Thanks for coming. All right, well, we'll just go ahead and get started. I believe it's the afternoon now. Oh, he's gonna mic you up, Seth.
Oh, I won't say. Seth isn't gonna say.
He's not gonna, we don't, he-
Sure, why?
Yeah. Well, I've got the team from Evolent here this afternoon. John Johnson, Seth Frank, thanks for joining us, guys.
Thank you for having us.
Yeah. Well, maybe just to start, we'll get into some of the real-time questions and topics that people are interested in. But, maybe just broad strokes, broad strokes, describe your, your two businesses, technology, services, Performance Suite, you know, the margin profile, the trajectory of each, and if you can comment on the maturation of the new, Performance services business.
Yeah. So the core of Evolent's proposition here is in specialty care management, with a focus in the highest and most complex conditions, oncology, cardiology, being the two largest. We take that product to market in two revenue models. One we call our Tech and Services Suite, which is a sort of thin installation of the platform, plus some services behind it. Average revenue for that product is around $0.30 per member per month, with a gross margin of 50%-60%. We also take the product to market through a capitated product, where we're taking the risk for a particular specialty, and average revenues there might be $30 per member per month, with a mature margin in the mid-teens.
That margin, as you noted, matures over time, where at initiation of the contract, for the first year, it might have a margin of 4%-6%, and that grows somewhat linearly over the first couple of years, to reach that mid-teens target. And I'd say two other really important things on that Performance Suite product, 'cause it's timely in with some of the chatter that's been going on. The first is, the way that we underwrite that product is not based on our customers, the health plan's top line. Right? We're not exposed to health plan top line. We underwrite the product based on actual costs within a population, historical claims, and what do we think we can do with those costs.
The second thing that's important is, because populations change over time, we include in our Performance Suite contracts the ability to update our capitation rates for things like changes in disease prevalence or disease acuity. That's an important way that we manage the risk of the product, and it's contributed to the sustained earnings of that product over time.
Okay. So, given what other health plans are saying today around redeterminations and the implications there, you feel like there's not much of a downstream impact on your business today? Okay, just wanted to-
We do. I'd hit two things on redeterminations. The first is, you know, we noted on our last call that we were more than 80% of the way through the process, right? So I think we have a pretty good visibility into the impacts that we're seeing in our populations from that move. Recall that Medicaid is only about 35% of our revenue.
Mm-hmm.
So it's a small part of the business. And through the end of Q1, that was proceeding sort of right on pace with our expectations in terms of total cumulative impact, both on the top and the bottom lines. And nothing that I've seen recently has changed that point of view.
Okay. As I've made calls around, and one of the common questions we get is, like, why is it so difficult for health plans to do this? And you guys, I think, are beginning to see even growing demand for your services in light of perhaps some of the challenges that certain plans are facing. What is the barrier that many plans have to be able to invest and perform these specialty services themselves?
Yeah. It is an important question. If you look at what is sort of core competency of Evolent in these markets, clearly there's a deep clinical knowledge, there's good technology that's put to work in these moments, and, but fundamentally, the thing that we are hired by the plans to do is influence physician behavior. In a lot of these cases, though we use the moment of prior authorization to do that intervention with the physician, the changes are not based on just a skinny prior auth list.
Okay.
It's not based on, "I'm gonna deny this because it's off of my policy." A lot of what we do is, there might be eight things that are approvable, right, for a particular disease state, but our analysis, based on the clinical data that's out there, suggests that two of the eight are much better than the other six. And we deploy all kinds of tools at our disposal, technology, alternative payment plans, things like that, to influence the physician towards what we believe to be the best medicine. That's a nuanced approach.
Yeah.
Right? And it's hard for a plan, given all of their competing priorities, to dedicate that level of attention to physician engagement... and so that's why we find they will come to a company like Evolent.
Got it. Can you go back and maybe just elaborate more on the guardrails that you have within your contracts, and how quickly you can make modifications, and what the triggers are in the contract specifically that would drive that change?
Yeah, absolutely. So you know, the way that we take risks, just going back to that first, we will document: here's what's explicitly in scope. It's gonna be these codes, it's gonna be these drugs in chemotherapy, it's gonna be these diagnoses, not those, in these facility settings, not those. It's a very detailed scope document. We'll then price based on a set of population characteristics that are agreed upon, right? So the historical period that we're underwriting may have cancer prevalence of X per thousand members-
Mm
... and average case mix acuity of Y. And we'll agree with our partner, "Hey, look, we don't control these things, and we can't influence it." And so if prevalence goes down, then our cap rate will go down as well. So we're not capturing unfair margin from the plan-
Right
... right? And vice versa. If prevalence goes up, then our revenue goes up. And those mechanisms, they're different in every contract, but they're really important to us in terms of how we think about underwriting what is typically quite a long-term risk-sharing arrangement with the the partner. And we've been able to exercise those sorts of protections numerous times over the last several years, including with most of our partners today. So they're both an important piece for us, also an important and aligning piece for our partner as populations shift.
Okay, so the increase in trend that you cited in March was prior authorization driven, not claims activity. When you look at the deviation relative to what your expectations were, like, I'm trying to think through, like, the magnitude. Was this within a normal level of deviation that you usually see in any given month, or is this larger than normal?
Yeah, so here's what we saw. And you're right, the source for this was the prior authorization data that we receive. We had lower claims visibility, in part due to the changed healthcare dynamic, as we were closing the quarter. But in the prior authorization data, we saw in specific markets, so not broad-based, but in specific markets, a meaningful step-up in both disease prevalence and case mix. And so the way to think about that, right, it's not we saw a 4% increase across the board. It's in this market over here, there's a 20% increase. And in this market over here, there's a stairstep increase.
Hotspots.
Hotspots, right? And what that tells us is one of two things, and again, we're just going off the leading indicator data right now. One is it could be that March was an aberration, 'cause we noted that what we saw really started in March in a big way, and that April had come down a little bit, so it could be just an aberration. If it is sustained and translates into elevated claims, what that indicates to us is it's the change in the underlying population. So more members, new members, coming in at the beginning of the year, who are now receiving cancer care at that particular carrier, right? That's exactly the sort of situation that our the protections in our contract are designed for.
Now, one of the things that we also noted, right, is, and this is the reason we have a wide guidance range for our second quarter, is the timing of a revenue update that's associated with an increase in prevalence is a little less known, right? High level of confidence in our ability to execute on that change, but if it happens on July fifteenth, then I capture it in Q2, right, before we report. If it happens on August fifteenth, then we capture it in Q3. So high level of confidence and visibility on the year, but a wide range of potential outcomes for Q2.
Okay. So how—just making numbers up in my head, let's say that utilization was ten percent higher than what you guys expected, and there's a continuation of that trend going forward. Hotspots, as we've sort of described it. How much of that ten percent deviation versus your plan could you pull back in with these triggers in your contract?
Yeah, we estimate that's about 70%-
70%
... of what we booked in March.
Okay.
That's right.
Okay, 70%. Wanna make sure I get that right. So of the... Is all of this the new Performance Suite business that's coming in, the, the new members, or is it legacy members as well, where you're seeing some of this?
Yeah, I like your term hotspots. The hotspots are mixed, so some of them are in new pockets, some of them are in old pockets. It doesn't seem to us to be correlated with a brand-new population to Evolent. It seems more likely to be driven by changes within a particular geographic population.
Okay. And, just wanna make sure I get all these, technical things right. When you were saying authorizations for oncology and cardiology peaked in March, were you saying that that was the highest month for the year, and it declined off that level, or it's declined now year over year?
Just comparing for this year.
Sequentially?
Yeah, sequentially.
Okay. Okay. And you'll know by the end of this quarter whether or not you need to pull down on those guardrails?
We will.
Cover 70% of the-
That's right.
Okay.
Our expectation-
You captured it within the range?
Yeah, our expectation is that some of the visibility issues that we had as we closed in Q1, right, will have worked their way through the system by the time we're closing Q2.
Cross-selling opportunities, where are you on advancing those initiatives, where you're finding success, where you're finding challenges?
Yeah. I think some really good early wins, and it is still quite early. So if you look at our product penetration, we have eight different products that we sell into a health plan, and on average, right now, we've got about 40 million unique members in the platform and 80 million product members for an average of two products per member. So very significant in-sell opportunity remaining there, really across the board. And if you then add on to that, our opportunity to convert where it's beneficial for all parties from the Tech and Services Suites-
Yeah
... into the Performance Suites, where we're both creating more value because we have more levers to create the value. And we're able to capture some of more of that incremental value for Evolent's. That's also a very attractive opportunity for us, and for our partners as well.
Okay. I think on one of your recent calls, you, you emphasized that acknowledging the challenging stock market and the commitment to shareholder returns. I'm just wondering, you know, when you suggest or reference that, what levers you're sort of suggesting you have within your control to drive that value creation?
Yep. I think the levers are pretty well known. You know, we think we have a really unique and valuable asset, with a really attractive path in front of us. We also generate a fair bit of cash at this point and have pretty minimal leverage on the business today. And given that set of factors, we think that there should be a really attractive path forward for value creation here, whether that is organically in the public markets, or not. And the board is open, right, in terms of the best way to create shareholder value here, and we're keeping our heads down and executing on the plan.
Okay. Let me cross one off here. I want to make sure I got this. Medicaid redetermination, just the membership disenrollment, how did that trend year to date versus expectations?
Yep, quite similar to expectations.
Okay.
Sort of right on the money.
Right. Okay. And there's no disconnect that you feel with the acuity matching the membership, like the plans had because you're not... Well, you're tied to revenue, but you're tied to your cost.
Yeah.
Okay.
You know, I think there's something there, Whit, that, we may have been more conservative than some of the plans. And we've talked about the magnitude of the EBITDA hit from Medicaid redeterminations, on us cumulatively, right? Since last year, through Q1, was $5.5 million a quarter, right, and we expect another $1 million a quarter, to come through in Q2. So total $6.5 million a quarter in headwinds that are sort of programmed into our guidance here. If you think about that on 35% of our business, that's a not insignificant chunk, right?
Mm-hmm.
But the important thing from our perspective is that's very well understood, we think, by the management team here and sort of fully incorporated into the numbers that we're driving at.
Okay. I wanted to shift gears for a second to MSSP. You have an ACO.
Mm-hmm.
By my calculation, and I could be off, but I was looking at the Medicare file, you've got about 90,000 members-
Yeah
... in the program, roughly.
That is correct.
Shared savings rate has been around 5%-6%. It's one of your highest performing years. How strategic is that ACO with what you're trying to advance on the specialty care side?
Yeah.
How does it sort of integrate together and wrap around it?
Yeah. So I'll answer that in two ways. We think of it as another category of specialty care. If you think about how do you create value in a total cost of care ACO, right? There's a premium lever, there's risk adjustment, and there's intervening in complex cases. There's the added layer that you have in a total cost of care situation where you need to predict those complex cases-
Mm-hmm
... and where it's gonna be most fruitful to intervene. But it's—that's, that is what it is, right? And we think we're pretty good at that. On the second part of the answer is we think of how does that total cost of care model interact with the specialty care disease-specific models? We think there could be a really interesting path over time, where the primary care piece and that contracting mechanism could meaningfully expand. It has, however, I will sort of say in candor, it hasn't been a huge focus of our go-to-market efforts, given the density of that space, which is the competitive landscape-
Right
... and the lead that we have in specialty management.
... The fee-for-service market's shrinking. Are you trying to grow the patient panel that are affiliated with these patients?
We are.
-or these, these, these-
We are
-physicians? Okay.
You know, the caveat, right, is we because it's not our biggest growth focus, we are quite mindful of avoiding J-curves in that population, right, in the total cost of care population. And so we seek to grow in ways where we're gonna make money off the bat, instead of having to go through one of those J-curves. And that does limit, you know, some of your growth pattern in that kind of a business.
Okay. Any guidance around how you're thinking about shared savings this year versus last year? I mean, it's kind of bounced around a little bit, but seems to be moving up and to the right over time.
Yeah. What we've incorporated into our guidance is an expectation of the same percentage that we had last year. We noted in our call a couple of weeks ago that the data we received during the first quarter was quite favorable. And so to the extent that those trends continue, we could come in above that range. But at this moment, given some of the noise that we see in that program over time, we've participated in it for a long time now, we haven't come off of our expectation there.
Okay. Maybe let's just spend some time on the NIA transaction, how that's progressing versus your expectations. I think you're kind of winding down elements of the Eviti integration here, just the strategic element of it, the financial impact, and how you feel it's performing.
Yeah. That has been a great addition to the portfolio so far. I think there were two really important strategic pieces that acquisition brought. The first is it allowed us to expand from principally only focusing on two specialties, right, oncology and cardiology, to being able to bring a stable of eight different specialties to a client. And in a world where one of the refrains that we hear from health plans is, "I wanna have fewer vendors. I wanna consolidate down the number of vendors that I'm dealing with," that's an attractive proposition.
Right.
We've seen some of that play out in some of the cross-sells that we've been able to execute on. That was really exciting. I think the second piece is it was quite financially accretive. And we've been able to execute on the core synergy case that we laid out at the time of the deal, and feel really good about both that execution and the ensuing delevering that we've done since then.
Okay. Careology.
Mm.
What is this, and what do you expect to get from this partnership?
Yeah. Yeah. So look, we've spent the last 21 minutes, talking about real payer and cost and quality-focused initiatives, that are oriented around the provider, right? The payer's paying us, and we're working with the provider, who is then working with the patient. We have had, for a while now, a strategic conviction that getting closer to the member and being able to provide supportive services to that member during a disease journey, is both differentiated from a commercial perspective for us and a high-value add for the health plan for their members. And we saw in this Careology partnership an opportunity to really accelerate what we are able to bring to market here by becoming the exclusive distributor of this platform in the States, right? It's a U.K. product.
By integrating it into our own platform, being able to do that in a way where we didn't spend a ton of money on organic product development, we didn't spend M&A capital in buying something. So, it's a capital-efficient partnership here that we think is gonna both sort of improve the quality of the patient's journey through their care. It will improve costs, right? The rates, for example, of a cancer patient going into the ER, are remarkably high, and anything you can do to work with that patient to keep them out of the ER, it's better for them, it's better for the health plan. So good for that, and ultimately, it increases the value of the product that we can offer.
Okay. Other capital deployment priorities right now-
Mm-hmm.
-that you haven't shared?
Yeah. So our capital allocation priorities remain the same, which is, 1, we continue to invest organically in the business, we spent a little more than $50 million last year in R&D, inclusive of capitalized software development. We'll spend a little bit more than that this year. 2, accretive and strategic M&A. I'd put that into 2 buckets as we look forward. 1 might be a capability type acquisition, where there's an asset that's out there, maybe it's a technology, an AI or something else that allows us to leapfrog our roadmap, and just get to where we're going faster-
Right
... in a more efficient way. And the second category of the strategic M&A would be adding another specialty to the portfolio. And so listening here to our customers saying: "Hey, we want to buy more from you. We want to have fewer vendors." If we have something else to execute on the cross-sell vision, we think that could be highly accretive at the right price. And then priority three is, at the right price-
Right.
is balance sheet management, right? Doing all of the above with reasonable net leverage, reasonable cash interest, and really focusing on accretive M&A, right? That we can see a clear case to.
All right, Seth asked me to ask a question about stock option expense and RSUs.
Sure. So we've gotten a
Just an investor question.
Yeah, exactly.
We've gotten a fair number of questions, so I wanted to get this one on the record. As folks probably know, most of the stock comp that is granted by the organization is in the form of PSUs, which are three-year cliff instruments that are based on performance against financial targets. And over the last several years, as those have been granted, the company has been performing quite well against our financial targets, principally right around the expansion of EBITDA. As the company does that, those tranches of PSUs are revalued each year. So we had a catch-up in the Q1 results, so a spike in the stock comp expense that was associated with that catch-up.
We would expect from here, about $15 million a quarter for the rest of this year. Most of that expense associated with PSUs that were granted, not this year, but in the prior couple of years.
All right. Were there any questions in the, in the room? All right. Well, guys, we can just cut it off a couple-