Good morning, and thank you for attending the conference. I'm Richard Close with Canaccord Genuity covering D igital and Tech-Enabled Health. We're excited to have AdaptHealth here again this year. I sit down with CFO Jason Clemens to discuss the current business trends and update on the operational initiatives put in place over the last year, the outlook going forward, and some comments on the big beautiful bill that we've been asking everyone their perspectives. Jason, thanks for being here.
Thanks for having us.
Maybe just to kick off, there's been a lot of simplification of the business over the last year, really some management coming in, dealing with some of the issues from previous years. Just curious in terms of your perception, in terms of the progress that you've made over the last several years and set the table for the discussion going forward.
Sure, sure, be happy to. I guess I'd start, first at the top of the company within senior management. Most importantly, our new CEO. I guess we can't say new anymore. It's been just over a year since Suzanne Foster joined the company from Danaher, where she was running a pretty big business over there. I think that Suzanne's biggest accomplishment in the first year was really getting the operating model simplified, as you said, and recruiting a really A-plus team across management. Today, there's six direct reports to the CEO. There's someone in charge of Commercial Operations, and that's all that person does. Russ Schuster joined us most recently from Cardinal . He was running their Canada at Home business. He joined us in December, and so he's running all things commercial. That's business development and M&A.
It includes top line growth in terms of sales, as well as rate, so managed care negotiations, things like that. He's been great. He's just a pleasure to work with, what you'd expect from a Chief Commercial Officer. Our Chief Operating Officer joined most recently from Qurate, the parent company to QVC. Scott Barnhart joined in October, had worked as a peer of Suzanne's back at Cardinal . He was running their global supply chain during the COVID pandemic. He's a class A COO. He's been doing a great job. Then there's others in, so essentially top of the P&L, middle of the P&L. I'm obviously on balance sheet, and then we've got some of our support functions, including Technology and Shared Services and Legal. That sounds pretty simple, but it was a very big deal for the organization.
As part of that reorg, we've gone from six operating regions down to four. Within those four operating regions, we've now got regional offices that there are leaders in each of these regional offices, as an example, in charge of intake, patient intake. That's still a heavy kind of paper-driven. We're installing a lot of e-prescribe, a lot of tech, but we've got someone in each region that that's all they do all day long is they're focused on intake of patient documentation information, chasing what is maybe missing from the referring provider and bringing that into the system. As well as customer service. We've centralized those in those regional offices, the customer service function, and we've hired great leaders across contact center, fleet, real estate, some of the core functions that are all in Scott's organization within the COO function.
That's, I'd say, really the biggest achievement that's been accomplished in the last year. I'd say a close second is the technology that we continue to invest in, including the myAPP. That's our proprietary app. We've added a lot of features in the last 12 months. Patients can go to the AdaptHealth myAPP, not across all business lines yet, but in diabetes and supplies to the home, they can reorder their supplies without talking to a human if they don't want to. We're working on sleep resupply. That'll be launching in the pretty near future. Folks can schedule their oxygen tank delivery and pickup. If you're a caregiver of maybe an elderly parent, that's worked out great. It's been well received. We've got 24/7 ability to text with an agent if that's what they want to do.
Outside of healthcare in general or outside of DME particularly, these sound like features of apps that you use every day to interface mostly in a retail environment. Within our industry, these are head and shoulder capabilities and improvements above what the competition's offering. I'd wrap by saying, in terms of agentic AI, some of the conversational AI that you might be aware of, as you might call in and ask where your order is or reschedule an appointment or even reorder your supply, we're coming out of pilot phase. We had talked about piloting this probably about two or three quarters ago. We're now starting to scale it. Now over 10% of our volume is going into those queues, those call queues, and it's actually pretty incredible to see how fast the AI learns and delivers a better patient experience.
It's without the labor line for humans to take care of that. We're pretty excited about it.
That's good. Needless to say, definitely a lot of room for technology, adoption, digitization in healthcare. You reported the second quarter last week. It was a busy quarter for all of us on the street, but it's probably worth it to hit on the highlights of that, and then we can obviously drill down into some other news items.
Sure. So, you know, we had a very solid second quarter. I mean, we met our expectations, really across every layer that we guide to, which is revenue, adjusted EBITDA, and free cash flow. On the revenue line, there are a lot of ins and outs this year. We did a little bit of M&A. We signed two terrific hospital system DME companies. You know, we welcomed them to the Adapt family on June 1st. With that comes the employees, the infrastructure, locations, and the inventory. As importantly is those referring relationships of being the easy button for these hospitals as discharges come out and those patients have needs at home for their chronic care needs. We're excited about that. We were very pleased to essentially finalize our disposition program.
We launched this about two years ago, the analytics and just the deep dives on what made sense strategically versus maybe what didn't. We completed now three different divestitures. The first being custom rehab, which is essentially like motorized wheelchairs, specialty wheelchairs. We sold that business late last year. I guess it was the third quarter of last year. Within the second quarter, we announced the divestiture of ActivStyle, which was an adult incontinence business, kind of direct to consumer. Think like television ads, mostly kind of late-night cable television ads. You know, we had bought that business back in 2020, actually a couple of days before I arrived. We just determined it didn't make a lot of sense. It doesn't drive ancillary revenue into the core of the business. We still offer incontinence products, but it's not through that direct-to-consumer channel.
We were pleased to sell that on May 1st. Separately, we got out of the home infusion business. We had essentially built up a collection of these assets through DME acquisitions over the years. I think it's no surprise, infusion multiples are running pretty nicely lately. We were very pleased to sell that business, and we completed that divestiture on June 9. With all that, and our free cash flow, which beat our expectations, we paid off another $150 million of debt just in the second quarter. We felt pretty good about the quarter and the momentum coming out the back half with sleep starts, you know, near record start levels, respiratory at record census level, diabetes census now back to growth mode for the second quarter in a row. The momentum's feeling pretty good in the back half.
Of course, we announced what we think is a truly transformational contract with a national hospital and payer relationship. We've been asked to shield the name and the specifics from the public domain by our new partner. I mean, it's a very large book of business. We've said that, once it ramps and it will ramp over the course of 2026, we believe that it will be producing at least $200 million of revenue a year for the next five years. This is a billion-dollar contract. We were, I mean, we're thrilled.
You took my next question.
Sorry, I could talk more about it.
Let's just dig into that a little bit more. It'd be interesting to hear what was the genesis of that contract. Was it, or that relationship? What exactly were they, what was the client looking for in terms of a relationship? Maybe what they were doing before with respect to that and sort of the competitive nature of the transaction.
Sure. There were some similarities to the business that we won with Humana a couple of years ago. Like Humana, this new partner came to market with an RFP. That implies somebody was running that business previously. They had their reasons for RFPing this book of business. We believe that our success with Humana was a big part of that win. This is a lot of business, and no one in the industry, to my knowledge, has ever pulled off anything near this size and scope until we did that with Humana. I mean, 33 states, every single patient, if you're on Humana HMO in those states, you're coming to AdaptHealth. That did not come without its mistakes and lessons for the company. We had a lot of startup costs, about $20 million that we had put into that startup. Today, it's running great, utilization spot on.
Humana's, I won't speak for them, but appears to be very satisfied. We've signed up for some pretty significant SLAs as part of that contract. We're doing that in the new contract. We're putting our money where our mouth is in terms of operations, on-time delivery, patient satisfaction, customer service, statistics like time to answer phone calls and things like that. Just having the ability to demonstrate that we've done this before, that was a big part of winning this new piece of business. The other part of this is much like Humana. This hospital system and payer is a very forward-thinking healthcare organization. Technology is the answer to a lot of the inefficiency and cost challenges in healthcare in general. This organization is at the tip of the spear on that.
Another aspect of what they liked about AdaptHealth was some of that myAPP that I was talking about earlier. We can turn some dials and cater that patient experience for this new customer and their patients. We can send them alerts. We can notify them when certain messages need to be sent. The incumbent, to our knowledge, did not have that type of capability, and our competitors, to our knowledge, did not have that capability, at least at the scale that we're offering it at. That patient engagement through the app and through tech was another big part of us winning the relationship.
At the end of the day, I think our ops and sales teams, look, we pride ourselves on being kind of the easy button in DME and being just easy to do business with, which frankly, at the end of the day, is sometimes more important even than cost. For this amount of volume, we're certainly happy to give a little bit of a reimbursement relief to a new partner if they're going to bring this kind of volume to us. We were happy to do that as well.
What about the adjacent opportunities? Is there any geographic, is this new geography for you? Can you expand off that? How do you think about that?
Yeah. There are two incremental revenue streams that we haven't put a number on. I don't know that we will until we're really up and running, but they're material. We know for sure. Unlike Humana, which when we came in and we won that RFP, there was a fair amount of cannibalization that happened because we were already servicing a lot of Humana patients that were on HMO MA plans. This is different. These are 100% new patient volume. There are a handful of markets that will start over the coming months that we already operate in today, and we've already got that fixed cost and that infrastructure paid for. We're confident those margins will be quite nice because you're just layering in more patients on the capacity that you've already got. In other markets, we don't have locations or we have very few.
What's unique about this is we've got a new revenue stream that's going to pay for that fixed cost as we stand up. I mean, we're going to stand up a few dozen new locations. We got to bring in a few hundred vehicles that we'll bring into this revenue stream. Those locations, we're not sizing just for this revenue stream. We're sizing it, call it twice as big, because we're looking for that capacity in these new markets. The two incremental revenue streams I talked about, the first is, there are patients that show up at this healthcare system, either in their hospitals or their hundreds of clinics that we're now supporting, and they don't have the same insurance. They don't have that healthcare system's insurance carrier.
They might have United or something else, but we're hardwiring into their EMRs in the hospitals and the clinics to catch that referral stream. That's not priced in. That's not part of this. That's all incremental business. Again, your fixed cost paid for, so margin can be pretty good. Separately, since these are locations we don't operate in today, what do you think the next thing we're going to do is? We're going to drop in salespeople left and right because there's a lot of business in these particular states and these markets that we just don't compete in today. Now we've got the revenue stream to support it. Everything else that you win through your new sales force that you're going to deploy is incremental. We're pretty excited about that. I wouldn't expect that for at least probably another year or so.
You know, if we do our jobs maybe a little sooner, but it's going to take some time to ramp. Job number one is to take care of this large chunk of business that we just won.
I definitely see the opportunity there once the provider is comfortable with you guys on the other side. It almost becomes automatic.
That's right.
In terms of referring patients, I had another company that, you know, you had the HMO business on Humana, but they lost PPO.
PPO as well. Yep. That halo effect is a real thing.
Yeah, maybe just on diabetes, spend some time there. The business is improving. It's been a challenge for two years, but as you mentioned, you've seen some progress in [Stars]. Can you just talk about where you stand on that? I know you shifted the supply down to Nashville, and just an update on how the whole diabetes, you're seeing that.
Yeah, sure. I'd start with the easy part or the smaller part, which is pump and pump supplies. You know, we went about a two-year period where we were compressing year over year each quarter. That was a result of some of the new tubeless pumps that had come to market in late 2022. What was it, 2023? I wasn't tracking at this point. When Omnipod came out from Insulet, that took a lot of share quickly from Tandem and Medtronic. Historically, we had been a pretty big Tandem and Medtronic shop. We're happy to report both quarters this year, we're growing pumps again. We're getting our fair share of Omnipod. We'll distribute that through our 50-state URAC pharmacy, as well as Beta Bionics, which is a newer entrant. We're getting, we think, our fair share there as well.
Of course, we're pleased to put out Tandem and Medtronic pumps when that's what's prescribed. That's some good news, that what was a pressure for the last couple of years is now back to growth mode. Shifting to the bigger part of the business, which is CGMs. Think about like Dexcom and Abbott, and there are some other entrants out there. Predominantly, those are the two CGMs in the U.S. We made a lot of changes. When I talked about in the opening about Suzanne 's leadership changes, some of that, there were some exits, some key exits that occurred as part of that reorganization as well, particularly in the diabetes business. It was mid-September last year where we installed brand new leadership on top of the division. That included a kind of a General Manager of the business who's a longtime DME person, Gary Sheehan.
I think you know Gary. He's a New Englander and sold a big business to us about four years ago now. He's running that business and doing a tremendous job. We've got a new sales leader that was with Suzanne at Medtronic as well as Cardinal and joined us most recently from Google Health. He's been running that sales force. As you said, in Nashville, we picked up the resupply operations and we installed it under the same team that runs our billion-dollar-a-year revenue stream in sleep resupply down in Nashville. The significance of that is on the top line of new patients, what our new GM and sales leader are doing. They've grown sequential CGM starts now for three quarters in a row. Essentially, from the quarter they got installed until now, they continue to show growth, which is great.
Those are the patients coming in at the top of the funnel. On the back end, in terms of what you retain and what you continue to resupply, that Nashville team, literally the quarter after we made the change, record retention in diabetes, that's now happened for three consecutive quarters. We're coming up now on a year of, arguably, easier comps in the back half, and we really got the volumes going. Now, payer mix is still a little tough. That resulted in, we dropped revenue about 4%. I think it was 4.1% in the second quarter. However, we're getting to the point the volume is going to greatly outpace that payer mix shift. We're pretty confident that as soon as the second half, diabetes will be back to growth mode. We think as we look towards 2026 that we're looking at a growing business again. So far so good.
No one's high-fiving, I'd say, but so far so good. We're making good progress.
Good. You know, sleep ran into a little bit of an issue in terms of in a few markets that you called out in first quarter, some improvement in second quarter. Can you go, you know, just go over what changed and, you know, how quickly you saw that take a hold?
Yeah. I'd say, you know, first quarter was disappointing. We had started 113,000 patients. For a Q1, we would typically expect closer to 115,000 - 120,000 patients. We were off our expectations. A year ago, we had put out 117,000 patients. We were off. As we ran the Pareto and kind of the deep dive on the reasons, it really pointed at one thing, and it was that in a few specific markets, we got very slow to set up. Inefficiencies in that intake—I talked about the operating model changes a little earlier—intake as well as availability for scheduling. This wasn't total rocket science, I'd say, but it did take a big lift to open up access. Not in every location, but in many, not closing the doors at 4:00 or 5:00, staying open until 7:00 P.M.
for setups, opening up weekend setup hours, more group setups, as well as turning back on the virtual setups. You can't do that in every state because many states require a certified respiratory therapist to conduct the setup. You can't do it everywhere, but we did turn that back on. That was pretty big during COVID, the ability to set up virtually. We didn't maintain it as a strategy coming out of COVID. That’s been turned back on as well. The result was pretty fantastic. We set up 128,000 patients in the second quarter. That's just 3,000 patients short of company records. We had good momentum coming out of the second quarter. We're feeling pretty optimistic that the changes that went in are effective, and we think they'll continue to be effective. We intend to continue to grow share.
We're going to do lightning round here since we got a couple of minutes. I do want to just get a quick comment on competitive bidding and how you're viewing that. Let you take it.
Yeah. I mean, so the proposed rule was released several weeks back. We are in a comment period. We, as well as the industry, our lobbyists, et cetera, are working on delivering comments by the end of August. We fully expect the final rule by the end of this year, this calendar year. We think it's most probable that bids, the bidding process, will start next year, and then contracts would be awarded for a 2027 start. That could slip to 2028, but we think it's most likely that that's going to occur sooner versus later. I'd say the CMS has been very clear that they intend to reduce the number of suppliers, the number of operators in the space. Now, CMS competitive bidding has been very effective in doing that over the last decade or so.
Once we understand the rules, there's a lot of details on the max bid versus the 75th percentile, and there's nuance in there that will give us insight into whether we think rates will go up or down as part of this program. We'll have a view on that once we understand the final rules. Either way, look, we're the biggest in the industry. We think we're best positioned to steer into competitive bidding, win the contracts we want to win. If the CMS is effective in reducing the number of suppliers, that's a good thing for [DAP ]. That means more business for us to take and/or more folks that become sellers, as they just can't withstand the pressure of competitive bidding. Bigger picture, it's a business we're in. We're looking forward to understanding the rules and taking the next steps.
Good. We're out of time. Thanks a lot for your participation.