Hi, everyone. Thank you so much for joining us this afternoon. My name is Harry Pearson. I'm a member of J.P. Morgan's Healthcare Investment Banking team. I'm pleased to be joined by Chris Hunter, the CEO of Acadia Healthcare, and Heather Dixon, their CFO. We'll give a presentation followed by Q&A. Chris, you wanna take it away?
Okay. Good afternoon, everyone. Thanks for joining us. We're gonna spend the bulk of our time today in this presentation kind of going through how we're continuing to advance our strategy at Acadia and also on Q&A. I'd like to start also by just introducing Acadia to those who are newer to our organization. I also wanna share an overview of just how quickly the overall behavioral health landscape is evolving and why that's such an important driver of our overall growth, but also the company's ambitions. So, just to start with a schematic of the U.S. Acadia is the leading pure-play behavioral health provider in the nation, with both national scale and regional density. You can see this. This is a map of our 253 facilities across the U.S.
So we have programs, services, and facilities that are spanning 39 states, as well as Puerto Rico, and we have four complementary service areas. So the green dots that you see here represent our 54 acute facilities, and this is where we treat high-acuity patients in inpatient facilities. The orange dots represent our 33 specialty facilities. This is where we primarily treat substance use and eating disorder patients through a residential care model. The blue dots represent our 157 opioid use disorder, or OUD, outpatient clinics. We call these our comprehensive treatment center, our CTC clinics for short. And finally, the purple dots represent our 9 child and adolescent residential treatment center facilities.
So across these four lines of business, we treat approximately 75,000 patients each and every day, and the breadth of our, our four service lines, we feel, is a key differentiator, as so many of our patients have comorbidities that end up cutting across service lines and acuity levels. So combined with our clinical quality, our operational track records, we really believe this gives us a unique platform to lead the behavioral health industry at a time of unprecedented demand and crisis. This is just a quick snapshot of the diversification of the company across service lines, payers, and geography. So you can see on the left, the four service lines that I just discussed. Acute is our largest service line by revenue, comprising about 51% of our revenue as of 9/30/2023.
But each of our service lines has significant scale and financial materiality for the overall business. On the payer front, in the middle chart, we treat patients with both government and commercial insurance. So a little more than 50% of our revenue is generated from Medicaid. Commercial is next at almost 30%, and Medicare is next at approximately 15% of our revenue. And then finally, on the far right, from a geographic diversification with facilities in 39 states and Puerto Rico, we feel like we have very strong geographic diversification across the board. So we did our first Investor Day last December, December 2022, our first as a public company, and this is the strategy slide from that presentation at Carnegie Hall. It still hasn't changed.
Our strategic vision remains to become the indispensable behavioral health provider for high-acuity and complex-need patient populations. To achieve that, we have three major priorities as a company. The first is to continue to grow our facility footprint and a number of beds to keep the pace overall with the growing demand that we're gonna see across the country, and I'll come back to some industry statistics in a second. Secondly, expanding across the continuum of care by facilitating clinically appropriate care navigation across our facilities and services, particularly for patients with opioid use disorder and other substance use disorders. This will improve clinical outcomes, really enabling us to compete on quality while we continue to drive growth. Then third, on the right, further strengthening our core capabilities through selective technology investments.
This has not been a part of healthcare that historically has seen a lot of investment in technology, so we're trying to use this third pillar to continue to enhance our quality and operational effectiveness across all areas. So just some quick I mean, we did the Investor Day for the first time again in December of 2022. This is a snapshot of what has changed over the last year, and I think these headlines will be familiar to many of you. I t really is not hyperbole to say that America is continuing to experience just an unprecedented mental health challenge.
The Surgeon General said last year that mental health is the defining public health crisis of our time, and I'm sure as you see these headlines, which come out every day. We really see that crisis taking shape.
So just a few of these, in the bottom left, CDC reporting 30% of teenage girls saying they have seriously considered suicide. You can see that Reuters said: U.S. suicide deaths reached record highs in 2002, substance use is climbing among seniors, children in mental health crisis surge in hospital ERs. So you can see that the crisis isn't in just one or two areas. It's really affecting the entire country in all ages and really all demographics. And just to go into a little bit more depth on that, we've put this analysis together, and I think more fundamentally than just the newspaper headlines, these statistics, I think, really resonate. So every year, both SAMHSA and the CDC rigorously track disease prevalence, deaths, and other kind of key statistics related to both mental and behavioral health.
These statistics have been worsening and certainly intensifying for several years now, and the pandemic just accelerated the problem. So even beyond that, even in just the last year, it's daunting that every single major statistic has gotten significantly worse. So notably, the number of Americans with co-occurring SMI, serious mental illness, and substance use disorder grew by 15% just in the last year. So that's 1 million incremental Americans just in the last year since we did our Investor Day. The number of Americans with high-severity opioid use disorder increased by 11% in the last year. And we're also seeing a significant increase in the number of suicide deaths and overdose deaths.
So as the leading pure-play provider of behavioral healthcare services, the company is really playing a crucial role in addressing the crisis, and we believe that the need for our services has truly never been greater than it is in the United States right at this time. So I want to share a little bit more about how we're advancing our strategy and also meeting the country's unmet overall need. So you'll recall at our Investor Day, we laid out five specific growth pathways. The first you can see at the top is joint ventures, partnering with health systems, premier health systems, to grow our acute line of business. Secondly, expansion of beds at our existing facilities. Third is continuing to add standalone de novo facilities that we build. Fourth is selective mergers and acquisitions as attractive opportunities arise.
And fifth is extending the continuum of care. So we really feel like in the last year, we've continued to make strong progress against all of these. I would say in 2023, we opened 2 new joint venture facilities, one de novo facility. We added significant beds. We added over 40 PHP and IOPs to extend the continuum of care in these existing markets. And we also announced our acquisition of Turning Point, which is a 76-bed substance abuse facility in the Salt Lake City area, which will complete our service lines in that geography, where we'll have all 4 lines of business in the Salt Lake City metro. So we're in the final stages right now of completing that transaction, which we expect certainly to close in the Q1 of this coming year.
This next slide just gives you photos of some of the facilities that we've either broken ground on recently and just the continued progress on our overall footprint and bed capacity. So these are a number of facilities that we either opened in 2023. A few of these are groundbreakings. I would call your attention to the Intermountain groundbreaking in the upper right which took place in the middle of last year. We expect to open that facility just outside of Denver partnering with Intermountain a little bit later this coming year. So overall, we continue to be on track. I would draw your attention in the lower left to the de novo facility in Indio, California. This is a hospital with 80 beds that is currently open to train our staff.
We're expecting our first patient very soon in that facility as well. So a lot of activity on the construction front, and we really expect that to continue well into 2024 and beyond. Maybe just to bring our JV growth pathway to life a little bit more, this next slide, I think, does a really good job of showcasing what an important pathway JVs are for the company. So this morning, we were really pleased to announce our 21st JV partnership with Ascension Seton, and this is a partnership that's going to enable us to access to improve and expand the access that we already have in Austin, Texas, to even more of the surrounding communities. This is actually our second JV that we've done with Ascension.
We developed and opened Ascension Saint Thomas, which is a facility, a behavioral health facility in Nashville, Tennessee, near our headquarters in 2020. So Ascension Seton selected Acadia as their JV partner in Austin because of our company's commitment and our shared commitment with them to high-quality, compassionate, mission-driven care to improve the health of the communities and the individuals that they serve. I would say that Ascension's decision here was further solidified by the proven track record that we have in joint venture partnerships and just the existing relationship that we have with that health system. Over the last several years, we've been able to establish partnerships with 21 different JV partners to build 22 facilities.
Currently, we have 11 of those 22 that are actually operational and accepting patients, and we have another 11 JVs that are under development with a very robust pipeline. I think the last thing I would say in this slide is that we're considered a leading partner for health systems, primarily because of the expertise and just the reputation that we bring. We're the number one pure-play provider in the country. We're known for clinical excellence and certainly for caring for high-need clinical patient populations. We're known also because we have programs, services, and facilities that are spanning the full continuum of care across the United States.
And not only have we secured partnerships with other strong health systems in the industry, Tufts, Geisinger, Henry Ford, Intermountain, but also has led other reputable health systems to gain trust and excitement to partner with us on building these acute facilities. So in short, Acadia has a really strong track record of financial, operational, and clinical outcomes with these JV partners, and this will continue to be an important part of our growth going forward. The last slide I want to cover, and I'm going to turn things over to Heather to talk a little bit about our CTC business, is our fifth and final growth pathway around the continuum of care, which remains absolutely critical to our clinical strategy and also drives significant growth going forward.
So from a clinical standpoint extending and integrating across the full continuum of care, it improves clinical outcomes, but just as importantly, improves patient experience. This is because our patients either have comorbidities and/or need to step up or down in acuity over time, given the chronic nature of behavioral health disease states. So extending this continuum of care, it's just a very high capital efficient growth pathway for us, and one that we're looking to continue to expand in 2024 and beyond. A key example of our continuum of care work is our partial hospitalization and intensive outpatient programs, PHP and IOP.
The vast majority of our acute and specialty patients can clinically benefit from these programs as they offer a step down in acuity post-discharge, and also enable these patients to step up again in acuity as needs in the coming months and years, occur. A nother example of our continuum of care is cross-referrals. So as previously mentioned, and this is becoming an even more important over time as the comorbidity between mental health and substance use continues to intensify, and that cross-referral opportunity is something we've been very deliberate about as a company in the past year.
All right, next, I'm just going to go ahead and pass things over to Heather, who's going to come up and talk a little bit about some of the investments that we're making to drive the business forward, starting with our CTC business. So, Heather, over to you.
Thanks, Chris. I'd like to take you through some of the investments we're making. We thought we'd start with highlighting the CTC business and some of the things that we've done over the past 12 months to really focus on growing that business and driving the best outcomes. So our CTC business, or our comprehensive treatment centers, are programs that are designed to treat patients with opioid use disorders. We like to say that this is a program and not just a pill. So if you look on the left-hand side, you'll see the services that encompass these centers, not just a dosage facility, but actually a much more comprehensive set of care for the patients in these centers.
We do dispense medication at those centers, but also we have overall a whole care continuum for those patients, group therapy, individual therapy, vocational training, support services, so that those patients can integrate back into the community and really focusing on the whole treatment of the person as they go through their recovery journey. Just a couple of things that I'd like to focus on is how we have invested in that business to really drive the best outcomes. So you see listed here a couple of the outcomes that we have driven. But when we looked at this business, we found that a couple of things were really driving the importance of that business to our patients. The first was availability, and the second was wait time.
When you have patients that are coming in, in many occasions for a daily visit for extended periods of time, it's very important to them that, one, they can, they can make it into the facilities, that there is availability at those facilities, because this is certainly a progressive care continuum where they need to stay in their care, and also that they can get in and out in a very short period of time. So we did a couple of things. One, we made sure that we have availability across the clinics.
There's no wait time. We have some very specific investments and centralized capabilities to make sure that we can put patients into care, into the right clinics, meet them where they are, have the right hours for the patients to come so that they can continue with their day.
We also invested in some very specific items to ensure that that wait time, once they were in the clinic, sort of in and out of the clinic, is across the board, on average, less than five minutes. Prior to this, we had, I would say, anywhere from five, 10, 15-minute wait times, depending on the clinic. And we really focused on this because that is very important in, in meeting those patients where they are. I want to just point out a couple of the things that we do in order to make sure that we are helping these patient, patients as much as possible. First, I would point to some of the investments in specialized treatment, but then I'll just talk about some of the investments we did on core infrastructure, specifically related to Medicaid Redetermination.
Throughout that process, we had a dedicated 1-800 hotline, we had kiosks in the facilities, we had QR codes, we had brochures, we had our counselors especially trained to help people retain coverage or regain coverage, and that bore itself out very, very positively. The last thing I'll say is, if you look on sort of the top right of this page, there's an accreditation body called CARF that assesses our clinics along with others, and we have a 99+% score from that accreditation body, which is best in class and certainly something that we're very proud of. I'll just talk for just a minute about the other investments that we're making, and specifically in technology.
If you think back to when we spoke to you about a year ago at an investor day that Chris mentioned, we talked about our need to invest in technology. We have done that over the past year, and we will continue to do so. A couple of the things on the page that you can see that we focused on are specific to our facilities. First of all, a core infrastructure to support the other technology needs that we will build on to deliver best in class patient care. But also some other things that some of you may not realize are not just part of the industry in behavioral health. So an EMR, or electronic medical record, is unique, and we are certainly industry leading in putting these EMRs in place.
That's having a real benefit to our staff, to our facilities, to how efficient we are, to how engaged our staff and our clinicians are, because they have the ability to work with electronic forms of records as opposed to paper records, which is certainly the way that most facilities in the behavioral space have run. I'll just maybe focus on a couple of other things, but I'll point out our remote patient monitoring technology that we've put in place. That remote patient technology really helps us ensure that the right processes are followed in our facilities, that we have the best patient care, the most regular patient care, to ensure that we are meeting our own quality standards, and certainly giving the best patient care delivery that is possible.
We're also making investments in our overall company structure, looking at things in addition to technology investments. We're focusing on how we really capture what we can from a value perspective with our scale and the breadth of capabilities that we have to really build on operational effectiveness and drive top-line growth. Those are coming across a multitude of functional areas within the business, and we are already seeing the benefits of these improvements as we really experience those results both in the top line, as we see very impressive top-line growth results, and in our overall output and bottom-line growth, impressive results there as well. I'm gonna turn it back to Chris to talk about our overall experience with patient care and quality.
Thanks, Heather. I want to intentionally close with the slide on quality. W hen we did the investor day a year ago, we talked about our aspiration of competing on the strength of our clinical health outcomes and really differentiating there. And I think this is clearly because we value the patient experience, but we think that quality drives operational effectiveness. And a pretty broad variety of stakeholder relationships, including payer relationships, are going to continue to really value strong quality going forward. So we're proud of the quality of the work that is happening in our facilities every day with our clinicians and frontline staff. W e're working on continuing, based on the investments that Heather just discussed, to play a significant leadership role here going forward.
And because quality is the product of everything we do our efforts here are multi-pronged really encompassing people, process, and technology. So just a couple things that I would leave you with. O n the left, on the people side we hired our first full-time dedicated Chief Quality Officer last year. That was a split role historically. We have brought on a very, very strong team there. We've restructured our operator incentives around quality, that is a change from prior years and really making that an emphasis across the board. We've elevated the focus of quality when we do our monthly operating reviews, where our operators are coming in and talking about their quality metrics before we even get into operational and financial results.
And we've put in place a number of proactive tools, working with our analytics team, as well as our quality leadership team, in identifying proactively risks and opportunities across the country, as opposed to being more reactive. So we're leveraging technology to continue to compete and differentiate on quality. We're seeing really good early results, and that will continue to be a crucial part of the way that we compete and hopefully make ourselves even more valuable as to with our payer partners going forward. So we'll leave it there and move to Q&A next. Harry, over to you.
Great. Chris, Heather, thank you both so much. I'll maybe start it with one question, then we'll turn it over to the audience. But Heather, could you talk to us a little bit about how you approach capital allocation from both different geographies, and then also whether it's de novo, joint ventures, M&A? What is, what is the strategy overall there?
Sure, sure, I'd be happy to. So I, I would say we break this into two parts, and it's really a focus that certainly I've had as I've come in and that we've had as a company over about the last year, of really focusing on first-
... what markets would we like to enter, or where would we like to really play? And then how do we enter those markets? So from a market identification perspective, we look at a range of characteristics and qualities to determine what our top markets are for entry. And those characteristics range from regulatory environment, labor environment, payer behavior, competitive landscape, across the board, looking at what those markets have in place already or what they might need to have in place.
Once we have that list of markets identified, we then have a conversation internally amongst the different groups to see how we enter those markets, and that could be through bed additions to our existing facilities. If there's a significant bed need in a market where we already have a presence and we have a facility, we could add on to that facility.
It could be in a market that we would really like to enter, but we don't have a presence, but there is a JV partner, as Chris showed you, there's a JV partner that has a really good footprint and could partner with us to enter that market. That could be a really good way for us to join. It might be that we want to enter a market, but it's a Certificate of Need state, and so it might behoove itself to really look at M&A opportunities in those markets, or if we just wanna join the markets a little bit earlier rather than building a de novo that takes a little bit more time. So really focusing on, I would say, to summarize, first, where do we wanna play? And second, how do we get into that market?
That's great. Chris, anything to add?
No, I think she nailed it.
Awesome. Awesome. Well, we'll turn it over to the audience now. Does anyone have any questions? Yes.
Hey, guys. Thank you so much for the presentation. I'm a little newer to the story, but just curious if there is a big differential in margin across the four different business that you sort of have highlighted?
There is not. Our margins are relatively consistent across the four lines of business. As you can imagine, there is some variation within those and maybe a little bit of variation, but broadly speaking, they're consistent across the business.
Okay.
I just want to ask a couple of questions. The first one is on the move towards, there's been in the news recently, kind of a move towards being able to get methadone from pharmacies. How does that affect your business in terms of just revenue impact? And also, going into the election year, how do you see kind of like the regulatory environment shifting depending on the outcome of the election, and how does that affect your fundamentals going forward? Yeah, so can you just kind of qualify that impact and then talk about the regulatory environment?
Why don't you start and I'll-
I'll take the first one-
Yeah
... you take the second one.
Sounds good.
How's that? So I'll start. There is certainly a bill that has been under discussion for quite some time called MOTA, the Modernization of the Opioid Treatment Act, that is out there. That bill has been under discussion for a while, but what that would mean from a practicality perspective, to answer your question, if it were passed, is that two things would need to be true to increase access to methadone treatment, and the goal is to increase access, and certainly, we are supportive of that. But two things would need to be true for that to be successful in addressing the access issues.
The first is that you would need to have a prescribing physician or psychiatrist who was willing to write the prescriptions for methadone, and the second is that you would need to have a retail pharmacy that was willing to fill those prescriptions. So the act is looking at increasing access or improving access through opening up who can prescribe and where the drugs can be filled. I would say that if you look at that, first of all, on the provider side, there is a relatively narrow group that could prescribe.
Those are, as the bill, I believe, is written, limited to physicians or psychiatrists who are board-certified in addiction therapy treatment, and so that's a smaller group. And they would need to think about the regularity of treatment that they would provide and how often they would need to see patients.
So, for example, would they see patients daily, as we most oftentimes do, and have the capacity to see hundreds of patients in their facilities every day? And or would they be comfortable writing multiple-day prescriptions for Methadone? Same concept to think about from a retail pharmacy perspective. A retail pharmacy would need to have the capability and the capacity to fill those prescriptions, and then certainly the willingness to fill those prescriptions as well. So that's, that's an overview of what that act means.
From our perspective, we feel very well positioned to continue to serve the patients that we serve and certainly provide the patient experience that they would like to have whenever they're seeking treatment, either through the investments that I mentioned, the ease of use of our facility, certainly the privacy of use of our facilities versus a local pharmacy, and also our physicians and practitioners that are very well-versed in this, in this overall therapy. I don't know, would you like to add something maybe with the regulatory environment as well?
Yeah, I think just on the regulatory environment, with this being an election year, I would just draw you back to this slide 8 that we went through earlier. I think all of the trends here, whether it's broader mental illness, SMI, SUD, OUD, suicide deaths, drug overdoses we continue to see pronounced acuity across the board, which really plays into our strategy. I think irrespective of the way the election goes, there increasingly is bipartisan support for mental health. We've seen that on both sides of the aisle, cooperation and collaboration, where there's not discrimination on that front at all.
I think we obviously need to continue to work with the National Association for Behavioral Healthcare, associations that are out there, but also with Congress in terms of just continuing to, as the leader in the space continue to really follow and track and support the policy initiatives underway.
Okay, could you discuss labor availability and labor cost currently moving forward?
Wage.
Yeah, sure.
Yeah, sure.
So, we have seen some nice trends with labor, certainly over the last 12 months. About 12 months ago, there were, I would say, peak moments in the cost of labor, and certainly that's driven by the availability. We've seen that base wage inflation decrease very steadily from around 8% about a year ago, all the way down in Q3 to just above 5%. We have seen those steady increases due to some of the external market factors and what's happening with the overall labor environment. But also, specifically related to some of the things that we're doing internally that's driving better engagement, better sense of purpose in the facilities, things that we're doing to focus on supporting the employees through training.
Even the EMR that I mentioned is certainly an employee satisfier whenever it comes to thinking about your labor force. So all of those things coming together, combined with the external labor market, we're seeing some really positive trends.
Yeah, I think the only thing I would add on that is, I think the improvement on the labor front ties into a number of the strategies that we've put in place from a labor standpoint in the last year. So, we have been very intentional about measuring employee engagement. We have 23,000 employees over 253 facilities, and so you can imagine there's variation there. So holding our operators accountable to improving engagement across the board, sharing best practices, is something that we do routinely with the town halls and just the other communications that we put in place. And then I think the training that Heather mentioned is very important, as we're attracting people into behavioral health.
We are such a purpose-driven organization, so frequently people join Acadia as the leader in behavioral health because they have someone in their community, a relative, a loved one, that has gone through a behavioral health challenge. And we need to consistently train folks that are joining Acadia consistently across all of our facilities, and we've seen a lot of opportunity to do that in a more routinized way that our clinical team has done a great job of leading. So I think a lot of these initiatives have played directly into the improvement that we've had on the labor front, but we clearly have additional opportunity and more that we can do here going forward.
All right, thanks. Hi. Are any of the opioid settlement dollars starting to come loose at the state level? And how is there a way to quantify that? What kind of tailwind that can be to your business, and-
Yeah
... I'm thinking in particular, though, like the Medicaid agencies, is that where that's showing up? Maybe you can help us quantify or even mechanically figure out how that's making its way into-
Yeah. So the question just on the opioid settlement dollars, again, $54 billion over the next 15-20 years, that will have begun to be dispersed. $54 billion in total, only a few billion have actually been allocated, and that's still just now trickling down to the states. I think a year ago at this time, we would have expected maybe a little bit more more RFPs out there. This has taken a little bit more time than we expected, but it's relatively unprecedented. We're trying to do everything we can. There's such a need out there for all the things that we've discussed earlier and on this slide. But we think this is really more of a 2025 phenomenon than having significant upside in 2024.
There will be opportunities, and there already are, but they're smaller opportunities, and we think that there will be more of size just in the coming year, so more 2025 than 2024.
I appreciate your focus on quality. Could you speak to your strategy when it comes to working with the payers and VBC?
Yeah, sure. I'll start, and Heather can chime in. I mean, we both have extensive payer backgrounds. I think increasingly, when I was on the payer side, one of the things that we always recognized was that if somebody has a chronic condition and you layer in a single behavioral health condition on top of that, the spending goes up 2-4X, and there's a lot of data that supports that, that we can share. Right now, this is a part of healthcare was surprising to me that there isn't a lot of data, primarily because there's been underinvestment in technology historically. There aren't EMRs across the board. The meaningful use dollars that flowed to the med-surg facilities, for whatever reason, were not offered to the behavioral health facilities.
So there is still, across the entire industry, if you went to inpatient facilities and a lot of SUD facilities as well, you would see a prevalence of paper that you don't see in other parts of healthcare. So it's pretty difficult for payers to enter into value-based arrangements where there's so much paper in an industry. That's one of the reasons, strategically, we felt like we needed to make investment into advancing technology, getting EMRs in place so that we would have data that we can show payers, and ultimately put some value-based contracts in place. There are a few payers that have been progressive on this. These contracts have been structured in a way that it's more shared savings, upside only type models, not capitated arrangements, or they're not asking behavioral health providers to take any sort of downside risk.
But we think that as we continue to roll this technology out, we have greater and better data. We're having regular conversations with these payers across the board. They understand that we're trying to compete on the strength of our clinical health outcomes and our quality, that we will begin to construct more mechanisms, to that degree. But Heather, anything you would share from your payer background?
The only thing that I would add is when you look at all of the things that Chris mentioned, but then a couple of things. One, the fact that we are a pure play specifically focused on behavioral health provider, and the fact that we have a full continuum of care across the different mechanisms of care. I think when you combine all of those things together that we both talked about, it is the perfect place to have those conversations with payers and really drive the conversation forward and develop the right value-based care model.
Great. I think we have time for maybe one more question. I think there's one in the...
Okay.
You can have it.
Can you just talk about 2024, just your outlook for the year? What are some of the things you're excited about, and what's- what are some of the, like, the drivers of growth and some of the things you're kinda worried about on the downside?
Go ahead.
I think, I think for 2024, there are many things that we are looking forward to. Chris talked about the growth pathways, and we laid those out in our Investor Day last year, sort of the number of beds that we'll be adding to our overall facility set, the focus that we have on the continuum of care from PHP, IOP services. Those are all things we're very much looking forward to. I think as we think about our opportunities to continue to gain ground when it comes to things like the rate environment and the labor environment, I think we're really excited about opportunities that we have and the way that we'll drive them forward.
I think the only thing I would just add is the visibility that we have into bed growth. I mean, we talked last year about going from 570 incremental beds in 2021 to 670 this past year, to making the ramp to 1,150 in 2024 and 2025. And so we have strong visibility there, driven in part by these JVs. I mean, we're really excited about not only the size, but just the caliber of the partners that we're breaking ground with. I mean, this coming year, we'll open a 144-bed facility with Intermountain just outside of Denver in Westminster, Colorado. We'll open a 192-bed facility with Henry Ford in Michigan, and then this Ascension Seton relationship in Austin, Texas, that we just announced this morning.
We will open that facility this year as well. So just a lot of a lot of excitement just on the construction front and execution on all of our growth levers. W ith a strong balance sheet, we're really looking forward to 2024 and beyond. So thanks for being with us.
Great. Thank you both.