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2024 Wells Fargo Healthcare Conference

Sep 4, 2024

Stephen Baxter
Analyst, Wells Fargo

All right, I think this is on? Okay. Yeah, good afternoon, everyone. Steve Baxter, the healthcare services analyst here at Wells Fargo. We're very pleased to have Agilon with us this afternoon. So Agilon is one of the largest, if not the largest, value-based care enablement company in the country. From the company, we have CEO Steve Sell and CFO Jeff Schwaneke. So thanks again for being here. Jump right into Q&A?

Steve Sell
CEO, Agilon

Go, go for it, Steve. Yeah. Thanks for having us.

Stephen Baxter
Analyst, Wells Fargo

Yeah, of course. No, thank you for coming. So just to kind of start things off, you know, most basic kind of blocking and tackling. You know, with Q2 results, I think, you know, pleasantly surprised to hear that, you know, cost trend was potentially trending better than when you initially booked it, at least when, you know, it came to Q1. Just remind us what you saw with Q1, how you approached booking Q2 from a cost trend perspective, and then anything incrementally you may have learned since about that.

Jeff Schwaneke
CFO, Agilon

Yeah, yeah. I can-

Steve Sell
CEO, Agilon

Go ahead.

Jeff Schwaneke
CFO, Agilon

I can start in here. So a couple things. In the original guide, we had over 10% cost trending loaded in Q1. That was subsequently came down into the 9% range, and now it's been recast into the 8.2% range. So, you know, I think it's important to remember, it's about where your expectations were. So we had high expectations at 10%, and now we're at 8.2%. So that, you know, it really came down across all categories from our expectations. Obviously, we're still seeing higher costs in the inpatient medical category, which I think everybody's kind of experiencing.

Second quarter, as we went into second quarter, we had forecasted 6.8%, ultimately recorded that up to 7.3%, just recognizing the, I think, the dynamic utilization environment that we're in at this point in time. And then, you know, going on Q3, we've got 6% cost trend loaded. And then, tailing into the fourth quarter, we switched to a PMPM because the jumping off point in the previous year-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Jeff Schwaneke
CFO, Agilon

was so high. So our our PMPM medical cost in the fourth quarter is higher than the third quarter.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Jeff Schwaneke
CFO, Agilon

So we have it... Yeah, and that's traditional seasonality. So that's what we've got.

Stephen Baxter
Analyst, Wells Fargo

Got it. And then, you know, obviously, to your point, you know, inpatient's been a huge area of focus, everything going on with, you know, Two-Midnight Rule dynamics and things like that. I believe you said that the second quarter saw inpatient lower than the first quarter.

Jeff Schwaneke
CFO, Agilon

Right.

Stephen Baxter
Analyst, Wells Fargo

It doesn't sound like you're seeing anything on the inpatient side that's incredibly deviating from your expectations. But I guess, what are you seeing on inpatient broadly and Two-Midnight Rule? Like, how are you guys planning for that, and what are you actually seeing at this point?

Steve Sell
CEO, Agilon

Yeah. So Steve, on our call, we kinda called out that we built in expectations around Two-Midnight Rule, with more lower acuity admissions coming in. I think we've seen that. We have census data for inpatient for about 50% of our membership from our three largest nationals. We get that on, like, a two-week lag, so we have the ability to track across time what that looks like. And I think we've seen some differences in terms of payers performance on that from a month-to-month perspective. But in general, we did see Q2 down versus Q1 from an ADK or admits per thousand perspective across that time. We did see some of the effect from Two-Midnight in terms of some of those low acuity admissions when we correlated with the paid claims data.

But that, that's giving us a pretty good read on that. And while we did see it come down, we felt like we only had 50% view across-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

And that'll step up to 75% here in the back half of the year, and it's dynamic. And so, as Jeff said, we chose to book the extra 50 basis points in Q2.

Stephen Baxter
Analyst, Wells Fargo

Okay. Yeah, I think that makes sense. That way, even if things are a little bit worse, like, you've planned for that, but no, no evidence yet that that's what you're actually saying.

Jeff Schwaneke
CFO, Agilon

Yeah. No, yeah. No, that's right.

Stephen Baxter
Analyst, Wells Fargo

Okay, and I think one of the other guidance updates, just... Can you hear me okay?

Steve Sell
CEO, Agilon

I was having a hard time.

Stephen Baxter
Analyst, Wells Fargo

Okay. One of the other guidance updates you provided was, you know, kind of an update on obviously, you took a contract out, you know, retroactively. I think you made some adjustments to some of the yield assumptions in your contracts, underneath that. Can you just walk us through, you know, some of those yield changes that you made? Like, if you exclude the contract exit, what was driving the lower PMPM yields, and what's the degree of confidence that that also results in lower medical costs underneath that?

Jeff Schwaneke
CFO, Agilon

Yeah. Yeah. So a couple things. I'll just talk about it all from start to finish here-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Jeff Schwaneke
CFO, Agilon

because, there's a lot of moving pieces, as I think you noted. So, the first piece was a retroactive contract termination, $110 million dollars. If you do the math on that, those members had a premium of roughly $1,075 dollars each. That was partially offset by continued new membership growth, and those new members coming in have a premium in the high eight hundreds, and so there is the mixed component there. And then another piece, as we mentioned on the call, was the RAF. So we had data from one of our national payers that indicated our risk adjustment was a little bit below what we expected.

And so ultimately, we flowed that through the first half of the year and then pushed a piece of that into the second half of the year as well, and that was the other component. And there was a margin component of all of that, and so that's why we guided from the midpoint of our previous guidance range down to the bottom. And so those are the kind of components that are, I would say, changing the PMPM on the revenue line.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

Then you asked about lower acuity revenue-

Stephen Baxter
Analyst, Wells Fargo

Yes

Steve Sell
CEO, Agilon

and the correlation with

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

-lower MedEx.

Stephen Baxter
Analyst, Wells Fargo

Like a practical example, I guess, of like, what is a lower yielding PMPM plan on the revenue side, and what makes the costs lower?

Steve Sell
CEO, Agilon

Yeah. I mean, that's typically the way it's correlated in our experience, is folks choosing lighter plans. Do you have lower Med Ex against that? And so we've just got enough pattern recognition that that's what we applied there.

Stephen Baxter
Analyst, Wells Fargo

... Okay. And then in terms of your, you know, your growth cohorts, you know, this year, and I think the upward trend you projected, like, can you update us on, you know, performance of your, your twenty twenty-four cohort, how it's performing versus your expectations?

Steve Sell
CEO, Agilon

Yeah, we have a really strong Class of 2024 . It's our largest class to date. We've got some really strong partners within that class, and they are off to a very good start. Some of the best groups in the country that brought in a tremendous amount of experience, Catalyst Health Group, as an example-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

-out of Dallas-Fort Worth and in North Texas. And all of the groups within that cohort are performing well. The implementation went very well.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

We had a full implementation in 2023. Some of them have implemented clinical programs earlier than some of our other year one markets, so we're off to a good start with that class.

Stephen Baxter
Analyst, Wells Fargo

Okay. It sounds like in the past, you know, few weeks, you started to get a lot more information from, you know, payers about, you know, 2025 offerings. I'd love to get, you know, your initial sense of what you're learning as you've gotten more visibility into those offerings, whatever you might be willing to share at this point, and then have some follow-up questions, you know, about like, you know, Part D recontracting or supplemental benefits and things like that, too.

Steve Sell
CEO, Agilon

I think we have to be pretty careful about what we would say publicly-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

about what we've got in. We are just digesting them. We've got about 50% of our membership that we've received the bids on for one one twenty-five, that have come in in the last week. We'll get the balance of those here over the next couple of weeks. I think the quick glance is they seem to be in line with public commentary, but the detail at the market level is really what matters.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

You know, where we're at is... I mean, Jeff's team is working 24/7 in terms of analyzing those bids.

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm.

Steve Sell
CEO, Agilon

And then we'll take that information and then apply it to 2025.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

Couple big things for 2025. One is Part D-

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm

Steve Sell
CEO, Agilon

with the changes with the Inflation Reduction Act, so that's a pretty active dialogue in terms of the ability to carve out or corridor, that benefit. Just to remind you, two-thirds of our payers in 2024, we don't have-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

High risk for in one-third of our membership, so this is the balance that we're talking about. That's moved beyond just concept to now we're sort of going back and forth about mechanically-

Stephen Baxter
Analyst, Wells Fargo

Okay

Steve Sell
CEO, Agilon

What, what could that look like? And I think just as we've looked at D historically, we don't feel like we have as much of the levers to manage that relative to a payer.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

We don't have the formulary, we don't have the manufacturer rebates around that, and so there's been receptivity around that, and we'll update.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

But then the last piece of this is 40% of the book is-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

Open for one one for renewals. So we'll reprice that for one one, incorporating all those things I talked about. We'll reprice 100% of the book by one one of 2027.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

So in the next, you know, 24-27 months, you'll basically reset all of that. And we've been able to get some nice language in there around sort of material changes, look-back period, some of the things that I think can reduce the volatility that we've seen historically.

Stephen Baxter
Analyst, Wells Fargo

Okay. And I think in the past, you've discussed, hey, there might be an opportunity around, you know, certain supplemental benefits. Obviously, you don't have a great-

Steve Sell
CEO, Agilon

That's right

Stephen Baxter
Analyst, Wells Fargo

ability to control. As you've gone through the, you know, kind of these renegotiation processes, do you feel like you're having success potentially, you know, making carve-outs anywhere there? Or do you think it's more, you know, "Hey, we just need to fix the underlying benefit structure," and then you'll benefit downstream from that, too?

Steve Sell
CEO, Agilon

I mean, that's one of our asks.

Stephen Baxter
Analyst, Wells Fargo

Yeah. Okay

Steve Sell
CEO, Agilon

-is to carve out or to corridor supplemental benefits, the same way we have less impact on things like dental or vision or somebody-

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm

Steve Sell
CEO, Agilon

using a cash card to purchase something at CVS. It's not sort of in that core medical. So I think there's an openness to that. What the payers have asked us to do is to go through those bids and then come back and talk about how we-

Stephen Baxter
Analyst, Wells Fargo

Okay

Steve Sell
CEO, Agilon

So understand what changes they made.

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

-for twenty-five.

Stephen Baxter
Analyst, Wells Fargo

Is this still important to you?

Steve Sell
CEO, Agilon

How big of an issue is this, really?

Stephen Baxter
Analyst, Wells Fargo

Yeah. Okay.

Steve Sell
CEO, Agilon

So again, we're gonna know a lot more. I mean, is there anything you'd add to that?

Jeff Schwaneke
CFO, Agilon

No, no, I mean, we have to go through the process, look at all the bids. We're gonna know a lot more by the time we get to the third quarter call, I'd say.

Stephen Baxter
Analyst, Wells Fargo

Okay. That makes sense. And in terms of, you know, just... You mentioned, like, the payer receptivity to some of the changes on, you know, Part D are pretty good at the moment, which is nice to hear. I guess, how do you think about the natural, you know, push and pull of you have a lot of large companies that are really underperforming their margin expectations, and at the same time, you know, you're trying to think about getting things that you probably feel like are very reasonable things to request. They might feel like they are, in some ways, concessions or make it harder for them to show the progress they want on margins. Like, how do you feel like that push and pull is sort of playing out?

Steve Sell
CEO, Agilon

I mean, I think the key is in terms of the value that we can provide to a large health plan. I think they all pretty consistently are looking to expand their value-based care penetration within their membership. I think the range of alternatives that they have to work within that have shrunk-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

in the last 24 months.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

So again, our relative value proposition is sort of elevated.

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm.

Steve Sell
CEO, Agilon

I think we've done a very good job on the things that we control within that core medical, driving 200-300 basis points better than what they see across their fee-for-service network, kind of their alternative within that geography, and so for all of those reasons, I think they are amenable.

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

to the things that we're asking about. Obviously, we're gonna find out a lot here in the next couple of months.

Stephen Baxter
Analyst, Wells Fargo

Right.

Steve Sell
CEO, Agilon

But that's the nature. I mean, it's constructive. If anything, they're asking us to go to more geographies and to take on more senior patients, and so we're having a really healthy back and forth on that.

Stephen Baxter
Analyst, Wells Fargo

Okay. Got it. Okay, so then, yeah, so the first lever for you guys to obviously improve your margins is being downstream from an improving industry dynamic.

Steve Sell
CEO, Agilon

Correct.

Stephen Baxter
Analyst, Wells Fargo

Can you talk a little bit about, you know, in order of magnitude, what are the other key drivers for you in terms of improving the margins? I mean, cohort maturation is obviously a big part of it, but you're also working on a lot of physician initiatives and clinical initiatives as well. Like, what are the most important things beyond MA, margin improvement at the industry level that we should be watching?

Steve Sell
CEO, Agilon

Yeah, I mean, there will be an impact from how the payers bid-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

... to your perspective. But the big things that we control is, you know, where we grow and the populations we serve. But within that, then, what we're doing in terms of sort of what we call burden of illness or risk adjustment, maturation each year, you typically see that move materially in those first few years, in particular, years one, two, three. Reminder, we're going to geographies that have typically been heavy fee-for-service, so we're starting from a lower standpoint in terms of that starting off point. Quality is very important, and there's pretty significant incentives in these physician or these payer arrangements around hitting four, and particularly four and a quarter stars. All of our year two markets are above four stars.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

Majority of them are actually above four and a quarter. And I think you know that the baselines are coming up, and so there are fewer and fewer people that are able to deliver that. So that's important for them. And then it's the core clinical work, right?

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

So the work we do to identify those highest-risk patients, to get them enrolled in our clinical programs, whether it's renal, whether it's palliative, we have some oncology programs, that we're working through, but those are what are allowing us to drive that sort of performance alpha of 2 to 300 basis points better than that alternative for them. So those are the things outside of their bids-

Stephen Baxter
Analyst, Wells Fargo

Right

Steve Sell
CEO, Agilon

... that we work on.

Stephen Baxter
Analyst, Wells Fargo

Okay. And then as we're thinking about, you know, the size of the cohorts, this is showing a nice upward trend over the past couple of years in terms of the size of the new-

Steve Sell
CEO, Agilon

The new membership.

Stephen Baxter
Analyst, Wells Fargo

Yeah. I guess, like, how are you guys thinking about that as a sustainable level? And I guess in general, I would love to hear how some of the discussions are going with prospective partner groups, especially in light of, you know, potentially other alternatives, maybe stepping back to your point earlier.

Steve Sell
CEO, Agilon

Yeah, I mean, I think the demand for what we're doing from the payer side and from the physician side has only increased, given the environment in which we operate today. Fewer alternatives for physicians and fewer alternatives for payers around that. The Class of 2025 that we've announced is five really strong groups, 60,000 senior patients. That group is four of those groups are in existing states, Steven, and one is in a new state. That's a little bit different growth profile for us. It's a conscious decision on our part. There's a lower beta to grow into an existing market where you've got contracts, you've got-

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm

Steve Sell
CEO, Agilon

... technology, you've got clinical programs that are set up around that. And so, that was a very conscious decision. That class could have been much larger.

Stephen Baxter
Analyst, Wells Fargo

Right.

Steve Sell
CEO, Agilon

I think, given the environment, we were talking about really sort of being prudent around our growth, and not only the volume, but where we wanted to do that, and so that's how we thought about that. There are groups that we're working on that could have been in twenty-five to bring them into twenty-six. There's new groups that we're talking about around that, but again, I think the key is gonna be what is sort of the economic profile that you can put them on in a market, which goes to-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

... those payer contracts that we're gonna know a lot about here, in the next few months. So that, that's sort of the process that we're going through right now-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

that can range, but the opportunity is fairly large around that.

Stephen Baxter
Analyst, Wells Fargo

Okay. So you're saying there's some things that might make sense to leave for twenty twenty-six, because maybe in twenty twenty-five, you're not necessarily where you wanna be with a given-

Steve Sell
CEO, Agilon

Well, we-

Stephen Baxter
Analyst, Wells Fargo

Payer or market?

Steve Sell
CEO, Agilon

We've done that.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

So we've announced Class 25.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

Right now we're working on the class twenty-six, and we made that decision to go from twenty-five to twenty-six, and some jointly with that partner based on dialogue with payers. There's a lot of wood to chop around these payer renewals, with 40% of the book open, with, you know, new contracts that are coming on as well. And so, that's an opportunity for us on a go-forward basis.

Stephen Baxter
Analyst, Wells Fargo

Yeah, and I guess how, in addition to the new market growth, like, should we think about the same store growth profile as well? I mean, for a while, I think you're kind of reporting like 13%-15% same store membership growth, and maybe it's slowed down a little bit as you've tried to focus more on, I think, like, physician standardization and making sure the new physicians are performing at the level that you expect. What's the latest interaction between improving the new physician performance and the level of same store enrollment that you can drive?

Steve Sell
CEO, Agilon

Yeah, so I think just in general, sort of the rule of thumb we have is we will grow at or above the local growth rate, one to one and a half times. Those local growth rates have come down-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

Relative to where they were, you know, two years ago. Next year, we'll see what that growth rate is. I mean, you have to go through all of these bids and sort of-

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm

Steve Sell
CEO, Agilon

understand what that growth rate would look like. But I'll pick a number. If it was 5% next year, averaging across our base, we might grow at 6% or 7%. And so I think the big thing will be those bids, what that looks like. The work we're doing on sort of the physician engagement and really narrowing sort of-

Stephen Baxter
Analyst, Wells Fargo

Mm

Steve Sell
CEO, Agilon

That performance has got a lot of traction.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

We talked about on our call, about 75% of our PCPs, we put through an active panel review. Every single quarter, they're meeting with a local medical director and a care team around that.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

They're not only just getting benchmarking back on their performance, but you're looking at how you identify those complex patients and get them matched up with the resources.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

And then is there anything like operationally that's in the way? And the early returns are encouraging for us. We talked about, we had three of those markets that got on early. Between January and May, they saw an 8% reduction-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

in ER and inpatient. In our, you know, the control group that had not gone on was basically flat in that time.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

So we'll see if-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

... We're expanding that pretty dramatically.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

But those are the things where we feel like if we block and tackle, we can really drive that type of difference relative to what a payer might be able to do in a broad fee-for-service network that's out there.

Stephen Baxter
Analyst, Wells Fargo

Yeah, I mean, it makes perfect sense when you provide the information, that they're compelled to act differently. I guess, are there examples of when it doesn't work? Like, why it doesn't work, like you said, some operational-

Steve Sell
CEO, Agilon

Well, I mean-

Stephen Baxter
Analyst, Wells Fargo

-considerations

Steve Sell
CEO, Agilon

... it could be an issue in terms of the EMR.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

In terms of the interface on that, and are you getting that? It could be scheduling, right?

Stephen Baxter
Analyst, Wells Fargo

Mm.

Steve Sell
CEO, Agilon

So, we're working with folks around... Those things are fixable, but as you look at that, there could be a difference between some offices and how those are being handled. One of the biggest things we've seen is strong clinical leadership that's sort of reinforcing with them around that.

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm.

Steve Sell
CEO, Agilon

We really tried to elevate the role of the local medical director around that.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

And we've brought in regional medical directors who've been practicing physicians in our network, and been strong local leaders, to actually become regional leaders. So they might be working with other groups-

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm

Steve Sell
CEO, Agilon

... within a state or within a region.

Stephen Baxter
Analyst, Wells Fargo

Okay, and in the past, you've had, like, a big focus on rolling out new clinical initiatives. You know, what's the latest update on... You know, I think at your Investor Day, for example, you highlighted a few big examples. Any big, new clinical programs that are a new focus area for you, that you guys have found incrementally as you've looked for ways to drive function?

Steve Sell
CEO, Agilon

I think oncology infusion-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

is a massive area, and so we've got a few of our markets where we're really piloting with a partner around the ability to meaningfully impact that. And I think if you look at the pipeline, you look at Part B spend after inpatient, Part B-

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm

Steve Sell
CEO, Agilon

... as in boy, is the other category this year that's running, you know, high single digits.

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm.

Steve Sell
CEO, Agilon

That is a big one. You know, outpatient surgeries, hips, knees, was a big issue last year, not as much of an issue this year.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

But we've got significant MSK work that's going on in a few of our markets. In terms of site of service, who is that, that place where you wanna get that, so you can channel that volume? Which is something that we have the ability to do pretty well. So those would be two that I would call out.

Stephen Baxter
Analyst, Wells Fargo

Okay. That might, like, more trying to make sure that things get into ASCs, that could be-

Steve Sell
CEO, Agilon

Correct

Stephen Baxter
Analyst, Wells Fargo

... an ASC.

Steve Sell
CEO, Agilon

Yeah, that's right.

Stephen Baxter
Analyst, Wells Fargo

So, like, moving them down the chain a little bit. Okay. Makes sense. And then in terms of, you know, your hospital partnerships were like a notable addition. You know, I guess, in general, like how have they performed? Is there more coming on the hospital side? Like, I know it's a pretty unique opportunity in the first place, but how are the provider opportunities coming along?

Steve Sell
CEO, Agilon

Yeah. So they're coming along well. We have three health system partners, just to remind you.

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm.

Steve Sell
CEO, Agilon

One that's in year two, which is MaineHealth.

Stephen Baxter
Analyst, Wells Fargo

Yep.

Steve Sell
CEO, Agilon

Two that are year one, which is Premier in Dayton and Holland in Western Michigan.

Stephen Baxter
Analyst, Wells Fargo

Uh.

Steve Sell
CEO, Agilon

You know, Premier and Holland have come on in markets that we had an independent partner in that market already. We had all that infrastructure-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

... set up, like I talked about.

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm.

Steve Sell
CEO, Agilon

And they've come on, and they've really hit the ground running, and so we really like that model a lot, particularly if our local partner has a good relation. In both cases, they were the ones who made that introduction, got those, physicians and leadership comfortable. Both health systems have a mix of, employed and affiliated or independent docs-

Stephen Baxter
Analyst, Wells Fargo

Mm

Steve Sell
CEO, Agilon

... around that. So but physicians trust physicians, and they know each other in the community, and-

Stephen Baxter
Analyst, Wells Fargo

Mm

Steve Sell
CEO, Agilon

... so those are, those are tracking very well, and they're in that Class of 2024 that I talked about in stepping up. MaineHealth is Class of 2023. That's a large, almost statewide-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

... network. It's, like, in ten different geographies within the state of Maine, and they're tracking well. They were our first. We learned a lot about things like-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

... the Epic interface, and it's difficult because each instance is a little different. But if you can get some things implemented there, you can see pretty meaningful step-ups in compliance around that. Working very closely with their medical directors back on that sort of reinforcement piece that I talked about.

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm.

Steve Sell
CEO, Agilon

... Health systems are definitely in our total addressable market, and we like this idea of pulling in health systems that are in the geographies we're serving.

Stephen Baxter
Analyst, Wells Fargo

Okay. And obviously, we're almost now complete the first year of, you know, the V28 rollout. You know, it seems like the company was always very comfortable with the ability to manage that. I mean, you're a year in now, like, what have you learned about that? How comfortable are you with the next two years of the phase-in?

Steve Sell
CEO, Agilon

I feel like I've been talking a lot. You want to?

Jeff Schwaneke
CFO, Agilon

Yeah, sure. So, yeah, we had V24, V28 in the forecast for this year. I think the only data point that we have was, you know, as I mentioned on the second quarter call, which we had one payer where we were just a little bit light. So we're getting the rest of that data this quarter, and you know, hopefully we'll have an answer by the time we get into Q3. But I think for all the reasons that Steve just mentioned on how we're controlling costs, and all of those factors, I think, you know, we're comfortable that we can manage that headwind going forward.

Stephen Baxter
Analyst, Wells Fargo

Okay, and then, you know, you mentioned a little bit with having greater visibility to inpatient census for, you know, your three largest payers. I think, like, a big focus of the investment community is trying to understand, I guess, like, how much your level of visibility on utilization has maybe improved versus where it was a year or two, maybe two years ago. Can you talk a little about that dynamic?

Jeff Schwaneke
CFO, Agilon

Yeah, yeah, sure. I mean, a year ago, we didn't even have the census data-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Jeff Schwaneke
CFO, Agilon

at all. So I think, you know, having 50% at this point in time, moving to 75% towards the end of the year, is going to be important. You know, that's, that's one data point that we're using that's more real-time, right? We talked about two-week delay that we're using in order to triangulate in on what we think the correct medical cost estimate is for the quarter. And so, you know, I think what I've been focused on since I've hit the ground here is, you know, what other kind of data points can we pull together that are more real time, that we can use to kind of paint the picture of what we think medical costs are and what cost trends are?

The other piece that we had going is we have a financial data pipeline that we've talked about. It's going to cover eleven of our top payers, over 80% of our members. It's going to provide member-level revenue and cost data and claim line cost data. That goes live in January of next year. That's certainly going to help in the reserving process, but I think more importantly, it's going to help us manage the business at a more granular level, which is super important. So, you know, we're not done. We still have progress to go.

Stephen Baxter
Analyst, Wells Fargo

Yeah

Jeff Schwaneke
CFO, Agilon

and a long way to go, I think, to pull all those pieces of data together. But, we're ahead of where we were a year ago, and by next year, we're even gonna be further ahead. So I think we're all heading in the right direction, but just a lot more work to go.

Stephen Baxter
Analyst, Wells Fargo

Got it. Yeah, that's a good, you know, lead-in to my next question. I probably should have asked this even earlier, is just, you know, you're obviously new to the role. You're not as new as you were a couple of months ago. In terms of the big opportunities that you see to really improve the financial process of the company beyond, you know, some of the visibility concerns, like, what do you think are some of the biggest things that you think are an opportunity for the company to innovate on?

Jeff Schwaneke
CFO, Agilon

Yeah, I think the first thing was obviously reserving.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Jeff Schwaneke
CFO, Agilon

You know, so I've spent a lot of time, I think, focused on reserving, pulling these pieces of data together, really applying judgment and trying to get the whole picture of where we think medical costs are going to land. I think forecasting and visibility on revenue and some of these other medical charges that we've talked about, I think there's an area there that we can spend more time on. But, you know, I'm two months in, and so I'm continuing to, you know, turn over every stone and learn more every day. And, you know, I'm excited about the things that we can do going ahead.

Stephen Baxter
Analyst, Wells Fargo

Yeah, that's great. And then obviously, you know, cash is just obviously a big focus for you guys. You know, I think, like, you provided some reasonably updated expectations on what you think the cash burn looks like over the next year or two. Just remind us, you know, your comfort level with where things are on a liquidity basis and your expectations for cash flow.

Jeff Schwaneke
CFO, Agilon

Yeah. Yeah, nothing's changed there since the second quarter call. We said this year, using between $125 million and $150 million in cash.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Jeff Schwaneke
CFO, Agilon

We have $408 million on the balance sheet and roughly, I'd say in the mid thirties on the ACO program.

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm

Jeff Schwaneke
CFO, Agilon

At the end of Q2. Next year, cash use of $25 million, and the way our cash flow works is, you know, this year really sets the stage for next year because we true up all the payments that are-

Stephen Baxter
Analyst, Wells Fargo

Got it

Jeff Schwaneke
CFO, Agilon

For this year's business into next year. And so, you know, as we look at it, we have a revolving credit facility. We're not, you know, we're not just standing by. We're actively managing our cash flow, and I guess what I'd say is we're comfortable that we have enough capital to get us where we need to go.

Stephen Baxter
Analyst, Wells Fargo

Okay. Just a couple more on MA. I mean, one thing we're starting to hear from, you know, the payers is a reasonably high expectation for switch-in in twenty twenty-five between different plan types. I guess, just holistically, I guess, how do you think about the impact that members switching from one plan to another has? And, you know, I think historically, you've positioned your model as being relatively agnostic between PPO membership and HMO membership. It does seem like a lot of the rationalization we might see could be on, you know, the PPO side of things. So you might have higher mix in HMO and kind of all said and done. Does that help you incremental to the underlying change in benefits, or how should we think about the membership mix changes?

Steve Sell
CEO, Agilon

Yeah, so I mean, I guess at a macro level, we are multi-payer or agnostic-

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm

Steve Sell
CEO, Agilon

... as you talked about in a geography, three, four, five different health plans. If people move between health plan A, B, or C, our retention typically runs in the low 90s. So we really don't lose people based on sort of movement between payers. I mean, the best you could do would be, like, 96%, just given the population that you're serving. So I think our retention is sort of best in class. So I think I don't worry about that as we look at next year. I think movement between plans and leaner plan designs or PPO versus HMO, we gotta kinda go through this analysis. I mean, conceptually, I think I agree with what you said, but we have to go through that a little bit, Steven.

I mean, there are markets we serve where there are very few HMO products, period.

Stephen Baxter
Analyst, Wells Fargo

Right.

Steve Sell
CEO, Agilon

and so, we've developed a facility, and what we've tried to do with this relationship between the PCP and the patient, is drive where that patient is going for their specialty care, where they're going for their inpatient or their elective. And so, we can do more on that, but I think we've had to build muscle around-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

- that sort of product set. If you move to a closed network HMO with a required auth, I mean, that just gives us sort of more leverage within that.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

We'll work closely with the payers. I do think what Jeff talked about on the financial pipeline is gonna help a lot because you can track that member longitudinally when they move from plan A to plan B-

Stephen Baxter
Analyst, Wells Fargo

Okay

Steve Sell
CEO, Agilon

... and see what that looks like pretty rapidly. Whereas before you had to go look at kinda each payer's data set, now you've got them standardized and normalized, so you can do that. So I think the things that we've been working on are gonna help if that scenario plays out. It will be dependent on... I think there'll be markets where there's not a lot of switching, and maybe there are some where there are a lot.

Stephen Baxter
Analyst, Wells Fargo

Okay.

Steve Sell
CEO, Agilon

It just totally depends on the bids-

Stephen Baxter
Analyst, Wells Fargo

Okay

Steve Sell
CEO, Agilon

and the relative relationship between them.

Stephen Baxter
Analyst, Wells Fargo

Yeah. Makes perfect sense. Okay, and then, you know, I haven't asked about ACO REACH, like, performance there. You know, it seems like it's held up. How you think about ACO REACH performance and potential for growth in the next couple of years? Like, why couldn't you grow more in ACO REACH than you are?

Steve Sell
CEO, Agilon

Yeah. I mean, it's been an area of strength.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

I mean, we've, our membership this year is above what we expected. We grew north of thirty thousand members, kinda year over year. I think we're at a hundred and thirty-two thousand at the end of Q2.

Stephen Baxter
Analyst, Wells Fargo

Mm-hmm.

Steve Sell
CEO, Agilon

We again beat that benchmark by 200-300 basis points, which is basically how you make the economics work.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

It's kind of a zero-sum game.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

If you beat it, you win. If you don't, you lose, and it's done within a year.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

So literally, it works back within that, and I think we're good at it for all the reasons that we've just talked about around those levers. So I think there's an opportunity to grow more membership within that.

Stephen Baxter
Analyst, Wells Fargo

Yeah.

Steve Sell
CEO, Agilon

I also think that there's bipartisan support for what comes after 2026, 'cause Reach does sunset at the end of 2026. But I think if you're looking at the Medicare Trust Fund, if you're thinking about a budget-based model in the fee-for-service world, that probably helps that economic outlook on the trust fund. And so there seems to be support from both sides of the aisle around that, and I think that could be an opportunity for us. But that'll play out here, and there's an election and other stuff-

Stephen Baxter
Analyst, Wells Fargo

Yeah

Steve Sell
CEO, Agilon

That'll affect it.

Stephen Baxter
Analyst, Wells Fargo

I've heard that there's an election.

Steve Sell
CEO, Agilon

There is. I think there is.

Stephen Baxter
Analyst, Wells Fargo

Okay. All right, well, I think that's a good place for us to leave it. So thanks again for your time today. I really appreciate it.

Steve Sell
CEO, Agilon

Great. Thanks. Thanks, Steven. Thanks. Appreciate it.

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