort of on target for the next 12 months.
Mm-hmm.
That annualizes out to $60 million-$80 million.
Mm-hmm.
Sort of similarly, maybe sort of walk us through-
Mm-hmm
... It's, you know, sort of where exiting this year, where within that $30 million-$50 million range-
Mm-hmm
... You think we'll be, and then-
Mm-hmm
... Sort of where do we get to exiting 2024?
Yeah. So that, that cost item, I would probably repeat myself a little bit what I said before, is gonna be the driver for us getting back to our higher income margin. That's a payroll and other line that's really important to look at within our purchased services. That's about the... It's right now, it costs us about $65 million a quarter. So that's made up of the thousands of people that take our 28 million calls, that manage our 34 million trips. There's a lot of people and a lot of infrastructure. That's where we're taking the cost out. Which is why, and the right way to think about it, to see progress, is on a per unit basis. So look at that payroll and other based on our trips, and that better be going down every quarter.
That's the item to look at, and you can quickly see if that goes down about $1, it should be about $30 million that come out, right? So you can start seeing that trend. We had Q3, it was around $7.3?
Seven.
And that's the, that's the number to look at. So, that's... I don't know what—did I finish answering your question, or what was it?
Yeah, yeah, and I could even follow up on that.
Yeah.
I know, Heath, we've talked about this before, as we sort of think about, you know, sort of the difference between the 7%-7.5% that you're at now-
Mm-hmm
... You know, sort of getting back into, let's call it, that 8% range, and then ultimately getting to that 10%+ .
Mm-hmm.
It's fair to think about it at the completion of those cost saves, right?
Yeah, it is.
So, like, ultimately-
Yeah
... As we sort of think about aspiring back towards a 10%+ margin, that would be correlative with achieving the $80 million-
Yeah
... Of sort of the full-
Correct
... Saves and sort of the increments of going from 7% to that 10%+ are looking at those increments-
Correct
... of the cost savings.
Yeah, and that reminds me, so what's... give some examples. We have a slide in our last deck that breaks them out into three different categories. It's this, omnichannel engagement with our members, and that's as simple as engaging more outside of a telephone, using things like text message, using things like when people call in, using IVR, "Mrs. Smith, are you calling about your 10 A.M. appointment?" to using apps, to using our facilities, to using our drivers. All the people that really can engage, as well as using normal technology, that, by the way, these members wanna use, especially text. So it's in line with the rest of the healthcare industry. If we just do that normal automation and empowerment of our team, that's omnichannel. That's where a lot of the dollars are gonna come out.
The second item really is around the trip management, and that requires really multiple things. What should we use, mass transit? Should we allow people to drive? Should we use Uber and Lyft? When to use certain types of transportation providers? That's just a normal logistical challenge that a lot... Like, UPS has it nailed. A lot of transportation companies have figured this out. Historically, a NEMT and us didn't, weren't as modern as we need to be. So it's just doing modern logistical, meeting the member where they are in accordance with the contract, and doing that in a more automated and better way. And then the last item, and this is really, this gets cost up, but most importantly, it's... Our customers are most important to us, and they wanna control the experience, so why not integrate with them?
Why not allow their contact centers to just API into ours to book the trip? Why not allow them to manage the post-trip? So it really is this integration into the customer that saves a little bit of cost, but more importantly, makes us sticky and really gets high. So those are the three things. We have multiple initiatives underneath that. Call it 60% of those, some have started. We have plans and actions to get the rest in place. So it is about execution and how fast can we go, and the how fast can we go is just the amount of execution that needs to happen with our bodies. But it also is just ensuring that we are partnering with our customers to ensure there's the appropriate member adoption. So I th- so more...
There's a lot around those cost savings, but I think it helps kinda, "Oh, what is it?" All the stuff that we use every day, that we're all used to, is the stuff that we're implementing.
Okay, great, and maybe we can toggle over to utilization, and-
Yeah.
that, in the third quarter, was at around 8.7%.
Mm-hmm, mm-hmm.
Sort of moving back towards more of the normalized range.
Mm-hmm.
I guess, you know, to the extent that you can sort of give us an update-
Mm-hmm.
And we're midway through the fourth quarter now.
Mm-hmm.
- And against, you know, sort of the assumptions that were built into the updated outlook.
Mm-hmm.
I mean, we obviously have a lot of our own-
Mm-hmm
... Sort of trackers, just general utilization-
Mm-hmm
... Things seem to be sort of tracking generally as expected.
Mm-hmm.
I would say, you know, from our vantage point.
Mm-hmm
... But certainly would love to get your sort of update on-
Mm-hmm
... To the extent you can, on how sort of recent utilization trends seem to be evolving, you know, relative to your expectations.
Yeah. So utilization's a product of kind of the denominator issue. It's a redetermination, members coming down, that's gonna increase utilization. But the utilization that really matters, maybe from a risk perspective, is members utilizing, right? So when are we getting back to a normalized healthcare environment? You know, what we said even over a year ago, the structural changes that happened in healthcare, and specifically for a lot of our customers' members, utilization has changed. It's not what it was in the past, primarily because of telehealth or different facilities doing different things. There, that structural change that we predicted, and is in the data, primarily around telehealth, is taking- is holding. So we know and is in track with what we expect normal utilization or trip volume to be. It's actually tracking how we thought.
So we expect, and are modeling all in the numbers that I gave earlier, that we will exit 2024 at the new normal rate, and that just... And we've said in the past 9%-10%, what we are modeling is exceeding that 10%. So that's in all the numbers, it's in all redetermination, all that gets to, we think we get to a new normal, which is a headwind. But by the way, it's a manageable headwind, and it's in line with all the stuff that I talked about. It's not incremental risk; it's all embedded what I've talked about before. So I think that aligns with the rest of the industry. I know there's some hospital usage that's a little different, so I wouldn't kinda go to really big, kinda hospital.
Really, in the utilization that's happening in healthcare services, we're tracking in line with that, and in general, I think everyone's kinda estimating end of 2024 we'll be back to the new normal.
Okay, and then, when thinking about your two sort of primary books of business in terms of customer segments with-
Mm-hmm
... With Medicaid and then with-
Mm-hmm
... With Medicare Advantage-
Mm-hmm
... Are you observing any real sort of variances in how utilization trends seem to be evolving?
Yeah, no. It's, again, for us, too, because we're so large. I think if you look at it individual contract basis, you're gonna see stuff upfront.
Yeah.
States are in a different spot, metrics in a different area. But because we're so large, it's as expected, and Medicaid and Medicare is in line with what we thought, from a utilization perspective.
Okay. Definitely wanna sort of talk about growth.
Yeah.
Obviously sort of delivering on the margins is such a key area of near-term focus. You know, we were pleased, I think, to see the update on those contract wins in the third quarter. You know, it shows that there's-
Mm-hmm.
There's a growth story here, too.
Yeah.
You know, maybe bring us up to speed in terms of the pipeline.
Yeah.
Um-
Yeah
... And if we can sort of break that down between-
Yeah
... let's sort of maybe break it down between sort of the MCO opportunity and then the, the sort of the State Medicaid customers...
Yeah
... And sort of think about sort of how you're looking at that pipeline.
Yeah.
And then I guess on the Medicaid side, obviously, you always have, you know, RF, sort of re-procurements that can be sort of plus or minus, too.
Yeah
... Right? So, yeah.
Yeah, so for NEMT in general, the TAM, the total addressable market, is around $6.5 billion-$7 billion. That's been pretty consistent, and kinda growing in accordance with Medicaid rates. MA has been a little bit higher growth, but that's the right way to think about the TAM. And then you have to really think about it in three buckets: MA, obviously, managed Medicaid, and then State Medicaid. State Medicaid, very different, and I'll start there. State. And why different? Because just like all state-based or government-based businesses, those contracts are done with a procurement process, with the bulk of the bias to be with the incumbent, because it's all about risk. So that market's kinda leveled out from a pricing perspective.
It's not really gonna be win or lose on price if you... It's gonna be, do you perform well, and do you go through the process of re-procurement in the right way? That market's about $1.3 billion. We have about $700 million of that. So we expect to win more than we lose, both on the renewals as well as the, as well as the new opportunities. So that... think about that $1.3 billion, and, and a lot of that business was delayed during COVID. So there's a bolus that's happening right now-
Mm
... Right now, and over the next two to three years. But you'll see a lot of that, three, four years really, that if you think about the entire $1.3 billion. That will turn. That will turn state... Most of it stay, most, and us win. So I feel really good about winning more of that $1.3 billion and retaining our $700 million. So the rest of the $6.5 billion is kind of MCO and MA side. The MA side is growing at a higher clip, and the big reason why that's growing at a higher clip is because other people are using transportation as an offering. A lot of them... It has been the main big six that did it, now all, well, not all, many MCOs are offering that as a benefit, because transportation's important.
And then really in the middle then is managed Medicaid, and that's, that's really where our sweet spot is and our ability to grow because, that's, the value beyond just giving the transaction is where we expect to. And that's... When I said the $700 million, that $700 million isn't just taking the TAM and guessing. That's not... It is, it's a requirement that, that $700 million is real, and it's based on our ability to win. It's... And the discussions that I've had, or I'm sure my team's had, so I feel really good about the $700 million on top of these wins we've had, and I expect that to continue to grow. The challenge for us is when does it come on?
A lot of this transformation work that I've talked about around people, process, tech, we did the same thing on the sales side. We didn't have a great pipeline, we didn't have growth, and now we do. That takes time to get on. The sales cycle is six to nine months, the implementation is kind of about the same. So it will start coming out in 2024. We really expect 2025 and beyond to hit the full stride of our filling up the hole. And it really is, we're winning way, way more than losing, especially for the big people that understand us.
Okay. One other question I just wanted to ask about NEMT is just the competitive environment.
Mm-hmm.
And I guess one piece of that is-
Mm
... You know, the investors often-
Mm
... Sort of have a perception of how actors like Lyft and Uber sort of fit into-
Mm-hmm
... Or, you know, sort of being competitors or disruptors versus potential channel partners. So-
Mm-hmm
... Can you sort of walk us through that dynamic?
Mm-hmm
... And how you suggest, you know, investors, you know, view those type of actors?
Well, Uber and Lyft are our channel partners. Important part of NEMT, and they view it the same way. I have dinner with their head of... one of them this tomorrow, 'cause we doubled our volume with Uber and Lyft over the last really six months. And why that's the case, 'cause they're our partner, they're not a competitor. They are not in the business of settling claims, doing billing, having call centers. That's not their model. In fact, it flies in the face of their model of having, being a technology company that has drivers. So they love the partnership we have with them. So not competitors, definitely partners. I expect to grow with them, as the months and years go by. And then the other competitors in this space have led first with tech.
It really was our Achilles heel prior to me getting here, and even really when I first got here, too. If we were to lose, it was losing to somebody that had the technology that enabled the right information to be shared or the right quality to be there. That is no longer the case. No one's better than us in quality. Tech helped us with that. We're at par, I'd say, with some of the data stuff, but no one has access like we do. So, because, and then again, how we've reorganized the group around hiring people in tech and product, we are quickly accelerating beyond that and taking advantage of our scale. So good competitors out there, no one is our size. Not complacent, never should be complacent, right?
But, like, it will show up in the data that we're better than all of them.
Okay, great. Gonna want to switch over to talk a little bit about balancing cash flow, but let me pause here, see if there's any questions out there. Okay, great. So... All right, so why don't we move over to the balance sheet and also sort of the asset dynamics. So maybe we could start with Matrix, and, you know, each time we catch up, always wanna-
Mm-hmm.
Have an update on sort of where things, you know, stand
Yeah
... With your view on, you know, sort of the opportunity to ultimately monetize Matrix.
Yeah. So Matrix, a risk adjustment business, right? We're the second largest behind Signify. We own 43%. That business is performing very well because it, it has gone through a transformation as well, and now we are really performing in that risk adjustment business. Getting back to the customer, regardless of the RADV rules that come out, and the RADV rules that came out are the right rules, by the way. They are absolutely the right rules. But nothing's still more important than a health plan risk adjusting. It's actually even more important now, if you wanna get... So they are really looking to people that can do it well, penetrate, and get that right risk adjustment. Matrix is doing that. Couple that with the other large player, Signify, owned by CVS, which has Aetna.
So the opportunity to grow other payers, you can think of all the other payers that view us now as maybe the top provider to them, because we can do what maybe we couldn't do a year ago. Technologically in line with Signify. And then, three, really getting back to, and this gets back to the payers as well, we have 5,000 nurses that can not just do risk adjustment, but they're in the home, and why not just do one other thing that will help them? Extremely valuable service, high growth rate. So that gets us out with that backdrop, because this is... What does this all mean, right? So we have this asset that we can monetize. We've owned it for many years in this partnership we've had with the other player, about seven years. It's a private equity firm.
Now is the time to release them into their future so they can really, really take advantage of the tech that they've built in these 5,000+ nurses. So we're gonna monetize that, sell it. And, I'm really careful about this because my first priority is to ensure that I'm aligned with my partners and aligned with the business to ensure they get the most value. So we're not giving much more information than I've said in the past, 'cause I don't wanna screw something up to ensure we get the right value. So, I expect that we monetize it sometime in 2024. And the EBITDA range, this, which is large, and I'm sticking with it, is between $50 million and $100 million.
So then when you do the math on that, you can see that it provides significant cash value to us to ensure that we can use that capital to de-lever. We're generating cash. We expect to generate cash, right? Depends on the timing. If there was anything on our line that was left, we'd pay that off, and then we have the ability to do something else with that cash. So it's an important part when you're looking at our company and wanna understand the cash flow profile or the balance sheet side. Matrix is a good thing to look at, and if you can plan it to be in 2024, you'll see the value that it adds to us.
And one follow-up on that, on the Matrix side is, in terms of thinking about sequencing with the refinancing ultimately-
Mm-hmm
... And thinking about the long-term-
Mm-hmm
... Debt on the balance sheet, how important is it, you know, to sort of monetize the Matrix to also,
Mm-hmm
... You know, address sort of the refinancing or sort of the future, you know, sort of scenarios that you have-
Mm-hmm
... With your debt?
So, we don't need to monetize to refinance our debt-
Okay
... Right? It obviously would improve our credit profile-
Mm-hmm
... W hich would therefore make our cost less. So it's a piece of our puzzle on refinancing the 2025s. We generate cash, we're performing, we have Matrix, so... And we have time. So at the same time, we're not, we're not cavalier about that. We know where we are. We have people that we talk to, so we're taking it very seriously. Of course, we don't wanna go anywhere near being current, right? That's just unnecessary noise to our stock price. So we'll refinance it at the right time, in the right structure, and Matrix, again, not required, but would sure help us from a cost perspective.
Sure. Then sort of, shifting over to FCF and leverage, obviously that's been another-
Mm-hmm
... Sort of big area of focus-
Mm-hmm
... Particularly given the-
Mm-hmm
... The interest rate environment that we're in.
Mm-hmm.
Walk us through again, you know, sort of your latest assumptions-
Mm-hmm
... Around 4Q.
Mm-hmm.
Clearly, you've been, you know, quite, I think, transparent in highlighting that.
Mm-hmm
... You know, the market needs to remember about interest payments and how that sort of-
Mm-hmm
- You know, will flow through into sort of the FCF profile. And then sort of your thinking at this point around FCF production, you know, next year with ultimately trying to get to-
Mm.
Obviously, you haven't guided for 2024, so we don't have the EBITDA piece yet.
Correct. Correct.
But putting that aside-
Mm
... You know, sort of ultimately how much deleveraging-
Mm-hmm
You know, you think is sort of achievable, you know, when we look at sort of the set of objectives that you have, you know, into next year?
Yeah. So it's an important part of our strategy to delever, right? We did this quarter, net 4.6 right now. And we expect that we will delever as we move through the number of quarters and years, because we're generating cash. We're CapEx light. Our interest rate now is very manageable, so we expect to continue to delever. To your other question underneath that, why we guided to in Q2 to a second half year number, is because we pay our interest twice a year, quarter two and quarter four. So we had a great quarter of generating free cash flow of about $45 million, right? And then we're gonna pay around $30 million in Q4. And what we've said publicly, and I think it's the right thing, considering the timing of our...
Some of the timing of our working capital, we said we expect to be about kinda flat or neutral in Q4, and that would hit right in line with our estimates and meet all our expectations. Q1, we don't pay interest, so you can start... I would model it out for the year or for the second half if you wanted to see, and expect, when you put that together, that we'll continue to generate that cash flow in line with our second half estimates.
Okay. Why don't we, I've not a ton of time left here, so let's try to get to the home-
Yeah
... You know, with the time that we have left. You know, I guess first just, you know, sort of giving us an update on, sort of caregiver, you know, sort of hiring trends. How you're sort of generally viewing-
Mm-hmm
... You know, sort of the labor environment.
Mm-hmm.
It feels like things have been getting easier on that front.
Mm-hmm
... You know, on the Personal Care front, just as-
Mm
... Some of that tightness has started to relax itself.
Mm.
you know, interested in sort of like maybe even from, like a, you know, new sort of hires per business day or at whatever metric you
Mm-hmm
... Track, sort of how-
Mm-hmm
... How you're sort of evolving over the back half of this year, and then how that plays into. I'm wrapping a lot in here, Ethan.
Yeah, that's okay.
I know we're running out of time.
We're trying to hurry. Trying to hurry, yes. I've been too long with you.
So wrapping that sort of into the volumes-
Yeah
... You know, sort of side of things, too.
Yeah. Again, the home business, where is healthcare going into the home? To lower cost. Our business is tailor-made for where healthcare is going. Personal care in general, the metric that we've given, that we're tracking, is kinda hours growth, and we're growing in line with the market. We've got about 2%, kinda, year-over-year on that. And I expect us to be in line with the market. I expect us to outpace the market when we finish off with the transformation, which is primarily building something for scale, which should be in the markets around... should be solely recruiting and retaining and servicing that member. Personal care in general, and us too, are made up of all these individual small offices, that they did everything. Well, that doesn't make sense.
You don't get scale, and you don't have the expertise on how do you support that hiring, retaining, and business. We're halfway through that transformation, so I expect us to kinda grow in line with the market, and as we kind of finish this off in 2024, that we'll outpace that market. So that kind of single digits revenue growth is to be expected. We're on the low end of our, we're kind of midpoint of our margins. We said 10-12. If you average all our quarters, we're about 11% margin. So I expect us to start growing more than the market, and then the margins being on the higher end as we exit 2024. I know it's similar to what I said in mobility, but that's the transformation that we've been at for a year, and that's the plans that we have.
And then that business will really start. That's an important part of MCOs. It's an important part of states, because of access, again. So that's that. And then the monitoring business, very strong. We're number two, number one size, strong margins, strong growth. That's just in kinda PERS. If you think about tech in the home, around vitals, there's a lot of opportunity, and we've invested in that. We have doctors, nurses, data people, and you'll start seeing that, growth and innovation as we move through the quarters. And then you put that all together in home, and both personal care and monitoring should be coming together, from a value prop to our customers.
And that sort of leads to the perfect, I think, sort of final topic to wrap things up, which is, you know, ultimately, when we think about the real way that shareholders, you know, can win, is if-
Mm-hmm
... Ultimately, you can achieve the bundle-
Yeah
... You know, opportunity and-
Yeah
... You know, where there's a real compelling, you know, sort of, you know, sort of concept around it, right? But sort of delivering on that proof of concept is still something that is still ahead. Obviously-
Yeah
... You guys have had a lot to deal with.
Yeah
... You know, in each of the individual businesses right now, but sort of bringing it all together, sort of how should we be thinking about?
Yeah
... Conceptually moving forward on ultimately, you know, being able to deliver the bundle to customers?
Well, yeah, I really appreciate that. You know, a lot of the sales, and we said this on the call, I think it was 17 new calls that we set up or 17 new contracts. Those 17 new contracts, and we said in the monitoring space, those are all innovation. Those are all innovation because we're bringing together multiple services, and then we have various pilots where we are having transportation, monitoring, and some Personal Care together, because it's the same member. It gets back to what I said at the beginning of the strategy call. That same member, likely the ones that are most ill, will need transportation, probably need a device at home, and probably need care. So it really is, it's not, it's a data challenge that we're working through, 'cause our customers want it. It's actually not...
We could even contract individually and still solve that same problem, and that's what we're doing in a lot of these contracts. So I'm really excited about that. That is the strategy, that is the future, and as we move... And we've hired people, right? So we have a, you can see on our website, we have a new head of innovation and strategy. We have a new Chief Commercial Officer. We have lots of technical talent that have come under our new CIO, coupled with all our, our, clinical talent, that will allow this connection of our supportive care services, because we have access to change clinical outcomes, and that's what we're proving. So I look forward to updating you guys every, every quarter.
Then, in terms of trying to set our expectations properly-
Yeah
... Around this-
Yeah
... Should we think about just given, again, all these near-term objectives, the 2025 selling cycle being where maybe we start to see this resonate more?
Definitely on the MA side, right? 'Cause it's a kind of once a year-
Yeah
... K ind of a one and done. Yes, that's the right way to think about it. I think thus continue to update on our stats and data, and excitement of how we're being able to sell, and how the proof of that, and then really it starts becoming more meaningful in 2025 and beyond.
It's reasonable to think about MA being the target customer segment-
Absolutely
... Where the bundle would have the most opportunity.
It is. It's also-
managed Medicaid as well, right?
And managed Medicaid, and then again, you get into the LTSS.
Mm-hmm
... The duals, right?
Yeah.
But from a sales perspective and the right way to think about it, it, it is MA.
Great.
Yeah.
All right. Well, I think we're at time now, so I wanna thank the Modivcare team for joining us. It's always great having you here, and I think we'll close out the session here. Thanks.
Thanks, everybody. Appreciate it.
Thanks, guys.