Good afternoon and welcome to the Sidoti & Company June Virtual Investor Conference. The next company to present is GoHealth. With us, we have the CEO, Vijay Kotte, and the VP of Investor Relations, John Shave. As always, this will be a 30-minute presentation. We should have some time at the end for questions, so if you do have a question, you can type them into the Q&A tab at the bottom of your screen. It's all yours, Vijay.
Great. Appreciate you all taking the time to learn a little bit about GoHealth. As Jim said, I am the CEO, I'm Vijay Kotte. I've been here for about 2 years. Before we get into the presentation, let me just remind you that we quickly flash past the disclosures, forward-looking statements, items. Please acquaint yourselves with those items at your leisure. To open up here, we'll start with our management team. The management team here has been uniquely established to really drive a differential business model. And that differential business model is uniquely focused on the Medicare Advantage population and delivering a service wrapped in technology approach. And so each person on this list has unique experiences. I've been in the Medicare space for nearly 25 years. Others have had other extensive experience in the healthcare and Medicare space.
And then more specifically, my COO, Mike Hargis, and myself also became licensed agents. But this turnaround and this leadership team really started to come together about two years ago in mid-2022. Now, let's talk about what we do and where we're going. So if we'll flip to the next slide, I'm going to highlight this as a quick gloss over of what I call the investment highlights. I'm not going to go through them all right now, but this is the page you'll take back to your teams to discuss what's unique about us and what makes us different and what makes us interesting. And I'm hopeful that by the end, we'll touch it one more time and you'll have the data to back this all up. So going to the next slide, John, we serve the Medicare population.
For those who don't know Medicare, Medicare is a unique subset of the population in the United States. There are 65 million consumers who are eligible for Medicare today. That number is growing. The CAGR expected from a number of different sources is between 5%-8% a year. On a daily basis, 11,000 new consumers become eligible for Medicare. That's 11,000 new per day. GoHealth has been serving this Medicare population for a long time and has provided over 30 million individual shopping experiences for consumers over that time. Those 30 million shopping experiences have been delivered to 10+ million unique consumers. That is unseen within the industry, and we have a unique data set that we apply in a number of different ways to make this very high-quality service more efficient, effective, and result in the best outcomes for the consumers we serve.
Now, as a snapshot, if you look at last year alone, we served over 2 million consumers in shopping experiences, resulting in over 825,000 new enrollments into Medicare Advantage. And you can see the numbers here: $735 million in total revenues, $75 million adjusted EBITDA. And very specifically here at the bottom, we highlight $109 million in cash flow from operations. That's interesting and unique because if you go back to fiscal year 2021, before I started, the company had burned over $300 million in cash, so it had negative $300 million and change cash flow from operations. Last year, with a positive $109 million, that's over $400 million swing. And we'll talk about what drove that, but a lot of it is about consistent experience, tech deployment, and unique opportunities to contract our business. So John, if you'll go to the next slide, why GoHealth?
The key element that you're going to see throughout this discussion is when you're delivering this high-value service to a population that really needs the help, the only way you can do it at scale and with speed to be personalized to the consumer is you have to embed technology through it. You got to have a standard workflow. You got to have the best-in-class training because this is still a human-to-human connection. But we can make that human-human connection be very personal. So you build trust fast, you establish credibility, and then you deliver a unique experience. And that's what we've done. Tech-driven, tech-enabled. We have proprietary workflows, and then we ultimately have delivered the industry-leading position of driving more enrollments than anybody else in the industry being leading in that space. And how do we measure that?
We are the top source of enrollments for nearly every major health plan in the country. Putting that all together, we've been able to deliver a very compelling financial story, and we'll talk you through that a little bit more here as we go forward. Let me just reestablish the market. We've talked about Medicare overall being 65 million. Medicare Advantage, which are the products that we make available to consumers, is about 50% penetrated into the marketplace. And with that, you are seeing the similar growth of Medicare Advantage as a percentage of the population grows. So are you seeing the Medicare Advantage enrollment growing just between 5% and 8% per year? What's really nuanced here is, remember, the health plans are the ones who are seeking our help to get consumers.
Now, we'll talk about how that model is unique in the way we approach who our actual customer is. But when you think about the health plans, they make their margin in two different buckets when it comes to these populations. You have what is the non-special needs population, which is the average Medicare consumer. And then you have what we call special needs populations. Special needs populations are consumers who maybe have Medicaid, maybe low income as well as Medicare. They might have chronic needs, so they might be diabetic, have heart failure, COPD, a lot of different conditions. And when it comes down to margins, health plans make three times the margin with special needs plan populations. Now, why is that interesting? It's because if you look at the overall MA market on the far right, you'll see that 25% of the market are in Special Needs Plans
But what GoHealth attracts and is uniquely able to market and attract into their model, and then have a specialized training of our team to address the unique needs of those special needs populations, we deliver 42% of our enrollment in Special Needs Plans . So you can see why both scale, mix, and quality of the consumers that we can provide access to health plans for is extremely differentiated and valuable to them. Now, going to the next slide, if you wouldn't mind, John, we work with all these major carriers that you see on the page: Centene, Cigna, Aetna, United, Humana. All of these are the major plans that we serve today. And why do they work with us? They work with us because consumers want an independent third-party marketplace to support them finding the most suitable plan for them.
They're not always sure they know exactly which carrier to go with, but they want to find somebody to help them do that. We enable access to those consumers uniquely. We do it with a very high compliance model. This is a very regulated business, lots of rules from CMS that need to be monitored and complied with at all times. So these health plans gain access to our model of multi-payer for a true shopping experience. They get scale, but more importantly, they get peace of mind in the confidence of our compliance with the regulations. That's a really important insight and a nuance about who we are. Now, going to the next slide, what you'll see is that the reason why consumers need us is because they struggle with figuring out who to work with and who to trust.
First and foremost, if any of you have watched TV in the middle of October through the early part of December, you know what I'm talking about. There's so much information out there. Good information, misinformation, but a lot of information that's overwhelming to consumers. Now, the next one is the number of plan options. If you live in a major metro area, sorry, going back to the other slide, John, if you live in a major metro area, you're going to have 50-75 plan options to choose from. Those of us who are on commercial insurance through our employer, you'll note that we might have three. We might have an HSA, a PPO, an HMO. So it's fairly easy to make a choice between those three. A Medicare consumer might have 50-100. Some HMOs, some PPOs, some have eligibility requirements they don't even know.
It's hard for them to decipher if the doctors are in or out. Very, very challenging. Oftentimes when they seek experience or help from others, they don't know who to trust. We support that entire model so that we can truly be an objective, trusted resource to navigate through all this noise and know that we've got their best interest at heart. That's a critical element of what we do. I'll talk to you more about how we have proven to be differentiated and not just say it, but put our money where our mouth is. Now, if you go to the next slide, these are the three general ways that people become enrolled in a Medicare Advantage plan.
So if you are on Medicare and you want to join a Medicare Advantage plan, a small portion of the population might actually start by saying, "Hey, I know I love Humana or I love United or whatever it is." And so you'll call that health plan directly. But what you need to understand you're going to get is no consumer choice or low. Why do we call it low? Because if you call Humana, they're not going to give you a United plan. And if you're on a United plan and you call Humana, they're not going to tell you to stay on that other plan. They're going to try to bring you into their organization. Technology? Well, they don't need a bunch of technology to navigate all the plans in the market. All they need to know is how to explain the plans that they offer.
And then finally, like I said, a PlanFit CheckUp, and you'll get used to this terminology. A PlanFit CheckUp is if you speak to a broker and that broker identifies the plan you're on and decides that it's the right one for you, they tell you to do nothing. And obviously, in these direct health plan conversations, if you're not on one of their health plans already, odds are they're not going to tell you to stay on that plan. They're likely going to tell you to join one of their plans. Now, go to the center. The center is where it's really interesting, the dynamic, because a consumer may go to an independent agent. Bobby, for instance. Bobby's your independent insurance broker. He lives within your community.
You assume that Bobby's going to be able to assess all the different plans available for you and then recommend one that's great for you. In reality, Bobby doesn't have the time or interest to invest the resources to get appointed by all the plans. There is cost to that. There is time investment to do that. So ultimately, what Bobby does is he learns a few plans pretty well. And then when you come in, it's again better than just one plan option, but he's really assessing around the three plans that he offers. So you get a little bit better consumer choice. They really don't need a lot of technology. Again, they're focusing only on three health plans. And Bobby generally only makes money if they enroll you in something new. So they have no motivation to do anything other than likely push you into or enroll you.
Let's not just say push enroll you into a new product, not leave you on the current product. Now, go to the far right. The GoHealth experience is different. Why? First and foremost, we are contracted and are able to offer most of the major health plans in the country. All the major carriers are in our marketplace. And then we round it out with some regional players that really have great products. So you get a lot of choice when you come in. Because we offer so many plans, we need to have tech to normalize all the data and do quick comparisons for the consumer themselves to go to our website just to understand how the model works or to speak to our agent who can navigate that for them as well. I'm a licensed agent.
If I have 80 products in one county, there's no way I can physically understand all the nuance of all of them. So if I don't have technology, I'm guessing or I'm only writing the product that I know best. So when GoHealth uses technology for this, we make sure that our agents are able to know the same amount, same depth, and expertise about every one of the products that are in our marketplace with the use of our technology popping it on the screen. And the most differentiated thing about GoHealth at the bottom right is if that consumer comes on with some plan that we didn't even ever enroll them in, and we do our plan fit assessment, and we determine that the plan they're on is one of the top three available in the marketplace, we tell them to do nothing.
Not only do we say we do that because the customer is at the center of everything we do, I pay my agents to do that. Nobody in the industry is doing that. Why aren't they doing it? Because nobody pays you to do that. We pay our agents to do that because we're playing the long game. Now, if you go to the next slide, this is what this ultimately delivers: a very consumer-centric, streamlined, standardized approach, which can be measured through the number of consumers who keep coming back to us, the revenue we're able to drive, and the growth that we've been delivering on that. More specifically on the efficiency side, you see it on the CAC, the cost per acquisition. And that's an important piece of what's made us uniquely differentiated.
We have the lowest CACs in the industry, and that's an important piece of how you can drive and continue to invest in growth. Obviously, we've already talked about the cash flow dynamics. Now, flipping to the next slide, our overall matching process, I've highlighted the fact that we think about the consumer's needs and we bring through. But the way you deliver a high-quality overall consumer experience is you have multi-steps that really reinforce confidence and peace of mind for the consumer. So at one, we start with a consumer comes in through our marketing. We usually do direct mail. We direct to personalized digital, and we also do a lot of TV and mix it in there. But generally, our primary sources are mail and digital. They come in, inbound phone call. We verify their eligibility and intent to shop.
The way you drive high experiences is to make sure you don't have a bait and switch. So make sure they know they have an intent to shop. Then we connect them to the agents who have the best skills to serve that consumer. So for instance, if the consumer is a special needs consumer, we'll find an agent who's licensed in the geography, who's our employee, who's licensed in the geography the consumer lives in, and has an extensive amount of knowledge around Special Needs Plans. Because then they can be able to answer the questions more effectively. So we'll first match the consumer to the right agent, and then the agent uses our PlanFit technology to ask a number of questions like, "Which doctors? What drugs are you on?
What are your forced rank priorities for benefits?" Go through that logic, and then they match you with the top three plans that we think are appropriate for you. If your current plan, as I told you, is the right one for you, one of those top three, we'll tell them to do nothing. We've given you a PlanFit CheckUp. You're good. Do nothing. Don't switch. But in the event that the plan they're currently on isn't one of the top three, we will explain to them what the differences are, what the value proposition can be. And if the consumer is interested in making the enrollment, we'll facilitate their enrollment. But what we do is we do real-time QA. So we then transfer to a separate team who's now more knowledgeable about that type of plans, and they reconfirm with the consumer, "Here's what's going to happen next.
This is what the agent walked you through. Is that what you intended to do? Are you okay with that?" So we have live QA. So there's no buyer's remorse. We want them to leave confident and excited about what's going to be available to them with their new benefit plan. Then, as a follow-up to that confirmation, we've now submitted their application. We now activate the benefits. We know what was important to them. We know why they chose the plan. The number one dissatisfier for consumers is that they join a plan and they don't know how to actually access the benefits they wanted. We make sure that they can do that here. And then finally, on access, we maintain a profile for them. So when they come back shopping again, they don't have to repeat all the information they gave us. We'll use it.
We'll continue to use it year after year after year. On the next slide, you'll see that. We deliver PlanFit CheckUps. You deliver a high experience, and you enable them to actually build trust. You can see that with Marcus, Marcus in both scenarios with a traditional broker or with GoHealth, he's not on a great plan today. Both of us will enroll him. He'll have a pretty good experience. Anne was on a pretty good plan already. They go through a traditional broker. They're going to put her on something else on average. For us, we're going to tell her to do nothing, and we're confident that builds even higher trust. What does that enable for us with Anne?
If you go to the next slide, it's a longitudinal multi-year relationship where Anne is going to have multiple shopping opportunities and inflections in her life where she needs to shop. And it's important that we support her through that by building trust at the onset. And our goal is that if we can build trust, they will keep coming back, and there'll be more than enough of a return for us. So it's not just one enrollment for that one CAC. It's multiple enrollments supported by a CAC. And that is a much higher leverage return for our consumer, the health plans, and more importantly, for our investors too. So now, if you go to the next slide, let me just bring you back to our key highlights. First, large and growing marketing. We have been serving a number of consumers in the marketplace. 65 million overall.
30 million are in Medicare Advantage plans already. We expect those numbers to only grow 5%-8%. We'll continue to grow 5%-8% per year after that. Unbiased shopping experience. Unbiased. Our agents aren't paid more or less based on which product they sell you. If they don't sell you anything but deliver a high-quality experience, I still pay them. Our Encompass workflow that I walked you through is unparalleled in the industry. Nobody's even close. They definitely do not have the level of focus on being objective that we do. Proprietary tech can't buy it on the open market. 30 million interactions. All that data that feeds our built-for-purpose technology is unique and absolutely differentiated. Our management experience of working with the Medicare population to understand their needs is what enables us to be at the forefront of innovation.
We use that knowledge base to drive a marketing engine that we can support on our own without having to buy it all externally. And then having health plan partners where we've got significance as well as from volume and quality standpoint enables us to sit at the table with them to innovate on new approaches that we can deliver. And finally, we're a stable and growing company who has a strong balance sheet to support our future growth. So with that, let me stop there and see if we have any questions. I know it went fast, but I'm hopeful that we can address your questions and be helpful.
Great. Great. So yeah, I'm going to start out with some of the questions I had. So you've been there about 2.5 years.
And when you got there, there was a lot of volatility, a lot of issues with the receivables on the balance sheet because of all the churn at that time. With the programs you've put in place, can you comment on the quality of the receivables now as compared to what they were when you got there?
Yeah. No, one of the things that we did early on is, one, we adjusted all our assumptions to be more flexible of reality, in my view. We looked at the market dynamics. And part of what you do on those assets, well, let me take a step back. There's two things that we did. One, we established two different approaches to how we recognize revenue. There are some products that we saw that had a little bit more volatility in their structure, approach, or otherwise.
We uniquely identified them and decided that we wanted to be paid on a service basis because it had less volatility. That way, we could de-risk the volatility by getting cash upfront and avoiding any risks around product structure or otherwise for the insurance company. That was a major driver of stabilizing the balance sheet as well as stabilizing our revenue profile. Those carriers who had a higher quality level and we had less variability around, we maintained on our agency model. And then even within that, we, as I was referring to earlier, relied on more realistic estimates of retention and tenure. And that is actually reflected in one of the lowest LTVs that are in the industry today because we believe that our goal is not to hope things don't happen, but expect them to happen, plan for them. And if they don't, then that's even better.
But our LTVs are built in that vein today to avoid the volatility that had been there as new data comes in. I know that's a lot, but hopefully, that's responsive.
All right. And one of the things you pointed out early on was the improvement in free cash flow since you've been there. Do you expect that to continue in 2024?
Yeah. I think we always want to make sure our cash flow is king. We don't want to burn cash, but we also want to be opportunistic. So as I think about how we look at our cash dynamics, we want to always return the best, have the best return on invested capital. And so it's one thing to have enough cash around your business, which we will always do, but there's always a mixed question and an opportunity question for us. So will it grow?
We've generally guided to the fact that we expect it to be directionally flat depending on what the mix of the business will be between those quality carriers that we serve. But long story short, we'll always be trying to optimize that balance sheet asset so that we're delivering great value for the investors and consumers.
But you do expect to be free cash flow positive this year, right?
Exactly. Yeah. I always want to be positive. I just want to be opportunistic as well.
Okay. Because that separates you a little bit from your peers, most of which have been burning cash the past couple of years.
Yes. We expect to continue to generate cash for the foreseeable future.
All right. You talked about the PlanFit CheckUp quite a bit. Is there a way for you to get compensated for doing that?
Great question. We did it for free. Like I said, we paid our agents in the fourth quarter of last year over 100,000 times. We did this. In the first quarter of this year, we did it approximately another 100,000 times. And with that proof of concept, we've been able to go to the health plans. They've observed it. They've proven that, yep, you did it, and you did high-quality experience, and we'd like to find a way to compensate you for that. So we're in very advanced conversations with health plans to do that, expecting to have the testing here in the Q2, Q3 timeframe, and then be launched at more of a scale in the fourth quarter of this year. But effectively, we'll get revenue now for the cost that was already borne by the company and already in our P&L.
The costs have already been there, and now we're going to have revenue against it. We're excited about that.
All right. I've moderated about a dozen presentations the last two days, and almost everyone talked about AI and how they're using AI to make their business more efficient. I mean, can you talk about what you're doing with AI right now?
Yeah. No, wonderful question. As I said, the basics of AI, real AI, is that you got to have a lot of data, right? Data is the key. Otherwise, you have to rent others or you have to kind of extrapolate or guess at it or build your data set. We have 30 million consumer interactions that is the basis upon which we deploy our AI.
That plan fit matching logic that we use takes characteristics of, let's say, Betty who calls us and says, "Betty lives in this geography, has these characteristics, has these forced prioritized needs." And when we see consumers like Betty, we can now use our predictive logic and tool to say, "Betty will likely have a better match and a longer high-quality experience with this health plan in this geography." And then we recommend that. So the AI logic is continuously learning from past consumers that we've had, how long they've stayed, what their concerns have been or experiences have been with health plans. And then it feeds into the most recent predictions that our agents are able to then extrapolate against to enroll and/or support consumers enrolling in plans.
So the greatest application to date is that proprietary logic of matching using all of the 30 million-plus interactions to have a predicted estimate for the consumer.
And can you use AI to identify potential consumers and lower your cost per acquisition?
We have a lot of historical logic. I'd say it's more machine learning as opposed to AI is the way that we think about it. It's all in the AI family, but it's more in that vein. We have a lot of effective testing that's been done in that process to be able to replicate in the digital space. What is the repeated approach and the different touchpoints that you want to use with different types of consumers to engage them into your marketing tool? So effectively, the answer is yes, we do.
It's most specifically in the digital space, be able to build customized messages to bring the consumers in with a very personalized message.
Can you just talk about trends with the cost per acquisition? Is that coming down the past year or so?
Yeah. Over the last couple of years since I've been here, so 2024 or sorry, 2023 compared to 2022, most recent data, let's just say it's over 10%, almost 15% improvement in our CAC that we've experienced. We continue to be the industry leader by nearly 25% in our cost per acquisition. Our deployment of technology is going to continue to enable that in the future.
There has been some disruption in your industry, companies struggling. Are you able to capitalize on that?
Yeah. It's a very exciting time, as a lot of what you're alluding to is there are a number of players who have historically been enrollment brokers, have had challenges maintaining their balance sheet, generating cash, operating their businesses, and many have shut their doors. We are a great destination for some of the high-quality agents that they've had who are trained and experienced to come join us. And it's opened up a little bit more of the aperture with health plans interested in finding us as a credible, stable, and continuously dependable group that they can look for to support new enrollments.
All right. You had one slide there where you showed the margins. Margins are significantly higher for the special needs consumers and your ability to identify those consumers. Does that make you a more attractive option to the healthcare plans if you can find those consumers for them?
Absolutely. When there's down markets, like a lot of people have indicated for the health plans in the upcoming year, the place where you'd rarely have that movement is in the special needs populations. It has three times the margin profile. And so even though health plans may at gross and at the overall total say that they intend to shrink, what that means is they want to shrink in certain areas. They want to grow in others. And that's a really important dynamic. And that means in certain products they want to grow in certain products in certain geographies. And we're able to be very laser-focused in that approach for them.
All right. All right. And one of the constants in healthcare is there's always more regulations. How does the increasing regulatory or the current regulatory environment and possibly increased regulations, how does that affect your business?
Well, so there are a lot of facets of regulations across all of our industry, and we're very focused on it. New regs come out every year. Most recently, the overall industry has been reacting and interpreting the latest rules that came out. Those rules were defined in such a way that they don't apply to organizations like us. Our direct agents don't get full commission. They're predominantly employees who have salaries and/or hourly wages that are the predominance of their compensation. And there's no variability by the type of health plan they write. So there's been an exception for what they call TPMOs or third-party marketing organizations like us who meet that profile.
And so though there are some nuances about ensuring the compliance with pre-existing rules that have been out there, we are uniquely excluded from the more material elements of the latest regulations.
All right. And then last one, most businesses have seasonality. I mean, it seems like you have seasonality on steroids at your business with the fourth quarter being a super strong quarter because of an Annual Enrollment Period . What are you assuming this year for CMS changes and how it'll affect your fourth quarter performance?
I'm sorry. Can you repeat that? I didn't catch you.
What are you thinking for this year? What do you expect CMS to do for the 2025 period regarding their benefits? And how do you think that'll impact your business in the fourth quarter?
We're very excited, but there's a lot of disruption that's coming this year. And it's really important that we are prepared for that. And so when there's disruption, consumers who haven't shopped for years will shop, which means you'll have more not only shopping, but switching. And that improves our efficiency. So we have more of the leads that come through have a valid reason to change. And so that's a really important piece of the puzzle of why we're excited about the number of consumers who can benefit from the services we can deliver to them. And we're looking forward to being able to have that what seems to be positive market dynamics for our business model this AEP.
Okay. All right. Well, we are out of time. So I just want to say thank you again for doing the presentation. Thank you for taking the meetings today. And I hope to talk to you soon.
Thank you.
Thank you.
Bye-bye.