All right. Good morning, everyone, and welcome to Cross Country Healthcare's first Investor Day. My name is Josh Vogel, Vice President of Investor Relations. Before we begin, a few housekeeping items. Please review the safe harbor language on the screen behind me. Following our presentation, we will conclude the day with a question and answer session. For those taking part virtually, please submit your questions through the chat or Q&A box within the webcast screen. Also, I'd like to note that today's presentation will be available on the investor relations page of the Cross Country website and in Form 8-K filed with the SEC. After the event's conclusion, a video webcast replay will also be available on our investor relations website. With that, let's begin.
From the moment we take our first breath, we discover a universe of connections. From invisible streams of data flowing across a global cellular network, to cellular structures populating the pathways of the microscopic universe, to roads spanning thousands of miles across the country, coalescing around homes, hospitals, offices, and schools. We soon realize the most important connection of all, the human connection. It is that human connection that encourages us in school, binds us in trying times, saves us in trauma, inspires us in recovery, and what brings us home. By empowering the human connection for health and well-being, we bring together talent with technology, doctor with patient, student with educator, job seeker with career options, and work with wellness. Whenever, wherever talent meets technology, Cross Country will be at the crossroads, innovating in this rapidly changing world.
Good morning. On behalf of the Cross Country team, I'm excited to welcome you to our inaugural Investor Day, which marks a significant journey in our 36-year history. Today, we will share a compelling roadmap and a plan of how we are delivering long-term, sustainable, and increasingly profitable growth. I would like to begin by recognizing the vision, legacy, and leadership of our Chairman of the Board and Co-Founder, Kevin Clark. Kevin is the inspiration and true champion of our purpose-driven culture. He created our tapestry of foundation of integrity, transparency, and ethical conduct to do the right thing for our people, for our clients, for our professionals, our communities, and our shareholders while making a meaningful difference. Kevin led Cross Country to a significant rise in market capitalization during his tenure as CEO. Thank you, Kevin.
Whether you know us well or you're new to the Cross Country story, our goal is to deepen your understanding of who we are and what we do. Cross Country is a high performance, tech-enabled workforce solutions firm. It is through that lens that I will tell our story. As CEO, I've been focused on three powerful principles since taking the helm six months ago. Specifically, evolving and elevating our suite of capabilities. Evolving and elevating the way we are leveraging our technology. Evolving and elevating our sales organization. Evolving and elevating how we deliver on our promise to bring quality care to our clients. Evolving and elevating on how we engage and nurture our relationships with our healthcare and education professionals. Evolving and elevating our business for accelerated growth, higher efficiency, and greater value creation.
The proof is in our execution, the results, the numbers, the return on investment, and the momentum we're generating. As you'll see today, Cross Country is executing on a winning strategy that differentiates us in the marketplace. A winning strategy that answers the question, why invest in Cross Country? That strategy is simply stated, we're focusing our leadership to pursue vast and growing traditional and new market segments. We're leveraging leading edge technology, creating a winning culture, a best-in-class sales organization, and an unrivaled delivery capability to win. We will win. Let me take a deeper dive into our market opportunity, share our current momentum, and why we are optimistic about our industry leadership and profitable growth aspirations. It starts with an ocean of opportunity.
The healthcare and education markets alone, according to the Staffing Industry Analysts, will represent an impressive $31 billion market opportunity in 2023 for Cross Country. Now, we all know the SIA numbers are traditionally a bit conservative, potentially creating an even larger addressable market. As a matter of fact, as many people might be aware, the SIA just updated their numbers again last night, unfortunately, after we finished our deck. We currently hold roughly an 8% share in this growing market. The significant work we have done on enhancing our sales team will and has already shown accelerated MSP wins. Additionally, we are entering the high margin vendor neutral market with the launch of our Intellify product. It's our cloud-based workforce management solution, which gives us access to greater than 40% of the addressable market, which we traditionally have not participated in.
To give that some context, 94% of all healthcare CEOs rank workforce as their number one priority today. Why? We believe that health systems spend more than $1 trillion annually on labor, more than half of all healthcare costs. First, let's review the state of the business. We are a digitally transformed, innovative enterprise with diverse capabilities to help clients solve their most pressing labor challenges. Cross Country has never been healthier, with significant availability under our lines of credit and a historic low leverage ratio. We have a record of superior execution. Cross Country is operating at a very different level with a backdrop of strong demand and relatively stable bill rates. We are fundamentally a different company with a winning strategy and a winning equation of success, with a healthy balance sheet, strong cash flow, and liquidity.
We have a focused merger and acquisition strategy designed to follow the patient across the continuum of care from pre-acute to acute to post-acute, spanning the healthcare and education segments. In the last year, we acquired Workforce Solutions Group, a leading provider in home health segment, serving a critical role in caring for our aging population. They manage the complexities of sourcing, recruiting, and employing healthcare professionals to meet the needs of patients requiring care in the home or in the community versus going into a nursing home. WSG is on track to be a $100 million annualized line of business, representing a 30% growth since we acquired them a year ago.
We've expanded our services in the education market with the acquisition of Selected, a cloud-based matching and hiring talent platform that pairs educators with schools based on mutually shared preferences to ensure a tailored and long-term fit. This SaaS-based subscription model expanded our tech capabilities in the education space and built on Cross Country's educator-led, student-driven, and solutions-oriented offering. Our track record for profitability is equally impressive, as we have met or exceeded guidance and consensus for 12 of the last 14 quarters. This is a good time for me to also update you on what I've been focusing on in the five months since I've been in this role as CEO. Last month, we announced a share repurchase program of $100 million, and as of today, we have already repurchased roughly 3% of shares outstanding.
You may have seen the press release last evening announcing our new acquisition of Mint Medical Physician Staffing, a leading temporary locum tenens agency dedicated to placing qualified physicians, nurse practitioners, and physician assistants, and Lotus Medical Staffing, a leading locums and permanent agency specializing in anesthesiologists and CRNAs, both which will significantly bolster our locums portfolio. I'm excited to announce that later in the presentation, you'll be hearing from Bill Burns, our Chief Financial Officer, and he'll be raising our guidance for the third quarter, and he will be unveiling our new 2023 minimum full year guidance. Based on our current trajectory and momentum, we are aspirationally setting our sights on the path to becoming a $3 billion revenue company and a $300 million adjusted EBITDA company within the next several years.
I know you'll agree that these are compelling signals that we are delivering long-term, sustainable, and increasing profitability and growth, further supporting why we believe our stock is undervalued. Now that you have an understanding of the progress we have made, I'd like to introduce you to our winning strategy, which encompasses five pillars. Starting with leadership, which is the foundation of our success as an organization. When I refer to leadership, it really starts with what Cross Country has built, a leading brand and thought leader, an industry leader in delivering quality, instilling trust, confidence, and value. A source of pride is our industry leadership in clinical excellence, where we have what we believe is an unrivaled 95% on-time onboarding start rate and a clinical cancellation rate of less than 0.5%.
We are built on a foundation of integrity, transparency, and ethical conduct, and we are committed to doing business the right way. Speaking of leaders, today you will meet some of our talented executives who share our winning strategy. Key members that represent the strategic evolution that drives how we win with superior execution. This team is a compelling mix of industry leaders and top functional professionals with an impressive track record of success. Next is technology, which represents the biggest area of growth and innovation at Cross Country. Those who follow us know we are making significant investments to generate greater levels of efficiencies and productivity while leveraging expanded scale, enhancing value for our healthcare clients, our healthcare professionals, and our own teams.
Two examples of our innovative technology are Intellify, a workforce management platform, and a game changer that is truly state-of-the-art versus older and existing platforms in the market, helping our clients more effectively manage and solve their most challenging people needs through data and analytics, advice and insights. Gateway, our career job portal for healthcare professionals, enabling job seekers to find the next right job more simply and easily through real-time frictionless experiences on their terms. Boldly, I will say to you today that our vision for the future is for Cross Country to continue to evolve towards being a service as a platform provider. Shifting to people and culture, it's the heartbeat of our firm. We're becoming the destination of choice for employees. We are committed to focusing on recruiting, training, and engaging the top talent in the industry.
A key imperative is cultivating internal talent, driving increased satisfaction, investing in our staff, and enabling them to be more productive, faster and earlier in their careers. We are proud of our robust and diverse culture, where we have proof that we are creating optimum working environments, leading to employee satisfaction. The fourth winning element is sales. This is the lifeblood to fueling our growth. With the arrival of Dan White as our Chief Commercial Officer, the sales organization has gone through a remarkable transformation, bringing talented professionals, aligning the organization for peak performance, implementing best practices, and of course, we're leveraging technology.
With a differentiated go-to-market approach and armed with a more diversified portfolio, we have evolved into a best-in-class consultative and indispensable partner for our clients, offering advice and creative solutions, addressing the entire workforce ecosystem versus only contingent labor, resulting in early impressive wins and a robust pipeline for the near future. Prior to the pandemic, our MSP spend under management had an annual run rate of about $450 million, and now we are on a $2 billion-plus trajectory. I'm enormously proud to say our pipeline of MSP relations and relationships has never been more robust. The final piece of our winning delivery and strategy is our world-class delivery capability. Fulfilling our promises and strengthening our relationships with clients through our digital, high tech, high touch approach.
We're focused on elevating and creating a differentiated experiences for our professionals through every touch point of their career journey. From interactions with our recruiters, to white glove service from our dedicated concierge teams, to our leading digital ecosystem like our own candidate portal Gateway, to the launch of our new state-of-the-art website designed to help professionals more easily find and apply for potential jobs. In fact, since we launched our new website, we've had a 100% increase in unique visitors. The other critical component is speed to market, getting quality professionals to work faster at the patient's bedside or in the classrooms. Through our sophisticated recruitment marketing ecosystem, we engage and capture professionals better than anyone.
In fact, our unmatched lead generation engine in the last year has generated 78% more leads for all of our lines of businesses and 190% more leads specifically to our travel lines of business, fueling our recruiters with a steady pipeline of quality professionals to meet demand. Our winning strategies are the foundation of who Cross Country is today, and you will hear through this presentation a story of preparation, of speed, of quality execution, of retention, and of scalability. Embedded in everything we do is the drive for continuous improvement in our people, our processes, and our technologies. Let me recap the value that we provide. First, for our clients, both direct and manage, Cross Country brings them the healthcare talent, technology, and advice they need to serve their patients and communities.
Secondly, we bring value to healthcare, education, and home care professionals seeking to secure career and/or job opportunities in the marketplace in the easiest, fastest and most frictionless manner possible, earning their loyalty and referrals with our successful placements. Of course, we create value through our people, offering meaningful work, career opportunities for advancement and a progressive, robust culture. It's critically important that we provide them with the tools, technologies, inspiration, and process so that they are equipped to deliver best-in-class service to our healthcare clients and to our healthcare professionals. As you will see, we are building on this foundation of quality and trust to make Cross Country the preeminent technology-led workforce management company in the segments we serve. This is the roadmap for today. Let's get started and hear specifics on our long-term winning strategy. Come on up, Bill Burns.
The floor is yours.
Thanks, John, and welcome everyone to our first ever Investor Day. We're so thrilled to be able to share with you today a bit more about Cross Country, the markets we serve, and how we intend to continue growing the company and deliver impressive results that'll drive shareholder value. As John mentioned a moment ago, the two largest contingent labor markets that we serve today include healthcare and education, representing an impressive $31 billion market opportunity. As I say, I just updated that is now over $50 billion. That's about a 67% increase from what we had expected. Keep that in mind as we go through the presentation. According to the Staffing Industry Analysts' previous estimates, the two markets were projected to be about $31 billion in 2023.
Looking at Cross Country's performance in 2022, we estimate that we have roughly an 8% share of those large and growing markets. As we dive a little deeper, you'll see that on the left side of the chart here, the healthcare staffing market actually breaks into several sub-markets, covering travel and per diem nursing, as well as allied specialties and locum tenens. With the impact from the pandemic fueling rising demand and higher bill rates, the market has nearly doubled in size in 2021 and is projected to come down just a bit in 2022 and 2023, primarily on the normalizing of the bill rates. I'll go into more detail on that dynamic in just a moment.
On the right side, you see a slightly different view of the marketplace, one that shows how we believe the market is segmented by the nature of the client relationships. We estimate that some 80% of the market currently operates through either a managed service program or a vendor-neutral offering, and that roughly 20% is contracting directly with the vendors. Under those assumptions, there's some $10 billion-$15+ billion in spend that runs through a vendor-neutral offering, a part of the market that was previously only accessible to Cross Country as a sub-vendor to one of the programs. Well, that's all set to change. With the launch of Intellify, we're positioning the company to access the entire market opportunity, and I'll get into a little more detail on how that could play out a little bit later in the presentation.
As I mentioned a moment ago, COVID's played a pretty big role in the market, with volatile swings in demand and rapid rises in bill rates. That effect was most evident in the travel nurse market. What's not immediately clear, though, is that the growth did not come from bill rates alone. In fact, if you were to apply an average bill rate to the market across the last several years, you'd quickly see that the primary driver has been the rise in the number of clinicians, which peaked in 2021, but projected to be well above pre-pandemic levels for the future. From a bill rate perspective, we've seen increasing stability in recent weeks amidst the pervasive labor shortages in the healthcare sector.
As we called out in our last earnings call, travel bill rates are expected to decline sequentially for the third quarter in the mid-teens. However, the sequential decline for the fourth quarter is not expected to be as severe, as we now anticipate a more modest sequential decline in the high single- to low double-digit range. As a result, we believe bill rates will settle in roughly 35% higher than pre-COVID rates heading into 2023, which equates to an annual compound growth rate of about 8% relative to those pre-pandemic rates.
Now, looking at this chart, the point we find most interesting is that when you calculate the average number of FTEs in the marketplace using bill rate trends, you see that the clinicians on assignment are expected to be up nearly 65% and likely higher with the new estimates relative to the pre-pandemic years, which represents a compound annual growth rate of about 13%. There are a number of factors that come into play for a clinician to decide to accept one of these contingent roles, which of course includes compensation, but it also includes the lifestyle and the freedoms to choose when and where you wanna work. When we look at our data, we've actually grown the travelers on assignment faster than the market, driven in large part by the improved productivity of our recruiters as well as the investments in capacity.
The fastest growth has come from younger travelers with a tenfold increase in the number of travelers under the age of 26, followed closely by the rise in the number of millennials. I won't spend too much time on this next slide, but suffice it to say contingent labor is here to stay. As we've all heard, systems have seen a dramatic increase in the reliance on contingent staff relative to the pre-pandemic periods, with some systems reporting contingent labor usage in the double digits relative to the total labor hours. Though expected to moderate somewhat, it's likely to remain well above those pre-pandemic levels for the foreseeable future. The crucial point here is that the labor shortages are only getting worse, with the number of openings nearly 3x the number of hires, and that gap widening in recent years.
As of today, demand for travel assignments remains elevated and is up nearly 16% for Cross Country relative to the start of the quarter. That still doesn't include the impact from anticipated orders that we'll have from recent wins. I'd like to spend just a couple minutes giving a sense of how we transformed the company and what has allowed us to execute so well across so many fronts. If I had to summarize the last three years, I'd say that 2019 was about leadership, culture, getting the technology roadmap correct, as well as improving our balance sheet. When we look at 2020, we were already making significant investments in capacity and advancing our technology initiatives, which allowed us to pivot the entire workforce to be remote and still deliver at unprecedented levels.
2020 saw the release of our new applicant tracking system, which has had a tremendous impact on our productivity. In 2021, we continued to make those investments in our people, but our focus on technology began to shift to be more externally facing as we embarked on several client and candidate-facing initiatives. When we look at Cross Country today, we are a digitally transformed, innovative enterprise with broad capabilities to help clients solve complex labor challenges across the continuum of care.
From a balance sheet perspective, I don't think we've ever been healthier, with a significant availability under our lines of credit and historically low leverage. I'll speak to our capital allocation strategy just a little later in the presentation. If I were to say what has allowed us to be so successful these last few years, well, it comes down to our ability to execute. Mark and Amy will talk about this just a little bit later, but with the capacity investments and our sustained productivity improvements, we're simply faster. The market in this market, as John pointed out, speed is critical. Add to the mix the deep client relationships we fostered throughout the pandemic by being flexible and responsive, as well as our clinical excellence, and we believe that's a winning formula.
Our transformation is evidenced by our proven ability to execute with double-digit revenue growth for the last seven quarters, and we have met or exceeded, in most cases exceeded, guidance and consensus for 13 of the last 14 quarters. Our track record on profitability is equally impressive, as we've now seen seven straight quarters of high single- to low double-digit adjusted EBITDA margins, and we again met or exceeded consensus and guidance for 12 of the last 14 quarters. Now, we're frequently asked whether we're taking share in the market and looking back to some of the data points. We feel we have grown more rapidly on an organic basis relative to the industry. With respect to companies, well, we only have one publicly traded competitor, which we understand is not the market, but we've outpaced their growth on an organic basis for the last six quarters.
It's the ability to execute that is once again allowing us to outperform for the third quarter. As a result, we're raising our third quarter guidance. Though the quarter's not yet finished, we now expect third quarter revenue to be between $615 million and $625 million, with an adjusted EBITDA between $58 million and $63 million and EPS of $0.90-$1.00. The majority of the driver for the increase is related to the volume, as bill rates have tracked fairly closely to our expectations. Because of the continued strong performance as well as the impact from the leveling bill rates, we're also raising our exit run rate for the fourth quarter. We now expect to exit the year north of $550 million a quarter, which is 10% higher than the previous estimates.
Looking ahead to 2023, we are now establishing full year minimum guidance for both revenue and adjusted EBITDA. We feel confident that with the organic growth across our lines of business, as well as the impact from tuck-in acquisitions like Mint and Lotus, that we'll be well-positioned to manage through future bill rate volatility and deliver revenues above $2.2 billion and deliver adjusted EBITDA in excess of $200 million. In a short while, I'll come back to step through some of the more of the drivers to our business as well as our capital allocation strategy. Now let me hand thing s over to Susan Ball, our General Counsel and Chief Administrative Officer, to take us through some of the insights into our leadership in the marketplace. Susan. Thank you, Bill.
I'd also like to add, in addition to some of our colleagues that are here today that are nurses, I'm also a registered nurse, so, you know, once a nurse, always a nurse. For those of you that are new to Cross Country, and there are several of you, we want you to understand our leadership and our legacy of success upon which we're executing our winning strategy. Quite simply, we have a strong foundation. We have great relationships with our clients, with our candidates. We have technology, culture, and we have a leading executive management team. Let me start with our leading relationships with clients and candidates, and it begins with our rich 36-year history. Over the years, we've built deep, trusting relationships with our clients to help them service their communities. Track records matter.
That's why many of Bickle's clients are still our clients today. How do we earn the trust of our current clients and our new clients? By delivering on every engagement, every day, with clinical excellence and integrity. I think the Executive Vice President and Chief Nurse Executive of Northwell Health probably put it best when she said, "A relationship of this length can only succeed if trust is established between the parties. That is certainly the case for the partnership between Cross Country and Northwell." That's the solid foundation that we're executing on. In the spirit of continuous improvement, we've recently established a clinical council led by Dr. Hank Drummond, who has his PhD in nursing, and he is a former chief nurse executive.
The council provides insight and guidance on national professional standards, on best practices, on public policy and recent trends, and those potential impacts to Cross Country and our clients. They bring a breadth of industry experience to ensure that we continue to excel at clinical excellence, that we support the advancement of the industry, and that we're delivering exceptional value add for our clients. We also have more than 50 clinicians on our corporate staff who regularly engage directly with professionals caring for patients at the bedside. Together, our corporate clinicians and focus groups of our professionals provide feedback and insights on our technology and our processes used to ensure quality matches of our clinicians and our clients. As you heard John mention, we believe we have an unrivaled 95% on time onboarding start rate and a clinical cancellation rate of less than 1.5 %.
As you can see, we have emerged from the worst of the pandemic stronger, faster, and better. That's because when others were uncertain, Cross Country leaned in. I remember, Kevin and various other colleagues, we were in a war room in the early days of COVID, and hospitals and CNOs across the country were calling us, and they were just absolutely panicked. They were asking us for advice on what they should do about certain protocols, how do they streamline processes without impacting quality, and how can they use their resources in other ways. I mean, they were asking us all kinds of things. We quickly aggregated information from our clients across the United States, and we shared best practices and insights to ensure that they could deliver care effectively at the bedside.
We also set up fair pricing guidelines, and we showed our clients empathy and compassion when they needed it the most. Clinical excellence and integrity, that's how we create leading client relationships, and that's a key differentiator for us in the marketplace. Of course, you can't be a leader with the healthcare clients without being a leader with candidates. Those are the professionals that are seeking the best opportunities to realize the promise of their careers. They look to Cross Country to guide them on their career journey, to support them through credentialing and onboarding, and to make sure that they're matched on an assignment where they are successful and satisfied. Candidates trust us with their future. We have a powerful mix of long-term professionals and an emerging group of professionals that are, in fact, new to Cross Country.
Nearly 30% of all travelers that are coming to Cross Country are new to Cross Country or they're new to the industry. Nearly 65% of our professionals are now Gen Y or millennials. You may ask, "How are we attracting them?" Well, based on a recent study by Truist, Cross Country is the most widely recognized brand in the industry, and we're leveraging our best-in-class marketing technology to reach more candidates as they embrace the gig economy. We've also instituted industry-leading market campaigns to elevate our organization and to position Cross Country as a top destination for candidates who want an easy process, who want great customer service, and a plethora of assignment choices. Most importantly, we're meeting candidates where and when they want. Where are we engaging them?
Well, this group, they live on social media, so we're on Facebook, we're on Instagram, and in fact, we've developed the largest presence in the healthcare staffing industry on TikTok, which is a growing source of lead generation and revenue for us. In less than a year on TikTok, we have grown to over 115,000 followers, and we have 1.1 million views. Every day, we showcase about 150 jobs on a live stream on TikTok. As you heard John mention, we also launched a new website which was specifically designed and developed for our professionals to easily find and apply for potential job opportunities. This website delivers a simplified, intuitive user experience, as demonstrated by the fact that we've had a 100% increase in unique traffic.
We're also enhancing our portal, called Gateway, to be a seamless, frictionless way for professionals to interact with us in a one-stop shopping environment. As we keep saying, it is all about speed and ease to market. When are we reaching them? Well, they can engage with us 24/7, 365 days a year through multiple channels and modalities, so essentially, whenever they want. Again, it's all about making it easy for candidates by creating the best experience possible. Now, I've talked about our leadership with candidates and clients. Finally, I'd like to talk about Cross Country's leadership team, which is a key pillar of our winning strategy. We have an unrivaled executive team that's delivering on the three E's, evolve, elevate, and execute.
Having worked at Cross Country for 20 years, I can unequivocally tell you that this is the most dynamic, collaborative, driven, and accountable team that Cross Country has had. We're led by John, who has an extremely successful track record in the industry, who is a thought leader in the industry, and who has a very clear vision for the future of the company with technology at the forefront. Our blend of long-term Cross Country experience with a dynamic influx, here in the front row, dynamic influx of talent from the industry puts us in a perfect position to continue executing on our technology, our culture, our delivery, and our sales. Now I'd like to turn it over to Phil Noe, our Chief Information Officer, who will talk more about his vision and strategy.
Thank you, Suzy. Good morning, everyone. My name is Phillip Noe, and as Suzy mentioned, I am the Chief Information Officer here at Cross Country. Earlier you heard John talk about Cross Country needing to excel in the experiences that it provides to its clients, to its candidates and healthcare, home care, and education professionals, and to its own internal employees to enable the highest level of productivity and efficiency. Through that technology strategy, we have achieved that. To better understand how we've delivered on that promise, let's look at where the industry is today. If you look at the two major types of industry players, there's the large scale traditional staffing agencies that have provided scale through acquisition and organic growth, and they have become such players in the traditional staffing space.
This has also created a non-integrated technology stack, providing an incredible number of inefficiencies and a user experience that can be very disconnected. On the other side, you can see where there are the technology upstarts who have focused on creating platforms to launch and grow their businesses, but they don't typically have the traditional capabilities of a large-scale staffing provider. Cross Country is unique in that we are excelling at both the traditional staffing model and also being the technology disruptor and providing a high touch user experience. Take a look. For 36 years, Cross Country has been leading the digital transformation of the healthcare and education staffing landscape. Newly launched Intellify is the nucleus of our current state-of-the-art tech-enabled workforce platforms. Using a customizable dashboard, hiring managers and highly qualified candidates can connect with lightning speed.
From requisition to job posting to our Gateway candidate portal, where our users get real-time notifications to precise matches, instant interviews, and job offers all in a matter of seconds. Seamless integration across the entire ecosystem allows for real-time decisions and actions, providing a world-class frictionless experience to both internal and external users, and ensuring the fastest, most relevant job placements in the industry. Cross Country Healthcare. The future of healthcare technology is here. Wow. I hope you're as excited about that future as I am. We are, to be honest. Just catching up here. Today I wanna spend some time. Sorry guys, technical difficulties. Can you roll it back? Okay. Thank you. We have shared our roadmap.
We have shaped our roadmap on all of these three channels and these models, providing for the needs of the client, the candidate, and our producers, and offering the technology to enable the most efficient and frictionless experience. Today, I wanna spend some time explaining how Cross Country has approached its roadmap in solving these problems. That is innovating a true frictionless and data-driven self-service experience for our candidates, for our clients and professionals. If you look at the candidate journey, you can see in the stages shown that we've identified the key interaction points of that journey from the candidate's first awareness of Cross Country, and then all the way through the onboarding, deployment, and then that extended experience of recognition, engagement, and retention.
From a technology perspective, Cross Country has approached this by deconstructing that journey that John mentioned before and focused on the portions of the workflow that have provided us the best opportunity for making significant impact and leapfrogging what the industry and what our competition is doing. This was the inspiration for us to create our candidate portal, Gateway, with its purpose to remove manual and labor-intensive practices and put the candidates in the driver's seat of the experience. Let me show you what makes Gateway unique. We see eight critical segments of the functionality that are vital to enhancing the experience for the healthcare professional of the future, and those are what is represented here surrounding the image of our native mobile platform.
Where I wanna focus today is on just a couple of the key ones where we see the biggest opportunity for the return on the investment and improving that experience dramatically. First is leveraging machine learning and artificial intelligence. Let's face it, many companies talk about this, but they haven't delivered. At Cross Country, we are utilizing our technology to provide real-time matching for candidates to jobs that represent their targeted interests. With our data and analytics, we have in-depth knowledge on the profiles and preferences of all of our professionals. Through our engine, imagine the candidate getting real-time notifications near the end of one assignment about the pay package and location of their next possible assignment, one that specifically aligns to their interests and preferences based on our matching algorithms. That's a powerful bond being created.
Because it is a self-service model with automation, we believe that this will improve internal operational productivity by 2x-3x. Another key element to showcase is our rewards and loyalty program. We've created an environment that enables Cross Country and its clients to attract and maintain the stickiest workforce possible through the incenting of their renewal and redeployments. It similarly provides substantial incentives for referring friends and colleagues through gamification. After all, the most cost-efficient candidate to provide a client is one that we've already credentialed and is ready to travel. Now let's turn our attention to the client experience. Similarly, we have provided a frictionless self-service experience for our clients, arming them with insights, analytics, and reporting to more effectively help them manage their workforce. How can Cross Country deliver to our clients the right candidate at the right time at the best possible cost?
If we look similarly at the client journey from awareness through consideration and all the way through delivery, you see a recurring model of our strategy and how we view it through the lens of the client. Cross Country has similarly deconstructed the journey of our clients to help us focus on what is, again, closest to our return on our investment, and we saw the biggest opportunities in the delivery phase. Enter Intellify. Truly a game changer, as John referenced. Yes, at its core, it's Cross Country's client-facing vendor management system platform. But it was one that was designed with a client-centric mindset as a data-forward analytical engine that allows clients to manage their workforce needs with the highest level of efficiencies, regardless of the suppliers that they use. For Intellify, we also identified eight key functional components of focus that allows us to achieve this goal.
I just wanna talk about a couple of these again. Probably the most important fact, and you've heard this a little bit before, is that this solution is a vendor-neutral platform, meaning that a client can use this technology as a PaaS or platform as a service, where they can run and manage their instance of Intellify with Cross Country as their managed service provider, or another supplier, or even themselves as that MSP. This enables Cross Country to also provide a tiered service model to its clients to augment this technology whenever and wherever the clients need it. No one else in the industry of our scale is providing this type of service. Those were just two of the major investments in our ecosystem that Cross Country has already made. It's important to understand that the power of each of these platforms would be limited just taken by themselves.
At Cross Country, our strategy has been to completely redesign our entire ecosystem from the ground up using a data-centric model that interconnects all the components of that ecosystem. The power of that ecosystem is in its integrated data and service model. This enabled us to have a single technology stack providing the highest level of analytics and to continue building additional capabilities on a roadmap that extends well into the future. Speaking of that future, truly, as John likes to say, the best is yet to come. As we continuously launch new features and functionality across our ecosystem and across the landscape, we provide for a multi-generational workforce that caters to new graduates, to the tenured travel professional, and to that new empty nester.
Also through our innovative design, Cross Country will be utilizing this technology across the landscape of our business models that we provide for, from the traditional contingent staffing, locums, per diem, home care, education, and beyond. Through the utilization of true self-service and automation, the candidate can move from showing interest in a job to the floor of the client in the shortest time possible. Through the increasing leverage of data insights and analytics, clients are maximizing their workforce management model, driving more diverse opportunities for both the client as well as Cross Country. Through fully integrating the end-to-end workflow across our ecosystem, our producers have dramatically increased their capacity and efficiency. That is the future. I'd like to take this opportunity to welcome Colin McDonald up to the stage. Thank you.
Thank you, Phil. Good morning. My name is Colin McDonald. I am Cross Country's Chief Human Resources Officer. Today, I'm going to elaborate on the story of evolve, elevate, and execute, and what this means to our people and to our culture. We are Cross Country, guided by our core values, how we conduct our business, how we treat our employees, how we serve our customers is what defines us. Our values are tied to the growth and culture of our organization. These values are instilled in all our team members, current and future. We are connected, providing an effortless experience with simplicity and ease of use. We are accountable, operating with the highest level of integrity and respect. We are compassionate, nurturing relationships with those we serve. We are driven, delivering proven quality services and excellence. We are entrepreneurial, fostering creativity that encourages innovation and fun.
You know, I was talking to Josh, the head of our investor relations, and I said, "Josh, what are investors interested in when they hear about human resources and culture?" Josh said to me, "Show them the money and show them the numbers." Guess what? I'm going to show you the numbers. Throughout this story, I'll draw your attention to specific stats and facts and validate why these numbers are essential to how Cross Country has evolved, elevated, and engaged. These numbers illustrate the measurable impact our people and our culture has on the business. Our HR strategy has been focused in three critical areas. Recruit, train, and engage.
Our people and our culture have evolved through the recruitment and training of unprecedented numbers of employees to Cross Country, making us the destination of choice by attracting world-class talent, and we're retaining that top talent by offering competitive benefits and compensation. Let's take a look at some of the numbers. In 2021, we hired over 1,100 new employees, a new record for Cross Country. How are we accomplishing these incredible hiring numbers? By creatively engaging our future employees through a variety of tactics, employee referrals, employee brand campaigns, social marketing, and much, much more. Once they join us, they're not leaving. We have historic attrition rate of 20%, and it's dropping, and our new employees are more experienced and more productive sooner than ever before.
With our investment in technology, such as our new applicant tracking system, we can onboard new employees faster and make them more productive within their first 90 days. For example, we've generated $350 million in revenue from our first-year travel recruiters over the last 12 months, and 42% of all new hires are coming from our sector. We're proactively ensuring that our employee selection process identifies employees who'll be the best fit and have the best chance of success through the introduction of tools such as the Predictive Index that we implemented last year, where we have retained 81% through its use. We can leverage the tool as a foundation for coaching, career development, and mentoring of current employees, so we're effectively recruiting and selecting talent. What are we doing to retain them?
Well, according to Gartner 2022 survey, turnover across all industries is likely to jump nearly 20% this year from pre-pandemic numbers. While another Gartner survey revealed 52% of employees report that flexible work policies will impact whether they stay at their organizations. In fact, 16% of employees are willing to quit their current job if required to work fully on-site. Cross Country's answer, evolving to a 100% hybrid workforce, enabling us to cultivate the best talent, but more importantly, allowing our employees to have the optimum work-life balance, job satisfaction, and have them work where they're most productive. How have we elevated our people and culture to ensure employees continue to grow, be more productive, and stay with us? By institutionalizing best-in-class practices for succession planning, career development, promotional opportunity.
For example, 68% of our directors completed our voluntary talent review and succession planning program, ensuring our next generation of leaders are identified and in the pipeline. Similarly, all our employees and leaders can access our on-demand corporate training through our new learning management system. There are over 200 available training courses and programs, including career and leadership development for our employees to access. These initiatives have resulted in a 36% increase in promotions year to date in comparison to 2021. On the flip side, 87% of our employees are predicted as a low flight risk using our internal business intelligence BI system. You have heard my colleagues talk about the red threads of the three Es: evolve, elevate, and execute.
Execute is a great word, but personally, when I think of culture, I tend to think of it as engage, meaning how we engage with each other and our communities. A key component to how we engage is through our corporate social responsibility program. In keeping with our core values, Cross Country is committed to creating a better future for our communities by supporting local and national nonprofit organizations through financial contributions and in-kind services. I'm proud to showcase key highlights of our CSR initiative. First, let's talk about ESG. We received ISS highest quality score of one for governance and improved ISS quality scores of one for social matters and two for environmental issues. Next, among so many other awards, Cross Country earned the A+ Award for 2021 Top Workplace for Diversity, Equality and Inclusion.
According to a 2020 Glassdoor survey, 76% of job seekers and employees polled said a diverse workforce was an important factor for them when evaluating job opportunities and companies. We know that more than three out of four workers prefer diverse companies. At Cross Country, we walk the talk. We have 42% minority employees. That is the highest level over the past three years. 78% of our workforce are female. Our recent employee survey states that 87% of our employees believe Cross Country is committed to diversity, and 88% of employees believe that Cross Country respects individuals and values their differences. We are also actively committed to ensuring everyone has a voice. In 2022, Cross Country Healthcare launched three inaugural employee resource groups, Cross Country Parents, LGBTQIA+ and Allies Group, and Cross Country Green.
These groups are created around common identities and interests to provide a supportive setting for community, education and advocacy. I hope you'll all agree that the initiatives and the numbers I just walked you through demonstrate that our people and culture are the heartbeat of the company and a key catalyst to fueling Cross Country's growth and value. How incredibly powerful was that? Don't take my word for it. Let's hear the voices of our employees and the answer to why they're at Cross Country.
I chose to work with Cross Country because I am passionate about making a positive impact in healthcare.
I wasn't exactly seeking something out in healthcare or recruitment even in general. However, Cross Country reached out to me and asked if I wanted to start, and here I am three years later as an assistant director making a difference in the company and leading a team.
I chose to work with Cross Country because of the leadership team and their commitment to helping me achieve not just my professional goals, but my personal goals as well.
I really wanted something more than just a job. I wanted something that I could turn into a career and something that would give me purpose, I could be passionate about, and that would really challenge me. I found that here at Cross Country.
People are most vulnerable in hospital settings, and being part of an organization that provides exceptional patient care gives the work purpose and meaning. My experience with the team at Cross Country has been phenomenal. Leadership has fostered a culture of empowerment with endless opportunities for people to expand their skill sets. It's a place where you can make your voice heard regardless of position or title, as evidenced by the annual Innovation Challenge, which I intend to win this year.
I've always felt in every department that I've worked in in the five years that I've been with the company, that I've been very supported by my peers and my teammates, and valued by my leaders as well.
I heard about the culture here before I even started, and now that I am here, I really don't know how to explain it. It's like being a part of something bigger than you, but knowing that your individual contribution is making a difference, not only in our nurses' lives or our clients' lives, but in the coworkers that we surround ourselves with every single day.
Everyone is always willing to help each other, whether it's during work hours, after work hours, on a weeknight or on a weekend. Many different people are willing to jump in and lend a helping hand and talk to you and assist you. I've never worked anywhere that was as helpful and as resourceful as my team here at Cross Country is.
They offer a work-life balance. We are able to work independently at home but come together as a team. We are always incentivized to get the job done. We come together as one. At the end of the day, we are one team.
What I think makes Cross Country different is the people. I realize that that might sound cliché, but that's truly how I feel. This doesn't just apply to the incredible people at CCL that I get to work with every day, but this goes organization wide across all the lines of businesses. CCH is truly a collaborative company and does whatever it takes to get the job done, which is something that I'm very grateful for and appreciate.
It's so different than anything anywhere I've ever worked at before. It truly feels like we're a family here, which is incredible considering that many of us work remote, and most of the people I've worked with I've never met before. To be able to build a bond and build trust with these people so easily and effortlessly here is just. It's a real testament to how amazing the culture is here at Cross Country.
Cross Country is a multi-billion dollar publicly traded company that maintains a small company feel. It does this by upholding a level of customer and employee care that makes everyone feel as if they know the CEO personally. Hi, John.
I think that what makes Cross Country different is all of us. The way that we care, the way that we dedicate our lives to improving other people's lives, and that white glove service definitely goes a long way and impacts a lot of people. My name is Denny, and I am Cross Country.
My name is Jan, and I am Cross Country.
My name is Reno, and I am Cross Country.
My name is Ruth Wright, and I am Cross Country.
My name is Tom, and I am Cross Country.
My name is Kylie, and I am Cross Country.
My name is Grant, and I am Cross Country.
My name is Angie, and I am Cross Country.
Good morning, everybody. I'm Dan White, and I too am Cross Country. I am Cross Country's Chief Commercial Officer. I know some of you know me, but for those of you who don't, I am not new to healthcare or workforce solutions. I spent the last 30 years of my career helping clients of all sizes and across many industries improve business outcomes with various workforce solutions. About a third of that time has been in the healthcare staffing market. Healthcare has gotten under my skin. It's really become more of a calling for me, actually. You might ask, why Cross Country now? For me, it's about three things. It's about our strategy, it's about our team, and it's also about that wonderful culture you just witnessed. Colin was spot on.
The culture, team, and strategy at Cross Country offers me an opportunity to operate at the very top of my game, to be my very best, and to deliver to our clients and the industry more right when they need it most. I have known and respected John for years. In fact, we're sort of kindred spirits in a way, having been grounded in technology early in our careers and now with an intense passion for healthcare. When I heard he had become CEO, I knew Cross Country would have a very high performance customer and employee-centric culture, and that combination is pretty rare. That's why I joined Cross Country. I like to win, and this is where we're winning. Let's talk about how we're winning and the powerful growth story that we have here at Cross Country.
For those of you who are new to healthcare staffing or workforce solutions, our traditional relationships come in kinda two flavors, direct staffing relationships and managed service relationships. In a direct relationship, we have an opportunity to fill a position. In contrast, in a managed service relationship, we have an obligation to fill their orders. It's kind of an exclusive BPO-like relationship where we bring in technology, process improvement, a mature supplier panel, in addition to our own great delivery teams to fill all of their contingent labor needs over a three to five-year period. Obviously, the second approach is far more strategic and consultative. As John mentioned in his opening remarks, our transformation has been evolve, elevate, and execute. I used that approach when I joined in April.
Our first task was to assess our people, organization, sales processes, and results, which we did in about 30 days. That consisted of both our new client sales teams or hunters in sales terms, and our program management teams or our farmers. We started with our hunters first. We found that we had mostly junior salespeople selling everything we had to offer by geography. We were seeing some success, but not nearly what I'm accustomed to. At the 60-day mark, we had evolved. We had organized into smaller, high-performing teams built on Lean Six Sigma principles with inside and outside sales roles. We added some of the best talent in the industry with existing personal brands and intimate client relationships very fast. In addition, we revised our sales compensation structure to incent the behavior we need to see.
I'm happy to say that all of the teams have embraced these challenges that we've implemented thus far and are thriving. Today, we've elevated to a more consultative approach to solve problems with clients rather than just selling at clients. Those teams are also focused distinctly in direct third-party and MSP business solutions segmented by size and geography. We can provide solutions that clients are looking for very quickly and respond to their specific needs. We also narrowed our third-party relationships to just two deeper relationships where our commitment is valued and exclusivity and other preferences are rewarded. These partners are prospects, and our team members are more focused and engaged, and our rapid results speak to our very high execution. Prior to the pandemic, as John said earlier, our MSP spend under management was around $450 million.
As we shared in our recent Q2 earnings call, the same quarter as our transformation, I might add, we added $84 million in new MSP contracts. We currently have an additional $70 million in MSP relationships at verbal award and in contracting. I'm enormously proud to say the pipeline of our MSP relationships has never been this robust. Now turning to our program management teams or our farmers, if you will. I found that we had been doing what you might expect during a pandemic, focused entirely on meeting unprecedented demand and being great stewards of their finances. Here, the results were equally impressive. Nearly 5x growth in spend under management from 2019 to present.
While clearly the growth has been impacted by higher COVID bill rates, it's also very clear, as Bill pointed out earlier, that our volume growth and our add-on service penetration in many of our strategic accounts has fueled this transformation. Our assessment of program management also was quick. We had grown so rapidly that our organizational structure and leadership had not kept up. As such, we were simply focused on meeting client demand or customer service. Our evolution here had been very similar as well. Bring in more senior experienced leadership with consultative approaches to solve business problems. We've doubled our VP level talent and added considerable bench strength underneath them in the past two quarters. In addition to evolving our people and our organization, we've also improved our business intelligence capability and upgraded our sales operations organization.
In collaboration with our finance and delivery teams, we are streamlining our CRM capability processes and developing dynamic dashboards that provide visibility and insights into our improved results real-time. Phil and others have spoken to you about our new technology, Intellify. It, like our overall approach, is customer-centric. The user experience starts with analytics and insights that better inform workforce decisions for our clients. In fact, we have five clients scheduled to go live on Intellify in Q3, another five clients scheduled for Q4. I'm really proud to say that all of our newly signed clients will be implemented on this terrific platform. As such, Intellify is a critical first step to our journey for Cross Country and our clients. I am really proud of our accomplishments so far and excited about the results we're seeing.
We've attracted some of the best talent in the industry to communicate our renewed vision and strategy, and we're executing very well. We're also just getting started. Many others have already spoken about our outstanding culture and values. I share an entrepreneurial spirit with many of my colleagues and our leaders. Our vision is bold, our strategy is differentiated, and like them, I came here for growth. As Bill mentioned, we enjoy a very large total addressable market of $30 billion, maybe $50 billion in contingent labor alone. To give you some context about this, 94% of CEOs in healthcare rank workforce as their number one priority today. As John mentioned earlier, we believe that health systems spend more than $1 trillion annually on labor, more than half of their costs.
Given the leadership focus on workforce challenges and the need for financial improvement, we have more than enough room to grow. Our customers also wanna have choices. One third of that TAM we just talked about is made up of vendor neutral programs, representing $500 million in higher profit revenue potential into which Cross Country can now grow and compete. We're seeing early signs of this same interest in our sales funnel. New products, new markets, new growth, this is the new Cross Country. Gartner tells us that clients don't buy from you or even renew your business with you based purely on customer service. That's just table stakes. They stay with you because you help them grow their business. We need to do more. We need to become an essential partner to our clients.
With the investments we're making in our technology platform, in our people and culture, and our delivery, I am very confident that we are that partner. When I speak with health system CEOs, and they ask me what we do or how we're different, or even how Cross Country could help them, I say this, "You and your leadership focus every single day on the patient experience. And if there's anything that we've learned in the last two and a half years, it's that the patient experience will be no better than the caregiver experience. We focus there. We innovate there, so you don't have to." For me and the many colleagues that have been recruited here, now is a fabulous and exciting time to be at Cross Country.
For those of you who know me, my word is everything, and when I make a promise to a client, it's personal, and I take it personally. Our ability to deliver has been a big part of my attraction to Cross Country. I'm gonna ask Mark and Amy to join the stage and talk more about how we keep those promises.
Thanks, Dan. Perfect transition into delivery. We, alongside our phenomenal business line leaders, are responsible for delivering to our clients and professionals. As John mentioned, we live our five strategic pillars. We have embedded these pillars into our world-class delivery ecosystem. This ecosystem enables our teams to move with speed, precision, and purpose. To illustrate this, Amy Hawkins, our Senior Vice President of Enterprise Operations, will walk you through a couple of case studies how we earn the trust of our clients and candidates by delivering on a daily basis. Amy.
Thank you, Mark, and good morning, everyone. Let me take you through two real examples that showcase our ability to deliver day in and day out at an exceptional level. The pandemic has been a true test of our ever-evolving delivery ecosystem, pushing us to deliver even faster and with leading outside-of-the-box solutions. In September of 2020, our MSP client, an academic medical center in the Midwest, called us in a panic. There was a labor disruption, and they had an ongoing EMR conversion, all during the height of COVID. They needed to fill more than 700 open positions in less than two weeks. With core staff extremely fatigued, patient census skyrocketing, and the always delicate balance needed to support patient care, our teams quickly mobilized to create a customized solution. Our real-time solution included sourcing, onboarding, logistics, quality management, scheduling, and so much more.
By taking on these responsibilities, we helped the client remain focused on patient care. Delivering quality professionals to the bedside was a priority on day one. As Susie said, we have a less than 0.5% clinical cancellation rate, a 95% onboarding on-time start rate, and this allowed us to confidently accept the challenge to deploy 700+ professionals in under two weeks while keeping quality at our core. We leveraged our always-on professional sourcing and match technology to drive outcomes needed within the first 48 hours, tapping into our database, algorithms, and self-service candidate portal to engage professionals in real time. As our production team worked around the clock to identify, secure, and deploy the professionals needed, our operations team worked to implement an on-site command center, technology enablement for scheduling and timekeeping, and on-site workflows. This allowed for streamlined and efficient management of the engagement.
In fact, in the face of this perfect storm, we executed flawlessly, and the client was thrilled, all while continuing to deploy professionals nationwide at other healthcare facilities at a record pace. As you can see, using our technology, people, and process, we made it happen. We mobilized and deployed 700+ professionals in under two weeks. The hospital completed its EMR conversion successfully, and we reacclimated their returning core staff. During the strike, on-site regulatory state audit was conducted, and we achieved 100% compliance with no deficiencies. The best, 5% of professionals converted to system-wide permanent positions, leaving the hospital better equipped as we returned to normal delivery services. Now, let me walk you through a much different event that continues to highlight our leading delivery capabilities. Let's turn to another client in the Southeast.
During the height of COVID, this client was managing 31 direct vendors on its own to try and fill all of its needs and was very unsuccessful. The Chief Nursing Officer called us and desperately needed dozens of ICU nurses within three days. In this unprecedented supply-constrained environment, we secured dozens of hard-to-find specialized ICU nurses who were cleared to start in less than 72 hours. The hospital was so appreciative of our efforts that they continued to provide Cross Country with exclusive orders within the first 60 days, resulting in 209 positions filled, sourcing of 500 unique candidates, and with an average of 1.7 days to candidate submission. In case studies one and two, and so many other instances, we're able to successfully respond based on our tried and true 70/30 MSP model.
This model allows Cross Country to capture 70% at our MSPs but leaves 30% of Cross Country's professionals available to be deployed at new clients and other urgent engagements. The remaining 30% of open positions at our MSPs are filled by our vendor network. This client was so happy with the delivery capabilities that we have since been awarded an MSP contract, and we are currently implementing Intellify, our premier technology, within this program.
As you've heard, COVID made us better, stronger, and faster, and these examples are just two of the many situations that demonstrate our ability to customize solutions with our ever-evolving technology and resources to deliver prompt quality care to the bedside. Mark will now share how technology has improved our productivity.
Wow, talk about delivery. Dan said it best. We have both opportunities and obligations, and by leveraging our technology, we ensure our obligations are met every time. While technology and people are the largest parts of our world-class delivery ecosystem, let's dive a bit deeper into how our delivery model employs six tenets across all streams to drive successful and scalable outcomes. Source the right professional for the right opportunity. Transparency and compensation. Customer success with exceptional service to our professionals and clients. Continuous engagement throughout the professional and client life cycle. Speed and purpose. Speed to partner, speed to support, speed to deliver, and retention from first contact to lifelong partnership. Using our six tenets, as mentioned, in parallel to our digital high touch model, has given us the leverage and scale to continue driving productivity to new heights. Here are a few highlights.
The average recruiter recognizes their first placement in one and a half weeks in the seat in our travel nursing business. One and a half weeks. Before our evolution, that same recruiter historically took up to four months to achieve their first placement. Current travel recruiter productivity is double from what it was before our digital transformation. As Amy shared, leveraging our technology and best practices, we believe we are leading the industry with 95% on time onboarding starts. You've heard about our technology from Phil, our sales from Dan, number of new people we've hired, trained, decreased attrition rate, and our culture from Colin. All this culminates in our successful delivery story and how we can deliver for our clients. As John mentioned, Cross Country Healthcare today is a story of preparation, speed, quality execution, retention, and scalability.
Embedded in everything we do is continuous improvement in people, process, and technologies. We are excited about our ability to scale. Our roadmap to an even better candidate experience is in place and evolving over time. This, combined with the monumental impact we know our technology will have for our clients, gives us great enthusiasm as we look to 2023 and beyond.
Good morning. My name is Sydney Appleseed, Ms. Appleseed, and I work with Cross Country Education. I've been teaching with them for many, many years, several years, and I really appreciate it. I love it. I actually used to sign up with a whole bunch of agencies, and now I'm just down to one.
Hello, my name is John Davis. I work ER locum, and I've been working with Cross Country for about the last eight months now. My scheduler and the entire team works with me very well. They are always responsive and help me solve problems very, very quickly, in ways that other companies I've worked with in the past have not, and I've been quite pleased.
I hear other travelers complain about how hard it is to get in touch with anybody from the agency, how long it takes, what they have to go through to get it. I don't have that issue. Same with pay. I hear other agencies don't wanna pay this, don't wanna pay that. I don't have that problem with Cross Country.
Hi, my name is Celine. I am currently an LVN, and I work with USC. I choose to work with Cross Country because of the variety of opportunities and flexibility that they offer us. What I think makes Cross Country different from any other agency is how resourceful and hands-on they are. They do go out of their way to find you the best opportunities that they have available, which I appreciate truly. In addition to that, we can't beat the flexibility.
This is my first travel assignment, my first travel company, so I can't say I have a lot of experience with others, but I will say the team at Cross Country has been wonderfully helpful. They're communicative at every turn. They help me navigate all of the confusing parts, and make sure that I'm set up and that I have everything that I need to do my job well.
Hello, my name is Jane, and I'm a critical care nurse. I work for Cross Country Staffing. I choose to work for Cross Country because it gives me enormous flexibility with my schedule. My passion is windsurfing and thanks to Cross Country, I can pretty much set my schedule to work on the days when there is no wind. To me, this is a miraculous and wonderful thing. Also, as I get older, I've been a nurse for 39 years, and I don't want to work quite as much, don't have quite as much energy, and it's been easy to scale back working for Cross Country. They're very understanding of my needs.
Now that is the candidate experience, and it's amazing to see how our delivery capabilities have driven our performance and helped to build the lasting relationships with our clients. I know we've covered a lot already from our growing addressable market and growing demand, to how we're winning and expanding our deep relationships to our enhanced fulfillment capabilities and of course, our investments in technology.
Let's take a look at how all this translates into our results. As you've already heard, we're a tech-enabled workforce solutions provider that seeks to place the most highly qualified professionals and clinicians with our clients across a wide range of specialties. Our major lines of business you see on the screen here include travel, where we send folks on 13-week assignments away from their primary residence. Local, where we fill urgent needs, leveraging a large pool of in-market talent. Locum tenens, which covers both doctors and advanced practitioners. We also cover the home care market, which we believe has huge growth potential, where firms like CVS are looking to acquire home care giants like Signify Health. The education market is a natural extension for us, where we staff everything from nurses to therapists to special educators and teachers.
All of these are services available to our clients on a direct basis or through our managed service programs, and soon to be our vendor-neutral offerings, which allows us to be the partner of choice for thousands of clients. When you look at our revenue streams today, the majority of it comes from contingent staffing and more specifically, travel assignments. Over the last several years, we went from a company that was under-scaled with extensive manual processes and outdated technology to one considerably larger, with a larger workforce that are more productive and capable of generating significantly more revenue on a per producer basis. Coming out of the pandemic, we have doubled our capacity and improved our productivity of our revenue producers by more than 50%, which has led to the near tripling of our revenue.
When you look at our client mix, we have very deep, well-diversified relationships with approximately 85% of our revenue generated from direct clients or managed service programs. Because we're a people business, a relatively small portion of our business does come from supporting other third-party programs, predominantly vendor-neutral programs. As we look ahead, our goal is to continue to foster these deep relationships with our clients, capturing a larger share of spend under management through both managed service programs as well as through our vendor-neutral program. Thanks to the introduction of our VMS technology, Intellify. When we are successful, we anticipate that roughly 90% of our revenue will come from MSPs, vendor-neutral offerings, or these direct contracts.
I mentioned a moment ago that our revenue comes from several continued staffing lines of business, and that today the majority comes from travel assignments for nurse and allied specialties. Looking ahead, we believe that travel assignments will remain the largest part of our business, but likely to comprise closer to 60% of the business relative to the near 80% that it does today. That's because of the moderation in bill rates as we anticipate organic growth across other parts of the business. It's worth noting that travel presently has a gross margin below that of our other parts of the business. As the mix shifts, we anticipate higher gross margins overall.
The only other point I really wanna make on this slide is that the growth in other is actually several revenue streams, including permanent placements, recruitment process outsourcing, and the likely technology fees associated with the launch of Intellify. The launch of Intellify is arguably one of the most significant developments for Cross Country in recent years. As our proprietary vendor management system, it not only will reduce our cost of fulfillment at our MSPs by millions of dollars annually, but it opens up a portion of the market that was previously not accessible to us. To just give you a sense of the potential impact, we're showing a scenario where Cross Country is able to capture roughly 8% of the spend under management across vendor-neutral opportunities, which should translate into higher margins. Now, let me explain how we see the economics.
Generally, there's two ways you earn revenue from a vendor-neutral offering. First, there's the revenue stream from the fees charged to the users of the technology, generally paid by vendors who participate in the program but can also be a SaaS license fee, you know, from their direct client. Generally, that line of business, that stream of revenue has very high margin profile, as they're expected to be minimal ongoing costs for delivery. The second revenue source comes from Cross Country's share of fulfillment, which we believe could be as high as 20% of the total spend that we manage. Now, this is obviously below our MSP capture rate, but we believe it's consistent with other vendor-neutral offerings when you have that program, 'cause you can anticipate a bit better about the client's needs.
Together, these are a very large potential area of growth for us and improved profitability. Though it's likely to be several years before we realize the full potential of Intellify. Over the last hour or so, we've highlighted many opportunities to further extend our margins, but let me just bring them together. They include robust organic growth in our higher margin businesses like education, home care, or recruitment process outsourcing. The launch of Intellify, which drives both cost savings and opens up new revenue opportunities. The expansion of our bill pay spreads, especially within travel, as those rates continue to normalize. As well as other operational efficiencies from continued process optimization and automation. Now, we're intentionally not sizing these, but we believe that they're going to be the catalyst to achieving sustained double-digit margins for Cross Country.
Thanks to our continued strong performance, we're expecting to generate significant cash flows, and we want to ensure that we're redeploying that cash in the most productive, value-enhancing way. What you see here is intended to solely be a guideline. Of course, business conditions will ultimately dictate our decisions on how best to allocate that capital. We firmly believe that a well-balanced strategy is the best way to proceed with a primary focus on growing our business while of course servicing our debt and returning capital to our shareholders through our participant share repurchases. As John mentioned earlier, this quarter alone, we repurchased more than 1 million shares at an aggregate cost of approximately $25 million under a combination of exhausting the shares authorized under the old plan. As well as dipping into the new $100 million plan announced last month.
Over the last several years, Cross Country has performed incredibly well through strong execution and not solely on the tailwinds from rates, and we intend to continue that performance. Yet despite our historic performance, it's not lost on us that we continue to trade at a discount to our historic multiples or those for our industry. I thought it'd be interesting just to share a graphic that highlights this dynamic. As you can see, we've exponentially improved our profitability and at the same time have seen a decline in our trading multiples. What we're highlighting here is really the significant opportunity for shareholder value creation just in the normalization of multiples as we, of course, continue to deliver the strong performance in a post-pandemic world.
This dynamic was a key factor in our decision to repurchase as many shares as we did over the last several weeks. With that, I'm gonna hand the call back over to John. Once again, we sincerely appreciate your time today and interest in Cross Country.
Thank you, Bill. You can tell why I'm so passionate and excited to be here at Cross Country. This morning we've demonstrated to you why we believe we are undervalued. We've shown you proof of our winning strategy, and the equation is very simple. Our investment in technology, plus new opportunities in a sprawling green space, plus a transformed and best-in-class team, plus our world-renowned delivery to market approach, plus talented people and our tapestry of culture, plus our commitment to integrity and transparency, equals unprecedented success. Where is the evidence that this equation works? We've delivered increased shareholder value. We've delivered on growing financial results. We've delivered on executing our strategic plan. We've delivered on being good stewards to our clients. We've delivered on creating attractive job opportunities for our candidates.
We've delivered on being the destination of choice for our employees, and we will deliver on our bold vision for the future. We deliver on our promises. At this time, we are here to answer any of your questions, and I'll have Bill Burns join me for a Q&A session. I think we're gonna have a microphone come down 'cause we are live streaming. The first question, I think, Brian from Jefferies.
Thank you.
Thanks, guys.
Thank you. Do we have a mic, Mike? That's gonna be in the second row, first seat right there.
Awesome. Guys, congratulations and thank you for hosting us today. I guess, Bill, I'll throw it at you. You've mentioned $3 billion revenue outlook longer term and $300 million EBITDA. Maybe just walk us through how you're thinking about timeline and how do we get there, like in terms of growth rates?
Well, actually, I said it. Just to be clear, the CFO did not say it. It, that's an aspirational goal of ours. You know, we look at where we're at, we look at what we can do, we look at the market segments to win, we look at the opportunities, and internally we say, you know, where we're gonna be this year. We know bill rates are high. We know it's gonna come back a little bit. We say, where can we go in the next several years? Looking at the different segments of business, looking at the opportunities in front of us, looking at our investments in technologies, the opportunity to enter into new market spaces, we believe that $3 billion is an achievable goal, but an aspirational goal as of now.
I guess I would just say, you know, we intentionally don't have a timeframe to it, but our goal is to get there as quickly as possible. You know, we know rates are gonna retreat in 2023, just on an average basis. We think they've leveled off kind of somewhat, as we come into the end of the quarter now, and actually they've ticked up just slightly. You know, we're looking at the backdrop of the market, but we also know that we have a robust pipeline for M&A tuck-in opportunities. Our goal is to get back to that $3 billion as quick as we can.
We've got a couple questions here.
Maybe just to follow up on that. Do you guys believe that the 2023 number is a base? 'Cause you talked about bill rates coming down and normalizing. Is 2023 kind of the floor and it's how long from 2.2- 3 is just the question in your minds, or is there any more setback before we can move forward?
No, we believe that is a floor, that $2.2 billion in revenue and $200 million in EBITDA.
Okay. Then you also mentioned that the pipeline for new relationships is as strong as it's been. Is that a function of the marketplace and COVID making hospitals think differently about it, or is it about something that you would say you have specifically done as far as reach or client relationships?
I think it's a combination. I think first of all, bringing on great sales talent is definitely helping propel us to be able to get into clients and have a different sales approach than we probably had previously. The opportunity is there. Of course, it's a very volatile market coming out of the pandemic, and there's lots of opportunities as clients want different changes and have different opportunities and different solutions than they've had before. One thing Phillip Noe said is, when we're looking at our technology and how our clients can use it, they can utilize it as an MSP, they can utilize it as a VMS, they can utilize it as an internal system for themselves.
What we're doing now is when we are talking to clients and being more consultative, is meeting the client where they're at now, but also where they need to be in the future.
Do you have any color on like the win rates on these MSPs? Like, and maybe how that might have compared to where you were a few years ago, I guess both on new MSP wins and maybe re-procurements.
Yeah, it's hard to establish a win rate relative to the prospects that you're, you know, going in and talking to. I would say it definitely feels as though there's tailwind for where we are right now in terms of, you know, if I go back in time, I can look back to when we were seeing, you know, pretty stable, consistent one to two wins a quarter. In the pandemic, you know, the pipeline kind of dried up a bit as hospitals were really entrenched in looking internally and figuring out their own problems. The opportunity now is that we can get back and accelerate that kind of trajectory.
Tobey Sommer with Truist. Just had a quick follow-up on that. In terms of MSP, no single company kind of wins and retains all their business. It's very difficult from the outside to take gross win dollar volume and plug it into a model and have it flow. Where are you on a net basis, in terms of wins and growth in dollars? I wanted to get your perspective in terms of vendor neutral MSPs. Are those taking share or losing share from your perspective over the next several years?
I'll start with the second question. I'll let Bill answer the first question. It's taking gains. When you talk about that vendor-neutral VMS, MSP, but really not the MSP, right? It's a vendor choice program for hospitals. That, right now we estimated, of course. This is not what the new $50 billion number from SIA and the $30 billion number we had previously till yesterday, four o'clock. We had marked the market about a $10 million-$15 billion vendor-neutral opportunity, and it will not be trading our current MSP client to turn them into vendor-neutral. It'll be taking a piece of that $10 million-$15 billion market and converting that and winning new market share.
I guess I was asking whether you think vendor neutral as a category is taking share, not from the company specifically.
I would say, Yeah, it's been pretty consistent, 50/50, 60/40. It kinda goes back and forth. I think that we're seeing some hospitals wanting to try to do it themselves, and so maybe that's gaining a little traction. We've seen that throughout after 2008, 2009, during the Great Recession, we kinda saw that happen. We're seeing a little bit of it happening now, and we're in a position to able to help those clients do that if they want to. So maybe it's giving a little bit more vendor neutral, but I think it's pretty much 50/50 split.
Just speaking to your question about the retention versus the wins. I'd say on a year-to-date basis, we've certainly won more than we've lost. You know, losses tend to be somewhat episodic, but if you look back at our historical trends there, I mean, our attrition's been incredibly low. You know, usually single number of programs in a year, like single digit number of programs in a year that we might have switched to another form. Many times they will go with vendor neutral if we do lose them. In which case, we don't lose all the revenue because, you know, we still have clinicians on assignment there. We support to a degree those vendor neutral programs.
It's not a complete, you know, loss typically when we do have an attrition.
Thanks. One more question from me. What do you think the sort of native tech-enabled staffing firms as a category, what do they look like in their 2.0 or 3.0 state, sort of post-pandemic as we move to endemic, given the fact that they, generally speaking, don't have customer relationships, don't have, at least an established sales force, and, at least my understanding is generally aren't particularly profitable?
Yeah. I think you'll see consolidation through that. I think you'll see a lot of them move away. I think there'll be maybe some people will gobble 'em up for people who don't have the technology prowess like Cross Country has built to be a platform for them. But those type of companies really increase prices, and so you know 'cause what they do is because they work on very low margin to try to gain market share, they have to pay the clinicians more money, which then forces bill rates up. We see that it's bad for the industry, and we look at it as they eventually don't make money.
They're trying to use an Uber model, but the problem is, you know, the Uber model when Uber was losing money, the issue is the market's too big and too fragmented with too many people for them to gain enough market for them to continue to lose money and eventually turn it into a profit. We do think, you know, our belief is that they will morph into other companies, traditional companies will acquire them, or they'll go away.
Hi, Kevin Steinke, Barrington Research. Bill, you laid out some of the factors that you thought could get you from a high single to low double digit adjusted EBITDA margin to double digits. I'm just trying to get a sense of how much of a differentiation we should think about between, you know, low double digit versus double digit. I mean, is kinda mid-teens a reasonable expectation or, you know, how are you thinking about that?
Yeah, I mean, we didn't really size it. You're right, we gave a kind of a sustained double digits, so I mean, anything north of 10 is double. I'd say, you know, in a long-term range, I think we'd probably be looking more in that 12%-ish kinda range right now based on our current mix of business. That's my aspirational goal to get us to that sustained 12. We've seen that over the last, you know, few quarters when the operating leverage was there and sufficient to cover our operating costs. I think when Intellify comes along and gets more mature into our offerings, that really can start to have a dramatic effect.
We are deploying that across our existing managed service programs today, so we'll start to see savings from that bleed in and start coming in in the fourth quarter in a more meaningful way.
Okay, great. When you think about capturing share or penetrating the vendor-neutral market, you know, can you speak to Intellify and what the points of differentiation are with that technology that you think will enable you to penetrate vendor-neutral and capture share in that piece of the market?
Sure. You know what? I'll get Phil, if you wanna get mic'd up, I'll have you answer some of the questions, but I'll start, if you have a mic. What I'll say is, really, when we built Intellify, we designed it from, I always like to say, from the end to the beginning. We went to clients and said, "What are you looking for? And what do you want?" Really what clients wanted and what differentiates us is we start with analytics and data and insights for the client. They're looking at what do they need next, not, "Hey, do you have a body today?" That's how we de-designed it and developed it. You have to remember, most of the technology out there, in the vendor neutral space, the vendor management space, it's old technology.
Many of the companies have not updated their technology in years. A couple have, but most haven't. We think there's a large opportunity in that space. We also believe that the space there's only very few players in that vendor-neutral space. Because there's so few players, there's not a lot of choices of companies to go to. We believe we can create a true vendor choice or true vendor neutral product that will compete with only the four or five people that are really competing in the industry. Phil, do you wanna add anything else to that?
Number four. Okay, there we go. I think, you know, how we designed this from the ground up was, you know, was based on insights, analytics, data forward, right? That is what has truly allowed it to be different. The transparency with the actual operating metrics are what is front and center. You know, I think the systems that we are looking to replace, you know, they really haven't had any major advancements in what? Five, six years. You know, it's kinda the same old transactional model that's there, and certainly our core product does that. You know, it's those insights and analytics that allows them to understand real-time where they are with their resources, when they're rolling off, when new starts are coming on. That's all very front and center.
It's just very different than just saying, you know, "What's the total spend? What's the metrics?" It's very focused on those insights. You know, look, I mean, there's a real thirst amongst our clients to gain access to this technology. John, I know we don't share client names, but you had an interesting interaction recently where one client offered to kind of be on the cutting edge of helping us develop and deploy new functionality.
More than one client. I've been probably in three or four client visits in the last month, and every client is looking for new technology. These are not necessarily our clients. Some of them are clients who wanna use technology in a different way. Some of them are our competitors' clients who are saying, "We need help looking at it differently." When we look at Intellify, we look at it as a 360-degree product which is on our roadmap. Some of it we've delivered and developed, and some of it is continuous improvement that will continue to always develop. You're never done when you're developing software. But part of it is to engage and retain the core staff.
Now, when we look at the shortage in healthcare and we saw all the BLS JOLTS data, which we all know all too well, there is a crisis in the number of nurse shortages we have, and it's not going to be solved anytime soon. As, I don't look at Cross Country as a healthcare staffing company. We are a healthcare labor company that needs to help and work with hospitals to help find the whole solution. That whole solution is not contingency labor. Contingency labor at 10% or 12% in the hospital is not good. We need to bring that down to a manageable level for hospitals. Traditionally, that's been about 2%-4%.
We need to make Intellify much more than just a contingency labor, and we're starting to build into that, into the retention and engagement of core staff so we can keep them and then help them. We also are bringing in programs with clients, and they're helping us develop them, is how can we help upskill through Intellify and keep and retain, clinicians moving through Intellify? What that means is we have clinicians who are maybe in a sub-acute care space. How can we help them become acute care clinicians and actually build supply? If we don't help build supply, we're not gonna be able to graduate enough nurses in the next several years.
International nursing, it's not a panacea, it can help, but there's only 13 billion nurses in the world according to WHO, and there's a 28 million nurse shortage worldwide. Oh, I'm sorry, 28 million nurses are needed to have equilibrium worldwide. We're gonna need several different areas. It's not gonna be one, you know, golden button that we're gonna hit that's gonna solve the problem. Part of it is Intellify will be part of that solution to help upskill clinicians and retain and engage the core staff. Yes, Brian?
Sorry. Some follow-up questions here. Just to that last point you brought up about hospitals and how we need to bring utilization down. You know, a lot of us here cover the hospitals as well, and they're all talking about trying to bring down utilization and rate, right? How do you view the tie-in between those comments and the projections that you've laid out, not just for 2023, but for the next few years?
Yeah. Well, it's when you look at the gap, the shortages that are there, we can cite so many different resources, so many different studies. Vivian Health did a study, I think in April, that showed, what was it? 65% of nurses are considering retiring in the next five years. We've had studies done with D'Youville University School of Nursing. At D'Youville University School of Nursing, we recently did a nurse study that showed, you know, most nurses wanna leave the bedside. You know, I think it was like, you know, only 5% or 10% want to be retained at the bedside, and that's down from 24% a year ago. Yes, I think the goal is, and this is the crisis part, right?
The hospitals want to make sure that they can be less dependent on contingency labor, but we just don't have the supply to do it. We're seeing some hospital systems having more nurses graduate nursing school. The problem is, we don't have enough preceptors and educators to go and have them and get them ready to be acute care nurses. I think we'll make a dent into that, you know, into the shortage over the next several years, but it's not gonna be a significant amount that's gonna impact the number of contingency labor and RNs that we're gonna need. I think we'd have to think of the delivery care model differently to figure out how to solve this problem long term.
Then just to follow up to that, you know, as we think about your ability to grow, obviously supply is the biggest driving factor right now, right? It feels like it's a supply-driven equation. I know we talked about culture and all these other things that you guys are doing. How are you thinking about your ability to gain share of the supply of nurses? Because just as you said, it's a tight market and it's, to some extent it's shrinking, right?
Speed is key. The faster we can move a clinician from the door to the floor within a frictionless manner, we will gain market share because it'll be easy for them to work. It'll be easy for them to do business with Cross Country. That's really where we're focusing on technology. That's why technology is really the backbone of what we're doing, is because we're going to increase the speed of which they can get to the floor, which will allow them to get jobs faster. When you have a job faster and you know you can go back to Cross Country because you have a job and you go to work within days, not weeks, you're more likely to come back to Cross Country to get your next job.
All right. Last question from me. Obviously, acquisitions announced last night. Maybe if you can walk us through the strategy on locums and how you're thinking about that and, you know, what you see the opportunity there is going forward.
Sure. Locums is a market that we're very bullish on. We look at what's happened in the pandemic. Now, if we all recall, the locum space did not have the tailwinds during COVID. As a matter of fact, it was the opposite, right? They pretty much shut down. We had surgery shut down. When we look at the amount of deferred right now, we have a lot of healthcare being utilized right now because of all the deferred services, right? Surgery, everyone knows, right? Surgeries are back online. People waiting to have knee surgeries, elbow surgeries, all types of surgeries. But what we sometimes don't hear as much is the deferred healthcare that caused chronic issues and chronic diseases. Right now, one of our most needed segments is cardiac care.
Any specialty in cardiac care is in high demand. Why? Because people sat for the last two years at home, maybe they didn't exercise as much, maybe they ate a little too much food. They worked from home, and they didn't go to see and have their regular preventative care, doctor's appointments. Now those chronic diseases are building. We're anticipating chronic diseases to be in diabetes and other chronic diseases to come through, and so there'll be more healthcare needed, which means more locums will be needed. We always talk about the nurse shortage, but there's been a physician shortage going on for years. That's why we thought it was really important for us to grow scale for locums and become a real player in the locums business. The Mint and the Lotus deal, that'll add.
They're on a run rate of about somewhere between $40 million-$50 million in revenue annually that will be added to our base of what we're at. We're, you know, almost at a run rate of $100 million prior to the acquisition.
Thanks. Tobey Sommer with Truist again. What do you think is the future of the business model with respect to the recruiter within nurse staffing, both travel and local? Could you see there be an evolution where there's sort of a meaningful growth in self-service that isn't involving a recruiter, and recruiters are focused on the hardest to fill jobs for your clients?
Yeah. It's pretty much the business plan. Yes, it is. What we're looking at is we believe you can have more capacity, right? You still need the human touch. One thing we forget, something about healthcare professionals, my mom was a nurse. You know, a lot of nurses obviously we know and deal with here in the room. They're very high touch people. While, yes, you can, we'll be utilizing technology, which we do currently in our per diem business, where people can just go on our app and self-service themselves.
We currently can self-submit on our Gateway portfolio, but instead of maybe holding, you know, X amount of clinicians for a recruiter, you'll double, triple, quadruple the number that they can actually deal with 'cause they won't have to do the actual day-to-day work, but they'll keep the relationship there. I think that the role of the recruiter will change in the future. You'll be able to have more of a one to many and then be able to really give the career coaching advice and will turn into more coaching and career consultants than recruiters.
Yeah. Thanks. Do you have any numbers associated with that? You know, some sort of vision out in the future about how much will be sort of low touch or high touch?
You know, I think, you know, we stated in the presentation with Phil Noe that we think we can gain a 2x-3x advantage, you know, in the near term as we roll out all our technology.
Okay. Thank you. Could you comment on the proportion of new nurse supply? In other words, when you're getting applications for travel nurse in particular, how many of them are, what proportion are new to the industry? I wanna get a sense for how it compares today versus when the pandemic was, and cases were at a very high level.
Yeah. We don't traditionally break that out. We haven't, and I don't think we do. We just don't track that stat. Right, Bill?
Sorry, I don't know if my mic's in. We don't know exactly the percentage of new to travel. We know who are new to us. We know a subset of those are new to travel. At the peak, I think we were calling out about 40% of our travelers were net new to Cross Country. That number's waned a little bit, but it's still north of 30%. We're still seeing, call it a third. We're still seeing a third of our travelers that are still coming to Cross Country that are net new to us for the first time.
Thanks. Last question from me. Could you describe in a little bit more detail the revised sales compensation structure, what you've seen in terms of results or hope to see in the future as a result of that?
Sure. You know, Dan, do you want to address that since you're so close to it?
Sure. As I mentioned in my remarks earlier, we had kind of more junior salespeople that were really focused on kind of selling whatever the client might be asking for. We've changed the compensation plans to be very focused on direct, third party, and MSP. An MSP relationship versus a direct one, for example, in a direct one, you start and you can start getting orders and filling them right away, so it's very near-term focused in terms of compensation. In a outsourced relationship like a managed service program, you have kind of an upfront, hey, attaboy.
Great job in winning this, but this is now a three to five year term. We give them a little bite at the apple quarterly for the duration of that particular relationship. It's almost like maybe in another industry, like an insurance annuity, right, that's coming to the salesperson. This personality, the strategic one, it has a very long-term view of their compensation and the results of it. The direct one is a very near-term, quick hit, get it over with, not strategic kind of a relationship. They're just different personalities and, as a result, you compensate them differently. Does that help?
Yeah, Dan.
Question about the guidance. Bill, I think you said that the number for next year includes tuck-ins like the ones you just did. Was that to mean that it includes those deals specifically? Or does it mean that it includes additional-
Yes. No, those deals specifically.
Okay. There's no new M&A kinda in your pipeline, right?
No. The 2.2% should be attainable on an organic basis, including the Mint and Lotus.
Okay. I might have missed it, but when you gave that today versus future goal, is that an organic way to get to where you're going? Or does that assume how you might apply capital?
Yeah, I think it’s a great question. I would say that tuck-ins would accelerate the path to get to that optimal mix for the future state. It’s achievable organically 'cause we are seeing, like we talked about, double-digit growth in home care, in education. Those businesses are gonna grow rapidly as the travel bill rates, you know, kind of normalize in the coming into 2023. We’ll see the mix shift just through that. Yeah, if we have other tuck-ins, we can see that mix even play out a little differently.
Okay. 'Cause on that today to future goal, like the number that's the two numbers that are growing the most, I guess education's 4x. I guess locums, we kinda saw with the deals, but we got home maybe 2x where it was. I guess first on the home side, is it more PACE-type things, or is it more kind of traditional home care? Then I guess on the education side, you know, why is that growing 4x? That seems the fastest on the page.
Sure. On the home health side, we are the leaders in PACE on MSOs, similar to an MSP. We're very similar, I should say, not exactly. We are the leader in that, and we'll continue to grow the business through PACE and through our MSOs and PACE, and staffing in the home health care through PACE. In terms of education, look, we're having the same issue with educators and teachers and healthcare workers in education as we are nurses. There's a crisis of shortages of teachers right now. That is expected to happen for the next several years. It's also a fragmented business. There's very few companies that have any scale in education, and we believe that we can create scale.
We believe there's opportunities, especially with Intellify, to create MSPs within the education business. We think there's a lot of green space in education.
I just throw in there that that's an area where we've invested heavily in capacity as well, just to the points John made about the backdrop of the marketplace. You know, over the last couple of quarters, we've really added a lot more capacity to that line of business now that the pandemic seems to be fading back, you know, to more of an endemic, and we think schools are more back in person. I think if we look at the fourth quarter, we're expecting that business to see, you know, strong sequential growth and significant year-over-year growth.
Okay, great. I guess one question we get a lot about, you know, we've talked a lot about supply, demand, and long-term, where this thing goes. I guess a recession. How would you think if we end up going into recession at some point next year, how does that impact, you know, your views on supply, demand, and your ability to grow and get to that 3 billion?
I'll start. I think it depends upon, you know, how much unemployment there is, right? I think right now we're technically in a recession. Unemployment, though, is very low. If inflation continues to go high, we see higher inflation, yeah, that will impact the business. But there's no roadmap, right, for this if another recession hits and how deep it is, especially when we look at Affordable Care Act that was enacted in 2014, millions more people having insurance. But yeah, of course, if it's a deep recession, Kevin, I do think that we would obviously see some pullback in usage from facilities.
just on a balancing act question. This is where I think the company has made tremendous strides with developing our internal capacity metrics, more predictive indices, so we can adapt, you know, more quickly, I think, than we would've been able to in the past. We're more centralized than we ever were. Things can scale up and down a little bit. I'm not saying it'll be immediate. I mean, you could have a recession hit, you know, something could change suddenly, but it might take us a quarter or two to right size. We'll be able to make the adjustments along the line, along the way to ensure that we don't cut too deeply so that we can't grow back on the way up.
All right, well. Back on. Well, again, thank you everyone who turned out virtually and to those who joined us at the iPic Theater today in Boca. This is an exciting time for Cross Country. We have a common purpose, right? That's to deliver efficiently and effectively on our promise of quality healthcare, on transparency and forward-thinking innovation. For those of you who already follow us or are meeting us for the first time, we look forward to hearing from you and engaging with you as investors and analysts. Thank you for coming, and we'll see you soon again. Thank you, everyone.