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Citi Healthcare & Medtech Conference

Mar 2, 2023

Daniel Grosslight
Healthcare Technology Analyst, Citi

All right. Good afternoon, everyone, thanks for joining us for the MultiPlan fireside chat here at the Citi healthcare conference. My name is Daniel Grosslight. I'm the Healthcare Technology An alyst here at Citi, and I'm pleased to welcome Dale White, the CEO of MultiPlan, and Jim Head, the CFO of MultiPlan. Thanks both for joining us here.

Jim Head
CFO, MultiPlan

Thank you.

Daniel Grosslight
Healthcare Technology Analyst, Citi

I'm sure I don't have to tell you this or anyone in this, in the room this, it's been a little bit of a wild ride for MultiPlan since you guys went public via de-SPAC. You know, I'd like to focus maybe our conversation, at least up front, on a few of the big controversies that I've talked to investors about quite frequently. The first one would be on just revenue visibility, particularly given some utilization challenges more recently. The second one would be competition and the potential for customer insourcing. The third one is just the NSA and the potential impact on-

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

on your business, which seems to be in flux every day. Let's kick it off with the revenue visibility question. As I mentioned, much of this revenue visibility headwind has come about because of a lack of utilization, or at least an abnormal utilization pattern this year coming out of COVID and with a potential recession. Given the lag between your procedures, your savings that you generate, revenue recognition, how much revenue visibility do you have on a quarterly basis?

Jim Head
CFO, MultiPlan

Right. Yeah, why don't I take that, and I'll go.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah.

Jim Head
CFO, MultiPlan

Talk about competition. It's interesting. We've got a platform that serves the out-of-network market, and we all of our distribution channels stretch out to 100,000 plan sponsors, which are basically companies like Citigroup and all their employees. On, on one hand, there's a fair amount of visibility into the ecosystem, right? Which is 'cause it doesn't shift year to year. Citigroup isn't changing its benefits wildly each year. They're tweaking it, and my guess is they're probably using MultiPlan. I'm gonna take a guess. What underneath the surface is the consumer behavior. Whether, Daniel, you choose to use in-network, out-of-network, whether you're utilizing healthcare, et cetera.

What we saw last year was a little bit of more of a change in the consumer behavior versus the change in the ecosystem we're in. The ecosystem really didn't change. The services we're offering, the plan sponsors, et cetera, were all intact. It started changing mid-year. That was one of the sources of our lack of visibility. I guess the unfortunate news is we. You can see it coming through our second half. All of a sudden, our savings came down, and it's kind of. The claims that were coming into the top of the system, we disclosed that in our commercial health plan. It started coming down, that's actually stabilized. I would say lack of visibility last year, absolutely, 'cause the world kind of changed.

Inflation, post-pandemic, a lot of behavioral changes. What we're. I'd say visibility into 2023, we're taking a pretty, sober point of view that we're not expecting any upswing. I think the other part of visibility in 2023 is we gave you we said we gave you a 3-fer. We put all three, you know, adjustments, if you will, client renewal adjustments into one number for 2023, and that really does kind of encapsulate it. Two of the things that were the biggest question marks a year ago, customer renewals and what's going on with the consumer, we've kind of reset that and have a, have a greater level of visibility, this year. On a quarter to quarter, you typically have a pretty good sense, on that.

You can always be surprised because the, you know, last year in the second half, there was some volatility in just the utilization of, you know, the system.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah. I guess that's just the nature of the business. If there is a significant behavior change that affects, you know, the macro environment, you just don't have that visibility.

Jim Head
CFO, MultiPlan

Well, we just went through two, right? We went through a pandemic that, you know, that caused consumer behavior to change because capacity went to zero. Then last year you had record-setting inflation, which impacted, you know, just generated a bunch of pocketbook issues that caused members to defer care.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah. Yeah. If I look at the guidance that you introduced, seems like a decade ago, but I think it was two days ago, it calls for.

Jim Head
CFO, MultiPlan

That is accurate.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Around a 12% decline-

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

in revenue year-over-year and around 500 basis points of margin compression. I think you broke out all the headwinds and tailwinds quite helpfully in your investor deck, which was great to see. If we can just kind of hone in on some of the headwinds, namely, you know, the lower utilization that we spoke about.

Jim Head
CFO, MultiPlan

Mm-hmm.

Daniel Grosslight
Healthcare Technology Analyst, Citi

The non-recurring contract that rolled off. It's around $120 million of headwind, and then you laid out kind of a contract renewal headwind of around $86 million or so. Let's start with the first-

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

headwind here on utilization. You noticed that or you noted that, December was your strongest month.

Jim Head
CFO, MultiPlan

Mm-hmm.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Since May 2022. Your guidance assumes basically that you're at the run rate of Q4. I guess help square that for us. Is there just conservatism built into that to that number because of the lack of-

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

of visibility? When do you think you can get confident that what you've saw in December, that the strength of utilization in December is gonna carry forward for the rest of the year?

Jim Head
CFO, MultiPlan

Yeah. Maybe to kind of put into contrast, you could track the quarters through last year. In the second half, really, you know, Q3 was $250, and Q4 was $241. It was kind of the new normal. Inside that, you had a little bit of a trough in October. I would not describe December as a, you know, as reaching escape velocity into a new realm. We are being cautious. We do think it's stabilized a little bit. Part of what was running through the system, we lag a little bit.

Our December, if you think about it, just take everything we record, our performance is essentially of data service claims that were two months prior-ish, you know, 8 weeks-10 weeks, 8 weeks-10 weeks. Our December really reflected what was going on in September, October. Our October, which was low, was reflecting what was going on in the middle of the summer. We definitely saw deferred care. We also saw capacity constraints. I think what's happening is the capacity is lifting a little bit. Some of the deferrals are, you know, coming. In the fall, you started seeing the classic back to school, you know, sniffles, RSV, flu, et cetera. We look to the leading indicators, so we're not devoid of that.

It's just not clear to us that there's a concomitant kind of explosion of demand coming in the hospital sector, for instance. There's been even some volatility on that. We're being cautious and then focusing on what we can do best with the volume environment that exists.

Dale White
CEO, MultiPlan

I think there's many of us in the healthcare sector who would love nothing more than to predict utilization with digital precision. Right? We're just being cautious and saying, look at what Yep, December uptick, modest. We built in a modest recovery going forward, in utilization. We don't wanna get out over our skis.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Thank you. Let's turn to the other major headwind for 2023, the contract renewals. You had two last year that started on one. You have another one which will renew by June of this year. Can you put a finer point on where the headwind specifically is coming from? Are you seeing folks direct volume to other solutions, or is it more of a pricing headwind?

Dale White
CEO, MultiPlan

It's more the latter. We, you know, look, we said that You know, we did two contracts, to your point, last year. Once since the earnings call, and now this one that we'll do by the end of June-ish, mid-summer. All of them are built into our guidance, right? The impact is all built into our guidance. It's not a change in scope, it's not a change in service, it's rates, to your point.

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Okay.

Jim Head
CFO, MultiPlan

You had predicted, you know, before what some of the earlier impacts just with one data point might have been.

Dale White
CEO, MultiPlan

Yeah.

Jim Head
CFO, MultiPlan

What we've done is wrapped it all into one big one.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah. I know you're not blessing my numbers, but If, if my estimate was right, that would mean that first renewal was the vast majority of this.

Jim Head
CFO, MultiPlan

You, your estimate, I will not bless your number, but you at least sized based on the guidance that we've given you that it was a significant number. How's that?

Daniel Grosslight
Healthcare Technology Analyst, Citi

Okay.

Jim Head
CFO, MultiPlan

What we've seen is, you know, this washing through into the view of 2023.

Dale White
CEO, MultiPlan

You know, from our perspective, right, it removes a considerable overhang, right? We've now addressed one of the biggest, you know, issues.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Controversies.

Dale White
CEO, MultiPlan

Controversies, is client concentration. Looking at those three and the overhang, we now have great line of sight into those contracts over multiple years.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah. Yeah. Although I think there are some bears that will never be satisfied by what you do, but it is a great signal that you are an important partner. If you look at the 10-K that you just filed, too, you know, the revenue from your top customers has remained pretty stable.

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

I think that's a good.

Dale White
CEO, MultiPlan

Mm-hmm.

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

You know.

Jim Head
CFO, MultiPlan

The way we should characterize it is, these are our top distributors.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah.

Jim Head
CFO, MultiPlan

Right? I mean, in the end, the, the ultimate buyer of the, you know, of our services is a Citigroup or a Honeywell or, you know, I'm naming just large corporates who make a benefit decision, and they want the MultiPlan offering as part of it, okay? It's very hard to actually change that year to year. 100,000 plan sponsors. We dissipate off into the market, and the choices are made at the plan sponsor level. There's no light switch in there because people. The, the HR lead or the benefits manager at a large organization is not bouncing around on their benefits choices year to year. They're, they're tweaking it, they're enhancing it, they're.

Generally speaking, the out-of-network is not a, you know, something that comes up and is thrown out one year and brought back the next year.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah. It's interesting, we just had our, a panel with, the head of Citi's benefits, and our consultant partner.

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah, it was very in line with what you just said. You know, I think this year is a little bit odd because of the concerns around a recession.

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

I'm wondering, and we've always said that, You know, relative to another product in the market that's reference-based, MultiPlan is a little more generous for the employee because you're not balance billed as much.

Jim Head
CFO, MultiPlan

Right.

Daniel Grosslight
Healthcare Technology Analyst, Citi

In times, weaker economic times, I'm wondering if the balance of power here moves back towards the employer, where they're now really looking closely at ways to save money and, could switching to a reference-based repricer be a way that they save money-

Jim Head
CFO, MultiPlan

Mm-hmm.

Daniel Grosslight
Healthcare Technology Analyst, Citi

in these more challenging times?

Jim Head
CFO, MultiPlan

Dale, maybe just start with the big picture issue. Cost, right? It's all about cost, right? I would say it's all about cost. Employers are always looking for ways, and self-funded Citi and others during now are always looking for ways to save on the total cost of care. Reference-based pricing, not a new service, it's been around for a while, is a form, is one way to do that by lowering the rate of reimbursement to providers.

HST, our reference-based pricing arm, is, has done very well and is in that same, you know, that same area and has done extraordinarily well and hit with, you know, in that middle market where the benefits and, you know, employers are struggling to provide a comprehensive set of benefits to their employees, and reference-based pricing helps manage the cost of care, so they can put more back into their benefit packages.

Dale White
CEO, MultiPlan

Yeah. Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Let's go to the margin headwind for 2023. I think you pointed out around 250 basis points of headwind, incremental headwind. Are these headwinds more structural in nature, or are you making significant one-time investments in 2023 which won't recur?

Jim Head
CFO, MultiPlan

I'll have to do the math on the bridge. We exited Q4. That, that kind of is the run rate of the business. We're a fixed cost shop when you really get down to it. We don't. If revenues are 10% higher or 10% lower, our cost base doesn't flex that much because it's basically people and a platform. What you heard from us on that was we took our fourth quarter and when we did identify some cost savings, we got smart on some components of external spend. We found about 4% savings in our cost base. Some of that was given back just on the rising cost of, you know, salaries and things like that, right? Merits, et cetera.

A big component of our cost base is salaries, it's people. We are also making investments in the business, and I think that's the real story here. We did have to make some investments in the infrastructure, NSA in particular. These aren't big numbers, but marginally, we had to invest more money back into NSA to kind of deal with the exploding IDR volumes and support our clients, were in the infrastructure. Importantly, we're investing in new products. That's what Dale had highlighted, his kind of four new products that we are launching throughout the course of this year towards the back end, largely.

That to us is pretty interesting because between that and the capital expenditures, what you're hearing from us is we're finding really good opportunities to launch new products into our existing customers that are essentially an upsell. The investment required is not dramatic. Nothing's even over, you know, much, you know, $5 million maybe, but $1 million-$5 million in terms of size. Those types of investments that could yield multiples on revenue and the opportunity. That's really good news for us because we're finding places to invest.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah. Yeah. I know you're not giving 2024 guidance yet. You know, if we think that your you know, costs are largely fixed.

Jim Head
CFO, MultiPlan

Yes. Mm-hmm.

Daniel Grosslight
Healthcare Technology Analyst, Citi

You're going to drive growth through some of these new products as well as your core business, and there's not a lot of incremental investment that you need to make, $1 million-$5 million.

Jim Head
CFO, MultiPlan

Yeah. Mm-hmm.

Daniel Grosslight
Healthcare Technology Analyst, Citi

As you return to growth in 2024 and beyond, should we expect to see margins improve?

Jim Head
CFO, MultiPlan

Right.

Daniel Grosslight
Healthcare Technology Analyst, Citi

You do have high incremental margins off of that.

Jim Head
CFO, MultiPlan

Yeah. I mean, if each $10 million that comes in could be an extra point, right? It's rough justice. There's a natural bias for uplift in our margins, okay? What's gonna offset that is just making sure that we're continuing to invest in the business. I think maybe the right way to say it is, we can show some modest uplift over time. We're not gonna get back to 75% margins. We don't think that's what that says is we're devoid of investment opportunities. We also don't think there's downward pressure in the sense that fixed cost base really is. You know, if we're finding more revenues, we should be fine.

Anything we're kind of adding into the mix, most of the opportunities we're looking at are basically in that corporate level margin opportunity. There's no mix shift in a dramatic way.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Got it. Should we think about this business as operating more in the mid to high 60% margin?

Jim Head
CFO, MultiPlan

That feels much more like the new normal. Feels right. Yeah. Probably healthier.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah. Let's talk about the model in general, because there has been, I think, some more products in the market that charge on a PEPM basis-

Jim Head
CFO, MultiPlan

Mm-hmm. Yes.

Daniel Grosslight
Healthcare Technology Analyst, Citi

versus a percentage of savings where you generate a majority, vast majority of your revenue right now.

Jim Head
CFO, MultiPlan

Mm-hmm.

Daniel Grosslight
Healthcare Technology Analyst, Citi

If we look at your financials, PEPM has become more prevalent in terms of where you're generating your savings. Can you just talk a little bit about how the market is evolving, perhaps, in terms of shifting from percentage of savings to PEPM, if at all, and how you're responding to that?

Jim Head
CFO, MultiPlan

Sure. On our, what we'll call our legacy platform, mainly our out-of-network cost savings, the model hasn't changed.

Dale White
CEO, MultiPlan

Right. The same way, you know, it's largely intact. The way we've been compensated as a percentage of the savings is largely intact. The reason why you see growth in the PEPM is HST. HST's model is a PEPM model. With its growth there, you've seen the growth as we played it out in the deck. As we go forward, and now you look at the four initiatives that are in flight to be deployed this year, and they're all aimed at our core, right? These are enhancements to the core, which largely will have the same pricing model as our core. The service that we said we were announcing a new service line, data analytics. I expect that could be a different pricing model, right?

That could be a different pricing model.

Daniel Grosslight
Healthcare Technology Analyst, Citi

As of now, no pushback from your clients, on the pricing models percentage savings. Let's dig a little deeper into those four new products that you laid out.

Dale White
CEO, MultiPlan

Sure.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Can you just spell out for us kinda where you're investing most of your time now? I guess more importantly, the cadence of that?

Dale White
CEO, MultiPlan

Sure. Jim and I, look, we've been in place for a year and for 15 months in these seats, and we see with this company has an incredible platform, incredible client relationships. One of its strength is its payer relationships, and on this side it has access to millions of claims. Those two assets are tough to beat. We just wanna take advantage of them, and we wanna take advantage of them with more product. We've gone about, you know, identifying with our team and with our customers. I mean, these four product launches are, you know, didn't come out of an innovation room, and now we're gonna go out and try and sell them to our customers. This is our customer wish list.

That's the benefit of having long and trusted relationships with your customers. We're sitting across the table collaborating on what their pain points are and what we can do to deliver more product to generate more value and more savings for them and their employer customers. We're focusing on bringing. One is to bring AI and machine learning to smart scoring, to how you route the claim. How do you take a claim that it comes in our front door and route it to the solution that maximizes the savings opportunity for the payer, drive it to the right answer? That's the lift is on our end. It's largely an IT lift, and we'll be ready to deploy by the end of this year. We're doing a lot of work in NSA.

We took NSA. I think you've identified it as a controversy. We didn't think it was a controversy. It's not a controversy. Most people don't today think it is. It's a real strength of the company for us. We've now taken that and we're adding to it. We're bringing analytics, reporting, client portals. We actually have a client working group together that where we're sitting around developing the product. That's another area of focus, right? Continue to build more on in the No Surprises area. Third, we're doing is the, you know, the refreshing IBR, right? We're taking Itemized Bill Review and building that. Those are one.

The fourth one is we're bringing a product to the HST platform, which will address the non-surprise bills, so not the emergency bills, but the other bills, and address the balance billing issues associated with that, and it will be part of the HST platform. Those are the four products, all aimed at our core. The fifth is the data service and data analytics business that we're working on. Now, in parallel, we're advancing more products. We're advancing more products to be launched next year. We're doing the advanced work needed. Too much this year. We have the four. We wanna do it right. We'll launch those in 2024.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Okay, great. You know, clearly a lot in the hopper-

Dale White
CEO, MultiPlan

Yep

Daniel Grosslight
Healthcare Technology Analyst, Citi

right now. Look at your growth rates going forward, longer term growth rates. I think you've said before that mid-single digit is kind of where you should be at. How much of that growth to mid-single digit is gonna be your core analytics networks, AI solutions, and how much is gonna be from some of these newer products that are in development?

Dale White
CEO, MultiPlan

In some ways, if you wanna think about how we think about the longer term growth algorithm, look at our bridge and essentially get rid of the headwind part.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Mm-hmm.

Dale White
CEO, MultiPlan

Maybe say in the longer term, there's a little headwind 'cause it's always. You will always give back a little bit of the volume and the inflation and the productivity gains because they're big customers in the core. I'm sorry, at the national account level, right? We have a pretty big revenue biz, you know, revenue business outside of that in regionals, the other blues, HST, et cetera. Between that mix, we think we can get to a mid-single-digit type of algorithm. The new products are on top of that. I think that that 1%-2% could be, you know, maybe lift up a little bit as we start seeing some of those things germinate.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Got it. Okay, let's turn to the second controversy then that I've identified.

Dale White
CEO, MultiPlan

That was just the first one?

Daniel Grosslight
Healthcare Technology Analyst, Citi

That was just number one.

Dale White
CEO, MultiPlan

Okay.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Competition. This has obviously been top of mind since you de-SPACed. Really, it's the threat of insourcing rather than competition from other similar companies that we get. 'Cause I think that there's no one really that can do what you do at the scale that you do it, except for the plans themselves.

Dale White
CEO, MultiPlan

Right.

Daniel Grosslight
Healthcare Technology Analyst, Citi

We've already touched on this a little bit, but, you know, what's preventing your clients from insourcing to their internal solutions, especially as the plans get bigger and more vertically integrated in technology? We saw United buy Change Healthcare. I suppose more importantly than insourcing itself is the threat of insourcing to really take down pricing, which is, you know, what happened on these recent contract renewals.

Dale White
CEO, MultiPlan

Yeah. Well, I'd say the best, you know, the best indicator of insourcing is we've been doing this for 42 years, and they've had You know, clients have had ample opportunity along the way to insource their services. To your point, Daniel, we have size, scale, you know, we have We're able to do it at a cost that's less than them. I mean, look at No Surprise. No Surprise was a great opportunity for a client, you know, for a, for a competitor to come in or to insource, and that didn't happen, right?

Jim Head
CFO, MultiPlan

That was the biggest RFP in the last 20 years.

Dale White
CEO, MultiPlan

In our case, we, as we've announced, two clients made decisions, one to insource. That was, to Jim's point, was the biggest RFP in years, and it didn't happen. Somebody could have taken our block off, and it didn't happen. It's all about providing value. It's all about providing innovation. It's all about driving you know, value at a reasonable price and performing.

Jim Head
CFO, MultiPlan

Yeah.

Dale White
CEO, MultiPlan

It's those variables that create a lot of stickiness. I mean, I'll speak to Surprise Bill, because that was an opportunity, and we were there ready to deploy, you know, ready to deploy on January 1 in less than 12 months.

Jim Head
CFO, MultiPlan

Yeah. Let me just give a couple fun facts. We're close to $500 million of investment in capitalized software on our platform.

Dale White
CEO, MultiPlan

Yeah.

Jim Head
CFO, MultiPlan

A lot of that is actually configurations for our customers' IT environments. One of the other parts about it is not just, you know, cost, but it's like, oh, gosh, I'm gonna have to recreate the system to allow us to do this. The other part is we are a trusted, call it clearing. We're not a clearinghouse. We're a trusted adjudicator of all this between the two parts of the system that are oftentimes clashing pretty hard and litigating.

Dale White
CEO, MultiPlan

Yeah.

Jim Head
CFO, MultiPlan

That is between the providers and the payers. Our independence is actually really important. Between independence, the investments we've made, we've sharpened our prices, the insourcing equation gets tougher and tougher every, you know, every bit we continue to invest and every time we sharpen our price. The idea is I can do better, but I have to go tell 20,000 plan sponsors that I can do better than what they've been doing for 20 years? That's not easy. Your HR person's like, "That's an interesting proposition. I'm not willing to do that because I don't want Daniel squawking, you know, Daniel and 20,000 other people squawking at me because I made the wrong decision.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yep. Yeah. Makes sense. I know you can't comment on this directly, but last year we heard a lot about Naviguard and United.

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

You know, we haven't really heard a lot about Naviguard recently. It seems to not be a huge factor in the market, at least not yet. If I look at your 10-K which you just filed, around 32% of your revenue is still coming from United, by far your largest customer. My question here is, if an ASO client wanted to move to a product like Naviguard.

Jim Head
CFO, MultiPlan

Sure

Daniel Grosslight
Healthcare Technology Analyst, Citi

How much notice would they need to give you? How much visibility would you have into some of that attrition at the self-insured level?

Dale White
CEO, MultiPlan

It varies from client to client in terms of the visibility that we have. I think, most of those, you said big clients, so most big clients renew.

Daniel Grosslight
Healthcare Technology Analyst, Citi

One, one.

Dale White
CEO, MultiPlan

One, one.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah.

Dale White
CEO, MultiPlan

Right? That's the biggest change. Clearly by typically, in some cases, we have visibility going in, and in other cases, we'll have visibility by March.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Okay.

Dale White
CEO, MultiPlan

You know, sort of because by then we'll see, you know, we'll see the run out-

Jim Head
CFO, MultiPlan

Yeah

Dale White
CEO, MultiPlan

if somebody changes. There's always change. You know, the bigs, if they make a move, they're usually moving to one of the others. We may see it over here. We see it over here with another carrier. If it goes to a completely another solution, we'll either know that in advance with some, or we'll see it in our claims by March.

Jim Head
CFO, MultiPlan

We've seen boomerangs.

Dale White
CEO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Explain that one.

Jim Head
CFO, MultiPlan

Meaning it goes, it goes one direction, then a year later comes back.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Okay

Jim Head
CFO, MultiPlan

We, the right way to describe it is we get a general sense from the, I'll call it our big distributor partners, kind of membership up, down, sideways, you know, kind of thing. You can track their ASO books through their filings.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Filings.

Jim Head
CFO, MultiPlan

Right? It, you know, generally speaking, it's kinda trending upwards at a couple percentage growth each year. Some are flat, some are up a little bit. Again, the reference-based pricing product is better suited for smaller customers, lower end of the market, maybe lower wage types of. That there's nothing pejorative about it. It's just that that's where the cost sensitivity seems to be most direct.

Dale White
CEO, MultiPlan

Maybe not at the larger end of the market. There will be big accounts that will switch over, but, so we have a sense of that, but it's also, there's a lot inside the competitive game between the, those platforms, we see sometimes we see accounts going back and forth because they make switches from, you know, one platform to the other, but it's not a sea change. One of the reasons why is each employer is not that big of the overall puzzle. It just isn't. We've got 60 million members ultimately through 100 thousand plus employers. Our exposure at the plan sponsor level is quite small.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Got it. Sitting here today, you know How much, I guess, I'm trying to get to how much visibility you have on potential attrition versus, you know, what you'll have in March? Are you kind of like-

Dale White
CEO, MultiPlan

I think we probably, yeah, I think we're fair amount of visibility. It's just not digital.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yep. Got it. Okay, with the last eight or so minutes we have here, let's talk about, we'll call it a non-controversy controversy. The, the NSA.

Dale White
CEO, MultiPlan

The weather?

Daniel Grosslight
Healthcare Technology Analyst, Citi

I remember actually last year when you were at our conference, we were talking about this as we have been-

Dale White
CEO, MultiPlan

It was.

Daniel Grosslight
Healthcare Technology Analyst, Citi

for the past year and a half. You said, at that time, it was the rules had just come out around the QPA, and it seemed like a very restrictive rules making process in favor of the payers where the QPA was effectively a de facto benchmark. At that time, I think you said, "Well, there's some litigation around this which might prevent that from happening." Lo and behold, a few, I think, a week later or so, that Texas lawsuit-

Dale White
CEO, MultiPlan

Right.

Daniel Grosslight
Healthcare Technology Analyst, Citi

was settled.

Dale White
CEO, MultiPlan

That's right.

Daniel Grosslight
Healthcare Technology Analyst, Citi

In favor of the Texas physicians, which made the QPA less of a benchmark. This year, it's a little bit of deja vu again, because we have another lawsuit out of the Texas physician group. Where do we stand now on the utilization of the QPA as what was effectively a de facto benchmark in the IDR process? How do you think, if you have your crystal ball, 'cause it worked so well last year, where do you think that goes eventually when some of the rules making is finalized?

Dale White
CEO, MultiPlan

I think it's All of that, it's great questions. I mean, from our perspective, the in terms of the No Surprises, last year was a learning year for everyone. We were priced, as we said, we priced almost $1.75 million Surprise Bills on behalf of our customers. The work we do, even despite the litigation in connection with the IDR, we've seen, you know, most of our work is done taking a Surprise Bill claim and identifying it as one, applying a client's QPA, returning it to the client, and they pay it. Then if the provider's unhappy with the reimbursement, they're obligated to reach out and enter into a negotiation. We do that.

That's where the lion's share of our work takes place, even with all the litigation that's taking place around it. Where the litigation has been focused is in the IDR process. And we, you know, as Jim said, we saw an explosion in the fourth quarter of IDR requests, still a small fraction of our overall volume. What the rulings did is it made the arbitration process more balanced between the payer and the provider. So with the ambiguity, with the rules change, by design, when we talked this time earlier last year, we designed our IDR process to be nimble and flexible regardless of which way the pendulum swung in favor of the provider or the payer. That's paid off for us.

We're comfortable where we are in terms of, you know, the rulings are the rulings. It's a more balanced approach, and the payers continue to rely on us on making, you know, on handling and managing the IDR process on their behalf under the rules that are in place now.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Got it. Would, I guess if a bulk of your work is done before the IDR process itself, would any, you know, major rules changes have an impact on?

Dale White
CEO, MultiPlan

The bulk of the revenue? Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah, the bulk of revenue. Not really?

Dale White
CEO, MultiPlan

Not really.

Daniel Grosslight
Healthcare Technology Analyst, Citi

I mean, I think Earlier in the year, the idea, like if you could do the math, 50,000+ on 1.7, it's like 3%, right? Early in the year, it was even less, so it kind of has exploded. We think it will calm down a little bit. There's a little bit of a let's throw some stuff up against the wall. CMS responded by making it perhaps a little bit more costly to play the game, which is they raised the fees on both sides. In the arbitration process, if you're on the hook for both, you just kinda made it more, you know, expensive to play the IDR game. We were seeing stuff that was claims that were coming in that were below the fees.

It was not necessarily, at least from the provider side, I think there was a little bit more of a test and learn kind of approach versus a, you know, a, an algorithmic, you know, decision going on in terms of whether it was a smart idea to, you know, put it into IDR.

Dale White
CEO, MultiPlan

I think one of the latest litigations is aimed at that. It's challenging the fee increase, right? There was a $50 fee that went to $350, now I think they're litigating that.

Daniel Grosslight
Healthcare Technology Analyst, Citi

$50 x 2.

Jim Head
CFO, MultiPlan

For the loser, and or $350 x 2 for the loser.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yes.

Jim Head
CFO, MultiPlan

$350 is seven. You know, you gotta, by definition, you have to be playing for more than $700, and the claims themselves are not 10,000 at a time, they're a couple thousand at a time.

Dale White
CEO, MultiPlan

Look, it's in line with what we expected. Good. It's been steady, you know, despite the decrease in utilization, this has been steady.

Jim Head
CFO, MultiPlan

Yeah.

Dale White
CEO, MultiPlan

ER visits and emergency care has been steady. We've turned it from a controversy into a strength of the company. We're investing in it. We're collaborating with our payer customers on what they need more from us as the process settles in. We're working around analytics and bringing machine learning to the IDR process, developing client portals, giving them dashboards, so they, on a real-time basis, know exactly where their claim volume sits inside our platform. All that work's being done now and will be launched later this year.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Got it. You know, putting that all together, at the beginning of, I think it was last year, you dimensionalized the overall headwind at most a 2% headwind. Is it now a tailwind? Are you now making money off it?

Jim Head
CFO, MultiPlan

Well, we're always making money off it.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Making more.

Jim Head
CFO, MultiPlan

It was the revenue headwind, if you will.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah.

Jim Head
CFO, MultiPlan

That. I mean, one went in-house and the other went to a very small vendor, that hasn't changed, so there was a little bit of a headwind. At this point, we kinda think it's, A, it came in right on track otherwise, and it's very steady. We gotta put a little bit more resource against it, but not, I don't think it's not like it's changing the margin dramatically. Now we've, we're kind of in a position where we feel like there's probably skewed towards opportunity. This is very much a strength of our business.

The harder it gets, the more complex, the more ambiguous it gets, the harder it is for somebody to do it themselves, because we're making all these investments, and the more, you know, the more analytics we can put around it, that's real value. That's where I think the bar just keeps on rising.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yep. Yep. In the last minute or so we have, with you today, let's talk about capital deployment priorities.

Jim Head
CFO, MultiPlan

Sure.

Daniel Grosslight
Healthcare Technology Analyst, Citi

I think there's two major ones that folks are focused on. Everyone obviously realizes you're investing in the business.

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

In terms of debt pay down and M&A, two big categories for you, how are you balancing-?

Jim Head
CFO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Those two areas of deployment?

Jim Head
CFO, MultiPlan

Last year, we talked about, you know, the construct, the priorities, investing in the business, M&A, debt repayment, and then to a lesser extent, share. That, as we pivot into this year, it's exactly the same, but the cost of capital just went up over the last 12 months. So you saw that we, sitting on cash, had a little bit more cost to it, and so we started addressing the debt in Q4, we bought some back. As you go forward, think about our stock of capital that we have on our balance sheet today, more than enough to operate with $300 million in cash. Then we're gonna generate cash going forward.

Our allowance is that, you know, that pie that we have, and it's, a lot's gonna be towards debt retirement. The M&A we identified doesn't speak for, you know, more than maybe a third of the capital that we're gonna have available over the next couple years. I think on the other end of the spectrum, we're kind of saying, listen, the authorization was important. We wanna make sure that we have capital to allocate towards share repurchase if necessary, but it's not the main event. We made that clear. It's not the main event. We need to chip away at our debt stack, and we'll do that over time. We know we wanna put ourselves in a position where we have a smooth refinancing in 2027.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Yeah. Yeah. Okay, well, we are, out of time. Shawn, do you need to read? Okay.

Jim Head
CFO, MultiPlan

I got something.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Don't worry. Don't sue the city. Thanks, Dale and Jim for-

Dale White
CEO, MultiPlan

Thank you.

Daniel Grosslight
Healthcare Technology Analyst, Citi

joining us this afternoon.

Jim Head
CFO, MultiPlan

Good to be in person with you.

Dale White
CEO, MultiPlan

Yeah.

Daniel Grosslight
Healthcare Technology Analyst, Citi

It's great to be in person with you.

Dale White
CEO, MultiPlan

Very much.

Daniel Grosslight
Healthcare Technology Analyst, Citi

Thank you, everyone, for joining us this afternoon.

Jim Head
CFO, MultiPlan

Great.

Dale White
CEO, MultiPlan

Thank you. Thank you.

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