Scrappy, but.
Good afternoon, everyone. Thanks for joining this next session of the 27th Annual Needham Growth Conference. I'm Ryan MacDonald, and I lead our digital health research efforts here at Needham. In this session, I'm pleased to be joined by DocGo CEO, Lee Bienstock. Lee, thanks for joining me today.
Thank you, Ryan. It's great to be here.
So for all of you in the audience, this is going to be a fireside chat format. We've got about 40 minutes to walk through some questions with Lee about DocGo. We'll save the last five to 10 minutes for Q&A from the audience. So if you do have questions for Lee, we'll make sure to get those asked and answered. But with that, we'll dive right in. So Lee, for those who are less familiar with DocGo, how about a brief overview of the business?
Sure. And Ryan, you know the business probably better than anyone. But for those that are newer to the story, so DocGo, we're one of the largest mobile healthcare companies in the country. We also operate in the U.K. We provide services in 30 states today in the U.S. We're licensed in all 48 continental states and the U.K. We just wrapped up a great year for the company. We're really proud of 2024. We brought care to 1.5 million patients last year. I'd like to share our teams drove over 8 million miles last year to provide that care.
Our clinicians worked over 600,000 shifts across the country in the U.K. And we have a fleet of 1,000 mobile vehicles with 5,000 clinicians going out and delivering care to where it's needed. Our whole goal is to bring healthcare to where it's needed, when it's needed, make it highly accessible, highly affordable for all. And that's really what we made great strides on doing in 2024. And we're set up nicely here for 2025.
It's kind of impressive to think about it in that context of the fact that you've got such massive scale in terms of visits and the amount of patients you see, the team you have, and you're still a very small, small drop in the bucket of what the overall healthcare industry is. And so it kind of speaks to how big the opportunity is.
Yeah. I mean, it's a trillion-dollar opportunity. It's 20% of GDP. And frankly, I think the real story there is, yes, the market's very large, but the healthcare market is very widely understood, very broken. The whole system is set up for the more tests and more services you provide, the more the provider makes, when in reality, the patient wants as little interaction with the healthcare system as they can possibly have. And so I think it's going to set up here for the next wave of healthcare really to be incentivizing the whole system to make the patients healthier. The companies, the providers, the ecosystem does better when the patients are healthier. And I think we're really leaning into that model. Very little of what we do is fee-for-service. Everything of what we do is really targeted to keep patients out of the hospital.
That's where they're most expensive. That's where they're most costly. Certainly, patients don't want to be there. Hospitals play a vital role. Of course, if you need, if you truly have a life-threatening emergency, you have an acute need, hospitals serve a vital purpose. And certainly, the hospitals don't want you if you only need an IV or an EKG. And so we're trying to really bring proactive care to the market so that we can help meet patients where they are, hopefully impact their health for the better, keep them out of the hospital, and ultimately save the whole system a lot of money doing it.
Yeah. And we'll get into sort of, I think, a little bit about how sort of this inefficiency and dissatisfaction with the healthcare market, which has been sort of bubbling underneath the surface for quite a bit of time, seems to be boiling over now and sort of now becoming, I think, a greater part of the national rhetoric that hopefully will drive some change. But before we kind of get into that, I want to be a little bit reflective with you because you're now 18 months into the role as CEO. It's a time where there's been great change within the organization from the day you joined the company to sort of where we're at today.
Can you talk about how you've sort of restructured, reoriented, refocused the organization as you've transitioned away from one that's very heavily focused on sort of large government RFPs, municipal work, to more of a balanced payer, provider, government contract type business that it is today?
Yeah. So I'm very proud. The company is very, very proud of all the progress we've made over the last 18 months. I think, first off, the company really is focused in on three customer sets that truly drive a lot of the healthcare spend in this country and own a lot of the healthcare system in this country. And really, we've focused in on those three, which are the hospital systems. Today, we work with hundreds of hospital systems providing medical transportation and other mobile health, which we can talk about, and really helping optimize the efficiency of patients being discharged and being taken from facility to facility. And we've built a whole technology stack around that. So we've really oriented around the hospital systems.
The municipal partners we have, we work with municipalities to bring care to their underserved populations, which are obviously a big piece of the equation, and we work with the payers, which is the fastest growing piece of what we're doing, where we work with health insurance companies to bring care to their sickest members, their members that are utilizing the system, the members that are, frankly, maybe not able to go see the doctor, and so we work with those three, so we've really, over the last 18 months, zeroed in and keyed in on those three customer sets, and we've oriented the whole company around that. We've brought in great leadership, either elevated leadership from inside the company or brought in external leadership to go and lead those three customer sets for us. We brought in Jen McLean. She's the previous Chief Operating Officer of City Harvest.
She helps lead our municipal business. We brought in Yong Kim, who came over from CVS, who is responsible for a lot of the strategy work around affordable care, accountable care, value-based care. He leads our payer business. And we have Stan Vashovsky, who has really helped us elevate and expand the medical transportation business and our work with the hospital systems. And those three are really leading those departments. So I'm very proud of the way we've sort of oriented the company around the customer needs. And the other piece I'm very proud of, which we were talking a little bit before we took the stage here, we've really continued to grow out our medical leadership at the company. So earlier in 2024, we launched our medical advisory board.
I would recommend going on our website and checking out sort of the members who are on that medical advisory board. These are world-class leaders from across the healthcare landscape, from behavioral health, cardiology, emergency medicine, and everywhere in between. And we brought on Dr. Barbara, who is the head of innovation at UT, to lead that medical advisory board. And he ran the largest EMS department in the country.
And then we brought on Dr. Klasko to be our chairman of our board in October. And he's the former CEO of the Jefferson Health System and executive in residence at General Catalyst for all the healthcare work that they're doing. So I'm just proud of the team we've really built out. I think it is the major league, world-class team, really, in healthcare, driving innovation. And then I'm really excited about the way we've oriented the company around our customers.
Yeah. So before we dive into sort of the segmented growth drivers of the business today, I wanted to sort of get your perspective on sort of the macro environment for healthcare. Coming off a year where, obviously, I think the payers have had a really rough time with higher utilization, particularly in their MA books, that's sort of stunted the growth in value-based care a little bit as we're sort of trying to reset the bar here. But also, we have a new administration coming in that's talked generally about some broad-based restructuring, whether it's within the FDA or HHS or CMS moving forward. Based on the conversations you have with your customers, what's your kind of view of the setup going into 2025?
I think the setup is optimistic going into 2025. I think it was pretty clear from the first Trump administration. They did lean very heavily into accountable care, value-based care. Medicare Advantage grew significantly under their first term. So I think, look, I mean, if past is prelude, I think that will play out again in this next administration. I think you'll continue to see CMS. I think you'll continue to see the whole system continue to drive towards the value-based world that we were just describing, where the providers do better when the patients are healthier, and I think they will drive that. That's sort of a free market incentive structure that I think the new administration will lean heavily into, which they did just four years prior. So I think we'll see that.
I also think we'll see some of the regulation come down in the pharmaceutical space as well and some of the trials that are happening. One of the things that we get asked about, it's something we haven't looked at, but maybe we would look at it, is how do we help with clinical trials, specimen collection, enrolling patients that are hard to reach and hard to serve, getting them in the clinical trial process. I'm meeting with some of the big pharmaceutical companies around that. So I think you'll see that play out as well. That might get fast-tracked. I think other areas that'll play out maybe not necessarily germane to our business, but I think certainly some of the ingredients in the food, I think they'll go for some quick wins there.
I think that some of the intermediaries in the pharmaceutical space and the PBMs, I think that they'll go for some quick wins there. And so that's the way I think we're seeing it. Those areas don't play so much in our side of the business. But I certainly think on clinical trials and specimen collection and mobile labs and things of that nature, we can definitely play a big role there. Because what I hear is the pool of some of these clinical trials is not representative really of the fabric of the patient population.
And partly because some of the harder-to-reach, underserved patients are not enrolling in these trials because they're not part of the system. We bridge that gap. We go see a lot of patients that, frankly, are unattached or drifting or not engaged in the health system. So I think that'll be an area we'll look at with the new administration coming in. And I definitely think this value-based care, accountable care, I think they'll continue to try to double down on that.
Yeah. Yeah. There's a real, obviously, been a strong multi-year growth in decentralized clinical trials as a percentage of the broader base. And trials continue to get more complex, require more data points from a number of different sources. So yeah, I could definitely see an opportunity there for the business, interestingly. So DocGo segments, you segment your revenue stream by transportation and mobile health. You really have been reorienting the business around the end markets you serve, which is hospitals, municipalities, and health insurance companies, payers. Maybe starting with the hospital systems, as you were looking into 2025, I think the rough expectation is around $250 million of revenue from that segment. What's the mix across transportation and mobile health for investors here? And where do you see the greatest opportunity for growth within that hospital segment today?
Yeah. So the hospital segment was ending the year last year at above $200 million a year run rate. That is the vast majority of which is medical transportation services that we're providing. Essentially, we built a tech platform similar to Uber, but for medical transportation. It's integrated with Epic. We can talk all about the technology stack, which is a big differentiator for us. And I think that business, as we said, is going to grow from about a $200 million-$250 million business in 2025 for us. 225 of that 250 will be medical transportation is our projection. The rest of it is going to be mobile health programs that help to bridge the transition of care as somebody's getting discharged from the hospital into their next setting, whether it be a nursing facility or their home. And hospitals are very focused.
They do not want you to bounce back to the hospital within 30 days. That impacts their quality scores. Very often, they're not getting reimbursement for that. So it's very, very penalizing when a patient bounces back within that 30-day window. So what we do is, as the patient's getting discharged, we'll go and visit that patient in the home every week for a month to make sure that their meds are titrated correctly. Perhaps the incision site might be getting infected. It needs to be redressed. We can take vitals, of course. And we're making sure that that patient has indeed transitioned safely home out of their discharge. So we think that program has a lot of legs. We're talking to a lot of health systems about that. And frankly, a lot of health systems themselves are getting vertically integrated. So some of them are acquiring health plans.
Some of them are in value-based arrangements themselves already. And so there's a big opportunity there to do care gap closure and some of the things we're doing with the traditional pure play payers. I think there's an opportunity to bring those services to the hospital systems that are obviously very incentivized in this new value-based world. So that's the $25 million of growth in that area on the mobile health side for the hospital systems.
I'm actually very surprised a little bit on the mix, just given how much value you provide on that sort of preventing the 30-day readmittance to the hospital. What do you think's been structurally preventing your health system customers from entering those arrangements? We've generally heard a lot of the movement around value-based care is associated with Medicare Shared Savings Program or ACO REACH or Medicare Advantage. A lot of that's been done, or a lot of the enablement's been around independent physician practices and not so much at the health system layer level yet. Is it simply that? Is that the health systems you're working with maybe not as deep on the value-based contracting at this point and you need to see an unlock there a bit more?
I think so. And I also think, frankly, a big focus of the hospital system over the last few years, especially coming out of COVID, was Hospital at Home, which really is a different model. You're basically saying that last day or two of that hospital stay, they need to continue to be hospitalized, but the last day or two, we could discharge them to the home. Or there's still actually an intake patient at home, and you're providing hospital-grade level services in the home. We really did not participate in that area. But I do think hospital systems and, in general, the industry was very bullish on that. Our view was like, no, let the hospital provide the hospital-level grade care.
Certainly, we have a lot of the pieces to provide hospital at home, but we really focus on the transition point, which is a less acute but still a very important part of the piece. And I think, look, hospital systems are very large, particularly the ones that we work with. They tend to be the largest hospital systems in the country. And I think they're starting to dip their toe in the water here. That's why we didn't come out with some enormous goal for this business, right? We're still saying the vast majority of the work we're doing with the hospital systems would be the medical transportation, which is the bread and butter, basically.
How do you think about what the refresh cycle looks like on the transportation side? You've clearly had some nice wins and renewals with major health systems recently. How does your technology differentiation really affect and factor into your win rates there?
Yeah, so the whole beginning of the company was grounded in this tech platform that we built to optimize medical transportation. It literally gives the discharging nurse an ETA of when we're going to arrive. And so that not only does it give the discharging nurse an ETA of when we're going to arrive, when to get the patient ready, it also alerts the receiving facility when we're going to arrive. It basically brought this entire consumerization experience of you know exactly when your lunch is going to arrive, you know when your packages are going to arrive. Now they know when medical transportation is going to arrive. It's not an easy thing to do, and we've been building that for eight years. And so that's the platform. That's the big differentiator for us on the medical transportation side.
We'll tend to come in, provide the entire software platform to the hospital system so they can manage all the patient flow, all of the medical transportation. And that's been very successful for us. It is also integrated with Epic. People say, "Oh, how did you get Epic to integrate this in?" Again, it goes back to we have very large hospital systems. So at the time when we started working with Jefferson, Jefferson's a top 15 hospital system in the country. Jefferson knocked on Epic's door and said, "Hey, we actually love working with this medical transportation company. Would you integrate their software into Epic?" And when Jefferson or some of the other hospital systems we work with ask Epic to do something, they're pretty receptive to that. So it's a pretty big differentiator for us.
Directly within the patient's chart, the discharging nurse, the hospital system can click a button to discharge, and all the patient information, all the insurance information, all gets ported over to our system so we're able to see that indeed this patient does need to be transported by an ambulance. We don't want to transport somebody by ambulance if they don't need to be. Nobody's getting reimbursed for that, and so we make sure that we do that. There's pre-authorizations that happen, and then we optimize all of the patient flow. The other magic that goes into it is the intake nurse will now know that that bed's freed up for the next patient. The housekeeping crew knows when to get the bed ready for the next patient so the bed management piece is a big thing. The hospital systems don't want empty beds.
Anybody that's been in an emergency room waiting to go up to the room, they want their beds to be full and utilized, and so we help them do that with the tech platform, and then we took that, which allows us to optimize all the units in the field, and then we applied it to the mobile health units that we have in the field now as well, which I'm sure we'll talk about.
Maybe just lastly on the hospital opportunity, how do you view the sort of mix of pipeline of sort of greater leveraging your existing footprint in specific regions and optimizing that better and adding new health systems more in New York or more in New Jersey or more in Pennsylvania versus net new states, regions, geographic expansion?
I think anytime we can expand in a market we're already in, there's good leverage there. There's good economics there. We can spread the resources across all the partners we have in that market. So we're always looking to do that. Yeah, I think you do see us expand to new markets, but it always comes with what I call an anchor tenant, right? We don't just go to a market and say, "We'd love to be in Dallas," right? A great market.
No, we launched in Dallas at the end of last year with Methodist, with the Methodist hospital system. Now, yes, we may add more to our portfolio in Dallas, but we went to the Dallas-Fort Worth area with Methodist as sort of the anchor tenant. So that's the way we view expansion. We don't go to a state and just hang a shingle. We'll go with a partner and then once we're there, I think there's a lot of opportunity for us to expand. We're very excited about the Texas market overall.
Nice.
Yeah.
All right. I want to discuss the payer channel next. Although it's the smallest revenue contributor in 2025, only about $50 million is what you're expecting, I think it represents one of the most exciting opportunities for long-term growth for DocGo. Can you talk a bit about the care gap closure business and how many payers are you working with today? How many members does that kind of give you access to and how quickly you're getting assigned sort of new lives with these relationships?
Yeah, so we started working with the payers, and I'll walk you through all the numbers there. I mean, we share that the payer business, that payer segment that we have, not the segment, but the vertical that we have around the customers, the payer customer is going to grow by 100% year- over- year for us. We feel very confident about that, and essentially, we started in December, basically about a year ago, 13 months ago. We had one payer give us 2,000 patients to go and close care gaps. Now, you have to understand the payers have members. Some of these members use the health system. They're engaged in their health. Some of the members, some of the patients are just, they're drifting, they're unattached, they have accessibility issues. They can't get a visit with their primary care provider, and they have a gap in care.
Perhaps they're a senior patient. They need an osteoporosis screening, a bone density scan. Perhaps they need a colon cancer screening. Perhaps they have diabetes and need a retinal scan. We do over 30 different care gaps in the home. So what the payers are doing is they're saying, "Hey, here's a list of our members of patients that are just, they have care gaps. They're not being addressed, and they're weighing down the plans." So we had one payer 13 months ago give us 2,000 members. Today, we have 6 payers that have given us over 500,000 patients. And what our patient engagement teams are doing is they're engaging these patients, and we could talk about all the great innovations we're doing there, but basically saying, "Hey, we're in your neighborhood. You do need a bone density scan, a diabetic retinal scan.
You do need a depression screen. You do need to check, we have to check your meds. We have to check your vitals. You need an annual wellness visit, a pediatric child well visit. We'll come to your home and do that." And so we've been really ramping up that business. We've done thousands and thousands of those visits. We'll do many, many more. We've increased our capacity by 5X over the last quarter or two in that area. So we feel very, very, very excited about that. And you have to remember, when we go to the home, we close those care gaps. It was funny. I was looking at the dashboards that the team is checking on a daily basis, and I saw that some of the care gaps were not getting closed.
I said, "Oh, the payers are not going to be happy about that." And I said, "Lee, you don't understand. It's actually, there's two sort of pieces of goodness here. One is we closed the care gaps. We did the diabetic retinal scan, and yes, the patient is not at risk of vision impairment or blindness, and we can close that gap. The plan wins when they close gaps, right? They're providing the care they need, and it's not a risk, and they're closing gaps, and their quality scores go up because their members don't have as many gaps. Everybody wins. But maybe that reading comes back high. Maybe the blood pressure is high. Maybe the bone density scan comes back high. Now that gap is not closed. That gap is open. That patient is at risk.
And so now there's an opportunity to navigate their care to make sure that they get that risk addressed because that risk will become very expensive. Should that patient that has osteoporosis, the bone density scan came back alarming, and they trip and fall and break something, obviously that patient, it's going to be horrible for the patient, and that patient's going to cost the health plan a lot more money. So either way, as long as we're able to engage the patient, either we close the gaps, the plan wins, or actually we find the patient has a specific need, and we have to get that addressed. Otherwise, the patient is going to, their condition is going to continue to precipitate and get worse. So that's been a great, we've been very, very emboldened by that.
Every patient we go see, absolutely, we are helping, and we're helping the plan. But what we're also finding is that 25% of Americans don't even have a primary care provider. Many of the patients we're going to see, maybe they're assigned a primary care provider, but they haven't visited that primary care provider, and we have our own physicians' practices. We're licensed. We can enroll them and become their primary care provider, which we're doing. We have patients as young; we have a 23-year-old patient, and we have a 100-year-old patient, everything in between, and we're finding that, absolutely, we can impact their health for the better. So now I think there's a big opportunity. We've been thinking this way. There's a big opportunity for the company. We can go in and close care gaps, but that's really just the first step. We can enroll them.
We can become their PCP provider. We can quarterback their care. We can help them navigate to find ways to close those care gaps. And that's really the way to do value-based care. I don't want to take risk on a patient that won't even open their door to us. That's not the way to do it. We want to take risk on those patients. These are the tough patients. The plans are not giving us the patients that are taking care of them and going to see the doctor. But if we can go in and we can close those care gaps and we're quarterbacking their care, maybe we enroll them in our RPM program, which we have 50,000 patients enrolled where we monitor. They're sending us their blood pressure every other day.
That's the right type of patient that a company and a provider should have a risk-value-based arrangement with. And that really is our strategy. And we've been building these pieces together to be able to put us in a position to be able to participate in this value-based world that we think is going to grow very, very much so over the next four years and to do it in a very, very intelligent way. And so we're starting to add all the pieces to be able to do that.
And I think, and correct me if I'm wrong, you don't have to take risk on these patients as it stands today, right? Which has been, I think, where if you look in the public markets with a lot of the value-based care enablement companies and value-based players, they have been taking on that risk, and that's where that's affected some of their business models in the interim during this transition, this time of higher utilization. So it allows you to almost help the payers solve a really big problem that they still have while also maybe minimizing the risk that DocGo takes in trying to solve the problem.
Yeah, and then that's part of the strategy. The other piece is the contracts we're signing right now. We're saying, "Look, we want to have a gradient, an onboarding to risk," right? So maybe we get some bonus payments as the patients are getting healthier, but we don't have downside risk, then maybe we take upside-only risk. Obviously, it's limited, but it's upside-only. As an example, right now, we're providing all the pediatric well visits. We're providing to many, many children in California, and we're providing them all the vaccinations they need. We're Vaccines for Children participants in California. And if we complete the full child panel, pediatric panel vaccination panel, we get a bonus payment for that, right? So obviously, we're incentivized. Of course, the children are getting all the vaccines they need.
If we complete the full panel of vaccines that they need from birth to their first birthday, then we get incentivized to make sure that we're giving them the full panel of vaccines, and then over time, we have upside-only risk, then upside, and then full risk at that point, so we're taking a very measured approach to us. The market probably wants us to go faster. We're a public company. Everything's in three-month increments. I know that, but we really are taking this very gradual, measured approach because of what's played out on the market, and we think that we can do it intelligently, and we can really help patients for the better, but we have to be cautious on how we do that and not just take uneducated or unintelligent risk.
We want to get our free-throw percentage 90% plus, and then I'll take the last two shots with 10 seconds left in game seven.
Look, I was at a major healthcare conference earlier this week with a competitor, and I think every sort of value-based care vendor I spoke to or company I spoke to is trying to find a way to spread out their risk or sort of better manage the progression of those contracts into risk so they can understand that risk pooling and the profile a little bit better. So I think the measured approach in this market is, I think, the right one in the near term for sure.
Yeah, and look, I mean, I'll tell two stories, so one is I mentioned the bone density scanning that we're doing. The plan's been trying to drive this patient into the clinic, into the doctor's office to get the bone density scan. She's not doing it. Has accessibility issues, mobility issues. Some of the patients, I hit the phones myself. I've been trying to get an appointment. I can, so we go into their home. We do the bone density scan. It's the same bone density scan you're going to get in the office, but now our clinicians are trained: "Wait a second. We see that there's loose carpeting all around the apartment," right? Now we see the patient's bedroom's actually upstairs, so now we understand a lot more of sort of their social determinants of health, their ecosystem around them, right?
The home is actually, they're even at more risk than you might have thought from just the scan alone because their environment is a little bit more risky, and so maybe perhaps we can recommend to the caregiver, "We actually should address this loose carpeting. Perhaps if there's a bedroom downstairs, or we can try to arrange a living situation that's maybe a little bit more conducive to the patient's state." Again, all of that drops the risk, and you don't get that insight unless you're actually meeting the patient where they are, so we think we'll have a very, very unique view into the patient needs once we're addressing them, again, where they are, so that's something that we're seeing for sure, and again, that's part of the whole value-based ecosystem where we're incentivized in a sense.
The system is incentivizing us to try to address the whole holistic patient. Another great example is we were seeing a patient, actually a PCP patient of ours, who we've converted over, and we noticed this PCP patient is scored on the RAF score, the risk-adjusted score is a 0.8, which as you know, is quite a healthy person. We noticed we went to go see this patient 23 times. Okay? I said to the team, "What's going on over here? We're seeing such a healthy patient 23 times?" Then we have another patient who's coded a 6, 6 point something. We saw that patient once, right?
So now, again, we're starting to get a chance to see. We actually probably should be seeing that patient who's scored much, much higher, much sicker. We should be seeing them more often than we probably are. And the patient who's coded a 0.8 probably is inaccurately coded. I bet anything that they are. So again, that's part of the whole understanding of the risk profile as well. And so we've been putting all of this together over the last year, year and a half at a scale that I think few companies are doing it at right now.
Very much so. Well, as you think about the mix of the member population that you've been assigned today, what's that look like, Medicaid versus Medicare versus perhaps duals, MA? What's that look like, and where do you see the most opportunity in terms of to be assigned more lives from a population perspective?
Yeah. So today, it's about 40% managed Medicaid, 40% Medicare Advantage. Another 3 or 4% are duals. The rest of the balance is sort of the exchange plans, commercial exchange plans. And that's kind of the way it's breaking out. I think absolutely we are really centered in on those managed members, which again, the plans have huge incentive to manage the costs. We help them do that. The plans have huge incentive to improve patient outcomes. We help them do that. So I think those two, you'll see us start to expand significantly in the managed Medicaid plans and as well as the Medicare Advantage plans. And I think both of those will grow under the next administration.
Is the changes on Star Ratings, has that been creating extra incentive on the MA book at all?
That's a huge incentive. So first off, folks have seen through the earnings calls of some of the plans. They are taking hits on those HEDIS star quality scores. Plan going from two and a half stars to three stars has a huge impact on the plan's profitability. Plus, it's sort of this. I think the system is set up quite intelligently in that. Look, when I, as a Medicare Advantage enrollee, get to see the plan's star rating. Which plan do you think I'm going to choose? The plan that has a three, four star, or the plan that has a two star, two and a half star?
So it creates this either virtuous cycle for the well-performing plans, or it creates this doom loop cycle for the lower performing plans. So the plans are very focused on that. They want to see those star ratings get impacted. And you can imagine the patients they're assigning to us are the ones that are probably impacting their star ratings because they're not going to get those care gaps closed. And a big percentage of the quality score is actually patient satisfaction.
Oh, interesting. Okay.
How happy the members are. That's a quality plan has happier, more satisfied members. Our patient satisfaction scores on the home visits that we're doing last quarter in Q4 was an 86.
Wow.
And all of our medical advisory board folks are telling us, I had Dr. Barbara, who's the chair of our medical advisory board. He was here this morning. He was saying that a great hospital system score is like 8.
Yeah. Yeah.
If it's not negative, it's a negative.
If it's not negative, yeah.
We have 86 because, again, we're going into the patient home. What could be more delightful than that? So again, and then that again gets factored into when CMS sends a satisfaction questionnaire to an MA member, that home visit was delightful and actually was able to provide great quality care. They're way more likely to fill out a positive review on that questionnaire.
I could spend easily the last five minutes talking more just only on payers, but we'll cap it there. Touch on municipality a little bit. Expecting it to be about $100 million of revenue next year or in 2025 here. Can you just talk about what types of RFPs you're responding to now relative to maybe some of the prior work that you did with the migrant contract? And has any of the, and I mean, this is sort of behind us, but has any of the NYC publicity impacted that pipeline at all?
Yeah. So really, again, in our mission, it's high quality, high affordable, highly accessible care for all. We really wanted to put that in there. I think the big opportunity here is not to provide a great experience to a very small subset of the population. You're not going to change the industry doing that. We want to address 100%, including uninsured, underinsured, and obviously underserved patients. A big way to do that is the municipalities we work with are the ones that really come to the rescue, so to speak, to provide care to the underserved or under-insured patients. So we've been doing that since we started the company. Obviously, COVID was a big catalyst for that.
As you mentioned, we had contracts relating to the wraparound services and the medical care of the asylum seeker population that was coming to New York City, and that got a lot of headlines. So I think that is a big foundational component of the company. The types of RFPs that we're responding to to answer that part of the question is we're really looking at population health style programs. Programs now that, A, hopefully cannot be politicized. I'll give you an example of one. And programs that are evergreen population health style programs. There'll always be some element of responsiveness that a municipality is trying to do to a patient population need. But as an example, we had a program in Michigan. We were going into the homes of disabled veterans and providing vaccinations, right? These veterans are disabled. Again, if it does get politicized, I'd be shocked.
I mean, I think everybody could agree that going and providing care to our heroes in the military and our disabled veterans is quite a life worth living and a service worth providing, and so those are the types of projects you'll see us do. We have a world-class program where we provide medical care to unsheltered homeless population. It's won many awards. We've been operating that now for four years. Again, I would hope that folks would not politicize a program like that, and people are clearly in need, and they're clearly underserved, uninsured. There's an opportunity for us to provide medical care, and by the way, it's good for everybody because if we don't address that medical need, again, we're doing it street-side in some cases, we go into the subway system, we do it in the parks. They're going to end up in the hospital.
And again, many of the hospitals don't have enough space for them. So we're trying to catch them before it gets worse. We're trying to catch the condition and provide medical care before it precipitates. So those are the types of contracts you'll see us looking at, I think. Again, we didn't talk about, but over the next administration, I think there'll be an additional focus on our service members, on the Department of Veterans Affairs, and so forth. And I think there'd be a lot of opportunities there as well.
Excellent. Any questions from the audience? All right. Go ahead.
Yeah. So I'll start with the latter part of the questions. First off, thank you for the questions. I think we did 99,000 behavioral health screenings last year. And that street health program that I was describing on the municipal side, we have teams that go out to provide care. That team is comprised of a PA or NP and a social worker and someone to protect their safety. So we very much take a team-based approach. On that program alone, we provide, I think, the numbers like another 90,000 social work and sort of behavioral health services as well. It's growing significantly. I think year- over- year, we doubled the number of sort of behavioral health engagements that we had done from the year prior. So it's certainly growing.
And I think there, we're taking an approach where 50% of all telehealth visits right now in the country are behavioral health visits. So I think that market's actually well served. There are a lot of providers providing. Our magic is being able to bring in-person care. And I think in the settings that we were describing in some of the humanitarian shelters, when a face-to-face human interaction is better for the patient, I think that is where we'll really shine. And so I'll give you just one more other example of that. We provide 30 different care gaps in the home for the insurance companies, the payers I was describing. One of those 30 is what's called a PHQ-9 depression screen. And very often, we go to the home to address a different care gap. Maybe we want to take a patient's vitals. We want to give some vaccination.
We want to do an annual wellness visit, and our clinicians are trained to perhaps identify that a patient might be depressed or having suicidal ideations and some of the behavioral health distress. And in that moment, we'll add an additional screening, a PHQ-9 assessment, and then we'll go back to the plan and say, "You didn't have it noted here for this member, but we actually think that they did score high on that PHQ-9 assessment. We think that additional follow-up is required. We can do it, but again, we want to make sure that we're closing the loop there, that they have a behavioral healthcare need as well that wasn't even identified." And so the capital requirement for us, particularly in that business, people are our most important and are also most expensive resource.
And so for us, the big requirement that we're finding is it's a big differentiator for us to be able to close those 30 care gaps, but it's also very expensive to train our clinicians to be able to have that wide scope and be able to operate all the different diagnostic tools and things like that that we have in the home. So over the last, I think we could be doing even more visits than we are right now. The need far exceeds what we have right now. But we make sure that our clinicians are trained in the full scope of what we're trying to do so that if they are in that patient's home and they do recognize that that patient has additional gaps in care, they can spring to action and close those gaps in care.
And so the big capital expenditure is obviously there's vehicles that are involved in this. We have 1,000 vehicles. Our personnel, our people are a big expense. And then when we ramp up quickly, it costs more money to do that. And so I always say to the team, "I'm not a pig. I know I can only have two of three things. It could be really fast and really cheap and good quality, but I can only have two of those three things. I know that." And I always tell the team which part of the business, which part of the evolution we're in. Right now, on our payer business, I'll never sacrifice on quality. So that always has to be one of them. So if we want to go fast, it's going to cost us.
Right now in that payer business, we're in the fast mode right now. In order to reach those 500,000 patients, not all of them are going to open their door. In fact, a small percentage are going to open their door to us. It's our obligation to at least try and contact and engage every single one of those 500,000. Every single one of them that does have a gap in care, the quicker we can get to them, the quicker we can respond and catch something that ultimately is going to be perhaps an emergency or something catastrophic like vision impairment or blindness or, again, we're doing colon cancer screenings, you can imagine. Our obligation is to get to those patients as quickly as possible. We're in very fast hyperscale mode on that business.
Part of that is the training and the onboarding and the sort of resourcing that's required to expand as rapidly as we're trying to right now.
Awesome.