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H.C. Wainwright 26th Annual Global Investment Conference 2024

Sep 10, 2024

Vijay Kotte
CEO, GoHealth

All right, well, thank you all for joining us today. Today I'm gonna introduce to you a little bit about a company called GoHealth. I'm Vijay Kotte. I'm the CEO of GoHealth. With me here today is our Interim Chief Financial Officer as well, Katie O'Halloran. And we're gonna talk to you about GoHealth, how we're performing, who we are, and where we're going as an organization. Before we get going, I'll just introduce you to our forward-looking statements, disclaimers. Please acquaint yourselves with those at your leisure. But we really wanna focus on the exciting things about who we are and where we're going. Now, let me first talk to you about the problem we're solving. Medicare, many of you may know about it, many of you may not.

Medicare has 65 million beneficiaries today, typically over the age of 65. You can also be eligible if you have a disability or have some other chronic conditions that may allow you to be covered by Medicare. Of that 65 million consumer base, you have about half of them are in this product called Medicare Advantage. Medicare Advantage is an alternative to the traditional Medicare payment model, so you can join an insurance company's product, like Humana, United, Cigna, brands you know, and what they provide you is incremental benefits above Medicare. That's fine and dandy, and it seems great for the consumer. But it can be an extremely confusing and challenging thing for a consumer, a Medicare beneficiary to think through.

So, for instance, between October 15th and December 7th every year, a consumer is bombarded with advertisements trying to get them to shop and switch to a new plan. You got them coming from the health plans. You get them from lead generation companies. You get them from brokerages and insurance agents. They're all over the place, and it's overwhelming, and what ultimately happens, many of them do nothing every year. What we believe here at GoHealth is that consumers need to shop. They need to shop every year because benefits change annually, and consumers' needs change annually, and this upcoming annual enrollment period, starting on October 15th, for the January 2025 benefit season, is ultimately gonna be one of the most important ones that they have to stare at because significant disruption is coming based upon what all the major health plans have said in the country.

We'll talk to you about how we feel we're well-positioned for this market dynamic that's upcoming. Now, GoHealth has evolved over the years. One thing that GoHealth has been known for is innovation. We have innovated on the way we deliver services to consumers, we have innovated in the way we've contracted to be compensated for that work, and we've innovated in how we take care of our customer. So we'll walk through it, but effectively, we moved from just innovating to serve Medicare Advantage in a telephonic shopping experience to now where the consumer is at the center of everything we do, and we are compensated for doing what's right for the consumer, which may not be switching them to any new plan at all. We'll talk through those details as we go through this presentation today. I hit on it earlier, large TAM.

So when you think about the TAM, 65 million Medicare beneficiaries, half of whom are on Medicare plans, Medicare Advantage plans today, and you can see that going up to another, up to 42 million by 2030, and that's a CAGR of, call it, 6%-8%, is what the different government agencies are projecting Medicare and Medicare Advantage to do over the years. Now, as you think about GoHealth, we are the leader in the industry of supporting more Medicare consumers in their shopping to find a new Medicare Advantage plan. As a result of that, on the right-hand side of the page, what you see is that we are the number one enrollment source for nearly every major health plan in the country and have been.

That's critical because when we are there, we are sitting at the table with the health plans to devise and work through their strategic goals and find out how we, together, can better serve the, the consumer that we're both seeking to serve more of. And when we do that, we're able to get these innovative new contract structures that support not only our cash profile, which we've proven over the last few years, but now also the incremental revenue opportunities that can be there for doing the right thing and becoming an engagement company, which is thinking about long-term relationships more so than just maximizing enrollments, which can happen by anybody, any year. But I would call that a transactional relationship, which is where the industry's at.

We're in a relational approach to how we deal with consumers, where we build trust, which is the number one missing factor in Medicare, and it starts here at the sell, selling process or shopping process. Now, let me explain to you how we build that trust and why we're unique. There are many ways that a Medicare beneficiary can access a Medicare Advantage plan. Remember, Medicare Advantage plans give incremental benefit over a traditional Medicare, over traditional Medicare coverage. One, some could say, "Why don't they just go straight to the health plan?" United runs these ads. We see them all the time. What do they need you for? Well, if you go to a traditional single health plan, what you're gonna find is, consumer's gonna come in. They're not gonna be presented any option other than a United health plan.

They're not going to need any technology because that, that agent on the other line is only sifting through the plans available by, from United. And then finally, that member's not with that health plan, United, in this instance, and the consumer comes in, the likelihood that that agent is gonna tell the consumer that they're on the right plan already, instead of telling them to enroll in a new United plan, is nearly zero. They are going to make sure the member comes in, picks a United health plan, and they're going to attempt to get them to make that switch. The traditional broker model is one where you could say local community insurance brokers. You remember Jimmy down the street? Jimmy, you trust. You know him. You've seen him. You go to Jimmy. Jimmy can't feasibly offer all the health plans in the country.

It takes work to learn those products, get appointed with those carriers, and to make sure that you can understand them well enough to explain and answer questions for the consumer. So when a consumer comes in to that local broker in a traditional model, you may get a few more options than if you went to the health plan directly, but it's generally going to be the ones that maybe paid the most, the ones who actually supported that agent and made it easy for them to understand it. They'll pick within those products. Again, they're not using technology, because they limited the number of plans that they use, and ultimately, that broker only gets paid if you switch to another health plan. So they're not going to tell you to do the right to stay where you're at.

Now, GoHealth, conveniently, all of them are green. That is purposeful, but it's also important as a differentiator with us in the market. When you come in, you get a choice of the major health plans across the country, high quality rated, and with the most innovation around benefit design. We put those in the marketplace for the agents to be able to walk you through. And let me tell you, I became a licensed agent when I came into GoHealth in June of 2022, and I can tell you, I spent a lot of time understanding benefits. I've run Medicare Advantage plans for over 20 years, building them from scratch, and it is nearly impossible to decipher all the plans available in the market without technology helping you along the way. It's too many plans.

In any given geography, a consumer may be have access to over 40, maybe 50 different health plans. That's hard. It's hard for the consumer to figure out. It's also hard for a licensed agent to figure out. So we use our technology, proprietary-built technology, that will go through the specific needs of the consumer and then match them with the right health plan, tell them the one that has the highest probability of high customer satisfaction. And then, finally, this is what we call a Plan Fit Check-Up, the third one. We ask and understand the health plan the consumer's already on. We compare it against our proprietary ranked plans, and if the plan they're on is one of the top three that we would rate, we tell the consumer to do nothing. We pay our agents to do that.

We pay our agents to give a high-quality experience because we are playing for the long run. That relational interaction with the consumer is critical to build trust, and so we are the only ones in the industry who pay our agents to tell the consumer not to do anything. Now, the organized workflow that we have, it's proprietary. It's called the Encompass Workflow. That's what I've got here on the page. It's a multi-phase approach. You start with the consumer coming in through our marketing. Typically an inbound phone call. They call us. This is not an online-only approach. You can go to our website and find out. It's a little teaser, but ultimately, we think the consumer, and we know from our research, wants to have a live interaction to ensure that their personalization's taking place.

We understand their doctors, what prescription drugs they're on. We understand their needs, and when we understand their needs and their forced ranking of benefits, we're able to match them with the highest probability, like I said, customer satisfaction product. So we use our proprietary tools, our Plan Fit technology. We do a Plan Fit Check-Up, and we make sure that the agents that we are matching them to for that shopping experience are really adept at their unique needs. Then, when we finally match them, and we decide, "You know what? There's a new product that's better for you," we have a secondary live confirmation, a QA process, to confirm that everything the consumer just chose and went through is the right one for them. "Do you understand the trade-offs?

When you make changes, not only good things happen, some bad things could happen. So do you understand the trade-offs? We'll walk you through that. Then, we make sure that within the first couple months of your enrollment in that new product, we continuously engage with you post-enrollment to verify that the benefit that mattered most to you is the one that you're able to activate and use. Many of us have seen this in many industries. If you use the benefit that you came in for, you're gonna be likely more satisfied with that product. So we drive hard at activation, and then on an annual basis, we want that consumer to come back to us.

We want them to be able to have a known relationship so that when you call back into our call center, we're gonna know your doctors, your drugs. We can just show that there's a difference, and now it's... You're instantly gaining trust of the consumer when you can do that. Because as we think about the relationship with the consumer, it's not just that one time, for Anne here as our example, that we're gonna talk to them and try to get them in a new plan. We're looking over 20 years, because Anne, in this example, Anne has different needs. She may move. That's an event which would require her to switch plans. She may have a new chronic illness that's been diagnosed, maybe new drugs that she needs to be on, new providers who may not be in their product.

All those are situations where she needs to make some sort of change or should be shopping. It's critically important that we are there to be her trusted resource over that timeframe. That's why it always made sense for us to pay our agents to do the right thing. We have gone further from there to do something that's truly differentiated, because now, when you think about our model, our Plan Fit Check-Up, like I told you, is that personalized shopping experience. 20%-30% of the time, when a consumer comes through our shopping experience, they are recommended a new plan to enroll in because it makes sense for them. It's the right thing for them, but 70% of the time, it doesn't. 70% of the time, they should stay on the same plan, or they don't even get through the full shopping experience.

But let's go to the far right. We have now entered into arrangements with our health plan partners, the majority of them, to do what we call a Plan Fit Save. That is now compensation for confirming that that consumer is on the right plan. Things that we paid for as a cost of doing business last year, we're going to be able to now generate revenue off of for the way we think about supporting consumers over the long run. That's a game changer. The majority of your calls don't end up in a new enrollment?...Now we're gonna be able to monetize more of those that didn't end up in enrollment.

That is very exciting to us, because we've always been committed to do the right thing first, and now we're finding a way to be compensated for it, and that's a game changer within the industry. Doing all of that, and already born in our cost structure, is the cost related to all that hard work of Plan Fit Check-Ups, and you can see we've been materially lower than our competitors in the space, and we're on track to be nearly 50% lower cost per acquisition or direct cost per submission than anyone else in the industry, and that's built off of our technology. We've got standardization, we've got automation, and we use the AI-driven logic for predictive comparisons to health plans or for the consumer uniquely that enables us to match them.

And we haven't even deployed it at its greatest opportunity yet, a full automation, and as we continue to innovate with more and more tools that we're building and launching, even this annual enrollment period, you can see we're materially below our competitors in the public space. From 2022 actuals to 2023 actuals, you can see we've already improved 10% on that CAC, and we have more room to go on that. Our proprietary technology that I talked about is really important to focus on as a differentiator. You can't just jump into this business and not really build made-for-purpose tools. These tools start with our Plan Fit tool, Plan Fit Check-Up, and our Customer 360, which is the customer or CRM for our business.

But all of this is built off of the fact that we already have 30 million Medicare shopping interactions with consumers that can build all these tools on top of that. We have the largest data set of generally anybody in the industry that we can now lean on to use predictive modeling, to deploy the AI around, and to drive some standard business practices that come out of that data to put into the automation algorithm. What that enables us to do is to drive highly efficient workflows and make sure that the agents that we bring on are able to ramp up faster and serve the consumer better. Today, our average sales average handle time on a sale is 67 minutes. It used to be over 120 minutes just two years ago. That's half the time.

But on that sixty-seven minutes, the majority of that time is still spent learning about that consumer, not just learning about their healthcare needs, but building trust, having a conversation, listening, not trying to rush through it. That's what we're enabling by driving efficiency, is more opportunity to build a connection. The connection is what keeps them coming back. The connection is what allows us to, gain the trust for them to listen when we reach out to them. Now, as I conclude here, what I'll tell you is that this is a great, summary sheet for those of you who go back to your investment committees and talk to your colleagues as to what you learned about us. There are eight key highlights about us as a company. First, we are attacking a market that is large and growing.

As we said, over 65 million consumers, 30 million of which are on Medicare Advantage plans already. The unbiased shopping experience. We're the only ones who put our money where our mouth is to prove that when you have a family member who's going through this tough decision-making process, we can support you better than anybody else because we pay our agents to do the right thing. We have our Encompass Workflow, our offering there, critically important. And then on proprietary tech and data platform, this is the basis upon which everything is operating so that we can differentiate ourselves and make sure that we're always 5, 10 steps ahead of the competition on what's gonna be best for the consumer, how do we best match what carriers want, and how do we best match what's gonna be good for us and our agents as well?

I already highlighted the fact that our management team has a significant amount of experience in the Medicare space, but then we also have our own internal marketing that we can control to make sure we're being compliant with all the regulatory needs out there, and then we're serving the health plans, who ultimately do write the checks to us on a revenue basis for us enrolling and supporting with services those consumers, and finally, our resilient balance sheet. We have paid down nearly 25%-30% of our debt over the last two years through our general operations and our ability to manage our cash flow through more efficient structures here, so with that, I'm really proud of who we are and what we've been doing and really look forward to having future conversations with all of you.

Any questions in the room at all? All right. Well, with that, I know I'm just about on time, so I appreciate it. We'll handle any other further questions out in the hall if we need to. Thank you so much. Appreciate it.

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