Okay, it's top of the hour, so we're going to get started with our next panel. I'm Scott Fidel. I'm the Healthcare Services Analyst with Stephens. We're really thrilled to have Guardian Pharmacy here for the first time at the Stephens Conference. Definitely not the last, though. Here from the company, we've got to my right, Fred Burke. Fred is President and CEO, and David Morris, David is Executive Vice President and Chief Financial Officer. Hopefully, as a number of you know, or all of you, Guardian did recently join the public markets with their initial public offering. Just in terms of some quick background, Guardian is a leading long-term care pharmacy provider with over 50 pharmacy operations nationally. The company does focus on the assisted living, memory care, and markets, but also has a strong presence in the skilled nursing facility space as well.
Currently, Guardian has around a 12% national market share in servicing the assisted living market, and certainly with plans to grow that meaningfully over time, so first of all, Fred and David, great to see you this morning. Fred, I thought maybe it would make sense just for you maybe to sort of kick things off if you want to provide a quick introduction to Guardian and your business model and maybe try to highlight what differentiates you competitively in the market.
Sure. Thank you, Scott, and thank you all for being here. Thank you for your introduction. We're pleased to be a newly public company. Guardian began 20 years ago. Our first pharmacy was in Phoenix, Arizona, and it addressed a market that we saw as very attractive, which is the assisted living and behavioral health group home market. And what we found is that pharmacies that were engineered to serve skilled nursing have a very difficult time pivoting and properly serving the very specialized needs of assisted living. We have leveraged that concept into this very, very attractive marketplace. Most, if not all, of the growth in long-term care facilities has occurred in the assisted living space. So we have a very strong tailwind of growth from just the market that we focus on and serve. So we're purpose-built to serve this different segment.
We can delve into more detail later if you wish, what the differences are, but suffice it to say that assisted living requires a very different type of service, mainly because there are very few clinically trained healthcare professionals in the assisted living environment, even though the residents have a very high acuity level. They're elderly, 87 years of age. They're impaired in multiple activities of daily living or ADLs, and yet there are no clinical professionals in the assisted living to provide care for them. So we have provided an extensive suite of tech-enabled services that are geared to accomplish two goals. First, to get the resident on the proper drug regimen. Very important. And our consulting pharmacists are dealing directly with the multiple physicians in the community to do that.
And then secondly, the platform to allow this non-healthcare professional caregiver in the home to safely and effectively administer the meds and achieve adherence. So many, many third-party reviewed studies indicate that if you get a patient on the proper drug regimen and they adhere to it, you improve outcomes and bend the cost curve, which is a great place to be as a healthcare company. We have grown with a multi-pronged strategy, strongly focused on organic growth, but also M&A, which we can delve into if you're more interested later. The company is far more than the two of us. We're so proud of our team, a very strong, experienced, long-standing, both in the field with our clinicians that serve our customers, but also with our subject matter experts in the Atlanta support office that allow these clinicians to properly turn this into a self-sustaining ongoing business.
We have been very good, we think, proud of the fact that we're good stewards of capital. We convert a lot of our EBITDA to free cash flow, and we can fund our organic and normal course M&A out of the operations of the business.
All right, great. Well, I want to start at the high level and sort of, I guess, more of the macro environment. And one thing we've been trying to do with each of the companies is fold in discussion around the elections, clearly given the timing here, and sort of highlight any particularly important potential implications for each company's business or end market. So I thought maybe we would sort of start with that, Fred and David, and from your perspective, maybe walk us through what's key on your watch list. Fred, you're obviously very engaged for your industry and advocacy in Washington. So maybe we'll start with a few of those topics, and then we can maybe sort of talk a little bit about the IRA, sort of in a little more detail as well as part of this.
Okay, super. Well, at 30,000 feet, we benefit greatly from our main payor being Part D, Medicare Part D, 70%. In fact, of our revenue derives from Medicare Part D. And this is arguably the most popular federal program of them all. So that leads to both red and blue members of Congress being very not interested in touching that third rail, which accrues to our benefit. So obviously, their difference is red versus blue, and we're about to have a changeover in Washington. But I think by and large, it'll be steady as we go in terms of this Part D program. Some slight nuances, differences like we were just discussing, is it Medicare Advantage or fee-for-service? Our reimbursement algorithm is the same for both.
So I think by and large, advantage accrues a bit more to our benefit because some of the things we do help them achieve stars, the payors, which is, as you know, very lucrative for them. But by and large, it's steady as we go. Red, blue, back and forth, about the same.
Okay, great. And why don't we just spend a moment? We'll just sort of talk about the IRA dynamics and offer the benefit of the group. So Fred and David, maybe just to sort of walk through, why don't you bring folks up to speed with, as it relates to the IRA, there's one particular change that was included in it. Feels like it was more of a sort of unintended consequence, maybe a glitch when you've got these vast legislation and with so much in there. But it affects some of the reimbursement dynamics for long-term care pharmacies, but also potentially creates an opportunity to maybe sort of come out of this addressing some historical quirks around contracting that could benefit or be addressed from that.
So, maybe first just spend a moment just sort of providing sort of a summary of what the change was, and then talk through some of the strategies that you're looking at from either a market-based or legislative perspective to get this addressed and hopefully maybe even improved coming out of this.
Super. I'll start and then hand to David, who's in the thick of it. But just from standing back and what is the difference, what has happened, the federal government has been authorized by the IRA to negotiate prices on certain branded drugs. They are typically those that are late in their cycle. They're nearing generic, actually, and they're large. This removes some of our margin, product margin on these drugs. We actually earn a product margin on branded drugs, unlike most every other player in the pharmacy industry. So that's why it was an unintended consequence. It was an anomaly, if you will, that this would impact this little small segment called long-term care pharmacy. We will lose a piece of our margin. We earn margins on the buy side, dispense fees.
This would be related to the sell side ingredient cost margin in that we must, according to the law, sell at MFP or manufacturer's fair price. David can talk about this. We have these kinds of headwinds and tailwinds all the time. This is not a big deal. We're undergoing a similar one right now as we speak with insulin, and as you can see from our numbers that have been posted up, we're navigating through that quite well. We're confident that we'll be able to do that with the IRA as well come 2026. The effort is two-pronged. I'll cover the political side in that I'm leading the task force for our industry to socialize this in Washington, and I think we're getting great traction. Both sides of the aisle want to fix this for slightly different reasons. The Ds are, this is a signature event for them.
They're very proud of this program, and they don't like the fact that there's a glitch, and they want to fix it. The Rs are generally more business-friendly and similarly would like to fix this problem as well. So we've got a major effort undergoing in Washington, and I think we've generated a tremendous amount of support to pressure CMS and/or the payors to not let this happen. But more importantly, I think David and I believe that this will ultimately be a commercial negotiation with our payors, which David is leading, and I'll hand to him to talk about that.
Thanks, Fred. A couple of things. As Fred mentioned, we're dealing with puts and takes in this business and have been the last 15 or 20 years. And with the insulin, we're dealing with a headwind quite effectively in 2024 that's a similar size to any type of issue we would have with IRA. But to that end, we've been and will continue talking to our payor partnerships. The four big PBMs drive 95% of our Medicare Part D reimbursement, and we're engaged, meeting, talking about 2024, 2025, 2026. They acknowledge and understand the unintended consequences for this long-term care space and want to work with us and will work with us to minimize, if not eliminate, any type of negative consequence. So to that end, we're confident while Fred and the team are working legislatively, we will solve this and the issues through payor relationships and contracting with them.
I'll add that perhaps we have made more of this than we should, but out of caution and conservatism, being a newly public company, we've been very strong in making sure our investors knew that we were facing this situation.
No, I think it's great that you've been transparent about this and sort of have it, for example. It allows us to be conservative in our model for 2026, and then hopefully this gets addressed and gives us an opportunity to reset numbers higher around this. One follow-up question for you, Fred, just around the legislative strategy. Obviously, we're expecting that there's going to be a pretty active calendar next year in 2025. Certainly, it feels like, obviously, this is not the only sort of issue with the IRA, right, so it feels like we need to be heading towards some type of technical corrections type of structure, whether it's through legislation, whether it's through CMS, to address a number of these types of items.
But, curious if there's how do you sort of think about a legislative vehicle, anything that specifically you see as sort of the logical sort of platform to have this addressed in legislation?
Good question, Scott. Senators Wyden, who is the current Senate Finance Chair, and Crapo, who will be the incoming in the new Senate, both are very interested in solving this problem and have actually recommended a couple of things to us. So we have some draft legislation that we're socializing on the Hill right now.
All right, great. Okay, let's sort of get back to the business, and maybe we'll sort of pick back up on talking about that strategy around the particular sub-markets that you focus on within long-term care. And certainly, a differentiating element of your strategy is that focus on assisted living. Why don't you sort of bring the group up to speed first in terms of the business mix, in terms of when you look at your current mix of residents served in the ALF market versus the SNF market? And then as you've talked about, the company's had a strong double-digit, low-to-mid-teens type consistent CAGR around volumes in terms of residents served.
Sort of if we were going to separate out over the last, let's say, few years around that overall CAGR, what do you tend to see sort of as the ALF sort of resident growth relative to the SNF growth that you see sort of driving that overall volume CAGR?
I'll start just by setting the stage, and David can outline our growth strategy. If you look at the 180,000 residents that we served at the end of the third quarter, roughly 120,000 or 2/3 were assisted living. Another 30,000 or so were skilled nursing. So we do serve skilled nursing. We do so selectively. It's easier for us to do, but we're very interested in making sure that we partner with like-minded operators. And then the balance would be the behavioral health and group. We have a multi-pronged growth strategy, which I'll hand to David to walk you through it.
As Fred said, our growth has been and will be moving forward driven by our focus on ALF. We enjoy a tailwind with the ALF growth in and of itself of about 5%. And our growth has been and will continue to be driven primarily through organic growth. And how do we grow organically in various ways? Number one, we bring on new communities in existing homes or in existing markets. Number two, once we bring on these new homes in existing pharmacy markets, we increase the adoption. The typical home when we take over from another pharmacy is the pharmacy we're serving about 50% of the residents. And through working with, say, a Brookdale community, and as the residents turnover, we drive the adoption from 50 to, on average, 90%.
And that's by talking to the residents, educating them on the reasons for safety, convenience, et cetera, why it's better to use a long-term care pharmacy. And then number three, we opportunistically will bolt-on pharmacies in existing markets and fold those into our existing platform. So those are key organic growth drivers. And the third growth is through M&A. And part of it's organic, part of it's M&A, we expand into geographic contiguous territories with existing operators. And that's part of our organic growth strategy. We've opened eight contiguous startups in the last 24 months. We've expanded into markets like Oklahoma City from Tulsa. We're moving into Columbus, Ohio, from Cincinnati. So those are examples of how we grow contiguously with existing operators. And then our M&A strategy is an example of that, the pharmacy we just bought in Morristown, New Jersey.
So these are new geographic territories with like-minded operators that have a high volume of national account growth opportunity there. So organic drives it, and then we supplement with M&A. And moving forward, we're guiding to organic growth of high single digits. And then when you accompany that with our M&A, we'll deliver a low double-digit growth moving forward.
So, to bring that to life, of our 51 pharmacies that we currently operate, in the past two years, we have launched four contiguous Greenfield startups. We did an M&A transaction April 1 that involved four new pharmacies. And then we have the Morristown. So, nine of our 51 are still coming up to scale and are new. And that helps you see the growth drivers behind the business as we bring those up to scale.
Great. And I'll ask you about, so clearly from a proactive strategy perspective, a lot of your efforts are focused on the ALF market in terms of where you're focused on from a growth perspective. Curious, how, from a, I guess, sort of external sort of activity level, how do you sort of approach SNF? Is it more do you view it as a legacy business, or are you still out there? Are there shots on goal? Do you sort of still actively market to that area? And then I'm curious from a margin perspective, because one thing about Guardian, definitely want to emphasize, is the consistency of your margins historically is quite notable. And frankly, probably about as consistent as any company we cover.
Underneath that, from the margin side, do you ultimately sort of land at similar margins with your SNF or your ALF sort of customers, or do some of these more favorable aspects of ALF ultimately sort of lead to a relatively higher margin profile? So basically, you're proactive, how much energy you spend sort of growing, looking to grow still the SNF side, and then the margin comparison between SNF and ALF?
Yeah, I would say that our energy is focused on ALF. Okay? And as Fred said, we selectively serve skilled. If we have a community that has a CCRC that has ALF, SNF, independent living, we'll obviously serve the SNF. So there are a lot of communities that we serve that way. But it's about a third of our business, and we're not actively pursuing it, but we are in conversations. We work with the Ensigns of the World and a lot of the regional and national skilled providers. So it has to be a win-win, and it has to economically make sense, and we serve them. So I think we'll continue to serve a similar population that we're serving today.
From a margin profile, keep in mind that a skilled customer, depending on the type of residents that they're serving, a substantial part of the reimbursement is Part D, which is exactly like the ALF. And then the Part A reimbursement could be 10% or 20% of the mix. So all in all, the margin profile for Guardian would be similar.
Got it. And then on the behavioral side too, maybe sort of walk us through ultimately how do you sort of end up sort of serving those buildings? And then how does that sort of fit into, I guess, proactive sort of efforts for sort of legacy exposure?
I mean, we serve, I think, over 20,000 behavioral health residents, and it varies market to market, and we've historically served that population for 20 years, and we'll continue to market toward it. It's not growing at the rate of ALF, but it's a legacy piece of our business that is good, and we'll continue to serve that. I mean, it ties into Hayes. We have four Hayes homes in sort of an adjacent market that we're working with, and we'll work to expand that business. It's not the size, scale, and scope of ALF or even behavioral health, but it's another market similar to behavioral health that we're working.
And then from the adjacent perspective, clearly you've got many, many innings to go on just being able to grow in the ALF market. So very long runway there. But I know that there are some adjacent markets that you also are thinking about and considering over time, looking to potentially expand into IDD and hospice might be too, right? Maybe give the group maybe sort of an update on sort of your thinking there and any type of timeline that you think we could potentially think about ultimately where that would make sense to maybe start pursuing some opportunities in those markets too.
I'll start with, you made the point that we have a 12% market share, which is true nationally. Even though we don't have 100% geographic coverage of the United States, we're the number one provider to ALF by a long shot. The way we look at that is that there's 88% left to go, and we feel like we're running in the open field, and that's our focus. That said, there are adjacent markets. David mentioned PACE and another. You ask about hospice. We serve a lot of hospice patients that continue to reside in their long-term care facility once they transition care to hospice, and we see some dislocations in that marketplace and feel like we may be able to develop a service model to expand into that adjacent market area. Stand by. It's all experimental at this point, not guiding to anything.
But yes, we're working on trying to address what we see as a significant market dislocation in hospice pharmacy.
Okay, great. Wanted to sort of move on to talk about M&A, but before we do that, maybe just take a pause here to see if anybody had any questions. Hal?
Maybe it's your future question, but wanted to talk more about the relationship with the PBMs and the contracts and the nature of buying and margin. Just the process of being a distributor.
Sure.
The private label.
We contract directly with our PBM partners, and we view it as such. Our conversations monthly, I mean, I'm meeting personally with them and our teams over the last few months. And so we're working on ways to increase the visibility with Optum as we're working with Brookdale, for instance, and some of their programs. And we work very closely with Humana and Caremark. So it's a direct contractual relationship. It's for the whole U.S. So our reimbursement in San Diego is the same as it is in Birmingham, Alabama. And we view it as a critically important partnership because Fred may touch on, you look at where we're going, we've really driven our market share up in the markets that we're in. Fred mentioned we serve 12% of the U.S. market. We want to grow it to 25%. But in some markets, like Phoenix, Arizona, we're over 50%.
Florida may be 30%. So the markets we're in, they need us. We need them. So it's, I think, a very productive and healthy relationship.
In terms of the growth, the private label, direct buying, how does that sit with them? How do they think about those initiatives?
You're talking about the PBMs really aren't involved with our buy side. So we work just from procurement. We work with multiple wholesalers and sophisticated purchasing portals in all of our pharmacies. And we negotiate the deals for the whole company. And then our pharmacy purchasing teams access those deals in each store depending on what's best for that market.
So it's on a local basis for you to decide where they're going to access to.
Yes.
Great. Thank you.
Any other questions, Fred?
Yeah.
Okay, great. All right. Why don't we sort of shift over to the M&A strategy? Why don't we start with maybe if you want to just sort of walk us through how you approach looking at opportunities in terms of what are your key criteria, and then maybe some flavor on sort of what the pipeline of opportunities looks like?
Sure. I'll take that. Over our history, just to step back and frame it, we've done 31, I think, M&A deals in our history. In the last couple of years, we've added, I think, eight new locations. So it's ramped up. But there are 1,200 plus or minus independent pharmacies in the U.S. And think of these as small mom and pops. They're $10 million-$15 million in revenue, serving 1,000-1,200 residents and doing a great job. I mean, it's really our competitors are these independents. They provide excellent service, but running one of these smaller businesses and making it economically viable can be challenging. So that's when we come in.
And we look, just like the Morristown, New Jersey acquisition we did November 1, we look for an operator who's in a national account rich market who will embrace our platform and wants to continue to grow that business, quadruple it, say, over the next five years. So that's the profile of the typical target that we're looking for. There are a couple of larger platforms, but there are not many in the U.S. that are focused on ALF. So how do we approach it? We have a pipeline. We're talking to 20 or 30 of the key targets. And over a 12, 24, 36-month period, we'll close several of these deals. We've got many in the pipeline now. The profile is quite attractive. I talked about we grow through M&A and buying these small operators. We also grow contiguously into new markets. Okay?
And there's pros and cons to both. And then let's take growing into a contiguous market. I mentioned Tulsa. We're expanding into Oklahoma City. In that profile, we have our existing operators. We have our platform, but we don't have volume because we're opening from ground zero. We have probably some customers in the market, but we have to build that business up. We have our platform, but we have to build volume. Conversely, if you look at the Morristown, New Jersey acquisition, we buy a business. We have volume, but we don't have our systems in place. It takes us one, two, three years to get our operating systems, our revenue cycle management, PBM contracting, purchasing to get our platform in place to achieve the operating margin we have across the whole system. So in both cases, the expansion is initially dilutive.
And then after we get our systems in over a two- or three-year period, they become highly accretive. The interesting thing, it takes two, three, four years for both of these markets to come up to scale. And the capital to do both is very similar.
David, on sort of a follow-up to that, maybe walk us through from that sort of profitability ramp. What do multiple sort of typically look like at sort of at the time of purchase? And then walk through that margin ramp. What is the typical profile of EBITDA margins when you're acquiring it? And then over that two- to three-year period, you bring them up, obviously, to your corporate level. So what does that imply towards how you could bring down the valuation effectively on the purchases?
Almost all these businesses cannot trade on multiple of EBITDA because they don't have EBITDA so they're priced based on residents served, okay? And then we'll bring the business on, get it up to profitability, and when you look back at the EBITDA multiple we can achieve in, say, three or four years, it would be a look-back multiple, say, 2x-3x, and back to what Fred mentioned when we started, that's what's driven our very effective deployment of capital and how we built this business to the scale, size, and scope it is with about $60 million-$65 million of capital over the years so look back after we get it up to scale, 2x-3x is a look-back multiple.
Got it. And then when you look at, so you acquire sort of an asset in a market, you're also typically looking for someone, the owner-operator, who's going to be entrepreneurial, growth-focused that can then go out and basically build and expand the business around that pharmacy. And that's where sort of the organic growth opportunities really kick in. Maybe we can sort of focus on that sort of long-term core ALF market opportunity. As you mentioned, you've already have partnerships with some of the leading providers out in the market like Brookdale and Sunrise. Maybe sort of, I guess, a two-pronged question for you. One, when you think about sort of against that 12% market share that you have nationally, where are you, would you say, with some of those major, let's call it national partners like a Brookdale and a Sunrise? Is it sort of similar?
So, thinking about how much ramp opportunity you still have to go there. So that would be sort of the existing partners. And then the second question would be that sort of pipeline in terms of how active are you in terms of pursuing other large assisted living partners as well for the future?
I'll start on that one with we have a very high market share where we have coverage of our national account. But we don't have full geographic coverage of the United States. So in many ways, our expansion strategy is being driven by our partnerships with the national accounts who are asking us to go to certain markets. And that's how we will increase our market share of those national accounts.
Great. And then on the, do you have other active? How do you, I guess, sort of evaluate other future partners? I guess it would be sort of also looking at, I guess it's a chicken and egg question, right? So ultimately, is it that based on the partners you're talking with and markets they want you in, then you go and try to look for a good target, or is it that you're looking for you have got your sort of pipeline of targets, and then you find a good target, and then you go out and try to find those ALF partners? Or can it be a split? It can be a mix of the two.
It's a mix of the two. But just stepping back, the assisted living industry is quite interesting. And its progression over time from a real estate play with a bit of hospitality to today delivering healthcare. And what's going on in the industry is the operators are coming to the realization that these are highly acute residents. As I mentioned, impaired in multiple ADLs, they require a very high level of care. And healthcare, therefore, is a major element of the service that they're providing. So that operator who's come to that realization is very attracted to our more sophisticated level of service. And so we see ourselves getting ever more and ever more partnerships with these larger, more sophisticated accounts.
That's a great point around just we could even validate that with some of the discussions at our conference. If we look at some of the other companies that we've had, we had Brookdale yesterday, and they're talking about their. They call it their Health Plus initiative.
Which we're a key element of.
Perfect. Perfect. Yeah. And then with the Pennant Group as well, they have what they call it their Cares initiative as well. So definitely, we hear that from these senior living operators that increased focus on the healthcare services, the clinical services that they can deliver in. And so it sounds like certainly you're part of that integrated into that.
That is correct.
That offering. Great. Perfect. Let me see if any other. I've got a couple, certainly, but any other questions, other? Okay. Thought maybe we can sort of spend a moment just talking about your technology solutions and your tech stack. So maybe if you want to just sort of walk through how you've built your technology framework and then some of the value-added services and capabilities that you have with payers and with your long-term care partners. Guardian, Compass, and Shield, for example, are two. So maybe sort of your technology approach and then Compass and Shield, if you want to call out those initiatives.
I'll start with that. This is an initiative that perhaps we launched even before we truly had the wherewithal to do it because we realized early on that data analytics is the absolute key to success in what we're doing. First, in running our own business, this is a complex business. I'm sure everybody says that, but there are a lot of moving parts going on under the covers of this pharmacy business, and data becomes the key, so we started with what we call the data warehouse. It's fed by all the various systems we use to run the business: Workday, Salesforce.com, all of our purchasing data, right down to the prescription level from the operating systems in the pharmacy, and the result is that we can cross any one metric with another, and we first used it to run our own business.
So we have many each functional area of the business has their dashboards and products to help them on a day-to-day basis run the business. And then over time, as you mentioned, Scott, we've migrated toward helping our customers with their business. And that we call our Compass is running our own business. Shield is helping our customers. A couple of example products that are fully in motion. Pharmacists perform very important healthcare behind a curtain, and they're not accustomed to tooting their own horn, so to speak. So we realized early on that the things our pharmacists are doing, particularly upon transition of care from community into the assisted living setting, are massively important. So we developed a tool, data analytics tool, to track what our pharmacists do. And you can read about that if you go to the S-1, or we gave some examples.
But our pharmacists are intervening in multiple ways and a tremendous amount of value add being brought to the equation. And that product has been very helpful to bring to life to our residents and their loved ones, to our home operators, our facility operators, and also to our payors, what we're doing, the value add we're bringing to the equation. Similarly, one of the things that's really important for assisted living is it falls on us, at least we assume this mantle of responsibility to make sure that our residents are following the formulary of their payor. And this saves them a lot of money. And it also benefits the payors. As an aside, pretty good business model. They get the rebates for the drugs on the formulary. And we do all the work to make that happen. But we have a data analytics tool to track that.
It's very, very useful to show our residents what we're saving them. I think the number was $21 million in the first half of this year that we saved our residents by getting them on their plan's formulary. There's a lot of work involved in doing that. Our pharmacists receive a prescription, determine that it's all formulary. They've got to go back to the physician who's moved on. And she may not remember exactly the situation. We have to refresh their memory. So a lot of work to do that. Very powerful data analytics tool. The newest that they're working on, and I happen to be here in Nashville last week with a group of our data analytics whiz kids, and they're working on a falls risk product that is really powerful. That's one of the key issues for an assisted living operator, falls.
And the drug regimen has a very important part to play in increasing the risk of a fall. So stand by for that one. It will be rolling that out soon. But that hopefully brings to life our data analytics stack, which is a very important element of our success.
Yeah. I'll just add, we wouldn't be here without the data analytics to run this fairly low-margin business. So we use it to run our business. We use it with our customers and residents to show them the care and the help we're giving them. And with our payors, it's very important. We use it in every meeting to show adherence that our pharmacies drive. It's unlike anything the payors have seen, our generic dispense rates. So these are all critical things that we think no one else in the industry really has, the analytics that we're using in all aspects of our business.
You'll recall that adherence is a major metric with a star rating.
Sure. Absolutely.
We're pretty much out of time. So I just want to check, though, if there's any final question out there.
Finally, I understand you don't charge your partners for that technology.
Right.
Are there any benefits that you've seen, whether in terms of commercial negotiations, that you want to continue using this solution?
Oh, I'll let David, who's doing that, negotiate. But yes, our payors find this. It brings to life for them the value add that we're bringing that they never really understood before.
So it's a massive education process. You think about long-term care pharmacy, it's 5% of the total drug spend in the U.S. So people really don't focus on it. So we're even educating the payors. And part of it is the value add that we bring and getting them to lean into why there's value there for us and them. So yes, we're working on that. It's a work in progress, but it's something we're going to continue to pursue.
All right. Great. Well, I think we're out of time. So Fred and David, thanks so much for joining us tonight.
Thanks for doing this.
Thank you.