Good afternoon, everyone. It's a pleasure for me to be presenting you MultiPlan Corporation. I'm Sherry Yang, one of the associates in the investment banking group in healthcare in New York. Today, I have Dale White, our President and CEO, and Jim Head, Executive VP and Chief Financial Officer for MultiPlan, on stage with me, and Luke Montgomery, Senior VP of Finance and Investor Relations, and Shawna Gasik, Assistant VP of Investor Relations, in the audience. The presentation, the presentation today will be slightly different in terms of format, and it will be a fireside chat in the form of Q&A. I'm gonna turn it over to Shawna for a brief moment to read a safe harbor statement before we get started.
Thank you, Sherry. As a quick reminder, our remarks and responses to questions may include forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those stated or implied due to risks and uncertainties associated with our business, which are discussed in the risk factors included in our quarterly and annual reports and other documents filed with the SEC. Any such forward-looking statements are based on assumptions and information available as of today, and while we may elect to update such forward-looking statements at some point in the future, please note that we assume no obligation to do so. And with that, I'll turn it back over to you. Thank you.
Thanks, Shawna. So firstly, for those in the audience who are unfamiliar with MultiPlan, can you provide us with a high-level overview of who MultiPlan is, what you do, and what your strategy is?
Sure. So we are a 44-year-old company that specializes in providing data analytics and tech-enabled end-to-end cost management solutions to the healthcare industry.
Mm-hmm
... mostly payers. We sort of coalesce around affordability, fairness, and efficiency in the healthcare delivery system. And by that, we work with payers on helping them, you know, manage their medical spend. So we, through a number of innovative and very different cost management solutions, but are focused in that sense of driving affordability, fairness, and efficiency in an independent way because we sit between payers and providers.
Mm-hmm.
All aimed at managing medical costs.
Thanks. Okay, second question. Here, clearly there was some big news last week. MultiPlan announced that I was-- it has named a new CEO to succeed Dale. Dale, can you comment on why now, why you chose the individual who is succeeding you, and what you'll be doing next, and what all this means for your growth strategy?
Sure. I'm not sure it would be classified as big news, but we did announce that I was going to step back from being President and CEO of MultiPlan, effective March first. As you, there's no perfect time to replace a CEO of a company, particularly one that's been in the business for four decades, and been with the company for 20 years, and was in many ways responsible for driving the growth of the company. Having said that, it was the right time.
Mm-hmm.
40 years, 40 decades, lots of gray hair, made it the right time to make that decision. The good news is, and it was the best possible outcome for the company, is that I will move into the role of the Executive Chairman and can, you know, provide that payer continuity-
Mm-hmm
... and do what I love doing the best, right? I love working with clients. I love being engaged with customers. I love driving our growth strategy, and that's what I'll get to do on a, you know, on a full-time basis, exclusively. So it gets me... It allows me to step back and repay a very large debt to my family for letting me devote the time, you know, to the company and to my career over the past 4 decades and 20 years with MultiPlan. Travis, heck of a choice, right? Couldn't be happier with Travis's decision to join the company. He was my first decision or my first choice. He was Jim's first choice.
Mm-hmm.
So we're super delighted that he's coming. He comes from a different perspective in that he's worked on the provider side, so he's looking at things—he's looked at things through the provider lens. He worked at Cerner for 20+ years, and in positions of increasing responsibility, and he's started new products. He's accelerated growth into new markets. He's got knowledge and experience across commercial, government, and international healthcare markets.
Mm-hmm.
He'll bring that provider perspective. For me, I think most people in the room would agree that the line between providers and payers is blurring.
Mm-hmm.
As it continues to blur, Travis's experience and knowledge, and the ability to look at it through that lens, will be incredibly valuable to the company long term. Great cultural fit, in it for the company. I think he'll blend in nicely-
Mm-hmm
... and work well with the team and the team that's already in place. So right choice, right time, right experience, right knowledge, and I'm excited that he's going to be that next-generational leader that'll take us to where we wanna go over the next five years.
Mm-hmm. Totally makes sense. Okay, the next one here is: What differentiates your service offerings? What would you say are your key competitive advantages, and why do payers look to you to perform these services, rather than doing it themselves?
Look, I'd say one of the biggest differences or the competitive advantages we have is the depth and breadth of our product suite, right? We're not a single-product company anymore.
Mm-hmm.
You know, our focus, and we haven't, you know, we haven't deviated from it in over 40 years, but our focus is to work with payers to find ways to help them manage their medical costs. And we've created a very successful business on what effectively is the out-of-network claims, which represents 5%-10% of the overall claim volume.
Mm-hmm.
We continue to, through acquisitions and through the development of organic solutions, continue to expand our product capability. We built an amazing platform. We have relationships with 700 payers. We have connectivity to all of them. And now, in the past 12 months, we did a number of things, right? We acquired Benefits Science Technologies-
Mm-hmm.
- which accelerated the formation of our data and decision sciences solutions.
Mm-hmm.
We partnered up with ECHO Health earlier this year to put us in the payments business. And we have launched, you know, what is a journey, right? It's really a journey in terms of transforming the business. And we launched our growth plan last year to do exactly that, to accelerate the transformation of the business over the next 3-5 years. And so now we have an array of solutions, all aimed at our core, that will help drive growth.
Mm-hmm.
Right? And look, this year, you know, Jim and I, you know, sort of looked back over the past year. January is always a good time to do that. And what a difference a year makes, right? Look at all that we accomplished last year in terms of stabilizing the business, resetting the customer contracts, and extending the larger ones multiple years. Looking at, you know, beginning to transform the business, execution of a growth plan to do that, our first-ever investor day, and the acquisition of BST. The acquisition of BST is a game changer. It's really a game changer for us because, as I said earlier, MultiPlan's focus over the past 40 years has been on out-of-network claims.
And the products and services that BST has in terms of data analytics, advanced healthcare analytics, all enable us. It's the gateway to the in-network claims. It's the gateway into Medicare Advantage. It's the gateway into Medicaid. Today, we have one product that can do that, right?
Mm-hmm.
Payment Integrity. It's a great program, but its batting average is low, right? It's in line with others, but the batting average is low.
Mm-hmm.
We wanna raise our batting average on in-network and on Medicare Advantage, and we've got the game plan to do that through BST.
Mm-hmm. No, that makes sense as well. Okay, so the next one here is: Can we get into more detail on your growth strategy? So what do you think your key growth initiatives are, and what progress did you make on these initiatives over the course of 2023?
I'd say, again, I'll start by saying, we in the second half of 2022, as a leadership group, came together and formed our growth plan to be executed in 2023 and provide, you know, the foundation for growth in 2024. As Jim and I said on our third quarter earnings call, we expect to see growth in 2024. The strategy, you know, the growth strategy in 2024 largely, you know, surrounds four initiatives, all aimed at our core products. The first one is one that we call ProPricer.
It's where we apply and, you know, where we apply AI or machine learning to dynamically route the claim to the best solution, whether that's network, Data iSight, negotiations, financial negotiations, clinical negotiations, but we route it to the best possible solution that maximizes the savings for the payer and therefore the revenue opportunity for us. On our third quarter earnings call, we announced that we went live with one of our larger customers, just one of our larger customers, who, you know, on an annual run rate basis, should deliver about an incremental $5 million-$6 million going forward. Delighted, launched it on time, and our goal next year is to continue to enhance that product-
Mm-hmm
... and then, and then accelerate its application to the rest of our business, right? That long tail of regional health plans and third-party administrators-
Mm-hmm
... and the other larger customers. Our second growth initiative was around what we call balance bill protection. Balance bill protection is on the HST platform. The HST platform is our direct-to-employer channel, and it's exactly that. We, you know, together with our HST product, our reference-based pricing product, this program provides balance bill protection to the member.
Mm-hmm.
And we're delighted, started it in July, signed up about 5,000-6,000, you know... Oh, I'm sorry, signed up about 11,000 lives. And now, as we said in Q3, we expect to double that come January 1.
Mm-hmm.
So we see that as a significant growth driver going forward in 2024. The other two that are part of the growth plan, one is, I won't spend a lot of time on this. One is we refreshed what we call our Itemized Bill Review program. It's a module of our Payment Integrity program. And we launched it in Q3. We signed a handful of customers in Q3, so we're delighted with its start. It just expands the depth and breadth of our Payment Integrity program. And the last one is NSA, right? And No Surprises. We continue to invest in No Surprises.
The process, as everyone in this room knows, has been very clunky, very, very difficult, changing, as the laws, as the feds lost the, you know, the three or four lawsuits in Texas, and the landscape of NSA changed. We continue to invest in that. So we're continuing to, you know, we're developing client portals. So where we work with our payers, providers, you know, payers will have-
... on access on a real-time basis to status of their claims. We're bringing AI and machine learning to that process. We're building flexibility into our platform. Now, they asked us to help them manage it next year. We're not ready to do it now, but to manage and build a module to help them manage their state surprise bill-
Mm-hmm
... issues and challenges. So we're delighted that those are the four initiatives. Now, right behind that, we have a number of initiatives underway that we're going to work on in 2024, and will be the foundation of growth in 2025. So we're doing things like we're continuing to add more products and services to HST. We're taking our data and decision science. We launched PlanOptix , which is a price transparency model, but we're gonna continue to enhance it. So just like in Q3, we launched the product price transparency called PlanOptix in July. We enhanced it, released a second module in October. So we're excited about where it's going, but we want to add more to it, and as we said on the earnings call, there's a possible application in the provider community.
Mm-hmm.
Taking that same concept, the same principle, and extending it to the provider community. So we're continuing to invest in the business. We're not stopping. This was not a one-time growth plan for initiatives, and we're done. We're continuing to... We know, we know where we wanna go. We know the roadmap to get there. We know the growth initiatives we need to implement, and it's all about execution.
Yeah.
The team is doing a phenomenal job at it.
Okay, that's great to hear. The next question here, you already kind of briefly mentioned about this, but in terms of the acquisition of BST, can you tell us a little bit about why you did the transaction, what products it brings to the table, and how those products fit into our growth strategy?
Yeah so, we acquired BST, which is a data analytics company, back in May of 2023, and the thesis was pretty simple. So Dale talked about this business that we've built over 40 years, which was a giant transaction processing platform, which ingested tons of claims in the prepayment environment, and we'd invested over $500 million into it, capitalized software. So big investment inside a valuable piece of real estate, and we had 700 payer clients on doing it, but we had one product: out-of-network repricing, essentially. We had multiple services around it, but in the end, we were selling out-of-network repricing. We know that there's more to be put onto this platform, given what we have, given what we've invested, and the incremental ease of putting new products on top of it.
We entered the year with our growth plan, thinking that we were either gonna build or buy a data and analytics capability, and building one is really expensive, and it takes a long time, and it wasn't the DNA that we had. So we bought—we went into the market and started looking at companies, and actually started jointly developing a product with BST before we even acquired them. So we got to know each other that way. But in the end, what we're doing is taking data and analytics capabilities that are very different than our core out-of-network repricing and putting it on top of the platform.
Mm.
And I'll give you a couple examples. Price transparency, using our data as well as data from that CMS makes the payers and the providers all put out there to create interesting solutions where price transparency matters a lot: benchmarking, strategy, marketing, things like that. Taking all that data and doing it at scale, that's one product suite. Risk. Ingest claims and look at what the risk profile is of a book of business, a Medicare Advantage book, which could be 50... At some of the big payers, could be 50, $100 billion of risk, medical spend. How can we give them analytic solutions to make them make smarter decisions around that? In the employer space, BenInsights, where...
This is a really slick product, where they can digest the information of a plan, like MultiPlan. I'm the CFO of MultiPlan. We spend $35 million on medical spend. I don't have a clue as to where it's going and why at all. I just know it's growing. These guys can take it and tell me where the hotspots are. They can tell me how to change my plan to take costs down. They can give me areas where we can improve. So we're – that's a, that's a wonderful area in the employer space that we're now putting on top of our HST business. And then last but not least, there's a bunch of other new use cases, models, in the supplemental insurance market. We never were in that. They, they've got – already have traction with the top players.
So this, this capability is not just horizontal across our platform and our clients, but it also gets us into new markets because it's solving some of the biggest problems that these participants in healthcare have, which is cost, utilization, and, you know, kind of how to make things more efficient and how to, how to actually generate insights that, that allow them to make decisions. So that's the thesis behind it. What, what meant the most to them is we had all these claims. This is a giant playground for a bunch of really smart people to play in. So we ... Dale and I went up to MIT, where the founder leads the decision science department, and we kind of made our case as to why it's a good fit.
We really do think this has got long, long tail to it. It's not one product. It's a suite of products, and it's the most important spot in the market right now.
Right. That's amazing. Okay, so the next question here is: You have a goal of adding incremental annual revenues of between $200 million-$275 million-
Mm-hmm
... which you hope to achieve over the next couple of years. How did you arrive to this estimate, and how quickly do you think the revenues will ramp?
Well, we in our each quarter, we're putting out kind of the buckets, if you will, of how to get there and the different products. You know, some's coming from HST, some's coming from payments, some's coming from BST. Well, you should consider those numbers as being a destination in the near term. Is it four years, five years?... some kind of, you know, midterm view. We're pretty confident we're gonna get there. The question is really timing and ramp, okay? And each one of those is not a giant bet. We like the idea that we're putting multiple chips on the table right now and growing these businesses, which we have a right to win, and we have a differentiated set of products.
So, the ramp will be different in each. In our core business, we think we can improve HSD relatively rapidly because it's already in market and flowing.
Mm-hmm.
In our core, where we're doing things like ProPricer, we think that's gonna be more immediate. Payments and BST is gonna be a longer ramp over time.
Mm-hmm.
But, I think our overarching strategy is to say, get those, going. And our new, our new CEO, this is the type of, stuff that he's done his entire career, in terms of building these businesses from, from relatively small levels and building them out. He built two—one $800 million business, one almost $2 billion business inside Cerner, from scratch. So that mentality is really, really good. But we're turning into a product company.
Mm-hmm.
We're not forgetting our core, but we're turning into a product company. Those products will be layered right on top of it, and planting more and more seeds. So in our Investor Day, we kinda talked about creating this portfolio of growth opportunities over time. We're gonna get these things launched, and then, as Dale mentioned, we come in with the next set of products to drive more growth.
Mm-hmm. Yeah, you mentioned growth a lot there. Can you discuss your capital allocation priorities? What is your appetite for M&A currently, and how would you balance investing in business with reducing debt?
Yep. They're not... Those aren't mutually exclusive. I think we put our a pretty big, you know, for us, a pretty good-sized bet on BST last year, and we wanna make sure we get that right. So I don't think, you know, we've talked on our earnings calls, we're not going to do M&A in size in the near term. That doesn't mean we're not developing more opportunities. Al van Heerden is here today. He's really opening up our architecture to the outside world on a partnership basis, and also maybe acquiring some smaller companies in the near term.
But we will continue to invest in the business, which is burdened in our P&L already, and it will be in capitalized software, which you'll see growing, but for all the right reasons, 'cause we're seeing really good opportunities. But in the end, we know that our mission is to retire debt. So last year, we retired $330 million, over $330 million gross of debt. We bought some at a discount, which was attractive to us, but we know we've got to chip away at this debt stack. The elephant in the room is a refinancing, you know, three years out. We know we have to put ourselves in a very good position to do that, stay on the right side of the agencies.
And so we're very, very focused on making sure that we use our capital as we generate it to be smart and retire debt.
Mm-hmm. Can you speak a little bit to the trajectory of your Adjusted EBITDA margins over the next two years? What is your long-term outlook for margin, and how does that fit into the equation we just discussed regarding your plan to invest in the business?
Right. Dale always calls me the person walking the tightrope, which is always and I can't tell if I'm 500 feet above the ground or 3 feet above the ground, but it's walking a tightrope. And that is between trying to take the operational leverage that we have in a platform business that's a lot of fixed costs, and, you know, growing the margins versus reinvesting back in the business. And so, that balancing act means we're, I don't think we're gonna let our margins lift too much, 'cause if we do, that means we're probably not investing enough in the business, nor are we gonna let our margins fall apart. There's mixed issues in some of the new products, but generally speaking, you know, I think we can hold our margins over time.
So I think we talked about 2023 coming in the mid-60, 64-65-ish kind of range, and that is making investments in the business. As we go forward, I don't think that's gonna materially change. And even, you know, had the conversation with the new CEO about it, which is, we've got to maintain this balancing act, and because we've got to generate cash flow, and I think the main, it turns our attention to the main event, which is generating more revenues.
Mm-hmm.
That's the name of the game for us, generating more revenues. If we do that with the types of products that we have at high gross margins, it'll be very attractive.
Yeah, the key to success. Okay, the next one here is: During your Investor Day, you stated that the goal was to have less than $4 billion in net debt by 2027-
Right
... or a net leverage of about around 4x multiple-
Yep
four times. Could you elaborate on the rhythm of such debt reduction? What levers do you have for de-leveraging?
Well, you know, our cash flow, if there's growth and there's cash generation, are the two components, mathematically, that'll get you there. But as we start, as growth comes, more is gonna drop down to the bottom line, we can pay down debt. Our interest expense is already starting to compress. It's sizable, over $300 million, $330 million this year, but it'll keep on coming down. What it's gonna do is just free up more cash to go generate debt. For the foreseeable future, given interest rate environment, we think we're gonna be able to buy stuff at a discount. Not, maybe not as deep as we get closer to our maturities, but we'll still be able to buy stuff at a discount.
So what you're really hearing from us is, we've got to tilt a lot of our free cash flow back into debt retirement. The objective here is to have a smooth, regular way refinance.
Mm-hmm.
We know we have to stay very disciplined about it, and nimble about it, and be opportunistic to do that.
Mm-hmm.
That's the goal, and we haven't wavered from that.
Mm-hmm. Okay. Could you provide us with an update on the regulatory backdrop of the No Surprises Act? Could you mention a little bit about that, NSA? In particular, what is the status of the independent dispute process?
Yes, it continues to evolve, and it continues to evolve. So for us, you know, we've been involved in NSA since the beginning, and it's gotten increasingly complex, as you saw last year with the stop-and-starts, the litigation in Texas, the wins by the provider, the changes in how the process worked, and ultimately, the suspension of IDR from-
Mm-hmm
... August, I think, later in August to later in October, before they reopened the portal for it, for providers to be able to submit claims.
Mm-hmm.
So it's been, it's been a rocky implementation. It's still complex. The Feds, the federal government, CMS issued regulations in the fall, gave everyone a 90-day window to comment on those. The process, the comments were due back, I think, right before the holiday break. And now they'll digest those and come back out at some point in time in 2024 with final regulations.
Mm-hmm.
The goal... You know, the process itself is relatively efficient and smooth, except for when it gets to the IDR stage. When it gets to the IDR stage, which is the smallest percentage of claims of our No Surprises claims, the NS, you know, the ones that end up in arbitration is a fraction of our overall NSA claim volume. But once it gets there, it's very clunky, very inefficient, and we've had to invest in it.
Mm-hmm.
And so we had to dedicate some expenses in 2023, 2022 and 2023, in support of just that IDR component. And we'll continue to do so. We think there's opportunity for us. It's a complex process. As I said earlier, we've invested in it. We've not run from NSA. We've invested in it. You know, we've invested in making our solution better. We're investing by putting AI and machine learning into the IDR process. We're investing in it by creating client portals. We're investing in it by incorporating flexibility, rules flexibility for payers as they get more sophisticated, and the rules, then the dust finally settles. So it's still a work in progress for everybody.
Mm-hmm.
It's still a work in progress for CMS. It's still a work in progress for us.
Mm-hmm.
The final regulations will tell us a lot.
Mm-hmm. That's good to know. The next question here is: Do you have any updates you wanted to provide on what you are seeing in the 2023 performance or the fourth quarter results?
I'll look to my IR folks. But, we're not, you know, we're not updating anything. We're providing our guidance in February, our fourth quarter results and guidance. We're a little bit unusual in the sense that we're gonna let our new CEO take a look at our budget and how we're gonna do things before we put out our guidance for the year. Only fair. But, I guess I would go back to what we told you all the way throughout the year, which is, things are tracking as expected. We talked about the second half being lifting in terms of revenues versus the first half. Very stable on a rate basis, within basis points, very stable.
Executing on our plan, tick, tick, tick, tick, each quarter, here's what we did, here's what we did, here's what we did. Dale, Dale and our new CEO are maniacally focused on just delivering results and execution. So, you know, as we exited the third quarter, we felt like the utilization environment had normalized. You saw some leading indicators saying it might even be a little bit better in the hospital side. But we touch a broader part of the market than just, you know, hospitals. So, you know, things were feeling very, very steady as we exited the third quarter. I guess there's no news to update in any great shape. But on the other hand, we haven't pre-announced any bad news.
We're gonna let our CEO get in the seat. We told people at third quarter, there will be growth in 2024.
Mm-hmm.
So now the next question will be: "So what is it specifically? How are you gonna get there? What are you gonna do?" And we're gonna lay that all out. So, no news is no news.
News. Yeah. Okay. You talk about transformation. What do you mean when you say that?
I think it's a great question. You know, to me, what transformation means is you know, moving the business in a different direction. And as I said earlier, right, we've been historically focused. We made a great business out of it, right? Out-of-network claims repricing, and but it represents a small fraction of the overall medical spend-
Mm-hmm
... here in the United States. So we want to continue to. We think our core business is solid. We think our core products that are focused on out-of-network cost management, there's growth still there. But our excitement is taking our data and decision sciences, our data analytics, and moving into the in-network claims, moving to, you know, looking at the other, you know, 90%-95% of the claims, which today, you know, we have one hand tied behind our back because we're just... You know, we're limited to what we can do. We have Payment Integrity, as I said. In Payment Integrity, our batting average is great, but it's low. We can do more. We can provide more value to our customers. And so we want to move upstream. We want to get into Medicare Advantage.
We want to deepen our penetration into Medicaid and other government programs. We have a right to win, and it's exciting with the addition of BST. They'll be the gateway into that transformation, into moving into those other markets.
Mm-hmm.
Core's still good. There'll still be growth in the core, but we're moving in that direction.
Mm-hmm. That's great. Now we're gonna open the questions to the audience. We also have a mic going around.
Hi, Kalani.
Behind you.
Oh, I'm pretty loud, but thank you. Good afternoon. Thank you for your remarks and comments and insights. I'm Kalani from CardioDiagnostics. We are a heart disease company with a direct-to-employer product called Heart Risk. You mentioned earlier that you have $35 million of medical spend, but not certain where and why and how it's growing. As you think about your employer-related products, what risk categories, diseases, spend line items are they thinking about, and how are you and your organization thinking about evolving and positioning your products? I really appreciated your comment about going from a platform company to a product company, because we are going through the same transition.
Oh, I see.
So, hoping to think through some ideas that I can take back to our own team.
Models.
Thank you.
I think, look, I think it's a, that's a great question. For us, we're when you look at the, when you look at our risk models. Okay, so start there. When you look at what we've done or and what we're doing through BST, is we're developing specific risk models, and they're very clinical specific. So today we have a number, but two that jump out. One is looking at MSK. So we have risk models to look at claims data, then algorithms that will tell us that will tell the payer, tell the plan sponsor, that well in advance, based on the claims data, if a member's going to need a knee replacement, shoulder replacement, hip replacement. The data will tell us that.
Mm-hmm.
We have the same thing for high-risk pregnancy. We're developing other risk models, and it's interesting, around cardiology, diabetes. And we're tailoring, we're now tailoring our algorithms for the Medicare Advantage population, because the utilization patterns there are much different than the commercially insured, you know, commercial population. So they're developing the algorithms and the clinical models aimed at the diagnoses that the seniors typically get. And that's how we're attacking it. So cardiology is important to us, right?
Mm-hmm.
Would be important on the Medicare side. It's important on the Medicare Advantage side.
Can I follow up on the dental care?
Mm-hmm.
Thank you.
First of all, thank you for your presentation. In terms of risk management, excuse me, you just mentioned, like, whether or not someone needs a knee replacement. So you take that role, like the utilization reviewer, and make the recommendation whether or not the provider should do that? I see what you're doing in terms of pricing, but in terms of risk management, I don't really follow that.
It-
The second part of the question is-
Okay
... it seems like there'd be a conflict of interest if you're representing the providers on one side and the insurance companies on the other side.
Mm-hmm.
Are you more of, like, an arbitrator with your decision-making algorithms? How does that all work?
Sure. What we're doing, we're on this, the algorithms are on the same side. So what the algorithms do is it takes a plan sponsor's claim data and will run... It will process, the algorithms will be applied to a plan sponsor's claim data, and what it does is it flags a member who, based on their historical claims utilization, their utilization, it'll flag a member or identify a member who's a candidate for a potential hip, shoulder, or knee replacement. It doesn't speak to the medical necessity of it. It's saying, "Hey, this, based on this member's utilization of care and treatment, this man, this person is likely to have a larger clinical out, you know, event in the next 12 months.
So, payer, bring your tools, bring your clinical managers, intervene earlier, get that member on the right clinical pathway, to the most, to the best possible outcome." That's what it does.
So it's a decision tool that is used by utilization management, care management, that kind of folks who are actually engaging with the member to potentially put them to the best quality doctor, intervene earlier, if you know. I've gotten three cortisone shots in the last three months in my hip and, you know, I haven't gotten any feedback for who the best, you know, hip replacement doctors are in the New York area. So it's that kind of stuff. It's information tools, not clinical, you know-
Many of the best doctors work outside of the system, excuse me. Many of the best doctors don't want to take the reduced fee, and they work outside of the system, so doesn't it have to be doctors who sign up and be part of the plan?
No.
No.
No.
With price transparency and quality metrics, et cetera, that's one of the beauties of the price transparency. We are creating the tools to actually look at solutions in-network and out-of-network, and the total cost of care around all that. And so that, it's not, it's not necessarily a closed system.
Any more questions?
Hello, thank you for the time. I have a question about kind of your core out-of-network repricing product. And you alluded to the NSA. How has the NSA really impacted the savings per claim historically and to date, and kind of what is your expectation going forward? More specifically, would you expect providers to start billing out-of-network claims closer to in-network rates as a result of NSA over time, which might be a headwind to kind of the savings per claim?
The QPA, so what do payers do under NSA, right? It's at their discretion what the initial payment is, right? Totally their discretion, whatever they want to pay. Most of them gravitated to paying the QPA, which is the median contracted rate. And that's still under litigation, too. What is the median contracted rate, how is it defined, and what does it mean, right? So that's still open. And for us, we're in that process, right? For our own provider network, we had to develop median contracted rates, and for those that use our provider network, we have that, and we apply it to the claim and then manage the post-pay and the IDR process.
Same thing happens for the payers that work with us today on the median contracted rates. We take their median contracted rates, and we load it in onto our platform. We receive the NSA claim. In some instances, we determine that if a claim is an NSA-eligible claim, and then we apply the QPA, and we return it back to the payer for pricing and for payment, right, you know, for adjudication and payment. And then any pushback from the provider, if they're unhappy with the payment, that starts the post-pay negotiation process and the IDR process. And so we see that... What does it mean to us?
You know, with our solution, though, we took QPA-related claims for NSA claims that took business, you know, took claims away from our provider network, took it away from our analytics, and but we didn't lose it, we just put it over here.
Mm-hmm.
And now we're doing different work through it for those exact claims.
Is it a similar kind of profit per claim, kind of moving it over to that?
Yeah, I mean, it's interesting. So just maybe I'll give you a... The volume of claims from NSA is actually very stable.
Stable.
Because it's, it's not, it's emergent. It's, it's, basically, it's not discretionary, so it doesn't vary quite as much. The, the spread, if you will, between the bill charge and the savings and, and the rate around it, kinda nets out in a, in a very neutral way. And one of the reasons why is, when we... we didn't, we weren't sure where this was gone. I'm not speaking on behalf of all of our relationships with the payers and Dale and others. But, the payers didn't want us to get a windfall, and we didn't want to get cut short on this. So we kind of figured out a way, based on the new spreads that were being, you know, put into the market, to make sure that it was kind of revenue neutral to us.
Mm-hmm.
So in a lot of ways, it's been very steady and really not a dramatic change. I think the main event in NSA. I'll give you three takeaways. Number one is, everybody thought this was gonna be the end of a big part of our business, and somebody could come in and steal it all away. Never happened. We kept just about all of it. Number two, it's been extremely steady. I think the third part is, the IDR process has created not a giant mess on the revenue side. It's a pretty small piece of the puzzle, so it's been pretty steady. It's been on the cost side.
We've had to put more manual processes up against a process that has not settled down, and that's to stay, you know, to make sure our customers are getting the service that they deserve. So you hear me talk on the earnings calls.
Mm-hmm.
It's like we had to put some costs up there. Hopefully, that's gonna slow down, and that's gonna go away. But that's been the major implication for us, is actually a little bit of hit to our margins.
Mm-hmm. Well, that concludes our presentation today. Thank you so much for coming. Let's give Dale and Jim a round of applause.