All right. Hi, I'm Chris Brustuen from Morgan Stanley's Healthcare Group. Thank you for joining us. Before I start, I wanna hit on the research disclosure. For important disclosures, please see the Morgan Stanley Research Disclosure website at www.morganstanley.com/researchdisclosures. If you have any questions, please reach out to your Morgan Stanley sales representative. Today, we're joined by DocGo. Thank you again for joining us. Maybe, any opening comments?
Oh, thank you. Thank you for having me. It's, it's been a wonderful conference so far. Amazing investors we have the opportunity to meet here.
Sounds great. Well, thank you, Anthony. The first point I wanted to ask on is just on the mobile health side. You've had significant growth in recent years. What types of services are you providing there? What's your end customer base like? Can you just expand on that a little?
Yeah. So at DocGo, we kinda, on the mobile health side, we really have two main divisions. One is where we focus on population health-related services for underserved groups. Usually, we're contracting with either a municipality or a state or federal government. Contract with all of those today, in order to focus on a kind of widespread care program for those underserved populations. That's kind of what we call our government vertical of mobile health.
Could be anything from primary care to urgent care to licensed social work, behavioral care, all of that can be grouped in there. You also have our payer division in mobile health, and the payer division in mobile health focuses predominantly today on care gap closure, remote patient monitoring, and chronic care management. We work with payers, and when working with those payers, they will assign lives to us, and in that assignment of the lives, we reach out, and then we close these care gaps, like a diabetic retinal exam or an annual A1C or a diabetic foot exam. Now, there's maybe 20+ of these called HEDIS measures we can close. They're kind of the two divisions of mobile health. You know, mobile health is about 70% of our business. Transport, ambulance transport is about 30% of our business.
Thanks. That's interesting. Can you discuss a little bit, too, about the, your strong track record of growth that you've seen outside of COVID? COVID was always a big driver historically, and now you've migrated kind of away from that. Can you hit on that a little?
Yeah. At this point, right now, we have pretty much no, almost no COVID revenue in the company at all. It was a part that allowed us to grow that government business, and so we began working with, very rapidly, with governments in order to work on population health contracts, and we were testing, vaccinating, and then we expanded those programs to do a lot more than that. So as an example, we worked with one municipality where we were doing testing services for, in homeless shelters.
And then we evolved that from just doing testing to then delivering primary care. So we'd go to each one of these homeless shelters, you know, each week, rotating through with our teams that come on site and provide primary care to these homeless individuals. So COVID allowed us to kind of get our foot in the door and prove our value of these widespread massive programs to municipalities, but then expand those programs into something that was much more intensive and involved in the whole care continuum for these underserved populations.
Thank you. That's helpful. Next point I wanna hit on is migration-related programs, and that's grown considerably in recent quarters. Can you hit on that a little bit and what you expect kind of in the growth engine for that front?
Yeah. The migrant programs that we've had to date were really drawn from existing programs that we had. So we were already delivering care in homeless shelters. We were already delivering care for not only sheltered homeless, but also unsheltered homeless, and so we began using those teams to treat migrants as they were arriving into these cities. And then that expanded to be able to do more and more services. We had, you know, vaccinations for children before they would get into school, doing mental and behavioral health assessments, but expanding on the services that we would provide for these migrant asylum-seeking populations, and then expanding the more involved programs by which we are fully responsible for both, you know, the licensed social work, the case management, and the medical for entire facilities.
We've done that in many parts of New York State, as an example. And to date, we have, you know, thousands and thousands of these asylum seekers where, you know, they're in our care. We're responsible for their social work, we're responsible for their case management, we're responsible for their medical care, and trying to make sure that they have the ability to graduate into a life where they're self-sufficient and they're able to be independent. That's really the goal of these programs is to take these oftentimes amazing people who come in that are from very vulnerable backgrounds, and get them through the process by which they have that self-sufficiency.
Thank you. I wanna spend a minute on the tech stack. You're fully integrated with Epic, EpicCare. How does that impact some of the referrals you get from a technology basis, but also just enhanced functionality with the caregivers?
It's big difference, a massive difference. So when you have a provider, health system that's trying to refer to you, and you have the ability to, with one click inside of their EMR, to order that transition of care visit, to order that transport, automatically transfer over all the demographics, the payer details, to have that full transparency back to the patient, to the patient's family-
It makes a big difference, not only in the quality of the care being provided, but also the efficiency of the care that is being utilized. So how many services can that provider do because they're not bogged down with inefficiency? It's been a big differentiator, and we've actually, we have been awarded many contracts now, where they reference technology as really the differentiator. And one thing that doesn't always so much get appreciated from DocGo is software as a, as almost a service within DocGo, is a very significant material part of our business. You know, we, we charge for software, and then-
You know, we have the ability to license our software. We've invested $70-$80 million in building out these four really critical tech systems that we have. We have one that is responsible on all of the logistics, one of the largest logistics companies in the U.S., that's moving around these medical professionals, optimizing, dispatching, coordinating.
We call that our DAR system. Then we have one that's for HealthPoint, which is our system that manages massive population health contracts, where you're dealing with thousands and thousands of individuals, with very procedural clinical encounters, and that integrates with all the states across the U.S. to do things like vaccine registration, to be able to do things like, you know, you do a widespread group of lead testing for pediatrics, like that handles these mass population health use cases. Then you have our third one, which is our remote patient monitoring and chronic care management system, you know, where you're being able to remotely observe and monitor people.
Then the fourth one is really the newest one that we've built, which is this highly sophisticated system that allows to help for these asylum seekers that are coming into the US. To make it all the way from the point where they arrive, to the point where they do become self-sufficient, there is 50 steps in that process. We built a sophisticated system that allows us to know what that workflow is-
and then to be able to coordinate with all of the other organizations that participate in that workflow in a very carefully controlled manner, with the whole goal of making sure that an individual that enters the workflow has the ability to confidently, successfully exit the workflow. So those four systems are highly sophisticated and very, very intensive- the development, and it's, it's important to note that the actual, the revenue generated from developing the software is significant.
Okay. That's very helpful. Thank you. Next point I want to hit on is on the profitability front. Your growth rate, it's not really typical we see profitability with companies that are growing at your pace, particularly across these segments. Can you touch a little bit on that and how technology plays a part of that, and how that just the interplay between that and what drives profitability?
Yeah. I mean, the main focus of our technology is to improve quality, to improve better patient outcomes. The second bit, biggest benefit of our technology is it dramatically increases efficiency. So in my opinion, the majority of the reason why healthcare companies struggle to make profit isn't because they're not necessarily charging enough, it's because they're just simply too inefficient. They have lots of idle time. They have lots of their resources that are not being utilized to the maximum ability, and so then you end up just simply having waste.
Yep.
Technology is critical for you to be able to track all of your resources, to utilize those resources, to pair the resources with patient needs. That pairing together, that kind of what they call the traveling salesman problem in computer science, that inefficiency tends to be why a lot of healthcare companies aren't able to make money. So we, when we ever have really any challenge that we're trying to solve, our first step of the solution is the technical solution-
... is how do we have the ability to write software and hardware that can improve the patient outcome, but also deliver a much more, do it on a much more reduced cost basis? So a good example, a good example is our clinical care delivery model across most most of our mobile health, you know, home programs, is where you have a lower level provider, like an LPN in the home, and they're remotely supervised by a mid-level provider that's remotely, like a nurse practitioner, or physician assistant.
Well, that model where you have this nurse practitioner remotely and the LPN on site, ends up coming at a cost basis, which is 30%-40% lower than if you had that, send that nurse practitioner into the home. That efficiency, then you have the ability to pass on, and it allows you to have much more sustainable financials. But it also delivers better patient care, because rather than sending in maybe an internal medicine-trained nurse practitioner into your home, you can say, "Oh, well, I'm going into a home for a patient that has CHF.
Let me have a nurse practitioner that's worked in a cardiology practice for the last 10 years, who has specialized training with CHF, to be the one who is guiding the LPN on what steps to do, and is making a diagnosis that is likely gonna be far more accurate.
Mm-hmm. That's very interesting. It's shifting the medical transport to that segment. Can you talk a little bit about any cross-selling opportunities there is with that, with mobile health? Are they kind of symbiotic between them with the sales cycle?
As far as the value proposition goes, the transition of care is a good example. You're working with a hospital system, and you're handling their discharges, or you're discharging their patients, and you want to make sure that those patients don't get readmitted unnecessarily. Well, if you're already bringing those patients home, you already have that logistics footprint, it makes a lot of sense to then have your, your lower low price, or your EMTs, your paramedics, or even a nurse, visit them on a frequent basis, maybe once a week, during the 30 days post-discharge, post-acute. And that same group, 'cause you're already integrated with the EMR, 'cause you already have the staff that's doing the discharge, that already knows the patient, visiting them, makes a lot of sense in that, that continuity of care. We've seen amazing success.
Some of our Transition of Care programs have had the ability to reduce the rates of readmissions by 40%-50%, which is a big, big delta, compared to the kind of the baseline of how most health systems work today. So they work synergistically as a value proposition because the logistics of it are very symbiotic.
Mm-hmm. Interesting. I wanna shift a little bit to labor and the inflationary environment we're in right now. Many of your peers are having impacts with staffing, being able to retain staff. Can you talk a little bit about how you've been able to navigate through this environment, and also any processes you've been able to automate to get through it?
A lot. I mean, there are few things that we don't, even if we start it manually, we don't immediately begin to automate. We have a very, very large engineering team. You know, we deploy code to production between 4-8 times every day.
Wow!
So we're constantly, constantly iterating on, the software, deploying new software in order to be more efficient to the programs that we do. A lot of things have to go on the reimbursement side, which can get really complicated, and you have many, many payers, and you have many types of business, whether it's transport or primary care, urgent care codes, RPM, CCM codes, you have to track all of that.
A good one is on the RPM. You're doing remote patient monitoring, and you're getting these readings in. Being able to use more sophisticated learning systems that can determine whether or not there are abnormal vitals-
... or a patient is rapidly decompensating, such that you don't need a human intervention initially, so you can more efficiently determine whether or not a patient needs an intervention. Those are some big examples right now, where we've invested a lot into ensuring that the patients get that quality care without having to layer on an additional cost.
Shifting to the M&A front, particularly in mobile health, but I guess, mobile would, or transport would be included in this, too. But what are areas you think about when you build your war chest, specific areas of focus from an M&A standpoint?
Our M&A strategy has been fairly simple, for the last, you know, pretty much the entirety of the company, which is, we'll have a customer that comes to us, usually an existing customer, who has a need, and they say: "I need you to, I'm asking, can you provide these clinical services?" Whether that be maybe transition of care services, maybe that be primary care services, or even transport services in this geography.
And then we say, "Well, I'm actually licensed in that geography. I don't have the staff in that geography right now." And then we'll go and do a tuck-in acquisition to be able to acquire a license, to be able to, you know, acquire staff that have that competency, 'cause that might save us 6 months, 12 months, if we wanted to do it de novo. And that's been nearly all of our acquisitions, or in certain cases, we have customers, like we have a large national customer that we announced publicly with Fresenius-
... who has, we've become their, you know, kind of a preferred partner to do remote patient monitoring for. So, you know, at the end of Q1, we purchased a company that does cardiac and RPM monitoring services. And in bringing them on, we've basically been able to pair together this need, this demand from Fresenius and their nephrology clinics or the participating nephrology clinics, with the competencies of Cardiac RMS in order to bring RPM to them. So it's usually, generally speaking, doing an acquisition for when you have a DocGo customer that has a very specific need and ask, and we're bringing in the supply for servicing that customer from an acquired entity.
Okay.
But usually small tuck-in.
Mm-hmm. Shifting to RFPs and that process, can you spend a little time talking about what is the typical RFP process like? Are you going after bigger contracts these days? Do you partner sometimes going into the, these RFPs? Just a little bit more about what that's like.
Yeah. Without question, the RFPs we're going after are larger-
Larger
... much larger than they were in the past. Every year, it seems that we've gone, you know, higher and higher in that, because we now have more experience that gives us the background to go for these larger contracts. You know, increasingly so, whether that's in a municipal level or a state or even, you know, some of the federal government contracts that we go after, it's because we now have more competencies, we have more experience, we have more people. We may have done that service now a lot more. So they're getting larger. The team is growing that submits them, and we're submitting a few, you know, every single week. We submit RFPs to a wide range. You know, our success rate's been fairly consistent.
You know, fairly consistent right now. And it, I think a lot of it has to do with it's. I wouldn't say self-fulfilling, but the more that you're able to win and then prove, the better track record you have to, you know, to win and to prove in the future.
Interesting. I wanna talk a little bit about market expansion and entering into a new market. You've entered into a number of new markets over the last 12 months. Can you hit a little bit about how you choose to enter into a new market and what you're looking for there, and kind of puts and takes about decision points before you'd enter into a new market?
... we are pretty simple in that we'll enter into a new market when you have a customer that is requesting us. We don't really do a whole build it, and they will come mentality.
Okay.
We follow more of a, does somebody have a need? If somebody has a need, we will work to service that need. The entire company that we have today, with the many thousands of providers across, you know, 10 states and multiple countries, is built because we have somebody who is requesting assistance. Now, I consider an RFP to be requesting assistance-
Non-public request for assistance, but somebody has specifically made a request for assistance, and then we go and we respond to that, and they say: "Okay, we would, we would like you to be the one that assists us," and then we launch into a market. We don't really have a mentality of we evaluate a state or country, and we say: "Oh, well, we think that, you know, with two years of investment, we could eventually get good unit economics here." That's just not. That's just never who we are.
We really follow need. If there's a need, if somebody asks us to provide a service, we're gonna provide that service as best as we possibly can. But if somebody is not asking us to do the service, then, you know, that probably means that they already have the service being provided by somebody, and they're happy with it.
Yeah.
If a customer is happy with their current provider, who are we to try and displace them? That's not us. We're not trying to... There's so much need out there that let's focus on those that have the need, and if anybody, you know, changes from not having need to having need, we'll be there. But our model is not to go out there and try and kind of take business away from customers that are already happy with their current provider.
Yeah. What I didn't appreciate is that your scale, it makes you very nimble to be able to react very quickly to these demands or these requests.
Yeah.
So that's, that's impressive.
That's part of the reason why in many of the contracts we have, we're just simply the only one that could do the service.
'Cause you don't find groups that will, with a couple of days' notice, end up standing up hundreds of, a site with hundreds of people. To have the ability to leverage all their technology, to leverage their pharmacy license, leverage their CLIA testing licenses-
... to leverage this really comprehensive logistics backbone that brings together, a one-stop solution and can do so with almost no notice, there's really nobody that can do that today. And so that's a unique value that DocGo provides, and a lot of it has to do with the fact that we just have an incredible staffing model with incredible staff- ... who work really hard, and they can scale quickly 'cause everything they do is built on a technology backbone that creates that transparency, that efficiency.
Interesting. I want to spend a minute on the sales cycle and go-to-market strategy across your customer segments, your government, enterprise, corporate, bigger health systems. Can you spend a minute on what that sales cycle is like to sell into these different pockets?
On the health system side, for us, we've been very fortunate that it's nearly 100% of the health systems, not all, but nearly 100% of the health systems are just by referral. So they will just simply reach out to us, and they'll say: "Hey, we're unhappy with our current provider. Can you help us come in?
We get our foot in the door with one service, and then, as an example, we have some large health systems where we just started doing one service for them, and now we offer 20 different services for them, clinical services. And so that, that's how that sales cycle really works entirely, and that is growing at a very, very significant clip every quarter without the need for a big sales team. The payer contracting ones, we have a team of people that reach out, and we have a pretty specific niche that we follow with payers, which is we focus on the payer patients that have not seen their PCP in over a year and who have chronic conditions-
... at least one chronic condition. So we go to them and we say, "This is the patient population that we focus on, that we can help with." It's maybe 12%-13% of your average Medicare plan. Those sales cycles can be as quick as 3 months, can be as long as 6+ months.
Interesting.
They're usually dealing with very large numbers of people. When we deal with that, usually we're being assigned 10-50,000 members.
And they give us those members, and then we begin, you know, kind of building care programs for them. And then, you know, on the transport side as well, that's pretty much really baked into the health system side, so it's the same cycle there. And the government side is almost always through a kind of procurement process.
Sometimes you'll have one contract that extends into another contract, which is, you know, kind of similar to some of the stuff that we've done with municipalities today. But almost all public procurements eventually become—or all public municipal contracts eventually become a public procurement process. Sometimes you'll have an emergency award initially because you have to stand something up in a couple of days or a couple of weeks, and a public procurement process might take three months. But eventually, you know, all of the government-related work goes through a public procurement process. Usually, that public procurement process can be, you know, 3-6 months.
Interesting. I guess so- somewhat hitting on kind of TAM and the, and the growth of these markets. So specific to mobile health to start, where do you see kind of the value drivers for these different channel partners that you have? So the hospitals, municipalities, payers, I know you've spent some time in the events segment as well. Where do you kind of see that market growing to?
The biggest area that the mobile health segment's gonna grow in is gonna be on the payer side.
Okay.
You know, I think that you're gonna see us, you know, having hundreds of thousands of members assigned to us, with a high degree of confidence in our ability to truly, dramatically improve their care, because the ones we're focused on, their care is not being provided because there are accessibility issues. That could be social determinants of health that are accessibility issues, it could be mobility issues, but for whatever reason, if the care is brought to them, they will be far more likely to have to receive that care than if they have to go to care. And so with that population, you're gonna see it grow dramatically, and you're gonna see the return on investment for the payers to be substantial. Very, very material. The other piece that you're gonna see growing is on our software side.
Okay.
You know, today, we've built out our software, you know, those four different software applications that we have, and we, you know, we license those, we give those to our existing partners, and it is a big, big, big software division of the company. You're gonna see us licensing out that software more. You're gonna see us really allowing more and more people to use this highly sophisticated software because it delivers unprecedented results.
Okay. Thank you. I guess, shifting to medical, transportation side then, can you talk a little bit about that market opportunity? So you've got strong partnerships with the Fresenius that you hit on before, Jefferson, Northwell, HCA, just to name a few. How big do you see this market growing, and where are kind of the key value drivers in that segment?
So a little bit different. On the health system side, you know, you continue out on transport, transition of care services, those are the really big key components. I think that those are gonna continue to grow. That business line, you know, I really expect a year, you know, more than 20% growth every single year. We've blown that out of the water so far.
Wow!
But on the Versanis side, that goes into our RPM and chronic care management product focus. We've already communicated that for all monitoring, which is not just RPM, but all monitoring, we'll have over 50,000 patients by the end of the year. Which we're on track for. We have over 50,000 total monitoring patients by the end of the year. And that is, that is the next phase in being able to deliver proactive healthcare.
Because we wanna, we need to be able to have the data, the information, the state of the patient, in order then to be able to act accordingly and say, "Okay, we are gonna titrate your meds," or, "We are going to rapidly respond and treat you on scene." We need to have all the data to be able to act accordingly.
Thank you. I guess, hitting on the telehealth front, it's, it's a pretty competitive environment there, just given how many new entrants have entered into that market over the last couple of years. Can you talk about that as a kind of a driving force for your care delivery, when you're treating a patient in the home or if that is an impact point?
Yeah. I mean, it's, it's definitely an impact point, for sure. It's... When you're, when you're going into the home, and you're, you're delivering the care to individuals who have chronic conditions, it's, it's important to understand that they're almost always complex, not just one-- It's very rarely one chronic condition, it's multiple chronic conditions. And so our ability to be able to have the monitoring, chronic care management, but also have that lab license, to have that pharmacy, so we can deliver the medications on site, it makes a big difference, because 30-ish% of people never pick up their prescription.
So if we have the ability to go on site and to assess, diagnose, and treat in a one-stop shop, the outcomes that you get from those patients are much, much greater. So one of the biggest value add of DocGo is that we are comprehensive in our solutions. Whether we need to transport somebody to a higher level of care, or we need to deliver urgent or primary care, or medications, and monitor, we can do it all under just one umbrella of DocGo.
Interesting. I guess we're almost up on time. Any, closing comments?
Yeah. I would just say that, you know, right now, because of the incredible investments that we've put into the foundation of the company, the foundation being the technology, the foundation being the 6,000+ people, all the licenses that we have, we are seeing substantial growth, very substantial growth in every single line of business in our company. There's no exceptions to that. All of our markets, all of our divisions are growing dramatically, and that I don't see stopping. DocGo has a unique proposition, value proposition, which allows us to deliver incredible value to our customers, and we're seeing the demand for that only increasing every single month.
Wow! Impressive. Anthony, thank you again for joining today.
Thank you. Appreciate it.