Good day, everyone. Thank you for standing by. Welcome to the Marpai First Quarter 2023 earnings conference call. All participants are currently in a listen only mode. If you should need operator assistance, you may press star and zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star and then one. To withdraw your questions, you may press star and two. Please also note today's event is being recorded. At this time, I'd like to hand the floor over to Simon Li , Vice President of Marpai. Please go ahead.
Thanks, operator. Welcome everyone to our Q1 2023 earnings call. With me on the call today are Marpai's Chief Executive Officer, Edmundo Gonzalez, and Chief Financial Officer, Yoram Bibring. Before turning the call over to Edmundo, please note that we'll be discussing certain non-GAAP financial measures that we believe are important when evaluating Marpai's performance. Details on the relationship between these non-GAAP measures to the most comparable GAAP measures and the reconciliation thereof can be found in the press release that is posted on our website. 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 Marpai to differ materially from those expressed or implied on this call. For additional information, please refer to our cautionary statements in our press release and our filings with the SEC, all of which are available at marpaihealth.com. With that, I will turn the call over to Marpai CEO, Edmundo Gonzalez. Edmundo.
Thanks, Simon. Good morning, everyone, and thanks for joining us. It's a pleasure to be here to discuss the financial results of the Q1 of 2023. As I've done in the past, let me just take one minute for some of you that are joining for the first time to review who we are and our strategy. Marpai is a technology company which is reinventing how employers around the country provide health benefits to their employees. We work with self-insured employers that elect not to buy traditional health insurance for their employees, but rather they self-insure. We create and manage the health plans for our clients. Almost 100,000 people carry a Marpai card in their wallet or often a digital card on the Marpai app, which they present to doctors offices, pharmacies, or hospitals around the country, just as one would with health plans from a large insurance company. Now, we make money from management fees related to administering our clients' health plans, which include managing all the healthcare claims of their employees, reviewing these, and eventually paying them on behalf of our clients. We also have a portfolio of ancillary services that add to our revenue. The ancillary services include care navigation and care management for members of our plans. We call employees of our clients and their families members, and these services often make a difference in their healthcare journeys.
For almost 200 clients across the country, Marpai's value proposition is clear. We save them money by engaging our members proactively in a manner that improves their health. As I've said before, yes, healthier employee populations cost our clients less. That's what we do. We reached $9.7 million of revenue during the Q1 of 2023. Our EBITDA was negative $6.7 million, but excluding severance and unused facilities, it was negative $5.9 million. We'll report on this metric going forward as it gives our shareholders a view into the effects of our consolidation activities and our drive towards profitability. During the Q1 , we continued to execute our integration plan for Maestro Health, forgive me, an acquisition which we completed in Q4 of 2022. We have eliminated duplicate positions, consolidated contracts, eliminated most contractors, and outsourced certain functions.
All this has been in search of greater efficiency, given our new scale of over 40,000 employee lives. We are executing per our plan and per our budget. Given the cost of severances and other breakup costs, public investors will begin to see the effects of this consolidation in Q2 and even into Q3. Our goal is to reach the scale required to achieve a profitable EBITDA level of operations within 2024. How are we doing this? Our focus is simple. First, keep to our expense budget and adjust fast if the top line is falling behind. Mind you, our revenue is pretty visible given the nature of our contracts. Second, sell to customers we already have. There's a great opportunity to upsell products which we have to clients we already have. For example, many of our legacy Marpai clients before the acquisition do not yet have care management provided by us. With the acquisition of Maestro Health, we now have an internal care management company. We also have MarpaiRx, our own pharmacy benefit manager. There's plenty of product for us to meet or even beat our goal of having at least $50 per employee per month in every life we manage. Some investors ask me what they should be looking for in terms of key metrics. I would look at three things. First, as I mentioned, our adjusted EBITDA loss, excluding these discontinued operations. This will show you our journey towards profitability. Supporting metrics, of course, are employee lives we manage, which we report, and the net revenue per employee per month that we earn. In closing, let me say a word about the future.
During our last call, I described how we're deploying AI and other technology to build a unique ecosystem of value-based care vendors. These are the best of the best clinical vendors out there. They represent evidence-based solutions that make a difference in our members' lives. These members may have chronic conditions like diabetes. We have gathered these specific solutions to provide a marketplace for our members. What's our role in all this? As I've mentioned, think of a mini Amazon in healthcare. We point you to the right solution that's evidence-based, that will deliver results such as lower A1C, for example, for you as a member. For our clients, the self-insured employers, it means lower overall cost of healthcare as healthier populations of employees and their families, of course, cost less. These vendors are also value-based, meaning they have put their fees at risk against the success of these programs. We are deploying this ecosystem throughout our joint customer base during 2023. I invite you to watch this space. Now let me turn it over to Yoram Bibring, our CFO, for a more detailed view of our financials in Q1. Yoram?
Thank you, Edmundo, good morning, everyone. Our revenues for the Q1 of 2023 were approximately $9.7 million, $400,000 higher than the high end of our guidance, which was $9.3 million, and $2.1 million higher than our revenues for the Q4 of 2022. The main reason for the increase in revenues from the Q4 was that Maestro Health's revenues were included for two months in the Q4 versus three months in the Q1 of 2023. As of March 31st, our total number of employee lives was 41,571, compared to 42,107 at the end of 2022. During the Q1 , we added new customers representing approximately 3,300 employee lives and lost customers with approximately 3,300 employee lives. Our existing customer base reduced its workforce by about 400-500 employee lives. When any service provider is acquired, some customers view this as a reason to test the market, find a cheaper deal, if you will. Indeed, most of the churn was with the Maestro legacy customer base. The transaction also impacted our ability to close new deals because many potential customers would shy away from signing up with a company that is in the midst of an integration project. Overall, we are happy that we were able to keep our customer base relatively stable, and we believe that by the end of 2023, when the next major round of renewals and new sales occur, all the concerns of the existing customers and the potential new customers will no longer be relevant as the integration will be over.
Moving on to expenses, I will be comparing Q1 2023 expenses to the Q4 2022 expenses. Cost of revenues historically included cost of processing and adjudicating claims, customer service costs, and amounts charged by third-party vendors for their services that we resell to our customers. With the acquisition of Maestro, we are now also providing care management services that are delivered by our nurses and cost containment services that have a labor component as well. All these costs are now included in our cost of revenues. Our cost of revenues for the Q1 , excluding depreciation and amortization, were approximately $6.4 million or 66% of revenues, versus $4.8 million or 63% of revenues in the Q4 . Our gross profit was $3.3 million or 34% of revenues in the Q1, compared to $2.8 million or 37% of revenues in the Q4. We expect to have some volatility in the gross margin from quarter- to- quarter. Most all our revenue streams have the same gross margin, and some of them, like cost containment for example, are more lumpy in nature. Our Q1 operating expenses, not including cost of revenues, depreciation and amortization, and stock-based compensation, were $10 million, an increase of approximately $200,000 compared to the Q4 when these expenses amounted to $9.8 million. Included in our Q1 expenses are approximately $800,000 related to severance and unused facility costs, which Edmundo mentioned.
Since Maestro expenses were included for two months in the Q4 and three months in the Q1, it is hard to compare the two quarters. Starting in the Q2 , the figure will become much more comparable on a sequential basis. We're expecting to see a reduction in our ongoing operating expenses, which exclude the severance costs and the cost of unused facilities starting in Q2 and continuing throughout the year. Operating loss for the Q1 was $ 8.5 million, compared to $8.9 million operating loss for the Q4. We believe that operating loss, excluding the severance costs and cost of unused facilities, will improve sequentially every quarter going forward. In the Q1, we recorded $388,000 of non-cash interest expense. This relates to the amount that we owe for the acquisition of Maestro, which we booked based on the present value of the purchase price. We'll continue to accrue this non-cash interest quarterly until the purchase price amount will be fully paid off.
Our net loss for the Q1 was approximately $8.9 million or $0.42 per share compared to a net loss of $8.5 million or $0.41 per share in the Q4. Excluding net expense, net interest expense of $401,000, stock-based compensation of $702,000, and depreciation and amortization and asset write-off expenses of approximately $1 million. Adjusted EBITDA for the Q1 was a negative of approximately $6.7 million compared to a negative of $7 million for the Q4. As Edmundo mentioned, the $6.7 million included approximately $800,000 relating to the severance and unused facility costs, as well as approximately $1.5 million dollars invested in the value-based care platform. Moving on to guidance. We're not changing our 2023 full year revenue guidance at this point and expect Q2 revenues to be in the range of $9.5 million-$9.8 million. Before I transfer the call back to the operator, I just want to recap the secondary that we completed in April. We issued 7.4 million shares at a price of $1 per share. Net proceeds were approximately $6.4 million after expenses. As per our Maestro purchase agreement, 35% of the net proceeds will be used to reduce the debt to the seller, and the balance will stay with the company. The balance of the cash will stay with the company. With that, we will open the call for questions. Operator?
Ladies and gentlemen, at this time, we'll begin the Q&A session. To ask a question, you may press star and then one on your touch-tone telephones. If you are using a speakerphone, we do ask that you please pick up your handsets prior to pressing the keys to ensure the best sound quality. To withdraw your questions, you may press star then two. Again, that is star and then one to join the question queue. Our first question today comes from Allen Klee from Maxim Group. Please go ahead with your question.
Hello, good morning. I heard you say that potential new customers were sitting, were waiting until because you're doing a big deal, they might wanna wait. To follow up on that, could you discuss your strategy with third-party insurance brokers to try to grow new business? Maybe are you planning a broker conference this year? What type of feedback do you get from the brokers of what they're looking for to consider recommending yourselves to a new customer? Thank you.
Thank you for the question, Allen. It's Edmundo. Look, I think in all acquisitions, especially at this scale, you know, people kind of wait a bit. Thankfully, I think this is behind us. This is really related to one of 2023, if you will. We continue our outreach with our, with our sales force. The channels obviously are very much live. Look, at the end of the day, people want two things, I think. First, a unique solution, something that they can talk about, which we certainly have. I'll remind everyone that with the acquisition of Maestro also came a lot of wonderful products that of course increase the value proposition to clients from the broker channel.
Obviously, it also increases their potential, you know, to make commission and to make revenue from these clients, right? All in one package. I do believe the solution itself is what drives the sale. We are working, you know, very hard not only with our current clients, but with new clients to communicate that. We continue to work with some of the largest brokers, you know, out there, and essentially work towards a 1:1, you know, renewal deadline. I don't mean renewal for our group, but renewal in general. I will also mention, Allen, a new kind of, maybe a new segment. There is a tremendous amount of interest in business here from smaller clients. Why is that? Well, as you know, the ACA mandates, you know, small businesses above 50 employees have insurance.
The issue is that a lot of businesses that, say, had 75 or 100 employees traditionally have been fully funded, meaning they buy traditional health insurance. Because of the rising cost of those products, that are great, by the way, I've been a consumer of these, you know, in the past. Because of the rising costs, a lot of businesses at the smaller scale just can't afford them anymore. You're seeing a massive wave of customers that are coming to self-insurance or self-funding for the first time ever. That's certainly a wave that we are leaning into. A lot of the new lives, we received in the last few quarters, have been in that profile. That's very exciting. First of all, because of volume. Yes, an individual client may be smaller, it may be not 500 lives, it may be 80 lives, but there's so many of them, so many of them. The decisions there are not necessarily a year out or three quarters out, but more 30 days out. It's very, very exciting. The industry is being shaken a bit. By this kind of trend and wave.
That's great. Thank you. I was also trying to think about. You've said you have these new programs, but for the partnerships for chronic diseases that you're offer some now, and you're planning a bunch more of these. I'm trying to think of the revenue that you can generate from it and if any of that is in 23 numbers. I get a back of the envelope math, but I could tell you it, but I'd rather hear how you think about it. In general, if you're saving the customers money, and then they're offering something for that, some of the savings, and then you get a cut of that, which mostly drops to the bottom line. Is there a way to think about how if that could be meaningful or when that might scale up? Thanks.
Yeah. Yeah. And Alan, just for others, I think what you're describing is the revenue related to ancillary products and maybe very specifically to our value-based care initiatives. Look, first and foremost, I do believe value-based care is the future. It's only just scratching the surface right now in commercial healthcare, meaning commercial insurance or what companies buy. This is obviously the standard in the Medicare world, right? With Medicare Advantage. We're really at the tip of the spear here in terms of bringing these solutions to the commercial world. Now, what does it mean for us? First and foremost, we have to deliver this value in a very meaningful way to our members and by extension, to our clients. Members must get the value. There, the value is in terms of healthcare, right? Did my A1C go down? Did my back pain go down? We're measuring real human outcomes. Now, what that translates to for the client is less claims or less costly claims. Our partners, like Virta Health, for example, have mountains of data on efficacy, meaning how do they deprescribe specialty medications because our patients are getting better, meaning they don't need to be on these medications that cost the programs or the plan so much.
These are very exciting times, meaning, the cost improvements here are certainly not provided by providing, you know, cheap healthcare or less healthcare. The lowering of costs is because human outcomes, health outcomes are going up, right? Costs are behave inversely to human outcomes going up or health outcomes going up. That's very exciting. Now, how we make money on this is, we're the matchmaker. We essentially have a fee from the vendor as we match make. Why? Because we're essentially eliminating their cost of acquisition, right? They cannot access our members. Our members are our own. We're very protective about that. If we find a member that may benefit, again, in human health terms from one of these programs, we're going to match make. We're gonna make that introduction, we're going to monitor it, and then we're gonna hold the vendor accountable for performance because they're value based. They put their fees at risk, right? That's what we do.
For that, they give us a chunk of their revenue. I don't expect within 2023 this to be a very meaningful, you know. Look, we're close to $40 million of revenue here, so I don't expect VBC to be that huge. What I do expect is for all of the groundwork to be laid, so in 2024 you do have a quite material chunk of very high margin revenue that is being created. Last point on that, Allen. You know, we have announced publicly two of these phenomenal value-based vendors. We are working with our client base, you know, 200 clients or so to implement these again as needed, right? Meaning, customer needs vary. You may not have a big population of people living with diabetes, or you may, right? It's very bespoke. I do expect that ecosystem to expand a lot within the next quarters. Obviously the more there, the more disease states you're covering, the more members' needs you're covering, and that obviously leads to more revenue share for us.
That's great. Thank you. I'm sorry, I just missed something from the call. When you were talking about the severance costs or kind of one-time costs related to Marpai in the quarter, could you just repeat what that was? Thank you.
Yes. What I was referring to, a few items here.
Right.
Based on our integration plan, we have eliminated duplicate positions. We have made basically all of the efforts that needed to be made to create one company from two, right? The reference to that is that we had severance costs, other breakup costs. There's leases that are not being used. That was approximately $800,000 in Q1. We'll be reporting on this particular item, meaning non-ongoing costs in the quarters to come, and the reference there was exactly that. I don't know if Yoram has additional thoughts on this particular item. Yoram?
No, I think you covered it. Basically, we're defining. These are the costs that are not connected to our ongoing operations, as Mond said. We have, you know, unused facilities that we inherited, and also we have severance costs. That's pretty much it.
The point is, I think we wanna separate that and outline that for our public shareholders, because it is, you know, obviously an indication of our cost structure going forward. Even if you may see the cost in this particular quarter, those costs are separate from our ongoing business or hopefully going away in the quarters to come. That was the whole point.
Thank you. You said on the last earnings call that roughly if you get to 50,000 lives and you get paid $50 per life, that gets you to break even, I believe. My question is, do you see a path to getting there organically, or is that more likely gonna happen with, you know, hopefully another acquisition?
Yeah. Look, it's certainly both. We're obviously exploring other fronts. There's limits to what I can say about that. One, the organic channel definitely is alive, well, and the demand is coming. Internally, you know, we're obviously very focused on keeping what we have. Meaning making sure that our customers are deriving maximum value, and they know it. because a customer kept is obviously worth everything, right? That is, you know, a huge initiative. I do believe that we can get there organically, but as you may know, there's a lot of other opportunities even with smaller assets out there. We're exploring everything, and definitely the two levers, both inorganic, you know, picking up some customer bases from smaller TPAs and the organic are live. That's what I can say at the moment.
Okay. This is a small question, but you broke out your revenue in two segments, and one of them was, it's very small, but it's captive insurance. What revenue is that? What does that relate to?
Yes. Yoram, would you like to explain the accounting? I can talk about.
Yeah.
Strategy, but please.
Yeah. I mean, I guess for us today, this is captive is an ancillary product or a TPA. A small number of our employee lives, we sell this, which is effectively, we're participating in the stop-loss insurance in a way. The revenue we're recognizing is premium, pre-premium revenue. It's small. It's very, very small. It's pretty much an ancillary product because it's an insurance type product, then you have to report it separately.
Okay, great. In terms of your use of AI for identifying potential big healthcare events before they happen, what is? I know it's always improving. Any update on how it's getting used and any other new ways or improving?
Yeah. Let me, let me talk a little bit about the future. Look, obviously there's a lot happening in the realm of AI, especially with large language models, I'm sure you've seen in the press. We are really leaning in here, with respect to value-based care, and deploying our, not only our AI, but other technologies, to making sure we can match-make appropriately, making sure we understand, you know, who that member is and what their journey is. The deployment of our technology is really around that. That's what the future looks like as well. In addition to that, we're very, very excited about being able to really predict the cost that may be a little bit hidden and unknown within subpopulations for our clients. For example, you may have a group that is pretty much maybe a little bit above the average in terms of cost. Based on our analysis of data, based on these models, we can tell and obviously based on huge, huge amount of history, we can tell that this subpopulation will potentially cost more or not, right.
This is critical information not only for the planning, the financial planning of our clients, but it's also very, very critical for stop loss underwriting. Remember that 100% of my clients, yes, of course, they're self-insured, meaning they're paying for those claims as they come, but they do have stop loss. Meaning at some point they have traded that risk to a large reinsurer, right? That reinsurer charges, you know, substantial premiums obviously for taking that risk. They have to really understand what those potential costs are. We see multiple audiences for these models, you know, again, in the quarters and in years to come as they get better. It really is about understanding risk. Predicting is one thing, very important thing, but modifying risk is perhaps even more important. I'll leave it there.
Thank you. Okay. I think that's it for my questions. Thank you very much and congrats on.
Thank you.
The good stuff you're doing.
Thank you so much. Thank you for your questions. Yeah.
Once again, if you would like to ask a question, please press star and one. Ladies and gentlemen, at this time it's showing no additional questions. I'd like to turn the floor back over to Edmundo Gonzalez for any closing remarks.
No, just, thank you, operator, and thank you everyone for participating in our Q1 earnings call. I appreciate your time this morning. Have a good day, and look forward to hearing from you and seeing you on the next quarterly release. Thank you so much, everyone.
Ladies and gentlemen, with that, we'll conclude today's conference call and presentation. We thank you for joining. You may now disconnect your lines.