Hello, everyone. Thank you for joining us this afternoon. It's my pleasure to introduce Chris Hunter and Todd Young, the Acadia Healthcare CEO and CFO. We're going to have a presentation and maybe a little time for Q&A at the end. Chris?
Thank you, Harry. Good afternoon, everyone. Thanks for joining us. We're going to spend today covering a few key themes. First, we're going to provide an overview of the company, and then we'll get into some of the progress that we've made in 2025, as well as some of the challenges. And finally, we'll talk about some of the key puts and takes as we look further into 2026. Before we get into that, I just wanted to flag that we did reiterate our 2025 guidance this morning. We continue to expect revenue of $3.28-$3.3 billion, adjusted EBITDA of $601-$611 million, and adjusted EPS of $1.94 to $1.94 to $2.04. As usual, we will provide fourth-quarter actual results in late February. For investors who are newer to our organization, I wanted to provide a quick introduction to Acadia.
We are the largest standalone behavioral health company in the country, with both national scale and regional density, as you can see from our map here of our 277 facilities. We have programs, services, and facilities spanning 40 states and Puerto Rico, and we have four complementary service lines. The green dots that you see here represent our 59 acute facilities, where we treat high-acuity patients in inpatient facilities for conditions such as schizophrenia, bipolar disorder, and other psychiatric disorders. The orange dots represent our 31 specialty facilities, where we primarily treat patients with substance use disorder via a residential care model. The blue dots represent our 178 opioid use disorder outpatient clinics. We call these our comprehensive treatment centers, or CTC clinics for short. Finally, the purple dots represent our nine child and adolescent residential treatment center, or RTC facilities.
So across these four service lines, we're serving more than 82,000 patients daily, and the breadth of our service lines is a key differentiator, as many of our patients have comorbidities that cut across service lines and acuity levels. Combined with our clinical quality and our operational track record, we believe this gives us a unique platform to lead the behavioral health industry. This slide reinforces our leading health system JV partners across the country. And an important part of our strategies that we're very proud of is that we have JV partnerships with leading health systems for acute psychiatric care and really some of the most prestigious names in all of healthcare. Generally, these health systems either seek us out directly or they choose us as a partner, as part of a competitive RFP process, as they look for the highest quality psychiatric partner for their patients.
Over the last few years, we've been able to establish partnerships with 21 different JV partners across the country, and we're really proud of our track record of success with these JV partnerships. And one outcome of this track record is that we now have multiple partners who have returned to set up an additional joint venture facility with us in a different geography. We'd call out Geisinger and Ascension that both fit that category. Acadia has strong diversification across three different dimensions. So you can see here we're covering service lines, payers, and geographies. So on the left, on our service lines, acute, you can see is the largest of our four service lines at 55%. And each of our service lines, as you can see, has significant scale.
In the middle, on payers, you can see we treat patients with both government and commercial insurance, with over half of our revenue from Medicaid, and then you can see on the right that we have strong geographic diversification with facilities across 40 states and Puerto Rico. Our strategic vision that we set out several years ago is to lead the industry as the indispensable behavioral health provider for high acuity and complex care patient populations. To achieve that, we have three major priorities that you can see in the dark blue boxes here. The first is to deliver high-quality patient care. The second is to further enhance our core capabilities. Examples of this include our technology investments that continue to enhance our quality and operational effectiveness across all areas, as well as continuing to strengthen and support our workforce.
Then the third is expanding access to care by selectively adding capacity across our business. I'd like to now talk about the progress that we've made across multiple fronts over the past year. Starting with quality, as we've discussed many times, a core part of our strategy at Acadia is winning on quality. First and foremost, this is because quality drives clinical outcomes and patient experience, but quality also drives operational effectiveness, a diverse set, a diverse array of stakeholder relationships, including payer relationships, and ultimately drives growth. We are extremely proud of the quality our clinicians and other frontline staff deliver every day, but we're also working to continue to play a leadership role in the industry and to take our quality to the next level.
Because quality is the product of everything else we do, our effort to continue to enhance quality is inherently multi-pronged, spanning the full gamut of people, process, and technology. We've talked a lot about the fact that we're implementing EMRs in each of our acute hospitals and RTCs. While EMRs are commonplace in med-surg hospitals, we are leading the way in the behavioral health industry with our approach. Another example is our implementation of remote patient monitoring devices to ensure adherence to our care requirements consistently across our facilities, as well as to provide critical documentation of patient care and outcomes. One final example I'll cite, which spans not only technology but also process and people, is that we're implementing robust analytics and dashboards for our operators in managing quality across our portfolio of facilities. On the labor front, we've also seen consistent improvement in labor trends.
As previously noted, we've seen six straight quarters of increased retention that we're very proud of. This has been a result of both an improving wage rate inflationary environment, as well as our efforts around centralized recruitment, employee engagement, and targeted training. Another thing we'd call out is a critical driver of our progress in 2025 was the transformation of our acute leadership team. So we recognize that achieving our quality ambitions required not just process and technology, but a different caliber of leadership at the facility level. And so over the past year, we have enhanced leadership across many of our hospitals with experienced operators who bring deep clinical and operational experience. These leaders are implementing our key quality initiatives at the local level, driving greater transparency and accountability and ensuring data-driven action planning.
They've managed this transformation while navigating a threefold increase in survey activity and external scrutiny across the entire industry, all while remaining laser-focused on maximizing clinical outcomes for our patients. This transformation wasn't about reacting to short-term challenges. It has been a deliberate forward-looking move we've made to raise the bar across our entire acute network. Our acute leaders are laser-focused on maximizing clinical outcomes for our patients, strengthening payer relationships, and positioning Acadia as the standard setter in behavioral healthcare. Finally, on new beds, we opened over 1,000 new beds in 2025, including 778 beds at newly constructed facilities. And over the past year, we've added over 2,500 beds from newly constructed facilities alone. As you'll see in a few minutes, there is a significant EBITDA opportunity to unlock as these facilities continue to ramp.
This next slide we've put together because we're really proud of the care that our providers deliver every day to patients in need, and this slide is reflecting the outcomes that we're beginning to see that our teams are driving, as well as patient experience. On the left, you can see the strong patient outcomes. Our caregivers are driving a 29% improvement in mental health quality of life and a 54% improvement in depression. On the right side, you can see that we're also driving an improved patient experience. Over the past year, we've seen an over 10% improvement in the overall rating of care provided and a greater than 10% improvement in the likelihood to recommend our facilities. At the same time, we've significantly increased the number of patient surveys we're capturing, with a 43% increase in surveys collected versus the year ago period.
I want to spend a moment on this slide talking about our CTC business. As mentioned earlier, our CTC line of business is comprised of 178 clinics for the treatment of opioid use disorder. We combine medication management with individual and group therapy, as well as other specific support services to assist the patient acclimate into the community. Our scale in this business allows us to strategically invest in technology to improve the overall patient experience. And that scale is what allows us to continue to make significant strides in how we manage our clinics to ensure the highest quality and best patient outcomes. For example, we realized early on that access and wait times were critical to the success of each clinic, as these often play an important role in keeping our patients in regular care.
Through a series of studies and analyses at our clinics, we've made process improvements to ensure that all patients can receive care, there are no waitlists at all at our facilities, and that our patients can receive care in the most efficient manner possible, with wait times at our clinics now around five minutes or below on average. This greatly improves the patient experience. You'll see at many competitor facilities, lines down the block, which is not only a deterrent to patient care, but it also can create a negative perception in the local community. At the same time, shorter wait times has improved throughput, driving operating leverage in our clinics, and this is also a relatively low capital intensity business. So we can efficiently deploy capital to grow our footprint while generating strong free cash flow within these CTCs.
This slide reinforces that 2025 was another year of very strong bed growth for the company. We opened nearly 1,100 new beds in 2025, including new joint venture facilities with key partners such as Henry Ford in Michigan, Geisinger in Pennsylvania, and Ascension in Texas. Those beds, along with the beds opened over the last few years, represent a significant EBITDA opportunity that we'll talk more about shortly. We've also been undertaking a portfolio review process and closed five facilities in 2025. When community needs evolve, we work with local stakeholders to adjust our service offerings and facility locations accordingly, and these decisions are never taken lightly, but they reflect our commitment to maintaining an optimized, high-performing portfolio that supports long-term growth and operational excellence.
By concentrating our resources on markets and service lines with the strongest demand fundamentals and reimbursement dynamics, we're positioning Acadia to deliver stronger, more consistent results, and we'll continue to assess our footprint with rigor and make thoughtful adjustments where appropriate, always with the goal of enhancing performance, improving shareholder returns, and creating long-term shareholder value, and we'll continue to do this while creating a world-class organization that sets the standard for treatment and behavioral health. I'd say finally, as we've previously communicated, we expect CapEx to come down materially this year in 2026. We anticipate a reduction of at least $300 million relative to our $610 million-$630 million 2025 guidance, while still adding between 500 and 700 beds this year, and we'd anticipate CapEx to decline further in 2027. That will enable us to begin generating meaningful free cash flow for the business.
While we've made progress against many key initiatives in 2025, it was a difficult year from a financial performance perspective. You can see here the drivers of the gap between our initial guidance at the start of 2025 to the midpoint of our current guidance. Starting with PL/GL in the first yellow bar on the left, over half of that variance versus guidance has been driven by higher-than-expected professional liability cost. We've experienced an increase in cost for claims related to prior policy years, as well as elevated claim frequency. The good news is that we materially ramped up our investments in quality and oversight beginning over three years ago, and we've made significant progress since that time. We expect these investments will help mitigate future growth in these expenses.
However, given the long tail on many of these claims, it will take time to show up in our financial results. In the middle, on the volume front, we saw softer-than-anticipated growth as our operating environment faced headwinds as we moved throughout 2025. This was particularly notable in our Medicaid book in the acute line of business, and what we've experienced is incremental pressure, as we've discussed before, from payers, Medicaid payers in particular, and we think that's been, in large part, a reflection of the pressure some of the Medicaid health plans have been under in their own businesses. We've also seen a slower ramp in occupancy from our recent cohorts of newly built facilities, and then finally, on the rate front, we've experienced incremental pressure on the revenue yield per patient day. That includes increases in bad debt and denials, as we've seen increased payer pressure.
And that pressure was offset, in part, by improved Medicaid supplemental payments as states continued to expand access to those programs. Turning to occupancy ramp for our recent new facility cohorts, this is an area where we faced headwinds in 2025. This chart shows our expectations versus actual occupancy for the 2023, 2024, and our 2025 cohorts. The light blue bars on the left represent where we expected occupancy to be for each cohort in 2025, and the dark blue bars next to them are the actual occupancy in 2025. So as you can see, actual occupancy trailed our initial projections across these cohorts. I think the question is why, and the answer is two main factors. First, softer volume trends in Medicaid-heavy markets driven by payer pressure and more aggressive utilization management.
And then secondly, the complexity of ramping new facilities in an environment of heightened regulatory scrutiny on our industry. To give you a sense of some of the complexity of ramping a new facility, first-year ramp is gated by licensure surveys and accreditation, which is usually around 75 days, and then a Medicare tie-in, which can take another two to six weeks, a Medicaid eligibility, which is often six to eight months, and payer credentialing. In markets where payer contracting moved quickly and referral pipelines were strong, we've seen occupancy build ahead of plan. These facilities demonstrate that our operating model works when external conditions align. Conversely, certain geographies have faced friction, particularly around Medicaid credentialing and authorization processes. Even with very strong referral activity, delays in network participation and heightened utilization management have slowed census growth in places. That said, these cohorts overall represent a significant embedded growth opportunity.
As we'll discuss in the next slide, we expect these beds to continue ramping and contribute meaningfully to EBITDA as we execute targeted initiatives. This next slide shows the opportunity that we see with these new facility openings. Despite some of the near-term ramp challenges, we still believe that the long-term opportunity for our recent investments is very compelling. Over the past three years, we have opened more than 2,500 new beds, and we expect to add another 500-700 beds in calendar 2026. These four cohorts, 2023 through 2026, represent over 2,000 beds from new facility builds, translating into at least $150 million of future EBITDA at maturity. When you factor in the burden of startup losses on current run rate EBITDA, the incremental opportunity exceeds $200 million. This is powerful, untapped earnings and free cash flow growth engine for Acadia.
Importantly, this estimate excludes expansion beds. These expansion beds would be incremental. Many of these projects are joint ventures with leading health systems, as we've covered before, which accelerates our volume ramp and certainly enhances our referral pipelines. Our focus in 2026, in one word, is execution, optimizing occupancy, leveraging payer engagement, and driving operational excellence to unlock this value. Let's speak for a moment about several of the headwinds and tailwinds that will impact us in 2026. While we will provide formal guidance, as we always do in February, I did want to take a few moments to call out some additional color here. Overall, we remain confident in the strategy we're executing across the company to provide strong clinical outcomes for our patients and the communities we serve.
We see the following headwinds and tailwinds as we enter 2026, and we'll start with headwinds in red here on the left. We do anticipate continued softness in acute care Medicaid volumes, along with continued payer-related pressures consistent with trends observed throughout 2025. We're also closely monitoring the reimbursement environment, which continues to evolve as government payers face significant cost pressures. We remain a committed partner to our payers, and we believe we can play a meaningful role in improving outcomes for the patients we serve. In one recent state development, the state of New York has decided that it will not allow its Medicaid patients to receive care in out-of-state facilities. We have multiple specialty facilities in Pennsylvania near the New York border that will feel the impact of this change. We currently estimate a $25-$30 million annual EBITDA impact if we're unable to backfill those beds.
As we've disclosed previously, we had a non-recurring $28.5 million benefit from Tennessee's 2024 supplemental payment program, which was recorded in the second quarter of 2025. And then finally, we're closely monitoring changes in staffing ratio requirements for the industry in California. California is a tight labor market, as many of you know, and if these ratios go into effect, we may need to reduce census at our California facilities. Turning to the right side of this slide in green on the tailwinds, several key adjusted EBITDA tailwinds include ramping contributions from the large number of bed additions over the last several quarters that we've covered before, expanded supplemental payments, which, if implemented, we estimate would provide a $22 million one-time EBITDA benefit, as well as an incremental run rate EBITDA benefit in excess of that.
We anticipate generating positive free cash flow this year, as we expect to see CapEx decline by at least $300 million, and finally, we expect a tailwind from anniversary recent facility closures and a modest decline in startup losses. This final slide I'd like to cover focuses on the multiple operational improvement initiatives that we've put in place across the company. As we move into 2026, we've taken decisive action to optimize both our growth investments and our existing portfolio to position our company for improved financial performance in a more uncertain environment, particularly in light of the current headwinds, which we believe will ultimately be transitory in nature. First, we are very focused on capturing the inherent growth opportunity that currently exists in the business.
As I noted earlier, we've added over 2,500 beds over the last three years, and we expect to add another 500-700 beds in 2026. This includes new facilities developed in partnerships with new marquee joint venture partners such as Tufts Medicine and Orlando Health. These are facilities that new JV partners will open this year. These additions are expected to contribute meaningfully to both same-store volume and EBITDA as they ramp over the next several years and reach their full performance potential. As we continue to optimize the impact from beds added in recent years, we are also driving execution across all of our facilities in order to provide high-quality and effective healthcare to our patients. To support these efforts, we've implemented a series of targeted initiatives focused on acute care referral sources.
We've developed these referral source action plans at underperforming facilities with senior operator ownership and weekly executive team updates. We've repositioned key clinical roles, introduced more data-driven planning, and allocated dedicated resources to support execution. Over the past several years, we've made meaningful investments in our quality platform, including standardized clinical protocols, enhanced data systems, outcome tracking, all of which are becoming increasingly important to both our payer partners and to our accrediting agencies. These investments are designed to strengthen care delivery and demonstrate the value of our services, and we expect them to drive long-term benefits for patients, payers, and our business. We're closely engaging with our important payer partners, particularly in Medicaid, to demonstrate how our unique investments in technology and process position us to be part of the solution to the cost pressures facing government and other providers and other payers.
As a result of these steps, as we finish 2025 and move into 2026, our company is in a better position to serve more vulnerable patients in our communities with higher quality care while at the same time delivering long-term growth and unlocking the free cash flow generating power of the business. So with that, I'm going to turn things back over to Harry, and we'll get into the Q&A.
Great. Thank you, Chris. That was awesome. A lot of great information there. I wanted to first touch upon the significant number of beds you've added over the past few years, and Todd, feel free to jump in here. Just overall, how do these investments position Acadia for growth long-term?
Yeah, we're very excited about the new capacity we've brought online. There's a lot of unmet need across the industry, and this is really the focus of our team across all of our facilities. It's how do we help this vulnerable patient population in times of distress get to better outcomes? And as you saw from the outcomes that Chris shared, meaningful reductions in depressive symptoms, meaningful improvements in quality of life. And so what these facilities are doing, first, they're with these really high-quality JV partners. In many cases, they're new beds working with some of the best health systems in those states, and they've turned to us as a way to treat this patient population because it is a really hard patient population to treat well.
And again, that's where these quality and clinical outcomes, we're thrilled to finally have data to share because it does go to what our teams are doing on the front lines every day. From the standpoint of EBITDA growth, these are the beds that are available. No more capital will be needed to fill these patients and these cohorts we brought on in 2023, 2024, and 2025, and most of the capital is behind us for the 2026 beds. This is a great opportunity. As we noted in the presentation, they've not been filled as fast as would be expected or what history would show with the information we shared last year. But we're very confident that we are going to continue to increase the occupancy rates and be able to provide for that. And with that, we're going to unlock a lot of growth.
As we said, over $200 million from these new facilities, excluding the expansion ones relative to what we're doing here of about just over $600 million in 2025. So a lot of earnings potential that's really from this bed growth. At the same time, we've made a decision to slow down these investments because we have asked a lot of our teams to digest this level of expansion to deal with all of the investments we've been making in quality and process and technology at the facility level. And so we had some growing pains in 2025. We didn't deliver at the level we expected, but we think greater continuity of leadership teams on the ground will help that as we move into 2026 and forward.
Great. And you sort of started to touch on it there, but Chris had mentioned the plans to reduce CapEx spending in 2026. How do we think about that decision in the broader context you were just laying out?
Yeah, a lot of it is we've got a lot of embedded growth available, and with that, we need to deliver against that and deliver higher occupancy and look to do that over 2026, 2027, 2028. The other element, construction costs have ballooned over the last few years. So the cost to add beds has jumped up dramatically where the rate environment we're facing is mitigating. It's going back to the historical norms of a couple% a year. So we're factoring all of that into where do we look to deploy capital. But we feel very good that we can continue to grow well while not adding the same number of beds that we've added the last couple of years, understanding that as we start to generate this free cash flow, we'll deleverage up a little higher than we would like, but the opportunity to bring that down.
And then we'll look at the M&A environment as well. It's a very fragmented industry. As Chris noted, we're the number one independent behavioral health company. There's one other big public competitor in the space, but there's a lot. So it may be more efficient to acquire beds than to build our own, depending on the different capital markets at the time we look at it. But right now, we're very confident we can get growth without needing to add beds here in the next few years as we get these facilities to ramp up to that sort of 80% occupancy that most of our historic facilities run at.
And Chris had touched upon some of the headwinds that you all are experiencing, and that's, I think, broadly felt across the industry. Can you dig a little deeper on the ways you're addressing those challenges? And I think it'd be interesting to hear about some of the payer pressure you're seeing and how you're partnering with your payer partners, and then also just the slower ramp in the new facilities as you're bringing those online.
Yeah, our government relations team does a great job of interacting with the different state and federal organizations. At times, there are decisions made that we don't, frankly, understand from an economic standpoint. This decision by the State of New York not to provide for their patients if they go to a facility right across the state line in Pennsylvania is one of those. That's a headwind to our business in 2026. It's unfortunate. Patients are going to have to travel farther to get care that's probably not as good as what we provide, and it's going to cost the state more money. So those are things that we are often trying to understand. The staffing ratios in California, again, not something that's going to be good for patient care. Our focus is on delivering for patients, delivering that high-quality care with really good outcomes.
And with that, it improves both the government relations side, but also on the payers. We've called out this payer friction that we've been experiencing, especially in the back half of 2025. It continues to be something we're engaging with all the time, but it is a part where we want to be able to show these outcomes because we think that helps in those discussions on length of stay and how long a patient needs to be treated for. Our acute patients are treated in the U.S. for a far shorter amount of time than anywhere else in the world, and that's not ideal for patient care. This is something where we've really made these investments in quality in data so we can provide outcomes and really help the payers understand the impact of their system of these patients coming back in.
If you have both a behavioral health need and another comorbidity, it increases your cost three to five times on the network. That's the sort of information we're sharing with payers. We're getting in front of them and having those conversations because it is such a critical element when over 50% of our revenue comes from Medicaid.
Right. Maybe on the flip side of that, what are the bigger opportunities that you all are keeping your eye on and teams are preparing for, say, for the next three years that you're trying to capitalize on?
Our focus is fundamentally the quality of care, delivering that with good process. Attrition in the industry is still very high. It's a tough environment for people to work in. And with that, we need really good process, really good technology to be able to deliver consistent care every day to the patients. And those investments are paying off. We're seeing it in the outcomes. And so for us, it's really continuing to do that while ramping occupancy, working with our referral partners, making sure we're getting payers to understand the best outcomes are with us and to have those emergency rooms, those police departments knowing that they can go to Acadia and get really good care. Given the number of beds we have available to occupy, that really is the focus for the next few years.
And as we do that, we're going to see profitability increase, cash flow increase, leverage come down. And again, we think that all provides a good result for shareholders.
That's great. You talked a little bit about clinical quality there, and so I just want to double-click. Clinical quality outcomes, how do you think about that in your overall strategy? How do you see it differentiate Acadia?
Yeah, I think, as you saw, this 27% improvement, 54% improvement, effect sizes at the 97% level, having a big material impact on patients' lives. First off, that's what we're here to do. That's what our people on the ground are focused on every day is really making that impact on the patients. And so as we do that, we're then taking the data. The investments we've made in electronic medical records now means we have the data. We're taking our data when a patient comes in the front door and then collecting that when they leave so that we can compare that. That then gives us more information to go to payers to help them reduce their overall care costs within the network on it.
So far, I would say we've made those investments and we're starting to deliver on the care and the data, but we haven't been able to get yet the higher level of reimbursement. But that will continue to be our focus as we do it. But really, it comes down to that process and technology so that we can give that consistent care. That's been investments. Our cost at our facilities is up because of the IT investments we've needed to make, license fees. But we do think over time that's going to be the driver that lets us give this consistent quality of care. It also should help on this litigation risk. Chris talked about the big downside to us in 2025. It was this increase in the cost of the product.
I guess it's not product liability on this side now that I'm on the provider side, but the provider liability that comes with treating patients. Most of those claims and the increases were from cases from 2019, 2020, before these investments were made at Acadia. As we're making them, we have better visibility to what's causing incidents to happen. We've got better control over that. And that should then reduce this and help bring that cost much lower than what we expect it'll be in 2025 or 2026.
So all of those things feed into this integrated loop that we've been driving, which is investments, good people on the ground, taking care of patients, delivering high-quality outcomes. With that, it makes for a long-term sustainability of our business. We'll have payers that want to work with us. We'll have referral partners that are excited. We'll have more JV facilities and health systems that want us to be the provider of choice. And better outcomes should lead to lower litigation costs in the future.
Yeah, that's great. I think we have maybe time for one more, so I just want to squeeze this in. Zooming out on behavioral health has been a recurring challenge in our country for a number of years, to say the least. What is your view on the demand trends overall heading into 2026 as you're working with your payer partners or the JV partners that you have?
Yeah, I mean, I think we put some stats in there, and they don't get refreshed quite as often as we would like, so they're a little dated. But unfortunately, I don't think that trend is stopping. Suicide rates for young people are certainly higher than we would like. I think a lot of us thought coming out of COVID that we'd get back to more of a normal course on this topic, but unfortunately, that hasn't been the case. I don't know if it's the screen time or whatnot that we all deal with with our kids. But certainly, it is an area. The opioid use deaths have come down with Narcan being far more available, but the incidence rates are still really high. That's where, as Chris mentioned, great results on our CTC business and where that plays out from just helping more people.
S o unfortunately, we don't see the demand dropping at all, and we think we're really well-positioned to help those patients as they come in need, and again, that's fundamentally the mission our teams have and what we look to do every day at Acadia.
Awesome. Well, that's great. I think we're going to have to leave it there. Thank you both. Thank you all for joining us today. Have a great rest of your evening.
Thanks, Harry. Thanks, everyone.
Thank you.