Hi, everyone. Thanks so much for joining. My name's Jess Tassin. I cover managed care and healthcare IT at Piper. I'm really excited to be here with Claritev Management this morning. We've got CEO Travis Dalton and CFO Doug Garis on stage with me. Travis and Doug, thank you guys so much for being here.
Thank you.
I'm excited to talk about Claritev. Claritev is a healthcare IT and services company that's focused on affordability and transparency in the healthcare market. Claritev recently renewed top 10 customers, comprising 70% of revenue. Travis, this is obviously a major accomplishment for you in your tenure as CEO. Can you talk about the renewal conversations? What did you learn from your top 10 customers? What's the value they see in Claritev?
Yeah, absolutely. So thanks for the invitation. Thanks for having us. I'm going into my second year, so I'll just make a couple of comments, and then I'll answer that. One is I'm actually really pleased with the performance of the team. So we're, I'd say, well ahead where I thought we would be in terms of our "turnaround." I'm highly confident in our outlook. This is probably the most visibility we've had to the business since I've been here in telemetry into the business. So a lot of the hard work we've done is allowing us to actually make better decisions and better focus. And call a number and hit a number, actually, with discipline. I think for our top 10 clients, the pressures in healthcare are real. Costs are going up dramatically. Everyone's reading the news every day. Our offerings add value, right? We bring transparency.
We take down cost. I think that they see that. We serve them well. We have an extraordinarily high NPS with our clients compared to my prior experiences, and we're not a point solution. So we offer a set of solutions across multiple areas, from access to care with networks to analytics and pricing transparency and payment revenue integrity solutions, so you add all of that up, and we've got the winds of healthcare behind us in terms of the macroeconomic costs and what we do solves those problems, and we have long-tenured relationships with big clients, and we've been able to, I think, renew, improve, and advance those relationships, and the last thing I'll say is that we've had dramatic pipeline increase in the business, so our pipeline has been up 67% over the last couple of years or last year.
And half of that is in our existing client base. So this idea that, "Oh, well, you renewed your client." Now, we didn't renew them to hang on. We renewed them to freaking grow the business, right? So I view those as every single one of those as opportunities for growth, not for, "Wow, I'm so glad they're still my client." So we're actually attacking that white space with our clients in a bigger way. So I think that the discussions actually have been wildly productive, and we're very excited about that because it forms a great foundation for us.
That's really good to hear, and I didn't appreciate that, that half of the pipeline is existing customers. I know that you guys can't provide specific detail on the terms of the renewals, but just interested if you want to comment at all about how potentially these renewals give you visibility into the future of analytics-based revenue, which is two-thirds of enterprise?
Yeah, yeah. Doug, why don't you spend some time on that one?
Yeah. And so we renewed our major customers this year, which was a great milestone for us. And the important thing, as Travis indicated, is we provide immense value to reduce the cost ultimately for the consumer of healthcare. And so in an opaque market where cost is inevitable and transparency is hard to come by, I think the value that we've been able to show across our portfolio of solutions allows us to now have a much different conversation to where we sit down with our large customers and plan our account, whereas maybe that might not have been the case prior to Travis getting here. What that enables you to do is not have a conversation about pricing and discounting.
Then by way of us communicating our success in the future, having a couple hundred million dollar pipeline that allows us to diversify the business doesn't make us be holden to a few contract renewals where we historically have come out and externally talked about client renewals. We're not going to do that in the future because we have a big pipeline. We have a growing and diversifying business, and we don't want to competitively disadvantage ourselves in the future. However, when it comes to what we've messaged externally, the renewals that we pursued this last year and the renewals of our major customers have been at commensurate economics. That's important for us because we spend $170 million a year of R&D and capital to make our products work better. So the tête-à-tête, if you will, is not having a conversation about discounting.
It's a conversation about how we have more things to sell and we can add more value.
That's also good for us because we know what a small 10 or 20 basis point change in PSAV means for the model.
Absolutely.
So that's encouraging. I want to move into just the model and specifically the PSAV model or PSAV model that generates 88% of revenue. So this is the model that's underlying Claritev's core out-of-network claims management business and also underlying Claritev's largest segment, analytics-based revenue. So maybe, Travis, can you describe what the PSAV model is and how does it align incentives and out-of-network claims management?
Yeah, certainly. So I guess I'll just have to say, so we have multiple ways that we do sell products. So we do have subscription-based revenue, software, and otherwise, but the lion's share is through PSAV. Just thinking about the market, it's how the market buys, actually. So the demand in the market for the service we provide is an aligned model off of savings. Actually, I'll just make a comment here. I think I've seen in other industries those types of models start to shift to more subscription-based models, including the area that I came from in the past. And so I do think that there may be a point in time where there's some value in scale, scale advantage to pricing versus this idea that you need multiple vendors and you have them battle against one another for savings supremacy. It may make sense. It may not.
But I do think that there are subscription-based pricing capabilities that are ultimately going to come to play. And large players have multiple solutions with scale will have the advantage over time. I've seen that in other industries. And so all that said, where we sit today is I'm glad to have the chance to talk about this because lots of other people talk about what we do. It's nice for us to be able to talk about it once in a while. Our view is we actually bring in insight. So there is no price in this market. And so savings are generated because there is no agreed-upon price. And so what we do is we bring in insight using publicly available data off of multiple baselines. Ultimately, the provider always has the choice to set that or not. Always. We don't set a price. We bring in insight.
The provider can say, "I'm taking that," or, "I'm not." Just under 99% of the time, that happens with no incident. It actually works really well. The example would be there's many, many, many examples. We give you thousands, but there are egregious ones like $20,000 splinter removals where we surface it and we say, "Hey, that's actually the average cost of that is $122. The network rate is this." The employer will be willing to accept the following price. Would you agree to that? There are others that are just simply there's opacity in this market, and there's not great transparency. There may be a charge that was higher than a median charge or a network charge or some other rate charge. You just bring that insight, "Okay, it makes sense. Sure." You negotiate it out quickly.
And so that's really how it works. If there was no service here, all of that cost would be passed through to the employer, all of it. And so in my mind, we actually serve the employee, which is the patient in healthcare, through the channels that exist in healthcare: brokers, TPAs, consultants, payers, you name it, multiple. And the last thing I'll say is we also work directly with providers every single day, providing many of the same services. And so the model works in that way. We find savings. As we find savings, we achieve some percentage of that saving as a fee, which we think we've earned because we have 40 years of IP development and capabilities and knowledge. And so that's how the model works. I don't know, Doug, if you want to put some numeric expression on that, great.
Yeah, no, that's great, and I mean, I would just add that it's an ROI model, right? We get paid if we derive value, and to Travis's point, the ultimate benefactor of the value is the consumer of healthcare for a small fraction of claims historically that go out-of-network, right, and so this is, on the surface, a niche part of the market, but when you look at the core PSAV model, it is an ROI-based model, and oftentimes, we get paid after our customer derives value and gets to a solution that ultimately works for employers, employees, and consumers of healthcare.
Got it. That's helpful. So just in terms of the model, do we think about the potential savings going forward as being an approximately 28%-30% of the medical charges processed, or is there kind of no visibility into that ratio?
Yeah, and so I think some of the metrics that Travis and I inherited are great high-level kind of macro metrics. When we do our Q4 earnings and 2026 guide, we're going to reframe things and provide much more simple, decomposable metrics to help model our business. I think we'll probably have a few other discussions. When we identify a saving, that doesn't mean necessarily our customer is using the savings. When you look at the gentle decline that we've had over the last few years, that really is a result and a residual effect of one customer that we've talked about that did some insourcing. If you look kind of over a five-year period, mid- high-20s has been the identified potential savings rate. Then there's a whole lot of things that customer-specific, macro-specific that you would unpack.
But I think that's a fair assumption. We typically don't guide to identified potential savings and some of those things. But we're really looking through our 2026 planning process right now to help tell our story in a much more simple fashion that helps folks model our business with the macro factors in healthcare and then one, two clicks down on how those macro factors relate to our business. And I know you're smiling. It's been an evolution process.
I wil clear the schedule on the day that you.
Believe it when you see it.
Yeah, that you've written. I appreciate the heads-up. So just from your perspective, why do TPAs and payers outsource out-of-network claims management instead of doing it themselves broadly?
Yeah. So when you look at it as a technology provider who spends nine figures a year on R&D, some things it's supplemental high-performance and complementary networks, and then payment and revenue integritymuch easier to buy than try to make yourself. And so our largest customers who use us for a range of solutions, not just out-of-network cost containment and affordability, but supplemental high-performance and complementary networks, and then payment and revenue integrity, a lot of the intelligence that we've built and we've spent nearly a billion dollars of R&D over the last decade making our products work and work extremely well. And when you look at technology solutions and services, there comes a time where a company might look to try to do something themselves. But when you look at our core business, and if you just use the identified potential savings metric, right?
So last year, we identified approximately $25 billion in savings. It is a fait accompli to try to disrupt something that's such a critical part of the economics of your P&L. And so what we found is the scale advantage, as Travis mentioned earlier, of having strategic partners that you can grow with makes your P&L much more functional and margin accretive as you go forward. If you make a decision to try to insource something and do yourself, it is a potentially disruptive thing that most of our customers have realized.
That's where if you unpack the one client issue that we've talked about over the last few years, most of our accounts have grown mid to high single digits because our ability to add value and solve customer problems and then the high operating leverage and margin that we have affords us the opportunity to invest 14% of our revenue in R&D and technology.
Okay. So that's helpful context. So I want to spend the majority of our time talking about the majority of your revenue, which is obviously the analytics-based segment or the out-of-network claims management business. So commercial medical charges process, potential medical cost savings, and revenue as a % of savings are kind of the drivers of this segment. We want to get your perspective on each. So commercial health plan medical charges process or out-of-network billed charges is how we think about that, grew 7% year over year in 2024 and up 8.5% year to date in 2025. What is driving the strong and accelerating growth? And can you just provide any color on categories of care, claims volume, or billed charges per claim?
Yep, sure. So I'll take a stab at that and, Travis, if you have any color. So when you look at the strong growth in medical charges processed, it's pretty much squarely aligned with healthcare inflation, right? And so our claims volume, especially in the out-of-network space, has been relatively stable on a like-for-like basis. But what we're seeing is a higher mix of higher out-of-network claims in areas like ambulatory surgery, musculoskeletal, and behavioral health. And so those are, and if you think about maybe taking behavioral health as an instance, those are categories of care that maybe rarely ever go in-network. And so when you see some of the benefit of the spend increase that we've seen, part of it's healthcare inflation, right? It's reflected in our results.
But then as we model the business long-term, we think that healthcare spend roughly will be 5%-7%. Out-of-network spend will be roughly 5%-7% and be very stable and ratable over the next few years. But what we've seen, especially this year in some of the improved metrics that we've provided, like revenue per claim, a lot of the growth and the savings that we're delivering and the associated revenue that fuels our PSAV model is in those categories of care that tend to be higher ticket price. So you look at things like the NSA. I think it's fair to say a lot more traditional claims have gone in-network. But where our customers really rely on us is in an opaque market for out-of-network claims trying to get to a fair reimbursement and a reasonable price.
Those categories specifically have been ones that have been higher cost, higher ticket price, and where our products perform exceptionally well when there's not a price or an insight to drive.
I would just add, I mean, it was critically important for us to renew those top clients, also launch six new markets this year, verticals. The reason is if you look at the macro of healthcare, it's not great for cost in healthcare, but it is great for the solutions we provide, right? So as medical inflation goes up, employer plan costs are going up dramatically, which, oh, by the way, ours have gone down the last two years, and we've improved our benefit because we use our own product called BenInsights, which is something we should.
Absolute basis.
I would love to come back.
Absolute basis.
Absolute basis. I would love to come back and talk to you about that in a different session. It's fascinating what we can achieve there. The call for transparency is up. The focus on waste, fraud, and abuse is increased. Care and healthcare will continue to move outside of the four walls, meaning out of the acute setting into these areas that Doug mentioned. We think all of that actually is going to drive greater need for our services than ever before.
Now that we've found our footing and our view, the reason we coined the term, we stepped out there, and so we're going to turn the business because we believed that we could see what was going to happen with our largest clients, the single client issue that we've been discussing, and where we could find the floor of that to create the upward momentum in the business. We've done that with our last two quarters, beat-and-raise quarters. We're very excited about our outlook, and we think that our future is extremely positive behind the tailwinds of healthcare, not magic tricks, no shiny lures. I'm going to make cool stuff, and we're going to sell it.
But you don't even have to believe that to believe in the story of the company, because what we do is real integral to what's happening right now in healthcare, in our view and in the data that's showing up, so.
Yeah. It makes a lot of sense. So just when we think about kind of 5%-7% of overall spend out-of-network and that level being relatively stable over the next however many years, three to five call it, how should we think about just recent moves from large national payers to try to curb out-of-network utilization? So for example, Elevance has announced that they'll be penalizing in-network providers who bill or who employ and bill out-of-network individuals or services at that facility. And then I'm also just we get this question from investors fairly often. How are large national payers responding to out-of-network utilization in 2025? Are they growing networks? Are networks contracting? What are you seeing?
Yeah. Maybe I'll take a first stab. So on the first part of the question, it's hard. Each one of our largest customers, if you look at the top 10, has roughly the same trajectory, kind of roughly the same portfolio of stuff they buy. What we've seen in our data indicates that the network has been relatively stable. I think from a macro perspective, when you look at one big beautiful bill, what's going to happen with ACA, I think in the near term, there's even a possibility for networks to narrow. And so it's hard to tell. We haven't necessarily seen that in our data thus far. But where we've kind of underpinned our plan on the kind of 5%-7% is we're planning on kind of modest and stable volume. We don't expect a significant or sharp increase in out-of-network volume.
We expect it to be stable. What that means from quarter to quarter, plus or minus a couple of percent on volume. But the spend and kind of the mid to high single-digit inflation is why we feel confident that that 5%-7% barometer is a good milestone and a good planning assumption. And then each payer is managing their network, and it's a significant part of their P&L. But we also sell high-performance supplemental and complementary networks to our customers as well. And so I think the most encouraging thing since Travis and I joined is when we got here, I think we underappreciated how strategic our network asset is. So we have negotiated rates with 1.4 million providers.
And as we had discussed with a couple of my colleagues on our webinar a few weeks ago, we have a few lines of defense to simulate in-network pricing before IDR happens through NSA, before conflicts happen or disputes and charges with a very high acceptance rate. And so we don't view one or other customers trying to manage the performance of their network against a backdrop of a P&L that they're managing when we look at the positive impact of having a stable out-of-network environment. And it's fair for those customers of ours and the large payers to try to manage and perform against their network. But we haven't seen anything in the data that suggests one thing or the other, which is why we're pretty confident with that stable outlook on out-of-network spend and claims volume over the next few years.
Great. That's really helpful. We addressed potential savings and PSAV, I think, a little earlier. So I'm going to just move on and ask Travis, how might the NSA and price transparency regulation reshape your out-of-network business in the analytics segment? What have you observed so far? And then in the future, how will this regulation impact commercial health plan medical charges processed, potential medical cost savings?
Yeah. I think when it predates my arrival here, when it first happened, there was this "existential crisis" to the business. But I think the company quickly pivoted and created a profit stream out of that, right? I mean, we serve our clients with NSA on NSA and the regulations. We serve them through the IDR process, and we serve them in many ways. It's similar to the prior discussion. We actually are really good at it because we do it at scale across multiple clients in multiple ways. And so we'll be applying more capital to this area, more AI, more focus to that area. So we support them. I view it as a growth opportunity, particularly at the state level. And so we're seeing more demand at state level for our services than we ever have.
And we also know that we have to continue to talk about this, advocate for it, understand the IDR process, understand the win rates that are out there. And we think that we can actually win at a higher percentage going forward, even though we're seven% better than any competitor that's doing it. And so we believe we have a competitive advantage, but we also think that it could be advantageous for us as we move forward. And it's only about 10%, I think, of our total claims volume.
Yes. It's even less than that. And I think we gave a little bit more of an explanation the last time we spoke just because we have a few lines of defense. When we get a claim and it goes through NSA, we have a network contracted rate with 1.4 million providers. Oftentimes, getting to a QPA is almost an instantaneous thing once an NSA claim enters into our ecosystem. If that doesn't work, we have a financial negotiations business, which is our second largest category within our analytics, where we have hundreds of folks who are experts and talk to providers sometimes hundreds of times a day. And so we can get to a qualified price or a QPA either in an automated fashion because we have network rates, negotiated rates, or through financial negotiations.
And then there is a very small fraction of claims that go through the IDR process. To Travis's point, we do exceptionally well. But the scales of justice in this category are something that probably a combination of awareness, which we've published white papers, we've had some research reports, we obviously study the CMS data, and then perhaps an update to the regulation, which, who knows, when that's going to happen. But we have turned that product into our third largest product category within our analytics business, which is a pretty exciting feat over the last three years to go from zero to a very high-performing and a growth product.
Yeah. That's extremely helpful. Travis, I hate to compress growth into the last.
I can do it in 30 seconds.
minute or two. But so just I do want to move from core to growth. Claritev's booked $45 million of new ACV year to date through 3Q. You expect to close an incremental $15 million by year-end. What are the categories of booking strength, and what is the timeline on bookings to revenue conversion?
Yeah. It's going to be tough to do in seven seconds. So let me just say.
That's okay.
So look, I'll just say this. So the core structure of the company at this will be the first year going in that we've actually had what I would call a true sales function, right? And so I spent the first year getting the company fit for growth, the second year getting the go-to-market function in place, and this year we're going to go for it. And so when I say go for it, I mean we have five product categories across the network, payment, revenue, integrity, our data science business. We're going to get more at bat across multiple vertical markets. And so you see our white space grow dramatically. You see our pipeline growing dramatically. We're selling opportunities direct to employer, brokers, consultants, government, direct to provider and payer.
And so you add that up, we don't have to do a lot of customization to get full value for our products across more opportunities, which results in a much higher TAM for us, not just TAM, but real bookings. And that's showing up in results. So we're starting to see that in our sales activities and our booking activities as we go forward. So.
So high incremental margins on the growth products, it sounds like.
Yeah. Absolutely. These aren't new products. These are existing products that we're just using in different ways or in targets that we've increased the size of our sales force three times in the last three quarters. And so I think we just have better telemetry in the business. We see where the opportunities are, and we're putting the right resources on it, so.
Yeah. And then maybe just finally on the bookings to revenue conversion, we go through our Q4 earnings and our 2026 guide in February. We will provide a much more distilled version of how you can think about bookings to revenue conversion, including what we expect to book in 2026 as well.
Okay. All right. Great. That's very helpful. Thanks so much for the time.
Thank you.
I appreciate it.
Good luck today.
Thank you.
Wonderful lunch.
Thanks. Appreciate it.