As consumers, during October 15th through December 7th, have an opportunity to select a new healthcare coverage plan. Everybody does. If they do nothing, generally speaking, most have been able to roll forward what plan they were on with no action. This year is unique. It is unique because there are more consumers disrupted this year than we have seen in any year in recent past, meaning their benefits got worse or their entire health plan went away. So you have a step function of shoppers who need to actively be out there, and the majority, over 80% of Medicare consumers, when they shop for Medicare plans, utilize a broker for that service. Very few do it on their own and go direct to health plans. They need help. And we are, and we'll talk to you about it, the largest enroller of consumers into Medicare Advantage plans nationally.
And for each of the major healthcare carriers in the country, we are the single greatest source of enrollment for each one of them: United, Humana, Cigna, you name them. We are at the top of their list. So it is an important problem for a lot of consumers, and we are important for those consumers and the health plans in that process. As you think about the organization, we've been in a process of evolution over time. The company's been around for over 20 years, but served a number of different populations over that time frame, started in the individual insurance space and marketplace as being a marketplace tool, and then moving on and evolving as the market dynamics changed. And in 2016, 2017, got into the Medicare space, went exclusively into Medicare in about 2020, and that is around the same time frame that we actually went public.
I joined the organization as CEO in 2022 as a part of a turnaround of the company to reset the business and to really make sure we stayed focused on how to drive efficient cash and returns on investment, and so there was a streamlining of operations as well as reassessing the way we were contracted and paid to ensure that we could be productive in putting the consumer as our true customer, and I know that doesn't seem novel, but in this industry it has been, especially since health plans typically write the checks to brokerages like ourselves, they're the ones who write checks to us, but by making sure the consumer's needs are put at the center and being paramount to everything else, that changes the way your business is operated, and it changes the way you incentivize your teams.
And we'll talk a little bit about that as we go through here. I talked about Medicare Advantage being 50% of the market. You can see that Medicare Advantage, which is an HMO, PPOs, you know, in the commercial space, that generally speaking, each one of you, if you have commercial insurance through your employers, you might get three options. You might get an HMO, a PPO, or a health savings account. You pick which flavor. You don't have a bunch of health plans to choose from. A Medicare consumer has, on average, over 40 options put in front of them, some of them HMOs, some of them PPOs. Your network is inclusive of your doctor. Your drugs are on the formulary. You have no idea. It's overwhelming.
It is really important to find a partner who can help you make that decision because you can see here that from all external indications, the CAGR of growth of the Medicare Advantage population is running at about 6.5% as it's projected to go forward into 2030 and beyond. The right side here is showing you here all the key logos that you'd recognize in the industry, and we have been and continue to be number one as their source of new enrollments. Now, let me walk you through the experience of the different way enrollment happens. Most of you may say, "Why do you even need to exist? Why doesn't a consumer just go direct to their health plan?" Well, if they do know that they want to be on, let's say, a Humana or an Aetna product, they could call Humana or Aetna directly.
And that's on the far left-hand side of this slide. And you could see that what would happen are three criteria. I'm going to show you distinctions of three criteria here at the bottom of how to differentiate by the different models that people can enroll. And no surprise, I know it ahead of time. They're all green on my side because I designed the slide, right? But in the far left, on the Health Plan Direct, you call Aetna. What are you going to get? Consumer choice? No, you're going to get an option of what Aetna plans are available. Regardless of what you're on, they're going to tell you an Aetna plan works for you because they work for Aetna. Technology assistance? They don't need a lot of technology to navigate 5,000 plans in the country.
They only need to talk about the few they offer in that county. So they don't need a bunch of tech. And in the end, this is going to be unique. I'll define it towards the end, but an unbiased Plan Fit Check-Up doesn't happen there. Meaning, an unbiased Plan Fit Check-Up is you are on a product. Let's say it's a Humana product, and that is the best one for you. The Aetna agent isn't going to tell you that. That's not their job. Their job is to get you to join an Aetna plan. So nobody's going to tell you to do nothing. That doesn't happen on the left-hand side. The second one is, "Hey, I know Tammy. Tammy's in the community. Tammy's helped a lot of people.
So why don't I go to Tammy and see if she can help me pick out a new Medicare Advantage plan for myself?" Well, Tammy, it's inefficient for her to get appointed by every health plan in the country. It's not practical for Tammy to understand all the different products that are available for the 40 different plans available in the county. So what Tammy does is she figures out a handful of carriers or health plans, and sometimes it's filtered by who pays her the most, and then she offers that to the consumer. So it's slightly better consumer choice. They still probably don't need technology because you're only picking between a few health plans. And again, Tammy only gets paid if you enroll in a new plan. So her incentives aren't necessarily aligned with the consumer on the other side.
Now, fast forward to GoHealth on the far right. Why do we exist? Why do the Uniteds of the world say they need us? They've actively stated that a number of consumers want a multi-payer shopping experience. They want to know they have access to choose from any of the products available, and it's really important to them. So we give them broader choice than they can get in the other two channels because we represent all the major health plans in the country. Technology. We have built-for-purpose proprietary technology that enables a consumer to be matched to a specific plan based upon their unique needs. We filter by if their doctor's in network, if their drugs are covered.
We do understand their prioritization of other benefits, and then we can, in real time, compare that to the current plan so that we can make sure that they're on the right product. That's only facilitated based on our technology to do that. And then finally, most importantly, we care about the right thing. We don't enroll consumers in plans. We provide them peace of mind in their coverage. And that can be really hokey if you want it to be. But in reality, what it means is we tell the consumer that there's a plan that could be better for them, or we tell them the plan they're on is the right one for them. Either way, we're giving them peace of mind.
In that latter scenario, where the current plan is the right one for them, we do that regardless if they're part of our historical relationship or anything like that, and we pay our agents to do it even if we don't get paid. That's where you build credibility and trust, and that's what's sustainable because you're not investing in the one-year relationship. You're investing in a 20-year relationship with that consumer. You want them to refer other customers to you because they can trust you, and you want them to come back to you every single year. This is that process that we go through. It's a proprietary process, except for the flywheel is not. That is straight word art from my software program that generated that picture. So I can't take credit for any of that. We did pick the colors, though.
And as you go around the flywheel from one through five, one is a really interesting funneling logic. We start at the top of funnel, non-licensed agents who take the phone call to verify the consumer's intent to actually shop. There's a lot of unscrupulous players out there who do marketing, who try to bring in consumers and don't really tell them they have to change health plans. We try to filter through that at the top. Do you know you're here to shop? Are you eligible on Medicare to actually shop for a plan? And if so, we send you to our licensed agent at stage two who does that personalized shopping experience. And if you're a return customer, we have all of your data, so we're doing an add change delete. You're not having to go through and repeat all of your doctors and your drugs.
If you don't want to take the time and if you trust us and give authorization, we can pull from external data sources the doctors you've seen in the last year and the drugs that you're on so that we can just confirm for you that those are the items that we need to filter in our logic. When you do that, you give them a much more customized experience. There's no surprises that their drugs aren't on formulary. There's no surprises that they forgot to give you one of their drugs when they're filtering through that they find out right after they enroll in a new plan. These are really important concepts of making sure you do a personalized, consumer-centric matching process. That's the match.
Then we confirm with a live, real-time confirmation with another agent to confirm that you are comfortable with the changes that we're making and you want to enroll in a new plan. Then we activate, which is making sure that those benefits that made you want to join the plan, you actually get to use. Did they work the way you expected in the first 30, 60, 90 days that you enrolled? When you do that, you drive higher satisfaction. Buyer's remorse happens within those first 30, 60, 90 days because whatever they thought they were going to get didn't happen, and so they disenroll from the plan and everybody loses. They're frustrated. Health plan's frustrated. We're frustrated. So it's in our best interest to make sure the consumer's activated. And then access is that return consumer.
We have a Customer 360, a proprietary CRM, which keeps and links all of those historical interactions we've had with them so that when they come back and they want to do a checkup of their plan options, they don't have to start from scratch, so that just drives efficiency in our model so that we can spend less time with the consumer while still providing them high-quality experience, and we can serve more consumers with that efficiency. This is the reason why we do all that. I talked about the longitudinal relationship. Anne's on a journey and naturally has changes that happen in her life that may justify a change. If she moves, most people don't know that in Medicare, if you move from one county to the next in the same geography, same city, same metro area, you need to change plans.
You can't stay on the same plan across county lines. That's an important inflection point for Anne's journey. She might move across town, closer to her family. She may be diagnosed with a new chronic condition like diabetes. She has new providers. She needs to make sure that they're in there, so she would need to change plans, or there may be better plan options like a chronic special needs plan that she can enroll in, so she needs to check in with us at those points, but most of the time, Anne's going to be on the right product, and unfortunately, if she goes to other brokerages, they're going to move her to something new just because that's the only thing that triggers compensation to them. For us, we're very focused on just do the right thing every single time.
Enable the consumer to get a Plan Fit Check-Up and get peace of mind. When you do that, you get all of these, and the return on that investment is significant, and the reputation you build is great, and what you probably wouldn't expect is that our agents love it. It decreases our attrition because they can feel good about what they're doing, and nobody's jamming them to jam people in new policies, and they can still be successful by doing the right thing. I don't care what people say. Agents aren't wired any different. They don't want to take advantage of people. They want to be proud of what they do, and we've proven that with our attrition rates that our agents love working in this environment. In our model, we're trying to break the mold. We're trying to be innovative.
We've been innovative for years and changed different opportunities of way we get compensated. One innovative way is to be able to be compensated for doing the right thing. Historically, like I said, if we told a consumer they were on the right product and they weren't part of our back book or somebody we got a tail commission on, we had no compensation for it, but we are testing now this AEP, which is right now with health plans, to be compensated for doing the right thing. Nobody in the industry has done it before, and we're breaking the mold there so that now those long calls that took over 60 minutes that you could have enrolled them in something, we're finding ways to test being able to be compensated for that on top of already investing in our agents to do the right thing. This is innovative. It's different.
We'll see where it goes. It's most valuable in market dynamics when you have less of a market degradation of benefits because when consumers are really needing the data would say they should stay in their current plans. This AEP is not that, actually. It is a market that is so dynamic because of the 10 million-plus consumers between plan exits and plan degradation who need to shop and likely choose a new plan. This is less of a dynamic that's important, but it is good as an investment in our model for the future so that regardless of what the market dynamics are, you can both be incentivized and double down on that incentives with your agents to do the right thing. How you prepare for all those different scenarios. We talked about our technology and utilization of our technology.
Our cost per acquisition versus our public peers is 30%-50% better than our peers, and in the private sector, you would say we're nearly 50% better. And this is last year, 2023, one of our least efficient market dynamic years. And as you come into 2024, you'll see Q1 and Q2 numbers; if you look at them, would say that we were already better than at $683 on the left on our cost per acquisition. And when you drive that down, you give yourself nimbleness on cash, right, so you retain more cash. It costs you less out the door to gain a new sale, which is at time zero, and it enables you flex capacity to do more with less.
That's what we've been able to do for the last couple of years is continue to get more from our agents without having to hire more agents. On a year-over-year basis, 2022 actuals versus 2023 actuals, you can see that was a 9% improvement. As I had said earlier, if you look at the reported numbers for 2024 already, you'll see we're on a trajectory to be on the same type of improvement, if not more this year. Here are all the proprietary things that set us apart. Everything on the left, nobody else has. It's what makes us special. It's why our average handle time for a sales call with a new enrollee is half the industry's.
We have high quality in that, and we have a lot of return visitors because of the high-quality experience we deliver and the efficiency in which we're able to do it. The right-hand side is how we really optimize and standardize the workflow to gain efficiency. In yesteryear, before I joined, before we deployed all this technology, we allowed agents to believe it was an artistic process, right? Everybody's an artist, right? In reality, that's not the case. You can standardize 80% of the process. Your goal is not to limit the artists, the best in the business. Your goal is to bring new agents up to average faster. When you do that, you unlock the cost per acquisition. You unlock the scale capacity, and we've done that.
We've brought what used to take almost, call it 18-24 months of a ramp down to four weeks because of our technology to get agents from new to average. That's it. And that's what we do with this process on the right and the tools on the left. As you all reflect on this opportunity in our company, this is our crib sheet. This is what you take back to your partners or if you want to remember who we are, why you wanted to think about GoHealth. This is it. It's a large and growing market. Unbiased shopping experience that you can feel proud of. I tell you all, if you have family members who aren't sure, you can send them through our process. Why? I know they'll have a good outcome and they'll gain peace of mind.
They may not make a switch, but they'll feel comfortable that they don't need to react to anybody else's marketing. That unbiased nature that we don't just say, we compensate our agents to do is really important because there's nothing that I've seen more in my career that I've learned has been proven time and time again. What you compensate and reward is what you get. And if you don't compensate doing the right thing, it doesn't happen out of goodness of everybody's heart. But if you double down with compensation, you will ensure that it will happen. Unique Encompass workflow. That workflow I described is important. Proprietary tech. We're the only ones who can lead with this tech and drive the efficiencies that we do that gives us that cash liquidity that's really important.
From 2021 reported, we burned $340 million in cash, negative $340 million in cash flow from operations. In 2023, we generated a positive $109 million in cash flow from operations. That is a major swing based upon contracting, but mainly operational workflow and making good decisions of reading the market and knowing when to pull back appropriately. Our experienced management team. I've been in Medicare for over 20-plus years, good, bad, or otherwise. It's all I know, and we apply that here. My leadership team has very unique experiences across their resumes that absolutely serves this population well. Our internal marketing engine, we have the ability to use external and internal to test and deploy innovative and unique marketing approaches that gives us efficiency and effectiveness that others can't access.
Our health plans are very aligned with us because we're so significant and we are consistently able to drive the growth where they want it. If anyone's following the healthcare insurers this year, you'll find out that they say their margins aren't great on Medicare Advantage. They've been compressed. That's not everywhere. It's in some pockets they want to step back. In other pockets, they want to grow. And how do we do that? Only parties like us who can be that scalpel-oriented that are across the entire United States, who have thousands of agents and the ability to do direct marketing in digital and in TV and in mail are able to enable that. And so that's why the health plan partners are really strong and aligned with us. And finally, our balance sheet.
I started here with $625 million worth of debt when I came in in June of 2022. We're down to $425 million worth of debt. I only issued one PIPE in that time of $50 million with strategics. The rest of it came through that efficient operating model, and so we're looking to continue to invest in that and ensure that we stay true to cash is important. You need to know when to spend it and to hold it. And that's really what you get with us is the ability to read and react to a very important service, but a dynamic marketplace. So with that, we've got about five, six minutes. I know I ran through that, but I wanted to give time for questions. I'm happy to take any from the audience if you have some. Yes, sir. Acquisitions. Very good question. The question was acquisitions.
I'm assuming you're asking if we've done acquisitions, we'll do acquisitions, or what specifically about them? Any of them? We just closed an acquisition, ironically, on October or sorry, technically September 30th. This was one of the most unique transactions that's out there today. That transaction, we put public documents, public PR on it. We invested $5 million into a company called e-TeleQuote. The parent company abandoned their shares simultaneous to that. So we took ownership of that entity net of fees by putting $5 million onto the balance sheet that we now 100% own. That brought to us 400 agents who are ready to sell in AEP, where they were expecting high demand this year and a low supply of agents in general. And we also got over $100 million contract asset, which is tail revenue stream, and nearly $20 million on the balance sheet.
So we just did that acquisition. We're the only ones who have actually been doing acquisitions in the marketplace today. We expect that there will be more opportunities, and we'll look forward to hearing more about them as time goes on. Our technology enables us access to synergy that doesn't turn into dis-synergy or diseconomies of scale. And so we are now at a point where that seems like a real good opportunity for us. Follow-up question? Why did you guys burn so much money and why are you guys so great now? Great question. Well, I think the question was, why did we burn so much money and why are we so great now?
Look, I don't like to go back and look at revisionist history, but the fact of the matter is at that time, there was an expectation of under 606 accounting, the lifetime value of a policy. For illustrative purposes, let's just assume that people thought the lifetime value of a policy you could recognize at the time of enrollment was $2,000. Then one might say you should be willing to spend up to $1,500 to get that $2,000. And maybe you could borrow against it because you've got to spend that $1,500 a day to get $2,000 over years, right? So you need to borrow against it. So they did. And people did at scale, thinking the market was allowing for that. And then they realized at the end of 2021, after they borrowed all that money, that the LTVs were actually much less.
Let's say they're now $1,000, illustratively, right? $1,000. Well, if you're spending $1,500 and you're only going to get $1,000 now, that changes the whole economics, but you already borrowed the money, right? So the money was already there as debt. And what we did after we came in, we actually did a write-down of that Q4 2021. I wasn't here for that. Q4 2022, I did a look-back adjustment of that asset because I said, "Look, let's get realistic. I've known this business for a long time. Here's what I actually think those are going to behave like over this timeframe," right? Because it's a seasonal business, three-year cycles. That's what Medicare does. So that's what we did. So we then said we need to manage our costs to a more conservative expectation on revenue. So that's why we've been aggressively driving down our CACs.
So if you think illustratively $1,500 and now we're below $600. Well, that's a material adjustment. And the goal here is to make sure that you can get CACs down so that the year-one cash delivers a year-one dollar-for-dollar return on investment. And that's where we're driving towards. But I can't say that we're so much better, but we've seen the light. And we're focused on what we can control, which is our cost per acquisition. Thank you for the question. Very good. Next question.
Can you talk about some of the early dynamics of the 2024 annual enrollment period?
The question was early dynamics in the 2024 annual enrollment period. I'd say it's a little early. What I'll tell you is what's been publicly discussed is that most have recognized that once the health plans put their benefit structures out in October 2021 to make them publicly available, that there was more disruption than anyone ever expected. More consumers needed to shop and switch. I think the other thing that's worthwhile to call out is that in public comments from a number of companies that they had to scale back the amount of ramp that they were going to do this year. Our competitors, right, had to scale back the ramp this year because they didn't have the cash to invest in enhancing their supply of agent capacity.
We're one of the few agencies or entities out there who was able to not only scale within our shop and grow because we saved that cash to do it, but then also do this acquisition, which was very little cash expenditure to do to get an extra 400 agents in the process, which gives us more supply of agents in a high-demand environment where we expect there to be lower spend in marketing, and so I think those are the dynamics that I would highlight right now that most have identified within the industry. Any other questions? Yes, sir.
So it seems like operating expenses have improved a lot since 2021 and 2022. Is there any more room for operating expenses around, and also your organization has been masking those public goods with some companies.
Yeah, the question was, is there more room? The OpEx has been improving. Is there more room in that? I think you're going to, on an absolute dollar level, you may not see a bunch of improvement as time goes on because I want to get scale capacity. The key way to look at it is the unit economics on a CAC basis, right? Are we getting more efficient with that while maybe delivering the same spend, right? Or am I getting more for it? And that's what I hope to continue to deliver. And I think there's still a decent amount of room on that, right, to be able to get more on that OpEx line related to that.
As it relates to amortization, etc., we don't have a bunch of CapEx out there in general. Some of this is just from the IPO, a bunch of other things that are still carried on the books there. But in that net, we're not amortizing a bunch of expense. All our marketing is expensed in the period when we incur it, right? So our expenses in acquisitions, etc., aren't amortized. And so I think in general, we have more room. And as we scale higher and we hopefully continue to grow to serve more consumers, that'll become a smaller percentage of the total. Other questions? If not, we've got 10 seconds. Thank you so much for your time today. Appreciate your interest and your continued engagement to learn more about us.