Hello, and welcome to the Evolent Health's announcement of acquisition of NIA and partnership with Centene. All participants will be in listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star, then one on a touch-tone phone. To withdraw your question, please press star then two. Please note, this event is being recorded. I would now like to turn the conference over to Seth Frank, Vice President of Investor Relations at Evolent. Please go ahead.
Thanks, MJ. Good afternoon, everyone, and thanks so much for jumping on the call on short notice. Very quickly, this conference call will contain forward-looking statements under the U.S. federal laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the company's reports that are filed with the Securities and Exchange Commission, including cautionary statements included in our current and periodic filings. For additional information on the company's results and outlook, please refer to today's release issued a few minutes ago. In addition, we have posted a presentation discussing today's transaction on the homepage of our investor relations website at ir.evolenthealth.com.
We will be speaking to those slides, so please make sure you pull up the presentation as management goes through it, and we'll call out slide numbers. Finally, as a reminder, reconciliations of non-GAAP measures discussed during today's call to their most direct comparable GAAP measures are available in a summary presentation on our website, and there is a presentation posted on the call, as I mentioned earlier, and in Form 8-K filed by the company this afternoon. With that, I think we'll go ahead and pass the call to CEO, Seth Blackley.
All right. Thank you, Seth. Welcome, everyone. I appreciate you dialing into the call this afternoon. I'm joined by John Johnson, our CFO, and also Dan McCarthy, our President, who also oversees all of our value-based specialty operations. Let's flip into slide three of the presentation to start. Just a couple opening remarks. You know, first, I'm very excited that today we're announcing the acquisition of NIA, the specialty asset owned by Centene. NIA is a proven asset that covers four specialties, including radiology, musculoskeletal, physical medicine rehabilitation, and Genetic Testing, all of which are complementary to our specialties and solutions at Evolent.
If you think back to when I became the CEO in 2020 , my main priority was to focus Evolent and ensure that we're deploying capital in a disciplined way that generated strong margins and strong organic growth for years to come. We posted our first year of strong EBITDA in 2020 and also divested four assets in the following several quarters. In that same time period, my team and I spent a tremendous amount of time with our key payer customers and growth targets. What we consistently heard then and continue to hear today is that the value-based specialty opportunity is tremendous, yet, and yet there is no market leader, and that Evolent has a clear opportunity to own that leadership position.
While we have been able to grow our specialty services at an approximately 40% CAGR over the last few years and continue to have a large growth opportunity ahead, we have heard loud and clear that our platform would be even more unique and valuable to them if we offered a broader set of specialty services under one roof. These payers prefer to have fewer vendors and do more with their trusted partners. That feedback led us to the successful acquisition integration of Vital Decisions in 2001 and IPG in 2022. Our decision to acquire NIA heading into 2023 builds on this same consistent strategy from the last few years. When the NIA opportunity came along, we were excited by three factors that led our board, our team, and I decided to proceed with the transaction.
First, the acquisition will be a significant positive to our current customers and future prospects, as we're able to do more for them in a fully integrated way. Our culture here is anchored around voice of customer and meeting the needs of key health plans and their members, and we're confident this transaction is a big step in that direction. As we integrate this acquisition, we turn our full attention to a disciplined operations and execution against our expanded organic opportunity. The second reason we decided to proceed with the transaction is it's highly attractive financially, and it diversifies our revenue streams and adds scale. We will add $50 million of EBITDA day one, and we'll have line of sight to $85 million of EBITDA through contracted new business and modest cost synergies.
I view this as adding $85 million of EBITDA before we get into any new growth. Evolent is approximately $100 million in EBITDA in 2022, and so obviously this adds significant scale to the organization. Regarding the price paid, we're paying up for a consideration of 13x NIA's standalone adjusted EBITDA of $50 million. We're paying, including the earn-out, if earned, approximately 9.4x pro forma synergized EBITDA of $85 million. Obviously, we believe the actual multiple will be much lower as we grow the asset.
The deal is also immediately accretive to Evolent's adjusted EBITDA margins and free cash flow per share, as we feel we're completing the transaction with a strong balance sheet position. Finally, I'm pleased that Centene was comfortable taking Evolent stock at a price of $29.50 a share and agreeing to an extended lockup. The third reason we're excited about the transaction is that we're confident we'll be able to successfully integrate this acquisition and execute on the opportunity ahead. The Vital and IPG acquisitions were less than 250 FTEs combined, and we've completed those integrations successfully. Further, NIA is very similar to our existing business, and so we understand it, we know how it works, we know what needs to get done to integrate it.
Across our pro forma base of more than $300 million of SG&A, our talented team, and our deep leadership bench, I believe we'll have the time and space to do the hard day-to-day execution required to make this deal work well for Evolent shareholders. On the strategic Centene partnership on the right-hand side of the page, we're already a key and rapidly growing partner for Centene, and we have, I think, a tremendous amount of mutual respect between the teams. When you combine Evolent and NIA, we believe we are now the go-to specialty partner for Centene. As part of that framework, Centene has extended all of our contracts across all of our products to the end of 2027 and committed substantial expansions of NIA across Centene.
It's important to note that the new expansions that Centene has added are focused on NIA, and all of the Evolent expansion opportunities are still out there in front of us to win in a traditional cross-sell framework. Turning now to slide four. We've organized the presentation this evening around the rationale for this transaction, which are, one, that accelerates our leadership in the value-based specialty space, two, that it's financially attractive, and three, that it builds on a strong core business that's firing on all cylinders. Turning now to page five, let's start with why this accelerates our market leadership in value-based specialty care. Our specialty platform has, of course, been the fastest growth part of Evolent the last few years.
Here, you can see that our clinical segment has grown in the 40%s and 50%s on an organic basis for several years now, and we've proven that as we add breadth to what we can offer, we can actually grow faster than we could if we were offering narrow products alone. When we started this specialty journey with the acquisition of New Century, the specialty strategy in today's clinical segment was 28% of Evolent revenue. Today, the clinical segment is 68% of Evolent, and it'll be closer to 80% after this transaction closes. This acquisition fits right into the core growth strategy of the company and is consistent with our path over the last three years. Flipping to page six, let's talk about NIA and why this transaction makes strategic sense.
NIA is a specialty platform focused on differentiated, evidence-based solutions and services against high-cost categories of radiology, musculoskeletal, physical medicine, Genetic Testing. NIA has been operating since 1995. It has 31 million members under management. The company addresses a significant and growing specialty market and offers solutions underpinned by unparalleled clinical rigor with a talented and mission-oriented staff of about 1,200, approximately 500 of whom are clinical in nature. NIA is supported by teams of deep clinical, operational, and technical expertise, and their analytics and automation-enabled technology platform drive differentiated outcomes and lead to strong, long-standing customer relationships that are complementary to Evolent's existing client base. As you can see, the NIA specialties are natural fits with our existing portfolio that allows us to more comprehensively meet the needs of the nation's payer organizations and further differentiates Evolent in the marketplace.
For example, genetics and radiology cut across multiple specialties and will make us better in oncology, cardiology, and musculoskeletal. And we're also excited to add the two new vertical pillars as well. The quote at the bottom of the page is from a large Blue Cross Blue Shield plan executive, and I think it illustrates the importance of breadth, as I noted earlier. This integrated broader set of specialties will be a big positive for our customers and prospects. Flipping to page seven. This transaction is also attractive financially. As you can see in the chart, the business has run rate EBITDA of $50 million . By the fourth quarter of 2024 , we are confident that the run rate EBITDA of the business before any new contract signings will be $85 million or over $21 million in the fourth quarter of 2024 .
The bridge between $50 million and $85 million is driven by two items. First, we've identified $15 million of high visibility cost synergies, which we'll discuss in a moment. While not all of the $15 million is from SG&A savings, $15 million is less than 5% of the combined total SG&A of Evolent and NIA of over $300 million when you include the Evolent business unit SG&A. Further, because of our deep knowledge of the business, we have confidence we'll capture these identified savings. The second component to the bridge is that we have hard contract commitments with detailed rollout schedules from Centene that we believe will contribute $20 million of new EBITDA in 2024, spread roughly evenly across that year. As I said earlier, these expansions are from NIA products and not Evolent, New Century, or Vital Decisions.
Beyond the $85 million of EBITDA, we obviously believe there are a lot of normal course organic growth, cross-sell, and Centene expansion opportunities that we'll talk about later. We believe the Q4 2024 run rate EBITDA will be higher than $85 million. Flipping to slide eight and the cost synergies. John and Dan can touch on these in more detail in Q&A if helpful, but I'll quickly highlight the levers. First, we have an opportunity to staff some of the future growth at NIA in our offshore captives in the Philippines and in India, which is a lever that NIA is not currently utilizing. Further, as I mentioned earlier, our combined SG&A is over $300 million and will yield some savings as there is some duplication. Second, we'll be automating and optimizing through our experience in robotic process engineering, AI, and machine learning.
The second box is also consistent with what our payer customers want us to do to remove friction in the provider ecosystem. Finally, there will be opportunities to integrate our software platforms and eliminating duplicative back-end costs. We look forward to sharing our progress and executing against these synergies over the coming quarters. All right, turning now into page nine, I wanna go in a little bit more detail around the contract extensions with Centene. First, to orient you, the top part of the page are the Evolent services. Those services really got traction at Centene in 2021, and our revenue from Centene in those services doubled from 2021 to 2022, all in tech and services. Those are fast-growing services on their own, and the new contracts with Centene as part of this deal are not focused there.
On the bottom part of the page are the NIA services. Prior to entering this agreement with us, Centene was using NIA for radiology, physical medicine, and Genetic Testing. As part of this agreement, we're expanding all three of those specialties and also adding musculoskeletal. That one addition and those three NIA expansions will, we believe, add $20 million of 2024 EBITDA while driving a very strong ROI for Centene. All four of these specialties are tech and services solutions with predictable margins. Finally, as you see at the bottom of the page in the green circles, we feel we have a lot of running room left at Centene. We see near-term opportunities with tech and services in cardiology and musculoskeletal on the IPG side, and we have medium-term opportunity with the Performance Suite.
Of course, there's also additional expansion within the NIA's products themselves. Of note, you can see that the NIA acquisition adds a third and fourth leg to the Performance Suite stool for Evolent across all of our prospects and for Centene, adding musculoskeletal and radiology to our oncology and cardiology Performance Suite offerings. All told, we feel we're less than 25% penetrated, even just to those near and medium-term opportunities in front of us. As with all of our customers, our main task is to do an excellent job for Centene in the time ahead, and we're confident we'll do that and continue to earn the right to expand with them over time. Finally, turning to page 10, I wanna highlight the new growth opportunity this transaction creates.
Of course, there's an organic opportunity that we have here at Evolent that's very attractive, and there's organic growth at NIA. Together, we create some new cross-sell opportunities. We've talked a lot about a $16 billion cross-sell opportunity at New Century the last few years, and we've been capturing that opportunity consistently. After this transaction, that $16 billion cross-sell opportunity is now $50 billion. As the talented NIA team joins Evolent, we're confident in the ability to address that cross-sell opportunity together. With that, let me turn it to John to talk a little bit about the transaction itself.
Thanks, Seth. We'll turn to page 11 in the deck. Evolent will acquire NIA for $650 million in upfront consideration, composed of $400 million in cash and $250 million of newly issued Evolent equity at a $29.50 reference price, a 24% premium to the closed price yesterday. The shares issued to Centene will be subject to a lockup and other typical provisions. There is also up to $150 million of contingent consideration payable in Q1 of 2024, based on reaching client retention and growth milestones during 2023. These performance milestones contribute in part to our $85 million fully synergized adjusted EBITDA expectation. This earn-out is payable in cash or up to 50% Evolent equity at our option.
We ran a competitive process to finance the cash component of the transaction, selecting Ares Capital based on the most favorable terms and our strong existing relationship. This committed financing package was designed to balance dilution, leverage, and cash interest, and includes upsizing of our existing first lien credit facility by up to $265 million, with cash interest at SOFR plus 600, along with $175 million of convertible perpetual preferred equity with an initial conversion price of $40 and cash dividends at SOFR plus 600. Turning to page 12, we believe the transaction is highly compelling, with attractive free cash flow characteristics, a strong balance sheet, and the flexible financing terms we have secured in a rapidly evolving debt market.
While our long-term capital allocation priorities remain consistent with what we have stated previously, post-transaction close, we will immediately prioritize deleveraging the balance sheet in the ensuing 24 months through both Adjusted EBITDA growth and debt paydown. We are targeting a net leverage ratio inclusive of senior debt and our 2025 outstanding convertible notes of below three turns of net leverage by the end of 2023, falling further to below two turns by the end of 2024. On a net senior basis, we expect to be at 2.9 turns at close and below 1.2 turns by the end of 2024. Turning to slide 13. As we approach the end of 2022, to provide clarity on our base business, we are providing an initial floor for our outlook for 2023.
We expect Evolent top-line growth prior to the acquisition to exceed 25%. Results will be driven by at least 20% organic growth, as well as the full year contribution of IPG in 2023 versus five months in 2022. Obviously, these numbers may go up higher with new contract signings over the next few months. We also expect to continue to expand our adjusted EBITDA margin versus our year-to-date 2022 performance before the accretive impact of NIA. As we have previously discussed, the total magnitude of percent margin expansion will be impacted in part by our final revenue growth rate. Finally, we continue to manage the enterprise with an eye towards growing our cash generation. On a consolidated basis, including NIA, we anticipate generating more than $120 million of cash flow in 2023 before interest payments.
This estimate excludes expected earn-out payments, which we will fund from cash on hand and customary one-time transaction expenses associated with the NIA acquisition. This $120 million is net of our usual investments in software development, as well as one-time costs associated with realizing our cost synergy targets. As we continue to grow our adjusted EBITDA beyond 2023, we expect our cash generation to be even stronger. I'll now hand the call back to Seth to wrap up our prepared comments before we take your questions.
All right. Thank you, John. I'll return to my opening remarks here by just saying that we believe this transaction is the right answer for our customers. We believe it's very attractive financially for our shareholders, and we're confident that we'll successfully integrate this company into Evolent and meet the commitments and targets we laid out today, just as we've done the last several years. I wanna close by thanking the Evolent employees for all their incredible work and also by welcoming the 1,200 talented, mission-oriented team members at NIA who'll be joining us next year. With that, we'll open it up for Q&A.
We will now begin the question-and-answer session. To ask a question, you may press star then one on your telephone keypad. If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star then two. At this time, we will pause momentarily to assemble our roster. The first question comes from Charles Rhyee with Cowen. Please go ahead.
Yeah, thanks for taking the questions. Congrats on the announcement here. Just really wanted to expand a little bit more on the Centene relationship going forward. You know, it looks like you're talking about more Performance Suite activity here going forward. Can you talk about sort of the timelines that you would expect some of this to materialize? Because you're only kind of highlighting maybe about $20 million of new EBITDA by the end of 2024. You know, when we think about Performance Suite, maybe can you give us a little help on the top line as we think further out? Thanks.
Yeah, sure, Charles, I'm happy to, happy to take it, and Dan may jump in as well. But, you know, what I would say is that, um, I'll think about this in two phases. Um, you know, the first phase is really about the tech and services work that we're doing with them, and we already have that kind of business, NIA already has that kind of business. And the new contracts that, um, are signed as part of this to drive the $20 million, uh, are more tech and services, as I noted today. I think inside of that first phase, there are gonna be additional significant opportunity for significant additional tech and services opportunities, Charles, that go beyond the $20 million, and that's the first thing that we'll attack.
Uh, and I think Centene has a lot of, uh, alignment around opportunities for those additional, uh, specialties that again, can drive really strong ROI for them. So I would think about things like, um, cardiology as a for instance, or things like, uh, IPG as a for instance, or frankly, even expanding further into the NIA ones that drive the $20 million, 'cause by no means are we fully penetrated with that first $20 million. I think that's a lot of opportunity right there in phase one of tech services. Uh, the Performance Suite is obviously significantly bigger on the top line and is very substantial on the bottom line too. NIA has some experience in Performance Suite, we do too. So I'd be surprised if we don't get to that over time because we think we can drive more savings.
I would think of that as phase two. You know, I want people to take away that in phase one, $20 million is only really part of the opportunity. There should be a lot more beyond that.
Great. If I just follow up on with NIA, it looks like Centene, to your point, is just mostly doing tech and services. Are they doing Performance Suite with other customers, or is this sort of a new area for you to build out sort of a risk model for radiology and the MSK that NIA does? Thanks.
Great question. This is Dan. At this point, I would say NIA's business most resembles the tech and services products we have at New Century Health. However, over time, certainly I'm excited about the important potential role that NIA can play in our Performance Suite strategy in the future. Let me talk about that in two ways. First is how does NIA support the Performance Suite products we have right now?
Second, how does NIA open up new Performance Suite products we don't currently have? On the former, I think there's a value unlock by starting to connect the puzzle pieces that unfortunately in healthcare are often very siloed and fragmented. As a for instance, Genetic Testing plays a really important role in oncology in terms of ensuring a cancer patient gets the right therapy the first time. In cardiology, imaging plays a really important role in making sure you figure out the appropriate intervention or test to do on a patient with heart failure. Same example occurs in MSK. Again, there's an opportunity as we integrate NIA to make our existing Performance Suite products in oncology and cardiology better as we bring together pieces that right now are fragmented.
Second, in terms of new Performance Suite products we don't currently have, I think there's an exciting opportunity in the future to create a Performance Suite product specifically around MSK. As you all recall, when we announced the IPG acquisition several months ago, we talked about how IPG optimizes surgical spend for surgeries that do in fact need to happen. IPG does that by optimizing where and how surgeries get done. NIA now brings the other piece of the equation in MSK, which is does that surgery in fact need to happen in the first place? Should you try more conservative therapy in terms of P.T.? Did we get the right imaging done before we operate? Is there an interventional pain management alternative?
Again, as we think about stitching together NIA with our existing asset in IPG, that also opens up an MSK Performance Suite solution in the future.
Great. Thank you.
The next question comes from Ryan Daniels with William Blair. Please go ahead.
Yeah, guys, thanks for taking the questions, and congrats on the deal. Wanted to ask a bit of a follow-up there. In regards to the sales model, you talk about it being analogous to the Tech and Services Suite and mentioned that the margins at scale are comparable at 50% or more. Can you bridge that comment there, the 50% or more, to the current margin profile of 20% at the organization?
Of course, Ryan, this is John. That is the flow-through margin on new business. Of course, the 20% has fixed costs, SG&A, development, and so on, included in it.
Okay. Incremental margin. That makes sense.
Mm-hmm.
If we think about the Centene relationship with NIA, given that they own them, what's driving the comfort to suddenly expand across all those categories now that it's under your ownership? You know, was that something that was already in play with NIA and Centene, and now you're inheriting it given that you own it? Is it part of the actual transaction that they're gonna drive more growth and use when it's under your control?
Yeah. Ryan, good question. You know, look, I think the biggest thing is that if you look at it, actually, Centene just closed on the acquisition of Magellan NIA earlier this year. They haven't had it that long, and, you know, there's some things that hadn't gotten done or were in flight or that kind of thing. I do think the strength of our relationship also, you know, Evolent to Centene and the work that we've done, and a slightly more clinical approach that we might take on, for example, on the oncology side and some of the value-based things that we do, were also a part of that decision to say, "Hey, this makes a ton of sense to do it with this entity going forward." I think it's a combination of those two things.
Okay. Thank you. Final question, I'll hop off. Just the fact that they're taking the stock at $29.50 is impressive. I don't know that I've seen that. It obviously shows a lot of confidence in your organization. Can you provide any color there? Is that just related to timing, where it got locked in the earlier date? As a follow-up there, how long is the lockup? You mentioned it's an extended lockup. Do you know how long that goes through? Thanks.
Yeah. Let me start on the first part, Ryan. You know, look, I think we've got a lot of mutual respect between the organizations, the leadership teams. We work really closely together historically and obviously have around this transaction. You know, the stock piece was, you know, I think really driven by where our stock's been over the last few months, and I think what it's implied and kind of more intrinsic value of the stock, and it has been undervalued a little bit. I think it's really just tied to that. You know, in terms of lockup, we hadn't broken out all the details, but, you know, it's a slightly longer term lockup that has, you know, some stages in it.
When you sort of apply those stages, it's kinda out into 2024, is the way I would think about it.
Okay. Perfect. Thank you, and congrats again.
Thanks, Ryan.
The next question is from Sandy Draper with Guggenheim. Please go ahead.
Thanks very much. I'll add my congrats on the transaction. I apologize. I jumped on a little bit late. I don't know, Seth, if you had talked about this. I'm just thinking through the transactions you mentioned. Magellan was just bought by Centene.
I'm just wondering, in terms of their decision to divest it, and this sort of follows up on Ryan's question, is this the type of business where once it was owned by Centene Corporation, there was good opportunity internally, but maybe other payers may not want to do as much business, and now if it goes in the hands of somebody independent like you, that's broadening more and more payer relationships, then it works better because it's under a, you know, neutral party, but also a party that has a lot of different options? You know, I'm not sure where the question is in that, but I'm just sort of thinking through.
Yeah.
I'm trying to think. Okay, Centene just bought Magellan. Now they're immediately divesting this. I'm just trying to think through their thinking, and what jumped out at me was, hey, maybe this is because this is gonna have a better growth opportunity in the hands of you guys than internally at Centene.
Yeah, I mean, obviously, I don't wanna comment too much on their strategy, and that's for them to do. Obviously they're making some interesting moves and, as a team, really accelerating what they do there. I will say, I think it's clear to everybody that these kinds of assets live better in an independent entity than in a payer. That's not specific to any one payer, that's just a generic statement. I think that, you know, the ability to do that in an integrated fashion, an independent fashion is part of the platform opportunity that we're talking about that we see with Evolent. We believe we have an opportunity to take that leadership position, and this piece to the puzzle is really significant in our minds.
It really adds a lot from a complementary perspective, Sandy. Per some of the earlier questions, it adds scale. We can now go to, I think, any health plan in the country and have a really good conversation about a very broad relationship, which is again, that's how we've directed everything we've done, is what do our customers want? What do they need? What are they asking us for? We're big into voice of customer, and that's what they want. I think putting this asset into an independent entity and combining it with the assets that we have, it's quite a special moment, and I think it's gonna be really interesting in the marketplace.
Great. That's really helpful, Seth. Again, congrats to everybody on both teams.
Thank you, Sandy.
Again, if you have a question, please press star then one. The next question is from Jailendra Singh with Truist. Please go ahead.
Hi, this is [Jenna] on behalf of Jailendra. We wanted to know more about the business mix within NIA.
We can't hear you. Sorry. Really faint.
Is it better now?
Not much.
Why don't we go to the next question and just go ahead and dial back in there at Truist, please.
As a reminder, you can enter the queue by pressing star then one. The next question is from Jessica Tassan with Piper Sandler. Please go ahead.
Hi. Thanks for taking the questions and congrats. This looks interesting. Can you just help us understand? Vital was, I think, particularly compelling because it looked like it could be layered into existing NCH Performance Suite contracts to drive incremental margin. Is that the case with this asset as well? Separately, can you just comment on Centene's kind of willingness to entertain the migration of lives from NCH Tech and Services into the NCH Performance Suite products across some of your existing relationships in cardio and oncology? Thanks.
Yeah. I'll start, Jess, then may pass it to Dan. On your first question, you know, similar to Dan's comment before, there absolutely are some components inside of NIA that we will layer into our Performance Suite for oncology and cardiology, and they'll be quite helpful, just like Vital's been helpful, so radiology and genetics in particular. In addition, they're also standalone products. You can sell genetics or radiology standalone. You can sell MSK and physical medicine standalone, and you can sell MSK and radiology as a Performance Suite opportunity. It creates several new opportunities for us, Jess, I would say, which is supporting our Performance Suite products, selling standalone and new Performance Suite, all three. I think that's sort of how to think about it.
With respect to Centene and, you know, Performance Suite opportunities, you know, similar to what I said before, but I think two phases. The first phase is gonna be a lot around rapid expansion of tech services. You know, our job is to do a great job for Centene on all this stuff. I think if we do that, we'll earn the right to have these Performance Suite conversations over time. You know, we've seen that example in other places where we deliver, we do a good job, and those opportunities present themselves. I think it will be like those other opportunities where it'll be a couple states here, a couple states there. That's how it's gonna play out, and it creates a really obviously interesting platform to do that within.
Thanks. Can I just ask one quick follow-up? On the radiology and genetic side within oncology, can you give us some sense of how much of spend that comprises of the total kind of oncology cost of care? Like how much of the oncology care is addressable by these new NIA assets? Thanks.
Jessica, a great question. You know, I think in terms of our world view on managing oncology, we think of it as an integrated specialty, which again, is part of our differentiator in the market. If you think about that integrated specialty, it's made up of several different subcomponents. There's drugs, there's radiation, there's Genetic Testing, there's imaging, and all those pieces fit together. I think what's interesting to your question is, you have to answer it two ways. What's the direct portion of the spend from those areas and what's the indirect? I think on a direct basis, imaging and Genetic Testing would be quite small as a % of total spend in oncology. The reason for that is if you look at the spend in oncology, it's mostly in drugs.
However, Genetic Testing and imaging play an extremely important role in optimizing drug spend. Again, just to give an example of that, Genetic Testing helps you get the right patient on the right treatment the first time instead of, you know, having them go on a therapy that's not gonna benefit them because of their genotype, and they're gonna fail that, and you're gonna spend money, and they're gonna have to get it on a second treatment. Same thing with imaging.
Just as an example, you know, after you're on a PDL1 inhibitor that might cost $30,000 per month, before we go on a second regimen of that, let's make sure we do a CT scan to see if the tumor is progressing, because if the tumor is growing, the treatment isn't working, and we should get you on something that is.
A very important role in managing the total cost of care in oncology.
Thank you. That's really helpful. Congrats again.
Thanks, Jess.
The next question is from [Jenny Chao] with Truist. Please go ahead.
Hi, this is Jenny on behalf of Jailendra Singh. We wanted to know more about the business mix from a specialty point of view between the radiology, musculoskeletal, physical medicine, and genetics, if growth rates, you know, vary by specialty and kind of touch on these synergies on which areas of specialty?
Yeah.
You know, the difference between the specialty and the businesses.
Yep. Yeah, Jenny, happy to. You know, the radiology one's the largest. That's kind of the oldest one and been around the longest and where NIA started. The other ones, you know, spread out kind of evenly with genetics maybe in the most recent and the other two kind of somewhere in between. You have a nice balance across that. You know, I think the main thing that we feel goes back to the last couple questions, which is there's so many different ways we can use these products on a go-forward basis, whether they're integrating them into our Performance Suite, bringing some of our Performance Suite capabilities to more rapidly grow their Performance Suite capabilities or selling, you know, the tech services components on a standalone basis, probably in a bundle with other things. They're all growing nicely.
I think you're gonna see us use them in different ways depending on which client situation it is and the like.
That's helpful. Thank you. What about the payer mix? Is there any way you can touch a little bit on that?
Yeah. I'm happy to take that one. It's a little less than 50% Medicaid, with the next largest chunk coming from commercial, rounded out with Medicare Advantage being the smallest component.
Okay, cool. Thank you.
Thanks, Jenny.
Again, if you have a question, please press star then one. Seeing no more questions in the queue, this concludes our question and answer session. I would like to turn the conference back over to Seth Blackley for any closing remarks.
All right. Appreciate everybody's time tonight. Look forward to talking in person or one-on-one soon. Thanks a lot.
The conference is now concluded. Thank you for attending today's presentation. You may now disconnect.