Good morning, everyone. Thank you all for joining us here at BrightSpring's headquarters in Louisville, and welcome to those of you who are on the webcast. Today's agenda will start with a company overview from Jon Rousseau, Chief Executive Officer, followed by detailed reviews of the Pharmacy businesses from the leaders of Specialty, infusion, and Home and Community Pharmacy. Following the Pharmacy overview, we'll bring up the leaders for question and answers before taking a break. After the break, we'll go through the Provider businesses, starting with Home Health, Hospice, and Rehab & Personal Care, followed by a Q&A session with the provider leaders before breaking for lunch. After lunch, we'll hear from the leaders of government relations and business development teams, followed by a discussion on the company's financials with a wrap-up discussion and Q&A with Jon and the other leaders.
Our goal is to end the day around 2:00 P.M. Eastern. Before we begin, I'm going to read the company's forward-looking statement. Today's discussion will include certain forward-looking statements that reflect our current assumptions and expectations, including those related to our future financial performance and industry and market conditions. Such forward-looking statements are not a guarantee of future performance. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from our expectations. We encourage you to review the information in today's presentation as well as in our annual report in Form 10-K that is filed with the SEC, including the specific risk factors and uncertainties discussed in our Form 10-K. Such factors may be updated from time to time in our periodic filings with the SEC, and we do not undertake any duty to update any forward-looking statements except as required by law.
During today's presentation, we will use non-GAAP financial measures when talking about the company's financial performance and financial condition. You can find additional information on these non-GAAP measures and reconciliations of our non-GAAP financial measures to the most directly comparable GAAP financial measures to the extent available without unreasonable effort in the company's 10-K. This presentation is being recorded and will be available for replay on our investor relations website. With that, I will now turn it over to Jon Rousseau, Chief Executive Officer.
Thanks, David. Good morning, everybody. Is this thing working good? You guys can hear me? Oh my gosh, the spotlights. Good thing I can't see so well. Well, good morning, and thank you for being here. Appreciate everybody traveling. For those that were able to get the walkthrough last night, over at Onco360 and CareMed, hopefully that went well, and you got a glimpse of the great things that the organization there does. So there we go. All right. With that, I know we've got a packed schedule, so we will dive right in. I'm gonna hit just an overview for about 20 minutes, then we'll hit Pharmacy, then the Provider side, and then we'll wrap up with some corporate development and finance, if that sounds good. If I could figure out the clicker.
Okay. Well, look, I think a lot of you are very familiar with the story at a high level. But I'll reiterate it. You know, we are a leading Home and Community health services company, full stop. Whether it's Pharmacy Services in a closed-door manner directly to the patient or whether its Provider Services going to where the patient are, you know, we are a solution for the future of healthcare, where we deliver very high-quality products and services at a lower cost for a very high ROI. We think that's a very good place to be, aligned with long-term healthcare trends, and we wanna ride that out as far as we can and continue to be an innovator and a solution provider within healthcare.
Again, we primarily take care of seniors and specialty populations, providing them with very needed solutions, which are also lower cost. In doing so, we really focus on the platform and our quality and operational capabilities. That's really been a hallmark now for nine and half years that we've invested in, process, people, operational excellence wherever we can, and that drives our growth. The quality reputation and our ability to get services out the door quickly drives our growth. Ultimately, we also have a lot of scale advantages with this platform, which I'll talk about more. Sometimes I think that's a little bit underappreciated. Yes, we have a lot of service lines that are doing well, and we are defined by broad-based growth with a few superstars in our portfolio from a growth perspective.
I also believe that the reason why we've been so successful, we're in the top 5%-6% of public companies in the last three years on EBITDA. You know, in the Russell 3000 for companies over $5 billion or $10 billion and profitable, we're second on revenue growth over the last three years, right? I think the reason why we've been able to do that is because we have the one enterprise platform. A little bit on our history. ResCare, our predecessor company and brand, goes back almost 50 years, founded here in Louisville, taking care of individuals with intellectual and developmental disabilities in group homes. Just an unbelievable mission. You know, that company has grown its revenue for about 30 or 40 years in a row consecutively, an incredible quality that leads that industry.
When I got here about a little over nine years ago now, we started more heavily investing on the clinical side. We also had a Pharmacy business taking care of those individuals in the home very smartly. We had a Rehab business, Personal Care, but we really started building out more of the clinical side with some of my background in particular in those areas. That went really, really well. Onex had been in the company for about 15 years, taking it private. We recapitalized to KKR about two and half years into that, a little bit sooner than we wanted to, but Onex literally had to exit. KKR has been incredible and wonderful partners throughout. I mean, their focus on quality, their focus on mission was just ideal for this company.
That happened in early 2019, and it's just been an incredible run. You know, our thesis then was to combine a large pharmacy company of scale, PharMerica, which they had bought about a year earlier, with our provider scale and create a very unique platform within healthcare, a very unique scaled pharmacy and provider platform that could more comprehensively serve patients. That has gone extremely well. Fortunately, that headquarters was about 4 mi down the road on the PharMerica side and very seamless for us all come together. After that, you know, it's really been about seven years at this point of just execution and building out the platform.
You know, we had the service lines we largely wanted to be in, and it's been growing in those service lines on the back of our quality and operational skill set, which has been the focus for the last six or seven years and has resulted in those growth rates that I spoke about before. You know, CAGRs of around 20% at this point on both the top and bottom line. You know, we've had some events now in the past couple years. We went public in January of 2024, so it's been about 26 months now.
That community living business, which we started with about 50 years ago, we decided late January of last year to divest that business, to have a strategic focus on more clinical services in the organization, also helpful from a deleveraging perspective and a cash flow perspective. We expect that to close here in the next few weeks. You know, we've also selectively done some acquisitions with these home health assets here more recently, which we think that'll be very favorable for the company. You know, our model today, you know the circle, the top half is Pharmacy, the bottom half is Provider, and we think those fit together extremely well.
It is a comprehensive and what we believe to be a very differentiated model for Home and Community healthcare services that better addresses required patient needs for improved outcomes. It creates market and integrated care opportunities, and it leverages our scale. I think everybody's probably pretty familiar with some of the challenges and opportunities in healthcare. I think the left side of this slide is very self-evident. There is a smaller percentage of the individuals in our society that make up a larger proportion of the spend. It's individuals on with chronic conditions, seniors and specialty indications. You know, one of the markers of these populations is that most people is typically on six or eight or more medications.
You know, when you look into healthcare and you see an individual who's on six or more medications in particular, that's referred to as polypharmacy. I mean, that is a pretty clear indicator of where your biggest risk is gonna be and where your most complex patients are. A lot of these individuals could be served in lower cost settings, very logically, and a lot of ER visits and hospitalizations could be curtailed with more proactive and more proximal care for these patients where they are. Our solution to that has been the integrated care model. These services are delivered in lower cost settings. We've been able to deliver very strong quality results. The comprehensive model does give us a lot of integrated care opportunities, whether it's cross referrals across our service lines or ultimately managing patients in more value-based care models.
This model, we believe again is the future of healthcare in many ways and what we need to keep driving. What constitutes that model more specifically from a product perspective? On the Pharmacy side, we have three key service lines. On the Provider side, we more or less have three key service lines. I always keep it straight in my head with kind of a three-by-three framework, if you will. On Pharmacy, this is closed-door pharmacy, okay? That is the big difference. This is not you and me walking into a retail pharmacy. It is the polar opposite of that. There are a myriad of settings and locations in our society and neighborhoods every day where people need their medications, where they are more chronic, more acute, where they can't walk into a Walgreens for one script.
That doesn't work for a large chunk of our population. We go to them. That's what closed door means. You cannot go in. We go to our customers. We go to our patients wherever they are. The first patient population that we do that for are individuals with cancer and individuals with rare and orphan diseases. That's our specialty Pharmacy business under two brands, Onco360 and CareMed. Onco360, as the name might indicate, is our focus on oncology. CareMed is our focus on LDDs and rare and orphan therapies outside of oncology, and that continues to grow. That is a leading quality business in the United States with excellent service metrics, net promoter scores of above almost 95.
On the backs of that, the team has developed incredibly deep and trusted partner relationships with pharma over the years, and our sales team really pulls through as a partner in the offices every day, prescriptions, working with patients and families. Our Infusion business, this is going to the home or sometimes in a suite or in a clinic and providing needed infusible therapies. We really do everything there and can do everything in infusion except oncology. The specialty business I talked about before is oral and injectable. This is infusion, and we do most things except oncology, which is primarily done by the hospitals and the doctors in the buy and bill model. In infusion, there's two key areas in patient population types that we focus on. It's our acute patients, antibiotics, nutritional therapies, et cetera.
The chronic specialty population, IVIG, a lot of neuro and gastro indications, et cetera. Wonderful business, large market, growing. Our Home and Community Pharmacy business. This was more or less the biggest legacy business of PharMerica. This is where we are getting drugs and medications to hundreds of thousands of people every day, wherever they may be. These are individuals, again, that are more acute with chronic conditions in skilled nursing facilities, in assisted living facilities, at home on hospice, at home-on-home health, in behavioral group homes. This is a good example of where we have integrated care in our company. All of our hospice patients, all of our behavioral IDD patients also receive all their pharmacy services from us. Collectively, across these Pharmacy businesses, we dispense over 40 million scripts a year.
I think that puts us in about the top 10 of the country as a pharmacy after the big retailers and after the big PBM mail order houses. Scale is very important in a lot of industries. It is absolutely vital, as Scott will talk about, in the pharmacy industry for purchasing, for payer contracting, for leveraging your OpEx, for driving automation. Pharmacy is just critical. We can be anywhere in the United States on the ground within three hours. That's our coverage, and that's our footprint that's been built up over the past 40 years, and it's a huge advantage. On the Provider side, Home Health Care, Rehab Care, and Personal Care. You know, Home Health Care, that's Home Health and Hospice, and we're building out our Home-Based Primary Care business. We'll talk more about that.
We're integrating presently the Home Health assets that we acquired in the UnitedHealth divestiture of Amedisys. That's going very well, but we love those businesses. You know, huge ROI of Home Health. Reduces hospitalization rates by 20%-30%, reduces costs. The same for hospice. These are wonderful services with very mission-driven clinicians who are out there every day taking care of people in their home so that they don't go to the ER unnecessarily, or they don't go to the hospital more than they have to. It seems incredibly intuitive that the more you get to somebody proactively in their home, see their setting, and make sure they have a customized care plan, like that works. I remember like 15 years ago, somebody told me there's not a lot of new ideas in healthcare. It's just the implementation and the execution of it.
A lot of these things are very clear in terms of what you should do. It's the ability to actually do it, and it's making sure that you have a reimbursement model that supports it. On the Rehab Care side, wonderful business with incredible clinical quality. Here is where historically we have taken care of individuals with severe neuro conditions, either a brain injury or a spinal cord injury. It's mostly a workers' comp and a commercial-funded business, where we have a footprint across about 30 states, very predictable, nice double-digit growth business. It's about a 7% growth market.
We are more recently leveraging that rehab and therapy expertise to also move into the senior setting adjacent to our Home Health, Hospice, Primary Care and Pharmacy and be the Rehab Provider in conjunction with Home Health in places like assisted living in the home for seniors under the Part B benefit. Personal Care, very, very steady business for us. You know, 2%-4% grower, but operationally, very consistent, very steady. It is not the easiest thing in the world to hire caregivers to go deliver Personal Care. You know, the less clinical home-based type services in the home, our team does that very predictably and, in a very consistent manner with really good quality results.
I really think that Personal Care and med management are the two ways, if you look at the data, that keep people out of the hospital the most. You know, if you just think about it, when somebody's in the home, you don't have to necessarily be a doctor or a nurse or a therapist to do common sense things at the home. What are you eating? Are you able to get around? Are there fall hazards in your home? Are you getting companionship? Are you taking your right meds? Any of us can do that. That's Personal Care, and it has an incredible impact on also keeping people out of the hospital. You know, our markets are large and growing, and they're also incredibly fragmented. So we think that creates a lot of runway for us in the future, both organically and from an acquisition standpoint.
If you look at our markets, they all have favorable demographic trends. Everybody, I think, knows the growth in the seniors population. I think people over 85, that population is supposed to triple in the next 10-15 years. People over 65, that's supposed to double in the next 30 years. A lot of long-term growth trends here. Specialty indications are generally growing at about 5%-7% or 8% in the country. You know, on the Pharmacy side, a lot of these specialty therapies have been growing more in the 10%-12% range. Ultimately, these markets, we believe, are very attractive. They're also very fragmented. We believe scale is gonna only be more and more important in the future. You need scale in these industries to invest in HR, to invest in technology.
I mean, Charlie and Viji are gonna talk for a second about how we're investing in AI. You know, to drive operational efficiency through the organization. You know, our ability to deliver really good operational services and sound practices should be so much better than a home health company in three states, than an infusion company in two states. You know, we try to leverage our expertise. We think scale will only be more important in these large and fragmented markets, while we also try to partner with the government and with payers on needed solutions. You know, the prevalence of chronic conditions, unfortunately, continues to escalate as well. These are all factors that are fueling the growth in these markets, where we wanna continue to be a standout provider.
We wanna not only benefit from addressing the demand needs in this market , but also through a differentiated model and better operations, take market share as well. You know, there's just some growth stats here for you. I won't go through all these. It's gonna be in your deck. You know, but on the Pharmacy side, we see Infusion, and especially Pharmacy, you know, generally growing in the 8%-12% range. There're some therapies and indications there that are growing higher than that. There's some that are growing lower than that. Acute tends to grow at 3%-4%. You know, other chronic conditions in infusion tend to grow in the double digits.
You know, within Specialty Pharmacy, oncology is not only one of the biggest segments of Specialty Pharmacy, it's one of the segments growing the most quickly because of all the innovation and the new therapies coming out of the pipeline that are literally extending life and saving people's lives. Obviously, we have the largest position as the independent pharmacy in that very interesting growth market. You know, on the Provider side, Personal Care tends to grow at the population growth rate, but Home Health and Hospice and Rehab are growing in that 5%-7%-ish range, depending on which one you look at. Very healthy growth rates.
The way we think about that is, look, if the market's growing at 5%-7% and we need to try to double that, we're taking market share, and that's our approach to try to get to double-digit growth in all those businesses on the clinical side of Provider, Rehab, Home Health and Hospice. Everything's based on quality, as I talked about before. I think one of the things that collectively our management team is most proud of is what we're doing from a service perspective and from a quality perspective. Again, a lot of pretty obvious comments today, but you literally can't almost do anything if your operations aren't very stable and predictable, and if you're not getting good quality outcomes. For us, really importantly, we try to benchmark everything, and we try to track everything, so we know how we're doing.
We try to do that in real time as much as we can with investments for the past seven or eight years in all of our data warehouses and reporting suites, so we can see in real time how we're performing, and then also how do we go get benchmark data in the industry to really hold ourselves accountable. On the Pharmacy side, you know, I could pick any one of about 20 metrics really that would show, you know, really strong and consistent performance, whether it's the predictability of getting our meds out on time, the accuracy of those meds, or net promoter scores that literally can be world-class in the mid- to upper 90s. You know, on the Provider side, in Hospice, we've been ranked a top 5% hospice provider.
Our Home Health branches, I think about 94% right now are over four-star. Our Hospice branches are well above the industry average on four-star. In hospice, we see our patients a lot more, right? If your mom or dad or somebody you knew was on hospice, would you want somebody coming once every two weeks, or would you want somebody coming four or five times? It makes a massive difference. We invest in quality, and we invest in service levels, and we think that's ultimately manifested in our ability to reach more patients and make a bigger impact and grow the organization. We've had over 30 articles and abstracts written about our outcomes in leading journals and publications. I would be surprised if I knew of another company with one or two or three of those.
It just really shows, and I think a tangible demonstration of how focused we are on wanting to drive quality and service through the organization. Slide here on some of our advantages as a one enterprise scale platform. You know, I think some of these things do go underappreciated oftentimes, but there are real reasons why these businesses collectively and why our company together as one does better. You know, first and foremost, probably, you know, stating the self-evident here. From a core procurement and contracting perspective, we're able to be much more effective in terms of how we buy across the company. You know, we are able to leverage IT spend and drive best practices in technology and data and analytics throughout the organizations.
It's not only the ability to buy that more effectively and save money, you know, as a bigger company, it's to make sure that's being deployed through the organization, the right way, so each one of the businesses has the right technology profile. Clinical quality and compliance, we invest heavily. We've got some 250 people that sit top side at corporate, even above the quality personnel in the businesses that are constantly auditing. They are constantly out there teaching and educating across all of our branches and locations. You know, we have a greater ability to invest and deliver those results on the prior slide because we leverage the organization. Sales and marketing. You know, we try to drive best practices in sales and marketing across every one of our businesses. How are we hiring sales reps?
How are we onboarding and training them? You know, what is our sales analytics for how we target our referral sources? You know, what kind of compensation plans do we have in place? Rewards and recognition. Just down the list of sales one on one, we try to make sure that that's very consistent across our businesses. You know, HR is an area we have been focused on, along with IT, along with sales and marketing at the corporate level. You know, we always aspire to be an HR quote-unquote academy company. You know, what is your experience like when you're recruited? How are you onboarded? How are you trained? You know, what is the intranet? What is the internal systems that you're able to use? You know, what systems do you use every day for your EHR? Is that an easier system to use?
Are there career pathways here? What can I do? These are all reasons why our retention and our turnover has improved every single year for the last nine or 10 years. If you look across our businesses, we are typically in the top 10%-20% of retention, as you benchmark us across our industries. The PMO, you know, that's something that I was very familiar with going back to my Medtronic days. That is a program management office. You know, the way that I like to describe the PMO is they just help make sure stuff gets done. You know, you have people that are in charge of everything in a business, there is always the need for follow-up no matter what, and things can always fall through the cracks when you're executing on cross-functional initiatives.
The PMO team, we've got about 20 people on that team right now. They are working on over 100 initiatives at a time in this company, helping to make sure those projects are on time and getting moved forward. You know, we have evolved that to take probably some informal process around smart lean process over the years, and in the last one or two years in particular, make that much formal in our company. We now have individuals and leaders in this company who drive Lean Six Sigma training, whether it's a white belt, a green belt, or a black belt, you can get that here at our company, just like you're at Medtronic or just like you're at GE in the old days. You can get that here.
We have something like 300 projects going on right now in this company, initiated by people on their own in their business, working on how to do something smarter. We want people to organically think about what we're doing every day. I've been taught about, you know, what lean and smart process looks like. Now, how can I go execute that as part of this training? Because I need a live project to get through graduation of this training, and I have to demonstrate the execution of a project. You know, really, really cool stuff that we get excited about, you know, that's in the bowels of the organization every day, but it's literally how things get done.
Really last from an acquisition perspective, we are able to leverage a lot of our size in terms of being able to be selective about our acquisitions, right? Like, we don't have to just pick from Home Health assets. We don't just have to pick from infusion assets. We can look at Infusion, Hospice, Rehab, Home Health, LTC Pharmacy, and we have the luxury of being able to sit back at any point in time and say, "Which one of those do we like the most?" Right? Think about what makes the most sense right now in our company for an acquisition to do. Most of them have been small tuck-ins, but we have the ability to execute on really almost any deal out there, with our team and with the synergies that we bring to bear.
You know, in some of the pharmacy deals, day one, day two after close, boom, you know, that financial profile looks very different because of the contracts that we have and the revenue and the cost synergies that we can bring to bear. These are all strengths of the organization that we believe we have, advantages of scale, driving best practice through the organization that I just am not sure, you know, a local or regional provider of one business alone would have. We wanna continue to push the pedal down on this as we move forward in the future and just drive more and more scale and more and more advantages of scale with really high-quality services. Just a slide here, a little bit more on the lean process. I mentioned it before.
There are over 700 projects in the last three or four years that our PMO team has completed in procurement or process or technology implementation, separate now from all of the organic, you know, on the ground Lean Sigma projects going on as a result of the Lean Sigma Academy training in the company. You know, this is in our DNA, and this is what drives operational service levels and the quality results that you saw. Charlie and Viji, did you just wanna take one or two minutes to talk about. We can't talk about all the things we do in AI for a few reasons, but we're excited about it, right? We feel like with a company of our size, a $15 billion company with our resources and our people, you know, sure, there's gonna be some things we go buy, right?
There're already some projects we've partnered with, paid for with outside AI vendors to get going. Home Health intake is a good example of that. We feel like we should have the sophistication and the ability to get these AI projects done. If we can do that, we're the ones with the workflows and the businesses that the vendors wanna get their hands on. We're doing this every day. We know what the problems are, we know what the opportunities are. If we can develop and leverage all the great work we're doing in tech on the AI side, we think that's probably an advantage for us going forward, probably saves us a lot of money, ultimately is more predictable if we have the team to be able to do it. That's what we've been building out.
Thanks, Jon. My name is Charlie Wardrip. I'm the Chief Information Officer here at BrightSpring. Thank you all for coming. Like Jon said, we've invested a lot in technology over the last couple of years. We've been able to establish a very sophisticated integrated data and technology platform that not only supports the needs of each individual line of business, but also supports the needs across the entire enterprise. It gives us the ability to provide integration where we need to and share data across the organization as we feel fit. In order to do that, we've done a few things. We really focused on establishing a very operationally focused platform. We work closely with our operators to make sure we can identify things and solutions they need, and that we can provide outcomes that they need to operate their business.
Also, we focus on hiring the best people, you know, and as Jon's said, you know, AI is a big focus that we have in place right now. We went out and found Viji Evers. I'll let her introduce herself. She's our Chief Technology Officer, who joined the company about seven months ago now. Viji, why don't you just introduce yourself for a second?
Good morning, everyone. I've been here for about six months, and my remit is all things technology advancement, including AI, ML, and intelligent automation. My background is, before joining BHS, I was with CoreWeave, which is a gen AI hyperscaler, and prior to that, I was leading the Machine Learning Fleet for Alphabet, working with 23 internal stakeholders, including DeepMind, Search, Research, and Ads. My passion is driving innovation to drive better quality outcomes for our patients while improving revenue and reducing costs and simultaneously improving employee productivity. We have several AI initiatives across the care continuum that will drive that scale that Jon was talking about. Thank you.
You know, Viji's been able to actually bring a lot of people from the industry into the organization. We focus on a couple key areas. Hire the best people to fill the gaps so we have the ability to service these things internally. At the same time, in order to accommodate scale and time to market, partner with key strategic partners. We've engaged, like, with several partners now that will allow us to drive these AI projects in the organization. We focus on, like Jon said, on about three areas. We try to keep it simple. I didn't realize we were all gonna get to threes today, but we did get to threes today. You know, one is we gotta provide clinical outcomes, great clinical care. We gotta support our clinicians in how they provide the services through the technology.
We focus on revenue generation and how can we support the company in revenue growth through referral management, through effective M&A integration capabilities and other strategies. At the same time, we focus on, like Jon was alluding to, how can we get rid of overhead burden? How can we automate processes? That's where we think AI has a tremendous amount of opportunity in the organization to automate those functions for us. Thank you all.
Thanks, guys. Charlie basically hit on it, but these are the fundamentals and the building blocks for IT that we've been very focused on. I would call out cyber as well. You know, it's a tricky world out there and, you know, Charlie's background in particular, deep on the infrastructure and cyber side, it's a huge focus. Really excited about how technology can help us drive forward from not only an operational perspective, but quality and growth as well. You know, look, these are our growth drivers at a high level as we go forward. You know, each one of the businesses obviously has their top five or 10 growth drivers.
When you look in broad strokes, number one, you know, as I mentioned before, we're fortunate to be in markets that are growing, where we can provide more needed solutions in participating in that market growth rate. Number two, in those markets, driving market share through a differentiated capability set and focus on quality and growth. You know, number three, we continue to try to expand geographically. You know, that is a big opportunity we have in this company. You know, I would say more on the Provider side and in Infusion, and especially in LTC Pharmacy. You know, we're pretty much everywhere. You know, there's some markets we can be Home and Community Pharmacy, but on Infusion, Home Health and Hospice and Rehab, I mean, there is still a good ways to go.
I mean, I don't even think we're 50% of the way there in terms of where we could be geographically in the next 10 years. One of the ways you do that is through just opening up new locations on a regular basis, which we've done, continuing to expand your geographic footprint. Continued platform efficiencies, that's a form of core growth for us as well. You know, continuing to drive the organization as efficiently as we can, reinvesting in IT and in our people and process. That's core growth. These are literally words we use in the company, core growth and strategic growth. Core growth is how do we take the service lines that we have today and just continue to scale them as best we can.
Strategic growth would then be getting into more and more investments, some of the newer AI initiatives that we've talked about before to hopefully continue to transform the company and support scale. Adjacent provider and pharmacy, patient and payer markets. You know, there are numerous patient types and payer types that we could address with what we are doing today. You know, a good example of that is in rehab, where we took our rehab platform and workers' comp and commercial, and now we're growing into the Medicare side and the ALFs. You know, there's quite a few more examples where we could continue to extend our services into certain patient, customer, and payer, and payer partners. Driving additional integrated care opportunities.
I'll talk about that on the next slide, but how does the business work together as effectively as possible to provide more integrated care? Then ultimately, from an M&A perspective, continuing to drive really accretive M&A. Integrated care, we're sort of getting to the end here of my section. You know, again, our focus every day is on core growth and how do we continue to provide great services in these attractive markets and scale our core service lines. There are a lot of other interesting opportunities available to us because of our platform. You know, some examples I talked about before is on the Provider side, where we provide a lot, most of those provider patients with our own pharmacy services.
That's just an obvious example of where we are a bigger company from a financial perspective, because we are able to offer multiple services to that patient and individual instead of just one. We think about integrated care in two buckets. On the top of the page, above the dotted line is really how do we better integrate care for patients within our service lines, right? As we look forward, some areas that we're most focused on, more and more integration of home health with palliative and hospice. More integration of hospital and SNF discharges into our other service lines.
Our skilled nursing customers in our Home and Community Pharmacy business, we're not the SNF, the customer where we are the pharmacy in that building. They will discharge about 250,000 people a year into the home from those buildings that we service on pharmacy. Some of those buildings we're getting into with primary care. Those are all individuals, 30%-40%, that will need home health, rehab and hospice. That's a huge opportunity from a care coordination and continuation standpoint. One-stop service solutions in the ALFs. ALFs need home health, hospice, rehab, primary care, and pharmacy. ALFs have to have that. We do all of those.
our ability to be that service provider, instead of saying, "Hey, we're just the hospice over here," or, "Hey, we're just the pharmacy in these buildings over there," we have the ability to go in as a one-stop shop, and we are really starting to do that more, really led by our Home Health and Rehab business, going in and offering one combined rehab solution to that building. Then really last, home-based primary care integration and patient management. We have been building out the house calls model. You know, Wilford Brimley, this is old school, going back to the 1920s. Doctors, largely NPs, going into the home or a SNF or an ALF, and they are your doctor. 50% reductions in hospitalizations in that model by the doctor coming to you, right? The doctor's the holder of the pen.
They are the ultimate care coordinator, and they can prescribe for the patient what they need. If we're better integrated with that doctor, and if that doctor exists under our organization, that's a nice opportunity to provide services for the physician and for the patient in a better way. Then there is integrated care from the perspective of value-based care. You know, for us, this would be managing patients in a quality-focused manner under a different payment model where you are compensated for the incredible work that we do in quality and the cost savings that we drive in the organization. We think there's three fundamental things you need in order to treat a complex, high-cost, high-risk patient who's out in the home on their own. How do you do that well? We think number one is home-based primary care.
You need to go to them in their home as the doctor, as the NP, see their environment, and proactively care for them on a regular basis. Number two, you have to put the meds on lockdown with a medication therapy management program that works. One of the top two leading causes of unnecessary hospitalizations and ER visits is medication issues. Our Continue Care Rx program is a customized program where we can do this for anybody in the United States, where they have a 30-day cycle fill with compliance packaging. They get phone call check-ins. Where we provide this service in conjunction with home health, a JAMDA study two and half years ago showed a 70% reduction in hospitalization. Like, that's just a staggering number. It's because we really focus on the medication issue, which so often goes unnoticed and underappreciated.
Number three, what do you do with the in-between time? It's great if a doctor's starting to go into the home, but you can't be there all the time. You need a clinical nursing hub or a way to monitor and be in touch with that patient in all of the in-between time. We're building out that hub with eight specific use cases as well. If we can deliver those services and that comprehensive model to patients, you can have the confidence to be able to go and get paid in a different way or at least be able to appreciate the savings you're generating in an ACO model. We have an ACO today that's been productive. It's been an EBITDA driver. It hasn't been overly significant.
We've got a couple thousand patients in it, but that's a huge opportunity to scale in the future. That is a shared savings model with no risk whatsoever. It's literally getting the savings, a piece of the savings that you're driving with your better clinical model. What we're trying to do is be an effective partner with the payers. Hey, payer, you have 5%-10% of your members that are 70%-80% of your cost. We will deploy this model for you with those individuals and get them a much better quality of life, better experience, and get you better outcomes. Let's please partner together. That's what we're trying to build out. Wrapping up here from a financial perspective, you know, Jen will hit these numbers in a bit later.
On the revenue side, you know, we have a three-year CAGR of about 20% now. It's almost the same from an Adjusted EBITDA perspective. You know, we were up to $13 billion of revenue at the end of 2025, $618 million of Adjusted EBITDA. I think one of the things Jen and I are most happy about or pleased with, in addition to a lot of the quality stuff of the organization over the years, is, you know, we went public at about 4.6x leverage, and that number is now down below 3x. It's 2.6x now pro forma, you know, should that community living transaction close. In addition to that, you know, we generated about $500 million of operating cash flow last year.
You know, you take community living out this year, you put in growth for this year, we expect that OCF number to be about the same in 2026. We just feel like that gives us a lot more optionality and flexibility as we move forward into the future. You know, that's been something that's been really pleasing for us. You know, Jen will talk about how we're thinking about this year and the next couple years, you know, later in the presentation. As we look out to 2028, you know, on our range that we see today, with what we know today, you know, we think this company can grow off of 2025 anywhere between 70%-85% in terms of EBITDA as we go from the end of 2025 to the end of 2028.
You know, that's what we're really excited about. That would be from an organic perspective. You look at the balance sheet, and you look from a leverage perspective, you know, that would be additive. You know, just very pleased that we've been able to grow into our leverage level, and cash flow continues to perform with continued increases in working capital and the CapEx-like nature of our business. You know, that's really it for me. If I were to sit here and just talk to you for one minute about what I think makes us different, it's this slide. I'm gonna spare you the details, but I'm sure you'll rush to pull this out after the day and read it for yourself.
Really, this is why we think BrightSpring is the difference, and it goes back to what I said before. You know, we are a Home and Community health services provider, full stop. We think that is a very good place to be, and we think doing that at scale with the operational quality and sales focus that we have is hopefully going to continue to allow us to grow and move forward in the future, importantly, so that we can continue making a bigger and bigger impact for so many patients that need these services in the U.S. With that's it for me for now, and I think we're gonna go right into the Onco360 and CareMed team. Chris, Ben, and Robert, if you guys come on up, I probably ate into your time by five or 10 minutes.
Robert Thomson is our Chief Commercial Officer for the business. Ben Fernandez runs trade. Chris Urban runs all things operations. That is forward.
Gotcha.
These guys do a tremendous job with the business, and the focus on our patients is always evident, and the creativity and the ingenuity in this business, the partnership mentality with everybody in the system has been phenomenal, and we're excited to continue to scale this business, not only in oncology, but in a lot of other areas that are defined by rare and orphan disease and LDDs. Guys, take it away.
Many of you yesterday, Ben Fernandez, Chief Commercial Officer, been in healthcare over 20 years here with Onco360 for about 14, really with a focus on driving access to therapies and our limited distribution portfolio.
Morning, everyone. Robert Thomson, Chief Growth Officer. I'm in charge of everything sales and business development. Included in that is payer sales, physician sales, which is an outside and inside sales team, hospital sales, and then also sales operations. I've been with the company 13 years now.
Nice to see everybody again. Chris Urban, Chief Operating Officer. Been with Onco360 for just over 10 years. For those that participated in the tour yesterday, thank you. Hopefully, you found that just as valuable as we did. For those that were not there, we are going to start this meeting like we start all external meetings, and that's to really talk about our mission, vision, and values. Mission, vision, and values are not just words on the screen, but they are what we truly live day in and day out with our employees and extended to our patients. Our focus is to improve the lives of patients living with cancer, rare, and orphan disease. How we do that? Through our vision, we will clearly demonstrate that in our presentation today.
The values are truly embedded in the DNA of each of our employees. Now, one of the really neat things that we do on a quarterly basis, we encourage our employees to nominate each other when they see our mission, vision, and values being demonstrated. We review hundreds of nominations a year, and then every quarter, we choose a winner or multiple winners, in some cases, when you're reviewing a hundred, and we put publications out both internally and externally celebrating that. Then that winner gets to choose a charity of their choice, and we make a donation to that charity in their name. It's something that we truly believe is awesome, and we really celebrate it as an organization. I think most of you that were there yesterday saw that.
We have had the unique ability to grow both organically with Onco360, but then also capitalize on opportunistic adjacent markets in rare and orphan. Back in 2014, we had 12 sales reps. We had 39 limited distribution drugs. Today, 275 sales reps strong and now over 149 limited distribution drugs. We also took our accreditations from two up to four, with the key being designations in some of those accreditations for rare and cancer. This execution has really allowed us, both Onco360 and CareMed, to become the largest independent oncology rare orphan pharmacy platform in the United States.
Thanks, Chris. As you all can see, we've been very intentional and purpose-driven with really an unbelievable focus on driving clinical and operating superiority across specialty with the focus on cancer, rare, and orphan disease. All of our focus has historically been around driving an optimal therapeutic experience for patients. Sounds simple in its message, pretty complex in its delivery. How have we done that? It's been through really investment in infrastructure and technology. Today, we have the benefit of going to market to support manufacturers across you know new pipeline innovation through three really defined businesses. In our Specialty Pharmacy, you have Onco360, which is really our largest, most mature business within you know the rare cancer and orphan space.
We have CareMed, which has been a solution to partners looking to get that same service, quality, performance, innovation, ingenuity that they saw in oncology at CareMed. In addition to Specialty Pharmacy, separate from the Pharmacy business, we have Connect360 that looks to partner with manufacturers and really provide support and services. All of the, you know, programs coming out of Connect360 are really fee-for-service driven through clinical programs, innovation, really providing a lot of path bridge, copay-free drug support, as an extension of the manufacturer partners we support. If you go to the next slide, we're gonna talk, you know, you've heard the theme of quality today, throughout every interaction.
Empathy, compassion, really drives all that we do across our care coordinators internally, our account management teams, our sales organization. From a manufacturer perspective, we've built a reputation and credibility based off consistency. You know, when we partner with manufacturers, we're consistently first to market. That's because Robert's team is driving pull-through. We leverage those 275 sales reps in the market to create awareness of access whenever we launch through limited distribution. Chris's team is operationally ready to launch on day one. Consistently, once a product gets FDA approval, that product's not generally in the channel for a period of time. That could be 48 hours, sometimes that can be two weeks.
A number of our program partners' products arrive on the shelf that same day, we're sharing the success, getting patients on therapy. You know, that speed to market really means a lot to a patient, a caregiver, could be a pediatric neurology, oncology patient that we're servicing. We saw that success with our partners. That continued focus and support really is what fuels our pipeline. We're gonna talk a little bit about, you know, pipeline and our LDD access in a little bit. Our people are an extreme differentiator for us, right? We have seasoned leaders within the business that have really positioned us for continued growth, whether it's through new access, our sales organization and our operational leaders.
Guys, this is how we view the business in simple terms. Ben acquires the drugs, thereby creating a differential advantage in the marketplace for Onco360 and CareMed. In doing that, he turns over the opportunity to us, my leading sales force around the country, 200+. What they try to do is create awareness of access with the physicians, educate the physicians, create a first mover opportunity, and then also just in simple terms, garner referrals. In doing this, one key aspect of Onco360 and what we've built by design is that our sales force is built into Chris's operational workflow. This literally means that they can see the prescriptions as they come in minute by minute and start educating the physicians as it relates to prescription status.
Of course, inclusive of this is the ability to troubleshoot should there be any prior authorization issues, medical issues, or just more information needed. Then lastly, upon final dispensing of the prescription, they educate the physicians to ensure that the patients who need this therapy in an urgent manner go on therapy. The last part of this is, of course, the payer access. We've got a team of fully dedicated sales folks dedicated to relationships with payers so we can service and have broad network access for all the referrals that the hospitals send to us and the physicians send to us because a high percentage fill is absolutely critical in this industry.
It all comes back down to the patients. Our high touch, white glove service model is truly delivering. A few call-outs here. Obviously, Onco360, Jon mentioned it, always in the high- to mid-90s. I do not wanna steal any thunder, Jon, from one of your upcoming calls.
What's the latest?
In Q4 of 2025, CareMed, our rare and orphan pharmacy, received a 100 net promoter score, okay? That's absolutely phenomenal. That is their third perfect 100 in the past five quarters. We are so proud of that team, and we're so proud of the service that they're delivering for our patients.
We're gonna expand a little bit about what you see on this page here is really the diversity of our manufacturer partnerships, right? You can see a mix of emerging biopharma as well as big pharma. You know, some manufacturers that are solely focused on oncology, but also others that have a healthy mix of oncology, rare and orphan pipeline. As we look at the market, we still feel very excited about the growth and the pipeline in oncology. But these partnerships really set us up for success, not only from launching a manufacturer's new drug, but oftentimes when we launch the first new drug, we're getting the next two, three, four drugs from the manufacturer's portfolio. As you know, there's a lot of consolidation in the marketplace. You'll see pharma acquire different organizations.
Consistently, our platform is the go-to from a partnership standpoint. We're coming off our most successful year in company history with 2025 new product launches. What we're seeing in, you know, the delivery and network selection of new drugs is, you know, compared to 2019, 97% of the products we're launching today are an exclusive launch in our network. You know, the value for that from our team and our program is, you know, in those networks, we're driving larger market share.
Robert's team has, you know, an extensive portfolio of products that, you know, they have as an availability for the offices. You know, some of the reasons why manufacturers wanna select Onco360, CareMed, and also partner with Connect360 in that platform is really driven by the consistency in the operating model. The ability to know near real time the status of all of our prescriptions, not only empowers them with access and visibility, but ensures we're driving, you know, speed to market and confidence in the model. The volume of new products we're launching on an annual basis also fuels new patient start growth and volume growth, right? You know, compared to the earlier part of the decade, you know, we're launching over one new drug a month. In 2025, it was 24.
We expect that to be very exciting again this year. Not only are they new molecular entities coming to market, but you also have examples of manufacturers that have broad and limited distribution networks or open access drugs that consolidate that. We had a number of examples of that in 2025. Ultimately creates a more captive market share and audience. As I look at 2026 and beyond, we're already working the pipeline 12-16 months out, 20 months out, in terms of near-term opportunities. A lot of those decisions are already made. We feel very excited about the future of the pipeline of the portfolio, and Robert's gonna talk a little bit more about that.
As you can see, over the past couple of years, the momentum is increasing with Ben's ability to garner drugs. We believe the future bodes extremely well for us. Over the next seven years, you can see on the left, $100 billion of new product is expected to come to market, and our leadership team feels very, very confident that we'll be within network, if not preferred or exclusive with all of these products. In addition, there's a unique opportunity in the market. On the right, a significant amount of brand drugs is going generic over the next seven years. Approximately $20 million or $20 billion of drug is gonna go generic.
Of course, our physicians rely on us and our hospitals rely on us due to our capabilities and access. They rely on us for brand drugs, LDDs, but also generics due to our capabilities. We're really excited over the next several years of that conversion cycle. Next slide. This is a really important slide to understand how the sales force is configured. Our sales force is configured of approximately 60 teams across the country. Think field sellers and inside sellers combined in a partnership model, where we use data and information, both external and internal, to focus on the biggest opportunities in the biggest markets and make sure that we're targeting the right physicians. Although Onco360 has a significant sales force, we pride ourselves in speed to market.
If you think about it, we try to get to the marketplace when Ben wins a drug over the first 24-48 hours. What that allows for is first-mover advantage, where we're educating the physicians on these needed drugs in the marketplace. Equally as important, it establishes that we can garner any pent-up market demand because these physicians are waiting for these unique therapies in the market. Lastly, on the right-hand side, we can never forget our existing patients. Our sellers truly are a sales and service model. We focus a significant amount of time working with our physicians on their current patients to ensure that they stay on therapy, talking about new patients that they've referred to us. It's really a white glove service model for the physicians and our hospital partners. Next slide.
One aspect is, of this, due to our unique market positioning with Onco360 and CareMed, we've formed the deep and long-standing direct relationships with PBMs around the country. This allows us to ensure broad network access in both their commercial networks, but also their Medicare networks at the appropriate rates. In addition to the PBMs, we have a team focused on smaller payers around the country who wanna establish a direct relationship due to our product access, but also our operating model. In many instances, we'll carve an exclusive out or a preferred relationship where we get to manage all of their patients, inclusive of LDDs, brand, and generics due to our capabilities.
Okay. Just one more time, just wanna summarize our value proposition, for, you know, for our patients in the industry. For our patients, it's the reassurance that they're receiving the best quality and the best care, based off of the protocols that we have built, with our board-certified oncology pharmacist and also our certified specialty pharmacist. Access, I think that pretty much speaks for itself, 149 key products, key LDD products, and growing. You know, compassion and care, mentioned it yesterday, we have 30, what we call oncology advocates that are dedicated solely to helping bring down that copay, and help with funding for our patients. Last year alone, they serviced 27,000 patients and helped them get their medication.
If you really think about that, if they were not able to do something to help bring down that copay, they may have to cut another expense. It could be, you know, a utility bill or maybe, you know, their food bill. It's really something that we're very proud of. Time to first fill, the North Star of metrics in Specialty Pharmacy. We're really proud of our approximate four days for 2025. Then that is all wrapped together with our IT and enterprise data services team so that we can provide, one, the highest quality data to our pharma partners. We can also provide to our sales and to our physician partners the most actionable updates.
At the end of the day, deliver the highest quality care and customer service to our patie nts.
Thank you very much, and I think we are going to hand it on over to Rich in Infusion.
Thanks, guys. Great job.
Yeah, thanks.
All right. Rich, thanks for being here today. Rich Denness is the President of our Infusion business. You know, Rich and I connected, you know, pretty quickly with our shared pharma background. You don't see that a lot in health services. Rich has been a seasoned leader of a lot of pharma organizations in the past, and Rich had been the chief commercial officer at Option Care as well, and just has a passion for infusion and bringing these products to as many people as possible. Rich, thanks for being here today.
Thank you.
Green button.
That would help. Yep.
The big one.
Well, thank you all for being here. Welcome to Louisville. I don't live here, so I hope your journey here was as eventful as mine. That said, you know, Jon raised something. We did share our pharma war stories back in the day, but when I look at infusion and when I look at Amerita, I think of the opportunity to truly build a brand and to build a brand within an industry that is truly evolving every day. As the pipeline comes out, and Chris and team referred to it, the amount of infused drugs in this pipeline, the amount of drugs that have to be administered by a healthcare professional just continues to grow. You know? It's evolving. It's changing.
I go back to the pharma days when, I'll age myself, I was at the Claritin launch meeting, which was about 1937, I think, somewhere back then. We became the official allergy medication of Major League Baseball, and I didn't know that Major League Baseball really needed an official allergy medication, but apparently they did. Over time, you saw the pharma industry get more and more heavily regulated because of things like becoming the official allergy medication of Major League Baseball. We have the ability to build our brand here, super exciting, and I would argue all of infusion has that ability to do it together. Let me get into a little bit, there we go, about who we are. Excuse me. Amerita. I would call us a super-regional infusion provider.
We're not fully national at this point, and I'll get to our footprint in just a minute, but a super- regional Infusion Provider focused on both the acute and the Chronic business. I'll probably use the term chronic and specialty interchangeably throughout the course of the presentation, but at the end of the day, we are involved heavily in both. That is significant because for those of you that, excuse me, follow the Infusion business, you know that over the last three to four years, a couple of large providers have backed away from the Acute business. Last year, a regional provider did the same, and we are still heavily involved in both.
We take both of those patient responsibilities very seriously, and at the end of the day, we are committed to the acute and the chronic or the specialty pieces of our core business. I don't need to probably explain to you know, who we serve in both of those markets, but I always liken the Acute business, excuse me, to riding the Tour de France in first gear. You have to be present to win. Your feet are moving and your legs are moving 1 million mi an hour. You get home, you rest, you come back the next day, and you do it all over again. That's kinda the acute market.
If you're not present to win, if you're not providing world-class service, if you're not, you know, timely with great nursing in the home that day upon discharge, you're probably not gonna be nearly as competitive. Chronic, a little bit different. You have fewer patients, high revenue, and basically an annuity business, you know, month after month moving forward. We focus, Jon mentioned it earlier, on the neurology and the gastroenterology markets. We're not, you know, unique in that section. Frankly, it's our ability to provide world-class service, best-in-industry service that makes us competitive in this market. Excuse me. When we look at the overall size of the business, you can see the market's growing, you know, quite well.
The 9% really includes the HOPD, the hospital infusion pharmacy department books of business, and then the 11% is the home and the alternate site Infusion business. Pardon me. When you look at the Acute business, the TAM is gonna be less than your Chronic business. That should be no surprise to anybody. Then the alternate site, where we are actively engaged and have a full-scale expansion strategy set up is still also growing at 9% or, excuse me, $9 billion on a TAM scale. Pardon me. Where is our footprint? I mentioned we're a super-regional. We're not everywhere in the country, but we are strategically located in many key markets around the country.
We have a plan to, as Jon said, organically grow where we currently exist and then expand our footprint into new markets. This footprint I think you can see will evolve over time, and we are actively engaged in M&A. Now, let's talk about the acute opportunity. This middle section I think is the most important on this slide. We currently have the ability to cover a third of the geography in the United States. 33% is where we have the ability to compete. Clearly, growing our geographic footprint in the Acute business is a significant opportunity, and we are currently active, looking in markets throughout the United States where we can grow our acute footprint.
The one thing that I will say when we look at the Acute business, we are currently number two or three in most markets where we compete in the Acute business. Our market share in acute is growing every day. Our market growth is a very healthy double-digit growth, so we're very pleased with that. Again, two out of three in 16 of the 18 major markets where we currently compete. On the Chronic side, we focus on about half of the market, the geography in the U.S. The difference is in chronic, as you guys know, you can actually service into other states from pharmacies that are not necessarily located within the state that the patient resides. We cover or have the opportunity to compete in half of that geography on a national basis.
In Pharmacy, our growth strategy is to basically be the fastest, most efficient in terms of getting benefits through the system and getting patients on service. You know, Chris and team talked about a white glove service. We are doing the same with IG. IG is the holy grail of the chronic specialty business. We are treating that with kid gloves, white glove, no pun intended, and we expect to be, excuse me, market leaders within the Chronic business. Reasons to expand. I mentioned the underserved population, the pipeline, our scalable strategy. We have excellent payer access. We continue to work with payers on what we can do to further differentiate ourselves. The opportunity for us to provide service above and beyond with payers is extremely significant. If you think about it, we spend 40-60 hours a year with patients.
How many other providers do that? How do we create value and extract value out of that? When we look at where the clinical innovation opportunities are, Amerita, our infusion services business, is very heavily involved in Alzheimer's. We are one of the key providers of Leqembi in the country, and Amerita has been selected by Eisai to participate in the Alzheimer's Advisory Board. We're certainly collaborating, excuse me, with both Eisai and Eli Lilly on opportunities to expand our Alzheimer's franchise. When we look at IG, I talked about our clinical focus on IG, our concierge services on IG. Excuse me. That is underway right now. Our growth in IG has been quite significant, and certainly proud of where we see our franchise going, excuse me, moving forward.
Then other limited distribution drug opportunities, we currently have access to around 20 that we are working with manufacturers on in the pipeline. I am very, very encouraged by where we're gonna go with our LDDs moving forward, and we've got new leadership that is heavily involved in the LDD franchise for us. Now, if you look at operational excellence, we're really focused on our turnaround times with both the acute and the specialty business. The acute turnaround times are running 30-45 minutes, specialty, 12-14 days. Chris mentioned a heck of a patient sat or NPS score. Ours are running at 94% right now. Very proud of that. If you look at where we have the ability to invest, people, process, technology.
Charlie and Viji spoke about our technology opportunities earlier, but we have put in an entirely new executive leadership team within Infusion. Excuse me, I'm very pleased with where, pardon me, where we're taking the business. The last thing I'd say, excuse me, is basically our overall growth drivers. I mentioned several of them, but we're excited about where this business is gonna go. Between the current growth we're seeing in the acute market, where we're gonna be taking the Chronic business, what we're doing with LDDs, where we're taking technology, and what our new leadership team is doing, the ability to build the Amerita brand within BrightSpring is massive. We look forward to it, and with that, excuse me, with that, I'll turn it over to Scott Greenwell. Thanks.
Thanks, Rich. Yeah, the Acute business. Rich, thanks. I know you're coming off of a case of pneumonia. Thank you. Most people would not have been able to do that with your last week or two. thank you. Scott, thanks for being here. Scott joins us, most recently from Humana. Scott ran all the pharmacy operations at the PBM there. I think among many things over the years, you know, really building that pharmacy operation out over there in a highly automated way, driving something like $5 cost per script reduction over a period of years that is very hard to do, also with exceptional quality.
Scott, we're thrilled you're here and, you know, just like Rich, I wanted to say Rich has done an incredible job in the last year at Infusion, really building out a broad team. If you look at the top 10 leaders in our Infusion business, everybody is essentially new in the last year and just, you know, A-caliber individuals, whether it's sales or operations or rev cycle or specialty in LDDs, et cetera. Scott has done the same really across the business, I would say just building on a lot of the strength we have, but going out and getting the people and the resources to build this out into the biggest and most efficient Home and Community Pharmacy in the country. Take it away, Scott. Thank you.
Thanks, Jon, and appreciate all your time today. By the way, happy St. Patrick's Day. I can't believe we said that, you know. When I think of St. Patrick's Day, I don't think of snow and sleet in the Kentucky market, but unfortunately, here we are, and I understand some people had some travel issues getting here. Again, Scott Greenwell, I'm a pharmacist by training. Been with the company now for about nine months. It's certainly been an exciting time to join the organization around the Home and Community segment, and we're gonna get into what that looks like here over the next couple slides. I am gonna try to save us some time. I'm used to batting cleanup, so hopefully I'll get us back on schedule.
You can see, you know, BrightSpring and PharMerica has really built a really powerful pharmacy platform to serve really all kinds of transitions of care as people navigate through the course of their lives between the work that we do in the group home setting and servicing our IDD members to assisted living under the senior living brand, and then OnePoint Patient Care, our Hospice Pharmacy and PBM provider business, and ultimately into the traditional skilled nursing business under the PharMerica brand. What I hope you gather from today is really around how this business has evolved over the last couple of years, how we're thinking about it going forward, and kind of pivoting from a SNF-focused long-term care Pharmacy business to really tackling each one of these individual business segments in a unique way. To do that takes scale, right?
We have 4,700 heartbeats every single day, working to take care of over 4 million patients across 120 pharmacies, servicing 6,500 facilities across the U.S. Those 4,700 heartbeats every single day waking up to take care of the nation's most vulnerable patients is our bread and butter. It is what makes us different. It's what makes us unique. I'm clearly proud to be part of an organization driven by such an incredible purpose. My father passed in 2020 of frontotemporal dementia, so I personally know all too well what our patients and their loved ones and caregivers have to navigate as they navigate through the long-term care setting.
One of the reasons why I'm here today is to help make this a meaningfully better process, and to offer a different level of care and focus that comes along with that. As we think about our quality deliverables and metrics, Jon has been, you know, incredibly passionate around this. But for me, it's simplified around the right patient, the right drug at the right time. We have to get those things right every single time. It is not something that is ever allowed to be off. And as you can see, by delivering across all three of those, right patient, right drug, right time, you ultimately get your retention with your customers. And we have an incredibly strong retention across each of our four business segments within Home and Community, and continue to grow and expand that.
Clicker. All right. This is the footprint. Jon's referenced scale. Frankly, this map speaks for itself. 120 pharmacy locations spread across the country. We most recently entered into the Alaska market with a pharmacy there. We are capable of servicing coast to coast any patient's need within three hours delivery to door. I think that is a competitive advantage for us, especially in this market right now with the disruption that we'll speak about here in a little bit that has been the long-term care pharmacy space. Next, strategy. One of the things I really want you to take away from this slide in our conversation is that this is not the PharMerica of old. This is a new PharMerica.
This is a PharMerica that is not trying to you know, stick a, you know, round peg in a square hole of skilled nursing facilities and capabilities into the IDD and senior living/assisted living marketplace. We are focused now around core general managers for each one of these businesses, focused on the unique sets of needs and skills for their respective businesses, and aggressively targeting growth across each of those. We have a leading sales team across each of those four business segments, aggressively targeting, leveraging our scale collectively to figure out how can we continue to grow double-digit growth across each of those four segments.
This is a new PharMerica that's, you know, backed by a tech stack that Viji and Charlie referenced earlier, that it gives us the ability to leverage our national scale and footprint, but to deliver a local, unique, customer service model that makes it feel, again, very local, by leveraging our account management teams and capabilities powered by the analytics and data that come along with that. Ultimately, to get to a $24 billion addressable marketplace, you know, we are trying to rethink, you know, how we service these customers, again, unique to each individual business segment. Part of that comes to also rethinking our clinical capabilities through formulary management, utilization management, particularly in the skilled setting, trying to think through how do you take traditional PBM tools to leverage total cost of care and optimizing clinical outcomes, at the most appropriate cost?
This is not something that, you know, as an outsider coming into the space that we've seen with the collective industry and one that we believe is a very real opportunity to differentiate strategically for PharMerica against everyone else and to power the growth that we've been referencing. Okay. One of the keys, again, around our focus and kind of the new way of how we're thinking about long-term care pharmacy and in the Home and Community segment is really standardization of processes.
How do we take and create a consistent standard process and onboarding experience for each and every one of our customers within their respective segment that allows us to partner with large regional players and national chains to make sure that whether it's in a skilled facility, whether it's an assisted community or whether it's an IDD, that they experience a consistent onboarding experience again and again and again. We have done that through leveraging technology in a way, and specifically things like robotic process automation and machine learning to make the onboarding process as smooth and streamlined as humanly possible.
We have a lot of investments today trying to automate a lot of the historic legacy clerical tasks that pharmacy have to, you know, pharmacies have to deal with, whether it be member load, prior authorization requirements, billing capabilities, and order entry within the pharmacy proper. You know, pharmacies, you know, candidly benefits from having a lot of structured data as a way for us to feed off of, which is highly adaptable to a lot of these new tech capabilities that we're partnering again with Charlie and Viji to deploy, which is gonna create a differential experience for each one of our customers that we've not yet seen across the industry. Incredibly excited about that.
By leveraging those things, we can get to a different operating model, in terms of how we think about our operating cost and cost to fill, as Jon referenced, which is something that I'm incredibly focused on right now, is how do we get to a differential to drive truly a world-class experience, and operating model. Okay. We're getting close here. Okay. Investments can clearly be kinda summed into two different parts. One, again, I've been referencing it, automation. How do we leverage automation in a way to streamline and take advantage of the scale that this business offers across our 120 pharmacies? Then ultimately to our customer and clinical experiences for our customers.
Way too often, our clinical counterparts within our facilities are dealing with being historians of a patient's care, navigating through a very bureaucratic process and ordering meds, getting meds, where's my meds, et cetera. You know, I think everyone today is very familiar with the pizza tracker analogy of trying to figure out how do we leverage technology in a way to improve our partner experiences, so they know exactly where the order the meds are, when they should expect them, and ultimately giving them back time to spend it where they should be spending it most, which is caring for the patients that they ultimately are tasked to do and not trying to figure out where their medications are.
We're spending a ton of time specifically in that realm in terms of improving those experiences again with Charlie and Viji's help. Ultimately, I think we'll probably spend some time at a future meeting talking about the outcomes of deploying a lot of these machine learning and robotic process automation tools and how they're evolving our cost structure and how we're thinking about the advantages that we'll create. Last, it's all about growth. I mentioned earlier, you know, we are expecting, trying to drive to double-digit growth across each of these four segments.
Again, backed by the national scale that we have, backed by the clinical capabilities that we have, backed by the technology and deployment enabling these things, and ultimately related to a best-in-class sales force that can go back and articulate this value prop, the differential that we're offering to each and every one of our customers. We are now seeing over the last several quarters, meaningful growth across each one of these business segments, and we expect to continue to see that. You know, it's an exciting time. All right. Five keys to our success, you know, really is around this high touch, reliable, and dependable partnerships with each one of our customers. It's a best-in-class clinical capabilities that we have built in the LTC model.
It's operating at scale and driving efficiencies both for our pharmacy operations, but as well as our clinical counterparts. How do we return, again, back operational efficiency time to them in nursing, especially when they're dealing with high turnover, a nursing environment, as well as constant training needs? It ultimately brings stability to a very disrupted market that currently is the long-term care pharmacy space. As we look across the market and see some of the large players and the legacy players having filed bankruptcy in the last year have been very public. We believe that disruption creates a very real tailwind for us, given our stability, market position, and scaled footprint to really take advantage of all of that disruption.
Couple that with some of the things we'll see with the IRA, particularly focused on the small regional independent pharmacies who are gonna have to navigate some of the complexities with the IRA that do not have the strength of BrightSpring or PharMerica's balance sheets, is gonna create another very real tailwind for this business as we think about growth going forward.
Jon referenced this earlier, you know, this organization has curated a leadership team over the last 24 months that takes advantage of the 40+ years of traditional long-term care pharmacy expertise, but has now coupled that with PBM clinical and cost containment excellence, modern pharmacy practice at very large scale and highly efficient, coupled with providers and operators that have a very unique perspective and point of view into the real, very real pain points that our customers and providers deal with every single day that can help reinform our products and suites and services and how we're showing up to the market.
Really, again, this has been a very real change over the last 24 months, and I'm really excited about what this team is starting to produce and how we're starting to think differently about this as a product and a service offering within this suite. Okay. At the end of the day, it's about winning. We are here to win. We love to win. We are focused on winning. That winning comes because we have 4,700 heartbeats showing up every single day, taking care of the patients, the over 4 million patients that we serve, and doing so as if they're caring for their own loved ones and family members. That is the differential.
Every single day, every single meeting that we kick off with a patient story and a patient persona, so we can continuously remind ourselves why we are showing up, what is our purpose every single day. We're here to win, to help our customers manage their overall drug costs. We're here to help them win related to making them more efficient and operationally effective. Ultimately, we wanna win so we can win for our shareholders and the investor community at large, which is why we're here. That strategic differentiators that I referenced earlier, I think positions incredibly well to do that here over the coming quarters and years. I think, Jon, that wraps me up. Yeah. Q&A.
Hey, Scott.
Yeah.
I think everybody comes up for Q&A.
Yeah.
Okay. Hey, while they're coming up, I'm just gonna sorta, you know, there's a lot of slides there. I'm just gonna recap, you know, some of the growth drivers for the businesses. You know, Onco360, again, if this is helpful, everything starts with quality, deep relationships with pharma. There's a very deep innovation pipeline that still exists today, coming to market. The opportunity to partner and bring these new brand LDDs to market, they ramp up over a period of years. You have this LDD growth that kinda stacks upon itself with launches every year as prior launches are still growing. Those drugs are pulled through by a sales force that we've heavily invested in.
Over time, in addition to the brand side, you have some brands going generic, and then the team has built out a really strong and rapidly scaling fee for service business of data and service agreements with pharma and hub programs. Multifactorial growth model there, and especially on Infusion. You really gotta run those businesses from an Acute and Chronic specialty perspective. You know, we are investing in the sales force on both sides of those. We're investing in turnaround time and service metrics to build those businesses out. We have a lot of geographical expansion opportunity, and we're building out suites over time to give patients and prescribers more alternatives on where their patients could be seen in addition to just the home, which should also drive labor efficiencies as well.
You Home and Community Pharmacy, building on 40 years there and the scale that we have today, you know, it is all about scale and continuing to scale that business as efficiently as we can. There's a lot of attractive end markets in that space with ALF, with behavioral, with hospice. PACE is emerging for us, and then you've got the historical skilled nursing channel, which is very healthy today. You know, look at some of the skilled nursing pharmacy companies out there today, and they are very healthy. A lot of very attractive growth markets for Home and Community healthcare, and how do we further penetrate those with leading services in a very efficient model, you know, with automation at its bedrock. That's our Pharmacy business.
Again, we go to where people are, hundreds and thousands and millions of acute chronic individuals every day, helping to take care of them better and to try to keep them out of the ER and the hospital and give them a better quality of life. With that, happy to take any questions on the Pharmacy side. Brian, maybe you wanna go first. I saw your hand quickly.
Yeah. Brian Tanquilut from Jefferies. Ben, just for you. When I think about the successes you've had with LDDs and bringing those in, how do we think about translating that to the opportunity in generics? Or maybe asked differently, how do you drive market share with these new generic introductions coming up?
Yes. I'll take the first part of that, and Robert will probably expand on it through the sales force. Our focus really is multifactor, right? We wanna be a part of the pharma when we're launching new therapeutic products coming to market. When we do that, and we're one of one or two multiple SPs, we're consistently driving larger market share than our competitors. That creates really an advantage for us as we think about the pipeline.
Organizations, manufacturers looking at getting in the space, you know, Onco360 is embedded in a lot of those relationships. Robert's team is focused on pull-through, wanna drive new patient starts, and then retain them over the life cycle of that brand. When that product brand goes generic, the larger the market share we have when that product's brand, the bigger the opportunity is in that respect.
When you think about pharma, I would just add, you think about when a drug goes generic, you know, the pharma sales force and the detailing just completely goes away. You know, that's where Robert and his team becomes very effective working with prescribers and patients to still be there as a supportive educational resource for the offices at that point in time.
Okay. Great, Jon thanks. Erin.
Erin Wright at Morgan Stanley. With the IPO, there was that significant opportunity to also kind of better integrate the businesses in terms of pharmacy provider. You talked a lot about that in terms of that one-stop shop, but what has surprised you, where does that stand relative to a couple years ago? And I guess for an analogy, like what inning are we in on that front in terms of that sort of overlap? And then one more pharmacy-specific question, just on the $100 billion in new products that are coming to market that you mentioned. I think that was just oncology if I read that slide correctly. You know, what about rare and orphan? Can you talk a little bit about that size?
Also the relative growth rates across, you know, your rare and orphan and then versus your Onco360 business.
Yeah. Maybe I'll go first, and then, you know, Ben or Robert, you can speak to the rare and orphan and the LDD or Rich chime in if you want on that, and maybe just characterize some of the rare and orphan growth in the portfolio. As it relates to integrated care opportunities and care coordination opportunities, that continues to be a really big opportunity for us. It continues to evolve and, you know, new opportunities present themselves seemingly on a regular basis.
You know, we have tried to be careful, not to let that distract from the strength of the growth in the core service lines as well, because I think, you know, Erin, as you're saying, and it was a question that we got repeatedly in the IPO. I think people look at the uniqueness of the platform and the integrated care services that we have, and they immediately say, "Well, that's different and that's unique, and that seems like a really obvious opportunity to combine all these services. That's a good idea." You know, we wanted to make sure that we also didn't lose the attention on, well, hey, the core services themselves are in great markets. They're executing really well. We view the integrated care opportunity, what I referred to here today as strategic growth, as just really additive to the core growth.
Hopefully, it's a lot of really interesting upside in the future, you know, which would be great for patients and the system. You know, I gave a few examples of those today. I mean, I do think we are in the second inning. What we have found is that you really do need to, like, this is not rocket science, you really do need to resource things in an organization for them to move, particularly when they're sort of in the gaps in between service lines, right? You know, Ben, Robert, Chris, Rich, Scott, I mean, they have a day job. Elizabeth, Rhonda, Jay in Hospice and Home Health, they have a day job to grow their business as much as we can. Now, they're also thinking from an enterprise perspective.
What we've done in the last really six months or so, we're starting to build out a team. We hired a gentleman, Scott Hawkins, who's terrific. We're starting to build out a team that just focuses on these integrated care opportunities more. You know, we're also continuing to resource that primary care team. There's a new leader there in the last year. We hired a CMO there in the last seven months. We just hired somebody to drive payer contracting. We're continuing to resource the primary care team. With that focus from a resource perspective on integrated care and growth in primary care, we expect to see these opportunities continue to present more growth and then more revenue and EBITDA as we go forward as well.
A ton of opportunities and, you know, frankly, you know, I think sometimes it's a situation for us where, you know, there's a lot of good stuff going on. You know, we don't wanna shortchange growth in Infusion, growth in Home Health and get distracted too much. What we've tried to do for these strategic growth areas, which I think are really unique to our organization, we've tried to resource them appropriately in the last year and be really sober and thoughtful about needing to do that so that hopefully in five to 10 years, you're getting nine figures of EBITDA from these areas and that's what we're focused on now. Maybe Ben, you can start with the second and third parts of that question.
Absolutely. Yeah. As we think about the pipeline from our perspective, oncology still remains kinda over the next five years probably 70% of where the innovation and biggest opportunities are gonna be from a growth opportunity perspective. You know, we're out there 16-20 months in advance. If you think about the life cycle of when they start to make pharmacy network decisions, distribution decisions, you know, sometimes that doesn't start till about 16 months when they're really thinking about access. We're typically right there. A lot of those same manufacturers that are launching products in oncology, there's a segment of the portfolio, very targeted therapies with like rare cancer patient populations. That's in that number that we described.
We think rare provides really a lot of opportunity as well. You know, probably 30% of the other segment of the market comes from a rare orphan disease. A lot of the activity today that we have around, you know, non-oncology products, it reminds me of where Onco360 was maybe in 2018, 2019, right? There's a lot of conversations around, you know, our support system, and transferability from oncology to rare. If you think about the programs that we've developed with pharma to support cancer medications. They're not only product specific, they're product indication specific, but then implemented. We talked about the infrastructure, the technology that overlays, you know, our operating model. You know, these are really patient dedicated programs, that the business is managing at scale.
That transferability into rare disease, which is a more fragmented market from a physician perspective, from a product perspective, a lot of the work that we're doing there early on is whiteboarding with pharma to create and develop solutions for those patients and caregivers across the pharmacy space, but also as you think about the Amerita team medical benefit, and being able to provide support and services in the home.
A.J.?
Just maybe a couple questions about PharMerica. There's been a lot of disruption on the competitive landscape over the last few years. Is that mostly done or are there still chunky opportunities for you to gain share vis-à-vis players that are struggling? Additionally, I guess when we talk about AI opportunities, it seems like to me, ambient listening with consulting pharmacists is they're going around doing charting. Are you doing that, and how big an opportunity might that be? I'm gonna throw one more in there. In terms of your other businesses, is there leverage because you have access to a unique population in the PharMerica, is that a selling point for you in these Specialty Pharmacy businesses that you're able to use?
Scott?
Yeah. Great questions, AJ. First, PharMerica and opportunities there, we do believe that there are very real opportunities in the traditional PharMerica SNF space for us to continue to take advantage of, given the disruption that you referenced. I'd love to have a crystal ball to try to figure out within the IRA for, you know, other pharmacies that do not have the same size and scale, and frankly, ability to contract with PBMs to offset that there'll be continued offset of that. I think we're all kind of in a wait-and-see lens to see where that ball ultimately drops.
We do expect there'll be opportunity there for us from that lens as well, as we're also trying to think through a repositioning of SNF, almost this lens of like a Part A PBM, and how do we really think about drug cost management in a different way for the SNFs during that Medicare Part A stay, and help them inform their budgets and spending projections for months and quarters out like a traditional PBM model would in the commercial market space. I do think there's a very real opportunity for us to continue to deepen our penetration in the SNF side. On the, I think AI was the next piece of it. Incredibly excited about that space, especially using AI as an enhancement to our clinicians, and to really, you know, do a couple things.
One, help us operate at scale and to think differently about how we can solve complex medication problems and challenges in a more efficient way by leveraging AI capabilities to help offset just the traditional reading of charts, finding medication opportunities, classifying those types of things. Those are all things that we are actively working on today to help enhance our model. We'll maybe get into more detail around that as that comes to fruition. I do think that's a space across frankly, all the medical landscape that's really gonna be a powerful tool for clinicians to take advantage of in an appropriate, safe manner, truly as an enhancement tool. Sorry, A.J., your third piece.
The third piece, maybe talk about Blake, you know, how we're
On the specialty piece, we do have we picked up an acquisition a couple years ago called Blake Rx. Blake is really focused today in a couple of states, literally a handful of states. It's trying to solve for this unmet need of specialty within an institutional care setting. It is an interesting space. We do think there's a lot of opportunity leveraging the CareMed and Onco360 specialty capabilities within that, within the PharMerica customer base already, as well as expanding beyond the PharMerica customer base, 'cause it's a bit of an unmet need across the industry that no one seems to have taken advantage of just yet.
Yeah, I didn't even mention that before as we're talking about it.
We, you know, we actually currently have a process built out among all three businesses where, you know, if Scott's team gets a referral, has some questions, we have it all worked out where it would come over to Onco360 or to CareMed to service that patient, where we can, based off of the payer associated with it. It's the same thing. We get an IVIG or hemophilia patient, you know, from that is also on an oncology medication, that is automatically going over to Rich and the Amerita team, and then both of those products are delivered to the patient.
I think within the Alzheimer's space, just given where that product is likely going in terms of the impact of that across all three of these platforms is a really an interesting opportunity we're gonna continue to take advantage of.
We really didn't even touch on that before. I mentioned ALF, behavioral, hospice, skilled nursing as the end markets in home and community. The specialty part of that business is really growing. You know, the team's doing a nice job of focusing on the specialty drug needs of individuals in those institutional long-term care settings. You know, it's interesting. I mean, you look at behavioral, Hospice, Specialty, ALF Pharmacy within Home and Community business. Skilled Nursing compared to those four is much smaller. That was a business that 10 years ago was all skilled nursing. It's a good market. It's just that the business has continued to evolve in really interesting ways, but all of those markets present an opportunity to be much, much, much bigger.
Thanks. Charles Rhyee with TD Cowen. Two questions. Maybe first follow up to Brian's question on generic opportunity. Obviously, it's a big everyone's kind of focused on it, but maybe talk about You talked a little bit about how you are working to gain share as these drugs go generic, but particularly, can you talk a little bit how you work with or, you know, around, you know, big PBM-owned specialty pharmacies that obviously would also wanna capture some of this generic conversion opportunity. And then secondly, you know, Jon, in one of your slides earlier, you were showing sort of the ramp of the LDDs, and it looked like in particular the 2023 and 2024 cohorts were ramping very nicely.
It looks like the 2019 cohort is now starting to ramp up. Anything particular about those years of LDDs that you'd call out, or what's interesting about those and why are they ramping so much better maybe than some of the others?
Yeah. Robert and Ben, go ahead.
I can take the generic question. If you think about cancer, which we showed the pipeline of the cancer drugs going generic, generally it's a disease of the elderly. If you think about the network configuration and the way the industry works, there's any willing provider regulations. Long story short, as long as you can meet the PBM criteria for access and participation and agree upon rates, which we've got into a good place, it's then about service. It's service and support, and your physicians by choice have the ability to use whoever they believe serves the patients in a better manner, whether it's the assisting with funding, like Chris said, turnaround time, communication, because this is a crisis diagnosis.
Absolutely, we compete against the PBMs, but we compete on service, we compete on relationships and support for the patients.
Ben, on the LDDs, like different cohorts, different growth rates, all depends, what's the drug? What's the market?
Yeah. On that side, you know, we're seeing just an acceleration of new products coming to market from an innovation standpoint, right? But it's not only new molecular entities and existing products that may be of open access or, you know, call it, we call it broader limited distribution networks. You know, let's call it 2013-2020, most of the limited distribution networks may have been comprised of, you know, over seven pharmacies. Today we are seeing 97% of those be three or less, right? With 30% of our launches in 2025 having been exclusive. That creates obviously that opportunity from a growth brand perspective. The products that are coming to market oftentimes have longer durations of therapy.
You know, because we're one of one, one of two, we have greater market share in those limited distribution networks. The longer durations of therapy also benefit us from a patient retention standpoint.
Have those networks shrunk over time too, some of those early ones that they?
There's a number of examples. In 2025, there was two significant products that were open access, and now we're one of two SPs.
Charles, I mean, we really try to partner with everybody out there as productively as we can. We've had really long-standing and positive relationships with all of our PBM partners, you know, just really aspiring to serve their members in as high quality a way as we can. We've invested in a clinical liaison team over the past 15 years that's, you know, close to 300 folks every day right now, you know, aside from the hundreds of individuals we have internally interacting with patients every day. Really invested in a field force and team over the last 10 years that we've been growing every single year, you know, to be there in prescriber accounts with patients every day, you know, just helping them through their decisions. Hey, Joanna.
Hi. Thank you. This is Joanna Gajuk with Bank of America. Rich, actually, I wanna switch to home infusion. A couple of things. First, on the 20 or over 20 LDDs in home infusion, that doesn't sound like you were involved in those. Can you give us a little bit more color in terms of what exactly you need to do to make it, you know, I guess, your presence shown in those LDDs? Does it require investment in pharmacies, people, technology, or anything else? The second question, on that map of the regions, are there some markets where you have, like, your eyes set on and why? Like, is there some priority where you're looking at this and like, "Okay, we gotta get that market next." Thank you.
Yeah.
First off, thanks for all of you putting up with me with my flare on slide five. I appreciate that very much. I wasn't expecting that. Two very good questions. I'll answer the last one first, if I may. We have a two-pronged growth strategy that we know is real in infusion. The team is absolutely excited about it. I mentioned earlier my entire leadership team has turned over, so nobody's been here for more than a year outside of my HR person and our finance person. Everybody else that touches the outside world is new.
The markets that we want to compete in, where we don't currently have a footprint, while I won't get into specific markets, think of the states that are highly populated, that aren't on our map, full of health systems, and I know that you are very familiar with the Infusion business, where we will be able to take our competitive strategy and compete against other players. That said too, there is the chronic and the acute side of it. I mentioned earlier, we are the number two market share now nationally in Acute. We are absolutely convinced we can compete with anybody in that book of business in any state, whether we're in it now or not. On the Chronic side, on the specialty side, same thing.
The best answer I can give you without giving you specific locations. A, we are very, very active in looking for acquisition opportunities. We are focusing on high population states. We are focusing on states where our combined experience, Jon mentioned where I came from, we have, our operations leader is from Coram, our sales leader is from Option Care. We have a, trade leader, which I'll get to the other part of your question, who has experience from Orsini, KabaFusion, and Soleo. We know where the opportunities lie, and that's where we're going. On the first question that you asked, we have access now to 20+ LDDs per se, by definition. Access is one thing. Having a relationship with the manufacturer where you're actually working with them is another thing. That's where we need to be.
Part of the strategy moving forward is to get heavily involved using some of that experience that I just mentioned from past companies where my leadership team has evolved, getting strategically involved with manufacturers. In some cases where we have access to drugs, we are rekindling those relationships because for whatever reason, historically, Amerita did not take advantage of that. That's a lost opportunity in the past, but moving forward, I think it's a big opportunity for us. Because as you know, with LDDs, there is an opportunity for us not only to successfully service patients, but there are data monetization opportunities, there are outcomes opportunities, and there are ways for us to help build our brand, which is our overall strategy. There's the existing portfolio that we're pursuing. My head of that business.
The gentleman that works for me that's responsible for that comes from a specialty pharmacy background, where basically the lifeblood of what his business did. He came from Orsini. He has had a very good track record historically, and he is. He has been very successful in his early tenure here. He's been here about four months now, four and half months, where he has reestablished, I think, our image, our brand, our experience, our approach with manufacturers. There are a number of, I think, novel, very interesting molecules where BLAs are filed, and we expect approvals coming in. You guys probably know a lot of these drugs.
I won't get into the details, but they're for cardiovascular disease, they're for diabetes, they're for other things that we are going to have to become involved in, as is every infusion provider, because the specialty landscape has changed so much on the GI front, which used to be a huge piece of the business. I hope I've answered your question, but two-prong approach on that.
The company was just so focused on acute with its history historically. You know, what we're doing today is trying to focus on both, you know, acute and chronic and specialty. You know, you just, you need to operationalize those two markets, you know, very independently within your organization. I think that's what the team is doing a good job now trying to focus on.
Hi, Dave Larsen with BTIG. Can you talk a bit about a day in the life of your sales rep? Like you've got Specialty, you've got Infusion, Home and Community Pharmacy. What is this sales rep doing all day? Is that person representing all of these different business lines? How is their commission determined? Are they calling on doc offices or hospitals or SNFs or all of the above or health plans? Can you just describe that, please?
Can I hit that just up front real quick to set the table, and then we'll just go one, two, three. Dave, I would just say two things up front. Number one, I've been at multiple organizations, you know, leading healthcare companies over the past 15 years. It is always a question as to whether or not you have a sales rep sell the whole bag or a suite of services or just their own service line or product. Let's say we have four reps in Boston, and we have, you know, each selling, you know, and we have four products at the company. Should we have four reps there selling each product, or should we have one rep there selling four? Our experience time and time again has been you need focus.
You know, you are always gonna have something that's left out if somebody's selling multiple pieces. We have made the decision again, which I think is the right one, is to have focused sales reps in our businesses to be much more productive. Now, if we can share relationships, if we're swinging by another doctor's office when we're at that hospital, if we're passing along referrals that come up, that's fantastic. Number one, you know, principally, we want focus. I would say number two at our company, as you look at the call point, it's either B2B or more of a call it pharma medical device, sales point, where it's a hospital, you know, case manager, physician, or a doctor's office. Home and community would be a good example of where it's all B2B.
You know, we are working with the assisted living facility CEO management team to win that contract for the chain. That's the way it works largely across home and community. In most other parts of our company, you have an individual clinical liaison going out there every day, whether it's home health, hospice, infusion, or oncology, and they are individually meeting with a case manager, a physician in the hospital or in an office to pull that individual referral through. It's more of a quote-unquote, "retail model." You know, Robert, Rich, and Scott
Maybe you can just, you know, hit anything more about what the sales reps are doing, who they're calling on?
I can go through the specialty side of the house, Onco360 and CareMed. We have two different types of salespeople. A field seller, which think about traditional pharma. They're going into doctors' offices, educating the doctors, the nurses, the oncology coordinators of our drug access capabilities, giving potential patient updates. They're going to see in certain metro areas, various hospitals around the country or actually around their region. Then they move on, and they do that all week long to go interact with the physicians. The inside sellers, which are partnered at a regional level with the field sellers. The strategy is aligned, the message is aligned, the targeting, they're behind a computer. They start the day with data and information.
Literally the night before, they have information on what referrals came in the day before. They start the follow-up, they start the education, they start the troubleshooting if necessary. Then they're working in conjunction with the field sellers to make sure that they're on one page as it relates to physician offices, next step strategies, opportunities. Long story short, over the past couple of years, we've shrunk territories. Chris showed that we've gone from 12 reps to 275. In shrinking territories, you can service more accounts, you can touch more accounts more frequently, you can provide better service updates. In the past, we might have had very expansive regions. Right now, they're smaller regions, so we can see the doctors in the offices more frequently.
Generally with the relationships, the sellers that are there most often providing real value to the doctor's offices win as it relates to where the doctors choose to send referrals. Then as far as the comp plan, we have a comp plan that rewards mix, making sure that there's a healthy mix of both brand and generic drugs. Then also you're comping as it relates to growth. New patient acquisition, because that turns into prescriptions and those who have the highest success rate as it relates to growth and mix are rewarded accordingly.
Okay. In infusion, we have two sales forces. We have an acute sales team and a specialty sales team. We have data that allows us to segment our customers and quintile them, quintile one through five based on where we see the potential. The data is heavily utilized in terms of call planning and things of that nature. We go with a four-week call plan. That doesn't mean we just see somebody every four weeks. We may double down. I may see you every week if you're a quintile five. I may be there so much that if you repeat back to me what I wanna say to you, I feel like I've done my job. That's the way that we operate with the acute and the specialty team.
The acute team is focused on health systems, hospitals, and getting referrals for those patients that are discharged from hospitals on a daily basis. I mentioned earlier, it's like riding the Tour de France in first gear. You have to be present to win because if you're not, the case manager needs to get that patient serviced by somebody, and you've got to be there. Now, the better job we do at providing service, the more we are front of mind, and that case manager knowing and building a relationship with our seller, will reach out to them and say, "I've got a patient who we wanna discharge today. They need daptomycin," blah, blah, right? That's the way we operate on the acute side. There are two roles in the Acute business.
We just use the analogy of the hunter and the farmer. The account executive is the hunter. They're building business in health systems or in hospitals. We may already exist, and they're expanding that business, but their job is to grow the business. We have clinical liaisons that we refer to as the farmers who are there to maintain the relationships, to put out any fires if there are any. But they really are the liaison between the patient, the referral source, and our pharmacy. That's how the Acute business works, and I'll get to how they're paid in just a second. On the Specialty side of the business, our folks there are calling typically on large neurology and gastroenterology practices. In some cases, there are other specialties that are involved.
Rheumatology, if you're dealing with gout or KRYSTEXXA or some of the chronic inflammatory diseases. Ophthalmology, if there's an opportunity with TEPEZZA and our partnership with Amgen, which goes back to your question earlier. The specialty team has a very, very clearly defined target audience that they call on as well. Again, four-week call cycle. Their job is to be the front-line representation of the Amerita brand and to get referrals from those physicians for basically, you know, the target opportunities that we showed on the slide earlier. In neurology, it would be IG, it would be multiple sclerosis, it would be drugs that have to be administered by a healthcare professional. A lot of those are for the emerging market in generalized myasthenia gravis. You see the TV ads all the time on TV.
We're involved in neurology in a heavy way and in gastroenterology, you know, with all of the drugs that you all know. The Remicades, the biosimilars, the Skyrizis, no longer the Stelaras, but at the end of the day, there's plenty of opportunity there as well. We are seeing a shift, and our focus is becoming more neurology-focused and gastro-focused, quite frankly. How they get paid? Everybody has goals and quotas. On the Acute side, we get paid based on the referral or the admit, not the referral, but the admit, the start, whatever terminology we wanna use, where a patient's actually put on service. Our focus is on antibiotics and TPN, as is pretty much every other acute provider's focus. They get paid on their ability to attain goal or exceed goal there.
Same thing on the Specialty side. It's a stars-based compensation plan. We don't make money on referrals, right? The last thing I'll say on that is the sales team's ability to partner with our pharmacies to make sure that referrals are as complete or clean as possible, so we don't have to keep going back and forth to the referral source. That is critical. As for those criteria that we put on the slide earlier, we show 12-14 days to get benefits through on a specialty patient. That's pretty darn good. We wanna get it below 10. We show 30-45 minutes on the Acute business. We'd like to get that way lower as well, but it's progress, and it keeps us competitive.
Our ability to partner between the sales team and the pharmacy is what keeps the service levels good. Frankly, referral sources don't want you to keep coming back to them. They want you to take this case and go get the patient service. The better we do that, you know, we always say good service begets more referrals. You know, good service with more referrals begets growth, and that's where we wanna be. I hope I've answered your question on infusion.
Lastly, in the Home and Community space, Jon referenced it. For us, it's mostly B2B as we think about it. I would say, this goes back to my reference earlier to kind of the new way of how Amerita's kinda approached this. Again, we think specificity is a differentiator in how we should think about growing the Home and Community space. I think historically, we had more of a SNF lead-in, and we got sold against by some of the other larger assisted living companies to say, "Well, they're just a skilled company. Why would you bother?" That's not the case anymore.
We are showing up in a very specific and unique way in how we're servicing the assisted buildings as well as IDD, and with a specific sales team focused on that. We're investing in the assisted side, you know, in the retirement belt, right? Where a lot of these assisted living communities are growing and expanding exponentially. That is where we are doubling down our efforts to focus our growth on those populations. We do have, as you can imagine, some large, vertically integrated customers, right? That have skilled, assisted living and some IDD communities. We have very clear ways to hand off those referrals as they may, you know, roll across multiple different settings for a institutional-based customer and client.
In terms of pay, it's again. We're very focused on profitable business, growing profitable business, and making sure that we have customers that can pay us on time, and are good partners for the business, and their comp plans are structured to take advantage of that.
Even within Home and Community, we have dedicated individuals, resources by those end markets that are focused on those. I would say, you know, Rich, with what Rich said about, think about, you know, the hunter versus the gardener, the hunter being more of an account manager per se, the gardener being more of a clinician per se, who's kinda settled maybe in one location versus hitting many, many different referral sources. That's a model that we employ broadly, you know, in home health and hospice as well. I mean, as you step back and look at our company, I mean, we're probably in over 10,000 different offices today across the country with our liaisons.
That's where, you know, thinking about the benefits of our organization, we do try to drive best practice consistency of sales methodologies and techniques throughout all of our businesses, but a lot of folks out there educating a lot of accounts and patients every day.
Jon, could I say one more thing on this?
Sure.
One of the really unique things about our service providing business is the interaction that our sales team will often have with patients, caregivers, and the ecosystem that is treated. If you're in pharma, you're not dealing with a patient if they get prescribed your drug. You're not. I mean, I am blown away at how professional our sales team is, as they interact with patients and caregivers on a regular basis to make sure that everybody understands what's happening next.
You know, you get discharged from a hospital and you get told, "Oh, you're gonna be on TPN for an indefinite period of time for your nutritional needs," or, you know, "You're gonna need this chronic drug possibly for the rest of your life." People need professional, I think, compassionate, but very knowledgeable folks to support them because our company shows up at their door. I think that's one of the cool, unique things that makes, you know, our business very, very special and very, very different from other sales jobs, if you will, that are out there in healthcare.
Yeah, I say this a lot, you know, in pharmacy, I think a lot of people just think about I grab my script and go. In closed-door pharmacy like we do, serving these populations where they are, there are easily over 30 things we are doing on an ongoing basis, interacting with the patient and with the family. You know, that is a huge part of why you can differentiate yourself from a service quality perspective and from a loyalty perspective, because you are very involved with so many things along that patient journey, and we are who they call.
We're gonna take a break.
Break time?
Yeah.
Well, thank you guys. That flew by about three hours already.
Two hours.
Two hours. Thank you guys for your attention this morning. I think we've got a little bit of a 20-minute break or so right now. Five minutes? Damn. We gotta do some work in these breaks. Yeah, it looks like we got about five or 10 minutes, and we'll continue the agenda after that. Thank you, guys. I think we got most people back, and we will continue the presentation and discussion. We're gonna shift into the Provider side of the business now. Elizabeth Robinson, our President of Home Health, Rhonda Sanders, our Chief Commercial at Hospice, Kim More, Rehab & Personal Care. They are here for the next provider section. I wanna say three quick things about the Provider side of our business.
You know, number one, it has been a really steady and nice performer for the company for a really long time. You know, double-digit revenue, EBITDA CAGRs, going back five, six, seven years now. I think that's based on the fact that we're in markets that provide a really great service, and they continue to have a lot of demand. It's a really steady provider business with an attractive growth profile. Number two, you know, really underpinning that is, you know, these are good businesses. Like, these are really good businesses in the company. You know, they're stable, they're consistent. We have really good people in them. You know, I guess, it's been almost, like, 13, 14 years for me, you know, in the health services provider world.
You know, I can tell you know, being at some pretty good companies that were industry leaders, you know, we have excellent people at the top and down through these businesses that we're thrilled about. We always have people knocking on our door wanting to come, and we're like, "Well, how do we find a place for that person 'cause they're an A?" But we have really good people in the businesses delivering really good quality results. These are just good businesses that we need to keep serving more and more people with these great services. Number three, you know, there's really a tie-in, you know, between the Provider Services and the Pharmacy businesses at our company. You know, Home Health is a good example of that.
I think we have a slide in there that shows, like, eight different tie-ins of Home Health to all of our different businesses. You know, there is really a lot of cross-functional work that goes on at the company, and they really fit together nicely. With that, Elizabeth, you've been a little busy lately integrating-
A little bit.
You know, about 100 branches here recently, but it's going really well. Elizabeth, maybe you can spin us through Home Health. Thank you.
Thank you so much, Jon. Thank you for that warm introduction.
You've got one?
Yes.
Good.
I am really excited to tell you about what we do in Home Health. We provide compassionate patient-centered care designed specifically for the older adult in the comfort of their home. Our teams treat a variety of illnesses, injuries, chronic conditions, and we definitely want to progress the patient toward a higher level of independence and produce better quality of life for them. Our primary focus, in the home is to make sure that patient can remain safely in their home. At the same time, we want to reduce avoidable rehospitalizations. We provide skilled nursing, occupational therapy, physical therapy, speech therapy, home health aides, and social work in the home. Now, in this division, we provide, home health services and private duty services in the home. They are different. Home health, we provide intermittent care primarily to seniors.
We treat multiple types of patients with a multidisciplinary approach. We are paid episodically and per visit. On the private duty side, we can be in that home up to 24 hours a day. We treat both the pediatric patient and the adult patient. We're paid hourly. We're in the home for long-term care for chronic conditions such as ALS, cerebral palsy, Parkinson's disease, and other neurological disorders. We provide skilled nursing and certified nursing assistants in the home. Why would one choose home health? Every patient receives a customized plan of care built around their personal goals, preferences, and needs. We believe if the patient is heard and involved in their care, they're much more likely to stay committed to that plan of care, thereby improving patient outcomes.
We provide support not only to that patient, but to the families and the significant others in that home. It can be overwhelming navigating illness and recovery. Our clinicians, our teams are in that home providing reassurance, guidance, and care every step of the way. They can call us 24 hours a day, seven days a week, 365 days of the year. We also focus on continuously improving our policies and procedures, investing in our staff education and training, and also using the latest and greatest technology to provide effective, efficient care. Our quality is the core of what we do. We strive every year to improve our performance scores. We use databases, we use data, we use feedback, we use best practices to elevate our plan of care and to elevate the care we give. We're committed to innovation.
With this innovation, we can rest assured that we are producing and delivering the best standard of care available in the industry. We partner with companies such as Homecare Homebase, Mosaic, PatientPing, CareFlo, Element5, et cetera. Our goal is to improve that patient's outcome with every episode of care. We believe BrightSpring is poised to meet the demand of the rapidly aging population in this country that will need high-quality, low-cost care. We believe as more individuals choose to age in place in their homes, the demand for convenient, accessible care is going to rise. Right now, the home health industry is valued at $119 billion, growing annually at 7%.
We believe by consistently improving our quality, we're gonna be trusted partners with ACOs, post-acute networks, preferred provider partnerships, and also managed care organizations. We are right now 12 out of 22 states are CON states. We have 181 branches and growing, and we're serving 27,000 patients. 81% of the branches acquired from LHC and Amedisys are in CON states. It is difficult to enter a CON state. You can do so two ways. You can apply for a CON and compete with other competitors trying to win that seldomly open CON, and at the same time, the people that have the CON already within that area is going to oppose you. It's a long and drawn-out process. You can acquire branches within that CON state.
We are very fortunate in the fact that LHC and Amedisys have achieved some of the highest quality scores in the industry. We have branches coming over with the same quality mindset as we do. We have new CON states that have been added to our portfolio, Arkansas, Kentucky, Illinois, West Virginia, New Jersey. We're currently progressing through a very detailed and thorough integration process. Each branch has a growth action plan assigned to it. We will be bringing over $30 million in additional EBITDA. We expect longer upside through additional operational efficiencies and also additional growth. As I said, quality is front and center. Right now, our 60-day readmission rate is 15.9%. We are improving and being invited into additional post-acute networks. We have developed our own internal OASIS certification process.
We're putting every branch manager and clinical manager through this certification program where we pay for their training internally and pay for them to take the national exam. We currently have a 90% pass rate. After all of our leaders progress through this program, we will then begin to invite professional clinicians to go through this type process. We compare ourselves to the industry using our SHP platform, SHP. We are constantly striving to improve, like I said, our quality scores. Right now, in patient care, we're 96% versus a national average of 90%. In rating of the agency, we're 94% versus a national average of 86%. In specific care issues, we're 94% versus a national average of 85%. We will continue to focus on our episodic payer mix. We always have.
We'll continue down that path. We've been very successful in negotiating stronger payer contracts. We'll continue that path forward. Right now, our integration and stabilization of our newly acquired branches are of utmost importance, and we're pleased with the progress to date. That integration should be completed by year-end. We also are putting significant efforts toward further automation of our referral and central intake departments, and we're pleased with their progress. How do we grow? How do we continue our growth? Of course, we're gonna continue to pursue organic growth by leveraging our ability to gain market share in our new and existing territories, and we have strategic plans in place for that. We will also continue to grow through this acquisition. We have strategic action plans and growth plans assigned to every branch.
We will continue to grow through leveraging our ability to successfully stand-up locations through de novos. We will continue to build on our de novo strategy. After we complete the successful integration of the LHC and Amedisys branches, we will continue to grow our M&A activity, with particular focus on CON states. Thank you so much for your time and attention today.
Thanks, Elizabeth. I'm gonna jump in here on Primary Care, but, you know, what's interesting about our Home Health and Hospice business, and we'll hear from Rhonda in a second. You know, that business, when you think about LHC and Amedisys, when they were still public companies going back a number of years, you know, our Home Health and Hospice business is pretty much right at the doorstep of where they were, you know, from a size perspective back then. If you think about, you know, the significance of this business, there's really only two companies out there, Genesis, in their most recent reincarnation, you know, in hospice. Gentiva, in their most recent, you know, rebranding back of the Gentiva focus on only hospice, and VITAS.
You know, those companies have been around for 40 years and in hospice and have very, very large censuses. You know, that's probably out of reach. Other than that, you know, we will be, you know, the biggest home health and hospice company in the United States. You know, we're essentially there today, and we'll keep that going. Thank you, Elizabeth. Elizabeth is one of the best, most accountable operators I've ever been around, you know, and has a ton of history in the industry going back to her Amedisys days. Primary care, we just have a couple slides here. For reporting purposes, we keep that within the home healthcare segment, so that's why that's here today. I think about this more as that strategic growth area, one of them, in addition to our core growth areas.
You know, why have we been doing this for a couple years, you know, getting this up and going? Number one is just simply, we have access to so many patients, hundreds of thousands of patients a year through our Pharmacy and Home Health and Hospice businesses, you know, that need better primary care. There's an opportunity, you know, to introduce that into the service lines that we have to provide patients in their home and in ALS and SNFs with a better primary care experience. The other one is, you know, we just wanna leverage our really strong quality outcomes into value-based care. We felt strongly that having the primary care capability set was important in that. You know, they are the quarterback in terms of the experience and the journey of the patient.
We wanted to build out that primary care capability, move up the value stream, if you will. That's been going pretty well the last couple years. You know, it's been a grind getting this going. It's been really all organic, but we've continued to bring good people into this business, including, as I mentioned earlier, a new CMO, a new head of payer partnerships just in the last six months, and we're really excited about further scaling this out. Home-based primary care, either in the home, but mostly in assisted living and senior living, in assisted living and skilled nursing, has incredible outcomes. You know, typically a 35%-50% reduction in hospitalization depending upon what you're looking at.
What we are trying to do is enter as many assisted living and skilled nursing facilities as we can, and service people in their homes to scale this business, you know, both from a fee for service and increasingly ACO opportunity perspective, but then also, as I mentioned before, the opportunity to partner with payers and manage their high-risk members. We can do that by combining primary care with our Continue Care Rx model in the home, med management in the home, and having an effective clinical nursing hub in the in-between time and the in-between space, helping to keep people out of the hospital, stepping in front of it. We're in 10 states today. You know, as I said, we're you know, we also recently hired a new sales leader for this business. We keep investing in this company and in this business.
You know, we are looking to enter into as many skilled nursing and assisted living facilities as we can as the Primary Care provider. We wanna partner and share leads with our home health and hospice and rehab teams as much as we can to gain access to these buildings, and we wanna provide great care. You know, if you're a skilled nursing facility or an assisted living facility, that primary care capability in your building. You know, has a huge outcome on your patients. That is vital for you. It's how you market yourself in the community. Do I keep people here longer? Do I keep them in my facility longer, less in the hospital? Primary care is really important for all of these, operators out there in the industry.
We're leaning into the ACO as well. Our definition of value-based care is really threefold. One of them would be having your own ACO, right? If these are our own patients that we are the doctor for, right? They are assigned to us. You know, if we're driving really strong outcomes for them, how do we see the benefit of that? What we're in today is a no risk, all upside shared savings model with Medicare. There's gonna be some new ACO models coming out in 2027 and 2028. We are gonna be joining those and continuing to try to grow the percent of the patients we see that are in a shared savings model.
You know, the second way, as I said before, is to go to payers and use our care management model here to better manage their members with an innovative contract with them that reflects the value that we're delivering. The third way is we have a really small I-SNP today. That's a special needs plan. That's a managed care plan. It's in two states. You have to get these things approved state by state. We think we can move much faster on the ACO and payer partnership side. This is a managed care plan in a couple states where we have a couple thousand patients in it.
If we're in a skilled nursing facility or an ALF, for example, we have the ability to treat Medicare patients under the ACO, or if not, we have the ability to see patients under a managed care plan construct like this I-SNP. We just wanna have a comprehensive solution and alternatives from a value-based care perspective. Hope to be talking about this business and this build out a lot more with you in the coming years. You know, our goal is to serve over 100,000 patients and more in time, you know, doing about 300,000 encounters a year today. But we wanna rapidly grow this business, and we think it has a dramatic impact on improving quality and reducing cost. It's very, very closely tied into our other service lines as well.
With that, we will then move over to Hospice, and Rhonda Sanders is gonna come on up. Rhonda knows the hospice sector as well as anybody I know. Not only, Rhonda, are you terrific from a day-to-day referral generation and sales standpoint, but also, you know, one of the best strategic thinkers and partnership-oriented type individuals I've seen in hospice before. Take it away.
Thanks so much, Jon, and good afternoon, everyone. Again, I lead the growth for our hospice division. It's one of the most compelling divisions in our portfolio. Every single person in this room will need hospice at some point in their life, right? It's a very compelling service, and I'm excited to talk with you about our growth potential today. Just hospice at a glance. I wanna make sure and paint the picture of who we are today and really what sets us apart as an organization. From a broad geographical reach, we're in 21 states and 93 locations across the U.S. That sets us up really coast to coast. We have a great opportunity to go deeper in every market that we're in. Very exciting about the growth potential in the hospice division.
From an integrated service offering, Jon's talked a lot today about our integrated model. It really is a continuum of care. It's making sure that we're servicing patients in a very fragmented healthcare world. It's very complex. I don't know how many of you have navigated the healthcare landscape lately, but it can be incredibly challenging, especially for a senior. Our ability as an integrated service organization to create a less fragmented model is a differentiator for us. We have our hospice, which we service patients that are terminally ill. Typically, last six months of life is what we're focused on. Our palliative service offering is even more broad, so we're really partnering around advanced illness patients. That's a broad scope.
Today, we service over 3,000 patients with palliative, with about an 80% conversion over to our hospice at some point, really focusing on right care, right time. We focus with our palliative patients around goals of care. Where are they in their decision-making? Where are they in their disease process? We work very closely with our OnePoint Patient Care. They do provide pharmacy services for our hospice patients. We've seen a lot of efficiency and enhanced customer service in working with OnePoint Patient Care. It's really been a differentiator for us. From a Home Health perspective, Elizabeth shared a lot about our Home Health. They have some of the highest quality in the industry, and again, we're really focused on getting patients upstream. Not only from our Home Health, but other home health in the country, right?
You know, they have patients on service that need advanced care, and it's really using the data that Elizabeth talked about, the SHP data, to really identify, you know, triggers for these patients and ensure that they're receiving that care at the most appropriate time. Then our home-based primary care services, which Jon talked about, our Abode Care Partners. I'll just give you an example of the type of scale that hospice has an opportunity in working with them. In the Ohio market last year, our Abode Care Partners actually made 400 hospice referrals. Just a tremendous opportunity there. Then from a focus on quality and operational excellence, you've heard a lot of that today, but that's really what we lead as an organization, ensuring that we're delivering the highest quality of care.
I'm pleased to say that over two-thirds of our hospice branches are four-star or greater. That's like a hotel, right? You know, many of you choose your hotel based on five-star rating. CMS actually gives us an opportunity to rank our hospices based on quality on a star rating scale. The consumer actually chooses a hospice based on overall quality. Many consumers in the AI world, they will, you know, use AI technology to choose their hospice. They choose us because we have the highest quality in the industry. As far as an average daily census standpoint, as you can see by this slide, we've continued to move up, and ending Q4 at 6,925. That's how many patients we have on service daily.
I'm pleased to report that we're over 7,000 in our core business as of today. Great opportunity. As far as our market growth and trends, this hospice sector in the healthcare world is a fast-growing one. As you can tell, $31 billion and growing 4.6% annually. The reason for that is 65 and older demographic is projected to nearly double. 10,000 people a day turn 65. That's outpacing births in the U.S. It's really a fantastic time to be in hospice. Routine care is actually over 90% of that revenue generated in the hospice industry. 98% of the entities have an annual revenue of greater than $50 million. Again, our margins are really solid as well in the industry.
This is just a great opportunity to outline our scale and our reach. Again, we're coast to coast as far as a hospice and palliative care division, so great opportunity. As far as why BrightSpring, why are we different than other organizations, and how are we well positioned in the U.S.? A lot of the sector in the hospice is either a standalone hospice with no continuum of care or they're small operators. Given the fact that we are a large organization, we really can provide economies of scale in working with our own pharmacy to also ensuring that we're putting best practices in place across the country. This differentiates us from other organizations. From a referral competition standpoint, we get to lead out there with quality. I lead the sales force.
Everything that we do in the communities that we serve starts and ends with quality. In a narrowed network, which is what most organizations are moving to, they want the highest and best quality at the lowest cost. Fortunately, for BrightSpring, that makes us an obvious choice. Then from a workforce shortage standpoint, that's something that the industry is certainly facing. You know, without RNs, without caregivers, CNAs, we cannot continue to grow our business. So at BrightSpring, we're really focused on workforce shortages. We're very competitive in terms of wages and benefits, but we're investing in our workforce in terms of skill sets. We're also, we just finished up our legacy awards, which Jon presented a couple of weeks ago, really recognizing top talent within the organization. All of those reasons are why people continue to choose BrightSpring.
Jon mentioned, you know, people really lining up to work with us. It really is our culture that drives the difference there. From an operational and administrative complexity, we have some of the best operators like Elizabeth in the country, really leading efficiencies. We are data-driven, so we have proprietary data that we utilize to enhance our overall offering and certainly drive quality results. As far as our hospice differentiators, we could really break that down into three categories. Strategic positioning, expanded palliative care model, and then health equity strategy. We've talked a lot about the strategic positioning. We're best in class from a quality perspective. In addition to that, we offer the lowest cost care out there. We're an obvious choice for payers, ACOs, and value-based care. Expanded palliative care reach.
We already talked about the conversion of our palliative care patients at 80%, ensuring that we're delivering the right care at the right time. This is an obvious opportunity for us to really expand our platform to help support more people who have advanced illness and are suffering from pain and symptom management. As far as the integrated care model, we've talked a lot about that today. Health equity is a strategy that we have at our hospice because 50% of people that are in need of hospice care get it today. That means we're focused on taking market share from our competitors, number one. Number two, we're focused on the 50% of the population that don't get the hospice care that they need.
Many times that is because of health equity challenges, whether it be cultural, whether it be socioeconomic. We've developed a proprietary strategy internally to really focus on that population and bringing education to the communities that we serve. Then just to talk about our performance metrics, to brag a little because this is really a fantastic slide. As far as we provide more visits than the national average by 30%. This is a really impressive number. Average discharge length of stay, again, we're focused on patients upstream, and so 99 days is over three and a half months of care, right? That's been a focus for us. We've been able to improve our margin year-over-year by 140 basis points. Also another impressive statistic in the hospice division.
This is one I'm incredibly proud of. We're bringing access to care to 22,800 patients. That's 19% year-over-year growth. We're slated again this year for double-digit growth in the hospice division. We've been able to do that through improvement in our referral conversion rate. Trending last year at 74.2%, we were able to improve that to 78.6%, really through education and training of our clinical teams. From a hospice building through clinical quality, I want to walk you through clinical quality because it truly is our number one differentiator, as I've talked about. The HVLDL is our hospice visits in the last days of life. This is a measurement that CMS has put out to measure our impact on patient care.
We're at 76.1% versus the national average of 48.3%. That is very impressive. 98% of BrightSpring hospices actually exceed the national average. That's almost 100% of our locations. The CAHPS survey, this is something from a consumer standpoint. We talk a lot about consumerism because people have a choice out there. The CAHPS survey actually goes out to patients, and it's their way to really evaluate how we did with their loved one. It goes out to patients at discharge, their families, and they basically grade us on the overall care that we provided. Also pleased to say 87% versus the 81% national average, so outpacing our competition.
From a continued improvement in our hospice care index, another CMS measurement, we're at 9.4 average scores versus 8.8 nationally. All these reasons set us apart as an obvious choice in the hospice industry. Skilled nursing visits. You know, we talked a lot about our workforce. It is imperative for us to have a strong workforce and strong retention so we can continue to build on our skilled nursing visits. We're currently at 8.1 versus the national average of 7.8. So some really nice statistics. Overall, this is just a review of our star ratings. Over 74% of our hospice agencies have a four-star or better. That's almost unheard of, right?
We really focus on timely help, enhanced communication back to our patients and families, and then certainly help around pain and symptoms. We do this through really a culture of eligibility, really teaching and training our teams on, you know, what eligibility looks like, specialized care that is patient-centered, and then certainly we have a protocol. From a growth lever standpoint, you know, we want to expand our reach and patient impact. That's our whole goal. We really do that through four strategies, organic growth strategy, de novo and CON strategy, integrated market, and strategic focus on growth. Just to talk a little bit about organic growth, we are focused organically and going deeper, as I mentioned, in the markets that we're already in.
Taking market share, we wanna drive to be one, two, or three in terms of overall market share in every market that we're in. As far as defined dementia strategy, dementia is one of the fastest-growing disease processes in the country. We have clinical pathways that we're focused on around dementia and cardiac. Expanding our liaisons. We use claims data today. We use proprietary data to basically ensure that we're in the right areas to drive access to care. Last, but certainly not least, ensuring that we are expanding our high targeted referral sources. From a de novo and CON strategy, just wanted to talk about de novos as an opportunity.
We were able to launch 5 de novos slated for this year, so really excited about what that brings to the bottom line from an EBITDA perspective as well. As far as the CON strategy, again, applying in five locations throughout four states this year, and Certificate of Need. We've talked a lot about the integrated market strategy. I think a key differentiator for us and then certainly a growth area. We've defined core KPIs across the continuum of care. We've actually selected multiple integrated markets to pilot, and so we'll be going deeper in each one of our integrated markets this year. From a strategic focus on growth, we've talked a lot about ACOs and value-based care. They truly are narrowing their network.
They're wanting to work with one, two, or three companies, right? They're not wanting to work with, you know, seven companies out there any longer. We are positioning ourselves to be the top choice for accountable care organizations and value-based entities. We've signed multiple preferred partnership agreements with ACOs this year, as well as going deeper with payers on unique opportunities. Then just in summary, this really sums it up. You know, coast-to-coast services, integrated care model, and then certainly our quality and operational excellence make us an obvious choice, and we want to continue to grow in this segment. Thank you so much for your time today, and we'll certainly be around later for questions. Thanks.
Thanks, Rhonda.
Terrific hospice business that's been built up over time. Thanks for all the strategic direction in that business today. Well, Kim More. You know, Kim and I go back about probably 12 years. Kim was probably our top operator at RehabCare back in the day, which was the biggest rehab company in the United States by sites of service and skilled nursing facilities and ALF. You know, Kim, has done a wonderful job with our very highly clinical neuro Rehab business, and now as we look to extend that into the senior space as well. Take it away, Kim. Thank you.
Thank you, Jon. Nice to have you all here with us. As Jon shared, my name is Kim More. I'm the Senior Vice President leading the rehab division at BrightSpring, and I've had the honor of being part of this organization for the past eight years now. I look forward today to sharing the integrated care platform that we've built and that we continue to scale across Rehab & Personal Care services. Let's dive in. All right. Every year in the U.S., millions of people survive brain injuries, they survive strokes, and neurological trauma. The challenge isn't just survival, it's in the recovery that follows.
Our highly trained and skilled clinicians are dedicated to this recovery, focusing on restoring critical functional abilities, including communication skills, basic physical independence, activities of daily living, mobility, cognitive skills recovery, executive functioning, and emotional regulation. Rehab's continuum of services span post-acute, transitional centers of excellence, Home and Community programs, day neuro and outpatient clinics, and now Rehab in Motion Senior Living Outpatient, which is embedded directly within the assisted and independent living communities. Beyond neuro rehab, we also provide complementary services that leverage that same clinical infrastructure and care coordination capabilities, including pediatric, ABA, which is applied behavior analysis, therapy for children with autism spectrum disorder. In 2026, the prevalence of autism today is one in 31 children.
We also provide state contracted foster care support programs focused on providing a safe home for children in need, counseling and wraparound services, supporting stability, life skills development, with the ultimate goal of family reunification and sometimes adoption. Again, another statistic to show you this is a chronic demand is 250,000 children enter the foster care market in the U.S. each year. That the thread that really ties all of this together is that coordinated multidisciplinary approach that is designed to help people recover function, to regain their independence, and reengage in their communities while delivering the care in the lower cost settings with the best in class outcomes. Now, next, to fully appreciate the opportunity that we have in rehabilitation, it's important to understand the structural problem that we have that we are solving today in the U.S.
The U.S. healthcare system was designed to treat episodes of care, a surgery, an acute illness, a hospital stay. Traditional rehab models assume a linear recovery, fixed lengths of stay, and volume driven reimbursement. Neurological recovery does not follow that pattern. Recovery from a brain injury is what we call nonlinear. Patients often progress, they plateau, and they improve again during that critical window of neuroplasticity. Patients with complex neurologic diagnoses are frequently underserved in home health and skilled nursing facilities because they were not designed for their needs. The results, as you've heard, hospice speak and home health as well, is fragmented care, inconsistent outcomes, unnecessary hospitalizations, and higher system-wide cost. BrightSpring's rehab model, on the other hand, was purpose-built for that nonlinear recovery. Our model is designed to follow patients across that full continuum.
Upon discharge from the acute care setting, our patients may transfer to our post-acute transitional living centers, to our Home and Community services, and through our day neuro and outpatient therapy services. What truly separates and differentiates us is our clinical specialization and longitudinal engagement. Our teams deliver neurospecialized therapy, cognitive rehab, behavioral integration, and community reintegration, including return to driving. We have a specialized return to driving program, return to school, return to work, and meaningful life recreational activities. This level of care requires specialized neuro clinicians, highly coordinated multidisciplinary teams, and regular engagements where the patients actually live. It also requires sustained investment in quality, in compliance, in clinical infrastructure, and IT advanced solutions that you heard Charlie and Viji mention earlier. Each year, approximately one in 60 Americans sustains a traumatic brain injury.
Over a lifetime, one in four U.S. adults will experience at least one TBI. One in four. That's incredible. Traumatic and acquired brain injuries affect individuals through pediatric, through geriatric populations. Examples include for our youth population, during sports injuries and trauma. For our working adults, from motor vehicle accidents, workplace accidents, falls, assault, violence, and extreme recreational sports. For our seniors, most often from falls. The U.S. neuro market alone is estimated at $6 billion, growing at around 7% annually. Payers and referral sources increasingly want scaled providers that can deliver predictable cost, standardized protocols, seamless care transitions, and consistent outcomes across markets that creates that clear advantage for national platforms like we have at BrightSpring. All right.
Next, I'd like to introduce our most exciting growth platform this year, Rehab in Motion, which is our Medicare Part B therapy model that is embedded directly within the assisted and independent living communities. This program serves our seniors where they live with dedicated on-site multidisciplinary team delivering physical, occupational, and speech therapy. The focus of our vitality program is on reducing frailty, preventing falls, improving their mobility, and maintaining independence, while also reducing that important hospitalization risk. A key differentiator is our proactive fall recovery training. We teach residents how to safely recover after a fall, building confidence, and reducing fear through our trauma-informed care model. Rehab in Motion is highly integrated with our home health partners, primary care, pharmacy, and care coordination services, creating that true continuum of care within our senior living environments.
Today, we operate in 20 communities across multiple states with expansion underway through de novo growth, through our partnerships, and through targeted acquisitions. As many of you already see and experience in our healthcare environment in the U.S., as it has completely and fundamentally shifted. That shift has created opportunity for us at BrightSpring. Aging in place is no longer optional. Acute care capacity constraints and cost pressures are pushing us to provide that care in lower cost settings. At the same time, value-based models are increasingly focused on functional outcomes, fewer hospitalizations, and predictable cost. BrightSpring combines that national scale, integrated care delivery, and deep clinical expertise to deliver rehab services across home and community, senior living environments, and align precisely with where the system is going today and into the future. Most providers have pieces to that solution.
BrightSpring operates the platform today. Let's next spend a moment on our geographic footprint and the structural advantages of our rehab model. One of the unique strengths of our platform is that it is not dependent on a fixed base of real estate. We deliver care directly in the home and community. Our model is inherently capital light and flexible, allowing us to scale efficiently as the demand grows. Another important advantage is our ability to enter new markets quickly. Since our model is built around clinical teams rather than brick and mortar, infrastructure expansion can happen much faster than in traditional rehabilitation settings. Brain injury and complex neuro referrals frequently cross state lines, and many of our referral partners operate on a national basis as well. Our national clinical infrastructure allows us to combine that local care delivery with enterprise-level support, quality oversight, and operational discipline.
When we talk about growth, we pursue it through three primary strategies. First, again, de novo expansion. We enter approximately eight new markets each year, focused on proven geographies and referral relationships. Second, payer contracting. Diversifying payer mix, strengthening reimbursement with our government and commercial and workers compensation contracts. And third, through disciplined strategic M&A, enhancing geographic density, scale efficiencies, and value-based alignment. Together, these levers support sustained capital efficient growth. Now our clinical outcomes, we are also proud, and I, you know, I've heard, you know, my peers as well, you know, speak to this, but this is absolutely the foundation of our rehab program. Our programs deliver measurable results, including an MPAI score of nine compared to a national average of five. This reflects a robust, clinically meaningful improvement for our brain injury patients.
More than 50% of our patients achieve eight or more hours of independence in the home environment, which is a critical milestone in brain injury recovery. Customer satisfaction also remains exceptionally strong. In the fourth quarter, in our fourth quarter results, we had 100% in our outpatient and 98% in our Home and Community services. These outcomes reflect the expertise, again, of our clinicians, our focus on quality and compliance, and the effectiveness of our integrated care market. When we step back, the opportunity should be really clear. Brain injuries and neurological conditions are cumulative, they are chronic, and they are increasingly prevalent as the population ages. Facility-based, episode-driven care models were not built to accommodate this reality.
BrightSpring's rehab platform meets patients where life actually happens, delivering that specialized care in post-acute settings designed to keep people out of the hospital and support long-term recovery. That's the model that we have built, that we are expanding, and we are proud to offer at BrightSpring, and why rehabilitation will remain a meaningful driver of growth, of impact, and value creation. All right. Next, I'm gonna shift on to our personal services platform. Recovery, here's a key point. Recovery doesn't end when therapy ends. That's where Personal Care becomes such an important part of BrightSpring's continuum of care. It allows us to extend that support beyond the clinical treatment and into daily living, helping individuals maintain independence, avoid unnecessary institutional care, and continue living in the environment they prefer most, their home.
From a healthcare perspective, this work is also extremely valuable because it helps delay the need for that higher cost institutional care such as skilled nursing facilities. Today, our Personal Care platform operates over 21 states, serving more than 16,000 individuals through over 160 locations nationwide. Supporting that care delivery is a workforce of more than 12,000 employees, including 10,000 caregivers working directly with families in their homes. In total, our teams deliver 13 million hours of care annually. This geographic footprint allows us to combine that scale with local opportunity expertise, which is critical in the service model that depends on those strong community relationships. Today, the business generates approximately $402 million in annual revenue, serving more than 16,000 individuals across the markets.
When you take a step back and you look, though, at that broader landscape, the U.S. Personal Care market alone is estimated at roughly $80 billion and continuing to grow. The underlying drivers of the growth are super clear. First, demographics. Nearly 90% of adults over the age of 65 say they want to remain in their homes as they age, and Personal Care services makes that possible. Second, economics. Home-based care is significantly more cost-effective than institutional alternatives, which makes it increasingly attractive solution for our payers and for our government programs. Third, our ability to expand through multiple channels, including VA programs, commercial payers, private pay services, and strategic de novo expansion. Importantly, this business also creates natural synergies with other BrightSpring services, including our Rehab Services, Home Health, Hospice, and Pharmacy, allowing us to support individuals across the full continuum of care.
Quality and compliance are also foundational to how we operate this business. Across Personal Care operations, our overall quality score currently stands at 87%, representing a 2.7% improvement since 2023. The scores reflect rigorous oversight of regulatory requirements, including supervision, care planning, documentation of service delivery, emergency preparedness, and infection control protocols. Our client record compliance score is 92%, demonstrating that strong adherence to state-specific regulatory documentation standards. Ultimately, our focus is simple here, delivering high-quality, evidence-based services that align with what patients and families value most, independence, safety, and dignity at home. What makes this platform particularly compelling is how all of these services work together across BrightSpring. Rehabilitation restores function. Personal Care helps individuals maintain that independence over time.
Together, they allow us to serve patients across a much longer period of their care journey while strengthening those referral relationships, improving those outcomes, and expanding market opportunity. Thank you for your time today and your partnership and the belief in the opportunity ahead.
Thanks, Kim.
Yeah.
I was wondering if you were gonna try to read that huge quote.
Oh, I know. No, definitely not.
Good job not reading it.
Definitely not.
Do you guys wanna come up here for a little Q&A?
Oh, yeah.
Hopefully, you guys are getting a sense of, you know, the broad-based quality of a lot of these businesses and the broad-based growth in the organization. Really some terrific Provider Service lines here that, you know, we're fortunate to have in the organization. Any questions on the Provider side? Joanna? Go ahead.
Good morning. Larry Solow, CJS . The first question, just from a high level, it seems like acquisition opportunities is more on this side of the business. So, as you look out five, 10 years, where do you see geographically? Do you see yourself expanding a lot, especially on the Home Health side, where you're only in the southeast? And then as a part of that, do you look for, you know, most of your properties are obviously very high provider scores, high quality service. When you look for acquisitions, do you only look for that, or will you also look for somewhat distressed assets where maybe service levels aren't as good, but it gives you an opportunity to expand geographically and also improve those service scores and financials?
Yeah. Thanks, Larry. Maybe I'll start, and you guys can add any thoughts. You know, clearly, I think, you know, we will continue to try to expand geographically in each one of our Hospice, Rehab, and Home Health businesses. You know, our focus in Home Health will largely be integration over the next year of those acquired assets. I think after that, we will continue to look at certain target markets. Hospice, we are very open to the right partnerships there. You know, hospice, like infusion, has seen extremely elevated multiples in those industries. Most of those businesses in both of those markets can trade at 15x or more. You know, we've been very patient there with more of an organic focus.
You know, wherever we've done, you know, a rehab tuck-in, it's worked out extremely well. I would say across the company, it's really balanced, you know, from a pharmacy and provider perspective. Chris was gonna talk about this in corporate development a little bit later, but our focus on M&A will remain balanced across Pharmacy and Provider. Hospice, Rehab, Home Health here, but then also Infusion and some very hopefully low multiple tuck-ins on the Home and Community Pharmacy side. You know, that's been our history. It's worked for us. It gives us a lot of optionality. We get a lot of selection, you know, preference by being able to look across those service lines, and I think that, you know, you'll see that posture continue into the future.
You know, on Home Health and Hospice, you know, there's probably ultimately 35 states in each, you know, that I can see us participating in, and we're roughly a little over 20, you know, sort of around in each today. You know, whether that's, you know, de novos or CONs organically or whether it's some tuck-ins, you know, that's where we'd like to build to ultimately. Any other thoughts from an acquisition standpoint?
I would just say we meet with business development on a regular basis and are looking at M&A opportunities. We have a team that is focused on a core strategy and making sure that, you know, these deals meet that strategy.
I would just say the last piece there too is, and it's, you know, these are just things that are meaningful every day for us that we see. There's a lot of operators out there in this incredibly fragmented, you know, set of markets that are looking for a long-term home.
Mm-hmm.
We are regularly approached about, from owners about, "I see BrightSpring. I see what you guys are doing, public company, public stock. I would love for that to be the long-term home for my people." A lot of the sellers that you come across, the good ones, really care about what happens to their organization and their people. Like, they don't wanna see their company dismantled, but change is inevitable. If there's going to be change, hopefully that change is focused on best practices within a company with a great culture. We routinely, and that's one of our drivers of M&A that we'll talk about, we see proprietary access to situations.
I can think of three right now that are going on, smaller deals, where the owners literally said, "We wanna go with you know, no offense," versus private equity or versus some other massive company. We win those, like, 80% of the time on preference. We look forward to being that long-term home, you know, within these ever-evolving industries. Joanna or
Hey. Thank you. Rhonda, a question for you on hospice, 'cause that business in the provider segment has been growing very nicely, and I guess prior to this recent acquisition, was the largest piece of that segment.
I wanna ask you about reimbursement, because that piece of that business, I guess, is driving some of the multiples as Jon talked about. Question here or two-part actually, the reimbursement is stable there, right? There's been more focus on fraud and abuse in certain markets specifically, but also at the federal level, more audits and things like that. Do you expect this to kind of, you know, put some pressure on reimbursement? Is there any indication that there could be some changes to reimbursement in hospice? And the second piece, on the Medicare Advantage carve-in, right? CMS kinda gave up on this idea, but do you guys expect this to eventually become reality, where you have to actually contract with Medicare Advantage payers in hospice? Thank you.
Sure. Great question. I would just say, to address your first question around fraud and abuse, you know, I think it's very well known that California and Texas are, you know, looked at as states that there's been a lot of fraud and abuse going on. Here at BrightSpring Health, we have, you know, a very detailed compliance process. We also work with an amazing accreditation organization actually, too. We work with CHAP in most of our hospice sites as well as ACHC. I feel like that really prepares us as an organization. We're doing the right thing. I'm not as concerned at BrightSpring . From an industry standpoint, I do think that will continue to be a focus. I actually sit on the board of CHAP.
You know, this is something we look at on an ongoing basis. I do feel like we're very well positioned, as an organization there. You know, your second piece of your question, you know, refresh my memory. I'm sorry.
Medicare Advantage.
Medicare Advantage. I do believe that at some point Medicare Advantage will become a reality. Right now, over 90% of the care that we provide is to fee-for-service Medicare patients. However, you know, we have had carve-in examples. They were not highly successful in the past, but M&A does seem to be still very focused on this as an opportunity. We meet with payers all the time, and they're very quick to ask us many questions about the business. I do think it is in our future, and we continue to prepare ourselves for that with some unique value-based agreements with payers today.
You know, hospice has such a strong value proposition, you know, from a quality and a cost reduction standpoint. You know, Rhonda is right. Those pilots or demos did not go well. You know, I don't think there's anything going on, and Daryn can speak to this in the GR section, you know, in this world of significance today, so not on a lot of people's radar screens. I would just say back on the fraud point, we have actually over 900 third-party accreditations in our company across all of our service lines. I mean, almost 1,000 different accreditations from third-party accrediting bodies, which are very difficult to get. They come in and audit you very deeply, and you only get that gold star if you meet all their criteria.
You know, we focus on that extensively. I would say, you know, we absolutely support the administration and what they would be doing around anything in this area, of course. I don't know the percentages. I would venture to guess that 99% plus of the providers out there in these industries are very well-intentioned, dedicated, committed, clinicians and individuals. You know, if there's fraud in any industry whatsoever, we should attack that and root that out. You know, hopefully, we can continue to collaborate with the government in this area to make sure that the right targeted solutions are implemented in the future. You would never wanna throw the baby out with the bath water because there are, you know, the vast preponderance of providers are very compliant.
We would look forward to, you know, dialoguing with the administration as they continue to try to go after any individuals who might be abusing the system.
Great.
Yeah.
Hey, Jon. It's Daryn.
Yeah.
Government relations. You know, the comments on MA, carve-in, there's nothing imminent on the horizon there. Certainly, industry's been very vocal about that, but we'll, you know, we'll watch it closely, and if it is inevitable, we'll certainly be ready for it. From a rate perspective on the hospice side, it's been very incredibly consistent because the statutory structures of those rates force it to be incredibly consistent. Yeah, we feel very good about where that sits.
Thanks, Daryn.
Question for Elizabeth. When we think about these Amedisys or former UnitedHealth Group assets that you've taken on from our previous coverage of that company, these are from our understanding that you've picked up some of the best assets within that portfolio. As we think about areas for potential improvement, whether that's margins, clinical outcomes, where do you see that? I guess the second part of my question is: What are you seeing in terms of the competitive environment as UnitedHealth Group is seemingly, like, losing focus on home health? Elara Caring just went to DaVita, so they're probably gonna take on some of that capacity in-house. Just curious what you're seeing on that front. Thanks.
Yes. I see significant opportunity in the home health space. Like you said, I have had a long history at Amedisys and definitely knew how that company operated. They are strong branches. They have a metrics-driven mindset, a culture-driven mindset. I have been out visiting those branches, they're excited to be here. I think because of the acquisition and that was taking place, and they had kind of been on hold for a little while, and now we are there with specific growth action plans. These teams are excited to grow. I definitely think we have opportunity with this acquisition. Same for LHC. LHC has had, we competed with them over and over, who's gonna knock each other off the top spot for quality.
Great quality mindsets. We brought that team here right after the acquisition and really had introduced and welcomed them to our company, showed them what our culture was, and all we hear is that they're excited to be here and ready to grow. We think there's definitely upside.
Yeah. The margin we acquired, you know, was a little bit lower than our margin. Over time, we would expect that to even out. I think that's an opportunity. Also from a growth perspective, it can be challenging when people, you know, are in a situation where there's a pending acquisition for a year or two. We're excited, as Elizabeth has said, to really drive a patient reach and growth focus in that business. I think as you look at the bigger industry, you know, Brian, I think what I said before is I just think we have a real opportunity there with, you know, some of the biggest independents having been acquired over the years. You know, Enhabit has now been taken private.
That was a little bit of a challenging situation with Encompass over the years. We see a really attractive runway. You know, as I think I mentioned before, there's probably only two companies who've been around for 40 or 50 years in the hospice space where, you know, that's out of reach. Other than that, you know, we absolutely want to be known not only as the biggest, but the best.
Absolutely.
Operator in home health and in hospice, in rehab, in the industry. I think we have every opportunity to do that. You know, we are well on the way down, you know, down that path. I think those dynamics in the market have probably created more opportunities. You know, we've been trying to work with MA and payer partners over the past year or two to partner with them, you know, just around outcomes and what is a fair rate given better outcomes. We've had some success there and, you know, we would look forward to continue to do that.
You know, I remember several years ago, one of the CEOs of one of the biggest payers in the United States said that, "You know, we've looked at everything over the years, and it is our opinion that home health impacts outcomes in a positive way more than anything else." We just wanna continue to try to scale that business when there's something like 40% of the people today written for home health who do not get it, which we just cringe when we hear that. You know, hopefully you'll get rate stability. I think CMS showed some real understanding in the final rule back at the end of last year.
We're optimistic that, you know, that the support will be there given the outcomes, and we wanna continue to scale in that market. A.J.
A.J. Rice from UBS. You commented on Personal Care services and what the market growth was. I wonder on Home Health and Hospice, I may have missed it, but I didn't see where you said, we think the market's growing this. We think we can pick up through geographic expansion or through de novos, additional growth. Do you have any way to size the metrics on growth around Hospice and Home Health? Then I might pivot over and ask about the primary care initiative. Is that MDs? Is that nurse practitioners? Are they your employees? Are you contracting with people? How are you structuring what you're doing there?
From a market standpoint, we see Home Health and Hospice as about 5%-7% market growth. You know, obviously, you get some of the demographics at play there. Hospice also, I think there's still only about 50% of the individuals eligible for hospice actually receive it. There is on top of the underlying population demographics growth, you know, if more people start utilizing hospice as they should, you know, that's what makes hospice a little bit of a higher growth rate than home health. We wanna grow in that industry double-digit. Our internal grow goals every year, you know, are gonna be around 12%-15%. You know, obviously, we have to be taking share, and we wanna do that through our volume, continuing to enter new markets and invest in sales.
On Primary Care, about 80% of those clinicians are NPs. You know, there is not an unlimited supply of PCPs and doctors who want to be making house calls, you know, versus perform neurosurgery. You have to augment that with very skilled NPs who can very capably be the primary care provider. For nurse practitioners, they love it. You know, the pay is very good, and you are your own clinician, you're the doctor. That's empowering. We see that NPs are very excited to have their own panel of patients, you know, in these various buildings and across homes. We've been investing a lot in those individuals with training and making sure they feel appropriately compensated. It's a great job.
You know, I go to that assisted living facility today and spend all day there treating their patients. I go home at five o'clock. We've got centralized on-call. It's a great job where they can make an incredible impact, so.
They're your employee?
Oh, absolutely.
Yeah.
All FTEs across our whole company, we're FTEs 1099. W-2.
All right.
I'm sorry.
Yeah. Raj Kumar from Stephens. Maybe just kind of focusing on Home Health and the preferred Provider arrangements. Maybe what's kind of driven initial success there? What's kind of the ongoing conversations around payers in terms of what they're looking for? Is it just capacity, high acuity focus? Maybe any specific targets as we go through the year, and maybe just any color on the economics of those arrangements relative to fee for service.
Elizabeth? Probably keep the economics out of it.
Okay. Yeah. We have had a lot of focus on that, but quality drives everything. That's what they're looking for. Reduced hospitalizations, keeping those patients out of the hospitals, that's where payers really have an advantage. We're getting phone calls now wanting to partner with us in post-acute networks and managed care organizations wanting to create some really, I guess, value-based care arrangements. I'm gonna stick with quality. Quality is what makes that phone ring...
Mm-hmm.
...for people to wanna partner with us.
Yeah. It's. Look, they have access to all the data. You know, across all their members, across all home health providers, what we hear is, you know, "We do better, so we wanna do more with you," right? You know, look, you know, there's some payers out there, you know, in the past, more so, but still even today, that, you know, aren't willing to pay a break-even rate, which is ridiculous, when this service is so incredibly valuable for their members. That has really improved over the years. You've seen a supply-demand imbalance in favor of the providers. What we've seen in the last three years is, you know, progress with rates.
Where we like to have preferred partnerships, "Send us more of your patients, and we will try to prioritize them," you know, there has to be a fair reimbursement rate for that. In these arrangements, we've generally moved in that direction to a level where we're willing to engage.
That's right.
One more.
Yeah. Jared Haase from William Blair. Thanks for taking all the questions. I guess maybe just a couple of quick ones on the Primary Care business. I'm curious from a go-to-market perspective, are you primarily leaning into the existing relationships that you have on the Pharmacy side in the Home and Community space with SNFs and assisted living facilities? I guess, you know, as we think about your growth initiatives on pharmacy, are you sort of leaning into almost a joint go-to-marketing, where it's, "Hey, we can manage both pharmacy and medical for this particular community." I guess a third point around this, just, if you are thinking about this as sort of a joint go-to-market, how penetrated is the Primary Care business relative to your existing book on the Pharmacy side?
Yeah. Where we are today is gonna lean more towards your second comment, which is, as we move forward, we see a lot more opportunity to work together in these buildings and in these communities as one organization, cross-selling, as you will, but really presenting yourself as one organization. I would say historically, we certainly have examples of where we are in settings and locations, because of a handoff, warm handoff referral from Pharmacy or even Home Health already being in the building. You know, that's not the majority of how we've entered into our home-based primary care buildings today. I think as we go forward, you know, to use just, you know, a generalization, 50/50.
You know, that just like all of our businesses, that primary care team will be responsible for their own growth, because you can't, in our view, be solely dependent on another service line and relationship for your growth. You have to own your own growth as well. The other 50%, we should be growing through relationships and partnerships that we have in these buildings in Pharmacy and Home Health and Rehab and Hospice, and that is a much bigger opportunity. To your third point, I think we're 5% down the road on that. You know, that strategic growth area, including this cross-sell integrated care, we're hesitant to talk about it too much and distract from core growth, but that really could be a very large opportunity for the company over the next five to 10 years.
It makes all the sense in the world, obviously. Well, thank you guys for your attention as we've gone through our provider business here for the last hour and a half or so. I think we're gonna take a break for lunch. It's about 12:10 P.M. We'd like to be back by 12:30 P.M.? 12:35 P.M.? 12:30 P.M.? So, if we could shoot for about 20 minutes, that would be terrific. Then we'll touch on government relations, M&A, finance with Jen, and we'll wrap up by 2:00 P.M.. So, thank you. Welcome back. You guys are doing a great job of adhering to the time schedule. So, thank you. Welcome back.
You know, I really do hope this is being an informative and enjoyable day for you guys here in Louisville, where our headquarters is. Thank you again for joining us. I wanted to also say they're not even in the room really, but Natalie and Lisa and Lee and a whole lot of people who helped put this event on today really wanted to thank them for everything they did. Really, these little bats here, Louisville Sluggers. Sometimes when we close an acquisition, you know, Louisville is home to Louisville Slugger, we'll do baseball bats as kind of the deal toy. In my office, you know, you would see like 15 really cool bats, different colors every time with the name of the deal on it.
You're not probably able to travel or you don't wanna travel with a full-size bat, so we just got you some little ones. It just says, BrightSpring Investor Day. These are safe to stick in your bag. They won't stop you. If you wanna grab one, there's a basket of them below the stairs before you leave. With that, we will wrap up the day over the next hour and 20 minutes, get you out of here on time. Daryn's gonna talk about government relations efforts, and then Chris Consalus will be here in corporate development, and then Jen on some of the numbers. Daryn, take it away.
Thank you, Jon. Good afternoon. The political guy loves the podium and loves the pomp and circumstance of a podium. Feel like I gotta get my hand gestures in. I did wanna take a moment to announce my candidacy for governor in Kentucky today, but just can't help that political side of me. It is an absolute honor to lead our government relations function here at BrightSpring Health Services. I've been in the leadership role for a decade, essentially, you know, as soon as Jon had come on with us, and I just really, I've been asked to, you know, kinda get straight to our issues pretty quickly today.
I did wanna say, you know, a couple things up front that are just really words that are, if you have any takeaways from what I say, because I know you all have a lot of familiarity with the issues I'm gonna talk about. Two words are outcomes and visibility. Outcomes. Proud to hear all of our operators today and when Jon and Jen do their earnings calls, investor meetings, the outcomes that we drive as a company are just incredibly impactful on our efficacy as advocates. It is just a really great thing, and it's also incredibly important to just our credibility as advocates as well. We use all the numbers you're hearing about, you know, for our specific divisions all the time. Just a super important thing. Super important for the company as well.
Then on visibility, I'd like to speak about that in two ways. One is, you know, visibility, you know, within my team, and the, you know, visibility for the company and relationships, for what we do, visibility on issues and visibility that's changing as we continue to grow as a company. A lot of regulators and lawmakers are coming to us proactively, you know, through preexisting relationships, through knowledge of the company, opposed to us, you know, going to them and introducing ourselves, who the company is, what we do. That's just a, you know, a great piece of our growth. You know, here on this opening slide, I would just note that we have a very, you know, experienced, you know, very consultant-heavy, you know, team on the GR team. That's very purposeful.
We're heavy with consultants, so we can be flexible. If we need new issue experts, if we need, you know, to move resources in a different state where we're not that strong and might need a lobbyist, we can do that, you know, very, very quickly. You know, on the resource side, I've one of the great things about partnering with Jon over the last decade is he's never said no to me on anything government relations related when I've asked for additional resource. I say no to him sometimes, but he never says no to me for just kind of, you know, approach and just, you know, to spend that we have available to us. We just are always, you know, well-heeled for what we need to do and to do it effectively. Our focus is really, you know, we're an education and advocacy function.
You know, we're out there talking about all those great outcomes that I mentioned before. Really, you know, everything from rate, workforce issues, structures of our programs, you know, we're just using all the facts and everything we have to educate and drive good outcomes for our programs. With that, I'm not gonna talk to you. You all know the environment is difficult. You know, there's stuff on the other side about you know, just team approach. I'll skip that in the. As it relates to just the environment, it is a complicated environment. As we look at the federal agenda for the balance of the year, there are not many legislative vehicles left that we'll be able to, you know, move our items in.
The upside of that is there's not many legislative vehicles left to move things that we're not excited about. We'll be working really, really hard for what is most likely trying to get two or three bills into a year-end package in D.C. We fully expect the Trump administration to continue to be very aggressive with their executive orders and rulemaking. We continue to have just good visibility on all of that. I would say everything we worked on in 2025, the first year of the Trump administration, there were some things that required heavy lifts. Those heavy lifts afforded us good access to leaders in the Trump administration, so we know who they are, they know who we are.
As we go into 2026 and beyond, you know, those relationships will be there. Jumping into just the key issues of the day for us, I'm gonna hit on seven different issues. Left side of this slide, you know, references stuff that happened in 2025. The other side is, you know, what we're gonna be focused on in 2026. I'm gonna commingle the two issue by issue. First is the Inflation Reduction Act. You know, going into, you know, the first 10 drugs going live on January first, you know, we did work very hard on parallel tracks with CMS and The Hill, introduced legislation in both the House and Senate, excellent momentum for our House legislation.
The other side of the track was working the White House and CMS, and we did have great success there with two different memos that went out to Part B plans and payers specific to our long-term care pharmacies that had the most impact from IRA. Those directives to you know say to be fair with pharmacies on IRA were very effective in mitigating you know the ultimate impacts. As we move into 2026 with IRA, our focus is gonna be you know very much on taking it another step further. We think there's more that CMS will do as they see the impacts that are happening in the field, particularly with some of the smaller pharmacies in the space.
We'll be moving, you know, to continue to gain co-sponsors for our House and Senate bills, in hopes that we're well positioned to pass it year end, if we need it, absent additional CMS action. Drug pricing, whether it's most favored nations, tariffs, you know, implementation of the IRA, certainly, you know, a million things out in the ether last year. Our singular focus in all of those things was to make sure, you know, one, are there impacts? Two, is anybody thinking about the impacts on pharmacies? I think we did that very effectively in 2025, and I know, you know, early on in 2026, we're doing that effectively again, will continue to be our focus on all things drug pricing this year. Next, PBM reform.
We were very, very excited to finally see PBM reform pass the federal level earlier this year. You know, it took a very, very long time, and our Specialty Pharmacy Association was particularly effective with our partners and their efforts to make sure that our most important element that was passed in there, you know, contract changes that, you know, finally give CMS some teeth in working with pharmacies and PBMs on contracting disputes. Over the next two years, CMS will be working to establish reasonable and relevant contracting terms. Then CMS will have some. Once that goes live in 2028, you know, CMS is gonna have the authorities to implement some civil penalties when those aren't followed.
On the home infusion side, and just going into this year with PBM reform, certainly our focus is gonna be working with CMS to make sure our voice is heard and, you know, the right things are implemented in that process. On the home infusion side, you know, going back to the Cures Act of 2016, there has been a real deficiency in the, you know, fee-for-service payments in infusion. We've got legislation focused on Part B that had a hearing a few weeks ago. It has a great group of co-sponsors, and we are very optimistic that this is the year that we get that fixed after many years of lawsuits and legislation or otherwise. This year, you know, our folks get it. It's a no-brainer. Needs to get done. Very optimistic that'll get done.
Home health rate, you've heard about that already from Jon today. We never celebrate a cut, but to go from where the administration started the proposed rule to an 80% mitigation in the final rule, you know, we felt exceptional about, as an industry and felt very optimistic about the stuff that's in the final rule, going into rulemaking for calendar year 2026 or 2027. We're excited about that and, you know, meeting with CMS, working The Hill, and just really pleased that we have good, strong champions, and really expect, you know, before too long to have more predictability and stability in that rate going forward. Medicaid, you know, people have asked a lot about just kind of what does the One Big Beautiful Bill Act, you know, mean to states.
In 2025, you know, we were net positive on the Medicaid side. We have just an incredible historic run of being net positive on the rate side in Medicaid. We certainly expect that to be the same in 2026. We're hearing a lot of conversation at the state level, you know, about the One Big Beautiful Bill Act. We're talking to them a lot about it. You know, post the behavioral transaction, obviously our Medicaid footprint will be smaller, but we will not be, you know, any less visible in states on that. The one thing that, you know, there were many positives in the One Big Beautiful Bill Act, including positives in Medicaid.
What they did in Medicaid is they just really signaled to states in the legislation that the populations that we serve, the must-serve populations in Medicaid, you know, must be protected as states implement elements of that bill. We've seen that so far, and we expect to have, you know, just a solid net positive rate in Medicaid this year.
Last, you know, my team supports all things in growth, certainly the transaction, home health transaction closed last year, you know, working in partnership with Chris and his team on, you know, the behavioral track transaction getting closed, tuck-in CONs, anything organic. You know, we're constantly in communication, providing intel, opening doors as needed, and just have a really great partnership with both operations and the M&A team on that front. Jon, that's it for me, and I'll be up a little bit later for the Q&A. Thank you.
I think as Daryn said, you know, one of the things that we take very seriously is just given our scale and our scope and given our quality, you know, we are routinely asked by individuals, offices on The Hill and you know at CMS and HHS for our views on things, just given what we're out there seeing every day and our relevance. You know, we're always honored and glad to be a part of conversations as they're occurring, to be able to provide our input and try to always be making decisions that make the most sense writ large for you know for society. With that, Jen and Chris are going to join, and Jen, I think we're starting with you.
Yes. I'm gonna be up here together.
We'll get into corporate development and then you'll go again. Everybody knows Jen Phipps, she's our Chief Financial Officer. What has it been? Over a year? I think over a year. Yeah, yeah. You're over a year. Jen has been here for almost my entire time, almost a decade, in a lot of different positions in the company, including Chief Accounting Officer, before being the CFO. Jen has just done an incredible job in this seat over the last year, but she had already been doing a ton in this capacity for years and years before that. Chris and I had worked together at Kindred. Chris has been here probably seven or eight years as well. Chris was one of the corporate development leaders at Kindred.
He's our corporate development leader here, SVP, at the company. Critical role as we have obviously done a lot of M&A. A ton of it's been small, accretive tuck-in, but have even more opportunities going forward. Chris, appreciate you walking us through that as well. Go ahead, Jen.
Thanks, Jon. As Jon mentioned earlier today, we are just very proud of what we've done from a leverage in our balance sheet position with the company. Post IPO, we were at about 4.5 x levered, and at the end of 12/31/2025, we were at 2.99 times. When you pro forma the balance sheet for the community living transaction, which we expect to close by the end of the quarter, we would be at 2.6 x. Before any uses of capital, we expect to be under 2 x for 2026. If you just think about the EBITDA growth and the cash flow generation that we would have. We continue to increase our EBITDA conversion to cash, and we've done that each of the last several years.
We expect to be at greater than 60% conversion to operating cash flow in the coming years. Our CapEx requirements, as a reminder, are very light. We are typically well under 1% of revenue from a CapEx standpoint. Ultimately, that position has allowed us to make significant investments in technologies and systems, de novos, automation equipment in our pharmacies, and has allowed us to obviously still generate really positive free cash flow. Our balance sheet and free cash flow generation or leverage position provides us with what we expect to be significant, and we'll talk a little bit more about it later, flexibility to fund additional deals through M&A. I'm gonna turn it over to Chris to spend a little more time talking about our M&A capabilities and our focus for 2026 and beyond.
Thanks, Jen. Thanks, everyone, for joining us today. One slide here to go through, and then my part will be done. I know a lot of this has already been discussed during today, so hopefully I won't be too repetitive, but did wanna drive a few things home. Since the beginning of 2018, when I arrived here at BrightSpring to partner with Jon and Jen and the rest of the team, we've completed approximately 79 acquisitions. 76 of those 79 are in a better place from an EBITDA perspective than when we acquired, looking through the last twelve months ended January of 2026. Over that time, our approximate multiple we paid on a TTM versus pro forma basis now is approximately 50% decline, which we're very, very proud of, as an organization, the M&A team, everybody involved.
Obviously, we'd love it to be 79 out of 79, but 76 out of 79 has been a pretty good record. The median purchase price, approximately $5 million, lots of tuck-in M&A. We have done some bigger deals throughout the years. I think there's probably 5 or 6 that we've done, north of $100 million. If you adjusted that for the average, the average price is probably closer to 20 than the 5, but median being what we look at. The deals range anywhere from $300,000 of spend that we've done to almost three-quarters of a billion dollars. We really run a full gamut there, of acquisitions. When we start thinking about, like, why are we successful, there's a variety of factors.
Mainly it's largely the teamwork here and the buy-in from the collective organization, whether it's the executive committee, whether it's corporate development, whether it's our operations leaders. There's people that really have an M&A growth-focused mindset, where we're able to go and find proactive deals or get involved with various bankers and brokers in terms of sell-side processes that are out there. That's probably square one of how we've been able to do so many accretive acquisitions over the years. The other, probably number two on my list, is disciplined investing. We're not just out there buying EBITDA. We're making sure it makes sense, and we're getting sign-off from not just Jon and Jen and Chris and the rest of my team over there between Doug, Nick, and Thomas. We're getting sign-off from the operations team.
We're getting sign-off from the person in charge of payroll and HR. I mean, it really takes a village to do an M&A deal here. We have, you know, between the 10-20 people you've talked to today, there's another 50 behind the scenes that are helping make all these acquisitions work. It's really an incredible team effort to get to that point. I know it's come up a couple times today, but we also have been successful in some deals in the past using more variable structures in terms of how we would finance or buy a business, whether that's offering equity, seller notes, a portion up front.
We did an acquisition in Q4 of 2024 down in Florida in the hospice space, where we got very creative in terms of the capital that we were willing to put together for a nonprofit system because of how their foundation worked. It was incredibly attractive to them, and they got a sizable chunk of BrightSpring stock, and that's worked out very well for them and was obviously a great transaction that we did. I would be remiss without mentioning our integration management office. They're kind of the quarterbacks behind everything once we get to a signed letter of intent to closing a deal and then integrating the transaction, running the show.
We meet weekly with them, with our 40 or so functional leaders, and make sure that everything that we're doing is being done the right way and any issues that come up are being addressed in the correct fashion. Then last but not least, we obviously leverage our economies of scale. When we started doing this back in 2018, we were largely a Medicaid company that now has one of the largest home health and hospice businesses in the country. As we've added those assets, each individual acquisition thereafter has gotten a lot easier to integrate and source. Generally, when we're looking at transactions, we're looking to do 10 to 15 deals a year. You could do the math. It's about 10 per year that we've averaged.
Ideally, with where we are now, the team that we have, the investment that BrightSpring has made in corporate development, we would love to be at 15 transactions a year. We think we have the team to get that done. Another thing that's come up, we're very balanced between pharmacy and provider. Historically, you're gonna be looking at, depending on the year, somewhere 60/40 split between transactions allocated to provider versus our Pharmacy business. It's one of the unique positioning factors for us as a company to be able to do transaction in both spaces, which also leads us to the sheer number of acquisitions we've been able to be closing over the last eight years.
Largely focusing on everything that we're investing in today, whether it's the Provider side or the Pharmacy side, Home Health, Hospice Pharmacy, Rehab, Home Infusion, tuck-in, lower multiple transactions in the LTC space, in the IDD, ALF and SNF space as well. And then also looking at select opportunities. We've done a couple of these acquisitions over the last 12 months in both the technology and home-based primary care space. Lastly, and I know Jen's mentioned this, and it's been mentioned throughout the day, but one of the other things that makes my job a lot easier than it otherwise could be is just the general performance of the company and our capital structure, IPO, deleveraging. The sheer amount of operating cash flow we threw off last year helps us fund deals.
It's a lot easier than having to go out and finance every transaction if we were in private equity. And then also generally just the low CapEx. I know Jon mentioned our time together at Kindred. That was a much more heavier facility-based CapEx industry. We don't have that here. 1% of revenue, very low, allows us to generate more free cash flow, and be successful. You know, thinking about the past, the future, I think we're set up very, very well to take what we've done and grow on that in the next couple of years, and I know we'll get into that a little bit more in terms of the capital that we have to deploy. Appreciate everyone for listening to my TED Talk.
Thanks, Chris. Well, you can go sit down, and then we'll bring you back up for questions. Perfect. We're gonna go ahead and just go through some of the financials, and I'll move through some of these slides a little bit quickly because you know most of our historical numbers. Just as a reminder, we have a really strong track record of historical growth in revenue and EBITDA. If you look at our revenue CAGR from 2022 - 2025, that is really a 26.6% compounded annual growth rate, and it's over 18% on Adjusted EBITDA. That has largely been organic over this time period, although it did have some M&A in there. Pharmacy's Adjusted EBITDA CAGR was about 17%, and providers is about 15%.
Really good, strong, balanced growth across both of our segments, as we've mentioned, you know, in many cases. Our total company CAGR being larger than that has been because we've been able to leverage our scale and really get an opportunity to drive down our corporate costs as a percentage of our total enterprise. We've done all of that. We've talked a lot about this in calls and other Q&A that we've done historically, but we've gotten a chance to really make investments, and that is something that we continue to do every single year. We've talked about a lot of the IT investments, the people investments. You've heard a lot about new members of teams that exist today that didn't exist sometimes earlier in this time period.
We are very focused on making sure we're balancing our growth for today with long-term growth as well. We've been able to continue to do that and still achieve these numbers. If in 2025 we saw a margin expansion, you know, in 2022, 2023, 2024, you did see some compression of margin as our specialty Pharmacy business was growing at an outsized pace to the rest of the growth in other of our businesses. With that growth, obviously, we've talked about from a mix standpoint, there was a compression in margin. We expect the continuation of margin expansion.
You saw that in our guide, which we'll talk about in a minute, for 2026, and we expect that to continue to grow as the underlying factors in all of our businesses. We expect margin expansion in those businesses. Just a few stats to note about our revenue and EBITDA growth. Jon mentioned a couple earlier today, but for the Russell 3000 companies greater than $5 billion of revenue, we were second in three-year revenue growth. If you were to compare our growth, obviously to the Russell 3000, we were second. For public companies over $10 billion in revenue, that were profitable, we were in the top 6% in three-year EBITDA growth. Really strong performance across you know various different companies in different industries.
We're really proud of the work that the teams have done. I'm not gonna spend much time on the KPI slide. You have all this information. We wanted to provide it to you again, just for ease of reference. Ultimately, we continue to grow volume above market. We're focused on that in each of our different service lines, and we're focused on doing that underpinned by our high-quality services. Maybe I'll just move on to the next. On February 27th, we initiated our 2026 guidance. This guidance, just as a reminder, excludes the community living business, and it excludes any acquisitions that have not yet closed.
Revenue is expected in the range of $14.45 billion-$15.0 billion, including Pharmacy Solutions revenue of $12.6 billion-$13.1 billion, and Provider Services revenue of $1.85 billion-$1.9 billion, reflecting growth of 11.9%-16.2% over full year 2025. Total Adjusted EBITDA is expected in the range of $760 million-$790 million for full year 2026, which reflects a 23.1%-27.9% growth over full year 2025. This guidance does include $30 million expected contribution from the Amedisys and LHC branches, as we had mentioned, you know, in our call. Maybe onto the slide that most people probably care about.
As mentioned, we have a historical track record of 18% CAGR over the last several years. We talked about from 2022, but you could actually do it from 2018, you could do it from 2020. It's a very similar number. That does include M&A. We have seen acceleration of that growth in the last three years, which you can see reflected from 2023 - 2025. Just another stat, if helpful. For public companies in healthcare over $5 billion, we rank fourth in three-year EBITDA growth. As we've had the opportunity to discuss in each of the business units, the underlying drivers of the growth that we have seen remains intact and underpins our view of 2026 through 2028. Today, we're hoping to provide a framework for growth over the next three years.
As we look forward, you know, we have provided, as we just talked about, a guidance range of 23%-28% EBITDA growth for 2026. As we look beyond 2026, off of the high point for 2026, we see the opportunity for 15%-20% organic CAGR from the end of 2026 - 2028. That represents, as Jon mentioned earlier, a 70%-85% growth from 2025. Please note, the spots on the graph are not actually intended to depict actual point estimates, but rather a framework for the CAGR and a visualization there. I had been informed that people might use protractors to, like, measure. So that is just representative of what. Not necessarily intended to depict a point estimate.
This does not include, to be clear, this is organic and does not include additional growth from capital deployment. As you know, as we discussed earlier, Chris talked a little bit about it as well, we have a really strong cash flow generation and balance sheet position. As you know, we think about the opportunities to deploy capital, we really think of this as at least $2 billion worth of additional incremental capital availability through 2028 to provide opportunities for growth in M&A. While you know, again, we're not putting that, you know, that's not a guidance number, but that's just really as we're thinking about the deals, we are gonna get the opportunity to be very strategic about the acquisitions that we do.
Our balance sheet position gives us a place of power as we think about the deals that we think are very important and can provide value to BrightSpring. With that, I will turn it over to Jon to wrap it up, and then ultimately we'll move into Q&A.
Thanks, Jen. What I had alluded to earlier, you know, as you look at Jen's numbers that she just went through, I had alluded to point-to-point aggregate growth numbers that we believe are achievable as you go from the end of 2025 to the end of 2028, that three-year period. You know, at the 15% scenario for 2027, 2028, that CAGR, at the low end of the base rate, you know, that produced about a 70% three-year aggregate total growth. At the 20% end of that range for 2027 and 2028 CAGRs from the end of 2025, that produces about 80% total growth over the three-year period. Hopefully, that's helpful.
You know, on M&A, you know, that's about half of the phalanx on the M&A on the wall over there in terms of our team. We've got about, you know, eight people or so on that M&A team today. It is a really highly capable group of M&A professionals that we've invested in and have at the company. I think one of the things we really try to do well is to really spread that M&A around in terms of the type of deals we're doing to create as much value as we can and to balance things out in terms of, you know, certain deals that look like this for size and multiple, and then other deals that look like this.
You know, things have really balanced out in a very healthy way over the last seven or eight years. I get fairly involved in those deals. Maybe it's like 7.25 FTEs we have on the team. I think with, as Chris said, the ability to find proprietary deal flow, being a preferred next destination partner home for the sellers, has worked in our advantage. I think as we go forward, you know, having capital available in the form of public stock is only something that's been helpful for us too. You know, Jen mentioned $2 billion of capital available for M&A. That would even be without using stock.
You know, that number's probably in the 2x-3x range, while still staying within the 2x to 2x-3x leverage range of theoretical capital deployment potential that we see to the end of 2028. That by no means indicates that we would go do that amount of M&A, but as you just run the very simple math on our base case, that is what the math produces in terms of that several billion dollars or plus of capital availability outside of stock currency. As we get into the last slide here in Q&A, you know, I did just wanna reiterate some of these historical numbers one more time. Jen just touched on them.
You know, you're sitting in the room of a company that has had seven, five, and three-year revenue CAGRs of 22%, 25%, and 27%. Adjusted EBITDA CAGRs over seven, five, and three years of 18%, 18%, and 19%. If you look at that three-year CAGR actually moved forward a year, including 2026, so 2024, 2025, and 2026, that three-year EBITDA CAGR, if we hit our guidance this year, would go up to 26%. Again, as you look at all of the Russell 3000 over $5 billion, that revenue CAGR over the last three years puts us second to Eli Lilly. As you look at all of the Russell 3000 for companies over $10 billion, within healthcare, we are again second to Eli Lilly.
From an EBITDA perspective, for all public companies in healthcare over $5 billion of revenue, we're fourth in EBITDA CAGR. For all public companies in healthcare above $10 billion, we're second in three-year EBITDA growth, again to Lilly. Really just wanna thank the team at this organization for what they've been able to do, you know, over the better part of a decade now driving these results. You know, hopefully, this has all been constructive, a good use of time today. We've obviously focused on some of the bigger themes, as we encapsulate the organization. Again, large growing markets that still clearly have unmet needs. Within those markets, we're providing high ROI services to very complex populations who benefit greatly from those services.
Everything's based on our outcomes and our capabilities, which has been driving market share gains on top of the healthy growth rates in those markets. We believe that our scaled platform, our one company platform, has many advantages and has been one of the reasons why we've been successful. From a financial perspective, we've been proud of what we've been able to achieve in our growth profile, particularly comparatively. Hopefully, we continue to build on a very experienced and proven management leadership team in this space. You know, what you've seen here today is just incredible. Tip of the iceberg. You know, we're going through bonus time in our company.
Every year, we literally go through every single person's name in the bonus file, bonus eligible employees, and make a final determination on their outcome for the year, as we do with the annual equity grant file. In the bonus file, there's some 1,800 people that we literally go through every single name every year, making sure that bonus makes sense. You know, the last couple of years have obviously been, that's been a fun exercise. The question has been, how can we do more for our best people? But when you go through that exercise, it is incredibly humbling to just see the amount of people in the list of names that we have in this organization that are just stars.
You know, just even in the last six months, I can think of 20 people that we hired that would be worthy to be up here today speaking in front of you guys. We will just continue to add to that depth in the organization. We are investing as much as we can this year to try to continue to position the company as best we can in the future. You know, I'll wrap it up. You know, you know, I am gonna read sort of that prior slide from this morning.
You know, if I was talking to my neighbor, you know, or one of our equity analysts, friends and colleagues, or somebody at KKR or one of you as an investor or any employee, you know, this is just in layman's terms, how I would describe our company, and this is on, you know, slide 18 or something like that. Why BrightSpring is different. BrightSpring focuses on Home and Community services to a large and growing population of complex patients, with services that all improve outcomes and reduce costs and thus create great value. That's everything we do in each business. We prioritize attractive markets, we leverage scale and create efficiencies in meaningful ways, and drive our best practices through each Home and Community Pharmacy and Provider businesses, delivering to them the resources they need to succeed and grow.
We execute at a high level on acquisitions, and our scale, leverage ratio, and cash flow position allows us to further capitalize on accretive and geographically expanding M&A. We still have many additional integrated care opportunities across the complementary service lines to drive more coordinated care in patient volume and impact. We have a large opportunity to leverage our care management capabilities and further develop our ACO scale and payer partnerships to grow in value-based care payment models. Moreover, we have related attractive service lines doing well and gaining share in growing high-need markets, and these service lines all do better and are better together within the BrightSpring platform. We're on the right side of healthcare trends and needs with a unique enterprise and set of assets from which to deliver solutions to all industry stakeholders. That's what this company is all about every day.
With that, thank you guys for your time. Make sure to pick up your bat if you want on the way out, and we are available for Q&A. Jen, I wasn't gonna forget Q&A. We've got a healthy amount of time here, about a half hour for Q&A, if we happen to use it all.
Jon, thank you. Jon and Jen, thank you for hosting us today. Really valuable use of time. Maybe Jon, as I think about just the runway for growth, when you lay out these things, large growing market, high ROI, we think about generics, LDDs, the demographic trends. I appreciate you've given us through 2028, but is it right to think that, you know, these trends should continue past 2028?
You know, I guess I would answer that in two ways. Number one, you know, chime in wherever you guys see fit. You know, really hard, big things, I think, in business and in life beyond a couple of years, you know, and we see it today, obviously, you know, business and trends, and disruption has never moved more quickly. You know, so, you know, hard for us to think much beyond the several year timeframe. I would say second, and maybe this is gonna be a three-part answer, we don't see anything necessarily other than the law of large numbers in math that would impact our growth in the future. We will continue to lean into that as much as we can.
I would say the third point would be, you know, we are very passionate here about continuing to leverage what we think is a unique and differentiated platform to continue to drive that growth. There will obviously be twists and turns in our markets this year and over the coming years. I think with our complementary diversification, I think with our scale, and I think with the operational quality and growth themes and priorities that we have in the organization, I think there's a resiliency there, you know, that is better positioned probably than anybody else in health services to continue to work through any changes as constructively as we can.
I would say we've never been more excited about the company, and I think I said that last year, and I think I said that the year before, but it's really true.
Jon, I would just add from a public policy perspective, our diversification has really proven to be a high value for us. If we've got, you know, one division that's had a challenge that we're working through, we've got others that are flourishing with opportunity, and we expect that to stay the same.
A.J.
Follow-up. I think since the IPO, the company's generally talked about 10-15 tuck-in deals a year, about $100 million of acquisition spend. With the capital that you have available now, do you see yourself leaning into maybe picking that up a little bit? I know also on secondaries, you've now started to buy when some of the distributions have happened in stock. What's your thoughts about that going forward?
Yeah, on the latter, I mean, I think we take secondaries as they come. You know, clearly, as we look out into the future on the last two secondaries, we were eager to acquire that stock back at those prices and think that'll, you know, that's very value accretive. So we'll take those case by case. You know, I think our base case would remain the same, is that we would lean into those. From an M&A perspective, you know, our pipeline has never been stronger. We just always have to be and try to be as judicious as we can around prices and valuation. You know, there's quite a few of our businesses that have been seeing 15x-20x+ EBITDA multiples in the M&A world.
You know, some of our businesses are in, you know, fairly, very highly valued markets. You know, I would say that's something that we're very careful about. We will continue the steady stream, almost, you know, to use a cliché, sort of the string of pearls, you know, approach to M&A, where we continue to do really good deals, probably more modestly sized or smaller sized and just stack those on top of each other. That really adds up. You know, that is our base case. The fact is that, you know, today our balance sheet is in a different position, and we think a very good position, as well as our cash flow generation capability.
You know, I think we would assume that the aggregate EBITDA acquired, particularly I would say as we get into 2027, would pick up. You know, we are not under LOI right now on any significant deal. You know, we need to see the community living deal in fact close, and we needed to get through the home health asset acquisition. And then we would reevaluate from there based on, you know, what is at hand. I think as we look into the later part of 2026, and as I think in particular, as we get into 2027 and 2028, you know, I would be probably a little bit surprised if that activity doesn't pick up.
Maybe this is for Jen too, but when we look at that 15%-20% consolidated or enterprise level EBITDA growth, I guess I don't think you're giving explicit components of that. I guess to what extent, how should we think about the trajectory in terms of any sort of change in the trajectory that we should anticipate across the two different key segments?
Yeah.
In terms of pharmacy versus provider? Or should it just be more of a continuation of the same on that front? Or any nuances to think about as we think about particularly like 2027 and 2028. From there, you're adding, I guess, 2-3 percentage points potentially from M&A, I guess, is kind of how it pans out. You mentioned the 60/40 split. You know, is that a little bit more weighted than historical on pharmacy? Should we read between the lines there on the potential around pharmacy deals, I guess, going forward?
Yeah. Going in reverse order again, so 2%-3%, that's your number. You know, we'll see what happens on M&A, but I think you know, we're in a really good position from a balance sheet perspective, I think, with a very unique ability to execute against successful M&A, and we're optimistic about that. You know, I think we'll continue to be opportunistic in terms of where the deals are. You know, barring larger, chunkier deals, 50/50 is a good assumption for how the provider and pharmacy deals would shake out. If we happen to do one or two more chunky deals, you know, that would skew things based on whatever industry that was in. You know, on growth as we go forward, you know, I mean, we expect a lot of consistency there, for sure.
You know, if we had to probably note a little bit of a change, you know, just given some of the growth on the Pharmacy side of our business, maybe does that moderate a little bit? We're very optimistic, though, about Home and Community Pharmacy stepping up their growth rates. We're optimistic about provider, you know, in terms of relative growth contribution in the company, you know, continuing to be more of that. There could be a little bit of it tilting more towards the Provider business and within Pharmacy Infusion and Home and Community, really just as a function of, hopefully, a lot of focus and execution in those businesses and those businesses doing well, you know, versus anything else pulling back. We continue to see what we've seen historically.
Our view is that, you know, we should expect to see in our attempting to drive, you know, a lot of consistent, broad-based growth throughout the organization that we have historically.
I would just add two things. The first is that, you know, really what we were trying to do in the 2027, 2028 is to provide a framework and not specifically any guidance related to our expectations. The second thing that I would say is that.
We would expect to continue to leverage all of our infrastructure that we have from a corporate standpoint as well as we grow, which will be, you know, beneficial from a growth rate perspective.
Can I ask a question to your government guy, please?
Government guy.
I'm using that. Yeah, I'm keeping that. Yeah.
for home health reimbursement
Sure.
The proposal was -6%, I think. It came in at -1%. I think that they were considering what they call like a clawback to implement in 2026, which did not happen. Is that risk now past us, so that will not happen ever? Or what are your thoughts there? I thought there was a certain time frame.
Yeah, there's the time period where it had to be revenue neutral, and we're, you know, getting at the end of that. You know, really what they signaled, which is, you know, we use the word signal very carefully, is just potentially no more permanent cuts going forward and just temporary cuts. So we would expect to see, you know, something in, you know, end of June, early July, with a proposed rule that has, you know, maybe a little element of a temporary cut in it. Then, you know, you always have the dance between the proposed rule, the final rule, and that's where the market basket stuff with your inflationary considerations come in. We're very optimistic that we'll end up somewhere net positive at year-end.
Going forward, there is a, you know, industry, you know, because we had a good reception from the Trump administration this last year, you know, we're, you know, really having some deep conversations about what the most appropriate ask is now, and I'm not gonna get into what some of those are, but it's pretty exciting to be asking for something that's really positive instead of just playing pure defense.
You would expect an increase, a modest increase with minimal risk.
We're optimistic about, you know, where things sit before a proposed rule. It, you know, like every year, we could see a proposed rule that we're not real excited about, then see a final rule that feels pretty good.
Okay. Just with IRA and drug pricing, Jen, maybe this is more for you. Do you collect rebates, and is that part of your negotiation process, your sort of standard negotiation process with manufacturers? Are rebate discussions part of that?
We have very little rebate, exposure or benefit in our company.
Okay. Just one more quick one. What kind of margin lift can we expect to see for generic? Just any color around that when it goes from brand to generic. Thanks.
Yeah, we would not be addressing that. Generics are, you know, ultimately positive for everybody in the, you know, positive for payers, and positive for everyone in the generic environment.
When a drug goes generic, there's just, you know, the manufacturing side with the participating manufacturers of a drug goes from one to many, many, many. You know, even though there is a dramatic price decline in a drug when it goes generic, which is helpful for the system, you know, you see the cost side improve as well because of the change in the manufacturing landscape.
Jen, you've talked on the call last time about the IRA headwind that you're facing. You talked about $15 million of mitigation in terms of, you know, working with PBMs for improving sort of dispensing fees. You know, Daryn, I think on your slide, you're talking about 26 focus areas, you know, engaging with CMS for these kind of rules and implementation and also seeking, you know, additional protections related to IRA. What is the necessary component to then further kind of mitigate some of these headwinds because of the changes? Is that rulemaking from CMS, or is that the direction that they've given the PBMs, and so you just have to negotiate PBMs?
Maybe before I turn it over to Daryn, I just wanna clarify, $15 million is our expected net exposure post mitigation.
Okay. Sure.
I just wanted to clarify that.
Going forward, CMS has signaled very clearly to us, and that's not even a signal, it's direct to our face, so I'm just using the careful, cautious words here today. Yeah, they fully appreciate that particularly our long-term care pharmacies had a very niche impact with IRA, given how they're paid, reliance on brand drugs, all that. We have full expectation that CMS is gonna listen as, you know, we're a couple months into this, there'll be good data after the first quarter from industry to take to CMS and talk about what the realities on the ground have been. We expect a positive response from them if, you know, additional mitigation is needed.
We've built, you know, exceptional bench of champions on The Hill that are supportive of us that'll communicate, you know, both to push legislation forward if we need it and just relay to CMS that we need additional help if we need it.
Great. Just to follow up maybe on Aaron's question, maybe if we think about pharmacy, could you sort of maybe rank order the components of growth? You know, maybe which ones are more contribute to growth in the coming year or the next couple years. If we think about LDDs, you know, generics, you know, prioritization of Infusion, Home and Community, like if you were to rank order, which are the bigger contributors, could you do that?
Yeah. You know, I think, you know, we'll have to see to a certain extent, you know, around the edges in each one of the businesses. But, you know, I think we like our position when we look at each one of those Pharmacy businesses as being in, you know, a solid growth position, you know, as we look to the future. You know, we think that's a good place to be. You know, we have a lot of aggressive initiatives going on right now in Infusion and Home Community Pharmacy, so we have to see how those play out over the next couple years. You know, there is the potential for those businesses to really step forward, you know, from a comparative growth perspective internally.
You know, I think, you know, as any Specialty Pharmacy business continues to scale, you know, that degree of growth from a percentage perspective, you know, just becomes more difficult. But we like, you know, we like being in a position where, you know, we are pushing businesses as much as we can, you know, for growth leadership in the company. You know, I would just say again, sort of related to the IRA question or, you know, policy, you know, in pharmacy, we absolutely believe that scale and efficiency and quality wins the day. You know, and then, you know, we'll see what happens in the external landscape.
You know, I think everybody views pharmacy as the white knight in the value chain, you know, providing a lot of value to everybody, interacting with the patients every day, driving generic utilization, driving patient services. You know, we get a lot of support out there, rightfully so, as Daryn said. Regardless of what happens, you know, we think that, you know, very differentiated scale of quality and efficiency is the name of the game. That's where all our efforts remain focused on.
Hi. Question, Jen, I wanna follow up on your comment about the margin growth, that you expect the margins to continue to expand. In the past, I wanna say, you talk about your kinda long-term target of 6% EBITDA margin. The question is, you know, is it still on the table, and how are you gonna get there? Sort of, kinda walk us through the thought process there in terms of margin expansion, what's driving that.
Yeah. 6% was what we had said really at the time of the IPO, and we really saw you know, very significant growth in specialty. That obviously we talked a little bit about in 2024 and 2025, what that did in terms of the margins. We're focused on each business expanding our margins based on, you know, and ultimately up to what we think is an appropriate margin for that business. We have action plans at each operational team that are focused on lean process improvements, leveraging the scale we have in each business, focusing on driving volume in the right areas, that is ultimately gonna be beneficial. I think we do believe that we have additional opportunities.
We've talked about Home and Community Pharmacy, Home Health, as being areas that we definitely see opportunities for margin expansion. You know, as Specialty you know is growing and we definitely see opportunities for real scale as well in that business and leveraging the infrastructure. I would say 6% is probably a little bit farther off in terms of a margin, but just given the growth of specialty and where we're at today, but we definitely expect the margin expansion as you know we noted in the guide as it related to 2026, and we'll be working to achieve some incremental in 2027 and beyond.
Just following up on Brian's question. From just as you look out long-term, be it, you know, next 10 years, what would you rank as, like, the biggest risk in terms of continuing this growth? Competitive, macro, regulatory? What do you think, you know, just from a high level, what could kinda interrupt this trend?
Yeah. A little bit difficult to conjecture, but, look, I think these markets are so large, so fragmented, and provide such clear value, that, you know, that gives us, you know, a lot of motivation, to just keep our heads down and to try to just keep grinding away and provide as many of these services to the people that need it as we can in each and every one of our core businesses. You know, we see a decade plus runway in doing that. You know, it's healthcare, you know, reimbursement, right?
There again, you know, I think if you look at the value of our services, you know, if our services, you know, are not utilized as much as they could and should be, you know, if you squeeze that balloon, the rest of that balloon is gonna explode and costs are gonna go way up. It's just math. I mean, the ROI for our service lines one by one by one is dramatic. The answer is to provide more of these services and to keep funding them more. We put all of these 700 projects that drive efficiency across the company in the last five years, it all goes back into people. You know, five years ago, nobody in home health, hospice or rehab had 401(k), right? Everybody's screaming about it.
Now, everybody has 401(k), right? That was not $1 million. That was very, very much more than that. These are the things that we are making sure we fund internally to have the clinicians to be able to deliver the services to grow. You know, it makes all the sense in the world to fund individuals and to fund services that are delivering needed solutions at a high ROI in healthcare. We have to continue to educate and advocate for all of those services, and our view is that they should all be funded more, because that's part of the solution in healthcare. You know, when you're in concept a price taker, you know, you have to make sure that the external landscape is as sane and logical as possible.
At the same time, I think our scale, our quality, our efficiency, our growing automation and AI initiatives, you know, put us in a unique situation as we advocate and as we negotiate with payers around fair rates. If there are disruptions, you know, I think that creates opportunity as well. You know, our base case is a lot of continuity and a 10+ year runway on just continuing to grow these services in these big core markets and advocating as much as we can to utilize these services even more given their value.
One little specific. On the I know the 2028's not guidance, but in that number, that value-based piece, I assume it's still probably not significant or are you sort of some kind of. It'll grow, but are you assuming actual material, you know, driver from the next three years in that piece, in the value-based piece?
We are not. That would potentially be upside, depending on, you know. I think related to the framework, which is not guidance, we would have the same philosophy regarding how we set guidance, which is high confidence in, you know, our views based on what we see today.
Any more? Well, thank you for coming every day. Coming today, everybody. Oh, do we have one? Jill's under the wire.
Can you talk a little more about the efficiencies, opportunities, like what you've done so far and where you see incremental opportunity in AI?
Yeah. We've got, you know, and you know, we're making pretty careful buy versus build decisions because we don't wanna sit on the sidelines for a year while we try to internally execute against some of these opportunities. There's been numerous examples of where we've already deployed AI in our company working with an external vendor. You know, a couple of those have been in home health, in particular, a few in home community pharmacy. And it's not always, you know, AI, quote-unquote. I mean, automation in and of itself is great. And, you know, there's automation that has less AI to do it with it, and then there's kinda classic AI automation. But we are leaning in.
You know, we don't—while we wanna partner with great people out there, you know, in five years, we don't wanna be held hostage by 20 AI vendors, right? We're leaning into that and, you know, and we're making the necessary hires and resource investments to do that. You know, I would say there's probably seven or eight key focus areas of initiatives going on right now in the company, spanning intake, rev cycle, clinical patient care management, and the hiring and onboarding process. You know, those are some of the central ones now. We're making good progress. I think by the end of the year, you know, most of those should be getting out, you know, to the other side of that work stream and going live.
I would assume next year we'll have 15 more.
Mm-hmm.
We'll keep driving that as much as we can. You know, we've been able to generate a good amount of savings here pretty much every year, you know, going back the last five years. While, you know, obviously, that net somehow finds its way to profitability, you know, we are using that to make continued resource investments in our people and in our processes and in our technology, and I think that served us really well. We will keep the focus on operational best practice as much as we can. I mean, you know, there's a lot of us that really get a lot of satisfaction and enjoyment out of, you know, just how do we run the tightest ship possible operationally.
You know, I mentioned before, you know, we aspire to be an HR academy company per se. You know, I think we're pretty close to that even today, but, you know, there's even more things we're doing from a career management perspective internally and automating a lot of the HR process that I think gets us fully there. I think we feel the same way about IT and lean in process. You know, I remember going back to my first days in the company world after banking and private equity and, you know, at Medtronic, not only were they very buttoned up around Lean and Black Belt, you could be sent to companies that were known for this.
You know, they would train you, even other companies that were just known for their lean and their best practice operations. We wanna be that company, right? I think within health services, at least, you know, we're way out in front. You know, as we talk internally and with, you know, Charlie and Viji every day, I don't know if it's realistic for us to be the most advanced technology company in the world. That's probably not possible. I think it is possible within healthcare, and I think it is absolutely possible within healthcare services in the next three years. That's where we're gonna continue to push and try to be. All right. Well, thank you guys for coming today. It's been really enjoyable for us to meet with you.
I hope you had, you know, a nice quick trip, and it's been great seeing you, and I'm sure we'll be talking to all of you very soon. Hopefully that was informative today. You know, I did, you know, wanna thank all of our employees, you know, out there across this organization. I mean, there are tens of thousands of people taking care of, you know, your family members and people in our communities every single day in a very mission-driven way. This company does an incredible amount of good, and with that mission, we just try to run the company in a good way as well. I think we had well over hundreds of people viewing in on video today, and we appreciate everybody's time, and hopefully it was an afternoon well spent.
Thank you.