Okay. Good afternoon. We're going to get started with our next panel. I'm Jamie Perez, healthcare provider and also Goldman Sachs. Next, we have DocGo and Lee Bienstock, CEO. Thank you for joining.
Thank you, Jamie. Thank you to Goldman. It's great to be here.
Thank you. Maybe we can just start. You've got a couple of different business lines, but maybe you can outline for us what is the core competency that connects these all and just give us a quick overview of the business, and we'll dive in from there.
Yes. An overview on DocGo. We're a mobile healthcare company. We bring care to where it's needed, or we'll transport a patient to a location of care that they need or as they're being discharged from the hospital. We have a very large medical transportation platform, and we have a mobile healthcare platform that brings care to patients where and when they need it.
I guess just starting from high level and work down from there, but you've gone through a little bit of a rebasing period across a couple of the businesses. How are you thinking about just the positioning of the business overall, redeploying assets and sort of using this period to transition to what's next?
Yes. As you mentioned, we are going through an evolution of the business, but really it's continuing to expand what we've always done and what we've been so successful doing. The company got started as a medical transportation company, and we built probably the best tech platform for EMS, non-emergency medical transportation, where essentially a discharging nurse can click a button on the platform and know exactly when the medical transportation, when the ambulance is arriving for that patient that's being discharged, to take that patient home. Just like the common tech platforms of today, get an exact ETA. Last year, our tech platform calculated 15 million ETAs for our partners. We have continued to expand on that.
As the country was hit with COVID, as New York City was hit with the migrant crisis, we were one of those companies that essentially the public health apparatus turned to because we had so many EMTs, paramedics, ambulances. We were very natural partners to help respond to some of these, frankly, what seemed to be once in a lifetime events, the pandemic and a big 200,000 person influx to New York City. Those events, like COVID and the migrant crisis, took on a lot of the story of the company. What I have focused the company on is to really focus in on continuing to expand the medical transportation platform that we have, and also all the while continuing to expand the care in the home business. That is really what the company has been focusing on.
Yes, we've done a lot of crisis response, a lot of municipal work, which I know we'll talk about, but all the while we've been really expanding our capabilities of the medical care we can deliver in patients' homes and really expanding the medical transportation platform. That is the focus of the company. We've been doing that. We're going to celebrate our 10-year anniversary this summer. Over that span, we've helped care for 10 million patients. We've been doing this at scale. Yes, we responded to a lot of these crises that have happened over the last five years, but all the while we've been building the capabilities to deliver care where it's needed, and that's the big focus of the company.
Okay. You mentioned some of these one-off things that have emerged over the last couple of years. We'll come back to that. I want to start with the core business today. Obviously, the medical transit business, I think that's $225 million in guidance of $325 million, excuse me, $315 million at the midpoint. So it's the bulk of the business today. You're coming off, I think, your highest medical transports ever in the first quarter. Can you just talk about the growth drivers? I think you're growing mid-teens or thereabouts. What's driving the bulk of the business today?
Yes. Our medical transportation business is focused on large hospital systems. We partner with large hospital systems, utilize our tech platform, and at the same time, we also provide them with the ambulances and the crews with which to transport the patients in the system. That's been a big focus of ours. We work with some of the largest hospital systems in the country. We work with New York City Health Hospitals, Northwell, HCA. We work with Methodist. We work with Jefferson, Mainl ine, lots of different hospital systems, and we go in and we help manage all the patient flow. They utilize our tech platform, and their discharging stations use our platform. It's all embedded and integrated with Epic. Directly from a patient's chart, the discharging nurse can click a button. That's how we grow that medical transportation business.
There is an inherent organic growth that happens with the hospital systems we are already working with. Unfortunately, America is getting sick, more patients are being moved around, and that tends to have tailwinds for us. At the same time, also, we sign new hospital systems that come onto the platform, and that creates a step change function in the growth. That is how we get, let's say, 2%-3% of organic growth just on the number of volume that just goes up for the trips, but then we bring on additional hospital systems that get us to the 10%-15% year-over-year growth rate.
Just thinking about the growth drivers in that way, is there opportunity to deepen relationships within existing health systems? You're in, I'm making this up, you're in five of 10 hospitals within a health system, and you can expand to additional hospitals. How does that fit into the growth algorithm?
Yes. Today we serve hundreds of hospitals across all of our markets. I should have mentioned in the opening, DocGo, we serve patients in 30 states. We're licensed to provide medical care through our physicians group in 48 states. We're serving hundreds of hospitals across many states in the U.S., as well as many of the hospital trusts in the U.K., which we can talk about. There's an opportunity for us to do more with the hospital systems we're already working with, bring on additional locations that they may have, but there's also an opportunity for us to provide more and more services to those hospital systems. I think we've only scratched the surface of that. Most of the hospital systems we work with, we're only providing medical transportation.
Because we're such an expanded mobile medical care company, some of the hospitals we work with now, we're doing cardiac monitoring and patient monitoring for them. Some of the hospitals we work with, we're doing transitional care management, which we can talk about as the patients being discharged, helping to stop and reduce them from being readmitted to the hospital within 30 days. We have great partnerships with the hospitals we work with. It's primarily medical transportation today, but we think that we could expand it pretty significantly to other services.
Just as we think about the next year or two, you've guided to 575,000 transits this year. I don't know that I'll call it guidance, but alluded to that you can get to 700,000 next year. That'd be like a 20% growth trajectory. Is that underpinned by visibility on new contracts coming online or just give us a sense? It sounds like new logos, new customers is a big piece of that. What's the visibility that's driving that?
Yes. So we have good visibility, certainly for this year's number. I think we have good visibility for next year's number. And really those numbers are based on three factors. One is signing new hospital systems onto the platform. So as an example, just this month, we signed a very large hospital system in New York City, in New York, that we're bringing on right now, actually, as we speak. Over the last six months, we've expanded to Chattanooga, Tennessee. We've expanded to the Dallas-Fort Worth area. We think that Texas is going to be a large market for us over this year and next year. So it's really a confluence of multiple variables. One is signing new hospital systems. Two is geographic expansion. And then also, of course, bringing on additional hospitals for the systems we already work with.
What are you displacing when you add these new customers? Is there just small regional competitors that you tend to be displacing? Maybe there's no solution. Who are you displacing?
Yes. On the medical transportation side, we are displacing existing providers. We're coming in with our own technology platform, which is displacing whatever technology platform they may be using. Sometimes they're just using Excel file. They're using Teams messages, things of that nature. Of course, we bring on our transfer center software that allows them to manage the whole system. There are existing providers that we're displacing very often. In that business, on the health insurance side, which we'll talk about, on the business where we provide care in the home, that's just an expanding pie. That's a greenfield opportunity for us.
Yep. And can you just give us a sense of the, sticking with the medical transit business, a sense of the market dynamic? I imagine it's very fragmented, and you've invested in the technology platform that's enabling an elevated, more sophisticated process for nurses, more seamless for integration with EHR, etc., that they probably can't provide. Is that what's enabling kind of this share gain dynamic that you're seeing?
Exactly. It's a very fragmented industry. We've invested heavily in that tech platform, and that's what's allowing us to win a lot of this share. That has been a focal point for us. It's a very fragmented industry, and we are coming in with scale. We're coming in with a certain level of service, and we could talk about what our model is because it's a very differentiated model from what has existed prior, which I think we should talk about, actually. The old model is really what I call a jump ball model, right? A patient is being discharged from the hospital. The nursing station has a list of ambulance providers that he or she can call. She calls the first one. They're not available. He or she calls the second one, and down the list they go.
We think that just fundamentally creates a bad experience for everybody. It creates a bad experience for the patient. They could be sitting around waiting for transportation. It creates a bad experience for the hospital system. They do not know when someone's going to arrive. They do not have sort of this predictability that they need to run their healthcare facility. We came and we said, We're going to upend that. A, we're going to give you a technology where you know exactly when we're arriving, so you know exactly when to get the patient ready. Intake knows exactly when that bed is being freed up for the next patient. We're going to provide you with a fleet of dedicated ambulances and crews for your facility. You tell us which patients are most critical to be moved. You tell us which patients to prioritize.
You know exactly that those ambulances and those crews are going to be there. It gives you tremendous predictability. It also gives us predictability because those hospital systems are guaranteeing the rate for those vehicles, those dedicated fleet of vehicles, so that we know that they're going to be highly utilized. This, I think, has revolutionized the space, not only the technology platform, but just the model itself, right? The hospital system gets predictability, and they know exactly that those fleet of ambulances are there, ready, willing, and able to transport those patients in real time. That's a big, big change to the industry. I think that combined has allowed us to really gain share.
You mentioned the New York Hospital, the Chattanooga Hospital. I imagine you do not want to speak about specific customers, but as you are going into these conversations and winning RFP, what is the one or two things that is most resonating pain points for hospitals that allow them to get across the finish line with DocGo?
Yes. I think the number one is the patient bed management and the flow because to bring on a new hospital bed in this country, just one new hospital bed will cost $3 million. Hospital systems are faced with, do we have to build more capacity, which costs a lot of money and takes a long time, or can we use the capacity we already have to be more efficient? We enable them to do that, right? As I was describing, when the discharging nurse clicks that button, A, he or she knows exactly when we're arriving, but then housekeeping gets a notification when to come and make the bed ready for the next patient. Intake is getting a notification alerting them that the bed is now ready for the next patient.
The flow of the patient allows their hospital system to be more efficient. As a result, they utilize the beds a lot more efficiently, and then their capacity as a system increases. That is a very, very profound value proposition for the hospital systems we work with. That really is the cornerstone of what we provide to them.
How does pricing work? Is that all contracted between you and the hospital? Is it Medicare rates? I mean, give us a sense of pricing dynamics. Are you taking price in this market?
Yes. We go to the hospital system and we say, "We're going to provide you with a dedicated ambulance and dedicated crew." Depending on, as an example, we know Friday at 2:00 P.M., you have the most number of discharges. We're going to have five ambulances and crews ready for you because we look at all your historical data, and we know exactly how many patients, on average, you're going to need to transport. We say to them, let's say our basic life support or advanced life support ambulance is going to cost you X for the day. It costs you X for the day. We're going to bill insurance. Whatever we collect, let's say it's $1,500, it's going to cost the hospital system. If we're able to collect $1,500, then the hospital system doesn't owe us any money.
If we collect $1,200, then the hospital system has to make up the shortfall. They are basically guaranteeing that they have capacity, but at the same time, they are also guaranteeing that they will help us make sure that all those vehicles are highly utilized. Also, we do not take on the reimbursement risk, right? If they require that we transport patients that are uninsured, underinsured, then ultimately, they are going to help fill the gap that is there between what we are able to collect and really what it costs to procure a great quality service.
Just in that example, how much is a hospital typically funding?
We have hospitals that fund almost, fund zero. In many cases, we have hospital systems that have payer mixes that allow them to fund zero. At the end of the month, they do not owe us anything. We have hospital systems, as an example, we work with a hospital. I am not going to call them out by name, but we work with a hospital, as an example, that 30% of their patients that are being discharged are either uninsured. It is a safety net hospital. As a result, a big percentage of their patients just do not have insurance, and we get no reimbursement for them. In the old jump ball days, they make phone calls. We need to transport this patient. Nobody is going to transport a patient that they are not getting reimbursed for at all.
That hospital tends to have to make up a shortfall to us, but they know that we're going to be ready, willing, and able to transport those patients and free up the next bed for the next patient. That's worth a lot more than what the shortfall ends up being with us.
Okay. Let's maybe shift gears to the payer-facing side of the business. Here, it seems like you're creating more of a market. I mean, these are patients that just aren't addressed by the healthcare system as it exists today. Can you talk a little bit about the needs from the perspective of the payer, your customer, and how your solution fills that need?
Yes. This is a really rapidly growing part of the company. Essentially, the way it works is we partner with the payers and provider groups, the value-based ecosystem, and they share with us lists of patients, and they assign us patients that have gaps in care. They maybe have diabetes, and they need a retinal scan or A1C check. They have osteoporosis. They need a bone density scan. We provide over 40 different care gap services in the home. Basically, the insurers are providing us with lists of patients that they know are chronically ill, that are not going to get these care gaps addressed. They have tried and tried to get them to go to the clinic or to their physician to get these care gaps closed, and they have not been successful doing that.
They give us those patients to meet the patients where they are in their home with success in closing out those care gaps. You say to yourself, "Why are the insurers doing this?" This is the reason why we're just so excited about this business. To me, it's like everybody wins in this scenario, right? You have the patient who, for whatever reason, is not accessing the care they need. Maybe they have mobility issues. Maybe they're disabled. Maybe they don't have good access to care. We're going and meeting them where they are. In pretty much any business, when you meet the customer or the patient where they are, you're going to be successful. The patient's winning. The insurer is basically funding and paying for the medical costs relating to this patient.
The more gaps in care they have, and the longer they go unaddressed, the more expensive that member is going to be for them. They're highly incentivized for us to go and provide care to that member. If we're successful doing it, our company does well. And the U.S. healthcare system also does well because the healthier patients are, the less of a cost they are on the system. We are very excited about this opportunity, and the insurers are really taking us up on this right now. We started doing this in Q4 of 2023. We had one payer assign us a list of 2,000 patients. It was December 3rd. They're trying to close out the year. Get a call. We've been working with this payer, and they're taking a while to sign the contract.
They call us on December 3rd and say, "Okay, we want you to make progress by the end of the year. We have a list of 2,000 patients. We want you to go to their homes to close care gaps." We have a culture of saying yes. We have a culture of taking on. That comes from the emergency medical background that we have on the transportation side. We took that list of 2,000 patients, and we were quite successful in going and meeting at least a portion of that list in their home, even over the holidays and over New Year's and so forth. Since then, since that list of 2,000 in December of 2023, we now have lists of patients that total 900,000 patients with a list of about a half a dozen very, very large payers.
They're giving us these lists of patients to go engage and close care gaps. We're very excited about that because ultimately, that's really, I know we'll talk about this. This is the right solution for the right time. This industry right now is under enormous stress, higher utilization, costing them a fortune, and now there's going to be potential cuts in funding. We feel like our solution is tailor-made for this. We are absolutely trying to cut costs in the system, and we're trying to meet patients that are sick to keep them out of the hospital so that it costs the system less money. Ultimately, that's going to be what the healthcare system in this country ultimately needs.
I mean, you mentioned the 900,000 list. I think that's up from 700,000 a year ago. It's a high 20s growth, 28%.
That's right.
How would you break this down into a revenue opportunity? I mean, is there a revenue per member type of goal? I mean, as a related point, what does success look like? If you can reach 50,000, is that 25,000? Excuse me. What does good and great look like in terms of addressing that list?
Yeah. So right now, we're getting paid essentially a custom rate per visit that we do per patient. It's basically a fee-for-service style model. We go and close the care gap in the home. We get paid an at-home visit rate. That's where we're starting right now. We're getting paid per care gap closed. As an example, we might go to, on average, we close two care gaps every visit we do. We might go and titrate a patient's meds, take vitals, and do a vaccination, or we might do a bone density scan, a diabetic retinal scan. We do multiple care gaps when we visit a patient's home. What we're finding is, we get paid that per visit rate. What we're finding is, so far, 50% of the patients that we're going and visiting don't have a primary care provider.
By the way, that's not like such a high number, but on average, right? I look in this room, one in four Americans, one in four average Americans do not have a primary care provider. What we're finding is we're going to the home, we're closing gaps in care, and we're finding these patients do not have a primary care provider. We are now starting to enroll them in our primary care practice so that they can become our primary care patients so we can get that longitudinal recurring revenue. Over time, we may take some capitation or value-based payments on these members, but we're being very, very cautious, and we're sort of gradually easing into that value-based. Right now, we're in a fee-for-service model.
Over time, we feel like we'll be in probably the most strategic position to take a value-based arrangement because we're in the patient's home, we're closing gaps in care, and we're their quarterback on the primary care side. We think those are crucial ingredients to take risk intelligently. Right now, we're starting the fee-for-service way. Over time, you can see us go from an at-home visit rate to a primary care rate to capitation to value-based payments as we go through the progression here.
I'll come back to primary care and the risk side in a minute. Just thinking about the list that you have today, how much runway does that give you in terms of growth opportunity over the next couple of years just in terms of penetrating that? Maybe as part of it, just talk about how you're doing that. I think you've talked in the past about you're constantly trying to figure out how to better reach patients in terms of when to call, all these different strategies to better reach them. How do you execute on that, and how much runway in terms of growth does it give you?
It's a lot of runway. It takes a lot. Obviously, we can convert a higher percentage of the lists we already have. There are so many great—that is a competency that the company is building that I think is going to be a tremendous strategic advantage to us. I'm going to give you a few examples. We get this list of patients. We know, God forbid, Jamie has diabetes. He needs a diabetic retinal scan, an A1C check, check his vitals. We get a list. Here's Jamie's name and number. Here's his address. We started reaching out to these patients. Originally, what happens is the health plan is going to send you a postcard from them. "Hey, Jamie, valued member. You need some critical screenings.
DocGo is going to be reaching out to you to schedule an at-home visit. Originally, I was maniacal with the team. The day that Jamie gets that postcard, make sure you call him. The day after Jamie gets that postcard, make sure you call him. The team gleefully comes back to me and says, "Lee, you were wrong. The best time to call is like 20 some odd days after he receives that postcard." Why? Because a lot of the population we're dealing with only checks their mailbox once or twice a month, right? We know that there are certain times now to call seniors during the day that's better. We know that we're calling in their native language. We know that text messages work better for certain populations.
We're creating this cadence of communication, and it's just getting better and better the more and more data we have and the more and more engagement we do. It's feeding the engine, and we're just getting smarter and smarter at this. First growth is just get more and more patients, but then also convert more and more of those lists. We're getting smarter and smarter about how we do that and then layering on more and more services. That's how we're going to grow. Right now, we're focused on New York for this business. Right now, we're focused on New York and California. There's absolutely an opportunity for us to also take the show on the road to other states as we grow this as well. There's growth with the lists we have, grow the lists we have.
There's growth to penetrate the lists we have even further on the conversion rate. We can sign more payers. We can go to new states. We're just scratching the surface of this opportunity.
One thing I'm unclear on, I guess, is the goal here to get them re-engaged and they'll have a primary care doctor on their own and you sort of are out of the picture at that point. You're re-engaging for a period of time and then get them back into regular engagement. Is there a longer longitudinal relationship here that you're trying to develop? I think that's part of the primary care strategy. Help us understand, I guess, the duration of the relationship you're trying to create.
We feel strongly that if a patient has a primary care doctor that they like and they're going to see, for whatever reason, we go to their home to close a gap in care, we're going to close the loop with their physician. It was once famously said, "If you have a doctor you like, you can keep your doctor," right? "If you have a doctor, you can keep your doctor." We believe that. If you have a physician that you like, we want you to continue. Like I said, half of the patients we go and see don't have a physician, don't have a primary care doctor. We are ready, willing, and able to fill that void. That's kind of the way we feel.
We feel like we are in existence to care for a subset of the patients that are not getting good care today or do not have coverage, do not have good access. That is the void we are filling. By the way, it is a massive void that we are filling. The patients that are well-served today, we bless them. We want them to continue to be well-served by the establishment that is serving them today. That is kind of the way we think about it.
Can you talk about the labor model a little bit, particularly as you're thinking about building the primary care side? It's lots of companies interested in hiring primary care doctors at this point. How challenging is that to build?
We have a very unique model, right? I mean, I always like to remind people this is not a new idea. Everyone's seen the Norman Rockwell paintings. The doctor used to come to your house. But it's wildly inefficient to have doctors travel from house to house. There's so much drive time, downtime that they're not utilizing. Everybody has this sort of cliché and meme that when you go and see the doctor, the doctor only comes into your room for like a minute and a half, and they're out, right? We basically don't do that, but we say we are sending an LPN, a licensed practical nurse from house to house. We're sending a medical assistant from house to house.
They're serving as the hands, eyes, and ears in the patient's home, and they're being directed synchronously in real time by a physician, nurse practitioner, physician assistant, and advanced provider centrally, let's say, in HQ in our headquarters. Where that LPN going house to house can see one patient an hour, our advanced providers in HQ can maybe see three, four patients an hour. That's how we're leveraging the very scarce resource that you're describing in HQ and scaling the more prevalent clinician base, which is the licensed practical nurse and the medical assistant. That's how we're sort of arbitraging between the two. We have a very scarce centralized resource that's then directing in real time the sort of more prevalent clinician that's going from house to house.
That clinician that's going from house to house is equipped with what we call a go-bag that includes all of the various different diagnostics to be able to listen to the chest, to see inside the ear, nose, and throat, to be able to take different swabs, to take bloods, to do various different diagnostics, and send back those readings in real time to the advanced practice provider that's centrally located. That is how we've been able to scale this model. I think this is by far going to be the model that's necessary if you want to be a successful mobile healthcare company.
It seems like you have a lot early in this opportunity. You can add primary care. This gives you a lot of runway. Why not just kind of focus on those pieces? You're already talking about risk. Why is that necessary at this point and not just building some scale and track record, I suppose, in some of these newer categories?
Yeah. We're not taking risk. We absolutely are focused on the sort of building scale fee-for-service today. The reason why I say that is because I know that we are leaving a lot of the value that we're creating on the table. I'll give you an example. The other month, one of our clinicians goes to a patient's home. They have six open gaps in care. We closed six gaps in care in that one visit that we got paid that one visit and home visit rate for. That visit was worth a lot more to the payer and to the system at large than what we were paid for that at-home visit because we closed so many different care gaps. Basically, there was a peer-reviewed study that published that said just the first preventative care visit is worth about $4,000 to the healthcare system.
We're getting paid a tenth or less of that. I just know that our company is creating a tremendous amount of value for the system, particularly with these hard-to-reach patients, particularly with these patients that cost the system so much money. Over time, we're going to look for ways for the company to receive credit for that value we're creating.
I probably got to move on here. I've been running a little long today. Just on the migrant business, really just one question. I mean, you've been pretty clear this is winding down. I think the primary question I'd have is just your visibility on the accounts receivable. It's a pretty significant balance. What's your level of confidence in sort of the collectibility? Have you taken any reserves against that? Any color there?
Yeah, we are very confident in the collectibility. In fact, we see progress. Just today, we received the payment. The payments are coming in. We had $150 million outstanding, went down to $120 million. Now it's sitting at $100 million, and we're making progress. That balance is being worked down, and that's what's being converted to cash on the balance sheet.
Any updates there relative to the guidance? I mean, you've already done most of the revenue you expect to do this year. There'll be a little more in Q2. I guess any updates?
Exactly. No, that's well said.
Perfect. On the government piece, this was a big focus coming off the last earnings call. You cut it entirely out of guidance. I guess, is the message there you kind of expect revenue, but you have no idea what it's going to be, and so it's out of guidance? I just want to make sure I understand what the message is. Do you have revenue in this channel today, or you would need some of these programs to launch in order to have any revenue?
Yeah, so we will have some revenue from the municipal programs this year. I think the reason, the decision that I made was really the predictability of how much it's going to be and the timing of that revenue became very difficult to predict. We said, "Let's remove that from the guidance. Any municipal revenue will be in addition to the guidance that we have on the medical transportation and the care and the home businesses that we've been talking about." Part of that is because I just feel like the company's message, it'll be easier for the company's message to resonate with investors. When I meet with the team, I talk a lot about, "We've never done more medical transportation than we're doing right now. We've never done more care in the home than what we're doing right now." The company's balance sheet is incredibly healthy.
We have over $100 million of cash on the balance sheet, very little to no debt. That is the message that needs to be resonating, not whether or not this municipal program is going to come on, how long it is going to be, whether it is episodic, whether it is an emergency, whether they are going to pay. Those are pieces that are just going to be incremental and reported separately. The base business, the business that we are growing on the medical transportation side, that is the reason why I gave a lot more specificity around that on the last earnings call.
Okay. Yeah, I think that makes sense from a communication standpoint. I want to understand what was embedded in the prior guidance, actually, just to think about how much potential upside it could be. Maybe it's this year. Maybe it's next year. I think it was $100 million that you took out of that. How much of that was projects that you had already approved that had not launched versus new RFPs that you were hoping to win, but obviously probability adjusted? Any context on that?
Exactly. We had a pipeline. First off, we had contracts that we had signed that were set to launch, and those got delayed with what is going on right now in Washington. We had projects that we had submitted that we were waiting to hear back on. I am going to give you a couple of examples of that. Then we had projects that were set to scale that are sort of sitting in the earlier, earlier stages. That was the reason why we said, "Hey, we have to." We saw companies pulling their guidance completely. I said to the team, "We saw a lot of companies doing that around that time that we had our earnings call." I said, "No, the predictability of the businesses that we were just talking about is there. It is really the municipal piece.
Let's just take that and put it incremental to the guidance. I'll give you an example. We have over 30 RFPs that are sitting that we submitted over half a year ago that we're just waiting to hear back on. We haven't heard that we've won it. We haven't heard that we lost it. We just don't know. It's sitting in limbo. It's sitting in purgatory. Ironically, the week of our last earnings call, we got notified that week that we had won, a small, but we had won a municipal vaccination program in Southern California. That we had expected to hear about at the end of last year that originally when we submitted that RFP was set to launch in February. Now, obviously, we can't launch something in February when they get back to us in May.
Now, we are in the process of launching that right now, and it's launching this month. The predictability of the timing of it just sort of precipitated us saying, "Let's take it and put it on the side".
Okay. Last minute or so here. On SG&A, you're going through a process of rationalizing that. How do you do that without cutting into future growth opportunities? Just give us a sense of your focus there.
Yeah. SG&A as a percentage of revenue is really what's driving the margin pressure for the business and sort of the adjusted EBITDA loss. We're focused on cutting the sort of centralized SG&A and being efficient there. At the same time, we want to preserve some of the capabilities we have for the future growth. It's a balance. The way I think about it is we're cutting SG&A around that municipal sort of municipal work. I think we continue to run the medical transportation business very efficiently. Like I said, we're now in our 10th year in that business. We're investing heavily, spending, and we're going to continue to do so in that payer and provider vertical that we talked about because the upside is just so enormous there.
Okay. I think with that, we're out of time. Thank you, Lee, for joining. And thanks everyone in the room.
Thank you so much. Appreciate it, Jamie.